AHFA Pharmacological Therapeutic Classifiaction F… · Web viewAHFA Pharmacological Therapeutic...

American Hospital Formulary Service (AHFS)Pharmacologic-Therapeutic Classification

4:00 Antihistamine Drugs 56:00 Gastrointestinal Drugs

8:00 Anti-Infective Agents 64:00 Heavy Metal Antagonists

10:00 Antineoplastic Agents 68:00 Hormones and Synthetic Substitutes

12:00 Autonomic Drugs 72:00 Local Anesthetics

16:00 Blood Derivatives 76:00 Oxytocics

20:00 Blood Formation and Coagulation 80:00 Serums, Toxoids, and Vaccines

24:00 Cardiovascular Drugs 84:00 Skin and Mucous Membrane Agents

28:00 Central Nervous System Agents 86:00 Smooth Muscle Relaxants

36:00 Diagnostic Agents 88:00 Vitamins

38:00 Disinfectants 92:00 Miscellaneous Therapeutic Agents

40:00 Electrolyte, Caloric and Water Balance 94:00 Devices

44:00 Enzymes 96:00 Pharmaceutical Aids

48:00 Antitussives, Expectorants, and Mucolytic Agents Non-AHFS Category Formulary Agents

52:00 Eye, Ear, Nose, and Throat (EENT) Preparations

Last Updated on June 21, 2017

AHFA Pharmacological Therapeutic Classification4:00 Antihistamine Drugs

4:04 - First Generation Antihistamines

04:04.04 Ethanolamine Derivatives

GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Diphenhydramine 4 Pack Benadryl 4 Pack (Equiv) CAP 25 Mg Po 1 CAP

Diphenhydramine HCl Benadryl (Equiv) CAP 25 Mg Po 1 CAP

Diphenhydramine HCl Benadryl (Equiv) Elixir 25 Mg Po 10 mL

Diphenhydramine HCl Benadryl (Equiv) CAP 50 Mg Po 1 CAP

Diphenhydramine HCl Benadryl (Equiv) Vial 50 Mg IV 1 mL

04:04.12 Phenothiazine Derivatives


Promethazine HCl Phenergan (Equiv) Supp 12.5 Mg Rec 1 Supp

Promethazine HCl Phenergan Homepack (Equiv) Qa 2 Supp Rec 1 Package

Promethazine HCl Phenergan Homepack (Equiv) Supp 2 Supp Rec 1 Package

Promethazine HCl Phenergan (Equiv) Ta 25 Mg Po 1 TAB

Promethazine HCl Phnergan (Equiv) Supp 25 Mg Rec 1 Supp

Promethazine HCl Phenergan Homepack (Equiv) TAB 4 TAB Po 1 Package

Promethazine HCl Phenergan (Equiv) Syrup 6.25 Mg Po 5 mL

Promethazine VC Phenergan Vc (Equiv) Syrup 5 mL Po 1 Cup

04:04.20 Propylamine Derivatives


Chlorpheniramine Maleate Chlor Trimeton (Equiv) TAB 4 Mg Po 1 TAB

4:08 – Second Generation Antihistamines

04:08.00 Second Generation

Antihistamines


Loratadine Claritin (Equiv) TAB 10 Mg Po 1 TAB

P-Ephed Sul/Loratadine Claritin-D 24 Hour (Equiv) T Sr 24 1 TAB Po 1 T Sr 24

8:00 Anti-Infective Agents

8:12 - Antibacterials 08:12.02 Aminoglycosides GENERIC NAME BRAND NAME DOSAGE

FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Amikacin Sulfate Amikacin Sulfate Vial 500 MG IV 2 mL

Gentamicin Gentamicin Opth 0.2 MG EYE 0.1 mL

Gentamicin 80mg In NS Garamycin 80 Mg (Equiv) In NS PB 80 MG IV 50 mL

Gentamicin Sulfate Garamycin Pf (Equiv) Vial 20 MG IV 2 mL

Gentamicin Sulfate Garamycin (Equiv) Vial 80 MG IV 2 mL

Kanamycin Sulfate Kantrex (Equiv) Vial 1,000 MG IV 3 mL

Neomycin Sulfate Neomycin (Equiv) TAB 500 MG PO 1 TAB

Streptomycin Sulfate Streptomycin Sulfate Vial 1 GM IM 1 Vial

Tobramycin Sulfate Tobramycin Sulfate HS 1.2 G INJ 1 Vial

Tobramycin Sulfate Nebcin (Equiv) Vial 80 MG IV 2 mL

08:12.06 Cephalosporins

08:12.06.04 First Generation GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Cefazolin Sodium Ancef (Equiv) Vial 1,000 MG IV 1 Vial

Cefazolin Sodium Ancef (Equiv) Vial 500 MG IV 1 Vial

Cefazolin/Dextrose 1gm PM Ancef PM (Equiv) Fz Pigg 1,000 MG IV 50 mL

Cephalexin Monohydrate Keflex (Equiv) CAP 250 MG PO 1 CAP

Cephalexin Monohydrate Keflex (Equiv) CAP 500 MG PO 1 CAP

Cephalexin Monohydrate Cephalexin PD 250 MG PO 5 mL

Cephalexin Monohydrate Keflex (Equiv) Sus Rec 125 MG PO 5 mL

Cephalexin Monohydrate Keflex (Equiv) Sus Rec 250 MG PO 5 mL

08:12.06.08 Second Generation GENERIC NAME BRAND NAME DOSAGE


08:12.06.12 Third Generation GENERIC NAME BRAND NAME DOSAGE


Restricted to SANE Cefixime Suprax Tab 400 MG PO 1 Tab

Cefotaxime Sodium Claforan (Equiv) Vial 1,000 Mg IV 1 Vial

Ceftazidime Fortaz (Equiv) Vial 1,000 Mg IV 1 Vial

Ceftazidime/Dex-Water 1gm Fortaz (Equiv) 1gm PM Fz Pigg 1,000 Mg IV 50 mL

Ceftazidime – Avibactam Avycaz Vial 2.5 MG IV 1 Vial

Cefdinir Omnicef (Equiv) Suspension 125 MG PO 5 mL

Ceftriaxone Sodium Rocephin (Equiv) Vial 1,000 Mg IV 1 Vial

Ceftriaxone Sodium Rocephin (Equiv) Vial 2,000 Mg IV 1 Vial

Ceftriaxone Sodium Rocephin (Equiv) Vial 250 Mg IV 1 Vial

Ceftriaxone Sodium Rocephin (Equiv) Vial 500 Mg IV 1 Vial

Ceftriaxone/Dextrose 1gm PM Rocephin (Equiv) 1gm PM Fz Pigg 1,000 Mg IV 50 mL

Ceftriaxone/Dextrose 2gm PM Rocephin (Equiv) 2gm PM Fz Pigg 2,000 Mg IV 50 mL

08:12.06.16 Fourth Generation GENERIC NAME BRAND NAME DOSAGE


Cefepime HCl Maxipime (Equiv) Hs 1,000 Mg IV 15 mL

08:12.06.20 Fifth Generation GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Ceftaroline Teflaro Vial 400 MG IV 1 VIAL

Ceftaroline Teflaro Vial 600 MG IV 1 VIAL

08:12:07 Miscellaneous beta- lactams

08:12.07.08 Carbapenems GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Ertapenem* Invanz (Equiv) Vial 1,000 Mg IV 30 mL

Imipenem/Cilastatin Sodium Primaxin (Equiv) Vial 500 Mg IV 1 Vial

Meropenem Merrem (Equiv) Hs 1,000 Mg IV 30 mL

08:12.07.12 Cephamycins GENERIC NAME BRAND NAME DOSAGE


Cefotetan Cefotan (generic) Vial 1 Gram IV 1 Gram

Cefotetan Cefotan (generic) Vial 2 Gram IV 2 Gram

08:12.07.16 Monobactam GENERIC NAME BRAND NAME DOSAGE


Aztreonam Azactam (Equiv) Vial 1,000 Mg IV 1 Vial

Aztreonam 1000mg PM Azactam 1000mg PM (Equiv) Hk 1,000 Mg IV 50 mL

08:12.08 Chloramphenicol GENERIC NAME BRAND NAME DOSAGE


ChloramphenicolSodium Succinate Chloromycetin (Equiv) Vial 1,000 mg IV 1 Vial

08:12:12 Macrolides

08:12.12.04 Erythromycin GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Erythromycin Lactobionate Erythrocin Lactobionate VIAL 1,000 MG IV 1 VIAL

Erythromycin Lactobionate Erythrocin Lactobionate VIAL 500 MG IV 1 VIAL

Erythromycin Ethylsuccinate EES 200mg Granules (Equiv) SUSP 200 MG PO 5 ML

Erythromycin Ethylsuccinate EES 400 (Equiv) TAB 400 MG PO 1 TAB

08:12.12.92 Other Macrolides GENERIC NAME BRAND NAME DOSAGE


Azithromycin Zithromax (Equiv) VIAL 500 MG IV 1 VIAL

Azithromycin Zithromax (Equiv) PACKET 1,000 MG PO 1 PACKET

Azithromycin Zithromax (Equiv) SUS REC 200 MG PO 5 ML

Azithromycin Zithromax (Equiv) TAB 250 MG PO 1 TAB

Clarithromycin Biaxin (Equiv) Tab 250 MG PO 1 Tab

Fidaxomicin Dificid (Equiv) Tab 200 MG PO 1 Tab

08:12.16 Penicillins

08:12.16.04 Natural Penicillins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Penicillin G Benzathine Bicillin L-A (Equiv) SYRING 600,000 UNITS IM 2 ML

Penicillin G Benzathine Bicillin L-A (Equiv) SYRING 1,200,000 UNITS IM 1 SYRING

Penicillin G Potassium Penicillin G Potassium VIAL 5,000,000 UNITS IV 1 VIAL

Penicillin V Potassium Veetids 250 (Equiv) PD 250 MG PO 5 ML

Penicillin V Potassium Veetids 250 (Equiv) SUS REC 250 MG PO 5 ML

Penicillin V Potassium Pen Vee K (Equiv) TAB 250 MG PO 1 TAB

08:12.16 Penicillins - Continued

08:12.16.08 Aminopenicillins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Amoxicillin Trihydrate Trimox (Equiv) CAP 250 MG PO 1 CAP

Amoxicillin Trihydrate Trimox (Equiv) SUS REC 250 MG PO 5 ML

Amoxicillin Trihydrate Triamox (Equiv) TAB 500 MG PO 1 TAB

Amox Tr/Pot Clavlante 200-28.5 Augmentin (Equiv) 200-28.5 SUS REC 1 BOTTLE PO 50 ML

Amox Tr/Pot Clavlante 200-28.5 Augmentin (Equiv) 200-28.5 SUS REC 1 CUP PO 5 ML

Amox Tr/Pot Clavulante 400-57 Augmentin (Equiv) 400-57 SUS REC 1 BOTTLE PO 50 ML

Amox Tr/Pot Clavulante 400-57 Augmentin (Equiv) 400-57 SUS REC 1 CUP PO 5 ML

Amox Tr/Pot Clavulante 500-125 Augmentin (Equiv) 500-125 TAB 1 TAB PO 1 TAB

Amox Tr/Pot Clavulante 875-125 Augmentin (Equiv) 875-125 TAB 1 TAB PO 1 TAB

Ampicillin Sodium Ampicillin Sodium VIAL 1,000 MG IV 1 VIAL

Ampicillin Sodium Ampicillin Sodium VIAL 2,000 MG IV 1 VIAL

Ampicillin Sodium Ampicillin Sodium VIAL 250 MG IV 1 VIAL

Ampicillin Sodium Ampicillin Sodium VIAL 500 MG IV 1 VIAL

Ampicillin Trihydrate Principen 250 (Equiv) SUS REC 250 MG PO 5 ML

Ampicillin Trihydrate Principen 250 (Equiv) SUS REC 250 MG PO 5 ML

Ampicillin Sodium/Sulbactam Na Unasyn (Equiv) VIAL 1.5 GM IV 1 VIAL

Ampicillin Sodium/Sulbactam Na Unasyn (Equiv) VIAL 3 GM IV 1 VIAL

08:12.16.12 Penicillinase Resistant

Penicillins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Dicloxacillin Sodium Dynapen (Equiv) CAP 250 MG PO 1 CAP Oxacillin Sod/Dextrose 2gm PM Bactocill/Dextrose PM (Equiv) FZ PIGG 2000 MG IV 50 ML

Oxacillin Sodium Bactocil (Equiv) VIAL 1 GM IV 1 VIAL Oxacillin Sodium Bactocil (Equiv) VIAL 2 GM IV 1 VIAL

08:12.1608:12.16.16 Extended Spectrum

Penicillins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Piperacill/Tazo 2.25gm/D5w PM Zosyn (Equiv) 2.25gm PM FZ PIGG 2.25 GM IV 50 ML

Piperacill/Tazo/D5w 3/375gm PM Zosyn (Equiv) 3.375gm PM FZ PIGG 3.375 GM IV 50 ML

Piperacill/Tazobactam 2.25gm Zosyn (Equiv) VIAL 2.25 GM IV 1 VIAL



08:12.18 Quinolones

08:12.18 Quinolones GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Ciprofloxacin HCl Cipro TAB 250 MG PO 1 TAB

Ciprofloxacin HCl Cipro (Equiv) TAB 500 MG PO 1 TAB

Ciprofloxacin Lactate Cipro I.V. (Equiv) PM 200 MG IV 100 ML

Ciprofloxacin Lactate Cipro I.V. (Equiv) PM 400 MG IV 200 ML

Levofloxacin Levaquin (Equiv) VIAL 500 MG IV 20 ML

Levofloxacin/Dext 500mg PM Levaquin/Dex 500mg PM (Equiv) PB 500 MG IV 100 ML

Levofloxacin/Dext 750mg PM Levaquin/Dex 750mg PM (Equiv) PB 750 MG IV 150 ML

Levofloxacin/Dextrose 250mg PM Levaquin/Dextrose 250mg (Equiv PB 250 MG IV 50 ML

Levofloxacin Levaquin (Equiv) TAB 250 MG PO 1 TAB

Levofloxacin Levaquin (Equiv) TAB 500 MG PO 1 TAB

08:12.20 Sulfonamides

08:12.20 Sufonamides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Sulfamethoxazole/Trimethoprim Bactrim Ds (Equiv) TAB 1 TAB PO 1 TAB

Sulfamethoxazole/Trimethoprim Bactrim Ds (Equiv) 800/160mg SUSP 1 CUP PO 20 ML

Sulfmth/Tmp 80mg-16mg/Ml Bactrim 80mg-16mg/Ml (Equiv) VIAL 1 VIAL IV 30 ML

Sulfadiazine Sulfadiazine Tab 500 MG PO 1 TAB

Sulfasalazine Azulfidine (Equiv) TAB 500 MG PO 1 TAB

08:12.24 Tetracylcines

08:12.24 Tetracyclines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Demeclocycline HCl Declomycin (Equiv) TAB 150 MG PO 1 TAB

Doxycycline Hyclate Vibramycin (Equiv) CAP 100 MG PO 1 CAP

Doxycycline Hyclate Vibramycin (Equiv) VIAL 100 MG IV 1 VIAL

Minocycline Minocin (Equiv) Vial 100 MG IV 1 VIAL

Tetracycline HCl Sumycin (Equiv) CAP 250 MG PO 1 CAP

08:12.24.12 Glycylcylines08:12.24.12 Glycylcyclines GENERIC NAME BRAND NAME DOSAGE


Tigecycline Tygacil (Equiv) VIALS 50 mg IV 1 Vial

08:12.28Miscellaneous Antibacterials

08:12.28.08 Bacitracin GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Bacitracin Bacitracin Sterile VIAL 50000 UNITS IM 30 ML

08:12.28.16 Glycopeptides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Oritavancion Orbactiv Vial 400 mg IV 1 Vial

Currently Restricted to Riverside for Ordering Process Evaluation

Vancomycin HCl Vancomycin HCl (Equiv) OPTH 20 MG TOP 0.4 ML

Vancomycin HCl Vancomycin HCl (Equiv) ORAL 125 MG PO 1.25 ML

Vancomycin HCl Vancomycin HCl (Equiv) ORAL 250 MG PO 2.5 ML

Vancomycin HCl Vancomycin HCl (Equiv) ORAL 500 MG PO 5 ML

Vancomycin HCl Vancomycin (Equiv) VIAL 1,000 MG IV 1 VIAL

Vancomycin/D5w 1000mg PM Vancocin 1000mg PM (Equiv) FZ PIGG 1,000 MG IV 200 ML

Vancomycin HCl Vancomycin (Equiv) VIAL 500 MG IV 1 VIAL

08:12.28.20 Lincomycins GENERIC NAME BRAND NAME DOSAGE


Clindamycin HCl Cleocin (Equiv) CAP 150 MG PO 1 CAP

Clindamycin Palmitate Cleocin Palmitate (Equiv) SOL REC 75 MG PO 5 ML

Clindamycin Phosphate Cleocin (Equiv) VIAL 600 MG IV 4 ML

08:12.28.24 Oxazolidinones GENERIC NAME BRAND NAME DOSAGE


Linezolid Zyvox (Equiv) TAB 600 MG PO 1 TAB

Linezolid 600mg PM Zyvox (Equiv) INJ 600 MG IV 300 ML

08:12.28.28 Polymyxins GENERIC NAME BRAND NAME DOSAGE


Colistimethate Sodium Coly-Mycin M (Equiv) VIAL 150 MG IV 1 Vial

Polymyxin B Sulfate Polymyxin B (Equiv) VIAL 500,000 UNITS IV 1 VIAL

8:14 - Antifungals

08:14.08 Azoles GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Fluconazole Diflucan (Equiv) TAB 100 MG PO 1 TAB

Fluconazole/NS 100mg/50ml Diflucan/NS 200mg PM (Equiv) PB 100 MG IV 50 ML

Fluconazole/NS 200mg Diflucan/NS 200mg PM (Equiv) PB 200 MG IV 100 ML

Fluconazole/NS 400mg PM Diflucan/ NS 400mg PM (Equiv) PB 400 MG IV 200 ML

Itraconazole Sporanox (Equiv) CAP 100 MG PO 1 CAP

Itraconazole Oral Solution Sporanox Oral Solution Dose Cup 100 MG PO 10 ML

Ketoconazole Ketoconazole Tablet 200 mg PO 1 Capsule

Ketoconazole Ketoconazole Cream 2 % TOP 1 Tube

Ketoconazole Ketoconazole Shampoo 2 % TOP 1 Tube

Posaconazole Noxafil (Equiv) Susp 40 MG PO 1 ML

Voriconazole VFEND (Equiv) Vial 200 MG IV 20 ML

Voriconazole VFEND (Equiv) Tablet 200 MG PO 1 TAB

Voriconazole VFEND (Equiv) Susp 40 MG PO 5 mL

08:14.28 Polyenes GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Amphotericin B Fungizone Iv (Equiv) HS 50 MG IV 1 VIAL

Amphotericin B Lipid Complex Abelcet (Equiv) Vial 5 Mg IV 20 mL

Nystatin Mycostatin (Equiv) SUSP 500 MU PO 5 ML

08:14.32 Pyrimidines GENERIC NAME BRAND NAME DOSAGE


Flucytosine Ancobon (Equiv) Cap 250 MG PO 1 CAP

8:16 - Antimycobacterials

08:16.04 Antituberculosis GENERIC NAME BRAND NAME DOSAGE


Ethambutol HCl Myambutol (Equiv) TAB 100 MG PO 1 TAB Isoniazid Isoniazid TAB 300 MG PO 1 TAB Pyrazinamide Pyrazinamide TAB 500 MG PO 1 TAB Rifampin Rifadin (Equiv) CAP 150 MG PO 1 CAP Rifampin Rifadin (Equiv) CAP 300 MG PO 1 CAP Rifampin Rifadin (Equiv) VIAL 600 MG IV 1 VIAL

08:16.92 Miscellaneous

Antimycobacterials GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Dapsone Dapsone TAB 100 MG PO 1 TAB

8:18 - Antivirals 8.08 / 8.12 / 8.20 Combination HIV

Antivirals GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Abacavir and Lamivudine Epzicom (Equiv) Tab 600/300 MG PO 1 TAB

Albendazole Albenza Tab 200 MG PO 1 TAB

Efavirenz/emtricitabine/tenofovir Atripla (Equiv) Tab 600/200/300 MG PO 1 TAB

Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Fumarate Stribild (Equiv) Tab 150/150/200/3

00 MG PO 1 TAB

Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide Genvoya (Equiv) Tab 150/150/200/3

00 MG PO 1 TAB

Emtricitabine/Tenofovir Truvada (Equiv) Tablet 200/300 MG PO 1 Tablet

Emtricitabine/Tenofovir alafenamide Descovy (Equiv) Tablet 200/25 MG PO 1 Tablet

Emtricitabine/Ripivirne/Tenofovir Complera (Equiv) Tablet 200/25/300 MG PO 1 Tablet

Emtricitabine / rilpivirine / tenofovir alafenamide Odefsey (Equiv) Tablet 200/25/25 MG PO 1 Tablet

Lamivudine/Zidovudine300-150mg Combivir 300-150mg (Equiv) TAB 1 TAB PO 1 TAB

08:18.08.04 HIV Entry and Fusion Inhibitors GENERIC NAME BRAND NAME DOSAGE


Maraviroc Selzentry (Equiv) TAB 150 MG PO 1 TAB

08:18.08.08 HIV Protease Inhibitor GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Atazanavir Reyataz (Equiv) Cap 200 MG PO 1 TAB

Atazanavir Reyataz (Equiv) Cap 300 MG PO 1 TAB

Darunavir Prezista (Equiv) TAB 600 MG PO 1 TAB

Darunavir Prezista (Equiv) TAB 800 MG PO 1 TAB

Nevirapime Viramune Sol 50 MG PO 1 ML

Rilpivirine Edurant TAB 25 MG PO 1 TAB

Ritonavir Norvir (Equiv) TAB 100 MG PO 1 TAB

08:18.08.12 Intergrase Inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Dolutegravir Tivacay TAB 50 MG PO 1 TAB

Raltegravir Isentress (Equiv) TAB 400 MG PO 1 Tablet

08:18.08.16 Non- Nucleoside

Reverse Transcriptase Inhibitors


Efaviranz Sustiva (Equiv) CAP 200 MG PO 1 CAP

Efaviranz Sustiva (Equiv) Tab 600 MG PO 1 TAB

Etravirine Intelence TAB 100 MG PO 1 TAB

Nivriapine Viramune Tab 200 MG PO 1 TAB

08:18.08.20 Nucleoside and

Nucleoside Reverse Transcriptase

Inhibitors


Abacavir Ziagen (Equiv) TAB 300 MG PO 1 TAB

Abacavir Ziagen (Equiv) Sol 20 MG PO 1 mL

Didanosine Videx TAB 125 MG PO 1 TAB

Didanosine Videx TAB 200 MG PO 1 TAB

Emtricitabine Emtriva (Equiv) TAB 200 MG PO 1 Tablet

Lamivudine Epivir (Equiv) TAB 150 MG PO 1 TAB

Tenofovir Disoproxil Fumarate Viread (Equiv) TA 300 MG PO 1 TABLET

Zidovudine Retrovir (Equiv) CAP 100 MG PO 1 CAP

08:18.20 Interferons GENERIC NAME BRAND NAME DOSAGE


Interferon Alfa-2b,Recomb. Intron A (Equiv) VIAL 10,000,000 UNITS IV 2 ML Interferon Alfa-2b,Recomb.-6ds Intron A (Equiv) - 6dose Pen SYRING 5,000,000 UNITS IV 0.2 ML

