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藥品代碼 藥品英文名稱 支付價(111年1月) A000072100 EPHEDRINE HCL TABELTS 25MG "CENTRAL" 0.56 A000076100 ACETAMINOPHEN TABLETS 0.3 GM "F.Y." 0.25 A000096100 MENNA CAPSULES 0.48 A0001191G0 DL-METHYLEPHEDRINE HCL TABLETS 25.MG "F.Y."(鋁箔/膠箔) 1.50 A000137151 BROWN MIXTURE LIQUID (WITHOUT OPIUM) 5.50 A000173100 FUDECOUGH TABLETS 15MG "F.Y." 0.47 A000389100 LUXSON TABLETS 40MG 0.20 A000415100 GASMIN TABLETS "F.Y." 0.30 A000429100 WINON TABLETS 2.22 A000604151 MEDICON SYRUP 29.70 A000822157 FUSOCO SYRUP "L.S." 30.10 A000895100 TRANZEPAM TABLETS 0.80 A001045100 VESSELON CAPSULES "H.L." 0.00 A001046100 MAGNESIUM OXIDE TABLETS 0.13 A001050277 DEXTROSE INJECTION 10% "ASTAR" 21.10 A001217100 DIAZEPAM TABLETS 0.80 A001226100 PREDNISOLONE TABLETS 5MG "S.Y." 0.90 A001398100 NALIDIN TABLETS 500MG "N.C.P." 2.22 A001420309 FURAN OINTMENT 0.28 A001437277 AMPICILLIN INJECTION 500 MG "CHI SHENG" 10.60 A001448100 NOSCAPINE TABLETS "YU SHENG" 0.83 A001584100 MAGNESIA TABLETS "WASHINGTON" 0.10 A001646100 DIAZEPAM TABLETS "KINGDOM" 0.80 A0016461G0 DIAZEPAM TABLETS(鋁箔) 1.50 A001701238 ANTIMIN INJECTION "C.C.P." 12.00 A001713100 ENZYME TABLETS "H.C.T." 3.68 A001782100 CABETAN S.C. TABLETS 0.38 A001850100 AMPICILLIN CAPSULES 250MG "PANBIOTIC" 1.02 A001866100 AMPICILLIN CAPSULES 500MG "PANBIOTIC" 1.34 A001963100 FULICLIN TABLETS 0.00 A0019631G0 FULICLIN TABLETS(鋁箔/膠箔) 0.00 A001997100 TRANSONE TABLETS 0.86 A002086100 WEIERNIN TABLETS "NAN TO" 0.85 A002314221 DIANZEM INJECTION "Y.Y." 0.00 A002362100 BROSCO TABLETS "ORIENTAL" 0.96 A002445100 CLOXAMPICIN CAPSULES 250MG "PANBIOTIC" 1.54 A002555100 MAWEI TABLETS "YU SHENG" 0.15 A002595100 BALON S.C. TABLETS 0.62 A002635100 GASTROPAN S.C. TABLETS 0.88 A002657229 PROGESTERONE INJECTION 2.5% "ASTAR" 15.30 A002658100 LIUMPIN TABLETS 1.83 A002760100 THIAN TABLETS "YU SHENG" 0.47 附件二 藥品給付品項暨支付標準表 通則:本表係依本標準第四條第八項規定公告一百十一年一月份之給付品項及支付價格;如有異動 ,以保險人最新公告為主。
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附件二 藥品給付品項暨支付標準表

May 02, 2023

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Page 1: 附件二 藥品給付品項暨支付標準表

藥品代碼 藥品英文名稱 支付價(111年1月)

A000072100 EPHEDRINE HCL TABELTS 25MG "CENTRAL" 0.56

A000076100 ACETAMINOPHEN TABLETS 0.3 GM "F.Y." 0.25

A000096100 MENNA CAPSULES 0.48

A0001191G0DL-METHYLEPHEDRINE HCL TABLETS 25.MG "F.Y."(鋁箔/膠箔)

1.50

A000137151 BROWN MIXTURE LIQUID (WITHOUT OPIUM) 5.50

A000173100 FUDECOUGH TABLETS 15MG "F.Y." 0.47

A000389100 LUXSON TABLETS 40MG 0.20

A000415100 GASMIN TABLETS "F.Y." 0.30

A000429100 WINON TABLETS 2.22

A000604151 MEDICON SYRUP 29.70

A000822157 FUSOCO SYRUP "L.S." 30.10

A000895100 TRANZEPAM TABLETS 0.80

A001045100 VESSELON CAPSULES "H.L." 0.00

A001046100 MAGNESIUM OXIDE TABLETS 0.13

A001050277 DEXTROSE INJECTION 10% "ASTAR" 21.10

A001217100 DIAZEPAM TABLETS 0.80

A001226100 PREDNISOLONE TABLETS 5MG "S.Y." 0.90

A001398100 NALIDIN TABLETS 500MG "N.C.P." 2.22

A001420309 FURAN OINTMENT 0.28

A001437277 AMPICILLIN INJECTION 500 MG "CHI SHENG" 10.60

A001448100 NOSCAPINE TABLETS "YU SHENG" 0.83

A001584100 MAGNESIA TABLETS "WASHINGTON" 0.10

A001646100 DIAZEPAM TABLETS "KINGDOM" 0.80

A0016461G0 DIAZEPAM TABLETS(鋁箔) 1.50

A001701238 ANTIMIN INJECTION "C.C.P." 12.00

A001713100 ENZYME TABLETS "H.C.T." 3.68

A001782100 CABETAN S.C. TABLETS 0.38

A001850100 AMPICILLIN CAPSULES 250MG "PANBIOTIC" 1.02

A001866100 AMPICILLIN CAPSULES 500MG "PANBIOTIC" 1.34

A001963100 FULICLIN TABLETS 0.00

A0019631G0 FULICLIN TABLETS(鋁箔/膠箔) 0.00

A001997100 TRANSONE TABLETS 0.86

A002086100 WEIERNIN TABLETS "NAN TO" 0.85

A002314221 DIANZEM INJECTION "Y.Y." 0.00

A002362100 BROSCO TABLETS "ORIENTAL" 0.96

A002445100 CLOXAMPICIN CAPSULES 250MG "PANBIOTIC" 1.54

A002555100 MAWEI TABLETS "YU SHENG" 0.15

A002595100 BALON S.C. TABLETS 0.62

A002635100 GASTROPAN S.C. TABLETS 0.88

A002657229 PROGESTERONE INJECTION 2.5% "ASTAR" 15.30

A002658100 LIUMPIN TABLETS 1.83

A002760100 THIAN TABLETS "YU SHENG" 0.47

附件二 藥品給付品項暨支付標準表通則:本表係依本標準第四條第八項規定公告一百十一年一月份之給付品項及支付價格;如有異動 ,以保險人最新公告為主。

Page 2: 附件二 藥品給付品項暨支付標準表

A002856100 FULLPHAGEN TABLETS "F.Y." 0.50

A002994100 KANGCHINMIN CAPSULES "Y.S." 0.89

A003023212 FUYULIN INJECTION "ASTAR" 7.10

A003092100 ASPIRIN TABLETS 500MG "S.Y." 0.45

A003156212 VITA-6 INJECTION "ANSHIN" 2.89

A003157221 HISTIDINE INJECTION "ANSHIN" 4.69

A003225212 ANCONMIN INJECTION "AN SHIN" 2.40

A003311100 TRIENZYME CAPSULES "WASHINGTON" 0.90

A003326100 PINGIN TABLETS 0.97

A003373321 FLUCONIN OINT. 34.10

A003373329 FLUCONIN OINT. 40.70

A003386209 ORICORT-IM INJECTION "ORIENTAL" 20.70

A003386212 ORICORT-IM INJECTION "ORIENTAL" 23.80

A003386229 ORICORT-IM INJECTION 57.00

A003393100 CHLORPROMAZINE HCL S.C. TABLETS 100MG "VPP" 1.46

A003417209 STREPTOMYCIN SULFATE FOR INJECTION 1G "VPP" 52.00

A003446221 ORICORT INJECTION "ORIENTAL" 23.80

A003469209 NEOSTIGMINE INJECTION "ASTAR" 4.97

A003551100 PRONALATE TABLETS "PANBIOTIC" 1.17

A003572421 CON-F EYE DROPS 18.20

A003621100 DEXCON TABLETS 10MG 0.43

A003622100 HONCALM CAPSULES 0.68

A003633100 BENDA TABLETS "Y.S." 0.16

A003715271 LEUCOMYCIN INTRAVENOUS INJ 400MG "T.T.Y" 50.00

A003727100 HITUS CAPSULES 25 MG 0.45

A003786209 ERGOMETRIN INJECTION "ASTAR" 2.76

A003792100 TOLBUTAMIDE TABLETS "R.S.P.P." 1.00

A003794100 EPHEDRINE SULFATE CAPSULES "VPP" 0.56

A003893100 NITROFURANTOIN TABLETS 100MG "R.S.P.P" 0.59

A003902100 SUSWUN TABLETS 0.89

A003911100 AMINOPHYLLINE TABLETS 200MG "VPP" 0.67

A003941421 NARPINA EYE DROPS 12.70

A004001421 PILOCARPINE EYE DROPS 4% 42.70

A004042100 LICOTIN TABLETS "YUNG CHI" 0.47

A004068429 SELEAR EYE DROPS 17.20

A004073221 STACORT-A INJECTION 10MG "STANDARD" 23.80

A004073299 STACORT-A INJECTION 10MG "STANDARD" 4.30

A004188417 F.A.D. EYE OINTMENT 21.80

A004189100 RESERPINE TABLETS "VPP" 0.08

A004219100 BISLAN TABLETS "YUNG SHIN" 0.23

A004223100 SULFISOMEZOLE TABLETS "R.S.P.P." 0.85

A004255100 ERYTHROMYCIN ESTOLATE CAPSULES "ASTAR" 1.43

A004263100 ANTICOUGH CAPSULES 0.89

A004322229 VITAMIN B COMPLEX INJECTION "VPP" 13.40

A004461100 ANTICOUGH TABLETS 0.46

A004466297 TRICILLIN INJECTION "VPP" 12.40

A004488421 BISMING EYE DROPS 16.70

A004489417 COLIMYCIN EYE OINTMENT 22.00

Page 3: 附件二 藥品給付品項暨支付標準表

A004491417 ERYSMYCIN EYE OINTMENT 17.70

A004539157 BOINTUSSIN SOLUTION 20MG/ML (GUAIFENESIN)"BOWLIN" 16.90

A004575100 SECOBARBITAL SODIUM CAPSULES "VPP" 0.00

A004648100 DECARON TABLETS 0.69

A004703100 CHLORDIAZEPOXIDE HCL CAPSULES 10MG "VPP" 0.68

A004704100 CHLORPHENIRAMINE TABLETS "ASTAR" 0.10

A004813100 ASPIRIN TABLETS "VPP" 0.25

A004835100 ECHICON TABLETS "Y.S." 0.34

A004852212 COUGSTIN INJECTION "ASTAR" 4.07

A004853209 TRILIZIN INJECTION "ASTAR" 3.64

A004973321 RINDERON-VA CREAM 0.06% 35.60

A004974416 EYE RINDERON-A OINTMENT 43.50

A004975416 EYE RINDERON-A SOLUTION 28.40

A004977421 YEN SAN EYE DROPS 15.20

A004977429 YEN SAN EYE DROPS 24.50

A005185100 TRIAMCINOLONE TABLETS "JEN SHENG" 0.89

A005225100 COLCHICINE TABLETS 0.99

A005232100 COLD CAPSULES "M.T." 0.50

A005300100 PHENOBARBITAL TABLETS 32MG "VPP" 0.68

A005359100 METRODIN S.C. TABLETS "YUNG CHI" 0.00

A005628229 PHENAMINCAL-B6 INJECTION "C.Y." 6.20

A005789100 FUSTON TABLETS 100MG "Y.S." 0.28

A005807100 LONFLEX CAPSULES "UNION" 1.13

A005827100 AMINOPHYLINE TABLETS "JEN SHENG" 0.67

A005869155 OPIUM TINCTURE 230.00

A005936100 SETON TABLETS 100MG (ETHAVERINE) 0.00

A005945100 DEXTROMETHORPHAN TABLETS "JEN SHENG" 0.37

A006171100 HEPI CAPSULES "H.C.T." 0.69

A006194100 PRONALOL TABLETS 0.87

A006245100 KINLIZONE TABLETS 0.73

A006271100 FUCOLE PARAN TABLETS 0.41

A006316100 CENTICON TABLETS 0.45

A006344100 BUSTON S.C. TABLETS 0.96

A006394100 PYRIDAMOLE S.C. TABLETS 0.90

A006485500 LYBRILE SUPPOSITORIES 2.26

A006552100 ALLERMIN TABLETS 4MG 0.11

A006572277 YEIAMIN-X INJECTION 0.00

A006618100 ZITHINE TABLETS 0.42

A006638100 CHINCHEN TABLETS 2.46

A006696100 DICYCLOMINE TABLETS "C.T." 0.85

A006698100 LONGCORT TABLETS 0.75

A006749209 LONGCORT INJECTION 11.90

A006761100 TRIZYLASE CAPSULES "BOWLIN" 0.90

A006795100 MAGNESIUM OXIDE TABLETS "HONTEN" 0.15

A006819100 CHLORPROMAZINE HCL S.C. TABLETS 50MG "VPP" 0.60

A006820277 SODIUM AMPICILLIN FOR INJECTION 500MG "VPP" 10.60

A006822100 CHLORPROMAZINE HCL S.C. TABLETS 25MG "VPP" 0.55

A006823100 CHLORPROPAMIDE TABLETS "RSPP" 0.84

Page 4: 附件二 藥品給付品項暨支付標準表

A006865100 CLOFIBRATE CAPSULES "HON TEN" 1.09

A006873100 TUNFON TABLETS "H.C.T." 0.99

A006943100 TETOCYN CAPSULES 0.82

A006984100 METHYLTESTOSTERONE TABLETS 10MG "VPP" 1.62

A006987100 RIRITON S.C. TABLETS 0.41

A007037100 CERIATIN TABLETS 0.70

A007038100 PROMIN TABLETS 0.69

A007067100 POLUN S.C. TABLETS "J.S." 0.62

A007114209 EPHEDRINE SULFATE INJECTION 25MG/ML "VPP" 0.00

A007157100 OXAPAM TABLETS 1.00

A007213100 AMINOPHYLLINE TABLETS "BEYDAR" 0.67

A007243100 EPHEDRINE HCL TABLETS 25MG "VPP" 0.56

A007264100 BETAMETHASONE TABLETS 0.75

A007266100 FUNINTAN S.C. TABLETS "J.S." 0.83

A007362100 CHINACAN TABLETS 0.89

A007374100 MAGNESIUM HYDROXIDE TABLETS "SHINLON" 0.16

A007443323 PARACORT OINTMENT 32.20

A007443329 PARACORT OINTMENT 38.70

A007544221 CHLORPROMAZINE HCL 125MG/5ML "VPP" 3.64

A007679100 RESPLAMIN TABLETS 1.58

A007681229 DEXASON INJECTION 2MG/ML "LITA" 16.80

A007786100 BACIDIM TABLETS "CHI SHENG" 0.90

A007822100 AMOXICILLIN CAPSULES "PANBIOTIC" 0.99

A007828277 LACTATED RINGER'S INJECTION "ASTAR" 21.10

A0079441G0 DETTACKS S.C. TABLETS 10 MG "F.Y."(瓶裝/84粒/瓶) 1.50

A007976100 RIKAPARIN CAPSULES 1.27

A008061100 WINCOU TABLETS 0.23

A008165100 WATOLIN TABLETS 8MG "TF" 0.23

A008192100 BROMOCIX TABLETS 0.26

A008355100 GASLAN TABLETS "CHINTENG" 0.35

A008534209 SCOBTIN INJECTION 9.20

A008541100 TONPHEN TABLETS 0.25

A008606100 HISTANTI F.C. TABLETS 0.89

A008645417 PZULEN EYE OINTMENT "OASIS" 15.50

A008661100 TONFONYUANIN CAPSULES "K.N." 0.87

A008676100 BENTEA "JENN MAW" 0.72

A008743100 COYENLIN TABLETS "S.C." 0.90

A008840100 BEINSON TABLETS "YUNG CHI" 0.75

A008883100 METHYLTESTOSTERONE CAPSULES "Y.S." 1.62

A008896100 WINTYL TABLETS "WINSTON" 1.00

A008907100 ASVERIN TABLETS 20MG 0.77

A008924321 SUFUCIN OINTMENT "S.T." 28.00

A008934100 RINMESON TABLETS 0.75

A009038100 BISCO TABLETS 8MG 0.24

A009104100 APAP TABLETS 0.20

A009106100 BROMINE TABLETS "YUNG SHIN" 0.25

A009111100 SOLCON TABLETS 8MG 0.26

A009115100 PRINCUR F.C. TABLETS 0.37

Page 5: 附件二 藥品給付品項暨支付標準表

A009138100 POINSTAN CAPSULES 0.75

A009255100 GERSCON TABLETS "C.L." 0.35

A009300100 BETAMETHASONE TABLETS "Y.S." 0.75

A009352100 HOMALIN TABLETS "W.S." 0.00

A009367100 AETHOCAF CAPSULES 0.77

A009369100 BISACODYL S.C. TABLETS "HONTEN" 0.40

A009397100 MIRACLIN CAPSULES "Y.S." 1.21

A009480100 RAMIN CAPSULES 25MG 0.43

A009486417 NEOSONE OPHTHALMIC OINTMENT 43.80

A009616100 GLANEGA TABLETS "MEIDER" 2.22

A009632100 BAKRIN TABLETS 0.90

A009691100 PUKAMIN TABLETS "CHINTENG" 0.25

A009705100 NADON CAPSULES 2.22

A009782100 INDAL TABLETS 0.00

A0099151G0 METASONE TABLETS "H.S."(鋁箔/膠箔) 1.50

A009983100 CYASIN S.C. TABLETS 0.90

A0099831G0 CYASIN S.C. TABLETS(鋁箔/膠箔) 1.50

A010057229 RESPLAMIN INJECTION 20% 0.00

A010079100 CARBETIN TABLETS 0.42

A0102071G0 INDECIN CAPSULES "H.S."(鋁箔/膠箔) 1.50

A010211100 BRONCOMINE TABLETS "HONTEN" 0.23

A010213100 CEPHALEXIN CAPSULES 250 MG "CHI SHENG" 1.13

A010256100 HUA PAM TABLETS "H.H." 0.80

A010376421 DECANEOMYCIN OPHTHALMIC SOLUTION 12.00

A010381316 PATRONCORT-F OINTMENT "PATRON" 17.30

A010381329 PATRONCORT-F OINTMENT "PATRON" 0.00

A010382100 PATOCILLIN CAPSULES "PATRON" 1.88

A010402100 ZINPIN TABLETS 0.00

A010416100 ENTERCON TABLETS 0.28

A0104461G0 ANZUWEI CAPSULES "H.H."(鋁箔/膠箔) 1.50

A010479100 PONPAI CAPSULES 0.60

A010482100 BENZEL CAPSULES "YUNG CHI" 0.54

A010576100 BROADIN-S TABLETS "EAYUNG" 0.90

A010638277 STAMINA INJECTION "CHI SHENG" 0.00

A010648100 PARAFLU CAPSULES "PANBIOTIC" 0.25

A010683100 ACETANIN TABLETS "HONTEN" 0.37

A010689100 LICOMINE TABLETS "WINSTON" 0.25

A010720209 OGECORT SUSPENDED INJECTIONS "Y.Y." 20.70

A010720221 OGECORT SUSPENDED INJECTIONS "Y.Y." 44.40

A010747100 SUROATE TABLETS "HONTEN" 0.23

A010777340 NIFUCIN OINTMENT "PATRON" 16.20

A010800100 DOXCYCLINE CAPSULES “TAITEN” 1.21

A010823100 TAREIN TABLETS "YUNG CHI" 0.50

A010928209 TUDIN INJECTION "Y.Y." 1.75

A011013100 ANTICOLD CAPSULES "PATRON" 0.89

A011014155 COUGH SYRUP "PATRON" 25.80

A011014157 COUGH SYRUP "PATRON" 25.80

A011081321 BENISON CREAM 0.1% "GENTLE" 13.50

Page 6: 附件二 藥品給付品項暨支付標準表

A011084100 NORSON TABLETS "HONTEN" 0.40

A011093151 COTAINE SYRUP "HEALTH" 17.00

A011189151 COLISO SYRUP 18.10

A011189157 COLISO SYRUP "WINSTON" 23.00

A011199212 MATOLON INJECTION "Y.A." 7.10

A0113171G0 ANTI-COUGH TABLETS (瓶裝/56粒/瓶) 1.50

A011341100 GLUVENTIN TABLETS 8MG 0.23

A011479100 CINNARIZINE TABLETS "JEN SHENG" 0.69

A011482238 POLYVITA INJECTION "Y.Y" 0.00

A011483100 GASTON TABLETS 0.21

A011493151 AREMIN COLD SOLUTION 22.00

A011564335 WANTACORT CREAM "W.T." 55.00

A011703212 SINCOVLIN INJECTION "ASTAR" 6.50

A011706100 MINXLN TABLETS 0.83

A0117061G0 MINXLN TABLETS 1.50

A011762212 SULIVITA INJECTION 100MG 2.42

A011762238 SULIVITA INJECTION 100MG 8.00

A011764216 BERINE INJECTION 5.00

A011786100 COFCON TABLETS 15MG 0.42

A011792100 AMOXCIN CAPSULES "PATRON" 0.99

A011794100 HUSCOL CAPSULES "SHIN FONG" 0.89

A011850155 CONFLU SYRUP 27.20

A011921238 CHINLIVITA INJECTION 10.00

A011928100 PARMINRIN F.C. TABLETS 0.50

A011949100 ENTERAN TABLETS "S.C." 0.69

A011969100 PINSU TABLETS 0.37

A012000100 TRIANPRES S.C. TABLETS "N.C.P." 1.07

A012008100 LISALENB TABLETS "BEYDAR" 1.89

A012050299 GENTACIN INJECTION 1.19

A012053212 GENTAMYCIN INJECTION 40MG "ORIENTAL" 13.10

A012080100 PURINOL TABLETS "CURIE" 0.99

A012147100 SULFATRIM TABLETS "JEN SHENG" 0.90

A012243100 B.H. TABLETS 8MG "LITA" 0.26

A012315100 DICA TABLETS 0.69

A012343100 BUSCIN TABLETS "Taiten" 0.96

A012377329 BETTER-INODINE OINTMENT (POVIDONE IODINE) "WEI-MING" 20.20

A012407500 ANTI-GI SUPPOSITORY 7.30

A012458100 EURODIN TABLETS 2MG 1.53

A012472100 BROMHEXIN TABLETS "GENTLE" 0.23

A012488100 SULININ TABLETS "K.N." 0.69

A012524100 MINRID TABLETS "H.H." 0.25

A012556109 SHECO GRANULES 4.67

A012596100 MECOFAN TABLETS "ASTAR" 0.46

A012646100 GYNEDOL TABLETS 1MG “H.L.” 1.09

A012675100 CINNARIZINE TABLETS "C.T." 0.69

A012804100 SUPITON TABLETS "S.C." 0.60

A012807100 OUTINFLAME TABLETS "H.H." 0.72

A012833100 PYMADON TABLETS "CHINTENG" 0.35

Page 7: 附件二 藥品給付品項暨支付標準表

A012876100 BIOTASE TABLETS "YUNG SHIN" 0.57

A012886321 SUNBIN MEDICINE CREAM 5.80

A012886329 SUNBIN MEDICINE CREAM 11.30

A012901321 AYGAUSHON OINTMENT "J.H." 13.30

A012955100 ECON TABLETS 40MG 0.30

A013078100 JIEE-SUAN-LONG TABLETS 0.73

A013084100 NOSCAPINE TABLETS 20MG "H.L." 0.85

A013091100 MEPENZOLATE TABLETS "S.C." 1.00

A0130911G0 MEPENZOLATE TABLETS "S.C."(鋁箔/膠箔) 1.50

A013093100 AMPICILLIN CAPSULES 500MG "CHI SHENG" 1.34

A013103109 HISTAPP GRANULES 3.90

A013126100 HCNORITLE PIPRINHYDRINATE TABLETS 0.35

A013137100 SCOPOMINE TABLETS "C.T." 0.80

A013168100 METOCLOPRAMIDE S.C. TABLETS "ORIENTAL" 0.69

A013230100 FUCOLE IBUPROFEN CAPSULES 0.72

A013247100 COBAMAMIDE CAPSULES "C.R." 1.08

A013339151 PANCOPAR SYRUP "BOWLIN" 0.00

A013339157 PANCOPAR SYRUP "BOWLIN" 0.00

A013382100 MAGNESIUM OXIDE TABLETS 250MG "VPP" 0.16

A013415100 "IBUPROFEN CAPSULES ""H.C.""" 0.58

A013480100 KANMO CAPSULES "H.L." 0.45

A013491100 SUNSHING COUGH CAPSULES "H.H." 1.00

A013520321 METHASONE OINTMENT "S.C." 14.90

A013531100 SEDASPA S.C. TABLETS "H.H." 1.12

A013535157 ANTICOUGH SYRUP WITH CODEINE "C.S.P." 21.70

A013548100 HOWELLS TABLETS "C.R." 0.85

A013612100 IBUPROFEN CAPSULES "HONTEN" 0.70

A013631100 CARBINOXAMINE TAB. 0.34

A013638100 BROMPHENIRAMINE TABLETS "J.S." 0.25

A013644100 LONTEC TABLETS "H.H." 0.89

A0136641G0 METRONIDAZOLE CAPSULES 250MG "SHINLON"(鋁箔/膠箔) 1.50

A013666100 RELAX ANALGESIC TABLETS 500MG 0.37

A013719100 LIBUSE S.C. TABLETS "JEN SHENG" 1.12

A013720100 MEFENAMIC ACID CAPSULES "JEN SHENG" 0.75

A013723100 CHLORZOXAZONE TABLETS "EAYUNG" 0.86

A013761100 TINIDAZOLE TABLETS "HONTEN" 2.06

A013876100 IBUPROFEN CAPSULES "S.T." 0.70

A013879100 COLD CAPSULES "S.T." 0.42

A013906238 VITAGEN-SF INJECTION 4.50

A013955100 ORCIPRENALINE TABLETS "S.Y." 1.34

A013990100 CHUWEIYU GRANULES "J.H." 1.32

A014088100 ZUNO-NATHASID TABLETS "Y.C." 2.18

A014093238 GISALCON INJECTION "Y.Y." 9.10

A014111100 PHLOROPROPIOPHENONE CAPSULES "S.T." 1.48

A014118335 FUMEI OINTMENT "IDEAL" 38.20

A014121100 BROMHEXINE TABLETS "ASTAR" 0.23

A0141841G0 PREDNISOLONE TABLETS "WINSTON"(鋁箔/膠箔) 1.50

A014185100 DEXTROMETHORPHAN TABLETS "WINSTON" 0.37

Page 8: 附件二 藥品給付品項暨支付標準表

A014205277 SURPLEX INJECTION "CHI SHENG" 19.10

A014230100 OXESILIN TABLETS "JOHNSON" 0.29

A0142383AN ZINC OXIDE OINTMENT "WST" 41.80

A014274100 ERYTHROMYCIN CAPSULES "UNION" 1.43

A0142741G0 ERYTHROMYCIN CAPSULES "UNION"(鋁箔/膠箔) 1.50

A014320435 NAZAMINE NASAL DROPS "PATRON" 32.10

A014350212 GENTAMICIN INJECTION 40MG/ML "Y.F." 13.10

A014350299 GENTAMICIN INJ. 40MG/ML 1.19

A014359209 ESTRADIOL CYPIONATE INJECTION "TAI YU" 18.10

A014447100 BROMELAIN ENTERIC S.C. TABLETS "H.C.T." 0.89

A014620435 OXYMETAZOLINE SPRAY "CURIE" 6.80

A014622238 FUTIGEN-H INJECTION "S.Y." 9.70

A014739100 ORCIRIMINE CAPSULES "C.R." 0.89

A014746100 SCOPOLAMINE BUTYLBROMIDE CAPSULES "YUNG CHI" 0.88

A014749100 ACETAMINOPHEN TABLETS "JINUP" 0.30

A014756209 PENICILLIN G SODIUM INJECTION "Y.F." 7.83

A014756229 PENICILLIN G SODIUM INJECTION 10000000U "Y.F." 45.00

A014783100 MEFENAMIC ACID CAPSULES "WST" 0.75

A014823100 ACETAMINOPHEN TABLETS 500MG "CHI SHENG" 0.28

A014864100 DEMETHOR TABLETS "CHI SHENG" 0.37

A014865100 IBUFEN TABLETS "S.C." 0.50

A014873100 IBUPROFEN S.C. TABLETS "J.S." 0.66

A014894299 GENTAMICIN INJ. 4% 1.19

A014922100 NOSOUTIN TABLETS "ORIENTAL" 0.89

A015090100 PSEUDOEPHEDRINE HCL TABLETS "HONTEN" 0.70

A015180212 COLISTIN POWDER FOR INJECTION 0.00

A015199100 PYRININ TABLETS "GENTLE" 0.50

A015242100 STOMACHIC TABLETS "PATRON" 2.17

A015269100 SINFLEX CAPSULES 500MG“TAITEN” 1.75

A015277429 PLATINUM EYE SOLUTION 25.40

A015287100 ACETAMINOPHEN TABLETS 500MG "C.S." 0.35

A015291100 CLEMASTINE TABLETS "S.T." 0.60

A015344100 BROMHEXINE TABLETS 8MG "F.Y." 0.23

A015345100 TRIMESIN TABLETS 0.90

A015346100 ACETAMINOPHEN TABLETS 500MG "F.Y." 0.26

A015354343 SABINA CREAM 42.60

A015376100 PORSUCON S.C. TABLETS "HONTEN" 1.12

A015409100 TAI CHI TABLETS "CURIE" 0.45

A015436100 URSODESOXYCHOLIC ACID TABLETS "Y.Y." 1.74

A015469100 COLD SUGAR COATING TABLETS "T.L.B" 0.78

A015540100 NORSECON TABLETS "CHINTENG" 0.50

A015566100 STROVITAN S.C. TABLETS 1.00

A015578100 MEBENDAZOLE TABLETS "CHI SHENG" 1.10

A0155791G0 TRIAMCINOLONE TABLETS 4MG "F.Y."(鋁箔/膠箔) 0.00

A015582277 AMPICLOXACIN INJECTION "TAI YU" 11.10

A015596100 APAP TABLETS 500MG 0.20

A015613209 ORCIPRENALINE INJECTIONS "Y.Y." 0.00

A015632209 DEPOT. TESTOESTRADIOL INJECTION "TAI YU" 21.30

Page 9: 附件二 藥品給付品項暨支付標準表

A015637100 MEBENDAZOLE TABLETS "H.L." 1.10

A015694100 IBUPROFEN S.C. TABLETS 100MG "F.Y." 0.66

A015762435 KASULO NASAL SPRAY "C.S.P." 30.00

A015815100 FONGMIN CAPSULES "EAYUNG" 0.89

A015829229 LINCOMYCIN INJECTION "CHI SHENG" 24.20

A015829299 LINCOMYCIN INJECTION "CHI SHENG" 1.96

A015834100 GLYCERYL GUAIACOLATE TABLETS "M.T." 0.33

A015845229 PENICILLIN G SODIUM INJECTION 10000000U "Y.F." 45.00

A015908209 HYDROXYPROGESTERONE CAPROATE INJECTIONS "TAI YU" 30.80

A015912100 SALBUTAMOL TABLETS 4MG "EAYUNG" 0.00

A015916100 POKITON TABLETS "Y.S." 0.91

A015917209 AMCLOCILLIN INJECTION "TAI YU" 16.20

A015919157 COLD COUGH SOLUTION "C.M." 12.40

A015988229 LINCOMYCIN HYDROCHLORIDE INJECTION "Y.F." 24.20

A015992100 PANATOL TABLETS "M.T." 0.50

A016028100 TONPYRON TABLETS "PATRON" 0.74

A016055100 MEBENDAZOLE TABLETS "SHINLON" 1.10

A016065229 DEXAMETHASONE INJECTIONS 4MG "ASTAR" 16.80

A016084100 ANTICOUGH CAPSULES "HEALTH" 0.89

A016093100 TONLAN TABLETS 500MG "CHEN TA" 0.29

A016099100 CLOXAMPICIN CAPSULES 500MG "PANBIOTIC" 1.88

A0161411G0 SALBUTAMOL TABLETS 4MG "F.Y."(84粒/瓶) 1.50

A016220100 ACETAMINOPHEN TABLETS "J.S." 0.34

A016222435 SUBICIN NASAL SPRAY "WINSTON" 23.30

A016223100 PROCHLORPERAZINE MALEATE S.C. TABLETS 5MG "VPP" 0.69

A016247100 MEBENDAZOLE TABLETS "PANBIOTIC" 1.10

A0162471G0 MEBENDAZOLE TABLETS "PANBIOTIC"(鋁箔/膠箔) 1.50

A016248157 NOGESIC SYRUP (ACETAMINOPHEN) "HEALTH" 17.10

A016298100 CHIAKANG TABLETS "ORIENTAL" 1.21

A016299100 PHLOROPROPIOPHENONE CAPSULES "H.S." 1.48

A016317100 CASCARA S.C. TABLETS 130MG "V.P.P." 0.00

A016318100 CASCARA S.C. TABLETS 250MG "V.P.P." 1.13

A016348100 RHIN TABLETS "GCPC" 0.62

A016350100 ENDURE TABLETS (PROPRANOLOL) "GCPC" 0.87

A016351100 EXTAMINE TABLETS (BROMPHENIRAMINE) "GCPC" 0.25

A016353435 EPHRINE NASAL DROPS (OXYMETAZOLIN) "GCPC" 5.00

A016373100 REH NAR TONG TABLETS "O.Y." 0.46

A016374100 WELIMIN TABLETS "M.T." 0.50

A016390155 ZUTON SYRUP 15MG/ML (ACETAMINOPHEN)"L.S." 23.30

A016392100 BETAMETHASONE TABLETS "HONTEN" 0.75

A016395100 BUCLIZINE TABLETS "H.L." 0.44

A016422100 SEUPHENON TABLETS "C.L." 0.89

A016474100 CEPHALEXIN CAPSULES "TAI YU" 1.13

A016489100 PSUBITY TABLETS "S.T." 0.42

A016503100 ISOPRIN TABLETS (ISOXSUPRINE) "P.J." 0.78

A016506100 DEXTROMETHORPHAN HBR TABLETS "P.J." 0.45

A016508100 BISOLDIN TABLETS (BROMHEXINE) "P.J." 0.23

A016509100 ACETAMINOPHEN TABLETS "P.J." 0.38

Page 10: 附件二 藥品給付品項暨支付標準表

A016594100 WEI YUNG AN TABLETS "K.B." 0.85

A0165941G0 WEI YUNG AN TABLETS "K.B." (鋁箔/膠箔) 1.50

A016595100 CHOLIGEN S.C. TABLETS "K.B." 0.00

A016672100 METOPELAN S.C. TABLETS (METOCLOPRAMIDE) "P.J. 0.69

A016674100 ITON CAPSULES "N.C.P." 0.50

A016692100 METHYLEPHEDRINE HCL TAB "J.S." 0.42

A016700100 METHYLSCOPOLAMINE METHYLSULFATE TABLETS 1.02

A0167121G0 ANTISEMIN TABLETS (CYPROHEPTADINE)(鋁箔/膠箔) 1.50

A016751100 COLDENIN S.C. TABLETS 0.89

A016830100 PAINLAX CAPSULES "JINUP" (DICYCLOMINE) 0.85

A016838100 KETOPROFEN CAPSULES 50MG "P.J." 1.20

A016839100 MEBENZOLE TABLETS (MEBENDAZOLE) "H.H." 1.10

A0168391G0 MEBENZOLE TABLETS "H.H."(MEBENDAZOLE)(鋁箔) 1.50

A016873100 YIPAITAN TABLETS 8MG "Y.S." (BROMHEXINE) 0.23

A016879100 WACICORT TABLETS "WST" (TRIAMCINOLONE) 0.89

A016932100 SEUDORIN TABLETS (PSEUDOEPHEDRINE HCL) 0.39

A016944100 IBUPROFEN TABLETS "SHINLON" 0.64

A016951100 LITON ENTERIC-COATED TABLETS (BISACODYL)"Y.C." 0.42

A016963221 SIVKORT STERILE SUSPENSION 40MG (TRIAMCINOLONE) 44.40

A016969100 CONAMIN TABLETS "GENTLE" 0.89

A017006100 FONES-TON CAPSULES "K.B." 1.02

A017014321 TOPCORT OINTMENT (FLUOCINONIDE) "S.C." 32.30

A017014329 TOPCORT OINTMENT (FLUOCINONIDE) "S.C." 44.10

A017017100 "MEBENDAZOLE TABLETS ""WELCAN"" " 1.10

A017084100 IBUPROFEN CAPSULES 0.72

A017088238 GISACON-B12 INJECTION "Y.A" 5.00

A017107100 DEPAIN TABLETS 0.74

A017121100 MIN'S TABLETS "H.C." (CLEMASTINE) 0.79

A017199100 TON FONLIN CAPSULES "Y.S." (IBUPROFEN) 0.72

A017205100 SHOUENLIN TABLETS (IBUPROFEN)"Y.Y." 0.72

A017279416 GENTAMICIN EYE DROPS "GCPC" 13.30

A017302100 COUGHXIN TABLET 8MG (BROMHEXINE) 0.25

A017343100 DEXTROMETHORPHAN TABLETS 30MG "EAYUNG" 0.82

A0173531G0N-METHYLSCOPOLAMINE METHYL SULFATE TABLETS "M.T."(鋁箔/

膠箔)1.50

A017367100 PILINTON CAPSULES "W.F." 3.50

A017383100 ANTICOLD CAPSULES "CHINTENG" 1.16

A017402100 SULNIN CAPSULES "LITA" 0.89

A017438100 IBUPROFEN CAPSULES "WINSTON" 0.55

A017441100 PITONNING TABLETS "CHEN TA" 0.74

A017450100 TINIDAZOLE TABLETS 500MG "H.H." 2.06

A017454423 RINTERON OPHTHALMIC SOLUTION "MAY SEE" 33.10

A017497100 ROWELCON S.C. TABLETS (METOCLOPRAMIDE) 0.69

A017543100 COLDEX CAPSULES "KINGDOM" 0.75

A017545100 ANTONE TABLETS 500MG"D.T.S" 0.19

A017568100 ASTHAN S.C. TABLETS "Y.Y" 0.89

A017711212 VILITOMIN INJECTION 19.90

A017799100 PAPAVERINE HCL TABLETS 30MG "HONTEN" 1.03

Page 11: 附件二 藥品給付品項暨支付標準表

A017805229 KANAMYCIN SULFATE INJECTION "ASTAR" 0.00

A017805238 KANAMYCIN SULFATE INJECTION "ASTAR" 0.00

A017805299 KANAMYCIN SULFATE INJECTION "ASTAR" 0.00

A017806157 PANCOUDENIN SYRUP "PANBIOTIC" 23.40

A017860100 ZEMIN TABLETS (CLEMASTINE) "PANBIOTIC" 0.60

A017882163 UNITUSSIN SYRUP " CENTER" 24.80

A017919209 TESTOSTERONE CYPIONATE INJECTION "Y.Y." 15.90

A017984100 METOCLOPRAMIDE TABALETS "Y.C." 0.69

A018014100 SULERGE "C.R." 0.90

A018062100 "O.Y."CHUNBIK TABLETS (MEBENDAZOLE) 1.10

A018069100 ANCOTON TABLETS (ACETAMINOPHEN) 0.30

A018091100 METHON TABLETS 15MG 0.47

A018098110 SUPERCILLIN (AMOXICILLIN) POWDER FOR ORAL SUSPENSION 31.00

A018100100 DELUGI TABLETS "WP" (NALIDIXIC ACID) 2.22

A018136100 ACETAMINOPHEN TABLETS "Y.S." 0.28

A018155100 BUCLIZINE TABLETS "P.J." 0.40

A018157329 CROLAX-H CREAM 10.10

A018160100 DEHYDRI S.C. TABLETS "P.J." 1.07

A018162100 PAINTYL TABLETS "P.J." 0.45

A018231100 MEPENZOL TABLETS "P.J." 0.64

A018237100 SOFTCOUGH CAPSULES "PANBITOTIC" 1.06

A018250100 CARDIOLOL TABLETS 40MG (PROPRANOLOL) 0.87

A0182501G0 CARDIOLOL TABLETS 40MG (PROPRANOLOL) (鋁箔/膠箔) 1.50

A018255212 U-GENCIN INJECTION 40MG/ML (GENTAMYCIN) 13.10

A018281100HUGALIN S.C. TABLETS (DIISOPROPYLAMINE DICHLOROACETATE)

"H.H."1.00

A018282100 SEPRONIN CAPSULES (KETOPROFEN) "SHITEH" 1.20

A018322321 GENDERON CREAM "PATRON" 12.20

A018322329 GENDERON CREAM "PATRON" 13.50

A018331100 SALBUTAMOL TABLETS "HONTEN" 0.93

A018332100 NOVAZIL TABLETS "S.C." 0.89

A0183321G0 NOVAZIL TABLETS "S.C."(鋁箔/膠箔) 1.50

A018432100 ACETAMINOPHEN TABLETS "WINSTON" 0.41

A018444100 CABIDRIN FILM COATED TABLETS "JOHNSON" 0.89

A018460100 BUU SHIEE VITAMINE CAPSULES "H.S."(COBAMAMIDE) 1.08

A018498100 PISANTONG TABLETS "CHINTENG" 0.99

A018555100 PUNORTOR TABLETS "PANBIOTIC" (ACETAMINOPHEN) 0.35

A018559100 LONZUMIN TABLETS "STANDARD" (BUCLIZINE) 0.44

A018570100 MYOLAX TABLETS 500MG (METHOCARBAMOL) "VPP" 1.00

A018597500 HEMODIN SUPPOSITORIES "PATRON" 5.50

A018609100 ANALGESIC TABLETS 500MG "SOURIREE" (ACETAMINOPHEN) 0.20

A018637100 COLAC E.C. TABLETS "S.C." (BISACODYL) 0.63

A018648100 KORYNASE E.C. TABLETS 10MG 2.84

A018659100 ACETAMINOPHEN TABLETS "S.Y." 0.28

A018669212 BETAMETHASONE SUSPENDED INJECTION "GENTLE" 16.90

A018678100 BIDICON TABLETS (DEXTROMETHORPHAN) 0.00

A0186921G0 MEBENDAZOLE TABLETS "M.T."(鋁箔/膠箔) 1.50

A018694209 ATROPINE SULFATE INJECTION 1MG/ML "VPP" 3.46

Page 12: 附件二 藥品給付品項暨支付標準表

A018696100 BIDYL S.C. TABLETS (BISACODYL) "C.C.P." 0.62

A018718100 ANTICOLD CAPSULES "C.R." 0.54

A018738100 SUFFIN TABLETS (PSEUDOEPHEDRINE HCL) "C.R." 0.70

A0187381G0SUFFIN TABLETS (PSEUDOEPHEDRINE HCL) "C.R."(鋁箔/膠箔)

1.50

A018750100 COLDENIN CAPSULES 0.89

A018791100 SEDENIN TABLETS "MEIDER" 0.74

A018798335 TRICODEX CREAM "C.C.P." 65.00

A018848421 ATROPINE EYE DROPS (ATROPINE SULFATE)"OASIS" 29.90

A018873100 BUCLIZINE TABLETS "H.H." 0.45

A018884265 SUPERCILLIN FOR INJECTION "VPP" 14.90

A018896100 SALUTOL TABLETS (SALBUTAMOL) "KINGDOM" 0.83

A0188961G0 SALUTOL TABLETS (SALBUTAMOL) "KINGDOM"(鋁箔) 1.50

A018916100 TOPICAINE TABLETS (OXETHAZINE) "Y.C." 0.17

A018926100 TIOPRONIN S.C. TABLETS "S.T." 4.39

A018929100 ANTALGIC TABLETS "H.H." 0.74

A018952333 HEPARINOID OINTMENT "Y.Y." 34.60

A018959100 POLYASE TABLETS "P.J." 0.52

A018985163 PACOUGH SYRUP "PATRON" 25.00

A018987421 BENOXINATE EYE DROPS "OASIS" 24.80

A019039100 KOCHANIIN TABLETS (CLONIDINE) "S.Y." 1.00

A019102100 BICOROMIN TABLETS "MEIDER" 0.69

A019115100 PAWINT TABLETS "PATRON" 1.10

A019144351 DEHIST LOTION "GCPC" 16.30

A019144355 DEHIST LOTION "GCPC" 22.80

A019150265 VITAPLEX INJECTION "S.Y." 17.80

A019159100 ACETA TABLETS (ACETAMINOPHEN) "J.H." 0.31

A019178100 ANTIASTHMA CAPSULES 2.96

A019251100 NEO-ANTIHISTAMINE TABLETS (CHLORPHENIRAMINE) "J.H." 0.13

A019260100 DYS-COLD CAPSULES "H.H." 0.89

A0192631G0MUQUAPIN S.C. TABLETS "H.S." (N-METHYLSCOPOLAMINE

METHYLSULFATE)(鋁箔/膠箔)1.50

A019299135 PANDOL LIQUID (HALOPERIDOL) "PANBIOTIC" 37.70

A019299143 PANDOL LIQUID (HALOPERIDOL) "PANBIOTIC" 45.50

A019299151 PANDOL LIQUID (HALOPERIDOL) "PANBIOTIC" 0.00

A019299157 PANDOL LIQUID (HALOPERIDOL) "PANBIOTIC" 0.00

A019328100 DEXTROMETORPHAN TABLETS "JEN SHENG" 0.82

A019339100 DIPHENIDOL HCL S.C. TABLETS "J.S." 0.91

A019343100 ACETAMINOPHEN TABLETS "C.T." 0.35

A019348100 KUANIUM S.C. TABLETS "VPP" 0.00

A019353100 STAZYME F.C. TABLETS "STANDARD" 1.66

A019410100 UNCOLA CAPSULES "S.C." 1.00

A0194101G0 UNCOLA CAPSULES "S.C."(鋁箔/膠箔) 1.50

A019412100 SEDICON TABLETS "YU SHENG" 0.40

A019422335 SCALPHEN OINTMENT (MESULPHEN) "SINPHAR" 40.30

A019444100 MEBENDAZOLE TABLETS "S.Y." 1.10

A019485100 DEXCHLORPHENIRAMINE TABLETS "HONTEN" 0.30

A019518100 FULOAN CAPSULES (FLUOXYMESTERONE) "N.C.P." 0.00

Page 13: 附件二 藥品給付品項暨支付標準表

A019577100 BACTALIN TABLETS "S.Y." 0.90

A019600100 NEGACHINE TABLETS (NALIDIXIC ACID) 2.22

A019614329 SINPHARDERM-HC CREAM "SINPHAR" 17.60

A019615329 SINQUART CREAM "SINPHAR" 17.90

A019624100 IPROFEN F.C. TABLETS (IBUPROFEN) "ROYAL" 0.72

A019650100 BROMCO TABLETS (BROMHEXINE) "ROYAL" 0.23

A019819100 ANTONIN CAPSULES 1.20

A019864100 ACEDOL TABLETS "ROYAL" 0.37

A019947100 NOSCAPINE TABLETS "J.L." 0.83

A019949100 ANTI-COUGH CAPSULES "SOURIREE" 1.00

A019961342 NITROFURAZONE OINTMENT "Y.Y." 22.80

A019977100 MESYTOL TABLETS 6MG "CHEN TA" (BETAHISTINE) 0.92

A019985100 KETOPROFEN CAPSULES 50MG "EAYUNG" 0.00

A020044100 SIOFULIN TABLETS (DICLOFENAC) "S.Y." 0.90

A020070100 CLOMIFEN CAPSULES (CLOMIPHENE) "ROYAL" 3.54

A020101100 SUFUPIN TABLETS (BUCLIZINE) "YUNG CHANG" 0.72

A0201031G0 DICLOFEN F.C. TABLET (DICLOFENAC) "H.H."(鋁箔/膠箔) 1.50

A0201121G0TRICOGYL F.C TABLETS (METRONIDAZOLE) "ROYAL"(鋁箔/膠箔)

1.50

A020148212 HEPATOSWISS IM INJECTION "SWISS" 20.10

A0201741G0 LOTINTON TABLETS(鋁箔/膠箔) 1.50

A020205100 ORONAMINE S.C. TABLETS "C.Y." 0.89

A020215343 SINBABY BABY LOTION "SINPHAR" 12.00

A020215357 SINBABY BABY LOTION "SINPHAR" 33.70

A020228221 HEPATOSWISS I.V. INJECTION "SWISS" 44.00

A020256100 SADIXIN TABLETS (NALIDIXIC ACID) "S.Y." 2.22

A0202851G0 SOLAX CAPSULAS "ROYAL"(鋁箔/膠箔) 1.50

A020296321 WINSOLVE ANTIFUNGAL CREAM 20.50

A020296329 WINSOLVE ANTIFUNGAL CREAM 34.20

A020299100 LIKANCOCHIEN S.C. TABLETS "ORIENTAL" 1.55

A020338100 ATUSSIN S.C. TABLETS (SODIUM DIBUNATE) "VPP" 1.31

A020435100 DISCO TABLETS (BROMHEXINE) "S.Y." 0.23

A020444100 PARAMOL TABLETS 0.41

A020455100 MAGNESIUM HYDROXIDE 300MG "CHEN TA" 0.18

A020459100 CP MYCIN CAPSULE 500MG (CEPHALEXIN)"WP" 1.75

A020538238 PLEXVITE INJECTION "ASTAR" 0.00

A020538277 PLEXVITA INJECTION "ASTAR" 0.00

A020557100 ACETOMIN TABLETS 500MG 0.20

A020613100 CLONIDINE TABLETS "H.H." 1.00

A020616100 NITRAZE TABLETS (NITRAZEPAM) "S.C." 0.77

A020694429 ENGENE EYE DROPS "PATRON" 42.80

A020707100 DEPYRETIN TABLETS (ACETAMINOPHEN) "VPP" 0.41

A020738100 SOUDIPAN TABLETS (DIAZEPAM) "S.Y." 0.80

A020755100 ERYCIN CAPSULES (ERYTHROMYCIN STEARATE) 1.43

A020843212 DICYCLOMINE INJECTION " K.S." 6.40

A020847100 WILCONIN TABLETS "C.Y." 0.85

A0208491G0 LOPERAMIDE TABLETS 2 MG "F.Y."(28粒/瓶裝)(鋁箔/膠箔) 0.00

A0208731G0 CLIXIN F.C. TABLETS "ROYAL"(鋁箔/膠箔) 1.50

Page 14: 附件二 藥品給付品項暨支付標準表

A020892343 SINPHARDERM CREAM "SINPHAR" 31.20

A020904100 JYYKO TABLETS 30MG (DEXTROMETHORPHEN) "N.C.P." 0.00

A020927100 PROPRALOL TABLETS "Y.Y." (PROPRANOLOL) 0.87

A020959100 CLONIN CAPSULES (CLOMIPHENE) 3.54

A020998321 BEGTI CREAM "STANDARD" 14.80

A021010100 LIAID CAPSULES (LOPERAMIDE) "SHIN FONG" 0.94

A021014100 SAUTUN TABLETS (DEXTROMETHORPHAN) "WP" 0.37

A021032100 ANTIDIA CAPSULES (LOPERAMIDE) "S.C." 0.94

A021109238 HICOVITA INJECTION "GENTLE" 9.40

A021148100 TRIAMCINOLONE TABLETS "S.Y." 0.89

A021189212 METOCLOPRAMIDE INJECTION "LITA" 7.10

A021196100 LIPIMIN TABLETS "S.C." (BUCLIZINE) 0.44

A021200100 LOPERAMIDE CAPSULES "CHI SHENG" 0.94

A021204209 CEFAMON INJECTION (CEFAMANDOLE) "LITA" 53.00

A021241100 METOCLOPRAMIDE HCL S.C. TABLETS 10MG "J.S." 0.69

A021274100 XANPLAMIN TABLETS 150MG (XANTHINOL NICOTINATE) "VPP" 0.00

A021372238 PIRACETAM INJECTION "Y.Y." 45.80

A021390100 HECAMOL TABLETS (ACETAMINOPHEN) "HEALTH" 0.34

A0214061G0 WETONLIN TABLETS "M.T."(鋁箔/膠箔) 1.50

A021455335 XYLMOL OINTMENT "SINPHAR" 40.00

A0214801G0 CLONIDINE TABLETS "SWISS"(鋁箔/膠箔) 1.50

A021529100 EXTANCIN TABLETS (GLYCERYL GUAIACOLATE) "H.H." 0.33

A021573316 SCHEREE CREAM "BOWLIN" 9.30

A021573324 SCHEREE CREAM "BOWLIN" 16.60

A021586100 DIMENHYDRINATE TABLETS "C.Y." 0.38

A0216061G0 WINLIPAN CAPSULES (LOPERAMIDE) "WINSTON"(鋁箔) 1.50

A0216351G0LIPIN TABLETS (METHYLSCOPOLAMINE METHYLSULFAT)

"ROYAL"(鋁箔/膠箔)1.50

A021703100 GENLATIN CAPSULES "TAITEN" (LOPERAMIDE) 0.94

A021707100 PERAMIDE CAPSULES (LOPERAMIDE) "KINGDOM" 0.94

A021709212 TRANEXAMIC ACID INJECTION "S.Y." 4.55

A021719438 NASAL SPRAY "NYSCO" 32.70

A021731157 ANTISEMIN DRY SYRUP (CYPROHEPTADINE) 22.80

A021748277 6-H.E.S. INJECTION 0.00

A021776151 CODEPIN SYRUPS "N.C.P." 0.00

A021776157 CODEPIN SOLUTION "N.C.P." 0.00

A021820100 SERPATHIAZIDE F.C. TABLETS "WST" 0.73

A021853329 DAFRIN CREAM (MICONAZOLE) "SWISS" 34.20

A021855100 "COLD S.C. TABLET ""WELCAN""" 0.89

A021870100 ASTAR TABLETS (ASPIRIN) "S.Y." 0.46

A021887417 LECORT IN ORAL BASE (TRIAMCINOLONE) 21.20

A021887423 LECORT IN ORAL BASE (TRIAMCINOLONE) 36.70

A021932100 CLEMASTINE TABLETS "YU SHENG" 0.64

A021960151 COCOSAU SYRUP "Y.Y" 0.00

A021990100 SONCHI TABLETS "CURIE" 1.66

A022010229 HYCOMIN INJECTION "S.Y." (HYDROXOCOBALAMINE) 22.00

A022023100 FUSO TABLETS "ROYAL" 0.72

A022077100 COLCHICINE TABLETS "N.Y." 0.99

Page 15: 附件二 藥品給付品項暨支付標準表

A022078321 ANTIFUNGUS CREAM "GCPC" 29.10

A022106100 SABUCHAN TABLETS (SALBUTAMOL)"YUNG CHANG" 0.93

A022109100 IMODINE CAPSULES (LOPERAMIDE) "KINK" 0.94

A022117100 PANACON TABLETS 0.26

A022120100 WHITE ANTI-PEPTIC ULCER TABLETS (GEFARNATE) 1.59

A022122100 LACTAM TABLETS (ACETAMINOPHEN) "SINPHAR" 0.35

A022141100 SILIPIN TABLETS 50MG "H.S." 0.39

A022199100 COULITIN TABLETS "ASTAR" 0.89

A022200500 XYLMOL SUPPOSITORY "SINPHAR" 3.24

A022210100 CIQUATE TABLETS "CBC" 1.00

A0222101G0 CIQUATE TABLETS "CBC" 1.50

A022226212 SULOFAGEN INJECTION 2.59

A022229100 WACO TABLETS (GLYCERYL GUAIACOLATE) "W.P." 0.33

A022259100 PRANOLOL TABLETS (PROPRANOLOL) "H.L." 0.00

A0222741G0 UFUNIN TABLETS (LOPERAMIDE) (鋁箔/膠箔) 1.50

A022407100 KETOPROFEN CAPSULES 50MG "CHI SHENG" 1.20

A022433151 SHOWMIN SYRUP "CURIE" (CYPROHEPTADINE) 17.00

A022433157 SHOWMIN SYRUP "CURIE" (CYPROHEPTADINE) 22.80

A022463100 CIMETIDINE TABLETS "SHIN FONG" 1.00

A022464100 CIMETIDINE TABLETS "CHI SHENG" 1.00

A022467100 INCALM TABLETS "SINPHAR" 0.53

A022473429 PATEAR EYE LOTIONS "PATRON" 29.60

A022474321 HIRUCORT CREAM "PATRON" 44.60

A022474329 HIRUCORT CREAM "PATRON" 70.00

A022499100 NYCITON CAPSULES (NIFLUMIC ACID) "CURIE" 2.36

A022507100 LOVEGEN F.C. TABLETS (CONJUGATED ESTROGEN) "ROYAL" 2.94

A022515435 JEN SHENG SUPER EYE LOTION 53.00

A022525321 CLOMELON CREAM (CLOTRIMAZOLE) "GENTLE" 8.40

A022526500 ASMETHOL SUPPOSITORIES "C.C.P." 3.70

A022529100 BROMPHENIRAMINE TABLETS "TAI YU" 0.23

A022540321 EPIDREM OINTMENT "SINPHAR" 15.00

A0225861G0 ELININ CAPSULES (LOPER AMIDE)"SHINLON"(鋁箔/膠箔) 1.50

A022595100 POUGENIN CAPSULES (SILYMARIN) 1.22

A022602100 BISCOMP TALBETS "Taiten" 0.74

A022611100 PAWSANLON CAPSULES "J.S." 1.08

A022622216 SUWELIN INJECTION (CIMETIDINE)"S.Y." 11.10

A022628100 PIPMA FILM COATED TABLETS (PIPEMIDIC ACID) 2.96

A0226301G0 WINTIN TABLETS (LORAZEPAM) "WINSTON"(鋁箔/膠箔) 1.50

A022634100 DIABITIN TABLETS 5MG (GLIBENCLAMIDE) "VPP" 0.99

A022657100 HEMA F S.C. TABLETS "S.C." 0.73

A022664100 AMOXICILLIN CAPSULES 500MG "Taiten" 1.23

A022678100 BRAMIN TABLETS (BROMPHENIRAMIN) "PANBIOTIC" 0.21

A022686329 CLOMAZOLE CREAM 1% (CLOTRIMAZOLE) "VPP" 15.40

A022689100 AMMONIUM CHLORIDE E.C. TABLETS "W.P." 0.18

A022693329 FLUOCINONIDE OINTMENT "H.S." 44.10

A022712100 TOLMETIN TABLETS "H.S.C." 5.50

A022719421 CONDRON-DEMISON EYE DROP 14.70

A022722100 BUCOFENE TABLETS 0.45

Page 16: 附件二 藥品給付品項暨支付標準表

A022729238 GENTAMICIN SULFATE INJECTION "ASTAR" 36.90

A022729299 GENTAMICIN SULFATE INJECTION "ASTAR" 1.19

A022747100 PISUNIN TABLETS "CHEN TA" 0.45

A022843100 CHLORMEZANONE TABLETS "S.Y." 0.73

A022872100 GASTROPIN TABLETS "VPP" 0.15

A022901100 TRICORT TABLETS (TRIAMCINOLONE) "S.C." 0.89

A022902100 GASTRODIN TABLETS 300MG (CIMETIDINE) 1.00

A022905100 TRANZANSHOW CAPSULES (TRANEXAMIC ACID)"CURIE" 1.27

A022928100 ODETIN TABLETS (BUCLIZINE) "VPP" 0.45

A022940209 DEPO-OVADIOL INJECTION "ORIENTAL" 48.00

A022941100 TRIAMCORT TABLETS "K.B." (TRIAMCINOLONE) 0.89

A022949277 COFLEX INJECTION "S.Y." 71.00

A022970209 CANHONLIN INJECTION "Y.A." (ANETHOLE TRITHIONE) 0.00

A022982100 BISOCU TABLETS (BROMHEXINE)"W.P." 0.23

A022990335 B. &N. BACINEOCIN OINTMENT 17.00

A022999100 IMOLI CAPSULES (LOPERAMIDE) "N.T." 0.94

A023012321 SINSODERM CREAM "S.Y." 15.00

A023020100 FASTOP TABLETS 200MG "SHITEH" 0.58

A023035321 GYNO-MYCODERIN CREAM (MICONAZOLE) "BOWLIN" 20.50

A023038321CHAA CREAM (CHLOROHYDROXY ALUMINUM ALLANTOINATE)

"H.C.T."0.00

A023041100 ALLOPURINOL TABLETS "PANBIOTIC" 0.00

A023109212 CIMETIDINE INJECTION 100MG/ML "Y.Y." 9.90

A023115335 CLOMAZOLE SOLUTION 1% (CLOTRIMAZOLE) "VPP" 45.00

A023143100 PSEUBYIRIN TABLETS (PSEUDOEPHEDRINE HCL) "EVEREST" 0.70

A023151100 ERGONOVINE MALEATE S.C. TABLETS "C.T." 0.68

A0231511G0 ERGONOVINE MALEATE S.C. TABLETS "C.T." (鋁箔/膠箔) 1.50

A023162100 RE-LIVER CAPSULES "JINUP" 1.35

A023230229 RASEMIN INJECTION 10% (TRANEXAMIC ACID) "Y.Y" 31.50

A023231321 CIVIDOID GEL (HEPARINOID) "SINPHAR" 17.50

A023231329 CIVIDOID GEL (HEPARINOID) "SINPHAR" 31.50

A023231338 CIVIDOID GEL (HEPARINOID) "SINPHAR" 34.60

A023250238K-CILLIN INJECTION 20,000,000 UNITS (POTASSIUM

PENICILLIN G) "VPP"76.00

A023281100 CIVIGEN TABLETS "Taiten" 1.00

A023284100 NEWZYME TABLETS "STANDARD" 0.57

A023319100 CLEMASTINE TABLETS "CHINTENG" 0.79

A023331100 PYLINATON TABLETS 500MG 0.20

A023336329 PASCA GEL "SHIONOGI" 33.90

A023352100 SATINMIN TABLETS "S.C." (CARBINOXAMINE) 0.27

A023356100 SU'S CAPSULES (SULPIRIDE) "CURIE" 1.08

A023380435 YIPI NASAL SOLUTION "HEALTH" 22.10

A0233891G0DICLOFON S.C. TABLETS (DICLOFENAC) "F.Y."(瓶裝/84粒/瓶)

1.50

A023391100 STROMAFON TABLETS "EAYUNG" 0.27

A023415100 WEIANLIN TABLETS "H.S.C." 0.85

A023434100 LYSOEM TABLETS (LYSOZYME) 1.01

A023483100 KU-WE-RIN TABLETS "Y.S." (CIMETIDINE) 1.00

Page 17: 附件二 藥品給付品項暨支付標準表

A023488100 ULCOGEN TABLETS "S.Y." 0.85

A023490100 SODICON TABLETS "SINPHAR" 0.47

A023499100 LOPERAMIDE CAPSULES "J.H." 0.64

A023521100 MAGNESIUM OXIDE TABLETS "KINGDOM" 0.16

A023524100 COSTENE TABLETS (CARBETAPENTANE) "H.H." 0.44

A023531421 BENEMYCIN EYE DROPS "OASIS" 28.40

A023533329 FUNGICIDE CREAM (CLOTRIMAZOLE) "ROYAL" 15.40

A023534100 ROPAL TABLETS (ASPIRIN) "ROYAL" 0.50

A0235891G0 LOGMAL CAPSULES (SULPIRIDE) "M.T."(鋁箔/膠箔) 1.50

A023600321 CAMISTEN CREAM (MICONAZOLE) "SINPHAR" 17.60

A023626321 DAFRIN-H CREAM "SWISS" 30.70

A023627100 VENTURIN TABLETS "Y.S." (DIPHENIDOL) 1.05

A023628212 GASPIN INJECTION (PIRENZEPINE) "GENTLE" 0.00

A023646100 CEPHALEXIN CAPSULES 1.13

A023652100 BECOLON CAPSULES 0.89

A023654100 DECOUGH CAPSULES (CARBOCISTEINE) 1.15

A023663321 ECONAZOLE TRIAMCINOLONE CREAM “TWI” 10.50

A023663329 ECONAZOLE TRIAMCINOLONE CREAM “TWI” 18.20

A023663335 ECONAZOLE TRIAMCINOLONE CREAM “TWI” 22.20

A023666329 TUAN OINTMENT "H.L." 27.50

A023668212 CLEMASTINE INJECTION "Y.Y." 3.77

A023687321 FUDELIN CREAM "L.S." (FLUOCINONIDE) 32.30

A023715100 CARMIN TABLETS "Y.Y." 0.89

A023743100 PARAMMINE TABLETS 0.53

A023819100 CODECON CAPSULES 0.33

A023839157 CORIGIN SYRUP "S.Y." 23.00

A023862100 FELON CAPSULES (PIROXICAM) "EAYUNG" 1.00

A023879100 ROTEC TABLETS "F.Y." 0.50

A023912100 BENZOLE TABLETS (MEBENDAZOLE) "HONTEN" 1.10

A023925100 COUGDAU TABLETS "NCP" 0.29

A023954100 ATON TABLETS (ACETAMINOPHEN) "NCP" 0.19

A023970100 ERYTHROCIN CAPSULES“TAITEN”(ERYTHROMYCIN ESTOLATES) 1.43

A023973100 ASU CAPSULES "NCP" 1.06

A023978100 BOCYLINE CAPSULES 500MG“TAITEN” 1.07

A023981100 ZIMIN S.C. TABLETS (CHLORCYCLIZINE) "NCP" 0.98

A024004100 BUGIFENE TABLETS "P.L." 0.45

A024010100 IBUPROFEN F.C. TABLETS "Y.C." 0.76

A0240171G0 CIMEDIN TABLETS 200MG (CIMETIDINE) "TBC" 1.50

A024055100 PAIN RELIEF F.C. TABLETS 200mg (Ibuprofen) 0.72

A024098100BISPLEN TABLETS 20MG "Y.C." (EPRAZINONE DIHYDROCHLORIDE)

0.54

A024142100 BRENCO TABLETS (FENOTEROL) 0.97

A0241421G0 BRENCO TABLETS (FENOTEROL)(鋁箔) 1.50

A024154100 SULIN TABLETS 5MG (DIAZEPAM) "ORIENTAL" 0.80

A024155100 CHLOPHEDIANOL HCL TABLETS "S.C." 0.86

A024182100 ROXSON TABLETS "Y.Y"(PRIDINOL) 0.00

A024192221 REPACIN LYO-INJECTION (BETA-AESCIN) 0.00

Page 18: 附件二 藥品給付品項暨支付標準表

A024195100ULOPINE TABLETS (PIRENZEPINE DIHYDROCHLORIDE)

"PANHIOTIC"1.77

A024198299 AMIKACIN INJECTION 125MG/ML "N.K." 14.00

A024225338 WHITE CLOUD OINTMENT (FLUOCINONIDE)"C.H." 94.00

A024227100 IBUPROFEN S.C. TABLETS "C.H." 0.70

A024239100 NEWTASE TABLETS "CHINTENG" 0.57

A024261100 ELIAMINE S.C. TABLETS (SILYMARIN) 1.22

A024280100 ANTOXINE TABLETS (DIHYDROERGOTOXINE METHANESULFONATE) 1.24

A024301100 FIMEPON S.C. TABLETS "H.S." 1.10

A024305100 ULSPAN CAPSULES (SULPIRIDE) 1.08

A024309100 DARAFFIN TABLETETS "S.C." 0.50

A024338321 TRISONE CREAM 0.00

A024338329 TRISONE CREAM 0.00

A024338335 TRISONE CREAM 0.00

A024384100 LORAZEPAM TABLETS 1MG 0.98

A0243841G0 LORAZEPAM TABLETS 1MG (鋁箔/膠箔) 1.50

A024398100 ANAPROX TABLETS (NAPROXEN SODIUM) 1.08

A024433100 FUBININ TABLETS "MEIDER" 0.77

A024465100 ASPIRIN TABLETS "JOHNSON" 0.45

A024514100 CONICA CAPSULES 400MG "S.T." (PIRACETAM) 1.14

A024519343 Sinpharderm A.D.E. CREAM 42.60

A024571321 EPARCORT CREAM 10.50

A024571329 EPARCORT CREAM 18.20

A024571338 EPARCORT CREAM 32.60

A024571355 EPARCORT CREAM 135.00

A024598100 SIULON TABLETS 0.90

A024609100 AMIPHEN TABLETS 500MG "SPC" 0.20

A024615100 PICOL F.C. TABLETS (PIPEMIDIC ACID) "ROYAL" 2.96

A024616100 ACETAMINOPHEN TABLETS 500MG "ASTAR" 0.39

A024620212 MULTIVITA INJECTION 20.40

A024623100 ACETAMINOPHEN TABLETS 325MG "ASTAR" 0.33

A024644100 WUNTON TABLETS "W.P." 0.91

A024695100 FUDELLINE TABLETS 0.92

A024706100 SUPIAN TABLETS (PSEUDOEPHEDRINE HCL) 0.70

A024710100 CIMETIDINE TABLETS 200MG "SOURIREE" 1.00

A0247101G0 CIMETIDINE TABLETS 200MG "SOURIREE" (鋁箔/膠箔) 1.50

A024714100 BIODASE TABLETS "H.H." 0.57

A024833100 FLURAZINE S.C. TABLETS 2MG (TRIFLUOPERAZINE) "VPP" 1.03

A024842100 ANTICOLD CAPAULES 0.89

A024856100 CEFLEXIN CAPSULES 250MG (CEPHALEXIN) "VPP" 1.13

A024862100 OROTIN S.C. TABLETS "C.H." 0.64

A024867100 RISCO TABLETS "Y.S." (EPRAZINONE) 0.57

A024878321 PERICON CREAM "CENTURY" 10.40

A024878335 PERICON CREAM "CENTURY" 22.20

A024889151 CASTEINE SYRUP (S-CARBOXYMETHLCYSTEINE) 59.00

A024921100 "LEPOTIN TABLETS 1MG ""WELCAN"" (CLEMASTINE) " 0.71

A024952229 DEXAMETHASONE INJECTION 4MG "Y.Y." 16.80

A024958100 MINLICK TABLETS (CLEMASTINE) "SPC" 0.60

Page 19: 附件二 藥品給付品項暨支付標準表

A025027100 DEXCHLORPHENIRAMINE MALEATE TABLETS 2MG "Y.K." 0.30

A025054100 TENOBEC TABLETS 5MG (FENOTEROL) "PANBIOTIC" 1.47

A025081100 RECOUGH TABLETS 20MG "S.C." (EPRAZINONE) 0.59

A025091100 MAGOCAIN TABLETS 0.42

A025118100 NEUROPAM TABLETS 2MG (LORAZEPAM) "PANBIOTIC" 0.98

A0251181G0NEUROPAM TABLETS 2MG (LORAZEPAM) "PANBIOTIC"(鋁箔/膠箔)

0.00

A025121100 BISCO TABLETS 12MG (BROMHEXINE) 0.30

A025124100 ZINC TABLETS 15MG "GCPC" 1.20

A025125209 CEFAMANDOLE FOR INJECTION 1GM 53.00

A025136321 MYCOSTEN CREAM 10MG/GM (CLOTRIMAZOLE) "SINPHAR" 8.40

A025136329 MYCOSTEN CREAM 10MG/GM (CLOTRIMAZOLE) "SINPHAR" 15.40

A025149100 LICHANYU TABLETS "HONTEN" 0.48

A025160100 ASPIRIN F.C. TABLETS 500MG "TAI YU" 0.61

A025170100 DEPAIN TABLETS 500MG (ACETAMINOPHEN) "W.P." 0.19

A025194157 KOSOLIN SYRUP 25.80

A025195100 DYPHACOL TABLETS 0.00

A0252021G0 FELCAM CAPSULES 10MG (PIROXICAM)(鋁箔/膠箔) 1.50

A025209100 COMFORT CAPSULES "S.C." 0.36

A025214100 CHLORPHENIRAMINE MALEATE TABLETS 4MG "W.P." 0.16

A025216229 POLIMIN-B12 INJECTION "Y.Y." 0.00

A025216238 POLIMIN-B12 INJECTION "Y.Y." 9.40

A025218329 KONAZOLE OINTMENT (MICONAZOLE)"Y.Y." 34.20

A025237321 TRETINOIN CREAM 0.1% 20.20

A025245209 APRELAZINE INJECTION 20MG/ML (HYDRALAZINE) 24.10

A025245277 APRELAZINE INJECTION 20MG/ML (HYDRALAZINE) 16.70

A025275100 NORSETOA CAPSULES "CHINTENG" 0.50

A025287277 CEFAMANDOLE FOR INJECTION 500MG 29.60

A025291321 SEEDO-SANIN CREAM 0.00

A025291325 SEEDO-SANIN CREAM 12.50

A025304100 COSTAN TABLETS 20MG (EPRAZINONE) "S.T." 0.54

A025309157 CARSTIN SYRUP 20MG/ML (S-CARBOXYMETHYLCYSTEINE) 20.50

A025310100 FUROKAN CAPSULES (PIROXICAM) 1.00

A0253961G0MEFETON F.C. TABLETS 500MG (MEFENAMIC ACID) "S.Y."(瓶裝

/84粒/瓶)0.00

A025419100 REZINON TABLETS 20MG (EPRAZINONE) 0.58

A025431100 DIPYRIDAMOLE S.C. TABLETS 75MG"ORIENTAL" 1.38

A025436100 DICLOTON TABLETS 25MG (DICLOFENAC) 0.90

A025471100 MUSZEPIN TABLETS 25MG (PIRENZEPINE HYDROCHLORIDE) 1.77

A025482209 ATROPINE SULFATE INJECTION 2MG/ML "VPP" 3.46

A025487100 LONDEC TABALETS "K.S." 0.45

A025492212 BITAS-H INJECTION "Y.Y." 5.80

A025495100 NAPROXEN TABLETS 250MG "TAH-AN" 1.08

A025507277 AMINOL INFUSION "S.T." 273.00

A025520100 METHOPTERIN TABLETS 2.5MG (METHOTREXATE) 3.17

A025581100 RICO CAPSULES "H.H." 0.89

A025582100 EPRANONE TABLETS 20MG (EPRAZINONE) "H.H." 0.59

A025596100 TOFOANIN TABLETS 25MG (INDOMETHACIN) 0.87

Page 20: 附件二 藥品給付品項暨支付標準表

A025601100 EPRAZINONE TABLETS 30MG "CHINTENG" 0.64

A025621212 TOBRA INJECTION 40MG/ML (TOBRAMYCIN) 0.00

A025624100 PLOCON TABLETS 3MG "Y.Y" 0.64

A025628100 CIMETIDINE TABLETS 200MG 1.00

A025654212 METOPERON INJECTION 5MG/ML " K.S." 7.10

A025663100 SUSOUCON CAPSULES 30MG (DEXTROMETHORPHAN) "ORIENTAL" 0.82

A025688100 ANTICON TABLETS 15MG (DEXTROMETHORPHAN) 0.45

A025692100 SHUBICO CAPSULES "S.C." 0.36

A025706100 STARGEN S.C. TABLETS 100MG (TIOPRONIN) "S.T." 0.00

A025711100 CEFADROXIL CAPSULES 500MG "Y.Y." 2.00

A025715100 ACTIZYME TABLETS 30MG"PANBIOTIC"(LYSOZYME) 0.00

A025720100 KETOPROFEN CAPSULES 50MG "TAH-AN" 1.20

A025748221FORSTRONG LYO-INJECTION 5000IU (CHORIONIC GONADOTROPIN)

161.00

A025760109 CYSTIN POWDER 40MG/GM (ACETYLCYSTEINE) "LITA" 0.84

A025773100ES MYCIN F.C. TABLETS 500MG (ERYTHROMYCIN STEARATE)

"W.P."3.38

A025778100 TRI-ZYME TABLETS "S.T." 0.57

A025806100 SINDELIN S.C. TABLETS 0.61

A0258281G0 PITOCAM CAPSULES 10MG (PIROXICAM) "SPC"(鋁箔/膠箔) 1.50

A025833100 SUSTON CAPSULES 250MG (MEFENAMIC ACID) "Y.C." 0.75

A025851100 UNISIN S.C. TABLETS 25MG (DIPYRIDAMOLE) "UNION" 0.90

A025856100 RESCO TABLETS 20MG (EPRAZINONE) "GENTLE" 0.59

A025883321 MICONASON CREAM 0.00

A025883335 MICONASON CREAM 91.00

A025883338 MICONASON CREAM 143.00

A025921100 REPRACON TABLETS 20MG (EPRAZINONE DIHYDROCHLORIDE) 0.59

A025937100 COEN TABLETS 20MG (EPRAZINONE)"YU SHENG" 0.59

A025939100 ACETIN CAPSULES 200MG (ACETYLCYSTEINE) "MAYER" 2.18

A025944100 ESMYCIN F.C. TABLETS 250MG (ERYTHROMYCIN) "W.P." 1.43

A025956100NORETONE TABLETS 5MG (NORETHINDRONE ACETATE) "SHIN FONG"

1.26

A025959277 CEFAZOLIN FOR INJECTION 500MG "ORIENTAL" 11.40

A025967500 PHEPIX VAGINAL SUPPOSITORY 150MG (ECONAZOLE) 8.50

A026008100 PENSALINE S.C. TABLETS 25MG (DIPYRIDAMOLE) "S 0.90

A026025100 BININ F.C. TABLET 0.89

A026039100 LOPERAMIDE CAPSULES 2MG 0.94

A026041100 CHUSELIN CAPSULES 250MG (TRANEXAMIC ACID) "Y.S." 1.27

A026043100 MOJUNE TABLETS 25MG (DIPHENIDOL) "K.B." 0.91

A026056100 A.T. TABLETS 500MG (ACETAMINOPHEN) "LITA" 0.19

A026058209 ALLERMIN INJECTION 3MG/ML (PIPRINHYDIRNATE)"Y.Y." 6.40

A026073100 COBACIDE TABLETS 0.90

A026078100 NOSEMIN TABLETS 0.78

A026102100 IBUPROFEN CAPSULES 200MG 0.70

A026164100 ASPIRIN CAFFEINE TABLETS "LITA" 0.91

A026185100 METHINOL TABLETS 500MG " PANBIOTIC " 3.54

A026199100 RIVAPRESS TABLETS 250MG (METHYLDOPA) "PANBIOTIC" 1.80

A026280100 EACOUG TABLETS 20MG (EPRAZINONE HCL) "NCP" 0.54

Page 21: 附件二 藥品給付品項暨支付標準表

A026287100 NOMA TABLETS "H.H." 1.00

A026299100 TSUFONLOL TABLETS "S.T." 0.42

A026319212 DICYCLOMINE HCL INJECTION 10MG/ML "S.Y." 6.40

A026323100 A.H.BUTON TABLETS 500MG "YU SHENG" 0.38

A026329100 AMMONIUM CHLORIDE E.F.C. TABLETS 500MG "W.P." 0.18

A026338329 CEFUL CREAM "S.C." 36.00

A026346100 BIMINING TABLETS "Y.S." 0.72

A026365100 ENODONE TABLETS "W.P." 3.60

A026390100 ANTIEXPECT TABLETS 20MG "JINUP" (EPRAZINONE HCL) 0.59

A026401277 TPN NO.4 INJECTION 25.50

A026405100 RELIZINE TABLETS "S.C." 0.98

A026407100 DIUREN TABLETS "GCPC" 1.06

A026420265 TPN NO.1 INJECTION "S.T." 25.10

A026420277 TPN NO.1 INJECTION 25.50

A026456100 UPANTA TABLETS 25MG (BUCLIZINE) "JINUP" 0.45

A026457100 DIMELON TABLETS 20MG (DIMETHOTHIAZINE) "H.H." 2.86

A026465100 UPMIDIC TABLETS 250MG (PIPEMIDIC ACID) "JINUP" 2.96

A026485212 ASCORBIC ACID INJECTION 250MG/ML "S.Y." 5.40

A026485221 ASCORBIC ACID INJECTION 250MG/ML "S.Y." 0.00

A026487100 LONFADROXIL CAPSULES 250MG (CEFADROXIL) "UNION" 1.98

A026489209 NEFOPAM INJECTION 20MG/ML "S.Y." 10.20

A026500100 BOLTONIN TABLETS 25MG (DICLOFENAC) "CHI SHENG 0.90

A026506212 CIMEWEI INJECTION 100MG/ML (CIMETIDINE) "LITA 9.90

A026514209 ANTON INJECTION 20MG/ML "Y.A" (NEFOPAM) 10.20

A026532100 BECTON F.C. TABLETS "W.P." 1.92

A026549100 KOUMIN TABLETS 2MG (DEXCHLORPHENIRAMINE) 0.30

A026551121 FLUTAFIN GRANULES 20MG/GM "SHITEH" (ACETYLCYSTEINE) 1.58

A026559100DELAMIN TABLETS 2MG (DEXCHLORPHENIRAMINE MALEATE)

"STANDARD"0.27

A026573209 HYCOMINE INJECTION 5MG/ML 8.10

A026573212 HYCOMINE INJECTION 5MG/ML 10.90

A026595100 NONANTICOLD S.C. TABLETS 0.40

A026633229 LINCOMYCIN HYDROCHLORIDE INJECTION 300MG/ML"ASTAR" 24.20

A026633238 LINCOMYCIN HYDROCHLORIDE INJECTION 300MG/ML"ASTAR" 39.20

A026633299 LINCOMYCIN HYDROCHLORIDE INJECTION 300MG/ML"ASTAR" 1.96

A026636329 ULEX CREAM "SINPHAR" 13.30

A026643100 RESPININE TABLETS 30MG (EPRAZINONE) 0.67

A026664229 PAMCL INJECTION 50MG/ML "ORIENTAL" 95.00

A026679100 SULIC TABLETS 200MG (SULINDAC) 1.90

A026711100 TANNALBIN TABLETS 500MG 0.55

A026717100 MUCO CAPSULES 375MG "PATRON" 1.15

A026728100 ZONON E.S.C. TABLETS 50MG (BROMELAIN)"BEYDAR" 0.89

A026742100 UCOL TABLETS 0.85

A026770100 PERSANTINE S.C. TABLETS 25MG 0.90

A026793265 GLYCEROL INJECTION "S.Y." 0.00

A026793266 GLYCEROL INJECTION "S.Y." 0.00

A026793277 GLYCEROL INJECTION "S.Y." 0.00

A026798100 BISLAN TABLETS 12MG (BROMHEXINE) "YUNG SHIN" 0.28

Page 22: 附件二 藥品給付品項暨支付標準表

A026805100 SUNCHISU TABLETS 2.5MG (FENOTEROL) 0.97

A026834100 PHYLLINTAL TABLETS "T.F." 0.89

A026849100 PYRUDON TABLETS 300MG (ACETAMINOPHEN) "T.F." 0.20

A026875100 RIYAZINE CAPSULES "H.S." 0.00

A026880100 INOSINE TABLETS 500MG (METHISOPRINOL) "H.S." 3.54

A026881100 REGASTRIC TABLETS 25MG "JINUP" (PIRENZEPINE) 1.70

A026906321 EPISONE CREAM "S.Y." 10.50

A026906329 EPISONE CREAM "S.Y." 18.20

A026906335 EPISONE CREAM 15GM "S.Y" 22.20

A026908100 RERTOXIN TABLETS 1.5MG (DIHYDROERGOTOXINE) "UNION" 0.00

A026922100 MUCORPIN CAPSULES 375MG "Y.Y." (CARBOCYSTLINE) 1.13

A026927100 LOTAL S.C. TABLETS 50MG (NITROCOLINE) "KINK" 1.53

A026955100 TOLSON CAPSULE 100MG (TOLPERISONE) "Y.Y" 1.30

A026963100 KUSO TABLETS 1.09

A027003265 SALINE INJECTION 0.9% (SODIUM CHLORIDE)"S.Y." 18.20

A027007100 SWEET TABLETS 50MG (SULPIRIDE) 1.08

A027013100 R.H.H TABLETS "Y.Y" 1.07

A027024100 RECOUGH TABLETS 30MG (EPRAZINONE) "S.C." 0.67

A027040100 DEX-CTM TABLETS 2MG "S.Y." 0.30

A0270441G0 ANTIBLEED CAPSULES 250MG "T.F."(鋁箔/膠箔) 1.50

A027055100 CURRENT TABLETS "H.S." 0.00

A027060100 NASALCON TABLETS "N.C.P." 0.89

A027087100 PROBUCOL TABLETS 250MG "PANBIOTIC" 3.33

A027093100 CEFAXIL CAPSULES 500MG (CEFADROXIL) "STANDARD 2.00

A027102100 ACETAMINOPHEN TABLETS 500MG "YUNG CHI" 0.19

A027109100 GRIFULCIN TABLETS 500MG (GRISEOFULVIN) "C.M." 2.66

A027123100 AMOCILLIN CAPSULES 500MG (AMOXICILLIN) "CHI SHENG" 1.23

A027144151 PEACE SYRUP "YUNG SHIN" 18.10

A027146321 FU-KONG CREAM "T.L.B" 9.70

A027146335 FU-KONG CREAM "T.L.B" 22.20

A027174100 LYSOZYME TABLETS 60MG "H.S." 0.98

A027177121 ACTEIN GRANULES 20MG/GM "S.Y." 1.58

A027233500SAINT-IODINE VAGINAL SUPPOSITORIES 200MG "PATRON"

(POVIDONE-IODINE)10.10

A027287100 UPROFEN TABLETS 200MG (IBUPROFEN) 0.72

A027289338 UREA CREAM 100MG/GM "YUNG SHIN" 23.70

A027297100 DOMILIUM TABLETS 10MG (TRIFLUOPERAZINE) 1.94

A027300100 SEZEN TABLETS 30MG (NEFOPAM)"CBC" 2.70

A027313100 METHYLSCOPOLAMINE TABLETS 1MG "Y.Y." 0.00

A027329277 LACTATED RINGER'S INJECTION "S.H." 21.10

A027330100 Sin Fun Le CAPSULES "N.C.P." 0.89

A027332209 PROASMA INJECTION 100MG/ML (METHOXYPHENAMINE)"Y.Y" 0.00

A027368100 ASGIN F.C. TABLETS (TINIDAZOLE) "S.Y." 2.06

A027373349 CALAMOL LOTION "VPP" 10.10

A027374100 ARTINE TABLETS 2MG “H.L.” 0.80

A027405100 SILLIVER CAPSULE 70MG (SILYMARIN) "C.M." 1.26

A027432100 DARVINE TABLETS 1.34MG (CLEMASTINE) "WEIDAR" 0.79

A027433100 COTINOL TABLETS "WEIDAR" 0.89

Page 23: 附件二 藥品給付品項暨支付標準表

A027444100CARBOTIN CAPSULES 375MG (S-CARBOXYMETHYLCYSTEINE)

"WEIDAR"1.14

A027479435 MEI-LIAN EYE SOLUTION 48.30

A0274921G0 KALIMINE-A S.C. TABLETS 50MG (UNION)(鋁箔/膠箔) 1.50

A027501100 SILIGEN CAPSULES "S.Y" 1.35

A027506100 KANPIAN CAPSULES "C.H." 1.34

A027569100 SOMIN TABLETS 2MG (DEXCHLORPHENIRAMINE) "YUNG SHIN" 0.30

A027676100 LOPID CAPSULES 300MG (GEMFIBROZIL) 1.50

A027687216 LIBAAMIN INJECTION 16.30

A027706100 CLODNIN TABLETS 25MG(CHLOPHEDIANOL)"MEDIDE" 0.86

A027718206 RINDERON INJECTION 4MG/ML (BETAMETHASONE) 11.90

A027818100 DEPERMIDE S.C. TABLETS (INDAPAMIDE) 1.92

A027876100 LIVORIN CAPSULES 70MG (SILYMARIN) "WEIDAR" 1.26

A027934100 DECOFEN TABLETS "VPP" 0.80

A027936100 BENAMINE CAPSULES 50MG "VPP" 0.45

A027939221 BEESIX INJECTION 100MG/ML (PYRIDOXINE HCL) "VPP" 0.00

A027946100 METHASONE TABLETS 0.25MG (DEXAMETHASONE) "VPP 0.59

A027948212 VANCONIN INJECTION 5MG/ML (DIAZEPAM) "VPP" 10.90

A027956209 CECONINE FOR INJECTION 1G (CEPHALORIDINE) "VPP" 33.50

A027957277 CECONINE FOR INJECTION 0.5G (CEPHALORIDINE) "VPP" 0.00

A028021321 AIRFUL CREAM 1MG/GM (TRETINOIN) 22.50

A028029100 DIMENHYDRINATE TABLETS 0.63

A028069100 KYOPINAL F.C. TABLETS (ALCLOFENAC) 5.80

A028080100 LEBUFEN F.C. TABLETS 200MG (FENBUFEN) "S.T." 1.28

A028098100 ACETAMOL TABLETS 500MG (ACETAMINOPHEN) "WEIDAR" 0.36

A028142100KASTEINE TABLETS 375MG (S-CARBOXYMETHYLCYSTEINE "YUNG

SHIN"1.15

A028149100 TITALAM TABLETS 0.25MG (TRIAZOLAM) 1.86

A028254329 LOSUCON CREAM 26.40

A028315500 HEMOTHOL SUPPOSITORIES 4.50

A028371100 SAFEWAY F.C. TABLETS 200MG (CIMETIDINE) "VPP" 1.00

A028380100 SULINDAC TABLETS 100MG "Y.S." 1.66

A028517100 PLOTON TABLETS 0.34

A028578329 PIRIGEN CREAM 0.5MG/MG (CLOBETASOL) 13.70

A028606138 COMPOUND GLYCYRRHIZA MIXTURE "KINGDOM" 3.78

A028606159 COMPOUND GLYCYRRHIZA MIXTURE "KINGDOM" 21.30

A028610100 PYRUDON TABLETS 500MG "T.F."(ACETAMINOPHEN) 0.20

A028642100 CRIPTINE TABLETS 2.5MG (BROMOCRIPTINE) 4.25

A028803100 YIAUKE TABLETS 100MG (MEBENDAZOLE) 0.75

A028938100 PHENOBARBITAL TABLETS 30MG "U.L." 0.68

A0289381G0 PHENOBARBITAL TABLETS 30MG "U.L."(鋁箔/膠箔) 1.50

A028942100 METHYLEPHEDRINE HCL TABLETS 25MG "U.L." 0.42

A0289421G0 METHYLEPHEDRINE HCL TABLETS 25MG "U.L."(鋁箔/膠箔) 1.50

A028943100 L.A. TABLET "U.L." 0.69

A028952343 ULEX LOTION 10%(CROTAMITON) 29.70

A028957100 DETICON TABLETS 25MG "S.T." (CHLOPHENDIANOL) 0.64

A028976100 NEO-FLU CAPSULES 1.00

Page 24: 附件二 藥品給付品項暨支付標準表

A028982110ERYMYCIN (ERYTHROMYCIN ESTOLATE) FOR ORAL SUSPENSION

"VPP"48.00

A029036100 AMANTADINE CAPSULES 100MG (AMANTADINE)"GENTLE" 2.54

A029210100 TRIDIGESTS TABLETS "T.F." 0.57

A029216100 VITABUTYRIMIN TABLETS "T.F." 0.30

A029217329 ANTIFUNGUO CREAM 10GM 18.20

A029217338 ANTIFUNGUO CREAM 20GM 32.60

A029226100 FUCOLE COLD CAPSULES 0.24

A029249100 U-PIRIDE TABLETS 200MG (SULPIRIDE) 1.30

A029250100 U-PIRIDE TABLETS 50MG (SULPIRIDE) 1.08

A0292501G0 U-PIRIDE TABLETS 50MG (SULPIRIDE) (鋁箔、膠箔) 1.50

A029253100 SOURIREE COM-COLD CO. CAPSULES 0.00

A029278216 CIDIX INJECTION "N.K." 0.00

A029286329 BIODYNE OINTMENT (POVIDONE IODINE) 20.20

A029292209 ULOTHIN NEUTRAL INJECTION 1.0GM (CEPHALOTHIN) 0.00

A029298338 LEEZE CREAM 50MG/G (BENZOYL PEROXIDE) "ROYAL" 60.00

A029325100 ESULIN TABLETS 100MG TOLAZAMIDE "C.M." 2.58

A029351209 URAZONE INJECTION 1GM (CEFOPERAZONE) 0.00

A029354319 CLOBESOL CREAM 0.5MG "GENTLE" (CLOBETASOL PROPIONATE) 7.30

A029354324 CLOBESOL CREAM 0.5MG "GENTLE" (CLOBETASOL PROPIONATE) 12.80

A029354329 CLOBESOL CREAM 0.5MG "GENTLE" (CLOBETASOL PROPIONATE) 13.70

A029473100 ASO TABLETS 500MG (SUCRALFATE) 1.06

A029484100 ALUFATE CHEWING TABLETS 1000MG "C.M." 0.00

A029506309 PERITONEAL DIALYSIS SOLUTION-A "S.T." 0.00

A029511100 MANLSUN CAPSULES 30MG (FLURAZEPAM) 2.85

A029522209 PRODIOL INJECTION "TAI YU" 8.20

A029523289 MENIMYCIN INJECTION 750MG "TAI YU" (CEFUROXIME) 0.00

A029524100 TRIZIN CAPSULES 250MG "TAI YU" (CEFATRIZINE) 0.00

A029563329 NYSUL CREAM 30MG/GM (NIFLUMIC ACID) 16.40

A029590100 CANERCON CAPSULES "T.F." 2.34

A029598155 AMANTA SOLUTION 10MG/ML "GENTLE" (AMANTADINE HCL) 0.00

A029600209 U-SAVE FOR INJECTION 1.0GM 23.10

A029623100 LACEF CAPSULES 500MG "TAI YU" (CEPHRADINE) 2.68

A029631157 PEDOLIN SYRUP "STANDARD" 19.60

A029634151 NOCOUGH SYRUP "SINPHAR" 8.20

A029634157 NOCOUGH SYRUP "SINPHAR" 19.20

A029704100 DOLCID TABLETS 400MG "SINPHAR"(PIPEMIDIC ACID) 2.99

A029722321 FLUCONIN S CREAM 0.5MG/GM "S.Y." 32.30

A029722329 FLUCONIN S CREAM 0.5MG/GM "S.Y." 44.10

A029727100 BECAME TABLETS 0.24

A029740100 A.A.C. TABLETS 1.40

A029758110 ACETIN GRANULES 66.67MG/GM "TAI YU" (ACETYLCYSTEINE) 1.58

A029758116 ACETIN GRANULES 66.67MG/GM "TAI YU" (ACETYLCYSTEINE) 1.63

A029828100 KASCOAL TABLETS 40MG (DIMETHYLPOLYSILOXANE) 0.35

A029847157 ANSOUHAU SYRUP "H.S." 31.60

A029853100 KANMAU CAPSULES "HS" 0.89

A029863100 SHIKENUOH TABLETS 500MG "HS" 0.28

A029881100 PROPRANOLOL TABLETS 40MG "YUNG SHIN" 0.87

Page 25: 附件二 藥品給付品項暨支付標準表

A029889212 CEDOL FOR INJECTION 500MG (CEFAMANDOLE NAFATE) 0.00

A029903329 INDECIN CREAM (INDOMETHACIN) 14.90

A029906100 FUCOLE NOSPAN TABLETS 15MG 0.47

A029917100 KASCOAL TABLETS 50MG (DIMETHYLPOLYSILOXANE) 0.39

A029949324 AKANA CREAM (BENZOYL PEROXIDE) 28.00

A029951100 DOTIDONE TABLETS 10MG (DOMPERIDONE)"CBC" 0.86

A0299511G0 DOTIDONE TABLETS 10MG (DOMPERIDONE)"CBC" 1.50

A029988100 LICODYNE TABLETS 375MG "Y.K."(CARBOCISTEINE) 1.14

A030270335 ACNE TREATMENT CREAM 88.00

A030281209 KOFATOL INJECTION 1.0GM (CEPHAZOLIN) 15.60

A030281277 KOFATOL INJECTION 0.5GM (CEPHAZOLIN) 11.40

A030384100 MELON TABLETS 50MG (MEPIRIZOLE) "H.S.C." 1.13

A030385100 SULPIRIDE TABLETS 1.30

A030453100 CHILDRENS ACETA 80 CHEWABLE TABLETS 0.24

A030456100 DIHYDROCHLOROTHIAZIDE TABLETS "ORIENTAL" 0.65

A030512100 DIAMICRON (GLICLAZIDE) TABLETS 80MG 1.02

A030531343 FOOTCON OINTMENT "STANDARD" 16.30

A0305561G0YUNGBENRONE TABLET "YUNG SINE"(BENZBROMARONE) (鋁箔膠箔)

1.50

A030563100 OROMIN CAPSULES 0.85

A030590100 BEZALITE TABLETS 200MG (BEZAFIBRATE) 2.85

A030601100 PACOMIN TABLETS 20MG "PATRON" (OXELADIN) 0.59

A030624343 SALICYLIC ACID AND BENZOIC ACID OINTMENT 0.00

A030748329 FUDGEN CREAM "H.S." 32.00

A030783338 MANNIN CREAM 0.5MG/G (CLOBETASOL) "SHITEH" 41.90

A030801212 CHLORAMPHENICOL INJECTION "Y.Y" 9.40

A030811100 AMOXICILLIN CAPSULES 500MG "TAI YU" 1.23

A030816100 CEPHALEXIN CAPSULES 500MG "TAI YU" 1.75

A030836157 MUCO SYRUP 20MG/ML (CARBOCISTEINE) "PATRON" 20.50

A030862157 COUGH MIXTURE 23.00

A030871100 ASKACEF (CEPHRADINE) CAPSULES 500MG "VPP" 2.68

A030873100 FLUTAFIN CAPSULE 200MG (ACEFYLOYSTEINE) 2.18

A030874100 ASKACEF (CEPHRADINE) CAPSULES 250MG "VPP" 1.59

A030895100 ACTIN TABLETS 0.98

A030897209 CEFIN INJECTION 1GM (CEPHRADINE) "TAI YU" 23.10

A0309131AHAUSTIN POWDER (C GLUCOSE)523.1MG (PSYLLIUM HUSK)

"GENTLE"4.51

A030944338 SULON SOLUTION (INDOMENTHACIN) 49.40

A030954100 HOKURAMIDE CAP. (COBAMAMIDE) "P.J." 1.00

A030963100 EPILEPTIN (PHENYTOIN) CAPSULES 100MG "VPP" 0.69

A031011157 COLIN SOLUTION 21.50

A031017329 PHISODERM ANTI-ACNE GEL 10% 40.10

A031032100 CARDINOL TAB. 100MG (METOPROLOL) "KINGDOM" 0.00

A031043212 CIMEFINE INJECTION 150MG/ML (CIMETIDINE) 11.10

A031055100 COSTINE TAB LETS 10MG (DOMPERIDONE) "K.N." 0.00

A031088100 SINUDIN TABLETS 1.00

A031094209 UROXIME INJECTION"UNION"(CEFUROXIME) 0.00

A031094210 UROXIME INJECTION (CEFUROXIME) "UNION" 0.00

Page 26: 附件二 藥品給付品項暨支付標準表

A031094265 UROXIME INJ. 250MG. (CEFUROXIME) "UNION" 21.10

A031094277 UROXIME INJ. 500MG. (CEFUROXIME) "UNION" 0.00

A031094289 UROXIME INJ. 750MG. (CEFUROXIME) "UNION" 21.10

A031100100 U-RITIS TABLETS 500MG (NAPROXEN) 2.41

A031110100RIKAPARIN CAPSULES 500MG (TRANEXAMIC ACID) "TAIWAN TUNG

YANG"3.72

A031174100 SULPYRONE TABLETS 100MG (SULPIRIDE) "EAYUNG" 1.23

A031179100 HYDROCHLOROTHIAZIDE TABLETS 25MG "JEN SHENG" 0.65

A031180100 PROCHLORPERAZINE MALEATE TABLETS 8MG "JEN SHENG" 0.69

A031183100 CHINSALO TABLETS 200MG (BEZAFIBRATE) "EAYUNG" 0.00

A031187100 SUMIN TABLETS 2MG (DEXCHLORPHENIRAMINE) "CHINTENG" 0.27

A031188329 VOREN EMULGEL (DICLOFENAC) 14.30

A031188338 VOREN EMULGEL (DICLOFENAC) 22.80

A031224100 KETOTIFEN CAPSULES "EAYUNG" 1.04

A031238100 MEBEN CAPSULES 300MG "Y.S." (FENBUFEN) 2.04

A031274212 UNISONE INJECTION 4MG/ML (DEXAMETHASONE) "UNION" 15.70

A031274229 UNISONE INJECTION 4MG/ML (DEXAMETHASONE) "UNION" 16.80

A031276100 TECYTEINE CAPSULES 375MG (CARBOCYSTEINE) "R.T." 1.14

A031291100 KONATON TABLETS 500MG (ACETAMINOPHEN) "KOJAR" 0.25

A031323100 SOLANTIN F.C. TABLETS (DIPYRIDAMOLE) 1.38

A031325324 SLIKA B CREAM (ISOCONAZOLE) "MEIDER" 31.40

A031356129 CONTRACID SUSPENSION 20MG/ML (CIMETIDINE) 0.00

A0314891G0 ANKUMIN TABLETS 6MG (BETAHISTINE) "R.T."(鋁箔) 1.50

A031501100 COLFERIN CAPSULES "CHINTENG" 0.50

A031519151 BECANDINE SOLUTION "R.T." 10.30

A031651417 SCORO ORABASE 21.20

A031673100 SOURIREE COM-TRIMETON TABLETS 4MG 0.16

A031680100 VOMISEDA TABLETS 25MG"SOURIREE" 0.22

A031728100 GASTRODIN TABLETS 400MG (CIMETIDINE) "U-LIANG" 1.00

A031737151 SANCOUGH-CO SYRUP 0.00

A031737157 SANCOUGH-CO SYRUP 0.00

A031800100 ALGITAB CHEWABLE TABLETS 3.29

A031831100 ULECIN CAPSULES 150MG (CLINDAMYCIN) "UNION" 1.26

A031833100 TRANXAMIDE CAPSULES "H.S." 3.72

A031837100 PORO TABLETS 80MG (ACETAMINOPHEN) 0.24

A031846212 ULECIN INJECTION 150MG/ML (CLINDAMYCIN) "UNION" 15.00

A031908255 FLUGEN INJECTION 5MG (TINIDAZOLE) "SIU GUAN" 0.00

A031922338 INDOCIN CREAM 10MG/GM (INDOMETHACIN) "S.Y." 28.20

A031932100 DIAMINE CAPSULES 25MG" SOURIREE"(DIPHENHYDRAMINE HCL)

0.39

A031933100 SOURIREE COMCEB CAPSULES 1MG (CYANOCOBALAMIN) 0.50

A0319331G0 SOURIREE COMCEB CAPSULES 1MG (CYANOCOBALAMIN)(鋁箔) 1.50

A031978329 TRINAZOLE CREAM "YUNG CHI" 0.00

A031983265 DITROSE INJECTION 5% (DEXTROSE) "S.Y." 17.80

A031983277 DITROSE INJECTION 5% (DEXTROSE) "S.Y." 19.10

A032001100 COSIN TABLETS 20MG "KOJAR" (NOSCAPINE) 0.83

A0320011G0 COSIN TABLETS 20MG "KOJAR" (NOSCAPINE)(鋁箔/膠箔) 1.08

A032006321 COBESONE CREAM 0.5MG/G (CLOBETASOL) "P.J." 11.90

Page 27: 附件二 藥品給付品項暨支付標準表

A032006324 COBESONE CREAM 0.5MG/GM "P.J" 12.80

A032006329 COBESONE CREAM 0.5MG/G (CLOBETASOL) "P.J." 13.70

A032018100 TRANLO TABLETS 15MG"D.T.S" 1.00

A032027338 TORICAM GEL 5MG/G (PIROXICAM) 31.70

A032045100 ASPIRIN E.F.C.TABLETS 650MG "KOJAR" 0.80

A032113100 TOSUMIN TABLETS "WEIDAR" 0.75

A032124100 C.A.P. CAPSULES 0.75

A032125209 PIXTIM INJECTION 20MG/ML (PIROXICAM) "UNION" 15.20

A032125212 PIXTIM INJECTION 20MG/ML (PIROXICAM) "UNION" 15.50

A032162100 SOURIREE COMTON TABLETS 0.00

A032173329 TRIECO CREAM "SHITEH" 18.20

A032173338 TRIECO CREAM "SHITEH" 26.80

A032175329 INDO CREAM 10MG/GM (INDOMETHACIN) "H.S." 14.90

A032175340 INDO CREAM 10MG/GM (INDOMETHACIN) "H.S." 50.00

A032208121 EQUSIL GRANULES 20MG/GM (ACETYLCYSTEINE) "LITA" 1.58

A032223151ACETAMINOPHEN LIQUID 12MG/ML (ACETAMINOPHEN) "STANDARD"

10.30

A032250100 SUPERTIDINE S.C. TABLETS 20MG (FAMOTIDINE) "VPP" 1.16

A032261100 LOPER CAPSULES 2MG (LOPERAMIDE) "H.S." 0.64

A032267500 CLOTRIMAZOLE VAG. TAB. (CLOTRIMAZOLE) "PANBIOTIC" 0.00

A032277100 PEESU TABLETS "KOJAR" 0.98

A032287100 SENIDOL TAB. 25MG (DIPHENIDOL) "PANBIOTIC" 0.00

A032295100 CEFADIN CAP 500MG (CEPHRADINE) "STANDARD" 2.68

A032319321 GENTADERM CREAM 14.60

A032320100 ACETAL TABLET 500MG (ACETAMINOPHEN) "PURZER" 0.39

A032323114 ACTEIN GRANULES 40MG/GM 1.58

A032323121 ACTEIN GRANULES 40MG/GM 1.63

A032325321 METHACIN GEL 10 MG/G "PURZER" (INDOMETHACIN) 11.80

A032325325 METHACIN GEL 10 MG/G "PURZER" (INDOMETHACIN) 14.70

A032325329 METHACIN GEL 10 MG/G "PURZER" (INDOMETHACIN) 14.90

A032325335 METHACIN GEL 10 MG/G "PURZER" (INDOMETHACIN) 27.30

A032325338 METHACIN GEL 10 MG/G "PURZER" (INDOMETHACIN) 28.20

A032333100 COLDOL CAPSULE 0.89

A032376329 NISOLON GEL 50MG/G (ETOFENAMATE) 0.00

A032419329 SINBETA DERM CREAM 13.50

A032469100 LONGIAN TABLETS 25MG (BUCLIZINE) 0.45

A032492100 TOMIN TABLETS 2MG (DEXCHLORPHENIRAMINE) "KOJAR" 0.30

A032496100 ALDIN F.C. TABLETS 250MG (METHYLDOPA) "KOJAR" 0.00

A032514421 TOBEYESON OPHTHALMIC SOLUTION 28.40

A032562319 CLEOSOL CREAM 0.5MG/GM (CLOBETASOL) "GCPC" 7.30

A032573100 MERANOM S.C. TABLETS 25MG (DIPHENIDOL) "P.J." 0.91

A032583100 ANTICOLD CAPSULES "KOJAR" 0.89

A032624212 EUDAMYCIN INJECTION 150MG/ML (CLINDAMYCIN) "U-LIANG" 0.00

A032625157 COSILY LIQUID 650MG/ML (LACTULOSE) "MEIDER" 43.50

A032634338 TONDONAC GEL 10MG/GM (DICLOFENAC SODIUM) 22.80

A032705221 DOPAMIN INJECTION 10MG/ML (DOPAMINE) "VPP" 18.70

A0327161G0DOMPERAN TABLETS 10MG (DOMPERIDONE) "SWISS"(30粒/瓶)(60

粒/瓶)1.50

Page 28: 附件二 藥品給付品項暨支付標準表

A032722177 YIAUKE GRANULES 100MG/GM (MEBENDAZOLE) "T.F." 63.00

A032724100 JEFRON S.C. TABLETS 25MG "KYORIN" (DIPHENIDOL) 0.91

A032760114 ACETYLEINE GRANULES 40MG/GM "H.S." (ACETYLCYSTEINE) 1.58

A032760155 ACETYLEINE GRANULES 40MG/GM "H.S." (ACETYLCYSTEINE) 96.00

A032761100 MINOCYCLINE CAPSULE 100MG "PANBIOTIC" 5.20

A032774100 SUWEL TABLETS 500MG (SUCRALFATE) 1.06

A032792229 DOPAMIN (DOPAMINE) INJECTION 20MG/ML "VPP" 18.70

A032803100 SLEEPING-DEPOT 0.25MG (TRIAZOLAM) "JINUP" 0.00

A032809500 NOTAREN SUPPOSITORIED 25MG (DICLOFENAC) "PATRON" 2.63

A032848324 DERMOSOL CREAM 0.5MG/G (CLOBETASOL) "PATRON" 12.80

A032849100 MEZAIN TABLET 5MG (OXETHAZAINE) "STANDARD" 0.29

A032885500 VAZOLE VAGINAL TABLETS 250MG (METRONIDAZOLE)"H.S." 1.96

A032886100 UPDOPA TABLETS 2.5MG (BROMOCRIPTINE) "JINUP" 0.00

A032891100 AMOXICILLIN CAPSULES 500MG "T.F." 1.23

A032898330 GOODLUCK CREAM 0.5MG/GM (CLOBETASONE) 41.30

A032927100 NOSCAPINE TABLETS 20MG "ROOT" 0.80

A032933100 ASIR TABLETS 20MG (TIPEPIDINE) "YU SHENG" 0.66

A032937500 DICLOFEN SUPPOSITORY 25MG (DICLOFENAC) "H.S." 2.63

A032946100 MINCON CAPSULES "ROOT" 0.84

A0329691G0 DEANTRAN TABLETS 1MG "R.T."(鋁箔) 1.50

A033073100 CASEMYCIN CAPSULES 500MG (CEPHALEXIN) "T.F." 0.00

A033093209 METACIN FOR INJECTION (CEFMETAZOLE) 0.00

A0330981G0 CIKETIN TABLETS 400MG (CIMETIDINE) "UNION"(鋁箔/膠箔) 1.50

A033126100 FUROL CAPSULES 10MG (BROMOPRIDE) "KOJAR" 1.10

A033153343BIOFUR ACNE LOTION 50MG/GM "SINPHAR"(SULFUR

PRECIPITATED)16.50

A033166100 BROMPHENIRAMINE MALEATE TABLETS "Y.C." 0.23

A033191100 PARKER TABLETS 8MG (BROMHEXINE HCL)"Y.C." 0.23

A033195100 MECLIZINE HCL TABLETS 25MG "Y.C." 0.22

A033207100 PIANT TABLETS 500MG(ACETAMINOPHEN)"ROOT" 0.19

A033214100 UMINON CAPSULES 100MG (MINOCYCLINE) "UNION" 5.20

A033260229 TRANEXAMIC ACID INJECTION 100MG/ML "ASTAR" 31.50

A033261229 PROGESTERONE INJECTION 50MG/ML "ASTAR" 30.30

A033268100 E-LICON CAPSULES 1.62

A033270100 KOPIN TABLETS 0.91

A033274100 ANCOUGH CAPSULES 3.75

A033282338 LIFULIN OINTMENT "M.T." 111.00

A033388100 EUGEN TABLETS "YU SHENG" 0.98

A033389100 DEGISON CAPSULES 25MG "KOJAR" (DANTROLENE) 0.00

A033391100ANCOU TABLETS 15MG"KOJAR"(DEXTROMETHORPHAN HYDROBROMIDE)

0.37

A033392100 SILYCON CAPSULES 150MG (SILYMARIN)"EAYUNG" 0.00

A033447338 PIROCAN 0.5% GEL "S.Y." 0.00

A033480100CLINCIN CAPSULES 150MG (CLINDAMYCIN)"TAIWAN TUNG YANG"

1.26

A033489100COFEDENIN TABELTS 22.14MG (TIPEPIDINE HIBENZATE) "C.J."

0.70

A033497100 COLD CAPSULES "SINPHAR" 0.45

Page 29: 附件二 藥品給付品項暨支付標準表

A033506100 OXELADINE TABLETS 20MG "SINPHAR" 0.40

A033532100 ANPIRIN TABLETS "SINPHAR" 0.45

A033578338CLOMOLD OINTMENT 0.5MG/GM (CLOBETASOL PROPIONATE) "T.F."

41.90

A033588100 URIBRONE TABELETS 50MG "W.P." 1.00

A033593211 TRANEXAMIC ACID INJECTION 50MG/ML "T.F." 4.55

A033676100 MULAX TABLETS 10MG (BACLOFEN) "TAIWAN TUNG YANG" 1.00

A033677335 FORMAX GEL 10MG/GM (DICLOFENAC SODIUM) "SHITEH" 14.30

A033677338 FORMAX GEL 10MG/GM (DICLOFENAC SODIUM) "SHITEH" 22.80

A033677343 FORMAX GEL "SHITEH" 10MG/GM(DICLOFENAC SODIUM) 27.90

A033773209 TUNNACORT INJECTION 40MG/ML"T.F" 20.70

A033854100 NOSCAPINE HYDROCHLORIDE TABLETS "T.F." 0.73

A0338721G0 CIKETIN TABLETS 200MG (CIMETIDINE) "UNION"(鋁箔/膠箔) 1.50

A033890100LIGAT TABLETS 100MG (URSODEOXYCHOLIC ACID) "TAIWAN TUNG

YANG"1.75

A0339001G0SINLIHAUL TABLETS 40MG (PROPRANOLOL) "H.S."(鋁箔/膠箔)

1.50

A0339011G0POTAN TABLETS 500MG "H.S." (MEFENAMIC ACID) (鋁箔/膠箔)

1.50

A033902100 BIESCON CAPSULES 0.89

A033922277 LACT-RINGER INJECTION "S.Y." 0.00

A033930330 EUNEN CREAM 0.05%(CLOBETASONE) 41.30

A033990100 GASAFE F.C. TABLETS 20MG (FAMOTIDINE) 1.16

A034002100 COUSEL TABLETS 20MG "KOJAR"(TIPEPIDINE HIBENZATE) 0.72

A034017100 CABOTIN TABLETS 375MG (CARBOCYSTEINE) "KOJAR" 1.15

A034059100 CIMEFINE F.C. TABLETS 400MG (CIMETIDINE) 1.00

A0340591G0 CIMEFINE F.C. TABLETS 400MG (CIMETIDINE)(鋁箔/膠箔) 1.50

A034071421 TOBRAMYCIN OPHTHALMIC SOLUTION 3MG/ML "WU-FU" 32.40

A034072100 CIMEFINE F.C. TABLETS 200MG (CIMETIDINE) 1.00

A034098100 SOTOCON TABLETS 20MG "CHINTENG"(DEXTROMETHORPHAN) 0.52

A0340981G0SOTOCON TABLETS 20MG "CHINTENG"(DEXTROMETHORPHAN)(鋁箔/

膠箔)0.88

A034111100 BETAHISTANE TABLETS 6MG (BETAHISTINE) "EAYUNG" 0.92

A034119100 POULI CAPSULES "CHINTENG" 0.86

A034127329 ACZO GEL 50MG/GM (BENZOYL PEROXIDE) "SINPHAR" 28.00

A034129212 LINCOMYCIN 300MG/ML INJECTION "S.Y." 11.40

A034129238 LINCOMYCIN 300MG/ML INJECTION "S.Y." 39.20

A034146329 PIROXIM GEL 0.5% (PIROXICAM) "STANDARD" 14.90

A034151100 VILLFULL TABLETS 5MG (NORETHINDRONE) 1.26

A034159338 TEIRIA GEL 50MG/GM(ETOFENAMATE) 44.90

A034159345 TEIRIA GEL 50MG/GM(ETOFENAMATE) 52.00

A034172277 KELIN FOR INJECTION (CEFAZOLIN) "TAI YU" 11.40

A034174335 NISOLON GEL 100MG/G (ETOFENAMATE) 0.00

A034222157 MAC SAFE ORAL SUSPENSION 20MG/ML (IBUPROFEN) 40.60

A034224312 DEVIRO CREAM 50MG/GM "HEALTH" 17.30

A034224321 DEVIRO CREAM 50MG/GM "HEALTH" 36.90

A034255356 EVAC ENEMA 35.80

A034272100 SEMPER TABLETS 25MG 0.00

Page 30: 附件二 藥品給付品項暨支付標準表

A0342831G0 URENIDE TABLETS 1MG (BUMETANIDE) "ROOT"(鋁箔/膠箔) 1.50

A034285100 VILI TABLETS "S.D." 0.71

A034288209 CEPIN FOR INJECTION 23.10

A034301209U-DOLAN DECANOATE INJ. 50MG/ML (HALOPERIDOL) "U-LIANG"

130.00

A034304100 PERIDON TABLETS 10MG (DOMPERIDONE) "EAYUNG" 0.86

A034307336 VIVICOME CREAM “S.D” 22.40

A034312100 ISOSORBIDE TABLETS 40MG "TWI" 3.12

A034329212 UFIN FOR IV INJECTION "UNION"(CEFTRIAXONE) 353.00

A034329265 UFIN FOR IV INJECTION (CEFTRIAXONE) "UNION" 0.00

A034372329 FUCON 0.05% CREAM (CLOBETASOL PROPIONATE) "Y.Y." 13.70

A034503429 ARTIFICIAL TEAR "WU-FU" 23.30

A034508338 CLOPAIN GEL 10MG/GM (DICLOFENAC SODIUM) "B & F" 22.50

A034523100 AMOXICILLIN 500MG CAPSULES "PANBIOTIC" 1.23

A0345231G0 AMOXICILLIN 500MG CAPSULES "PANBIOTIC"鋁箔/膠箔 1.50

A034524100 BACLOFEN 10MG "S.Y." 1.00

A034528100 ERY-B E.C. CAPSULES 250MG (ERYTHROMYCIN) "KINGDOM" 1.43

A034531321 SUGENFU CREAM 10MG/GM (BIFONAZOLE) 15.40

A034535100 SUPELI CAPSULES "KOJAR" 0.78

A0345501G0GLUPIZIDE TABLETS 5MG "MACRO"(GLIPIZIDE) (鋁箔/膠箔)

1.50

A034558100 BROSOU TABLETS 20MG (TIPEPIDINE) "CHINTENG" 0.72

A034573329 SALOSON 1% EMUGEL (DICLOFENAC) "MEY SEE" 0.00

A034573343 SALOSON 1% EMUGEL (DICLOFENAC) "MEY SEE" 27.90

A034577212 AMIKACIN INJECTION 125MG/ML "S.Y." 28.70

A034577229 AMIKACIN INJECTION 125MG/ML "S.Y." 86.00

A0345841G0EASYING FILM COATED TABLETS 25MG (DIPYRIDAMOLE)

"ROOT"(鋁箔)1.50

A034614209 KELIN FOR INJECTION "TAI YU" (CEFAZOLIN) 15.60

A034614212 KELIN FOR INJECTION "TAI YU" (CEFAZOLIN) 0.00

A034614221 KELIN FOR INJECTION "TAI YU" (CEFAZOLIN) 131.00

A034618343 UNDACID OINTMENT "VPP" 15.50

A034632100 DANAL 200MG CAPSULES (DANAZOLE) "ROYAL" 9.70

A034636100 BROMHEXIN 8MG TABLETS "EVEREST" 0.23

A034654155 LOSOLVAN 3MG/ML SOLUTION (AMBROXOL) 25.00

A034660329 SPORTON GEL 100MG/GM (ETOFENAMATE) "C.T." 28.70

A034660338 SPORTON GEL 100MG/GM (ETOFENAMATE) "C.T." 31.70

A034721100 SUFUCON TABLETS 500MG (ACETAMINOPHEN) "ORIENTAL" 0.20

A034723100 FUSTHMA TABLETS 1MG "J.M" (KETOTIFEN) 1.04

A034802100 KING-P CAPSULES "H.S." 0.78

A034819100 ANLITON TABLETS 500MG (ACETAMINOPHEN) "EVEREST" 0.30

A034825157 LOPERAMIDE SYRUP 0.2MG/ML "ORIENTAL" 0.00

A034827100 CAFEMINE TABLETS "M.T." 0.71

A034869329 FULIN CREAM 30MG/GM (NIFLUMIC ACID)"GCPC" 16.40

A034889100 MOGADON TABLETS 5MG (NITRAZEPAM) 1.50

A034909100 AMCLO CAPSULES "UNION" 1.88

A034940100PROPHYLAXIN TABLETS 30MG (PYRIDOSTIGMINE BROMIDE) "VPP"

0.00

Page 31: 附件二 藥品給付品項暨支付標準表

A0349441G0 LISEIPIN F.C. TABLETS "ROOT"(鋁箔) 1.50

A034950100 SHITAN TABLETS 8MG (BROMHEXINE) "KOJAR" 0.26

A034968100 SEROLIN CAPSULES 10MG (OXAZOLAM)"W.P." 0.94

A035035317 VIRUN CREAM 50MG/GM (ACYCLOVIR) "H.S." 17.30

A035037329 DICLOFEN GEL 1% (DICLOFENAC) "H.S." 14.30

A035037335 DICLOFEN GEL 1% (DICLOFENAC) "H.S." 14.30

A035037340 DICLOFEN GEL 1% (DICLOFENAC) "H.S." 27.90

A035045100 NOCA TABLETS 15MG (NOSCAPINE) "H.S." 0.69

A035046151 CODERINE SYRUP "C.P." 23.50

A035049277 UFO POWDER FOR INJ. 500MG. (FOSFOMYCIN) 67.00

A035051500 DOMPE SUPPOSITORIES 10MG (DOMPERIDONE) "H.S." 3.37

A035072329 INOTON CREAM 1% (INDOMETHACIN) "WEIDAR" 14.90

A035145100 LOPERAMIDE CAPSULES 2MG "J.A." 0.00

A035149100 YUCHITONMIN CAPSULES "J.A." 0.77

A035150100 SABOLI CAPSULES "J.A." 0.00

A035151100 TINIZIN TABLETS 500MG "J.A." (TINIDAZOLE) 2.06

A035152100 YUCHITONMIN TABLETS "J.A." 1.07

A035153100 TRAVE LAC TABLETS "J.A." 0.57

A035154100 EULON CAPSULES 100MG (TOCOPHEROL NICOTINATE) "J.A." 0.94

A035155100 URITEC CAPSULES 250MG (PIPEMIDIC ACID) "J.A." 2.96

A035157100 BETA-AESCIN CAPSULES 20MG "J.A." 1.78

A035158100 DEMISOLE TABLETS 150MG "J.A."(LEVAMISOLE) 4.68

A035161100 PROPHYRIN S.C. TABLETS 200MG (PROTOPORPHYRIN) "J.A." 0.00

A035164100 LONGIMIN TABLETS 50MG "J.A." (BUCLIZINE) 0.72

A035165100 TRIRAZINE CAPSULES 2MG (TRIFLUOPERAZINE) "J.A." 1.03

A035176100 LYSOZYME TABLETS 30MG "J.A." 0.92

A0351771G0ROTILIUM 10MG F.C. TABLETS (DOMPERIDONE) "ROYAL"(鋁箔/膠

箔)1.50

A035188321 EULIGAN CREAM 0.05% "Y.Y." (CLOBETASONE) 20.60

A035188329 EULIGAN CREAM 0.05% "Y.Y." (CLOBETASONE) 37.60

A035188335 EULIGAN CREAM 0.05% (CLOBETASONE) "Y.Y." 61.00

A035211100MEBERINE F.C.TABLET 135MG "T.T.Y" (MEBEVERINE

HYDROCHLORIDE)1.58

A035212100 SIMETHICONE TABLETS 40MG "KOJAR" 0.18

A035235100 SEROL TABLETS 20MG (OXAZOLAM) "KOJAR" 1.64

A035254100 TANTELL TABLETS 5MG (GLIBENCLAMIDE) "EVEREST" 0.99

A035281100 PROXEN TABLETS "S.D." (NAPROXEN) 2.41

A035287336 AYFUCO CREAM "ROOT" 22.40

A035293338 TEIMEI CREAM 10MG/GM "U CHU" (CENTELLA ASIATICA) 72.00

A035324100 METFORMIN TABLETS 500MG "EAYUNG" 1.00

A0353241G0 METFORMIN TABLETS 500MG "EAYUNG"(鋁箔/膠箔) 1.50

A035397338 DICLOREN EMULGEL 1% (DICLOFENAC SODIUM) "WEIDAR" 22.80

A035414100 DIARONZIDE TABLETS 80MG (GLICLAZIDE) "CHEN TA" 1.02

A0354141G0DIARONZIDE TABLETS 80MG (GLICLAZIDE) "CHEN TA"(鋁箔/膠

箔)1.50

A035418100 LISSES CAPSULES "YY" 0.86

A035423151 PANATOL SOLUTION 24MG/ML "PANBIOTIC" (ACETAMINOPHEN) 15.40

A035423157 PANATOL SOLUTION 24MG/ML "PANBIOTIC" (ACETAMINOPHEN) 17.10

Page 32: 附件二 藥品給付品項暨支付標準表

A035436100 PIERCOL TABLETS 250MG (PIPEMIDIC ACID) 2.96

A035440329 INDOL GEL 10MG/GM "SINPHAR"(INDOMETHACIN) 14.80

A035451330 WAZOLE CREAM 10MG/G (ISOCONAZOLE) "W.P." 42.30

A035452100 LOPERAMIDE CAPSULES 2MG "JENSHENG" 0.76

A035463100 DECO TABLETS 20MG (DEXTROMETHORPHAN) "S.D." 0.52

A035473209ORIZONE POWDER FOR INJECTION (CEFOPERAZONE) "ORIENTAL"

0.00

A035476500 VORTAGEN SUPPS. 12.5MG (DICLOFENAC) "EVEREST" 1.71

A035487321 KETOZOL CREAM 2% "WEIDAR" (KETOCONAZOLE). 11.90

A035500209 NEOBA INJECTION 0.5MG/ML (MECOBALAMINE) "S.Y." 7.90

A035519100 LACEF CAPSULES 250MG (CEPHRADINE) "TAI YU" 1.59

A035546429SINDECON NASAL SPRAY 0.5MG/ML "STANDARD" (OXYMETAZOLINE)

49.10

A035676338 PAINSTOP GEL 1% "SWISS"(DICLOFENAC) 22.80

A035804221FETODRIN INJECTION 10MG/ML (RITODRINE

HYDROCHLORDE)"T.T.Y."40.90

A035837212 FAMODINE INJECTION 10MG/ML (FAMOTIDINE)"S.Y." 22.20

A035837219 FAMODINE INJECTION 10MG/ML "S.Y." (FAMOTIDINE) 0.00

A035870335 ISOGEN CREAM 10MG/G "PURZER" (ISOCONAZOLE) 42.30

A0358703AH ISOGEN CREAM 10MG/G "PURZER" (ISOCONAZOLE) 18.50

A035883329 HYDROCORTISONE CREAM 10MG/GM "SINPHAR" 15.00

A035913100 ANLICIDE TABLETS 500MG "ASTAR" (NALIDIXIC ACID) 2.22

A035931212 AMIKACIN 250MG/ML INJECTION "S.Y." 34.60

A035931229 AMIKACIN 250MG/ML INJECTION "S.Y." 0.00

A035957100KINGDACIN CAPSULE 300MG (CLINDAMYCIN HYDROCHLORIDE)

"CHI SHENG"2.13

A035966100 PARKINIDYL TABLETS 5MG (TRIHEXYPHENIDYL) 1.00

A035967100 PARKINIDYL TABLETS 2MG (TRIHEXYPHENIDYL) 0.80

A035968321 QUARDISONE CREAM 14.80

A035969100 MINOCYCLINE HYDROCHLORIDE 100MG CAPSULE "YY" 5.20

A036041109 SUCA GRANULES FOR SUSPENSION 1GM/1.02GM(SUCRALFATE) 5.00

A036075100 WEISU CAPSULES 0.78

A036088221 PENTOXILLINE INJECTION 20MG/ML "S.Y." 31.50

A036091100 TAILIWELL TABLETS 200MG (CIMETIDINE) "JENSHENG" 1.00

A036094157 GUAPHEN SYRUP 20MG/ML (GUAIFENESIN) "CENTER" 16.60

A036094163 GUAPHEN SYRUP 20MG/ML (GUAIFENESIN) "CENTER" 24.80

A036131100 ILACEN CAPSULE (DIFLUNISAL) 0.00

A036159109 TIPIDINE POWDERS (TIPEPIDINE) 3.05

A036161209 ORICEF INJECTION "ORIENTAL" (CEFAZOLIN) 15.60

A036167212 TRAMADOL INJECTION 50MG/ML "S.Y" 22.70

A036182151 IBUPROFEN ORAL SUSPENSION 20MG/ML "TWI" 25.00

A036184100 PICKTON TABLET 0.00

A036193100 CEPHALEXIN CAPSULES 500MG "YY" 1.75

A036207338 FLUSAN OINTMENT "T.F." 72.00

A036243100GINLOBA FILM COATED TABLETS 9.6MG (GINKGO

FLAVONGLYCOSIDE) "UNION"1.64

A036268100 DEXFERIN TABLETS 2MG (DEXCHLORPHENIRAMINE) "JOHNSON" 0.30

A036284212 GENTAMYCIN INJECTION 140MG/ML "S.Y." 15.00

Page 33: 附件二 藥品給付品項暨支付標準表

A036284229 GENTAMYCIN INJECTION 140MG/ML"S.Y." 57.00

A036349100 UFORMIN TABLETS 500MG 1.00

A036374100 EULIP TABLETS "W.P." (BEZAFIBRATE) 0.00

A036408326 OPPVIR CREAM 50MG/GM (ACYCLOVIR) "S.D." 42.20

A036416421 EYECALM EYE DROPS "SUN YOU" 17.30

A036423127 CHOLESTAMIN POWDER "CHI SHENG" (CHOLEXTYRAMINE RESIN) 14.00

A036440118 IBUFINE SYRO 20MG/ML (IBUPROFEN) "EAYUNG" 0.00

A036440157 IBUFINE SYRO 20MG/ML (IBUPROFEN) "EAYUNG" 0.00

A036542100 CULIUM TABLET 3MG "CURIE" (BROMAZEAM) 1.18

A036587329 VORTAGEN EMULGEL 1% (DICLOFENAC SODIUM) "EVEREST" 14.30

A036587338 VORTAGEN EMULGEL 1% (DICLOFENAC SODIUM) "EVEREST" 22.80

A036587343 VORTAGEN EMULGEL 1% 27.90

A036587396 VORTAGEN EMULGEL 1% 28.80

A036588100GINKGO F.C.TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE) "C.H."

1.64

A036591321 RIPA OINTMENT 36.40

A036591345 RIPA OINTMENT 82.00

A036599100 CADIOPIRIN TABLETS (ASPIRIN) 100MG "VPP" 0.68

A036661100 CERELINE TABLETS 5MG (NICERGOLINE) "ROYAL" 2.49

A0366621G0ISCAN F.C. TABLETS 400MG (CIMETIDINE) "S.L"(鋁箔/膠箔)

1.50

A036676100 LOPERDIN CAPSULES 2MG (LOPERAMIDE) "S.Y." 0.94

A036733100 BACOFEN TABLETS 10MG (BACLOFEN) "S.Y." 1.00

A036739321 VIRHAIL CREAM 5% (ACYCLOVIR) "H.S." 36.90

A036758100 VICAPOLE CAPSULES"H.S." 0.86

A036769100 TONMEX TABLETS 20MG (PIROXICAM) "PANBIOTIC" 1.03

A036772100 FLOCIDAL F.C. TABLETS 100MG (NORFLOXACIN) "VPP" 1.83

A036790100 EXCEL TABLETS 25MG (CAPTOPRIL)"VPP" 1.05

A036813100 MINOLINE CAPSULES 50MG (MINOCYCLINE) 3.43

A036841143 CYPRO SYRUP 0.4MG/ML (CYPROHEPTADINE) "PANBIOTIC" 8.20

A036841151 CYPRO SYRUP 0.4MG/ML"PANBIOTIC" 17.00

A036841157 CYPRO SYRUP 0.4MG/ML"PANBIOTIC" 22.80

A036844100 BETTERLOCK TABLET 100MG (METOPROLOL) "CURIE" 2.84

A036864151 ACTIN SOLUTION "CHINTENG" 10.30

A036864155 ACTIN SOLUTION "CHINTENG" 17.30

A036867329 KEPANIN GEL 1% (DICLOFENAC) "CHEN TA" 14.30

A036867338 KEPANIN GEL 1% (DICLOFENAC) "CHEN TA" 22.80

A036867343 KEPANIN GEL 1% (DICLOFENAC) "CHEN TA" 27.90

A036885221 MECOBALAMIN INJECTION 0.5MG/ML "ASTAR" 8.10

A036894329 CHIN LEIN CREAM "CHINTENG" 17.90

A036925338 VETIN GEL 10MG/GM (DICLOFENAC) 0.00

A036951100 A-CONTENT TABLETS 500MG (ACETAMINOPHEN) "H.S." 0.28

A036961100 SUMETON TABLETS 200MG (SULINDAC) "CHEN TA" 1.90

A036969314 ESTRA GEL 0.6MG/GM (ESTRADIOL) 15.00

A036984277 Y.F. NO.2 INJECTION "Y.F." 25.50

A037099100 KETOTIFEN TABLETS 1MG "ASTAR" 1.04

A037162338 DERMALIN CREAM 0.00

A037212100 PIPEMIC TABLETS 250MG "ASTAR" (PIPEMIDIC ACID) 2.96

Page 34: 附件二 藥品給付品項暨支付標準表

A037249100 ANLITO TABLETS "EVEREST" 0.62

A037286329 VICORAX CREAM 5% "WEIDAR" 42.20

A037287421 DENECIN EYE DROPS 12.00

A037287429 DENECIN EYE DROPS 0.00

A037309100 NOXACIN 100MG F.C.TABLETS (NORFLOXACIN) "KINGDOM" 1.83

A037384277 CEFOXINE FOR INJECTION (CEFOTAXIME SODIUM) "TAI YU" 62.00

A037402100 EFACO TABLETS 20MG (EPRAZINONE) "KOJAR" 0.54

A037431329 INHFUNGUS CREAM "CHEN TA" 18.20

A037431335 INHFUNGUS CREAM "CHEN TA" 22.20

A037500100 LIVERON CAPSULES (SILYMARIN) "H.S." 1.31

A037565100 TINIJING F.C.TABLETS 500MG "CHINTENG" 0.00

A037580330 CLOSONE CREAM 37.80

A037598116 ACTEIN GRANULES 66.7MG/GM (ACETYLCYSTEINE) "S.Y." 1.63

A037607321 CLOTRIMAZOLE CREAM 20MG/GM "PANBIOTIC" 23.60

A037607329 CLOTRIMAZOLE CREAM 20MG/GM "PANBIOTIC" 60.00

A037645500 ATHMACON SUPPOSITORIES "H.S." 3.48

A0376542B9 A.S.P.-L INJECTION 900MG (LYSINE ASPIRIN) "ORIENTAL" 9.90

A037661100TENSIONLEX TABLETS 100MG (ORHENADRINE CITRATE)

"PANBIOTIC"0.00

A0376913AK PIROCAM CREAM 10MG/GM 28.20

A037697100 THROUGH F.C. TABLETS "C.M."(SENNOSIDES) 0.98

A037703100 PEDOLIN F.C. TABLETS "STANDARD" 0.81

A037739329 NAZOLE CREAM 2% (KETOCONAZOLE) "S.Y." 13.10

A037739335 NAZOLE CREAM 2% "S.Y."(KETOCONAZOLE) 31.50

A037807100 ACECAINE TABLETS "P.L." 0.60

A037858277 V-CEFRA FOR INJECTION (CEPHRADINE)"VPP" 0.00

A037861100 UNIMARON TABLETS 50 MG 0.00

A037868100 TORICAM CAPSULES 20MG (PIROXICAM) 1.03

A037899100 GEFANATE CAPSULES 50MG (GEFARNATE) "ROYAL" 1.59

A037923316 MINSONE CREAM 0.5MG/GM "M.H"(CLOBETASONE) 20.60

A037923321 MINSONE CREAM 0.5MG/GM "M.H"(CLOBETASONE) 20.60

A037944100 "U CHIU" ANALGESIC CAPLETS 0.60

A037988100 GOUTIL TABLETS 50MG(BENZBROMARONE) 1.00

A0380811G0 ANSUTAN CAP.(瓶裝/84粒/瓶) 0.00

A038102100 BEZILON TABLETS 200MG (BEZAFIBRATE) 0.00

A038108212 RANIDAC INJECTION 25MG/ML (RANITIDINE) "Y.Y" 0.00

A038113421 PILOCARPINE EYE DROPS 2% "OASIS" 32.00

A038162100 BEROCOL TABLETS 5MG (TERBUTALINE SULFATE) "PANBIOTIC" 1.00

A038163116 ACETYL GRANULES 66.67MG/GM (ACETYLCYSTEINE) "CHEN TA" 1.63

A038189100 CIMEDIN F.C. TABLETS 800MG (CIMETIDINE) "S.T." 10.80

A038275116CHITAN GRANULES 66.67 MG/GM (ACETYLCYSTEINE) "CHINTENG"

1.63

A038276329 KERPHEN CREAM 1% "Y.Y." (DICLOFENAC) 0.00

A038280100 ANSOLIN TABLET 5MG (HALOPERIDOL) "GCPC" 1.30

A038281100 ANSOLIN TABLET 10MG (HALOPERIDOL) "GCPC" 0.00

A038295100 KAPOS TAB. 250MG 1.15

A038356329 SUITERIN CREAM 1% (DICLOFENAC) "EVEREST" 0.00

A038356338 SUITERIN CREAM 1% (DICLOFENAC) "EVEREST" 22.80

Page 35: 附件二 藥品給付品項暨支付標準表

A038434100 CO-RELAX TABLETS 20MG "C.M."(BENPROPERINE) 1.02

A038438338 DICLOFENAC EMULGEL 1% "S.Y." 22.80

A038445277 GLUSALINE INJECTION "ASTAR" 19.50

A038450100 ACETIN TABLETS"S.C." 1.22

A038458100LADIES PEARL S.C. TABLETS 1.25MG (CONJUGATED ESTROGENS)

"S.C."3.20

A038462100 KOMPIMIN TABLETS "S.C." 0.36

A038466100 KOBAMIN TABLETS "S.C" 0.89

A038480100 THI FEN TABLETS 300MG "Y.Y." (TRIMETHOPRIM) 1.96

A0384871G0CHIANDA TABLETS 0.15MG "CHINTENG" (CLONIDINE)(鋁箔/膠箔)

1.50

A038494100 NALODINE F.C. TABLETS 100MG (TICLOPIDINE) "ROYAL" 3.08

A038498100 METFORMIN F.C. TABLET 500MG "KINGDOM" 1.00

A0384981G0 METFORMIN F.C. TABLET 500MG "KINGDOM"(鋁箔) 1.50

A038506100 KYOMUDYNE F.C. TABLETS 250MG (CARBOCYSTEINE) 1.15

A038511321 VAGENT CREAM 10MG/GM (ISOCONAZOLE) "GCPC" 13.10

A0385113AH VAGENT CREAM 10MG/G 18.50

A038527100UNIPRO FILM-COATED TABLETS 750MG (CIPROFLOXACIN) "UNION"

0.00

A0385561G0 CIMEDIN TABLETS 400MG (CIMETIDINE) "TBC" 1.50

A038559100GINKGO S.C. TABLETS 9.6MG 'C.H.(GINKGOFLAVONGLYCOSIDE)

1.64

A038571100 KETOLIN CAP. 10MG 1.00

A038578100 I.B.F.F.C. TABLETS 400MG (IBUPROFEN) "KINGDOM" 0.98

A0385781G0 I.B.F.F.C. TABLETS 400MG "KINGDOM"(IBUPROFEN)(鋁箔) 1.50

A038618209 CLINDAMYCIN INJECTION 150MG/ML "S.Y." 0.00

A0386201G0MEDROLIN FILM COATED TABLETS 50MG (MEBHYDROLINE)

"F.Y."(鋁箔/膠箔)0.00

A038657100 ROLFEC CAP 250MG 3.20

A038758321 CANSEN CREAM 10MG/GM "F.Y" (CLOTRIMAZOLE) 8.20

A038758338 CANSEN CREAM 10MG/GM "F.Y" (CLOTRIMAZOLE) 32.50

A038760100 KERI CAPSULES 200MG "H.S." (NIFUROXAZIDE) 2.26

A038772443 BERTON NASAL SPRAY 0.1% (OXYMETAZOLINE) "C.M." 99.00

A038776100 Jiawiller F.C. Tablets 40mg (Famotidine) "C.L." 3.50

A038821140 GINLOBA DROPS 9.6 MG/ML (GINKGOFLAVONGLYCOSIDE) "HS" 0.00

A038837100 CIMENICE TABLETS 200MG (CIMETIDINE) "JINUP" 0.00

A038848109TOPCEF GRANULES FOR ORAL SUSPENSION 50MG/ML (CEPHRADINE)

0.00

A038862329 DICLOFEN GEL 10MG/GM (DICLOFENAC) "KOJAR" 14.30

A038862338 DICLOFEN GEL 10MG/GM "KOJAR" 22.80

A038862343 DICLOFEN GEL 10MG/GM "KOJAR" 27.90

A038865100 BETALEN TAB. 100MG 2.05

A038944100 PHOS-CAL F.C. TABLETS 667MG (CALCIUM ACETATE) "W.P." 1.12

A038972277 AXONECEF FOR IV INJECTION (CEFTRIAXONE) 53.00

A038974100 SILYVITA CAPSULES 1.01

A038989100 DICLOFENAC SODIUM ENTERIC F.C TABLET 50MG "KINGDOM" 0.93

A038997100 NATOXEN TABLETS 250MG"Y.J."(NAPROXEN) 1.08

A039037100 NEURONIN CAPSULES 0.00

Page 36: 附件二 藥品給付品項暨支付標準表

A039045100 MEPRED TABLETS 4MG (METHYLPREDNISOLONE) "F.S." 0.00

A039057110 SUTUN GRANULE 66.67MG/G 1.5G 1.58

A039057116 SUTUN GRANULE 66.67MG/G 3G 1.63

A039075100 NAPROXEN F.C. TABLET 500MG "KINGDOM" 0.00

A039078209 ZONCEF FOR INJECTION(CEFOPERAZONE) 1G 0.00

A039138277 KLITOL INJECTION 5% "S.T." (XYLITOL) 0.00

A039139238 KLITOL INJECTION 10% "S.T." (XYLITOL) 3.68

A039146100 SIUBOGA CAPSULES 150MG "S.Y." (SILYMARIN) 1.31

A039169277 L.A. INJECTION 900MG (LYSINE ASPIRIN) "STANDARD" 9.90

A039218100 SOWECAINE TABLETS 5MG "EVEREST" 0.17

A039251277 Y.F. NO.1 INJECTION "Y.F." 25.50

A039252277 Y.F. NO.3 INJECTION "Y.F." 25.50

A039271100UNIPRO FILM COATED TABLETS 250MG (CIPROFLOXACIN) "UNION"

4.39

A039278271 Y.F. NO.5 INJECTION "Y.F." 0.00

A039278277 YF NO.5 INJECTION 25.50

A039279277 Y.F. NO.4 INJECTION "Y.F." 25.50

A039303500 DOMPERID SUPP. 30MG 4.97

A039322100 MENTON TABLETS 500MG (ACETAMINOPHEN)"Y.Y." 0.19

A039323100 METHYLNICE CAPSULES 0.5MG (MECOBALAMIN) "JINUP" 1.32

A039346209 HALDECAN INJ. 50MG 1ML 0.00

A039349343 VOREN-G GEL 10MG/GM (DICLOFENAC) 27.90

A039349345 VOREN-G GEL 10MG/GM (DICLOFENAC) 28.80

A039366100 BOFEN TABLETS 200MG (IBUPROFEN) 0.76

A039488100UNIPRO FILM-COATED TABLETS 500MG (CIPROFLOXACIN) "UNION"

5.00

A039522212 UNIZID FOR INJECTION "UNION"(CEFTAZIDIME) 199.00

A039522277 UNIZID FOR INJECTION "UNION"(CEFTAZIDIME) 0.00

A039546100 GLUCOBIN TABLETS 500MG "W.P." (METFORMIN) 1.00

A039578100 PROTAB TABLETS 10MG (MEDROXYPROGESTERONE) 1.79

A039586335 CLOTRI SOLUTION 10MG/ML (CLOTRIMAZOLE) "KOJAR" 43.20

A039599100 ESTRA TABLETS 2MG (ESTRADIOL) 1.53

A039620321 SYAWE CREAM 50MG/GM (ACYCLOVIR)"MEIDER" 36.90

A039621100 TOZY EXTRA. TAB. 0.64

A039623321 MEXAC OINTMENT 5GM 24.00

A039623329 MEXAC OINTMENT 10GM 28.00

A039628100 SKIRAX 400MG TAB 5.40

A039629100 SKIRAX TABLETS 200MG (ACYCLOVIR) 4.26

A039630100 CEKOR CAPSULES 250MG (CEFACLOR) "STANDARD" 3.20

A039631216 MUCO-T INJECTION (ACETYLCYSTEINE) "S.Y." 0.00

A039634100 WEILE CAP.500MG 0.93

A039661100 NOSCAPINE TABLET 20MG "Y.S." 0.80

A039688100DIMETINE TABLETS 4MGDIMETINE TABLETS 4MG "EVEREST"

(BROMPHENIRAMINE)0.23

A039693335 DICLOFE GEL 1% (DICLOFENAC SODIUM) "ROOT" 14.30

A039707151 SYNTIFEN SOLUTION 0.2MG/ML (KETOTIFEN) "S.Y." 41.80

A039722100CIFLODAL F.C. TABLETS 250MG (CIPROFLOXACIN) "C.C.P.C."

4.39

Page 37: 附件二 藥品給付品項暨支付標準表

A039727100 OXEWAY TABLETS 5MG (OXETHAZAINE) 0.17

A039774100 AMANXIN F.C. TABLETS 100MG "Y.J."(AMANTADINE) 2.54

A039776100 AMOCILLIN CAPSULES 250 MG "CHI SHENG" (AMOXICILLIN) 0.99

A039780100 NOSCAPINE TABLETS 10MG "Y.S." 0.69

A039804100 TICOS CAPSULES "CHINTENG" 0.50

A039824100 SUCWAY TAB. 1000MG 1.88

A039832335 Miconitrate Cream "H.S." 73.00

A039854100 DEVIRO TABLETS 800MG (ACYCLOVIR) "KINGDOM" 0.00

A039858100IPENTOL CONTROLLED-RELEASE F.C. TABLETS 400 MG

(PENTOXIFYLLINE) "S.Y."1.79

A039871100 KENTON TAB.200MG 1.90

A039878100 CYLLERMIN TABLETS 4MG (CYPROHEPTADINE HYDROCHLORIDE) 0.70

A0398791G0 VARAPAMIL TABLETS 40MG "F.Y."(21粒/瓶) 0.00

A039944212 SUPREN INJECTION 2MG/ML (ONDANSETRON) "S.T" 0.00

A039947100 SINSULIN TABLETS 20MG "ASTAR" 1.64

A039956143 PSEU SOLUTION "KOJAR" 5.70

A039956151 PSEU SOLUTION "KOJAR" 10.30

A039956157 PSEU SOLUTION "KOJAR" 18.40

A039971110"U-LIANG" U-CLOR FOR ORAL SUSPENSION 125MG/5ML

(CEFACLOR)106.00

A040059210 NETROCIN INJECTION 100MG/ML (NETILMICIN) "S.T." 0.00

A040064100 MINOSINE CAP. 5.20

A040076100 HALINE TAB. 5MG 1.30

A040103100 SERVISPOR CAPSULES 500MG "STANDARD"(CEPHALEXIN) 1.75

A040105100 SYNORID TAB. 300MG 2.20

A040158100 UROXATE F.C.TABLETS 200MG "Y.J."(FLAVOXATE) 3.52

A040161143ANTI-PHEN INFANTS' DROPS 100MG/ML "CENTER"

(ACETAMINOPHEN)34.40

A040163100 HOMELAIN ENTERIC F.C. TABLETS 50MG "W.S." 0.00

A040164151 ANTI-PHEN SYRUP 24MG/ML"CENTER" 15.40

A040170157MISTURA GLYCYRRHIZAE COMPOSITA (BROWN MIXTURE WITH

OPIUM)21.30

A040173100 UROTIN TAB. 50MG 1.00

A040184100 AMINOPHYLLINE TABLET 100MG "H.S" 0.67

A040307100 IMORA CAPSULES 2MG (LOPERAMIDE)"Y.Y." 0.94

A040369100 UISPAN TABLETS 200MG (SULPIRIDE) "PANBIOTIC" 1.30

A040370100 URANID TAB. 100MG 0.99

A040423209 CEPONIN INJECTION (CEPHRADINE) "CHI SHENG." 0.00

A040423277 CEPONIN INJ. 0.00

A040427100 CLINDAMYCIN CAP. 150MG 1.26

A040475321 CHIUH-YEANG-SHU OINT. 5G 9.00

A040475329 CHIUH-YEANG-SHU OINT. 450G 18.10

A040558277 KALY INJ.50MG/ML500ML 0.00

A040559277 FULIN INJECTION "ASTAR" 0.00

A040563100 QUITEN CAPSULE 10MG (UBIDECARENONE) "Y.S." 2.85

A040641100 GLIZIDE TABLETS 5MG (GLIPIZIDE) "S.Y" 0.00

A0406411G0 GLIZIDE TABLETS 5MG (GLIPIZIDE) "S.Y"(鋁箔/膠箔) 0.00

A040656100 SPASMO-EUVERNIL F.C. TAB. 3.03

Page 38: 附件二 藥品給付品項暨支付標準表

A040658100 ASRIN E.C.TABLETS 165MG "H.S." 1.00

A040662100 KASMA TABLETS "KOJAR" 0.51

A040767321 TONEX CREAM 10MG/GM "MEIDER" (PIROXICAM) 11.20

A040767329 TONEX CREAM 10MG/GM (PIROXICAM) "MEIDER" 14.60

A040767335 TONEX CREAM 10MG/GM (PIROXICAM) "MEIDER" 22.20

A040767338 TONEX CREAM 10MG/GM "MEIDER" (PIROXICAM) 23.10

A0407673AK TONEX CREAM 10MG/G 22G 28.20

A040779100 CAPROINE TABLETS 25MG (CAPTOPRIL) "ROYAL" 1.05

A040812100 PERILAX SLOW RELEASE F.C.TAB. 400MG 1.79

A040833157 SECORINE SYRUP 24.30

A040908100 TINTEN TABLETS "EXTRA" 0.58

A040925100 JEN TON YAN CAPSULES 250MG "D.S." (MEFENAMIC ACID) 0.75

A040949100 CAPOTIL TABLETS 25MG(CAPTOPRIL)"KINGDOM" 1.05

A040972100 AN-LIH CAPSULES 2MG "DS" (LOPERAMIDE) 0.93

A041018100 NIMAPE ENTERIC F.C. TAB. 100MG 1.00

A041026100 REGITAN TAB. 10MG 0.59

A041032100 PINRIJIN S.C. TAB. 10MG 0.68

A041047100 COLDAN CAPSULES "KOJAR" 0.89

A041049100 VITABONIN TABLETS "KOJAR" 0.50

A041056338 ISOCORTANT CREAM 49.80

A041068100 ERYTHROMYCIN CAP. 250MG 1.43

A041170100 CHIYUANPIN E.C. TAB. 1.14

A041208100 BENZYDAMINE CAP. 50MG 0.74

A041213100 KEZINTEA TAB. 0.89

A041237335 COGESAN CREAM 100MG/G 31.70

A041237343 COGESAN CREAM 0.00

A041237345 COGESAN CREAM 100MG/GM "MEIDER" (ETOFENAMATE) 0.00

A041258100 INSHEL S.C. TAB. 1.79

A041260100 UROPYRIN S.C.TAB. 100MG 0.78

A041264100 AZUNOL TABLETS 2MG "KOJAR" 0.76

A041278100 CYRONA TABLETS 50MG "MACRO" (CYPROTERONE) 25.40

A041281100 KINTEC TABLETS 20MG "KINGDOM"(ENALAPRIL) 1.22

A041349100 CHIFONEON TAB. 50MG 0.27

A041355321 IMEFU CREAM 450GM 0.00

A041355329 IMEFU CREAM 10GM 0.00

A041355335 IMEFU CREAM 450GM 0.00

A041355338 IMEFU CREAM 450GM 0.00

A041428289 ORIXIM POWDER FOR INJECTION "ORIENTAL"(CEFUROXIME) 0.00

A0414421G0URINOGEN TABLETS 50MG "S.L." (BENZBROMARONE)(鋁箔/膠箔)

1.50

A041452338 ANNIE CREAM 0.00

A041464335 ANTIFUNGUS CREAM 22.20

A041505100 URIMANONE TABLETS 100MG 2.05

A041541100 URSOL TAB. 100MG 1.75

A0415441G0 MEPAZOLE TABLETS 5MG(30粒/瓶) 1.50

A041599100 FISHDON TAB. 50MG 1.15

A041601100 KIMODIN F.C. TAB. 40MG "KINGDOM"(FAMOTIDINE) 3.50

A041625100 QUIT A.C. ANALGESIC TABLET 0.68

Page 39: 附件二 藥品給付品項暨支付標準表

A041639221 PEXACIN I.V. INJECTION 378.00

A041651100 KIRADIN F.C.TAB.300MG "KINGDOM"(RANITIDINE) 0.00

A041672329 ZUME CREAM 0.00

A041676209 TYDINE INJECTION 1000MG (CEPHRADINE)"T.T.Y" 0.00

A041679100 ATENOL F.C. TABLETS 100MG 1.24

A041681329 BICOS CREAM 34.50

A041691421 KODOLO ORBASE 0.1% 34.70

A041724100 NURODIN TABLETS 400MG 1.00

A041725329 MENLIN CREAM 13.50

A041730100 PICOSULU E.S.C.TABLETS 1.35

A041804100 TIFENIC 200MG TAB. 2.74

A041806335 EUDAMYCIN GEL 1% (CLINDAMYCIN PHOSPHATE) "U-LIANG" 20.20

A041806338 EUDAMYCIN GEL 1% (CLINDAMYCIN PHOSPHATE) "U-LIANG" 49.90

A041811100 SHYS TAB. 0.50

A041822100 CEPHALEXIN CAPSULES 1.75

A041941100 SHINLICIN F.C. TABLETS 9.6MG"J.S." 1.64

A041972321 MORZIN CREAM 10MG/GM (CLOTRIMAZOLE) 8.40

A041975100 SILICON TABLETS 40MG (SIMETHICONE) "EAYUNG" 0.00

A041979321 BECLOMIN CREAM 18.90

A041979329 BECLOMIN CREAM 56.00

A041979335 BECLOMIN CREAM 0.00

A041980321 GENTASON CREAM 12.20

A041980329 GENTASON CREAM 13.50

A041980338 GETASON CREAM 19.60

A041982321 TOLNAMIN CREAM 14.80

A041982329 TOLNAMIN CREAM 17.90

A041982355 TOLNAMIN CREAM 33.40

A041984321 URESON CREAM 8.60

A041984329 URESON CREAM 17.80

A042006323 UCOFU CREAM 0.00

A042006330 UCOFU CREAM 0.00

A042092100 RIVOSIN F.C. TAB. 9.6MG "S.Y." 1.64

A042129100 BAUSUTONER CAPSULES 0.75

A042136100 SHINSIN CAPSULES 10MG (UBIDECARENONE) "S.P." 2.85

A042142155ALTANT ELIXIR 0.4MG/ML (TRIHEXYPHENIDYL

HYDROCHLORIDE)"PANBIOTIC"0.00

A042142157 ALTANT ELIXIR 0.4MG/ML "PANBIOTIC" 0.00

A042229335 B.& N. EXFUNGUS CREAM 10MG/GM (BIFONAZOLE) 45.30

A042239100 URSOL CAPSULES 3.47

A042247100 LUMELIN TABLETS 2MG "S.D." 1.53

A042253100 UROTIN TABLETS 100MG 2.05

A042267151 SPIZ SYRUP 11.40

A042267155 SPIZ SYRUP 17.10

A042280100 DEVIRO TAB. 400MG "KINGDOM"(ACYCLOVIR) 5.40

A042346100 PERISAFE TAB. 20MG 1.22

A042366100 MUCAINE TABLETS 1.00

A042373338 CIPIROID CREAM 250U/GM 34.60

A042389100 LOVATIN TABLETS 20MG "PANBIOTIC" 3.24

Page 40: 附件二 藥品給付品項暨支付標準表

A042395100 DIMICON TAB. 80MG 1.02

A042401100 URINONE TABLETS 100MG (BENZBROMARONE) "EAYUNG" 2.05

A042433100 CEFXIN F.C. TABLETS 125MG "STANDARD" (CEFUROXIME) 5.90

A042435100 BENSAU(BENZONATATE 100MG)SOFT CAPSULE "LOTUS" 1.61

A042439100 CEFXIN F.C. TABLETS 250MG "STANDARD" (CEFUROXIME) 5.90

A042441338 BICAEN CREAM 10MG/GM"S.D." 23.10

A042464100 PANFORMIN TABLETS 500MG (METFORMIN) "PANBIOTIC" 1.00

A0424641G0 PANFORMIN TABLETS 500MG (METFORMIN) "PANBIOTIC" 1.50

A042508100 FULULIN TABLETS 10MG "S.D." 1.79

A042585100 PANAZIL F.C. TABLETS 600MG 2.43

A042592100 REGAL-HR TABLETS 4.03

A042618100 NOFATER CAPSULES 50MG "F.M." (DICLOFENAC SODIUM) 0.93

A042711100 PERISAFE TABLETS 5MG (ENALAPRIL) 0.00

A042712100 PERISAFE TABLETS 10MG (ENALAPRIL) 1.18

A042745100RITORIN TABLETS 10MG "PANBIOTIC"(RITODRINE

HYDROCHLORIDE)3.61

A0428291G0 ANTHOLIN CAPSULES "WINSTON"(鋁箔/膠箔) 1.50

A042846314 ESTRADE GEL 0.6MG/GM "S.Y." (ESTRADIOL) 15.00

A042846343 ESTRADE GEL 0.6MG/GM "S.Y." (ESTRADIOL) 68.00

A042846348 ESTRADE GEL 0.6MG/GM "S.Y." (ESTRADIOL) 0.00

A042854151 SAURIN SUSPENSION 20MG/ML "GCPC." (IBUPROFEN) 25.00

A042854157 SAURIN SUSPENSION 20MG/ML "GCPC." (IBUPROFEN) 0.00

A042869100 FLUNEPAN TABLETS 1MG "PANBIOTIC" (FLUNITRAZEPAM) 0.00

A042870421 TIMOL OPHTHALMIC SOLUTION 5MG/ML 0.00

A0429341G0SULIN ENTERIC-MICROENCAPSULATED CAPSULES 100MG "WINSTON"

(ASPIRIN)(鋁箔)1.50

A042941100 MAYJOU TABLETS 0.25GM "F.Y." (MAGNESIUM OXIDE) 0.13

A042954500 DOMPE SUPPOSITORIES 30MG "H.S." (DOMPERIDONE) 4.97

A042955321 ONEPASS CREAM 200MG/G (AZELAIC ACID) 26.00

A042955329 ONEPASS CREAM 200MG/G (AZELAIC ACID) 43.60

A042955330 ONEPASS CREAM 200MG/G (AZELAIC ACID) 45.30

A042955338 ONEPASS CREAM 200MG/G (AZELAIC ACID) 0.00

A042955343 ONEPASS CREAM 200MG/G (AZELAIC ACID) 207.00

A042962421 F.S. OPHTHALMIC SUSPENSION 0.1% 12.40

A043031100 SPIZ-H TABLETS "S.T." 0.98

A043051100 EUCON TABLETS 5MG (GLIBENCLAMIDE) "PANBIOTIC" 0.99

A0431141G0 TARLIN TABLETS "S.T"(鋁箔/膠箔) 1.50

A043190100 MECOBAL CAPSULE 0.5MG "TA FONG" 1.32

A043216100 DEGOUT TABLETS 100MG "H.S."(BENZBROMARONE) 2.05

A043222100 Becandin Tablet "DTS" 0.98

A043248421 TRIALON ORAL PASTE 1MG/ML 28.40

A043257100 MEFNO TABLET 200MG 1.00

A043285321 LIBIDO GEL "MEIDER" 9.00

A043361151 DINCO SYRUP "CENTER" 17.50

A043361157 DINCO SYRUP "CENTER" 23.00

A043361163 DINCO SYRUP "CENTER" 50.00

A043442100 ETODO CAPSULES 200MG 3.06

A043470100 MEKEI TABLETS "PANBIOTIC" 36.60

Page 41: 附件二 藥品給付品項暨支付標準表

A043483166 MACOTREIS EFFERESCENT GRANULES 75MG/GM "S.D" 8.30

A043488100 SENNAPUR TABLETS 0.99

A043618165 MAGCY ORAL SOLUTION "S.T" 0.00

A043626343 VOLRAN GEL 1% "C.M" 27.90

A043707100 "U-LIANG" U-MISO TABLETS 200MCG (MISOPROSTOL) 9.00

A043733100 U-ERGO TAB. 1.5MG "U-LIANG 0.00

A043786238 SALCA INJECTION 10.90

A0438481G0 BRONXIN CAPSULES "WINSTON"(鋁箔) 1.50

A043853329 CB CREAM 29.80

A043853338 CB CREAM 67.00

A043858100 DIACRON TABLETS 80MG "GENTLE" 1.02

A043866100 ZETON F.C TABLETS 100MG 2.48

A043868100 UPISIN F.C. TABLETS 25MG 1.22

A043869277 "TTY"MAXTAM INJECTION 500MG(SULBACTAM SODIUM) 67.00

A043887100 'U-LIANG 'U-PRAVA TAB. 5MG 0.00

A043899500 VAZOLE VAGINAL TAB. 500MG "H.S." 3.73

A043925345 PIPON CREAM 10MG/GM "Y.C." (PIROXICAM) 35.00

A0439481G0 IBUPROFEN F.C.TABLETS "S.L"(鋁箔/膠箔) 1.50

A043957100 GEN BO CAP. 35MG "C.H" 0.00

A043959100 "U-LIANG "U-SULAX TAB. 200MG 1.00

A0439591G0 "U-LIANG "U-SULAX TABLETS 200MG(鋁箔/膠箔) 1.50

A043988100 JINBERCHANQ TABLETS "T.F." 0.00

A043992100 CHIN NI CHUAN CAP. "JENSHENG." 1.04

A044016100SINLO ENTERIC-MICROENCAPSULATED CAPSULES 100MG "H.S"

(ASPIRIN)1.00

A0440161G0SINLO ENTERIC-MICROENCAPSULATED CAPSULES 100MG "H.S"

(ASPIRIN)(鋁箔/膠箔)1.50

A044040209 AVAGIN INJECTION 25MG/ML 0.00

A0440671G0 BAYMIN TABLETS 5MG (MEQUITAZINE) "T.F."(鋁箔/膠箔) 1.50

A044069100 ACETYL SALICYLIC ACID TABLETS "T.L.B" 0.24

A044073121 GUAROL GRANULES "S.Y" 0.00

A044092100 CLINDAMYCIN CAP. 150MG CAP "PATRON" 1.26

A044202100 LAZOL CAPSULES 200MG "S.T" (DANAZOL) 0.00

A044241321 DR. PI. A.F CREAM "MEIDER" 16.00

A044241355 DR.PI.A.F CREAM "MEIDER" 112.00

A044268329 CLINDAMYCIN GEL 10MG/G "T.F" 13.60

A044268335 CLINDAMYCIN GEL 10MG/GM "T.F" 20.20

A044268338 CLINDAMYCIN GEL 10MG/G "T.F" 49.90

A044294143 RODAMINE SYRUP "W.P." 25.00

A044294151 RODAMINE SYRUP "W.P." 26.40

A044315100 FONITEC TABLETS 20MG "T.F" 1.22

A044367321 BETASON CREAM 0.5MG/GM 11.90

A044367323 BETASON CREAM 0.5MG/GM 15.30

A044367329 BETASON CREAM 0.5MG/GM 15.30

A044367330 BETASON CREAM 0.5MG/GM 18.30

A044394321 BETASOL CREAM 0.5MG/GM 11.90

A044394323 BETASOL CREAM 0.5MG/GM 12.80

A044394324 BETASOL CREAM 0.5MG/GM 12.80

Page 42: 附件二 藥品給付品項暨支付標準表

A044394329 BETASOL CREAM 0.5MG/GM 13.70

A044435340 POSULEN EXT SOLUTION "PATRON" 142.00

A044464321 GLINDA GEL 10MG/GM 9.00

A044464323 GLINDA GEL 10MG/GM 11.40

A044464329 GLINDA GEL 10MG/GM 13.60

A044464330 GLINDA GEL 10MG/GM 16.50

A044464335 GLINDA GEL 10MG/GM 20.20

A044464338 GLINDA GEL 10MG/GM 49.90

A044467321 BETAME OINTMENT 10.90

A044467329 BETAME OINTMENT 19.30

A044467335 BETAME OINTMENT 48.50

A044578100 SYNLET ENTERIC-MICROENCAPSULATED CAPSULES 100MG 1.00

A044600100 CARRY FILM-COATED TABLETS 4MG 31.50

A044611221 GENAXOL INJECTION 6MG/ML "GENTLE" 0.00

A044653100 CA-P TABLETS 667MG "YU SHENG"(CALCIUM ACETATE) 1.12

A044810100 ENARIL TABLETS 20MG "WEIDAR" 1.22

A044879100 PSOLE F.C TAB. 3.52

A044969343 CIPROSONE CREAM 0.5MG/GM 31.90

A045188100 KLARCIN F.C. TABLETS 250MG 3.24

A045228323 MIZTIN CREAM "MEIDER." 14.30

A045228336 MIZTIN CREAM "MEIDER" 29.70

A045233100 NORTIN S.C. TABLETS 4.57

A0452481G0 SUCONIN CAPSULES 鋁箔/膠箔) 1.50

A045280335 MEDAGEN GEL 0.75% "HEALTH" (METRONIDAZOLE) 38.10

A045280338 MEDAGEN GEL 0.75% "HEALTH" (METRONIDAZOLE) 0.00

A045280343 MEDAGEN GEL 0.75% "HEALTH" (METRONIDAZOLE) 0.00

A045306100 AMSHA TABLET 250MG "Y.Y" 3.30

A045308100 YETAN CHEWABLE TABLETS "Y.A" 2.98

A0453511G0 ACTIWE TABLETS "UELIAN" 鋁箔/膠箔) 1.50

A045357335 KENETON GEL 22.20

A045357340 KENETON GEL 28.20

A045357343 KENETON GEL 28.40

A045451100 FERALL SOFT CAPSULES 2.03

A045571321 FORMEI CREAM "Y.C" 16.00

A045600212 NEUROMIA INJECTION 0.00

A045643212 VITAMIN BC COMPLEX INJECTION "ORIENTAL" 1.40

A045650421 NORFOCIN EYE DROPS 0.3% 24.10

A045650429 NORFOCIN EYE DROPS 0.3% 67.00

A045677100 METICORT TABLETS 2MG "KINGDOM" 1.14

A045887326 OXPIN CREAM 50MG/GM (DOXEPIN) 37.20

A045925326 FUTEN CREAM 2% 39.70

A045925338 FUTEN CREAM 2% 0.00

A045957321 ANCENT CREAM "Y.C" 20.40

A045957329 ANCENT CREAM "Y.C" 31.60

A046022100 "U-LIANG" U-PRAVA TABLETS 10MG (PRAVASTATIN SODIUM) 5.50

A046026100 LABETA F.C L TABLETS 100MG "ROYAL" 2.75

A046140100 BETARL F.C TABLETS 200MG "ROYAL" 2.75

A046143100 ACYLO TABLETS 200 MG (ACYCLOVIR) 4.26

Page 43: 附件二 藥品給付品項暨支付標準表

A046176100 JULILIN CAPSULES 1MG "S.D' 0.25

A046178329 AMYDA GEL 0.75% "Y.Y" 26.70

A046178338 AMYDA GEL 0.75% "Y.Y" 52.00

A046183529 ZOCON VAGINAL GEL 0.75% "Y.Y" 0.00

A046183540 ZOCON VAGINAL GEL 0.75% "Y.Y" 0.00

A046183596 ZOCON VAGINAL GEL 0.75% "Y.Y" 121.00

A046253100 KORFAN TABLETS 15MG "TAI" 0.69

A046273100 KORFAN TABLETS 20MG "TAI" 0.85

A046275151 LALLERGY SYRUP "ROYAL" 26.40

A046275157 LALLERGY SYRUP "ROYAL" 0.00

A046300151 CATEROL LIQUID 5MCG/ML 0.00

A046302363 KWAIE GEL 0.1% 0.00

A046453345 FLU RO FEN PATCH 40MG/12GM 5.20

A046487112 TERCANYL NEBULISER SOLUTION 2.5MG/ML 0.00

A046490248 DIPROFEN INJECTION 0.00

A046562335 METOPZOLE GEL 7.5MG/GM 0.00

A046584335 ADAMEI GEL "S.C." 0.00

A046618229 DROPEDOL INJECTION 2.5MG/ML 0.00

A046633326 LOMEANE CREAM "S.C." 26.60

A046633329 LOMEANE CREAM "S.C." 0.00

A046637457 BESONIN AQUA NASAL SPRAY 32 UG/DOSE 137.00

A046686100 METO TABLETS 250MG "EB"(METFORMIN) 0.00

A046691100 METOZONE TABLETS 0.5MG "Y.Y." 2.55

A046732100 GLUCOMET F.C. TABLETS 2.5/500MG 1.87

A046933100 FLUVOXIN F.C. TABLETS 50MG 6.00

A047071212 KOP INJECTION 17.60

A047089100 METO TABLETS 500MG 1.00

A047157343 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 119.00

A047157363 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 0.00

A047278100 FORMIN E.F.C.TABLETS 50MG "PANBIOTIC" 0.93

A047375238 LIPOVAN INJECTION 0.00

A047375248 LIPOVAN INJECTION 0.00

A047420100 INMIDE F.C. TABLETS 1.25MG "EB" 0.00

A047517100 LATRIGINE TABLETS 100MG "KINGDOM" (LAMOTRIGINE) 13.80

A047556340 FUBODYL Concentrate Solution "Meider" 0.00

A047572100 IFONOL TABLETS 100 MG "ASTAR" 0.00

A047610100 IFONOL TABLETS 300MG "ASTAR" 0.00

A047615157 BESUMIN SYRUP "Y.C" 0.00

A047623100 EBASTEL TABLETS 5MG 1.55

A047624100 EBASTEL TABLETS 10MG 3.71

A047628100 VEMARY TABLETS 2MG "JOHNSON" 1.53

A047680100 Decarbay Tablets 50mg "Kingdom" 1.93

A047681321 Palene gel 0.1% "Panbiotic" 16.80

A047681335 Palene gel 0.1% "Panbiotic" 0.00

A047681343 Palene gel 0.1% "Panbiotic" 0.00

A047681345 Palene gel 0.1% "Panbiotic" 0.00

A047681363 Palene gel 0.1% "Panbiotic" 0.00

A047791100 MESUN S.R.M.C. 125MG "UELIAN" 1.39

Page 44: 附件二 藥品給付品項暨支付標準表

A047809435 Cromyn Nasal Spray "H.S." 86.00

A047810329 SPERSIN OINTMENT 78.00

A047814100 COFONCIN TABLETS 0.5MG "ASTAR" 0.99

A047843143 ZOCOMIN ORAL SOLUTION 0.1%W/V 25.40

A047843151 ZOCOMIN ORAL SOLUTION 0.1%W/V 26.10

A047843157 ZOCOMIN ORAL SOLUTION 0.1%W/V 0.00

A047846337 Fluzole cream "Royal" 49.80

A047847329 SPALIN OINTMENT 49.70

A047900100 TITON Tablets 60mg "MEIDER" 0.70

A047966100 TONE F.C. Tablets 25mg "MEIDER" 1.22

A047994100 SCATEN TABLETS 20MG "MEIDER" 0.73

A048060321 Superin cream "Y.C." 28.20

A048060355 Superin cream "Y.C." 0.00

A048087100 TONE F.C. TABLETS 10MG "MEIDER" 1.20

A048093321 Adalene Gel 0.1% "S.D." 16.80

A048093335 Adalene Gel 0.1% "S.D." 57.00

A048093343 Adalene Gel 0.1% "S.D." 0.00

A048093345 Adalene Gel 0.1% "S.D." 0.00

A048093363 Adalene Gel 0.1% "S.D." 0.00

A048178329 Betapro Cream "Patron" 0.00

A048183100 Riston F.C. Tablets 2mg "CHI SHENG" 6.50

A048188100 Sufolin Tablets 60mg "Astar" 0.70

A048225321 Debesol Ointment 0.05% 11.90

A048225324 Debesol Ointment 0.05% 12.80

A048225329 Debesol Ointment 0.05% 13.70

A048225338 Debesol Ointment 0.05% 41.90

A048225340 Debesol Ointment 0.05% 0.00

A048225355 Debesol Ointment 0.05% 0.00

A048252100 Nincolide Tablets 100mg "Kingdom" (Nimesulide) 2.08

A048277457 BUDES NASAL AQUA (64UG/DOSE) "PANBIOTIC" 120.00

A048295321 Pindome Gel 0.1% (Adapalene)"HEALTH" 16.80

A048295335 Pindome Gel 0.1% (Adapalene)"HEALTH" 57.00

A048295343 Pindome Gel 0.1% (Adapalene)"HEALTH" 119.00

A048295345 Pindome Gel 0.1% (Adapalene)"HEALTH" 0.00

A048295363 Pindome Gel 0.1% (Adapalene)"HEALTH" 0.00

A048339100 SINTAN ENTERIC COATED TABLETS 100MG "MEIDER" 0.00

A0483391G0 SINTAN ENTERIC COATED TABLETS 100MG "MEIDER"(鋁箔) 0.00

A048345100 BOSU F.C. TABLETS 9.6MG "SOUNLIN" 0.00

A048390209 ANALIF FOR IV INJECTION 15.90

A048390212 ANALIF FOR IV INJECTION 17.60

A048442225 Diprofen Injection 20mg/ml 0.00

A048442229 Diprofen Injection 20mg/ml 0.00

A048442240 Diprofen Injection 20mg/ml 114.00

A048442248 Diprofen Injection 20mg/ml 0.00

A048448345 FUBIPROFEN PLASTER "JENSHENG" 5.20

A048512100 NooSafe Film Coated Tablets 800mg 1.81

A0485421G0 ENCINLO E.M. CAPSULES 100MG "UELIAN" (鋁箔/膠箔) 1.50

A048561238 OLATIN I.V. INJECTION 5MG/ML 0.00

Page 45: 附件二 藥品給付品項暨支付標準表

A048641209 Oxacillin Sodium Injection "Union" 36.00

A048641212 OXACILLIN SODIUM INJECTION "UNION" 84.00

A048641265 Oxacillin Sodium Injection "Union" 0.00

A048641277 OXACILLIN SODIUM INJECTION "UNION" 19.00

A048662100 FUCOLE MINLIFE ORALLY DISINTEGRATING TABLETS 0.75

A048682100 ANXIEDIN TABLETS 2 MG (LORAZEPAM) 0.98

A0486821G0 ANXIEDIN TABLETS 2 MG (LORAZEPAM)(鋁箔/膠箔) 1.50

A048685109 Gesure Granules 2.69

A0487491G0 COLCHICINE TABLETS 0.5MG“F.Y.”(鋁箔/膠箔) 0.00

A048756100 SUGANLIN SOFT CAPSULES“F.M” 0.00

A048783345 FO BI PU LUO FUM PATCH 5.20

A048786321 MOFUROATE CREAM 0.1 %〝Y.S.〞 0.00

A048786326 MOFUROATE CREAM 0.1 %〝Y.S.〞 0.00

A048786329 MOFUROATE CREAM 0.1 %〝Y.S.〞 0.00

A048786335 MOFUROATE CREAM 0.1 %〝Y.S.〞 0.00

A048840212 Irinotecan Solution for I.V. Infusion “LOTUS” 0.00

A048864329 Jelnizole Gel 0.75% "Panbiotic" 0.00

A048864335 Jelnizole Gel 0.75% "Panbiotic" 0.00

A048864338 Jelnizole Gel 0.75% "Panbiotic" 0.00

A048864343 Jelnizole Gel 0.75% "Panbiotic" 0.00

A0488681G0 SLOSUGAR TABLETS 500 MG(鋁箔/膠箔) 1.50

A048890166 CARBOTEINE EFFERESCENT GRANULES 8.30

A048894100 MIGOFF TABLETS 10 MG 0.00

A048895100 Prosten F.C. tablets "Panbiotic" 0.79

A048992421 KIRTOLAC OPHTHALMIC SOLUTION 0.5% 0.00

A0490111T0 FUNNIX SR TABLETS 150MG 11.70

A049023100 PIRACETAM FILM COATED TABLETS 1200MG“Y.Y.” 1.81

A049033143 XINGTON DROPS 9.6 MG/ML“PANBIOTIC” 0.00

A049033151 XINGTON DROPS 9.6 MG/ML“PANBIOTIC” 0.00

A049033155 XINGTON DROPS 9.6 MG/ML“PANBIOTIC” 0.00

A049033157 XINGTON DROPS 9.6 MG/ML“PANBIOTIC” 0.00

A049058100 RISTON F.C. TABLETS 1 MG "CHI SHENG" 5.30

A0490891G0 ANCOPIN TABLETS "H.S."(鋁箔/膠箔) 1.50

A049108321 KANGFUJING OINTMENT 2 % 28.60

A049108326 KANGFUJING OINTMENT 2 % 0.00

A049108329 KANGFUJING OINTMENT 2 % 44.00

A049108335 KANGFUJING OINTMENT 2 % 0.00

A049132100 FUTE F.C. TABLETS 3MG 8.90

A049140280 AMOCLAN FOR I.V. INJECTION "UNION" 0.00

A049140297 AMOCLAN FOR I.V. INJECTION "UNION" 72.00

A049144100 REPANORM TABLETS 1MG”KINGDOM”(REPAGLINIDE) 1.78

A049149209 SIROLAC IV INJECTION 30 MG/ML “SIEHO” 15.90

A049149212 SIROLAC IV INJECTION 30 MG/ML “SIEHO” 17.60

A049307100 LERPIN F.C. TABLETS 10 MG (LERCANIDIPINE) 5.00

A049314221 DOPAR INJECTION 40 MG/ML 0.00

A0493221T0BUPROTRIN SUSTAINED RELEASE F.C. TABLETS 150MG 〝ROYAL〞

11.70

A049388173 CHALIAN POWDER 770.00

Page 46: 附件二 藥品給付品項暨支付標準表

A049395100 TIABINE FILM COATED TABLETS 5MG (TIAGABINE) 0.00

A049416173 KUZEM POWDER 0.00

A049418321 POCOMMI CREAM 13.80

A049418323 POCOMMI CREAM 14.30

A049418330 POCOMMI CREAM 19.30

A049418335 POCOMMI CREAM 29.40

A049418336 POCOMMI CREAM 29.70

A049425100 SONIMAX CAPSULES 10MG 2.31

A049426209MEFLUPIN POWDER FOR INJECTION 0.25G、0.5G、1G“TAI YU”

0.00

A049426265MEFLUPIN POWDER FOR INJECTION 0.25G、0.5G、1G“TAI YU”

0.00

A049426277MEFLUPIN POWDER FOR INJECTION 0.25G、0.5G、1G“TAI YU”

0.00

A049554229 LIPOFOL INJECTION 20MG/ML 0.00

A049554248 LIPOFOL INJECTION 20MG/ML 0.00

A049565321 FUTEZOLE CREAM 1% 15.40

A049565329 FUTEZOLE CREAM 1% 0.00

A049565335 FUTEZOLE CREAM 1% 45.30

A049565338 FUTEZOLE CREAM 1% 73.00

A049580221 POTASSIUM CHLORIDE COMPLEX INJECTION 15% "SYNMOSA" 5.80

A049580229 POTASSIUM CHLORIDE COMPLEX INJECTION 15% "SYNMOSA" 0.00

A049580238 POTASSIUM CHLORIDE COMPLEX INJECTION 15% "SYNMOSA" 8.40

A049601209 PRISUTOMYCIN FOR INJECTION“TAI YU” 0.00

A049601212 PRISUTOMYCIN FOR INJECTION“TAI YU” 0.00

A049601219 PRISUTOMYCIN FOR INJECTION“TAI YU” 0.00

A049603317 FLUNOLONE OINTMENT 22.50

A049606100 FUTE F.C. TABLETS 1MG 3.50

A049615100 VIDYA FILM COATED TABLETS 4 MG (ROSIGLITAZONE) 23.50

A049624265 DOPAMINE“C.C.P.C.”INJECTION 0.00

A049652355 TRISEC CREAM 112.00

A049710321 SOHOUO HYDROPHILIC CREAM 16.00

A049710329 SOHOUO HYDROPHILIC CREAM 34.10

A049710338 SOHOUO HYDROPHILIC CREAM 71.00

A049712265 IMENAM POWDER FOR IV INJECTION 0.00

A049712277 IMENAM POWDER FOR IV INJECTION 0.00

A049718100 SUBININ EFFERVESCENT TABLETS 600 MG 5.40

A049734209 PRIDIN INJECTION 2 MG/ML 12.80

A049752321 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 11.90

A049752329 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 0.00

A049752335 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 31.50

A049752338 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 36.90

A049752355 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 0.00

A049762100 CAFONA TABLETS 15 MG 0.00

A049907321 PEVIGEN OINTMENT 0.5MG/GM (CLOBETASOL PROPIONATE) 11.90

A049914100 AMSOLVON SR TABLET 75MG 1.60

A049924121 QUARTON GRANULES 0.00

A049973100 QUEROPIN FILM COATED TABLETS 100MG“YUNG SHIN” 0.00

Page 47: 附件二 藥品給付品項暨支付標準表

A049975100 "U-LIANG" ETOPIN CAPSULES 200 MG 3.06

A049991421 ANKEMIN EYE DROPS“UNION” 16.90

A049991429 ANKEMIN EYE DROPS "UNION" 32.70

A049999326 DOFU CREAM 37.20

A049999335 DOFU CREAM 44.40

A050055100 DINONE CAPSULE 2.5MG 0.00

A050096100 ETL CAPSULES 200 MG 3.06

A050103100 NISULIN TABLETS 24MG 2.31

A050119100 ANDM EXTENDED RELEASE TABLETS 1.28

A050124163 GUWEI SUSPENSION 20MG/ML 0.00

A050153100 MENOLON TABLETS 200MG 1.00

A050164209 CEFMAY POWDER FOR INJECTION“TAI YU” 0.00

A050164212 CEFMAY POWDER FOR INJECTION“TAI YU” 0.00

A050164277 CEFMAY POWDER FOR INJECTION“TAI YU” 0.00

A050176209 CEFEROM POWDER FOR I.V. INJECTION 1GM“TAI YU” 0.00

A050176212 CEFEROM POWDER FOR I.V. INJECTION 2GM“TAI YU” 0.00

A050246151 NOOSAFE 200 MG SOLUTION 0.00

A050253138 Surotec Solution 5mg/ml 207.00

A050339100 ZALE CAPSULES 10MG 2.31

A050424100 VANTYDIN 12 HOUR SR F.C. TABLETS 3.64

A050430100 MEKEI TABLETS 40MG“PANBIOTIC” 0.00

A051028435 SUALLERGIC Nasal Spray Solution 64.00

A051388100 INDAMIDE SR F.C. TABLETS 1.5MG“KINGDOM”(INDAPAMIDE) 1.52

A051391100 CLENSAN TABLETS 16MG 1.24

A051719100 PURINOL-300 TABLETS 300MG“ROYAL” 2.20

A051731100 EPILEN F.C. TABLETS 500MG 19.70

A0523571G0 TOLAX TABLETS 400MG(鋁箔/膠箔) 1.50

A052361220 JEITA FOR I.V. INJECTION“UNION” 191.00

A0523612CX JEITA FOR I.V. INJECTION“UNION” 116.00

A052438148 Witgen Oral Drop“LOTUS” 0.00

A052460100 LIOBIGEN FILM COATED TABLETS“PANBIOTIC” 1.92

A052541100 CAMOSA F.C. TABLET 500MG“UNION” 4.59

A052589100 PIOGO TABLETS 30MG 7.70

A052618209 OXACILLIN POWDER FOR INJECTION“UNICARE” 0.00

A052618212 OXACILLIN POWDER FOR INJECTION“UNICARE” 0.00

A052618265 OXACILLIN POWDER FOR INJECTION“UNICARE” 0.00

A052618277 OXACILLIN POWDER FOR INJECTION“UNICARE” 0.00

A054856100 UTAPINE F.C. TABLETS 300MG“UNION” 29.50

A054860100 EPRAM F.C. TABLETS 20 MG 14.10

A054863100 LOPIRIN ENTERIC-COATED TABLETS 81MG 1.00

A054972100 MOKAST CHEWABLE TABLETS 5 MG 8.00

A0549771T0 BUPORIN SUSTAINED-RELEASE TABLETS 150MG 11.70

A054981321 FLANSON OINTMENT 0.00

A054981329 FLANSON OINTMENT 0.00

A054981335 FLANSON OINTMENT 38.20

A054981338 FLANSON OINTMENT 0.00

A054993100 AIDA TABLETS 2MG“H.H.”(BIPERIDEN) 1.43

A0550051T0 PREWELL SUSTAINED-RELEASE TABLETS 150MG“MACRO” 11.70

Page 48: 附件二 藥品給付品項暨支付標準表

A055044100 PLATOUT FILM COATED TABLETS 75MG 28.80

A0552841T0 BUPOPIN SR TABLETS 150 MG 11.70

A055286266 HYSON POWDER FOR INJECTION 0.00

A055290329 MEFREE GEL 0.75% 26.70

A055290335 MEFREE GEL 0.75% 38.10

A055290338 MEFREE GEL 0.75% 0.00

A055290343 MEFREE GEL 0.75% 0.00

A0555341T0 BETETRIM S.R. FILM-COATED TABLETS 150MG 11.70

A055899326 FUDOPIN CREAM 50MG/G“PANBIOTIC” 0.00

A055899335 FUDOPIN CREAM 50MG/G“PANBIOTIC” 0.00

A055915100 KINZAAR F.C. TABLETS 50MG“KINGDOM”(LOSARTAN) 3.53

A055967100 SIMVA F.C. TABLETS 40MG“UNION” 7.10

A055969255 TEICON POWDER FOR I.V. INJECTION“UNION” 0.00

A055969263 TEICON POWDER FOR I.V. INJECTION“UNION” 455.00

A055969271 TEICON POWDER FOR I.V. INJECTION“UNION” 0.00

A056308100 SUPERCILLIN CAPSULES 500MG 1.23

A056650100 CYSERINE CAPSULES 250MG "UNION" 43.00

A056678100 Ixepran Capsules 50mg (Milnacipran) 8.60

A056719100 FUZATAN F.C. TABLETS 50/12.5MG "KINGDOM" 3.53

A056752100 ASTARIL TABLETS 25MG 1.06

A0567821T0 BUPION SR TABLETS 150MG 11.70

A057123100 SEDOGREL F.C. TABLETS 75MG "UNION" 0.00

A0571353AK SOFTCAM GEL 10MG/G 28.20

A057169116 SMECTIN POWDER FOR ORAL SUSPENSION 3G/SACHET 5.10

A057184100 Begalin S.C. Tablets "N.C.P." 0.74

A057202265 MOXACIN INFUSION SOLUTION 400MG/250ML 0.00

A057302151 PATADINE ORAL SOLUTION 10MG/ML "CENTER" 0.00

A057302155 PATADINE ORAL SOLUTION 10MG/ML "CENTER" 0.00

A057373100 SULFIN F.C. TABLETS 200MG (SULFINPYRAZONE) 5.20

A057775100KINCOUGH SUSTAINED RELEASE F.C. TABLET 60MG "KINGDOM"

(DEXTROMETHORPHAN HYDROBROMIDE)1.90

A057792212 FEVA INJECTION 2% 0.00

A057835321 OMEX CREAM 10MG/GM 0.00

A057999209 VENAN INJECTGION 1.54

A058000221 VENAN-CALCIUM B6 INJECTION 3.50

A058008212 ASCOLIN INJECTION 5.40

A058010212 METALIN-C INJECTION 1.44

A058011209 METHORON INJECTION 0.00

A058081317 RAXZOR CREAM 5% "Y.C." 0.00

A058118113 INTEMENO GRANULES FOR ORAL SOLUTION 2400MG 5.40

AA01085209 SODIUM CHLORIDE INJECTION "Y.F."(1000 ML塑膠軟袋裝) 35.00

AA01085255 SODIUM CHLORIDE INJECTION "Y.F."(100ML) 22.00

AA01085265 SODIUM CHLORIDE INJECTION "Y.F."(250ML) 22.00

AA01085277 SODIUM CHLORIDE INJECTION "Y.F."(500ML) 25.00

AA01086209 GLUCOSE INJECTION 10% "Y.F." 35.00

AA01086277 GLUCOSE INJECTION 10% "Y.F." 25.00

AA10654277 NORM-SALINE INJECTION "OTSUKA"(500ML注射劑裝) 25.00

AA11711277 10% DEXTROSE INJECTION "OTSUKA" 25.00

Page 49: 附件二 藥品給付品項暨支付標準表

AA12986277 DEXT-SALINE INJECTION 5:0.3 "OTSUKA" 25.00

AA137182775%/0.45% DEXTROSE AND SODIUM CHLORIDE INJECTION

"Y.F."(塑膠軟袋裝)25.00

AA19280209 CEFAZOLIN INJECTION 1GM "CHI SHENG" 25.00

AA19280277 CEFAZOLIN INJECTION "CHI SHENG" 25.00

AA20591277 DEXT-SALINE INJECTION 2.5:0.45 "OTSUKA" 25.00

AA24516209 "SODIUM CHLORIDE INJECTION 0.9 ""TAI YU"(軟袋裝)。 35.00

AA24516277 SODIUM CHLORIDE INJECTION 0.9% "TAI YU" 25.00

AA29836209 SALINE INJECTION 0.9% "N.K." (1L) 35.00

AA29836212 SALINE INJECTION 0.9% "N.K." (2L) 72.00

AA29836255 SALINE INJECTION 0.9% "N.K." (100ML) 22.00

AA29836265 SALINE INJECTION 0.9% "N.K." (250ML) 22.00

AA29836277 SALINE INJECTION 0.9% "N.K." (500ML) 25.00

AA36015345 TEIRIA GEL 100MG/GM (ETOFENAMATE)(40GM) 84.00

AA36176277 0.45% SOLUTIO NATRII CHLORIDI ISOTONICA "CHI-SHENG" 25.00

AA36418229 DOXOR LYO INJECTION 10MG 399.00

AA38330277 SODIUM CHLORIDE INJECTION 3% "Y.F." 25.00

AA39604209 SALINE INJECTION 0.45% "N.K." 35.00

AA39604265 SALINE INJECTION 0.45% "N.K." 22.00

AA39604277 SALINE INJECTION 0.45% "N.K." 25.00

AA42704100 NOBAR TABLETS 5MG (AMLODIPINE BESYLATE)28粒/鋁箔盒裝 3.84

AA43124429VOLEN OPHTHALMIC SOLUTION 0.1% "WINSTON"(DICLOFENAC

SODIUM)70.00

AA44508229 OXALIP INJECTION (10毫升/瓶裝) 1336.00

AA44508238 OXALIP INJECTION (20毫升/瓶裝) 4420.00

AA44598309 NORMAL SALINE SOLUTION "N.K." 24.10

AA44598312 NORMAL SALINE SOLUTION "N.K." 55.00

AA44598377 NORMAL SALINE SOLUTION "N.K." 18.40

AA45670100 NOVA TABLETS (28粒/鋁箔盒裝) 3.84

AA47170212 IRINO SOLUTION FOR I.V. INFUSION 1589.00

AA47170221 IRINO SOLUTION FOR I.V. INFUSION 2975.00

AA47469100 ARCDONE F.C. TABLETS 5 MG(28粒/鋁箔盒裝)。 55.00

AA47702100 ANXOKAST CHEWABLE TABLET 5MG(28粒/鋁箔盒裝) 9.30

AA47792151 LACTULOSE LIQUID "SHUN HWA"(60ML/塑膠瓶裝) 25.00

AA47813100 ANXOKAST F.C. TABLETS 10MG(28粒/鋁箔盒裝) 12.30

AA47895263 TEICOD FOR INJECTION 200MG 0.00

AA47960100 ANXOKAST CHEWABLE TABLETS 4MG(28粒/鋁箔盒裝) 9.10

AA48161145Sodium Valproate Oral Solution 200mg/ml "Center" (Sodium

Valproate)177.00

AA48161154SODIUM VALPROATE ORAL SOLUTION 200MG/ML "CENTER" (SODIUM

VALPROATE)437.00

AA48333100 GLUTAZONE TABLETS 30MG(30粒/鋁箔盒裝) 9.60

AA48334100 SMILON F.C. TABLETS 30MG(30粒/鋁箔盒裝)。 8.90

AA48352143 SERIDOL ORAL SOLUTION 1MG/ML "CENTER"(30ML/塑膠瓶裝) 548.00

AA48661100 ESCIPRO F.C. TABLETS 20 MG “D.T.” (30粒/鋁箔盒裝) 15.50

AA48730100 THROMBIFREE F.C. TABLETS 75 MG(28粒/鋁箔盒裝) 32.10

AA48757100 Candanxo F.C. Tablets 50/12.5 mg 4.11

AA48879100 ANXOLIPO F.C. TABLET 10 MG,30粒/鋁箔/膠箔盒裝 9.00

Page 50: 附件二 藥品給付品項暨支付標準表

AA49097100 AMILLIAN TABLETS 200 MG 〝D.T.〞(30粒鋁箔盒裝) 18.40

AA49116100 PIOTAS TABLETS 30 MG ”P.L.”(30粒/鋁箔盒裝) 9.60

AA49226100 ANXOLIGHTOR F.C. TABLETS 20 MG (30粒/鋁箔盒裝) 16.60

AA49288100 ANXOLIPO F.C TABLETS 40MG(30粒/鋁箔/膠箔盒裝) 20.20

AA49344100 CARVETONE F.C. TABLETS 75 MG(28粒/鋁箔盒裝) 32.10

AA49429100 U-CHU PIOZON TABLETS 30 MG(30粒/鋁箔盒裝) 9.60

AA49500100 PIOTAS TABLETS 15 MG“P.L.”(30粒/鋁箔盒裝) 6.90

AA49543100 ATORIN F.C. TABLET 10MG(28粒/鋁箔盒裝) 9.00

AA49629100 LEEYO F.C. TABLETS 10 MG(28粒/鋁箔盒裝) 9.70

AA49805100VENFAXIME S.R. CAPSULES 75MG“EVEREST”(28粒/鋁箔盒裝)

10.00

AA49920100 XADOSIN SR F.C. TABLETS 4 MG(28粒/鋁箔盒裝) 9.40

AA49930100 GLITIS TABLETS 30MG (30粒裝/鋁箔膠箔) 9.60

AA52337100 GLUFAST TABLET 10MG (84粒/鋁箔盒裝) 3.09

AA52339219BOLENIC FOR SOLUTION FOR IV INFUSION 4 MG (凍晶注射劑附

加注射用水)5433.00

AA55020219ZOBONIC LYOPHILIZED POWDER FOR SOLUTION FOR I.V.

