FlexBenefits - Off Formulary Listing Level 4&5 Date: November 29, …€¦ · 14/12/2016 ·...

Date: November 29, 2016

DIN FULLNAME GENERIC_NAME

Off Formulary for all but Quebec

Off formulary for Quebec

00001937 XYLOCARD 2% VIAL LIDOCAINE HCL Y Y00009881 PAPAVERINE HCL 65MG/2ML AMPUL PAPAVERINE HCL Y Y00037842 SODIUM CL 0.9% IV SOLUTION SODIUM CHLORIDE 0.9% Y Y00060208 SODIUM CL 0.9% IV SOLUTION SODIUM CHLORIDE 0.9% Y Y00394394 ALCOHOL DEHYDRATED 100% AMPUL ETHYL ALCOHOL Y Y00402230 SODIUM CHLORIDE 23.4% INJ SODIUM CHLORIDE Y Y00414220 SOM PAM 15MG CAPSULE FLURAZEPAM HCL Y Y00414239 SOM PAM 30MG CAPSULE FLURAZEPAM HCL Y Y00432814 SANDOZ FLUOROMETHOLONE 0.1% EYE DROP FLUOROMETHOLONE Y N00537640 ALCOHOL DEHYDRATED AMPOULE ETHYL ALCOHOL Y Y00623857 HYDROXY COBAL INJ 1000MCG/ML HYDROXOCOBALAMIN Y Y00674621 ALBUMIN HUMAN DILUENT VIAL ALBUMIN HUMAN/SODIUM CHLORIDE Y Y00693820 VASOPRESSIN 20U/ML INJ. VASOPRESSIN Y Y00868426 JAA PREDNISONE TAB 1MG USP PREDNISONE Y Y00868434 JAA PREDNISONE TAB 50MG USP PREDNISONE Y Y00903079 MIX:DISULFIRAM 250MG CAPSULE (NS) DISULFIRAM Y Y00904028 POMALYST 1MG CAPSULE (NS) POMALIDOMIDE Y Y00904029 POMALYST 2MG CAPSULE (NS) POMALIDOMIDE Y Y00904030 POMALYST 3MG CAPSULE (NS) POMALIDOMIDE Y Y00904031 POMALYST 4MG CAPSULE (NS) POMALIDOMIDE Y Y00904081 HOLKIRA PAK TABLETS (NS) RITONAVIR/PARITAPREVIR/OMBITASVIR/DASABUVIR Y Y00904082 HOLKIRA PAK TABLETS (NS) RITONAVIR/PARITAPREVIR/OMBITASVIR/DASABUVIR Y Y00921300 SODIUM CHL 0.9% (PQ)(250ML) SODIUM CHLORIDE Y Y00950792 NEORAL 10MG CAPSULE (SK) CYCLOSPORINE Y Y00963836 PROGESTERONE PD (PQ) PROGESTERONE PWDR Y Y00990210 REIM: LOCAL ANESTHETIC MD INJ (PQ) ADMINISTRATIVE DIN Y Y00990286 REIM: XYLOCAINE/MARCAINE/LIQUID NITROGEN XYLOCAINE/MARCAINE/LIQUID NITROGEN Y Y00990337 REIM:DRUGS/INJECTIONS REC'D IN DR OFFICE/CLINIC ADMINISTRATIVE DIN Y Y01913972 NUBAIN 20MG/ML VIAL NALBUPHINE HCL Y Y01913980 NUBAIN 10MG/ML VIAL NALBUPHINE HCL Y Y01924303 SODIUM CL 0.9% IV SOLUTION SODIUM CHLORIDE 0.9% Y Y02010240 ODAN-TIMOLOL 0.5% EYE DROPS TIMOLOL MALEATE Y Y02010259 ODAN-TIMOLOL 0.25% EYE DROPS TIMOLOL MALEATE Y Y02023792 DIOSPORIN OPH OINTMENT NEOMY SULF/BACITRACIN/POLYMYXIN B SULFATE Y Y02063670 SANTYL OINTMENT COLLAGENASE Y Y02131536 BACTERIOSTATIC WATER FOR INJECTION USP WATER FOR INJECTION/ STERILE Y Y

FlexBenefits - Off Formulary Listing Level 4&5






02142546 STERILE WATER FOR INJECTION WATER FOR INJECTION-STERILE Y Y02148463 PILOCARPINE NITRATE 2% MINIMS PILOCARPINE NITRATE Y Y02148722 LUPRON DEPOT 11.25MG/VIAL LEUPROLIDE ACETATE Y Y02148730 LUPRON DEPOT 15MG/VIAL LEUPROLIDE ACETATE Y Y02223732 DILUENT FOR ALLERGENIC EXTRACT STERILE ALBUMIN SALINE WITH PHENO ALBUMIN Y Y02229437 PHOSLO 667MG TABLET CALCIUM ACETATE Y Y02238903 BENZTROPINE OMEGA 1MG/ML INJECTION BENZTROPINE MESYLATE Y Y02241230 METHYLPREDNISOLONE SODIUM SUCCINATE FOR INJECTION 5G/VIAL METHYLPREDNISOLONE SOD SUCC Y Y02242810 SCOPOLAMINE HYDROBROMIDE INJECTION 0.4MG/ML HYOSCINE HYDROBROMIDE Y N02242811 SCOPOLAMINE HYDROBROMIDE INJECTION 0.6MG/ML HYOSCINE HYDROBROMIDE Y N02243681 ORZEL TABLET TEGAFUR/URACIL/LEUCOVORIN CALCIUM Y Y02243723 OESCLIM 7.5MG PATCH ESTRADIOL Y Y02243725 OESCLIM 15MG PATCH ESTRADIOL Y Y02243726 OESCLIM 20MG PATCH ESTRADIOL Y Y02246133 PRESSYN AR 20U/ML INJECTION VASOPRESSIN Y Y02247099 ZYPREXA INTRAMUSCULAR 10MG/VIAL INJECTION OLANZAPINE Y Y02247938 VASOPRESSIN 20U/ML INJECTION VASOPRESSIN Y Y02248297 EVRA TRANSDERMAL PATCH ETHINYL ESTRAD/NORELGESTROMIN Y N02249499 ANDROGEL 1% TOP'L GEL PUMP TESTOSTERONE Y Y02250519 ZAVESCA 100MG CAPSULE MIGLUSTAT Y Y02254174 AERODIOL 150MCG NASAL SPRAY ESTRADIOL HEMIHYDRATE Y Y02254735 OXYTROL 36MG PATCH OXYBUTYNIN Y Y02255707 RISPERDAL CONSTA 25MG/VIAL RISPERIDONE Y Y02255723 RISPERDAL CONSTA 37.5MG/VIAL RISPERIDONE Y Y02255731 RISPERDAL CONSTA 3N 37.5MG/VIAL RISPERIDONE Y Y02255758 RISPERDAL CONSTA 50MG/VIAL RISPERIDONE Y Y02255766 RISPERDAL CONSTA 3N 50MG/VIAL RISPERIDONE Y Y02256290 RELPAX 20MG TABLET ELETRIPTAN HYDROBROMIDE Y N02256304 RELPAX 40MG TABLET ELETRIPTAN HYDROBROMIDE Y N02256460 VFEND 50MG TABLET VORICONAZOLE Y Y02256479 VFEND 200MG TABLET VORICONAZOLE Y Y02257084 FROVA 2.5MG TABLET FROVATRIPTAN SUCCINATE Y Y02257130 SENSIPAR 30MG TABLET CINACALCET HCL Y Y02257149 SENSIPAR 60MG TABLET CINACALCET HCL Y Y02257157 SENSIPAR 90MG TABLET CINACALCET HCL Y Y02257270 ZYMAR 3MG/ML OPH DROP GATIFLOXACIN Y Y






02258781 AVANDARYL 4MG/1MG TABLET ROSIGLITAZONE MALEATE/ GLIMEPIRIDE Y Y02258803 AVANDARYL 4MG/2MG TABLET ROSIGLITAZONE MALEATE/ GLIMEPIRIDE Y Y02258811 AVANDARYL 4MG/4MG TABLET ROSIGLITAZONE MALEATE/ GLIMEPIRIDE Y Y02259117 DITROPAN 15MG XL TABLET OXYBUTYNIN CHLORIDE Y Y02260565 XOLAIR 150MG/VIAL INJECTION OMALIZUMAB Y Y02260638 EBIXA 10MG TABLET MEMANTINE HCL Y Y02262339 NIASPAN 1000MG SR TABLET NICOTINIC ACID Y Y02262347 NIASPAN 500MG SR TABLET NICOTINIC ACID Y Y02262355 NIASPAN 750MG SR TABLET NICOTINIC ACID Y Y02262800 STRATTERA 10MG CAPSULE ATOMOXETINE HCL Y Y02262819 STRATTERA 18MG CAPSULE ATOMOXETINE HCL Y Y02262827 STRATTERA 25MG CAPSULE ATOMOXETINE HCL Y Y02262835 STRATTERA 40MG CAPSULE ATOMOXETINE HCL Y Y02262843 STRATTERA 60MG CAPSULE ATOMOXETINE HCL Y Y02264846 TRAMACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02266121 SATIVEX SL SPRAY TETRANABINEX/NABIDIOLEX-CANNABIS SATIVA L. Y Y02267225 MACUGEN 0.3MG/90MCL SYRINGE PEGAPTANIB SODIUM Y Y02267233 TECTA 40MG EC TABLET PANTOPRAZOLE MAGNESIUM Y N02268272 XYREM 500MG/ML SOLUTION SODIUM OXYBATE Y Y02269007 TARCEVA 25MG TABLET ERLOTINIB HCL Y Y02269015 TARCEVA 100MG TABLET ERLOTINIB HCL Y Y02269023 TARCEVA 150MG TABLET ERLOTINIB HCL Y Y02269570 STERILE WATER FOR INJECTION USP WATER FOR INJECTION-STERILE Y Y02270064 MENOSTAR 0.99MG PATCH ESTRADIOL HEMIHYDRATE Y Y02272091 EMTRIVA 200MG CAPSULE EMTRICITABINE Y Y02272199 SOMAVERT 10MG VIAL PEGVISOMANT Y Y02272202 SOMAVERT 15MG VIAL PEGVISOMANT Y Y02272210 SOMAVERT 20MG VIAL PEGVISOMANT Y Y02272415 PRAVASA 10MG/81MG TABLET PRAVASTATIN SODIUM/ASA Y Y02272423 PRAVASA 20MG/81MG TABLET PRAVASTATIN SODIUM/ASA Y Y02272431 PRAVASA 40MG/81MG TABLET PRAVASTATIN SODIUM/ASA Y Y02272458 PRAVASA 10MG/162MG TABLET PRAVASTATIN SODIUM/ASA Y Y02272466 PRAVASA 20MG/162MG TABLET PRAVASTATIN SODIUM/ASA Y Y02272474 PRAVASA 40MG/162MG TABLET PRAVASTATIN SODIUM/ASA Y Y02273217 ENABLEX 7.5MG SR TABLET DARIFENACIN Y Y02273225 ENABLEX 15MG SR TABLET DARIFENACIN Y Y