08:18.28 Neuramidase Inhibitors GENERIC NAME BRAND NAME DOSAGE


Oseltamivir Tamiflu CAP 75 MG PO 1 CAP

Oseltamivir Tamiflu Solution 6 MG PO 1 ML

Peramavir Rapivab VIAL 200 MG IV 20 ML

08:18.32 Nucleosides and Nucleotides GENERIC NAME BRAND NAME DOSAGE


Acyclovir Zovirax (Equiv) SUSP 200 MG PO 5 ML

Acyclovir Zovirax (Equiv) CAP 200 MG PO 1 CAP

Acyclovir Zovirax (Equiv) TAB 800 MG PO 1 TAB

Acyclovir Sodium Zovirax (Equiv) VIAL 500 MG IV 10 ML

Entecavir Baraclude (Equiv) Tab 150 MG PO 1 TAB

Ganciclovir Sodium Cytovene (Equiv) VIAL 500 MG IV 1 VIAL

Ribaviran Rebetol (Equiv) TAB 200 MG PO 1 TAB

Valganciclovir Valcyte (Equiv) TAB 450 MG PO 1 TAB

8:30- Protozoals 08:30.08 Antimalarials GENERIC NAME BRAND NAME DOSAGE


Hydroxychloroquine Sulfate Plaquenil (Equiv) TAB 200 MG PO 1 TAB

Quinine Sulfate Qualaquin (Equiv) CAP 324 MG PO 1 CAP


Antiprotozoals GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Atovaquone Mepron (Equiv) Susp 750 MG PO 5 mL

Metronidazole Flagyl (Equiv) TAB 250 MG PO 1 TAB

Metronidazole/Nacl 500mg/100ml Flagyl (Equiv)PM 500mg/100ml PB 500 MG IV 100 ML

Metronidazole/Nacl Additive Flagyl (Equiv)Additive PB 500 MG IV 100 ML

Pentamidine Isethionate Pentam 300 (Equiv) VIAL 300 MG IV 1 VIAL

8:36 - Urinary Anti-Infectives

08:36.00Urinary Anti-Infectives GENERIC NAME BRAND NAME DOSAGE


Fosfomycin Monurol (Equiv) Packet 3 Gram PO 1 Packet

Mth/Me Blue/Ba/Salicy/Atp/Hyos Usept (Equiv) TAB 1 TAB PO 1 TAB

Nitrofurantoin Macrocrystal Macrodantin (Equiv) CAP 50 MG PO 1 CAP

Nitrofurantoin/Nitrofuran Mac Macrobid (Equiv) CAP 100 MG PO 1 CAP

Trimethoprim Primsol Tablet 100 Mg PO 1 Tablet

10:00 - Antineoplastic Agents

10:00.00 GENERIC NAME BRAND NAME DOSAGE


Aldesleukin Proleukin (Equiv) VIAL 22,000 UNITS IV 1 VIAL

Alemtuzumab Lemtrada (Equiv) INJ 12 MG IV 1.2 ML

Arsenic Trioxide Trisenox (Equiv) HH 10 MG IV 10 ML

Asparaginase Elspar (Equiv) VIAL 10,000 UNITS IV 10 ML

Atezolizumab Tecentriq VIAL 1200 MG IV 20 ML

Azacitidine Vidaza HS 100 MG 1 VIAL

Bendamustine Bendeka VIAL 100 MG IV 4 ML

Bevacizumab Avastin (Equiv) VIAL 100 MG IV 4 ML

Bevacizumab Avastin (Equiv) VIAL 400 MG IV 16 ML

Bicalutamide Casodex TAB 50 MG PO 1 TAB

Bleomycin Sulfate Bleomycin Sulfate VIAL 15 UNITS IV 1 VIAL

Bortezomib Velcade (Equiv) HS 3.5 MG IV 1 VIAL

Carboplatin Paraplatin (Equiv) VIAL 150 MG IV 1 VIAL



Carfilzomib Kyprolis (Equiv) VIAL 60 MG IV 1 VIAL

Carmustine Bicnu (Equiv) VIAL 100 MG IV 1 VIAL

Carmustine/Polfeprosan Gliadel Wafer 1 WAFER 1 WAFER

Cetuximab Erbitux HV 100 MG 50 ML

Chlorambucil Leukeran (Equiv) TAB 2 MG PO 1 TAB

Cisplatin Platinol (Equiv) VIAL 50 MG IV 50 ML

Cladribine Cladribine (Equiv) HV 1 MG IV 1 ML

Cyclophosphamide Cytoxan (Equiv) TAB 50 MG PO 1 TAB

Cyclophosphamide Cytoxan Lyophilized (Equiv) VIAL 1,000 MG IV 1 VIAL

Cyclophosphamide Cytoxan Lyophilized (Equiv) VIAL 500 MG IV 1 VIAL

Cytarabine Cytosar U (Equiv) VIAL 100 MG IV 5 ML

Cytarabine Cytosar U (Equiv) VIAL 1,000 MG IV 1 VIAL

Cytarabine Cytosar U (Equiv) VIAL 500 MG IV 10 ML

Dacarbazine Dtic Dome (Equiv) VIAL 200 MG IV 20 ML

Dactinomycin Cosmegan VIAL 0.5 MG IV 1 VIAL

Daratumumab Darzelex VIAL 100 MG IV 5 ML

Daratumumab Darzelex VIAL 400 MG IV 20 ML

Dasatinib Sprycel Tab 50 MG PO 1 TAB

Dasatinib Sprycel Tab 100 MG PO 1 TAB

Daunorubicin HCl Cerubidine (Equiv) VIAL 20 MG IV 4 ML

Docetaxel Taxotere (Equiv) VIAL 20 MG IV 0.5 ML

Docetaxel Taxotere (Equiv) VIAL 80 MG IV 2 ML

Doxorubicin HCl Adriamycin (Equiv) VIAL 20 MG IV 10 ML

Doxorubicin HCl Adriamycin (Equiv) VIAL 50 MG IV 25 ML

Doxorubicin HCl Liposomal Doxil (Equiv) HV 20 MG IV 10 ML

Doxorubicin Pf Adriamycin Pfs (Equiv) VIAL 10 MG IV 5 ML

Epirubicin HCl Ellence (Equiv) VIAL 50 MG IV 25 ML

Eribulin Halaven VIAL 1 MG IV 2 ML

Estramustine Phosphate Sodium Emcyt (Equiv) CAPSULE 140 MG PO 1 CAP

Etoposide Vepesid (Equiv) VIAL 100 MG IV 5 ML

Fludarabine Phosphate Fludara (Equiv) VIAL 50 MG IV 1 VIAL

Fluorouracil Fluorouracil VIAL 1,000 MG IV 20 ML

Flutamide Eulexin (Equiv) CAP 125 MG PO 1 CAP

Fulvestrant Faslodex (Equiv) SYRING 250 MG IM 5 ML

Gemcitabine HCl Gemzar (Equiv) VIAL 1,000 MG IV 1 VIAL

Gemcitabine HCl Gemzar (Equiv) VIAL 200 MG IV 10 ML

Hydroxyurea Hydrea (Equiv) CAP 500 MG PO 1 CAP

Idarubicin HCl Idarubicin HCl HV 10 MG IV 10 ML

Ifosfamide Ifex (Equiv) KIT 1,000 MG IV 1 VIAL

Imatinib Gleevec TAB 100 MG PO 1 TAB

Imatinib Gleevec TAB 400 MG PO 1 TAB

Interferon Alfa 2B Intron A Vial 10 MU IV 1 EACH



Ipilimumab Yervoy Vial 50 MG IV 1 VIAL

Ipilimumab Yervoy Vial 200 MG IV 1 VIAL

Irinotecan HCl Camptosar (Equiv) VIAL 100 MG IV 5 ML

Irinotecan HCl Camptosar (Equiv) VIAL 40 MG IV 2 ML

Irinotecan Liposomal Onivyde Vial 13 mg IV 10 mL

Letrozole Femara TAB 2.5 MG PO 1 TAB

Leuprolide Acetate Lupron Depot (Equiv) SYRING 7.5 MG IM 1 SYRINGE

Lomustine CeeNu Tab 10 MG PO 1 TAB

Lomustine CeeNu Tab 40 MG PO 1 TAB

Mechlorethamine HCl Mustargen VIAL 10 MG IV 1 VIAL

Megestrol Acetate Megace (Equiv) TAB 40 MG PO 1 TAB

Megestrol Acetate Megace (Equiv) SUSP 400 MG PO 10 ML

Melphalan Alkeran (Equiv) TAB 2 MG PO 1 TAB

Mercaptopurine Purinethol (Equiv) TAB 50 MG PO 1 TAB

Methotrexate Sodium Methotrexate TAB 2.5 MG PO 1 TAB

Methotrexate Sodium/Pf Methotrexate VIAL 100 MG IV 4 ML

Methotrexate Sodium/Pf Methotrexate VIAL 1,000 MG IV 40 ML

Methotrexate Sodium/Pf Methotrexate VIAL 20 MG IV 1 VIAL



Mitomycin Mutamycin (Equiv) VIAL 20 MG IV 1 VIAL

Mitomycin Mutamycin (Equiv) VIAL 5 MG IV 1 VIAL

Mitomycin Opth Mutamycin Opth (Equiv) VIAL 5 MG OPH 10 ML

Mitoxantrone HCl Novantrone (Equiv) VIAL 20 MG IV 10 ML

Mitoxantrone HCl Novantrone (Equiv) HV 25 MG IV 12.5 ML

Nivolumab Opdivo VIAL 40 MG IV 4 ML

Nivolumab Opdivo VIAL 100 MG IV 10 ML

Obinutuzumab Gazyva VIAL 1000 MG IV 40 ML

Oxaliplatin Eloxatin (Equiv) VIAL 100 MG IV 1 VIAL

Paclitaxel,Semi-Synthetic Taxol (Equiv) VIAL 30 MG IV 5 ML

Paclitaxel,Semi-Synthetic Taxol (Equiv) VIAL 300 MG IV 50 ML

Pembrolizumab Keytruda VIAL 100 MG IV 4 ML

Pentostatin Nipent (Equiv) HS 10 MG 1 VIAL

Ramucirumab Cyramza Vial 100 MG IV 10 ML

Ramucirumab Cyramza Vial 500 MG IV 50 ML

Rituximab Rituxan (Equiv0 VIAL 100 MG IV 10 ML

Rituximab Rituxan (Equiv) VIAL 500 MG IV 50 ML

Sorafenib Nexavar TAB 200 MG PO 1 TAB

Tamoxifen Citrate Nolvadex (Equiv) TAB 10 MG PO 1 TAB

Tamoxifen Citrate Soltamox SOL 10 MG PO 5 ML

Temozolomide Temodar CAPSULE 100 MG PO 1 CAP

Thioguanine Tabloid TAB 40 MG PO 1 TAB

Topotecan HCl Hycamtin (Equiv) VIAL 4 MG IV 1 VIAL

Trastuzumab Herceptin (Equiv) VIAL 440 MG IV 1 VIAL

Trastuzumab (Nci Study Drug) Herceptin (Nci Study Drug) HS 440 MG 1 HS

Tretinoin/ATRA Vesanoid CAP 10 MG PO 1 CAP

Valrubicin Valstar VIAL 40 MG IV 1 ML

Vinblastine Sulfate Vinblastine (Equiv) VIAL 10 MG IV 10 ML

Vincristine Sulfate Vincristine (Equiv) VIAL 2 MG IV 2 ML

Vinorelbine Tartrate Navelbine (Equiv) VIAL 10 MG IV 1 ML

12:00 Autonomic Drugs

12:04.00 Parasympathetic GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Bethanechol Chloride Urecholine (Equiv) TAB 25 MG PO 1 TAB

Donepezil HCl Aricept (Equiv) TAB 5 MG PO 1 TAB

Galantamine Hydrobromide Razadyne (Reminyl - Equiv) TA 4 MG PO 1 TA

Neostigmine Methylsulfate Neostigmine 1:1000 VIAL 10 MG IV 10 ML

Neostigmine Methylsulfate Neostigmine 1:2000 VIAL 5 MG IV 10 ML

Physostigmine Salicylate Physostigmine INJ 2 MG IV 2 ML

Pyridostigmine Bromide Mestinon (Equiv) TAB 60 MG PO 1 TAB

Rivastigmine Tartrate Exelon (Equiv) CAP 1.5 MG PO 1 CAP

Rivastigmine Tartrate Exelon (Equiv) CAP 3 MG PO 1 CAP

12:08.04 Antiparkinsonian Agents GENERIC NAME BRAND NAME DOSAGE


Benztropine Mesylate Cogentin (Equiv) TAB 0.5 MG PO 1 TAB

Benztropine Mesylate Cogentin (Equiv) TAB 1 MG PO 1 TAB

Benztropine Mesylate Cogentin (Equiv) TAB 2 MG PO 1 TAB

Benztropine Mesylate Cogentin (Equiv) INJ 2 MG IV 2 ML

Trihexyphenidyl HCl Artane (Equiv) TAB 2 MG PO 1 TAB

Trihexyphenidyl HCl Artane (Equiv) TAB 5 MG PO 1 TAB

12:08.08 Antimuscarinics / Antispasmodics GENERIC NAME BRAND NAME DOSAGE


Atropine Sulfate Atropine Sulfate VIAL 0.4 MG IV 1 ML

Atropine Sulfate Atropine Sulfate VIAL 1 MG IV 1 ML

Atropine Sulfate Atropine Sulfate SYRING 1 MG IV 10 ML

Belladonna Alkaloids/Phenobarb Donnatal (Equiv) TAB 1 TAB PO 1 TAB

Belladonna Alkaloids/Phenobarb Donnatal (Equiv) ELIXIR 5 ML PO 5 ML

Dicyclomine HCl Bentyl (Equiv) CAP 10 MG PO 1 CAP

Dicyclomine HCl Bentyl (Equiv) TAB 20 MG PO 1 TAB

Dicyclomine HCl Bentyl (Equiv) INJ 20 MG IM 2 ML

Glycopyrrolate Robinul (Equiv) VIAL 0.4 MG IV 2 ML

Glycopyrrolate Robinul (Equiv) TAB 1 MG IV 1 TAB

Hyoscyamine Sulfate Levsin (Equiv) TAB 0.125 MG PO 1 TAB

Hyoscyamine Sulfate Levsinex (Equiv) C SR 12 0.375 MG PO 1 C SR 1

Hyoscyamine Sulfate Levsinex (Equiv) VIAL 0.5 MG IV 1 ML

Ipratropium Bromide Atrovent (Equiv) AER 18 MCG RT 1 PUFF

Ipratropium Bromide 0.02% Atrovent (Equiv) 0.02% SOLN 0.5 MG RT 2.5 ML

Scopolamine Hydrobromide Scopolamine Hydrobromide(Equiv HV 0.4 MG IV 1 ML

Tiotropium Bromide Spiriva (Equiv) CD 18 MCG RT 1 CD

12:12.00 Sympathomimetic (Andrenergic) Agents GENERIC NAME BRAND NAME DOSAGE


Albuterol Albuterol AER 90 MCG RT 1 PUFF

Albuterol Sulfate Albuterol Sulfate TAB 2 MG PO 1 TAB

Albuterol Sulfate Albuterol Sulfate SYRUP 2 MG PO 5 ML

Albuterol Sulfate Proventil (Equiv) SOLN 5 MG RT 1 ML

Albuterol Sulfate 0.083% Albuterol Sulfate 0.083% SOLN 2.49 MG RT 3 ML

Albuterol Sulfate/Ipratropium Combivent (Equiv) AER 1 DOSE RT 1 PUFF

Albuterol Sulfate/Ipratropium Duoneb (Equiv) SOLN 1 AMPULE RT 3 ML

Budesonide and Formoterol Symbicort INH 80/4.5 MCG RT 1 PUFF

Budesonide and Formoterol Symbicort INH 160/4.5 MCG RT 1 PUFF

Dobutamine HCl Dobutamine HCl VIAL 500 MG IV 40 ML

Dobutamine HCl/D5w 500mg PM Dobutamine HCl/D5w 500mg PM INJ 500 MG IV 250 ML

Dopamine 400mg D5w Dopamine 400mg In 5% Dextrose INJBAG 400 MG IV 250 ML

Dopamine 800mg / D5w Dopamine 800mg In 5% Dextrose INJBAG 800 MG IV 250 ML

Dopamine HCl Dopamine HCl VIAL 400 MG IV 5 ML

Ephedrine Sulfate Ephedrine Sulfate VIAL 50 MG IV 1 ML

Epinephrine Epinephrine INJ 1 MG IV 1 ML

Epinephrine Epinephrine SYRING 1 MG IV 10 ML

Epinephrine Epinephrine VIAL 30 MG IV 30 ML

Epinephrine 1:1,000 Epinephrine 1:1,000 SYRINGE 0.3 MG IV 0.3 ML

Epinephrine X4/ D5w 250ml Kit Epinephrine Kit (Open Heart) HH 1 EACH IV 1 KIT

Isoproterenol HCl Isuprel (Equiv) INJ 1 MG IV 5 ML

Levalbuterol HCl Xopenex (Equiv) SOLN 1.25 MG RT 3 ML

Midodrine HCl Proamatine (Equiv) TAB 5 MG PO 1 TAB

Norepinephrine Bitartrate Levophed (Equiv) INJ 4 MG IV 4 ML

Phenylephrine HCl Neo-Synephrine (Equiv) INJ 10 MG IV 1 ML

Phenylephrine HCl Neosynephrine (Equiv) VIAL 50 MG IV 5 ML

Pirbuterol Acetate Maxair Autohaler (Equiv) AEO BRE 200 MCG RT 1 PUFF

Pseudoephedrine HCl Sudafed (Equiv) TAB 30 MG PO 1 TAB

Racepinephrine HCl 2.25% Vaponephrine (Equiv) SOLN 1 SYRINGE INH 0.5 ML

Terbutaline Sulfate Brethine (Equiv) INJ 1 MG IV 1 ML

Terbutaline Sulfate Brethine (Equiv) TAB 2.5 MG PO 1 TAB

12:12.12 Alpha- and Beta- Agonists GENERIC NAME BRAND NAME DOSAGE


Droxidopa Northera CAP 100 MG PO 1 CAP



12:16.00 Sympatholytic (Andrenergic Blocker)

Agents


Dihydroergotamine Mesylate D.H.E.45 (Equiv) INJ 1 MG IV 1 ML

Phentolamine Mesylate Regitine (Equiv) VIAL 5 MG IM 2 ML

12:20.00 Skeletal Muscle Blockers GENERIC NAME BRAND NAME DOSAGE


Atracurium Besylate Tracrium (Equiv) VIAL 100 MG IV 10 ML

Baclofen Baclofen TAB 10 MG PO 1 TAB

Baclofen Lioresal Intrathecal VIAL 10 MG IT 20 ML

Cisatracurium Besylate Nimbex (Equiv) VIAL 10 MG IV 5 ML

Cyclobenzaprine HCl Flexeril (Equiv) TAB 10 MG PO 1 TAB

Dantrolene Sodium Dantrium Iv VIAL 20 MG IV 70 ML

Dantrolene Sodium Ryanodex VIAL 250 MG IV 1 Vial

Methocarbamol Robaxin (Equiv) TAB 500 MG PO 1 TAB

Orphenadrine Citrate Norflex (Equiv) INJ 60 MG IV 2 ML

Pancuronium Bromide Pavulon (Equiv) VIAL 10 MG IV 5 ML

Pancuronium Bromide Pavulon (Equiv) INJ 4 MG IV 2 ML

Rocuronium Bromide Zemuron (Equiv) VIAL 50 MG IV 5 ML

Succinylcholine Chloride Quelicin (Equiv) VIAL 200 MG IV 10 ML

Vecuronium Bromide Norcuron (Equiv) VIAL 10 MG IV 1 VIAL

12:20.04 Centrally Acting Skeletal Muscle GENERIC NAME BRAND NAME DOSAGE


Relaxants Carisprodol Soma Currently Non-stocked

Metaxolone Skelaxin Currently Non-stocked

Tizanidine Zanaflex Currently Non-stocked


Autonomic Drugs GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Non Stocked Item Nicotine Habitorol INH

Nicotine Nicoderm (Equiv) PAT 24H 14 MG TD 1 PATCH



Nicotine Polacrilex Nicorette Gum (Equiv) CHGUM 10 CHGUM BUC 1 PACKAGE

16:00 Blood Derivatives

16:00.00 Blood Derivative GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Albumin Human 25% Albuminar-25 VIAL 25 GM IV 100 ML

Albumin Human 25% Albuminar-25 VIAL 50 ML IV 1 VIAL

Albumin Human 5% Albumin 5% VIAL 12.5 GM IV 250 ML

20:00 Blood Formation and Coagulation

20:04 Antianemia Drugs20:04.4 Iron Preparations GENERIC NAME BRAND NAME DOSAGE


Ferric carboxymaltose Injectafer IV 750 MG IV 15 ML

Ferrous Sulfate Ferrous Sulfate LIQUID 300 MG PO 5 ML

Ferrous Sulfate Ferrous Sulfate ECTAB 325 MG PO 1 ECTAB

Ferrous Sulfate/Vit C/Fa Fero Folic 500 (Equiv) SR TAB 1 SR TAB PO 1 SR TAB

Iron Dextran Complex Infed (Equiv) VIAL 100 MG IV 2 ML

Iron Polysaccharides Complex Niferex (Equiv) CAP 150 MG PO 1 CAP

Iron Polysaccharides B12 / FA Niferex Plus (Equiv) Capsule 150 mg PO 1 Capsule

Iron Sucrose Complex Venofer (Equiv) HV 100 MG IV 5 ML

Sodium Ferric Gluconate Ferrlcit Vial 12.5 MG IV 1 ML

20:12 Coagulants and Anticoagulants

20:12.04 Anticoagulants GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

20:12.04.08 Coumarin and Indandione

Warfarin Sodium Coumadin (Equiv) TAB 1 MG PO 1 TAB



Warfarin Sodium Coumadin (Equiv) TAB 2.5 MG PO 1 TAB



Warfarin Sodium Coumadin (Equiv) TAB 7.5 MG PO 1 TAB

20:12.04.12 Direct Thrombin Inhibitors GENERIC NAME BRAND NAME DOSAGE


Argatroban Argatroban VIAL 250 MG IV 2.5 ML

Bivalirudin Angiomax (Equiv) VIAL 250 MG IV 1 VIAL

Dabigatran Pradaxa (Equiv) Tablet 75 mg PO 1 Tab

Dabigatran Pradaxa (Equiv) Tablet 150 mg PO 1 Tab

20:12.04.14 Direct Factor Xa Inhibitors GENERIC NAME BRAND NAME DOSAGE


Fondaparinux Sodium Arixtra (Equiv) HQ 2.5 MG SQ 0.5 ML

Apixaban Eliquis (Equiv) Tab 2.5 MG PO 1 TAB

Apixaban Eliquis (Equiv) Tab 5 MG PO 1 TAB

Edoxaban Savasya Tab 15 MG PO 1 TAB



Rivaroxaban Xarelto TAB 10 MG PO 1 TAB



20:12.04.16 Heparins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Heparin Sodium,Porcine Heparin Lock Flush SYRING 10 UNITS IV 1 ML