INFUSION 4MG5433.00

AA55113206 ISOTERA CONCENTRATE FOR INFUSION 40MG/ML 3199.00

AA55113212 ISOTERA CONCENTRATE FOR INFUSION 40MG/ML 10751.00

AA55417100 EASYFOR SR CAPSULES 37.5MG(28粒/鋁箔盒裝) 8.90

AA55545261LEVOFLOXACIN I.V. SOLUTION FOR INFUSION 5MG/ML“CHI

SHENG”(玻璃瓶裝)619.00

AA55555100 ANOTROLE F.C. TABLETS 1MG“P.L.”(30粒/鋁箔盒裝)。 45.30

AA55904100 ARIZOLE TABLETS 10 MG (30粒/鋁箔盒裝) 47.30

AA56639100 ESCITALO F.C. TABLETS 10MG(28粒/鋁箔盒裝) 9.70

AA56672206 DOFOR CONCENTRATE FOR INFUSION 40MG/ML 3199.00

AA56672212 DOFOR CONCENTRATE FOR INFUSION 40MG/ML 0.00

AA56680100 OLAN ORALLY DISINTEGRATING TABLETS 5MG(28粒/鋁箔盒裝) 39.50

AA56736100 NOBELIN XR F.C. TABLETS 750MG(60粒/鋁箔盒裝) 29.40

AA56739100 ANXOLIPO F.C. TABLETS 20MG(30粒/鋁箔盒裝) 16.60

AA56761100 MIRTAZAPINE F.C. TABLETS 30MG "CYH"(30粒/鋁箔盒裝) 8.90

AA56776100 DUXETINE CAPSULES 30MG(28粒/鋁箔盒裝) 16.60

AA56787100 OKPINE F.C. TABLETS 10MG (28粒/鋁箔裝) 65.00

AA56799100 SU-CHIN FILM COATED TABLETS(28粒/鋁箔盒裝) 65.00

AA57140100 Clofree F.C. Tablets 75mg "Yu Sheng" 32.10

AA57191255 Lexacin I.V. Solution for infusion 5mg/ml "Tai Yu" 601.00

AA57213100 OLZAPINE F.C. TAB. 10MG(28粒/鋁箔盒裝) 65.00

AA57320100 ARIPIPRAZOLE TABLETS 10MG "GENOVATE"(28粒/鋁箔盒裝) 47.30

AA57321100OLAN ORALLY DISINTEGRATING TABLETS 10MG【28粒/鋁箔盒裝】

65.00

AA57322100 ENVIR F.C. TABLETS 0.5MG(30粒/鋁箔盒裝) 104.00

AA57364100 ARIPIPRAZOLE TABLETS 15MG "GENOVATE"(28粒/鋁箔盒裝) 47.30

AA57372100 PITATOR TABLETS 2MG(28粒/鋁箔盒裝) 11.90

AA57409100 UBIXA FILM COATED TABLETS 10MG (28粒/鋁箔盒裝) 65.00

AA57743100 DUXETINE CAPSULES 60MG(28粒/鋁箔盒裝) 29.50

AA57769100 GLITOS TABLETS 15MG(30粒/鋁箔盒裝) 6.90

AA57770145 DUASMA HFA 200 (BUDESONIDE 200MCG) INHALER 351.00

Page 51: 附件二 藥品給付品項暨支付標準表

AA57774100 ATOVER F.C. TAB. 10MG "P.L."(30粒/鋁箔盒裝) 9.00

AA57786100 BECAVIR F.C. TABLETS 0.5MG(30粒/鋁箔盒裝) 104.00

AA57802100 ROTY F.C. TABLETS 10MG(28粒/鋁箔盒裝) 13.40

AA57829100 Q-PINE F.C. TABLETS 100MG "TAI YU" (30粒/鋁箔盒裝) 12.10

AA57838100DOSABIN XL TABLETS 4MG "STANDARD" (DOXAZOSIN

MESYLATE)(30粒/鋁箔盒裝)9.40

AA57843100 ROTY F.C. TABLETS 5MG(28粒/鋁箔盒裝) 9.60

AA57880100 ROPICIN F.C. TABLETS 10MG(28粒/鋁箔盒裝) 13.40

AA579194E5 TRISONIN AQUEOUS NASAL SPRAY 55 MCG/DOSE 160.00

AA57950100 ATOVER F.C. TABLETS 20MG "P.L."(30粒/鋁箔盒裝) 16.60

AA57956221LEVETIR CONCENTRATE FOR SOLUTION FOR INFUSION 100MG/ML

320.00

AA57959100"UBIASIA" LAMIVUDINE FILM COATED TABLETS 150MG (60粒/塑

膠瓶裝)78.00

AA57995100OLIPINE ORALLY DISINTEGRATING TABLETS 10MG "TAI YU"(28粒

/鋁箔盒裝)65.00

AA58005209 GLUCOSE INJECTION 5% 35.00

AA58005255 GLUCOSE INJECTION 5% 22.00

AA58005265 GLUCOSE INJECTION 5% 22.00

AA58005277 GLUCOSE INJECTION 5% 25.00

AA58033238 5-FU INJECTION 50MG/ML(20ML/玻璃瓶裝)。 115.00

AA58033248 5-FU INJECTION 50MG/ML(50ML/玻璃瓶裝)。 230.00

AA58033255 5-FU INJECTION 50MG/ML(100ML/玻璃瓶裝)。 414.00

AA58055100 APA-BILY TABLETS 10MG(30粒/鋁箔盒裝) 47.30

AA58091100 LIVEPRO F.C. TABLETS 0.5MG(28粒/鋁箔盒裝) 104.00

AA58106100 Q-PINE F.C. TABLETS 200MG "TAI YU"(30粒/鋁箔盒裝) 16.30

AA58112100 AMOTEN F.C. TABLETS 5/80MG(28粒/鋁箔盒裝) 9.50

AA58181100 "LEXINPING CAPSULES 30MG "TAI YU" (28粒/鋁箔盒裝) 16.60

AA58233100 UBIXA FILM COATED TABLETS 5MG(28粒/鋁箔盒裝) 39.50

AA58268100 CANDIS TABLETS 8MG(28粒/鋁箔盒裝) 6.90

AA58282100 ROSTATIN F.C. TABLETS 10MG "STANDARD"(30粒/鋁箔盒裝) 13.40

AA58292100 LYGABA HARD CAPSULE 75MG "STANDARD"(56粒/鋁箔盒裝) 14.20

AA58542100 HEPURI F.C. TABLETS 0.5MG(30粒/鋁箔盒裝) 104.00

AA58570100 VALSOON F.C. TABLETS 5/80MG(30粒/鋁箔盒裝) 9.00

AA58628100Q-PINE XR EXTENDED-RELEASE TABLETS 200MG "TAI YU"(30粒/

鋁箔盒裝)35.70

AA58648100 PITARTY F.C. TABLETS 2MG(28粒/鋁箔盒裝) 11.90

AB01641100 CYTADINE TABLETS 4MG 1.50

AB01673100 CINNAZINE TABLETS 1.50

AB016731G0 CINNAZINE TABLETS((鋁箔/膠箔) 2.00

AB03318100 PROMERAN F.C. TABLETS 3.84MG 1.50

AB033181G0 PROMERAN F.C. TABLETS 3.84MG (鋁箔/膠箔) 2.00

AB03388100 HYDROCHLOROTHIAZIDE TABLETS "VPP" 1.50

AB033881G0 HYDROCHLOROTHIAZIDE TABLETS "VPP""(鋁箔/膠箔) 2.00

AB03389100 ACETAZOLAMIDE TABLETS 250MG "VPP" 1.50

AB03552212 PROMERAN INJECTION 15.00

AB07140100 CHLORZOXAZONE TABLETS "VPP" 1.50

AB071401G0 CHLORZOXAZONE TABLETS "VPP"(鋁箔/膠箔) 2.00

Page 52: 附件二 藥品給付品項暨支付標準表

AB07641100 DELCOPAN TABLETS 30MG 1.50

AB08642209 FUCON INJECTION 15.00

AB08774100 PONSTAN F.C. TABLETS 1.50

AB09102100 PROPRANOLOL TABLETS 10MG 1.50

AB091021G0 PROPRANOLOL TABLETS 10MG (鋁箔/膠箔) 2.00

AB13578209 "TRIAMCINOLONE SUSPENDED INJECTION 10MG ""TAI YU""" 18.90

AB13578221 "TRIAMCINOLONE SUSPENDED INJECTION 10MG ""TAI YU""" 23.80

AB13578229 "TRIAMCINOLONE SUSPENDED INJECTION 10MG ""TAI YU""" 23.80

AB14154100 ALLOPURINOL TABLETS "STANDARD" 1.50

AB141541G0 ALLOPURINOL TABLETS "STANDARD" (鋁箔/膠箔) 2.00

AB14184100 PREDNISOLONE TABLETS "WINSTON" 1.50

AB14422143 CYTADINE SYRUP 0.4MG/ML"STANDARD" 25.00

AB14422151 CYTADINE SYRUP 0.4MG/ML"STANDARD" 25.00

AB14422157 CYTADINE SYRUP 0.4MG/ML"STANDARD" 25.00

AB14914209 "TRIAMCINOLONE SUSPENDED INJECTION 4% ""TAI YU""" 20.70

AB14914221 "TRIAMCINOLONE SUSPENDED INJECTION 4% ""TAI YU""" 44.40

AB14914229 "TRIAMCINOLONE SUSPENDED INJECTION 4% ""TAI YU""" 57.00

AB15842209 CEFAZOLIN INJECTION 1GM "YUNG SHIN" 25.00

AB16887209 "ANTITUSSIVE INJECTION (DEXTROMETHORPHAN) ""TAI YU" 15.00

AB18251100 CARDIOLOL TABLETS 10MG (PROPRANOLOL) 1.50

AB182511G0 CARDIOLOL TABLETS 10MG (PROPRANOLOL)(鋁箔/膠箔) 2.00

AB19505209 BUTYSCOL INJECTION "STANDARD" (SCOPOLAMINE) 15.00

AB198751G0CARDOLOL TABLETS 40MG (PROPRANOLOL) "V.P.P."(鋁箔/膠箔)

2.00

AB19877100 EPBUTOL TABLETS "YU SHENG" (ETHAMBUTOL) 3.97

AB20333100VOREN ENTERIC COATED TABLETS "YUNG SHIN" (DICLOFENAC)

1.50

AB203331G0VOREN ENTERIC COATED TABLETS "YUNG SHIN" (DICLOFENAC)(鋁

箔/膠箔)2.00

AB20785212 VOREN INJECTION (DICLOFENAC) "YUNG SHIN" 15.00

AB20785216 VOREN INJECTION (DICLOFENAC) "YUNG SHIN" 15.00

AB21199100 SULPIRIDE CAPSULES "JOHNSON" 1.53

AB211991G0 SULPIRIDE CAPSULES "JOHNSON"(鋁箔/膠箔) 2.00

AB22345100 TAMEDIN F.C. TABLETS "STANDARD" (CIMETIDINE) 1.50

AB223451G0TAMEDIN F.C. TABLETS "STANDARD" (CIMETIDINE)(鋁箔/膠箔)

2.00

AB22903100 GASTRODIN TABLETS 200MG (CIMETIDINE) 1.50

AB229031G0 GASTRODIN TABLETS 200MG (CIMETIDINE))(鋁箔/膠箔) 2.00

AB23008100 "CIMETIN TABLETS (CIMETIDINE) ""TAI YU" 1.50

AB23037100 CARDOLOL TABLETS 10MG (PROPRANOLOL) "VPP" 1.50

AB230371G0 CARDOLOL TABLETS 10MG (PROPRANOLOL) "VPP" (鋁箔/膠箔) 2.00

AB23048209 CEZOLIN INJECTION 1GM "SWISS" 25.00

AB23435216 STAREN INJECTION "N.K." (DICLOFENAC) 15.00

AB24197100 DICLOFENAC E.F.C. TABLETS 25MG"CHINTENG" 1.50

AB241971G0 DICLOFENAC E.F.C. TABLETS 25MG"CHINTENG" (鋁箔/膠箔) 2.00

AB24516255 "SODIUM CHLORIDE INJECTION 0.9 ""TAI YU"。 22.00

AB24516265 "SODIUM CHLORIDE INJECTION 0.9 ""TAI YU"。 22.00

AB24924216 DICLOFENAC SODIUM INJECTION 25MG/ML "S.Y." 15.00

Page 53: 附件二 藥品給付品項暨支付標準表

AB25402100 SOLACON TABLETS 200MG (CHLORZOXAZONE) "STANDARD" 1.50

AB254021G0SOLACON TABLETS 200MG (CHLORZOXAZONE) "STANDARD"(鋁箔/膠

箔)2.00

AB25524100 VOREN ENTERIC COATED TABLETS 50MG "YUNG SHIN 1.50

AB255241G0VOREN ENTERIC COATED TABLETS 50MG "YUNG SHIN"(鋁箔/膠箔)

2.00

AB25682500 ECONAZOLE NITRATE SUPPOSITORIES 150MG "YUNG SHIN" 9.70

AB26442100 ANPIN CAPSULES 15MG(SEAPROSE-S) 5.60

AB26462209 PROGESTERONE INJECTION 50MG/ML "TAI YU" 15.00

AB26462229 PROGESTERONE INJECTION 50MG/ML "TAI YU" 32.90

AB26653100DIFENA ENTERIC F.C. TABLETS 25MG "STANDARD" (DICLOFENAC)

1.50

AB27082100 SECORIN CAPSULES 10MG "STANDARD"(OXAZOLAM) 1.52

AB270821G0SECORIN CAPSULES 10MG (OXAZOLAM) "STANDARD"(鋁箔/膠箔)

2.00

AB27629100 VOLBRO CAPSULES 2.5MG (BROMOCRIPTINE) 4.58

AB27812212 TAMEDIN INJECTION 100MG/ML "STANDARD"(CIMETIDINE) 15.00

AB27928212 ROSIS IV INJECTION "VPP" 15.00

AB28041100 Amiorone Tablets 200mg 4.86

AB28476100"ANTITUSSIVE TABLETS 30MG (DEXTROMETHORPHAN) ""TAI YU"

1.50

AB28576216 DIFENA INJECTION 25MG/ML "STANDARD" (DICLOFENAC) 15.00

AB28649100 SECORIN S.C.TABLET 10MG "STANDARD" (OXAZOLAM) 1.52

AB286491G0SECORIN S.C.TABLET 10MG "STANDARD" (OXAZOLAM)(鋁箔/膠箔)

2.00

AB28656500 VOREN SUPPOSITORIES 12.5MG (DICLOFENAC) 5.00

AB28921100 PICETAM CAPSULES 400MG "STANDARD" (PIRACETAM) 1.50

AB289211G0PICETAM CAPSULES 400MG "STANDARD" (PIRACETAM)(鋁箔/膠箔)

2.00

AB29447209 CEFA INJECTION 25.00

AB29447212 CEFA INJECTION 61.00

AB29447277 CEFA INJECTION 25.00

AB29478100 UROSIN FILM COATED TABLETS 100MG (ATENOLOL) 1.51

AB294781G0UROSIN FILM COATED TABLETS 100MG (ATENOLOL)(鋁箔/膠箔)

2.00

AB29551100 YUPIN CAPSULES 10MG "YU SHENG" (OXAZOLAM) 1.52

AB29581100 DICENS TABLETS 50MG (DICLOFENAC) 1.50

AB29905100 NOSPAN TABLETS 30MG (DEXTROMETHORPHAN) 1.50

AB29987100 DOMPEDON F.C. TAB. 10MG (DOMPERIDONE)"STANDARD" 1.50

AB30119100 POTARLON FILM COATED TABLETS 500MG (MEFENAMIC ACID) 1.50

AB30122100 POTARLON CAPSULES 250MG (MEFENAMIC ACID) 1.50

AB301221G0 POTARLON CAPSULES 250MG (MEFENAMIC ACID)(鋁箔/膠箔) 2.00

AB30647500 DIFENA SUPP. 12.5MG "STANDARD" (DICLOFENAC SODIUM) 5.00

AB30651500 DIFENA SUPP. 25MG "STANDARD" (DICLOFENAC SODIUM) 5.00

AB30749100 RASITOL TABLETS 40MG (FUROSEMIDE) 1.50

AB307491G0 RASITOL TABLETS 40MG (FUROSEMIDE)(鋁箔/膠箔) 2.00

AB30917100 DIFENA ENTERIC F.C.TAB. 50MG "STANDARD" (DICLOFENAC) 1.50

AB30970100 MEZIDE TABLETS 80MG (GLICLAZIDE) "M.S." 1.50

Page 54: 附件二 藥品給付品項暨支付標準表

AB30999100PETHO S.C. TABLETS 10MG (PIPETHANATE

ETHOBROMIDE)"STANDARE"1.50

AB309991G0PETHO S.C. TABLETS 10MG "STANDARE" (PIPETHANATE

ETHOBROMIDE)(鋁箔/膠箔)2.00

AB31034377 NORMAL SALINE SOLUTION "OTSUKA" 18.40

AB31086329 SEPTON SOL (BETAMETHASONE DIPROPIONATE) "SHIONOGI" 97.00

AB31138100 BEFAT F.C. TAB. 200MG "STANDARD" (BEZAFIBRATE) 3.62

AB31176500 VOREN SUPPOSITORIES 25MG (DICLOFENAC) 5.00

AB31295100 SEANTO CAPSULES 10MG (OXAZOLAM) "KOJAR" 1.52

AB312951G0 SEANTO CAPSULES 10MG (OXAZOLAM) "KOJAR"(鋁箔/膠箔) 2.00

AB31327212 VESYCA INJECTION 25MG/ML (RANITIDINE) 0.00

AB31447100 SUPERFECT FILM COATING TABLETS 50MG (DICLOFENAC) 1.50

AB31596100 LICODIN F.C. TABLET 100MG (TICLODINE) 3.53

AB31608500 DOMPEDON SUPPOSITORY 10MG "STANDARD" (DOMPERIDONE) 5.00

AB31881500 VOTALIN SUPPOSITORY 12.5MG (DICLOFENAC SODIUM) "P.L." 5.00

AB31889100HESOR TABLETS 30MG "YU SHENG" (DILTIAZEM HYDROCHLORIDE)

1.50

AB31896100MUSCO TABLETS 30MG "STANDARD" (AMBROXOL HYDROCHLORIDE)

1.50

AB318961G0MUSCO TABLETS 30MG "STANDARD" (AMBROXOL

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AB31990100 FENCAINE TABLETS 10MG (OXETHAZAINE)"Y.S." 1.50

AB319901G0 FENCAINE TABLETS 10MG (OXETHAZAINE)"Y.S." (鋁箔膠箔) 2.00

AB32309100 SOCAINE TABLET 1.50

AB323091G0 SOCAINE TABLET 2.00

AB32312100 PURFEN F.C. TABLET 400MG (IBUPROFEN) "PURZER" 1.50

AB323121G0 PURFEN F.C. TABLET 400MG (IBUPROFEN) "PURZER" 2.00

AB32315100 DUOCER F.C TABLET 200MG (CIMETIDINE) "PURZER" 1.50

AB323151G0 DUOCER F.C TABLET 200MG (CIMETIDINE) "PURZER" 2.00

AB32322100 TENOLOL F.C TABLET 100MG (ATENOLOL) "PURZER" 1.51

AB323221G0 TENOLOL F.C TABLET 100MG (ATENOLOL) "PURZER" 2.00

AB32506100PIPETO F.C. TAB. 10MG "STANDARD" (PIPERILATE

ETHOBROMIDE)1.50

AB325061G0PIPETO F.C. TAB. 10MG "STANDARD" (PIPERILATE

ETHOBROMIDE)(鋁箔/膠箔)2.00

AB32549209 STAZOLIN INJ. "STANDARD" (CEFAZOLIN) 25.00

AB32549277 STAZOLIN INJ. "STANDARD" (CEFAZOLIN) 25.00

AB32576216 PAINSTOP INJECTION 25MG/ML (DICLOFENAC) 15.00

AB32648100VESYCA FILM COATED TABLETS 150MG (RANITIDINE

HYDROCHLORIDE)0.00

AB326481G0VESYCA FILM COATED TABLETS 150MG (RANITIDINE

HYDROCHLORIDE)(鋁箔/膠箔)0.00

AB32814100 MERO TABLETS 30MG 1.50

AB32926100 DICLOFENAC E.F.C. TABLETS 50MG "CHINTENG" 1.50

AB329261G0 DICLOFENAC E.F.C. TABLETS 50MG "CHINTENG"(鋁箔/膠箔) 2.00

AB32990238 FADIN LYO-INJECTION 20MG "STANDARD" (FAMOTIDINE) 23.20

AB33029100 ATEOL F.C.TAB. 100MG (ATENOLOL) "STANDARD" 1.51

Page 55: 附件二 藥品給付品項暨支付標準表

AB330291G0ATEOL F.C. TAB. 100MG "STANDARD" (ATENOLOL) (鋁箔/膠箔)

2.00

AB33091100 LICODIN F.C.TABLET 250MG (TICLOPIDINE) 3.79

AB33128100 MEFENA F.C.TABLETS 500MG"KOJAR" 0.00

AB331281G0MEFENA F.C. TABLETS 500MG"KOJAR" (MEFENAMIC ACID)(鋁箔/

膠箔)0.00

AB33411100 ANCOU TABLETS 30MG "KOJAR" (DEXTROMETHORPHAN) 1.50

AB334111G0ANCOU TABLETS 30MG "KOJAR"(DEXTROMETHORPHAN)(鋁箔/膠箔)

2.00

AB33540100 RECEF CAPSULE 250MG (CEPHRADINE)"PURZER" 1.72

AB33541421 ORALOG ORABASE 1MG/GM (TRIAMCINOLONE)"PURZER" 28.40

AB33541423 ORALOG ORABASE 1MG/GM (TRIAMCINOLONE)"PURZER" 36.70

AB33544100 MEPHAN TABLET 30MG (DEXTROMETHORPHAN) "PURZER" 1.50

AB33545100 CLOFEN E.C TABLET 50MG (DICLOFENAC)"PURZER" 1.50

AB33546100 CLOFEN E.C TABLET 25MG (DICLOFENAC)"PURZER" 1.50

AB33571248 RND LYO-INJECTION 50MG "STANDARD" (RANITIDINE) 0.00

AB33698209 VETERIN (CEFAZOLIN) FOR INJECTION "VPP" 25.00

AB33698277 VETERIN (CEFAZOLIN) FOR INJECTION "VPP" 25.00

AB33699100VOREN ENTERIC-MICROENCAPSULATED CAPSULES 50MG

(DICLOFENAC)1.50

AB336991G0VOREN ENTERIC-MICROENCAPSULATED CAPSULES 50MG

(DICLOFENAC)(鋁箔/膠箔)2.00

AB33829100 MOTON TABLETS 500MG "YU SHENG" (MEFENAMIC ACID) 1.50

AB33945216 VOTAN INJECTION 25MG/ML 15.00

AB33947100 EMETROL TABLET 10MG (DOMPERIDONE) "PURZER" 1.50

AB339471G0 EMETROL TABLET 10MG (DOMPERIDONE) "PURZER" 2.00

AB34032209 CHEF FOR INJECTION (CEFTRIAXONE) "PURZER" 82.00

AB34032277 CHEF FOR INJECTION (CEFTRIAXONE) "PURZER" 54.00

AB34087100 RND F.C. TABLETS 150MG "STANDARD"(RANITIDINE) 0.00

AB340871G0RND F.C. TABLETS 150MG (RANITIDINE) "STANDARD"(鋁箔/膠

箔)0.00

AB34096100 GLUCOMINE F.C. TABLETS 500MG "P.L"(METFORMIN) 1.50

AB340961G0GLUCOMINE F.C. TABLETS 500MG"P.L"( (METFORMIN) 鋁箔/膠

箔)2.00

AB34331209 CEBID FOR INJECTION (CEFOPERAZONE) "PURZER" 135.00

AB34331277 CEBID FOR INJECTION (CEFOPERAZONE) "PURZER" 0.00

AB34359100 STERMIN F.C. TABLETS 100MG (ATENOLOL) "S.T." 1.51

AB343591G0STERMIN F.C. TABLETS 100MG "S.T." (ATENOLOL)(鋁箔/膠箔)

2.00

AB34364100 PENTOP S.C. TABLETS 100MG (PENTOXIFYLLINE) "Y.S" 1.50

AB34736100 GLICALIN TABLETS 80MG "KOJAR" (GLICLAZIDE) 1.50

AB347361G0 GLICALIN TABLETS 80MG "KOJAR"(GLICLAZIDE)(鋁箔/膠箔) 2.00

AB348041G0 IPROFEN TABLETS 400MG (IBUPROFEN)"MACRO"(鋁箔/膠箔) 2.00

AB35054100 LEFENINE F.C.TABLETS 50MG"C.H." (FLURBIPROFEN) 1.50

AB350541G0LEFENINE F.C.TABLETS 50MG (FLURBIPROFEN) "C.H."(鋁箔/膠

箔)2.00

AB35169500 CAMAZOLE VAGINAL TABLET 100MG (CLOTRIMAZOLE) "PURZER" 5.90

AB35179100 LEFENINE F.C. TABLETS 100MG "C.H."(FLURBIPROFEN) 2.49

Page 56: 附件二 藥品給付品項暨支付標準表

AB35665100 GLUCOMINE F.C. TABLETS 250MG (METFORMIN) "P.L." 1.50

AB356651G0GLUCOMINE F.C. TABLETS 250MG "P.L."(METFORMIN)(鋁箔/膠

箔)2.00

AB35680321 S.Z. CREAM 0.5MG/G "STANDARD" (CLOBETASOL) 11.90

AB35680329 S.Z. CREAM 0.5MG/G "STANDARD" (CLOBETASOL) 13.70

AB35833309 NORMAL SALINE SOLUTION "CHI SHENG" 24.10

AB35833377 NORMAL SALINE SOLUTION "CHI SHENG" 18.40

AB36015338 TEIRIA GEL 100MG/GM (ETOFENAMATE) 33.00

AB36082100 CERO CAPSULES 250MG (CAFACLOR) "S.T." 3.35

AB361291G0 ATENOLOL F.C. TABLETS 50MG "JOHNSON"(鋁箔/膠箔) 2.00

AB36130100 ATENOLOL F.C. TABLETS 100MG "JOHNSON" 1.51

AB361301G0 ATENOLOL F.C. TABLETS 100MG "JOHNSON" (鋁箔/膠箔) 2.00

AB36176209 0.45% SOLUTIO NATRII CHLORIDI ISOTONICA "CHI-SHENG" 0.00

AB36247100 TAMEDIN F.C. TABLET 400MG (CIMETIDINE) "STANDARD" 1.50

AB362471G0TAMEDIN F.C. TABLET 400MG (CIMETIDINE) "STANDARD"(鋁箔/

膠箔)2.00

AB36248100 L.F.N. TABLET "C.H." 100MG (FLURBIPROFEN) 2.49

AB36534100 NOOJOHN CAPSULES 400MG. (PIRACETAM) "JOHNSON" 1.50

AB365341G0NOOJOHN CAPSULES 400MG. (PIRACETAM) "JOHNSON"(鋁箔/膠箔)

2.00

AB36751209 SINTRIX FOR INJECTION 1G (CEFTRIAXONE) 82.00

AB36751212 SINTRIX FOR INJECTION 2G (CEFTRIAXONE) 363.00

AB36751277 SINTRIX FOR INJECTION 500MG (CEFTRIAXONE) 54.00

AB36788100 CAPDON TABLETS 25MG "STANDARD" (CAPTOPRIL) 1.50

AB367881G0 CAPDON TABLETS 25MG "STANDARD" (CAPTOPRIL)(鋁箔/膠箔) 2.00

AB37126221ANPO INJECTION 10MG/ML "S.T" (RITODRINE HYDROCHLORIDE)

44.40

AB37196100 ANPO TABLETS 10MG 4.15

AB37550212 AMINFEC INJECTION 125MG/ML "STANDARD" (AMIKACIN) 29.00

AB37577100 ERA TABLET 0.25MG "T.T.Y." (FLUDIAZEPAM) 1.95

AB37608100 PIRACETAM CAPSULES 400MG "KOJAR" (PIRACETAM) 0.00

AB376081G0PIRACETAM CAPSULES 400MG "KOJAR" (PIRACETAM)(鋁箔/膠箔)

0.00

AB38016100 GEM-S F.C. TABLETS 600MG "S.T." (GEMFIBROZIL) 2.46

AB38019100 VOREN SR FILM COATED TABLETS 100MG (DICLOFENAC) 2.13

AB38075351 CORTEMA ENEMA 1.667MG/ML (HYDROCORTISONE) "PURZER" 55.00

AB38213100 SINFLO F.C.TAB. 200MG 1.88

AB38288312 DEHERP CREAM 5% "STANDARD"(ACYCLOVIR) 17.30

AB38288321 DEHERP CREAM 5% "STANDARD" (ACYCLOVIR) 41.10

AB38288329 DEHERP CREAM 5% "STANDARD" (ACYCLOVIR) 42.90

AB38332100 UCLOR CAPSULES 250MG (CEFACLOR) 3.35

AB38554100 SINFLO F.C.TAB. 100MG 1.58

AB38574100 POTARLON TABLETS 250MG (MEFENAMIC ACID) 1.50

AB38600100HESOR TABLETS 60MG (DILTIAZEM HYDROCHIORIDE) "YU SHENG"

2.15

AB38605100 FADIN F.C. TABLET 20MG "STANDARD" (FAMOTIDINE) 1.59

AB386051G0FADIN F.C. TABLET 20MG (FAMOTIDINE) "STANDARD"(鋁箔/膠

箔)2.00

Page 57: 附件二 藥品給付品項暨支付標準表

AB38685100 POTARLON TABLETS 500MG (MEFENAMIC ACID) 1.50

AB38710100VESYCA FILM COATED TABLETS 300MG (RANITIDINE

HYDROCHLORIDE)0.00

AB38843212 CEFMORE INJECTION "SWISS" (CEFOXITIN SODIUM) 143.00

AB38867100 ATEOL F.C. TABLETS 50MG "STANDARD" (ATENOLOL) 1.50

AB388671G0ATEOL F.C. TABLETS 50MG "STANDARD" (ATENOLOL)(鋁箔/膠箔)

2.00

AB38927323 ZOPES CREAM 50MG/GM (ACYCLOVIR) "PURZER" 41.80

AB39013100 MECO TABLETS 30MG (DEXTROMETHORPHAN)"CHINTENG" 1.50

AB39223209 CEFULIN FOR INJECTION (CEFTAZIDIME) 39.20

AB39223212 CEFULIN FOR INJECTION (CEFTAZIDIME) 199.00

AB39223277 CEFULIN FOR INJECTION (CEFTAZIDIME) 0.00

AB39701151 LACTUL SYRUP 666MG/ML (LACTULOSE) "SINPHAR" 25.00

AB39701166 LACTUL SYRUP 666MG/ML (LACTULOSE) "SINPHAR" 105.00

AB39701177 LACTUL SYRUP 666MG/ML (LACTULOSE) "SINPHAR" 161.00

AB39894248CALCININ INJECTION 50I.U./ML (SALMON CALCITONIN)

"PURZER"88.00

AB40046100 MINOCYCINE CAP.50MG "KOJAR" 3.68

AB40116255CALCININ INJECTION 100IU/ML (SALMON CALCITONIN) "PURZER"

126.00

AB403021G0DESPUTIN TABLETS 30MG"TAI YU"(AMBROXOL HYDROCHLORIDE)(鋁

箔/膠箔)2.00

AB40517100 TENCAM F.C. TABLETS 20MG "STANDARD" (TENOXICAM) 3.59

AB40583100 GLUZIDE TABLETS 80MG "STANDARD" (GLICLAZIDE) 1.50

AB405831G0GLUZIDE TABLETS 80MG "STANDARD" (GLICLAZIDE)(鋁箔/膠箔)

2.00

AB40644100 MINOCYCLINE CAPSULES 100MG "KOJAR" 5.90

AB408351G0MEFORIN F.C. TABLETS 500MG "JOHNSON" (METFORMIN)(鋁箔/膠

箔)2.00

AB40982209 CEXITIN FOR INJECTION 1GM "PURZER" (CEFOXITIN) 67.00

AB40983100 U-Ca soft capsules 0.5mcg "SINPHAR" (Calcitriol) 4.37

AB41037229 LIPO-DOX LIPOSOME INJECTION 2MG/ML (DOXORUBICIN HCL) 12181.00

AB41226100 TRAND CAPSULES 250MG "STANDARD"(TRANEXAMIC ACID) 1.50

AB412261G0TRAND CAPSULES 250MG "STANDARD"(TRANEXAMIC ACID) (鋁箔/

膠箔)2.00

AB41233100 GLUBIN F.C. TABLET 500MG "PURZER" (METFORMIN) 1.50

AB412331G0 GLUBIN F.C. TABLET 500MG "PURZER" (METFORMIN) 2.00

AB41236151 MUSCO SOLUTION 3MG/ML "STANDARD" (AMBROXOL) 25.00

AB41236155 MUSCO SOLUTION 3MG/ML "STANDARD" (AMBROXOL) 25.00

AB41236157 MUSCO SOLUTION 3MG/ML "STANDARD" (AMBROXOL) 50.00

AB41332100 LIPDOWN CAP. 300MG "STANDARD" (GEMFIBROZIL) 1.50

AB413321G0LIPDOWN CAPSULES 300MG "STANDARD" (GEMFIBROZIL)(鋁箔/膠

箔)2.00

AB41519100 FLUPINE TABLETS 0.25MG "JOHNSON" (FLUDIAZEPAM) 1.95

AB41535100 PENTOP S.R. TABLETS 400MG "YU SHENG" (PENTOXIFYLLINE) 1.82

AB41606100 SINZAC CAPSULES 20MG "S.T." 2.80

AB41641100 NAKAMIDE F.C. TABLETS 2.5MG "N.K."(INDAPAMIDE) 1.92

Page 58: 附件二 藥品給付品項暨支付標準表

AB41654100DIFENA ENTERIC MICROENCAPSULATED CAP. 50MG "STANDARD"

(DICLOFENAC SODIUM)1.50

AB416541G0DIFENA ENTERIC MICROENCAPSULATED CAPSULES 50MG

"STANDARD"(DICLOFENAC SODIUM) (鋁箔/膠箔)2.00

AB41669100 ACEBOL F.C. TABLET 400MG (ACEBUTOLOL) "STANDARD" 5.00

AB41684238TENCAM LYOPHILIZED INJECTION 20MG "STANDARD" (TENOXICAM)

31.10

AB41956100 CARTALOC TABLETS 100MG "S.C." (METOPROLOL TARTRATE) 3.06

AB42198100 SPASPA CAPSULES 60MG (ALVERINE CITRATE)"MACRO" 1.74

AB42390245 OMEZOL LYO-INJ 40MG "STANDARD" (OMEPRAZOLE) 57.00

AB42687100 REGROW SUSTAINED RELEASE F.C. TABLET 60MG 1.98

AB42855100SAWTO ENTERIC-MICROENCAPSULATED CAPSULES 50MG "CHINTENG"

(DICLOFENAC SODIUM)1.50

AB428551G0SAWTO ENTERIC-MICROENCAPSULATED CAPSULES 50MG "CHINTENG"

(DICLOFENAC SODIUM)(鋁箔/膠箔)2.00

AB42908100 DIAMIN TABLETS 80MG "S.T." (GLICLAZIDE) 1.50

AB429081G0 DIAMIN TABLETS 80MG "S.T." (GLICLAZIDE)(鋁箔/膠箔) 2.00

AB42977100FLUX MICROENCAPSULATED CAPSULES 20MG "STANDARD"

(FLUOXETINE)2.80

AB43122151 MEPTIN LIQUID 33.90

AB43124421VOLEN OPHTHALMIC SOLUTION 0.1% (DICLOFENAC

SODIUM)"WINSTON"44.50

AB432231G0PAINSTOP ENTERIC-MICROENCAPSULATED CAPSULE 50MG "SWISS"

(DICLOFENAC SODIUM)(鋁箔/膠箔)2.00

AB43265100 SYNCON TABLET 80MG 1.50

AB432651G0 SYNCON TABLETS 80MG(鋁箔/膠箔) 2.00

AB43622100 MEPTIN TABLETS 3.06

AB43657100 EUNAC SR F.C. TABLETS 100MG 2.13

AB43680100 BUFEN TABLET 400MG 1.50

AB437001G0 MEPTIN-MINI TABLETS(鋁箔/膠箔) 2.00

AB43706100 LODITON F.C. TABLETS 500MG "STANDARD" 1.50

AB437061G0 LODITON F.C. TABLETS 500MG "STANDARD"(鋁箔/膠箔) 2.00

AB43735112BUTANYL INHALATION SOLUTION 2.5MG/ML (TERBUTALINE

SULFATE)9.40

AB43837100 DICLOFENAC S.R F.C. TABLETS 2.13

AB43847335 ZALAIN CREAM 2% 89.00

AB43852100 MIKELAN 5MG TABLETS "T.O.P." 2.82

AB43859100 USPEN TABLETS 100MG "YU SHENG" 4.55

AB43929100SALAZINE ENTERIC COATED TABLETS 500MG (SULFASALAZINE)

"S.T"2.45

AB43943412IPRATRAN INHALATION SOLUTION 0.25MG/ML

"S.T."(IPRATROPIUM BROMIDE)7.40

AB44046157 FUMIDE ORAL SOLUTION 10MG/ML "PURZER" 194.00

AB44091100 MEPHENOXALONE TABLETS 200MG "U-CHU." 1.50

AB440911G0 MEPHENOXALONE TABLETS 200MG "U-CHU."(鋁箔/膠箔) 2.00

AB44098100 FEDIL S.R TABLETS 5MG "STANDARD" 2.04

AB44122100 ACYLO TABLETS 400MG "S.T." (ACYCLOVIR) 5.60

AB44124100 PLETAAL TABLETS 100 11.30

Page 59: 附件二 藥品給付品項暨支付標準表

AB44136100 PLETAAL TAB. 50 5.50

AB44374100 YOU-JET F.C. TABLETS 50MG 6.10

AB44403100 VOREN-K SUGAR COATED TAB. 50MG "YUNG SHIN" 1.50

AB444031G0VOREN-K SUGAR COATED TABLETS 50MG "YUNG SHIN" (鋁箔/膠

箔)2.00

AB44434100 DELIBS F.C. TABLETS 50MG 5.30

AB44449100 AVERINE TABLETS 40MG 1.83

AB44451500 ZALAIN VAGINAL TABLET 93.00

AB44463100 SEMI-NAX F.C. TAB. 10MG "D.T" 1.76

AB44466221 PHYXOL INJECTION 6MG/ML "SINPHAR" 662.00

AB44466229 PHYXOL INJECTION 6MG/ML "SINPHAR" 995.00

AB44466235 PHYXOL INJECTION 6MG/ML "SINPHAR" 1116.00

AB44466240 PHYXOL INJECTION 6MG/ML "SINPHAR" 3724.00

AB44466248 PHYXOL INJECTION 6MG/ML "SINPHAR" 16418.00

AB444662E2 PHYXOL INJECTION 6MG/ML "SINPHAR" 1711.00

AB444662FG PHYXOL INJECTION 6MG/ML "SINPHAR" 1711.00

AB44468100 FELOPINE E.R F.C. TABLETS 5MG 2.04

AB44475100 AMPIN TABLETS 5MG 3.84

AB44478100 VOTAN SR F.C TABLETS 100MG 2.13

AB44482143 EXDILA LIQUID 5UG/ML "CENTER" 25.90

AB44482151 EXDILA LIQUID 5UG/ML "CENTER" 33.90

AB44482157 EXDILA LIQUID 5MCG/ML "CENTER" 111.00

AB44509143 EUFAN SOLUTION 2.5MG/ML "STANDARD" 25.00

AB44509151 EUFAN SOLUTION 2.5MG/ML "STANDARD" 25.00

AB44509157 EUFAN SOLUTION 2.5MG/ML "STANDARD" 34.60

AB44510100 EUFAN F.C TABLETS 10MG "STANDARD" 1.50

AB445101G0 EUFAN F.C TABLETS 10MG "STANDARD"(鋁箔/膠箔) 2.00

AB44607100 AMLOBIN TABLETS 5MG "STANDARD" 3.84

AB44619100 BEXOLO F.C. TABLETS 20MG "S.T" 3.72

AB44621100 DOSABIN TABLETS 2MG 1.78

AB44685100 ALPRALINE TABLETS 0.5MG "S.T" 1.50

AB446851G0 ALPRALINE TABLETS 0.5MG "S.T"(鋁箔/膠箔) 2.00

AB44829100 DELCOPAN SR F.C.T 60MG 1.98

AB44832100 TANLEEG F.C. TABLETS 500MG "S.T." (NABUMETONE) 3.23

AB44843100 UROSIN FILM COATED TABLETS 50MG (ATENOLOL) 1.50

AB448431G0 UROSIN FILM COATED TABLETS 50MG (ATENOLOL)(鋁箔/膠箔) 2.00

AB44997100VOLNA-K F.C. TABLET 25MG "STANDARD" (DICLOFENAC

POTASSIUN)1.50

AB449971G0VOLNA-K F.C. TABLET 25MG "STANDARD" (DICLOFENAC

POTASSIUM) (鋁箔/膠箔)2.00

AB45016100 OMEZOL CAP. 20MG (OMEPRAZOLE) 2.51

AB45041100 BABUROL TABLETS 10MG 2.01

AB45070100 "U-CHU" APRAZO TABLETS 0.5MG (ALPRAZOLAM) 1.50

AB450701G0 "U-CHU" APRAZO TABLETS 0.5MG (ALPRAZOLAM)(鋁箔/膠箔) 2.00

AB45150100VOLNA-K F.C. TABLET 50MG "STANDARD" (DICLOFENAC

POTASSIUM)1.50

AB451501G0VOLNA-K F.C. TABLET 50MG "STANDARD" (DICLOFENAC

POTASSIUM) (鋁箔/膠箔)2.00

Page 60: 附件二 藥品給付品項暨支付標準表

AB45279100 "U-CHU" ZODEM TABLETS 10MG 1.76

AB45305100 VOREN-K SUGAR COATED TABLETS 25MG "YUNG SHIN" 1.50

AB453051G0VOREN-K SUGAR COATED TABLETS 25MG "YUNG SHIN"(鋁箔/膠箔)

2.00

AB45348100 BISO F.C TABLETS 5 MG 2.15

AB45363100 FURIDE TABLETS 40MG "STANDARD"(FUROSEMIDE) 1.50

AB453631G0 FURIDE TABLETS 40MG "STANDARD"(FUROSEMIDE)(鋁箔/膠箔) 2.00

AB45387100 "PURZER" PROLEAK TABLETS 5MG 12.60

AB45392100FELPIN EXTENDED RELEASE TABLETS 5MG "S.T" (FELODIPINE)

2.04

AB45412100 NOOPOL F.C. TABLETS 1200MG "N.K." 1.91

AB45415151 IDEFEN SUSPENSION 20MG/ML (IBUPROFEN) 25.00

AB45415157 IDEFEN SUSPENSION 20MG/ML (IBUPROFEN) 45.10

AB45416100 POCATHMA-MINI TAB. 25MCG "STANDARD" 1.50

AB454161G0 POCATHMA-MINI TAB. 25MCG "STANDARD"(鋁箔/膠箔) 2.00

AB45438151 IDOFEN SUSPENSION 20MG/ML "STANDARD" (IBUPROFEN) 25.00

AB45438157 IDOFEN SUSPENSION 20MG/ML "STANDARD" 45.10

AB45485430 BESONIN AQUA NASAL SPRAY 100MCG/DOSE 94.00

AB45485438 BESONIN AQUA NASAL SPRAY 100MCG/DOSE 125.00

AB45492100MECATER TABLETS 25MCG (PROCATEROL HYDROCHLORIDE

HEMIHYDRATE)1.50

AB454921G0MECATER TABLETS 25MCG (PROCATEROL HYDROCHLORIDE

HEMIHYDRATE)(鋁箔/膠箔)2.00

AB45592100 U-CHU LAMOGIN TABLETS 100MG 13.80

AB45621100 FYNASID F.C TABLETS 5MG 12.60

AB45668100 VALNON E.C TABLETS "S.C." 2.75

AB45725100 LACOXA SR TABLETS 400MG 8.90

AB45844100 CLOFEN-P F.C. TABLETS 50MG 1.50

AB458441G0 CLOFEN-P F.C. TABLETS 50MG 2.00

AB45856100 VALPROTINE ENTERIC COATED TABLETS 200MG "PURZER" 2.75

AB45955100 NAKAMIDE SR TABLETS 1.5MG "N.K" 1.75

AB45961100 VALOSINE TABLET 37.5MG (VENLAFAXINE HYDROCHLORIDE) 5.20

AB45993100 ACTEIN EFFERVESCENT TABLETS 600MG 5.40

AB46016100 TAMLOSIN S.R. CAPSULES 0.2MG "STANDARD" 5.60

AB46029100 PRATIN TABLETS 10MG "S.T" (PRAVASTATIN SODIUM) 5.70

AB46074100 GLUSAFE TABLETS 2MG (GLIMEPIRIDE) 1.95

AB46145100 ALEPAN TABLETS 15MG 3.13

AB46173151 PROCAROL LIQUID 5UG/ML 33.90

AB46184100 TOPEE F.C. TABLETS 150MG 1.61

AB461841G0 TOPEE F.C. TABLETS 150MG(鋁箔/膠箔) 2.00

AB46237100 CILOPA F.C TABLETS 20MG "S.C" 7.10

AB46242151 WEMPTY SUSPENSION "CENTER" 1MG/ML 25.60

AB46283100 ICOMEIN CAPSULE 100MG "EVEREST" 17.80

AB46315100LOSART F.C. TABLETS 50MG "STANDARD" (LOSARTAN POTASSIUM)

4.11

AB46480100 STAPIN S.R. TABLETS 5MG 2.04

AB46524100 DIPACHRO S.R. FILM COATED TABLETS 500MG 5.90

AB46613100 U-CHU TONEC TABLETS 100MG (ACECLOFENAC) 3.29

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AB46620100 SUPERNIDE TABLETS 1MG "YU SHENG" 2.09

AB46639457 HEBIS AQUA NASAL SPRAY 64 MCG/DOSE 126.00

AB46646100 POZOLA ENTERIC F.C. TABLETS 40MG "S.C." 10.10

AB46656100 CALIFE TABLETS 15MG "N.K." 9.10

AB46658100 KLUDONE MR TABLETS 30MG 1.65

AB46661100 DISARTAN CAPSULES 80MG "KINGDOM"(VALSARTAN) 6.00

AB46742100 AMTREL TABLETS 9.60

AB46749100 EPILRAMATE F.C. TABLETS 100MG 23.20

AB46766100 GLIMARYL TABLETS 2MG (GLIMEPIRIDE) 1.95

AB46991157 MEGEST ORAL SUSPENSION 40MG/ML 683.00

AB46991164 MEGEST ORAL SUSPENSION 40MG/ML 1735.00

AB47003221 EPICIN INJECTION 407.00

AB47003229 EPICIN INJECTION 990.00

AB47003240 EPICIN INJECTION 2311.00

AB47070100 GLU-A TABLET 80MG (GLICLAZIDE) 1.50

AB470701G0 GLU-A TABLET 80MG (GLICLAZIDE)(鋁箔/膠箔) 2.00

AB47071209 KOP INJECTION 17.00

AB47079100 U-CHU LAMOGIN TABLETS 50MG 10.10

AB47147100 PICETAM F.C. TABLETS 1200MG "STANDARD" (PIRACETAM) 1.91

AB47172100 AMEPIRIDE TABLETS 2.0MG 1.95

AB47228100 FENOLIP-U TABLETS 160MG "C.H." 3.92

AB47273100 VENFORSPINE XR CAPSULES 75MG 10.00

AB47294100 APA-RISDOL F.C. TABLETS 2MG 7.70

AB47310100 DOMTOO F.C. TABLETS 10MG (DOMPERIDONE) 1.50

AB473101G0 DOMTOO F.C. TABLETS 10MG (DOMPERIDONE)(鋁箔/膠箔) 2.00

AB47348100 VATATIN F.C. TABLETS 20MG "STANDARD" 3.58

AB47368100 LANXO CAPSULES 30MG 10.00

AB47372100 INDAP S.R. TABLETS 1.5MG "STANDARD" 1.75

AB47407100 APA-RISDOL F.C. TABLETS 3MG 20.30

AB47419100 APA-RISDOL F.C. TABLETS 1MG 6.80

AB47472100 ABUTOL F.C. TABLETS 400MG (ACEBUTOLOL) 5.00

AB47477100 GATINE CAPSULES 300MG 7.90

AB47516100 CRAVIT F.C. TAB 500MG 20.90

AB47532100 ANSURES EXTENDED RELEASE TABLETS 1.54

AB475321G0 ANSURES EXTENDED RELEASE TABLETS(鋁箔/膠箔) 2.00

AB47538100 BISOL FILM COATED TABLETS 5MG(BISO PROLOL FUMARATE) 2.15

AB47539100 ANAZO F.C. TABLETS 45.30

AB47553100 DEPATEC 500 MG FILM.COATED.TABLETS"PURZER" 5.90

AB47557229 EPICIN LYO INJECTION 10MG 0.00

AB47629100 TAMSO SR CAPSULES 0.2MG 5.60

AB47656100 MOPRIDE F.C. TABLETS 5MG 1.75

AB47671100 Glubose Tablet 50mg 2.27

AB47689100 Neurtrol F.C. Tablets 300mg 7.80

AB47792166 Lactulose Liquid "SHUN HWA" 105.00

AB47792177 Lactulose Liquid "SHUN HWA" 161.00

AB47811100 TAGLU F.C. TABLETS 100MG 4.69

AB47848100 TAGLU F.C. TABLETS 50MG 2.27

AB47872223 GEMMIS INJECTION 38 MG/ML 598.00

Page 62: 附件二 藥品給付品項暨支付標準表

AB47872243 GEMMIS INJECTION 38 MG/ML 2854.00

AB47882206 TYXAN INJECTION 3199.00

AB47882212 TYXAN INJECTION 10751.00

AB47945100 PBF Mobicam Tablets 7.5mg 1.72

AB47979265 BOJUM INTRAVENOUS INJECTION 0.25G 281.00

AB47979277 BOJUM INTRAVENOUS INJECTION 0.5G 284.00

AB47981100 Acarose Tablets 50mg "Standard" (Acarbose) 2.27

AB47984100 CARLIPIN TABLETS 50MG 2.27

AB47991100 ANXOFIN F.C TABLETS 850MG 1.68

AB48027100 RIBARIN CAPSULES 10.80

AB48089100 DIAMIN MR TABLETS 30MG (GLICLAZIDE) 1.65

AB48130100 C.T.L. XR TABLETS 500MG "C.H." 1.54

AB48190100 Gastroloc Gastro-resistant Tablets 40mg 10.10

AB48229100 ANXOKEN F.C. TABLETS 1000MG 1.75

AB48329248 EPICIN LYO INJECTION 50MG 2311.00

AB48351100 RISPAL F.C TABLETS 2MG 7.70

AB48439100 PURCON F.C TABLETS 5MG 2.15

AB48484100 Glucomin X.R. Tablets 500mg "P.L." 1.58

AB484841G0 GLUCOMIN X.R. TABLETS 500MG "P.L."(鋁箔/膠箔) 2.00

AB48506100 EPRAM TABLETS 10MG 9.70

AB48507100 EPILRAMATE FILM-COATED TABLETS 25MG 5.50

AB48586100PAVATIN PROTECT TABLETS 20MG "STANDARD" (PRAVASTATIN

SODIUM)5.90

AB48644100 MECHOL TABLETS 20MG "YUNG SHIN" 5.90

AB48681100 PAVADIN TABLETS 20MG 5.90

AB48699209 KTOLAC INJECTION 30MG/ML (KETOROLAC) 17.00

AB48747100 MIRTAN TABLETS 30MG "UNION" 8.90

AB48751265 PENEM FOR I.V. INJECTION 187.00

AB48751277 PENEM FOR I.V. INJECTION 275.00

AB48802265 YOUNAM POWDER FOR IV INJECTION 187.00

AB48802277 YOUNAM POWDER FOR IV INJECTION 275.00

AB48836100 RAPMITEC TABLETS 10MG 5.10

AB48878100 VAKIN CHRONO FILM COATED TABLETS 500 MG 5.90

AB48909100 ANSUZOLE F.C TABLETS 1MG 45.30

AB48911265 BESTNEM POWDER FOR I.V. INJECTION 187.00

AB48911277 BESTNEM POWDER FOR I.V. INJECTION 275.00

AB48969100 THADO CAPSULES 50 MG 229.00

AB48991100 NIRANDIL TABLETS 5 MG (NICORANDIL) “STANDARD” 2.89

AB48993245 PANE FOR IV INJECTION 119.00

AB49011100 FUNNIX SR TABLETS 150MG 11.70

AB49012100 RISDAL F.C. TABLETS 2MG 7.70

AB49021100 PRATIN TABLETS 20 MG 5.90

AB49053143 POCATHMA LIQUID 5UG//ML“STANDARD” 25.90

AB49053151 POCATHMA LIQUID 5UG/ML“STANDARD” 33.90

AB49053157 POCATHMA LIQUID 5UG/ML“STANDARD” 0.00

AB49110100 NIDIL TABLETS 5 MG“S.C.” 2.89

AB49143100 DEHYPOTIN PROTECT TABLETS 40MG 14.10

AB49145100 LAXYMIG ER TABLETS 500 MG "LOTUS" 5.90

Page 63: 附件二 藥品給付品項暨支付標準表

AB49147209 SUPECEF POWDER FOR INJECTION 242.00

AB49147212 SUPECEF POWDER FOR INJECTION 450.00

AB49147277 SUPECEF POWDER FOR INJECTION 151.00

AB49165100 ANXOPONE F.C. TABLETS 200MG 17.20

AB49189100 LOATA TABLETS 50 MG 5.50

AB49225100 GLIMED MR TABLETS 30MG 1.65

AB49240100 SMILON F.C TABLETS 15MG 5.10

AB49342100 URNAL S.R.F.C. TABLETS 0.2 MG 5.60

AB49446100 CARBATIN F.C. TABLETS 800 MG 19.20

AB49454100 PRATIN TABLETS 40 MG (PRAVASTATIN SODIUM) 14.10

AB49457100 GLUCOFIT ER TABLETS 500 MG ”SWISS” 1.54

AB494571G0 GLUCOFIT ER TABLETS 500 MG ”SWISS”(鋁箔/膠箔) 2.00

AB49466100 GLICLAX SUSTAINED RELEASE TABLETS 30MG 1.65

AB49503100 DEHYPOTIN PROTECT TABLETS 20MG 5.90

AB49518100 NEUROQUEL F.C. TABLETS 100MG 12.10

AB49532100 SUPERNIDE TABLETS 2MG ”YUSHENG” 2.49

AB49551100 LINLIP MICRONISED CAPSULES 200MG”CHINTENG” 3.92

AB49556100 YOU-JET F.C. TABLETS 100 MG 11.80

AB49581100 PIOSUGAR TABLETS 30 MG 9.60

AB49599100 BETAFORM TABLETS 850MG ”M.T.”(METFORMIN) 1.68

AB49656100 MIRTAPINE ORALLY DISINTEGRATING TABLETS 30MG 8.90

AB49696100 LEFLODAL F.C. TABLETS 500 MG 20.90

AB49719100 CLOPID F.C. TABLETS 75 MG“P.L.” 32.10

AB49735265 MEPENEM POWDER FOR INTRAVENOUS INJECTION 281.00

AB49735277 MEPENEM POWDER FOR INTRAVENOUS INJECTION 284.00

AB49742100 HILOCA F.C. TABLETS 200MG 16.30

AB49770221 NOESIN INJECTION“TAI YU”(PIRACETAM) 15.00

AB49770229 NOESIN INJECTION“TAI YU”(PIRACETAM) 28.20

AB49905100AZOSIN S.R. TABLETS 10 MG“STANDARD”(ALFUZOSIN

HYDROCHLORIDE)5.80

AB49969100 AMLOBIN TABLETS 10 MG“STANDARD” 3.84

AB49977209 YUPIME POWDER FOR INJECTION 242.00

AB49977212 YUPIME POWDER FOR INJECTION 450.00

AB49977277 YUPIME POWDER FOR INJECTION 151.00

AB50006100 ALFUZO XL TABLETS 10 MG“S.C.” 5.80

AB50115100 QUETIALIN F.C. TABLETS 25MG“KINGDOM” 7.30

AB50154100 IMMUFINE CAPSULES 250MG 41.30

AB50168100 HOLIGIN S.R. CAPSULES 0.2MG 5.60

AB50204100 CHME CAPSULES 100MG“WECAM” 17.80

AB50206151 PIRACETAM ORAL SOLUTION“CENTER” 28.20

AB50206157 PIRACETAM ORAL SOLUTION“CENTER” 48.70

AB50206163 PIRACETAM ORAL SOLUTION“CENTER” 76.00

AB50206164 PIRACETAM ORAL SOLUTION“CENTER” 92.00

AB50227100 AMBRO SR TABLETS 75MG“C.H.” 1.77

AB50240100 LOWTEN F.C. TABLETS 50 MG 4.11

AB50256209 MEROXIN POWDER FOR INJECTION 525.00

AB50256265 MEROXIN POWDER FOR INJECTION 0.00

AB50256277 MEROXIN POWDER FOR INJECTION 284.00

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AB50343209 MELOPEN POWDER FOR INJECTION 1G 525.00

AB50343265 MELOPEN POWDER FOR INJECTION 0.25G 281.00

AB50343277 MELOPEN POWDER FOR INJECTION 0.5G 284.00

AB50431100HISART F.C. TABLETS 50/12.5MG“STANDARD”(LOSARTAN

POTASSIUM AND HYDROCHLOROTHIAZIDE)4.11

AB51029100 SYNTACE TABLETS 10 MG 5.10

AB51526245 OMEZOL I.V. INFUSION 40MG“STANDARD”(OMEPRAZOLE) 57.00

AB515971G0 MIROBECT TABLET 50 (鋁箔/膠箔) 2.00

AB51714100 MIGBOSE F.C. TABLETS 50MG “STANDAED” (MIGLITOL) 3.39

AB51728100 “Purzer” Purtraline Film Coated Tablet 50mg 6.10

AB51732100 ATORIN F.C. TABLETS 40MG 20.20

AB52308100 REGLIDE TABLETS 1 MG 2.09

AB52446100 QUETIALIN F.C. TABLETS 200MG“KINGDOM”(QUETIAPINE) 16.30

AB52462100 SMARTGEN TAB. 2 MG 2.72

AB52485100 LVTANGSU TABLETS 500MG“KOJAR” 1.50

AB524851G0 LVTANGSU TABLETS 500MG“KOJAR”(鋁箔/膠箔) 2.00

AB52548100 TONLIEF F.C. TABLETS 100MG (ACECLOFENAC) 3.00

AB52615100 LEVOCIN F.C. TABLETS 100MG"P.L." 3.21

AB54966100 Prinwin Tablets 8mg 9.40

AB54967100 ATOVER F.C. TABLETS 40 MG“P.L.” 20.20

AB54977100 BUPORIN SUSTAINED-RELEASE TABLETS 150MG 11.70

AB55028100 IRBETAN F.C. TABLETS 150 MG 5.40

AB55041100 NEUROQUEL F.C. TABLETS 25MG 7.30

AB55057100 HILOCA F.C. TABLETS 300 MG 30.80

AB55103100 QUEPINE F.C. TABLET 200MG 16.30

AB55108100 NARGIN F.C. TABLETS 5MG 3.05

AB55244100 HILOCA F.C. TABLETS 25 MG 7.30

AB55258100 LVTANGSU TABLETS 250MG“KOJAR” 1.50

AB552581G0 LVTANGSU TABLETS 250MG“KOJAR”(鋁箔/膠箔) 2.00

AB55264209 MEROBIOTIC POWDER FOR IV INJECTION“SLC”1.0GM 525.00

AB55264265 MEROBIOTIC POWDER FOR IV INJECTION“SLC”250MG 281.00

AB55264277 MEROBIOTIC POWDER FOR IV INJECTION“SLC”500MG 284.00

AB55275100 GLUFIT TABLETS 30 MG“YU SHENG” 9.60

AB55276277 IMIBIOTIC POWDER FOR I.V. INJECTION“SLC” 0.00

AB55298100 KOTANG X.R. TABLETS 500 MG 1.58

AB55406100 SINBISOL FILM COATED TABLETS 5 MG 2.15

AB55536100 Sinlukast Chewable Tablets 5mg(Montelukast) 9.30

AB55547100 DIVAPRODIUM E.C. TABLETS 500MG“SC” 7.40

AB55553343 CALSKIN OINTMENT 461.00

AB55557100 DECPRESS FILM COATED TABLETS 160MG“STANDARD” 7.30

AB55560100 KLUDONE MR TABLETS 60MG 2.91

AB55564100 MOSAD TABLETS 5 MG (MOSAPRIDE) 1.75

AB55582100 DIVOSHOT EXTENDED-RELEASE TABLETS 500MG“TWI” 0.00

AB55585100 DECPRESS FILM COATED TABLETS 80MG “STANDARD” 6.00

AB55931100 ZOSATAN FILM COATED TABLETS 50 MG 4.11

AB55954100FEXODINE F.C. TABLETS 60MG“STANDARD”(FEXOFENADINE

HYDROCHLORIDE)1.80

AB55966220 TAPI MYCIN LYO-INJECTION 226.00

Page 65: 附件二 藥品給付品項暨支付標準表

AB559662CX TAPI MYCIN LYO-INJECTION 136.00

AB55984100 BISOL F.C. TABLETS 1.25MG 2.01

AB55990100 MOSA F.C. TABLETS 5MG 1.75

AB55991100 MECATER TABLETS 50 MCG 3.06

AB56626100 LFLOCIN F.C. TABLETS 500MG 20.90

AB56661100 LODITON FILM-COATED TABLETS 850MG "STANDARD" 1.68

AB56670100 VOSAA F.C. TABLETS 80MG 6.00

AB56697100 IRBEPROVEL F.C. TABLETS 150MG 5.40

AB56698343 ZALAIN EXTERNAL GEL 2% 164.00

AB56718100 Aripizole Tablets 10mg 47.30

AB56724100 QUIAPINE F.C. TABLETS 100MG 12.10

AB56731209 CEFEPIN POWDER FOR IV INJECTION 242.00

AB56731212 CEFEPIN POWDER FOR IV INJECTION 450.00

AB56731277 CEFEPIN POWDER FOR IV INJECTION 0.00

AB56756100 LIFORMIN TABLETS 500MG 1.50

AB567561G0 LIFORMIN TABLETS 500MG(鋁箔/膠箔) 2.00

AB56773100 DIVAPRODIUM E.C. TABLETS 250MG "SC" 3.78

AB56774100 PANHO ENTERIC F.C. TABLETS 40MG 10.10

AB56782100 BUPION SR TABLETS 150MG 11.70

AB57103100 LOSARTAN F.C. TABLETS 50MG "CYH" 4.11

AB57107100 PROMONE 100MG SOFT CAPSULES "P.L." 6.30

AB57116100 LOSARZIDE F.C. TABLETS 50/12.5MG 4.11

AB57178100 APROTAN F.C. TAB. 150MG "STANDARD" 5.40

AB57191248 Lexacin I.V. Solution for infusion 5mg/ml "Tai Yu" 376.00

AB57194100 ROZININ F.C. TABLETS 10MG 13.40

AB57204100 IRBETAN F.C. TABLETS 300MG 9.10

AB57206100 TAMSULOSIN S.R. CAPSULES 0.2MG "CYH" 5.60

AB57217100 GLUCOFIT ER TABLETS 750MG "SWISS" 1.59

AB572171G0 GLUCOFIT ER TABLETS 750MG "SWISS"(鋁箔/膠箔) 2.00

AB57225100 REPAGLINIDE TABLETS 1MG "CYH" 2.09

AB57234100 OLSAA F.C. TABLETS 20MG 7.30

AB57237100 LOSA&HYDRO F.C. TABLETS 50/12.5MG "CYH" 4.11

AB57240209 TYNEN INJECTION 3199.00

AB57240219 TYNEN INJECTION 10751.00

AB57254100 MOSAPIN F.C. TABLET 5MG "STANDARD" (MOSAPRIDE) 1.75

AB57263100 DEVENLOFE S.R. CAPSULES 75MG 10.00

AB57275100 RISPERIDONE F.C. TABLETS 2MG "CYH" 7.70

AB57312100 ACARBOSE F.C. TABLETS 50MG "CYH" 2.27

AB57327100 RELINIDE TABLETS 2MG "STANDARD" (REPAGLINIDE) 2.49

AB57337100 ANBUTRINE XL 300MG TABLETS 33.90

AB57343100 VOSAA F.C. TABLETS 160MG 7.30

AB57351100 ZHIKUI GASTRO-RESISTANT TABLETS 40MG 10.10

AB57361100 LOSIN S.R. TABLETS 400MG 8.90

AB57367100 BAMROL TABLETS 10MG 2.01

AB57415100 DISARTAN CAPSULES 160MG "KINGDOM" (VALSARTAN) 7.30

AB57426100 Sinlukast F.C. Tablets 10mg (Montelukast) 12.30

AB57427100 BYRAXO F.C. TABLETS 10MG 0.00

AB57733100 ARIZOLE TABLETS 15MG 47.30

Page 66: 附件二 藥品給付品項暨支付標準表

AB57737100 DIVOSHOT EXTENDED-RELEASE TABLETS 250 MG "TWI" 4.01

AB57740100 ALPRAZOLAM TABLETS 0.5MG "CYH" 1.50

AB577401G0 ALPRAZOLAM TABLETS 0.5MG "CYH"(鋁箔/膠箔) 2.00

AB57759100 RELUNG F.C. TABLETS 20MG 176.00

AB57772100 ATORSTIN FILM COATED TABLETS 40MG 20.20

AB57783248 TIGELIN LYOPHILIZED POWDER FOR INJECTION 50MG 1297.00

AB57839100 LEVOFLOXACIN F.C. TABLET 750MG "P.L." 47.30

AB57845100 GLIMEPINE TABLETS 2MG 1.95

AB57848100 FLUOXETINE CAPSULES 20MG "CYH" 2.80

AB57850100 Quepine F.C. Tablet 100mg 12.10

AB57864100 HEIPO F.C. TABLETS 300MG "EVEREST" 9.10

AB57879100 BYRAXO F.C. TABLETS 5MG 0.00

AB57892100 QUIAPINE F.C. TABLETS 25MG 7.30

AB57923100 LAVUDIN F.C. TABLETS 100MG "STANDARD" (LAMIVUDINE) 0.00

AB57926100 QUIAPINE F.C. TABLETS 200MG 16.30

AB57940100 ROSULATOR F.C. TABLETS 10MG "S.C." 13.40

AB57963100 ANBUTRINE XL 150MG TABLETS 11.70

AB57966100 PINTON SR TABLETS 400MG "C.H." 8.90

AB57967100 ATORSTIN FILM COATED TABLETS 10MG 9.00

AB57982248 Ampholipad Liposome for Injection 50mg 5523.00

AB57991100 Bensau Soft Capsules 200mg "Lotus" 3.12

AB57992248 LIPO-AB FOR INJECTION 5523.00

AB58005238 GLUCOSE INJECTION 5% 15.00

AB58049100 ATORSTIN FILM COATED TABLETS 20MG 16.60

AB58065209 DOCE INJECTION 20MG/ML, 1ML/VIAL 3199.00

AB58071100 GLIMET F.C. TABLETS 2/500MG 2.89

AB58075100 ADAPINE S.R.F.C. TAB. 30MG "STANDARD" 5.10

AB58173100 KETOFAN S.R. CAPSULES 200MG 4.75

AB58253100 CIPROGEN F.C. TABLETS 250MG 5.10

AB58278100 CINSUTON TABLETS 5MG 3.84

AB58280100 METFOPIN F.C. TABLETS 500MG 1.50

AB582801G0 METFOPIN F.C. TABLETS 500MG(鋁箔/膠箔) 2.00

AB58303100 U-CHU CASODOL TABLETS 250MG 2.17

AC00015421 YEN KUANG EYE DROPS 12.00

AC00059100 DIAPIN TABLETS 2MG (DIAZEPAM)"PINE LAWER" 1.50

AC000591G0 DIAPIN TABLETS 2MG (DIAZEPAM)"PINE LAWER"(鋁箔/膠箔) 2.00

AC00060100 DIAPIN TABLETS 5MG (DIAZEPAM) "PINE LAWER" 1.50

AC000601G0 DIAPIN TABLETS 5MG (DIAZEPAM) "PINE LAWER"(鋁箔/膠箔) 2.00

AC00106100 ERYTHROMYCIN CAPSULES 250MG "KINGDOM" 1.77

AC00118100 EPHEDRINE HCL TABLETS 25 MG "F.Y." 1.50

AC001181G0 EPHEDRINE HCL TABLETS 25 MG "F.Y."(鋁箔/膠箔) 2.00

AC00119100 DL-METHYLEPHEDRINE HCL TABLETS 25.MG "F.Y." 1.50

AC00162100 SUYI TABLETS "HEALTH" 1.50

AC001621G0 SUYI TABLETS "HEALTH"(鋁箔/膠箔) 0.00

AC00178100 APREZIN TABLETS "JOHNSON" 1.50

AC001781G0 APREZIN TABLETS "JOHNSON"(84粒/瓶) 2.00

AC00263209 DEXTROSE AND SODIUM CHLORIDE INJECTION "Y.F." 0.00

AC00263277 DEXTROSE AND SODIUM CHLORIDE INJECTION "Y.F." 25.00

Page 67: 附件二 藥品給付品項暨支付標準表

AC00373100 PELITIN CAPSULES 1.50

AC00420100 REIZER S.C. TABLETS 100 MG "F.Y." 1.50

AC00480209 ADRENALIN INJECTION 15.00

AC00605321 FLUCORT-F OINTMENT 0.025% 34.90

AC00639100 TRYNOL S.C. TABLETS 25MG "JOHNSON" 1.50

AC006391G0 TRYNOL S.C. TABLETS 25MG "JOHNSON" (鋁箔/膠箔) 2.00

AC00647100 CYTADINE 2MG TABLETS(CYPROHEPTADINE) 1.50

AC00649100 TRYNOL S.C. TABLETS 10MG 1.50

AC00655100 AMINOPHYLLINE TABLETS 0.1GM "F.Y." 1.50

AC00844100 TRANCOLON F.C. TABLETS 7.5MG (MEPENZOLATE BROMIDE) 1.50

AC008441G0TRANCOLON F.C. TABLETS 7.5MG (MEPENZOLATE BROMIDE)(鋁箔/

膠箔)2.00

AC00849100 ERYTHROMYCIN ESTOLATE CAPSULES "LITA" 1.77

AC00863100 ISOXINE TABLETS 1.50

AC00913100 DECANS TABLETS "C.M." 1.50

AC01041100 SANTIN TABLETS 1.50

AC01047100 URETROPIC TABLETS 1.50

AC010471G0 URETROPIC TABLETS(鋁箔/膠箔) 2.00

AC01154100 INDOY CAPSULES 1.50

AC011541G0 INDOY CAPSULES(鋁箔/膠箔) 2.00

AC01177100 LITALON TABLETS "LITA" 2.22

AC01386500 INDOMEN SUPPOSITORIES "YUNG SHIN" 5.00

AC01400100 PROPHYLLIN TABLETS"T.F." 1.50

AC01577100 TRIPYLINE TABLETS 25MG"HL" 1.50

AC01604212 HOROMPELIN INJECTION "TBC" 15.00

AC01624100 GLYCYRRHIZA AND OPIUM COMPOUND TABLETS 1.50

AC016241G0 GLYCYRRHIZA AND OPIUM COMPOUND TABLETS (鋁箔/膠箔) 2.00

AC01662100 AMINOPHYLLINE TABLETS 100MG "JOHNSON" 1.50

AC016621G0 AMINOPHYLLINE TABLETS 100MG "JOHNSON"(鋁箔/膠箔) 2.00

AC01691100 PULIN S.C. TABLETS 1.50

AC01735100 KAPIN S.C. TABLETS "YU SHENG" 1.50

AC01741100 ASPARA-CA TABLETS 1.50

AC01779100 MEDESONE TABLETS "Y.K." 1.50

AC01781100 VANMESON TABLETS 1.50

AC01799100 WE-WANG TABLETS 1.50

AC01806100 PROPRANOLOL TABLETS 40MG 1.50

AC01816100 VANTYL TABLETS 1.50

AC01832209 DEMETHOR INJECTION "CHI SHENG" 15.00

AC01853277 AMPOLIN INJECTION 500MG 25.00

AC01923229 CALCIUM GLUCONATE INJECTION "CHI SHENG" 15.00

AC01941100 PERZIN F.C. TABLETS "YU SHENG" 1.50

AC019411G0 PERZIN F.C. TABLETS "YU SHENG"(鋁箔/膠箔) 2.00

AC01946100 PREVOMIC S.C. TABLETS 1.50

AC019461G0 PREVOMIC S.C. TABLETS(鋁箔/膠箔) 2.00

AC01963100 FULICLIN TABLETS 1.52

AC019631G0 FULICLIN TABLETS(鋁箔/膠箔) 2.00

AC02101100 PERONE S.C. TABLETS "JOHNSON" 1.50

AC02112100 UROBENIN S.C. TABLETS 1.50

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AC02242100 UNSULON TABLETS "CHINTENG" 2.22

AC02244100 JINLUN TABLETS "CHINTENG" 1.50

AC022441G0 JINLUN TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC02314212 DIANZEM INJECTION "Y.Y." 15.00

AC02320100 ALEVIATIN TABLETS 1.50

AC023201G0 ALEVIATIN TABLETS(鋁箔/膠箔) 2.00

AC02321212 BUSCOMINE INJECTION 15.00

AC02328100 BOMIT TABLETS "C.C.P." 1.50

AC02359100 PREDNISOLONE TABLETS "YU SHENG" 1.50

AC02368100 NADIS TABLETS 1.50

AC023681G0 NADIS TABLETS(鋁箔/膠箔) 2.00

AC02394238 PAMPARA INJECTION 130.00

AC02444100 ANCILLIN CAPSULES 500MG 1.50

AC02573100 SKELAXINE TABLETS 1.50

AC025731G0 SKELAXINE TABLETS(鋁箔/膠箔) 2.00

AC02581277 CHIAMINE-S INJECTION 71.00

AC02589100 DIPORAX S.C. TABLETS 1.62

AC02626100 PROSTEN CAPSULES 1.50

AC02644100 TONIPIN TABLETS "YU SHENG" 1.50

AC02657209 PROGESTERONE INJECTION 2.5% "ASTAR" 15.00

AC02756100 YAJUNLO TABLETS "YU SHENG" 1.50

AC02763100 PHENYTOIN TABLETS "JOHNSON" 1.50

AC027631G0 PHENYTOIN TABLETS "JOHNSON"(84粒/瓶) 2.00

AC027631GA PHENYTOIN TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

AC02801209 LACTATED RINGER'S B INJECTION "Y.F." 35.00

AC02801277 "LACTATED RINGER'S B INJECTION ""Y.F.""" 25.00

AC02844100 DL-METHYLEPHEDRINE HCL TABLETS "YU SHENG" 1.50

AC02846100 WANSE S.C. TABLETS "YU SHENG" 1.50

AC028461G0 WANSE S.C. TABLETS "YU SHENG"(鋁箔/膠箔) 2.00

AC02863100 GLIBEN TABLETS 1.50

AC028631G0 GLIBEN TABLETS(鋁箔/膠箔) 2.00

AC02904100 CYPRODIN TABLETS 1.50

AC02915100 ESUMIN S.C. TABLETS "YU SHENG" 1.50

AC02938100 MEDAZEPAM CAPSULES 1.50

AC02947100 SHITON S.C. TABLETS "YU SHENG" 1.66

AC029471G0 SHITON S.C. TABLETS "YU SHENG"(鋁箔/膠箔) 2.00

AC02956100 YONG WANG CAPSULES "T.F." 1.93

AC02962100 PREIN TABLETS "T.F." 1.50

AC02963100 CALCIUM GLUCONATED 1.50

AC029631G0 "ZM"CALCIUM GLUCONATED TABLETS 2.00

AC029631G5 "ZM"CALCIUM GLUCONATED TABLETS(84粒/瓶) 2.00

AC03084100 FUZIN CAPSULES "LITA" 1.50

AC03086100 DEXAMETHASONE TABLETS "Y.S." 1.50

AC030861G0 DEXAMETHASONE TABLETS "Y.S."(鋁箔/膠箔) 2.00

AC03098100 DITHIAZIDE TABLETS 1.50

AC030981G0 DITHIAZIDE TABLETS(鋁箔/膠箔) 2.00

AC03171100 DECALON TABLETS "YU SHENG" 1.50

AC03206100 PASSTON CAPSULES 1.50

Page 69: 附件二 藥品給付品項暨支付標準表

AC03224100 SUROLE CAPSULES 3.26

AC03243100 TRANTHISON TABLETS "YU SHENG" 1.50

AC03244100 ROUMIN TABLETS "YU SHENG" 1.50

AC03245100 EARMIN TABLETS "YU SHENG" 1.50

AC032451G0 EARMIN TABLETS "YU SHENG"(鋁箔/膠箔) 2.00

AC03266100 D.X. CAPSULES "LITA" 1.50

AC03286100 HYLOMYCIN CAPSULES 250MG "SWISS" 1.77

AC032861G0 HYLOMYCIN CAPSULES 250MG "SWISS"(鋁箔/膠箔) 2.00

AC03291100 PINSAUN TABLETS "YU SHENG" 1.50

AC032911G0 PINSAUN TABLETS "YU SHENG"(鋁箔/膠箔) 2.00

AC03293212 DIAZEPAM INJECTION 15.00

AC03314100 YUNSTAN CAPSULES 1.50

AC03355212 DIANLIN INJECTION "N.K." 15.00

AC03365100 PREDNISOLONE TABLETS 5MG "VPP" 1.50

AC033651G0 PREDNISOLONE TABLETS 5MG "VPP"(鋁箔/膠箔) 2.00

AC03494100 BETAMETHASONE TABLETS "LITA" 1.50

AC03534100 DESON TABLETS 1.50

AC035341G0 DESON TABLETS(鋁箔/膠箔) 2.00

AC03558212 PROPHYLLIN INJECTION "ASTAR" 15.00

AC03573221 PLASLLOID INJECTION 15.00

AC03619209 DEXTROSE IN SALINE INJECTION "SINTONG" 35.00

AC03619277 DEXTROSE IN SALINE INJECTION "SINTONG" 25.00

AC03697417 TETRACYCLINE EYE OINTMENT "OASIS" 12.00

AC03697421 TETRACYCLINE EYE OINTMENT "OASIS" 16.60

AC03700212 DEXARON INJECTION 2MG 15.00

AC03700229 DEXARON INJECTION 2MG 19.10

AC03703100 EPILON TABLETS "YUNG SHIN" 1.50

AC037031G0 EPILON TABLETS "YUNG SHIN"(鋁箔/膠箔) 2.00

AC03759100 INTEAN CAPSULES 1.50

AC03773100 SWEICON TABLETS "YUNG CHI" 1.50

AC037731G0 SWEICON TABLETS "YUNG CHI"(鋁箔/膠箔) 2.00

AC03775100 ERYTHROMYCIN CAPSULES "YUNG SHIN" 1.77

AC03782209 CHLORPHENIRAMINE INJECTION "ASTAR"" 15.00

AC03796229 AMINOPHYLLINE INJECTION "VPP" 15.00

AC03867209 LIHOSIN INJECTION 15.00

AC03881209 DEXAMETHASONE INJECTION 17.20

AC03898238 KCL INJECTION "C.C.P." 15.00

AC03903100 PELION TABLETS 1.50

AC039031G0 PELION TABLETS(鋁箔/膠箔) 2.00

AC03948417 ATROPINE EYE OINTMENT 21.40

AC03967229 CYANOCOBALAMIN INJECTION "R.S.P.P." 15.40

AC03968421 SULOMIN EYE DROPS 12.00

AC03968429 SULOMIN EYE DROPS 12.00

AC03969417 CODEMYCIN EYE OINTMENT 17.90

AC03976100 BISMUTH SUBCARBONATE TABLETS 324MG "VPP" 1.50

AC03994421 CON-N EYE-DROPS 14.10

AC04052100 JOHNSTAL CAPSULES 1.50

AC04115100 GENCAN S.C. TABLETS "YUNG CHI" 1.50

Page 70: 附件二 藥品給付品項暨支付標準表

AC04122100 BAOGIN TABLETS 2MG "BOWLIN" 1.50

AC04156417 VITA A EYE OINTMENT "OASIS" 18.00

AC04156421 VITA A EYE OINTMENT "OASIS" 22.80

AC04158100 "HEALTH" PREDINISOLONE TABLETS 1.50

AC041581G0 "HEALTH" PREDINISOLONE TABLETS(鋁箔/膠箔) 2.00

AC04163100 ESCIN S.C. TABLETS 1.78

AC041631G0 ESCIN S.C. TABLETS(鋁箔/膠箔) 2.00

AC04166421 COLSAMIN EYE DROPS 12.20

AC04221100 LICA TABLETS 1.50

AC042211G0 LICA TABLETS(鋁箔/膠箔) 2.00

AC04222100 BETA-DEXALONE TABLETS 1.50

AC04249100 DYNIN TABLETS 1.52

AC04265100 TONILIN CAP. 250MG 1.52

AC04266100 "NAGOMIN TABLETS (NALIDIXIC ACID)""M.T.""" 0.00

AC04276100 EAZIDE TABLETS 1.50

AC042761G0 EAZIDE TABLETS (鋁箔/膠箔) 2.00

AC04300100 TAWEGEN TABLETS "YUNG CHI" 1.50

AC04347209 VITAMIN K1 INJECTION "N.K." 15.00

AC04411100 TUBAX S.C. TABLETS 6.20

AC04441100 DEAN TABLETS 5MG "YUNG CHI" 1.50

AC04462100 "DEXAMETHASONE TABLETS ""ASTAR""" 1.50

AC04463212 SINTHATO INJECTION 15.00

AC04475100 "PREDNISOLONE TABLETS ""ASTAR""" 1.50

AC04484100 SOLIKIN CAPSULES "YUNG SHIN" 1.50

AC04490417 CHLORAMPHENICOL OPHTHALMIC OINTMENT 13.30

AC04506100 FUCON TABLETS 1.50

AC045061G0 FUCON TABLETS(鋁箔/膠箔) 2.00

AC04514100 DUOCIDE TABLETS 1.50

AC04565209 DECAMIN INJECTION 4MG/ML "ORIENTAL" 15.00

AC04565229 DECAMIN INJECTION 4MG/ML "ORIENTAL" 20.00

AC04574100 WINDOL TABLETS 2.22

AC04587238 DEXTRON V INJECTION "N.K." 15.00

AC04643100 XATONE E.C. TABLETS "F.Y." 1.50

AC04678277 MORIAMIN-2 INJECTION 70.00

AC04692100 "COPALIN TABLETS (CHLORMEZANONE) ""M.T.""" 1.50

AC04715100 DIABETIN TABLETS "Y.S." 1.50

AC047151G0 DIABETIN TABLETS "Y.S." (鋁箔/膠箔) 2.00

AC04722100 CYPRO TABLETS 4MG "F.Y." 1.50

AC04737100 PILIAN TABLETS "Y.S." 1.50

AC047371G0 PILIAN TABLETS "Y.S."(鋁箔/膠箔) 2.00

AC04761329 SHIELIN POWDER 44.50

AC04763100 HONTAN TABLETS 1.50

AC04771238 MAGNESIUM SULFATE INJECTION "TBC" 21.40

AC04771263 MAGNESIUM SULFATE INJECTION "TBC" 120.00

AC04776229 AMINOPHYLLINE INJECTION "ASTAR" 15.00

AC04778100 LI SHIH NING CAPSULES 25MG (INDOMETHACIN) "C.H." 1.50

AC04815100 "DIAZEPAM TABLETS ""ASTAR""" 1.50

AC04820100 CHITOU TABLETS "Y.S." 1.50

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AC048201G0 CHITOU TABLETS "Y.S."(鋁箔/膠箔) 2.00

AC04838100 PISULOU CAPSULES "Y.S." 1.50

AC048381G0 PISULOU CAPSULES "Y.S."(鋁箔/膠箔) 2.00

AC04857100 ZIKAN TABLETS "LITA" 1.50

AC04865209 VITAMIN K1 INJECTION 15.00

AC04899100 NARIZIN TABLETS "JOHNSON" 1.50

AC048991G0 NARIZIN TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

AC04919100 BAKTAR TABLETS 400MG 1.50

AC049191G0 BAKTAR TABLETS 400MG (鋁箔/膠箔) 2.00

AC04928321 BETADERM CREAM 25.70

AC04933100 FUWEININ CAPSULES "Y.S." 1.50

AC04951209 ATROPINE SULFATE INJECTION "SINTONG" 15.00

AC04963100 TETRACYCLINE HCL CAPSULES "C.C.P." 1.50

AC049631G0 TETRACYCLINE HCL CAPSULES "C.C.P."(鋁箔/膠箔) 2.00

AC04975421 EYE RINDERON-A SOLUTION 29.60

AC05041100 NICOXAN TABLETS 1.50

AC05045100 YUNGISUMIN TABLETS "CHEN TA" 1.21

AC050451G0 YUNGISUMIN TABLETS (鋁箔/膠箔) 1.53

AC05054100 INDOCINE CAPSULES 1.50

AC05062100 Kidolex Capsules 250mg (Cephalexin) 1.50

AC05200100 PERSINE S.C. TABLETS 25MG 1.50

AC05247100 "METHYLEPHEDRINE HCL TABLETS ""ASTAR""" 1.50

AC05250100 LINAGAN TABLETS 25MG 1.50

AC05272100 HUEI YI CAPSULES "J.H." 2.22

AC05305100 SATAMOL TABLETS 1.50

AC05313100 TRANTAL FILM COATED TABLETS "YUNG SHIN" 1.50

AC05324209 DELTONIN INJECTION "N.K." 15.40

AC05324221 DELTONIN INJECTION "N.K." 0.00

AC05381100 SHUTON CAPSULES "Y.K." 1.50

AC053811G0 SHUTON CAPSULES "Y.K."(鋁箔/膠箔) 2.00

AC05418100 "O.D.K. CAPSULES ""ORIENT""" 0.00

AC05445100 PARAFLEX CAPSULES 500MG "PANBIOTIC" 1.78

AC05446100 PARAFLEX CAPSULES 250MG "PANBIOTIC" 1.50

AC05495100 DOINMYCIN CAPSULES 1.50

AC05508100 GLARE CAPSULES "F.Y." 1.50

AC05515100 AMINOPHYLLINE TABLETS "LITA" 1.50

AC055151G0 AMINOPHYLLINE TABLETS "LITA"(鋁箔/膠箔) 2.00

AC05521421 CODEMYCIN EYE DROPS 18.40

AC05603221 GLUCAL BLACK INJECTION 21.40

AC05669100 "AMINOPHYLLINE TABLETS ""ASTAR""" 1.50

AC05708100 BROWN MIXTURE TABLETS 1.50

AC057081G0 BROWN MIXTURE TABLETS (84粒/瓶裝) 2.00

AC05712100 "DIPROPHYLLIN TABLETS ""ASTAR""" 1.50

AC057121G0 DIPROPHYLLIN TABLETS "ASTAR"(鋁箔/膠箔) 2.00

AC05753212 THIAMINE HYDROCHLORIDE INJECTION 50MG "ASTAR" 15.00

AC05757100 CHIERHSIN TABLETS 10MG 1.50

AC05811100 STROCAIN TABLETS 1.50

AC058111G0 STROCAIN TABLETS(鋁箔/膠箔) 2.00

Page 72: 附件二 藥品給付品項暨支付標準表

AC05812100 HOMOCLOMIN TABLETS 1.50

AC058121G0 HOMOCLOMIN TABLETS(鋁箔/膠箔) 2.00

AC05813100 SOLAXIN TABLETS 1.50

AC058131G0 SOLAXIN TABLETS(鋁箔/膠箔) 2.00

AC05857100 CODEINE PHOSPHATE TABLETS 15MG 4.50

AC05858100 PETHIDINE HYDROCHLORIDE TABLETS 50 MG 22.50

AC05860100 MORPHINE HYDROCHLORIDE TABLETS 10MG 2.80

AC05865100 CODEINE PHOSPHATE TABLETS 30MG 5.00

AC05874209 PETHIDINE HYDROCHLORIDE INJECTION 50MG/ML 26.50

AC05886209 MORPHINE HYDROCHLORIDE 20MG/ML 26.00

AC05889209 CODEINE PHOSPHATE INJECTION 15MG/ML 29.00

AC05891209 MORPHINE HYDROCHLORIDE INJECTION 10MG/ML 25.00

AC05896209 IMPERAN INJECTION "N.K." 15.00

AC05896212 IMPERAN INJECTION "N.K." 15.00

AC05925100 MERISLON TABLETS 6MG (BETAHISTINE MESILATE) 1.50

AC059251G0MERISLON TABLETS 6MG (BETAHISTINE MESILATE)(鋁箔/膠箔)

2.00

AC05954100 COSPANON CAPSULES 1.50

AC059541G0 COSPANON CAPSULES(鋁箔/膠箔) 2.00

AC05986100 "MENIPERAN TABLETS 5MG ""M.T."" (METOCLOPRAMIDE)" 1.50

AC05987100 INOLIN TABLETS 3MG 1.50

AC05989100 INDOCAPS CAPSULES "Y.K." 1.50

AC06187417 COLSAMIN EYE OINTMENT 13.20

AC06232100 MATALMIN TABLETS 200MG "W.S." 1.50

AC06373100 HEMAGEN CAPSULES 1.50

AC06543100 PREDNISOLONE TABLETS 5MG "CHEN TA" 1.50

AC065431G0 PREDNISOLONE TABLETS 5MG "CHEN TA"(鋁箔/膠箔) 2.00

AC06554100 ERYTHROMYCIN CAPSULES 250MG "HONTEN" 1.77

AC06645100 METHYLEPHEDRINE TABLETS "TEM CPARP" 1.50

AC06677100 VALEMATE TABLETS 10 MG 1.50

AC06691100 UCALON TABLETS 0.5MG "CHEN TA" (DEXAMETHASONE) 1.50

AC066911G0UCALON TABLETS 0.5MG "CHEN TA" (DEXAMETHASONE)(鋁箔/膠

箔)2.00

AC06747100 CEPHALEXIN CAPSULES 1.50

AC067471G0 CEPHALEXIN CAPSULES(鋁箔/膠箔) 2.00

AC06821100 AMPICILLIN CAPSULES 250MG "VPP" 1.50

AC06827100 AMINOPHYLLINE TABLETS 100MG "VPP" 1.50

AC06869100 YOURISIN TABLETS 500MG "CHEN TA" (NALIDIXIC ACID) 2.22

AC07024100 FUNIONE TABLETS 250MG (METRONIDAZOLE) 1.52

AC07073100 LNDACIN CAPSULES 1.50

AC07096209 CYANOCOBALAMIN INJECTION "PANBIOTIC" 15.00

AC07096229 CYANOCOBALAMIN INJECTION "PANBIOTIC" 15.40

AC07175100 PRANOL TABLETS 20MG "JOHNSON" 1.50

AC07204229 LIFUTIN INJECTION "ASTAR" 15.00

AC07233100 DOXYCYCLINE CAPSULES 1.50

AC07256100 PROCID TABLETS 2.83

AC07342100 APULON TABLETS "Y.S." 1.50

AC07350323 PARACORT CREAM 32.20

Page 73: 附件二 藥品給付品項暨支付標準表

AC07350335 PARACORT CREAM 56.00

AC07371100 VASODILAN TABLETS 0.00

AC07372100 GRISEOFULVIN TABLETS 1.50

AC07454221 GLYMINE INJECTION 15.00

AC07543100 FOLIC ACID TABLETS "VPC" 1.50

AC075431G0 FOLIC ACID TABLETS "VPC" (鋁箔/膠箔) 2.00

AC07630212 PULIN INJECTION "YUNG SHIN" 15.00

AC07673100 PREDNISOLONE TABLETS "P.L." 1.50

AC07680100 LIPHALEXIN CAPSULES 250MG "LITA" 1.50

AC07682229 DEXASON INJECTION 4MG/ML "LITA" 20.00

AC07715421 LOSEMIN EYE DROPS "OASIS" 16.50

AC07749100 DELAX TABLETS "SHOU CHAN" 1.50

AC07796100 PETTI CAPSULES 1.50

AC07819100 ACETAZOLAMAX TABLETS 1.50

AC07936100 BORGAL TABLETS "LITA" 1.50

AC07944100 DETTACKS S.C. TABLETS 10 MG "F.Y." 1.50

AC07973421 NEOSINICIN EYE DROPS 5% "OASIS" 29.90

AC08097100 INDOMETHACIN CAPSULES "MEIDER" 1.50

AC08160100 CANON CAPSULES "YUNG SHIN" 1.58

AC08169100 OUTALLERGIN TABLETS 1.50

AC081691G0 OUTALLERGIN TABLETS(鋁箔/膠箔) 2.00

AC08309100 BEGATAL S.C. TABLETS 1.50

AC08310100 RIFAMPICIN CAPSULES 300MG "LITA" 8.10

AC08311100 RIFAMPICIN CAPSULES 150MG "LITA" 4.48

AC08380100 PERISIN S.C. TABLETS "LITA" 1.50

AC08505100 METOPERAN TABLETS 1.50

AC08510100 DACOCILIN CAPSULES 250MG 1.50

AC08519100 VALEMATE S.C. TABLETS 10MG 1.50

AC08526100 SZULEN S.C. TABLETS 1.50

AC08662100 SENFIHU TABLETS 1.50

AC08663100 CHIAOWELGEN F.C. TABLETS 1.50

AC08678335 BETASON-G CREAM "LITA" 19.60

AC08715100 PRENIN TABLETS 1.50

AC08753100 TRAMEZIN TABLETS "HONTEN" 1.50

AC087531G0 TRAMEZIN TABLETS "HONTEN"(鋁箔/膠箔) 2.00

AC08764100 COSTOL CAPSULES 1.50

AC08851209 ANCILLINA INJECTION 1GM 25.00

AC08855100 CHEMIX TABLETS "YUNG SHIN" 1.50

AC08890100 "WINACORT-A TABLETS ""WINSTON""" 1.50

AC08910248 SANYL LYO INJECTION 18.10

AC08912221 ESCIN LYO-INJECTION 37.60

AC08913209 PIPETO INJECTION 15.00

AC08917100 PULIN COATED TABLETS 5MG 1.50

AC089171G0 PULIN SUGAR COATED TABLETS 5MG(鋁箔/膠箔) 2.00

AC08928100 DEXAMETHASONE TABLETS "MEIDER" 1.50

AC08956212 GENTAMYCIN INJECTION 15.00

AC08956299 GENTAMYCIN INJECTION 1.35

AC08957100 "WINCOLD CAPSULES ""WINSTON""" 1.50

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AC09010421 NEOCOSON EYE DROPS "PATRON" 21.40

AC09043100 SUMENCHITON TABLETS 1.50

AC090431G0 SUMENCHITON TABLETS(鋁箔/膠箔) 2.00

AC09067212 KASON INJECTION "YUNG SHIN" 15.00

AC09086212 GUAIC INJECTION 15.00

AC09099100 IKODIN CAPSULES 250MG 1.50

AC090991G0 IKODIN CAPSULES 250MG(鋁箔/膠箔) 2.00

AC09191238 DOAMIN INJECTION "TF" 15.00

AC09203100 LIBLAN S.C. TABLETS "YUNG SHIN" 1.62

AC09211100 ALUDENE TABLETS 1.50

AC092111G0 ALUDENE TABLETS(鋁箔/膠箔) 2.00

AC09250500 BISACODYL SUPPOSITORIES "YUNG SHIN" 5.00

AC09252100 LUTUTIN TABLETS 1.50

AC09256100 SOMEPRIM TABLETS 1.50

AC09271277 SORBIT-HARTMANN INJECTION 36.40

AC09275100 VICOMP S.C. TABLETS 1.50

AC09291100 EUCLIDAN TABLETS 50MG 1.50

AC092911G0 EUCLIDAN S.C.TABLETS 50MG(鋁箔/膠箔) 2.00

AC09299100 LIGILIN CAPSULES 1.50

AC092991G0 LIGILIN CAPSULES(鋁箔/膠箔) 2.00

AC09334100 FUZUIN S.C. TABLETS "CHINGTENG" 1.52

AC093341G0 FUZUIN S.C. TABLETS "CHINGTENG"(鋁箔/膠箔) 2.00

AC09346212 PYRIDOXAL PHOSPHATE INJECTION 20MG "KYORIN" 15.00

AC09352100 HOMALIN TABLETS "W.S." 1.50

AC09386100 CYPROMIN TABLETS 1.50

AC09393100 BETAMETHASONE TABLETS "YU SHENG" 1.50

AC09408100 METRONIDAZOLE TABLETS "YU SHENG" 1.52

AC09438212 SINCEN INJECTION 15.00

AC09453100 CEPHANMYCIN CAPSULES "YUNG SHIN" 1.50

AC094531G0 CEPHANMYCIN CAPSULES "YUNG SHIN"(鋁箔/膠箔) 2.00

AC09459100 ANECOL S.C. TABLETS 1.50

AC09514100 "EGOTAN S.C. TABLETS ""WINSTON""" 1.50

AC09570100 OUTERDZEN S.C. TABLETS "CHINTENG" 1.50

AC095701G0 OUTERDZEN S.C. TABLETS "CHINTENG" (鋁箔/膠箔) 2.00

AC09587100 FROTIN ENTERIC SUGAR COATED TABLETS 1.52

AC09607100 PREDNISOLONE TABLETS 1.50

AC096071G0 PREDNISOLONE TABLETS(鋁箔/膠箔) 2.00

AC09609100 AMPICILLIN CAPSULES 500MG "VPP" 1.50

AC096091G0 AMPICILLIN CAPSULES 500MG "VPP"(鋁箔/膠箔) 2.00

AC09614100 SUYI TABLETS 5MG "HEALTH" 0.00

AC096141G0 SUYI TABLETS 5MG "HEALTH"(鋁箔/膠箔) 0.00

AC09615100 CYPRODINE TABLETS "MEIDER" 1.50

AC09619100 BISADYL E.C. TABLETS "MEIDER" 1.50

AC096191G0 BISADYL E.C. TABLETS "MEIDER"(鋁箔/膠箔) 2.00

AC09633255 MANITON INJECTION 39.40

AC09633266 MANITON INJECTION 39.40

AC09633277 MANITON INJECTION 108.00

AC09645209 STACORT-A INJECTION 40MG "STANDARD" 20.70

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AC09645221 STACORT-A INJECTION 40MG "STSNDARD" 44.40

AC09654100 DOXYMYCIN CAPSULES "YUNG SHIN" 1.50

AC09683277 XYLITOL INJECTION 5% "KYORIN" 26.70

AC09722100 "MEFEINE TABLETS ""H.C""MEFEINE TABLETS" 1.50

AC09743100 RIDONRA TABLETS 0.00

AC09754209 B-RED INJECTION "KYORIN" 15.00

AC09763100 BENZAMINE TABLETS 1.50

AC09782100 INDAL TABLETS 1.50

AC097821G0 INDAL TABLETS(鋁箔/膠箔) 2.00

AC09792100 BENTYL TABLETS 10MG 1.50

AC09915100 METASONE TABLETS "H.S." 1.50

AC09916100 DEXAN TABLETS "H.S." 1.50

AC09945100 MUSCLO TABLETS "Y.K." 1.50

AC09982238 DEXTROSE INJECTION 20% "S.Y." 15.00

AC09987100 CONICINE TABLETS "H.H." 1.50

AC099871G0 CONICINE TABLETS "H.H."(鋁箔/膠箔) 2.00

AC09990212 "ASCORBIC ACID INJECTION ""S.Y.""" 15.00

AC09990221 "ASCORBIC ACID INJECTION ""S.Y.""" 15.00

AC09991100 TOUFONG TABLETS 5MG "CHEN TA." 1.50

AC10058100 PROPRANOLOL TABLETS "YU SHENG" 1.50

AC10066277 FRUCTOSE INJECTION 5% 30.70

AC10069277 HARTMANN'S INJECTION 25.00

AC10120100 CO-TRIMOXAZOL TABLETS “H.L.” 1.50

AC10137100 PREDNISOLONE TABLETS "YUNG CHI" 1.50

AC10139100 PREDSON TABLETS "H.S." 1.50

AC10150212 "DIZEPAM INJECTION ""S.Y.""" 15.00

AC10168100 DECAN TABLETS "YUNG SHIN" 1.50

AC101681G0 DECAN TABLETS "YUNG SHIN"(鋁箔/膠箔) 2.00

AC10182209 KANAMYCIN INJECTION "YUNG SHIN" 15.00

AC10183100 "WITHAMYCIN CAPSULES ""WINSTON""" 1.50

AC10192100 "WINTELLIN CAPSULES ""WINSTON""" 1.50

AC10204100 FUZINLIN CAPSULES "H.L." 1.50

AC10207100 INDECIN CAPSULES "H.S." 1.50

AC10221321 "WINCORT CREAM ""WINSTON""" 25.80

AC10221329 "WINCORT CREAM ""WINSTON""" 32.40

AC10229100 THIMAZOL TABLETS "SHUN HWA" 1.50

AC102291G0 THIMAZOL TABLETS "SHUN HWA"(鋁箔/膠箔) 2.00

AC10246100 NITROFURANTOIN E.C. TABLETS 1.50

AC10248100 COOCHIL TABLETS "CHINTENG" 1.50

AC102481G0 COOCHIL TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC10249100 PIWEILIN TABLETS "CHINTENG" 1.50

AC102491G0 PIWEILIN TABLETS "CHINTENG"(鋁箔/膠箔) 0.00

AC10282100 BACIDE TABLETS "VPP" 1.50

AC102821G0 BACIDE TABLETS "VPP"(鋁箔/膠箔) 2.00

AC10320277 "ELECTRO-5% DEXTROSE INFUSION SOLUTION ""Y.F.""" 29.50

AC10323100 BIGUNAL TABLETS 50MG 2.64

AC10332100 CINDERAL TABLETS "PATRON" 1.50

AC10334100 TONTYL TABLETS "PATRON" 1.50

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AC10358100 HERBESSER TABLETS 1.50

AC103581G0 HERBESSER TABLETS(鋁箔/膠箔) 2.00

AC10365100 AMOXICILLIN CAPSULES 250MG "KINGDOM" 1.50

AC10374100 CINNARIN TABLETS "HONTEN" 1.50

AC103741G0 CINNARIN TABLETS "HONTEN" (鋁箔/膠箔) 2.00

AC10381321 PATRONCORT-F OINTMENT "PATRON" 34.90

AC10395100 TRAN TABLETS "YUNG SHIN" 1.50

AC10398100 MELLAZINE S.C. TABLETS 50MG"HL" 2.31

AC10414417 EYE WINACORT OINTMENT "WINSTON" 22.20

AC10414429 EYE WINACORT OINTMENT "WINSTON" 54.00

AC10415100 ANCOCILLIN CAPSULES 1.90

AC10422212 THIAMINE HYDROCHLORIDE INJECTION 50MG "S.Y." 15.00

AC10428100 WINHOAMIN S.C. TABLETS 100MG"HL" 1.50

AC10431100 CALITH CAPSULES "PATRON" 1.50

AC10446100 ANZUWEI CAPSULES "H.H." 1.50

AC10452221 HISTIDINE INJECTION 15.00

AC10457212 PANTHOL INJECTION 100MG "Y.Y" 15.00

AC10478416 "EYE BETASON-N OINTMENT ""WINSTON""" 15.50

AC10487100 HUASWEI TABLETS "H.H." 1.50

AC104871G0 HUASWEI TABLETS "H.H."(鋁箔/膠箔) 2.00

AC10488100 HUAVINE TABLETS "H.S." 1.50

AC10489100 HUAROKINE CAPSULES "H.S." 1.50

AC104891G0 HUAROKINE CAPSULES "H.S."(鋁箔/膠箔) 2.00

AC10491100 NOGERON CAPSULES "PATRON" 1.50

AC10547212 DIAZEPAM INJECTION "LITA" 15.00

AC10571100 COLIGIN CAPSULES "HEALTH" 0.00

AC10582100 GYLONOL TABLETS "HL" 1.50

AC10638277 STAMINA INJECTION "CHI SHENG" 25.00

AC10654209 NORM-SALINE INJECTION "OTSUKA"(1L) 35.00

AC10654255 NORM-SALINE INJECTION "OTSUKA"(100ML) 22.00

AC10654265 NORM-SALINE INJECTION "OTSUKA"(250ML) 22.00

AC10688100 ERYTHROCIN CAPSULES "WINSTON" 1.77

AC10710100 SERNVITA S.C. TABLETS 50MG "CHINTENG" 1.50

AC107101G0 SERNVITA S.C. TABLETS 50MG "CHINTENG"(鋁箔/膠箔) 2.00

AC10721209 "CYANOCOBALAMINE INJECTIONS ""S.Y.""" 15.00

AC10721229 "CYANOCOBALAMINE INJECTION ""S.Y.""" 15.40

AC10722209 SEKIJIS INJECTION 15.00

AC10726100 MELLAZINE S.C. TABLETS 100MG"HL" 4.15

AC10742100 OPEND TABLETS "D.T.S." 1.50

AC10764100 BACDAN TABLETS "PATRON" 1.50

AC10774100 PIMINTON TABLETS "PATRON" 1.50

AC10775100 BRONDIN TABLETS "PATRON" 1.50

AC10802100 PECTRIN S.C. TABLETS 25MG 1.50

AC10812100 HERSUN TABLETS 10MG "F.Y." 1.50

AC10819100 SUPERCILLIN CAPSULES 250MG 1.50

AC108191G0 SUPERCILLIN CAPSULES 250MG "VPP"(鋁箔/膠箔) 2.00

AC10826100 GREEN TABLETS "YUNG SHIN" 1.50

AC10830212 DIAZEPAM INJECTION 15.00

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AC10848212 PRANOL INJECTION "Y.Y." 15.00

AC10871277 STIN POWDER FOR INJECTION 15.00

AC10909100 CINNARIZINE TABLETS "YU SHENG" 1.50

AC10914221 LIDOCAINE HCL 2% FOR I.V. INJECTION "LITA" 50.00

AC10917100 BEHYD TABLETS 1.50

AC109171G0 BEHYD TABLETS(鋁箔/膠箔) 2.00

AC10941100 FUNGACIN CAPSULES "PATRON" 1.65

AC11006100 NICAMET F.C. TABLETS 1.50

AC110061G0 NICAMET F.C. TABLETS(鋁箔/膠箔) 2.00

AC11012100 SKETA CAPSULES "PATRON" 1.50

AC110121G0 SKETA CAPSULES "PATRON"(鋁箔/膠箔) 2.00

AC11047221 METHIOLAMINE-B12 INJECTION "Y.Y." 15.00

AC11082100 INDOZU E.C. TABLETS "YUNG CHI" 1.50

AC11124100 BUTYPON S.C. TABLETS 1.50

AC11125100 KERCORT TABLETS "CHIN TENG" 1.50

AC111251G0 KERCORT TABLETS "CHIN TENG"(鋁箔/膠箔) 2.00

AC11136209 "VETHASONE INJECTION ""S.Y.""" 15.40

AC11150212 SUOPINCHON INJECTION "S.Y." 15.00

AC11154100 SEQUITON TABLETS 1.50

AC111541G0 SEQUITON TABLETS(鋁箔/膠箔) 2.00

AC11168100 BETAMETHASONE TABLETS "NCP" 1.50

AC11193100 TEITHCAN SUGAR COATING TABLETS "CHIN TENG" 1.50

AC111931G0 TEITHCAN SUGAR COATING TABLETS "CHIN TENG"(鋁箔/膠箔) 2.00

AC11207155 SOMEPRIM GRANULES 99.00

AC11224100 DOXYNIN CAPSULES "SWISS" 1.50

AC112241G0 DOXYNIN CAPSULES "SWISS"(鋁箔/膠箔) 2.00

AC11230100 HICOBAL CAPSULES "GENTLE" 1.50

AC11317100 ANTI-COUGH TABLETS 1.50

AC11318100 OLYRRHIZIN S.C TABLETS "MEIDER" 1.50

AC11331212 GENTAMICIN INJECTION "YUNG SHIN" 15.00

AC11331229 GENTAMICIN INJECTION "YUNG SHIN" 16.50

AC11331238 GENTAMICIN INJECTION "YUNG SHIN" 40.80

AC11331299 GENTAMICIN INJECTION "YUNG SHIN" 1.35

AC11358100 TRANTIN S.C. TABLETS "YU SHENG" 1.50

AC11420221 NOOPOL INJECTION "N.K." 15.00

AC11420229 NOOPOL INJECTION "N.K." 28.20

AC11421100 NOOPOL CAPSULES "N.K." 1.50

AC114211G0 NOOPOL CAPSULES "N.K."(鋁箔/膠箔) 2.00

AC11444277 SEAFAR POWDER 0.5G FOR INJECTION 25.00

AC11465212 HUAZIN INJECTION 15.00

AC11475209 SHINCORT I.M. INJECTION "YUNG SHIN" 20.70

AC11475229 SHINCORT I.M. INJECTION "YUNG SHIN" 57.00

AC11476221 SHINCORT INJECTION "YUNG SHIN" 23.80

AC11476229 SHINCORT INJECTION "YUNG SHIN" 23.80

AC11477212 DECAN INJECTION "YUNG SHIN" 15.00

AC11518100 NEOMYCIN CAPSULES 250MG 1.88

AC11552277 DEXTROSE INJECTION 5% "OTSUKA" 25.00

AC11562100 PANTRIM TABLETS 1.50

Page 78: 附件二 藥品給付品項暨支付標準表

AC11570212 SERACIN INJECTION 15.00

AC11570216 SERACIN INJECTION 15.50

AC11570229 SERACIN INJECTION 16.50

AC11570238 SERACIN INJECTION 40.80

AC11576212SWITYL INJECTION "SWISS"

SWITYL INJECTION "SWISS BRAND"15.00

AC11644100 CONQUER TABLETS "YUNG SHIN" 1.50

AC116441G0 CONQUER TABLETS "YUNG SHIN" (鋁箔/膠箔) 2.00

AC11652321 BETTERSONE OINTMENT 12.80

AC11652329 BETTERSONE OINTMENT 14.90

AC11652335 BETTERSONE OINTMENT 19.60

AC11652338 BETTERSONE OINTMENT 19.60

AC11655100 VIVIKA TABLETS "YUNG SHIN" 1.50

AC116551G0 VIVIKA TABLETS "YUNG SHIN"(鋁箔/膠箔) 2.00

AC11665209 ASTHPIN INJECTION 15.00

AC11701100 PEIWETSU TABLETS "P.L." 1.50

AC11723277 AMINOL-K INJECTION 81.00

AC11750212 BIOMIN INJECTION "YUNG SHIN" 15.00

AC11775212 CHIAOWELGEN INJECTION "SWISS" 15.00

AC11776212 SWELIUM INJECTION 15.00

AC11780212 METOPERAN INJECTION 15.00

AC11782209 ASTHNIL INJECTION 0.00

AC11795212 CHUCO INJECTION 15.00

AC11806100 INDOTHAN CAPSULESINDOTHAN CAPSULES 1.50

AC11807100 DIPYRON TABLETS 1.50

AC118071G0 DIPYRON TABLETS(鋁箔/膠箔) 2.00

AC11832209 SEAFAR POWDER 1G FOR INJECTION 25.00

AC11832212 SEAFAR POWDER 2G FOR INJECTION 0.00

AC11832221 SEAFAR POWDER 5G FOR INJECTION 0.00

AC11832229 SEAFAR POWDER 10G FOR INJECTION 0.00

AC11832238 SEAFAR POWDER 20G FOR INJECTION 0.00

AC11838416 GENTAMICIN OPHTHALMIC OINTMENT "OASIS" 18.20

AC11838417 GENTAMICIN OPHTHALMIC OINTMENT "OASIS" 18.20

AC11838421 GENTAMICIN OPHTHALMIC OINTMENT "OASIS" 22.80

AC11845209 FRUCTOSE INJECTION 5% "N.K." 38.10

AC11845265 FRUCTOSE INJECTION 5% "N.K." 22.00

AC11845277 FRUCTOSE INJECTION 5% "N.K." 30.70

AC11865212 BIOVITAS INJECTION 15.00

AC11886277 "DEXTROSE AND SODIUM CHLORIDE INJECTION ""ASTAR""" 25.00

AC11890212 UCOUGIN-MEI INJECTION 15.00

AC11929100 SOLAX CAPSULES "CHEN TA" 1.50

AC11931100 PREDNISOLONE TABLETS "MEIDER" 1.50

AC11933209 CEFACIN INJECTION "LITA" 25.00

AC11933277 CEFACIN INJECTION "LITA" 25.00

AC11964100 TEKILON CAPSULES "P.L." 1.50

AC11982100 NICEFON TABLETS 1.50

AC11983100 "ORCITRAN TABLETS ""H.C."" " 1.50

AC12050212 GENTACIN INJCETON "S.T." 15.00

Page 79: 附件二 藥品給付品項暨支付標準表

AC12050229 GENTACIN INJECTION "S.T." 16.50

AC12051100 AMOXICILLIN CAPSULES 250MG "C.C.P." 1.50

AC120511G0 AMOXICILLIN CAPSULES 250MG"C.C.P."(鋁箔/膠箔) 2.00

AC12053229 GENTAMYCIN INJECTION 40MG "ORIENTAL" 16.50

AC12055100"MIN-TA-WE TABLETS (DIHYDROXYALUMINUM

ALLANTOIN)""M.T."""1.50

AC12081100 SPIRON TABLETS 1.50

AC120811G0 SPIRON TABLETS 2.00

AC12311221 TROBICIN INJECTION "CHI SHENG" 15.00

AC12311238 TROBICIN INJECTION "CHI SHENG" 15.00

AC12318100 YIKANG TABLETS 1.52

AC12371100 "BETAMETHASONE TABLETS ""M.T.""" 1.50

AC12393417 BENEMYCIN EYE OINTMENT "OASIS" 43.80

AC12414100 COLIOPAN TABLETS 1.50

AC12443500 INTHACID SUPPOSITORIES "PATRON" 5.00

AC12446100 BETASON TABLETS 0.5MG "CHEN TA" (BETAMETHASONE) 1.50

AC12447100 BOSCON F.C. TABLETS 10MG "T.F." 1.50

AC12451229 HIDOMIN INJECTION "YUNG SHIN" 15.40

AC12452100 FLACIL CAPSULES 0.00

AC124581G0 EURODIN TABLETS 2MG 2.00

AC12474209 DEXAMETHASONE INJECTION 4MG/ML "N.K." 15.00

AC12474212 DEXAMETHASONE INJECTION 4MG/ML "N.K." 17.30

AC12474229 DEXAMETHASONE INJECTION 4MG/ML "N.K." 20.00

AC12519100 ANETHION S.C. TABLETS 1.50

AC12521212 GENTACIN INJECTION 15.00

AC12521229 GENTACIN INJECTION 16.50

AC12521299 GENTACIN INJECTION 1.35

AC12527209 SIVKORT SUSPENSION 18.90

AC12527229 SIVKORT SUSPENSION 23.80

AC12528221 SEVATRIM INJECTION 18.30

AC12551100 SKELIN TABLETS "F.Y." 1.50

AC12552100 CININ TABLETS "N.C.P." 1.50

AC12603100 METHOMINE TABLETS "H.S." 1.50

AC12639100 TETRACYCLINE HCL TABLETS "C.C.P." 1.50

AC12694100 ULCEN TABLETS "MEIDER" 1.50

AC12703100 SINPRIM F.C. TABLETS "CHINTENG" 1.50

AC127031G0 SINPRIM F.C. TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC12745321 PARMASON CREAM "BOWLIN" 13.50

AC12745329 PARMASON CREAM "BOWLIN" 16.80

AC12745338 PARMASON CREAM "BOWLIN" 42.00

AC12763100 DEYANJUNN TABLETS 1.50

AC12782100 DOXYCYCLINE CAPSULES 100MG "CSP" 1.50

AC12803100 EULIVER F.C. TABLETS "H.S." 1.50

AC128031G0 EULIVER F.C. TABLETS "H.S."(鋁箔/膠箔) 2.00

AC12824277 LOW MOLECULAR DEXTRAN DEXTROSE INJECTION "OTSUKA" 233.00

AC12825100 NITROGLYCERIN TABLETS 0.6MG "NYSCO" 4.97

AC12828100 ALUZAINE TABLETS 1.50

AC128281G0 ALUZAINE TABLETS(鋁箔/膠箔) 2.00

Page 80: 附件二 藥品給付品項暨支付標準表

AC12831100 MEFEN TABLETS "CHINTENG" 1.50

AC128311G0 MEFEN TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC12858277 DICILLIN INJECTION 500MG 25.00

AC12880100 COUGHMIN S.C. TABLETS "KYORIN" 1.50

AC12902100 KUAY WEY HAO TABLETS "J.H." 1.50

AC12951100 TRIMEZOLE TABLETS 1.50

AC12973421 GENTAMICIN EYE DROPS "OASIS" 14.50

AC12975100 SALTOLIN TABLETS "GENTLE" 1.50

AC13077100 HUALISHIH CAPSULES "H.S." 1.50

AC13089100 SALBUTAMOL TABLETS 1.50

AC13118100 CHLORMEZANONE TABLETS "SHINLON" 1.50

AC13130100 OXELADIN CAP. 1.50

AC13162100 BETAMETHASONE TABLETS "JOHNSON" 1.50

AC13175100 PREDNISOLONE TABLETS "C.H." 1.50

AC13180100 NALIDIXIC ACID TABLETS 500MG "SHINLON" 2.22

AC13181100 URINTESTIN TABLETS 500MG 2.22

AC13229100 AMOXICILLIN CAPSULES "YUNG SHIN" 1.50

AC132291G0 AMOXICILLIN CAPSULES "YUNG SHIN"(鋁箔/膠箔) 2.00

AC13361100 MEFENAMIC ACID CAPSULES "C.H." 1.50

AC13366100 SINZUIN TABLETS "YUNG CHI" 1.50

AC13381100 CORTISONE ACETATE TABLETS 25MG "PING LAWER" 1.50

AC133811G0CORTISONE ACETATE TABLETS 25MG “PINE LAWER”(鋁箔/膠箔)

2.00

AC13405100 MEFENAMIC ACID CAPSULES "N.C.P." 1.50

AC13433100 ALLOPURINOL TABLETS "MEIDER" 1.50

AC13450100 TEDOFURYL CAPSULES 21.10

AC13509277 DEXSALIN INJECTION "CHI SHENG" 25.00

AC13511100 CHLOROMEZANONE TABLETS "YUNG CHI" 1.50

AC13547100 "ANETHOL CAPSULES ""M.T.""" 1.50

AC13574238 "TAIBILONE INJECTION ""TAI YU""" 15.00

AC13575209 "PROGESTERONE INJECTION ""TAI YU" 15.00

AC13575229 "PROGESTERONE INJECTION ""TAI YU""" 15.60

AC13576229 "KANAMYCIN INJECTION ""TAI YU""" 19.00

AC13576238 "KANAMYCIN INJECTION ""TAI YU""" 0.00

AC13576299 "KANAMYCIN INJECTION ""TAI YU""" 1.33

AC13577212 "VITAMIN C INJECTION ""TAI YU""" 15.00

AC13577229 "VITAMIN C INJECTION ""TAI YU" 0.00

AC13577238 "VITAMIN C INJECTION ""TAI YU""" 15.00

AC13582238 "GLUCAMETHI INJECTION ""TAI YU""" 15.00

AC13583209 "HYDROXOCOBALAMIN INJECTION ""TAI YU""" 15.00

AC13583229 "HYDROXOCOBALAMIN INJECTION ""TAI YU""" 15.40

AC13627100 RIFAMPICIN CAPSULES "YUNG SHIN" 4.48

AC13634100 DIPYRIDAMOLE S.C. TABLETS "YUNG SHIN" 1.50

AC136341G0 DIPYRIDAMOLE S.C. TABLETS "YUNG SHIN"(鋁箔/膠箔) 2.00

AC13637212 GENTAMICIN SULFATE INJECTION "SOURIREE" 15.00

AC13637229 GENTAMICIN SULFATE INJECTION "SOURIREE" 16.50

AC13637238 GENTAMICIN SULFATE INJECTION "SOURIREE" 40.80

AC13647321 GENTASONE CREAM 20.70

Page 81: 附件二 藥品給付品項暨支付標準表

AC13647329 GENTASONE CREAM 23.50

AC13647335 GENTASONE CREAM 38.50

AC13651229 FELINAMIN INJECTION "CHI SHENG" 15.00

AC13651238 FELINAMIN INJECTION "CHI SHENG" 15.00

AC13662100 METRONIDAZOLE CAPSULES "C.H." 1.52

AC13664100 METRONIDAZOLE CAPSULES 250MG "SHINLON" 1.52

AC13679229 LINCOMYCIN INJECTION "SWISS" 27.20

AC13718209"5%/0.45% DEXTROSE AND SODIUM CHLORIDE INJECTION

""Y.F."""35.00

AC13722500 METROCIDE VAGINAL SUPPOSITORIES 250MG "T.F." 5.00

AC13778100 "NO-COUGH CAPSULES ""M.T.""" 1.50

AC137781G0 "NO-COUGH CAPSULES ""M.T.""(鋁箔/膠箔)" 2.00

AC13796100 BETAMETHASONE TABLETS "SHINLON" 1.50

AC13801100 DIPYRIDAMOLE S.C. TABLETS "STANDARD" 1.50

AC138011G0 DIPYRIDAMOLE S.C. TABLETS "STANDARD"(鋁箔/膠箔) 2.00

AC13817265 "AMINOPLEX INJECTION ""TAI YU""" 63.00

AC13817266 "AMINOPLEX INJECTION ""TAI YU""" 65.00

AC13817277 "AMINOPLEX INJECTION ""TAI YU""" 70.00

AC13900100 NALIDIXIC ACID TABLETS 2.22

AC13907238 VITAGEN-S INJECTION 15.00

AC13912209 DEXAMETHASONE INJECTION "PANBIOTIC" 15.00

AC13912229 DEXAMETHASONE INJECTION "PANBIOTIC" 20.00

AC13929238 "DEXTROSE-LACTATED RINGER'S INJECTION ""TAI YU""" 15.00

AC13929265 "DEXTROSE-LACTATED RINGER'S INJECTION ""TAI YU""" 26.30

AC13929277 "DEXTROSE-LACTATED RINGER'S INJECTION ""TAI YU""" 29.50

AC13980238 "DEXTROSE INJECTION 20% ""TAI YU""" 15.00

AC13980277 "DEXTROSE INJECTION 20% ""TAI YU""" 25.00

AC13985209 TESTOSTERONE CYPIONATE INJECTION "TAI YU" 117.00

AC14015100 SPIRONOLACTONE TABLETS 25 MG "C. L." 1.50

AC140151G0 SPIRONOLACTONE TABLETS 25 MG "C. L." 2.00

AC14025100 KENTAMIN CAPSULES 1.68

AC140251G0 KENTAMIN CAPSULES (鋁箔/膠箔) 2.00

AC14030212 "METOCLOPRAMIDE INJECTION ""TAI YU""" 15.00

AC14079100 CLONIDINE TABLETS "YUNG SHIN" 1.96

AC14148212 HYDROXOCOBALAMIN INJECTION "CHI SHENG" 15.00

AC14148229 HYDROXOCOBALAMIN INJECTION "CHI SHENG" 22.00

AC14148299 HYDROXOCOBALAMIN INJECTION "CHI SHENG" 2.20

AC14170100 DEXAMETHASONE TABLETS "YUNG CHI" 1.50

AC14183100 "DEXAMETHASONE TABLETS ""WINSTON""" 1.50

AC14195100 D.A.A. TABLETS "F.Y." 1.50

AC14205238 SURPLEX INJECTION "CHI SHENG" 15.00

AC14227100 BETAMETHASONE TABLETS "YUNG SHIN" 1.50

AC142271G5 BETAMETHASONE TABLETS "YUNG SHIN" (84粒/瓶) 2.00

AC14228100 ALLOPURINOL TABLETS"YUNGSHIN" 1.50

AC142281G0 ALLOPURINOL TABLETS"YUNGSHIN"(鋁箔/膠箔) 2.00

AC14235100 GUAPYNG TABLETS 1.50

AC14241212 "DIPROPHYLLIN INJECTION ""TAI YU""" 15.00

AC14277100 SAUSCON TABLETS 1.50

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AC14321421 PAMESONE OPHTHALMIC SOLUTION "PATRON" 12.20

AC14321429 PAMESONE OPHTHALMIC SOLUTION "PATRON" 25.40

AC14325209 "DEXAMETHASONE INJECTION ""TAI YU""" 15.00

AC14325229 "DEXAMETHASONE INJECTION ""TAI YU""" 19.10

AC14343100 COBAMAMIDE CAPSULES "HONTEN" 1.50

AC143431G0 COBAMAMIDE CAPSULES "HONTEN"(鋁箔/膠箔) 2.00

AC14346100 HYDROCHLOROTHIAZIDE TABLETS "SHINLON" 1.50

AC14354277 "XYLITOL INJECTION 5% ""TAI YU""" 26.70

AC14355209 "ATROPINE SULFATE INJECTION ""TAI YU""" 15.00

AC14356209 TESTOSTERONE PROPIONATE INJECTION "TAI YU" 103.00

AC14357238 "PYRICOBAMIN INJECTION ""TAI YU""" 15.00

AC14360212 "SKIMITIN INJECTION ""TAI YU""" 15.00

AC14360238 "SKIMITIN INJECTION ""TAI YU""" 15.00

AC14361209 "NEOSTIGMINE METHYLSULFATE INJECTION ""TAI YU""" 15.00

AC14363209 "ERGONOVINE MALEATE INJECTION ""TAI YU""" 15.00

AC14441221 BLONDA INJECTION 5% (TRANEXAMIC ACID) "C.C.P. 15.00

AC14449100 COUGH CAPSULES "PATRON" 1.50

AC14456238 "AMINO COMPOSITE INJECTION ""TAI YU""" 15.00

AC14596500 NYSTATIN VAGINAL TABLETS "YUNG SHIN" 5.00

AC14622212 FUTIGEN-H INJECTION "S.Y." 15.00

AC14622221 FUTIGEN-H INJECTION "S.Y." 15.00

AC14624100 BUPROFEN CAPSULES 400MG "LITA" 1.50

AC14692100 DEXAMETHASONE TABLETS "PANBIOTIC" 1.50

AC14750229 LICOMYCIN INJECTION 300MG/ML "CSP" 0.00

AC14755100 DIKUTON TABLETS 1.50

AC14756216 PENICILLIN G SODIUM INJECTION 3000000U "Y.F." 106.00

AC14759209 "B-COMPLEX INJECTION ""TAI YU""" 15.00

AC14759229 "B-COMPLEX INJECTION ""TAI YU""" 15.00

AC14833100 CHOLAR S.C. TABLETS 25MG "YUNG SHIN" 1.50

AC14842100 DEXTROMETHORPHAN TABLETS 30MG "LITA" 1.50

AC148421G0 DEXTROMETHORPHAN TABLETS 30MG "LITA"(鋁箔/膠箔) 2.00

AC14845100 FULUCON TABLETS "S.T." 1.50

AC14880100 METHYLSCOPOLAMINE METHYLSULFASTE TABLETS "S.Y." 1.50

AC14894212 "GENTAMICIN INJECTION 4% ""TAI YU""" 15.00

AC14894229 "GENTAMICIN INJECTION 4% ""TAI YU""" 16.50

AC14894238 "GENTAMICIN INJECTION 4% ""TAI YU""" 40.80

AC14909100 MEFENAMIC ACID CAPSULES 250MG"D.T.S" 1.50

AC14915329 FLUCORTONE OINT. 41.20

AC14917100 FERACON F.C. TABLETS 2.04

AC14925100 ANETHOLE CAPSULES "LITA" 1.50

AC14926212 "BROMHEXINE INJECTION ""S.Y.""" 15.00

AC14930100 "CHLORZOXAZONE TABLETS ""WINSTON""" 1.50

AC14981209 CLONIDINE INJECTION "YUNG SHIN" 36.00

AC15021100 GUAIAZULENE SODIUM SULFONATE TABLETS "YUNG CHI" 1.50

AC15024100 METHYLSCOPOLAMINE METHYLSULFATE TABLETS "P.L. 1.50

AC15041100 KETOFEN CAPSULES "H.H." 1.59

AC15042100 JINCIN TABLETS 10MG“N.C.P” 1.50

AC15056238 "DEXTROSE INJECTION 50% ""TAI YU""" 15.00

Page 83: 附件二 藥品給付品項暨支付標準表

AC15065100 LITONBA TABLETS "Y.S." 1.50

AC15078100 DIPHENIDOL S.C. TABLETS 1.50

AC150781G0 DIPHENIDOL S.C. TABLETS (鋁箔/膠箔) 2.00

AC15080329 Y.T.M. OINTMENT "TAI YU" 26.60

AC150901G0 PSEUDOEPHEDRINE HCL TABLETS "HONTEN"(鋁箔/膠箔) 2.00

AC15091100 KETOPROFEN CAPSULES 50MG "F.Y." 1.59

AC15180212 COLISTIN POWDER FOR INJECTION 130.00

AC15195100 NARCARICIN CAPSULES (BENZBROMARONE) "SWISS" 1.50

AC151951G0 NARCARICIN CAPSULES (BENZBROMARONE)(鋁箔/膠箔) 2.00

AC15218238 "DEXTROSE INJECTION 5% ""TAI YU""" 15.00

AC15218255 "DEXTROSE INJECTION 5% ""TAI YU""" 22.00

AC15218265 "DEXTROSE INJECTION 5% ""TAI YU""" 22.00

AC15218277 "DEXTROSE INJECTION 5% ""TAI YU""" 25.00

AC15246265 5% DEXTROSE IN 0.33% SALINE INJECTION "SIN TONG" 22.00

AC15246277 5% DEXTROSE IN 0.33% SALINE INJECTION 25.00

AC15253209 PYRIDOXINE HCL INJECTION 100MG/ML "TAI YU" 15.00

AC15253229 PYRIDOXINE HCL INJECTION 100MG/ML "TAI YU" 15.00

AC15265100 CHLORPROMAZINE TABLETS "Y.Y." 0.00

AC15268100 "DEXAMETHASONE TABLETS ""S.Y.""" 1.50

AC15279209 "DEXAMETHASONE INJECTION 4MG ""TAI YU""" 15.00

AC15279229 "DEXAMETHASONE INJECTION 4MG ""TAI YU""" 20.00

AC15343221 "HISTIDINE INJECTION ""TAI YU""" 15.00

AC15359100 ANETHOL TRITHIONE S.C. TABLETS "SHINLON" 1.50

AC15368100 DIPHENIDOL SUGAR COATING TABLETS "YUNG SHIN" 1.50

AC15387100 NAPOSIN TABLETS (NAPROXEN)250MG 1.50

AC153871G0 NAPOSIN TABLETS 250MG(NAPROXEN)(鋁箔/膠箔) 2.00

AC15394100 METHYLSCOPOLAMINE METHYLSULFATE TABLETS "LITA 1.50

AC15407229 LINCOMYCIN INJECTION "SINTONG" 27.20

AC15422100 RELAZIDE S.C. TABLETS "STANDARD" 1.50

AC154221G0 RELAZIDE S.C. TABLETS "STANDARD"(鋁箔/膠箔) 2.00

AC15467100 DEXAMETHASONE TABLETS 4MG "STANDARD" 1.50

AC15473229 "LINCOMYCIN HCL INJECTION 300MG ""TAI YU""" 27.20

AC15473238 "LINCOMYCIN HCL INJECTION 300MG ""TAI YU""" 39.20

AC15473299 LINCOMYCIN HCL INJ. 300MG 1.96

AC15514209 EPINEPHRINE INJECTION "VPP" 15.00

AC15522100 CANCIDIN TABLETS 500MG "BOWLIN" (TINIDAZOLE) 0.00

AC15526229 LINCOMYCIN INJECTION "YUNG SHIN" 27.20

AC15529100 DICYCLOMINE TABLETS "D.T.S." 1.50

AC15539229 K.C.L. INJECTION "CHI SHENG" 15.00

AC15539238 K.C.L. INJECTION "CHI SHENG" 15.00

AC15543100 PEICHIA TABLETS "P.L." 1.50

AC155431G0 PEICHIA TABLETS "P.L."(鋁箔)/膠箔 2.00

AC15561255 MANNITOL INJECTION 20% 100ML"SHUN HWE" 39.40

AC15561266 MANNITOL INJECTION 20% 300ML 39.40

AC15561277 MANNITOL INJECTION 20% "SHUN HWA" 108.00

AC15579100 TRIAMCINOLONE TABLETS 4 MG "F.Y." 1.50

AC155791G0 TRIAMCINOLONE TABLETS 4MG "F.Y."(鋁箔/膠箔) 2.00

AC15584299 LINCOMYCIN INJECTION "C.C.P." 1.96

Page 84: 附件二 藥品給付品項暨支付標準表

AC15616100 BACZINE TABLETS "H.S." 1.50

AC15622100 MEBENDAZOLE TABLETS "YUNG CHI" 1.50

AC15629100 CINNARIZINE TABLETS "CHINTENG" 1.50

AC156291G0 CINNARIZINE TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC15660100 CEPHALEXIN CAPSULES "S.T." 1.78

AC156601G0 CEPHALEXIN CAPSULES "S.T."(鋁箔/膠箔) 2.00

AC15674100 SESDEN CAPSULES (TIMEPIDIUM) 2.55

AC15697100 LIPHALEXIN CAPSULES 500MG "LITA" 1.78

AC15721100 DIS S.C. TABLETS (DIPHENIDOL) 1.50

AC15748100ALDIOXA TABLETS "PATRON" (DIHYDROXYALUMINUM

ALLANTOINATE)1.50

AC15791100 TETRACYCLINE HCL CAPSULES 250MG "VPP" 1.50

AC157911G0 TETRACYCLINE HCL CAPSULES 250MG "VPP"(鋁箔/膠箔) 2.00

AC15837100 PIRAMIDE TABLETS "P.L." 3.74

AC15843277 CEFAZOLIN INJECTION "YUNG SHIN" 25.00

AC15845216 PENICILLIN G SODIUM INJECTION "Y.F." 106.00

AC15849100 CLOMIPHENE CAPSULES 50MG "YU SHENG" 3.87

AC15910100 PIPRINHYDRINATE TABLETS "P.L." 1.50

AC15911209 AMPOLIN INJECTIONS 1000MG 25.00

AC15987212 "DIAZEPAM INJECTIONS ""TAI YU""" 15.00

AC16020100 BATHOLIN TABLETS "GENTLE" 1.50

AC16038100 BEC CAPSULES 1.50

AC16065209 DEXAMETHASONE INJECTIONS 4MG "ASTAR" 15.00

AC16065212 DEXAMETHASONE INJECTIONS 4MG "ASTAR" 17.30

AC16141100 SALBUTAMOL TABLETS 4MG "F.Y." 1.50

AC16144100 CINNARIZINE TABLETS "S.T." 1.50

AC16162100 CO-TRIMO TABLETS "F.Y." 1.50

AC16195100 DEXTROMETHORPHAN TABLETS 30 MG 1.50

AC16227100 DOXYCYCLINE CAPSULES "YY" 1.50

AC16303421 DECASON EYE DROPS 12.20

AC16322100 HOWEI TABLETS 1.50

AC16336100 "BEYLIYAN TABLETS ""M.T.""" 0.00

AC16349321 "BETASONE CREAM (BETAMETHASONE) ""GCPC""" 13.00

AC16349329 "BETASONE CREAM (BETAMETHASONE) ""GCPC""" 15.90

AC16349335 BETASONE CREAM (BETAMETHASONE) "GCPC" 31.90

AC16378100 AMPICILLIN CAPSULES "SINTONG" 1.50

AC16402338 SILVER SULFADIAZINE CREAM 32.30

AC16402348 SILVER SULFADIAZINE CREAM 43.70

AC16402371 SILVER SULFADIAZINE CREAM 267.00

AC16402377 SILVER SULFADIAZINE CREAM 357.00

AC16420100 CHLORZOXAZONE TABLETS "PL." 1.50

AC16432100 ANTON TABLETS 1.52

AC164321G0 ANTON TABLETS (鋁箔/膠箔) 2.00

AC16444100 PRINATE TABLETS "CHINTENG" (PIPRINHYDRINATE) 1.50

AC164441G0PRINATE TABLETS "CHINTENG" (PIPRINHYDRINATE)(鋁箔/膠箔)

2.00

AC16449100 CEPHENDOL S.C. TABLETS 25MG (DIPHENIDOL) "F.Y 1.50

Page 85: 附件二 藥品給付品項暨支付標準表

AC164491G0CEPHENDOL S.C. TABLETS 25MG (DIPHENIDOL) "F.Y"(鋁箔/膠

箔)2.00

AC16457212 HYCOBAL INJECTION (HYDROXOCOBALAMINE) "SWISS" 15.00

AC16464100 PREDNISOLONE TABLETS "P.J." 1.50

AC16476238 "MANNITOL INJECTION ""TAI YU""" 0.00

AC16476266 "MANNITOL INJECTION ""TAI YU""" 39.40

AC16476277 "MANNITOL INJECTION ""TAI YU""" 108.00

AC16485100 TONREN CAPSULES "C.M." 1.50

AC16496100 DEXAMETHASONE TABLETS"C.L" 1.50

AC16500100 CHYMOTRYPSIN E.C. TABLETS "CHINTENG" 3.78

AC16584209 SALBUTAMOL INJECTION "YUNG SHIN" 15.00

AC16589209 ORIDERON INJECTION "ORIENTAL" 15.40

AC16605299 LINCOMYCIN INJECTION "STANDARD" 1.96

AC16706100 ULEXIN CAPSULES (CEPHALEXIN) 1.50

AC167061G0 ULEXIN CAPSULES (CEPHALEXIN)(鋁箔/膠箔) 2.00

AC16712100 ANTISEMIN TABLETS 1.50

AC16816100 CYPRODINE TABLETS (CYPROHEPTADINE HCL) 1.50

AC16821100 LOPERAMIDE CAPSULES "HONTEN" 1.50

AC168211G0 LOPERAMIDE CAPSULES "HONTEN"(鋁箔/膠箔) 2.00

AC16850100TAR WEING TABLETS (METHYLSCOPOLAMIN METHYL

SULFATE)"S.T."1.50

AC16862321 TOPCORT CREAM "RICHEVER" 34.10

AC16862329 TOPCORT CREAM "RICHEVER" 44.10

AC16863212 BISCO INJECTION "STANDARD" (BROMHEXINE) 15.00

AC16868209"HYOSCON INJECTION (SCOPOLAMINE BUTYLBROMIDE)""TAI YU"""

15.00

AC16878229 LINCOMYCIN HYDROCHLORIDE INJECTION "LITA" 27.20

AC16902100 "METOPERAN S.C. TABLETS (METOCLOPRAMIDE) ""H.C.""" 1.50

AC16908209 5% DEXTROSE IN 0.225% SALINE INJECTION "S.T." 35.00

AC16908277 5% DEXTROSE IN 0.225% SALINE INJECTION "S.T." 25.00

AC16913209 CARBENMYCIN INJECTION "YUNG SHIN"(CARBENICILLIN) 0.00

AC169321G0 SEUDORIN TABLETS (PSEUDOEPHEDRINE HCL)(鋁箔/膠箔) 2.00

AC16953100 RIFAMPICIN CAPSULES 300MG "YUNG SHIN" 8.00

AC16958100 NICOFEROL CAPSULES "GENTLE" (TOCOPHEROL NICOTINATE) 0.00

AC16962100 SABUTAL TABLETS (SALBUTAMOL) "SWISS" 1.50

AC16963209 SIVKORT STERILE SUSPENSION 40MG (TRIAMCINOLONE) 20.70

AC16963212 SIVKORT STERILE SUSPENSION 40MG (TRIAMCINOLONE) 23.80

AC16963229 SIVKORT STERILE SUSPENSION 40MG (TRIAMCINOLONE) 57.00

AC16964100 LISUZONE TABLETS "Y.K."(HYDROCHLOROTHIAZIDE) 1.50

AC16972100 SWITYL TABLETS 1.50

AC17007277 CEFAZOLIN INJECTION 0.5GM "C.C.P." 25.00

AC17018100 LETANLON S.C. TABLETS (ANETHOLE TRITHIONE) 1.50

AC17022277 HARTMANN'S G INJECTION 36.40

AC17082100 SIDUS TABLETS "F.Y." 1.50

AC170821G0 SIDUS TABLETS "F.Y."(鋁箔/膠箔) 2.00

AC17124100 WEYAN TABLETS "M.T." 1.50

AC171241G0 WEYAN TABLETS "M.T." (鋁箔/膠箔) 2.00

AC17136100 TONPEN TABLETS "W.S." 1.50

Page 86: 附件二 藥品給付品項暨支付標準表

AC17138100 CYHEPDIN TABLETS (CYPROHEPTADINE)"J.H." 1.50

AC17153100 CYPROHEPTADINE HCL TABLETS "SHINLON" 1.50

AC17179100 SHULIJN TABLETS " CHEN TA" 1.50

AC17185100 MEFENA TABLETS "GCPC" (MEFENAMIC ACID) 1.50

AC171851G0 MEFENA TABLETS "GCPC"(MEFENAMIC ACID)鋁箔/膠箔)" 2.00

AC17200421 DECASON EYE DROPS "OASIS" (DEXAMETHASONE) 12.80

AC17203100 GLYCYRRIZINE & OPIUM COMPOUND TABLETS "HEALTH" 1.50

AC172031G0GLYCYRRIZINE & OPIUM COMPOUND TABLETS "HEALTH"(鋁箔/膠

箔)0.00

AC17245100 MORIEIN TABLETS "D.T.S." (BENZYDAMINE) 1.50

AC17248100 MIGUZETO TABLETS "M.T." 0.00

AC172481G0 MIGUZETO TABLETS "M.T."(鋁箔/膠箔) 2.00

AC17256100 BETALIN TABLETS (BETAMETHASONE) 1.50

AC17279421 GENTAMICIN EYE DROPS "GCPC" 14.50

AC17279429 GENTAMICIN EYE DROPS "GCPC" 37.10

AC17280151 ULEXIN FOR ORAL SUSPENSION (CEPHALEXIN) 124.00

AC17291100 PYSTON TABLETS 250MG"SHINLON"(MEFENAMIC ACID) 1.50

AC17292100 LITONIN TABLETS (TRIAMCINOLONE) 0.00

AC17328100 DEXTROMETHORPHAN TABLETS 30MG "HONTEN" 1.50

AC173281G0 DEXTROMETHORPHAN TABLETS 30MG "HONTEN"(鋁箔/膠箔) 2.00

AC17331100 "MEFENAMIC ACID CAPSULES ""WINSTON""" 1.50

AC17350212 DIPYRIDAMOLE INJECTION "STANDARD" 15.00

AC17353100 N-METHYLSCOPOLAMINE METHYL SULFATE TABLETS 1MG "M.T." 1.50

AC17382100 NORDRON S.C. TABLETS (NORETHINDRONE) 1.66

AC173821G0 NORDRON S.C. TABLETS (NORETHINDRONE)(鋁箔/膠箔) 2.00

AC17429100 ISOPRINE S.C. TABLETS (ISOXSUPRINE) 1.50

AC17433100 SULFATRIME TABLETS "J.H." 1.50

AC17508100 KNOWFUL CAPSULES "YUNG SHIN"(PIRACETAM) 1.50

AC175081G0 KNOWFUL CAPSULES "YUNG SHIN"(PIRACETAM)(鋁箔/膠箔) 2.00

AC17594100 RIFAMPIN CAPSULES 300MG 8.00

AC17628100STOPIN TABLETS "GENTLE" (METHYL-SCOPOLAMINE METHYL

SULFATE)0.00

AC17712209 CEFAZOLIN INJECTION 1GM "C.C.P." 25.00

AC17713100 MEBENDAZOLE TABLETS "LITA" 1.50

AC17795321 SOFT CREAM 12.80

AC17795329 SOFT CREAM 14.90

AC17795335 SOFT CREAM 19.60

AC17795338 SOFT CREAM 19.60

AC17809100 NOSCOUGH TABLETS "CHINTENG" 1.50

AC178091G0 NOSCOUGH TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC17857100 DE-ASTHMA TABLETS "H.S." 1.50

AC17859100 AMPICILLIN CAPSULES 500MG "KINGDOM" 1.50

AC17866100 SPARTIN TABLETS 1.50

AC17868100 SUWIMIN TABLETS "CHEN TA"(DICYCLOMINE) 1.50

AC17877100 COSUTONE TABLETS "H.H." 1.50

AC17890100 SELADIN CAPSULES 1.50

AC18037100 DIPHENIDOL TABLETS "P.L." 1.50

AC18051100 HALOSTEN TABLETS 1MG (HALOPERIDOL) 1.50

Page 87: 附件二 藥品給付品項暨支付標準表

AC18053321 SWISSCORT CREAM "SWISS BRAND" 13.90

AC18061100 COPHYLLINE TABLETS 1.50

AC18063321 TOPSYM CREAM (FLUOCINONIDE) 34.10

AC18063329 TOPSYM CREAM (FLUOCINONIDE) 44.10

AC18063338 TOPSYM CREAM (FLUOCINONIDE) 109.00

AC18088321 TOPSYM OINTMENT (FLUOCINONIDE) 34.10

AC18088338 TOPSYM OINTMENT (FLUOCINONIDE) 109.00

AC18097100 "KETOPROFEN CAPSULES ""M.T.""" 1.59

AC18132100 WETUNLIN TABLETS "S.Y." 1.50

AC18171100 WEICOLA TABLETS "CHINTENG" 1.50

AC181711G0 WEICOLA TABLETS "CHINTENG" (鋁箔/膠箔) 2.00

AC18183100 RELAPINE TABLETS "C.H." 1.50

AC18193100 HOMSHIPEN CAPSULES 1.59

AC181931G0 HOMSHIPEN CAPSULES(鋁箔/膠箔) 2.00

AC18204212 SEQUITON INJECTION 0.00

AC18232100 "SUSEMIDE TABLETS (HYDRALAZINE) ""H.C."" " 1.52

AC18240100 PHENYTOIN TABLETS 100MG "VPP" 1.50

AC182401G0 PHENYTOIN TABLETS 100MG"VPP"(鋁箔/膠箔) 2.00

AC18291212 GENTA-C INJECTION 40MG/ML "GENTLE" 15.00

AC18291229 GENTA-C INJECTION 40MG/ML "GENTLE" 16.50

AC18342100 LOBAK TABLETS "CHINTENG" 1.50

AC183421G0 LOBAK TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC18373100 TATONLIN CAPSULES "Y.S." (MEFENAMIC ACID) 1.50

AC18406100 CINNARIZINE TABLETS "C.H." 1.50

AC18411100 MEBENDAZOLE TABLETS "CHINTENG" 1.50

AC18416100 "PRO-LIVER S.C. TABLETS ""M.T.""" 1.58

AC18424212 ASCORBIC ACID INJECTION 500MG "SWISS BRAND" 15.00

AC184441G0 CABIDRIN FILM COATED TABLETS "JOHNSON"(鋁箔/膠箔) 1.54

AC18451100 G.P.D. CAPSULES "HEALTH" 1.50

AC184511G0 G.P.D. CAPSULES "HEALTH"(鋁箔/膠箔) 2.00

AC18458100 PROSANOL TABLETS (PROPRANOLOL) 1.50

AC184581G0 PROSANOL TABLETS (PROPRANOLOL)(鋁箔/膠箔) 2.00

AC18467100 HALOSTEN TABLETS 2MG (HALOPERIDOL) 1.50

AC18519209 PROMIN INJECTION "N.K." 58.00

AC18519265 PROMIN INJECTION "N.K." 22.40

AC18519277 PROMIN INJECTION "N.K." 27.50

AC18569100 SPIROTONE TABLETS 25MG "V.P.P." (SPIRONOLACTONE) 1.50

AC185691G0SPIROTONE TABLETS 25MG "V.P.P." (SPIRONOLACTONE)(鋁箔/膠

箔)2.00

AC18572100 KETOPROFEN CAPSULES "CHEN TA" 1.59

AC18589209 NEO-ERGO INJECTION "ORIENTAL" 17.40

AC18592100 ECAN CAPSULES (ANETHOLE) "S.T." 1.50

AC18598329 HEMODIN OINTMENT "PATRON" 49.00

AC18598335 HEMODIN OINTMENT "PATRON" 60.00

AC18620100 UNDIARRHEA CAPSULES"YUNG SHIN" (LOPERAMIDE) 1.50

AC18646100 DIPHENIDOL S.C. TABLETS "H.S." 1.50

AC186461G0 DIPHENIDOL S.C. TABLETS "H.S."(鋁箔/膠箔) 2.00

AC18649100 KORYNASE E.C. TABLETS 5MG 2.80

Page 88: 附件二 藥品給付品項暨支付標準表

AC18654100 COFFEGOT TABLETS "Y.Y." 1.50

AC18670209 DEXAMETHASONE INJECTION 4MG/ML "GENTLE" 15.00

AC18670212 DEXAMETHASONE INJECTION 4 MG/ML "GENTLE" 0.00

AC18670229 DEXAMETHASONE INJECTION 4 MG/ML "GENTLE" 20.00

AC18679209 DEXAMETHASONE INJECTION 0.5% 17.20

AC18692100 MEBENDAZOLE TABLETS "M.T." 1.50

AC18705100 ALLOPRIM TABLETS "SL"(ALLOPURINOL) 1.50

AC18719100 IMIMINE S.C. TABLETS 25MG "VPP" (IMIPRAMINE) 1.55

AC187191G0IMIMINE S.C. TABLETS 25MG "VPP" (IMIPRAMINE) (鋁箔/膠箔)

2.00

AC18726100 GU YEN TABLETS "S.T." 1.50

AC187261G0 GU YEN TABLETS "S.T."(鋁箔/膠箔) 2.00

AC18772121 KOSULER PASTE (TRIAMCINOLONE) "PANBIOTIC" 28.40

AC18772129 KOSULER PASTE (TRIAMCINOLONE) "PANBIOTIC" 59.00

AC18789100 POSTON CAPSULES 250MG "CHEN TA" 1.50

AC18823100 SUNET HTON TABLETS 1.50

AC18862100 MEFENAMIC ACID CAPSULES "S.T." 1.50

AC18886100 KETOPROFENE CAPSULES "LITA" 1.59

AC18887100 HOTITON TABLETS 1.50

AC18892100 KOSIWAY TABLETS "T.F." 1.50

AC18895100 NYSTATIN CAPSULES "YUNG SHIN" 2.64

AC18905100 THIRIZINE S.C. TABLETS 25MG 1.50

AC18920100 DACTIRAN F.C. TABLETS (PIPERIDOLATE) "KYORIN" 2.02

AC18946209 DEXAMETHASONE INJECTION "Y.Y." 15.00

AC18946212 DEXAMETHASONE INJECTION "Y.Y." 15.00

AC18946229 DEXAMETHASONE INJECTION "Y.Y." 19.10

AC18949100 BISACODYL E.C. TABLETS 5MG "VPP" 1.50

AC189491G0 BISACODYL E.C. TABLETS 5MG "VPP"(鋁箔/膠箔) 2.00

AC18973100 AMPICILLIN CAPSULES 250MG "CSP" 1.50

AC18996100 M.B. TABLETS (MEPENZOLATE BROMIDE) "M.T." 1.50

AC19033100 GEMOX CAPSULES 500MG (AMOXYCILLIN) "GENTLE" 1.50

AC19054100 GEMOX CAPSULES 250MG (AMOXYCILLIN) "GENTLE" 1.50

AC19072100 KETOPROFEN CAPSULES "Y.S." 1.59

AC190721G0 KETOPROFEN CAPSULES "Y.S."(鋁箔/膠箔) 2.00

AC19093100 DIPHENIDOL TABLETS 25MG“N.C.P” 1.50

AC19097100 LOFAXIN CAPSULES 250MG "GENTLE" (CEPHALEXIN) 1.50

AC19127100 STANOL TABLETS "H.H." (STANOZOLOL) 1.50

AC19135100 AMPICILLIN CAPSULES 500MG "GENTLE" 1.50

AC19137100 ANICAMET S.C. TABLETS (NICAMETATE) "W.S." 1.50

AC19138100 DIPYRIDAMOLE S.C. TABLETS "SHINLON" 1.50

AC19141100 TENING TABLETS (DIAZEPAM) "C.H." 0.00

AC19142100 ACETAZONE TABLETS "J.H." 1.50

AC19154100 CAPDES TABLETS "JOHNSON" 1.50

AC19157100 NIFUTOIN TABLETS "C.H."(NITROFURANTOIN) 1.50

AC19177100 "SUWEILAN TABLETS (METOCLOPRAMIDE) ""S.Y.""" 1.50

AC19192100 PROPRANOLOL TABLETS "SHINLON" 1.50

AC19210100 ERGOCAFE TABLETS "C.H." 1.50

AC19246100 BONAS E.S. TABLETS (BROMELAIN) 1.50

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AC19247100 SILENCE TABLETS "YUNG SHIN" (LORAZEPAM) 1.50

AC192471G0 SILENCE TABLETS "YUNG SHIN"(LORAZEPAM)(鋁箔/膠箔) 2.00

AC19252100 KETOFEN CAPSULES "J.H." 1.59

AC19254100 DOXYCYCLINE CAPSULES 1.50

AC192541G0 DOXYCYCLINE CAPSULES(鋁箔/膠箔) 2.00

AC19263100MUQUAPIN F.C. TABLETS "H.S." (N-METHYLSCOPOLAMINE

METHYLSULFATE)1.50

AC19275100 SARIN TABLETS "J.H." 1.50

AC19276212 "THIOCTAN INJECTION (THIOCTIC ACID) ""TAI YU""" 15.00

AC19276221 "THIOCTAN INJECTION (THIOCTIC ACID) ""TAI YU""" 15.00

AC19280212 CEFAZOLIN INJECTION "CHI SHENG" 61.00

AC19280221 CEFAZOLIN INJECTION "CHI SHENG" 0.00

AC19280229 CEFAZOLIN INJECTION "CHI SHENG" 0.00

AC19280238 CEFAZOLIN INJECTION "CHI SHENG" 0.00

AC19296238 "DEPAINING INJECTION ""TAI YU""" 15.00

AC19337100 LIMODIUM TABLETS (LOPERAMIDE) 1.50

AC193371G0 LIMODIUM TABLETS (LOPERAMIDE) 2.00

AC19358277 CEFAMANDOLE INJECTION "YUNG SHIN" 32.60

AC19359100 PAINLESS TABLETS "YUNG SHIN" 1.50

AC19360100 ASMELLIN-EPG TABLETS "CHINTENG" 1.50

AC193601G0 ASMELLIN-EPG TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC19362321 TODERMGEN CREAM 25.70

AC19362329 TODERMGEN CREAM 55.00

AC19362335 TODERMGEN CREAM 96.00

AC19411100 DOXYMYCIN ENTERIC COATED TABLETS "YUNG SHIN" 1.50

AC19418100 DECONE TABLETS (DEXAMETHASONE) "SINPHAR" 1.50

AC194181G0 DECONE TABLETS (DEXAMETHASONE) "SINPHAR" 2.00

AC19419100 PONSTAL CAPSULES 250MG "SINPHAR"(MEFENAMIC ACID) 1.50

AC194191G0 PONSTAL CAPSULES 250MG "SINPHAR"(MEFENAMIC ACID) 2.00

AC19420100 PONSTAL F.C. TABLETS 500MG (MEFENAMIC ACID) "SINPHAR" 1.50

AC194201G0 PONSTAL F.C. TABLETS 500MG (MEFENAMIC ACID) "SINPHAR" 2.00

AC19421100 Ponstal F.C. Tablets 250mg "Sinphar" (Mefenamic Acid) 1.50

AC19445100 KPHADOL TABLETS "SWISS" (DIPHENIDOL) 1.50

AC194451G0 KPHADOL TABLETS "SWISS" (DIPHENIDOL)(鋁箔/膠箔) 2.00

AC19461100 METHYLDOPA F.C. TABLETS "JOHNSON" 2.46

AC19462100 STOLINE TABLETS "LITA" 1.50

AC19495100 LORAZEPAM TABLETS 1MG "LITA" 1.50

AC19503100 SINPHADOL S.C. TABLETS (DIPHENIDOL) "SINPHAR" 1.50

AC195031G0 SINPHADOL S.C. TABLETS (DIPHENIDOL) "SINPHAR" 2.00

AC19506100 DISCO TABLETS (DIPHENIDOL) 1.50

AC19522100 BICOTAN E.C. TABLETS (BISACODYL) 1.50

AC195221G0 BICOTAN E.C. TABLETS (BISACODYL)(鋁箔/膠箔) 2.00

AC19548100 "ASRITIN TABLETS (ORCIPRENALINE) ""ROYAL""" 1.50

AC19549100 "TELINCOL TABLETS ""ROYAL""" 1.50

AC195491G0 "TELINCOL TABLETS ""ROYAL""(鋁箔/膠箔)" 2.00

AC19553100 HALOLIUM TABLETS (HALOPERIDOL) "ROYAL" 1.50

AC19556100 CYPRO TABLETS (CYPROHEPTADINE) "ROYAL" 1.50

AC195561G0 CYPRO TABLETS (CYPROHEPTADINE) "ROYAL"(鋁箔/膠箔) 2.00

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AC19557100 "PURINOL TABLETS (ALLOPURINOL) ""ROYAL""" 1.50

AC195571G0 PURINOL TABLETS (ALLOPURINOL) "ROYAL"(鋁箔/膠箔) 2.00

AC19558100 "NAPROXEN TABLETS ""ROYAL""" 1.50

AC19562100 TOROFEN CAPSULES (KETOPROFEN) "STANDARD" 1.59

AC19573100 CLOMIPHENE TABLETS "PEILI" 3.87

AC19579100 LIMIN TABLETS (NITRAZEPAM) "YU SHENG" 1.50

AC19595100 INDALGIN CAPSULES 25MG (INDOMETHACIN) 1.50

AC195951G0 INDALGIN CAPSULES 25MG (INDOMETHACIN) 2.00

AC19596100 IBUPROFEN TABLETS 400MG "HONTEN" 1.50

AC195961G0 IBUPROFEN TABLETS 400MG "HONTEN" (鋁箔/膠箔) 2.00

AC19610100 ROITONIN S.C. TABLETS (DICLOFENAC) "JOHNSON" 1.50

AC19616321 BETAMETHASONE OINTMENT "SINPHAR" 13.00

AC19616329 BETAMETHASONE OINTMENT "SINPHAR" 15.90

AC19620100 NAPROXEN TABLETS "SINPHAR" 1.50

AC196201G0 NAPROXEN TABLETS "SINPHAR" 2.00

AC19625100 PISANTA CAPSULES (PIRACETAM) "ROYAL" 1.50

AC196251G0 PISANTA CAPSULES (PIRACETAM) "ROYAL"(鋁箔/膠箔) 2.00

AC19627100 PESADIN F.C TABLETS (DIPYRIDAMOLE) "ROYAL" 1.50

AC196271G0 PESADIN F.C TABLETS (DIPYRIDAMOLE) "ROYAL"(鋁箔/膠箔) 2.00

AC19636100 CLEANSERA CAPSULES (TOCOPHERYL NICOTINATE) "ROYAL" 1.50

AC19639100 PROPRA TABLETS (PROPRANOLOL) "ROYAL" 1.50

AC196391G0 PROPRA TABLETS (PROPRANOLOL) "ROYAL"(鋁箔/膠箔) 2.00

AC19640100 "ALKANTIN TABLETS ""ROYAL""" 1.50

AC196401G0 "ALKANTIN TABLETS ""ROYAL""(鋁箔/膠箔)" 2.00

AC19643100 "DORISON TABLETS (DEXAMETHASONE) ""ROYAL""" 1.50

AC196431G0"DORISON TABLETS (DEXAMETHASONE) ""ROYAL""(鋁箔/膠箔)"

2.00

AC19649100 "JACIDE TABLETS ""ROYAL""" 1.50

AC19654299 KANAMYCIN INJECTION "YUNG SHIN" 1.33

AC19656100 AZUNEN TABLETS "MEIDER" (GUAIAZULENE) 1.50

AC19665100 LORAZEPAM TABLETS 0.5MG "LITA" 1.50

AC196651G0 LORAZEPAM TABLETS 0.5MG "LITA"(鋁箔/膠箔) 2.00

AC19706100 DIFENDOL S.C. TABLETS "JOHNSON" 1.50

AC197061G0 DIFENDOL S.C. TABLETS "JOHNSON"(84粒/瓶) 2.00

AC197061GA DIFENDOL S.C. TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

AC19709100MESCO TABLETS "J.H." (METHYLSCOPOLAMINE METHYLSULFATE)

1.50

AC19725100 TRANCORON TABLETS 1.50

AC19749100 PRIMRAN F.C. TABLETS (METOCLOPRAMIDE) "ROYAL" 1.50

AC197491G0PRIMRAN F.C. TABLETS (METOCLOPRAMIDE) "ROYAL"(鋁箔/膠箔)

2.00

AC19764212 STOPNIN INJECTION 5MG "KYORIN" 15.00

AC19769100 LOPERAMIDE CAPSULES "H.H." 1.50

AC197691G0 LOPERAMIDE CAPSULES "H.H."(鋁箔/膠箔) 2.00

AC19786100 TIDAZOL F.C. TABLETS (TINIDAZOLE) "STANDARD" 2.09

AC19799212 "PYRIDOXAL PHOSPHATE INJECTION ""TAI YU""" 15.00

AC19800100 DECALIN TABLETS (DEXAMETHASONE)"C.H." 1.50

AC19865100 MEMODIN TABLETS (DIPHENIDOL) "ROYAL" 1.50

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AC198651G0 MEMODIN TABLETS (DIPHENIDOL) "ROYAL"(鋁箔/膠箔) 2.00

AC19875100 CARDOLOL TABLETS 40MG "V.P.P." (PROPRANOLOL) 1.50

AC19895100 CARDITONIN S.C. TABLETS 25MG (DIPYRIDAMOLE) "VPP" 1.50

AC198951G0CARDITONIN S.C. TABLETS 25MG (DIPYRIDAMOLE) "VPP" (鋁箔/

膠箔)2.00

AC19899100 DACTJIN F.C. TABLETS "SHITEH" 1.50

AC19904421 "WINMEGEN OPHTHALMIC SOLUTION ""WINSTON""" 12.30

AC19904429 "WINMEGEN OPHTHALMIC SOLUTION ""WINSTON""" 19.30

AC19904435 "WINMEGEN OPHTHALMIC SOLUTION ""WINSTON""" 34.20

AC19915421 DELONE EYE DROP "SINPHAR" 12.20

AC19915429 DELONE EYE DROPS "SINPHAR" 25.40

AC19935265 VELIP INFUSION SOLUTION "N.K." 0.00

AC19935277 VELIP INFUSION SOLUTION "N.K." 29.50

AC19937421 FLUOROMETHOLONE EYE DROPS "OASIS" 12.40

AC19941277 "VITAMINOPLEX INJECTION ""TAI YU""" 122.00

AC19962277 "AMINOPLEXYTOL INJECTION ""TAI YU""" 81.00

AC19970100 THIAMPHENICOL CAP. 250MG "P.J." 1.51

AC19976100 RIFAMPIN CAPSULES 300MG "VPP" 8.00

AC19982100 AMOXICILLIN CAPSULES 500MG "KINGDOM" 1.50

AC19983100 KETOFEN CAPSULE. (KETOPROFEN) 1.59

AC19984100 COBAMAMIDE CAPSULES "C.H." 1.50

AC199841G0 COBAMAMIDE CAPSULES "C.H."(鋁箔/膠箔) 2.00

AC19987100 BROAIN S.C. TABLETS (BROMELAIN) "CHIN TENG" 1.50

AC199871G0BROAIN S.C. TABLETS (BROMELAIN) "CHIN TENG"(鋁箔/膠箔)

2.00

AC20018100 CANTIL TABLETS "C.H." 1.50

AC20022100 TERBULINE TABLETS (TERBUTALINE) 1.50

AC20037100 SONGORA F.C TABLETS (NICAMETATE) "ROYAL" 1.50

AC200371G0 SONGORA F.C TABLETS "ROYAL"(NICAMETATE)(鋁箔/膠箔) 2.00

AC20043100 SINOX TABLETS (MEBENDAZOLE)"N.C.P." 1.50

AC200431G0 SINOX TABLETS "N.C.P." (MEBENDAZOLE)(鋁箔/膠箔) 2.00

AC20046100 LESUTON TABLETS "YUNG CHI" 1.50

AC20058100 LIDERIUM CAPSULES (LOPERAMIDE) 1.50

AC200581G0 LIDERIUM CAPSULES (LOPERAMIDE)(鋁箔/膠箔) 2.00

AC20059100 LOPERAM CAPSULES (LOPERAMIDE) "JOHNSON" 1.50

AC200591G0 LOPERAM CAPSULES (LOPERAMIDE) "JOHNSON"(鋁箔/膠箔) 2.00

AC20069100 TONIFEN CAPSULES (MEFENAMIC ACID) "ROYAL" 1.50

AC200691G0 TONIFEN CAPSULES (MEFENAMIC ACID) "ROYAL"鋁箔盒裝 2.00

AC20080212 BIOCON INJECTION "GENTLE" 15.00

AC20084100 FENOTEROL TABLETS "YUNG SHIN" 1.50

AC20092100 SOOTHING TABLETS (OXETHAZAINE) "YUNG SHIN" 1.50

AC200921G0 SOOTHING TABLETS (OXETHAZAINE) "YUNG SHIN"(鋁箔/膠箔) 2.00

AC20096100 SULQUINYL CAPSULES (SULPIRIDE) "PATRON" 1.53

AC20102321 TRIACT CREAM "GCPC" 13.90

AC20102323 TRIACT CREAM "GCPC" 14.40

AC20102329 TRIACT CREAM "GCPC" 18.40

AC20102335 TRIACT CREAM "GCPC" 29.70

AC20102336 TRIACT CREAM "GCPC" 29.70

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AC20102338 TRIACT CREAM "GCPC" 57.00

AC20103100 DICLOFEN F.C. TABLETS "H.S."(DICLOFENAC) 1.50

AC20109100 "ROYADRIN TABLETS ""ROYAL""" 1.50

AC201091G0 ROYADRIN TABLETS "ROYAL"(鋁箔/膠箔) 2.00

AC20111100 TRISDOWN F.C TABLETS "ROYAL" 1.50

AC201111G0 TRISDOWN F.C. TABLETS "ROYAL"(鋁箔/膠箔) 2.00

AC20112100 "TRICOGYL F.C TABLETS (METRONIDAZOLE) ""ROYAL""" 1.52

AC20115100TRIDERGEN TABLETS (DIHYDROERGOTOXINE MESYLATE)" ROYAL "

1.50

AC201151G0TRIDERGEN TABLETS (DIHYDROERGOTOXINE MESYLATE)" ROYAL "

2.00

AC20116100 "URODIX TABLETS (NALIDIXIC ACID) ""ROYAL""" 2.22

AC20118212 GURON-BC INJECTION "GENTLE" 0.00

AC20118221 GURON-BC INJECTION "GENTLE" 0.00

AC20137100 IBUPROFEN F.C. TABLETS 400MG "SINPHAR" 1.50

AC20174100 LOTINTON TABLETS 1.50

AC20257100 "MEFENAMIC ACID CAPSULE ""A.S.""" 1.50

AC20276348 UBURN CREAM (SILVER SULFADIAZINE) 43.70

AC20276365 UBURN CREAM (SILVER SULFADIAZINE) 140.00

AC20276377 UBURN CREAM (SILVER SULFADIAZINE) 357.00

AC20279100 ANCHEN TABLETS "J.H." (MEBENDAZOLE) 1.50

AC20285100 "SOLAX CAPSULES ""ROYAL""" 1.50

AC20286100"SUSPAN F.C TABLETS (SCOPOLAMINE BUTYL BROMIDE) "" ROYAL

"""1.50

AC20287100 CINATIN TABLETS (CINNARIZINE) "ROYAL" 1.50

AC202871G0 CINATIN TABLETS (CINNARIZINE) "ROYAL"(鋁箔/膠箔) 2.00

AC20291100 OXETHAINE TABLETS "C.L." 1.50

AC202911G0 OXETHAINE TABLETS "C.L."(鋁箔/膠箔) 2.00

AC20295500 ANTIFUNGAL VAGINAL TABLETS "YUNG SHIN"(MICONAZOLE) 5.00

AC20340100 DISKO S.C. TABLETS "CHEN TA" 1.50

AC20359209 "瑞士"KPHADOL INJECTION "SWISS" (DIPHENIDOL) 15.00

AC20359212 KPHADOL INJECTION "SWISS" (DIPHENIDOL) 15.00

AC20368100 NAPROXEN TABLETS "JOHNSON" 1.50

AC20387100 NAPROXEN TABLETS "YUNG CHI" 1.50

AC20405100 AMCLOCIN CAPSULE "KINGDOM" 1.90

AC20420100 BININ-U TABLETS 2MG (HALOPERIDOL) 1.50

AC204201G0 BININ-U TABLETS 2MG (HALOPERIDOL)(鋁箔/膠箔) 2.00

AC20433100 MEFENAMIC CAPSULES "UNION" 1.50

AC20441421 KINGMIN OPHTHALMIC SOLUTION (SULFAMETHOXAZOLE) 12.00

AC20441429 KINGMIN OPHTHALMIC SOLUTION (SULFAMETHOXAZOLE) 12.00

AC20441435 KINGMIN OPHTHALMIC SOLUTION (SULFAMETHOXAZOLE) 13.90

AC20451100 ALOPRINOL TABLETS (ALLOPURINOL) "JOHNSON" 1.50

AC204511G0 ALOPRINOL TABLETS (ALLOPURINOL) "JOHNSON"(鋁箔/膠箔) 2.00

AC20453212 "DIPROPHYLLINE INJECTION ""S.Y.""" 15.00

AC20485100JOHNSTAL FILM COATED TABLETS (MEFENAMIC ACID)"JOHNSON"

1.50

AC20520100 YU-MIN TABLETS "YU SHENG" 1.50

AC20573221 POTASSIUM CHLORIDE INJECTION 15% 15.00

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AC20573229 POTASSIUM CHLORIDE INJECTION 15% 15.00

AC20573238 POTASSIUM CHLORIDE INJECTION 15% 15.00

AC20604100 ALLOPURINOL TABLETS 100MG "CHEN TA" 1.50

AC20651255 SOLU-TISONE INJECTION 100MG "C.C.P." (HYDROCORTISONE) 28.20

AC20700100 "KETOPROFEN CAPSULES ""WINSTON""" 1.59

AC20713100 DIABEN TABLETS "ROYAL" (GLIBENCLAMIDE) 1.50

AC207131G0 DIABEN TABLETS "ROYAL" (GLIBENCLAMIDE)(鋁箔/膠箔) 2.00

AC20715100 SINTON TABLETS "CHINTENG" (NAPROXEN) 1.50

AC20758100 COBA B12 CAPSULES "Y.Y." 1.50

AC20781100 TRIAMCINOLONE TABLETS "N.C.P." 1.50

AC20782209 PANDOL INJECTION (HALOPERIDOL) "PANBIOTIC" 22.40

AC20782212 PANDOL INJECTION (HALOPERIDOL) "PANBIOTIC" 32.40

AC20791100 PYRAZODINE S.C. TABLETS "C.H."(PHENAZOPYRIDINE) 1.50

AC20832100 DL-METHYLEPHEDRINE HCL TABLET "C.L." 1.50

AC20842209 ESTRADIOL INJECTION"T.F." 25.00

AC20849100 LOPERAMIDE TABLETS 2 MG "F.Y." 1.50

AC208491G0 LOPERAMIDE TABLETS 2 MG "F.Y."(鋁箔/膠箔) 2.00

AC208491G2 LOPERAMIDE TABLETS 2 MG "F.Y."(28粒/瓶裝) 2.00

AC20854100 CENSOLIN TABLETS 1.50

AC208541G0 CENSOLIN TABLETS (鋁箔/膠箔) 2.00

AC20857100 ROSTAN CAPSULES (BETA-AESCIN) "CHEN TA" 3.47

AC20860100 SINSOLAX TABLETS 1.76

AC20871100 PROPRA TABLETS 10MG (PROPRANOLOL) "ROYAL" 1.50

AC208711G0 PROPRA TABLETS 10MG (PROPRANOLOL) "ROYAL"(鋁箔/膠箔) 2.00

AC20873100 "CLIXIN F.C TABLETS ""ROYAL""" 1.62

AC20879151 HALOLIUM DROPS "ROYAL" 68.00

AC20894100 URINOL TABLETS (ALLOPURINOL) "SINPHAR" 1.50

AC208941G0 URINOL TABLETS (ALLOPURINOL) "SINPHAR" 2.00

AC20900100 SIRIN S.C. TABLETS (SILYMARIN) "Y. S." 1.50

AC209001G0 SIRIN S.C. TABLETS (SILYMARIN) "Y. S." (鋁箔/膠箔) 2.00

AC20904100 JYYKO TABLETS 30MG (DEXTROMETHORPHEN) "N.C.P." 1.50

AC20910100 DOLCOL FILM COATING TABLETS 250MG 3.54

AC20911100 SONCO TABLETS "ROYAL" 1.50

AC209111G0 SONCO TABLETS "ROYAL"(鋁箔/膠箔) 2.00

AC20921100 CEFENINE S.C. TABLETS (DIPHENIDOL) 1.50

AC209211G0 CEFENINE S.C. TABLETS (DIPHENIDOL) (鋁箔/膠箔) 2.00

AC20926329 FUTOCAN CREAM (FLUCOCINOLONE)"SHINLON" 38.70

AC20930100 CYRITIN TABLETS (CINNARIZINE) "SHINLON" 1.50

AC20931100 DOMYCIN CAPSULES 1.50

AC20936100 MUSLAX-A TABLETS "C.C.P." 1.50

AC20964329 SCABI CREAM (GAMMA-BHC) "HEALTH" 93.00

AC209751G0 VOLTON CAPSULES (DICLOFENAC) "N.C.P."(鋁箔/膠箔) 2.00

AC20976100 SEUSTON CAPSULES (MEFENAMIC ACID) 1.50

AC21020212 ORPHENADRINE INJECTION "Y.Y." 15.00

AC21029100 FULNIN CAPSULES (LOPERAMIDE) "PANBIOTIC" 1.50

AC21036100 LOTAMIN TABLETS "SWISS" (PROCHLORPERAZINE) 1.50

AC21063100 LOPEDIN CAPSULES "STANDARD" (LOPERAMIDE) 1.50

AC21078100 CINNARIZINE TABLETS 50MG "M.T." 1.50

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AC21109229 HICOVITA INJECTION "GENTLE" 15.00

