1 1030061568 BC26304225 ELIGARD 7.5, TOLMAR POWDER AND SOLVENT INC. FOR SOLUTION FOR INJECTION LEUPROLIDE ACETATE 7.5 7.5 -- 4365 104/01/01 2 1030061568 BC263052FQ ELIGARD 22.5, TOLMAR POWDER AND SOLVENT INC. FOR SOLUTION FOR INJECTION LEUPROLIDE ACETATE 22.5 22.5 -- 10389 104/01/01 3 1030061568 BC263062AP ELIGARD 45, TOLMAR POWDER AND SOLVENT INC. FOR SOLUTION FOR INJECTION LEUPROLIDE ACETATE 45 45 -- 14960 104/01/01 4 1030071646 A043311329 TIFIN 1% CREAM "H.S." 元宙 NAFTIFINE HCL 10 /GM 5 1030071646 A043311335 TIFIN 1% CREAM "H.S." 元宙 NAFTIFINE HCL 10 /GM 6 1030071646 A043311338 TIFIN 1% CREAM "H.S." 元宙 NAFTIFINE HCL 10 /GM 7 1030071646 A043311399 TIFIN 1% CREAM "H.S." 元宙 NAFTIFINE HCL 10 /GM 10 GM 0 44.3 104/01/01 15 GM 0 44.3 104/01/01 20 GM 0 85 104/01/01 1 GM 0 0 104/01/01 8 1030072538 BC26301443 ULTIBRO BREEZHALER 110/50 MICROGRAM, INHALATION POWDER HARD CAPSULES NOVARTIS INDACATEROL MALEATE 0.11 /DOSE 吸入用膠囊 30 DOSE -- 1611 104/01/01 9 1030072707 A016303421 DECASON EYE DROPS "KINGDOM" 景德桃園廠 DEXAMETHASONE PHOSPHATE (SODIUM) 1 / 5 0 13 104/01/01 10 1030072707 A020441421 KINGMIN OPHTHALMIC 景德桃園廠 SULFAMETHOXAZOLE SOLUTION "KINGDOM" SODIUM 40 / (SULFAMETHOXAZOLE) 5 0 7.4 104/01/01 11 1030072707 A020441429 KINGMIN OPHTHALMIC SOLUTION (SULFAMETHOXAZOLE) "KINGDOM" 景德桃園廠 SULFAMETHOXAZOLE SODIUM 40 / 10 0 7.5 104/01/01 12 1030072707 A020441435 KINGMIN OPHTHALMIC SOLUTION "KINGDOM" 景德桃園廠 SULFAMETHOXAZOLE SODIUM 40 / 15 0 10.1 104/01/01 13 1030072707 A032282421 CHLORAMPHENICOL OPHTHALMIC SOLUTION 0.25% "KINGDOM" 景德桃園廠 CHLORAMPHENICOL 2.5 / 5 0 11.5 104/01/01 14 1030072707 A032282429 CHLORAMPHENICOL OPHTHALMIC SOLUTION 0.25% "KINGDOM" 景德桃園廠 CHLORAMPHENICOL 2.5 / 10 0 14.1 104/01/01 第 1 頁, 共 174 頁
15 1030072707 A033738320 DEVIRO OPHTHALMIC OINTMENT 3% (ACYCLOVI "KINGDOM" 景德桃園廠 ACYCLOVIR 30 /GM 軟膏 4.5 GM 0 427 104/01/01 16 1030072707 A033738321 DEVIRO OPHTHALMIC OINTMENT 3% (ACYCLOVI "KINGDOM" 景德桃園廠 ACYCLOVIR 30 /GM 軟膏 5 GM 0 427 104/01/01 17 1030072707 A045062421 KARTEOL OPHTHALMIC 景德桃園廠 CARTEOLOL HCL 10 SOLUTION 1% / "KINGDOM"(CARTEOLO L HCL) 5 0 119 104/01/01 18 1030072707 A045676421 PREDILONE OPH. SOL. 1% "KINGDOM" 景德桃園廠 PREDNISOLONE PHOSPHATE SODIUM 10 / 5 0 78 104/01/01 19 1030072707 A045731421 KINGCORT OPH. SOL. 0.125% "KINGDOM" (PREDNISOLONE SODIUM PHOSPHATE) 景德桃園廠 PREDNISOLONE PHOSPHATE SODIUM 1.25 / 5 0 63 104/01/01 20 1030072707 A045809421 FLUCASON OPHTHALMIC SUSPENSION 0.1% "KINGDOM" (FLUOROMETHOLONE) 景德桃園廠 FLUOROMETHOLONE 1 / 5 0 14.6 104/01/01 21 1030072707 A045809429 FLUCASON OPHTHALMIC SUSPENSION 0.1% "KINGDOM" (FLUOROMETHOLONE) 景德 FLUOROMETHOLONE 1 / 10 -- 77 104/01/01 22 1030072707 A046069417 CHLORLYMIN OPHTHALMIC OINTMENT 景德桃園廠 CHLORAMPHENICOL 10 /GM 點眼膏 3.5 GM 0 13.3 104/01/01 23 1030072707 A046069421 CHLORLYMIN OPHTHALMIC OINTMENT 景德桃園廠 CHLORAMPHENICOL 10 /GM 點眼膏 5 GM 0 13.3 104/01/01 24 1030072707 A046103421 FLUCASON OPHTHALMIC SUSPENSION0.02% "KINGDOM" FLUOROMETOLONE 景德桃園廠 FLUOROMETHOLONE 0.2 / 5 0 17.8 104/01/01 25 1030072707 A046103429 FLUCASON OPHTHALMIC SUSPENSION0.02% "KINGDOM" FLUOROMETOLONE 景德桃園廠 FLUOROMETHOLONE 0.2 / 10 0 78 104/01/01 26 1030072707 A046899421 SALUTE OPHTHALMIC SOLUTION "KINGDOM" 景德桃園廠 SULFAMETHOXAZOLE SODIUM 20 / 5 0 13.5 104/01/01 第 2 頁, 共 174 頁
27 1030072707 A046899429 SALUTE OPHTHALMIC SOLUTION "KINGDOM" 景德桃園廠 SULFAMETHOXAZOLE SODIUM 20 / 規格原核定新核定生效日期量價價 10 0 27.1 104/01/01 28 1030072707 A047117421 GENDERMIN OPH. SOLUTION 0.3% "KINGDOM" (GENTAMICIN SULFATE) 景德桃園廠 GENTAMICIN (SULFATE) 3 / 5 0 19.5 104/01/01 29 1030072707 A047117429 GENDERMIN OPH. SOLUTION 0.3% "KINGDOM" (GENTAMICIN SULFATE) 景德桃園廠 GENTAMICIN (SULFATE) 3 / 10 0 37.1 104/01/01 30 1030072707 A047124416 GENDERMIN OPHTHALMIC OINTMENT 3/GM "KINGDOM" (GENTAMICIN SULFATE) 31 1030072707 A047124417 GENDERMIN OPHTHALMIC OINTMENT 3/GM "KINGDOM" (GENTAMICIN SULFATE) 32 1030072707 A047124421 GENDERMIN OPHTHALMIC OINTMENT 3/GM "KINGDOM" (GENTAMICIN SULFATE) 33 1030072707 A047370417 ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% "KINGDOM" 景德桃園廠 GENTAMICIN SULFATE 3 /GM 景德桃園廠 GENTAMICIN SULFATE 3 /GM 景德桃園廠 GENTAMICIN (SULFATE) 3 景德桃園廠 ERYTHROMYCIN BASE 5 /GM 點眼膏 點眼膏 點眼膏 點眼膏 3 GM 0 21 104/01/01 3.5 GM 0 21 104/01/01 5 GM 0 27 104/01/01 3.5 GM 0 12.1 104/01/01 34 1030072707 A047521414 LANOPROST OPHTHALMIC SOLUTION 0.005% (LATANOPROST) 景德桃園廠 LATANOPROST 50 MCG/ (=UG/) 2.5 0 382 104/01/01 35 1030072707 A047641421 Topimide Ophthalmic Solution 0.5% "Kingdom" (Tropicamide) 景德桃園廠 TROPICAMIDE 5 / 5 0 20.6 104/01/01 36 1030072707 A047717417 CINDECASON OPHTHALMIC OINTMENT "KINGDOM" 景德桃園廠 NEOMYCIN (SULFATE) 3.5 /GM 點眼膏 3.5 GM 0 13.2 104/01/01 37 1030072707 A048431421 Topimide Ophthalmic Solution 1% "Kingdom" (Topicamide) 景德桃園廠 TROPICAMIDE 10 / 5 0 66 104/01/01 38 1030072707 A048965421 SITROMIN EYE DROPS 0.005% KINGDOM 景德桃園廠 NEOSTIGMINE METHYLSULFATE 0.05 / 5 0 10.4 104/01/01 39 1030072707 A048965429 SITROMIN EYE DROPS 0.005% KINGDOM 景德桃園廠 NEOSTIGMINE METHYLSULFATE 0.05 / 10 0 16.7 104/01/01 第 3 頁, 共 174 頁
40 1030072707 A048999421 SITROMIN EYE DROPS 0.01% KINGDOM 景德桃園廠 NEOSTIGMINE METHYLSULFATE 0.1 / 規格原核定新核定生效日期量價價 5 0 9.3 104/01/01 41 1030072707 A048999429 SITROMIN EYE DROPS 0.01% KINGDOM 景德桃園廠 NEOSTIGMINE METHYLSULFATE 0.1 / 10 0 13.2 104/01/01 42 1030072707 A055951423 VICEMER EYE GEL 0.2% KINGDOM (CARBOME 43 1030072707 A055951429 VICEMER EYE GEL 0.2% KINGDOM (CARBOME 44 1030072707 A055989421 LEMIN EYE DROPS KINGDOM 景德桃園廠 CARBOMER 眼用 (=CARBOPOL=CARBOXYP 凝膠 OLYMETHYLENE) 2 /GM 景德桃園廠 CARBOMER 眼用 (=CARBOPOL=CARBOXYP 凝膠 OLYMETHYLENE) 2 /GM 景德桃園廠 CHONDROITIN SULFATE SODIUM 30 / 6 GM 0 74 104/01/01 10 GM 0 124 104/01/01 5 0 14.7 104/01/01 45 1030072707 A056663421 ALMIDINE OPHTHALMIC SOLUTION 0.15% "KINGDOM" (BRIMONIDINE) 46 1030072707 A056663429 ALMIDINE OPHTHALMIC SOLUTION 0.15% "KINGDOM" (BRIMONIDINE) 47 1030072707 A056700421 ALMONINE OPHTHALMIC SOLUTION 0.2% "KINGDOM" (BRIMONIDINE) 景德桃園廠 BRIMONIDINE TARTRATE 1.5 / 景德桃園廠 BRIMONIDINE TARTRATE 1.5 / 景德桃園廠 BRIMONIDINE TARTRATE 2 / 5 0 207 104/01/01 10 0 387 104/01/01 5 0 221 104/01/01 48 1030061659 AC57276255 POTASSIUM CHLORIDE INJECTION 1MEQ/ "TBC" 信東 POTASSIUM CHLORIDE 1000 MEQ/L 注射液 100 -- 27.5 104/01/01 49 1030061659 AC58248255 1.49% POTASSIUM CHLORIDE IN WATER INJECTION "TBC" 信東 POTASSIUM CHLORIDE 400 MEQ/L 注射液 100 -- 27.5 104/01/01 50 1030065451 BC255532A5 NUTRIFLEX OMEGA SPECIAL( 依仿單含熱量 1475KCAL) B. BRAUN SOYBEAN OIL 16 / MELSUNGE N A 1.25 L -- 1270 104/01/01 51 1030065643 AB46145100 ALEPAN TABLETS 15 華興 OXAZEPAM 15 錠 -- 3.88 104/01/01 52 1030065643 AC46145100 ALEPAN TABLETS 15 華興 OXAZEPAM 15 錠 3.88 0 104/02/01 53 1030065644 AB52462100 SMARTGEN TAB. 2 十全 DIHYDROERGOTOXINE METHANESULFONATE 2 54 1030065644 AC52462100 SMARTGEN TAB. 2 十全 DIHYDROERGOTOXINE METHANESULFONATE 2 錠 -- 3.65 104/01/01 錠 3.65 0 104/02/01 第 4 頁, 共 174 頁