Heparin Sodium,Porcine Heparin Lock VIAL 100 UNITS IV 1 ML

Heparin Sodium,Porcine Heparin Lock VIAL 1,000 UNITS IV 10 ML

Heparin Sodium,Porcine Heparin Sodium VIAL 1,000 UNITS IV 1 ML

Heparin Sodium,Porcine Heparin Sodium HV 1,000 UNITS IV 1 ML

Heparin Sodium,Porcine Heparin Sodium VIAL 10,000 UNITS IV 1 ML

Heparin Sodium,Porcine Heparin Sodium VIAL 5,000 UNITS SQ 1 ML

Heparin 25,000 Units D5w Heparin 25,000 Units D5w INJ 25,000 UNITS IV 500 ML

Heparin 2,000 Units,Porcine/NS Heparin 2,000 Units/ 0.9% Nacl INJ 2,000 UNITS IV 1000 ML

Heparin 1,000 Unit,Porcine/NS Heparin 1,000unit In 0.9% Nacl INJ 1,000 UNITS IV 500 ML

Enoxaparin Sodium Lovenox (Equiv) SYRING 80 MG SUB 0.8 ML




Enoxaparin Sodium Lovenox (Equiv) SYRING 150 MG SUB 1 ML Enoxaparin Sodium Lovenox (Equiv) SYRING 120 MG SUB 0.8 ML

20:12.08 Antiheparin Agents GENERIC NAME BRAND NAME DOSAGE


Protamine Sulfate Protamine (Equiv) VIAL 250 MG IV 25 ML

Protamine Sulfate Protamine (Equiv) VIAL 50 MG IV 5 ML

20:12.14 Platelet-Reducing Agents GENERIC NAME BRAND NAME DOSAGE


Anagrelide Agrylin TAB 0.5 MG PO 1 TAB

20:12.18 Platelet Aggregation Inhibitors GENERIC NAME BRAND NAME DOSAGE


Abciximab Reopro (Equiv) VIAL 10 MG IV 5 ML

Cilostazol Pletal (Equiv) TAB 100 MG PO 1 TAB

Clopidogrel Bisulfate Plavix (Equiv) TAB 75 MG PO 1 TAB

Eptifibatide Integrilin (Equiv) HV 20 MG IV 10 ML

Eptifibatide Integrilin (Equiv) HV 200 MG IV 100 ML

Prasugrel Effient (Equiv) TAB 10 MG PO 10 MG

Ticagrelor Brilinta (Equiv) TAB 90 MG PO 90 MG

20:16.00 Hematopoietic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Epoetin Alfa Epogen (Equiv) VIAL 2,000 UNITS SQ 1 ML






Filgrastim-sndz Zarxio (Equiv) VIAL 300 MCG SQ 1 ML

Filgrastim-sndz Zarxio (Equiv) VIAL 480 MCG SQ 1.6 ML

Pegfilgrastim – Device Neulasta On Body Injector

Pegfilgrastim Neulasta (Equiv) SYRING 6 MG SUB 0.6 ML

Romiplostim NPLate Vial 250 MCG SUB 1 VIAL

Romiplostim NPLate Vial 500 MCG SUB 1 VIAL

20:24.00 Hemorrheologic

Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Pentoxifylline Trental (Equiv) SR TAB 400 MG PO 1 SR TAB

20:28.16 Hemostatics GENERIC NAME BRAND NAME DOSAGE


Aminocaproic Acid Amicar (Equiv) TAB 500 MG PO 1 TAB

Aminocaproic Acid Amicar (Equiv) VIAL 5,000 MG IV 20 ML

Antihemophilic Factor 8 Human Koate-Dvi (Equiv) KIT 100 UNITS IV 100 UNITS

Antihemophilic Factor, Hum Rec Recombinate (Equiv) VIAL 1,000 UNITS IV 1 VIAL

Anti-Inhibitor Coagulant Comp. Feiba Vh Immuno (Equiv) HS 1 UNIT IV 1 UNIT

Aprotinin Trasylol (Equiv) VIAL 10,000 UNITS IV 100 ML

Factor Ix Human Recombinant Benefix (Equiv) KIT 1 UNIT IV 1 UNIT

Non-stocked Ferric Subsulfate Monsel’s Solution Solution

Prothrombin Complex Concentrate KCentra (equiv) Vial 500 IU IV 1 Vial

Thrombin 2,000units/Cacl Thrombin Tissue Adhesive SYRINGE 1 EACH TOP 1 SYRINGE

Tranexamic Acid Cyklokapron™ (Equiv) Vial 1 100 mg IV 1 mL

Tranexamic Acid Lysteda TAB 650 MG PO 1 TAB

20:40.00 Thrombolytic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Alteplase Activase (Equiv) VIAL 50 MG IV 50 ML

Alteplase Activase (Equiv) VIAL 100 MG IV 100 ML

Alteplase Cathflo Activase VIAL 2 MG IV 1 VIAL

Tenecteplase TNKase Kit 50 MG IV 1 Kit

24:00 Cardiovascular Drugs

24:04 Cardiac Drugs

24:04.04 Antiarrythmic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Adenosine Adenocard Iv (Equiv) VIAL 6 MG IV 2 ML

Amiodarone HCl Pacerone (Equiv) TAB 200 MG PO 1 TAB

Amiodarone HCl Amiodarone HCl VIAL 50 MG IV 1 ML

Amiodarone HCl Amiodarone HCl HV 900 MG IV 18 ML

Disopyramide Phosphate Norpace Cr (Equiv) SR CAPS 100 MG PO 1 SR CAP

Disopyramide Phosphate Norpace Cr (Equiv) SR CAPS 150 MG PO 1 SR CAP

Dofetilide Tikosyn (Equiv) CAP 0.125 MG PO 1 CAP



Dronedarone Multaq TAB 400 MG PO 1 TAB

Ibutilide Fumarate Corvert (Equiv) HV 1 MG IV 10 ML

Lidocaine 2gm HCl/D5w Xylocaine 2gm /D5w (Equiv) INJ 500 ML IV 500 ML

Lidocaine HCl 2% Lidocaine HCl 2% SYRING 100 MG IV 5 ML

Mexiletine HCl Mexitil (Equiv) CAP 150 MG PO 1 CAP



Procainamide HCl Procainamide HCl VIAL 1000 MG IV 10 ML

Propafenone HCl Rythmol (Equiv) TAB 150 MG PO 1 TAB

Quinidine Gluconate Quinidine Gluconate (Equiv) SR TAB 324 MG PO 1 SR TAB

Quinidine Gluconate Quinidine Gluconate (Equiv) VIAL 800 MG IV 10 ML

Quinidine Sulfate Quinidine Extendtab (Equiv) SR TAB 300 MG PO 1 SR TAB

Quinidine Sulfate Quinidine (Equiv) TAB 300 MG PO 1 TAB

24:04.08 Cardiotonic Agents GENERIC NAME BRAND NAME DOSAGE


Digoxin Digoxin ELIXIR 0.25 MG PO 5 ML

Digoxin Lanoxin (Equiv) INJ 0.5 MG IV 2 ML

Digoxin Lanoxin Pediatric (Equiv) INJ 100 MCG IV 1 ML

Digoxin Lanoxin (Equiv) TAB 125 MCG PO 1 TAB

Digoxin Lanoxin (Equiv) TAB 250 MCG PO 1 TAB

Inamrinone Lactate Inocor (Equiv) INJ 100 MG IV 20 ML

Milrinone Lactate Primacor (Equiv) VIAL 20 MG IV 20 ML

Milrinone Lactate/D5w PM Primacor/D5w PM (Equiv) PB 20 MG IV 100 ML

24:04.92 Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Ivabradine Corlanor TAB 5 MG PO 1 TAB

Ivabradine Corlanor TAB 7.5 MG PO 1 TAB

Regadenoson Lexiscan (Equiv) Syringe 0.4 MG IV 5 ML

24:06 Antilipemic Agents

Bile Acid Sequestrants24:06.04 GENERIC NAME BRAND NAME DOSAGE


Cholestyramine/AspartameQuestran

Light (Equiv)

PACKET 4 GM PO 1 PACKET

2-Azetidinone24:06.05 GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Ezetimibe Zetia (Equiv) TA 10 MG PO 1 TABLET

24:06.06 Fibric Acid Derivatives GENERIC NAME BRAND NAME DOSAGE


Fenofibrate,Micronized Lofibra (Equiv) TA 54 MG PO 1 TABLET

Fenofibrate,Micronized Lofibra (Equiv) TA 160 MG PO 1 TABLET

Gemfibrozil Lopid (Equiv) TAB 600 MG PO 1 TAB

24:06.08 HMG-CoA Reductase

Inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Atorvastatin Lipitor TAB 10 MG PO 1 TAB




Pravastatin Pravachol (Equiv) TAB 20 MG PO 1 TAB

Pravastatin Pravachol (Equiv) TAB 40 MG PO 1 TAB

Simvastatin Simvastatin (Equiv) TAB 10 MG PO 1 TAB



24:06.92 Antilipemic Agents

Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Niacin Niacin TAB 100 MG PO 1 TAB

Omega-3-Ethyl Esters

Niacin Niaspan (Equiv) SR TAB 500 MG PO 1 SR TAB

Lovaza Tab 1 Gram PO 1 TAB

24:08 Hypotensive Agents

24:08.16 Central Alpha AgonitsGENERIC NAME BRAND

NAMEDOSAGE

FORMSTRENGT

H UNIT ROUTE VOLUMEVOLU

ME UNIT

Clonidine HCl Catapres (Equiv) TAB 0.1 MG PO 1 TAB

Clonidine HCl Catapres (Equiv) TAB 0.2 MG PO 1 TAB

Clonidine HCl Catapres-Tts 1 (Equiv) PAT TDW 0.1 MG TD 1 PATCH



Guanfacine HCl Tenex (Equiv) TAB 1 MG PO 1 TAB

Methyldopa Aldomet (Equiv) TAB 250 MG PO 1 TAB

Methyldopa Aldomet (Equiv) TAB 500 MG PO 1 TAB

Methyldopate HCl Aldomet (Equiv) VIAL 250 MG IV 5 ML

24:08.20 Direct Vasodilators GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Diazoxide Hyperstat I.V. INJ 300 MG IV 20 ML

Hydralazine HCl Apresoline (Equiv) TAB 10 MG PO 1 TAB



Hydralazine HCl Apresoline (Equiv) VIAL 20 MG IV 1 ML

Minoxidil Loniten (Equiv) TAB 3 MG PO 1 TAB

Minoxidil Loniten (Equiv) TAB 10 MG PO 1 TAB

Nitroprusside Sodium Nitropress (Equiv) VIAL 50 MG IV 2 ML

24:12 Vasodilating Agents

24:12.08 Nitrates and Nitrites GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Amyl Nitrite Amyl Nitrite AMP 0.3 ML INH 1 INJ

Isosorbide Dinitrate Isordil (Equiv) TAB 5 MG PO 1 TAB



Isosorbide Mononitrate Imdur (Equiv) T SR 24 30 MG PO 1 T SR 24

Isosorbide Mononitrate Imdur (Equiv) T SR 24 60 MG PO 1 T SR 24

Nitroglycerin Nitrostat (Equiv) SL TAB 0.4 MG SL 1 SL TAB

Nitroglycerin Nitroglycerin Sr SR CAPS 6.5 MG PO 1 SR CAP

Nitroglycerin 0.1mg/Hr Nitrodur (Equiv) 0.1mg/Hr PAT 24H 2.5 MG TD 1 PATCH

Nitroglycerin 0.2mg/Hr Nitrodur (Equiv) 0.2mg/Hr PAT 24H 5 MG TD 1 PATCH

Nitroglycerin 0.3mg/Hr Nitrodur (Equiv) 0.3mg/Hr PAT 24H 7.5 MG TD 1 PATCH



Nitroglycerin 2% Nitroglycerin 2% OINT 1 GM TD 1 PACKET

Nitroglycerin Nitroglycerin VIAL 50 MG IV 10 ML

Nitroglycerin/D5w PM Nitroglycerin In D5w PM INFUS 50 MG IV 250 ML

24:12.92 Vasodilating Agents,


Aspirin/Dipyridamole 200/25 Mg Aggrenox (Equiv)200mg/25mg CM 1 TAB PO 1 TAB

Dipyridamole Persantine (Equiv) INJ 10 MG IV 2 ML

Dipyridamole Persantine (Equiv) TAB 25 MG PO 1 TAB

Papaverine HCl Papaverine VIAL 60 MG IV 2 ML

Papaverine HCl Papaverine VIAL 300 MG IV 10 ML

24:16 Sclerosing Agents

24:16.00 Sclerosing Agents GENERIC NAME BRAND NAME DOSAGE


Ethanolamine Oleate 5% Ethamolin 5% (Equiv) INJ 100 MG IV 2 INJ

Sodium Morrhuate Morrhuate Sodium VIAL 50 MG IV 1 ML

Sodium Morrhuate Morrhuate Sodium VIAL 1500 MG IV 30 ML

24:20 Alpha Adrenergic Blocking Agents

24:20.00 Alpha Adrenergic

Blocking Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Doxazosin Mesylate Cardura (Equiv) TA 2 MG PO 1 Tab

Doxazosin Mesylate Cardura (Equiv) TA 4 MG PO 1 Tab

Prazosin HCl Minipres (Equiv) CAP 1 MG PO 1 CAP



Terazosin HCl Hytrin (Equiv) CAP 1 MG PO 1 CAP

Terazosin HCl Hytrin (Equiv) CAP 5 MG PO 1 CAP

24:24 Beta-Adrenergic Blocking Agents

24:24.00Beta-Adrenergic Blocking Agents GENERIC NAME BRAND NAME DOSAGE


Atenolol Tenormin (Equiv) TAB 25 MG PO 1 TAB

Atenolol Tenormin (Equiv) TAB 50 MG PO 1 TAB

Bisoprolol Bisoprolol TAB 2.5 MG PO 1 TAB

Bisoprolol Bisoprolol TAB 5 MG PO 1 TAB

Bisoprolol Bisoprolol TAB 10 MG PO 1 TAB

Carvedilol Coreg (Equiv) TAB 3.125 MG PO 1 TAB

Carvedilol Coreg (Equiv) TAB 6.25 MG PO 1 TAB

Esmolol HCl Brevibloc (Equiv) VIAL 100 MG IV 10 ML

Esmolol HCl Brevibloc (Equiv) INJ 2500 MG IV 10 ML

Esmolol HCl/Nacl Iso Osm Brevibloc (Equiv) IV 2500 MG IV 250 ML

Labetalol HCl Trandate (Equiv) VIAL 100 MG IV 20 ML

Labetalol HCl Normodyne (Equiv) SYRING 20 MG IV 4 ML

Labetalol HCl Normodyne (Equiv) TAB 200 MG PO 1 TAB

Labetalol HCl Normodyne (Equiv) TAB 300 MG PO 1 TAB

Metoprolol Succinate Toprol Xl (Equiv) T SR 24 50 MG PO 1 T SR 24

Metoprolol Succinate Toprol Xl (Equiv) T SR 24 100 MG PO 1 T SR 24

Metoprolol Tartrate Lopressor (Equiv) INJ 5 MG IV 5 ML

Metoprolol Tartrate Lopressor (Equiv) TAB 25 MG PO 1 TAB

Metoprolol Tartrate Lopressor (Equiv) TAB 50 MG PO 1 TAB

Nebivolol Bystolic TAB 2.5 MG PO 1 TAB

Nebivolol Bystolic TAB 5 MG PO 1 TAB

Nebivolol Bystolic TAB 10 MG PO 1 TAB

Pindolol Visken (Equiv) TAB 5 MG PO 1 TAB

Propranolol HCl Inderal (Equiv) INJ 1 MG IV 1 ML

Propranolol HCl Inderal (Equiv) TAB 10 MG PO 1 TAB



Propranolol HCl Inderal La (Equiv) SR CAPS 60 MG PO 1 SR CAP

Propranolol HCl Inderal La (Equiv) SR CAPS 80 MG PO 1 SR CAP

Sotalol HCl Betapace (Equiv) TAB 80 MG PO 1 TAB

24:28 Calcium-Channel Blocking Agents

24:28.08 Dihydropyridines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Amlodipine Besylate Norvasc (Equiv) TAB 5 MG PO 1 TAB

Clevidipine Butyrate Cleviprex (Equiv) Vial 0.5 MG IV 50 ML

Nicardipine HCl Cardene (Equiv) 2.5mg/Ml INJ 25 MG IV 10 ML

Nifedipine Procardia (Equiv) CAP 10 MG PO 1 CAP

Nifedipine Procardia (Equiv) CAP 20 MG PO 1 CAP

Nifedipine Adalat Cc/Procardia Xl (Equiv) SR TAB 30 MG PO 1 SR TAB

Nifedipine Adalat Cc/Procardia Xl (Equiv) SR TAB 60 MG PO 1 SR TAB

Nimodipine Nimotop (Equiv) CAP 30 MG PO 1 CAP

Nimodipine Nimotop (Equiv) Solution 60 mg PO 20 mL

24:28.92 Calcium-Channel Blocking Agents,

MiscellaneousGENERIC NAME BRAND NAME DOSAGE


Diltiazem Cd Cardizem Cd (Equiv) C SR 24 120 MG PO 1 C SR 2




Diltiazem HCl Cardizem (Equiv) VIAL 25 MG IV 5 ML

Diltiazem HCl Cardizem (Equiv) VIAL 50 MG IV 10 ML

Diltiazem Cardizem (Equiv) TAB 30 MG PO 1 TAB

Diltiazem HCl Cardizem (Equiv) TAB 60 MG PO 1 TAB

Diltiazem HCl Cardizem (Equiv) TAB 90 MG PO 1 TAB

24:28.92 Calcium-Channel

Blocking Agents, Miscellaneous


(continued) Verapamil HCl Calan (Equiv) TAB 120 MG PO 1 TAB

Verapamil HCl Calan (Equiv) TAB 40 MG PO 1 TAB

Verapamil HCl Calan (Equiv) TAB 80 MG PO 1 TAB

Verapamil HCl Verapamil ER (Equiv) ER TAB 120 MG PO 1 ER TAB



Verapamil HCl Calan (Equiv) VIAL 5 MG IV 2 ML

24:32 Renin-Angiotensin-Aldosterone Sytem Inhibitors

24:32.04 Angiotensin-

Converting Enzyme Inhibitors


Captopril Captopril TAB 12.5 MG PO 1

Captopril Captopril TAB 25 MG PO 1 TAB

Captopril Capoten (Equiv) TAB 50 MG PO 1 TAB

Enalaprilat Dihydrate Vasotec (Equiv) VIAL 2.5 MG IV 2 ML

Lisinopril Prinivl/Zestril (Equiv) TAB 5 MG PO 1 TAB

Lisinopril Prinivil/Zestril (Equiv) TAB 10 MG PO 1 TAB

Lisinopril Prinivil/Zestril (Equiv) TAB 20 MG PO 1 TAB

24:32.08 Agiontensin II

Receptor Antagonists GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Losartan Cozaar (Equiv) TAB 25 MG PO 1 TAB



Valsartan Diovan (Equiv) TAB 20 `MG PO 1 TAB

Valsartan Diovan (Equiv) TAB 40 `MG PO 1 TAB

24:32.20 Mineralocorticoid (Aldosterone) Receptor

GENERIC NAME BRAND NAME DOSAGE FORM

STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

AntagonistsSpironolactone Aldactone (Equiv) TAB 25 MG PO 1 TAB

24:32.40 Renin Inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Aliskerin Tecturna TAB 150 MG PO 1 TAB

Aliskerin Tecturna TAB 300 MG PO 1 TAB

28:04.04.92 GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Desflurane Suprane (Equiv) LIQUID 60 CC INH 1 HOUR

Etomidate Amidate (Equiv) SYRING 40 MG IV 20 ML

Isoflurane Isoflurane LIQUID 8 ML INH 1 DOSE

Ketamine HCl Ketalar (Equiv) VIAL 200 MG IV 20 ML

Ketamine HCl 10mg Charge Dose Ketamine HCl 10mg Charge Dose HV 10 MG INJ 0.2 ML

Propofol Diprivan (Equiv) VIAL 1000 MG IV 100 ML



Sevoflurane Ultane (Equiv) LIQUID 15 ML INH 1 UNIT

28:08 Analgesics and Antipyretics

28:08.04 Nonsteroidal Anti-inflammatory Agents

28:08.04.08 COX-II Inhibitors GENERIC NAME BRAND NAME DOSAGE


Celecoxib Celebrex Capsule 100 mg PO 1 Capsule

Celecoxib Celebrex Capsule 200 mg PO 1 Capsule

28:08.04.24 Salicylicylates GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Aspirin Aspirin CHWTAB 81 MG PO 1 CHWTAB

Aspirin Ecotrin (Equiv) ECTAB 81 MG PO 1 ECTAB

Aspirin Aspirin ECTAB 325 MG PO 1 ECTAB

Aspirin Aspirin TAB 325 MG PO 1 TAB

Aspirin Aspirin SUPP 300 MG REC 1 SUPP

Aspirin Aspirin SUPP 600 MG REC 1 SUPP

Aspirin/Caffeine/Butalbital Fiorinal (Equiv) CAP 1 CAP PO 1 CAP

Salsalate Disalcid (Equiv) TAB 500 MG PO 1 TAB

28:08.04.92 Other Nonsteroidal Anti-Inflammatory

AgentsGENERIC NAME BRAND NAME DOSAGE


Ibuprofen Motrin (Equiv) SUSP 100 MG PO 5 ML

Ibuprofen Motrin (Equiv) TAB 200 MG PO 1 TAB



Ibuprofen Ibuprofen TAB 800 MG PO 1 TAB

Indomethacin Indocin (Equiv) CAP 25 MG PO 1 CAP

Ketorolac Tromethamine Toradol (Equiv) TAB 10 MG PO 1 TAB

Ketorolac Tromethamine Toradol (Equiv) VIAL 15 MG IM 1 ML



Meloxicam Mobic (Equiv) Tablet 7.5 MG PO 1 Tablet

Meloxicam Mobic (Equiv) Tablet 15 MG PO 1 Tablet

Naproxen Naprosyn (Equiv) TAB 250 MG PO 1 TAB

Naproxen Naprosyn (Equiv) TAB 375 MG PO 1 TAB

28:08.08 Opiate Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Acetaminophen/Cod. #3 300/30mg Tylenol #3 (Equiv) 300/30mg TAB 1 TAB PO 1 TAB