AC21111151 "KODAPIN SYRUP ""ROYAL""" 25.00

AC21117100 ERGOFEIN CAPSULES "PATRON" 1.50

AC21190100 LOPERAMIDE CAPSULES "LITA" 1.50

AC21213100 DICLOCIN CAPSULES "KINGDOM" (DICLOXACILLIN) 1.50

AC21243100 LINDALONE TABLETS "C.A."(BETAMETHASONE) 1.50

AC21265100 "LIVERGEN CAPSULES ""ROYAL""" 1.50

AC212651G0 LIVERGEN CAPSULES "ROYAL"(鋁箔/膠箔) 2.00

AC21281212 KETOPROFEN I.M INJECTION "Y.Y." 15.00

AC21298100 COBAMAMIDE CAPSULES "M.T." 1.50

AC212981G0 COBAMAMIDE CAPSULES "M.T."(鋁箔/膠箔) 2.00

AC21316100 "SALBUTAMOL TABLETS ""M.T.""" 1.50

AC21326100 ISIDIUM CAPSULES "Y.K." 1.50

AC213261G0 ISIDIUM CAPSULES "Y.K."(鋁箔/膠箔) 2.00

AC21328100 SILYGEN CAPSULES "STANDARD" 1.50

AC213281G0 SILYGEN CAPSULES "STANDARD"(鋁箔/膠箔) 2.00

AC21343238 POTASSIUM PHOSPHATE INJECTION 125.00

AC21372221 PIRACETAM INJECTION "Y.Y." 15.00

AC21399100 NAPROXEN TABLETS "LITA" 1.50

AC213991G0 NAPROXEN TABLETS "LITA"(鋁箔/膠箔) 2.00

AC21406100 WETONLIN TABLETS "M.T." 1.50

AC21462100 ZECOL TABLETS 1.50

AC214621G0 ZECOL TABLETS (30粒/瓶)(84粒/瓶) 2.00

AC21480100 CLONIDINE TABLETS "SWISS" 1.96

AC21484100 TONCOPIN TABLETS "N.C.P." 1.50

AC21490100 HESTAZIN TABLETS"HEALTH"(TRIFLUOPERAZINE) 0.00

AC21491100 IZAN E.C. TABLETS 100MG (BROMELAIN) "LITA" 1.50

AC214911G0 IZAN E.C. TABLETS 100MG (BROMELAIN) "LITA"(鋁箔/膠箔) 2.00

AC21495100 ATIPAM TABLETS (LORAZEPAM) "ROYAL" 1.50

AC214951G0 ATIPAM TABLETS (LORAZEPAM) "ROYAL"(鋁箔/膠箔) 2.00

AC21507100 OXECAIN TABLETS "YU SHENG" 1.50

AC21514100 CHLORZOXAZONE TABLETS 200MG 1.50

AC21539100 RISONIN CAPSULES "D.T.S." 2.35

AC21552100 SUNTONIN CAPSULES "STANDARD" 0.00

AC21566100 PYDAMOLE S.C. TABLETS 25 MG (DIPYRIDAMOLE) 1.50

AC21603100 HEMALOL TABLETS (PROPRANOLOL) "SWISS" 1.50

AC21606100 "WINLIPAN CAPSULES (LOPERAMIDE) ""WINSTON""" 1.50

AC21607100 ALDOPA FILM COATED TABLETS (METHYLDOPA) "YUNG SHIN" 2.46

AC21611100 "DEXAMETHASONE TABLETS ""M.T.""" 1.50

AC21614100 SPOLINE S.C. TABLETS (SCOPOLAMINE BUTYLBROMIDE) 1.50

AC21622100 MEPRAM S.C. TABLETS (METOCLOPRAMIDE) "SHINLON" 1.50

AC21629265 TAITA NO.3 INJECTION "OTSUKA" 26.30

AC21629277 TAITA NO.3 INJECTION "OTSUKA" 29.50

AC21630265 TAITA NO.2 INJECTION "OTSUKA" 26.30

AC21630277 TAITA NO.2 INJECTION "OTSUKA" 29.50

AC21632265 TAITA NO.1 INJECTION "OTSUKA" 26.30

AC21632277 TAITA NO.1 INJECTION "OTSUKA" 29.50

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AC21635100"LIPIN TABLETS (METHYLSCOPOLAMINE METHYLSULFAT)

""ROYAL"""1.50

AC216401G0 GLIDIAB TABLETS 5MG(GLIPIZIDE) (鋁箔盒裝) 2.00

AC21652143 MINTAPP SYRUP "SINPHAR" 25.00

AC21652151 MINTAPP SYRUP "SINPHAR" 26.80

AC21652155 MINTAPP SYRUP "SINPHAR" 72.00

AC21652157 MINTAPP SYRUP "SINPHAR" 72.00

AC21678151 CODIN P SYRUP "SINPHAR" 25.00

AC21678157 CODIN P SYRUP "SINPHAR" 25.80

AC21681100 GRAMAZINE TABLETS 500MG (NALIDIXIC ACID) "JOHSON" 2.22

AC21684100 CLONIDINE TABLETS "JOHNSON" 1.96

AC21706100 RIFAMPIN CAPSULES 450MG "VPP" 12.00

AC21709221 TRANEXAMIC ACID INJECTION "S.Y." 15.00

AC21709238 "TRANEXAMIC ACID INJECTION ""S.Y.""" 33.00

AC21730209 LIFOXITIN INJECTION (CEFOXITIN) "LITA" 67.00

AC21730212 LIFOXITIN INJECTION (CEFOXITIN) "LITA" 143.00

AC21754100 COLCIN TABLETS (COLCHICINE) 1.50

AC217541G0 COLCIN TABLETS (COLCHICINE)(鋁箔/膠箔) 2.00

AC21756209 "SCODEXIN INJECTION ""TAI YU""" 15.00

AC21758100 MEDICON-A CAPSULES 1.50

AC217581G0 MEDICON-A CAPSULES(鋁箔/膠箔) 2.00

AC21767100 DIPHENIDOL S.C. TABLETS 1.50

AC217671G0 DIPHENIDOL S.C. TABLETS(鋁箔/膠箔) 2.00

AC21792100 "CHLORZOXAZONE TABLETS ""ASTAR""" 1.50

AC21815100 BROMELAIN ENTERIC SUGAR COATED TABLETS "YUNG CHI" 1.50

AC21819100 LOPERAMIDE CAPSULES "YUNG CHI" 1.50

AC21830100 "LOPERAMIN TABLETS (LOPERAMIDE) ""M.T.""" 1.50

AC218301G0 LOPERAMIN TABLETS (LOPERAMIDE) "M.T."(鋁箔/膠箔) 2.00

AC21841100 SUMINCON TABLETS "H.S." 1.50

AC21845321 "BEAUTYSKIN CREAM ""ROYAL""" 25.70

AC21845329 BEAUTYSKIN CREAM "ROYAL" 55.00

AC21871100 MEBEZOL TABLETS (MEBENDAZOLE) "JOHNSON" 1.50

AC21875100 IMODE CAPSULES (LOPERAMIDE) "YU SHENG" 1.50

AC21882100 NINGILON CAPSULES "P.L." 1.57

AC21883263 AMINOL 12X INJECTION "S.T" 108.00

AC21883265 AMINOL 12X INJECTION "S.T" 114.00

AC21886100 "BETAMETHASONE TABLETS ""S.Y.""" 1.50

AC21887416 LECORT IN ORAL BASE (TRIAMCINOLONE) 18.50

AC21887429 LECORT IN ORAL BASE (TRIAMCINOLONE) 59.00

AC21890100 METATU HON TABLETS 1.50

AC21893209 METHYLERGONOVINE INJECTION "TAI YU" 44.30

AC21923100 SODIUM BICARBONATE TABLETS "ASTAR" 1.50

AC219231G0 SODIUM BICARBONATE TABLETS "ASTAR"(鋁箔/膠箔) 2.00

AC21924321 MY COMB CREAM "SINPHAR" 13.90

AC21924323 MY COMB CREAM "SINPHAR" 14.40

AC21924329 MY COMB CREAM "SINPHAR" 18.40

AC21924336 MY COMB CREAM "SINPHAR" 29.70

AC21924338 MY COMB CREAM "SINPHAR" 57.00

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AC21959209 "BETAMETHASONE INJECTION ""TAI YU""" 15.40

AC21959221 "BETAMETHASONE INJECTION ""TAI YU""" 16.90

AC21959229 "BETAMETHASONE INJECTION ""TAI YU""" 0.00

AC21961100 CEPHADROXIL CAPSULES "LITA" 2.13

AC21965100 "LYSOZYME TABLETS 30MG ""M.T.""" 1.50

AC21978221 URAMIN INJECTION (DOPAMINE) 19.90

AC21981417 NINCORT ORAL GEL (TRIAMCINOLONE) "SINPHAR" 21.50

AC21981421 NINCORT ORAL GEL (TRIAMCINOLONE) "SINPHAR" 28.40

AC21981423 NINCORT ORAL GEL (TRIAMCINOLONE) "SINPHAR" 36.70

AC21994100 VI JANE CAPSULES (FLUOXYMESTERONE) "S.T." 0.00

AC21996100 "OPIUM AND GLYCYRRHIZA MIXTURE TABLETS ""ASTAR""" 1.50

AC219961G0"OPIUM AND GLYCYRRHIZA MIXTURE TABLETS ""ASTAR""(鋁箔/膠

箔)"2.00

AC22010212 "HYCOMIN INJECTION ""S.Y."" (HYDROXOCOBALAMINE)" 15.00

AC22043100 ALETON TABLETS "YUNG CHI" 1.50

AC22049209 "DIPHENHYDRAMINE HCL INJECTION ""TAI YU""" 15.00

AC22069100 SILYMARIN CAPSULES "P.L." 1.50

AC22083238 NUTRASE INJECTION 20MG (COCARBOXYLASE) 15.00

AC22084100 "TECOLIN TABLETS ""ROYAL""" 1.50

AC22096151 APPITAMINE SYRUP "S.Y." 25.00

AC22096157 APPITAMINE SYRUP 25.00

AC22100100 LYZOIN TABLETS (LYSOZYME) "YUNG CHI" 1.50

AC22105100 ULEXIN CAPSULES 500MG (CEPHALEXIN) 1.78

AC221051G0 ULEXIN CAPSULES 500MG (CEPHALEXIN)(鋁箔/膠箔) 2.00

AC22123100 IMOLEX CAPSULES (LOPERAMIDE) "SINPHAR" 1.50

AC221231G0 IMOLEX CAPSULES (LOPERAMIDE) "SINPHAR" 2.00

AC22128100 "DIAZEPAM TABLETS ""TAI YU""" 1.50

AC22150100 CHICOUGH TABLETS (DEXTROMETHORPHAN) 1.50

AC221501G0 CHICOUGH TABLETS (DEXTROMETHORPHAN)(鋁箔/膠箔) 2.00

AC22189100 CIMETINE TABLETS "PATRON" 1.50

AC22190100 CIMETIDINE TABLETS 200MG "C.L." 1.50

AC22198421 GENTAMICIN EYE DROPS "SINPHAR" 14.50

AC22203212 GENTA 40MG/ML INJECTION 15.00

AC22207100 DICLOFEN TABLETS (DICLOFENAC)"WELCAN" 1.50

AC222071G0 DICLOFEN TABLETS (DICLOFENAC) "WELCAN"(鋁箔/膠箔) 2.00

AC22209100 ANROKIN TABLETS (CHLORZOXAZONE) 1.50

AC222091G0 ANROKIN TABLETS (CHLORZOXAZONE) 2.00

AC22211100 STAPAM TABLETS (LORAZEPAM) "STANDARD" 1.50

AC222111G0 STAPAM TABLETS (LORAZEPAM) "STANDARD"(鋁箔/膠箔) 2.00

AC22223100 "YONFUPHARM" IBUPROFEN TABLETS 1.50

AC22225100 NICE FILM COATED TABLETS (NITROXOLINE)"YUNG SHIN" 1.69

AC22227100 BICODIN TABLETS "STANDARD" 1.50

AC222271G0 BICODIN TABLETS "STANDARD"(鋁箔/膠箔) 2.00

AC22265100 OXACAIN TABLETS (OXETHAZAINE)"M.T." 1.50

AC222651G0 OXACAIN TABLETS "M.T."(OXETHAZAINE) (鋁箔/膠箔) 2.00

AC22272209 BININ-U INJECTION (HALOPERIDOL) 22.40

AC22274100 UFUNIN TABLETS 1.50

AC22289100 LOPERAMIDE CAPSULES "CHEN TA."" 1.50

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AC222891G0 LOPERAMIDE CAPSULES "CHEN TA" (鋁箔/膠箔) 2.00

AC22296100 CIMETIN TABLETS (CIMETIDINE) "JOHNSON" 1.50

AC222961G0 CIMETIN TABLETS "JOHNSON"(CIMETIDINE)(鋁箔/膠箔) 2.00

AC22297135 BININ-U SOLUTION (HALOPERIDOL) 59.00

AC22297157 BININ-U SOLUTION (HALOPERIDOL) 125.00

AC22314100 RADI-K TABLETS "BOWLIN" (POTASSIUM GLUCONATE) 1.72

AC22340321 TOTUSAN OINTMENT 0.00

AC22340329 TOTUSAN OINTMENT 0.00

AC22340335 TOTUSAN OINTMENT 0.00

AC22343277 LOFALIN INJECTION 500MG "GENTLE" (CEFAZOLIN) 25.00

AC22355419 COYENSU IN ORABASE (DEXAMETHASONE) 32.70

AC22355426 COYENSU IN ORABASE (DEXAMETHASONE) 61.00

AC22357100 LYCOZE TABLETS (LYSOZYME) 1.50

AC223571G0 LYCOZE TABLETS (LYSOZYME) 2.00

AC22392321 NEOSONE CREAM "GCPC" 23.90

AC22392329 NEOSONE CREAM "GCPC" 30.00

AC22393221 RASEMIN INJECTION "Y.Y." (TRAREXAMIC ACID) 0.00

AC22404100 LILITIN TABLETS 1.50

AC224041G0 LILITIN TABLETS(鋁箔/膠箔) 2.00

AC22408100 C.M.T. TABLETS "BOWLIN" (CIMETIDINE) 1.50

AC22441100 WINPRON TABLETS 250MG (NAPROXEN) "WINSTON" 1.50

AC22442100 ENLAIN F.C TABLETS 100MG "CHEN TA" 1.50

AC22444100 TIGAWET TABLETS (CIMETIDINE) 1.50

AC224441G0 TIGAWET TABLETS (CIMETIDINE) 2.00

AC22448100 DOLAN TABLETS 1.76

AC224481G0 DOLAN TABLETS(鋁箔/膠箔) 2.00

AC22459209 GENTAMICIN INJECTION 140MG/ML "GENTLE" 16.50

AC22459212 GENTAMICIN INJECTION 140MG/ML "GENTLE" 16.50

AC22459229 GENTAMICIN INJECTION 140MG/ML "GENTLE" 75.00

AC22461238 "LICOTON INJECTION ""S.Y.""" 15.00

AC22465212 CIMETIDINE INJECTION "CHI SHENG" 15.00

AC22470100 "DEXAMETHASONE TABLETS ""TAI YU""" 1.50

AC22476216 FUMUCIL INJECTION (ACETYLCYSTEINE) 15.00

AC22519277 LYO-POVIGEN INJECTION "C.C.P." 53.00

AC22534100 COLICINE TABLETS (COLCHICINE) 1.50

AC225341G0 COLICINE TABLETS (COLCHICINE)(鋁箔/膠箔) 2.00

AC22535100 METHASONE TABLETS (BETAMETHASONE) 1.50

AC225351G0 METHASONE TABLETS (BETAMETHASONE)(鋁箔/膠箔) 2.00

AC22554100 "GERIUM CAPSULES (LOPERAMIDE) ""ROYAL""" 1.50

AC225541G0 "GERIUM CAPSULES (LOPERAMIDE) ""ROYAL""(鋁箔/膠箔)" 2.00

AC22557100 REASON TABLETS (LYSOZYME) "ROYAL" 1.50

AC225571G0 "REASON TABLETS (LYSOZYME) ""ROYAL""(鋁箔/膠箔)" 2.00

AC22559100 "ROYAMET F.C. TABLETS (CIMETIDINE) ""ROYAL""" 1.50

AC225591G0 ROYAMET F.C. TABLETS (CIMETIDINE) "ROYAL"(鋁箔/膠箔) 2.00

AC22565212 "KETOPROFEN INJECTION ""S.Y.""" 15.00

AC22565216 "KETOPROFEN INJECTION ""S.Y.""" 15.00

AC22565238 KETOPROFEN INJECTION "S.Y." 25.40

AC22568212 CIMETIDINE INJECTION "N.K." 15.00

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AC22568216 CIMETIDINE INJECTION "NK" 15.00

AC22569100 CIMETIDINE TABLETS 200MG "T.F." 1.50

AC225691G0 CIMETIDINE TABLETS 200MG "T.F."(鋁箔/膠箔) 2.00

AC22572100 TETRACYCLINE HCL CAPSULES 500MG "SWISS" 1.52

AC225721G0 TETRACYCLINE HCL CAPSULES 500MG "SWISS"(鋁箔/膠箔) 2.00

AC22582212 LICOXIN INJECTION 300MG/ML "GENTLE" (LINCOMYCIN) 16.90

AC22582229 LICOXIN INJECTION 300MG/ML "GENTLE" (LINCOMYCIN) 0.00

AC22586100 ELININ CAPSULES (LOPER AMIDE)"SHINLON" 1.50

AC22588209BENAMINE INJECTION 30MG/ML (DIPHENHYDRAMINE HCL) "VPP"

15.00

AC22608212 ORFLEX INJECTION "GENTLE" (ORPHENADRINE) 15.00

AC22622212 "SUWELIN INJECTION (CIMETIDINE)""S.Y.""" 15.00

AC22630100 "WINTIN TABLETS (LORAZEPAM) ""WINSTON""" 1.50

AC226341G0DIABITIN TABLETS 5MG "VPP" (GLIBENCLAMIDE) (鋁箔/膠箔)

2.00

AC22641100 ROSIS TABLETS 40MG "VPP" (FUROSEMIDE) 1.50

AC226411G0 ROSIS TABLETS 40MG "VPP" (FUROSEMIDE)(鋁箔/膠箔) 2.00

AC22656100 "DICYCLOMINE TABLETS ""S.Y.""" 1.50

AC22658100 PRESITON TABLETS 250MG "HL" 1.50

AC22666209"DEXTROSE 5% AND SODIUM CHLORIDE 0.33% INJECTION

""Y.F."""35.00

AC22666277"DEXTROSE 5% AND SODIUM CHLORIDE 0.33% INJECTION

""Y.F."""25.00

AC22674100 PRESITON TABLETS 500MG "HL" 1.50

AC22682265 TAITA NO.5 INJECTION "OTSUKA" 26.30

AC22682271 TAITA NO.5 INJECTION "OTSUKA" 29.50

AC22682277 TAITA NO.5 INJECTION "OTSUKA" 29.50

AC22685100 WERGEN TABLETS (CIMETIDINE) "YUNG CHI" 1.50

AC22701266 ALLAMIN INJECTION 3% ISOTONIC "KYORIN" 65.00

AC22701277 ALLAMIN INJECTION ISOTONIC "KYORIN" 70.00

AC22723100 "DIPYRIDAMOLE TABLETS ""TAI YU""" 1.50

AC22729229 GENTAMICIN SULFATE INJECTION "ASTAR" 16.50

AC22743100 STOGAMET TABLETS (CIMETIDINE) "SWISS" 1.50

AC227431G0 STOGAMET TABLETS "SWISS" (CIMETIDINE)(鋁箔/膠箔) 2.00

AC22746100 "SUWELIN TABLETS (CIMETIDINE)""S.Y.""" 1.50

AC22767500 DAFRIN VAGINAL TABLETS "SWISS"(MICONAZOLE) 5.00

AC22786100 SPOLIN TABLETS (LORAZEPAM) "H.H." 1.50

AC227861G0 SPOLIN TABLETS (LORAZEPAM) "H.H."(鋁箔/膠箔) 2.00

AC22796212 KETOPROFEN I.M. INJECTION 50MG/ML "Y.Y." 15.00

AC22801100 CONSPIN TABLETS (TOLPERISONE) "H.H." 1.52

AC22814229 GENTAMYCIN SULFATE INJECTION 40MG/ML "T.F." 16.50

AC22815100 LORAZEPAM TABLETS 0.5 MG "F.Y." 1.50

AC228151G0 LORAZEPAM TABLETS 0.5 MG "F.Y."(鋁箔/膠箔) 2.00

AC22816100 LORAZIN TABLETS "JOHNSON" (LORAZEPAM) 1.50

AC228161G0LORAZIN TABLETS "JOHNSON" (LORAZEPAM)(84粒/瓶裝及鋁箔/

膠箔)2.00

AC22819100 LORAZEPAM TABLETS 1 MG "F.Y." 1.50

AC228191G0 LORAZEPAM TABLETS 1 MG "F.Y."(鋁箔/膠箔) 2.00

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AC22836100 DEFENSE FILM COATED TABLETS (CIMETIDINE) "YUNG SHIN" 1.50

AC228361G0DEFENSE FILM COATED TABLETS "YUNG SHIN"(CIMETIDINE)(鋁箔

/膠箔)2.00

AC22840209 ATROPINE SULFATE INJCETION "ORIENTAL" 15.00

AC22852100 DIPHENIDOL F.C. TABLETS "SHOU CHAN" 1.50

AC22867421 MYCOMB OTIC DROPS "SINPHAR" 49.30

AC22876100 LYSOZYME TABLETS 30MG "P.L." 1.50

AC22879100DHAA TABLETS 100MG (DIHYDROXY ALUMINUM

ALLANTOINATE)"H.C.T."1.50

AC22890100 MILISHER TABLETS (LYSOZYME) "H.S." 1.50

AC22908100 SPIRONOLACTONE TABLETS "S.C." 1.50

AC229081G0 SPIRONOLACTONE TABLETS "S.C."(鋁箔/膠箔) 2.00

AC22920417 CHLORSON EYE OINTMENT "OASIS" 18.20

AC22930212 GEXAMIN INJECTION "GENTLE" (TRANEXAMIC ACID) 0.00

AC22952289 UCEFAXIM INJECTION 750MG (CEFUROXIME) 25.00

AC22960100 ZINGA TABLETS (ZINC GLUCONATE) "BOWLIN" 1.50

AC22964100 NARCARICIN CAPSULES 100MG (BENZBROMARONE) "SWISS" 2.05

AC22971100 PAINSTOP CAPSULES (DICLOFENAC) "SWISS" 1.50

AC22987100 PRIMPERAN FILM COATED TABLETS (METOCLOPRAMIDE 1.50

AC229871G0PRIMPERAN FILM COATED TABLETS (METOCLOPRAMIDE)(鋁箔/膠

箔)2.00

AC22995100 CIMETIDINE TABLETS 200MG "F.Y." 1.50

AC229951G0 CIMETIDINE TABLETS 200MG "F.Y."(鋁箔/膠箔) 2.00

AC23023209 CEPHEN INJECTION (DIPHENIDOL) "Y.Y." 15.00

AC23023212 CEPHEN INJECTION (DIPHENIDOL) "Y.Y." 15.00

AC23028100 DA CON WEI TABLETS "C.M."(CIMETIDINE) 1.50

AC23041100 ALLOPURINOL TABLETS "PANBIOTIC" 1.50

AC23054100 CEPHEN S.C. TABLETS "Y.Y." 1.50

AC23087212 MEGATO INJECTION (CIMETIDINE) "GENTLE" 15.00

AC23102100 PONTON TABLETS 500MG"Y.K." (MEFENAMIC ACID) 1.50

AC231021G0PONTON TABLETS 500MG"Y.K." (MEFENAMIC ACID)(鋁箔/膠箔)

2.00

AC23110100 MEGATO TABLETS "GENTLE"(CMETIDINE) 0.00

AC23114212 SERACIN INJECTION 6% (GENTAMYCIN SULFATE) "SWISS" 15.50

AC23131321 AIFUPO OINTMENT "Y.U." 10.00

AC23131329 AIFUPO OINTMENT "Y.U." 18.10

AC23133323 EXTRACOMB CREAM "S.Y." 14.40

AC23133329 EXTRACOMB CREAM "S.Y." 18.40

AC23133330 EXTRACOMB CREAM 20.20

AC23133335 EXTRACOMB CREAM "S.Y." 29.70

AC23135100 TAGASONE TABLETS "Y.Y."(CIMETIDINE) 1.50

AC231351G0 TAGASONE TABLETS "Y.Y." (CIMETIDINE)(鋁箔/膠箔) 2.00

AC231431G0 PSEUBYIRIN TABLETS "S.D." (鋁箔/膠箔) 2.00

AC23150421 EYESMIN EYE DROPS (NEOSTIGMINE METHYLSULFATE) "OASIS" 12.00

AC23150429 EYESMIN EYE DROPS (NEOSTIGMINE METHYLSULFATE) "OASIS" 15.60

AC23152100 CAFEGOTAMINE S.C. TABLETS "HL" 1.50

AC23156221 ZUCERIN INJECTION "LITA" (TRANEXAMIC ACID) 15.00

AC23169500 CLOMAZOLE VAGINAL TABLETS 100MG "VPP" (CLOTRIMAZOLE) 5.90

Page 100: 附件二 藥品給付品項暨支付標準表

AC23186100 "BETAMETHASONE TABLETS ""ASTAR""" 1.50

AC23194100 SABUMOL TABLETS (SALBUTAMOL) 1.50

AC231941G0 SABUMOL TABLETS (SALBUTAMOL) 2.00

AC23196100 PIZEPIN TABLETS "STANDARD" (PIRENZEPINE 2HCL) 1.79

AC23220100 BIOSAREN CAPSULES (TRANEXAMIC ACID) "PANBIOTIC" 1.50

AC23230221 RASEMIN INJECTION 10% "Y.Y" (TRANEXAMIC ACID) 15.00

AC23234100 "DOGEN TABLETS (PIPEMIDIC ACID) ""M.T.""" 3.54

AC23239100 AMOXICILLIN CAPSULES 500MG "S.T." 1.50

AC232391G0 AMOXICILLIN CAPSULES 500MG "S.T."(鋁箔/膠箔) 2.00

AC23264100 AMOXICILLIN CAPSULES 250MG "S.T." 1.50

AC232641G0 AMOXICILLIN CAPSULES 250MG "S.T."(鋁箔/膠箔) 2.00

AC23297100 "METICON TABLETS 30MG (DEXTROMETHORPHAN) ""S.Y.""" 1.50

AC23309100 AFUCO TABLETS 100MG 1.50

AC23312277 AMINOGEN X INJECTION "N.K." 132.00

AC23318100 DIFENDIN TABLETS (DIPHENIDOL) "CHINTENG" 1.50

AC233181G0 DIFENDIN TABLETS (DIPHENIDOL) "CHINTENG"(鋁箔/膠箔) 2.00

AC23320100 "YUMENIN TABLETS (NITROFURANTOIN) ""TAI YU""" 1.50

AC23321100 PYDAMOLE S.C. TABLETS 12.5MG (DIPYRIDAMOLE) 1.50

AC23322100 POSTAN CAPSULES "W.S." (MEFENAMIC ACID) 1.50

AC23341216 VENTON INJECTION "LITA" (DICLOFENAC) 15.00

AC23342100 "LORAT TABLETS (LORAZEPAM) ""M.T.""" 1.50

AC233421G0 LORAT TABLETS (LORAZEPAM) "M.T."(鋁箔/膠箔) 2.00

AC23353100 PARANADRINE TABLETS "S.C." 1.50

AC23370100 ANZEPAM TABLETS 0.5MG (LORAZEPAM) 1.50

AC233701G0 ANZEPAM TABLETS 0.5MG (LORAZEPAM) 2.00

AC23374212 "CIMETINE INJECTION 100MG/ML (CIMETIDINE) ""TAI YU""" 15.00

AC23381100 THYROID TABLETS "GCPC" 1.50

AC23389100 DICLOFON S.C. TABLETS (DICLOFENAC) "F.Y." 1.50

AC23397100 EACO TABLETS 30MG (DEXTROMETHORPHAN) 1.50

AC23422238 GLYGEN-M INJECTION "N.K." 15.00

AC23430100 GASPIN TABLETS "GENTLE" (PIRENZEPINE) 1.79

AC23445209 "TRAVELLIN INJECTION ""TAI YU""" 15.00

AC23466100 TRIFLUOPERAZINE HCL TABLETS "S.C." 1.50

AC23479209 "DEXAMETHASONE INJECTION 1MG/ML ""TAI YU""" 15.00

AC23479229 "DEXAMETHASONE INJECTION 1MG/ML ""TAI YU""" 19.00

AC23479299 "DEXAMETHASONE INJECTION 1MG/ML ""TAI YU""" 0.75

AC234881G0 ULCOGEN TABLETS(鋁箔/膠箔) 2.00

AC23491100 SODICON-G TABLETS "SINPHAR" 1.50

AC234911G0 SODICON-G TABLETS "SINPHAR" 2.00

AC23492212 DEPO-B12 INJECTION 15.00

AC23508100 DALCONE TABLETS "H.H." (PIPEMIDIC ACID) 3.54

AC23532100 LIZEPINE TABLETS (PIRENZEPINE DIHYDROCHLORIDE) 1.79

AC23562216 ORITAREN INJECTION (DICLOFENAC) "ORIENTAL" 15.00

AC23563212 KETOFEN INJECTION (KETOPROFEN) "ORIENTAL" 15.00

AC23563216 KETOFEN INJECTION (KETOPROFEN) "ORIENTAL" 15.00

AC23572100 WYPIRIDE CAPSULES (SULPIRIDE) "S.P.C." 1.53

AC23587421 E E N EYE DROPS "GCPC" 29.60

AC23587423 E E N EYE DROPS "GCPC" 34.90

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AC23589100 LOGMAL CAPSULES (SULPIRIDE) "M.T 1.53

AC23592100 CIMETIDINE TABLETS 200MG"D.T.S" 1.50

AC23599100 PELIN CAPSULES (DL-ALPHA-TOCOPHEROL NICOTINATE) 1.50

AC23606100 PEPTIDIN TABLETS 1.50

AC236061G0 PEPTIDIN TABLETS (鋁箔/膠箔) 2.00

AC23616100 SEDENTON TABLETS 1.50

AC23624271 PAREMENTAL A INJECTION "C.C.P." 43.60

AC23625271 PAREMENTAL-B INJECTION "C.C.P." 43.60

AC23631321 TOPICON CREAM (FLUCLOROLONE) 24.50

AC23635100 RITESONE CAPSULES (ERYTHROMYCIN ESTOLATE) 1.77

AC23644100 PERITIN TABLET 25MG "Y.C." (DIPYRIDAMOLE) 1.50

AC236441G0 PERITIN TABLET 25MG "Y.C." (DIPYRIDAMOLE)(鋁箔/膠箔) 2.00

AC23645100 HECODEN TABLETS 1.50

AC236451G0 HECODEN TABLETS(鋁箔/膠箔) 2.00

AC23648100 DOXYCYCLINE CAPSULES 1.50

AC236481G0 DOXYCYCLINE CAPSULES(鋁箔/膠箔) 2.00

AC23655100 SALBUTAMOL TABLETS 1.50

AC23662329 ECOSONE CREAM "BOWLIN" 18.80

AC23662330 ECOSONE CREAM "BOWLIN" 24.10

AC23662335 ECOSONE CREAM "BOWLIN" 30.40

AC23670100 PIROCAM CAPSULES "GENTLE" (PIROXICAM) 1.50

AC23671100 FENOT TABLETS 2.5MG (FENOTEROL) 1.50

AC23683100 REPACIN F.C TABLETS (BETA-AESCIN) "ROYAL" 1.78

AC23686100 LYSOZYME TABLETS 90MG "S.D." 1.50

AC23708100 ESCIN S.C. TABLETS (BETA-AESIN) 1.78

AC23723100 TRIAMCINOLONE TABLETS "C.H." 1.50

AC23733263 GLYCETOSE INJECTION "S.T." 67.00

AC23733266 GLYCETOSE INJECTION "S.T." 70.00

AC23733277 GLYCETOSE INJECTION "S.T." 75.00

AC23736100 PIROCAM CAPSULES "SWISS" (PIROXICAM) 1.50

AC237361G0 PIROCAM CAPSULES (PIROXICAM) "SWISS"(鋁箔/膠箔) 2.00

AC23752221 KNOWFUL INJECTION "YUNG SHIN" (PIRACETAM) 15.00

AC23756100 LOPERAMIDE CAPSULES 1.50

AC237561G0 LOPERAMIDE CAPSULES(鋁箔/膠箔) 2.00

AC23763100 LYZOTOSE TABLETS (LYSOZYME) 1.50

AC237631G0 LYZOTOSE TABLETS (LYSOZYME)(鋁箔/膠箔) 2.00

AC23769100 MEFENAMA CAPSULES "Y.C." (MEFENAMIC ACID) 1.50

AC237691G0 MEFENAMA CAPSULES "Y.C."(MEFENAMIC ACID)(鋁箔/膠箔) 2.00

AC23771100 PROCOTON TABLETS "J.L." 1.50

AC237711G0 PROCOTON TABLETS "J.L."(鋁箔/膠箔) 2.00

AC23773100 FOLDCAM CAPSULES (PIROXICAM) "CHINTHENG" 1.50

AC237731G0 FOLDCAM CAPSULES (PIROXICAM) "CHINTHENG"(鋁箔/膠箔) 2.00

AC23775100 COLISTIN SULFATE CAPSULES 6.20

AC23785100 ASCOPINE TABLETS "YU SHENG" 1.50

AC23789100 TRANCOSU TABLETS 2.97

AC23790100 FENOTER TABLETS (FENOTEROL) "LITA" 1.50

AC237901G0 FENOTER TABLETS (FENOTEROL) "LITA"(鋁箔/膠箔) 2.00

AC23791100 ENLAIN F.C. TABLETS "CHEN TA" 4.14

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AC23793100 LIVERALL F.C. TABLETS "Y.C." 1.58

AC237931G0 LIVERALL F.C. TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC23796500 ECORIN VAGINAL SUPPOSITORY (ECONAZOLE) "H.C.T." 9.70

AC23820100 CITIDINE TABLETS (CIMETIDINE) 1.50

AC238201G0 CITIDINE TABLETS (CIMETIDINE)(鋁箔/膠箔) 2.00

AC23822100 DEPHEDOL F.C. TABLETS 25MG (DIPHRNIDOL) 1.50

AC238221G0 DEPHEDOL F.C. TABLETS 25MG(DIPHRNIDOL)(鋁箔/膠箔) 2.00

AC23825100 SPLOTIN TABLETS (SULPIRIDE) 1.53

AC238251G0 SPLOTIN TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC23833100 SWEI TABLETS "YU SHENG" 1.50

AC23844212 STOGAMET INJECTION "SWISS"(CIMETIDINE) 15.00

AC23845100 CHIERHSIN-40MG TABLETS 1.50

AC23846100 WINDPIN TABLETS (BETAHISTINE) "YUNG CHI" 1.50

AC23850100 AN-AN TABLETS 1.76

AC23857100 LORAZEPAM TABLETS 1.50

AC238571G0 LORAZEPAM TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC23866100 GENLIMIN S.C. TABLETS "F.Y." 1.50

AC23870100 AMMONIUM CHLORIDE E.C. TABLETS "HEALTH" 0.00

AC23889100 KONSUL TABLETS (PRIDINOL) "LITA" 1.50

AC238891G0 KONSUL TABLETS (PRIDINOL) "LITA"(鋁箔/膠箔) 2.00

AC23890277 AMINOL-V INJECTION "S.T." 104.00

AC23901100 PYROCAM CAPSULES 10MG (PIROXICAM) "F.Y." 1.50

AC23904100 "LIDONIN TABLETS (DICLOFENAC) ""TAI YU""" 1.50

AC23913100 WEICOLIN TABLETS (CIMETIDINE) "W.P." 1.50

AC23915277 AMOXICILLIN INJECTION 500MG "KINGDOM" 25.00

AC23918100 FLUZINE TABLETS 5MG(FLUNARIZINE)"STANDARD" 1.52

AC239181G0FLUZINE TABLETS "STANDARD" (FLUNARIZINE) 5MG(鋁箔/膠箔)

2.00

AC23920100 BROPIN F.C. TABLETS (BROMOPRIDE) "STANDARD" 1.50

AC239201G0BROPIN F.C. TABLETS (BROMOPRIDE) "STANDARD"(鋁箔/膠箔)

2.00

AC23932100 AZOL TABLETS (ACETAZOLAMIDE) "NCP" 1.50

AC23936100 BISMUTH SUBCARBONATE TABLETS "N.C.P." 1.50

AC23969100 MERO CAPSULES (KETOPROFEN) "NCP" 1.59

AC23996100 PIROXICAM CAPSULES "S.C." 1.50

AC23999100 BACIDE CAPSULES (PIPEMIDIC ACID) "S.C." 2.06

AC24006271 TBC NO.8A INJECTION 0.00

AC24014221 TRANSACID INJECTION (TRANEXAMIC ACID) 15.00

AC24014229 TRANSACID INJECTION (TRANEXAMIC ACID) 15.00

AC24014238 TRANSACID INJECTION (TRANEXAMIC ACID) 33.00

AC24017100 CIMEDIN TABLETS 200MG (CIMETIDINE) "TBC" 1.50

AC24018100 NIFEPIN CAPSULES (NIFEDIPINE) "ROYAL" 1.81

AC240181G0 NIFEPIN CAPSULES (NIFEDIPINE) "ROYAL"(鋁箔/膠箔) 2.00

AC24020100 POUDERCAM CAPSULES "H.S." 1.50

AC24023100 ANJAL TABLETS "YU SHENG" 1.50

AC24029263 MORIAMIN-SN INJECTION 138.00

AC24029277 MORIAMIN-SN INJECTION 209.00

AC24040209 KONSUL INJECTION "LITA" (PRIDINOL) 15.00

Page 103: 附件二 藥品給付品項暨支付標準表

AC24053100 BLOODFULL S.C. TABLETS "C.H." 1.50

AC240531G0 BLOODFULL S.C. TABLETS "C.H."(60粒/瓶裝) 2.00

AC24073212 CIMEDIN INJECTION (CIMETIDINE) "S.T." 15.00

AC24076100 PRANOL F.C. TABLETS (PROPRANOLOL) 1.50

AC24077100 CIMEWET TABLETS (CIMETIDINE) "N.C.P." 1.50

AC240771G0 CIMEWET TABLETS (CIMETIDINE) "N.C.P."(鋁箔/膠箔) 2.00

AC24085100 "WEIBAMYCIN CAPSULES ""TAI YU"" (DOXYCYCLINE)" 1.50

AC24103100 TONTARIN F.C. TABLETS (DICLOFENAC) 1.50

AC24104100 HERSUN TABLETS 40MG (PROPRANOLOL HYDROCHLORIDE)"F.Y." 1.50

AC24113209"DEXTROSE AND SODIUM CHLORIDE INJECTION 5%/0.9%

""Y.F."""35.00

AC24113277"DEXTROSE AND SODIUM CHLORIDE INJECTION 5%/0.9%

""Y.F."""25.00

AC24115100 DICLOFENAC ENTERIC COATED TABLETS "Y.C." 1.50

AC24127100 DICLOFEN TABLETS (DICLOFENAC) 1.50

AC24132100 AMOXICILLIN CAPSULES 500MG 1.50

AC241321G0 AMOXICILLIN CAPSULES 500MG.(鋁箔/膠箔) 2.00

AC24175100 REAZONE TABLETS 1.50

AC24187100 TRENTAL DRAGEE 100MG (PENTOXIFYLLINE) 1.50

AC241871G0 TRENTAL DRAGEE 100MG (PENTOXIFYLLINE)(鋁箔/膠箔) 2.00

AC24196100 PIPEMID TABLETS 250MG "Y.C."(PIPEMIDIC ACID) 3.54

AC24198212 AMIKACIN INJECTION 125MG/ML "N.K." 29.00

AC24199100 NAROXIN TABLETS (NAPROXEN) 1.50

AC24203216 ACETYLCYSTEINE INJECTION 100MG/ML "LITA" 15.00

AC24212238 0.45% SODIUM CHLORIDE INJECTION 15.00

AC24212277 SODIUM CHLORIDE INJECTION 0.45% "S.T." 25.00

AC242122D9 SODIUM CHLORIDE INJECTION 0.45% "S.T." (塑膠軟袋裝) 85.00

AC24229100 PRIMRAM S.C. TABLETS (METOCLOPRAMIDE) "C.H." 1.50

AC24236100 CARBETAN F.C. TABLETS 30MG "CHINTENG" 1.50

AC242361G0 CARBETAN F.C. TABLETS 30MG "CHINTENG"(鋁箔/膠箔) 2.00

AC24251100 LITAZIN CAPSULES (PIPEMIDIC ACID) "LITA" 2.06

AC24258277 TAITA NO.4 INJECTION 35.00

AC24266100 DIYUN TABLETS (DIPHENIDOL) "S.T." 1.50

AC24269100 BUSKOBUN S.C. TABLETS C.H." (HYOSCINE BUTYLBROMIDE) " 1.50

AC24270100 PISON CAPSULES "C.H." 1.60

AC24271100 ISMEDINE TABLETS (GUANETHIDINE SULFATE) "C.H." 0.00

AC24272100 ERGO-M S.C. TABLETS "C.H."(ERGOMETRINE MALEATE) 1.50

AC24277100 SULYANG CAPSUES (SULPIRIDE) "S.T." 1.53

AC24282100 TREN CAPSULES 250MG (TRANEXAMIC ACID) "YUNG SHIN" 1.50

AC24310100 RESERZIDE S.C. TABLETS 1.50

AC243101G0 RESERZIDE S.C. TABLETS(鋁箔/膠箔) 2.00

AC24318100 LORAZEPAM TABLETS 2MG "LITA" 1.50

AC243181G0 LORAZEPAM TABLETS 2MG "LITA"(鋁箔/膠箔) 2.00

AC24319221 TREN INJECTION 100MG (TRANEXAMIC ACID) "YUNG SHIN" 15.00

AC24329100 LIROCAM CAPSULE (PIROXICAM) "LITA" 1.50

AC24330100 PIROCAM CAPSULES "J.L." 1.50

AC24335100 SALBUTAMO TABLETS 4MG (SALBUTAMOL) 1.50

AC24350100 RELCON CAPSULES 250MG "YUNG CHI" 1.50

Page 104: 附件二 藥品給付品項暨支付標準表

AC24362100 BI AUI AN LINN TABLETS "NCP" 1.50

AC24369100FELVITEN S.C. TABLETS "C.H."

(ANETHOLE)1.50

AC24374100 THIAMPHENICOL CAPSULES 250MG "C.L." 1.51

AC243741G0 THIAMPHENICOL CAPSULES 250MG "C.L."(鋁箔/膠箔) 2.00

AC24375100 GRISEOFULVIN TABLETS 250MG 1.65

AC243751G0 GRISEOFULVIN TABLETS 250MG(鋁箔/膠箔) 2.00

AC24385100 LOPERAMIDE CAPSULES 1.50

AC24431100 PAOWEIAN TABLETS 200MG "C.H." (CIMETIDINE ) 1.50

AC24440100 IKODIN CAPSULES 500MG (CEPHALEXIN) 1.78

AC244401G0 IKODIN CAPSULES 500MG (CEPHALEXIN)(鋁箔/膠箔) 2.00

AC24441100 CODEM CAPSULES "C.H." 1.50

AC24463100 ANXIEDIN TABLETS 0.5MG (LORAZEPAM) 1.50

AC244631G0 ANXIEDIN TABLETS 0.5MG (LORAZEPAM)(鋁箔/膠箔) 2.00

AC24474100 LIDIN TABLETS 300MG (LITHIUM CARBONATE) 1.50

AC24488100 PROAZINE TABLETS (PROCHLORPERAZINE MALEATE) 1.50

AC244881G0PROAZINE TABLETS (PROCHLORPERAZINE MALEATE)(鋁箔/膠箔)

2.00

AC24490100 PIPERAN CAPSULES (PIPEMIDIC ACID )"YU SHENG" 3.54

AC24493100 TEANLANG TABLETS 0.75MG 1.50

AC24494100 LISOME TABLETS 30MG "HONTEN" (LYSOZYME) 1.50

AC24509100 FLURAZINE F.C. TABLETS 5MG "VPP" (TRIFLUOPERAZINE) 1.50

AC24516210 "SODIUM CHLORIDE INJECTION 0.9% ""TAI YU""" 40.90

AC24516212 "SODIUM CHLORIDE INJECTION 0.9% ""TAI YU""" 72.00

AC24516216 "SODIUM CHLORIDE INJECTION 0.9% ""TAI YU""" 86.00

AC24516248 "SODIUM CHLORIDE INJECTION 0.9% ""TAI YU""" 15.00

AC24536100 PROPRANOLOL HYDROCHLORIDE TABLETS "C.H." 1.50

AC24588100 SALUPEN TABLETS "Y.K." 1.50

AC24592100 SULMIN TABLETS 1.50

AC24597100 ALLERCON TABLETS 1.50

AC24620221 MULTIVITA INJECTION 0.00

AC24667265 RINGER INJECTION 22.00

AC24667277 RINGER INJECTION 25.00

AC24696216 "DICLOFENAC INJECTION 25MG ""TAI YU""" 15.00

AC24703100 "SULPI CAPSULES 50MG (SULPIRIDE) ""WINSTON""" 1.53

AC247031G0 SULPI CAPSULES 50MG (SULPIRIDE) "WINSTON"(鋁箔/膠箔) 2.00

AC247061G0 SUPIAN TABLETS "F.B" (鋁箔/膠箔) 2.00

AC24708100 SORIN TABLETS 200MG "YUNG SHIN" (CHLORZOXAZONE) 1.50

AC247081G0SORIN TABLETS 200MG "YUNG SHIN" (CHLORZOXAZONE)(鋁箔/膠

箔)2.00

AC24726100 PARAS TABLETS "YUNG SHIN" 1.50

AC24730500 FUCODINE VAGINAL TABLETS 100MG "Y.K." 5.90

AC24740100 "LYSOZYME TABLETS 100MG ""M.T.""" 1.50

AC24742100 MILISHER TABLETS 100MG "H.H." (LYSOZYME) 1.50

AC24750212 CIMETIDINE INJECTION 100MG "ORIENTAL" 15.00

AC24751221 POTASSIUM CHLORIDE INJECTION 15% "KINGDOM" 15.00

AC24754100 ZECOLIN TABLETS 250MG 1.50

AC24756277 "DEXTROSE INJECTION 10% ""TAI YU""" 25.00

Page 105: 附件二 藥品給付品項暨支付標準表

AC24757100 SUITONE F.C. TABLETS 500MG "Y.K." 1.50

AC247571G0 SUITONE F.C. TABLETS 500MG "Y.K."(鋁箔/膠箔) 2.00

AC24758100 LYSOZYME TABLETS 90MG "SPC" 1.50

AC24766100 "HETEL CAPSULES (CLOMIPHENE)""M.T.""" 3.87

AC24772212 ORISANTIN INJECTION 5MG/ML (DIPYRIDAMOLE) "ORIENTAL" 15.00

AC24789100 ERYMYCIN CAPSULES 250MG (ERYTHROMYCIN ESTOLATE) "VPP" 1.77

AC247891G0ERYMYCIN CAPSULES 250MG (ERYTHROMYCIN ESTOLATE) "VPP"(鋁

箔/膠箔)2.00

AC24810100 WEIZAIN TABLETS "HONTEN" 1.50

AC24817100 BROTHINE TABLETS 2.5MG (TERBUTALINE SULFATE) 1.50

AC248171G0BROTHINE TABLETS 2.5MG (TERBUTALINE SULFATE)(鋁箔/膠箔)

2.00

AC24837100"TONIFEN F.C. TABLETS 500MG (MEFENAMIC ACID) "" ROYAL

"""1.50

AC248371G0"TONIFEN F.C. TABLETS 500MG (MEFENAMIC ACID) "" ROYAL

"""2.00

AC24838100 RIFAMPICIN CAPSULES 8.10

AC24840209 CEMANDOLE INJECTION (CEFAMANDOLE) 0.00

AC24840277 CEMANDOLE INJECTION (CEFAMANDOLE) 0.00

AC24841100 CLOMIPHENE CAPSULES 50MG "Y.C." 3.87

AC24843100 CHIMIN TABLETS 0.5MG "Y.C." (BETAMETHASONE) 1.50

AC24866100 HYTERGEN TABLETS 1.5MG "Y.C." 1.50

AC24877100 STANOZOLOL TABLETS 2MG "C.H." 1.50

AC24885100 ANXIEDIN TABLETS 1MG (LORAZEPAM) 1.50

AC248851G0 ANXIEDIN TABLETS 1MG (LORAZEPAM)(鋁箔/膠箔) 2.00

AC24888100 CEFLEXIN CAPSULES 500MG "VPP" (CEPHALEXIN) 1.78

AC248881G0 CEFLEXIN CAPSULES 500MG (CEPHALEXIN) "VPP"(鋁箔/膠箔) 2.00

AC24894100 E-BUTOL F.C. TABLETS 400MG 3.97

AC24936100 ERGODAN F.C. TABLETS 1.50

AC24937100 ENBRAIN TABLETS 1.5MG (DIHYDROERGOTOXINE MESYLATE) 1.50

AC24942209 SALTOLIN INJECTION "GENTLE" (SALBUTAMOL) 0.00

AC24943100 LORAPAM TABLETS 1MG 1.50

AC249431G0 LORAPAM TABLETS 1MG(鋁箔/膠箔) 2.00

AC24944100 SPIRZIDE TABLETS 1.50

AC24952209 DEXAMETHASONE INJECTION 4MG "Y.Y." 15.00

AC24952212 DEXAMETHASONE INJECTION 4MG/ML "Y.Y." 17.30

AC24957100 ISCAN F.C. TABLETS 200MG (CIMETIDINE) "SPC" 1.50

AC24961212T.T.Y. COLIMYCIN INJECTION 2000000 U (COLISTIN

METHANESULFONATE)314.00

AC24964100 MORCASIN TABLETS "SINPHAR" 1.50

AC249641G0 MORCASIN TABLETS "SINPHAR" 2.00

AC24974100 MERIS SC TABLETS (BETAHISTINE) 1.50

AC24986265 GLYCEROL INJECTION "N.K." 70.00

AC24986266 GLYCEROL INJECTION "N.K." 70.00

AC24986277 GLYCEROL INJECTION 75.00

AC24987100 Cendmycin Capsules 500mg (Cefadroxil) 2.13

AC24990271 TBC NO.8B INJECTION 0.00

AC24991100 DIPHENIDOL S.C.TABLETS 25MG "C.H" 1.50

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AC24995100 TACRETON TABLETS 200MG "HL" 1.50

AC25015238 SANVITA INJECTION "ASTAR" 15.00

AC25017100 "YULANTYL TABLETS ""TAI YU""" 1.50

AC25020100ERYSTAC CAPSULES 250MG (ERYTHROMYCIN STEARATE) "KINGDOM"

1.77

AC25025100 NYSTATIN TABLETS 500000 UNITS "Y.C." 2.64

AC25058100 VANCONIN TABLETS 2MG (DIAZEPAM) "VPP" 1.50

AC250581G0 VANCONIN TABLETS 2MG (DIAZEPAM) "VPP" (鋁箔/膠箔) 2.00

AC25061100 MEPENATE TABLETS 1.50

AC25079100 COMBICILLIN CAPSULES "C.R." 3.81

AC25083100 UCEFA CAPSULES 500MG (CEFADROXIL) 2.13

AC25095100 "WINTIDINE TABLETS 200MG (CIMETIDINE) ""WINSTON" 1.50

AC25096100 DIAZEPAM TABLETS 2MG 1.50

AC250961G0 DIAZEPAM TABLETS 2MG(鋁箔/膠箔) 2.00

AC25104277 "FRUCERINTONE INTECTION ""TAI YU""" 0.00

AC25110100 DEXTROLAMINE CAPSULES "S.C." 1.50

AC251181G0NEUROPAM TABLETS 2MG (LORAZEPAM) "PANBIOTIC"(鋁箔/膠箔)

2.00

AC25128417 GENTAMYCIN OPHTH. OINTMENT 3MG/GM "GCPC" 18.20

AC25128421 GENTAMYCIN OPHTH. OINTMENT 3MG/GM "GCPC" 22.80

AC25130100 NOFLAGMA CAPSULES 50MG (LYSOZYME) "YUNG SHIN" 1.50

AC25159100 GRIFUCIN TABLETS 500MG 2.66

AC25163100 DECA TABLETS 0.75MG (DEXAMETHASONE) "S.T." 1.50

AC25164219 BUNISEX INJECTION 0.5MG "Y.Y."(BUMETANIDE) 47.10

AC25191100 WINSUMIN F.C. TABLETS 50MG (CHLORPROMAZINE HCL) 1.50

AC25195100 DYPHACOL TABLETS 1.50

AC25196100 EASYGO TABLETS "S.T." 1.50

AC25201100 TECON CAPSULES 10MG (PIROXICAM) "PANBIOTIC" 1.50

AC25202100 FELCAM CAPSULES 10MG (PIROXICAM) 1.50

AC25217500 ANTIFUNGAL VAGINAL TABLETS 100MG "S.C." (MICONAZOLE) 5.00

AC25223100 TOEEFON TABLETS 250MG (MEFENAMIC ACID) "T.F." 1.50

AC25224100 ORIBIRA TABLETS 4.58

AC25230100 DOGWEISU CAPSULES 50MG (SULPIRIDE) 1.53

AC252301G0 DOGWEISU CAPSULES 50MG (SULPIRIDE)(鋁箔/膠箔) 2.00

AC25231100 KETOEN CAPSULES 50MG (KETOPROFEN) "SPC" 1.59

AC25243100ERGOXIN TABLETS 1.5MG (DIHYDROERGOTOXINE

METHANESULFONATE) "S.C."1.50

AC252431G0ERGOXIN TABLETS 1.5MG "S.C." (DIHYDROERGOTOXINE

METHANESULFONATE) (鋁箔/膠箔)2.00

AC25244100 LIKODIN CAPSULES 500MG "SWISS" (CEFADROXIL) 2.13

AC25254100 LYSOZYME TABLETS 90MG "S.C." 1.50

AC25272100 DIPYRIDAMOLE S.C. TABLETS 25MG "C.H." 1.50

AC25273100 DOCOLER TABLETS 250MG "Y.Y." 3.54

AC25279100 SUPERZYME TABLETS 90MG 1.50

AC25290100 PIROX CAPSULES 10MG "Y.C."(PIROXICAM) 1.50

AC252901G0 PIROX CAPSULES 10MG "Y.C." (PIROXICAM)(鋁箔/膠箔) 2.00

AC25291329 SEEDO-SANIN CREAM 18.80

AC25291335 SEEDO-SANIN CREAM 30.40

Page 107: 附件二 藥品給付品項暨支付標準表

AC25301100 OXO CAPSULES "YUNG SHIN" (OXOLAMINE CITRATE) 1.50

AC253011G0OXO CAPSULES (OXOLAMINE CITRATE) "YUNG SHIN"(鋁箔/膠箔)

2.00

AC25314100 NIFLUCIL CAPSULES 250MG "Y.C." (NIFLUMIC ACID) 2.36

AC25316100 TRANEXMIN CAPSULES 250MG "CHINTENG" (TRANEXAMIC ACID) 1.50

AC253161G0TRANEXMIN CAPSULES 250MG "CHINTENG" (TRANEXAMIC ACID)(鋁

箔/膠箔)2.00

AC25349100 LICOTIN-A CAPSULES "YUNG CHI" 1.50

AC25355266 FRUCEROL INJECTION 70.00

AC25355277 FRUCEROL INJECTION 75.00

AC25365100 "ESIDAR S.C. TABLETS ""M.T.""" 1.50

AC253651G0 "ESIDAR S.C. TABLETS ""M.T.""(鋁箔/膠箔)" 2.00

AC25377100 TIOPRONIN S.C. TABLETS 100MG "H.S." 4.39

AC25396100 MEFETON F.C. TABLETS 500MG 1.50

AC253961G0MEFETON F.C. TABLETS 500MG (MEFENAMIC ACID)(鋁箔/膠箔)

2.00

AC253961G5MEFETON F.C. TABLETS 500MG (MEFENAMIC ACID)(84粒/瓶裝)

2.00

AC25406100 PERANSIN F.C. TABLETS 75MG (DIPYRIDAMOLE) "C.H." 1.58

AC25426212 PYRIDOXAL PHOSPHATE INJECTION 10MG/ML "Y.Y." 15.00

AC25427100 DISOPYRAMIDE CAPSULES 100MG "F.Y." 5.00

AC25443100 KONSHIEN CAPSULES "YU SHENG" 1.50

AC25446100 PIROXIM CAPSULES 10MG (PIROXICAM) "STANDARD" 1.50

AC254461G0PIROXIM CAPSULES 10MG (PIROXICAM) "STANDARD" (鋁箔/膠箔)

2.00

AC25447100 ANSRON FILM COATED TABLETS 100MG 3.54

AC25449114 AMIYU GRANULES 13.90

AC25452100 ZUCON TABLETS 25MG "Y.Y." (DICLOFENAC) 1.50

AC25456100"HOWELL TABLETS 100MG ""WELCAN"" (DIHYDROXY ALUMINUM

ALLANTOINATE)"1.50

AC25460100 TRANEXAMIC ACID 250MG CAPSULES 1.50

AC25466100 LEVAZOL TABLETS 40MG (LEVAMISOLE) "S.T." 2.23

AC25467100 LYZINE TABLETS 50MG (LYSOZYME) "S.T." 1.50

AC25485209"DEXTROSE 5% AND SODIUM CHLORIDE 0.225% INJECTION

""Y.F."""35.00

AC25485277"DEXTROSE 5% AND SODIUM CHLORIDE 0.225% INJECTION

""Y.F."""25.00

AC25504421 YECOLON ORABESE (TRIAMCINOLONE) 28.40

AC25504423 YECOLON ORABASE (TRIAMCINOLONE) 36.70

AC25517100 THECOUGHEN TABLETS "T.F." 1.50

AC25525100 KODERLIN TABLETS "MEIDER" 1.50

AC25528277 KALTOSE INJECTION "N.K." 112.00

AC25541100 SILYMARIN F.C. TABLETS 35MG 1.50

AC255411G0 SILYMARIN F.C. TABLETS 35MG(鋁箔/膠箔) 2.00

AC25547100 REMEXIN TABLETS "S.T." 2.01

AC25548100 PIZEPINE TABLETS 25MG (PIRENZEPINE DIHYDROCHLORIDE) 1.79

AC25549100 TOLMETIN TABLETS 200MG "LITA" 6.80

AC25550263 AMIYU INJECTION 113.00

Page 108: 附件二 藥品給付品項暨支付標準表

AC25555100 BAKTSIN TABLETS "Y.S." 1.50

AC255551G0 BAKTSIN TABLETS "Y.S."(鋁箔/膠箔) 2.00

AC25567321 ECONALONE CREAM "SINPHAR" 10.50

AC25567329 ECONALONE CREAM "SINPHAR" 18.80

AC25571100 SPANTON TABLETS 1.50

AC25586100 LORAZEPAM TABLETS 1MG "C.H." 1.50

AC25589100 LORAZEPAM TABLETS 1MG "CHEN TA" 1.50

AC25590100 LYSOZYME CHLORIDE TABLETS 50MG "CHINTENG" 1.50

AC255901G0 LYSOZYME CHLORIDE TABLETS 50MG "CHINTENG"(鋁箔/膠箔) 2.00

AC25595229 LINCOMYCIN HCL INJECTION 300MG/ML "T.F." 27.20

AC25595238 LINCOMYCIN HCL INJECTION 300MG/ML"TF" 39.20

AC25604100 BERODIN TABLETS 2.5MG "N.C.P."(FENOTEROL) 1.50

AC25617100 CEFADROXIL CAPSULES 500MG "Y.S." 2.13

AC25623100 LOVAMIN TABLETS 1MG "T.F." 1.50

AC256231G0 LOVAMIN TABLETS 1MG "T.F."(鋁箔/膠箔) 2.00

AC25629100 DICYCLOMINE TABLETS 10MG "Y.Y" 1.50

AC25644100 PRIMLAN TABLETS 10MG (METOCLOPRAMIDE) "P.L." 1.50

AC25659100 CEFADROXIL CAPSULES 500MG "S.T." 2.13

AC25675277 MALTOSE INJECTION 10% "N.K." 0.00

AC25686100 POSHINLEN F.C. TABLETS 25MG "H.S." 1.50

AC256861G0 POSHINLEN F.C. TABLETS 25MG"H.S." (鋁箔/膠箔) 2.00

AC25698100 PIPEMIDON CAPSULES 250MG"T.F." (PIPEMIDIC ACID) 3.54

AC25714100 CIWIDINE TABLETS 200MG 1.50

AC25715100 ACTIZYME TABLETS 30MG"PANBIOTIC"(LYSOZYME) 1.50

AC25716100 TRANEXAMIN CAPSULES 250MG (TRANEXAMIC ACID) "S.C." 1.50

AC25717317 "ECONOL-T CREAM ""GCPC""" 10.50

AC25717321 "ECONOL-T CREAM ""GCPC""" 10.50

AC25717329 "ECONOL-T CREAM ""GCPC""" 18.80

AC25717335 "ECONOL-T CREAM ""GCPC""" 30.40

AC25739100ERYTHROMYCIN STEARATE FILM COATED TABLETS 250MG "SHITEH"

1.77

AC25754100 PICOTAM CAPSULES 400MG GENTLE (PIPEMIDIC ACID) 3.54

AC25789100 ACTIZYME 90MG CAPSULES (LYSOZYME) 1.50

AC257891G0 ACTIZYME 90MG CAPSULES (LYSOZYME)(鋁箔/膠箔) 2.00

AC25802265 CEFURO INJECTION 250MG 0.00

AC25816329 YEAFULIN CREAM "Y.S" 18.80

AC25816335 YEAFULIN CREAM "Y.S." 30.40

AC25816338 YEAFULIN CREAM "Y.S" 0.00

AC25828100 PITOCAM CAPSULES 10MG (PIROXICAM) "SPC" 1.50

AC25835100 SEIZYME TABLETS 60MG "Y.Y." 1.50

AC25840100 ATENOL F.C. TABLETS 100MG (ATENOLOL) 1.51

AC258401G0 ATENOL F.C. TABLETS 100MG (ATENOLOL)(鋁箔/膠箔) 2.00

AC25841100 ANTIMIGRAINE FILM COATED TABLETS "T.F." 1.50

AC258411G0 ANTIMIGRAINE FILM COATED TABLETS "T.F."(鋁箔/膠箔) 2.00

AC25842100 TRANEXIC TABLETS 250MG "P.L." 1.50

AC25844209 METHYLERGONOVINE MALEATE INJECTION 0.2MG/ML "Y.Y." 17.40

AC25849212 METOCLOPRAMIDE INJECTION "Y.Y." 15.00

AC25866100 AMOXICILLIN CAPSULES 500MG "YUNG SHIN" 1.50

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AC258661G0 AMOXICILLIN CAPSULES 500MG "YUNG SHIN" (鋁箔/膠箔) 2.00

AC25871100 PIROXICAM CAPSULES 10MG "Y.Y." 1.50

AC25882100 LYCOSU TABLETS 50MG 1.50

AC25897216 MUCOCIL INJECTION 100MG/ML "GENTLE" (ACETYLCYSTEINE) 15.00

AC25902277 MALTOSE INJECTION 10% 130.00

AC25905100 KODAPIN F.C. TABLETS 1.50

AC25918212 DICYCLOMINE INJECTION 10MG/ML "Y.Y" 15.00

AC25925100 ANCOGEN TABLETS "H.H." 1.50

AC259251G0 ANCOGEN TABLETS "H.H."(鋁箔/膠箔) 2.00

AC25941100 DECAMIN TABLETS 4MG (CYPROHEPTADINE HCL) "S.Y." 1.50

AC25965100 SHYYLOUH TABLETS 25MG (SPIRONOLACTONE) "Y.S." 1.50

AC259651G0SHYYLOUH TABLETS 25MG (SPIRONOLACTONE) "Y.S."(鋁箔/膠箔)

2.00

AC25977125 AMOXICILLIN GRANULES 200MG/GM "YUNG SHIN" 31.00

AC25983277 FRUCTOSE INJECTION 5% "CHI SHENG" 30.70

AC26002100 CODEMIN CAPSULES "S.T." 1.60

AC26007100 NOFLAGMA TABLETS 90MG (LYSOZYME) "YUNG SHIN" 1.50

AC26021214 ANTISAMIN INJECTION 100MG/ML (TRANEXAMIC ACID) 15.00

AC26021221 ANTISAMIN INJECTION 100MG/ML (TRANEXAMIC ACID) 15.00

AC26026100 TRAXEMIN CAPSULES 250MG (TRANEXAMIC ACID) "S.T." 1.50

AC26028238 CONBIHOL INJECTION "LITA" 15.00

AC26032100 ALMEDOPA TABLETS 250MG (L-ALPHA-METHYL DOPA) "UNION" 2.46

AC26079100 BROMAZIN TABLETS 6MG (BROMAZEPAM) 2.82

AC26080100 BROMAZIN TABLETS 3MG (BROMAZEPAM) 1.53

AC260801G0 BROMAZIN TABLETS 3MG "JOHNSON"(BROMAZEPAM)(鋁箔/膠箔) 2.00

AC26082238 KACILEN INJECTION 15.00

AC26089100 "SU-FU-DOU TABLETS 500MG (TINIDAZOLE)""M.T.""" 2.09

AC26090100 NAPROXEN TABLETS 250MG "N.C.P" 1.50

AC26093100 TRANEXAMIC ACID 500MG TABLETS "C.L." 3.72

AC26105100ELISTIN TABLETS 1.5MG "STANDARD" (DIHYDROERGOTOXINE

MESYLATE)1.50

AC261051G0ELISTIN TABLETS 1.5MG "STANDARD" (DIHYDROERGOTOXINE

MESYLATE)2.00

AC26114100 EMODINE CAPSULES 1.50

AC26115100 IRIDINE CAPSULES 2MG (LOPERAMIDE) "Y.S." 1.50

AC261151G0 IRIDINE CAPSULES 2MG (LOPERAMIDE) "Y.S."(鋁箔/膠箔) 2.00

AC26118209 SOON INJECTION "YUNG SHIN" 15.00

AC26121100 COBICIN TABLETS "YU SHENG" 1.50

AC26123151 ANTICA SYRUP 25.00

AC26123157 ANTICA SYRUP 25.00

AC26124100 GAWEI TABLETS 200MG (CIMETIDINE) "YU SHENG" 1.50

AC261241G0GAWEI TABLETS 200MG (CIMETIDINE) "YUSHENG" (鋁箔/膠箔)

2.00

AC26127100 NAPOXEN TABLETS 250MG 1.50

AC26128340 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 35.50

AC26128348 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 43.70

AC26128363 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 139.00

AC26128365 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 140.00

Page 110: 附件二 藥品給付品項暨支付標準表

AC26128377 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 357.00

AC26133100SUCAFATE TABLETS 500MG (BASIC ALUMINUM SUCROSE SULFATE)

1.50

AC26138100 TOLPERISONE TABLETS 100MG "S.C." 1.52

AC26144100 CLONIDINE TABLETS 0.15MG "C.H." 0.00

AC26154100 BUDEMA TABLETS 1MG (BUMETANIDE) "S.T." 1.69

AC26155329 "ECONAT CREAM ""WINSTON""" 18.80

AC26173212 "TRANEXAMIC ACID INJECTION 50MG ""TAI YU""" 15.00

AC26173221 "TRANEXAMIC ACID INJECTION 50MG ""TAI YU""" 15.00

AC26175100 URODINE F.C. TABLETS 100MG "T. F." (PHENAZOPYRIDINE) 1.50

AC26176100 PESUGEN CAPSULES 10MG (PIROXICAM) "S.T." 1.50

AC26205100 SULFAMETHOXAZOLE TABLETS 500MG "SPC" 1.50

AC26233100 FLUNAZON CAPSULES 5MG (FLUNARIZINE) "N.K." 1.52

AC262331G0 FLUNAZON CAPSULES 5MG (FLUNARIZINE) "N.K." 2.00

AC26234500 KANEZIN VAGINAL TABLETS 100MG (CLOTRIMAZOLE) 5.90

AC26256100 FUTON E.C. TABLETS 25MG 1.50

AC262561G0 FUTON E.C. TABLETS 25MG (鋁箔/膠箔) 2.00

AC26259100 TININ TABLETS 500MG (TINIDAZOLE) "S.C." 2.09

AC26261100 Soprinol Tablets ''H.S.'' 5.60

AC26263100 VIRUX TABLETS 500MG (METHISOPRINOL) 5.60

AC26265209 AVTON INJECTION 20MG/ML (NEFOPAM) "N.K." 15.00

AC26266209 ANOPAIN INJECTION 20MG/ML "GENTLE" (NEFOPAM) 15.00

AC26272100 CAPAIN F.C. TABLETS 30MG (NEFOPAM) "YUNG SHIN 2.73

AC26273209 ACUPAINLEX INJECTION 20MG/ML (NEFOPAM) "PANBIOTIC" 15.00

AC26275209 STOPAIN INJECTION 20MG/ML "T.F." 15.00

AC26276100 LYSOZYME CAPSULES 90MG "T.F." 1.50

AC26278100 NOSCAPINE TABLETS 15MG "SINPHAR" 0.91

AC26284100 CEPIN TABLETS 25MG (DIPHENIDOL) "SPC" 1.50

AC26289100 P.P.C. CAPSULES 1.50

AC262891G0 P.P.C. CAPSULES(鋁箔/膠箔) 2.00

AC26303100 ZUCERINE TABLETS 250MG (TRANEXAMIC ACID) "LITA" 1.50

AC26308321"CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE)

""WINSTON"""15.80

AC26308340"CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE)

""WINSTON"""35.50

AC26308348"CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE)

""WINSTON"""43.70

AC26308365"CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE)

""WINSTON"""140.00

AC26308372"CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE)

""WINSTON"""267.00

AC26308377"CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE)

""WINSTON"""357.00

AC26324100"PIROCAM CAPSULES 10MG (PIROXICAM)""M.T.""(鋁箔/膠箔)"

1.50

AC263241G0 PIROCAM CAPSULES 10MG (PIROXICAM)"M.T."(鋁箔/膠箔) 2.00

AC26328100 NEWMAZOLE TABLETS 10MG (CARBIMAZOLE) 1.50

AC263281G0 NEWMAZOLE TABLETS 10MG (CARBIMAZOLE)(鋁箔/膠箔) 2.00

Page 111: 附件二 藥品給付品項暨支付標準表

AC26330100 TRANEXAM TABLETS 250MG (TRANEXAMIC ACID) 1.50

AC263301G0 TRANEXAM TABLETS 250MG (TRANEXAMIC ACID)(鋁箔/膠箔) 2.00

AC26343321 ECONOL CREAM 1% "GCPC" 11.20

AC26343329 ECONOL CREAM 1% "GCPC" 20.10

AC26357265 "DEXTROSE-SALINE INJECTION ""TAI YU""" 22.00

AC26357277 "DEXTROSE-SALINE INJECTION ""TAI YU""" 25.00

AC26361100 PIROCAM CAPSULES 10MG 1.50

AC26363100 MUSCONE TABLETS 50MG (TOPERISONE) "SHIN FONG" 1.52

AC26380216 FORMIN INJECTION 25MG/ML (DICLOFENAC) "PZNBIOTIC" 15.00

AC26385100 NEFOPAM TABLETS 30MG "S.T." 2.73

AC26400277 TBC NO.2 INJECTION 29.50

AC26402277 TBC NO.3 INJECTION 29.50

AC26410216 DICLODENAC INJECTION 25MG/ML "Y.Y" 15.00

AC26425100 ININ TABLETS 2MG "YU SHENG" 1.50

AC26430100 METICON-A CAPSULES "K.S." 1.50

AC26439100 LONFADROXIL CAPSULES 500MG (CEFADROXIL) "UNION" 2.13

AC26440100 ERGOTIN TABLETS 1.5MG (DIHYDROERGOTOXINE) "C.H." 1.68

AC26445209 ANWINTO INJECTION 50MG/ML "T.F." 15.00

AC26454100 DEASTHMA TABLETS 2.5MG (FENOTEROL) "S.T." 1.50

AC26461100 PIROXIM CAPSULES 20MG (PIROXICAM) "STANDARD" 1.50

AC26468429 PILOCARPINE HCL OPHTHALMIC SOLUTION 2% "WU-FU" 37.70

AC26468435 PILOCARPINE HCL OPHTHALMIC SOLUTION 2% "WU-FU" 79.00

AC26491100 PITON CAPSULES 10MG (PIROXICAM) "N.C.P." 1.50

AC26501500 ZOOZEAN VAGINAL TABLETS 100MG (MICONAZOLE) 5.00

AC26511100 "LICOU TABLETS ""S.Y.""" 1.50

AC265261G0 DOGMATYL F.C. TABLETS 50MG (SULPIRIDE)(鋁箔/膠箔) 2.00

AC26547100 KOPIDIN TABLETS "CHEN TA" 1.50

AC26550100 LYSOZYME TABLETS 90MG "W.P." 1.50

AC26552212"HYCOMIN-S INJECITON 5MG/ML (HYDROXOCOBALAMIN) ""S.Y."""

15.40

AC26554321 STADERM CREAM "STANDARD" 10.50

AC26554329 STADERM CREAM "STANDARD" 18.80

AC26554335 STADERM CREAM "STANDARD" 30.40

AC26556100 SULFINPYRAZONE CAPSULES 100MG "S.C." 3.54

AC26563500 FASTIN VAGINAL TABLETS 200MG (CLOTRIMAZOLE) 8.20

AC26572212"HYDROXOBAM INJECTION 2.5MG/ML (HYDROXOCOBALAMIN) ""TAI

YU"""15.00

AC26572229"HYDROXOBAM INJECTION 2.5MG/ML (HYDROXOCOBALAMIN) ""TAI

YU"""22.00

AC26576209 HI-OHB12 INJECTION 5MG/ML "GENTLE" (HYDROXOCOBALAMIN) 15.00

AC26583100 TIBICAN TABLETS 500MG (TINIDAZOLE) 2.09

AC26588100 SPAGASGEL TABLETS 2.34

AC26604429 PILOCARPINE OPHTHALMIC SOLUTION 1% "WU-FU" 27.70

AC26604435 PILOCARPINE OPHTHALMIC SOLUTION 1% "WU-FU" 81.00

AC26642212 BROMHEXINE INJECTION 2MG/ML "Y.Y" 15.00

AC26644100 "DICOK E.C. TABLETS 25MG (DICLOFENAC)""M.T.""" 1.50

AC266441G0"DICOK E.C. TABLETS 25MG (DICLOFENAC)""M.T.""(鋁箔/膠

箔)"2.00

Page 112: 附件二 藥品給付品項暨支付標準表

AC26649100 HELOSON CAPSULES (ERYTHROMYCIN) "HEALTH" 1.77

AC26677100 SULINDEC TABLETS 200MG "S.T." 1.98

AC266771G0 SULINDEC TABLETS 200MG "S.T."(鋁箔/膠箔) 2.00

AC26678100 SULINDAC TABLETS 100MG "W.P." 1.72

AC26683100 SULINDA TABLETS 100MG (SULINDAC) 1.72

AC26686209 LICOPAM INJECTION 20MG/ML (NEFOPAM) "Y.Y." 15.00

AC26703338 "SILVA-SULFA 1% CREAM (SILVER SULFADIAZINE) ""GCPC""" 32.30

AC26703340 SILVA-SULFA 1% CREAM 35.50

AC26703348 SILVA-SULFA 1% CREAM 43.70

AC26703363 SILVA-SULFA 1% CREAM 139.00

AC26703365 SILVA-SULFA 1% CREAM 140.00

AC26703371 SILVA-SULFA 1% CREAM 0.00

AC26703372 SILVA-SULFA 1% CREAM 0.00

AC26703377 SILVA-SULFA 1% CREAM 357.00

AC26741100 DAMIN TABLETS 1MG (PRAZOSIN) 1.50

AC267411G0 DAMIN TABLETS 1MG (PRAZOSIN)(鋁箔/膠箔) 2.00

AC26763100NICE SUGAR COATED TABLETS 100MG (NITROXOLINE) "YUNG

SHIN"2.52

AC26772238 "SODIUM BICARBONATE INJECTION 70MG/ML ""TAI YU""" 15.00

AC26804209METHASONE INJECTION 5MG/ML (DEXAMETHASONE PHOSPHATE)

"VPP"17.20

AC26817255 SABS INJECTION FOR IV INFUSION 5MG/ML 41.00

AC26817266 SABS INJECTION FOR IV INFUSION 5MG/ML 138.00

AC268341G0 PHYLLINTAL TABLETS "T.F."."(鋁箔/膠箔) 2.00

AC26858321 PROPADOM CREAM 0.25MG/GM (BECLOMETHASONE)"N.C.P." 24.10

AC26858329 PROPADOM CREAM 0.25MG/GM (BECLOMETHASONE)"N.C.P." 52.00

AC26858335 PROPADOM CREAM 0.25MG/GM (BECLOMETHASONE)"N.C.P." 105.00

AC26861329 PECIGEN CREAM "VPP" 18.80

AC26861338 PECIGEN CREAM "VPP" 32.60

AC26870100 FELCAM CAPSULES 10MG (PIROXICAM) "VPP" 1.50

AC268701G0 FELCAM CAPSULES 10MG (PIROXICAM) "VPP"(鋁箔/膠箔) 2.00

AC26872100 BENDOL F.C. TABLETS 1.50

AC26883100 CODEPINE TABLETS 1.50

AC26926216 ENCORE INJECTION 100MG/ML (ACETYLCYSTEINE) 15.00

AC26946100 PIROCAM CAPSULES 20MG (PIROXICAM) 1.50

AC269461G0 PIROCAM CAPSULES 20MG (PIROXICAM)(鋁箔/膠箔) 2.00

AC26961265 "SALINE-TROSE INJECTION ""TAI YU""" 22.00

AC26961277 "SALINE-TROSE INJECTION ""TAI YU""" 25.00

AC26974100 PYDINOL TABLETS (PRIDINOL) 1.50

AC26975100 DOXEPIN CAPSULES 25MG "S.C." 1.78

AC269751G0 DOXEPIN CAPSULES 25MG "S.C."(鋁箔/膠箔) 2.00

AC269841G0 PEACE TABLETS(鋁箔/膠箔) 2.00

AC26990209 BETASON INJECTION 4MG/ML "LITA" (BETAMETHASONE) 15.40

AC26990229 BETASON INJECTION 4MG/ML "LITA" (BETAMETHASONE) 19.50

AC27003277 "SALINE INJECTION 0.9% (SODIUM CHLORIDE)""S.Y.""" 25.00

AC27011100 THRONE ENTERIC SUGAR COATED TABLETS 100MG "YUNG SHIN" 1.50

AC270111G0THRONE ENTERIC SUGAR COATED TABLETS 100MG "YUNG SHIN"(鋁

箔/膠箔)2.00

Page 113: 附件二 藥品給付品項暨支付標準表

AC27016209 "VITAMIN C INJECTION 100MG/ML ""TAI YU""" 15.00

AC27016221 "VITAMIN C INJECTION 100MG/ML ""TAI YU""" 15.00

AC27034100 DICLOFEN E.C. TABLETS 50MG (DICLOFENAC) "H.H." 1.50

AC27044100 ANTIBLEED CAPSULES 250MG "T.F." (TRANEXAMIC ACID) 1.50

AC27049212 HYCOBAMIN INJECTION 2.5MG "Y.Y." 15.00

AC27055100 CURRENT TABLETS "H.S." 2.01

AC27068100 SUZYME TABLETS 90MG "YU SHENG"(LYSOZYME) 1.50

AC27088100 DICLOPHEN TABLETS 25MG"D.T.S" 1.50

AC27090263 AMINOL-RF INJECTION "S.T." 113.00

AC27137255 "RINGER'S SOLUTION FOR INJECTION ""TAI YU""" 22.00

AC27137265 "RINGER'S SOLUTION FOR INJECTION ""TAI YU""" 22.00

AC27137277 "RINGER'S SOLUTION FOR INJECTION ""TAI YU""" 25.00

AC27163100 TRANEX CAPSULES 250MG (TRANEXAMIC ACID) 1.50

AC27164100"TON-PASS FILM COATED TABLETS 500MG (MEFENAMIC ACID)

""TAI YU"""1.50

AC27170209 CEFADIN INJECTION "STANDARD" (CEPHRADINE) 25.00

AC27170277 CEFADIN INJECTION (CEPHRADINE) "STANDARD" 25.00

AC27172100 QUINIDINE SULFATE TABLETS 200MG "U-LIANG" 3.93

AC27196100 KOCAT TABLETS 1.50

AC27210212 "SURSO INJECTION ""S.Y.""" 15.00

AC27221100 LEUCOMYCIN CAPSULES 250MG "CENTER" 2.25

AC27234100 TRIMETHOPRIM TABLETS 100MG "PATRON" 1.50

AC27244100 BUMETA TABLETS 1MG (BUMETANIDE) "H.H." 1.69

AC27246277 HARTMANN-SORBITOL INJECTION "S.T." 36.40

AC27254100 ANOPAIN TABLETS 30MG (NEFOPAM) "GENTLE" 2.73

AC27261100 NIPAM TABLETS 30MG (NEFOPAM) 2.73

AC27280212 HUSTEN INJECTION "Y.Y" 15.00

AC27307212 U-SODIN INJECTION 2.5MG/ML (VERAPAMIL) 136.00

AC27317100 ESUSIN S.C. TABLETS 20MG "M.T." 1.78

AC273171G0 ESUSIN S.C. TABLETS 20MG "M.T."(鋁箔/膠箔) 2.00

AC27325209LOFORAN FOR INJECTION 1GM (CEFOTAXIME SODIUM) "GENTLE"

113.00

AC27325212 LOFORAN FOR INJECTION 2GM "GENTLE"(CEFOTAXIME SODIUM) 387.00

AC27338100 CLOMIPHENE TABLET 50MG "YUNG SHIN" 3.87

AC27356221 HEMOCLOT INJECTIONS 10% (TRANEXAMIC ACID) 15.00

AC27361100 DITROPAN TABLETS 5MG (OXYBUTYNIN) 2.12

AC27407100 SILUMA CAPSULE "M.T." 1.50

AC274071G0 SILUMA CAPSULE "M.T."(鋁箔/膠箔) 2.00

AC27413100 CAPETAN TABLETS 30MG (CARBETAPENTANE) "WEIDAR" 1.50

AC27418100 PRO F.C.TABLETS 200MG 6.60

AC27434100 BETASONE TABLETS 0.6MG (BETAMETHASONE) "WEIDAR" 1.50

AC27435100 SADAMOL TABLETS 4MG (SALBUTAMOL) "WEIDAR" 1.50

AC27436100 LOPAM TABLETS 1MG "WEIDAR" 1.50

AC274361G0 LOPAM TABLETS 1MG "WEIDAR"(鋁箔/膠箔) 2.00

AC27437100 METHOCON TABLETS 30MG "WEIDAR" (DEXTROMETHORPHAN) 1.50

AC27438100 ISOBIDE TABLETS 10MG "WEIDAR" 1.50

AC274381G0 ISOBIDE TABLETS 10MG "WEIDAR"(鋁箔/膠箔) 2.00

AC27439100 NEDIPIN CAPSULES 10MG (NIFEDIPINE) "WEIDAR" 1.81

Page 114: 附件二 藥品給付品項暨支付標準表

AC274391G0 NEDIPIN CAPSULES 10MG "WEIDAR"(鋁箔/膠箔) 2.00

AC27440100 ETHAVIN TABLETS 100MG (ETHAVERINE) "WEIDAR" 2.79

AC27443100 PIRODENE CAPSULES 20MG "WEIDAR" (PIROXICAM) 1.50

AC27445100 SANDEL S.C. TABLETS 50MG "WEIDAR" (DIPYRIDAMOLE) 1.54

AC274451G0SANDEL S.C. TABLETS 50MG (DIPYRIDAMOLE) "WEIDAR"(鋁箔/膠

箔)2.00

AC27446100 BENOTON TABLETS 30MG "WEIDAR" (NEFOPAM) 2.73

AC27448100 SLOSAT TABLETS "WEIDAR" 2.27

AC27449100 LOPICOL F.C. TABLETS 250MG (PROBUCOL) "WEIDAR 3.33

AC27450100 PROLAX TABLETS 250MG "WEIDAR" (CHLORZOXAZONE) 1.50

AC27451100 SULORIL TABLETS 100MG "WEIDAR" (SULINDAC) 1.72

AC27452100 ATENOL TABLETS 50MG (ATENOLOL) "WEIDAR" 1.50

AC274521G0 ATENOL TABLETS 50MG (ATENOLOL) "WEIDAR"(鋁箔/膠箔) 2.00

AC27456238 ROLIKAN INJECTION (SODIUM BICARBONATE) 15.00

AC27456263 ROLIKAN INJECTION (SODIUM BICARBONATE) 0.00

AC27456265 ROLIKAN INJECTION 35.20

AC27457100 LIPOLAR CAPSULES 10MG (BROMOPRIDE) "S.T." 1.50

AC27459100 DEPROLAC TABLETS 2.87MG "WEIDAR" (BROMOCRIPTINE) 4.58

AC27476100 SCRAT TABLETS 500MG 1.50

AC27492100 KALIMINE-A S.C. TABLETS 50MG (UNION) 1.50

AC27499100 SILYME-V CAPSULES "Y.Y" 1.50

AC27504100 POULICAN CAPSULES 1.50

AC275041G0 POULICAN CAPSULES 2.00

AC27505100 TALCAN CAPSULES "S.T." 1.50

AC27508100 SIMALON CAPSULES 1.50

AC275081G0 SIMALON CAPSULES(鋁箔/膠箔) 2.00

AC27513100 U-CLOR CAPSULES 250MG (CEFACLOR) "U.L." 3.35

AC27519321 BETAGEN CREAM "SWISS" 12.80

AC27519329 BETAGEN CREAM "SWISS" 14.90

AC27519335 BETAGEN CREAM "SWISS" 19.60

AC27519338 BETAGEN CREAM "SWISS" 19.60

AC27528100 METHON TABLETS 30MG (DEXTROMETHORPHAN) "C.C.P." 1.50

AC27531100 PROMETIN S.C. TABLETS 5 (METOCLOPRAMIDE) 1.50

AC275311G0 PROMETIN S.C. TABLETS 5 (METOCLOPRAMIDE)(鋁箔/膠箔) 2.00

AC27557500STATIN VAGINAL TABLETS 100,000 UNITS "STANDARD"

(NYSTATIN)5.00

AC27558100 SELADIN TABLETS 250MG (NAPROXEN) "YUNG SHIN" 1.50

AC275581G0SELADIN TABLETS 250MG "YUNG SHIN" (NAPROXEN)(鋁箔/膠箔)

2.00

AC27568100 ZIMARON TABLETS 50MG (BENZBROMARONE) "S.T." 1.50

AC275681G0ZIMARON TABLETS 50MG (BENZBROMARONE) "S.T." (鋁箔/膠箔)

2.00

AC27577212 BUSIX INJECTION 0.25MG/ML (BUMETANIDE) "S.T." 15.00

AC27598100 FUCOU CAPSULES "H.S." 1.50

AC275981G0 FUCOU CAPSULES "H.S."(鋁箔/膠箔) 2.00

AC27638209 CLAVOX FOR INJECTION 1.0 GM (CEFOTAXIME) 0.00

AC27638277 CLAVOX FOR INJECTION 0.5 GM (CEFOTAXIME) 0.00

AC27646216 FUKAN INJECTION "Y.Y." 15.00

Page 115: 附件二 藥品給付品項暨支付標準表

AC276761G0 LOPID CAPSULES 300MG (GEMFIBROZIL)(鋁箔/膠箔) 2.00

AC27716209 NOVAMIN INJECTION 5MG/ML (PROCHLORPERAZINE) 15.30

AC27718209 RINDERON INJECTION 4MG/ML (BETAMETHASONE) 15.40

AC27737216 CITRUGEN INJECTION "STANDARD" 24.00

AC27775100 SINROX F.C TABLETS 40MG (VERAPAMIL) 1.53

AC277751G0 SINROX F.C TABLETS 40MG (VERAPAMIL)(鋁箔/膠箔) 2.00

AC27776100 GRISEN TABLETS 500MG (GRISEOFULVIN) "VPP" 2.66

AC27849100 LOWEN TABLETS 0.5MG (LORAZEPAM) "C.C.P." 1.50

AC278491G0 LOWEN TABLETS 0.5MG (LORAZEPAM) "C.C.P."(鋁箔/膠箔) 2.00

AC27850212 DUPIN INJECTION 5MG/ML (DIAZEPAM) "C.C.P." 15.00

AC27851255MEDAZOLE INJECTION FOR INTRAVENOUS INFUSION 0.5%

(METRONIDAZOLE)41.00

AC27864212 AMIKACIN INJECTION 250MG/ML "N.K." 40.80

AC27864229 AMIKACIN INJECTION 250MG/ML "N.K." 199.00

AC27887100 VERTIZINE TABLETS 5MG "Y.Y." 1.52

AC27926100 FU LI HORMONE CAPSULES "WELCAN" 0.00

AC27940100 BEESIX TABLETS 50MG (PYRIDOXINE HCL) "VPP" 1.50

AC27943100 VANCONIN TABLETS 5MG "VPP" 1.50

AC279431G0 VANCONIN TABLETS 5MG "VPP(鋁箔/膠箔) 2.00

AC27971100 MISPANTON CAPSULES 500MG "C.M."(MEFENAMIC ACID) 1.50

AC27973289 CEFURO INJECTION 750MG 25.00

AC28013100 CLOMID TABLETS 50MG "SHIONOGI"(CLOMIFENE) 3.87

AC28014100 PIPERA CAPSULES 200MG "WEIDAR" (PIPEMIDIC ACID) 2.06

AC28015100 TRIPRIM TABLETS 100MG (TRIMETHOPRIM) "WEIDAR" 1.50

AC28016100 TINIZOL TABLETS 500MG (TINIDAZOLE) "WEIDAR" 2.09

AC28017100 DICLOREN E.C. TABLETS 50MG (DICLOFENAC) "WEIDAR" 1.50

AC28032100 VETRIMIL S.C. TABLETS 40MG (VERAPAMIL) 1.53

AC28033100 SUCWAY TABLETS 500MG (SUCRALFATE) 1.50

AC28047212 SAVOX INJECTION 125MG/ML (AMIKACIN) 29.00

AC28047229 SAVOX INJECTION 125MG/ML (AMIKACIN) 86.00

AC28054100 FUYOU TABLETS 1.50

AC28055100 FUYOU TABLETS 500MG 2.66

AC28066100 HEBOVITA TABLETS 1.50

AC28078100 SULPIN F.C. TABLETS 200MG "S.T." (SULPIRIDE) 1.71

AC280781G0SULPIN F.C. TABLETS 200MG (SULPIRIDE) "S.T."(鋁箔/膠箔)

2.00

AC28079100 BUSIX TABLETS 1.0MG (BUMETANID) "S.T." 1.69

AC28099210 FUROXIME FOR INJECTION "S.T." (CEFUROXIME) 52.00

AC28099265 FUROXIME FOR INJECTION "S.T." (CEFUROXIME) 25.00

AC28099289 FUROXIME FOR INJECTION "S.T." (CEFUROXIME) 25.00

AC28130100 AN-SU TABLETS 500MG (MEFENAMIC ACID) 1.50

AC28131100 ALAT CAPSULES 5MG (NIFEDIPINE) "YUNG SHIN" 1.81

AC28136100 SELADIN TABLETS 500MG (NAPROXEN) "YUNG SHIN" 2.95

AC28140100 RIPIN CAPSULE 300MG 8.00

AC28160100 ANDIZA FILM COATED TABLETS 25MG (DIPHENIDOL) 1.50

AC281601G0ANDIZA FILM COATED TABLETS 25MG(DIPHENIDOL)(鋁箔/膠箔)

2.00

AC28168338 SILVADENE CREAM 1% (SILVER SULFADIAZINE) 32.30

Page 116: 附件二 藥品給付品項暨支付標準表

AC28168348 SILVADENE CREAM 1% (SILVER SULFADIAZINE) 43.70

AC28168371 SILVADENE CREAM 1% (SILVER SULFADIAZINE) 267.00

AC28171100 SOOTHER TABLETS 1MG (KETOTIFEN) 1.54

AC28210100 INFLAMNIL TABLETS 100MG (TRIMETHOPRIM) 1.50

AC282101G0INFLAMNIL TABLETS 100MG (TRIMETHOPRIM)(瓶裝/56粒/瓶)、

(鋁箔/膠箔)2.00

AC28218100 LOPELA CAPSULES 2MG (LOPERAMIDE) "WEIDAR" 1.50

AC28245100 GLIBIDE TABLETS 5MG "WEIDAR" (GLIBENCLAMIDE) 1.50

AC282451G0GLIBIDE TABLETS 5MG "WEIDAR" (GLIBENCLAMIDE)(鋁箔/膠

箔)2.00

AC28283100 SUFUNI CAPSULES 5MG (FLUNARIZINE) 1.52

AC282831G0 SUFUNI CAPSULES 5MG (FLUNARIZINE) (鋁箔/膠箔) 2.00

AC28284100 COCOBITA F.C. TABLETS 30MG "T.F." (CARBETAPENTANE) 1.50

AC28312100 SIAGIAN E.S.C. TABLETS "C.A." 100MG (BROMELAIN) 1.50

AC28321100 UPROFEN TABLETS 400MG (IBUPROFEN) 1.50

AC28332100 GAIN-TONIN TABLETS 10MG (DOMPERIDONE)"MEIDER" 1.50

AC28333100 LUCKYHEPA CAPSULES "YUNG SHIN" 1.50

AC283331G0 LUCKYHEPA CAPSULES (鋁箔/膠箔) 2.00

AC28341500GYNOMYCODERIN VAGINAL TABLETS 100MG (MICONAZOE NITRATE)

5.00

AC28350212 ACEMYCIN INJECTION 100MG/ML (AMIKACIN) "YUNG SHIN" 29.00

AC28379100 PIROXICAM CAPSULES 20MG "YUNG CHI" 1.50

AC28461100 DOMPE TABLETS 10MG "H.H." (DOMPERIDONE) 1.50

AC284611G0 DOMPE TABLETS 10MG "H.H." (DOMPERIDONE)(鋁箔/膠箔) 2.00

AC28462100 CRIP CAPSULES 2.5MG (BROMOCRIPTINE)"H.H." 4.58

AC28477212 ACEMYCIN INJECTION 250MG/ML (AMIKACIN) "YUNG SHIN" 40.80

AC28477229 ACEMYCIN INJECTION 250MG/ML (AMIKACIN) "YUNG SHIN" 199.00

AC28478209 "CHLORPHENIRAMINE INJECTION 5MG/ML ""TAI YU""" 15.00

AC28482100 VILIABES S.C. TABALETS "JOHNSON" 1.50

AC28518209 PLOTON INJECTION 15.00

AC28533100 NOOBICA CAPSULES 400MG "YU SHENG" (PIRACETAM) 1.50

AC285331G0NOOBICA CAPSULES 400MG "YU SHENG" (PIRACETAM)(鋁箔/膠箔)

2.00

AC28535277 POTACOL-R INJECTION 0.00

AC28538209 C.P.Z. INJECTION 1GM "STANDARD" (CEFOPERAZONE) 135.00

AC28542265 PANTOGEN INJECTION "SINTONG" 0.00

AC28542277 PANTOGEN INJECTION "SINTONG" 0.00

AC28560255 METRONIDAZOLE INJECTION 5MG/ML 41.00

AC28560263 METRONIDAZOLE INJECTION 5MG/ML 92.00

AC28562321 CLOBETASOL OINTMENT 0.5MG/GM "SINPHAR" 11.90

AC28562324 CLOBETASOL OINTMENT 0.5MG/GM "SINPHAR" 12.80

AC28562329 CLOBETASOL OINTMENT 0.5MG/GM "SINPHAR" 13.70

AC28562340 CLOBETASOL OINTMENT 0.5MG/GM "SINPHAR" 61.00

AC28581100 FLUNAZINE TABLETS 5MG (FLUNARIZINE) 1.52

AC285811G0 FLUNAZINE TABLETS 5MG(FLUNARIZINE)(鋁箔/膠箔) 2.00

AC28592100 PAROTIN S.C. TABLETS 75MG "Y.S." (DIPYRIDAMOLE) 1.58

AC285921G0 PAROTIN S.C. TABLETS 75MG "Y.S." (DIPYRIDAMOLE) 2.00

AC28605216 VETIN INJECTION 25MG/ML (DICLOFENAC) 15.00

Page 117: 附件二 藥品給付品項暨支付標準表

AC28606157 COMPOUND GLYCYRRHIZA MIXTURE "KINGDOM" 25.70

AC28606163 COMPOUND GLYCYRRHIZA MIXTURE "KINGDOM" 27.50

AC28607329 DERMOCURE CREAM 0.5MG/GM"WEIDAR" 13.70

AC28615500 ECOZOL VAGINAL TABLETS 150MG "WEIDAR" (ECONAZOLE) 9.70

AC28618100 SUTONLEN TABLETS 1.50

AC28619100 ANTIRHEUMATIC CAPSULES 200MG "T.F."(FLUFENAMIC ACID) 1.71

AC28623100 TOEEFON CAPSULES 500MG "T.F." 1.50

AC286231G0 TOEEFON CAPSULES 500MG "T.F." (鋁箔/膠箔) 2.00

AC28648100 KETIBRON CAPSULES 1MG (KETOTIFEN) "WEIDAR" 1.54

AC286481G0 KETIBRON CAPSULES 1MG (KETOTIFEN) "WEIDAR"(鋁箔/膠箔) 2.00

AC28650209 CETAX INJECTION "STANDARD" (CEFOTAXIME) 113.00

AC28650277 CETAX INJECTION "STANDARD" (CEFOTAXIME) 87.00

AC28779100 MEROLIN TABLETS 50MG (MEBHYDROLINE)"H.S." 1.50

AC287791G0MEROLIN TABLETS 50MG "H.S."(MEBHYDROLINE)"H.S."(鋁箔/膠

箔)2.00

AC28801100 HALDOLIN TABLETS 5MG "WEIDAR" (HALOPERIDOL) 1.75

AC28804500 MULTIDON SUPPOSITORY 25MG (DICLOFENAC) 0.00

AC28805500 MULTIDON SUPPOSITORY 12.5MG (DICLOFENAC) 5.00

AC28922100 FUNOW CAPSULES 400MG (PIRACETAM)"SPC" 1.50

AC28925321 ECONAZINE CREAM 10.50

AC28925329 ECONAZINE CREAM 18.80

AC28927100 LIPITIN TABLETS "T.F." (LOPERAMIDE) 1.50

AC28945100 AMINOPHYLLINE TABLETS 100MG "U.L." 1.50

AC289451G0 AMINOPHYLLINE TABLETS 100MG "U.L."(鋁箔/膠箔) 2.00

AC28958100 CHOLEXAMIN TABLETS 200MG (NICOMOL) 3.56

AC28965100 SUTA CAPSULES 300MG"C.M."(FENBUFEN) 2.08

AC29005421 MYROSONE OPHTHALMIC SOLUTION 20.30

AC29008100 DICLOFENAC SODIUM TABLETS 25MG "S.C." 1.50

AC290341G0METHYCOBAL CAPSULES 250UG "EISAI"(MECOBALAMIN)(鋁箔/膠

箔)2.00

AC29037100 RELAX CAPSULES "H.S." 3.21

AC29061209 HATERMAS INJECTION "N.K." 79.00

AC29061277 HATERMAS INJECTION "N.K." 36.40

AC29078209 SHINFOMYCIN INJECTION (CEFOPERAZONE) 0.00

AC29079100 ZIEFMYCIN CAPSULES 250MG (DICLOXACILLIN) 1.50

AC29085209 MEDASON FOR INJECTION 1076.00

AC29085245 MEDASON FOR INJECTION 39.30

AC29085258 MEDASON FOR INJECTION 108.00

AC29085265 MEDASON FOR INJECTION 172.00

AC29085277 MEDASON FOR INJECTION 188.00

AC29090100 TONFUL TABLETS 3.21

AC29106100 BEHYD RA TABLETS 2.67

AC29108209 BABYSALT INJECTION "N.K." 35.00

AC29108265 BABYSALT INJECTION "N.K." 22.00

AC29108266 BABYSALT INJECTION "N.K." 24.20

AC29108277 BABYSALT INJECTION "N.K." 25.00

AC29132100 ENSOQONE CAPSULES 50MG"T.F." (ESCIN) 2.89

AC29172100 CEPHANMYCIN CAPSULES 500MG(CEPHALEXIN) 1.78

Page 118: 附件二 藥品給付品項暨支付標準表

AC291721G0 CEPHANMYCIN CAPSULES 500MG(CEPHALEXIN) (鋁箔/膠箔) 2.00

AC29213500FUNGICIDON VAGINAL SUPPOSITORIES 150MG "T.F."

(ECONAZOLE)9.70

AC29227100 DEXADROL TABLETS (DEXAMETHASONE)"T.F." 1.50

AC29231277ANOPIRIN INJECTION 500MG "GENTLE" (ACETYLSALICYLIC ACID)

15.00

AC29244421 TROPICAMIDE OPHTHALMIC SOLUTION 0.5% "WU FU" 16.50

AC29251100 SERENIN TABLETS 10MG "S.T." (OXAZOLAM) 1.52

AC29252100 "LIDONIN E.C. TABLETS 50MG (DICLOFENAC)""TAI YU""" 1.50

AC29276277 AMINOPOLY-H INJECTION 143.00

AC29279321 BESTASOL CREAM (CLOBETASOL) 11.90

AC29279324 BESTASOL CREAM (CLOBETASOL) 12.80

AC29279329 BESTASOL CREAM (CLOBETASOL) 13.70

AC29279340 BESTASOL CREAM (CLOBETASOL) 61.00

AC29301100 CANCLIOL TABLETS 100MG (METOPROLOL) 3.06

AC29313100 BETAPRESS TABLETS 100MG "S.D." (METOPROLOL) 3.06

AC29320100 AMIZIDE TABLETS "STANDARD" 1.88

AC293201G0 AMIZIDE TABLETS "STANDARD"(鋁箔/膠箔) 2.00

AC29327100 WEISDIN F.C. TABLETS 400MG "WEIDAR" (CIMETIDINE) 1.50

AC293271G0WEISDIN F.C. TABLETS 400MG "WEIDAR" (CIMETIDINE) (鋁箔/

膠箔)2.00

AC29330277 NAKO NO.4 INJECTION "N.K." 29.50

AC29331277 NAKO NO.2 INJECTION "N.K." 29.50

AC29332277 NAKO NO.3 INJECTION "N.K." 29.50

AC29333265 NAKO NO.1 INJECTION "N.K."(塑膠軟袋) 26.30

AC29333277 NAKO NO.1 INJECTION "N.K." 29.50

AC29334277 NAKO NO.5 INJECTION "N.K." 29.50

AC29337100 DICLAZIDE TABLETS 80MG "WEIDAR" (GLICLAZIDE) 1.50

AC293371G0DICLAZIDE TABLETS 80MG "WEIDAR" (GLICLAZIDE)(鋁箔/膠箔)

2.00

AC29343429NEOSTIGMINE METHYLSULFATE OPHTHALMIC SOLUTION (O.N.S.D.)

0.01%12.80

AC29345100 FLAGYL ORAL TABLETS 250MG (METRONIDAZOLE) 1.52

AC293451G0 FLAGYL ORAL TABLETS 250MG (METRONIDAZOLE)(鋁箔/膠箔) 2.00

AC29349100 CIWETIN TABLETS 400 MG 1.50

AC293491G0 CIWETIN TABLETS 400 MG (鋁箔/膠箔) 2.00

AC29352100 SUTENTEN TABLETS "CHEN TA" 1.50

AC293521G0 SUTENTEN TABLETS "CHEN TA"(鋁箔/膠箔) 2.00

AC29353209 LOFALIN INJECTION 1000MG "GENTLE" (CEFOZOLIN SODIUM) 25.00

AC29354321 CLOBESOL CREAM 0.5MG "GENTLE" (CLOBETASOL PROPIONATE) 11.90

AC29355100 STACAINE TABLETS "STANDARD" 1.52

AC293551G0 STACAINE TABLETS "STANDARD"(鋁箔/膠箔) 2.00

AC293561G0MERISLON TABLETS 12MG (BETAHISTINE MESYLATE)(鋁箔/膠箔)

2.00

AC29371100 THIAMCOL CAPSULES 250MG "UNION" (THIAMPHENICOL) 1.51

AC29374100 DIEN E.C. TABLETS 50MG "S.T." (DICLOFENAC) 1.50

AC29375100 CAMAPINE TABLETS 200MG "P.L." (CARBAMAZEPINE) 2.18

AC29378100 SUMOFEN E.C. TABLETS 50MG (DICLOFENAC) 1.50

Page 119: 附件二 藥品給付品項暨支付標準表

AC29417263 TALAMIN-E INJECTION "CHI SHENG" 0.00

AC29418100 PIECHAN TABLETS "T.F." 1.50

AC29436100SINDIPINE MICROENCAPSULATED CAPSULE 10MG (NIFEDIPINE)

"Y.S."1.81

AC294361G0SINDIPINE MICROENCAPSULATED CAPSULE 10MG

"Y.S."(NIFEDIPINE)(鋁箔/膠箔)2.00

AC29439321 LTOFLA OINTMENT 34.10

AC29439329 LTOFLA OINTMENT 44.10

AC29439335 LTOFLA OINTMENT 54.00

AC29439338 LTOFLA OINTMENT 109.00

AC29439355 LTOFLA OINTMENT 477.00

AC29440100 FUNAZINE TABLETS 10MG "WEIDAR" (FLUNARIZINE) 2.66

AC29442100 AMANDIN CAPSULES 100MG "YU SHENG" (AMANTADIN) 3.77

AC29455266 PAREN-AID NO. 1 INJECTION "OTSUKA" 62.00

AC29457271 PAREN-AID NO. 2 INJECTION "OTSUKA" 67.00

AC29457283 PAREN-AID NO. 2 INJECTION "OTSUKA" 0.00

AC29458271 PAREN-AID NO.3 INJECTION "OTSUKA" 67.00

AC29458283 PAREN-AID NO.3 INJECTION "OTSUKA" 0.00

AC29465100 METISONE TABLETS 2MG "S.T." (METHYLPREDNISOLONE) 1.53

AC29475265 FRUCEOL INJECTION "CHI SHENG" 0.00

AC29476100 LUTIN R CAPSULES 10MG (OXAZOLAM) 1.52

AC294761G0 LUTIN R CAPSULES 10MG (OXAZOLAM)(鋁箔/膠箔) 2.00

AC29496209 PU-I NO.2 INJECTION "CHI SHENG" 0.00

AC29496265 PU-I NO.2 INJECTION "CHI SHENG" 0.00

AC29496277 PU-I NO.2 INJECTION "CHI SHENG" 25.00

AC29499100 TERSULTRAN TABLETS 2.5MG (TERBUTALINE) "LITA" 1.50

AC29503100 BROPAN TABLETS 3MG "GENTLE" (BROMAZEPAM) 1.53

AC295031G0 BROPAN TABLETS 3MG "GENTLE" (BROMAZEPAM)(鋁箔/膠箔) 2.00

AC29504209 LOFADINE INJECTION 1000MG "GENTLE" (CEPHRADINE) 25.00

AC29510100 BACCIDAL F.C. TABLETS (NORFLOXACIN) 1.96

AC29513100 ANTIGLUCON TABLETS 5MG "T.F." (GLIBENCLAMIDE) 1.50

AC295131G0ANTIGLUCON TABLETS 5MG"T.F."(GLIBENCLAMIDE) (鋁箔/膠箔)

2.00

AC29515100 SUCRA TABLETS 500 MG "H.S." (SUCRALFATE) 1.50

AC29517277 "ELECTROSE INJECTION ""TAI YU""" 25.00

AC29521100 C.M.T. TABLETS 400MG (CIMETIDINE) 1.50

AC29544100 "FLUFENAMIC ACID CAPSULES ""M.T.""" 1.71

AC29545100 "METOCO TABLETS(METOCLOPRAMIDE)""M.T.""" 1.50

AC29546100 "METHYLTESTOSTERONE CAPSULES 10MG ""M.T.""" 1.93

AC29549100"SUGENT CAPSULES 10MG (CHLORDIAZEPOXIDE HYDROCHLORIDE

)""M.T."""1.50

AC295491G0"SUGENT CAPSULES 10MG (CHLORDIAZEPOXIDE HYDROCHLORIDE

)""M.T.""(鋁箔/膠箔)"2.00

AC29558500 SHOREN SUPPOSITORIES 12.5MG "T.F." (DICLOFENAC) 5.00

AC29559500 SHOREN SUPPOSITORIES 25MG "T.F." (DICLOFENAC) 5.00

AC29562100 OXY TABLETS 100MG "S.T." (OXOLAMINE CITRATE) 1.50

AC29572100 SUZIN CAPSULES 5MG (FLUNARIZINE) "STANDARD" 1.52

AC295721G0 SUZIN CAPSULES 5MG "STANDARD"(FLUNARIZINE)(鋁箔/膠箔) 2.00

Page 120: 附件二 藥品給付品項暨支付標準表

AC29574329 SONGI OINTMENT "STANDARD" 19.50

AC29575100 SUZIN CAPSULES 10MG (FLUNARIZINE) "STANDARD" 2.66

AC29576100 SERELAM CAPSULES 10MG "WEIDAR" (OXAZOLAM) 1.52

AC29594100 ZECO TABLETS 100MG "YU SHENG" (OXOLAMIN CITRATE) 1.50

AC29599100 U-SAVE CAPSULES 250MG (CEPHRADINE) 1.72

AC29601100 PREDNISOLONE TABLETS 5MG 1.50

AC296011G0 PREDNISOLONE TABLETS 5MG(鋁箔/膠箔) 2.00

AC29608500 SUMOFEN SUPPOSITORY 12.5MG (DICLOFENAC) 5.00

AC29609500 SUMOFEN SUPPOSITORY 25MG (DICLOFENAC) 5.00

AC29611100 "MEFENAMIC ACID CAPSULES ""M.T.""" 1.50

AC29613100 MEBENDAZOLE TABLETS 100MG "S.T." 1.50

AC296131G0 MEBENDAZOLE TABLETS 100MG "S.T."(鋁箔/膠箔) 2.00

AC29617100 UROXATE TABLETS 200MG (FLAVOXATE)"WEIDAR" 3.74

AC29627100 TINIDAZOLE FILM COATED TABLETS "YUNG SHIN" 2.09

AC296301G0METHYCOBAL CAPSULES 500UG "EISAI"(MECOBALAMIN) (鋁箔/膠

箔)2.00

AC29635100 CINNARIZINE TABLETS "YUNG SHIN" 1.50

AC296351G0 CINNARIZINE TABLETS "YUNG SHIN"(鋁箔/膠箔) 2.00

AC29702100 AMANDINE TABLETS 100MG "H.H." (AMANTADINE) 3.77

AC29724209 FOSMYCIN INJECTION 120.00

AC29724212 FOSMYCIN INJECTION 187.00

AC29724219 FOSMYCIN INJECTION 305.00

AC29726500 CHLOTIN VAGINAL SUPPOSITORIES "YUNG SHIN" 5.00

AC29729100 SUCRAL TABLETS 500MG "VPP" (SUCRALFATE) 1.50

AC297291G0 SUCRAL TABLETS 500MG "VPP" (鋁箔/膠箔) 2.00

AC29735100 TIATENOL TABLETS 100MG "T.F." 1.51

AC297351G0 TIATENOL TABLETS 100MG "T.F." (ATENOLOL) (鋁箔/膠箔) 2.00

AC29736100 ULSAWE TABLETS 500MG "T.F."(SUCRALFATE) 1.50

AC29738209 SUNTOSE INJECTION 0.45% "N.K." 35.00

AC29738277 SUNTOSE INJECTION 0.45% "N.K." 25.00

AC29739329 TOPSYM LOTION (FLUOCINONIDE) 67.00

AC29739338 TOPSYM LOTION (FLUOCINONIDE) 149.00

AC29742277 BIOLYTE NO.4 INJECTION "CHI SHENG" 29.50

AC29743277 BIOLYTE NO.3 INJECTION "CHI SHENG" 0.00

AC29744277 BIOLYTE NO.2 INJECTION "CHI SHENG" 29.50

AC29746209 EUJUM INJECTION 5MG/ML (PROSTAGLANDIN F2) 201.00

AC29747100 FOCUS CAPSULES 10MG (PIROXICAM) 1.50

AC297471G0 FOCUS CAPSULES 10MG (PIROXICAM)(鋁箔/膠箔) 2.00

AC29748100 CINCA S.C. TABLETS 50MG "Y.S." (NICAMETATE) 1.50

AC297481G0CINCA S.C. TABLETS 50MG "Y.S." (NICAMETATE)(鋁箔/膠箔)

2.00

AC29752100 ALLERGEN TABLETS 50MG "S.T." (MEBHYDROLIN) 1.50

AC29753100 STONE TABLETS 500MG "S.T." (MEFENAMIC ACID) 1.50

AC29754100 MUSOLIN TABLETS "S.D." 1.58

AC29755500 EKONA VAGINAL SUP. (ECONAZOLE) 9.70

AC29759100 MAIYITONG CAPSULES 0.5MG (METHYLCOBALAMIN)"C.M." 1.55

AC29760421 "GARABETA EYE DROPS ""WINSTON""" 20.00

AC29784100 ERGOMETRINE TABLETS 0.2MG "YUNG SHIN" 1.50

Page 121: 附件二 藥品給付品項暨支付標準表

AC297841G0 ERGOMETRINE TABLETS 0.2MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC29789321 EXELDERM CREAM (SULCONAZOLE) 31.80

AC29789329 EXELDERM CREAM (SULCONAZOLE) 52.00

AC29789338 EXELDERM CREAM (SULCONAZOLE) 107.00

AC29790329 EXELDERM SOLUTION (SULCONAZOLE) 60.00

AC29791212 PITAMYCIN INJECTION 2GM (PIPERACILLIN SODIUM) 33.90

AC29791219 PITAMYCIN INJECTION 4GM (PIPERACILLIN SODIUM) 0.00

AC29793100 MULER TABLETS 200MG (FENBUFEN) "GENTLE" 1.50

AC29794100 SENTA TABLETS 250MG (DIFLUNISAL)"GENTLE" 6.80

AC29796100 ENZIL FILM COATED TABLETS 100MG (AMANTADINE) 3.77

AC29797100 CIWEI TABLETS 200MG "H.H." (CIMETIDINE) 1.50

AC297971G0 CIWEI TABLETS 200MG "H.H." (CIMETIDINE)(鋁箔/膠箔) 2.00

AC29798100 CIWEI TABLETS 400MG "H.H." (CIMETIDINE) 1.50

AC297981G0 CIWEI TABLETS 400MG "H.H."(CIMETIDINE)(鋁箔/膠箔) 2.00

AC29804100 SHPYNJA TABLETS "C.M." 4.13

AC29805100 DEURON TABLETS 50MG "YU SHENG" (BENZBROMARONE) 1.50

AC298051G0DEURON TABLETS 50MG "YU SHENG" (BENZBROMARONE)(鋁箔/

膠箔)2.00

AC29810100 TRILONE TABLETS 4MG "H.H." (TRIAMCINOLONE) 1.50

AC298101G0 TRILONE TABLETS 4MG "H.H." (TRIAMCINOLONE)(鋁箔/膠箔) 2.00

AC29811100 KALIPION CAPSULES 250MG "YUNG SHIN" (CLOFIBRATE) 1.50

AC29812100 SCOTON TABLETS 400MG (IBUPROFEN) 1.50

AC29823100 AMANTEC CAPSULES 100MG (AMANTADINE) 3.77

AC29833100 KAICIDE TABLETS 600MG (PRAZIQUANTEL) 118.00

AC29834209 SUNTOSE INJECTION 5% "N.K." 35.00

AC29834265 SUNTOSE INJECTION 5% "N.K." 22.00

AC29834277 SUNTOSE INJECTION 5% "N.K." 25.00

AC29835209 GITOSE INJECTION 5% "N.K." 35.00

AC29835238 GITOSE INJECTION 5% "N.K." 15.00

AC29835255 GITOSE INJECTION 5% "N.K." 22.00

AC29835265 GITOSE INJECTION 5% "N.K." 22.00

AC29835277 GITOSE INJECTION 5% "N.K." 25.00

AC29837209 HAFORMAN INJECTION "N.K." 35.00

AC29837255 HAFORMAN INJECTION "N.K." 0.00

AC29837265 HAFORMAN INJECTION "N.K." 0.00

AC29837277 HAFORMAN INJECTION "N.K." 25.00

AC29838277 GITOSE INJECTION 10% "N.K." 25.00

AC29852329"SFUSONE CREAM 5MG/G (TRIAMCINOLONE ACETONIDE) ""H.S."""

52.00

AC29866100 "HIRANIN CAPSULES 350MG (CARISOPRODOL) ""HS""" 2.78

AC29875100 "HOW NAMIN CAPSULES ""HS""" 1.21

AC298751G0 "HOW NAMIN CAPSULES ""HS""(鋁箔/膠箔)" 1.53

AC29882100 SOCHIN FILM COATED TABLETS 60MG (PANTETHINE) 2.42

AC29885100 TOEEFON FILM COATED TABLETS 500MG "T.F." 1.50

AC29889209 CEDOL FOR INJECTION 500MG (CEFAMANDOLE NAFATE) 56.00

AC29889277 CEDOL FOR INJECTION 500MG (CEFAMANDOLE NAFATE) 0.00

AC29907151 "CODENIN SYRUP ""H.S.""" 0.00

AC29907157 "CODENIN SYRUP ""H.S.""" 23.00

Page 122: 附件二 藥品給付品項暨支付標準表

AC29931100 "CHANSIAN CAPSULES 5MG (PREDNISOLONE) ""HS""" 1.50

AC29933100 "TIBILIN S.C. TABLETS ""HS""" 1.50

AC29960265 SUNTOSE INJ. "N.K." 2.5% 22.00

AC29960277 SUNTOSE INJ. "N.K." 2.5% 25.00

AC29984209 HARINGER INJECTION "N.K." 35.00

AC29984238 HARINGER INJECTION "N.K." 15.00

AC29984255 HARINGER INJECTION "N.K." 0.00

AC29984265 HARINGER INJECTION "N.K." 22.00

AC29984277 HARINGER INJECTION "N.K." 25.00

AC30039209 CEDO INJECTION 1GM 56.00

AC30054212 ORPHENADRINE INJECTION "YUNG SHIN" 15.00

AC30058100 EROMYCIN F.C. TABLET 250MG "SHITEH" 1.77

AC30120100CINTSU SUGAR COATED TABLETS 40MG (VERAPAMIL)"YUNG SHIN"

1.53

AC301201G0CINTSU SUGAR COATED TABLETS 40MG "YUNG SHIN"(VERAPAMIL)

(鋁箔/膠箔)2.00

AC30257100 AMANDA F.C. TABLETS 100MG "WEIDAR" (AMANTADINE) 3.77

AC30268212 DEFENSE INJECTION 150MG/ML (CIMETIDINE) 15.00

AC30305100 LITANGEN TABLETS 250MG (CHLORPROPAMIDE)" M.T." 1.50

AC303051G0LITANGEN TABLETS 250MG (CHLORPROPAMIDE)" M.T."(鋁箔/膠

箔)2.00

AC30308100"SULUGEN S.C. TABLETS 100MG (PHENAZOPYRIDINE)""M.T."""

1.50

AC30309100 "NAUEAN TABLETS (CINNARIZINE)""M.T.""" 1.50

AC303091G0 "NAUEAN TABLETS (CINNARIZINE)""M.T.""(鋁箔/膠箔)" 2.00

AC30310100"THINTHIN CAPSULES 10MG (HYOSCINE-N-BUTYL

BROMIDE)""M.T."""1.50

AC30311100 "DEXAMETHASONE TABLETS ""M.T.""" 1.50

AC30312100 NITROFURANTOIN CAPSULES 100MG "M.T." 1.50

AC30319100 VEKAIN TABLETS (R) 1.50

AC30383135 HALDOMIN ORAL SOLUTION (HALOPERIDOL) 59.00

AC30383155 HALDOMIN ORAL SOLUTION (HALOPERIDOL) 122.00

AC30390212 AMIKACIN INJECTION 125MG/ML 29.00

AC303961G0 COLCHICINE TABLETS 0.5MG "SHIONOGI"(鋁箔/膠箔) 2.00

AC30415100 MINISON TABLETS 1MG (PRAZOSIN) 1.50

AC30417209 LYBRILE INJECTION (ACETYLSALICYLIC ACID) 15.00

AC30442212 KETOPROFEN IM INJECTION 25MG/ML "ASTAR" 15.00

AC30452100 CAPOMIL TABLETS 25MG (CAPTOPRIL)"WEIDAR" 1.50

AC304521G0 CAPOMIL TABLETS 25MG "WEIDAR" (CAPTOPRIL)(鋁箔/膠箔) 2.00

AC30465329 EPISONE SOLUTION (BETAMETHASONE) 31.80

AC30465338 EPISONE SOLUTION (BETAMETHASONE) 33.50

AC30465340 EPISONE SOLUTION (BETAMETHASONE) 33.50

AC30465345 EPISONE SOLUTION (BETAMETHASONE) 51.00

AC30466100 IBUPROFEN FILM COATED TABLETS 400MG "YUNG SHIN" 1.50

AC304661G0IBUPROFEN FILM COATED TABLETS 400MG "YUNG SHIN"(鋁箔/膠

箔)2.00

AC30467100 ASUMALIFE CAPSULES 1MG (KETOTIFEN) 1.54

AC304671G0 ASUMALIFE CAPSULES 1MG (KETOTIFEN) (鋁箔/膠箔) 2.00

Page 123: 附件二 藥品給付品項暨支付標準表

AC30507100 DIAZEPAM TABLETS 2MG "YUNG SHIN" 1.50

AC305071G0 DIAZEPAM TABLETS 2MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC30510100 DIAZEPAM TABLETS 5MG "YUNG SHIN" 1.50

AC30513100 MORESAFE TABLETS 5MG (ALLYLESTRENOL) 2.72

AC30521212 RASITOL INJECTION 10MG/ML (FUROSEMIDE) 15.00

AC30526100 "SPIRONOLACTONE TABLETS ""ROYAL""" 1.50

AC305261G0 "SPIRONOLACTONE TABLETS ""ROYAL""(鋁箔/膠箔)" 2.00

AC30532100 ASTIFEN TABLETS 1MG (KETOTIFEN) "VPP" 1.54

AC30535209 LEPHOCIN INJECTION 1GM (CEFOXITIN) 67.00

AC30538500 ECOVAL SUPPOSITORY 50MG (ECONAZOLE) "P.L." 9.20

AC30545100 INFLU CAPSULES 100MG (AMANTADINE) 3.77

AC30549100 ANTIFLAN E.S.C. TABLETS 100MG (BROMELAIN)"C.H." 1.50

AC30556100 YUNGBENRONE TABLET (BENZBROMARONE) "LITA" 1.50

AC30557100 DICLOFENAC E.S.C. TABLETS 50MG"F.Y." 1.50

AC30559277 LOFADINE INJECTION 500MG"GENTLE" (CEPHRADINE) 0.00

AC30560277 LOFORAN INJECTION 0.5G "GENTLE"(CEFOTAXIME SODIUM) 0.00

AC30581100 THIOPHENICOL F.C. TABLET 250MG "SHITEH" 1.51

AC30587100 TEGOL TABLETS 200MG "YU SHENG" (CARBAMAZEPINE) 2.18

AC30591500 VOTALIN SUPPOSITORY 50MG (DICLOFENAC) 6.60

AC30605100 MAMICON CAPSULES 1MG "PATRON" (KETOTIFEN) 1.54

AC30610100 INROLIN TABLETS 50MG (MEBBYDROLINE) "YU SHENG" 1.50

AC30611100 KATIFEN TABLETS 1MG (KETOTIFEN) "YU SHENG" 1.54

AC30614100 DOPERAN CAPSULES 400MG "Y.S." (PIPEMIDIC ACID) 3.54

AC30615100 ISOMIL S.C. TABLETS 40MG (VERAPAMIL) "Y.S." 1.53

AC306151G0ISOMIL S.C. TABLETS 40MG (VERAPAMIL) "Y.S."(鋁箔/膠箔)

2.00

AC30618100 BROMAZAEPAM TABLETS(BROMAZEPAM) 1.53

AC306181G0 BROMAZAEPAM TABLETS(BROMAZEPAM)(鋁箔/膠箔) 2.00

AC30619100 D.M.P. TABLETS (DOMPERIDONE) 1.50

AC306191G0 D.M.P. TABLETS (DOMPERIDONE)(鋁箔/膠箔) 2.00

AC30620289 CEFUROXIME INJECTION 750MG 25.00

AC30629100 NAKASSER TABLET 30MG (DILTIAZEM.HCL) "N.K." 1.50

AC306291G0 NAKASSER TABLET 30MG "N.K."(DILTIAZEM HCL)(鋁箔/膠箔) 2.00

AC30641100 YUNGKEN FILM COATED TABLETS 200MG (FLAVOXATE) 3.74

AC30642100 DEFENSE FILM COATED TABLET 400MG (CIMETIDINE) 1.50

AC306421G0DEFENSE FILM COATED TABLET 400MG (CIMETIDINE)(鋁箔/膠箔)

2.00

AC30648100 "SUTAN CAPSULES 500MG (MEFENAMIC ACID) ""H.S.""" 1.50

AC306481G0"SUTAN CAPSULES 500MG ""H.S.""(MEFENAMIC ACID)(鋁箔/膠

箔)"2.00

AC30649100 "DAWEISON TAB. 10MG (DOMPERIDONE) ""H.S.""" 1.50

AC306491G0"DAWEISON TAB. 10MG (DOMPERIDONE) ""H.S.""(鋁箔/膠箔)"

2.00

AC30693100 "KETOFEN TABLETS ""WELCAN"" (KETOTIFENE)" 1.54

AC30694100 DICOKAN TABLETS 30MG "T.F." (DEXTROMETHORPHAN) 1.50

AC30695100 CORTICORD TABLETS 4MG (TRIAMCINOLONE) "T.F." 1.50

AC30697100 LYSIX TABLETS 40MG "T.F." (FUROSEMIDE) 1.50

AC306971G0 LYSIX TABLETS 40MG "T.F." (FUROSEMIDE)(鋁箔/膠箔) 2.00

Page 124: 附件二 藥品給付品項暨支付標準表

AC30698100 GLICRON TABLETS 80MG (GLICLAZIDE) "YU SHENG" 1.50

AC306981G0GLICRON TABLETS 80MG "YU SHENG" (GLICLAZIDE)(鋁箔/膠箔)

2.00

AC30741100 WEITUL F.C. TABLETS 10MG "WEIDAR"(DOMPERIDONE) 1.50

AC30742100 APRESOLINE (R) S.C. TABLETS 25MG (HYDRALAZINE) 1.52

AC30743100 APRESOLINE (R) S.C. TABLETS 50MG (HYDRALAZINE) 1.52

AC30754321 HUPICON CREAM "Y.Y." 10.50

AC30754329 HUPICON CREAM "Y.Y." 18.80

AC30754335 HUPICON CREAM "Y.Y." 30.40

AC30763221 INFUVITA INJECTION 62.00

AC30766100 "CLOESTIN TABLETS 200MG (BEZAFIBRATE) ""H.S.""" 3.62

AC30767100 "KANYENING CAPSULES 300MG (FENBUFEN) ""H.S.""" 2.08

AC30791209 CETAXIMA INJECTION 0.5GM,1GM (CEFOTAXIME SODIUM) 113.00

AC30791277 CETAXIMA INJECTION 0.5GM (CEFOTAXIME SODIUM) 0.00

AC30800221 NICEWE INJ. 10MG/ML "N.K." (RANITIDINE HCL) 0.00

AC30803100 DITROPAN TABLETS 2.5MG (OXYBUTYNIN) 1.60

AC30837100 "ANRIGIN TABLETS 100MG (AMANTADINE HCL) ""H.S.""" 3.77

AC30838335 "KOTASON CREAM 0.5MG/G (CLOBETASOL) ""H.S.""" 24.80

AC30838338 KOTASON CREAM 0.5MG/G (CLOBETASOL) "H.S." 41.90

AC30838340 KOTASON CREAM 0.5MG/G (CLOBETASOL) "H.S." 61.00

AC30857421PHENYLEPHRINE HYDROCHLORIDE OPHTHALMIC SOLUTION 5%"WU

FU"29.90

AC30859421PHENYLEPRINE HYDROCHLORIDE OPHTHALMIC SOLUTION 10% "WU

FU"49.30

AC30865100 LINDAC TABLETS 200MG (SULINDAC) "S.C." 1.98

AC30879100 APRESOLIN S.C. TABLETS 10MG (HYDRALAZINE) 1.50

AC30888100 TAGAWEI TABLETS 400MG "Y.S."(CIMETIDINE) 1.50

AC308881G0TAGAWEI TABLETS 400MG "Y.S." (CIMETIDINE)(鋁箔/膠箔)

2.00

AC30889100 KOBAL CAPSULES 0.5MG "WEIDAR" (MECOBALAMIN) 1.55

AC308891G0KOBAL CAPSULES 0.5MG "WEIDAR" (MECOBALAMIN)(鋁箔/膠箔)

2.00

AC30890100 ULSATE TABLETS 500MG (SUCRALFATE) "WEIDAR" 1.50

AC308941G0TOFRANIL S.C. TABLETS 25MG (IMIPRAMINE HYDROCHLORIDE)(鋁

箔/膠箔)2.00

AC30896100 "EUMI TABLETS 100MG ""H.S."" (TRIMETHOPRIM)" 1.50

AC308961G0"EUMI TABLETS 100MG ""H.S."" (TRIMETHOPRIM)(鋁箔/膠箔)"

2.00

AC30916100 "KOTOGEN TABLETS 50MG ""H.S."" (BENZBROMARONE)" 1.50

AC309161G0KOTOGEN TABLETS 50MG "H.S." (BENZBROMARONE)(鋁箔/膠箔)

2.00

AC30936100 FOSELIN TABLETS 10MG (DOMPERIDONE) 1.50

AC30940100 YUNGFU CAPSULES 30MG (TIMEPIDIUM BROMIDE) 2.55

AC30964100 SHOREN ENTERIC FILM COATED TABLETS 25MG"T.F." 1.50

AC30967100 SHOREN ENTERIC FILM COATED TABLETS 50MG "T.F." 1.50

AC309701G0 MEZIDE TABLETS 80MG (GLICLAZIDE) "M.S." 2.00

AC30984100 INFAXIL CAPSULES 500MG (CEPHADROXIL) 2.13

AC30987100 "REBAMOL TABLETS 500MG (METHOCARBAMOL) "" WINSTON """ 1.50

Page 125: 附件二 藥品給付品項暨支付標準表

AC30989329 "RICH CREAM 20MG/G (KETOCONAZOLE) ""WINSTON""" 0.00

AC30989335 "RICH CREAM 20MG/G (KETOCONAZOLE) ""WINSTON""" 31.90

AC30994151 AMTADINE SYRUP 10MG/ML(AMANTADINE) 32.50

AC30994155 AMTADINE SYRUP 10MG/ML(AMANTADINE) 0.00

AC30996100 KETIMIN TABLETS 1MG (KETOTIFEN) 1.54

AC30997100 VENTON TAB. 50MG"LITA"(DICLOFENAC) 1.50

AC309971G0 VENTON TABLETS 50MG(DICLOFENAC) "LITA"(鋁箔/膠箔) 2.00

AC31000100 INFLAMNIL TABLET 300MG (TRIMETHOPRIM) 2.05

AC31002212 SERACIN INJECTION 140MG/ML (GENTAMYCIN) "SWISS" 16.50

AC31002229 SERACIN INJECTION 140MG/ML (GENTAMYCIN) "SWISS" 75.00

AC31003151 COUGH MIXTURE A SOLUTION "CHI SHENG" 25.00

AC31003159 COUGH MIXTURE A SOLUTION "CHI SHENG" 25.00

AC31004151 COUGH MIXTURE B SYRUP 25.00

AC31004159 COUGH MIXTURE B SYRUP 25.80

AC31006100 TREPIN CAPSULES 250MG (TRANEXAMIC ACID) "Y.Y" 1.50

AC31008421 "ZENICORTINE OPHTHALMIC SUSPENSION ""WINSTON""" 38.80

AC31020100 UNIDAC F.C. TABLETS 200MG (SULINDAC)"UNION" 1.98

AC31036155 EA TEN ORAL SOLUTION (TRIHEXYPHENIDYL) 197.00

AC31049157 "COUGEL SYRUP ""H.S.""" 0.00

AC31050100 VIRACON TABLETS 100MG "Y.Y." (AMANTADINE) 3.77

AC31053100 HEADGEN TABLETS (DIHYDROERGOTOXINE MESYLATE) 1.50

AC310531G0HEADGEN TABLETS (DIHYDROERGOTOXINE MESYLATE) (鋁箔/膠箔)

2.00

AC31054100 ARRING TABLETS 0.25MG (TRIAZOLAM) 1.88

AC310541G0 ARRING TABLETS 0.25MG (TRIAZOLAM) (鋁箔/膠箔) 2.00

AC31058100 FLUFEN S.C. TABLETS 50MG (FLURBIPROFEN) "WEIDAR" 1.50

AC310581G0FLUFEN S.C. TABLETS 50MG "WEIDAR" (FLURBIPROFEN)(鋁箔/膠

箔)2.00

AC31072100 UNIFRADINE CAPSULES 250MG (CEPHRADINE) "UNION" 1.72

AC310721G0 UNIFRADINE CAPSULES 250 MG (CEPHRADINE)(鋁箔/膠箔) 2.00

AC31073100 UNIFRADINE CAPSULES 500MG (CEPHRADINE) "UNION" 2.72

AC31095100 Kidolex Capsules 500mg (Cephalexin) 1.78

AC31101100 "LOLIAN CAPSULES 150MG ""H.S."" (SILYBIN)" 1.34

AC311011G0 "LOLIAN CAPSULES 150MG ""H.S."" (SILYBIN)(鋁箔/膠箔)" 1.43

AC31105209 AMPICILLIN SODIUM INJECTION 1G 25.00

AC31113121 U-CITRA GRANULES 6.90

AC31119100 AMANTADINE SULFATE CAPSULES 100MG "HCT" 3.77

AC31154212 HYCOMB INJECTION 10MG (HYDROXOCOBALAMIN) 15.40

AC31165100 ATADIN CAP. 100MG "STANDARD" (AMANTADINE) 3.77

AC31168100 ISORMOL TABLET 20MG (ISOSORBIDE) "TAIWAN TUNG YANG" 1.54

AC311681G0ISORMOL TABLET 20MG (ISOSORBIDE) "TAIWAN TUNG YANG"(鋁箔

/膠箔)2.00

AC31171100 CLINDAMYCIN CAPSULES 150MG "KINGDOM" 1.50

AC31185100 DIFLUINE F.C. TABLETS 250MG "CHINTENG" (DIFLUNISAL) 6.80

AC31186100 DEANGER TABLETS 10MG "S.C."(TRIFLUOPERAZINE) 2.34

AC31189100 TRIMCORT TABLETS 100MG (TRIMETHOPRIM) "YUNG SHIN" 1.50

AC31190100 LICHEIN CAPSULES 0.5MG (MECOBALAMIN) "CHINTENG" 1.55

Page 126: 附件二 藥品給付品項暨支付標準表

AC311901G0LICHEIN CAPSULES 0.5MG (MECOBALAMIN) "CHINTENG")(鋁箔/膠

箔)2.00

AC31193151 SUNSO SYRUP 25.00

AC31193157 SUNSO SYRUP 25.80

AC31194100 RANIDINE F.C.TAB. "S.T." (RANITIDINE) 0.00

AC311941G0 RANIDINE F.C.TAB. (RANITIDINE) "S.T."(鋁箔/膠箔) 0.00

AC31213209 LOFATIN INJECTION 1000MG "GENTLE"(CEFOXITIN) 67.00

AC31213212 LOFATIN INJECTION 1000MG (CEFOXITIN) "GENTLE" 143.00

AC31213277 LOFATIN INJECTION 1000MG (CEFOXITIN) "GENTLE" 49.80

AC31219100 BISTOR CAPSULE (DOXYCYCLINE) "SHITEH" 1.50

AC31223100 ATENO F.C. TABLETS 100MG (ATENOLOL) "CHINTENG" 1.51

AC312231G0ATENO F.C. TABLETS 100MG (ATENOLOL) "CHINTENG"(鋁箔/膠

箔)2.00

AC31225100 ACERINE S.C. TABLETS 5MG (NICERGOLINE) "WEIDAR" 2.56

AC31226100 LATOL F.C.TABLET 200MG "STANDARD" 2.82

AC31228100 EFOSIN S.C. TABLETS 50MG "KOJAR" (DIPYRIDAMOLE) 1.54

AC312281G0 EFOSIN S.C. TABLETS 50MG (DIPYRIDAMOLE) "KOJAR" 2.00

AC31259100 UNITADIN CAPSULES 100MG (AMANTADINE) "UNION" 0.00

AC31260100HODRIN TABLETS 1.5MG "WEIDAR" (DIHYDROERGOTOXINE

MESYLATE)1.50

AC312601G0HODRIN TABLETS 1.5MG "WEIDAR" (DIHYDROERGOTOXINE

MESYLATE)2.00

AC31280100 DANOL CAPSULES 200MG 9.80

AC31282100 MARION TABLETS 10MG "LITA" 4.38

AC31283100 MARION TABLETS 5MG"LITA" 2.56

AC31284100 CHAZE TABLETS 200MG "CHINTENG" (BEZAFIBRATE) 3.62

AC31292100 SANWELL F.C. TABLETS 200MG (CIMETIDINE) "KOJAR" 1.50

AC312921G0SANWELL F.C. TABLETS 200MG "KOJAR" (CIMETIDINE) 鋁箔/膠

箔2.00

AC31300100FORMAX ENTERIC-MICRO-ENCAPSULED CAPSULE 50MG "SHITEN"

(DICLOFENAC)1.50

AC31302319MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE)

"WINSTON"10.00

AC31302321MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE)

"WINSTON"11.90

AC31302323MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE)

"WINSTON"12.80

AC31302324MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE)

"WINSTON"12.80

AC31302329MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE)

"WINSTON"13.70

AC31302335MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE)

"WINSTON"24.80

AC31302338MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE)

"WINSTON"41.90

AC31302340MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE)

"WINSTON"61.00

Page 127: 附件二 藥品給付品項暨支付標準表

AC31303319"MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""0.00

AC31303321"MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""11.90

AC31303324"MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""12.80

AC31303329"MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""13.70

AC31303335"MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""24.80

AC31303338"MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""41.90

AC31303340"MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""61.00

AC31303355"MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""195.00

AC31307100 "DECOLD CAPSULES 100MG (AMANTADINE) wR.T.""" 3.77

AC31308100 "TICOQUER TABLETS 100MG (MEBENDANOLE) ""R.T.""" 1.50

AC313081G0TICOQUER TABLETS 100MG (MEBENDANOLE) "R.T."(鋁箔/膠箔)

2.00

AC31309100 IMIN TABLETS YUNG "SHIN"(METHISOPRINOL) 5.60

AC31317421 ACOLON ORABASE 1MG/G (DEXAMETHASONE) "MEIDER" 35.60

AC31317426 ACOLON ORABASE 1MG/G (DEXAMETHASONE) "MEIDER" 61.00

AC31321335 SLIKA A CREAM "MEIDER" 39.30

AC313213AH SLIKA A CREAM "MEIDER" 22.30

AC31349100 UNEW F.C. TABLETS 2.5MG "CHINTENG"(BROMOCRIPTINE) 4.58

AC31368212 CLINCIN INJ. "N.K." 150MG/ML (CLINDAMYCIN) 15.00

AC31446324 "CLOTASOL CREAM 0.5MG/GM (CLOBETASOL) ""R.T""" 12.80

AC31446329 "CLOTASOL CREAM 0.5MG/GM (CLOBETASOL) ""R.T""" 13.70

AC31446335 "CLOTASOL CREAM 0.5MG/GM""R.T"" (CLOBETASOL)" 24.80

AC31446338 "CLOTASOL CREAM 0.5MG/GM""R.T"" (CLOBETASOL)" 41.90

AC31446340 "CLOTASOL CREAM 0.5MG/GM""R.T"" (CLOBETASOL)" 61.00

AC31450100 HALOPIN TABLETS 5MG "JOHNSON" (HALOPERIDOL) 1.75

AC31451100 BENZHEXOL TABLETS 5MG "JOHNSON" (TRIHEXYPHENIDYL HCL) 1.50

AC314511G0BENZHEXOL TABLETS 5MG "JOHNSON" (TRIHEXYPHENIDYL HCL)(84

粒)2.00

AC31476100 ETUMINE TABLETS 40MG (CLOTIAPINE) 6.20

AC31481100 SILIRIN CAPSULES 150MG (SILYMARIR) "CHINTENG" 1.52

AC314811G0SILIRIN CAPSULES 150MG "CHINTENG" (SILYMARIR)(鋁箔/膠箔)

2.00

AC31482100 SEROMIN S.C. TABLETS 10MG (NICERGOLIN) "Y.S." 4.38

AC31489100 "ANKUMIN TABLETS 6MG (BETAHISTINE) ""R.T.""" 1.50

AC31493100 "CHIPHONE TABLETS 100MG (BENZBROMARONE) ""R.T.""" 2.05

AC31505100 HALIN TABLETS 5MG "YU SHENG" (HALOPERIDOL) 1.75

AC315051G0 HALIN TABLETS 5MG "YU SHENG" (HALOPERIDOL)(鋁箔/膠箔) 2.00

AC31507100 DUORIDONE TABLETS 10MG (DOMPERIDONE) "LITA" 1.50

AC315071G0DUORIDONE TABLETS 10MG (DOMPERIDONE) "LITA" (鋁箔/膠

箔)2.00

Page 128: 附件二 藥品給付品項暨支付標準表

AC31508209 "PIROCAN INJECTION 20MG (PIROXICAM) ""SIU GUAN""" 16.90

AC31508212 "PIROCAN INJECTION 20MG (PIROXICAM) ""SIU GUAN""" 16.90

AC31513100 ROPECON TABLETS 250MG (PIPEMIDIC ACID) "YUNG CHI" 3.54

AC31514100 ASMAC TABLETS 2.5MG (FENOTEROL HBR) "YUNG CHI" 1.50

AC31515100 "ELININ TABLETS 20MG (OXAZOLAM) ""R.T.""" 1.67

AC31521221 PENTAL INJECTION 20MG/ML "LITA" 51.00

AC31525100 "LILONTON CAPSULE 400MG (PIRACETAM) ""SIU GUAN""" 1.50

AC31526221 "LILONTON INJECTION 200MG (PIRACETAM) ""SIU GUAN""" 15.00

AC31526229 "LILONTON INJECTION 200MG (PIRACETAM) ""SIU GUAN""" 28.20

AC31534100 STABLE TABLETS 25 MG (HYDRALAZINE) 1.52

AC315341G0 STABLE TABLETS 25 MG (HYDRALAZINE) 2.00

AC31535100 ULSAFE F.C.TABLETS 150MG(RANITIDINE HYDROCHLORIDE) 0.00

AC315351G0ULSAFE F.C.TABLETS 150MG(RANITIDINE HYDROCHLORIDE)(鋁箔/

膠箔)0.00

AC31536100 PICOLIN F.C. TABLETS 250MG (PIPEMIDIC ACID) "KOJAR" 3.54

AC31537100 SINGEN F.C.TABLETS 40MG "KOJAR" (VERAPAMIL) 1.53

AC315371G0SINGEN F.C.TABLETS 40MG (VERAPAMIL) "KOJAR"(鋁箔/膠箔)

2.00

AC31540100 STABLE (HYDRALAZINE) TABLETS 10MG "VPP" 1.50

AC315401G0STABLE (HYDRALAZINE) TABLETS 10MG "VPP" (90粒/瓶裝及鋁箔

/膠箔)2.00

AC31544100 KODAZOL CAPSULES 200MG "KOJAR" (DANAZOL) 9.80

AC31592100 MEWELLIN F.C. TABLETS 10MG "KOJAR"(DOMPERIDONE) 1.50

AC315921G0MEWELLIN F.C. TABLETS 10MG (DOMPERIDONE) "KOJAR"(鋁箔/膠

箔)2.00

AC31593100 FURNAZM TABLETS 5MG "CHINTENG"(FLUNARIZINE) 1.52

AC315931G0FURNAZM TABLETS 5MG "CHINTENG"(FLUNARIZINE) (鋁箔/膠箔)

2.00

AC31609100 LIGISIN F.C. TABLETS 200MG "KOJAR" (BEZAFIBRATE) 3.62

AC31614423 STACORT DENTAL PASTE 1MG/G "STANDARD" (TRIAMCINOLONE) 36.70

AC31628277 AMINOLEBAN INJECTION 182.00

AC31630209 CETAME FOR INJECTION "SWISS" (CEFOTAXIME) 113.00

AC31630212 CETAME FOR INJECTION "SWISS" (CEFOTAXIME) 387.00

AC31630265 CETAME FOR INJECTION "SWISS" (CEFOTAXIME) 0.00

AC31630277 CETAME FOR INJECTION "SWISS" (CEFOTAXIME) 0.00

AC31641100 FEVILON TABLETS 200MG "LITA" (BEZAFIBRATE) 3.62

AC31651421 SCORO ORABASE 1MG/G (TRIAMCINOLONE) "MEIDER" 28.40

AC31651423 SCORO ORABASE 1MG/G (TRIAMCINOLONE) "MEIDER" 36.70

AC31651429 SCORO ORABASE 1MG/G (TRIAMCINOLONE) "MEIDER" 59.00

AC31656100 WEISU TABLETS 400MG (CIMETIDINE) "S.D." 1.50

AC316561G0 WEISU TABLETS 400MG (CIMETIDINE) "S.D."(鋁箔/膠箔) 2.00

AC31658100 FORKNOW TABLETS 10MG (FLUNARIZINE) "YUNG SHIN" 2.66

AC31659100 BUTIN TABLETS 2.5MG (BROMOCRIPTINE) 4.58

AC31660100 ANTISSVES CAPSULES "CHINTENG" 1.50

AC316601G0 ANTISSVES CAPSULES "CHINTENG"(鋁箔/膠箔) 2.00

AC31662100 AXOL TABLETS 30MG (AMBROXOL) "YUNG SHIN" 1.50

AC316621G0 AXOL TABLETS 30MG (AMBROXOL) "YUNG SHIN"(鋁箔/膠箔) 2.00

AC31666100 CATIN TABLETS 100MG "KOJAR" (TRIMETHOPRIM) 1.50

Page 129: 附件二 藥品給付品項暨支付標準表

AC316661G0 CATIN TABLETS 100MG (TRIMETHOPRIM) "KOJAR"(鋁箔/膠箔) 2.00

AC31667100 NIFU CAPSULES 250MG "KOJAR" (NIFLUMIC ACID) 2.36

AC31676100 COMPESOLON TABLETS 5MG "PINE LAWER" (PREDNISOLONE) 1.50

AC316761G0COMPESOLON TABLETS 5MG "PINE LAWER" (PREDNISOLONE) (鋁箔

/膠箔)2.00

AC31690100 FETISMA TABLETS 2.5MG "KOJAR" (FENOTEROL) 1.50

AC316901G0 FETISMA TABLETS 2.5MG (FENOTEROL) "KOJAR"(鋁箔/膠箔) 2.00

AC31694100 STOIN TABLETS 10MG (OXETHAZAINE) "KOJAR" 1.50

AC316941G0 STOIN TABLETS 10MG (OXETHAZAINE) "KOJAR"(鋁箔/膠箔) 2.00

AC31695209 BUFENCON INJECTION 16.90

AC31695221 BUFENCON INJECTION 19.50

AC31753100 B.M.O. TABLETS 1.50

AC31757157 B.M.O LIQUID 25.70

AC31770100 LIDONIN TABLETS 10MG (DOMPERIDONE) "S.D." 1.50

AC31778100 PROXEN TABLETS 375MG (NAPROXEN) "TAIWAN TANABE" 2.31

AC31796100 OXOLA TABLETS 100MG "KOJAR" (OXOLAMINE CITRATE) 1.50

AC317961G0OXOLA TABLETS 100MG "KOJAR" (OXOLAMINE CITRATE) (鋁箔/

膠箔)2.00

AC31801100 KETOSMA CAPSULES 1MG "KOJAR" (KETOTIFEN) 1.54

AC318011G0 KETOSMA CAPSULES 1MG "KOJAR" (KETOTIFEN)(鋁箔/膠箔) 2.00

AC31809100 CATON TAB "C.H." 3.60

AC31823100 BENZSIN TABLETS 50MG "KOJAR" (BENZBROMARONE) 1.50

AC318231G0BENZSIN TABLETS 50MG (BENZBROMARONE) "KOJAR" (鋁箔/膠箔)

2.00

AC31824100 CIMEWELL F.C. TABLETS 400MG "KOJAR" (CIMETIDINE) 1.50

AC318241G0CIMEWELL F.C. TABLETS 400MG "KOJAR" (CIMETIDINE) (鋁箔/

膠箔)2.00

AC31825100 BECASONE TABLETS 0.6MG "KOJAR" (BETAMETHASONE) 1.50

AC318251G0BECASONE TABLETS 0.6MG (BETAMETHASONE) "KOJAR"(鋁箔/膠

箔)2.00

AC31835289 CEFLOUR INJECTION 0.75GM "YUNG SHIN" (CEFUROXIME) 25.00

AC31853100 GENXATE F.C. TABLETS 200MG "Y.S." (GLAVOXATE) 3.74

AC31878209 DIMEN INJECTION 50MG/ML (DIMENHYDRINATE) "UNION" 15.00

AC31882209 U-SAVE-A FOR INJECTION (CEPHRADINE) 25.00

AC31882277 U-SAVE-A FOR INJECTION (CEPHRADINE) 0.00

AC318891G0HESOR TABLETS 30MG "YU SHENG" (DILTIAZEM

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC31894100 ASTHAN TABLETS 1MG (KETOTIFEN) "P.L" 1.54

AC318941G0 ASTHAN TABLETS 1MG (KETOTIFEN) "P.L"(鋁箔/膠箔) 2.00

AC31895100 MELLERZIN S.C. TABLETS 50MG (THIORIDAZINE) "P.L" 2.31

AC31906100 BARLOLIN CAPSULE 2.5MG "SWISS" (BROMOCRIPTINE) 4.58

AC31907100 "NEOBA CAPSULES 500MCG (METHYL COBALAMINE) ""S.Y.""" 1.55

AC31912100 AMBROXOL TABLETS 30MG "CHINTENG" 1.50

AC319121G0 AMBROXOL TABLETS 30MG "CHINTENG"(鋁箔/膠箔) 2.00

AC31952100 FUNASIN CAPSULES 5MG "KOJAR" (FLUNARIZINE) 1.52

AC319521G0 FUNASIN CAPSULES 5MG "KOJAR" (FLUNARIZINE)(鋁箔/膠箔) 2.00

AC31953100SULISOU CAPSULES 250MG "KOJAR" (CHENODEOXYCHOLIC ACID)

8.70

Page 130: 附件二 藥品給付品項暨支付標準表

AC31954100 BEZIN TABLETS 200MG (BEZAFIBRATE) "S.D." 3.62

AC31976500 STAZOL VAG. SUPP. 150MG "STANDARD" (ECONAZOLE) 9.70

AC31977100 FLUOXYMESTERONE CAPSULES 5MG "C.H." (FLUOXYMESTERONE) 2.39

AC31979100 ANTADINE TABLETS 100MG (AMANTADINE) "YUNG CHI" 3.77

AC31983238 "DITROSE INJECTION 5% (DEXTROSE) ""S.Y.""" 15.00

AC31988100 MOTURIN TALBETS 10MG "Y.S." (DOMPERIDONE) 1.50

AC31991100UTELAX TABLETS 10MG (RITODRINE HYDROCHLORIDE) "WEIDAR"

4.15

AC31993100 BESUTIN TABLETS 6MG "Y.S." (BETAHISTINE) 1.50

AC31999100MUCOBRON TABLETS 30MG "WEIDAR" (AMBROXOL HYDROCHLORIDE)

1.50

AC319991G0MUCOBRON TABLETS 30MG "WEIDAR" (AMBROXOL HYDROCHLORIDE)

(鋁箔/膠箔)2.00

AC32000100 PENTOSIN E.S.C.TABLETS 100MG "KOJAR" (PENTOXIFYLLINE) 1.50

AC320001G0PENTOSIN E.S.C.TABLETS 100MG "KOJAR"(PENTOXIFYLLINE)(鋁

箔/膠箔)2.00

AC32002100 MEBLIN TABLETS 50MG"KOJAR"(MEBHYDROLIN) 1.50

AC320021G0 MEBLIN TABLETS 50MG "KOJAR"(MEBHYDROLIN)(鋁箔/膠箔) 2.00

AC32003100 NAPOSIN TABLETS 250MG "KOJAR" (NAPROXEN) 1.50

AC320031G0 NAPOSIN TABLETS 250MG "KOJAR" (NAPROXEN)(鋁箔/膠箔) 2.00

AC32007100 ETOSCOL TABLETS 0.5MG (HEXOPRENALINE) 1.50

AC32014100 EUZIP TABLETS 50MG (NICAMETATE) 1.50

AC320141G0 EUZIP TABLETS 50MG (NICAMETATE)(鋁箔/膠箔) 2.00

AC32028100 VITAMIN B12 TALBETS 1MG "JOHNSON" 1.50

AC32029100 FLURAZIN F.C. TABLETS 5MG "JOHNSON" (TRIFLUOPERAZINE) 1.50

AC320291G0FLURAZIN F.C. TALBETS 5MG "JOHNSON" (TRIFLUOPERAZINE)(鋁

箔/膠箔)2.00

AC32046100 DIPYRIDAMOLE S.C. TABLETS 75MG "YUNG SHIN" 1.58

AC320461G0 DIPYRIDAMOLE S.C. TABLETS 75MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC32050429 ATROPINE SULPHATE OPHTHALMIC SOLUTION 1% "WU FU" 33.90

AC32051321 BETAMETHASONE OINTMENT 0.5MG/GM "SINPHAR" 13.00

AC32051329 BETAMETHASONE OINTMENT 0.5MG/GM "SINPHAR" 15.90

AC32053100 PENTAL S.C.TABLETS 100MG (PENTOXIFYLLINE) "JOHNSON" 1.50

AC320531G0PENTAL S.C.TABLETS 100MG (PENTOXIFYLLINE) "JOHNSON"(84

粒)2.00

AC320531GAPENTAL S.C.TABLETS 100MG "JOHNSON" (PENTOXIFYLLINE)(鋁箔

/膠箔)2.00

AC32054100 LICOS TABLETS 50MG (PIPERIDOLATE) "MEIDER" 2.02

AC32058421 ATROPINE SULPHATE OPHTHALMIC SOLUTION 0.5% "WU FU" 21.00

AC32058429 ATROPINE SULPHATE OPHTHALMIC SOLUTION 0.5% "WU FU" 33.90

AC32070317 EYME CREAM "CHINTENG" 10.40

AC32070321 EYME CREAM "CHINTENG" 10.40

AC32070329 EYME CREAM "CHINTENG" 18.80

AC32070330 EYME CREAM "CHINTENG" 24.10

AC32070335 EYME CREAM "CHINTENG" 30.40

AC32070338 EYME CREAM "CHINTENG" 32.60

AC32070355 EYME CREAM "CHINTENG" 135.00

AC32105321 FUCON CREAM "S.Y." 10.50

Page 131: 附件二 藥品給付品項暨支付標準表

AC32105329 "FUCON CREAM ""S.Y.""" 18.80

AC32105335 "FUCON CREAM ""S.Y.""" 30.40

AC321111G0 ACTIRIN TABLETS "SINPHAR"(鋁箔/膠箔) 2.00

AC32112100 COLIMAN S.C. TABLETS 100MG (CHLORPROMAZINE) "P.L." 1.50

AC32114100 BENZBROMARONE TABLETS 50MG "CHIN TENG" 1.50

AC321141G0 BONZBROMARONE TABLETS 50MG "CHIN TENG")(鋁箔/膠箔) 2.00

AC32117100 APOLIN TABLETS 25MG "T.S." (HYDRALAZINE) 1.52

AC321171G0 APOLIN TABLETS 25MG "Y.S."(HYDRALAZINE)(鋁箔/膠箔) 2.00

AC32118212 EUKACIN INJECTION 250MG/ML (AMIKACIN) "U-LIANG" 40.80

AC32118229 EUKACIN INJECTION 250MG/ML (AMIKACIN) "U-LIANG" 0.00

AC32122255SATA INJECTION FOR INTRAVENOUS INFUSION 5MG/ML "S.T."

(TINIDAZOLE)117.00

AC32135421 TIMOLOL OPHTHALMIC SOLUTION 0.5% "WU-FU" 122.00

AC32136421 TIMOLOL OPHTHALMIC SOLUTION 0.25% "WU-FU" 51.00

AC32137100 TIDACT CAPSULES 150MG (CLINDAMYCIN) 1.50

AC321371G0 TIDACT CAPSULES 150MG (CLINDAMYCIN)(鋁箔/膠箔) 2.00

AC32170335 ALLERCURE CREAM "SHITEH" 24.90

AC32171221 AGGLUTEX INJECTION 1000U./ML (HEPARIN SODIUM) 38.30

AC32171299 AGGLUTEX INJECTION 1000U. (HEPARIN SODIUM) 2.88

AC32172221 AGGLUTEX INJECTION 5000U/ML (HEPARIN SODIUM) 36.80

AC32172240 AGGLUTEX INJECTION 5000U./ML (HEPARIN SODIUM) 166.00

AC32172248 AGGLUTEX INJECTION 5000U./ML (HEPARIN SODIUM) 298.00

AC32172299 AGGLUTEX INJECTION 5000IU/ML(HEPARIN SODIUM) 2.88

AC32181329 C.P.P. CREAM 500MCG/G (CLOBETASOL) "SWISS" 13.70

AC32181335 C.P.P. CREAM 500MCG/G (CLOBETASOL) "SWISS" 24.80

AC32181338 C.P.P. CREAM 500MCG/G (CLOBETASOL) "SWISS" 41.90

AC32181340 C.P.P. CREAM 500MCG/G (CLOBETASOL) "SWISS" 61.00

AC32182100 DANAZOL CAPSULES 200MG "SWISS"(DANAZOL) 9.80

AC32217321 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 13.00

AC32217323 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 0.00

AC32217329 SHIN-SHIN CREAM"SWISS" 0.5MG (BETAMETHASONE) 15.90

AC32217330 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 0.00

AC32217335 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 0.00

AC32217343 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 31.90

AC322501G0SUPERTIDINE F.C. TABLETS 20MG "VPP" (FAMOTIDINE)(鋁箔/膠

箔)2.00

AC32251212 "AMIKACIN INJECTION 250MG/ML ""TAI YU""" 40.80

AC32251229 "AMIKACIN INJECTION 250MG/ML ""TAI YU""" 199.00

AC32263212 GENTAMYCIN INJECTION 40MG/ML "S.Y." (GENTAMYCIN) 15.00

AC32263229 "GENTAMYCIN INJECTION 40MG/ML (GENTAMYCIN)""S.Y.""" 16.50

AC32263238 "GENTAMYCIN INJECTION 40MG/ML ""S.Y."" (GENTAMYCIN)" 40.80

AC32264321"CLOBETA CREAM 500MCG ""S.Y."" (CLOBETASOL 17-

PROPIONATE)"11.90

AC32264324"Clobeta Cream 500mcg""S.Y.""(Clobetasol 17-Propionate)"

12.80

AC32264329"CLOBETA CREAM 500MCG ""S.Y."" (CLOBETASOL 17-

PROPIONATE)"13.70

Page 132: 附件二 藥品給付品項暨支付標準表

AC32264335"CLOBETA CREAM 500MCG ""S.Y."" (CLOBETASOL 17-

PROPIONATE)"24.80

AC32264338"CLOBETA CREAM 500MCG ""S.Y."" (CLOBETASOL 17-

PROPIONATE)"41.90

AC32264340CLOBETA CREAM 500MCG (CLOBETASOL 17-PROPIONATE) "S.Y."