02273322 APTIVUS 250MG CAPSULE TIPRANAVIR Y Y02275066 TROSEC 20MG TABLET TROSPIUM CHLORIDE Y Y02277131 BIPHENTIN 15MG CER TABLET METHYLPHENIDATE HCL Y Y02277158 BIPHENTIN 20MG CER TABLET METHYLPHENIDATE HCL Y Y02277166 BIPHENTIN 10MG CER TABLET METHYLPHENIDATE HCL Y Y02277174 BIPHENTIN 30MG CER TABLET METHYLPHENIDATE HCL Y Y02277182 BIPHENTIN 40MG CER TABLET METHYLPHENIDATE HCL Y Y02277190 BIPHENTIN 50MG CER TABLET METHYLPHENIDATE HCL Y Y02277204 BIPHENTIN 60MG CER TABLET METHYLPHENIDATE HCL Y Y02277212 BIPHENTIN 80MG CER TABLET METHYLPHENIDATE HCL Y Y02277263 VESICARE 5MG TABLET SOLIFENACIN SUCCINATE Y Y02277271 VESICARE 10MG TABLET SOLIFENACIN SUCCINATE Y Y02278383 VANTAS 50MG IMPLANT HISTRELIN ACETATE Y Y02279347 STRATTERA 80MG CAPSULE ATOMOXETINE HCL Y Y02279355 STRATTERA 100MG CAPSULE ATOMOXETINE HCL Y Y02279401 REVATIO 20MG TABLET SILDENAFIL CITRATE Y Y02279754 SODIUM CHLORIDE INJECTION USP 0.9% SODIUM CHLORIDE Y Y02279991 VFEND 3GM SUSPENSION VORICONAZOLE Y Y02281074 ACZONE 5% GEL DAPSONE Y Y02281368 APO-ZIDOVUDINE-LAMIVUDINE-NEVIRAPINE 300/150/200MG TABLET ZIDOVUDINE/LAMIVUDINE/NEVIRAPINE Y Y02282097 ORENCIA 250MG IV INJECTION ABATACEPT Y Y02283395 SOMATULINE AUTOGEL 60MG/0.3ML LANREOTIDE Y N02283409 SOMATULINE AUTOGEL 90MG/0.3ML LANREOTIDE Y N02283417 SOMATULINE AUTOGEL 120MG/0.5ML LANREOTIDE Y N02283735 STERILE DILUENT FOR ALLERGENIC EXTRACT - ALBUMIN SALINE WITH PHE ALBUMIN Y N02284227 NEXAVAR 200MG TABLET SORAFENIB Y Y02284642 AZILECT 0.5MG TABLET RASAGILINE MESYLATE Y Y02284650 AZILECT 1MG TABLET RASAGILINE MESYLATE Y Y02285541 ACTONEL SACHET KIT RISEDRONATE SODIUM/CALCIUM/VIT D3 Y Y02286386 TYSABRI 300MG/15ML IV NATALIZUMAB Y Y02286424 ZYTRAM XL 150MG TABLET TRAMADOL HCL Y Y02286432 ZYTRAM XL 200MG TABLET TRAMADOL HCL Y Y02286440 ZYTRAM XL 300MG TABLET TRAMADOL HCL Y Y02286459 ZYTRAM XL 400MG TABLET TRAMADOL HCL Y Y02287145 FOSRENOL 250MG TABLET LANTHANUM Y Y02287153 FOSRENOL 500MG TABLET LANTHANUM Y Y






02287161 FOSRENOL 750MG TABLET LANTHANUM Y Y02287188 FOSRENOL 1000MG TABLET LANTHANUM Y Y02290820 JULIET-35 2MG/35MCG TABLET CYPROTERONE/ETHINYL ESTRADIOL Y Y02291096 ORO-CLEAR 0.12% ORAL RINSE CHLORHEXIDINE GLUCONATE Y Y02291924 BICILLIN L-A 1200000U/2ML INJ PENICILLIN G BENZATHINE Y N02292165 DUODOPA 20-5MG/ML GEL LEVODOPA/CARBIDOPA Y Y02292661 XOLEGEL 2% GEL KETOCONAZOLE Y Y02293129 SPRYCEL 20MG TABLET DASATINIB MONOHYDRATE Y Y02293137 SPRYCEL 50MG TABLET DASATINIB MONOHYDRATE Y Y02293145 SPRYCEL 70MG TABLET DASATINIB MONOHYDRATE Y Y02293269 CAMPRAL 333MG DR TABLET ACAMPROSATE CALCIUM Y Y02293404 POSANOL 40MG/ML SUSP POSACONAZOLE Y Y02293692 REQUIP SR-24 2MG TABLET ROPINIROLE HCL Y Y02293706 REQUIP SR-24 3MG TABLET ROPINIROLE HCL Y Y02293714 REQUIP SR-24 4MG TABLET ROPINIROLE HCL Y Y02293722 REQUIP SR-24 8MG TABLET ROPINIROLE HCL Y Y02295695 SUBOXONE 2MG/0.5MG SL TABLET BUPRENORPHINE HCL/NALOXONE HCL Y Y02295709 SUBOXONE 8MG/2MG SL TABLET BUPRENORPHINE HCL/NALOXONE HCL Y Y02296187 LIDOCAINE HYDROCHLORIDE INJECTION USP 2% LIDOCAINE HCL Y Y02296195 LIDOCAINE HYDROCHLORIDE INJECTION USP 1% LIDOCAINE HCL Y Y02296381 TRIDURAL 100MG ER TABLET TRAMADOL HCL Y Y02296403 TRIDURAL 200MG ER TABLET TRAMADOL HCL Y Y02296411 TRIDURAL 300MG ER TABLET TRAMADOL HCL Y Y02296462 ADVAGRAF 0.5MG CAPSULE TACROLIMUS Y N02296470 ADVAGRAF 1MG CAPSULE TACROLIMUS Y N02296489 ADVAGRAF 5MG CAPSULE TACROLIMUS Y N02296659 SEASONALE 0.15MG/0.03MG TABLET LEVONORGESTREL/ETHINYL ESTRADIOL Y N02296810 LUCENTIS 10MG/ML OPH INJECTION RANIBIZUMAB Y Y02296934 MIRANOVA 21 TABLET LEVONORGESTREL/ETHINYL ESTRADIOL Y Y02296942 MIRANOVA 28 TABLET LEVONORGESTREL/ETHINYL ESTRADIOL Y Y02298007 2% LIDOCAINE AND EPINEPHRINE 1:100 000 INJECTION USP LIDOCAINE HCL/EPINEPHRINE Y Y02298465 RISPERDAL CONSTA 12.5MG/VIAL RISPERIDONE Y Y02298597 ZELDOX 20MG CAPSULE ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE Y N02298600 ZELDOX 40MG CAPSULE ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE Y N02298619 ZELDOX 60MG CAPSULE ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE Y N02298627 ZELDOX 80MG CAPSULE ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE Y N






02298791 EMEND 80MG CAPSULE APREPITANT Y Y02298805 EMEND 125MG CAPSULE APREPITANT Y Y02298813 EMEND TRI-PACK APREPITANT Y Y02299186 STERILE WATER FOR INJECTION USP WATER FOR INJECTION-STERILE Y Y02299194 RALIVIA 100MG ER TABLET TRAMADOL HCL Y Y02299208 RALIVIA 200MG ER TABLET TRAMADOL HCL Y Y02299216 RALIVIA 300MG ER TABLET TRAMADOL HCL Y Y02299844 CELSENTRI 150MG TABLET MARAVIROC Y Y02299852 CELSENTRI 300MG TABLET MARAVIROC Y Y02300435 PARVOLEX 200MG/ML LIQUID ACETYLCYSTEINE Y Y02300559 DERMOTIC OIL 0.01% EAR DROPS FLUOCINOLONE ACETONIDE Y Y02300613 BELESSE 28 TABLET LEVONORGESTREL/ETHINYL ESTRADIOL Y Y02300621 BELESSE 21 TABLET LEVONORGESTREL/ETHINYL ESTRADIOL Y Y02300648 DIMENHYDRINATE INJECTION USP 250MG/5ML (50MG/ML) DIMENHYDRINATE Y Y02301482 CYMBALTA 30MG DR CAPSULE DULOXETINE HCL Y Y02301490 CYMBALTA 60MG DR CAPSULE DULOXETINE HCL Y Y02301601 PRAVASA 10MG/325MG TABLET PRAVASTATIN SODIUM/ASA Y Y02301628 PRAVASA 20MG/325MG TABLET PRAVASTATIN SODIUM/ASA Y Y02301636 PRAVASA 40MG/325MG TABLET PRAVASTATIN SODIUM/ASA Y Y02301881 ISENTRESS 400MG TABLET RALTEGRAVIR POTASSIUM Y N02302411 XYLOCAINE 1% (WITH PRESERVATIVE) LIDOCAINE HCL Y Y02302438 XYLOCAINE 2% (WITH PRESERVATIVE) LIDOCAINE HCL Y Y02302497 ZEMPLAR 1MCG CAPSULE PARICALCITOL Y Y02302500 ZEMPLAR 2MCG CAPSULE PARICALCITOL Y Y02302519 ZEMPLAR 4MCG CAPSULE PARICALCITOL Y Y02303922 JANUVIA 100MG TABLET SITAGLIPTIN PHOSPHATE MONOHYDRATE Y Y02304341 SODIUM CHLORIDE INJECTION USP 0.9% SODIUM CHLORIDE Y Y02304821 PMS-MOXIFLOXACIN 400MG TABLET MOXIFLOXACIN HCL Y Y02304899 REVLIMID 5MG CAPSULE LENALIDOMIDE Y Y02304902 REVLIMID 10MG CAPSULE LENALIDOMIDE Y Y02305720 SIMVASA 5MG/81MG TABLET SIMVASTATIN/ASA Y Y02305739 SIMVASA 10MG/81MG TABLET SIMVASTATIN/ASA Y Y02305747 SIMVASA 20MG/81MG TABLET SIMVASTATIN/ASA Y Y02305755 SIMVASA 40MG/81MG TABLET SIMVASTATIN/ASA Y Y02305763 SIMVASA 80MG/81MG TABLET SIMVASTATIN/ASA Y Y02305771 SIMVASA 5MG/162MG TABLET SIMVASTATIN/ASA Y Y






02305798 SIMVASA 10MG/162MG TABLET SIMVASTATIN/ASA Y Y02305801 SIMVASA 20MG/162MG TABLET SIMVASTATIN/ASA Y Y02305828 SIMVASA 40MG/162MG TABLET SIMVASTATIN/ASA Y Y02305836 SIMVASA 80MG/162MG TABLET SIMVASTATIN/ASA Y Y02305844 SIMVASA 5MG/325MG TABLET SIMVASTATIN/ASA Y Y02305852 SIMVASA 10MG/325MG TABLET SIMVASTATIN/ASA Y Y02305860 SIMVASA 20MG/325MG TABLET SIMVASTATIN/ASA Y Y02305879 SIMVASA 40MG/325MG TABLET SIMVASTATIN/ASA Y Y02305887 SIMVASA 80MG/325MG TABLET SIMVASTATIN/ASA Y Y02305895 MARCAINE 0.25% MULTIDOSE VIAL INJECTION BUPIVACAINE HCL Y Y02305909 MARCAINE 0.5% (MULTIDOSE VIAL W/METHYLPARABEN) BUPIVACAINE HCL Y Y02305933 STALEVO 200-50-12.5MG TABLET LEVODOPA/CARBIDOPA/ENTACAPONE Y N02305941 STALEVO 200-100-25MG TABLET LEVODOPA/CARBIDOPA/ENTACAPONE Y N02305968 STALEVO 200-150-37.5MG TABLET LEVODOPA/CARBIDOPA/ENTACAPONE Y N02306190 DICLOFENAC 25MG DR TABLET DICLOFENAC SODIUM Y Y02306204 DICLOFENAC 50MG DR TABLET DICLOFENAC SODIUM Y Y02306514 CLINDESSE 2% VAGINAL CREAM CLINDAMYCIN PHOSPHATE Y Y02307065 VOLIBRIS 5MG TABLET AMBRISENTAN Y Y02307073 VOLIBRIS 10MG TABLET AMBRISENTAN Y Y02307502 ALTARGO 1% OINTMENT RETAPAMULIN Y Y02307995 MIRCERA 50MCG/ML VIAL METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308002 MIRCERA 100MCG/ML VIAL METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308010 MIRCERA 200MCG/ML VIAL METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308029 MIRCERA 300MCG/ML VIAL METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308037 MIRCERA 400MCG/ML VIAL METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308045 MIRCERA 600MCG/ML VIAL METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308053 MIRCERA 1000MCG/ML VIAL METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308061 MIRCERA 50MCG/0.3ML PFS METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308088 MIRCERA 75MCG/0.3ML PFS METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308096 MIRCERA 100MCG/0.3ML PFS METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308118 MIRCERA 150MCG/0.3ML PFS METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308126 MIRCERA 200MCG/0.3ML PFS METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308134 MIRCERA 250MCG/0.3ML PFS METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308142 MIRCERA 400MCG/0.6ML PFS METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308150 MIRCERA 600MCG/0.6ML PFS METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA Y Y02308215 RELISTOR 12MG/0.6ML VIAL (20MG/ML) INJECTION METHYLNALTREXONE BROMIDE Y Y