項次 發文號 健保代碼 藥品名稱 廠牌 成分及含量 型 規格原核定新核定量價價 生效日期 55 1030065647 A029726 CHLOTIN VAGINAL SUPPOSITORIES "YUNG SHIN" 永信台中幼獅廠 CHLORAMPHENICOL 100 栓 3.08 0 104/02/01 56 1030065647 AC29726 CHLOTIN VAGINAL SUPPOSITORIES "YUNG SHIN" 永信台中幼獅廠 CHLORAMPHENICOL 100 栓 -- 3.08 104/01/01 57 1030065648 A055406100 SINBISOL FILM COATED TABLETS 5 信東 BISOPROLOL HEMIFUMARATE 5 3.3 0 104/02/01 58 1030065648 AB27928212 ROSIS IV INJECTION "VPP" 信東 FUROSEMIDE 10 / 注射 2 -- 15 104/01/01 59 1030065648 AB55406100 SINBISOL FILM COATED TABLETS 5 信東 BISOPROLOL HEMIFUMARATE 5 -- 3.86 104/01/01 60 1030065648 AC27928212 ROSIS IV INJECTION "VPP" 信東 FUROSEMIDE 10 / 注射 2 15 0 104/02/01 61 1030065694 A009633255 MANITON INJECTION 杏林新生 MANNITOL 200 / 注射 62 1030065694 A009633266 MANITON INJECTION 杏林新生 MANNITOL 200 / 注射 63 1030065694 A009633277 MANITON INJECTION 杏林新生 MANNITOL 200 / 注射 100 300 39.4 0 104/02/01 39.4 0 104/02/01 117 0 104/02/01 64 1030065694 A010917100 BEHYD TABLETS 杏林新生 BENZYLHYDROCHLOROT HIAZIDE 4 65 1030065694 A0109171G0 BEHYD TABLETS( 鋁箔 ) 杏林新生 BENZYLHYDROCHLOROT HIAZIDE 4 錠 1.5 0 104/02/01 錠 2 0 104/02/01 66 1030065694 A018649100 KORYNASE E.C. TABLETS 5 杏林新生 SEAPROSE S 5 腸溶 錠 3.05 0 104/02/01 67 1030065694 A018920100 DACTIRAN F.C. TABLETS (PIPERIDOLATE) "KYORIN" 68 1030065694 A022701266 ALLAMIN INJECTION 3%ISOTONIC "KYORIN" 杏林新生 PIPERIDOLATE HCL 50 杏林新生 PHENYLALANINE L- 3.07 300 2.02 0 104/02/01 65 0 104/02/01 69 1030065694 A022701277 ALLAMIN INJECTION ISOTONIC "KYORIN" 杏林新生 PHENYLALANINE L- 3.07 65 0 104/02/01 70 1030065694 A025355266 FRUCEROL INJECTION 杏林新生 GLYCERIN (=GLYCEROL) 100 / 300 82 0 104/02/01 71 1030065694 AC09633255 MANITON INJECTION 杏林新生 MANNITOL 200 / 注射 100 -- 39.4 104/01/01 72 1030065694 AC09633266 MANITON INJECTION 杏林新生 MANNITOL 200 / 注射 300 -- 39.4 104/01/01 73 1030065694 AC09633277 MANITON INJECTION 杏林新生 MANNITOL 200 / 注射 -- 117 104/01/01 第 5 頁, 共 174 頁
項次 發文號 健保代碼 藥品名稱 廠牌 成分及含量 型 規格原核定新核定量價價 生效日期 74 1030065694 AC10917100 BEHYD TABLETS 杏林新生 BENZYLHYDROCHLOROT 錠 -- 1.5 104/01/01 HIAZIDE 4 75 1030065694 AC109171G0 BEHYD TABLETS( 鋁箔 / 膠箔 ) 杏林新生 BENZYLHYDROCHLOROT HIAZIDE 4 錠 -- 2 104/01/01 76 1030065694 AC18649100 KORYNASE E.C. TABLETS 5 杏林新生 SEAPROSE S 5 腸溶 錠 -- 3.05 104/01/01 77 1030065694 AC18920100 DACTIRAN F.C. TABLETS (PIPERIDOLATE) "KYORIN" 杏林新生 PIPERIDOLATE HCL 50 -- 2.02 104/01/01 78 1030065694 AC22701266 ALLAMIN INJECTION 3% ISOTONIC "KYORIN" 杏林新生 PHENYLALANINE L- 3.07 300 -- 65 104/01/01 79 1030065694 AC22701277 ALLAMIN INJECTION ISOTONIC "KYORIN" 杏林新生 PHENYLALANINE L- 3.07 -- 70 104/01/01 80 1030065694 AC25355266 FRUCEROL INJECTION 杏林新生 GLYCERIN (=GLYCEROL) 100 / 300 -- 85 104/01/01 81 1030065695 A025355277 FRUCEROL INJECTION 杏林新生 GLYCERIN (=GLYCEROL) 100 / 82 0 104/02/01 82 1030065695 A026583100 TIBICAN TABLETS (TINIDAZOLE) 杏林新生 TINIDAZOLE 錠 2.11 0 104/02/01 83 1030065695 A028958100 CHOLEXAMIN TABLETS 200 (NICOMOL) 84 1030065695 A029106100 BEHYD RA TABLETS 杏林新生 BENZYLHYDROCHLOROT HIAZIDE 4 杏林新生 NICOMOL 200 錠 3.61 0 104/02/01 錠 2.67 0 104/02/01 85 1030065695 A029510100 BACCIDAL F.C. TABLETS (NORFLOXACIN) 86 1030065695 A032723100 PAPIROR E.C. TABLETS 100 (PENTOXYFYLLINE) "KYORIN" 杏林新生 杏林新生 NORFLOXACIN (=BACCIDAL) 100 PENTOXIFYLLINE 100 腸溶錠 2.61 0 104/02/01 1.51 0 104/02/01 87 1030065695 A035398100 TRIVEMIN TABLETS 杏林新生 MECLIZINE HCL 12.5 錠 1.56 0 104/02/01 88 1030065695 A040542100 BACCIDAL F.C 200 杏林新生 NORFLOXACIN (=BACCIDAL) 200 2.61 0 104/02/01 89 1030065695 A042623277 HESPANDER INJECTION 杏林新生 HYDROXYETHYL STARCH 70000 60 / 256 0 104/02/01 90 1030065695 A043573100 SANCOS TABLETS 杏林新生 LOVASTATIN 20 錠 5.3 0 104/02/01 91 1030065695 AC25355277 FRUCEROL INJECTION 杏林新生 GLYCERIN (=GLYCEROL) 100 / -- 101 104/01/01 92 1030065695 AC26583100 TIBICAN TABLETS (TINIDAZOLE) 杏林新生 TINIDAZOLE 錠 -- 2.12 104/01/01 93 1030065695 AC28958100 CHOLEXAMIN TABLETS 200 (NICOMOL) 杏林新生 NICOMOL 200 錠 -- 3.61 104/01/01 第 6 頁, 共 174 頁
項次 發文號 健保代碼 藥品名稱 廠牌 成分及含量 型 規格原核定新核定量價價 生效日期 94 1030065695 AC29106100 BEHYD RA TABLETS 杏林新生 BENZYLHYDROCHLOROT 錠 -- 2.67 104/01/01 HIAZIDE 4 95 1030065695 AC29510100 BACCIDAL F.C. TABLETS (NORFLOXACIN) 96 1030065695 AC32723100 PAPIROR E.C. TABLETS 100 (PENTOXYFYLLINE) "KYORIN" 杏林新生 杏林新生 NORFLOXACIN (=BACCIDAL) 100 PENTOXIFYLLINE 100 腸溶錠 -- 2.61 104/01/01 -- 1.6 104/01/01 97 1030065695 AC35398100 TRIVEMIN TABLETS 杏林新生 MECLIZINE HCL 12.5 錠 -- 1.56 104/01/01 98 1030065695 AC40542100 BACCIDAL F.C 200 杏林新生 NORFLOXACIN (=BACCIDAL) 200 -- 2.61 104/01/01 99 1030065695 AC42623277 HESPANDER INJECTION 杏林新生 HYDROXYETHYL STARCH 70000 60 / -- 256 104/01/01 100 1030065695 AC43573100 SANCOS TABLETS 杏林新生 LOVASTATIN 20 錠 -- 5.3 104/01/01 101 1030065789 A034904139 MYCOSTATIN FOR ORAL SUSPENSION 100,000 UNITS/ (NYSTATIN) 102 1030065789 AC34904139 MYCOSTATIN FOR ORAL SUSPENSION 100,000 UNITS/ (NYSTATIN) 103 1030065789 X000109139 MYCOSTATINE (NYSTATINE) SUSPENSION BUVABLE 100,000IU/ 健亞 健亞 HAUPT GMBH. NYSTATIN 100000 U/ (UNIT/) NYSTATIN 100000 U/ (UNIT/) NYSTATIN 100000 U/ (UNIT/) 懸液用粉 懸液用粉 懸液用粉 24 98 0 104/02/01 24 -- 98 104/01/01 24 79 0 104/02/01 104 1030065803 AB34096100 GLUCOMINE F.C. TABLETS "P.L"(METFORMIN) 培力 METFORMIN HCL -- 1.5 104/01/01 105 1030065803 AB340961G0 GLUCOMINE F.C. TABLETS "P.L"( (METFORMIN) 鋁箔 / 膠箔 ) 106 1030065803 AC34096100 GLUCOMINE F.C. TABLETS "P.L" (METFORMIN) 培力 培力 METFORMIN HCL METFORMIN HCL -- 2 104/01/01 1.5 0 104/02/01 107 1030065803 AC340961G0 GLUCOMINE F.C. TABLETS "P.L"((METFORMIN) 鋁箔 / 膠箔 ) 培力 METFORMIN HCL 2 0 104/02/01 108 1030065880 AC58327421 ANTOL EYE DROPS 1% "Y.Y." 應元 ATROPINE SULFATE 10 / 5 -- 29.9 104/01/01 109 1030065880 AC58327429 ANTOL EYE DROPS 1% "Y.Y." 應元 ATROPINE SULFATE 10 / 10 -- 33.9 104/01/01 第 7 頁, 共 174 頁
