Community Health Choice (HMO D-SNP) 2021 FORMULARY

CommunityHealthChoice.org/Medicare833.276.8306 or 713.295.5007 (TTY 711)October 1 through March 31, 8:00 am to 8:00 pm, 7 days a week and April 1 through September 30, Monday through Friday, 8:00 am to 8:00 pm

H9826_BD_10051_COMP_2021_C LAST UPDATED 09/01/2020

Community Health Choice (HMO D-SNP)

2021 FORMULARYLIST OF COVERED DRUGSPLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN

This formulary was updated on 09/01/2020. For more recent information or other questions, please contact Community Health Choice Member Services, at 1-833-276-8306 or, for TTY users, 711, October 1 through March 31, 8:00 am to 8:00 pm, 7 days a week and April through September 30, Monday through Friday, 8:00 am to 8:00 pm, or visit www.communityhealthchoice.org/Medicare.

Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take.

When this drug list (formulary) refers to “we,” “us”, or “our,” it means Community Health Choice. When it refers to “plan” or “our plan,” it means Community Health Choice (HMO D-SNP).

This document includes list of the drugs (formulary) for our plan which is current as of 09/01/2020. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages.

You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 2021, and from time to time during the year.

H9826_BD_10051_COMP_2021_C Last Updated 09/01/2020 1

Abridged Formulary

What is the Community Health Choice (HMO D-SNP) Formulary?

A formulary is a list of covered drugs selected by Community Health Choice in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Community Health Choice will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Community Health Choice network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

Can the Formulary (drug list) change?

Most changes in drug coverage happen on January 1, but we may add or remove drugs on the Drug List during the year, move them to different cost-sharing tiers, or add new restrictions. We must follow the Medicare rules in making these changes.

Changes that can affect you this year: In the below cases, you will be affected by coverage changes during the year:

• New generic drugs. We may immediately remove a brand name drug on our Drug List if weare replacing it with a new generic drug that will appear on the same or lower cost sharingtier and with the same or fewer restrictions. Also, when adding the new generic drug, we maydecide to keep the brand name drug on our Drug List, but immediately move it to a differentcost-sharing tier or add new restrictions. If you are currently taking that brand name drug, wemay not tell you in advance before we make that change, but we will later provide you withinformation about the specific change(s) we have made.

- If we make such a change, you or your prescriber can ask us to make an exception andcontinue to cover the brand name drug for you. The notice we provide you will also includeinformation on how to request an exception, and you can also find information in the sectionbelow entitled “How do I request an exception to the Community Health Choice (HMOD-SNP) Formulary?”

• Drugs removed from the market. If the Food and Drug Administration deems a drug on ourformulary to be unsafe or the drug’s manufacturer removes the drug from the market, we willimmediately remove the drug from our formulary and provide notice to members who take thedrug.

• Other changes. We may make other changes that affect members currently taking a drug.For instance, we may add a new generic drug to replace a brand name drug currently on theformulary; or add new restrictions to the brand name drug or move it to a different cost-sharingtier or both. Or we may make changes based on new clinical guidelines. If we remove drugsfrom our formulary, or add prior authorization, quantity limits and/or step therapy restrictionson a drug, we must notify affected members of the change at least 30 days before the changebecomes effective, or at the time the member requests a refill of the drug, at which time themember will receive a 30-day supply of the drug.

H9826_BD_10051_COMP_2021_C Last Updated 09/01/2020

Abrid

ged

Form

ular

y

2

- If we make these other changes, you or your prescriber can ask us to make an exception andcontinue to cover the brand name drug for you. The notice we provide you will also includeinformation on how to request an exception, and you can also find information in the sectionbelow entitled “How do I request an exception to the Community Health Choice (HMOD-SNP) Formulary?”

Changes that will not affect you if you are currently taking the drug. Generally, if you are taking a drug on our 2021 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2021 coverage year except as described above. This means these drugs will remain available at the same cost sharing and with no new restrictions for those members taking them for the remainder of the coverage year. You will not get direct notice this year about changes that do not affect you. However, on January 1 of the next year, such changes would affect you, and it is important to check the Drug List for the new benefit year for any changes to drugs.

The enclosed formulary is current as of 09/01/2020. To get updated information about the drugs covered by Community Health Choice, please contact us. Our contact information appears on the front and back cover pages.

How do I use the Formulary?

There are two ways to find your drug within the formulary:

Medical Condition

The formulary begins on page 8. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular Agents. If you know what your drug is used for, look for the category name in the list that begins on page number 8. Then look under the category name for your drug.

Alphabetical Listing

If you are not sure what category to look under, you should look for your drug in the Index that begins on page 8. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list.


Abridged Formulary

What are generic drugs?

Community Health Choice covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.

Are there any restrictions on my coverage?

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

• Prior Authorization: Community Health Choice requires you or your physician to get priorauthorization for certain drugs. This means that you will need to get approval from CommunityHealth Choice before you fill your prescriptions. If you don’t get approval, we may not cover thedrug.

• Quantity Limits: For certain drugs, Community Health Choice limits the amount of the drugthat we will cover. For example, Community Health Choice provides 60 per prescription forcelecoxib. This may be in addition to a standard one-month or three-month supply.

• Step Therapy: In some cases, Community Health Choice requires you to first try certain drugs totreat your medical condition before we will cover another drug for that condition. For example,if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you tryDrug A first. If Drug A does not work for you, we will then cover Drug B.

You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 8. You can also get more information about the restrictions applied to specific covered drugs by visiting our Web site. We have posted on line documents that explain our prior authorization restriction and step therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages.

You can ask Community Health Choice to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, “How do I request an exception to the Community Health Choice (HMO D-SNP) formulary?” on page 8 for information about how to request an exception.

What if my drug is not on the Formulary?

If your drug is not included in this formulary (list of covered drugs), you should first contact Member Services and ask if your drug is covered. For more information, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages.


Abrid

ged

Form

ular

y

4

If you learn that Community Health Choice does not cover your drug, you have two options:

• You can ask Member Services for a list of similar drugs that are covered by us. When youreceive the list, show it to your doctor and ask him or her to prescribe a similar drug that iscovered by Community Health Choice.

• You can ask us to make an exception and cover your drug. See below for information about howto request an exception.

How do I request an exception to the Community Health Choice (HMO D-SNP) Formulary?

You can ask Community Health Choice to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make.

• You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will becovered at a pre-determined cost-sharing level, and you would not be able to ask us to providethe drug at a lower cost-sharing level.

• You can ask us to waive coverage restrictions or limits on your drug. For example, for certaindrugs, Community Health Choice limits the amount of the drug that we will cover. If your drughas a quantity limit, you can ask us to waive the limit and cover a greater amount.

Generally, we will only approve your request for an exception if the alternative drugs included on the plan’s formulary, or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects.

You should contact us to ask us for an initial coverage decision for a formulary or utilization restriction exception. When you request a formulary or utilization restriction exception you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescriber’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get a supporting statement from your doctor or other prescriber.

What do I do before I can talk to my doctor about changing my drugs or requesting an exception?

As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request


Abridged Formulary

a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan.

For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 30-day supply. If your prescription is written for fewer days, we’ll allow refills to provide up to a maximum 30-day supply of medication. After your first 30-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days.

If you are a resident of a long-term care facility and you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug while you pursue a formulary exception.

Exceptions are available for members who have experienced a change in the level of care they are receiving which requires them to transition from one facility or treatment center to another. Examples of situations in which members would be eligible for the one-time temporary fill exception when they are outside of their first 90 days of enrollment in our plan are as follows:

i. Members who enter LTC facilities from hospitals with a discharge list of medications from thehospital formulary with very short term planning taken into account (e.g., under 8 hours).

ii. Members who are discharged from a hospital to a home with very short-term planning takeninto account.

iii. Members who end their skilled nursing facility Medicare Part A stay (where payments includeall pharmacy charged) and who need to return to their Part D plan formulary.

iv. Members who give up hospice status to return to standard Medicare Part A and P benefits.

v. Members who end an LTC facility stay and return to the community.

vi. Members who are discharged from psychiatric hospitals with drug regimens that are highlyindividualized.

For more information

For more detailed information about your Community Health Choice prescription drug coverage, please review your Evidence of Coverage and other plan materials.

If you have questions about Community Health Choice, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages.

If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users should call 1-877-486-2048. Or, visit http://www.medicare.gov.


Abrid

ged

Form

ular

y

6

Community Health Choice (HMO D-SNP) Formulary

The abridged formulary below provides coverage information about some of the drugs covered by Community Health Choice. If you have trouble finding your drug in the list, turn to the Index that begins on page 8.

The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., HUMIRA) and generic drugs are listed in lower-case italics (e.g., celecoxib).

The information in the Requirements/Limits column tells you if Community Health Choice has any special requirements for coverage of your drug.

The following tables describes the abbreviations used in the Drug List Table.

ABBREVIATION ABBREVIATION MEANING

FF First Fill Limited to one-month supply: You may be able to receive greater than a 1-month supply of most of the drugs on your Formulary. Drugs noted with “FF” are limited to a 1-month supply for both Retail and Mail Order on your first fill only. After the first fill, an extended day supply would be available.

LD Limited Distribution: The symbol [LD] next to a drug name indicates that the drug has been noted as being restricted to certain pharmacies by the Food and Drug Administration. These drugs can only be obtained at specialty designated pharmacies able to appropriately handle the drugs.

NDS Non-Extended Day Supply: You may be able to receive greater than a 1-month supply of most of the drugs on your Formulary via mail order at areduced cost share. Drugs noted with “NDS” are limited to a 1-month supplyfor both Retail and Mail Order.

PA Prior Authorization: Community Health Choice requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from us before you fill your prescriptions. If you don’t get approval, we may not cover the drug.

PA_BvD Prior Authorization Restriction for Part B vs Part D: This drug may be eligible for payment under Medicare Part B or Part D. You or your physician are required to get prior authorization from us to determine that this drug is covered under Medicare Part D before you fill your prescription for this drug. Without prior approval, we may not cover this drug.


Abridged Formulary

ABBREVIATION ABBREVIATION MEANING

PA_NSO Prior Authorization Restriction for New Starts Only: If this drug is new to you, you (or your physician) are required to get prior authorization from Community Health Choice before you fill your prescription for this drug. Without prior approval, we may not cover this drug.

QL Quantity Limits: For certain drugs, we limit the amount of the drug that will be covered. This could include a: per fill, daily, monthly, or yearly limitation.

ST Step Therapy: In some cases, we require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

ST_NSO Step Therapy for New Starts Only: If this drug is new to you, you are required to first try certain drugs to treat your medical condition before we will cover another drug for that condition.

DRUG NAME DRUG TIER REQUIREMENTS/LIMITS

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTSAMPHETAMINES

1amphetamine 10mg er cap

1amphetamine 10mg tab

1amphetamine 12.5mg tab










1amphetamine 7.5mg tab

1dextroamphetamine sulfate 10mg er cap

1dextroamphetamine sulfate 10mg tab



1dextroamphetamine sulfate 5mg tabATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS

1atomoxetine 100mg cap QL=60 EA/30 Days







1guanfacine 1mg er tab



1guanfacine 4mg er tabDOPAMINE AND NOREPINEPHRINE REUPTAKE INHIBITORS (DNRIS)

1SUNOSI 150MG TAB PA QL=30 EA/30 Days

1SUNOSI 75MG TAB PA QL=30 EA/30 DaysHISTAMINE H3-RECEPTOR ANTAGONIST/INVERSE AGONISTS

1WAKIX 17.8MG TAB NDS PA QL=60 EA/30 Days

1WAKIX 4.45MG TAB NDS PA QL=60 EA/30 DaysSTIMULANTS - MISC.

1armodafinil 150mg tab PA QL=30 EA/30 Days




1dexmethylphenidate 10mg er cap

1dexmethylphenidate 10mg tab


You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table.

8


1dexmethylphenidate 2.5mg tab







1dexmethylphenidate 5mg tab

1methylphenidate 10mg cr cap

1methylphenidate 10mg er tab

1methylphenidate 10mg la cap

1methylphenidate 10mg tab

1METHYLPHENIDATE 18MG ER TAB


1methylphenidate 1mg/ml oral soln





1methylphenidate 27mg sr tab

1methylphenidate 2mg/ml oral soln










1modafinil 100mg tab PA QL=60 EA/30 Days

1modafinil 200mg tab PA QL=60 EA/30 Days

AMINOGLYCOSIDESAMINOGLYCOSIDES

1amikacin 250mg/ml inj

1ARIKAYCE 590MG/8.4ML INH SUSP NDS PA QL=252 ML/30 Days

1GENTAMICIN 0.8MG/ML INJ

1gentamicin 1.2mg/ml inj

1GENTAMICIN 1.6MG/ML INJ

1GENTAMICIN 1MG/ML INJ

1gentamicin 40mg/ml inj

1neomycin sulfate 500mg tab

1PAROMOMYCIN 250MG CAP

1STREPTOMYCIN 1000MG INJ

1TOBRAMYCIN 10MG/ML INJ

1tobramycin 40mg/ml inj


9


1tobramycin 60mg/ml inh soln NDS PA QL=300 ML/30 Days

ANALGESICS - ANTI-INFLAMMATORYANTIRHEUMATIC - ENZYME INHIBITORS

1OLUMIANT 1MG TAB NDS PA

1OLUMIANT 2MG TAB NDS PA

1RINVOQ 15MG ER TAB NDS PA

1XELJANZ 10MG TAB NDS PA

1XELJANZ 5MG TAB NDS PA

1XELJANZ XR 11MG TAB NDS PA

1XELJANZ XR 22MG TAB NDS PAANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES

1HUMIRA 10MG/0.1ML SYRINGE NDS PA




1HUMIRA 40MG/0.4ML AUTO-INJECTOR NDS PA


1HUMIRA 40MG/0.8ML AUTO-INJECTOR NDS PA


1HUMIRA PEDIATRIC CROHN'S STARTER PACK (3) 80MG/0.8ML INJ

NDS PA

1HUMIRA PEDIATRIC CROHN'S STARTER PACK SYRINGE (2) 40MG/0.4ML

NDS PA

1HUMIRA PEN - CROHN'S STARTER PACK 40MG/0.8ML INJ

NDS PA

1HUMIRA PEN - CROHN'S STARTER PACK 80MG/0.8ML INJ

NDS PA

1HUMIRA PEN - PSORIASIS STARTER PACK 40MG/0.8ML INJ

NDS PA

1HUMIRA PEN - PSORIASIS STARTER PACK 80MG/0.8ML INJ

NDS PA

1SIMPONI 100MG/ML AUTO-INJECTOR NDS PA

1SIMPONI 100MG/ML SYRINGE NDS PA

1SIMPONI 50MG/0.5ML AUTO-INJECTOR NDS PA

1SIMPONI 50MG/0.5ML SYRINGE NDS PAGOLD COMPOUNDS

1RIDAURA 3MG CAPINTERLEUKIN-1 BLOCKERS

1ARCALYST 220MG INJ NDS PAINTERLEUKIN-6 RECEPTOR INHIBITORS

1ACTEMRA 162MG/0.9ML AUTO-INJECTOR NDS PA

1ACTEMRA 162MG/0.9ML SYRINGE NDS PA

1KEVZARA 150MG/1.14ML AUTO-INJECTOR NDS PA

1KEVZARA 150MG/1.14ML SYRINGE NDS PA

1KEVZARA 200MG/1.14ML AUTO-INJECTOR NDS PA

1KEVZARA 200MG/1.14ML SYRINGE NDS PA


10


NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)

1celecoxib 100mg cap QL=60 EA/30 Days




1diclofenac potassium 50mg tab

1diclofenac sodium 100mg er tab

1diclofenac sodium 25mg dr tab


1diclofenac sodium 50mg/misoprostol 0.2mg dr tab


1diclofenac sodium 75mg/misoprostol 0.2mg dr tab

1etodolac 200mg cap

1etodolac 300mg cap

1etodolac 400mg er tab

1etodolac 400mg tab


1etodolac 500mg tab


1flurbiprofen 100mg tab

1ibu 600mg tab

1ibu 800mg tab

1ibuprofen 20mg/ml susp

1ibuprofen 400mg tab



1INDOCIN 50MG RECTAL SUPP

1indomethacin 25mg cap

1indomethacin 50mg cap

1indomethacin 75mg er cap

1ketorolac tromethamine 10mg tab QL=20 EA/5 Days

1meloxicam 15mg tab

1meloxicam 7.5mg tab

1nabumetone 500mg tab

1nabumetone 750mg tab

1naproxen 250mg tab

1naproxen 375mg dr tab

1naproxen 375mg tab

1naproxen 500mg dr tab

1naproxen 500mg tab

1naproxen sodium 275mg tab

1naproxen sodium 550mg tab

1oxaprozin 600mg tab

1piroxicam 10mg cap

1piroxicam 20mg cap

1sulindac 150mg tab


11


1sulindac 200mg tabPHOSPHODIESTERASE 4 (PDE4) INHIBITORS

1OTEZLA 28-DAY STARTER PACK NDS PA

1OTEZLA 30MG TAB NDS PAPYRIMIDINE SYNTHESIS INHIBITORS

1leflunomide 10mg tab

1leflunomide 20mg tabSELECTIVE COSTIMULATION MODULATORS

1ORENCIA 125MG/ML AUTO-INJECTOR NDS PA

1ORENCIA 125MG/ML SYRINGE NDS PA

1ORENCIA 50MG/0.4ML SYRINGE NDS PA

1ORENCIA 87.5MG/0.7ML SYRINGE NDS PASOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS

1ENBREL 25MG INJ NDS PA

1ENBREL 25MG/0.5ML SYRINGE NDS PA

1ENBREL 50MG/ML AUTO-INJECTOR NDS PA

1ENBREL 50MG/ML CARTRIDGE NDS PA

1ENBREL 50MG/ML SYRINGE NDS PA

ANALGESICS - NONNARCOTICSALICYLATES

1diflunisal 500mg tab

ANALGESICS - OPIOIDOPIOID AGONISTS

1CODEINE SULFATE 15MG TAB QL=240 EA/30 Days

1codeine sulfate 30mg tab QL=240 EA/30 Days

1codeine sulfate 60mg tab QL=180 EA/30 Days

1duramorph 0.5mg/ml inj PA BvD

1duramorph 1mg/ml inj PA BvD

1fentanyl 0.012mg/hr patch QL=10 EA/30 Days




1FENTANYL 0.1MG BUCCAL TAB PA QL=120 EA/30 Days



1fentanyl 0.2mg lozenge PA QL=120 EA/30 Days









1FENTORA 100MCG BUCCAL TAB PA QL=120 EA/30 Days



12





1hydrocodone bitartrate 10mg er cap QL=60 EA/30 Days






1hydromorphone 10mg/ml (1ml) inj

1hydromorphone 10mg/ml (5ml) inj

1hydromorphone 1mg/ml oral soln QL=2400 ML/30 Days

1hydromorphone 2mg tab QL=450 EA/30 Days



1methadone 10mg tab QL=360 EA/30 Days

1methadone 5mg tab QL=360 EA/30 Days

1morphine sulfate 100mg er tab QL=120 EA/30 Days


1morphine sulfate 15mg tab QL=180 EA/30 Days


1morphine sulfate 20mg/ml oral soln QL=180 ML/30 Days



1morphine sulfate 30mg tab QL=180 EA/30 Days



1NUCYNTA 100MG ER TAB QL=60 EA/30 Days





1oxycodone 10mg tab QL=180 EA/30 Days


1oxycodone 1mg/ml oral soln QL=5400 ML/30 Days


1oxycodone 20mg/ml oral soln QL=270 ML/30 Days


1oxycodone 5mg cap QL=360 EA/30 Days


1oxymorphone 10mg tab QL=360 EA/30 Days

1oxymorphone 5mg tab QL=360 EA/30 Days

1tramadol 100mg er tab QL=60 EA/30 Days

1tramadol 100mg er tab (matrix delivery) QL=60 EA/30 Days




13




1tramadol 50mg tab QL=240 EA/30 Days

1XTAMPZA 13.5MG ER CAP QL=120 EA/30 Days

1XTAMPZA 18MG ER CAP QL=120 EA/30 Days



1XTAMPZA 9MG ER CAP QL=120 EA/30 DaysOPIOID COMBINATIONS

1acetaminophen 21.7mg/ml/hydrocodone bitartrate 0.5mg/ml oral soln

QL=5400 ML/30 Days

1acetaminophen 24mg/ml/codeine phosphate 2.4mg/ml oral soln

QL=4980 ML/30 Days

1acetaminophen 300mg/codeine phosphate 15mg tab QL=390 EA/30 Days



1acetaminophen 300mg/hydrocodone bitartrate 10mg tab

QL=390 EA/30 Days


QL=390 EA/30 Days

1acetaminophen 300mg/hydrocodone bitartrate 7.5mg tab

QL=390 EA/30 Days


QL=360 EA/30 Days


QL=360 EA/30 Days

1acetaminophen 325mg/hydrocodone bitartrate 7.5mg tab

QL=360 EA/30 Days

1acetaminophen 325mg/oxycodone 10mg tab QL=360 EA/30 Days

1acetaminophen 325mg/oxycodone 2.5mg tab QL=360 EA/30 Days

1acetaminophen 325mg/oxycodone 5mg tab QL=360 EA/30 Days

1acetaminophen 325mg/oxycodone 7.5mg tab QL=360 EA/30 Days

1acetaminophen 325mg/tramadol 37.5mg tab QL=360 EA/30 Days

1ASPIRIN 325MG/OXYCODONE 4.84MG TAB QL=360 EA/30 Days

1endocet 325-10mg tab QL=360 EA/30 Days

1endocet 325-5mg tab QL=360 EA/30 Days

1endocet 325-7.5mg tab QL=360 EA/30 Days

1hydrocodone bitartrate 10mg/ibuprofen 200mg tab QL=480 EA/30 Days

1hydrocodone bitartrate 5mg/ibuprofen 200mg tab QL=480 EA/30 Days

1hydrocodone bitartrate 7.5mg/ibuprofen 200mg tab QL=480 EA/30 Days

1lorcet 325-10mg tab QL=360 EA/30 Days

1lorcet 325-5mg tab QL=360 EA/30 Days

1lorcet 325-7.5mg tab QL=360 EA/30 DaysOPIOID PARTIAL AGONISTS

1buprenorphine 12mg/naloxone 3mg sublingual film

1buprenorphine 2mg sl tab


14


1buprenorphine 2mg/naloxone 0.5mg sl tab

1buprenorphine 2mg/naloxone 0.5mg sublingual film


1buprenorphine 8mg sl tab

1buprenorphine 8mg/naloxone 2mg sl tab


1butorphanol tartrate 1mg/act nasal inhaler QL=10 ML/30 Days

1ZUBSOLV 1.4-0.36MG SL TAB QL=90 EA/30 Days





ANDROGENS-ANABOLICANABOLIC STEROIDS

1ANADROL-50 50MG TAB

1oxandrolone 10mg tab

1oxandrolone 2.5mg tabANDROGENS

1ANDRODERM 2MG/24HR PATCH PA QL=60 EA/30 Days

1ANDRODERM 4MG/24HR PATCH PA QL=30 EA/30 Days

1danazol 100mg cap

1danazol 200mg cap

1danazol 50mg cap

1testosterone 1% (25mg) gel PA QL=300 GM/30 Days

1testosterone 1% (50mg) gel PA QL=300 GM/30 Days

1testosterone 1.62% (1.25gm) gel PA QL=75 GM/30 Days

1testosterone 1.62% (2.5gm) gel PA QL=150 GM/30 Days

1TESTOSTERONE 12.5MG/ACT GEL PA QL=300 GM/30 Days

1testosterone 20.25mg/act gel PA QL=150 GM/30 Days

1testosterone cypionate 100mg/ml inj

1testosterone cypionate 200mg/ml (1ml) inj

1testosterone cypionate 200mg/ml inj

1TESTOSTERONE ENANTHATE 200MG/ML INJ

ANORECTAL AGENTSINTRARECTAL STEROIDS

1hydrocortisone 1.67mg/ml enema

1UCERIS 2MG/ACT RECTAL FOAM PAVASODILATING AGENTS

1RECTIV 0.4% RECTAL OINTMENT QL=30 GM/30 Days

ANORECTAL AND RELATED PRODUCTSRECTAL COMBINATIONS

1hydrocortisone/pramoxine 1-1% rectal creamRECTAL STEROIDS

1procto-med 2.5% cream

1procto-pak 1% rectal cream

1proctosol 2.5% cream


15


1proctozone hc 2.5% cream

ANTHELMINTICSANTHELMINTICS

1albendazole 200mg tab

1BENZNIDAZOLE 100MG TAB PA

1BENZNIDAZOLE 12.5MG TAB PA

1ivermectin 3mg tab

ANTIANGINAL AGENTSANTIANGINALS-OTHER

1ranolazine 1000mg er tab

1ranolazine 500mg er tabNITRATES

1isosorbide dinitrate 10mg tab




1isosorbide mononitrate 10mg tab

1isosorbide mononitrate 120mg er tab

1isosorbide mononitrate 20mg tab



1minitran 0.1mg/hr patch




1NITRO-BID 2% OINTMENT

1NITRO-DUR 0.3MG/HR PATCH

1NITRO-DUR 0.8MG/HR PATCH

1nitroglycerin 0.1mg/hr patch


1nitroglycerin 0.3mg sl tab


1nitroglycerin 0.4mg/act spray




ANTIANXIETY AGENTSANTIANXIETY AGENTS - MISC.

1buspirone 10mg tab

1buspirone 15mg tab

1buspirone 30mg tab

1buspirone 5mg tab

1buspirone 7.5mg tab

1hydroxyzine 10mg tab


1hydroxyzine 2mg/ml oral soln


16



1HYDROXYZINE PAMOATE 100MG CAP

1hydroxyzine pamoate 25mg cap

1hydroxyzine pamoate 50mg capBENZODIAZEPINES

1alprazolam 0.25mg odt

1alprazolam 0.25mg tab

1alprazolam 0.5mg er tab

1alprazolam 0.5mg odt

1alprazolam 0.5mg tab

1alprazolam 1mg er tab

1alprazolam 1mg odt

1alprazolam 1mg tab


1alprazolam 2mg odt

1alprazolam 2mg tab


1chlordiazepoxide 10mg cap



1clorazepate dipotassium 15mg tab

1clorazepate dipotassium 3.75mg tab

1clorazepate dipotassium 7.5mg tab

1diazepam 10mg tab

1DIAZEPAM 1MG/ML ORAL SOLN

1diazepam 2mg tab

1diazepam 5mg tab

1diazepam 5mg/ml oral soln

1lorazepam 0.5mg tab

1lorazepam 1mg tab

1lorazepam 2mg tab

1lorazepam 2mg/ml oral soln

1OXAZEPAM 10MG CAP

1OXAZEPAM 15MG CAP

1OXAZEPAM 30MG CAP

ANTIARRHYTHMICSANTIARRHYTHMICS TYPE I-A

1disopyramide 100mg cap

1disopyramide 150mg cap

1NORPACE 100MG ER CAP

1NORPACE 150MG ER CAP

1quinidine gluconate 324mg er tab

1QUINIDINE SULFATE 200MG TAB

1QUINIDINE SULFATE 300MG TABANTIARRHYTHMICS TYPE I-B

1mexiletine 150mg cap


17


1mexiletine 200mg cap

1mexiletine 250mg capANTIARRHYTHMICS TYPE I-C

1flecainide acetate 100mg tab



1propafenone 150mg tab

1propafenone 225mg er cap



1propafenone 325mg er cap

1propafenone 425mg er capANTIARRHYTHMICS TYPE III

1amiodarone 200mg tab

1amiodarone 400mg tab

1dofetilide 0.125mg cap



1MULTAQ 400MG TAB

1pacerone 200mg tab

1pacerone 400mg tab

ANTIASTHMATIC AND BRONCHODILATOR AGENTSANTIASTHMATIC - MONOCLONAL ANTIBODIES

1FASENRA 30MG/ML AUTO-INJECTOR PA

1FASENRA 30MG/ML SYRINGE PA

1NUCALA 100MG INJ NDS PA

1NUCALA 100MG/ML AUTO-INJECTOR NDS PA

1NUCALA 100MG/ML SYRINGE NDS PA

1XOLAIR 150MG INJ NDS PA

1XOLAIR 150MG/ML SYRINGE NDS PA

1XOLAIR 75MG/0.5ML SYRINGE NDS PABRONCHODILATORS - ANTICHOLINERGICS

1ATROVENT 17MCG INH

1INCRUSE 62.5MCG/INH INH

1ipratropium bromide 0.2mg/ml inh soln PA BvD

1LONHALA 25MCG/ML INH SOLN ST

1SPIRIVA 1.25MCG INH ST QL=4 GM/30 DaysLEUKOTRIENE MODULATORS

1montelukast 10mg tab

1montelukast 4mg chew tab

1montelukast 4mg granules

1montelukast 5mg chew tab

1zafirlukast 10mg tab

1zafirlukast 20mg tabSELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS

1DALIRESP 250MCG TAB


18


1DALIRESP 500MCG TABSTEROID INHALANTS

1ARNUITY 100MCG INH QL=30 EA/30 Days



1ASMANEX 100MCG INH QL=13 GM/30 Days

1ASMANEX 110MCG/INH INH QL=1 EA/30 Days

1ASMANEX 200MCG INH QL=13 GM/30 Days

1ASMANEX 220MCG (120ACT) INH QL=1 EA/30 Days



1ASMANEX 50MCG HFA INH QL=13 GM/30 Days

1budesonide 0.125mg/ml inh susp PA BvD QL=120 ML/30 Days



1FLOVENT 100MCG/BLIST INH QL=60 EA/30 Days

1FLOVENT 110MCG INH QL=24 GM/30 Days

1FLOVENT 220MCG INH QL=24 GM/30 Days

1FLOVENT 250MCG/BLIST INH QL=60 EA/30 Days

1FLOVENT 44MCG INH QL=21.20 GM/30 Days

1FLOVENT 50MCG/BLIST INH QL=60 EA/30 DaysSYMPATHOMIMETICS

1ADVAIR 0.045-0.021MG INH QL=12 GM/30 Days



1albuterol 0.21mg/ml inh soln PA BvD


1albuterol 0.4mg/ml oral soln


1albuterol 2mg tab

1ALBUTEROL 4MG ER TAB

1albuterol 4mg tab

1albuterol 5mg/ml inh soln PA BvD

1ALBUTEROL 8MG ER TAB

1ANORO 0.0625-0.025MG INH QL=60 EA/30 Days

1BREO 0.1-0.025MG INH QL=60 EA/30 Days

1BREO 0.2-0.025MG INH QL=60 EA/30 Days

1COMBIVENT 0.1-0.02MG INH

1DULERA 0.005-0.1MG INH QL=13 GM/30 Days

1DULERA 0.005-0.2MG INH QL=13 GM/30 Days

1DULERA 50-5MCG INH QL=13 GM/30 Days

1fluticasone propionate 0.1mg/salmeterol 0.05mg inh QL=60 EA/30 Days



1FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE 113-14MCG/ACT POWDER INH

QL=1 EA/30 Days


19



QL=1 EA/30 Days


QL=1 EA/30 Days

1ipratropium/albuterol 0.5-2.5mg/3ml inh soln PA BvD

1levalbuterol 0.103mg/ml inh soln PA BvD




1METAPROTERENOL SULFATE 2MG/ML ORAL SOLN

1SEREVENT 50MCG/DOSE INH

1STIOLTO 0.0025-0.0025MG INH QL=4 GM/30 Days

1terbutaline sulfate 2.5mg tab

1terbutaline sulfate 5mg tab

1TRELEGY 0.1-0.0625-0.025MG INH QL=60 EA/30 Days

1VENTOLIN 108MCG INH QL=36 GM/30 Days

1wixela 0.1-0.05mg inh QL=60 EA/30 Days

1wixela 0.25-0.05mg inh QL=60 EA/30 Days

1wixela 0.5-0.05mg inh QL=60 EA/30 DaysXANTHINES

1THEOPHYLLINE 300MG ER TAB

1theophylline 400mg er tab

1theophylline 5.33mg/ml oral soln

1theophylline 600mg er tab

ANTICOAGULANTSCOUMARIN ANTICOAGULANTS

1jantoven 10mg tab

1jantoven 1mg tab

1jantoven 2.5mg tab

1jantoven 2mg tab

1jantoven 3mg tab

1jantoven 4mg tab

1jantoven 5mg tab

1jantoven 6mg tab

1jantoven 7.5mg tab

1warfarin sodium 10mg tab


1warfarin sodium 2.5mg tab






1warfarin sodium 7.5mg tabDIRECT FACTOR XA INHIBITORS


20


1ELIQUIS 2.5MG TAB

1ELIQUIS 30-DAY STARTER PACK 5MG

1ELIQUIS 5MG TAB

1XARELTO 10MG TAB

1XARELTO 15MG TAB

1XARELTO 2.5MG TAB

1XARELTO 20MG TAB

1XARELTO KIT PACKHEPARINS AND HEPARINOID-LIKE AGENTS

1enoxaparin sodium 100mg/ml (0.3ml) syringe QL=18 ML/30 Days




1enoxaparin sodium 100mg/ml (1ml) syringe QL=60 ML/30 Days


1enoxaparin sodium 150mg/ml (1ml) syringe QL=60 ML/30 Days

1fondaparinux sodium 12.5mg/ml (0.4ml) syringe



1fondaparinux sodium 5mg/ml syringe

1FRAGMIN 10000UNIT/ML SYRINGE

1FRAGMIN 12500UNIT/0.5ML SYRINGE


1FRAGMIN 18000UNT/0.72ML SYRINGE




1FRAGMIN 95000UNIT/3.8ML INJ

1heparin sodium porcine 10000unit/ml inj



1heparin sodium porcine 5000unit/ml injTHROMBIN INHIBITORS

1PRADAXA 110MG CAP

1PRADAXA 150MG CAP

1PRADAXA 75MG CAP

ANTICONVULSANTSAMPA GLUTAMATE RECEPTOR ANTAGONISTS

1FYCOMPA 0.5MG/ML SUSP PA NSO

1FYCOMPA 10MG TAB PA NSO





1FYCOMPA 8MG TAB PA NSOANTICONVULSANTS - BENZODIAZEPINES


21


1clobazam 10mg tab

1clobazam 2.5mg/ml susp

1clobazam 20mg tab

1clonazepam 0.125mg odt



1clonazepam 0.5mg tab

1clonazepam 1mg odt

1clonazepam 1mg tab

1clonazepam 2mg odt

1clonazepam 2mg tab

1DIASTAT 10MG RECTAL GEL

1DIASTAT 2.5MG RECTAL GEL

1DIASTAT 20MG RECTAL GEL

1DIAZEPAM 10MG/2ML RECTAL GEL

1DIAZEPAM 2.5MG/0.5ML RECTAL GEL

1DIAZEPAM 20MG/4ML RECTAL GEL

1NAYZILAM 5MG/0.1ML NASAL SPRAY

1SYMPAZAN 10MG ORAL FILM ST_NSO



1VALTOCO 10MG DOSE KIT 10MG/0.1ML PACK

1VALTOCO 15MG DOSE KIT 7.5MG/0.1ML PACK

1VALTOCO 20MG DOSE KIT 10MG/0.1ML PACK

1VALTOCO 5MG DOSE KIT 5MG/0.1ML PACKANTICONVULSANTS - MISC.

1APTIOM 200MG TAB PA NSO




1BANZEL 200MG TAB PA NSO

1BANZEL 400MG TAB PA NSO

1BANZEL 40MG/ML SUSP PA NSO

1BRIVIACT 100MG TAB PA NSO QL=60 EA/30 Days


1BRIVIACT 10MG/ML ORAL SOLN PA NSO




1carbamazepine 100mg chew tab

1carbamazepine 100mg er cap

1carbamazepine 100mg er tab



1carbamazepine 200mg tab

1carbamazepine 20mg/ml susp


22




1EPIDIOLEX 100MG/ML ORAL SOLN PA NSO

1epitol 200mg tab

1gabapentin 100mg cap



1gabapentin 50mg/ml oral soln

1gabapentin 600mg tab

1gabapentin 800mg tab

1LAMICTAL XR BLUE KIT

1LAMICTAL XR GREEN KIT

1LAMICTAL XR ORANGE KIT

1lamotrigine 100mg er tab

1lamotrigine 100mg odt

1lamotrigine 100mg tab






1lamotrigine 25mg chew tab



1lamotrigine 25mg pack





1lamotrigine 5mg chew tab

1lamotrigine tab 25mg (42)/100mg (7) starter pack

1lamotrigine tab 25mg (84)/100mg (14) starter pack

1levetiracetam 1000mg tab

1levetiracetam 100mg/ml oral soln


1levetiracetam 500mg er tab


1levetiracetam 750mg er tab


1oxcarbazepine 150mg tab



1oxcarbazepine 60mg/ml susp

1OXTELLAR 150MG ER TAB




23


1pregabalin 100mg cap



1pregabalin 20mg/ml oral soln






1primidone 250mg tab

1primidone 50mg tab

1QUDEXY 100MG ER CAP PA NSO





1roweepra 1000mg tab

1roweepra 500mg er tab

1roweepra 500mg tab

1roweepra 750mg er tab

1roweepra 750mg tab

1SPRITAM 1000MG TAB FOR ORAL SUSP PA NSO




1TOPIRAMATE 100MG ER CAP PA NSO

1topiramate 100mg tab


1topiramate 15mg cap



1topiramate 25mg cap





1TROKENDI 100MG ER CAP PA NSO




1VIMPAT 100MG TAB QL=60 EA/30 Days

1VIMPAT 10MG/ML ORAL SOLN




1zonisamide 100mg cap


24


1zonisamide 25mg cap

1zonisamide 50mg capCARBAMATES

1felbamate 120mg/ml susp

1felbamate 400mg tab

1felbamate 600mg tab

1XCOPRI 100MG TAB PA NSO

1XCOPRI 12.5/25MG TITRATION PACK PA NSO

1XCOPRI 150/200MG TITRATION PACK PA NSO



1XCOPRI 50/100MG TITRATION PACK PA NSO


1XCOPRI TAB 150/200MG PACK PA NSO

1XCOPRI TAB 50/200MG PACK PA NSOGABA MODULATORS

1tiagabine 12mg tab

1tiagabine 16mg tab

1tiagabine 2mg tab

1tiagabine 4mg tab

1vigabatrin 500mg powder for oral soln NDS PA NSO

1vigabatrin 500mg tab NDS PA NSO

1vigadrone 500mg powder for oral soln NDS PA NSOHYDANTOINS

1DILANTIN 30MG ER CAP

1PEGANONE 250MG TAB

1phenytoin 25mg/ml susp

1phenytoin 50mg chew tab

1phenytoin sodium 100mg er cap

1phenytoin sodium 200mg er cap

1phenytoin sodium 300mg er capSUCCINIMIDES

1CELONTIN 300MG CAP

1ethosuximide 250mg cap

1ethosuximide 50mg/ml oral solnVALPROIC ACID

1divalproex sodium 125mg dr cap

1divalproex sodium 125mg dr tab


1divalproex sodium 250mg er tab


1divalproex sodium 500mg er tab

1valproic acid 250mg cap

1valproic acid 50mg/ml oral soln

ANTIDEPRESSANTSALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)


25


1mirtazapine 15mg odt

1mirtazapine 15mg tab





1mirtazapine 7.5mg tabANTIDEPRESSANTS - MISC.