61.00

AC32265100 FLUNEPAN TABLET 2MG "PANBIOTIC" (FLUNITRAZEPAM) 1.77

AC322651G0FLUNEPAN TABLET 2MG "PANBIOTIC"(FLUNITRAZEPAM)(鋁箔/膠

箔)2.00

AC32267500 CLOTRIMAZOLE VAG. TAB. (CLOTRIMAZOLE) "PANBIOTIC" 12.50

AC32268100 DOMPERIDONE 10MG (DOMPERIDONE) "Y.S" 1.50

AC322681G0DOMPERIDONE 10MG TABLETS "Y.S."(DOMPERIDONE)(鋁箔/膠箔)

2.00

AC32275100 CEPORIN TABLETS 25MG (CAPTOPRIL) "S.T." 1.50

AC322751G0 CEPORIN TABLETS 25MG (CAPTOPRIL) "S.T."(鋁箔/膠箔) 2.00

AC322771G0 PEESU TABLETS "KOJAR"(鋁箔/膠箔) 2.00

AC32282421 CHLORAMPHENICOL OPHTHALMIC SOLUTION 0.25% "SYNMOSA" 12.00

AC32282429 CHLORAMPHENICOL OPHTHALMIC SOLUTION 0.25% "SYNMOSA" 12.70

AC32283429 PILOCARPINE OPHTHALMIC SOLUTION 2% "SYNMOSA" 37.70

AC32283435 PILOCARPINE OPHTHALMIC SOLUTION 2% "SYNMOSA" 79.00

AC32284429 PILOCARPINE OPHTHALMIC SOLUTION 1% "Synmosa" 27.70

AC32284435 PILOCARPINE OPHTHALMIC SOLUTION 1% "Synmosa" 81.00

AC32286100 ANTIASTH SLOW RELEASE TABLETS 225MG (AMINOPHYLLINE) 2.83

AC32287100 SENIDOL TAB. 25MG (DIPHENIDOL) "PANBIOTIC" 1.50

AC32288321 "FUTUSOA CREAM ""S.Y.""" 12.80

AC32288329 "FUTUSOA CREAM ""S.Y.""" 14.90

AC32288338 "FUTUSOA CREAM ""S.Y.""" 19.60

AC32292100 PANCOBAMIN CAPSULE 500MCG (MECOBALAMIN) "PANBIOTIC" 1.55

AC322921G0PANCOBAMIN CAPSULE 500MCG (MECOBALAMIN) "PANBIOTIC"(鋁箔

/膠箔)2.00

AC32311100 DANALOL CAPSULE 200MG (DANAZOL) "PURZER" 9.80

AC32313100 REFEXIN CAPSULE 500MG (CEPHALEXIN) "PURZER" 1.78

AC323131G0 REFEXIN CAPSULE 500MG (CEPHALEXIN) "PURZER" 2.00

AC32314100 DUOCER F.C TABLET 400MG (CIMETIDINE) "PURZER" 1.50

AC323141G0 DUOCER F.C TABLET 400MG (CIMETIDINE) "PURZER" 2.00

AC32317209 SEZOLIN FOR INJECTION (CEFAZOLIN) "PURZER" 25.00

AC32324100 RECEF CAPSULE 500MG (CEPHRADINE) "PURZER" 2.72

AC32327100 LONINE CAPSULES 200MG (ETODOLAC) 3.25

AC32332100 TIARAM TABLETS 100MG "H.H." (TIARAMIDE) 1.50

AC32334209 RECEF-A FOR INJECTION 1000MG (CEPHRADINE) 25.00

AC32334277 RECEF-A FOR INJECTION 1000MG (CEPHRADINE) 25.00

AC32336100 HOMOMIN TABLETS 10MG "Y.Y" (HOMOCHLORCYCLIZINE) 1.50

AC323361G0HOMOMIN TABLETS 10MG "Y.Y" (HOMOCHLORCYCLIZINE)(鋁箔/膠

箔)2.00

AC32340100 NIXO TABLETS 5MG (NICERGOLINE) "H.H." 2.56

AC32350221 TRANDATE INJECTION 5MG/ML (LABETALOL) 72.00

AC32353100 NICAN F.C. TABLETS 50MG (NICAMETATE) "CHIN TENG" 1.50

Page 133: 附件二 藥品給付品項暨支付標準表

AC323531G0NICAN F.C. TABLETS 50MG "CHIN TENG" (NICAMETATE)(鋁箔/

膠箔)2.00

AC32358100 DOMPER TABLETS 10MG (DOMPERIDONE) 1.50

AC323581G0 DOMPER TABLETS 10MG (DOMPERIDONE)(鋁箔/膠箔) 2.00

AC32361100 UROL TABLETS 200MG "H.H" (FLAVOXATE) 3.74

AC32367100 WEICHILIN TABLETS 150MG (RANITIDINE HYDROCHLORIDE) 0.00

AC323671G0 WEICHILIN TABLETS 150MG (鋁箔/膠箔) 0.00

AC32368100 KETOTI TABLETS 1MG (KETOTIFEN) "YUNG CHI" 1.54

AC32369209 MECOBAL INJECTION 500MCG/ML (MECOBALAMIN) 15.00

AC32369212 MECOBAL INJECTION 500MCG/ML (MECOBALAMIN) 15.00

AC32372100 CONSLIFE SUGAR COATED TABLETS 1.50

AC323721G0 CONSLIFE SUGAR COATED TABLETS(鋁箔/膠箔) 2.00

AC32373100 QUICRAN F.C.TABLETS 150MG (RANITIDINE HYDROCHLORIDE) 0.00

AC323731G0QUICRAN F.C.TABLETS 150MG (RANITIDINE HYDROCHLORIDE)(鋁

箔/膠箔)0.00

AC32378500 FEMSTAT VAGINAL SUPPOSITORY 100MG (BUTOCONAZOLE) 25.50

AC32380100 TERLAM CAPSULE 10MG 1.52

AC32383100 PELIDONE TABLET 10MG (DOMPERIDONE) "YUNG SINE" 1.50

AC32385321 FULIAN CREAM "MEIDER" 13.90

AC32385329 FULIAN CREAM "MEIDER" 32.20

AC32385335 FULIAN CREAM "MEIDER" 51.00

AC32413100 MEFEN F.C TABLETS 500MG (MEFENAMIC ACID) "CHINTENG" 1.50

AC324131G0MEFEN F.C TABLETS 500MG (MEFENAMIC ACID) "CHINTENG" (鋁

箔/膠箔)2.00

AC32416209 PIROCAM INJECTION 20MG/ML (PIROXICAM) 16.90

AC32437100 NORMABRAIN F.C. TABLETS 800MG (PIRACETAM) 1.88

AC32490100 WYEANIN F.C. TABLETS 10MG (DOMPERIDONE) "S.L." 1.50

AC32495100 COWBALIN TABLETS 100MG (MEBENDAZOLE) "KOJAR" 1.50

AC324951G0COWBALIN TABLETS 100MG "KOJAR" (MEBENDAZOLE)(鋁箔/膠

箔)2.00

AC32504100 ANTADINE CAPSULES 100MG (AMANTADINE) "S.L." 3.77

AC32524100 MOKOTAM TABLETS 30MG "Y.S."(AMBROXOL) 1.50

AC32528151 TRIMERIN SYRUP 0.00

AC32530100 SOLANTIN S.C. TABLETS 25MG (DIPYRIDAMOLE) 1.50

AC325301G0 SOLANTIN S.C. TABLETS 25MG (DIPYRIDAMOLE)(鋁箔/膠箔) 2.00

AC32535100 TRIMERIN TABLETS 1.50

AC32561100 URINOL TABLETS 200MG (FLAVOXATE) "ROYAL" 3.74

AC32562321 CLEOSOL CREAM 5GM 11.90

AC32562324 "CLEOSOL CREAM 0.5MG/GM ""GCPC""" 12.80

AC32562329 "CLEOSOL CREAM 0.5MG/GM (CLOBETASOL) ""GCPC""" 13.70

AC32562335 CLEOSOL CREAM 0.5MG/GM (CLOBETASOL) "GCPC" 24.80

AC32562338 "CLEOSOL CREAM 0.5MG/GM ""GCPC"" (CLOBETASOL0" 41.90

AC32562340 "CLEOSOL CREAM 0.5MG/GM (CLOBETASOL) ""GCPC""" 61.00

AC32571338"SINPHAR" SILIVERZINE CREAM 10MG/GM(SULFADIAZINE

SILVER)32.30

AC32571348"SINPHAR" SILIVERZINE CREAM 10MG/GM(SULFADIAZINE

SILVER)43.70

Page 134: 附件二 藥品給付品項暨支付標準表

AC32571363"SINPHAR" SILIVERZINE CREAM 10MG/GM(SULFADIAZINE

SILVER)139.00

AC32571365"SINPHAR" SILIVERZINE CREAM 10MG/GM(SULFADIAZINE

SILVER)140.00

AC32571371"SINPHAR" SILIVERZINE CREAM 10MG/GM(SULFADIAZINE

SILVER)267.00

AC32571372"SINPHAR" SILIVERZINE CREAM 10MG/GM(SULFADIAZINE

SILVER)267.00

AC32571377"SINPHAR" SILIVERZINE CREAM 10MG/GM(SULFADIAZINE

SILVER)357.00

AC32579100 DEBLEEDING CAPSULES 250MG "C.L." 1.50

AC32584100 BININ-U TABLETS 5MG (HALOPERIDOL) 1.75

AC325841G0 BININ-U TABLETS 5MG (HALOPERIDOL)(鋁箔/膠箔) 2.00

AC32601329 MYCOCIN CREAM 22.30

AC32601335 MYCOCIN CREAM 39.30

AC32619100 NIDOLIUM TABLETS 10MG "SINPHAR"(DOMPERIDONE) 1.50

AC326191G0 NIDOLIUM TABLETS 10MG "SINPHAR"(DOMPERIDONE) 2.00

AC32625151 COSILY LIQUID 650MG/ML (LACTULOSE) "MEIDER" 25.00

AC32625166 COSILY LIQUID 650MG/ML "MEIDER" (LACTULOSE) 105.00

AC32631100 "CIMETIDINE TABLETS 400MG ""R.T.""" 1.50

AC326311G0 CIMETIDINE TABLETS 400MG "R.T."(鋁箔/膠箔) 2.00

AC32632100 SPINAX TABLETS 10.0MG "HEMONY" (BACLOFEN) 1.50

AC326321G0 SPINAX TABLETS 10.0MG "HEMONY" (BACLOFEN)(鋁箔/膠箔) 2.00

AC32640212 TIDACT INJECTION 150MG/ML (CLINDAMYCIN) 15.00

AC32642100"GIKO FILM-COATED TABLETS 9.6MG

(GYNKGOFLAVONGLYCOSIDE)""H.S."""1.71

AC326421G0GIKO FILM-COATED TABLETS 9.6MG

(GINKGOFLAVONGLYCOSIDES)"H.S."(鋁箔/膠箔)2.00

AC32649100 "SWEGA TABLETS 400MG (CIMETIDINE) ""H.S.""" 1.50

AC326491G0"SWEGA TABLETS 400MG ""H.S.""(CIMETIDINE) (鋁箔/膠箔)"

2.00

AC32651100 "KETIFEN TABLETS 1MG (KETOTIFEN) ""H.S.""" 1.54

AC32684321 VIRLESS CREAM 5% 41.10

AC32704221 DOPAMIN (DOPAMINE) INJECTION 40MG/ML "VPP" 19.90

AC32706100 CAPTOPRI TABLETS 25MG (CAPTOPRIL) 1.50

AC32711100 CAPTOPRI TABLETS 12.5MG (CAPTOPRIL) 1.50

AC32716100 DOMPERAN TABLETS 10MG "SWISS" (DOMPERIDONE) 1.50

AC32723100 PAPIROR E.C. TABLETS 100MG (PENTOXYFYLLINE) "KYORIN" 1.50

AC327231G0PAPIROR E.C. TABLETS 100MG (PENTOXYFYLLINE) "KYORIN"(鋁

箔/膠箔)2.00

AC32729100 SHERY E.C. TABLETS 100MG "H.S." (PENTOXIFYLLINE) 1.50

AC327291G0SHERY E.C. TABLETS 100MG "H.S." (PENTOXIFYLLINE)(鋁箔/膠

箔)2.00

AC32785321 U-Chu Acyclovir Cream 50 mg/gm 41.10

AC32800500 DICLOREN SUPPOSITORIES 12.5MG "WEIDAR" (DICLOFENAC) 5.00

AC32801100 ALAT CAPSULES 10MG (NIFEDIPINE) 1.81

AC328011G0 ALAT CAPSULES 10MG (NIFEDIPINE) (鋁箔/膠箔) 2.00

AC32805100 BUTANIDE TABLET 1MG (BUMETANIDE) "LITA" 1.69

Page 135: 附件二 藥品給付品項暨支付標準表

AC32812321 CLOMOLD CREAM 0.5MG/GM"T.F." 11.90

AC32812338 CLOMOLD CREAM 0.5MG/GM 41.90

AC32815100 DEPRESS TABLETS "CHINTENG" 1.50

AC32816100 "NASCO TABLETS ""H.S.""" 1.36

AC328161G0 "NASCO TABLETS ""H.S.""(鋁箔/膠箔)" 1.54

AC32825100 MENTONG TABLETS "CHINTENG" 1.52

AC32828338 SIGEL CREAM 10MG/G "C.H." (SILVER SULFADIAZINE) 32.30

AC32830100 BETAPID TABLETS 200MG (BEZAFIBRATE) 3.62

AC32831100 DESUMIDE TABLETS 100MG (TOLAZAMIDE) "H.S." 2.58

AC32833100 GEMD CAPSULES 300MG "YUNG SHIN" (GEMFIBROZIL) 1.50

AC328331G0GEMD CAPSULES 300MG "YUNG SHIN"(GEMFIBROZIL) (鋁箔/膠箔)

2.00

AC32834100 MOLIN TABLETS 10MG (DOMPERIDONE)"T.F." 1.50

AC32848321 DERMOSOL CREAM 0.5MG/G "PATRON" (CLOBETASOL) 11.90

AC32848329 DERMOSOL CREAM 0.5MG/G "PATRON"(CLOBETASOL) 13.70

AC32848335 DERMOSOL CREAM 0.5MG/G "PATRON"(CLOBETASOL) 24.80

AC32848338 DERMOSOL CREAM 0.5MG/G "PATRON"(CLOBETASOL) 41.90

AC32848340 DERMOSOL CREAM 0.5MG/G "PATRON"(CLOBETASOL) 61.00

AC32848355 DERMOSOL CREAM 0.5MG/G "PATRON"(CLOBETASOL) 195.00

AC32851100 ADERNAN TABLETS 50MG (HYDRALAZINE) 1.52

AC32856329 WEICORT-N CREAM "WEIDAR" 32.40

AC32876100 HERBESSER TABLETS 60MG 2.15

AC32877100 "VOLEN E.C. TABLET 50MG (DICLOFENAC) ""WINSTON""" 1.50

AC32880100 AMBROXOL TABLETS 30MG "KOJAR" 1.50

AC328801G0 AMBROXOL TABLETS 30MG "KOJAR"(鋁箔/膠箔) 2.00

AC32881321 E.F. CREAM 13.90

AC32881329 E.F. CREAM 22.30

AC32881330 E.F. CREAM 12GM 37.90

AC32881338 E.F. CREAM 20GM 60.00

AC32882321 SALIC OINTMENT 10.90

AC32882329 SALIC OINTMENT 19.50

AC32882335 SALIC OINTMENT 52.00

AC32882338 SALIC OINTMENT 68.00

AC32882340 SALIC OINTMENT 81.00

AC32882343 SALIC OINTMENT 81.00

AC32892500 MOLIN SUPPOSITORY 10MG "T.F." 5.00

AC32893100 ERYMYCIN FILM COATED TABLETS 500MG"T.F" 3.67

AC32917209 PIROCAM INJ. 20MG/ML (PIROXICAM) "N.K" 16.90

AC32917212 PIROCAM INJ. 20MG/ML (PIROXICAM) "N.K" 16.90

AC32918100 Culcer DAILY F.C. Tablet 300mg 0.00

AC32934151 LIKANCOUGH LIQUID 25.00

AC32934157 LIKANCOUGH LIQUID 25.00

AC32938323 CHEMIN OINTMENT 0.25%(DESOXIMETASONE)"H.S." 29.30

AC32938329 CHEMIN OINTMENT 0.25%(DESOXIMETASONE)"H.S." 50.00

AC32938338 CHEMIN OINTMENT 0.25%(DESOXIMETASONE)"H.S." 77.00

AC32942100 DEMIL TABLETS 2.5MG "KOJAR" (BROMOCRIPTINE) 4.58

AC32943100 "NIFAN CAPSULES 250MG (NIFLUMIC ACID) ""H.S.""" 2.36

AC32945100 "TUENSILIN TABLETS 2.5MG (FENOTEROL)""ROOT""" 1.50

Page 136: 附件二 藥品給付品項暨支付標準表

AC32949100 "SUCROXINE TABLETS ""ROOT""" 1.50

AC32950100 "POUWEPIN TABLETS 200MG (CIMETIDINE)""ROOT""" 1.50

AC32951100 "COYENPIN TABLETS 25MG (DICLOFENAC)""ROOT""" 1.50

AC32952100 "PANMITIN TABLETS 100MG (TRIMETHOPRIM)""ROOT""" 1.50

AC32969100 "DEANTRAN TABLETS 1MG ""R.T.""" 1.54

AC32970100 SANTITEN TABLETS 1MG(KETOTIFEN)"S.D." 1.54

AC32971329 YIHFU OINTMENT 0.5MG/GM (CLOBETASOL PROPIONATE)"S.D." 13.70

AC32985100 COLIBRATE TABLET 200MG 0.00

AC32988329 ECORT CREAM "WEIDAR" 18.80

AC32989209 MECOBAL INJECTION 0.5MG/ML"T.F" 15.00

AC32989221 MECOBAL INJECTION 0.5MG/ML"T.F" 15.00

AC33023100 "SULOWEILIN TABLETS ""ROOT"" 1.50

AC330231G0 "SULOWEILIN TABLETS ""ROOT""(鋁箔/膠箔)" 2.00

AC33027100 TRICOLINE TABLETS 3MG(TRIMETOQUINO)"S.D." 1.50

AC33048100 NAPTON S.R. TABLETS 750MG "B&F" (NAPROXEN) 3.63

AC33049100 TALIPIN TABLET 30MG (AMBROXOL) "SWISS" 1.50

AC330491G0 TALIPIN TABLET 30MG "SWISS" (AMBROXOL)(鋁箔/膠箔) 2.00

AC33052100 "ANCOUGH TABLETS 100MG (OXOLAMINE CITRATE)""ROOT""" 1.50

AC33063321 JINRIH CREAM 50MG/GM "CHINTENG"(ACYCLOVIR) 41.10

AC33064100 IBUPROFEN F.C. TABLETS 400MG "KOJAR" 1.50

AC330641G0 IBUPROFEN F.C. TABLETS 400MG "KOJAR"(鋁箔/膠箔) 2.00

AC33072212 FAMODINE INJECTION 10MG/ML "N.K." (FAMOTIDINE) 23.20

AC33072219 FAMODINE INJECTION 10MG/ML "N.K."(FAMOTIDINE) 39.40

AC33072229 FAMODINE INJECTION 10MG/ML "N.K."(FAMOTIDINE) 44.80

AC33074321 KENALON CREAM "T.F." 13.90

AC33079100 "PIROXICAM TABLETS 20MG ""H.S.""" 1.50

AC330791G0 "PIROXICAM TABLETS 20MG ""H.S.""(鋁箔/膠箔)" 2.00

AC33080100 PROTANON TABLETS 5MG "Y.S" (ALLYLESTRENOL) 2.72

AC33081100 KEFEN TABLETS 1MG "H.S" (KETOTIFEN) 1.54

AC330811G0 KEFEN TABLETS 1MG "H.S" (KETOTIFEN)(鋁箔/膠箔) 2.00

AC33082100 ULCERBAN TABLETS 500MG (SUCRALFATE) 1.50

AC33093277 METACIN FOR INJECTION (CEFMETAZOLE) 64.00

AC33098100 CIKETIN TABLETS 400MG (CIMETIDINE) "UNION" 1.50

AC33122100DICLOFEN ENTERIC FILM COATING TABLETS 50MG "KOJAR"

(DICLOFENAC)1.50

AC331221G0DICLOFEN ENTERIC FILM COATING TABLETS 50MG "KOJAR"(

DICOLFENAC)(鋁箔/膠箔)2.00

AC33124100 ANLIPIN F.C. TABLETS 100MG (ATENOLOL) "KOJAR" 1.51

AC331241G0ANLIPIN F.C. TABLETS 100MG (ATENOLOL) "KOJAR"(鋁箔/膠箔)

2.00

AC33125100 FUCOTIN F.C. TABLETS 200MG "KOJAR" (FLAVOXATE) 3.74

AC33128100 MEFENA F.C.TABLETS 500MG"KOJAR" 1.50

AC331281G0MEFENA F.C. TABLETS 500MG"KOJAR" (MEFENAMIC ACID)(鋁箔/

膠箔)2.00

AC33140100 FREE S.C. TABLETS 1.50

AC33149209 S-60 INJECTION (CEPHRADINE) 25.00

AC33149277 S-60 INJECTION (CEPHRADINE) 0.00

AC33157100 WEISUFU TABLETS "CHIN TENG" 1.50

Page 137: 附件二 藥品給付品項暨支付標準表

AC331571G0 WEISUFU TABLETS "CHIN TENG" (鋁箔/膠箔) 2.00

AC33163100 CO-TRIZOL TABLETS "Y.C." 1.50

AC33170100 SHUAYAN TABLETS 0.5MG (DEXAMETHASONE)"Y.C." 1.50

AC331701G0SHUAYAN TABLETS 0.5MG (DEXAMETHASONE)"Y.C."(鋁箔/膠箔)

2.00

AC33171100 ANSWET TABLETS 5MG (NITRAZEPAM) "Y.C." 1.50

AC33172100 HEITOMIN S.C. TABLETS "Y.C." 1.50

AC33175100 MENICON TABLETS 30MG (DEXTROMETHORPHAN)"Y.C." 1.50

AC331751G0MENICON TABLETS 30MG (DEXTROMETHORPHAN)"Y.C."(鋁箔/膠箔)

2.00

AC33178100 MEZOLE TABLETS 100MG "Y.C." (MEBENDAZOLE) 1.50

AC33180100 SU KU TA TABLETS "Y.C." 1.50

AC33184100 PRITHMOW TABLETS 5MG (PREDNISOLONE)"Y.C." 1.50

AC33185100 TERICO-S .TABLETS 250MG (METRONIDAZOLE) "Y.C." 1.52

AC33187100 TRIAMCINOLONE TABLETS 4MG (TRIAMCINOLONE)"Y.C." 1.50

AC331871G0TRIAMCINOLONE TABLETS 4MG (TRIAMCINOLONE)"Y.C."(鋁箔/膠

箔)2.00

AC33190100 SONZIN TABLETS 250MG "Y.C." (CHLORZOXAZONE) 1.50

AC33194100 OROLISIN F.C. TABLETS "Y.C." 1.50

AC331941G0 OROLISIN F.C. TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC33197100 NALIDIXIC ACID TABLETS 500MG (NALIDIXIC ACID )"Y.C." 2.22

AC33201100 SEPHYLLINE TABLETS 100MG (PENTOXIFYLLINE) 1.50

AC33203100 YUETAN TABLETS 30MG (AMBROXOL)"S.D." 1.50

AC33204100 "AMBROXOL TABLETS 30MG ""R.T.""" 1.50

AC332041G0 "AMBROXOL TABLETS 30MG ""R.T.""(鋁箔/膠箔)" 2.00

AC33208100 "HEXOPAL TABLETS 100MG (PENTOXIPHYLLINE)""R.T""" 1.50

AC33220100 ACTIRIN CAPSULES 10MG "Y.C." (OXAZOLAM) 1.52

AC33223229 TRACE ELEMENT INJECTION "C.C.P.C" 95.00

AC33224100DILTISSER TABLETS 30MG "C.C.C.P." (DILTIAZEM

HYDROCHLORIDE)1.50

AC332241G0DILTISSER TABLETS 30MG "C.C.P." (DILTIAZEM

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC33253329 E-FLOW CREAM "M.T." 18.80

AC33253335 E-FLOW CREAM "M.T." 30.40

AC33253338 E-FLOW CREAM "M.T." 32.60

AC33253355 E-FLOW CREAM "M.T." 135.00

AC33258321 BETAMAZOLE CREAM 5GM 13.90

AC33258329 BETAMAZOLE CREAM "GCPC" 32.20

AC33258335 BETAMAZOLE CREAM "GCPC" 51.00

AC33258338 BETAMAZOLE CREAM "GCPC" 74.00

AC33260221 "TRANEXAMIC ACID INJECTION 100MG/ML ""ASTAR""" 15.00

AC33261209 PROGESTERONE INJECTION 50MG/ML "ASTAR" 15.00

AC33285151 FUSOSHU SYRUP "M.T" 19.70

AC33288329 "FLUSIN CREAM 0.05% 10GM ""M.T""" 44.10

AC33304100 IBUPROFEN F.C. TABLETS 400MG "C.H." 1.31

AC33321212NICEWE INJECTION 25MG/ML "N.K." (RANITIDINE

HYDROCHLORIDE)0.00

AC33376212 GENTAMYCIN INJECTION 140MG/ML "T.F" 16.50

Page 138: 附件二 藥品給付品項暨支付標準表

AC33376229 GENTAMYCIN INJECTION 140MG/ML "T.F." 75.00

AC33377321 URESON CREAM 10.00

AC33377329 URESON CREAM 17.80

AC33377335 URESON CREAM 41.80

AC33377336 URESON CREAM 41.80

AC33382100 CLINDAMYCIN CAPSULES 150MG "T.F" 1.50

AC33387100 SURIN TABLETS 200MG "YU SHENG" (SULPIRIDE) 1.71

AC333871G0 SURIN TABLETS 200MG "YU SHENG"(SULPIRIDE)(鋁箔/膠箔) 2.00

AC33390100 SOMILIN TABLETS 0.25MG (TRIAZOLAM)"KOJAR" 1.88

AC333901G0 SOMILIN TABLETS 0.25MG (TRIAZOLAM)"KOJAR" 2.00

AC33415100 AMBROXOL TABLETS 30MG "SINPHAR" 1.50

AC334151G0 AMBROXOL TABLETS 30MG "SINPHAR" 2.00

AC33425266 SUNNYTOL INFUSION 20% "N.K" (MANNITOL) 39.40

AC33429238PITRESSIN INJECTION 20 UNITS/ML (ARGININE VASOPRESSIN)

222.00

AC33433100 "SINSULIN CAPSULES 10MG ""ASTAR""" 1.52

AC33435100 "CIMETIDINE TABLETS 200MG ""ASTAR""" 1.50

AC33436212 CIMETIDINE INJECTION 100MG/ML "ASTAR" 15.00

AC33445229 MITOXANTRONE INJECTION 2MG/ML "KINGDOM" 4160.00

AC33449100 NAPROXEN 250MG TABLETS "Y.S." 1.50

AC334491G0 NAPROXEN 250MG TABLETS "Y.S."(鋁箔/膠箔) 2.00

AC33453100 MECOMIN CAPSULES 0.5MG (MECOBALAMIN)"Y.C." 1.55

AC334531G0MECOMIN CAPSULES 0.5MG "Y.C." (MECOBALAMIN)(鋁箔/膠箔)

2.00

AC33457100 CLINDAMYCIN CAPSULES 150MG "C.C.P." 1.50

AC33459100 NOXACIN CAPSULE 100MG "GENTLE" (NORFLOXACIN) 1.96

AC33460100 NOXACIN CAPSULE 400MG "GENTLE" (NORFLOXACIN) 38.40

AC33461100 FENOTIN TABLETS 2.5MG (FENOTEROL HYDROBROMIDE) "S.L." 1.50

AC33468100 SILIMIN CAPSULES 150MG (SILYMARIN) "KOJAR" 1.52

AC334681G0 SILIMIN CAPSULES 150MG (SILYMARIN) "KOJAR" 2.00

AC33471100 BORYMYCIN CAPSULES 100MG (MINOCYCLINE) 5.90

AC33474221 GETWAY 10MG INJ. (RANITIDINE)"SWISS" 0.00

AC33476100 GEMNPID CAPSULE 300MG (GEMFIBROZIL) "C.C.P.C" 1.50

AC33487212 KETOPROFEN INJECTION 50MG/ML "ASTAR" 15.00

AC33493100 "GENUPROXIN TABLETS 250MG (NAPROXEN) ""GCPC""" 1.50

AC33504100 IBUPROFEN TABLETS 400MG "SINPHAR" 1.50

AC335041G0 IBUPROFEN TABLETS 400MG "SINPHAR" 2.00

AC33518100 AN ANTLER HORMON CAPSULES "SINPHAR" 1.93

AC33531100 LYSOZYME TABLETS 90MG "SINPHAR" 1.50

AC33547212 ANTHIMIN INJECTION "T.F." 15.00

AC33548212 C-B COMPLEX INJECTION "T.F." 15.00

AC33549238 NEO METHION B INJECTION "T.F." 15.00

AC33558212 NEO HUSTEN INJECTION "T. F." 15.00

AC33560212 BERBENOL INJECTION "T.F." 15.00

AC33561221 ANTI-ULCER INJECTION "T.F." 15.00

AC33562238 GLUCRON DEXTROSE INJECTION "T.F." 15.00

AC33563212 ANTICO INJECTION 5MG/ML "T.F." 15.00

AC33564212 OBALLERGEN-H INJECTION "T.F." 15.00

Page 139: 附件二 藥品給付品項暨支付標準表

AC33566209 RE-HISTAMIN INJECTION 30MG/ML (DIPHENHYDRAMINE)"T.F." 15.00

AC33569212 DIPHYLLIN-M INJECTION 150MG/ML "T.F." 15.00

AC33572212 CLINDAMYCIN INJECTION 150MG "C.C.P.C." 15.00

AC33582238 SODIUM ACETATE INJECTION 4MEQ/ML "KINGDOM" 28.00

AC33586238 SALSOBROCAROSE INJECTION "T.F." 15.00

AC33589212 "RANNINE INJECTION 25MG/ML (RANITIDINE)""S.Y.""" 0.00

AC33590312 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 17.30

AC33590316 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 17.30

AC33590317 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 17.30

AC33590319 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 17.30

AC33590321 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 41.10

AC33590323 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 41.80

AC33590325 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 42.50

AC33590326 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 42.90

AC33590329 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 42.90

AC33590355 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 431.00

AC33591100 THIAMPHENICOL CAPSULES 250MG "Y.C." 1.51

AC335911G0 THIAMPHENICOL CAPSULES 250MG "Y.C."(鋁箔/膠箔) 2.00

AC33593221 TRANEXAMIC ACID INJECTION 50MG/ML "T.F." 15.00

AC33594212 METOPERAN INJECTION 5MG/ML "T.F." (METOCLOPRAMIDE) 15.00

AC33595212 FUROSEMIDE IV INJECTION 10MG/ML "T.F." 15.00

AC33597212 DIAZEPAM INJECTION 5MG/ML "T.F." 15.00

AC33598209 PAOSU COAN INJECTION 20MG/ML "T.F." (SCOPOLAMINE) 15.00

AC33664100 MESYREL TABLETS 50MG "LOTUS" 1.60

AC336641G0 MESYREL TABLETS 50MG "LOTUS"(鋁箔/膠箔) 2.00

AC33675100 DECLOT F.C. TABLETS 100MG "WEIDAR" (TICLOPIDINE) 3.53

AC33701100 MEFENA CAPSULES 250MG (MEFENAMIC ACID) "KOJAR" 1.50

AC337011G0MEFENA CAPSULES 250MG (MEFENAMIC ACID) "KOJAR" (鋁箔/膠

箔)2.00

AC33729329 ISORADIN CREAM "YUNG SHIN" 22.30

AC33730321 MYCOSON CREAM 10MG/G (BIFONAZOLE) "S.Y." 18.20

AC33730329 MYCOSON CREAM 10MG/G (S.Y.) (BIFONAZOLE) 44.60

AC33730335 MYCOSON CREAM 10MG/G (BIFONAZOLE) "S.Y." 49.40

AC33730338 MYCOSON CREAM 10MG/G (BIFONAZOLE) "S.Y." 81.00

AC33733100 CEGELIN TABLETS 200MG (BEZAFIBRATE) "YUNG CHI" 0.00

AC33738320 DEVIRO OPHTHALMIC OINTMENT 3% (ACYCLOVIR) "KINGDOM" 400.00

AC33738321 DEVIRO OPHTHALMIC OINTMENT 3% (ACYCLOVIR) "KINGDOM" 0.00

AC33757238 GLUCOSE INJECTION 50% "T.F." 15.00

AC33758212 TAURINE B INJECTION "T.F." 15.00

AC33760212 ANTIDOTALGEN INJECTION "T.F." 15.00

AC33761209EPIRENAMIN HYDROCHLORIDE INJECTION 1MG/ML

(EPINEPHRINE)"T.F."15.00

AC33763209 ATROPINE SULFATE INJECTION 1MG/ML "T.F." 15.00

AC33773229 TUNNACORT INJECTION 40MG/ML "T.F." 57.00

AC33774100DAILY-PLUS CHEWABLE TABLET 0.5MG (HYDROXOCOBALAMIN

ACETATE )"SHITEH"1.50

AC33822100 ISOPERDINE TABLETS 40MG "S.L." 1.53

AC33823100 PREDNISOLONE 5MG TABLETS "Y.Y." 1.50

Page 140: 附件二 藥品給付品項暨支付標準表

AC338231G0 PREDNISOLONE 5MG TABLETS "Y.Y." (鋁箔/膠箔) 2.00

AC338231G5 PREDNISOLONE 5MG TABLETS "Y.Y."(84粒/瓶) 2.00

AC33825100 NIGOLINE TABLETS 10MG "Y.C." (NICERGOLINE) 4.38

AC33830329 HUAN HSI CREAM 0.6MG/GM (ESTRADIOL) "CHINTENG" 61.00

AC33862100 METROCIDE CAPSULES 250MG "T.F."(METRONIDAZOLE) 1.52

AC33866221 OBALLERCAL INJECTION "T.F." 15.00

AC33867209 EPHEDRIN INJECTION 40MG/ML "T.F." 15.00

AC33871100 "FORLIVER CAPSULES 150MG ""ROOT"" (SILYBIN)" 1.52

AC338711G0 FORLIVER CAPSULES 150MG "ROOT" (SILYBIN)(鋁箔/膠箔) 2.00

AC33872100 CIKETIN TABLETS 200MG (CIMETIDINE) "UNION" 1.50

AC33873229 OXOCIN INJECTION 10IU/ML "T.F." (OXYTOCIN) 21.00

AC33876221 REHISTACAL B6 INJECTION "T.F." 15.00

AC33883100 EXSOL CAPSULES 100MG "Y.Y."(OXOLAMINE CITRATE) 1.50

AC338831G0EXSOL CAPSULES 100MG (OXOLAMINE CITRATE) "Y.Y."(鋁箔/膠

箔)2.00

AC33887321 ENFULON CREAM 1MG/GM (DIFLUCORTOLONE) "GCPC" 14.10

AC33887329 "ENFULON CREAM 1MG/GM (DIFLUCORTOLONE) ""GCPC""" 44.50

AC33887343 ENFULON CREAM 1MG/GM(DIFLUCORTOLONE)"GCPC" 79.00

AC33892100 "TRANEXAMIC ACID TABLETS 250MG ""ASTAR""" 1.50

AC33894100 DECA TABLETS 0.75MG "KOJAR" (DEXAMETHASONE) 1.50

AC338941G0 DECA TABLETS 0.75MG (DEXAMETHASONE)"KOJAR"(鋁箔/膠箔) 2.00

AC33896100 SUWEIDA TABLETS 10MG (DOMPERIDONE)"S.C." 1.50

AC33900100 SINLIHAUL TABLETS 40MG (PROPRANOLOL) "H.S." 1.50

AC33901100 POTAN TABLETS 500MG "H.S." (MEFENAMIC ACID) 1.50

AC33910100 CAPTOPIN TABLETS 25MG "B & F"(CAPTOPRIL) 1.50

AC33915100 CAPTOPIN TABLETS 12.5MG "B & F" (CAPTOPRIL) 1.50

AC33920209 PHENOBITAL INJECTION 100MG/ML "T.F." (PHENOBARBITAL) 15.00

AC33925216 DICLOFENAC INJECTION 25MG/ML "ASTAR" 15.00

AC33927100 L.K.T E.C. TABLETS 50MG "C.H." 1.50

AC33929100 LARPAM TABLETS 2MG (LORAZEPAM) "S.D." 1.50

AC339291G0 LARPAM TABLETS 2MG (LORAZEPAM) "S.D."(鋁箔/膠箔) 2.00

AC33933100 CARBIZO TABLETS 10MG (CARBIMAZOLE) "YU SHENG" 1.50

AC33934100 LIPLOW F.C. TABLETS 200MG (BEZAFIBRATE) "H.S." 3.62

AC33935209CEFTAM INJECTION 0.5GM,1GM,2GM (CEFOTAXIME SODIUM)

"LITA"113.00

AC33935212CEFTAM INJECTION 0.5GM,1GM,2GM (CEFOTAXIME SODIUM)

"LITA"387.00

AC33935277CEFTAM INJECTION 0.5GM,1GM,2GM (CEFOTAXIME SODIUM)

"LITA"87.00

AC33938329 FUNGIN CREAM 10MG/GM (BIFONAZOLE) "SWISS" 44.60

AC33938335 FUNGIN CREAM 10MG/GM "SWISS" (BIFONAZOLE) 49.40

AC33939100ABROXOL TABLETS 30MG (AMBROXOL HYDROCHLORIDE) "JOHNSON"

1.50

AC339391G0ABROXOL TABLETS 30MG (AMBROXOL HYDROCHLORIDE)

"JOHNSON"(鋁箔/膠箔)2.00

AC33943321 CHENG HOU CREAM "C.T" 13.90

AC33943323 CHENG HOU CREAM "C.T" 14.40

AC33943329 CHENG HOU CREAM "C.T" 18.40

Page 141: 附件二 藥品給付品項暨支付標準表

AC33943335 CHENG HOU CREAM "C.T" 29.70

AC33943336 CHENG HOU CREAM "C.T" 29.70

AC33943338 CHENG HOU CREAM "C.T" 57.00

AC33950100 N.F.S. F.C.T. 100MG "C.H."(NORFLOXACIN) 1.96

AC33959100 DROWSY TABLETS 0.25MG "H.S" 1.88

AC339591G0 DROWSY TABLETS 0.25MG "H.S"(鋁箔/膠箔) 2.00

AC33960100 CLEDOMYCIN CAPSULES 150MG "ASTAR" (CLINDAMYCIN) 1.50

AC33961100 IPUFEN F.C. TABLETS 400MG "CHINTENG"(IBUPROFEN) 1.50

AC339611G0IPUFEN F.C. TABLETS 400MG "CHINTENG"(IBUPROFEN)(鋁箔/膠

箔)2.00

AC33962100 COTAZYM CAPSULES 1.50

AC33968417 CLEO EYE DROP 3MG/ML (TOBRAMYCIN) "PURZER" 32.80

AC33971100 LEDOLIUM "C.L." 1.50

AC339711G0 LEDOLIUM "C.L."(鋁箔/膠箔) 2.00

AC33998165 MAGVAC ORAL SDUTION 40.90

AC34000151 AXOL LIQUID 3MG/ML (AMBROXOL) "YUNG SHIN" 25.00

AC34003100WANIDINE CAPSULES 200MG (QUINIDINE SULFATE) "WASHINGTON"

3.93

AC34004321 ISOCORT CREAM 13.90

AC34004329 ISOCORT CREAM 22.30

AC34008329 BESOL CREAM 0.05% (CLOBETASOL) "C.H." 13.70

AC34011421 LENSPURE EYE DROPS "SINPHAR" 20.00

AC34014100 NOYAN TABLETS 375MG "WEIDAR" (NAPROXEN) 2.31

AC34015317 "ANCLOZIN CREAM 50MG/GM (ACYCLOVIR) ""ROOT""" 17.30

AC34015321 "ANCLOZIN CREAM 50MG/GM (ACYCLOVIR) ""ROOT""" 41.10

AC34018100 DECA TABLETS 0.5MG "KOJAR" (DEXAMETHASONE) 1.50

AC340181G0 DECA TABLETS 0.5MG (DEXAMETHASONE) "KOJAR"(鋁箔/膠箔) 2.00

AC34037100 CEKODIN CAPSULES 250MG "SWISS"(CEPHRADINE) 1.72

AC340371G0 CEKODIN CAPSULES 250MG "SWISS"(CEPHRADINE)(鋁箔/膠箔) 2.00

AC34038100 CEKODIN CAPSULES 500MG "SWISS"(CEPHRADINE) 2.72

AC34040321 S.S. CREAM 0.00

AC34040329 S.S. CREAM 0.00

AC34040330 S.S. CREAM 37.90

AC34040335 S.S. CREAM 37.90

AC34040336 S.S. CREAM 47.30

AC34040338 S.S. CREAM 60.00

AC34061500 ISOGEN VAG. TABLET 100MG (ISOCONAZOLE) "PURZER" 5.00

AC34070421 GENTAMYCIN OPHTHALMIC SOLUTION 3MG/ML "WU-FU" 14.50

AC34078100 NYSIN S.C. TABLETS 100MG "CHINTENG"(NITROXOLINE) 2.52

AC34079100 VESUTON F.C TABLETS 10MG "CHINTENG"(SCOPOLAMINE) 1.50

AC340791G0VESUTON F.C TABLETS 10MG "CHINTENG"(SCOPOLAMINE) (鋁箔/

膠箔)2.00

AC34088100 KANTUU TABLETS 10MG "CHINTENG"(DOMPERIDONE) 1.50

AC340881G0KANTUU TABLETS 10MG "CHINTENG"(DOMPERIDONE) (鋁箔/膠箔)

2.00

AC34089417"AYCO IN ORABASE 1MG/GM (TRIAMCINOLONE ACETONIDE)

""ROOT"""21.50

Page 142: 附件二 藥品給付品項暨支付標準表

AC34089421"AYCO IN ORABASE 1MG/GM (TRIAMCINOLONE ACETONIDE)

""ROOT"""28.40

AC34089423"AYCO IN ORABASE 1MG/GM (TRIAMCINOLONE ACETONIDE)

""ROOT"""36.70

AC34090100 MILIX CAPSULES 2.5MG "M.S." (INDAPAMIDE) 1.92

AC34103100 "PROLIVRIN CAPSULES ""ROOT""" 1.50

AC341031G0 PROLIVRIN CAPSULES "ROOT"(鋁箔/膠箔) 2.00

AC34105100 SINTON TABLETS 375MG (NAPROXEN) "CHIN TENG" 2.31

AC34108209 PIROCAM INJECTION 20MG/ML (PIROXICAM) "GENTLE" 16.90

AC34110100 AMANTADINE F.C. TABLETS 100MG "KOJAR" 3.77

AC34112100 LOPETIN CAPSULES 2MG (LOPERAMIDE) "KOJAR" 1.50

AC341121G0 LOPETIN CAPSULES 2MG (LOPERAMIDE) "KOJAR"(鋁箔/膠箔) 2.00

AC34114212 META C-B INJECTION "T.F." 15.00

AC34120100 WEIZIP TABLETS 500MG (SUCRALFATE) 1.50

AC341201G0 WEIZIP TABLETS 500MG (SUCRALFATE)(鋁箔/膠箔) 2.00

AC34123100 YUTODIN TABLET 10MG (RITODRINE HCL) "PURZER" 4.15

AC34124321 GENTAMYCIN CREAM 1MG/GM "SINPHAR" 13.20

AC34124335 GENTAMYCIN CREAM 1MG/GM "SINPHAR" 37.20

AC34128321 CLOTRISONE CREAM 13.90

AC34128329 CLOTRISONE CREAM 32.20

AC34128335 CLOTRISONE CREAM 51.00

AC34128338 CLOTRISONE CREAM 74.00

AC34129229 "LINCOMYCIN 300MG/ML INJECTION ""S.Y.""" 27.20

AC34145100 PAINIL TABLETS 50MG (FLURBIPROFEN) 1.50

AC341451G0 PAINIL TABLETS 50MG (FLURBIPROFEN)(鋁箔/膠箔) 2.00

AC34157100 CERETAL S.C. TAB. 400MG "S.T." (PENTOXIFYLLINE) 1.82

AC341571G0CERETAL S.C. TAB. 400MG (PENTOXIFYLLINE) "S.T."(鋁箔/膠

箔)2.00

AC34165265 NEPHROCARE INJECTION 5.4% "N.K." 141.00

AC34166255 HEPACARE INJECTION 8% "N.K." 0.00

AC34166277 HEPACARE INJECTION 8% "N.K." 0.00

AC34171100 FOAN CAPSULES 10MG "S.C" (OXAZOLAM) 1.52

AC341711G0 FOAN CAPSULES 10MG (OXAZOLAM) "S.C"(鋁箔/膠箔) 2.00

AC34222151 MAC SAFE ORAL SUSPENSION 20MG/ML (IBUPROFEN) 25.00

AC34223151 "KOJAR" AMBROXOL SOLUTION 3MG/ML 25.00

AC34223157 "KOJAR" AMBROXOL SOLUTION 3MG/ML 50.00

AC34240100 SUSA TABLETS 2.5MG (FENOTEROL) "H.S." 1.50

AC342401G0 SUSA TABLETS 2.5MG (FENOTEROL) "H.S."(鋁箔/膠箔) 2.00

AC34243100 TON LIN CAPSULES 10MG "CHINTENG" (FLUOXYMESTERONE) 2.46

AC34244100 CORIN TABLETS 100MG "CHINTENG" (OXOLAMINE CITRATE) 1.50

AC34283100 URENIDE TABLETS 1MG "ROOT"(BUMETANIDE) 1.69

AC34300100 TENSOLIN TABLET "T.F" 4.13

AC34306321KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE)

"CHINTENG"11.90

AC34306323KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE)

"CHINTENG"12.80

AC34306324KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE)

"CHINTENG"12.80

Page 143: 附件二 藥品給付品項暨支付標準表

AC34306329KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE)

"CHINTENG"13.70

AC34306335KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE)

"CHINTENG"24.80

AC34306338KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE)

"CHINTENG"41.90

AC34308100 TONLIN TABLETS 200MG (FLAVOXATE) "S.D." 3.74

AC34314100 RECALM TABLETS "STANDARD" 1.50

AC343141G0 RECALM TABLETS "STANDARD"(鋁箔/膠箔) 2.00

AC34323100 COWEMIN TABLETS 300MG (CIMETIDINE) "CHINTENG" 1.50

AC343231G0COWEMIN TABLETS 300MG (CIMETIDINE) "CHINTENG"(鋁箔/膠箔)

2.00

AC34326100 URICIN TABLETS 50MG "GENTLE" (BENZBROMARONE) 1.50

AC343261G0URICIN TABLETS 50MG (BENZBROMARONE) "GENTLE"(鋁箔/膠箔)

2.00

AC34329209 UFIN FOR I.V. INJ. 1GM (CEFTRIAXONE) "UNION" 82.00

AC34348100 "ANNEUTON TABLETS 80MG (GLICLAZIDE) "ROOT" 1.50

AC343481G0 ANNEUTON TABLETS 80MG (GLICLAZIDE) "ROOT"(鋁箔/膠箔) 2.00

AC34355321 CYCLOUIR CREAM 50MG/GM "T.F" 41.10

AC34358100 DEFEN CAPSULE 1MG (KETOTIFEN) "PURZER" 1.54

AC343581G0 DEFEN CAPSULE 1MG (KETOTIFEN) "PURZER" 2.00

AC34363229 AMIKACIN INJECTION 250MG/ML (AMIKACIN) "C.C.P.C." 199.00

AC34366100 OXYBAN TABLETS 5MG "WEIDAR" (OXYBUTYNIN) 2.12

AC34373100 AERISIN TABLETS 30MG (DILTIAZEM) "YUAN CHOU" 1.50

AC34375100 TIMEN CAPSULES 30MG "WEIDAR" (TIMEPIDIUM BROMIDE) 2.55

AC34504100 PAWEGON 200MG TABLETS (CIMETIDINE) "EVEREST" 1.50

AC34511100 "LISUMEN CAPSULES 30MG ""ASTAR""" 3.75

AC34518100 COFEN 1MG TABLETS (KETOTIFEN) "C.H." 1.54

AC34534100 SOLOFEN TABLETS 10MG (BACLOFEN) 1.50

AC345341G0 SOLOFEN TABLETS 10MG (BACLOFEN)(鋁箔/膠箔) 2.00

AC34542100 NEWEDON TABLETS 10MG "Y.K." 1.50

AC345421G0 NEWEDON TABLETS 10MG "Y.K."(鋁箔/膠箔) 2.00

AC34545314 WIPOIDO CREAM 15.00

AC34545329 WIPOIDO CREAM 0.00

AC34545343 WIPOIDO CREAM 74.00

AC34545348 WIPOIDO CREAM 249.00

AC34547100 "MEFENAMIC ACID TABLETS 500MG ""M.T""" 1.50

AC345471G0 "MEFENAMIC ACID TABLETS 500MG ""M.T""鋁箔/膠箔" 2.00

AC34550100 Glupizide Tablets 5mg 〝MACRO〞 (Glipizide) 1.50

AC34551100 SULIMEN TABLETS 100MG "KOJAR" (SULINDAC) 1.72

AC345511G0 SULIMEN TABLETS 100MG (SULINDAC) "KOJAR"(鋁箔/膠箔) 2.00

AC34553100 NICARPINE S.C. TABLETS 20MG (NICARDIPINE) "P.L" 2.01

AC34556100 SOU-AN CAPSULES "CHINTENG" 1.50

AC34557100 ZU-U TABLETS 100MG "CHINTENG" (BENZARONE) 2.79

AC34559100 KETOTIFEN TABLETS 1MG "CHINTENG" 1.54

AC345591G0 KETOTIFEN TABLETS 1MG "CHINTENG"(鋁箔/膠箔) 2.00

AC34564100 LIVER CHOLINE S.C. TABLETS "EVEREST" 1.50

AC345641G0 LIVER CHOLINE S.C. TABLETS "EVEREST"(鋁箔/膠箔) 2.00

Page 144: 附件二 藥品給付品項暨支付標準表

AC34567209 GOODGEN INJECTION 20MG/ML "T.F." 16.90

AC34567212 GOODGEN INJECTION 20MG/ML "T.F." 16.90

AC34569329BESONG SCALP SOLUTION 1MG/ML ''SINPHAR''(BETAMETHASONE)

31.80

AC34569340BESONG SCALP SOLUTION 1MG/ML ''SINPHAR''(BETAMETHASONE)

33.50

AC34569345BESONG SCALP SOLUTION 1MG/ML ''SINPHAR''(BETAMETHASONE)

51.00

AC34575100 SUCRATE TABLETS 500MG (SUCRALFATE) "KOJAR" 1.50

AC345751G0 SUCRATE TABLETS 500MG (SUCRALFATE) "KOJAR"(鋁箔/膠箔) 2.00

AC34579216 GARA INJECTION 40MG/ML (GENTAMYCIN SULFATE) 15.50

AC34579229 GARA INJECTION 40MG /ML (GENTAMYCIN SULFATE) 16.50

AC34579299 GARA INJ. 40MG/ML (GENTAMYCIN IULFATE) 1.35

AC34581321 SHUKANG OINTMENT "C.A." 13.90

AC34581329 SHUKANG OINTMENT "C.A." 32.20

AC34581335 SHUKANG OINTMENT "C.A." 51.00

AC34583100 VIRLESS TABLETS 200MG "YUNG SHIN" (ACYCLOVIR) 4.26

AC34584100"EASYING FILM COATED TABLETS 25MG (DIPYRIDAMOLE) "ROOT"

1.50

AC34585500 NYDASIN VAGINAL SUPPOSITORIES "WEIDAR" 5.00

AC34598100 CAPTROL TABLET 25MG (CAPTOPRIL) "PURZER" 1.50

AC345981G0 CAPTROL TABLET 25MG (CAPTOPRIL) "PURZER" 2.00

AC34608100 EULICA TABLETS 50MG (NICAMETATE) "S.D." 1.50

AC34610100 RELAC TABLETS 5MG (BUSPIRONE) "UNION" 1.50

AC34613100 "MODRON TABLETS 50MG (ORPHENADRINE) ""TAI YU""" 1.50

AC34621100 GLUTROL TABLET 5MG (GLIPIZIDE) "PURZER" 1.50

AC346211G0 GLUTROL TABLET 5MG (GLIPIZIDE) "PURZER" 2.00

AC34626209 MECO B12 INJECTION 0.5MG/ML (MECOBALAMIN) "ORIENTAL" 15.00

AC34626212 MECO B12 INJECTION 0.5MG/ML (MECOBALAMIN) "ORIENTAL" 15.00

AC34633100 MANTA 100MG CAPSULES (AMANTADINE) "C.H." 3.77

AC34634100 KETOZEN 1MG TABLETS (KETOTIFEN)"S.L." 1.54

AC34635100 DERCON 10MG TABLETS (DEMPERIDONE) "YUNG CHI" 1.50

AC34637100 BAFEN 10MG TABLETS (BACLOFEN) 1.50

AC34641100 LEZECON CAPSULES 30MG "Y.C." (TIMEPIDIUM) 2.55

AC34643421 GENDERON OPHTHALMIC SOLUTION "PATRON" 20.00

AC34643429 GENDERON OPHTHALMIC SOLUTION "PATRON" 49.70

AC34648209 LOMANDOLE FOR INJECTION "GENTLE" (CEFAMANDOLE) 0.00

AC34648212 LOMANDOLE FOR INJECTION "GENTLE"(CEFAMANDOLE) 0.00

AC34648277 LOMANDOLE FOR INJECTION "GENTLE" (CEFAMANDOLE) 0.00

AC34654151 LOSOLVAN 3MG/ML SOLUTION (AMBROXOL) 25.00

AC34654157 LOSOLVAN 3MG/ML SOLUTION(AMBROXOL) 50.00

AC34658100 ME DROLINE 50MG S.C. TABLETS "C.H." (MEBHYDROLIN) 1.50

AC34660345 SPORTON GEL 100MG/GM "F.B" 84.00

AC34670100 FOLACIN F.C. TABLETS 5MG (FOLIC ACID) "JOHNSON" 1.50

AC346701G0FOLACIN F.C. TABLETS 5MG (FOLIC ACID) "JOHNSON" (鋁箔/膠

箔)2.00

AC34727100 MEGEJOHN TABLETS 40MG 8.90

AC34764500 DICLOFEN SUPPOSITORIES 12.5MG (DICLOFENAC)"H.S" 5.00

Page 145: 附件二 藥品給付品項暨支付標準表

AC34799100 MEDRONE TABLETS 10MG 2.63

AC34804100 "Iprofen Tablets 400mg ""MACRO"" (Ibuprofen)" 1.50

AC34805100 SUTOLIN TABLETS 250MG (NAPROXEN) "S.D." 1.50

AC348051G0 SUTOLIN TABLETS 250MG (NAPROXEN) "S.D."(鋁箔/膠箔) 2.00

AC34806100FORPHEN FILM COATED TABLETS 100MG (FLURBIPROFEN) "YUNG

SHIN"2.49

AC34811100 LOPERADINE CAPSULES 2MG "EVEREST" (LOPERAMIDE) 1.50

AC34821321 AMELON CREAM "EVEREST" 10.50

AC34821329 AMELON CREAM "EVEREST" 18.80

AC34822100 TINIZOLE F.C. TABLETS 500MG (TINIDAZOLE) "JOHNSON" 2.09

AC34824100 URIDRON F.C. TABLETS 200MG (FLAVOXATE) "JOHNSON" 3.74

AC34829100 BENKORINE TABLETS 20MG (BENPROPERINE) "PFOSHEN" 1.50

AC34834330 ISUCON CREAM "PATRON" 37.90

AC34854100 MACALOL SOFT CAPSULES 0.25UG "F.M." 2.16

AC34859100 PACOALON CAPSULES "H.S." 1.50

AC348591G0 PACOALON CAPSULES "H.S."(鋁箔/膠箔) 2.00

AC34862100 AMSOL TABLETS 30MG "Y.Y." (AMBROXOL) 1.50

AC348621G0 AMSOL TABLETS 30MG "Y.Y." (AMBROXOL)(鋁箔/膠箔) 2.00

AC34880100 CAPTOLIN TABLETS 25MG (CAPTOPRIL) "KOJAR" 1.50

AC348801G0 CAPTOLIN TABLETS 25MG (CAPTOPRIL) "KOJAR"(鋁箔/膠箔) 2.00

AC34883329 CLODAI CREAM "CHINTENG" 32.20

AC34885100 ERYTHROMYCIN ETHYLSUCCINATE CAPSULES 250MG "P.L." 1.77

AC34893100 GLIMICON TABLETS 80MG "Y.C." (GLICLAZIDE) 1.50

AC34896100 "LIME TABLETS 0.25MG (TRIAZOLAM) ""H.S.""" 1.88

AC34898100"VOLTON ENTERIC-COATED TABLETS 50MG (DICLOFENAC)

""H.S."""1.50

AC348981G0"VOLTON ENTERIC-COATED TABLETS 50MG (DICLOFENAC)

""H.S.""(鋁箔/膠箔)"2.00

AC34900100 DOXYCYCLINE CAPSULES 100MG "P.L." 1.50

AC34901100 COLISTIN SULFATE CAPSULES 1,000,000 U "P.L" 6.20

AC34904139MYCOSTATIN FOR ORAL SUSPENSION 100,000 UNITS/ML

(NYSTATIN)98.00

AC34911329 DERMOLEX CREAM 0.5MG/GM (CLOBETASOL)"PURZER" 13.70

AC34911338 DERMOLEX CREAM 0.5MG/GM (CLOBETASOL)"PURZER" 41.90

AC34921321 ISO COSAN CREAM "PFOSHEN" 0.00

AC34921329 ISO COSAN CREAM "PFOSHEN" 22.30

AC34922100 GLIN TABLETS 2.5MG (TERBUTALINE SULFATE) 1.50

AC34924100 FENOL TABLETS 2.5MG "CHINTENG"(FENOTEROL) 1.50

AC34927100 TICLOUD F.C. TABLETS 100MG 3.53

AC34944100 "LISEIPIN F.C. TABLETS ""ROOT"" 1.50

AC34952100 HAUANMIN TABLETS 0.25MG "CHIN TENG" (TRIAZOLAM) 1.88

AC349521G0HAUANMIN TABLETS 0.25MG (TRIAZOLAM)"CHIN TENG")(鋁箔/膠

箔)2.00

AC34957421 FULONE 0.1% EYE DROPS (FLUOROMETHOLONE) 12.40

AC34957429 FULONE 0.1% EYE DROPS (FLUOROMETHOLONE) 51.00

AC34966321 CLOSOL 0.05% CREAM (CLOBETASOL PROPIONATE) "CHEN TA" 11.90

AC34966323 CLOSOL 0.05% CREAM (CLOBETASOL PROPIONATE) "CHEN TA" 12.80

AC34966324 CLOSOL 0.05% CREAM (CLOBETASOL PROPIONATE) "CHEN TA" 12.80

Page 146: 附件二 藥品給付品項暨支付標準表

AC34966329 CLOSOL 0.05% CREAM (CLOBETASOL PROPIONATE) "CHEN TA" 13.70

AC34966335 CLOSOL 0.05% CREAM "CHEN TA"(CLOBETASOL PROPIONATE) 24.80

AC34966338 CLOSOL 0.05% CREAM (CLOBETASOL PROPIONATE) "CHEN TA" 41.90

AC34966340 CLOSOL 0.05% CREAM (CLOBETASOL PROPIONATE) "CHEN TA" 61.00

AC34969100 SERECIN CAPSULES 10MG "YY" (OXAZOLAM) 1.52

AC34978500 DICLOPHEN SUPPOSITORY 12.5MG (DICLOFENAC) "DTS" 5.00

AC34979100 "DERZIQU TABLETS 400MG (CIMETIDINE) ""M.T.""" 1.50

AC349791G0 "DERZIQU TABLETS 400MG (CIMETIDINE) ""M.T.""(鋁箔)" 2.00

AC34980500 DICLOPHEN SUPPOSITORY 25MG "DTS" 5.00

AC34981100 BENMARONE TABLETS 50MG 1.50

AC34986100 "CUNTONG TABLETS 20MG (PIROXICAM) ""ROOT""" 1.50

AC35009100 OXYTYNIN TABLETS 5MG "CHINETENG" (OXYBUTYNIN) 2.12

AC35011100 "BUSP TABLETS 10MG (BUSPIRONE) ""H.S.""" 2.83

AC35035316 VIRUN CREAM 50MG/GM (ACYCLOVIR) "H.S." 17.30

AC35035321 VIRUN CREAM 50MG/GM (ACYCLOVIR) "H.S." 41.10

AC35049212 UFO POWDER FOR INJECTION (FOSFOMYCIN) 187.00

AC35049219 UFO POWDER FOR INJECTION (FOSFOMYCIN) 305.00

AC35055321 BECYLIC OINTMENT 10.90

AC35055329 BECYLIC OINTMENT 19.50

AC35055335 BECYLIC OINTMENT 52.00

AC35055338 BECYLIC OINTMENT 68.00

AC35060100 AMGICOL 30MG TABLETS (AMBROXOL) "ROYAL" 1.50

AC350601G0 AMGICOL 30MG TABLETS (AMBROXOL) "ROYAL"(鋁箔/膠箔) 2.00

AC35065100 BIGAST TABLETS 1000MG "Y.C." (SUCRALFATE) 2.04

AC35068100 MYCOME TABLETS 125MG "SWISS" (MICONAZOLE) 11.40

AC35069100 "Blasec Tablets 5mg ""MACRO"" (Oxybutynin)" 2.12

AC35087100 BENZARONE TABLETS 100MG "C.H." 2.79

AC35088500 VETIN SUPPOSITORIES 12.5MG (DICLOFENAC) "C.C.P.C." 5.00

AC35129100 "SURING TABLETS ""ROOT"" 1.50

AC35140337 TEMENAZOLE CREAM 60.00

AC35140365 TEMENAZOLE CREAM 0.00

AC35146100 SALBUTAN TABLETS 4MG (SALBUTAMOL) 1.50

AC35159100 CIMETIN TABLETS 300MG "N.C.P" (CIMETIDINE) 1.50

AC35160100 PAURAPOL CAPSULES 250MG (METRONIDAZOLE) "J.A." 1.52

AC35163100 SULPIDIN CAPSULES 50MG "J.A." (SULPIRIDE) 1.53

AC35177100 "ROTILIUM 10MG F.C. TABLETS (DOMPERIDONE) ""ROYAL""" 1.50

AC35178100 KETOMIN CAPSULES 1MG "EVEREST" (KETOTIFEN) 1.54

AC35180100 FENOTEC TABLETS 2.5MG (FENOTEROL) "EVEREST" 1.50

AC35182209 CETAZONE INJECTION "S.T." (CEFMETAZOLE) 78.00

AC35182212 CETAZONE INJECTION "S.T." (CEFMETAZOLE) 246.00

AC35182277 CETAZONE INJECTION (CEFMETAZOLE) "S.T." 64.00

AC35183321 KETOCONAZOLE CREAM 20MG/GM "SINPHAR" 11.90

AC35183329 KETOCONAZOLE CREAM 20MG/GM "SINPHAR" 13.10

AC35183335 KETOCONAZOLE CREAM 20MG/GM "SINPHAR" 31.90

AC35183338 KETOCONAZOLE CREAM 20MG/GM "SINPHAR" 38.70

AC35184100"TUSOLOC TABLETS 2.5MG (TERBUTALINE SULFATE) ""MACRO"""

1.50

AC35194100 SULPIRIDE TABLETS 200MG "Y.Y" 1.71

Page 147: 附件二 藥品給付品項暨支付標準表

AC35195100 MELLERZIN SC.TABLETS 100MG (THIORIDAZINE) "P.L." 4.15

AC35213100 SALINE S.C. TABLETS 50MG "EVEREST" (NICAMETATE) 1.50

AC352131G0SALINE S.C. TABLETS 50MG (NICAMETATE) "EVEREST" (90粒/

瓶) (鋁箔/膠箔)2.00

AC35255100 ADEC TABLETS 100MG (MEBENDAZOLE) "EVEREST" 1.50

AC35256100 SULNINE CAPSULES 10MG "EVEREST" (OXAZOLAM) 1.52

AC352561G0 SULNINE CAPSULES 10MG (OXAZOLAM) "EVEREST"(90/瓶) 2.00

AC35266238 GITOSE 20% INJECTION "N.K." (DEXTROSE) 15.00

AC35267238 GITOSE 50% INJECTION (DEXTROSE) ".N.K." 15.00

AC35269209KETOFPAN FOR I.M.INJECTION 50MG (KETOPROFEN) "PANBIOTIC"

15.00

AC35269212KETOFPAN FOR I.M.INJECTION 50MG (KETOPROFEN) "PANBIOTIC"

15.00

AC35278100 UROCON TABLETS 5MG "STANDARD" (OXYBUTYNIN) 2.12

AC35282100 POWEGON F.C.T. 400MG "EVEREST" (CIMETIDINE) 1.50

AC352821G0POWEGON F.C.T. 400MG "EVEREST" (CIMETIDINE) (鋁箔/膠箔)

2.00

AC35285100 "SOONWAY TABLETS 10MG (SCOPOLAMINE) ""ROOT""" 1.50

AC35287321 "AYFUCO CREAM ""ROOT"" 10.50

AC35287329 "AYFUCO CREAM ""ROOT""" 18.80

AC35287330 "AYFUCO CREAM ""ROOT"" 24.10

AC35287335 AYFUCO CREAM "ROOT" 30.40

AC35287338 AYFUCO CREAM 32.60

AC35291212 FEBIN INJECTION 25MG/ML "TAI YU"(KETOPROFEN) 15.00

AC35336100 URINSU TABLETS 200MG (FLAVOXATE)"YY" 3.74

AC35355100"PARTANE TABLETS 5MG ""MACRO"" (TRIHEXYPHENIDYL

HYDROCHLORIDE)"1.50

AC35363338 MYCOSON EXTERNAL SOLUTION 10MG/ML "S.Y." (BIFONAZOLE) 85.00

AC35363345 MYCOSON EXTERNAL SOLUTION 10MG/ML "S.Y." (BIFONAZOLE) 123.00

AC35365100 GENOLIN TABLETS 10MG "YY" (DOMPERIDONE) 1.50

AC353651G0 GENOLIN TABLETS 10MG "YY" (DOMPERIDONE)(鋁箔/膠箔) 2.00

AC35366135 FUNWIHU SUSPENSION 20MG/ML (CIMETIDINE) "CHEN TA" 13.40

AC35366165 FUNWIHU SUSPENSION 20MG/ML (CIMETIDINE) "CHEN TA" 0.00

AC35367100 WESIPIN F.C.TABLETS 100MG "EVEREST" (ATENOLOL) 1.51

AC353671G0WESIPIN F.C.TABLETS 100MG (ATENOLOL) "EVEREST"(鋁箔/膠

箔)2.00

AC35370100 DECORON TABLETS 0.5MG "EVEREST" (DEXAMETHASONE) 1.50

AC35391321 ACLOVIR CREAM 500MG/GM (ACYCLOVIR) "SINPHAR" 41.10

AC35398100 TRIVEMIN TABLETS 1.56

AC35399100 "NAPROXEN TABLETS 500MG ""ASTAR""" 2.95

AC35410100 "NAPROXEN TABLETS 250MG ""ASTAR""" 1.50

AC35411100 "CIMETIDINE TABLETS 400MG ""ASTAR""" 1.50

AC35415100 BEROASMA TABLETS 2.5MG (FENOTEROL) "CHEN TA" 1.50

AC35417100 GINTEC FILM COATED TABLET 1.71

AC354171G0 GINTEC FILM COATED TABLET(鋁箔/膠箔) 2.00

AC35420100 SMARTEN TABLETS 25MG "H.S." (CAPTOPRIL) 1.50

AC354201G0 SMARTEN TABLETS 25MG (CAPTOPRIL)"H.S."(鋁箔/膠箔) 2.00

AC35422100 BACLOFEN TABLETS 10MG "C.H." 1.50

Page 148: 附件二 藥品給付品項暨支付標準表

AC35424127 CHOLES POWDER "S.D." (CHOLESTYRAMINE RESIN) 15.40

AC35430209 BINISON INJ. 50MG/ML "SWISS"(HALOPERIDOL) 135.00

AC35430216 BINISON INJ. 50MG/ML "SWISS"(HALOPERIDOL) 312.00

AC35434100 BOKENSHI CAPSULES 150MG "Y.K." 1.52

AC35439100 "ANTIFAT TABLETS 200MG (BEZAFIBRATE) ""ASTAR""" 0.00

AC35441151 JINCOLIN SYRUP "CHEN TA" 25.00

AC35445100TINSAN F.C. TABLETS 9.6MG "CHINTENG"

(GINKGOFLAVONGLYCOSIDE)1.71

AC35455151 SALBUTAMOL SYRUP 0.4MG/ML "C.H." 0.00

AC35461100 LOTAN TABLETS 3MG "W.S." 1.53

AC354611G0 LOTAN TABLETS 3MG "W.S."(鋁箔/膠箔) 2.00

AC35462100 "SEGININE TABLETS 5MG (SELEGILINE) ""MACRO""" 2.46

AC35467100 "NEWIN TABLETS 5MG (OXYBUTYNIN) ""ROOT""" 2.12

AC35477100 "PADALIN TABLETS 100MG ""MACRO"" (MEBEVERINE)" 1.75

AC354771G0 PADALIN TABLETS 100MG "MACRO"(MEBEVERINE)(鋁箔/膠箔) 2.00

AC35486100 KETOFPAN CAPSULE 100MG (KETOPROFEN) "PANBIOTIC" 2.98

AC35487338 KETOZOL CREAM 2% "WEIDAR" (KETOCONAZOLE) 38.70

AC35488221 SONTAC INJECTION 10MG/ML "T.F." 0.00

AC35502100 BACLOFEN TABLETS 5MG "C.H." 1.50

AC35506100EYZU F.C. TABLETS 0.625MG "CHINTENG" (CONJUGATED

ESTROGENS)1.85

AC355061G0EYZU F.C. TABLETS 0.625MG (CONJUGATED ESTROGENS)

"CHINTENG")(鋁箔/膠箔)2.00

AC35514100 FUJEN F.C. TABLETS 500MG (TINIDAZOLE) "S.D." 0.00

AC35515100MYLIN F.C. TABLETS 9.6MG (GINKGOFLAVON GLYCOSIDE) "S.D."

1.71

AC35544321 V.F. CREAM 50MG/GM (ACYCLOVIR) "SWISS" 41.10

AC35597421 TROPICAMIDE OPHTHALMIC SOLUTION 4MG/ML "WU-FU" 47.50

AC35634100 PARAMINE CAPSULE "EVEREST" 1.50

AC356341G0 PARAMINE CAPSULE "EVEREST"(鋁箔/膠箔) 2.00

AC35638100 BADUSON F.C.TABLETS 200MG (FLAVOXATE) "C.C.P.C" 3.74

AC35639309 "N.S. IRRIGATION ""Y.F.""" 24.10

AC35639312 "N.S. IRRIGATION ""Y.F.""" 55.00

AC35639316 "N.S. IRRIGATION ""Y.F.""" 68.00

AC35639377 "N.S. IRRIGATION ""Y.F.""" 18.40

AC35641238 ANVITA INJECTION "ASTAR" 15.00

AC35649100 "IPROFEN 400MG F.C.T ""ROYAL""" 1.50

AC356491G0 "IPROFEN 400MG F.C.T ""ROYAL""(鋁箔/膠箔)" 2.00

AC35651151 IBUPROFEN SYRUP 20MG/ML (IBUPROFEN) "C.H." 25.00

AC35656100 "SULPIRIDE TABLETS 200MG ""ASTAR""" 1.71

AC35668209 "DIPHENIDOL INJECTION 20MG/ML ""S.Y.""" 15.00

AC35670100 GLIPIN TABLET 5MG (GLIPIZIDE) "SWISS" 1.50

AC35671209 FLUCAN INJECTION 25MG/ML (FLUPAHEAZINE) "SWISS" 78.00

AC35671219 FLUCAN INJECTION 25MG/ML (FLUPAHEAZINE) "SWISS" 235.00

AC35672100 SULAN TABLETS 100MG "Y.K." 2.49

AC35678100 WECOLI TABLET 10MG "YY"(BETHANECHOL CHLORIDE) 1.50

AC356781G0WECOLI TABLET 10MG"YY"( (BETHANECHOL CHLORIDE) (鋁箔/膠

箔)2.00

Page 149: 附件二 藥品給付品項暨支付標準表

AC35679212 KETOFEN INJECTION 50MG/ML (KETOPROFEN) "SWISS" 15.00

AC35691100 Binin-U Tablet 10 mg (Haloperidol) 2.33

AC35692100DOXYMYCIN ENTERIC COATED CAPSULES 100MG "YUNG

SHIN"(DOXYCYCLINE)1.50

AC356921G0DOXYMYCIN ENTERIC COATED CAPSULES 100MG "YUNG SHIN"

(DOXYCYCLINE) (鋁箔/膠箔)2.00

AC35696329 FREE GEL 7.5MG/GM (METRONIDAZOLE) "SWISS" 27.30

AC35696335 FREE GEL 7.5MG/GM "SWISS"(METRONIDAZOLE) 38.60

AC35696338 FREE GEL 7.5MG/GM (METRONIDAZOLE) "SWISS" 57.00

AC35697335 ZUMELIN CREAM 20MG/GM "H.S." (KETOCONAZOLE) 31.90

AC35697338 ZUMELIN CREAM 20MG/GM "H.S."(KETOCONAZOLE) 38.70

AC35702100 FRAGIVIX TABLETS 100MG (BENZARONE) "S.D." 2.79

AC35705100 BONSTAN F.C. TABLET 500MG "EVEREST" (MEFENAMIC ACID) 1.50

AC357051G0BONSTAN F.C. TABLET 500MG (MEFENAMIC ACID) "EVEREST"(鋁

箔/膠箔)2.00

AC35788321 NYCINDIN CREAM 13.90

AC35788330 NYCINDIN CREAM 20.20

AC35788335 NYCINDIN CREAM 29.70

AC35788336 NYCINDIN CREAM 29.70

AC35795100 GLICLA TABLETS 80MG "CHINTENG" (GLICLAZIDE) 1.50

AC357951G0GLICLA TABLETS 80MG "CHINTENG" (GLICLAZIDE) (鋁箔/膠箔)

2.00

AC35806100 GLUPIZIDE TABLETS 5MG (GLIPIZIDE)"S.D." 1.50

AC35817100 BECANTEX S.C.TABLET 30MG "C.H." (SODIUM DIBUNATE) 1.50

AC358171G0BECANTEX S.C.TABLET 30MG "C.H." (SODIUM DIBUNATE)(鋁箔/

膠箔)2.00

AC35831209 CETALIN FOR INJECTION (CEFTRIAXONE)"CHI SHENG" 82.00

AC35831277 CETALIN FOR INJECTION (CEFTRIAXONE)"CHI SHENG" 0.00

AC35835100 MEDNIN TABLETS 4MG "H.S." (METHYLPREDNISOLONE) 1.53

AC358351G0MEDNIN TABLETS 4MG (METHYLPREDNISOLONE)"H.S."(鋁箔/膠箔)

2.00

AC35836100 CAPROINE TABLETS 50MG "ROYAL" (CAPTOPRIL) 2.94

AC35838100 GEMBIT CAPSULES 300MG (GEMFIBROZIL) 1.50

AC358381G0 GEMBIT CAPSULES 300MG (GEMFIBROZIL)(鋁箔/膠箔) 2.00

AC35844100 SEPHROS CAPSULES 500MG (CEPHRADINE) "YUNG SHIN" 2.72

AC35845100 M.F.N. F.C.T. 500MG (MEFENAMIC ACID) "C.H." 1.50

AC35868100 MINOCYCLINE CAPSULE 100MG "CCPC" 5.90

AC35869329 EFUCON GEL 7.5MG/GM (METRONIDAZOLE) 27.30

AC35869330 EFUCON GEL 7.5MG/GM (METRONIDAZOLE) 34.50

AC35869335 EFUCON GEL 7.5MG/GM (METRONIDAZOLE) 38.60

AC35878100 TONLAEN CAPSULE 300MG "CHEN TA" (FENBUFEN) 2.08

AC35888321 SALINSE OINTMENT "GCPC" 20.60

AC35888329 SALINSE OINTMENT "GCPC" 34.30

AC35888335 SALINSE OINTMENT "GCPC" 39.70

AC35890100 CLINDAMYCIN HYDROCHLORIDE 150MG CAP "YY" 1.50

AC35891100 AJULATE SOFT CAPSULE 10MG "F.M." (NIFEDIPINE) 1.81

AC35912100 LITION CAPSULES 10MG (PHENOXYBENZAMINE HYDROCHLORIDE) 2.15

AC35929209 LISACEF FOR INJECTION (CEPHRADINE) 1G "S.T." 25.00

Page 150: 附件二 藥品給付品項暨支付標準表

AC35929277 LISACEF FOR INJECTION (CEPHRADINE) 500MG "S.T." 0.00

AC35955100 S.C.F. TABLET 1000MG "C.H." (SUCRALFATE) 2.04

AC35960100 "CLOZE TABLETS 100MG (BENZARONE) ""ROOT""" 2.79

AC35961100 SULMATYL TABLETS 100MG (SULPIRIDE)"P.L" 1.71

AC35963100 SULMATYL TABLETS 200MG (SULPIRIDE)"P.L." 1.71

AC35974100 P.U.N.F.C.TABLET 400MG "C.H." (CIMETIDINE) 1.50

AC35977321 "CYCLOVIR CREAM 50MG/GM (ACYCLOVIR) ""S.Y.""" 41.10

AC35977329 "CYCLOVIR CREAM 50MG/GM ""S.Y."" (ACYCLOVIR)" 42.90

AC35981100 AMBRON TABLET 30MG "F.Y"(AMBROXOL) 1.50

AC359811G0 AMBRON TABLET 30MG (AMBROXOL) "F.Y"(鋁箔/膠箔) 2.00

AC35986100 DEGOUT TABLETS 50MG(BENZBROMARONE)"H.S." 1.50

AC359861G0 DEGOUT TABLETS 50MG (BENZBROMARONE) "H.S."(鋁箔/膠箔) 2.00

AC35989100 LIBRAX S.C. TABLETS 0.00

AC35991209 ROLES POWDER FOR INJECTION 1GM "GENTLE" (CEPHALEXIN) 61.00

AC35996100PERTIAZEM TABLETS 30MG (DILTIAZEM HYDROCHLORIDE)"ROYAL"

1.50

AC359961G0PERTIAZEM TABLETS 30MG (DILTIAZEM HYDROCHLORIDE)"ROYAL"

(鋁箔/膠箔)2.00

AC35997100 MECO 0.5MG CAPSULES. (MECOBALAMIN) "S.L" 1.55

AC36004100 "IBUPROFEN TABLETS 400MG ""ASTAR""" 1.50

AC36008100 MESTINON S.C. TABLETS 60MG (PYRIDOSTIGMINE BROMIDE) 4.73

AC36014238 0.45% SODIUM CHLORIDE INJECTION "Y.F." 15.00

AC36014277 "0.45% SODIUM CHLORIDE INJECTION ""Y.F.""" 25.00

AC36031321 BETAGEN CREAM 12.80

AC36031329 BETAGEN CREAM 14.90

AC36031335 BETAGEN CREAM 19.60

AC36031338 BETAGEN CREAM 19.60

AC36034100 "SILYMARIN CAPSULES 70MG ""TAI YU""" 1.50

AC36047100 B.B. CAP. 150MG (CLINDAMYCIN) 1.50

AC360471G0 B.B. CAP. 150MG (CLINDAMYCIN)(鋁箔/膠箔) 2.00

AC36049109 BABYATE ORAL ELECTROLYTE MAINTENANCE SOLUTION 0.00

AC36049165 BABYATE ORAL ELECTROLYTE MAINTENANCE SOLUTION 28.60

AC36049177 BABYATE ORAL ELECTROLYTE MAINTENANCE SOLUTION 45.00

AC36060100 DE-SPASM CAPSULES 30MG "H.S." (TIMEPIDIUM BROMIDE) 2.55

AC36069100"MOREN E.F.C. TABLET 50MG (DICLOFENAC SODIUM) ""ROYAL"""

1.50

AC360691G0"MOREN E.F.C. TABLET 50MG (DICLOFENAC SODIUM) ""ROYAL""

(鋁箔/膠箔)"2.00

AC36072100 CLEDOMYCIN CAPSULES 300MG "ASTAR" (CLINDAMYCIN) 2.80

AC36083100 DUBLECON TABLETS "EVEREST" 1.50

AC36084421 CORKELIN ORAL GEL 1MG/GM "M.S"(TRIAMCINOLONE) 28.40

AC36084429 CORKELIN ORAL GEL 1MG/GM "M.S"(TRIAMCINOLONE) 59.00

AC36092329 XAMACID CREAM 29.10

AC36098100 A.P.N. TABLETS 100MG "C.H." (ALLOPURINOL) 1.50

AC36099100 DICLOFENAC E.F.C. TABLETS 25MG "KOJAR" 1.50

AC360991G0 DICLOFENAC E.F.C. TABLETS 25MG "KOJAR"(鋁箔/膠箔) 2.00

AC36105100 NAPOSIN C.R. TABLETS 750MG (NAPROXEN) 3.63

AC36129100 ATENOLOL F.C. TABLETS 50MG "JOHNSON" 1.50

Page 151: 附件二 藥品給付品項暨支付標準表

AC36132100 BLOODNONE CAPSULES 250MG (TRANEXAMIC ACID) "EVEREST" 1.50

AC36151100 MUBROXOL TABLETS 30MG (AMBROXOL) "C.C.P.C" 1.50

AC361511G0MUBROXOL TABLETS 30MG (AMBROXOL) "C.C.P.C" (鋁箔/膠箔)

2.00

AC36157100 "URIMARONE TABLETS 50MG (BENZBROMARONE) ""ASTAR""" 1.50

AC36160110 AMOLIN POWDER FOR ORAL SUSPENSION (AMOXICILLIN) 31.00

AC36162100 PIROCAM CAPSULES 20MG "KOJAR" (PIROXICAM) 1.50

AC361621G0 PIROCAM CAPSULES 20MG "KOJAR" (PIROXICAM)(鋁箔/膠箔) 2.00

AC36170212 EMELIME INJECTION 5MG/ML "T.F." 15.00

AC36172157 SECODRINE-C SYRUP 25.80

AC36174321 "BETAGEN CREAM ""GCPC""" 12.80

AC36174329 BETAGEN CREAM 10G 14.90

AC36174335 "BETAGEN CREAM ""GCPC""" 19.60

AC36174338 BETAGEN CREAM"GCPC"20GM 19.60

AC36178100 PIROCAM CAPSULES 10MG "KOJAR" 1.50

AC361781G0 PIROCAM CAPSULES 10MG "KOJAR" (PIROXICAM)(鋁箔/膠箔) 2.00

AC36181321 "VACORT CREAM ""GCPC""" 13.90

AC36181329 "VACORT CREAM""GCPC""" 22.30

AC36181335 "VACORT CREAM ""GCPC""" 39.30

AC36181338 "VACORT CREAM ""GCPC""" 60.00

AC36184100 PICKTON TABLET 1.50

AC36188100 B.B CAPSULE 300MG (CLINDAMYCIN ) 2.80

AC36192100 NIXO TABLETS 10MG "H.S." (NICERGOLINE) 4.38

AC36195100 ZUSENLU TABLETS 12MG "CHINTENG"(BETAHISTINE) 1.50

AC361951G0ZUSENLU TABLETS 12MG "CHINTENG"(BETAHISTINE)(鋁箔/膠箔)

2.00

AC36201100 METFORMIN TABLET 500MG "LITA" 1.50

AC362011G0 METFORMIN TABLET 500MG "LITA"(鋁箔/膠箔) 2.00

AC36204100 BICANOL TABLETS 500MG "CHINTENG" (METFORMIN) 1.50

AC362041G0BICANOL TABLETS 500MG (METFORMIN) "CHINTENG"(鋁箔/膠箔)

2.00

AC36214100 CITAMET F.C. TABLETS 400MG "Y.C." (CIMETIDINE) 1.50

AC362141G0CITAMET F.C TABLETS 400MG "YC" (CIMETIDINE)(鋁箔/膠箔)

2.00

AC36215100 PARKRYL TABLETS "M.S."(SELEGILINE) 2.46

AC36216100 CHIWEGON TABLETS "EVEREST" 1.50

AC36237100LINTON F.C. TABLETS 10MG "KOJAR" (HYOSCINE BUTYLBROMIDE)

1.50

AC362371G0LINTON F.C. TABLETS 10MG "KOJAR" (HYOSCINE

BUTYLBROMIDE)(鋁箔/膠箔)2.00

AC36240100 "GLIZIDE TABLETS 80MG ""H.S."" (GLICLAZIDE)" 1.50

AC362401G0"GLIZIDE TABLETS 80MG ""H.S."" (GLICLAZIDE) (鋁箔/膠箔)"

2.00

AC36241100 "TIMEPIN TABLETS 30MG ""H.S."" (TIMEPIDIUM)" 2.55

AC36252100 "NITRAZEPAM TABLETS 5MG ""ASTAR""" 1.50

AC36266100 MELICIN CAPSULES 100MG (MINOCYCLINE) "H.S." 5.90

AC36267100 ANAZIN TABLETS 50MG (FLURBIPROFEN) "SHOU CHAN" 1.50

Page 152: 附件二 藥品給付品項暨支付標準表

AC362671G0ANAZIN TABLETS 50MG (FLURBIPROFEN) "SHOU CHAN" (鋁箔/膠

箔)2.00

AC36280100 REPININ TABLETS 5MG (OXYBUTYNIN) 2.12

AC36281100 CYCLIN CAPSULE 100MG (MINOCYCLINE) "PURZER" 5.90

AC36283100 BECLOFEN TABLETS 10MG "Y.Y." 1.50

AC36312100TOCOLIN F.C.T. 30MG "EVEREST" (CARBETAPENTANE CITRATE)

1.50

AC36315321 CLOBETASOL CREAM 0.5MG/GM "SINPHAR" 11.90

AC36315324 CLOBETASOL CREAM 0.5MG/GM "SINPHAR" 12.80

AC36315329 CLOBETASOL CREAM 0.5MG/GM "SINPHAR" 13.70

AC36315340 CLOBETASOL CREAM 0.5MG/GM "SINPHAR" 61.00

AC36322100 ETHOS CAPSULES 100MG (MECLOFENAMIC ACID) 2.18

AC36330151 "Purzer" Ventol Liquid 5.34mg/mL (Theophylline) 25.00

AC36332143 GIKO DROPS 9.6MG (GYNKGOFLAVONGLYCOSIDE) "H.S." 176.00

AC36338100 HEMOBEND TABLETS 100MG "H.S." (BENZARONE) 2.79

AC36345255 PROXACIN INFUSION SOLUTION 2MG/ML (CIPROFLOXACIN) 0.00

AC363491G0 UFORMIN TABLETS 500MG (鋁箔/膠箔) 2.00

AC36350500 BISADYL SUPPOSITORIES 10MG (BISACODYL) "MEIDER" 5.00

AC36356100 TIDACT CAPSULES 300MG (CLINDAMYCIN) 2.80

AC36357329 SAN-TON GEL 100MG/GM "CHINTENG" (ETOFENAMATE) 0.00

AC36360100 VORTAGEN E.C. TAB. 50MG "EVEREST" (DICLOFENAC) 1.50

AC36365209 CETAXIME FOR INJECTION 113.00

AC36365212 CETAXIME FOR INJECTION 387.00

AC36365265 CETAXIME FOR INJECTION 83.00

AC36365277 CETAXIME FOR INJECTION 0.00

AC36367100 AMITON TABLETS "H.S." 1.88

AC36370100 CLONICE TABLETS 5MG"T.F." (OXYBUTYNIN) 2.12

AC36385100 MESCO CAPSULES 500UG (MECOBALAMIN) "YY" 1.55

AC363851G0 MESCO CAPSULES 500UG "YY"(MECOBALAMIN)(鋁箔/膠箔) 2.00

AC36389100 LEGAFEN TABLETS "Y.C" (BACLOFEN) 1.50

AC36395100 GLIGLUCON TABLETS 5MG (GLIPIZIDE) "ROYAL" 1.50

AC363951G0 GLIGLUCON TABLETS 5MG (GLIPIZIDE) "ROYAL"(鋁箔/膠箔) 2.00

AC36396100 MENCHUAN TABLET 100MG (TICLOPIDINE) 3.53

AC36399100 "SILYGEN-F.S.C. TABLETS 35MG ""H.C."" (SILYMARIN) " 1.50

AC36402209 MENITO INJECTION 50MG/ML (DIMENHYDRINATE) "ORENTAL" 15.00

AC36403100 STAYBAN TAB. 50MG "YC" (FLURBIPROFEN) 1.50

AC364031G0 STAYBAN TABLETS 50MG“Y.C.” (FLURBIPROFEN(鋁箔/膠箔) 2.00

AC36410100 MODONE TABLETS 10MG "EVEREST" (DOMPERIDONE) 1.50

AC364101G0MODONE TABLETS 10MG "EVEREST" (DOMPERIDONE)(鋁箔/膠

箔)2.00

AC36413329SEU-SU CREAM 1MG/GM "CHINTENG" (TRIAMCINOLONE ACETONIDE)

12.10

AC36420209 SISOGEN INJECTION 50MG/ML (SISOMICIN) "GENTLE" 0.00

AC36420212 SISOGEN INJECTION 50MG/ML (SISOMICIN) "GENTLE" 0.00

AC36422100 MEPRIM TABLETS 100MG. (TRIMETHOPNIM) "JOHNSON" 1.50

AC36425100 KERFENMYCIN CAPSULES 500MG (CEFACLOR) 8.00

AC36426100 KERFENMYCIN CAPSULES 250MG (CEFACLOR) 3.35

AC36427100 "BACLOFEN TABLETS 10MG ""ASTER""" 1.50

Page 153: 附件二 藥品給付品項暨支付標準表

AC36430100 COAN CAPSULES 250MG "S.C." (NIFLUMIC ACID) 2.36

AC36431100 GLIBETIN TABLETS 5MG (GLIPIZIDE)"JOHNSON" 1.50

AC36454100 MEZOLIN CAPSULES "EVEREST" 1.50

AC364541G0 MEZOLIN CAPSULES "EVEREST"(鋁箔/膠箔) 2.00

AC36469212 B. B. INJECTION 150MG/ML (CLINDAMYCIN) 15.00

AC36475100CIRCULON F.C. TABLETS 9.6MG "PBF" (GINKGOFLAVON

GLYCOSIDES)1.71

AC36480100 ANWENIN TABLETS 500MG "C.L." 1.50

AC364801G0 ANWENIN TABLETS 500MG "C.L."(鋁箔/膠箔) 2.00

AC36481312 ANTIVIRS CREAM 50MG/GM 17.30

AC36481317 ANTIVIRS CREAM 50MG/GM 17.30

AC36481321 "ANTIVIRS CREAM 50MG/GM (ACYCLOVIR) ""GCPC""" 41.10

AC36481325 ANTIVIRS CREAM 50MG/GM"GCPC"(ACYCLOVIR) 42.50

AC36481329 ANTIVIRS CREAM 50MG/GM (ACYCLOVIR) "GCPC" 42.90

AC36483100 CLEAROL CAPSULES 300MG "H.S" (GEMFIBROZIL) 1.50

AC364831G0 CLEAROL CAPSULES 300MG "H.S"(GEMFIBROZIL)(鋁箔/膠箔) 2.00

AC36484100 METIPINE TABLETS 300MG "KOJAR"(TRIMETHOPRIM) 2.05

AC36485100 FUKON TABLETS 50MG "KOJAR" (FLURBIPROFEN) 1.50

AC364851G0 FUKON TABLETS 50MG (FLURBIPROFEN)"KOJAR"(鋁箔/膠箔) 2.00

AC36500321 SHU-BA-HANI CREAM "CHINTENG" 24.00

AC36500329 SHU-BA-HANI CREAM"CHINTENG" 29.10

AC36500335 SHU-BA-HANI CREAM"CHINTENG" 54.00

AC36503100 CONAPIN TABLET 1.50

AC365031G0 CONAPIN TABLET(鋁箔/膠箔)(21粒/瓶) 2.00

AC36506100 "SUNPYLON TABLETS 50MG ""MACRO"" (SULPIRIDE)" 1.53

AC365061G0"SUNPYLON TABLETS 50MG ""MACRO"" (SULPIRIDE)(鋁箔/膠箔)"

2.00

AC36508100 OFLOCIN F.C. TABLETS. 100MG (OFLOXACIN) "H.S." 1.58

AC36510209 CEFZONE FOR IM/IV POWDER FOR INJECTION 135.00

AC36510277 CEFZONE FOR IM/IV POWDER FOR INJECTION 94.00

AC36511100 SPASTOLATE TABLETS "NYSCO" 1.50

AC36574110 CERO GRANULES FOR SYRUP 50MG/ML "S.T." (CEFACOLR) 0.00

AC36576477 GENTAX EYE DROPS 3MG/ML "MEDICINE" (GENTAMICIN) 4.00

AC36580100 SUXEN FILM COATED TABLETS 750MG (CIPROFLOXACIN) 39.50

AC36597209TRADOL INJECTION 50MG/ML "GENTLE"(TRAMADOL

HYDROCHLORIDE)0.00

AC36597212TRADOL INJECTION 50MG/ML (TRAMADOL HYDROCHLORIDE)

"GENTLE"0.00

AC36600100 TOWELL TABLETS "EVEREST" 1.50

AC366001G0 TOWELL TABLETS "EVEREST"(鋁箔/膠箔) 2.00

AC36601221"GINTEC INJECTION 0.84MG/ML ""S.Y.""

(GINKGOFLAVONGLYCOSIDE)"25.00

AC36632421SINTROPIC OPHTHALMIC SOLUTION 10MG/ML (TROPICAMIDE)

"SINPHAR"65.00

AC36644100 "ATROGEM TABLETS 200MG(TIAPROFENIC ACID) ""MACRO""" 2.91

AC36654477 FUSONE EYE DROPS 1MG/ML "MEDICINE" (BETAMETHASONE) 4.00

AC36657121 K-CITRATE GRANULES "GENTLE" 6.90

AC36662100 ISCAN F.C. TABLETS 400MG (CIMETIDINE) "S.L" 1.50

Page 154: 附件二 藥品給付品項暨支付標準表

AC36667100 NOCIGEN CAPSULES 100MG "SWISS" (MINOCYCLINE) 5.90

AC36669212 ULCERTIN INJECTION 10MG/ML"SWISS" (FAMOTIDINE) 23.20

AC36669221 ULCERTIN INJECTION 10MG/ML (FAMOTIDINE) "SWISS" 39.40

AC36675100 ELP CAPSULES 50MG (ALPRENOLOL HYDROCHLORIDE) "S.D." 6.60

AC36677100 DALMADORM CAPSULES 30MG (FLURAZEPAM) 3.75

AC36679100 DALMADORM CAPSULES 15MG (FLURAZEPAM) 3.42

AC36693100 LISACEF CAPSULES 250MG (CEPHRADINE) "S.T." 1.72

AC36694406 SINZOLE OPHTHALMIC SOLUTION 4% 4.00

AC36736100 "ROYAMET F.C.TABLETS 400MG (CIMETIDINE) ""ROYAL""" 1.50

AC367361G0"ROYAMET F.C.TABLETS 400MG (CIMETIDINE) ""ROYAL""(鋁箔/

膠箔)"2.00

AC36740212 "KETOFEN-S INJECTION 50MG/ML (KETOPROFEN) ""S.Y.""" 15.00

AC36749100 SOMA CAPSULES "STANDARD" 1.50

AC367491G0 SOMA CAPSULES "STANDARD"(鋁箔/膠箔) 2.00

AC36753100 "SAFE CAPSULES 2MG (LOPERAMIDE) ""TAI YU""" 1.50

AC36757100 COUDE CAPSULES "S.D." 1.50

AC36759151 KOUSULIN SYRUP "M.T" 0.00

AC36759157 KOUSULIN SYRUP "M.T" 0.00

AC36763209 CEFOPIN INJECTION (CEFOPERAZONE) 0.00

AC36763212 CEFOPIN INJECTION (CEFOPERAZONE) 0.00

AC36763277 CEFOPIN INJECTION (CEFOPERAZONE) 0.00

AC36765321 "PRURINON CREAM""M.S" 13.90

AC36765329 PRURINON CREAM "M.S" 32.20

AC36765335 PRURINON CREAM "M.S" 51.00

AC36765338 PRURINON CREAM "M.S" 74.00

AC36768209 TONMEX INJECTION 20MG/ML (PIROXICAM) "PANBIOTIC" 16.90

AC36768212 TONMEX INJECTION 20MG/ML (PIROXICAM) "PANBIOTIC" 16.90

AC36783100 S.N.A. CAPSULES 10MG "C.H." (FLUNARIZINE) 2.66

AC36785100 ASFEN TABLETS 1MG "STANDARD" (KETOTIFEN) 1.54

AC36787338"SILIVERINE CREAM 10MG/GM ""S.Y"" (SILVER SULFADIAZINE)"

32.30

AC36787340 SILIVERINE CREAM 10MG/GM "S.Y." (SILVER SULFADIAZINE) 35.50

AC36787348 SILIVERINE CREAM 10MG/GM "S.Y." (SILVER SULFADIAZINE) 43.70

AC36787363 SILIVERINE CREAM 10MG/GM "S.Y." (SILVER SULFADIAZINE) 139.00

AC36787372 SILIVERINE CREAM 10MG/GM "S.Y." (SILVER SULFADIAZINE) 267.00

AC36787377 SILIVERINE CREAM 10MG/GM "S.Y." (SILVER SULFADIAZINE) 357.00

AC36794100 PROCAL TABLETS 667MG (CALCIUM ACETATE) "PL" 1.58

AC367941G0PROCAL TABLETS 667MG (CALCIUM ACETATE) "PL"(鋁箔/膠箔)

2.00

AC36811212 DUOCER INJECTION 100MG/ML "T.F." 15.00

AC36815100 MINOLINE CAPSULES 100MG "S.T" (MINOCYCLINE) 5.90

AC36816100 ANSOCAINE TABLETS "ASTAR" 1.50

AC36817100 CIMETIDINE TABLET 400MG"T.F." 1.50

AC36820100 METFORMIN TABLETS 500MG "C.H." 1.50

AC368201G0 METFORMIN TABLETS 500MG "C.H."(鋁箔/膠箔) 2.00

AC36824421 "OASIS" FLUOROMETHOLONE OPH. SUSPEN. 0.02% 13.60

AC36824429 "OASIS" FLUOROMETHOLONE OPHTHALMIC. SUSPENSION. 0.02% 53.00

AC36825316 YUTAM CREAM 50MG/GM "YU SHENG"(ACYCLOVIR) 17.30

Page 155: 附件二 藥品給付品項暨支付標準表

AC36836100 CONJUESTROGEN F.C TABLETS 0.625MG 1.85

AC368361G0 CONJUESTROGEN F.C. TABLETS 0.625 MG(鋁箔/膠箔) 2.00

AC36840100 BENDOPA CAPSULES "WEIDAR" 3.34

AC36845100 DECORON F.C. TABLET 0.75MG "EVEREST" (DEXAMETHASONE) 1.50

AC36853100 ACE-CAL TABLETS 667 MG (CALCIUM ACETATE) "MACRO" 0.00

AC36854100"GINKO TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE) ""S.Y."""

1.71

AC36858423AMCICORT IN ORABASE 0.1% (TRIAMCINOLONE ACETONIDE) "CL"

36.70

AC36863500 DOMPER SUPPOSITORIES 10MG (DOMPERIDONE) 5.00

AC36865321 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 26.20

AC36865329 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 45.30

AC36865330 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 45.30

AC36865338 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 152.00

AC36865343 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 207.00

AC36868212 VITAMIN C INJECTION 250MG/ML "Y.Y." 15.00

AC36868221 VITAMIN C INJECTION 250MG/ML "Y.Y." 15.00

AC36869100 FAMODINE F.C. TABLETS 40MG (FAMOTIDINE) "N.K." 3.77

AC36885209 MECOBALAMIN INJECTION 0.5MG/ML "ASTAR" 15.00

AC36885212 MECOBALAMINE INJECTION 0.5MG/ML "ASTAR" 15.00

AC36892100HOU WE MING F.C. TABLETS 200MG "CHINTENG" (CIMETIDINE)

1.50

AC368921G0HOU WE MING F.C. TABLETS 200MG (CIMETIDINE)

"CHINTENG"(鋁箔/膠箔)2.00

AC36907209 PRIDINOL INJECTION 2MG/ML (PRIDINOL MESILATE) "ASTAR" 15.00

AC36915100 URIBENORM TABLETS 100MG "CHEN TA" (BENZBROMARONE) 2.05

AC36926100 VETIN E.C. TABLETS 25MG. (DICLOFENAC) 1.50

AC36927100 VETIN E.C. TABLETS 50MG. (DICLOFENAC) 1.50

AC36940100 MERO CAPSULE 100MG (MINOCYCLINE) "KINGDOM" 5.90

AC36944100 BIPIDEN TABLET 2MG "SWISS"(BIPERIDEN) 1.67

AC369441G0 BIPIDEN TABLET 2MG "SWISS"(BIPERIDEN)(鋁箔/膠箔) 2.00

AC36963321 BENCOGEN CREAM 20.70

AC36963329 BENCOGEN CREAM 23.50

AC36964100 UROBENIN S.C. TABLET 100MG "SWISS" (PHENAZOPYRIDINE) 1.50

AC36966100 CARTIL TABLETS 30MG (DILTIAZEM HYDROCHLORIDE) 1.50

AC369661G0 CARTIL TABLETS 30MG (DILTIAZEM HCL)(鋁箔/膠箔) 2.00

AC36967212 "FEBIN INJECTION 50MG/ML (KETOPROFEN) ""TAI YU""" 15.00

AC36971100 CLINDAMYCIN CAPSULE 300MG "KINGDOM" 2.80

AC37004248CIPROFLO INFUSION SOLUTION 2MG/ML "S.Y." (CIPROFLOXACIN)

206.00

AC37004255CIPROFLO INFUSION SOLUTION 2MG/ML "S.Y." (CIPROFLOXACIN)

450.00

AC37029100 "NIFUROX CAPSULES 200MG (NIFUROXAZIDE) ""H.S.""" 2.30

AC37035100 ROMISTANE CAPSULES 1.50

AC37042329 FLUTHASONE CREAM "CHINTENG" 34.30

AC37053209 PIROXICAM INJECTION 20MG/ML "Y.Y" 16.90

AC37053212 PIROXICAM INJECTION 20MG/ML "Y.Y" 16.90

AC37054100 STOGAMET TABLETS 400MG "SWISS" (CIMETIDINE) 1.50

Page 156: 附件二 藥品給付品項暨支付標準表

AC370541G0STOGAMET TABLETS 400MG "SWISS" (CIMETIDINE)(鋁箔/膠箔)

2.00

AC37062209PANCOBAMIN INJECTION 0.5MG/ML (MECOBALAMIN) "PANBIOTIC"

15.00

AC37062221PANCOBAMIN INJECTION 0.5MG/ML (MECOBALAMIN) "PANBIOTIC"

15.00

AC37063421TRACORT ORABASE 1MG/GM (TRIAMCINOLONE ACETONIDE)"PATRON"

28.40

AC37064209 CEFE INJECTION "SWISS" (CEFMETAZOLE) 78.00

AC37064212 CEFE INJECTION "SWISS" (CEFMETAZOLE) 246.00

AC37064265 CEFE INJECTION "SWISS" (CEFMETAZOLE) 0.00

AC37064277 CEFE INJECTION "SWISS" (CEFMETAZOLE) 64.00

AC37067329 CLOSONE CREAM 32.20

AC37067335 CLOSONE CREAM 0.00

AC37069321 "BETA CREAM ""SINPHAR""" 13.00

AC37069329 BETA CREAM 0.5MG/GM "S.Y."(BETAMETHASONE) 15.90

AC37069335 "BETA CREAM ""SINPHAR""" 31.90

AC37069343 "BETA CREAM ""SINPHAR""" 31.90

AC37074321 CETALA CREAM 1% "Y.Y." (CENTELLA ASIATICA) 0.00

AC37074329 CETALA CREAM 1% "Y.Y." (CENTELLA ASIATICA) 0.00

AC37074335 CETALA CREAM 1% "Y.Y." (CENTELLA ASIATICA) 0.00

AC37074338 CETALA CREAM 1% "Y.Y." (CENTELLA ASIATICA) 0.00

AC37078321 BALINSE OINTMENT "GCPC" 10.90

AC37078329 BALINSE OINTMENT "GCPC" 19.50

AC37078335 BALINSE OINTMENT "GCPC" 52.00

AC37078338 BALINSE OINTMENT "GCPC" 68.00

AC37078340 BALINSE OINTMENT "GCPC" 81.00

AC37082100 IMOLEX TABLETS 2MG "SINPHAR"(LOPERAMIDE) 1.50

AC370821G0 IMOLEX TABLETS 2MG "SINPHAR"(LOPERAMIDE) 2.00

AC37093329 EASY ACNE SOLUTION 10MG/ML (CLINDAMYCIN) 19.60

AC37093338 EASY ACNE SOLUTION 10MG/ML (CLINDAMYCIN) 30.80

AC37093343 EASY ACNE SOLUTION 10MG/ML (CLINDAMYCIN) 87.00

AC37096321 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 11.90

AC37096324 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 12.80

AC37096329 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 13.70

AC37096335 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 24.80

AC37096338 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 41.90

AC37125100 LISACEF CAPSULES 500MG "S.T." (CAPHRADINE) 2.72

AC37127238 SODIUM BICARBONATE INJECTION 70MG/ML "ASTAR" 15.00

AC37128319 EUCLOBE CREAM 0.5MG/GM 10.00

AC37128321 EUCLOBE CREAM 0.5MG/GM 11.90

AC37128323 EUCLOBE CREAM 0.5MG/GM 12.80

AC37128324 EUCLOBE CREAM 0.5MG/GM 12.80

AC37128329 EUCLOBE CREAM 0.5MG/GM 13.70

AC37128335 EUCLOBE CREAM 0.5MG/GM 24.80

AC37128338 EUCLOBE CREAM 0.5MG/GM 41.90

AC37128340 EUCLOBE CREAM 0.5MG/GM 61.00

AC37128343 EUCLOBE CREAM 0.5MG/GM 90.00

Page 157: 附件二 藥品給付品項暨支付標準表

AC37128355 EUCLOBE CREAM 0.5MG/GM 195.00

AC37134329 B.B. GEL 1% (CLINDAMYCIN) 14.10

AC37134335 B.B. GEL 1% (CLINDAMYCIN) 20.70

AC37134338 B.B. GEL 1% (CLINDAMYCIN) 65.00

AC37134343 B.B. GEL 1% (CLINDAMYCIN) 185.00

AC37139316 C.B ACYLETE CREAM 50MG/GM (ACYCLOVIR) 17.30

AC37139321 C.B ACYLETE CREAM 50MG/GM (ACYCLOVIR) 41.10

AC37140100 BEFON TABLETS 10MG "M.S." (BACLOFEN) 1.50

AC371401G0 BEFON TABLETS 10MG "M.S." (BACLOFEN) 2.00

AC371401G5 BEFON TABLETS 10MG "M.S." (BACLOFEN) 2.00

AC37141100 BEFON TABLETS 5MG (BACLOFEN) "M.S." 1.50

AC371411G0 BEFON TABLETS 5MG (BACLOFEN) "M.S." 2.00

AC371411G5 BEFON TABLETS 5MG (BACLOFEN) "M.S." 2.00

AC37157100 MEHYMINE TABLETS 50MG "CHINTENG" (MEBHYDROLIN) 1.50

AC371571G0MEHYMINE TABLETS 50MG "CHINTENG" (MEBHYDROLIN)(鋁箔/膠

箔)2.00

AC37162321 DERMALIN CREAM 13.90

AC37162329 DERMALIN CREAM 0.00

AC37162330 DERMALIN CREAM 0.00

AC37162335 DERMALIN CREAM 51.00

AC37166100SIN TONG E.F.C TABLETS 100MG "CHINTENG" (PENTOXYFYLLINE)

1.50

AC37167100 RINA CAPSULES "P.L." 12.10

AC37190100 "NIROZIDE CAPSULES 200MG (NIFROXAZIDE) ""ROYAL""" 2.30

AC37197100 SWIFLOR CAPSULES 250MG (CEFACLOR) "SWISS" 3.35

AC37200209 KEPRO INJECTION 50MG/ML "T.F." 15.00

AC37200212 KEPRO INJECTION 50MG/ML (KETOPROFEN) 15.00

AC37204100 CALATEC TABLETS 25MG (CAPTOPRIL) 1.50

AC37214421 BETAGEN OPHTHALMIC SOULTION "GCPC" 20.00

AC37214429 BETAGEN OPHTHALMIC SOLUTION "GCPC" 0.00

AC37224100 ASMALIN TABLETS 2.5MG (FENOTEROL) 1.50

AC372241G0 ASMALIN TABLETS 2.5MG (FENOTEROL)(鋁箔/膠箔) 2.00

AC37225100 WECOLI TABLETS 25MG (BETHANECHOL CHLORIDE) "YY" 1.63

AC372251G0WECOLI TABLETS 25MG (BETHANECHOL CHLORIDE) "YY"(鋁箔膠

箔)2.00

AC37227100 Cefaclor Capsules 250mg "Synmosa" 3.35

AC37228329 LEVALONE CREAM 22.30

AC37228336 LEVALONE CREAM "EVEREST" 47.30

AC37228338 LEVALONE CREAM 60.00

AC37229100 CINTSU S.R.F.C. TABLETS 240MG (VERAPAMIL) "YUNG SHIN" 5.20

AC37240329 CORTOLONE CREAM 22.30

AC37252212 KETOPROFEN I.M. INJECTION 25MG/ML "N.K." 15.00

AC37252216 KETOPROFEN I.M. INJECTION 25MG/ML "N.K." 15.00

AC37255100 LIVER HOW CAPSULES "CHINTENG" 1.50

AC372551G0 LIVER HOW CAPSULES "CHINTENG"(鋁箔/膠箔) 2.00

AC37256100 CHILON E.F.C. TABLETS 50MG "Y.K" 1.50

AC372561G0 CHILON E.F.C. TABLETS 50MG "Y.K"(鋁箔/膠箔) 2.00

AC37257100 "DEGITON F.C. TABLETS 400MG (IBUPROFEN) ""ROOT""" 1.50

Page 158: 附件二 藥品給付品項暨支付標準表

AC372571G0"DEGITON F.C. TABLETS 400MG (IBUPROFEN) ""ROOT""(鋁箔/膠

箔)"2.00

AC37286321 VICORAX CREAM 5% "WEIDAR" 41.10

AC37288321 SWIVAZIN CREAM 10MG/GM (CENTELLA ASIATICA) 36.40

AC37288329 SWIVAZIN CREAM 10MG/GM (CENTELLA ASIATICA) 57.00

AC37288335 SWIVAZIN CREAM 10MG/GM (CENTELLA ASIATICA) 58.00

AC37288337 SWIVAZIN CREAM 10MG/GM (CENTELLA ASIATICA) 70.00

AC37288338 SWIVAZIN CREAM 10MG/GM (CENTELLA ASIATICA) 77.00

AC37290209 VANCO POWDER FOR INJECTION "GENTLE"(VANCOMYCIN) 179.00

AC37290277 VANCO POWDER FOR INJECTION (VANCOMYCIN) "GENTLE" 76.00

AC37292100 "NICER TABLETS 10MG (NICERGOLINE) ""H.S.""" 4.38

AC37301157 ZECOL SYRUP 21.90

AC37311321 AROMA CREAM 20MG/G 0.00

AC37311329 AROMA CREAM 20MG/G 13.10

AC37311335 AROMA CREAM 20MG/G 0.00

AC37311338 AROMA CREAM 20MG/G 0.00

AC37311355 AROMA CREAM 20MG/GM (KETOCONAZOLE) 407.00

AC37314321 CLINDAMYCIN GEL 10MG/GM "C.C.P.C." 10.00

AC37314338 CLINDAMYCIN GEL 10MG/GM "C.C.P.C." 65.00

AC37344100BOKEY ENTERIC-MICROENCAPSULATED CAPSULES 100MG (ASPIRIN)

1.50

AC373441G0BOKEY ENTERIC-MICROENCAPSULATED CAPSULES 100MG (ASPIRIN)

(鋁箔/膠箔)2.00

AC37352100 HOPAN TABLETS 0.5MG "KOJAR" (HALOPERIDOL) 1.50

AC373521G0 HOPAN TABLETS 0.5MG (HALOPERIDOL) "KOJAR"(鋁箔/膠箔) 2.00

AC37355100 DICLOFENAC E.S.C. TABLETS 50MG "YUNG CHI" 1.50

AC37368100FLUFEN FILM COATED TABLETS 250MG (ALUMINUM FLUFENAMATE)

"P.L"3.26

AC37375100GINKON FILM COATED TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE)

1.71

AC373751G0GINKON FILM COATED TABLETS 9.6MG

(GINKGOFLAVONGLYCOSIDE)(鋁箔/膠箔)2.00

AC37376100 SULORIL TABLETS 200MG "WEIDAR" (SULINDAC) 1.98

AC37378100 TRIMSOAN TABLETS 3MG (TRIMETOQUINOL) "CHINTENG" 1.50

AC373781G0TRIMSOAN TABLETS 3MG (TRIMETOQUINOL) "CHINTENG" (鋁箔/

膠箔)2.00

AC37384209 CEFOXINE FOR INJECTION (CEFOTAXIME SODIUM) "TAI YU" 113.00

AC37386314 LADIOL GEL 0.6MG/GM "SINPHAR" (ESTRADIOL) 15.00

AC37386343 LADIOL GEL 0.6MG/GM "SINPHAR" (ESTRADIOL) 74.00

AC37390100 U-SAVE CAPSULES 500MG "U-LIANG"(CEPHRADINE) 2.72

AC37396100BRANDYL TABLETS 2.5MG (TERBUTALINE SULFATE) "C.C.P.C."

1.50

AC373961G0BRANDYL TABLETS 2.5MG "C.C.P.C." (TERBUTALINE

SULFATE)(鋁箔/膠箔)2.00

AC37441100 BIPERIN TABLETS 2MG (BIPERIDEN) "UNION" 1.67

AC374411G0 BIPERIN TABLETS 2MG (BIPERIDEN)"UNION"(鋁箔/膠箔) 2.00

AC37442209 CEFOTIN POWDER FOR INJECTION "CEFOXITIN" 67.00

AC37442212 CEFOTIN POWDER FOR INJECTION "CEFOXITIN" 143.00

Page 159: 附件二 藥品給付品項暨支付標準表

AC37497100 SELEGYL TABLETS 5MG "SWISS" (DEPRENYL) 2.46

AC37501329 "ISOLON CREAM ""H.S.""" 0.00

AC37501335 "ISOLON CREAM ""H.S.""" 39.30

AC37510329 SONA CREAM 0.00

AC37510335 SONA CREAM 0.00

AC37511329 C.G.B. CREAM "H.S." 35.00

AC37511338 C.G.B. CREAM "H.S." 84.00

AC37519100 OXETHAZAINE TABLETS "SENTAI" 1.50

AC37520100 CAPHOS TABLETS 667MG (CALCIUM ACETATE) "M.S." 1.58

AC375201G0 CAPHOS TABLETS 667MG (CALCIUM ACETATE) "M.S." 2.00

AC37523100 CEPHALEXIN F.C.TABLET 500MG "S.T." 1.78

AC37527100 GLEUTON TABLETS 5MG (GLYBURIDE) "YU SHENG" 1.50

AC375271G0 GLEUTON TABLETS 5MG "YU SHENG" (GLYBURIDE)(鋁箔/膠箔) 2.00

AC37549100 TRENTINE F.C. TABLETS 9.6MG "N.K." 1.71

AC375491G0 TRENTINE F.C. TABLETS 9.6MG "N.K."(鋁箔/膠箔) 2.00

AC37551100KINTHREE FILM TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE)

"EVEREST"1.71

AC37556100 VICIN CAPSULE 150MG (CLINDAMYCIN) "PURZER" 1.50

AC37557100 DICYCLOMINE TABLETS 10MG "SENTAI" 1.50

AC37563321 SAFELON CREAM "EVEREST" 0.00

AC37570109ULSAMIN FINE GRANULES 900MG/GM (BASIC ALUMINUM SUCROSE

SULFATE)6.00

AC375771G0 ERA TABLET 0.25MG (FLUDIAZEPAM) "T.T.Y."(鋁箔/膠箔) 2.00

AC37579100 FLU-D TABLETS 200MG 206.00

AC37580321 CLOSONE CREAM 13.90

AC37580329 CLOSONE CREAM 32.20

AC37580335 CLOSONE CREAM 51.00

AC37586100GINKOBA F.C.TABLETS 9.6MG "ROYAL"(GINKGOFLAVONGLYCOSIDE)

1.71

AC37591100 WENISU TABLETS 5MG (NORETHISTERONE) "H.S." 1.66

AC375911G0"WENISU TABLETS 5MG (NORETHISTERONE) "H.S."(鋁箔/膠箔)

2.00

AC37592148 COJALIN SYRUP "CHINTENG" 0.00

AC37595100 "NAFXEN TABLETS 500MG (NAPROXEN) ""TAI YU""" 2.95

AC37601100 WELIZEN F.C. TABLETS 20MG "N.K." 1.59

AC376011G0 WELIZEN F.C.TABLETS 20MG "N.K"(鋁箔/膠箔) 2.00

AC37603100VALTAFEN ENTERIC F.C. TABLETS 50MG "SINPHAR"(DICLOFENAC)

1.50

AC376031G0VALTAFEN ENTERIC F.C. TABLETS 50MG "SINPHAR"(DICLOFENAC)

2.00

AC37608100 PIRACETAM CAPSULES 400MG "KOJAR" (PIRACETAM) 1.50

AC376081G0PIRACETAM CAPSULES 400MG "KOJAR" (PIRACETAM)(鋁箔/膠箔)

2.00

AC37622321 DERMALEAN GEL 10MG/GM "B&F"(CLINDAMYCIN) 10.00

AC37622323 DERMALEAN GEL 10MG/GM "B&F"(CLINDAMYCIN) 11.40

AC37622329 DERMALEAN GEL 10MG/GM "B&F"(CLINDAMYCIN) 14.10

AC37622330 DERMALEAN GEL 10MG/GM "B&F"(CLINDAMYCIN) 17.40

AC37622335 DERMALEAN GEL 10MG/GM 20.70

Page 160: 附件二 藥品給付品項暨支付標準表

AC37632151 SCONIN ORAL SUSPENSION 20MG/ML 25.00

AC37632157 SCONIN ORAL SUSPENSION 20MG/ML 45.10

AC37637157 POWEGON SUSPENSION 20MG/ML "EVEREST" (CIMETIDINE) 0.00

AC37644100 EFOSIN S.C TABLETS 25MG "KOJAR" (DIPYRIDAMOLE) 1.50

AC376441G0EFOSIN S.C TABLETS 25MG "KOJAR" (DIPYRIDAMOLE)(鋁箔/膠

箔)2.00

AC37651100CEGOLIN F.C. TABLETS 9.6MG (GINKFLAVONGLYCOSIDE)

"WEIDAR"1.71

AC376511G0CEGOLIN F.C. TABLETS 9.6MG "WEIDAR"

(GINKGOFLAVONGLYCOSIDE)(鋁箔/膠箔)2.00

AC37652100 SEAPRO CAPSULES 10MG (SEAPROSE) "CHINTENG" 2.90

AC37656100SCOPINE F.C. TABLETS 10MG "EVEREST" (SCOPOLAMINE

BUTYLBROMIDE)1.50

AC37661100TENSIONLEX TABLETS 100MG (ORHENADRINE CITRATE)

"PANBIOTIC"2.82

AC37668143 CIRLITON DROPS 9.6MG(GINKGOFLAVONGLYCOSIDES)"Y.Y." 176.00

AC37668153 CIRLITON DROPS 9.6MG(GINKGOFLAVONGLYCOSIDES)"Y.Y." 320.00

AC37669143 EUMED DROPS 9.6MG/ML(GINGOFLAVONGLYCOSIDES) 0.00

AC37669151 EUMED DROPS 9.6MG/ML(GINGOFLAVONGLYCOSIDES) 0.00

AC37669155 EUMED DROPS 9.6MG/ML(GINGOFLAVONGLYCOSIDES) 0.00

AC37669157 EUMED DROPS 9.6MG/ML(GINGOFLAVONGLYCOSIDES) 0.00

AC37675100 "BACONE TABLETS 10MG ""H.S."" (BACLOFEN)" 1.50

AC376751G0 "BACONE TABLETS 10MG ""H.S."" (BACLOFEN)(鋁箔/膠箔)" 2.00

AC37679100 BEENRONE TABLETS 50MG "YUNG SHIN" (BENZBROMARONE) 1.50

AC376791G0BEENRONE TABLETS 50MG "YUNG SHIN" (BENZBROMARONE)(鋁箔/

膠箔)2.00

AC37680100 ANLIN CAPSULES 10MG "CHINTENG" (OXAZOLAM) 1.52

AC376801G0 ANLIN CAPSULES 10MG "CHINTENG" (OXAZOLAM)(鋁箔/膠箔) 2.00

AC37682100 NAPUSIN TABLETS 250MG (NAPROXEN) 1.50

AC37685100 GEMD FILM COATED TABLETS 600MG (GEMFIBROZIL) 2.46

AC37687100SENIN F.C. TABLET 9.6MG "PURZER"(GINKGOFLAVONE

GLYCOSIDES)1.71

AC376871G0SENIN F.C. TABLET 9.6MG "PURZER"(GINKGOFLAVONE

GLYCOSIDES)2.00

AC37688245CIPROFLO INFUSION SOLUTION 10MG/ML "S.Y."(CIPROFLOXACIN)

621.00

AC37689100 AELOCON S.C. TABLETS "EVEREST" 1.50

AC376891G0 AELOCON S.C. TABLETS "EVEREST"(鋁箔/膠箔) 2.00

AC37691329 PIROCAM CREAM 10MG/GM(PIROXICAM) 0.00

AC37691336 PIROCAM CREAM 10MG/GM 22.20

AC37691338 PIROCAM CREAM 10MG/GM(PIROXICAM) 23.10

AC37691340 PIROCAM CREAM 10MG/GM(PIROXICAM) 28.20

AC37691345 PIROCAM CREAM 10MG/GM(PIROXICAM) 35.00

AC37691355 PIROCAM CREAM 10MG/GM(PIROXICAM) 225.00

AC37696100 HOPAN TABLETS 5MG "KOJAR" (HALOPERIDOL) 1.75

AC376961G0 HOPAN TABLETS 5MG (HALOPERIDOL) "KOJAR"(鋁箔/膠箔) 2.00

AC37702100 KERSAN TABLETS 100MG (ASPIRIN) "CHINTENG" 1.50

AC37704100 QUIT ANALGESIC TABLET 1.50

Page 161: 附件二 藥品給付品項暨支付標準表

AC37712100"PARTANE TABLETS 2MG ""MACRO"" (TRIHEXYPHENIDYL

HYDROCHLORIDE)"1.50

AC377121G0PARTANE TABLETS 2MG "MACRO" (TRIHEXYPHENIDYL

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC37715100 YENTAC TABLET 200MG (SULINDAC) "S.L." 1.98

AC37720100 URSOLIC TABLETS 100MG (URSODEOXYCHOLIC ACID) 1.76

AC377201G0URSOLIC TABLETS 100MG (URSODEOXYCHOLIC ACID)(鋁箔/膠箔)

2.00

AC37722221 RANIDINE INJETION 10MG/ML (RANTIDINE) "S.T." 0.00

AC37739321 NAZOLE CREAM 2% (KETOCONAZOLE) "S.Y." 11.90

AC37740100 BONSTAN CAPSULES 250MG "EVEREST"(MEFENAMIC ACID) 1.50

AC37741209 TRICEF FOR I.V. INJECTION "SWISS" (CEFTRIAXAXONE) 82.00

AC37741212 TRICEF FOR I.V. INJECTION "SWISS" (CEFTRIAXAXONE) 363.00

AC37741265 TRICEF FOR I.V. INJECTION "SWISS" (CEFTRIAXAXONE) 54.00

AC37741277 TRICEF FOR I.V. INJECTION "SWISS" (CEFTRIAXAXONE) 54.00

AC37809100 NAPOFEN TABLETS 200MG(FENBUFEN) 1.50

AC37833100 APUZIN TABLETS 50MG (CAPTOPRIL) 2.94

AC37835100 APUZIN TABLETS 25MG (CAPTOPRIL) 1.50

AC37837100 KCB F.C. TABLETS 120MG (DIBISMUTH TRIOXIDE) "SWISS" 5.30

AC37838335 SEFUCON CREAM 1% (SILVER SULFADIAZINE) 18.50

AC37838338 SEFUCON CREAM 1% (SILVER SULFADIAZINE) 32.30

AC37838372 SEFUCON CREAM 1% (SILVER SULFADIAZINE) 0.00

AC37861100 UNIMARON TABLETS 50 MG 1.50

AC378611G0 UNIMARON TABLETS 50 MG(鋁箔/膠箔) 2.00

AC37862100 FUYANTONG CAPSULES 3.36

AC37866421 SINTROPIC OPHTHALMIC SOLUTION 5MG/ML "SINPHAR" 16.50

AC37874421 EUXINC ORABASE 0.1% 35.60

AC37874426 EUXINC ORABASE 0.1% 61.00

AC37875100 AMSOLVON TABLETS 30MG "S.Y." 1.50

AC37876100 POKEN CAP. 1.52

AC378761G0 POKEN CAPSULES 150MG (SILYMARIN) "MEIDER"(鋁箔/膠箔) 2.00

AC37878500 VALTAFEN SUPPOSITORY 12.5MG (DICLOFENAC) "SINPHAR" 5.00

AC37902100 SULIRAM TABLETS 200MG "F.Y."(SULINDAC) 1.98

AC37909329 TONIN GEL 100MG/GM (ETOFENAMATE) 28.70

AC37909335 TONIN GEL 100MG/GM (ETOFENAMATE) 0.00

AC37909338 TONIN GEL 100MG/GM (ETOFENAMATE) 33.00

AC37909345 TONIN GEL 100MG/GM (ETOFENAMATE) 84.00

AC37923329 MINSONE CREAM 0.5MG/GM (CLOBETASONE) "YUNG CHI" 37.60

AC37924477 BAXICIN SINGLE DOSE UNIT EYE DROPS 4.00

AC37928100 ATENOL F.C. TABLETS 100MG (ATENOLOL) "WEIDAR" 1.51

AC379281G0ATENOL F.C. TABLETS 100MG (ATENOLOL) "WEIDAR"(鋁箔/膠箔)

2.00

AC37934100 SYNOTEC TABLETS 200MG (TIAPROFENIC ACID) 2.91

AC37945100 CIMETIN F.C. TABLETS 400MG "JOHNSON" (CIMETIN) 1.50

AC379451G0CIMETIN F.C. TABLETS 400MG "JOHNSON" (CIMETIDINE)(56粒/

瓶)2.00

AC379451GACIMETIN F.C. TABLETS 400MG (CIMETIDINE) "JOHNSON"(鋁箔/

膠箔)2.00

Page 162: 附件二 藥品給付品項暨支付標準表

AC379881G0 GOUTIL TABLETS 50MG (BENZBROMARONE)(鋁箔/膠箔) 2.00

AC37991100 WEIDOS F.C. TABLET 300MG "WEIDAR" (RANITIDINE) 0.00

AC37995209 TRIMIN INJECTION 50MG/ML "SWISS"(DIMENHYDRINATE) 15.00

AC37995221 TRIMIN INJECTION 50MG/ML "SWISS"(DIMENHYDRINATE) 51.00

AC37996100 PHOSUNK TABLET 667MG "SWISS"(CALCIUM ACETATE) 1.58

AC379961G0PHOSUNK TABLET 667MG "SWISS" (CALCIUM ACETATE)(鋁箔/膠

箔)2.00

AC37997100 MODIPANOL TABLET 2MG "SWISS"(FLUNITRAZEPAM) 1.77

AC379971G0MODIPANOL TABLET 2MG "SWISS" (FLUNITRAZEPAM)(鋁箔/膠箔)

2.00

AC38013500 ECOVALE SUPPOSITORIES 150 MG "P.L." (ECONAZOLE) 9.70

AC38023100 UROPRIL TABLETS 100MG (ALLOPURINOL) "T.F." 1.50

AC380231G0 UROPRIL TABLETS 100MG (ALLOPURINOL) "T.F."(鋁箔/膠膠) 2.00

AC38030100 PROCAM CAPSULES 150MG "EVEREST" (SILYMARIN) 1.52

AC380301G0PROCAM CAPSULES 150MG (SILYMARIN) "EVEREST"(膠箔/鋁箔)

2.00

AC38034100 BISOL F.C.TABLET 300MG (DIBISMUTH TRIOXIDE) "PURZER" 5.30

AC38049321 CENTALLA OINTMENT "SINPHAR" 42.50

AC38049329 CENTALLA OINTMENT "SINPHAR" 71.00

AC38049338 CENTALLA OINTMENT "SINPHAR" 115.00

AC38053212 GETWAY INJECTION 25 MG/ML (RANITIDINE) 0.00

AC38055100 FUAN TABLETS 5MG "CHINTENG"(MEDROXYPROGESTERONE) 1.50

AC380551G0FUAN TABLETS 5MG "CHINTENG"(MEDROXYPROGESTERONE)(鋁箔/膠

箔)2.00

AC38056100 "Blasec Tablets 2.5mg ""MACRO"" (Oxybutynin)" 1.60

AC38073314 "ESTRAD GEL 0.06% (ESTRADIOL) ""H.S.""" 15.00

AC38073343 "ESTRAD GEL 0.06% (ESTRADIOL) ""H.S.""" 74.00

AC38076100 BENZU TABLETS 3MG "CHINTENG" (BROMAZEPAM) 1.53

AC380761G0 BENZU TABLETS 3MG (BROMAZEPAM) "CHINTENG"(鋁箔/膠箔) 2.00

AC38081100 ANSUTAN CAPSULES"F.Y." 1.50

AC380811G0 ANSUTAN CAPSULES "F.Y"(鋁箔/膠箔) 2.00

AC380811G5 ANSUTAN CAPSULES "F.Y"(84粒/瓶裝) 2.00

AC38088100 WERGEN TABLETS 400MG (CIMETIDINE) "YUNG CHI" 1.50

AC38089100 SUXEN FILM COATED TABLETS 250MG (CIPROFLOXACIN) 5.10

AC38090100 SUXEN FILM COATED TABLETS 500MG (CIPROFLOXACIN) 6.10

AC38091100 TENGEN TABLETS "MACRO" 4.17

AC38097100 HEPANAT CAPSULES 150MG (SILYMARIN) 1.52

AC38098209 FOCUS IM INJECTION 20MG/ML (PIROXICAM) 16.90

AC38104100 Pyrazinamide Tablets 500mg "P.L." 4.68

AC38132100 SALALIN TABLETS 250MG"KOJAR" (CHLORZOXAZONE) 1.50

AC381321G0SALALIN TABLETS 250MG "KOJAR" (CHLORZOXAZONE)(鋁箔/膠箔)

2.00

AC38134100 SILYMA CAPSULES 150MG (SILYMARIN) 1.52

AC381341G0 SILYMA CAPSULES 150MG (SILYMARIN)(鋁箔/膠箔) 2.00

AC38135209TRAMED INJECTION 50MG/ML (TRAMADOL HYDROCHLORIDE)

"SWISS"22.80

AC38135212TRAMED INJECTION 50MG/ML (TRAMADOL HYDROCHLORIDE)

"SWISS"25.90

Page 163: 附件二 藥品給付品項暨支付標準表

AC38145212 TRAMTOR INJECTION 50MG/ML (TRAMADOL HYDROCHLORIDE) 25.90

AC38147100 GENOL TABLETS 120MG "GENTLE" (DIBISMUTH TRIOXIDE) 5.30

AC38154100 AJULATE SOFT CAPSULES 5MG (NIFEDIPINE) "F.M." 1.81

AC38158100 ERYTH F.C. TABLET 500 MG "LONG LIFE" 3.67

AC38159321 AZOL-CORT CREAM 13.90

AC38159335 AZOL-CORT CREAM 39.30

AC38164100 TIAP TABLET 200MG (TIAPROFENIC ACID) "SWISS" 2.91

AC38168100 PROPRANOL TAB. 40MG "SENTAI" (PROPRANOLOL) 1.50

AC38180100 COHEAL CAPSULES "STANDARD" 1.50

AC381801G0 COHEAL CAPSULES "STANDARD" (鋁箔/膠箔) 2.00

AC38184321 TRIDERMSONE CREAM 16.00

AC38184329 TRIDERMSONE CREAM 35.00

AC38184336 TRIDERMSONE CREAM 53.00

AC38184338 TRIDERMSONE CREAM 84.00

AC38185212 SUWELIN INJ. 150MG/ML 2ML 15.00

AC38186100 YIPA CAPSULES 0.5MG "KOJAR" 1.55

AC381861G0 YIPA CAPSULES 0.5MG (MECOBALAMIN) "KOJAR" (鋁箔/膠箔) 2.00

AC38188100 PAINOUT F.C. TABLETS "Y.Y." 1.50

AC38192212TAIBAMIN INJECTION 5MG/ML "TAI YU" (HYDROXOCOBALAMINE)

15.40

AC38194100 HEARTQUINONE CAPSULES 10MG (UBIDECARENONE) "S.D." 2.85

AC38204100 CABUDAN TABLETS 25MG 1.50

AC382041G0 CABUDAN TABLETS 25MG (CAPTOPRIL) "S.Y."(鋁箔/膠箔) 2.00

AC38211100 POSTON TABLETS 500MG (MEFENAMIC ACID) "CHEN TA" 1.50

AC382111G0POSTON TABLETS 500MG (MEFENAMIC ACID)"CHEN TA"(鋁箔/膠

箔)2.00

AC38229263 CALCIUM GLUCONATE INJECTION 10% "C.C.P.C." 270.00

AC38235100 PROCANPEN S.C TABLETS "CHINTENG" 1.58

AC38244100 HOPAN TABLETS 10MG "KOJAR" (HALOPERIDOL) 2.33

AC38247100 CIMETIDINE TABLETS 400MG "D.T.S" 1.50

AC38259100 NIFUGEN CAP. 200MG 2.30

AC38260100JINBO FILM-COATING TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE)

"YU-SHENG"1.71

AC38266100 CODELIN TABLETS "KOJAR" 1.50

AC382661G0 CODELIN TABLETS "KOJAR"(鋁箔/膠箔) 2.00

AC38283309 SALINE SOLUTION "S.T" 24.10

AC38283312 SALINE SOLUTION "S.T" 0.00

AC38283316 SALINE SOLUTION "S.T" 0.00

AC38283377 SALINE SOLUTION "S.T" 18.40

AC38284238 BUTAMINE INJECTION 12.5MG/ML (DOBUTAMINE) 113.00

AC38286100 THIAMPHENICOL CAPSULES 250MG "KINGDOM" 1.51

AC38291100 WEIMOK F.C. TABLETS 40MG (FAMOTIDINE) "WEIDAR" 3.77

AC38296100 GEMNPID F.C. TABLETS 600MG (GEMFIBROZIL) "C.C.P.C." 2.46

AC38300329 SMOOTH CREAM 10MG/GM 57.00

AC38317209 DRAMINE INJECTION 50MG/ML (DIMENHYDRINATE) "S.Y." 15.00

AC38327100 REFEN TABLETS 200MG "Y.J."(TIAPROFENIC ACID) 2.91

AC38353100 TOPCEF CAPSULES 250MG (CEPHRADINE) 1.72

AC383531G0 TOPCEF CAPSULES 250MG (CEPHRADINE)(鋁箔/膠箔) 2.00

Page 164: 附件二 藥品給付品項暨支付標準表

AC38357100 MEDECOUGH CAPSULES "C.L." 1.50

AC383571G0 MEDECOUGH CAPSULES "C.L."(鋁箔/膠箔) 2.00

AC38368100 SUPEROCIN F.C. TABLETS 500MG "WEIDAR" 6.10

AC38415100 ANIN TABLETS 5MG "Y.K." 1.75

AC384151G0 ANIN TABLETS 5MG "Y.K."(鋁箔/膠箔) 2.00

AC38419100 STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS" 1.50

AC384191G0STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"(鋁箔/膠

箔)2.00

AC384191G1STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"(14粒/

瓶)2.00

AC384191G2STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"28粒/瓶)

2.00

AC384191G4STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"(56粒/

瓶)2.00

AC384191G6STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"(112粒/

瓶)2.00

AC38422100 CARTIL TABLETS 60MG (DILTIAZEM HYDROCHLORIDE) 2.15

AC38426100 ANTIDIA CAPSULES 200MG (NIFUROXAZIDE) "S.D." 2.30

AC38427321 RAMIN CREAM "EVEREST" 16.00

AC38427329 RAMIN CREAM "EVEREST" 35.00

AC38427336 RAMIN CREAM "EVEREST" 53.00

AC38427338 RAMIN CREAM "EVEREST" 84.00

AC38427355 RAMIN CREAM "EVEREST" 145.00

AC38446100 BUSPAN TABLETS 10MG (SCOPOLAMINE BUTYLBROMIDE)"S.C" 1.50

AC38453100 TRIMPRIM TABLETS 100MG (TRIMETHOPRIM) "S.C" 1.50

AC38454100 CIMETIDINE TABLETS 200MG "S.C" 1.50

AC384541G0 CIMETIDINE TABLETS 200MG "S.C"(鋁箔/膠箔) 2.00

AC38460100 PIROCAM TABLETS 20MG (PIROXICAM) "S.C" 1.50

AC38464100 ASTHMA TABLETS "S.C" 1.50

AC38465100 DIALICON TABLETS "S.C" 1.50

AC384651G0 DIALICON TABLETS "S.C"(鋁箔/膠箔) 2.00

AC38472151 ALUZAINE SUSPENSION "STANDARD" 15.00

AC38472157 ALUZAINE SUSPENSION "STANDARD" 30.00

AC38472169 ALUZAINE SUSPENSION "STANDARD" 81.00

AC38474100SPANIL TABLETS 135MG (MEBEVERINE HYDROCHLORIDE) "ROYAL"

1.75

AC38479100"GINKGO BILOBA F.C. TABLETS 9.6MG

(GINKGOFLAVONGLYCOSIDE)""RO OT"""1.71

AC384791G0GINKGO BILOBA F.C. TABLETS 9.6MG "ROOT"

(GINKGOFLAVONGLYCOSIDE)(鋁箔/膠箔)2.00

AC38487100 CHIANDA TABLETS 0.15MG "CHINTENG" (CLONIDINE) 1.96

AC38493100PAS CALCIUM F.C. TABLETS 500MG (CALCIUM

PAMINOSALICYLATE) "P.L."4.59

AC38500100 GLICRON TABLETS 80MG (GLICLAZIDE) 1.50

AC38502337 B.&N. ISOCON-F CREAM "SHITEH" 60.00

AC38504100 CALOWLIN TABLETS 667MG (CALCIUM ACETETE) "U-LIANG" 1.58

AC385041G0CALOWLIN TABLETS 667MG (CALCIUM ACETETE) "U-LIANG"(鋁箔/

膠箔)2.00

Page 165: 附件二 藥品給付品項暨支付標準表

AC38509348 U-BURNDIN CREAM "U-LIANG" 56.00

AC38509377 U-BURNDIN CREAM"U-LIANG" 480.00

AC38510100 SUME TABLETS 2MG 1.77

AC385101G0 SUME TABLETS 2MG(鋁箔/膠箔) 2.00

AC38523238 DEOSE INJECTION 50MG/ML (DEXTROSE)"ASTAR" 15.00

AC38523277 DEOSE INJECTION 50MG/ML (DEXTROSE)"ASTAR" 25.00

AC38524321 ENCORT CREAM 0.1% "EVEREST" (TRIAMCINOLONE ACETONIDE) 10.00

AC38524329 ENCORT CREAM 0.1% "EVEREST" (TRIAMCINOLONE ACETONIDE) 12.10

AC38524335 ENCORT CREAM 0.1% "EVEREST" (TRIAMCINOLONE ACETONIDE) 15.10

AC38528100CIFLODAL F.C. TABLETS 500MG (CIPROFLOXACIN) "C.C.P.C."

6.10

AC38540321 FUMELON CREAM 10MG/GM "Y.K." 36.40

AC38540329 FUMELON CREAM 10MG/GM "Y.K." 57.00

AC38540335 FUMELON CREAM 10MG/GM "Y.K." 58.00

AC38540337 FUMELON CREAM 10MG/GM "Y.K." 70.00

AC38540338 FUMELON CREAM 10MG/GM "Y.K." 77.00

AC38544265 CEKONIN FOR INJECTION (CEFUROXIME)"SWISS" 25.00

AC38544289 CEKONIN FOR INJECTION "SWISS" (CEFUROXIME) 25.00

AC38555255 CINOLONE IV INFUSION 2MG/ML 450.00

AC38556100 CIMEDIN TABLETS 400MG (CIMETIDINE) "TBC" 1.50

AC38575100 MABAL CAPSULES 0.5MG "YU SHENG" (MECOBALAMIN) 1.55

AC385751G0MABAL CAPSULES 0.5MG "YU SHENG" (MECOBALAMIN)(鋁箔/膠箔)

2.00

AC38599100 HSIAOCHIH TABLETS 100MG "C.A."(BENZARONE) 2.79

AC38604329 ANKAJEN CREAM 5% "C.H."(ACYCLOVIR) 42.90

AC38612100 AN LIN TABLETS 2MG (FLUNITRAZEPAM) 1.77

AC386121G0 AN LIN TABLETS 2MG (FLUNITRAZEPAM)(鋁箔/膠箔) 2.00

AC38614216 KOTAN INJECTION 100MG/ML (ACETYLCYSTEINE) "ASTAR" 15.00

AC38615209 CEFIN FOR I.V. INJECTION (CEFTRIAXONE) "PANBIOTIC" 82.00

AC38615212 CEFIN FOR I.V. INJECTION (CEFTRIAXONE) "PANBIOTIC" 363.00

AC38615265 CEFIN FOR I.V. INJECTION (CEFTRIAXONE) "PANBIOTIC" 54.00

AC38615277 CEFIN FOR I.V. INJECTION (CEFTRIAXONE) "PANBIOTIC" 54.00

AC38616100 MECOMIN CAPSULES 0.5MG (MECOBALAMIN) "LITA" 1.55

AC386161G0MECOMIN CAPSULES 0.5MG (MECOBALAMIN) "LITA"(鋁箔/膠箔)

2.00

AC38620100 MEDROLIN F.C. TABLETS 50MG "F.Y." 1.50

AC386201G0 MEDROLIN F.C. TABLETS 50MG "F.Y." (鋁箔/膠箔) 2.00

AC38622100 PAINSTOP E.C. TABLET 50MG "SWISS" (DICLOFENAC) 1.50

AC386221G0PAINSTOP E.C. TABLET 50MG "SWISS" (DICLOFENAC)(鋁箔/膠

箔)2.00

AC38650100 AKIN TABLETS 2MG (BIPERIDEN) "H.S." 1.67

AC386501G0 AKIN TABLETS 2MG (BIPERIDEN) "H.S."(鋁箔/膠箔) 2.00

AC38652212 V-GENTA INJECTION 40MG/ML (GENTAMICIN SULFATE) "VPP" 15.00

AC38663421DELOLOL OPHTHALMIC SOLUTION 5MG/ML "SINPHAR" (TIMOLOL)

122.00

AC38680100 VOLV TABLETS 500MG (METFORMIN) 1.50

AC386801G0 VOLV TABLETS 500MG (MOTFORMIN)(鋁箔/膠箔) 2.00

Page 166: 附件二 藥品給付品項暨支付標準表

AC38686100GINBININ S.C TABLETS 9.6 MG (GINKGOFLAVONGLYCOSIDE)

"LITA"1.71

AC38691100 NAROTON TABLETS 275MG "H.S." (NAPAROXEN SODIUM) 1.50

AC38711209 CEFAMID FOR INJECTION "GENTLE" 0.00

AC38711212 CEFAMID FOR INJECTION "GENTLE" 0.00

AC38712321 TOPIDIN CREAM 13.90

AC38712335 TOPIDIN CREAM 29.70

AC38722100 COS TABLETS "CHINTENG" 1.50

AC387221G0 COS TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC38723100 VICARIN CAPSULES "H.S." 1.50

AC38724209 MECOMIN INJECTION 0.5MG/ML "LITA" (MECOBALAMIN) 15.00

AC38724221 MEC0MIN INJECTION 0.5MG/ML "LITA" (MECOBALAMIN) 15.00

AC38737209 PIXICAM I.M. INJECTION 20MG/ML (PIROXICAM)"ORIENTAL" 16.90

AC38737212 PIXICAM I.M. INJECTION 20MG/ML (PIROXICAM)"ORIENTAL" 16.90

AC38747100 CINOLONE F.C. TABLET 250MG 5.10

AC38761100 MELICIN CAPSULES 50MG "H.S." (MINOCYCLINE) 3.68

AC38763100 N-WAY TABLETS 400MG (CIMETIDINE) "MEIDER" 1.50

AC38764100 N-WAY TABLETS 200MG "MEIDER"(CIMETIDINE) 1.50

AC38766100 METHYLPREDNISOLONE TABLETS 4MG "YUNG SHIN" 1.53

AC387661G0 METHYLPREDNISOLONE TABLETS 4MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC38777209 GIBICEF POWDER FOR INJECTION (CEFUROXIME) 51.00

AC38777277 GIBICEF POWDER FOR INJECTION (CEFUROXIME) 0.00

AC38779100 VOLEN E.C. TABLET (DICLOFENAC) "CHEN TA" 1.50

AC387791G0 VOLEN E.C. TABLET (DICLOFENAC) "CHEN TA" (鋁箔/膠箔) 2.00

AC38785212 QUICRAN INJECTION 25MG/ML(RANITIDINE) 0.00

AC38810100 MEBAL CAPSULES 0.5MG ""H.S"" (MECOBALAMIN)" 1.55

AC388101G0MEBAL CAPSULES 0.5MG ""H.S"" (MECOBALAMIN)"(鋁箔/膠箔)

2.00

AC38819100 ROMICON-A CAPSULES "KINGDOM" 1.50

AC388191G0 ROMICON-A CAPSULES "KINGDOM"(鋁箔/膠箔) 2.00

AC38833100 SIGAMET F.C. TABLETS 400MG (CIMETIDINE) "SINPHAR" 0.00

AC38840100 Silyrin-H Capsule 150mg (Silymarin) "WELCAN" 1.52

AC388401G0 Silyrin-H Capsule 150mg (Silymarin) "WELCAN" 2.00

AC38843209 CEFMORE INJECTION "SWISS" (CEFOXITIN SODIUM) 67.00

AC38846100 BENZOX TABLETS 2MG (TRIHEXYPHENIDYL) "LITA" 1.50

AC388461G0BENZOX TABLETS 2MG (TRIHEXYPHENIDYL) "LITA"(鋁箔/膠箔)

2.00

AC38847100 BENZOX TABLETS 5MG 0.00

AC38850151 COLDYNIL SOLUTION 25.00

AC38850157 COLDYNIL SOLUTION 25.00

AC38851100 "TECON TABLETS 200MG (TIAPROFENIC ACID) ""M.T.""" 2.91

AC38854209 CETADIME FOR INJETION 39.20

AC38854212 CETADIME FOR INJETION 199.00

AC38854277 CETADIME FOR INJETION 0.00

AC38856100GINKON F.C. TABLET 9.6MG (GINKGOFLAVONE GLYCOSIDE)

"JOHNSON"1.71

AC38868100 PAINSTOP E.C. TABLETS 25MG (DICLOFENAC)"SWISS" 1.50

Page 167: 附件二 藥品給付品項暨支付標準表

AC388681G0

PAINSTOP E.C. TABLETS 25MG "SWISS" (DICLOFENAC)(鋁箔/膠

箔)(21粒/瓶)(28粒/瓶)(42粒/瓶)(84粒/瓶)(112粒/瓶)(168粒/

瓶)2.00

AC38870321 KETONA CREAM 20MG/GM "KOJAR" (KETOCONAZOLE) 11.90

AC38870329 KETONA CREAM 20MG/GM "KOJAR"(KETOCONAZOLE) 13.10

AC38870335 KETONA CREAM 20MG/GM "KOJAR" (KETOCONAZOLE) 31.90

AC38870338 KETONA CREAM 20MG/GM"KOJAR" (KETOCONAZOLE) 38.70

AC38870355 KETONA CREAM 20MG/GM (KETOCONAZOLE) "KOJAR" 407.00

AC38873100 MEQUIT TABLETS 5MG "YU SHENG "(MEQUITAZINE) 1.50

AC38890100 VEWON TABLETS 5MG (FLUOXYMESTERONE) "YUNG SHIN" 2.39

AC38891100BIGACON FILM COATED TABLETS 200MG"YUNG SHIN"

(CIMETIDINE)1.50

AC388911G0BIGACON FILM COATED TABLETS 200MG"YUNG SHIN"

(CIMETIDINE)(鋁箔/膠箔)2.00

AC38925100GIBBER S.C. TABLETS 9.6MG "Y.Y"(GINKGOFLAVONGLYCOSIDE)

1.71

AC38926100 SINSO F.C TABLETS. 40MG "CHINTENG" (VERAPAMIL) 1.53

AC38935263 MAGNESIUM SULFATE INJECTION 100MG/ML"C.C.P.C." 120.00

AC38946100BEBENLINE F.C. TABLETS 135MG (MEBEVERINE HYDROCHLORIDE)

1.75

AC389461G0BEBENLINE F.C. TABLETS 135MG (MEBEVERINE

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC38948100 5-HTP CAPSULE 100MG "C.C.P.C."(OXITRIPTAN) 21.80

AC38949209TATUMCEF POWDER FOR INJECTION (CEFTAZIDIME) "C.C.P.C."

39.20

AC38949212 TATUMCEF POWDER FOR INJECTION "C.C.P.C."(CEFTAZIDIME) 199.00

AC38949277 TATUMCEF POWDER FOR INJECTION"C.C.P.C." (CEFTAZIDIME) 26.60

AC38954100 MEGATO TABLETS 400MG "GENTLE"(CIMETIDINE) 1.50

AC38955100 METISONE TABLETS 4MG (METHYLPREDNISOLONE) "S.D." 1.53

AC38956100 SOLIKY TABLETS 200MG 1.98

AC38972209 AXONECEF FOR IV INJECTION (CEFTRIAXONE) 82.00

AC38972212 AXONECEF FOR IV INJECTION (CEFTRIAXONE) 363.00

AC38980421 LAN-YEN EYE DROPS "YY" 20.00

AC38980429 LAN-YEN EYE DROPS "YY" 49.70

AC38982321 ROYALSENSE ACNE GEL 10MG/GM "SINPHAR" (CLINDAMYCIN) 10.00

AC38982329 ROYALSENSE ACNE GEL 10MG/GM "SINPHAR" (CLINDAMYCIN) 14.10

AC38982335 ROYALSENSE ACNE GEL 10MG/GM "SINPHAR" (CLINDAMYCIN) 20.70

AC38982338 ROYALSENSE ACNE GEL 10MG/GM "SINPHAR" (CLINDAMYCIN) 65.00

AC38983100 NOMPIN TABLETS 20MG (NOSCAPINE) "CHINTENG" 1.02

AC389831G0NOMPIN TABLETS 20MG (NOSCAPINE) "CHINTENG"(鋁箔/膠箔)

1.26

AC38992100 PROCA TABLETS 667MG "BOWLIN" (CALCIUM ACETATE) 1.58

AC38996100 NIFECARDIA CAPSULES 10MG (NIFEDIPINE) 1.81

AC39007100 ARAX TABLETS 25MG (HYDROXYZINE HYDROCHLORIDE) 1.50

AC390071G0ARAX TABLETS 25MG (HYDROXYZINE HYDROCHLORIDE)(鋁箔/膠

箔)"2.00

AC39012100 ASUMALIFE TABLETS 1MG (KETOTIFEN) 1.54

AC39017321 KEMEZIMIN CREAM 10MG/GM (BIFONAZOLE) "Y.K." 18.20

Page 168: 附件二 藥品給付品項暨支付標準表

AC39017323 KEMEZIMIN CREAM 10MG/GM (BIFONAZOLE) "Y.K." 27.40

AC39017329 KEMEZIMIN CREAM 10MG/GM (BIFONAZOLE) "Y.K." 44.60

AC39017335 KEMEZIMIN CREAM 10MG/GM (BIFONAZOLE) "Y.K." 49.40

AC39017338 KEMEZIMIN CREAM 10MG/GM (BIFONAZOLE) "Y.K." 81.00

AC39033477 ANME EYE DROPS 0.5% 7.50

AC39034477 ANME EYE DROPS 0.25% 4.08

AC39035100 QUICRAN F.C. TABLETS 300MG (RANITIDINE HYDROCHLORIDE) 0.00

AC39039321 YUHEALFU CREAM "S.C." 13.90

AC39039329 YUH EEL FU CREAM "S.C"10GM 32.20

AC39039335 YUH EEL FU CREAM 15GM 51.00

AC39039338 YUH EEL FU CREAM 20GM 74.00

AC39040212 KETIN INJECTION 50MG (KETOPROFEN) 15.00

AC39042100 DIMOLE S.C. TABLETS 25MG "EVEREST" (DIPYRIDAMOLE) 1.50

AC390421G6DIMOLE S.C. TABLETS 25MG "EVEREST" (DIPYRIDAMOLE)(90顆)

2.00

AC39048123 KERFENMYCIN GRAN. FOR ORAL SUSP. 250MG/GM 0.00

AC39054100 UBIHEART CAPSULES 10MG(UBIDECARENONE)"JENN MAW" 2.85

AC39058209 LIMADOL INJECTION 50MG/ML (TRAMADOL HCL) "N.K." 22.80

AC39058212 LIMADOL INJECTION 50MG/ML (TRAMADOL HCL) "N.K." 25.90

AC39069100 MEFENTIN CAPSULES 250MG (MEFENAMIC ACIA) "C.C.P.C." 1.50

AC390691G0MEFENTIN CAPSULES 250MG (MEFENAMIC ACIA) "C.C.P.C."(鋁箔

/膠箔)2.00

AC39074100 MINOINE ANTIBIOTIC CAP. 100MG "C.H." (MINOCYCLINE) 5.90

AC39082209 VIOHEPATIN INJECTION 0.5MG/ML (MECOBALAMIN) 0.00

AC39082212 VIOHEPATIN INJECTION 0.5MG/ML (MECOBALAMIN) 0.00

AC39087100 TRENFYLLINE S.R.F.C. TABLETS 400MG (PENTOXIFYLLINE) 1.82

AC390871G0TRENFYLLINE S.R.F.C. TABLETS 400MG (PENTOXIFYLLINE)(鋁箔

/膠箔)2.00

AC39094209 CEFODUR FOR INJECTION (CEFOPERAZONE) "VPP" 0.00

AC39094212 CEFODUR FOR INJECTION (CEFOPERAZONE) "VPP" 0.00

AC39094277 CEFODUR FOR INJECTION (CEFOPERAZONE) "VPP" 0.00

AC39120100 AELICON CAPSULES 200MG (NIFURXAZIDE) Y.C." 2.30

AC39137212 NEOPHYLLIN INJECTION 150MG/ML "S.T." (DYPHYLLINE) 15.00

AC39144100 CLAZIDE TABLETS 80MG "JOHNSON" (GLICLAZIDE) 0.00

AC39168100VEINTONIC F.C. TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE)

"SWISS"1.71

AC391681G0VEINTONIC F.C. TABLETS 9.6MG

"SWISS"(GINKGOFLAVONGLYCOSIDE)2.00

AC39170100 CIPROFLOXACIN F.C. TABLETS 500MG "KINGDOM" 6.10

AC39217100 WEIDOS F.C. TABLETS 150MG "WEIDAR" (RANITIDINE) 0.00

AC392171G0WEIDOS F.C. TABLETS 150MG "WEIDAR" (RANITIDINE)(鋁箔/膠

箔)0.00

AC39220100 PASHIN F.C. TABLETS 25MG (CLOMIPRAMINE) "S.D." 2.64

AC39221100 BUISLINE TABLETS 10MG "H.S." (BUSPIRONE) 2.83

AC39229100 IEJYHHAO TABLETS 100MG "S.C." (BENZARONE) 2.79

AC39239100 BROEN-C ENTERIC F.C. TABLETS "N.K." 4.14

AC39240100 WEISUN TABLETS 400MG (CIMETIDINE) "EVEREST" 1.50

AC39257100 "SULPYRIDE F.C.TABLETS 200MG ""WELCAN"" (SULPIRIDE)" 1.71

Page 169: 附件二 藥品給付品項暨支付標準表

AC39277100 Ibufen Tablets 400mg "LITA" (Ibuprofen) 1.23

AC39293100 SUROLE CAPSULE 50MG (CLOMIPHENE) "STANDARD" 3.87

AC39304100 ESTROMON F.C.TABLETS 0.625MG "STANDARD" 1.85

AC393041G0 ESTROMON F.C.TABLETS 0.625MG "STANDARD"(鋁箔/膠箔) 2.00

AC39305100 RINDARON TABLETS 0.5MG"EVEREST" (BETAMETHASONE) 1.50

AC39306338 AG-S COMPLEX CREAM 56.00

AC39306348 AG-S COMPLEX CREAM 56.00

AC39306377 AG-S COMPLEX CREAM 0.00

AC39307100 DELIPIC TABLETS 20MG (LOVASTATIN) "STANDARD" 3.24

AC39309151 "KOJAR" KETOTIFEN SOLUTION 0.2 MG/ML 42.80

AC39309157 "KOJAR" KETOTIFEN SOLUTION 0.2 MG/ML 78.00

AC39312100 URICIN TABLETS 100MG (BENZBROMARONE) 2.05

AC39315100 ACYLETE TABLETS 400MG (ACYCLOVIR) 5.60

AC39318212 ONZOD INJ. 2MG/ML 2ML 87.00

AC39319209 TONCAM INJECTION 20MG/ML (PIROXICAM) "CHI SHENG" 0.00

AC39319212 TONCAM INJECTION 20MG/ML (PIROXICAM) "CHI SHENG" 16.90

AC39345421MORCASIN OPHTHALMIC SOLUTION 40MG/ML (SULFAMETHOXAZOLE)

"SINPHAR"12.00

AC39345435MORCASIN OPHTHALMIC SOLUTION 40MG/ML (SULFAMETHOXAZOLE)

"SINPHAR"13.90

AC39350500 DICLOFEN SUPPOSITORY 25MG "KOJAR" (DICLOFENAC) 5.00

AC39351500 DICLOFEN SUPPOSITORY 12.5MG "KOJAR"(DICLOFENAC) 5.00

AC39368100 VIRLESS TABLETS 800MG (ACYCLOVIR) "YUNG SHIN" 11.80

AC39385100 BOLAXIN F.C. TABLETS 500MG (METHOCARBAMOL) 1.50

AC393851G0 BOLAXIN F.C. TABLETS 500MG (METHOCARBAMOL)(鋁箔/膠箔) 2.00

AC39392221 LYO-POVIGENT INJECTION 62.00

AC39396100 DISPEC TAB 40MG 1.50

AC39397100 ANFLUPIN TAB 100MG 2.49

AC39401100 ENALATEC TABLETS 20MG (ENALAPRIL) 1.54

AC394011G0 ENALATEC TABLETS 20MG (ENALAPRIL)(鋁箔/膠箔) 2.00

AC39403100 LOZUTIN TABLETS 20MG (LOVASTATIN) 3.24

AC39407100 MEKIN TABLETS 5MG "S.C." 1.50

AC394071G0 MEKIN TABLETS 5MG "S.C." (MEQUITAZINE)(鋁箔/膠箔) 2.00

AC39408100 GLIUCON TABLETS 5MG (GLIBENCLAMIDE) 1.50

AC394081G0 GLIUCON TABLETS 5MG (GLIBENCLAMIDE)(鋁箔/膠箔) 2.00

AC39409100 TRIVEGEN F.C. TABLETS "ROYAL" 2.01

AC39414100 SINTEC TABLETS 20MG "S.T."(ENALAPRIL) 1.54

AC394141G0 SINTEC TABLETS 20MG "S.T." (ENALAPRIL)(鋁箔/膠箔) 2.00

AC39429329 TORICAM GEL 10MG/G (PIROXICAM) 14.80

AC39429338 TORICAM GEL 10MG/G (PIROXICAM) 23.10

AC39429343 TORICAM GEL 10MG/G (PIROXICAM) 28.40

AC39429345 TORICAM GEL 10MG/G (PIROXICAM) 35.00

AC394293AK TORICAM GEL 10MG/G (PIROXICAM) 28.20

AC39431100 DOPADINE F.C. TABLET 100MG (AMANTADINE) "SWISS" 3.77

AC39432438 BECOTON NASAL SPRAY 0.42MG/GM (BECLOMETHASONE) "B&F" 118.00

AC39485151 IPUTON SUSPENSION 20MG/ML "Y.K." 25.00

AC39485157 IPUTON SUSPENSION 20MG/ML "Y.K." 45.10

AC39518100 SUFEN TABLETS 200MG (TIAPROFENIC ACID ) 2.91

Page 170: 附件二 藥品給付品項暨支付標準表

AC39519100TETRALIN CAPSULES 250MG "KOJAR" (TERACYCLINE HYDROCHLO-

RIDE)1.50

AC395191G0 TETRALIN CAPSULES 250MG (TERACYCLINE HYDROCHLO-RIDE)

"KOJAR"(鋁箔/膠箔)2.00

AC39523100 OFCIN FILM COATED TABLETS 400MG (OFLOXACIN) 25.10

AC39537100 SILYMIN CAPSULE 150MG "SWISS"(SILYMARIN) 1.52

AC395371G0 SILYMIN CAPSULE 150MG (SILYMARIN) "SWISS"(鋁箔/膠箔) 2.00

AC39547100 CENTAL F.C. TABLETS 100MG 1.50

AC395471G0CENTAL F.C. TABLETS 100MG "S.Y."(PENTTOXIFYLLINE)(鋁箔/

膠箔)2.00

AC39553100 ETOFAT CAPSULES "STANDARD" 3.23

AC39560100 BACIZIDE CAPSULES 200MG (NIFUROXAZIDE) "S.C." 2.30

AC39561100 LIHOSIN F.C. TABLETS 10MG (SCOPOLAMINE BUTYLBROMIDE) 1.50

AC395611G0LIHOSIN F.C. TABLETS 10MG (SCOPOLAMINE BUTYLBROMIDE)(鋁

箔/膠箔)2.00

AC39567100 KOLININ TABLETS 1MG 1.50

AC395671G0 KOLININ TABLETS 1MG(鋁箔/膠箔) 2.00

AC39575100 KERSYN F.C. TABLETS 100MG (TICLOPIDINE) "CHINTENG" 3.53

AC39584100MEBEVER F.C. TABLETS 135MG (MEBEVERINE)

"SINPHAR"(MEBEVERINE HYDROCHLORIDE)1.75

AC395841G0MEBEVER F.C. TABLETS 135MG (MEBEVERINE)

"SINPHAR"(MEBEVERINE HYDROCHLORIDE)2.00

AC39589100 DEGOUT TABLETS 0.5MG (CLOCHICINE) "CHINTENG" 1.50

AC395891G0DEGOUT TABLETS 0.5MG (CLOCHICINE) "CHINTENG"(鋁箔/膠箔)

2.00

AC39595100 SANPO CAPSULES 2MG (LOPERAMIDE) "CHINTENG" 1.50

AC395951G0SANPO CAPSULES 2MG (LOPERAMIDE) "CHINTENG" (鋁箔/膠箔)

2.00

AC39596321 CHENFU CREAM 20MG/GM"CHINTENG" (KETOCONAZOLE) 0.00

AC39596329 CHENFU CREAM 20MG/GM"CHINTENG" (KETOCONAZOLE) 0.00

AC39596335 CHENFU CREAM 20MG/GM"CHINTENG" (KETOCONAZOLE) 0.00

AC39596338 CHENFU CREAM 20MG/GM"CHINTENG" (KETOCONAZOLE) 38.70

AC39597100 SWITANE TABLET 2MG "SWISS" (TRIHEXYPHENIDYL) 1.50

AC395971G0SWITANE TABLET 2MG "SWISS" (TRIHEXYPHENIDYL)(鋁箔/膠箔)

2.00

AC39598212VEINTONIC INJECTION 0.84MG/ML "SWISS"

(GINKGOFLAVONEGLYCOSIDE)22.90

AC39598221VEINTONIC INJECTION 0.84MG/ML "SWISS"

(GINKGOFLAVONEGLYCOSIDE)25.00

AC39600100MINO CAPSULES 100MG "CHINTENG" (MINOCYCLINE

HYDROCHLORIDE)5.90

AC39601100 ASACOR TABLETS 20MG 0.00

AC39609151 CYPROMINE SYRUP 0.4MG/ML "W.P." (CYPROHEPTADINE) 25.00

AC39614338 BIFONA TOPICAL SOLUTION 10MG/ML "S.C." (BIFONAZOLE) 85.00

AC39614345 BIFONA TOPICAL SOLUTION 10MG/ML "S.C." (BIFONAZOLE) 123.00

AC39615100 CIMETIDINE TAB. 400MG 1.50

AC396151G0 CIMETIDINE TABLETS. 400MG "S.C."(鋁箔/膠箔) 2.00

AC39616321 AN HAO CREAM 50MG/GM "S.C." (ACYCLOVIR) 41.10

Page 171: 附件二 藥品給付品項暨支付標準表

AC39616329 AN HAO CREAM 50MG/GM "S.C." (ACYCLOVIR) 42.90

AC39619238 ANKOTON INJECTION "ASTAR" 15.00

AC396203AH SYAWE CREAM 50MG/GM (ACYCLOVIR)"MEIDER" 41.80

AC39623335 MEXAC OINTMENT 15G 54.00

AC39625100 FELDEMIN CAPSULES 20MG "EVEREST" (PIROXICAM) 1.50

AC396251G0FELDEMIN CAPSULES 20MG "EVEREST" (PIROXICAM)(鋁箔/膠箔)

2.00

AC39626209 ANXICAM INJECTION 2MG/ML (LORAZEPAM) "SWISS" 15.00

AC39651100 KOLININ TABLETS 2MG 1.50

AC396511G0 KOLININ TABLETS 2MG(鋁箔/膠箔) 2.00

AC39660277 SALINE INJECTION 3% "N.K." 0.00

AC39682100 METERONE TABLETS 10MG (MEDROXYPROGESTERONE ACETATE) 2.63

AC39683100 CIMETIN TABLETS 200MG "SENTAI"(CIMETIDINE) 1.50

AC39684209 CEKODIN-A INJECTION (CEPHRADINE) 25.00

AC39684277 CEKODIN-A INJECTION (CEPHRADINE) 25.00

AC39689209FOLSMYCIN POWDER FOR INJECTION "YUNG SHIN" (FOSFOMYCIN)

0.00

AC39689212FOLSMYCIN POWDER FOR INJECTION "YUNG SHIN"(FOSFOMYCIN)

187.00

AC39689219FOLSMYCIN POWDER FOR INJECTION (FOSFOMYCIN) "YUNG SHIN"

305.00

AC39689277FOLSMYCIN POWDER FOR INJECTION "YUNG SHIN" (FOSFOMYCIN)

0.00

AC39692100 WEISU F.C. TABLETS 200MG "KOJAR" (SULINDAC) 1.98

AC396921G0WEISU F.C. TABLETS 200MG (SULINDAC) "KOJAR"(鋁箔/膠箔)

2.00

AC39694220 TAZOCIN LYO-INJECTION 226.00

AC396942CX TAZOCIN LYO-INJECTION 136.00

AC39703100 LABTAL F.C. TABLETS 200MG (LABETALOL) "SINPHAR" 2.82

AC39718100 DICLOFENAC SODIUM E.F.C.TAB. 1.50

AC39725100 MECOBALAMINE CAPSULES 0.5MG "S.C." 1.55

AC397251G0 MECOBALAMINE CAPSULES 0.5MG "S.C."(鋁箔/膠箔) 2.00

AC39728100 MOTALINE TAB. 10MG 0.00

AC39729100 MECIDAL F.C. TABLETS 50MG (MEBHYDROLINE)"Y.Y." 1.50

AC39731100 JOINTELL CAPSULES 300MG "EVEREST" (GEMFIBROZIL) 1.50

AC39734100 DICRON TABLETS 80MG "S.Y."(GLICLAZIDE) 0.00

AC397341G0 DICRON TABLETS 80MG "S.Y."(GLICLAZIDE)(鋁箔/膠箔) 0.00

AC39740100 KENCORT TABLETS 4MG "EVEREST"(TRIAMCINOLONE) 1.50

AC39769100 ROSUP CAPSULES 25MG (LOXAPINE) "SWISS" 3.96

AC39772100 VOKER FILM COATES TABLETS 40MG (FAMOTIDINE) 3.77

AC39775100 NAPTON F.C. TABLETS 275MG (NAPROXEN SODIUM) "B&F" 1.50

AC39778100 SEPIRONE TABLETS 10MG 2.83

AC39782209 TRICEF FOR IM. INJECTION (CEFTRIAXONE) "SWISS" 82.00

AC39782265 TRICEF FOR IM. INJECTION (CEFTRIAXONE) "SWISS" 54.00

AC39782277 TRICEF FOR IM. INJECTION (CEFTRIAXONE) "SWISS" 54.00

AC39788100 EGOLDER TABLETS 60MG "H.S." 1.50

AC397881G0 EGOLDER TABLETS 60MG "H.S." (鋁箔/膠箔) 2.00

AC39790100 BENRONE TABLETS100MG "WEIDAR" (BENZBROMARONE) 2.05

Page 172: 附件二 藥品給付品項暨支付標準表

AC39793100 OFLODAL F.C. TABLETS 100MG (OFLOXACIN) 1.58

AC39794100 QUIMADINE F.C. TABLETS 20MG (FAMOTIDINE) 1.59

AC39797100 OFCIN FILM COATED TABLETS 200MG (OFLOXACIN) 1.88

AC397971G0OFCIN FILM COATED TABLETS 200MG (OFLOXACIN)(鋁箔/膠箔)

2.00

AC39798100 OFCIN FILM COATED TABLETS 100MG (OFLOXACIN) 1.58

AC397981G0OFCIN FILM COATED TABLETS 100MG (OFLOXACIN)(鋁箔/膠箔)

2.00

AC39812321 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 11.20

AC39812329 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 14.80

AC39812335 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 0.00

AC39812338 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 23.10

AC39812340 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 28.20

AC39812343 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 28.40

AC39812345 ENTON GEL10MG/GM "CHINTENG" (PIROXICAM) 35.00

AC39812355 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 225.00

AC398123AK ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 28.20

AC39816100 ANLIPIN F.C. TABLETS 50MG (ATENOLOL) "KOJAR" 1.50

AC398161G0ANLIPIN F.C. TABLETS 50MG (ATENOLOL) "KOJAR"(鋁箔/膠箔)

2.00

AC39819100 OXACIN F.C. TABLETS 200MG "CHINTENG" (OFLOXACIN) 1.88

AC39822100 ESTRADE TABLETS 2MG(ESTRADIOL) 3.78

AC39830212 GENTAMICIN INJECTION 40MG/ML "N.K." 15.00

AC39830229 GENTAMICIN INJECTION 40MG/ML "N.K." 16.50

AC39830238 GENTAMICIN INJECTION 40MG/ML "N.K." 40.80

AC39831100 DICOREN TABLETS 50MG "SENTAI"(DICLOFENAC) 1.50

AC39843100 SWINORIN F.C. TABLETS 100MG "SWISS" (ATENOLOL) 1.51

AC398431G0SWINORIN F.C. TABLETS 100MG "SWISS" (ATENOLOL)(鋁箔/膠

箔)2.00

AC39851100 CYMA CAPSULES "CHINTENG" 1.50

AC398511G0 CYMA CAPSULES."CHINTENG" (鋁箔/膠箔) 2.00

AC39855100 DRINGEN S.C. TABLETS 10MG "EVEREST"(METOCLOPRAMIDE) 1.50

AC39859143CYPROH SOLUTION 0.4MG/ML "KOJAR" (CYPROHEPTADINE

HYDROCHLORIDE)25.00

AC39859151CYPROH SOLUTION 0.4MG/ML "KOJAR" (CYPROHEPTADINE

HYDROCHLORIDE)25.00

AC39859157CYPROH SOLUTION 0.4MG/ML "KOJAR" (CYPROHEPTADINE

HYDROCHLORIDE)25.00

AC39863100GINCARE FILM COATED TABLETS 9.6MG

(GINKGOFLAVONGLYCOSIDES)1.71

AC398631G0GINCARE FILM COATED TABLETS 9.6MG

(GINKGOFLAVONGLYCOSIDES)(鋁箔/膠箔)2.00

AC39876100 SILTIN TABLETS 5MG 2.46

AC39879100 VARAPAMIL TABLETS 40MG "F.Y." 0.00

AC39880129 SPEEDON POWDER "N.K."(LACTITOL) 11.00

AC39880138 SPEEDON POWDER "N.K."(LACTITOL) 18.90

AC39893100 IBUPROFEN TABLETS 400MG "F.Y" 1.50

AC398931G0 IBUPROFEN TABLETS 400MG "F.Y."(鋁箔/膠箔) 2.00

Page 173: 附件二 藥品給付品項暨支付標準表

AC39896100 "SINSULIN TABLETS 10MG ""ASTAR""" 1.52

AC398961G0 "SINSULIN TABLETS 10MG ""ASTAR""(鋁箔/膠箔)" 2.00

AC39910100 POSMETAN F.C.TAB. 1.50

AC39928100 KOWELL TABLETS 2MG "EVEREST" 1.50

AC399281G0 KOWELL TABLETS 2MG "EVEREST"(鋁箔/膠箔) 2.00

AC39931100KOJARCLINDA CAPSULES 150“KOJAR” (CLINDAMYCIN

HYDROCHLORIDE)1.50

AC399311G0KOJARCLINDA CAPSULES 150“KOJAR” (CLINDAMYCIN

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC39932100 LOMIDINE TABLETS 10MG (LORATADINE) "H.S." 1.50

AC399321G0 LOMIDINE TABLETS 10MG (LORATADINE) "H.S."(鋁箔/膠箔) 2.00

AC39940209 CEFT-S FOR I.V INJECTION (CEFTRIAXONE )"STANDARD" 82.00

AC39940277 CEFT-S FOR I.V INJECTION (CEFTRIAXONE )"STANDARD" 54.00

AC39944219 SUPREN INJECTION 2MG/ML"S.T." (ONDANSETRON) 94.00

AC39945100 N.F.S. F.C. TABLETS 200MG "C.H." (NORFLOXACIN) 1.96

AC39950100 KOJARCLINDA CAPSULES 300MG "KOJAR" (CLINDAMYCIN) 2.80

AC39953500 DOMPERID SUPPOSITORY 10MG "KOJAR" (DOMPERIDONE) 5.00

AC39962100 DAMIN CAPSULES 2MG (PRAZOSIN HYDROCHLORIDE) "S.C." 3.53

AC39964477 SINTAL SINGLE DOSE UNIT EYE DROPS 2% 4.00

AC39969100 MOTIN TABLETS 10MG "Y.J."(DOMPERIDONE) 1.50

AC39974100 SINTEC TABLETS 5MG "S.T." (ENALAPRIL) 1.54

AC399741G0 SINTEC TABLETS 5MG "S.T." (ENALAPRIL)(鋁箔/膠箔) 2.00

AC40011100 ACEMET CAPSULES 60MG (ACEMETACIN) 1.54

AC400111G0 ACEMET CAPSULES 60MG (ACEMETACIN)(鋁箔/膠箔) 2.00

AC40042100 NEUQUINON S.C. TABLETS 10MG 2.85

AC40045277 SORLATE INJECTION "CHI SHENG" 36.40

AC40047100 BENTOMIN TABLETS 500MG "S.C." (METFORMIN) 1.50

AC400471G0 BENTOMIN TABLETS 500MG "S.C."(METFORMIN)(鋁箔/膠箔) 2.00

AC40051100 AZU TABLETS 2 MG(AZULENE) "S.D." 1.50

AC40065100 FANCIN CAPSULES 500MG "EVEREST"(TINIDAZOLE) 2.09

AC40073151 CO-BO SYRUP "D.J." 0.00

AC40085100 BUISLINE TABLETS 5MG "H.S."(BUSPIRONE) 1.50

AC400851G0 BUISLINE TAB.5MG "H.S."(BUSPIRONE)(鋁箔/膠箔) 2.00

AC40090100 ACYLETE TABLETS 200MG (ACYCLOVIR) 4.26

AC40091100 AZOL-FLUCON CAPSULES 150MG(FLUCONAZOLE) 52.00

AC40096162 ALL-RIGHT CALCIUM SUSPENSION "STANDARD" 152.00

AC40098100 MEMIN TABLETS 250MG "SENTAI"(METFORMIN) 1.50

AC40099214 EUCOL LYOPHILIZED INJECTION 2.5G "STANDARD" 0.00

AC40106100 SYNORID TABLETS 100MG (ALLOPURINOL) 1.50

AC401061G0 SYNORID TABLETS 100MG (ALLOPURINOL)(鋁箔/膠箔) 2.00

AC40115100 TESPO CAPSULES 20MG(METHYLTESTOSTERONE)"CHEN TA" 1.93

AC40119100 BENTOMIN TABLETS 850MG "S.C." (METFORMIN) 1.68

AC401191G0 BENTOMIN TABLETS 850MG "S.C."(METFORMIN)(鋁箔/膠箔) 2.00

AC401201G0FRANDYL TABLETS 2.5MG (FENOTEROL HYDROBROMIDE) (鋁箔/膠

箔)2.00

AC40121100 NAPOSIN ENTERIC F.C. TABLETS 500MG (NAPROXEN) 2.95

AC40122100 NAPOSIN ENTERIC F.C. TABLETS 250MG (NAPROXEN) 1.50

AC40123100 TERBELINE TAB. 2.5MG 1.50

Page 174: 附件二 藥品給付品項暨支付標準表

AC40124100 METERONE TABLETS 5MG (MEDROXYPROGESTERONE ACETATE) 1.50

AC40134100 SEPIRONE TABLETS 5 MG 1.50

AC401341G0 SEPIRONE TABLETS 5MG(鋁箔/膠箔) 2.00

AC40147100PURSIN F.C. TABLET 500MG (IBUPROFEN LYSINATE) "PURZER"

1.64

AC401471G0PURSIN F.C. TABLET 500MG (IBUPROFEN LYSINATE) "PURZER"

2.00

AC40148100 FLUZEPAM TABLETS 2MG (FLUNITRAZEPAM) 1.77

AC401481G0 FLUZEPAM TABLETS 2MG (FLUNITRAZEPAM)(鋁箔/膠箔) 2.00

AC40149321 E.T. CREAM 10.50

AC40149329 E.T. CREAM 18.80

AC40149335 E.T. CREAM 30.40

AC40150338 AN FU CREAM "C.H." 0.00

AC40151321 YI-FU CREAM "S.C." 0.00

AC40151329 YI-FU CREAM "S.C." 0.00

AC40151335 YI-FU CREAM "S.C." 39.30

AC40152100 HOMAGYL TABLETS 50MG "W.S." 1.53

AC401521G0 HOMAGYL TABLETS 50MG "W.S."(鋁箔/膠箔) 2.00

AC40163100 HOMELAIN ENTERIC F.C. TABLETS 50MG "W.S." 1.50

AC401631G0 HOMELAIN ENTERIC S.C. TABLETS 50MG "W.S."(鋁箔/膠箔) 2.00

AC40168100 SIDALAT SOFT CAP. 10MG 1.81

AC401681G0SIDALAT SOFT CAPSULES 10MG "CHINTENG" (NIFEDIPINE) (鋁箔

/膠箔)2.00

AC40171100 CEFADOR TABLETS . 25MG (DIPHENIDOL) "SENTAI" 1.50

AC40174100 BENZRO CAPSULES "C.H." 2.05

AC40175100 LYSOZYME CHLORIDE TABLETS 90MG "F.Y." 1.50

AC401751G0 LYSOZYME CHLORIDE TABLETS 90MG "F.Y."(鋁箔/膠箔) 2.00

AC40196100 Jiawiller F.C. Tablets 20mg(Famotidine) "C.L." 1.59

AC401961G0 Jiawiller F.C. Tablets 20mg(Famotidine) "C.L." 2.00

AC40198100 MESYREL TABLET 150MG "M.S."(TRAZODONE HYDROCHLORIDE) 8.70

AC40206100 VOKER FILM COATED TABLET 20MG(FAMOTIDINE) 1.59

AC402061G0 VOKER FILM COATED TABLET 20MG(FAMOTIDINE)(鋁箔/膠箔) 2.00

AC40207100 FENOT TAB. 2.5MG 1.50

AC402071G0"FENOT TAB. 2.5MG""H.S.""(FENOTEROL HYDROBROMIDE)(鋁箔/

膠箔)"2.00

AC40232100 JIACANG TABLETS 1.50

AC402321G0 JIACANG TABLETS(鋁箔/膠箔) 2.00

AC40233100 GLIX TABLETS 5MG (GLIPIZIDE) "YUNG SHIN" 1.50

AC402331G0 GLIX TABLETS 5MG (GLIPIZIDE) "YUNG SHIN"(鋁箔/膠箔) 2.00

AC40245321 KOJARCORT CREAM "KOJAR" 10.50

AC40245329 KOJARCORT CREAM "KOJAR" 18.80

AC40245335 KOJARCORT CREAM "KOJAR" 30.40

AC40245338 KOJARCORT CREAM "KOJAR" 32.60

AC40245355 KOJARCORT CREAM"KOJAR" 135.00

AC40249100 MEVOLING TABLETS 200MG (SULPIRIDE) "KOJAR" 1.71

AC402491G0 MEVOLING TABLETS 200MG (SULPIRIDE) "KOJAR"(鋁箔/膠箔) 2.00

AC40265100 DAZID TABLETS "H.S" 1.50

AC40292500 CARESS SUPPOSITORIES "MEIDER" 5.00

Page 175: 附件二 藥品給付品項暨支付標準表

AC40293100 "URICAM TABLETS 50MG ""TAI YU"" (BENZBROMARONE)" 1.50

AC40294100 HYBOZIDE TAB 50MG 1.50

AC40300100 POULICAN-U SOFT CAPSULE 150MG "SINPHAR"(SILYMARIN) 1.52

AC40302100 DESPUTIN TAB 30MG 1.50

AC40333100 OSTALFA SOFT CAPSULES 0.25UG "F.M."(ALFACALCIDOL) 4.81

AC40334100 MACALOL SOFT CAPSULES 0.5UG "F.M."(CALCITRIOL) 4.37

AC40352100 DANAMIN CAPSULES 100MG "CHIHTENG"(DANAZOL) 9.80

AC40355100 BRONYL TABLETS 4MG (TRIMETOQUINOL) "S.S.P" 1.60

AC40356100 CLOMI CAPSULES 25MG "CHINTENG"(CLOMIPRAMINE) 2.64

AC40358345 FLUR DI FEN PATCH 40MG/12GM 5.30

AC40363100 VOREN E.C. TABLETS 75MG (DICLOFENAC SODIUM) 1.50

AC40399100FORFLOW SUSTAINEDRELEASED TABLETS 400MG (PENTOXIFYLLINE)

"M.S."1.82

AC403991G0FORFLOW SUSTAINEDRELEASED TABLETS 400MG (PENTOXIFYLLINE)

"M.S."2.00

AC40421100 BLADATON TABLET 200MG "SENTAI" (FLAVOXATE) 3.74

AC40424100 PAR YIH TABLETS 5MG "C.H." (OXYBUTYNIN CHLORIDE) 2.12

AC40426100 S.K.J.CAPSULES 250MG "C.H."(ERYTHOMYCIN) 1.77

AC40428100 EDEPIN TABLETS 5MG "SWISS" (AMILORIDE) 2.88

AC40429100 SUPEROCIN F.C. TABLETS 250MG "WEIDAR" 5.10

AC40458321 AESCIN GEL 15MG/G "C.H."(ESCIN) 32.60

AC40458338 AESCIN GEL 15MG/G "C.H."(ESCIN) 86.00

AC40523100CIRZODONE TABLET 100MG "SINPHAR"(TRAZODONE

HYDROCHLORIDE)2.97

AC40532100 ENOLI CAPSULES 400MG "CHINTENG" (PIRACETAN) 1.50

AC405321G0ENOLI CAPSULES 400MG "CHINTENG" (PIRACETAN)(鋁箔/膠箔)

2.00

AC40536100 IBUPROFEN TABLETS 400MG "SWISS" 1.50

AC405361G0 IBUPROFEN TABLETS 400MG "SWISS"(鋁箔/膠箔) 2.00

AC405361G2 IBUPROFEN TABLETS 400MG "SWISS"(28粒/瓶) 2.00

AC405361G4 IBUPROFEN TABLETS 400MG "SWISS"(56粒/瓶) 2.00

AC405361G6 IBUPROFEN TABLETS 400MG "SWISS"(112粒/瓶) 2.00

AC40542100 BACCIDAL F.C 200MG 1.96

AC40544100 CLOPRAN F.C. TABLETS 25MG (CLOMIPRAMINE) 2.64

AC40545100 SUSINE F.C.TABLETS 200MG "SWISS"(SULPIRIDE) 1.71

AC405451G0SUSINE F.C.TABLETS 200MG "SWISS"(SULPIRIDE)(鋁箔/膠箔)

2.00

AC40564100 IBUPROFEN F.C.TABLETS 400MG "SWISS" 1.50

AC405641G0 IBUPROFEN F.C. TABLETS 400MG "SWISS"(鋁箔/膠箔) 2.00

AC405641G2 IBUPROFEN F.C. TABLETS 400MG "SWISS"(28粒/瓶) 2.00

AC405641G4 IBUPROFEN F.C. TABLETS 400MG "SWISS"(56粒/瓶) 2.00

AC405641G6 IBUPROFEN F.C. TABLETS 400MG "SWISS"(112粒/瓶) 2.00

AC40567100 LOPERATIN TABLETS 2MG "EVEREST"(LOPERAMIDE) 1.50

AC40568100GINGONIN F.C. TABLETS 40MG "Y.C."

(GINKGOFLAVONGLYCOSIDES)1.71

AC405681G0GINGONIN F.C.TABLETS 40MG

(GINKGOFLAVONGLYCOSIDES)"Y.C."(鋁箔/膠箔)2.00

AC40569321 CONAZOL CREAM 20MG /GM "STANDARD"(KETOCONAZOLE) 11.90

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AC40569335 CONAZOL CREAM 20MG /GM "STANDARD"(KETOCONAZOLE) 31.90

AC40569338 CONAZOL CREAM 20MG /GM (KETOCONAZOLE) "STANDARD" 38.70

AC40573100 NYSTATIN CAPSULES 500000UNITS "CHIN TENG" 2.64

AC40575100 EBUFEN F.C.TABLETS 400MG (IBUPROFEN) "S.C" 1.50

AC40576100 ZINBOSS TABLETS "C.H." (ZINC GLUCONATE) 1.50

AC40580100 EDENIL TABLETS 1.88

AC40615100 CHILON E.F.C. TABLETS 75MG "Y.K." 1.50

AC406151G0 CHILON E.F.C. TABLETS 75MG "Y.K."(鋁箔/膠箔) 2.00

AC40639100 ERCIN CAPSULES 10MG (UBIDECARENONE) "YUNG CHI" 2.85

AC40643100 S.K.J.TABLETS 500MG "C.H." (ERYTHROMYCIN ESTOLATE) 3.67

AC40649100 MEBERINE TABLETS 135MG (MEBEVERINE HCL) "Y.C." 1.75

AC406491G0MEBERINE TABLETS 135MG (MEBEVERINE HCL) "Y.C."(鋁箔/膠

箔)2.00

AC40651500 YI-FU VAGINAL TABLETS 100MG (ISOCONAZOLE) "S.C." 5.00

AC40653100 EXTACOL TAB. 200MG 1.94

AC40655100DEXTROLAMINE TABLETS 20MG (DEXTROMETHORPHAN

HYDROBROMIDE) "S.C."0.80

AC40659110 CEFACLOR FOR ORAL SUSPENSION 25MG/ML "SCB" 106.00

AC40666248 FLUCON FOR IV INJECTION 258.00

AC40666255 FLUCON FOR IV INJECTION 274.00

AC40685100"COYENPIN E.C.TABLETS 50MG (DICLOFENAC SODIUM) ""ROOT"""

1.50

AC406851G0"COYENPIN E.C.TABLETS 50MG (DICLOFENAC SODIUM)

""ROOT"(鋁箔/膠箔)"2.00

AC40686100DICLOFEN ENTERIC-MICRO-ENCAPSULED CAPSULES 50MG "H.S."