110 1030065936 AC58239100 CRAIGO F.C. TABLETS 200 五洲製 QUETIAPINE (AS FUMARATE) 200 -- 37.3 104/01/01 111 1030065977 AC58342421 COMALOL 0.25% OPHTHALMIC SOLUTION 健亞 TIMOLOL (MALEATE) 2.5 / 5 -- 86 104/01/01 112 1030065980 AC10652277 RINGER'S INJECTION "OTSUKA" 大塚 SODIUM CHLORIDE 8.6 / 25 0 104/02/01 113 1030065980 AC10655277 DEXT-SALINE INJECTION "OTSUKA" 大塚 SODIUM CHLORIDE 9 / 25 0 104/02/01 114 1030065980 AC58307277 DEXT-SALINE INJECTION "OTSUKA" 大塚 SODIUM CHLORIDE 9 / -- 25 104/01/01 115 1030065980 AC58324277 RINGER'S INJECTION "OTSUKA" 大塚 SODIUM CHLORIDE 8.6 / -- 25 104/01/01 116 1030065997 A046030100 KEROLAC FILM COATED TABLETS 10 永信台中幼獅廠 KETOROLAC TROMETHAMINE 10 6 0 104/02/01 117 1030065997 A046303100 INTESLET TABLETS 0.125 永信台中幼獅廠 HYOSCYAMINE SULFATE 0.125 錠 2.19 0 104/02/01 118 1030065997 A049055100 OMEPROTECT ENTERIC MICROENCAPSULATED CAPSULES 20 ANGEL 永信台中幼獅廠 OMEPRAZOLE 20 膠囊 5.7 0 104/02/01 119 1030065997 AC46030100 KEROLAC FILM COATED TABLETS 10 永信台中幼獅廠 KETOROLAC TROMETHAMINE 10 -- 6 104/01/01 120 1030065997 AC46303100 INTESLET TABLETS 0.125 永信台中幼獅廠 HYOSCYAMINE SULFATE 0.125 錠 -- 2.72 104/01/01 121 1030065997 AC49055100 OMEPROTECT ENTERIC MICROENCAPSULATED CAPSULES 20 ANGEL 永信台中幼獅廠 OMEPRAZOLE 20 膠囊 -- 5.7 104/01/01 122 1030066063 A048329248 EPICIN LYO INJECTION 50 "UNION" 123 1030066063 AB48329248 EPICIN LYO INJECTION 50 "UNION" 南光 EPIRUBICIN HCL 50 凍晶 注射 南光 EPIRUBICIN HCL 50 凍晶 注射 50 2359 0 104/02/01 50 -- 3640 104/01/01 124 1030066067 A058330238 POTASSIUM CHLORIDE 台裕 INJECTION 15%"TAI YU" POTASSIUM CHLORIDE 150 / 20 -- 8.4 104/01/01 125 1030066070 AB24197100 DICLOFENAC E.F.C. TABLETS 25"CHINTENG" 井田國際醫藥廠 DICLOFENAC SODIUM 25 腸溶 -- 1.5 104/01/01 第 8 頁, 共 174 頁
126 1030066070 AB241971G0 DICLOFENAC E.F.C. TABLETS 25"CHINTENG" ( 鋁箔 / 膠箔 ) 井田國際醫藥廠 DICLOFENAC SODIUM 25 腸溶 -- 2 104/01/01 127 1030066070 AB32926100 DICLOFENAC E.F.C. TABLETS 50 "CHINTENG" 128 1030066070 AB329261G0 DICLOFENAC E.F.C. TABLETS 50 "CHINTENG"( 鋁箔 / 膠 箔 ) 井田國際醫藥廠 井田國際醫藥廠 DICLOFENAC SODIUM 50 DICLOFENAC SODIUM 50 腸溶腸溶 -- 1.5 104/01/01 -- 2 104/01/01 129 1030066070 AB39013100 MECO TABLETS 30 井田國際醫 (DEXTROMETHORPHAN 藥廠 ) "CHINTENG" DEXTROMETHORPHAN HBR 30 錠 -- 1.5 104/01/01 130 1030066070 AB42855100 SAWTO ENTERIC- MICROENCAPSULATED CAPSULES 50 "CHINTENG" (DICLOFENAC SODIUM) 井田國際醫藥廠 DICLOFENAC SODIUM 50 腸溶微粒膠囊 -- 1.5 104/01/01 131 1030066070 AB428551G0 SAWTO ENTERIC- MICROENCAPSULATED CAPSULES 50 "CHINTENG" (DICLOFENAC SODIUM)( 鋁箔 / 膠箔 ) 井田國際醫藥廠 DICLOFENAC SODIUM 50 腸溶微粒膠囊 -- 2 104/01/01 132 1030066070 AB43837100 DICLOFENAC S.R F.C. TABLETS 井田國際醫藥廠 DICLOFENAC SODIUM 100 持續性 -- 3.35 104/01/01 133 1030066070 AC24197100 DICLOFENAC E.F.C. TABLETS 25"CHINTENG" 井田國際醫藥廠 DICLOFENAC SODIUM 25 腸溶 1.5 0 104/02/01 134 1030066070 AC241971G0 DICLOFENAC E.F.C. TABLETS 25"CHINTENG" ( 鋁箔 / 膠箔 ) 井田國際醫藥廠 DICLOFENAC SODIUM 25 腸溶 2 0 104/02/01 135 1030066070 AC32926100 DICLOFENAC E.F.C. TABLETS 50 "CHINTENG" 井田國際醫藥廠 DICLOFENAC SODIUM 50 腸溶 1.5 0 104/02/01 136 1030066070 AC329261G0 DICLOFENAC E.F.C. TABLETS 50 "CHINTENG"( 鋁箔 ) 井田國際醫藥廠 DICLOFENAC SODIUM 50 腸溶 2 0 104/02/01 137 1030066070 AC39013100 MECO TABLETS 30 井田國際醫 (DEXTROMETHORPHAN 藥廠 ) "CHINTENG" DEXTROMETHORPHAN HBR 30 錠 1.5 0 104/02/01 第 9 頁, 共 174 頁
138 1030066070 AC42855100 SAWTO ENTERIC- MICROENCAPSULATED CAPSULES 50 "CHINTENG" (DICLOFENAC SODIUM) 井田國際醫藥廠 DICLOFENAC SODIUM 50 腸溶微粒膠囊 1.5 0 104/02/01 139 1030066070 AC428551G0 SAWTO ENTERIC- MICROENCAPSULATED CAPSULES 50 "CHINTENG" (DICLOFENAC SODIUM)( 鋁箔 / 膠箔 ) 井田國際醫藥廠 DICLOFENAC SODIUM 50 腸溶微粒膠囊 2 0 104/02/01 140 1030066070 AC43837100 DICLOFENAC S.R F.C. TABLETS 井田國際醫藥廠 DICLOFENAC SODIUM 100 持續性 3.35 0 104/02/01 141 1030066121 AC58310100 LERKA F.C. TABLETS 10 健喬信元健喬廠 LERCANIDIPINE 10 -- 8.5 104/01/01 142 1030066122 AC58282100 ROSTATIN F.C. TABLETS 10 "STANDARD" 143 1030066123 A025739100 ERYTHROMYCIN STEARATE FILM COATED TABLETS 250 "SHITEH" 生達二廠 大豐製藥股份有限公司 ROSUVASTATIN CALCIUM 10 ERYTHROMYCIN (STEARATE) 250 -- 21.3 104/01/01 1.43 0 104/02/01 144 1030066123 AC25739100 ERYTHROMYCIN STEARATE FILM COATED TABLETS 250 "SHITEH" 大豐製藥股份有限公司 ERYTHROMYCIN (STEARATE) 250 -- 2.31 104/01/01 145 1030066190 AC56299100 METINA TABLETS 健喬信元健 喬廠 NORETHINDRONE ACETATE 10 錠 -- 2.01 104/01/01 146 1030066190 AC56693100 ALISA F.C. TABLETS 健喬信元健 喬廠 ESTRADIOL 17- VALERINATE 2 -- 3.93 104/01/01 147 1030066290 A022987100 PRIMPERAN FILM COATED TABLETS (METOCLOPRAMIDE 聯亞生技新竹二廠 METOCLOPRAMIDE (2HCL MONOHYDRATE) 3.84 1.5 0 104/02/01 148 1030066290 A0229871G0 PRIMPERAN FILM COATED TABLETS (METOCLOPRAMIDE) ( 鋁箔 / 膠箔 ) 聯亞生技新竹二廠 METOCLOPRAMIDE (2HCL MONOHYDRATE) 3.84 2 0 104/02/01 第 10 頁, 共 174 頁
149 1030066290 A024187100 TRENTAL DRAGEE 100 (PENTOXIFYLLINE) 聯亞生技新竹二廠 PENTOXIFYLLINE 100 糖衣錠 1.6 0 104/02/01 150 1030066290 A026526100 DOGMATYL FILM COATED TABLETS 50 (SULPIRIDE) 聯亞生技新竹二廠 SULPIRIDE 50 1.73 0 104/02/01 151 1030066290 A026976100 DOGMATYL FILM COATED TABLETS 200 (SULPIRIDE) 聯亞生技新竹二廠 SULPIRIDE 200 2.69 0 104/02/01 152 1030066290 A028470100 TRENTAL DRAGEE 400 (PENTOXIFYLLINE) 聯亞生技新竹二廠 PENTOXIFYLLINE 400 持續性糖衣錠 2.29 0 104/02/01 153 1030066290 AC22987100 PRIMPERAN FILM COATED TABLETS (METOCLOPRAMIDE 聯亞生技新竹二廠 METOCLOPRAMIDE (2HCL MONOHYDRATE) 3.84 -- 1.5 104/01/01 154 1030066290 AC229871G0 PRIMPERAN FILM COATED TABLETS (METOCLOPRAMIDE) ( 鋁箔 / 膠箔 ) 聯亞生技新竹二廠 METOCLOPRAMIDE (2HCL MONOHYDRATE) 3.84 -- 2 104/01/01 155 1030066290 AC24187100 TRENTAL DRAGEE 100 (PENTOXIFYLLINE) 聯亞生技新竹二廠 PENTOXIFYLLINE 100 糖衣錠 -- 1.6 104/01/01 156 1030066290 AC26526100 DOGMATYL FILM COATED TABLETS 50 (SULPIRIDE) 157 1030066290 AC26976100 DOGMATYL FILM COATED TABLETS 200 (SULPIRIDE) 聯亞生技新竹二廠 聯亞生技新竹二廠 SULPIRIDE 50 SULPIRIDE 200 -- 1.73 104/01/01 -- 2.69 104/01/01 158 1030066290 AC28470100 TRENTAL DRAGEE 400 (PENTOXIFYLLINE) 聯亞生技新竹二廠 PENTOXIFYLLINE 400 持續性糖衣錠 -- 2.29 104/01/01 159 1030066304 A019573100 FOCEL TABLETS (CLOMIPHENE) "S.C." 160 1030066304 AC19573100 CLOMIPHENE TABLETS "PEILI" 培力 CLOMIPHENE CITRATE 50 培力 CLOMIPHENE CITRATE 50 錠 3.8 0 104/02/01 錠 -- 5.5 104/01/01 161 1030066305 AB47984100 CARLIPIN TABLETS 50 永信台中幼獅廠 ACARBOSE 50 錠 -- 3.61 104/01/01 162 1030066305 AC47984100 CARLIPIN TABLETS 50 永信台中幼獅廠 ACARBOSE 50 錠 3.61 0 104/02/01 第 11 頁, 共 174 頁