1APLENZIN 174MG ER TAB ST_NSO



1bupropion 100mg er tab

1bupropion 100mg tab

1bupropion 150mg sr (12 hr) tab

1bupropion 150mg xl (24 hr) tab



1bupropion 75mg tab

1MAPROTILINE 25MG TAB

1MAPROTILINE 50MG TAB

1MAPROTILINE 75MG TABMONOAMINE OXIDASE INHIBITORS (MAOIS)

1EMSAM 12MG/24HR PATCH



1MARPLAN 10MG TAB

1phenelzine 15mg tab

1tranylcypromine 10mg tabSELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)

1citalopram 10mg tab


1citalopram 2mg/ml oral soln


1escitalopram 10mg tab

1escitalopram 1mg/ml oral soln



1fluoxetine 10mg cap

1fluoxetine 10mg tab


1fluoxetine 20mg tab


1fluoxetine 4mg/ml oral soln

1fluvoxamine maleate 100mg er cap ST_NSO

1fluvoxamine maleate 100mg tab

1fluvoxamine maleate 150mg er cap ST_NSO


26




1paroxetine 10mg tab

1paroxetine 12.5mg er tab


1paroxetine 25mg er tab


1paroxetine 37.5mg er tab


1PAXIL 10MG/5ML SUSP

1PEXEVA 10MG TAB

1PEXEVA 20MG TAB

1PEXEVA 30MG TAB

1PEXEVA 40MG TAB

1sertraline 100mg tab

1sertraline 20mg/ml oral soln

1sertraline 25mg tab

1sertraline 50mg tabSEROTONIN MODULATORS

1NEFAZODONE 100MG TAB





1trazodone 100mg tab



1trazodone 50mg tab

1TRINTELLIX 10MG TAB ST_NSO QL=30 EA/30 Days



1VIIBRYD 10/20MG STARTER PACK ST_NSO QL=30 EA/30 Days

1VIIBRYD 10MG TAB ST_NSO QL=30 EA/30 Days

1VIIBRYD 20MG TAB ST_NSO QL=30 EA/30 Days

1VIIBRYD 40MG TAB ST_NSO QL=30 EA/30 DaysSEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)

1desvenlafaxine succinate 100mg er tab



1DRIZALMA 20MG DR CAP ST_NSO




1duloxetine 20mg dr cap


1duloxetine 40mg dr cap ST_NSO QL=30 EA/30 Days


27



1FETZIMA 120MG ER CAP ST_NSO QL=30 EA/30 Days




1FETZIMA PACK ST_NSO QL=30 EA/30 Days

1venlafaxine 100mg tab

1venlafaxine 150mg er cap


1venlafaxine 37.5mg er cap

1venlafaxine 37.5mg tab


1venlafaxine 75mg er cap

1venlafaxine 75mg tabTRICYCLIC AGENTS

1amitriptyline 100mg tab






1AMOXAPINE 100MG TAB

1AMOXAPINE 150MG TAB

1AMOXAPINE 25MG TAB

1AMOXAPINE 50MG TAB

1clomipramine 25mg cap



1desipramine 100mg tab






1doxepin 100mg cap

1doxepin 10mg cap

1doxepin 10mg/ml oral soln

1doxepin 150mg cap

1doxepin 25mg cap

1doxepin 50mg cap

1doxepin 75mg cap

1imipramine 10mg tab



1imipramine pamoate 100mg cap



28




1nortriptyline 10mg cap


1NORTRIPTYLINE 2MG/ML ORAL SOLN



1protriptyline 10mg tab

1protriptyline 5mg tab

1trimipramine 100mg cap



ANTIDIABETICSALPHA-GLUCOSIDASE INHIBITORS

1acarbose 100mg tab

1acarbose 25mg tab

1acarbose 50mg tab

1miglitol 100mg tab

1miglitol 25mg tab

1miglitol 50mg tabANTIDIABETIC COMBINATIONS

1glipizide 2.5mg/metformin 250mg tab

1glipizide 2.5mg/metformin 500mg tab

1glipizide 5mg/metformin 500mg tab

1glyburide 1.25mg/metformin 250mg tab

1glyburide 2.5mg/metformin 500mg tab

1glyburide 5mg/metformin 500mg tab

1GLYXAMBI 10-5MG TAB QL=30 EA/30 Days

1GLYXAMBI 25-5MG TAB QL=30 EA/30 Days

1JANUMET 1000-100MG ER TAB QL=30 EA/30 Days


1JANUMET 1000-50MG TAB QL=60 EA/30 Days


1JANUMET 500-50MG TAB QL=60 EA/30 Days

1JENTADUETO 2.5-1000MG ER TAB QL=30 EA/30 Days

1JENTADUETO 2.5-1000MG TAB QL=60 EA/30 Days



1JENTADUETO 5-1000MG ER TAB QL=30 EA/30 Days

1SOLIQUA 100UNIT-0.033MG/ML PEN INJ PA QL=15 ML/25 Days

1SYNJARDY 10-1000MG ER TAB QL=30 EA/30 Days

1SYNJARDY 12.5-1000MG ER TAB QL=60 EA/30 Days

1SYNJARDY 12.5-1000MG TAB QL=60 EA/30 Days

1SYNJARDY 12.5-500MG TAB QL=60 EA/30 Days




29


1SYNJARDY 5-1000MG TAB QL=60 EA/30 Days

1SYNJARDY 5-500MG TAB QL=60 EA/30 Days

1TRIJARDY 10-5-1000MG ER TAB QL=30 EA/30 Days

1TRIJARDY 12.5-2.5-1000MG ER TAB QL=60 EA/30 Days

1TRIJARDY 25-5-1000MG ER TAB QL=30 EA/30 Days

1TRIJARDY 5-2.5-1000MG ER TAB QL=60 EA/30 Days

1XIGDUO 10-1000MG ER TAB QL=30 EA/30 Days


1XIGDUO 2.5-1000MG ER TAB QL=60 EA/30 Days



1XULTOPHY 100UNIT-3.6MG/ML PEN INJ PA QL=15 ML/30 DaysBIGUANIDES

1metformin 1000mg tab

1metformin 500mg er tab

1metformin 500mg tab

1metformin 750mg er tab

1metformin 850mg tabDIABETIC OTHER

1BAQSIMI 3MG/DOSE NASAL POWDER QL=2 EA/7 Days

1diazoxide 50mg/ml susp

1GLUCAGEN 1MG INJ QL=2 EA/7 Days

1GLUCAGON (RDNA) 1MG INJ QL=2 EA/7 Days

1GVOKE 0.5MG/0.1ML AUTO-INJECTOR QL=.20 ML/7 Days

1GVOKE 0.5MG/0.1ML SYRINGE QL=.20 ML/7 Days

1GVOKE 1MG/0.2ML AUTO-INJECTOR QL=.40 ML/7 Days

1GVOKE 1MG/0.2ML SYRINGE QL=.40 ML/7 Days

1KORLYM 300MG TAB NDS PADIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS

1JANUVIA 100MG TAB QL=30 EA/30 Days



1TRADJENTA 5MG TAB QL=30 EA/30 DaysINCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)

1BYDUREON 2MG PEN INJ QL=4 EA/28 Days

1BYDUREON 2MG/0.85ML AUTO-INJECTOR QL=3.40 ML/28 Days

1OZEMPIC 2MG/1.5ML PEN INJ QL=1.50 ML/28 Days

1OZEMPIC 2MG/1.5ML PEN INJ (1MG DOSE) QL=3 ML/28 Days

1RYBELSUS 14MG TAB QL=30 EA/30 Days



1TRULICITY 0.75MG/0.5ML AUTO-INJECTOR QL=2 ML/28 Days

1TRULICITY 1.5MG/0.5ML AUTO-INJECTOR QL=2 ML/28 Days

1VICTOZA 18MG/3ML PEN INJ QL=9 ML/30 DaysINSULIN

1FIASP 100UNIT/ML CARTRIDGE


30


1FIASP 100UNIT/ML INJ PA BvD

1FIASP 100UNIT/ML PEN INJ

1HUMALOG 100UNIT/ML CARTRIDGE

1HUMALOG 100UNIT/ML INJ

1HUMALOG 100UNIT/ML KWIKPEN SYRINGE

1HUMALOG 200UNIT/ML PEN INJ

1HUMALOG JR PEN INJ

1HUMALOG MIX 25-75UNIT/ML INJ

1HUMALOG MIX 25-75UNIT/ML PEN INJ

1HUMALOG MIX 50-50UNIT/ML INJ

1HUMALOG MIX 50-50UNIT/ML PEN INJ

1HUMULIN 70-30UNIT/ML PEN INJ

1HUMULIN R 500UNIT/ML INJ PA BvD

1HUMULIN R 500UNIT/ML PEN INJ

1LANTUS 100UNIT/ML INJ

1LANTUS 100UNIT/ML PEN INJ

1LEVEMIR 100UNIT/ML INJ

1LEVEMIR 100UNIT/ML PEN INJ

1NOVOLIN 70-30UNIT/ML INJ

1NOVOLIN N 100UNIT/ML INJ

1NOVOLIN N 100UNIT/ML PEN INJ

1NOVOLIN R 100UNIT/ML INJ

1NOVOLIN R 100UNIT/ML PEN INJ

1NOVOLOG 100UNIT/ML CARTRIDGE

1NOVOLOG 100UNIT/ML INJ PA BvD

1NOVOLOG 100UNIT/ML PEN INJ

1NOVOLOG MIX 70-30UNIT/ML INJ

1NOVOLOG MIX 70-30UNIT/ML PEN INJ

1TOUJEO 300UNIT/ML PEN INJ

1TOUJEO MAX 300UNIT/ML PEN INJ (3ML)

1TRESIBA 100UNIT/ML INJ

1TRESIBA 100UNIT/ML PEN INJ

1TRESIBA 200UNIT/ML PEN INJINSULIN SENSITIZING AGENTS

1AVANDIA 2MG TAB

1AVANDIA 4MG TAB

1pioglitazone 15mg tab

1pioglitazone 30mg tab

1pioglitazone 45mg tabMEGLITINIDE ANALOGUES

1nateglinide 120mg tab

1nateglinide 60mg tab

1repaglinide 0.5mg tab

1repaglinide 1mg tab

1repaglinide 2mg tabSODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS


31


1FARXIGA 10MG TAB QL=30 EA/30 Days

1FARXIGA 5MG TAB QL=30 EA/30 Days

1JARDIANCE 10MG TAB QL=30 EA/30 Days

1JARDIANCE 25MG TAB QL=30 EA/30 DaysSULFONYLUREAS

1glimepiride 1mg tab



1glipizide 10mg er tab

1glipizide 10mg tab

1glipizide 2.5mg er tab

1glipizide 5mg er tab

1glipizide 5mg tab

1glyburide 1.25mg tab



1glyburide 3mg tab

1glyburide 5mg tab

1glyburide 6mg tab

ANTIDIARRHEAL/PROBIOTIC AGENTSANTIPERISTALTIC AGENTS

1atropine sulfate 0.005mg/ml/diphenoxylate 0.5mg/ml oral soln

1atropine sulfate 0.025mg/diphenoxylate 2.5mg tab

1loperamide 2mg cap

ANTIDOTES AND SPECIFIC ANTAGONISTSANTIDOTES - CHELATING AGENTS

1CHEMET 100MG CAP

1deferasirox 125mg tab for oral susp

1deferasirox 180mg tab





1FERRIPROX 1000MG TAB NDS PA

1FERRIPROX 100MG/ML ORAL SOLN NDS PA

1FERRIPROX 500MG TAB NDS PA

1JADENU 180MG GRANULES NDS

1JADENU 360MG GRANULES NDS

1JADENU 90MG GRANULES NDSOPIOID ANTAGONISTS

1NALOXONE 0.4MG/ML CARTRIDGE QL=2 ML/2 Days

1naloxone 0.4mg/ml inj QL=2 ML/2 Days

1naloxone 1mg/ml syringe

1naltrexone 50mg tab

1NARCAN 4MG/0.1ML NASAL SPRAY


32


1VIVITROL 380MG INJ NDS

ANTIEMETICS5-HT3 RECEPTOR ANTAGONISTS

1granisetron 1mg tab PA BvD QL=60 EA/30 Days

1ondansetron 0.8mg/ml oral soln PA BvD

1ONDANSETRON 24MG TAB PA BvD

1ondansetron 4mg odt PA BvD

1ondansetron 4mg tab PA BvD

1ondansetron 8mg odt PA BvD

1ondansetron 8mg tab PA BvDANTIEMETICS - ANTICHOLINERGIC

1meclizine 12.5mg tab

1meclizine 25mg tab

1scopolamine 0.0139mg/hr patch

1trimethobenzamide 300mg capANTIEMETICS - MISCELLANEOUS

1doxylamine succinate 10mg/pyridoxine 10mg dr tab QL=120 EA/30 Days

1dronabinol 10mg cap PA

1dronabinol 2.5mg cap PA

1dronabinol 5mg cap PASUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS

1aprepitant 125mg cap PA BvD QL=3 EA/2 Days

1aprepitant 125mg/aprepitant 80mg pack PA BvD QL=6 EA/4 Days



1VARUBI 90MG TAB PA BvD QL=4 EA/28 Days

ANTIFUNGALSANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS)

1caspofungin acetate 50mg inj NDS

1caspofungin acetate 70mg inj NDS

1ERAXIS 100MG INJ

1ERAXIS 50MG INJ

1micafungin sodium 100mg inj

1micafungin sodium 50mg injANTIFUNGALS

1ABELCET 5MG/ML INJ PA BvD

1AMBISOME 50MG INJ PA BvD

1AMPHOTERICIN B 50MG INJ PA BvD

1flucytosine 250mg cap

1flucytosine 500mg cap

1griseofulvin 125mg tab


1griseofulvin 25mg/ml susp


1nystatin 500000unit tab

1terbinafine 250mg tab


33


IMIDAZOLE-RELATED ANTIFUNGALS

1fluconazole 100mg tab

1fluconazole 10mg/ml susp



1fluconazole 2mg/ml (100ml) inj

1fluconazole 2mg/ml (200ml) inj

1fluconazole 40mg/ml susp


1itraconazole 100mg cap PA

1ketoconazole 200mg tab

1NOXAFIL 40MG/ML SUSP PA

1posaconazole 100mg dr tab PA

1voriconazole 200mg inj PA

1voriconazole 200mg tab NDS PA

1voriconazole 40mg/ml susp PA

1voriconazole 50mg tab NDS PA

ANTIHISTAMINESANTIHISTAMINES - NON-SEDATING

1cetirizine 1mg/ml oral soln

1desloratadine 5mg tab

1levocetirizine 0.5mg/ml oral soln

1levocetirizine 5mg tabANTIHISTAMINES - PHENOTHIAZINES

1promethazine 1.25mg/ml oral soln

1promethazine 12.5mg rectal supp

1promethazine 12.5mg tab

1promethazine 25mg rectal supp

1promethazine 25mg tab

1promethazine 50mg tab

1promethegan 25mg rectal supp

1PROMETHEGAN 50MG RECTAL SUPPANTIHISTAMINES - PIPERIDINES

1cyproheptadine 0.4mg/ml oral soln

1cyproheptadine 4mg tab

ANTIHYPERLIPIDEMICSANTIHYPERLIPIDEMICS - MISC.

1omega-3 acid ethyl esters (usp) 1000mg cap

1VASCEPA 0.5GM CAP QL=120 EA/30 Days

1VASCEPA 1GM CAP QL=120 EA/30 DaysBILE ACID SEQUESTRANTS

1cholestyramine resin 4gm sf powder for oral susp

1cholestyramine resin 4gm sf powder for oral susp (sugar free)

1colesevelam 3750mg powder for oral susp

1colesevelam 625mg tab


34


1colestipol 1000mg tab

1colestipol 5000mg granules for oral susp

1prevalite 4gm powder for oral suspFIBRIC ACID DERIVATIVES

1fenofibrate 134mg cap

1fenofibrate 145mg tab

1FENOFIBRATE 150MG CAP




1FENOFIBRATE 50MG CAP



1fenofibric acid 135mg dr cap

1fenofibric acid 45mg dr cap

1gemfibrozil 600mg tab

1TRIGLIDE 160MG TABHMG COA REDUCTASE INHIBITORS

1atorvastatin 10mg tab




1fluvastatin 20mg cap

1fluvastatin 40mg cap

1fluvastatin 80mg er tab

1lovastatin 10mg tab



1pravastatin sodium 10mg tab




1rosuvastatin calcium 10mg tab




1simvastatin 10mg tab




1simvastatin 80mg tabINTESTINAL CHOLESTEROL ABSORPTION INHIBITORS

1ezetimibe 10mg tab QL=30 EA/30 DaysMICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN (MTP) INHIBITORS

1JUXTAPID 10MG CAP NDS PA



35





1JUXTAPID 60MG CAP NDS PANICOTINIC ACID DERIVATIVES

1niacin 1000mg er tab

1niacin 500mg er tab

1niacin 750mg er tabPROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS

1PRALUENT 150MG/ML AUTO-INJECTOR PA QL=2 ML/28 Days

1PRALUENT 75MG/ML AUTO-INJECTOR PA QL=2 ML/28 Days

1REPATHA 140MG/ML AUTO-INJECTOR PA QL=2 ML/28 Days

1REPATHA 140MG/ML SYRINGE PA QL=2 ML/28 Days

1REPATHA 420MG/3.5ML CARTRIDGE PA QL=3.50 ML/28 Days

ANTIHYPERTENSIVESACE INHIBITORS

1benazepril 10mg tab



1benazepril 5mg tab

1captopril 100mg tab

1captopril 12.5mg tab

1captopril 25mg tab

1captopril 50mg tab

1enalapril maleate 10mg tab

1enalapril maleate 2.5mg tab



1fosinopril sodium 10mg tab



1lisinopril 10mg tab

1lisinopril 2.5mg tab




1lisinopril 5mg tab

1moexipril 15mg tab

1moexipril 7.5mg tab

1perindopril erbumine 2mg tab



1QBRELIS 1MG/ML ORAL SOLN PA

1quinapril 10mg tab

1quinapril 20mg tab

1quinapril 40mg tab


36


1quinapril 5mg tab

1ramipril 1.25mg cap

1ramipril 10mg cap

1ramipril 2.5mg cap

1ramipril 5mg cap

1trandolapril 1mg tab

1trandolapril 2mg tab

1trandolapril 4mg tabAGENTS FOR PHEOCHROMOCYTOMA

1DEMSER 250MG CAP NDS

1phenoxybenzamine 10mg capANGIOTENSIN II RECEPTOR ANTAGONISTS

1irbesartan 150mg tab



1losartan potassium 100mg tab



1olmesartan medoxomil 20mg tab



1telmisartan 20mg tab



1valsartan 160mg tab

1valsartan 320mg tab

1valsartan 40mg tab

1valsartan 80mg tabANTIADRENERGIC ANTIHYPERTENSIVES

1clonidine 0.00417mg/hr weekly patch



1clonidine 0.1mg tab



1doxazosin 1mg tab

1doxazosin 2mg tab

1doxazosin 4mg tab

1doxazosin 8mg tab

1guanfacine 1mg tab

1guanfacine 2mg tab

1methyldopa 250mg tab

1methyldopa 500mg tab

1prazosin 1mg cap

1prazosin 2mg cap

1prazosin 5mg cap


37


1terazosin 10mg cap

1terazosin 1mg cap

1terazosin 2mg cap

1terazosin 5mg capANTIHYPERTENSIVE COMBINATIONS

1amlodipine 10mg/benazepril 20mg cap


1amlodipine 10mg/hydrochlorothiazide 12.5mg/valsartan 160mg tab

1amlodipine 10mg/hydrochlorothiazide 25mg/valsartan 160mg tab


1amlodipine 10mg/olmesartan medoxomil 20mg tab


1amlodipine 10mg/valsartan 160mg tab


1amlodipine 2.5mg/benazepril 10mg cap




1amlodipine 5mg/hydrochlorothiazide 12.5mg/valsartan 160mg tab






1atenolol 100mg/chlorthalidone 25mg tab

1atenolol 50mg/chlorthalidone 25mg tab

1benazepril 10mg/hydrochlorothiazide 12.5mg tab


1benazepril 20mg/hydrochlorothiazide 25mg tab


1bisoprolol fumarate 10mg/hydrochlorothiazide 6.25mg tab

1bisoprolol fumarate 2.5mg/hydrochlorothiazide 6.25mg tab

1bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mg tab

1captopril 25mg/hydrochlorothiazide 15mg tab

1CAPTOPRIL 25MG/HYDROCHLOROTHIAZIDE 25MG TAB

1captopril 50mg/hydrochlorothiazide 15mg tab


38


1CAPTOPRIL 50MG/HYDROCHLOROTHIAZIDE 25MG TAB

1enalapril maleate 10mg/hydrochlorothiazide 25mg tab

1enalapril maleate 5mg/hydrochlorothiazide 12.5mg tab

1fosinopril sodium 10mg/hydrochlorothiazide 12.5mg tab

1fosinopril sodium 20mg/hydrochlorothiazide 12.5mg tab

1hydrochlorothiazide 12.5mg/irbesartan 150mg tab

1hydrochlorothiazide 12.5mg/irbesartan 300mg tab

1hydrochlorothiazide 12.5mg/lisinopril 10mg tab

1hydrochlorothiazide 12.5mg/lisinopril 20mg tab

1hydrochlorothiazide 12.5mg/losartan potassium 100mg tab

1hydrochlorothiazide 12.5mg/losartan potassium 50mg tab

1hydrochlorothiazide 12.5mg/olmesartan medoxomil 20mg tab

1hydrochlorothiazide 12.5mg/olmesartan medoxomil 40mg tab

1hydrochlorothiazide 12.5mg/quinapril 10mg tab

1hydrochlorothiazide 12.5mg/quinapril 20mg tab

1hydrochlorothiazide 12.5mg/valsartan 160mg tab



1hydrochlorothiazide 15mg/methyldopa 250mg tab

1hydrochlorothiazide 25mg/lisinopril 20mg tab

1hydrochlorothiazide 25mg/losartan potassium 100mg tab

1hydrochlorothiazide 25mg/methyldopa 250mg tab

1hydrochlorothiazide 25mg/metoprolol tartrate 100mg tab


1hydrochlorothiazide 25mg/olmesartan medoxomil 40mg tab

1hydrochlorothiazide 25mg/propranolol 40mg tab

1hydrochlorothiazide 25mg/propranolol 80mg tab

1hydrochlorothiazide 25mg/quinapril 20mg tab

1hydrochlorothiazide 25mg/valsartan 160mg tab

1hydrochlorothiazide 25mg/valsartan 320mg tab


1TRANDOLAPRIL 1MG/VERAPAMIL 240MG ER TAB


39


1trandolapril 2mg/verapamil 180mg er tab

1trandolapril 2mg/verapamil 240mg er tab

1trandolapril 4mg/verapamil 240mg er tabDIRECT RENIN INHIBITORS

1aliskiren 150mg tab

1aliskiren 300mg tabSELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)

1eplerenone 25mg tab

1eplerenone 50mg tabVASODILATORS

1hydralazine 100mg tab




1minoxidil 10mg tab

1minoxidil 2.5mg tab

ANTI-INFECTIVE AGENTS - MISC.ANTI-INFECTIVE AGENTS - MISC.

1metronidazole 250mg tab

1metronidazole 375mg cap

1metronidazole 500mg tab

1metronidazole 5mg/ml inj

1pentamidine isethionate 300mg inj

1pentamidine isethionate 50mg/ml inh soln PA BvD

1tinidazole 250mg tab

1tinidazole 500mg tab

1trimethoprim 100mg tab

1XIFAXAN 200MG TAB QL=9 EA/3 Days

1XIFAXAN 550MG TAB PA QL=60 EA/30 DaysANTI-INFECTIVE MISC. - COMBINATIONS

1sulfamethoxazole 400mg/trimethoprim 80mg tab

1sulfamethoxazole 40mg/ml/trimethoprim 8mg/ml susp

1sulfamethoxazole 800mg/trimethoprim 160mg tabANTIPROTOZOAL AGENTS

1ALINIA 100MG/5ML SUSP PA QL=150 ML/3 Days

1ALINIA 500MG TAB PA QL=6 EA/3 Days

1atovaquone 150mg/ml suspCARBAPENEMS

1CILASTATIN 250MG/IMIPENEM 250MG INJ

1cilastatin 500mg/imipenem 500mg inj

1ertapenem 1000mg inj

1meropenem 1000mg inj

1meropenem 500mg injCYCLIC LIPOPEPTIDES

1daptomycin 500mg inj NDSGLYCOPEPTIDES


40


1DALVANCE 500MG INJ NDS

1FIRVANQ 25MG/ML ORAL SOLN

1FIRVANQ 50MG/ML ORAL SOLN

1vancomycin 1000mg inj

1vancomycin 100mg/ml inj

1vancomycin 125mg cap QL=120 EA/30 Days

1vancomycin 250mg cap QL=120 EA/30 Days

1VANCOMYCIN 250MG INJ

1vancomycin 500mg inj

1vancomycin 750mg injLEPROSTATICS

1dapsone 100mg tab

1dapsone 25mg tabLINCOSAMIDES

1clindamycin 12mg/ml inj

1clindamycin 150mg cap

1clindamycin 150mg/ml (2ml) inj



1clindamycin 15mg/ml oral soln


1clindamycin 300mg cap


1clindamycin 75mg capMONOBACTAMS

1aztreonam 1000mg inj

1CAYSTON 75MG INH SOLN NDS PAOXAZOLIDINONES

1linezolid 20mg/ml susp

1linezolid 2mg/ml inj

1linezolid 600mg tab

1SIVEXTRO 200MG INJ NDS PA QL=6 EA/6 Days

1SIVEXTRO 200MG TAB NDS PA QL=6 EA/6 DaysPLEUROMUTILINS

1XENLETA 600MG TAB PA QL=14 EA/7 DaysPOLYMYXINS

1colistin 75mg/ml inj

1polymyxin b 250000unit/ml inj

ANTIMALARIALSANTIMALARIAL COMBINATIONS

1atovaquone 250mg/proguanil 100mg tab

1atovaquone 62.5mg/proguanil 25mg tab

1COARTEM 20-120MG TABANTIMALARIALS

1CHLOROQUINE PHOSPHATE 250MG TAB

1chloroquine phosphate 500mg tab


41


1hydroxychloroquine sulfate 200mg tab

1KRINTAFEL 150MG TAB

1MEFLOQUINE 250MG TAB

1PRIMAQUINE PHOSPHATE 26.3MG TAB

1quinine sulfate 324mg cap PA

ANTIMYASTHENIC/CHOLINERGIC AGENTSANTIMYASTHENIC/CHOLINERGIC AGENTS

1GUANIDINE 125MG TAB

1pyridostigmine bromide 180mg er tab

1pyridostigmine bromide 60mg tab

1RUZURGI 10MG TAB NDS PA

ANTIMYCOBACTERIAL AGENTSANTIMYCOBACTERIAL AGENTS

1ethambutol 100mg tab

1ethambutol 400mg tab

1isoniazid 100mg tab

1ISONIAZID 10MG/ML ORAL SOLN

1isoniazid 300mg tab

1PASER D/R 4GM GRANULES

1PRIFTIN 150MG TAB

1pyrazinamide 500mg tab

1rifabutin 150mg cap

1rifampin 150mg cap

1rifampin 300mg cap

1rifampin 600mg inj

1SIRTURO 100MG TAB NDS PA

1TRECATOR 250MG TAB

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIESALKYLATING AGENTS

1CYCLOPHOSPHAMIDE 25MG CAP PA BvD

1CYCLOPHOSPHAMIDE 50MG CAP PA BvD

1LEUKERAN 2MG TABANTIMETABOLITES

1mercaptopurine 50mg tab

1methotrexate 2.5mg tab

1methotrexate 25mg/ml (2ml) inj

1methotrexate 25mg/ml inj

1PURIXAN 2000MG/100ML SUSP

1TABLOID 40MG TAB

1XATMEP 2.5MG/ML ORAL SOLN PAANTINEOPLASTIC - BCL-2 INHIBITORS

1VENCLEXTA 100MG TAB NDS PA NSO

1VENCLEXTA 10MG TAB PA NSO

1VENCLEXTA 50MG TAB PA NSO

1VENCLEXTA STARTING PACK NDS PA NSOANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS


42


1DAURISMO 100MG TAB NDS PA NSO

1DAURISMO 25MG TAB NDS PA NSO

1ERIVEDGE 150MG CAP NDS PA NSO

1ODOMZO 200MG CAP NDS PA NSOANTINEOPLASTIC - HORMONAL AND RELATED AGENTS

1abiraterone acetate 250mg tab QL=120 EA/30 Days

1anastrozole 1mg tab

1bicalutamide 50mg tab

1DEPO-PROVERA 400MG/ML INJ

1ELIGARD 22.5MG SYRINGE

1ELIGARD 30MG SYRINGE

1ELIGARD 45MG SYRINGE

1ELIGARD 7.5MG SYRINGE

1EMCYT 140MG CAP

1ERLEADA 60MG TAB NDS PA NSO QL=120 EA/30 Days

1exemestane 25mg tab

1FIRMAGON 120MG INJ PA NSO

1FIRMAGON 80MG INJ PA NSO

1flutamide 125mg cap

1letrozole 2.5mg tab

1leuprolide acetate 5mg/ml inj

1LUPRON 11.25MG SYRINGE



1LUPRON 30MG SYRINGE

1LUPRON 45MG SYRINGE


1LYSODREN 500MG TAB

1megestrol acetate 20mg tab PA NSO

1megestrol acetate 40mg tab PA NSO

1megestrol acetate 40mg/ml susp PA

1nilutamide 150mg tab NDS

1NUBEQA 300MG TAB NDS PA NSO QL=120 EA/30 Days

1SOLTAMOX 10MG/5ML ORAL SOLN PA NSO

1tamoxifen 10mg tab

1tamoxifen 20mg tab

1toremifene 60mg tab

1TRELSTAR 11.25MG INJ



1XTANDI 40MG CAP NDS PA NSO QL=120 EA/30 DaysANTINEOPLASTIC - IMMUNOMODULATORS

1POMALYST 1MG CAP NDS PA NSO





43


ANTINEOPLASTIC - XPO1 INHIBITORS

1XPOVIO 100 MG ONCE WEEKLY NDS PA NSO QL=32 EA/28 Days



1XPOVIO 80 MG TWICE WEEKLY NDS PA NSO QL=32 EA/28 DaysANTINEOPLASTIC COMBINATIONS

1KISQALI FEMARA CO-PACK 200 PACK NDS PA NSO QL=49 EA/28 Days



1LONSURF 6.14-15MG TAB NDS PA NSO

1LONSURF 8.19-20MG TAB NDS PA NSOANTINEOPLASTIC ENZYME INHIBITORS

1AFINITOR 10MG TAB NDS PA NSO QL=30 EA/30 Days

1AFINITOR 2MG TAB FOR ORAL SUSP NDS PA NSO



1ALECENSA 150MG CAP NDS PA NSO QL=240 EA/30 Days

1ALUNBRIG 180MG TAB NDS PA NSO QL=30 EA/30 Days



1ALUNBRIG INITIATION PACK NDS PA NSO QL=30 EA/30 Days

1AYVAKIT 100MG TAB NDS PA NSO QL=30 EA/30 Days



1BALVERSA 3MG TAB NDS PA NSO QL=60 EA/30 Days



1BOSULIF 100MG TAB NDS PA NSO



1BRAFTOVI 75MG CAP NDS PA NSO QL=180 EA/30 Days

1BRUKINSA 80MG CAP NDS PA NSO QL=120 EA/30 Days

1CABOMETYX 20MG TAB NDS PA NSO



1CALQUENCE 100MG CAP NDS PA NSO QL=60 EA/30 Days

1CAPRELSA 100MG TAB NDS PA NSO QL=60 EA/30 Days

1CAPRELSA 300MG TAB NDS PA NSO QL=30 EA/30 Days

1COMETRIQ 100MG DAILY DOSE CARTON PACK NDS PA NSO



1COPIKTRA 15MG CAP NDS PA NSO QL=60 EA/30 Days

1COPIKTRA 25MG CAP NDS PA NSO QL=60 EA/30 Days

1COTELLIC 20MG TAB NDS PA NSO QL=63 EA/28 Days

1erlotinib 100mg tab PA NSO



44



1everolimus 2.5mg tab PA NSO QL=30 EA/30 Days

1everolimus 5mg tab PA NSO QL=30 EA/30 Days

1everolimus 7.5mg tab PA NSO QL=30 EA/30 Days

1FARYDAK 10MG CAP NDS PA NSO

1FARYDAK 20MG CAP NDS PA NSO

1GILOTRIF 20MG TAB NDS PA NSO QL=30 EA/30 Days



1IBRANCE 100MG CAP NDS PA NSO QL=21 EA/28 Days

1IBRANCE 100MG TAB NDS PA NSO QL=21 EA/28 Days





1ICLUSIG 15MG TAB NDS PA NSO QL=60 EA/30 Days

1ICLUSIG 45MG TAB NDS PA NSO QL=30 EA/30 Days

1IDHIFA 100MG TAB NDS PA NSO QL=30 EA/30 Days

1IDHIFA 50MG TAB NDS PA NSO QL=30 EA/30 Days

1imatinib 100mg tab

1imatinib 400mg tab

1IMBRUVICA 140MG CAP NDS PA NSO QL=90 EA/30 Days

1IMBRUVICA 140MG TAB NDS PA NSO QL=30 EA/30 Days




1IMBRUVICA 70MG CAP NDS PA NSO QL=30 EA/30 Days

1INLYTA 1MG TAB NDS PA NSO

1INLYTA 5MG TAB NDS PA NSO

1INREBIC 100MG CAP NDS PA NSO QL=120 EA/30 Days

1IRESSA 250MG TAB NDS PA NSO

1JAKAFI 10MG TAB NDS PA NSO QL=60 EA/30 Days





1KISQALI 200MG DAILY DOSE PACK NDS PA NSO QL=21 EA/28 Days



1KOSELUGO 10MG CAP NDS PA NSO

1KOSELUGO 25MG CAP NDS PA NSO

1LENVIMA 10 10MG PACK NDS PA NSO QL=30 EA/30 Days


1LENVIMA 14 PACK NDS PA NSO QL=60 EA/30 Days




45





1LORBRENA 100MG TAB NDS PA NSO QL=30 EA/30 Days

1LORBRENA 25MG TAB NDS PA NSO QL=90 EA/30 Days

1LYNPARZA 100MG TAB NDS PA NSO QL=120 EA/30 Days

1LYNPARZA 150MG TAB NDS PA NSO QL=120 EA/30 Days

1MEKINIST 0.5MG TAB NDS PA NSO QL=90 EA/30 Days

1MEKINIST 2MG TAB NDS PA NSO QL=30 EA/30 Days

1MEKTOVI 15MG TAB NDS PA NSO QL=180 EA/30 Days

1NERLYNX 40MG TAB NDS PA NSO

1NEXAVAR 200MG TAB NDS PA NSO

1NINLARO 2.3MG CAP NDS PA NSO

1NINLARO 3MG CAP NDS PA NSO

1NINLARO 4MG CAP NDS PA NSO

1PEMAZYRE 13.5MG TAB NDS PA NSO QL=14 EA/21 Days

1PEMAZYRE 4.5MG TAB NDS PA NSO QL=14 EA/21 Days

1PEMAZYRE 9MG TAB NDS PA NSO QL=14 EA/21 Days

1PIQRAY 200MG DAILY DOSE PACK NDS PA NSO QL=30 EA/30 Days

1PIQRAY 250MG DAILY DOSE PACK NDS PA NSO QL=60 EA/30 Days

1PIQRAY 300MG DAILY DOSE 150MG PACK NDS PA NSO QL=60 EA/30 Days

1QINLOCK 50MG TAB NDS PA NSO QL=90 EA/30 Days

1RETEVMO 40MG CAP NDS PA NSO QL=180 EA/30 Days

1RETEVMO 80MG CAP NDS PA NSO QL=120 EA/30 Days

1ROZLYTREK 100MG CAP NDS PA NSO QL=30 EA/30 Days

1ROZLYTREK 200MG CAP NDS PA NSO QL=90 EA/30 Days

1RUBRACA 200MG TAB NDS PA NSO QL=120 EA/30 Days



1RYDAPT 25MG CAP NDS PA NSO

1SPRYCEL 100MG TAB NDS PA NSO






1STIVARGA 40MG TAB NDS PA NSO QL=84 EA/28 Days

1SUTENT 12.5MG CAP NDS PA NSO

1SUTENT 25MG CAP NDS PA NSO

1SUTENT 37.5MG CAP NDS PA NSO

1SUTENT 50MG CAP NDS PA NSO

1TABRECTA 150MG TAB NDS PA NSO QL=120 EA/30 Days

1TABRECTA 200MG TAB NDS PA NSO QL=120 EA/30 Days

1TAFINLAR 50MG CAP NDS PA NSO QL=120 EA/30 Days

1TAFINLAR 75MG CAP NDS PA NSO QL=120 EA/30 Days

1TAGRISSO 40MG TAB NDS PA NSO


46


1TAGRISSO 80MG TAB NDS PA NSO

1TALZENNA 0.25MG CAP NDS PA NSO QL=90 EA/30 Days

1TALZENNA 1MG CAP NDS PA NSO QL=30 EA/30 Days

1TASIGNA 150MG CAP NDS PA NSO



1TAZVERIK 200MG TAB NDS PA NSO QL=240 EA/30 Days

1TIBSOVO 250MG TAB NDS PA NSO QL=60 EA/30 Days

1TUKYSA 150MG TAB NDS PA NSO QL=120 EA/30 Days

1TUKYSA 50MG TAB NDS PA NSO QL=120 EA/30 Days

1TURALIO 200MG CAP NDS PA NSO QL=120 EA/30 Days

1TYKERB 250MG TAB NDS PA NSO

1VERZENIO 100MG TAB NDS PA NSO QL=56 EA/28 Days




1VITRAKVI 100MG CAP NDS PA NSO

1VITRAKVI 20MG/ML ORAL SOLN NDS PA NSO

1VITRAKVI 25MG CAP NDS PA NSO

1VIZIMPRO 15MG TAB NDS PA NSO QL=30 EA/30 Days



1VOTRIENT 200MG TAB NDS PA NSO

1XALKORI 200MG CAP NDS PA NSO QL=60 EA/30 Days

1XALKORI 250MG CAP NDS PA NSO QL=60 EA/30 Days

1XOSPATA 40MG TAB NDS PA NSO

1ZEJULA 100MG CAP NDS PA NSO QL=90 EA/30 Days

1ZELBORAF 240MG TAB NDS PA NSO QL=240 EA/30 Days

1ZOLINZA 100MG CAP NDS PA NSO

1ZYDELIG 100MG TAB NDS PA NSO QL=60 EA/30 Days

1ZYDELIG 150MG TAB NDS PA NSO QL=60 EA/30 Days

1ZYKADIA 150MG TAB NDS PA NSO QL=90 EA/30 DaysANTINEOPLASTICS MISC.

1ACTIMMUNE 2000000UNIT/0.5ML INJ NDS PA NSO

1bexarotene 75mg cap PA NSO

1hydroxyurea 500mg cap

1INTRON A 10MU INJ

1INTRON A 10MU/ML INJ

1INTRON A 18MU INJ NDS

1INTRON A 50MU INJ NDS

1INTRON A 6000000UNIT/ML INJ

1MATULANE 50MG CAP NDS

1SYLATRON 200MCG INJ NDS PA NSO

1SYLATRON 300MCG INJ NDS PA NSO

1SYNRIBO 3.5MG INJ NDS

1tretinoin 10mg cap


47


CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS

1LEUCOVORIN 10MG TAB

1LEUCOVORIN 15MG TAB

1leucovorin 25mg tab

1leucovorin 5mg tab

1MESNEX 400MG TAB

ANTIPARKINSON AGENTSANTIPARKINSON ANTICHOLINERGICS

1benztropine mesylate 2mg tab

1trihexyphenidyl 2mg tab

1trihexyphenidyl 5mg tabANTIPARKINSON DOPAMINERGICS

1amantadine 10mg/ml oral soln

1bromocriptine 2.5mg tab

1bromocriptine 5mg cap

1carbidopa 10mg/levodopa 100mg odt

1carbidopa 10mg/levodopa 100mg tab

1carbidopa 25mg/levodopa 100mg er tab




1carbidopa 50mg/levodopa 200mg er tab

1NEUPRO 1MG/24HR PATCH






1pramipexole 0.125mg tab


1pramipexole 0.375mg er tab






1pramipexole 1mg tab



1pramipexole 3mg er tab


1ropinirole 0.25mg tab

1ropinirole 0.5mg tab

1ropinirole 12mg er tab


1ropinirole 3mg tab


48



1ropinirole 4mg tab

1ropinirole 5mg tab



ANTIPARKINSON AND RELATED THERAPY AGENTSANTIPARKINSON ADJUNCTIVE THERAPY

1carbidopa 25mg tab

1NOURIANZ 20MG TAB PA QL=30 EA/30 Days

1NOURIANZ 40MG TAB PA QL=30 EA/30 DaysANTIPARKINSON ANTICHOLINERGICS

1benztropine mesylate 0.5mg tab

1benztropine mesylate 1mg tab

1trihexyphenidyl 0.4mg/ml oral solnANTIPARKINSON COMT INHIBITORS

1entacapone 200mg tab

1tolcapone 100mg tabANTIPARKINSON DOPAMINERGICS

1amantadine 100mg cap

1amantadine 100mg tab

1APOKYN 30MG/3ML CARTRIDGE NDS

1CARBIDOPA 12.5MG/ENTACAPONE 200MG/LEVODOPA 50MG TAB


1CARBIDOPA 25MG/ENTACAPONE 200MG/LEVODOPA 100MG TAB




1CARBIDOPA 50MG/ENTACAPONE 200MG/LEVODOPA 200MG TAB

1ropinirole 1mg tab

1ropinirole 2mg tabANTIPARKINSON MONOAMINE OXIDASE INHIBITORS

1rasagiline 0.5mg tab

1rasagiline 1mg tab

1selegiline 5mg cap

1selegiline 5mg tab

ANTIPSYCHOTICS/ANTIMANIC AGENTSANTIMANIC AGENTS

1lithium carbonate 150mg cap


1lithium carbonate 300mg er tab


49


1lithium carbonate 300mg tab

1lithium carbonate 450mg er tab


1lithium citrate 60mg/ml oral solnANTIPSYCHOTICS - MISC.