02308983 NEVANAC 0.1% OPTH.SUSP. NEPAFENAC Y Y02309254 NIASPAN FCT 500MG TABLET NICOTINIC ACID Y N02309262 NIASPAN FCT 750MG TABLET NICOTINIC ACID Y N02309289 NIASPAN FCT 1000MG TABLET NICOTINIC ACID Y N02312433 PRADAXA 75MG CAPSULE DABIGATRAN ETEXILATE Y Y02312441 PRADAXA 110MG CAPSULE DABIGATRAN ETEXILATE Y Y02313766 ADALAT XL PLUS 20/81MG TABLET NIFEDIPINE/ACETYLSALICYLIC ACID Y Y02313774 ADALAT XL PLUS 30/81MG TABLET NIFEDIPINE/ACETYLSALICYLIC ACID Y Y02313782 ADALAT XL PLUS 60/81MG TABLET NIFEDIPINE/ACETYLSALICYLIC ACID Y Y02313952 TEVA-ZOLMITRIPTAN 1MG TABLET ZOLMITRIPTAN Y Y02314541 TEVA-ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02314568 TEVA-ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02314576 TEVA-ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02314584 TEVA-ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02314592 TEVA-ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02315874 TASIGNA 200MG CAPSULE NILOTINIB HCL MONOHYDRATE Y Y02316986 XARELTO 10MG TABLET RIVAROXABAN Y Y02317699 REVLIMID 15MG CAPSULE LENALIDOMIDE Y Y02317710 REVLIMID 25MG CAPSULE LENALIDOMIDE Y Y02318024 APO-ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02318032 APO-ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02318040 APO-ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02318059 APO-ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02318067 APO-ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02318075 APO-ATOMOXETINE 80MG CAPSULE ATOMOXETINE HCL Y Y02318083 APO-ATOMOXETINE 100MG CAPSULE ATOMOXETINE HCL Y Y02318555 ARCOSYL PLUS 5MG/1.25MG TABLET PERINDOPRIL ARGININE/INDAPAMIDE Y Y02318563 ARCOSYL PLUS LD 2.5MG/0.625MG TABLET PERINDOPRIL ARGININE/INDAPAMIDE Y Y02319500 RATIO-SILDENAFIL R 20MG TABLET SILDENAFIL CITRATE Y Y02320193 SPRYCEL 100MG TABLET DASATINIB MONOHYDRATE Y Y02320398 M-ESLON IR 5MG CAPSULE MORPHINE SULFATE Y Y02320428 M-ESLON IR 10MG CAPSULE MORPHINE SULFATE Y Y02320436 M-ESLON IR 20MG CAPSULE MORPHINE SULFATE Y Y02320444 M-ESLON IR 30MG CAPSULE MORPHINE SULFATE Y Y02320673 STELARA 45MG/0.5ML INJECTION USTEKINUMAB Y Y02320681 STELARA 90MG/ML INJECTION USTEKINUMAB Y Y






02320908 RATIO-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02320924 ALREX 0.2% OPH SUSP LOTEPREDNOL ETABONATE Y Y02321092 PRISTIQ 50MG ER TABLET DESVENLAFAXINE SUCCINATE Y Y02321106 PRISTIQ 100MG ER TABLET DESVENLAFAXINE SUCCINATE Y Y02321114 LOTEMAX 0.5% OPHTHALMIC SUSPENSION LOTEPREDNOL ETABONATE Y Y02321130 PMS-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02321599 NOVO-MEMANTINE 5MG TABLET MEMANTINE HCL Y Y02321602 NOVO-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02321661 AZASITE 1% OPH SOLUTION AZITHROMYCIN Y Y02322951 VYVANSE 30MG CAPSULE LISDEXAMFETAMINE DIMESYLATE Y Y02322978 VYVANSE 50MG CAPSULE LISDEXAMFETAMINE DIMESYLATE Y Y02323052 INSPRA 25MG TABLET EPLERENONE Y Y02323060 INSPRA 50MG TABLET EPLERENONE Y Y02323273 METVIX 16.8% CREAM METHYL AMINOLEVULINATE HCL Y Y02323923 ADALAT OROS 20MG TABLET NIFEDIPINE Y Y02323931 ADALAT OROS 30MG TABLET NIFEDIPINE Y Y02323958 ADALAT OROS 60MG TABLET NIFEDIPINE Y Y02324032 XEOMIN 100U VIAL INCOBOTULINUMTOXINA Y Y02324059 ACT MEMANTINE 5MG TABLET MEMANTINE HCL Y Y02324067 ACT MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02324776 SIMPONI (PRE-FILLED SYRINGE) 50MG/0.5ML INJECTION GOLIMUMAB Y Y02324784 SIMPONI (AUTOINJECTOR) 50MG/0.5ML INJECTION GOLIMUMAB Y Y02326213 ASCORBIC ACID INJECTION USP 500MG/ML ASCORBIC ACID Y Y02326442 TYKERB 250MG TABLET LAPATINIB DITOSYLATE MONOHYDRATE Y Y02327260 APO-GATIFLOXACIN 3MG/ML OPH SOLUTION GATIFLOXACIN Y Y02327619 ZOLINZA 100MG CAPSULE VORINOSTAT Y Y02329840 CAYSTON 75MG/VIAL AZTREONAM Y Y02330989 MULTAQ 400MG TABLET DRONEDARONE Y Y02331667 ADVAGRAF 3MG CAPSULE TACROLIMUS Y N02331675 CIMZIA 200MG/ML SOLUTION CERTOLIZUMAB PEGOL Y Y02332906 DORIBAX 500MG VIAL INJECTION DORIPENEM MONOHYDRATE Y Y02333023 METHOTREXATE 25MG/ML INJECTION BP METHOTREXATE SODIUM Y Y02333554 ONGLYZA 5MG TABLET SAXAGLIPTIN HCL Y Y02333856 JANUMET 50/500MG TABLET SITAGLIPTIN/METFORMIN HCL Y Y02333864 JANUMET 50/850MG TABLET SITAGLIPTIN/METFORMIN HCL Y Y02333872 JANUMET 50/1000MG TABLET SITAGLIPTIN/METFORMIN HCL Y Y






02334186 DURAGESIC MAT 12MCG/HR (2.1MG) PATCH FENTANYL Y Y02336790 APO-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02336847 BESIVANCE 0.6% OPH SUSPENSION DROP BESIFLOXACIN Y Y02337266 JURNISTA 4MG ER TABLET HYDROMORPHONE HCL Y Y02337274 JURNISTA 8MG ER TABLET HYDROMORPHONE HCL Y Y02337282 JURNISTA 16MG ER TABLET HYDROMORPHONE HCL Y Y02337290 JURNISTA 32MG ER TABLET HYDROMORPHONE HCL Y Y02337304 JURNISTA 64MG ER TABLET HYDROMORPHONE HCL Y Y02337630 TOCTINO 10MG CAPSULE ALITRETINOIN Y Y02337649 TOCTINO 30MG CAPSULE ALITRETINOIN Y Y02337681 ELOINE TABLET DROSPIRENONE/ETHINYL ESTRADIOL Y Y02337703 PALANDRA 21 TABLET DROSPIRENONE/ETHINYL ESTRADIOL Y Y02337711 PALANDRA 28 TABLET DROSPIRENONE/ETHINYL ESTRADIOL Y Y02337827 STALEVO 200-75-18.75MG TABLET LEVODOPA/CARBIDOPA/ENTACAPONE Y N02337835 STALEVO 200-125-31.25MG TABLET LEVODOPA/CARBIDOPA/ENTACAPONE Y N02337932 ARCOSYL 2.5MG OD TABLET PERINDOPRIL ARGININE Y Y02337940 ARCOSYL 5MG OD TABLET PERINDOPRIL ARGININE Y Y02337959 ARCOSYL 10MG OD TABLET PERINDOPRIL ARGININE Y Y02338017 FERONA 0.3MG VIAL INTERFERON BETA-1B Y Y02338327 ADCIRCA 20MG TABLET TADALAFIL Y Y02338572 SILKIS OINTMENT CALCITRIOL Y N02339501 AFINITOR 5MG TABLET EVEROLIMUS Y Y02339528 AFINITOR 10MG TABLET EVEROLIMUS Y Y02339609 TARGIN 10/5MG TABLET OXYCODONE HCL/NALOXONE HCL Y Y02339617 TARGIN 20/10MG TABLET OXYCODONE HCL/NALOXONE HCL Y Y02339625 TARGIN 40/20MG TABLET OXYCODONE HCL/NALOXONE HCL Y Y02339706 SANCTURA XR 60MG CAPSULE TROSPIUM CHLORIDE Y Y02340038 FLUCONAZOLE 150MG CAPSULE FLUCONAZOLE Y Y02340445 ZYCLARA 3.75% CREAM IMIQUIMOD Y Y02341174 BUTRANS 5MCG/HR PATCH BUPRENORPHINE Y Y02341212 BUTRANS 10MCG/HR PATCH BUPRENORPHINE Y Y02341220 BUTRANS 20MCG/HR PATCH BUPRENORPHINE Y Y02341662 DICLOFENAC SODIUM SLOW-RELEASE 75MG TABLET DICLOFENAC SODIUM Y Y02342235 GD-ELETRIPTAN 20MG TABLET ELETRIPTAN HYDROBROMIDE Y N02342243 GD-ELETRIPTAN 40MG TABLET ELETRIPTAN HYDROBROMIDE Y N02342553 TEVA-ZOLMITRIPTAN OD 1MG TABLET ZOLMITRIPTAN Y Y