項次 發文號 健保代碼 藥品名稱 廠牌 成分及含量 型 規格原核定新核定量價價 生效日期 163 1030066371 AB33411100 ANCOU TABLETS 30 "KOJAR" (DEXTROMETHORPHAN ) DEXTROMETHORPHAN HBR 30 錠 -- 1.5 104/01/01 164 1030066371 AB34736100 GLICALIN TABLETS 80 "KOJAR" (GLICLAZIDE) GLICLAZIDE 80 錠 -- 1.5 104/01/01 165 1030066371 AB52485100 LVTANGSU TABLETS KOJAR METFORMIN HCL 錠 -- 1.5 104/01/01 166 1030066371 AB55258100 LVTANGSU TABLETS 250 KOJAR METFORMIN HCL 250 錠 -- 1.5 104/01/01 167 1030066371 AC33411100 ANCOU TABLETS 30 "KOJAR" (DEXTROMETHORPHAN ) 168 1030066371 AC34736100 GLICALIN TABLETS 80 "KOJAR" (GLICLAZIDE) DEXTROMETHORPHAN HBR 30 錠 1.5 0 104/02/01 GLICLAZIDE 80 錠 1.5 0 104/02/01 169 1030066371 AC52485100 LVTANGSU TABLETS KOJAR METFORMIN HCL 錠 1.5 0 104/02/01 170 1030066371 AC55258100 LVTANGSU TABLETS 250 KOJAR METFORMIN HCL 250 錠 1.5 0 104/02/01 171 1030066380 A047570100 Rayor Tablets "Cosmic" 衛達製造 DIHYDROERGOTAMINE 錠 2.59 0 104/02/01 METHANESULPHONATE 1 172 1030066380 AC47570100 Rayor Tablets "Cosmic" 衛達製造 DIHYDROERGOTAMINE 錠 -- 2.59 104/01/01 METHANESULPHONATE 1 173 1030066480 A030883100 BRINERDIN S.C. TABLETS 聯亞生技新竹二廠 DIHYDROERGOCRISTINE (MESYLATE) 0.58 糖衣錠 3.2 0 104/02/01 174 1030066480 AC30883100 BRINERDIN S.C. TABLETS 聯亞生技新竹二廠 DIHYDROERGOCRISTINE (MESYLATE) 0.58 糖衣錠 -- 3.2 104/01/01 175 1030066480 B024171100 STALEVO FILM- COATED TABLETS 100/25/200 ORION CORPORAT ION LEVODOPA 100 25 0 104/02/01 176 1030066480 B024172100 STALEVO FILM- COATED TABLETS150/37.5/200 ORION CORPORAT ION LEVODOPA 150 25 0 104/02/01 177 1030066480 B024173100 STALEVO FILM- COATED TABLETS 50/12.5/200 ORION CORPORAT ION LEVODOPA 50 25 0 104/02/01 178 1030066480 B024989100 STALEVO FILM- COATED TABLETS 200/50/200 ORION CORPORAT ION LEVODOPA 200 25.4 0 104/02/01 第 12 頁, 共 174 頁
179 1030066480 BC24171100 STALEVO FILM- COATED TABLETS 100/25/200 ORION CORPORAT ION LEVODOPA 100 -- 25 104/01/01 180 1030066480 BC24172100 STALEVO FILM- COATED TABLETS150/37.5/200 ORION CORPORAT ION LEVODOPA 150 -- 25 104/01/01 181 1030066480 BC24173100 STALEVO FILM- COATED TABLETS 50/12.5/200 ORION CORPORAT ION LEVODOPA 50 -- 25 104/01/01 182 1030066480 BC24989100 STALEVO FILM- COATED TABLETS 200/50/200 ORION CORPORAT ION LEVODOPA 200 -- 25.4 104/01/01 183 1030066515 AC42601266 ANOL INJECTION 200/ (MANNITOL) "ASTAR" 安星製造 MANNITOL 200 / 注射 300 -- 39.4 104/01/01 184 1030066515 AC42601277 ANOL INJECTION 200/ (MANNITOL) "ASTAR" 安星製造 MANNITOL 200 / 注射 -- 117 104/01/01 185 1030066533 A031882209 U-SAVE-A FOR INJECTION (CEPHRADINE) 瑞士新市廠 CEPHRADINE 1000 乾粉 1 GM 28.4 0 104/02/01 186 1030066533 A031882277 U-SAVE-A FOR INJECTION (CEPHRADINE) 瑞士新市廠 CEPHRADINE 乾粉 23.8 0 104/02/01 187 1030066533 AC31882209 U-SAVE-A FOR INJECTION (CEPHRADINE) 瑞士新市廠 CEPHRADINE 1000 乾粉 1 GM -- 28.4 104/01/01 188 1030066533 AC31882277 U-SAVE-A FOR INJECTION (CEPHRADINE) 瑞士新市廠 CEPHRADINE 乾粉 -- 25.8 104/01/01 189 1030066612 AC58360100 DALISOON F.C. TABLETS 5 "STANDARD" (SOLIFENACIN SUCCINATE) 190 1030066800 A048911265 BESTNEM POWDER FOR I.V. INJECTION 生達化學 SOLIFENACIN SUCCINATE 5 展旺針廠 IMIPENEM 250 乾粉 250 -- 26.9 104/01/01 191 0 104/02/01 191 1030066800 A048911277 BESTNEM POWDER FOR I.V. INJECTION 展旺針廠 IMIPENEM 乾粉 348 0 104/02/01 192 1030066800 AB48911265 BESTNEM POWDER FOR I.V. INJECTION 展旺針廠 IMIPENEM 250 乾粉 250 -- 205 104/01/01 193 1030066800 AB48911277 BESTNEM POWDER FOR I.V. INJECTION 展旺針廠 IMIPENEM 乾粉 -- 471 104/01/01 第 13 頁, 共 174 頁
194 1030066850 A029852329 SFUSONE CREAM 5/G (TRIAMCINOLONE ACETONIDE) "H.S." 195 1030066850 A029859100 COCHILIN CAPSULES "HS" 黃氏 TRIAMCINOLONE (ACETONIDE) 5 /GM 黃氏 NITROFURANTOIN 100 膠囊 規格原核定新核定量價價 生效日期 10 GM 196 1030066850 A0298591G0 COCHILIN CAPSULES "HS"( 鋁箔 / 膠箔 ) 黃氏 NITROFURANTOIN 100 膠囊 197 1030066850 A029860100 ISIHTONNIN CAPSULES 50 (KETOPROFEN) "HS" 黃氏 KETOPROFEN 50 膠囊 198 1030066850 A029866100 HIRANIN CAPSULES 350 (CARISOPRODOL) "HS" 黃氏 CARISOPRODOL 350 膠囊 199 1030066850 A029867100 ANTIRHEUMATIC CAPSULES 25 (INDOMETHACIN) "HS" 黃氏 INDOMETHACIN 25 膠囊 200 1030066850 A0298671G0 ANTIRHEUMATIC CAPSULES 25 "HS"(INDOMETHACIN)( 鋁箔 / 膠箔 ) 黃氏 INDOMETHACIN 25 膠囊 201 1030066850 A029874100 VOTONNIN CAPSULES 25 (DICLOFENAC) "HS" 黃氏 DICLOFENAC SODIUM 25 膠囊 202 1030066850 A0298741G0 VOTONNIN CAPSULES 25 (DICLOFENAC) "HS"( 鋁箔 / 膠箔 ) 黃氏 DICLOFENAC SODIUM 25 膠囊 203 1030066850 A029875100 HOW NAMIN CAPSULES "HS" 黃氏 CHLORPHENIRAMINE MALEATE 1 膠囊 204 1030066850 A0298751G0 HOW NAMIN CAPSULES "HS"( 鋁箔 / 膠箔 ) 黃氏 CHLORPHENIRAMINE MALEATE 1 膠囊 205 1030066850 A029907157 CODENIN SYRUP "H.S." 黃氏 CHLORPHENIRAMINE MALEATE 0.25 / 糖漿 120 206 1030066850 A029929100 METHYLTESTOSTERON E CAPSULES 10 (METHYLTESTOSTERON E) "HS" 黃氏 METHYLTESTOSTERONE 10 膠囊 207 1030066850 A029931100 CHANSIAN CAPSULES 5 (PREDNISOLONE) "HS" 黃氏 PREDNISOLONE 5 膠囊 208 1030066850 A029933100 TIBILIN S.C. TABLETS "HS" 黃氏 LIVER 20 糖衣 錠 209 1030066850 A030648100 SUTAN CAPSULES (MEFENAMIC ACID) "H.S." 黃氏 MEFENAMIC ACID 膠囊 第 14 頁, 共 174 頁
210 1030066850 A0306481G0 SUTAN CAPSULES "H.S."(MEFENAMIC ACID)( 鋁箔 / 膠箔 ) 黃氏 MEFENAMIC ACID 膠囊 211 1030066850 A030649100 DAWEISON TAB. 10 (DOMPERIDONE) "H.S." 212 1030066850 A0306491G0 DAWEISON TAB. 10 (DOMPERIDONE) "H.S."( 鋁箔 / 膠箔 ) 213 1030066850 A030650100 HITOLIN TABLETS 100 (MEBENDAZOLE) "H.S." 214 1030066850 A030766100 CLOESTIN TABLETS 200 (BEZAFIBRATE) "H.S." 黃氏 DOMPERIDONE 10 錠 黃氏 DOMPERIDONE 10 錠 黃氏 MEBENDAZOLE 100 錠 黃氏 BEZAFIBRATE 200 錠 215 1030066850 A030767100 KANYENING CAPSULES 300 (FENBUFEN) "H.S." 黃氏 FENBUFEN 300 膠囊 216 1030066850 A030837100 ANRIGIN TABLETS 100 (AMANTADINE HCL) "H.S." 黃氏 AMANTADINE HCL 100 錠 217 1030066850 A030838335 KOTASON CREAM 0.5/G (CLOBETASOL) "H.S." 黃氏 CLOBETASOL PROPIONATE 0.5 /GM 15 GM 218 1030066850 A030896100 EUMI TABLETS 100 "H.S." (TRIMETHOPRIM) 黃氏 TRIMETHOPRIM 100 錠 219 1030066850 A0308961G0 EUMI TABLETS 100 "H.S." (TRIMETHOPRIM)( 鋁箔 / 膠箔 ) 黃氏 TRIMETHOPRIM 100 錠 220 1030066850 A030916100 KOTOGEN TABLETS 50 "H.S." (BENZBROMARONE) 黃氏 BENZBROMARONE 50 錠 221 1030066850 A031049157 COUGEL SYRUP "H.S." 黃氏 CHLORPHENIRAMINE MALEATE 0.4 / 糖漿 120 222 1030066850 A031101100 LOLIAN CAPSULES 150 "H.S." (SILYBIN) 黃氏 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 150 膠囊 223 1030066850 A0311011G0 LOLIAN CAPSULES 150 "H.S." (SILYBIN)( 鋁箔 / 膠箔 ) 黃氏 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 150 膠囊 224 1030066850 A032642100 GIKO FILM-COATED TABLETS 9.6 (GYNKGOFLAVONGLYC OSIDE)"H.S." 黃氏 GINKGO BILOBA EXTRACT 40 第 15 頁, 共 174 頁
項次 發文號 健保代碼 藥品名稱 廠牌 成分及含量 型 規格原核定新核定量價價 生效日期 225 1030066850 A032649100 SWEGA TABLETS 黃氏 CIMETIDINE 400 錠 400 (CIMETIDINE) "H.S." 226 1030066850 A0326491G0 SWEGA TABLETS 黃氏 CIMETIDINE 400 錠 400 "H.S."(CIMETIDINE) ( 鋁箔 / 膠箔 ) 227 1030066850 A032651100 KETIFEN TABLETS 1 (KETOTIFEN) "H.S." 黃氏 KETOTIFEN (FUMARATE) 1 錠 228 1030066850 A032710100 MECON TABLETS 30 黃氏 (DEXTROMETHORPHAN ) "H.S." DEXTROMETHORPHAN HBR 30 錠 229 1030066850 A032816100 NASCO TABLETS "H.S." 黃氏 PSEUDOEPHEDRINE HCL 60 錠 230 1030066850 A0328161G0 NASCO TABLETS "H.S."( 鋁箔 / 膠箔 ) 黃氏 PSEUDOEPHEDRINE HCL 60 錠 231 1030066850 A032943100 NIFAN CAPSULES 250 (NIFLUMIC ACID) "H.S." 232 1030066850 A033079100 PIROXICAM TABLETS 20 "H.S." 233 1030066850 A0330791G0 PIROXICAM TABLETS 20 "H.S."( 鋁箔 / 膠箔 ) 黃氏 NIFLUMIC ACID 250 膠囊 黃氏 PIROXICAM 20 錠 黃氏 PIROXICAM 20 錠 234 1030066850 A034545329 WIPOIDO CREAM 黃氏 ESTRADIOL 0.6 /GM 乳膏 10 GM 235 1030066850 A034896100 LIME TABLETS 0.25 (TRIAZOLAM) "H.S." 黃氏 TRIAZOLAM 0.25 錠 236 1030066850 A034898100 VOLTON ENTERIC- COATED TABLETS 50 (DICLOFENAC) "H.S." 237 1030066850 A0348981G0 VOLTON ENTERIC- COATED TABLETS 50 (DICLOFENAC) "H.S."( 鋁箔 / 膠箔 ) 黃氏 DICLOFENAC SODIUM 50 黃氏 DICLOFENAC SODIUM 50 腸溶錠 腸溶錠 238 1030066850 A035011100 BUSP TABLETS 10 (BUSPIRONE) "H.S." 黃氏 BUSPIRONE HCL 10 錠 239 1030066850 A036240100 GLIZIDE TABLETS 80 "H.S." (GLICLAZIDE) 240 1030066850 A0362401G0 GLIZIDE TABLETS 80 "H.S." (GLICLAZIDE) ( 鋁 箔 / 膠箔 ) 黃氏 GLICLAZIDE 80 錠 黃氏 GLICLAZIDE 80 錠 241 1030066850 A036241100 TIMEPIN TABLETS 30 "H.S." (TIMEPIDIUM) 242 1030066850 A036367100 AMITON TABLETS "H.S." 黃氏 TIMEPIDIUM BROMIDE 30 黃氏 AMILORIDE HCL (DIHYDRATE) 5 錠 錠 第 16 頁, 共 174 頁