Acetaminophen/Codeine 300/30 Tylenol #3 (Equiv) 300/30 TAB 4 TAB PO 1 PACKAGE

Acetaminophen W/Cod Elixi(4pk) Acetaminophen W/Cod Elixi(4pk) SE 4 PACK PO 4 PACK

Acetaminophen/Codeine 120mg/12mg Tylenol W/Codeine (Equiv) SUSP 5 ML PO 5 ML

Aspirin/Buta/Caff/Cod #3 Fiorinal #3 (Equiv) CAP 1 CAP PO 1 CAP

Belladonna/Opium 60/16.2 Mg Belladonna & Opium 60/16.2mg SUPP 1 SUPP REC 1 SUPP

Codeine Sulf Codeine Sulfate TAB 30 MG PO 1 TAB

Fentanyl 12 Mcg/Hr Duragesic (Equiv) 12 Mcg/Hr PAT 12H 1.2 MG TD 1 PATCH


Fentanyl 50 Mcg/Hr Duragesic (Equiv) 50 Mcg/Hr PAT 12H 5 MG TD 1 PATCH


Fentanyl 100 Mcg/Hr Duragesic (Equiv) 100 Mcg/Hr PAT 12H 10 MG TD 1 PATCH

Fentanyl Citrate/Pf Sublimaze (Equiv) INJ 0.1 MG IV 2 ML

Fentanyl Citrate/Pf Sublimaze (Equiv) INJ 0.25 MG IV 5 ML

Fentanyl Citrate/Pf Sublimaze (Equiv) INJ 1 MG IV 20 ML

Hydrocodone Bit/Acetaminophen Vicodin (Equiv) TAB 1 TAB PO 1 TAB

Hydrocodone Bit/Acetaminophen Hydrocodone W/Acetaminophen TAB 6 TAB PO 1 PACKAGE

Hydrocodone Bit/Acetaminophen Vicodin (Equiv) SOLN 5 ML PO 5 ML

Hydromorphone HCl Dilaudid (Equiv) SYRING 1 MG IV 1 ML

Hydromorphone HCl Dilaudid (Equiv) SYRING 2 MG IV 1 ML

Hydromorphone HCl Dilaudid-Hp (Equiv) INJ 50 MG IV 5 ML

Hydromorphone HCl Dilaudid (Equiv) SOL 1 MG PO 1 ML

Hydromorphone HCl Dilaudid (Equiv) TAB 2 MG PO 1 TAB

Hydromorphone HCl Dilaudid (Equiv) TAB 4 MG PO 1 TAB

Hydromorphone HCl Hydromorphone HCl TAB 8 MG PO 1 TABLET

Hydromorphone HCl Dilaudid (Equiv) SUPP 3 MG REC 1 SUPP

Meperidine HCl Demerol (Equiv) SYRING 25 MG IV 1 ML



Meperidine HCl Demerol (Equiv) VIAL 100 MG IV 1 ML

Meperidine HCl Pca Demerol (Equiv) Pca SYRING 500 MG IV 50 ML

Meperidine HCl Demerol (Equiv) TAB 50 MG PO 1 TAB

Methadone HCl Methadone HCl TAB 5 MG PO 1 TAB

Methadone HCl Methadone HCl SOLN 5 MG PO 5 ML

Morphine Liposomol Pf Depodur VIAL 15 MG EPI 1.5 ML

Morphine Sulfate Morphine SYRING 2 MG IV 1 ML



Morphine Sulfate Morphine 15mg/Ml VIAL 300 MG IV 20 ML

Morphine Sulfate Pca Morphine Pca SYRING 50 MG IV 50 ML

Morphine Sulfate Morphine Sulfate SOLN 10 MG PO 5 ML

Morphine Sulfate Ms Contin (Equiv) SR TAB 15 MG PO 1 SR TAB


Morphine Sulfate Morphine Sulfate SOLN 20 MG PO 10 ML

Morphine Sulfate Roxanol (Equiv) SOLN 20 MG PO 1 ML

Morphine Sulfate Morphine SOLTAB 30 MG PO 1 SOLTAB


Morphine Sulfate Ms Contin(Equiv) SR TAB 60 MG PO 1 SR TAB

Morphine Sulfate Morphine Sulfate SUPP 10 MG REC 1 SUPP

Morphine Sulfate Morphine SUPP 5 MG REC 1 SUPP

Morphine Sulfate/Pf Astramorph-Pf (Equiv) INJ 2 MG IV 2 ML

Morphine Sulfate/Pf Duramorph (Equiv) INJ 10 MG IV 10 ML

Morphine Sulfate/Pf Morphine Pres-Free SYRING 250 MG IV 10 ML

Morphine Sulfate/Pf Morphine Pres-Free SYRING 500 MG IV 20 ML

Morphine Sulfate/Pf Morphine Pres-Free SYRING 1,000 MG IV 20 ML

Oxycodone HCl Oxycontin (Equiv) T SR 12 10 MG PO 1 T SR 1



Oxycodone HCl Oxy Ir (Equiv) TAB 5 MG PO 1 TAB

Oxycodone HCl/Acetaminophen Percocet (Equiv) TAB 1 TAB PO 1 TAB

Oxycodone HCl/Acetaminophen Percocet Home Pack (Equiv) TA 4 TAB PO 1 PACKAGE

Oxycodone HCl/Acetaminophen Roxicet (Equiv) SJ 5 ML PO 1 SJ

Remifentanil HCl Ultiva (Equiv) VIAL 5 MG IV 1 VIAL

Sufentanil Citrate Sufenta (Equiv) INJ 100 MCG IV 2 ML

Tapentadol Nucynta TAB 50 MG PO 1 TAB

Tapentadol Nucynta TAB 75 MG PO 1 TAB

Tramadol 50mg Home Pack X4 Ultram 50mg(Equiv) Homepack X4 TA 1 PACKAGE PO 4 TABLET

Tramadol HCl Ultram (Equiv) TAB 50 MG PO 1 TAB

28:08.12 Opiate Partial Agonists GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Nalbuphine HCl Nubain (Equiv) IM 10 MG IV 1 ML

28:08.92 Analgesics and

Antipyretis, Miscellaneous


Acetaminophen Tylenol (Equiv) TAB 325 MG PO 1 TAB

Acetaminophen Tylenol (Equiv) TAB 500 MG PO 1 TAB

Acetaminophen Tylenol (Equiv) CUP 650 MG PO 20.3 ML

Acetaminophen Tylenol (Equiv) SUPP 120 MG REC 1 EA

Acetaminophen Feverall (Equiv) SUPP 325 MG REC 1 SUPP

Acetaminophen Acephen SUPP 650 MG REC 1 SUPP

Acetaminophen/Caffeine/Butalb Fioricet (Equiv) TAB 1 TAB PO 1 TAB

Clonidine HCl Duraclon (Equiv) VIAL 1 MG EPI 10 ML

28:10 Opiate Antagonists

28:10.00Opiate Antagonists GENERIC NAME BRAND NAME DOSAGE


Methylnaltrexone Bromide Relistor Vial 12 MG SQ 0.6 ML

Naloxone HCl Narcan (Equiv) VIAL 0.4 MG IV 1 ML

Naloxone HCl Narcan (Equiv) INJ 2 MG IV 2 ML

Naloxone HCl Multi-Dose Narcan (Equiv) Multi-Dose VIAL 4 MG IV 10 ML

Non-stocked Naloxone HCl Narcan (Equiv) Spray 4 MG NAS 0.1 ML

Naltrexone HCl Revia (Equiv) TAB 50 MG PO 1 TAB

28:12 Anticonvulsants

28:12.04 Barbiturates GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Primidone Mysoline (Equiv) TAB 250 MG PO 1 TAB

Primidone Mysoline (Equiv) TAB 50 MG PO 1 TAB

28:12.08 Benzdiazepines GENERIC NAME BRAND NAME DOSAGE


Clobazam Onfi Tab 10 MG PO 1 TAB

Clonazepam Klonopin (Equiv) TAB 0.5 MG PO 1 TAB

Clonazepam Klonopin (Equiv) TAB 1 MG PO 1 TAB

Diazepam Diastat Rectal Gel Gel 2.5 MG REC 1 EACH

28:12.12 Hydantoins GENERIC NAME BRAND NAME DOSAGE


Fosphenytoin Sodium Cerebyx (Equiv) VIAL 100 MG IV 2 ML

Fosphenytoin Sodium Cerebyx (Equiv) VIAL 500 MG IV 10 ML

Phenytoin Dilantin (Equiv) VIAL 100 MG IV 2 ML

Phenytoin Dilantin (Equiv) VIAL 250 MG IV 5 ML

Phenytoin Sodium Dilantin (Equiv) CAP 30 MG PO 1 CAP

Phenytoin Sodium Dilantin (Equiv) CAP 100 MG PO 1 CAP

Phenytoin Sodium Extended Dilantin (Equiv) CHWTAB 50 MG PO 1 CHWTAB

Phenytoin Sodium Extended Dilantin (Equiv) SUSP 100 MG PO 4 ML

28:12.92 Anticonvulsants,


Brivaracetam Briviact TAB 50 MG PO 1 TAB

Brivaracetam Briviact IV 50 MG PO 5 ML

Carbamazepine Tegretol (Equiv) CHWTAB 100 MG PO 1 CHWTAB

Carbamazepine Tegretol (Equiv) TAB 200 MG PO 1 TAB

Carbamazepine Tegretol (Equiv) SUSP 200 MG PO 10 ML

Divalproex Er Depakote Er (Equiv) T SR 24 250 MG PO 1 T SR 24

Divalproex Er Depakote Er (Equiv) T SR 24 500 MG PO 1 T SR 24

Divalproex Sodium Depakote (Equiv) ECTAB 250 MG PO 1 ECTAB

Divalproex Sodium Depakote (Equiv) ECTAB 500 MG PO 1 ECTAB

Divalproex Sprinkle Depakote Sprinkle (Equiv) CAPSP 125 MG PO 1 CAP Spinkle

Eslicarbazepine acetate Aptiom Tab 200 MG PO 1 TAB

Eslicarbazepine acetate Aptiom Tab 400 MG PO 1 TAB

Felbamate Felbatol (Equiv) Tablet 400 MG PO 1 TAB

Gabapentin Neurontin (Equiv) CAP 100 MG PO 1 CAP



Gabapentin Neurontin (Equiv) SOL 250 MG PO 5 ML

Lamotrigine Lamictal (Equiv) TAB 25 MG PO 1 TAB

Lamotrigine Lamictal (Equiv) TAB 200 MG PO 1 TAB

Levetiracetam Keppra (Equiv) TAB 500 MG PO 1 TAB

Levetiracetam I.V. Keppra I.V. (Equiv) VIAL 500 MG IV 5 mL

Magnesium Sulfate Epsom Salt (Equiv) CRYSTL 1 PACKAGE MSC 1 PACKAGE

Magnesium Sulfate 50% Magnesium Sulfate 50% VIAL 500 MG IV 1 ML

Oxcarbazepine Trileptal (Equiv) TAB 150 MG PO 1 TAB

Oxcarbazepine Trileptal (Equiv) TAB 300 MG PO 1 TAB

Rufinamide Banzel TAB 400 MG PO 1 TAB

Tiagabine Gabitril TAB 4 MG PO 1 TAB

Topiramate Topamax (Equiv) TAB 25 MG PO 1 TAB

Topiramate Topamax (Equiv) TAB 100 MG PO 1 TAB

Valproic Acid Depakene (Equiv) CAP 250 MG PO 1 CAP

Valproic Acid Depekene (Equiv) SYRUP 250 MG PO 5 ML

Valproate Sodium Depacon (Equiv) VIAL 500 MG IV 5 ML

Zonisamide Zonegran (Equiv) CAP 25 MG PO 1 CAP

Zonisamide Zonegran (Equiv) CAP 100 MG PO 1 CAP

28:16 Psychotherapeutic Agents

28:16.04 Antidepressants28:16.04.20 Selective Seratonin Reuptake Inhibitors

GENERIC NAME BRAND NAME

DOSAGE FORM

STRENGTH UNIT ROUTE VOLUME

VOLUME

UNIT Citalopram Hydrobromide Celexa (Equiv) TAB 20 MG PO 1 TAB

Escitalopram Oxalate Lexapro (Equiv) TAB 10 MG PO 1 TAB

Fluoxetine HCl Prozac (Equiv) TAB 20 MG PO 1 TAB

Fluvoxamine Maleate Luvox (Equiv) TAB 50 MG PO 1 TAB

Paroxetine HCl Paxil (Equiv) TAB 10 MG PO 1 TAB




Non-stocked Paroxetine Paxil (equiv) Sol’n 10 mg PO 5 mL

Sertraline HCl Zoloft (Equiv) TAB 50 MG PO 1 TAB

28:16.04.24 Seratonin Modulators GENERIC NAME BRAND NAME DOSAGE


Trazodone HCl Desyrel (Equiv) TAB 50 MG PO 1 TAB

Trazodone HCl Desyrel (Equiv) TAB 150 MG PO 1 TAB

Vortioexetine Trintellix Tab 5 MG PO 1 TAB

Vortioexetine Trintellix Tab 10 MG PO 1 TAB

28:16.04.28 Tricylics and Other

Norepinephrine Reuptake Inhibitors


Amitriptyline HCl Elavil (Equiv) TAB 10 MG PO 1 TAB

Amitriptyline HCl Elavil (Equiv) TAB 25 MG PO 1 TAB

Desipramine HCl Norpramin (Equiv) TAB 25 MG PO 1 TAB

Doxepin HCl Sinequan (Equiv) CAP 10 MG PO 1 CAP

Nortriptyline HCl Pamelor (Equiv) CAP 10 MG PO 1 CAP

Nortriptyline HCl Pamelor (Equiv) CAP 25 MG PO 1 CAP

28:16.04.92 Antidepressants,


Bupropion HCl Wellbutrin (Equiv) TAB 75 MG PO 1 TAB

Bupropion HCl Wellbutrin (Equiv) TAB 100 MG PO 1 TAB

Bupropion Sr HCl Wellbutrin Sr (Equiv) SR TAB 100 MG PO 1 SR TAB

Bupropion Sr HCl Wellbutrin Sr (Equiv) SR TAB 150 MG PO 1 SR TAB

Bupropion Xl HCl Wellbutrin Xl (Equiv) T 24 150 MG PO 1 T 24

Mirtazapine Remeron Solutab (Equiv) TAB LN 15 MG PO 1 TAB LN

Mirtazapine Remeron Solutab (Equiv) TAB LN 30 MG PO 1 TAB LN

Venlafaxine HCl Effexor (Equiv) TAB 37.5 MG PO 1 TAB

Venlafaxine HCl Effexor (Equiv) TAB 50 MG PO 1 TAB

Venlafaxine HCl Effexor Xr (Equiv) C SR 24 37.5 MG PO 1 C SR 2

Venlafaxine HCl Effexor Xr (Equiv) C SR 24 75 MG PO 1

28:16.08 Antipsychotics C SR 2

28:16.08.04 Atypical Antipsychotics GENERIC NAME BRAND NAME DOSAGE


Aripiprazole Abilify (Equiv) TAB 2 MG PO 1 TAB



Non-Stocked Aripiprazole Abilify (Equiv) ODT 10 MG PO 1 ODT

Non-Stocked Aripiprazole Abilify (Equiv) ODT 15 MG PO 1 ODT

Company Aripiprazole Aristada Lauroxil SYR 441 MG IM 1 SYR

Replacement Aripiprazole Aristada Lauroxil SYR 662 MG IM 1 SYR

Program Aripiprazole Aristada Lauroxil SYR 882 MG IM 1 SYR

Asenapine Saphris (Equiv) CAP 5 mg PO 1 CAP

Clozapine Clozaril (Equiv) TAB 100 MG PO 1 TAB

Clozapine Clozaril (Equiv) TAB 25 MG PO 1 TAB

Iloperidone Fanapt (Equiv) TAB 2 MG PO 1 TAB

Iloperidone Fanapt (Equiv) TAB 6 MG PO 1 TAB

Lurasidone Latuda (Equiv) Tab 40 mg PO 1 TAB

Lurasidone Latuda (Equiv) Tab 80 mg PO 1 TAB

Olanzapine Zyprexa (Equiv) TAB 5 MG PO 1 TAB

Olanzapine Zyprexa (Equiv) TAB 10 MG PO 1 TAB

Olanzapine Zyprexa Zydis (Equiv) TAB LN 5 MG PO 1 TAB LN

Olanzapine Zyprexa (Equiv) HS 10 MG IM 1 VIAL

Paliperidone Invega (Equiv) Tablet 3 mg PO 1 Tablet

Paliperidone Invega (Equiv) Tablet 6 mg PO 1 Tablet

Paliperidone injection Invega Sustenna SYR 234 MG IM 1 SYRINGE

Paliperidone injection Invega Sustenna SYR 156 MG IM 1 SYRINGE(Conditionally approved until voucher

replacement program ends)28:16.08.04 Atypical

Antipsychotics (continued)


Quetiapine Fumarate Seroquel (Equiv) TAB 25 MG PO 1 TAB

Quetiapine Fumarate Seroquel (Equiv) TAB 100 MG PO 1 TAB

Risperidone Risperdal (Equiv) TAB 0.25 MG PO 1 TAB

Risperidone Risperdal (Equiv) TAB 1 MG PO 1 TAB



Risperidone M Risperdal M (Equiv) TAB LN 0.5 MG PO 1 TAB LN

Risperidone M Risperdal M (Equiv) TAB LN 1 MG PO 1 TAB LN

Risperidone Microspheres Risperdal Consta HX 25 MG IM 2 ML

Ziprasidone HCl Geodon (Equiv) CA 20 MG PO 1 CAP

Ziprasidone Mesylate Geodon (Equiv) VIAL 20 MG IM 1 VIAL

28:16.08.08 Butyrophenones GENERIC NAME BRAND NAME DOSAGE


Haloperidol Haldol (Equiv) TAB 0.5 MG PO 1 TAB

Haloperidol Haldol (Equiv) TAB 1 MG PO 1 TAB



Haloperidol Lactate Haldol (Equiv) PO CON 10 MG PO 5 ML

Haloperidol Lactate Haldol (Equiv) INJ 5 MG IM 1 ML

Haloperidol Decanoate Haldol Decanoate (Equiv) INJ 50 MG IM 1 ML

28:16.08.24 Phenothiazines GENERIC NAME BRAND NAME DOSAGE


Chlorpromazine HCl Thorazine (Equiv) TAB 10 MG PO 1 TAB

Chlorpromazine HCl Thorazine (Equiv) TAB 25 MG PO 1 TAB

Chlorpromazine HCl Thorazine (Equiv) INJ 25 MG IV 1 ML

Fluphenazine Decanoate Prolixin Dc (Equiv) VIAL 125 MG IM 5 ML

Fluphenazine HCl Prolixin (Equiv) TAB 1 MG PO 1 TAB

Fluphenazine HCl Prolixin (Equiv) TAB 2.5 MG PO 1 TAB

Fluphenazine HCl Prolixin (Equiv) VIAL 25 MG IM 10 ML

Perphenazine Trilafon (Equiv) TAB 2 MG PO 1 TAB

Thioridazine HCl Mellaril (Equiv) TAB 10 MG PO 1 TAB

Thioridazine HCl Mellaril (Equiv) TAB 25 MG PO 1 TAB

28:16.08.32 Thioxanthenes GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Thiothixene Navane (Equiv) CAP 2 MG PO 1 CAP

Thiothixene Navane (Equiv) CAP 5 MG PO 1 CAP


28:16.08.92Antipsychotics, Miscellaneous

28:20

Anorexigenic and Respiratory and Cerebral Stimulants28:20.04 Amphetamines GENERIC NAME BRAND NAME DOSAGE


Amphet Asp/Amphet/D-Amphet Adderal (Equiv) TAB 10 MG PO 1 TAB

Non-stocked Dextroamphetamine Salts Dexedrine Spansule CAP ER 5 MG PO 1 CAP

Non-stocked Dextroamphetamine Salts Dexedrine Spansule CAP ER 10 MG PO 1 CAP

Methylphenidate HCl Ritalin (Equiv) TAB 5 MG PO 1 TAB

Methylphenidate HCl Concerta (Equiv) TAB SA 18 MG PO 1 TAB SA

Modafinil Provigil (Equiv) TABLET 100 MG PO 1 TAB

28:20.92 Anorexigenic and

Respiratory and Cerebral Stimulants,

Miscellaneous


Caffeine/Sodium Benzoate Caffeine And Sodium Benzoate INJ 500 MG IV 2

Anxiolytics, Sedatives, and HypnoticsBarbiturates

28:2428:24.04 GENERIC NAME BRAND NAME DOSAGE


Pentobarbital Sodium Nembutal Sodium HV 50 MG IV 1 ML

Pentobarbital Sodium Nembutal (Equiv) VIAL 1000 MG IV 20 ML

Phenobarbital Phenobarbital TAB 32.4 MG PO 1 TAB

Phenobarbital Phenobarbital TAB 97.2 MG PO 1 TAB

Phenobarbital Phenobarbital SE 30 MG PO 7.5 ML

Phenobarbital Sodium Phenobarbital VIAL 65 MG IV 1 ML

Phenobarbital Sodium Luminal (Equiv) SYRING 130 MG IV 1 ML

28:24.08 Benzodiazepines GENERIC NAME BRAND NAME DOSAGE


Alprazolam Xanax (Equiv) TAB 0.25 MG PO 1 TAB

Alprazolam Xanax (Equiv) TA 0.5 MG PO 1 TAB

Diazepam Valium (Equiv) SYRING 10 MG IV 2 ML

Diazepam Valium (Equiv) TAB 2 MG PO 1 TAB



Non-stocked Diazepam Diastat Gel

Lorazepam Ativan (Equiv) TAB 1 MG PO 1 TAB

Lorazepam Ativan (Equiv) VIAL 2 MG IV 1 ML

Lorazepam Ativan (Equiv) SYRING 2 MG IV 1 ML

Midazolam HCl Versed (Equiv) VIAL 2 MG IV 2 ML



Midazolam HCl Versed (Equiv) SYRUP 2 MG PO 1 ML

Midazolam HCl Versed (Equiv) ST 10 MG PO 5 ML


Anxiolytics, Sedatives, and Hypnotics


Buspirone HCl Buspar (Equiv) TAB 5 MG PO 1 TAB

Dexmedetomidine (Precedex) Vial 200 mcg IV 2 mL

Droperidol Inapsine (Equiv) VIAL 5 MG IM 2 ML

Hydroxyzine 10mg/5ml (Ud) Vistaril (Equiv.) 10mg/5ml ST 10 MG PO 5 ML

Hydroxyzine HCl Atarax (Equiv) TAB 10 MG PO 1 TAB

Hydroxyzine HCl Vistaril (Equiv) VIAL 50 MG IM 1 ML

Hydroxyzine Pam Vistaril (Equiv) CAP 25 MG PO 1 CAP

Hydroxyzine Pamoate Vistaril (Equiv) CAP 50 MG PO 1 CAP

Zolpidem Tartrate Ambien (Equiv) TAB 5 MG PO 1 TAB

28:28 ANTIMANIC AGENTS

28:28.00 Antimanic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Lithium Carbonate Lithobid (Equiv) SR TAB 300 MG PO 1 SR TAB