(DICLOFENAC SODIUM)1.50

AC406861G0DICLOFEN ENTERIC-MICRO-ENCAPSULED CAPSULES 50MG

(DICLOFENAC SODIUM) "H.S."(鋁箔/膠箔)2.00

AC40699100GINKGOCENTRATE F.C. TABLET 9.6MG "SINPHAR"

(Ginkgoflavonglycosides)1.71

AC406991G0GINKGOCENTRATE F.C. TABLET 9.6MG "SINPHAR"

(Ginkgoflavonglycosides)2.00

AC40706151 SORTUSS COUGH LIQUID "CENTER" 25.00

AC40706157 SORTUSS COUGH LIQUID "CENTER" 25.00

AC40715100 BACLOFEN TABLETS 10MG "JOHNSON" 1.50

AC40716100 BACLOFEN TABLETS 5MG"JOHNSON" 1.50

AC407161G0 BACLOFEN TABLETS 5MG"JOHNSON"(84粒/瓶) 2.00

AC407161GA BACLOFEN TABLETS 5MG "JOHNSON"(鋁箔/膠箔) 2.00

AC40724421 KOSA ORABASE 0.1% (DEXAMETHASONE) "STANDARD" 35.60

AC40725100 URIMETON TABLETS 200MG (FLAVOXATE) "CHEN TA" 3.74

AC40767343 TONEX CREAM 10MG/GM (PIROXICAM) "MEIDER" 28.40

AC40767345 TONEX CREAM 10MG/GM "MEIDER" (PIROXICAM) 35.00

AC40774100 ANTON TAB. 250MG "EVEREST"(DIFLUNISAL) 6.80

AC40776100 ROLAX TABLETS 10MG "EVEREST" (BACLOFEN) 0.00

AC40778321 LEDERNIN OINTMENT "EVEREST" 10.50

AC40778329 LEDERNIN OINTMENT "EVEREST" 18.80

AC40778335 LEDERNIN OINTMENT "EVEREST" 30.40

AC40780335 EPIFU CREAM "SENTAI" 30.40

Page 177: 附件二 藥品給付品項暨支付標準表

AC40781100 GLUCOFIT F.C.TABLETS 500MG (METFORMIN) "SWISS" 1.50

AC407811G0GLUCOFIT F.C.TABLETS 500MG "SWISS" (METFORMIN) (鋁箔/膠

箔)2.00

AC407811G4GLUCOFIT F.C.TABLETS 500MG "SWISS" (METFORMIN) (60粒/瓶)

2.00

AC407811G7GLUCOFIT F.C.TABLETS 500MG "SWISS" (METFORMIN) (168粒/

瓶)2.00

AC40782100 LIVERON S.C.TABLETS 25MG "EVEREST" (ANETHOL) 1.50

AC40783100 TRANCOSIL TABLETS 200MG "EVEREST" (CHLORMEZANONE) 1.50

AC40787100 SORIALEN F.C.TABLETS 10MG "SWISS" (METHOXSALEN) 18.40

AC40790100 MEDORONE TABLETS 5MG (NORETHINDRONE ACETATE) "S.C." 1.66

AC40791100CYPROH TABLETS 4MG "KOJAR" (CYPROHEPTADINE

HYDROCHLORIDE)1.50

AC407911G0CYPROH TABLETS 4MG (CYPROHEPTADINE HYDROCHLORIDE

"KOJAR"(鋁箔/膠箔)2.00

AC40792238 LYSIMIN INJECTION 15.00

AC40794100 COSOPIN TABLETS "CHINTENG" 1.50

AC407941G0 COSOPIN TABLETS "CHINTENG" (鋁箔/膠箔) 2.00

AC40796321 TRIMALON CREAM 10.50

AC40796329 TRIMALON CREAM 0.00

AC40796335 TRIMALON CREAM 30.40

AC40808321 KEPOLINE OINTMENT 5% "EVEREST" (ACYCLOVIR) 0.00

AC40813209 GLYCAL-AMIN INJECTION 0.00

AC40813277 GLYCAL-AMIN INJECTION 182.00

AC408132A1 GLYCAL-AMIN INJECTION 0.00

AC40815329 MEFUDAZOLE GEL 0.75% "S.L" 27.30

AC40815338 MEFUDAZOLE GEL 0.75% "S.L." 57.00

AC40818100 KOWEISHU TABLETS 200MG "C.E."(CIMETIDINE) 1.50

AC40825100 ZINCO TABLETS 78MG (ZINC GLUCONATE) "ROYAL" 1.50

AC40835100 MEFORIN F.C.TAB. 500MG 1.50

AC40864100 U-Ca soft capsule 0.25mcg (CALCITRIOL) "SINPHAR" 2.16

AC40868321 KETOSONE CREAM 20MG/GM (KETOCONAZOLE) "PBF" 11.90

AC40868329 KETOSONE CREAM 20MG/GM (KETOCONAZOLE) "PBF" 13.10

AC40868335 KETOSONE CREAM 20MG/GM (KETOCONAZOLE) "PBF" 31.90

AC40870100 BROWN MIXTURE TABLETS (WITH OPIUM) "CENTER" 1.50

AC408701G0 BROWN MIXTURE TABLET (WITH OPIUM) "CENTER"(鋁箔/膠箔) 2.00

AC40871100 COMPOUND GLYCYRRHIZA MIXTURE TABLET "CENTER" 1.50

AC408711G0COMPOUND GLYCYRRHIZA MIXTURE TABLET "CENTER"(鋁箔/膠箔)

2.00

AC40881100 LINCO CAPSULES 500MG"S.Y"(LINCOMYCIN HYDROCHLORIDE) 4.29

AC40887100 TNYH TABLETS 10MG "CHIN TENG" (OXETHAZAINE) 1.50

AC408871G0 TNYH TABLETS 10MG (OXETHAZAINE) "CHINTENG"(鋁箔/膠箔) 2.00

AC40892100 NALOXEN F.C. TABLETS 550MG "PBF"(NAPROXEN SODIUM) 2.95

AC40894100 LIVORIN CAPSULES 150MG "WEIDAR" (SILYMARIN) 1.52

AC408941G0LIVORIN CAPSULES 150MG (SILYMARIN) "WEIDAR" (鋁箔/膠箔)

2.00

AC40974500 CLOMAZOLE VAGINAL TABLETS 500MG "VPP" (CLOTRIMAZOLE) 12.50

AC40977100 SWITANE TABLETS 5MG "SWISS" (TRIHEXYPHENIDYL) 1.50

Page 178: 附件二 藥品給付品項暨支付標準表

AC409771G0SWITANE TABLETS 5MG "SWISS" (TRIHEXYPHENIDYL)(鋁箔/膠箔)

2.00

AC40979100 MEQAZINE TABLETS 5MG "Y.C." (MEQUITAZINE) 1.50

AC409791G0 MEQAZINE TABLETS 5MG "Y.C." (MEQUITAZINE)(鋁箔/膠箔) 2.00

AC40986100 WEIMOK F.C.TAB. 20MG "WEIDAR" (FAMOTIDINE) 1.59

AC409861G0WEIMOK F.C. TABLETS 20MG "WEIDAR" (FAMOTIDINE)(鋁箔/膠

箔)2.00

AC41013209 CETA FOR INJECTION "CHI SHENG"(CEFTAZIDIME) 39.20

AC41013277 CETA FOR INJECTION "CHI SHENG"(CEFTAZIDIME) 0.00

AC41017100 ERGOLOID TAB. 1.5MG 1.50

AC41019100 BIPER TABLETS 2MG "S.C."(BIPERIDEN) 1.67

AC410191G0 BIPER TABLETS 2MG "S.C."(BIPERIDEN)(鋁箔/膠箔) 2.00

AC41020100 MESURIN TABLETS 2MG"S.C"(METHYLPREDNISOLONE) 1.53

AC41021100 FLOGIN TABLETS 2MG "W.S." 1.67

AC410211G0 FLOGIN TABLETS 2MG "W.S."(鋁箔/膠箔) 2.00

AC41022100 CHUNLIN CAPSULES "ROOT"(NIFUROXAZIDE) 2.30

AC41023100 BUFEN TABLET 200MG "CHINTENG" (FENBUFEN) 1.50

AC41024100 FREE TAB.2MG 1.67

AC41025100 TOLIZOLE CAP. 250MG 1.52

AC410251G0TOLIZOLE CAPSULES 250MG"KOJAR"(METRONIDAZOLE)(鋁箔/膠箔)

2.00

AC41029100 TRIAMCINOLONE TABLETS 4MG "KOJAR" 1.50

AC41030100 SUBILIN TAB. 60MG 1.50

AC410301G0SUBILIN TABLETS 60MG "KOJAR" 8PSEUDOEPHEDRINE

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC41035100 CATHARTINOL E.C. TABLETS 5MG "KOJAR"(BISACODYL) 1.50

AC410351G0CATHARTINOL E.C. TABLETS 5MG "KOJAR"(BISACODYL)(鋁箔/膠

箔)2.00

AC41036100 CINRIZIN TABLETS 25MG "KOJAR"(CINNARIZINE) 1.50

AC410361G0 CINRIZIN TABLETS 25MG "KOJAR"(CINNARIZINE)(鋁箔/膠箔) 2.00

AC41038100PENPHYLLINE FILM-COATED SUSTAINED-RELEASE TABLETS 400MG

(PENTOXIFYLLINE)1.82

AC41039100 GLU ZIN TAB. 1.50

AC41040438 BELAX AQUA NASAL SPRAY 0.42MG/GM 118.00

AC41056337 ISOCORTANT CREAM 60.00

AC410563AH ISOCORTANT CREAM 22.30

AC41057321 "CLOBA CREAM 0.5MG/GM ""S.Y."" (CLOBETASONE)" 24.40

AC41057329 CLOBA CREAM 0.5MG/GM "S.Y." (CLOBETASONE) 37.60

AC41057330 CLOBA CREAM 0.5MG/GM"S.Y" 44.00

AC41057335 CLOBA CREAM 70.00

AC41057343 CLOBA CREAM 30GM 121.00

AC41058100 NIFEPINE SUSTAINED RELEASE 20MG F.C.T "ROYAL" 3.12

AC41062100 DERGINPIN TABLETS 5MG(DIAZEPAM)"KOJAR" 1.50

AC410621G0 DERGINPIN TABLETS 5MG "KOJAR"(DIAZEPAM)(鋁箔/膠箔) 2.00

AC41065100 ANEDANE CAPSULES 25MG "KOJAR" (ANETHOLE) 1.50

AC410651G0 ANEDANE CAPSULES 25MG "KOJAR"(鋁箔/膠箔) 2.00

AC41069100 TRAN CAPSULES 250MG "KOJAR" 1.50

AC410691G0 TRAN CAPSULES 250MG "KOJAR"(鋁箔/膠箔) 2.00

Page 179: 附件二 藥品給付品項暨支付標準表

AC41070100 KANPO CAPSULES 50MG "KOJAR" (SULPIRIDE) 1.53

AC410701G0 KANPO CAPSULES 50MG "KOJAR"(SULPIRIDE)(鋁箔/膠箔) 2.00

AC41167100 SUKEYEN CAPSULES 50MG "KOJAR" (KETOPROFEN) 1.59

AC411671G0 SUKEYEN CAPSULES 50MG (KETOPROFEN)(鋁箔/膠箔) 2.00

AC41169100 KOJAZYME TABLETS 90MG "KOJAR" 1.50

AC411691G0 KOJAZYME TABLETS 90MG "KOJAR"(鋁箔/膠箔) 2.00

AC41174277 TALAMIN-HEPA INJECTION 0.00

AC41220100 ASPLATELET E.C. CAPSULE 100MG "PBF" (ASPIRIN) 1.50

AC41224100 SUCAN CAPSULES 150MG "YU SHENG" (SILYMARIN) 1.52

AC412241G0SUCAN CAPSULES 150MG "YU SHENG" (SILYMARIN)(鋁箔/膠箔)

2.00

AC41225100 BIWEISHI F.C. TAB. 120MG 5.30

AC41229321"CLEODACIN GEL 10MG/GM ""S.Y.""(CLINDAMYCIN PHOSPHATE)"

10.00

AC41229329"CLEODACIN GEL 10MG/GM ""S.Y.""(CLINDAMYCIN PHOSPHATE)"

14.10

AC41229335 CLEODACIN GEL 15GM 20.70

AC41229338 CLEODACIN GEL 10MG/GM"S.Y."(CLINDANMYEIN PHOSPHATE) 65.00

AC41229343 CLEODACIN GEL30GM 185.00

AC41230100 FENOTEROL TAB. 2.5MG 1.50

AC41234151 IBUFEN SUSPENSION 20MG/ML "C.H."(IBUPROFEN) 25.00

AC41234157 IBUFEN SUSPENSION 20MG/ML "C.H."(IBUPROFEN) 45.10

AC41238100 HICATROL SOFT CAPSULES 0.5UG "CHINTENG"(CALCITRIOL) 4.37

AC41239100 HICALOL SOFT CAPSULES 0.25UG "CHINTENG"(CALCITRIOL) 2.16

AC412441G0 B C LIVER CAPSULES 150MG "C.A."(SILYMARIN)(鋁箔/膠箔) 2.00

AC41247100 CARPINE TABLETS 200MG "S.T."(CARBAMAZEPINE) 2.18

AC41251100 MENCHUAN F.C.TABLETS 100MG(TICLOPIDINE) 3.53

AC41268100 KANYEN CAPSULES 200MG "KOJAR" (FLUFENAMIC ACID) 1.71

AC412681G0KANYEN CAPSULES 200MG "KOJAR" (FLUFENAMIC ACID)(鋁箔/膠

箔)2.00

AC41269100PRIPRAM TABLETS 5MG "KOJAR" (METOCLOPRAMIDE

HYDROCHLORIDE)1.50

AC412691G0"KOJAR"PRIPRAM TABLETS 5MG (METOCLOPRAMIDE

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC41270100KUETONBILY TABLETS 10MG "KOJAR" (DICYCLOMINE

HYDROCHLORIDE)1.50

AC412701G0"KOJAR"KUETONBILY TABLETS 10MG (DICYCLOMINE

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC41275151 TRACESLIN SYRUP 0.4MG/ML (SALBUTAMOL SULFATE) 25.00

AC41277100 ANTIGLUCO TABLETS 500MG "Y.K." 1.50

AC412771G0 ANTIGLUCO TABLETS 500MG "Y.K."(鋁箔/膠箔) 2.00

AC41280100 KINXETIN CAPSULES 20MG "KINGDOM"(FLUOXETINE) 2.80

AC41284100 INTESTICIN TAB. 1.50

AC412841G0 INTESTICIN TABLETS "KOJAR"(鋁箔/膠箔) 2.00

AC41287316 KOJARDERM OINTMENT "KOJAR" 10.00

AC41287321 KOJARDERM OINTMENT "KOJAR" 15.30

AC41287324 KOJARDERM OINTMENT "KOJAR" 17.30

AC41287329 KOJARDERM OINTMENT "KOJAR" 18.40

Page 180: 附件二 藥品給付品項暨支付標準表

AC41289100 WETOYI TABLETS "KOJAR" 1.50

AC41296100 TENTON CAPSULES 25MG "KOJAR" (INDOMETHACIN) 1.50

AC412961G0TENTON CAPSULES 25MG (INDOMETHACIN) "KOJAR"(鋁箔/膠箔)

2.00

AC41314151 BISUN ANTI-COUGH SYRUP 25.00

AC41314157 BISUN ANTI-COUGH SYRUP 25.80

AC41316100 COLCHICINE TABLETS 0.5MG "S.T." 1.50

AC413161G0 COLCHICINE TABLETS 0.5MG "S.T."(鋁箔/膠箔) 2.00

AC41318100 ASUTAF F.C. TABLET "Y.C." 1.50

AC413181G0 ASUTAF F.C. TABLET "Y.C."(鋁箔/膠箔) 2.00

AC41328100 SUNLING TABLETS 2MG "KOJAR" 1.50

AC413281G0 SUNLING TABLETS 2MG (SALBUTAMOL)"KOJAR"(鋁箔/膠箔) 2.00

AC41329100 SUNLING TABLETS 4MG "KOJAR" (SALBUTAMOL) 1.50

AC413291G0 SUNLING TABLETS 4MG "KOJAR" (SALBUTAMOL)(鋁箔/膠箔) 2.00

AC41330100 ASTREX CAPSULES 200MG (CETRAXATE) 0.00

AC41335100 AZOL-FLUCON CAPSULES 50MG(FLUCNAZOLE) 23.50

AC41338100 JUXAC CAP.20MG 2.80

AC41342238VASOSIN INJECTION 20UNITS/ML "PURZER" (ARGININE

VASOPRESSIN)222.00

AC41344100 PIROCAN CAP. 10MG 1.50

AC41350100TRAZO F.C. TABLETS 100MG "C.H." (TRAZODONE

HYDROCHLORIDE)2.97

AC41352100 ULSTOP F.C. TABLETS 20MG "C.H." (FAMOTIDINE) 1.59

AC413521G0ULSTOP F.C. TABLETS 20MG "C.H." (FAMOTIDINE)(鋁箔/膠箔)

2.00

AC41358100 MEDLIN TAB. 4MG 1.53

AC413581G0MEDLIN TABLETS 4MG "KOJAR" (METHYLPREDNISOLONE) (鋁箔/

膠箔)2.00

AC41359100 CERGOLINE F.C. TABLETS 5MG "KOJAR" (NICERGOLINE) 2.56

AC41360100 PINTYLIN TABLETS 5MG "KOJAR"(OXYBUTYNIN CHLORIDE) 2.12

AC41373100 AMANDIN CAP. 100MG"T.F."(AMANTADINE) 3.77

AC41378100 PRECONIN TABLETS. 5MG"KOJAR"(PREDNISOLONE) 1.50

AC413781G0PRECONIN TABLETS 5MG (PREDNISOLONE) "KOJAR"(鋁箔/膠箔)

2.00

AC41380100 INOLIM TABLETS 3MG "KOJAR"(TRIMETOQUINOL) 1.50

AC413801G0 INOLIM TABLETS 3MG (TRIMETOQUINOL) "KOJAR"(鋁箔/膠箔) 2.00

AC41391100 KINAZOLE CAPSULES 150MG "KINGDOM" (FLUCONAZOLE) 52.00

AC41429100 NAPROXEN SODIUM TABLETS 275MG "S.C." 1.50

AC41430100 ENALATEC TAB. 5MG 1.54

AC41435100 FEPRON CAPSULES 200MG(FENOPROFEN)"Y.Y." 3.36

AC41437321 YA FU CREAM "STANDARD" 13.90

AC41437335 YA FU CREAM "STANDARD" 0.00

AC41442100 URINOGEN TABLETS 50MG "S.L." (BENZBROMARONE) 1.50

AC41443209 U-VANCO INJECTION 500MG 1GM(VANCOMYCIN) "U-LIANG" 179.00

AC41443277 U-VANCO INJECTION 500MG 1GM(VANCOMYCIN) "U-LIANG" 76.00

AC41445100 BUSRON TABLETS 10MG (BUSPIRONE HYDROCHLORIDE) 2.83

AC41454100 SOTER TABLETS 2.5MG "CHINTENG" (TERBUTALINE) 1.50

Page 181: 附件二 藥品給付品項暨支付標準表

AC414541G0SOTER TABLETS 2.5MG "CHINTENG" (TERBUTALINE)(鋁箔/膠箔)

2.00

AC41465100 KINAX TABLETS 1MG (ALPRAZOLAM) 2.07

AC41474300 CARBOXE HEALING BUCCAL TABLETS 7.40

AC41476100 KOJASPOL FILM COATED TABLETS 9.6MG "KOJAR" 1.71

AC414761G0 KOJASPOL FILM COATED TABLETS 9.6MG "KOJAR"(鋁箔/膠箔) 2.00

AC41481151 DOMPEDON SUSPENSION 1MG/ML "STANDARD" (DOMPERIDONE) 25.60

AC41482321 TOLFENE CREAM "CHINTENG" 20.00

AC41482329 TOLFENE CREAM "CHINTENG" 0.00

AC41482335 TOLFENE CREAM "CHINTENG" 41.80

AC41488100FYLIN RETARD F.C. TABLETS 400MG "C.H."(PENTOXIFYLLINE)

1.82

AC414881G0FYLIN RETARD F.C. TABLETS 400MG

"C.H."(PENTOXIFYLLINE)(鋁箔/膠箔)2.00

AC41492265 VIRLESS INJECTION "YUNG SHIN"(ACYCLOVIR) 287.00

AC41496100 NILPID F.C. TABLETS 600MG "SWISS"(GEMFIBROZIL) 2.46

AC41497100 ATINOL F.C. TABLETS 100MG 1.51

AC414971G0ATINOL F.C TABLET 100MG (ATENOLOL) "S.Y." (鋁箔/膠箔)

2.00

AC41499100CIRZODONE TABLET 50MG "SINPHAR"(TRAZODONE

HYDROCHLORIDE)1.60

AC414991G0CIRZODONE TABLET 50MG "SINPHAR"(TRAZODONE

HYDROCHLORIDE)2.00

AC41511100 ENCINE E.M. CAPSULES 100MG "EVEREST" 1.50

AC415111G0 ENCINE E.M. CAPSULES 100MG "EVEREST"(鋁箔/膠箔) 2.00

AC41514321 PIROCAN GEL 10MG/GM 5GM 11.20

AC41514329 PIROCAN GEL 10G 14.80

AC41514335 PIROCAN GEL 15GM 22.20

AC41514338 PIROCAN GEL 20G 23.10

AC41514343 PIROCAN GEL 10MG/GM 30G 28.40

AC41514345 PIROCAN GEL 10MG/GM "S.Y." (PIROXICAM) 35.00

AC41518100 MEBLIN TABLETS 50MG "S.C."(MEBHYDROLIN) 1.50

AC415191G0FLUPINE TABLETS 0.25MG (FLUDIAZEPAM) "JOHNSON"(鋁箔/膠

箔)2.00

AC41530100 WEICON-BI TAB. 300MG 5.30

AC41532100 MEOMTN CAPSULES 500UG "H.S." 1.55

AC415351G0PENTOP S.R TABLET 400MG"YU SHENG"(PENTOXIFYLLINE)(鋁箔/

膠箔)2.00

AC41536100 SODAN TABLETS 100MG "C.H."(URSODESOXYCHOLIC ACID) 1.76

AC41537321 GENTA CREAM 0.1%(GENTAMICIN SULFATE)"CHINTENG" 13.20

AC41537329 GENTA CREAM 0.1% "CHINTENG"(GENTAMICIN SULFATE) 18.00

AC41537335 GENTA CREAM 0.1%(GENTAMICIN SULFATE)"CHINTENG" 37.20

AC41540100 LUNAR F.C. TABLETS“MACRO” 7.00

AC41542100 OXACIN F.C.TABLETS 100MG "CHINTENG" (OFLOXACIN) 1.58

AC415421G0OXACIN F.C. TABLETS 100MG "CHINTING"(OFLOXACIN)(鋁箔/膠

箔)2.00

AC41543265 TALAMIN-NEPHRO INJECTION 192.00

AC41544100 MEPAZOLE TABLETS 5MG 1.50

Page 182: 附件二 藥品給付品項暨支付標準表

AC41545100 ALDACTIN TABLETS 1.50

AC415451G0 ALDACTIN TABLETS(鋁箔/膠箔) 2.00

AC41547100MOREFINE F.C. TABLETS 100MG "VPP"(CHLORPROMAZINE

HYDROCHLORIDE)1.50

AC41548100 ANGINAR F.C.TABLET 25MG"PURZER"(DIPYRIDAMOLE) 1.50

AC415481G0 ANGINAR F.C.TABLET 25MG"PURZER"(DIPYRIDAMOLE) 2.00

AC41554100 NORAXIN F.C. TABLETS 200MG "STANDARD" (NORFLOXACIN) 1.96

AC415541G0NORAXIN F.C. TABLETS 200MG "STANDARD" (NORFLOXACIN)(鋁箔

/膠箔)2.00

AC41557100TRAMTOR CAPSULES 50MG "PATRON"(TRAMADOL HYDROCHLORIDE)

2.43

AC41558335 ETO GEL 100MG/GM (ETOFENAMATE) 32.60

AC41558345 ETO GEL 100MG/GM (ETOFENAMATE) 84.00

AC41560100TRAZO F.C. TABLETS 50MG "C.H."(TRAZODONE HYDROCHORIDE)

1.60

AC415601G0TRAZO F.C. TABLETS 50MG "C.H."(TRAZODONE

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC41561277 LYTOL INFUSION 0.00

AC41563100 GLIGEN TABLETS 80MG (GLICLAZIDE) 0.00

AC41568265 TALAMIN-HBC INJECTION 0.00

AC41568277 TALAMIN-HBC INJECTION 0.00

AC41570321 FLUSALIC OINTMENT "SINPHAR" 20.60

AC41570335 FLUSALIC OINTMENT "SINPHAR" 39.70

AC41574100 CARMAPINE C.R.TAB. 400MG 8.60

AC41577100 DESTONE TAB. 540MG "N.K" (POTASSIUM CITRATE) 4.17

AC41597100 CONTAN TABLETS 5MG "CHINTENG" (GLIPIZIDE) 0.00

AC41605100 L.K.T. E.C. TABLETS 25MG "C.H."(DICLOFENAC SODIUM) 1.50

AC41628151AMOLIN POWDER FOR ORAL SUSPENSION 50MG/ML (AMOXICILLIN)

80.00

AC41631100 KETO FILM COATED TABLETS 10MG (KETOROLAC) 4.13

AC41633363BETASONE SOLUTION 0.1% "CHINTENG" (BETAMETHASONE

VALEARATE)0.00

AC41638100 ANLIN TABLETS 2MG "EVEREST" (DIAZEPAM) 0.00

AC41640100 BEMARON TABLETS 100MG "S.C."(BENZBROMARONE) 2.05

AC41659100 ANZA TABLETS "CHINTENG" 1.88

AC416591G0 ANZA TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

AC41664100FLAMQUIT F.C.TABLETS 50MG "SWISS" (DICLOFENAC POTASSIUM)

1.50

AC416641G0FLAMQUIT F.C.TABLETS 50MG "SWISS" (DICLOFENAC

POTASSIUM)(鋁箔/膠箔)2.00

AC41670321 KEDOFU CREAM 20MG (KETOCONAZOLE)"CHEN TA" 11.90

AC41670329 KEDOFU CREAM 20MG (KETOCONAZOLE)"CHEN TA" 13.10

AC41670335 KEDOFU CREAM 20MG (KETOCONAZOLE)"CHEN TA" 31.90

AC41670338 KEDOFU CREAM 20MG (KETOCONAZOLE)"CHEN TA" 38.70

AC41670355 KEDOFU CREAM 20MG (KETOCONAZOLE)"CHEN TA" 407.00

AC41673100 SULFIN TABLETS 100MG (SULFINPYRAZONE) "TTY" 3.54

AC41732416 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 18.50

AC41732417 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 0.00

Page 183: 附件二 藥品給付品項暨支付標準表

AC41732421 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 28.40

AC41732423 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 36.70

AC41732429 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 59.00

AC41734100 LISHIN TAB. 200MG 1.71

AC41749100 ZATIZEN TABLETS 1MG "S.C."(KETOTIFEN) 1.54

AC417501G0GLIBUDON F. C. TABLETS 500MG(METFORMIN HYDROCHLORIDE)

(鋁箔/膠箔)2.00

AC41751248CIXA IV INFUSION SOLUTION 2MG/ML "STANDARD"

(CIPROFLOXACIN)0.00

AC41751255CIXA IV INFUSION SOLUTION 2MG/ML "STANDARD"

(CIPROFLOXACIN)450.00

AC41753321 Azeic-A Cream 200 mg/gm (Azelaic Acid)"Sinphar" 26.20

AC41753329 Azeic-A Cream 200 mg/gm (Azelaic Acid)"Sinphar" 45.30

AC41753330 Azeic-A Cream 200 mg/gm (Azelaic Acid)"Sinphar" 45.30

AC41753338 Azeic-A Cream 200 mg/gm (Azelaic Acid)"Sinphar" 152.00

AC41753343 Azeic-A Cream 200 mg/gm (Azelaic Acid)"Sinphar" 207.00

AC41754209 CETAZINE INJ. "STANDARD" (CEFTAZIDIME) 39.20

AC41797321 WOLEN CREAM 25.70

AC41797329 WOLEN CREAM 0.00

AC41797335 WOLEN CREAM 0.00

AC41802255 FLUCON I.V. INFUSION 2MG/ML (FLUCONAZOLE) "S.T." 274.00

AC41805100 DIABAC TAB 5MG 1.50

AC41807100 NOGOUT TABLETS 100MG (BENZBROMARONE) "SINPHAR" 2.05

AC41814100ASPICORE ENTERIC-MICROENCAPSULATED CAP. 100MG

(ASPIRIN)"WEIDAR"1.50

AC418141G0ASPICORE ENTERIC-MICROENCAPSULATED CAP. 100MG

(ASPIRIN)"WEIDAR"(鋁箔/膠箔)2.00

AC41816100 LIMY CAPSULES 10MG (PHENOXYBENZAMINE HYDROCHLORIDE) 2.15

AC41823209 ASPIRIN INJECTION (LYSINE ASPIRIN) "CHI SHENG" 15.00

AC41823277 ASPIRIN INJ. 15.00

AC41831100 PATRICIN F.C. TABLETS 200MG "Y.C." (FLAVOXATE) 3.74

AC41832100 BACTON TABLETS 10MG "S.C."(BACLOFEN) 1.50

AC41833100 DILTAREN E.C. TABLETS 50MG "Y.C." 1.50

AC418331G0DILTAREN E.C. TABLETS 50MG (DICLOFENAC SODIUM)"Y.C."(鋁

箔/膠箔)2.00

AC41835100 WEID TAB. 300MG 1.50

AC41836255METRONIDAZOLE INJECTION 5MG/ML "ASTAR" (METRONIDAZOLE)

41.00

AC41837100 LIPOLIN CAPSULES 100MG (FENOFIBRATE) "P.L" 2.51

AC41838100"CHUM F.C. TABLETS 135MG (MEBEVERINE HYDROCHLORIDE)

""ROOT"""1.75

AC418381G0CHUM F.C. TABLETS 135MG "ROOT" (MEBEVERINE

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC41840338 ISOCONA CREAM "STANDARD" 60.00

AC41877100 PUSHINLIN F.C. TAB. 75MG 0.00

AC41882100 FAMO F.C. TABLET 40MG "S.T." (FAMOTIDINE) 3.77

AC41885335 IFLUCON OINT"C.H." 39.30

AC41905100 PREDNISOLONE TABLETS 5MG 1.50

Page 184: 附件二 藥品給付品項暨支付標準表

AC41918100 MENISONE TABLETS 4MG (METHYLPREDNISOLONE) "P.L." 1.53

AC41919100 USOL TABLETS 100MG "S.D." (URSODESOXYCHOLIC ACID) 1.76

AC41926100 WEMET TABLETS 300MG "Y.C." (DIBISMUTH TRIOXIDE) 5.30

AC41927100 SELEZIN TAB. 5MG 2.46

AC41929100 NURODIN TABLETS 200MG (CIMETIDINE) "PANBIOTIC" 1.50

AC419291G0NURODIN TABLETS 200MG (CIMETIDINE) "PANBIOTIC"(鋁箔/膠

箔)2.00

AC41930100"GASO F.C. TABLET 10MG ""S.Y"" (PIPERILATE ETHOBROMIDE)"

1.50

AC41931100 NILPID F.C.TABLETS 300MG"SWISS"(GEMFIBROZIL) 1.50

AC419311G0NILPID F.C.TABLETS 300MG"SWISS"(GEMFIBROZIL) 28粒、56粒

及112粒/瓶裝暨鋁箔/膠箔2.00

AC41934321 L.G.T CREAM 10MG/GM "S.C."(CENTELLA ASIATICA) 36.40

AC41934329 L.G.T. CREAM 10MG/GM "S.C."(CENTELLA ASIATICA) 57.00

AC41934337 L.G.T CREAM 10MG/GM"S.C."(CENTELLA ASIATICA) 70.00

AC41934338 L.G.T CREAM 10MG/GM"S.C."(CENTELLA ASIATICA) 77.00

AC41944100 OXIPAN TABLETS 5MG "EVEREST"(OXYBUTYNIN CHLORIDE) 2.12

AC41948100 PROSU TABLETS 2MG "CHINTENG"(ESTRADIOL) 3.78

AC41952100 BAO-GAN CAPSULES 150MG "CHEN TA"(SILYMARIN) 1.52

AC419521G0BAO-GAN CAPSULES 150MG "CHEN TA"(SILYMARIN)(鋁箔/膠箔)

2.00

AC41962100 EVERONE CAPSULES 20MG "EVEREST"(METHYLTESTOSTERONE) 1.93

AC41987100 IBUTIN F.C.TABLETS 400MG "EVEREST"(IBUPROFEN) 1.50

AC41989212 ADENOZER INJECTION 3MG/ML "PURZER"(ADENOSINE) 127.00

AC41990321 USON CREAM 2.5MG/GM 26.90

AC41990329 USON CREAM 2.5MG/GM 50.00

AC41990338 USON CREAM 2.5MG/GM 77.00

AC41990343 USON CREAM 2.5MG/GM 0.00

AC41992100 "BROMARONE TABLETS 50MG ""WELCAN"" (BENZBROMARONE) " 1.50

AC41994100 "BROMARONE TABLETS 100MG ""WELCAN"" (BENZBROMARONE) " 2.05

AC41995100 BENZON TABLETS 50MG "S.T." (BENZBROMARONE) 1.50

AC419951G0 BENZON TABLETS 50MG "S.T." (BENZBROMARONE)(鋁箔/膠箔) 2.00

AC41997100 FLUENE CAPSULES 50MG (FLUCONAZOLE) "PURZER" 23.50

AC42001100 FLUXEN CAPSULES 20MG "W.S"(FLUOXETINE) 2.80

AC42017100 NONCOUGH CAP. 1.50

AC42026100 COVINA F.C. TABLETS. 3.49

AC42029321 IDIF CREAM 13.90

AC42029329 IDIF CREAM 22.30

AC42029335 IDIF CREAM 0.00

AC42090209 CEFZON FOR INJECTION "STANDARD" 0.00

AC42090277 CEFZON FOR INJECTION "STANDARD" 0.00

AC42091209 SINTUM FOR INJ. 39.20

AC42091212 SINTUM FOR INJ. 199.00

AC42091277 SINTUM FOR INJ. 0.00

AC42096100 SQUMIN TABLET 5MG "STANDARD" (MEQUITAZINE) 1.50

AC42103100 SUTAIN TABLET 200MG "EVEREST" (TIAPROFENIC ACID) 2.91

AC42104100 LORA TABLET 10MG 1.50

AC421041G0 LORA TABLET 10MG "S.Y."(LORATADINE)(鋁箔/膠箔) 2.00

Page 185: 附件二 藥品給付品項暨支付標準表

AC42138221VITAMIN C INJECTION 250MG/ML (ASCORBIC ACID) "ORIENTAL"

15.00

AC42138238VITAMIN C INJECTION 250MG/ML (ASCORBIC ACID) "ORIENTAL"

15.00

AC42139100 YUPAR TABLETS 10MG "C.L." 4.15

AC42141238 GENDOBU INJECTION 12.5MG/ML (DOBUTAMINE) 113.00

AC42145100 BACFEN TABLETS 10MG (BACLOFEN) "S.T" 1.50

AC42147100 EURICON TAB. 100MG (BENZBROMARONE) 2.05

AC42203100 ZIMARON TABLETS 100MG (BENZBROMARONE)"S.D." 2.05

AC42204100 PIPOXIN TABLETS 10MG"S.C."(PIPOXOLAN) 2.94

AC42210100 GENURSO TABLETS 100MG (URSODESOXYCHOLIC ACID) 1.76

AC422101G0GENURSO TABLETS 100MG (URSODESOXYCHOLIC ACID)(鋁箔/膠箔)

2.00

AC42212321 KANDO CREAM 200MG/G ”C.H.”(AZELAIC ACID) 0.00

AC42214326 ICHDERM CREAM 50MG/GM "M.S."(DOXEPIN) 44.80

AC42214335 ICHDERM CREAM 50MG/GM "M.S."(DOXEPIN) 48.40

AC42216100FLAMQUIT F.C.TABLETS 25MG "SWISS" (DICLOFENAC POTASSIUM)

1.50

AC422161G0FLAMQUIT F.C.TABLETS 25MG "SWISS" (DICLOFENAC

POTASSIUM)(鋁箔/膠箔)2.00

AC42218100 NORCOL TABLETS 20MG "S.C." (BENPROPERINE) 1.50

AC42221100 SUSAN TABLETS 0.00

AC422211G0 SUSAN TABLETS 50MG(鋁箔/膠箔) 2.00

AC42222100SYNDOMAN CAPSULES 30MG (FLURAZEPAM HYDROCHLORIDE)"S.T."

3.75

AC42223265 PROLYTE INJECTION 0.00

AC42223277 PROLYTE INJECTION 0.00

AC42227100SYNDOMAN CAPSULES 15MG (FLURAZEPAM HYDROCHLORIDE)"S.T."

3.42

AC42240100 SUWELIN TABLETS 400MG 1.50

AC42244100 GEMBRIL F.C.TAB. 600MG 2.46

AC42257100 QUITAZINE TABLETS 5MG "W.S." (MEQUITAZINE) 1.50

AC42261248 VENOLIPID INJECTION 20% "CHI SHENG" 0.00

AC42261255 VENOLIPID INJECTION 20% "CHI SHENG" 0.00

AC42261265 VENOLIPID INJECTION 20% "CHI SHENG" 0.00

AC42262265 VENOLIPID INJECTION 10% "CHI SHENG" 0.00

AC42263100 BENDOPAR CAP. 250MG 6.30

AC42269321 BETASAY OINTMENT "SINPHAR" 10.90

AC42269329 BETASAY OINTMENT "SINPHAR" 19.50

AC42269335 BETASAY OINTMENT "SINPHAR" 52.00

AC42269338 BETASAY OINTMENT "SINPHAR" 68.00

AC42271421 DEXA ORABASE 0.1% "SINPHAR" (DEXAMETHASONE) 35.60

AC42272100 ROWAPRAXIN F.C. TABLETS 10MG (PIPOXOLAN) 2.94

AC42273100 NORAXIN F.C.TABLET 400MG "STANDARD"(NORFLOXACIN) 38.40

AC42274100 BENDOPAR CAP. 125MG 3.34

AC42339321 BIFONAZOLE CREAM 1% "SINPHAR" 18.20

AC42339323 BIFONAZOLE CREAM 1% "SINPHAR" 27.40

AC42339329 BIFONAZOLE CREAM 1% "SINPHAR" 44.60

Page 186: 附件二 藥品給付品項暨支付標準表

AC42340100 FUWEHO CAPSULES 200MG "CHINTENG" (CETRAXATE) 0.00

AC42347100 MOCLOD F.C. TABLETS 150MG 2.22

AC42349100 LAXURIN F.C. TABLETS 200MG (FLAVOXATE) "S.T." 3.74

AC42362329 "PIROCAM GEL 10MG/GM ""M.S."" (PIROXICAM)" 14.80

AC42362345 "PIROCAM GEL 10MG/GM ""M.S.""(PIROXICAM)" 35.00

AC42365209 CEFIN FOR I.M. INJECTION (CEFTRIAXONE) "PANBIOTIC" 82.00

AC42365265 CEFIN FOR I.M. INJECTION (CEFTRIAXONE) "PANBIOTIC" 0.00

AC42365277 CEFIN FOR I.M. INJECTION (CEFTRIAXONE) "PANBIOTIC" 0.00

AC423661G0 MUCAINE TABLETS (鋁箔/膠箔) 2.00

AC42368219 ONDAN INJECTION 2MG/ML "STANDARD" (ONDANSETRON) 94.00

AC42374209 U-RON FOR I.V. INJECTION 82.00

AC42374212 U-RON FOR I.V. INJECTION 0.00

AC42374277 U-RON FOR I.V. INJECTION 0.00

AC42375100 N.F.S. CAPSULES 400MG "C.H."(NORFLOXACIN) 0.00

AC42378100 GENZOSIN TABLET 2MG (DOXAZOSIN MESYLATE) 1.78

AC423781G0 GENZOSIN TABLET 2MG (DOXAZOSIN MESYLATE)(鋁箔/膠箔) 2.00

AC42379100 I PUU F.C. TABLETS 400MG (IBUPROFEN) "CHEN TA" 1.31

AC423791G0I PUU F.C. TABLETS 400MG (IBUPROFEN) "CHEN TA" (鋁箔/膠

箔)1.68

AC42380100 MILIX TABLETS 1.25MG (INDAPAMIDE)"M.S." 1.54

AC423801G0 MILIX TABLETS 1.25MG (INDAPAMIDE)"M.S." 2.00

AC42394100 HEXOLINE TABLETS 0.5MG "S.C."(HEXOPRENALINE) 1.50

AC42412209 KETO INJECTION 30MG/ML (KETOROLAC) 17.00

AC42412212 KETO INJECTION 30MG/ML (KETOROLAC) 24.00

AC42414209 LICEF-A FOR INJECTION "S.T" (CEPHRADINE) 25.00

AC42414277 LICEF-A FOR INJECTION "S.T" (CEPHRADINE) 25.00

AC42415100 CHITUNFEN TABLETS 100MG "C.A." (BENZBROMARONE) 2.05

AC42416100 FUWEIDIN F.C.TABLETS 40MG ”S.D.”(FAMOTIDINE) 3.77

AC424351G0 BENSAU(BENZONATATE 100MG)SOFT CAPSULE "LOTUS" 2.00

AC42448100 CLOPINE TABLETS 100MG "SWISS" (CLOZAPINE) 4.55

AC42449216 CVVH SOLUTION A "S.T." 144.00

AC42459100 NORAXIN F.C. TABLET 100MG"STANDARD" (NORFLOXACIN) 1.96

AC42461100FUSEN ENTERIC MICROENCAPSULATED CAPSULES 100MG"CHINTENG"

1.50

AC424611G0FUSEN ENTERIC MICROENCAPSULATED CAPSULES 100MG"CHINTENG"

(鋁箔)2.00

AC42501321 BOLOVER CREAM 0.1% 25.90

AC42501329 DERMA-E CREAM 39.60

AC42501335 BOLOVER CREAM 0.1% 0.00

AC42501338 BOLOVER CREAM 0.1% 65.00

AC42507100 TIPROFEN TABLETS 200MG 2.91

AC42511100 NOSPASM TABLETS 10MG (PIPOXOLAN) 2.94

AC42512100VORTAGEN E.M. CAPSULS 50MG "EVEREST" (DICLOFENAC SODIUM)

1.50

AC425121G0VORTAGEN E.M. CAPSULS 50MG "EVEREST" (DICLOFENAC

SODIUM)(鋁箔/膠箔)2.00

AC42513100SETON CAPSULES 10MG "CHINTENG"(PHENOXYBENZAMINE

HYDROCHLORIDE)2.15

Page 187: 附件二 藥品給付品項暨支付標準表

AC42514100 GENDERGIN TABLETS 0.5MG (ALPRAZOLAM) 1.50

AC425141G0 GENDERGIN TABLET 0.5MG (ALPRAZOLAM)(鋁箔/膠箔) 2.00

AC42521100 FOGLUGEN DISPERSIBLE-20 TABLETS 20MG "S.T." 1.50

AC425211G0FOGLUGEN DISPERSIBLE-20 TABLETS 20MG "S.T."

(PIROXICAM)(鋁箔/膠箔)2.00

AC42526100 MEQAZINE TABLETS 5MG "H.S."(MEQUITAZINE) 1.50

AC42533100 PAINLAX CAPSULES 50MG "PBF" (TRAMADOL) 2.43

AC42534100MORPHINE SULFATE SUSTAINED-RELEASE F.C. TABLETS 30MG

"PPCD"13.00

AC42535100 SANCIN F.C. TABLET 50MG "S.C."(DIPYRIDAMOLE) 1.54

AC425351G0SANCIN F.C. TABLET 50MG "S.C."(DIPYRIDAMOLE) (鋁箔/膠箔)

2.00

AC42536100 SEVINA F.C. TABLETS 3.49

AC425371G0 AMPRAZO TABLETS 0.5 MG (ALPRAZOLAM)(鋁箔/膠箔) 2.00

AC42538100 "MEQUITINE TABLETS 5MG""WINSTON""" 1.50

AC42539100 "LESLIPID TABLETS 20MG (LOVASTATIN) ""H.C""" 3.24

AC42554230 ANESVAN INJECTION 10MG/ML "CHI SHENG"(PROPOFOL) 37.40

AC42554238 ANESVAN INJECTION 10MG/ML "CHI SHENG"(PROPOFOL) 37.40

AC42554248 ANESVAN INJECTION 10MG/ML "CHI SHENG"(PROPOFOL) 128.00

AC42556100 ARICEPT F.C. TABLETS 5MG 55.00

AC42558100 LOVAST TABLETS 20MG "H.S." (LOVASTATIN) 3.24

AC42570100 FLOXT CAPSULE 20MG "C.L" 2.80

AC425701G0 FLOXT CAPSULE 20MG "C.L"(鋁箔/膠箔) 0.00

AC42584100 SYNBOT TABLETS 20MG 1.54

AC425841G0 SYNBOT TABLETS 20MG (ENALAPRIL MALEATE)(鋁箔/膠箔) 2.00

AC42588100"VOLEN ENTERIC-MICROENCAPSULATED CAPSULES. 50MG

(DICLOFENAC SODIUM) ""WINSTON"""1.50

AC42601238 ANOL INJECTION 200MG/ML (MANNITOL) "ASTAR" 15.00

AC42601255 ANOL INJECTION 200MG/ML (MANNITOL) "ASTAR" 39.40

AC42601266 ANOL INJECTION 200MG/ML (MANNITOL) "ASTAR" 39.40

AC42601277 ANOL INJECTION 200MG/ML (MANNITOL) "ASTAR" 108.00

AC42602100 PAIN WILL PASS TABLETS 200MG 2.91

AC42605100 MEDIKA CAPSULES "CHEN TA" 1.50

AC426051G0 MEDIKA CAPSULES "CHEN TA"(鋁箔/膠箔) 2.00

AC42619100 FENOLIP MICRONISED CAPSULES 200MG (FENOFIBRATE)"C.H." 3.92

AC42621100 CLOPINE TABLETS 25MG "SWISS" (CLOZAPINE) 3.11

AC42623277 HESPANDER INJECTION 256.00

AC42626100 FINSKA TABLETS 10MG 1.50

AC426261G0 FINSKA TABLETS 10MG(鋁箔/膠箔) 2.00

AC42627100 LOVASTA TABLETS 20MG 3.24

AC42629500 METROCIDE VAGINAL SUPPOSITORIES 500MG "T.F." 5.00

AC42646100 ESZO TABLETS 2MG(ESTAZOLAM)"S.T." 1.53

AC426461G0 ESZO TABLETS 2MG "S.T." (ESTAZOLAM)(鋁箔/膠箔) 2.00

AC42656100 CETIZINE F. C. TABLETS 10MG (CETIRIZINE) 1.50

AC426561G0 CETIZINE F.C. TABLET 10MG (CETIRIZINE)(鋁箔/膠箔) 2.00

AC42657100 PINFAN TABLETS 0.25MG "M.S." (FLUDIAZEPAM) 0.00

AC42659100 ILOKA F.C TABLETS 2.5MG "YUNG SHIN" (INDAPAMIDE) 1.92

Page 188: 附件二 藥品給付品項暨支付標準表

AC426591G0ILOKA F.C. TABLETS 2.5MG (INDAPAMIDE)"YUNG SHIN"(鋁箔/膠

箔)2.00

AC42660100 ANBICYN F.C.TABLETS 625MG 5.90

AC42686100 KINAX TABLETS 0.5MG (ALPRAZOLAM) 1.50

AC426861G0 KINAX TABLETS 0.5MG (ALPRAZOLAM)(鋁箔/膠箔) 2.00

AC42697280 ANBICYN POWDER FOR INJECTION 32.30

AC42697297 ANBICYN POWDER FOR INJECTION 74.00

AC42708321 "FOOHOL CREAM 10MG/GM ""ROOT"" (BIFONAZOLE)" 18.20

AC42708329 "FOOHOL CREAM 10MG/GM ""ROOT"" (BIFONAZOLE)" 44.60

AC42708335 "FOOHOL CREAM 10MG/GM ""ROOT"" (BIFONAZOLE)" 49.40

AC42714209 CEFAZO INJETCION 1GM (CEFAZOLIN SODIUM)"PANBIOTIC" 25.00

AC42714277 CEFAZO INJECTION (CEFAZOLIN SODIUM) "PANBIOTIC" 25.00

AC42722100 CALGALIN TABLETS 667MG "WINSTON"(CALCIUM ACETATE) 1.58

AC427221G0CALGALIN TABLETS 667MG (CALCIUM ACETATE) "WINSTON"(鋁箔

膠箔)2.00

AC42725321 NATIFIN CREAM 1% "CHINTENG" (NAFTIFIN) 20.40

AC42725329 NATIFIN CREAM 1% "CHINTENG" (NAFTIFIN) 32.70

AC42725338 NATIFIN CREAM 1% "CHINTENG" (NAFTIFIN) 69.00

AC42746265 VENOLIPID INJECTION MCT/LCT 10% "CHI SHENG" 165.00

AC42748100 MECOLA F.C. TABLETS 20MG "S.D."(BENPROPERINE) 1.50

AC42749100 ILOKA F.C. TABLETS 1.25MG "YUNG SHIN" (INDAPAMIDE) 1.54

AC42752100 OFLODAL F.C. TABLETS 200MG (OFLOXACIN) 1.88

AC42754100 EURICON TAB. 50MG (BENZBROMARONE) 1.50

AC427541G0 EURICON TAB. 50MG (BENZBROMARONE)(鋁箔/膠箔) 2.00

AC42755100 DEHERP TABLET 200MG "STANDARD" (ACYCLOVIR) 3.15

AC42756210 ANSULLINA POWDER FOR INJECTION 55.00

AC42756216 ANSULLINA POWDER FOR INJECTION 137.00

AC42756289 ANSULLINA POWDER FOR INJECTION 55.00

AC42764335 PIPO CREAM 10MG/GM "EVEREST" (PIROXICAM) 22.20

AC42764343 PIPO CREAM 10MG/GM "EVEREST" (PIROXICAM) 28.40

AC42764345 PIPO CREAM 10MG/GM "EVEREST" (PIROXICAM) 35.00

AC42764355 PIPO CREAM 10MG/GM "EVEREST" (PIROXICAM) 225.00

AC42766100 LIPO CAPSULES 300MG "GENTLE" (URSODEOXYCHOLIC ACID) 4.36

AC42768151 SUCOUGH SYRUP 25.00

AC42770100MUACTION SUSTAINED RELEASE TABLETS 100MG "Lotus"

(TRAMADOL HYDROCHLORIDE)3.74

AC42774100 ANSIN E.C. TABLETS 100MG "EVEREST" (ASPIRIN) 1.50

AC42775100 FENOFIBRATE CAPSULES 100MG "S.C." 2.51

AC42798329 BENOVATE SOLUTION 1MG/ML 31.80

AC42798338 BENOVATE SOLUTION 1MG/ML 33.50

AC42798340 BENOVATE SOLUTION 1MG/ML 33.50

AC42798345 BENOVATE SOLUTION 1MG/ML 51.00

AC42798363 BENOVATE SOLUTION 1MG/ML 326.00

AC42800255 VENOLIPID INJECTION MCT/LCT 20% "CHI SHENG" 163.00

AC42800265 VENOLIPID INJECTION MCT/LCT 20% "CHI SHENG" 168.00

AC42802151SYNMIN SYRUP 0.4MG/ML "S.T." (CYPROHEPTADINE

HYDROCHLORIDE)25.00

Page 189: 附件二 藥品給付品項暨支付標準表

AC42802157SYNMIN SYRUP 0.4MG/ML "S.T." (CYPROHEPTADINE

HYDROCHLORIDE)25.00

AC42823421 BIOMICIN OPHTHALMIC SOLUTION 0.3% "WINSTON" 32.80

AC42824100 NOPRISIL TABLETS 10MG (LISINOPRIL) 2.29

AC42826100 SYNPID CAPSULES 100MG "S.Y." (FENOFIBRATE) 2.51

AC42828209 PICILLINA POWDER FOR INJECTION (PIPERACILLIN SODIUM) 0.00

AC42828212 PICILLINA POWDER FOR INJECTION (PIPERACILLIN SODIUM) 33.90

AC42828219 PICILLINA POWDER FOR INJECTION (PIPERACILLIN SODIUM) 74.00

AC42829100 "ANTHOLIN CAPSULES ""WINSTON""" 1.50

AC42830100 TICLOD F.C. TABLETS 250MG "WINSTON" (TICLOPIDINE) 3.79

AC42831151 ALBUTEROL SYRUP 0.4MG/ML "CENTER" (SALBUTAMOL) 25.00

AC42837100 UXETINE CAPSULES 20MG (FLUOXETINE) 2.80

AC42840100 AMLO TABLETS 5MG "S.Y."(AMLODIPINE) 3.84

AC42844338 ALCOS-ANAL OINTMENT 46.80

AC42856100 SHUANE TABLETS 200MG "S.C." (MEPHENOXALONE) 1.50

AC42857100 AMNDILINE TABLETS 5MG (AMLODIPINE) 3.84

AC42859100 PANMOMEL CAPSULE 30MG (FLURAZEPAM) "PANBIOTIC" 3.75

AC42860100 GENADINE TABLET 10MG (LORATADINE) 1.50

AC428601G0 GENADINE TABLET 10MG (LORATADINE)(鋁箔/膠箔) 2.00

AC42863100 FAMO F.C. TAB. 20MG "S.T." (FAMOTIDINE) 1.59

AC428631G0 FAMO F.C. TAB. 20MG (FAMOTIDINE) "S.T."(鋁箔/膠箔) 2.00

AC42869100 FLUNEPAN TABLETS 1MG "PANBIOTIC" (FLUNITRAZEPAM) 1.50

AC428691G0"FLUNEPAN TABLETS 1MG (FLUNITRAZEPAM) "PANBIOTIC"(鋁箔/

膠箔)2.00

AC42874100 GENZOSIN TABLET 4MG (DOXAZOSIN MESYLATE) 4.80

AC42877317 ACV CREAM 5% (ACYCLOVIR) "CHEN TA" 17.30

AC42877326 ACV CREAM 5% (ACYCLOVIR) "CHEN TA" 42.90

AC42877343 ACV CREAM 5% (ACYCLOVIR) "CHEN TA" 0.00

AC42879214 GENSO INJECTION 10MG/ML (ATRACURIUM) 51.00

AC42883100TARNIN TABLETS 50MG "S.C."(CHLORPROTHIXENE

HYDROCHLORIDE)4.03

AC42884100 FLUCON CAPSULES 150MG "S.T." (FLUCONAZOLE) 52.00

AC42886100 MEZAPIN TABLETS 100MG(CLOZAPINE) 4.55

AC42887100 "CETIZIN F. C. TABLETS 10MG ""H.S.""(CETIRIZINE)" 1.50

AC428871G0"CETIZIN F. C. TABLETS 10MG ""H.S.""(CETIRIZINE) (鋁箔/

膠箔)"2.00

AC42888100 GLIC TABLETS 80MG "S.C." (GLICLAZIDE) 1.50

AC42899100GENIQUIN FILM COATED TABLETS 200MG (HYDROXYCHLOROQUINE

SULFATE)2.07

AC42903100NINKO F.C. TABLETS 40MG "STANDARD" (GINKGOFLAVONE

GLYCOSIDE)1.71

AC42906100TRAZONE TABLETS 100MG "S.T." (TRAZODONE HYDROCHLORIDE)

2.97

AC42916100 SIMELIN F.C. TABLETS 500MG (METFORMIN) 1.50

AC429161G0 SIMELIN F.C. TABLETS 500MG (METFORMIN)(鋁箔/膠箔) 2.00

AC42917100 LOLATE TABLETS 5MG"MACRO" (AMLODIPINE) 3.84

AC42919100 DOFLEX TABLETS 200MG "GENTLE" (MEPHENOXALONE) 1.50

Page 190: 附件二 藥品給付品項暨支付標準表

AC429191G0DOFLEX TABLETS 200MG)"GENTLE"(MEPHENOXALONE)(鋁箔/膠箔)

2.00

AC42932151 ATHMIN SYRUP (KETOTIFEN) "CENTER" 42.80

AC42932157 ATHMIN SYRUP "CENTER"(KETOTIFEN) 78.00

AC42934100"SULIN ENTERIC-MICROENCAPSULATED CAPSULES 100MG

""WINSTON"" (ASPIRIN)"1.50

AC42936100 TEZOPIN TABLETS 2MG "WEIDAR" (TERAZOSIN) 1.92

AC42944100 CONWU TABLETS 25MG "W.S." 4.20

AC42946100 SULMATYL FILM COATED TABLETS 50MG (SULPIRIDE) "P.L." 1.53

AC429461G0SULMATYL FILM COATED TABLETS 50MG (SULPIRIDE) "P.L."(鋁

箔/膠箔)2.00

AC42948100 GENDERGIN TABLET 0.25MG (ALPRAZOLAM) 1.50

AC429481G0 GENDERGIN TABLET 0.25MG (ALPRAZOLAM)(鋁箔/膠箔) 2.00

AC42957100 EUTAC F.C. TABLETS 150MG "S.T." (MECLOBEMIDE) 2.22

AC42965100 QUITAZINE TABLETS 5MG "C.L." 1.50

AC429651G0 QUITAZINE TABLETS 5MG "C.L."(鋁箔/膠箔) 2.00

AC42966100 MUGADINE CAPSULES 100MG (MEXILETINE HYDROCHLORIDE) 2.98

AC42967100 SINCER TABLETS 400MG (ACEBUTOLOL) 5.00

AC42974100JANCIN SOFT CAPSULES 100MG "CHINTENG." (TOCOPHEROL

NICOTINATE)1.50

AC42990100 BEZAFIBRATE TABLETS 200MG(BEZAFIBRATE)"Y.Y." 3.62

AC42997100 KINFLOCIN F.C. TABLETS 200MG "KINGDOM" (OFLOXACIN) 1.88

AC43000248 GENAZOLE IV INJECTION 2MG/ML (FLUCONAZOLE) 258.00

AC43000255 GENAZOLE IV INJECTION 2MG/ML (FLUCONAZOLE) 274.00

AC43000263 GENAZOLE IV INJECTION 2MG/ML (FLUCONAZOLE) 0.00

AC43003321 "CHU-FU CREAM ""WINSTON""" 16.00

AC43003329 "CHU-FU CREAM ""WINSTON""" 35.00

AC43003336 "CHU-FU CREAM ""WINSTON""" 53.00

AC43003338 "CHU-FU CREAM ""WINSTON""" 84.00

AC43003355 "CHU-FU CREAM ""WINSTON""" 145.00

AC43018100 ZUMIN F.C.TABLETS 50MG "YUNG SHIN" (MEBHYDROLIN) 1.50

AC430181G0ZUMIN FILM COATED TABLETS 50MG (MEBHYDROLIN) "YUNG

SHIN"(鋁箔/膠箔)2.00

AC43026100 TIA TON TABLETS 200MG "Y.Y." (TIAPROFENIC ACID) 2.91

AC43038100 ASLEX TABLETS 200MG (MEPHENOXALONE) "SIEHO" 1.50

AC43040100 PEYSAN F.C. TABLETS 75MG "S.C." (DIPYRIDAMOLE) 1.58

AC430401G0PEYSAN F.C. TABLETS 75MG "S.C." (DIPYRIDAMOLE) (鋁箔/膠

箔)2.00

AC43045100 LOPAR TABLETS 5MG "STANDARD" (SELEGILINE HCL) 0.00

AC43046100CANLIN M.CAPSULES 300MG "EVEREST"(URSODEXOXYCHOLIC ACID)

4.36

AC43048100 SETIZIN F. C. TABLETS 10MG "H.S."(CETIRIZINE) 1.50

AC43071100 CINTSU F.C. TABLETS 80MG (VERAPAMIL) 3.88

AC43074100 TONSARIC TABLETS 100MG "S.T." (ALLOPURINOL) 1.50

AC430741G0TONSARIC TABLETS 100MG "S.T." (ALLOPURINOL)(鋁箔/膠箔)

2.00

AC43079100 DALPAM CAPSULE 30MG (FLURAZEPAM) 3.75

AC43080100 LASCAINE TABLETS 1.53

Page 191: 附件二 藥品給付品項暨支付標準表

AC43112321 FLUNIDE CREAM 0.5MG/GM 34.10

AC43112329 FLUNIDE CREAM 0.5MG/GM 44.10

AC43112338 FLUNIDE CREAM 0.5MG/GM 109.00

AC43112355 FLUNIDE CREAM 0.5MG/GM 0.00

AC43114100 TARLIN TABLETS "S.T" 1.50

AC43116343 "PIROCAM GEL 10MG/GM ""M.T."" (PIROXICAM)" 0.00

AC43116345 "PIROCAM GEL 10MG/GM ""M.T."" (PIROXICAM)" 35.00

AC43116355 PIROCAM GEL 10MG/GM (PIROXICAM) "M.T." 225.00

AC43118100 TOPIMO TABLETS 2MG "S.C."(PIMOZIDE) 6.40

AC43120321 TRANCINE CREAM 1MG/GM 10.00

AC43120329 TRANCINE CREAM 1MG/ML 12.10

AC43120335 TRANCINE CREAM 1MG/ML 15.10

AC43120338 TRANCINE CREAM 1MG/GM 18.10

AC43138321 "BIFOZOL CREAM 10MG/GM ""GCPC""" 18.20

AC43138329 "BIFOZOL CREAM 10MG/GM ""GCPC""" 44.60

AC43138335 "BIFOZOL CREAM 10MG/GM ""GCPC""" 49.40

AC43138338 BIFOZOL CREAM 10MG/GM "GCPC" 81.00

AC43139100 CLOTSTOP TABLETS 100MG "Y.Y." 1.50

AC43141100 BEENRONE TABLETS 100MG (BENZBROMARONE) 2.05

AC43142100 FOSEN EFC TABLETS 100MG "CHINTENG" 1.50

AC43144100 LIFEN F.C. T. 500MG (IBUPROFEN LYSINE) "EVEREST" 1.64

AC43152151 IBUPROFEN ORAL SUSPENSION 20MG/ML "CENTER" 25.00

AC43152157 IBUPROFEN ORAL SUSPENSION 20MG/ML "CENTER" 45.10

AC43158100 ANTIGLUCO TABLETS 850MG "Y.K." 1.68

AC431581G0 ANTIGLUCO TABLETS 850MG "Y.K."(鋁箔/膠箔) 2.00

AC43160151 SOLTAN LIQUID 3MG/ML "CENTER" 25.00

AC43160155 SOLTAN LIQUID 3MG/ML "CENTER" 25.00

AC43160157 SOLTAN LIQUID 3MG/ML "CENTER" 50.00

AC43161500 ALCOS-ANAL SUPPOSITORIES 5.00

AC43177100 TADIN TABLETS 80MG 1.50

AC43180345 FUBIFEN PAP "F.M" 40MG/10GM 5.30

AC43184421 VISCONE EYE DROPS 0.1% "SINPHAR" 12.40

AC43184429 VISCONE EYE DROPS 0.1% "SINPHAR" 51.00

AC43187100"GINKON TABLETS 9.6MG (GINKGOFLAVON GLYCOSIDE)

""M.T."""1.71

AC43188100 TERADRIN TABLETS 2MG "S.Y." (TERAZOSIN) 1.92

AC43189151 STROLIN LIQUID 0.5MG/ML "CENTER" 25.20

AC431901G0MECOBAL CAPSULE 0.5MG (MECOBALAMIN) "TA FONG"(鋁箔/膠箔)

2.00

AC43205100 MINRO TABLETS 5MG "CHINTENG" 1.50

AC432051G0 MINRO TABLETS 5MG "CHINTENG"(鋁箔/膠箔) 2.00

AC43210100 GENOPRIL TABLETS 20MG 4.25

AC43212100 JULRIN ENTERIC-COATED TABLETS 1.50

AC43213100 ALLTEC F. C. TABLETS 10MG 1.50

AC432131G0 ALLTEC F. C. TABLETS 10MG(鋁箔/膠箔) 2.00

AC432131G1 ALLTEC F. C. TABLETS 10MG (14粒/瓶) 2.00

AC432131G2 ALLTEC F. C. TABLETS 10MG (28粒/瓶) 2.00

AC43214345 FOCUS GEL 10MG/GM (PIROXICAM) 35.00

Page 192: 附件二 藥品給付品項暨支付標準表

AC43215329 CLOBE CREAM "S.L." 0.00

AC43218100 LOMIN TABLETS 5MG "CHEN TA" 1.50

AC432181G0 LOMIN TABLETS 5MG "CHEN TA" 2.00

AC432221G0 BECANDIN TABLET "DTS"(鋁箔/膠箔) 2.00

AC43223100PAINSTOP ENTERIC-MICROENCAPSULATED CAPSULE 50MG "SWISS"

(DICLOFENAC SODIUM)1.50

AC43254100 ANTACHE ENTERIC COATED TABLETS 100MG 1.50

AC43255423 CINOLONE ORABASE "W.P." 36.70

AC432571G0 MEFNO TABLET 200MG(鋁箔/膠箔) 2.00

AC43285329 LIBIDO GEL "MEIDER" 14.10

AC43285335 LIBIDO GEL "MEIDER" 20.70

AC43285338 LIBIDO GEL "MEIDER" 65.00

AC43285343 LIBIDO GEL "MEIDER" 185.00

AC43286100 DALPAM CAPSULE 15MG (FLURAZEPAM) 3.42

AC43293100 UZOL CAPSULES 50MG "C.H." (FLUCONAZOLE) 23.50

AC43294100 WINIFUL F.C. TABLETS 40MG "EVEREST" 3.77

AC43302100 ZEFFIX TABLETS 100MG 44.80

AC43305100 NO-TON F.C. TABLETS 500MG "STANDARD" 3.23

AC43306100 CETIA TABLETS 10MG "S.T." 1.50

AC433061G0 CETIA TABLETS 10MG "S.T."(鋁箔/膠箔) 2.00

AC43309100 ASPA E. M.C.100MG "YU SHENG" (ASPIRIN) 1.50

AC433091G0 ASPA E. M.C.100MG "YU SHENG" (ASPIRIN)(鋁箔/膠箔) 2.00

AC43311329 TIFIN 1% CREAM "H.S." 32.70

AC43311335 TIFIN 1% CREAM "H.S." 35.10

AC43311338 TIFIN 1% CREAM "H.S." 69.00

AC43313321 ET CREAM 10.50

AC43313329 ET CREAM 18.80

AC43313335 ET CREAM 0.00

AC43313338 ET CREAM 0.00

AC43316100 SOVERINE CAPSULES 60MG "S.C." 1.74

AC433161G0 SOVERINE CAPSULES 60MG "S.C."(鋁箔/膠箔) 2.00

AC43317100 CONMY TABLETS 2MG "S.T." 1.92

AC433171G0 CONMY TABLETS 2MG "S.T."(鋁箔/膠箔) 2.00

AC43326100 SPASMOL CAPSULES 60MG 1.74

AC43327321 NINERLNIN CREAM "CHEN TA" 13.90

AC43327329 NINERLNIN CREAM "CHEN TA" 32.20

AC43327330 NINERLNIN CREAM "CHEN TA" 43.40

AC43327335 NINERLNIN CREAM "CHEN TA" 51.00

AC43327338 NINERLNIN CREAM "CHEN TA" 74.00

AC43328100WEREN ENTERIC-MICROENCAPSULATED CAPSULE 50MG "YU SHENG"

1.50

AC433281G0WEREN ENTERIC-MICROENCAPSULATED CAPSULE 50MG "YU

SHENG"(鋁箔/膠箔)2.00

AC43330100 GENOPRIL 10MG TABLETS 2.29

AC43335100 POLUPI TABLETS 50MG "PANBIOTIC" 1.90

AC433351G0 POLUPI TABLET 50MG "PANBIOTIC"(鋁箔/膠箔) 2.00

AC43339100 FUMAY CAPSULES 50MG "STANDARD" 23.50

AC43362151 SUTUSSI LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) 25.00

Page 193: 附件二 藥品給付品項暨支付標準表

AC43362157 SUTUSSI LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) 25.00

AC43362163 SUTUSSI LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) 25.00

AC43364100 COXINE TABLETS 20MG (ISOSORBIDE MONONITRATE) 1.54

AC433641G0COXINE TABLETS 20MG (ISOSORBIDE MONONITRATE)(鋁箔/膠箔)

2.00

AC43366100 ULIDEN TABLETS 100MG "SWISS" 1.76

AC433661G0 ULIDEN TABLETS 100MG "SWISS"(鋁箔/膠箔) 2.00

AC43397100 MERINE F.C. TABLETS 135MG "Y.Y." 1.75

AC43403100 CEMINE F.C. TABLETS 10MG "S.C." 1.50

AC434031G0 CEMINE F. C. TABLETS 10MG "S.C."(鋁箔/膠箔) 2.00

AC43408100 "EASCO CAPSULES ""WINSTON""" 1.50

AC43431100 MESYREL TABLETS 25MG "M.S." 1.50

AC43432100 BRIKEMIN TABLETS 5MG "PATRON" (MEQUITAZINE) 1.50

AC43436151 IBULIN SUSPENSION 20MG/ML (IBUPROFEN) "S.T" 25.00

AC43436157 IBULIN SUSPENSION 20MG/ML (IBUPROFEN) "S.T." 45.10

AC43437100 MINO TABLETS 5MG "EVEREST" 1.50

AC43443100 NOXALONE TABLETS 500MG 2.83

AC43445100 OMELON ENTERIC-MICROENCAPSULATED CAPSULES 20MG 2.51

AC43448309 "Normal Saline Solution ""Tai Yu""" 24.10

AC43448312 "Normal Saline Solution ""Tai Yu""" 0.00

AC43448316 "Normal Saline Solution ""Tai Yu""" 68.00

AC43448377 "Normal Saline Solution ""Tai Yu""" 18.40

AC43458100 SUTONDIN 20MG F.C. TABLETS "H.S." 3.59

AC43459500 LICOMILE VAGINAL TABLETS 100MG "H.S." (ISOCONAZOLE) 0.00

AC43460100 GENCLONE F.C.T. 7.5MG 1.98

AC43467100 DOXAZON TABLETS 2MG "S.C." 1.78

AC43473100 BRONCOLIN TABLETS 1.50

AC43474100 METHOLONE TABLETS 16MG 3.51

AC43493345 FLURBI PAP "D.S" 5.30

AC43496421 "SERENE OPHTHALMIC SOLUTION ""WINSTON""" 12.20

AC43499100 ESOMIN TABLETS 2MG "P.L." 1.53

AC434991G0 ESOMIN TABLETS 2MG "P.L."(鋁箔/膠箔) 2.00

AC43501100 WINIFUL F.C.TABLETS 20MG (FAMOTIDINE) "EVEREST" 1.59

AC435011G0WINIFUL F.C. TABLETS 20MG (FAMOTIDINE) "EVEREST"(鋁箔/膠

箔)2.00

AC43523100 FLURONIN CAPSULES 20MG "YUNG SHIN" 2.80

AC43527100 AVERINE CAPSULES 60MG "ROYAL" 1.74

AC43545100 ACEO CAPSULES 60MG " 1.54

AC435451G0 ACEO CAPSULES 60MG(鋁箔/膠箔) 2.00

AC43572414SALDOLIN INHALATION SOLUTION 2MG/ML "S.T."(SALBUTAMOL)

4.95

AC43573100 SANCOS TABLETS 3.24

AC43574438 BELAX AQUA NASAL SPRAY 100MCG/DOSE (1MG/GM) 186.00

AC43575100 LISIM TABLETS 250MG 7.80

AC43588143 CYPROMIN SOLUTION 0.4MG/ML "CENTER" 25.00

AC43588151 CYPROMIN SOLUTION 0.4MG/ML "CENTER" 25.00

AC43588157 CYPROMIN SOLUTION 0.4MG/ML "CENTER" 25.00

Page 194: 附件二 藥品給付品項暨支付標準表

AC43589421FLUORONE OPHTHALMIC SOLUTION 1.0MG/ML "PATRON"

(FLUOROMETHOLONE)12.40

AC43589429FLUORONE OPHTHALMIC SOLUTION 1.0MG/ML "PATRON"

(FLUOROMETHOLONE)51.00

AC43591321 ID CREAM 13.90

AC43591329 ID CREAM 0.00

AC43591335 ID CREAM 0.00

AC43591338 ID CREAM 0.00

AC43597100 CAMADOL CAPSULES 50MG (TRAMADOL HCL) 2.43

AC43598100 ATENO F.C. TABLETS 50MG 1.50

AC435981G0 ATENO F.C. TABLETS 50MG)(鋁箔/膠箔) 2.00

AC43601421 PICON EYE DROPS 0.5%"Y.Y." 16.50

AC43601429 PICON EYE DROPS 0.5%"Y.Y." 36.50

AC43602416 "CHEER ORABASE 1MG/GM ""WINSTON""" 18.50

AC43602417 "CHEER ORABASE 1MG/GM ""WINSTON""" 21.50

AC43602421 "CHEER ORABASE 1MG/GM ""WINSTON""" 28.40

AC43602423 "CHEER ORABASE 1MG/GM ""WINSTON""" 36.70

AC43602429 "CHEER ORABASE 1MG/GM ""WINSTON""" 59.00

AC43619423 "SENCORT OPHTHALMIC SOLUTION ""WINSTON""" 34.90

AC43621321 B.C.G CREAM 16.00

AC43621329 B.C.G CREAM 35.00

AC43621336 B.C.G. CREAM 53.00

AC43621338 B.C.G CREAM 84.00

AC43624100 "ABCOT CHEWABLE TABLETS 20MG ""WINSTON""" 1.50

AC43625100 WESON TABLETS 2MG "EVEREST" 1.92

AC43627100 MESULONE TABLETS "Y.Y." 1.53

AC43629100 MEZAPIN TABLETS 25MG 3.11

AC43630100 YUSIN F.C TABLETS 75MG 0.00

AC43632100 MELETIN CAPSULES 100MG "S.T." (MEXILETINE) 2.98

AC43633100 TOLESIN F.C. TABLETS 150MG "S.T." 1.61

AC436331G0 TOLESIN F.C. TABLETS 150MG "S.T."(鋁箔/膠箔) 2.00

AC43634100 TRAZONE TABLETS 50MG "S.T." (TRAZODONE HCL) 1.60

AC43635100 BAXICIN F.C. TABLETS 200MG "S.T." (NORFLOXACIN) 1.96

AC43637100 NOGOUT TABLETS 50MG "SINPHAR" 1.50

AC436371G0 NOGOUT TABLETS 50MG "SINPHAR" 2.00

AC43641100 "SUROTEN TABLETS 200MG ""ROYAL"" (TIAPROFENIC ACID)" 2.91

AC43642421 SHOWMIN EYE DROPS 0.01% 12.00

AC43642429 SHOWMIN EYE DROPS 0.01% 12.80

AC43656100 KINZOSIN TABLETS 2MG (TERAZOSIN) 1.92

AC43658238 ORIKERN-A I.V INJ. "ORIENTAL" 15.00

AC43661151 LECOTIN SOLUTION (0.2MG/ML LOPERAMIDE HCL) 25.00

AC43662100 TENSEN FILM COATING TABLETS 5MG "CHINTENG" 12.60

AC43663100ASCOTYL ENTERIC-MICROENCAPSULATED CAPSULES 100MG

"STANDARD"1.50

AC436631G0ASCOTYL ENTERIC-MICROENCAPSULATED CAPSULES 100MG

"STANDARD"(鋁箔)2.00

AC43664100 ESPIN E. M.CAPSULES 100MG (ASPIRIN) 1.50

Page 195: 附件二 藥品給付品項暨支付標準表

AC436641G0ESPIN E. M.CAPSULES 100MG "EVEREST" (ASPIRIN)(鋁箔/膠

箔)2.00

AC43667421 TIMIN EYE DROPS 0.5% 122.00

AC43679421 GENELIN OPHTHALMIC SOLUTION "PATRON" 29.60

AC43681421 "SMILE ORABASE 1MG/G ""WINSTON""" 35.60

AC43681426 "SMILE ORABASE 1MG/G ""WINSTON""" 61.00

AC43682100 "PWP TABLETS 200MG ""ROOT""" 1.50

AC43688100 LOTTON CAPSULES "C.M." 3.25

AC43692321 JIA MEI CREAM "S.C" 20.40

AC43692329 JIA MEI CREAM "S.C" 32.70

AC43692335 JIA MEI CREAM "S.C" 35.10

AC43692338 JIA MEI CREAM "S.C." 69.00

AC43693321 CLOB CREAM 11.90

AC43693324 CLOB CREAM 12.80

AC43693329 CLOB CREAM 0.00

AC43693335 CLOB CREAM 0.00

AC43693338 CLOB CREAM 0.00

AC43695100 CERIN F. C. TABLETS 10MG "EVEREST" (CETIRIZINE) 1.50

AC436951G0CERIN F. C. TABLETS 10MG "EVEREST" (CETIRIZINE)(鋁箔/膠

箔)2.00

AC43696151 KOPIN SOLUTION 25.00

AC43698100 UFUR CAPSULE 65.00

AC43699421 CORSUM ORALBASE 0.1% (DEXAMETHASONE) 35.60

AC43699426 CORSUM ORALBASE 0.1% (DEXAMETHASONE) 61.00

AC43700100 MEPTIN-MINI TABLETS 1.50

AC43703100 UMENI F.C.T. "EVEREST" 3.49

AC43704100 ATINOL F.C. TABLETS 50MG 1.50

AC437041G0 ATINOL F.C. TABLETS 50MG "S.Y." (ATENOLOL)(鋁箔/膠箔) 2.00

AC43705100 FLUX MICROENCAPSULATED CAP.10MG "STANDARD" 1.67

AC43708100 YIPO S.C.T 0.625MG "EVEREST" 1.85

AC43726209 MEPRON POWDER FOR INJ.1G "GENTLE" 1076.00

AC43726245 MEPRON POWDER FOR INJECTION 0.04GM"GENTLE" 39.30

AC43726265 MEPRON POWDER FOR INJ. 0.25G "GENTLE" 172.00

AC43726277 MEPRON INJ. 0.5G "GENTLE" 188.00

AC43727100 MEDNIN TABLETS 2MG (METHYLPREDNISOLONE) "H.S" 1.53

AC43728100 "UTRILIX CAPSULE 2.5MG ""ROOT""" 1.92

AC43729100 LEGAN TABLETS 1.76

AC43730151 ASWELL SOLUTION 1MG/ML 25.20

AC43730157 ASWELL SOLUTION 1MG/ML 62.00

AC43731321 ANTISCAR CREAM 24.00

AC43731329 ANTISCAR CREAM 29.10

AC43731335 ANTISCAR CREAM 54.00

AC43736100 SUTONDIN F.C. TABLETS 10MG "H.S" (TENOXICAM) 2.07

AC43740100 TONI F.C. TABLETS 500MG (IBUPROFEN LYSINE) "EVEREST" 1.64

AC43744100 KINLOFT F.C.TABLETS 50MG (SERTRALINE) "KINGDOM" 6.10

AC43747421 FLOXIN OPHTHALMIC SOLUTION 3.0MG/ML "PATRON" 29.00

AC43747429FOXIN OPHTHALMIC SOLUTION 3.0MG/ML "PATRON"

(NORFLOXACIN)83.00

Page 196: 附件二 藥品給付品項暨支付標準表

AC43758100 UCOJN TABLETS 4.03

AC43759100 KIMODIN F.C. TABLETS 20MG (AMOTIDINE) 1.59

AC437591G0 KIMODIN F.C. TABLETS 20MG (AMOTIDINE) 2.00

AC43761100 METHYLONE TABLETS 4MG (METHYLPREDNISOLONE) 1.53

AC437611G0 METHYLONE TABLETS 4MG (METHYLPREDNISOLONE)(鋁箔/膠箔) 2.00

AC43764421 GEMIN EYE DROPS "Y.Y" 14.50

AC43764429 GEMIN EYE DROPS "Y.Y" 37.10

AC43765100 KINXABEN TAB. 2MG (DOXAZOSIN) 1.78

AC437651G0 KINXABEN TAB. 2MG (DOXAZOSIN)(鋁箔/膠箔) 2.00

AC43770100"EXCELIN TABLETS 4MG (METHYLPREDNISOLONE) ""WINSTON."""

1.53

AC43771100 KIRADIN F.C. TABLETS 150MG "KINGDON" (RANITIDINE) 0.00

AC437711G0KIRADIN F.C. TABLETS 150MG (RANITIDINE)"KINGDOM"(鋁箔/膠

箔)0.00

AC43802100 "LYDICON CAP. ""ROYAL""" 1.50

AC438021G0 LYDICON CAPSULES "ROYAL"(鋁箔/膠箔) 2.00

AC43806100 MODIPANOL TABLETS 1MG "SWISS" 1.50

AC43818100 SYMITEC F.C TABLETS 10MG "S.D" 1.50

AC438181G0 SYMITEC F.C TABLETS 10MG "S.D"(鋁箔/膠箔) 2.00

AC43823100 NATON-S.R TAB. 750MG "EVEREST" 3.63

AC43824100 TRAMED CAPSULES 50MG "SWISS" 2.43

AC43832321 BEFONE CREAM 18.20

AC43832329 BEFONE CREAM 44.60

AC43832335 BEFONE CREAM 0.00

AC43833151 AMSOVAN SOLUTION 3MG/ML 25.00

AC43833157 AMSOVAN SOLUTION 3MG/ML 0.00

AC43835480 MESA INHALATION SOLUTION 200MG/ML "N.K." 36.50

AC43842100 OKWE ENTERIC-MICROENCAPSULATED CAPSULE 40 MG "N.K." 6.10

AC43843421 FLUORONE OPHTHALMIC SUSPENSION 0.2MG/ML "PATRON" 13.60

AC43843429 FLUORONE OPHTHALMIC SUSPENSION 0.2MG/ML "PATRON" 53.00

AC43848100 "BRONXIN CAPSULES ""WINSTON""" 1.60

AC43850100 "CIMETIN F.C TABLETS 400MG ""TAI YU""" 1.50

AC43851100 "TON-PASS CAPSULES 250MG ""TAI YU.""" 1.50

AC43854321 KESHUZHI GEL 10.00

AC43854329 KESHUZHI GEL 14.10

AC43854335 KESHUZHI GEL 20.70

AC43854338 KESHUZHI GEL 65.00

AC43854343 KESHUZHI GEL 185.00

AC43857100 ZUSAWTO E.M. CAPSULES 1.50

AC43860100 ELAM TABLETS 2MG "EVEREST" 1.53

AC438601G0 ELAM TABLETS 2MG "EVEREST"(鋁箔/膠箔) 2.00

AC43861100 SYNFLEX TABLETS 200MG 1.50

AC43862100 COFARIN TAB 1MG "GENTLE" 3.60

AC43867100 ALVERINE CAPSULES 60MG "EVEREST" 1.74

AC43892100 "CBC"BIORIX F.C TABLETS 150MG 2.22

AC43893100 "IBUPROFEN FILM COATED TABLETS 600MG ""WINSTON""" 1.64

AC43896100 MEITAN F.C.TABLETS 50MG "EVEREST" 1.50

AC438961G0 MEITAN F.C.TABLETS 50MG "EVEREST"(鋁箔/膠箔) 2.00

Page 197: 附件二 藥品給付品項暨支付標準表

AC43898100 FLU-D CAPSULES 150MG 52.00

AC43900100 BAXICIN F.C. TABLETS 100MG "S.T"(NORFLOXACIN) 1.96

AC43913321 BEFURINE GEL 0.05% "S.L" 0.00

AC43913329 BEFURINE GEL 0.05% "S.L" 13.70

AC43913338 BEFURINE GEL 0.05% "S.L" 41.90

AC43914321 TICARE CERAM 13.90

AC43914329 TICARE CERAM 22.30

AC43914335 TICARE CERAM 39.30

AC43914336 TICARE CERAM 47.30

AC43914338 TICARE CERAM 60.00

AC43920329 CLOBEGEN CREAM 35.00

AC43920338 CLOBEGEN CREAM 84.00

AC43924338 SHUJEN GEL 10MG/G "T.F." 23.10

AC43924345 SHUJEN GEL 10MG/G "T.F." 35.00

AC43927100 GOULESS TABLETS 50MG "STANDARD" (BENZBROMARONE) 1.50

AC439271G0GOULESS TABLETS 50MG "STANDARD" (BENZBROMARONE)(鋁箔/膠

箔)2.00

AC43928100 TOPCEF CAPSULES 500MG "GENTLE" 2.72

AC43931100 FELOPINE E.R. F.C. TABLET 10MG 3.58

AC43932100 CEDOL TABLETS "P.L." 1.50

AC439321G0 CEDOL TABLETS "P.L."(鋁箔/膠箔) 2.00

AC43935100 FAMOSTER F.C. TABLETS 20MG "T.F" 1.59

AC439351G0 FAMOSTER F.C. TABLETS 20MG "T.F."(鋁箔/膠箔) 2.00

AC43937100 FONZAC CAPSULES 20MG (FLUOXETINE) "T.F." 2.80

AC43939100 MEP TABLET 1.53

AC43941100 "SPICA CAPSULES 250MG (TRANEXAMIC ACID) ""WINSTON""" 1.50

AC43944100DOYA FILM COATING TABLETS 250MG "S.T."(PIPEMIDIC ACID)

3.54

AC43945129 SCRAT SUSPENSION "STANDARD" 20.40

AC43945157 SCRAT SUSPENSION "STANDARD" 78.00

AC43948100 IBUPROFEN F.C.TABLETS "S.L" 1.50

AC43949100 VENSI CAPSULES 0.00

AC43950100 TANATRIL TAB. 5MG 6.20

AC43951100 TANATRIL TAB. 10MG 6.50

AC43954100 YUGEN FILM COATING TABLETS 0.00

AC43956100 GEN BO CAPSULES 150MG "C.H" 0.00

AC43961100 TERAZOSIN TABLETS 2MG "U-CHU" 1.92

AC43970100 NITREN TABLETS 2.48

AC43971100 LOSAGEN CAPSULES 25MG "PATRON" 3.96

AC43972100 LABISU TABLETS 100MG "S.D" 3.53

AC43978209 "SOROCAM INJECTION 20MG/ML ""TAI YU""" 16.90

AC43978212 "SOROCAM INJECTION 20MG/ML ""TAI YU""" 16.90

AC43981321 NEOCOMB CREAM 13.90

AC43981330 NEOCOMB CREAM 20.20

AC43983321 "GRIST CREAM ""WINSTON""" 13.90

AC43983323 GRIST CREAM "WINSTON" 14.40

AC43983329 "GRIST CREAM ""WINSTON""" 18.40

AC43983330 "GRIST CREAM ""WINSTON""" 20.20

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AC43983335 GRIST CREAM "WINSTON" 29.70

AC43983336 "GRIST CREAM ""WINSTON""" 29.70

AC43983338 "GRIST CREAM ""WINSTON""" 57.00

AC43985100 ETODON CAPSULES 200MG "S.L" 3.25

AC43990100 SUCOUGH F.C TABLET 20MG "YC" 1.50

AC43991100 LINDACIN CAPSULES 150MG "S.T""(CLINDAMYCIN) 1.50

AC439911G0LINDACIN CAPSULES 150MG "S.T."(CLINDAMYCIN) (鋁箔/膠

箔)2.00

AC44011100 GENDERGIN-SR TAB. 1MG 2.17

AC44012321 MENTAX CREAM 1% "SINPHAR" 28.80

AC44012329 MENTAX CREAM 1% "SINPHAR" 45.00

AC44012335 MENTAX CREAM 1% "SINPHAR" 56.00

AC44012355 MENTAX CREAM 1% "SINPHAR" 623.00

AC44014100 USERM TABLETS, 100MG 1.52

AC440141G0 USERM S.C. TABLET 100MG(鋁箔/膠箔) 2.00

AC44022100 NIMED TABLETS 100MG "S.C." 0.00

AC44023143 CETIRIZINE ORAL SOLUTION 1MG/ML "CENTER" 28.00

AC44023151 CETIRIZINE ORAL SOLUTION 1MG/ML "CENTER" 28.10

AC44023157 CETIRIZINE ORAL SOLUTION 1MG/ML "CENTER" 87.00

AC44029100 KINZOLAM TABLETS 2MG 1.53

AC440291G0 KINZOLAM TABLETS 2MG(鋁箔/膠箔) 2.00

AC44031100 ANPURIN TAB. 100MG "H.S" (ALLOPURINOL) 1.50

AC440311G0 ANPURIN TABLETS 100MG "H.S" (ALLOPURINOL)(鋁箔/膠箔) 2.00

AC44034121 SOONMELT POWDER FOR SYRUP 62.5MG/ML 160.00

AC44037100 "NINGIST TABLETS 200MG ""WINSTON""" 1.50

AC44038100 SONLI CAPSULES 1.50

AC440381G0 SONLI CAPSULES (鋁箔/膠箔) 2.00

AC44039500 ZOLGEN VAGINAL TABLETS 100MG "Y.Y." 5.00

AC44041100MEITIFEN SUSTAINED RELEASE F.C. TABLETS 75MG "EEVEREST"

1.92

AC44042100 FLUXEN CAPSULES 10MG "W.S." 1.67

AC440421G0 FLUXEN CAPSULES 10MG "W.S."(鋁箔/膠箔) 2.00

AC44043348 YULYFORD CREAM 43.70

AC44043371 YULYFORD CREAM 267.00

AC44043377 YULYFORD CREAM 357.00

AC44060480 SIRUTA INHALATION SOLUTION 200MG/ML "S.T."(MESNA) 36.50

AC44061100 RIFAMPICIN CAPSULES 300MG "KOJAR" 8.00

AC44063100 TERASIN TABLETS 2MG "PURZER" 1.92

AC44064321 FUSOTEX CREAM 20MG/GM "PATRON" 32.20

AC44064326 FUSOTEX CREAM 20MG/GM "PATRON" 42.70

AC44064329 FUSOTEX CREAM 20MG/GM "PATRON" 45.20

AC44064335 FUSOTEX CREAM 20MG/GM "PATRON" 126.00

AC44064348 FUSOTEX CREAM 20MG/GM "PATRON" 0.00

AC44065321 GOODGEN GEL 10MG/GM "PATRON" (PIROXICAM) 11.20

AC44065338 GOODGEN GEL 10MG/GM "PATRON" (PIROXICAM) 23.10

AC44065345 GOODGEN GEL 10MG/GM "PATRON." (PIROXICAM) 35.00

AC44067100 BAYMIN TABLETS 5MG "T.F" (MEQUITAZINE) 1.50

AC44070280 SOONMELT FOR INTRAVENOUS INJECTION 32.30

Page 199: 附件二 藥品給付品項暨支付標準表

AC44070297 SOONMELT FOR INTRAVENOUS INJECTION 74.00

AC44078100 "PRENILONE TABLETS 5MG ""TAI YU"" (PREDNISOLONE)" 1.50

AC44083151 CENTERTHEO LIQUID 5.34MG//ML "CENTER" 25.00

AC44083157 CENTERTHEO LIQUID 5.34MG//ML "CENTER" 28.90

AC44084321 CLINGENE-T GEL 10MG/G "PATRON" 10.00

AC44084329 CLINGENE-T GEL 10MG/GM "PATRON" 14.10

AC44084335 CLINGENE-T GEL 10MG/GM "PATRON" 20.70

AC44084338 CLINGENE-T GEL 10MG/GM "PATRON" 65.00

AC44084343 CLINGENE-T GEL 10MG/GM "PATRON" 185.00

AC44086100 SUDORXAN TABLETS 200MG 1.50

AC440861G0 SUDORXAN TABLETS 200MG(鋁箔/膠箔) 2.00

AC44088238 MEJUOLINE INJECTION "N.K." 15.00

AC44090221 DOPAVATE INJECTION 40MG/ML 19.90

AC44093209 AVAPYRA INJECTION 15.00

AC44094100 DICOKAN-A CAP. "T.F" 1.50

AC44113100 ESDIAN F.C. TABLETS 7.00

AC44114100 SUFLEX TABLETS 200MG "YUNG SHIN" 1.50

AC441141G0 SUFLEX TABLETS 200MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC44115100 MEQUITAZINE TABLETS 5MG "U-CHU" 1.50

AC441151G0 MEQUITAZINE TABLETS 5MG "U-CHU"(鋁箔/膠箔) 2.00

AC44117329 CLOBEGEN CREAM "WEIDAR" 35.00

AC44123114 SOONMELT POWDER FOR SYRUP 31.25MG/ML 84.00

AC44127100 ALLOPURINOL TABLETS 300MG "U-CHU" 2.20

AC44140100 YURINOM TABLETS 100MG "T.F"(BENZBROMARONE) 2.05

AC44141321 GENTAMYCIN CREAM 0.1% 13.20

AC44141329 GENTAMYCIN CREAM 0.1% 18.00

AC44141335 GENTAMYCIN CREAM 0.1% 37.20

AC44161100 LISINOPRIL TABLETS 10MG "U-CHU" 2.29

AC44162100 SPASVERINE CAP. 60MG "PATRON" 1.74

AC44163100 SWINORIN F.C. TABLETS 50MG "SWISS" 1.50

AC44164421 SHINSOX VISCOUS EYE DROP 10MG/ML "PATRON" 65.00

AC44165100 SINGSONG CAPSULES 25MG 1.99

AC44167421 "FOXONE OPHTHALMIC SUSPENSION 1MG/ML ""WINSTON""" 12.40

AC44167429 "FOXONE OPHTHALMIC SUSPENSION 1MG/ML ""WINSTON""" 51.00

AC44169110AMOXICILLIN POWDER FOR ORAL SUSPENSION 25MG/ML

(AMOXICILLIN TRIHYDRATE)31.00

AC44172100 GELID TABLETS 80MG "H.S." (GLICLAZIDE) 1.50

AC441721G0 GELID TABLETS 80MG "H.S."(GLICLAZIDE)(鋁箔/膠箔) 2.00

AC44174100 MUSOLAX F.C. TABLETS 150MG 1.61

AC441741G0 MUSOLAX F.C. TABLETS 150MG(鋁箔/膠箔) 2.00

AC44175100 FOPO TABLETS 0.00

AC44176100THROMKEY ENTERIC-MICROENCAPSULATED CAPSULES 100MG

(ASPIRIN)"SWISS"1.50

AC441761G0THROMKEY ENTERIC-MICROENCAPSULATED CAPSULES 100MG

(ASPIRIN) "SWISS" (鋁箔/膠箔)2.00

AC44186100 "CISBILE CAPSULES 300MG ""WINSTON""" 0.00

AC44187209 BIPIDEN INJECTION 34.80

AC44194100 KEPROLINE TABLETS 25MG "PATRON" 4.20

Page 200: 附件二 藥品給付品項暨支付標準表

AC44196100 FEROMINE CAPSULES 10MG "H.S" 2.15

AC44197100 "SAVORY CAPSULES 60MG ""WINSTON""" 0.00

AC44201100 DORISIN F.C. TABLET "S.C" 1.71

AC442011G0 DORISIN F.C.TABLETS"S.C."(鋁箔/膠箔) 2.00

AC44203100 HAVINA F.C TABLETS 2.85

AC44208421 TOCIN OPHTHALMIC SOLUTION 0.3% "PATRON" 32.80

AC44209100 SPASTIN TABLETS "EVEREST" 1.83

AC44212100 ULIDEN CAPSULES 300MG "SWISS" 4.36

AC44213100 SYNTERON TABLETS 50MG 27.70

AC44223100 LIKEJHN CAPSULES 250MG "C.H" 2.25

AC44233100 GLUCOFIT F.C. TABLETS 850MG "SWISS" (METFORMIN) 1.68

AC44241329 DR.PI.A.F CREAM "MEIDER" 35.00

AC44241336 DR.PI.A.F CREAM "MEIDER" 53.00

AC44241338 DR.PI.A.F. CREAM "MEIDER" 84.00

AC44245421 LANYUNG EYE DROPS 0.1% "Y.Y" 44.50

AC44245429 LANYUNG EYE DROPS 0.1% "Y.Y" 70.00

AC44248100 FOLINA TABLETS 15MG 9.10

AC44250100 IZYMIN F. C. TABLETS 10MG "H.S" 1.50

AC442501G0 IZYMIN F. C. TABLETS 10MG "H.S"(鋁箔/膠箔) 2.00

AC44252329 B.C.CREAM 93.00

AC44253100 USER TAB. "T.F" (TIAPROFENIC ACID) 2.91

AC44254100 BETHANECHOL TABLETS 25MG "JOHNSON" 1.63

AC442541G0 BETHANECHOL TABLETS 25MG "JOHNSON"(鋁箔/膠箔) 2.00

AC44261100 RICH CAPSULES 30MG "N.K" 10.00

AC44264421 CHLORODECA OPHTHALMIC SOLUTION "PATRON" 49.10

AC44267100 "COTENIN CAP. ""TAI YU""" 1.50

AC44268321 CLINDAMYCIN GEL 10MG/G "T.F" 10.00

AC44270100 OKWE CAP. 20MG "N.K" 2.51

AC44272100 FORMOROL TAB. "S.C" 2.03

AC44274100 URISUE TAB. 50MG 1.50

AC442741G0 URISUE TAB. 50MG(鋁箔/膠箔) 2.00

AC44277100 FINSKA-LP S.R.F.C TABLETS 3.01

AC44281100 GABALON TAB. 5MG 1.50

AC44282100 DICLOREN E.M. CAPSULES 50MG "WEIDAR" 1.50

AC442821G0 DICLOREN E.M. CAP. 50MG "WEIDAR"(鋁箔/膠箔) 2.00

AC44295100 EDIOL F.C TABLATS 1MG 3.54

AC44297100 KINFLOCIN F.C. TABLETS 100MG "KINGDON" (OFLOXACIN) 0.00

AC44298421 DEXAMETHASONE EYE DROPS 0.1% "SINPHAR" 0.00

AC44299429 BETONASE AQUEOUS NASAL SPRAY 50UG/SPRAY 118.00

AC44300100 UROSE CAPSULES 300MG 4.36

AC443151G0 FRONITEC TABLETS 20MG "T.F."(鋁箔/膠箔) 2.00

AC44317100 BUWECON TAB. 0.125MG "YUNG SHIN" 1.75

AC443171G0 BUWECON TABLETS 0.125MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC44320100 BASORLIN TABLETS 200MG "T.F" 1.50

AC44321151 SULFACOTRIM SUSPENSION "CENTER" 28.00

AC44331100 FINTA F.C TABLETS 5MG "N.K" 12.60

AC44332212 FENTANYL INJECTION 0.05MG/ML "PPCD" 38.00

AC44332229 FENTANYL INJECTION 0.05MG/ML "PPCD" 90.00

Page 201: 附件二 藥品給付品項暨支付標準表

AC44338100 COLONIL F.C. TABLETS 135MG "SWISS" 1.75

AC443381G0 COLONIL F.C. TABLETS 135MG "SWISS"(鋁箔/膠箔) 2.00

AC44365100 DAMPURINE TABLETS 25MG 1.63

AC443651G0 DAMPURINE TABLETS 25MG(鋁箔/膠箔) 2.00

AC44366100 ULICIN F.C. TABLETS 250MG "H.S." 3.24

AC44371100 AMOPINE TABLETS 5MG "S.T" 3.84

AC44396151 MINLIFE SYRUP 1MG/ML 26.80

AC44402100 Kinscar F.C. Tablets 5mg 12.60

AC44414100 CLATINE TABLET 10MG "STANDAND"(LORATADINE) 1.50

AC444141G0 CLATINE TABLET 10MG "STANDAND"(鋁箔/膠箔) 2.00

AC44418100 THEOLIN S.R. TABLETS "PEI.LI" 1.72

AC444181G0 THEOLIN S.R. TABLETS "PEI.LI"(鋁箔/膠箔) 2.00

AC44419100 GLYCON TABLETS 80MG "SWISS" 1.50

AC44420100 LANDING TABLETS 20MG "YUNG SHIN" 1.54

AC444201G0 LANDING TABLETS 20MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC444201G2 LANDING TABLETS 20MG "YUNG SHIN"(30粒/瓶裝) 2.00

AC44421100 YAMTAC S.C. TABLETS 20MG 0.00

AC44436221 MIDAZO AMPOULE 5MG/5ML 17.70

AC44437209 MIDAZO AMPOULE 5MG/ML 17.70

AC44437216 MIDAZO AMPOULE 5MG/ML 23.50

AC44437229 MIDAZO AMPOULE 5MG/ML 203.00

AC44438100 BETHANCOL TABLETS 25MG 1.63

AC444491G0 AVERINE TABLETS 40MG(鋁箔/膠箔) 2.00

AC44450100 MEITAN F.C TABLETS 25MG "EVEREST" 1.50

AC444501G0 MEITAN F.C TAB. 25MG "EVEREST" (鋁箔/膠箔) 2.00

AC44459100 MUXALON TABLETS 200MG“H.S.” 1.50

AC444591G0 MUXALON TABLETS 200MG“H.S.”(鋁箔/膠箔) 2.00

AC44461100 LOW-LIP MICRONISED CAPSULES 2.51

AC44462335 ANTA CREAM 19.60

AC444631G0 SEMI-NAX F.C. TABLETS 10MG "D.T."(鋁箔/膠箔) 2.00

AC44469100 ULYMIN TABLET 30MG 2.00

AC444691G0 ULYMIN TABLETS 30MG(鋁箔/膠箔) 2.00

AC44470100 FLURONIN CAP. 10MG "YUNG SHIN" 1.67

AC44477100 SAFEPRIL TABLETS 10MG "STANDARD" 2.29

AC44479100 CLARICIN F.C. TABLETS 250MG "P.L" 3.24

AC44480100 LANDING TABLETS 10MG "YUNG SHIN" 1.54

AC444801G0 LANDING TABLETS 10MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC44481100 BIOZOLE TABLET 20MG 2.51

AC44483421 CHLORAMPHENICOL 0.25% EYE DROPS "SINPHAR" 12.00

AC44483429 CHLORAMPHENICOL 0.25% EYE DROPS "SINPHAR" 12.70

AC44484100 CLINDAMYCIN HCL CAPSULES 300MG "Y.Y" 2.80

AC44485100 LAIDEC F.C TABLETS 50MG 137.00

AC44498100 TELIN S.R TAB. 200MG "STANDARD" 1.61

AC444981G0 TELIN S.R TABLETS 200MG "STANDARD"(鋁箔/膠箔) 2.00

AC44500109 GASTINE GRANULES 20MG/GM "PURZER" 5.80

AC44503421 TROPICAN OPHTHALMIC SOLUTION 1.0% "PATRON" 0.00

AC44505321 DECENT CREAM 1% 20.40

AC44505329 DECENT CREAM 1% 32.70

Page 202: 附件二 藥品給付品項暨支付標準表

AC44505335 DECENT CREAM 1% 35.10

AC44505338 DECENT CREAM 1% 69.00

AC44507100 FENOX TAB. 500MG 2.83

AC44541100 CETIMIN FILM COATED TABLETS 10MG "C.H" 1.50

AC445411G0 CETIMIN FILM COATED TABLETS 10MG "C.H"(鋁箔/膠箔) 2.00

AC44542100 NABUTON FILM COATED TABLETS 500MG "YUNG SHIN" 3.23

AC44546100 VANIPEN TABLETS 0.5MG 1.50

AC445461G0 VANIPEN TABLETS 0.5MG(鋁箔/膠箔) 2.00

AC44547100 TELOWSIN TABLETS 2MG "YUNG SHIN" 1.92

AC445471G0 TELOWSIN TABLETS 2MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC44548209 "LACTATED RINGER INJECTION ""TAI YU""" 35.00

AC44548265 "LACTATED RINGER INJECTION ""TAI YU""" 22.00

AC44548277 "LACTATED RINGER INJECTION ""TAI YU""" 25.00

AC44567100 SAXOBIN TAB. 2MG 1.78

AC44571151 ASTOFEN SOLUTION "W.P." 42.80

AC44572100 FOXATE F.C TABLETS 200MG 3.74

AC44573321 ACURE GEL 0.1% 17.30

AC44573335 ACURE GEL 0.1% 68.00

AC44573343 ACURE GEL 0.1% 154.00

AC44573345 ACURE GEL 0.1% 211.00

AC44573363 ACURE GEL 0.1% 682.00

AC44574100 COUSOTIN CAPSULES 1.50

AC445741G0 COUSOTIN CAPSULES(鋁箔/膠箔) 2.00

AC44575100 FEPINE E.R. TABLETS 5MG "WECAM" 2.04

AC44577100 TORLEX TABLETS 50MG "YUNG SHIN" 1.60

AC445771G0 TORLEX TABLETS 50MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC44595100 MINLIFE TABLETS 10MG 1.50

AC445951G0 MINLIFE TABLETS 10MG(鋁箔/膠箔) 2.00

AC44597100 COXINE SR TABLETS 40MG 2.87

AC44601221 FORMOXOL INJECTION 662.00

AC44601229 FORMOXOL INJECTION 995.00

AC44601240 FORMOXOL INJECTION 3724.00

AC446012FG FORMOXOL INJECTION 1711.00

AC44602100 BIDOPAR TABLETS 25/250MG 9.10

AC44605100 ZOLNOX F.C. TABLETS 10MG 1.76

AC446051G0 ZOLNOX F.C. TABLETS 10MG(鋁箔/膠箔) 2.00

AC44606100 CEPHANMYCIN FILM COATED TAB. 500MG 1.78

AC44622100 SETINE F.C TAB.20MG "STANDARD" 5.30

AC44630100 PINAVEN F.C. TABLETS 50MG 5.30

AC44649321 AZEL CREAM 26.20

AC44649329 AZEL CREAM 45.30

AC44649330 AZEL CREAM 45.30

AC44649338 AZEL CREAM 152.00

AC44649343 AZEL CREAM 207.00

AC44650100 ROBATROL CAPSULES 200MG 10.80

AC44672100 TAXIFEN FILM COATED TAB. 10MG "YUNG SHIN" 3.63

AC44675540 MEFUGEL VAGINAL GEL 0.75% "S.L" 106.00

AC44675596 MEFUGEL VAGINAL GEL 0.75% "S.L" 124.00

Page 203: 附件二 藥品給付品項暨支付標準表

AC44680100 FLU-D CAPSULES 50MG 23.50

AC44682100 CAMISAN TABLETS 250MG "S.T." (TERBINAFINE) 7.80

AC44684100 ZOLMAN F.C. TAB. 10MG "S.C" 1.76

AC446841G0 ZOLMAN F.C. TABLETS 10MG "S.C."(鋁箔/膠箔) 2.00

AC44687100 AMILO TABLETS 10MG 3.84

AC44689100 THOIN S.R.M.C 250MG "EVEREST" 1.72

AC446891G0 THOIN S.R.M.C. 250MG "EVEREST"(鋁箔/膠箔) 2.00

AC44710100 CETY FILM COATED TABLETS 10MG 1.50

AC447101G0 CETY FILM COATED TABLETS 10MG (鋁箔/膠箔) 2.00

AC44713100 SOONMELT FILM COATED TABLETS 375MG 5.80

AC44715100 ECYCLE F.C.TABLETS 8MG "Y.Y." 1.50

AC44731100 LONGCARDIO(CARVEDILOL) TABLETS 25MG 3.19

AC44733100 COLIROCIN F.C. TABLETS 250MG 3.24

AC44777100 DEKU FC TAB. 500MG 3.23

AC44781100 DETOSIV SUSTAINED RELEASE TABLETS 60MG "LOTUS" 1.98

AC44801100 "IBU TABLETS ""ROOT""" 1.50

AC448011G0 "IBU TABLETS ""ROOT""(鋁箔/膠箔)" 2.00

AC44805221 HEPAC INJECTION 5000UNITS/ML "N.K" 36.80

AC44805240 HEPAC INJECTION 5000UNITS/ML "N.K" 166.00

AC44805248 HEPAC INJECTION 5000UNITS/ML "N.K" 298.00

AC44805299 HEPAC INJECTION 5000 UNITS/ML "N.K." 2.88

AC44807100 OXAMIDE TABLETS 30MG "S.T" 2.00

AC448071G0 OXAMIDE TABLETS 30MG "S.T."(鋁箔/膠箔) 2.00

AC44809248 SEFORCE INJECTION 2MG/ML "N.K" 206.00

AC44809255 SEFORCE INJECTION 2MG/ML "N.K" 450.00

AC44809263 SEFORCE INJECTION 2MG/ML "N.K" 621.00

AC448101G0 ENARIL TABLETS 20MG "WEIDAR"(鋁箔/膠箔) 2.00

AC44826100 ZOPIDEM F.C. TABLETS 10MG "STANDARD" 1.76

AC448261G0 ZOPIDEM F.C. TABLETS 10MG "STANDARD"(鋁箔/膠箔) 2.00

AC44827340 ZOLCHIN LIQUID "Y.Y" 142.00

AC44828100 NAKAMIDE F.C. TABLETS 1.25MG "N.K" 1.54

AC44850100 ALOZIDE TABLETS 1.88

AC448501G0 ALOZIDE TABLETS(鋁箔/膠箔) 2.00

AC44853100 DOPHILIN TABLETS 2MG "S.T" 1.78

AC448531G0 DOPHILIN TABLETS 2MG "S.T."(鋁箔/膠箔) 2.00

AC44877100 FERRIAN CHEWABLE TABLETS 3.01

AC44878100 BORY MYCIN PELLET-FILLED CAPSULES 50MG 3.68

AC44882100 NIAN TABLETS 10MG "Y.Y." 2.48

AC44916100 LABUTON F.C. TABLETS 500MG "WEIDAR" 3.23

AC44917100 KOMENI F.C TABLETS "EVEREST" 2.85

AC44919321 BELOLIN CREAM 0.5MG/GM (CLOBETASOL) 11.90

AC44919324 BELOLIN CREAM 0.5MG/GM 12.80

AC44919329 BELOLIN CREAM 0.5MG/GM(CLOBETASOL) 13.70

AC44919335 BELOLIN CREAM 0.5MG/GM(CLOBETASOL) 24.80

AC44919338 BELOLIN CREAM 0.5MG/GM(CLOBETASOL) 41.90

AC44919340 BELOLIN CREAM 0.5MG/GM (CLOBETASOL) 61.00

AC44920100 STAWEI TABLETS 1.52

AC449201G0 STAWEI TABLETS (鋁箔/膠箔) 2.00

Page 204: 附件二 藥品給付品項暨支付標準表

AC44921100 PUTAN CHEWABLE TABLETS "Y.Y." 3.01

AC44924100THOIN SUSTAINED-RELEASE MICROSPHERES CAP. 125MG

"EVEREST"1.50

AC449241G0THOIN SUSTAINED-RELEASE MICROSPHERES CAPSULES 125MG

"EVEREST""(鋁箔/膠箔)2.00

AC44925100 AMPIN TAB. 10MG 3.84

AC44951100FORMAX RETARD SLOW RELEASE FILM-COATING TAB.75MG

"SHITEH"1.92

AC44969321 CIPROSONE CREAM 0.5MG/GM 13.00

AC44969329 CIPROSONE CREAM 0.5MG/GM 15.90

AC44969335 CIPROSONE CREAM 0.5MG/GM 31.90

AC44970143 LEDAMIN SYRUP 1MG/ML "CENTER" (LORATADINE) 25.00

AC44970151 LEDAMIN SYRUP 1MG/ML "CENTER"(LORATADINE) 26.80

AC44971312 ACLOR CREAM 5% "Y.Y." 17.30

AC44971316 ACLOR CREAM 5% "Y.Y." 17.30

AC44971317 ACLOR CREAM 5% "Y.Y." 17.30

AC44971319 ACLOR CREAM 5% "Y.Y." 17.30

AC44971321 ACLOR CREAM 5% "Y.Y." 41.10

AC44971329 ACLOR CREAM 5% "Y.Y" 42.90

AC44972100 KALIJYUN CAPSULES 150MG "C.H" 1.50

AC44973321 FUGEN CREAM 2% "Y.Y" 32.20

AC44973326 FUGEN CREAM 2% "Y.Y" 42.70

AC44973329 FUGEN CREAM 2% "Y.Y" 45.20

AC44973335 FUGEN CREAM 2% "Y.Y" 126.00

AC44973338 FUGEN CREAM 2% "Y.Y" 160.00

AC44974229 ANGIDIL INJECTION 0.1% 151.00

AC44975329 ZA CREAM 200MG/GM 45.30

AC44976100 PEIFLAM FILM COATED TAB. "P.L" 1.50

AC449761G0 PEIFLAM FILM COATED TAB. "P.L"(鋁箔/膠箔) 2.00

AC44977100 GOWELL TABLETS "WECAN" 1.50

AC449771G0 GOWELL TABLETS "WECAM"(鋁箔/膠箔) 2.00

AC44980100 DEALLERGY F.C TAB. 1.50

AC44998100 ZOLOTIN FILM COATED TABLETS 20MG 3.58

AC45000100 AZUGEN TABLETS 2MG "WECAM" 1.50

AC450001G0 AZUGEN TABLETS 2MG "WECAM" (鋁箔/膠箔) 2.00

AC45001100 SPASTEC F.C. TABLETS 50MG "SWISS" 5.30

AC45013100 DOXTER TABLETS 2MG 1.78

AC450131G0 DOXTER TABLETS 2MG(鋁箔/膠箔) 2.00

AC45017321 COMYBOR CREAM 10MG/GM(BIFONAZOLE) 18.20

AC45017329 COMYBOR CREAM 10MG/GM(BIFONAZOLE) 44.60

AC45017335 COMYBOR CREAM 10MG/GM(BIFONAZOLE) 49.40

AC45017338 COMYBOR CREAM 10MG/GM (BIFONAZOLE) 81.00

AC45018100 STIMIN F.C.TABLETS 10MG 1.76

AC45020100 MUSGUD TABLETS 10MG "LOTUS" 2.95

AC45031100 IWELL TABLETS "EVEREST" 1.50

AC450311G0 IWELL TABLETS "EVEREST"(鋁箔/膠箔) 2.00

AC45037421 NORFU EYE DROPS 0.3% 29.00

AC45037429 NORFU EYE DROPS 0.3% 83.00

Page 205: 附件二 藥品給付品項暨支付標準表

AC45039100 XADOSIN TAB. 2MG 1.78

AC450391G0 XADOSIN TABLETS 2MG(鋁箔/膠箔) 2.00

AC45062421 KARTEOL OPHTHALMIC SOLUTION 1% (CARTEOLOL HCL) 120.00

AC45067321 FULOSIN CREAM 2% 32.20

AC45067326 FULOSIN CREAM 2% 42.70

AC45067329 FULOSIN CREAM 2% 45.20

AC45067335 FULOSIN CREAM 2% 126.00

AC45069316 EVERSONE CREAM 0.1% 22.40

AC45069321 EVERSONE CREAM 0.1% 27.60

AC45069326 EVERSONE CREAM 0.1% 0.00

AC45085100 AMLODINE TABLETS 3.84

AC45090100 SELADIN ENTERIC COATED TABLETS 500MG 2.95

AC45101421KARTEOL OPHTHALMIC SOLUTION 2% "KINGDOM"(CARTEOLOL HCL)

177.00

AC45102100 E WEI AN CAPSULES 15MG "N.K." 8.30

AC45105321 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL ) 11.90

AC45105324 BELOLIN OINTMENT 0.5MG/GM 12.80

AC45105329 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL) 13.70

AC45105335 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL) 24.80

AC45105338 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL ) 41.90

AC45105340 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL ) 61.00

AC45128238 VITATICANIN-G INJECTION 15.00

AC45144100 SAXOBIN TABLET 1MG 1.78

AC45145421 "FOXONE OPHTHALMIC SUSPENSION 0.2MG/ML ""WINSTON""" 13.60

AC45145423 "FOXONE OPHTHALMIC SUSPENSION 0.2MG/ML ""WINSTON""" 19.20

AC45145429 "FOXONE OPHTHALMIC SUSPENSION 0.2MG/ML ""WINSTON""" 53.00

AC45146421 SUZOLE EYE DROPS "Y.Y" 12.00

AC45146429 SUZOLE EYE DROPS "Y.Y" 12.00

AC45146435 SUZOLE EYE DROPS "Y.Y" 13.90

AC45147100 ZOPIM F.C. TABLETS 10MG "S.T."(ZOLPIDEM) 1.76

AC451471G0 ZOPIM F.C. TABLETS 10MG(ZOLPIDEM)(鋁箔/膠箔) 2.00

AC45154221 TRANSAMIN INJECTION "DAIICHI SANKYO" 15.00

AC45155100 ZOLDOX F.C. TAB. 10MG "WEIDAR" 1.76

AC451551G0 ZOLDOX F.C. TABLETS 10MG " WEIDAR"(鋁箔/膠箔) 2.00

AC45172100 Vastril Tablets 10mg 2.29

AC45177100 NIFECARDIA S.R.F.C TAB. 30MG 5.10

AC45178100 LUNGTEC TAB. 10MG 2.01

AC45179100 WEMENI F.C TAB. "WECAM" 2.85

AC45181100 SYNNA TABLETS 4.17

AC45182100 PHENEULIN CAP. 10MG "YUNG SHIN" 2.15

AC45183412 ZINE ORABASE 0.1% 31.80

AC45183421 ZINE ORABASE 0.1% 35.60

AC45183426 ZINE ORABASE 0.1% 61.00

AC45186321 KOLINCIN GEL 10MG/G 10.00

AC45186323 KOLINCIN GEL 10MG/G 11.40

AC45186329 KOLINCIN GEL 10MG/G 14.10

AC45186335 KOLINCIN GEL 10MG/G 20.70

AC45186338 KOLINCIN GEL 10MG/G 65.00

Page 206: 附件二 藥品給付品項暨支付標準表

AC45186343 KOLINCIN GEL 10MG/G 185.00

AC45187100 YAWAHO TABLETS 3.84

AC45201100 CIPROFLO F.C. TABLET 500MG 6.10

AC45203100 LOSA F.C. TABLETS 50MG 4.11

AC45205321 BECLOSOL GEL 11.90

AC45205324 BECLOSOL GEL 12.80

AC45228321 MIZTIN CREAM "MEIDER" 13.90

AC45228338 MIZTIN CREAM "MEIDER" 57.00

AC45230100 PIPEINE F.C. TAB. "S.C" 1.50

AC45245321 CIPROSONE OINTMENT 0.5MG/GM 13.00

AC45245329 CIPROSONE OINTMENT 0.5MG/GM 15.90

AC45245335 CIPROSONE OINTMENT 0.5MG/GM 31.90

AC45247100 DOBECON SUGAR COATED TAB. 100MG "YUNG SHIN" 1.75

AC452471G0DOBECON SUGAR COATED TABLETS 100MG "YUNG SHIN"(鋁箔/膠

箔)2.00

AC45248100 SUCONIN CAPSULES 1.50

AC45249321 BADINE OINTMENT 13.00

AC45249329 BADINE OINTMENT 15.90

AC45249335 BADINE OINTMENT 31.90

AC45250100 OMP E.C CAPSULES 20MG (OMEPRAZOLE) 2.51

AC45251129 SCOTON ORAL SUSPENSION 25.00

AC45251151 SCOTON ORAL SUSPENSION 25.00

AC45251157 SCOTON ORAL SUSPENSION 45.10

AC45254100 SYNBOT TAB. 5MG 1.54

AC452541G0 SYNBOT TAB. 5MG(鋁箔/膠箔) 2.00

AC45267100 "U-CHU" ACEO CAPSULES RETARD 90MG 2.37

AC45274100 TONTEC F.C. TABLETS 500MG "SWISS" 3.23

AC45276100 SOONMELT FILM COATED TABLETS 625MG 5.90

AC452791G0 "U-CHU" ZODEM TABLETS 10MG(鋁箔/膠箔) 2.00

AC45289321 BETASALIC OINTMENT 10.90

AC45289329 BETASALIC OINTMENT 19.50

AC45289335 BETASALIC OINTMENT 52.00

AC45289338 BETASALIC OINTMENT 68.00

AC45290100 MECON TABLETS 7.5MG 1.72

AC452901G0 MECON TABLETS 7.5MG(鋁箔/膠箔) 2.00

AC45293417 KAMIN EYE DROPS 0.3% "Y.Y" 32.80

AC45293421 KAMIN EYE DROPS 0.3% "Y.Y" 32.80

AC45307421 SHOWEN EYE DROPS 0.25% "Y.Y" 12.00

AC45307429 SHOWEN EYE DROPS 0.25% "Y.Y" 12.70

AC45310263 AMIPAREN INJECTION 10% W/V 152.00

AC45310271 AMIPAREN INJECTION 10% W/V 206.00

AC45311100 BEDASON TABLETS "S.C" 1.50

AC45312100 LIDAMOLE F.C TABLETS "S.C" 1.50

AC45331221 GENETAXYL CREM LESS INJECTION 662.00

AC45331229 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 995.00

AC45331235 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 0.00

AC45331240 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 0.00

AC45331248 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 0.00

Page 207: 附件二 藥品給付品項暨支付標準表

AC453312E2 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 1711.00

AC45334100 MIDORINE TABLETS "P.L" 3.42

AC45337321 BASOL OINTMENT 11.90

AC45337324 BASOL OINTMENT 12.80

AC45337329 BASOL OINTMENT 13.70

AC45337335 BASOL OINTMENT 24.80

AC45337338 BASOL OINTMENT 41.90

AC45338157 CONSRINE SYRUP 25.80

AC45340321 BASOL CREAM 11.90

AC45340324 BASOL CREAM 12.80

AC45340329 BASOL CREAM 13.70

AC45340335 BASOL CREAM 24.80

AC45340338 BASOL CREAM 41.90

AC45340340 BASOL CREAM 61.00

AC45341321 BADINE CREAM 13.00

AC45341329 BADINE CREAM 15.90

AC45341335 BADINE CREAM 31.90

AC45341343 BADINE CREAM 31.90

AC45342100 CLONOPAM TABLETS 0.5MG "KINGDOM"(CLONAZEPAM) 1.50

AC453421G0CLONOPAM TABLETS 0.5MG "KINGDOM"(CLONAZEPAM)(鋁箔/膠箔)

2.00

AC45343100 CARIMYCIN FILM COATED TABLETS 250MG 3.24

AC45345100 CLONOPAM TABLETS 2MG "KINGDOM" 1.86

AC453451G0 CLONOPAM TABLETS 2MG (CLONAZEPAM)(鋁箔/膠箔) 2.00

AC45346100 KER KER CAPSULES "S.C." 1.50

AC45349329 BESALIC OINTMENT 19.50

AC45349335 BESALIC OINTMENT 52.00

AC45349338 BESALIC OINTMENT 68.00

AC45349343 BESALIC OINTMENT 81.00

AC45351100 ACTIWE TABLETS "UELIAN" 1.50

AC45354100 BETARUN F.C TABLETS 20MG 3.72

AC45355209 DROPEL INJECTION 2.5MG/ML 15.00

AC45357345 KENETON GEL 35.00

AC453573AK KENETON GEL 28.20

AC45358100 DEFLAM-K F.C. TABLETS 25MG (DICLOFENAC POTASSIUM) 1.50

AC453581G0 DEFLAM-K F.C. TABLETS 25MG (DICLOFENAC POTASSIUM) 2.00

AC45361321 D.F. CREAM 1MG/GM 14.10

AC45361329 D.F CREAM 1MG/GM 44.50

AC45361343 D.F CREAM 1MG/GM 79.00

AC45362212 FE-BACK INJECTION 2% "N.K." 35.20

AC45362221 FE-BACK INJECTION 2% "N.K." 65.00

AC45374100 DOWN-LIP MICRONISED CAPSULES 200MG 3.92

AC45375100 MELOCAM TABLETS "P.L" 1.72

AC45379114 ANBICYN POWDER FOR SYRUP 31.25MG/ML 84.00

AC45380100 KITAPRAM F.C. TABLETS 20MG "KINGDOM" (CITALOPRAM) 7.10

AC45381100 LOTE E.C TABLETS 100MG 21.10

AC45382100 "MINING TABLETS 5MG ""TAI YU""" 1.50

AC45383100 BAFEN TABLETS 5MG 1.50

Page 208: 附件二 藥品給付品項暨支付標準表

AC453831G0 BAFEN TABLETS 5MG(鋁箔/膠箔) 2.00

AC453831G5 BAFEN TABLETS 5MG(84粒/瓶) 2.00

AC45385100 MOPIK TABLETS 7.5MG "N.K" 1.72

AC453851G0 MOPIK TABLETS 7.5MG "N.K."(鋁箔/膠箔) 2.00

AC45386529 SUTROL GEL-VAGINAL 55.00

AC45386540 SUTROL GEL-VAGINAL 106.00

AC45388321 BECLOSOL OINTMENT 11.90

AC45388324 BECLOSOL OINTMENT 12.80

AC45407100 MELOXIN TABLETS 7.5MG 1.72

AC454071G0 MELOXIN TABLETS 7.5MG(鋁箔/膠箔) 2.00

AC45408326 PATODERM CREAM 50MG "PATRON" 44.80

AC45408335 PATODERM CREAM 50MG "PATRON" 0.00

AC45409277 "LAG FOR INJECTION 500MG ""TAI YU""" 15.00

AC454121G0 NOOPOL F.C. TABLETS 1200MG "N.K."(鋁箔/膠箔) 2.00

AC45414100 ZAPINE TABLETS 100MG "S.T" 4.55

AC45437100ANWU ENTERIC COATED TABLETS 50MG (FLUVOXAMINE MALEATE)

6.20

AC45439100 SPASLAX TABLETS 4MG 8.10

AC45441100 MELICAM TABLETS 7.5MG (MELOXICAM) 1.72

AC45443245 BELON INJECTION "ORIENTAL" 39.30

AC45443258 BELON INJECTION "ORIENTAL" 108.00

AC45447429ALLERCORT NASAL AQUA 50UG/DOSE "STANDARD" (BUDESONIDE)

120.00

AC45448100 AMILO TABLETS 5MG 3.84

AC45450100 LICHIA TABLETS 1.50

AC454501G0 LICHIA TABLETS(鋁箔/膠箔) 2.00

AC45489100 MIXAPIN TABLETS 25MCG "H.S" 1.50

AC454891G0 MIXAPIN TABLETS 25MCG "H.S"(鋁箔/膠箔) 2.00

AC45494221 YUTOPAR INJECTION 10MG/ML 44.40

AC45510100 POLO SR TABLET 10MG "N.K" 3.58

AC45538251 UROKINASE INJECTION 60,000I.U. "YAO CHIH HSIANG" 898.00

AC45539100NOSMA SUSTAINED-RELEASE MICROSPHERES CAPSULES 125MG

"WECAM"1.50

AC455391G0NOSMA SUSTAINED-RELEASE MICROSPHERES CAPSULES 125MG

"WECAM"(鋁箔/膠箔)2.00

AC45541100 STIDINE TABLETS 2MG "KINGDOM" (TIZANIDINE) 1.62

AC455411G0 STIDINE TABLETS 2MG (TIZANIDINE)(鋁箔/膠箔) 2.00

AC45543100 "JENAC CAPSULES ""ROOT.""" 3.25

AC45552100 MEDRONE TABLETS 5MG 1.50

AC455521G0 MEDRONE TABLETS 5MG(鋁箔/膠箔) 2.00

AC45553321 NIFFULENE GEL 0.1% 17.30

AC45553335 NIFFULENE GEL 0.1% 68.00

AC45553343 NIFFULENE GEL 0.1% 154.00

AC45553345 NIFFULENE GEL 0.1% 211.00

AC45553363 NIFFULENE GEL 0.1% 682.00

AC45556321 GENCIN CREAM 13.20

AC45556329 GENCIN CREAM 18.00

AC45556335 GENCIN CREAM 37.20

Page 209: 附件二 藥品給付品項暨支付標準表

AC455563AK GENCIN CREAM 52.00

AC45557100 LOTARIN TABLETS 10MG "WEIDAR" 1.50

AC455571G0 LOTARIN TABLETS 10MG "WEIDAR"(鋁箔/膠箔) 2.00

AC45571329 FORMEI CREAM "Y.C" 35.00

AC45571336 FORMEI CREAM "Y.C." 53.00

AC45571338 FORMEI CREAM "Y.C" 84.00

AC45581100 PAROXE F.C TABLETS 20MG 5.30

AC45582100 RIPEDON F.C. TABLETS 2MG "STANDARD" 7.70

AC45590100 BACLOSPAS TABLETS 10MG 1.50

AC45591100 BACLOSPAS TABLETS 5MG 1.50

AC45595316 HONMET OINTMENT 0.1% 22.40

AC45595321 HONMET OINTMENT 0.1% 27.60

AC45595326 HONMET OINTMENT 0.1% 28.60

AC45595335 HONMET OINTMENT 0.1% 65.00

AC45599345 ANTIPAIN PATCH "SHENG CHUN" (FLURBIPROFEN) 40MG/12GM 5.30

AC45602100 YUTOPAR TABLETS 10MG 4.15

AC45620100 BAMBEROL TAB. 10MG "S.C" 2.01

AC45645248 FLUENE IV INJECTION 2MG/ML "PURZER" 258.00

AC45646100 DEGLU TABLETS 50MG "LOTUS" 2.27

AC45648100 MECORDA TABLETS "S.C" 1.50

AC45649100 "TONZOUGE F.C TABLETS 400MG ""TAI YU""" 1.50

AC45653100 BIOKIN F.C. TABLET 9.6MG "MEIDER" 1.71

AC45664100 FUXITOL S.C. TABLETS 3MG "TAXO" 10.70

AC45667314 ELISONE CREAM 21.40

AC45667316 ELISONE CREAM 22.40

AC45667321 ELISONE CREAM 27.60

AC45667326 ELISONE CREAM 28.60

AC45667329 ELISONE CREAM 43.80

AC45667335 ELISONE CREAM 65.00

AC45671100 CEFLOUR FILM COATED TABLETS 250MG 5.90

AC45672321 "MOSONE CREAM ""H.S""" 27.60

AC45672329 "MOSONE CREAM ""H.S""" 0.00

AC45672335 "MOSONE CREAM ""H.S""" 65.00

AC45673321 PROBISALIC OINTMENT 0.00

AC45673329 PROBISALIC OINTMENT 19.50

AC45673335 PROBISALIC OINTMENT 0.00

AC45673338 PROBISALIC OINTMENT 68.00

AC45673340 PROBISALIC OINTMENT 0.00

AC45673343 PROBISALIC OINTMENT 0.00

AC45676421 PREDILONE OPH. SOL 1% (PREDNISOLONE SODIUM PHOSPHATE) 76.00

AC45685412 NEO SMILE ORABASE 31.80

AC45685421 NEO SMILE ORABASE 35.60

AC45685426 NEO SMILE ORABASE 61.00

AC45696355 COLASA ENEMA 20MG/ML 192.00

AC45699100 CEFIXMYCIN CAPSULE 100MG "YUNG SHIN" 4.51

AC45700100 UROTROL F.C TABLETS 15MG 4.63

AC45701221 ALEVIATIN INJECTION 69.00

AC45703100 CHITIAN TABLETS 80MG "C.H." 0.00

Page 210: 附件二 藥品給付品項暨支付標準表

AC45704220 TAPIMYCIN INJECTION "YUNG SHIN" 226.00

AC457042CX TAPIMYCIN INJECTION "YUNG SHIN" 136.00

AC45705100 BERIAN F.C. TABLETS "N.K." 1.50

AC45706143 LORADIN SYRUP "H.S" 19.60

AC45706151 "LORADIN SYRUP ""H.S""" 0.00

AC45706155 "LORADIN SYRUP ""H.S""" 0.00

AC45708100 CANASE CAPSULES 1.50

AC457081G0 CANASE CAPSULES(鋁箔/膠箔) 2.00

AC45719423 BESONIN AQUA NASAL SPRAY 50MCG/DOSE 76.00

AC45719429 BESONIN AQUA NASAL SPRAY 50MCG/DOSE 120.00

AC45721421 ANTOL EYE DROPS 0.3% 12.00

AC45721429 ANTOL EYE DROPS 0.3% 20.30

AC45722100 "ELAC CAPSULES 200MG ""ROYAL""" 3.25

AC45731421KINGCORT OPH. SOL. 0.125% (PREDNISOLONE SODIUM

PHOSPHATE)0.00

AC45732100 MELIXOL SC TABLET 2.15

AC45733100 ASMATIN TABLETS "SINPHAR" 1.50

AC457331G0 ASMATIN TABLETS "SINPHAR" 2.00

AC45737100 MEOSICAM TABLETS 7.5MG 1.72

AC45751321 PROMISONE CREAM "START" 0.00

AC45751329 PROMISONE CREAM "START" 15.90

AC45751335 PROMISONE CREAM "START" 31.90

AC45751343 PROMISONE CREAM "START" 31.90

AC45752100 SLEEPMAN TABLETS 1.76

AC457521G0 SLEEPMAN TABLETS(鋁箔/膠箔) 2.00

AC45755100 SPASLAX TABLETS 2MG 1.62

AC45756100 SUPCAL TABLETS 667MG "N.K." 1.58

AC45757100 EBUFEN F.C.TAB. 600MG "S.C" 1.64

AC45777100 Tazac Capsules 150mg 5.40

AC45778343 CALTRIOL OINTMENT 461.00

AC45779100 MODIPANOL F.C TABLETS 1MG "SWISS" 1.50

AC457791G0 MODIPANOL F.C TABLETS 1MG "SWISS"(鋁箔/膠箔) 2.00

AC45780100 "DOLOC CAPSULES 200MG ""MACRO""" 3.25

AC45781100 AZAMUN FILM COATED TABLETS 50MG 9.60

AC45782321 CLOBESONE CREAM "START" 11.90

AC45782324 CLOBESONE CREAM "START" 12.80

AC45782329 CLOBESONE CREAM "START" 13.70

AC45782338 CLOBESONE CREAM "START" 0.00

AC45782340 CLOBESONE CREAM "START" 61.00

AC45800100 CHENCOUGH CAPSULES "S.C." 1.39

AC45801421 CIROXIN OPHTHALMIC SOLUTION 0.3% "PATRON" 0.00

AC45807100 CITAO TABLETS 20MG (CITALOPRAM) 7.10

AC45809421FLUCASON OPHTHALMIC SUSPENSION 0.1% "KINGDOM"

(FLUOROMETHOLONE)12.40

AC45809429FLUCASON OPHTHALMIC SUSPENSION 0.1% "KINGDOM"

(FLUOROMETHOLONE)51.00

AC45822100 XETINE-P F.C TABLETS 20MG 5.30

AC45825321 DANCE CREAM 27.60

Page 211: 附件二 藥品給付品項暨支付標準表

AC45825329 DANCE CREAM 43.80

AC45825335 DANCE CREAM 65.00

AC45826100 TAQUIDINE CAPSULES 30MG 10.00

AC45827100 SUCAM CAPSULES 50MG "EVEREST" 5.30

AC45829100 LAVOL TABLETS 3MG 0.00

AC45847100 SLUXDIN FILM COATED TABLETS 50MG 4.11

AC45851321 IN-QUADEICREN CREAM 13.90

AC45851323 IN-QUADEICREN CREAM 14.40

AC45851329 IN-QUADEICREN CREAM 18.40

AC45851335 IN-QUADEICREN CREAM 29.70

AC45851336 IN-QUADEICREN CREAM 29.70

AC45851338 IN-QUADEICREN CREAM 57.00

AC45855100 FERICH CAPSULES 2.88

AC45859421 CIPCIN EYE DROPS 0.3% "YY" 0.00

AC45860100 PEIFLAM FILM COATED TABLETS 25MG "P.L" 1.50

AC45863100 FEDCEN SUSTAINED RELEASE TABLETS 120MG "LOTUS" 2.13

AC45892100 LAVOL TABLETS 5MG 4.99

AC45915326 ANTIDOXE CREAM "S.C." 44.80

AC45915335 ANTIDOXE CREAM "S.C." 48.40

AC45917321 CLOBA OINTMENT 24.40

AC45917329 CLOBA OINTMENT 37.60

AC45917330 CLOBA OINMENT 44.00

AC45917335 CLOBA OINTMENT 70.00

AC45919321 CONFUMIN CREAM "H.S." 45.20

AC45919335 CONFUMIN CREAM "H.S." 130.00

AC45921100 FERROSAN TABLETS "S.C." 3.01

AC45923100 METICORT TABLETS 4MG "KINGDOM" (METHYLPREDNISOLONE) 1.53

AC45925321 FUTEN CREAM 2% 32.20

AC45925329 FUTEN CREAM 2% 45.20

AC45926100 NAKASSER SR CAPSULES 120MG "N.K." (DILTIAZEM HCL) 5.70

AC45950100 FUNGITECH TABLETS 250MG "SINPHAR" 7.80

AC45951100 DIBECINE CAPSULES "S.C" 2.15

AC45952100 TOPESON F.C. TABLETS 150MG "STANDARD" 1.61

AC459551G0 NAKAMIDE SR TABLETS 1.5MG "N.K."(鋁箔/膠箔) 2.00

AC45956100 ENPUROL TAB. "Y.C" 2.20

AC45957335 ANCENT CREAM "Y.C" 35.10

AC45957338 ANCENT CREAM "Y.C" 69.00

AC45958100 MOGEN ENTERIC-MICROENCAPSULATED CAPSULES 50MG "WECAM" 1.50

AC459581G0MOGEN ENTERIC-MICROENCAPSULATED CAPSULES 50MG "WECAM"(鋁

箔/膠箔)2.00

AC45959100 NOVAMIN TABLETS 1.50

AC45960435 SINOMIN OPHTHALMIC SOLUTION 13.90

AC45962100 ENPEX CAPSULES 1.52

AC459621G0 ENPEX CAPSULES "Y.C."(鋁箔/膠箔) 2.00

AC45965100 KETO ENTERIC-MICROENCAPSUIATED CAP. 10MG 4.13

AC45967100 RINDERON TABLETS 1.50

AC45971100 ARHEUMA TABLETS 20MG "LOTUS" 35.20

AC45972100 DENOSIN FILM-COATED TABLETS 5MG "LOTUS" 2.19

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AC45973100 NEPHRONORM S.C. TABLETS 4.05

AC45974100 DAFUTEN CAPSULES 150MG "S.L" 2.88

AC45975100 ROYATEC TABLET "ROYAL." 1.54

AC45994100 SUBIC TABLETS 7.5MG 1.72

AC46012321 BEAUTYFACE GEL "H.S" 0.00

AC46012335 BEAUTYFACE GEL "H.S" 68.00

AC46012343 BEAUTYFACE GEL "H.S" 0.00

AC46012345 BEAUTYFACE GEL "H.S" 0.00

AC46012363 BEAUTYFACE GEL "H.S" 0.00

AC46013100 ZOLON FILM COATED TABLETS 7.5MG(ZOPICLONE) 1.98

AC46018100 FUPROSTATE TABLETS 30.20

AC46028100 FLUITRAN TABLETS 1.50

AC460281G0 FLUITRAN TABLETS(鋁箔/膠箔) 2.00

AC46030100 KEROLAC FILM COATED TABLETS 10MG 4.13

AC46046100 LACIPIL TABLETS 4MG 4.87

AC46049100 SETONLIN F.C.TAB. "Y.C" 1.64

AC460491G0 SETONLIN F.C. TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC46050100 MELOCAM TABLETS 7.5MG 1.72

AC460501G0 MELOCAM TABLETS 7.5MG(鋁箔/膠箔) 2.00

AC46067100 PROTASE ENTERIC COATED CAPSULES 7.80

AC46068100 SUNIME TABLETS 5MG "EVERESR" 0.00

AC46069417 CHLORLYMIN OPHTHALMIC OINTMENT 1% (CHLORAMPHENICOL) 13.30

AC46069421 CHLORLYMIN OPHTHALMIC OINTMENT 1% (CHLORAMPHENICOL) 13.30

AC46070100 MEZIDE MR TABLETS 30MG "LOTUS" 1.65

AC46072100 ACEMET RETARD CAPSULES 90MG (ACEMETACIN) 2.37

AC46077100 ADARONE TABLETS 200MG 4.86

AC46100143 CLATINE SYRUP 1MG/ML "STANDARD" 25.00

AC46100151 CLATINE SYRUP 1MG/ML "STANDARD" 26.80

AC46100155 CLATINE SYRUP 1MG/ML "STANDARD" 72.00

AC46101321 CONLIFU OINTMENT 2% 32.20

AC46102100 RISDON F.C. TABLETS 2MG "WEIDAR" 7.70

AC46103421FLUCASON OPHTHALMIC SUSPENSION0.02% "KINGDOM"

FLUOROMETOLONE13.60

AC46103429FLUCASON OPHTHALMIC SUSPENSION0.02% "KINGDOM"

FLUOROMETOLONE53.00

AC46105100 PICEDIN CAPSULES 400MG 1.50

AC46116355 COLASA ENEMA 40MG/ML 282.00

AC46117143 LOTADIN SYRUP 1MG/ML (LORATADINE) 0.00

AC46117151 LOTADIN SYRUP 1MG/ML (LORATADINE) 26.80

AC46118100 B.H.L. TABLETS 2MG 1.50

AC46136412 WETHYCO ORABASE "Y.C." 31.80

AC46136421 WETHYCO ORABASE "Y.C" 35.60

AC46153321 EUROTECH ACNE GEL (5 GM) 10.00

AC46153329 EUROTECH ACNE GEL (10 GM) 14.10

AC46153338 EUROTECH ACNE GEL (20 GM) 65.00

AC46154100 LITHCAN CAPSULES 300MG 1.50

AC461541G0 LITHCAN CAPSULES 300 MG(28粒及84粒/瓶裝暨鋁箔/膠箔) 2.00

AC46164100 TOSPIN TABLETS 5MG (TROSPIUM) 2.15

Page 213: 附件二 藥品給付品項暨支付標準表

AC46166100 TEDALIN CHEWABLE TABLETS "Y.C" 3.01

AC46170209 UZOLAM INTRAVENOUS INJECTION 5MG/ML "UNION" 17.70

AC46170216 UZOLAM INTRAVENOUS INJECTION 5MG/ML "UNION" 0.00

AC46170229 UZOLAM INTRAVENOUS INJECTION 5MG/ML "UNION" 0.00

AC46173143 PROCAROL LIQUID 5UG/ML 25.90

AC46189423 "SUYENIN ORAL BASE ""H.S""" 36.70

AC46199100 FORSINE F.C TABLETS 10MG 4.17

AC46204100 BAMBUVENT TABLETS 10MG 2.01

AC46223421 KELAC OPHTHALMIC SOLUTION 0.5% "PATRON" 86.00

AC46224143 RESPOR ORAL SOLUTION 1MG/ML 548.00

AC46225100 IROTEX CHEWABLE TABLETS "ROYAL" 3.01

AC46226265 UROKINASE INJECTION 250,000I.U. "YAO CHIH HSIANG" 3378.00

AC46236100 B.H.L. TABLETS 5MG 1.50

AC46245100 DINIDOL S.C. TABLETS 25MG 1.50

AC462451G0 DINIDOL S.C. TABLETS 25MG(鋁箔/膠箔) 2.00

AC46246100 LANPO CAPSULES 30MG "EVEREST" 10.00

AC46254100 SPAGASTIN TABLETS 2.34

AC46255100 ZOLPI F.C TABLETS 10MG 1.76

AC462551G0 ZOLPI F.C. TABLETS 10MG(鋁箔/膠箔) 2.00

AC46257421 ATROPINE EYE DROPS 0.3% "SINPHAR" 12.00

AC46258500 JETOO SUPPOSITORIES "MEIDER" 5.00

AC46259412 DRXALINE ORAL PASTE 1MGGM 31.80

AC46259421 DRXALINE ORAL PASTE 1MGGM 35.60

AC46261143 MEPROTIN LIQUID 5UG/ML 0.00

AC46261151 MEPROTIN LIQUID 5UG/ML 0.00

AC46261157 MEPROTIN LIQUID 5UG/ML 0.00

AC46282143 DEALLERGY ORAL SOLUTION 0.1% W/V 0.00

AC46282151 DEALLERGY ORAL SOLUTION 0.1% W/V 28.10

AC46285209 MIDATIN INJECTION 5MG/ML 17.70

AC46285212 MIDATIN INJECTION 5MG/ML "N.K." 0.00

AC46285216 MIDATIN INJECTION 5MG/ML 23.50

AC46285221 MIDATIN INJECTION 5MG/ML "N.K." 58.00

AC46285229 MIDATIN INJECTION 5MG/ML "N.K." 0.00

AC46285237 MIDATIN INJECTION 5MG/ML "N.K." 0.00

AC46286100 LOTE E.C. TABLETS 50MG "N.K." 6.20

AC46289321 MAYDO GEL "ROOT" 17.30

AC46289335 MAYDO GEL "ROOT" 68.00

AC46289343 MAYDO GEL "ROOT" 154.00

AC46290321 FEELING GEL 0.1% 17.30

AC46290335 FEELING GEL 0.1% 68.00

AC46290338 FEELING GEL 0.1% 72.00

AC46290343 FEELING GEL 0.1% 0.00

AC46290345 FEELING GEL 0.1% 0.00

AC46290363 FEELING GEL 0.1% 0.00

AC46297209 CLP POWDER FOR INJECTION 1GM "Y.Y" 61.00

AC46298238 DOBUHA INJECTION 12.5MG/ML 113.00

AC46302321 KWAIE GEL 0.1% 17.30

AC46302335 KWAIE GEL 0.1% 68.00

Page 214: 附件二 藥品給付品項暨支付標準表

AC46302343 KWAIE GEL 0.1% 154.00

AC46302345 KWAIE GEL 0.1% 0.00

AC46303100 INTESLET TABLETS 0.125MG 1.75

AC46312100 PBF MOBICAM TABLETS 15MG 4.07

AC46314321 TIFFORLY GEL 17.30

AC46314335 TIFFORLY GEL 68.00

AC46314343 TIFFORLY GEL 154.00

AC46314345 TIFFORLY GEL 0.00

AC46314363 TIFFORLY GEL 682.00

AC46318335 FUTISONE OINTMENT (0.005%) 94.00

AC46320321 CLINDA GEL 1% "Y.Y" 10.00

AC46320329 CLINDA GEL 1% "Y.Y" 14.10

AC46321321 FUTISONE CREAM 0.05% 25.80

AC46321335 FUTISONE CREAM (0.05%) 74.00

AC46348209 KEROLAC INJECTION 30MG/ML 17.00

AC46348212 KEROLAC INJECTION 30MG/ML 24.00

AC46349316 MOMO CREAM 22.40

AC46349321 MOMO CREAM 27.60

AC46349326 MOMO CREAM 0.00

AC46349329 MOMO CREAM 43.80

AC46349335 MOMO CREAM 65.00

AC46350100 BODOPINE CAPSULES 'Y.C" 3.25

AC46351100 Dimotil Repe Tablets "Meider" 2.01

AC46385100 ETOLAC XL TABLET 500MG "STANDARD" 8.90

AC46386100 LOXOL SR TABLETS 75MG 1.77

AC463861G0 LOXOL SR TABLETS 75MG(鋁箔/膠箔) 2.00

AC46402100 SIMVATIN FILM COATING TABLETS 20MG 3.58

AC46403100 SINCAPIN TABLETS 20MG "SINPHAR" 0.94

AC464031G0 SINCAPIN TABLETS 20MG "SINPHAR" 1.26

AC46404100 SYNTREND TABLETS 25MG 3.19

AC46419314 ELOFUTE CREAM 0.1% 21.40

AC46419321 ELOFUTE CREAM 0.1% 27.60

AC46419326 ELOFUTE CREAM 0.1% 28.60

AC46419329 ELOFUTE CREAM 0.1% 43.80

AC46419335 ELOFUTE CREAM 0.1% 65.00

AC46420100 CLOFEN-P F.C TABLETS 25MG 1.50

AC46423100 GABEMID TABLETS 5MG 1.50

AC464231G0 GABEMID TABLETS 5MG(鋁箔/膠箔) 2.00

AC46424100 FINASTATE F.C. TABLETS 5MG "H.S." 12.60

AC46431143 ALLTEC ORAL SOLUTION (0.1%) 28.00

AC46431151 ALLTEC ORAL SOLUTION (0.1%) 28.10

AC46431157 ALLTEC ORAL SOLUTION (0.1%) 87.00

AC46439100 Nakasser SR Capsules 90mg "N.K."(diltiazem Hcl) 5.70

AC46440100 COMEWELL TABLETS "Y.C" 1.50

AC464401G0 COMEWELL TABLETS "Y.C"(鋁箔/膠箔) 2.00

AC46442151 SHECO SOLUTION "CENTER" 0.00

AC46442157 SHECO SOLUTION "CENTER" 0.00

AC46443100 CANTOR DISPERSIBLE TABLETS "Y.C." 1.50

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AC464431G0 CANTOR DISPERSIBLE TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC46444151 NAPTON SUSPENSION 0.00

AC46444157 NAPTON SUSPENSION 0.00

AC46447100 TIZALIN TABLETS 2MG "GENTLE" 1.62

AC464471G0 TIZALIN TABLETS 2MG "GENTLE"(鋁箔/膠箔) 2.00

AC46448317 TRIMYZOLE CREAM 10.50

AC46448321 TRIMYZOLE CREAM 10.50

AC46448329 TRIMYZOLE CREAM 18.80

AC46448335 TRIMYZOLE CREAM 30.40

AC46448355 TRIMYZOLE CREAM 0.00

AC46451345 DISPAIN PATCH "T.S." 5.30

AC46456100 CORTISONE ACETATE TABLETS 25MG "WEAL-CHANCE" 1.50

AC464561G0CORTISONE ACETATE TABLETS 25MG "WEAL-CHANCE"(鋁箔/膠箔)

2.00

AC46457263 Gipamine Injection 3mg/ml "N.K." 196.00

AC46458100 GLYCOPYRODYN TABLETS 1MG 4.36

AC46459345 FLUAN PATCH "LI KANG" (FLURBIPROFEN) 5.30

AC46460100 SALAFLOW FILM COATED TABLETS 5mg 14.90

AC46461100 MESOLONE TABLETS "Y.C." 1.53

AC464611G0 MESOLONE TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC464631G0 PREDNISOLONE TABLETS 5MG "WEAL-CHANCE"(鋁箔/膠箔) 2.00

AC46486100CARMAPINE C.R. FILM COATED TABLETS 200MG "P.L."

(CARBAMAZEPINE)2.23

AC46488100 KARBOSE F.C. TABLETS "Y.C." 2.27

AC46489100 TIZAN TABLETS 2MG "S.C." 1.62

AC464891G0 TIZAN TABLETS 2MG "S.C."(鋁箔/膠箔) 2.00

AC46490238 DIPROFEN INJECTION 37.40

AC46491100 ZORIMIN F.C. TABLETS 10MG 1.76

AC46525100 NUXITAM F.C TABLET 1200MG 1.91

AC465251G0 NUXITAM F.C. TABLET 1200MG(鋁箔/膠箔) 2.00

AC46538100 MILIX SR TABLETS 1.5MG "LOTUS" 1.75

AC46540316 FUMESONE CREAM 1MG/GM 0.00

AC46540321 FUMESONE CREAM 1MG/GM 27.60

AC46540326 FUMESONE CREAM 1MG/GM 0.00

AC46540329 FUMESONE CREAM 1MG/GM 43.80

AC46540335 FUMESONE CREAM 1MG/GM 65.00

AC46542321 MINYEAR OINTMENT 0.1% 27.60

AC46542326 MINYEAR OINTMENT 0.1% 28.60

AC46542329 MINYEAR OINTMENT 0.1% 43.80

AC46542335 MINYEAR OINTMENT 0.1% 65.00

AC46544210 SUBACILLIN INJECTION "YUNG SHIN" 55.00

AC46546100 MEXTON F.C. TABLETS 500MG "MEIDER 1.50

AC46549100 GENBOU F.C. TABLET 50MG 6.20

AC46560100 SOPID-400MG FILM COATED TABLETS 3.65

AC46563100 ZIPSOON F.C. TABLETS 10MG 1.76

AC465631G0 ZIPSOON F.C. TABLETS 10MG(鋁箔/膠箔) 2.00

AC46564421 "WU-FU" ATROPINE SULPHATE EYE DROPS 0.125% 12.00

AC46564429 "WU-FU" ATROPINE SULPHATE EYE DROPS 0.125% 12.00

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AC46565421 "WU-FU" ATROPINE SULPHATE EYE DROPS 0.25% 12.00

AC46565429 "WU-FU" ATROPINE SULPHATE EYE DROPS 0.25% 21.00

AC46584321 ADAMEI GEL "S.C." 0.00

AC46584363 ADAMEI GEL "S.C." 0.00

AC46585151 "EISO LIQUID 5.34 MG/ML""H.S.""" 25.00

AC46585157 "EISO LIQUID 5.34 MG/ML""H.S.""" 28.90

AC46587100 A.M.Z. TABLETS 1.50

AC465871G0 A.M.Z. TABLETS 2.00

AC46588100 FUITEN F.C. TABLETS "MEIDER" 1.50

AC46604100 MELOCAM TABLETS 15MG "P.L." 4.07

AC46605421 SUPERDEX ORABASE 0.1% 35.60

AC46606100 SITALO F.C. TABLETS 20MG (CITALOPRAM) 7.10

AC46612100 WITGEN TABLETS 10MG "LOTUS" 7.40

AC46614135 KIDSOLONE ORAL SOLUTION "CENTER" 25.00

AC46614143 KIDSOLONE ORAL SOLUTION "CENTER" 29.20

AC46614151 KIDSOLONE ORAL SOLUTION "CENTER" 49.00

AC46618212 DROPEDOL INJECTION 2.5MG/ML 25.40

AC46633321 LOMEANE CREAM "S.C." 27.60

AC46633335 LOMEANE CREAM "S.C." 65.00

AC46634100 ROZOXIN F.C. TABLETS 100MG 3.21

AC46638100 KLARITH F.C. TABLETS 500MG 13.20

AC46640100 GRUMED TABLETS 2MG "STANDARD" 1.95

AC46643100 BASAZYDE CAPSULES 750MG "LOTUS' 6.70

AC46647100 GLIPID TABLETS 2MG 1.95

AC466581G0 KLUDONE MR TABLETS 30MG(鋁箔/膠箔) 2.00

AC46659100 FUXIDOL S.C. TABLETS 10.70

AC46663100 SULGIN TABLETS 400MG 3.65

AC46677100 "SORDINING CAPSULES ""TAI YU""" 1.50

AC46681100 SYNTAM F.C. TABLETS 1200MG 1.91

AC466811G0 SYNTAM F.C. TABLETS 1200MG(鋁箔/膠箔) 2.00

AC46682100 MUSLEX TABLETS 3.21

AC46687220 PISUTAM POWDER FOR INJECTION 226.00

AC466872CX PISUTAM POWDER FOR INJECTION 136.00

AC46689321 BUTEMAX CREAM 28.80

AC46689329 BUTEMAX CREAM 45.00

AC46689335 BUTEMAX CREAM 56.00

AC46689355 BUTEMAX CREAM 623.00

AC46697100 "SHINMING TABLETS 4MG ""TAI YU""" 1.53

AC46699100 SYNTREND TABLETS 6.25MG 2.39

AC46703151 CENPROFEN ORAL SUSPENSION 20MG/ML "CENTER"(60 ML) 25.00

AC46706100 MOODYTEC S.C. TABLETS 10.70

AC46707321 OXIZOLE CREAM "S.C." 0.00

AC46729100 ERISPAN-S TABLETS 0.25MG 1.95

AC46733100 GLUCOMET F.C. TABLETS 5/500MG 2.01

AC46744340 "TOGIAM CONCENTRATE LIQUID ""H.S.""" 142.00

AC46746100 SELARS TABLETS 30MG "Y.Y." 3.13

AC46756100 PYSTON TABLET 500MG "S.L." 1.50

AC46758100 LA FERRUM CHEWABLE TABLETS 100MG 3.01

Page 217: 附件二 藥品給付品項暨支付標準表

AC46759100 MOCALM S.C. TABLET 2.15

AC46867100 CATACOR TABLETS "Y.C." 2.82

AC46869209 GLYCOPYRODYN INJECTION 0.2MG/ML 15.00

AC46899421 SALUTE OPHTHALMIC SOLUTION "KINGDOM" 12.10

AC46899429 SALUTE OPHTHALMIC SOLUTION "KINGDOM" 23.80

AC46902412 IPRASTHMA NEBULISER SOLUTION 0.25MG/ML 0.00

AC46903100 YITUNGYEN F.C. TABLETS 400MG 1.31

AC469031G0 YITUNGYEN F.C. TABLETS 400MG 1.68

AC46929100 CODICON-U CAPSULES "SINPHAR" 1.50

AC469291G0 CODICON-U CAPSULES "SINPHAR" 2.00

AC46930421 CATOL EYE DROPS 1% 120.00

AC46931421 CATOL EYE DROPS 2% 177.00

AC46936229 OXYTOCIN INJECTION 10IU/ML 21.00

AC46937100 URMARON TABLETS "Y.C." 2.05

AC46938100 MENISON TABLETS 2MG "P.L" 1.53

AC46939321 FUSIK CREAM "Y.C." 32.20

AC46939326 FUSIK CREAM "Y.C." 0.00

AC46939329 FUSIK CREAM "Y.C." 45.20

AC46939335 FUSIK CREAM "Y.C." 126.00

AC46939338 FUSIK CREAM "Y.C." 0.00

AC46939345 FUSIK CREAM "Y.C." 241.00

AC46939348 FUSIK CREAM "Y.C." 0.00

AC46940100 INCO F.C. TABLET "S.Y." 4.13

AC46978100 MESLON TABLETS 12MG "JOHNSON" 1.50

AC469781G0 MESLON TABLETS 12MG "JOHNSON"(84粒/瓶) 2.00

AC46985100 POCATO CAPSULES 25UG (PROCATEROL) 1.50

AC469851G0 POCATO CAPSULES 25UG (PROCATEROL)(鋁箔/膠箔) 2.00

AC46989100 ARICEPT F.C. TABLETS 10MG 57.00

AC46990421 EYEHELP EYE DROPS 0.01% 12.00

AC46990429 EYEHELP EYE DROPS 0.01% 12.80

AC46991161 MEGEST ORAL SUSPENSION 40MG/ML 891.00

AC46995100 RAMITACE CAPSULE 2.5MG "ROYAL" 2.98

AC46998321 GENUVATE OINTMENT "GCPC" 11.90

AC46998323 "GENUVATE OINTMENT ""GCPC""" 12.80

AC46998324 "GENUVATE OINTMENT ""GCPC""" 12.80

AC46998329 GENUVATE OINTMENT "GCPC" 13.70

AC46998335 GENUVATE OINTMENT "GCPC" 24.80

AC46998338 "GENUVATE OINTMENT ""GCPC""" 0.00

AC46998340 "GENUVATE OINTMENT ""GCPC""" 61.00

AC46999414 UNITAN EYE DROPS 0.05MG/ML "UNION" 439.00

AC47002100 FONOSIL TABLETS 10MG "STANDARD" (FOSINOPRIL SODIUM) 4.17

AC47028321 EUTISEN CREAM 25.80

AC47028335 EUTISEN CREAM 74.00

AC47029500 POSULINE SUPPOSITORIES "P.L." 7.20

AC47044100 AKINFREE TABLETS 2MG 1.67

AC470441G0 AKINFREE TABLETS 2MG(鋁箔/膠箔) 2.00

AC47045100 "NORHEUM TABLETS ""ROOT""" 1.50

AC47050100 YOUR IRON CAPSULES "S.L." 4.44

Page 218: 附件二 藥品給付品項暨支付標準表

AC47074326 DOSPIN CREAM "H.S." 0.00

AC47074335 DOSPIN CREAM "H.S." 48.40

AC47075321 CLINDACIN GEL 10.00

AC47075323 CLINDACIN GEL 11.40

AC47075329 CLINDACIN GEL 14.10

AC47075330 CLINDACIN GEL 17.40

AC47075335 CLINDACIN GEL 20.70

AC47075338 CLINDACIN GEL 65.00

AC47075340 CLINDACIN GEL 77.00

AC47075343 CLINDACIN GEL 185.00

AC47076329 ZYNOC SOLUTION 1% 60.00

AC47078100 BON JOUR TABLETS 7.5MG(MELOXICAM) 1.72

AC47086100 ANKOMIN F.C. TABLETS 500MG 1.50

AC470861G0 ANKOMIN TABLETS 500MG(鋁箔/膠箔) 2.00

AC47090100 VENFORSPINE TABLETS 37.5MG 5.20

AC47091100 TERFUNG TABLETS 250MG 7.80

AC47092100 NILASEN TABLETS 16MG 1.50

AC470921G0 NILASEN TABLETS 16MG(鋁箔/膠箔) 2.00

AC47093100 ALOPINE TABLETS 5MG "WEIDAR" 3.84

AC47114100 FAXINE TABLETS 37.5MG 5.20

AC47116421 EARFLO OTIC SOLUTION 51.00

AC47117421GENDERMIN OPH. SOLUTION 0.3% "KINGDOM" (GENTAMICIN

SULFATE)14.50

AC47117429GENDERMIN OPH. SOLUTION 0.3% "KINGDOM" (GENTAMICIN

SULFATE)37.10

AC47124416GENDERMIN OPHTHALMIC OINTMENT 3MG/GM "KINGDOM"

(GENTAMICIN SULFATE)18.20

AC47124417GENDERMIN OPHTHALMIC OINTMENT 3MG/GM "KINGDOM"

(GENTAMICIN SULFATE)18.20

AC47124421GENDERMIN OPHTHALMIC OINTMENT 3MG/GM (GENTAMICIN

SULFATE)22.80

AC47126151 CARDIACIN ELIXIR 50MCG/ML "CENTER" 234.00

AC47129100 NATENIDE F.C. TABLETS 60MG "STANDARD" 0.00

AC47144321 KAFUTINEA CREAM 20.40

AC47144329 KAFUTINEA CREAM 32.70

AC47144335 KAFUTINEA CREAM 35.10

AC47144338 KAFUTINEA CREAM 69.00

AC471471G0PICETAM F.C. TABLETS 1200MG "STANDARD" (PIRACETAM)(鋁箔/

膠箔)2.00

AC47148100 MONO-GETIC F.C.T. 750MG "JOHNSON" 0.00

AC47157321 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 17.30

AC47157335 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 68.00

AC47157345 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 0.00

AC47176100 BUSACON TABLETS 0.125MG 1.75

AC471761G0 BUSACON TABLETS 0.125MG(鋁箔/膠箔) 2.00

AC47179143 PROCATIN LIQUID 25.90

AC47179151 PROCATIN LIQUID 0.00

AC47181100 HIPURIC TABLETS "Y.C." 1.50

Page 219: 附件二 藥品給付品項暨支付標準表

AC471811G0 HIPURIC TABLETS "Y.C.(鋁箔/膠箔) 2.00

AC47182255 PEDICARE INJECTION 10% (W/V) 196.00

AC47182265 PEDICARE INJECTION 10% (W/V) 0.00

AC47190100 PAINOFF F.C. TABLETS 10MG 4.13

AC47227100 KETOZINE TABLETS 24MG 2.36

AC47230100 ECOMIN TABLETS 5MG "JOHNSON" 1.50

AC472301G0 ECOMIN TABLETS 5MG "JOHNSON" (56粒/瓶裝) 2.00

AC472301GA ECOMIN TABLETS 5MG "JOHNSON"(鋁箔/膠箔) 2.00

AC47231100 GLUNORMAL TABLETS 30MG "Y.Y." 1.94

AC472311G0 GLUNORMAL TABLETS 30MG "Y.Y."(鋁箔/膠箔) 2.00

AC47232100 NILASEN TABLETS 24MG 2.36

AC47236100 DICLOFENAC ENTERIC FILM COATED TABLETS 25MG "LITA" 1.50

AC47239100 CARVEDIL TABLETS 25MG 3.19

AC47258100 DONGLU TABLETS 2MG "ANXO" 1.95

AC47265100 REMEMBER F.C. TABLETS 8MG 26.50

AC47266100 NETCOSE F.C. TABLETS 120MG "C.H." 2.83

AC47268100 MEROCAM TABLETS 7.5MG "H.S." (MELOXICAM) 1.72

AC472681G0 MEROCAM TABLETS 7.5MG "H.S." (MELOXICAM)(鋁箔/膠箔) 2.00

AC47270100 IROME CAPSULES 150MG 2.88

AC47272100 MESLON TABLETS 6MG "JOHNSON" 1.50

AC472721G0 MESLON TABLETS 6MG "JOHNSON"(84粒/瓶) 2.00

AC47276255 PEDICARE INJECTION 6% W/V "N.K." 0.00

AC47280500 GYNOX VAGINAL TABLETS 500MG 12.50

AC47281100 DICLOFENAC E.F.C. TABLETS "LITA" 1.50

AC47289321 FUCIMYCIN CREAM 32.20

AC47289326 FUCIMYCIN CREAM 42.70

AC47289329 FUCIMYCIN CREAM 45.20

AC47289335 FUCIMYCIN CREAM 126.00

AC47289338 FUCIMYCIN CREAM 160.00

AC47289348 FUCIMYCIN CREAM 0.00

AC47290100 SPITERIN F.C. TABLETS 2MG "KINGDOM" (RISPERIDONE) 7.70

AC47291421 BETTER EYE DROPS 0.5% (TROPICAMIDE) 16.50

AC47295100 CARVO TABLETS 25MG 3.19

AC47306100 ESLAM TABLETS 1MG "JOHNSON" 1.50

AC47307100 GLUCOCAR TABLETS "S.C." 2.27

AC47309100 DESBLUE S.C. TABLETS 2.15

AC47312321 "GENAF CREAM ""GCPC""" 20.40

AC47312329 "GENAF CREAM ""GCPC""" 32.70

AC47312335 "GENAF CREAM ""GCPC""" 35.10

AC47312338 "GENAF CREAM ""GCPC""" 69.00

AC47314421 BRIMO OPHTHALMIC SOLUTION 0.2% "PATRON" 229.00

AC47314429 BRIMO OPHTHALMIC SOLUTION 0.2% "PATRON" 503.00

AC47341100 MELSTATIN TABLETS 20MG 5.90

AC47346100 DIZYNIL TABLET 8MG 1.50

AC473461G0 DIZYNIL TABLET 8MG(鋁箔/膠箔) 2.00

AC47370417 ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% "SYNMOSA" 12.10

AC47371100 TODO CAPSULES 200MG "JOHNSON" 3.25

AC473721G0 INDAP S.R. TABLETS 1.5MG "STANDARD"(鋁箔/膠箔) 2.00

Page 220: 附件二 藥品給付品項暨支付標準表

AC47374100 MELUX TABLETS 200MG "JOHNSON" 1.50

AC473741G0 MELUX TABLETS 200MG "JOHNSON"(鋁箔/膠箔) 2.00

AC47398421 "SUBICAN OPHTHALMIC SOLUTION ""WINSTON""" 16.50

AC47399100 MELUX TABLETS 500MG "JOHNSON" 2.83

AC47400100 LAMTA TABLETS 50MG (LAMOTRIGINE) 10.10

AC47403121 NISAN GRANULES 5GM "JOHNSON" 0.00

AC47405321 OXICONE CREAM 54.00

AC47406321 DERMOFUTE CREAM 11.90

AC47406323 DERMOFUTE CREAM 0.00

AC47406324 DERMOFUTE CREAM 12.80

AC47406329 DERMOFUTE CREAM 13.70

AC47406335 DERMOFUTE CREAM 0.00

AC47406338 DERMOFUTE CREAM 41.90

AC47406340 DERMOFUTE CREAM 61.00

AC47406355 DERMOFUTE CREAM 0.00

AC47418100 SURIDE F.C. TABLETS 200MG "EB" (SULPIRIDE) 1.71

AC474181G0 SURIDE F.C.TABLETS 200MG "EB"(SULPIRIDE)(鋁箔/膠箔) 2.00

AC47432329 EUROTECH UREA CREAM 40% 33.80

AC47432343 EUROTECH UREA CREAM 40% 93.00

AC47434100 CARLATREND TABLETS 25MG "KINGDOM" (CARVEDILOL) 3.19

AC47441100 ROVO TABLETS 1MG 2.09

AC47442212 FAMOSTER INJECTION 10MG/ML "TF" 23.20

AC47443161 ITRAZOLE ORAL SOLUTION "H.S." 951.00

AC47444100 UROSO TABLETS 100MG "JOHNSON" 1.76

AC474441G0 UROSO TABLETS 100MG "JOHNSON"(鋁箔/膠箔) 2.00

AC47446100 VASOCARD CAPSULES "Y.C." 0.00

AC47456100 HOTE CHEWABLE TABLETS 100MG 3.01

AC47457100 TRAMADOL RETARD TABLETS 100MG "U-CHU" 3.74

AC47460100 CARDILO TABLETS 25MG "S.T." 3.19

AC47461100 MELICAM TABLETS 15MG (MELOXICAM) 4.07

AC47473421 ATROPIN EYE DROPS 0.125% "SINPHAR" 12.00

AC47476100 HAMGO F.C. TABLETS 1200MG "Y.C." 1.91

AC474761G0 HAMGO F.C. TABLETS 1200MG "Y.C."(鋁箔/膠箔) 2.00

AC47479100 ESLAM TABLETS 2MG "JOHNSON" 1.53

AC474791G0 ESLAM TABLETS 2MG "JOHNSON" (鋁箔/膠箔) 2.00

AC47480100 ACPURIN TABLETS 300MG "MEIDER" 0.00

AC47482100 SANTEROL TABLETS 25 μG 1.50

AC474821G0 SANTEROL TABLETS 25 ΜCG(鋁箔/膠箔) 2.00

AC47485100 AMARINE TABLETS 2MG "KINGDOM" 1.95

AC47486197 HAMGO GRANULES FOR ORAL SOLUTION 1200MG "Y.C." 6.00

AC47487343 CALKIS OINTMENT 330.00

AC47510100 CARDIOL TABLETS 25MG "YUNG SHIN" 3.19

AC47511100 MESHIN TABLETS 500MG 2.83

AC47512100 DIZYNIL TABLET 16MG 1.50

AC475121G0 DIZYNIL TABLET 16MG(鋁箔/膠箔) 2.00

AC47518138 CENFENOL SOLUTION 5 MG/ML "CENTER" 207.00

AC47519100 MEPRO TABLETS 100MG 10.10

AC47521414 LANOPROST OPHTHALMIC SOLUTION 0.005% (LATANOPROST) 439.00

Page 221: 附件二 藥品給付品項暨支付標準表

AC47534100 PANTAZOL GASTRO-RESISTANT TABLETS "Y.C." 10.10

AC47536100 FEDISYN E.R. F.C. TABLETS 5 MG 2.04

AC47537245 METISOL INJECTION 0.00

AC47537258 METISOL INJECTION 108.00

AC47540329 MOMESONE LOTION 0.1% W/W 32.70

AC47550500 EBODYL SUPPOSITORIES 7.20

AC47551209 Laston Injection 30 mg/ml (Ketorolac Tromethamine) 17.00

AC47551212 Laston Injection 30 mg/ml (Ketorolac Tromethamine) 24.00

AC47558100 CIMEWEI TABLETS 400MG "LITA" 1.50

AC475581G0 CIMEWEI TABLETS 400MG "LITA"(鋁箔/膠箔) 2.00

AC47560209 Inco Injection 17.00

AC47560212 INCO INJECTION 24.00

AC47561100 Mono-getic F.C.T. 500mg "Johnson" 3.98

AC47568100 Latrigine Tablets 50 mg "Kingdom" 10.10

AC47569100 PISANTA TABLETS "ROYAL" 1.91

AC47590100 ISOLIN F.C. TABLETS 500MG "JOHNSON" 5.60

AC47594100 ILIMIN FILM COATED TABLETS 850MG "S.D" 1.68

AC47596321 Dermofute Ointment 11.90

AC47596323 Dermofute Ointment 0.00

AC47596324 Dermofute Ointment 12.80

AC47596329 Dermofute Ointment 13.70

AC47596335 Dermofute Ointment 0.00

AC47596338 Dermofute Ointment 41.90

AC47596340 Dermofute Ointment 61.00

AC47596355 Dermofute Ointment 0.00

AC47599100 ZOTAN S.R. CAPSULES 0.2MG 5.60

AC47606100 KAMART TABLETS "Y.C." 1.54

AC476061G0 KAMART TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC47611500 SUBODYL SUPPOSITORIES 7.20

AC47612100 CIMEWEI TABLETS 200MG "LITA" 1.50

AC476121G0 CIMEWEI TABLETS 200MG "LITA"(鋁箔/膠箔) 2.00

AC47615143 BESUMIN SYRUP "Y.C" 25.00

AC47615151 BESUMIN SYRUP "Y.C" 26.80

AC47615155 BESUMIN SYRUP "Y.C" 0.00

AC47621221 COVORIN INJECTION 10MG/ML 69.00

AC47621229 COVORIN INJECTION 10MG/ML 86.00

AC47622421 Laimin Eye Drops 2% "Y.Y." 14.50

AC47622429 Laimin Eye Drops 2% "Y.Y." 28.30

AC47625316 Momesone Ointment 0.1% 22.40

AC47625321 Momesone Ointment 0.1% 27.60

AC47625326 Momesone Ointment 0.1% 28.60

AC47625329 Momesone Ointment 0.1% 43.80

AC47625335 Momesone Ointment 0.1% 65.00

AC47626248 Amocure Injection 0.2mg/ml 598.00

AC47631100 Glunat Tablets 60mg 0.00

AC47632100 Amcopine Tablets 10mg "H.S." (Amlodipine) 3.84

AC47633414 Centesol Inhalation Solution 2mg/ml "Center" 4.95

AC47638100 Zapline Film Coated Tablets 50mg 6.10

Page 222: 附件二 藥品給付品項暨支付標準表

AC47639100 MONPHELON TABLETS "Y.C" 2.83

AC47640329 Eurotech Pimple Cream 45.30

AC47641421Topimide Ophthalmic Solution 0.5% "Kingdom"

(Tropicamide)16.50

AC47643100 "Shuful Tablet ""H.S.""" 10.80

AC47644100 VALOSINE S.R. CAPSULES 75MG 10.00

AC47646100 DINSIA SOFT CAPSULES 300MG 5.80

AC47647223 UROKINASE INJECTION 6000I.U. "YAO CHIH HSIANG" 191.00

AC47648100 DOSIN TABLETS 10MG 1.50

AC476481G0 DOSIN TABLETS 10MG(鋁箔/膠箔) 2.00

AC47653100 MOCOUGH CAPSULES "LITA" 1.50

AC476531G0 MOCOUGH CAPSULES "LITA"(鋁箔/膠箔) 2.00

AC47655100 TONLEX F.C. TABLETS 750MG 0.00

AC476561G0 MOPRIDE F.C. TABLETS 5MG(鋁箔/膠箔) 2.00

AC47658277 Lyo-Vancin for I.V. Injection 500mg 76.00

AC47672229 Conpac Injection 2500IU/ml 190.00

AC47676248 Ciflogen Injection 2mg/ml 0.00

AC47676255 Ciflogen Injection 2mg/ml 450.00

AC47676263 Ciflogen Injection 2mg/ml 621.00

AC47678209 PAINOFF INJECTION 15MG/ML 15.00

AC47678212 PAINOFF INJECTION 15MG/ML 17.00

AC47679100 Knowful Film Coated Tablets 1200mg 1.91

AC476791G0 KNOWFUL FILM COATED TABLETS 1200MG(鋁箔/膠箔) 2.00

AC47687100 Henformin F.C. Tablet 850mg 1.68

AC476871G0 HENFORMIN F.C. TABLET 850MG(鋁箔/膠箔) 2.00

AC47690100 RISDONE TABLETS 2MG "S.T." (RISPERIDONE) 7.70

AC47692316 Momesone Cream 0.1% W/W 22.40

AC47692321 Momesone Cream 0.1% W/W 27.60

AC47692326 Momesone Cream 0.1% W/W 28.60

AC47692329 Momesone Cream 0.1% W/W 43.80

AC47692335 Momesone Cream 0.1% W/W 65.00

AC47698100 Klarith F.C. Tablets 250mg 3.24

AC47700321 Antimax cream 1% "H.S." 28.80

AC47700329 Antimax cream 1% "H.S." 45.00

AC47700335 Antimax cream 1% "H.S." 56.00

AC47700355 Antimax cream 1% "H.S." 0.00

AC47717417 Cindecason Ophthalmic Ointment 13.20

AC47718209 Painoff Injection 30 mg/ml 17.00

AC47718212 Painoff Injection 30 mg/ml 24.00

AC47721197 NUPITAM GRANULES FOR ORAL SOLUTION 1200MG 5.40

AC47722321 Olena Gel 17.30

AC47722335 Olena Gel 68.00

AC47722343 Olena Gel 0.00

AC47722345 Olena Gel 0.00

AC47722363 Olena Gel 0.00

AC47750100 NATENIDE F.C. TABLETS 120MG "STANDARD" 2.83

AC47771100 Lafuzo XL prolonged release tablets 10 mg 5.80

AC47772100 BONY Tablets "Y.C." 2.28

Page 223: 附件二 藥品給付品項暨支付標準表

AC47773329 MUROZO LOTION 0.1% W/W 32.70

AC47773343 MUROZO LOTION 0.1% W/W 0.00

AC47775100 ZOLOTIN F.C. TABLETS 40MG 7.50

AC47782100 Mucolow SR Tablets 75mg "LOTUS" 0.00

AC47784209 ANALAC FOR IV INJECTION 30MG/ML 17.00

AC47784212 ANALAC FOR IV INJECTION 30MG/ML 24.00

AC47785100 Deflam-K F.C. Tablets 50mg (Diclofenac Potassium) 1.50

AC47787100 FLEXER F.C. TABLETS 10MG 2.95

AC47788100 MEPRO TABLETS 500MG 40.30

AC47789100 DANOW TABLETS "Y.C." 1.92

AC47790100 AMADM TABLETS 2.0MG 1.95

AC47793100 SPITERIN F.C. TABLETS 1MG "KINGDOM" (RISPERIDONE) 6.80

AC47812263 TECOPIN FOR IV INJECTION "N.K." 516.00

AC47812271 Tecopin for IV Injection "N.K." 1164.00

AC47828209 MYRON POWDER FOR INJECTION 0.00

AC47828277 MYRON POWDER FOR INJECTION 284.00

AC47830100 RIPER F.C. TABLETS 2 MG 7.70

AC47833529 Formenin Vaginal Gel 0.75% 0.00

AC47833540 Formenin Vaginal Gel 0.75% 0.00

AC47833596 Formenin Vaginal Gel 0.75% 0.00

AC47834335 EUTISEN OINTMENT 0.005% 94.00

AC47840100 "Iprofen 600mg F.C. Tablet ""Royal""" 1.64

AC47841321 SOFUNI OINTMENT 2% 32.20

AC47841326 SOFUNI OINTMENT 2% 42.70

AC47841329 SOFUNI OINTMENT 2% 45.20

AC47841335 SOFUNI OINTMENT 2% 126.00

AC47870151 "IBU SUSPENSION ""ROOT""" 25.00

AC47870157 "IBU SUSPENSION ""ROOT""" 45.10

AC47871100 Hanazide MR Tablets 1.65

AC478711G0 HANAZIDE MR TABLETS(鋁箔/膠箔) 2.00

AC47874100 SINCLOTE CAPSULES 400MG "SINPHAR" 29.60

AC47875500 FUBODYL Vaginal Suppositories 10.90

AC47877100 Lax Capsules 3.21

AC47878100 "Tonfuse Tablets 50mg ""H.S.""" 2.27

AC47879455 AZELA NASAL SPRAY 0.1% W/V 97.00

AC47879457 AZELA NASAL SPRAY 0.1% W/V 102.00

AC47884100 TOLTON CAPSULES 3.21

AC47885321 Dermasafe Ointment 64.00

AC47885335 Dermasafe Ointment 124.00

AC47889209 "Kethonixine Injection ""Tai Yu""" 15.00

AC47889212 "Kethonixine Injection ""Tai Yu""" 15.00

AC47890100 NASAGA F.C TABLETS "Y.C" 1.80

AC478901G0 NASAGA F.C. TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC47893500 ATYL Vaginal suppositories 10.90

AC47894100 CARVIO TABLET 25MG 3.19

AC47895263 TEICOD FOR INJECTION 200MG 516.00

AC47901100 SILYMARIN CAPSULES 150MG "TBC" 1.52

AC479011G0 SILYMARIN CAPSULES 150MG "TBC"(鋁箔/膠箔) 2.00

Page 224: 附件二 藥品給付品項暨支付標準表

AC47902277 10%W/V RHEOMACRODEX IN GLUCOSE INJECTION 233.00

AC47905100 GATY FILM-COATED TABLET 600MG 10.50

AC47906314 FURO CREAM "PATRON" 0.00

AC47906316 FURO CREAM "PATRON" 0.00

AC47906321 Furo Cream "Patron" 0.00

AC47906326 Furo Cream "Patron" 0.00

AC47906329 Furo Cream "Patron" 0.00

AC47906335 Furo Cream "Patron" 0.00

AC47907100 Sinty F.C. Tablets 20mg 3.58

AC47909100 THIONA F.C. TABLETS 250MG "JOHNSON" 5.60

AC47910100 Pipemi Capsules 400mg "Patron" 3.54

AC47911100 Zosaa F.C. Tablets 50mg 4.11

AC47912314 "Pydercon Cream 0.1% ""Winston""" 21.40

AC47912316 "Pydercon Cream 0.1% ""Winston""" 0.00

AC47912321 "Pydercon Cream 0.1% ""Winston""" 27.60

AC47912326 "Pydercon Cream 0.1% ""Winston""" 28.60

AC47912329 "Pydercon Cream 0.1% ""Winston""" 43.80

AC47912335 "Pydercon Cream 0.1% ""Winston""" 65.00

AC47913100 Gestrin Capsule 2.5mg "P.L." 168.00

AC47915321 NAFINE CREAM 20.40

AC47915329 NAFINE CREAM 32.70

AC47915335 NAFINE CREAM 35.10

AC47915338 NAFINE CREAM 69.00

AC47920321 LANBASON CREAM 0.1% 13.50

AC47920329 LANBASON CREAM 0.1% 16.80

AC47920335 LANBASON CREAM 0.1% 25.90

AC47920338 LANBASON CREAM 0.1% 42.00

AC47920343 LANBASON CREAM 0.1% 56.00

AC47922100 Alloprim Tablets 300mg "S.L." 2.20

AC47924100 ZOSTATIN F.C TABLETS 20MG "S.C" 3.58

AC47925100DIVODIUM (DIVALPROEX SODIUM) ENTERIC-COATED TABLETS

250MG0.00

AC47926100 Setizin-CP SR F.C.Tablets 2.33

AC47928100 Sivasin Film Coated Tablets 20mg 3.58

AC47937321 TACROLI OINTMENT 0.1% "H.S." 208.00

AC47937329 Tacroli Ointment 0.1% "H.S." 370.00

AC47937343 Tacroli Ointment 0.1% "H.S." 1228.00

AC47950100 U-Chu Ebastin Tablets 10mg 0.00

AC47953100 HIROS S.R.M. CAPSULES "EVEREST" 2.33

AC47954335 Troza Topical Gel 0.1% 0.00

AC47954343 Troza Topical Gel 0.1% 0.00

AC47955100 Phenomine Capsules 10mg 2.15

AC47961100 Alpragin Tablets 2mg 3.27

AC47964321 Sumelo cream 0.00

AC47964329 Sumelo cream 0.00

AC47964335 Sumelo cream 0.00

AC47964355 Sumelo cream 0.00

AC479661G0 TONE F.C. TABLETS 25MG "MEIDER"(鋁箔/膠箔) 2.00

Page 225: 附件二 藥品給付品項暨支付標準表

AC47977321 "Fluson cream ""ROOT""" 25.80

AC47977335 "Fluson cream ""ROOT""" 74.00

AC47980421 CARTOLOL EYE DROPS 1% 120.00

AC47982100 Gaty film-coated tablets 800mg 19.20

AC47983209 Antifect injection "Standard" 242.00

AC47983277 Antifect injection "Standard" 151.00

AC47989100 SPITERIN F.C. Tablets 3mg "Kingdom" (Risperidone) 20.30

AC47990421 Rosumin Eye Drops 14.50

AC47990429 Rosumin Eye Drops 28.30

AC479911G0 ANXOFIN F.C. TABLETS 850MG 2.00

AC47993100 Ciflogen F.C. Tablets 250mg 5.10

AC47995321 SERGEN CREAM 28.80

AC47995329 SERGEN CREAM 45.00

AC47995335 SERGEN CREAM 0.00

AC47995355 SERGEN CREAM 0.00

AC47996100 DAPAMIDE S.R. F.C TABLETS 1.5MG 1.75

AC48004210 Achefree Injection 15mg/1.5ml 22.50

AC48005421 Sightclear Eye Drops "Sinphar" 12.00

AC48005429 Sightclear Eye Drops "Sinphar" 15.60

AC48007100 PIOGLIT TABLETS 30MG "STANDARD" (PIOGLITAZONE) 9.60

AC48022113 NUXITAM GRANULES FOR ORAL SOLUTION 2400MG 5.70

AC48023335 Flusalic Ointment 39.70

AC48024100 Mucopd Effervescent Tablets 600mg 5.40

AC48028100 MELOXICAM TABLETS 15MG "S.D." 4.07

AC48032321 Ankorme Cream "S.C." 28.80

AC48032329 Ankorme Cream "S.C." 45.00

AC48032335 Ankorme Cream "S.C." 56.00

AC48032355 Ankorme Cream "S.C." 623.00

AC48034316 "Mena Ointment 0.1% ""Winston""" 0.00

AC48034321 "Mena Ointment 0.1% ""Winston""" 0.00

AC48034326 "Mena Ointment 0.1% ""Winston""" 0.00

AC48034329 "Mena Ointment 0.1% ""Winston""" 0.00

AC48034335 "Mena Ointment 0.1% ""Winston""" 0.00

AC48035100 "Suyuni Tablets 0.5mg ""Tai Yu""" 1.50

AC48039321 Nafdin Cream 20.40

AC48039329 Nafdin Cream 32.70

AC48039335 Nafdin Cream 35.10

AC48039338 Nafdin Cream 69.00

AC48041100 PERISDONE F.C TABLETS 2MG "RAYAL" 7.70

AC48054100 Calmdown Tablets 37.5mg 5.20

AC48055100 TOPINMATE TABLETS 100MG "LOTUS" 23.20

AC48056100 Lanpo Capsules 15mg "EVEREST" 8.30

AC48057100 Anxotos Tablets 30mg 9.60

AC48059100 Hepa-V Capsule 0.00

AC48060329 Superin cream "Y.C." 45.00

AC48060335 Superin cream "Y.C." 56.00

AC48061421 Sussmine Ophthalmic Solution 12.00

AC48061429 Sussmine Ophthalmic Solution 12.80

Page 226: 附件二 藥品給付品項暨支付標準表

AC48062100 PLATON FILM-COATED TABLETS 75MG 32.10

AC48064100 LESYN F.C. TABLETS 4MG 4.87

AC48066343 KOSIAN TOPICAL CREAM 0.1% 343.00

AC48068100 Nonin Tablets 2mg 1.95

AC480681G0 NONIN TABLETS 2MG(鋁箔/膠箔) 2.00

AC48069343 Scepos scalp solution 0.00

AC48071100 Erin Tablets 0.25 mg 1.95

AC48072100 FINSKA-LP 24 HOUR SR F.C. TABLETS 6.70

AC48081100 KUWEIHAU "Chin Teng" 1.50

AC480811G0 KUWEIHAU "CHIN TENG" (鋁箔/膠箔) 2.00

AC48082197 SYNTAM GRANULES FOR ORAL SOLUTION 1200 MG 6.00

AC48083265 LASTIN FOR INJECTION 0.00

AC48083277 LASTIN FOR INJECTION 275.00

AC48086100 JOMARIN CAPSULES 150MG "JOHNSON" 1.52

AC480861G0 JOMARIN CAPSULES 150MG "JOHNSON"(84粒) 2.00

AC480861GA JOMARIN CAPSULES 150MG "JOHNSON"(鋁箔/膠箔) 2.00

AC480871G0 TONE F.C. TABLETS 10MG "MEIDER"(鋁箔/膠箔) 2.00

AC48088321 FUSIDIC ACID CREAM "PBF" 32.20

AC48088326 FUSIDIC ACID CREAM "PBF" 42.70

AC48088329 FUSIDIC ACID CREAM "PBF" 45.20

AC48088335 FUSIDIC ACID CREAM "PBF" 126.00

AC48088338 FUSIDIC ACID CREAM "PBF" 160.00

AC48088348 FUSIDIC ACID CREAM "PBF" 337.00

AC480891G0 DIAMIN MR TABLETS 30MG (GLICLAZIDE)(鋁箔/膠箔) 2.00

AC48092100 Caremod F.C. Tablets 20mg 5.30

AC48095100 Glucout Tablets 50 mg "Weidar" 2.27

AC48098100 Glitos Tablets 30mg 9.60

AC48099100 TOPINMATE TABLETS 25 MG "LOTUS" 5.50

AC48119100 Enapril Tab. 20mg "standard" (Enalapril maleate) 1.54

AC481191G0ENAPRIL TAB. 20MG "STANDARD" (ENALAPRIL MALEATE)(鋁箔)

2.00

AC48121100 GLIPIRIDE TABLETS 2MG "YUNG SHIN" 1.95

AC481211G0 GLIPIRIDE TABLETS 2MG "YUNG SHIN"(鋁箔/膠箔) 2.00

AC48122100 NARIX SR F.C. TABLETS 1.5 MG 1.75

AC481221G0 NARIX SR F.C. TABLETS 1.5 MG(鋁箔/膠箔) 2.00

AC48125100 Cetipo E.R. F.C. Tablets "S.C." 2.33

AC48127100 Diltelan Capsules 90mg 0.00

AC48128100 Diltelan Capsules 120mg 5.70

AC481301G0 C.T.L. XR TABLETS 500MG "C.H."(鋁箔/膠箔) 2.00

AC48146100 Minieton Tablets 1.50

AC481461G0 MINIETON TABLETS(鋁箔/膠箔) 2.00

AC481461G1 MINIETON TABLETS(14粒/瓶) 2.00

AC481461G2 MINIETON TABLETS(28粒/瓶) 0.00

AC481461G4 MINIETON TABLETS(56粒/瓶) 2.00

AC48148340 POLILEN EXT SOLUTION 142.00

AC48149321 Gentesone Cream 20.70

AC48149329 Gentesone Cream 23.50

AC48149335 Gentesone Cream 0.00

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AC48150100 NUSPAS TABLETS 0.125MG 1.75

AC481501G0 NUSPAS TABLETS 0.125MG (鋁箔/膠箔) 2.00

AC48152100 LIV-UP Capsule 200mg "Greenpharm" 9.60

AC48159100 NIYAN TABLETS 100MG 2.10

AC48166321 "Genusone Cream ""GCPC""" 24.40

AC48166330 Genusone Cream "GCPC" 44.00

AC48167209 BAIN INJECTION 10MG/ML 37.90

AC48168100 CARDIOL TABLETS 6.25MG "YUNG SHIN" 2.39

AC48169100 LICOLONE TABLETS 4MG "ASTAR" 1.53

AC48171100 SILIMA CAPSULES 150MG "PINE LAWER" 1.52

AC481711G0 SILIMA CAPSULES 150MG “PINE LAWER”(鋁箔/膠箔) 2.00

AC48176100 Tizaflex Tablets 2mg 1.62

AC481761G0 TIZAFLEX TABLETS 2MG(鋁箔/膠箔) 2.00

AC48177329 yafu cream "Y.C." 33.80

AC48177343 yafu cream "Y.C." 93.00

AC48178321 Betapro Cream "Patron" 0.00

AC48181100 VENINA TABLETS 6.40

AC48182100 MEGEJOHN TABLETS 160MG 36.90

AC48184209 NALOXONE INJECTION "G.B.L." 0.4MG/ML 303.00

AC481881G0 "SUFOLIN TABLETS 60MG ""ASTAR""(鋁箔/膠箔)" 2.00

AC48189265 Culin Powder for I.V. Injection 187.00

AC48189277 Culin Powder for I.V. Injection 275.00

AC48191100 THYROID-S TABLETS 100UG "JOHNSON" 1.50

AC481911G0 THYROID-S TABLETS 100UG "JOHNSON"(鋁箔/膠箔)(56粒/瓶) 2.00

AC48193321 Demaclean Gel 1% (Clindamycin) 0.00

AC48193323 Demaclean Gel 1% (Clindamycin) 11.40

AC48193329 Demaclean Gel 1% (Clindamycin) 14.10

AC48193335 Demaclean Gel 1% (Clindamycin) 20.70

AC48193338 DEMACLEAN GEL 1% (CLINDAMYCIN) 65.00

AC48193343 Demaclean Gel 1% (Clindamycin) 0.00

AC48195421 Timolol Eye Drops 0.25% "MEDICINE" (Timolol) 51.00

AC48216100 RISDONE TABLETS 1 MG (RISPERIDONE) 6.80

AC48220421 Siproxan Otic Drops 59.00

AC48222145 Obucort Swinghaler 351.00

AC48228100 Acaben Tab 50mg "Royal" 2.27

AC482291G0 ANXOKEN F.C. TABLETS 1000MG 2.00

AC48243100 HEANA F.C. TABLETS 2.85

AC48245209 GIFRO POWDER FOR INJECTION 0.00

AC48245210 GIFRO POWDER FOR INJECTION 0.00

AC48245265 GIFRO POWDER FOR INJECTION 0.00

AC48245277 GIFRO POWDER FOR INJECTION 0.00

AC48245289 GIFRO POWDER FOR INJECTION 25.00

AC48248277 Methylprednisolone Injection 500mg "Yung Shin" 188.00

AC48251421 TROPINE EYE DROPS 0.3% "MEDICINE" (ATROPINE SULFATE) 12.00

AC48251429 TROPINE EYE DROPS 0.3% "MEDICINE" (ATROPINE SULFATE) 20.30

AC48266100 NOBBY F.C. TABLETS 1200MG 1.91

AC48267245 Methylprednisolone Injection 40mg "Yung Shin" 39.30

AC48268421 ANTOL EYE DROPS 0.125%"Y.Y' 12.00

Page 228: 附件二 藥品給付品項暨支付標準表

AC48268429 ANTOL EYE DROPS 0.125%"Y.Y' 12.00

AC48272100 MeHo Tablets "Y.C." 1.53

AC482721G0 MEHO TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC48275100 Factive Tablets 320mg 82.00

AC48276343 BECANEX Ointment 536.00

AC48280100 "ROOT" K.U.N. TABLET 1.50

AC482801G0 "ROOT" K.U.N. TABLET(鋁箔/膠箔) 2.00

AC48284100 Stomacine Tablets 500mg 1.50

AC482841G0 STOMACINE TABLETS 500MG(鋁箔/膠箔) 2.00

AC48285321 NISKIN Cream "Chin Teng" 0.00

AC48285329 NISKIN Cream "Chin Teng" 0.00

AC48285338 NISKIN Cream "Chin Teng" 0.00

AC48285343 NISKIN Cream "Chin Teng" 0.00

AC48286321 Anefree Gel 0.1% 17.30

AC48286335 Anefree Gel 0.1% 68.00

AC48286343 Anefree Gel 0.1% 154.00

AC48286345 ANEFREE GEL 0.1% 0.00

AC48286363 Anefree Gel 0.1% 682.00

AC48287100 COGME-A CAPSULES 1.50

AC48293100 COLONCURE E.C.T. 400MG "JOHNSON" 0.00

AC48307100 Glycon Sustained-Release Tablets 30mg 1.65

AC483071G0 GLYCON SUSTAINED-RELEASE TABLETS 30MG(鋁箔/膠箔) 2.00

AC48308100 "Ancuton Tablets 30mg ""Tai Yu""" 2.73

AC48309100 Carvio Tablets 6.25mg 2.39

AC48310100 JOHNPIRIN E.M. CAPSULES 100MG "JOHNSON" 1.50

AC48313100 Lodipine Tablets 5mg 3.84

AC48319329 "Genfuxen Solution ""Winston""" 0.00

AC48320100 KOLAX TABLETS "Y.C" 3.21

AC48323100 Femina Tablets "Y.C." 1.50

AC483231G0 FEMINA TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC48324321 BUTEFINE CREAM 10MG/G 0.00

AC48324329 BUTEFINE CREAM 10MG/G 45.00

AC48324335 BUTEFINE CREAM 10MG/G 56.00

AC48324355 BUTEFINE CREAM 10MG/G 0.00

AC48325100 UNICLONE F.C TABLETS 7.5MG "UNION" 1.98

AC48326321 Gamicin Cream 13.20

AC48326335 Gamicin Cream 37.20

AC48327143 Risdine Oral Solution 1mg/ml 548.00

AC48336100 TONAC CAPSULES "LITA" 3.25

AC48337143 PERISDONE ORAL SOLUTION 1MG/ML 548.00

AC48337151 PERISDONE ORAL SOLUTION 1MG/ML 1113.00

AC48342209 SUKERIN FOR I.V INJECTION 30MG/ML "UNION" 17.00

AC48342212 SUKERIN FOR I.V INJECTION 30MG/ML "UNION" 24.00

AC48343100 BRICARDYL TABLETS 2.5MG "JOHNSON" 1.50

AC48344100 COLIAN CAPSULES 25MG "JOHNSON" 1.78

AC483441G0 COLIAN CAPSULES 25MG "JOHNSON"(鋁箔/膠箔) 2.00

AC48347209 TISAN FOR I.V. POWDER INJECTION 242.00

AC48347212 TISAN FOR I.V. POWDER INJECTION 0.00

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AC48347277 TISAN FOR I.V. POWDER INJECTION 0.00

AC48349165 Magca Oral Solution 0.00

AC48352151 SERIDOL ORAL SOLUTION 1MG/ML "CENTER" 1113.00

AC48354421 Thamic Otic Solution 0.3% 51.00

AC48355100 Flusine Tablets 83.00

AC48357100 Gapatin Capsules 300mg 7.90

AC48358321 Desosone Cream 0.25% 26.90

AC48358329 Desosone Cream 0.25% 50.00

AC48358338 Desosone Cream 0.25% 77.00

AC48358343 Desosone Cream 0.25% 140.00

AC48359314 MENTASONE CREAM 21.40

AC48359316 MENTASONE CREAM 22.40

AC48359321 MENTASONE CREAM 27.60

AC48359326 MENTASONE CREAM 28.60

AC48359335 MENTASONE CREAM 65.00

AC48362429 DIPRINE EYE DROPS 0.1% "Y.Y" 0.00

AC48363100 Musgud Tablets 5mg "LOTUS" 2.19

AC48376321 Benafine Cream 28.80

AC48376329 Benafine Cream 45.00

AC48376335 Benafine Cream 56.00

AC48376338 BENAFINE CREAM 59.00

AC48376355 Benafine Cream 0.00

AC48377100 PLESTAR TABLETS 100MG 11.30

AC48385112 TITANYL SOLUTION FOR NEBULIZING 2.5MG/ML "CENTER" 0.00

AC48389421 ALMINTO EYE DROPS "KINGDOM" 15.70

AC48389429 Alminto Eye Drops "Kingdom" 37.90

AC48391314 Metsone Cream 0.1% "Sinphar" 21.40

AC48391316 Metsone Cream 0.1% "Sinphar" 22.40

AC48391321 Metsone Cream 0.1% "Sinphar" 27.60

AC48391326 Metsone Cream 0.1% "Sinphar" 28.60

AC48391329 Metsone Cream 0.1% "Sinphar" 43.80

AC48391335 Metsone Cream 0.1% "Sinphar" 65.00

AC48392100 Blue-Up F.C. Tablets 2mg 7.70

AC48394100 COTON TABLETS 500MG "LITA" 1.50

AC483941G0 COTON TABLETS 500MG "LITA"(鋁箔/膠箔) 2.00

AC48396321 KHOIOU CREAM 1.5MG "CHINTENG" 531.00

AC48397100 Kerloli Capsules 250mg "Panbiotic" 3.35

AC48426221 Folina Injection 10mg/ml 69.00

AC48426229 FOLINA INJECTION 10MG/ML 86.00

AC48428100 FENLO E.M. CAPSULES 50MG "UELIAN" 1.50

AC48431421 Topimide Ophthalmic Solution 1% (Topicamide) 65.00

AC48432129 LOTICAL POWDER 11.00

AC48432138 LOTICAL POWDER 18.90

AC48435321 "Udaxen Cream 1% ""Winston""" 28.80

AC48435329 "Udaxen Cream 1% ""Winston""" 45.00

AC48435335 "Udaxen Cream 1% ""Winston""" 56.00

AC48435355 "Udaxen Cream 1% ""Winston""" 623.00

AC48436100 TALEX SUGAR COATED TABLETS "Y.C." 2.01

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AC48437329 U Soft Cream 40.0% 33.80

AC48437343 U Soft Cream 40.0% 93.00

AC48440421Oxybupro Eye Drops 0.05% "MEDICINE" (Oxybuprocaine HCl)