243 1030066850 A037029100 NIFUROX CAPSULES 200 (NIFUROXAZIDE) "H.S." 黃氏 NIFUROXAZIDE 200 膠囊 244 1030066850 A037292100 NICER TABLETS 10 (NICERGOLINE) "H.S." 黃氏 NICERGOLINE 10 錠 245 1030066850 A037501329 ISOLON CREAM "H.S." 黃氏 DIFLUCORTOLONE 21- VALERATE 1 /GM 246 1030066850 A037501335 ISOLON CREAM "H.S." 黃氏 DIFLUCORTOLONE 21- VALERATE 1 /GM 10 GM 15 GM 247 1030066850 A037675100 BACONE TABLETS 10 "H.S." (BACLOFEN) 248 1030066850 A0376751G0 BACONE TABLETS 10 "H.S." (BACLOFEN)( 鋁箔 / 膠箔 ) 黃氏 BACLOFEN 10 錠 黃氏 BACLOFEN 10 錠 249 1030066850 A038073314 ESTRAD GEL 0.06% (ESTRADIOL) "H.S." 黃氏 ESTRADIOL 0.6 /GM 外用 凝膠 2.5 GM 250 1030066850 A038073343 ESTRAD GEL 0.06% (ESTRADIOL) "H.S." 黃氏 ESTRADIOL 0.6 /GM 外用 凝膠 30 GM 251 1030066850 A039235100 SERRASE ENTERIC- COATED 10 黃氏 SERRAPEPTASE (=SERRATIOPEPTIDASE) 10 252 1030066850 A040207100 FENOT TAB. 2.5 黃氏 FENOTEROL HBR 2.5 錠 253 1030066850 A0402071G0 FENOT TAB. 2.5"H.S."(FENOTERO L HYDROBROMIDE)( 鋁箔 / 膠箔 ) 黃氏 FENOTEROL HBR 2.5 錠 254 1030066850 A041024100 FREE TAB.2 黃氏 BIPERIDEN HCL 2 錠 255 1030066850 A041420100 SILIBIN CAP. 70 黃氏 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 70 膠囊 256 1030066850 A0414201G0 SILIBIN CAPSULES 黃氏 70 "H.S." (SILYMARIN)( 鋁箔 / 膠箔 ) SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 70 膠囊 257 1030066850 A041530100 WEICON-BI TAB. 300 黃氏 BISMUTH SUBCITRATE COLLOIDAL(=TRIPOTASSI UM DICITRATE BISMUTHATE) 300 錠 258 1030066850 A042887100 CETIZIN F. C. TABLETS 10 "H.S."(CETIRIZINE) 259 1030066850 A0428871G0 CETIZIN F. C. TABLETS 10 "H.S."(CETIRIZINE) ( 鋁箔 / 膠箔 ) 黃氏 黃氏 CETIRIZINE DIHYDROCHLORIDE 10 CETIRIZINE DIHYDROCHLORIDE 10 第 17 頁, 共 174 頁
260 1030066850 A044299429 BETONASE AQUEOUS NASAL SPRAY 50UG/SPRAY 黃氏 BECLOMETHASONE DIPROPIONATE 50 MCG/DOSE 鼻用噴液 200 DOSE 261 1030066850 A045672321 MOSONE CREAM "H.S" 黃氏 MOMETASONE FUROATE 1 /GM 262 1030066850 A045672329 MOSONE CREAM "H.S" 黃氏 MOMETASONE FUROATE 1 /GM 263 1030066850 A045672335 MOSONE CREAM "H.S" 黃氏 MOMETASONE FUROATE 1 /GM 5 GM 10 GM 15 GM 264 1030066850 A045706151 LORADIN SYRUP "H.S" 黃氏 LORATADINE 1 / 糖漿 60 265 1030066850 A045706155 LORADIN SYRUP "H.S" 黃氏 LORATADINE 1 / 糖漿 100 266 1030066850 A046189423 SUYENIN ORAL BASE "H.S" 黃氏 TRIAMCINOLONE (ACETONIDE) 1 /GM 口內膏 6 GM 267 1030066850 A046585151 EISO LIQUID 5.34 /"H.S." 黃氏 THEOPHYLLINE (ANHYDROUS) 5.34 / 內服液 60 268 1030066850 A046585157 EISO LIQUID 5.34 /"H.S." 黃氏 THEOPHYLLINE (ANHYDROUS) 5.34 / 內服液 120 269 1030066850 A046744340 TOGIAM CONCENTRATE LIQUID "H.S." 黃氏 POLYCRESOLSULFONATE (POLICRESULEN) 360 /GM 外用液 25 270 1030066850 A047643100 Shuful Tablet "H.S." 黃氏 CIMETIDINE 800 錠 271 1030066850 A047878100 Tonfuse Tablets 50mg "H.S." 黃氏 ACARBOSE 50 錠 272 1030066850 A048676100 SUPLAX TABLETS "H.S." 黃氏 ACETAMINOPHEN (=PARACETAMOL) 450 錠 273 1030066850 A048690100 SURMAX TABLETS H.S. 黃氏 MEPHENOXALONE 錠 274 1030066850 A048804438 BECLOMASE AQUEOUS NASAL SPRAY " H.S." 黃氏 BECLOMETHASONE DIPROPIONATE 100 MCG/DOSE 鼻用噴液 200 DOSE 275 1030066850 A048830100 WELLMAX TABLETS "H.S." 黃氏 ALUMINUM DIHYDROXYALLANTOIN ATE (=ALDIOXA) 50 錠 276 1030066850 A0488301G0 WELLMAX TABLETS "H.S."( 鋁箔 ) 黃氏 ALUMINUM DIHYDROXYALLANTOIN ATE (=ALDIOXA) 50 錠 277 1030066850 A080100 GLUCODUE TABLETS "H.S." 黃氏 METFORMIN HCL 1000 錠 第 18 頁, 共 174 頁
278 1030066850 AC29852329 "SFUSONE CREAM 5/G (TRIAMCINOLONE ACETONIDE) ""H.S.""" 黃氏 TRIAMCINOLONE (ACETONIDE) 5 /GM 規格原核定新核定生效日期量價價 10 GM -- 52 104/01/01 279 1030066850 AC29859100 "COCHILIN CAPSULES ""HS""" 黃氏 NITROFURANTOIN 100 膠囊 -- 1.5 104/01/01 280 1030066850 AC298591G0 "COCHILIN CAPSULES ""HS""( 鋁箔 / 膠箔 )" 黃氏 NITROFURANTOIN 100 膠囊 -- 2 104/01/01 281 1030066850 AC29860100 "ISIHTONNIN CAPSULES 50 (KETOPROFEN) ""HS""" 黃氏 KETOPROFEN 50 膠囊 -- 2.09 104/01/01 282 1030066850 AC29866100 "HIRANIN CAPSULES 350 (CARISOPRODOL) ""HS""" 283 1030066850 AC29867100 "ANTIRHEUMATIC CAPSULES 25 (INDOMETHACIN) ""HS""" 黃氏 CARISOPRODOL 350 膠囊 黃氏 INDOMETHACIN 25 膠囊 -- 4.72 104/01/01 -- 1.5 104/01/01 284 1030066850 AC298671G0 "ANTIRHEUMATIC CAPSULES 25 ""HS""(INDOMETHACIN) ( 鋁箔 / 膠箔 )" 黃氏 INDOMETHACIN 25 膠囊 -- 2 104/01/01 285 1030066850 AC29874100 "VOTONNIN CAPSULES 25 (DICLOFENAC) ""HS""" 黃氏 DICLOFENAC SODIUM 25 膠囊 -- 1.5 104/01/01 286 1030066850 AC298741G0 "VOTONNIN CAPSULES 25 (DICLOFENAC) ""HS""( 鋁箔 / 膠箔 )" 黃氏 DICLOFENAC SODIUM 25 膠囊 -- 2 104/01/01 287 1030066850 AC29875100 "HOW NAMIN CAPSULES ""HS""" 黃氏 CHLORPHENIRAMINE MALEATE 1 膠囊 -- 1.5 104/01/01 288 1030066850 AC298751G0 "HOW NAMIN CAPSULES ""HS""( 鋁箔 / 膠箔 )" 黃氏 CHLORPHENIRAMINE MALEATE 1 膠囊 -- 2 104/01/01 289 1030066850 AC29907151 "CODENIN SYRUP ""H.S.""" 黃氏 CHLORPHENIRAMINE MALEATE 0.25 / 糖漿 60 -- 25 104/01/01 290 1030066850 AC29907157 "CODENIN SYRUP ""H.S.""" 黃氏 CHLORPHENIRAMINE MALEATE 0.25 / 糖漿 120 -- 30.5 104/01/01 291 1030066850 AC29929100 "METHYLTESTOSTERO NE CAPSULES 10 (METHYLTESTOSTERON E) ""HS""" 黃氏 METHYLTESTOSTERONE 10 膠囊 -- 1.93 104/01/01 292 1030066850 AC29931100 "CHANSIAN CAPSULES 5 (PREDNISOLONE) ""HS""" 黃氏 PREDNISOLONE 5 膠囊 -- 1.5 104/01/01 293 1030066850 AC29933100 "TIBILIN S.C. TABLETS ""HS""" 黃氏 LIVER 20 糖衣 錠 -- 1.5 104/01/01 第 19 頁, 共 174 頁
