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項次發文號健保代碼藥品名稱廠牌成分及含量型 1 1030009468 A025817100 GOODGEN CAPSULES 臺灣 PIROXICAM10 膠囊 10 (PIROXICAM) 派頓 "PATRON" 2 1030009468 A044318100 DORSIFLEX TABLETS 200mg "PATRON" 規格量原核定新核定價生效日期價 1.07 0 103/12/01 派頓 MEPHENOXALONE200 1.5 0 103/12/01 3 1030009468 A0443181G0 DORSIFLEX TABLETS 200 "PATRON"( 鋁箔 / 膠箔 ) 派頓 MEPHENOXALONE200 2 0 103/12/01 34 1030061660 AC41606100 SINZAC CAPSULES 20 "S.T." 36 1030061823 AB49835100 LOWTAN F.C. TABLETS 50 C.H." 37 1030061919 A032278100 CLOZENE CAPSULES 7.5 (CLORAZEPATE) "WEIDAR" 正和新營廠衛達製造 38 1030061919 A037651100 CEGOLIN F.C. TABLETS 9.6 (GINKFLAVONGLYCOSI DE) "WEIDAR" 衛達 39 1030061919 A038291100 WEIMOK F.C. TABLETS 40 (FAMOTIDINE) "WEIDAR" 衛達製造 40 1030061919 A040986100 WEIMOK F.C.TAB. 20 衛達 "WEIDAR" 製造 41 1030061919 A041814100 ASPICORE ENTERIC- 衛達 MICROENCAPSULATED 製造 CAP. 100 (ASPIRIN)"WEIDAR" 42 1030061919 A0418141G0 ASPICORE ENTERIC- 衛達 MICROENCAPSULATED 製造 CAP. 100 (ASPIRIN)"WEIDAR"( 鋁箔 / 膠箔 ) 43 1030061919 A045155100 ZOLDOX F.C. TAB. 10 "WEIDAR" 44 1030061919 A048095100 Glucout Tablets 50 mg "Weidar" 45 1030061919 A049303100 CHLOGUIN F.C. TABLETS 200 WEIDAR" 衛達製造衛達製造衛達製造 FLUOXETINE (HCL) 20 膠囊 LOSARTAN POTASSIUM 50 CLORAZEPATE DIPOTASSIUM 7.5 GINKGO BILOBA EXTRACT 40 FAMOTIDINE 40 FAMOTIDINE 20 ASPIRIN 100 ASPIRIN 100 膠囊腸溶微粒膠囊腸溶微粒膠囊 3.3 0 104/01/01 10.8 0 104/01/01 2.93 0 104/01/01 2.2 0 104/01/01 6.7 0 104/01/01 1.88 0 104/01/01 1 0 104/01/01 1.5 0 104/01/01 ZOLPIDEM 膜衣 2.52 0 104/01/01 HEMITARTRATE 10 ACARBOSE 50 2.07 0 104/01/01 HYDROXYCHLOROQUINE SULFATE 200 2.86 0 104/01/01 56 1030062124 A049659100 ANFORMIN TABLETS 十全 METFORMIN HCL 850 2.08 0 104/01/01 850 58 1030062257 A046656100 CALIFE TABLETS 15 南光 FOLINATE CALCIUM 17.1 0 104/01/01 "N.K." 5H2O 15 60 1030062257 AC44331100 FINTA F.C TABLETS 南光 FINASTERIDE 5 膜衣 23.3 0 104/01/01 5 "N.K" 62 1030062258 A011420229 NOOPOL "N.K." 南光 PIRACETAM 200 注射 10 ML 33.7 0 104/01/01 63 1030062258 A027864212 AMIKACIN 南光 AMIKACIN (SULFATE) 250 注射 2 ML 34.6 0 104/01/01 250 "N.K." 64 1030062258 A033425266 SUNNYTOL INFUSION 20% "N.K" (MANNITOL) 南光 MANNITOL D- 200 注射 300 ML 39.4 0 104/01/01 68 1030062337 A055404316 FUISU CREAM 衛達 FLUOCINONIDE 0.5 乳膏 3 GM 36.3 0 104/01/01 69 1030062337 A055404321 FUISU CREAM 衛達 FLUOCINONIDE 0.5 第 1 頁, 共 31 頁乳膏 5 GM 39.8 0 104/01/01

項次發文號健保代碼藥品名稱廠牌成分及含量型 72 1030062341 A044300100 UROSE CAPSULES 政德 URSODEOXYCHOLIC 膠囊 300 ACID 300 74 1030062343 A033429238 PITRESSIN 聯亞 ARGIPRESSIN (=8- 注射 20 UNITS/ML 生技 ARGININE VASOPRESSIN) (ARGININE 新竹 20 U/ML (UNIT/ML) VASOPRESSIN) 二廠規格量原核定新核定價生效日期價 4.39 0 104/01/01 20 IU 263 0 104/01/01 76 1030062383 A035455151 SALBUTAMOL SYRUP 0.4 "C.H." 77 1030062383 A035651151 IBUPROFEN SYRUP 20 (IBUPROFEN) "C.H." 正和新營廠正和新營廠 78 1030062383 A040150338 AN FU CREAM "C.H." 正和新營廠 79 1030062383 A041234151 IBUFEN SUSPENSION 20 "C.H."(IBUPROFEN) 80 1030062383 A041234157 IBUFEN SUSPENSION 20 "C.H."(IBUPROFEN) 86 1030062467 A043180345 FUBIFEN PAP "F.M" 40/10GM 88 1030062520 A056629100 LECITOL XL FILM- COATED TABLETS 80 正和新營廠正和新營廠 SALBUTAMOL (SULFATE) 0.4 IBUPROFEN 20 SULFADIAZINE SILVER 10 IBUPROFEN 20 IBUPROFEN 20 糖漿糖漿乳膏懸液懸液德山 FLURBIPROFEN 40 藥膠布衛達 FLUVASTATIN SODIUM 80 緩釋製造膜衣 60 ML 25 0 104/01/01 60 ML 25 0 104/01/01 20 GM 40.9 0 104/01/01 60 ML 25 0 104/01/01 120 ML 53 0 104/01/01 40 6.8 0 104/01/01 17.4 0 104/01/01 93 1030062603 AC45415151 IDEFEN SUSPENSION 生達 IBUPROFEN 20 懸液 60 ML 25 0 104/01/01 20 (IBUPROFEN) 二廠 94 1030062603 AC45415157 IDEFEN SUSPENSION 20 (IBUPROFEN) 生達二廠 IBUPROFEN 20 懸液 120 ML 78 0 104/01/01 99 1030062604 AC19877100 EPBUTOL TABLETS "YU 優生 ETHAMBUTOL HCL 400 2.4 0 104/01/01 SHENG" 100 1030062604 AC29443100 TENOL TABLETS 100 優生 ATENOLOL 100 1.65 0 104/01/01 "Y.S." (ATENOLOL) 101 1030062604 AC294431G0 TENOL TABLETS 100 優生 ATENOLOL 100 2 0 104/01/01 "Y.S."(ATENOLOL)( 鋁箔 / 膠箔 ) 102 1030062604 AC33829100 MOTON TABLETS 500 "YU SHENG" (MEFENAMIC ACID) 103 1030062828 B025040100 JANUMET 50/1000 FILM-COATED TABLETS 104 1030062828 B025041100 JANUMET 50/850 FILM-COATED TABLETS 108 1030062880 AC46681100 SYNTAM F.C. TABLETS 1200 109 1030062882 A016420100 CHLORZOXAZONE TABLETS "PL." 優生 MEFENAMIC ACID 500 1.5 0 104/01/01 PATH SITAGLIPTIN EON PHOSPHATE(AS PUER MONOHYDRATE TO PHOSPHATE SALT) 50 RICO, PATH SITAGLIPTIN EON PHOSPHATE(AS PUER MONOHYDRATE TO PHOSPHATE SALT) 50 RICO, 健喬信元健喬廠 PIRACETAM 1200 培力 CHLORZOXAZONE 200 15 0 104/01/01 15 0 104/01/01 2.98 0 104/01/01 0.86 0 104/01/01 第 2 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 111 1030062913 B023388248 AMBISOME FOR AMPHOTERICIN B 50 113 1030062935 A0193371G0 LIMODIUM TABLETS "H.C." (LOPERAMIDE)( 鋁箔 / 膠箔 ) 114 1030062935 A0222091G0 ANROKIN TABLETS "H.C." (CHLORZOXAZONE)( 鋁箔 / 膠箔 ) 115 1030062935 A0223571G0 LYCOZE TABLETS "H.C." (LYSOZYME)( 鋁箔 / 膠箔 ) GILE AD SCIEN CES 乾粉注射規格原核定新核定價生效日期量價 50 6486 0 104/01/01 LOPERAMIDE HCL 2 1.5 0 104/01/01 CHLORZOXAZONE 200 LYSOZYME (CHLORIDE) 30 1.5 0 104/01/01 1.5 0 104/01/01 116 1030062935 A0224441G0 TIGAWET TABLETS "H.C." (CIMETIDINE)( 鋁箔 / 膠箔 ) 117 1030062935 A0231941G0 SABUMOL TABLETS "H.C." (SALBUTAMOL)( 鋁箔 / 膠箔 ) 123 1030062936 A003534100 DESON TABLETS "H.C." 合誠製造 124 1030062936 A008169100 OUTALLERGIN 合誠 TABLETS "A.L." 製造 125 1030062936 A008505100 METOPERAN TABLETS 合誠 "H.C." 製造 CIMETIDINE 200 1.5 0 104/01/01 SALBUTAMOL (SULFATE) 4 1.5 0 104/01/01 DEXAMETHASONE 0.5 0.69 0 104/01/01 CYPROHEPTADINE HCL 4 0.7 0 104/01/01 METOCLOPRAMIDE (2HCL 0.62 0 104/01/01 MONOHYDRATE) 5 126 1030062936 A009722100 MEFEINE TABLETS "H.C" 127 1030062936 A009763100 BENZAMINE TABLETS 合誠製造 128 1030062936 A011806100 INDOTHAN CAPSULES 合誠製造 129 1030062936 A011982100 NICEFON TABLETS 合誠製造 130 1030062936 A011983100 ORCITRAN TABLETS 合誠 "HC" 製造 131 1030062936 A018232100 SUSEMIDE TABLETS (HYDRALAZINE) "HC" MEFENAMIC ACID 250 0.75 0 104/01/01 BENZYDAMINE HCL 50 0.74 0 104/01/01 INDOMETHACIN 25 膠囊 0.87 0 104/01/01 TRIAMCINOLONE 4 0.89 0 104/01/01 METAPROTERENOL SULFATE(=ORCIPRENALI NE SULFATE) 10 HYDRALAZINE HCL 25 0.92 0 104/01/01 1.05 0 104/01/01 132 1030062936 A018458100 PROSANOL TABLETS (PROPRANOLOL) 143 1030062937 A019337100 LIMODIUM TABLETS "H.C." (LOPERAMIDE) PROPRANOLOL HCL 40 0.87 0 104/01/01 LOPERAMIDE HCL 2 0.94 0 104/01/01 144 1030062937 A020022100 TERBULINE TABLETS "H.C." (TERBUTALINE) TERBUTALINE SULFATE 5 1 0 104/01/01 145 1030062937 A020758100 COTAMIDE CAPSULES "H.C." (COBAMAMIDE) 146 1030062937 A022150100 CHICOUGH TABLETS 合誠 (DEXTROMETHORPHAN 製造 ) "H.C." 147 1030062937 A022207100 DICLOFEN TABLETS "H.C." (DICLOFENAC) COBAMAMIDE 0.5 DEXTROMETHORPHAN HBR 30 DICLOFENAC SODIUM 25 膠囊 1.08 0 104/01/01 0.82 0 104/01/01 0.9 0 104/01/01 第 3 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 148 1030062937 A022209100 ANROKIN TABLETS 合誠 CHLORZOXAZONE 200 0.86 0 104/01/01 "H.C." 