Lithium Carbonate Lithium Carbonate CAP 300 MG PO 1 CAP

Lithium Carbonate Lithium Carbonate TAB 300 MG PO 1 TAB

Lithium Carbonate Eskalith Cr (Equiv) SR TAB 450 MG PO 1 SR TAB

Lithium Citrate Lithium Citrate SYRUP 8 MEQ PO 5 ML

28:32ANTIMIGRAINE AGENTS

28:32.28 Selective Seratonin Agonists GENERIC NAME BRAND NAME DOSAGE


Sumatriptan Succinate Imitrex (Equiv) TAB 25 MG PO 1 TAB

Sumatriptan Succinate Imitrex (Equiv) VIAL 6 MG SUB 0.5 ML

28:36.20.04

Ergot derived Dopamine Receptor

AntagonistGENERIC NAME BRAND NAME DOSAGE


Bromocriptine Mesylate Parlodel (Equiv) TAB 2.5 MG PO 1 TAB

28:36.20.08Non-Ergot Derivative Dopamine Receptor

AntagonistsGENERIC NAME BRAND NAME DOSAGE


Apomorphine Apokyn Vial 10 mg/mL SQ 1 VIAL

Rotigotine Neupro Patch 2 MG 24 HR PATCH

28:36.32.00 Monoamine Oxidase-B Inhibitors GENERIC NAME BRAND NAME DOSAGE


Rasalagine Azilect (Equiv) TAB 0.5 MG PO 1 TAB

Selegiline Eldepryl (Equiv) CAP 0.5 MG PO 1 TAB

28:40 Fibromyalgia Agents

28:40 Fibromyalgia Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Non-stocked Milnaciprin Savella TAB 12.5 MG PO 1 TAB

Non-stocked Milnaciprin Savella TAB 50 MG PO 1 TAB

28:92

Central Nervous System Agents, Miscellaneous

28:92.00 Central Nervous System Agents, Miscellaneous


Non-stocked Acamprosate Campral TAB ER 333 MG PO 1 TAB

Amantadine HCl Amantadine HCl CAP 100 MG PO 1 CAP

Atomoxetine HCl Strattera (Equiv) CAP 25 MG PO 1 CA

Atomoxetine HCl Strattera (Equiv) CAP 40 MG PO 1 CAP

Atomoxetine HCl Strattera (Equiv) CAP 60 MG PO 1 CAP

Carbidopa/Levodopa 10/100mg Sinemet (Equiv) 10/100mg TAB 1 TAB PO 1 TAB

Carbidopa/Levodopa 25/100mg Sinemet (Equiv) 25/100 Mg TAB 1 TAB PO 1 TAB

Carbidopa/Levodopa 25/250mg Sinemet (Equiv) 25/250mg TAB 1 EACH PO 1 TAB

Carbidopa/Levodopa Cr 50/200mg Sinemet Cr (Equiv) 50/200 Mg SR TAB 1 SR TAB PO 1 SR TAB

Carbidopa/Levodopa/Entacapone Stalevo Tab 1 50/12.5/100 PO 1 Tab

Carbidopa/Levodopa/Entacapone Stalevo Tab 1 100/25/200 PO 1 Tab



Dextromethorphan hydrobromide/quinidine sulfate Nuedexta CAP 20 / 10 Mg PO 1 CAP

Entacapone Comtan (Equiv) TAB 200 MG PO 1 TABLET

Flumazenil Romazicon (Equiv) VIAL 0.5 MG IV 5 ML

Memantine HCl Namenda TAB 5 MG PO 1 TABLET

Memantine HCl Namenda (Equiv) TAB 10 MG PO 1 TABLET

Selegiline HCl Eldepryl (Equiv) CAP 5 MG PO 1 CAP

36:00 Diagnostic Agents

36:00.00 Diagnostic Agents GENERIC NAME BRAND NAME DOSAGE


Fluorescein Sodium Fluor-I-Strip (Equiv) STRIP 1 MG EYE 1 STRIP

Fluorescein Sodium 10% Fluorescite 10% (Equiv) INJ 5 ML IV 1 AMP

Methacholine Challenge Test Provocholine (Equiv) Challenge VIAL 100 MG RT 1 VIAL

36:04.00 Adrenocorticoid

Insufficiency GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Cosyntropin Cortrosyn (Equiv) VIAL 0.25 MG IV 1 VIAL

Fungi36:32.00 GENERIC NAME BRAND NAME DOSAGE


Candida Antigen Candida (Equiv) ALLERGE 1 VIAL ID 1 ML

36:34.00 Gallbladder Function GENERIC NAME BRAND NAME DOSAGE


Sincalide Kinevac (Equiv) VIAL 5 MCG IV 1 VIAL

36:40.00 Kidney Function GENERIC NAME BRAND NAME DOSAGE


Indigotindisulfonate 0.8% Indigo Carmine 0.8% (Equiv) INJ 5 ML IV 5 ML

36:44.00 Liver Function GENERIC NAME BRAND NAME DOSAGE


Indocyanine Green Ic Green (Equiv) VIAL 25 MG IV 10 ML

36:56.00 Myasthenia Gravis GENERIC NAME BRAND NAME DOSAGE


Edrophonium Chloride Enlon (Equiv) VIAL 100 MG IV 10 ML

36:60.00 Thyroid Function GENERIC NAME BRAND NAME DOSAGE


Thyrotropin Alfa Thyrogen (Equiv) VIAL 1.1 MG IM 1

36:68.00 Roentgenography GENERIC NAME BRAND NAME DOSAGE


Diatrizoate Sodium 50% Hypaque Sodium 50% VIAL 1 BAG IV 50 ML

Iohexol Omnipaque (Equiv) INFUS 240 MG IV 1 ML

Iohexol Omnipaque (Equiv) INJBAG 240 MG IV 1 ML

36:84.00 Tuberculosis GENERIC NAME BRAND NAME DOSAGE


Tuberculin,Purif.Prot.Deriv. Tubersol (Equiv) VIAL 5 TEST UNITS ID 0.1 ML

38:00 Disinfectants 38:00.00 Disinfectants GENERIC NAME BRAND NAME DOSAGE


Na Hypochlorite Qtr Str 0.125% Dakin's Qtr Str 0.125% (Equiv) SL 1000 ML MSC 1 BOTTLE

Na Hypochlorite Half Str 0.25% Dakin's Half Str 0.25% (Equiv) SL 473 ML MSC 1 BOTTLE

40:00 Electrolyte, Caloric and Water Balance

40:08.00 Alkalinizing Agents


Potassium Citrate Urocit-K Tablet ER 10 mEq PO 1 tablet

Citric Acid/Sodium Citrate Bicitra (Equiv) SOLN 1 CUP PO 1 CUP

Sodium Bicarbonate 4.2% Sodium Bicarbonate 4.2% VIAL 0.5 MEQ IV 1 ML

Sodium Bicarbonate 4.2% Sodium Bicarbonate 4.2% SYRING 0.5 MEQ IV 1 ML

Sodium Bicarbonate 5% Sodium Bicarbonate 5% INJ 500 ML IV 500 ML

Sodium Bicarbonate 8.4% Sodium Bicarbonate 8.4% SYRING 1 MEQ IV 1 ML

Sodium Bicarbonate 8.4% Sodium Bicarbonate 8.4% SYRING 50 MEQ IV 50 ML

Tromethamine Tham (Equiv) INJ 1 BOTTLE IV 500 ML

40:10.00 Ammonia Detoxicants GENERIC NAME BRAND NAME DOSAGE


Lactulose Kristalose (Equiv) PACKET 10 GM PO 1 PACKET

Lactulose Kristalose (Equiv) PACKET 20 GM PO 1 PACKET

40:12.00 Replacement

Preparations GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Calcium Carb/Vit D 250/125mg Oscal D (Equiv) 250mg/125unit TAB 1 TAB PO 1 TAB

Calcium Carb/Vit D 600mg/200un Caltrate D (Equiv)600mg/200unt TAB 1 TAB PO 1 TAB

Calcium Carbonate Os-Cal (Equiv) TAB 500 MG PO 1 TAB

Calcium Carbonate Calcium Carbonate TAB 650 MG PO 1 TAB

Calcium Chloride 10% Calcium Chloride 10% SYRING 1,000 MG IV 10 ML

Calcium Citrate, Combinations Citracal + D Tab 600/200 Mg PO 1 TAB

Calcium Gluconate Calcium Gluconate VIAL 1,000 MG IV 10 ML

Calcium Gluconate Calcium Gluconate HV 10,000 MG IV 100 ML

Calcium Gluconate Calcium Gluconate TAB 500 MG PO 1 TAB

Copper Chloride Copper Chloride Vial 0.4 Mg IV 1 mL

Dextran 10% (40)/Normal Saline Gentran 10% (40) Normal Saline INJ 500 ML IV 500 ML

Dextran 40/Dextrose 5%-Water Gentran 40 In Dextrose 5% INJ 500 ML IV 500 ML

Dextran 75/Normal Saline Gentran 75 In Normal Saline INJ 500 ML IV 500 ML

Dextrose 5%-Lactated Ringers Dextrose 5% Lactated Ringers INJ 500 ML IV 500 ML

Dextrose 5%-Lactated Ringers Dextrose 5% Lactated Ringers INJ 1,000 ML IV 1000 ML

Dextrose 2.50% Dextrose 2.50% IV Various See Lexi

Dextrose 10% Dextrose 10% IV Various See Lexi



Dextrose - Aviva Bag Dextrose - Aviva Bag IV Various See Lexi

40:12.00 Replacement Preparations GENERIC NAME BRAND NAME DOSAGE


Dextrose - Excel Bag Dextrose - Excel Bag IV Various See Lexi

D10 / 0.9 NaCl D10 / 0.9 NaCl IV Various See Lexi

D10 / 0.45 NaCl D10 / 0.45 NaCl IV Various See Lexi

D 12.5 / 0.2% NaCl D 12.5 / 0.2% NaCl IV Various See Lexi

D 12.5 / 0.45% NaCl D 12.5 / 0.45% NaCl IV Various See Lexi

D 15 / 0.2% NaCl D 15 / 0.2% NaCl IV Various See Lexi

Electrolyte-48 Solution/D5w Dextrose 5%-Electrolyte #48 INJ 500 ML IV 500 ML

Electrolyte-48 Solution/D5w Dextrose 5%-Electrolyte #48 INJ 1,000 ML IV 1000 ML

Electrolyte-75 Solution/D5w Dextrose 5%-Electrolyte #75 INJ 1,000 ML IV 1000 ML

Electrolyte-M Solution/D5w Plasma-Lyte M In Dextrose INJ 500 ML IV 500 ML

Electrolyte-M Solution/D5w Plasma-Lyte M In Dextrose INJ 1,000 ML IV 1000 ML

Electrolyte-R Solution Plasma-Lyte R INJ 1,000 ML IV 1000 ML

Electrolyte-R Solution/D5w Plasma-Lyte R In Dextrose INJ 1,000 ML IV 1000 ML

Electrolyte Solution, Renal Replacement Prismasol B22GK 4/0 Bag 5 Liter IV 5000 mL

Electrolyte Solution, Renal Replacement PrismaSol BGK 2/0 Bag 5 Liter IV 5000 mL

Electrolyte Solution, Renal Replacement PrismaSol BGK 4/0/1.2 Bag 5 5 Liter IV 5000

Electrolyte Solution, Renal Replacement PrismaSol BK 0/3.5 Bag 5 Liter IV 5000 mL

Hetastarch/Normal Saline Hespan (Equiv) INJBAG 30,000 MG IV 500 ML

Naph,Mb-Db/K Ph,Mbdb Neutra-Phos (Equiv) PACKET 1 PACKET PO 1 PACKET

Normal Saline 0.45% Sodium Chloride 0.45% INJ 500 ML IV 500 ML

Normal Saline 0.45% Sodium Chloride 0.45% INJ 1,000 ML IV 1000 ML

Normal Saline 0.9% Sodium Chloride 0.9% IV 25 ML IV 25 ML






Normal Saline 0.9% Sodium Chloride 0.9% INJ 1,000 ML IV 1000 ML

Normal Saline 0.9% Pres-Free Sodium Chloride 0.9% Pres-Free VIAL 10 ML IV 1 VIAL

Normal Saline 0.9% Syringe Sodium Chloride 0.9% Syringe HQ 10 ML INJ 1 DISP SY

Potassium Acetate Potassium Acetate VIAL 200 MEQ IV 100 ML

Potassium Bicarbonate/Cit Ac K-Lyte (Equiv) EFFTAB 25 MEQ PO 1 EFFTAB

Potassium Cl Micro-K (Equiv) SR CAPS 8 MEQ PO 1 SR CAP

Potassium Chloride Klor-Con 10 (Equiv) TAB 10 MEQ PO 1 TAB

Potassium Chloride Kdur (Equiv) TAB SR 20 MEQ PO 1 TAB SR

Potassium Chloride 10% Potassium Chloride 10% LIQUID 20 MEQ PO 15 ML

Potassium Chloride 20meq PM Potassium Chloride 20meq PM PB 20 MEQ IV 100 ML

40:12.00 Replacement Preparations GENERIC NAME BRAND NAME DOSAGE


Potassium Chloride 40meq PM Potassium Chloride 40meq PM PB 40 MEQ IV 100 ML

Potassium Cl 20meq/D5 0.45 Nac Potassium Cl 20meq/D5 0.45 Nac HM 1000 ML IV 1000 ML

Potassium Cl/NS 20meq PM Potassium Cl/NS 20meq PM INJ 20 MEQ IV 1000 ML

Potassium Chloride/D5-NS 20meq Potassium Chloride In D5w/Nacl HM 20 MEQ IV 1000 ML

Potassium Cl Potassium Cl VIAL 20 MEQ IV 10 ML

Potassium Cl Potassium Cl VIAL 40 MEQ IV 20 ML

Potassium Phos,M-Basic-D-Basic Potassium Phosphate VIAL 220 MEQ IV 50 ML

Ringers Solution Ringers Solution INJ 1000 ML IV 1000 ML

Ringers Solution,Lactated Lactated Ringers INJ 250 ML IV 250 ML

Ringers Solution,Lactated Lactated Ringers INJ 500 ML IV 500 ML

Ringers Solution,Lactated Lactated Ringers IV 1,000 ML IV 1000 ML

Selenium IV Selenium IV IV 40 mcg IV 10 mL

Sodium Acetate Sodium Acetate VIAL 2 MEQ IV 1 ML

Sodium Chloride Sodium Chloride TAB 1 GM PO 1 TAB

Sodium Chloride 0.9 Bacteriost Sodium Chloride 0.9% Bacterios VIAL 30 ML IV 1 VIAL

Sodium Chloride 14.6% Sodium Chloride 14.6% VIAL 2.5 MEQ IV 1 ML

Sodium Chloride 23.4% Sodium Chloride 23.4% HV 1000 MEQ IV 250 ML

Sodium Chloride 3% Sodium Chloride 3% INJ 500 ML IV 500 ML

Sodium Chloride 5% Sodium Chloride 5% INJ 500 ML IV 500 ML

Sodium Cl For Inhalation 0.9% Sodium Chloride 0.9% INH 3 ML RT 1 VIAL

Sodium Cl For Inhalation 0.9% Sodium Chloride 0.9% INH 5 ML RT 1 VIAL

Sodium Phosphate Sodium Phosphate VIAL 4 MEQ IV 1 ML

Zinc Sulfate Zinc-220 (Equiv) CAP 220 MG PO 1 CAP

Zinc Sulfate Zinc Zulfate IV 1 Mg IV 1 mL

Zinc Sulfate Concentrate Zinc Zulfate Concetnrate IV 5 Mg IV 1 mL

Znso4 Hep/Cuso4 P-Hyd/Mn/Cr/Se Multitrace-5 (Equiv) VIAL 1 VIAL IV 10 ML

40:18 Ion Removing Agents Diagnostic Agents

40:18.18 Potassium Removing Agents GENERIC NAME BRAND NAME DOSAGE


Sodium Polystyrene Sulfonate Sps (Equiv) SUSP 15 GM PO 1 BOTTLE

Phosphate Removing Agents40:18.19 GENERIC NAME BRAND NAME DOSAGE


Calcium Acetate Phoslo (Equiv) TAB 667 MG PO 1 TAB

Sevelamer Carbonate Renvela (Equiv) TAB 800 MG PO 1 TAB

40:18.92 Ion-removing Agents,

other GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Ferric hexacyanoferrate (Prussian blue) Radiogardase CAP 0.5 gram PO 1 CAP

40:20.00 Caloric Agents GENERIC NAME BRAND NAME DOSAGE STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

FORMAmino Acids 15% Novamine (Equiv) INJ 500 MG IV 500 ML

Amino Acids 8% Hepatamine 8% (Equv) INJ 500 ML IV 500 ML

Dextrose Glucose Tab (Equiv) TAB 5 GM PO 1 TAB

Dextrose Glucose Gel Gel 40 % PO 50 %

Dextrose 10%-Normal Saline Dextrose 10% Sodium Chloride INJ 1,000 ML IV 1000 ML

Dextrose 10%-Water Dextrose 10% In Water INJ 500 ML IV 500 ML

Dextrose 10%-Water Dextrose 10% In Water INJ 1,000 ML IV 1000 ML

Dextrose 25%-Water Dextrose 25% In Water SYRING 10 ML IV 1 SYRINGE

Dextrose 5%-0.2% Normal Saline Dextrose 5%-0.2% Sodium Chlrde INJ 500 ML IV 500 ML

Dextrose 5%-0.2% Normal Saline Dextrose 5%-0.2% Sodium Chlrde INJ 1,000 ML IV 1000 ML

Dextrose 5%-0.33 Normal Saline Dextrose 5%-0.33 Sodium Chlrde INJ 500 ML IV 500 ML

Dextrose 5%-0.33 Normal Saline Dextrose 5%-0.33 Sodium Chlrde INJ 1,000 ML IV 1000 ML

Dextrose 5%-0.45% Normal Salne Dextrose 5%-0.45% Sod Chloride INJ 250 ML IV 250 ML

Dextrose 5%-0.45% Normal Salne Dextrose 5%-0.45% Sod Chloride INJ 500 ML IV 500 ML

Dextrose 5%-0.45% Normal Salne Dextrose 5%-0.45% Sod Chloride INJ 1,000 ML IV 1000 ML

Dextrose 5%-0.9% Nacl Dextrose 5% / 0.9% Nacl INJ 250 ML IV 250 ML

Dextrose 5%-Normal Saline Dextrose 5% Sodium Chloride INJ 500 ML IV 500 ML

Dextrose 5%-Normal Saline Dextrose 5% Sodium Chloride INJ 1,000 ML IV 1000 ML







Dextrose 5%-Water Dextrose 5% In Water INJ 1,000 ML IV 1000 ML

Dextrose 5%-Water Poly Dextrose 5% In Water Poly INJ 250 ML IV 250 ML

Dextrose 50%-Water Dextrose 50% In Water SYRING 50 ML IV 1 SYRINGE

Ethyl Alcohol/D5w Alcohol In Dextrose INJ 1,000 ML IV 1000 ML

Fatty Acid Solution MCT Oil (oral) PO 14 GRAM PO 15 ML

Fat Emulsions 20% Intralipid 20% (Equiv) EMULSN 1 BAG IV 500 ML

L-cysteine L-Cysteine IV 50 Mg IV 1 mL

40:28 DiureticsGENERIC NAME BRAND NAME DOSAGE


40:28.08 Loop Diuretics Bumetanide Bumex (Equiv) TAB 0.5 MG PO 1 TAB

Bumetanide Bumex (Equiv) TAB 1 MG PO 1 TAB

Bumetanide Bumex (Equiv) VIAL 1 MG IV 4 ML

Bumetanide Bumex (Equiv) VIAL 2.5 MG IV 10 ML

Furosemide Lasix (Equiv) VIAL 100 MG IV 10 ML

Furosemide Lasix (Equiv) TAB 20 MG PO 1 TAB


Furosemide Lasix (Equiv) SOLN 40 MG PO 5 ML

Furosemide Lasix (Equiv) TAB 40 MG PO 1 TAB


40:28.16Potassium Sparing

Diuretics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Amiloride Amiloride TAB 5 MG PO 1 TAB

Triamterene/Hctz 37.5/25 Maxzide-25mg (Equiv) TAB 1 TAB PO 1 TAB

Triamterene/Hctz 75/50 Maxzide (Equiv) 75/50 TAB 1 TAB PO 1 TAB

40:28.20 Thiazide Diuretics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Chlorothiazide Sodium Diuril Sodium (Equiv) VIAL 500 MG IV 20 ML

Hydrochlorothiazide Hydrochlorothiazide TAB 12.5 MG PO 1 TAB

Hydrochlorothiazide Hydrochlorothiazide TAB 25 MG PO 1 TAB

Hydrochlorothiazide Hydrochlorothiazide TAB 50 MG PO 1 TAB

Mannitol 20% Osmitrol (Equiv) 20% INJ 200 MG IV 1 ML

Mannitol 20% Osmitrol 20% (Equiv) INJ 500 ML IV 500 ML

Mannitol 25% Mannitol 25% VIAL 12.5 GM IV 50 ML

40:28.24 Thiazide-like Diuretics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Metolazone Zaroxolyn (Equiv) TAB 2.5 MG PO 1 TAB

40:28.92Diuretics,


Tolvaptan Samsca TAB 15 TAB PO 1 TAB

40:36 Irrigating Solutions GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

40:36.00 Irrigating Solutions Acetic Acid 0.25% Acetic Acid 0.25% IRRIG 1000 ML IRR 1 BOTTLE

Dianeal Lc 1.5% Dianeal Lc 1.5% HY 1 BAG IP 2000 ML




Dianeal W/4.25% Dextrose Dianeal W/4.25% Dextrose HY 483 MOSM IP 1 L

Glycine Glycine IRR 15 mg IRR 1 mL

Lactated Ringers Lactated Ringers IRR IRR 1000 mL



Renacidin Citric acid, magnesium carbonate, glucono-delta-lactone IRR

Citric acid 6.602 g,

magnesium carbonate

3.177 g, andglucono-delta-lactone 0.198

g

IRR 100 mL

Sorbitol Sorbitol IRR 3 % IRR

Water, Sterile Water, Sterile IRR IRR

40:40 Uricosuric Agents

40:40.00 Uricosuric Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Probenecid Probenecid TAB 500 MG PO 1 TAB