294 1030066850 AC30648100 "SUTAN CAPSULES (MEFENAMIC ACID) ""H.S.""" 黃氏 MEFENAMIC ACID 膠囊 -- 1.5 104/01/01 295 1030066850 AC306481G0 "SUTAN CAPSULES ""H.S.""(MEFENAMIC ACID)( 鋁箔 / 膠箔 )" 黃氏 MEFENAMIC ACID 膠囊 -- 2 104/01/01 296 1030066850 AC30649100 "DAWEISON TAB. 10 (DOMPERIDONE) ""H.S.""" 黃氏 DOMPERIDONE 10 錠 -- 1.5 104/01/01 297 1030066850 AC306491G0 "DAWEISON TAB. 10 (DOMPERIDONE) ""H.S.""( 鋁箔 / 膠箔 )" 黃氏 DOMPERIDONE 10 錠 -- 2 104/01/01 298 1030066850 AC30650100 "HITOLIN TABLETS 100 (MEBENDAZOLE) ""H.S.""" 299 1030066850 AC30766100 "CLOESTIN TABLETS 200 (BEZAFIBRATE) ""H.S.""" 黃氏 MEBENDAZOLE 100 錠 -- 1.52 104/01/01 黃氏 BEZAFIBRATE 200 錠 -- 8.1 104/01/01 300 1030066850 AC30767100 "KANYENING CAPSULES 300 (FENBUFEN) ""H.S.""" 黃氏 FENBUFEN 300 膠囊 -- 2.34 104/01/01 301 1030066850 AC30837100 "ANRIGIN TABLETS 100 (AMANTADINE HCL) ""H.S.""" 黃氏 AMANTADINE HCL 100 錠 -- 8.5 104/01/01 302 1030066850 AC30838335 "KOTASON CREAM 0.5/G (CLOBETASOL) ""H.S.""" 黃氏 CLOBETASOL PROPIONATE 0.5 /GM 15 GM -- 29.8 104/01/01 303 1030066850 AC30896100 "EUMI TABLETS 100 ""H.S."" (TRIMETHOPRIM)" 黃氏 TRIMETHOPRIM 100 錠 -- 1.5 104/01/01 304 1030066850 AC308961G0 "EUMI TABLETS 100 ""H.S."" (TRIMETHOPRIM)( 鋁箔 / 膠箔 )" 305 1030066850 AC30916100 "KOTOGEN TABLETS 50 ""H.S."" (BENZBROMARONE)" 黃氏 TRIMETHOPRIM 100 錠 -- 2 104/01/01 黃氏 BENZBROMARONE 50 錠 -- 1.5 104/01/01 306 1030066850 AC31049157 "COUGEL SYRUP ""H.S.""" 黃氏 CHLORPHENIRAMINE MALEATE 0.4 / 糖漿 120 -- 45.2 104/01/01 307 1030066850 AC31101100 "LOLIAN CAPSULES 150 ""H.S."" (SILYBIN)" 黃氏 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 150 膠囊 -- 1.7 104/01/01 308 1030066850 AC311011G0 "LOLIAN CAPSULES 150 ""H.S."" (SILYBIN)( 鋁箔 / 膠箔 )" 黃氏 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 150 膠囊 -- 2 104/01/01 第 20 頁, 共 174 頁
309 1030066850 AC32642100 "GIKO FILM-COATED TABLETS 9.6 (GYNKGOFLAVONGLYC OSIDE)""H.S.""" 黃氏 310 1030066850 AC32649100 "SWEGA TABLETS 400 (CIMETIDINE) ""H.S.""" GINKGO BILOBA EXTRACT 40 -- 2.51 104/01/01 黃氏 CIMETIDINE 400 錠 -- 1.5 104/01/01 311 1030066850 AC326491G0 "SWEGA TABLETS 400 ""H.S.""(CIMETIDINE) ( 鋁箔 / 膠箔 )" 黃氏 CIMETIDINE 400 錠 -- 2 104/01/01 312 1030066850 AC32651100 "KETIFEN TABLETS 1 (KETOTIFEN) ""H.S.""" 黃氏 313 1030066850 AC32710100 "MECON TABLETS 黃氏 30 (DEXTROMETHORPHAN ) ""H.S.""" 314 1030066850 AC32816100 "NASCO TABLETS ""H.S.""" 黃氏 KETOTIFEN (FUMARATE) 1 DEXTROMETHORPHAN HBR 30 PSEUDOEPHEDRINE HCL 60 錠 -- 1.86 104/01/01 錠 -- 1.5 104/01/01 錠 -- 1.5 104/01/01 315 1030066850 AC328161G0 "NASCO TABLETS ""H.S.""( 鋁箔 / 膠箔 )" 黃氏 PSEUDOEPHEDRINE HCL 60 錠 -- 2 104/01/01 316 1030066850 AC32943100 "NIFAN CAPSULES 250 (NIFLUMIC ACID) ""H.S.""" 黃氏 NIFLUMIC ACID 250 膠囊 -- 2.57 104/01/01 317 1030066850 AC33079100 "PIROXICAM TABLETS 20 ""H.S.""" 黃氏 PIROXICAM 20 錠 -- 1.58 104/01/01 318 1030066850 AC330791G0 "PIROXICAM TABLETS 20 ""H.S.""( 鋁箔 / 膠 箔 )" 黃氏 PIROXICAM 20 錠 -- 2 104/01/01 319 1030066850 AC34545329 WIPOIDO CREAM 黃氏 ESTRADIOL 0.6 /GM 乳膏 10 GM -- 61 104/01/01 320 1030066850 AC34896100 "LIME TABLETS 0.25 (TRIAZOLAM) ""H.S.""" 黃氏 TRIAZOLAM 0.25 錠 -- 1.96 104/01/01 321 1030066850 AC34898100 "VOLTON ENTERIC- COATED TABLETS 50 (DICLOFENAC) ""H.S.""" 322 1030066850 AC348981G0 "VOLTON ENTERIC- COATED TABLETS 50 (DICLOFENAC) ""H.S.""( 鋁箔 / 膠箔 )" 黃氏 DICLOFENAC SODIUM 50 黃氏 DICLOFENAC SODIUM 50 腸溶錠 腸溶錠 -- 1.5 104/01/01 -- 2 104/01/01 323 1030066850 AC35011100 "BUSP TABLETS 10 (BUSPIRONE) ""H.S.""" 黃氏 BUSPIRONE HCL 10 錠 -- 4.15 104/01/01 324 1030066850 AC36240100 "GLIZIDE TABLETS 80 ""H.S."" (GLICLAZIDE)" 325 1030066850 AC362401G0 "GLIZIDE TABLETS 80 ""H.S."" (GLICLAZIDE) ( 鋁箔 / 膠 箔 )" 黃氏 GLICLAZIDE 80 錠 -- 1.5 104/01/01 黃氏 GLICLAZIDE 80 錠 -- 2 104/01/01 第 21 頁, 共 174 頁
項次 發文號 健保代碼 藥品名稱 廠牌 成分及含量 型 規格原核定新核定量價價 生效日期 326 1030066850 AC36241100 "TIMEPIN TABLETS 黃氏 TIMEPIDIUM BROMIDE 30 錠 -- 3.07 104/01/01 30 ""H.S."" (TIMEPIDIUM)" 327 1030066850 AC36367100 "AMITON TABLETS ""H.S.""" 黃氏 AMILORIDE HCL (DIHYDRATE) 5 錠 -- 2.7 104/01/01 328 1030066850 AC37029100 "NIFUROX CAPSULES 200 (NIFUROXAZIDE) ""H.S.""" 329 1030066850 AC37292100 "NICER TABLETS 10 (NICERGOLINE) ""H.S.""" 330 1030066850 AC37501329 "ISOLON CREAM ""H.S.""" 黃氏 NIFUROXAZIDE 200 膠囊 -- 2.52 104/01/01 黃氏 NICERGOLINE 10 錠 -- 7.1 104/01/01 黃氏 DIFLUCORTOLONE 21- VALERATE 1 /GM 10 GM -- 24.9 104/01/01 331 1030066850 AC37501335 "ISOLON CREAM ""H.S.""" 黃氏 DIFLUCORTOLONE 21- VALERATE 1 /GM 15 GM -- 60 104/01/01 332 1030066850 AC37675100 "BACONE TABLETS 10 ""H.S."" (BACLOFEN)" 333 1030066850 AC376751G0 "BACONE TABLETS 10 ""H.S."" (BACLOFEN)( 鋁箔 / 膠箔 )" 334 1030066850 AC38073314 "ESTRAD GEL 0.06% (ESTRADIOL) ""H.S.""" 黃氏 BACLOFEN 10 錠 -- 1.5 104/01/01 黃氏 BACLOFEN 10 錠 -- 2 104/01/01 黃氏 ESTRADIOL 0.6 /GM 外用 凝膠 2.5 GM -- 15 104/01/01 335 1030066850 AC38073343 "ESTRAD GEL 0.06% (ESTRADIOL) ""H.S.""" 黃氏 ESTRADIOL 0.6 /GM 外用 凝膠 30 GM -- 89 104/01/01 336 1030066850 AC39235100 SERRASE ENTERIC- COATED 10 黃氏 SERRAPEPTASE (=SERRATIOPEPTIDASE) 10 -- 1.5 104/01/01 337 1030066850 AC40207100 FENOT TAB. 2.5 黃氏 FENOTEROL HBR 2.5 錠 -- 1.5 104/01/01 338 1030066850 AC402071G0 "FENOT TAB. 2.5""H.S.""(FENOTER OL HYDROBROMIDE)( 鋁箔 / 膠箔 )" 黃氏 FENOTEROL HBR 2.5 錠 -- 2 104/01/01 339 1030066850 AC41024100 FREE TAB.2 黃氏 BIPERIDEN HCL 2 錠 -- 2.38 104/01/01 340 1030066850 AC41420100 SILIBIN CAP. 70 黃氏 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 70 膠囊 -- 1.7 104/01/01 341 1030066850 AC414201G0 "SILIBIN CAPSULES 黃氏 70"H.S." (SILYMARIN)( 鋁箔 / 膠箔 ) SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 70 膠囊 -- 2 104/01/01 342 1030066850 AC41530100 WEICON-BI TAB. 300 黃氏 BISMUTH SUBCITRATE COLLOIDAL(=TRIPOTASSI UM DICITRATE BISMUTHATE) 300 錠 -- 6.3 104/01/01 第 22 頁, 共 174 頁
343 1030066850 AC42887100 "CETIZIN F. C. TABLETS 10 ""H.S.""(CETIRIZINE)" 黃氏 CETIRIZINE DIHYDROCHLORIDE 10 -- 1.5 104/01/01 344 1030066850 AC428871G0 "CETIZIN F. C. TABLETS 10 ""H.S.""(CETIRIZINE) ( 鋁箔 / 膠箔 )" 黃氏 CETIRIZINE DIHYDROCHLORIDE 10 -- 2 104/01/01 345 1030066850 AC44299429 BETONASE AQUEOUS NASAL SPRAY 50UG/SPRAY 黃氏 BECLOMETHASONE DIPROPIONATE 50 MCG/DOSE 鼻用噴液 200 DOSE -- 118 104/01/01 346 1030066850 AC45672321 "MOSONE CREAM ""H.S""" 黃氏 MOMETASONE FUROATE 1 /GM 5 GM -- 44.9 104/01/01 347 1030066850 AC45672329 "MOSONE CREAM ""H.S""" 黃氏 MOMETASONE FUROATE 1 /GM 10 GM -- 44.9 104/01/01 348 1030066850 AC45672335 "MOSONE CREAM ""H.S""" 黃氏 MOMETASONE FUROATE 1 /GM 15 GM -- 128 104/01/01 349 1030066850 AC45706151 "LORADIN SYRUP ""H.S""" 黃氏 LORATADINE 1 / 糖漿 60 -- 32.6 104/01/01 350 1030066850 AC45706155 "LORADIN SYRUP ""H.S""" 黃氏 LORATADINE 1 / 糖漿 100 -- 72 104/01/01 351 1030066850 AC46189423 "SUYENIN ORAL BASE ""H.S""" 黃氏 TRIAMCINOLONE (ACETONIDE) 1 /GM 口內膏 6 GM -- 45.9 104/01/01 352 1030066850 AC46585151 "EISO LIQUID 5.34 /""H.S.""" 353 1030066850 AC46585157 "EISO LIQUID 5.34 /""H.S.""" 354 1030066850 AC46744340 "TOGIAM CONCENTRATE LIQUID ""H.S.""" 黃氏 黃氏 黃氏 THEOPHYLLINE (ANHYDROUS) 5.34 / THEOPHYLLINE (ANHYDROUS) 5.34 / POLYCRESOLSULFONATE (POLICRESULEN) 360 /GM 內服液 內服液 外用液 60 -- 25 104/01/01 120 -- 28.9 104/01/01 25 -- 142 104/01/01 355 1030066850 AC47643100 "Shuful Tablet ""H.S.""" 黃氏 CIMETIDINE 800 錠 -- 10.8 104/01/01 356 1030066850 AC47878100 "Tonfuse Tablets 50mg ""H.S.""" 黃氏 ACARBOSE 50 錠 -- 3.61 104/01/01 357 1030066850 AC48676100 "SUPLAX TABLETS ""H.S.""" 358 1030066850 AC48690100 "SURMAX TABLETS ""H.S.""" 黃氏 ACETAMINOPHEN (=PARACETAMOL) 450 黃氏 MEPHENOXALONE 錠 -- 1.73 104/01/01 錠 -- 5.6 104/01/01 359 1030066850 AC48804438 "BECLOMASE AQUEOUS NASAL SPRAY "" H.S.""" 黃氏 BECLOMETHASONE DIPROPIONATE 100 MCG/DOSE 鼻用噴液 200 DOSE -- 234 104/01/01 360 1030066850 AC48830100 "WELLMAX TABLETS ""H.S.""" 黃氏 ALUMINUM DIHYDROXYALLANTOIN ATE (=ALDIOXA) 50 錠 -- 1.5 104/01/01 第 23 頁, 共 174 頁