製造 149 1030062937 A022357100 LYCOZE TABLETS 合誠 LYSOZYME (CHLORIDE) 0.92 0 104/01/01 "H.C." (LYSOZYME) 製造 30 150 1030062937 A022444100 TIGAWET TABLETS 合誠 CIMETIDINE 200 1 0 104/01/01 "H.C." (CIMETIDINE) 製造 151 1030062937 A022534100 COLICINE TABLETS 合誠 COLCHICINE 0.5 0.99 0 104/01/01 "H.C." (COLCHICINE) 製造 152 1030062937 A023194100 SABUMOL TABLETS "H.C." (SALBUTAMOL) SALBUTAMOL (SULFATE) 4 0.93 0 104/01/01 163 1030062938 A023322100 POSTON CAPSULES (MEFENAMIC ACID) "H.C." 164 1030062938 A024199100 NAROXIN TABLETS "H.C" (NAPROXEN) 165 1030062938 A024488100 PROAZINE TABLETS (PROCHLORPERAZINE MALEATE) 166 1030062938 A024937100 ENBRAIN TABLETS 1.5 (DIHYDROERGOTOXIN E MESYLATE) 167 1030062938 A024943100 LORAPAM TABLETS 1 "HC" 168 1030062938 A025096100 DIAZEPAM TABLETS 2 "H.C" 169 1030062938 A025273100 PIMICOL TABLETS 250 (PIPEMIDIC ACID) 170 1030062938 A025456100 HOWELL TABLETS 100 "H.C." (DIHYDROXYALUMINU M ALLANTOINATE) 171 1030062938 A027887100 FLUNAZINE TABLETS 5 "H.C."(FLUNARIZINE) MEFENAMIC ACID 250 膠囊 0.75 0 104/01/01 NAPROXEN 250 1.09 0 104/01/01 PROCHLORPERAZINE ((DI)MALEATE) 5 0.69 0 104/01/01 DIHYDROERGOTOXINE 1.57 0 104/01/01 METHANESULFONATE 1.5 LORAZEPAM 1 0.98 0 104/01/01 DIAZEPAM 2 0.8 0 104/01/01 PIPEMIDIC ACID 250 3.48 0 104/01/01 ALUMINUM DIHYDROXYALLANTOIN ATE (=ALDIOXA) 100 1.17 0 104/01/01 FLUNARIZINE (HCL) 5 1.09 0 104/01/01 172 1030062938 A030618100 BROMAZAEPAM TABLETS (BROMAZEPAM) BROMAZEPAM 3 1.21 0 104/01/01 183 1030062939 A030693100 KETOFEN TAB. "H.C." (KETOTIFENE) 184 1030062939 A033971100 MENTON TABLETS 10 "H.C" (DOMPERIDONE) 185 1030062939 A036280100 REPININ TABLETS 5 "H.C" (OXYBUTYNIN) KETOTIFEN (FUMARATE) 1.3 0 104/01/01 1 DOMPERIDONE 10 0.86 0 104/01/01 OXYBUTYNIN CHLORIDE (=OXIBUTININA HCL=OXYBUTYNIN H 5 2.6 0 104/01/01 186 1030062939 A036283100 MUSCOFEN TABLETS 10 "H.C" (BACLOFEN) 187 1030062939 A038188100 DICLOFEN F.C.TABLET 50 "H.C."(DICLOFENAC) 188 1030062939 A038840100 SILYGEN-H CAPSULE 150 "H.C." (SILYMARIN) BACLOFEN 10 1 0 104/01/01 DICLOFENAC SODIUM 50 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 150 膠囊 0.93 0 104/01/01 1.57 0 104/01/01 第 4 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 189 1030062939 A039257100 SULPYRIDE F.C. 合誠 SULPIRIDE 200 膜衣 TABLETS 200 "H.C" 製造 (SULPIRIDE) 190 1030062939 A040152100 HOMAGYL TABLETS 50 "H.C" (SULPIRIDE) 191 1030062939 A041563100 GLIGEN TABLETS 80 合誠 "H.C" (GLICLAZIDE) 製造 192 1030062939 A041992100 BROMARONE TABLETS 合誠 50 "H.C" 製造 (BENZBROMARONE) 203 1030062940 A041994100 BROMARONE TABLETS 100 "H.C" (BENZBROMARONE) 204 1030062940 A042257100 QUITAZINE TABLETS 5 "H.C" (MEQUITAZINE) 規格量原核定新核定價生效日期價 2.36 0 104/01/01 SULPIRIDE 50 1.47 0 104/01/01 GLICLAZIDE 80 1.15 0 104/01/01 BENZBROMARONE 50 1.28 0 104/01/01 BENZBROMARONE 100 3.2 0 104/01/01 MEQUITAZINE 5 0.96 0 104/01/01 205 1030062940 A042539100 LESLIPID TABLETS 20 "H.C."(LOVASTATIN) 206 1030062940 A043139100 HOCOTON TABLETS 100 "H.C" 207 1030062940 A043627100 MESOLONE TABLETS 2 "H.C" LOVASTATIN 20 5.3 0 104/01/01 ASPIRIN 100 0.68 0 104/01/01 METHYLPREDNISOLONE 2 1.71 0 104/01/01 213 1030062941 A011562100 PANTRIM TABLETS"HC" 214 1030062941 A018061100 COPHYLLINE TABLETS 合誠 "H.C." 製造 215 1030062941 A025571100 SPANTON 合誠 TABLETS"HC" 製造 219 1030062941 N012165100 ULCERMIN TABLETS 合誠 "HC" 製造 222 1030063079 AC57923100 LAVUDIN F.C. TABLETS 生達 100 "STANDARD" 二廠 (LAMIVUDINE) TRIMETHOPRIM 80 0.9 0 104/01/01 ETHAVERINE HCL (=BALBORIN) 10 0.89 0 104/01/01 ATROPINE SULFATE 0.019 0.72 0 104/01/01 ALUMINUM HYDROXIDE 1 0 104/01/01 DRIED GEL 400 LAMIVUDINE 100 膜衣 66 0 104/01/01 228 1030063089 AC28533100 NOOBICA CAPSULES 400 "YU SHENG" (PIRACETAM) 229 1030063089 AC285331G0 NOOBICA CAPSULES 400 "YU SHENG" (PIRACETAM)( 鋁箔 / 膠箔 ) 優生 PIRACETAM 400 膠囊優生 PIRACETAM 400 膠囊 1.5 0 104/01/01 2 0 104/01/01 230 1030063089 AC43859100 USPEN TABLETS 100 "YU SHENG" 優生 CLOZAPINE 100 10.7 0 104/01/01 231 1030063089 AC57140100 CLOFREE F.C. TABLETS 優生 CLOPIDOGREL 75 膜衣 44 0 104/01/01 75 "YU SHENG" 232 1030063089 AC57930100 ATOVA F.C. TABLETS 優生 ATORVASTATIN 膜衣 15.8 0 104/01/01 10 "YU SHENG" (CALCIUM) 10 234 1030063166 A019875100 CARDOLOL TABLETS 40 "V.P.P." (PROPRANOLOL) 榮民製藥廠 PROPRANOLOL HCL 40 0.87 0 104/01/01 235 1030063166 A022501100 EBUTOL F.C. TABLETS 400 "VPP" (ETHAMBUTOL) 榮民製藥廠 ETHAMBUTOL HCL 400 2.05 0 104/01/01 236 1030063166 A057116100 LOSARZIDE F.C. TABLETS 50/12.5 241 1030063167 AC07641100 DELCOPAN TABLETS 30 榮民製藥強生 LOSARTAN POTASSIUM 50 DEXTROMETHORPHAN HBR 30 膜衣 8.1 0 104/01/01 1.5 0 104/01/01 第 5 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 242 1030063169 A022448100 DOLAN TABLETS 衛達 ORPHENADRINE CITRATE 2.45 0 104/01/01 製造 35 243 1030063169 A023309100 AFUCO TABLETS 衛達 OXOLAMINE CITRATE 100 0.96 0 104/01/01 100 製造 246 1030063173 A045339280 AMOCLAVUNIN FOR INTRAVENOUS 0.6GM "TAI YU" 政德 AMOXICILLIN SODIUM 500 乾粉注射 600 48.5 0 104/01/01 247 1030063173 A045339297 AMOCLAVUNIN FOR INTRAVENOUS 1.2GM "TAI YU" 251 1030063210 AC48909100 ANSUZOLE F.C TABLETS 1 256 1030063222 AC47811100 TAGLU F.C. TABLETS 100 257 1030063222 AC47848100 TAGLU F.C. TABLETS 50 258 1030063222 AC47991100 ANXOFIN F.C TABLETS 850 259 1030063222 AC48229100 ANXOKEN F.C. TABLETS 1000 260 1030063274 A049090277 SULTAM FOR 500 (SULBACTAM SODIUM) 政德 AMOXICILLIN SODIUM 1 GM 美時南投廠歐帕生技歐帕生技歐帕生技歐帕生技政德 ANASTROZOLE 1 乾粉注射 ACARBOSE 100 ACARBOSE 50 METFORMIN HCL 850 METFORMIN HCL 1000 SULBACTAM (SODIUM) 乾粉 500 注射 1.2 GM 158 0 104/01/01 500 85 0 104/01/01 7.7 0 104/01/01 3.61 0 104/01/01 2.54 0 104/01/01 2.54 0 104/01/01 151 0 104/01/01 261 1030063274 A057278263 TARGONIN FOR IV 政德 TEICOPLANIN 200 乾粉注射 262 1030063274 A057278271 TARGONIN FOR IV 政德 TEICOPLANIN 400 乾粉注射 263 1030063274 A057313255 HYDROCORTISONE 政德 HYDROCORTISONE 乾粉 POWDER FOR (SODIUM SUCCINATE) 100 注射 100"S.T." 268 1030063274 N001681209 STREPTOMYCIN 1GM "TBC" 政德 STREPTOMYCIN 1 GM 乾粉注射 200 400 100 607 0 104/01/01 1229 0 104/01/01 28.2 0 104/01/01 1 GM 52 0 104/01/01 270 1030063283 A045031100 IWELL TABLETS "EVEREST" 永勝 ALUMINUM DIHYDROXYALLANTOIN ATE (=ALDIOXA) 50 1 0 104/01/01 273 1030063312 A0396942CX TAZOCIN LYO- 輝瑞生技 PIPERACILLIN SODIUM 2 GM 275 1030063356 A046417214 EULIGEN LYOPHILIZED 中化 ARGININE DI- 2.5GM 新豐 OXOGLURATE 2.5 GM 製 276 1030063356 