1CAPLYTA 42MG CAP PA NSO QL=30 EA/30 Days

1EQUETRO 100MG ER CAP



1LATUDA 120MG TAB ST_NSO QL=30 EA/30 Days





1NUPLAZID 10MG TAB PA NSO QL=30 EA/30 Days

1NUPLAZID 34MG CAP PA NSO QL=30 EA/30 Days

1VRAYLAR 1.5/3MG MIXED PACK PA NSO QL=30 EA/30 Days

1VRAYLAR 1.5MG CAP PA NSO QL=30 EA/30 Days

1VRAYLAR 3MG CAP PA NSO QL=30 EA/30 Days

1VRAYLAR 4.5MG CAP PA NSO QL=30 EA/30 Days

1VRAYLAR 6MG CAP PA NSO QL=30 EA/30 Days

1ziprasidone 20mg cap

1ziprasidone 20mg inj



1ziprasidone 80mg capBENZISOXAZOLES

1FANAPT 10MG TAB PA NSO QL=60 EA/30 Days







1FANAPT TITRATION PACK PA NSO QL=60 EA/30 Days

1INVEGA 117MG/0.75ML SYRINGE

1INVEGA 156MG/ML SYRINGE








1paliperidone 1.5mg er tab PA NSO QL=30 EA/30 Days

1paliperidone 3mg er tab PA NSO QL=30 EA/30 Days


50




1PERSERIS 120MG SYRINGE NDS

1PERSERIS 90MG SYRINGE NDS

1RISPERDAL 12.5MG INJ

1RISPERDAL 25MG INJ

1RISPERDAL 37.5MG INJ

1RISPERDAL 50MG INJ

1risperidone 0.25mg odt

1risperidone 0.25mg tab

1risperidone 0.5mg odt

1risperidone 0.5mg tab

1risperidone 1mg odt

1risperidone 1mg tab

1risperidone 1mg/ml oral soln






1risperidone 4mg tabBUTYROPHENONES

1azelastine/fluticasone 137-50mcg/act nasal spray

1haloperidol 0.5mg tab

1haloperidol 10mg tab




1haloperidol 2mg/ml oral soln


1haloperidol 5mg/ml inj

1haloperidol decanoate 100mg/ml (1ml) inj

1haloperidol decanoate 100mg/ml inj

1haloperidol decanoate 50mg/ml injDIBENZAPINES

1clozapine 100mg odt

1clozapine 100mg tab

1CLOZAPINE 12.5MG ODT

1CLOZAPINE 150MG ODT

1CLOZAPINE 200MG ODT

1clozapine 200mg tab

1clozapine 25mg odt

1clozapine 25mg tab

1clozapine 50mg tab

1loxapine 10mg cap

1loxapine 25mg cap


51


1loxapine 50mg cap

1loxapine 5mg cap

1olanzapine 10mg inj

1olanzapine 10mg odt

1olanzapine 10mg tab



1olanzapine 2.5mg tab



1olanzapine 5mg odt

1olanzapine 5mg tab

1olanzapine 7.5mg tab

1quetiapine 100mg tab

1quetiapine 150mg er tab










1SAPHRIS 10MG SL TAB PA NSO QL=60 EA/30 Days

1SAPHRIS 2.5MG SL TAB PA NSO QL=60 EA/30 Days

1SAPHRIS 5MG SL TAB PA NSO QL=60 EA/30 Days

1SECUADO 3.8MG/24HR PATCH PA NSO QL=30 EA/30 Days



1VERSACLOZ 50MG/ML SUSP

1ZYPREXA 210MG INJDIHYDROINDOLONES

1MOLINDONE 10MG TAB

1MOLINDONE 25MG TAB

1MOLINDONE 5MG TABPHENOTHIAZINES

1chlorpromazine 100mg tab





1compro 25mg rectal supp

1FLUPHENAZINE 0.5MG/ML ORAL SOLN

1fluphenazine 10mg tab



52


1fluphenazine 2.5mg tab

1FLUPHENAZINE 2.5MG/ML INJ


1FLUPHENAZINE 5MG/ML ORAL SOLN

1fluphenazine decanoate 25mg/ml inj

1perphenazine 16mg tab




1prochlorperazine 10mg tab

1prochlorperazine 25mg rectal supp

1prochlorperazine 5mg tab

1thioridazine 100mg tab




1trifluoperazine 10mg tab



1trifluoperazine 5mg tabQUINOLINONE DERIVATIVES

1ABILIFY 300MG INJ NDS

1ABILIFY 300MG SYRINGE NDS

1ABILIFY 400MG INJ NDS

1ABILIFY 400MG SYRINGE NDS

1aripiprazole 10mg odt PA NSO QL=60 EA/30 Days

1aripiprazole 10mg tab

1aripiprazole 15mg odt PA NSO QL=60 EA/30 Days


1aripiprazole 1mg/ml oral soln PA NSO





1ARISTADA 1064MG/3.9ML SYRINGE

1ARISTADA 441MG/1.6ML SYRINGE NDS



1ARISTADA 882MG/3.2ML SYRINGE

1REXULTI 0.25MG TAB PA NSO QL=30 EA/30 Days

1REXULTI 0.5MG TAB PA NSO QL=30 EA/30 Days

1REXULTI 1MG TAB PA NSO QL=30 EA/30 Days



1REXULTI 4MG TAB PA NSO QL=30 EA/30 DaysTHIOXANTHENES


53


1thiothixene 10mg cap




ANTIVIRALSANTIRETROVIRALS

1abacavir 20mg/ml oral soln

1abacavir 300mg tab

1abacavir 300mg/lamivudine 150mg/zidovudine 300mg tab

1abacavir 600mg/lamivudine 300mg tab NDS

1APTIVUS 100MG/ML ORAL SOLN NDS

1APTIVUS 250MG CAP NDS

1atazanavir 150mg cap



1ATRIPLA 600-200-300MG TAB NDS

1BIKTARVY 50-200-25MG TAB NDS

1CIMDUO 300-300MG TAB NDS

1COMPLERA 200-25-300MG TAB NDS

1CRIXIVAN 200MG CAP

1CRIXIVAN 400MG CAP

1DELSTRIGO 100-300-300MG TAB NDS

1DESCOVY 200-25MG TAB NDS

1DIDANOSINE 250MG DR CAP

1DIDANOSINE 400MG DR CAP

1DOVATO 50-300MG TAB NDS

1EDURANT 25MG TAB NDS

1efavirenz 200mg cap

1efavirenz 50mg cap

1efavirenz 600mg tab

1EMTRIVA 10MG/ML ORAL SOLN

1EMTRIVA 200MG CAP

1EVOTAZ 300-150MG TAB NDS

1fosamprenavir 700mg tab NDS

1FUZEON 90MG INJ NDS

1GENVOYA 150-150-200-10MG TAB NDS

1INTELENCE 100MG TAB NDS



1INVIRASE 500MG TAB NDS

1ISENTRESS 100MG CHEW TAB NDS

1ISENTRESS 100MG GRANULES FOR ORAL SUSP

1ISENTRESS 25MG CHEW TAB

1ISENTRESS 400MG TAB NDS

1ISENTRESS 600MG TAB NDS


54


1JULUCA 50-25MG TAB NDS

1KALETRA 100-25MG TAB

1KALETRA 200-50MG TAB NDS

1lamivudine 10mg/ml oral soln

1lamivudine 150mg tab

1lamivudine 150mg/zidovudine 300mg tab


1LEXIVA 50MG/ML SUSP

1lopinavir 80mg/ml/ritonavir 20mg/ml oral solution NDS

1NEVIRAPINE 100MG ER TAB

1nevirapine 10mg/ml susp

1nevirapine 200mg tab

1nevirapine 400mg er tab

1NORVIR 100MG ORAL POWDER

1NORVIR 80MG/ML ORAL SOLN

1ODEFSEY 200-25-25MG TAB NDS

1PIFELTRO 100MG TAB NDS

1PREZCOBIX 150-800MG TAB NDS

1PREZISTA 100MG/ML SUSP

1PREZISTA 150MG TAB

1PREZISTA 600MG TAB NDS

1PREZISTA 75MG TAB

1PREZISTA 800MG TAB NDS

1REYATAZ 50MG ORAL POWDER NDS

1ritonavir 100mg tab

1SELZENTRY 150MG TAB NDS

1SELZENTRY 20MG/ML ORAL SOLN NDS

1SELZENTRY 25MG TAB



1stavudine 15mg cap

1stavudine 20mg cap

1stavudine 30mg cap

1stavudine 40mg cap

1STRIBILD 150-150-200-300MG TAB NDS

1SYMFI 400-300-300MG TAB

1SYMFI 600-300-300MG TAB

1SYMTUZA 800-150-200-10MG TAB NDS

1tenofovir disoproxil fumarate 300mg tab NDS

1TIVICAY 10MG TAB

1TIVICAY 25MG TAB

1TIVICAY 50MG TAB NDS

1TRIUMEQ 600-50-300MG TAB NDS

1TRUVADA 100-150MG TAB NDS




55



1TYBOST 150MG TAB

1VIRACEPT 250MG TAB NDS

1VIRACEPT 625MG TAB NDS

1VIREAD 150MG TAB NDS



1VIREAD 40MG/GM ORAL POWDER

1zidovudine 100mg cap

1zidovudine 10mg/ml oral soln

1zidovudine 300mg tabCMV AGENTS

1PREVYMIS 240MG TAB NDS PA QL=30 EA/30 Days

1PREVYMIS 480MG TAB NDS PA QL=30 EA/30 Days

1valganciclovir 450mg tab NDS

1valganciclovir 50mg/ml oral soln NDSHEPATITIS AGENTS

1adefovir dipivoxil 10mg tab

1entecavir 0.5mg tab

1entecavir 1mg tab

1EPIVIR HBV 5MG/ML ORAL SOLN


1MAVYRET 100-40MG TAB NDS PA QL=90 EA/30 Days

1PEGASYS 180MCG/0.5ML AUTO-INJECTOR NDS

1PEGASYS 180MCG/0.5ML SYRINGE NDS

1PEGASYS 180MCG/ML INJ NDS

1ribavirin 200mg cap

1ribavirin 200mg tab

1SOFOSBUVIR 400MG/VELPATASVIR 100MG TAB NDS PA QL=30 EA/30 Days

1VEMLIDY 25MG TAB NDS

1VOSEVI 400-100-100MG TAB NDS PA QL=30 EA/30 DaysHERPES AGENTS

1acyclovir 200mg cap

1acyclovir 400mg tab

1acyclovir 40mg/ml susp

1acyclovir 50mg/ml inj PA BvD

1acyclovir 800mg tab

1famciclovir 125mg tab



1valacyclovir 1000mg tab

1valacyclovir 500mg tabINFLUENZA AGENTS

1oseltamivir 30mg cap QL=84 EA/180 Days


1oseltamivir 6mg/ml susp QL=540 ML/180 Days


56



1RELENZA 5MG/BLISTER INH QL=120 EA/30 Days

1RIMANTADINE 100MG TAB

1XOFLUZA 20MG THERAPY PACK QL=2 EA/30 Days

1XOFLUZA 40MG THERAPY PACK QL=2 EA/30 Days

ASSORTED CLASSESIMMUNOSUPPRESSIVE AGENTS

1AZASAN 100MG TAB PA BvD

1AZASAN 75MG TAB PA BvD

1cyclosporine 100mg cap PA BvD

1cyclosporine 25mg cap PA BvD

1cyclosporine modified 100mg cap PA BvD


1gengraf 100mg cap PA BvD

1gengraf 100mg/ml oral soln PA BvD

1gengraf 25mg cap PA BvD

1mycophenolate mofetil 200mg/ml susp PA BvD

1mycophenolate mofetil 250mg cap PA BvD

1mycophenolate mofetil 500mg tab PA BvD

1SANDIMMUNE 100MG/ML ORAL SOLN PA BvD

1sirolimus 0.5mg tab PA BvD

1sirolimus 1mg tab PA BvD

1sirolimus 2mg tab PA BvD

1tacrolimus 0.5mg cap PA BvD

1tacrolimus 1mg cap PA BvD

1tacrolimus 5mg cap PA BvD

BETA BLOCKERSALPHA-BETA BLOCKERS

1carvedilol 12.5mg tab

1carvedilol 25mg tab



1labetalol 100mg tab

1labetalol 200mg tab

1labetalol 300mg tabBETA BLOCKERS CARDIO-SELECTIVE

1acebutolol 200mg cap

1acebutolol 400mg cap

1atenolol 100mg tab

1atenolol 25mg tab

1atenolol 50mg tab

1betaxolol 10mg tab

1betaxolol 20mg tab

1bisoprolol fumarate 10mg tab

1bisoprolol fumarate 5mg tab

1BYSTOLIC 10MG TAB


57


1BYSTOLIC 2.5MG TAB

1BYSTOLIC 20MG TAB

1BYSTOLIC 5MG TAB

1metoprolol succinate 100mg er tab




1metoprolol tartrate 100mg tab

1metoprolol tartrate 25mg tab

1metoprolol tartrate 50mg tabBETA BLOCKERS NON-SELECTIVE

1INNOPRAN 120MG ER CAP

1INNOPRAN 80MG ER CAP

1nadolol 20mg tab

1nadolol 40mg tab

1nadolol 80mg tab

1pindolol 10mg tab

1pindolol 5mg tab

1propranolol 10mg tab

1propranolol 120mg er cap




1PROPRANOLOL 4MG/ML ORAL SOLN





1PROPRANOLOL 8MG/ML ORAL SOLN

1sorine 120mg tab

1sorine 160mg tab

1sorine 240mg tab

1sorine 80mg tab

1sotalol 120mg tab

1sotalol 160mg tab

1sotalol 240mg tab

1sotalol 80mg tab

1sotalol af 120mg tab

1sotalol AF 160mg tab

1sotalol AF 80mg tab

1timolol 10mg tab

1timolol 20mg tab

1timolol 5mg tab

CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS

1amlodipine 10mg tab


58


1amlodipine 2.5mg tab

1amlodipine 5mg tab

1cartia 120mg er cap




1DILT 120MG ER CAP

1DILT 180MG ER CAP

1DILT 240MG ER CAP

1diltiazem 120mg er (12 hr) cap

1diltiazem 120mg er (24 hr) cap

1diltiazem 120mg tab

1diltiazem 180mg er cap



1diltiazem 30mg tab




1diltiazem 60mg tab


1diltiazem 90mg tab

1felodipine 10mg er tab

1felodipine 2.5mg er tab

1felodipine 5mg er tab

1isradipine 2.5mg cap

1isradipine 5mg cap

1matzim 180mg er tab





1nicardipine 20mg cap

1nicardipine 30mg cap

1nifedipine 30mg er tab

1nifedipine 30mg osmotic er tab





1nimodipine 30mg cap

1nisoldipine 17mg er tab


1NISOLDIPINE 25.5MG ER TAB




59



1nisoldipine 8.5mg er tab

1taztia 120mg er cap





1tiadylt 120mg er cap






1VERAPAMIL 100MG ER CAP

1verapamil 120mg er cap

1verapamil 120mg er tab

1verapamil 120mg tab








1verapamil 40mg tab

1verapamil 80mg tab

CARDIOTONICSCARDIAC GLYCOSIDES

1digitek 0.125mg tab

1digitek 0.25mg tab

1digox 125mcg tab

1digox 250mcg tab

1digoxin 0.05mg/ml oral soln

1digoxin 0.125mg tab

1digoxin 0.25mg tab

CARDIOVASCULAR AGENTS - MISC.CARDIOVASCULAR AGENTS MISC. - COMBINATIONS

1amlodipine 10mg/atorvastatin 10mg tab




1amlodipine 2.5mg/atorvastatin 10mg tab






60




1BIDIL 37.5-20MG TAB

1ENTRESTO 24-26MG TAB QL=60 EA/30 Days

1ENTRESTO 49-51MG TAB QL=60 EA/30 Days

1ENTRESTO 97-103MG TAB QL=60 EA/30 DaysPROSTAGLANDIN VASODILATORS

1ORENITRAM 0.125MG ER TAB PA

1ORENITRAM 0.25MG ER TAB NDS PA

1ORENITRAM 1MG ER TAB NDS PA

1ORENITRAM 2.5MG ER TAB NDS PA

1ORENITRAM 5MG ER TAB NDS PA

1VENTAVIS 10MCG/ML INH SOLN NDS PA

1VENTAVIS 20MCG/ML INH SOLN NDS PAPULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS

1ambrisentan 10mg tab PA QL=30 EA/30 Days

1ambrisentan 5mg tab PA QL=30 EA/30 Days

1bosentan 125mg tab PA QL=60 EA/30 Days

1bosentan 62.5mg tab PA QL=60 EA/30 Days

1OPSUMIT 10MG TAB NDS PA QL=30 EA/30 Days

1TRACLEER 32MG TAB FOR ORAL SUSP NDS PA QL=120 EA/30 DaysPULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS

1alyq 20mg tab PA

1sildenafil 20mg tab PA

1tadalafil 20mg tab PAPULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST

1UPTRAVI 1000MCG TAB NDS PA








1UPTRAVI TITRATION PACK NDS PA QL=200 EA/28 DaysPULMONARY HYPERTENSION - SOL GUANYLATE CYCLASE STIMULATOR

1ADEMPAS 0.5MG TAB NDS PA


1ADEMPAS 1MG TAB NDS PA


1ADEMPAS 2MG TAB NDS PASINUS NODE INHIBITORS

1CORLANOR 5MG TAB PA

1CORLANOR 5MG/5ML ORAL SOLN PA

1CORLANOR 7.5MG TAB PATRANSTHYRETIN STABILIZERS


61


1VYNDAMAX 61MG CAP NDS PA QL=30 EA/30 Days

1VYNDAQEL 20MG CAP NDS PA QL=120 EA/30 Days

CEPHALOSPORINSCEPHALOSPORIN COMBINATIONS

1AVYCAZ 500-2000MG INJ NDS

1ZERBAXA 1000-500MG INJ NDSCEPHALOSPORINS - 1ST GENERATION

1cefadroxil 1000mg tab

1cefadroxil 100mg/ml susp

1cefadroxil 500mg cap

1cefadroxil 50mg/ml susp

1cefazolin 1000mg inj

1cefazolin 200mg/ml inj

1cefazolin 500mg inj

1cephalexin 250mg cap

1cephalexin 25mg/ml susp

1cephalexin 500mg cap

1cephalexin 50mg/ml suspCEPHALOSPORINS - 2ND GENERATION

1cefaclor 250mg cap

1cefaclor 500mg cap

1cefotetan 1000mg inj

1cefotetan 2000mg inj

1cefoxitin 1000mg inj

1cefoxitin 2000mg inj

1cefoxitin 200mg/ml inj

1cefprozil 250mg tab

1cefprozil 25mg/ml susp

1cefprozil 500mg tab

1cefprozil 50mg/ml susp

1cefuroxime 1500mg inj

1cefuroxime 250mg tab

1cefuroxime 500mg tab

1cefuroxime 750mg inj

1cefuroxime 95mg/ml injCEPHALOSPORINS - 3RD GENERATION

1cefdinir 25mg/ml susp

1cefdinir 300mg cap

1cefdinir 50mg/ml susp

1cefixime 20mg/ml susp

1cefixime 400mg cap

1cefixime 40mg/ml susp

1cefpodoxime 100mg tab

1cefpodoxime 10mg/ml susp

1cefpodoxime 200mg tab

1cefpodoxime 20mg/ml susp


62


1ceftazidime 1000mg inj

1ceftazidime 2000mg inj

1ceftazidime 200mg/ml inj

1ceftriaxone 1000mg inj

1ceftriaxone 100mg/ml inj




1tazicef 1gm inj

1tazicef 2gm inj

1tazicef 6gm injCEPHALOSPORINS - 4TH GENERATION

1cefepime 1000mg inj

1cefepime 2000mg injCEPHALOSPORINS - 5TH GENERATION

1TEFLARO 400MG INJ NDS

1TEFLARO 600MG INJ NDS

CONTRACEPTIVESCOMBINATION CONTRACEPTIVES - ORAL

1altavera 28 day pack

1alyacen 1/35 28 day pack

1amethia 91 day pack

1apri 28 day pack

1aranelle 28 pack

1ashlyna 91 day pack

1aubra 28 day pack

1aviane 28 pack

1balziva 28 day pack

1blisovi 21 fe 1.5/30 28 day

1blisovi 24 fe 1/20 28 day pack

1briellyn 28 day pack

1camreselo 91 day pack

1caziant 28 day pack

1cryselle 28 pack

1cyclafem 1/35 28 day pack

1cyclafem 7/7/7 28 day pack

1cyred 28 day pack

1desogestrel/ethinyl estradiol 28 day pack

1desogestrel/ethinyl estradiol pack

1drospirenone 3mg/ethinyl estradiol 0.02mg/inert 1 mg pack

1drospirenone 3mg/ethinyl estradiol 0.03mg/inert ingredients 1mg pack

1emoquette pack

1enpresse 28 day pack

1enskyce 28 day pack


63


1estarylla 28 day pack

1ethinyl estradiol 0.01mg/ethinyl estradiol 0.02mg/levonorgestrel 0.1mg 91 day pack

1ethinyl estradiol 0.01mg/ethinyl estradiol 0.03mg/levonorgestrel 0.15mg pack

1ethinyl estradiol 0.025mg/ferrous fumarate 75mg/norethindrone 0.8mg pack

1ethinyl estradiol 0.025mg/inert/norgestimate 0.18mg/0.215mg/0.25mg pack

1ethinyl estradiol 0.02mg/inert ingredients 1mg/levonorgestrel 0.1mg pack

1ethinyl estradiol 0.02mg/norethindrone acetate 1mg pack

1ethinyl estradiol 0.035mg/ethynodiol 1mg 28 day pack

1ethinyl estradiol 0.035mg/ferrous fumarate 75mg/norethindrone 0.4mg pack

1ethinyl estradiol 0.035mg/inert/norgestimate 0.18mg/0.215mg/0.25mg pack

1ethinyl estradiol 0.035mg/norgestimate 0.25mg pack

1ethinyl estradiol 0.03mg/0.04mg /inert/levonorgestrel 0.05mg/ 0.075mg pack

1ethinyl estradiol 0.03mg/inert ingredients 1mg/levonorgestrel 0.15mg pack

1ethinyl estradiol 0.03mg/levonorgestrel 0.15mg tab 28 day pack

1ethinyl estradiol 0.05mg/ethynodiol 1mg/inert ingredients 1mg 28 day pack

1ethinyl estradiol/levonorgestrel 91 day pack

1falmina 28 day pack

1fayosim 91 day pack

1femynor 28 day pack

1gianvi 28-day pack

1hailey 24 fe 28 day pack

1introvale 91 day pack

1isibloom 28 day pack

1jasmiel 28 day pack

1juleber 28 day pack

1junel 1.5/30 21 day pack

1junel 1/20 21 day pack

1junel fe 1.5/30 28 day pack

1junel fe 1/20 28 day pack

1junel fe 24 1/20 28 day pack

1kaitlib fe 28 day pack

1kariva 28 day pack

1kelnor 1/35 28 day pack

1kelnor 1/50 28 day pack


64


1kurvelo pack

1larin 1.5/30 pack

1larin 1/20 pack

1larin fe 1.5/30 pack

1larin fe 1/20 pack

1larissia 28 day pack

1layolis fe 28 pack

1leena 28 day pack

1lessina 28 day pack

1levonest 28 day pack

1levora 0.15/30 28 day pack

1loryna 28 day pack

1low-ogestrel 28 day pack

1lutera 28 day pack

1marlissa 28 day pack

1microgestin 1.5/30 21 day pack

1microgestin 1/20 21 day pack

1microgestin fe 1.5/30 28 day pack

1microgestin fe 1/20 28 day pack

1mili 28 day pack

1NATAZIA 28 DAY PACK

1necon 0.5/35 28 day pack

1nikki 28 day pack

1nortrel 0.5/35 28 day pack

1nortrel 1/35 21 day pack

1nortrel 1/35 28 day pack

1nortrel 7/7/7 28 day pack

1ocella 28 day pack

1orsythia 28 day pack

1pimtrea pack

1pirmella 1/35 28 day pack

1portia 28 day pack

1previfem 28 day pack

1reclipsen 28 day pack

1rivelsa 91 day pack

1setlakin 91 day pack

1sprintec 28 day pack

1sronyx 28 day pack

1syeda 28 day pack

1tarina 24 fe 1/20 28 day pack

1tarina fe 1/20 28 day pack

1tri-estarylla 28 day pack

1tri-legest 28 day pack

1tri-lo-estarylla 28 day pack

1tri-lo-sprintec 28 day pack

1tri-mili 28 day pack


65


1tri-previfem 28 day pack

1tri-sprintec 28 day pack

1tri-vylibra 28 day pack

1tri-vylibra lo 28 day pack

1trivora 28 day pack

1velivet 28 day pack

1vienva 28 day pack

1vyfemla 28 day pack

1vylibra 28 day pack

1wymzya fe 28 day pack

1zarah pack

1zovia 1/35e 28 day packCOMBINATION CONTRACEPTIVES - TRANSDERMAL

1XULANE 0.00146-0.00625MG/HR PATCHCOMBINATION CONTRACEPTIVES - VAGINAL

1eluryng 0.000625-0.005mg/hr vaginal system

1etonogestrel-ethinyl estradiol 0.120-0.015mg/24hr vaginal ring

PROGESTIN CONTRACEPTIVES - INJECTABLE

1medroxyprogesterone acetate 150mg/ml inj

1medroxyprogesterone acetate 150mg/ml syringePROGESTIN CONTRACEPTIVES - ORAL

1camila 28 day 0.35mg pack

1deblitane 28 day 0.35mg pack

1errin 28 day 0.35mg pack

1incassia 28 day 0.35mg pack

1lyza 0.35mg pack

1nora-be 28 day 0.35mg pack

1norethindrone 0.35mg pack

1sharobel 28 day 0.35mg pack

1SLYND 4MG TAB

CORTICOSTEROIDSGLUCOCORTICOSTEROIDS

1budesonide 3mg dr cap

1budesonide 9mg er tab PA QL=30 EA/30 Days

1CORTISONE ACETATE 25MG TAB

1dexamethasone 0.1mg/ml oral soln

1dexamethasone 0.5mg tab



1DEXAMETHASONE 1MG TAB

1DEXAMETHASONE 1MG/ML ORAL SOLN

1DEXAMETHASONE 2MG TAB

1dexamethasone 4mg tab

1dexamethasone 6mg tab

1hydrocortisone 10mg tab


66




1MEDROL 2MG TAB PA BvD

1methylprednisolone 16mg tab PA BvD


1methylprednisolone 4mg pack



1prednisolone 10mg odt PA BvD


1prednisolone 1mg/ml oral soln PA BvD


1PREDNISOLONE 3MG/ML ORAL SOLN PA BvD

1prednisone 10mg tab PA BvD


1PREDNISONE 1MG/ML ORAL SOLN PA BvD

1prednisone 2.5mg tab PA BvD




1PREDNISONE 5MG/ML ORAL SOLN PA BvDMINERALOCORTICOIDS

1fludrocortisone 0.1mg tab

COUGH/COLD/ALLERGYCOUGH/COLD/ALLERGY COMBINATIONS

1CLARINEX-D 2.5-120MG ER TAB

1PHENYLEPHRINE 1MG/ML/PROMETHAZINE 1.25MG/ML ORAL SOLN

MUCOLYTICS

1acetylcysteine 100mg/ml inh soln PA BvD

1acetylcysteine 200mg/ml inh soln PA BvD

DERMATOLOGICALSACNE PRODUCTS

1adapalene 0.1% cream PA

1adapalene 0.1% gel PA

1adapalene 0.3% gel PA

1adapalene/benzoyl peroxide 0.1-2.5% gel PA

1amnesteem 10mg cap

1amnesteem 20mg cap

1amnesteem 40mg cap

1avita 0.025% cream PA

1avita 0.025% gel PA

1claravis 10mg cap

1claravis 20mg cap

1claravis 30mg cap

1claravis 40mg cap


67


1clindacin 1% pad QL=120 EA/30 Days

1clindamycin 1% gel QL=180 GM/30 Days

1clindamycin 1% lotion QL=180 ML/30 Days

1clindamycin 1% pad QL=120 EA/30 Days

1clindamycin 1% topical soln QL=300 ML/30 Days

1clindamycin/benzoyl peroxide 1-5% gel QL=100 GM/30 Days

1EPIDUO 0.3-2.5% GEL PA

1ERY 2% PAD

1erythromycin 2% gel

1erythromycin 2% topical soln

1erythromycin/benzoyl peroxide 5-3% gel

1isotretinoin 10mg cap




1myorisan 10mg cap

1myorisan 20mg cap

1myorisan 30mg cap

1myorisan 40mg cap

1sulfacetamide sodium 10% lotion

1tretinoin 0.01% gel PA

1tretinoin 0.025% cream PA







1zenatane 10mg cap

1zenatane 20mg cap

1zenatane 30mg cap

1zenatane 40mg capANTIBIOTICS - TOPICAL

1gentamicin 0.1% cream QL=120 GM/30 Days

1gentamicin 0.1% ointment QL=120 GM/30 Days

1mupirocin 2% ointment QL=220 GM/30 DaysANTIFUNGALS - TOPICAL

1betamethasone/clotrimazole 1-0.05% cream QL=270 GM/30 Days

1betamethasone/clotrimazole 1-0.05% lotion QL=180 ML/30 Days

1ciclopirox 0.77% cream QL=270 GM/30 Days

1ciclopirox 0.77% gel QL=300 GM/30 Days

1ciclopirox 0.77% lotion QL=240 ML/30 Days

1ciclopirox 1% shampoo QL=240 ML/30 Days

1ciclopirox 8% topical soln QL=13.20 ML/30 Days

1clotrimazole 1% cream QL=180 GM/30 Days

1clotrimazole 1% topical soln QL=240 ML/30 Days


68


1econazole nitrate 1% cream QL=255 GM/30 Days

1ketoconazole 2% cream QL=240 GM/30 Days

1ketoconazole 2% foam QL=300 GM/30 Days

1ketoconazole 2% shampoo QL=360 ML/30 Days

1ketodan 2% foam QL=300 GM/30 Days

1naftifine 1% cream QL=270 GM/30 Days

1naftifine 2% cream QL=240 GM/30 Days

1nyamyc 100000unit/gm topical powder QL=480 GM/30 Days

1nystatin 100000unit/ml cream QL=240 GM/30 Days

1nystatin 100unit/mg ointment QL=240 GM/30 Days

1nystatin 100unit/mg topical powder QL=480 GM/30 Days

1nystop 100000unit/gm topical powder QL=480 GM/30 DaysANTI-INFLAMMATORY AGENTS - TOPICAL

1diclofenac sodium 1% gel QL=1000 GM/30 Days

1diclofenac sodium 1.5% topical soln QL=450 ML/30 DaysANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL

1diclofenac sodium 3% gel PA QL=300 GM/30 Days

1FLUOROPLEX 1% CREAM

1FLUOROURACIL 2% TOPICAL SOLN

1fluorouracil 5% cream

1FLUOROURACIL 5% TOPICAL SOLN

1PICATO 0.015% GEL QL=3 EA/10 Days

1PICATO 0.05% GEL QL=2 EA/10 Days

1TARGRETIN 1% GEL NDS PA NSO

1VALCHLOR 0.016% GEL NDS PA NSO QL=240 GM/30 DaysANTIPSORIATICS

1acitretin 10mg cap

1acitretin 17.5mg cap

1acitretin 25mg cap

1calcipotriene 0.005% cream PA QL=240 GM/30 Days

1calcipotriene 0.005% ointment PA QL=240 GM/30 Days

1calcipotriene 0.005% topical soln PA

1methoxsalen 10mg cap

1SKYRIZI 150MG DOSE PACK 75MG/0.83ML PA

1STELARA 45MG/0.5ML INJ PA

1STELARA 45MG/0.5ML SYRINGE PA

1STELARA 90MG/ML SYRINGE PA

1TALTZ 80MG/ML AUTO-INJECTOR NDS PA

1TALTZ 80MG/ML SYRINGE NDS PA

1tazarotene 0.1% cream

1TAZORAC 0.05% CREAM

1TAZORAC 0.05% GEL

1TAZORAC 0.1% GELANTISEBORRHEIC PRODUCTS

1selenium sulfide 2.5% shampooANTIVIRALS - TOPICAL


69


1acyclovir 5% ointment QL=60 GM/30 Days

1DENAVIR 1% CREAM QL=5 GM/7 DaysBURN PRODUCTS

1silver sulfadiazine 1% cream

1ssd 1% cream

1SULFAMYLON 85MG/GM CREAMCORTICOSTEROIDS - TOPICAL

1ala-cort 1% cream

1alclometasone dipropionate 0.05% cream

1alclometasone dipropionate 0.05% ointment

1betamethasone 0.05% aug cream

1betamethasone 0.05% aug lotion

1betamethasone 0.05% aug ointment

1betamethasone 0.05% cream

1BETAMETHASONE 0.05% GEL

1betamethasone 0.05% lotion

1betamethasone 0.05% ointment

1betamethasone 0.1% cream

1betamethasone 0.1% lotion

1betamethasone 0.1% ointment

1calcipotriene/betamethasone 0.005-0.064% ointment PA QL=420 GM/30 Days

1clobetasol propionate 0.05% cream

1clobetasol propionate 0.05% e cream

1clobetasol propionate 0.05% foam

1clobetasol propionate 0.05% gel

1clobetasol propionate 0.05% lotion

1clobetasol propionate 0.05% ointment

1clobetasol propionate 0.05% shampoo

1clobetasol propionate 0.05% spray

1clobetasol propionate 0.05% topical soln QL=450 ML/30 Days

1clodan 0.05% shampoo

1desonide 0.05% ointment

1desoximetasone 0.05% gel QL=240 GM/30 Days

1desoximetasone 0.25% cream QL=300 GM/30 Days

1desoximetasone 0.25% ointment QL=300 GM/30 Days

1fluocinolone acetonide 0.01% cream

1fluocinolone acetonide 0.01% topical soln

1fluocinolone acetonide 0.025% cream

1fluocinolone acetonide 0.025% ointment

1fluocinolone acetonide 0.1mg/ml oil

1fluocinonide 0.05% e cream

1fluocinonide 0.05% gel

1fluocinonide 0.05% ointment

1fluocinonide 0.05% topical soln

1fluticasone propionate 0.005% ointment

1fluticasone propionate 0.05% cream


70


1halobetasol propionate 0.05% cream

1halobetasol propionate 0.05% ointment

1hydrocortisone 1% cream

1hydrocortisone 2.5% cream

1hydrocortisone 2.5% lotion

1hydrocortisone 2.5% ointment

1mometasone furoate 0.1% cream

1mometasone furoate 0.1% lotion

1mometasone furoate 0.1% ointment

1PREDNICARBATE 0.1% CREAM

1PREDNICARBATE 0.1% OINTMENT

1triamcinolone acetonide 0.0147% spray

1triamcinolone acetonide 0.025% cream

1triamcinolone acetonide 0.025% lotion

1triamcinolone acetonide 0.025% ointment


1triamcinolone acetonide 0.1% lotion




1triderm 0.1% creamECZEMA AGENTS

1DUPIXENT 200MG/1.14ML SYRINGE NDS PA

1DUPIXENT 300MG/2ML SYRINGE NDS PAEMOLLIENTS

1ammonium lactate 12% cream

1ammonium lactate 12% lotionENZYMES - TOPICAL

1SANTYL 250UNIT/GM OINTMENT QL=90 GM/30 DaysIMMUNOMODULATING AGENTS - TOPICAL

1imiquimod 5% cream

1ZYCLARA 2.5% CREAMIMMUNOSUPPRESSIVE AGENTS - TOPICAL

1pimecrolimus 1% cream

1tacrolimus 0.03% ointment QL=100 GM/30 Days

1tacrolimus 0.1% ointment QL=100 GM/30 DaysKERATOLYTIC/ANTIMITOTIC AGENTS

1podofilox 0.5% topical solnLOCAL ANESTHETICS - TOPICAL

1LIDOCAINE 2% GEL

1lidocaine 4% topical soln

1lidocaine 5% ointment PA QL=107 GM/30 Days

1lidocaine 5% patch PA QL=90 EA/30 Days

1lidocaine/prilocaine 2.5-2.5% cream QL=60 GM/30 DaysROSACEA AGENTS

1azelaic acid 15% gel


71


1FINACEA 15% FOAM

1metronidazole 0.75% cream

1metronidazole 0.75% gel

1metronidazole 0.75% lotion

1metronidazole 1% gelSCABICIDES & PEDICULICIDES

1lindane 1% shampoo

1malathion 0.5% lotion

1permethrin 5% creamWOUND CARE PRODUCTS

1REGRANEX 0.01% GEL QL=30 GM/15 Days

DIGESTIVE AIDSDIGESTIVE ENZYMES

1CREON 120000-76000-24000UNIT DR CAP

1CREON 15000-9500-3000UNIT DR CAP


1CREON 36000-114000-180000UNIT DR CAP


1SUCRAID 8500UNIT/ML ORAL SOLN NDS PA

1ZENPEP 105000-79000-25000UNIT DR CAP ST







DIURETICSCARBONIC ANHYDRASE INHIBITORS

1acetazolamide 125mg tab

1acetazolamide 250mg tab

1acetazolamide 500mg er cap

1methazolamide 25mg tab

1methazolamide 50mg tabDIURETIC COMBINATIONS

1amiloride 5mg/hydrochlorothiazide 50mg tab

1hydrochlorothiazide 25mg/spironolactone 25mg tab

1hydrochlorothiazide 25mg/triamterene 37.5mg cap

1hydrochlorothiazide 25mg/triamterene 37.5mg tab

1hydrochlorothiazide 50mg/triamterene 75mg tabLOOP DIURETICS

1bumetanide 0.25mg/ml inj

1bumetanide 0.5mg tab

1bumetanide 1mg tab

1bumetanide 2mg tab

1ethacrynic acid 25mg tab

1furosemide 10mg/ml inj


72


1furosemide 10mg/ml oral soln

1furosemide 10mg/ml syringe

1furosemide 20mg tab



1FUROSEMIDE 8MG/ML ORAL SOLN

1torsemide 100mg tab

1torsemide 10mg tab

1torsemide 20mg tab

1torsemide 5mg tabPOTASSIUM SPARING DIURETICS

1amiloride 5mg tab

1spironolactone 100mg tab



1triamterene 100mg cap

1triamterene 50mg capTHIAZIDES AND THIAZIDE-LIKE DIURETICS

1chlorthalidone 25mg tab

1chlorthalidone 50mg tab

1DIURIL 250MG/5ML SUSP

1hydrochlorothiazide 12.5mg cap

1hydrochlorothiazide 12.5mg tab

1hydrochlorothiazide 25mg tab

1hydrochlorothiazide 50mg tab

1indapamide 1.25mg tab

1indapamide 2.5mg tab

1metolazone 10mg tab

1metolazone 2.5mg tab

1metolazone 5mg tab

ENDOCRINE AND METABOLIC AGENTS - MISC.BONE DENSITY REGULATORS

1ALENDRONIC ACID 0.933MG/ML ORAL SOLN

1alendronic acid 10mg tab



1FORTEO 600MCG/2.4ML PEN INJ NDS

1ibandronic acid 150mg tab QL=1 EA/30 Days

1NATPARA 100MCG CARTRIDGE NDS PA




1PROLIA 60MG/ML SYRINGE PA

1risedronate sodium 150mg tab


1risedronate sodium 35mg (12) pack


73


1risedronate sodium 35mg (4) pack



1salmon calcitonin 200unit/act nasal spray

1TYMLOS 3120MCG/1.56ML PEN INJ NDS

1XGEVA 120MG/1.7ML INJ NDS PAGNRH/LHRH ANTAGONISTS

1ORILISSA 150MG TAB PA QL=30 EA/30 Days

1ORILISSA 200MG TAB PA QL=60 EA/30 DaysGROWTH HORMONE RECEPTOR ANTAGONISTS

1SOMAVERT 10MG INJ NDS PA




1SOMAVERT 30MG INJ NDS PAGROWTH HORMONES

1GENOTROPIN 0.2MG SYRINGE NDS PA








1GENOTROPIN 12MG CARTRIDGE NDS PA

1GENOTROPIN 1MG SYRINGE NDS PA

1GENOTROPIN 2MG SYRINGE NDS PA

1GENOTROPIN 5MG CARTRIDGE NDS PAHORMONE RECEPTOR MODULATORS

1OSPHENA 60MG TAB PA

1raloxifene 60mg tabINSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS)

1INCRELEX 40MG/4ML INJ NDS PALHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS

1LUPANETA PACK 1-MONTH PACK NDS

1LUPANETA PACK 3-MONTH PACK

1SYNAREL 2MG/ML NASAL INHALER NDSMETABOLIC MODIFIERS

1calcitriol 0.00025mg cap

1calcitriol 0.0005mg cap

1calcitriol 0.001mg/ml oral soln

1CARBAGLU 200MG TAB FOR ORAL SUSP PA

1cinacalcet 30mg tab



1doxercalciferol 0.0005mg cap


74




1GALAFOLD 28 DAY WALLET 123MG PACK NDS PA QL=15 EA/30 Days

1KUVAN 100MG POWDER FOR ORAL SOLN NDS PA

1KUVAN 100MG TAB NDS PA

1KUVAN 500MG POWDER FOR ORAL SOLN NDS PA

1levocarnitine 100mg/ml oral soln

1levocarnitine 330mg tab

1nitisinone 10mg cap NDS PA



1ORFADIN 20MG CAP NDS PA

1ORFADIN 4MG/ML SUSP NDS PA

1PALYNZIQ 10MG/0.5ML SYRINGE NDS PA

1PALYNZIQ 2.5MG/0.5ML SYRINGE NDS PA

1PALYNZIQ 20MG/ML SYRINGE NDS PA

1paricalcitol 0.001mg cap



1RAVICTI 1.1GM/ML ORAL SOLN NDS PA

1sodium phenylbutyrate 0.94mg/mg oral powderPOSTERIOR PITUITARY HORMONES

1desmopressin acetate 0.01mg/act nasal spray

1desmopressin acetate 0.1mg tab

1desmopressin acetate 0.2mg tab

1STIMATE 1.5MG/ML NASAL INHALERPROLACTIN INHIBITORS

1cabergoline 0.5mg tabSOMATOSTATIC AGENTS

1octreotide 0.05mg/ml inj




1octreotide 1mg/ml inj

1SIGNIFOR 0.3MG/ML INJ NDS PA QL=60 ML/30 Days



1SOMATULINE 120MG/0.5ML SYRINGE NDS

1SOMATULINE 60MG/0.2ML SYRINGE NDS

1SOMATULINE 90MG/0.3ML SYRINGE NDSVASOPRESSIN RECEPTOR ANTAGONISTS

1JYNARQUE 15MG TAB NDS PA QL=120 EA/30 Days

1JYNARQUE 30MG TAB NDS PA QL=120 EA/30 Days

1JYNARQUE 45/15 THERAPY PACK NDS PA QL=60 EA/30 Days




75


1JYNARQUE TAB 15/15MG THERAPY PACK NDS PA QL=60 EA/30 Days

1JYNARQUE TAB 30/15MG THERAPY PACK NDS PA QL=60 EA/30 Days

ESTROGENSESTROGEN COMBINATIONS

1amabelz 0.5/0.1mg 28 day pack

1amabelz 1/0.5mg 28 day pack

1COMBIPATCH 0.00208-0.00583MG/HR PATCH

1COMBIPATCH 0.00208-0.0104MG/HR PATCH

1estradiol 0.5mg/norethindrone acetate 0.1mg pack

1estradiol 1mg/norethindrone acetate 0.5mg pack

1ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mg pack

1ethinyl estradiol 0.005mg/norethindrone acetate 1mg pack

1fyavolv 0.0025-0.5mg tab

1fyavolv 0.005-1mg tab

1jinteli 0.005-1mg tab

1lopreeza 1/0.5mg 28 day pack

1mimvey pack

1PREMPHASE 28 DAY PACK

1PREMPRO 0.3/1.5MG 28 DAY PACK

1PREMPRO 0.45/1.5 28 DAY PACK

1PREMPRO 0.625/2.5MG 28 DAY PACK

1PREMPRO 0.625/5MG 28 DAY PACKESTROGENS

1dotti 0.025mg/24hr patch





1estradiol 0.00104mg/hr twice weekly patch

1estradiol 0.00104mg/hr weekly patch










1estradiol 0.5mg tab

1estradiol 1mg tab

1estradiol 2mg tab

1estradiol valerate 20mg/ml inj

1estradiol valerate 40mg/ml inj


76


1PREMARIN 0.3MG TAB

1PREMARIN 0.45MG TAB


1PREMARIN 0.9MG TAB


FLUOROQUINOLONESFLUOROQUINOLONES

1BAXDELA 450MG TAB PA QL=60 EA/30 Days

1ciprofloxacin 250mg tab

1ciprofloxacin 2mg/ml inj



1levofloxacin 250mg tab

1levofloxacin 25mg/ml inj

1levofloxacin 25mg/ml oral soln


1levofloxacin 5mg/ml (100ml) inj

1levofloxacin 5mg/ml (150ml) inj


1moxifloxacin 1.6mg/ml inj

1moxifloxacin 400mg tab

1ofloxacin 400mg tab

GASTROINTESTINAL AGENTS - MISC.AGENTS FOR CHRONIC IDIOPATHIC CONSTIPATION (CIC)