18.00

AC48441500 JOPHUN VAGINAL TABLETS 100MG "JOHNSON" 5.00

AC48442238 DIPROFEN INJECTION 20MG/ML 99.00

AC48445229 MYDILL Injection 0.1% 151.00

AC48446100 SOKEZ TABLETS 20MG "CHINTENG" 1.50

AC48447100 URIDIN F.C. TABLETS 2MG 7.60

AC48459245 OMEPRON 40MG IV INFUSION ""ROYAL"" 57.00

AC48461314 MOLISON CREAM 21.40

AC48461316 MOLISON CREAM 22.40

AC48461321 MOLISON CREAM 27.60

AC48461326 MOLISON CREAM 28.60

AC48461329 MOLISON CREAM 43.80

AC48461335 MOLISON CREAM 65.00

AC48465100 NORDIPINE TABLETS 5MG "ANXO" 3.84

AC48467100 UTAPINE F.C. TABLET 200MG "UNION" 16.30

AC48469100 MECHOL TABLETS 10MG "YUNG SHIN" 5.70

AC48471421 ANZOMIN EYE DROPS 15.70

AC48471429 ANZOMIN EYE DROPS 37.90

AC48472100 Fallep Tablets 2mg 1.77

AC484721G0 FALLEP TABLETS 2MG(鋁箔/膠箔) 2.00

AC48473417 GINPOL GEL 31.30

AC48473423 GINPOL GEL 61.00

AC48473429 GINPOL GEL 102.00

AC48499100 Fibrolaxin Tablets 10mg "Patron" 0.00

AC48500100 SURIDE F.C. Tablets 400mg "EB" (Sulpiride) 3.65

AC48505321 FLUTICOSONE CREAM "S.C." 25.80

AC48505335 FLUTICOSONE CREAM "S.C." 74.00

AC48510100 Dicron MR Tablets 30mg 1.65

AC485101G0 DICRON MR TABLETS 30MG(鋁箔/膠箔) 2.00

AC48511335 TEZARAC GEL 0.1% 0.00

AC48511343 Tezarac Gel 0.1% 0.00

AC48513100 Melstatin tablet 40mg 14.10

AC48514100 COSLAN CAPSULES "Y.C" 1.50

AC485141G0 COSLAN CAPSULES "Y.C."(鋁箔/膠箔) 2.00

AC48516100 ROSIZONE FILM COATED TABLETS 4MG 0.00

AC48517100 NooSafe 1200 mg Film Coated Tablets 0.00

AC48520100 IPU FILM COATED TABLETS 600MG "CHINTENG" 1.64

AC485201G0 IPU FILM COATED TABLETS 600MG "CHINTENG"(鋁箔/膠箔) 2.00

AC48541100 Lustraline Film Coated Tablets 50mg 0.00

AC48542100 ENCINLO E.M. CAPSULES 100MG "UELIAN" 1.50

AC48545100 ASGACON TABLETS 50MCG "YUNG SHIN" 3.06

AC48553209 Kidoton I.V. Injection 30mg/ml "Standard" (Ketorolac) 17.00

AC48554421 DORZOMIDE OPHTHALMIC SOLUTION 2% 235.00

AC48555100 LEGAN CAPSULES 300MG "CHINTENG" 4.36

AC48556100 Alpragin S.R. Tablets 1mg 2.17

Page 231: 附件二 藥品給付品項暨支付標準表

AC48557100 FINARIDE FILM COATED TABLETS 5MG "YUNG SHIN" 12.60

AC48558100 Arheuma Tablets 10mg "LOTUS" 26.60

AC48559100 "AMLOPINE TABLETS 5MG ""TAI YU""" 3.84

AC48560100 Amaride Tablets 1.95

AC48561229 OLATIN I.V. INJECTION 5MG/ML 1336.00

AC48564100 Deurinol Tablets 300mg 2.20

AC48565209 TOKELAN I.V. INJECTION 30MG/ML 17.00

AC48565212 TOKELAN I.V. INJECTION 30MG/ML 24.00

AC48566209 "TONFUPIN INJECTION ""TAI YU""" 15.00

AC48567277 CEFIM POWDER FOR INJECTION 500MG 151.00

AC48569100 BRICARDYL TABLETS 5mg "JOHNSON" 1.50

AC48572100 YOU Tie Chewable Tablets "Chinteng" 3.01

AC48573100 CYCLOCIN CAPSULES "P.L" 44.10

AC48575100 THRONE SUSTAINED-RELEASE SUGAR-COATED TABLETS 400MG 1.82

AC485751G0THRONE SUSTAINED-RELEASE SUGAR-COATED TABLETS 400MG(鋁箔

/膠箔)2.00

AC48581421 Norcin Eye Drops 0.3% "Sinphar" 29.00

AC48582335 "Can Ointment ""ROOT""" 0.00

AC48584100 VEINCURRENT F.C. TABLETS 40MG "T.F." 1.71

AC48585100 COTON CAPSULES 250MG "LITA" 1.50

AC485851G0 COTON CAPSULES 250MG "LITA"(鋁箔/膠箔) 2.00

AC48587212 IRICAN SOLUTION FOR I.V. INFUSION "SINPHAR" 1589.00

AC48587221 Irican Solution for I.V. Infusion "Sinphar" 2975.00

AC48589209 OTRIL I.V. INJECTION 0.00

AC48589216 OTRIL I.V. INJECTION 347.00

AC48590263 Teiconin powder for I.V. Injection 516.00

AC48590271 TEICONIN POWDER FOR I.V. INJECTION 1164.00

AC48592100 PMS Sugar-Coated Tablets 0.625mg "Yung Shin" 1.85

AC48599100 MANOTIN F.C. TABLETS 10MG 7.40

AC48600100 CALNELPRESS TABLETS 5MG 3.84

AC48601100 Milpran Capsules 50mg 8.70

AC48602100 DIAZONE TABLETS 15MG "C.H" 6.90

AC48605100 BE-EASY F.C. TABLETS 200MG "SL" 2.07

AC48608100 SIMVA F.C TABLETS 20MG "UNION" 3.58

AC48612100 MIRTINE F.C. TABLETS 30MG 8.90

AC48624412 DEMA ORABASE 0.1% "PATRON" 31.80

AC48624421 DEMA ORABASE 0.1% "PATRON" 35.60

AC48624426 DEMA ORABASE 0.1% "PATRON" 61.00

AC48629100 RISDON F.C. TABLETS 1MG "WEIDAR" 6.80

AC48630100 SUMAKIN CAPSULES 1.50

AC486301G0 SUMAKIN CAPSULES(鋁箔/膠箔) 2.00

AC48633100 U-ZEPINE F.C. TABLETS 30MG 8.90

AC48635455 AZETIN NASAL SPRAY 140MCG/DOSE 96.00

AC48635457 AZETIN NASAL SPRAY 1MG/ML(0.14MG/DOSE) 99.00

AC48636457BUNO NASAL AQUA 64ΜG/DOSE "JOHNSON"(64MCG/DOSE/120DOSE)

126.00

AC48637100 ELEGANT S.R. CAPSULES 0.2mg "JOHNSON" 5.60

AC48643151 IBUPROFEN-FP SUSPENSION 20MG/ML 25.00

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AC48643157 IBUPROFEN-FP SUSPENSION 20MG/ML 45.10

AC48646100 FORASMA TABLETS 40 MCG 2.03

AC48649100 Cloflow F.C. tablets 75mg "Standard" (Clopidogrel) 32.10

AC48658345 KOTTON PATCH “CHI-HUANG”(FLURBIPROFEN) 5.30

AC48660100 Tansin Tablets 1mg 〝EVEREST〞 2.09

AC48663100 LINOOPIL CAPSULES “ASTAR” 1.50

AC48666500 SENZOLE VAGINAL TABLETS 100MG “JOHNSON” 5.00

AC48676100 "SUPLAX TABLETS ""H.S.""" 1.53

AC486761G0 SUPLAX TABLETS "H.S."(鋁箔/膠箔) 2.00

AC48678145 HECALIS SOLUTION 177.00

AC48680321 ADAGENE-T GEL 17.30

AC48680335 ADAGENE-T GEL 68.00

AC48680343 ADAGENE-T GEL 0.00

AC48680345 ADAGENE-T GEL 0.00

AC48680363 ADAGENE-T GEL 682.00

AC48684100 MECHOL TABLETS 40MG 〝YUNG SHIN〞 14.10

AC48686143CENZOFT CONCENTRATE SOLUTION 20 MG/ML“CENTER”(30 ML)

230.00

AC48686151CENZOFT CONCENTRATE SOLUTION 20 MG/ML“CENTER”(60 ML)

486.00

AC48687100 EUGINE F.C. TABLETS 20 MG 〝H.S.〞 5.30

AC48689100 CURGAN CAPSULES 150MG (SILYMARIN) 1.35

AC48690100 "SURMAX TABLETS ""H.S.""" 2.83

AC48691100 MERONIN ORALLY DISINTEGRATING TABLETS 15 MG 5.10

AC48692321 BETASA OINTMENT 10.90

AC48692329 BETASA OINTMENT 0.00

AC48692335 BETASA OINTMENT 52.00

AC48692338 BETASA OINTMENT 68.00

AC48692340 BETASA OINTMENT 81.00

AC48694100 LEFLODAL F.C. TABLETS 100MG 3.21

AC48697100 ZEPANC TABLETS 1.86

AC48701412 ITRAPIN NEBULIZER SOLUTION 0.25 MG/ML“CENTER” 0.00

AC48701438 Itrapin Nebulizer Solution 0.25 mg/ml“Center” 0.00

AC48705100 INDAPIN SR FILM-COATED TABLETS 1.5 MG 1.75

AC487051G0 INDAPIN SR FILM-COATED TABLETS 1.5 MG(鋁箔/膠箔) 2.00

AC48722251 UROKINASE-GREEN CROSS INJ. 60,000 IU 898.00

AC48727113 SYNTAM GRANULES FOR ORAL SOLUTION 2400 MG 5.70

AC48731100 CAFONIA TABLETS“Y.C.” 9.10

AC48734100 Slosugar F.C. Tablets 1000 mg 1.75

AC48749100 COLCHICINE TABLETS 0.5MG“F.Y.” 1.50

AC487491G0 COLCHICINE TABLETS 0.5MG“F.Y.”(鋁箔/膠箔) 2.00

AC48753100 PIOTA TABLETS 30 MG 9.60

AC48754100 DIKINEX REPE S.C. TABLETS 0.00

AC487561G0 SUGANLIN SOFT CAPSULES“F.M”(鋁箔/膠箔) 2.00

AC48758100 ACCUFEN F.C. TABLETS "Y.Y." 1.64

AC48764321 ACNE-CURE GEL "MACRO" 17.30

AC48764335 ACNE-CURE GEL "MACRO" 68.00

AC48764343 ACNE-CURE GEL "MACRO" 154.00

Page 233: 附件二 藥品給付品項暨支付標準表

AC48764345 ACNE-CURE GEL "MACRO" 0.00

AC48764363 ACNE-CURE GEL "MACRO" 0.00

AC48765100 Bloodlet Tablets 15mg“Yung Shin” 9.10

AC48770143 LOSTA SYRUP 1 MG/ML 25.00

AC48770151 LOSTA SYRUP 1 MG/ML 26.80

AC48770157 LOSTA SYRUP 1 MG/ML 72.00

AC48771321 Clobecin Cream“Patron” 16.00

AC48771329 CLOBECIN CREAM“PATRON” 0.00

AC48771338 CLOBECIN CREAM“PATRON” 84.00

AC48772100 Anxomine Tablet 2mg 2.72

AC48784113 NOCETAM GRANULES FOR ORAL SOLUTION 2400 MG 〝LITA〞 5.50

AC48788143 DEBIMIN SYRUP 1.0MG/ML “Y.K.” 25.00

AC48788151 DEBIMIN SYRUP 1.0MG/ML “Y.K.” 26.80

AC48788155 DEBIMIN SYRUP 1.0MG/ML “Y.K.” 72.00

AC48788157 DEBIMIN SYRUP 1.0MG/ML “Y.K.” 72.00

AC48790321 ACNEAN CREAM 200MG/G 26.20

AC48790329 ACNEAN CREAM 200MG/G 0.00

AC48790330 ACNEAN CREAM 200MG/G 45.30

AC48790338 ACNEAN CREAM 200MG/G 0.00

AC48790343 ACNEAN CREAM 200MG/G 0.00

AC48793421 TROPICAN OPHTHALMIC SOLUTION 0.5% "PATRON" 0.00

AC48799345 FUBOFEN PATCH 〝YING CHUAN〞(FLURBIPROFEN) 5.30

AC48800100 MESACLON ENTERIC FILM COATED TABLETS 400 MG 0.00

AC48801100 SEULIN F.C. TABLETS〝S.L.〞 1.50

AC48803212 ZEDIPINE INJECTION 1MG/ML 51.00

AC48803229 ZEDIPINE INJECTION 1MG/ML 141.00

AC48803240 ZEDIPINE INJECTION 1MG/ML 0.00

AC48804438 "BECLOMASE AQUEOUS NASAL SPRAY "" H.S.""" 186.00

AC48808100 ECYCLE F.C. TABLETS 16MG“Y.Y.” 1.50

AC48809209 KYTRON I.V. INJECTION 1MG/ML 185.00

AC48809216 KYTRON I.V. INJECTION 1MG/ML 347.00

AC48810100 CALFOLIN TABLETS 15MG “JOHNSON” 0.00

AC48811100 Anyou F.C. Tablets“ROOT” 2.15

AC48812421 APINE OPHTHALMIC SOLUTION 0.125%“PATRON” 12.00

AC48812429 APINE OPHTHALMIC SOLUTION 0.125%“PATRON” 12.00

AC48813100 Simvatenin F.C. Tablets 20mg (Simvastatin) 3.58

AC48814100 OXAZE TABLETS 3.13

AC48816100 ACLONAX TABLETS 1.50

AC488161G0 ACLONAX TABLETS(鋁箔/膠箔) 2.00

AC48830100 "WELLMAX TABLETS ""H.S.""" 0.00

AC488301G0 "WELLMAX TABLETS ""H.S.""(鋁箔/膠箔)" 2.00

AC48831209 CHI SHENG NO. 2 INJECTION 0.00

AC48831277 CHI SHENG NO. 2 INJECTION 0.00

AC48832321 FUSIDER CREAM 32.20

AC48832326 FUSIDER CREAM 42.70

AC48832329 FUSIDER CREAM 45.20

AC48832335 FUSIDER CREAM 0.00

AC48832338 FUSIDER CREAM 0.00

Page 234: 附件二 藥品給付品項暨支付標準表

AC48832348 FUSIDER CREAM 337.00

AC48833100 AMCOPINE TABLETS 5MG "H.S"(AMLODIPINE) 3.84

AC48834209 CEFIM POWDER FOR INJECTION 1 GM 242.00

AC48835321 Shuli qing Gel “Sentai” 10.00

AC48835329 Shuli qing Gel “Sentai” 14.10

AC48835335 Shuli qing Gel “Sentai” 20.70

AC48835338 Shuli qing Gel “Sentai” 65.00

AC48837100 MIXAPIN TABLETS 50MCG "H.S" 3.06

AC48838229 OPATIN I.V. INJECTION 5MG/ML 1336.00

AC48839100 FULIN F.C.T.“ROOT” 4.88

AC48840221 Irinotecan Solution for I.V. Infusion “LOTUS” 2975.00

AC48842412 COENKASU ORALBASE 1MG 31.80

AC48842421 COENKASU ORALBASE 1MG 35.60

AC48842426 COENKASU ORALBASE 1MG 61.00

AC48844100 SICAN CAPSULES 150 MG “ASTAR” 1.52

AC488441G0 SICAN CAPSULES 150 MG “ASTAR”(鋁箔/膠箔) 2.00

AC48845100 MOODYTEC S.C. TABLETS 1 MG 4.88

AC48846100 GLUFAR TABLETS 2.0MG "H.S" 1.95

AC48855100 DIBOSE F.C. TABLETS “Y.C.” 4.69

AC48859100 AMLOPINE TABLETS 5 MG 〝S.D.〞 3.84

AC48860143 MINERGY ORAL SOLUTION 1MG/ML"Y.K." 28.00

AC48860151 MINERGY ORAL SOLUTION 1 MG/ML “Y.K.” 28.10

AC48862300 TECORO TABLETS 0.025MG "EVEREST" 7.40

AC48863100 BENTOMIN TABLETS 1000MG “S.C.” 1.75

AC488631G0 BENTOMIN TABLETS 1000MG"S.C."(鋁箔/膠箔) 2.00

AC48865100 ANXOWEN TABLETS 1.50

AC48867100 RIBELITE TABLETS 200MG 18.40

AC48868100 SLOSUGAR TABLETS 500 MG 0.00

AC48871100 MECOLIN TABLETS 30 MG ”ASTAR” 0.00

AC48873209 CHI SHENG NO. 3 INJECTION 0.00

AC48873277 CHI SHENG NO. 3 INJECTION 0.00

AC48875100 CALMDOWN SUSTAINED-RELEASE CAPSULES 75MG 10.00

AC48882229 NICARPINE I.V INJECTION 1MG/ML "P.L" 141.00

AC48884321 AMOCOAT NAIL LACQUER " H.S " 691.00

AC48891321 ADARIN GEL 0.1% 17.30

AC48891335 ADARIN GEL 0.1% 68.00

AC48891343 ADARIN GEL 0.1% 154.00

AC48891345 ADARIN GEL 0.1% 0.00

AC48891363 ADARIN GEL 0.1% 0.00

AC48892100 CEXIME CAPSULES 100 MG (CEFIXIME) 4.51

AC48896209 CHI SHENG NO.4 INJECTION 0.00

AC48896277 CHI SHENG NO. 4INJECTION 0.00

AC48897326 DOXEFEN CREAM 50MG/GM 0.00

AC48897335 DOXEFEN CREAM 50MG/GM 48.40

AC48898100 LITACARBOSE TABLETS 50MG "LITA" 2.27

AC48900421 CROMO EYE DROPS 2% (CROMOLYN SODIUM)“MEDICINE” 14.50

AC48900429 CROMO EYE DROPS 2% (CROMOLYN SODIUM)“MEDICINE” 28.30

AC48905100 BIOCOR FILM COATED TABLETS 5MG 2.15

Page 235: 附件二 藥品給付品項暨支付標準表

AC48908100 ANTILON F.C. TABLETS "Y.C." 4.73

AC48910100 URIMIN TABLETS 1000MG "Y.C." 1.75

AC489101G0 URIMIN TABLETS 1000 MG“Y.C.”(鋁箔/膠箔) 2.00

AC48925421 CO-DORZOMIDE OPHTHALMIC SOLUTION 317.00

AC48926100 SIMVA F.C TABLETS 20MG 3.58

AC48927417 TOTIFEN OPHTHALMIC SOLUTION 0.025% ”PATRON” 32.90

AC48927421 TOTIFEN OPHTHALMIC SOLUTION 0.025% ”PATRON” 43.90

AC48929100 MEQUIMIN TABLETS 5 MG 1.50

AC489291G0 MEQUIMIN TABLETS 5 MG(鋁箔/膠箔) 2.00

AC48934151MIRATE LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) “CENTER”

25.00

AC48934157MIRATE LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) “CENTER”

25.00

AC48934163MIRATE LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) “CENTER”

25.00

AC48937157SUCRALFATE ORAL SUSPENSION 100MG/ML (SUCRALFATE) "CENTER

78.00

AC48941212 Herocan Conc. Solution for I.V. Infusion 20 mg/ml 0.00

AC48941221 Herocan Conc. Solution for I.V. Infusion 20 mg/ml 2975.00

AC48960209 CHI SHENG NO.1 INJECTION 0.00

AC48960277 CHI SHENG NO.1 INJECTION 0.00

AC48961251 ROFEW I.V.INFUSION SOLUTION 200MG/ML 163.00

AC48963321 POLISU CREAM 50 MG/GM“SENTAI” 0.00

AC48963329 POLISU CREAM 50 MG/GM“SENTAI” 42.90

AC48965421 Sitromin Eye Drops 0.005% 12.00

AC48965429 Sitromin Eye Drops 0.005% 15.60

AC48972100 PERDOPRIL TABLETS 4MG 6.10

AC48990100 ZOSAAHY F.C TABLETS 50/12.5MG 4.11

AC48994100 CINOPIN TABLETS 5MG 3.84

AC48996100 Blue-Up F.C. Tablets 1mg 6.80

AC48997100 SPALYTIC TABLETS 0.125MG "H.S." 1.75

AC489971G0 SPALYTIC TABLETS 0.125MG "H.S."(鋁箔/膠箔) 2.00

AC48999421 Sitromin Eye Drops 0.01% 12.00

AC48999429 Sitromin Eye Drops 0.01% 12.80

AC49000209 OCILLINA POWDER FOR INJECTION 38.30

AC49000212 OCILLINA POWDER FOR INJECTION 0.00

AC49000277 OCILLINA POWDER FOR INJECTION 25.00

AC49001265 CARPEM FOR INTRAVENOUS INJECTION 0.00

AC49001277 CARPEM FOR INTRAVENOUS INJECTION 0.00

AC49002248 AZOL-FLUCON I.V INJECTION 2MG/ML 0.00

AC49005221 LINOOPIL INJECTION ”ASTAR” 15.00

AC49008100 CITAZOL TABLETS 50MG“STANDARD” 5.50

AC49016421 KINTROPINE EYE DROPS 0.125%“KINGDOM” 12.00

AC49016429 KINTROPINE EYE DROPS 0.125%“KINGDOM” 12.00

AC49018100 COXINE C.R. F.C. TABLETS 60 MG 3.05

AC49020100 MINIVANE F.C. TABLETS 30MG 8.90

AC49024100 KHOTONGFENG TABLETS 300MG 〝CHINTENG〞 2.20

AC49026143 TIRIZIN ORAL SOLUTION 1MG/ML 28.00

Page 236: 附件二 藥品給付品項暨支付標準表

AC49026151 TIRIZIN ORAL SOLUTION 1MG/ML 28.10

AC49026157 TIRIZIN ORAL SOLUTION 1MG/ML 87.00

AC49028165 POTAMAGCID SOLUTION “CENTER” 40.90

AC49029151 ANTIMIN SYRUP 25.00

AC49029157 ANTIMIN SYRUP 25.00

AC49032463 NOSECONE AQUA NASAL SPRAY 0.42MG/GM“JOHNSON” 0.00

AC49049100 SULGIN TABLETS 200 MG 1.71

AC49050329 UREA CREAM 40%“F.Y.” 33.80

AC49050343 UREA CREAM 40%“F.Y.” 93.00

AC49051100 KEPINTON S.R. CAPSULES 200MG 4.75

AC49054100 ZOMIANNE F.C. TABLETS 7.5 MG 0.00

AC49055100OMEPROTECT ENTERIC MICROENCAPSULATED CAPSULES 20MG”

ANGEL”2.51

AC49057100 AMOCURE F.C. TABLETS 30 MG 0.00

AC49059100 KONAX EXTENDED-RELEASE F.C. TABLETS 60 MG 1.98

AC49060100 ISOMIN F.C. TABLETS 15.50

AC49061100 RELINIDE TABLETS 1MG “STANDARD” (REPAGLINIDE) 2.09

AC49062321 ADAYUNG GEL 0.1% 〝S.L.〞 0.00

AC49062335 ADAYUNG GEL 0.1% 〝S.L.〞 68.00

AC49063340 VIMAX FOAMING SOLUTION 105.00

AC49072100 GLIPIRIDE TABLETS 1MG “YUNG SHIN” 1.61

AC49073100 Blue-Up F.C. Tablets 3mg 20.30

AC49075430 BUDESONIDE NASAL SPRAY 2MG/ML 94.00

AC49077209 KETOROLAC FOR IV INJECTION30MG/ML“T.F.” 17.00

AC49078100 MIRZAPINE F.C. TABLETS 30MG "KINGDOM" (MIRTAZAPINE) 8.90

AC49080321 GENRITE CREAM 1MG/G 13.20

AC49080335 GENRITE CREAM 1MG/G 37.20

AC49083100 Biscor F.C. Tablets 5mg 2.15

AC49084100 SOTALON CAPSULES 10MG 2.37

AC49085100 PITAZONE TABLET 30 MG 9.60

AC49089100 ANCOPIN TABLETS "H.S." 1.50

AC49090277 SULTAM FOR INJECTION 500MG (SULBACTAM SODIUM) 67.00

AC49092100 LOXU TABLETS 15MG 4.07

AC49095421 FLOZOLIN OPHTHALMIC SOLUTION ”PATRON” 24.60

AC49099100 DESDIN FILM-COATED TABLETS 5MG 2.19

AC49100229 ANESVAN 2% INJECTION “CHI SHENG” 37.40

AC49100248 ANESVAN 2% INJECTION “CHI SHENG” 0.00

AC491021G0 BUPLIVER CAPSULES"N.C.P"(SILYMARIN)(鋁箔/膠箔) 2.00

AC49103100 LIVERCON CAPSULES 150 MG "S.D." 1.52

AC491031G0 LIVERCON CAPSULES 150 MG "S.D."(鋁箔/膠箔) 2.00

AC49105100 UNDIZZ TABLETS“Y.C.” 1.50

AC491051G0 UNDIZZ TABLETS“Y.C.”(鋁箔/膠箔) 2.00

AC49107345 TIE SHR SHU PAP 〝P.Y〞 5.30

AC49109100 BAENAZIN TABLETS 100 MG 2.49

AC49112100 FLURAN TABLETS 50 MG ”ASTAR” 1.50

AC49113100 FYNADIN F.C. TABLETS 60 MG 1.80

AC49114100 DAYCOSE M.R. TABLETS 30 MG "WEIDAR" 1.65

AC491141G0 DAYCOSE M.R. TABLETS 30 MG "WEIDAR"(鋁箔/膠箔) 2.00

Page 237: 附件二 藥品給付品項暨支付標準表

AC49115209 CHI SHENG NO.5 INJECTION 0.00

AC49115265 CHI SHENG NO.5 INJECTION 0.00

AC49115271 CHI SHENG NO.5 INJECTION 0.00

AC49115277 CHI SHENG NO.5 INJECTION 0.00

AC49119100 BEFREE TABLETS 30MG 9.60

AC49127412 LAVISOL ORALBASE 31.80

AC49127421 LAVISOL ORALBASE 35.60

AC49127426 LAVISOL ORALBASE 61.00

AC49129321 GENTERMAY CREAM 13.20

AC49129335 GENTERMAY CREAM 37.20

AC49130209 PHEL POWDER FOR INJECTION 1 GM 61.00

AC49131100 RISDONE TABLETS 3MG“S.T.”(RISPERIDONE) 20.30

AC49133100 LAMTA TABLETS 100 MG (LAMOTRIGINE) 13.80

AC49134321 GENTERMAY OINTMENT 13.20

AC49134335 GENTERMAY OINTMENT 37.20

AC49137221 RACETAM INJECTION 0.00

AC49137229 RACETAM INJECTION 0.00

AC49137235 RACETAM INJECTION 0.00

AC49137238 RACETAM INJECTION 0.00

AC49142100 METERLON TABLETS “Y.C.” 1.50

AC491421G0 METERLON TABLETS “Y.C.”(鋁箔/膠箔) 2.00

AC49146100 MOPIK TABLETS 15 MG 〝N.K.〞 4.07

AC49150265 SUPERNEM POWDER FOR INJECTION 0.00

AC49150277 SUPERNEM POWDER FOR INJECTION 0.00

AC49151255 TEICOIN POWDER FOR I.V. INJECTION 0.00

AC49151263 TEICOIN POWDER FOR I.V. INJECTION 0.00

AC49151271 TEICOIN POWDER FOR I.V. INJECTION 0.00

AC49152209 OXACILLIN SOIDUM INJECTION “O-S” 38.30

AC49152212 OXACILLIN SODIUM INJECTION “O-S” 100.00

AC49152219 OXACILLIN SODIUM INJECTION “O-S” 180.00

AC49152229 OXACILLIN SODIUM INJECTION “O-S” 0.00

AC49152277 OXACILLIN SOIDUM INJECTION “O-S” 25.00

AC49153100 OXBU EXTENDED-RELEASE TABLETS 5MG 6.00

AC49155209 MEXOPEM POWDER FOR INJECTION 525.00

AC49155265 MEXOPEM POWDER FOR INJECTION 0.00

AC49155277 MEXOPEM POWDER FOR INJECTION 284.00

AC49163321 CHYNDACIN GEL 10.00

AC49163323 CHYNDACIN GEL 11.40

AC49163329 CHYNDACIN GEL 14.10

AC49163330 CHYNDACIN GEL 17.40

AC49163335 CHYNDACIN GEL 20.70

AC49163338 CHYNDACIN GEL 65.00

AC49163343 CHYNDACIN GEL 185.00

AC49164100 SHUXIA E.C. TABLETS 1.50

AC491641G0 SHUXIA E.C. TABLETS(鋁箔/膠箔) 2.00

AC49166100 ONSLEEP CAPSULES 10MG “STANDARD”(ZALEPLON) 2.58

AC491761G0 HYWEN F.C. TABLETS 10 MG(鋁箔/膠箔) 2.00

AC49177209 GRANTRON I.V. INJECTION 1 MG/ML 0.00

Page 238: 附件二 藥品給付品項暨支付標準表

AC49177216 GRANTRON I.V. INJECTION 1 MG/ML 347.00

AC49178100 PERIPIL TABLETS 4 MG 6.10

AC49183112 TERBUTE SOLUTION FOR NEBULIZING 2.5MG/ML 9.40

AC49184100 MELOXIN TABLETS 15MG 4.07

AC49186421 KINTROPINE EYE DROPS 0.25%”KINGDOM” 12.00

AC49186429 KINTROPINE EYE DROPS 0.25%”KINGDOM” 21.00

AC49188100 RACEPHENICOL TABLETS "Y.C." 1.51

AC491881G0 RACEPHENICOL TABLETS“Y.C.”(鋁箔/膠箔) 2.00

AC49190100 SIVASIN FILM COATED TABLETS 40MG 7.50

AC49193100 CATILON TABLETS 40MG 2.83

AC49202100 MODUP SUSTAINED-RELEASE CAPSULES 25 MG 6.60

AC49204100 LITACARBOSE TABLETS 100MG" LITA " 4.69

AC49208345 TIE TUNG AN PAP 〝GP〞 5.30

AC49209421 SAFIN OPHTHALMIC SOLUTION "PATRON" 12.10

AC49209429 SAFIN OPHTHALMIC SOLUTION "PATRON" 23.80

AC49210335 TAZAROTENE GEL 0.1%“S.C.” 205.00

AC49210343 TAZAROTENE GEL 0.1%“S.C.” 343.00

AC49211138 NOPANT RESPIRATOR SOLUTION 81.00

AC49213329 CLOGEL GEL 7.5MG/GM 27.30

AC49213330 CLOGEL GEL 7.5MG/GM 34.50

AC49213335 CLOGEL GEL 7.5MG/GM 38.60

AC49213338 CLOGEL GEL 7.5MG/GM 0.00

AC49213343 CLOGEL GEL 7.5MG/GM 133.00

AC49217100 ZODENOX FILM COATED TABLETS 10MG“YUNG SHIN” 1.76

AC492171G0ZODENOX FILM COATED TABLETS 10MG“YUNG SHIN”(鋁箔/膠箔)

2.00

AC49218121 CRASHTONE GRANULES“PATRON” 6.90

AC49223100 ANTICOUGH TABLETS“CHINTENG” 1.50

AC492231G0 ANTICOUGH TABLETS“CHINTENG”(鋁箔/膠箔) 2.00

AC49224100 COTOL F.C. TABLETS 75MG "EVEREST" 32.10

AC492251G0 GLIMED MR TABLETS 30MG(鋁箔/膠箔) 2.00

AC49237100 TONLEX F.C. TABLETS 500MG 3.23

AC49239335 TAZOTEN CREAM "H.S." 205.00

AC49239343 TAZOTEN CREAM "H.S." 343.00

AC49242100 MONTEKA F.C TABLETS 10MG 12.30

AC49247209 PROCHLOZINE INJECTION 5MG/ML "T.F" 15.30

AC49255312 ACYVIR CREAM 50MG/G (ACYCLOVIR) 17.30

AC49255316 ACYVIR CREAM 50MG/G (ACYCLOVIR) 17.30

AC49255317 ACYVIR CREAM 50MG/G (ACYCLOVIR) 17.30

AC49255319 ACYVIR CREAM 50MG/G (ACYCLOVIR) 17.30

AC49255321 ACYVIR CREAM 50MG/G (ACYCLOVIR) 41.10

AC49255323 ACYVIR CREAM 50MG/G (ACYCLOVIR) 41.80

AC49255325 ACYVIR CREAM 50MG/G (ACYCLOVIR) 42.50

AC49255326 ACYVIR CREAM 50MG/G (ACYCLOVIR) 42.90

AC49255329 ACYVIR CREAM 50MG/G (ACYCLOVIR) 42.90

AC49255343 ACYVIR CREAM 50MG/G (ACYCLOVIR) 0.00

AC49255355 ACYVIR CREAM 50MG/G (ACYCLOVIR) 431.00

AC492553AH ACYVIR CREAM 50MG/G (ACYCLOVIR) 41.80

Page 239: 附件二 藥品給付品項暨支付標準表

AC49260229 ISOCIN INJECTION 0.1% 151.00

AC49261100 LIMECRO CAPSULES 2.83

AC49263100 NOSETEC SUSTAINED-RELEASE CAPSULES 2.33

AC49264100 POWECON TABLETS 1.75

AC49266100 LABEDIN F.C. TABLETS 200MG 2.82

AC492671G0 SILYMARIN CAPSULES(鋁箔/膠箔) 2.00

AC49274321 FLUSONE CREAM 0.05% 0.00

AC49274335 FLUSONE CREAM 0.05% 74.00

AC49275209 OMIDA INJECTION 5MG/ML 17.70

AC49275212 OMIDA INJECTION 5MG/ML 21.20

AC49275216 OMIDA INJECTION 5MG/ML 23.50

AC49275221 OMIDA INJECTION 5MG/ML 58.00

AC49275229 OMIDA INJECTION 5MG/ML 0.00

AC49275237 OMIDA INJECTION 5MG/ML 0.00

AC49276245 CINOLONE IV INFUSION 10 MG/ML 0.00

AC49277416 TILOL OPHTHALMIC SOLUTION 0.25% ”PATRON” 0.00

AC49277421 TILOL OPHTHALMIC SOLUTION 0.25% ”PATRON” 0.00

AC49278100 MONTEXIN CHEWABLE TABLETS 5 MG 9.30

AC49279321 FULIJING CREAM“SENTAI” 32.20

AC49279326 FULIJING CREAM“SENTAI” 0.00

AC49279329 FULIJING CREAM“SENTAI” 45.20

AC49279335 FULIJING CREAM“SENTAI” 126.00

AC49279338 FULIJING CREAM“SENTAI” 0.00

AC49279348 FULIJING CREAM“SENTAI” 0.00

AC49280321 ADAPALENE GEL 0.1%“SINPHAR” 17.30

AC49280335 ADAPALENE GEL 0.1%“SINPHAR” 68.00

AC49280343 ADAPALENE GEL 0.1%“SINPHAR” 154.00

AC49280345 ADAPALENE GEL 0.1%“SINPHAR” 211.00

AC49280363 ADAPALENE GEL 0.1%“SINPHAR” 682.00

AC49283100 ASAZIPAM FILM COATED TABLETS 50MG 9.60

AC49284414 TILOL OPHTHALMIC SOLUTION 0.5% ”PATRON” 0.00

AC49284421 TILOL OPHTHALMIC SOLUTION 0.5% ”PATRON” 0.00

AC49289100 TIABINE FILM COATED TABLETS 10MG 25.80

AC49291100 ALPRAGIN S.R. TABLETS 0.5 MG 1.50

AC49303100 CHLOGUIN F.C. TABLETS 200MG“WEIDAR” 2.07

AC49304263TARCONIN FOR I.V. INJECTION 200MG“STANDARD”

(TEICOPLANIN)516.00

AC49305100 KLARITH XL TABLETS 500MG 18.70

AC49306100 NICODIL TABLETS 5MG 2.89

AC49309209 AVACAN INJECTION”ASTAR” 0.00

AC49312319 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 0.00

AC49312321 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 0.00

AC49312323 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 0.00

AC49312324 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 12.80

AC49312329 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 13.70

AC49312335 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 24.80

AC49312338 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 41.90

AC49312340 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 61.00

Page 240: 附件二 藥品給付品項暨支付標準表

AC49312355 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 0.00

AC49313329 BUTEDERM CREAM 1% 45.00

AC49313335 BUTEDERM CREAM 1% 56.00

AC49316100 CALM-EZ F.C. TABLETS 200MG 16.30

AC49319321 ANDOPIN GEL 0.1%“P.L.” 0.00

AC49319335 ANDOPIN GEL 0.1%“P.L.” 0.00

AC49319343 ANDOPIN GEL 0.1%“P.L.”(30G) 0.00

AC49319363 ANDOPIN GEL 0.1%“P.L.” 0.00

AC49320382 LIDOPAT PATCH 5% 36.60

AC49322100BUPROTRIN SUSTAINED RELEASE F.C. TABLETS 150MG 〝ROYAL〞

11.70

AC49328421 KETORO OPHTHALMIC SOLUTION 0.5% "PATRON" 86.00

AC49329100 NOMI-NOX F.C. TABLETS 5MG 55.00

AC49331151 LACOLY SOLUTION“CENTER” 25.00

AC49331166 LACOLY SOLUTION“CENTER” 105.00

AC49331177 LACOLY SOLUTION“CENTER” 161.00

AC49332321 DERMONE CREAM 0.1%“Y.K.” 0.00

AC49332329 DERMONE CREAM 0.1%“Y.K.” 0.00

AC49332335 DERMONE CREAM 0.1%“Y.K.” 0.00

AC49333100 LIFENOZ-U TABLETS 160MG 3.92

AC49334421 CURZOLAN EYE DROPS 17.70

AC49334429 CURZOLAN EYE DROPS 33.20

AC49335100 BACLON 10MG TABLETS 1.50

AC49337321 BUNAFINE CREAM 1% “P.L.”(5G) 28.80

AC49337329 BUNAFINE CREAM 1% “P.L.”(10G) 45.00

AC49337335 BUNAFINE CREAM 1% “P.L.”(15G) 56.00

AC49337355 BUNAFINE CREAM 1% “P.L.”(100G) 0.00

AC49339321 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 32.20

AC49339326 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 42.70

AC49339329 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 45.20

AC49339335 FUSIDIC ACID CREAM 20MG/GM "SINPHAR" 126.00

AC49339338 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 160.00

AC49339348 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 337.00

AC49340209 FUNJAPIN POWDER FOR IV INJECTION“PANBIOTIC” 242.00

AC49343100 MESTROL TABLETS 40 MG 8.90

AC49345100 ZONIN S.C. TABLETS 50MG 9.40

AC49348100 Epalon F.C. Tablets 10mg 57.00

AC49351421 COMOLYN OPHTHALMIC SOLUTION 2%“PATRON” 14.50

AC49351429 COMOLYN OPHTHALMIC SOLUTION 2%“PATRON” 28.30

AC49357335 FUL LEE CREAM 0.1%(W/W)”CHINTENG” 205.00

AC49357343 FUL LEE CREAM 0.1%(W/W)”CHINTENG” 0.00

AC49358100 UDILOL TABLETS 6.25MG 2.39

AC49360100 BEZOSTATIN F.C. TABLETS 40 MG“S.C.” 7.50

AC49362100 MINLIFE-P SUSTAINED RELEASE FILM COATED TABLETS 3.01

AC49367100 PADELIN TABLETS “PATRON” (LORAZEPAM) 0.00

AC49368421 NOFOXIN EYE DROPS 0.3% “MEDICINE”(NORFLOXACIN) 29.00

AC49368429 NOFOXIN EYE DROPS 0.3% “MEDICINE”(NORFLOXACIN) 83.00

AC49369114 BESMATE INHALATION SOLUTION 13.90

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AC49372100 SORDUR CONTROLLED-RELEASE TABLETS 60MG 3.05

AC49373100 PEDEN RETARD TABLETS 4 MG 2.27

AC49374100 COSPIRIT F.C. TABLETS 400MG 40.20

AC49375220 BETAMYCIN FOR INJECTION 226.00

AC493752AE BETAMYCIN FOR INJECTION 199.00

AC493752CX BETAMYCIN FOR INJECTION 136.00

AC49376100 FELO E.R. TABLETS 2.5MG“EVEREST” 2.04

AC49388121 CHALIAN POWDER 9.50

AC49390209 SUKETON I.V. INJECTION“TAI YU” 17.00

AC49390212 SUKETON I.V. INJECTION“TAI YU” 24.00

AC49396100 MESTROL TABLETS 160 MG 0.00

AC49397100 Mequitazine Tablets 5mg“Sinphar” 1.50

AC49416135 KUZEM POWDER 28.30

AC49419421 CATELOL OPHTHALMIC SOLUTION 1.0%“PATRON” 120.00

AC49421100 JOLINDAC TABLETS 200 MG“JOHNSON” 1.98

AC49422321 Betaclogen Cream“Sinphar” 16.00

AC49422329 Betaclogen Cream“Sinphar” 35.00

AC49422336 Betaclogen Cream“Sinphar” 53.00

AC49422338 Betaclogen Cream“Sinphar” 84.00

AC49422355 Betaclogen Cream“Sinphar” 145.00

AC49423100 SONAPLON CAPSULES 10MG "D.T" 2.65

AC49424100 JALUMEN CAPSULES 10MG 2.48

AC49428100 JEXIT S.C. TABLETS“JOHNSON” 2.15

AC49447321 TOCOCLEAN GEL 10.00

AC49447323 TOCOCLEAN GEL 0.00

AC49447329 TOCOCLEAN GEL 0.00

AC49447330 TOCOCLEAN GEL 0.00

AC49447335 TOCOCLEAN GEL 20.70

AC49447338 TOCOCLEAN GEL 0.00

AC49447343 TOCOCLEAN GEL 0.00

AC49451221 ENHANCIR INJECTION 0.84 MG/ML“Y.Y.” 25.00

AC49452100 LEVONOLON F.C. TABLETS 500 MG 20.90

AC49453100 EASYFOR SR CAPSULES 75MG 10.00

AC49459423 GINSOL GEL 61.00

AC49459429 GINSOL GEL 102.00

AC49461100 U-MIRTARON F.C. TABLETS 30 MG“S.C.” 8.90

AC49465100 Carbatin Capsules 300 mg 7.90

AC494661G0 GLICLAX SUSTAINED RELEASE TABLETS 30MG(鋁箔/膠箔) 2.00

AC49467100 ANXILET FILM COATED TABLETS 2MG 7.70

AC49469100 CARLATREND TABLETS 6.25MG”KINGDOM”(CARVEDILOL) 2.39

AC49470151 COCOPINE SYRUP“CENTER” 25.00

AC49470157 COCOPINE SYRUP“CENTER” 25.80

AC49471329 ZORIA CREAM 40%"EVEREST" 33.80

AC49471343 ZORIA CREAM 40%"EVEREST" 93.00

AC49493100 Epalon F.C. Tablets 5 mg 55.00

AC49494100 Kertonbose Tablets 50 mg 2.27

AC49496100 UTAPINE F.C. TABLET 100MG“UNION” 12.10

AC49502100 FLUCOGUS CAPSULES 150MG"H.S." (FLUCONAZOLE) 52.00

Page 242: 附件二 藥品給付品項暨支付標準表

AC49504100 BISO F.C. TABLETS 1.25 MG 2.01

AC49505248 LEVONOLON IV SOLUTION FOR INFUSION 5MG/ML 0.00

AC49505255 LEVONOLON IV SOLUTION FOR INFUSION 5MG/ML 601.00

AC49506321 GAMICIN OINTMENT 13.20

AC49506335 GAMICIN OINTMENT 37.20

AC49514100 IBIMO C.R.F.C. TABLETS 60 MG“S.C.” 3.05

AC49515100 AMORFAN FILM COATED TABLETS 10 MG 1.50

AC49516100 FELOEN EXTENDED-RELEASE FILM-COATED TABLETS 5.80

AC49517100 GAPATIN F.C. TABLETS 600MG 10.50

AC49520321 DOULISHU CREAM 1MG/GM“SENTAI” 0.00

AC49520335 DOULISHU CREAM 1MG/GM“SENTAI” 0.00

AC49520343 DOULISHU CREAM 1MG/GM“SENTAI” 0.00

AC49520345 DOULISHU CREAM 1MG/GM“SENTAI” 0.00

AC49520363 DOULISHU CREAM 1MG/GM“SENTAI” 0.00

AC49521100 YUROBEN F.C. TABLETS 600MG“Y.S.” 1.64

AC49522100 INSURE CONTROLLED-RELEASE TABLETS 60MG”KINGDOM” 3.05

AC49525100 D.P.L. CAPSULES“Y.Y.” 1.50

AC495251G0 D.P.L. CAPSULES“Y.Y.”(鋁箔/膠箔) 2.00

AC49526100 LIMUS F.C. TABLETS 25 MG 7.30

AC49527100 LESYN F.C. TABLETS 2 MG 3.30

AC49529321 B-N-O OINTMENT 23.90

AC49529329 B-N-O OINTMENT 30.00

AC49529335 B-N-O OINTMENT 40.50

AC49530421 FLUZOCON EYE DROPS 24.60

AC49531100 METFORMIN TABLETS 850MG“Synmosa” 1.68

AC49535100 SIMATIN F.C TABLETS 80MG 33.50

AC495361G0CARDIOPIRIN ENTERIC COATED TABLETS 100MG (ASPIRIN)(鋁箔/

膠箔)2.00

AC49542265 CIPENEM POWDER FOR IV INJECTION (250MG/ 250MG) 0.00

AC49542277 CIPENEM POWDER FOR IV INJECTION (500MG/500MG) 275.00

AC49544100 KENCO F. C. TABLETS 5MG”CHINTENG” 2.15

AC49545100 FLEXER F.C. TABLETS 5 MG 2.19

AC49547100 Quitulcer Capsules 30mg“C.L.” 10.00

AC49549100 DIAZONE TABLETS 30MG“C.H.” 9.60

AC49550221 CHENDAY INJECTION 5MG/ML 72.00

AC49558420 DEVIRUS OPHTHALMIC OINTMENT 400.00

AC49558421 DEVIRUS OPHTHALMIC OINTMENT 427.00

AC49559220 CO-TAZO POWDER FOR INJECTION 0.00

AC495592AE CO-TAZO POWDER FOR INJECTION 0.00

AC495592CX CO-TAZO POWDER FOR INJECTION 0.00

AC49560100 POLITONE TABLETS 30MG (PIOGLITAZONE) 9.60

AC49561421 PREDNICONE OPHTHALMIC SUSPENSION 1 % 76.00

AC49563100 FURIL CAPSULES "LOTUS" 65.00

AC49564100 COUGIN F.C. TABLETS 10MG "H.S." 1.50

AC495641G0 COUGIN F.C. TABLETS 10MG "H.S."(鋁箔/膠箔) 2.00

AC49568100 TORAMATE FILM COATED TABLETS 100MG 23.20

AC49574100 UTAPINE F.C. TABLETS 25MG“UNION” 7.30

AC49577100 FUTE F.C. TABLETS 0.5MG 2.11

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AC49579100 PRECOSE TABLETS 50MG 2.27

AC49582245 LOMETIN 40 MG I.V. INFUSION 57.00

AC49583100 RAFAX XR CAPSULES 75 MG 10.00

AC49593100 TALLSEA TABLETS“S.C.” 1.53

AC495931G0 TALLSEA TABLETS“S.C.”(鋁箔/膠箔) 2.00

AC49598321 ANTIMYCOLIN CREAM 0.00

AC495991G0 BETAFORM TABLETS 850MG ”M.T.”(METFORMIN)(鋁箔/膠箔) 2.00

AC49605100 MILPRAN CAPSULES 25 MG 5.00

AC49609100 DIFAN F.C. TABLETS 10MG“Y.Y.” 0.00

AC49610100 COXCO F.C.TABLETS 50MG 4.11

AC49619100 CIFLOGEN F.C. TABLETS 500 MG 6.10

AC49621100 MONTEXIN CHEWABLE TABLETS 4 MG 9.10

AC49623100 BIOCOR FILM COATED TABLETS 10 MG 3.93

AC49625100 ROSIGLIT F.C. TABLETS 4MG“STANDARD”(ROSIGLITAZONE) 0.00

AC49627151MERCATER LIQUID 5UG/ML (PROCATEROL HYDROCHLORIDE

HEMIHYDRATE)33.90

AC49627157MECATER LIQUID 5 UG/ML(PROCATEROL HYDROCHLORIDE

HEMIHYDRATE)111.00

AC49628143 Cetirizine Oral Solution“Sinphar” 28.00

AC49628151 Cetirizine Oral Solution“Sinphar” 28.10

AC49628157 Cetirizine Oral Solution“Sinphar” 87.00

AC49634100 MERONIN ORALLY DISINTEGRATING TABLETS 30MG 8.90

AC49636100 LOTEPIN S.C. TABLETS 50 MG 9.40

AC49638100 GATINE CAPSULES 100 MG 3.32

AC49640100 TERCO TABLETS”PATRON” 1.50

AC49648100 MELOXICAM TABLETS 7.5 MG“S.D.” 1.72

AC49650100BETACOR F.C. TABLETS 5MG“STANDARD”(BISOPROLOL

HEMIFUMARATE)2.15

AC49651248 LEFLODAL I.V. SOLUTION FOR INFUSION 5MG/ML 376.00

AC49651255 LEFLODAL I.V. SOLUTION FOR INFUSION 5MG/ML 601.00

AC49652329 TRISEC CREAM 35.00

AC49652336 TRISEC CREAM 53.00

AC49652338 TRISEC CREAM 84.00

AC49653100 CALM-EZ F.C. TABLETS 100MG 12.10

AC49654338 AGSDINE CREAM 56.00

AC49654348 AGSDINE CREAM 56.00

AC49654377 AGSDINE CREAM 0.00

AC49655210 AMBACILLIN POWDER FOR INJECTION 55.00

AC49655216 AMBACILLIN POWDER FOR INJECTION 137.00

AC49655289 AMBACILLIN POWDER FOR INJECTION 0.00

AC49657100 COSPIRIT F.C. TABLETS 200MG 18.40

AC49659100 ANFORMIN TABLETS 850MG 1.68

AC49661100 LIPIDOFF F.C. TABLETS 20MG 3.58

AC49663100 TRIDINE TABLETS 1.50

AC49666100 RAPNOTIC F.C. TABLETS 10MG "H.S." 1.76

AC496661G0 RAPNOTIC F.C. TABLETS 10MG "H.S."(鋁箔/膠箔) 2.00

AC49670335 KARAC CREAM 205.00

AC49670343 KARAC CREAM 343.00

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AC49672100 SIMATIN F.C. TABLETS 20MG 3.58

AC49689209 BUPRENORPHINE INJECTION 0.3MG/ML ”O-S” 84.00

AC49695265 EASYDOPA INJECTION 105.00

AC49695277 EASYDOPA INJECTION 210.00

AC49697100 GLUCOBOSE TABLETS 50MG"H.S." 2.27

AC49699100 SIMATIN F.C. TABLETS 10MG 2.97

AC49700100 Estimin F.C. Tablets 5mg (Ebatine) 1.55

AC497001G0 Estimin F.C. Tablets 5mg (Ebatine) 2.00

AC49704100 DISFECT F.C. TABLETS 250MG 48.90

AC49707100 CONTEXIN CAPSULES“ASTAR” 1.50

AC49709335 Tarac Topical Cream 0.05%“Purzer” 0.00

AC49709343 Tarac Topical Cream 0.05%“Purzer” 0.00

AC49711100 ALPUTON TABLETS 300MG "LITA" 2.20

AC49713157 REMALTIN ORAL SOLUTION “CENTER” 191.00

AC49713164 REMALTIN ORAL SOLUTION “CENTER” 355.00

AC497131FI REMALTIN ORAL SOLUTION “CENTER” 0.00

AC49731316 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 20.90

AC49731321 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 24.40

AC49731329 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 37.60

AC49731330 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 0.00

AC49731335 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 70.00

AC49731343 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 121.00

AC49735209 MEPENEM POWDER FOR INTRAVENOUS INJECTION 525.00

AC49738100 SUKERIN F.C. TABLETS 10MG“UNION” 4.13

AC49739100 LOSENTA F.C. TABLETS 50MG 4.11

AC49740321 APALENE GEL 0.1% "EVEREST" 17.30

AC49740335 APALENE GEL 0.1% "EVEREST" 0.00

AC49740343 APALENE GEL 0.1% "EVEREST" 0.00

AC49740345 APALENE GEL 0.1% "EVEREST" 0.00

AC49740363 APALENE GEL 0.1% "EVEREST" 0.00

AC49741100 QUEROPIN FILM COATED TABLETS 200MG“YUNG SHIN” 16.30

AC49743216 DEPAVENT INJECTION 100MG/ML 0.00

AC49743219 DEPAVENT INJECTION 100MG/ML(4ML) 296.00

AC49743221 DEPAVENT INJECTION 100MG/ML 336.00

AC49743229 DEPAVENT INJECTION 100MG/ML 0.00

AC49744321 B.&N. BACTERMIN OINTMENT 64.00

AC49744335 B.&N. BACTERMIN OINTMENT 124.00

AC49751100 CODEVERINE TABLETS”PATRON” 1.50

AC49754209 SETRON I.V. INJECTION 1 MG/ML 185.00

AC49754216 SETRON I.V. INJECTION 1 MG/ML 347.00

AC49755100 RAMILY TABLETS 10MG 5.10

AC49756100 MOREEZ COMPLEX TABLETS 5.90

AC49758151 “PPCD”MORPHINE SULFATE ORAL SOLUTION 2MG/ML 132.00

AC49758157 “PPCD”MORPHINE SULFATE ORAL SOLUTION 2MG/ML 240.00

AC49760100PEALETON SUSTAINED RELEASE F.C. TABLETS 120MG“YUNG SHIN

”2.13

AC49763100 NOLIDIN TABLETS“Y.C.” 2.34

AC49764100 NEO-VIS TABLETS“SWISS” 1.55

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AC497641G0 NEO-VIS TABLETS“SWISS”(168粒/瓶裝)(鋁箔/膠箔) 2.00

AC49766100 GASTERIN TABLETS“Y.C.” 1.71

AC497661G0 GASTERIN TABLETS“Y.C.”(鋁箔/膠箔) 2.00

AC49767100 Codeine-T Tablets“Sinphar” 1.50

AC497671G0 Codeine-T Tablets“Sinphar” 2.00

AC49769100 FINASPRO F.C. TABLETS 5MG 12.60

AC49786343 TAROTE CREAM 1MG/GM”PATRON” 0.00

AC49787100 COVAXIN TABLETS 70MG 152.00

AC49788100 GETRAN TABLETS 2.5MG“TAI YU” 1.50

AC49792100 SO. H. F. C. TABLETS“ROOT” 3.58

AC49793321 QUTACIN OINTMENT 1MG/GM “YUNZAN” 0.00

AC49793329 QUTACIN OINTMENT 1MG/GM “YUNZAN” 0.00

AC49793335 QUTACIN OINTMENT 1MG/GM “YUNZAN” 0.00

AC49798100 LANDUET TABLETS 10MG/25MG 5.60

AC49799100 LANDUET TABLETS 5MG/12.5MG 1.50

AC49804329 MYCONXIN CREAM 0.5% 69.00

AC49808100 SYNPID MICRONIZED CAPSULES 200 MG 3.92

AC49811209 CEFEPIME POWDER FOR INJECTION "O-S" 0.00

AC49811212 CEFEPIME POWDER FOR INJECTION "O-S" 0.00

AC49811277 CEFEPIME POWDER FOR INJECTION "O-S" 0.00

AC49812100 SOLMIN CAPSULES 10MG“C.H.” 2.38

AC49814100 TORSIX TABLETS 10MG 5.90

AC49815100 TORSIX TABLETS 20MG 5.90

AC49816100 TORSIX TABLETS 5MG 3.77

AC49829100 DIABAN TABLETS 100MG “C.H.” 5.70

AC49831100 NOBISIN F.C 1200MG TABLETS“TAI YU” 1.91

AC49833100LEVOZINE F.C. TABLETS 5MG“STANDARD”(LEVOCETIRIZINE

DIHYDROCHLORIDE)2.21

AC49835100 LOWTAN F.C. TABLETS 50MG“C.H.” 4.11

AC49840100 TORAMATE FILM COATED TABLETS 50MG 11.80

AC49841100 SIMPOTIN F.C. TABLETS 20 MG“WEIDAR” 3.58

AC49842321 THREE-UNITE CREAM“F.Y.” 16.00

AC49842329 THREE-UNITE CREAM“F.Y.” 35.00

AC49842336 THREE-UNITE CREAM“F.Y.” 53.00

AC49842338 THREE-UNITE CREAM“F.Y.” 84.00

AC49842355 THREE-UNITE CREAM“F.Y.” 0.00

AC49843100 SUELODE TABLETS 400 MG 3.65

AC49844151 BUTAMIRATE LIQUID 1.5 MG/ML“CENTER” 25.00

AC49844157 BUTAMIRATE LIQUID 1.5 MG/ML“CENTER” 25.00

AC49844163 BUTAMIRATE LIQUID 1.5 MG/ML“CENTER” 30.80

AC49848345 FU-TONG PROFEN PLASTER 5.30

AC49851100 CIDINCOR FILM COATED TABLETS 1.25 MG 2.01

AC49853316 FUNOCIN CREAM 0.5MG/G "PATRON" 32.40

AC49853321 FUNOCIN CREAM 0.5MG/G "PATRON" 0.00

AC49853329 FUNOCIN CREAM 0.5MG/G "PATRON" 0.00

AC49853335 FUNOCIN CREAM 0.5MG/G "PATRON" 54.00

AC49853338 FUNOCIN CREAM 0.5MG/G "PATRON" 0.00

AC49853355 FUNOCIN CREAM 0.5MG/G "PATRON" 0.00

Page 246: 附件二 藥品給付品項暨支付標準表

AC49854100 ALPRAGIN TABLETS 1.0 MG 2.07

AC49857221 WENTIN INJECTION 10MG/ML“T.F.” 44.40

AC49858100 VACYLESS FILM COATED TABLETS 500 MG 52.00

AC49859212 SETORAL INJECTION 0.3MG 323.00

AC49861100 TORAMATE FILM COATED TABLETS 25MG 5.50

AC49863321 CHIZOCIN CREAM 20.40

AC49863329 CHIZOCIN CREAM 32.70

AC49863335 CHIZOCIN CREAM 35.10

AC49863338 CHIZOCIN CREAM 69.00

AC49864321 FULTIN CREAM 0.05% 25.80

AC49864335 FULTIN CREAM 0.05% 0.00

AC49876100 WINLOPINE EXTENDED RELEASE TABLETS 5MG 2.04

AC49877321 B-Gencin cream“Sinphar” 20.70

AC49877329 B-Gencin cream“Sinphar” 23.50

AC49877335 B-Gencin cream“Sinphar” 38.50

AC49881209 MACEPIM POWDER FOR I.V. INJECTION(1GM) 242.00

AC49881212 MACEPIM POWDER FOR I.V. INJECTION(2GM) 450.00

AC49881277 MACEPIM POWDER FOR I.V. INJECTION(500MG) 151.00

AC49883321 SOFTNSUPPLE OINTMENT 20.60

AC49883335 SOFTNSUPPLE OINTMENT 39.70

AC49887100 DEPRESSOR F.C. TABLETS 50MG"H.S." 4.11

AC49888329 Sinpharderm Keratolytic Cream 40%“Sinphar” 33.80

AC49888343 Sinpharderm Keratolytic Cream 40%“Sinphar” 93.00

AC49889100 MONTEXIN FILM COATED TABLETS 10 MG (MONTELUKAST) 12.30

AC49890212 INNOCAN CONC. SOLUTION FOR I.V. INFUSION 20MG/ML 1589.00

AC49890221 INNOCAN CONC. SOLUTION FOR I.V. INFUSION 20MG/ML 2975.00

AC49891151 LAXUS LIQUID 0.00

AC49891166 LAXUS LIQUID 105.00

AC49891177 LAXUS LIQUID 161.00

AC49899100 NOBELIN F.C. TABLETS 500 MG 22.30

AC49901263 EASYDOBU INJECTION 1MG/ML 173.00

AC49901265 EASYDOBU INJECTION 1MG/ML 197.00

AC49901277 EASYDOBU INJECTION 1MG/ML 0.00

AC49903335 Tarac Topical Cream 0.1%“Purzer” 0.00

AC49903343 Tarac Topical Cream 0.1%“Purzer” 0.00

AC49904100 ACETEC TABLETS 4 MG 6.10

AC49906321 SANMASU CREAM 1.0%“EVEREST” 28.80

AC49906329 SANMASU CREAM 1.0%“EVEREST” 45.00

AC49906335 SANMASU CREAM 1.0%“EVEREST” 56.00

AC49906355 SANMASU CREAM 1.0%“EVEREST” 0.00

AC49908421 TIMOLOL EYE DROPS 0.5% 〝MEDICINE〞(TIMOLOL) 122.00

AC49915100 CIDINCOR FILM COATED TABLETS 2.5 MG 2.01

AC49917321 BUTEFIN CREAM 10MG/G“PATRON” 0.00

AC49917329 BUTEFIN CREAM 10MG/G“PATRON” 0.00

AC49917335 BUTEFIN CREAM 10MG/G“PATRON” 0.00

AC49917355 BUTEFIN CREAM 10MG/G“PATRON” 0.00

AC49918100 LAMIDINE F.C. TABLETS 100 MG 44.80

AC49919321 ALEDO GEL 10MG/GM 10.00

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AC49919323 ALEDO GEL 10MG/GM 11.40

AC49919329 ALEDO GEL 10MG/GM 14.10

AC49919330 ALEDO GEL 10MG/GM 17.40

AC49919335 ALEDO GEL 10MG/GM 20.70

AC49919338 ALEDO GEL 10MG/GM 65.00

AC49919343 ALEDO GEL 10MG/GM 185.00

AC49922100 MINIVANE F.C. TABLETS 45MG 18.40

AC49929100 "RIPUNIN TABLETS 100MG ""TAI YU"" (ALLOPURINOL)" 1.50

AC49932417 BIOMICIN STERILE OPHTHALMIC OINTMENT 61.00

AC49934321 FUSKIN CREAM 20MG/GM 32.20

AC49934329 FUSKIN CREAM 20MG/GM 45.20

AC49934335 FUSKIN CREAM 20MG/GM 126.00

AC49934338 FUSKIN CREAM 20MG/GM 160.00

AC49934348 FUSKIN CREAM 20MG/GM 337.00

AC49953100 SOANDINE CAPSULES 5MG 1.82

AC499531G0 SOANDINE CAPSULES 5MG(鋁箔/膠箔) 2.00

AC49957100 VOLV EXTENDED-RELEASE TABLETS 750MG 1.62

AC49958100 CALMDOWN SUSTAINED-RELEASE CAPSULES 37.5MG 8.90

AC49960100 JALUMEN CAPSULES 5 MG 0.00

AC49962321 FUSIGEN CREAM 20MG/GM 32.20

AC49962326 FUSIGEN CREAM 20MG/GM 42.70

AC49962329 FUSIGEN CREAM 20MG/GM 45.20

AC49962335 FUSIGEN CREAM 20MG/GM 0.00

AC49962338 FUSIGEN CREAM 20MG/GM 0.00

AC49962348 FUSIGEN CREAM 20MG/GM 0.00

AC49963100 WINLOPINE EXTENDED RELEASE TABLETS 10MG 3.58

AC49966100 AMLODINE TABLETS 10MG 3.84

AC49967100 CLOFIX F.C. TABLETS 75MG 32.10

AC49974321 ANEFREE CREAM 0.1% 17.30

AC49974335 ANEFREE CREAM 0.1% 68.00

AC49974343 ANEFREE CREAM 0.1% 154.00

AC49974345 ANEFREE CREAM 0.1% 0.00

AC49974363 ANEFREE CREAM 0.1% 0.00

AC49990209 CEFEMAX POWDER FOR I.V. INJECTION (1 GM) 242.00

AC49990212 CEFEMAX POWDER FOR I.V. INJECTION (2 GM) 450.00

AC49990277 CEFEMAX POWDER FOR I.V. INJECTION (500 MG) 0.00

AC49992100 BROPAN TABLETS 1.5MG 1.52

AC499921G0 BROPAN TABLETS 1.5MG(鋁箔/膠箔) 2.00

AC49995100 REGLINIDE TABLETS 1MG“YUNG SHIN” 2.09

AC49997100 SIMATIN F.C. TABLETS 40 MG 7.50

AC50008100 URACARE TABLETS 10MG 4.29

AC50009100 "RIPUNIN TABLETS 300MG ""TAI YU"" (ALLOPURINOL)" 0.00

AC50010100 MOTEN F.C. TABLETS 10MG“JOHNSON” 1.50

AC500101G0 MOTEN F.C. TABLETS 10MG“JOHNSON”(鋁箔/膠箔) 2.00

AC50011100 CILOPA F.C. TABLETS 40 MG“S.C.” 16.00

AC50013100 GELSO TABLETS 25MG (DIPHENIDOL)“TAI YU” 1.50

AC50014312 CLOVIR CREAM 50MG/GM“PATRON” 0.00

AC50014316 CLOVIR CREAM 50MG/GM“PATRON” 0.00

Page 248: 附件二 藥品給付品項暨支付標準表

AC50014317 CLOVIR CREAM 50MG/GM“PATRON” 0.00

AC50014319 CLOVIR CREAM 50MG/GM“PATRON” 0.00

AC50014321 CLOVIR CREAM 50MG/GM“PATRON” 41.10

AC50014329 CLOVIR CREAM 50MG/GM“PATRON” 42.90

AC50014343 CLOVIR CREAM 50MG/GM“PATRON” 0.00

AC50014355 CLOVIR CREAM 50MG/GM“PATRON” 0.00

AC50015100 SODIUM BICARBONATE TABLETS 0.3 GM“Y.C.” 1.50

AC500151G0 SODIUM BICARBONATE TABLETS 0.3 GM“Y.C.”(鋁箔/膠箔) 2.00

AC50016100 MINIVANE F.C. TABLETS 15MG“SYNRAY” 5.10

AC50018311 FENTANYL TRANSDERMAL PATCH 25 UG/HR "PPCD" 220.00

AC50027100 PLEYA TABLETS 100 MG 11.30

AC50032100 MOBUFEN TABLETS 1.64

AC50034100 PLESTAR TABLETS 50MG 5.50

AC50036100 GAPATIN CAPSULES 400MG 8.80

AC50043100 BEFREE TABLETS 15 MG 6.90

AC50054100 FUTE F.C. TABLETS 5MG 16.90

AC50057100 SPICA CAPSULES 500MG 3.72

AC50061100 BITEVEN F.C. TABLETS 5 MG 2.15

AC50062100 QUEROPIN FILM COATED TABLETS 300MG“YUNG SHIN” 30.80

AC50063265 MEROPEM INTRAVENOUS INJECTION“YUNG SHIN” 281.00

AC50063277 MEROPEM INTRAVENOUS INJECTION“YUNG SHIN” 284.00

AC50078321 DERMACA CREAM 12.80

AC50078329 DERMACA CREAM 14.90

AC50078335 DERMACA CREAM 19.60

AC50078338 DERMACA CREAM 19.60

AC50080100 "GLUCODUE TABLETS ""H.S.""" 0.00

AC50081209 CEFADIME POWDER FOR IV INJECTION 39.20

AC50081212 CEFADIME POWDER FOR IV INJECTION 199.00

AC50081277 CEFADIME POWDER FOR IV INJECTION 26.60

AC50083100 CALM-EZ F.C. TABLETS 25MG 7.30

AC50084100 DIABAN TABLETS 50 MG“C.H.” 3.06

AC50086100 ATORCAL F.C. TABLETS 40 MG“S.C.” 20.20

AC50087100 FENDOWN F.C. TABLETS 160MG 3.92

AC50089100 SYNSEQ TABLETS 4.17

AC50090100 CODEPINE TABLETS 1.50

AC50091100 SYNCON MR TABLETS 30 MG 1.65

AC50092421 SINLIN OPHTHALMIC SOLUTION“SINPHAR” 12.10

AC50092429 SINLIN OPHTHALMIC SOLUTION“SINPHAR” 23.80

AC50094321 CONTRIZOL CREAM 16.00

AC50094329 CONTRIZOL CREAM 35.00

AC50094336 CONTRIZOL CREAM 0.00

AC50094338 CONTRIZOL CREAM 84.00

AC50094355 CONTRIZOL CREAM 0.00

AC50095100 MAFARIN TABLETS 5 MG 4.98

AC50104100 BACFLOCIN F.C. TABLETS 500 MG 20.90

AC50114100 REVELIN CAPSULES 4.5 MG 30.60

AC50116100 SKYTON F.C. TABLETS 25MG 1.50

AC501161G0 SKYTON F.C. TABLETS 25MG (鋁箔/膠箔) 2.00

Page 249: 附件二 藥品給付品項暨支付標準表

AC501161G4 SKYTON F.C. TABLETS 25MG(56粒/瓶) 2.00

AC501161G5 SKYTON F.C. TABLETS 25MG (84粒/瓶) 2.00

AC501161G6 SKYTON F.C. TABLETS 25MG (112粒/瓶) 2.00

AC50123100 LOCEMINE F.C. TABLETS 5 MG“S.C.” 2.21

AC50124138 GUWEI SUSPENSION 20MG/ML 22.50

AC50126100 CLOGREL FILM COATED TABLETS 75MG (CLOPIDOGREL) 32.10

AC50127100 TonBiShu F.C. Tablets 600mg 0.00

AC50128316 AMFULAN CREAM 0.05%“EVEREST” 0.00

AC50128321 AMFULAN CREAM 0.05%“EVEREST” 34.10

AC50128329 AMFULAN CREAM 0.05%“EVEREST” 0.00

AC50128335 AMFULAN CREAM 0.05%“EVEREST” 0.00

AC50128338 AMFULAN CREAM 0.05%“EVEREST” 0.00

AC50128355 AMFULAN CREAM 0.05%“EVEREST” 0.00

AC50130100 ANXOTOS TABLETS 15 MG 6.90

AC50132321 AMI CREAM "EVEREST" 0.00

AC50132329 AMI CREAM "EVEREST" 0.00

AC50132330 AMI CREAM "EVEREST" 0.00

AC50132338 AMI CREAM "EVEREST" 0.00

AC50132343 AMI CREAM "EVEREST" 0.00

AC50135100 Paspertase F.C. Tablets 2.01

AC50136100 MYKYO TABLETS 0.5MG (METOLAZONE) 2.58

AC50137255 TECOSID POWDER FOR I.V. INJECTION 0.00

AC50137263 TECOSID POWDER FOR I.V. INJECTION 0.00

AC50137271 TECOSID POWDER FOR I.V. INJECTION 0.00

AC50138100 FELO E.R. F.C. TABLETS 10MG "EVEREST" 3.58

AC50140100 IMMURIN SOFT GELATIN CAPSULE 100 MG 121.00

AC50141321 T.G.B. CREAM 0.00

AC50141323 T.G.B. CREAM 14.40

AC50141329 T.G.B. CREAM 18.40

AC50141330 T.G.B. CREAM 0.00

AC50141335 T.G.B. CREAM 0.00

AC50141336 T.G.B. CREAM 0.00

AC50141338 T.G.B. CREAM 57.00

AC50142100 HYDROQUINE FILM COATED TABLETS 200MG 2.07

AC50145100 XYZINE F.C. TABLETS 5MG 2.21

AC50152100 GENCARI TABELETS 350MG 2.78

AC50163100 DESCHU TABLETS 5MG 2.19

AC50165100 REMECIN F.C. TABLETS 5MG 55.00

AC50170321 DESONE CREAM 0.25%“PATRON” 0.00

AC50170329 DESONE CREAM 0.25%“PATRON” 0.00

AC50170338 DESONE CREAM 0.25%“PATRON” 0.00

AC50170343 DESONE CREAM 0.25%“PATRON” 0.00

AC50173100 NAGLIX FILM COATED TABLETS 120MG“YUNG SHIN” 2.83

AC50174100 TICLOD F.C. TABLETS 100 MG 3.53

AC50177100 Maxipril 10mg Tablets 5.10

AC50179100 Spasmotin Tablets“Sinphar” 1.75

AC501791G0 Spasmotin Tablets“Sinphar” 2.00

AC50181100 GLIDIER EXTENDED RELEASE TABLETS 5 MG (GLIPIZIDE) 1.51

Page 250: 附件二 藥品給付品項暨支付標準表

AC501811G0GLIDIER EXTENDED RELEASE TABLETS 5 MG (GLIPIZIDE)(鋁箔/

膠箔)2.00

AC50182100 METHIMAZOLE TABLETS 5MG "JOHNSON" 1.50

AC501821G0 METHIMAZOLE TABLETS 5MG "JOHNSON"(鋁箔/膠箔) 2.00

AC50188321 CLENITON GEL 1% 〝S.L.〞 0.00

AC50188329 CLENITON GEL 1% 〝S.L.〞 0.00

AC50188338 CLENITON GEL 1% 〝S.L.〞 0.00

AC50191162 CALAD CALCIUM SUSPENSION 0.00

AC50206177 PIRACETAM ORAL SOLUTION“CENTER” 193.00

AC50207209 CEPIRO POWDER FOR I.V. INJECTION 1GM 206.00

AC50207212 CEPIRO POWDER FOR I.V. INJECTION 1GM, 2GM 0.00

AC50208321 Turnstyle Analgesia Gel“Sinphar” 11.20

AC50208329 Turnstyle Analgesia Gel“Sinphar” 14.80

AC50208335 Turnstyle Analgesia Gel“Sinphar” 22.20

AC50208338 Turnstyle Analgesia Gel“Sinphar” 0.00

AC50208340 Turnstyle Analgesia Gel“Sinphar” 28.20

AC50208343 Turnstyle Analgesia Gel“Sinphar” 28.40

AC50208345 Turnstyle Analgesia Gel“Sinphar” 35.00

AC502083AK Turnstyle Analgesia Gel“Sinphar” 28.20

AC50209151 IEPAIN SUSPENSION 20MG/ML“EVEREST” 25.00

AC50209157 IEPAIN SUSPENSION 20MG/ML“EVEREST” 0.00

AC50210100 RHYNORM FILM COATED TABLETS 150 MG 10.00

AC50214343 SILCIKIS OINTMENT 330.00

AC50222100 DIPERTASE F.C. TABLETS 2.01

AC50223100 Naizhu Tablets 2 mg“S.D.” 2.72

AC50225212LOW CALCIUM (2.5 MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 1.5% DEXTROSE “CHI SHENG”0.00

AC50237100 "WECAM" ELLIC SUSTAINED RELEASE F.C. TABLETS 75MG 1.92

AC50241100 Clotinil F.C. Tablets 75mg 32.10

AC50243121 Elimi-K Powder 9.50

AC50243173 Elimi-K Powder 797.00

AC50254100 RIXIA TABLETS 0.5MG“MACRO”(METOLAZONE) 2.58

AC50260100 TONTARIN TABLETS 50MG“S.L”(DICLOFENAC) 1.50

AC50261100 “T.F.”SU-TON TABLETS 1.53

AC50262321 EASY ACNE GEL 0.1% (ADAPALENE) 17.30

AC50262335 EASY ACNE GEL 0.1% (ADAPALENE) 68.00

AC50262343 EASY ACNE GEL 0.1% (ADAPALENE) 0.00

AC50262345 EASY ACNE GEL 0.1% (ADAPALENE) 0.00

AC50262363 EASY ACNE GEL 0.1% (ADAPALENE) 0.00

AC50263100 DOXTER TABLETS 4 MG 4.80

AC50273100 DEMENZIL F.C. TABLETS 10MG 57.00

AC50340100 SODIUM BICARBONATE TABLETS 0.6 GM“Y.C.” 1.50

AC503401G0 SODIUM BICARBONATE TABLETS 0.6 GM“Y.C.”(鋁箔/膠箔) 2.00

AC50342100 AXOL SUSTAINED RELEASE TABLETS 75MG“YUNG SHIN” 1.77

AC50420100 DESCHU TABLETS 2.5 MG 1.50

AC504201G0 DESCHU TABLETS 2.5 MG(鋁箔/膠箔) 2.00

AC50423100 MAFARIN TABLETS 2.5 MG 4.11

AC50425100 CYLIDER CAPSULES 250MG 43.00

Page 251: 附件二 藥品給付品項暨支付標準表

AC50426100 ROVENDIA F.C. TABLETS 4MG 23.80

AC50428219 NOREPINE INJECTION 100.00

AC50432100 TAKEPRON CAPSULE 30 MG 10.00

AC50768209 KYOTIL IV INJECTION 1MG/ML 185.00

AC50768216 KYOTIL IV INJECTION 1MG/ML 0.00

AC50769100 GLICRON MR TABLETS 30 MG 1.65

AC507691G0 GLICRON MR TABLETS 30 MG(鋁箔/膠箔) 2.00

AC50772100 MYCROS TABLETS 0.5MG 2.58

AC50866100 MYCOCEP CAPSULES 250MG 41.30

AC50874100 FE MIN FILM COATED TABLETS 60MG “CHINTENG” 1.80

AC508741G0FE MIN FILM COATED TABLETS 60MG “CHINTENG”(鋁箔/膠箔)

2.00

AC50880209 CEFEPIME INJECTABLE “TBC” 242.00

AC50880212 CEFEPIME INJECTABLE “TBC” 450.00

AC50880277 CEFEPIME INJECTABLE “TBC” 151.00

AC51022100 FERICH FORTE CAPSULES 4.44

AC51034271 TEICOD FOR INJECTION 400MG 1164.00

AC51036220 PISUTAM LYO FOR INJECTION 226.00

AC510362CX PISUTAM LYO FOR INJECTION 136.00

AC51192100 MUPOD TABLETS 200 MG“S.C.” 18.40

AC51195100 DIGALO TABLETS 1 MG“YU SHENG” 2.01

AC51196421 Shu Kou Yan oral paste 1mg/ g 28.40

AC51196429 Shu Kou Yan oral paste 1mg/ g 59.00

AC51197100 DESORA F.C. TABLETS 5 MG“YU SHENG” 2.19

AC51198100 FUSODATE F.C. TABLET 250MG“YUHSIN” 48.90

AC51203100 LEVOZAL TABLETS 5MG “MACRO” 2.21

AC51389100 NODIZY TABLETS 16 MG 1.50

AC51392430 BUDESON AQUA NASAL SPRAY 100 MCG/DOSE“WEIDAR” 94.00

AC51392438 BUDESON AQUA NASAL SPRAY 100 MCG/DOSE“WEIDAR” 125.00

AC515211A5 FENOTEROL INHALATION SOLUTION“CENTER” 7.80

AC51522321 ESARIN GEL 28.60

AC51522338 ESARIN GEL 80.00

AC51523100 MAXATIN TABLETS 40 MG 14.10

AC51524100 CARBATIN CAPSULES 100 MG 3.32

AC51531143 ASGACON LIQUID 5MCG/ML 0.00

AC51531151 ASGACON LIQUID 5MCG/ML 0.00

AC51531157 ASGACON LIQUID 5MCG/ML 0.00

AC51533209 VANLYO POWDER FOR INJECTION “TAI YU”(VANCOMYCIN) 179.00

AC51533277 VANLYO POWDER FOR INJECTION “TAI YU”(VANCOMYCIN) 76.00

AC51598100 ATOTY F.C. TABLETS 10 MG 9.00

AC51713321 SALISONE OINTMENT 10.90

AC51713329 SALISONE OINTMENT 0.00

AC51713335 SALISONE OINTMENT 52.00

AC51713338 SALISONE OINTMENT 68.00

AC51713340 SALISONE OINTMENT 0.00

AC51713343 SALISONE OINTMENT 0.00

AC51715100 LEVOFLOXACIN F.C. TABLET 500MG “UNION” 20.90

AC517173CS FENTANYL TRANSDERMAL PATCH 50 ΜCG/HR “PPCD” 430.00

Page 252: 附件二 藥品給付品項暨支付標準表

AC51718100 NEPES F.C. TABLETS 10MG 57.00

AC51729100 EVY F.C. TABLETS 10MG 8.10

AC52113100 DONGLU TABLETS 4MG 2.42

AC52114100 DEUNI F.C. TABLETS 25MG “EVEREST” 1.50

AC521141G0 DEUNI F.C. TABLETS 25MG “EVEREST”(鋁箔/膠箔) 2.00

AC52116151 TAMBROXOL SOLUTION 3MG/ML 25.00

AC52116155 TAMBROXOL SOLUTION 3MG/ML 25.00

AC52120265 MOFLODAL INFUSION SOLUTION 400MG/250ML 624.00

AC52122416 CORTIBOND ORABASE 18.50

AC52122417 CORTIBOND ORABASE 21.50

AC52122421 CORTIBOND ORABASE 28.40

AC52122423 CORTIBOND ORABASE 36.70

AC52122429 CORTIBOND ORABASE 59.00

AC52301100 LIPIMINUS F.C TABLETS 40MG 20.20

AC52345100 SILYMARIN CAPSULES "S.C" 1.52

AC523451G0 SILYMARIN CAPSULES "S.C"(鋁箔/膠箔) 2.00

AC52347100 RIBELITE TABLETS 50MG“SYNRAY” 0.00

AC52351100 DEMENZIL F.C. TABLETS 5MG 55.00

AC52354100 NEOCETIN F.C TABLETS 5MG 2.21

AC52357100 TOLAX TABLETS 400MG 1.50

AC52416338 ESECIN GEL 1.5%“P.L.” 86.00

AC52416343 ESECIN GEL 1.5%“P.L.” 113.00

AC52428100 ACERINE S.C. TABLETS 10 MG“WEIDAR” 4.38

AC52430100 METERONE TABLETS 500 MG 0.00

AC52432100 Pentixol F.C. Tablets 10.70

AC52433100 DIMOFAN F.C. TABLETS 1.50

AC52436100 LOSATER F.C. TABLETS 100MG“CHINTENG” 5.80

AC52438143 Witgen Oral Drop“LOTUS” 397.00

AC52452100 TUBERGONE F.C. TABLETS 500MG 4.59

AC52453209 TERLISSIN INJECTION 1MG 805.00

AC52464155 OXYPINE ORAL SUSPENSION〝CENTER〞 308.00

AC52464165 OXYPINE ORAL SUSPENSION〝CENTER〞 755.00

AC52465100 Simva F.C. Tablets 40mg 7.50

AC52473212PERITONEAL DIALYSIS SOLUTION WITH 1.5% DEXTROSE“CHI

SHENG”0.00

AC524741G0PSEUDOEPHEDRINE HCL TABLETS 30MG“PBF” (鋁箔/膠箔)

2.00

AC52475100 Etodolac Capsules 200mg“Sinphar” 3.25

AC52478151 XANLIN LIQUID 5.34MG/ML 25.00

AC52478157 XANLIN LIQUID 5.34MG/ML 28.90

AC52479100 KEZHI FILM COATED TABLETS 40MG 7.50

AC52481100 AN-COUGH CAPSULES“H.S.” 1.50

AC52520100 DU.Q TABLETS 10MG“ROOT” 3.84

AC52522100 CANAFI F.C. TABLETS“Y.C.” 32.10

AC52530100 ATORIN F.C. TABLETS 20MG 16.60

AC52532100 Cetirizine F.C. Tablets 10mg“Sinphar” 1.50

AC525321G0 Cetirizine F.C. Tablets 10mg“Sinphar” 2.00

AC52533100 CHUTAN SR TABLETS 75MG 1.77

Page 253: 附件二 藥品給付品項暨支付標準表

AC52534100 GLIBUDON XR TABLETS 750 MG 1.58

AC525341G0 GLIBUDON XR TABLETS 750 MG(鋁箔/膠箔) 2.00

AC52537100 RIZATAN TABLET 5MG“UNION” 49.80

AC52540121 K-Stone Granules 6.90

AC52544277 0.298% KCL IN 0.9% NACL INJECTION“TBC” 25.40

AC52551277 0.149% KCL IN 0.9% NACL INJECTION“TBC” 25.40

AC52553210 Sulampi powder for IV Injection 750mg、1500mg、3000mg 55.00

AC52553216 SULAMPI POWDER FOR IV INJECTION 750MG、1500MG、3000MG 137.00

AC52553289 Sulampi powder for IV Injection 750mg、1500mg、3000mg 0.00

AC52555417 TETRACYCLINE OPHTHALMIC OINTMENT“WINSTON” 12.00

AC52555421 TETRACYCLINE OPHTHALMIC OINTMENT“WINSTON” 16.60

AC52558416 LOMOLAN OPHTHALMIC SOLUTION 0.25%“GENTLE” 0.00

AC52558421 LOMOLAN OPHTHALMIC SOLUTION 0.25%“GENTLE” 0.00

AC52559100 MAFARIN TABLETS 1 MG 3.60

AC52565263 TEIYU FOR I.V. INJECTION“TAI YU” 516.00

AC52565271 TEIYU FOR I.V. INJECTION“TAI YU” 1164.00

AC52566157 Rivast Oral Solution“Center” 1225.00

AC52568100 SYNZAR F.C. TABLETS 50/12.5 MG 4.11

AC52569421TROPINE EYE DROPS 0.125% 〝MEDICINE〞(ATROPINE SULFATE)

12.00

AC52569429TROPINE EYE DROPS 0.125% 〝MEDICINE〞(ATROPINE SULFATE)

12.00

AC52575100 FLUCOLIN CAPSULES 250 MG 1.60

AC525751G0 FLUCOLIN CAPSULES 250 MG (鋁箔/膠箔) 2.00

AC52576100 LOTEPIN S.C. TABLETS 25 MG 3.57

AC52581100 JOINLO TABLETS 40MG "EVEREST" 14.10

AC52588100 LIMINO F.C. TABLETS 5 MG“H.S.” 2.21

AC52592209 CEPIROM POWDER FOR I.V. INJECTION 1G 206.00

AC52592212 CEPIROM POWDER FOR I.V. INJECTION 2G 0.00

AC52612100 DOPINE TABLETS 10MG“H.H.” 1.50

AC52614100 LOSAPIN F.C TABLETS 50MG "WEIDAR" 4.11

AC52616100 LUXTAB F.C. TABLETS 4 MG (LACIDIPINE) 4.87

AC52617100 NODOFF F.C. TABLETS 5MG 39.50

AC52620100 MENBER TABLETS 5MG“H.H.” 1.50

AC54641209 D.S.E.L. INJECTION“TAI YU” 0.00

AC54641277 "D.S.E.L. INJECTION ""TAI YU""" 29.50

AC54643100 COCINE TABLETS“H.H.”(COLCHICINE) 1.50

AC54647277 SULBACTAM POWDER FOR INJECTION 500 MG“C.C.P.C.” 67.00

AC54857100 AMALIN TABLETS 4MG“C.H.” 2.42

AC54859100 SIPO TABLETS 10MG "EVEREST" 5.10

AC548631G0 LOPIRIN ENTERIC-COATED TABLETS 81MG(鋁箔/膠箔) 2.00

AC54971421 SHUCOMING EYE GEL 0.00

AC54973100 MELINE TABLETS 50MG (MEBHYDROLINE) 1.50

AC54974100 WUTANNING CAPSULES 300MG“KOJAR” 4.36

AC54975100 METERONE TABLETS 100 MG 0.00

AC54979100 ULICIN F.C. TABLETS 500MG“H.S.” 13.20

AC54980100 CITAO-S F.C. TABLETS 10 MG 9.70

AC54983100 REVINA TABLETS 0.00

Page 254: 附件二 藥品給付品項暨支付標準表

AC54985100 ASPIRE ENTERIC-MICROENCAPSULATED CAPSULES 100 MG 1.50

AC549851G0ASPIRE ENTERIC-MICROENCAPSULATED CAPSULES 100 MG(鋁箔/膠

箔)2.00

AC549901G0 PSEUDOEPHEDRINE HCL TABLETS 60MG“PBF” (鋁箔/膠箔) 2.00

AC54992100 VACYLESS FILM COATED TABLETS 1G 91.00

AC55003329 BEING LOTION SOLUTION 1MG/ML 31.80

AC55003338 BEING LOTION SOLUTION 1MG/ML 33.50

AC55003340 BEING LOTION SOLUTION 1MG/ML 33.50

AC55003345 BEING LOTION SOLUTION 1MG/ML 51.00

AC55003363 BEING LOTION SOLUTION 1MG/ML 0.00

AC55005100 PREWELL SUSTAINED-RELEASE TABLETS 150MG“MACRO” 11.70

AC55010100 TILOR TABLETS 50 MG 5.50

AC55011100 ROSITAL F.C. TABLETS 4MG 23.80

AC55012100 SINMARON O.D. TABLETS 30MG 8.90

AC55013100 NEPES F.C. TABLETS 5 MG 55.00

AC55014151 TONINE SUSPENSION 1MG/ML 0.00

AC55021100 NOSMA S.R.M.C. 250MG“WECAM” 1.72

AC55025219 NOREPINEPHRINE INJECTION 4MG/4ML“TAI YU” 100.00

AC55026100 CLOPIDOGREL F.C. TABLETS 75 MG“C.Y.H.” 32.10

AC55029100 SUSEI TABLETS 2.5MG“H.H.”(FENOTEROL) 1.50

AC55043100 CLINDAMYCIN CAPSULES 300MG“PBF” 2.80

AC55051100 MISUL TABLETS 200 MG 18.40

AC551041G0 UN-IMPEDE E.F.C. TABLETS 81MG“MACRO”(鋁箔/膠箔) 2.00

AC55109113 NOOPOL GRANULES FOR ORAL SOLUTION 2400MG 5.70

AC55110220 PIPETAZO POWDER FOR I.V. INJ. 226.00

AC551102AE PIPETAZO POWDER FOR I.V. INJ. 199.00

AC551102CX PIPETAZO POWDER FOR I.V. INJ. 136.00

AC55114212LOW CALCIUM (2.5 MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 4.25% DEXTROSE“CHI SHENG”0.00

AC55115212PERITONEAL DIALYSIS SOLUTION WITH 4.25% DEXTROSE“CHI

SHENG”0.00

AC55118100 URIEF CAPSULES 4 MG 5.70

AC55121209 LOFETA POWDER FOR IV INJ. 1G 78.00

AC55121212 LOFETA POWDER FOR IV INJ. 2G 0.00

AC55121265 LOFETA POWDER FOR IV INJ. 250MG 0.00

AC55121277 LOFETA POWDER FOR IV INJ. 0.5G 0.00

AC55123100PANZYME FILM-COATED TABLETS 212.5/5MG“STANDARD”

(PANCREATIN 212.5MG+METOCLOPRAMIDE HCL 5MG)2.01

AC55227100 ARIPLE TABLETS 10MG 47.30

AC55231343 CALSKIN SCALP SOLUTION 487.00

AC55232100 KETEN E.M.C. 10MG“EVEREST” 4.13

AC55233100 CLINDAMYCIN CAPSULES 150MG“PBF” 1.50

AC55238500 POLININ VAGINAL SUPPOSITORIES“P.L.” 10.90

AC55245100 QUETIA F.C. TABLETS 200 MG 16.30

AC55248100 CETON S.R.M. CAPSULES“WECAM” 2.33

AC55249209 LOTIAM POWDER FOR IV INJ. 1000MG 168.00

AC55249265 LOTIAM POWDER FOR IV INJ. 250 MG 60.00

AC55249277 LOTIAM POWDER FOR IV INJ. 500 MG 136.00

Page 255: 附件二 藥品給付品項暨支付標準表

AC55250321 LIDALENE GEL 17.30

AC55250335 LIDALENE GEL 68.00

AC55250343 LIDALENE GEL 0.00

AC55250345 LIDALENE GEL 0.00

AC55250363 LIDALENE GEL 0.00

AC55252155 LEVIM ORAL SOLUTION 100 MG/ML 419.00

AC55252161 LEVIM ORAL SOLUTION 100 MG/ML 705.00

AC55252166 LEVIM ORAL SOLUTION 100 MG/ML 1337.00

AC55260421 TOBACIN EYE DROPS 0.3%“MEDICINE”(TOBRAMYCIN) 32.80

AC55263197 CEREGENT GRANULES FOR ORAL SOLUTION 1200MG 6.00

AC55267157 Megatus Oral Suspension 40mg/ml 683.00

AC55268100ATORVA FILM-COATED TABLETS 40MG“STANDARD”

(ATORVASTATIN)20.20

AC55269100 HUACOSE TABLETS 100MG 2.58

AC55271100 COFARIN TABLETS 5 MG“GENTLE” 4.98

AC55272100ATORVA FILM-COATED TABLETS 10MG “STANDARD”

(ATORVASTATIN)9.00

AC55277421SULMEZOLE EYE DROPS 4%“MEDICINE”(SULFAMETHOXAZOLE

SODIUM)12.00

AC55277429SULMEZOLE EYE DROPS 4%“MEDICINE”(SULFAMETHOXAZOLE

SODIUM)12.00

AC55277435SULMEZOLE EYE DROPS 4%“MEDICINE”(SULFAMETHOXAZOLE

SODIUM)13.90

AC55283100 LETAMPIN F.C. TABLETS 500MG 22.30

AC55284100 BUPOPIN SR TABLETS 150 MG 11.70

AC55291212PERITONEAL DIALYSIS SOLUTION WITH 2.5% DEXTROSE“CHI

SHENG”0.00

AC55292212PERITONEAL DIALYSIS SOLUTION WITH 2.5% DEXTROSE“CHI

SHENG”0.00

AC55295221Bonecare Concentrate for solution for infusion 4mg/5ml

5433.00

AC55296100 LOSTAN F.C. TABLETS 50MG 4.11

AC55297321 CLEARCIN GEL 10.00

AC55297323 CLEARCIN GEL 11.40

AC55297329 CLEARCIN GEL 14.10

AC55297330 CLEARCIN GEL 17.40

AC55297335 CLEARCIN GEL 20.70

AC55297338 CLEARCIN GEL 65.00

AC55297343 CLEARCIN GEL 185.00

AC552981G0 KOTANG X.R. TABLETS 500 MG(鋁箔/膠箔) 2.00

AC55299100 MULAXIS TABLETS 200MG 1.50

AC552991G0 MULAXIS TABLETS 200MG(鋁箔/膠箔) 2.00

AC55404316 FUISU CREAM 32.40

AC55404321 FUISU CREAM 34.10

AC55404329 FUISU CREAM 44.10

AC55408100 TERODINE F.C. TABLETS 2 MG 7.60

AC55416100 ON LIVER CAPSULES 1.50

Page 256: 附件二 藥品給付品項暨支付標準表

AC55423209FORTIEAN POWDER FOR I.V. INJECTION“PANBIOTIC”(1000MG)

168.00

AC55423265FORTIEAN POWDER FOR I.V. INJECTION“PANBIOTIC”(250MG)

60.00

AC55423277FORTIEAN POWDER FOR I.V. INJECTION“PANBIOTIC”(500MG)

136.00

AC55425329 Shu Le Fu Cream 0.05% 0.00

AC55425335 Shu Le Fu Cream 0.05% 24.80

AC55425338 Shu Le Fu Cream 0.05% 41.90

AC55426100 MINLO F.C. TABLETS 5MG“EVEREST” 2.21

AC55427100 TYRAME TABLETS 100MG (TIARAMIDE) 1.50

AC55428100 PROGREL F.C. TABLETS 75 MG 32.10

AC55530100 Gatamine F.C. Tablets 8mg 26.50

AC55531100 TANZA F.C. TABLETS 50MG 4.11

AC55534100 BETETRIM S.R. FILM-COATED TABLETS 150MG 11.70

AC55538100 “Purzer” Arin F.C. Tablet 10mg (Donepezil HCl) 57.00

AC55539265 EZDOPA INJECTION 3.2 MG/ML 229.00

AC55539277 EZDOPA INJECTION 3.2 MG/ML 0.00

AC55540100 LESYN F.C. TABLETS 6 MG 7.50

AC55541100 TAMEDINE TABLETS 400MG (CIMETIDINE) 1.50

AC55544100 ARIKA TABLETS 15MG 47.30

AC55545248LEVOFLOXACIN I.V. SOLUTION FOR INFUSION 5MG/ML“CHI

SHENG”0.00

AC55545255LEVOFLOXACIN I.V. SOLUTION FOR INFUSION 5MG/ML“CHI

SHENG”0.00

AC55546321 WART DEL CREAM 578.00

AC55552100 “ROOT”DU. Q 5 MG TABLETS 3.84

AC55554166 AZITHROM POWDER FOR ORAL SUSPENSION 140.00

AC55554180 AZITHROM POWDER FOR ORAL SUSPENSION 216.00

AC55554197 AZITHROM POWDER FOR ORAL SUSPENSION 0.00

AC555541B9 AZITHROM POWDER FOR ORAL SUSPENSION 357.00

AC55556100 AMSULPIN TABLETS 200MG 18.40

AC55558100 LOSATER F.C. TABLETS 50MG“CHINTENG” 4.11

AC55561100 IRINA TABLETS 6.40

AC55563100 LAVEZOL CAPSULES 30 MG“WEIDAR” 10.00

AC555641G0 MOSAD TABLETS 5 MG (MOSAPRIDE)(鋁箔/膠箔) 2.00

AC55565100 MOSPEW F.C. TABLETS 5MG“H.S.” 1.75

AC555651G0 MOSPEW F.C. TABLETS 5MG“H.S.”(鋁箔/膠箔) 2.00

AC55566100 MOSAPULIN FILM COATED TABLETS 5MG 1.75

AC555661G0 MOSAPULIN FILM COATED TABLETS 5MG(鋁箔/膠箔) 2.00

AC55567100 PUSADE F.C. TABLETS 5MG 1.75

AC55568100 PERISCON F.C. TABLETS 5 MG 1.75

AC555681G0 PERISCON F.C. TABLETS 5 MG(鋁箔/膠箔) 2.00

AC55569100 MOSDE F.C. TABLETS 5MG 1.75

AC555691G0 MOSDE F.C. TABLETS 5MG(鋁箔/膠箔) 2.00

AC55570100 WELSTRONG TABLETS 5 MG 0.00

AC55571100 MOSAPE F.C. TABLETS 5MG 1.73

AC555711G0 MOSAPE F.C. TABLETS 5MG(鋁箔/膠箔) 2.00

Page 257: 附件二 藥品給付品項暨支付標準表

AC55572100 Weymosa F.C. Tablets 5mg“S.C.” 1.75

AC555721G0 WEYMOSA F.C. TABLETS 5MG“S.C.”(鋁箔/膠箔) 2.00

AC55575209 UBITRON I.V. INJECTION 1 MG/ML 0.00

AC55575216 UBITRON I.V. INJECTION 1 MG/ML (3 ML) 0.00

AC55576100 HANLOSIN S.R.O.D. TABLETS 0.2 MG 5.60

AC55577114 IPRATRAMOL INHALATION SOLUTION 〝CENTER〞 0.00

AC55583100 ATORCAL F.C. TABLETS 20MG“S.C.” 16.60

AC55584100 MOZAPRY F.C. TABLETS 5 MG 1.75

AC555841G0 MOZAPRY F.C. TABLETS 5 MG(鋁箔/膠箔) 2.00

AC55888100 FOLIC ACID TABLETS 5MG“Y.Y.” 1.50

AC558881G0 FOLIC ACID TABLETS 5MG“Y.Y.”(鋁箔/膠箔) 2.00

AC558881G2 FOLIC ACID TABLETS 5MG“Y.Y.”(30粒/瓶) 2.00

AC55889100 KANTEC CAPSULES“Y.C.” 2.83

AC55890100 HEARTOACE CAPSULES 100MG“Y.Y.” 5.00

AC55892209 CEFDIME FOR IV INJECTION 39.20

AC55892212 CEFDIME FOR IV INJECTION 199.00

AC55892265 CEFDIME FOR IV INJECTION 0.00

AC55892277 CEFDIME FOR IV INJECTION 0.00

AC55894100 PLAQUIL F.C. TABLETS 200 MG "Y.C." 2.07

AC55895100 ATORCAL F.C. TABLETS 10MG“S.C.” 9.00

AC55896100 FELO E.R. F.C. TABLETS 5MG“EVEREST” 2.04

AC55901100 BRISTIN TABLETS“Y.C.” 1.50

AC55902100 MESACOL TABLETS 25MG“Y.C.” 1.63

AC559021G0 MESACOL TABLETS 25MG“Y.C.”(鋁箔/膠箔) 2.00

AC55905100 DOFEN CAPSULES 1.59

AC55906100 PENLEX TABLETS 5MG“Y.C.” 2.15

AC55907100 SPASFEN TABLETS“Y.C.”25MG (BACLOFEN) 8.70

AC55908100 PONTAN F.C. TABLETS 500MG“Y.Y.” 1.50

AC55909421 DELLERGY EYE DROPS“Y.Y.” 17.70

AC55909429 DELLERGY EYE DROPS“Y.Y.” 33.20

AC55910100 MEXAZOL TABLETS“Y.C.” 1.62

AC559101G0 MEXAZOL TABLETS“Y.C.”(鋁箔/膠箔) 2.00

AC55913209 VOMSTOP I.V. INJECTION 1MG/ML 185.00

AC55913216 VOMSTOP I.V. INJECTION 1MG/ML 347.00

AC55916100 “T.F.”SU-MIN F.C.T 180MG 4.60

AC55917100 MYSOZYME TABLETS 100MG (LYSOZYME) 1.50

AC55920100 BERON F.C.TABLETS 8MG“EVEREST” 2.28

AC55924100 RIVOPAM TABLETS 2MG“Y.Y.” 1.86

AC559241G0 RIVOPAM TABLETS 2MG “Y.Y.”(鋁箔/膠箔) 2.00

AC55925100 LISEN F.C. TABLETS 200MG“Y.Y.” 2.07

AC55926100 TARACTEN TABLETS 50MG“Y.Y.” 4.03

AC55927100 DELIPID CAPSULES 300MG“Y.Y.” 0.00

AC55928100 LEVIM FILM COATED TABLETS 500 MG 22.30

AC55934229 ORECTALIP IV INJECTION 5MG/ML“SINPHAR” 1336.00

AC55934238 ORECTALIP IV INJECTION 5MG/ML“SINPHAR” 4420.00

AC55934245 ORECTALIP IV INJECTION 5MG/ML“SINPHAR” 9592.00

AC55939100 EXMEM FILM-COATED TABLETS 10 MG 7.60

AC55940321 HONEX OINTMENT 0.00

Page 258: 附件二 藥品給付品項暨支付標準表

AC55940329 HONEX OINTMENT 44.50

AC55941100 TONTIN TABLETS 200MG“Y.Y.” 6.80

AC55945100 ALLEVO F.C. TABLETS 5MG“CBC” 2.21

AC55947100 TANFU TABLETS 100MG“KOJAR” 1.76

AC559471G0 TANFU TABLETS 100MG“KOJAR”(鋁箔/膠箔) 2.00

AC55949209 TONYUAN FOR I.V. INJECTION 30MG/ML"Y.Y." 17.00

AC55949212 TONYUAN FOR I.V. INJECTION 30MG/ML "Y.Y." 24.00

AC55950100 COSAR F.C. TABLETS 50 MG 4.11

AC55951417 VICEMER EYE GEL 0.2%“KINGDOM”(CARBOMER) 31.30

AC55951423 VICEMER EYE GEL 0.2%“KINGDOM”(CARBOMER) 61.00

AC55951429 VICEMER EYE GEL 0.2%“KINGDOM”(CARBOMER) 102.00

AC55952100 ATOTY F.C. TABLETS 20 MG 16.60

AC55953100 SETRON F.C. TABLETS 1MG 167.00

AC559541G0FEXODINE F.C. TABLETS 60MG“STANDARD”(FEXOFENADINE

HYDROCHLORIDE)(鋁箔/膠箔)2.00

AC55956100 LIPIMINUS F.C. TABLETS 20MG 16.60

AC55957100 LISIPRIL TABLETS 10 MG“S.D.” 2.29

AC55958221 ENBOSUN INJECTION 0.84MG/ML 25.00

AC55961100 CARISOMA TABLETS 250 MG 2.17

AC55963100 ANPUROL TABLETS 100MG (ALLOPURINOL) 0.00

AC55965100 ZOLMIN CAPSULES 5MG“C.H.” 1.81

AC55974100 SUPERIDE TABLETS 200MG“KINGDOM”(AMISULPRIDE) 18.40

AC55981209 JUSTIAM POWDER FOR INTRAVENOUS INJECTION 0.00

AC55981277 JUSTIAM POWDER FOR INTRAVENOUS INJECTION 0.00

AC55985100 METFOPIN F.C. TABLETS 850MG 1.68

AC559851G0 METFOPIN F.C. TABLETS 850MG(鋁箔/膠箔) 2.00

AC55987100 YESINDON TABLETS 25 MG 3.19

AC55989421 LEMIN EYE DROPS“KINGDOM” 14.10

AC559901G0 MOSA F.C. TABLETS 5MG(鋁箔/膠箔) 2.00

AC56296255 CAKEEP 5MG/100ML SOLUTION FOR INFUSION 9697.00

AC56299100 METINA TABLETS 2.01

AC56306100 "PPCD"MORPHINE SULFATE TABLETS 15MG 6.00

AC56311100 NICORDIL TABLETS 5 MG“S.D.” 2.89

AC56313100 BENECOL TABLETS“Y.C.”50MG 3.45

AC56314100 PODO CAPSULES 20 MG 0.00

AC56316100 Tamos Capsules 100 mg 2543.00

AC56317100 ACTEIN EFFERVESCENT TABLETS 1200MG 11.10

AC56319100 LIPIMINUS F.C.TABLETS 10MG 9.00

AC56321100 NORINA TABLETS 5MG 1.66

AC56629100 LECITOL XL FILM-COATED TABLETS 80MG 10.20

AC56633100 CONIEL F.C. TABLETS 4MG 3.31

AC56643100 BIBI-U CAPSULES 150MG 1.50

AC566431G0 BIBI-U CAPSULES 150MG(鋁箔/膠箔) 2.00

AC56645100 NODOFF F.C. TABLETS 10MG "SYNRAY" 65.00

AC56646100 AREZIL ODT TABLETS 5 MG "STANDARD" 55.00

AC56647100 SOTREL CAPSULES 9.50

AC56652100 METDIA E. R. TABLETS 500MG 1.50

AC56657209 CETICIN FOR IV INJECTION 312.00

Page 259: 附件二 藥品給付品項暨支付標準表

AC56657212 CETICIN FOR IV INJECTION 0.00

AC56657265 CETICIN FOR IV INJECTION 0.00

AC56657277 CETICIN FOR IV INJECTION 163.00

AC56659100 PACLONE CAPSULES 1.50

AC56660100 FLUXEL F.C. TABLETS 2.15

AC566611G0LODITON FILM-COATED TABLETS 850MG "STANDARD"(鋁箔/膠箔)

2.00

AC56662100 BELOTON F. C. TABLETS 5MG 2.21

AC56663421ALMIDINE OPHTHALMIC SOLUTION 0.15% "KINGDOM"

(BRIMONIDINE)229.00

AC56663429ALMIDINE OPHTHALMIC SOLUTION 0.15% "KINGDOM"

(BRIMONIDINE)503.00

AC56666100 FUWELL F.C. TABLET 40MG 3.77

AC56667100 LECADOPA 25/100 TABLETS 4.74

AC56669100 ROSITAZONE F.C. TABLETS 4MG 23.80

AC56673265 N.T.G. PREMIXED INJECTION 0.2MG/ML 369.00

AC56673277 N.T.G. PREMIXED INJECTION 0.2MG/ML 664.00

AC56679100 MUXA TABLETS 500MG "H.S." 2.83

AC56681100 LADIPINE F.C. TABLETS 4MG 4.87

AC56682100 ATOROTY F.C. TABLETS 10MG 9.00

AC56688100 FLAVO TABLETS 200MG 3.74

AC56689100 IBESAA F.C. TABLETS 150MG 5.40

AC56692100 U-CHU PIOZON TABLETS 15MG 6.90

AC56693100 ALISA F.C. TABLETS 3.91

AC56700421 Almonine Ophthalmic Solution 0.2% (Brimonidine) 229.00

AC56701100 UFREE ER TABLETS 750 MG 30.20

AC56702100 UFREE ER TABLETS 500 MG 20.80

AC56706100 TRACETON FILM COATED TABLETS 3.32

AC56707161 MEMARY ORAL SOLUTION "CENTER" 436.00

AC56708100 ABIMAY TABLETS 20MG 69.00

AC56711321 FUSIDINE CREAM 32.20

AC56711326 FUSIDINE CREAM 42.70

AC56711329 FUSIDINE CREAM 45.20

AC56711335 FUSIDINE CREAM 126.00

AC56711338 FUSIDINE CREAM 160.00

AC56711348 FUSIDINE CREAM 0.00

AC56712100 EPINE F.C. TABLETS 25MG 7.30

AC56713312 KOULENING ORALBASE 31.80

AC56713321 KOULENING ORALBASE 35.60

AC56713326 KOULENING ORALBASE 61.00

AC56716100 JIANGHO TABLETS 10MG 3.84

AC56720100 SYNPID F.C TABLETS 160MG 3.92

AC56725161 TALOPRAM ORAL SOLUTION "CENTER" 259.00

AC56725164 TALOPRAM ORAL SOLUTION "CENTER" 415.00

AC56726100 ARIPLE TABLETS 20MG 69.00

AC56730100 ANASTROZOLE F.C. TABLETS 1MG "SINPHAR" 45.30

AC56733100 HARKIN TABLETS "Y.C." 2.36

AC56734265 EASY-ISOSORBIDE INJECTION 0.01% 795.00

Page 260: 附件二 藥品給付品項暨支付標準表

AC56734277 EASY-ISOSORBIDE INJECTION 0.01% 0.00

AC56735100 TOPLAX FILM-COATED TABLETS 50MG 1.52

AC56737100 DONEZIL F.C TABLETS 5MG 55.00

AC56738100 MIXRE CAPSULES 25MG 55.00

AC56745100 TESAA TABLETS 40MG 6.90

AC56746100 BREXA F.C. TABLETS 10MG 65.00

AC56750248 BACFLOCIN I.V. SOLUTION FOR INFUSION 5MG/ML 376.00

AC56750255 BACFLOCIN I.V. SOLUTION FOR INFUSION 5MG/ML 601.00

AC56751100 ALLEDINE F.C. TABLETS 180MG 4.60

AC56754100 FENOFIBRATE CAPSULE 200MG "S.C." 3.92

AC56755100 SINMARON O.D. TABLETS 15MG 5.10

AC56759220 PIPE & TAZO POWDER FOR INJECTION "CYH" 226.00

AC567592CX PIPE& TAZO POWDER FOR INJECTION "CYH" 136.00

AC56760100 LECADOPA 10/100 TABLETS 3.95

AC56767143 LEVOCETIRIZINE ORAL SOLUTION "CENTER" 25.00

AC56767151 LEVOCETIRIZINE ORAL SOLUTION "CENTER" 34.50

AC56767157 LEVOCETIRIZINE ORAL SOLUTION "CENTER" 83.00

AC56770143 Spiterin Oral Solution 1mg/ml (Risperidone) 548.00

AC56770151 Spiterin Oral Solution 1mg/ml (Risperidone) 1113.00

AC56771345 DANAFEN PLASTER "T.S." 5.30

AC56775100 IMMUPNYN F.C. TABLETS 600MG 42.70

AC56778100 SALICRET F.C. TABLETS 5MG 14.90

AC56780100 MICAPINE F.C. TABLETS 10MG 5.50

AC56785100 MONTEKA CHEWABLE TABLETS 5MG 9.30

AC56789100 JFS FCT "ROOT" 180MG 4.60

AC56790100 FLUGALIN TABLETS "Y.C." 2.49

AC56791100 LIPIKON F.C. TABLETS 10MG 9.00

AC56794100 Xyrizine F.C. Tablets 5mg (Levocetirizine) 2.21

AC56798321 TAIYA NAIL LACQUER 666.00

AC56800100 APA-MIRTAZAPINE O.D.T. 30MG 8.90

AC56801100 SERULINE F.C. TABLETS 50MG "ROYAL" 6.10

AC56804100 SIMVASTATIN F.C. TABLETS 20MG "CYH" 3.58

AC56806100 SINTY F.C. TABLETS 40MG 7.50

AC56807421 CHICALING GEL 0.00

AC57101100 LEVOPING F.C. TABLETS 500MG 20.90

AC57102100 NITROLIN F.C. TABLETS 100MG "Y.Y." 2.52

AC57104100 SUPRIDE F.C. TABLETS 5MG "MACRO" 1.73

AC571061G0 ZHITI TABLETS 60MG(鋁箔/膠箔) 0.00

AC57111100 LURIDE TABLETS 50MG "LITA" 1.53

AC57113321 "SENTAI" COSHIYAN CREAM 13.90

AC57113323 "SENTAI" COSHIYAN CREAM 0.00

AC57113329 "SENTAI" COSHIYAN CREAM 0.00

AC57113330 "SENTAI" COSHIYAN CREAM 0.00

AC57113335 "SENTAI" COSHIYAN CREAM 0.00

AC57113336 "SENTAI" COSHIYAN CREAM 29.70

AC57113338 "SENTAI" COSHIYAN CREAM 57.00

AC57114100 AMLODIPINE TABLETS 5MG "CYH" 3.84

AC57115100 JFS FCT "ROOT" 60MG 1.80

Page 261: 附件二 藥品給付品項暨支付標準表

AC571151G0 JFS FCT "ROOT" 60MG(鋁箔/膠箔) 2.00

AC57117100 GLIMEPIRIDE TABLETS 2MG "CYH" 1.95

AC57121100 LORAPSEUDO SR F.C. TABLETS 5/120MG "CYH" 3.01

AC57122100 NSTEINE EFFERVESCENT TABLETS 600MG 5.40

AC57126100PAVATIN PROTECT TABLETS 40MG "STANDARD" (PRAVASTATIN

SODIUM)14.10

AC57127100 FEXOFENADINE F.C. TABLETS 60MG "CYH" 1.80

AC571271G0 FEXOFENADINE F.C.TABLETS 60MG "CYH"(鋁箔/膠箔) 2.00

AC57128100 CARVEDILOL TABLETS 25MG "CYH" 3.19

AC57130100 ROTLIP FILM-COATED TABLETS 10MG 13.40

AC57131100 ARIFY TABLETS 10MG "STANDARD" (ARIPIPRAZOLE) 47.30

AC57132221 TRANEXAMIN INJECTION 5% (TRANEXAMIC ACID) "CHI SHENG" 15.00

AC57132229 TRANEXAMIN INJECTION 5% (TRANEXAMIC ACID) "CHI SHENG" 15.00

AC57133100 ATOTIN F.C. TABLETS 40MG 20.20

AC57135321 SOFTCAM GEL 10MG/G 11.20

AC57135329 SOFTCAM GEL 10MG/G 14.80

AC57135335 SOFTCAM GEL 10MG/G 22.20

AC57135336 SOFTCAM GEL 10MG/G 22.20

AC57135338 SOFTCAM GEL 10MG/G 23.10

AC57135340 SOFTCAM GEL 10MG/G 28.20

AC57135343 SOFTCAM GEL 10MG/G 28.40

AC57135345 SOFTCAM GEL 10MG/G 35.00

AC57135355 SOFTCAM GEL 10MG/G 0.00

AC57138100 EPINE F.C. TABLETS 200MG 16.30

AC57139100 SULPIRIDE TABLETS 200MG "LITA" 1.71

AC57142100 ARIFY TABLETS 15MG "STANDARD" (ARIPIPRAZOLE) 47.30

AC57143417KINZATEN OPHTHALMIC SOLUTION 0.25MG/ML "KINGDOM"

(KETOTIFEN)32.90

AC57143421KINZATEN OPHTHALMIC SOLUTION 0.25MG/ML "KINGDOM"

(KETOTIFEN)45.10

AC57147100 ALLEDINE F.C. TABLETS 60MG 1.80

AC571471G0 ALLEDINE F.C. TABLETS 60MG(鋁箔/膠箔) 2.00

AC57153100 CO-DAIANXO CAPSULES 80/12.5MG 6.00

AC57157338 AI-SHU JHONG GEL 15MG/G "S.D." 0.00

AC57168100 TANG BI TUO TABLETS 100MG "Y.Y." 0.00

AC57170100 LORAPSEUDO 24H SR F.C. TABLETS 10/240MG "CYH" 6.70

AC57171100 "U-LIANG" EUTOMIN TABLETS 1000MG 1.75

AC571711G0 "U-LIANG" EUTOMIN TABLETS 1000MG(鋁箔/膠箔) 2.00

AC57172100 "U-LIANG" EUTOMIN TABLETS 850MG 1.68

AC571721G0 "U-LIANG" EUTOMIN TABLETS 850MG(鋁箔/膠箔) 2.00

AC57173100 MOXICIN F.C. TABLETS 400MG 80.00

AC57176100 KEZHI FILM COATED TABLETS 20MG 3.58

AC57177100 GLIBUDON TABLETS 500MG 1.50

AC571771G0 GLIBUDON TABLETS 500MG(鋁箔/膠箔) 2.00

AC57182343 CALPONEX OINTMENT 461.00

AC57183100 "COUGHMEN TABLETS 20MG (BENPROPERINE) ""ASTAR""" 1.50

AC57185248 CRAVIT IV SOLUTION FOR INFUSION 5MG/ML 376.00

AC57185255 CRAVIT IV SOLUTION FOR INFUSION 5MG/ML 601.00

Page 262: 附件二 藥品給付品項暨支付標準表

AC57188100 TANLIXOL S.R. CAPSULES 75MG 1.77

AC57191261 LEXACIN I.V. SOLUTION FOR INFUSION 5MG/ML "TAI YU" 619.00

AC57192100 QUETIALIN F.C. TABLETS 100MG "KINGDOM" (QUETIAPINE) 12.10

AC57196100 GAPATIN CAPSULES 100MG "SYNRAY" 3.32

AC57199100 ZONEGRAN FILM-COATED TABLETS 100 MG 14.10

AC57202265 MOXACIN INFUSION SOLUTION 400MG/250ML 624.00

AC57216100 LINICOR F.C.T. 500/20MG 8.30

AC57219100 NIFEDIPINE S.R.F.C. TABLETS 30MG "CYH" 5.10

AC57220248 LFLOCIN IV SOLUTION FOR INFUSION 5MG/ML 0.00

AC57220255 LFLOCIN IV SOLUTION FOR INFUSION 5MG/ML 601.00

AC57220261 LFLOCIN IV SOLUTION FOR INFUSION 5MG/ML 619.00

AC57221221 HESHARIN INJECTION 5000 IU/ML "TAI YU" 38.30

AC57221240 HESHARIN INJECTION 5000 IU/ML "TAI YU" 166.00

AC57221248 HESHARIN INJECTION 5000 IU/ML "TAI YU" 298.00

AC57221299 HESHARIN INJECTION 5000 IU/ML "TAI YU" 2.88

AC57222221 HESHARIN INJECTION 1000 IU/ML "TAI YU" 38.30

AC57222229 HESHARIN INJECTION 1000 IU/ML "TAI YU" 73.00

AC57226100 MUSINE TABLETS "H.S." 1.53

AC572261G0 MUSINE TABLETS "H.S."(鋁箔/膠箔) 2.00

AC57229351 BECLOSOL WASH SHAMPOO 0.5MG/G 218.00

AC57229358 BECLOSOL WASH SHAMPOO 0.5MG/G 471.00

AC57231100 EPINE F.C. TABLETS 300MG 30.80

AC57232100 Depressure Film Coated Tablets 80mg 6.00

AC57235100 ROOPRIL TABLETS 2.5MG "S.C." 2.98

AC57236100 IBUPROFEN F.C. TABLETS 600MG "C.H." 1.64

AC572361G0 IBUPROFEN F.C. TABLETS 600MG "C.H." 2.00

AC57238100 CORTA F.C. TABLETS "Y.C." 1.95

AC572381G0 CORTA F.C. TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC57239100 FREKEY F.C. TABLETS 100MG "EVEREST" 2.97

AC57241421 CARTOLOL EYE DROPS 2% "MEDICINE" (CARTEOLOL HCL) 177.00

AC57242100 BACFLOCIN F.C. TABLETS 100MG 3.21

AC57244100 GLUPIN TABLETS 850MG 1.68

AC57246100 SYNBOT TABLETS 10MG 1.54

AC57248343 CALCITOL CREAM 461.00

AC57249100 BIDERMIN CAPSULES "Y.C." 1.60

AC572491G0 BIDERMIN CAPSULES "Y.C."(鋁箔/膠箔) 2.00

AC57250100 KERIS TABLETS 350MG 2.78

AC57253329 HULI GEL 7.5MG/GM "SENTAI" 0.00

AC57253330 HULI GEL 7.5MG/GM "SENTAI" 0.00

AC57253335 HULI GEL 7.5MG/GM "SENTAI" 38.60

AC57253338 HULI GEL 7.5MG/GM "SENTAI" 0.00

AC57253343 HULI GEL 7.5MG/GM "SENTAI" 0.00

AC572541G0MOSAPIN F.C. TABLET 5MG "STANDARD" (MOSAPRIDE)(鋁箔/膠

箔)2.00

AC57259100 LEPRAM F.C. TABLETS 10MG "KINGDOM" (ESCITALOPRAM) 9.70

AC57261100SINPRAZOLE ENTERIC F.C. TABLETS 20MG "KINGDOM"

(RABEPRAZOLE)8.70

AC57262321 CIVIDOID CREAM "SINPHAR" 17.50

Page 263: 附件二 藥品給付品項暨支付標準表

AC57262329 CIVIDOID CREAM "SINPHAR" 32.60

AC57262333 CIVIDOID CREAM "SINPHAR" 37.50

AC57262338 CIVIDOID CREAM "SINPHAR" 37.50

AC57262345 CIVIDOID CREAM "SINPHAR" 109.00

AC57264100 DIPACHRO S.R. FILM COATED TABLETS 300MG 4.26

AC57265100 METFORMIN F.C. TABLETS 850MG "C.H." 1.68

AC57267100 ATOTIN F.C. TABLETS 10MG 9.00

AC57269100 THALI CAPSULES 50MG 0.00

AC57270100 MOBUFEN TABLETS 400MG "S.C." 1.50

AC57271100 FUWELL F.C. TABLETS 20MG 1.59

AC57274100 LANSOPRAZOLE CAPSULES 30MG "CYH" 10.00

AC57276255 POTASSIUM CHLORIDE INJECTION 1MEQ/ML "TBC" 24.70

AC57278263 TARGONIN FOR IV INJECTION 516.00

AC57278271 TARGONIN FOR IV INJECTION 1164.00

AC57280100 "T.F." SU-MIN F.C. TABLETS 60MG 1.80

AC572801G0 "T.F." SU-MIN F.C. TABLETS 60MG(鋁箔/膠箔) 2.00

AC57281245 PANTYL FOR I.V. INJECTION 40MG 119.00

AC57282100 LILONTON F.C. TABLETS 1200MG 1.91

AC57284100 MIRTINE ORALLY DISINTEGRATING TABLETS 30MG 8.90

AC57285209 MEROPENEM POWDER FOR INJECTION "CYH" 0.00

AC57285265 MEROPENEM POWDER FOR INJECTION "CYH" 281.00

AC57285277 MEROPENEM POWDER FOR INJECTION "CYH" 284.00

AC57286277 VANCOMYCIN FOR I.V. INJECTION 500MG "CYH" 76.00

AC57288100 DOXAZON TABLETS 4MG "S.C." 4.80

AC57289216 ANCARE INJECTION 100MG/ML 15.00

AC57292100 LIPAOSHU TABLETS 400MG "KOJAR" 5.60

AC57297100 FENADIN F.C. TABLETS 60MG "WEIDAR" 1.80

AC572971G0 FENADIN F.C. TABLETS 60MG "WEIDAR"(鋁箔/膠箔) 2.00

AC57298100 NOBELIN (R) XR F.C. TABLETS 500MG 20.70

AC57300100 LEVOFLOXACIN F.C. TABLETS 100MG "CYH" 3.21

AC57304100 QUETIA F.C. TABLETS 100MG 12.10

AC57306100 ZOLPIDEM F.C. TABLETS 10MG "CYH" 1.76

AC573061G0 ZOLPIDEM F.C. TABLETS 10MG "CYH"(鋁箔/膠箔) 2.00

AC57308100 ALLREX TABLETS "Y.C." 4.29

AC57313255 HYDROCORTISONE POWDER FOR INJECTION 100MG"S.T." 28.20

AC57314235 CARBOPLATIN IV INJECTION 10MG/ML "SINPHAR" 1448.00

AC573142AP CARBOPLATIN IV INJECTION 10MG/ML "SINPHAR" 3058.00

AC57316113 CETAM GRANULES FOR ORAL SOLUTION 2400MG "Y.C." 6.00

AC573172770.149% KCL IN 5% DEXTROSE AND 0.33% NACL INJECTION "TBC"

29.50

AC57318100 IBESAA F.C. TABLETS 300MG 9.10

AC57323151 NAPOTIN ORAL SUSPENSION "CENTER" 44.30

AC57323157 NAPOTIN ORAL SUSPENSION "CENTER" 84.00

AC57325100 AMLOBENTREL TABLET 9.60

AC57326100 GLIBOS F.C. TABLETS 100MG 4.69

AC57329421 CROMOMIN EYE DROPS "SINPHAR" 14.50

AC57329429 CROMOMIN EYE DROPS "SINPHAR" 28.30

AC57339100 BIPROFEN TABLETS 50MG 1.50

Page 264: 附件二 藥品給付品項暨支付標準表

AC57341100 ARIPRAZOLE TABLETS 10MG "KINGDOM" (ARIPIPRAZOLE) 0.00

AC57342100 VOSAA F.C. TABLETS 320MG 28.20

AC57345221ZODONIC CONCENTRATE FOR SOLUTION FOR INFUSION 4MG/5ML

"YUNG SHIN"5433.00

AC57352100 VALANVIR FILM COATED TABLETS 500MG 52.00

AC57353100 VALANVIR FILM COATED TABLETS 1GM 91.00

AC57356100 LESITON CAPSULES 5MG 9.70

AC57359100 RABETT E.F.C. TABLETS "Y.C." 8.70

AC57363100 LETAMPIN F.C. TABLETS 250MG 8.90

AC57366100 PLUSDMAX TABLETS "SINPHAR" 152.00

AC57368100 CONIEL F.C. TABLETS 8 MG 6.20

AC57370100 PINVIO TABLETS 12.5MG 2.76

AC57371100 KOVAN PLUS Film Coated Tablets 80/12.5mg 〝MACRO〞 6.00

AC57374277 LYACETY POWDER FOR INJECTION "CYH" 15.00

AC57376248 LEVOFOR IV SOLUTION FOR INFUSION 5MG/ML 0.00

AC57376255 LEVOFOR IV SOLUTION FOR INFUSION 5MG/ML 601.00

AC57376261 LEVOFOR IV SOLUTION FOR INFUSION 5MG/ML 619.00

AC57377100 MIXRE CAPSULES 18MG 0.00

AC57378100 ANSUMYCIN TABLETS 250MG "YUNG SHIN" 17.50

AC57380100 VALSARDIN FILM COATED TABLETS 160MG "YUNG SHIN" 7.30

AC57381100 VALSARDIN FILM COATED TABLETS 80MG "YUNG SHIN" 6.00

AC57383100 ESCITALO F.C. TABLETS 5MG 3.78

AC57385151 ANTIFLAM ORAL SOLUTION "CHI SHENG" 49.00

AC57387100 JIANGMIN E.R. F.C. TABLETS "S.C." 7.90

AC57392100 TORODINE F.C. TABLETS 2MG "KINGDOM" (TOLTERODINE) 7.60

AC57397100 ADENO TABLETS "Y.C." 1.50

AC573971G0 ADENO TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC57399100 SHITERIN TABLETS 25MG "S.L." 1.50

AC57400100 COLOLEX. TABLETS 20MG 9.90

AC57401100 MIXRE CAPSULES 40MG 54.00

AC57403100 PATAMIN F.C. TABLETS 100MG "Y.C." 0.00

AC57404100 ACHELEX TABLETS "SINPHAR" 3.21

AC57410100 OLSAA F.C. TABLETS 40MG 13.60

AC57413100 PERDOPRIL TABLETS 8MG 9.40

AC574172770.298% KCL IN 5% DEXTROSE AND 0.9% NACL INJECTION "TBC"

29.50

AC574182770.149% KCL IN 5% DEXTROSE AND 0.9% NACL INJECTION "TBC"

29.50

AC57729100 NORCOL F.C. TABLETS 20MG "S.C." 1.50

AC577291G0 NORCOL F.C. TABLETS 20MG "S.C."(鋁箔/膠箔) 2.00

AC57730100 CLEANLIP CAPSULE 100MG 2.51

AC57731100 RAKINSON TABLETS "CENTER" 68.00

AC57732100 LENOZOLE F.C. TABLETS 2.5MG 38.70

AC57735135 ANCOWI SUSPENSION 20MG/ML "CHEN SING" 13.40

AC57735165 ANCOWI SUSPENSION 20MG/ML "CHEN SING" 91.00

AC57738265VIRLESS LYOPHILIZED I.V. INFUSION 250MG "YUNG SHIN"

(ACYCLOVIR)287.00

AC57741100 JOINLO TABLET 20MG "EVEREST" 5.90

Page 265: 附件二 藥品給付品項暨支付標準表

AC57745151 DOXYCOUGH SYRUP "CENTER" 25.00

AC57745157 DOXYCOUGH SYRUP "CENTER" 25.00

AC57747100 DAMPURINE TABLETS 50MG 3.45

AC57748277 0.298% KCL IN 5% DEXTROSE INJECTION "TBC" 29.50

AC57749255 HYDROCORTISONE INJECTION 100MG "CYH" 35.30

AC57753209 OXACILLIN POWDER FOR INJECTION "CYH" 38.30

AC57753212 OXACILLIN POWDER FOR INJECTION "CYH" 0.00

AC57753265 OXACILLIN POWDER FOR INJECTION "CYH" 0.00

AC57753277 OXACILLIN POWDER FOR INJECTION "CYH" 0.00

AC57761151 SYNTAM ORAL SOLUTION 200 MG/ML 0.00

AC57761157 SYNTAM ORAL SOLUTION 200 MG/ML 48.70

AC57761163 SYNTAM ORAL SOLUTION 200 MG/ML 76.00

AC57761164 SYNTAM ORAL SOLUTION 200 MG/ML 0.00

AC57762210 AMSULBER POWDER FOR INJECTION "CYH" 55.00

AC57762216 AMSULBER POWDER FOR INJECTION "CYH" 0.00

AC57762289 AMSULBER POWDER FOR INJECTION "CYH" 55.00

AC57763100 MONTEKA CHEWABLE TABLETS 4MG 9.10

AC57777100UTRAPHEN F.C. TABLETS 37.5MG/325MG "STANDARD" (TRAMADOL

HCL + ACETAMINOPHEN)3.32

AC57779100 TRAMACET F.C. TABLETS 3.32

AC57782100 E-ULCER ENTERIC F.C. TABLETS 20MG "S.C." 8.70

AC57784277 0.149%KCL IN 5% DEXTROSE INJECTION "TBC" 29.50

AC57788212 DIAZEPAM INJECTION 5MG/ML "CYH" 15.00

AC57789100 SU-AN TABLETS 400MG "T.F." 1.50

AC57790100 PANTOPRO GASTRO-RESISTANT TABLETS 40MG 10.10

AC57791100 FAMOTIDINE F.C. TABLETS 20MG "CYH" 1.59

AC577911G0 FAMOTIDINE F.C. TABLETS 20MG "CYH"(鋁箔/膠箔) 2.00

AC57793100 DIAZEPAM TABLETS 5MG "CYH" 1.50

AC57794245 PANOLE FREEZE-DRIED POWDER FOR INJECTION 119.00

AC57797100 EXNORTAN F.C. TABLETS 5/80MG 9.00

AC57798100 ASCOFEN F.C. TABLETS 100MG "STANDARD" (ACECLOFENAC) 2.97

AC57799100 DIABECON F.C. TABLETS 15/850MG "YUNG SHIN" 8.20

AC57800100 MIXRE CAPSULES 10MG 0.00

AC57803100 ROTY F.C. TABLETS 20MG 22.20

AC57804151 TONESTOP LIQUID 0.8MG/ML 25.00

AC57805100 ATORVA F.C. TAB. 20MG "STANDARD" (ATORVASTATIN) 16.60

AC57808138 SYNVENT HFA 100 (ALBUTEROL 100MCG) LNHALER 109.00

AC57809100 ROLIPOSTATIN 10MG F.C. TABLETS "MACRO" 13.40

AC57811100 PREDNISOLONE TABLETS 5MG "CYH" 1.50

AC578111G0 PREDNISOLONE TABLETS 5MG "CYH"(鋁箔/膠箔) 2.00

AC57814100 LOATA TABLETS 100MG 11.30

AC57817100 LEVOTINE F.C. TABLETS 5MG "TAI YU" 2.21

AC57818100 COMFORTINE F.C.T. 50MG 5.30

AC57819100 Clopidogrel "Alvogen" F.C. tablets 75mg 32.10

AC57821100 IRSAR F.C. TABLET 300MG 9.10

AC57822248 LEVOLOSACIN FOR I.V. INFUSION 5MG/ML 0.00

AC57822255 LEVOLOSACIN FOR I.V. INFUSION 5MG/ML 601.00

AC57822261 LEVOLOSACIN FOR I.V. INFUSION 5MG/ML 0.00

Page 266: 附件二 藥品給付品項暨支付標準表

AC57823209 VITAMIN B12 INJECTION 1000MCG/ML "CHI SHENG" 15.00

AC57823229 VITAMIN B12 INJECTION 1000MCG/ML "CHI SHENG" 15.40

AC57830221 ZOBONIC CONCENTRATE FOR SOLUTION FOR INFUSION 4MG/5ML 0.00

AC57832421BETAME EYE DROPS 0.1% "MEDICINE" (BETAMETHASONE SODIUM

PHOSPHATE)18.50

AC57840100 CLAROCID XL TABLETS 500MG "PURZER" 18.70

AC57842100 ZIROCIN F.C. TABLETS 250MG 17.50

AC57844209 PIPERACILLIN POWDER FOR INJECTION "CYH" 33.90

AC57844212 PIPERACILLIN POWDER FOR INJECTION "CYH" 33.90

AC57844219 PIPERACILLIN POWDER FOR INJECTION "CYH" 0.00

AC578451G0 GLIMEPINE TABLETS 2MG(鋁箔/膠箔) 2.00

AC57847209 DEXAMETHASONE INJECTION 0.5% "CYH" 17.20

AC578481G0 FLUOXETINE CAPSULES 20MG "CYH"(鋁箔/膠箔) 0.00

AC57852100 LORATADINE TABLETS 10MG "CYH" 0.88

AC57853100 IRON BEAUTY CHEWABLE TABLETS 100MG "C.H." 3.01

AC57856100 ENVIR F.C. TABLETS 1MG 138.00

AC57857100 MONTELUKAST F.C. TABLETS 10MG "CYH" 12.30

AC57858100 CELECOLEN CAPSULES 200MG 4.66

AC57859500 MEKECIN VAGINAL TABLETS 200MG (CLOTRIMAZOLE) 8.20

AC57860100 REPASS F.C. TABLETS 1/500MG 2.09

AC57861100 MEGLIDE F.C. TABLETS 1/500MG 0.00

AC57862100 UROSAN CAPSULES 59.00

AC57865100 GASOTIN F.C. TABLETS 5MG "YU SHENG" 1.73

AC578651G0 GASOTIN F.C. TABLETS 5MG "YU SHENG"(鋁箔/膠箔) 2.00

AC57868100 BISOL FILM COATED TABLETS 10MG 3.93

AC57872100 PIOGLITAZONE "ALVOGEN" TABLETS 30MG 9.60

AC57875212 FOCIMYCIN POWDER FOR INJECTION 0.00

AC57875219 FOCIMYCIN POWDER FOR INJECTION 0.00

AC57877280 AMOCLAV IV POWDER FOR INJECTION "CYH" 32.30

AC57877297 AMOCLAV IV POWDER FOR INJECTION "CYH" 74.00

AC57881421 EMENTIN OPHTHALMIC SOLUTION 53.00

AC57883100 EVOXAC (CEVIMELINE HCL) CAPSULES 30MG 18.10

AC57884221 FERRUM INJECTION 65.00

AC57887100 DILTIAZEM TABLETS 30MG "CYH" 1.50

AC57889209 PROGESTERONE INJECTION "CHI SHENG" 15.00

AC57889229 PROGESTERONE INJECTION "CHI SHENG" 15.60

AC57890209 EPINEPHRINE INJECTION 1MG/ML "CYH" 15.00

AC57891100 DIPYRIDAMOLE S.C. TABLETS 25MG "CYH" 1.50

AC578911G0 DIPYRIDAMOLE S.C. TABLETS 25MG "CYH"(鋁箔/膠箔) 2.00

AC57895100 EX-CA-D SOFT CAPSULES 0.5UG 4.37

AC57896100 EX-CA-D SOFT CAPSULES 0.25UG 2.16

AC57897100 PIOGLITAZONE "ALVOGEN" TABLETS 15MG 6.90

AC57902100 AMBROXOL TABLETS 30MG "CYH" 1.50

AC57904421 DESALONE EYE DROPS 0.1% "MEDICINE" 12.80

AC57905100 MONKAST CHEWABLE TABLETS 5MG 9.30

AC57907100 TRENXAMIC TABLETS 500MG "Y.Y." 3.72

AC57909100 RETONIN F.C. TABLETS 80MG 6.00

AC57910100 MOSFLOW FILM COATED TABLETS 400MG 80.00

Page 267: 附件二 藥品給付品項暨支付標準表

AC57911100 LEVELIN F.C. TABLETS 100MG 23.20

AC57913216 KEYBONE INJECTION 1MG/ML 2114.00

AC57915100 LEEVK F.C. TABLETS 100MG 524.00

AC57921100 GLIPIZIDE TABLETS 5MG "CYH" 1.50

AC579211G0 GLIPIZIDE TABLETS 5MG "CYH"(鋁箔/膠箔) 2.00

AC57924500 FUKEAN VAGINAL TABLETS 100,000UNITS (NYSTATIN) 5.00

AC57925100 VIBOX F.C. TABLETS 500MG 52.00

AC57929100 HAXASIN XL TABLETS 4MG 9.40

AC57930100 ATOVA F.C. TABLETS 10MG "YU SHENG" 9.00

AC57936109 MEGRAN GRANULES 1000 MG 102.00

AC57937177 MEGRAN GRANULES 500 MG 40.30

AC57939100 RECIN TABLETS 2MG"D.T.S" 1.50

AC57944100 DOWN LIP-U TABLETS 160MG 3.92

AC57948100 ZOTAN ORALLY DISINTEGRATING TABLETS 0.2MG 5.60

AC57949209 SODIUM CHLORIDE INJECTION 0.9% "RENABIO" 35.00

AC57949277 SODIUM CHLORIDE INJECTION 0.9% "RENABIO" 25.00

AC57951100 ANCOM TABLETS "D.T.S." 1.50

AC57962100 ARIZOLE ORALLY DISINTEGRATING TABLETS 15MG 47.30

AC57964100 COYUE F.C. TABLETS 10MG 65.00

AC57965100 REMECIN F.C. TABLETS 10MG "SYNRAY" 57.00

AC57970421 Santone Ophthalmic Solution 0.125% 12.00

AC57970429 Santone Ophthalmic Solution 0.125% 12.00

AC57971209 NOLBAXOL INJECTION 20MG/ML "YUNG SHIN" 3199.00

AC57971219 NOLBAXOL INJECTION 20MG/ML "YUNG SHIN" 10751.00

AC57972155 LEVOTAM ORAL SOLUTON 100MG/ML "CENTER" 0.00

AC57972161 LEVOTAM ORAL SOLUTON 100MG/ML "CENTER" 759.00

AC57972166 LEVOTAM ORAL SOLUTON 100MG/ML "CENTER" 1378.00

AC57973335 YIBANING OINTMENT 54.00

AC57974100 PANTYL GASTRO-RESISTANT TABLETS 40MG 10.10

AC57976100 EXEN S.R. TABLETS 400MG 8.90

AC57977100 RANITIDINE F.C. TABLETS 150MG "CYH" 0.00

AC579771G0 RANITIDINE F.C. TABLETS 150MG "CYH"(鋁箔/膠箔) 0.00

AC57979100 METFORMIN "ALVOGEN" F.C. TABLET 850MG 1.68

AC57980416 ORALFIX ORAL BASE 18.50

AC57980421 ORALFIX ORAL BASE 0.00

AC57980423 ORALFIX ORAL BASE 36.70

AC57980429 ORALFIX ORAL BASE 59.00

AC57985221 Epirudo Injection 2mg/ml "Sinphar" 407.00

AC57985229 Epirudo Injection 2mg/ml "Sinphar" 0.00

AC57985240 Epirudo Injection 2mg/ml "Sinphar" 2311.00

AC57986245EMAZOLE POWDER FOR SOLUTION FOR INJECTION/INFUSION 40MG

"STANDARD"57.00

AC57989100 NONIN TABLETS 4MG 2.42

AC57994100 COLON TABLETS "D.T.S" 1.50

AC57996245 WENICE LYOPHILIZED INJECTION 40MG 119.00

AC57998151 ApraZ oral Solution "CENTER" 310.00

AC57998161 ApraZ oral Solution "CENTER" 743.00

AC58001229 AMINOPHYLLINE INJECTION 2.5% 0.00

Page 268: 附件二 藥品給付品項暨支付標準表

AC58004238 GLUCOSE INJECTION 20% "Y.F." 15.00

AC58006229 CALGLON I.V. INJECTION 15.00

AC58007238 BICARBONA INJECTION 15.00

AC58017100 RIPAM TABLETS0.5MG 1.50

AC580171G0 RIPAM TABLETS 0.5MG(鋁箔/膠箔) 2.00

AC58018219 NOBIFY INJECTION 4MG/4ML 100.00

AC58021421 CARLEO EYE DROPS 2% 177.00

AC58022265 MOSFLOW INFUSION SOLUTION 400MG/250ML 624.00

AC58023321 BEROLIN CREAM "F.Y." 11.90

AC58023329 BEROLIN CREAM "F.Y." 13.70

AC58023335 BEROLIN CREAM "F.Y." 24.80

AC58023338 BEROLIN CREAM "F.Y." 41.90

AC58023340 BEROLIN CREAM "F.Y." 61.00

AC58023355 BEROLIN CREAM "F.Y." 195.00

AC58025100 Tamos Capsules 20mg 539.00

AC58027100 PAINOFF ENTERIC - MICROENCAPSULATED CAPSULE 10MG 4.13

AC58028100 OLANZINE FILM COATED TABLETS 5MG 39.50

AC58030100 EXECELA TABLETS 'Y.C" 2.17

AC58032277 SODIUM CHLORIDE INJECTION 0.45% "ASTAR" 25.00

AC58034100 PEXO TABLETS 0.25MG 9.00

AC58035248 CALIFE LYOPHILIZED INJECTION 50MG 0.00

AC58036100 ABIMAY TABLETS 15MG 47.30

AC58037162 BOCA CALCIUM EMULSION "LONG LIFE" 152.00

AC58038100 ZAPRINSE F.C. TABLETS 5MG "KINGDOM" (OLANZAPINE) 39.50

AC58039100 LAVIDINE F.C. Tablets 100mg "Purzer" 0.00

AC58041100 ATOTY F.C. TABLETS 40MG 20.20

AC58044100 LFLOCIN F.C. TABLETS 100MG 3.21

AC58048100 COMLAX TABLETS 3.21

AC58050412 ORACURE ORABASE 31.80

AC58050421 ORACURE ORABASE 35.60

AC58050426 ORACURE ORABASE 61.00

AC58053265 MOFACIN INFUSION SOLUTION 400MG/250ML 624.00

AC58057421 SANTONE OPHTHALMIC SOLUTION 1% 29.90

AC58057429 SANTONE OPHTHALMIC SOLUTION 1% 33.90

AC58058421 SANTONE OPHTHALMIC SOLUTION 0.5% 21.00

AC58058429 SANTONE OPHTHALMIC SOLUTION 0.5% 33.00

AC58059421 SANTONE OPHTHALMIC SOLUTION 0.3% 12.00

AC58059429 SANTONE OPHTHALMIC SOLUTION 0.3% 20.30

AC58060100 VITAMIN B COMPLEX S.C. TABLETS "F.Y." 1.50

AC580601G0 VITAMIN B COMPLEX S.C. TABLETS "F.Y."(鋁箔/膠箔) 2.00

AC58061100 DENSET S.C. TABLETS "BORA" 2.15

AC58063100 CANLEAVER F.C. TABLETS 0.5MG 0.00

AC58064100 DIYAVAL F.C. TABLETS 80MG "S.C." 6.00

AC58066209 Isotera Injection Concentrate 20mg/ml 3199.00

AC58066219 Isotera Injection Concentrate 20mg/ml 10751.00

AC58067100 ROSUTOR FILM-COATED TABLETS 10MG 13.40

AC58068100 REPADE TABLETS 2MG (REPAGLINIDE) 2.49

AC58069100 POSTONE EXTENDED RELEASE TABLETS 540MG 4.17

Page 269: 附件二 藥品給付品項暨支付標準表

AC58070100 QSTAR FILM COATED TABLETS 9.10

AC58072100 METFORMIN TABLET 500MG "S.G." 1.50

AC580721G0 METFORMIN TABLET 500MG "S.G."(鋁箔/膠箔) 2.00

AC58074209 ANTIPIME INJECTION 0.00

AC58074277 ANTIPIME INJECTION 0.00

AC58077100 BISOL FILM COATED TABLETS 2.5MG 2.01

AC58078100 PITAVOL F.C.TABLETS 2MG 11.10

AC58081312 RAXZOR CREAM 5% "Y.C." 0.00

AC58081316 RAXZOR CREAM 5% "Y.C." 0.00

AC58081321 RAXZOR CREAM 5% "Y.C." 41.10

AC58081343 RAXZOR CREAM 5% "Y.C." 431.00

AC58085100 DIVASTAN F.C. TABLETS 160MG 7.30

AC58088100 NONIN TABLETS 1MG 1.61

AC58090100 KLUMIN F.C. TABLETS 160MG 7.30

AC58092100 DIASET TABLETS 100MG 5.70

AC58093100 Pidogrel Film Coated Tablets 75mg 32.10

AC58094229 FOLEP INJECTION 5MG/ML "YUNG SHIN" 1336.00

AC58094238 FOLEP INJECTION 5MG/ML "YUNG SHIN" 4420.00

AC58094245 FOLEP INJECTION 5MG/ML "YUNG SHIN" 0.00

AC58096265 AVERON INFUSION SOLUTION 400MG/250ML 624.00

AC58098100 CROSUTY F.C. TABLETS 5MG 9.60

AC58104343 CALFINE OINTMENT 536.00

AC58108100 ARPIZO TABLET 10MG 0.00

AC58113100 FERRIN CAPSULES "Y.C." 4.44

AC58114100 URORIN F.C. TABLETS 15MG 0.00

AC58116157 RISTIG ORAL SOLUTION 2MG/ML 1219.00

AC58121100 GLIMARYL TABLETS 4MG (GLIMEPIRIDE) 2.42

AC58122100 LOTIFEN TABLETS 1MG"JOHNSON" 0.00

AC58127100 VIRAPINE TABLETS 200MG 0.00

AC58129417 Tetracycline Hydrochloride Ophthalmic Ointment "GCPC" 12.00

AC58129421 Tetracycline Hydrochloride Ophthalmic Ointment "GCPC" 16.60

AC58130277 CHIAMIN-A INJECTION 104.00

AC58135100 RIPAM TABLETS 2MG 1.86

AC581351G0 RIPAM TABLETS 2MG(鋁箔/膠箔) 2.00

AC58137100 ARPIZO TABLET 15MG 0.00

AC58138100 ATOTINE TABLETS 40MG "Y.Y." 55.00

AC58145100 COSLIN F.C. TABLETS 25MG "JOHNSON" 2.64

AC58146209 CEPHALEXIN 1G FOR INJECTION "TBC" 61.00

AC58147100 SIGRA FILM COATED TABLETS 20MG 188.00

AC58150255 EASYMILRINONE INJECTION 0.2MG/ML 798.00

AC58156209 BROSYM FOR INJECTION 149.00

AC58156212 BROSYM FOR INJECTION 381.00

AC58156219 BROSYM FOR INJECTION 680.00

AC58162221 NOWSHIN INJECTION 200MG/ML "T.F." 15.00

AC58168100 OPICET F.C. TABLETS 3.32

AC58169100 APOSA F.C. TAB. 150MG (IRBESARTAN) 5.40

AC58170100 VAKS F.C. TAB 160MG 7.30

AC58171100 IDOFEN TABLETS 400MG "STANDARD"(IBUPROFEN) 1.50

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AC581711G0IDOFEN TABLETS 400MG "STANDARD" (IBUPROFEN)(鋁箔/膠箔)

2.00

AC58174100 FLUPEN F.C. TABLETS 3MG "JOHNSON" 10.70

AC58177100 EMA F.C.TABLETS 100MG "JOHNSON" 3.77

AC58188100 WINPAIN F.C. TABLETS 3.32

AC58189100 SLANPINE ORODISPERSIBLE TABLETS 5MG 39.50

AC58190100 VAKS F.C. TABLETS 80MG 6.00

AC58191100 VAKS F.C.TABLETS 320MG 0.00

AC58194216 UNVOMIT IV INJECTION 347.00

AC58196245ESOMELONE POWDER FOR SOLUTION FOR INJECTION / INFUSION

40MG57.00

AC58197100 CLARTHROCIN F.C. TABLETS 500MG 13.20

AC58198100 FOLIC-AID TABLETS 1MG "S.L." 1.50

AC581981G0 FOLIC-AID TABLETS 1MG "S.L."(鋁箔/膠箔) 2.00

AC58199100 BESITAN F.C. TABLETS 150MG "S.C." 5.40

AC58202100 ZCOUGH SOFT CAPSULES 100MG 1.82

AC582021G0 ZCOUGH SOFT CAPSULES 100MG(鋁箔/膠箔) 2.00

AC58203100 RABE ENTERIC FILM COATED TABLETS 20MG 8.70

AC58204100 "OLIPINE ORALLY DISINTEGRATING TABLETS 5MG "TAI YU" 39.50

AC58205221 SU-PU IRON INJECTION 20MG/ML "ASTAR" 65.00

AC58207100 Simvatin Film Coating Tablets 40mg 7.50

AC58208100 YALOP E.R. F.C. TABLETS 5MG "S.C." 2.04

AC58209329 High-Xylmol Ointment "Sinphar" 49.00

AC58209335 High-Xylmol Ointment "Sinphar" 60.00

AC58210335 DALEMEI GEL 0.1% 0.00

AC58211100 ATOTIN F.C. TABLETS 20MG 16.60

AC58212209 SAFEROME POWDER FOR I.V. INJECTION 1G "STANDARD" 206.00

AC58213100 DECOLONE TABLETS 1.50

AC58217100 ECOPAIN CAPSULES 200MG 4.66

AC58220100 STOPAIN CAPSULES "M.T." 1.50

AC582201G0 STOPAIN CAPSULES "M.T."(鋁箔/膠箔) 2.00

AC58222100 URIEF CAPSULES 8MG 11.00

AC58223382 MEDISUPER PATCH 5% 34.90

AC58225221ZOLEBONIC CONCENTRATE FOR SOLUTION FOR INFUSION 4MG/5ML

5433.00

AC58228329 FLUCO-U CREAM 33.80

AC58228343 FLUCO-U CREAM 93.00

AC58229421 OFOXIN EYE DROPS 0.3% "MEDICINE" 144.00

AC58231100 BESTAN 150MG FILM-COATED TABLETS 5.40

AC58234100 EBY F.C. TABLETS 600MG 1.64

AC582341G0 EBY F.C. TABLETS 600MG(鋁箔/膠箔) 2.00

AC58235100 BESTAN 300MG FILM-COATED TABLETS 9.10

AC58239100 CRAIGO F.C. TABLETS 200MG 16.30

AC582401G0 TOFRANIL S.C. TABLETS 10 MG(鋁箔/膠箔) 2.00

AC58241100 MIGLU F.C. TABLETS 50MG (MIGLITOL) 3.32

AC58243265 IMICURE POWDER FOR I.V. INJECTION "SLC" 187.00

AC58243277 IMICURE POWDER FOR I.V. INJECTION "SLC" 275.00

AC58244100 CARIDOL TABLETS "Y.C." 2.78

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AC58245119 MONKAST ORAL GRANULES 4MG 9.10

AC58248255 1.49% POTASSIUM CHLORIDE IN WATER INJECTION "TBC" 24.70

AC58252100 Zopimen F.C. Tablets 10mg 1.76

AC582521G0 Zopimen F.C. Tablets 10mg 2.00

AC58256100 PAROXIN F.C. TABLETS 20MG 5.30

AC58257100 LOFORMIN FILM-COATED TABLETS 850MG (METFORMIN) 1.68

AC58263100 MOSARAN F.C. TAB. 5MG (MOSAPRIDE) 1.73

AC58264100 HPS TABLETS 1.53

AC582641G0 HPS TABLETS(鋁箔/膠箔) 2.00

AC58265100 RECKACIN F.C. TABLETS 250MG 48.90

AC58267312 CLOVIR OINTMENT 5% 17.30

AC58267316 CLOVIR OINTMENT 5% 17.30

AC58267317 CLOVIR OINTMENT 5% 17.30

AC58267321 CLOVIR OINTMENT 5% 41.10

AC58269100 CENIDOL TABLETS 25MG "Y.J." (DIPHENIDOL) 1.50

AC58270100 CROSUTY F.C. TABLETS 10MG 13.40

AC58271209 PAINDOCINE INJECTION 30MG/ML 17.00

AC58271212 PAINDOCINE INJECTION 30MG/ML 24.00

AC58273100 LASOVAN F.C. TABLETS 80MG "C.H." 6.00

AC58275100 RASALINE TABLETS 1MG "STANDARD" (RASAGILINE) 67.00

AC58277100 PRODERA F.C. TABLETS 40MG 0.00

AC58283100 XEIRDA F.C. TABLETS 40MG 55.00

AC58287143 LEVOZINE ORAL SOLUTION 0.5MG/ML "STANDARD" 25.00

AC58287151 LEVOZINE ORAL SOLUTION 0.5MG/ML "STANDARD" 0.00

AC58287157 LEVOZINE ORAL SOLUTION 0.5MG/ML "STANDARD" 83.00

AC58288100 IVIC FILM-COATED TABLETS 100MG 524.00

AC58291100 ROSUSTIN FILM COATED TABLETS 10MG 13.40

AC58293100 LYGABA HARD CAPSULE 150MG "STANDARD" 26.60

AC58294100 ECOPAIN CAPSULES 100MG 2.09

AC58296265 GENEM FOR INJECTION 187.00

AC58296277 GENEM FOR INJECTION 275.00

AC58300157 BROWN MIXTURE LIQ. (WITH OPIUM) "HEALTH" 25.70

AC58300163 BROWN MIXTURE LIQ. (WITH OPIUM) "HEALTH" 27.50

AC58302100 COTRMA F.C. TABLETS 3.32

AC58307277 DEXT-SALINE INJECTION 5:0.9 "OTSUKA" 25.00

AC58310100 LERKA F.C. TABLETS 10MG 5.50

AC58314265 N.T.G. PREMIXED INJECTION 0.4MG/ML 664.00

AC58315100 ROSUSTIN FILM COATED TABLETS 20MG 22.20

AC58316100 ROSUSTIN FILM COATED TABLETS 5MG 9.60

AC58318421 ODICON EARDROPS 49.30

AC58319421 TILLO 0.5% OPHTHALMIC SOLUTION 0.00

AC58324277 RINGER'S INJECTION "OTSUKA" 25.00

AC58327421 ANTOL EYE DROPS 1% "Y.Y." 29.90

AC58327429 ANTOL EYE DROPS 1% "Y.Y." 33.90

AC58330221 POTASSIUM CHLORIDE INJECTION 15% "TAI YU" 15.00

AC58330229 POTASSIUM CHLORIDE INJECTION 15% "TAI YU" 15.00

AC58330238 "POTASSIUM CHLORIDE INJECTION 15%""TAI YU""" 15.00

AC58331421 TROPINE EYE DROPS 0.5% (ATROPINE SULFATE) 21.00

Page 272: 附件二 藥品給付品項暨支付標準表

AC58331429 TROPINE EYE DROPS 0.5% (ATROPINE SULFATE) 33.00

AC58333100 NEWCALM SUSTAINED - RELEASE CAPSULES 75MG 10.00

AC58334100 ENTIGIN FILM COATED TABLETS 1MG 143.00

AC58335100 ENTIGIN FILM COATED TABLETS 0.5MG 99.00

AC58336100 ESCITALO F.C. TABLETS 20MG 15.50

AC58337100 LOZEPAM CAPSULES 30MG 3.75

AC58340100 MONKAST F.C. TABLETS 10MG 12.30

AC58342421 COMALOL 0.25% OPHTHALMIC SOLUTION 51.00

AC58345216 IBANDRONATE INJECTION "TAI YU" 2119.00

AC58346100 ESCITALO F.C. TABLETS 15MG 13.30

AC58348255HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION

100MEQ/L "YF"24.70

AC58350100 BEGLIPIN TABLETS 30MG 9.60

AC58356100 APA-CYMBA CAPSULES 60MG 29.50

AC58359248HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION

400MEQ/L "YF"24.70

AC58359255HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION

400MEQ/L "YF"24.70

AC58360100DALISOON F.C. TABLETS 5MG "STANDARD" (SOLIFENACIN

SUCCINATE)10.30

AC58361100 ACLOPAIN F.C. TABLETS 100MG 3.14

AC58362255HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION

300MEQ/L "YF"24.70

AC58363248HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION

200MEQ/L "YF"24.70

AC58363255HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION

200MEQ/L "YF"24.70

AC58364421 RESCULA EYE DROPS 0.00

AC58366100 ATORSIN F.C. TABLETS 40MG 20.20

AC58367343 CALPOBET OINTMENT 536.00

AC58369100 BOCANON FILM-COATED TABLETS 0.5MG 101.00

AC58370100 EXNORTAN F.C. TABLETS 10/160MG 25.20

AC58373100 LIPAOSHU TABLETS 200MG "KOJAR" 4.26

AC58381100 A-LITAMIN TABLETS "CBC" 1.50

AC58382219 Ibuprofen Injection 100mg/mL 153.00

AC58382226 Ibuprofen Injection 100mg/mL 307.00

AC58384100 ROSU F.C. TABLETS 10MG 13.40

AC58388100 MYGLIN F.C. TABLETS 3.16

AC58390100 HEPAMARIN CAPSULES "Y.C 1.50

AC583901G0 HEPAMARIN CAPSULES "Y.C."(鋁箔/膠箔) 2.00

AC58391100 Ecoxia F.C. Tablet 60mg 5.00

AC58392100 EFANZY FILM COATED TABLETS 600MG 42.70

AC58393100 URIEF F.C. TABLETS 8 MG 11.00

AC58396100 ROVASTIN F.C. TABLETS 10MG "Y.C." 13.40

AC58397100 SLANPINE ORODISPERSIBLE TABLETS 10MG 65.00

AC58401100 LIPIKON F.C. TABLETS 20MG 16.60

AC58402100 ASTHLAX TABLETS "H.S." 1.50

AC584021G0 ASTHLAX TABLETS "H.S."(鋁箔/膠箔) 2.00

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AC58405100 LIMESON TABLETS "Y.C." 1.50

AC584051G0 LIMESON TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC58410100 LITUOTANG TABLETS 30MG "KOJAR" 9.60

AC58411100 ROSULIP F.C. TABLETS 10MG "C.H." 13.40

AC58517100 ATOROTY F.C. TABLETS 20MG 16.60

AC58518100 BENPRO F.C. TABLETS 20MG "JOHNSON" (BENPROPERINE) 1.50

AC585181G0BENPRO F.C. TABLETS 20MG "JOHNSON" (BENPROPERINE)(鋁箔/

膠箔)2.00

AC58521243 WESFOR LYOPHILIZED INJECTION 30MG 166.00

AC58523100 LVTANGSU TABLETS 850MG"KOJAR" 1.68

AC585231G0 LVTANGSU TABLETS 850MG"KOJAR"(鋁箔/膠箔) 2.00

AC58524321 ECOSIN CREAM "C.H." 10.50

AC58524329 ECOSIN CREAM "C.H." 18.80

AC58524335 ECOSIN CREAM "C.H." 30.40

AC58524338 ECOSIN CREAM "C.H." 32.60

AC58525100 PITASTATIN F.C. TABLETS 4MG 15.40

AC58526100 PITASTATIN F.C. TABLETS 2MG 11.60

AC58529245 ESOMYL POWDER FOR I.V. INJECTION AND INFUSION 40MG 57.00

AC58530100 Ficough Capsules 1.50

AC58532100 SU GEI TABLETS 10MG "D.T.S." 1.50

AC58533143 SORIMINE ORAL SOLUTION "C.H." 25.00

AC58533151 SORIMINE ORAL SOLUTION "C.H." 34.50

AC58533157 SORIMINE ORAL SOLUTION "C.H." 83.00

AC58534100 METFORMIN F.C. TABLETS 500MG "CYH" 1.50

AC585341G0 METFORMIN F.C. TABLETS 500MG "CYH"(鋁箔/膠箔) 2.00

AC58535100 LEYOUMIAN F.C. TABLETS 10MG "KOJAR" 1.76

AC585351G0 LEYOUMIAN F.C. TABLETS 10MG "KOJAR"(鋁箔/膠箔) 2.00

AC58537100 Valen F.C. Tablets 160mg 7.30

AC58538100 TOPALESS F.C. TABLETS 100MG 23.20

AC58540100 TAIGEXYN CAPSULE 250MG (NEMONOXACIN) 171.00

AC58541100 HEPURI F.C. TABLETS 1MG 140.00

AC58543100 LORAZIN TABLETS 0.5MG "JOHNSON" 1.50

AC585431G0 LORAZIN TABLETS 0.5MG "JOHNSON"(鋁箔/膠箔) 2.00

AC58546151 BUTMIRA LIQUID 0.8MG/ML 25.00

AC58546157 BUTMIRA LIQUID 0.8MG/ML 25.00

AC58547161 LIZEPEN ORAL SOLUTION "CENTER" 1074.00

AC58548100 TAMLOSIN D TABLETS 0.2MG 5.60

AC58549100 COSATEN TABLETS "Y.C." 2.97

AC58551100 CARELAX TABLETS 350MG 2.78

AC58553212 LOCOLIN POWDER FOR INJECTION 2,000,000U "GENTLE" 130.00

AC58555421 DORZOPT OPHTHALMIC SOLUTION 2% 235.00

AC58559100 ANXICAM TABLETS 1MG 1.50

AC585591G0 ANXICAM TABLETS 1MG(鋁箔/膠箔) 2.00

AC58560100 ANXICAM TABLETS 0.5MG 1.50

AC585601G0 ANXICAM TABLETS 0.5MG(鋁箔/膠箔) 2.00

AC58561100 ANXICAM TABLETS 2MG 1.50

AC585611G0 ANXICAM TABLETS 2MG(鋁箔/膠箔) 2.00

AC58564100 DIABEX TABLETS "Y.C." 1.50

Page 274: 附件二 藥品給付品項暨支付標準表

AC585641G0 DIABEX TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC58566238 DOBUTAMINE INJECTION 12.5MG/ML "UNIPHARMA" 113.00

AC58571209 PROGESTERONE INJECTION 25MG/ML "T.F." 15.00

AC58573100 PERIPIL PLUS TABLETS 5.90

AC58575265 MOLA INFUSION SOLUTION 400MG/250ML 624.00

AC58577100 SOONAN TABLETS 10MG (DICYCLOMINE HYDROCHLORIDE) 1.50

AC58579100 LIPIKON F.C. TABLETS 40MG 20.20

AC58580219 PEXEDA INJECTION 5258.00

AC58580238 PEXEDA INJECTION 24060.00

AC58581209Phyxotere 20mg/mL Concentrate for solution for infusion

3199.00

AC58581219Phyxotere 20mg/mL Concentrate for solution for infusion

10751.00

AC58581223Phyxotere 20mg/mL Concentrate for solution for infusion

12646.00

AC58585100 ARIPIZOLE TABLETS 15MG 47.30

AC58586100 ARIPIZOLE TABLETS 20MG 69.00

AC58589100 MOCOLAX TABLETS "Y.C." 3.56

AC58592100 RESEDEN TABLETS "Y.C." 1.94

AC58596100 OMESAR F.C. TABLETS 20MG 7.30

AC58597100 TEMPO TABLETS 4.86

AC58600100 BOCANON FILM-COATED TABLETS 1MG 135.00

AC58604100 ASAID FILM-COATED TABLETS 100MG 2.97

AC586062550.745% KCL IN 5% DEXTROSE AND 0.33% NACL INJECTION "TBC"

24.70

AC58612100 TRIKLOR TABLETS 2MG 1.50

AC586121G0 TRIKLOR TABLETS 2MG(鋁箔/膠箔) 2.00

AC58613100 METOSE F.C. TABLETS 500MG 1.50

AC586131G0 METOSE F.C. TABLETS 500MG(鋁箔/膠箔) 2.00

AC58617100 SPALEX TABLETS 5MG 2.15

AC58618100 SPALEX TABLETS 10MG 4.29

AC58620100 Gluvia F.C. Tablets 100mg 22.10

AC58621100 ROTLIP FILM-COATED TABLETS 20MG 22.20

AC58622100 ROTLIP FILM-COATED TABLETS 5MG 9.60

AC58623100 ACLONAC F.C. TABLETS 100MG 2.99

AC58624100 PRODERA F.C. TABLETS 10MG 1.50

AC58627100 BROMAZIN TABLETS 1.5MG "JOHNSON" 1.52

AC586271G0 BROMAZIN TABLETS 1.5MG "JOHNSON"(鋁箔/膠箔) 2.00

AC58633100 PITARTY F.C. TABLETS 4MG 15.20

AC586352770.149% KCL IN 5% DEXTROSE AND 0.45% NACL INJECTION "TBC"

25.40

AC58639100 ZULITOR TABLETS 4MG 15.60

AC58640412 KOULELE ORABASE 1MG/G "SOUNLIN" (DEXAMETHASONE) 31.80

AC58640421 KOULELE ORABASE 1MG/G "SOUNLIN" (DEXAMETHASONE) 35.60

AC58640426 KOULELE ORABASE 1MG/G "SOUNLIN" (DEXAMETHASONE) 61.00

AC58641100 DIVASTAN F.C. TABLETS 80MG 6.00

AC58643255 NOBELIN PREMIXED SOLUTION FOR INJECTION 500MG/100ML 292.00

AC58644255 NOBELIN PREMIXED SOLUTION FOR INJECTION 1000MG/100ML 577.00

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AC58645255 NOBELIN PREMIXED SOLUTION FOR INJECTION 1500MG/100ML 866.00

AC58646209 ANTABINE LYOPHILIZED POWDER FOR INJECTION 2854.00

AC58646263 ANTABINE LYOPHILIZED POWDER FOR INJECTION 598.00

AC58649245 PANZOLEC LYO-INJ 40MG (PANTOPRAZOLE) 119.00

AC58650255 1.49% KCL IN 5% DEXTROSE INJECTION "TBC" 24.70

AC58755100 FLEXER EXTENDED-RELEASE F.C. TABLETS 15MG 7.70

AC58758421 HINSUL ORABASE (DEXAMETHASONE)1MG/G 35.60

AC58764196 MEGAXIA ES ORAL SUSPENSION 125MG/ML 807.00

AC58767255 1.49% KCL IN 0.9% NACL INJECTION "TBC" 24.70

AC58768100 OLSAR F.C. TABLETS 20MG 7.30

AC58770265 EASYDOBU INJECTION 2 MG/ML 373.00

AC58775100 PREON TAB 1.50

AC587751G0 PREON TABLETS(鋁箔/膠箔) 2.00

AC58777424 MOMENASE AQUEOUS NASAL SPRAY 50MCG/DOSE 126.00

AC58778100 BECAVIR F.C. TABLETS 1MG 141.00

AC58779421 GINZA EYE DROPS 17.70

AC58779429 GINZA EYE DROPS 33.20

AC58780229 Mifiry Injection 47.40

AC58780248 Mifiry Injection 117.00

AC58780255 Mifiry Injection 211.00

AC58781145 DEPROATE SOLUTION 200MG/ML 177.00

AC58782121 KACOPIN POWDER 9.50

AC58784100 STALOP F.C. TABLETS 10MG "YU SHENG" 9.70

AC58786329 P.L. ESTROL GEL 0.06% 61.00

AC58786343 P.L. ESTROL GEL 0.06% 74.00

AC58786348 P.L. ESTROL GEL 0.06% 249.00

AC58787100 RIPRA F.C. TABLETS 10MG "YU SHENG" 47.30

AC58791414 LANPROTAN 50UG/ML (0.005%) 439.00

AC58800100 OXOMINE TABLETS 100MG "H.S." 1.50

AC58802100 CYMTA CAPSULE 30MG 16.60

AC58806209 PROTERNOL-L INJECTION 190.00

AC58807155 LETAMPIN ORAL SOLUTION 100MG/ML 419.00

AC58807161 LETAMPIN ORAL SOLUTION 100MG/ML 717.00

AC58807166 LETAMPIN ORAL SOLUTION 100MG/ML 1375.00

AC58809100 BELIAN F.C. TABLETS 200MG "JOHNSON" 2.07

AC58810100 ZEROPIN HARD CAPSULE 75MG 14.00

AC58812100 QUIPINE F.C. TABLETS 25MG 0.00

AC58813100 ROZININ F.C. TABLETS 20MG 22.20

AC58816100 CALM-RELAX F.C. TABLETS 200MG 16.30

AC58817100 TAMOKAS PROLONGED RELEASE TABLETS 0.4MG 14.50

AC58819100 LETRAMASE F.C. TABLETS 2.5MG 38.70

AC58821100 MELIN TABLETS 4MG "J.L." 1.53

AC588211G0 MELIN TABLETS 4MG "J.L."(鋁箔/膠箔) 2.00

AC58822100 ROZININ F.C. TABLETS 5MG 9.60

AC58826277 PEMEDA LYOPHILIZED POWDER FOR INJECTION 500MG 24682.00

AC58827255 PEMEDA LYOPHILIZED POWDER FOR INJECTION 100MG 5465.00

AC58828321 DERCOMFIN CREAM ''C.L.'' 13.90

AC58828323 DERCOMFIN CREAM ''C.L.'' 14.40

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AC58828329 DERCOMFIN CREAM ''C.L.'' 18.40

AC58828330 DERCOMFIN CREAM ''C.L.'' 20.20

AC58828335 DERCOMFIN CREAM ''C.L.'' 29.70

AC58828336 DERCOMFIN CREAM ''C.L.'' 29.70

AC58828338 DERCOMFIN CREAM ''C.L.'' 57.00

AC58829100 CALM-UP F.C. TABLETS 200MG 1.71

AC588291G0 CALM-UP F.C. TABLETS 200MG(鋁箔/膠箔) 2.00

AC58834100 EUSARTAN FILM COATED TABLETS 20MG 7.30

AC58837277 PG2 LYO. INJECTION 500MG 12650.00

AC58838100 URIEF F.C. TABLETS 4 MG 5.70

AC58841100 OLMESARDIN FILM COATED TABLETS 20MG 7.30

AC58842238 FUPADINE INJECTION 50MG/ML 115.00

AC58944321 GRISCOMB CREAM 13.90

AC58944323 GRISCOMB CREAM 14.40

AC58944329 GRISCOMB CREAM 18.40

AC58944330 GRISCOMB CREAM 20.20

AC58944335 GRISCOMB CREAM 29.70

AC58944336 GRISCOMB CREAM 29.70

AC58944338 GRISCOMB CREAM 57.00

AC58946100 TIRICA CAPSULES 75MG (PREGABALIN) 15.50

AC58949100 AZICIIN F.C. TABLETS 250MG 17.50

AC58950100 ZAPLINE FILM COATED TABLETS 100MG 11.80

AC58954100 AMAMET F.C. TABLETS 2/500MG "C.H." 2.81

AC58956135 K-GLU ORAL SOLUTION 14.60

AC58958151 Minstop Solution 0.4mg/mL 25.00

AC58958157 Minstop Solution 0.4mg/mL 25.00

AC58965100 ABIOMAY TABLETS 20MG 69.00

AC58966151 SUSENIN ORAL SOLUTION 667MG/ML 25.00

AC58966166 SUSENIN ORAL SOLUTION 667MG/ML 105.00

AC58966177 SUSENIN ORAL SOLUTION 667MG/ML 161.00

AC58973100 CELECOR CAPSULES 200MG 4.66

AC589741G0 TENSOMIN TABLETS 500MG(鋁箔/膠箔) 2.00

AC58975100 MIGBOSE F.C. TABLETS 100MG "STANDARD" (MIGLITOL) 5.60

AC58976100 MITITOL F.C. TABLETS 50MG 3.25

AC58977100 MITITOL F.C. TABLETS 100MG 5.50

AC58979255 ANDASON LYOPHILIZED POWDER FOR INJECTION 11495.00

AC58980151 BICODIN SYRUP 25.00

AC58980157 BICODIN SYRUP 25.00

AC58984100 BYE-ZU TABLETS 100MG "T.F." 2.79

AC58985421 TROPINE EYE DROPS 1.0% (ATROPINE SULFATE) 29.90

AC58985429 TROPINE EYE DROPS 1.0% (ATROPINE SULFATE) 33.90

AC58993229 HOLDIPINE INJECTION 1MG/ML 141.00

AC58993238 HOLDIPINE INJECTION 1MG/ML 271.00

AC58994100 Q-PINE F.C. TABLETS 25MG "TAI YU" 7.30

AC58997100 Aripizole Tablets 5mg 33.00

AC58998100 CECOLEX CAPSULES 200MG "C.H." 4.66

AC59001500 MIKIZOL VAGINAL TABLETS 100MG 5.90

AC59009100 OTABIN TABLETS "Y.C." 1.68

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AC590091G0 OTABIN TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC59013417 COTOBRA OPHTHALMIC OINTMENT 100.00

AC59017255 E-JEAN INJECTION 5MG/ML "ASTAR" 601.00

AC59018417 VITAMIN A EYE OINTMENT "WINSTON" 18.00

AC59018421 VITAMIN A EYE OINTMENT "WINSTON" 22.80

AC59022100 RAMILY TABLETS 5MG 3.35

AC59023100 SELEXIB CAPSULE 200MG 4.66

AC59025100 PXITON TABLETS 500MG 1.50

AC59027100 SURATON TABLETS 10MG 4.29

AC59028100 ENTAPON F.C. TABLETS 200MG 17.20

AC59031157 GIGA ORAL SUSPENSION 40MG/ML 683.00

AC59031161 GIGA ORAL SUSPENSION 40MG/ML 891.00

AC59031164 GIGA ORAL SUSPENSION 40MG/ML 1735.00

AC59032100 IRSUTAN F.C. TABLETS 150MG 5.40

AC59035129 LIQUID BROWN MIXTURE "CENTER"(鋁箔) 6.00

AC59035151 LIQUID BROWN MIXTURE "CENTER" 25.00

AC59035157 LIQUID BROWN MIXTURE "CENTER" 26.50

AC59035163 LIQUID BROWN MIXTURE "CENTER" 28.50

AC59036157 COMPOUND GLYCYRRHIZA MIXTURE ORAL SOLUTION "CENTER" 25.70

AC59036163 COMPOUND GLYCYRRHIZA MIXTURE ORAL SOLUTION "CENTER" 27.50

AC59040111 ACTEIN EFFERVESCENT GRANULES 600MG 6.00

AC59050100 LANAPINE ORALLY DISINTEGRATING TABLETS 5MG 39.50

AC59052100 UNVOMIT F.C. TABLETS 1MG 167.00

AC59053406 BETER-FREE EYE DROPS 0.5% (TROPICAMIDE) 4.00

AC59054100 RAYOR TABLETS "COSMIC" 2.01

AC59055100 PRO-NERV CAPSULES 1.68

AC590551G0 PRO-NERV CAPSULES(鋁箔/膠箔) 2.00

AC59056100 TAISHUNMAI TABLETS 5MG "KOJAR" 3.84

AC59059321 SULEM OINTMENT 13.20

AC59059329 SULEM OINTMENT 18.00

AC59059335 SULEM OINTMENT 37.20

AC59063421 OFLOXIN OTIC SOLUTION 0.3% 51.00

AC59066100 Q-PINE XR EXTENDED-RELEASE TABLETS 300MG "TAI YU" 39.00

AC59068100 PREBALIN HARD CAPSULES 75MG 13.50

AC59069421 PROTECTIER OTIC DROPS 49.30

AC59071221 GOOD-FE INJECTION 2% "TAI YU" 65.00

AC59073100 LANAPINE ORALLY DISINTEGRATING TABLETS 10MG 65.00

AC59078209 ERTACURE "SLC" 1G 651.00

AC59185100 FEBUTON F.C. TABLETS 80MG (FEBUXOSTAT) 15.50

AC59192100 PITANXO F.C. TABLETS 4MG 15.60

AC59193100 PITANXO F.C. TABLETS 2MG 11.20

AC59196100 RETONIN F.C. TABLETS 160MG 7.30

AC59197100 RETONIN F.C. TABLETS 40MG 4.73

AC59199100 LASOVAN F.C. TABLETS 160MG "C.H." 7.30

AC59209100 FORLITON F.C. TABLETS 80MG 15.50

AC59210100 BUPRONIL CAPSULES 30MG 16.60

AC59212100 QUELIP XR TABLETS 200MG 32.40

AC59213538 TERCONER VAGINAL CREAM 0.8% "S.L." 143.00

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AC59214100 OMESAR F.C. TABLETS 40MG 13.60

AC59215100 SOLIN F.C. TABLETS 5MG 9.40

AC59221266 PREZOLID INJECTION 2MG/ML 725.00

AC59225100 DERSPIN TABLETS 9.90

AC59226100 CECOXII CAPSULES 200MG 4.66

AC59228100 CLARTHROCIN F.C. TABLETS 250MG 3.24

AC59232100 VAWAY FILM-COATED TABLETS 200MG 1117.00

AC59239100 TERNIBIN F.C. TABLETS 250MG 637.00

AC59240100 ROSTINE F.C. TABLETS 10MG 13.40

AC59242100 ADHOOD ER TABLETS 36MG 50.00

AC59243100 AMIPASOLE ENTERIC COATED TABLETS 40MG "TAI YU" 6.10

AC59245100 ETOXIB F.C. TABLET 60MG 4.50

AC59247209 VANCOMYCIN POWDER FOR I.V. INJECTION "CYH" 179.00

AC59247277 VANCOMYCIN POWDER FOR I.V. INJECTION "CYH" 76.00

AC59248245 ESOWEI POWDER FOR INJECTION AND INFUSION 40MG 57.00

AC59251100 AGITIN TABLETS 10/20MG 11.00

AC59253100 LIVEPRO F.C. TABLETS 1MG 138.00

AC59260100 SARTANIN TABLETS 8MG 6.90

AC59265100 ROSTATIN F.C. TABLETS 20MG "STANDARD" 22.20

AC59266100 ROSTATIN F.C. TABLETS 5MG "STANDARD" 9.60

AC59271100 FEURI F.C. TABLETS 80MG 15.50

AC59272100 LEUKURE MICRO-T CAPSULES 100MG 524.00

AC59274100 APA-CYMBA CAPSULES 30MG 16.60

AC59275100 Quepine F.C. Tablet 25mg 7.30

AC59278100 OLMESARDIN FILM COATED TABLETS 40MG 13.60

AC59281100 SILIFLO CAPSULES 4MG "STANDARD" 5.20

AC59282100 HISBETA TABLETS 12MG 1.50

AC592821G0 HISBETA TABLETS 12MG(鋁箔/膠箔) 2.00

AC59283100 HISBETA TABLETS 6MG 1.50

AC592831G0 HISBETA TABLETS 6MG(鋁箔/膠箔) 2.00

AC59285100 SINVOMIN F.C. TABLETS 3.84MG 1.50

AC592851G0 SINVOMIN F.C. TABLETS 3.84MG(鋁箔/膠箔) 2.00

AC59291382 LIDOCAINE PATCH 5% "L.L." 35.70

AC59292100 CEFICIN CAPSULES 100MG 4.51

AC59293414 TIMAL OPHTHALMIC SOLUTION 0.5% "KINGDOM" 122.00

AC59293421 TIMAL OPHTHALMIC SOLUTION 0.5% "KINGDOM" 122.00

AC59294416 TIMAL OPHTHALMIC SOLUTION 0.25% "KINGDOM" 51.00

AC59294421 TIMAL OPHTHALMIC SOLUTION 0.25% "KINGDOM" 51.00

AC59295100 RELECOX CAPSULES "Y.C." 4.66

AC59298151 Bucoughrate Liquid 0.8 mg/ml "Sinphar" 25.00

AC59298157 Bucoughrate Liquid 0.8 mg/ml "Sinphar" 25.00

AC59298163 Bucoughrate Liquid 0.8 mg/ml "Sinphar" 25.00

AC59300100 SAFEMAT F.C. TABLETS 2/500MG 2.81

AC59303100 DELINCAL TABLETS 667MG "GENTLE" (CALCIUM ACETATE) 1.58

AC59306209 MUTONPAIN INJECTION 10MG/ML 37.90

AC59308100 SIJATIN F.C. TABLETS 100MG 21.30

AC59363100 FIZATE TABLETS "Y.C." 3.62

AC59368143 ALLEVO ORAL SOLUTION 0.5MG/ML 25.00

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AC59368151 ALLEVO ORAL SOLUTION 0.5MG/ML 34.50