A046417221 EULIGEN LYOPHILIZED 5GM 277 1030063356 A046417229 EULIGEN LYOPHILIZED 10GM 286 1030063442 AC49375220 BETAMYCIN FOR 287 1030063442 AC493752AE BETAMYCIN FOR 288 1030063442 AC493752CX BETAMYCIN FOR 289 1030063473 A038870321 KETONA CREAM 20 (KETOCONAZOLE) 中化新豐製中化新豐製 ARGININE DI- OXOGLURATE 5 GM ARGININE DI- OXOGLURATE 10 GM 政德 PIPERACILLIN (SODIUM) 4 GM 政德 PIPERACILLIN (SODIUM) 3 GM 政德 PIPERACILLIN SODIUM 2 GM 國嘉 KETOCONAZOLE 20 幼獅三廠凍晶注射凍晶注射凍晶注射凍晶注射乾粉注射乾粉注射乾粉注射乳膏 2.25 298 0 104/01/01 GM 2.5 GM 362 0 104/01/01 5 GM 623 0 104/01/01 10 GM 1314 0 104/01/01 4.5 GM 520 0 104/01/01 3.375 GM 353 0 104/01/01 2.25 298 0 104/01/01 GM 5 GM 14.2 0 104/01/01 第 6 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 290 1030063473 A038870329 KETONA CREAM 國嘉 KETOCONAZOLE 20 乳膏 20 幼獅 (KETOCONAZO 三廠 LE) 291 1030063473 A038870335 KETONA CREAM 20 (KETOCONAZOLE) 292 1030063473 A038870338 KETONA CREAM 20 (KETOCONAZOLE) 293 1030063473 A039350500 DICLOFEN SUPPOSITORY 25 國嘉幼獅 (DICLOFENAC) 三廠 294 1030063473 A039351500 DICLOFEN SUPPOSITORY 12.5 (DICLOFENAC) 295 1030063473 A039953500 DOMPERID SUPPOSITORY 10 (DOMPERIDONE) 304 1030063520 AC56776100 DUXETINE CAPSULES 30 中化新豐製 305 1030063564 A024474100 LIDIN TABLETS 300 健喬 (LITHIUM CARBONATE) 信元健喬廠 306 1030063564 A028945100 AMINOPHYLLINE TABLETS 100 "U.L." 307 1030063564 A0289451G0 AMINOPHYLLINE TABLETS 100 "U.L."( 鋁箔 / 膠箔 ) 311 1030063568 A024463100 ANXIEDIN TABLETS 0.5 (LORAZEPAM) 健喬信元健喬廠健喬信元健喬廠健喬信元健喬廠 312 1030063568 A0244631G0 ANXIEDIN TABLETS 健喬 0.5 (LORAZEPAM)( 鋁信元箔 / 膠箔 ) 健喬廠 KETOCONAZOLE 20 KETOCONAZOLE 20 乳膏乳膏規格原核定新核定價生效日期量價 10 GM 14.2 0 104/01/01 15 GM 36.9 0 104/01/01 20 GM 36.9 0 104/01/01 DICLOFENAC 25 栓 2.63 0 104/01/01 DICLOFENAC 12.5 栓 1.71 0 104/01/01 DOMPERIDONE 10 栓 3.37 0 104/01/01 DULOXETINE HYDROCHLORIDE 30 LITHIUM CARBONATE 300 AMINOPHYLLINE (=COROPHYLLIN) 100 AMINOPHYLLINE (=COROPHYLLIN) 100 膠囊 26.1 0 104/01/01 1.33 0 104/01/01 0.67 0 104/01/01 1.5 0 104/01/01 LORAZEPAM 0.5 0.91 0 104/01/01 LORAZEPAM 0.5 1.5 0 104/01/01 316 1030063687 A049320382 LIDOPAT PATCH 5% 德山 LIDOCAINE 700 貼片 700 49.2 0 104/01/01 319 1030063695 AC33544100 MEPHAN TABLET 30 瑞安 DEXTROMETHORPHAN 1.5 0 104/01/01 "PURZER" (DEXTROMETHORPHAN ) 觀音 (HBR) 30 320 1030063832 A049107345 TIE SHR SHU PAP P.Y 德山 FLURBIPROFEN 40 藥膠布 322 1030063838 A037637157 POWEGON SUSPENSION 永勝 CIMETIDINE 20 懸液 20 "EVEREST" (CIMETIDINE) 323 1030063838 A039059100 DANLASE E.C.TABLETS 5"EVEREST" 324 1030063838 A039240100 WEISUN TABLETS 400 (CIMETIDINE) "EVEREST" 永勝 SERRAPEPTASE (=SERRATIOPEPTIDASE) 5 腸溶 40 6.8 0 104/01/01 120 ML 66 0 104/01/01 1 0 104/01/01 永勝 CIMETIDINE 400 1 0 104/01/01 第 7 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 325 1030063838 A039731100 JOINTELL CAPSULES 永勝 GEMFIBROZIL 300 膠囊 300 "EVEREST" (GEMFIBROZIL) 326 1030063838 A040776100 ROLAX TABLETS 10 "EVEREST" (BACLOFEN) 327 1030063838 A041314157 BISUN ANTI-COUGH SYRUP 規格量原核定新核定價生效日期價 1.44 0 104/01/01 永勝 BACLOFEN 10 1 0 104/01/01 永勝 GUAIACOL GLYCOLATE 糖漿 (=GLYCERYL GUAIACOLATE) 20 120 ML 52 0 104/01/01 328 1030063838 A041511100 ENCINE E.M. CAPSULES 100 "EVEREST" 永勝 ASPIRIN 100 腸溶微粒膠囊 1 0 104/01/01 329 1030063838 A042774100 ANSIN E.C. TABLETS 100 "EVEREST" (ASPIRIN) 330 1030063838 A050209151 IEPAIN SUSPENSION 20 EVEREST" 340 1030063839 A037228336 LEVALONE CREAM "EVEREST" 341 1030063839 A038524335 ENCORT CREAM 0.1% "EVEREST" (TRIAMCINOLONE ACETONIDE) 342 1030063839 A042764343 PIPO CREAM 10 "EVEREST" (PIROXICAM) 343 1030063839 A042764345 PIPO CREAM 10 "EVEREST" (PIROXICAM) 344 1030063839 A042764355 PIPO CREAM 10 "EVEREST" (PIROXICAM) 永勝 ASPIRIN 100 腸溶永勝 IBUPROFEN 20 懸液永勝 ISOCONAZOLE NITRATE 乳膏 10 永勝 TRIAMCINOLONE (ACETONIDE) 1 乳膏永勝 PIROXICAM 10 乳膏永勝 PIROXICAM 10 乳膏永勝 PIROXICAM 10 乳膏 1 0 104/01/01 60 ML 25 0 104/01/01 16 GM 47.3 0 104/01/01 15 GM 15.1 0 104/01/01 30 GM 43 0 104/01/01 40 GM 43 0 104/01/01 100 GM 225 0 104/01/01 345 1030063839 A050128316 AMFULAN CREAM 永勝 FLUOCINONIDE 0.5 乳膏 3 GM 36.3 0 104/01/01 0.05% EVEREST" 346 1030063839 A050128335 AMFULAN CREAM 永勝 FLUOCINONIDE 0.5 乳膏 15 GM 54 0 104/01/01 0.05% EVEREST" 347 1030063839 A050128355 AMFULAN CREAM 0.05% EVEREST" 永勝 FLUOCINONIDE 0.5 乳膏 100 GM 477 0 104/01/01 348 1030063839 A050132338 AMI CREAM "EVEREST" 永勝 AZELAIC ACID 200 乳膏 20 GM 152 0 104/01/01 358 1030063840 A025849212 METOCLOPRAMIDE 應元 METOCLOPRAMIDE HCL 5 注射 2 ML 7.1 0 104/01/01 "Y.Y." 364 1030064023 AC44829100 DELCOPAN SR F.C.T 60 強生 DEXTROMETHORPHAN HBR 60 緩釋 2.41 0 104/01/01 367 1030064033 AC57254100 MOSAPIN F.C. TABLET 5 "STANDARD" (MOSAPRIDE) 368 1030064129 A028321100 UPROFEN TABLETS 400 (IBUPROFEN) 生達二廠健喬信元健喬廠 372 1030064212 A041465100 KINAX TAB. 1 寶齡 "KINGDOM"(ALPRAZOL 富錦 AM) 平鎮廠 373 1030064212 A042686100 KINAX TABLETS 0.5 寶齡 "KINGDOM"(ALPRAZOL 富錦 AM) 平鎮廠 MOSAPRIDE (CITRATE DIHYDRATE) 5 2.93 0 104/01/01 IBUPROFEN 400 0.98 0 104/01/01 ALPRAZOLAM 1 3.76 0 104/01/01 ALPRAZOLAM 0.5 1 0 104/01/01 第 8 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 374 1030064212 A0426861G0 KINAX TABLETS 0.5 寶齡 ALPRAZOLAM 0.5 1.5 0 104/01/01 "KINGDOM"(ALPRAZOL 富錦 AM)( 鋁箔 / 膠箔 ) 平鎮廠 375 1030064212 A045441100 MELICAM TABLETS 7.5 "KINGDOM" 376 1030064212 A047461100 MELICAM TABLETS 15 "KINGDOM" (MELOXICAM) 382 1030064212 N006271100 COLCHICINE TABLETS 0.5 "KINGDOM" 寶齡富錦平鎮廠寶齡富錦平鎮廠寶齡富錦平鎮廠 383 1030064212 N0062711G0 COLCHICINE TABLETS 寶齡 "KINGDOM"0.5( 鋁箔 / 富錦膠箔 ) 平鎮廠 386 1030064220 A057859500 MEKECIN VAGINAL TABLETS 200 (CLOTRIMAZOLE) 391 1030064226 AC47368100 LANXO CAPSULES 30 392 1030064228 B025066265 FINIBAX FOR 0.25G 394 1030064229 B024321209 FLUMARIN FOR 1G 397 1030064249 AC57743100 DUXETINE CAPSULES 60 399 1030064250 AC57843100 ROTY F.C. TABLETS 5 井田國際醫藥廠 MELOXICAM 7.5 2.4 0 104/01/01 MELOXICAM 15 9 0 104/01/01 COLCHICINE 0.5 0.99 0 104/01/01 COLCHICINE 0.5 1.5 0 104/01/01 CLOTRIMAZOLE 200 陰道永勝 LANSOPRAZOLE 30 膠囊 SHIO NK SHIO NG 中化新豐製中化新豐製 DORIPENEM HYDRATE 250 FLOMOXEF(SODIUM) 1 GM DULOXETINE HYDROCHLORIDE 60 ROSUVASTATIN CALCIUM 5 乾粉注射凍晶注射膠囊 250 11.2 0 104/01/01 21.4 0 104/01/01 369 0 104/01/01 1 GM 392 0 104/01/01 43.5 0 104/01/01 20.1 0 104/01/01 400 1030064253 A0243101G0 RESERZIDE S.C. 元宙 RESERPINE 0.1 糖衣 1.5 0 104/01/01 TABLETS( 鋁箔 / 膠箔 ) 401 1030064253 A0464401G0 COMEWELL TABLETS "Y.C"( 鋁箔 / 膠箔 ) 元宙 ALUMINUM DIHYDROXYALLANTOIN ATE (=ALDIOXA) 50 1.5 0 104/01/01 402 1030064253 A0471811G0 HIPURIC TABLETS 元宙 BENZBROMARONE 50 1.5 0 104/01/01 "Y.C.