02343541 PROLIA 60MG/ML PRE-FILLED SYRINGE DENOSUMAB Y Y02343568 PROLIA 60MG/ML VIAL DENOSUMAB Y Y02344408 OLUX-E 0.05% SPRAY CLOBETASOL PROPIONATE Y Y02344807 SANDOZ-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02344939 ILARIS 150MG/VIAL INJECTION CANAKINUMAB Y Y02345099 IZILOX 400MG TABLET MOXIFLOXACIN HCL Y Y02345498 AZASITE 1% OPH SOLUTION AZITHROMYCIN Y Y02346176 SEASONIQUE 0.15/0.03MG & 0.1MG TABLET LEVONORGESTREL-ETHINYL ESTRADIOL/ETHYINL ESTRADIOL Y N02347156 VYVANSE 20MG CAPSULE LISDEXAMFETAMINE DIMESYLATE Y Y02347164 VYVANSE 40MG CAPSULE LISDEXAMFETAMINE DIMESYLATE Y Y02347172 VYVANSE 60MG CAPSULE LISDEXAMFETAMINE DIMESYLATE Y Y02347180 TEVA-TRAMADOL/ACETAMINOPHEN 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02348195 LIDOCAINE HCL INJECTION USP 1% (50MG/5ML) LIDOCAINE HCL Y Y02348489 VERDESO 0.05% AEROSOL TOPICAL FOAM DESONIDE Y Y02348950 RIVA-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02349116 MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02349124 EFFIENT 10MG TABLET PRASUGREL HCL Y Y02349450 TAMSULOSIN 0.4MG ER CAPSULE TAMSULOSIN HCL Y Y02349469 ULTRAM 50MG TABLET TRAMADOL HCL Y Y02349760 STERILE WATER FOR INJECTION USP WATER FOR INJECTION-STERILE Y Y02350092 ACTEMRA 80MG/4ML INJECTION TOCILIZUMAB Y Y02350106 ACTEMRA 200MG/10ML INJECTION TOCILIZUMAB Y Y02350114 ACTEMRA 400MG/20ML INJECTION TOCILIZUMAB Y Y02350351 SODIUM CHLORIDE INJECTION USP 0.9% SODIUM CHLORIDE Y Y02350580 KUVAN 100MG TABLET SAPROPTERIN DIHYDROCHLORIDE Y Y02350661 ONSOLIS 200MCG/UNIT FILM FENTANYL CITRATE Y Y02350688 ONSOLIS 400MCG/UNIT FILM FENTANYL CITRATE Y Y02350696 ONSOLIS 600MCG/UNIT FILM FENTANYL CITRATE Y Y02350718 ONSOLIS 800MCG/UNIT FILM FENTANYL CITRATE Y Y02350726 ONSOLIS 1200MCG/UNIT FILM FENTANYL CITRATE Y Y02351056 VICTOZA 1.2MG PEN INJECTOR LIRAGLUTIDE Y Y02351064 VICTOZA MULTIDOSE PEN INJECTOR LIRAGLUTIDE Y Y02352303 VOTRIENT 200MG TABLET PAZOPANIB HCL Y Y02352311 VOTRIENT 400MG TABLET PAZOPANIB HCL Y Y02352370 NTP-FENOFIBRATE-S 100MG TABLET FENOFIBRATE Y Y02352389 NTP-FENOFIBRATE-S 160MG TABLET FENOFIBRATE Y Y






02354047 MIRAPEX ER 0.375MG TABLET PRAMIPEXOLE DI-HCL Y Y02354055 MIRAPEX ER 0.75MG TABLET PRAMIPEXOLE DI-HCL Y Y02354063 MIRAPEX ER 1.5MG TABLET PRAMIPEXOLE DI-HCL Y Y02354071 MIRAPEX ER 3MG TABLET PRAMIPEXOLE DI-HCL Y Y02354098 MIRAPEX ER 4.5MG TABLET PRAMIPEXOLE DI-HCL Y Y02354209 INVEGA SUSTENNA 25MG/0.25ML INJECTION PALIPERIDONE PALMITATE Y Y02354217 INVEGA SUSTENNA 50MG/0.5ML INJECTION PALIPERIDONE PALMITATE Y Y02354225 INVEGA SUSTENNA 75MG/0.75ML INJECTION PALIPERIDONE PALMITATE Y Y02354233 INVEGA SUSTENNA 100MG/ML INJECTION PALIPERIDONE PALMITATE Y Y02354241 INVEGA SUSTENNA 150MG/1.5ML INJECTION PALIPERIDONE PALMITATE Y Y02354586 RENVELA 800MG TABLET SEVELAMER CARBONATE Y Y02354772 ZUACTA 0.075% CREAM ZUCAPSAICIN Y Y02354802 ZMAX SR 2G/BOTTLE EXTENDED RELEASE GRANULES AZITHROMYCIN DIHYDRATE Y Y02354950 DEXILANT 30MG CAPSULE DEXLANSOPRAZOLE Y N02354969 DEXILANT 60MG CAPSULE DEXLANSOPRAZOLE Y N02355191 THALOMID 50MG CAPSULE THALIDOMIDE Y Y02355205 THALOMID 100MG CAPSULE THALIDOMIDE Y Y02355213 THALOMID 150MG CAPSULE THALIDOMIDE Y Y02355221 THALOMID 200MG CAPSULE THALIDOMIDE Y Y02355655 RESTASIS 0.05% OPH EMULSION CYCLOSPORINE Y Y02356422 DIAMICRON MR 60MG TABLET GLICLAZIDE Y Y02356481 RELISTOR 8MG/0.4ML (20MG/ML) PRE FILLED SYRINGE METHYLNALTREXONE BROMIDE Y Y02356503 RELISTOR 12MG/0.6ML (20MG/ML) PRE FILLED SYRINGE METHYLNALTREXONE BROMIDE Y Y02357321 ARCOSYL PLUS 10MG/2.5MG TABLET PERINDOPRIL ARGININE/INDAPAMIDE Y Y02357380 ULORIC 80MG TABLET FEBUXOSTAT Y Y02357615 VIMPAT 50MG TABLET LACOSAMIDE Y Y02357623 VIMPAT 100MG TABLET LACOSAMIDE Y Y02357631 VIMPAT 150MG TABLET LACOSAMIDE Y Y02357658 VIMPAT 200MG TABLET LACOSAMIDE Y Y02357801 DORZOLAMIDE-TIMOLOL 2%-0.5% OPH SOLUTION DORZOLAMIDE HCL/TIMOLOL MALEATE Y Y02358190 ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02358204 ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02358212 ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02358220 ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02358239 ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02358247 ATOMOXETINE 80MG CAPSULE ATOMOXETINE HCL Y Y






02358255 ATOMOXETINE 100MG CAPSULE ATOMOXETINE HCL Y Y02358328 ACETAZOLAMIDE 500MG VIAL ACETAZOLAMIDE Y Y02358808 PRADAXA 150MG CAPSULE DABIGATRAN ETEXILATE Y Y02359456 DAXAS 500MCG TABLET ROFLUMILAST Y Y02360322 ZYTRAM XL 75MG TABLET TRAMADOL HCL Y Y02360349 ZYTRAM XL 100MG TABLET TRAMADOL HCL Y Y02360373 NUCYNTA CR 50MG TABLET TAPENTADOL HCL Y Y02360381 NUCYNTA CR 100MG TABLET TAPENTADOL HCL Y Y02360403 NUCYNTA CR 150MG TABLET TAPENTADOL HCL Y Y02360411 NUCYNTA CR 200MG TABLET TAPENTADOL HCL Y Y02360438 NUCYNTA CR 250MG TABLET TAPENTADOL HCL Y Y02360810 SPRYCEL 80MG TABLET DASATINIB MONOHYDRATE Y Y02360829 SPRYCEL 140MG TABLET DASATINIB MONOHYDRATE Y Y02361663 RAPAFLO 4MG CAPSULE SILODOSIN Y N02361671 RAPAFLO 8MG CAPSULE SILODOSIN Y N02361701 VIMOVO 375MG/20MG TABLET NAPROXEN/ESOMEPRAZOLE Y Y02361728 VIMOVO 500MG/20MG TABLET NAPROXEN/ESOMEPRAZOLE Y Y02361809 BYETTA (1.2ML PREFILLED PEN. 60 DOSES OF 5UG/DOSE) EXENATIDE Y Y02361817 BYETTA (2.4ML PREFILLED PEN. 60 DOSES OF 10UG/DOSE) EXENATIDE Y Y02361825 REVOLADE 25MG TABLET ELTROMBOPAG OLAMINE Y Y02361833 REVOLADE 50MG TABLET ELTROMBOPAG OLAMINE Y Y02361868 OLEPTRO 150MG TABLET TRAZODONE HCL Y Y02361876 OLEPTRO 300MG TABLET TRAZODONE HCL Y Y02362171 PATADAY 0.2% OPH SOLUTION OLOPATADINE HCL Y Y02362457 RATIO-ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02362465 RATIO-ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02362473 RATIO-ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02362481 RATIO-ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02362503 RATIO-ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02362511 TEVA-ATOMOXETINE 80MG CAPSULE ATOMOXETINE HCL Y Y02362538 TEVA-ATOMOXETINE 100MG CAPSULE ATOMOXETINE HCL Y Y02363445 OZURDEX (DEXAMETHASONE INTRAVITREAL IMPLANT 0.7MG) DEXAMETHASONE Y Y02364174 ABSTRAL 100MCG TABLET SL FENTANYL CITRATE Y Y02364182 ABSTRAL 200MCG TABLET SL FENTANYL CITRATE Y Y02364190 ABSTRAL 300MCG TABLET SL FENTANYL CITRATE Y Y02364204 ABSTRAL 400MCG TABLET SL FENTANYL CITRATE Y Y






02364212 ABSTRAL 600MCG TABLET SL FENTANYL CITRATE Y Y02364220 ABSTRAL 800MCG TABLET SL FENTANYL CITRATE Y Y02365480 GILENYA 0.5MG CAPSULE FINGOLIMOD Y Y02365561 VYLOMA 3.75% CREAM IMIQUIMOD Y Y02366142 GELNIQUE 100MG/G GEL PUMP 10% OXYBUTYNIN CHLORIDE Y Y02366150 GELNIQUE 100MG/G GEL 10% OXYBUTYNIN CHLORIDE Y Y02366487 APO-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02366665 AVA-DICLOFENAC 25MG DR TABLET DICLOFENAC SODIUM Y Y02366673 AVA-DICLOFENAC 50MG DR TABLET DICLOFENAC SODIUM Y Y02366924 LUXIQ 0.12% AEROSOL FOAM BETAMETHASONE VALERATE Y Y02368153 XGEVA (DENOSUMAB FOR ADVANCED CANCER) 70MG/ML DENOSUMAB Y Y02368250 TASIGNA 150MG CAPSULE NILOTINIB HCL MONOHYDRATE Y Y02368676 TRIESENCE 40MG/ML SUSP INJECTION TRIAMCINOLONE ACETONIDE Y Y02369257 AFINITOR 2.5MG TABLET EVEROLIMUS Y Y02369362 ACUVAIL 0.45% OPH SOLUTION KETOROLAC TROMETHAMINE Y Y02369613 BANZEL 100MG TABLET RUFINAMIDE Y Y02369621 BANZEL 200MG TABLET RUFINAMIDE Y Y02369648 BANZEL 400MG TABLET RUFINAMIDE Y Y02370050 BENLYSTA 120MG VIAL BELIMUMAB Y Y02370069 BENLYSTA 400MG VIAL BELIMUMAB Y Y02370417 ACTONEL DR 35MG TABLET (ENTERIC COATED) RISEDRONATE SODIUM Y Y02370433 SUBLINOX 10MG TABLET (ORALLY DISINTEGRATING) ZOLPIDEM TARTRATE Y Y02370468 SAMSCA 15MG TABLET TOLVAPTAN Y Y02370476 SAMSCA 30MG TABLET TOLVAPTAN Y Y02370484 SAMSCA 60MG TABLET TOLVAPTAN Y Y02370816 VICTRELIS 200MG CAPSULE BOCEPREVIR Y Y02370921 TRAJENTA 5MG TABLET LINAGLIPTIN Y Y02371065 ZYTIGA 250MG TABLET ABIRATERONE ACETATE Y Y02371081 XEOMIN 50U VIAL INCOBOTULINUMTOXINA Y Y02371448 VICTRELIS TRIPLE KIT 200MG CAP + 200MG CAP + 80UG/0.5ML INJ BOCEPREVIR/RIBAVIRIN/PEGINTERFERON ALFA-2B Y Y02371456 VICTRELIS TRIPLE KIT 200MG CAP + 200MG CAP + 100UG/0.5ML INJ BOCEPREVIR/RIBAVIRIN/PEGINTERFERON ALFA-2B Y Y02371464 VICTRELIS TRIPLE KIT 200MG CAP + 200MG CAP + 120UG/0.5ML INJ BOCEPREVIR/RIBAVIRIN/PEGINTERFERON ALFA-2B Y Y02371472 VICTRELIS TRIPLE KIT 200MG CAP + 200MG CAP + 150UG/0.5ML INJ BOCEPREVIR/RIBAVIRIN/PEGINTERFERON ALFA-2B Y Y02372010 JALYN 0.4MG/0.5MG CAPSULE TAMSULOSIN HCL/DUTASTERIDE Y Y02372525 OXYNEO 10MG TABLET OXYCODONE HCL Y Y02372533 OXYNEO 15MG TABLET OXYCODONE HCL Y Y