1TRULANCE 3MG TAB PABILE ACID SYNTHESIS DISORDER AGENTS

1CHOLBAM 250MG CAP NDS PA

1CHOLBAM 50MG CAP NDS PAFARNESOID X RECEPTOR (FXR) AGONISTS

1OCALIVA 10MG TAB NDS PA QL=30 EA/30 Days

1OCALIVA 5MG TAB NDS PA QL=30 EA/30 DaysGALLSTONE SOLUBILIZING AGENTS

1CHENODAL 250MG TAB NDS

1ursodiol 250mg tab

1ursodiol 300mg cap

1ursodiol 500mg tabGASTROINTESTINAL ANTIALLERGY AGENTS

1cromolyn sodium 20mg/ml oral solnGASTROINTESTINAL STIMULANTS

1metoclopramide 10mg tab

1metoclopramide 1mg/ml oral soln

1metoclopramide 5mg tabINFLAMMATORY BOWEL AGENTS

1balsalazide disodium 750mg cap

1CIMZIA 200MG INJ NDS PA

1CIMZIA 200MG/ML SYRINGE NDS PA


77


1DIPENTUM 250MG CAP

1mesalamine 1000mg rectal supp

1mesalamine 1200mg dr tab

1mesalamine 375mg er cap

1mesalamine 400mg dr cap

1mesalamine 66.7mg/ml enema

1mesalamine 800mg dr tab

1sulfasalazine 500mg dr tab

1sulfasalazine 500mg tabINTESTINAL ACIDIFIERS

1enulose 10gm/15ml oral soln

1generlac 10gm/15ml oral solnIRRITABLE BOWEL SYNDROME (IBS) AGENTS

1alosetron 0.5mg tab

1alosetron 1mg tab

1VIBERZI 100MG TAB PA

1VIBERZI 75MG TAB PAPERIPHERAL OPIOID RECEPTOR ANTAGONISTS

1MOVANTIK 12.5MG TAB PA

1MOVANTIK 25MG TAB PA

1RELISTOR 12MG/0.6ML INJ PA

1RELISTOR 12MG/0.6ML SYRINGE PA

1RELISTOR 8MG/0.4ML SYRINGE PA

1SYMPROIC 0.2MG TAB PAPHOSPHATE BINDER AGENTS

1AURYXIA 210MG TAB PA

1calcium acetate 667mg cap

1calcium acetate 667mg tab

1FOSRENOL 1000MG ORAL POWDER

1FOSRENOL 750MG ORAL POWDER

1lanthanum carbonate 1000mg chew tab



1PHOSLYRA 667MG/5ML ORAL SOLN

1sevelamer carbonate 2400mg powder for oral susp

1sevelamer carbonate 800mg powder for oral susp

1sevelamer carbonate 800mg tabSHORT BOWEL SYNDROME (SBS) AGENTS

1GATTEX 5MG INJ NDS PA

GENITOURINARY AGENTS - MISCELLANEOUSALKALINIZERS

1potassium citrate 10meq er tab

1potassium citrate 15meq er tab

1potassium citrate 5meq er tabCYSTINOSIS AGENTS

1CYSTAGON 150MG CAP


78


1CYSTAGON 50MG CAPGENITOURINARY IRRIGANTS

1sodium chloride 0.154meq/ml solnINTERSTITIAL CYSTITIS AGENTS

1ELMIRON 100MG CAPPROSTATIC HYPERTROPHY AGENTS

1alfuzosin 10mg er tab

1dutasteride 0.5mg cap

1dutasteride 0.5mg/tamsulosin 0.4mg cap

1finasteride 5mg tab

1silodosin 4mg cap

1silodosin 8mg cap

1tamsulosin 0.4mg capURINARY STONE AGENTS

1LITHOSTAT 250MG TAB

1THIOLA 100MG DR TAB

1THIOLA 100MG TAB

1THIOLA 300MG DR TAB

GOUT AGENTSGOUT AGENT COMBINATIONS

1colchicine 0.5mg/probenecid 500mg tabGOUT AGENTS

1allopurinol 100mg tab

1allopurinol 300mg tab

1febuxostat 40mg tab ST

1febuxostat 80mg tab ST

1MITIGARE 0.6MG CAPURICOSURICS

1probenecid 500mg tab

HEMATOLOGICAL AGENTS - MISC.BRADYKININ B2 RECEPTOR ANTAGONISTS

1icatibant 10mg/ml syringe NDS PACOMPLEMENT INHIBITORS

1BERINERT 500UNIT INJ NDS PA

1CINRYZE 500UNIT INJ NDS PA

1HAEGARDA 2000UNIT INJ NDS PA

1HAEGARDA 3000UNIT INJ NDS PA

1RUCONEST 2100UNIT INJ NDS PAHEMATAOLOGIC - TYROSINE KINASE INHIBITORS

1TAVALISSE 100MG TAB NDS PA QL=60 EA/30 Days

1TAVALISSE 150MG TAB NDS PA QL=60 EA/30 DaysHEMATORHEOLOGIC AGENTS

1pentoxifylline 400mg er tabPLASMA KALLIKREIN INHIBITORS

1TAKHZYRO 300MG/2ML INJ NDS PA QL=4 ML/28 DaysPLATELET AGGREGATION INHIBITORS


79


1anagrelide 0.5mg cap

1anagrelide 1mg cap

1aspirin 25mg/dipyridamole 200mg er cap

1BRILINTA 60MG TAB

1BRILINTA 90MG TAB

1CABLIVI 11MG INJ NDS PA QL=30 EA/30 Days

1cilostazol 100mg tab

1cilostazol 50mg tab

1clopidogrel 75mg tab

1dipyridamole 25mg tab



1prasugrel 10mg tab

1prasugrel 5mg tab

HEMATOPOIETIC AGENTSAGENTS FOR GAUCHER DISEASE

1CERDELGA 84MG CAP NDS PA QL=60 EA/30 Days

1miglustat 100mg cap NDS PAAGENTS FOR SICKLE CELL ANEMIA

1DROXIA 200MG CAP

1DROXIA 300MG CAP

1DROXIA 400MG CAP

1ENDARI 5GM POWDER FOR ORAL SOLN NDS PA QL=180 EA/30 Days

1OXBRYTA 500MG TAB NDS PA QL=90 EA/30 DaysHEMATOPOIETIC GROWTH FACTORS

1ARANESP 100MCG/0.5ML SYRINGE PA BvD ST

1ARANESP 100MCG/ML INJ PA BvD ST











1ARANESP 500MCG/ML SYRINGE PA BvD ST



1DOPTELET 20MG TAB NDS PA QL=60 EA/30 Days

1DOPTELET 40MG DAILY DOSE PACK NDS PA QL=10 EA/5 Days

1DOPTELET 60MG DAILY DOSE PACK NDS PA QL=15 EA/5 Days

1FULPHILA 6MG/0.6ML SYRINGE NDS

1NIVESTYM 300MCG/0.5ML SYRINGE NDS

1NIVESTYM 300MCG/ML INJ NDS


80


1NIVESTYM 480MCG/0.8ML SYRINGE NDS

1NIVESTYM 480MCG/1.6ML INJ NDS

1PROMACTA 12.5MG POWDER FOR ORAL SUSP NDS PA

1PROMACTA 12.5MG TAB NDS PA

1PROMACTA 25MG POWDER FOR ORAL SUSP NDS PA

1PROMACTA 25MG TAB NDS PA



1RETACRIT 10000UNIT/ML INJ PA BvD





1ZARXIO 300MCG/0.5ML SYRINGE NDS

1ZARXIO 480MCG/0.8ML SYRINGE NDS

1ZIEXTENZO 6MG/0.6ML SYRINGE NDS

HEMOSTATICSHEMOSTATICS - SYSTEMIC

1tranexamic acid 650mg tab

HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTSBARBITURATE HYPNOTICS

1phenobarbital 100mg tab


1phenobarbital 16.2mg tab



1phenobarbital 4mg/ml oral soln



1phenobarbital 97.2mg tabNON-BARBITURATE HYPNOTICS

1estazolam 1mg tab

1estazolam 2mg tab

1eszopiclone 1mg tab QL=30 EA/30 Days



1FLURAZEPAM 15MG CAP

1FLURAZEPAM 30MG CAP

1temazepam 15mg cap

1temazepam 22.5mg cap

1temazepam 30mg cap

1temazepam 7.5mg cap

1triazolam 0.125mg tab

1triazolam 0.25mg tab

1zaleplon 10mg cap QL=30 EA/30 Days

1zaleplon 5mg cap QL=30 EA/30 Days


81


1zolpidem tartrate 10mg tab QL=30 EA/30 Days

1zolpidem tartrate 5mg tab QL=60 EA/30 DaysSELECTIVE MELATONIN RECEPTOR AGONISTS

1HETLIOZ 20MG CAP NDS PA QL=30 EA/30 Days

1ramelteon 8mg tab QL=30 EA/30 Days

LAXATIVESLAXATIVE COMBINATIONS

1CLENPIQ 75-21.9-0.0625MG/ML ORAL SOLN

1GAVILYTE-C ORAL SOLN

1gavilyte-g powder for oral soln

1gavilyte-n powder for oral soln

1peg 3350/electrolyte oral soln

1peg 3350/kcl/sodium bicarbonate/sodium chloride powder for oral soln

1trilyte powder for oral solnLAXATIVES - MISCELLANEOUS

1constulose 10gm/15ml oral soln

1lactulose 667mg/ml oral soln

MACROLIDESAZITHROMYCIN

1azithromycin 20mg/ml susp

1azithromycin 250mg pack

1azithromycin 250mg tab

1azithromycin 40mg/ml susp

1azithromycin 500mg inj

1azithromycin 500mg pack

1azithromycin 500mg tab

1azithromycin 600mg tabCLARITHROMYCIN

1clarithromycin 250mg tab

1CLARITHROMYCIN 25MG/ML SUSP

1clarithromycin 500mg er tab

1clarithromycin 500mg tab

1CLARITHROMYCIN 50MG/ML SUSPERYTHROMYCINS

1ERYTHROCIN 500MG INJ

1erythromycin 250mg dr cap

1erythromycin 250mg tab

1erythromycin 500mg tab

1erythromycin ethylsuccinate 40mg/ml susp

1erythromycin ethylsuccinate 80mg/ml susp

MEDICAL DEVICESPARENTERAL THERAPY SUPPLIES

1INSULIN SYRINGE (DISP) U-100 1/2ML

MEDICAL DEVICES AND SUPPLIES


82


BANDAGES-DRESSINGS-TAPE

1GAUZE PADS & DRESSINGS - PADS 2 X 2MISC. DEVICES

1ISOPROPYL ALCOHOL 0.7ML/ML PADPARENTERAL THERAPY SUPPLIES

1INSULIN PEN NEEDLE

1INSULIN SYRINGE (DISP) U-100 0.3ML

1INSULIN SYRINGE (DISP) U-100 1ML

1NEEDLES INSULIN DISP. SAFETY

MIGRAINE PRODUCTSCALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG

1AIMOVIG 140MG/ML AUTO-INJECTOR PA

1AIMOVIG 70MG/ML AUTO-INJECTOR PA

1EMGALITY 100MG/ML SYRINGE PA

1EMGALITY 120MG/ML AUTO-INJECTOR PA

1EMGALITY 120MG/ML SYRINGE PAMIGRAINE PRODUCTS

1dihydroergotamine mesylate 0.5mg/act nasal inhaler QL=16 ML/30 DaysSEROTONIN AGONISTS

1eletriptan 20mg tab QL=18 EA/30 Days

1eletriptan 40mg tab QL=18 EA/30 Days

1naratriptan 1mg tab QL=18 EA/30 Days

1naratriptan 2.5mg tab QL=18 EA/30 Days

1rizatriptan 10mg odt QL=36 EA/60 Days

1rizatriptan 10mg tab QL=36 EA/60 Days

1rizatriptan 5mg odt QL=36 EA/60 Days

1rizatriptan 5mg tab QL=36 EA/60 Days

1sumatriptan 100mg tab QL=18 EA/30 Days

1sumatriptan 12mg/ml auto-injector QL=5 ML/30 Days

1sumatriptan 12mg/ml cartridge QL=5 ML/30 Days

1sumatriptan 12mg/ml inj QL=5 ML/30 Days

1SUMATRIPTAN 12MG/ML SYRINGE QL=5 ML/30 Days

1sumatriptan 20mg/act nasal spray QL=12 EA/30 Days



1sumatriptan 5mg/act nasal spray QL=12 EA/30 Days

1sumatriptan 8mg/ml auto-injector QL=5 ML/30 Days

1sumatriptan 8mg/ml cartridge QL=5 ML/30 Days

1zolmitriptan 2.5mg odt QL=18 EA/30 Days

1zolmitriptan 2.5mg tab QL=18 EA/30 Days

1zolmitriptan 5mg odt QL=18 EA/30 Days

1zolmitriptan 5mg tab QL=18 EA/30 Days

1ZOMIG 2.5MG NASAL SPRAY QL=16 EA/30 Days

1ZOMIG 5MG NASAL SPRAY QL=12 EA/30 Days

MINERALS & ELECTROLYTESELECTROLYTE MIXTURES


83


1GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0342 MEQ/ML INJ

PA BvD


PA BvD


1glucose 50 mg/ml/potassium chloride 0.04meq/ml/sodium chloride 4.5mg/ml inj

1glucose 50mg/ml/potassium chloride 0.01 meq/ml/sodium chloride 0.0769 meq/ml inj

1glucose 50mg/ml/potassium chloride 0.02 meq/ml inj



1glucose 50mg/ml/potassium chloride 0.02meq/ml/sodium chloride 4.5mg/ml inj


1GLUCOSE 50MG/ML/POTASSIUM CHLORIDE 0.04 MEQ/ML/SODIUM CHLORIDE 0.154 MEQ/ML INJ

1glucose 50mg/ml/sodium chloride 0.0342 meq/ml inj


1glucose 50mg/ml/sodium chloride 4.5mg/ml inj

1glucose 50mg/ml/sodium chloride 9mg/ml inj

1ISOLYTE P INJ

1ISOLYTE S INJ

1KCL/D5W/LR INJ 0.15%

1NORMOSOL-M INJ

1NORMOSOL-R INJ

1PLASMA-LYTE 148 INJ

1PLASMALYTE A INJ

1potassium chloride 0.02 meq/ml/sodium chloride 0.0769 meq/ml inj

1potassium chloride 0.02 meq/ml/sodium chloride 0.154 meq/ml inj

1POTASSIUM CHLORIDE 0.04 MEQ/ML/SODIUM CHLORIDE 0.154 MEQ/ML INJ

MAGNESIUM

1magnesium sulfate 500mg/ml inj

1magnesium sulfate 500mg/ml syringePOTASSIUM

1K-TAB 8MEQ ER TAB

1klor-con 10meq er tab

1klor-con 10meq micro er tab


84


1KLOR-CON 15MEQ MICRO ER TAB

1klor-con 20meq micro er tab

1klor-con 20meq powder for oral soln

1klor-con 8meq er tab

1POTASSIUM CHLORIDE 0.1MEQ/ML INJ



1potassium chloride 1.33meq/ml oral soln

1potassium chloride 10meq er cap

1potassium chloride 10meq er tab

1potassium chloride 10meq micro er tab

1potassium chloride 2.67meq/ml oral soln

1potassium chloride 20meq er tab

1potassium chloride 20meq micro er tab

1potassium chloride 20meq powder for oral soln

1potassium chloride 2meq/ml (20ml) inj

1potassium chloride 2meq/ml inj

1potassium chloride 8meq er cap

1potassium chloride 8meq er tabSODIUM

1sodium chloride 30mg/ml inj

1sodium chloride 4.5mg/ml inj



MISCELLANEOUS THERAPEUTIC CLASSESCHELATING AGENTS

1clovique 250mg cap PA

1penicillamine 250mg tab

1trientine 250mg cap PAIMMUNOMODULATORS

1REVLIMID 10MG CAP NDS PA NSO QL=30 EA/30 Days


1REVLIMID 2.5MG CAP NDS PA NSO QL=30 EA/30 Days




1THALOMID 100MG CAP NDS PA NSO



1THALOMID 50MG CAP NDS PA NSOIMMUNOSUPPRESSIVE AGENTS

1ASTAGRAF 0.5MG ER CAP PA BvD

1ASTAGRAF 1MG ER CAP PA BvD

1ASTAGRAF 5MG ER CAP PA BvD

1azathioprine 50mg tab PA BvD

1cyclosporine modified 100mg/ml oral soln PA BvD


85



1ENVARSUS 0.75MG ER TAB PA BvD

1ENVARSUS 1MG ER TAB PA BvD

1ENVARSUS 4MG ER TAB PA BvD

1everolimus 0.25mg tab PA BvD



1mycophenolic acid 180mg dr tab PA BvD

1mycophenolic acid 360mg dr tab PA BvD

1PROGRAF 0.2MG GRANULES FOR ORAL SUSP PA BvD

1PROGRAF 1MG GRANULES FOR ORAL SUSP PA BvD

1sirolimus 1mg/ml oral soln PA BvDPOTASSIUM REMOVING AGENTS

1kionex 15gm/60ml susp

1LOKELMA 10GM POWDER FOR ORAL SUSP PA

1LOKELMA 5GM POWDER FOR ORAL SUSP PA

1sodium polystyrene sulfonate 15000mg powder for oral susp

1sodium polystyrene sulfonate 250mg/ml susp

1sps 15gm/60ml susp

1VELTASSA 16.8GM POWDER FOR ORAL SUSP PA

1VELTASSA 25.2GM POWDER FOR ORAL SUSP PA

1VELTASSA 8.4GM POWDER FOR ORAL SUSP PASYSTEMIC LUPUS ERYTHEMATOSUS AGENTS

1BENLYSTA 200MG/ML AUTO-INJECTOR NDS PA QL=4 ML/28 Days

1BENLYSTA 200MG/ML SYRINGE NDS PA QL=4 ML/28 Days

MOUTH/THROAT/DENTAL AGENTSANESTHETICS TOPICAL ORAL

1lidocaine 2% topical solnANTI-INFECTIVES - THROAT

1clotrimazole 10mg lozenge

1nystatin 100000unit/ml suspANTISEPTICS - MOUTH/THROAT

1chlorhexidine gluconate 0.12% mouthwashSTEROIDS - MOUTH/THROAT/DENTAL

1triamcinolone acetonide 0.1% oral pasteTHROAT PRODUCTS - MISC.

1cevimeline 30mg cap

1pilocarpine 5mg tab

1pilocarpine 7.5mg tab

MUSCULOSKELETAL THERAPY AGENTSCENTRAL MUSCLE RELAXANTS

1baclofen 10mg tab

1baclofen 20mg tab

1carisoprodol 350mg tab

1chlorzoxazone 500mg tab


86


1cyclobenzaprine 10mg tab

1cyclobenzaprine 5mg tab

1METAXALONE 400MG TAB

1metaxalone 800mg tab

1methocarbamol 500mg tab

1methocarbamol 750mg tab

1orphenadrine citrate 100mg er tab

1tizanidine 2mg cap

1tizanidine 2mg tab

1tizanidine 4mg cap

1tizanidine 4mg tab

1tizanidine 6mg capDIRECT MUSCLE RELAXANTS

1dantrolene sodium 100mg cap



NASAL AGENTS - SYSTEMIC AND TOPICALNASAL ANTIALLERGY

1azelastine 0.137mg/act nasal inhaler

1azelastine 0.206mg/act nasal inhaler

1olopatadine 0.665mg/act nasal inhalerNASAL ANTICHOLINERGICS

1ipratropium bromide 0.021mg/act nasal inhaler

1ipratropium bromide 0.042mg/act nasal inhalerNASAL STEROIDS

1FLUNISOLIDE 0.025MG/ACT NASAL INHALER QL=50 ML/30 Days

1fluticasone propionate 0.05mg/act nasal inhaler QL=32 GM/30 Days

NEUROMUSCULAR AGENTSALS AGENTS

1riluzole 50mg tab

NUTRIENTSCARBOHYDRATES

1glucose 100mg/ml inj PA BvD

1glucose 50mg/ml injLIPIDS

1INTRALIPID 20GM/100ML INJ PA BvD

1NUTRILIPID 20GM/100ML INJ PA BvDPROTEINS

1AMINOSYN II 10% INJ PA BvD

1AMINOSYN-PF 7% INJ PA BvD

1CLINIMIX 4.25/10 INJ PA BvD

1CLINIMIX 4.25/5 INJ PA BvD

1CLINIMIX 5/15 INJ PA BvD

1CLINIMIX 5/20 INJ PA BvD

1CLINIMIX E 2.75/5 INJ PA BvD



87



1CLINIMIX E 5/15 INJ PA BvD

1CLINIMIX E 5/20 INJ PA BvD

1clinisol 15% inj PA BvD

1FREAMINE 6.9% INJ PA BvD

1HEPATAMINE 8% INJ PA BvD

1NEPHRAMINE 5.4% INJ PA BvD

1plenamine 15% inj PA BvD

1PREMASOL 10% INJ PA BvD

1PROCALAMINE 3% INJ PA BvD

1PROSOL 20% INJ PA BvD

1TRAVASOL 10% INJ PA BvD

1TROPHAMINE 10% INJ PA BvD

OPHTHALMIC AGENTSBETA-BLOCKERS - OPHTHALMIC

1betaxolol 0.5% ophth soln

1BETIMOL 0.25% OPHTH SOLN

1BETIMOL 0.5% OPHTH SOLN

1BETOPTIC S 0.25% OPHTH SUSP

1CARTEOLOL 1% OPHTH SOLN

1COMBIGAN 2-5MG/ML OPHTH SOLN

1dorzolamide 20mg/ml/timolol 5mg/ml ophth soln

1dorzolamide/timolol 22.3-6.8mg/ml ophth soln (preservative-free)

1LEVOBUNOLOL 0.5% OPHTH SOLN

1TIMOLOL 0.25% OPHTH GEL

1timolol 0.25% ophth soln

1TIMOLOL 0.5% OPHTH GEL

1timolol 0.5% ophth soln

1timolol 5mg/ml ophth 24hr ophth soln

1TIMOPTIC 0.25% OPHTH GEL

1TIMOPTIC 0.5% OPHTH GELCYCLOPLEGIC MYDRIATICS

1ATROPINE SULFATE 1% OPHTH SOLNMIOTICS

1PHOSPHOLINE IODIDE 0.125% OPHTH SOLN

1pilocarpine 1% ophth soln

1pilocarpine 2% ophth soln

1pilocarpine 4% ophth solnOPHTHALMIC ADRENERGIC AGENTS

1ALPHAGAN 0.1% OPHTH SOLN

1apraclonidine 0.5% ophth soln

1brimonidine tartrate 0.15% ophth soln

1brimonidine tartrate 0.2% ophth soln

1IOPIDINE 1% OPHTH SOLN

1SIMBRINZA 0.2-1% OPHTH SUSP


88


OPHTHALMIC ANTI-INFECTIVES

1AZASITE 1% OPHTH SOLN

1BACITRACIN 0.5UNIT/MG OPHTH OINTMENT

1bacitracin 0.5unit/mg/polymyxin b 10unit/mg ophth ointment

QL=7 GM/7 Days

1ciprofloxacin 0.3% ophth soln QL=60 ML/30 Days

1erythromycin 0.5% ophth ointment QL=7 GM/7 Days

1gatifloxacin 0.5% ophth soln QL=5 ML/7 Days

1GENTAK 0.3% OPHTH OINTMENT QL=7 GM/7 Days

1gentamicin 0.3% ophth soln QL=10 ML/7 Days

1GRAMICIDIN 0.025MG/ML/NEOMYCIN 1.75MG/ML/POLYMYXIN B 10000UNIT/ML OPHTH SOLN

QL=10 ML/7 Days

1levofloxacin 0.5% ophth soln QL=60 ML/30 Days

1moxifloxacin 0.5% ophth soln QL=6 ML/7 Days

1NATACYN 5% OPHTH SUSP QL=15 ML/7 Days

1neomycin/bacitracin/polymyxin ophth ointment 5(3.5)mg-400unit-10000unit

QL=7 GM/7 Days

1ofloxacin 0.3% ophth soln QL=60 ML/30 Days

1polymyxin b 10000unit/ml/trimethoprim 1mg/ml ophth soln

QL=10 ML/7 Days

1SULFACETAMIDE SODIUM 10% OPHTH OINTMENT QL=7 GM/7 Days

1sulfacetamide sodium 10% ophth soln QL=15 ML/7 Days

1tobramycin 0.3% ophth soln QL=60 ML/30 Days

1TRIFLURIDINE 1% OPHTH SOLN QL=15 ML/7 Days

1ZIRGAN 0.15% OPHTH GEL QL=10 GM/7 DaysOPHTHALMIC IMMUNOMODULATORS

1RESTASIS 0.05% OPHTH SUSPOPHTHALMIC KINASE INHIBITORS

1RHOPRESSA 0.02% OPHTH SOLN QL=5 ML/30 Days

1ROCKLATAN 0.05-0.2MG/ML OPHTH SOLN QL=5 ML/30 DaysOPHTHALMIC LOCAL ANESTHETICS

1proparacaine 0.5% ophth solnOPHTHALMIC NERVE GROWTH FACTORS

1OXERVATE 0.002% OPHTH SOLN NDS PA QL=112 ML/365 DaysOPHTHALMIC STEROIDS

1ALREX 0.2% OPHTH SUSP

1BLEPHAMIDE 0.2-10% OPHTH SUSP

1DEXAMETHASONE PHOSPHATE 0.1% OPHTH SOLN

1dexamethasone/neomycin/polymyxin b 0.1% ophth ointment

1dexamethasone/neomycin/polymyxin b 0.1% ophth susp

1dexamethasone/tobramycin 0.3-0.1% ophth susp

1DUREZOL 0.05% OPHTH SUSP


89


1fluorometholone 0.1% ophth susp

1hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml ophth susp

1LOTEMAX 0.5% OPHTH GEL

1LOTEMAX 0.5% OPHTH OINTMENT

1loteprednol etabonate 0.5% ophth susp

1MAXIDEX 0.1% OPHTH SUSP

1neomycin/polymyxin/bacitracin/hydrocortisone ophth ointmentment 1%

1PRED MILD 0.12% OPHTH SUSP

1PRED-G 0.3-1% OPHTH SUSP

1PREDNISOLONE 1% OPHTH SOLN

1PREDNISOLONE ACETATE 1% OPHTH SUSP

1PREDNISOLONE SODIUM PHOSPHATE 2.5MG/ML/SULFACETAMIDE SODIUM 100MG/ML OPHTH SOLN

1TOBRADEX 0.1-0.3% OPHTH OINTMENT

1ZYLET 0.5-0.3% OPHTH SUSPOPHTHALMICS - MISC.

1ALOCRIL 2% OPHTH SOLN

1ALOMIDE 0.1% OPHTH SOLN

1azelastine 0.05% ophth soln

1AZOPT 1% OPHTH SUSP

1bromfenac 0.09% ophth soln

1cromolyn sodium 4% ophth soln

1CYSTARAN 0.44% OPHTH SOLN NDS PA QL=60 ML/30 Days

1diclofenac sodium 0.1% ophth soln

1dorzolamide 2% ophth soln

1epinastine 0.05% ophth soln

1FLURBIPROFEN SODIUM 0.03% OPHTH SOLN

1ILEVRO 0.3% OPHTH SUSP

1ketorolac tromethamine 0.4% ophth soln

1ketorolac tromethamine 0.5% ophth soln

1NEVANAC 0.1% OPHTH SUSP

1olopatadine 0.1% ophth soln

1olopatadine 0.2% ophth solnPROSTAGLANDINS - OPHTHALMIC

1bimatoprost 0.03% ophth soln QL=5 ML/30 Days

1latanoprost 0.005% ophth soln QL=5 ML/30 Days

1LUMIGAN 0.01% OPHTH SOLN QL=5 ML/30 Days

1travoprost 0.004% ophth soln QL=5 ML/30 Days

OTIC AGENTSOTIC AGENTS - MISCELLANEOUS

1acetic acid 2% otic solnOTIC ANTI-INFECTIVES

1CETRAXAL 0.2% OTIC SOLN


90


1CIPROFLOXACIN 0.2% OTIC SOLN

1ofloxacin 0.3% otic solnOTIC COMBINATIONS

1CIPRODEX 0.3-0.1% OTIC SUSP

1hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic soln

1hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic susp

OTIC STEROIDS

1acetic acid/hydrocortisone 1-2% otic soln

1flac 0.01% otic soln

1fluocinolone acetonide 0.01% otic soln

PASSIVE IMMUNIZING AND TREATMENT AGENTSIMMUNE SERUMS

1BIVIGAM 5GM/50ML INJ NDS PA

1FLEBOGAMMA 5GM/50ML INJ NDS PA

1GAMMAGARD 10GM INJ NDS PA

1GAMMAGARD 2.5GM/25ML INJ NDS PA

1GAMMAGARD 5GM INJ NDS PA

1GAMMAKED 1GM/10ML INJ NDS PA

1GAMMAPLEX 10GM/100ML INJ NDS PA




1GAMUNEX 1GM/10ML INJ NDS PA

1OCTAGAM 1GM/20ML INJ NDS PA

1OCTAGAM 2GM/20ML INJ NDS PA

1PANZYGA 10GM/100ML INJ NDS PA


1PANZYGA 2.5GM/25ML INJ NDS PA




1PRIVIGEN 20GM/200ML INJ NDS PA

1VARIZIG 125UNIT/1.2ML INJ NDS

PENICILLINSAMINOPENICILLINS

1amoxicillin 125mg chew tab

1amoxicillin 250mg cap

1AMOXICILLIN 250MG CHEW TAB

1amoxicillin 25mg/ml susp


1amoxicillin 500mg cap

1amoxicillin 500mg tab




91


1amoxicillin 875mg tab

1ampicillin 1000mg inj

1ampicillin 100mg/ml inj

1AMPICILLIN 125MG INJ

1AMPICILLIN 500MG CAPNATURAL PENICILLINS

1BICILLIN L-A 1200000UNIT/2ML SYRINGE

1BICILLIN L-A 2400000UNIT/4ML SYRINGE

1BICILLIN L-A 600000UNIT/ML SYRINGE

1penicillin g potassium 1000000unit/ml inj

1PENICILLIN G POTASSIUM 40000UNIT/ML INJ

1PENICILLIN G POTASSIUM 60000UNIT/ML INJ

1PENICILLIN G PROCAINE 600000UNIT/ML SYRINGE

1PENICILLIN G SODIUM 100000UNIT/ML INJ

1penicillin v potassium 250mg tab

1PENICILLIN V POTASSIUM 25MG/ML ORAL SOLN

1penicillin v potassium 500mg tab

1PENICILLIN V POTASSIUM 50MG/ML ORAL SOLNPENICILLIN COMBINATIONS

1AMOXICILLIN 1000MG/CLAVULANATE 62.5MG ER TAB

1amoxicillin 120mg/ml/clavulanate 8.58mg/ml susp

1AMOXICILLIN 200MG/CLAVULANATE 28.5MG CHEW TAB

1amoxicillin 250mg/clavulanate 125mg tab

1AMOXICILLIN 400MG/CLAVULANATE 57MG CHEW TAB






1ampicillin 1000mg/sulbactam 500mg inj

1ampicillin 100mg/ml/sulbactam 50mg/ml inj

1ampicillin 2000mg/sulbactam 1000mg inj

1BICILLIN 300000-300000UNIT/ML SYRINGE

1BICILLIN 450000-150000UNIT/ML SYRINGE

1piperacillin 2000mg/tazobactam 250mg inj

1piperacillin 200mg/ml/tazobactam 25mg/ml inj



1ZOSYN 2000-250MG INJ

1ZOSYN 3000-375MG INJPENICILLINASE-RESISTANT PENICILLINS

1dicloxacillin 250mg cap


92


1dicloxacillin 500mg cap

1nafcillin 1000mg inj

1nafcillin 100mg/ml inj

1nafcillin 2000mg inj

1oxacillin 1000mg inj

1oxacillin 100mg/ml inj

1oxacillin 2000mg inj

1OXACILLIN 20MG/ML INJ

1OXACILLIN 40MG/ML INJ

PROGESTINSPROGESTINS

1medroxyprogesterone acetate 10mg tab

1medroxyprogesterone acetate 2.5mg tab

1medroxyprogesterone acetate 5mg tab

1megestrol acetate 125mg/ml susp PA

1norethindrone acetate 5mg tab

1progesterone 100mg cap

1progesterone 200mg cap

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.AGENTS FOR CHEMICAL DEPENDENCY

1acamprosate calcium 333mg dr tab

1disulfiram 250mg tab

1disulfiram 500mg tabANTI-CATAPLECTIC AGENTS

1XYREM 500MG/ML ORAL SOLN NDS PA QL=540 ML/30 DaysANTIDEMENTIA AGENTS

1donepezil 10mg odt QL=30 EA/30 Days

1donepezil 10mg tab

1donepezil 23mg tab QL=30 EA/30 Days

1donepezil 5mg odt QL=30 EA/30 Days

1donepezil 5mg tab

1galantamine 12mg tab



1galantamine hydrobromide 16mg er cap


1GALANTAMINE HYDROBROMIDE 4MG/ML ORAL SOLN


1memantine 10mg tab

1memantine 10mg/memantine 5mg pack

1memantine 14mg er cap



1memantine 2mg/ml oral soln

1memantine 5mg tab


93



1rivastigmine 0.192mg/hr patch



1rivastigmine 1.5mg cap

1rivastigmine 3mg cap

1rivastigmine 4.5mg cap

1rivastigmine 6mg capCOMBINATION PSYCHOTHERAPEUTICS

1AMITRIPTYLINE 10MG/PERPHENAZINE 2MG TAB


1amitriptyline 12.5mg/chlordiazepoxide 5mg tab

1amitriptyline 25mg/chlordiazepoxide 10mg tab




1fluoxetine 25mg/olanzapine 12mg cap




1fluoxetine 50mg/olanzapine 6mg capFIBROMYALGIA AGENTS

1SAVELLA 100MG TAB QL=60 EA/30 Days

1SAVELLA 12.5MG TAB QL=60 EA/30 Days

1SAVELLA 25MG TAB QL=60 EA/30 Days

1SAVELLA 4-WEEK TITRATION PACK

1SAVELLA 50MG TAB QL=60 EA/30 DaysMOVEMENT DISORDER DRUG THERAPY

1AUSTEDO 12MG TAB NDS PA



1INGREZZA 40MG CAP NDS PA

1INGREZZA 80MG CAP NDS PA

1tetrabenazine 12.5mg tab PA

1tetrabenazine 25mg tab PAMULTIPLE SCLEROSIS AGENTS

1AUBAGIO 14MG TAB NDS

1AUBAGIO 7MG TAB NDS

1AVONEX 30MCG/0.5ML AUTO-INJECTOR NDS

1AVONEX 30MCG/0.5ML SYRINGE NDS

1dalfampridine 10mg er tab QL=60 EA/30 Days

1EXTAVIA 0.3MG INJ NDS

1GILENYA 0.5MG CAP NDS

1glatiramer acetate 20mg/ml syringe

1glatiramer acetate 40mg/ml syringe

1glatopa 20mg/ml syringe


94


1glatopa 40mg/ml syringe

1MAYZENT 0.25MG TAB NDS

1MAYZENT 2MG TAB NDS

1PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR NDS

1PLEGRIDY 125MCG/0.5ML SYRINGE NDS

1PLEGRIDY PEN STARTER PACK NDS

1PLEGRIDY STARTER PACK NDS

1REBIF 22MCG/0.5ML AUTO-INJECTOR NDS

1REBIF 22MCG/0.5ML SYRINGE NDS

1REBIF 44MCG/0.5ML AUTO-INJECTOR NDS

1REBIF 44MCG/0.5ML SYRINGE NDS

1REBIF REBIDOSE PACK NDS

1REBIF TITRATION PACK NDS

1TECFIDERA 120MG DR CAP NDS

1TECFIDERA 240MG DR CAP NDS

1TECFIDERA 30-DAY STARTER PACK NDSPSEUDOBULBAR AFFECT (PBA) AGENTS

1NUEDEXTA 20-10MG CAP PA QL=60 EA/30 DaysPSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.