( 鋁箔 / 膠箔 ) 403 1030064253 A0483231G0 FEMINA TABLETS ( 鋁箔 / 膠箔 ) 元宙 MEFENAMIC ACID 500 1.5 0 104/01/01 413 1030064254 A023708100 ESCIN S.C. TABLETS 元宙 ESCIN 20 糖衣 1.98 0 104/01/01 (BETA-AESIN) 414 1030064254 A023764100 CLONIDINE TABLETS 元宙 CLONIDINE HCL 0.15 1.11 0 104/01/01 415 1030064254 A023998100 ALUFIBRATE CAPSULES 元宙 CLOFIBRATE 500 膠囊 2.9 0 104/01/01 416 1030064254 A034641100 LEZECON CAPSULES 30 (TIMEPIDIUM) 417 1030064254 A034893100 GLIMICON TABLETS 80 (GLICLAZIDE) 418 1030064254 A041926100 WEMET TABLETS 元宙 300 (DIBISMUTH TRIOXIDE) 元宙 TIMEPIDIUM BROMIDE 30 膠囊 2.18 0 104/01/01 元宙 GLICLAZIDE 80 1.15 0 104/01/01 BISMUTH SUBCITRATE COLLOIDAL(=TRIPOTASSI UM DICITRATE BISMUTHATE) 300 5.3 0 104/01/01 第 9 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 429 1030064291 A020276348 UBURN CREAM 瑞士 SULFADIAZINE SILVER 10 軟膏 (SILVER 新市 SULFADIAZINE) 廠 430 1030064291 A020276365 UBURN CREAM (SILVER SULFADIAZINE) 431 1030064291 A020276377 UBURN CREAM (SILVER SULFADIAZINE) 432 1030064291 A042374209 U-RON FOR I.V. 433 1030064291 A042374212 U-RON FOR I.V. 434 1030064291 A042374277 U-RON FOR I.V. 瑞士新市廠瑞士新市廠中化台南三廠中化台南三廠中化台南三廠 SULFADIAZINE SILVER 10 SULFADIAZINE SILVER 10 CEFTRIAXONE (DISODIUM 3.5 H2O) 1 GM CEFTRIAXONE (DISODIUM) 2 GM CEFTRIAXONE (DISODIUM 3.5 H2O) 500 軟膏軟膏乾粉注射乾粉注射乾粉注射糖衣膠囊規格原核定新核定價生效日期量價 50 GM 44 0 104/01/01 250 GM 500 GM 151 0 104/01/01 587 0 104/01/01 1 GM 243 0 104/01/01 2 GM 628 0 104/01/01 500 102 0 104/01/01 441 1030064295 A023793100 LIVERALL S.C. TABLETS 元宙 LIVER HYDROLYSATE 70 1.6 0 104/01/01 442 1030064295 A027508100 SIMALON CAPSULES 元宙 CYANOCOBALAMIN (=VIT 1.38 0 104/01/01 B12) 1.2 MCG 443 1030064295 A033170100 SHUAYAN TABLETS 元宙 DEXAMETHASONE 0.5 0.69 0 104/01/01 0.5 (DEXAMETHASONE)"Y. C." 444 1030064295 A033172100 HEITOMIN S.C. TABLETS 445 1030064295 A033453100 MECOMIN CAPSULES 0.5 (MECOBALAMIN) 446 1030064295 A041318100 ASUTAF F.C. TABLET 447 1030064295 A052522100 CANAFI F.C. TABLETS Y.C." 448 1030064295 A055889100 KANTEC CAPSULES Y.C." 449 1030064295 A056757100 FENSCO TABLETS 450 1030064295 A057316113 CETAM GRANULES FOR ORAL SOLUTION 2400 461 1030064296 A023756100 LOPERAMIDE CAPSULES 元宙 PROSULTIAMINE (=THIAMINE PROPYL DISULFIDE) 1 糖衣元宙 MECOBALAMIN 500 MCG 膠囊元宙 PROSULTIAMINE (=THIAMINE PROPYL DISULFIDE) 50 0.5 0 104/01/01 1.83 0 104/01/01 0.73 0 104/01/01 元宙 CLOPIDOGREL 75 36.3 0 104/01/01 元宙 HYMECROMONE 膠囊 3.68 0 104/01/01 (=IMECROMONE) 200 元宙 FENSPIRIDE HCL 40 1.73 0 104/01/01 元宙 PIRACETAM 2400 內服顆粒元宙 LOPERAMIDE HCL 2 膠囊 2.4 GM 9.5 0 104/01/01 0.94 0 104/01/01 462 1030064296 A023820100 CITIDINE TABLETS (CIMETIDINE) 463 1030064296 A030936100 FOSELIN TABLETS 10 (DOMPERIDONE) 464 1030064296 A033082100 ULCERBAN TABLETS 500 (SUCRALFATE) 465 1030064296 A036214100 CITAMET F.C. TABLETS 400 (CIMETIDINE) 466 1030064296 A040649100 MEBERINE TABLETS 135 (MEBEVERINE HCL) 元宙 CIMETIDINE 200 1 0 104/01/01 元宙 DOMPERIDONE 10 0.86 0 104/01/01 元宙 SUCRALFATE(=BASIC ALUMINUM SUCROSE SULFATE) 500 1.11 0 104/01/01 元宙 CIMETIDINE 400 膜衣 1 0 104/01/01 元宙 MEBEVERINE HCL 135 1.78 0 104/01/01 第 10 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 467 1030064296 A046440100 COMEWELL TABLETS 元宙 ALUMINUM 1 0 104/01/01 "Y.C" DIHYDROXYALLANTOIN ATE (=ALDIOXA) 50 468 1030064296 A048436100 TALEX SUGAR COATED 元宙 PANCREATIN (=DIASTASE 糖衣 2.62 0 104/01/01 TABLETS VERA) 212.5 469 1030064296 A049763100 NOLIDIN TABLETS 元宙 BUTINOLIN PHOSPHATE 2 2.93 0 104/01/01 Y.C." 470 1030064296 A057308100 ALLREX TABLETS 481 1030064297 A024076100 PRANOL F.C. TABLETS (PROPRANOLOL) 482 1030064297 A024310100 RESERZIDE S.C. TABLETS 元宙 TROSPIUM CHLORIDE 10 元宙 PROPRANOLOL HCL 20 元宙 RESERPINE 0.1 糖衣 5.7 0 104/01/01 0.87 0 104/01/01 1.3 0 104/01/01 483 1030064297 A034373100 AERISIN TABLETS 元宙 DILTIAZEM (HCL) 30 1.29 0 104/01/01 30 (DILTIAZEM) "YUAN CHOU" 484 1030064297 A044165100 SINGSONG CAPSULES 25 元宙 DOTHIEPIN HCL 25 膠囊 2.16 0 104/01/01 485 1030064297 A044850100 ALOZIDE TABLETS 元宙 HYDROCHLOROTHIAZIDE 1.88 0 104/01/01 50 486 1030064297 A046867100 CATACOR TABLETS 元宙 CARTEOLOL HCL 5 3.01 0 104/01/01 487 1030064297 A049105100 UNDIZZ TABLETS Y.C. 元宙 BETAHISTINE 2HCL 16 1.55 0 104/01/01 " 488 1030064297 A049142100 METERLON TABLETS Y.C." 元宙 BETAHISTINE 2HCL 8 1.03 0 104/01/01 497 1030064298 A033194100 OROLISIN F.C. TABLETS 元宙 OROTIC ACID (=VIT B13) 膜衣 0.89 0 104/01/01 30 498 1030064298 A033220100 ACTIRIN CAPSULES 元宙 OXAZOLAM 10 膠囊 0.94 0 104/01/01 10 499 1030064298 A033825100 NIGOLINE TABLETS 元宙 NICERGOLINE 10 5.1 0 104/01/01 10 500 1030064298 A047615143 BESUMIN SYRUP "Y.C" 元宙 LORATADINE 1 糖漿 30 ML 25.3 0 104/01/01 501 1030064298 A047615151 BESUMIN SYRUP "Y.C" 元宙 LORATADINE 1 糖漿 60 ML 30.1 0 104/01/01 502 1030064298 A047615155 BESUMIN SYRUP "Y.C" 元宙 LORATADINE 1 糖漿 100 68 0 104/01/01 503 1030064298 A048514100 COSLAN CAPSULES "Y.C" 元宙 DEXTROMETHORPHAN HBR 30 膠囊 1.01 0 104/01/01 504 1030064298 A055901100 BRISTIN TABLETS 元宙 TERBUTALINE SULFATE 5 1 0 104/01/01 Y.C." 505 1030064298 A056790100 FLUGALIN TABLETS 元宙 FLURBIPROFEN 100 4.08 0 104/01/01 515 1030064299 A023645100 HECODEN TABLETS 元宙 BROMHEXINE HCL 8 1.06 0 104/01/01 516 1030064299 A024817100 BROTHINE TABLETS 2.5 (TERBUTALINE SULFATE) 元宙 TERBUTALINE SULFATE 2.5 1 0 104/01/01 517 1030064299 A025447100 ANSRON FILM COATED 元宙 SULFINPYRAZONE 100 TABLETS 100 518 1030064299 A030996100 KETIMIN TABLETS 1 元宙 KETOTIFEN (FUMARATE) (KETOTIFEN) 1 519 1030064299 A033175100 MENICON TABLETS 元宙 DEXTROMETHORPHAN 30 HBR 30 (DEXTROMETHORPHAN ) 4.19 0 104/01/01 1.3 0 104/01/01 0.82 0 104/01/01 520 1030064299 A043990100 SUCOUGH F.C TABLET 20 "YC" 元宙 BENPROPERINE PHOSPHATE 20 521 1030064299 A045708100 CANASE CAPSULES 元宙 DEXTROMETHORPHAN (HBR) 20 522 1030064299 A045962100 ENPEX CAPSULES 元宙 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 150 第 11 頁, 共 31 頁膠囊膠囊 1.17 0 104/01/01 0.89 0 104/01/01 1.57 0 104/01/01