項次 發文號 健保代碼 藥品名稱 廠牌 成分及含量 型 規格原核定新核定量價價 生效日期 361 1030066850 AC488301G0 "WELLMAX TABLETS ""H.S.""( 鋁箔 / 膠箔 )" 黃氏 ALUMINUM DIHYDROXYALLANTOIN ATE (=ALDIOXA) 50 錠 -- 2 104/01/01 362 1030066850 AC80100 "GLUCODUE TABLETS ""H.S.""" 黃氏 METFORMIN HCL 1000 錠 -- 2.54 104/01/01 363 1030066853 AC486761G0 SUPLAX TABLETS "H.S."( 鋁箔 / 膠箔 ) 364 1030066859 A045919321 CONFUMIN CREAM "H.S." 黃氏 ACETAMINOPHEN (=PARACETAMOL) 450 黃氏 HALCINONIDE MICRO 1 /GM 錠 -- 2 104/01/01 5 GM 62 0 104/02/01 365 1030066859 A045919335 CONFUMIN CREAM "H.S." 黃氏 HALCINONIDE MICRO 1 /GM 15 GM 169 0 104/02/01 366 1030066859 A046012321 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 5 GM 21.6 0 104/02/01 367 1030066859 A046012335 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 15 GM 64 0 104/02/01 368 1030066859 A046012343 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 30 GM 119 0 104/02/01 369 1030066859 A046012345 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 40 GM 212 0 104/02/01 370 1030066859 A046012363 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 200 GM 672 0 104/02/01 371 1030066859 A047074326 DOSPIN CREAM "H.S." 黃氏 DOXEPIN (HCL) 50 /GM 372 1030066859 A047074335 DOSPIN CREAM "H.S." 黃氏 DOXEPIN (HCL) 50 /GM 8 GM 37.2 0 104/02/01 15 GM 55 0 104/02/01 373 1030066859 A047443161 ITRAZOLE ORAL SOLUTION "H.S." 黃氏 ITRACONAZOLE 10 / 內服液 150 1079 0 104/02/01 374 1030066859 AC34545314 WIPOIDO CREAM 黃氏 ESTRADIOL 0.6 /GM 外用 凝膠 2.5 GM -- 15 104/01/01 375 1030066859 AC34545343 WIPOIDO CREAM 黃氏 ESTRADIOL 0.6 /GM 外用 凝膠 376 1030066859 AC34545348 WIPOIDO CREAM 黃氏 ESTRADIOL 0.6 /GM 外用 凝膠 377 1030066859 AC35035316 VIRUN CREAM 50/GM (ACYCLOVI "H.S." 黃氏 ACYCLOVIR 50 /GM 乳膏 30 GM -- 89 104/01/01 50 GM -- 249 104/01/01 3 GM -- 41.3 104/01/01 第 24 頁, 共 174 頁
378 1030066859 AC45706143 LORADIN SYRUP "H.S" 黃氏 LORATADINE 1 / 糖漿 規格原核定新核定生效日期量價價 30 -- 25.9 104/01/01 379 1030066859 AC45919321 CONFUMIN CREAM "H.S." 黃氏 HALCINONIDE MICRO 1 /GM 5 GM -- 62 104/01/01 380 1030066859 AC45919335 CONFUMIN CREAM "H.S." 黃氏 HALCINONIDE MICRO 1 /GM 15 GM -- 169 104/01/01 381 1030066859 AC46012321 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 382 1030066859 AC46012335 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 383 1030066859 AC46012343 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 384 1030066859 AC46012345 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 5 GM -- 21.6 104/01/01 15 GM -- 84 104/01/01 30 GM -- 139 104/01/01 40 GM -- 212 104/01/01 385 1030066859 AC46012363 BEAUTYFACE GEL "H.S" 黃氏 ADAPALENE 1 /GM 外用 凝膠 200 GM -- 791 104/01/01 386 1030066859 AC47074326 DOSPIN CREAM "H.S." 黃氏 DOXEPIN (HCL) 50 /GM 387 1030066859 AC47074335 DOSPIN CREAM "H.S." 黃氏 DOXEPIN (HCL) 50 /GM 8 GM -- 46.4 104/01/01 15 GM -- 68 104/01/01 388 1030066859 AC47443161 ITRAZOLE ORAL SOLUTION "H.S." 黃氏 ITRACONAZOLE 10 / 內服液 150 -- 1079 104/01/01 389 1030066861 A047700321 Antimax cream 1% "H.S." 黃氏 BUTENAFINE HCL 10 /GM 390 1030066861 A047700329 Antimax cream 1% "H.S." 黃氏 BUTENAFINE HCL 10 /GM 391 1030066861 A047700335 Antimax cream 1% "H.S." 黃氏 BUTENAFINE HCL 10 /GM 5 GM 36.7 0 104/02/01 10 GM 62 0 104/02/01 15 GM 83 0 104/02/01 392 1030066861 A047700355 Antimax cream 1% "H.S." 黃氏 BUTENAFINE HCL 10 /GM 100 GM 656 0 104/02/01 393 1030066861 A047937329 Tacroli Ointment 0.1% "H.S." 394 1030066861 A047937343 Tacroli Ointment 0.1% "H.S." 黃氏 TACROLIMUS 1 /GM 軟膏 黃氏 TACROLIMUS 1 /GM 軟膏 10 GM 428 0 104/02/01 30 GM 1156 0 104/02/01 395 1030066861 A048884321 AMOCOAT NAIL LACQUER " H.S " 黃氏 AMOROLFINE HCL 55.74 / 油 5 695 0 104/02/01 396 1030066861 A049239335 TAZOTEN CREAM "H.S." 黃氏 TAZAROTENE 1 /GM 乳膏 397 1030066861 A049239343 TAZOTEN CREAM "H.S." 黃氏 TAZAROTENE 1 /GM 乳膏 15 GM 246 0 104/02/01 30 GM 476 0 104/02/01 第 25 頁, 共 174 頁
398 1030066861 AC47700321 Antimax cream 1% "H.S." 黃氏 BUTENAFINE HCL 10 /GM 規格原核定新核定生效日期量價價 5 GM -- 36.7 104/01/01 399 1030066861 AC47700329 Antimax cream 1% "H.S." 黃氏 BUTENAFINE HCL 10 /GM 10 GM -- 62 104/01/01 400 1030066861 AC47700335 Antimax cream 1% "H.S." 黃氏 BUTENAFINE HCL 10 /GM 15 GM -- 83 104/01/01 401 1030066861 AC47700355 Antimax cream 1% "H.S." 黃氏 BUTENAFINE HCL 10 /GM 100 GM -- 668 104/01/01 402 1030066861 AC47937321 TACROLI OINTMENT 0.1% "H.S." 黃氏 TACROLIMUS 1 /GM 軟膏 5 GM -- 202 104/01/01 403 1030066861 AC47937329 Tacroli Ointment 0.1% "H.S." 黃氏 TACROLIMUS 1 /GM 軟膏 10 GM -- 428 104/01/01 404 1030066861 AC47937343 Tacroli Ointment 0.1% "H.S." 黃氏 TACROLIMUS 1 /GM 軟膏 30 GM -- 1156 104/01/01 405 1030066861 AC48884321 AMOCOAT NAIL LACQUER " H.S " 黃氏 AMOROLFINE HCL 55.74 / 油 5 -- 695 104/01/01 406 1030066861 AC49239335 TAZOTEN CREAM "H.S." 黃氏 TAZAROTENE 1 /GM 乳膏 407 1030066861 AC49239343 TAZOTEN CREAM "H.S." 黃氏 TAZAROTENE 1 /GM 乳膏 15 GM -- 246 104/01/01 30 GM -- 476 104/01/01 408 1030066864 AA47469100 ARCDONE F.C. TABLETS 5 (28 粒 / 鋁箔盒裝 ) 中化新豐製 DONEPEZIL HCL 5 -- 82 104/01/01 409 1030066864 AB47469100 ARCDONE F.C. TABLETS 5 中化新豐製 DONEPEZIL HCL 5 75 0 104/02/01 410 1030066885 AB57361100 LOSIN S.R. TABLETS 400 十全 ETODOLAC 400 持續 性藥 效錠 -- 11.7 104/01/01 411 1030066885 AC57361100 LOSIN S.R. TABLETS 400 十全 ETODOLAC 400 持續 性藥 效錠 11 0 104/02/01 412 1030066927 B024625212 Irinotel Injection FRESENIUS KABI ONCOL IRINOTECAN HYDROCHLORIDE TRIHYDRATE 20 / 2 1843 0 104/02/01 413 1030066927 B024625221 IRINOTEL INJECTION FRESENIUS KABI ONCOL IRINOTECAN HYDROCHLORIDE TRIHYDRATE 20 / 5 3935 0 104/02/01 414 1030066927 B024804235 KEMOCARB INJECTION FRESENIUS KABI ONCOL CARBOPLATIN 10 / 15 1485 0 104/02/01 第 26 頁, 共 174 頁