1ERGOLOID MESYLATES USP 1MG TAB

1PIMOZIDE 1MG TAB

1PIMOZIDE 2MG TABSMOKING DETERRENTS

1bupropion 150mg sr tab

1CHANTIX 0.5MG TAB

1CHANTIX 1MG TAB

1CHANTIX CONTINUING MONTHS OF THERAPY 1MG PACK

1CHANTIX FIRST MONTH OF THERAPY PACK

1NICOTROL 10MG INH SOLN

1NICOTROL 10MG/ML NASAL INHALERTRANSTHYRETIN AMYLOIDOSIS AGENTS

1TEGSEDI 284MG/1.5ML SYRINGE NDS PA QL=6 ML/28 Days

RESPIRATORY AGENTS - MISC.ALPHA-PROTEINASE INHIBITOR (HUMAN)

1ARALAST 1000MG INJ NDS

1GLASSIA 1000MG/50ML INJ NDS

1PROLASTIN 1000MG INJ NDS

1ZEMAIRA 1000MG INJ NDSCYSTIC FIBROSIS AGENTS

1KALYDECO 150MG TAB NDS PA QL=60 EA/30 Days

1KALYDECO 25MG GRANULES NDS PA QL=60 EA/30 Days



1ORKAMBI 125-100MG GRANULES NDS PA QL=60 EA/30 Days

1ORKAMBI 125-100MG TAB NDS PA QL=120 EA/30 Days


95


1ORKAMBI 125-200MG TAB NDS PA QL=120 EA/30 Days

1ORKAMBI 188-150MG GRANULES NDS PA QL=60 EA/30 Days

1PULMOZYME 1MG/ML INH SOLN NDS PA BvD

1SYMDEKO 50-75MG/75MG PACK NDS PA QL=60 EA/30 Days

1SYMDEKO TAB 4-WEEK PACK NDS PA QL=60 EA/30 Days

1TRIKAFTA 100-50-75MG/150MG PACK NDS PA QL=90 EA/30 DaysPULMONARY FIBROSIS AGENTS

1ESBRIET 267MG CAP NDS PA

1ESBRIET 267MG TAB NDS PA

1ESBRIET 801MG TAB NDS PA

1OFEV 100MG CAP NDS PA

1OFEV 150MG CAP NDS PA

SULFONAMIDESSULFONAMIDES

1SULFADIAZINE 500MG TAB

TETRACYCLINESAMINOMETHYLCYCLINES

1NUZYRA 150MG TAB NDS PA QL=30 EA/14 DaysGLYCYLCYCLINES

1TIGECYCLINE 50MG INJ NDSTETRACYCLINES

1demeclocycline 150mg tab

1demeclocycline 300mg tab

1doxy 100mg inj

1doxycycline hyclate 100mg cap

1doxycycline hyclate 100mg tab

1doxycycline hyclate 20mg tab

1doxycycline hyclate 50mg cap

1doxycycline monohydrate 100mg cap

1doxycycline monohydrate 100mg tab

1doxycycline monohydrate 50mg cap

1doxycycline monohydrate 50mg tab

1doxycycline monohydrate 5mg/ml susp

1minocycline 100mg cap

1minocycline 100mg tab





1mondoxyne 100mg cap

1tetracycline 250mg cap

1tetracycline 500mg cap

THYROID AGENTSANTITHYROID AGENTS

1methimazole 10mg tab

1methimazole 5mg tab


96


1propylthiouracil 50mg tabTHYROID HORMONES

1euthyrox 100mcg tab







1euthyrox 25mcg tab

1euthyrox 50mcg tab

1euthyrox 75mcg tab

1euthyrox 88mcg tab

1levo-t 100mcg tab

1levo-t 112mcg tab

1levo-t 125mcg tab

1levo-t 137mcg tab

1levo-t 150mcg tab

1levo-t 175mcg tab

1levo-t 200mcg tab

1levo-t 25mcg tab

1levo-t 300mcg tab

1levo-t 50mcg tab

1levo-t 75mcg tab

1levo-t 88mcg tab

1levothyroxine sodium 0.025mg tab












1levoxyl 100mcg tab

1levoxyl 112mcg tab

1levoxyl 125mcg tab

1levoxyl 137mcg tab

1levoxyl 150mcg tab

1levoxyl 175mcg tab

1levoxyl 200mcg tab

1levoxyl 25mcg tab

1levoxyl 50mcg tab


97


1levoxyl 75mcg tab

1levoxyl 88mcg tab

1liothyronine sodium 0.005mg tab



1SYNTHROID 100MCG TAB












1unithroid 100mcg tab











TOXOIDSTOXOID COMBINATIONS

1ADACEL INJ

1ADACEL SYRINGE

1BOOSTRIX INJ

1BOOSTRIX SYRINGE

1DAPTACEL INJ

1DIPHTHERIA/TETANUS TOXOID INJ PA BvD

1INFANRIX INJ

1KINRIX INJ

1KINRIX PF INJ

1PEDIARIX INJ

1QUADRACEL INJ

1TDVAX 4-4UNIT/ML INJ PA BvD

1TENIVAC 4-10UNIT/ML SYRINGE PA BvD

ULCER DRUGSANTISPASMODICS

1dicyclomine 10mg cap


98


1dicyclomine 20mg tab

1glycopyrrolate 1mg tab

1glycopyrrolate 2mg tabH-2 ANTAGONISTS

1cimetidine 200mg tab




1famotidine 20mg tab

1famotidine 8mg/ml susp

1nizatidine 150mg cap

1nizatidine 300mg capMISC. ANTI-ULCER

1sucralfate 1000mg tabPROTON PUMP INHIBITORS

1esomeprazole 20mg dr cap

1lansoprazole 15mg dr cap

1lansoprazole 30mg dr cap

1omeprazole 20mg dr cap

1pantoprazole 20mg dr tab

1rabeprazole sodium 20mg dr tab

ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICSANTISPASMODICS

1dicyclomine 2mg/ml oral soln

1METHSCOPOLAMINE BROMIDE 2.5MG TAB

1METHSCOPOLAMINE BROMIDE 5MG TABH-2 ANTAGONISTS

1CIMETIDINE 60MG/ML ORAL SOLN

1famotidine 40mg tabMISC. ANTI-ULCER

1sucralfate 100mg/ml suspPROTON PUMP INHIBITORS

1esomeprazole 40mg dr cap



1pantoprazole 40mg dr tabULCER DRUGS - PROSTAGLANDINS

1misoprostol 0.1mg tab

1misoprostol 0.2mg tabULCER THERAPY COMBINATIONS

1amoxicillin 500mg/clarithromycin 500mg/lansoprazole 30mg pack

1PYLERA 140-125-125MG CAP

URINARY ANTI-INFECTIVESURINARY ANTI-INFECTIVES

1methenamine hippurate 1000mg tab


99


1nitrofurantoin macro 25mg/nitrofurantoin mono 75mg cap

1nitrofurantoin macrocrystals 100mg cap

1nitrofurantoin macrocrystals 50mg cap

URINARY ANTISPASMODICSURINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC)

1oxybutynin chloride 10mg er tab


1oxybutynin chloride 1mg/ml oral soln


1oxybutynin chloride 5mg tab

1solifenacin succinate 10mg tab

1solifenacin succinate 5mg tab

1tolterodine tartrate 1mg tab

1tolterodine tartrate 2mg er cap

1tolterodine tartrate 2mg tab

1tolterodine tartrate 4mg er cap

1trospium chloride 20mg tab

1trospium chloride 60mg er capURINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS

1MYRBETRIQ 25MG ER TAB

1MYRBETRIQ 50MG ER TABURINARY ANTISPASMODICS - CHOLINERGIC AGONISTS

1bethanechol chloride 10mg tab



1bethanechol chloride 5mg tabURINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS

1flavoxate 100mg tab

VACCINESBACTERIAL VACCINES

1ACTHIB INJ

1BCG LIVE TICE STRAIN 50MG INJ

1BEXSERO SYRINGE

1HIBERIX 10MCG INJ

1MENACTRA INJ

1MENVEO INJ

1PEDVAXHIB 7.5MCG/0.5ML INJ

1TRUMENBA SYRINGE

1TYPHIM VI 25MCG/0.5ML INJ

1TYPHIM VI 25MCG/0.5ML SYRINGEVIRAL VACCINES

1ENGERIX-B 10MCG/0.5ML SYRINGE PA BvD

1ENGERIX-B 20MCG/ML SYRINGE PA BvD

1GARDASIL 9 INJ

1GARDASIL 9 SYRINGE


100


1HAVRIX 1440ELU/ML INJ

1HAVRIX 1440ELU/ML SYRINGE

1HAVRIX 720ELU/0.5ML SYRINGE

1IMOVAX 2.5UNIT/ML INJ PA BvD

1IPOL INJ

1IXIARO 0.012MG/ML SYRINGE

1M-M-R II INJ

1PROQUAD INJ

1RABAVERT 2.5UNIT/ML INJ PA BvD

1RECOMBIVAX 10MCG/ML INJ PA BvD

1RECOMBIVAX 10MCG/ML SYRINGE PA BvD

1RECOMBIVAX 40MCG/ML INJ PA BvD

1RECOMBIVAX 5MCG/0.5ML SYRINGE PA BvD

1ROTARIX SUSP

1ROTATEQ SUSP

1SHINGRIX 50MCG/0.5ML INJ

1TWINRIX 720UNIT SYRINGE

1VAQTA 25UNIT/0.5ML INJ

1VAQTA 25UNIT/0.5ML SYRINGE

1VAQTA 50UNIT/ML INJ

1VAQTA 50UNIT/ML SYRINGE

1VARIVAX 1350PFU/0.5ML INJ

1YF-VAX 4000UNIT/ML INJ

1ZOSTAVAX 19400UNT/0.65ML INJ

VAGINAL AND RELATED PRODUCTSVAGINAL ANTI-INFECTIVES

1clindamycin 2% vaginal cream

1metronidazole 0.75% vaginal gel

1terconazole 0.4% vaginal cream

1TERCONAZOLE 0.8% VAGINAL CREAM

1terconazole 80mg vaginal insert

1vandazole 0.75% vaginal gelVAGINAL ESTROGENS

1estradiol 0.01% vaginal cream

1ESTRING 2MG VAGINAL SYSTEM ST

1PREMARIN 0.625MG/GM VAGINAL CREAMVAGINAL PROGESTINS

1CRINONE 4% VAGINAL GEL PA

1CRINONE 8% VAGINAL GEL PA

VASOPRESSORSANAPHYLAXIS THERAPY AGENTS

1epinephrine 0.5mg/ml auto-injector QL=2 EA/15 Days

1epinephrine 1mg/ml auto-injector QL=2 EA/15 Days

1SYMJEPI 0.15MG/0.3ML SYRINGE QL=2 EA/15 Days

1SYMJEPI 0.3MG/0.3ML SYRINGE QL=2 EA/15 DaysNEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS


101


1NORTHERA 100MG CAP NDS PA

1NORTHERA 200MG CAP NDS PA

1NORTHERA 300MG CAP NDS PAVASOPRESSORS

1midodrine 10mg tab

1midodrine 2.5mg tab

1midodrine 5mg tab


102

ALPHABETICAL LISTING OF DRUGS

A

abacavir 20mg/ml oral soln

54

abacavir 300mg tab 54 abacavir 300mg/lamivudine 150mg/zidovudine 300mg tab

54

abacavir 600mg/lamivudine 300mg tab

54

ABELCET 5MG/ML INJ 33 ABILIFY 300MG INJ 53 ABILIFY 300MG SYRINGE

53

ABILIFY 400MG INJ 53 ABILIFY 400MG SYRINGE

53

abiraterone acetate 250mg tab

43

acamprosate calcium 333mg dr tab

93

acarbose 100mg tab 29 acarbose 25mg tab 29 acarbose 50mg tab 29 acebutolol 200mg cap 57 acebutolol 400mg cap 57 acetaminophen 21.7mg/ml/hydrocodone bitartrate 0.5mg/ml oral soln

14

acetaminophen 24mg/ml/codeine phosphate 2.4mg/ml oral soln

14

acetaminophen 300mg/codeine phosphate 15mg tab

14


14


14

acetaminophen 300mg/hydrocodone bitartrate 10mg tab

14


14

acetaminophen 300mg/hydrocodone bitartrate 7.5mg tab

14


14


14

acetaminophen 325mg/hydrocodone bitartrate 7.5mg tab

14

acetaminophen 325mg/oxycodone 10mg tab

14

acetaminophen 325mg/oxycodone 2.5mg tab

14

acetaminophen 325mg/oxycodone 5mg tab

14

acetaminophen 325mg/oxycodone 7.5mg tab

14

acetaminophen 325mg/tramadol 37.5mg tab

14

acetazolamide 125mg tab 72 acetazolamide 250mg tab 72 acetazolamide 500mg er cap

72

acetic acid 2% otic soln 90 acetic acid/hydrocortisone 1-2% otic soln

91

acetylcysteine 100mg/ml inh soln

67

acetylcysteine 200mg/ml inh soln

67

acitretin 10mg cap 69 acitretin 17.5mg cap 69 acitretin 25mg cap 69 ACTEMRA 162MG/0.9ML AUTO-INJECTOR

10

ACTEMRA 162MG/0.9ML SYRINGE

10

ACTHIB INJ 100 ACTIMMUNE 2000000UNIT/0.5ML INJ

47

acyclovir 200mg cap 56 acyclovir 400mg tab 56 acyclovir 40mg/ml susp 56 acyclovir 5% ointment 70 acyclovir 50mg/ml inj 56 acyclovir 800mg tab 56 ADACEL INJ 98 ADACEL SYRINGE 98 adapalene 0.1% cream 67 adapalene 0.1% gel 67 adapalene 0.3% gel 67 adapalene/benzoyl peroxide 0.1-2.5% gel

67

adefovir dipivoxil 10mg tab

56

ADEMPAS 0.5MG TAB 61 ADEMPAS 1.5MG TAB 61 ADEMPAS 1MG TAB 61 ADEMPAS 2.5MG TAB 61 ADEMPAS 2MG TAB 61 ADVAIR 0.045-0.021MG INH

19

ADVAIR 0.115-0.021MG INH

19

ADVAIR 0.23-0.021MG INH

19

AFINITOR 10MG TAB 44 AFINITOR 2MG TAB FOR ORAL SUSP

44

AFINITOR 3MG TAB FOR ORAL SUSP

44


103


AFINITOR 5MG TAB FOR ORAL SUSP

44

AIMOVIG 140MG/ML AUTO-INJECTOR

83

AIMOVIG 70MG/ML AUTO-INJECTOR

83

ala-cort 1% cream 70 albendazole 200mg tab 16 albuterol 0.21mg/ml inh soln

19

albuterol 0.417mg/ml inh soln

19

albuterol 0.4mg/ml oral soln

19

albuterol 0.83mg/ml inh soln

19

albuterol 2mg tab 19 ALBUTEROL 4MG ER TAB

19

albuterol 4mg tab 19 albuterol 5mg/ml inh soln 19 ALBUTEROL 8MG ER TAB

19

alclometasone dipropionate 0.05% cream

70

alclometasone dipropionate 0.05% ointment

70

ALECENSA 150MG CAP 44 ALENDRONIC ACID 0.933MG/ML ORAL SOLN

73

alendronic acid 10mg tab 73 alendronic acid 35mg tab 73 alendronic acid 70mg tab 73 alfuzosin 10mg er tab 79 ALINIA 100MG/5ML SUSP

40

ALINIA 500MG TAB 40 aliskiren 150mg tab 40 aliskiren 300mg tab 40 allopurinol 100mg tab 79 allopurinol 300mg tab 79

ALOCRIL 2% OPHTH SOLN

90

ALOMIDE 0.1% OPHTH SOLN

90

alosetron 0.5mg tab 78 alosetron 1mg tab 78 ALPHAGAN 0.1% OPHTH SOLN

88

alprazolam 0.25mg odt 17 alprazolam 0.25mg tab 17 alprazolam 0.5mg er tab 17 alprazolam 0.5mg odt 17 alprazolam 0.5mg tab 17 alprazolam 1mg er tab 17 alprazolam 1mg odt 17 alprazolam 1mg tab 17 alprazolam 2mg er tab 17 alprazolam 2mg odt 17 alprazolam 2mg tab 17 alprazolam 3mg er tab 17 ALREX 0.2% OPHTH SUSP

89

altavera 28 day pack 63 ALUNBRIG 180MG TAB 44 ALUNBRIG 30MG TAB 44 ALUNBRIG 90MG TAB 44 ALUNBRIG INITIATION PACK

44

alyacen 1/35 28 day pack 63 alyq 20mg tab 61 amabelz 0.5/0.1mg 28 day pack

76

amabelz 1/0.5mg 28 day pack

76

amantadine 100mg cap 49 amantadine 100mg tab 49 amantadine 10mg/ml oral soln

48

AMBISOME 50MG INJ 33 ambrisentan 10mg tab 61 ambrisentan 5mg tab 61 amethia 91 day pack 63 amikacin 250mg/ml inj 9 amiloride 5mg tab 73

amiloride 5mg/hydrochlorothiazide 50mg tab

72

AMINOSYN II 10% INJ 87 AMINOSYN-PF 7% INJ 87 amiodarone 200mg tab 18 amiodarone 400mg tab 18 amitriptyline 100mg tab 28 amitriptyline 10mg tab 28 AMITRIPTYLINE 10MG/PERPHENAZINE 2MG TAB

94

AMITRIPTYLINE 10MG/PERPHENAZINE 4MG TAB

94

amitriptyline 12.5mg/chlordiazepoxide 5mg tab

94

amitriptyline 150mg tab 28 amitriptyline 25mg tab 28 amitriptyline 25mg/chlordiazepoxide 10mg tab

94


94


94

amitriptyline 50mg tab 28 AMITRIPTYLINE 50MG/PERPHENAZINE 4MG TAB

94

amitriptyline 75mg tab 28 amlodipine 10mg tab 58 amlodipine 10mg/atorvastatin 10mg tab

60

amlodipine 10mg/atorvastatin 20mg tab

60


60


104



60

amlodipine 10mg/benazepril 20mg cap

38


38

amlodipine 10mg/hydrochlorothiazide 12.5mg/valsartan 160mg tab

38

amlodipine 10mg/hydrochlorothiazide 25mg/valsartan 160mg tab

38


38

amlodipine 10mg/olmesartan medoxomil 20mg tab

38


38

amlodipine 10mg/valsartan 160mg tab

38


38

amlodipine 2.5mg tab 59 amlodipine 2.5mg/atorvastatin 10mg tab

60

amlodipine 2.5mg/atorvastatin 20mg tab

60

amlodipine 2.5mg/atorvastatin 40mg tab

60

amlodipine 2.5mg/benazepril 10mg cap

38

amlodipine 5mg tab 59 amlodipine 5mg/atorvastatin 10mg tab

60


60


61


61


38


38


38

amlodipine 5mg/hydrochlorothiazide 12.5mg/valsartan 160mg tab

38


38


38


38


38


38

ammonium lactate 12% cream

71

ammonium lactate 12% lotion

71

amnesteem 10mg cap 67

amnesteem 20mg cap 67 amnesteem 40mg cap 67 AMOXAPINE 100MG TAB

28

AMOXAPINE 150MG TAB

28

AMOXAPINE 25MG TAB 28 AMOXAPINE 50MG TAB 28 AMOXICILLIN 1000MG/CLAVULANATE 62.5MG ER TAB

92

amoxicillin 120mg/ml/clavulanate 8.58mg/ml susp

92

amoxicillin 125mg chew tab

91

AMOXICILLIN 200MG/CLAVULANATE 28.5MG CHEW TAB

92

amoxicillin 250mg cap 91 AMOXICILLIN 250MG CHEW TAB

91

amoxicillin 250mg/clavulanate 125mg tab

92

amoxicillin 25mg/ml susp 91 AMOXICILLIN 400MG/CLAVULANATE 57MG CHEW TAB

92

amoxicillin 40mg/ml susp 91 amoxicillin 40mg/ml/clavulanate 5.7mg/ml susp

92

amoxicillin 500mg cap 91 amoxicillin 500mg tab 91 amoxicillin 500mg/clarithromycin 500mg/lansoprazole 30mg pack

99

amoxicillin 500mg/clavulanate 125mg tab

92

amoxicillin 50mg/ml susp 91


105


amoxicillin 50mg/ml/clavulanate 12.5mg/ml susp

92

amoxicillin 80mg/ml susp 91 amoxicillin 80mg/ml/clavulanate 11.4mg/ml susp

92

amoxicillin 875mg tab 92 amoxicillin 875mg/clavulanate 125mg tab

92

amphetamine 10mg er cap

8

amphetamine 10mg tab 8 amphetamine 12.5mg tab 8 amphetamine 15mg er cap

8

amphetamine 15mg tab 8 amphetamine 20mg er cap

8

amphetamine 20mg tab 8 amphetamine 25mg er cap

8

amphetamine 30mg er cap

8

amphetamine 30mg tab 8 amphetamine 5mg er cap 8 amphetamine 5mg tab 8 amphetamine 7.5mg tab 8 AMPHOTERICIN B 50MG INJ

33

ampicillin 1000mg inj 92 ampicillin 1000mg/sulbactam 500mg inj

92

ampicillin 100mg/ml inj 92 ampicillin 100mg/ml/sulbactam 50mg/ml inj

92

AMPICILLIN 125MG INJ 92 ampicillin 2000mg/sulbactam 1000mg inj

92

AMPICILLIN 500MG CAP

92

ANADROL-50 50MG TAB

15

anagrelide 0.5mg cap 80 anagrelide 1mg cap 80 anastrozole 1mg tab 43 ANDRODERM 2MG/24HR PATCH

15

ANDRODERM 4MG/24HR PATCH

15

ANORO 0.0625-0.025MG INH

19

APLENZIN 174MG ER TAB

26


26


26

APOKYN 30MG/3ML CARTRIDGE

49

apraclonidine 0.5% ophth soln

88

aprepitant 125mg cap 33 aprepitant 125mg/aprepitant 80mg pack

33

aprepitant 40mg cap 33 aprepitant 80mg cap 33 apri 28 day pack 63 APTIOM 200MG TAB 22 APTIOM 400MG TAB 22 APTIOM 600MG TAB 22 APTIOM 800MG TAB 22 APTIVUS 100MG/ML ORAL SOLN

54

APTIVUS 250MG CAP 54 ARALAST 1000MG INJ 95 aranelle 28 pack 63 ARANESP 100MCG/0.5ML SYRINGE

80

ARANESP 100MCG/ML INJ

80

ARANESP 10MCG/0.4ML SYRINGE

80


80


80


80


80


80


80


80


80


80

ARANESP 500MCG/ML SYRINGE

80


80


80

ARCALYST 220MG INJ 10 ARIKAYCE 590MG/8.4ML INH SUSP

9

aripiprazole 10mg odt 53 aripiprazole 10mg tab 53 aripiprazole 15mg odt 53 aripiprazole 15mg tab 53 aripiprazole 1mg/ml oral soln

53

aripiprazole 20mg tab 53 aripiprazole 2mg tab 53 aripiprazole 30mg tab 53 aripiprazole 5mg tab 53 ARISTADA 1064MG/3.9ML SYRINGE

53


106


ARISTADA 441MG/1.6ML SYRINGE

53


53


53


53

armodafinil 150mg tab 8 armodafinil 200mg tab 8 armodafinil 250mg tab 8 armodafinil 50mg tab 8 ARNUITY 100MCG INH 19 ARNUITY 200MCG INH 19 ARNUITY 50MCG INH 19 ashlyna 91 day pack 63 ASMANEX 100MCG INH 19 ASMANEX 110MCG/INH INH

19

ASMANEX 200MCG INH 19 ASMANEX 220MCG (120ACT) INH

19

ASMANEX 220MCG (30ACT) INH

19

ASMANEX 220MCG (60ACT) INH

19

ASMANEX 50MCG HFA INH

19

aspirin 25mg/dipyridamole 200mg er cap

80

ASPIRIN 325MG/OXYCODONE 4.84MG TAB

14

ASTAGRAF 0.5MG ER CAP

85

ASTAGRAF 1MG ER CAP 85 ASTAGRAF 5MG ER CAP 85 atazanavir 150mg cap 54 atazanavir 200mg cap 54 atazanavir 300mg cap 54 atenolol 100mg tab 57 atenolol 100mg/chlorthalidone 25mg tab

38

atenolol 25mg tab 57 atenolol 50mg tab 57 atenolol 50mg/chlorthalidone 25mg tab

38

atomoxetine 100mg cap 8 atomoxetine 10mg cap 8 atomoxetine 18mg cap 8 atomoxetine 25mg cap 8 atomoxetine 40mg cap 8 atomoxetine 60mg cap 8 atomoxetine 80mg cap 8 atorvastatin 10mg tab 35 atorvastatin 20mg tab 35 atorvastatin 40mg tab 35 atorvastatin 80mg tab 35 atovaquone 150mg/ml susp

40

atovaquone 250mg/proguanil 100mg tab

41

atovaquone 62.5mg/proguanil 25mg tab

41

ATRIPLA 600-200-300MG TAB

54

atropine sulfate 0.005mg/ml/diphenoxylate 0.5mg/ml oral soln

32

atropine sulfate 0.025mg/diphenoxylate 2.5mg tab

32

ATROPINE SULFATE 1% OPHTH SOLN

88

ATROVENT 17MCG INH 18 AUBAGIO 14MG TAB 94 AUBAGIO 7MG TAB 94 aubra 28 day pack 63 AURYXIA 210MG TAB 78 AUSTEDO 12MG TAB 94 AUSTEDO 6MG TAB 94 AUSTEDO 9MG TAB 94 AVANDIA 2MG TAB 31 AVANDIA 4MG TAB 31 aviane 28 pack 63

avita 0.025% cream 67 avita 0.025% gel 67 AVONEX 30MCG/0.5ML AUTO-INJECTOR

94

AVONEX 30MCG/0.5ML SYRINGE

94

AVYCAZ 500-2000MG INJ

62

AYVAKIT 100MG TAB 44 AYVAKIT 200MG TAB 44 AYVAKIT 300MG TAB 44 AZASAN 100MG TAB 57 AZASAN 75MG TAB 57 AZASITE 1% OPHTH SOLN

89

azathioprine 50mg tab 85 azelaic acid 15% gel 71 azelastine 0.05% ophth soln

90

azelastine 0.137mg/act nasal inhaler

87

azelastine 0.206mg/act nasal inhaler

87

azelastine/fluticasone 137-50mcg/act nasal spray

51

azithromycin 20mg/ml susp

82

azithromycin 250mg pack 82 azithromycin 250mg tab 82 azithromycin 40mg/ml susp

82

azithromycin 500mg inj 82 azithromycin 500mg pack 82 azithromycin 500mg tab 82 azithromycin 600mg tab 82 AZOPT 1% OPHTH SUSP 90 aztreonam 1000mg inj 41

B

BACITRACIN 0.5UNIT/MG OPHTH OINTMENT

89


107


bacitracin 0.5unit/mg/polymyxin b 10unit/mg ophth ointment

89

baclofen 10mg tab 86 baclofen 20mg tab 86 balsalazide disodium 750mg cap

77

BALVERSA 3MG TAB 44 BALVERSA 4MG TAB 44 BALVERSA 5MG TAB 44 balziva 28 day pack 63 BANZEL 200MG TAB 22 BANZEL 400MG TAB 22 BANZEL 40MG/ML SUSP

22

BAQSIMI 3MG/DOSE NASAL POWDER

30

BAXDELA 450MG TAB 77 BCG LIVE TICE STRAIN 50MG INJ

100

benazepril 10mg tab 36 benazepril 10mg/hydrochlorothiazide 12.5mg tab

38

benazepril 20mg tab 36 benazepril 20mg/hydrochlorothiazide 12.5mg tab

38

benazepril 20mg/hydrochlorothiazide 25mg tab

38

benazepril 40mg tab 36 benazepril 5mg tab 36 benazepril 5mg/hydrochlorothiazide 6.25mg tab

38

BENLYSTA 200MG/ML AUTO-INJECTOR

86

BENLYSTA 200MG/ML SYRINGE

86

BENZNIDAZOLE 100MG TAB

16

BENZNIDAZOLE 12.5MG TAB

16

benztropine mesylate 0.5mg tab

49

benztropine mesylate 1mg tab

49

benztropine mesylate 2mg tab

48

BERINERT 500UNIT INJ 79 betamethasone 0.05% aug cream

70

betamethasone 0.05% aug lotion

70

betamethasone 0.05% aug ointment

70

betamethasone 0.05% cream

70

BETAMETHASONE 0.05% GEL

70

betamethasone 0.05% lotion

70

betamethasone 0.05% ointment

70

betamethasone 0.1% cream

70

betamethasone 0.1% lotion

70

betamethasone 0.1% ointment

70

betamethasone/clotrimazole 1-0.05% cream

68

betamethasone/clotrimazole 1-0.05% lotion

68

betaxolol 0.5% ophth soln

88

betaxolol 10mg tab 57 betaxolol 20mg tab 57 bethanechol chloride 10mg tab

100

bethanechol chloride 25mg tab

100


100


100

BETIMOL 0.25% OPHTH SOLN

88

BETIMOL 0.5% OPHTH SOLN

88

BETOPTIC S 0.25% OPHTH SUSP

88

bexarotene 75mg cap 47 BEXSERO SYRINGE 100 bicalutamide 50mg tab 43 BICILLIN 300000-300000UNIT/ML SYRINGE

92

BICILLIN 450000-150000UNIT/ML SYRINGE

92

BICILLIN L-A 1200000UNIT/2ML SYRINGE

92

BICILLIN L-A 2400000UNIT/4ML SYRINGE

92

BICILLIN L-A 600000UNIT/ML SYRINGE

92

BIDIL 37.5-20MG TAB 61 BIKTARVY 50-200-25MG TAB

54

bimatoprost 0.03% ophth soln

90

bisoprolol fumarate 10mg tab

57

bisoprolol fumarate 10mg/hydrochlorothiazide 6.25mg tab

38

bisoprolol fumarate 2.5mg/hydrochlorothiazide 6.25mg tab

38

bisoprolol fumarate 5mg tab

57

bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mg tab

38

BIVIGAM 5GM/50ML INJ

91

BLEPHAMIDE 0.2-10% OPHTH SUSP

89


108


blisovi 21 fe 1.5/30 28 day

63

blisovi 24 fe 1/20 28 day pack

63

BOOSTRIX INJ 98 BOOSTRIX SYRINGE 98 bosentan 125mg tab 61 bosentan 62.5mg tab 61 BOSULIF 100MG TAB 44 BOSULIF 400MG TAB 44 BOSULIF 500MG TAB 44 BRAFTOVI 75MG CAP 44 BREO 0.1-0.025MG INH 19 BREO 0.2-0.025MG INH 19 briellyn 28 day pack 63 BRILINTA 60MG TAB 80 BRILINTA 90MG TAB 80 brimonidine tartrate 0.15% ophth soln

88

brimonidine tartrate 0.2% ophth soln

88

BRIVIACT 100MG TAB 22 BRIVIACT 10MG TAB 22 BRIVIACT 10MG/ML ORAL SOLN

22

BRIVIACT 25MG TAB 22 BRIVIACT 50MG TAB 22 BRIVIACT 75MG TAB 22 bromfenac 0.09% ophth soln

90

bromocriptine 2.5mg tab 48 bromocriptine 5mg cap 48 BRUKINSA 80MG CAP 44 budesonide 0.125mg/ml inh susp

19

budesonide 0.25mg/ml inh susp

19

budesonide 0.5mg/ml inh susp

19

budesonide 3mg dr cap 66 budesonide 9mg er tab 66 bumetanide 0.25mg/ml inj 72 bumetanide 0.5mg tab 72 bumetanide 1mg tab 72 bumetanide 2mg tab 72

buprenorphine 12mg/naloxone 3mg sublingual film

14

buprenorphine 2mg sl tab 14 buprenorphine 2mg/naloxone 0.5mg sl tab

15

buprenorphine 2mg/naloxone 0.5mg sublingual film

15


15

buprenorphine 8mg sl tab 15 buprenorphine 8mg/naloxone 2mg sl tab

15


15

bupropion 100mg er tab 26 bupropion 100mg tab 26 bupropion 150mg sr (12 hr) tab

26

bupropion 150mg sr tab 95 bupropion 150mg xl (24 hr) tab

26

bupropion 200mg er tab 26 bupropion 300mg er tab 26 bupropion 75mg tab 26 buspirone 10mg tab 16 buspirone 15mg tab 16 buspirone 30mg tab 16 buspirone 5mg tab 16 buspirone 7.5mg tab 16 butorphanol tartrate 1mg/act nasal inhaler

15

BYDUREON 2MG PEN INJ

30

BYDUREON 2MG/0.85ML AUTO-INJECTOR

30

BYSTOLIC 10MG TAB 57 BYSTOLIC 2.5MG TAB 58 BYSTOLIC 20MG TAB 58 BYSTOLIC 5MG TAB 58

C

cabergoline 0.5mg tab 75 CABLIVI 11MG INJ 80 CABOMETYX 20MG TAB

44

CABOMETYX 40MG TAB

44

CABOMETYX 60MG TAB

44

calcipotriene 0.005% cream

69

calcipotriene 0.005% ointment

69

calcipotriene 0.005% topical soln

69

calcipotriene/betamethasone 0.005-0.064% ointment

70

calcitriol 0.00025mg cap 74 calcitriol 0.0005mg cap 74 calcitriol 0.001mg/ml oral soln

74

calcium acetate 667mg cap

78

calcium acetate 667mg tab

78

CALQUENCE 100MG CAP

44

camila 28 day 0.35mg pack

66

camreselo 91 day pack 63 CAPLYTA 42MG CAP 50 CAPRELSA 100MG TAB 44 CAPRELSA 300MG TAB 44 captopril 100mg tab 36 captopril 12.5mg tab 36 captopril 25mg tab 36 captopril 25mg/hydrochlorothiazide 15mg tab

38

CAPTOPRIL 25MG/HYDROCHLOROTHIAZIDE 25MG TAB

38

captopril 50mg tab 36


109


captopril 50mg/hydrochlorothiazide 15mg tab

38

CAPTOPRIL 50MG/HYDROCHLOROTHIAZIDE 25MG TAB

39

CARBAGLU 200MG TAB FOR ORAL SUSP

74

carbamazepine 100mg chew tab

22

carbamazepine 100mg er cap

22

carbamazepine 100mg er tab

22


22


22

carbamazepine 200mg tab

22

carbamazepine 20mg/ml susp

22


23


23

carbidopa 10mg/levodopa 100mg odt

48

carbidopa 10mg/levodopa 100mg tab

48

CARBIDOPA 12.5MG/ENTACAPONE 200MG/LEVODOPA 50MG TAB

49


49

carbidopa 25mg tab 49 CARBIDOPA 25MG/ENTACAPONE 200MG/LEVODOPA 100MG TAB

49

carbidopa 25mg/levodopa 100mg er tab

48


48


48


48


49


49


49

CARBIDOPA 50MG/ENTACAPONE 200MG/LEVODOPA 200MG TAB

49

carbidopa 50mg/levodopa 200mg er tab

48

carisoprodol 350mg tab 86 CARTEOLOL 1% OPHTH SOLN

88

cartia 120mg er cap 59 cartia 180mg er cap 59 cartia 240mg er cap 59 cartia 300mg er cap 59 carvedilol 12.5mg tab 57 carvedilol 25mg tab 57 carvedilol 3.125mg tab 57 carvedilol 6.25mg tab 57 caspofungin acetate 50mg inj

33

caspofungin acetate 70mg inj

33

CAYSTON 75MG INH SOLN

41

caziant 28 day pack 63 cefaclor 250mg cap 62 cefaclor 500mg cap 62 cefadroxil 1000mg tab 62 cefadroxil 100mg/ml susp 62 cefadroxil 500mg cap 62 cefadroxil 50mg/ml susp 62 cefazolin 1000mg inj 62 cefazolin 200mg/ml inj 62 cefazolin 500mg inj 62 cefdinir 25mg/ml susp 62 cefdinir 300mg cap 62 cefdinir 50mg/ml susp 62 cefepime 1000mg inj 63 cefepime 2000mg inj 63 cefixime 20mg/ml susp 62 cefixime 400mg cap 62 cefixime 40mg/ml susp 62 cefotetan 1000mg inj 62 cefotetan 2000mg inj 62 cefoxitin 1000mg inj 62 cefoxitin 2000mg inj 62 cefoxitin 200mg/ml inj 62 cefpodoxime 100mg tab 62 cefpodoxime 10mg/ml susp

62

cefpodoxime 200mg tab 62 cefpodoxime 20mg/ml susp

62

cefprozil 250mg tab 62 cefprozil 25mg/ml susp 62 cefprozil 500mg tab 62 cefprozil 50mg/ml susp 62 ceftazidime 1000mg inj 63 ceftazidime 2000mg inj 63 ceftazidime 200mg/ml inj 63 ceftriaxone 1000mg inj 63 ceftriaxone 100mg/ml inj 63 ceftriaxone 2000mg inj 63 ceftriaxone 250mg inj 63 ceftriaxone 500mg inj 63 cefuroxime 1500mg inj 62 cefuroxime 250mg tab 62


110


cefuroxime 500mg tab 62 cefuroxime 750mg inj 62 cefuroxime 95mg/ml inj 62 celecoxib 100mg cap 11 celecoxib 200mg cap 11 celecoxib 400mg cap 11 celecoxib 50mg cap 11 CELONTIN 300MG CAP 25 cephalexin 250mg cap 62 cephalexin 25mg/ml susp 62 cephalexin 500mg cap 62 cephalexin 50mg/ml susp 62 CERDELGA 84MG CAP 80 cetirizine 1mg/ml oral soln

34

CETRAXAL 0.2% OTIC SOLN

90

cevimeline 30mg cap 86 CHANTIX 0.5MG TAB 95 CHANTIX 1MG TAB 95 CHANTIX CONTINUING MONTHS OF THERAPY 1MG PACK

95

CHANTIX FIRST MONTH OF THERAPY PACK

95

CHEMET 100MG CAP 32 CHENODAL 250MG TAB 77 chlordiazepoxide 10mg cap

17

chlordiazepoxide 25mg cap

17

chlordiazepoxide 5mg cap

17

chlorhexidine gluconate 0.12% mouthwash

86

CHLOROQUINE PHOSPHATE 250MG TAB

41

chloroquine phosphate 500mg tab

41

chlorpromazine 100mg tab

52

chlorpromazine 10mg tab 52 chlorpromazine 200mg tab

52

chlorpromazine 25mg tab 52 chlorpromazine 50mg tab 52 chlorthalidone 25mg tab 73 chlorthalidone 50mg tab 73 chlorzoxazone 500mg tab 86 CHOLBAM 250MG CAP 77 CHOLBAM 50MG CAP 77 cholestyramine resin 4gm sf powder for oral susp

34

cholestyramine resin 4gm sf powder for oral susp (sugar free)

34

ciclopirox 0.77% cream 68 ciclopirox 0.77% gel 68 ciclopirox 0.77% lotion 68 ciclopirox 1% shampoo 68 ciclopirox 8% topical soln 68 CILASTATIN 250MG/IMIPENEM 250MG INJ

40

cilastatin 500mg/imipenem 500mg inj

40

cilostazol 100mg tab 80 cilostazol 50mg tab 80 CIMDUO 300-300MG TAB

54

cimetidine 200mg tab 99 cimetidine 300mg tab 99 cimetidine 400mg tab 99 CIMETIDINE 60MG/ML ORAL SOLN

99

cimetidine 800mg tab 99 CIMZIA 200MG INJ 77 CIMZIA 200MG/ML SYRINGE

77

cinacalcet 30mg tab 74 cinacalcet 60mg tab 74 cinacalcet 90mg tab 74 CINRYZE 500UNIT INJ 79 CIPRODEX 0.3-0.1% OTIC SUSP

91

CIPROFLOXACIN 0.2% OTIC SOLN

91

ciprofloxacin 0.3% ophth soln

89

ciprofloxacin 250mg tab 77 ciprofloxacin 2mg/ml inj 77 ciprofloxacin 500mg tab 77 ciprofloxacin 750mg tab 77 citalopram 10mg tab 26 citalopram 20mg tab 26 citalopram 2mg/ml oral soln

26

citalopram 40mg tab 26 claravis 10mg cap 67 claravis 20mg cap 67 claravis 30mg cap 67 claravis 40mg cap 67 CLARINEX-D 2.5-120MG ER TAB

67

clarithromycin 250mg tab 82 CLARITHROMYCIN 25MG/ML SUSP

82

clarithromycin 500mg er tab

82

clarithromycin 500mg tab 82 CLARITHROMYCIN 50MG/ML SUSP

82

CLENPIQ 75-21.9-0.0625MG/ML ORAL SOLN

82

clindacin 1% pad 68 clindamycin 1% gel 68 clindamycin 1% lotion 68 clindamycin 1% pad 68 clindamycin 1% topical soln

68

clindamycin 12mg/ml inj 41 clindamycin 150mg cap 41 clindamycin 150mg/ml (2ml) inj

41

clindamycin 150mg/ml (4ml) inj

41

clindamycin 150mg/ml (6ml) inj

41

clindamycin 15mg/ml oral soln

41

clindamycin 18mg/ml inj 41


111


clindamycin 2% vaginal cream

101

clindamycin 300mg cap 41 clindamycin 6mg/ml inj 41 clindamycin 75mg cap 41 clindamycin/benzoyl peroxide 1-5% gel

68

CLINIMIX 4.25/10 INJ 87 CLINIMIX 4.25/5 INJ 87 CLINIMIX 5/15 INJ 87 CLINIMIX 5/20 INJ 87 CLINIMIX E 2.75/5 INJ 87 CLINIMIX E 4.25/10 INJ 87 CLINIMIX E 4.25/5 INJ 88 CLINIMIX E 5/15 INJ 88 CLINIMIX E 5/20 INJ 88 clinisol 15% inj 88 clobazam 10mg tab 22 clobazam 2.5mg/ml susp 22 clobazam 20mg tab 22 clobetasol propionate 0.05% cream

70

clobetasol propionate 0.05% e cream

70

clobetasol propionate 0.05% foam

70

clobetasol propionate 0.05% gel

70

clobetasol propionate 0.05% lotion

70

clobetasol propionate 0.05% ointment

70

clobetasol propionate 0.05% shampoo

70

clobetasol propionate 0.05% spray

70

clobetasol propionate 0.05% topical soln

70

clodan 0.05% shampoo 70 clomipramine 25mg cap 28 clomipramine 50mg cap 28 clomipramine 75mg cap 28 clonazepam 0.125mg odt 22 clonazepam 0.25mg odt 22 clonazepam 0.5mg odt 22

clonazepam 0.5mg tab 22 clonazepam 1mg odt 22 clonazepam 1mg tab 22 clonazepam 2mg odt 22 clonazepam 2mg tab 22 clonidine 0.00417mg/hr weekly patch

37

clonidine 0.00833mg/hr weekly patch

37

clonidine 0.0125mg/hr weekly patch

37

clonidine 0.1mg tab 37 clonidine 0.2mg tab 37 clonidine 0.3mg tab 37 clopidogrel 75mg tab 80 clorazepate dipotassium 15mg tab

17

clorazepate dipotassium 3.75mg tab

17

clorazepate dipotassium 7.5mg tab

17

clotrimazole 1% cream 68 clotrimazole 1% topical soln

68

clotrimazole 10mg lozenge

86

clovique 250mg cap 85 clozapine 100mg odt 51 clozapine 100mg tab 51 CLOZAPINE 12.5MG ODT

51

CLOZAPINE 150MG ODT

51

CLOZAPINE 200MG ODT

51

clozapine 200mg tab 51 clozapine 25mg odt 51 clozapine 25mg tab 51 clozapine 50mg tab 51 COARTEM 20-120MG TAB

41

CODEINE SULFATE 15MG TAB

12

codeine sulfate 30mg tab 12 codeine sulfate 60mg tab 12

colchicine 0.5mg/probenecid 500mg tab

79

colesevelam 3750mg powder for oral susp

34

colesevelam 625mg tab 34 colestipol 1000mg tab 35 colestipol 5000mg granules for oral susp