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 523 1030064299 A047181100 HIPURIC TABLETS 元宙 BENZBROMARONE 50 1.28 0 104/01/01 524 1030064299 A048323100 Femina Tablets 元宙 MEFENAMIC ACID 500 0.79 0 104/01/01 535 1030064300 A023599100 PELIN CAPSULES (DL- ALPHA-TOCOPHEROL NICOTINATE) 元宙 TOCOPHEROL NICOTINATE ALPHA DL- 100 膠囊 0.94 0 104/01/01 536 1030064300 A023644100 PERITIN FILM COATED TABLETS 25 (DIPYRIDAMOLE) 537 1030064300 A023822100 DEPHEDOL F.C. TABLETS 25 (DIPHRNIDOL) 538 1030064300 A033201100 SEPHYLLINE TABLETS 100 (PENTOXIFYLLINE) 539 1030064300 A040568100 GINGONIN F.C. TABLETS 40 (GINKGOFLAVONGLYC OSIDES) 540 1030064300 A047476100 HAO F.C. TABLETS 1200 541 1030064300 A047486197 HAO GRANULES FOR ORAL SOLUTION 1200 元宙 DIPYRIDAMOLE 25 膜衣元宙 DIPHENIDOL HCL 25 膜衣 0.9 0 104/01/01 0.91 0 104/01/01 元宙 PENTOXIFYLLINE 100 1.51 0 104/01/01 元宙 GINKGO BILOBA EXTRACT 40 元宙 PIRACETAM 1200 元宙 PIRACETAM 1200 內服顆粒 542 1030064300 A047606100 KAMART TABLETS 元宙 INDAPAMIDE (HEMIHYDRATE) 1.25 543 1030064300 A047789100 DANOW TABLETS 元宙 INDAPAMIDE (HEMIHYDRATE) 2.5 554 1030064301 A045825321 DANCE CREAM 元宙 MOMETASONE FUROATE 1 555 1030064301 A045825329 DANCE CREAM 元宙 MOMETASONE FUROATE 1 556 1030064301 A045825335 DANCE CREAM 元宙 MOMETASONE FUROATE 1 557 1030064301 A045957335 ANCENT CREAM "Y.C" 元宙 NAFTIFINE HCL 10 2.2 0 104/01/01 2.81 0 104/01/01 1.2 GM 4.88 0 104/01/01 1.63 0 104/01/01 2.46 0 104/01/01 乳膏乳膏乳膏乳膏 558 1030064301 A046939321 FUSIK CREAM 元宙 FUSIDIC ACID 20 乳膏 559 1030064301 A048060329 Superin cream 元宙 BUTENAFINE HCL 10 乳膏 560 1030064301 A048177329 yafu cream 元宙 UREA 400 乳膏 561 1030064301 A048177343 yafu cream 元宙 UREA 400 乳膏 5 GM 28 0 104/01/01 10 GM 40.4 0 104/01/01 15 GM 82 0 104/01/01 15 GM 44.3 0 104/01/01 5 GM 44.2 0 104/01/01 10 GM 62 0 104/01/01 10 GM 47.2 0 104/01/01 30 GM 113 0 104/01/01 562 1030064301 A056733100 HARKIN TABLETS 572 1030064302 A023825100 SPLOTIN TABLETS (SULPIRIDE) 573 1030064302 A036389100 LEGAFEN TABLETS "Y.C" (BACLOFEN) 574 1030064302 A036403100 STAYBAN TAB. 50 "YC" (FLURBIPROFEN) 575 1030064302 A040979100 MEQAZINE TABLETS 5 (MEQUITAZINE) 元宙 BETAHISTINE 2HCL 24 3.78 0 104/01/01 元宙 SULPIRIDE 50 1.47 0 104/01/01 元宙 BACLOFEN 10 1 0 104/01/01 元宙 FLURBIPROFEN 50 1.56 0 104/01/01 元宙 MEQUITAZINE 5 0.96 0 104/01/01 576 1030064302 A046166100 TEDALIN CHEWABLE TABLETS "Y.C" 元宙 IRON (HYDROXIDE POLYMALTOSE COMPLEX) 100 咀嚼 4.27 0 104/01/01 第 12 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 577 1030064302 A046488100 KARBOSE TABLETS 元宙 ACARBOSE 50 2.07 0 104/01/01 "Y.C' 578 1030064302 A047534100 PANTAZOL GASTRO- RESISTANT TABLETS 元宙 PANTOPRAZOLE SODIUM SESQUIHYDRATE 40 腸溶 18.8 0 104/01/01 579 1030064302 A048320100 KOLAX TABLETS "Y.C" 元宙 CARISOPRODOL 175 5.2 0 104/01/01 580 1030064302 A057238100 CORTA F.C. TABLETS 元宙 THIAMINE HCL 膜衣 2.22 0 104/01/01 (=THIAMINE CHLORIDE HYDROCHLORIDE) 125 581 1030064302 A057249100 BIDERMIN CAPSULES 元宙 CARBINOXAMINE 膠囊 1.91 0 104/01/01 MALEATE 4 592 1030064303 A025504423 YECOLON ORABASE 元宙 TRIAMCINOLONE 口內 6 GM 45.9 0 104/01/01 (TRIAMCINOLONE) (ACETONIDE) 1 膏 593 1030064303 A045357345 KENETON GEL 元宙 PIROXICAM 10 外用凝膠 40 GM 43 0 104/01/01 594 1030064303 A0453573AK KENETON GEL 元宙 PIROXICAM 10 外用凝膠 22 GM 41.3 0 104/01/01 595 1030064303 A046136421 WETHYCO ORABASE "Y.C" 元宙 DEXAMETHASONE 1 口內膏 5 GM 61 0 104/01/01 596 1030064303 A055894100 PLAQUIL F.C. TABLETS 元宙 HYDROXYCHLOROQUINE 膜衣 2.86 0 104/01/01 200 SULFATE 200 597 1030064303 A055902100 MESACOL TABLETS 元宙 BETHANECHOL 2.32 0 104/01/01 25 Y.C." CHLORIDE 25 598 1030064303 A056313100 BENECOL TABLETS 元宙 BETHANECHOL 3.86 0 104/01/01 Y.C."50 CHLORIDE 50 606 1030064304 A023763100 LYZOTOSE TABLETS 元宙 LYSOZYME (CHLORIDE) 0.92 0 104/01/01 (LYSOZYME) 50 607 1030064304 A024754100 ZECOLIN TABLETS 元宙 TRANEXAMIC ACID 250 1.3 0 104/01/01 608 1030064304 A033178100 MEZOLE TABLETS 100 (MEBENDAZOLE) 元宙 MEBENDAZOLE 100 1.1 0 104/01/01 609 1030064304 A041831100 PATRICIN F.C. TABLETS 200 (FLAVOXATE) 610 1030064304 A048731100 CAFONIA TABLETS Y.C." 元宙 FLAVOXATE HCL 200 膜衣元宙 4.49 0 104/01/01 FOLINATE 17.1 0 104/01/01 (CALCIUM)=LEUCOVORIN (CALCIUM) 15 611 1030064304 A048855100 Dibose Tablets Y.C." 元宙 ACARBOSE 100 5.3 0 104/01/01 612 1030064304 A048910100 URIMIN TABLETS 1000 元宙 METFORMIN HCL 1000 2.08 0 104/01/01 613 1030064304 A049188100 RACEPHENICOL 元宙 THIAMPHENICOL 250 1.52 0 104/01/01 TABLETS 614 1030064304 A055910100 MEXAZOL TABLETS 元宙 SULFAMETHOXAZOLE 1 0 104/01/01 Y.C." 800 624 1030064305 A024127100 DICLOFEN TABLETS 元宙 DICLOFENAC SODIUM 25 0.9 0 104/01/01 (DICLOFENAC) 625 1030064305 A025314100 NIFLUCIL CAPSULES 元宙 NIFLUMIC ACID 250 膠囊 2.56 0 104/01/01 250 (NIFLUMIC ACID) 626 1030064305 A025504421 YECOLON ORABESE 元宙 TRIAMCINOLONE 口內 5 GM 28.4 0 104/01/01 (TRIAMCINOLONE) (ACETONIDE) 1 膏 627 1030064305 A041833100 DILTAREN E.C. 元宙 DICLOFENAC SODIUM 50 腸溶 0.93 0 104/01/01 TABLETS 50 628 1030064305 A044281100 GABALON TAB. 5 元宙 BACLOFEN 5 1 0 104/01/01 629 1030064305 A045956100 ENPUROL TAB. "Y.C" 元宙 ALLOPURINOL 300 2.94 0 104/01/01 630 1030064305 A046049100 SETONLIN F.C.TAB. "Y.C" 631 1030064305 A046350100 BODOPINE CAPSULES 'Y.C" 元宙 IBUPROFEN 600 膜衣元宙 ETODOLAC 200 膠囊 1.9 0 104/01/01 4.01 0 104/01/01 第 13 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 632 1030064305 A046443100 CANTOR DISPERSIBLE 元宙 PIROXICAM 20 1.17 0 104/01/01 TABLETS 633 1030064305 A055907100 SPASFEN TABLETS 元宙 BACLOFEN 25 8.7 0 104/01/01 Y.C."25 644 1030064322 A023635100 RITESONE CAPSULES (ERYTHROMYCIN ESTOLATE) 元宙 ERYTHROMYCIN (ESTOLATE) 250 膠囊 1.43 0 104/01/01 645 1030064322 A023648100 DOXYCYCLINE 元宙 DOXYCYCLINE (HCL) 100 膠囊 1.31 0 104/01/01 CAPSULES 646 1030064322 A033184100 PRITHMOW TABLETS 5 (PREDNISOLONE) 元宙 PREDNISOLONE 5 0.9 0 104/01/01 647 1030064322 A033187100 TRIAMCINOLONE TABLETS 4 (TRIAMCINOLONE)"Y.C. " 元宙 TRIAMCINOLONE 4 0.89 0 104/01/01 648 1030064322 A033591100 THIAMPHENICOL 元宙 THIAMPHENICOL 250 膠囊 CAPSULES 250 1.52 0 104/01/01 649 1030064322 A046461100 MESOLONE TABLETS 元宙 METHYLPREDNISOLONE 4 650 1030064322 A047772100 BONY Tablets 元宙 METHYLPREDNISOLONE 8 651 1030064322 A048272100 MeHo Tablets 元宙 METHYLPREDNISOLONE 2 652 1030064322 A057359100 RABETT E.F.C. 元宙 RABEPRAZOLE SODIUM TABLETS 20 662 1030064324 A023616100 SEDENTON TABLETS 元宙 ETHENZAMIDE (=ETHOXYBENZAMIDE) 200 663 1030064324 A033180100 SU KU TA TABLETS 元宙 ACETAMINOPHEN (=PARACETAMOL) 450 664 1030064324 A033190100 SONZIN TABLETS 250 (CHLORZOXAZONE) 665 1030064324 A035065100 BIGAST TABLETS 1000 (SUCRALFATE) 666 1030064324 A044086100 SUDORXAN TABLETS 200 667 1030064324 A047639100 MONPHELON TABLETS "Y.C" 668 1030064324 A049766100 GASTERIN TABLETS Y.C." 669 1030064324 A050015100 SODIUM BICARBONATE TABLETS 0.3 GM Y.C. " 元宙 CHLORZOXAZONE 250 元宙 SUCRALFATE(=BASIC ALUMINUM SUCROSE SULFATE) 1000 元宙 MEPHENOXALONE 200 元宙 MEPHENOXALONE 500 元宙 BUTINOLIN PHOSPHATE 2 元宙 SODIUM BICARBONATE 300 1.73 0 104/01/01 3.51 0 104/01/01 1.71 0 104/01/01 腸溶 14.6 0 104/01/01 0.74 0 104/01/01 0.91 0 104/01/01 0.86 0 104/01/01 2.27 0 104/01/01 1.12 0 104/01/01 4.79 0 104/01/01 1.84 0 104/01/01 1.5 0 104/01/01 670 1030064324 A050340100 SODIUM BICARBONATE 元宙 TABLETS 0.6 GM Y.C. " SODIUM BICARBONATE 600 1.5 0 104/01/01 671 1030064324 A055906100 PENLEX TABLETS 5 元宙 TROSPIUM CHLORIDE 5 3.07 0 104/01/01 Y.C." 682 1030064325 A023775100 COLISTIN SULFATE 元宙 COLISTIN (SULFATE) 膠囊 6 0 104/01/01 CAPSULES 1000000 U (UNIT) 683 1030064325 A024375100 GRISEOFULVIN TABLETS 250 元宙 GRISEOFULVIN 250 1.65 0 104/01/01 684 1030064325 A024838100 RIFAMPICIN CAPSULES 元宙 RIFAMPIN (=RIFAMYCIN) (=RIMACTAN) 300 膠囊 8.1 0 104/01/01 第 14 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 685 1030064325 A030994151 AMTADINE SYRUP 元宙 AMANTADINE HCL 10 糖漿 10(AMANTADIN E) 規格原核定新核定價生效日期量價 60 ML 32.5 0 104/01/01 686 1030064325 A033163100 CO-TRIZOL TABLETS 687 1030064325 A033185100 TERICO-S.TABLETS 250 (METRONIDAZOLE) 688 1030064325 A033197100 NALIDIXIC ACID TABLETS 500 (NALIDIXIC ACID ) 元宙 TRIMETHOPRIM 80 0.9 0 104/01/01 元宙 METRONIDAZOLE 250 1.22 0 104/01/01 元宙 NALIDIXIC ACID 500 2.26 0 104/01/01 689 1030064325 A039120100 AELICON CAPSULES 200 (NIFURXAZIDE) Y.C." 