02372541 OXYNEO 30MG TABLET OXYCODONE HCL Y Y02372568 OXYNEO 40MG TABLET OXYCODONE HCL Y Y02372576 OXYNEO 60MG TABLET OXYCODONE HCL Y Y02372584 OXYNEO 80MG TABLET OXYCODONE HCL Y Y02372797 OXYNEO 20MG TABLET OXYCODONE HCL Y Y02372983 XYLOCAINE 0.5% VIAL (WITHOUT PRESERVATIVE) LIDOCAINE HCL Y Y02373017 DURELA 100MG ER CAPSULE TRAMADOL HCL Y Y02373025 DURELA 200MG ER CAPSULE TRAMADOL HCL Y Y02373033 DURELA 300MG ER CAPSULE TRAMADOL HCL Y Y02373955 LODALIS 625MG TABLET COLESEVELAM HCL Y Y02374803 SAPHRIS 5MG SL TABLET ASENAPINE Y Y02374811 SAPHRIS 10MG SL TABLET ASENAPINE Y Y02375532 SANDOZ-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02375842 ONGLYZA 2.5MG TABLET SAXAGLIPTIN HCL Y Y02375885 APPRILON 40MG CAPSULE DOXYCYCLINE Y Y02375907 CERTICAN 0.25MG TABLET EVEROLIMUS Y Y02375915 CERTICAN 0.5MG TABLET EVEROLIMUS Y Y02375923 CERTICAN 0.75MG TABLET EVEROLIMUS Y Y02376334 AVA-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02376938 ONBREZ BREEZHALER 75MCG CAPSULE INDACATEROL MALEATE Y N02377012 RESOTRAN 1MG TABLET PRUCALOPRIDE SUCCINATE Y Y02377020 RESOTRAN 2MG TABLET PRUCALOPRIDE SUCCINATE Y Y02377098 DIVIGEL 0.1% TRANSDERMAL GEL - 0.25MG PACK ESTRADIOL Y Y02377225 MOZOBIL 20MG/ML SOLUTION PLERIXAFOR Y Y02377233 ELIQUIS 2.5MG TABLET APIXABAN Y Y02377691 TEVA-ERLOTINIB 25MG TABLET ERLOTINIB HCL Y Y02377705 TEVA-ERLOTINIB 100MG TABLET ERLOTINIB HCL Y Y02377713 TEVA-ERLOTINIB 150MG TABLET ERLOTINIB HCL Y Y02378272 NUCYNTA IR 50MG TABLET TAPENTADOL HCL Y Y02378280 NUCYNTA IR 75MG TABLET TAPENTADOL HCL Y Y02378299 NUCYNTA IR 100MG TABLET TAPENTADOL HCL Y Y02378450 LOVENOX HP 90MG/0.6ML INJECTION ENOXAPARIN SODIUM Y Y02378582 CAPRELSA 100MG TABLET VANDETANIB Y Y02378590 CAPRELSA 300MG TABLET VANDETANIB Y Y02378604 XARELTO 15MG TABLET RIVAROXABAN Y Y02378612 XARELTO 20MG TABLET RIVAROXABAN Y Y






02378930 MYLAN-ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02378949 MYLAN-ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02378957 MYLAN-ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02378965 MYLAN-ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02378973 MYLAN-ATOMOXETINE 80MG CAPSULE ATOMOXETINE HCL Y Y02378981 MYLAN-ATOMOXETINE 100MG CAPSULE ATOMOXETINE HCL Y Y02379112 NATAZIA 28 TABLET ESTRADIOL VALERATE/DIENOGEST Y Y02379910 FAMPYRA 10MG TABLET FAMPRIDINE Y Y02380021 TOVIAZ 4MG EXTENDED RELEASE TABLET FESOTERODINE FUMARATE Y Y02380048 TOVIAZ 8MG EXTENDED RELEASE TABLET FESOTERODINE FUMARATE Y Y02380242 ZELBORAF 240MG TABLET VEMURAFENIB Y Y02380544 VANCOMYCIN HYDROCHLORIDE CAPSULES 125MG VANCOMYCIN HCL Y Y02380552 VANCOMYCIN HYDROCHLORIDE CAPSULES 250MG VANCOMYCIN HCL Y Y02380846 GD-LINEZOLID 3G SUSPENSION LINEZOLID Y Y02380986 GD-VORICONAZOLE 50MG TABLET VORICONAZOLE Y Y02380994 GD-VORICONAZOLE 200MG TABLET VORICONAZOLE Y Y02381001 GD-VORICONAZOLE 3G SUSPENSION VORICONAZOLE Y Y02381028 PMS-ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02381036 PMS-ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02381044 PMS-ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02381052 PMS-ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02381060 PMS-ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02381389 EDARBI 40MG TABLET AZILSARTAN MEDOXOMIL Y Y02381397 EDARBI 80MG TABLET AZILSARTAN MEDOXOMIL Y Y02381680 CAMBIA 50MG POWDER/DOSE DICLOFENAC POTASSIUM Y Y02381729 ALOXI 0.5MG CAPSULE PALONOSETRON HCL Y Y02382091 TEVA-ELETRIPTAN 20MG TABLET ELETRIPTAN HYDROBROMIDE Y N02382105 TEVA-ELETRIPTAN 40MG TABLET ELETRIPTAN HYDROBROMIDE Y N02382296 HEPARIN SODIUM INJECTION 10000U/10ML VIAL HEPARIN SODIUM Y N02382326 HEPARIN SODIUM INJECTION 10000U/2ML VIAL HEPARIN SODIUM Y N02382334 HEPARIN SODIUM INJECTION 50000U/10ML VIAL HEPARIN SODIUM Y Y02382369 AXIRON 2% SOLUTION 30MG/1.5ML DOSE TESTOSTERONE Y N02382830 PMS-MEMANTINE 5MG TABLET MEMANTINE HCL Y Y02382857 GLYCOPYRROLATE 0.2MG/ML INJECTION GLYCOPYRROLATE Y Y02383209 ACT TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02383403 OPANA ER 5MG TABLET OXYMORPHONE HCL Y Y






02383438 OPANA ER 10MG TABLET OXYMORPHONE HCL Y Y02383454 OPANA ER 20MG TABLET OXYMORPHONE HCL Y Y02383470 OPANA ER 40MG TABLET OXYMORPHONE HCL Y Y02384256 XALKORI 200MG CAPSULE CRIZOTINIB Y Y02384264 XALKORI 250MG CAPSULE CRIZOTINIB Y Y02384272 G.U.M. PAROEX 0.12% ORAL RINSE CHLORHEXIDINE GLUCONATE Y Y02386054 APO-ELETRIPTAN 20MG TABLET ELETRIPTAN HYDROBROMIDE Y N02386062 APO-ELETRIPTAN 40MG TABLET ELETRIPTAN HYDROBROMIDE Y N02386410 SANDOZ-ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02386429 SANDOZ-ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02386437 SANDOZ-ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02386445 SANDOZ-ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02386453 SANDOZ-ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02386461 SANDOZ-ATOMOXETINE 80MG CAPSULE ATOMOXETINE HCL Y Y02386488 SANDOZ-ATOMOXETINE 100MG CAPSULE ATOMOXETINE HCL Y Y02387123 IPG-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02387174 DIFICID 200MG TABLET FIDAXOMICIN Y Y02387425 TARGIN 5/2.5MG TABLET OXYCODONE HCL/NALOXONE HCL Y Y02387433 YAZ PLUS TABLET ETHINYL ESTRADIOL/DROSPIRENONE/LEVOMEFOLATE CALCIUM Y Y02387751 LATUDA 40MG TABLET LURASIDONE HYDROCHLORIDE Y Y02387778 LATUDA 80MG TABLET LURASIDONE HYDROCHLORIDE Y Y02387786 LATUDA 120MG TABLET LURASIDONE HYDROCHLORIDE Y Y02388006 JAKAVI 5MG TABLET RUXOLITINIB Y Y02388014 JAKAVI 15MG TABLET RUXOLITINIB Y Y02388022 JAKAVI 20MG TABLET RUXOLITINIB Y Y02388197 RAN-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02388294 TRAMAPHEN-ODAN 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02388308 JAMP-ACET-TRAMADOL 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02388316 XIAFLEX 0.9MG/VIAL INJECTION COLLAGENASE CLOSTRIDIUM HISTOLYTICUM Y Y02388324 MAR-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02388685 BANZEL 40MG/ML ORAL SUSPENSION RUFINAMIDE Y Y02388839 JANUVIA 25MG TABLET SITAGLIPTIN PHOSPHATE MONOHYDRATE Y Y02388847 JANUVIA 50MG TABLET SITAGLIPTIN PHOSPHATE MONOHYDRATE Y Y02389169 KOMBOGLYZE 2.5/500MG TABLET SAXAGLIPTIN/METFORMIN HCL Y Y02389177 KOMBOGLYZE 2.5/850MG TABLET SAXAGLIPTIN/METFORMIN HCL Y Y02389185 KOMBOGLYZE 2.5/1000MG TABLET SAXAGLIPTIN/METFORMIN HCL Y Y