35

colistin 75mg/ml inj 41 COMBIGAN 2-5MG/ML OPHTH SOLN

88

COMBIPATCH 0.00208-0.00583MG/HR PATCH

76

COMBIPATCH 0.00208-0.0104MG/HR PATCH

76

COMBIVENT 0.1-0.02MG INH

19

COMETRIQ 100MG DAILY DOSE CARTON PACK

44


44


44

COMPLERA 200-25-300MG TAB

54

compro 25mg rectal supp 52 constulose 10gm/15ml oral soln

82

COPIKTRA 15MG CAP 44 COPIKTRA 25MG CAP 44 CORLANOR 5MG TAB 61 CORLANOR 5MG/5ML ORAL SOLN

61

CORLANOR 7.5MG TAB 61 CORTISONE ACETATE 25MG TAB

66

COTELLIC 20MG TAB 44


112


CREON 120000-76000-24000UNIT DR CAP

72


72


72

CREON 36000-114000-180000UNIT DR CAP

72


72

CRINONE 4% VAGINAL GEL

101

CRINONE 8% VAGINAL GEL

101

CRIXIVAN 200MG CAP 54 CRIXIVAN 400MG CAP 54 cromolyn sodium 20mg/ml oral soln

77

cromolyn sodium 4% ophth soln

90

cryselle 28 pack 63 cyclafem 1/35 28 day pack

63

cyclafem 7/7/7 28 day pack

63

cyclobenzaprine 10mg tab

87

cyclobenzaprine 5mg tab 87 CYCLOPHOSPHAMIDE 25MG CAP

42

CYCLOPHOSPHAMIDE 50MG CAP

42

cyclosporine 100mg cap 57 cyclosporine 25mg cap 57 cyclosporine modified 100mg cap

57

cyclosporine modified 100mg/ml oral soln

85

cyclosporine modified 25mg cap

57

cyclosporine modified 50mg cap

86

cyproheptadine 0.4mg/ml oral soln

34

cyproheptadine 4mg tab 34 cyred 28 day pack 63 CYSTAGON 150MG CAP 78 CYSTAGON 50MG CAP 79 CYSTARAN 0.44% OPHTH SOLN

90

D

dalfampridine 10mg er tab

94

DALIRESP 250MCG TAB 18 DALIRESP 500MCG TAB 19 DALVANCE 500MG INJ 41 danazol 100mg cap 15 danazol 200mg cap 15 danazol 50mg cap 15 dantrolene sodium 100mg cap

87

dantrolene sodium 25mg cap

87

dantrolene sodium 50mg cap

87

dapsone 100mg tab 41 dapsone 25mg tab 41 DAPTACEL INJ 98 daptomycin 500mg inj 40 DAURISMO 100MG TAB 43 DAURISMO 25MG TAB 43 deblitane 28 day 0.35mg pack

66

deferasirox 125mg tab for oral susp

32

deferasirox 180mg tab 32 deferasirox 250mg tab for oral susp

32

deferasirox 360mg tab 32 deferasirox 500mg tab for oral susp

32

deferasirox 90mg tab 32 DELSTRIGO 100-300-300MG TAB

54

demeclocycline 150mg tab

96

demeclocycline 300mg tab

96

DEMSER 250MG CAP 37 DENAVIR 1% CREAM 70 DEPO-PROVERA 400MG/ML INJ

43

DESCOVY 200-25MG TAB

54

desipramine 100mg tab 28 desipramine 10mg tab 28 desipramine 150mg tab 28 desipramine 25mg tab 28 desipramine 50mg tab 28 desipramine 75mg tab 28 desloratadine 5mg tab 34 desmopressin acetate 0.01mg/act nasal spray

75

desmopressin acetate 0.1mg tab

75

desmopressin acetate 0.2mg tab

75

desogestrel/ethinyl estradiol 28 day pack

63

desogestrel/ethinyl estradiol pack

63

desonide 0.05% ointment 70 desoximetasone 0.05% gel

70

desoximetasone 0.25% cream

70

desoximetasone 0.25% ointment

70

desvenlafaxine succinate 100mg er tab

27


27


27

dexamethasone 0.1mg/ml oral soln

66

dexamethasone 0.5mg tab 66 dexamethasone 0.75mg tab

66


113


dexamethasone 1.5mg tab 66 DEXAMETHASONE 1MG TAB

66

DEXAMETHASONE 1MG/ML ORAL SOLN

66

DEXAMETHASONE 2MG TAB

66

dexamethasone 4mg tab 66 dexamethasone 6mg tab 66 DEXAMETHASONE PHOSPHATE 0.1% OPHTH SOLN

89

dexamethasone/neomycin/polymyxin b 0.1% ophth ointment

89

dexamethasone/neomycin/polymyxin b 0.1% ophth susp

89

dexamethasone/tobramycin 0.3-0.1% ophth susp

89

dexmethylphenidate 10mg er cap

8

dexmethylphenidate 10mg tab

8


8

dexmethylphenidate 2.5mg tab

9


9


9


9


9


9


9

dexmethylphenidate 5mg tab

9

dextroamphetamine sulfate 10mg er cap

8

dextroamphetamine sulfate 10mg tab

8


8


8

dextroamphetamine sulfate 5mg tab

8

DIASTAT 10MG RECTAL GEL

22

DIASTAT 2.5MG RECTAL GEL

22

DIASTAT 20MG RECTAL GEL

22

diazepam 10mg tab 17 DIAZEPAM 10MG/2ML RECTAL GEL

22

DIAZEPAM 1MG/ML ORAL SOLN

17

DIAZEPAM 2.5MG/0.5ML RECTAL GEL

22

DIAZEPAM 20MG/4ML RECTAL GEL

22

diazepam 2mg tab 17 diazepam 5mg tab 17 diazepam 5mg/ml oral soln

17

diazoxide 50mg/ml susp 30 diclofenac potassium 50mg tab

11

diclofenac sodium 0.1% ophth soln

90

diclofenac sodium 1% gel 69 diclofenac sodium 1.5% topical soln

69

diclofenac sodium 100mg er tab

11

diclofenac sodium 25mg dr tab

11

diclofenac sodium 3% gel 69 diclofenac sodium 50mg dr tab

11

diclofenac sodium 50mg/misoprostol 0.2mg dr tab

11

diclofenac sodium 75mg dr tab

11

diclofenac sodium 75mg/misoprostol 0.2mg dr tab

11

dicloxacillin 250mg cap 92 dicloxacillin 500mg cap 93 dicyclomine 10mg cap 98 dicyclomine 20mg tab 99 dicyclomine 2mg/ml oral soln

99

DIDANOSINE 250MG DR CAP

54

DIDANOSINE 400MG DR CAP

54

diflunisal 500mg tab 12 digitek 0.125mg tab 60 digitek 0.25mg tab 60 digox 125mcg tab 60 digox 250mcg tab 60 digoxin 0.05mg/ml oral soln

60

digoxin 0.125mg tab 60 digoxin 0.25mg tab 60 dihydroergotamine mesylate 0.5mg/act nasal inhaler

83

DILANTIN 30MG ER CAP

25

DILT 120MG ER CAP 59 DILT 180MG ER CAP 59 DILT 240MG ER CAP 59 diltiazem 120mg er (12 hr) cap

59

diltiazem 120mg er (24 hr) cap

59

diltiazem 120mg tab 59 diltiazem 180mg er cap 59 diltiazem 240mg er cap 59 diltiazem 300mg er cap 59 diltiazem 30mg tab 59 diltiazem 360mg er cap 59


114


diltiazem 420mg er cap 59 diltiazem 60mg er cap 59 diltiazem 60mg tab 59 diltiazem 90mg er cap 59 diltiazem 90mg tab 59 DIPENTUM 250MG CAP 78 DIPHTHERIA/TETANUS TOXOID INJ

98

dipyridamole 25mg tab 80 dipyridamole 50mg tab 80 dipyridamole 75mg tab 80 disopyramide 100mg cap 17 disopyramide 150mg cap 17 disulfiram 250mg tab 93 disulfiram 500mg tab 93 DIURIL 250MG/5ML SUSP

73

divalproex sodium 125mg dr cap

25

divalproex sodium 125mg dr tab

25


25

divalproex sodium 250mg er tab

25


25

divalproex sodium 500mg er tab

25

dofetilide 0.125mg cap 18 dofetilide 0.25mg cap 18 dofetilide 0.5mg cap 18 donepezil 10mg odt 93 donepezil 10mg tab 93 donepezil 23mg tab 93 donepezil 5mg odt 93 donepezil 5mg tab 93 DOPTELET 20MG TAB 80 DOPTELET 40MG DAILY DOSE PACK

80

DOPTELET 60MG DAILY DOSE PACK

80

dorzolamide 2% ophth soln

90

dorzolamide 20mg/ml/timolol 5mg/ml ophth soln

88

dorzolamide/timolol 22.3-6.8mg/ml ophth soln (preservative-free)

88

dotti 0.025mg/24hr patch 76 dotti 0.0375mg/24hr patch

76

dotti 0.05mg/24hr patch 76 dotti 0.075mg/24hr patch 76 dotti 0.1mg/24hr patch 76 DOVATO 50-300MG TAB 54 doxazosin 1mg tab 37 doxazosin 2mg tab 37 doxazosin 4mg tab 37 doxazosin 8mg tab 37 doxepin 100mg cap 28 doxepin 10mg cap 28 doxepin 10mg/ml oral soln

28

doxepin 150mg cap 28 doxepin 25mg cap 28 doxepin 50mg cap 28 doxepin 75mg cap 28 doxercalciferol 0.0005mg cap

74

doxercalciferol 0.001mg cap

75

doxercalciferol 0.0025mg cap

75

doxy 100mg inj 96 doxycycline hyclate 100mg cap

96

doxycycline hyclate 100mg tab

96

doxycycline hyclate 20mg tab

96

doxycycline hyclate 50mg cap

96

doxycycline monohydrate 100mg cap

96

doxycycline monohydrate 100mg tab

96

doxycycline monohydrate 50mg cap

96

doxycycline monohydrate 50mg tab

96

doxycycline monohydrate 5mg/ml susp

96

doxylamine succinate 10mg/pyridoxine 10mg dr tab

33

DRIZALMA 20MG DR CAP

27


27


27


27

dronabinol 10mg cap 33 dronabinol 2.5mg cap 33 dronabinol 5mg cap 33 drospirenone 3mg/ethinyl estradiol 0.02mg/inert 1 mg pack

63

drospirenone 3mg/ethinyl estradiol 0.03mg/inert ingredients 1mg pack

63

DROXIA 200MG CAP 80 DROXIA 300MG CAP 80 DROXIA 400MG CAP 80 DULERA 0.005-0.1MG INH

19

DULERA 0.005-0.2MG INH

19

DULERA 50-5MCG INH 19 duloxetine 20mg dr cap 27 duloxetine 30mg dr cap 27 duloxetine 40mg dr cap 27 duloxetine 60mg dr cap 28 DUPIXENT 200MG/1.14ML SYRINGE

71

DUPIXENT 300MG/2ML SYRINGE

71

duramorph 0.5mg/ml inj 12 duramorph 1mg/ml inj 12


115


DUREZOL 0.05% OPHTH SUSP

89

dutasteride 0.5mg cap 79 dutasteride 0.5mg/tamsulosin 0.4mg cap

79

E

econazole nitrate 1% cream

69

EDURANT 25MG TAB 54 efavirenz 200mg cap 54 efavirenz 50mg cap 54 efavirenz 600mg tab 54 eletriptan 20mg tab 83 eletriptan 40mg tab 83 ELIGARD 22.5MG SYRINGE

43

ELIGARD 30MG SYRINGE

43

ELIGARD 45MG SYRINGE

43

ELIGARD 7.5MG SYRINGE

43

ELIQUIS 2.5MG TAB 21 ELIQUIS 30-DAY STARTER PACK 5MG

21

ELIQUIS 5MG TAB 21 ELMIRON 100MG CAP 79 eluryng 0.000625-0.005mg/hr vaginal system

66

EMCYT 140MG CAP 43 EMGALITY 100MG/ML SYRINGE

83

EMGALITY 120MG/ML AUTO-INJECTOR

83

EMGALITY 120MG/ML SYRINGE

83

emoquette pack 63 EMSAM 12MG/24HR PATCH

26

EMSAM 6MG/24HR PATCH

26

EMSAM 9MG/24HR PATCH

26

EMTRIVA 10MG/ML ORAL SOLN

54

EMTRIVA 200MG CAP 54 enalapril maleate 10mg tab

36

enalapril maleate 10mg/hydrochlorothiazide 25mg tab

39

enalapril maleate 2.5mg tab

36

enalapril maleate 20mg tab

36

enalapril maleate 5mg tab

36

enalapril maleate 5mg/hydrochlorothiazide 12.5mg tab

39

ENBREL 25MG INJ 12 ENBREL 25MG/0.5ML SYRINGE

12

ENBREL 50MG/ML AUTO-INJECTOR

12

ENBREL 50MG/ML CARTRIDGE

12

ENBREL 50MG/ML SYRINGE

12

ENDARI 5GM POWDER FOR ORAL SOLN

80

endocet 325-10mg tab 14 endocet 325-5mg tab 14 endocet 325-7.5mg tab 14 ENGERIX-B 10MCG/0.5ML SYRINGE

100

ENGERIX-B 20MCG/ML SYRINGE

100

enoxaparin sodium 100mg/ml (0.3ml) syringe

21


21


21


21

enoxaparin sodium 100mg/ml (1ml) syringe

21


21

enoxaparin sodium 150mg/ml (1ml) syringe

21

enpresse 28 day pack 63 enskyce 28 day pack 63 entacapone 200mg tab 49 entecavir 0.5mg tab 56 entecavir 1mg tab 56 ENTRESTO 24-26MG TAB

61

ENTRESTO 49-51MG TAB

61

ENTRESTO 97-103MG TAB

61

enulose 10gm/15ml oral soln

78

ENVARSUS 0.75MG ER TAB

86

ENVARSUS 1MG ER TAB 86 ENVARSUS 4MG ER TAB 86 EPIDIOLEX 100MG/ML ORAL SOLN

23

EPIDUO 0.3-2.5% GEL 68 epinastine 0.05% ophth soln

90

epinephrine 0.5mg/ml auto-injector

101

epinephrine 1mg/ml auto-injector

101

epitol 200mg tab 23 EPIVIR HBV 5MG/ML ORAL SOLN

56

eplerenone 25mg tab 40 eplerenone 50mg tab 40 EQUETRO 100MG ER CAP

50

EQUETRO 200MG ER CAP

50

EQUETRO 300MG ER CAP

50

ERAXIS 100MG INJ 33 ERAXIS 50MG INJ 33


116


ERGOLOID MESYLATES USP 1MG TAB

95

ERIVEDGE 150MG CAP 43 ERLEADA 60MG TAB 43 erlotinib 100mg tab 44 erlotinib 150mg tab 44 erlotinib 25mg tab 45 errin 28 day 0.35mg pack 66 ertapenem 1000mg inj 40 ERY 2% PAD 68 ERYTHROCIN 500MG INJ

82

erythromycin 0.5% ophth ointment

89

erythromycin 2% gel 68 erythromycin 2% topical soln

68

erythromycin 250mg dr cap

82

erythromycin 250mg tab 82 erythromycin 500mg tab 82 erythromycin ethylsuccinate 40mg/ml susp

82

erythromycin ethylsuccinate 80mg/ml susp

82

erythromycin/benzoyl peroxide 5-3% gel

68

ESBRIET 267MG CAP 96 ESBRIET 267MG TAB 96 ESBRIET 801MG TAB 96 escitalopram 10mg tab 26 escitalopram 1mg/ml oral soln

26

escitalopram 20mg tab 26 escitalopram 5mg tab 26 esomeprazole 20mg dr cap

99

esomeprazole 40mg dr cap

99

estarylla 28 day pack 64 estazolam 1mg tab 81 estazolam 2mg tab 81

estradiol 0.00104mg/hr twice weekly patch

76

estradiol 0.00104mg/hr weekly patch

76


76


76


76


76


76


76


76


76


76

estradiol 0.01% vaginal cream

101

estradiol 0.5mg tab 76 estradiol 0.5mg/norethindrone acetate 0.1mg pack

76

estradiol 1mg tab 76 estradiol 1mg/norethindrone acetate 0.5mg pack

76

estradiol 2mg tab 76 estradiol valerate 20mg/ml inj

76

estradiol valerate 40mg/ml inj

76

ESTRING 2MG VAGINAL SYSTEM

101

eszopiclone 1mg tab 81 eszopiclone 2mg tab 81 eszopiclone 3mg tab 81 ethacrynic acid 25mg tab 72 ethambutol 100mg tab 42 ethambutol 400mg tab 42

ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mg pack

76

ethinyl estradiol 0.005mg/norethindrone acetate 1mg pack

76

ethinyl estradiol 0.01mg/ethinyl estradiol 0.02mg/levonorgestrel 0.1mg 91 day pack

64

ethinyl estradiol 0.01mg/ethinyl estradiol 0.03mg/levonorgestrel 0.15mg pack

64

ethinyl estradiol 0.025mg/ferrous fumarate 75mg/norethindrone 0.8mg pack

64

ethinyl estradiol 0.025mg/inert/norgestimate 0.18mg/0.215mg/0.25mg pack

64

ethinyl estradiol 0.02mg/inert ingredients 1mg/levonorgestrel 0.1mg pack

64

ethinyl estradiol 0.02mg/norethindrone acetate 1mg pack

64

ethinyl estradiol 0.035mg/ethynodiol 1mg 28 day pack

64

ethinyl estradiol 0.035mg/ferrous fumarate 75mg/norethindrone 0.4mg pack

64

ethinyl estradiol 0.035mg/inert/norgestimate 0.18mg/0.215mg/0.25mg pack

64


117


ethinyl estradiol 0.035mg/norgestimate 0.25mg pack

64

ethinyl estradiol 0.03mg/0.04mg /inert/levonorgestrel 0.05mg/ 0.075mg pack

64

ethinyl estradiol 0.03mg/inert ingredients 1mg/levonorgestrel 0.15mg pack

64

ethinyl estradiol 0.03mg/levonorgestrel 0.15mg tab 28 day pack

64

ethinyl estradiol 0.05mg/ethynodiol 1mg/inert ingredients 1mg 28 day pack

64

ethinyl estradiol/levonorgestrel 91 day pack

64

ethosuximide 250mg cap 25 ethosuximide 50mg/ml oral soln

25

etodolac 200mg cap 11 etodolac 300mg cap 11 etodolac 400mg er tab 11 etodolac 400mg tab 11 etodolac 500mg er tab 11 etodolac 500mg tab 11 etodolac 600mg er tab 11 etonogestrel-ethinyl estradiol 0.120-0.015mg/24hr vaginal ring

66

euthyrox 100mcg tab 97 euthyrox 112mcg tab 97 euthyrox 125mcg tab 97 euthyrox 137mcg tab 97 euthyrox 150mcg tab 97 euthyrox 175mcg tab 97 euthyrox 200mcg tab 97 euthyrox 25mcg tab 97 euthyrox 50mcg tab 97 euthyrox 75mcg tab 97

euthyrox 88mcg tab 97 everolimus 0.25mg tab 86 everolimus 0.5mg tab 86 everolimus 0.75mg tab 86 everolimus 2.5mg tab 45 everolimus 5mg tab 45 everolimus 7.5mg tab 45 EVOTAZ 300-150MG TAB

54

exemestane 25mg tab 43 EXTAVIA 0.3MG INJ 94 ezetimibe 10mg tab 35

F

falmina 28 day pack 64 famciclovir 125mg tab 56 famciclovir 250mg tab 56 famciclovir 500mg tab 56 famotidine 20mg tab 99 famotidine 40mg tab 99 famotidine 8mg/ml susp 99 FANAPT 10MG TAB 50 FANAPT 12MG TAB 50 FANAPT 1MG TAB 50 FANAPT 2MG TAB 50 FANAPT 4MG TAB 50 FANAPT 6MG TAB 50 FANAPT 8MG TAB 50 FANAPT TITRATION PACK

50

FARXIGA 10MG TAB 32 FARXIGA 5MG TAB 32 FARYDAK 10MG CAP 45 FARYDAK 20MG CAP 45 FASENRA 30MG/ML AUTO-INJECTOR

18

FASENRA 30MG/ML SYRINGE

18

fayosim 91 day pack 64 febuxostat 40mg tab 79 febuxostat 80mg tab 79 felbamate 120mg/ml susp 25 felbamate 400mg tab 25 felbamate 600mg tab 25 felodipine 10mg er tab 59

felodipine 2.5mg er tab 59 felodipine 5mg er tab 59 femynor 28 day pack 64 fenofibrate 134mg cap 35 fenofibrate 145mg tab 35 FENOFIBRATE 150MG CAP

35

fenofibrate 160mg tab 35 fenofibrate 200mg cap 35 fenofibrate 48mg tab 35 FENOFIBRATE 50MG CAP

35

fenofibrate 54mg tab 35 fenofibrate 67mg cap 35 fenofibric acid 135mg dr cap

35

fenofibric acid 45mg dr cap

35

fentanyl 0.012mg/hr patch

12

fentanyl 0.025mg/hr patch

12

fentanyl 0.05mg/hr patch 12 fentanyl 0.075mg/hr patch

12

FENTANYL 0.1MG BUCCAL TAB

12

fentanyl 0.1mg/hr patch 12 FENTANYL 0.2MG BUCCAL TAB

12

fentanyl 0.2mg lozenge 12 FENTANYL 0.4MG BUCCAL TAB

12


12


12

fentanyl 0.8mg lozenge 12 fentanyl 1.2mg lozenge 12 fentanyl 1.6mg lozenge 12 FENTORA 100MCG BUCCAL TAB

12


118


FENTORA 200MCG BUCCAL TAB

12


13


13


13

FERRIPROX 1000MG TAB

32

FERRIPROX 100MG/ML ORAL SOLN

32

FERRIPROX 500MG TAB 32 FETZIMA 120MG ER CAP

28

FETZIMA 20MG ER CAP 28 FETZIMA 40MG ER CAP 28 FETZIMA 80MG ER CAP 28 FETZIMA PACK 28 FIASP 100UNIT/ML CARTRIDGE

30

FIASP 100UNIT/ML INJ 31 FIASP 100UNIT/ML PEN INJ

31

FINACEA 15% FOAM 72 finasteride 5mg tab 79 FIRMAGON 120MG INJ 43 FIRMAGON 80MG INJ 43 FIRVANQ 25MG/ML ORAL SOLN

41

FIRVANQ 50MG/ML ORAL SOLN

41

flac 0.01% otic soln 91 flavoxate 100mg tab 100 FLEBOGAMMA 5GM/50ML INJ

91

flecainide acetate 100mg tab

18


18


18

FLOVENT 100MCG/BLIST INH

19

FLOVENT 110MCG INH 19

FLOVENT 220MCG INH 19 FLOVENT 250MCG/BLIST INH

19

FLOVENT 44MCG INH 19 FLOVENT 50MCG/BLIST INH

19

fluconazole 100mg tab 34 fluconazole 10mg/ml susp 34 fluconazole 150mg tab 34 fluconazole 200mg tab 34 fluconazole 2mg/ml (100ml) inj

34

fluconazole 2mg/ml (200ml) inj

34

fluconazole 40mg/ml susp 34 fluconazole 50mg tab 34 flucytosine 250mg cap 33 flucytosine 500mg cap 33 fludrocortisone 0.1mg tab 67 FLUNISOLIDE 0.025MG/ACT NASAL INHALER

87

fluocinolone acetonide 0.01% cream

70

fluocinolone acetonide 0.01% otic soln

91

fluocinolone acetonide 0.01% topical soln

70

fluocinolone acetonide 0.025% cream

70

fluocinolone acetonide 0.025% ointment

70

fluocinolone acetonide 0.1mg/ml oil

70

fluocinonide 0.05% e cream

70

fluocinonide 0.05% gel 70 fluocinonide 0.05% ointment

70

fluocinonide 0.05% topical soln

70

fluorometholone 0.1% ophth susp

90

FLUOROPLEX 1% CREAM

69

FLUOROURACIL 2% TOPICAL SOLN

69

fluorouracil 5% cream 69 FLUOROURACIL 5% TOPICAL SOLN

69

fluoxetine 10mg cap 26 fluoxetine 10mg tab 26 fluoxetine 20mg cap 26 fluoxetine 20mg tab 26 fluoxetine 25mg/olanzapine 12mg cap

94

fluoxetine 25mg/olanzapine 3mg cap

94


94

fluoxetine 40mg cap 26 fluoxetine 4mg/ml oral soln

26


94


94

FLUPHENAZINE 0.5MG/ML ORAL SOLN

52

fluphenazine 10mg tab 52 fluphenazine 1mg tab 52 fluphenazine 2.5mg tab 53 FLUPHENAZINE 2.5MG/ML INJ

53

fluphenazine 5mg tab 53 FLUPHENAZINE 5MG/ML ORAL SOLN

53

fluphenazine decanoate 25mg/ml inj

53

FLURAZEPAM 15MG CAP

81

FLURAZEPAM 30MG CAP

81

flurbiprofen 100mg tab 11


119


FLURBIPROFEN SODIUM 0.03% OPHTH SOLN

90

flutamide 125mg cap 43 fluticasone propionate 0.005% ointment

70

fluticasone propionate 0.05% cream

70

fluticasone propionate 0.05mg/act nasal inhaler

87

fluticasone propionate 0.1mg/salmeterol 0.05mg inh

19


19


19

FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE 113-14MCG/ACT POWDER INH

19


20


20

fluvastatin 20mg cap 35 fluvastatin 40mg cap 35 fluvastatin 80mg er tab 35 fluvoxamine maleate 100mg er cap

26

fluvoxamine maleate 100mg tab

26

fluvoxamine maleate 150mg er cap

26


27


27

fondaparinux sodium 12.5mg/ml (0.4ml) syringe

21


21


21

fondaparinux sodium 5mg/ml syringe

21

FORTEO 600MCG/2.4ML PEN INJ

73

fosamprenavir 700mg tab 54 fosinopril sodium 10mg tab

36

fosinopril sodium 10mg/hydrochlorothiazide 12.5mg tab

39

fosinopril sodium 20mg tab

36

fosinopril sodium 20mg/hydrochlorothiazide 12.5mg tab

39

fosinopril sodium 40mg tab

36

FOSRENOL 1000MG ORAL POWDER

78

FOSRENOL 750MG ORAL POWDER

78

FRAGMIN 10000UNIT/ML SYRINGE

21

FRAGMIN 12500UNIT/0.5ML SYRINGE

21


21

FRAGMIN 18000UNT/0.72ML SYRINGE

21


21


21


21

FRAGMIN 95000UNIT/3.8ML INJ

21

FREAMINE 6.9% INJ 88 FULPHILA 6MG/0.6ML SYRINGE

80

furosemide 10mg/ml inj 72 furosemide 10mg/ml oral soln

73

furosemide 10mg/ml syringe

73

furosemide 20mg tab 73 furosemide 40mg tab 73 furosemide 80mg tab 73 FUROSEMIDE 8MG/ML ORAL SOLN

73

FUZEON 90MG INJ 54 fyavolv 0.0025-0.5mg tab 76 fyavolv 0.005-1mg tab 76 FYCOMPA 0.5MG/ML SUSP

21

FYCOMPA 10MG TAB 21 FYCOMPA 12MG TAB 21 FYCOMPA 2MG TAB 21 FYCOMPA 4MG TAB 21 FYCOMPA 6MG TAB 21 FYCOMPA 8MG TAB 21

G

gabapentin 100mg cap 23 gabapentin 300mg cap 23 gabapentin 400mg cap 23 gabapentin 50mg/ml oral soln

23

gabapentin 600mg tab 23 gabapentin 800mg tab 23 GALAFOLD 28 DAY WALLET 123MG PACK

75

galantamine 12mg tab 93 galantamine 4mg tab 93


120


galantamine 8mg tab 93 galantamine hydrobromide 16mg er cap

93

galantamine hydrobromide 24mg er cap

93

GALANTAMINE HYDROBROMIDE 4MG/ML ORAL SOLN

93

galantamine hydrobromide 8mg er cap

93

GAMMAGARD 10GM INJ

91

GAMMAGARD 2.5GM/25ML INJ

91

GAMMAGARD 5GM INJ 91 GAMMAKED 1GM/10ML INJ

91

GAMMAPLEX 10GM/100ML INJ

91


91


91


91

GAMUNEX 1GM/10ML INJ

91

GARDASIL 9 INJ 100 GARDASIL 9 SYRINGE 100 gatifloxacin 0.5% ophth soln

89

GATTEX 5MG INJ 78 GAUZE PADS & DRESSINGS - PADS 2 X 2

83

GAVILYTE-C ORAL SOLN

82

gavilyte-g powder for oral soln

82

gavilyte-n powder for oral soln

82

gemfibrozil 600mg tab 35

generlac 10gm/15ml oral soln

78

gengraf 100mg cap 57 gengraf 100mg/ml oral soln

57

gengraf 25mg cap 57 GENOTROPIN 0.2MG SYRINGE

74

GENOTROPIN 0.4MG SYRINGE

74


74


74


74


74


74


74

GENOTROPIN 12MG CARTRIDGE

74

GENOTROPIN 1MG SYRINGE

74

GENOTROPIN 2MG SYRINGE

74

GENOTROPIN 5MG CARTRIDGE

74

GENTAK 0.3% OPHTH OINTMENT

89

gentamicin 0.1% cream 68 gentamicin 0.1% ointment 68 gentamicin 0.3% ophth soln

89

GENTAMICIN 0.8MG/ML INJ

9

gentamicin 1.2mg/ml inj 9 GENTAMICIN 1.6MG/ML INJ

9

GENTAMICIN 1MG/ML INJ

9

gentamicin 40mg/ml inj 9

GENVOYA 150-150-200-10MG TAB

54

gianvi 28-day pack 64 GILENYA 0.5MG CAP 94 GILOTRIF 20MG TAB 45 GILOTRIF 30MG TAB 45 GILOTRIF 40MG TAB 45 GLASSIA 1000MG/50ML INJ

95

glatiramer acetate 20mg/ml syringe

94

glatiramer acetate 40mg/ml syringe

94

glatopa 20mg/ml syringe 94 glatopa 40mg/ml syringe 95 glimepiride 1mg tab 32 glimepiride 2mg tab 32 glimepiride 4mg tab 32 glipizide 10mg er tab 32 glipizide 10mg tab 32 glipizide 2.5mg er tab 32 glipizide 2.5mg/metformin 250mg tab

29

glipizide 2.5mg/metformin 500mg tab

29

glipizide 5mg er tab 32 glipizide 5mg tab 32 glipizide 5mg/metformin 500mg tab

29

GLUCAGEN 1MG INJ 30 GLUCAGON (RDNA) 1MG INJ

30

glucose 100mg/ml inj 87 GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0342 MEQ/ML INJ

84

GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0769 MEQ/ML INJ

84


121



84

glucose 50 mg/ml/potassium chloride 0.04meq/ml/sodium chloride 4.5mg/ml inj

84

glucose 50mg/ml inj 87 glucose 50mg/ml/potassium chloride 0.01 meq/ml/sodium chloride 0.0769 meq/ml inj

84

glucose 50mg/ml/potassium chloride 0.02 meq/ml inj

84

glucose 50mg/ml/potassium chloride 0.02 meq/ml/sodium chloride 0.0342 meq/ml inj

84


84

glucose 50mg/ml/potassium chloride 0.02meq/ml/sodium chloride 4.5mg/ml inj

84


84

GLUCOSE 50MG/ML/POTASSIUM CHLORIDE 0.04 MEQ/ML/SODIUM CHLORIDE 0.154 MEQ/ML INJ

84

glucose 50mg/ml/sodium chloride 0.0342 meq/ml inj

84


84

glucose 50mg/ml/sodium chloride 4.5mg/ml inj

84

glucose 50mg/ml/sodium chloride 9mg/ml inj

84

glyburide 1.25mg tab 32 glyburide 1.25mg/metformin 250mg tab

29

glyburide 1.5mg tab 32 glyburide 2.5mg tab 32 glyburide 2.5mg/metformin 500mg tab

29

glyburide 3mg tab 32 glyburide 5mg tab 32 glyburide 5mg/metformin 500mg tab

29

glyburide 6mg tab 32 glycopyrrolate 1mg tab 99 glycopyrrolate 2mg tab 99 GLYXAMBI 10-5MG TAB

29

GLYXAMBI 25-5MG TAB

29

GRAMICIDIN 0.025MG/ML/NEOMYCIN 1.75MG/ML/POLYMYXIN B 10000UNIT/ML OPHTH SOLN

89

granisetron 1mg tab 33 griseofulvin 125mg tab 33 griseofulvin 250mg tab 33 griseofulvin 25mg/ml susp

33

griseofulvin 500mg tab 33 guanfacine 1mg er tab 8 guanfacine 1mg tab 37

guanfacine 2mg er tab 8 guanfacine 2mg tab 37 guanfacine 3mg er tab 8 guanfacine 4mg er tab 8 GUANIDINE 125MG TAB 42 GVOKE 0.5MG/0.1ML AUTO-INJECTOR

30

GVOKE 0.5MG/0.1ML SYRINGE

30

GVOKE 1MG/0.2ML AUTO-INJECTOR

30

GVOKE 1MG/0.2ML SYRINGE

30

H

HAEGARDA 2000UNIT INJ

79

HAEGARDA 3000UNIT INJ

79

hailey 24 fe 28 day pack 64 halobetasol propionate 0.05% cream

71

halobetasol propionate 0.05% ointment

71

haloperidol 0.5mg tab 51 haloperidol 10mg tab 51 haloperidol 1mg tab 51 haloperidol 20mg tab 51 haloperidol 2mg tab 51 haloperidol 2mg/ml oral soln

51

haloperidol 5mg tab 51 haloperidol 5mg/ml inj 51 haloperidol decanoate 100mg/ml (1ml) inj

51

haloperidol decanoate 100mg/ml inj

51

haloperidol decanoate 50mg/ml inj

51

HAVRIX 1440ELU/ML INJ

101

HAVRIX 1440ELU/ML SYRINGE

101

HAVRIX 720ELU/0.5ML SYRINGE

101


122


heparin sodium porcine 10000unit/ml inj

21


21


21


21

HEPATAMINE 8% INJ 88 HETLIOZ 20MG CAP 82 HIBERIX 10MCG INJ 100 HUMALOG 100UNIT/ML CARTRIDGE

31

HUMALOG 100UNIT/ML INJ

31

HUMALOG 100UNIT/ML KWIKPEN SYRINGE

31

HUMALOG 200UNIT/ML PEN INJ

31

HUMALOG JR PEN INJ 31 HUMALOG MIX 25-75UNIT/ML INJ

31

HUMALOG MIX 25-75UNIT/ML PEN INJ

31

HUMALOG MIX 50-50UNIT/ML INJ

31

HUMALOG MIX 50-50UNIT/ML PEN INJ

31

HUMIRA 10MG/0.1ML SYRINGE

10


10


10


10

HUMIRA 40MG/0.4ML AUTO-INJECTOR

10


10

HUMIRA 40MG/0.8ML AUTO-INJECTOR

10


10

HUMIRA PEDIATRIC CROHN'S STARTER PACK (3) 80MG/0.8ML INJ

10

HUMIRA PEDIATRIC CROHN'S STARTER PACK SYRINGE (2) 40MG/0.4ML

10

HUMIRA PEN - CROHN'S STARTER PACK 40MG/0.8ML INJ

10

HUMIRA PEN - CROHN'S STARTER PACK 80MG/0.8ML INJ

10

HUMIRA PEN - PSORIASIS STARTER PACK 40MG/0.8ML INJ

10

HUMIRA PEN - PSORIASIS STARTER PACK 80MG/0.8ML INJ

10

HUMULIN 70-30UNIT/ML PEN INJ

31

HUMULIN R 500UNIT/ML INJ

31

HUMULIN R 500UNIT/ML PEN INJ

31

hydralazine 100mg tab 40 hydralazine 10mg tab 40 hydralazine 25mg tab 40 hydralazine 50mg tab 40 hydrochlorothiazide 12.5mg cap

73

hydrochlorothiazide 12.5mg tab

73

hydrochlorothiazide 12.5mg/irbesartan 150mg tab

39

hydrochlorothiazide 12.5mg/irbesartan 300mg tab

39

hydrochlorothiazide 12.5mg/lisinopril 10mg tab

39

hydrochlorothiazide 12.5mg/lisinopril 20mg tab

39

hydrochlorothiazide 12.5mg/losartan potassium 100mg tab

39

hydrochlorothiazide 12.5mg/losartan potassium 50mg tab

39

hydrochlorothiazide 12.5mg/olmesartan medoxomil 20mg tab

39

hydrochlorothiazide 12.5mg/olmesartan medoxomil 40mg tab

39

hydrochlorothiazide 12.5mg/quinapril 10mg tab

39

hydrochlorothiazide 12.5mg/quinapril 20mg tab

39

hydrochlorothiazide 12.5mg/valsartan 160mg tab

39


39


39

hydrochlorothiazide 15mg/methyldopa 250mg tab

39

hydrochlorothiazide 25mg tab

73

hydrochlorothiazide 25mg/lisinopril 20mg tab

39

hydrochlorothiazide 25mg/losartan potassium 100mg tab

39

hydrochlorothiazide 25mg/methyldopa 250mg tab

39


123


hydrochlorothiazide 25mg/metoprolol tartrate 100mg tab

39


39

hydrochlorothiazide 25mg/olmesartan medoxomil 40mg tab

39

hydrochlorothiazide 25mg/propranolol 40mg tab

39

hydrochlorothiazide 25mg/propranolol 80mg tab

39

hydrochlorothiazide 25mg/quinapril 20mg tab

39

hydrochlorothiazide 25mg/spironolactone 25mg tab

72

hydrochlorothiazide 25mg/triamterene 37.5mg cap

72

hydrochlorothiazide 25mg/triamterene 37.5mg tab

72

hydrochlorothiazide 25mg/valsartan 160mg tab

39

hydrochlorothiazide 25mg/valsartan 320mg tab

39

hydrochlorothiazide 50mg tab

73


39

hydrochlorothiazide 50mg/triamterene 75mg tab

72

hydrocodone bitartrate 10mg er cap

13

hydrocodone bitartrate 10mg/ibuprofen 200mg tab

14


13


13


13


13


13

hydrocodone bitartrate 5mg/ibuprofen 200mg tab

14

hydrocodone bitartrate 7.5mg/ibuprofen 200mg tab

14

hydrocortisone 1% cream 71 hydrocortisone 1.67mg/ml enema

15

hydrocortisone 10mg tab 66 hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml ophth susp

90

hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic soln

91

hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic susp

91

hydrocortisone 2.5% cream

71

hydrocortisone 2.5% lotion

71

hydrocortisone 2.5% ointment

71

hydrocortisone 20mg tab 67 hydrocortisone 5mg tab 67 hydrocortisone/pramoxine 1-1% rectal cream

15

hydromorphone 10mg/ml (1ml) inj

13

hydromorphone 10mg/ml (5ml) inj

13

hydromorphone 1mg/ml oral soln

13

hydromorphone 2mg tab 13 hydromorphone 4mg tab 13 hydromorphone 8mg tab 13 hydroxychloroquine sulfate 200mg tab

42

hydroxyurea 500mg cap 47 hydroxyzine 10mg tab 16 hydroxyzine 25mg tab 16 hydroxyzine 2mg/ml oral soln

16

hydroxyzine 50mg tab 17 HYDROXYZINE PAMOATE 100MG CAP

17

hydroxyzine pamoate 25mg cap

17

hydroxyzine pamoate 50mg cap

17

I

ibandronic acid 150mg tab

73

IBRANCE 100MG CAP 45 IBRANCE 100MG TAB 45 IBRANCE 125MG CAP 45 IBRANCE 125MG TAB 45 IBRANCE 75MG CAP 45 IBRANCE 75MG TAB 45 ibu 600mg tab 11 ibu 800mg tab 11 ibuprofen 20mg/ml susp 11 ibuprofen 400mg tab 11 ibuprofen 600mg tab 11 ibuprofen 800mg tab 11 icatibant 10mg/ml syringe 79 ICLUSIG 15MG TAB 45 ICLUSIG 45MG TAB 45 IDHIFA 100MG TAB 45 IDHIFA 50MG TAB 45 ILEVRO 0.3% OPHTH SUSP

90

imatinib 100mg tab 45 imatinib 400mg tab 45


124


IMBRUVICA 140MG CAP

45

IMBRUVICA 140MG TAB 45 IMBRUVICA 280MG TAB 45 IMBRUVICA 420MG TAB 45 IMBRUVICA 560MG TAB 45 IMBRUVICA 70MG CAP 45 imipramine 10mg tab 28 imipramine 25mg tab 28 imipramine 50mg tab 28 imipramine pamoate 100mg cap

28

imipramine pamoate 125mg cap

28


29


29

imiquimod 5% cream 71 IMOVAX 2.5UNIT/ML INJ

101

incassia 28 day 0.35mg pack

66

INCRELEX 40MG/4ML INJ

74

INCRUSE 62.5MCG/INH INH

18

indapamide 1.25mg tab 73 indapamide 2.5mg tab 73 INDOCIN 50MG RECTAL SUPP

11

indomethacin 25mg cap 11 indomethacin 50mg cap 11 indomethacin 75mg er cap

11

INFANRIX INJ 98 INGREZZA 40MG CAP 94 INGREZZA 80MG CAP 94 INLYTA 1MG TAB 45 INLYTA 5MG TAB 45 INNOPRAN 120MG ER CAP

58

INNOPRAN 80MG ER CAP

58

INREBIC 100MG CAP 45

INSULIN PEN NEEDLE 83 INSULIN SYRINGE (DISP) U-100 0.3ML

83

INSULIN SYRINGE (DISP) U-100 1/2ML

82

INSULIN SYRINGE (DISP) U-100 1ML

83

INTELENCE 100MG TAB 54 INTELENCE 200MG TAB 54 INTELENCE 25MG TAB 54 INTRALIPID 20GM/100ML INJ

87

INTRON A 10MU INJ 47 INTRON A 10MU/ML INJ 47 INTRON A 18MU INJ 47 INTRON A 50MU INJ 47 INTRON A 6000000UNIT/ML INJ

47

introvale 91 day pack 64 INVEGA 117MG/0.75ML SYRINGE

50

INVEGA 156MG/ML SYRINGE

50

INVEGA 234MG/1.5ML SYRINGE

50


50


50


50


50


50


50

INVIRASE 500MG TAB 54 IOPIDINE 1% OPHTH SOLN

88

IPOL INJ 101

ipratropium bromide 0.021mg/act nasal inhaler

87

ipratropium bromide 0.042mg/act nasal inhaler

87

ipratropium bromide 0.2mg/ml inh soln

18

ipratropium/albuterol 0.5-2.5mg/3ml inh soln

20

irbesartan 150mg tab 37 irbesartan 300mg tab 37 irbesartan 75mg tab 37 IRESSA 250MG TAB 45 ISENTRESS 100MG CHEW TAB