元宙 NIFUROXAZIDE 200 膠囊 2.49 0 104/01/01 699 1030064326 A023769100 MEFENAMA CAPSULES (MEFENAMIC ACID) 元宙 MEFENAMIC ACID 250 膠囊 0.75 0 104/01/01 700 1030064326 A023857100 LORAZEPAM TABLETS 元宙 LORAZEPAM 1 0.98 0 104/01/01 701 1030064326 A024196100 PIPEMID TABLETS 250 (PIPEMIDIC ACID) 元宙 PIPEMIDIC ACID 250 3.48 0 104/01/01 702 1030064326 A024841100 CLOMIPHENE 元宙 CLOMIPHENE CITRATE 50 膠囊 3.8 0 104/01/01 CAPSULES 50 703 1030064326 A024843100 CHIMIN TABLETS 0.5 (BETAMETHASONE) 元宙 BETAMETHASONE 0.5 0.75 0 104/01/01 704 1030064326 A024866100 HYTERGEN TABLETS 元宙 DIHYDROERGOTOXINE 1.57 0 104/01/01 1.5 METHANESULFONATE 1.5 705 1030064326 A025025100 NYSTATIN TABLETS 500000 UNITS 元宙 NYSTATIN 500000 U (UNIT) 2.65 0 104/01/01 706 1030064326 A025290100 PIROX CAPSULES 10 元宙 PIROXICAM 10 膠囊 1.07 0 104/01/01 (PIROXICAM) 707 1030064326 A026974100 PYDINOL TABLETS (PRIDINOL) 元宙 PRIDINOL METHANESULFONATE 4 0.92 0 104/01/01 708 1030064326 A048908100 ANTILON F.C. TABLETS 元宙 PYRIDOSTIGMINE 膜衣 3 0 104/01/01 BROMIDE 60 719 1030064327 A057397100 ADENO TABLETS 元宙 ALLOPURINOL 100 0.99 0 104/01/01 720 1030064327 A057403100 PATAMIN F.C. 元宙 PANTETHINE 100 膜衣 3.5 0 104/01/01 TABLETS 100 721 1030064327 A058030100 EXECELA TABLETS 'Y.C" 元宙 CARISOPRODOL 250 3.65 0 104/01/01 722 1030064327 A058081312 RAXZOR CREAM 5% 723 1030064327 A058081321 RAXZOR CREAM 5% 724 1030064327 A058113100 FERRIN CAPSULES 725 1030064327 A058244100 CARIDOL TABLETS 元宙 ACYCLOVIR 50 乳膏 2 GM 17.3 0 104/01/01 元宙 ACYCLOVIR 50 乳膏 5 GM 45 0 104/01/01 元宙 IRON (POLYSACCHARIDE 膠囊 5.6 0 104/01/01 COMPLEX) 150 元宙 CARISOPRODOL 350 3.17 0 104/01/01 734 1030064366 B020802100 NITROSTAT 0.6 PFIZE NITROGLYCERIN 0.6 2.92 0 104/01/01 R PHAR MACE UTIC A 第 15 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 738 1030064462 AC57991100 BENSAU SOFT 美時 BENZONATATE 200 軟膠 CAPSULES 200 南投囊 "LOTUS" 廠 739 1030064487 A031690100 FETISMA TABLETS 2.5 (FENOTEROL) 740 1030064487 A031801100 KETOSMA CAPSULES 1 (KETOTIFEN) 741 1030064487 A031823100 BENZSIN TABLETS 50 (BENZBROMARONE) 規格量原核定新核定價生效日期價 3.92 0 104/01/01 FENOTEROL HBR 2.5 0.97 0 104/01/01 KETOTIFEN (FUMARATE) 1 膠囊 1.3 0 104/01/01 BENZBROMARONE 50 1.28 0 104/01/01 742 1030064487 A031825100 BECASONE TABLETS 0.6 (BETAMETHASONE) 743 1030064487 A032000100 PENTOSIN E.S.C.TABLETS 100 (PENTOXIFYLLINE) BETAMETHASONE 0.6 0.75 0 104/01/01 PENTOXIFYLLINE 100 腸溶 1.51 0 104/01/01 744 1030064487 A039519100 TETRALIN CAPSULES 250 (TERACYCLINE HYDROCHLO-RIDE) TETRACYCLINE HCL 250 膠囊 0.82 0 104/01/01 745 1030064487 A039931100 KOJARCLINDA CAPSULES 150 KOJAR " (CLINDAMYCIN HYDROCHLORIDE) CLINDAMYCIN (HCL) 150 膠囊 1.28 0 104/01/01 746 1030064487 A039950100 KOJARCLINDA CAPSULES 300 (CLINDAMYCIN) CLINDAMYCIN (HCL) 300 膠囊 2.26 0 104/01/01 747 1030064487 A041065100 ANEDANE CAPSULES 25 (ANETHOLE) ANETHOLE TRITHIONE 25 膠囊 0.98 0 104/01/01 757 1030064488 A031295100 SEANTO CAPSULES 10 (OXAZOLAM) 758 1030064488 A033390100 SOMILIN TABLETS 0.25 (TRIAZOLAM) 759 1030064488 A040046100 MINOCYCINE CAP.50 760 1030064488 A040644100 MINOCYCLINE CAPSULES 100 761 1030064488 A041025100 TOLIZOLE CAP. 250 762 1030064488 A041030100 SUBILIN TAB. 60 國嘉幼獅三廠 763 1030064488 A041284100 INTESTICIN TAB. 國嘉幼獅三廠 764 1030064488 A041358100 MEDLIN TAB. 4 國嘉幼獅三廠 765 1030064488 A054974100 WUTANNING CAPSULES 300 KOJAR" OXAZOLAM 10 膠囊 0.94 0 104/01/01 TRIAZOLAM 0.25 1.93 0 104/01/01 MINOCYCLINE (HCL) 50 MINOCYCLINE (HCL) 100 膠囊膠囊 METRONIDAZOLE 250 膠囊 PSEUDOEPHEDRINE HCL 60 MEPENZOLATE BROMIDE 7.5 METHYLPREDNISOLONE 4 URSODEOXYCHOLIC ACID 300 第 16 頁, 共 31 頁 3.43 0 104/01/01 5.2 0 104/01/01 1.22 0 104/01/01 0.7 0 104/01/01 0.64 0 104/01/01 1.73 0 104/01/01 膠囊 4.39 0 104/01/01

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 766 1030064488 A055947100 TANFU TABLETS 國嘉 URSODEOXYCHOLIC 2 0 104/01/01 100 KOJAR" 幼獅三廠 ACID 100 777 1030064489 A031544100 KODAZOL CAPSULES 200 (DANAZOL) DANAZOL (=CYCLOMEN) 200 膠囊 11.8 0 104/01/01 778 1030064489 A031666100 CATIN TABLETS 100 (TRIMETHOPRIM) TRIMETHOPRIM 100 0.82 0 104/01/01 779 1030064489 A031667100 NIFU CAPSULES 250 (NIFLUMIC ACID) NIFLUMIC ACID 250 膠囊 2.56 0 104/01/01 780 1030064489 A041063100 AMADINE CAPSULE 100 (AMANTADINE HYDROCHLORIDE) AMANTADINE HCL 100 膠囊 4.44 0 104/01/01 781 1030064489 A041069100 TRAN CAPSULES 250 782 1030064489 A041296100 TENTON CAPSULES 25 (INDOMETHACIN) 791 1030064559 AC57351100 ZHIKUI GASTRO- RESISTANT TABLETS 40 795 1030064570 AC49829100 DIABAN TABLETS 100 C.H." 796 1030064570 AC50084100 DIABAN TABLETS 50 C.H." 797 1030064570 AC50227100 AMBRO SR TABLETS 75 C.H." 803 1030064594 AB47702100 Anxokast Chewable Tablet 5mg 804 1030064594 AB47813100 ANXOKAST F.C. TABLETS 10 805 1030064594 AB47960100 Anxokast chewable tablets 4mg 808 1030064599 B025865100 JUBILANT OLANZAPINE ORODISPERSIBLE TABLETS 5 817 1030064644 AC48867100 RIBELITE TABLETS 200 818 1030064644 AC49020100 MINIVANE F.C. TABLETS 30 819 1030064644 AC49517100 GAPATIN F.C. TABLETS 600 820 1030064644 AC50083100 CALM-EZ F.C. TABLETS 25 821 1030064644 AC50240100 LOWTEN F.C. TABLETS 50 井田國際醫藥廠正和新營廠正和新營廠正和新營廠歐帕生技歐帕生技歐帕生技 JUBIL ANT LIFE 瑞士新市廠瑞士新市廠瑞士新市廠瑞士新市廠瑞士新市廠 TRANEXAMIC ACID 250 INDOMETHACIN 25 PANTOPRAZOLE SODIUM SESQUIHYDRATE 40 膠囊膠囊腸溶 1.3 0 104/01/01 0.87 0 104/01/01 18.8 0 104/01/01 MIGLITOL 100 8.2 0 104/01/01 MIGLITOL 50 3.91 0 104/01/01 AMBROXOL HYDROCHLORIDE 75 MONTELUKAST (SODIUM) 5 MONTELUKAST (SODIUM) 10 MONTELUKAST (SODIUM) 4 OLANZAPINE MICRONIZED 5 持續性藥效咀嚼咀嚼口溶 2.56 0 104/01/01 20 0 104/01/01 25.6 0 104/01/01 20 0 104/01/01 59 0 104/01/01 AMISULPRIDE 200 29.8 0 104/01/01 MIRTAZAPINE 30 GABAPENTIN 600 QUETIAPINE (AS FUMARATE) 25 LOSARTAN POTASSIUM 50 第 17 頁, 共 31 頁 19.6 0 104/01/01 15.7 0 104/01/01 14.2 0 104/01/01 9.3 0 104/01/01