02389274 PAT-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02389630 INLYTA 1MG TABLET AXITINIB Y Y02389649 INLYTA 5MG TABLET AXITINIB Y Y02389800 MINT-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02390469 DOM-ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02390477 DOM-ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02390485 DOM-ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02390493 DOM-ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02390515 DOM-ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02391449 CIPRALEX MELTZ 10MG TABLET ESCITALOPRAM Y Y02391457 CIPRALEX MELTZ 20MG TABLET ESCITALOPRAM Y Y02391554 PRIVA-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02391678 SUBLINOX 5MG TABLET (ORALLY DISINTEGRATING) ZOLPIDEM TARTRATE Y Y02392054 ZYCLARA 2.5% CREAM IMIQUIMOD Y Y02392429 ISENTRESS 25MG CHEWABLE TABLET RALTEGRAVIR POTASSIUM Y Y02392437 ISENTRESS 100MG CHEWABLE TABLET RALTEGRAVIR POTASSIUM Y Y02392453 HEPARIN SODIUM INJECTION/ USP HEPARIN SODIUM Y Y02392682 GD-SILDENAFIL R 20MG TABLET SILDENAFIL CITRATE Y Y02393751 ESBRIET 267MG CAPSULE PIRFENIDONE Y Y02394944 POTIGA 50MG TABLET EZOGABINE Y Y02394960 POTIGA 100MG TABLET EZOGABINE Y Y02394979 POTIGA 200MG TABLET EZOGABINE Y Y02394987 POTIGA 300MG TABLET EZOGABINE Y Y02394995 POTIGA 400MG TABLET EZOGABINE Y Y02395150 SODIUM CL 0.9% IV SOLUTION SODIUM CHLORIDE Y Y02396866 TEVA-VORICONAZOLE 50MG TABLET VORICONAZOLE Y Y02396874 TEVA-VORICONAZOLE 200MG TABLET VORICONAZOLE Y Y02396904 ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02396912 ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02396920 ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02396939 ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02396947 ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02396998 EPURIS 20MG CAPSULE ISOTRETINOIN Y Y02397005 EPURIS 30MG CAPSULE ISOTRETINOIN Y Y02397412 KALYDECO 150MG TABLET IVACAFTOR Y Y02397714 ELIQUIS 5MG TABLET APIXABAN Y Y






02397749 EDARBYCLOR 40MG/12.5MG TABLET AZILSARTAN MED/CHLORTHALIDONE Y Y02397757 EDARBYCLOR 80MG/12.5MG TABLET AZILSARTAN MED/CHLORTHALIDONE Y Y02397765 EDARBYCLOR 40MG/25MG TABLET AZILSARTAN MED/CHLORTHALIDONE Y Y02397900 TEVA-SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02397919 TEVA-SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02397927 NOCDURNA ODT 25MCG TABLET DESMOPRESSIN ACETATE Y Y02397935 NOCDURNA ODT 100MCG TABLET DESMOPRESSIN ACETATE Y Y02398028 PLIAGLIS CREAM 7%-7% LIDOCAINE/TETRACAINE Y Y02398168 RASILAMLO 150/5MG TABLET ALISKIREN FUMARATE/AMLODIPINE BESYLATE Y Y02398176 RASILAMLO 150/10MG TABLET ALISKIREN FUMARATE/AMLODIPINE BESYLATE Y Y02398184 RASILAMLO 300/5MG TABLET ALISKIREN FUMARATE/AMLODIPINE BESYLATE Y Y02398192 RASILAMLO 300/10MG TABLET ALISKIREN FUMARATE/AMLODIPINE BESYLATE Y Y02398257 SILENOR 3MG TABLET DOXEPIN HCL Y Y02398265 SILENOR 6MG TABLET DOXEPIN HCL Y Y02398869 INDAYO 0.15MG/0.03MG TABLET LEVONORGESTREL/ETHINYL ESTRADIOL Y N02398958 DIACOMIT 250MG CAPSULE STIRIPENTOL Y Y02398966 DIACOMIT 500MG CAPSULE STIRIPENTOL Y Y02398974 DIACOMIT 250MG POWDER FOR SUSPENSION STIRIPENTOL Y Y02398982 DIACOMIT 500MG POWDER FOR SUSPENSION STIRIPENTOL Y Y02398990 BYSTOLIC 2.5MG TABLET NEBIVOLOL Y Y02399008 BYSTOLIC 5MG TABLET NEBIVOLOL Y Y02399016 BYSTOLIC 10MG TABLET NEBIVOLOL Y Y02399024 BYSTOLIC 20MG TABLET NEBIVOLOL Y Y02399032 SANDOZ SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02399040 SANDOZ SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02399245 SANDOZ VORICONAZOLE 50MG TABLET VORICONAZOLE Y Y02399253 SANDOZ VORICONAZOLE 200MG TABLET VORICONAZOLE Y Y02399962 MYLAN-VORICONAZOLE 50MG TABLET VORICONAZOLE Y Y02399989 MYLAN-VORICONAZOLE 200MG TABLET VORICONAZOLE Y Y02400987 PICATO 0.015% GEL INGENOL MEBUTATE Y Y02400995 PICATO 0.05% GEL INGENOL MEBUTATE Y Y02401657 PMS-TRAMADOL-ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02401959 LYSTEDA 650MG TABLET TRANEXAMIC ACID Y Y02402211 TRAMADOL/ACETAMINOPHEN 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02402475 ORENCIA 125MG/ML SC INJECTION ABATACEPT Y Y02402823 APO-OLOPATADINE 0.2% OPH SOLUTION OLOPATADINE HCL Y Y






02402874 MYRBETRIQ 25MG ER TABLET MIRABEGRON Y Y02402882 MYRBETRIQ 50MG ER TABLET MIRABEGRON Y Y02403250 JENTADUETO 2.5/500MG TABLET LINAGLIPTIN/METFORMIN HCL Y Y02403269 JENTADUETO 2.5/850MG TABLET LINAGLIPTIN/METFORMIN HCL Y Y02403277 JENTADUETO 2.5/1000MG TABLET LINAGLIPTIN/METFORMIN HCL Y Y02403390 STIVARGA 40MG TABLET REGORAFENIB Y Y02403404 ESTROGEL PROPAK 0.06% GEL /100MG CAPSULE ESTRADIOL/PROGESTERONE Y Y02403595 SOLIFENACIN SUCCINATE 5MG TABLET SOLIFENACIN SUCCINATE Y Y02403609 SOLIFENACIN SUCCINATE 10MG TABLET SOLIFENACIN SUCCINATE Y Y02403897 NEUPRO 1MG PATCH ROTIGOTINE Y Y02403900 NEUPRO 2MG PATCH ROTIGOTINE Y Y02403919 NEUPRO 3MG PATCH ROTIGOTINE Y Y02403927 NEUPRO 4MG PATCH ROTIGOTINE Y Y02403935 NEUPRO 6MG PATCH ROTIGOTINE Y Y02403943 NEUPRO 8MG PATCH ROTIGOTINE Y Y02404044 XERESE 5%/1% CREAM ACYCLOVIR/HYDROCORTISONE Y Y02404095 ACT OLOPATADINE 0.2% OPH SOLUTION OLOPATADINE HCL Y Y02404508 TECFIDERA 120MG DR CAPSULE DIMETHYL FUMARATE Y Y02404516 FYCOMPA 2MG TABLET PERAMPANEL Y Y02404524 FYCOMPA 4MG TABLET PERAMPANEL Y Y02404532 FYCOMPA 6MG TABLET PERAMPANEL Y Y02404540 FYCOMPA 8MG TABLET PERAMPANEL Y Y02404559 FYCOMPA 10MG TABLET PERAMPANEL Y Y02404567 FYCOMPA 12MG TABLET PERAMPANEL Y Y02404664 PMS-ATOMOXETINE 80MG CAPSULE ATOMOXETINE HCL Y Y02404672 PMS-ATOMOXETINE 100MG CAPSULE ATOMOXETINE HCL Y Y02404680 APO-RASAGILINE 0.5MG TABLET RASAGILINE MESYLATE Y Y02404699 APO-RASAGILINE 1MG TABLET RASAGILINE MESYLATE Y Y02405962 RIVA-ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02405970 RIVA-ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02405989 RIVA-ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02405997 RIVA-ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02406004 RIVA-ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02407124 APO-GLICLAZIDE MR 60MG TABLET GLICLAZIDE Y Y02407329 XTANDI 40MG CAPSULE ENZALUTAMIDE Y Y02407868 STRIVERDI RESPIMAT 2.5MCG/ACT INHALATION SPRAY OLODATEROL HYDROCHLORIDE Y Y






02407981 TRAMADOL HCL AND ACETAMINOPHEN 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02408007 FENTORA 100MCG TABLET FENTANYL CITRATE Y Y02408015 FENTORA 200MCG TABLET FENTANYL CITRATE Y Y02408023 FENTORA 400MCG TABLET FENTANYL CITRATE Y Y02408031 FENTORA 600MCG TABLET FENTANYL CITRATE Y Y02408058 FENTORA 800MCG TABLET FENTANYL CITRATE Y Y02408090 MYLAN-BUPRENORPHINE/NALOXONE 2MG/0.5MG SL TABLET BUPRENORPHINE HCL/NALOXONE HCL Y Y02408104 MYLAN-BUPRENORPHINE/NALOXONE 8MG/2MG SL TABLET BUPRENORPHINE HCL/NALOXONE HCL Y Y02408546 INSTANYL 50MCG/DOSE FENTANYL CITRATE Y Y02408554 INSTANYL 200MCG/DOSE FENTANYL CITRATE Y Y02408562 INSTANYL 100MCG/DOSE FENTANYL CITRATE Y Y02408570 MYLAN-PANTOPRAZOLE T 40MG TABLET PANTOPRAZOLE MAGNESIUM Y Y02409100 INTUNIV XR 1MG TABLET GUANFACINE HCL Y Y02409119 INTUNIV XR 2MG TABLET GUANFACINE HCL Y Y02409127 INTUNIV XR 3MG TABLET GUANFACINE HCL Y Y02409135 INTUNIV XR 4MG TABLET GUANFACINE HCL Y Y02409267 ERIVEDGE 150MG CAPSULE VISMODEGIB Y Y02409607 TAFINLAR 50MG CAPSULE DABRAFENIB Y Y02409615 TAFINLAR 75MG CAPSULE DABRAFENIB Y Y02409623 MEKINIST 0.5MG TABLET TRAMETINIB Y Y02409631 MEKINIST 1MG TABLET TRAMETINIB Y Y02409658 MEKINIST 2MG TABLET TRAMETINIB Y Y02409674 APO-VORICONAZOLE 50MG TABLET VORICONAZOLE Y Y02409682 APO-VORICONAZOLE 200MG TABLET VORICONAZOLE Y Y02409887 MED-MEMANTINE 5MG TABLET MEMANTINE HCL Y Y02409895 MED-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02410702 ZAXINE 550MG TABLET RIFAXIMIN Y Y02411172 VITEKTA 85MG TABLET ELVITEGRAVIR Y Y02411180 VITEKTA 150MG TABLET ELVITEGRAVIR Y Y02411393 ILEVRO 0.3% OPTH.SUSP. NEPAFENAC Y Y02411423 TYBOST 150MG TABLET COBICISTAT Y Y02411849 VEREGEN 10% OINTMENT SINECATECHINS Y Y02412179 PMS-SILDENAFIL R 20MG TABLET SILDENAFIL CITRATE Y Y02412764 ADEMPAS 0.5MG TABLET RIOCIGUAT Y Y02412772 ADEMPAS 1MG TABLET RIOCIGUAT Y Y02412799 ADEMPAS 1.5MG TABLET RIOCIGUAT Y Y