54

ISENTRESS 100MG GRANULES FOR ORAL SUSP

54

ISENTRESS 25MG CHEW TAB

54

ISENTRESS 400MG TAB 54 ISENTRESS 600MG TAB 54 isibloom 28 day pack 64 ISOLYTE P INJ 84 ISOLYTE S INJ 84 isoniazid 100mg tab 42 ISONIAZID 10MG/ML ORAL SOLN

42

isoniazid 300mg tab 42 ISOPROPYL ALCOHOL 0.7ML/ML PAD

83

isosorbide dinitrate 10mg tab

16


16


16


16

isosorbide mononitrate 10mg tab

16

isosorbide mononitrate 120mg er tab

16


125


isosorbide mononitrate 20mg tab

16


16


16

isotretinoin 10mg cap 68 isotretinoin 20mg cap 68 isotretinoin 30mg cap 68 isotretinoin 40mg cap 68 isradipine 2.5mg cap 59 isradipine 5mg cap 59 itraconazole 100mg cap 34 ivermectin 3mg tab 16 IXIARO 0.012MG/ML SYRINGE

101

J

JADENU 180MG GRANULES

32


32


32

JAKAFI 10MG TAB 45 JAKAFI 15MG TAB 45 JAKAFI 20MG TAB 45 JAKAFI 25MG TAB 45 JAKAFI 5MG TAB 45 jantoven 10mg tab 20 jantoven 1mg tab 20 jantoven 2.5mg tab 20 jantoven 2mg tab 20 jantoven 3mg tab 20 jantoven 4mg tab 20 jantoven 5mg tab 20 jantoven 6mg tab 20 jantoven 7.5mg tab 20 JANUMET 1000-100MG ER TAB

29

JANUMET 1000-50MG ER TAB

29

JANUMET 1000-50MG TAB

29

JANUMET 500-50MG ER TAB

29

JANUMET 500-50MG TAB

29

JANUVIA 100MG TAB 30 JANUVIA 25MG TAB 30 JANUVIA 50MG TAB 30 JARDIANCE 10MG TAB 32 JARDIANCE 25MG TAB 32 jasmiel 28 day pack 64 JENTADUETO 2.5-1000MG ER TAB

29

JENTADUETO 2.5-1000MG TAB

29


29


29

JENTADUETO 5-1000MG ER TAB

29

jinteli 0.005-1mg tab 76 juleber 28 day pack 64 JULUCA 50-25MG TAB 55 junel 1.5/30 21 day pack 64 junel 1/20 21 day pack 64 junel fe 1.5/30 28 day pack

64

junel fe 1/20 28 day pack 64 junel fe 24 1/20 28 day pack

64

JUXTAPID 10MG CAP 35 JUXTAPID 20MG CAP 35 JUXTAPID 30MG CAP 36 JUXTAPID 40MG CAP 36 JUXTAPID 5MG CAP 36 JUXTAPID 60MG CAP 36 JYNARQUE 15MG TAB 75 JYNARQUE 30MG TAB 75 JYNARQUE 45/15 THERAPY PACK

75

JYNARQUE 60/30 THERAPY PACK

75

JYNARQUE 90/30 THERAPY PACK

75

JYNARQUE TAB 15/15MG THERAPY PACK

76

JYNARQUE TAB 30/15MG THERAPY PACK

76

K

kaitlib fe 28 day pack 64 KALETRA 100-25MG TAB

55

KALETRA 200-50MG TAB

55

KALYDECO 150MG TAB 95 KALYDECO 25MG GRANULES

95

KALYDECO 50MG GRANULES

95

KALYDECO 75MG GRANULES

95

kariva 28 day pack 64 KCL/D5W/LR INJ 0.15% 84 kelnor 1/35 28 day pack 64 kelnor 1/50 28 day pack 64 ketoconazole 2% cream 69 ketoconazole 2% foam 69 ketoconazole 2% shampoo

69

ketoconazole 200mg tab 34 ketodan 2% foam 69 ketorolac tromethamine 0.4% ophth soln

90

ketorolac tromethamine 0.5% ophth soln

90

ketorolac tromethamine 10mg tab

11

KEVZARA 150MG/1.14ML AUTO-INJECTOR

10

KEVZARA 150MG/1.14ML SYRINGE

10

KEVZARA 200MG/1.14ML AUTO-INJECTOR

10


126


KEVZARA 200MG/1.14ML SYRINGE

10

KINRIX INJ 98 KINRIX PF INJ 98 kionex 15gm/60ml susp 86 KISQALI 200MG DAILY DOSE PACK

45

KISQALI 400MG DAILY DOSE PACK

45

KISQALI 600MG DAILY DOSE PACK

45

KISQALI FEMARA CO-PACK 200 PACK

44


44


44

klor-con 10meq er tab 84 klor-con 10meq micro er tab

84

KLOR-CON 15MEQ MICRO ER TAB

85

klor-con 20meq micro er tab

85

klor-con 20meq powder for oral soln

85

klor-con 8meq er tab 85 KORLYM 300MG TAB 30 KOSELUGO 10MG CAP 45 KOSELUGO 25MG CAP 45 KRINTAFEL 150MG TAB 42 K-TAB 8MEQ ER TAB 84 kurvelo pack 65 KUVAN 100MG POWDER FOR ORAL SOLN

75

KUVAN 100MG TAB 75 KUVAN 500MG POWDER FOR ORAL SOLN

75

L

labetalol 100mg tab 57 labetalol 200mg tab 57

labetalol 300mg tab 57 lactulose 667mg/ml oral soln

82

LAMICTAL XR BLUE KIT

23

LAMICTAL XR GREEN KIT

23

LAMICTAL XR ORANGE KIT

23

lamivudine 100mg tab 56 lamivudine 10mg/ml oral soln

55

lamivudine 150mg tab 55 lamivudine 150mg/zidovudine 300mg tab

55

lamivudine 300mg tab 55 lamotrigine 100mg er tab 23 lamotrigine 100mg odt 23 lamotrigine 100mg tab 23 lamotrigine 150mg tab 23 lamotrigine 200mg er tab 23 lamotrigine 200mg odt 23 lamotrigine 200mg tab 23 lamotrigine 250mg er tab 23 lamotrigine 25mg chew tab

23

lamotrigine 25mg er tab 23 lamotrigine 25mg odt 23 lamotrigine 25mg pack 23 lamotrigine 25mg tab 23 lamotrigine 300mg er tab 23 lamotrigine 50mg er tab 23 lamotrigine 50mg odt 23 lamotrigine 5mg chew tab 23 lamotrigine tab 25mg (42)/100mg (7) starter pack

23

lamotrigine tab 25mg (84)/100mg (14) starter pack

23

lansoprazole 15mg dr cap 99 lansoprazole 30mg dr cap 99 lanthanum carbonate 1000mg chew tab

78

lanthanum carbonate 500mg chew tab

78

lanthanum carbonate 750mg chew tab

78

LANTUS 100UNIT/ML INJ

31

LANTUS 100UNIT/ML PEN INJ

31

larin 1.5/30 pack 65 larin 1/20 pack 65 larin fe 1.5/30 pack 65 larin fe 1/20 pack 65 larissia 28 day pack 65 latanoprost 0.005% ophth soln

90

LATUDA 120MG TAB 50 LATUDA 20MG TAB 50 LATUDA 40MG TAB 50 LATUDA 60MG TAB 50 LATUDA 80MG TAB 50 layolis fe 28 pack 65 leena 28 day pack 65 leflunomide 10mg tab 12 leflunomide 20mg tab 12 LENVIMA 10 10MG PACK

45

LENVIMA 12 4MG PACK 45 LENVIMA 14 PACK 45 LENVIMA 18 PACK 45 LENVIMA 20 10MG PACK

45

LENVIMA 24 PACK 46 LENVIMA 4 4MG PACK 46 LENVIMA 8 4MG PACK 46 lessina 28 day pack 65 letrozole 2.5mg tab 43 LEUCOVORIN 10MG TAB

48

LEUCOVORIN 15MG TAB

48

leucovorin 25mg tab 48 leucovorin 5mg tab 48 LEUKERAN 2MG TAB 42 leuprolide acetate 5mg/ml inj

43


127


levalbuterol 0.103mg/ml inh soln

20


20


20


20

LEVEMIR 100UNIT/ML INJ

31

LEVEMIR 100UNIT/ML PEN INJ

31

levetiracetam 1000mg tab 23 levetiracetam 100mg/ml oral soln

23

levetiracetam 250mg tab 23 levetiracetam 500mg er tab

23

levetiracetam 500mg tab 23 levetiracetam 750mg er tab

23

levetiracetam 750mg tab 23 LEVOBUNOLOL 0.5% OPHTH SOLN

88

levocarnitine 100mg/ml oral soln

75

levocarnitine 330mg tab 75 levocetirizine 0.5mg/ml oral soln

34

levocetirizine 5mg tab 34 levofloxacin 0.5% ophth soln

89

levofloxacin 250mg tab 77 levofloxacin 25mg/ml inj 77 levofloxacin 25mg/ml oral soln

77

levofloxacin 500mg tab 77 levofloxacin 5mg/ml (100ml) inj

77

levofloxacin 5mg/ml (150ml) inj

77

levofloxacin 750mg tab 77 levonest 28 day pack 65 levora 0.15/30 28 day pack

65

levo-t 100mcg tab 97 levo-t 112mcg tab 97 levo-t 125mcg tab 97 levo-t 137mcg tab 97 levo-t 150mcg tab 97 levo-t 175mcg tab 97 levo-t 200mcg tab 97 levo-t 25mcg tab 97 levo-t 300mcg tab 97 levo-t 50mcg tab 97 levo-t 75mcg tab 97 levo-t 88mcg tab 97 levothyroxine sodium 0.025mg tab

97

levothyroxine sodium 0.05mg tab

97


97


97


97


97


97


97


97


97


97


97

levoxyl 100mcg tab 97 levoxyl 112mcg tab 97 levoxyl 125mcg tab 97 levoxyl 137mcg tab 97 levoxyl 150mcg tab 97 levoxyl 175mcg tab 97 levoxyl 200mcg tab 97 levoxyl 25mcg tab 97 levoxyl 50mcg tab 97

levoxyl 75mcg tab 98 levoxyl 88mcg tab 98 LEXIVA 50MG/ML SUSP 55 LIDOCAINE 2% GEL 71 lidocaine 2% topical soln 86 lidocaine 4% topical soln 71 lidocaine 5% ointment 71 lidocaine 5% patch 71 lidocaine/prilocaine 2.5-2.5% cream

71

lindane 1% shampoo 72 linezolid 20mg/ml susp 41 linezolid 2mg/ml inj 41 linezolid 600mg tab 41 liothyronine sodium 0.005mg tab

98

liothyronine sodium 0.025mg tab

98

liothyronine sodium 0.05mg tab

98

lisinopril 10mg tab 36 lisinopril 2.5mg tab 36 lisinopril 20mg tab 36 lisinopril 30mg tab 36 lisinopril 40mg tab 36 lisinopril 5mg tab 36 lithium carbonate 150mg cap

49

lithium carbonate 300mg cap

49

lithium carbonate 300mg er tab

49

lithium carbonate 300mg tab

50

lithium carbonate 450mg er tab

50

lithium carbonate 600mg cap

50

lithium citrate 60mg/ml oral soln

50

LITHOSTAT 250MG TAB 79 LOKELMA 10GM POWDER FOR ORAL SUSP

86


128


LOKELMA 5GM POWDER FOR ORAL SUSP

86

LONHALA 25MCG/ML INH SOLN

18

LONSURF 6.14-15MG TAB

44

LONSURF 8.19-20MG TAB

44

loperamide 2mg cap 32 lopinavir 80mg/ml/ritonavir 20mg/ml oral solution

55

lopreeza 1/0.5mg 28 day pack

76

lorazepam 0.5mg tab 17 lorazepam 1mg tab 17 lorazepam 2mg tab 17 lorazepam 2mg/ml oral soln

17

LORBRENA 100MG TAB 46 LORBRENA 25MG TAB 46 lorcet 325-10mg tab 14 lorcet 325-5mg tab 14 lorcet 325-7.5mg tab 14 loryna 28 day pack 65 losartan potassium 100mg tab

37

losartan potassium 25mg tab

37

losartan potassium 50mg tab

37

LOTEMAX 0.5% OPHTH GEL

90

LOTEMAX 0.5% OPHTH OINTMENT

90

loteprednol etabonate 0.5% ophth susp

90

lovastatin 10mg tab 35 lovastatin 20mg tab 35 lovastatin 40mg tab 35 low-ogestrel 28 day pack 65 loxapine 10mg cap 51 loxapine 25mg cap 51 loxapine 50mg cap 52

loxapine 5mg cap 52 LUMIGAN 0.01% OPHTH SOLN

90

LUPANETA PACK 1-MONTH PACK

74

LUPANETA PACK 3-MONTH PACK

74

LUPRON 11.25MG SYRINGE

43


43


43

LUPRON 30MG SYRINGE

43

LUPRON 45MG SYRINGE

43


43

lutera 28 day pack 65 LYNPARZA 100MG TAB 46 LYNPARZA 150MG TAB 46 LYSODREN 500MG TAB 43 lyza 0.35mg pack 66

M

magnesium sulfate 500mg/ml inj

84

magnesium sulfate 500mg/ml syringe

84

malathion 0.5% lotion 72 MAPROTILINE 25MG TAB

26

MAPROTILINE 50MG TAB

26

MAPROTILINE 75MG TAB

26

marlissa 28 day pack 65 MARPLAN 10MG TAB 26 MATULANE 50MG CAP 47 matzim 180mg er tab 59 matzim 240mg er tab 59 matzim 300mg er tab 59 matzim 360mg er tab 59 matzim 420mg er tab 59

MAVYRET 100-40MG TAB

56

MAXIDEX 0.1% OPHTH SUSP

90

MAYZENT 0.25MG TAB 95 MAYZENT 2MG TAB 95 meclizine 12.5mg tab 33 meclizine 25mg tab 33 MEDROL 2MG TAB 67 medroxyprogesterone acetate 10mg tab

93

medroxyprogesterone acetate 150mg/ml inj

66

medroxyprogesterone acetate 150mg/ml syringe

66

medroxyprogesterone acetate 2.5mg tab

93

medroxyprogesterone acetate 5mg tab

93

MEFLOQUINE 250MG TAB

42

megestrol acetate 125mg/ml susp

93

megestrol acetate 20mg tab

43

megestrol acetate 40mg tab

43

megestrol acetate 40mg/ml susp

43

MEKINIST 0.5MG TAB 46 MEKINIST 2MG TAB 46 MEKTOVI 15MG TAB 46 meloxicam 15mg tab 11 meloxicam 7.5mg tab 11 memantine 10mg tab 93 memantine 10mg/memantine 5mg pack

93

memantine 14mg er cap 93 memantine 21mg er cap 93 memantine 28mg er cap 93 memantine 2mg/ml oral soln

93

memantine 5mg tab 93 memantine 7mg er cap 94


129


MENACTRA INJ 100 MENVEO INJ 100 mercaptopurine 50mg tab 42 meropenem 1000mg inj 40 meropenem 500mg inj 40 mesalamine 1000mg rectal supp

78

mesalamine 1200mg dr tab

78

mesalamine 375mg er cap 78 mesalamine 400mg dr cap 78 mesalamine 66.7mg/ml enema

78

mesalamine 800mg dr tab 78 MESNEX 400MG TAB 48 METAPROTERENOL SULFATE 2MG/ML ORAL SOLN

20

METAXALONE 400MG TAB

87

metaxalone 800mg tab 87 metformin 1000mg tab 30 metformin 500mg er tab 30 metformin 500mg tab 30 metformin 750mg er tab 30 metformin 850mg tab 30 methadone 10mg tab 13 methadone 5mg tab 13 methazolamide 25mg tab 72 methazolamide 50mg tab 72 methenamine hippurate 1000mg tab

99

methimazole 10mg tab 96 methimazole 5mg tab 96 methocarbamol 500mg tab

87

methocarbamol 750mg tab

87

methotrexate 2.5mg tab 42 methotrexate 25mg/ml (2ml) inj

42

methotrexate 25mg/ml inj 42 methoxsalen 10mg cap 69 METHSCOPOLAMINE BROMIDE 2.5MG TAB

99

METHSCOPOLAMINE BROMIDE 5MG TAB

99

methyldopa 250mg tab 37 methyldopa 500mg tab 37 methylphenidate 10mg cr cap

9

methylphenidate 10mg er tab

9

methylphenidate 10mg la cap

9

methylphenidate 10mg tab

9

METHYLPHENIDATE 18MG ER TAB

9


9

methylphenidate 1mg/ml oral soln

9

methylphenidate 20mg cr cap

9


9


9

methylphenidate 20mg tab

9

methylphenidate 27mg sr tab

9

methylphenidate 2mg/ml oral soln

9


9


9


9


9


9


9


9

methylphenidate 5mg tab 9


9

methylprednisolone 16mg tab

67


67

methylprednisolone 4mg pack

67


67


67

metoclopramide 10mg tab 77 metoclopramide 1mg/ml oral soln

77

metoclopramide 5mg tab 77 metolazone 10mg tab 73 metolazone 2.5mg tab 73 metolazone 5mg tab 73 metoprolol succinate 100mg er tab

58

metoprolol succinate 200mg er tab

58


58


58

metoprolol tartrate 100mg tab

58


58


58

metronidazole 0.75% cream

72

metronidazole 0.75% gel 72 metronidazole 0.75% lotion

72

metronidazole 0.75% vaginal gel

101

metronidazole 1% gel 72 metronidazole 250mg tab 40 metronidazole 375mg cap 40 metronidazole 500mg tab 40 metronidazole 5mg/ml inj 40


130


mexiletine 150mg cap 17 mexiletine 200mg cap 18 mexiletine 250mg cap 18 micafungin sodium 100mg inj

33

micafungin sodium 50mg inj

33

microgestin 1.5/30 21 day pack

65

microgestin 1/20 21 day pack

65

microgestin fe 1.5/30 28 day pack

65

microgestin fe 1/20 28 day pack

65

midodrine 10mg tab 102 midodrine 2.5mg tab 102 midodrine 5mg tab 102 miglitol 100mg tab 29 miglitol 25mg tab 29 miglitol 50mg tab 29 miglustat 100mg cap 80 mili 28 day pack 65 mimvey pack 76 minitran 0.1mg/hr patch 16 minitran 0.2mg/hr patch 16 minitran 0.4mg/hr patch 16 minitran 0.6mg/hr patch 16 minocycline 100mg cap 96 minocycline 100mg tab 96 minocycline 50mg cap 96 minocycline 50mg tab 96 minocycline 75mg cap 96 minocycline 75mg tab 96 minoxidil 10mg tab 40 minoxidil 2.5mg tab 40 mirtazapine 15mg odt 26 mirtazapine 15mg tab 26 mirtazapine 30mg odt 26 mirtazapine 30mg tab 26 mirtazapine 45mg odt 26 mirtazapine 45mg tab 26 mirtazapine 7.5mg tab 26 misoprostol 0.1mg tab 99 misoprostol 0.2mg tab 99

MITIGARE 0.6MG CAP 79 M-M-R II INJ 101 modafinil 100mg tab 9 modafinil 200mg tab 9 moexipril 15mg tab 36 moexipril 7.5mg tab 36 MOLINDONE 10MG TAB 52 MOLINDONE 25MG TAB 52 MOLINDONE 5MG TAB 52 mometasone furoate 0.1% cream

71

mometasone furoate 0.1% lotion

71

mometasone furoate 0.1% ointment

71

mondoxyne 100mg cap 96 montelukast 10mg tab 18 montelukast 4mg chew tab

18

montelukast 4mg granules

18

montelukast 5mg chew tab

18

morphine sulfate 100mg er tab

13


13

morphine sulfate 15mg tab

13


13

morphine sulfate 20mg/ml oral soln

13


13


13

morphine sulfate 30mg tab

13


13


13

MOVANTIK 12.5MG TAB 78 MOVANTIK 25MG TAB 78

moxifloxacin 0.5% ophth soln

89

moxifloxacin 1.6mg/ml inj 77 moxifloxacin 400mg tab 77 MULTAQ 400MG TAB 18 mupirocin 2% ointment 68 mycophenolate mofetil 200mg/ml susp

57

mycophenolate mofetil 250mg cap

57

mycophenolate mofetil 500mg tab

57

mycophenolic acid 180mg dr tab

86

mycophenolic acid 360mg dr tab

86

myorisan 10mg cap 68 myorisan 20mg cap 68 myorisan 30mg cap 68 myorisan 40mg cap 68 MYRBETRIQ 25MG ER TAB

100

MYRBETRIQ 50MG ER TAB

100

N

nabumetone 500mg tab 11 nabumetone 750mg tab 11 nadolol 20mg tab 58 nadolol 40mg tab 58 nadolol 80mg tab 58 nafcillin 1000mg inj 93 nafcillin 100mg/ml inj 93 nafcillin 2000mg inj 93 naftifine 1% cream 69 naftifine 2% cream 69 NALOXONE 0.4MG/ML CARTRIDGE

32

naloxone 0.4mg/ml inj 32 naloxone 1mg/ml syringe 32 naltrexone 50mg tab 32 naproxen 250mg tab 11 naproxen 375mg dr tab 11 naproxen 375mg tab 11 naproxen 500mg dr tab 11


131


naproxen 500mg tab 11 naproxen sodium 275mg tab

11

naproxen sodium 550mg tab

11

naratriptan 1mg tab 83 naratriptan 2.5mg tab 83 NARCAN 4MG/0.1ML NASAL SPRAY

32

NATACYN 5% OPHTH SUSP

89

NATAZIA 28 DAY PACK 65 nateglinide 120mg tab 31 nateglinide 60mg tab 31 NATPARA 100MCG CARTRIDGE

73

NATPARA 25MCG CARTRIDGE

73


73


73

NAYZILAM 5MG/0.1ML NASAL SPRAY

22

necon 0.5/35 28 day pack 65 NEEDLES INSULIN DISP. SAFETY

83

NEFAZODONE 100MG TAB

27


27


27


27

NEFAZODONE 50MG TAB

27

neomycin sulfate 500mg tab

9

neomycin/bacitracin/polymyxin ophth ointment 5(3.5)mg-400unit-10000unit

89

neomycin/polymyxin/bacitracin/hydrocortisone ophth ointmentment 1%

90

NEPHRAMINE 5.4% INJ 88 NERLYNX 40MG TAB 46 NEUPRO 1MG/24HR PATCH

48

NEUPRO 2MG/24HR PATCH

48


48


48


48


48

NEVANAC 0.1% OPHTH SUSP

90

NEVIRAPINE 100MG ER TAB

55

nevirapine 10mg/ml susp 55 nevirapine 200mg tab 55 nevirapine 400mg er tab 55 NEXAVAR 200MG TAB 46 niacin 1000mg er tab 36 niacin 500mg er tab 36 niacin 750mg er tab 36 nicardipine 20mg cap 59 nicardipine 30mg cap 59 NICOTROL 10MG INH SOLN

95

NICOTROL 10MG/ML NASAL INHALER

95

nifedipine 30mg er tab 59 nifedipine 30mg osmotic er tab

59


59


59

nikki 28 day pack 65 nilutamide 150mg tab 43

nimodipine 30mg cap 59 NINLARO 2.3MG CAP 46 NINLARO 3MG CAP 46 NINLARO 4MG CAP 46 nisoldipine 17mg er tab 59 nisoldipine 20mg er tab 59 NISOLDIPINE 25.5MG ER TAB

59

nisoldipine 30mg er tab 59 nisoldipine 34mg er tab 59 nisoldipine 40mg er tab 60 nisoldipine 8.5mg er tab 60 nitisinone 10mg cap 75 nitisinone 2mg cap 75 nitisinone 5mg cap 75 NITRO-BID 2% OINTMENT

16

NITRO-DUR 0.3MG/HR PATCH

16

NITRO-DUR 0.8MG/HR PATCH

16

nitrofurantoin macro 25mg/nitrofurantoin mono 75mg cap

100

nitrofurantoin macrocrystals 100mg cap

100

nitrofurantoin macrocrystals 50mg cap

100

nitroglycerin 0.1mg/hr patch

16


16

nitroglycerin 0.3mg sl tab 16 nitroglycerin 0.4mg sl tab 16 nitroglycerin 0.4mg/act spray

16


16

nitroglycerin 0.6mg sl tab 16 nitroglycerin 0.6mg/hr patch

16

NIVESTYM 300MCG/0.5ML SYRINGE

80


132


NIVESTYM 300MCG/ML INJ

80

NIVESTYM 480MCG/0.8ML SYRINGE

81

NIVESTYM 480MCG/1.6ML INJ

81

nizatidine 150mg cap 99 nizatidine 300mg cap 99 nora-be 28 day 0.35mg pack

66

norethindrone 0.35mg pack

66

norethindrone acetate 5mg tab

93

NORMOSOL-M INJ 84 NORMOSOL-R INJ 84 NORPACE 100MG ER CAP

17

NORPACE 150MG ER CAP

17

NORTHERA 100MG CAP 102 NORTHERA 200MG CAP 102 NORTHERA 300MG CAP 102 nortrel 0.5/35 28 day pack

65

nortrel 1/35 21 day pack 65 nortrel 1/35 28 day pack 65 nortrel 7/7/7 28 day pack 65 nortriptyline 10mg cap 29 nortriptyline 25mg cap 29 NORTRIPTYLINE 2MG/ML ORAL SOLN

29

nortriptyline 50mg cap 29 nortriptyline 75mg cap 29 NORVIR 100MG ORAL POWDER

55

NORVIR 80MG/ML ORAL SOLN

55

NOURIANZ 20MG TAB 49 NOURIANZ 40MG TAB 49 NOVOLIN 70-30UNIT/ML INJ

31

NOVOLIN N 100UNIT/ML INJ

31

NOVOLIN N 100UNIT/ML PEN INJ

31

NOVOLIN R 100UNIT/ML INJ

31

NOVOLIN R 100UNIT/ML PEN INJ

31

NOVOLOG 100UNIT/ML CARTRIDGE

31

NOVOLOG 100UNIT/ML INJ

31

NOVOLOG 100UNIT/ML PEN INJ

31

NOVOLOG MIX 70-30UNIT/ML INJ

31

NOVOLOG MIX 70-30UNIT/ML PEN INJ

31

NOXAFIL 40MG/ML SUSP

34

NUBEQA 300MG TAB 43 NUCALA 100MG INJ 18 NUCALA 100MG/ML AUTO-INJECTOR

18

NUCALA 100MG/ML SYRINGE

18

NUCYNTA 100MG ER TAB

13


13


13


13

NUCYNTA 50MG ER TAB

13

NUEDEXTA 20-10MG CAP

95

NUPLAZID 10MG TAB 50 NUPLAZID 34MG CAP 50 NUTRILIPID 20GM/100ML INJ

87

NUZYRA 150MG TAB 96 nyamyc 100000unit/gm topical powder

69

nystatin 100000unit/ml cream

69

nystatin 100000unit/ml susp

86

nystatin 100unit/mg ointment

69

nystatin 100unit/mg topical powder

69

nystatin 500000unit tab 33 nystop 100000unit/gm topical powder

69

O

OCALIVA 10MG TAB 77 OCALIVA 5MG TAB 77 ocella 28 day pack 65 OCTAGAM 1GM/20ML INJ

91

OCTAGAM 2GM/20ML INJ

91

octreotide 0.05mg/ml inj 75 octreotide 0.1mg/ml inj 75 octreotide 0.2mg/ml inj 75 octreotide 0.5mg/ml inj 75 octreotide 1mg/ml inj 75 ODEFSEY 200-25-25MG TAB

55

ODOMZO 200MG CAP 43 OFEV 100MG CAP 96 OFEV 150MG CAP 96 ofloxacin 0.3% ophth soln 89 ofloxacin 0.3% otic soln 91 ofloxacin 400mg tab 77 olanzapine 10mg inj 52 olanzapine 10mg odt 52 olanzapine 10mg tab 52 olanzapine 15mg odt 52 olanzapine 15mg tab 52 olanzapine 2.5mg tab 52 olanzapine 20mg odt 52 olanzapine 20mg tab 52 olanzapine 5mg odt 52 olanzapine 5mg tab 52 olanzapine 7.5mg tab 52 olmesartan medoxomil 20mg tab

37


133


olmesartan medoxomil 40mg tab

37

olmesartan medoxomil 5mg tab

37

olopatadine 0.1% ophth soln

90

olopatadine 0.2% ophth soln

90

olopatadine 0.665mg/act nasal inhaler

87

OLUMIANT 1MG TAB 10 OLUMIANT 2MG TAB 10 omega-3 acid ethyl esters (usp) 1000mg cap

34

omeprazole 10mg dr cap 99 omeprazole 20mg dr cap 99 omeprazole 40mg dr cap 99 ondansetron 0.8mg/ml oral soln

33

ONDANSETRON 24MG TAB

33

ondansetron 4mg odt 33 ondansetron 4mg tab 33 ondansetron 8mg odt 33 ondansetron 8mg tab 33 OPSUMIT 10MG TAB 61 ORENCIA 125MG/ML AUTO-INJECTOR

12

ORENCIA 125MG/ML SYRINGE

12

ORENCIA 50MG/0.4ML SYRINGE

12

ORENCIA 87.5MG/0.7ML SYRINGE

12

ORENITRAM 0.125MG ER TAB

61


61

ORENITRAM 1MG ER TAB

61


61

ORENITRAM 5MG ER TAB

61

ORFADIN 20MG CAP 75

ORFADIN 4MG/ML SUSP

75

ORILISSA 150MG TAB 74 ORILISSA 200MG TAB 74 ORKAMBI 125-100MG GRANULES

95

ORKAMBI 125-100MG TAB

95

ORKAMBI 125-200MG TAB

96

ORKAMBI 188-150MG GRANULES

96

orphenadrine citrate 100mg er tab

87

orsythia 28 day pack 65 oseltamivir 30mg cap 56 oseltamivir 45mg cap 56 oseltamivir 6mg/ml susp 56 oseltamivir 75mg cap 57 OSPHENA 60MG TAB 74 OTEZLA 28-DAY STARTER PACK

12

OTEZLA 30MG TAB 12 oxacillin 1000mg inj 93 oxacillin 100mg/ml inj 93 oxacillin 2000mg inj 93 OXACILLIN 20MG/ML INJ

93

OXACILLIN 40MG/ML INJ

93

oxandrolone 10mg tab 15 oxandrolone 2.5mg tab 15 oxaprozin 600mg tab 11 OXAZEPAM 10MG CAP 17 OXAZEPAM 15MG CAP 17 OXAZEPAM 30MG CAP 17 OXBRYTA 500MG TAB 80 oxcarbazepine 150mg tab 23 oxcarbazepine 300mg tab 23 oxcarbazepine 600mg tab 23 oxcarbazepine 60mg/ml susp

23

OXERVATE 0.002% OPHTH SOLN

89

OXTELLAR 150MG ER TAB

23


23


23

oxybutynin chloride 10mg er tab

100


100

oxybutynin chloride 1mg/ml oral soln

100


100

oxybutynin chloride 5mg tab

100

oxycodone 10mg tab 13 oxycodone 15mg tab 13 oxycodone 1mg/ml oral soln

13

oxycodone 20mg tab 13 oxycodone 20mg/ml oral soln

13

oxycodone 30mg tab 13 oxycodone 5mg cap 13 oxycodone 5mg tab 13 oxymorphone 10mg tab 13 oxymorphone 5mg tab 13 OZEMPIC 2MG/1.5ML PEN INJ

30

OZEMPIC 2MG/1.5ML PEN INJ (1MG DOSE)

30

P

pacerone 200mg tab 18 pacerone 400mg tab 18 paliperidone 1.5mg er tab 50 paliperidone 3mg er tab 50 paliperidone 6mg er tab 51 paliperidone 9mg er tab 51 PALYNZIQ 10MG/0.5ML SYRINGE

75

PALYNZIQ 2.5MG/0.5ML SYRINGE

75


134


PALYNZIQ 20MG/ML SYRINGE

75

pantoprazole 20mg dr tab 99 pantoprazole 40mg dr tab 99 PANZYGA 10GM/100ML INJ

91

PANZYGA 1GM/10ML INJ

91

PANZYGA 2.5GM/25ML INJ

91


91


91


91

paricalcitol 0.001mg cap 75 paricalcitol 0.002mg cap 75 paricalcitol 0.004mg cap 75 PAROMOMYCIN 250MG CAP

9

paroxetine 10mg tab 27 paroxetine 12.5mg er tab 27 paroxetine 20mg tab 27 paroxetine 25mg er tab 27 paroxetine 30mg tab 27 paroxetine 37.5mg er tab 27 paroxetine 40mg tab 27 PASER D/R 4GM GRANULES

42

PAXIL 10MG/5ML SUSP 27 PEDIARIX INJ 98 PEDVAXHIB 7.5MCG/0.5ML INJ

100

peg 3350/electrolyte oral soln

82

peg 3350/kcl/sodium bicarbonate/sodium chloride powder for oral soln

82

PEGANONE 250MG TAB 25 PEGASYS 180MCG/0.5ML AUTO-INJECTOR

56

PEGASYS 180MCG/0.5ML SYRINGE

56

PEGASYS 180MCG/ML INJ

56

PEMAZYRE 13.5MG TAB 46 PEMAZYRE 4.5MG TAB 46 PEMAZYRE 9MG TAB 46 penicillamine 250mg tab 85 penicillin g potassium 1000000unit/ml inj

92

PENICILLIN G POTASSIUM 40000UNIT/ML INJ

92

PENICILLIN G POTASSIUM 60000UNIT/ML INJ

92

PENICILLIN G PROCAINE 600000UNIT/ML SYRINGE

92

PENICILLIN G SODIUM 100000UNIT/ML INJ

92

penicillin v potassium 250mg tab

92

PENICILLIN V POTASSIUM 25MG/ML ORAL SOLN

92

penicillin v potassium 500mg tab

92

PENICILLIN V POTASSIUM 50MG/ML ORAL SOLN

92

pentamidine isethionate 300mg inj

40

pentamidine isethionate 50mg/ml inh soln

40

pentoxifylline 400mg er tab

79

perindopril erbumine 2mg tab

36


36


36

permethrin 5% cream 72 perphenazine 16mg tab 53 perphenazine 2mg tab 53 perphenazine 4mg tab 53 perphenazine 8mg tab 53 PERSERIS 120MG SYRINGE

51

PERSERIS 90MG SYRINGE

51

PEXEVA 10MG TAB 27 PEXEVA 20MG TAB 27 PEXEVA 30MG TAB 27 PEXEVA 40MG TAB 27 phenelzine 15mg tab 26 phenobarbital 100mg tab 81 phenobarbital 15mg tab 81 phenobarbital 16.2mg tab 81 phenobarbital 30mg tab 81 phenobarbital 32.4mg tab 81 phenobarbital 4mg/ml oral soln

81

phenobarbital 60mg tab 81 phenobarbital 64.8mg tab 81 phenobarbital 97.2mg tab 81 phenoxybenzamine 10mg cap

37

PHENYLEPHRINE 1MG/ML/PROMETHAZINE 1.25MG/ML ORAL SOLN

67

phenytoin 25mg/ml susp 25 phenytoin 50mg chew tab 25 phenytoin sodium 100mg er cap

25

phenytoin sodium 200mg er cap

25

phenytoin sodium 300mg er cap

25

PHOSLYRA 667MG/5ML ORAL SOLN

78

PHOSPHOLINE IODIDE 0.125% OPHTH SOLN

88

PICATO 0.015% GEL 69 PICATO 0.05% GEL 69 PIFELTRO 100MG TAB 55


135


pilocarpine 1% ophth soln

88


88


88

pilocarpine 5mg tab 86 pilocarpine 7.5mg tab 86 pimecrolimus 1% cream 71 PIMOZIDE 1MG TAB 95 PIMOZIDE 2MG TAB 95 pimtrea pack 65 pindolol 10mg tab 58 pindolol 5mg tab 58 pioglitazone 15mg tab 31 pioglitazone 30mg tab 31 pioglitazone 45mg tab 31 piperacillin 2000mg/tazobactam 250mg inj

92

piperacillin 200mg/ml/tazobactam 25mg/ml inj

92

piperacillin 3000mg/tazobactam 375mg inj

92

piperacillin 4000mg/tazobactam 500mg inj

92

PIQRAY 200MG DAILY DOSE PACK

46

PIQRAY 250MG DAILY DOSE PACK

46

PIQRAY 300MG DAILY DOSE 150MG PACK

46

pirmella 1/35 28 day pack 65 piroxicam 10mg cap 11 piroxicam 20mg cap 11 PLASMA-LYTE 148 INJ 84 PLASMALYTE A INJ 84 PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR

95

PLEGRIDY 125MCG/0.5ML SYRINGE

95

PLEGRIDY PEN STARTER PACK

95

PLEGRIDY STARTER PACK

95

plenamine 15% inj 88 podofilox 0.5% topical soln

71

polymyxin b 10000unit/ml/trimethoprim 1mg/ml ophth soln

89

polymyxin b 250000unit/ml inj

41

POMALYST 1MG CAP 43 POMALYST 2MG CAP 43 POMALYST 3MG CAP 43 POMALYST 4MG CAP 43 portia 28 day pack 65 posaconazole 100mg dr tab

34

potassium chloride 0.02 meq/ml/sodium chloride 0.0769 meq/ml inj

84

potassium chloride 0.02 meq/ml/sodium chloride 0.154 meq/ml inj

84

POTASSIUM CHLORIDE 0.04 MEQ/ML/SODIUM CHLORIDE 0.154 MEQ/ML INJ

84

POTASSIUM CHLORIDE 0.1MEQ/ML INJ

85


85


85

potassium chloride 1.33meq/ml oral soln

85

potassium chloride 10meq er cap

85

potassium chloride 10meq er tab

85

potassium chloride 10meq micro er tab

85

potassium chloride 2.67meq/ml oral soln

85


85

potassium chloride 20meq micro er tab

85

potassium chloride 20meq powder for oral soln

85

potassium chloride 2meq/ml (20ml) inj

85

potassium chloride 2meq/ml inj

85

potassium chloride 8meq er cap

85


85

potassium citrate 10meq er tab

78


78


78

PRADAXA 110MG CAP 21 PRADAXA 150MG CAP 21 PRADAXA 75MG CAP 21 PRALUENT 150MG/ML AUTO-INJECTOR

36

PRALUENT 75MG/ML AUTO-INJECTOR

36

pramipexole 0.125mg tab 48 pramipexole 0.25mg tab 48 pramipexole 0.375mg er tab

48

pramipexole 0.5mg tab 48 pramipexole 0.75mg er tab

48

pramipexole 0.75mg tab 48 pramipexole 1.5mg er tab 48 pramipexole 1.5mg tab 48 pramipexole 1mg tab 48 pramipexole 2.25mg er tab

48


136


pramipexole 3.75mg er tab

48

pramipexole 3mg er tab 48 pramipexole 4.5mg er tab 48 prasugrel 10mg tab 80 prasugrel 5mg tab 80 pravastatin sodium 10mg tab

35

pravastatin sodium 20mg tab

35


35


35

prazosin 1mg cap 37 prazosin 2mg cap 37 prazosin 5mg cap 37 PRED MILD 0.12% OPHTH SUSP

90

PRED-G 0.3-1% OPHTH SUSP

90

PREDNICARBATE 0.1% CREAM

71

PREDNICARBATE 0.1% OINTMENT

71

PREDNISOLONE 1% OPHTH SOLN

90

prednisolone 10mg odt 67 prednisolone 15mg odt 67 prednisolone 1mg/ml oral soln

67

prednisolone 30mg odt 67 PREDNISOLONE 3MG/ML ORAL SOLN

67

PREDNISOLONE ACETATE 1% OPHTH SUSP

90

PREDNISOLONE SODIUM PHOSPHATE 2.5MG/ML/SULFACETAMIDE SODIUM 100MG/ML OPHTH SOLN

90

prednisone 10mg tab 67 prednisone 1mg tab 67

PREDNISONE 1MG/ML ORAL SOLN

67

prednisone 2.5mg tab 67 prednisone 20mg tab 67 prednisone 50mg tab 67 prednisone 5mg tab 67 PREDNISONE 5MG/ML ORAL SOLN

67

pregabalin 100mg cap 24 pregabalin 150mg cap 24 pregabalin 200mg cap 24 pregabalin 20mg/ml oral soln

24

pregabalin 225mg cap 24 pregabalin 25mg cap 24 pregabalin 300mg cap 24 pregabalin 50mg cap 24 pregabalin 75mg cap 24 PREMARIN 0.3MG TAB 77 PREMARIN 0.45MG TAB 77 PREMARIN 0.625MG TAB