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 822 1030064644 AC56718100 ARIPIZOLE TABLETS 瑞士 ARIPIPRAZOLE 10 73 0 104/01/01 10 新市廠 824 1030064675 AC57759100 RELUNG F.C. TABLETS 20 十全 SILDENAFIL CITRATE 20 218 0 104/01/01 827 1030064732 AC47348100 VATATIN F.C. TABLETS 生達 SIMVASTATIN 20 膜衣 8.1 0 104/01/01 20 "STANDARD" 化學 834 1030064733 AC02368100 NADIS TABLETS 優生 FUROSEMIDE 40 1.5 0 104/01/01 835 1030064733 AC023681G0 NADIS TABLETS( 鋁箔 / 膠箔 ) 優生 FUROSEMIDE 40 2 0 104/01/01 836 1030064733 AC29551100 YUPIN CAPSULES 10 "YU SHENG" (OXAZOLAM) 837 1030064733 AC33387100 SURIN TABLETS 200 "YU SHENG" (SULPIRIDE) 優生 OXAZOLAM 10 膠囊 1.68 0 104/01/01 優生 SULPIRIDE 200 2.69 0 104/01/01 838 1030064733 AC41535100 PENTOP S.R. TABLETS 400 "YU SHENG" (PENTOXIFYLLINE) 優生 PENTOXIFYLLINE 400 持續性藥效 2.29 0 104/01/01 839 1030064733 AC46620100 SUPERNIDE TABLETS 1 "YU SHENG" 840 1030064740 A035697335 ZUMELIN CREAM 20 "H.S." (KETOCONAZOLE) 優生 REPAGLINIDE 1 3.31 0 104/01/01 瑞士新市廠 KETOCONAZOLE 20 乳膏 15 GM 36.9 0 104/01/01 841 1030064740 A035697338 ZUMELIN CREAM 20 "H.S." (KETOCONAZOLE) 844 1030064781 A044434100 DELIBS F.C TABLETS 50 850 1030064826 AC408351G0 MEFORIN F.C. TABLETS 500 "JOHNSON" (METFORMIN)( 鋁箔 / 膠箔 ) 851 1030064828 A033064100 IBUPROFEN F.C. TABLETS 400 852 1030064828 A036485100 FUKON TABLETS 50 (FLURBIPROFEN) 853 1030064828 A040245321 KOJARCORT CREAM 854 1030064828 A040245329 KOJARCORT CREAM 855 1030064828 A040245335 KOJARCORT CREAM 856 1030064828 A040245338 KOJARCORT CREAM 866 1030064829 A038132100 SALALIN TABLETS 250 (CHLORZOXAZONE) 867 1030064829 A041378100 PRECONIN TABLETS. 5 (PREDNISOLONE) 瑞士新市廠衛達製造 KETOCONAZOLE 20 乳膏 PINAVERIUM BROMIDE 50 膜衣強生 METFORMIN HCL 500 膜衣 868 1030064829 A041380100 INOLIM TABLETS 3 國嘉 (TRIMETOQUIN 幼獅 OL) 三廠 IBUPROFEN 400 20 GM 36.9 0 104/01/01 7.8 0 104/01/01 2 0 104/01/01 0.98 0 104/01/01 FLURBIPROFEN 50 1.56 0 104/01/01 ECONAZOLE NITRATE 10 ECONAZOLE NITRATE 10 ECONAZOLE NITRATE 10 ECONAZOLE NITRATE 10 CHLORZOXAZONE 250 乳膏乳膏乳膏乳膏 5 GM 11.7 0 104/01/01 10 GM 23.7 0 104/01/01 15 GM 25.8 0 104/01/01 20 GM 36.2 0 104/01/01 0.86 0 104/01/01 PREDNISOLONE 5 0.9 0 104/01/01 TRIMETOQUINOL HCL 3 1.08 0 104/01/01 第 18 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 869 1030064829 A048929100 MEQUIMIN TABLETS 5 國嘉 MEQUITAZINE 5 0.96 0 104/01/01 幼獅三廠 870 1030064829 A052485100 LVTANGSU TABLETS 500 KOJAR" 871 1030064829 A055258100 LVTANGSU TABLETS 250 KOJAR" 879 1030064847 A032003100 NAPOSIN TABLETS 250 (NAPROXEN) 880 1030064847 A032942100 DEMIL TABLETS 2.5 (BROMOCRIPTINE) 881 1030064847 A033411100 ANCOU TABLETS 30 (DEXTROMETHORPHAN ) 882 1030064847 A037644100 EFOSIN S.C TABLETS 25 (DIPYRIDAMOLE) 883 1030064847 A037696100 HOPAN TABLETS 5 (HALOPERIDOL) 884 1030064847 A038244100 HOPAN TABLETS 10 (HALOPERIDOL) 885 1030064847 A040791100 CYPROH TABLETS 4 (CYPROHEPTADINE HYDROCHLORIDE) 895 1030065002 A039429329 TORICAM GEL 10/G (PIROXICAM) 五洲製 METFORMIN HCL 500 1 0 104/01/01 METFORMIN HCL 250 1 0 104/01/01 NAPROXEN 250 1.09 0 104/01/01 BROMOCRIPTINE (MESYLATE) 2.5 DEXTROMETHORPHAN HBR 30 DIPYRIDAMOLE 25 5.6 0 104/01/01 0.82 0 104/01/01 糖衣 0.9 0 104/01/01 HALOPERIDOL 5 2.09 0 104/01/01 HALOPERIDOL 10 3.68 0 104/01/01 CYPROHEPTADINE HCL 4 PIROXICAM 10 0.7 0 104/01/01 外用凝膠 10 GM 22.7 0 104/01/01 896 1030065002 A039429338 TORICAM GEL 10/G (PIROXICAM) 五洲製 PIROXICAM 10 外用凝膠 20 GM 28.5 0 104/01/01 897 1030065002 A039429343 TORICAM GEL 10/G (PIROXICAM) 五洲製 PIROXICAM 10 外用凝膠 30 GM 43 0 104/01/01 898 1030065002 A0394293AK TORICAM GEL 10/G (PIROXICAM) 五洲製 PIROXICAM 10 外用凝膠 22 GM 41.3 0 104/01/01 909 1030065037 AC49147209 SUPECEF POWDER FOR 910 1030065037 AC49147277 SUPECEF POWDER FOR 914 1030065174 A0238201G0 CITIDINE TABLETS (CIMETIDINE)( 鋁箔 / 膠箔 ) 中化台南三廠中化台南三廠 CEFEPIME (AS HYDROCHLORIDE) 1 GM CEFEPIME (AS HYDROCHLORIDE) 500 乾粉注射乾粉注射 1 GM 432 0 104/01/01 500 282 0 104/01/01 元宙 CIMETIDINE 200 1.5 0 104/01/01 915 1030065174 A0362141G0 CITAMET F.C TABLETS 400 "YC" (CIMETIDINE)( 鋁箔 / 膠箔 ) 元宙 CIMETIDINE 400 膜衣 1.5 0 104/01/01 第 19 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 921 1030065220 A029735100 TIATENOL TABLETS 大豐 ATENOLOL 100 1.49 0 104/01/01 100 "T.F." 製藥股份有限公司 922 1030065220 A030695100 CORTICORD TABLETS 4 (TRIAMCINOLONE) "T.F." 923 1030065220 A044253100 USER TAB. "T.F" (TIAPROFENIC ACID) 924 1030065220 A050261100 T.F."SU-TON TABLETS 925 1030065220 A055916100 T.F."SU-MIN F.C.T 180 926 1030065220 A057280100 "T.F." SU-MIN F.C. TABLETS 60 936 1030065221 A002956100 YONG WANG CAPSULES "T.F." 937 1030065221 A025698100 PIPEMIDON CAPSULES 大豐 250"T.F." (PIPEMIDIC 製藥 ACID) 股份有限公司 938 1030065221 A025847100 AISOPENT TABLETS 20"T.F." (ORCIPRENALINE) 939 1030065221 A028619100 ANTIRHEUMATIC CAPSULES 200 "T.F."(FLUFENAMIC ACID) 940 1030065221 A029132100 ENSOQONE CAPSULES 50 "T.F."(ESCIN) 941 1030065221 A032893100 ERYMYCIN FILM COATED TABLETS 500 "T.F" TRIAMCINOLONE 4 0.89 0 104/01/01 TIAPROFENIC ACID 200 MEPHENOXALONE 200 FEXOFENADINE 膜衣 HYDROCHLORIDE 180 FEXOFENADINE HYDROCHLORIDE 60 METHYLTESTOSTERONE 10 PIPEMIDIC ACID (TRIHYDRATE) 250 METAPROTERENOL SULFATE(=ORCIPRENALI NE SULFATE) 20 FLUFENAMIC ACID 200 ESCIN 50 ERYTHROMYCIN (ESTOLATE) 500 2.92 0 104/01/01 1.64 0 104/01/01 膠囊膠囊 6.8 0 104/01/01 2.64 0 104/01/01 1.62 0 104/01/01 3.48 0 104/01/01 1.5 0 104/01/01 膠囊膠囊 1.77 0 104/01/01 2.89 0 104/01/01 3.67 0 104/01/01 第 20 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 942 1030065221 A034300100 TENSOLIN TABLET 大豐 ATENOLOL 100 5.9 0 104/01/01 "T.F" 製藥股份有限公司 950 1030065222 A022814229 GENTAMYCIN SULFATE 40 "T.F." 951 1030065222 A025595229 LINCOMYCIN HCL 300 "T.F." 952 1030065222 A033376212 GENTAMYCIN 140 "T.F" 953 1030065222 A033376229 GENTAMYCIN 140 "T.F." 954 1030065222 A033757238 GLUCOSE 50% "T.F." 955 1030065222 A033773229 TUNNACORT 40 "T.F." 956 1030065222 A041836255 METROCIDE 5 "TA FONG"(METRONIDAZO LE) 957 1030065222 A049857221 WENTIN 10 T.F." 966 1030065222 N008800229 DEXAMESONE 4 "T.F." 967 1030065222 N016986209 HYDROXOCOBALAMIN "T.F." 970 1030065223 A025595238 LINCOMYCIN HCL 300"TF" GENTAMICIN (SULFATE) 40 LINCOMYCIN (HCL) 300 GENTAMICIN (SULFATE) 140 GENTAMICIN (SULFATE) 140 DEXTROSE 500 TRIAMCINOLONE (ACETONIDE) 40 METRONIDAZOLE 5 RITODRINE HCL 10 DEXAMETHASONE PHOSPHATE (SODIUM) 4 HYDROXOCOBALAMIN 1 LINCOMYCIN (HCL) 300 注射注射注射注射注射注射注射注射注射注射注射 10 ML 15.6 0 104/01/01 10 ML 24.2 0 104/01/01 2 ML 15.6 0 104/01/01 10 ML 82 0 104/01/01 20 ML 5.7 0 104/01/01 10 ML 57 0 104/01/01 100 ML 48.6 0 104/01/01 5 ML 50 0 104/01/01 10 ML 18.8 0 