02412802 ADEMPAS 2MG TABLET RIOCIGUAT Y Y02412810 ADEMPAS 2.5MG TABLET RIOCIGUAT Y Y02413175 SIMPONI 100MG INJECTION GOLIMUMAB Y Y02413183 SIMPONI (AUTOINJECTOR) 100MG/ML INJECTION GOLIMUMAB Y Y02413299 SIGNIFOR 0.3MG/ML INJ PASIREOTIDE Y Y02413302 SIGNIFOR 0.6MG/ML INJ PASIREOTIDE Y Y02413310 SIGNIFOR 0.9MG/ML INJ PASIREOTIDE Y Y02413361 LATUDA 60MG TABLET LURASIDONE HYDROCHLORIDE Y Y02413388 JUBLIA 10% TOPICAL SOLUTION EFINACONAZOLE Y Y02413795 MYLAN-CYANOCOBALAMIN 1000MCG/ML CYANOCOBALAMIN Y N02415534 DUREZOL 0.05% OPHTHALMIC DIFLUPREDNATE Y Y02415577 NUCYNTA EXTENDED RELEASE 50MG TABLET TAPENTADOL HCL Y Y02415585 NUCYNTA EXTENDED RELEASE 100MG TABLET TAPENTADOL HCL Y Y02415593 NUCYNTA EXTENDED RELEASE 150MG TABLET TAPENTADOL HCL Y Y02415607 NUCYNTA EXTENDED RELEASE 200MG TABLET TAPENTADOL HCL Y Y02415615 NUCYNTA EXTENDED RELEASE 250MG TABLET TAPENTADOL HCL Y Y02415666 GIOTRIF 20MG TABLET AFATINIB DIMALEATE Y Y02415674 GIOTRIF 30MG TABLET AFATINIB DIMALEATE Y Y02415682 GIOTRIF 40MG TABLET AFATINIB DIMALEATE Y Y02415690 OPSUMIT 10MG TABLET MACITENTAN Y Y02415844 TEVA-FROVATRIPTAN 2.5MG TABLET FROVATRIPTAN SUCCINATE Y Y02416441 GALEXOS 150MG CAPSULE SIMEPREVIR Y Y02416522 OLANZAPINE FOR INJECTION 10MG/VIAL INJECTION OLANZAPINE Y Y02416786 JANUMET XR 50/500MG TABLET SITAGLIPTIN/METFORMIN HCL Y Y02416794 JANUMET XR 50/1000MG TABLET SITAGLIPTIN/METFORMIN HCL Y Y02416808 JANUMET XR 100/1000MG TABLET SITAGLIPTIN/METFORMIN HCL Y Y02417162 CONSTELLA 145MCG CAPSULE LINACLOTIDE Y Y02417170 CONSTELLA 290MCG CAPSULE LINACLOTIDE Y Y02417189 NESINA 6.25MG TABLET ALOGLIPTIN BENZOATE Y Y02417197 NESINA 12.5MG TABLET ALOGLIPTIN BENZOATE Y Y02417200 NESINA 25MG TABLET ALOGLIPTIN BENZOATE Y Y02417219 KAZANO 12.5MG/500MG TABLET ALOGLIPTIN BENZOATE/METFORMIN HCL Y Y02417227 KAZANO 12.5MG/850MG TABLET ALOGLIPTIN BENZOATE/METFORMIN HCL Y Y02417235 KAZANO 12.5MG/1000MG TABLET ALOGLIPTIN BENZOATE/METFORMIN HCL Y Y02417456 LOLO 1MG/10UG TABLET NORETHINDRONE/ETHINYL ESTRADIOL Y Y02417472 SIMPONI IV 50MG/4ML INJECTION GOLIMUMAB Y Y






02417502 TRAMADOL-ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02417723 PMS-SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02417731 PMS-SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02418118 APO-SILDENAFIL R 20MG TABLET SILDENAFIL CITRATE Y Y02418282 ULTIBRO BREEZHALER 50MCG/110MCG CAP GLYCOPYRONIUM BROMIDE/INDACATEROL MALEATE Y Y02418320 LEMTRADA 12MG/VIAL IV SOLUTION ALEMTUZUMAB Y Y02418355 SOVALDI 400MG TABLET SOFOSBUVIR Y Y02418401 ANORO ELLIPTA 62.5MCG/25MCG POWDER FOR INHALATION UMECLIDINIUM BROMIDE/VILANTEROL TRIFENATATE Y Y02418436 TEVA-RASAGILINE 0.5MG TABLET RASAGILINE MESYLATE Y Y02418444 TEVA-RASAGILINE 1MG TABLET RASAGILINE MESYLATE Y Y02419149 BOSULIF 100MG TABLET BOSUTINIB Y Y02419157 BOSULIF 500MG TABLET BOSUTINIB Y Y02419300 OSENI 12.5MG/15MG TABLET ALOGLIPTIN BENZOATE/PIOGLITAZONE HCL Y Y02419319 OSENI 12.5MG/30MG TABLET ALOGLIPTIN BENZOATE/PIOGLITAZONE HCL Y Y02419327 OSENI 12.5MG/45MG TABLET ALOGLIPTIN BENZOATE/PIOGLITAZONE HCL Y Y02419335 OSENI 25MG/15MG TABLET ALOGLIPTIN BENZOATE/PIOGLITAZONE HCL Y Y02419343 OSENI 25MG/30MG TABLET ALOGLIPTIN BENZOATE/PIOGLITAZONE HCL Y Y02419351 OSENI 25MG/45MG TABLET ALOGLIPTIN BENZOATE/PIOGLITAZONE HCL Y Y02419475 INFLECTRA 100MG/VIAL INJECTION INFLIXIMAB Y Y02419483 REMSIMA 100MG/VIAL INJECTION INFLIXIMAB Y Y02419580 POMALYST 1MG CAPSULE POMALIDOMIDE Y Y02419599 POMALYST 2MG CAPSULE POMALIDOMIDE Y Y02419602 POMALYST 3MG CAPSULE POMALIDOMIDE Y Y02419610 POMALYST 4MG CAPSULE POMALIDOMIDE Y Y02420015 PAT-OXYBUTYNIN CHLORIDE ER 15MG TABLET OXYBUTYNIN CHLORIDE Y Y02420147 JAMP-CYANOCOBALAMIN 1000MCG/ML CYANOCOBALAMIN Y N02420171 SANDOZ OLOPATADINE 0.2% OPH SOLUTION OLOPATADINE HCL Y Y02420201 TECFIDERA 240MG DR CAPSULE DIMETHYL FUMARATE Y Y02420341 JUXTAPID 5MG CAPSULE LOMITAPIDE MESYLATE Y Y02420376 JUXTAPID 10MG CAPSULE LOMITAPIDE MESYLATE Y Y02420384 JUXTAPID 20MG CAPSULE LOMITAPIDE MESYLATE Y Y02420864 ABILIFY MAINTENA 300MG/VIAL INJECTION ARIPIPRAZOLE Y Y02420872 ABILIFY MAINTENA 400MG/VIAL INJECTION ARIPIPRAZOLE Y Y02421208 ONRELTEA 5MG/G GEL BRIMONIDINE TARTRATE Y Y02421364 RAN-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02421933 APO-TADALAFIL PAH 20MG TABLET TADALAFIL Y Y






02421941 LOTEMAX 0.5% OPH OINTMENT LOTEPREDNOL ETABONATE Y Y02421984 LIDOCAINE HCL INJECTION USP 1% LIDOCAINE HCL Y Y02421992 LIDOCAINE HCL 2% INJECTION LIDOCAINE HCL Y Y02422026 LIDOCAINE HCL INJECTION WITH PRESERVATIVE 20MG/ML LIDOCAINE HCL Y Y02422050 LATUDA 20MG TABLET LURASIDONE HYDROCHLORIDE Y Y02422239 ACT SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02422247 ACT SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02422824 RIVA-ATOMOXETINE 80MG CAPSULE ATOMOXETINE HCL Y Y02422832 RIVA-ATOMOXETINE 100MG CAPSULE ATOMOXETINE HCL Y Y02422883 INLYTA 3MG TABLET AXITINIB Y Y02422891 INLYTA 7MG TABLET AXITINIB Y Y02423049 REVOLADE 75MG TABLET ELTROMBOPAG OLAMINE Y Y02423294 MINT-GLICLAZIDE MR 60MG TABLET GLICLAZIDE Y Y02423375 APO-SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02423383 APO-SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02423677 EGRIFTA 2MG/VIAL TESAMORELIN Y Y02423898 XELJANZ 5MG TABLET TOFACITINIB CITRATE Y Y02424339 JAMP-SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02424347 JAMP-SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02424622 POSANOL 100MG TABLET POSACONAZOLE Y Y02424770 ACTEMRA 162MG/0.9ML INJECTION TOCILIZUMAB Y Y02424835 DIVIGEL 0.1% TRANSDERMAL GEL - 0.5MG PACK ESTRADIOL Y Y02424843 DIVIGEL 0.1% TRANSDERMAL GEL - 1MG PACK ESTRADIOL Y Y02424851 TEVA-BUPRENORPHINE/NALOXONE 2MG/0.5MG SL TABLET BUPRENORPHINE HCL/NALOXONE HCL Y Y02424878 TEVA-BUPRENORPHINE/NALOXONE 8MG/2MG SL TABLET BUPRENORPHINE HCL/NALOXONE HCL Y Y02424924 DIVIGEL 0.1% TRANSDERMAL GEL - 0.25MG PACK ESTRADIOL Y Y02424959 RIVA-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02425149 SAFLUTAN 15MCG/ML OPH SOLUTION TAFLUPROST Y Y02425483 INVOKANA 100MG TABLET CANAGLIFLOZIN Y Y02425491 INVOKANA 300MG TABLET CANAGLIFLOZIN Y Y02425599 MYLAN-TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02425629 LUCENTIS 10MG/ML OPH PRE-FILLED SYRINGE RANIBIZUMAB Y Y02425645 AFINITOR DISPERZ 2MG TABLET EVEROLIMUS Y Y02425653 AFINITOR DISPERZ 3MG TABLET EVEROLIMUS Y Y02425661 AFINITOR DISPERZ 5MG TABLET EVEROLIMUS Y Y02425696 FIRAZYR 10MG/ML INJECTION ICATIBANT ACETATE Y Y






02425742 MEMANTINE HYDROCHLORIDE 10MG TABLETS MEMANTINE HCL Y Y02426153 APO-TRAMADOL 50MG TABLET TRAMADOL HCL Y Y02426471 APO-FROVATRIPTAN 2.5MG TABLET FROVATRIPTAN SUCCINATE Y Y02426633 MYLAN-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02426641 MYLAN-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02426803 TRAMADOL/ACET 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02426862 APTIOM 200MG TABLET ESLICARBAZEPINE ACETATE Y Y02426870 APTIOM 400MG TABLET ESLICARBAZEPINE ACETATE Y Y02426889 APTIOM 600MG TABLET ESLICARBAZEPINE ACETATE Y Y02426897 APTIOM 800MG TABLET ESLICARBAZEPINE ACETATE Y Y02428911 MED-SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02428938 MED-SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02428946 ACTIKERALL 0.5%/10% TOPICAL SOLUTION FLUOROURACIL/SALICYLIC ACID Y Y02428954 ALVEDA DIMENHYDRINATE INJECTION USP 50 MG/ML VIAL DIMENHYDRINATE Y Y02429446 PMS-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02429454 PMS-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02429772 ACT GLICLAZIDE MR 60MG TABLET GLICLAZIDE Y Y02429969 TRAMADOL/ACETAMINOPHEN 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02429977 ZEULIDE DEPOT 5.06MG VIAL LEUPROLIDE ACETATE Y Y02430371 MYLAN-MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02430886 BUPIVACAINE HYDROCHLORIDE INJECTION USP 2.5MG/ML BUPIVACAINE HCL Y Y02430894 BUPIVACAINE HYDROCHLORIDE INJECTION USP 5MG/ML BUPIVACAINE HCL Y Y02430908 BUPIVACAINE HYDROCHLORIDE INJECTION USP 7.5MG/ML BUPIVACAINE HCL Y Y02430916 BUPIVACAINE HYDROCHLORIDE INJECTION USP (MDV) 5MG/ML BUPIVACAINE HCL Y Y02430924 BUPIVACAINE HYDROCHLORIDE INJECTION USP (MDV) 2.5MG/ML BUPIVACAINE HCL Y Y02430932 TRIUMEQ 600/300/50MG TABLET ABACAVIR/LAMIVUDINE/DOLUTEGRAVIR Y N02431076 NOCDURNA ODT 50MCG TABLET DESMOPRESSIN ACETATE Y Y02431998 ACH-VORICONAZOLE 50MG TABLET VORICONAZOLE Y Y02432005 ACH-VORICONAZOLE 200MG TABLET VORICONAZOLE Y Y02432226 HARVONI 90MG/400MG TABLET LEDIPASVIR/SOFOSBUVIR Y Y02432250 JAMP-BUPIVACAINE 2.5MG/ML VIAL (PRESERVATIVE FREE) BUPIVACAINE HCL Y Y02432269 JAMP-BUPIVACAINE 2.5MG/ML VIAL (WITH PRESERVATIVE) BUPIVACAINE HCL Y Y02432277 JAMP-BUPIVACAINE 5MG/ML VIAL (PRESERVATIVE FREE) BUPIVACAINE HCL Y Y02432285 JAMP-BUPIVACAINE 5MG/ML VIAL (WITH PRESERVATIVE) BUPIVACAINE HCL Y Y02432331 DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02432447 DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y