415 1030066927 B0248042AP KEMOCARB INJECTION FRESENIUS KABI ONCOL CARBOPLATIN 10 / 規格原核定新核定生效日期量價價 45 3200 0 104/02/01 416 1030066927 B025143100 TROZET FILM-COATED TABLETS 2.5 FRESENIUS KABI ONCOL LETROZOLE 2.5 38.1 0 104/02/01 417 1030066927 B025206100 BYPRO FILM-COATED TABLETS 50 FRESENIUS KABI ONCOL BICALUTAMIDE 50 113 0 104/02/01 418 1030066927 B025681263 GEMITA LYOPHILIZED FOR INJECTION FRESENIUS KABI ONCOL GEMCITABINE 凍晶 HYDROCHLORIDE 200 200 817 0 104/02/01 419 1030066927 B025840221 ADRIM INJECTION FRESENIUS KABI ONCOL DOXORUBICIN HCL 2 / 5 307 0 104/02/01 420 1030066927 BC24625212 Irinotel Injection FRESENIUS KABI ONCOL IRINOTECAN HYDROCHLORIDE TRIHYDRATE 20 / 2 -- 2456 104/01/01 421 1030066927 BC24625221 IRINOTEL INJECTION FRESENIUS KABI ONCOL IRINOTECAN HYDROCHLORIDE TRIHYDRATE 20 / 5 -- 5246 104/01/01 422 1030066927 BC24804235 KEMOCARB INJECTION FRESENIUS KABI ONCOL CARBOPLATIN 10 / 15 -- 2702 104/01/01 423 1030066927 BC248042AP KEMOCARB INJECTION FRESENIUS KABI ONCOL CARBOPLATIN 10 / 45 -- 6055 104/01/01 424 1030066927 BC25143100 TROZET FILM-COATED TABLETS 2.5 FRESENIUS KABI ONCOL LETROZOLE 2.5 -- 40 104/01/01 425 1030066927 BC25206100 BYPRO FILM-COATED TABLETS 50 FRESENIUS KABI ONCOL BICALUTAMIDE 50 -- 116 104/01/01 426 1030066927 BC25681263 GEMITA LYOPHILIZED FOR INJECTION FRESENIUS KABI ONCOL GEMCITABINE 凍晶 HYDROCHLORIDE 200 200 -- 1019 104/01/01 427 1030066927 BC25840221 ADRIM INJECTION FRESENIUS KABI ONCOL DOXORUBICIN HCL 2 / 5 -- 545 104/01/01 428 1030066928 BC26334209 DAXOTEL INJECTION CONCENTRATE 20/ FRESENIUS KABI ONCOL DOCETAXEL 20 / 注射液 1 -- 3647 104/01/01 429 1030066928 BC26334219 DAXOTEL INJECTION CONCENTRATE 20/ FRESENIUS KABI ONCOL DOCETAXEL 20 / 4 -- 13822 104/01/01 第 27 頁, 共 174 頁
430 1030066970 A014915329 FLUCORTONE OINT. 健康製 FLUOCINOLONE ACETONIDE 0.25 /GM 軟膏 規格原核定新核定生效日期量價價 10 GM 43.4 0 104/02/01 431 1030066970 A015080329 Y.T.M. OINTMENT "TAI YU" 健康製 TRIAMCINOLONE ACETONIDE 1 /GM 軟膏 10 GM 26.6 0 104/02/01 432 1030066970 A047915321 Naftifine Cream 1% "Tai Yu" 健康製 NAFTIFINE HCL 10 /GM 5 GM 27 0 104/02/01 433 1030066970 A047915329 Naftifine Cream 1% "Tai Yu" 健康製 NAFTIFINE HCL 10 /GM 10 GM 44.3 0 104/02/01 434 1030066970 A047915335 Naftifine Cream 1% "Tai Yu" 健康製 NAFTIFINE HCL 10 /GM 15 GM 44.3 0 104/02/01 435 1030066970 A047915338 Naftifine Cream 1% "Tai Yu" 健康製 NAFTIFINE HCL 10 /GM 20 GM 85 0 104/02/01 436 1030066970 AC14915329 FLUCORTONE OINT. 健康製 FLUOCINOLONE ACETONIDE 0.25 /GM 軟膏 10 GM -- 43.4 104/01/01 437 1030066970 AC15080329 Y.T.M. OINTMENT "TAI YU" 健康製 TRIAMCINOLONE ACETONIDE 1 /GM 軟膏 10 GM -- 26.6 104/01/01 438 1030066970 AC47915321 Naftifine Cream 1% "Tai Yu" 健康製 NAFTIFINE HCL 10 /GM 5 GM -- 27 104/01/01 439 1030066970 AC47915329 Naftifine Cream 1% "Tai Yu" 健康製 NAFTIFINE HCL 10 /GM 10 GM -- 46.4 104/01/01 440 1030066970 AC47915335 Naftifine Cream 1% "Tai Yu" 健康製 NAFTIFINE HCL 10 /GM 15 GM -- 50 104/01/01 441 1030066970 AC47915338 Naftifine Cream 1% "Tai Yu" 健康製 NAFTIFINE HCL 10 /GM 20 GM -- 93 104/01/01 442 1030066971 AC58366100 ATORSIN F.C. TABLETS 40 信東 ATORVASTATIN (CALCIUM) 40 -- 30.6 104/01/01 443 1030066977 AC32051321 BETAMETHASONE OINTMENT 0.5/GM "SINPHAR" 杏輝 BETAMETHASONE (DIPROPIONATE) 0.5 /GM 軟膏 5 GM -- 22.9 104/01/01 444 1030066977 AC32051329 BETAMETHASONE OINTMENT 0.5/GM "SINPHAR" 杏輝 BETAMETHASONE (DIPROPIONATE) 0.5 /GM 軟膏 10 GM -- 23.3 104/01/01 445 1030066977 AC32571371 "SINPHAR" SILVERZINE CREAM 10/GM (SULFADIAZINE SILVE 446 1030066977 AC36315340 CLOBETASOL CREAM 0.5/GM "SINPHAR" 杏輝 SULFADIAZINE SILVER 10 /GM 杏輝 CLOBETASOL PROPIONATE 0.5 /GM 400 GM -- 286 104/01/01 25 GM -- 91 104/01/01 447 1030066979 A046419321 ELOFUTE CREAM 0.1% 歐帕生技 MOMETASONE FUROATE 1 /GM 448 1030066979 A046419335 ELOFUTE CREAM 0.1% 歐帕生技 MOMETASONE FUROATE 1 /GM 5 GM 28 0 104/02/01 15 GM 82 0 104/02/01 第 28 頁, 共 174 頁
449 1030066979 AC46419321 ELOFUTE CREAM 0.1% 歐帕生技 MOMETASONE FUROATE 1 /GM 規格原核定新核定生效日期量價價 5 GM -- 44.9 104/01/01 450 1030066979 AC46419335 ELOFUTE CREAM 0.1% 歐帕生技 MOMETASONE FUROATE 1 /GM 451 1030066980 A049127421 LAVISOL ORALBASE 正和新營廠 DEXAMETHASONE 1 /GM 口內膏 15 GM -- 128 104/01/01 5 GM 61 0 104/02/01 452 1030066980 AC49127421 LAVISOL ORALBASE 正和新營廠 DEXAMETHASONE 1 /GM 口內膏 5 GM -- 65 104/01/01 453 1030066994 BC26369100 TELCARD 80 CADILA HEALTHCA RE LI TELMISARTAN 80 錠 -- 18.5 104/01/01 454 1030067032 AC57236100 IBUPROFEN F.C. TABLETS 600 "C.H." 正和新營廠 IBUPROFEN 600 -- 1.9 104/01/01 455 1030067032 AC572361G0 IBUPROFEN F.C. TABLETS 600 "C.H." 正和新營廠 IBUPROFEN 600 -- 2 104/01/01 456 1030067046 A025224100 ORIBIRA TABLETS "ORIENTAL" 衛達 PROBENECID 錠 4.72 0 104/02/01 457 1030067046 AC25224100 ORIBIRA TABLETS "ORIENTAL" 衛達 PROBENECID 錠 -- 4.72 104/01/01 458 1030067049 AA58055100 APA-BILY TABLETS 10(30 粒 / 鋁箔盒裝 ) 強生 ARIPIPRAZOLE 10 錠 -- 91 104/01/01 459 1030067049 AB58055100 APA-BILY TABLETS 10 強生 ARIPIPRAZOLE 10 錠 81 0 104/02/01 460 1030067092 AB57275100 RISPERIDONE F.C. TABLETS 2 "CYH" 中化新豐製 RISPERIDONE 2 -- 22.6 104/01/01 461 1030067092 AC57275100 RISPERIDONE F.C. TABLETS 2 "CYH" 中化新豐製 RISPERIDONE 2 22.6 0 104/02/01 462 1030067093 A030740100 RITALIN TABLETS 10 (METHYLPHENIDATE) 聯亞生技新竹二廠 METHYLPHENIDATE HCL 10 錠 2.67 0 104/02/01 463 1030067093 A030881100 ZADITEN TABLETS 1 (KETOTIFEN) 聯亞生技新竹二廠 KETOTIFEN (FUMARATE) 1 錠 1.86 0 104/02/01 第 29 頁, 共 174 頁
項次 發文號 健保代碼 藥品名稱 廠牌 成分及含量 型 規格原核定新核定量價價 生效日期 464 1030067093 A036020100 TEGRETOL TABLETS 200 (CARBAMAZEPINE) 聯亞生技新竹二廠 CARBAMAZEPINE 200 錠 3.01 0 104/02/01 465 1030067093 AC30740100 RITALIN TABLETS 10 (METHYLPHENIDATE) 聯亞生技新竹二廠 METHYLPHENIDATE HCL 10 錠 -- 2.67 104/01/01 466 1030067093 AC30881100 ZADITEN TABLETS 1 (KETOTIFEN) 聯亞生技新竹二廠 KETOTIFEN (FUMARATE) 1 錠 -- 1.86 104/01/01 467 1030067093 AC36020100 TEGRETOL TABLETS 200 (CARBAMAZEPINE) 聯亞生技新竹二廠 CARBAMAZEPINE 200 錠 -- 3.01 104/01/01 468 1030067135 BC26363100 PMS-LEFLUNOMIDE 10 TABLETS SC IENCE INC. LEFLUNOMIDE 10 -- 41.6 104/01/01 469 1030067135 BC26364100 PMS-LEFLUNOMIDE 20 TABLETS SC IENCE INC. LEFLUNOMIDE 20 -- 64 104/01/01 470 1030067198 A050153100 MENOLON TABLETS 200 臺灣派頓 MEPHENOXALONE 200 錠 -- 1.12 104/01/01 471 1030067203 A045752100 SLEEPMAN TABLETS 中美製 ZOLPIDEM HEMITARTRATE 10 472 1030067203 AC45752100 SLEEPMAN TABLETS 中美製 ZOLPIDEM HEMITARTRATE 10 錠 2.52 0 104/02/01 錠 -- 2.81 104/01/01 473 1030067204 A049990209 CEFEMAX POWDER FOR I.V. INJECTION (1 GM) 濟生 CEFEPIME HCL (EQ TO CEFEPIME) 1 GM 乾粉 1 GM 397 0 104/02/01 474 1030067204 A049990212 CEFEMAX POWDER FOR I.V. INJECTION (2 GM) 濟生 CEFEPIME HCL (EQ TO CEFEPIME) 2 GM 乾粉 2 GM 717 0 104/02/01 475 1030067204 A049990277 CEFEMAX POWDER FOR I.V. INJECTION ( ) 濟生 CEFEPIME HCL (EQ TO CEFEPIME) 乾粉 236 0 104/02/01 476 1030067204 AC49990209 CEFEMAX POWDER FOR I.V. INJECTION (1 GM) 濟生 CEFEPIME HCL (EQ TO CEFEPIME) 1 GM 乾粉 1 GM -- 397 104/01/01 477 1030067204 AC49990212 CEFEMAX POWDER FOR I.V. INJECTION (2 GM) 濟生 CEFEPIME HCL (EQ TO CEFEPIME) 2 GM 乾粉 2 GM -- 717 104/01/01 第 30 頁, 共 174 頁