44:00 Enzymes

44:00.00 Enzymes GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Dornase alpha Pulmozyme Sol, Inh 1 mg/mL INH 2.5 mL

Hyaluronidase Amphadase VIAL 150 UNIT IM 1 ML

48:00 Antitussives, Expectorants, and Mucolytics Agents

48:08.00Antitussives GENERIC NAME BRAND NAME DOSAGE


Benzonatate Tessalon Perles (Equiv) CAP 100 MG PO 1 CAP

Dextromethorphan Hbr Benylin (Equiv) SYRUP 30 MG PO 10 ML

Guaifenesin/Codeine Phos Robitussin W/ Codeine (Equiv) SYRUP 5 ML PO 5 ML

Guaifenesin/D-Methorphan Hb Humibid Dm 600/30 Mg(Equiv) T SR 12 1 TAB PO 1 T SR 12

Guaifenesin/D-Methorphan Hb Robitussin Dm (Equiv) SYRUP 10 ML PO 10 ML

48:10 Anti-imflammatory Agents (Resp Tract) GENERIC NAME BRAND NAME DOSAGE


Mepolizumab Nucala Vial 100 MG SQ 1 VIAL

48:10.24 Leukotriene Modifiers GENERIC NAME BRAND NAME DOSAGE


Montelukast Sodium Singulair (Equiv) TAB 10 MG PO 1 TAB

48:16.00 Expectorants GENERIC NAME BRAND NAME DOSAGE


Guaifenesin Robitussin (Equiv) SYRUP 100 MG PO 5 ML

Guaifenesin Guaifenesin ST 200 MG PO 10 ML

48:24.00 Mucolytic Agent GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Acetylcysteine Mucomyst 10% (Equiv) VIAL 400 MG MSC 4 ML

Acetylcysteine Mucomyst 20% (Equiv) VIAL 800 MG MSC 4 ML

Acetylcysteine 20% Mucomyst 20% (Equiv) VIAL 6000 MG MSC 30 ML

48:32 Phosphodiesterase

Type 4 Inhibitor GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Roflumilast Daliresp TAB 500 MCG PO 1 TAB

48:36 Pulmonary Surfactants GENERIC NAME BRAND NAME DOSAGE


Poractant Alpha Curosruf Susp 80 mg/mL INH 1.5 mL

Poractant Alpha Curosruf Susp 80 mg/mL INH 3 mL

48:92Respiratory Tract

Agents, Misc. GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Omalizumab Xolair HS 150 MG 1 VIAL

52:00 Eye, Ear, Nose, and Throat (EENT) Preparations

52:02 Anti-allergicAgents GENERIC NAME BRAND NAME DOSAGE


Azelastine (nasal) Astelin (nasal) Solution 137 mcg/mL NAS 30 mL

Optivar Azelastine (Opthalmic) Solution 0.05 % Opth 6 mL

52:04 Anti-infectives52:04.04 Antibacterials GENERIC NAME BRAND NAME DOSAGE


Bacitracin Bacitracin OINT 3.5 GM EYE 1 TUBE

Bacitracin/Polymyxin B Sulfate Polysporin (Equiv) OINT 3.5 GM EYE 1 TUBE

Cipro Otiprio Gel 6 % OTIC 1 inj

CiproDex 0.3 %Ciprofloxaxin /0.1% Dexamethasome Drops 7.5 mL Opth 1 Bottle

Erythromycin Base Erythromycin OINT 1 GM EYE 1 TUBE

Gentamicin Sulfate Gentak (Equiv) OINT 1 APPL EYE 1 APPL

Gentamicin Sulfate Genoptic (Equiv) DROPS 5 ML EYE 1 BOTTLEGentamicin Sulfate 0.3% /

Predisolone 0.6% Pred-G Susp 5 mL EYE 1 Bottle

Moxifloxacin 0.5% Vigamox 0.5% (Equiv) DROPS 3 ML EYE 1 BOTTLE

Na Sulfacetm/Prednisol Ac 0.2% Blephamide 0.2% (Equiv) DROPS 5 ML EYE 1 BOTTLE

Neo/Polymyx B Sulf/Dexameth Maxitrol (Equiv) DROPS 1 APPL EYE 1 Bottle

Neo/Polymyx B Sulf/Dexameth Maxatrol (Equiv) OINT 1 APPL EYE 1 Bottle

Neo/Polymyx B Sulf/HC PediOtic Drops 10 mL EYE 1 Bottle

Neomy Sulf/Bacitra/Polymyxin B Neosporin (Equiv) OINT 1 APPL EYE 1 Bottle

Neomy Sulf/Gramicid D/Poly Neosporin (Equiv) DROPS 1 APPL EYE 1 Bottle

Ofloxacin 0.3% Ocuflox 0.3% (Equiv) DROPS 5 ML EYE 1 BOTTLE

Ofloxacin 0.3% Ocuflox 0.3% (Equiv) DROPS 5 ML EAR 1 BOTTLE

Polymyxin B Sulfate/Tmp Polytrim (Equiv) DROPS 10 ML EYE 1 BOTTLE

Sulfacetamide Sodium 10% Bleph-10 (Equiv) DROPS 15 ML EYE 1 BOTTLE

Sulfacetamide Sodium 10% Sulfacetamide Sodium 10% OINT 3.5 GM EYE 1 TUBE

Tobramycin Sulfate 0.3% Tobrex (Equiv) 0.3% DROPS 5 ML EYE 1 BOTTLE

Tobramycin Sulfate/Dexameth Tobradex (Equiv) DROPS 2.5 ML EYE 1 BOTTLE

Tobramycin Sulfate/Dexameth Tobradex (Equiv) OINT 3.5 GM EYE 1 TUBE

52:04.92 Anti-infectives,


Acetic Acid/Hydrocortisone Viosol Hc (Equiv) DROP 10 ML EAR 1 BOTTLE

Carbamide Peroxide 6.5% Debrox 6.5%(Equiv) DROPS 15 ML EAR 1 BOTTLE

Chlorhexidine Gluconate 0.12% Peridex (Equiv) 0.12% LIQUID 15 ML MM 1 BOTTLE

Povidone-Iodine 5% Betadine 5% (Equiv) SOLN 1 APPL EYE 1 APPL

52:08 Anti-Inflammatory Agents52:08.08 Corticosteroids GENERIC NAME BRAND NAME DOSAGE


Dexamethasone 0.1% Maxidex (Equiv) 0.1% DROPS 5 ML EYE 1 BOTTLE

Fluorometholone 0.1% Fluor-Op (Equiv) 0.1% DROPS 5 ML EYE 1 BOTTLE

Fluorometholone 0.25% Fml Forte (Equiv) 0.25% DROPS 5 ML EYE 1 BOTTLE

Fluticasone Propionate Flonase (Equiv) SPRAY 50 MCG NAS 1 SPRAY

Prednisolone Acetate 1% Pred Forte 1% (Equiv) DROPS 5 ML EYE 1 BOTTLE

52:08.20 Nonsteroidal Anti-Inflammatory Agents GENERIC NAME BRAND NAME DOSAGE


Flurbiprofen Sodium 0.03% Ocufen 0.03% (Equiv) DROPS 2.5 ML EYE 1 BOTTLE Ketorolac Tromethamine 0.45% Acular 0.45% (Equiv) DROPS 3 ML EYE 1 BOTTLE

Non stocked Phenylephrine/Ketorolac Omidria (Equiv)

52:10

Carbonic Anhydrase Inhibitors

52:10.00 Carbonic Anhydrase Inhibitors GENERIC NAME BRAND NAME DOSAGE


Acetazolamide Diamox (Equiv) TAB 250 MG PO 1 TAB

Acetazolamide Diamox Sequels (Equiv) SR CAPS 500 MG PO 1 SR CAP

Acetazolamide Sodium Diamox (Equiv) VIAL 500 MG IV 1 VIAL

Dorzolamide HCl 2% Trusopt (Equiv) 2% DROPS 5 ML EYE 1 BOTTLE

52:16 Local Anesthetics52:16.00 Local Anesthetics GENERIC NAME BRAND NAME DOSAGE


Cetylpyridinium/Menthol Cepacol (Equiv) LOZ 9 LOZ MM 1 PACKAGE

Cocaine HCl 4% Cocaine HCl 4% SOLN 4 ML TOP 1 BOTTLE

Lidocaine HCl 2% Xylocaine 2% (Equiv) JEL 1 APPL MM 1 APPL

Lidocaine HCl 2% Lidocaine HCl 2% JEL 200 MG MM 10 ML

Lidocaine HCl 4% Lidocaine HCl 4% SOLN 1 APPL MM 1 APPL

Lidocaine HCl Viscous 2% Lidocaine HCl Viscous 2% SOLN 20 ML MM 1 BOTTLE

Proparacaine HCl 0.5% Alcaine 0.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE

Tetracaine HCl 0.5% Tetracaine HCl 0.5% (Equiv) DROPS 2 ML EYE 1 BOTTLE

52:20 Miotics52:20.00 Miotics GENERIC NAME BRAND NAME DOSAGE


Acetylcholine Chloride Miochol-E (Equiv) DROPS 2 ML INT 1 BOTTLE

Carbachol 1.5% Isopto Carbachol 1.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE

Carbachol 3% Isopto Carbachol 3% (Equiv) DROPS 15 ML EYE 1 BOTTLE

Pilocarpine 0.5% Pilocar 0.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE

Pilocarpine 1% Pilocar 1% (Equiv) DROPS 2 ML EYE 1 BOTTLE

Pilocarpine 2% Pilocar 2% (Equiv) DROPS 2 ML EYE 1 BOTTLE

Pilocarpine 3 Pilocar 3% (Equiv) DROPS 15 ML EYE 1 BOTTLE

Pilocarpine HCl 4% Gel Pilopine Hs Gel (Equiv) 4% GEL 4 GM EYE 1 PACKAGE

52:24 Mydriatics52:24.00 Mydriatics GENERIC NAME BRAND NAME DOSAGE


Atropine Sulfate 1% Atropine 1% DROPS 2 ML EYE 1 BOTTLE

Atropine Sulfate 1% Atropine Sulfate 1% OINT 3.5 GM EYE 1 TUBE

Cyclopentolate HCl 1% Cyclogyl (Equiv) 1% DROPS 2 ML EYE 1 BOTTLE

Cyclopentolate HCl 2% Cyclogyl (Equiv) 2% DROPS 2 ML EYE 1 BOTTLE

Homatropine Hbr 5% Homatropine 5% DROPS 15 ML EYE 1 BOTTLE

Scopolamine Hydrobromide 0.25% Isopto Hyoscine 0.25% (Equiv) DROPS 5 ML EYE 1 BOTTLE

Tropicamide 0.5% Mydriacyl 0.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE

Tropicamide 1% Mydriacyl 1% (Equiv) DROPS 3 ML EYE 1 BOTTLE

52:28.00 Mouthwashes and

Gargles GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Hydrogen Peroxide 3% Hydrogen Peroxide 3%

52:32 Vasoconstrictors52:32.00 Vasoconstrictors GENERIC NAME BRAND NAME DOSAGE


Epinephrine 1:1,000 Nasal Adrenalin Chloride Nasal (Equi SOLN 30 ML NAS 1 BOTTLE

Naphazoline HCl Naphcon Forte (Equiv) DROPS 15 ML EYE 1 BOTTLE

Oxymetazoline HCl 0.05% Afrin (Equiv) 0.05% SPRAY 15 ML NAS 1 BOTTLE

Phenylephrine HCl Mydfrin (Equiv) DROPS 3 ML EYE 1 BOTTLE

Phenylephrine HCl Ak-Dilate (Equiv) DROPS 5 ML EYE 1 BOTTLE

Phenylephrine Drops 0.5% Neo-Synephrine Drops (Equiv) DROPS 1 APPL MUC 1 APPL

Phenylephrine Spray 0.5% Neo-Synephrine Spray (Equiv) NASAL 1 APPL MUC 1 APPL

Tetrahydrozoline HCl 0.05% Visine 0.05% (Equiv) DROPS 15 ML EYE 1 BOTTLE

52:92 EENT Drugs, Miscellaneous

52:92.00 EENT Drugs Miscellaneous GENERIC NAME BRAND NAME DOSAGE


Apraclonidine HCl 1% Iopidine 1% (Equiv) DROPER 0.1 ML EYE 1 BOTTLE

Betaxolol HCl 0.5% Betoptic S 0.25% (Equiv) DROPS 2.5 ML EYE 1 BOTTLE

Botulinum Toxin Type A Botox (Equiv) VIAL 100 UNITS IM 1 ML

Brimonidine Tartrate 0.15% Alphagan P 0.15% (Equiv) SO 5 ML EYE 1 BOTTLE

Carteolol Ocupress Drops 1 % EYE 1 Bottle

Gelatin Gelfilm EA 1 EACH EYE 1 EACH

Hypromellose 2.5% Gonak 2.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE

Lanolin/Min Oil/Petrolat,Wht Artificial Tears (Equiv) PACKET 3.5 GM EYE 1 TUBE

Latanoprost 0.005% Xalatan 0.005% (Equiv) DROPS EYE

Levobunolol HCl 0.5% Betagan 0.5% (Equiv) DROPS 5 ML EYE 1 BOTTLE

52:92.00 EENT Drugs Miscellaneous GENERIC NAME BRAND NAME DOSAGE


Polyvinyl Alcohol Artificial Tears (Equiv) DROPS 15 ML EYE 1 BOTTLE

Sodium Chloride 0.65% Ocean 0.65% (Equiv) SPRAY 45 ML NAS 1 BOTTLE

Sodium Chloride gel Ayr Saline Gel Gel 14.1 Gram EYE 1 BOTTLE

Sodium/Potassium/Cal/Magnesium Bss (Equiv) SOLN 15 ML EYE 1 BOTTLE

Sodium/Potassium/Sod Chl Dacriose (Equiv) DROPS 120 ML EYE 1 BOTTLE

Timolol Maleate 0.25% Timoptic 0.25% (Equiv) DROPS 5 ML EYE 1 BOTTLE

Timolol Maleate 0.5% Timoptic 0.5% (Equiv) DROPER 0.45 ML EYE 1 DROPER

Timolol Maleate 0.5% Timoptic 0.5% (Equiv) DROPS 5 ML EYE 1 BOTTLE

56:00 Gastrointestinal Drugs

56:04:00 Antacids and Adsorbents GENERIC NAME BRAND NAME DOSAGE


Activated Charcoal Actidose-Aqua (Equiv) LIQUID 50 GM PO 1 TUBE

Calcium Carb 1250 mg (Equiv) Calcium Carb 1250 mg (Equiv) Tablet 1250 Tablet PO 1 PACKAGE

Calcium Carb 1250 mg / 5 mL (Equiv) Calcium Carb 1250 mg / 5 mL (Equiv) Chew Tablet 5 mL PO 1 PACKAGE

Charcoal/Sorbitol Solution Actidose / Sorbitol (Quiv) LIQUID 50 GM PO 1 TUBE

Mag Hydrox/Al Hydrox/Simeth Maalox Plus Ex Strgth (Equiv) SUSP 30 ML PO 30 ML

Magnesium Oxide Mag Ox (Equiv) TAB 400 MG PO 1 TAB

Mg Trisilicate/Alh/Nahco3/Aa Gaviscon (Equiv) CHWTAB 1 EACH PO 1 CHWTAB

Mylanta/Lido Visc/Donnatol Gi Cocktail SC 1 EA PO 50 ML

Sodium Bicarbonate Sodium Bicarbonate TAB 325 MG PO 1 TAB

56:08.00 Antidiarrhea Agents GENERIC NAME BRAND NAME DOSAGE


Bismuth Subsalicylate Pepto Bismol (Equiv) SUSP 262 MG PO 15 ML

Diphenoxylate HCl/Atrop Sulf Lomotil (Equiv) TAB 1 EACH PO 1 TAB

Diphenoxylate HCl/Atrop Sulf Diphenoxylate W/Atropine LIQUID 5 ML PO 1 EACH

Loperamide HCl Imodium(Equiv) LIQUID 1 MG PO 5 ML

Loperamide HCl Imodium (Equiv) CAP 2 MG PO 1 CAP

Paregoric Paregoric LIQUID 2 MG PO 5 ML

56:10.00 Antiflatulents GENERIC NAME BRAND NAME DOSAGE


Simethicone Gas-X (Equiv) CHWTAB 80 MG PO 1 CHWTAB

Simethicone 40mg/0.6ml Mylicon (Equiv) DROPS 1 BOTTLE PO 30 ML

56:12.00 Cathartics and

Laxatives GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Bisacodyl Dulcolax (Equiv) SUPP 10 MG REC 1 SUPP

Bisacodyl Dulcolax (Equiv) ECTAB 5 MG PO 1 ECTAB

Calcium Polycarbophil Fibercon (Equiv) TA 625 MG PO 1 TAB

Docusate Sodium Colace (Equiv) LIQUID 100 MG PO 10 ML

Docusate Sodium Colace (Equiv) CAP 100 MG PO 1 CAP

Glycerin Anhydrous 99.5% Glycerin Anhydrous 99.5% Liquid 1 Each

Glycerin Glycerin Top

Glycerin Glycerin (Equiv) SUPP 1 SUPP REC 1 SUPP

Glycerin Child Glycerin Child (Equiv) SUPP 1 SUPP REC 1 SUPP

Magnesium Chloride Mag Delay (Equiv) SR TAB 64 MG PO 1 SR TAB

Magnesium Citrate Citrate Of Magnesia SOLN 10 OZ PO 1 BOTTLE

Magnesium Hydroxide Milk Of Magnesia Conc. (Equiv) SUSP 2400 MG PO 10 ML

Psyllium Metamucil (Equiv) 654 MG PO 5.8 GM

Psyllium Wafers (Equiv) Metamucil Wafers (Equiv) PKG 3.4 GM PO 2 WAFERS

Sennosides Senokot (Equiv) TAB 8.6 MG PO 1 TAB

Sennosides/Docusate Sodium Senokot-S (Equiv) TAB 1 TAB PO 1 TAB

Sod Sulf/Sod/Nahco3/Kcl/Peg's Golytely (Equiv) SOL REC 4000 ML PO 1 BOTTLE

Sorbitol Solution 70% Sorbitol 70% (Equiv) SOLN 30 ML MSC 1 CUP

56:14.00 Cholelitholytic Agents GENERIC NAME BRAND NAME DOSAGE


Nonstocked Ursodiol Ursodiol CAP 300 MG PO 1 CAPNonstocked Ursodiol Ursodiol SUSP 20 MG PO 1 ML

56:16.00 Digestants GENERIC NAME BRAND NAME DOSAGE


Amylase/Lipase/Protease Creon 6 (Equiv) CAP EC 1 EACH PO 1 CAP EC

Amylase/Lipase/Protease Creon 24 (Equiv) CAP EC 1 EACH PO 1 CAP EC

56:22 Antiemetics

56:22.08 Antihistamines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Meclizine HCl Antivert (Equiv) TAB 12.5 MG PO 1 TAB

Meclizine HCl Antivert (Equiv) TAB 25 MG PO 1 TAB

Prochlorperazine Edisylate Compazine (Equiv) VIAL 10 MG IV 2 ML

Prochlorperazine Maleate Compazine (Equiv) TAB 10 MG PO 1 TAB

Prochlorperazine Maleate Compazine (Equiv) TAB 5 MG PO 1 TAB

Prochlorperazine Maleate Compazine (Equiv) SUPP 25 MG REC 1 SUPP

56:22.20 5-HT3 Receptor Antagonists GENERIC NAME BRAND NAME DOSAGE


Ondansetron HCl Zofran (Equiv) VIAL 4 MG IV 2 ML

Ondansetron HCl Zofran (Equiv) VIAL 40 MG IV 20 ML

Ondansetron HCl Zofran (Equiv) SOLN 4 MG PO 5 ML

Ondansetron HCl Zofran (Equiv) TAB 8 MG PO 1 TAB

Palonosetron HCl Aloxi (Equiv) HV 0.25 MG IV 5 ML

56:22.92 Antiemetics,

miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Dronabinol Marinol (Equiv) CA 2.5 MG PO 1 CAPSULE

Fosapreptitant Emend for Innjection (Equiv) Vial 115 MG IV 1 Vial

56:28 Antiulcer Agents

and Acid

Suppressants56:28.12 Histamine

H2-blockers GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Famotidine Pepcid (Equiv) TAB 20 MG PO 1 TAB

Famotidine Pepcid (Equiv) VIAL 20 MG IV 2 ML

Famotidine Pepcid (Equiv) VIAL 40 MG IV 4 ML

56:28.12 Histamine H2-blockers GENERIC NAME BRAND NAME DOSAGE


Restricted to Neonates Ranitidine Zantac Suspension Susp 15 mg PO 1 mLRestricted to Neonates Ranitidine IV Zantac IV Vial 25 mg IV 1 mL

56:28.28 Prostaglandins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Misoprostol Cytotec (Equiv) TAB 200 MCG PO 1 TAB

56:28.32 Protectants GENERIC NAME BRAND NAME DOSAGE


Sucralfate Carafate (Equiv) SUSP 1 GM PO 10 ML

Sucralfate Carafate (Equiv) TAB 1 GM PO 1 TAB

56:28.36 Proton-Pump


Pantoprazole Suspension Protonix Suspension (equiv) UJ 40 MG NG 1 PACKET

Pantoprazole I.V. Protonix I.V. (equiv) VIAL 40 MG IV 1 VIAL

Pantoprazole Protonix (equiv) CAP 20 MG PO 1 CAP

Pantoprazole Protonix (equiv) CAP 40 MG PO 1 CAP

56:32 Prokinetic Agents

56:32.00 Prokinetic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Metoclopramide HCl Reglan (Equiv) VIAL 10 MG IV 2 ML

Metoclopramide HCl Reglan (Equiv) TAB 5 MG PO 1 TAB

Metoclopramide HCl Reglan (Equiv) TAB 10 MG PO 1 TAB

Metoclopramide HCl Reglan (Equiv) SOLN 10 MG PO 10 ML

56:36 Anti-

Inflammatory Agents

56:36.00 Anti-Inflammatory Agents GENERIC NAME BRAND NAME DOSAGE


Non-stocked Balsalazide Colazal Cap 750 MG PO 1 CAP

Mesalamine Rowasa (Equiv) ENEMA 4 GM REC 60 ML

Mesalamine Delzicol (Equiv) ECTAB 400 MG PO 1 ECTAB

Non-stocked Mesalamine Apriso (Equiv) DR/ERCap 0.375 G PO 1 Delayed And ExtendedRelease Capsules