AC59368157 ALLEVO ORAL SOLUTION 0.5MG/ML 83.00

AC59369416 BIMOTAN OPHTHALMIC SOLUTION 0.01% 431.00

AC59370100 SUBITONG TABLETS 25MG"T.F." 1.50

AC593701G0 SUBITONG TABLETS 25MG"T.F."(鋁箔/膠箔) 2.00

AC59376100 MESYN CAPSULES 100MG 2.98

AC59378100 HEPATO-EASE F.C. TABLETS 1MG 140.00

AC59379100 MOGRACE F.C. TABLETS 5MG 1.73

AC593791G0 MOGRACE F.C. TABLETS 5MG(鋁箔/膠箔) 2.00

AC59380421 Sumin Ophthalmic Solution 2% 14.50

AC59380429 Sumin Ophthalmic Solution 2% 28.30

AC59384151 CYLIMIN ORAL SOLUTION 0.4MG/ML 25.00

AC59384157 CYLIMIN ORAL SOLUTION 0.4MG/ML 25.00

AC59386100 SUJNLI TABLETS "CHEN TA" 1.50

AC59388100 PHUDIALIN HARD CAPSULES 75MG 15.30

AC59390100 PIRACETAM F.C. TABLETS 1200MG "KOJAR" 1.91

AC593901G0 PIRACETAM F.C. TABLETS 1200MG "KOJAR"(鋁箔/膠箔) 2.00

AC59391100 WIJETON TABLET 400MG "CHEN TA" 1.50

AC593911G0 WIJETON TABLET 400MG "CHEN TA"(鋁箔/膠箔) 2.00

AC59393100 LODIGLIT F.C. TABLETS 15MG/850MG 8.00

AC59394100 MEMSYN F.C. TABLETS 10MG 7.20

AC59395100 CO-AMNDILINE F.C. TABLETS 5/10MG 9.30

AC59396100 GLYCON SUSTAINED-RELEASE TABLETS 60MG 2.91

AC59398100 PIVAS F.C. TABLETS 2MG 11.20

AC59400100 CLOSIAN TABLETS 100MG 4.55

AC59401221 HEPARIN SODIUM INJECTION 1000 IU/ML "TAI YU" 38.30

AC59401229 HEPARIN SODIUM INJECTION 1000 IU/ML "TAI YU" 73.00

AC59402221 HEPARIN SODIUM INJECTION 5000 IU/ML "TAI YU" 38.30

AC59402240 HEPARIN SODIUM INJECTION 5000 IU/ML "TAI YU" 166.00

AC59402248 HEPARIN SODIUM INJECTION 5000 IU/ML "TAI YU" 298.00

AC59402299 HEPARIN SODIUM INJECTION 5000 IU/ML "TAI YU" 2.88

AC59403100 ROSUCIN F.C. TABLETS 250MG 17.50

AC59405100 Suya Tablets 90mg "C.L." 1.50

AC594051G0 SUYA TABLETS 90MG "C.L."(鋁箔/膠箔) 2.00

AC59406100 PANZOLEC GASTRO-RESISTANT TABLETS 40MG 10.10

AC59407100 IRBEST F.C. TABLETS 300MG "YU SHENG" 9.10

AC59409100 ESTENGY F.C. TABLETS 5/80MG 9.00

AC59410100 RALOXY F.C. TABLETS 60MG 34.00

AC59413329 CALMSIT CREAM 49.00

AC59413335 CALMSIT CREAM 60.00

AC59414212 METHOATE INJECTION 25MG/ML 89.00

AC59414226 METHOATE INJECTION 25MG/ML 211.00

AC59414238 METHOATE INJECTION 25MG/ML 470.00

AC59414245 METHOATE INJECTION 25MG/ML 869.00

AC59415100 AMLOS TABLETS 5MG 3.84

AC59416100 PHUDIALIN HARD CAPSULES 150MG 30.00

AC59417100 ADHOOD ER TABLETS 27MG 42.70

AC59418100 LEVELIN F.C. TABLETS 25MG 5.50

Page 280: 附件二 藥品給付品項暨支付標準表

AC59419100 LEVELIN F.C. TABLETS 50MG 11.80

AC59420100 "UBIP" LAMIVUDINE FILM COATED TABLETS 300MG 105.00

AC59621100 VIRCLEAN F.C. TABLETS 300MG 95.00

AC59625100 LOWMALIN TABLETS 4MG 2.42

AC59626321 UFORCIN OINTMENT 13.20

AC59626329 UFORCIN OINTMENT 18.00

AC59626335 UFORCIN OINTMENT 37.20

AC59633100 MAXFLOW PROLONGED-RELEASE 0.4MG TABLETS 14.50

AC59640100 SUCULIN HARD CAPSULE 75MG 15.60

AC59642114 ATROLIN UNIT DOSE AMPOULE INHALATION SOLUTION 13.90

AC59643100 ESTENGY F.C. TABLETS 5/160MG 15.20

AC59645100 RIVOPAM TABLETS 0.5MG "Y.Y." 1.50

AC596451G0 RIVOPAM TABLETS 0.5MG "Y.Y."(鋁箔/膠箔) 2.00

AC59647100 FLATIN FILM COATED TABLETS 40MG 2.88

AC59649100 ROSULIP F.C. TABLETS 5MG "C.H." 9.60

AC59652100 ROSULATOR F.C. TABLETS 5MG "S.C." 9.60

AC59654100 GUFRE TABLETS 500MG 1.50

AC596541G0 GUFRE TABLETS 500MG(鋁箔/膠箔) 2.00

AC59656100 WIJETON TABLET 200MG "CHEN TA" 1.35

AC596561G0 WIJETON TABLET 200MG "CHEN TA"(鋁箔/膠箔) 1.72

AC59663100 LEAVDO CAPSULES 15MG 3570.00

AC59664100 LEAVDO CAPSULES 25MG 3570.00

AC59665100 WETA B6 TAB 50MG 1.50

AC59668100 LEAVDO CAPSULES 10MG 3405.00

AC59669100 LEAVDO CAPSULES 5MG 1601.00

AC59670100 CYCLOREX EXTENDED-RELEASE TABLETS 30MG 10.90

AC59671100 BESANO F.C. TABLETS 1.0MG 136.00

AC59675100 AZAPRINE F.C. TABLETS 50MG 9.60

AC59680100 Slivec Film Coated Tablets 100mg "Sinphar" 524.00

AC59685100 TENOEM F.C. TABLETS 310.00

AC59686100 BETAFORM F.C. TABLETS "M.T."(METFORMIN) 1.50

AC596861G0 BETAFORM F.C. TABLETS"M.T."(METFORMIN)(鋁箔/膠箔) 2.00

AC59689414 TRAPTAN OPHTHALMIC SOLUTION 0.004% 426.00

AC59690121 PIRACETAM GRANULES FOR ORAL SOLUTION 2400MG "KOJAR" 5.40

AC59691114 PIRACETAM GRANULES FOR ORAL SOLUTION 1200MG "KOJAR" 6.00

AC59692151 CENTIMIN ORAL SOLUTION 0.5MG/ML "KOJAR" 34.50

AC59692157 CENTIMIN ORAL SOLUTION 0.5MG/ML "KOJAR" 83.00

AC59693100 EMAZOLE TABLETS 40MG 6.10

AC59694129 WEITONHOU SUSPENSION 20MG/ML "SENTAI" 13.40

AC59694135 WEITONHOU SUSPENSION 20MG/ML "SENTAI" 13.40

AC59694138 WEITONHOU SUSPENSION 20MG/ML "SENTAI" 22.50

AC59695100 CIMETIN TABLETS 400MG "SENTAI" 1.50

AC59697209 FLOMOXEF POWDER FOR I.V. INJECTION 1G "C.C.P.C" 292.00

AC59704100 TENO B TABLETS 300MG 95.00

AC59705277 DEXT-SALINE INJECTION 5:0.225 "OTSUKA" 25.00

AC59708151 SINNATON ORAL SOLUTION 200MG "KOJAR" 26.90

AC59708157 SINNATON ORAL SOLUTION 200MG "KOJAR" 48.70

AC59708163 SINNATON ORAL SOLUTION 200MG "KOJAR" 76.00

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AC59708164 SINNATON ORAL SOLUTION 200MG "KOJAR" 92.00

AC59709100 IVAHEART F.C. TABLETS 5MG 18.60

AC59715100 PROMONE SOFT CAPSULES 200MG "P.L." 12.50

AC59716100 ZODIN CR TABLETS 6.25MG 3.30

AC59720100 ETOCOXII F.C. TABLETS 60MG 4.35

AC59723100 BESANO F.C. TABLETS 0.5MG 97.00

AC59725100 TONDERINL TABLETS 25MG "N.C.P." (DICLOFENACSODIUM) 1.50

AC59727100 VEBACIN F.C. TABLETS 5MG "C.H." 9.70

AC59732248CAFOLINATE LYOPHILIZED POWDER FOR INJECTION 50MG "JENG

CHANG RONG"69.00

AC59734453 OLASIL EAR DROPS 100.00

AC59736100 LIZHENSIN TABLETS 16MG "S.C." 8.70

AC59737219 NOREPINEPHRINE INJECTION "C.C.P.C." 100.00

AC59738423 FLUNASE AQUEOUS NASAL SPRAY 50MCG/SPRAY 152.00

AC59742100 HYCOPRESS F.C. TABLETS 160/12.5MG 7.30

AC59743100 VAWAY FILM-COATED TABLETS 50MG 326.00

AC59744100 ADHOOD ER TABLETS 18MG 29.90

AC59746100 SYNGEXA CAPSULES 75MG 14.00

AC59750100 BARAVIR F.C. Tablets 0.5mg 95.00

AC59758100 Sefree Capsules 250mg "Panbiotic" (Cephradine) 1.72

AC59759100 GRUMED-M F.C. TAB. 2MG/500MG 2.85

AC59767100 FOLIC ACID TABLETS 10MG "Y.C." 1.50

AC597671G0 FOLIC ACID TABLETS 10MG "Y.C."(鋁箔/膠箔) 2.00

AC59769329 DOCOSIL TOPICAL SOLUTION 1% 19.60

AC59769338 DOCOSIL TOPICAL SOLUTION 1% 30.80

AC59769343 DOCOSIL TOPICAL SOLUTION 1% 87.00

AC59771100 EXNORTAN F.C. TABLETS 5/160MG 16.10

AC59774100 RALO F.C. TABLETS 60MG 34.00

AC59775100 ULITINE CAPSULES 60MG 29.50

AC59776100 THEOPHY S.R. TABLETS 200MG "P.L." 1.61

AC597761G0 THEOPHY S.R. TABLETS 200MG "P.L."(鋁箔/膠箔) 2.00

AC59778100 BERGALIN CAPSULES 75MG "Y.C." 15.50

AC59781263 HOLDIPINE PREMIXED SOLUTION FOR INJECTION 0.2 MG/ML 524.00

AC59782100 VIDATIN TAB. 50MG 9.20

AC59784209 GEMPHAR LYO-INJECTION "YUNG SHIN" 2854.00

AC59784263 GEMPHAR LYO-INJECTION "YUNG SHIN" 598.00

AC59790100 BESTRIM XL 300MG TABLETS "Y.Y." 33.90

AC59797100 TONCUS EXTENDED RELEASE TABLETS 36MG 50.00

AC59802100 K-SUPPLY TABLETS 595MG "C.H." 1.72

AC598021G0 K-SUPPLY TABLETS 595MG "C.H."(鋁箔/膠箔) 2.00

AC59808100 Lenli Capsules 25mg 3405.00

AC59809100 HYCOPRESS F.C. TABLETS 80/12.5MG 6.00

AC59818100 THYROID TABLETS 64MG "C.L." 1.50

AC598181G0 THYROID TABLETS 64MG "C.L."(鋁箔/膠箔) 2.00

AC59821100 EXFOPINE FILM-COATED TABLET 5/160MG 17.50

AC59825100 ULITINE CAPSULES 30MG 16.60

AC59830100 SAUA F.C. TABLETS 5MG 1.73

AC598301G0 SAUA F.C. TABLETS 5MG(鋁箔/膠箔) 2.00

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AC59831248 LEFXIN IV SOLUTION FOR INFUSION 5MG/ML 376.00

AC59831255 Lefxin IV Solution for Infusion 5mg/ml 601.00

AC59831261 Lefxin IV Solution for Infusion 5mg/ml 619.00

AC59835100 FOLIC ACID TABLETS 5MG "Y.C." 1.50

AC598351G0 FOLIC ACID TABLETS 5MG "Y.C."(鋁箔/膠箔) 2.00

AC59836100 VALSOON F.C. TABLETS 5/160MG 16.50

AC59840209 PROGESTERONE INJECTION 25MG "Y.Y." 15.00

AC59841100 CO-VOSAA FILM COATED TABLETS 80/12.5MG 6.00

AC59843100 ETOCOXII F.C. TABLETS 90MG 4.35

AC59846100 Cimetidine Tablets "W.S." 1.50

AC598461G0 CIMETIDINE TABLETS "W.S."(鋁箔/膠箔) 2.00

AC59850100 BOKEN CAPSULES 200MG "T.F." 3.25

AC59855248 TYLIN LYOPHILIZED POWDER FOR INJECTION 50MG 1250.00

AC59864151 BUTARAY ORAL SOLUTION 0.8MG/ML "KOJAR" 25.00

AC59866100 SOFLOW FILM COATED TABLETS 5MG 9.40

AC59867209 CEFOXITIN POWDER FOR INJECTION "C.C.P.C." 67.00

AC59868500 ESVATIN VAGINAL TABLETS 12.80

AC59872100 FOFNIR F.C. TABLETS 300MG 95.00

AC59880417 ERYTHROCIN OPHTHALMIC OINTMENT 12.10

AC59884143 QTING ORAL SUSPENSION "CENTER" 156.00

AC59884151 QTING ORAL SUSPENSION "CENTER" 313.00

AC59884157 QTING ORAL SUSPENSION "CENTER" 537.00

AC59887100 DUALPRESS F.C. TABLETS 5MG/10MG 8.50

AC59888100 LEFLO F.C. TABLETS 500MG "H.S." 20.90

AC59894100 ESOCOMFORT E.F.C. TABLETS 40MG 6.10

AC59895100 Barazer F.C. Tablets 0.5mg 103.00

AC59896100 Lenli Capsules 5mg 1601.00

AC59897100 LENLI CAPSULES 10MG 3570.00

AC59898100 Lenli Capsules 15mg 3405.00

AC59899500 Mikizol Vaginal Tablets 500mg 12.50

AC59901265 MOXISTAR INJECTION 400MG/250ML "ASTAR" 624.00

AC59902100 GENLEASE TABLETS 2MG 1.78

AC599021G0 GENLEASE TABLETS 2MG(鋁箔/膠箔) 2.00

AC60105100 CLOSIAN TABLETS 25MG 3.11

AC60106100 BLADERIN FILM-COATED TABLETS 5MG 9.40

AC60109100 BARAVIR F.C. Tablets 1mg 132.00

AC60114100 ROSUTOR FILM-COATED TABLETS 5MG 9.60

AC60131271 URONA INJECTION 100MG/ML (MESNA) 175.00

AC60133100 PARDONE EXTENDED-RELEASE TABLETS 6MG 110.00

AC60134100 TEMILG F.C. TABLETS 2/500MG 2.88

AC60139321 Mupirocin Ointment "H.S." 64.00

AC60139335 Mupirocin Ointment "H.S." 124.00

AC60145263 VORISAM LYOPHILIZED POWDER FOR INJECTION 200MG 3914.00

AC60149240 BENDASTIN LYOPHILIZED POWDER FOR INJECTION 2218.00

AC60149255 BENDASTIN LYOPHILIZED POWDER FOR INJECTION 8530.00

AC60151209 OXACILLIN FOR INJECTION "GENTLE" 38.30

AC60151212 OXACILLIN FOR INJECTION "GENTLE" 100.00

AC60152100 METHYDUR SUSTAINED RELEASE CAPSULES 33MG 66.00

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AC60153100 METHYDUR SUSTAINED RELEASE CAPSULES 44MG 68.00

AC601541G0 SUBILIN TABLETS 30MG "KOJAR"(鋁箔/膠箔) 2.00

AC60155221 OKMILON INJECTION 590.00

AC60156100 AMITRIDE TABLETS 5MG 28.70

AC60158151 CETIRIZINE ORAL SOLUTION 1MG/ML "KOJAR" 28.10

AC60158157 CETIRIZINE ORAL SOLUTION 1MG/ML "KOJAR" 87.00

AC60159100 SETRON F.C. TABLETS 2MG 255.00

AC60161212 Ledipine Injection 1mg/ml 51.00

AC60161229 LEDIPINE INJECTION 1MG/ML 141.00

AC60161240 LEDIPINE INJECTION 1MG/ML 488.00

AC60165100 METHYDUR SUSTAINED RELEASE CAPSULES 22MG 55.00

AC60168100 UWARIN TABLETS 5MG 4.98

AC60174100 PITAVASTATIN F.C. TABLETS 2MG "CYH" 11.50

AC60175100 LAVITOL FILM COATED TABLETS 2MG 11.40

AC60176100 CELECOLEN CAPSULES 100MG 2.09

AC60177100 PEXO TABLETS 1MG 36.60

AC60178100 HEPAR-PRO FILM-COATED TABLETS 300MG 95.00

AC60182100 Veiasu Film-Coated Tablets 250mg 637.00

AC60185100 CARICALM TABLETS "Y.Y." 3.21

AC60186100 SIGTIN FILM-COATED TABLETS 100MG 20.00

AC60188100 ETOR F.C. TABLETS 60MG 4.13

AC60194100 NORVAN FILM-COATED TAB. 5/80MG "Y.J." 9.20

AC60197100 ROSUTOR FILM-COATED TABLETS 20MG 22.20

AC60201100 CO-MIDIS TABLETS 80/5MG 11.60

AC60202238 ALPROSM LYOPHILIZED POWDER FOR INJECTION 569.00

AC60205100 XAROBAN FILM-COATED TABLETS 15MG 48.00

AC60206100 HUCANON TABLETS 300MG 95.00

AC60217196 FLUZOLE POWDER FOR ORAL SUSPENSION 40MG/ML "CENTER" 847.00

AC60219100 VIPROOF FILM COATED TABLETS 300MG 95.00

AC60227209 INJECTIO NALORPHINE HYDROCHLORIDI 26.70

AC60230209 AMPICILLIN INJECTION 1GM (POTENCY)/VIAL "TAI YU" 25.00

AC60231280AMOCLAVUNIN FOR INTRAVENOUS INJECTION 0.6GM, 1.2GM "TAI

YU"32.30

AC60231297AMOCLAVUNIN FOR INTRAVENOUS INJECTION 0.6GM, 1.2GM "TAI

YU"74.00

AC60233100 LEVO F.C.T 5MG 2.21

AC60234100 VITAMIN B COMPLEX F.C. TABLETS "Y.C." 1.50

AC602341G0 VITAMIN B COMPLEX F.C. TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC60235100 MELOPAM TABLETS 2MG 1.77

AC60236500 CATHARTINOL SUPPOSITORY 10MG "KOJAR" 5.00

AC60237100 OKPINE F.C. TABLETS 5MG 39.50

AC602384CR AN-EYESI OPHTHALMIC EMULSION 0.05% 38.70

AC60239100 Deferan (deferasirox) Dispersible Tablets 125mg 150.00

AC60243100 FOBIFEN TABLETS 100MG "H.S." 2.49

AC602451G0 SHUDRINE TABLETS 30MG(鋁箔/膠箔) 2.00

AC60247100 QUETIPINE 200MG F.C. TABLETS "L.L." 16.30

AC60254238 SPORMINE INJECTION "TAI YU" 15.00

AC60255500 CLINBEAUTY VAGINAL TABLETS 100MG "YUNG SHIN" 5.90

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AC60258100 PARDONE EXTENDED-RELEASE TABLETS 9MG 110.00

AC60259100 PARDONE EXTENDED-RELEASE TABLETS 3MG 56.00

AC60262100 Sincoxib Capsules 200mg 4.66

AC60264100 TROKENDI XR EXTENDED-RELEASE CAPSULES 25MG 8.30

AC60265100 TROKENDI XR EXTENDED-RELEASE CAPSULES 50MG 16.30

AC60266100 TROKENDI XR EXTENDED-RELEASE CAPSULES 100MG 32.90

AC60267100 TROKENDI XR EXTENDED-RELEASE CAPSULES 200MG 57.00

AC60270100 FORLITON F.C. TABLETS 40 MG 7.30

AC60271421 ANSEE OPHTHALMIC SOLUTION 317.00

AC60273100 PREGABALIN CAPSULES 75MG "C.C.P.C." 14.40

AC60277100 LAXTONE TABLETS "Y.C." 1.50

AC602771G0 LAXTONE TABLETS "Y.C."(鋁箔/膠箔) 2.00

AC60278209 ZEFOTAM POWDER FOR I.V. INJECTION 145.00

AC60278212 ZEFOTAM POWDER FOR I.V. INJECTION 374.00

AC60278219 ZEFOTAM POWDER FOR I.V. INJECTION 680.00

AC60285100 LEXINPING CAPSULES 60MG "TAI YU" 29.50

AC60286100 PAKINLINE TABLETS 1MG 63.00

AC60290100 LAVITOL FILM COATED TABLETS 4MG 15.40

AC60294100 XI-GOOD CAPSULES 200MG 4.66

AC60297338 COMYBOR ANTIFUNGAL TOPICAL SOLUTION 10MG/ML 85.00

AC60297345 COMYBOR ANTIFUNGAL TOPICAL SOLUTION 10MG/ML 123.00

AC60305100 NUMIENT EXTENDED-RELEASE CAPSULES 23.75MG/95MG 65.00

AC60306100 NUMIENT EXTENDED-RELEASE CAPSULES 36.25MG/145MG 65.00

AC60307100 NUMIENT EXTENDED-RELEASE CAPSULES 48.75MG/195MG 65.00

AC60308100 NUMIENT EXTENDED-RELEASE CAPSULES 61.25MG/245MG 65.00

AC60313457 BESONIN AQUA NASAL SPRAY 64MCG/DOSE 126.00

AC60314100 VANCOVER CAPSULES 250MG 110.00

AC60316100 VANCOVER CAPSULES 125MG 61.00

AC60318100 UWARIN TABLETS 2.5MG 4.11

AC60319221 STOTHU SOLUTION FOR INJECTION 557.00

AC60320151 THEOLIN ORAL SOLUTION 5.34MG/ML "KOJAR" 25.00

AC60320157 THEOLIN ORAL SOLUTION 5.34MG/ML "KOJAR" 28.90

AC60326100 BERYDONE EXTENDED-RELEASE TABLETS 9MG 110.00

AC60327100 BERYDONE EXTENDED-RELEASE TABLETS 3MG 56.00

AC60328100 BERYDONE EXTENDED-RELEASE TABLETS 6MG 110.00

AC60335100 SOLINACIN F.C. TABLETS 5MG 9.20

AC60341151 BUTARAY ORAL SOLUTION 1.5MG/ML "KOJAR" 25.00

AC60341157 BUTARAY ORAL SOLUTION 1.5MG/ML "KOJAR" 25.00

AC60341163 BUTARAY ORAL SOLUTION 1.5MG/ML "KOJAR" 30.80

AC60353100 SIWEN TABLETS 10MG 1.50

AC603531G0 SIWEN TABLETS 10MG(鋁箔/膠箔) 2.00

AC60356263 VAWAY LYO-INJECTION 200MG 3914.00

AC60357100 EUSARTAN FILM COATED TABLETS 40MG 13.60

AC60358100 EVEING F.C. TABLETS 400MG "Y.K." 1.50

AC603581G0 EVEING F.C. TABLETS 400MG "Y.K."(鋁箔/膠箔) 2.00

AC60359221 WINBEST INJECTION 2MG/ML 56.00

AC60366417 KANHEAL ORABASE 21.50

AC60366423 KANHEAL ORABASE 36.70

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AC60366429 KANHEAL ORABASE 59.00

AC60371329 ANZUMEI CREAM "Y.K." 32.70

AC60371335 ANZUMEI CREAM "Y.K." 35.10

AC60371338 ANZUMEI CREAM "Y.K." 69.00

AC60384212 FUROSEMIDE SOLUTION FOR INJECTION "TAI YU" 15.00

AC60386100 COXIA F.C. TABLETS 60MG 4.13

AC60388100 ANXOFIN TABLETS 500MG 1.50

AC60391100 UWARIN TABLETS 1MG 3.60

AC60394221 LIDOCAINE 2% FOR I.V. INJECTION "TAI YU" 50.00

AC60402100 Sacure Tablets 10/20mg 11.00

AC60407100 Damicin Capsules 150mg "H.S." 1.50

AC60408100 Damicin Capsules 300mg "H.S." 2.80

AC60409100 Olzapine Film Coated Tablets 5mg 39.50

AC60414100 Gefissa Film Coated Tablets 250mg 573.00

AC60420209 NUVANCO LYOPHILIZED INJECTION 1GM 179.00

AC60420277 NUVANCO LYOPHILIZED INJECTION 500MG 76.00

AC60421100 Celecon Capsules 200mg "Synray" 4.66

AC60426100 Solinacin F.C. Tablets 10mg 9.20

AC60428421 VISCONE EYE DROPS 0.02% "SINPHAR" 13.60

AC60428429 VISCONE EYE DROPS 0.02% "SINPHAR" 53.00

AC60430100 K-mycin Film-Coated Tablets 500mg 13.20

AC60433100 FUIRONS CAPSULES 150MG "JOHNSON" 2.88

AC60434221 Focas Injection 10mg/ml "L.L." 69.00

AC60434229 Focas Injection 10mg/ml "L.L." 86.00

AC60436100 Omorose Tablets 2mg 37.80

AC60438265 Xinvir Lyophilized Injection 250mg 287.00

AC60441100 Naxodine F.C. Tablets 180mg "YC" 4.60

AC60457100 Amvlo Film-Coated Tablets 5/160mg 16.70

AC604581G0 SLATONE TABLETS 25MG(鋁箔/膠箔) 2.00

AC60471321 FLUTISU CREAM 0.05% 25.80

AC60471335 FLUTISU CREAM 0.05% 74.00

AC60477500 LO-LO VAGINAL TABLETS 200MG "T.F." 8.20

AC60478500 LO-LO VAGINAL TABLETS 100MG "T.F." 5.90

AC60480100 GOLFER CAPSULES 25MG "SINPHAR" 168.00

AC60482100 GOLFER CAPSULES 20MG "SINPHAR" 148.00

AC60488221 U-GETEN INJECTION 100MG/ML "ASTAR" 279.00

AC60492255 NICARPINE PREMIXED I.V. INJECTION 0.1MG/ML "P.L." 141.00

AC60501100 STROINE TABLETS "W.S." 1.50

AC605011G0 STROINE TABLETS "W.S."(鋁箔/膠箔) 2.00

AC60503533 PREMARE VAGINAL CREAM "H.S." 219.00

AC60503547 PREMARE VAGINAL CREAM "H.S." 406.00

AC60505382 KE TENG PATCH "Z.F" 36.60

AC60509321 CLOBENOFE GEL 0.05% 11.90

AC60509329 CLOBENOFE GEL 0.05% 13.70

AC60509335 CLOBENOFE GEL 0.05% 24.80

AC60509338 CLOBENOFE GEL 0.05% 41.90

AC60509340 CLOBENOFE GEL 0.05% 61.00

AC60511100 URELINE TABLETS 25MG "H.T." 1.63

Page 286: 附件二 藥品給付品項暨支付標準表

AC605111G0 URELINE TABLETS 25MG "H.T."(鋁箔/膠箔) 2.00

AC60512100 FEBUTON F.C. TABLETS 40 MG (FEBUXOSTAT) 7.30

AC60515100 HEPATO-EASE F.C. TABLETS 0.5MG 94.00

AC60519265 UROKINASE-TGCC INJ. 250,000I.U. 3378.00

AC60520100 ABICALUTAMIDE F.C. TABLETS 50MG 75.00

AC60531100 Encaver F.C. Tablets 0.5mg "S.C." 97.00

AC60535335 Shinny gel 0.1% "T.F." 68.00

AC60536100 Slatone Tablets 50mg 2.16

AC60537321 ACYCLOVIR CREAM 5% "ANGEL" 41.10

AC60544209 Progesterone Injection 50mg/ml "T.F." 15.00

AC60546100 ETOCOXIA F.C. TABLETS 60MG "WEIDAR" 4.13

AC60549100 Topaless F.C. Tablets 50mg "S.C." 11.80

AC60553100 Budida soft capsules 0.5mg 14.60

AC60554100 Alsuni capsules 50mg 2759.00

AC60560100 CONST-K EXTENDED-RELEASE TABLETS 750MG 9.60

AC60561100 HUITON F.C. TABLETS 2MG 11.10

AC60563100 Uwarin Tablets 3mg 4.29

AC60568312 Penvir Cream 162.00

AC60572100 Alsuni Capsules 12.5mg 851.00

AC60574100 TAMLOSIN PROLONGED RELEASE TABLETS 0.4MG 14.50

AC60583100 Alsuni capsules 25mg 1532.00

AC60584100 EZOLE TABLETS 5MG 33.00

AC60586100 Alsuni capsules 37.5 mg 2068.00

AC60589100 ARIPIZOLE TABLETS 2MG 14.10

AC60590265 Moflogen infusion solution 400mg/250ml 624.00

AC605951G0 HENFORMIN TABLETS 500MG(鋁箔/膠箔) 2.00

AC60597100 Anamide Soft Capsule 40mg 593.00

AC60603277 Petrex Lyophilized Inj. 500mg 23577.00

AC60604255 Petrex Lyophilized Inj. 100mg 5143.00

AC60607343 PSORACAL OINTMENT 536.00

AC60608100 Vinobin Softgel Capsules 30mg 2680.00

AC60610100 Ezetity Tablets 10mg 7.30

AC60612100 Cymlutine Capsules 30mg 16.60

AC60617161 Reset oral Solution 1mg/mL "Kojar" 1074.00

AC60618100 Mecaxin Tablets 500mg 1.50

AC60825100 Fencare FCT 5mg "Johnson" 9.20

AC60826100 Fetrin Film Coated Tablets 80mg 15.80

AC60828100 Meyuan "Y.C." 3.51

AC60830100 JAWELL TABLETS "KOJAR" 1.50

AC60835100 U-CHU DUTA SOFT CAPSULES 0.5MG 14.60

AC60836100 Dualpress F.C. Tablets 5mg/20mg 10.20

AC60839100 NIMED TABLETS 100MG "S.C." 2.10

AC60841100 VINOBIN SOFTGEL CAPSULES 20MG 1878.00

AC60842245 Xinpo Lyo Inj. 40mg 119.00

AC60849100 Vinobin softgel Capsules 80mg 6356.00

AC60853217 BORTEZOMIB FOR INJECTION 3.5MG "GBC" 10539.00

AC60864129 BOWLAX 10G "KOJAR" 5.40

AC60868151 BM oral solution "Kojar" 25.00

Page 287: 附件二 藥品給付品項暨支付標準表

AC60868157 BM oral solution "Kojar" 26.50

AC60868163 BM oral solution "Kojar" 28.50

AC60885219 Ibufor Injection 100mg/ml 153.00

AC60885226 Ibufor Injection 100mg/ml 307.00

B001973421 SANCOBA EYE DROPS 17.50

B008644100 LAC-B GRANULAR POWDER 2.58

B010671340 NITRODERM TTS 5 25.50

B010940100 PANTETHINE TABLETS 100MG 3.50

B011143343 SELSUN SUSPENSION 2.5% 0.00

B012164100 JOLETHIN TABLETS 0.00

B013497100 UTROGESTAN CAPSULES 0.00

B015374100 MARSTHINE TAB. 0.60

B015749221 DOPAMINE HYDROCHLORIDE INJECTION 40MG/ML "HOSPIRA" 0.00

B016066100 ALUSA TABLETS 1.05

B016846100 MECOBALAMIN TABLETS 500 "TOWA" 1.32

B017081124 NORMACOL GRANULES 0.00

B017091435 TEARS NATURALE 47.10

B017121417 DURATEARS STERILE OPH OINT 70.00

B017218124 NORMACOL PLUS GRANULES 7.60

B017369255 INTRALIPID 20% INJECTION "KABI VITRUM" 229.00

B017369265 INTRALIPID 20% INJECTION "KABI VITRUM" 0.00

B017603335 DUOFILM 174.00

B018580299 ADRIBLASTINA RAPID DISSOLUTION 10MG 39.60

B018797100 SENOKOT TABLETS 0.81

B018813100 TOCOPHEROL NICOTINATE CAPSULES 200MG 2.02

B019120299 PHARMORUBICIN RAPID DISSOLUTION 10MG 40.20

B019889335 CANDIPLAS CREAM 134.00

B020392100 CLARINASE REPETABS TABLETS 0.00

B020548100 TAMBOCOR TABLET 100MG 9.90

B020549248 CALCO INJECTION 50IU 0.00

B020735429 ARTELAC EYE DROPS 106.00

B021354421 OFLOVID OPHTHALMIC SOLUTION 0.00

B021369329 CANDIPLAS H CREAM 36.00

B021369338 CANDIPLAS H CREAM 0.00

B021417329 MUNDISAL GEL 81.00

B021432338 RHEUMON GEL 0.00

B021515321 BRUMIXOL CREAM 94.00

B021515329 BRUMIXOL CREAM 94.00

B0215491CC CARBOMIX GRANULES FOR SUSPENSION "NORIT" 404.00

B022087299 HEPARIN "LEO" 1.12

B022143100 INDERAL TABLETS 10MG 1.50

B023417100 HEPAWELL TAB. 1.31

B0234281T0 WELLBUTRIN SUSTAINED-RELEASE TABLETS 150MG 0.00

B023602100 PANADOL TABLETS FOR CHILDREN 80MG (ACETAMINOPHEN) 0.00

B0237061E4SPIRIVA 18MCG INHALATION POWDER HARD CAPSULE WITH

HANDIHALER DEVICE ( 30CAP)0.00

B024213240 HIDONAC INJECTION 422.00

B024280145 GIONA EASYHALER 200MCG/DOSE 0.00

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B024297100 PRAVASTATIN NA TABLETS 5 KN 0.00

B0243292FBSTRUCTOKABIVEN EMULSION FOR INFUSION(依仿單含熱量

1100Kcal)0.00

B0243292FCSTRUCTOKABIVEN EMULSION FOR INFUSION(依仿單含熱量

1600Kcal)0.00

B0243292FDSTRUCTOKABIVEN EMULSION FOR INFUSION(依仿單含熱量

2100Kcal)0.00

B0243382FESTRUCTOKABIVEN PERIPHERAL EMULSION FOR INFUSION(依仿單含

熱量830Kcal)0.00

B0243382FFSTRUCTOKABIVEN PERIPHERAL EMULSION FOR INFUSION(依仿單含

熱量1300Kcal)0.00

B024899214 NUTRIFLEX LIPID PERI 2500ML(依仿單含熱量1910Kcal) 0.00

B024901214 NUTRIFLEX LIPID SPECIAL 2500ML(依仿單含熱量2950Kcal) 0.00

B0249012BH NUTRIFLEX LIPID SPECIAL 1875ML(依仿單含熱量2215Kcal) 1281.00

B024919277 LIPOPLUS 20% 0.00

B025412100 MEDOSTATIN 40MG TABLETS 0.00

B025730312 FENISTIL PENCIVIR (FOR COLD SORE) CREAM 162.00

B025840240 ADRIM INJECTION 0.00

B025921429 ARTELAC NIGHTTIME EYE GEL 102.00

B025929429 Artelac Lipid Eye Drops 0.00

B025941100 EPIMATE 100 20.70

B026103100 EPIMATE 50MG 0.00

B026212100 LAMIVUDINE / ZIDOVUDINE TEVA FILM-COATED TABLETS 31.00

BA18095248 CIPROXIN INF. SOL. 50ML/100MG (50毫升/瓶裝) 206.00

BA18095255 CIPROXIN INF. SOL. 100ML/200MG (100毫升/瓶裝) 450.00

BA18095263 CIPROXIN INF. SOL. 200ML/400MG(200毫升/瓶裝) 621.00

BA22951100 ADALAT OROS 30 5.10

BA24468100 BARACLUDE TABLETS 1MG (30粒鋁箔/盒裝) 156.00

BA24469100 BARACLUDE TABLETS 0.5MG (30粒鋁箔/盒裝) 113.00

BA24545100 SERLIN 50 TABLETS(28粒/鋁箔盒裝) 6.10

BA24634100 LOSACAR 50 TABLETS(28粒/鋁箔盒裝) 4.11

BA24876100 AMARYL M FILM-COATED TABLETS 2/500MG(30粒/鋁箔盒裝) 3.09

BA25087100 PMS-BICALUTAMIDE 50MG F.C. TABLETS(30粒/鋁箔盒裝) 75.00

BA25104100 Alendronate Sandoz 70mg Tablets 152.00

BA25109100 Bicalutamide Sandoz 50mg Film Coated Tablets 75.00

BA25200100 Tulip 10mg Film coated Tablets 9.00

BA25201100 Tulip 40mg Film coated Tablets 20.20

BA25209100 ZYDUS TOPIRAMATE TABLETS 100 MG(28粒/鋁箔盒裝) 23.20

BA25218100 ZYDUS ARIPIPRAZOLE TABLETS 10 MG(28粒/鋁箔盒裝) 47.30

BA25248143 APO-RISPERIDONE SOLUTION, 1MG/ML(30ML/塑膠瓶裝) 0.00

BA25279100OLANDUS 10 TABLETS (OLANZAPINE TABLETS)(28粒/鋁箔盒裝)

65.00

BA25308100 BIGSENS-XR 500 TABLETS(鋁箔盒裝/60粒瓶裝) 1.58

BA253081G0 BIGSENS-XR 500 TABLETS(28粒/鋁箔盒裝) 2.00

BA25337100 Tulip 20mg Film coated Tablets 16.60

BA25589100 LOSACAR 100 TABLETS【28粒/鋁箔盒裝】 5.80

BA25684100 Celecoxib Sandoz Capsule 200mg 4.66

BA25797100 Robestar Sandoz Film-coated Tablets 5mg 9.60

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BA25798100 Robestar Sandoz Film-coated Tablets 10mg 13.40

BA25813100 OLANZAPINE TABLETS 10MG(30粒/鋁箔盒裝) 65.00

BA25842100 OLANZAPINE TABLETS 5MG(30粒/鋁箔盒裝) 39.50

BA25845100 REOSTEO 35MG TABLETS(4粒/鋁箔盒裝) 152.00

BA25890100 MOSMASS TABLETS 70MG(4粒/鋁箔盒裝) 152.00

BA26108100 LETARA FILM-COATED TABLETS 2.5MG(30粒/鋁箔盒裝) 38.70

BA26189100 ESOMEPSUN 40MG TABLETS "SUNYET"(28粒/鋁箔盒裝 ) 6.10

BA26206100 Letrozole "Alvogen" FCT 2.5mg 38.70

BA26264100 OZAPEX ORODISPERSIBLE TABLETS 5MG(28粒/鋁箔盒裝) 39.50

BA26352100 ALFATAM CAPSULE 0.4MG(28粒/鋁箔盒裝) 14.50

BA26482100EC-PRAM 20 (ESCITALOPRAM F.C. TABLETS 20MG)(30粒/鋁箔盒

裝)15.50

BA26483100EC-PRAM 10 (ESCITALOPRAM F.C. TABLETS 10MG)(30粒/鋁箔盒

裝)9.70

BA26489100 OZAPEX ORODISPERSIBLE TABLETS 10MG(28粒/鋁箔盒裝) 65.00

BB17692100 CIPROXIN 250, FILM-COATED TABLETS 5.10

BB17742277 VANCOMYCIN HYDROCHLORIDE FOR INJECTION 500MG ,USP 76.00

BB20786100 GLUCOBAY TABLETS 50MG 2.27

BB20787100 GLUCOBAY TABLETS 100MG 4.69

BB21062100 CIPROXIN FILM-COATED TABLETS 500MG 6.10

BB21157221 TAXOL (PACLITAXEL) INJECTION 30MG/5ML 662.00

BB211572E2 TAXOL (PACLITAXEL) INJECTION 30MG/5ML 0.00

BB21777277 MAXIPIME INJECTABLE 500MG 151.00

BB22650100 CURAM FILM-COATED TABLETS 625MG 5.90

BB24023100 EVISTA 60MG FILM COATED TABLETS 34.00

BB24292100 MEL-OD 15 TABLETS (MELOXICAM TABLETS) 4.07

BB24489100 MEL-OD 7.5 Tablets(Meloxicam tablets) 1.72

BB24617212 IRINOTECAN INJECTION CONCENTRATE 1589.00

BB24617221 Irinotecan Injection Concentrate 2975.00

BB24808100 Curam 1000mg Film-coated tablets 7.20

BB24847280 Curam powder for injection 500/100 mg, 1000/200 mg 32.30

BB24847297 Curam powder for injection 500/100 mg, 1000/200 mg 74.00

BB24898100 AMLODAC 5 TABLETS 3.84

BB24958100 DACTIVE 10 TABLETS 1.76

BB25093100 ZYTHROCIN 250 TABLETS 17.50

BB25132297 MOXICLAV 1200MG POWDER FOR INJECTION 74.00

BB25183212 DBL GEMCITABINE FOR INJECTION 0.00

BB25183263 DBL GEMCITABINE FOR INJECTION 0.00

BB25250220 Piperacillin/Tazobactam Sandoz powder for injection 226.00

BB252502CX Piperacillin/Tazobactam Sandoz powder for injection 136.00

BB25266100 DIAMICRON MR TABLETS 60 MG 2.91

BB25369100 ZYDUS ESCITALOPRAM OXALATE TABLETS 10 MG 9.70

BB25465100 APO-QUETIAPINE TABLETS 300MG 30.80

BB25466100 APO-QUETIAPINE TABLETS 200MG 16.30

BB25467100 APO-QUETIAPINE TABLETS 25MG 7.30

BB25535100 ARBREAST F.C. TAB. 1MG (ANASTROZOLE) 0.00

BB25600212 HOSPIRA DOCETAXEL INJECTION 3199.00

BB25600226 HOSPIRA DOCETAXEL INJECTION 10751.00

Page 290: 附件二 藥品給付品項暨支付標準表

BB25653100 APO-QUETIAPINE TABLETS 100MG 12.10

BB25828100 LEVOZYD 500 (LEVOFLOXACIN TABLETS 500MG) 20.90

BB25864100 JUBILANT OLANZAPINE ORODISPERSIBLE TABLETS 10MG 65.00

BB25865100 JUBILANT OLANZAPINE ORODISPERSIBLE TABLETS 5MG 39.50

BB25873100 CLOPISTAD 32.10

BB25968221 Epirubicin "Alvogen" 2mg/ml Injection solution 407.00

BB25968240 Epirubicin "Alvogen" 2mg/ml Injection solution 2311.00

BB26001100 TOPIZ 50 11.80

BB26025209Ceftriaxone "Alvogen" 1g Powder for solution for IV

Injection82.00

BB26026221 DOXORUBICIN "ALVOGEN" SOLUTION FOR INJECTION 2MG/ML 399.00

BB26026229 DOXORUBICIN "ALVOGEN" SOLUTION FOR INJECTION 2MG/ML 0.00

BB26026240 DOXORUBICIN "ALVOGEN" SOLUTION FOR INJECTION 2MG/ML 0.00

BB26026248 DOXORUBICIN "ALVOGEN" SOLUTION FOR INJECTION 2MG/ML 0.00

BB26409100 Alvoprel Film Coated tablet 300mg 9.10

BB26410100 Adempas film-coated tablets 0.5mg 1261.00

BB26411100 Adempas film-coated tablets 1.0mg 1261.00

BB26412100 Adempas film-coated tablets 1.5mg 1261.00

BB26413100 Adempas film-coated tablets 2.0mg 1261.00

BB26414100 Adempas film-coated tablets 2.5mg 1261.00

BB26515100 AROMATT 1 (ANASTROZOLE TABLETS 1MG) 45.30

BB26528100 MONTE-H 10 (MONTELUKAST TABLETS 10MG) 12.30

BB26554100 BINFIN 5 (FINASTERIDE TABLETS 5MG) 12.60

BB26577100 IRBIS H 300 (IRBESARTAN F.C. TABLETS 300MG) 9.10

BB26613100 Alvotinib 100mg Film-Coated tablets 524.00

BB26614100 Alvotinib 400mg Film-Coated tablets 1441.00

BC01879277 CYTOSAR FREEZE-DRIED POWDER FOR INJECTION 500MG 285.00

BC03077100 RIVOTRIL 0.5MG TABLET 1.50

BC030771G0 RIVOTRIL 0.5MG TABLET 2.00

BC03078100 RIVOTRIL 2MG TABLET 0.00

BC030781G0 RIVOTRIL 2MG TABLET(鋁箔/膠箔) 2.00

BC04248245 SOLU-MEDROL STERILE POWDER 40MG 39.30

BC04405421 LACRIMIN OPHTHALMIC SOLUTION 18.00

BC044571G0 LEXOTAN TABLETS 3MG 2.00

BC044591G0 LEXOTAN TABLETS 1.5MG 2.00

BC04858100 FLUANXOL 3MG film coated tablets 10.70

BC04922277 STERILE SOLU-MEDROL 188.00

BC04923100 FLUANXOL 1MG film coated tablets 4.88

BC05037209 FLUANXOL DEPOT 1ML 245.00

BC051761G0 BURINEX TABLETS 1MG(鋁箔/膠箔) 2.00

BC05819100 PROGYLUTON S.C. TABLETS 3.91

BC06049100 SECTRAL TABLETS 400MG 0.00

BC07107421 MYDRIN-M 47.50

BC07125100 BEZALIP COATED TABLETS 0.00

BC071521G0 GLUCOPHAGE TABLETS(鋁箔/膠箔) 2.00

BC07538100 LONITEN 10MG 8.60

BC09100100 VOLTAREN SR 100 2.13

BC09115100 MYLERAN BUSULPHAN TABLETS 2MG 31.50

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BC09145100 ALKERAN MELPHALAN TABLETS 2MG 52.00

BC09146100 LEUKERAN CHLORAMBUCIL TABLETS 2MG 12.30

BC09147100 IMURAN AZATHIOPRINE TABLETS 50MG B.P. 9.60

BC09554100 LANOXIN DIGOXIN TABLETS 0.25MG B.P. 1.75

BC09714212 LANOXIN DIGOXIN INJECTION 0.5MG B.P. 37.90

BC09796100 MADOPAR 250 TABLETS "ROCHE" 6.30

BC11051100 PANAGESIC TABLETS 2.73

BC112121G0 ISMO 20(鋁箔/膠箔) 2.00

BC11225100 COSTI TABLETS 0.00

BC112251G0 COSTI TABLETS(鋁箔/膠箔) 0.00

BC11315100 DEANXIT FILM COATED TABLETS 2.15

BC11326265 ZOVIRAX I.V. 287.00

BC11917277 DESFERAL VIALS 500MG 251.00

BC11978100 DEVODIL TABLETS 1.53

BC119781G0 DEVODIL TABLETS(鋁箔/膠箔) 2.00

BC121641G0 JOLETHIN TABLETS(鋁箔/膠箔) 0.00

BC12258248 FUNGIZONE INTRAVENOUS 575.00

BC125401G0 REMYCIN CAPSULES 100MG(鋁箔/膠箔) 2.00

BC12554100 ANDROCUR TABLETS 27.70

BC12601100 ENDOXAN SUGAR-COATED TABLETS 11.90

BC12640221PROTAMINE SULPHATE LEO PHARMA 1400 ANTI-HEPARIN IU/ML

SOLUTION FOR INJECTION AND INFUSION128.00

BC126761G0 LOPERIUM TABLETS 2MG 1.52

BC12873100 MINIDIAB TABLETS 5MG 1.50

BC128731G0 MINIDIAB TABLETS 5MG(鋁箔/膠箔) 2.00

BC12946100 PROVERA 10MG 2.63

BC12963177 ISOBIDE SOLUTION 1095.00

BC13027148 SANDIMMUN NEORAL ORAL SOLUTION 100MG/ML 7941.00

BC13049209 SANDIMMUN CONCENTRATE FOR INTRAVENOUS INFUSIO 117.00

BC13059238 DAUNOBLASTINA 20MG FOR INJECTION 457.00

BC13086121 KALIMATE POWDER 9.50

BC13116343 OESTROGEL GEL 74.00

BC13148214 TRACRIUM INJECTION 51.00

BC13159209 METHERGIN (R) AMPOULES 0.2MG/1ML 44.30

BC13304429 ALLERGOPOS EYE DROPS 37.90

BC13409100 AKAMON TABLETS 3MG 1.53

BC134091G0 AKAMON TABLETS 3MG(鋁箔/膠箔) 2.00

BC14029100 SERMION TABLETS 5MG 2.56

BC14822100 CORDARONE TABLETS 4.86

BC14860100 PROVERA 5MG (MEDROXYPROGESTERONE ACETATE) TABLETS 1.50

BC14861216 CORDARONE INJECTION 61.00

BC14899100 DEPAKINE GASTRO-RESISTANT TABLET 200MG 2.75

BC14902145 DEPAKINE ORAL SOLUTION 177.00

BC14966100 ROACCUTANE “ROCHE”SOFT GELATIN CAPSULES 20MG 61.00

BC14967100 ROACCUTANE "ROCHE" SOFT GELATIN CAPSULES 10MG 37.90

BC15152100 ECTOPAL CAPSULES 9.80

BC15234209 "VITAMIN B12 INJECTIONS 1000 ""KOBAYASHI""" 15.00

BC15290100 SERMION TABLETS 10MG 4.38

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BC15292421 ARTEOPTIC 2% OPHTHALMIC SOLUTION 177.00

BC15293421 ARTEOPTIC 1% OPHTHALMIC SOLUTION 120.00

BC15387255 "HOSPIRA" METRONIDAZOLE INJECTION 5MG/ML 41.00

BC15467209 SUSTANON 191.00

BC15478255 MIACALCIC AMPOULES 100I.U./ML 126.00

BC15875212 TRAMAL INJECTION 25.90

BC15880100 TADEX TABLETS 10MG 3.63

BC15979209 PLEGISOL 482.00

BC16028100 TEGRETOL CR 200MG FILM-COATED TABLETS (DIVISIBLE) 2.23

BC16033100 TEGRETOL CR 400MG FILM-COATED TABLETS (DIVISIBLE) 0.00

BC160661G0 ALUSA TABLETS(鋁箔/膠箔) 2.00

BC16080100 PINDOLOL TABLETS "TOWA" 3.91

BC16094100 BEZALIP RETARD COATED TABLETS 12.10

BC16120100 RETROVIR 100MG CAPSULES 34.20

BC16194100 TREXAN 2.5MG TABLETS 4.46

BC16229500 ALBOTHYL VAGINAL SUPPOSITORIES (OVULES) 10.90

BC16450500 FAKTU SUPPOSITORIES 7.20

BC16477100 CALMDAY 5MG,SUGAR COATED TABLETS 3.05

BC16483435 ISOPTO CARPINE 2% 79.00

BC16504100 FERRUM HAUSMANN CHEWABLE TABLETS 3.01

BC16528100 MILLIBAR CAPUSLES 1.92

BC16548421 TOBREX STERILE OPHTHALMIC SOLUTION 32.80

BC16704248 MIACALCIC INJECTION 50 MRC-U/ML (50IU /ML) 88.00

BC16710421 MYDRIACYL 0.5 % OPHTHALMIC SOLUTION (R) 16.50

BC16711421 MYDRIACYL 1% 65.00

BC16717100 NOVOFEN TABLETS 10MG 3.63

BC16732335 MEDODERMONE OINTMENT 24.80

BC16732340 MEDODERMONE OINTMENT 61.00

BC16738335 MEDODERMONE CREAM 24.80

BC16738340 MEDODERMONE CREAM 61.00

BC16765421 MAXITROL STERILE OPH SUSPENSION 106.00

BC16784100 TIADEN TABLETS 1.88

BC168461G0 MECOBALAMIN TABLETS 500 "TOWA" (鋁箔/膠箔) 2.00

BC16851417 TOBREX EYE OINTMENT 61.00

BC16863100 TRAMAL 50 CAPSULES 2.43

BC16876417 MAXITROL STERILE OPHTHALMIC OINTMENT 139.00

BC16888100 DENEX TABLETS 100MG 3.06

BC16894435 NATACYN 5% OPHTHALMIC SUSPENSION 1800.00

BC16898100 CONVULEX 300MG CAPSULES 5.80

BC16904100 CONVULEX 150 SOFT CAPSULES 2.67

BC16973100 JUVELA N SOFT CAPSULES 200MG 2.05

BC16998100 CONVULEX 500MG CAPSULES 7.40

BC16999100 MECOBALAMIN TABLETS 500μg 1.55

BC17039316 IODOSORB POWDER 61.00

BC17057209 PROSTIN VR PEDIATRIC 500 MICROGRAMS PER ML 1552.00

BC17077100 MADOPAR HBS CAPSULES 125MG "ROCHE" 4.76

BC17090100 CONCOR 10 0.00

BC17118100 ANPEC 40 TABLETS 0.00

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BC17124221 ANEXATE AMPOULE 910.00

BC17125100 CONCOR 5 MG 2.15

BC17140100 OLBETAM 250MG CAPSULES 6.20

BC17161158 ZOVIRAX SUSPENSION 722.00

BC17196100 MECOLAMIN CAPSUL 1.55

BC17214112 BRICANYL SOLUTION FOR NEBULIZING 2.5MG/ML 9.40

BC17283100 METALCAPTASE 300 13.40

BC17312210 CAPD 3 PERITONEAL DIALYSIS SOLUTION 156.00

BC17312212 CAPD 3 PERITONEAL DIALYSIS SOLUTION 180.00

BC17312221 CAPD3 PERITONEAL DIALYSIS SOLUTION 0.00

BC17400421 ECONOPRED PLUS 1% 76.00

BC17407100 DICETEL 50MG FILM COATED TABLETS 5.30

BC17469100 PLENDIL EXTENDED RELEASE TABLETS 10MG 3.58

BC17488100 PLENDIL TABLETS 5MG 2.04

BC17528126 VENTOLIN INHALER (80DOSE) 97.00

BC17528138 VENTOLIN INHALER (200DOSE) 109.00

BC17536100 VENTOLIN TABLETS 2MG 1.50

BC175361G0 VENTOLIN TABLETS 2MG(鋁箔/膠箔) 2.00

BC17577100 DORMICUM "ROCHE" FILM-COATED TABLETS 7.5MG 3.72

BC17728265 GLYCEROSTERIL 10% 85.00

BC17819265 NEPHROSTERIL INFUSION SOLUTION 192.00

BC17835255 METRONIDAZOL FRESENIUS 41.00

BC17867210 CAPD 2 PERITONEAL DIALYSIS SOLUTION 156.00

BC17867212 CAPD 2 PERITONEAL DIALYSIS SOLUTION 180.00

BC17867214 CAPD 2 PERITONEAL DIALYSIS SOLUTION 199.00

BC17867221 CAPD 2 PERITONEAL DIALYSIS SOLUTION 280.00

BC17873209 SANDOSTATIN AMPOULES 0.1MG/ML 390.00

BC18008255 LIPOVENOS 20% EMULSION FOR INTRAVENOUS INFUSION 0.00

BC18008265 LIPOVENOS 20% EMULSION FOR INTRAVENOUS INFUSION 0.00

BC18151100 FUTRAFUL CAPSULES 21.10

BC18155100 AUGMENTIN TABLETS 375MG 5.80

BC18158100 IMOVANE TABLETS 7.5MG 1.98

BC18167255 SOLU-CORTEF STERILE POWDER 100MG 35.30

BC18196210 CAPD 4 PERITONEAL DIALYSIS SOLUTION 156.00

BC18196212 CAPD 4 PERITONEAL DIALYSIS SOLUTION 180.00

BC18196214 CAPD 4 PERITONEAL DIALYSIS SOLUTION 199.00

BC18196221 CAPD 4 PERITONEAL DIALYSIS SOLUTION 280.00

BC18215500 PROSTIN E2 VAGINAL TABLETS 308.00

BC182311G0 GLUCOPHAGE TABLET 850MG(鋁箔/膠箔) 2.00

BC18273100 KETOSTERIL TABLETS 15.50

BC18279100 PHYLLOCONTIN CONTINUS TABLETS 2.83

BC18307255 LIPOFUNDIN MCT/LCT 20% I.V. INFUSION 163.00

BC18307265 LIPOFUNDIN MCT/LCT 20% I.V. INFUSION 168.00

BC18308255 LIPOFUNDIN MCT/LCT 10% I.V. INFUSION "B. BRAUN" 155.00

BC18308265 LIPOFUNDIN MCT/LCT 10% I.V. INFUSION 165.00

BC18308277 LIPOFUNDIN MCT/LCT 10% I.V. INFUSION 168.00

BC18348155 CONVULEX SYRUP 50MG/ML 135.00

BC18425100 ALEPAM 15 TABLET 0.00

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BC18433114 AUGMENTIN FOR SYRUP 84.00

BC18479212 HOLOXAN (2GM) 2700.00

BC18485271 UROMITEXAN INJECTION 175.00

BC18540248 HERBESSER INJECTION 50MG 390.00

BC18542100 CLOZARIL TABLETS 100MG 4.55

BC18580229 ADRIBLASTINA RAPID DISSOLUTION 10MG 399.00

BC18584100 ZOFRAN TABLETS 8MG 115.00

BC18585212 ZOFRAN INJECTION 2MG/ML 87.00

BC18585219 ZOFRAN INJECTION 2MG/ML 94.00

BC18617421 TOBRADEX OPHTHALMIC SUSPENSION 109.00

BC18654421 1% PRED FORTE OPHTHALMIC SUSPENSION 76.00

BC18656429 FML LIQUIFILM OPHTHALMIC SUSPENSION 51.00

BC18669255 FOY FOR INJECTION 203.00

BC18720238 PROMOSTAN FOR INJECTION 569.00

BC18741100 ATIVAN TABLETS 0.5MG 1.50

BC187411G0 ATIVAN TABLETS 0.5MG 2.00

BC18776421 BETOPTIC S STERILE OPHTHALMIC SUSPENSION 125.00

BC18790248 DIFLUCAN IV INJECTION 258.00

BC18842100 NIMOTOP F.C. TABLETS 30MG 16.40

BC18843248 NIMOTOP INFUSION SOLUTION 0.02%W/V 598.00

BC18863412ATROVENT NEBULISER SOLUTION 0.5MG/2ML IN UNIT-DOSE VIALS

7.40

BC18873238 CISPLATIN-EBEWE 0.5MG/ML INJECTION 0.00

BC18873255 CISPLATIN-EBEWE 0.5MG/ML INJECTION 0.00

BC18876221 Methotrexat "Ebewe" 470.00

BC18876229 Methotrexat "Ebewe" 0.00

BC18876248 Methotrexat "Ebewe" 0.00

BC18960100 LEVOHALTE TABLETS 10.90

BC18979229 MILLISROL INJECTION 47.40

BC18979255 MILLISROL INJECTION 227.00

BC19000100 MST CONTINUS TABLETS 60MG 80.00

BC19001100 MST CONTINUS TABLETS 30MG 53.00

BC19086100 UNASYN TABLETS 11.20

BC19107321 FUCIDIN OINTMENT 2% 32.20

BC19108100 FUCIDIN TABLETS 48.90

BC19109219 BURINEX INJECTION 0.5MG/ML 47.10

BC19116321 FUCIDIN CREAM 32.20

BC19116335 FUCIDIN CREAM 126.00

BC19119248 PHARMORUBICIN RAPID DISSOLUTION 50MG 2311.00

BC19120229 PHARMORUBICIN RAPID DISSOLUTION 10MG 407.00

BC19122412 DEXALTIN ORAL PASTE 31.80

BC19122421 DEXALTIN ORAL PASTE 35.60

BC19124235 BLEOCIN FOR INJECTION 15MG 1265.00

BC19190100 DIVINA TABLETS 4.17

BC19191221 BLEOCIN FOR INJECTION 5MG 0.00

BC19238100 ACERTIL TABLETS 4MG 6.10

BC19259421 TIMOPTOL OPHTHALMIC SOLUTION 0.5% 122.00

BC19320100 LAMISIL TABLETS 250MG 7.80

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BC19327500 OVESTIN VAGINAL SUPPOSITORIES 0.5MG 0.00

BC19338209 HALDOL INJECTION 22.40

BC19339100 GENURIN 200MG 3.74

BC19363100 APO-CIMETIDINE 200MG TABLETS 0.00

BC19376221 "FRAGMIN 5 70.00

BC19378229 "FRAGMIN 2 190.00

BC19456221 DORMICUM "ROCHE" AMPOULES 5MG/5ML 17.70

BC19457209 DORMICUM "ROCHE" AMPOULES 5MG/ML 17.70

BC19457216 DORMICUM "ROCHE" AMPOULES 5MG/ML 23.50

BC19475209 HALDOL DECANOAS 135.00

BC19488343 SKINOREN CREAM 207.00

BC19489533 PREMARIN VAGINAL CREAM 219.00

BC19489547 PREMARIN VAGINAL CREAM 406.00

BC194932AA LEUPLIN DEPOT 3.75MG S.C. INJECTION 3807.00

BC19536414 VENTOLIN NEBULES 5MG PER 2.5ML INHALATION SOLUTION 4.95

BC19538100 GASTRO-TIMELETS 5.40

BC19557100 UNIPHYLLIN CONTINUS TABLETS 400MG 4.01

BC19567100 XANTHIUM 400MG CAPSULE 4.01

BC19595426 SURVANTA 200MG/8ML/VIAL INTRATRACHEAL SUSPENSION 13787.00

BC19624100 XANTHIUM 200MG CAPSULES. 1.61

BC196241G0 XANTHIUM 200MG CAPSULES.(鋁箔/膠囊) 2.00

BC19626100 SIRDALUD TABLETS 2MG 1.62

BC19631100 APO-CAPTO 12.5MG TABLETS 1.50

BC19632100 APO-CAPTO 25MG TABLETS 1.50

BC19836100 RYTMONORM 300MG FILM COATED TABLETS 20.30

BC19845221 ZAVEDOS 5MG 3600.00

BC19879100 SYNTOCRIPTINE TABLETS 4.58

BC19885100 CARDIZEM RETARD 90MG 5.70

BC19918100 RYTMONORM 150MG FILM COATED TABLETS 10.00

BC19924221 PICIBANIL 5KE 2460.00

BC19953100 ISOPTIN SR 240MG FILM COATED TABLETS 5.20

BC19955209 KYTRIL 3MG IN 3ML 185.00

BC19955216 KYTRIL 3MG IN 3ML 347.00

BC20021229 PERDIPINE INJECTION 1MG/ML 141.00

BC20022335 LOMEXIN CREAM 2% 94.00

BC20042335 LOMEXIN 106.00

BC20053500 LOMEXIN VAGINAL SUPPOSITORY 200MG 36.90

BC20144210 UNASYN IM/IV FOR INJECTION 0.75G & 1.5G 55.00

BC20144289 UNASYN IM/IV FOR INJECTION 0.75G & 1.5G 55.00

BC20157100 CATAFLAM 25MG SUGAR-COATED TABLETS 1.50

BC201571G0 CATAFLAM 25MG SUGAR-COATED TABLETS 2.00

BC20158100 CATAFLAM 50MG SUGAR-COATED TABLETS 0.00

BC20162100 SINEMET 25/250 TABLETS 9.10

BC20174100 BETALOC ZOK 100MG TABLETS 6.20

BC20198100 PROSCAR (FINASTERIDE) 5MG TABLET 12.60

BC20200314 ELOMET CREAM 0.1% 21.40

BC20200321 ELOMET CREAM 0.1% 27.60

BC20230343 DAIVONEX OINTMENT 461.00

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BC20249343 CLEOCIN T GEL 1% 185.00

BC20251100 SINEMET 25/100 TABLETS 4.74

BC20256116 BREXIN SACHETS 9.50

BC20266277 ERYTHROCIN LACTOBIONATE-I.V. 366.00

BC20323100 APO-RANITIDINE 150MG F.C. TABLETS 0.00

BC20452100 DILATREND TABLETS 25MG 3.19

BC20454438 BECLOMET NASAL AQUA 100 MCG/DOSE NASAL SPRAY 186.00

BC20509100 LAMICTAL TABLETS 50MG 10.10

BC20510100 LAMICTAL TABLETS 100MG 13.80

BC20554100 IMDUR CONTROLLED-RELEASE TABLETS 60MG 3.05

BC20576100 EUPHYLLIN RETARD FILM-COATED TABLETS 250MG 0.00

BC20630100 NITROCONTIN CONTINUS TABLETS 6.4 MG 0.00

BC20674100 CYTOTEC (MISOPROSTOL) 200MCG 9.20

BC20706265 AMINOSTERIL N HEPA 8% INFUSION SOLUTION 144.00

BC20706277 AMINOSTERIL N HEPA 8% INFUSION SOLUTION 182.00

BC20802100 NITROSTAT 0.6MG 4.97

BC20824209 MINIRIN SOLUTION FOR INJECTION 4MCG/ML 315.00

BC20825209 GLYPRESSIN 1MG 805.00

BC20826100 MINIRIN TABLETS 0.1MG 37.90

BC208272AA DECAPEPTYL CR 3311.00

BC20862100 CIPRAM TABLETS 20MG 7.10

BC20882100 VEPESID CAPSULES 50MG 372.00

BC20895100 VOLTAREN RETARD 75MG SLOW RELEASE FILM-COATED TABLETS 1.92

BC20915417 TOBRADEX STERILE OPHTHALMIC OINTMENT 100.00

BC20932221 XYLOCAINE 2% FOR INTRAVENOUS INJECTION 50.00

BC20936238 CAVERJECT STERILE POWDER 569.00

BC20940209 NUTRIFLEX PERI 40/80 364.00

BC20951343 CLEOCIN T TOPICAL 1% SOLUTION 87.00

BC209712CX TAZOCIN 0.00

BC20975209 NUTRIFLEX SPECIAL 390.00

BC20975210 NUTRIFLEX SPECIAL 696.00

BC20991100 SIGMART TABLETS 5MG 2.89

BC20992100 SIGMART TABLETS 2.5MG 0.00

BC20999100 MYCOBUTIN 93.00

BC21026229 MITOMYCIN-C KYOWA 10MG 640.00

BC21027100 NEUROTOL SLOW TABLETS 300 MG 0.00

BC21028100 NEUROTOL SLOW TABLETS 200MG 0.00

BC21032229 LEUNASE INJECTION (10,000 K.U.) 1192.00

BC21034100 KALMA TABLETS 1MG 0.00

BC21043100 FLORINEF TABLETS 0.1MG 7.40

BC21073248 ALKERAN INJECTION 1961.00

BC21083500 ASACOL SUPPOSITORIES 25.00

BC21093100 LAMICTAL DISPERSIBLE/CHEWABLE TABLETS 5MG 5.60

BC21128229 PRIMACOR I.V. INJECTION 367.00

BC21140100 XANAX TABLETS 0.5MG 1.50

BC211401G0 XANAX TABLETS 0.5MG(鋁箔/膠箔) 2.00

BC21144145 BUVENTOL EASYHALER 200MCG/DOSE INHALATION POWDER 405.00

BC21150100 FARLUTAL TAB. 500MG 40.30

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BC21174100 ALFACALCIDOL SOFT CAPSULES 0.25TY 4.81

BC21175100 ALFACALCIDOL SOFT CAPSULES 0.5 TY 8.40

BC21188100 SANDIMMUN NEORAL SOFT GELATIN CAP. 100MG 121.00

BC21189100 SANDIMMUN NEORAL SOFT GELATIN CAP. 25MG 37.20

BC21191216 SOMATOSAN 3MG FOR I.V. INFUSION "CURAMED" 1005.00

BC21198100 LESCOL CAPSULES 20MG 0.00

BC21199100 LESCOL CAPSULES 40MG 0.00

BC21218145 BECLOMET EASYHALER 200MCG/DOSE 451.00

BC21224229 FENTANYL INJ. 0.05MG/ML 98.00

BC21234100 XANAX TABLETS 0.25MG 1.50

BC212341G0 XANAX TABLETS 0.25MG(鋁箔/膠箔) 2.00

BC21236212 ZOFRAN INJECTION 2MG/ML 87.00

BC21236219 ZOFRAN INJECTION 2MG/ML 94.00

BC21269421 TIMOLOL-POS EYE DROPS 0.5% 122.00

BC21277429 VIDISIC GEL 102.00

BC21298100 UNIPHYLLIN CONTINUS TABLETS 300MG 0.00

BC21303100 MIKELAN LA CAPSULES 15MG 13.10

BC21304263 ENDOXAN INJECTION 78.00

BC21304277 ENDOXAN INJECTION 156.00

BC21333216 STILAMIN 3MG 1005.00

BC21379265 UROKINASE-GCC INJECTION 250,000 I.U. 0.00

BC21397251 NOOTROPIL I.V. INFUSION SOLUTION 200MG/ML 0.00

BC21422100 RANTUDIL CAPSULES 60MG 0.00

BC21427345 TRAUMON GEL 0.00

BC21439212 ADENOCOR INJECTION 3MG/ML 127.00

BC21446421 CUSIMOLOL 0.5% STERILE EYE DROPS 122.00

BC21454100 TIOGAM TABLETS 200mg 2.91

BC21477423 FLIXONASE AQUEOUS NASAL SPRAY 50MCG/METERED SPRAY 152.00

BC21530100 "KERLONE 20MG 0.00

BC215311G0 STILNOX FILM-COATED SCORED TABLETS 10MG(鋁箔/膠箔) 2.00

BC21536100 SEROXAT F.C. TABLETS 20MG 5.30

BC21545414 TIMOPTOL XE 0.5% OPHTHALMIC SOLUTION 122.00

BC21571100 NORVASC TABLETS 5MG 3.84

BC21625100 TEMGESIC SUBLINGUAL TABLETS 0.2MG 20.00

BC21626209 TEMGESIC INJECTION 0.3MG/ML 84.00

BC21628421 KARY UNI OPHTHALMIC SUSPENSION 29.80

BC216411G0 DOXABEN TABLET 2MG(鋁箔/膠箔) 2.00

BC216431G0 DOXABEN TABLET 1MG(鋁箔/膠箔) 2.00

BC21663100 HALDOL TABLETS 5MG 1.75

BC21676100 DIFLUCAN CAPSULE 150MG 52.00

BC21686429 SUPREMON NASAL SOLUTION 0.00

BC21689221 FLUOROURACIL INJECTION VIAL "DBL" 25.60

BC21689229 FLUOROURACIL INJECTION VIAL "DBL" 57.00

BC21689248 FLUOROURACIL INJECTION VIAL "DBL" 230.00

BC21696212 METHOTREXATE INJECTION "DBL" 89.00

BC21698100 XANAX XR EXTENDED-RELEASE TABLETS 0.5MG 1.50

BC216981G0 XANAX XR EXTENDED-RELEASE TABLETS 0.5MG(鋁箔/膠箔) 2.00

BC21701235 CARBOPLATIN INJECTION "DBL" 1448.00

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BC217012AP CARBOPLATIN INJECTION "DBL" 3058.00

BC21713229 METHOTREXATE INJECTION BP 100MG/ML 0.00

BC21726100 HALCION TABLETS 0.25MG 1.88

BC217261G0 HALCION TABLETS 0.25MG(鋁箔/膠箔) 2.00

BC21754100 NAPAMIDE F.C TABLETS 2.5MG 1.92

BC21757100 CELLCEPT CAPSULES 250MG 41.30

BC21776209 MAXIPIME INJ. (CEFEPIME) 0.00

BC21779100 DIFLUCAN CAPSULE 50MG 23.50

BC21780100 ZOLOFT FILM COATED TABLETS 50MG 6.10

BC21782248 CISPLATIN INJECTION "DBL" 350.00

BC21782255 CISPLATIN INJECTION "DBL" 350.00

BC21784335 METROGEL 0.75% 38.60

BC21784343 METROGEL 0.75% 133.00

BC21788100 VALTREX TABLETS 500MG 52.00

BC21808100 BONEFOS CAPSULES 400MG 29.60

BC21824435 ALLERGOCROM NASAL SPRAY SOLUTION 2.8MG/SPRAY 15ML 64.00

BC21830180 ZITHROMAX POWDER FOR ORAL SUSPENSION 216.00

BC21840100 TRAMAL RETARD 100MG 3.74

BC21847100 SABRIL FILM-COATED TABLETS 500MG 25.20

BC21848263 TARGOCID 200MG FOR INJECTION (I.M.I.V.) 516.00

BC21874414 MINIRIN NASAL SPRAY 10UG/DOSE 1656.00

BC21879248 SODIUM NITROPRUSSIDE FOR INTRAVENOUS INFUSION "DBL" 265.00

BC21880229 VINBLASTINE SULFATE INJECTION 1MG/ML "DBL" 606.00

BC21905100 RILUTEK 50MG TABLETS 137.00

BC21914100 COZAAR F.C.TAB. 50MG 4.11

BC21921135 FLIXOTIDE ACCUHALER 250MCG/DOSE 472.00

BC21927100 RIFINAH 300 S. C. TABLETS 13.50

BC21928100 RIFINAH 150 S.C. TABLETS 7.50

BC21989138 PULMICORT TURBUHALER 200MICROGRAMS/DOSE 294.00

BC21989145 PULMICORT TURBUHALER 200MICROGRAMS/DOSE 351.00

BC21992229 LEUSTATIN INJECTION 9014.00

BC22008100 DEPAKINE CHRONO 500MG FILM COATED TABLETS 5.90

BC22013219 LEVOPHED BITARTRATE 100.00

BC22014163 RETROVIR SYRUP 780.00

BC22014164 RETROVIR SYRUP 841.00

BC22016100 KYTRIL 1MG F.C.TABLETS 167.00

BC22022255 AMINOSTERIL INFANT 6% W/V FOR INTRAVENOUS INFUSION 208.00

BC22023255 AMINOSTERIL INFANT 10% W/V FOR INTRAVENOUS INFUSION 196.00

BC22043100 PROGRAF CAPSULES 1MG 114.00

BC22044100 PROGRAF CAPSULES 5MG 480.00

BC22047209 VINCRISTINE SULPHATE INJECTION 1MG/1ML "DBL" 224.00

BC22049109PULMICORT RESPULES 1MG/2ML NEBULISING SUSPENSION FOR

INHALATION52.00

BC22060100 RIFATER S.C.TAB. 11.50

BC22064100 PROZAC 20MG DISPERSIBLE 2.80

BC220641G0 PROZAC 20MG DISPERSIBLE(鋁箔/膠箔) 0.00

BC22071100 DILATREND TAB. 6.25MG 2.39

BC22074164 3TC ORAL SOLUTION 1362.00

Page 299: 附件二 藥品給付品項暨支付標準表

BC22075100 3TC FILM COATED TABLETS 150MG 78.00

BC22082148 BRICANYL TURBUHALER 0.5MG/DOSE 0.00

BC22082155 BRICANYL TURBUHALER 0.5MG/DOSE 0.00

BC22087240 HEPARIN "LEO" 166.00

BC22094143 RISPERDAL ORAL SOLUTION 1MG/ML 548.00

BC22097100 FOLIROMIN FILM-COATED TAB. 50MG 2.24

BC22107421 TRUSOPT OPHTHALMIC SOLUTION 2% 235.00

BC22115265 MEPEM INTRAVENOUS INJECTION 0.25G/VIAL 281.00

BC22115277 MEPEM INTRAVENOUS INJECTION 0.5G/VIAL 284.00

BC22117100 NEOTIGASON CAPSULES 25MG 71.00

BC22118100 NEOTIGASON CAPSULES 10MG 37.20

BC22124100 ACCUPRIL F.C. TABLETS 10 MG 7.70

BC22131263 DACARBAZINE FOR INJECTION 200MG 879.00

BC22132229 METHOTREXATE INJECTION 1G/10ML "DBL" 869.00

BC221372CS ZOLADEX 3.6MG DEPOT 3569.00

BC22139100 PANTOLOC GASTRO-RESISTANT TAB. 40MG 10.10

BC221431G0 INDERAL TABLETS 10MG(84粒/瓶) 2.00

BC22144100 APO-ATENOL 100MG TABLETS 1.51

BC221441G0 APO-ATENOL 100MG TABLETS(鋁箔/膠箔) 2.00

BC22151100 ZESTRIL TABLETS 5MG 0.00

BC22152100 ZESTRIL TABLETS 10MG 2.29

BC22154100 NOLVADEX TABLETS 10MG 3.63

BC22158100 APO-ATENOL 50MG TABLETS 1.50

BC221581G0 APO-ATENOL 50MG TABLETS(鋁箔/膠箔) 2.00

BC221591G0 TENORMIN TABLETS 100MG(鋁箔/膠箔) 2.00

BC221601G0 TENORMIN TABLETS 50MG(鋁箔/膠箔) 2.00

BC22177203 CLEXANE INJECTION 126.00

BC22179100 FAMVIR 59.00

BC22193100 ELDEPRYL TABLETS 10MG 5.10

BC22198209DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE

156.00

BC22198210DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE

156.00

BC22198212DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE

180.00

BC22198214DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE

199.00

BC22198221DIANEAL PD-2 PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE

"BAXTER"280.00

BC22199209DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE

0.00

BC22199210DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE

156.00

BC22199212DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE

180.00

BC22199214DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE

199.00

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BC22199221DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE

"BAXTER"280.00

BC22208100 TEGRETOL TABLETS 200MG 2.18

BC22211100 ELDEPRYL TABLETS 5MG 2.46

BC22214221 LEUCOVORIN CALCIUM INJECTION 50MG/5ML "DBL" 69.00

BC22214229 LEUCOVORIN CALCIUM INJECTION 50MG/5ML "DBL" 0.00

BC22215209 NAVELBINE 10MG/ML INJECTION SOLUTION 1075.00

BC22215221 NAVELBINE 10MG/ML INJECTION SOLUTION 6031.00

BC22218209DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25%

DEXTROSE "BAXTER"0.00

BC22218210DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25%

DEXTROSE "BAXTER"156.00

BC22218212DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25%

DEXTROSE "BAXTER"180.00

BC22218214DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25%

DEXTROSE "BAXTER"0.00

BC22218221DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25%

DEXTROSE "BAXTER"280.00

BC22232277 CYMEVENE LYOPHILIZED IV INJECTION 500MG/VIAL 1492.00

BC222332D1 ZOLADEX LA 10.8MG DEPOT 10308.00

BC22251229 ACICLOVIR INTRAVENOUS INFUSION "DBL" 287.00

BC22251238 ACICLOVIR INTRAVENOUS INFUSION "DBL" 0.00

BC22282100 ARIMIDEX TABLETS 1MG 45.30

BC22283421 TARIVID OTIC SOLUTION 51.00

BC22297210DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 1.5% DEXTROSE "BAXTER"156.00

BC22297212DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 1.5% DEXTROSE "BAXTER"180.00

BC22297214DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 1.5% DEXTROSE "BAXTER"199.00

BC22297221DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 1.5% DEXTROSE "BAXTER"280.00

BC22298210DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 4.25% DEXTROSE "BAXTER"156.00

BC22298212DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 4.25% DEXTROSE "BAXTER"180.00

BC22298214DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 4.25% DEXTROSE "BAXTER"199.00

BC22298221DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 4.25% DEXTROSE "BAXTER"280.00

BC22299210DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 2.5% DEXTROSE "BAXTER"156.00

BC22299212DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 2.5% DEXTROSE "BAXTER"180.00

BC22299214DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 2.5% DEXTROSE "BAXTER"199.00

BC22299221DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS

SOLUTION WITH 2.5% DEXTROSE "BAXTER"280.00

Page 301: 附件二 藥品給付品項暨支付標準表

BC22310100 FARESTON TABLETS 60MG 25.60

BC22319209 CLAFORAN IV INJECTION 0.5/1.0G 113.00

BC22319277 CLAFORAN IV INJECTION 0.5/1.0G 87.00

BC22320212 CLAFORAN IV INJECTION 2.0G 387.00

BC22324100 ZYPREXA FILM COATED TABLETS 5MG 39.50

BC22326100 ZYPREXA FILM COATED TABLETS 10MG 65.00

BC22342100 PENTASA PROLONGED-RELEASE TABLETS 500MG 8.50

BC22354280 CLEXANE INJECTION 137.00

BC22357100 VESANOID SOFT GELATIN CAPSULES 10MG 127.00

BC22365100 UNIPHYLLIN CONTINUS TABLETS 200MG 0.00

BC22366100 SEFTEM CAPSULES 15.00

BC22372421 CILOXAN STERILE OPHTHALMIC SOLUTION 107.00

BC22376100 PLAQUENIL TABLETS 200MG 2.07

BC22384100 VIRAMUNE TABLETS 200MG 81.00

BC223871G0 NATRILIX SR FILM-COATED TABLETS 1.5MG(鋁箔/膠箔) 2.00

BC22393277 "B.BRAUN" AMINOPLASMAL HEPA 10% 242.00

BC22395271 DEPAKINE LYOPHILIZED INJECTION 400MG/VIAL 296.00

BC22396100 COMBIVIR TABLETS 31.00

BC22409100 XELODA TABLETS 500MG 90.00

BC22420100 KLARICID FILM-COATED 500MG TABLETS 13.20

BC22438100 APO-FLUOXETINE CAPSULES 20MG 2.80

BC224421G0 DAONIL TABLETS 5MG(鋁箔/膠箔) 0.00

BC224471E1 AUGMENTIN SYRUP 457MG/5ML /35ML 118.00

BC22449219 HYCAMTIN 4MG INJECTION 6546.00

BC22462100 FEMARA FILM-COATED TABLETS 2.5MG 38.70

BC22473212 CAMPTO CONC. SOLUTION FOR I.V. INFUSION 1589.00

BC22473221 CAMPTO CONC. SOLUTION FOR I.V. INFUSION 2975.00

BC22483277 DESFERRIOXAMINE MESYLATE FOR INJECTION 500MG "DBL" 0.00

BC225015FR MIRENA (LEVONORGESTREL 20UG/24H) INTRAUTERINE SYSTEM 4040.00

BC22507100 TOPAMAX FILM-COATED TABLETS 50MG 11.80

BC22508100 TOPAMAX FILM-COATED TABLETS 100MG 23.20

BC22509100 TOPAMAX FILM-COATED TABLETS 25MG 5.50

BC22510100 TOPAMAX FILM-COATED TABLETS 200MG 69.00

BC22535100 LASIX TABLETS 40MG 1.50

BC225351G0 LASIX TABLETS 40MG(鋁箔/膠箔) 2.00

BC22540414 XALATAN 50UG/ML (0.005%) 439.00

BC22542100 SEROQUEL TABLETS 100MG 12.10

BC22543100 SEROQUEL TABLETS 25MG 7.30

BC22544100 SEROQUEL TABLETS 200MG 16.30

BC22551100 APROVEL 150MG FILM-COATED TABLETS 5.40

BC22553100 BETAC TABLETS 20MG 3.72

BC22587335 DIFFERIN GEL 0.1% 68.00

BC225931G0 ATANAAL CAPSULE 5(鋁箔/膠箔) 2.00

BC22600321 ESPERSON OINTMENT 0.25% 0.00

BC22600329 ESPERSON OINTMENT 0.25% 0.00

BC22606248 AGGRASTAT CONCENTRATE FOR INFUSION 7382.00

BC22610100 ALDACTONE TABLETS 25MG 1.50

BC226101G0 ALDACTONE TABLETS 25MG(鋁箔/膠箔) 2.00

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BC22612100 AUGMENTIN 1G F.C. TABLETS 7.20

BC22617100 DURIDE CR TABLETS 60MG 0.00

BC22622100 SIBELIUM CAPSULES 5MG 1.52

BC226221G0 SIBELIUM CAPSULES 5MG(鋁箔/膠箔) 2.00

BC22635421 ALPHAGAN OPHTHALMIC SOLUTION 0.2% 229.00

BC22641100 NOVONORM 1MG TABLETS 2.09

BC22653421 ACULAR OPHTHALMIC SOLUTION 0.5% W/V 86.00

BC22654100 LIPANTHYL 200M CAPSULES 3.92

BC22655243 SANDOSTATIN LAR MICROSPHERES FOR INJECTION 30MG 47768.00

BC22657238 SANDOSTATIN LAR MICROSPHERES FOR INJECTION 20MG 36228.00

BC22658100 DOSTINEX TABLETS 0.5MG 125.00

BC22671100 AMARYL 2.0 TABLETS 1.95

BC22678100 CARDIZEM UNOTARD PROLONGED RELEASE TABLETS 180MG 9.50

BC22695221 PHARMORUBICIN INJECTION 2MG/ML 407.00

BC22695240 PHARMORUBICIN INJECTION 2MG/ML 2311.00

BC22712221 ADRIAMYCIN INJ. 2MG/ML 399.00

BC22726100 METHOTREXATE SODIUM TABLETS 2.5MG 4.46

BC22727209 BUSCOPAN AMPOULES 15.00

BC22732248 FLUDARA LYOPHILIZED IV INJECTION 5706.00

BC22737500 PENTASA SUPPOSITORIES 1GM 34.30

BC22754329 NERISONE FATTY OINTMENT 44.50

BC22767100 Risperdal Film Coated Tablet 1mg 6.80

BC22768100 RISPERDAL Film Coated TABLET 2MG 7.70

BC22769100 Risperdal Film Coated Tablet 3mg 20.30

BC22770221 NIMBEX INJECTION 2MG/ML 56.00

BC22778100 SINGULAIR FILM COATED TABLETS 10MG 12.30

BC22779100 SINGULAIR CHEWABLE TAB. 5MG 9.30

BC22781100 PARIET ENTERIC-COATED TABLETS 10 MG 7.70

BC22782100 PARIET ENTERIC-COATED TABLETS 20MG 8.70

BC22783100 DETRUSITOL F.C. TAB. 2MG 7.60

BC22784100 DETRUSITOL F.C. TAB. 1MG 0.00

BC22790238 INNOHEP INJ. 10000 ANTI-XA IU/ML IN VIALS 353.00

BC22793412 FLIXOTIDE NEBULES 2MG/2ML 80.00

BC22803100 CASODEX TABLETS 50MG 75.00

BC22816100 SPORANOX CAPSULES 100MG 17.80

BC228204E5 NASACORT AQ 160.00

BC22821100 NEURONTIN CAPSULES 300MG 7.90

BC22822100 NEURONTIN CAPSULES 400MG 8.80

BC22823100 NEURONTIN CAPSULES 100MG 3.32

BC22840212 LASIX 20MG SOLUTION FOR INJECTION 15.00

BC22843100 APROVEL 300MG FILM-COATED TABLETS 9.10

BC22856421 EMADINE STERILE OPHTHALMIC SOLUTION 53.00

BC22858100 EXELON CAPSULES 3MG 30.60

BC22859100 EXELON CAPSULES 6MG 30.60

BC22861100 EXELON CAPSULES 1.5MG 30.60

BC22863100 EXELON CAPSULES 4.5MG 30.60

BC22868238 FRESOFOL 1% MCT/LCT 37.40

BC22868248 FRESOFOL 1% MCT/LCT 128.00

Page 303: 附件二 藥品給付品項暨支付標準表

BC22869100 ZIAGEN TABLETS 131.00

BC22870164 ZIAGEN ORAL SOLUTION 2450.00

BC22874255 LIPOVENOES MCT 20% EMULSION FOR INFUSION 0.00

BC22874265 LIPOVENOES MCT 20% EMULSION FOR INFUSION 168.00

BC22877100 DIANE-35 S.C. TABLETS 7.00

BC22882100 REQUIP FILM-COATED TAB. 0.25MG 5.10

BC22883100 REQUIP FILM-COATED TAB. 1MG 13.40

BC22886100 LIPITOR FILM-COATED TABLETS 10MG 9.00

BC22889100 LIPITOR FILM-COATED TABLETS 40MG 20.20

BC22890100 LIPITOR FILM-COATED TABLETS 20MG 16.60

BC22915212 "BAXTER" NUTRINEAL PD4 WITH 1.1% AMINO ACID 0.00

BC22917100 XATRAL XL 10MG 5.80

BC22919351 CLEOCIN T TOPICAL LOTION 1% 0.00

BC22920100 ETUMINE TABLETS 40MG (CLOTIAPINE) 6.20

BC22923277 LIPOVENOES MCT 10% EMULSION FOR INFUSION 168.00

BC22924424 NASONEX AQUEOUS NASAL SPRAY 133.00

BC22927100 MEDOVIR 400MG TABLETS 5.60

BC22931116 CURAM POWDER FOR ORAL SUSPENSION 312.5MG/5ML 70.00

BC22932100 PLAVIX FILM-COATED TABLETS 75MG 32.10

BC22934421 AZOPT 10MG/ML EYE DROPS,SUSPENSION 256.00

BC22959100 HYTRIN TABLETS 2MG 1.92

BC22962100 Controloc control Gastro-Resistant Tablets 20 mg 0.00

BC22989100 HYZAAR F.C TAB. 50/12.5MG 4.11

BC22995100 ESTRACYT CAPSULES 140MG 52.00

BC22997100 PROGOR CAPSULE 180MG 9.50

BC23000216 APO-GO PEN 10MG/ML 1120.00

BC23001100 PROGOR CAPSULE 120MG 5.70

BC23010100 ALLEGRA TABLETS 180MG 4.60

BC23012500 MYCORIL 100 VAGINAL TABLETS 5.80

BC23016100 ALLEGRA 60MG TAB. 1.80

BC230161G0 ALLEGRA 60MG TABLETS(鋁箔/膠箔) 2.00

BC23029100 ONEALFA TABLET 1.0 MCG 11.70

BC23031100 ONEALFA TABLET 0.5MCG 8.40

BC23049164 VIRAMUNE ORAL SUSPENSION 50MG/5ML 2126.00

BC23057151 RAPAMUNE ORAL SOLUTION 1MG/ML 0.00

BC23071100 FRISIUM TABLET 10MG 2.71

BC23074163 BEROTEC N 100MCG/PUFF METERED AEROSOL 137.00

BC23076277 2.5% DEXTROSE AND 0.45% SODIUM CHLORIDE INJECTION USP 0.00

BC23078100 KLARICID XL TABLETS 500MG 18.70

BC23086100 PROGRAF CAPSULES 0.5MG 63.00

BC23087209NORMAL SALINE (SODIUM CHLORIDE INTRAVENOUS INFUSION

B.P.)0.00

BC23097100 AROMASIN SUGAR COATED TABLETS 25MG 46.00

BC23106277 5% GLUCOSE INTRAVENOUS INFUSION B.P. 0.00

BC23109100 CO-DIOVAN 80/12.5 FILM COATED TABLETS 6.00

BC23128100 BLOPRESS TAB. 8MG 6.90

BC23133100 ONEALFA TAB. 0.25MCG 0.00

BC23134100 TRAMADOL 50 STADA CAPSULES 0.00

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BC23135100 HYDREA CAPSULES 500MG 15.20

BC23150377 FLAMAZINE CREAM 0.00

BC23161100 MICARDIS TABLETS 80MG 11.60

BC23162100 MICARDIS TABLETS 40MG 6.90

BC23177100 CELEBREX CAPSULE 200MG 4.66

BC23178212 PRIMPERAN 10MG/2ML INJECTABLE SOLUTION 15.00

BC23179100 DETANTOL R.F.C TAB. 3MG 6.60

BC23181100 ZYVOX TABLETS 600MG 583.00

BC23186266 ZYVOX INJECTION 906.00

BC23196100 NEURAMIN CAPSULES 500UG 1.55

BC231961G0 NEURAMIN CAPSULES 500UG(鋁箔/膠箔) 2.00

BC23202127 SERETIDE 100 ACCUHALER INHALATION POWDER 60DOSE 620.00

BC23203137 SERETIDE 250 ACCUHALER INHALATION POWDER 60DOSE 792.00

BC23206100 ACTOS TABLETS 30MG 9.60

BC23207100 ACTOS TABLETS 15MG 6.90

BC23210212 "BAXTER"CLINIMIX N14G30E SOLUTION FOR INFUSION 0.00

BC23215100 FENOGAL 200MG LIDOSE 3.92

BC23218210 "BAXTER"CLINIMIX N17G35E SOLUTION FOR INFUSION 507.00

BC23220100 CO-DIOVAN 160/12.5 FILM COATED TABLETS 7.30

BC23221100 NEXIUM TAB. 40MG 6.10

BC23223100 AVELOX FILM-COATED TABLET 400MG 80.00

BC23224210 "BAXTER"CLINIMIX N9G15E SOLUTION FOR INFUSION 410.00

BC23232100 ASACOL TABLETS 11.40

BC23244100 STARLIX FILM-COATED TABLETS 60MG 0.00

BC23245100 STARLIX FILM-COATED TABLETS 120MG 2.83

BC23248100 COMTAN FILM-COATED TABLET 200MG 17.20

BC23257100 ZITHROMAX 250M TABLETS 17.50

BC232621EL SYMBICORT TURBUHALER 80/4.5UG/DOSE 120 DOSES/BOT 858.00

BC232651E7 SYMBICORT TURBUHALER 160/4.5UG/DOSE 120 DOSES/BOT 969.00

BC23266100 COAPROVEL 150MG/12.5MG FILM-COATED TABLETS 5.40

BC23267100 COAPROVEL 300MG/12.5MG FILM-COATED TABLES 9.10

BC23280100 MIRAPEX TAB. 0.25MG 9.00

BC23282100 MIRAPEX TAB. 1MG 36.60

BC23291100 GLIVEC CAPSULES 100MG 0.00

BC23293100 ZANIDIP F.C TAB. 10MG 5.50

BC23298263 GEMZAR 598.00

BC23306245 PANTOLOC I.V 119.00

BC23313221 ZAVEDOS 1MG/ML INJECTION VIAL 3600.00

BC23323100 TEMODAL CAPSULES 20MG 539.00

BC23324100 TEMODAL CAPSULES 100MG 2543.00

BC23335100 MESULID TAB. 100MG 2.10

BC23337421 COSOPT OPHTHALMIC SOLUTION 317.00

BC23345321 PROTOPIC OINTMENT 0.03% 196.00

BC23345329 PROTOPIC OINTMENT 0.03% 393.00

BC23345343 PROTOPIC OINTMENT 0.03% 1216.00

BC23346321 PROTOPIC OINTMENT 0.1% 208.00

BC23346329 PROTOPIC OINTMENT 0.1% 370.00

BC23346343 PROTOPIC OINTMENT 0.1% 1228.00

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BC23349116 SMECTA, POWDER FOR ORAL SUSPENSION 5.30

BC23357114 COMBIVENT UDV INHALATION SOLUTION 13.90

BC23363100 RAPAMUNE TABLETS 1MG 130.00

BC23373100 DIOVAN FILM-COATED TABLETS 80MG 6.00

BC23374100 DIOVAN FILM-COATED TABLETS 160MG 7.30

BC23380100 TOPAMAX SPRINKLE CAP. 15MG 4.76

BC23381100 TOPAMAX SPRINKLE CAP. 25MG 5.50

BC23382100 TOPAMAX SPRINKLE CAP. 50MG 0.00

BC23388248 AMBISOME FOR INJECTION 5523.00

BC23396221 ANZATAX INJECTION CONCENTRATE 0.00

BC23396240 ANZATAX INJECTION CONCENTRATE 3724.00

BC23396248 ANZATAX INJECTION CONCENTRATE 0.00

BC233962E2 ANZATAX INJECTION CONCENTRATE 0.00

BC23398100 SINGULAIR CHEWABLE TAB. 4MG 9.10

BC23403343 SILKIS OINTMENT 330.00

BC23428100 WELLBUTRIN SUSTAINED-RELEASE TABLETS 150MG 0.00

BC23462129 FORLAX 10GM 5.40

BC23470100 GEODON CAPSULES 60MG 39.10

BC23471100 GEODON CAPSULES 40MG 39.10

BC23473129 BERODUAL N METERED AEROSOL 269.00

BC23479235 VISUDYNE POWDER FOR SOLUTION FOR INFUSION 15MG/VIAL 38264.00

BC23480127 SERETIDE 50 EVOHALER 120DOSE 620.00

BC23481157 SERETIDE 250 EVOHALER 120DOSE 1048.00

BC23482137 SERETIDE 125 EVOHALER 120DOSE 792.00

BC23484100 UFT CAPSULES 65.00

BC23485248 CANCIDAS INJECTION 50MG 7250.00

BC23489100 ZITROMAX AVIUM 600 129.00

BC23492100 SOLIAN TAB. 200MG 18.40

BC23493100 SOLIAN TABLET 50MG 9.40

BC235031G0 DIAMICRON MR TABLETS 30MG(鋁箔/膠箔) 2.00

BC23518100 TRITACE 2.5MG TABLETS 2.98

BC23521421 ALEGYSAL OPHTHALMIC SOLUTION 64.00

BC23522100 TRILEPTAL FILM COATED TABLETS 600MG 15.80

BC23524100 TRILEPTAL FILM COATED TABLETS 300MG 7.80

BC23537414 XALACOM EYE DROPS 542.00

BC23538123 TRILEPTAL 6% ORAL SUSPENSION 308.00

BC23538135 TRILEPTAL 6% ORAL SUSPENSION 779.00

BC23548100 SALAGEN TABLETS 5MG 14.90

BC23556100 LESCOL XL FILM-COATED TABLETS 80MG 10.20

BC23568100 DETRUSITOL SR PROLONGED-RELEASE CAPSULES 4MG 23.00

BC23570100 EFEXOR XR 150MG CAPSULES 58.00

BC23571100 EFEXOR XR 75MG CAPSULES 10.00

BC23572100 ORFARIN TABLETS 5MG 3.68

BC23573100 ORFARIN TABLETS 3MG 2.13

BC23596100 MEVALOTIN PROTECT 40MG TABLETS 14.10

BC23597100 MEVALOTIN PROTECT 20MG TABLETS 5.90

BC23603100 TRITACE 10MG TABLETS 5.10

BC23613335 DIFFERIN CREAM 0.1% 68.00

Page 306: 附件二 藥品給付品項暨支付標準表

BC23615100 ARAVA 10MG FILM-COATED TABLETS 26.60

BC23632100 INDIVINA TABLET 1MG/2.5MG 6.40

BC23633221 PAMISOL CONCENTRATED INJECTION 3MG/ML 1003.00

BC23633229 PAMISOL CONCENTRATED INJECTION 3MG/ML 0.00

BC23634229 PAMISOL CONCENTRATED INJECTION 9MG/ML 0.00

BC23635229 PAMISOL CONCENTRATED INJECTION 6MG/ML 0.00

BC23645329 ELIDEL 1% CREAM 276.00

BC23645335 ELIDEL 1% CREAM 15GM 394.00

BC23645343 ELIDEL 1% CREAM 30GM 747.00

BC23646100 VFEND FILM-COATED TABLETS 200MG 1117.00

BC23647100 VFEND FILM-COATED TABLETS 50MG 326.00

BC23648263 VFEND 200MG FOR SOLUTION FOR INJECTION 3914.00

BC23649100 MICARDIS PLUS TABLETS 80/12.5 MG 11.60

BC23654100 MICARDIS PLUS TABLETS 40/12.5MG 6.90

BC23655100 COZAAR F.C. TABLETS 100MG 5.80

BC23661100 SILVINOL TABLETS 5M 2.89

BC23672100 NEURONTIN F.C. TABLETS 600MG 10.50

BC23679340 NADIXA CREAM 223.00

BC23681421 DEXAGEL EYE DROPS 95.00

BC23687212"BAXTER" EXTRANEAL PERITONEAL DIALYSIS SOLUTION WITH

7.5% ICODEXTRIN317.00

BC23695421 ALPHAGAN P OPHTHALMIC SOLUTION 0.15% 229.00

BC23695429 ALPHAGAN P OPHTHALMIC SOLUTION 0.15% 503.00

BC23708100 "ABBOTT" ISOPTIN 40MG FILM COATED TABLETS 1.53

BC237081G0 "ABBOTT" ISOPTIN 40MG FILM COATED TABLETS (鋁箔/膠箔) 2.00

BC237092EPKABIVEN PI, EMULSION FOR INFUSION(依仿單含熱量1000KCAL)

639.00

BC237092ESKABIVEN PI, EMULSION FOR INFUSION(依仿單含熱量1400KCAL)

895.00

BC237102EQ KABIVEN EMULSION FOR INFUSION(依仿單含熱量900KCAL) 0.00

BC237102ER KABIVEN EMULSION FOR INFUSION(依仿單含熱量1400KCAL) 926.00

BC237102ET KABIVEN EMULSION FOR INFUSION(依仿單含熱量1900KCAL) 1257.00

BC23711100 DOXABEN XL TABLETS 4MG 9.40

BC23712265 AVELOX INFUSION SOLUTION 400MG/250ML 624.00

BC23731100 CONCERTA EXTENDED RELEASE TABLETS 18MG 29.90

BC23735100 ZOLDEM 10 FILM-COATED TABLETS 1.76

BC23737100 MYFORTIC 180MG GASTRO-RESISTANT TABLETS 43.10

BC23738100 MYFORTIC 360MG GASTRO-RESISTANT TABLETS 84.00

BC23741438 IMIGRAN NASAL SPRAY 20MG 151.00

BC23749209 INVANZ 1G INJECTION 651.00

BC23755123 FLIXOTIDE EVOHALER 50 MCG 191.00

BC23756210 MOBIC INJ. 15MG/1.5ML 22.50

BC23757100 PRETERAX SCORED TABLETS 5.90

BC23758100 ACERTIL PLUS TABLETS 0.00

BC23770100 LIPANTHYL SUPRA 160MG FILM-COATED TABLET 3.92

BC23779100 MXL PROLONGED-RELEASE CAPSULES 60MG 95.00

BC23785229 BUSULFEX INJECTION 7200.00

BC23792100 XYZAL FILM-COATED TABLETS 5MG 2.21

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BC23793421 ZADITEN 0.25MG/ML EYE DROPS 50.00

BC237941EW KLARICID PAEDIATRIC SUSPENSION 125MG/5ML,70ML 185.00

BC23799100 BETALOC ZOK 25MG 3.80

BC23800221 DOBUJECT 50MG/ML CONCENTRATE FOR PARENTERAL INFUSION 113.00

BC23808100 IRESSA FILM-COATED TABLETS 250MG 637.00

BC23839340 DERMOVATE CREAM 61.00

BC23839343 DERMOVATE CREAM 90.00

BC23840340 DERMOVATE OINTMENT 61.00

BC23840343 DERMOVATE OINTMENT 90.00

BC23857240 RISPERDAL CONSTA 25MG SUSPENSION FOR I.M INJECTION 2775.00

BC23858248 RISPERDAL CONSTA 50MG SUSPENSION FOR I.M INJECTION 4847.00

BC238592EV RISPERDAL CONSTA 37.5MG SUSPENSION FOR I.M INJECTION 3821.00

BC23878209 AMINOFLUID 0.00

BC23880100 CONCERTA EXTENDED RELEASE TABLETS 36MG 50.00

BC23889100 KEPPRA FILM-COATED TABLETS 500MG 22.30

BC23892429 ALLERGO-COMOD EYE DROPS 28.30

BC23898100 FLUIMUCIL A 600MG EFFERVESCENT TABLETS 5.40

BC23901212BALANCE 1.5% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL

DIALYSIS SOLUTION201.00

BC23901214BALANCE 1.5% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL

DIALYSIS SOLUTION226.00

BC23901221BALANCE 1.5% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL

DIALYSIS SOLUTION384.00

BC23906212BALANCE 4.25% GLUCOSE, 1.75MMOL/L CALCIUM, PERITONEAL

DIALYSIS SOLUTION201.00

BC23906221BALANCE 4.25% GLUCOSE, 1.75MMOL/L CALCIUM, PERITONEAL

DIALYSIS SOLUTION384.00

BC23907212BALANCE 2.3% GLUCOSE, 1.75MMOL/L CALCIUM, PERITONEAL

DIALYSIS SOLUTION201.00

BC23907214BALANCE 2.3% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL

DIALYSIS SOLUTION226.00

BC23907221BALANCE 2.3% GLUCOSE, 1.75 MMOL/L CALCIUM,PERITONEAL

DIALYSIS SOLUTION384.00

BC23912100 ZYPREXA ZYDIS 10MG ORODISPERSIBLE TABLETS 65.00

BC23913100 ZYPREXA ZYDIS 5MG ORODISPERSIBLE TABLETS 39.50

BC23917100 ULTRACET TABLETS 3.32

BC23920100 HEPSERA TABLETS 118.00

BC23922100 CO-DIOVAN 160/25 FILM-COATED TABLETS 0.00

BC23923251SOMATULINE AUTOGEL 60MG PROLONGED RELEASE SOLUTION FOR

INJECTION IN PRE-FILLED SYRINGE22330.00

BC23924254SOMATULINE AUTOGEL 90MG PROLONGED RELEASE SOLUTION FOR

INJECTION IN PRE-FILLED SYRINGE38374.00

BC23925257SOMATULINE AUTOGEL 120MG PROLONGED RELEASE SOLUTION FOR

INJECTION IN PRE-FILLED SYRINGE44007.00

BC23936343 DAIVOBET OINTMENT 536.00

BC23952100 AVODART SOFT CAPSULES 0.5MG 16.30

BC23959100 LEXAPRO TABLETS 5MG 0.00

BC23960100 LEXAPRO TABLETS 10MG 9.70

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BC23964453 OTOZAMBON EAR DROPS 100.00

BC23969216 FLUIMUCIL 300MG/3ML INJECTABLE SOLUTION 15.00

BC23970100 SIMVAHEXAL FILM-COATED TABLETS 20MG 3.58

BC23974126 MONUROL 3G GRANULES 130.00

BC239801E7 SYMBICORT TURBUHALER 320/9UG/DOSE 60 DOSES/BOT 0.00

BC23981100 ARCOXIA TABLET 90MG 0.00

BC23983100 ARCOXIA TABLET 60MG 5.30

BC23985100 EMEND CAPSULES 80MG 485.00

BC23986100 EMEND CAPSULES 125MG 485.00

BC23999100 CONCERTA EXTENDED RELEASE TABLETS 27MG 42.70

BC24002212 PRECEDEX INJECTION 100MCG/ML 563.00

BC24005100 GLUCOVANCE TABLETS 500MG/2.5MG 2.01

BC24006100 GLUCOVANCE TABLETS 500MG/5MG 2.01

BC24009100 REMERON SOL TAB. 30MG 8.90

BC24015100 CITALOPRAM HEXAL FILM-COATED TABLETS 20MG 7.10

BC24025100 ASPIRIN PROTECT 100 1.50

BC240251G0 ASPIRIN PROTECT 100 2.00

BC24027100 GLIVEC FILM-COATED TABLETS 100MG 524.00

BC24039100 CONCOR 1.25 2.01

BC24041277 GELOFUSINE 204.00

BC24046100 OTSUKA ABILIFY TABLETS 5MG 33.00

BC24047100 OTSUKA ABILIFY TABLETS 10MG 47.30

BC24048100 OTSUKA ABILIFY TABLETS 15MG 47.30

BC24049100 OTSUKA ABILIFY TABLETS 20MG 69.00

BC24050100 OTSUKA ABILIFY TABLETS 30MG 69.00

BC24058100 EZETROL TABLETS 10MG 8.20

BC24069100 RISPERDAL QUICKLET ORODISPERSIBLE TABLETS 1MG 0.00

BC24071100 VALCYTE FILM-COATED TABLETS 450MG 503.00

BC24074235 PARAPLATIN IV INJECTION 1448.00

BC240742AP PARAPLATIN IV INJECTION 3058.00

BC24079245 NEXIUM POWDER FOR INJECTION AND INFUSION 40MG 57.00

BC24081238 PROPOFOL-LIPURO 1% 37.40

BC24081248 PROPOFOL-LIPURO 1% 128.00

BC24083229 ZYPREXA 10MG POWDER FOR SOLUTION FOR INJECTION 330.00

BC24084277 ALIMTA (PEMETREXED FOR INJECTION) 500MG 28282.00

BC24093100 REYATAZ CAPSULES 200MG 78.00

BC24094100 REYATAZ CAPSULES 150MG 78.00

BC24129100 CRESTOR 20MG FILM-COATED TABLETS 22.20

BC24131100 CRESTOR 10MG FILM-COATED TABLETS 13.40

BC24134119 SINGULAIR ORAL GRANULES 4MG 9.10

BC24139414 TRAVATAN 40 MICROGRAMS/ML EYE DROPS, SOLUTION 426.00

BC24154229 FENTANYL-FRESENIUS INJECTION 0.05 MG/ML 98.00

BC24171100 STALEVO FILM-COATED TABLETS 100/25/200MG 19.30

BC24172100 STALEVO FILM-COATED TABLETS 150/37.5/200MG 19.30

BC24173100 STALEVO FILM-COATED TABLETS 50/12.5/200MG 0.00

BC24179209 AMINOVEN 10% SOLUTION FOR INFUSION 384.00

BC24180265 AMINOVEN 5% SOLUTION FOR INFUSION 100.00

BC24180277 AMINOVEN 5% SOLUTION FOR INFUSION 104.00

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BC24183100 SEROQUEL TABLETS 300MG 30.80

BC241891G0 GLUCOPHAGE TABLETS 1000MG(鋁箔/膠箔) 2.00

BC24205100 SOLIAN 400MG FILM-COATED SCORED TABLET 40.20

BC242064CR RESTASIS OPHTHALMIC EMULSION 0.05% 40.90

BC24211421 BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 229.00

BC24215100 CELLCEPT F.C. TABLETS 500MG 85.00

BC24219212 NUTRINEAL PD4 WITH 1.1% AMINO ACID SOLUTION 297.00

BC24220100 EBIXA FILM-COATED TABLETS 10MG 8.90

BC24228248 FRESOFOL 2% MCT/LCT 247.00

BC24229100 CONCERTA EXTENDED RELEASE TABLETS 54MG 59.00

BC24239100 CYMBALTA 60MG 29.50

BC24240100 CYMBALTA 30MG 16.60

BC24250100 VYTORIN TABLETS 10/20 MG 11.00

BC24256100 SEROXAT CR TABLETS 12.5MG 8.20

BC24260277 VOLUVEN 6% SOLUTION FOR INFUSION 176.00

BC24268100 NAVELBINE 30MG, SOFT CAPSULE 3311.00

BC24269100 NAVELBINE 20MG, SOFT CAPSULE 2292.00

BC24270209OLICLINOMEL N7-1000 E EMULSION FOR INFUSION(依仿單含熱量

1200KCAL)705.00

BC24270210OLICLINOMEL N7-1000 E EMULSION FOR INFUSION(依仿單含熱量

1800KCAL)1057.00

BC24270212OLICLINOMEL N7-1000 E EMULSION FOR INFUSION(依仿單含熱量

2400KCAL)0.00

BC24272100 TAKEPRON OD 15MG TABLETS 8.30

BC24273100 TAKEPRON OD 30MG TABLETS 10.00

BC24274100 REMINYL PROLONGED RELEASE CAPSULES 16MG 73.00

BC24275100 REMINYL PROLONGED RELEASE CAPSULES 8MG 59.00

BC24276100 REMINYL PROLONGED RELEASE CAPSULES 24MG 73.00

BC24289212 TRAMAZAC IV INJECTION 50MG/ML 25.90

BC24294421 COMBIGAN EYE DROPS 379.00

BC24301212 VOMIZ for IV INJECTION 2MG/ML 87.00

BC24301219 VOMIZ for IV INJECTION 2MG/ML 94.00

BC24304100 ACERTIL TABLETS 8MG 0.00

BC24306100 INSPRA F.C. TABLETS 50MG 27.60

BC243091G0 PEROFEN 400 F.C. TABLETS(鋁箔/膠箔) 1.68

BC24320100 LAMOTRIX 100mg Tablets 13.80

BC24321209 FLUMARIN FOR INJECTION 1G 292.00

BC24330429 Liposic eye gel 102.00

BC24332421 RELESTAT OPHTHALMIC SOLUTION 0.05% 69.00

BC24339100 Simvahexal Film-coated Tablets 40mg 7.50

BC24340100 TRAMADOL SANDOZ UNO 200MG RETARDTABLETTEN 10.00

BC24347248 UROKINASE-GCC INJECTION 50,000 I.U. 0.00

BC24353238 PROVIVE 1% Injection 37.40

BC24353248 PROVIVE 1% Injection 128.00

BC24353255 PROVIVE 1% Injection 247.00

BC24364100 Norvasc Tablets 10mg 3.84

BC24368100 Zoloft Film coated tablets 100mg 0.00

BC24371271 Targocid 400 mg for Injection (I.M.I.V.) 1164.00

Page 310: 附件二 藥品給付品項暨支付標準表

BC24379100 Apo-Citalopram Film-coated Tablets 40mg 16.00

BC24380100 Imigran FDT Tablets 50mg 157.00

BC243822AA Diphereline P.R. 3.75mg 3311.00

BC24389100 KIVEXA Film-coated tablets 375.00

BC24391100 CADUET 5MG/10MG TABLET 9.60

BC24392100 CADUET 5MG/20MG TABLET 12.90

BC24398421 CRAVIT OPHTHALMIC SOLUTION 99.00

BC24403100 Harnalidge D tablets 0.2mg 5.60

BC24405100 Apo-Paroxetine Tablets 30mg 14.20

BC24408100 Apo-Citalopram Tablets 20mg 7.10

BC24421100 EFEXOR XR 37.5MG SUSTAINED-RELEASE CAPSULES 8.90

BC24427221 Epirubicin Hydrochloride For IV Injection 0.00

BC24427240 Epirubicin Hydrochloride For IV Injection 0.00

BC24430157 Exelon oral solution 1430.00

BC24437100 Vesicare film-coated tablets 5mg 11.70

BC24443248 TYGACIL (TIGECYCLINE) 50MG LYOPHILIZED POWDER 1440.00

BC24444100 Perofen 600 F.C. Tablets 1.64

BC244441G0 PEROFEN 600 F.C. TABLETS(鋁箔/膠箔) 2.00

BC24453148 Clenil 250 mcg Pressurised Inhalation Solution 0.00

BC24460100 Apo-Paroxetine 20mg 5.30

BC24464100 APO-DIVALPROEX 250MG 3.78

BC24472209 Vinorelbine Injection Concentrate 1075.00

BC24472221 Vinorelbine Injection Concentrate 6031.00

BC244881G0 Perofen F.C. Tablets 400mg 1.68

BC24492100 Tramazac Capsules (Tramadol HCl Capsules) 2.43

BC24497100 OLMETEC FILM COATED TABLETS 20MG 7.30

BC24509248 Mycamine for Injection 50mg/vial 945.00

BC24514100 Strattera 10mg Hard Capsules 63.00

BC24515100 Strattera 18mg Hard Capsules 63.00

BC24516100 Strattera 25mg Hard Capsules 63.00

BC24517100 Strattera 40mg Hard Capsules 63.00

BC24518100 Strattera 60mg Hard Capsules 63.00

BC24519255 SMOFLIPID 20% EMULSION FOR INFUSION 152.00

BC24519265 SMOFLIPID 20% EMULSION FOR INFUSION 154.00

BC24519277 SMOFLIPID 20% EMULSION FOR INFUSION 0.00

BC24521100 OLMETEC PLUS 20/25MG, FILM COATED TABLETS 0.00

BC24524100 MELOX 15mg Tablets 4.07

BC245282CN

Diphereline P.R. 11.25 mg, Powder and Solvent for

Suspension for Injection (I.M. or S.C.), 3-month

prolonged release fo10406.00

BC24530100 pms-MIRTAZAPINE Tablets 30mg 8.90

BC24532100 Trandate Tablets 200mg 2.82

BC24544100 TRIAPIN 5MG SLOW-RELEASE TABLETS 0.00

BC24555100 APTIVUS CAPSULES 250MG 238.00

BC24560100 Kaletra Tablets 85.00

BC24563229 ELOXATIN 5MG/ML,CONCENTRATE FOR SOLUTION FOR INFUSION 1336.00

BC24563238 ELOXATIN 5MG/ML,CONCENTRATE FOR SOLUTION FOR INFUSION 4420.00

BC24563245 ELOXATIN 5MG/ML,CONCENTRATE FOR SOLUTION FOR INFUSION 9592.00

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BC24565277 Cubicin Injection 3129.00

BC24580100 Ultidep 20 Tablets 7.10

BC24585309 DIVIGEL 0.1% GEL 10.00

BC24592100 BLOPRESS 16MG PLUS 12.5MG TABLETS 8.70

BC24593100 SUTENT CAPSULES 12.5MG 1064.00

BC24594100 SUTENT CAPSULES 25MG 1916.00

BC24595100 SUTENT CAPSULES 50MG 3449.00

BC24597100 CRESTOR 5MG FILM-COATED TABLETS 9.60

BC24601100 Apo-Divalproex Tablets 500mg 7.40

BC24603100 Exjade 125mg dispersible tablets 189.00

BC24611100 ASACOL 800MG GASTRO-RESISTANT TABLETS 21.90

BC24622100 REVATIO 20MG FILM-COATED TABLETS 200.00

BC24625212 Irinotel Injection 0.00

BC24625221 Irinotel Injection 2975.00

BC24626100 Apo-Zopiclone Tablets 7.5mg 1.98

BC246291G0 Cinnaron 25 Tablets 2.00

BC24630216 BONVIVA 3MG/3ML SOLUTION FOR INJECTION 2442.00

BC24638221 FYTOSID FOR IV INJECTION 216.00

BC24643100 HYZAAR FC TABLETS 100/12.5 MG 5.80

BC24645100 Diovan Film-Coated Tablets 40mg 4.73

BC24646100 BLOPRESS 8MG PLUS 12.5MG TABLETS 0.00

BC24651161 KEPPRA ORAL SOLUTION 100MG/ML 782.00

BC24651166 KEPPRA ORAL SOLUTION 100MG/ML 1500.00

BC24655100 Diovan film-coated tablets 320 mg 28.20

BC24656112 ZMAX EXTENDED-RELEASE POWDER FOR ORAL SUSPENSION 357.00

BC24662100 SEBIVO 600MG FILM-COATED TABLETS 82.00

BC24668100 JANUVIA 100 MG F.C. TABLETS 23.70

BC24677100 Stilnox CR Tablet 6.25 mg 3.59

BC24679209“BAXTER” OLICLINOMEL N4-550E EMULSION FOR INFUSION (依

仿單含熱量610KCAL)390.00

BC24679210“BAXTER” OLICLINOMEL N4-550E EMULSION FOR INFUSION(依

仿單含熱量910KCAL)582.00

BC24679212“BAXTER” OLICLINOMEL N4-550E EMULSION FOR INFUSION(依

仿單含熱量1215KCAL)0.00

BC24690100 VIREAD TABLETS 120.00

BC24692255 ACLASTA 5MG/100ML SOLUTION FOR INFUSION 9697.00

BC24701248 OXITAN LYOPHILIZED POWDER FOR INJECTION 0.00

BC24701255 OXITAN LYOPHILIZED POWDER FOR INJECTION 0.00

BC24702100 LEPAX FILM-COATED TABLETS 5MG 0.00

BC24708100 Eltroxin Tablets 100mcg 〝Germany〞 1.50

BC24725100 ACERTIL FILM-COATED TABLETS 5 MG 6.10

BC24727100 Nexavar film-coated tablets 200mg 863.00

BC24731100 INVEGA EXTENDED RELEASE TABLETS 6MG 127.00

BC24732100 INVEGA EXTENDED RELEASE TABLETS 3MG 68.00

BC24738221 INTAXEL INJECTION 662.00

BC24738248 INTAXEL INJECTION 0.00

BC247382BE INTAXEL INJECTION 0.00

BC247382FG INTAXEL INJECTION 1711.00

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BC24743321 BENCORT CREAM 20.70

BC24743329 BENCORT CREAM 0.00

BC24743335 BENCORT CREAM 0.00

BC24750100 LUVOX 50, FILM-COATED TABLETS 6.20

BC24758255 ERAXIS FOR INJECTION 100MG 2015.00

BC24762221 ANTHRACIN FOR IV INJECTION 407.00

BC24762240 ANTHRACIN FOR IV INJECTION 0.00

BC24766414 DUOTRAV eye drops, solution 581.00

BC24769100 Truvada Tablets 345.00

BC24770100 Certican 0.25mg tablets 80.00

BC24771100 Certican 0.75mg tablets 240.00

BC24772100 Certican 0.5mg tablets 169.00

BC24785221 ALOXI SOLUTION FOR INJECTION 657.00

BC24786151 ALVESCO 160 INHALER 382.00

BC24789255 Metronidazole Injection USP 0.5% w/v 41.00

BC24790209 Ceftriaxone Sandoz powder for IV Injection 82.00

BC24790212 Ceftriaxone Sandoz powder for IV Injection 363.00

BC24790277 Ceftriaxone Sandoz powder for IV Injection 54.00

BC24791100 XET 20 TABLETS 5.30

BC24792321 TAMICORT CREAM 16.00

BC24792329 TAMICORT CREAM 0.00

BC24792336 TAMICORT CREAM 0.00

BC24792338 TAMICORT CREAM 84.00

BC24794100 SPRYCEL FILM-COATED TABLETS 50MG 1282.00

BC247973AI DUROGESIC D-TRANS TRANSDERMAL PATCH 100 MCG/H 745.00

BC24800100 SPRYCEL TABLETS 70MG 1695.00

BC24804235 KEMOCARB INJECTION 1448.00

BC248042AP KEMOCARB INJECTION 3058.00

BC24806316 CYCLOVAX 5% CREAM 17.30

BC24806317 CYCLOVAX 5% CREAM 17.30

BC24806321 CYCLOVAX 5% CREAM 41.10

BC24806326 CYCLOVAX 5% CREAM 42.90

BC24811255 Ciprofloxacin Injection 450.00

BC24813100 SPRYCEL FILM-COATED TABLETS 20MG 514.00

BC24823100 Exforge film-coated tablet 10/160mg 0.00

BC24824100 Exforge film-coated tablet 5/80mg 9.60

BC24827100 FLUCOZYD 200 CAPSULES 206.00

BC24829210 CAPD/DPCA 19 SOLUTION FOR PERITONEAL DIALYSIS 0.00

BC24829212 CAPD/DPCA 19SOLUTION FOR PERITONEAL DIALYSIS 180.00

BC24829214 CAPD/DPCA 19 SOLUTION FOR PERITONEAL DIALYSIS 199.00

BC24829221 CAPD/DPCA 19 SOLUTION FOR PERITONEAL DIALYSIS 280.00

BC24830210 CAPD/DPCA 17 SOLUTION FOR PERITONEAL DIALYSIS 0.00

BC24830212 CAPD/DPCA 17 SOLUTION FOR PERITONEAL DIALYSIS 180.00

BC24830214 CAPD/DPCA 17 SOLUTION FOR PERITONEAL DIALYSIS 199.00

BC24830221 CAPD/DPCA 17 SOLUTION FOR PERITONEAL DIALYSIS 280.00

BC24831212 CAPD/DPCA 18 SOLUTION FOR PERITONEAL DIALYSIS 180.00

BC24831214 CAPD/DPCA 18 SOLUTION FOR PERITONEAL DIALYSIS 0.00

BC24831221 CAPD/DPCA 18 SOLUTION FOR PERITONEAL DIALYSIS 0.00

Page 313: 附件二 藥品給付品項暨支付標準表

BC24834100 Tasigna Capsules 200 mg 1019.00

BC24839100 ACTOSMET 15/850MG FILM COATED TABLETS 8.70

BC248403CM DUROGESIC D-TRANS TRANSDERMAL PATCH 75 ΜCG/H 610.00

BC24841311 DUROGESIC D-TRANS TRANSDERMAL PATCH 25 ΜCG/H 250.00

BC248423CS DUROGESIC D-TRANS TRANSDERMAL PATCH 50MCG/H 470.00

BC24844255 Fluconazole Infusion 274.00

BC24846209 GEMITA FOR I.V. LYOPHILIZED INJECTION 2854.00

BC24846263 GEMITA FOR I.V. LYOPHILIZED INJECTION 598.00

BC248491C5 SERETIDE 50/500 ACCUHALER, INHALATION POWDER 1048.00

BC24850248OXALIPLATINE-MYLAN 5MG/ML POWDER FOR SOLUTION FOR

INFUSION1336.00

BC24850255OXALIPLATINE-MYLAN 5MG/ML POWDER FOR SOLUTION FOR

INFUSION4420.00

BC24853297TORISEL CONCENTRATE AND DILUENT FOR SOLUTION FOR

INFUSION28261.00

BC24855100 ACERTIL FILM-COATED TABLETS 10 MG 0.00

BC24856100 VOMIZ 8 TABLETS 115.00

BC24857109 Ulban A Gran. 6.00

BC248703B9 DUROGESIC D-TRANS TRANSDERMAL PATCH 12 ΜCG/H 188.00

BC24874255 Alimta for Injection 100mg 6192.00

BC248774FK AVAMYS NASAL SPRAY 220.00

BC24878100 TYKERB FILM-COATED TABLETS 250MG 502.00

BC24883100 RASILEZ FILM-COATED TABLET 300MG 38.90

BC24884100 RASILEZ FILM-COATED TABLET 150MG 19.80

BC24885100 SEROQUEL XR TM 400 MG EXTENDED-RELEASE TABLETS 65.00

BC24886100 SEROQUEL XR TM 300 MG EXTENDED-RELEASE TABLETS 42.40

BC24887100 SEROQUEL XR TM 200 MG EXTENDED-RELEASE TABLETS 35.80

BC24894100 ADVAGRAF 0.5MG PROLONGED-RELEASE HARD CAPSULES 51.00

BC24895100 ADVAGRAF 5MG PROLONGED-RELEASE HARD CAPSULES 433.00

BC24896100 ADVAGRAF 1MG PROLONGED-RELEASE HARD CAPSULES 98.00

BC248992A5 NUTRIFLEX LIPID PERI 1250ML(依仿單含熱量955KAL) 632.00

BC248992BH NUTRIFLEX LIPID PERI 1875ML(依仿單含熱量1435KCAL) 949.00

BC249012A5 NUTRIFLEX LIPID SPECIAL 1250ML(依仿單含熱量1475KCAL) 889.00

BC24919255 LIPOPLUS 20% 163.00

BC24919265 LIPOPLUS 20% 163.00

BC24920212BALANCE 2.3% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS201.00

BC24920214BALANCE 2.3% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS226.00

BC24920221BALANCE 2.3% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS384.00

BC24921212BALANCE 4.25% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS201.00

BC24921214BALANCE 4.25% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS226.00

BC24921221BALANCE 4.25% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS384.00

Page 314: 附件二 藥品給付品項暨支付標準表

BC24922212BALANCE 1.5% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS201.00

BC24922214BALANCE 1.5% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS226.00

BC24922221BALANCE 1.5% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS384.00

BC24926355 PENTASA ENEMAS 1G/100ML 100.00

BC24927100 CELSENTRI FILM-COATED TABLETS 150MG 163.00

BC24928100 CELSENTRI FILM-COATED TABLETS 300MG 163.00

BC24929100 SEVIKAR 5/20MG FILM COATED TABLETS 9.60

BC24934319 NEUPRO TRANSDERMAL PATCH 4MG/24H 67.00

BC24935323 NEUPRO TRANSDERMAL PATCH 6MG/24H 93.00

BC24936326 NEUPRO TRANSDERMAL PATCH 8MG/24H 103.00

BC24947100OTSUKA ABILIFY DISCMELT 10MG ORALLY DISINTEGRATING

TABLETS0.00

BC24961109 PENTASA SACHET, PROLONGED RELEASE GRANULES, 1G 16.80

BC24962112 PENTASA SACHET, PROLONGED RELEASE GRANULES, 2G 32.70

BC24967100 Carvedilol HEXAL Tablets 25mg 3.19

BC24968100 Co-Diovan 320/25 Film-Coated Tablet 0.00

BC24969100 Co-Diovan 320/12.5 Film-Coated Tablet 0.00

BC24976100 Mirtazapine Sandoz 30 mg Orodispersible Tablets 8.90

BC24977414 Mikelan LA Ophthalmic Solution 2% 177.00

BC24978414 Mikelan LA Ophthalmic Solution 1% 0.00

BC24979100 APO-METHYLPHENIDATE TABLETS 20MG 3.86

BC24988100 ISENTRESS FILM COATED TABLETS 400 MG 175.00

BC24989100 Stalevo Film-Coated Tablets 200/50/200mg 0.00

BC24991129NEXIUM 10MG GASTRO-RESISTANT GRANULES FOR ORAL

SUSPENSION20.30

BC24995100 LYRICA HARD CAPSULE 75MG 17.40

BC24998100OTSUKA ABILIFY DISCMELT 15MG ORALLY DISINTEGRATING

TABLETS47.30

BC25001100 SEROQUEL XR TM 50 MG EXTENDED-RELEASE TABLETS 19.00

BC25005100 OLMETEC FILM COATED TABLETS 40MG 13.60

BC25006321 Bencort Cream 0.00

BC25006329 Bencort Cream 0.00

BC25006335 Bencort Cream 38.50

BC25013351 CLOBEX 500ΜG/G SHAMPOO 218.00

BC25013358 CLOBEX 500ΜG/G SHAMPOO 471.00

BC25016100 APO-METHYLPHENIDATE Tablets 10mg 2.66

BC25020100 MINIRIN MELT 120 ΜCG 48.00

BC25021100 MINIRIN MELT 60 UG 37.90

BC25033161 SPIRIVA RESPIMAT 2.5MCG, SOLUTION FOR INHALATION 1564.00

BC25034100 APO-CLOPIDOGREL 75MG FILM-COATED TABLET 32.10

BC25041100 JANUMET 50/850 MG FILM-COATED TABLETS 12.00

BC25043100 JANUMET 50/500 MG FILM-COATED TABLETS 11.70

BC25045100 PRETERAX 2.5 MG/0.625 MG 0.00

BC25046100 ACERTIL PLUS 5 MG/1.25 MG 5.90

BC25053235 IXEMPRA for Injection 9242.00

Page 315: 附件二 藥品給付品項暨支付標準表

BC25059100 Mirtazapine Sandoz 45 mg Orodispersible Tablets 18.40

BC25065100 Topiramate Sandoz FC Tablets 100mg 23.20

BC25066265 FINIBAX FOR INJECTION 0.25G 271.00

BC25068255 LEVOX IV SOLUTION FOR INFUSION 601.00

BC25070100 Carvedilol HEXAL Tablets 12.5mg 0.00

BC25071100 Tarceva Film-coated tablets 150mg“Italy” 774.00

BC25072100 Exforge film-coated tablet 5/160mg 16.40

BC25073100 LEXAPRO FILM-COATED TABLETS 15MG 0.00

BC25074100 LEXAPRO FILM-COATED TABLETS 20MG 15.50

BC25075255 FLUCONAZOLE INJECTION 0.00

BC25075263 FLUCONAZOLE INJECTION 0.00

BC25077100 Tarceva Film-coated tablets 100mg“Italy” 630.00

BC25078100 LAMIDUS 50 TABLETS 0.00

BC25080277 TETRASPAN 6% SOLUTION FOR INFUSION 176.00

BC25081100 INTELENCE TABLETS 100MG 128.00

BC25090100 LEPAX FILM-COATED TABLETS 10MG 9.70

BC25091277 VOLULYTE 6% SOLUTION FOR INFUSION 176.00

BC250921FL FOSTER 708.00

BC25095100 BLOPRESS TABLETS 16 MG 8.70

BC25103321 TAMICORT CREAM 0.00

BC25103329 TAMICORT CREAM 35.00

BC25103336 TAMICORT CREAM 53.00

BC25103338 TAMICORT CREAM 84.00

BC25106100 Wellbutrin XL 150 mg Tablet “Canada” 11.70

BC25114100 Clopidogrel Sandoz 75 mg Film-coated Tablets 32.10

BC25115421 Azarga Eye drops, suspension 288.00

BC25118100 REQUIP PD 2MG PROLONGED RELEASE TABLET 15.20

BC25119100 REQUIP PD 4MG PROLONGED RELEASE TABLET 30.40

BC25120100 REQUIP PD 8MG PROLONGED RELEASE TABLET 55.00

BC25126206ARIXTRA 2.5MG/0.5ML SOLUTION FOR INJECTION ,PRE-FILLED

SYRINGE278.00

BC25129100 Xarelto film-coated tablets 10mg 58.00

BC25143100 TROZET FILM-COATED TABLETS 2.5 MG 38.70

BC25144100 Topiramate Sandoz FC Tablets 25mg 5.50

BC25145100 Topiramate Sandoz FC Tablets 50mg 11.80

BC251502FFSMOFKABIVEN PERIPHERAL EMULSION FOR INFUSION(依仿單含熱

量1300KCAL)782.00

BC251502FNSMOFKABIVEN PERIPHERAL EMULSION FOR INFUSION(依仿單含熱

量1000KCAL)601.00

BC25158100 INVEGA EXTENDED RELEASE TABLETS 9MG 133.00

BC25159343 XAMIOL GEL 536.00

BC25160100 Wellbutrin XL 300mg Tablets 33.90

BC25161100 CO-RASILEZ 150/25MG FILM-COATED TABLETS 19.80

BC25162100 CO-RASILEZ 150/12.5MG FILM-COATED TABLETS 0.00

BC25163100 CO-RASILEZ 300/12.5MG FILM-COATED TABLETS 0.00

BC25164100 CO-RASILEZ 300/25MG FILM-COATED TABLETS 0.00

BC25165100 AFINITOR 5MG TABLETS 563.00

BC25166100 AFINITOR 10MG TABLETS 0.00

Page 316: 附件二 藥品給付品項暨支付標準表

BC25172265 AMINOPLASMAL NEO 5% E 100.00

BC25172277 AMINOPLASMAL NEO 5% E 104.00

BC25173277 AMINOPLASMAL NEO 10% 209.00

BC25174277 AMINOPLASMAL NEO 10% E 209.00

BC25179209 BFLUID INJECTION 306.00

BC25179277 BFLUID INJECTION 198.00

BC25182100 Metfogamma 850mg Film Coated Tablets 0.00

BC25183209 DBL GEMCITABINE FOR INJECTION 0.00

BC25192100 PREZISTA TABLETS 600MG 392.00

BC251932CN LEUPLIN DEPOT 3M 11.25MG S.C. INJECTION 8601.00

BC25197100 TAREG 160MG FILM COATED TABLETS 7.30

BC25198100 Amlodipine Sandoz 10 mg Tablets 0.00

BC25199100 Amlodipine Sandoz 5 mg Tablets 3.84

BC252032BJSMOFKABIVEN EMULSION FOR INFUSION(依仿單含熱量2700KCAL)

0.00

BC252032FBSMOFKABIVEN EMULSION FOR INFUSION(依仿單含熱量1100KCAL)

629.00

BC252032FCSMOFKABIVEN EMULSION FOR INFUSION(依仿單含熱量1600KCAL)

916.00

BC252032FDSMOFKABIVEN EMULSION FOR INFUSION(依仿單含熱量2200KCAL)

1259.00

BC25205100 ATRIPLA TABLETS 430.00

BC25206100 BYPRO FILM-COATED TABLETS 50 MG 75.00

BC25207100 CO-TAREG FILM COATED TABLETS 80/12.5MG 6.00

BC25208100 CO-TAREG FILM COATED TABLETS 160/12.5MG 0.00

BC25210100 TAREG 80MG FILM COATED TABLETS 6.00

BC25211100 ZYSIM 10 TABLETS 2.97

BC25214100 REVLIMID CAPSULES 25MG 4154.00

BC25215100 REVLIMID CAPSULES 15MG 4154.00

BC25216100 REVLIMID CAPSULES 10MG 4154.00

BC25217100 REVLIMID CAPSULES 5MG 1952.00

BC25220100 ONGLYZA FILM-COATED TABLETS 2.5MG 14.20

BC25221100 ONGLYZA FILM-COATED TABLETS 5MG 21.40

BC25224100 MULTAQ 400MG FILM-COATED TABLETS 48.30

BC252251G0 REMETHAN 25 EC TABLETS(鋁箔/膠箔) 0.00

BC252261G0 REMETHAN 50 EC TABLETS(鋁箔/膠箔) 2.00

BC25227221 Dopamine HCl-Fresenius 200mg/5ml Infusion 19.90

BC25232100 ZYVERIN 200MG CAPSULES 0.00

BC252343FA EXELON PATCH 5 62.00

BC25242100 TS-1 CAPSULES 25MG 168.00

BC25243100 TS-1 CAPSULES 20MG 148.00

BC25244100 HYCAMTIN CAPSULES 0.25MG 392.00

BC25245100 HYCAMTIN CAPSULES 1MG 1553.00

BC25246243 TAKEPRON INTRAVENOUS 30MG 182.00

BC25251100 AREMED 1 FC TABLETS 45.30

BC25253100 MIRAPEX 0.75MG PROLONGED-RELEASE TABLETS 25.60

BC25258100 MIRAPEX 0.375MG PROLONGED-RELEASE TABLETS 15.10

BC25260100 MIRAPEX 1.5MG PROLONGED-RELEASE TABLETS 46.70

Page 317: 附件二 藥品給付品項暨支付標準表

BC25262100 Venlafaxine Sandoz 150mg prolonged release Capsules 0.00

BC25272100 Revolade film-coated tablets 25mg 1078.00

BC25278212 Pancuronium Bromide-Fresenius 4mg/2ml Injection 0.00

BC25280221 LIGNOCAINE HCL-FRESENIUS INJECTION 2 % 50.00

BC25282443Onbrez Breezhaler 150 mcg inhalation powder, hard

capsule832.00

BC25286100 PREZISTA TABLETS 400MG 156.00

BC25289209TAXOTERE 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION

3199.00

BC25289219TAXOTERE 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION

10751.00

BC25294416 LUMIGAN OPHTHALMIC SOLUTION 0.01% 431.00

BC25296100 SAMSCA TABLETS 15MG 543.00

BC25302166 DUPHALAC ORAL SOLUTION 105.00

BC25302177 DUPHALAC ORAL SOLUTION 161.00

BC25303297 MOZOBIL SOLUTION FOR INJECTION 166525.00

BC25306100 GALVUS TABLETS 50MG 10.10

BC25310100 CURAM 625MG DISPERSIBLE TABLETS 5.90

BC25311100 CURAM 1000MG DISPERSIBLE TABLETS 7.20

BC25316221 KEPPRA CONCENTRATE FOR SOLUTION FOR INFUSION 100MG/ML 333.00

BC25317100 Tasigna Capsules 150mg 660.00

BC25321100 MYCOPHENOLATE SANDOZ 500 MG FILM-COATED TABLETS 0.00

BC25322219 LEVOPHED INJECTION 100.00

BC25326100 COPLAVIX FILM COATED TABLETS 75MG/100MG 32.10

BC25332100 RITALIN LA CAPSULES 10MG 17.70

BC25333100 RITALIN LA CAPSULES 20MG 29.90

BC25334100 RITALIN LA CAPSULES 30MG 42.70

BC25335100 RITALIN LA CAPSULES 40MG 50.00

BC25336100 Venlafaxine Sandoz 75mg prolonged release Capsules 0.00

BC25342100 ZYDUS IRBESARTAN TABLETS USP 150 MG 5.40

BC25350100 LIVALO TABLETS 2MG 13.10

BC25351100Mezavant XL, 1200mg gastro-resistant, prolonged release

tablets30.50

BC25352100 Madopar 125 Capsules“Italy” 3.34

BC25360200 OZURDEX (DEXAMETHASONE INTRAVITREAL IMPLANT) 0.7MG 33350.00

BC25364100 APO-ALENDRONATE 70MG TABLETS 152.00

BC25377414 TAFLOTAN OPHTHALMIC SOLUTION 303.00

BC25386221PRISMASOL 4MMOL/LPOTASSIUM,SOLUTION FOR HAEMOFILTRATION

AND HAEMODIALYSIS289.00

BC25387221PRISMASOL B0,SOLUTION FOR HAEMOFILTRATION AND

HAEMODIALYSIS289.00

BC25388221PRISMASOL 2MMOL/LPOTASSIUM,SOLUTION FOR HAEMOFILTRATION

AND HAEMODIALYSIS289.00

BC25391100 CATAPRES TABLETS 75 μg 1.83

BC25394206INVEGA SUSTENNA PROLONGED RELEASE SUSPENSION FOR

INTRAMUSCULAR INJECTION 100MG/ML3524.00

BC25394207INVEGA SUSTENNA PROLONGED RELEASE SUSPENSION FOR

INTRAMUSCULAR INJECTION 100MG/ML6873.00

Page 318: 附件二 藥品給付品項暨支付標準表

BC25394209INVEGA SUSTENNA PROLONGED RELEASE SUSPENSION FOR

INTRAMUSCULAR INJECTION 100MG/ML8365.00

BC25394210INVEGA SUSTENNA PROLONGED RELEASE SUSPENSION FOR

INTRAMUSCULAR INJECTION 100MG/ML8670.00

BC25401255 Innomustine Injection 8567.00

BC25410403 COSOPT PRESERVATIVE-FREE OPHTHALMIC SOLUTION 9.00

BC25413100 HARNALIDGE OCAS PROLONGED RELEASE TABLETS 0.4 MG 14.50

BC25414221 SUCROFER INJECTION 65.00

BC25416100 TRAMAZAC XL 200 TABLETS 10.00

BC25418100 Exforge HCT Film Coated Tablets 5/160/25 mg 0.00

BC25419100 Exforge HCT Film Coated Tablets 5/160/12.5 mg 14.50

BC25420100 Exforge HCT Film Coated Tablets 10/160/12.5 mg 0.00

BC25421100 Exforge HCT Film Coated Tablets 10/160/25 mg 18.60

BC25423100 DUODART CAPSULES 31.90

BC25427100 FEBURIC 80 MG FILM COATED TABLETS 17.40

BC25429100 MIRAPEX PROLONGED-RELEASE TABLETS 2.25MG 0.00

BC25433100 Votrient (Pazopanib HCl) film-coated tablets 200mg 590.00

BC25442100 RAPAMUNE TABLETS 0.5 MG 69.00

BC25446100 TWYNSTA TABLETS 80/5 MG 11.60

BC25447100 TWYNSTA TABLETS 80/10 MG 0.00

BC25451100 VALDOXAN FILM-COATED TABLETS 25MG 35.30

BC25452100 Apo-Tramadol/ Acet 37.5/ 325mg tablets 3.32

BC25453100 KOMBIGLYZE XR TABLETS 5MG/1000MG 17.80

BC25454100 KOMBIGLYZE XR TABLETS 5MG/500MG 0.00

BC25455100 KOMBIGLYZE XR TABLETS 2.5MG/1000MG 0.00

BC25458100 PRADAXA CAPSULES 150 MG 41.70

BC25459100 PRADAXA CAPSULES 110 MG 41.70

BC25472238 EVOLTRA CONCENTRATE FOR SOLUTION FOR INFUSION 37676.00

BC25473100 NORVIR FILM-COATED TABLETS 100 MG 31.30

BC25480100 Galvus Met 50/500 film-coated tablets 10.10

BC25481100 Galvus Met 50/850 film-coated tablets 10.10

BC25482100 Galvus Met 50/1000 film-coated tablets 10.10

BC25489209 VINELBINE INJECTION 1075.00

BC25489221 VINELBINE INJECTION 0.00

BC25492100 SEVIKAR HCT 20/5/12.5MG 9.60

BC25493100 SEVIKAR HCT 40/5/25MG 0.00

BC25494100 SEVIKAR HCT 40/5/12.5MG 16.80

BC25495100 SEVIKAR HCT 40/10/12.5MG 0.00

BC25496100 SEVIKAR HCT 40/10/25MG 0.00

BC25501100 LOSACAR-H TABLETS 0.00

BC25508100 APO-ESCITALOPRAM 20MG TABLETS 0.00

BC25509100 TEMAZO CAPSULES 20MG 539.00

BC25510100 TEMAZO CAPSULES 250MG 0.00

BC25518100 AKURIT-4 16.50

BC25519100 AKURIT-3 8.20

BC25522261 EMEND IV 150MG POWDER FOR INJECTION 1543.00

BC25533100 ELTROXIN TABLETS 50 MCG 1.50

BC25537100 TRAJENTA 5MG FILM-COATED TABLETS 16.70

Page 319: 附件二 藥品給付品項暨支付標準表

BC25551229 DBL OXALIPLATIN CONCENTRATE FOR INFUSION 1336.00

BC25551238 DBL OXALIPLATIN CONCENTRATE FOR INFUSION 4420.00

BC255532A5 NUTRIFLEX OMEGA SPECIAL(依仿單含熱量1475KCAL) 0.00

BC25556100 DUOVIR-N 167.00

BC25557229 GLYPRESSIN 0.1MG/ML SOLUTION FOR INJECTION 805.00

BC25558212Docetaxel“Ebewe”10 mg/ml Concentrate for Solution for

Infusion0.00

BC25558226Docetaxel“Ebewe”10 mg/ml Concentrate for Solution for

Infusion0.00

BC25559217 VELCADE POWDER FOR SOLUTION FOR INJECTION 13175.00

BC25563277 Cymevene Lyophilized IV Injection 500mg/Vial 1492.00

BC25594100 LIPANTHYL PENTA 145 MG FILM-COATED TABLET 3.92

BC25603221 CYTARINE INJECTION 0.00

BC25605100 Copegus film-coated tablets 200 mg 0.00

BC25607333 Hirudoid Cream 300mg/100g 0.00

BC25607345 Hirudoid Cream 300mg/100g 109.00

BC25612243 LEUPLIN DEPOT 6 M 30 MG S.C. INJECTION 14960.00

BC25615100 EFAVIR 600 42.70

BC25619100 DUOVIR 31.00

BC25624100 "Apo-Citalopram Tablets 20mg ""Etobicoke""" 7.10

BC25626235Carboplatin "Ebewe" 10mg/ml concentrate for solution for

infusion0.00

BC256262APCarboplatin "Ebewe" 10mg/ml concentrate for solution for

infusion0.00

BC25631229 OXITAN INJECTION 1336.00

BC25631238 OXITAN INJECTION 0.00

BC25635100 GLUCOPHAGE FILM-COATED TABLETS 500MG 0.00

BC25647100 Xarelto Film-coated Tablets 20 mg 58.00

BC25648100 Xarelto Film-coated Tablets 15 mg 58.00

BC25674100 Carvedilol HEXAL Tablets 6.25mg 2.39

BC25678100 TEMAZO CAPSULES 100MG 2543.00

BC25681209 GEMITA LYOPHILIZED FOR INJECTION 2854.00

BC25681263 GEMITA LYOPHILIZED FOR INJECTION 598.00

BC25690100 FLUCOZYD CAPSULES 150MG 52.00

BC25691100 BRILINTA FILM-COATED TABLETS 90 MG 28.40

BC256961G0 DULCOLAX ENTERIC SUGAR COATED TABLET 5MG(鋁箔/膠箔) 2.00

BC25699100 Moxiclav 1G F.C. Tablets 7.20

BC25706209GRANISETRON KABI 1MG/ML, CONCENTRATE FOR SOLUTION FOR

INJECTION/INFUSION0.00

BC25706216GRANISETRON KABI 1MG/ML, CONCENTRATE FOR SOLUTION FOR

INJECTION/INFUSION0.00

BC25708209 NEOPAREN NO.1 INJECTION 1L 0.00

BC25708210 NEOPAREN NO.1 INJECTION 1.5L 0.00

BC25708212 NEOPAREN NO.1 INJECTION 2L 0.00

BC257091G0 BUSCOPAN SUGAR COATED TABLETS 10MG(鋁箔/膠箔) 2.00

BC25713100 Lendormin (R) 0.25mg Tablets 3.60

BC25717100 VIVIANT FILM-COATED TABLET 20MG 29.30

Page 320: 附件二 藥品給付品項暨支付標準表

BC25728212IRINOTECAN BIOPRO 20MG/ML, CONCENTRATE FOR SOLUTION FOR

INFUSION0.00

BC25728221IRINOTECAN BIOPRO 20MG/ML, CONCENTRATE FOR SOLUTION FOR

INFUSION2975.00

BC25729148 Bisolvon (R) Solution 2mg/ml 49.30

BC25744248 KEMOPLAT INJECTION 1MG/ML 350.00

BC25746100 MOBIC (R) TABLETS 7.5MG 1.72

BC25747100 MOBIC (R) TABLETS 15MG 4.07

BC25754100 AZAMUN FILM COATED TABLETS 50MG 9.60

BC25756100 EDARBI TABLETS 40MG 10.40

BC25757100 DIFICID FILM-COATED TABLET 200MG 1064.00

BC25765212IRINOTECAN SANDOZ 20MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION0.00

BC25765221IRINOTECAN SANDOZ 20MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION0.00

BC25766100 VALAZYD 160 TABLETS 7.30

BC25781255 VIDAZA POWDER FOR SUSPENSION FOR INJECTION 12227.00

BC25782248FLUDARABINE BIOPRO 25MG/ML, POWDER FOR SOLUTION FOR

INJECTION/INFUSION0.00

BC25783100 APO-PANTOPRAZOLE 40MG ENTERIC COATED TABLETS 10.10

BC25789100 Apo-Citalopram Tablets 40mg 16.00

BC25791209Topotecan Sandoz 1mg/ml Concentrate for Solution for

Infusion0.00

BC25791216Topotecan Sandoz 1mg/ml Concentrate for Solution for

Infusion0.00

BC25791219Topotecan Sandoz 1mg/ml Concentrate for Solution for

Infusion6546.00

BC25792100 TRAJENTA DUO 2.5/850MG FILM-COATED TABLETS 12.50

BC25794100 TRAJENTA DUO 2.5/1000MG FILM-COATED TABLETS 0.00

BC25796100 Robestar Sandoz Film-coated Tablets 20mg 0.00

BC25804100 APO-ESOMEPRAZOLE ENTERIC COATED TABLET 40MG 6.10

BC25807100 PHAROXIFENE (RALOXIFENE) FILM-COATED TABLETS 60MG 34.00

BC25808221 DOXORUBICIN MYLAN 399.00

BC25808229 DOXORUBICIN MYLAN 619.00

BC25808240 DOXORUBICIN MYLAN 2458.00

BC25814100 EDURANT FILM COATED TABLETS 25MG 276.00

BC25817100MONTEZYD TABLETS 5MG (MONTELUKAST CHEWABLE TABLETS 5MG)

9.30

BC258203FP Sancuso transdermal patch 3.1mg/24hours 1872.00

BC25823100 VIRAMUNE XR 400MG EXTENDED-RELEASE TABLETS 171.00

BC25829100 SINLUE CHEWABLE TABLETS 5MG 9.30

BC25830100 SINLUE CHEWABLE TABLETS 4MG 9.10

BC25840221 ADRIM INJECTION 0.00

BC25849100 VOMIZ FILM COATED TABLETS 4MG 88.00

BC25853100 INLYTA FILM-COATED TABLETS 1 MG 208.00

BC25854100 INLYTA FILM-COATED TABLETS 5 MG 937.00

BC25856414 Latanoprost Ophthalmic Solution 0.005% 439.00

BC25877100 DAFIRO 5/160MG FILM-COATED TABLETS 14.50

Page 321: 附件二 藥品給付品項暨支付標準表

BC25879100 Irbesartan Sandoz 150mg Film Coated Tablets 5.40

BC25882253FIRMAGON 80MG, POWDER AND SOLVENT FOR SOLUTION FOR

INJECTION4259.00

BC25883257FIRMAGON 120MG, POWDER AND SOLVENT FOR SOLUTION FOR

INJECTION4259.00

BC25886100 DEXILANT DELAYED RELEASE CAPSULES 30MG 0.00

BC25887100 DEXILANT DELAYED RELEASE CAPSULES 60MG 15.90

BC25893100 APO-PRAMIPEXOLE 0.25MG TABLETS 9.00

BC25897100 Irbesartan Sandoz 300mg Film Coated Tablets 9.10

BC25899221Gemcitabine Sandoz 40mg/ml Concentrate for Solution for

Infusion598.00

BC25899240Gemcitabine Sandoz 40mg/ml Concentrate for Solution for

Infusion2854.00

BC25899248Gemcitabine Sandoz 40mg/ml Concentrate for Solution for

Infusion0.00

BC25900100 APO-OLANZAPINE ODT 5MG 39.50

BC25901100 APO-OLANZAPINE ODT 10MG 65.00

BC25902209 NEOPAREN NO.2 INJECTION 1L 0.00

BC25902210 NEOPAREN NO.2 INJECTION 1.5L 0.00

BC25902212 NEOPAREN NO.2 INJECTION 2L 0.00

BC25913100 DAFIRO 5/80MG FILM-COATED TABLETS 8.40

BC25918100 INTELENCE TABLETS 200MG 230.00

BC25923100 Utrogestan soft capsule 100mg 6.30

BC25924100 MONTEZYD TABLETS 4MG 9.10

BC259342AA Leuplin Depot 1M 3.75mg S.C. Injection 3807.00

BC25936245Pantoprazole Sandoz 40mg powder for solution for

injection119.00

BC25937100 Montelukast Sandoz 5mg chewable Tablets 9.30

BC25938100 XALKORI CAPSULES 250MG 2399.00

BC25939100 XALKORI CAPSULES 200MG 1920.00

BC25965100 CONVERIUM 300MG TABLETS 9.10

BC25967209 Vancomycin Sandoz powder for solution for injection 179.00

BC25967277 Vancomycin Sandoz powder for solution for injection 76.00

BC25972100 ZYDUS LANS DR 30 10.00

BC25980100 SINLUE F.C. TABLET 10MG 12.30

BC25981100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 200MCG 275.00

BC25982100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 400MCG 330.00

BC25983100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 600MCG 395.00

BC25984100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 800MCG 485.00

BC25985100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 1200MCG 585.00

BC25993100 PLETAAL OD TABLETS 100MG 11.30

BC25994100 PLETAAL OD TABLETS 50MG 5.50

BC26002421 DORZOSTILL EYE-DROPS 2% 235.00

BC26028100 LIPISTAD 20 16.60

BC260293C8 EXELON PATCH 10 64.00

BC26031100 GIOTRIF FILM-COATED TABLETS 20 MG 1392.00

BC26032100 GIOTRIF FILM-COATED TABLETS 30 MG 1392.00

BC26033100 GIOTRIF FILM-COATED TABLETS 40 MG 1392.00

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BC26034100 GIOTRIF FILM-COATED TABLETS 50 MG 1392.00

BC26037100 JURNISTA PROLONGED-RELEASE TABLETS 8MG 135.00

BC26042100 Sibelium Tablets 5mg 0.00

BC26043100 Zelboraf film-coated tablets 240mg (vemurafenib) 736.00

BC26045100 APO-DONEPEZIL FILM TABLETS 5MG 55.00

BC26046100 APO-DONEPEZIL TABLETS 10MG 57.00

BC26048100 Losartan Sandoz Comp Film Coated Tablet 50/12.5 mg 0.00

BC260491G0 PEROFEN 600 F.C. TABLETS(鋁箔/膠箔) 2.00

BC26050229Oxaliplatin Sandoz 5mg/ml concentrate for solution for

infusion0.00

BC26050238Oxaliplatin Sandoz 5mg/ml concentrate for solution for

infusion0.00

BC26051100 Montelukast Sandoz 4mg chewable Tablets 9.10

BC26064100 Utrogestan soft capsule 200mg 12.50

BC26074271 Teicoplanin Sandoz powder for injection 0.00

BC26082100 ACC 600 Effervescent Tablets 5.40

BC26090100 PHARACETAM FILM-COATED TABLET 1000MG 38.20

BC26093205 SIGNIFOR 0.3MG/ML SOLUTION FOR INJECTION IN AMPOULE 2161.00

BC26094228 SIGNIFOR 0.6MG/ML SOLUTION FOR INJECTION IN AMPOULE 2337.00

BC26095208 SIGNIFOR 0.9MG/ML SOLUTION FOR INJECTION IN AMPOULE 2367.00

BC26097100 CORALAN FILM-COATED TABLETS 5 MG 23.60

BC26098100 CORALAN FILM-COATED TABLETS 7.5 MG 23.60

BC26104100 Pantoprazol Sandoz 40mg gastro-resistant tablets 10.10

BC26105100 Montelukast Sandoz 10mg film-coated Tablets 12.30

BC26112100 ZOVILAM 31.00

BC26124100 ELIQUIS FILM-COATED TABLET 2.5MG 29.60

BC26127100 LETROZOLE-TEVA 2.5MG TABLETS 0.00

BC26128100 ZYDUS LANS DR 15 8.30

BC26133100 ELIQUIS FILM-COATED TABLET 5MG 29.60

BC26136100 FOSAMAX PLUS TABLETS 70MG/5600 IU 152.00

BC26139100 ZYTIGA TABLETS 250MG 483.00

BC26140212 HALAVEN 0.5MG/ML SOLUTION FOR INJECTION 11092.00

BC26147100 FLUVASTATIN XL FILM-COATED TABLETS 80MG 10.20

BC26153100 Moxiclav 625mg F.C. Tablets 5.90

BC26154343 UNIVATE OINTMENT 0.5MG/GM (CLOBETASOL) 90.00

BC26157400Seebri Breezhaler 50 microgram, inhalation powder hard

capsules982.00

BC26167100 TREZAV 147.00

BC26168100 Stivarga Film-Coated Tablets 40mg 885.00

BC26169100 PRAVAFEN 40MG/160MG HARD CAPSULES 16.40

BC26171335 VIZOMET CREAM 0.1% 65.00

BC26173100 TRACLEER FILM COATED TABLETS 62.5MG 1320.00

BC26174100 TRACLEER FILM COATED TABLETS 125MG 1549.00

BC26179100 UNISIA 8MG/5MG TABLETS 8.10

BC26184100 NEVIMAT 81.00

BC26185238 Propofol-Lipuro 1% 37.40

BC26188100 PHAVIR FILM-COATED TABLETS 500MG 52.00

BC26193100 APO-ATOMOXETINE CAPSULES 25MG 54.00

Page 323: 附件二 藥品給付品項暨支付標準表

BC26194100 APO-ATOMOXETINE CAPSULES 10MG 54.00

BC26195100 APO-ATOMOXETINE CAPSULES 18MG 54.00

BC26196100 APO-ATOMOXETINE CAPSULES 40MG 54.00

BC26197100 APO-ATOMOXETINE CAPSULES 60NG 54.00

BC26198100 BICALUTAMIDE-TEVA FILM-COATED TABLETS 50MG 75.00

BC26200100 ALLTERA 85.00

BC26209100 EDARBYCLOR TABLET 40MG/12.5MG 17.40

BC26210100 EDARBYCLOR TABLET 40MG/25MG 17.40

BC26214100 Esomeprazol Sandoz 40mg Gastro Resistant Tablets 6.10

BC26216100 BETMIGA PROLONGED-RELEASE TABLETS 50MG 36.00

BC26217100 BETMIGA PROLONGED-RELEASE TABLETS 25MG 36.00

BC26219100 XELJANZ FILM-COATED TABLETS 5MG 414.00

BC26222229NICARDIPINE AGUETTANT 10MG/10ML SOLUTION FOR INJECTION

141.00

BC26225100 ABAMAT 0.00

BC26228343 UNIVATE CREAM 0.05% W/W 90.00

BC26233100 PRADAXA CAPSULES 75MG 21.20

BC26237100 EFAMAT 42.70

BC26239100 Bicalutamide "Alvogen" Film Coated Tablets 50mg 75.00

BC26240209 Vaxcel Ceftriaxone-1g Injection 0.00

BC26241100 RIBUTIN CAPSULE 150MG 74.00

BC26244100 PHARODINE IR FILM-COATED TABLETS 2MG 7.60

BC26246100 WAKA-OLANZAPINE ODT 10 65.00

BC26247100 WAKA-OLANZAPINE ODT 5 39.50

BC26252100 NOKLOT 75 (CLOPIDOGREL TABLETS USP 75MG) 32.10

BC262604CR LUMIGAN PF EYE DROPS 18.00

BC26262220 ALVOTAZ POWDER FOR SOLUTION FOR INJECTION 226.00

BC262622CX ALVOTAZ POWDER FOR SOLUTION FOR INJECTION 136.00

BC26269100 REPAGLINID JUBILANT TABLETS 2MG 0.00

BC26270100 BICALUTAMIDE-ACEPHARM FILM COATED TABLETS 50MG 75.00

BC26272100 WALKIN 35MG FILM-COATED TABLET 152.00

BC26273429 Vidisic, eye gel 102.00

BC26274100NIFEDIPINE EXTENDED RELEASE TABLETS(OROS) 30MG "SUNYET"

5.10

BC26283238 VIMPAT 10MG/ML SOLUTION FOR INFUSION 1083.00

BC26284100 VIMPAT 50MG FILM-COATED TABLETS 28.80

BC26285100 VIMPAT 100MG FILM-COATED TABLETS 52.00

BC26286100 VIMPAT 150MG FILM-COATED TABLETS 82.00

BC26287100 VIMPAT 200MG FILM-COATED TABLETS 100.00

BC26289100 WAKA-QUETIAPINE XR 200 0.00

BC26290100 WAKA-QUETIAPINE XR 300 0.00

BC26292443STRIVERDI RESPIMAT 2.5 MICROGRAM SOLUTION FOR INHALATION

923.00

BC26298100 NESINA TABLETS 25MG 18.70

BC26299100 NESINA TABLETS 12.5MG 13.50

BC26300100 NESINA TABLETS 6.25MG 6.70

BC26301443Ultibro Breezhaler 110/50 microgram, inhalation powder

hard capsules1245.00

Page 324: 附件二 藥品給付品項暨支付標準表

BC26302321 AXCEL ACYCLOVIR CREAM 41.10

BC26304225ELIGARD 7.5 MG, POWDER AND SOLVENT FOR SOLUTION FOR

INJECTION3807.00

BC263052FQELIGARD 22.5 MG, POWDER AND SOLVENT FOR SOLUTION FOR

INJECTION8601.00

BC263062APELIGARD 45 MG, POWDER AND SOLVENT FOR SOLUTION FOR

INJECTION14960.00

BC26307209TOPOTECAN BIOPRO POWDER FOR CONCENTRATE FOR SOLUTION FOR

INFUSION0.00

BC26307219TOPOTECAN BIOPRO POWDER FOR CONCENTRATE FOR SOLUTION FOR

INFUSION6546.00

BC26308100 Voriconazole Sandoz Film-Coated Tablets 50mg 0.00

BC26309100 Voriconazole Sandoz Film-Coated Tablets 200mg 1117.00

BC26310100 ZETLAM 44.80

BC26313100 LETERO FILM COATING TABLET 2.5MG 38.70

BC26315143 ANORO ELLIPTA 55/22 MCG INHALATION POWDER 1271.00

BC26318143 RELVAR ELLIPTA 92/22 MCG INHALATION POWDER 800.00

BC26321100 LOSARTAN JUBILANT FILM-COATED TABLET 50MG 4.11

BC26322100 LOSARTAN JUBILANT FILM-COATED TABLET 100MG 0.00

BC26328100 FYCOMPA FILM-COATED TABLETS 2MG 57.00

BC26329100 FYCOMPA FILM-COATED TABLETS 4MG 111.00

BC26330100 FYCOMPA FILM-COATED TABLETS 8MG 144.00

BC26331100 LAMIDUS 25 TABLETS 0.00

BC26334209 DAXOTEL INJECTION CONCENTRATE 20MG/ML 3199.00

BC26334219 DAXOTEL INJECTION CONCENTRATE 20MG/ML 10751.00

BC26337100 VORICONAZOLE MYLAN 200MG 1117.00

BC26343157Flutiform 50/5mcg per actuation Pressurised, Inhalation,

Suspension705.00

BC26344157Flutiform 250/10mcg per actuation Pressurised,

Inhalation, Suspension1190.00

BC26345157Flutiform 125/5mcg per actuation Pressurised,

Inhalation, Suspension651.00

BC26346277CEFTRIAXONE KABI 0.5G POWDER FOR SOLUTION FOR INJECTION

54.00

BC26347209 CEFTRIAXONE KABI 1G POWDER FOR SOLUTION FOR INJECTION 82.00

BC26349297Alvoclav powder for solution for injection 1000mg/200mg

74.00

BC26350100 LIPISTAD 10 9.00

BC26359100 JAKAVI 5mg tablet 1001.00

BC26360100 JAKAVI 15mg tablet 2002.00

BC26361100 JAKAVI 20mg tablet 2002.00

BC26367100 APO-ROSUVASTATIN TABLET 20MG 22.20

BC26368100 APO-ROSUVASTATIN TABLET 10MG 13.40

BC26369100 TELCARD 80 11.60

BC26376100 POSANOL TABLETS 100MG 594.00

BC26383100 VATIVIO FILM-COATED TABLETS 100MG 0.00

BC26385255 ZOLDRIA 4MG/100ML SOLUTION FOR INFUSION 0.00

BC26387235 Caxatin Solution for Intravenous Infusion 10mg/ml 1448.00

Page 325: 附件二 藥品給付品項暨支付標準表

BC26391100 LOSARTAN TEVAPHARM FILM COATED TABLETS 50MG 0.00

BC26396100 RABEPRAZOLE SODIUM GASTRO RESISTANT MYLAN 20MG 8.70

BC26397100 MYCOPHENOLATE MOFETIL TEVA HARD CAPSULES 250MG 41.30

BC26398100Irbesartan 300mg+Hydrochlorothiazide 25mg Sandoz Film

Coated Tablet0.00

BC26399100IRBESARTAN 150MG+HYDROCHLOROTHIAZIDE 12.5MG SANDOZ FILM

COATED TABLET0.00

BC26405100 JARDIANCE 25MG FILM-COATED TABLETS 29.30

BC26406100 JARDIANCE 10MG FILM-COATED TABLETS 29.30

BC26407100 TIVICAY FILM-COATED TABLETS 50MG 355.00

BC26415100 LERCANIDIPINE MYLAN 10MG 5.50

BC26419209FOLOTYN (PRALATREXATE INJECTION) SOLUTION FOR

INTRAVENOUS INJECTION21993.00

BC26420100 OXYNORM IMMEDIATE RELEASE CAPSULES 20MG 35.00

BC26421100 OXYNORM IMMEDIATE RELEASE CAPSULES 5MG 14.50

BC26422100 OXYNORM IMMEDIATE RELEASE CAPSULES 10MG 20.00

BC26432100 OxyContin Controlled-Release Tablets 10 mg 40.00

BC26434100 OxyContin Controlled-Release Tablets 20 mg 76.00

BC26436100 OxyContin Controlled-Release Tablets 40 mg 134.00

BC26442100 Tecta 40mg enteric coated tablet 10.10

BC26446100 ZYSAR 16 (CANDESARTAN CILEXETIL TABLETS 16MG) 0.00

BC26447100 PRAMIPEXOLE DIHYDROCHLRODIE TABLETS MYLAN 0.25MG 9.00

BC26449100 PRAMIPEXOLE-ACEPHARM TABLETS 0.25MG 0.00

BC26453100 PMS-DESMOPRESSIN TABLETS 0.1MG 37.90

BC26455100 VALACYCLOVIR MYLAN 500MG 52.00

BC26463100 Olmesartan Sandoz Film Coated Tablet 20mg 7.30

BC26464100 OLMESARTAN SANDOZ FILM COATED TABLET 40MG 0.00

BC26465100 DAFIRO HCT 5/160/12.5MG FILM-COATED TABLETS 14.50

BC26466100 DAFIRO HCT 5/160/25MG FILM-COATED TABLETS 0.00

BC26467100 DAFIRO HCT 10/160/12.5MG FILM-COATED TABLETS 20.00

BC26468100 DAFIRO HCT 10/160/25MG FILM-CATED TABLETS 20.00

BC26472100 ZYSAR 8 (CANDESARTAN CILEXETIL TABLETS 8MG) 6.90

BC26475100 FORXIGA FILM-COATED TABLETS 5MG 28.10

BC26476100 FORXIGA FILM-COATED TABLETS 10MG 28.10

BC26484255 ABRAXANE FOR INJECTABLE SUSPENSION 7812.00

BC26485100 AZICINE CAPSULES 250MG 17.50

BC26491100 MOXETERO (MOXIFLOXACIN HCL TABLETS 400MG) 80.00

BC26496100 CANDESARTAN AND HYDROCHLOROTHIAZIDE MYLAN 16MG/12.5MG 8.70

BC26497100 ROSUVASTATIN MYLAN 10MG 13.40

BC26500143 INCRUSE ELLIPTA 55 MCG INHALATION POWDER 1112.00

BC26503100 TELCARD 40 6.90

BC26505100 PMS-ROSUVASTATIN 5MG TABLETS 0.00

BC26506151 IBUFEN SYRUP 25.00

BC26514100 PMS-PREGABALIN CAPSULES 75MG 15.90

BC26516100 FINASTERIDE-TEVA 5MG FILM-COATED TABLETS 0.00

BC26518100 TRIUMEQ FILM-COATED TABLETS 440.00

BC26520100 SEVIKAR 5/40MG FILM COATED TABLETS 16.80

BC26521100 SEVIKAR 10/40MG FILM COATED TABLETS 0.00

Page 326: 附件二 藥品給付品項暨支付標準表

BC26526209Meropenem "U-NEURON" Powder for Solution for IV

Injection525.00

BC26526277Meropenem "U-NEURON" Powder for Solution for IV

Injection284.00

BC26527100 JUBILANT DONEPEZIL 10MG FILM-COATED TABLETS 57.00

BC26536100 OPSUMIT(CM) FILM-COATED TABLETS 10 MG 2237.00

BC26537100 Co-Alvoprel 300mg/25mg film-coated tablets 0.00

BC26541221CISATRACURIUM KABI 2MG/ML SOLUTION FOR

INJECTION/INFUSION56.00

BC26541229CISATRACURIUM KABI 2MG/ML SOLUTION FOR

INJECTION/INFUSION87.00

BC26543100 Alvostat film coated tablets 10mg 13.40

BC26544100 Alvostat film coated tablets 20mg 22.20

BC26552100 Ezetimibe Sandoz 10mg Tablets 6.60

BC26557100 TELCARD 20 5.00

BC26560100 FENTORA BUCCAL TABLETS 200MCG 250.00

BC26561100 FENTORA BUCCAL TABLETS 400MCG 300.00

BC26562100 FENTORA BUCCAL TABLETS 100MCG 220.00

BC26564100 FEMAPLEX FILM COATED TABLET 2.5MG 0.00

BC26565100BINOSTO (ALENDRONATE SODIUM) EFFERVESCENT TABLETS FOR

ORAL SOLUTION, 70 MG152.00

BC26566100 BICATERO 50 75.00

BC26568100 OFEV SOFT CAPSULES 150MG 876.00

BC26569100 OFEV SOFT CAPSULES 100MG 876.00

BC265702E2 POSANOL 18MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 7731.00

BC26571100 PMS-METHYLPHENIDATE ER 36MG TABLETS 0.00

BC26572221 "BIOADAMANT" DOXOTIL SOLUTION FOR INJECTION 2MG/ML 0.00

BC26572240 "BIOADAMANT" DOXOTIL SOLUTION FOR INJECTION 2MG/ML 0.00

BC26573100 QUETIAPINE-TEVA 25MG FILM-COATED TABLETS 0.00

BC26578100 Tafinlar Capsules 50mg 672.00

BC26579100 Tafinlar Capsules 75mg 908.00

BC26581100 LETROZOLE-ACEPHARM F.C. TABLETS 2.5MG 0.00

BC26582100 AMLODIPINE BESYLATE AND ATORVASTATIN MYLAN 10MG/10MG 7.60

BC26591221 SETROVEL INJECTION 5MG/5ML 0.00

BC26592100 SOVALDI 400MG FILM-COATED TABLETS 0.00

BC26593100 ZYDUS ARIPIPRAZOLE TABLET 15MG 47.30

BC26597100 ZYDUS ARIPIPRAZOLE TABLETS 5MG 33.00

BC26598100 WONTRAN ER 9.20

BC26599100 LIXIANA F.C. TABLETS 60MG 73.00

BC26600100 LIXIANA F.C. TABLETS 30MG 73.00

BC26601100 LIXIANA F.C. TABLETS 15MG 73.00

BC26602100 Complera Film-coated Tablets 451.00

BC26604100 STADNEX 40 CAP 6.10

BC26611280ZINFORO 600 MG POWDER FOR CONCENTRATE FOR SOLUTION FOR

INFUSION1423.00

BC26612100 WAKA MEMO 10 0.00

BC26615405 TAFLOTAN-S OPHTHALMIC SOLUTION 13.80

BC26616100 STADNEX 20 CAP 2.51

Page 327: 附件二 藥品給付品項暨支付標準表

BC26618251SIGNIFOR LAR 60MG POWDER AND SOLVENT FOR SUSPENSION FOR

INJECTION59878.00

BC26619238SIGNIFOR LAR 20MG POWDER AND SOLVENT FOR SUSPENSION FOR

INJECTION33265.00

BC26620245SIGNIFOR LAR 40MG POWDER AND SOLVENT FOR SUSPENSION FOR

INJECTION59878.00

BC26622100 PANTOPRAZOLE 40MG GASTRO RESISTANT TABLET 10.10

BC26625100 "BIOADAMANT" BICAMIDE FILM COATED TABLETS 150MG 0.00

BC26626100 "BIOADAMANT" BICAMIDE FILM COATED TABLETS 50MG 0.00

BC266272AF DBL GEMCITABINE FOR INJECTION 598.00

BC266272FS DBL GEMCITABINE FOR INJECTION 2854.00

BC26631100 DICETEL 100MG FILM COATED TABLETS 5.30

BC26633414 XALANOL EYE DROP 542.00

BC26634100 XTANDI SOFT CAPSULES 40 MG 645.00

BC26637100 METSAFE 1000 ER 1.89

BC266371G0 METSAFE 1000 ER(鋁箔/膠箔) 2.00

BC26638100 MACOX PLUS 300 TABLETS 10.80

BC26639100 TRAC 3 TABLETS 8.20

BC26640414 XALAPROST EYE DROPS 439.00

BC26641100 EXEMESTANE/GENEPHARM FILM COATED TABLETS 25MG 0.00

BC26643100 ATOZET F.C. TABLETS 10/10MG 17.30

BC26645100 CAPRELSA FILM-COATED TABLETS 100MG 1769.00

BC26646100 CAPRELSA FILM-COATED TABLETS 300MG 4793.00

BC26648100 TRAC 4 TABLETS 16.50

BC26651109 HIDRASEC INFANTS 10MG GRANULES FOR ORAL SUSPENSION 6.90

BC26652116 HIDRASEC CHILDREN 30MG GRANULES FOR ORAL SUSPENSION 6.90

BC26653100 COVERAM 5MG / 5MG 9.40

BC26655229 ONIVYDE TM (IRINOTECAN LIPOSOME INJECTION) 5MG/ML 23734.00

BC26656100 Imbruvica Capsules 140mg 1922.00

BC266571E7 SYMBICORT RAPIHALER 160/4.5UG/DOSE 969.00

BC26658100 Azithromycin Sandoz Film-coated Tablets 250mg 17.50

BC26659100 TELSAR 80 (TELMISARTAN TABLETS 80MG) 11.60

BC26660100 SUNVEPRA CAPSULE 100MG 0.00

BC26661100 DAKLINZA TABLET 30MG 0.00

BC26662100 DAKLINZA TABLET 60MG 0.00

BC26667100 LATUDA (LURASIDONE HYDROCHLORIDE) 80 MG TABLET 92.00

BC26668100 LATUDA (LURASIDONE HYDROCHLORIDE) 40 MG TABLET 47.20

BC26670100 ENTRESTO 50mg film-coated tablets 59.00

BC26671100 ENTRESTO 200mg film-coated tablets 59.00

BC26672100 ENTRESTO 100mg film-coated tablets 59.00

BC26674100 Zykadia capsules 150 mg 955.00

BC26675100 HARVONI TABLETS 0.00

BC26676229 BW-FLUCIL 50MG/ML SOLUTION FOR INJECTION 0.00

BC26676238 BW-FLUCIL 50MG/ML SOLUTION FOR INJECTION 0.00

BC26676255 BW-FLUCIL 50MG/ML SOLUTION FOR INJECTION 0.00

BC26678414 IZBA 30 ug/ml Eye Drops, Solution 426.00

BC26679100 ESTIVA-600 (EFAVIRENZ F.C. TABLETS 600MG) 42.70

BC26681100 OSENI TABLETS 12.5MG/15MG 0.00

Page 328: 附件二 藥品給付品項暨支付標準表

BC26682100 OSENI TABLETS 12.5MG/30MG 0.00

BC26683100 OSENI TABLETS 25MG/30MG 22.80

BC26685100 NESINA MET TABLETS 12.5MG/1000MG 13.50

BC26686100 NESINA MET TABLETS 12.5MG/500MG 13.50

BC26688240 VAXCEL HEPARIN SODIUM INJECTION 5000 IU/ML 166.00

BC26697100 ALBAVIR F.C. TABLETS 300.00

BC26698263 Voriconazole Sandoz Lyophilized Powder for Injection 3914.00

BC26699221 CIAZIL SOLUTION FOR INJECTION 2MG/ML 0.00

BC26699240 CIAZIL SOLUTION FOR INJECTION 2MG/ML 0.00

BC26700100 NEBILET 5 MG 4.41

BC26701100 FLOXSAFE 400 (MOXIFLOXACIN TABLETS 400MG) 80.00

BC26702209CEFTAZIDIME KABI 1G, POWDER FOR SOLUTION FOR INJECTION

39.20

BC26703212CEFTAZIDIME KABI 2G, POWDER FOR SOLUTION FOR INJECTION

OR INFUSION199.00

BC267042AA Pamorelin 3.75mg, Powder for Suspension for Injection 3311.00

BC267052CNPAMORELIN 11.25MG, POWDER FOR SUSPENSION FOR INJECTION

10406.00

BC267062FQ PAMORELIN 22.5MG, POWDER FOR SUSPENSION FOR INJECTION 20553.00

BC26708100 EXVIERA 250MG FILM-COATED TABLETS 0.00

BC26709100 VIEKIRAX 12.5MG/75MG/50MG FILM-COATED TABLETS 0.00

BC26714100 Valgovir 450 F.C. Tablets 401.00

BC26715209 VAXCEL CEFEPIME 1G IV INJECTION 242.00

BC26716100 HEPWIN F.C. TABLETS 1MG 132.00

BC26717100 HEPWIN F.C. TABLETS 0.5MG 94.00

BC26719100 LATUDA (LURASIDONE HYDROCHLORIDE) 20 MG TABLET 24.30

BC26722100 Nykob 5mg Orodispersible Tablets 0.00

BC26723100 Nykob 10mg Orodispersible Tablets 0.00

BC26727212 RAMGIC (TRAMADOL HCL INJECTION 50MG/ML) 25.90

BC26734100 PIRESPA TABLETS 200 MG 129.00

BC26735443 SPIOLTO RESPIMAT, SOLUTION FOR INHALATION 1557.00

BC26737209Meropenem Kabi Powder for Solution for injection or

infusion 500 mg, 1g525.00

BC26737277Meropenem Kabi Powder for Solution for injection or

infusion 500 mg, 1g284.00

BC26741277Imipenem/Cilastatin Kabi 500mg/500mg Powder for Solution

for Infusion275.00

BC26747277 KLARICID IV 500MG 351.00

BC26751100 PMS-METHYLPHENIDATE ER 18MG TABLETS 0.00

BC26752100 ARIMAC 10 57.00

BC26753414 XALAPROST EYE DROPS SOLUTION 50MCG/ML 439.00

BC26762100 NUCOXIA 60 (ETORICOXIB TABLETS 60MG) 4.13

BC26765209CEFEPIME KABI 1G, POWDER FOR SOLUTION FOR INJECTION OR

INFUSION242.00

BC26770405 TAPCOM-S OPHTHALMIC SOLUTION 15.50

BC26772100 LEVIN-500 (LEVOFLOXACIN TABLETS 500MG) 20.90

BC26776100 Inovelon Film-coated Tablets 100 mg 19.70

BC26777100 Inovelon Film-coated Tablets 200 mg 38.10

Page 329: 附件二 藥品給付品項暨支付標準表

BC26778100 Inovelon Film-coated Tablets 400 mg 66.00

BC26783129 MEGEX-I SUSPENSION 67.00

BC26783138 MEGEX-I SUSPENSION 131.00

BC26783164 MEGEX-I SUSPENSION 1735.00

BC26785100 MONTE-H 5 (MONTELUKAST CHEWABLE TABLETS 5MG) 9.30

BC26791100 EXEMESTANE-ACEPHARM 25MG F.C. TABLETS 0.00

BC26799265 ALVOLES LYOPHILIZED FOR INJECTION 250MG 0.00

BC26800100ZIDOLAM (LAMIVUDINE AND ZIDOVUDINE TABLETS 150MG/300MG)

31.00

BC268161FL FOSTER NEXTHALER 708.00

BC26817100 Mekinist Film-Coated Tablets 0.5mg 1010.00

BC26818100 Mekinist Film-Coated Tablets 2mg 3636.00

BC26820100 HETLOSAR 50 (LOSARTAN TABLETS 50MG) 4.11

BC26830100 HETLOSAR 100 (LOSARTAN TABLETS 100MG) 5.80

BC26837100 LEVIN-250 (LEVOFLOXACIN TABLETS 250MG) 11.30

BC26839100 POMALYST 4mg capsules 9047.00

BC26840100 POMALYST 3mg capsules 9047.00

BC26841100 POMALYST 2mg capsules 9047.00

BC26842100 POMALYST 1mg capsules 9047.00

BC26843414 XALAMOL EYE DROPS SOLUTION 50MCG+5MG/ML 542.00

BC26848100 JURNISTA PROLONGED-RELEASE TABLETS 16MG 190.00

BC26853100 CELEXIB CAPSULE 200MG 4.66

BC26858245 ALPANZOLE 40MG LYOPHILIZED FOR INJECTION 119.00

BC26860221 Variquel 0.2mg/ml Solution for Injection 805.00

BC26869100 RYTMONORM SR 225MG CAPSULES 8.80

BC26870100 RYTMONORM SR 325MG CAPSULES 11.00

BC26871100 RYTMONORM SR 425MG CAPSULES 14.70

BC26873100 Tarceva Film-coated tablets 100mg 630.00

BC26874100 Tarceva Film-coated tablets 150mg 774.00

BC26876100 DONEPEZIL MYLAN 5MG 55.00

BC26900100 ZYROVA 20 (ROSUVASTATIN TABLETS 20MG) 22.20

BC26901240 PINE INJECTION 5,000IU/ML 166.00

BC26901299 PINE INJECTION 5,000IU/ML 2.88

BC26914100 Capecitabine Alvogen 500mg Film-Coated Tablets 90.00

BC26915229 VAXCEL ACYCLOVIR 25MG/ML IV INFUSION 287.00

BC26921255 DBL PEMETREXED (AS DISODIUM) POWDER FOR INJECTION 0.00

BC26921277 DBL PEMETREXED (AS DISODIUM) POWDER FOR INJECTION 0.00

BC26922209MORFINA LABESFAL (SEM CONSERVANTES) 10MG/ML, SOLUTION

FOR INJECTION18.00

BC26933100 LENVIMA CAPSULES 4 MG 971.00

BC26934100 LENVIMA CAPSULES 10 MG 971.00

BC269353BP TRANSTEC 35UG/H, TRANSDERMAL PATCH 114.00

BC269363BQ TRANSTEC 52.5UG/H, TRANSDERMAL PATCH 157.00

BC269422EWINVEGA TRINZA PROLONGED-RELEASE SUSPENSION FOR INJECTION

23938.00

BC269422FVINVEGA TRINZA PROLONGED-RELEASE SUSPENSION FOR INJECTION

11402.00

Page 330: 附件二 藥品給付品項暨支付標準表

BC269422FWINVEGA TRINZA PROLONGED-RELEASE SUSPENSION FOR INJECTION

17773.00

BC269422FXINVEGA TRINZA PROLONGED-RELEASE SUSPENSION FOR INJECTION

26582.00

BC26944100 Tecavir 1 133.00

BC26945100 Tecavir 0.5 94.00

BC26946421 SIMBRINZA* 10mg/ml + 2mg/ml eye drops, suspension 325.00

BC26950100 CANAGLU TABLETS 100MG 27.90

BC26960100 CAPECITABINE TEVA FILM-COATED TABLETS 500MG 90.00

BC26961100 PHARACETAM FILM-COATED TABLETS 500MG 22.30

BC26963100 KETOROLAC TABLET, 10MG 4.13

BC26966219 BICILLIN L-A INJECTABLE SUSPENSION 949.00

BC26967100 CANDESARTAN MYLAN 8MG 6.90

BC26968100 TAGRISSO FILM-COATED TABLETS 80 MG 3635.00

BC26969100 TAGRISSO FILM-COATED TABLETS 40 MG 3635.00

BC26972100 ZEPATIER (ELBASVIR AND GRAZOPREVIR) TABLET 0.00

BC26985266

ABILIFY MAINTENA (ARIPIPRAZOLE) FOR EXTENDED-RELEASE

INJECTABLE SUSPENSION, 300MG/PRE-FILLED DUAL CHAMBER

SYRINGE7954.00

BC26987271

ABILIFY MAINTENA (ARIPIPRAZOLE) FOR EXTENDED-RELEASE

INJECTABLE SUSPENSION, 400MG/PRE-FILLED DUAL CHAMBER

SYRINGE7954.00

BC26989100 TELCARD H 80/25 11.60

BC26990100 VIACORAM 3.5MG/2.5MG 5.90

BC26991100 VIACORAM 7MG/5MG 0.00

BC26992100 VALETERO 320 (VALSARTAN TABLETS 320MG) 28.20

BC26993229 ADDAVEN CONCENTRATE FOR SOLUTION FOR INFUSION 95.00

BC26995100 BRINTELLIX FILM-COATED TABLETS 5MG 16.50

BC26996100 BRINTELLIX FILM-COATED TABLETS 10MG 33.20

BC26997100 BRINTELLIX FILM-COATED TABLETS 15MG 33.20

BC26998100 BRINTELLIX FILM-COATED TABLETS 20MG 33.20

BC27000100 XELJANZ XR EXTENDED RELEASE TABLETS 11 MG 828.00

BC27001100 GENVOYA FILM-COATED TABLETS 466.00

BC27002100 LIVALO OD TABLETS 2MG 13.10

BC27006100 CORTIMENT MMX 9MG PROLONGED RELEASE TABLETS 93.00

BC27011100 MEGAZON PROLONGED-RELEASE TABLETS 50MG 16.10

BC27012100 MEGAZON PROLONGED-RELEASE TABLETS 200MG 30.60

BC27013100 MEGAZON PROLONGED-RELEASE TABLETS 400MG 58.00

BC27014100 TELMISARTAN/HYDROCHLOROTHIAZIDE MYLAN 80MG/12.5MG 11.60

BC27015100 ANASTROZOLE 1MG FILM-COATED TABLETS "CYH" 45.30

BC27022100 REOSTEO 150MG TABLETS 661.00

BC27025100 MEGAZON PROLONGED-RELEASE TABLETS 300MG 37.70

BC27028100 ALECENSA 150MG CAPSULES 390.00

BC27029100 Visanne 2 mg tablet 44.90

BC27033100 OTSUKA ABILIFY TABLETS 2MG 14.10

BC27034143 RELVAR ELLIPTA 184/22 MCG INHALATION POWDER 1234.00

BC27035100 JARDIANCE DUO 5/500MG FILM-COATED TABLETS 15.40

BC27036100 JARDIANCE DUO 5/850MG FILM-COATED TABLETS 15.40

Page 331: 附件二 藥品給付品項暨支付標準表

BC27037100 JARDIANCE DUO 5/1000MG FILM-COATED TABLETS 15.40

BC27038100 JARDIANCE DUO 12.5/500MG FILM-COATED TABLETS 15.40

BC27039100 JARDIANCE DUO 12.5/850MG FILM-COATED TABLETS 15.40

BC27040100 JARDIANCE DUO 12.5/1000MG FILM-COATED TABLETS 15.40

BC27042100 RICOVIR F.C. TABLETS 95.00

BC27043100 PROBALIN 75MG CAPSULES 15.50

BC27044100 CRESTATIN 10MG TABLETS 13.40

BC27048263 LYXUMIA SOLUTION FOR INJECTION 10MCG/0.2ML 1213.00

BC27049263 LYXUMIA SOLUTION FOR INJECTION 20MCG/0.2ML 1213.00

BC27052212MORFINA LABESFAL (SEM CONSERVANTES) 20MG/ML, SOLUTION

FOR INJECTION25.00

BC27053100 MEGAZON PROLONGED-RELEASE TABLETS 150MG 27.80

BC27054100 PREGABALINA KERN PHARMA 75MG CAPSULE 13.20

BC27065100 ARITERO 5 (ARIPIPRAZOLE TABLETS 5MG) 33.00

BC27066255 PEMETREXED FOR INJECTION 100MG/VIAL 5307.00

BC27073100 Glyxambi Film-Coated Tablets 25/5 mg 34.90

BC27074100 Glyxambi Film-Coated Tablets 10/5 mg 34.90

BC27080100 Ritalin Tablets 10mg 2.66

BC27082229 OXALIPLATIN MYLAN 1336.00

BC27082238 OXALIPLATIN MYLAN 4420.00

BC27082245 OXALIPLATIN MYLAN 9681.00

BC27083235 CARBOPLATIN MYLAN 1448.00

BC270832AP CARBOPLATIN MYLAN 3058.00

BC27086100 VEMLIDY FILM-COATED TABLETS 130.00

BC27087210 Zerbaxa for Injection 1792.00

BC27093100 AMLOSIN 10 (AMLODIPINE TABLETS 10MG) 3.84

BC27098100 PHARNOMIDE FILM-COATED TABLETS 100MG 206.00

BC27102100 IBRANCE CAPSULES 75 MG 3054.00

BC27103100 IBRANCE CAPSULES 100 MG 3054.00

BC27104100 IBRANCE CAPSULES 125 MG 3054.00

BC27106209 GEMCITABINE MYLAN 2854.00

BC27106263 GEMCITABINE MYLAN 598.00

BC27108100 DONEPEZIL FILM-COATED TABLETS 10MG "EGIS" 0.00

BC27111100 STACYTINE 600 5.40

BC27114100 Xigduo XR Extended-Release Tablets 5mg/500mg 28.10

BC27115100 Xigduo XR Extended-Release Tablets 5mg/1000mg 28.10

BC27116100 Xigduo XR Extended-Release Tablets 10mg/500mg 28.10

BC27117100 Xigduo XR Extended-Release Tablets 10mg/1000mg 28.10

BC27122100 EPNONE 50 (EPLERENONE TABLETS 50MG) 28.10

BC27125209 AMINOVEN 15% SOLUTION FOR INFUSION 558.00

BC27125277 AMINOVEN 15% SOLUTION FOR INFUSION 305.00

BC27134100 STROMECTOL TABLETS 3 MG 180.00

BC27138206 DOCETAXEL MYLAN 3199.00

BC27138212 DOCETAXEL MYLAN 10751.00

BC27139100 AMLOSIN 5 (AMLODIPINE TABLETS 5MG) 3.84

BC27147100 JUBIUM (ESOMEPRAZOLE GASTRO RESISTANT TABLETS 40MG) 6.10

BC27148100 JUBIUM (ESOMEPRAZOLE GASTRO RESISTANT TABLETS 20MG) 2.51

BC27149100 ARITERO 10 (ARIPIPRAZOLE TABLETS 10MG) 47.30

Page 332: 附件二 藥品給付品項暨支付標準表

BC27155219LEVOPHED SF 1MG/ML CONCENTRATE SOLUTION FOR IV INFUSION

100.00

BC27156100 LINETERO (LINEZOLID TABLETS 600MG) 464.00

BC271571G0 DIABETMIN TABLET 500MG (F/COATED)(鋁箔/膠箔) 2.00

BC27165100 CAPEDA 150MG FILM-COATED TABLETS 24.80

BC27166100 CAPEDA 500MG FILM-COATED TABLETS 90.00

BC27175100 PHARNOMIDE FILM-COATED TABLETS 10MG 26.60

BC27176100 PHARNOMIDE FILM-COATED TABLETS 20MG 35.20

BC27178217 ORITEZOMIB 10539.00

BC27180265 MOXIFLOXACIN KABI 400MG SOLUTION FOR INFUSION 624.00

BC27182100 CLOPIDOGREL FILM-COATED TABLETS 75MG "EGIS" 32.10

BC27195100 KAPETRAL F.C. TABLETS 150MG 24.80

BC27223405 Ikervis 1mg/1mL eye drops, emulsion 41.50

BC27228100 Linezolid Sandoz 600mg Film-Coated Tablets 0.00

BC27229100 KAPETRAL 500MG FILM-COATED TABLETS 90.00

BC27233100 AKYNZEO CAPSULES 1871.00

BC27253100 WAKA CANDI TABLETS 8MG 6.90

BC27255100 EPNONE 25 (EPLERENONE TABLETS 25MG) 14.50

BC27256100 ATORVASTATIN "EGIS" 10MG FILM-COATED TABLETS 0.00

BC27257100 KEAMINE FILM COATED TABLETS 15.50

BC27258100 CELOFEN 200 (CELECOXIB CAPSULES 200MG) 4.66

BC27263100 PREZCOBIX FLIM-COATED TABLETS 340.00

BC27269100 ICLUSIG 15MG FILM-COATED TABLETS 1704.00

BC27270100 ICLUSIG 45MG FILM-COATED TABLETS 4949.00

BC27281100 LONSURF FILM-COATED TABLETS 15 MG 672.00

BC27282100 LONSURF FILM-COATED TABLETS 20 MG 902.00

BC27283100 ATOZET F.C. TABLETS 10/20MG 17.30

BC27288100 OLUMIANT FILM-COATED TABLETS 2MG 972.00

BC27289100 OLUMIANT FILM-COATED TABLETS 4MG 972.00

BC27291100 ZYTIGA FILM-COATED TABLETS 500MG 966.00

BC27303240 ORIMUSTINE 2218.00

BC27303255 ORIMUSTINE 8255.00

BC27309100 Jadenu film-coated tablets 360 mg 580.00

BC27310100 Jadenu film-coated tablets 180 mg 290.00

BC27311100 EZZICAD (EZETIMIBE) 10MG TABLETS 6.40

BC27318100 ARIPIPRAZOL KERN PHARMA ODT TABLETS 10MG 47.30

BC27320100 KISQALI 200MG FILM-COATED TABLETS 1100.00

BC27323100 MAVIRET FILM-COATED TABLETS 100MG/40MG 0.00

BC27324100 NOCDURNA 25MCG 20.30

BC27325100 NOCDURNA 50ΜCG 20.30

BC27327100 NINLARO CAPSULES 3 MG 34539.00

BC27328100 NINLARO CAPSULES 4 MG 45048.00

BC27332100 AZILECT TABLETS 68.00

BC27333221ZOLEDRONIC ACID HOSPIRA CONCENTRATE FOR SOLUTION FOR

INFUSION 4MG/5ML0.00

BC27339100 ATORVASTATIN "EGIS" 40MG FILM-COATED TABLETS 0.00

BC27341100 JINARC TABLETS 15MG 408.00

BC27342100 Jinarc Tablets 30mg 408.00

Page 333: 附件二 藥品給付品項暨支付標準表

BC27343100 Jinarc Tablets 45mg 408.00

BC27344100 Jinarc Tablets 60mg 408.00

BC27345100 Jinarc Tablets 90mg 408.00

BC27347277 PEMETREXED "KABI" FOR INJECTION 500MG/VIAL 23707.00

BC27348100 DUROTINE 60 (DULOXETINE HYDROCHLORIDE CAPSULES 60MG) 29.50

BC27354266 LINEZOLID 2MG/ML SOLUTION FOR INFUSION "KABI" 723.00

BC27357100 Venclexta Film-Coated Tablets 10mg 143.00

BC27358100 Venclexta Film-Coated Tablets 50mg 716.00

BC27359100 Venclexta Film-Coated Tablets 100mg 1344.00

BC27361100 EFIENT F.C. TABLETS 3.75 MG 37.40

BC27362100 EFIENT F.C. TABLETS 5 MG 42.70

BC27365100 REXULTI (BREXPIPRAZOLE) TABLETS 1MG 42.00

BC27366100 REXULTI (BREXPIPRAZOLE) TABLETS 2MG 74.00

BC27367100 REXULTI (BREXPIPRAZOLE) TABLETS 3MG 74.00

BC27368100 REXULTI (BREXPIPRAZOLE) TABLETS 4MG 74.00

BC27372100 IMAREM 100MG FILM-COATED TABLETS 524.00

BC27373100 IMAREM 400MG FILM-COATED TABLETS 1441.00

BC27375100 TENOF (TENOFOVIR DISOPROXIL FUMARATE TABLETS) 95.00

BC27377100 Solifenacin Sandoz 5mg Film-coated Tablets 9.20

BC27393100 MINIRIN MELT 240 ΜCG 83.00

BC27395443 TRELEGY ELLIPTA 92/55/22 MCG INHALATION POWDER 1770.00

BC274021G0 DIABETMIN 1000MG FILM-COATED TABLET(鋁箔/膠箔) 2.00

BC274151G0 DIABETMIN 850MG FILM-COATED TABLET(鋁箔/膠箔) 2.00

BC27416263Alvoazole 200mg Lyophilized Powder for Solution for

Infusion3914.00

BC27421100 CREON 25000 9.60

BC27422100 CREON 40000 13.80

BC27426100 RYDAPT 25MG SOFT CAPSULE 3178.00

BC27432217 MYZOMIB 10539.00

BC27433100 OLMETERO 40 F.C. TABLETS 13.60

BC27434221 Paclitaxel Injection 6mg/ml Sandoz 662.00

BC27434240 Paclitaxel Injection 6mg/ml Sandoz 3724.00

BC27434248 Paclitaxel Injection 6mg/ml Sandoz 16418.00

BC27434255 Paclitaxel Injection 6mg/ml Sandoz 41328.00

BC27434296 Paclitaxel Injection 6mg/ml Sandoz 6528.00

BC274342E2 Paclitaxel Injection 6mg/ml Sandoz 1711.00

BC27435221 Fluorouracil Injection 50mg/ml Sandoz 0.00

BC27435229 Fluorouracil Injection 50mg/ml Sandoz 0.00

BC27435238 Fluorouracil Injection 50mg/ml Sandoz 0.00

BC27435248 Fluorouracil Injection 50mg/ml Sandoz 0.00

BC27435255 Fluorouracil Injection 50mg/ml Sandoz 0.00

BC27436217BORTEZOMIB 3.5MG LYOPHILIZED POWDER FOR SOLUTION FOR

INJECTION PHARMIDEA10539.00

BC27440100 Telmisartan Sandoz Tablets 80mg 11.60

BC27441100 Telmisartan Sandoz Tablets 40mg 6.90

BC27445100 LYNPARZA FILM-COATED TABLETS 100MG 1500.00

BC27446100 LYNPARZA FILM-COATED TABLETS 150MG 1600.00

BC27448100 FEMOLET 38.70

Page 334: 附件二 藥品給付品項暨支付標準表

BC27449263 Teicoplanin Sandoz Powder for Injection 200mg 0.00

BC27458100 STEGLATRO 5MG F.C. TABLETS 28.20

BC27463100 STEGLUJAN 5/100 MG F.C. TABLETS 34.30

BC27467100 QTERN 5MG/10MG FILM-COATED TABLETS 34.30

BC27468209 Gemtero (Gemcitabine for injection) 2854.00

BC27468263 GEMTERO (GEMCITABINE FOR INJECTION) 598.00

BC27469240"IUAN" BENDAMUSTINE HYDROCHLORIDE LYOPHILIZED POWDER FOR

SOLUTION FOR INJECTION2241.00

BC27469255"IUAN" BENDAMUSTINE HYDROCHLORIDE LYOPHILIZED POWDER FOR

SOLUTION FOR INJECTION8340.00

BC27472119 PENTASA SACHET, PROLONGED RELEASE GRANULES, 4G 60.00

BC27473100 ARICEPT EVESS 10MG ORODISPERSIBLE TABLETS 57.00

BC27482221ZOLEDRONIC ACID-HAMELN CONCENTRATE FOR SOLUTION FOR

INFUSION 4MG/5ML5433.00

BC27490243 KYPROLIS FOR INJECTION 30MG 14154.00

BC27491209 MIDAZOLAM-HAMELN 5MG/ML INJECTION 17.70

BC27491216 MIDAZOLAM-HAMELN 5MG/ML INJECTION 23.50

BC27491229 MIDAZOLAM-HAMELN 5MG/ML INJECTION 203.00

BC27503100 ALZER 10 (DONEPEZIL HYDROCHLORIDE TABLETS USP 10MG) 57.00

BC27504221 PACLITERO (PACLITAXEL INJECTION 6MG/ML) 662.00

BC27504248 PACLITERO (PACLITAXEL INJECTION 6MG/ML) 16418.00

BC275042E2 PACLITERO (PACLITAXEL INJECTION 6MG/ML) 1711.00

BC27505100 ODEFSEY FILM-COATED TABLETS 440.00

BC27511100 CABOMETYX FILM-COATED TABLET 20MG 4395.00

BC27512100 CABOMETYX FILM-COATED TABLET 40MG 4395.00

BC27513100 CABOMETYX FILM-COATED TABLET 60MG 4395.00

BC27514100 JULUCA FILM COATED TABLETS 440.00

BC27524457Bevespi Aerosphere 7.2/5.0 micrograms Pressurised

Inhalation, Suspension1299.00

BC27525209TAXOHOPE-N 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION

3199.00

BC27525219TAXOHOPE-N 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION

10751.00

BC27532255PEMETREXED LYOPHILIZED POWDER FOR CONCENTRATE FOR

SOLUTION FOR INFUSION "CYH"5116.00

BC27532277PEMETREXED LYOPHILIZED POWDER FOR CONCENTRATE FOR

SOLUTION FOR INFUSION "CYH"23436.00

BC27534100 SimvaEZ Tablets 10/20mg 11.00

BC27535100 SimvaEZ Tablets 10/10mg 11.00

BC27547100 EPCLUSA FILM-COATED TABLETS 0.00

BC27555100 PREVYMIS F.C. TABLETS 240MG 5480.00

BC27559230PREVYMIS CONCENTRATE FOR SOLUTION FOR INFUSION 20MG/ML

6521.00

BC27562100 Quetiapine Sandoz Prolonged Release Tablets 400mg 55.00

BC27563100 Quetiapine Sandoz Prolonged Release Tablets 300mg 35.40

BC27564100 Quetiapine Sandoz Prolonged Release Tablets 200mg 29.70

BC27565100 Quetiapine Sandoz Prolonged Release Tablets 50mg 15.70

BC27570100 BIKTARVY TABLETS 440.00

Page 335: 附件二 藥品給付品項暨支付標準表

BC27582161 QUETRA 100MG/ML ORAL SOLUTION 670.00

BC27582166 QUETRA 100MG/ML ORAL SOLUTION 1285.00

BC27592100 VALGAN-450 (VALGANCICLOVIR TABLETS 450MG) 401.00

BC27593238 FRESOFOL 1% MCT/LCT INJECTION (SWEDEN) 37.40

BC27596100 Erleada Film-Coated Tablets 60mg 519.00

BC27602217 "ITALY" VELCADE POWDER FOR SOLUTION FOR INJECTION 13175.00

BC27613100 SYMTUZA FILM-COATED TABLETS 650.00

BC27614100 DUROTINE 30 (DULOXETINE HYDROCHLORIDE CAPSULES 30MG) 16.60

BC27615221PALONOSETRON 250 MICROGRAMS SOLUTION FOR INJECTION

FRESENIUS KABI561.00

BC27653217 BORTEZOMIB POWDER FOR SOLUTION FOR INJECTION 3.5MG 10539.00

BC276563B9 OPIODUR TRANSDERMAL PATCH 12ΜCG/H 188.00

BC27657311 OPIODUR TRANSDERMAL PATCH 25ΜCG/H 250.00

BC276583CS OPIODUR TRANSDERMAL PATCH 50ΜCG/H 470.00

BC276593CM OPIODUR TRANSDERMAL PATCH 75ΜCG/H 610.00

BC276603AI OPIODUR TRANSDERMAL PATCH 100ΜCG/H 745.00

BC27672457 TRIMBOW 1699.00

BC27673219"WOCKHARDT" VALPROATE SODIUM 100MG/ML SOLUTION FOR

INJECTION OR INFUSION296.00

BC27673229"WOCKHARDT" VALPROATE SODIUM 100MG/ML SOLUTION FOR

INJECTION OR INFUSION696.00

BC27678255 LEVOFLOXACIN-HAMELN IV SOLUTION FOR INFUSION 5MG/ML 601.00

BC27691100 LORVIQUA FILM-COATED TABLETS 25MG 1256.00

BC27692100 LORVIQUA FILM-COATED TABLETS 100MG 4525.00

BC27700100 ENTECAVIR SANDOZ FILM COATED TABLETS 0.5MG 92.00

BC27701100 ENTECAVIR SANDOZ FILM COATED TABLETS 1MG 129.00

BC27704221IDARUBICIN SANDOZ CONCENTRATE FOR SOLUTION FOR INFUSION

1MG/ML0.00

BC27705214ZAVICEFTA 2 G/0.5 G POWDER FOR CONCENTRATE FOR SOLUTION

FOR INFUSION3389.00

BC27711110 DYNA AMOXYCILLIN 125MG/5ML 31.00

BC27712209 DOCETAXEL STADA 3199.00

BC27712219 DOCETAXEL STADA 10751.00

BC27716100 BRIVIACT FILM-COATED TABLETS 50MG 46.40

BC27717100 BRIVIACT FILM-COATED TABLETS 100MG 46.40

BC27720255 PEMGEM100 5228.00

BC27721277 PEMGEM500 23968.00

BC27729100 LETRAM 1000 (LEVETIRACETAM F.C. TABLETS 1000MG) 38.20

BC27730100 ALUNBRIG FILM-COATED TABLETS 30MG 920.00

BC27731100 ALUNBRIG FILM-COATED TABLETS 90MG 2793.00

BC27732100 ALUNBRIG FILM-COATED TABLETS 180MG 4999.00

BC27733100 XARELTO FILM-COATED TABLETS 10MG "ITALY" 58.00

BC27734100 XARELTO FILM-COATED TABLETS 15MG "ITALY" 58.00

BC27735100 XARELTO FILM-COATED TABLETS 20MG "ITALY" 58.00

BC27738217 MYBORTE 10539.00

BC27739100 DELSTRIGO TABLET 430.00

BC27744277 MYPREXIN 23968.00

BC27745251 ALIQOPA 56700.00

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BC27750100 XARELTO FILM-COATED TABLETS 2.5MG 22.00

BC27752100 Rasteride 0.5mg soft capsule 13.00

BC27755100 Alvoazole Film-Coated Tablets 200mg 1117.00

BC27758100 Alvoazole Film-Coated Tablets 50mg 326.00

BC27762229Cisplatin Taxo Injection 1mg/mL Concentrate Solution for

Infusion0.00

BC27762248Cisplatin Taxo Injection 1mg/mL Concentrate Solution for

Infusion0.00

BC27766100 ABIRATRED Film-Coated Tablet 250mg 392.00

BC27767157 SEROFLO 250 INHALER (CFC free) 1048.00

BC27769100 VIZIMPRO FILM-COATED TABLETS 15MG 1128.00

BC27770100 VIZIMPRO FILM-COATED TABLETS 30MG 1128.00

BC27771100 VIZIMPRO FILM-COATED TABLETS 45MG 1128.00

BC27780209 Aminomix Peripheral Solution for Infusion 342.00

BC27781100 Zyrova 10 (Rosuvastatin Tablets 10mg) 13.40

BC27782100 Zyrova 5 (Rosuvastatin Tablets 5mg) 9.60

BC27783100 THROMBAN 5 (APIXABAN TABLETS 5MG) 24.40

BC27786209Docetaxel HerngShan 20mg/ml Concentrate for Solution for

Infusion3199.00

BC27786219Docetaxel HerngShan 20mg/ml Concentrate for Solution for

Infusion10751.00

BC27787100 ACCORD PREGABALIN 150 (PREGABALIN CAPSULES 150MG) 26.60

BC27788100 Redistra 524.00

BC27789100 THROMBAN 2.5 (APIXABAN TABLETS 2.5MG) 24.40

BC27795100 CRESEMBA 100 mg capsules 1325.00

BC27796263CRESEMBA 200 mg powder for concentrate for solution for

infusion9883.00

BC27798238 Glycophos, Concentrate for Solution for Infusion 180.00

BC27801100 Talzenna Capsules 0.25 mg 1600.00

BC27802100 Talzenna Capsules 1 mg 6400.00

BC27808221Gemcitabine Taxo 40mg/ml Concentrate Solution for

Infusion0.00

BC27808240Gemcitabine Taxo 40mg/ml Concentrate Solution for

Infusion0.00

BC27808248Gemcitabine Taxo 40mg/ml Concentrate Solution for

Infusion0.00

BC27809100 PREGAPAIN CAPSULE 75MG 13.50

BC27822277 "HETERO" PEMETREXED FOR INJECTION 500MG/VIAL 23577.00

BC27825421 Vyzulta 0.024%, solution 904.00

BC27829100 Apo-Tenofovir F.C. Tablets 300mg 95.00

BC27833100 BISOCOR TABLET 5MG 2.15

BC27847100 BISOSTAD 5 FILM-COATED TABLET 2.15

BC27856100 Smyraf film-coated Tablets 50mg 276.00

BC27857100 Smyraf film-coated Tablets 100mg 552.00

BC27860100 DOVATO film-coated tablets 360.00

BC27865100 Rozlytrek 200mg hard capsules 1599.00

BC27876100 LENANGIO 25 3418.00

BC27877100 LENANGIO 15 3418.00

Page 337: 附件二 藥品給付品項暨支付標準表

BC27878100 LENANGIO 10 3418.00

BC27879100 Lenangio 5 1612.00

BC27886229 DOXLOX 12181.00

BC27886240 DOXLOX 27186.00

BC27888167 FYCOMPA 0.5 MG/ML ORAL SUSPENSION 2231.00

BC27902100 RINVOQ Extended-Release Tablets 15 mg 844.00

BC27908100 ZYCEL 200 (CELECOXIB CAPSULES 200MG) 4.66

BC27909100 ZYCEL 100 (CELECOXIB CAPSULES 100MG) 2.09

BC27915100 Vosevi Film-Coated Tablets #NULL!