77

PREMARIN 0.625MG/GM VAGINAL CREAM

101

PREMARIN 0.9MG TAB 77 PREMARIN 1.25MG TAB 77 PREMASOL 10% INJ 88 PREMPHASE 28 DAY PACK

76

PREMPRO 0.3/1.5MG 28 DAY PACK

76

PREMPRO 0.45/1.5 28 DAY PACK

76

PREMPRO 0.625/2.5MG 28 DAY PACK

76

PREMPRO 0.625/5MG 28 DAY PACK

76

prevalite 4gm powder for oral susp

35

previfem 28 day pack 65 PREVYMIS 240MG TAB 56 PREVYMIS 480MG TAB 56 PREZCOBIX 150-800MG TAB

55

PREZISTA 100MG/ML SUSP

55

PREZISTA 150MG TAB 55 PREZISTA 600MG TAB 55 PREZISTA 75MG TAB 55 PREZISTA 800MG TAB 55 PRIFTIN 150MG TAB 42 PRIMAQUINE PHOSPHATE 26.3MG TAB

42

primidone 250mg tab 24 primidone 50mg tab 24 PRIVIGEN 20GM/200ML INJ

91

probenecid 500mg tab 79 PROCALAMINE 3% INJ 88 prochlorperazine 10mg tab

53

prochlorperazine 25mg rectal supp

53

prochlorperazine 5mg tab 53 procto-med 2.5% cream 15 procto-pak 1% rectal cream

15

proctosol 2.5% cream 15 proctozone hc 2.5% cream

16

progesterone 100mg cap 93 progesterone 200mg cap 93 PROGRAF 0.2MG GRANULES FOR ORAL SUSP

86

PROGRAF 1MG GRANULES FOR ORAL SUSP

86

PROLASTIN 1000MG INJ 95 PROLIA 60MG/ML SYRINGE

73

PROMACTA 12.5MG POWDER FOR ORAL SUSP

81

PROMACTA 12.5MG TAB

81


137


PROMACTA 25MG POWDER FOR ORAL SUSP

81

PROMACTA 25MG TAB 81 PROMACTA 50MG TAB 81 PROMACTA 75MG TAB 81 promethazine 1.25mg/ml oral soln

34

promethazine 12.5mg rectal supp

34

promethazine 12.5mg tab 34 promethazine 25mg rectal supp

34

promethazine 25mg tab 34 promethazine 50mg tab 34 promethegan 25mg rectal supp

34

PROMETHEGAN 50MG RECTAL SUPP

34

propafenone 150mg tab 18 propafenone 225mg er cap

18

propafenone 225mg tab 18 propafenone 300mg tab 18 propafenone 325mg er cap

18

propafenone 425mg er cap

18

proparacaine 0.5% ophth soln

89

propranolol 10mg tab 58 propranolol 120mg er cap

58

propranolol 160mg er cap

58

propranolol 20mg tab 58 propranolol 40mg tab 58 PROPRANOLOL 4MG/ML ORAL SOLN

58

propranolol 60mg er cap 58 propranolol 60mg tab 58 propranolol 80mg er cap 58 propranolol 80mg tab 58 PROPRANOLOL 8MG/ML ORAL SOLN

58

propylthiouracil 50mg tab

97

PROQUAD INJ 101 PROSOL 20% INJ 88 protriptyline 10mg tab 29 protriptyline 5mg tab 29 PULMOZYME 1MG/ML INH SOLN

96

PURIXAN 2000MG/100ML SUSP

42

PYLERA 140-125-125MG CAP

99

pyrazinamide 500mg tab 42 pyridostigmine bromide 180mg er tab

42

pyridostigmine bromide 60mg tab

42

Q

QBRELIS 1MG/ML ORAL SOLN

36

QINLOCK 50MG TAB 46 QUADRACEL INJ 98 QUDEXY 100MG ER CAP

24

QUDEXY 150MG ER CAP

24

QUDEXY 200MG ER CAP

24

QUDEXY 25MG ER CAP 24 QUDEXY 50MG ER CAP 24 quetiapine 100mg tab 52 quetiapine 150mg er tab 52 quetiapine 200mg er tab 52 quetiapine 200mg tab 52 quetiapine 25mg tab 52 quetiapine 300mg er tab 52 quetiapine 300mg tab 52 quetiapine 400mg er tab 52 quetiapine 400mg tab 52 quetiapine 50mg er tab 52 quetiapine 50mg tab 52 quinapril 10mg tab 36 quinapril 20mg tab 36 quinapril 40mg tab 36

quinapril 5mg tab 37 quinidine gluconate 324mg er tab

17

QUINIDINE SULFATE 200MG TAB

17

QUINIDINE SULFATE 300MG TAB

17

quinine sulfate 324mg cap

42

R

RABAVERT 2.5UNIT/ML INJ

101

rabeprazole sodium 20mg dr tab

99

raloxifene 60mg tab 74 ramelteon 8mg tab 82 ramipril 1.25mg cap 37 ramipril 10mg cap 37 ramipril 2.5mg cap 37 ramipril 5mg cap 37 ranolazine 1000mg er tab 16 ranolazine 500mg er tab 16 rasagiline 0.5mg tab 49 rasagiline 1mg tab 49 RAVICTI 1.1GM/ML ORAL SOLN

75

REBIF 22MCG/0.5ML AUTO-INJECTOR

95

REBIF 22MCG/0.5ML SYRINGE

95

REBIF 44MCG/0.5ML AUTO-INJECTOR

95

REBIF 44MCG/0.5ML SYRINGE

95

REBIF REBIDOSE PACK 95 REBIF TITRATION PACK 95 reclipsen 28 day pack 65 RECOMBIVAX 10MCG/ML INJ

101

RECOMBIVAX 10MCG/ML SYRINGE

101

RECOMBIVAX 40MCG/ML INJ

101


138


RECOMBIVAX 5MCG/0.5ML SYRINGE

101

RECTIV 0.4% RECTAL OINTMENT

15

REGRANEX 0.01% GEL 72 RELENZA 5MG/BLISTER INH

57

RELISTOR 12MG/0.6ML INJ

78

RELISTOR 12MG/0.6ML SYRINGE

78

RELISTOR 8MG/0.4ML SYRINGE

78

repaglinide 0.5mg tab 31 repaglinide 1mg tab 31 repaglinide 2mg tab 31 REPATHA 140MG/ML AUTO-INJECTOR

36

REPATHA 140MG/ML SYRINGE

36

REPATHA 420MG/3.5ML CARTRIDGE

36

RESTASIS 0.05% OPHTH SUSP

89

RETACRIT 10000UNIT/ML INJ

81


81


81


81


81

RETEVMO 40MG CAP 46 RETEVMO 80MG CAP 46 REVLIMID 10MG CAP 85 REVLIMID 15MG CAP 85 REVLIMID 2.5MG CAP 85 REVLIMID 20MG CAP 85 REVLIMID 25MG CAP 85 REVLIMID 5MG CAP 85 REXULTI 0.25MG TAB 53 REXULTI 0.5MG TAB 53 REXULTI 1MG TAB 53

REXULTI 2MG TAB 53 REXULTI 3MG TAB 53 REXULTI 4MG TAB 53 REYATAZ 50MG ORAL POWDER

55

RHOPRESSA 0.02% OPHTH SOLN

89

ribavirin 200mg cap 56 ribavirin 200mg tab 56 RIDAURA 3MG CAP 10 rifabutin 150mg cap 42 rifampin 150mg cap 42 rifampin 300mg cap 42 rifampin 600mg inj 42 riluzole 50mg tab 87 RIMANTADINE 100MG TAB

57

RINVOQ 15MG ER TAB 10 risedronate sodium 150mg tab

73

risedronate sodium 30mg tab

73

risedronate sodium 35mg (12) pack

73

risedronate sodium 35mg (4) pack

74


74


74

RISPERDAL 12.5MG INJ 51 RISPERDAL 25MG INJ 51 RISPERDAL 37.5MG INJ 51 RISPERDAL 50MG INJ 51 risperidone 0.25mg odt 51 risperidone 0.25mg tab 51 risperidone 0.5mg odt 51 risperidone 0.5mg tab 51 risperidone 1mg odt 51 risperidone 1mg tab 51 risperidone 1mg/ml oral soln

51

risperidone 2mg odt 51 risperidone 2mg tab 51 risperidone 3mg odt 51

risperidone 3mg tab 51 risperidone 4mg odt 51 risperidone 4mg tab 51 ritonavir 100mg tab 55 rivastigmine 0.192mg/hr patch

94

rivastigmine 0.396mg/hr patch

94

rivastigmine 0.554mg/hr patch

94

rivastigmine 1.5mg cap 94 rivastigmine 3mg cap 94 rivastigmine 4.5mg cap 94 rivastigmine 6mg cap 94 rivelsa 91 day pack 65 rizatriptan 10mg odt 83 rizatriptan 10mg tab 83 rizatriptan 5mg odt 83 rizatriptan 5mg tab 83 ROCKLATAN 0.05-0.2MG/ML OPHTH SOLN

89

ropinirole 0.25mg tab 48 ropinirole 0.5mg tab 48 ropinirole 12mg er tab 48 ropinirole 1mg tab 49 ropinirole 2mg er tab 48 ropinirole 2mg tab 49 ropinirole 3mg tab 48 ropinirole 4mg er tab 49 ropinirole 4mg tab 49 ropinirole 5mg tab 49 ropinirole 6mg er tab 49 ropinirole 8mg er tab 49 rosuvastatin calcium 10mg tab

35

rosuvastatin calcium 20mg tab

35


35


35

ROTARIX SUSP 101 ROTATEQ SUSP 101 roweepra 1000mg tab 24


139


roweepra 500mg er tab 24 roweepra 500mg tab 24 roweepra 750mg er tab 24 roweepra 750mg tab 24 ROZLYTREK 100MG CAP

46

ROZLYTREK 200MG CAP

46

RUBRACA 200MG TAB 46 RUBRACA 250MG TAB 46 RUBRACA 300MG TAB 46 RUCONEST 2100UNIT INJ

79

RUZURGI 10MG TAB 42 RYBELSUS 14MG TAB 30 RYBELSUS 3MG TAB 30 RYBELSUS 7MG TAB 30 RYDAPT 25MG CAP 46

S

salmon calcitonin 200unit/act nasal spray

74

SANDIMMUNE 100MG/ML ORAL SOLN

57

SANTYL 250UNIT/GM OINTMENT

71

SAPHRIS 10MG SL TAB 52 SAPHRIS 2.5MG SL TAB 52 SAPHRIS 5MG SL TAB 52 SAVELLA 100MG TAB 94 SAVELLA 12.5MG TAB 94 SAVELLA 25MG TAB 94 SAVELLA 4-WEEK TITRATION PACK

94

SAVELLA 50MG TAB 94 scopolamine 0.0139mg/hr patch

33

SECUADO 3.8MG/24HR PATCH

52


52


52

selegiline 5mg cap 49 selegiline 5mg tab 49

selenium sulfide 2.5% shampoo

69

SELZENTRY 150MG TAB 55 SELZENTRY 20MG/ML ORAL SOLN

55

SELZENTRY 25MG TAB 55 SELZENTRY 300MG TAB 55 SELZENTRY 75MG TAB 55 SEREVENT 50MCG/DOSE INH

20

sertraline 100mg tab 27 sertraline 20mg/ml oral soln

27

sertraline 25mg tab 27 sertraline 50mg tab 27 setlakin 91 day pack 65 sevelamer carbonate 2400mg powder for oral susp

78

sevelamer carbonate 800mg powder for oral susp

78

sevelamer carbonate 800mg tab

78

sharobel 28 day 0.35mg pack

66

SHINGRIX 50MCG/0.5ML INJ

101

SIGNIFOR 0.3MG/ML INJ

75


75


75

sildenafil 20mg tab 61 silodosin 4mg cap 79 silodosin 8mg cap 79 silver sulfadiazine 1% cream

70

SIMBRINZA 0.2-1% OPHTH SUSP

88

SIMPONI 100MG/ML AUTO-INJECTOR

10

SIMPONI 100MG/ML SYRINGE

10

SIMPONI 50MG/0.5ML AUTO-INJECTOR

10

SIMPONI 50MG/0.5ML SYRINGE

10

simvastatin 10mg tab 35 simvastatin 20mg tab 35 simvastatin 40mg tab 35 simvastatin 5mg tab 35 simvastatin 80mg tab 35 sirolimus 0.5mg tab 57 sirolimus 1mg tab 57 sirolimus 1mg/ml oral soln

86

sirolimus 2mg tab 57 SIRTURO 100MG TAB 42 SIVEXTRO 200MG INJ 41 SIVEXTRO 200MG TAB 41 SKYRIZI 150MG DOSE PACK 75MG/0.83ML

69

SLYND 4MG TAB 66 sodium chloride 0.154meq/ml soln

79

sodium chloride 30mg/ml inj

85

sodium chloride 4.5mg/ml inj

85


85


85

sodium phenylbutyrate 0.94mg/mg oral powder

75

sodium polystyrene sulfonate 15000mg powder for oral susp

86

sodium polystyrene sulfonate 250mg/ml susp

86

SOFOSBUVIR 400MG/VELPATASVIR 100MG TAB

56

solifenacin succinate 10mg tab

100

solifenacin succinate 5mg tab

100


140


SOLIQUA 100UNIT-0.033MG/ML PEN INJ

29

SOLTAMOX 10MG/5ML ORAL SOLN

43

SOMATULINE 120MG/0.5ML SYRINGE

75


75


75

SOMAVERT 10MG INJ 74 SOMAVERT 15MG INJ 74 SOMAVERT 20MG INJ 74 SOMAVERT 25MG INJ 74 SOMAVERT 30MG INJ 74 sorine 120mg tab 58 sorine 160mg tab 58 sorine 240mg tab 58 sorine 80mg tab 58 sotalol 120mg tab 58 sotalol 160mg tab 58 sotalol 240mg tab 58 sotalol 80mg tab 58 sotalol af 120mg tab 58 sotalol AF 160mg tab 58 sotalol AF 80mg tab 58 SPIRIVA 1.25MCG INH 18 spironolactone 100mg tab

73

spironolactone 25mg tab 73 spironolactone 50mg tab 73 sprintec 28 day pack 65 SPRITAM 1000MG TAB FOR ORAL SUSP

24

SPRITAM 250MG TAB FOR ORAL SUSP

24


24


24

SPRYCEL 100MG TAB 46 SPRYCEL 140MG TAB 46 SPRYCEL 20MG TAB 46 SPRYCEL 50MG TAB 46

SPRYCEL 70MG TAB 46 SPRYCEL 80MG TAB 46 sps 15gm/60ml susp 86 sronyx 28 day pack 65 ssd 1% cream 70 stavudine 15mg cap 55 stavudine 20mg cap 55 stavudine 30mg cap 55 stavudine 40mg cap 55 STELARA 45MG/0.5ML INJ

69

STELARA 45MG/0.5ML SYRINGE

69

STELARA 90MG/ML SYRINGE

69

STIMATE 1.5MG/ML NASAL INHALER

75

STIOLTO 0.0025-0.0025MG INH

20

STIVARGA 40MG TAB 46 STREPTOMYCIN 1000MG INJ

9

STRIBILD 150-150-200-300MG TAB

55

SUCRAID 8500UNIT/ML ORAL SOLN

72

sucralfate 1000mg tab 99 sucralfate 100mg/ml susp 99 sulfacetamide sodium 10% lotion

68

SULFACETAMIDE SODIUM 10% OPHTH OINTMENT

89

sulfacetamide sodium 10% ophth soln

89

SULFADIAZINE 500MG TAB

96

sulfamethoxazole 400mg/trimethoprim 80mg tab

40

sulfamethoxazole 40mg/ml/trimethoprim 8mg/ml susp

40

sulfamethoxazole 800mg/trimethoprim 160mg tab

40

SULFAMYLON 85MG/GM CREAM

70

sulfasalazine 500mg dr tab

78

sulfasalazine 500mg tab 78 sulindac 150mg tab 11 sulindac 200mg tab 12 sumatriptan 100mg tab 83 sumatriptan 12mg/ml auto-injector

83

sumatriptan 12mg/ml cartridge

83

sumatriptan 12mg/ml inj 83 SUMATRIPTAN 12MG/ML SYRINGE

83

sumatriptan 20mg/act nasal spray

83

sumatriptan 25mg tab 83 sumatriptan 50mg tab 83 sumatriptan 5mg/act nasal spray

83

sumatriptan 8mg/ml auto-injector

83

sumatriptan 8mg/ml cartridge

83

SUNOSI 150MG TAB 8 SUNOSI 75MG TAB 8 SUTENT 12.5MG CAP 46 SUTENT 25MG CAP 46 SUTENT 37.5MG CAP 46 SUTENT 50MG CAP 46 syeda 28 day pack 65 SYLATRON 200MCG INJ 47 SYLATRON 300MCG INJ 47 SYMDEKO 50-75MG/75MG PACK

96

SYMDEKO TAB 4-WEEK PACK

96

SYMFI 400-300-300MG TAB

55

SYMFI 600-300-300MG TAB

55


141


SYMJEPI 0.15MG/0.3ML SYRINGE

101

SYMJEPI 0.3MG/0.3ML SYRINGE

101

SYMPAZAN 10MG ORAL FILM

22


22


22

SYMPROIC 0.2MG TAB 78 SYMTUZA 800-150-200-10MG TAB

55

SYNAREL 2MG/ML NASAL INHALER

74

SYNJARDY 10-1000MG ER TAB

29

SYNJARDY 12.5-1000MG ER TAB

29

SYNJARDY 12.5-1000MG TAB

29

SYNJARDY 12.5-500MG TAB

29


29


29

SYNJARDY 5-1000MG TAB

30

SYNJARDY 5-500MG TAB

30

SYNRIBO 3.5MG INJ 47 SYNTHROID 100MCG TAB

98

SYNTHROID 112MCG TAB

98


98


98


98


98


98

SYNTHROID 25MCG TAB

98


98

SYNTHROID 50MCG TAB

98

SYNTHROID 75MCG TAB

98

SYNTHROID 88MCG TAB

98

T

TABLOID 40MG TAB 42 TABRECTA 150MG TAB 46 TABRECTA 200MG TAB 46 tacrolimus 0.03% ointment

71

tacrolimus 0.1% ointment 71 tacrolimus 0.5mg cap 57 tacrolimus 1mg cap 57 tacrolimus 5mg cap 57 tadalafil 20mg tab 61 TAFINLAR 50MG CAP 46 TAFINLAR 75MG CAP 46 TAGRISSO 40MG TAB 46 TAGRISSO 80MG TAB 47 TAKHZYRO 300MG/2ML INJ

79

TALTZ 80MG/ML AUTO-INJECTOR

69

TALTZ 80MG/ML SYRINGE

69

TALZENNA 0.25MG CAP 47 TALZENNA 1MG CAP 47 tamoxifen 10mg tab 43 tamoxifen 20mg tab 43 tamsulosin 0.4mg cap 79 TARGRETIN 1% GEL 69 tarina 24 fe 1/20 28 day pack

65

tarina fe 1/20 28 day pack

65

TASIGNA 150MG CAP 47

TASIGNA 200MG CAP 47 TASIGNA 50MG CAP 47 TAVALISSE 100MG TAB 79 TAVALISSE 150MG TAB 79 tazarotene 0.1% cream 69 tazicef 1gm inj 63 tazicef 2gm inj 63 tazicef 6gm inj 63 TAZORAC 0.05% CREAM

69

TAZORAC 0.05% GEL 69 TAZORAC 0.1% GEL 69 taztia 120mg er cap 60 taztia 180mg er cap 60 taztia 240mg er cap 60 taztia 300mg er cap 60 taztia 360mg er cap 60 TAZVERIK 200MG TAB 47 TDVAX 4-4UNIT/ML INJ 98 TECFIDERA 120MG DR CAP

95

TECFIDERA 240MG DR CAP

95

TECFIDERA 30-DAY STARTER PACK

95

TEFLARO 400MG INJ 63 TEFLARO 600MG INJ 63 TEGSEDI 284MG/1.5ML SYRINGE

95

telmisartan 20mg tab 37 telmisartan 40mg tab 37 telmisartan 80mg tab 37 temazepam 15mg cap 81 temazepam 22.5mg cap 81 temazepam 30mg cap 81 temazepam 7.5mg cap 81 TENIVAC 4-10UNIT/ML SYRINGE

98

tenofovir disoproxil fumarate 300mg tab

55

terazosin 10mg cap 38 terazosin 1mg cap 38 terazosin 2mg cap 38 terazosin 5mg cap 38 terbinafine 250mg tab 33


142


terbutaline sulfate 2.5mg tab

20

terbutaline sulfate 5mg tab

20

terconazole 0.4% vaginal cream

101

TERCONAZOLE 0.8% VAGINAL CREAM

101

terconazole 80mg vaginal insert

101

testosterone 1% (25mg) gel

15

testosterone 1% (50mg) gel

15

testosterone 1.62% (1.25gm) gel

15

testosterone 1.62% (2.5gm) gel

15

TESTOSTERONE 12.5MG/ACT GEL

15

testosterone 20.25mg/act gel

15

testosterone cypionate 100mg/ml inj

15

testosterone cypionate 200mg/ml (1ml) inj

15

testosterone cypionate 200mg/ml inj

15

TESTOSTERONE ENANTHATE 200MG/ML INJ

15

tetrabenazine 12.5mg tab 94 tetrabenazine 25mg tab 94 tetracycline 250mg cap 96 tetracycline 500mg cap 96 THALOMID 100MG CAP 85 THALOMID 150MG CAP 85 THALOMID 200MG CAP 85 THALOMID 50MG CAP 85 THEOPHYLLINE 300MG ER TAB

20

theophylline 400mg er tab

20

theophylline 5.33mg/ml oral soln

20

theophylline 600mg er tab

20

THIOLA 100MG DR TAB 79 THIOLA 100MG TAB 79 THIOLA 300MG DR TAB 79 thioridazine 100mg tab 53 thioridazine 10mg tab 53 thioridazine 25mg tab 53 thioridazine 50mg tab 53 thiothixene 10mg cap 54 thiothixene 1mg cap 54 thiothixene 2mg cap 54 thiothixene 5mg cap 54 tiadylt 120mg er cap 60 tiadylt 180mg er cap 60 tiadylt 240mg er cap 60 tiadylt 300mg er cap 60 tiadylt 360mg er cap 60 tiadylt 420mg er cap 60 tiagabine 12mg tab 25 tiagabine 16mg tab 25 tiagabine 2mg tab 25 tiagabine 4mg tab 25 TIBSOVO 250MG TAB 47 TIGECYCLINE 50MG INJ 96 TIMOLOL 0.25% OPHTH GEL

88

timolol 0.25% ophth soln 88 TIMOLOL 0.5% OPHTH GEL

88

timolol 0.5% ophth soln 88 timolol 10mg tab 58 timolol 20mg tab 58 timolol 5mg tab 58 timolol 5mg/ml ophth 24hr ophth soln

88

TIMOPTIC 0.25% OPHTH GEL

88

TIMOPTIC 0.5% OPHTH GEL

88

tinidazole 250mg tab 40 tinidazole 500mg tab 40 TIVICAY 10MG TAB 55 TIVICAY 25MG TAB 55 TIVICAY 50MG TAB 55

tizanidine 2mg cap 87 tizanidine 2mg tab 87 tizanidine 4mg cap 87 tizanidine 4mg tab 87 tizanidine 6mg cap 87 TOBRADEX 0.1-0.3% OPHTH OINTMENT

90

tobramycin 0.3% ophth soln

89

TOBRAMYCIN 10MG/ML INJ

9

tobramycin 40mg/ml inj 9 tobramycin 60mg/ml inh soln

10

tolcapone 100mg tab 49 tolterodine tartrate 1mg tab

100

tolterodine tartrate 2mg er cap

100

tolterodine tartrate 2mg tab

100

tolterodine tartrate 4mg er cap

100

TOPIRAMATE 100MG ER CAP

24

topiramate 100mg tab 24 TOPIRAMATE 150MG ER CAP

24

topiramate 15mg cap 24 TOPIRAMATE 200MG ER CAP

24

topiramate 200mg tab 24 topiramate 25mg cap 24 TOPIRAMATE 25MG ER CAP

24

topiramate 25mg tab 24 TOPIRAMATE 50MG ER CAP

24

topiramate 50mg tab 24 toremifene 60mg tab 43 torsemide 100mg tab 73 torsemide 10mg tab 73 torsemide 20mg tab 73 torsemide 5mg tab 73


143


TOUJEO 300UNIT/ML PEN INJ

31

TOUJEO MAX 300UNIT/ML PEN INJ (3ML)

31

TRACLEER 32MG TAB FOR ORAL SUSP

61

TRADJENTA 5MG TAB 30 tramadol 100mg er tab 13 tramadol 100mg er tab (matrix delivery)

13

tramadol 200mg er tab 13 tramadol 200mg er tab (matrix delivery)

13

tramadol 300mg er tab 14 tramadol 300mg er tab (matrix delivery)

14

tramadol 50mg tab 14 trandolapril 1mg tab 37 TRANDOLAPRIL 1MG/VERAPAMIL 240MG ER TAB

39

trandolapril 2mg tab 37 trandolapril 2mg/verapamil 180mg er tab

40

trandolapril 2mg/verapamil 240mg er tab

40

trandolapril 4mg tab 37 trandolapril 4mg/verapamil 240mg er tab

40

tranexamic acid 650mg tab

81

tranylcypromine 10mg tab

26

TRAVASOL 10% INJ 88 travoprost 0.004% ophth soln

90

trazodone 100mg tab 27 trazodone 150mg tab 27 trazodone 300mg tab 27 trazodone 50mg tab 27 TRECATOR 250MG TAB 42

TRELEGY 0.1-0.0625-0.025MG INH

20

TRELSTAR 11.25MG INJ 43 TRELSTAR 22.5MG INJ 43 TRELSTAR 3.75MG INJ 43 TRESIBA 100UNIT/ML INJ

31

TRESIBA 100UNIT/ML PEN INJ

31

TRESIBA 200UNIT/ML PEN INJ

31

tretinoin 0.01% gel 68 tretinoin 0.025% cream 68 tretinoin 0.025% gel 68 tretinoin 0.04% gel 68 tretinoin 0.05% cream 68 tretinoin 0.05% gel 68 tretinoin 0.1% cream 68 tretinoin 0.1% gel 68 tretinoin 10mg cap 47 triamcinolone acetonide 0.0147% spray

71

triamcinolone acetonide 0.025% cream

71

triamcinolone acetonide 0.025% lotion

71

triamcinolone acetonide 0.025% ointment

71


71

triamcinolone acetonide 0.1% lotion

71


71

triamcinolone acetonide 0.1% oral paste

86


71


71

triamterene 100mg cap 73 triamterene 50mg cap 73 triazolam 0.125mg tab 81 triazolam 0.25mg tab 81 triderm 0.1% cream 71

trientine 250mg cap 85 tri-estarylla 28 day pack 65 trifluoperazine 10mg tab 53 trifluoperazine 1mg tab 53 trifluoperazine 2mg tab 53 trifluoperazine 5mg tab 53 TRIFLURIDINE 1% OPHTH SOLN

89

TRIGLIDE 160MG TAB 35 trihexyphenidyl 0.4mg/ml oral soln

49

trihexyphenidyl 2mg tab 48 trihexyphenidyl 5mg tab 48 TRIJARDY 10-5-1000MG ER TAB

30

TRIJARDY 12.5-2.5-1000MG ER TAB

30

TRIJARDY 25-5-1000MG ER TAB

30

TRIJARDY 5-2.5-1000MG ER TAB

30

TRIKAFTA 100-50-75MG/150MG PACK

96

tri-legest 28 day pack 65 tri-lo-estarylla 28 day pack

65

tri-lo-sprintec 28 day pack

65

trilyte powder for oral soln

82

trimethobenzamide 300mg cap

33

trimethoprim 100mg tab 40 tri-mili 28 day pack 65 trimipramine 100mg cap 29 trimipramine 25mg cap 29 trimipramine 50mg cap 29 TRINTELLIX 10MG TAB 27 TRINTELLIX 20MG TAB 27 TRINTELLIX 5MG TAB 27 tri-previfem 28 day pack 66 tri-sprintec 28 day pack 66


144


TRIUMEQ 600-50-300MG TAB

55

trivora 28 day pack 66 tri-vylibra 28 day pack 66 tri-vylibra lo 28 day pack 66 TROKENDI 100MG ER CAP

24

TROKENDI 200MG ER CAP

24


24


24

TROPHAMINE 10% INJ 88 trospium chloride 20mg tab

100

trospium chloride 60mg er cap

100

TRULANCE 3MG TAB 77 TRULICITY 0.75MG/0.5ML AUTO-INJECTOR

30

TRULICITY 1.5MG/0.5ML AUTO-INJECTOR

30

TRUMENBA SYRINGE 100 TRUVADA 100-150MG TAB

55

TRUVADA 133-200MG TAB

55


55


56

TUKYSA 150MG TAB 47 TUKYSA 50MG TAB 47 TURALIO 200MG CAP 47 TWINRIX 720UNIT SYRINGE

101

TYBOST 150MG TAB 56 TYKERB 250MG TAB 47 TYMLOS 3120MCG/1.56ML PEN INJ

74

TYPHIM VI 25MCG/0.5ML INJ

100

TYPHIM VI 25MCG/0.5ML SYRINGE

100

U

UCERIS 2MG/ACT RECTAL FOAM

15

unithroid 100mcg tab 98 unithroid 112mcg tab 98 unithroid 125mcg tab 98 unithroid 150mcg tab 98 unithroid 175mcg tab 98 unithroid 200mcg tab 98 unithroid 25mcg tab 98 unithroid 300mcg tab 98 unithroid 50mcg tab 98 unithroid 75mcg tab 98 unithroid 88mcg tab 98 UPTRAVI 1000MCG TAB 61 UPTRAVI 1200MCG TAB 61 UPTRAVI 1400MCG TAB 61 UPTRAVI 1600MCG TAB 61 UPTRAVI 200MCG TAB 61 UPTRAVI 400MCG TAB 61 UPTRAVI 600MCG TAB 61 UPTRAVI 800MCG TAB 61 UPTRAVI TITRATION PACK

61

ursodiol 250mg tab 77 ursodiol 300mg cap 77 ursodiol 500mg tab 77

V

valacyclovir 1000mg tab 56 valacyclovir 500mg tab 56 VALCHLOR 0.016% GEL 69 valganciclovir 450mg tab 56 valganciclovir 50mg/ml oral soln

56

valproic acid 250mg cap 25 valproic acid 50mg/ml oral soln

25

valsartan 160mg tab 37 valsartan 320mg tab 37 valsartan 40mg tab 37

valsartan 80mg tab 37 VALTOCO 10MG DOSE KIT 10MG/0.1ML PACK

22

VALTOCO 15MG DOSE KIT 7.5MG/0.1ML PACK

22

VALTOCO 20MG DOSE KIT 10MG/0.1ML PACK

22

VALTOCO 5MG DOSE KIT 5MG/0.1ML PACK

22

vancomycin 1000mg inj 41 vancomycin 100mg/ml inj 41 vancomycin 125mg cap 41 vancomycin 250mg cap 41 VANCOMYCIN 250MG INJ

41

vancomycin 500mg inj 41 vancomycin 750mg inj 41 vandazole 0.75% vaginal gel

101

VAQTA 25UNIT/0.5ML INJ

101

VAQTA 25UNIT/0.5ML SYRINGE

101

VAQTA 50UNIT/ML INJ 101 VAQTA 50UNIT/ML SYRINGE

101

VARIVAX 1350PFU/0.5ML INJ

101

VARIZIG 125UNIT/1.2ML INJ

91

VARUBI 90MG TAB 33 VASCEPA 0.5GM CAP 34 VASCEPA 1GM CAP 34 velivet 28 day pack 66 VELTASSA 16.8GM POWDER FOR ORAL SUSP

86

VELTASSA 25.2GM POWDER FOR ORAL SUSP

86

VELTASSA 8.4GM POWDER FOR ORAL SUSP

86

VEMLIDY 25MG TAB 56


145


VENCLEXTA 100MG TAB

42

VENCLEXTA 10MG TAB 42 VENCLEXTA 50MG TAB 42 VENCLEXTA STARTING PACK

42

venlafaxine 100mg tab 28 venlafaxine 150mg er cap 28 venlafaxine 25mg tab 28 venlafaxine 37.5mg er cap

28

venlafaxine 37.5mg tab 28 venlafaxine 50mg tab 28 venlafaxine 75mg er cap 28 venlafaxine 75mg tab 28 VENTAVIS 10MCG/ML INH SOLN

61

VENTAVIS 20MCG/ML INH SOLN

61

VENTOLIN 108MCG INH 20 VERAPAMIL 100MG ER CAP

60

verapamil 120mg er cap 60 verapamil 120mg er tab 60 verapamil 120mg tab 60 verapamil 180mg er cap 60 verapamil 180mg er tab 60 VERAPAMIL 200MG ER CAP

60

verapamil 240mg er cap 60 verapamil 240mg er tab 60 VERAPAMIL 300MG ER CAP

60

VERAPAMIL 360MG ER CAP

60

verapamil 40mg tab 60 verapamil 80mg tab 60 VERSACLOZ 50MG/ML SUSP

52

VERZENIO 100MG TAB 47 VERZENIO 150MG TAB 47 VERZENIO 200MG TAB 47 VERZENIO 50MG TAB 47 VIBERZI 100MG TAB 78 VIBERZI 75MG TAB 78

VICTOZA 18MG/3ML PEN INJ

30

vienva 28 day pack 66 vigabatrin 500mg powder for oral soln

25

vigabatrin 500mg tab 25 vigadrone 500mg powder for oral soln

25

VIIBRYD 10/20MG STARTER PACK

27

VIIBRYD 10MG TAB 27 VIIBRYD 20MG TAB 27 VIIBRYD 40MG TAB 27 VIMPAT 100MG TAB 24 VIMPAT 10MG/ML ORAL SOLN

24

VIMPAT 150MG TAB 24 VIMPAT 200MG TAB 24 VIMPAT 50MG TAB 24 VIRACEPT 250MG TAB 56 VIRACEPT 625MG TAB 56 VIREAD 150MG TAB 56 VIREAD 200MG TAB 56 VIREAD 250MG TAB 56 VIREAD 40MG/GM ORAL POWDER

56

VITRAKVI 100MG CAP 47 VITRAKVI 20MG/ML ORAL SOLN

47

VITRAKVI 25MG CAP 47 VIVITROL 380MG INJ 33 VIZIMPRO 15MG TAB 47 VIZIMPRO 30MG TAB 47 VIZIMPRO 45MG TAB 47 voriconazole 200mg inj 34 voriconazole 200mg tab 34 voriconazole 40mg/ml susp

34

voriconazole 50mg tab 34 VOSEVI 400-100-100MG TAB

56

VOTRIENT 200MG TAB 47 VRAYLAR 1.5/3MG MIXED PACK

50

VRAYLAR 1.5MG CAP 50

VRAYLAR 3MG CAP 50 VRAYLAR 4.5MG CAP 50 VRAYLAR 6MG CAP 50 vyfemla 28 day pack 66 vylibra 28 day pack 66 VYNDAMAX 61MG CAP 62 VYNDAQEL 20MG CAP 62

W

WAKIX 17.8MG TAB 8 WAKIX 4.45MG TAB 8 warfarin sodium 10mg tab

20

warfarin sodium 1mg tab 20 warfarin sodium 2.5mg tab

20

warfarin sodium 2mg tab 20 warfarin sodium 3mg tab 20 warfarin sodium 4mg tab 20 warfarin sodium 5mg tab 20 warfarin sodium 6mg tab 20 warfarin sodium 7.5mg tab

20

wixela 0.1-0.05mg inh 20 wixela 0.25-0.05mg inh 20 wixela 0.5-0.05mg inh 20 wymzya fe 28 day pack 66

X

XALKORI 200MG CAP 47 XALKORI 250MG CAP 47 XARELTO 10MG TAB 21 XARELTO 15MG TAB 21 XARELTO 2.5MG TAB 21 XARELTO 20MG TAB 21 XARELTO KIT PACK 21 XATMEP 2.5MG/ML ORAL SOLN

42

XCOPRI 100MG TAB 25 XCOPRI 12.5/25MG TITRATION PACK

25

XCOPRI 150/200MG TITRATION PACK

25

XCOPRI 150MG TAB 25 XCOPRI 200MG TAB 25


146


XCOPRI 50/100MG TITRATION PACK

25

XCOPRI 50MG TAB 25 XCOPRI TAB 150/200MG PACK

25

XCOPRI TAB 50/200MG PACK

25

XELJANZ 10MG TAB 10 XELJANZ 5MG TAB 10 XELJANZ XR 11MG TAB 10 XELJANZ XR 22MG TAB 10 XENLETA 600MG TAB 41 XGEVA 120MG/1.7ML INJ

74

XIFAXAN 200MG TAB 40 XIFAXAN 550MG TAB 40 XIGDUO 10-1000MG ER TAB

30

XIGDUO 10-500MG ER TAB

30

XIGDUO 2.5-1000MG ER TAB

30


30


30

XOFLUZA 20MG THERAPY PACK

57

XOFLUZA 40MG THERAPY PACK

57

XOLAIR 150MG INJ 18 XOLAIR 150MG/ML SYRINGE

18

XOLAIR 75MG/0.5ML SYRINGE

18

XOSPATA 40MG TAB 47 XPOVIO 100 MG ONCE WEEKLY

44

XPOVIO 60 MG ONCE WEEKLY

44

XPOVIO 80 MG ONCE WEEKLY

44

XPOVIO 80 MG TWICE WEEKLY

44

XTAMPZA 13.5MG ER CAP

14

XTAMPZA 18MG ER CAP

14

XTAMPZA 27MG ER CAP

14

XTAMPZA 36MG ER CAP

14

XTAMPZA 9MG ER CAP 14 XTANDI 40MG CAP 43 XULANE 0.00146-0.00625MG/HR PATCH

66

XULTOPHY 100UNIT-3.6MG/ML PEN INJ

30

XYREM 500MG/ML ORAL SOLN

93

Y

YF-VAX 4000UNIT/ML INJ

101

Z

zafirlukast 10mg tab 18 zafirlukast 20mg tab 18 zaleplon 10mg cap 81 zaleplon 5mg cap 81 zarah pack 66 ZARXIO 300MCG/0.5ML SYRINGE

81

ZARXIO 480MCG/0.8ML SYRINGE

81

ZEJULA 100MG CAP 47 ZELBORAF 240MG TAB 47 ZEMAIRA 1000MG INJ 95 zenatane 10mg cap 68 zenatane 20mg cap 68 zenatane 30mg cap 68 zenatane 40mg cap 68 ZENPEP 105000-79000-25000UNIT DR CAP

72

ZENPEP 14000-10000-3000UNIT DR CAP

72


72


72


72


72


72

ZERBAXA 1000-500MG INJ

62

zidovudine 100mg cap 56 zidovudine 10mg/ml oral soln

56

zidovudine 300mg tab 56 ZIEXTENZO 6MG/0.6ML SYRINGE

81

ziprasidone 20mg cap 50 ziprasidone 20mg inj 50 ziprasidone 40mg cap 50 ziprasidone 60mg cap 50 ziprasidone 80mg cap 50 ZIRGAN 0.15% OPHTH GEL

89

ZOLINZA 100MG CAP 47 zolmitriptan 2.5mg odt 83 zolmitriptan 2.5mg tab 83 zolmitriptan 5mg odt 83 zolmitriptan 5mg tab 83 zolpidem tartrate 10mg tab

82

zolpidem tartrate 5mg tab 82 ZOMIG 2.5MG NASAL SPRAY

83

ZOMIG 5MG NASAL SPRAY

83

zonisamide 100mg cap 24 zonisamide 25mg cap 25 zonisamide 50mg cap 25


147


ZOSTAVAX 19400UNT/0.65ML INJ

101

ZOSYN 2000-250MG INJ 92 ZOSYN 3000-375MG INJ 92 zovia 1/35e 28 day pack 66 ZUBSOLV 1.4-0.36MG SL TAB

15

ZUBSOLV 11.4-2.9MG SL TAB

15


15


15


15

ZYCLARA 2.5% CREAM 71 ZYDELIG 100MG TAB 47 ZYDELIG 150MG TAB 47 ZYKADIA 150MG TAB 47 ZYLET 0.5-0.3% OPHTH SUSP

90

ZYPREXA 210MG INJ 52


148

Community Health Choice (HMO D-SNP)

CommunityHealthChoice.org/Medicare

Member Services

Method Member Services – Contact InformationCALL (833) 276-8306

Calls to this number are free. Community Health Choice HMO D-SNP is open Octo-ber 1 to March 31, 8:00 am to 8:00 pm, 7 days a week and April 1 through September 30, Monday through Friday, 8:00 am to 8:00 pm. On certain holidays your call will be handled by our automated phone system. Member Services also has free language interpreter services available for non-Eng-lish speakers.

TTY 711This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking. Calls to this number are free. The National Relay is available 24 hours a day, 7 days a week.

FAX (713) 295-7041WRITE P.O. Box 301413

Houston, TX 77230WEBSITE www.communityhealthchoice.org

Texas Health Information, Counseling and Advocacy Program (HICAP)

Health Information, Counseling and Advocacy Program (HICAP) is a state program that gets money from the Federal government to give free local health insurance counseling to people with Medicare.

Method Contact InformationCALL (800) 252-9240TTY 711 WRITE Health Information, Counseling and Advocacy Program (HICAP)

P.O. Box 149104 Austin, TX 78714-9030

WEBSITE https://www.tdi.texas.gov/consumer/hicap/index.html

PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are re-quired to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1051. If you have comments or sug-gestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Community Health Choice (HMO D-SNP) 2021 FORMULARY

Documents

Transcript of Community Health Choice (HMO D-SNP) 2021 FORMULARY