Non-stocked Mesalamine Canasa (Equiv) Supp 1000 mg REC 1 Supp

Non-stocked Mesalamine Lialda (Equiv) EC Tab 1.2 G PO 1 Tab

56:92 GI Drugs,

Miscellaneous56:92.00 GI Drugs,


Alvimopan Entereg Capsule 12 MG PO 1 Capsule

Stocked in Shelby

Non-stock MansfieldMethylnaltrexone Bromide Relistor Vial 12 MG SQ 0.6 ML

Naloxego Movantik TAB 12.5 MG PO 1 TAB

Naloxego Movantik TAB 25 MG PO 1 TAB

Saliva Substitute Biotene Spray 1 Appl MM 1 APPL

Vedolizumab Entyvio Vial 300 MG IV 1 Vial

64:00 Heavy Metal Antagonists

64:00.00Heavy Metal Antagonists


Deferoxamine Mesylate Desferal Mesylate (Equiv) VIAL 500 MG IV 5 ML

Dimercaprol Bal In Oil (Equiv) INJ 300 MG IM 3 ML

Edetate Calcium Disodium Calcium Disodium Versent(Equiv INJ 1000 MG IV 5 ML

Hydroxocobalamin Cyanokit 1 KIT IV 1 KIT

Sodium Thiosulfate 25% Sodium Thiosulfate 25% VIAL 50 ML IV 1 VIAL

68:00 Hormones and Synthetic Substitutes

68:04 Adrenals

68:04.00 Adrenals GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Betamet Acet/Betamet Na Ph Celestone (Equiv) VIAL 30 MG IM 5 ML

Budesonide Entocort (Equiv) CAP 3 MG PO 1 CAP

Cortisone Acetate Cortisone Acetate TAB 25 MG PO 1 TAB

Dexamethasone Decadron (Equiv) TAB 0.75 MG PO 1 TAB

Dexamethasone Decadron (Equiv) TAB 2 MG PO 1 TAB

Dexamethasone Decadron (Equiv) TAB 4 MG PO 1 TAB

Dexamethasone Sod Phosphate Decadron (Equiv) VIAL 10 MG IV 1 ML



Fludrocortisone Acetate Florinef Acetate (Equiv) TAB 0.1 MG PO 1 TAB

Fluticasone Propionate 110 Mcg Flovent 110mcg (Equiv) AER 110 MCG RT 1 PUFF

Fluticasone Propionate 220 Mcg Flovent 220 Mcg(Equiv) AER 220 MCG RT 1 PUFF

Hydrocortisone Cortef (Equiv) TAB 10 MG PO 1 TAB

Hydrocortisone Sod Succinate Solu-Cortef (Equiv) VIAL 100 MG IV 2 ML

Hydrocortisone Sod Succinate Solu-Cortef (Equiv) VIAL 1000 MG IV 8 ML

Methylprednisolone Medrol (Equiv) TAB 4 MG PO 1 TAB

Methylprednisolone Acetate Depo-Medrol (Equiv) VIAL 40 MG IM 1 ML

Methylprednisolone Acetate Depo-Medrol (Equiv) VIAL 80 MG IM 1 ML

Methylprednisolone Sod Succ Solu-Medrol (Equiv) VIAL 1000 MG IV 8 ML




Prednisolone Prelone (Equiv) SYRUP 15 MG PO 5 ML

Prednisolone Prednisolone TAB 5 MG PO 1 TAB

Prednisolone Sod Phosphate Pediapred (Equiv) SOLN 5 MG PO 5 ML

Prednisone Prednisone TAB 10 MG PO 1 TAB

Prednisone Prednisone TAB 2.5 MG PO 1 TAB


Prednisone Prednisone CUP 5 MG PO 5 ML



Triamcinolone Acetonide Kenalog-40 (Equiv) VIAL 40 MG IM 1 ML

68:08 Androgens68:08.00 Androgens GENERIC NAME BRAND NAME DOSAGE


Danazol Danocrine (Equiv) CAP 200 MG PO 1 CAP

Me-Testosterone/Estrogen,Ester Estratest (Equiv) TAB 1 TAB PO 1 TAB

Nandrolone Deca-Durabolin INJ

68:12 Contraceptives68:12.00 Contraceptives GENERIC NAME BRAND NAME DOSAGE


Non-stocked Etonogestrel Nexplanon Implant

Levonorgestrel 0.75 Mg Plan B (Equiv) 0.75 Mg TAB 2 TAB PO 1 PACKAGE

Levonorgesterol IUD Mirena IUD IUD

Norgestrel-Ethinyl Estradiol Ovral-28 (Equiv) TAB 1 TAB PO 1 PACKAGE

68:16 Estrogens and

Anti-Estrogens

68:16.04 Estrogens GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Estradiol Estraderm (Equiv) PAT TDW 0.05 MG/24h TD 1 PAT TD

Estradiol Estraderm (Equiv) PAT TDW 0.1 MG/24h TD 1 PAT TD

Estradiol Estrace (Equiv) TA 1 MG PO 1 TAB

Estradiol Valerate Delestrogen (Equiv) VIAL 100 MG IM 5 ML

Estrogens,Conjugated Premarin (Equiv) TAB 0.3 MG PO 1 TAB



Estrogens,Conjugated Premarin (Equiv) CRM 1 APPL VAG 1 APPL


Estrogens,Conjugated Premarin (Equiv) VIAL 25 MG IV 5 ML

Estropipate Ogen 0.625 (Equiv) TAB 0.75 MG PO 1 TAB

68:18 Gonadotropins

68:18.00 Gonadotropins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Gonadotropin,Chorionic,Human Novarel (Equiv) HS 10000 UNIT 1 VIAL

68:20 Antidiabetic68:20.02 α-glucosidase

inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Non-stocked Acarbose Precise TAB 25 MG PO 1 TAB

Non-stocked Acarbose Precise TAB 25 MG PO 1 TAB

68:20.04 Biguanides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Metformin HCl Glucophage (Equiv) TAB 500 MG PO 1 TAB

Metformin HCl Glucophage (Equiv) TAB 850 MG PO 1 TAB

68:20.05 Dipeptidyl Peptidase-4 Inhibitors


Sitagliptin Januvia Tab 25 MG PO 1 TAB



68:20.06 Incretin Mimetics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Exenatide Byetta Pen 5 Mcg SQ 1.2 mL

Exenatide Byetta Pen 10 Mcg SQ 2.4 mL

68:20.08 Insulins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Insulin 70/30 Humulin 70/30 (Equiv) VIAL 100 UNITS SUB 1 ML

Insulin NPH Human Recom Humulin N (Equiv) VIAL 100 UNITS SUB 1 ML

Insulin Reg Human (Novolin) Humulin R (Equiv) VIAL 100 UNITS SQ 1 ML

Insulin Reg Human IV Additive Humulin R (Equiv) IV Additive HV 100 UNITS INJ 1 ML

Insulin Lispro Humalog (Equiv) HV 100 UNITS SQ 1 ML

Insulin Glargine Lantus(Equiv) Pen 100 UNITS SUB 1 ML

68:20.16 Metglitinides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Nateglinide Starlix (Equiv) TAB 120 MG PO 1 TAB

Non-stocked Repaglinide Prandin (Equiv) TAB 0.5 MG PO 1 TAB

Non-stocked Repaglinide Prandin (Equiv) TAB 1 MG PO 1 TAB

Non-stocked Repaglinide Prandin (Equiv) TAV 2 MG PO 1 TAB

68:20.20 Sulfonylureas GENERIC NAME BRAND NAME DOSAGE


Glimepiride Amaryl (Equiv) TAB 1 MG PO 1 TAB



Glipizide Glucotrol Xl (Equiv) TAB SA 5 MG PO 1 TAB SA

Glipizide Glucotrol Xl (Equiv) TAB SA 2.5 MG PO 1 TAB SA

Glipizide Glucotrol (Equiv) TAB 5 MG PO 1 TAB

Glipizide Glucotrol (Equiv) TAB 10 MG PO 1 TAB

Glyburide Diabeta/Micronase (Equiv) TAB 2.5 MG PO 1 TAB

Glyburide Diabeta/Micronase (Equiv) TAB 5 MG PO 1 TAB

68:20.28 Thiazolidinediones GENERIC NAME BRAND NAME DOSAGE


Pioglitazone Actos (Equiv) TAB 15 MG PO 1 TAB



68:22Antihypoglycemic Agents

68:22.12 Glycogenolytic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Glucagon,Human Recombinant Glucagon (Equiv) KIT 1 MG IV 1 KIT

68:24 Parathyroid68:24.00 Parathyroid GENERIC NAME BRAND NAME DOSAGE


Calcitonin,Salmon,Synthetic Miacalcin (Equiv) SPRAY 200 IU NAS 1 SPRAY

Calcitonin,Salmon,Synthetic Miacalcin (Equiv) VIAL 400 UNITS SQ 2 ML

68:28 Pituitary68:28.00 Pituitary GENERIC NAME BRAND NAME DOSAGE


Desmopressin Acetate Ddavp Rhinal Tube (Equiv) SOLN 0.25 MG NAS 2.5 ML

Desmopressin Acetate Ddavp (Equiv) INJ 4 MCG IV 1 ML

Vasopressin Pitressin (Equiv) VIAL 20 UNITS IV 1 ML

68:32 Progestins68:32.00 Progestins GENERIC NAME BRAND NAME DOSAGE


Medroxyprogesterone Acet Depo-Provera (Equiv) VIAL 150 MG IM 1 ML

Medroxyprogesterone Acet Provera (Equiv) TAB 2.5 MG PO 1 TAB

Medroxyprogesterone Acet Depo-Provera (Equiv) VIAL 400 MG IM 1 ML

Medroxyprogesterone Acet 10mg Provera (Equiv) TAB 10 MG PO 1 TAB

Non-stocked Norethindrone Aygestin (Equiv) TAB 5 MG PO 1 TAB

Non-stocked Progresterone Vaginal Gel Progesterone Vaginal Gel Gel 8%

68:36

Thyroid and Antithyroid Agents

68:36.04 Thyroid Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Levothyroxine Sodium Synthroid (Equiv) TAB 25 MCG PO 1 TAB







Levothyroxine Sodium Synthroid (Equiv) VIAL 200 MCG IV 5 ML

Liothyronine Cytomel (Equiv) Tablet 50 mcg PO 1 Tablet

Thyroid Armour Thyroid (Equiv) TAB 30 MG PO 1 TAB

68:36.08 Antithyroid Agents GENERIC NAME BRAND NAME DOSAGE


Methimazole Tapazole (Equiv) TAB 10 MG PO 1 TAB

Potassium Iodide 1gm/1ml Sski (Equiv) SOLN 30 ML PO 30 ML

Non-stocked Potassium Iodide and Iodine 5% Lugol’s Solution SOLN

Propylthiouracil Propylthiouracil TAB 50 MG PO 1 TAB

72:00 Local Anesthetics

72:00.00 Local Anesthetics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Bupivacaine 0.25% Marcaine 0.25% (Equiv) VIAL 2.5 MG IV 1 ML

Bupivacaine 0.25% Mpf Marcaine 0.25% Mpf (Equiv) VIAL 2.5 MG IV 1 ML

Bupivacaine 0.25% Mpf Marcaine 0.25% Mpf (Equiv) VIAL 2.5 MG IM 1 ML

Bupivacaine 0.5% Mpf Marcaine 0.5% Mpf (Equiv) VIAL 5 MG IV 1 ML

Bupivacaine 0.5% Mpf Marcaine 0.5% Mpf (Equiv) VIAL 5 MG IM 1 ML

Bupivacaine 0.75% Mpf Marcaine 0.75% Mpf (Equiv) VIAL 7.5 MG IM 1 ML

Bupivacaine Spinal/Mpf Marcaine Spinal Mpf 0.75%(Eqv) INJ 7.5 MG IV 1 ML

Non-stocked Bupivacaine (D8.25W PM) Bupivacaine (D8.25W PM)

Bupivacaine/Epi 0.25% Marcaine/Epi 0.25% (Equiv) HV 1 VIAL IM 50 ML

Bupivacaine/Epi 0.25% Mpf Marcaine /Epi 0.25% Mpf(Equiv) VIAL 1 VIAL IM 30 ML

Bupivacaine/Epi 0.5% Mpf Marcaine/Epi 0.5% Mpf (Equiv) VIAL 1 VIAL IM 30 ML

Chloroprocaine 3% Mpf Nesacaine 3% Mpf (Equiv) VIAL 1 VIAL IV 30 ML

Lidocaine 0.5% Xylocaine (Equiv) 0.5% HV 1 VIAL IM 50 ML

Lidocaine 0.5% Mpf Xylocaine Mpf (Equiv) 0.5% VIAL 1 VIAL IV 50 ML

Lidocaine 1.5% Mpf Dex. 7.5% Xylocaine 1.5% Mpf/Dex (Equiv INJ 1 AMPULE IV 2 ML

Lidocaine 2%/Epi 1:50,000 Mpf Xylocaine 2%/Epi 1:50,000 Mpf HV 1 VIAL IV 20 ML

Lidocaine HCl 0.5%/Epi Xylocaine 0.5% W/Epin (Equiv) VIAL 1 VIAL IM 50 ML

Lidocaine HCl 1% Lidocaine HCl 1% VIAL 1 VIAL IM 20 ML


Lidocaine HCl 1% Mpf Xylocaine-Mpf 1% (Equiv) INJ 1 AMPULE IV 2 ML

Lidocaine HCl 1% Mpf Xylocaine 1% Mpf (Equiv) VIAL 1 VIAL IM 30 ML

Lidocaine HCl 1% Mpf/Epi Xylocaine 1% Mpf W/Epi (Equiv VIAL 1 VIAL IM 30 ML

Lidocaine HCl 1%/Epi Xylocaine HCl 1% W/Epi (Equiv) VIAL 1 VIAL IM 20 ML

Lidocaine HCl 1.5% Mpf Xylocaine-Mpf 1.5% (Equiv) VIAL 1 AMPULE IM 20 ML

Lidocaine HCl 1.5% Mpf/Epi Xylocaine 1.5% Mpf W/Epi (Equi VIAL 1 VIAL IM 30 ML



Lidocaine HCl 2%/Epi 1:100000 Xylocaine 2% W/Epi (Equiv) VIAL 1 VIAL IM 20 ML

Lidocaine HCl 2%Epi 1:200000 Xylocaine 2% Mpf W/Epi (Equiv) VIAL 1 VIAL IV 20 ML


Non-stocked Lidocaine 4%-LMX-4 Kit Lidocaine 4%-LMX-4 Kit Kit 1 KIT TOP

Non-stocked Lidocaine 5% Lidocaine 5% OINT 1 APPL TOP 1 APPL

Lidocaine HCl 5% Mpf /D7.5w Lidocaine 5% Mpf / Dex 7.5% INJ 1 AMPULE INT 2 ML

Mepivacaine HCl 1.5% Mpf Carbocaine 1.5% Mpf (Equiv) VIAL 15 MG IM 1 ML

Non-stocked Chloroprocaine 2% Chloroprocaine 2% Vial

Non-stocked Chloroprocaine 3% Chloroprocaine 3% Vial

Ropivacaine HCl Naropin (Equiv) HH 40 MG INJ 20 ML

Ropivacaine HCl Naropin (Equiv) HV 150 MG INJ 30 ML

Ropivacaine HCl Naropin (Equiv) INFUS 200 MG IV 100 ML

Ropivacaine PM Naropin PM (Equiv) BAG 150 MG IV 75 ML

Tetracaine HCl 1% Pontocaine 1% (Equiv) INJ 20 MG IV 2 ML

76:00 Oxytocics 76:00.00 Oxytocics GENERIC NAME BRAND NAME DOSAGE


Carboprost Tromethamine Hemabate (Equiv) INJ 250 MCG IM 1 ML

Dinoprostone Cervidil (Equiv) SUP VA 10 MG VAG 1 QC

Dinoprostone Prostin E2 (Equiv) SUP VAG 20 MG VAG 1 SUP VA

Methylergonovine Maleate Methergine (Equiv) TA 0.2 MG PO 1 TAB

Methylergonovine Maleate Methergine (Equiv) INJ 0.2 MG IV 1 ML

Oxytocin Pitocin (Equiv) VIAL 10 UNITS IV 1 ML

80:00 Serums, Toxoids, and Vaccines

80:04.00 Antitoxins and Immune Globulins GENERIC NAME BRAND NAME DOSAGE


Antivenin (Latrodectus mactans) Antivenin Vial 6000 Unites IM/IV 1 VIALCrotalinae Polyvalent Immune Fab

(Ovine) CroFab Vial IV 1 Vial

Digoxin Immune Fab Digifab (Equiv) HS 40 MG 1 VIAL

Digoxin Immune Fab Digibind (Equiv) VIAL 40 MG IV 1 VIAL

Hepatitis B Immune Globulin Hepatitis B Immune Globulin HQ 0.5 ML IM 1 SYRINGE

Hepatitis B Immune Globulin Bayhep B (Equiv) VIAL 5 ML IM 1 VIAL

Immu Globulin,Gamma (Igg) Iveegam En (Equiv) VIAL 1 GM IV 10 ML

Immune Globgam Caprlte(Igg)10% Gamunex (Equiv)10% VIAL 1000 MG IV 10 ML

Rabies Immune Globulin Imogam Rabies-Ht (Equiv) VIAL 1500 UNITS IM 10 ML

Rabies Immune Globulin Imogam Rabies-Ht (Equiv) VIAL 300 UNITS IM 2 ML

Rho(D) Immune Globulin Rhophylac (Equiv) VIAL 300 MCG IV 2 ML

Rho(D) Immune Globulin Rhophylac (Equiv) VIAL 1500 UNITS IV 1 VIAL

Tetanus Immune Globulin Baytet (Equiv) SYRING 250 UNITS IM 1 SYRING

Varicella Immune Globulin VariZIG Vial 625 UNITS IM 1 VIAL

Zoster Zostavax Vial 1 EACH SQ 0.5 ML

80:08.00 Toxiods GENERIC NAME BRAND NAME DOSAGE


Diphth,Pertuss(Acell),Tet Ped Daptacel HV 0.5 ML IM 1 VIAL

Tetanus Toxoid,Fluid Tetanus Toxoid (Equiv) SYRING 5 ML IM 1 SYRINGE

Tetanus,Diphtheria Toxoid Adul Diphtheria-Tetanus Toxoid Adlt VIAL 0.5 ML IM 0.5 ML

Tetanus,Diphtheria Toxoid Ped Diphtheria-Tetanus Toxoid Ped HV 1 VIAL IM 0.5 ML

80:12.00 Vaccines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Bcg Live Tice Bcg Live HS 50 MG 1 VIALDtap, poliovirus, haemophilus b

conjugate Pentecel Vial 1 EACH IM 0.5 mL vial

Haemoph B Polysac Conj-Tet Tox Acthib (Equiv) HS 10 MCG 1 VIAL

Hepatitis A (Adult) Vaqta Vial 1 EACH IM 0.5 mL vial

Hepatitis A (Pediatric) Vaqta Vial 1 EACH IM 0.5 mL vial

Hep B Vir Vacc Recomb Engerix-B (Equiv) VIAL 10 MCG IM 1 ML

Hep B Vir Vacc Recomb Recombivax Hb (Equiv) HV 5 MCG IM 0.5 ML

Influenza Virus Triv-Surf-Pure Flu Vaccine (Equiv) SYRING 1 SYRINGE IM 0.5 ML

Measles,Mumps&Rubella Vaccine M-M-R Ii Vaccine W/Dil (Equiv) VIAL 1 VIAL SUB 1 VIAL

Meningococcal Vac A,C,Y,W-135 Menomune-A/C/Y/W-135 (Equiv) HS 1 EACH SQ 1 VIAL

Meningococcal b vacc,4-comp/pf BEXSERO VIAL 1 EACH SQ 1 VIAL

Papillomavirus Gardasil Vial 1 EACH IM 1 VIAL

Pneumococcal 23-Val P-Sac Vac Pneumovax 23 Equiv) VIAL 0.5 ML IM 1 VIAL

Pneumococcal 23-Val P-Sac Vac Prevnar 13 (Equiv) Vial 0.5 mL IM 1 Vial

Rabies Vac,Pf Chick-Emb Cell Rabavert (Equiv) YK 2.5 UNIT IM 1 KIT

Rabies Vaccine,Human Diploid Imovax Rabies Vaccine (Equiv) VIAL 2.5 UNITS IM 1 ML

Rotavirus Vaccine RotaTeq®; SUSP 1 EACH PO 2.5 ML

Rubella Vaccine Meruvax Ii Vaccine W/Dil(Equiv VIAL 0.5 ML SUB 1 VIAL

Tetanus-diphtheria-pertussis Adacel SYRINGE 0.5 ML IM 1 Vial

Varicella Varivax Vial 1 EACH SQ 1 VIAL

84:00 Skin and Mucous Membrane Agents

84:04 Anti-Infectives84:04.04 Antibacterials GENERIC NAME BRAND NAME DOSAGE


Bacitracin Zinc Bacitracin Zinc OINT 1 APPL TOP 1 APPL

Bacitracin/Polymyxin B Sulfate Polysporin (Equiv) PA 1 APPL TOP 1 APPL

Non-stocked Clindamycin Cleocin T Solution 1 APPL TOP 1 APPL

Non-stocked Clindamycin Vaginal Cream Clindamycin Vaginal Cream Solution 1 APPL TOP 1 APPL

Gentamicin Sulfate 0.1% Garamycin 0.1% (Equiv) CREAM 1 APPL TOP 1 APPL

Gentamicin Sulfate 0.1% Garamycin 0.1% (Equiv) OINT 1 APPL TOP 1 APPL

Mupirocin 2% Bactroban 2% (Equiv) OINT 1 APPL TOP 1 APPL

Non-stocked Mupirocin 2% Bactroban 2% (Equiv) CREAM 1 APPL TOP 1 APPL

Neomy Sulf/Bacitra/Polymyxin B Neosporin (Equiv) OINT 1 APPL TOP 1 APPL

84:04.06 Antivirals GENERIC NAME BRAND NAME DOSAGE


Docosanol Abrevia OINT 2 GM TOP 1 Tube

84:04.08 Antifungals

84:04.08.04 Allylamines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Terbinafine HCl 1% Lamisil At 1% (Equiv) CREAM 1 APPL TOP 1 APPL

84:04.08.08 Azoles GENERIC NAME BRAND NAME DOSAGE


Clotrimazole Mycelex Troche (Equiv) TROCHE 10 MG MM 1 TROCHE

Clotrimazole 1% Lotrimin (Equiv) 1% CREAM 1 APPL TOP 1 APPL

Non-stocked Clotrimazole 1% Vaginal Cream Cream 1 APPL TOP 1 APPL

Clotrimazole/Betamet Diprop Lotrisone (Equiv) CREAM 1 APPL TOP 1 APPL

Ketoconazole 2% Nizoral 2% (Equiv) CREAM 1 APPL TOP 1 APPL

Ketoconazole 2% Nizoral 2% (Equiv) SHAMPO 1 APPL TOP 1 APPL

Non-stocked Miconazole Miconazole SUPP 100 MG REC 1 SUPP

Non-stocked Miconazole Miconazole SUPP 200 MG REC 1 SUPP

Miconazole Nitrate 2% Miconazole 7 2% (Equiv) CRM 45 GM VAG 1 TUBE

Miconazole Nitrate 2% Desenex 2% (Equiv) POWDER 1 APPL TOP 1 APPL

84:04.08.20 Hydryoxypyridones GENERIC NAME BRAND NAME DOSAGE


Non-stocked Ciclodan Cream 0.77% Ciclodan Cream Cream 1 Application TOP 1 Application