BC27920100 DUTASTERIDE 0.5MG DOUGLAS SOFT CAPSULES 13.00

BC27936100 NUBEQA F.C. TABLETS 300 MG 519.00

BC27952100 Ongentys 50mg Hard Capsules 98.00

BC27954116 FLUIMUCIL 600MG GRANULES FOR ORAL SOLUTION 6.00

BC27957212DEXMEDETOMIDINE EVER PHARMA 100UG/ML CONCENTRATE FOR

SOLUTION FOR INFUSION470.00

BC27957219DEXMEDETOMIDINE EVER PHARMA 100UG/ML CONCENTRATE FOR

SOLUTION FOR INFUSION846.00

BC27957229DEXMEDETOMIDINE EVER PHARMA 100UG/ML CONCENTRATE FOR

SOLUTION FOR INFUSION2116.00

BC27972100 REDISTRA (Imatinib Mesylate Tablets 100mg) 524.00

BC27973100 REDISTRA (Imatinib Mesylate Tablets 400mg) 1441.00

BC28016414 LATANOPROST Ophthalmic Solution 0.005% "KYORIN" 439.00

BC28020100 LIPOZOL TABLETS 2MG 11.10

BC28023100 Alvoceva film-coated tablets 100mg 504.00

BC28024100 Alvoceva film-coated tablets 150mg 619.00

BC28032100 Jedoxred 500 (Deferasirox Dispersible tablets 500mg) 540.00

BC28035157SIRDUPLA 25 MICROGRAM/ 250 MICROGRAM, PER METERED DOSE

PRESSURISED INHALATION, SUSPENSION1048.00

BC28036157SIRDUPLA 25 MICROGRAM/ 125 MICROGRAM, PER METERED DOSE

PRESSURISED INHALATION, SUSPENSION792.00

BC28039100 Jedoxred 125 (Deferasirox Dispersible tablets 125mg) 150.00

BC28041100 Jedoxred 250 (Deferasirox Dispersible tablets 250mg) 270.00

BC28043100 GEFITINIB SANDOZ FILM-COATED TABLETS 250MG 640.00

BR00091223 Xofigo solution for injection 143771.00

HCVDAA0001 DAKLINZA + SUNVEPRA治療基因型1B型24週療程 0.00

HCVDAA0002VIEKIRAX + EXVIERA治療基因型1B型,無肝硬化或具代償性肝硬

化12週療程0.00

HCVDAA0003VIEKIRAX + EXVIERA + RIBAVIRIN治療基因型1A型,無肝硬化12

週療程0.00

HCVDAA0004VIEKIRAX + EXVIERA + RIBAVIRIN治療基因型1A型,代償性肝硬

化24週療程0.00

HCVDAA0005ZEPATIER +/- RIBAVIRIN治療基因型1A型,無抗藥性病毒株,12

週療程2140.00

HCVDAA0006ZEPATIER + RIBAVIRIN治療基因型1A型,有抗藥性病毒株,16週

療程1605.00

HCVDAA0007 ZEPATIER +/- RIBAVIRIN治療基因型1B型,12週療程 2140.00

HCVDAA0008 ZEPATIER治療基因型第4型,12週療程 2140.00

HCVDAA0009 ZEPATIER + RIBAVIRIN治療基因型第4型,16週療程 1605.00

Page 338: 附件二 藥品給付品項暨支付標準表

HCVDAA0010HARVONI +/- RIBAVIRIN治療基因型第1、2、4、5或6型,12週療

程2140.00

HCVDAA0011 SOVALDI + RIBAVIRIN治療基因型第2型,12週療程 2140.00

HCVDAA0012 MAVIRET治療基因型第1、2、3、4、5或6型,8週療程 3210.00

HCVDAA0013 MAVIRET治療基因型第1、2、3、4、5或6型,12週療程 2140.00

HCVDAA0014 MAVIRET治療基因型第1或3型,16週療程 1605.00

HCVDAA0015 EPCLUSA治療基因型第1、2、3、4、5或6型,12週療程 2140.00

HCVDAA0016EPCLUSA + RIBAVIRIN治療基因型第1、2、3、4、5或6型,12週

療程2140.00

HCVDAA0017 VOSEVI治療基因型第1、2、3、4、5或6型,12週療程 2140.00

J000089209 TETANUS TOXOID ALUM PRECIPITATED "KUO KWANG" 66.00

J000089299 TETANUS TOXOID ALUM PRECIPITATED "KUO KWANG" 16.50

JC00006212ANTIVENIN OF TR. MUCROSQUAMATUS AND TR. GRAMINEUS

(LYOPHILIZED)25376.00

JC00009212ANTIVENIN OF B. MULTICINCTUS AND N. NAJA ATRA

(LYOPHILIZED)25376.00

JC00010209 ANTIVENIN OF D. ACUTUS (LYOPHILIZED) 25376.00

JC00139240TUNEX 25MG POWDER AND SOLVENT FOR SOLUTION FOR INJECTION

2927.00

K000285214 CYTOTECT BIOTEST 24468.00

K000285221 CYTOTECT BIOTEST 2446.00

K000653299 HUMULIN 70/30 100 IU/ML 0.27

K000657299HUMULIN N (NPH HUMAN INSULIN RECOMBINANT DNA ORIGIN)

ISOPHANE SUSPENSION) 100I.U.//ML0.27

K000663299HUMULIN R (REGULAR HUMAN INSULIN RECOMBINANT DNA ORIGIN

INJECTION) 100 I.U./ML0.27

K000700220 ROFERON-A ( SOLUTION FOR INJECTION ) 0.00

K000700223 ROFERON-A ( SOLUTION FOR INJECTION ) 0.00

K000714229 METALYSE INJECTION 50MG(10KU) 37670.00

K000739299 ACTRAPID 100 I.U./ML 0.30

K000744238 ACTILYSE INJECTION 20MG 8248.00

K000760299 INSULATARD 0.27

K000938248Eylea aflibercept (rch) 40 mg/mL solution for

intravitreal injection pre-filled syringe20203.00

KC00069248 BISEKO 1143.00

KC00079265 PLASBUMIN -5 1519.00

KC00197238 PLASBUMIN-25 616.00

KC00197248 PLASBUMIN-25 1519.00

KC00198265 PLASMANATE 1600.00

KC00274212 HEPATECT CP INJECTION 3504.00

KC00274229 HEPATECT CP INJECTION 18594.00

KC00285229 CYTOTECT CP BIOTEST 6042.00

KC00285248 CYTOTECT BIOTEST 31387.00

KC00303248 ALBUMINAR-25 1480.00

KC00308240THYMOGLOBULINE (ANTITHYMOCYTE IMMUNOGLOBULIN OF RABBIT

ORIGIN)7631.00

KC00319299 KOATE-DVI ANTIHEMOPHILIC FACTOR (HUMAN) 500IU, 1000IU 14.50

KC00320299 KOATE-DVI ANTIHEMOPHILIC FACTOR (HUMAN) 250IU 14.50

Page 339: 附件二 藥品給付品項暨支付標準表

KC00375248 ALBUTEIN 25% SOLUTION 1519.00

KC00380229 ALBIOMIN 20% 230.00

KC00380238 ALBIOMIN 20% 460.00

KC00380248 ALBIOMIN 20% 1212.00

KC00380255 ALBIOMIN 20% 1963.00

KC00400248 ALBUMINAR-20 1212.00

KC00426299 HAEMATE P 1000I.U. 18.30

KC00427299 HAEMATE P 500I.U. 18.30

KC00428299 BERIATE 0.00

KC00430299 HAEMATE P 250IU 18.30

KC00439209 HAEMOCOMPLETTAN P 0.00

KC00452206 HEPATITIS B IMMUNE GLOBULIN(HUMAN) HYPERHEP B S/D 2690.00

KC00452209 HEPATITIS B IMMUNE GLOBULIN(HUMAN) HYPERHEP B S/D 4941.00

KC00452221 HEPATITIS B IMMUNE GLOBULIN (HUMAN) HYPERHEP B S/D 23782.00

KC00461265 TETANUS IMMUNE GLOBULIN (HUMAN), HYPERTET S/D 1440.00

KC00462209RHO (D) IMMUNE GLOBULIN (HUMAN), HYPERRHO S/D FULL DOSE

2528.00

KC00487248 ALBUTEIN 20% SOLUTION 1212.00

KC00491248 HUMAN ALBUMIN 20% "BEHRING" 1212.00

KC00497277 ALPHANINE SD COAGULATION FACTOR IX(HUMAN) 7550.00

KC00520277 BERIPLEX P/N 250/500 9924.00

KC00525299BOTOX (BOTULINUM TOXIN TYPE A) PURIFIED NEUROTOXIN

COMPLEX "ALLERGAN"63.00

KC00580216 EPREX INJECTION 10000IU/ML 555.00

KC00580219 EPREX INJECTION 10000IU/ML 555.00

KC00580221 EPREX INJECTION 10000IU/ML 1300.00

KC00580223 EPREX INJECTION 10000IU/ML 1404.00

KC00580224 EPREX INJECTION 10000IU/ML 1474.00

KC00580226 EPREX INJECTION 10000IU/ML 1872.00

KC00580227 EPREX INJECTION 10000IU/ML 1895.00

KC00580229 EPREX INJECTION 10000IU/ML 2051.00

KC00581209 EPREX INJECTION 2000IU/ML 199.00

KC00582212 EPREX INJECTION 4000IU/ML 287.00

KC00595266 HUMALOG MIX 25 100IU/ML (3ML) 231.00

KC00596266 HUMALOG MIX 50 100IU/ML ( 3ML) 231.00

KC00601265 BETAFERON (INTERFERON BETA-1B) 1820.00

KC00608299 BENEFIX(RFIX) COAGULATION FACTOR IX (RECOMBINANT) 21.00

KC00615239 SAIZEN 8MG CLICK EASY 0.00

KC00630299 ALPHANATE 250IU 18.30

KC00631299 ALPHANATE 1000IU 18.30

KC00641299KOGENATE FS, ANTIHEMOPHILIC FACTOR (RECOMBINANT),

FORMULATED WITH SUCROSE23.20

KC00642299KOGENATE FS, ANTIHEMOPHILIC FACTOR (RECOMBINANT),

FORMULATED WITH SUCROSE, 500 IU/vial23.20

KC00643209 HEPATITIS B IMMUNOGLOBULIN P "BEHRING" 4941.00

KC00643221 HEPATITIS B IMMUNOGLOBULIN P "BEHRING" 23782.00

KC00644299 ALPHANATE 500IU 18.30

KC00653209 HUMULIN 70/30 100 IU/ML 282.00

Page 340: 附件二 藥品給付品項暨支付標準表

KC00657209HUMULIN N (NPH HUMAN INSULIN RECOMBINANT DNA ORIGIN)

ISOPHANE SUSPENSION) 100I.U.//ML282.00

KC00663209HUMULIN R (REGULAR HUMAN INSULIN RECOMBINANT DNA ORIGIN

INJECTION) 100 I.U./ML282.00

KC00670282 FILGRASTIM INJECTION M300,300?g/0.7ML 1745.00

KC00672248 FLEBOGAMMA 5% 4500.00

KC00672255 FLEBOGAMMA 5% 9000.00

KC00672263 FLEBOGAMMA 5% 18000.00

KC00677243 NORDITROPIN NORDIFLEX 10MG/1.5ML 5131.00

KC00683236 GENOTROPIN 5.3MG 1895.00

KC00700216 ROFERON-A ( SOLUTION FOR INJECTION ) 0.00

KC00711280 FILGRASTIM INJECTION 150 μG/0.6ML 1383.00

KC00712266 FILGRASTIM INJECTION 75 μG/0.3ML 610.00

KC00713240 ENBREL (ETANERCEPT) 25MG 3338.00

KC00728266 LANTUS 100U/ML, SOLUTION FOR INJECTION 416.00

KC00729266 NOVORAPID PENFILL 3ML 100U/ML 238.00

KC00733277 PROFILNINE 500 IU 9924.00

KC00735209 GLUCAGEN 1MG 799.00

KC00739209 ACTRAPID 100 IU/ML 282.00

KC00740299KOGENATE FS, ANTIHEMOPHILIC FACTOR (RECOMBINANT),

FORMULATED WITH SUCROSE, 250 IU/VIAL23.20

KC00743248 ACTILYSE INJECTION 18272.00

KC00745209 LANTUS 100 UNITS/ML SOLUTION FOR INJECTION, 10ML VIAL 1144.00

KC00746209 FEIBA 50U/ml 34424.00

KC00747277 FEIBA 25U/ml 17190.00

KC00756265 GRANOCYTE 250 1782.00

KC00757255 GRANOCYTE 100 678.00

KC00760209 INSULATARD 282.00

KC00761210FASTURTEC POWDER AND SOLVENT FOR CONCENTRATE FOR

SOLUTION FOR INFUSION 1.5MG/ML2668.00

KC00774280IMMUNINE PURIFIED FACTOR IX CONCENTRATE, VIRUS-

INACTIVATED 600 IU9060.00

KC00777248 PLASBUMIN-20 1212.00

KC00787216 FORTEO FOR INJECTION 13357.00

KC00788277 PEGASYS PREFILLED SYRINGES 135MCG/0.5ML 2185.00

KC00789277 PEGASYS PREFILLED SYRINGES 180MCG/0.5ML 2205.00

KC00795266 HUMALOG U-100 231.00

KC00796229 GAMUNEX-C 1800.00

KC00796240 GAMUNEX-C 4500.00

KC00796248 GAMUNEX-C 9000.00

KC00796255 GAMUNEX-C 18000.00

KC00796263 GAMUNEX-C 36000.00

KC00803266 APIDRA 100 U/ML SOLUTION FOR INJECTION 158.00

KC00807219 AVASTIN INJECTION 8770.00

KC00810266 LEVEMIR FLEX PEN 414.00

KC00820266 NOVOMIX 30 FLEXPEN 238.00

KC00823266 NOVORAPID FLEXPEN 238.00

KC00828238 Eprex Injection 40000 IU/ml 4125.00

Page 341: 附件二 藥品給付品項暨支付標準表

KC00828245 Eprex Injection 40000 IU/ml 7453.00

KC00835261Xolair 150 mg powder and solvent for solution for

injection14569.00

KC00836299 Advate 500 IU Powder And Solvent For Injection 23.20

KC00837299 Advate 250 IU Powder And Solvent For Injection 23.20

KC00838299 Advate 1000 IU Powder And Solvent For Injection 23.20

KC00841248 "TBSF" HUMAN IMMUNOGLOBULIN FOR INTRAVENOUS USE 5400.00

KC00841263 "TBSF" HUMAN IMMUNOGLOBULIN FOR INTRAVENOUS USE 19440.00

KC00842248 "TBSF" (20%) HUMAN ALBUMIN SOLUTION 1212.00

KC00842255 "TBSF" (20%) HUMAN ALBUMIN SOLUTION 1963.00

KC00843277 "TBSF" HIGH PURITY FACTOR IX CONCENTRATE 7550.00

KC00844299"TBSF" High Purity Factor VIII/Von Willebrand Factor

Concentrate18.30

KC00845244 GENOTROPIN 12 MG 6371.00

KC00846248ENBREL 50MG SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE

6530.00

KC00851240ENBREL 25MG SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE

3338.00

KC00852299 XYNTHA 500 IU 23.20

KC00853299 XYNTHA 250 IU 0.00

KC00854299 XYNTHA 1000 IU 23.20

KC00857244 HUMATROPE FOR INJECTION 12 MG(36 IU) 6371.00

KC00867295Mircera solution for injection in pre-filled syringe 75

mcg/0.3ml3303.00

KC00868248Mircera solution for injection in pre-filled syringe 50

mcg/0.3ml1961.00

KC00869255Mircera solution for injection in pre-filled syringe 100

mcg/0.3ml3203.00

KC00870299 DYSPORT, POWDER FOR INJECTION 16.40

KC00875221Recormon solution for injection in pre-filled syringe

5000IU659.00

KC00876212Recormon solution for injection in pre-filled syringe

2000IU274.00

KC00877238 ERBITUX 5MG/ML SOLUTION FOR INFUSION 5855.00

KC00878248 NOVOSEVEN RT 25698.00

KC00879205 Lucentis 10mg/ml solution for injection 19879.00

KC008792FM Lucentis 10mg/ml solution for injection 19879.00

KC00894214RABIPUR PCEC RABIES VACCINES BEHRING POWDER AND SOLVENT

FOR SOLUTION FOR INJECTION0.00

KC00895248 KIOVIG 100 mg/ml Solution for Infusion 9000.00

KC00895255 KIOVIG 100 mg/ml Solution for Infusion 18000.00

KC00895263 KIOVIG 100 mg/ml Solution for Infusion 36000.00

KC00896243 Omnitrope 10mg/1.5mL Solution for Injection 5131.00

KC00897265 ORENCIA LYOPHILIZED POWDER FOR IV INFUSION 250MG 7421.00

KC00898266 HUMALOG MIX 25 100U/ML KWIKPEN 231.00

KC00899266 HUMALOG MIX 50 100U/ML KWIKPEN 231.00

KC00900266 HUMALOG 100U/ML KWIKPEN 231.00

KC00905261 Ilaris 150 mg powder for solution for injection 408996.00

Page 342: 附件二 藥品給付品項暨支付標準表

KC00907219 Actemra Solution for Infusion 3783.00

KC00907229 Actemra Solution for Infusion 8874.00

KC00907238 Actemra Solution for Infusion 18398.00

KC00908266 NOVOMIX 50 FLEXPEN 238.00

KC00911206 SIMPONI TM (GOLIMUMAB),SOLUTION FOR INJECTION 30190.00

KC00911209 SIMPONI TM (GOLIMUMAB),SOLUTION FOR INJECTION 30190.00

KC00914216 VICTOZA 1371.00

KC00918209 PROLIA 6039.00

KC00919280 Neulasta 17490.00

KC00920206 STELARA SOLUTION FOR INJECTION 94140.00

KC00920209 STELARA SOLUTION FOR INJECTION 94140.00

KC00922248 Human Albumin 200g/l Baxter 1212.00

KC00923248 Flexbumin 25%, Albumin (Human), USP, 25% Solution 1480.00

KC00923255 Flexbumin 25%, Albumin (Human), USP, 25% Solution 2208.00

KC009242FO XGEVA 9246.00

KC00926248 UMAN ALBUMIN SOLUTION FOR INFUSION 20% 1212.00

KC00926255 UMAN ALBUMIN SOLUTION FOR INFUSION 20% 1963.00

KC009272B4 Romiplate 250μg injection 18172.00

KC00928229 Mabthera solution for IV Infusion 7967.00

KC00928248 Mabthera solution for IV Infusion 38106.00

KC00932244 SAIZEN 12 MG(36IU) SOLUTION FOR INJECTION 6371.00

KC00933251 SAIZEN 20 MG (60IU) SOLUTION FOR INJECTION 12818.00

KC00936248Eylea aflibercept (rch) 40 mg/mL solution for

intravitreal injection vial20203.00

KC00940229Recormon solution for injection in pre-filled syringe

10000 IU1466.00

KC00941221 VECTIBIX SOLUTION FOR INFUSION 9355.00

KC00942233 Perjeta Vial 420mg 62620.00

KC00945258ORENCIA (ABATACEPT) INJECTION FOR SUBCUTANEOUS USE 125MG

PER SYRINGE(125MG/ML)4716.00

KC00949255 KADCYLA 36597.00

KC009492AX KADCYLA 52700.00

KC00950206 NESP Injection Plastic Syringe 180 mcg/0.5 ml 6920.00

KC00951206 NESP Injection Plastic Syringe 120 mcg/0.5 ml 4927.00

KC00952206 NESP Injection Plastic Syringe 60 mcg/0.5 ml 2753.00

KC00953206 NESP Injection Plastic Syringe 40 mcg/0.5 ml 1405.00

KC00954206 NESP Injection Plastic Syringe 30 mcg/0.5 ml 1109.00

KC00955206 NESP Injection Plastic Syringe 20 mcg/0.5 ml 796.00

KC00956206 NESP Injection Plastic Syringe 10 mcg/0.5 ml 0.00

KC00957206 STELARA SOLUTION FOR INJECTION 94140.00

KC00957209 STELARA SOLUTION FOR INJECTION 94140.00

KC00959248 ALBURX TM 20 1212.00

KC00959255 ALBURX TM 20 1963.00

KC00960248 ALBURX TM 25 1480.00

KC009612B5 Herceptin Vial 440mg 43844.00

KC00964248ADCETRIS 50 mg powder for concentrate for solution for

infusion118324.00

KC00965240 PRIVIGEN 4500.00

Page 343: 附件二 藥品給付品項暨支付標準表

KC00965248 PRIVIGEN 9000.00

KC00965255 PRIVIGEN 18000.00

KC00965263 PRIVIGEN 36000.00

KC00969214VERORAB POWDER AND SOLVENT FOR SUSPENSION FOR INJECTION

1134.00

KC00970299 RIXUBIS (nonacog gamma) 500IU 21.00

KC00971299 RIXUBIS (nonacog gamma) 1000IU 21.00

KC00972299 RIXUBIS (nonacog gamma) 2000IU 21.00

KC00973245 GAZYVA SOLUTION FOR INFUSION 99911.00

KC00977208 Actemra 162mg for SC Injection 8307.00

KC00978206 TRULICITY INJECTION 1.5MG/0.5ML 897.00

KC00979206 TRULICITY INJECTION 0.75MG/0.5ML 897.00

KC00980255Remicade powder for concentrate for solution for

infusion9924.00

KC00986266 BASAGLAR 100U/ML SOLUTION FOR INJECTION 350.00

KC00990288Lucentis solution for injection 10mg/mL in pre-filled

syringe19879.00

KC00991209 Cosentyx 150mg/ml Solution for Injection 19442.00

KC00992261 Cosentyx 150 mg Powder for Solution for Injection 19442.00

KC00996299 NOVOEIGHT 1000IU 23.20

KC00997299 NOVOEIGHT 500IU 23.20

KC00999229 CYRAMZA injection 9292.00

KC00999248 CYRAMZA injection 41816.00

KC01010206 SYNAGIS 100MG/ML SOLUTION FOR INJECTION 14486.00

KC01011272 TOUJEO 300 UNITS/ML SOLUTION FOR INJECTION 566.00

KC01013229 OPDIVO (nivolumab) Injection 10mg/mL 41642.00

KC01015255 NUCALA POWDER FOR SOLUTION FOR INJECTION 32811.00

KC01016299 ALPROLIX POWDER FOR INJECTION 3000IU 34.30

KC01017299 ALPROLIX POWDER FOR INJECTION 500IU 34.30

KC01018299 ALPROLIX POWDER FOR INJECTION 250IU 34.30

KC01019299 ALPROLIX POWDER FOR INJECTION 1000IU 34.30

KC01020299 ALPROLIX POWDER FOR INJECTION 2000IU 34.30

KC010222FY MabThera solution for subcutaneous injection 47019.00

KC01024209 CIMZIA 200 MG/ML SOLUTION FOR INJECTION 12210.00

KC01025219 KEYTRUDA INJECTION 67859.00

KC01026299 ELOCTATE POWDER FOR INJECTION 250IU 21.40

KC01027299 ELOCTATE POWDER FOR INJECTION 500IU 21.40

KC01028299 ELOCTATE POWDER FOR INJECTION 750IU 21.40

KC01029299 ELOCTATE POWDER FOR INJECTION 1000IU 21.40

KC01030299 ELOCTATE POWDER FOR INJECTION 1500IU 21.40

KC01031299 ELOCTATE POWDER FOR INJECTION 2000IU 21.40

KC01032299 ELOCTATE POWDER FOR INJECTION 3000IU 21.40

KC01033209 REPATHA SOLUTION FOR INJECTION 4582.00

KC01034266ENTYVIO POWDER FOR CONCENTRATE FOR SOLUTION FOR INFUSION

54933.00

KC01035255 Remsima 8765.00

KC01037209 PRALUENT SOLUTION FOR INJECTION 75MG 4588.00

KC01038209 PRALUENT SOLUTION FOR INJECTION 150MG 4588.00

Page 344: 附件二 藥品給付品項暨支付標準表

KC01039271HUMIRA 40MG SOLUTION FOR INJECTION(針筒裝注射劑,筆型注

射器(內含單次使用預充填式注射器))13116.00

KC01040296 BLINCYTO FOR INJECTION 60898.00

KC01041248 PRAXBIND SOLUTION FOR INJECTION/INFUSION 31500.00

KC01042299 KOVALTRY INJECTION 1000 IU 21.40

KC01043299 KOVALTRY INJECTION 500 IU 21.40

KC01044299 KOVALTRY INJECTION 250 IU 21.40

KC01045299 KOVALTRY INJECTION 2000 IU 21.40

KC01048221 Hizentra 1800.00

KC01048229 Hizentra 3600.00

KC01048238 Hizentra 7200.00

KC01048248 Hizentra 18000.00

KC01050238 Tecentriq 132450.00

KC01051248 Albunorm 25% 1480.00

KC01051255 Albunorm 25% 2208.00

KC01052248 Albunorm 20% 1212.00

KC01052255 Albunorm 20% 1963.00

KC01053216 RYZODEG FLEXTOUCH 483.00

KC01054266 TRESIBA FLEXTOUCH 483.00

KC01055299 NOVOEIGHT 250 IU 23.20

KC01056221DARZALEX CONCENTRATE FOR SOLUTION FOR INFUSION 20MG/ML

11801.00

KC01056238DARZALEX CONCENTRATE FOR SOLUTION FOR INFUSION 20MG/ML

47698.00

KC01059299 IDELVION 250IU 57.00

KC01060299 IDELVION 500IU 57.00

KC01061299 IDELVION 1000IU/2000IU 57.00

KC01062209Xolair Solution for injection, 150mg/mL in pre-filled

syringe14569.00

KC01063209 TALTZ INJECTION 29644.00

KC01065221 Herceptin solution for injection 35713.00

KC01067209 Ilaris 150mg/mL solution for injection 389169.00

KC01068299 Nuwiq 250 IU 23.20

KC01069299 Nuwiq 500 IU 23.20

KC01070299 Nuwiq 1000 IU 23.20

KC01071299 ADYNOVATE 500IU 23.60

KC01072299 ADYNOVATE 1000IU 23.60

KC01073299 ADYNOVATE 2000IU 23.60

KC010762DA LUMICEF Subcutaneous Injection 210mg Syringe 16718.00

KC01077209 TREMFYA SOLUTION FOR INJECTION 69540.00

KC01078299 XYNTHA SOLOFUSE 2000 IU 23.20

KC01080216 Soliqua solution for injection 100 units+50μg 910.00

KC01081209BESPONSA 1 MG POWDER FOR CONCENTRATE FOR SOLUTION FOR

INFUSION372418.00

KC01082212 DUPIXENT SOLUTION FOR INJECTION 300MG 19738.00

KC01084241STELARA CONCENTRATE FOR SOLUTION FOR INFUSION (130

MG/26ML)48422.00

Page 345: 附件二 藥品給付品項暨支付標準表

KC01085229BAVENCIO 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION

27703.00

KC01086299 HEMLIBRA SC INJECTION 30 MG/ML 2969.00

KC01087299 HEMLIBRA SC INJECTION 150 MG/ML 2969.00

KC010892B5 OGIVRI 440 MG 39860.00

KC01094229 TRUXIMA 6536.00

KC01094248 TRUXIMA 32348.00

KC01098283 AMGEVITA SOLUTION FOR INJECTION 9079.00

KC01099263 NIVESTIM SOLUTION FOR INJECTION/INFUSION 623.00

KC01099277 NIVESTIM SOLUTION FOR INJECTION/INFUSION 1559.00

KC01100277 NIVESTIM SOLUTION FOR INJECTION/INFUSION 480ΜG/0.5ML 2245.00

KC01101209 FASENRA SOLUTION FOR INJECTION 30MG 64667.00

KC01102299 Afstyla 250IU 21.40

KC01103299 Afstyla 500IU 21.40

KC01104299 Afstyla 1000/2000IU 21.40

KC01106248 SK ALBUMIN 20% INJECTION 1212.00

KC01107210 OZEMPIC SOLUTION FOR INJECTION 3585.00

KC01107216 OZEMPIC SOLUTION FOR INJECTION 3585.00

KC01108280 FULPHILA 15229.00

KC011092BK SKYRIZI 75MG / 0.83ML PRE-FILLED SYRINGE 52023.00

KC011112DEKANJINTI POWDER FOR CONCENTRATE FOR SOLUTION FOR

INFUSION 420MG34879.00

KC01113209 EMGALITY INJECTION 11226.00

KC011162B5 Herzuma Inj. 440mg, Lyophilized powder for injection 34460.00

KC01117219 MVASI SOLUTION FOR INJECTION 6723.00

KC01118229 Rixathon Concentrate for Solution for Infusion 5275.00

KC01118248 Rixathon Concentrate for Solution for Infusion 26377.00

KC01119299 Jivi 250 IU 24.70

KC01120299 Jivi 500 IU 24.70

KC01121299 Jivi 1000 IU 24.70

KC01122299 Jivi 2000 IU 24.70

KC01124299 ADYNOVATE 250IU 23.60

KC01129299Refixia powder and solvent for solution for injection

500 IU41.30

KC01130299Refixia powder and solvent for solution for injection

1000 IU41.30

KC01131299Refixia powder and solvent for solution for injection

2000 IU41.30

KC01132255IXIFI POWDER FOR CONCENTRATE FOR SOLUTION FOR INFUSION

8633.00

KC011362B5Trazimera Powder for Concentrate for Solution for

infusion 440 mg34460.00

KC011372BN EVENITY Solution for Injection 6922.00

KC01139206 Erelzi Solution for Injection 2452.00

KC01139209 Erelzi Solution for Injection 4254.00

KC01144209 Nucala Solution for Injection 100mg/mL 32811.00

KC01146219 Zirabev Concentrate for Solution for Infusion 6723.00

KC01153283 IDACIO 40MG/0.8ML SOLUTION FOR INJECTION, VIAL KIT 8884.00

Page 346: 附件二 藥品給付品項暨支付標準表

KC01154283IDACIO 40MG/0.8ML SOLUTION FOR INJECTION, PRE-FILLED

SYRINGE/PRE-FILLED PEN7437.00

N000107100 BETTY CAPSULES 0.24

N000162100 CHLORPHENIRAMINE MALEATE TABLETS "JOHNSON" 0.10

N000181100 DEXICONE "STANDARD" 0.29

N000218100 OROTOMINE S.C. TABLETS 0.50

N000282100 STIGMIN-C TABLETS "JOHNSON" 0.28

N000338100 TRANZANONE TABLETS "STANDARD" 0.73

N000370100 SPARTE TABLETS 0.46

N000460100 VALETAN TABLETS "JOHNSON" 0.55

N000465100 TRIPYLINE TABLETS 10MG “H.L.” 0.49

N000475209 DL-METHYL EPHEDRINE HCL INJECTION 4% "Y.Y." 2.73

N000589229 YOBRAMIN INJECTION "ASTAR" 10.90

N000608100 DESTRINALIS CAPSULES "KINGDOM" 1.02

N000686238 20% DEXTROSE INJECTION "ASTAR" 5.60

N000687238 50% DEXTROSE INJECTION "ASTAR" 5.70

N000703100 GASNONE TABLETS 0.35

N001004209 TESTO INJECTION "ASTAR" 4.00

N001007100 CHINTAN TABLETS "C.M." 0.77

N001065100 CHE SU S.C. TABLETS 0.96

N001246209 VITAMIN B COMPLEX INJECTION "ASTAR" 4.54

N001246229 VITAMIN B COMPLEX INJECTION "ASTAR" 13.40

N001319229 LITOCIN INJECTION 6.80

N001500100 MEDICON TABLETS 15MG 0.60

N001510100 IS-BLOOD S.C. TABLETS 4.00

N001585238 AMINOL INJECTION 0.00

N001682221 VITACICOL INJECTION 500MG 0.00

N001728100 DIMENHYDRINATE TABLETS 50MG "JOHNSON" 0.48

N001758100 DESPAS S.C. TABLETS 0.96

N001816100 MAGNESIUM HYDROXIDE TABLETS 324MG "JOHNSON" 0.00

N001849100 DELCOPAN TABLETS 10MG "JOHNSON" 0.43

N001878221 WESCO INJECTION 4.69

N001929100 DECASON TABLETS 0.69

N001934209 UABASIN INJECTION 0.00

N001993209 ANTALL INJECTION 3.87

N001997209 PROGESTERONE INJECTION 25MG "SINTONG" 4.80

N002000221 HECIRAMIN INJECTION 4.86

N002051212 ALISIN INJECTION 2.40

N002055212 ASIPHYLLINE-M INJECTION 3.50

N002089209 MERO INJECTION 10MG 4.32

N002199100 ERYTHROMYCIN-L CAPSULES "SINTONG" 1.43

N002253100 URSOCID TABLETS "T.F." 1.74

N002266265 AMPOLIN INJECTION 0.00

N002332212 RUBOLIN INJECTION 2.5% 0.00

N002355277 YEIAMIN-2 INJECTION 0.00

N002454100 BALISA S.C. TABLETS 0.59

N0026371G0 LIPAN CHEWABLE TABLETS(鋁箔/膠箔) 1.24

N002638100 VENAMINE TABLETS 0.18

Page 347: 附件二 藥品給付品項暨支付標準表

N002640100 IMENTON TABLETS 1.56

N002643100 FULIES S.C. TABLETS 0.89

N002676100 TINTEN TABLETS 0.25

N002893100 ALLERMIN TABLETS 0.11

N002958277 SODIUM CHLORIDE INJECTION "C.C.P." 18.90

N003061212 SINTOMIN INJECTION 0.00

N003061221 SINTOMIN INJECTION 0.00

N003068212 VITA-B1 INJECTION 20MG 2.40

N003074212 VITACICOL INJECTION 100MG 5.40

N003107209 HORMON-M 25MG INJECTION 4.00

N003187209 VITAMIN B1 INJECTION 100MG "C.C.P." 4.48

N003190209 BARTROPIN INJECTION 2.10

N003316100 DIHYDROCHL OZIDE TABLETS. 0.65

N003335238 BLUTON INJECTION 20% "C.C.P." 5.60

N003354100 VISTARIL CAPSULES 1.06

N003449100 TABELLAE EPHEDRINI HYDROCHLORIDI "Y.Y." 0.56

N003841100 MUSLELAX TABLETS 0.73

N004008209 BUFFERED PENICILLIN G FOR INJECTION 1000000 U "Y.F." 6.90

N004487100 PAPAVERINE HCL TABLETS “H.L.” 0.60

N0045121G0DEMESON TABLETS 0.5MG "F.Y."(瓶裝/42粒/瓶)、(瓶裝/84粒/

瓶)1.50

N004550321 C.B. OINTMENT "STRONG" 9.00

N004612100 ANTOLON TABLETS 1.42

N004730157 CO-TUSSIN COUGH SYRUP "HEALTH" 34.10

N004781100 MECLIZINE TABLETS 25MG "F.Y." 0.47

N004901209NANNISMON-DEPOT INJECTION "CHI SHENG"

0021.30

N004905299 B-COMPLEX INJECTION "CHI SHENG" 1.13

N004923212 SOSAPHYLLINE INJECTION "CHI SHENG" 7.00

N004944221 INJECTIO HEXAMINI 24% "Y.Y." 4.86

N004959100 TRAVEZIN TABLETS "H.L." 0.22

N004963100 HEXIN TABLETS "H.L." 1.00

N004968100 DECOTON TABLETS "N.C.P." 0.00

N004979100 HIRMAZINE TABLETS 25MG “H.L.” 0.00

N005124100 VENA TABLETS 0.41

N005223100 LONTOMIN COMPOUND S.C. TABLETS "F.Y." 0.50

N0052291G0 ANATEN TABLETS 10MG "F.Y."(21粒/瓶.84粒/瓶) 1.50

N0052361G0 PYRESON TABLETS(瓶裝/84粒/瓶) 1.50

N0052451G0COLSIN 5MG TABLETS "F.Y."(21粒/瓶.84粒/瓶) (鋁箔/膠箔)

0.00

N005328299 DEXAMESONE INJECTION 4MG "CHI SHENG." 1.50

N005337238 50% GLUCOS INJECTION "CHI SHENG" 5.70

N005337263 50% GLUCOSE INJECTION "CHI SHENG" 19.10

N005337277 50% GLUCOS INJECTION "CHI SHENG" 0.00

N005438100 TRANKINSON TABLETS "N.C.P." 0.00

N005458100 A.D.A. TABLETS 0.90

N005461342 HEMORRHOIDS OINTMENT 25.80

N005854100 PRENIN TABLETS "N.C.P." 0.00

Page 348: 附件二 藥品給付品項暨支付標準表

N005881100 OROTIN S.C. TABLETS “H.L.” 0.38

N005894343 DIBUTON ANESTHETIC OINTMENT 0.00

N006061209 DEPOT HORMON-F INJECTION 18.10

N006164100 WINCONIN TABLETS "S.C." 1.00

N006186100 SINDILIUM TABLETS "H.L." 0.00

N006235100 LUMBELLA TABLETS 0.00

N006279340 KINGLENIC OINTMENT "KINGDOM" 16.30

N0063101G0 ANATEN CAPSULES 10MG "F.Y."(21粒/瓶.84粒/瓶) 1.50

N006511209 DEPOT HORMON-MF INJECTION 21.30

N006516212 STRONG VITA-B INJECTION 0.00

N006517238 TICANIN INJECTION 0.00

N006519238 VITATICAMIN-T INJECTION 4.50

N006530209 SINSERPINE INJECTION 3.47

N006532209 DEPOT HORMON-M INJECTION 20.00

N006732209 COMYCIN INJECTION 0.00

N006734100 PURE CALCIUM TABLETS 0.32

N006815209 PHENAMIN INJECTION "LITA" 5.40

N006853100 ADJUST S.C. TABLETS 0.68

N006864212 ORISERPINE INJECTION 1.87

N007182212 ANTICOUGH INJECTION "LITA" 5.40

N007342212 VITACICOL FORTE INJECTION 5.40

N007484335 KESEZINE OINTMENT "N.C.P." 6.50

N007484338 KESEZINE OINTMENT "N.C.P." 16.30

N007609209 ASMATHIN INJECTION "LITA" 6.10

N007626100 SCONIN S.C. TABLETS "N.C.P." 0.96

N007655100 NEO-WEIAN TABLETS 5.20

N007695338 BENAZON OINTMENT "HEALTH" 48.20

N007755429 SUPER SALOON EYE LOTION 23.70

N007888100 TASPAN TABLETS 0.74

N007897100 AMPICILLIN CAPSULES 250MG "CHI SHENG" 1.02

N008029100 METHACID CAPSULES 0.87

N008387209 METHODEX G INJECTION 2.72

N008737340 UNDECYL OINTMENT (STRONG ANTIMYCOTIC OINTMENT) 16.30

N008799229 DEXAMESONE INBJECTION 10MG 16.00

N009046100 DOCAN TABLETS 0.90

N009048100 CURIEMYLON TABLETS 500MG 2.22

N009051100 METHOXIN TABLETS "ORIENTAL" 0.54

N009057100 MAGELIN TABLETS 0.50

N009094100 SMA TABLETS 0.51

N009174238 VITATICANIN-T 4.68

N009208100 CHOZINE TABLETS (METRONIDAZOLE) "N.C.P." 1.02

N009215340 HEMORRHOIDS OINTMENT "N.C.P." 45.20

N009417277 LACTATED RINGER'S INJECTION "C.C.P." 21.10

N009541100 THININ TABLETS 50MG "N.C.P." 2.10

N009643100 NIULACKMIN TABLETS 0.23

N009683212 PROTOSIN "ASTAR" 18.20

N009702100 MERGON TABLETS "N.C.P." 0.68

N009741238 NEO-BILNIN F 100 INJECTION "ASTAR" 5.30

Page 349: 附件二 藥品給付品項暨支付標準表

N009747238 PALGIN INJECTION "ASTAR" 8.00

N009748209 MECOFAN INJECTION "ASTAR" 2.56

N009750209 ESTRADIOL BENZOATE INJECTION "ASTAR" 4.49

N009753209 METHYL EPHEDRINE INJECTION "ASTAR" 2.73

N009754277 RINGER'S INJECTION "ASTAR" 19.90

N009769229 SULMIN INJECTION 15.00

N009772209 VITAKEY INJECTION 4.54

N009772229 VITAKEY INJECTION 13.00

N009774212 B. C. COMPLEX INJECTION 1.45

N009775238 SIUVITA INJECTION 8.00

N009796277 RINGER'S SOLUTION "C.C.P." 19.90

N009839238 PANTOSAN INJECTION 7.70

N009847100 ERGONOVINE MALEATE TABLETS 0.68

N009940238 LACT SALINE INJECTION 0.00

N009940277 LACT SALINE INJECTION 25.50

N010308100 METHATIN CAPSULES 0.87

N010365209 BLUTON 5% INJECTION 26.30

N010365277 BLUTON 5% INJECTION 19.10

N010577321 RINDERON-V CREAM 0.06% 29.20

N010755157 SEDACOUGH 0.00

N010867100 CASCARA SAGRADA EXTRACT TABLETS 0.13GM 0.46

N011066100 NOSCAPINE TABLETS "JEN SHENG" 0.73

N011069100 DOANG TABLETS "JEN SHENG" 0.63

N011074100 VASONIN S.C. TABLETS 12.5MG "JEN SHENG" 0.61

N011093100 BISATON TABLETS 0.30

N011096100 SCOPAM S.C. TABLETS "JEN SHENG" 0.96

N011097100 ROLIMIN S.C. TABLETS 0.73

N011100100 DIMETHICON TABLETS 20MG "JEN SHENG" 0.30

N011122342 NEOMYCIN OINTMENT 16.40

N011224100 HONCALM S.C. TABLETS 0.68

N011233100 METHACIN TABLETS 0.87

N011238100 NOSCAPIN TABLETS "HONTEN" 0.69

N011241100 CHLORPHENIRAMINE MALEATE TABLETS "HONTEN" 0.14

N011267229 DEXAMETHASONE-21-P INJECTION "ASTAR" 16.00

N011267299 DEXAMETHASONE-21-P INJECTION "ASTAR" 0.75

N011557209 PROGESTERONE INJECTION "ORIENTAL" 10.00

N011585100 AMPICILLIN CAPSULES "SINTONG" 1.02

N0116071G0 PREDNISOLONE TABLETS "SINTONG" (84粒/瓶) 1.50

N011693100 ASPIRIN TABLETS "SHIN LON" 0.35

N011747155 COUGH SYRUP WITH CODEINE "CBC" 0.00

N011760100 PREKILINEN TABLETS 0.90

N011832100 VITA-SINATOMIN CAPSULES "N.C.P." 2.34

N012059221 GLIAGEN-H INJECTION "Y.Y." 3.08

N012059238 GLIAGEN-H INJECTION "Y.Y." 7.80

N012086433 NAZAL SPRAY "JEN SHENG" 17.60

N012089100 BELLATON TABLETS "JEN SHENG" 0.72

N012090100 CHOMOZIN S.C. TABLETS 250MG "JEN SHENG" 1.02

N012091100 MUSLAXIN TABLETS 200MG "JEN SHENG" 0.86

Page 350: 附件二 藥品給付品項暨支付標準表

N012168100 DIGESTIN TABLETS 0.45

N012173329 PAONIMIN OINTMENT 9.90

N012343266 MANNITOL INJECTION "SINTONG" 39.40

N012916100 MECLIZINE HCL TABLETS 25MG "JOHNSON" 0.38

N012936100 DEXAMETHASONE TABLETS "JEN SHENG" 0.69

N012940100 CHLORPHENIRAMINE MALEATE TABLETS 4MG "JEN SHENG" 0.10

N012942100 INDOMECIN CAPSULES "JEN SHENG" 0.87

N013071100 SUSUI TABLETS 0.77

N013076100 BENDAZOL S.C. TABLETS 0.74

N013079100 PAPAVERIN TABLETS "HONTEN" 0.60

N013084100 OROTIN S.C. TABLETS 0.50

N013187100 CONTERIN CAPSULES 0.89

N013302100 WINTOLON TABLETS "JEN SHENG" 2.22

N013307100 EPHEDRINUM TABLETS 0.56

N013417100 SORELESS TABLETS 0.72

N013475100 FERROUS SULFATE S.C. TABLETS 324MG "WASHINGTON" 0.90

N013488100 AETOMIN TABLETS "S.C." 0.66

N013550100 TRIMIN TABLETS "SWISS" 0.60

N013611299 HEPAPLEX-B "Y.Y" 9.40

N013617243 YINGAN CA INJECTION 0.00

N013675100 UROZOLE TABLETS 250MG "JEN SHENG" 0.55

N013678100 SOFTRAN TABLETS 100MG "JEN SHENG" 0.73

N013679100 PROPANTHELINE BROMIDE S.C. TABLETS 15MG "JEN SHENG" 0.55

N013697100 KINGCORT TABLETS 0.90

N013698100 ANTICOFEN CAPSULES "KINGDOM" 1.60

N013702100 PREDNISOLONE "KUANG NAN" 0.90

N013857100 TECOSIN TABLETS 0.89

N013999100 GEEL S.C. TABLETS 1.02

N014938100 PHENOBARBITAL TABLETS 30MG “H.L.” 0.68

N015223100 PAPAVERINE HCL TABLETS 30MG "JEN SHENG" 1.03

N015343221 SHINMIOCHIEN INJECTION 8.90

N015352212 CONTAMIN INJECTION "Y.Y." 6.40

N015357155 COUTHY SYRUP 0.00

N015357159 COUTHY SYRUP 0.00

N015750100 BROWN MIXTURE OPIUM TABLETS 0.16

N015943209 ESTOL-DEPOT INJECTION "ASTAR" 18.10

N0161401G0 DIAZEPAM TABLETS 5 MG “KINGDOM”(鋁箔) 0.00

N016423221 ASCORBIC ACID INJECTION "ASTAR" 5.40

N016524100 ENITOL F.C. TABLETS 0.00

N016528100 NOSCAPINE TABLETS"LITA" 0.73

N0165281G0 NOSCAPINE TABLETS"LITA"(鋁箔/膠箔) 1.08

N016598212 DAIBINAL INJECTION 0.00

N016598221 DAIBINAL INJECTION 0.00

N016638329 ANCINALON OINT. 10G 26.40

N016698100 HEAMIN TABLETS "HEALTH" 0.10

N016770100 SINTABEX S.C. TABLETS 1.77

N016803100 WINTEN CAPSULES 1.34

N016925100 ANTOCHIN CAPSULES 0.87

Page 351: 附件二 藥品給付品項暨支付標準表

NA04135277 GLUCOSE INJECTION 50% 39.90

NA10222209 ESCOPAN INJECTION "N.K." (1ML/玻璃安瓿裝) 15.00

NA15737209 SOLUTIO NATRII CHLORIDI ISOTONICA "CHI SHENG" 35.00

NA15737265 SOLUTIO NATRII CHLORIDE ISOTONICA "CHI SHENG" 22.00

NA15737277SOLUTIO NATRII CHLORIDI ISOTONICA "CHI SHENG"(軟袋及塑膠

瓶)25.00

NB00220100 DEXAMETHASONE TABLETS 0.5MG "STANDARD" 1.50

NB00711100 PREDONINE TABLETS 1.50

NB007111G0 PREDONINE TABLETS(鋁箔/膠箔) 2.00

NB00979100 BUTYSCOL S.C. TABLETS 1.50

NB009791G0 BUTYSCOL S.C. TABLETS(鋁箔/膠箔) 2.00

NB01043100 PONSTAN KAPSEALS 1.50

NB04135238 GLUCOSE INJECTION 50% "Y.F." 15.00

NB09931100 SANYL S.C. TABLETS 1.50

NB099311G0 SANYL S.C. TABLETS(鋁箔/膠箔) 2.00

NB15737212 SOLUTIO NATRII CHLORIDI ISOTONICA "CHI SHENG" 72.00

NC00007100 HEXIN TABLETS 1.50

NC00055100 BET TABLETS 1.50

NC00084100 ANNA F COATED TABLETS 1.50

NC00094100 LIBULIN COATED TABLETS 1.50

NC00102100 UROPRIN COATED TABLETS 100MG 1.50

NC00140100 ERGOTON FILM COATED TABLETS "JOHNSON" 1.50

NC00141100 HYCHLOZIDE TABLETS 1.50

NC001411G0 HYCHLOZIDE TABLETS (84粒/瓶) 2.00

NC001411GA HYCHLOZIDE TABLETS(鋁箔/膠箔) 2.00

NC00164100 ISONIAZIDE TABLETS 1.50

NC001641G0 ISONIAZIDE TABLETS(鋁箔/膠箔) 2.00

NC00198100 SINCEN TABLETS 1.50

NC00230100 DICETAMIN CAPSULES 1.50

NC00258100 PELONINE CAPSULES "JOHNSON" 1.50

NC00261100 JOHNLAX ENTERIC COATED TABLETS "JOHNSON" 1.50

NC002611G0 JOHNLAX ENTERIC COATED TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC00276100 SUN SEE TABLETS "JOHNSON" 1.50

NC00278100 DEXAZONE TABLETS "JOHNSON" 1.50

NC002781G0 DEXAZONE TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC00286100 KINZANONE TABLETS "JOHNSON" 1.50

NC00294155 BENTYLINE GRANULES "JOHNSON" 49.60

NC00307100 ERGOLAR CAFFEINE TABLETS "NCP" 1.50

NC00337209 NEOSTIGMINE INJECTION "CHI SHENG" 15.00

NC00394100 HEXAZIN TABLETS "JOHNSON" 1.50

NC00457100 ISOPRIN TABLETS "JOHNSON" 1.50

NC00476209 B-COMPLEX INJECTION "Y.Y." 15.00

NC00476229 B-COMPLEX INJECTION "Y.Y." 15.00

NC00480209 BASSON INJECTION 1% "Y.Y." 15.00

NC00509100 FUCON CAPSULES 1.50

NC00577209 LACTATED RINGER'S INJECTION"SINTONG" 35.00

NC00577277 LACTATED RINGER'S INJECTION "SINTONG" 25.00

NC00587212 THIOCTIC ACID INJECTION 0.5% "Y.Y." 15.00

Page 352: 附件二 藥品給付品項暨支付標準表

NC00588209 "SODIUM CHLORIDE INJECTION ""ASTAR""" 35.00

NC00588210 SODIUM CHLORIDE INJECTION "ASTAR." 40.90

NC00588212 "SODIUM CHLORIDE INJECTION ""ASTAR.""" 0.00

NC00588216 SODIUM CHLORIDE INJECTION "ASTAR." 0.00

NC00588265 "SODIUM CHLORIDE INJECTION ""ASTAR.""" 22.00

NC00588277 "SODIUM CHLORIDE INJECTION ""ASTAR""" 25.00

NC00589209 YOBRAMIN INJECTION "ASTAR" 15.00

NC00694100 MELLAZINE S.C. TABLETS 25MG "HL" 1.50

NC00701212 KOTIN INJECTION "N.K." 15.00

NC00702100 MUSCLAX TABLETS 100MG 1.50

NC00781100 HALOPIN TABLETS "JOHNSON" 1.50

NC00799100 COLCINE TABLETS "HONTEN" 1.50

NC00805100 DL-METHYLEPHEDRINE HCL TABLETS "JOHNSON" 1.50

NC00817100 DILANTIN KAPSEALS 1.50

NC00827212 CHLORAMIN INJECTION "Y.Y." 15.00

NC00847500 FROTIN SUPPOSITORIES 5.00

NC00849100 SOLLON TABLETS "JOHNSON" 1.50

NC008491G0 SOLLON TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC00874212 BERBERINE HCL INJECTION 0.2% "Y.Y." 15.00

NC00884100 POLENIN TABLETS 1.50

NC00990100 QUINIDINE SULFATE CAPSULES "NYSCO" 3.93

NC01073500 CHILDREN'S SENTIN SUPPOSITORIES 5.00

NC01109100 THYROID TABLETS 64MG "JOHNSON" 1.50

NC011091G0 THYROID TABLETS 64MG "JOHNSON"(鋁箔/膠箔) 2.00

NC01204151 COUSIN SYRUP 25.00

NC01204157 COUSIN SYRUP 25.80

NC01246212 VITAMIN B COMPLEX INJECTION "ASTAR" 15.00

NC01320238 SALSOROITIN INJECTION "CHI SHENG" 17.10

NC01451100 DL-METHYLEPHEDRINE HCL TABLETS 25MG "T.F." 1.50

NC01503100 TAEE S.C. TABLETS 5MG 1.50

NC01542100 TETRACYCLINE HCL CAPSULES "KINGDOM" 1.50

NC015421G0 TETRACYCLINE HCL CAPSULES "KINGDOM"(鋁箔/膠箔) 2.00

NC01580100 PROPHYLLINE TABLETS 1.50

NC01595100 ALUNLAN CAPSULES 1.50

NC01647277 ANCILLINA INJECTION 500MG 25.00

NC01681209 STREPTOMYCIN INJECTION 1GM "TBC" 52.00

NC01727100 SODIUM BICARBONATE COMPOUND TABLETS "JOHNSON" 1.50

NC01730500 METROZOLE LOCAL TABLETS "JOHNSON" 5.00

NC01736100 PHENOBARBITAL TABLETS 30MG "JOHNSON" 1.50

NC017361G0 PHENOBARBITAL TABLETS 30MG "JOHNSON"(鋁箔/膠箔) 2.00

NC01749100 ERGOMETRINE MALEATE TABLETS 0.2MG "JOHNSON" 1.50

NC017491G0ERGOMETRINE MALEATE TABLETS0.2MG "JOHNSON"(瓶裝/21粒/瓶)

2.00

NC01752100 FRONIL S.C. TABLETS "JOHNSON" 1.55

NC017521G0 FRONIL S.C. TABLETS "JOHNSON" (鋁箔/膠箔) 2.00

NC01757221 CANBIN -C INJECTION 0.00

NC01774100 CHLORPHENIRAMINE MALEATE TABLETS 8MG "JOHNSON 1.50

Page 353: 附件二 藥品給付品項暨支付標準表

NC017741G0CHLORPHENIRAMINE MALEATE TABLETS 8MG "JOHNSON(鋁箔/膠箔)

2.00

NC01780100 BENTYLINE-S TABLETS "JOHNSON" 1.50

NC01783100 UROGEN S.C. TABLETS "JOHNSON" 1.50

NC017831G0 UROGEN S.C. TABLETS "JOHNSON" (瓶裝/42粒/瓶) 2.00

NC01790100 MUSCOL TABLETS 200MG "JOHNSON" 1.50

NC01794100 BETHANECHOL CHLORIDE TABLETS 10MG "JOHNSON" 1.50

NC01796100 METHYLTESTOSTERONE TABLETS 10MG "JOHNSON" 1.93

NC01803100 AMINOPHYLLINE TABLETS 200MG "JOHNSON" 1.50

NC01807100 PELONINE-R TABLETS "JOHNSON" 1.50

NC01808100 BISMUTH SUBCARBONATE TABLETS 324MG "JOHNSON" 1.50

NC01811100 METROZOLE ORAL S.C. TABLETS "JOHNSON" 1.52

NC01817100 NOSCOTIN TABLETS 20MG "JOHNSON" 0.94

NC01820100 BENTYLINE TABLETS "JOHNSON" 1.50

NC01821100 PYRIDOXINE HCL TABLETS 50MG "JOHNSON" 1.50

NC01822100 FERROUS GLUCO-B S.C. TABLETS 1.50

NC018221G0 FERROUS GLUCO-B S.C. TABLETS(鋁箔/膠箔) 2.00

NC01851100 CHYMOSIN TABLETS "JOHNSON" 1.50

NC01870238 DABION INJECTION 25MG 15.00

NC01976209 VAGOSTIN INJECTION 15.00

NC02046209 DESPAS INJECTION 15.00

NC02090209 PHYTONADIONE INJECTION 10MG "TBC" 15.00

NC02121100 SENLIS TABLETS 1.50

NC02124100 AMMONIUM CHLORIDE ENTRIC S.C. TABLETS 1.50

NC02211100 SCOMINE S.C. TABLETS 10MG "JOHNSON" 1.50

NC02213100 PELONINE TABLETS "JOHNSON" 1.50

NC022131G0 PELONINE TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC02256238 TILISE-DEXTROSE INJECTION "N.K." 15.00

NC02319100 NINLAXIN TABLETS 1.50

NC023191G0 NINLAXIN TABLETS(鋁箔/膠箔) 2.00

NC02342212 DESMAN INJECTION 17.40

NC02368100 BILIMYCIN CAPSULES "SWISS BRAND" 1.50

NC02473100 INDOME CAPSULES 25MG "F.Y." 1.50

NC024731G0 INDOME CAPSULES 25MG "F.Y."(鋁箔/膠箔) 2.00

NC02479100 PENICILLIN V TABLETS 400000U "C.C.P." 1.59

NC024791G0 PENICILLIN V TABLETS 400000U "C.C.P."(鋁箔/膠箔) 2.00

NC02507212 SINPHYLLIN INJECTION 15.00

NC02531100 DONISON TABLETS 1.50

NC025311G0 DONISON TABLETS(鋁箔/膠箔) 2.00

NC02535100 VITAPOLY TABLETS 1.50

NC02589100 PAPAVERINE HCL TABLETS 30MG "JOHNSON" 1.50

NC02593100 INDOMIN TABLETS 1.50

NC02596100 NEO-WEITUPIN TABLETS 1.50

NC02597100 KOLISIDE TABLETS 25MG 1.50

NC02599100 VOLIMIN TABLETS 1.50

NC02613100 PROPANLINE S.C. TABLETS 1.50

NC02637100 LIPAN CHEWABLE TABLETS 1.24

NC02704209 INJECTIO ATROPINI SULFATIS 0.05% "Y.Y." 15.00

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NC02781240 LYO-DONISON INJECTION 17.40

NC02789209 KATIMIN "1" INJECTION 10MG 15.00

NC02791100 DIHYDRODIAZID TABLETS 1.50

NC027911G0 DIHYDRODIAZID TABLETS(鋁箔/膠箔) 2.00

NC02812212 MELERMIN-H INJECTION 15.00

NC02816209 ALLERMIN INJECTION 15.00

NC02888212 LYOVITA-B12 INJECTION 15.30

NC02967209 INJECTIO DIPHENHYDRAMINI HYDROCHLORIDI 3% "Y.Y." 15.00

NC02980277 3% SODIUM CHLORIDE INJECTION "SINTONG" 25.00

NC03002209 CHLORPHENIRAMINE MALEATE INJECTION 5MG "SINTONG" 15.00

NC03055238 BLUTON INJECTION 50% "C.C.P" 15.00

NC03055277 BLUTON INJECTION 50% "C.C.P." 39.90

NC03058238 VITAGEN INJECTION "S.T." 20% 15.00

NC03063238 VITACAL INJECTION 15.00

NC03067209 COMBEPLEX INJECTION 15.00

NC03067229 COMBEPLEX INJECTION 15.00

NC03097100 DEXAMETHASONE TABLETS "C.C.P." 1.50

NC030971G0 DEXAMETHASONE TABLETS "C.C.P."(鋁箔/膠箔) 2.00

NC03159100 OLYMPIC HORMONE CAPSULES 2.73

NC03182209 ERGOVIN INJECTION 15.00

NC03196221 ALLECIUM B6 INJECTION 15.00

NC03213221 ASCORMIN INJECTION 15.00

NC033541G0 VISTARIL CAPSULES(鋁箔/膠箔) 2.00

NC03379100 KIBO TABLETS 1.50

NC03414100 GRUVIN TABLETS 1.50

NC034141G0 GRUVIN TABLETS(鋁箔/膠箔) 2.00

NC03418100 NEO-VIBON-S S.C. TABLETS 1.50

NC03419100 ANCILLIN CAPSULES 1.50

NC034191G0 ANCILLIN CAPSULES(鋁箔/膠箔) 2.00

NC034491G0 TABELLAE EPHEDRINI HYDROCHLORIDI "Y.Y."(鋁箔/膠箔) 2.00

NC03516100 BUSCOTON S.C. TABLETS "H.L" 1.50

NC03540212 METHON-S INJECTION 15.00

NC03633100 TABELLAE AMINOPHYLLINAE 100MG "Y.Y." 1.50

NC036331G0 TABELLAE AMINOPHYLLINAE 100MG "Y.Y."(鋁箔/膠箔) 2.00

NC03657100 THIAGEN F S.C. TABLETS 50MG "HL" 1.50

NC03659100 IMIPRAMINE CAPSULES "H.L" 1.55

NC03667100 L.A. TABLETS "JOHNSON" 1.50

NC036671G0 L.A. TABLETS "JOHNSON"(瓶裝/42粒/瓶) 2.00

NC036671GA L.A. TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC03675100 A.H.P. TABLETS "JOHNSON" 1.50

NC036751G0 A.H.P. TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC03676100 SLEEPIN TABLETS "JOHNSON" 1.50

NC036761G0 SLEEPIN TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC03776100 ASCORBIC ACID S.C. TABLETS 200MG "HL" 1.50

NC03893100 PEITAON S.C. TABLETS 1.50

NC038931G0 PEITAON S.C. TABLETS(鋁箔/膠箔) 2.00

NC04085100 ALINAMIN-F 50 S.C. TABLETS 1.50

NC040851G0 ALINAMIN-F 50 S.C. TABLETS 2.00

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NC04245100 TABELLAE DL-METHYL EPHEDRINE HCL "Y.Y." 1.50

NC042451G0 TABELLAE DL-METHYL EPHEDRINE HCL "Y.Y."(鋁箔/膠箔) 2.00

NC04248212 INJECTIO AMINOPHYLLIN 12.5% "Y.Y." 15.00

NC04385100 WINSUMIN F.C. TABLETS 12.5MG 1.50

NC04485100 WINHOAMIN S.C. TABLETS 25MG "HL" 1.50

NC04492100 PRESOLONE TABLETS"HL" 1.50

NC04497100 DEXAMETHASONE TABLETS “H.L.” 1.50

NC04498100 PROMETHAZINE S.C. TABLETS "HL" 1.50

NC04499100 WINHOAMIN S.C. TABLETS 50 MG "H.L" 1.50

NC04509100 SODIUM BICARBONATE TABLETS 1.50

NC04510100 ANIMIN S.C. TABLETS 4MG "F.Y." 1.50

NC04512100 DEMESON TABLETS 0.5MG "F.Y." 1.50

NC04516100 SLEEP TABLETS 5MG "F.Y." 1.50

NC045161G0 SLEEP TABLETS 5MG "F.Y."(鋁箔/膠箔) 2.00

NC04517100 COLSIN TABLETS 2MG "F.Y." 1.50

NC045171G0 COLSIN TABLETS 2MG "F.Y."(鋁箔/膠箔) 2.00

NC04582238 SODIUM BICARBONATE INJECTION "CHI SHENG" 15.00

NC04586238 5% SAL-BRON INJECTION "CHI SHENG" 15.00

NC04587209 LIQUOR RINGER INJECTION "CHI SHENG" 35.00

NC04587265 LIQUOR RINGER INJECTION "CHI SHENG" 22.00

NC04587277 LIQUOR RINGER INJECTION "CHI SHENG" 25.00

NC04707100 SORAFLEX TABLETS"HL" 1.50

NC04717100 ALEVIATIN & LUMINAL TABLETS "HL" 1.50

NC04780100 FULLSERPINE TABLETS 0.25MG "F.Y." 1.50

NC04799100 CAPSULAE TYTRACYCLINI HYDROCHLOIDI 250MG "Y.Y." 1.50

NC04875100 DIAPINE TABLETS 2MG "JOHNSON" 1.50

NC048751G0 DIAPINE TABLETS 2MG "JOHNSON"(鋁箔/膠箔) 2.00

NC04899238 LACTATE RINGER'S INJECTION "CHI SHENG" 15.00

NC04899277 LACTATE RINGER'S INJECTION "CHI SHENG" 25.00

NC04904238 GLUCO-METHIONIN B INJECTION 15.00

NC04905209 B-COMPLEX INJECTION "CHI SHENG" 15.00

NC04922229 AMINOPHYLLIN INJECTION "CHI SHENG" 15.00

NC049281G0 DailyCare Actibest S.C. Tablets 2.00

NC04968100 DECOTON TABLETS "N.C.P." 1.50

NC04971100 SOLA TABLETS "N.C.P." 1.50

NC04974100 TRANFLEX TABLETS "HL" 1.50

NC05014100 PREDNISOLONE 5MG TABLETS "WELCAN" 1.50

NC050141G0 PREDNISOLONE 5MG TABLETS "WELCAN"(鋁箔/膠箔) 2.00

NC05038100 DIPOXIDO CAPSULES "JOHNSON" 1.50

NC050381G0 DIPOXIDO CAPSULES "JOHNSON"(84粒/瓶) 2.00

NC05040100 PROCHLORPERAZINE MALEATE TABLETS "JOHNSON" 1.50

NC050401G0 PROCHLORPERAZINE MALEATE TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC05042100 INDOMESA CAPSULES "JOHNSON" 1.50

NC050421G0 INDOMESA CAPSULES "JOHNSON"(鋁箔/膠箔) 2.00

NC05069100 DEXAMETHASONE TABLETS " Y.Y." 1.50

NC05072100 BAYU TABLETS 1.50

NC050721G0 BAYU TABLETS(鋁箔/膠箔) 2.00

NC05219100 TRICON S.C. TABLETS "F.Y." 1.52

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NC05225100 SODIUM BICARBONATE TABLETS 0.3 GM "F.Y." 1.50

NC052251G0 SODIUM BICARBONATE TABLETS 0.3 GM "F.Y."(鋁箔/膠箔) 2.00

NC05226100 SODIUM BICARBONATE TABLETS 0.6 GM "F.Y." 1.50

NC052261G0 SODIUM BICARBONATE TABLETS 0.6 GM "F.Y."(鋁箔/膠箔) 2.00

NC05229100 ANATEN TABLETS 10MG "F.Y." 1.50

NC05236100 PYRESON TABLETS"F.Y." 1.50

NC05245100 COLSIN 5MG TABLETS "F.Y." 1.50

NC052451G0 COLSIN 5MG TABLETS "F.Y."(鋁箔/膠箔) 2.00

NC052451G1 COLSIN 5MG TABLETS "F.Y."(21粒/瓶裝) 2.00

NC052451G5 COLSIN 5MG TABLETS "F.Y."(84粒/瓶裝) 2.00

NC05246100 DIWODON TABLETS "F.Y." 1.50

NC05328209 DEXAROID INJECTION 4 MG "CHI SHENG" 15.00

NC05328229 DEXAROID INJECTION 4 MG "CHI SHENG" 20.00

NC05334209 INJECTION DEXTROSIET SODII CHLORIDI "CHI SHENG" 35.00

NC05334238 INJECTION DEXTROSIET SODII CHLORIDI "CHI SHENG" 0.00

NC05334277 INJECTION DEXTROSIET SODII CHLORIDI "CHI SHENG" 25.00

NC05339238 20% GLUCOS INJECTION "CHI SHENG" 15.00

NC05340238 5% CALCIUM CHLORIDE INJECTION "CHI SHENG" 15.00

NC05342209 5% GLUCOS INJECTION "CHI SHENG" 35.00

NC05342238 5% GLUCOS INJECTION "CHI SHENG" 15.00

NC05342265 5% GLUCOS INJECTION "CHI SHENG" 22.00

NC05342277 5% GLUCOS INJECTION "CHI SHENG" 25.00

NC05344209 VITAMIN C INJECTION "CHI SHENG" 15.00

NC05344221 VITAMIN C INJECTION "CHI SHENG" 15.00

NC05347265 PU-I REPLENISHER NO.1 "CHI SHENG" 22.00

NC05347277 PU-I REPLENISHER NO.1 "CHI SHENG" 25.00

NC05348209 HYSCOPAN INJECTION "CHI SHENG" 15.00

NC05351209 10% GLUCOSE INJECTION "CHI SHENG" 35.00

NC05351277 10% GLUCOSE INJECTION "CHI SHENG" 25.00

NC05396100 NEOMYCIN CAP 1.88

NC05438100 TRANKINSON TABLETS "N.C.P." 1.50

NC05454100 PROCHLORPERAZINE MALEATE TABLETS "HL" 1.50

NC05508100 NALIDIN TABLETS 0.5GM "F.Y." 2.22

NC05612212 FUROSEMIDE INJECTION "N.K." 15.00

NC05616100 WINSUMIN F.C. TABLETS 25MG "JOHNSON" 1.50

NC056161G0 WINSUMIN F.C. TABLETS 25MG "JOHNSON" (84粒/瓶裝) 2.00

NC05854100 PRENIN TABLETS "N.C.P." 1.50

NC05874100 HYDROCHLOROTHIAZIDE TABLETS "N.C.P." 1.50

NC05932100 PHENOBARBITAL TABLETS 32 MG "F.Y." 1.50

NC059321G0 PHENOBARBITAL TABLETS 32 MG "F.Y." (鋁箔/膠箔) 2.00

NC06021100 O.G.S.C. TABLETS "JOHNSON" 1.50

NC060211G0 O.G.S.C. TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC06066209 VITAGEN INJECTION 5% 35.00

NC06066238 VITAGEN INJECTION 5% 15.00

NC06066255 VITAGEN INJECTION 5% 0.00

NC06066265 VITAGEN INJECTION 5% 0.00

NC06066277 VITAGEN INJECTION 5% 25.00

NC06067238 VITAGEN INJECTION 50% 15.00

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NC06067266 VITAGEN INJECTION 50% 39.90

NC06163100 PRESURIN TABLETS "S.C." 1.50

NC06263100 BISMUTH SUBCARBONATE TABLETS 1.50

NC062631G0 "BISMUTH SUBCARBONATE TABLETS""GCPC""(鋁箔/膠箔)" 2.00

NC06271100 "COLCHICINE TABLETS 0.5MG ""SYNMOSA"" 1.50

NC062711G0 "COLCHICINE TABLETS 0.5MG ""SYNMOSA""(鋁箔/膠箔)" 2.00

NC06306100 DEXASON TABLETS 0.5MG "LITA" 1.50

NC063061G0 DEXASON TABLETS 0.5MG "LITA"(鋁箔/膠箔) 2.00

NC06310100 ANATEN CAPSULES 10MG "F.Y." 1.50

NC06377229 AMINOPHYLLIN INJECTION "ORIENTAL" 15.00

NC06379212 PROPHYLLIN M INJECTION 15.00

NC06480238 NEO-VITABOSE INJECTION "CHI SHENG" 15.00

NC06489212 POSINTIN INJECTION 15.00

NC06513212 VITACICOL INJECTION 15.00

NC06514265 DEXTROSE IN SALINE INJECTION 22.00

NC06514277 DEXTROSE IN SALINE INJECTION 25.00

NC06528221 VENACALO-B6 INJECTION 15.00

NC06650209 CYANOCOBALAMIN INJECTION 1000MCG/ML "N.K." 15.00

NC06650229 CYANOCOBALAMIN INJECTION 1000MCG/ML "N.K." 15.40

NC06766100 CHLORTETRACYCLINE HCL CAPSULES 250MG "LITA" 1.50

NC06780100 OXYTETRACYCLINE HCL CAPSULES 250MG "LITA" 1.50

NC06845209 NE0-BENAMIN INJECTION 15.00

NC06854212 PHENINE-H INJECTION 15.00

NC06858212 VITAMIN C INJECTION "ORIENTAL" 15.00

NC06862221 MAGENSTIN INJECTION 15.00

NC07189212 DIPHYLLINE INJECTION "LITA" 15.00

NC07262209 RINGER'S SOLUTION 35.00

NC07262277 RINGER'S SOLUTION 25.00

NC07380100 ALINAMIN-F 100 S.C. TABLETS 2.70

NC07547100 FOLIC ACID TABLETS 1.50

NC075471G0 "FOLIC ACID TABLETS 5MG""GCPC""(鋁箔/膠箔)" 2.00

NC07548100 "ACETAZOLAMIDE TABLETS ""N.Y.""" 1.50

NC07724221 THIOCTOSAN INJECTION 15.00

NC07734212 SCOPOMIN INJECTION "ASTAR" 15.00

NC07755421 SUPER SALOON EYE LOTION 12.10

NC07870100 PROCIL TABLETS 1.90

NC078701G0 PROCIL TABLETS(鋁箔/膠箔) 2.00

NC07872100 ERGONOVINE MALEATE TABLETS 1.50

NC08035212 CILNIN INJECTION "ASTAR" 15.00

NC08039209 DIPHENHYDRAMINE HCL INJECTION "ASTAR" 15.00

NC08061209 EPHEDRINE HYDROCHLORIDE INJECTION 15.00

NC08138100 TRICOZIDE TABLETS "JOHNSON" 1.50

NC081381G0 TRICOZIDE TABLETS "JOHNSON"(鋁箔/膠箔) 2.00

NC08167100 INDOMEN CAPSULES "Y.S." 1.50

NC081671G0 INDOMEN CAPSULES "Y.S."(鋁箔/膠箔) 2.00

NC08387212 METHODEX G INJECTION 15.00

NC08389212 METHIVITAN-S INJECTION 15.00

NC08393209 METHOXINE M INJECTION 15.00

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NC08393212 METHOXINE M INJECTION 15.00

NC08792238 METHICOSE INJECTION 15.00

NC08800209 DEXAMESONE INJECTION 4MG "T.F." 15.00

NC08800229 DEXAMESONE INJECTION 4MG/ML "T.F." 20.00

NC09187100 DL-METHYLEPHEDRINE HCL TABLETS 1.50

NC09234277 AMINOL-S INJECTION 71.00

NC09236100 SULFADIAZINE TABLETS 1.50

NC09649417 BACITRACIN OPHTHALMIC OINTMENT "GCPC" 12.10

NC09768238 KANCAL-G INJECTION 15.00

NC09840209 BUSTON INJECTION 15.00

NC09857100 CORTISONE TABLETS 1.50

NC09994229 ASIPHYLLINE INJECTION 15.00

NC09997209 ISOTONIC SODIUM CHLORIDE SOLUTION(塑膠瓶) 35.00

NC09997277 ISOTONIC SODIUM CHLORIDE SOLUTION(塑膠瓶) 25.00

NC10002212 "T.F." VITACIN INJECTION 15.00

NC10004212 Vitamin B1 Injection 50mg/ml "T.F." 15.00

NC10213212 BISOTIN INJECTION "N.K." 15.00

NC10468100 DUPIN TABLETS 1.50

NC104681G0 DUPIN TABLETS(鋁箔/膠箔) 2.00

NC10645100 REX CAPSULES 1.93

NC10862100 BISMUTH SUBCARBONATE TABLETS "WASHINGTON" 1.50

NC10886209 PREDNISOLONE INJECTION "T.F." 15.00

NC10887229 AMINOPHYLLIN INJECTION "T.F." 15.00

NC10896209 VITAMIN B6 INJECTION 50MG "G.L." 15.00

NC10908238 PYRIDO-CALCIUM INJECTION 15.00

NC10913238 NEO-METHIOVITA INJECTION "ASTAR" 15.00

NC10915238 NEO-BILNIN INJECTION "ASTAR" 15.00

NC11133417 NEOBACIN OPHTHALMIC OINTMENT 25.90

NC11269100 DOLTON E.S.C. TABLETS 5MG(BISACODYL) 1.50

NC112691G0 DOLTON E.S.C. TABLETS 5MG(BISACODYL)(鋁箔/膠箔) 2.00

NC11290100 ONE-RESEM S.C. TABLETS 1.50

NC11357209 DEXARON INJECTION 15.00

NC11357229 DEXARON INJECTION 20.00

NC11607100 PREDNISOLONE TABLETS "SINTONG" 1.50

NC11747151 COUGH SYRUP WITH CODEINE "CBC" 25.00

NC11865100 ERGOFFEINE TABLETS "HONTEN" 1.50

NC11931435 BIOMYCIN NASAL SPRAY "CBC" 33.40

NC11948100 DECAZON TABLETS "CBC" 1.50

NC11950100 KEETOMIN S.C. TABLETS "CBC" 0.00

NC12059212 GLIAGEN-H INJECTION "Y.Y." 15.00

NC12113100 FOLIC ACID TABLETS 10MG"GCPC" 1.50

NC12165100 "ULCERMIN TABLETS ""H.C.""" 1.50

NC12342421 LIXAMIN EYE DROPS 12.20

NC12342429 LIXAMIN EYE DROPS 25.40

NC12380221 POTASSIUM CHLORIDE INJECTION "SINTONG" 0.00

NC12702212 BILCININ INJECTION "ASTAR" 15.00

NC12714100 DOMISUI-N TABLETS 5MG "CBC" 0.00

NC12732100 ERGONOVINE MALEATE TABLETS 0.2MG "CBC" 1.50

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NC12741100 PRESOLONE TABLETS 5MG "CBC" 1.50

NC12914100 DIAPINE TABLETS 5MG "JOHNSON" 1.50

NC129141G0 DIAPINE TABLETS 5MG "JOHNSON"(鋁箔/膠箔) 2.00

NC12925209 B-COMPLEX INJECTION "N.K." 15.00

NC12925229 B-COMPLEX INJECTION "N.K." 15.00

NC13075100 NOVOMIT TABLETS 1.50

NC130751G0 NOVOMIT TABLETS(鋁箔/膠箔) 2.00

NC13083100 ERGOLATE TABLETS 1.50

NC13093100 DEXAMETHASONE TABLETS "SENTAI" 1.50

NC13141209 VITAGEN INJECTION 10% "S.T." 35.00

NC13141277 VITAGEN INJECTION 10% "S.T." 25.00

NC13247151 ANTICO SYRUP WITH CODEINE 25.00

NC13247157 ANTICO SYRUP WITH CODEINE 25.80

NC13404100 PREDNISOLONE TABLETS "CHINTENG" 1.50

NC134041G0 PREDNISOLONE TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

NC13419100 PHENOBARBITAL TABLETS "Y.Y." 1.50

NC134191G0 PHENOBARBITAL TABLETS "Y.Y."(鋁箔/膠箔) 2.00

NC13481100 PREDNISOLONE TABLETS "WASHINGTON" 1.50

NC13507321 PRESOLON OINTMENT 10.20

NC13507329 PRESOLON OINTMENT 0.00

NC13507340 PRESOLON OINTMENT 41.60

NC13508329 BIOMYCIN OINTMENT "CBC" 13.70

NC13508338 BIOMYCIN OINTMENT "CBC" 28.80

NC13508345 BIOMYCIN OINTMENT "CBC" 44.10

NC13551100 SWISSMYLON TABLETS 2.22

NC13611209 HEPAPLEX-B INJECTION "Y.Y" 15.00

NC13753100 PRESON TABLETS "Y.K." 1.50

NC137531G0 PRESON TABLETS "Y.K."(鋁箔/膠箔) 2.00

NC13906100 TONFONRIN TABLETS "SWISS" 1.50

NC13913100 TETRACYCLINE HCL CAPSULES 250MG "SWISS" 1.50

NC139131G0 TETRACYCLINE HCL CAPSULES 250MG "SWISS"(鋁箔/膠箔) 2.00

NC13928100 ATROPINE SULFATE TABLETS "SHIN LON" 1.50

NC14145100 LIBMIN 1.50

NC14268100 METHYL TESTOSTERONE CAPSULES "SWISS" 1.93

NC142681G0 METHYL TESTOSTERONE CAPSULES "SWISS"(鋁箔/膠箔) 2.00

NC14286100 CHITOUNEN TABLETS "SWISS" 1.50

NC14296100 DEXAMETHASONE "SWISS" 1.50

NC14312100 NEO ZINE TABLETS 2MG "SWISS" 1.50

NC14318100 BOGEN-50 S.C. TABLETS 1.50

NC14321100 REZOXIN TABLETS 1.50

NC14787100 MEITAMIN S.C. TABLETS 1.50

NC14793155 BROCIN CODEINE SYRUP 25.80

NC15066100 ASNIN TABLETS "JOHNSON" 1.50

NC15101100 KOVIN TONG TABLETS 1.50

NC151011G0 KOVIN TONG TABLETS (鋁箔/膠箔) 2.00

NC15235100 PREDNISOLONE TABLETS "CHUNG MEI" 1.50

NC15343212 SHINMIOCHIEN INJECTION 15.00

NC15375212 STOMALLIN INJECTION 15.00

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NC15392100 TRANSAMIN CAPSULES 1.50

NC15685100 INDERSHIN CAPSULES 1.50

NC156851G0 INDERSHIN CAPSULES(鋁箔/膠箔) 2.00

NC15951157 CODECOL SYRUP 25.80

NC16157100 IMINE S.C. TABLETS 1.55

NC161571G0 IMINE S.C. TABLETS)(鋁箔/膠箔) 2.00

NC16158100 WEIZEL S.C. TABLETS 1.50

NC161581G0 WEIZEL S.C. TABLETS(鋁箔/膠箔) 2.00

NC16234100 FUDECHAN S.C. TABLETS 25MG 1.50

NC16235277 BLUPLEX INJECTION 25.00

NC16332100 RUMIL TABLETS 1.50

NC163321G0 RUMIL TABLETS(鋁箔/膠箔) 2.00

NC16430421 TETRACYCLINE HCL OPHTHALMIC OINTMENT 1% "KINGDOM" 16.60

NC164304A9 TETRACYCLINE HCL OPHTHALMIC OINTMENT 1% "KINGDOM" 12.00

NC16499100 CANALON TABLETS 1.50

NC16638335 ANCINALONE OINTMENT "N.C.P." 41.30

NC16644100 SURISHIA TABLETS 1.50

NC166441G0 SURISHIA S.C. TABLETS(鋁箔/膠箔) 2.00

NC166441G3 SURISHIA F.C. TABLETS "CHINTENG"(瓶裝/42粒/瓶) 2.00

NC16648100 COLONRAITAI TABLETS "CHINTENG" 1.50

NC166481G0 COLONRAITAI TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

NC16650100 DL-METHYLEPHEDRINE HCL TABLETS 1.50

NC166501G0 DL-METHYLEPHEDRINE HCL TABLETS(鋁箔/膠箔) 2.00

NC16652100 BISMUTH SUBCARBONATE TABLETS "CHINTENG" 1.50

NC166521G0 BISMUTH SUBCARBONATE TABLETS(鋁箔/膠箔) 2.00

NC16654421 MING MEI EYE DROPS "Y.Y." 12.20

NC16654429 MING MEI EYE DROPS "Y.Y." 25.40

NC16669209 HYDROXOCOBALAMIN INJECTION "Y.Y." 15.00

NC16669229 HYDROXOCOBALAMIN INJECTION "Y.Y." 15.40

NC16719212 COLMIN INJECTION 15.00

NC16753100 NOCOU TABLETS 1.50

NC16799100 VITAMIN K1 TABLETS 1.50

NC167991G0 VITAMIN K1 TABLETS(鋁箔/膠箔) 2.00

NC16929100 SHINSHINPEN F.C. TABLETS "CHINTENG" 1.50

NC169291G0 SHINSHINPEN F.C. TABLETS "CHINTENG"(鋁箔/膠箔) 2.00

NC16986209 HYDROXOCOBALAMIN INJECTION "T.F." 15.00

NC16986229 HYDROXOCOBALAMIN INJETION "T.F." 15.40

TPN0101209 CPN-A 0.00

TPN0102297 CPN-B 0.00

TPN0103209 CPN-C 0.00

TPN0104297 CPN-D 0.00

TPN0105277 TPN-1 0.00

TPN01062D3 CPN-A2 0.00

TPN01072D4 CPN-B2 0.00

TPN01082D3 CPN-C2 0.00

TPN01092D4 CPN-D2 0.00

TPN01102D3 CPN-E 0.00

TPN01112D4 CPN-F 0.00

Page 361: 附件二 藥品給付品項暨支付標準表

TPN01122D4 CPN-G 0.00

TPN01132D5 CPN-G2 0.00

TPN01142D4 CPN-H 0.00

TPN01152D5 CPN-H2 0.00

TPN0123299 TPN-NEO 1.37

TPN0124299 TPN-ADULT 0.72

TPN0125299 TPN-ADULT-BCAA RIBH 0.38

TPN0126299 TPN-PED 0.64

TPN0127299 NEO_STARTER 7.5 0.74

TPN0128299 NEO_STARTER 10 0.75

TPN0201209 TCVH1 0.69

TPN0202209 TCVH2 0.81

TPN0203209 TCVH3 0.00

TPN0204209 TCVHH 0.56

TPN0205209 TCVHR 0.50

TPN0206299 TCVH-0(1200ML) 0.35

TPN0207299 TCVH-NSPN-1(150ML) 1.54

TPN0208299 TCVH-N1(1300ML) 0.43

TPN0209299 TCVH-N2(1400ML) 0.40

TPN0210299 TCVH-N3(2000ML) 0.38

TPN0211299 TCVH-H1(1200ML) 0.31

TPN0212299 TCVH-H2(1300ML) 0.29

TPN0213299 TCVH-H3(1200ML) 0.26

TPN0214299 TCVH-H4(1300ML) 0.25

TPN0215299 TCVH-R1(1100ML) 0.33

TPN0216299 TCVH-R2(1200ML) 0.39

TPN0217299 TCVH-R3(1300ML) 0.37

TPN0301255 TPNP-1 0.38

TPN0302209 TPNP-10 0.26

TPN0303263 TPNP-2 0.29

TPN0304266 TPNP-3 0.26

TPN0305271 TPNP-4 0.25

TPN0306277 TPNP-5 0.24

TPN0307280 TPNP-6 0.27

TPN0308282 TPNP-7 0.27

TPN0309283 TPNP-8 0.26

TPN03102B9 TPNP-9 0.26

TPN0311212 TPNP-100 0.86

TPN0312212 TPN-105 0.90

TPN0313212 TPN-110 0.93

TPN0314209 TPN-20 0.47

TPN0315209 TPN-25 0.54

TPN0316212 TPN-30 0.37

TPN0317212 TPN-35 0.41

TPN0318212 TPN-40 0.44

TPN0319212 TPN-45 0.48

TPN0320212 TPN-50 0.51

TPN0321212 TPN-55 0.55

Page 362: 附件二 藥品給付品項暨支付標準表

TPN0322212 TPN-60 0.58

TPN0323212 TPN-65 62.00

TPN0324212 TPN-70 0.65

TPN0325212 TPN-75 0.69

TPN0326212 TPN-80 0.72

TPN0327212 TPN-85 0.76

TPN0328212 TPN-90 0.79

TPN0329212 TPN-95 0.83

TPN04012C0 TPAI-1 0.00

TPN04022A5 TPAI-2 0.00

TPN04032CP TPAI-3 0.00

TPN0404209 TPAI-4 0.00

TPN0405209 TPAI-5 0.00

TPN04062CQ TPPI-1 0.00

TPN04072CR TPPI-2 0.00

TPN04082CR TPPI-3 0.00

TPN0409299 TPNA-1 (1224ML) 署立新竹醫院 0.00

TPN0410299 TPNA-2 (1019ML) 署立新竹醫院 0.00

TPN0411299 TPNA-3 (1524ML) 署立新竹醫院 0.00

TPN0412299 TPNA-4 (1160ML) 署立新竹醫院 0.00

TPN0413299 TPNA-5 (1229ML) 署立新竹醫院 0.00

TPN0414299 TPNA-6 (1924ML) 署立新竹醫院 0.00

TPN0415299 TPNA-7 (1924ML) 署立新竹醫院 0.00

TPN0416299 KNO2 (1000ML) 署立新竹醫院 0.00

TPN0417299 KNO4 (1000ML) 署立新竹醫院 0.00

TPN0418299 KR01 (1000ML) 署立新竹醫院 0.00

TPN0419299 TPPI-4 (126ML) 署立新竹醫院 0.00

TPN0420299 TPPI-5 (106ML) 署立新竹醫院 0.00

TPN0421299 TPPI-6 (106ML) 署立新竹醫院 0.00

TPN0422299 PED-1 100ML 署立新竹醫院 0.91

TPN0423299 PED-2 100ML 署立新竹醫院 0.91

TPN0424299 PED-3 100ML 署立新竹醫院 1.05

TPN0425299 PED-4 100ML 署立新竹醫院 1.05

TPN0426299 PED-5 100ML 署立新竹醫院 1.06

TPN0427299 PED-6 100ML 署立新竹醫院 1.07

TPN0501209 TPN-1 0.79

TPN0502297 TPN-2 0.94

TPN05032CS TPN-3 0.87

TPN05042CT TPN-R 0.80

TPN0505297 TPN-H 0.00

TPN0506255 TPN-P1 1.10

TPN0507255 TPN-P2 1.31

TPN0508255 TPN-P3 1.52

TPN0509299 TPN-H (臺安醫院) 1200ML 0.00

TPN0510299 TPN-RHD (臺安醫院) 1009ML 0.00

TPN0601211 TPNA 0.00

TPN0602211 TPNB 0.00

TPN0603211 TPNC 0.00

Page 363: 附件二 藥品給付品項暨支付標準表

TPN0604211 TPND 0.00

TPN0605211 TPNE 0.00

TPN0606211 TPNF 0.00

TPN06072CU PPNSOL. 0.56

TPN06082A8 TPN-X 0.45

TPN07012CV TPN-1 0.00

TPN0702297 TPN-2 0.00

TPN07032CW TPN-3 0.00

TPN07042CX TPN-4 0.00

TPN07052A6 TPN-5 0.00

TPN0706261 TPN-6 1.50

TPN0707299 TPN7(STANDARD TPN) 1019ML (國泰綜合醫院) 0.32

TPN0708299 TPN8(HIGH PROTEIN TPN) 1165ML (國泰綜合醫院) 0.36

TPN0709299TPN9(PERIPHERAL PARENTALNUTRITION) 1265ML (國泰綜合醫

院)0.21

TPN0710299 TPN 10 0.51

TPN0711299 TPN B 0.39

TPN0712299 TP08 1000ML 0.46

TPN0801209 TPN RENAL 0.53

TPN0802209 TPN STANARD 0.91

TPN0803209 TPN HN 1.00

TPN0804209 TPN PERIPHERAL 0.50

TPN0805209 TPN HEPATIC 0.88

TPN0901209 TPN-A 0.00

TPN0902209 TPN-C 0.00

TPN0903209 TPN-E 0.62

TPN09042CY TPN-PED1 1.30

TPN09052CZ TPN-PED2 1.68

TPN09062D1 TPN-PED3 2.14

TPN09072D2 TPN-PED4 0.00

TPN0908299 TPNF 1300ML/BOT. 0.00

TPN0909299 TPN-G 0.33

TPN0910299 TPN-H 0.37

TPN1001209 TPN-A 0.00

TPN1002209 TPN-B 0.57

TPN1003209 TPN-C 0.64

TPN1004209 TPN-D 0.00

TPN1005209 TPN-E 0.00

TPN1006209 TPN-F 0.74

TPN1007209 TPN-G 0.00

TPN1008209 TPN R.F. 0.46

TPN1009209 TPN H.F. 0.53

TPN1010299 TPN N SOLN 1000ML/BAG 0.00

TPN1011299 TPN 1 (奇美醫院) 0.00

TPN1012299 TPN J (奇美醫院) 0.00

TPN1013299 TPN K(奇美醫院) 0.91

TPN1014299 TPN L(奇美醫院) 0.00

TPN1015299 KABIVEN PI 1.44L/BAG 0.71

Page 364: 附件二 藥品給付品項暨支付標準表

TPN1016299 SMOFKABIVEN-TPN 0.67

TPN1017299 TPN K1(100ML) 1.40

TPN1018299 SMOFKABIVEN-TPN PI-1(1462ML) 0.75

TPN1019299 OLICLINOMEL N-7-1000 E-TPN(1514ML) 1.16

TPN1101209 TPNA 0.00

TPN1102209 TPNB 0.00

TPN1103209 TPNC 0.00

TPN1104209 TPND 0.00

TPN1105209 TPNE 0.00

TPN1106209 TPNF 0.00

TPN1201209 TPNA-20 0.00

TPN1202209 TPNA-30 0.41

TPN1203209 TPNA-35 0.44

TPN1204209 TPNA-40 0.47

TPN1205209 TPNA-45 0.50

TPN1206209 TPNA-50 0.00

TPN1207209 TPNR-20 0.00

TPN1208209 TPNR-30 0.00

TPN1209209 TPNR-35 0.00

TPN1210209 TPNR-40 0.00

TPN1211209 TPNR-45 0.00

TPN1212209 TPNR-50 0.00

TPN1213209 TPNH-20 0.00

TPN1214209 TPNH-30 0.71

TPN1215209 TPNH-35 0.80

TPN1216209 TPNH-40 0.88

TPN1217209 TPNH-45 0.00

TPN1218209 TPNH-50 0.00

TPN1219255 TPNP-10 1.26

TPN1220263 TPNP-20 0.89

TPN1221266 TPNP-30 0.77

TPN1222271 TPNP-40 0.71

TPN1223277 TPNP-50 0.67

TPN1224280 TPNP-60 0.65

TPN1225282 TPNP-70 0.63

TPN1226283 TPNP-80 0.62

TPN12272B9 TPNP-90 0.60

TPN1228209 TPNP-100 0.60

TPN1232299 TPN C-9(1514ML) 0.47

TPN1233299 TPN F-1(1014ML) 0.57

TPN1234299 TPN O-4(1514ML) 0.68

TPN1235299 TPN-S75(1491ML) 0.92

TPN1236299 PPN-S46(1462ML) 0.63

TPN1301209 TPN-A 0.64

TPN1302209 TPN-B 0.00

TPN1303209 TPN-C 0.58

TPN1304209 TPN-D 0.00

TPN1305209 TPN-E 0.00

Page 365: 附件二 藥品給付品項暨支付標準表

TPN1306209 TPN-F 0.00

TPN1307209 TPN-G 1.03

TPN1308209 TPN-H 0.77

TPN1309209 TPN-I 0.00

TPN1310209 TPN-J 0.54

TPN1311209 TPN-K 0.71

TPN1312209 TPN-X 0.60

TPN1313299 TPN-H2 0.58

TPN1314299 TPN-J2 0.42

TPN1315299 TPN-K2 0.54

TPN1401209 5%TPN-PED 1000ML/BOT 0.47

TPN1402209 7.5%TPN-PED 1000ML/BOT 0.48

TPN1403209 10%TPN-PED 1000ML/BOT 0.60

TPN1404209 12.5%TPN-PED 1000ML/BOT 0.63

TPN1405209 20%TPN-PED 0.73

TPN1406209 5%PEDIATRIC TPN 1000ML/BOT 0.27

TPN1407209 7.5%PEDIATRIC TPN 1000ML/BOT 0.27

TPN1408209 10%PEDIATRIC TPN 1000ML/BOT 0.33

TPN1409209 12.5%PEDIATRIC TPN 1000ML/BOT 0.33

TPN1410209 20%PEDIATRIC TPN 1000ML/BOT 0.35

TPN1411209 10%ADULT TPN 1000ML/BOT 0.31

TPN1412209 15%ADULT TPN 1000ML/BOT 0.00

TPN1413209 20%ADULT TPN 1000ML/BOT 0.48

TPN1414209 25%ADULT TPN 1000ML/BOT 0.00

TPN1415209 30%ADULT TPN 1000ML/BOT 0.50

TPN1416209 35%ADULT TPN 1000ML/BOT 0.50

TPN1417297 20%ADULT TPN 1200ML/BOT 0.00

TPN1418209 LOW-PROTEIN 5% 0.00

TPN1419209 LOW-PROTEIN 7.5% 0.00

TPN1420209 LOW-PROTEIN 10% 0.00

TPN1421209 LOW-PROTEIN 12.5% 0.00

TPN1422209 LOW-PROTEIN 20% 0.00

TPN1423209 LOW-PROTEIN ADULT PTN 0.00

TPN1424209 HEPATIC FAILURE TPN 0.00

TPN1425209 RENAL FAILURE 20% TPN 0.00

TPN1426299 ADULT TPN-C 17.5% 1502.5ML 0.43

TPN1427299 ADULT TPN-C 7.5% 1502.5ML 0.35

TPN1428299 ADULT TPN-N 24% 1500ML 0.50

TPN1429299 TPN-NUTRIFLEX* 24% 1L(1000.5ML) 0.43

TPN15012D6 STANDARD TPN18% 0.82

TPN15022D7 STANDARD TPN+FAT18% 0.96

TPN15032D6 HIGH N TPN18% 0.76

TPN15042D7 HIGH N TPN+FAT18% 0.92

TPN15052D6 RENAL TPN18% 0.79

TPN15062D7 RENAL TPN+FAT18% 0.94

TPN15072D6 HEPATIC TPN18% 0.77

TPN15082D7 HEPATIC TPN+FAT18% 0.91

TPN15092D7 PERIPHERAL TPN12% 0.92

Page 366: 附件二 藥品給付品項暨支付標準表

TPN1510259 PEDIATRIC TPN 1.07

TPN16012D8 TPN-A 0.00

TPN16022D8 TPN-B 0.00

TPN1607299 0.92

TPN1608299 0.99

TPN1609299 TPN-I(1514ML) 0.68

TPN1610299 TPN-J(1491ML) 1.07

TPN17012E3 TPN-A SOLUTION 0.00

TPN17022E3 TPN-B SOLUTION 0.37

TPN17032E3 TPN-D SOLUTION 0.46

TPN17042E3 TPN-E SOLUTION 0.38

TPN17052E3 TPN-F SOLUTION 0.55

TPN17062E3 TPN-G SOLUTION 0.66

TPN17072E4 PEDIATRIC TPN-A SOLUTION 0.00

TPN17082E4 PEDIATRIC TPN-B SOLUTION 0.00

TPN17092E4 PEDIATRIC TPN-C SOLUTION 0.00

TPN17102E4 PEDIATRIC TPN-D SOLUTION 0.00

TPN1711299 PEDIATRIC TPN-A SOLUTION 0.00

TPN1712299 PEDIATRIC TPN-B SOLUTION 0.00

TPN1713299 PEDIATRIC TPN-C SOLUTION 0.00

TPN1714299 PEDIATRIC TPN-D SOLUTION 0.00

TPN1715299 TPN-H SOLUTION (新光紀念醫院) 0.48

TPN1716299 PEDIATRIC TPN-A SOLUTION (新光醫院) 0.64

TPN1717299 PEDIATRIC TPN-B SOLUTION (新光醫院) 0.80

TPN1718299 PEDIATRIC TPN-C SOLUTION (新光醫院) 0.00

TPN1719299 PEDIATRIC TPN-D SOLUTION (新光醫院) 0.51

TPN1720299 PEDIATRIC TPN-F 0.55

TPN1721299 PEDIATRIC TPN-G 0.69

TPN1722299 PEDIATRIC TPN-H 0.42

TPN1723299 Pediatric TPN- I 0.52

TPN1724299 PEDIATRIC TPN-J 0.51

TPN18012E5 TPN-1 0.60

TPN18022E6 TPN-2 0.59

TPN18032E7 TPN-3 0.00

TPN18042E7 TPN-4 0.00

TPN18052E5 TPN-5 0.61

TPN18062E6 TPN-6 0.00

TPN18072E8 TPN-7 0.63

TPN18082E9 TPN-8 0.62

TPN18092F1 TPN-9 0.00

TPN1810299 TPN-10 (沙鹿童綜合醫院) 0.47

TPN1811299 TPN-11 (沙鹿童綜合醫院) 0.00

TPN1812299 TPN-12 童綜合醫院 0.00

TPN1813299 TPN-13童綜合醫院 0.00

TPN1814299 TPN-14童綜合醫院 0.00

TPN1815299 TPN兒科配方(2) 0.84

TPN1816299 PPN肝功能不全配方(3) 0.27

TPN1817299 PPN肝功能不全配方(4) 0.21

Page 367: 附件二 藥品給付品項暨支付標準表

TPN1818299 PPN腎功能不全配方(3) 0.28

TPN1819299 PPN腎功能不全配方(4) 0.20

TPN1820299 TPN標準配方(1000ML) 0.53

TPN1821299 TPN肝功能不全配方(1150ML) 0.42

TPN1822299 TPN腎功能不全配方(900ML) 0.44

TPN1823299 TPN兒科配方(3)(300ML) 0.80

TPN1824299 PPN腎功能不全配方(5)(800ML) 0.36

TPN1825299 PPN肝功能不全配方(5)(1150ML) 0.39

TPN1901209 T15 0.00

TPN1902209 TPN-TH 0.70

TPN1903209 TR 0.75

TPN1904299 T.N (高雄中和紀念醫院) 1.30

TPN1905299 TPN-T16 1000ML 0.44

TPN2001280 TPNA 0.71

TPN2002280 TPNB 0.71

TPN2003277 PPNA 0.61

TPN2004255 NPN1 0.00

TPN20052AV NPN2 0.00

TPN2006257 NPN3 0.00

TPN20072AW NPN4 0.00

TPN2008265 NPN5 0.00

TPN2009299 TPN-1(1207ML) 0.37

TPN2117212 CSM 2040 0.00

TPN2117277 CSM 2040 0.00

TPN2118299 CSM 0815 2000ML/BTL 0.00

TPN2119299 CSM 1015 2000ML/BTL 0.00

TPN2120299 CSM 1220 2000ML/BTL 0.00

TPN2121299 CSM 1520 2000ML/BTL 0.00

TPN2122299 CSM 1730 2000ML/BTL 0.00

TPN2123299 CSM 2030 2000ML/BTL 0.00

TPN2124299 CSR 2515 2000ML/BTL 0.00

TPN2125299 CSH 2020 2000ML/BTL 0.00

TPN2126299 CSP 0515 500ML/BTL 0.00

TPN2127299 CSP 0815 500ML/BTL 0.00

TPN2128299 CSP 1015 500ML/BTL 0.00

TPN2129299 CSP 1020 500ML/BTL 0.00

TPN2130299 CSP 1220 500ML/BTL 0.00

TPN2131299 CSP 1530 500ML/BTL 0.00

TPN2132299 CSP 1730 500ML/BTL 0.00

TPN2133299 CSP 2030 500ML/BTL 0.00

TPN2134299 CSM1530 2000ML/BTL 0.00

TPN2135299 CSM2530 2000ML/BTL 0.00

TPN2136299 CSM2540 2000ML/BTL 0.00

TPN2137299 CSM2040 2000ML/BTL 0.00

TPN2138299 CSM 1030PPN 517.3ML (孫中山先生紀念醫院) 0.00

TPN2139299 CSM1335START 621.1ML (孫中山先生紀念醫院) 0.00

TPN2140299 CSM2540NORMAL 931.1ML (孫中山先生紀念醫院) 0.00

TPN2141299 CSM1640NORMAL 751.1ML (孫中山先生紀念醫院) 0.85

Page 368: 附件二 藥品給付品項暨支付標準表

TPN2142299 CSM1540NORMAL 731.1ML (孫中山先生紀念醫院) 0.88

TPN2143299 CSM2535NORMAL 881.1ML (孫中山先生紀念醫院) 0.00

TPN2144299 CSM1730NORMAL 671.1ML (孫中山先生紀念醫院) 0.77

TPN2145299 CSM1530NORMAL 631.1ML (孫中山先生紀念醫院) 0.82

TPN2146299 CSM1070HP 931.1ML (孫中山先生紀念醫院) 0.00

TPN2147299 CSM1170HP 951.1ML (孫中山先生紀念醫院) 0.00

TPN2148299 CSM1270HP 971.1ML (孫中山先生紀念醫院) 1.02

TPN2149299 CSM2050STRESS 931.1ML (孫中山先生紀念醫院) 0.82

TPN2150299 CSM2345STRESS 941.1ML (孫中山先生紀念醫院) 0.76

TPN2151299 CSH1640HEPAIC 851.1ML (孫中山先生紀念醫院) 0.77

TPN2152299 CSH1740HEPAIC 871.1ML (孫中山先生紀念醫院) 0.75

TPN2153299 CSR1740HD 912.1ML (孫中山先生紀念醫院) 0.76

TPN2154299 CSR1640HD 892.1ML (孫中山先生紀念醫院) 0.78

TPN2155299 CSR2530NHD 927.1ML (孫中山先生紀念醫院) 0.00

TPN2156299 CSR2825NHD 930.2ML (孫中山先生紀念醫院) 0.00

TPN2157299 CSP2040 408.6ML (孫中山先生紀念醫院) 1.56

TPN2158299 CSP1740 378.6ML (孫中山先生紀念醫院) 1.67

TPN2159299 CSP2030 358.6ML (孫中山先生紀念醫院) 0.00

TPN2160299 CSP1530 308.6ML (孫中山先生紀念醫院) 1.62

TPN2161299 CSP1330 288.6ML (孫中山先生紀念醫院) 1.72

TPN2162299 CSP1225 258.6ML (孫中山先生紀念醫院) 1.66

TPN2163299 CSP1220 228.6ML (孫中山先生紀念醫院) 1.59

TPN2164299 CSN2030 43.2ML (孫中山先生紀念醫院) 0.00

TPN2165299 CSN1530 34.2ML (孫中山先生紀念醫院) 0.00

TPN2166299 CSN1330 30.2ML (孫中山先生紀念醫院) 0.00

TPN2167299 CSN1225 28.2ML (孫中山先生紀念醫院) 0.00

TPN2168299 CSN1220 28.2ML (孫中山先生紀念醫院) 0.00

TPN2201209 TPN-A 0.00

TPN2202209 TPN-B 0.46

TPN2203209 TPN-C 0.00

TPN2204209 TPN-D 0.47

TPN2205263 PED. TPN-A 0.00

TPN2206263 PED. TPN-B 0.00

TPN2207263 PED. TPN-C 0.00

TPN2208263 PED. TPN-D 0.00

TPN23012F2 TPN 0.00

TPN23022F3 TPN 0.00

TPN23032F4 TPN 0.00

TPN2304299 TPNI 1202ML/BAG 0.58

TPN2305299 TPN II 702ML/BAG 0.48

TPN2306299 TPN III 1802ML/BAG 0.81

TPN2307299 TPN IV 1421ML/BAG 0.46

TPN2308299 TPN 8 0.00

TPN2309299 TPN 9 0.00

TPN2310299 TPN 10 0.00

TPN2311299 TPN 11 0.00

TPN2401209 TPN-NORMAL 1000ML/BOT 0.00

TPN2402209 TPN 0.00

Page 369: 附件二 藥品給付品項暨支付標準表

TPN2403209 TPN 0.00

TPN25012F2 TPN 0.00

TPN25022F3 TPN 0.00

TPN25032F5 TPN 0.00

TPN25042F6 TPN 0.86

TPN25052F6 TPN 0.00

TPN25062F3 TPN 0.00

TPN25072F6 TPN 0.00

TPN25082F4 TPN 0.00

TPN25092F4 TPN 0.00

TPN25102F7 TPN 0.00

TPN26012F8 TPN-A 0.00

TPN26022F8 TPN-B 0.00

TPN27012F9 TPN 1.02

TPN27022F9 1.02

TPN27032FA 0.00

TPN27042FA TPN 0.00

TPN27052F9 TPN 0.84

TPN27062FK TPN-N 0.00

TPN27072FL TPN-I 0.00

TPN27082FM TPN-T 0.00

TPN27092FN TPN-C 0.00

TPN27102G9 TPN-P1 447.55ML/BOT 0.00

TPN27112GA TPN-P2 748.5ML/BOT 0.00

TPN27122GB TPN-P3 1501.65ML/BOT 0.00

TPN27132GC TPN-P4 2295.7ML/BOT 0.00

TPN27142GD TPN-P5 3166.25ML/BOT 0.00

TPN27152GE TPN 0.00

TPN27162GF TPN-P7 5049.7ML/BOT 0.00

TPN27172GG TPN-P8 6463.5ML/BOT 0.00

TPN2718299 TPN-P9 222.55ML/BOT 0.00

TPN2719299 TPN-P10 373.5ML/BOT 0.00

TPN2720299 TPN-P11 751.65ML/BOT 0.00

TPN2721299 TPN-P12 1295.7ML/BOT 0.00

TPN2722299 TPN-P13 1916.25ML/BOT 0.00

TPN2723299 TPN-P14 2506.2ML/BOT 0.00

TPN2724299 TPN-P15 3049.7ML/BOT 0.00

TPN2725299 TPN-P16 3963.5ML/BOT 0.00

TPN2726299 CPN-5 601ML/BOT 0.63

TPN2727299 CPN-6 602ML/BOT 0.64

TPN2728299 CPN-7 601ML/BOT 0.00

TPN2729299 CPN-8 602ML/BOT 0.00

TPN2730299 CPN-9 501ML/BOT 0.00

TPN2731299 CPN-10 502ML/BOT 0.00

TPN2732299 CPN-11 601ML/BOT 0.00

TPN2733299 CPN-12 602ML/BOT 0.00

TPN2734299 PED TPN (三軍總醫院) 302ML 1.06

TPN2735299 CPN-NORMAL 0.63

Page 370: 附件二 藥品給付品項暨支付標準表

TPN2736299 CPN-HIGH PROTEIN 0.72

TPN2737299 CPN-RENAL PROTEIN 0.48

TPN2738299 CPN-LIVER PROTEIN 0.32

TPN2739299 PED CPN-1 INJ 0.83

TPN2740299 PED CPN-2 INJ(6~12M) 0.90

TPN2741299 PED CPN-3 INJ(1~7Y) 0.44

TPN2742299 PED CPN-4 INJ(7~12Y) 0.44

TPN2743299 PED CPN-5 INJ(12~18Y) 0.41

TPN2744299 PED PPN-1 INJ(<6M) 0.45

TPN2745299 PED PPN-2 INJ(6~12M) 0.42

TPN2746299 PED PPN-3 INJ(1~7Y) 0.22

TPN2747299 PED PPN-4 INJ(7~12Y) 0.26

TPN2748299 PED PPN-5 INJ(12~18Y) 0.25

TPN2749299 CPN-NORMAL 0.64

TPN2750299 CPN-HIGH PROTEIN 0.74

TPN2751299 CPN-RENAL PROTEIN 0.52

TPN2752299 CPN-LIVER PROTEIN 0.34

TPN2753299 PED CPN-1 INJ(<6M) 0.89

TPN2754299 PED CPN-2 INJ(6~12M) 0.96

TPN2755299 PED CPN-3 INJ(1~7Y) 0.47

TPN2756299 PED CPN-4 INJ(7~12Y) 0.47

TPN2757299 PED CPN-5 INJ(12~18Y) 0.43

TPN2758299 PED PPN-1 INJ(<6M) 0.48

TPN2759299 PED PPN-2 INJ(6~12M) 0.46

TPN2760299 PED PPN-3 INJ(1~7Y) 0.24

TPN2761299 PED PPN-4 INJ(7~12Y) 0.28

TPN2762299 PED PPN-5 INJ(12~18Y) 0.27

TPN28012FB TPN-A 0.00

TPN28022FC TPN-B 0.00

TPN28032FD TPN-C 0.00

TPN28042FE TPN-D 0.00

TPN28052FF TPN-E 0.00

TPN28062FB TPN-F 0.00

TPN2807209 PPN-A 0.00

TPN2808209 PPN-B 0.00

TPN2809209 PPN-C 0.00

TPN2810209 PPN-D 0.00

TPN28112AV PPN-E 0.00

TPN2812209 PPN-F 0.00

TPN2813209 PPN-G 0.00

TPN2814209 PPN-H 0.00

TPN2815209 PPN-I 0.00

TPN28162AV PPN-J 0.00

TPN28172AV PPN-K 0.00

TPN2901209 TPN A 0.00

TPN2902209 TPN B 0.00

TPN2903209 TPN C 0.00

TPN2904209 TPN D 0.00

Page 371: 附件二 藥品給付品項暨支付標準表

TPN2905209 TPN E 0.00

TPN2906209 TPN F 0.00

TPN2907209 TPN G 0.00

TPN2908209 TPN H 0.00

TPN2909209 TPN I 0.00

TPN2910209 TPN J 0.00

TPN30012FH TPN-1 0.47

TPN30022FI TPN-2 0.55

TPN30032FJ TPN-3 0.65

TPN3004299 FORMULAL 1 台北醫學大學附醫 0.00

TPN3005299 FORMULAL 2 台北醫學大學附醫 0.85

TPN3006299 FORMULAL 3 台北醫學大學附醫 0.00

TPN3007299 FORMULAL 4 台北醫學大學附醫 0.58

TPN3008299 FORMULAL 5 台北醫學大學附醫 0.62

TPN3009299 FORMULAL 6 台北醫學大學附醫 0.00

TPN3010299 FORMULAL 7 台北醫學大學附醫 0.98

TPN3011299 FORMULAL 8 台北醫學大學附醫 0.89

TPN3101209 TPN-A 1000ML/BOT 0.79

TPN3102209 TPN-B 1000ML/BOT 0.94

TPN3103209 TPN-C 1000ML/BOT 0.31

TPN3104209 TPN-D 1000ML/BOT 0.90

TPN3105209 TPN-E 1000ML/BOT 0.63

TPN3106299 TPN-P (慈濟醫院) 1.30

TPN32012F0 PN-P1 1518ML/BOT 0.00

TPN32022F0 PN-P2 1518ML/BOT 0.00

TPN32032F0 PN-P3 1518ML/BOT 0.00

TPN32042FP PN-P4 1768/BOT 0.00

TPN32052FQ PN-P5 2728ML/BOT 0.00

TPN32062FQ PN-P6 2728ML/BOT 0.00

TPN32072FQ PN-P7 2728ML/BOT 0.00

TPN32082FR PN-P8 2978ML/BOT 0.00

TPN32092FS PN-A1 1318ML/BOT 0.00

TPN32102FS PN-A2 1318ML/BOT 0.00

TPN32112FT PN-A3 1568ML/BOT 0.00

TPN32122FU PN-A4 2328ML/BOT 0.00

TPN32132FU PN-A5 2328ML/BOT 0.00

TPN32142FW PN-A6 2578ML/BOT 0.00

TPN32152FS PN-N1 1318ML/BOT 0.00

TPN32162FU PN-N2 2328ML/BOT 0.00

TPN32172FX PN-L1 1618ML/BOT 0.00

TPN32182FY PN-L2 1868ML/BOT 0.00

TPN32192FZ PN-L3 2428ML/BOT 0.00

TPN32202G1 PN-L4 2678ML/BOT 0.00

TPN32212FX PN-L5 1618ML/BOT 0.00

TPN32222FY PN-L6 1868ML/BOT 0.00

TPN32232FZ PN-L7 2428ML/BOT 0.00

TPN32242G1 PN-L8 2678ML/BOT 0.00

TPN32252G2 PN-R1 1368ML/BOT 0.00

Page 372: 附件二 藥品給付品項暨支付標準表

TPN32262FY PN-R2 1868ML/BOT 0.00

TPN32272FZ PN-R3 2428ML/BOT 0.00

TPN32282G1 PN-R4 2678ML/BOT 0.00

TPN32292G3 PN-C1 1218ML/BOT 0.00

TPN32302G4 PN-T1 918ML/BOT 0.00

TPN32312G4 PN-T2 918ML/BOT 0.00

TPN32322G5 PN-T3 2128ML/BOT 0.00

TPN32332G5 PN-T4 2128ML/BOT 0.00

TPN32342G6 PN-T5 818ML/BOT 0.00

TPN32352G6 PN-T6 818ML/BOT 0.00

TPN32362FU PN-T7 2328ML/BOT 0.00

TPN32372FU PN-T8 2328ML/BOT 0.00

TPN3238299 TPN 1 0.00

TPN3239299 TPN 2 0.00

TPN3240299 TPN 3 0.00

TPN3241299 TPN 4 0.00

TPN3242299 TPN 5 1.01

TPN3243299 TPN 6 0.00

TPN3244299 TPN 7 0.00

TPN3245299 TPN 8 0.00

TPN3254299 TPN1-A 48/100(818ML) 0.50

TPN3255299 TPN1-B 63/100(1318ML) 0.45

TPN3256299 TPN2-A 70/240(1018ML) 0.54

TPN3257299 TPN2-B 72/150(1218ML) 0.45

TPN3258299 PPN3-A 40/80(1018ML) 0.50

TPN3259299 PPN3-B (GLYCEROL)(518ML) 0.60

TPN3260299 PPN3-C 46/103/41(1466ML) 0.66

TPN3261299 TPN4-A 18/100(668ML) 0.43

TPN3262299 TPN2-C 75/187/56(1492ML) 0.94

TPN3263299 PPN3-D(1018ML) 0.47

TPN3264299 TPN9-A(1018ML) 0.63

TPN34012G7 TPN-A1904ML/BAG 0.00

TPN34022G7 TPN-B1904ML/BAG 0.00

TPN34032G7 TPN-C1904ML/BAG 0.00

TPN34042G7 TPND1904ML/BAG 0.00

TPN34052G8 TPN-E1804ML/BAG 0.00

TPN34062G8 TPN-F1804ML/BAG 0.00

TPN34072G8 TPN-G1804ML/BAG 0.00

TPN3408299 TPN-G1 1816ML (台北巿立仁愛醫院) 0.00

TPN3409299 TPN-G2 1816ML (台北巿立仁愛醫院) 0.00

TPN3410299 TPN-A 1916ML (台北巿立仁愛醫院) 0.00

TPN3411299 TPN-B 1916ML (台北巿立仁愛醫院) 0.00

TPN3412299 TPN-C 1914ML (台北巿立仁愛醫院) 0.00

TPN3413299 TPN-D 1914ML (台北巿立仁愛醫院) 0.00

TPN3414299 TPN-E 1814ML (台北巿立仁愛醫院) 0.00

TPN3415299 TPN-F 1814ML (台北巿立仁愛醫院) 0.00

TPN3501280 TPN A 600ML/BOT 0.00

TPN3502280 TPN B 600ML/BOT 0.00

Page 373: 附件二 藥品給付品項暨支付標準表

TPN3503299 START (豐原醫院) 0.00

TPN3504299 NORMAL (豐原醫院) 0.00

TPN3505299 HP (豐原醫院) 0.00

TPN3506299 PPN (豐原醫院) 0.00

TPN3507299 HEPAIC (豐原醫院) 0.00

TPN3508299 HD (豐原醫院) 0.00

TPN3509299 NHD (豐原醫院) 0.00

TPN3510299 NHO (豐原醫院) 0.00

TPN3511299 PED (豐原醫院) 0.00

TPN3512299 TPN 1 (豐原醫院) 0.70

TPN3513299 TPN 2 (豐原醫院) 0.47

TPN3514299 TPN 3 (豐原醫院) 0.65

TPN3515299 TPN 4 (豐原醫院) 0.41

TPN3516299 TPN 5 (豐原醫院) 0.00

TPN3517299 TPN 6 (豐原醫院) 0.62

TPN3518299 TPN 7 (豐原醫院) 0.62

TPN3601209 TPN-1-A 1000ML/BAG 0.00

TPN3602210 TPN-2 1500ML/BAG 0.00

TPN3603210 TPN-3 1500ML/BAG 0.00

TPN3604210 TPN-4 1500ML/BAG 0.00

TPN3605210 TPN-5 1500ML/BAG 0.00

TPN3606210 TPN-6 1500ML/BAG 0.00

TPN3607210 TPN-7 1500ML/BAG 0.00

TPN3608210 TPN-8 1500ML/BAG 0.00

TPN3609210 TPN I-B 1500ML/BAG 0.00

TPN3610212 TPN-9 2000ML/BAG 0.00

TPN3611212 TPN-10 2000ML/BAG 0.00

TPN3612212 TPN-C 2000ML/BAG 0.00

TPN3613209 TPN II-A 1000ML/BAG 0.52

TPN3614212 TPN II-B 2000ML/BAG 0.00

TPN3615299 FORMULA 1 (????????????????) 0.00

TPN3616299 FORMULA 2 (????????????????) 0.36

TPN3617299 FORMULA 3 (????????????????) 0.00

TPN3618299 FORMULA 4 (????????????????) 0.00

TPN3619299 FORMULA 5 (????????????????) 0.00

TPN3620299 FORMULA 6 (????????????????) 0.48

TPN3639299 K3PO4 5ML IN N/S 500ML 0.06

TPN3640299 K3PO4 5ML IN D2.5%/S0.45% 500ML 0.06

TPN3665299 CPN-1 1001ML 0.35

TPN3666299 CPN-2 1201ML 0.32

TPN3667299 CPN-3 1502ML 0.29

TPN3668299 CPN-4 1902ML 0.26

TPN3669299 CPN-5 1201ML 0.28

TPN3670299 PED-1 371ML 0.24

TPN3701299 ADULT-A 1000ML/BAG 0.00

TPN3702299 ADULT-B 1000ML/BAG 0.00

TPN3703299 ADULT-C 1000ML/BAG 0.00

TPN3704299 ADULT-D 1000ML/BAG 0.00

Page 374: 附件二 藥品給付品項暨支付標準表

TPN3705299 ADULT-E 1000ML/BAG 0.00

TPN3706299 ADULT-F 1000ML/BAG 0.00

TPN3707299 CHILD-A 1000ML/BAG 0.00

TPN3708299 CHILD-B 1000ML/BAG 0.00

TPN3709299 CHILD-C 1000ML/BAG 0.00

TPN3710299 CHILD-D 1000ML/BAG 0.00

TPN3711299 CHILD-E 1000ML/BAG 0.00

TPN3712299 CHILD-F 1000ML/BAG 0.00

TPN3801299 TPN I 1004ML/BAG 0.00

TPN3802299 TPN II 1204ML/BAG 0.00

TPN3803299 TPN III 1204ML/BAG 0.00

TPN3804299 TPN IV 1204ML/BAG 0.00

TPN3805299 TPN V 889ML/BAG 0.00

TPN3806299 TPN VI 739ML/BAG 0.00

TPN3807299 TPN VII 889ML/BAG 0.00

TPN3808299 TPN VIII 739ML/BAG 0.00

TPN3809299 TPN 1X 342.5ML/BAG 0.00

TPN3810299 TPN X 342.5ML/BAG 0.00

TPN3811299 TPN XI 342.5ML/BAG 0.00

TPN3812299 TPN 1 0.00

TPN3813299 TPN 2 0.00

TPN3814299 TPN 3 0.00

TPN3815299 TPN 5 0.00

TPN3816299 TPN 6 0.00

TPN3817299 TPN I 1057CC 0.26

TPN3818299 TPN II 1307CC 0.29

TPN3819299 TPN III 1307CC 0.38

TPN3820299 TPN IV 1307CC 0.62

TPN3824299 TPN24(1056ML) 0.42

TPN3825299 TPN21(1056ML) 0.33

TPN3826299 TPN22(1306ML) 0.35

TPN3827299 TPN23(1306ML) 0.32

TPN3828299 TPN25(1056ML) 0.30

TPN3829299 TPN26(1306ML) 0.33

TPN3830299 TPN27(1306ML) 0.30

TPN3831299 TPN28(1056ML) 0.40

TPN3901299 TPNS1 1405ML/PKG 0.00

TPN3902299 TPNS2 2005ML/PKG 0.00

TPN3903299 TPNS3 2605ML/PKG 0.00

TPN3904299 TPNH1 1555ML/PKG 0.00

TPN3905299 TPNH2 1955ML/PKG 0.00

TPN3906299 TPNH3 2355ML/PKG 0.00

TPN3907299 TPNR1 1455ML/PKG 0.00

TPN3908299 TPNR2 2055ML/PKG 0.00

TPN3909299 TPNR3 2055ML/PKG 0.00

TPN3910299 TPN HN1 1655ML/PKG 0.00

TPN3911299 TPN HN2 2255ML/PKG 0.00

TPN3912299 TPN PED-1 226ML/PKG 0.00

Page 375: 附件二 藥品給付品項暨支付標準表

TPN3913299 TPNS1 1461ML/PKG 0.00

TPN3914299 TPNS2 2061ML/PKG 0.00

TPN3915299 TPNS3 2661ML/PKG 0.00

TPN3916299 TPNH1 1561ML/PKG 0.00

TPN3917299 TPNH2 1961ML/PKG 0.00

TPN3918299 TPNH3 2361ML/PKG 0.00

TPN3919299 TPN R1 1461ML/PKG 0.00

TPN3920299 TPN R2 2061ML/PKG 0.00

TPN3921299 TPN R3 2661ML/PKG 0.00

TPN3922299 TPN H1 1661ML/PKG 0.00

TPN3923299 TPN H2 2261ML/PKG 0.00

TPN3924299 TPN PED-1 0.00

TPN3925299 TPN S1 1461ML 0.00

TPN3926299 TPN S2 2061ML 0.00

TPN3927299 TPN S3 2661ML 0.00

TPN3928299 TPN H1 1561ML 0.00

TPN3929299 TPN H2 1961ML 0.00

TPN3930299 TPN H3 2361ML 0.00

TPN3931299 TPN R1 1461ML 0.00

TPN3932299 TPN R2 2061ML 0.00

TPN3933299 TPN HN1 1261ML 0.00

TPN3934299 TPN HN2 1761ML 0.00

TPN3935299 TPN HN3 2261ML 0.00

TPN3942299 TPN KC 2064ML 0.87

TPN3943299 TPN KP 1451ML 0.87

TPN3953299 TPN HN1 1.04

TPN3954299 TPN HN2 1.02

TPN3955299 PPN LP 0.70

TPN3956299 PPN NP 0.45

TPN3957299 TPNS1(1456ML) 0.49

TPN3958299 TPNS2(2056ML) 0.45

TPN3959299 TPNH1(1556ML) 0.44

TPN3960299 TPNR1(1456ML) 0.45

TPN3961299 TPNS1DL (1206ML) 0.40

TPN3962299 TPNS2DL(1806ML) 0.38

TPN3963299 TPNH1DL(1306ML) 0.35

TPN3964299 TPNR1DL(1206ML) 0.36

TPN3965299 TPNHN1DL(1006ML) 0.49

TPN3966299 TPNHN2DL(1506ML) 0.47

TPN4001299 TPNA1 1051.3ML/BAG. 0.62

TPN4002299 TPNA2 1051.8ML/BAG. 0.66

TPN4003299 TPNA3 1051.5ML/BAG. 0.80

TPN4004299 TPNA4 765ML/BAG. 0.73

TPN4005299 TPNA5 1085ML/BAG. 0.00

TPN4006299 TPNB1 1015ML/BAG. 0.00

TPN4007299 TPNP1 109ML/BAG. 0.00

TPN4008299 TPNP2 100ML/BAG. 1.39

TPN4009299 TPNP3 100ML/BAG. 1.55

Page 376: 附件二 藥品給付品項暨支付標準表

TPN4010299 TPNP4 100ML/BAG. 1.56

TPN4011299 TPNP5 100ML/BAG. 1.83

TPN4012299 TPNB2 0.47

TPN4101299 TPN-A 1200ML/PKG 0.00

TPN4102299 TPN-B 1300ML/PKG 0.00

TPN4103299 TPN-C 500ML/PKG 0.56

TPN4104299 TPN-D 1600ML/PKG 0.00

TPN4105299 TPNE (阮綜合醫院) 0.00

TPN4106299 TPN-1 1228ML (阮綜合醫院) 0.69

TPN4107299 TPN-2 1914ML (阮綜合醫院) 0.00

TPN4108299 TPN-3 1228ML (阮綜合醫院) 0.65

TPN4109299 TPN-4 1914ML (阮綜合醫院) 0.00

TPN4110299 TPN-5 1243ML (阮綜合醫院) 0.00

TPN4111299 TPN-6 1518ML (阮綜合醫院) 0.61

TPN4112299 TPN-7 2022ML (阮綜合醫院) 0.61

TPN4113299 TPN-1A 0.61

TPN4114299 TPN-1B 0.44

TPN4115299 TPN-2A 0.40

TPN4116299 TPN-3A 0.37

TPN4117299 TPN-4A 0.98

TPN4201299 TPN-A 607ML/PKG 0.00

TPN4202299 TPN-B 600ML/PKG 0.00

TPN4203299 TPN-C 957ML/PKG 0.00

TPN4204299 TPN-D 950ML/PKG 0.00

TPN4205299 TPN-E 657ML/PKG 0.00

TPN4206299 TPN-F 650ML/PKG 0.00

TPN4207299 TPN-G 607ML/PKG 0.00

TPN4208299 TPN-H 600ML/PKG 0.00

TPN4209299 TPNI 950ML/BOT 0.00

TPN4210299 TPNJ 1007ML/BOT 0.00

TPN4211299 TPN-K (南雲醫院) 500ML 0.00

TPN4212299 TPN-L (南雲醫院) 600ML 0.00

TPN4213299 TPN-M (南雲醫院) 600ML 0.00

TPN4214299 TPN-N (南雲醫院) 550ML 0.00

TPN4215299 TPN-O (南雲醫院) 650ML 0.00

TPN4216299 TPN-P (南雲醫院) 650ML 0.00

TPN4217299 TPN-Q (南雲醫院) 600ML 0.00

TPN4218299 TPN-R (南雲醫院) 600ML 0.00

TPN4231299 TPN-A(1200ML) 0.32

TPN4232299 TPN-B(1300ML) 0.24

TPN4233299 TPN-C(600ML) 0.32

TPN4234299 TPN-D(650ML) 0.24

TPN4301299 TPN S1 1500ML/PKG 0.00

TPN4302299 TPN S2 2100ML/PKG 0.00

TPN4303299 TPN H1 1300ML/PKG 0.00

TPN4304299 TPN H2 2050ML/PKG 0.00

TPN4305299 TPN R1 1800ML/PKG 0.00

TPN4306299 TPN R2 950ML/PKG 0.00

Page 377: 附件二 藥品給付品項暨支付標準表

TPN4307299 TPN HNI 2000ML/PKG 0.00

TPN4308299 TPN PPNI 1200ML/PKG 0.00

TPN4309299 TPN KC 1549ML/PKG 0.88

TPN4310299 TPN KP 1449ML/PKG 0.74

TPN4311299 TPN NP 1009ML/PKG 0.44

TPN4312299 TPN NC 1009ML/PKG 0.48

TPN4401299 TPNA1 1742ML/PKG 0.91

TPN4402299 TPNA2 1942ML/PKG 0.94

TPN4403299 TPN B 1192ML/PKG 1.11

TPN4404299 TPN C 1842ML/PKG 0.00

TPN4405299 TPN E1 1542ML/PKG 0.00

TPN4406299 TPN E2 2042ML/PKG 0.00

TPN4407299 TPN A3(1464ML) 0.65

TPN4408299 TPN A4(1664ML) 0.66

TPN4409299 TPN D(1564ML) 0.67

TPN4410299 TPN F(2214ML) 0.44

TPN4501299 TPN-S 0.67

TPN4502299 TPN-H 0.73

TPN4503299 TPN-R 0.79

TPN4504299 TPN-H.N 0.00

TPN4505299 TPN-1 1.35

TPN4506299 TPN-2 0.00

TPN4601299 TPNA 2007ML/BOT 0.00

TPN4602299 TPNB 2257ML/BOT 0.00

TPN4603299 TPNC 2257ML/BOT 0.00

TPN4604299 TPNCHF 1507ML/BOT 0.00

TPN4605299 TPNRF 1507ML/BOT 0.00

TPN4606299 TPNL 1507ML/BOT 0.00

TPN4607299 PPN 1 153ML/BOT 0.90

TPN4608299 PPN 2 203ML/BOT 1.01

TPN4609299 PPN 3 453ML/BOT 1.26

TPN4610299 PPN 1 803ML/BOT 0.00

TPN4611299 PPN C 1503ML/BOT 0.00

TPN4706299 TPN F 620ML 0.00

TPN4707299 TPN G 620ML 0.00

TPN4708299 TPN G 620ML 0.00

TPN4709299 TPN I 520ML 0.00

TPN4710299 TPN F (新樓醫院) 0.60

TPN4711299 TPN G(新樓醫院) 0.60

TPN4712299 TPN H(新樓醫院) 0.00

TPN4713299 TPN I(新樓醫院) 0.73

TPN4714299 TPN J(新樓醫院) 0.40

TPN4715299 TPN K(新樓醫院) 0.00

TPN4716299 TPNP (新樓醫院) 0.00

TPN4717299 TPN-1 (新樓醫院) 1218ML 0.00

TPN4718299 TPN-2 (新樓醫院) 1916ML 0.00

TPN4719299 TPN-3 (新樓醫院) 1218ML 0.00

TPN4720299 TPN-4 (新樓醫院) 1916ML 0.00

Page 378: 附件二 藥品給付品項暨支付標準表

TPN4721299 TPN-5 (新樓醫院) 1243ML 0.00

TPN4723299 TPN-7 (2012ML) 新樓醫院 0.00

TPN4727299 TPN A 1112ML 0.53

TPN4728299 TPN B 1412ML 0.40

TPN4729299 TPN C 1012ML 0.40

TPN4730299 TPN D 1212ML 0.49

TPN4731299 TPN E 1312ML 0.34

TPN4732299 TPN-6 1512ML 0.45

TPN4733299 TPN-8 1512ML 0.35

TPN4734299 TPN9 1012ML 0.38

TPN4735299 TPN X 0.41

TPN4736299 TPN N 0.40

TPN4737299 TPN AA(1114ML) 0.65

TPN4738299 TPN BB(1414ML) 0.50

TPN4739299 TPN CC(1014ML) 0.56

TPN4740299 TPN DD(1214ML) 0.60

TPN4741299 TPN EE(1314ML) 0.48

TPN4742299 TPN NN(1064ML) 0.58

TPN4743299 TPN 66(1514ML) 0.55

TPN4744299 TPN 88(1514ML) 0.47

TPN4745299 TPN 99(1014ML) 0.57

TPN4746299 TPN XX(1514ML) 0.54

TPN4801299 TPN A 0.00

TPN4802299 TPN B 0.00

TPN4803299 TPN C 0.00

TPN4804299 TPN H 0.00

TPN4805299 TPN R 0.00

TPN4901299 FORMULA 1 0.00

TPN4902299 FORMULA 2 0.00

TPN4903299 FORMULA 3 0.00

TPN4904299 FORMULA 4 0.00

TPN4905299 FORMULA 5 0.00

TPN4906299 FORMULA 6 0.00

TPN4907299 FORMULA 7 0.00

TPN4908299 FORMULA 8 0.00

TPN4909299 FORMULA 9 0.00

TPN4910299 FORMULA 10 0.00

TPN4911299 FORMULA 11 0.00

TPN4912299 FORMULA 12 0.00

TPN4913299 FORMULA 13 0.00

TPN4914299 FORMULA 14 0.00

TPN5001299 TPN A (為恭) 0.00

TPN5002299 TPN B (為恭) 0.00

TPN5003299 TPN C (為恭) 0.00

TPN5004299 TPN D (為恭) 0.00

TPN5005299 TPN E (為恭) 0.00

TPN5006299 TPN P (為恭) 0.00

TPN5007299 CPN 1 (為恭) 0.00

Page 379: 附件二 藥品給付品項暨支付標準表

TPN5008299 CPN 2 (為恭) 0.00

TPN5009299 CPN 3 (為恭) 0.00

TPN5010299 CPN 4 (為恭) 0.00

TPN5011299 CPN 5 (為恭) 0.00

TPN5012299 CPN 6 (為恭) 0.45

TPN5013299 CPN 7 (為恭) 0.55

TPN5109299 NEOA (羅東博愛醫院) 0.61

TPN5110299 NEOB(羅東博愛醫院) 0.71

TPN5111299 NEOC(羅東博愛醫院) 0.76

TPN5112299 NEOD(羅東博愛醫院) 0.80

TPN5113299 NEOA(D10W-BASED)(羅東博愛醫院) 0.57

TPN5114299 NEOB(D10W-BASED)(羅東博愛醫院) 0.69

TPN5115299 NEOC(D10W-BASED)(羅東博愛醫院) 0.75

TPN5116299 NEOD(D10W-BASED)(羅東博愛醫院) 0.78

TPN5201299 TPNA-1000 (慈濟大林綜合醫院) 999.05ML 0.00

TPN5202299 TPNB-1000 (慈濟大林綜合醫院) 1001ML 0.78

TPN5203299 TPNC-1000 (慈濟大林綜合醫院) 1006ML 0.00

TPN5204299 TPND-1000 (慈濟大林綜合醫院) 898.1ML 0.79

TPN5206299 TPNP-1000 (慈濟大林綜合醫院) 984.84ML 1.11

TPN5209299 TPNE-1000 0.47

TPN5210299 TPNF-1000 0.35

TPN5301299 TPN-A (1104ML) 屏東基督教醫院 0.00

TPN5302299 TPN-B (1214ML) 屏東基督教醫院 0.00

TPN5303299 TPN-C (1214ML) 屏東基督教醫院 0.00

TPN5304299 TPN-D (1914ML) 屏東基督教醫院 0.00

TPN5305299 TPN-E (1914ML) 屏東基督教醫院 0.00

TPN5306299 TPN-F (1514ML) 屏東基督教醫院 0.00

TPN5307299 TPN-G (2014ML) 屏東基督教醫院 0.00

TPN5308299 TPN-H (1136ML) 屏東基督教醫院 0.00

TPN5309299 TPN-N (1070ML) 屏東基督教醫院 0.00

TPN5401299 TPNA-1 1229ML (伍倫綜合醫院) 0.00

TPN5402299 TPNA-2 1229ML (伍倫綜合醫院) 0.00

TPN5403299 TPNA-3 1024ML (伍倫綜合醫院) 0.00

TPN5404299 TPNA-4 1524ML (伍倫綜合醫院) 0.00

TPN5405299 TPNA-5 1924ML (伍倫綜合醫院) 0.00

TPN5406299 TPNA-6 1924ML (伍倫綜合醫院) 0.00

TPN5407299 TPNA-7 1254ML (伍倫綜合醫院) 0.00

TPN5501299 TPN-1 1226ML (署立雲林醫院) 0.00

TPN5502299 TPN-2 1226ML (署立雲林醫院) 0.00

TPN5503299 TPN-3 1914ML (署立雲林醫院) 0.00

TPN5504299 TPN-4 1914ML (署立雲林醫院) 0.00

TPN5505299 TPN-5 1144ML (署立雲林醫院) 0.00

TPN5506299 TPN-6 1016ML (署立雲林醫院) 0.00

TPN5507299 CPN-A2 0.46

TPN5508299 CPN-B2 0.51

TPN5509299 CPN-G 0.53

TPN5510299 CPN-G2 0.49

TPN5511299 TPN-11 1.38

Page 380: 附件二 藥品給付品項暨支付標準表

TPN5512299 TPN1 100ML 0.93

TPN5601299 TPN-1 1231ML 東港安泰醫院 0.00

TPN5602299 TPN-2 1231ML 東港安泰醫院 0.00

TPN5603299 TPN-3 1019ML 東港安泰醫院 0.00

TPN5604299 TPN-4 1524ML 東港安泰醫院 0.00

TPN5605299 TPN-5 2024ML 東港安泰醫院 0.00

TPN5606299 TPN-6 1926ML 東港安泰醫院 0.00

TPN5607299 TPN-7 1926ML 東港安泰醫院 0.00

TPN5608299 TPN-8 1256ML 東港安泰醫院 0.00

TPN5609299 TPN-9 946ML 東港安泰醫院 0.00

TPN5610299 TPN-10 1026ML 東港安泰醫院 0.00

TPN5611299 TPN-11 1526ML 東港安泰醫院 0.00

TPN5612299 TPN-12 1323ML 東港安泰醫院 0.00

TPN5613299 TPN-13 1066ML 東港安泰醫院 0.00

TPN5614299 TPN-14 1926ML 東港安泰醫院 0.00

TPN5615299 tpn 1457ml 0.89

TPN5701299 TPN-1 0.00

TPN5702299 TPN-2 0.00

TPN5703299 TPN-3 0.51

TPN5704299 TPN-4 0.00

TPN5705299 TPN-5 0.00

TPN5706299 TPN-6 0.00

TPN5707299 TPN-7 0.00

TPN5708299 TPN-8 0.00

TPN5709299 TPN-9 0.00

TPN5710299 TPN-10 0.00

TPN5801299 TPN-A1 0.00

TPN5802299 TPN-A2 0.00

TPN5803299 TPN-B1 0.00

TPN5804299 TPN-B2 0.00

TPN5805299 TPN-C 0.00

TPN5806299 TPN-D 0.00

TPN5807299 TPN-E 0.00

TPN5808299 TPN-F 0.00

TPN5809299 TPN-G 0.60

TPN5810299 TPN-M 0.00

TPN5811299 TPN-H 0.00

TPN5812299 TPN-L 0.76

TPN5813299 TPN-K2 0.68

TPN5814299 TPN-K1 0.00

TPN5815299 TPN-R 0.00

TPN5816299 TPN-KN 1.36

TPN5817299 TPN-KR 0.00

TPN5818299 TPN-KH 0.00

TPN5819299 TPN-1 0.00

TPN5820299 TPN-2 0.00

TPN5821299 TPN-3 0.00

TPN5822299 TPN-4 0.00

Page 381: 附件二 藥品給付品項暨支付標準表

TPN5823299 TPN-5 0.00

TPN5824299 TPN-P 0.99

TPN5825299 TPN-Q 0.48

TPN5826299 TPN-KX 0.50

TPN5827299 TPN-B3 0.46

TPN5828299 TPN-R2 0.49

TPN5829299 TPN-H2 0.42

TPN5830299 TPN-6 0.70

TPN5831299 TPN-S 0.93

TPN5832299 TPN-P1(817ML) 0.50

TPN5833299 TPN-P2(1037ML) 0.53

TPN5834299 TPN-PH(1067ML) 0.44

TPN5835299 TPN-PR(967ML) 0.56

TPN5836299 TPN-N7(1506ML) 0.97

TPN5837299 TPN-PA1(927ML) 0.48

TPN5838299 TPN-PA2(1077ML) 0.46

TPN5839299 TPN-PAH(1117ML) 0.35

TPN5840299 TPN-PAR(997ML) 0.47

TPN5841299 TPN-PAL(1613.5ML) 0.31

TPN5842299 TPN-PK1(1309.5ML) 0.38

TPN5843299 TPN-PK2(1308ML) 0.38

TPN5901299 TPN-STD1 1012ML 0.00

TPN5902299 TPN-STD2 1112ML 0.47

TPN5903299 TPN-STD3 1412ML 0.00

TPN5904299 TPN-STD4 1612ML 0.52

TPN5907299 TPN-1 1800ML 0.20

TPN5908299 TPN-2 1500ML 0.00

TPN5909299 TPN-RENAL 1361ML 0.63

TPN5910299 TPN-HEPATIC 1772ML 0.46

TPN5915299 TPN-STD5 0.42

TPN5924299 TPN-PED A 0.16

TPN5925299 TPN-PED B 0.20

TPN5926299 TPN-PED C 0.20

TPN5927299 TPN-PED D 0.20

TPN5928299 TPN-NEO E 0.75

TPN5929299 TPN-NEO F 0.82

TPN5930299 TPN-NEO G 0.82

TPN5931299 TPN-NEO H 0.82

TPN6001299 TPN-1 1219ML 0.00

TPN6002299 TPN-2 1911ML 0.00

TPN6003299 TPN-3 1219ML 0.00

TPN6004299 TPN-4 1911ML 0.00

TPN6005299 TPN-5 1238.4ML 0.00

TPN6006299 TPN-6 1519ML 0.00

TPN6007299 TPN-7 2019ML 0.00

TPN6101299 PPN 550.6ML 0.96

TPN6102299 START 440.3ML 0.95

TPN6103299 NORMAL1 738ML 0.74

Page 382: 附件二 藥品給付品項暨支付標準表

TPN6104299 NORMAL2 788ML 0.76

TPN6105299 NORMAL3 838ML 0.79

TPN6106299 HN 938ML 0.00

TPN6107299 HEPATIC 921ML 0.59

TPN6108299 HD 896.9ML 0.62

TPN6109299 MHD 963.6ML 0.29

TPN6110299 NEO 1 1.39

TPN6111299 NEO 2 1.53

TPN6112299 NEO 3 128.84ML 1.72

TPN6113299 NEO 4 155.84ML 1.85

TPN6114299 NEO 5 373.8ML 1.56

TPN6115299 NEO 6 478.8ML 1.76

TPN6116299 TPNPED 1 785.8ML 0.88

TPN6117299 TPNPED 2 888.8ML 0.91

TPN6118299 CTPNS2 0.00

TPN6201299 TPN-G 1559ML 0.97

TPN6202299 TPN-H 2074ML 0.89

TPN6301299 TPN A 0.51

TPN6302299 TPN B 0.63

TPN6303299 TPN C 0.00

TPN6304299 TPN D 0.33

TPN6305299 TPN E 0.28

TPN6306299 TPN P 1.09

TPN6401299 TPN-B2 0.45

TPN6402299 TPN-A1 0.43

TPN6403299 TPN-A2 0.47

TPN6404299 TPN-A3 0.38

TPN6405299 TPN-A4 0.48

TPN6406299 新生兒TPN-P1 0.76

TPN6407299 小兒TPN-P2 1.49

TPN6435299 TPN-A2S 0.63

TPN6438299 TPN-A3S 0.78

TPN6439299 TPN-B1 0.60

TPN6501299 TPN-N 0.50

TPN6502299 TPN-C 0.41

TPN6503299 PPN-K2 0.25

TPN6504299 PPN-K3 0.22

TPN6505299 CPN-M 0.51

TPN6506299 CPN-A 0.18

TPN6507299 TPNA-N 0.50

TPN6508299 TPNA-C 0.42

TPN6509299 TPNA-M 0.51

TPN6510299 TPNA-A 0.36

TPN6511299 NEO_STARTER(200ML) 0.73

TPN6601299 TPN-S 0.55

TPN6602299 TPN-H 0.34

TPN6603299 TPN-R 0.39

TPN6604299 TPN-N 0.59

Page 383: 附件二 藥品給付品項暨支付標準表

TPN6605299 TPN-P1 1.21

TPN6606299 TPN-P2 1.45

TPN6607299 TPN-P3 1.05

TPN6608299 TPN-PN 0.63

TPN6609299 TPN-C 0.42

TPN6701299 TPN-A 0.41

TPN6702299 TPN-B 0.41

TPN6703299 PPN 0.38

TPN6704299 TPN-N 0.80

TPN6705299 TPN-M(1206ML) 0.43

TPN6801299 DIVNI01標準 0.49

TPN6802299 DIVNI02腎功能不佳限水 0.34

TPN6803299 DIVNI03肝功能不佳 0.30

TPN6804299 DIVNI04小兒配方 0.12

TPN6805299 DTPNI10 0.42

TPN6806299 DTPNI20 0.53

TPN6807299 DTPNI40 0.42

TPN6808299 DTPNI50 0.35

TPN6809299 DTPNI60 0.62

TPN6810299 DTPNI70 0.31

TPN6901299 TPN-REGULAR 0.69

TPN6902299 TPN-HD 0.97

TPN6903299 TPN-HEPA 0.66

TPN6904299 TPN-RF 0.79

TPN6905299 TPN-FLUID 0.77

TPN6906299 OLICLINOMEL N4-550E 0.63

TPN6907299 OLICLINOMEL N7-1000 1.01

TPN7001299 TPN A 0.00

TPN7002299 TPN B 0.00

TPN7003299 TPN C 0.00

TPN7004299 TPN D 0.00

TPN7005299 TPN E 0.00

TPN7006299 TPN 6 0.00

TPN7007299 TPN 8 0.00

TPN7008299 TPN 9 0.00

TPN7009299 TPN X 0.00

TPN7010299 TPN N 0.00

TPN7011299 TPN AA(1114ML) 0.65

TPN7012299 TPN BB(1414ML) 0.50

TPN7013299 TPN CC(1014ML) 0.56

TPN7014299 TPN DD(1214ML) 0.60

TPN7015299 TPN EE(1314ML) 0.48

TPN7016299 TPN NN(1064ML) 0.58

TPN7017299 TPN 66(1514ML) 0.55

TPN7018299 TPN 88(1514ML) 0.47

TPN7019299 TPN 99(1014ML) 0.57

TPN7020299 TPN XX(1514ML) 0.54

VC00001129 STIMOL ORAL SOLUTION 1GM/10ML 39.00

Page 384: 附件二 藥品給付品項暨支付標準表

VC00002100 DIMAVAL CAPSULES 282.00

VC00003221 DIMAVAL INJECTION SOLUTION 1447.00

VC00005100 KELFER CAPSULES 500MG 60.00

VC00006100 CARNITENE 1G CHEWABLE TABLETS 131.00

VC00007100 AGRYLIN 0.5MG CAPSULES 154.00

VC00010100 PROVIGIL TABLETS 200MG 166.00

VC00011138 VENTAVIS NEBULISER SOLUTION 865.00

VC00012100 TRACLEER FILM COATED TABLETS 62.5MG 1433.00

VC00013100 TRACLEER FILM COATED TABLETS 125MG 1241.00

VC00014209 CARNITENE Injection 1g/5mL 314.00

VC00017277 FLOLAN INJECTION 0.5MG 650.00

VC00020100 VOTUBIA 5 MG TABLETS 1848.00

VC00021100 VOTUBIA 2.5 MG TABLETS 924.00

VC00023100 VOLIBRIS FILM-COATED TABLETS 10MG 3157.00

VC00024100 VOLIBRIS FILM-COATED TABLETS 5MG 3460.00

VC00025100 Gilenya hard capsules 0.5mg 1916.00

VC00026100 XENAZINE 25MG 59.00

VC00027100 XENAZINE 12.5MG 53.00

VC00028100 ZAVESCA HARD CAPSULE 100MG 2642.00

VC00033238 COPAXONE 20MG/ML, PRE-FILLED SYRINGE FOR INJECTION 1063.00

VC00034100 OPSUMIT FILM-COATED TABLETS 10MG 2965.00

VC00035209 COPAXONE 40MG/ML, PRE-FILLED SYRINGE FOR INJECTION 1975.00

VC00038100 AUBAGIO FILM COATED TABLET 14 MG 909.00

VC00039100 TECFIDERA 120MG GASTRO-RESISTANT HARD CAPSULE 252.00

VC00040100 TECFIDERA 240MG GASTRO-RESISTANT HARD CAPSULE 454.00

VC00041100 KUVAN SOLUBLE TABLET 100MG 780.00

VC00042100 CERDELGA CAPSULES 84MG 11641.00

VC00045100 UPTRAVI FILM-COATED TABLETS 200 MCG 1105.00

VC00047100 UPTRAVI FILM-COATED TABLETS 600 MCG 1105.00

VC00048100 UPTRAVI FILM-COATED TABLETS 800 MCG 1105.00

VC00055100 CHOLBAM 50MG 1448.00

VC00057221 SPINRAZA SOLUTION FOR INJECTION 2450800.00

VC00058100 MAVENCLAD TABLETS 10MG 72424.00

VC00059100 GILENYA HARD CAPSULES 0.25MG 1064.00

VC00062100 Analide 0.5mg Capsule 154.00

VC00064100 MAYZENT 2MG FILM COATED TABLETS 1832.00

VC00065100 MAYZENT 0.25MG FILM COATED TABLETS 303.00

W000006100 THADO CAPSULES 50MG 271.00

W000008100 WILIZIN CAPSULES 25MG 30.00

W000009100 WILIZIN CAPSULES 50MG 48.70

WB00014100 PHENBUTY 500MG TABLETS 241.00

WC00001100 PURE SODIUM BENZOATE CAP. 250MG 24.10

WC00005229 ASADIN INJ. 1MG/ML (ARSENIC TRIOXIDE) 3569.00

WC00007100 ZINCA CAPSULES 50MG 48.70

WC00010100 Zinca Capsules 25 mg 30.00

WC00011100 DIMERSU CAPSULES 200 MG 417.00

WC00015221 L-CARNIT "SHINER" INJECTION 1G/5ML 314.00

WC00016210 FOMEJECT INJECTION 1.5G/1.5ML 42234.00

Page 385: 附件二 藥品給付品項暨支付標準表

WC00017100 "EXCELSIOR" BH4 TABLETS 10 MG 73.00

WC00018100 "EXCELSIOR" BH4 TABLETS 50 MG 433.00

WC00019100 METACU CAPSULES 300MG 776.00

WC00021216 Icanticure Injection 64527.00

X000005162 NEUTRAL PHOSPHATE POWDER 20.93GM FOR 180ML ORAL SOLN(榮

總)36.00

X000009100 BUPHENYL TAB. 500MG (SOD. PHENYLBUTYRATE 500MG)(UCYCLYD

PHARMA INC.)228.00

X000014238 DANTROLENE 20MG IV 5000.00

X000025177 JOULICE SOLUTION (91.5GM)500ML(台大) 169.00

X000028156 SUCRAID ORAL SOLUTION (SACROSIDASE ORAL SOLUTION

8500I.U./ML 118ML/BTL.) NUTRAMAX PRODUCTS16957.00

X000037100 CYSTAGON CAP. 150MG 86.00

X000042255 BICNU (CARMUSTINE (BCNU)) 100MG 1800.00

X000046177 NEUTRAL PHOSPHATE ORAL SOLUTION 500ML (NA2HPO4 28GM

NAHPO4 18GM)46.30

X000047129 LEVOCARNITIN ORAL SOLUTION (1GM/10ML/BOT) 138.00

X000048177 NA-PHOSPHATE ORAL SOLUTION(145MG/ML) 500ML 155.68

X000054163 NEUTRAL PHOSPHATE ORAL SOLUTION (25.5 MG/ML /ML) 200ML27.44

X000057162 NEUTRAL PHOSPHATE ORAL SOLUTION(116.20 MG/ML)180ML 35.91

X000067162 CYSTADANE POWDER FOR ORAL SOL N 1GM/SCOOPFUL (BETAINE

ANHYDROUS)(ORPHAN MEDICAL,INC.)22067.00

X000071110 PROGLYCEM 50MG/ML 30ML/BOT 1317.00

X000073163 JOULIE'S SOLUTION 200ML/BOT 78.70

X000074100 ZAVESCA CAPSULES 100MG (MIGLUSTAT) GALEN LIMITED 2642.00

X000077100 ORFADIN CAP 2MG(NITISINONE) SWEDISH ORPHAN

INTERNATIONAL AB946.00

X000078238 REMODULIN INJ. 1.0MG/ML 20ML 39915.00

X000083121 TOBI NEBULIZER SOLUTION (TOBRAMYCIN) 300MG/5ML/AMP 2154.00

X000085100 TRIENTINE DIHYDROCHLORIDE 300MG 769.00

X000087229 GLYCERYL TRINITRATE (NITROGLYCERIN) CONCENTRATE

INJECTION 50MG/10ML/AMP211.00

X000103100 LYSODREN TAB. 266.00

X000107226 LEUSTATIN (CLADRIBINE) 8MG/8ML/VIAL 8013.00

X000116248 ONCOTICE (CONTAINING 2-8╳10︿8 CFU TICE BCG)(專案進口)4552.00

X000120238 REMODULIN INJ. 5.0MG/ML 20ML 179618.00

X000123100 CARBAGLU TABLETS 200MG 2524.00

X000127266 HYPERRAB S/D 4224.00

X000128210 HYPERRAB S/D 13945.00

X000129209 FAVIRAB 534.00

X000133248 MYOZYME 50MG/VIAL 27232.00

X000135237 PROLEUKIN FOR INJECTION 11837.00

X000141100 MERCAPTOPURINE TABLETS USP 73.00

X000142100 PURI-NETHOL TABLETS(MERCAPTOPURINE)50MG/TAB. 73.00

X000144229 PEDITRACE CONCENTRATE FOR INFUSION SOLUTION (10ML/VIAL)200.00

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X000148100 METALITE 250 CAPSULES 750.00

X000151100 TRIENTINE HYDROCHLORIDE CAPSULES 300MG 810.00

X000162343 PERMETHRIN 5% W/W CREAM 30GM 341.00

X000163255 CARMUTHER 100 7412.00

X000167206 IMMUKIN (INTERFERON GAMMA 1B) 0.1MG/0.5ML 6427.00

X000168277 DACTILON ( DACTINOMYCIN ) 0.5MG / VIAL 1311.00

X000176206 TETANUS VACCINE ADSORBED SUSPENSION FOR INJECTION

0.5ML/AMP84.00

X000177206 ADSORBED TETANUS VACCINE B.P. 0.5ML 84.00

X000178163 PHOSPHATE ORAL SOLUTION 400.00

X000179100 HARVONI TABLETS 0.00

X000179123 KONSYL 0.00

X000183100 ZEPATIER (ELBASVIR AND GRAZOPREVIR) TABLET 0.00

X0001864E6 TYVASO SOLUTION FOR ORAL INHALATION 0.6MG/ML 5204.00

X000187229 MITONCO FOR INJ 10MG ( MITOMYCIN C 10MG) 640.00

X000188100 FLORINEF ACETAAT 0.1MG 0.00

X000189229 VESIMYCIN 10 ( MITOMYCIN FOR INJECTION USP 10MG)

10MG/VIAL640.00

X000191248 MELPHALAN FOR INJECTION BP 50MG 0.00

X000192100 ZITHROMAX 250MG TABLETS 0.00

X000194100 DIGOSIN TAB 0.25MG 2.29

X000196223 XOFIGO SOLUTION FOR INJECTION 0.00

X000204100 CHLORAMINOPHENE CAPSULES 2MG 0.00

X000205235 VISUDYNE POWDER FOR SOLUTION FOR INFUSION 15MG/VIAL 0.00

X000210100 TROLOVOL 300MG FILM-COATED TABLET 27.80

X000211100 HYDREA CAPSULES 500MG 15.20

X000212216 FERONSURE,RECOMBINANT HUMAN INTERFERON ALFA-2A 3 MIU 728.00

X000213248 ALKERAN INJECTION MELPHALAN 50MG 1961.00

X000214545 SII-ONCO-BCG CONTAINING 1-19.2X10^8 CFU(BACILLUS

CALMETTE-GUERIN)40MG1517.00

X000215219 ACTEMRA 80 MG SOLUTION FOR INFUSION 3783.00

X000216238 ACTEMRA 400 MG SOLUTION FOR INFUSION 18398.00

X000217209 VINOREL SOLUTION FOR INJECTION(VINORELBINE 10MG/VIAL)1384.00

X000218100 NAVELBINE ORAL 20MG(VINORELBINE TARTRATE) 2292.00

X000219280 ENOXAPARIN SODIUM INJECTION 137.00

X000220206 BIO-TT;SUSPENSION FOR INJECTION 0.5ML/AMP 84.00

X000221255 ABRAXANE(PACLITAXEL 100MG/VIAL) 7812.00

X000222206 SYNAGIS 100MG/ML SOLUTION FOR INJECTION 14486.00

X000222255 ABRAXANE POWDER FOR SUSPENSION FOR INFUSION (PACLITAXEL

100MG/VIAL)7812.00

X000223235 VISUDYNE (VERTEPORFIN FOR INFUSION)15MG/VIAL 38264.00

XC00166265 FIBROGAMMIN 250IU 0.00

XC00169266 HYPERRAB 300IU/ML 1ML 4224.00

XC00195100 XARELTO FILM-COATED TABLETS 10MG 0.00

XC00197435 NATACYN 5% OPHTHALMIC SUSPENSION 1800.00

XC00198243 FIRAZYR 30MG 64527.00

XC00199100 VIMPAT (LACOSAMIDE) 100MG FILM-COATED TABLETS 0.00

Page 387: 附件二 藥品給付品項暨支付標準表

XC00200100 VIMPAT (LACOSAMIDE) 200MG FILM-COATED TABLETS 0.00

XC00201209 NALOXONE INJECTION "G.B.L." 0.4MG/ML 303.00

XC00202100 LORBRENA FILM-COATED TABLETS 25MG 0.00

XC00203100 SABRIL FILM-COATED TABLETS 500MG 0.00

XC00208123 KOCEL POWDER 8.40

Y0000012AK REBIF 22 MICROGRAMS(6MIU) 2545.00

Y000009219 INCRELEX INJECTION 22745.00

Y000014235 Tysabri concentrate for solution for infusion 300mg 55756.00

YC000022E3 REBIF 44 MICROGRAMS (12MIU) 2760.00

YC00004217 REPLAGAL 1MG/ML CONCENTRATION FOR SOLUTION FOR INFUSION72095.00

YC00005296 FABRAZYME 35MG INJ. 175190.00

YC00007221 ALDURAZYME CONCENTRATED SOLUTION 31539.00

YC00008221 Aldurazyme Concentrated Solution 31539.00

YC00010229 NORMOSANG 25MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION24221.00

YC00011216 ELAPRASE (IDURSULFASE) INJECTION 92601.00

YC000132CI REBIF SOLUTION FOR INJECTION 132 MICROGRAMS (36MIU) 8442.00

YC00015271 CEREZYME 400U 66655.00

YC00016243 SOLIRIS 300 MG CONCENTRATE FOR SOLUTION FOR INFUSION 153256.00

YC00018209 "AMGEN" REPATHA SOLUTION FOR INJECTION(PRE-FILLED

SYRINGE/PRE-FILLED SURECLICK AUTOINJECTOR)6654.00

YC00019277 PLEGRIDY 63MCG SOLUTION FOR INJECTION 5782.00

YC00020277 PLEGRIDY 94MCG SOLUTION FOR INJECTION 8627.00

YC00021277 PLEGRIDY 125MCG SOLUTION FOR INJECTION 10326.00

YC00022263 ELELYSO LYOPHILIZED POWDER FOR INJECTION 200 UNITS 27361.00

YC00023221 VIMIZIM 1 MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 27173.00

YC00024221 NAGLAZYME (GALSULFASE) INJECTION 64099.00

YC00025297 LEMTRADA 12MG CONCENTRATE FOR SOLUTION FOR INFUSION 257108.00

YC00026271 VPRIV 46566.00

YC00027265 CLUVOT 250IU 6000.00

ZC00001209 ANTIVENIN OF D.RUSSELLII (LYOPHILIZED) 25376.00