104/01/01 1 ML 7.9 0 104/01/01 20 ML 39.2 0 104/01/01 第 21 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 971 1030065223 A033547212 ANTHIMIN 注射 "T.F." 972 1030065223 A033866221 OBALLERCAL "T.F." 973 1030065223 A033867209 EPHEDRIN 40 "T.F." 974 1030065223 A033876221 REHISTACAL B6 "T.F." 975 1030065223 A035488221 SONTAC 10 "T.F." 976 1030065223 A047442212 FAMOSTER 10 "TF" 977 1030065223 A049077209 KETOROLAC FOR IV 30 T.F." 978 1030065223 A049247209 PROCHLOZINE 5 "T.F" 988 1030065223 N010908238 PYRIDO-CALCIUM 990 1030065224 A013722500 METROCIDE VAGINAL SUPPOSITORIES 250 "T.F." 991 1030065224 A032812338 CLOMOLD CREAM 0.5 "T.F" 992 1030065224 A032892500 MOLIN SUPPOSITORY 10 "T.F." 993 1030065224 A033074321 KENALON CREAM "T.F." 994 1030065224 A034355321 CYCLOUIR CREAM 50 "T.F" PROSULTIAMINE (=THIAMINE PROPYL DISULFIDE) 5 CHLORPHENIRAMINE MALEATE 0.4 EPHEDRINE HCL 40 DIPHENHYDRAMINE HCL 4 RANITIDINE (HCL) 10 注射注射注射注射大豐 FAMOTIDINE 10 注射大豐 KETOROLAC 注射 TROMETHAMINE 30 大豐 PROCHLORPERAZINE (METHANESULFONATE) 5 PYRIDOXINE HCL 1 注射注射規格原核定新核定價生效日期量價 2 ML 2.4 0 104/01/01 5 ML 3.44 0 104/01/01 1 ML 6.4 0 104/01/01 5 ML 6 0 104/01/01 5 ML 27.7 0 104/01/01 2 ML 35.4 0 104/01/01 1 ML 17.8 0 104/01/01 1 ML 12.8 0 104/01/01 20 ML 3 0 104/01/01 METRONIDAZOLE 250 栓 1.96 0 104/01/01 CLOBETASOL PROPIONATE 0.5 乳膏 20 GM 47 0 104/01/01 DOMPERIDONE 10 栓 3.37 0 104/01/01 NYSTATIN 100000 IU/GM ACYCLOVIR 50 第 22 頁, 共 31 頁乳膏乳膏 5 GM 14.5 0 104/01/01 5 GM 45 0 104/01/01

項次發文號健保代碼藥品名稱廠牌成分及含量型 995 1030065224 A037200209 KEPRO KETOPROFEN 50 注射 50 "T.F." 996 1030065224 A042629500 METROCIDE VAGINAL SUPPOSITORIES 500 "T.F." 997 1030065224 A043924338 SHUJEN GEL 10/G "T.F." 998 1030065224 A043924345 SHUJEN GEL 10/G "T.F." 999 1030065224 A044268321 CLINDAMYCIN GEL 10/G "T.F" 1013 1030065255 AB55272100 ATORVA FILM-COATED TABLETS 10 STANDARD" (ATORVASTATIN) 1014 1030065255 AB57805100 ATORVA F.C. TAB. 20 "STANDARD" (ATORVASTATIN) 1015 1030065310 A048993245 PANE FOR IV 1017 1030065320 A048193338 Demaclean Gel 1% (Clindamycin) 1019 1030065321 A031228100 EFOSIN S.C. TABLETS 50 (DIPYRIDAMOLE) 1020 1030065321 A032056100 SERRALO E.F.C.TABLETS 5 (SERRATIOPEP TIDASE) 1021 1030065321 A033128100 MEFENA F.C.TABLETS 500(MEFEN AMIC ACID) 生達二廠生達二廠杏林新生正和新營廠規格原核定新核定價生效日期量價 1 ML 11.1 0 104/01/01 METRONIDAZOLE 500 栓 3.73 0 104/01/01 PIROXICAM 10 PIROXICAM 10 CLINDAMYCIN (PHOSPHATE) 10 ATORVASTATIN (CALCIUM) 10 ATORVASTATIN (CALCIUM) 20 PANTOPRAZOLE 40 CLINDAMYCIN (PHOSPHATE) 10 DIPYRIDAMOLE 50 SERRAPEPTASE (=SERRATIOPEPTIDASE) 5 凝膠外用凝膠凝膠凍晶注射外用凝膠糖衣 MEFENAMIC ACID 500 20 GM 28.5 0 104/01/01 40 GM 43 0 104/01/01 5 GM 9.4 0 104/01/01 20 0 104/01/01 31.1 0 104/01/01 40 181 0 104/01/01 20 GM 64 0 104/01/01 1.43 0 104/01/01 1 0 104/01/01 0.79 0 104/01/01 1022 1030065321 A036099100 DICLOFENAC E.F.C. TABLETS 25 1023 1030065321 A038209100 SERRALO E.F.C. TABLETS 10 (SERRATIOPEPTIDASE) 1024 1030065321 A040232100 JIACANG TABLETS 國嘉幼獅三廠 DICLOFENAC SODIUM 25 SERRAPEPTASE (=SERRATIOPEPTIDASE) 10 GUAIACOL GLYCERYL ETHER (=GUAIFENESIN) 200 腸溶腸溶 0.9 0 104/01/01 1 0 104/01/01 0.92 0 104/01/01 第 23 頁, 共 31 頁

項次發文號健保代碼藥品名稱廠牌成分及含量型 1031 1030065322 A031536100 PICOLIN F.C. TABLETS 國嘉 PIPEMIDIC ACID 膜衣 250 幼獅 (TRIHYDRATE) 250 (PIPEMIDIC ACID) 三廠規格量原核定新核定價生效日期價 3.48 0 104/01/01 1032 1030065322 A031537100 SINGEN F.C.TABLETS 40 (VERAPAMIL) VERAPAMIL HCL 40 1.17 0 104/01/01 1033 1030065322 A031609100 LIGISIN F.C. TABLETS 200 (BEZAFIBRATE) BEZAFIBRATE 200 4.22 0 104/01/01 1034 1030065322 A033125100 FUCOTIN F.C. TABLETS 200 (FLAVOXATE) FLAVOXATE HCL 200 4.49 0 104/01/01 1035 1030065322 A034110100 AMANTADINE F.C. TABLETS 100 1036 1030065322 A036237100 LINTON F.C. TABLETS 10 (HYOSCINE BUTYLBROMIDE) 1037 1030065322 A037352100 HOPAN TABLETS 0.5 (HALOPERIDOL) 1038 1030065322 A039692100 WEISU F.C. TABLETS 200 (SULINDAC) 1039 1030065322 A041270100 KUETONBILY TABLETS 10 (DICYCLOMINE HYDROCHLORIDE) 1040 1030065322 A041476100 KOJASPOL FILM COATED TABLETS 9.6 1051 1030065323 A033122100 DICLOFEN ENTERIC FILM COATING TABLETS 50 (DICLOFENAC) AMANTADINE HCL 100 BUTYLSCOPOLAMINE BROMIDE (=HYOSCINE BUTYLBROMIDE) 10 4.44 0 104/01/01 0.96 0 104/01/01 HALOPERIDOL 0.5 0.75 0 104/01/01 SULINDAC 200 1.96 0 104/01/01 DICYCLOMINE HCL 10 0.85 0 104/01/01 GINKGO BILOBA EXTRACT 40 DICLOFENAC SODIUM 50 腸溶 2.2 0 104/01/01 0.93 0 104/01/01 1052 1030065323 A033894100 DECA TABLETS 0.75 (DEXAMETHASONE) 1053 1030065323 A034018100 DECA TABLETS 0.5 (DEXAMETHASONE) 1054 1030065323 A034551100 SULIMEN TABLETS 100 (SULINDAC) 1055 1030065323 A034736100 GLICALIN TABLETS 80 (GLICLAZIDE) 1056 1030065323 A036484100 METIPINE TABLETS 300 (TRIMETHOPRI M) 1057 1030065323 A041029100 TRIAMCINOLONE 國嘉 TABLETS 4 幼獅三廠 DEXAMETHASONE 0.75 0.69 0 104/01/01 DEXAMETHASONE 0.5 0.69 0 104/01/01 SULINDAC 100 1.87 0 104/01/01 GLICLAZIDE 80 1.15 0 104/01/01 TRIMETHOPRIM 300 1.96 0 104/01/01 TRIAMCINOLONE 4 0.89 0 104/01/01 第 24 頁, 共 31 頁

規格原核定項次發文號健保代碼藥品名稱廠牌成分及含量型新核定價生效日期量價 1058 1030065323 A041169100 KOJAZYME TABLETS 國嘉 LYSOZYME (CHLORIDE) 0.98 0 104/01/01 90 幼獅三廠 90 1059 1030065323 A041269100 PRIPRAM TABLETS 5 (METOCLOPRAMIDE HYDROCHLORIDE) 1060 1030065323 A041329100 SUNLING TABLETS 4 (SALBUTAMOL) 1072 1030065382 A025061100 MEPENATE TABLETS 井田國際醫藥廠 1073 1030065382 A025714100 CIWIDINE TABLETS 200 1074 1030065382 A025882100 LYCOSU TABLETS 50 井田國際醫藥廠井田國際醫藥廠 1075 1030065382 A026114100 EMODINE CAPSULES 井田國際醫藥廠 1076 1030065382 A026127100 NAPOXEN TABLETS 250 1077 1030065382 A026361100 PIROCAM CAPSULES 10 1078 1030065382 A043857100 ZUSAWTO E.M. CAPSULES 井田國際醫藥廠井田國際醫藥廠井田國際醫藥廠 1079 1030065382 A044038100 SONLI CAPSULES 井田國際醫藥廠 1080 1030065382 A0440381G0 SONLI CAPSULES ( 鋁箔 ) 井田國際醫藥廠 1090 1030065383 N002121100 SENLIS TABLETS 井田國際醫藥廠 1091 1030065383 N002124100 AMMONIUM CHLORIDE ENTRIC S.C. TABLETS 井田國際醫藥廠 1092 1030065383 N002593100 INDOMIN TABLETS 井田國際醫藥廠 1093 1030065383 N002596100 NEO-WEITUPIN TABLETS 井田國際醫藥廠 METOCLOPRAMIDE (2HCL MONOHYDRATE) 3.84 SALBUTAMOL (SULFATE) 4 MEPENZOLATE BROMIDE 25 0.62 0 104/01/01 0.93 0 104/01/01 1 0 104/01/01 CIMETIDINE 200 1 0 104/01/01 LYSOZYME (CHLORIDE) 50 LOPERAMIDE HCL 2 0.92 0 104/01/01 膠囊 0.94 0 104/01/01 NAPROXEN 250 1.09 0 104/01/01 PIROXICAM 10 DICLOFENAC SODIUM 50 DEXTROMETHORPHAN HBR 20 DEXTROMETHORPHAN HBR 20 膠囊腸溶微粒膠囊膠囊膠囊 1.07 0 104/01/01 0.93 0 104/01/01 0.99 0 104/01/01 1.5 0 104/01/01 NEOSTIGMINE 0.45 0 104/01/01 METHYLSULFATE 0.05 AMMONIUM CHLORIDE 300 腸溶 0.18 0 104/01/01 INDOMETHACIN 25 0.87 0 104/01/01 CALCIUM CARBONATE 25 0.78 0 104/01/01 第 25 頁, 共 31 頁