84:04.08.28 Polyenes GENERIC NAME BRAND NAME DOSAGE


Nystatin Mycostatin (Equiv) CREAM 1 APPL TOP 1 APPL

Non-stocked Nystatin Nystatin Ointment 1 Application TOP 1 Application

Non-stocked Nystatin Vaginal Tablet Nystatin Vaginal Tablet TAB 100,000 Units TOP 1 Application

Nystatin/Triamcin 0.1% Mycolog Ii (Equiv) 0.1% CREAM 1 APPL TOP 1 APPL

Nystatin/Triamcin 0.1% Mycolog Ii (Equiv) 0.1% OINT 1 APPL TOP 1 APPL

Nystatin Nystatin Powder 1 Application TOP 1 Application

84:04.08.92 Antifungals, Misc GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Non-stocked Gentian Violet 0.5% Gentian Violet 0.5% Solution 1 APPL TOP 1 APPL

Non-stocked Gentian Violet 1% Gentian Violet 1% Solution 1 APPL TOP 1 APPL

84:04.12 Scabacides and

Pediculicides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Non-stocked Benzyl Alcohol Topical 5% Lotion Benzyl Alcohol Topical 5% Lotion Lotion 1 APPL TOP 1 APPL

Lindane 1% Lindane 1% (Equiv) LOTION 1 APPL TOP 1 APPL

Lindane 1% Lindane 1% (Equiv) SHAMPO 1 APPL TOP 1 APPL

84:04.92 Miscellaneous Local

Anti-infectives GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Non-stocked Benzoin Compound Tinc Benzoin Compound Tinc 1 APPL TOP 1 APPL

Carbolic Acid 6% Phenol 6% (Equiv) LIQUID 10 ML MSC 1 BOTTLE

Carbolic Acid 9% Phenol 9% (Equiv) LIQUID 10 ML MSC 1 BOTTLE

Hexachlorophene Phisohex (Equiv) LIQUID 148 ML TOP 1 BOTTLE

Hexachlorophene Chg Dose Phisohex (Equiv) Chg Dose LIQUID 30 ML TOP 1 UNIT

Non-stocked Mafenide Sulfamylon CREAM 1 APPL TOP 1 APPL

Metronidazole 0.75% Metrogel-Vaginal 0.75% (Equiv) GEL 1 APPL VAG 1 APPL

Metronidazole 1% Noritate 1% (Equiv) CREAM 1 APPL TOP 1 APPL

Povidone-Iodine Betadine (Equiv) OINT 1 APPL TOP 1 APPL

Non-stocked Povidone-Iodine 10% Povidone-Iodine 10% Solution 1 Application TOP 1 Application

Non-stocked Selenium Sulfide 2.25% Selenium Sulfide 2.25% Shampoo 1 Application TOP 1 Application

Non-stocked Selenium Sulfide 2.5% Selenium Sulfide 2.5% Lotion 1 Application TOP 1 Application

Silver Nitrate Silver Nitrate Applicator EACH 1 STICK TOP 1 STICK

Silver Sulfadiazine 1% Thermazene 1% (Equiv) CREAM 1 APPL TOP 1 APPL

Silver Sulfadiazine 1% Thermazene 1% (Equiv) CREAM 1 APPL TOP 1 APPL

Non-stocked Sulfanilamide 15% Sulfanilamide 15% Cream 1 APPL TOP 1 APPL

84:06

Anti-inflammatory Agents

84:06.00 Anti-inflammatory Agents GENERIC NAME BRAND NAME DOSAGE


Clobetasol Propionate 0.05% Temovate (Equiv) 0.05% CREAM 1 APPL TOP 1 APPL

Clobetasol Propionate 0.05% Temovate (Equiv) 0.05% OINT 15 GM TOP 1 TUBE

Desonide 0.05% Desowen (Equiv) 0.05% CREAM 1 APPL TOP 1 APPL

Desonide 0.05% Desowen (Equiv) 0.05% OINT 1 APPL TOP 1 APPL

Fluocinonide 0.05% Vanos CREAM 1 APPL TOP 1 APPL

Fluocinonide 0.05% Vanos OINT 1 APPL TOP 1 APPL

Hydrocortisone Cortenema (Equiv) ENEMA 100 MG REC 60 ML

Hydrocortisone 1% Hydrocortisone 1% CREAM 1 APPL TOP 1 APPL

Hydrocortisone Acetate Anusol Hc (Equiv) SUPP 25 MG REC 1 SUPP

Non-stocked Hydrocortisone Powder Hydrocortisone Powder Powder 1 APPL TOP 1 APPL

Non-stocked Hydrocortisone 1% Hydrocortisone 1% Lotion 1 APPL TOP 1 APPL

Non-stocked Hydrocortisone 1% Hydrocortisone 1% OINT 1 APPL TOP 1 APPL

Non-stocked Hydrocortisone 10% Hydrocortisone 10% GEL 1 APPL TOP 1 APPL

Triamcinolone Acetonide 0.1% Kenalog 0.1% (Equiv) OINT 1 APPL TOP 1 APPL

Triamcinolone Acetonide 0.1% Kenalog 0.1% (Equiv) CREAM 1 APPL TOP 1 APPL

Triamcinolone Acetonide 0.1% Kenalog In Orabase 0.1%(Equiv) PASTE 5 GM DEN 1 TUBE

Non-stocked Triamcinolone Acetonide Aerosol Triamcinolone Acetonide Aerosol Spray 0.2 Mg Top 2 Second

84:08Antipruritics and Local Anesthetics

84:08.00 Antipruritics and Local Anesthetics GENERIC NAME BRAND NAME DOSAGE


Non-stocked Calamine 8% Calamine 8% Lotion 1 Application TOP 1 Application

Non-stocked Ethyl Chloride 100 % Ethyl Chloride 100% Spray 1 Application TOP 1 Application

Non-stocked Lactic acid 12% with ammonium hydroxide Lac-Hydrin Lotion 1 Application TOP 1 Application

Non-stocked Lanolin-Mineral Oil Therma-Derm 1 Application TOP 1 Application

Lidocaine/Prilocaine Emla (Equiv) KIT 1 APPL TOP 1 APPL

Non-stocked Nivea w/clove oil Nivea w/ Clove Oil Lotion 1 Application TOP 1 Application

Phenazopyridine HCl Pyridium (Equiv) TAB 100 MG PO 1 TAB

Phenazopyridine HCl Pyridium (Equiv) TAB 200 MG PO 1 TAB

Non-stocked Pramoxine 1% Proctofoam (Equiv) Foam 15 GM TOP 1 APPL

Tetracaine HCl 2% Pontocaine 2% (Equiv) SOLN 30 ML TOP 1 BOTTLE

Tetracaine/Benzocaine/Butamben Cetacaine (Equiv) SPRAY 1 APPL TOP 1 APPL

84:24 Emoillents, Demulcents, and Protectants84:24.04 Basic Lotions and

Liniments GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Ammonium Lactate Lac-Hydrin (Equiv) LOTION 1 APPL TOP 1 APPL

Cetyl Alcohol/Propylene Glycol Cetaphil (Equiv) LOTION 1 APPL TOP 1 APPL

84:24.08 Basic Oils and Other Solvents GENERIC NAME BRAND NAME DOSAGE


Mineral Oil Mineral Oil OIL 10 ML TOP 10 ML

84:24.12 Basic Ointments and

Protectants GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Mineral Oil/Pet Hy-Phl Aquaphor (Equiv) OA 1 APPL TOP 1 APPL

Vitamins A And D A & D Ointment (Equiv) OINT 1 APPL TOP 1 APPL

Zinc Oxide 20% Zinc Oxide 20% (Equiv) OINT 1 APPL TOP 1 APPL

Non-stocked Zinc Ox-Cod Liv Oil-Vit A 40% Destin 40 40% OINT 1 APPL TOP 1 APPL

Talc Talc POWDER 5 GM TOP 1 PACKAGE

84:28 Keratolytics GENERIC NAME BRAND NAME DOSAGE


Non-stocked Urea Skin Emollient 10% Aqua Care (Equiv) Lotion 1 APPL TOP 1 APPL

84:32 Keratoplastic Agents GENERIC NAME BRAND NAME DOSAGE


Non-stocked Coal Tar Coar Tar Shampoo 1 APPL TOP 1 APPL

84:92Skin and Mucous Membrane Agents,

Miscellaneous84:92.00 Skin and Mucous

Membrane Agents, Miscellaneous


Becaplermin 0.01% Regranex 0.01% (Equiv) GEL 15 GM TOP 1 APPL

Non-stocked Benzoyl Peroxide 10% Persa Gel Gel 10% APPL TOP 1 APPL

Capsaicin 0.025% Zostrix (Eqiuv) 0.025% CREAM 1 APPL TOP 1 APPL

Collagenase Santyl (Equiv) OINT 1 APPL TOP 1 APPL

Fluorouracil 2% Efudex (Equiv) 2% SOLN 1 APPL TOP 1 APPL

Fluorouracil 5% Efudex (Equiv) 5% CREAM 1 APPL TOP 1 APPL

Hydrocortisone 2.5% Anusol-Hc 2.5% (Equiv) CREAM 1 APPL REC 1 APPL

Phenylephrine 0.25% Anusol 0.25% (Equiv) QA 1 EACH REC 1 SUPP

Uskekinumab Stelara VIAL 130 MG IV 26 ML

86:00 Smooth Muscle Relaxants86:12.00 Genitourinary Smooth

Muscle Relaxants GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Oxybutynin Chloride Ditropan (Equiv) TAB 5 MG PO 1 TAB

Respiratory Smooth Muscle Relaxants86:16.00 GENERIC NAME BRAND NAME DOSAGE


Aminophylline (Anhydrous) Aminophylline TAB 100 MG PO 1 TAB

Aminophylline (Anhydrous) Aminophylline TAB 200 MG PO 1 TAB

Aminophylline Aminophylline VIAL 250 MG IV 10 ML

Aminophylline Aminophylline VIAL 500 MG IV 20 ML

Theophylline Theophylline 24hr Tab 400 MG PO 1 24 hr Tab

Theophylline Theophylline 24hr Tab 600 MG PO 1 24 hr Tab

Theophylline Theophylline Solution 80 MG PO 15 ML

88:00 Vitamins

88:04.00 Vitamin A GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Vitamin A Palmitate Aquasol A (Equiv) TAB 100000 UNIT PO 1 TAB

Vitamin A Palmitate Aquasol A (Equiv) HV 100000 UNIT IM 2 ML

88:08.00 Vitamin B Complex GENERIC NAME BRAND NAME DOSAGE


Cyanocobalamin Vitamin B12 (Equiv) VIAL 1,000 MCG IM 1 ML

Folic Acid Folic Acid VIAL 1 MG IV 0.2 ML

Folic Acid Folic Acid VIAL 50 MG IV 10 ML

Folic Acid Folic Acid TAB 1 MG PO 1 TABFolic Acid, Cyanocobalamin, and

Pyridoxine Fol-Tx Tab 1 Each PO 1 Tablet

Folic Acid/Vitamin B Comp W-C Nephrocaps (Equiv) CAP 1 CAP PO 1 CAP

Pyridoxine HCl Vitamin B6 (Equiv) VIAL 100 MG IV 1 ML

Pyridoxine HCl Vitamin B6 (Equiv) TAB 50 MG PO 1 TAB

Thiamine HCl Vitamin B1 (Equiv) VIAL 100 MG IV 1 ML

Thiamine HCl Vitamin B1 (Equiv) TAB 100 MG PO 1 TAB

88:12.00 Vitamin C GENERIC NAME BRAND NAME DOSAGE


Ascorbic Acid Vitamin C (Equiv) TAB 250 MG PO 1 TAB

Ascorbic Acid Vitamin C (Equiv) TAB 500 MG PO 1 TAB

Ascorbic Acid Vitamin C (Equiv) Solution 500 MG PO 1 ml

Ascorbic Acid Ascorbic Acid VIAL 25000 MG IV 50 ML

88:16.00 Vitamin D GENERIC NAME BRAND NAME DOSAGE


Calcitriol Rocaltrol (Equiv) CAP 0.25 MCG PO 1 CAP

Cholecalciferol Vitamin D 5000 UNIT TAB 5000 Int Units PO 1 TAB

Cholecalciferol Vitamin D 400 IU Drops DROPS 400 Int Units PO 1 ML

Ergocalciferol Drisdol (Equiv) CAP 50000 UNITS PO 1 CAP

Non-stocked Ergocalciferol Calciferol Solution 8000 UNITS PO 1 ML

Non-stocked Parecalcitol Zemplar Cap 1 mcg PO 1 CAP

Non-stocked Parecalcitol Zemplar INJ 2 mcg IV 1 EACH

Non-stocked Parecalcitol Zemplar INJ 5 mcg IV 1 EACH

88:20.00 Vitamin E GENERIC NAME BRAND NAME DOSAGE


Vitamin E Vitamin E (Equiv) CAP 100 UNITS PO 1 CAP

Vitamin E Vitamin E (Equiv) CAP 400 UNITS PO 1 CAP

Non-stocked Vitamin E Vitamin E (Equiv) DROP 50 UNITS PO 1 DROP

Non-stocked Vitamin E Vitamin E (Equiv) Solution 15 UNITS PO 0.3 ML

Non-stocked Vitamin E Vitamin E (Equiv) Cream 50 UNITS TOP 1 GRAM

88:24.00 Vitamin K GENERIC NAME BRAND NAME DOSAGE


Phytonadione Vitamin K (Equiv) SYRING 1 MG SQ 0.5 ML

Phytonadione Vitamin K (Equiv) INJ 10 MG SQ 1 ML

Phytonadione Mephyton (Equiv) TAB 5 MG PO 1 TAB

88:28.00 Multivitamin Preparations GENERIC NAME BRAND NAME DOSAGE


Multivitamins Infuvite VIAL 1 VIAL IV 10 ML

Multivitamins Mvi-12 VIAL 1 VIAL IV 10 ML

Multivitamins, Therapeutic Poly-ViSol (Equiv) Liquid PO 50 mL

Multivitamins, Therapeutic Poly-ViSol w/ Iron(Equiv) Liquid PO 50 mL

Multivitamins,Therapeutic Theragran (Equiv) TAB 1 TAB PO 1 TAB

Multivits,Th W-Ca,Fe,Oth Min Theragran M (Equiv) TAB 1 TAB PO 1 TAB

92:00 Miscellaneous Therapeutic Agents

92:08 5-α Reductase Inhibitor GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Finasteride Proscar (Equiv) TAB 5 MG PO 1 TAB

Tamsulosin HCl Flomax (Equiv) C SR 24 0.4 MG PO 1 C SR 24

92:12 Antidotes GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Acetylcysteine 20% 200mg/mL Acetadote (Equiv) 20% IV 6000 MG IV 30 ML

Glucarpidase Voraxaze VIAL 1000 Units IV 1 VIAL

Fomepizole Antizol (Equiv) VIAL 1500 MG IV 1.5 ML

Leucovorin Calcium Leucovorin Calcium VIAL 100 MG IV 1 VIA

Leucovorin Calcium Leucovorin Calcium VIAL 350 MG IV 1 VIAL

Leucovorin Calcium Leucovorin Calcium TAB 5 MG PO 1 TAB

Leucovorin Calcium Leucovorin Calcium VIAL 50 MG IV 1 VIAL

Pralidoxime Chloride Protopam Chloride (Equiv) VIAL 1000 MG IV 1 VIAL

Uridine Triacetat Vistogard Packet 10 Gram PO 1 Packet

92:16 Antigout Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Allopurinol Allopurinol TAB 100 MG PO 1 TAB

Allopurinol Allopurinol TAB 300 MG PO 1 TAB

Colchicine Colchicine TAB 0.6 MG PO 1 TAB

92:16Bone Resorption


Ibandronate Boniva IV Vial 1 ML IV 1 mL

Pamidronate Disodium Aredia (Equiv) VIAL 30 MG IV 1 VIAL

Pamidronate Disodium Aredia (Equiv) VIAL 90 MG IV 1 VIAL

Zoledronic Acid Zometa (Equiv) VIAL 4 MG IV 5 ML

Zoledronic Acid Reclast (Equiv) VIAL 5 MG IV 5 ML

92:20Biologic Response

Modifiers GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Glatiramer Acetate Copaxone Syringe 20 MG SQ 1 ML

Glatiramer Acetate Copaxone Syringe 40 MG SQ 1 ML

Interferon Beta-1b Betaseron HS 0.3 MG 1 VIAL

Natalizumab Tysabri Vial 300 MG IV 1 Vial

Ocrelizumab Ocrevus) VIAL 300 MG IV 10 ML

92:32Complement Inhibitors GENERIC NAME BRAND NAME DOSAGE


C1-Esterase Inhibitor Berinert VIAL 500 UNITS IV 1 VIAL

92:36Disease Modifying

Antirheumatic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Abatacept Orencia (Equiv) VIAL 250 MG IV 1 VIAL

Adalumumab Humira KIT 150 MG SQ 1 KIT

Infliximab Remicade (Equiv) VIAL 100 MG IV 1 VIAL

Tocilizumab Actemera (Equiv) VIAL 200 MG IV 1 VIAL

Tocilizumab Actemera (Equiv) VIAL 400 MG IV 1 VIAL

92:44Immunosuppresant

Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Azathioprine Azathioprine (Equiv) TAB 50 MG PO 1 TAB

Belimumab Benlysta (Equiv) VIAL 120 MG IV 1 VIAL

Belimumab Benlysta (Equiv) VIAL 400 MG IV 1 VIAL

Cyclosporine Sandimmune (Equiv) CAP 100 MG PO 1 CAP

Cyclosporine Sandimmune (Equiv) LIQUID 100 MG PO 1 ML

Cyclosporine Sandimmune (Equiv) CAP 25 MG PO 1 CAP

Cyclosporine Sandimmune (Equiv) IV 50 MG IV 5 ML

Cyclosporine, Modified Neoral (Equiv) CAP 100 MG PO 1 CAP

Cyclosporine, Modified Neoral (Equiv) SOLN 100 MG PO 1 ML

Cyclosporine, Modified Neoral (Equiv) CAP 25 MG PO 1 CAP

Mycophenolate Mofetil Cellcept (Equiv) CAP 250 MG PO 1 CAP

Mycophenolate Mofetil Myfortic (Equiv) CAP 180 MG PO 1 CAP

Mycophenolate Mofetil Myfortic (Equiv) CAP 360 MG PO 1 CAP

Sirolimus Rapamune TAB 0.5 MG PO 1 Tab

Sirolimus Rapamune TAB 1 MG PO 1 Tab

Sirolimus Rapamune Solution 1 MG PO 1 ML

92:56 Protective Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT

Amifostine Crystalline Ethyol (Equiv) VIAL 500 MG IV 1 VIAL

Dexrazoxane Totect, Zinecard VIAL 500 MG IV 1 ML

Mesna Mesna (Equiv) VIAL 100 MG IV 1 ML

92:92.00 Miscellaneous Therapeutic Agents GENERIC NAME BRAND NAME DOSAGE


Chondro Su A/Hyalur Sod Duovisc (Equiv) KIT 1 KIT INT 1 KIT

Chondro Su A/Hyalur Sod Viscoat (Equiv) SYRING 1 SYRINGE INT 1 SYRINGE

Cobicistat TYBOST Tab 150 MG PO 1 TAB

Ethyl Alcohol 98% Alcohol,Dehydrated 98% INJ 5 ML IV 1 AMP

Levocarnitine Levocarnitine TAB 330 MG PO 1 TAB

Methylene Blue 1% Methylene Blue 1% (Equiv) VIAL 1 VIAL IV 1 VIAL

Octreotide Acetate Sandostatin (Equiv) INJ 0.05 MG IV 1 ML

Octreotide Acetate Sandostatin (Equiv) VIAL 1 MG IV 5 ML

Octreotide Acetate Sandostatin Lar (Equiv) KIT 20 MG IM 1 KIT

Octreotide Acetate Sandostatin Lar (Equiv) YK 30 MG IM 1 KIT

94:00 Devices 94:00.00 Devices GENERIC NAME BRAND NAME DOSAGE


Hyaluronate Sodium Synvisc (Equiv) SYRING 16 MG INT 2 ML

Hyaluronate Sodium Synvisc one (Equiv) SYRING 8 MG INT 1 mL

96:00 Pharmaceutical Aids96:00.00 Pharmaceutical Aids GENERIC NAME BRAND NAME DOSAGE


Water For Inj.,Bacteriostatic Water VIAL 1 VIAL IV 30 ML

Water For Injection,Sterile Water VIAL 1 EACH IV 10 ML

Water For Injection,Sterile Water VIAL 1 VIAL IV 100 ML

Water For Injection,Sterile Water For Injection Sterile IV 1000 ML IV 1000 ML

Non-AHFS Catergory Formulary Agents


Acd-Solution Formula A Anticoagulant Dextrose Solutio IV 1 BAG IV 1000 MLAlum So4/ Ca Acetate Domeboro Pdr (Equiv) PACKET 1 PACKET TOP 1 PACKETBupivacaine/Epi 0.5% Marcaine / Epi 0.5% (Equiv) AMPULE 1 AMPULE IV 1.8 ML

Cepacol (Equiv) Cepacol (Equiv) LOZENGE 6 TABLETS PO 1 PACKAGEColloidal Oatmeal Pkt Aveeno Bath Reg (Equiv) POWDER 1 PACKET TOP 1 PACKET

Hepatitis B Ped Amin. Charge Hepatitis B Ped Admin. Charge EACH 1 EACH IM 1 CHARGEInspirease Drug Del System Inspirease KIT 1 EACH RT 1 KIT

Isosulfan Blue 1% Lymphazurin 1% (Equiv) AMPULE 1 AMPULE IM 5 ML

Lozengers, Cherry Sf Nice Lozengers Sf,Cherry(Equiv LOZENGE 8 TAB PO 1 PACKAGEMenthol/Benzocaine Chloraseptic (Equiv) LOZENGE 1 PACKAGE PO 6 TABLETS

Methylsalicylate/Mentol Bengay (Equiv) TUBE 1 APPL TOP 1 APPLPadimate/Oxyben/Dime Oint Blistex (Equiv) TUBE 1 APPL TOP 1 APPL

Prismasate Bgk2/0 Prismasate Bgk2/0 EACH 5000 ML IV 1 BAGPrismasate Bko / 3.5 Prismasate Bko / 3.5 EACH 5,000 ML IV 1 BAG

Talc, Aerosol Talc, Aerosol EA 1 BOTTLE TOP 4 GMUndecylenate Acid 10% Caldesene Pdr (Equiv) POWDER 1 APPL TOP 1 APPL

Zinc Oxide/Calamine/Gelatin Dome Paste Bandage (Equiv) BANDAGE 1 PACKAGE TOP 1 PACKAGE

AHFA Pharmacological Therapeutic Classifiaction F… · Web viewAHFA Pharmacological Therapeutic...

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