02432463 LODALIS 3.75G/UNIT POWDER FOR SUSPENSION COLESEVELAM HCL Y Y02432854 DUAVIVE 20MG/0.45MG TABLET BAZEDOXIFENE ACETATE/CONJUGATED ESTROGENS Y Y02432889 DYMISTA 137MCG/50MCG NASAL SPRAY AZELASTINE/FLUTICASONE Y Y02432919 TRINTELLIX 5MG TABLET VORTIOXETINE HYDROBROMIDE Y Y02432927 TRINTELLIX 10MG TABLET VORTIOXETINE HYDROBROMIDE Y Y02432935 TRINTELLIX 15MG TABLET VORTIOXETINE HYDROBROMIDE Y Y02432943 TRINTELLIX 20MG TABLET VORTIOXETINE HYDROBROMIDE Y Y02434318 OTEZLA 10/20/30MG (27-COUNT STARTER PACK) APREMILAST Y Y02434334 OTEZLA 30MG TAB APREMILAST Y Y02434342 PMS-ELETRIPTAN 20MG TABLET ELETRIPTAN HYDROBROMIDE Y N02434350 PMS-ELETRIPTAN 40MG TABLET ELETRIPTAN HYDROBROMIDE Y N02434407 IMBRUVICA 140MG CAPSULE IBRUTINIB Y Y02434539 MYLAN-CINACALCET 30MG TABLET CINACALCET HCL Y Y02434547 MYLAN-CINACALCET 60MG TABLET CINACALCET HCL Y Y02434555 MYLAN-CINACALCET 90MG TABLET CINACALCET HCL Y Y02434814 JAKAVI 10MG TABLET RUXOLITINIB Y Y02434946 APO-ZOLPIDEM ODT 10MG TABLET ZOLPIDEM TARTRATE Y Y02435241 DIMENHYDRINATE INJECTION USP 250MG/5ML (50MG/ML) DIMENHYDRINATE Y Y02435411 SIMBRINZA 0.2% OPHTHALMIC SUSPENSION BRIMONIDINE TARTRATE/BRINZOLAMIDE Y N02435462 FORXIGA 5MG TABLET DAPAGLIFLOZIN Y Y02435470 FORXIGA 10MG TABLET DAPAGLIFLOZIN Y Y02435659 GENERESS 0.8/0.025MG CHEWABLE TABLET NORETHINDRONE/ETHINYL ESTRADIOL Y Y02435853 LOTEMAX 0.5% OPH GEL LOTEPREDNOL ETABONATE Y Y02436159 APO-ZOLPIDEM ODT 5MG TABLET ZOLPIDEM TARTRATE Y Y02436329 ELLA 30MG TABLET ULIPRISTAL ACETATE Y Y02436396 MODERIBA 200MG TABLET RIBAVIRIN Y Y02436418 MODERIBA 400MG TABLET RIBAVIRIN Y Y02436426 MODERIBA 600MG TABLET RIBAVIRIN Y Y02436523 FERRIPROX 100MG/ML SOLUTION DEFERIPRONE Y Y02436531 FERRIPROX 500MG TABLET DEFERIPRONE Y Y02436558 FERRIPROX 1000MG TABLET DEFERIPRONE Y Y02436647 AURO-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02436655 AURO-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02436663 PHEBURANE 483MG/G GRANULES SODIUM PHENYLBUTYRATE Y Y02436779 ZYKADIA 150MG CAPSULE CERITINIB Y Y02436817 TEVA-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y






02436825 TEVA-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02436841 ENTYVIO 300MG VIAL VEDOLIZUMAB Y Y02437082 DULOXETINE DR 30MG CAPSULE DULOXETINE HCL Y Y02437090 DULOXETINE DR 60MG CAPSULE DULOXETINE HCL Y Y02437252 SIGNIFOR LAR 20MG VIAL PASIREOTIDE Y Y02437260 SIGNIFOR LAR 40MG VIAL PASIREOTIDE Y Y02437279 SIGNIFOR LAR 60MG VIAL PASIREOTIDE Y Y02437333 ICLUSIG 15MG TABLET PONATINIB HYDROCHLORIDE Y Y02437341 ICLUSIG 45MG TABLET PONATINIB HYDROCHLORIDE Y Y02437503 JINARC 45MG/15MG TABLET TOLVAPTAN/TOLVAPTAN Y Y02437511 JINARC 60MG/30MG TABLET TOLVAPTAN/TOLVAPTAN Y Y02437538 JINARC 90MG/30MG TABLET TOLVAPTAN/TOLVAPTAN Y Y02437988 RAN-SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02437996 RAN-SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02438062 COSENTYX 150MG/ML INJECTION SECUKINUMAB Y Y02438070 COSENTYX 150MG/ML PFS INJECTION SECUKINUMAB Y Y02438089 IPG-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02438097 IPG-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02438259 RAN-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02438267 RAN-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02438623 SIVEXTRO 200MG TABLET TEDIZOLID PHOSPHATE Y Y02438712 EGRIFTA 1MG/VIAL TESAMORELIN Y Y02438798 ZYDELIG 100MG TABLET IDELALISIB Y Y02438801 ZYDELIG 150MG TABLET IDELALISIB Y Y02438984 MINT-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02438992 MINT-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02439050 AURO-TRAMADOL/ACETAMINOPHEN 37.5/325MG TABLET TRAMADOL HCL/ACETAMINOPHEN Y Y02439123 PROLENSA 0.07% OPH SOLUTION BROMFENAC SODIUM SESQUIHYDRATE Y Y02439328 RAN-GLICLAZIDE MR 60MG TABLET GLICLAZIDE Y Y02439344 ACH-SOLIFENACIN SUCCINATE 5MG TABLET SOLIFENACIN SUCCINATE Y Y02439352 ACH-SOLIFENACIN SUCCINATE 10MG TABLET SOLIFENACIN SUCCINATE Y Y02439360 CARBAGLU 200MG TABLET CARGLUMIC ACID Y Y02439603 VYVANSE 10MG CAPSULE LISDEXAMFETAMINE DIMESYLATE Y Y02439638 ZOLPIDEM TARTRATE ODT 10MG TABLET ZOLPIDEM TARTRATE Y Y02439646 ZOLPIDEM TARTRATE ODT 5MG TABLET ZOLPIDEM TARTRATE Y Y02439948 SANDOZ DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y






02439956 SANDOZ DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02440342 ROSIVER 1.0% CREAM IVERMECTIN Y Y02440423 APO-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02440431 APO-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02440601 REVLIMID 20MG CAPSULE LENALIDOMIDE Y Y02440628 TEVA-PANTOPRAZOLE MAGNESIUM 40MG TABLET PANTOPRAZOLE MAGNESIUM Y Y02440970 FETZIMA 20MG CAPSULE LEVOMILNACIPRAN Y Y02440989 FETZIMA 40MG CAPSULE LEVOMILNACIPRAN Y Y02440997 FETZIMA 80MG CAPSULE LEVOMILNACIPRAN Y Y02441004 FETZIMA 120MG CAPSULE LEVOMILNACIPRAN Y Y02441357 GD-ZIPRASIDONE 20MG CAPSULE ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE Y Y02441365 GD-ZIPRASIDONE 40MG CAPSULE ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE Y Y02441373 GD-ZIPRASIDONE 60MG CAPSULE ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE Y Y02441381 GD-ZIPRASIDONE 80MG CAPSULE ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE Y Y02441535 XARELTO 15MG/20MG TABLETS STARTER PACK RIVAROXABAN Y Y02441853 PANTOPRAZOLE MAGNESIUM 40MG TABLET PANTOPRAZOLE MAGNESIUM Y Y02442167 MOVANTIK 12.5MG TABLET NALOXEGOL OXALATE Y Y02442175 MOVANTIK 25MG TABLET NALOXEGOL OXALATE Y Y02442302 QUINSAIR 240MG INHALATION SOLUTION LEVOFLOXACIN Y Y02442388 MINT-LEVETIRACETAM 250MG TABLET LEVETIRACETAM Y Y02442396 MINT-LEVETIRACETAM 500MG TABLET LEVETIRACETAM Y Y02442418 MINT-LEVETIRACETAM 750MG TABLET LEVETIRACETAM Y Y02442612 KALYDECO 50MG GRANULES IVACAFTOR Y Y02442620 KALYDECO 75MG GRANULES IVACAFTOR Y Y02442734 VIIBRYD 10MG TABLET VILAZODONE HYDROCHLORIDE Y Y02442744 YASMIN PLUS TABLET ETHINYL ESTRADIOL/DROSPIRENONE/LEVOMEFOLATE CALCIUM Y Y02443066 OFEV 100MG CAPSULE NINTEDANIB Y Y02443074 OFEV 150MG CAPSULE NINTEDANIB Y Y02443082 MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02443171 MINT-SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02443198 MINT-SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02443635 EPERZAN 30MG/0.5ML INJECTION ALBIGLUTIDE Y Y02443643 EPERZAN 50MG/0.5ML INJECTION ALBIGLUTIDE Y Y02443686 BUPIVACAINE HYDROCHLORIDE INJECTION BP 2.5MG/ML INJECTION BUPIVACAINE HCL Y Y02443694 BUPIVACAINE HYDROCHLORIDE INJECTION BP 5MG/ML INJECTION BUPIVACAINE HCL Y Y02443732 VIIBRYD 20MG TABLET VILAZODONE HYDROCHLORIDE Y Y






02443740 VIIBRYD 40MG TABLET VILAZODONE HYDROCHLORIDE Y Y02443759 VIIBRYD 10MG/20MG TABLET VILAZODONE HYDROCHLORIDE Y Y02443767 VIIBRYD 10MG/20MG/40MG TABLET VILAZODONE HYDROCHLORIDE Y Y02443937 JARDIANCE 10MG TABLET EMPAGLIFLOZIN Y Y02443945 JARDIANCE 25MG TABLET EMPAGLIFLOZIN Y Y02444267 VARITHENA 285ML-303ML-180MG/U INJECTION CARBON DIOXIDE/OXYGEN/POLIDOCANOL Y Y02444607 STRENSIQ 12MG/0.3ML INJECTION ASFOTASE ALFA Y Y02444615 STRENSIQ 18MG/0.45ML INJECTION ASFOTASE ALFA Y Y02444623 STRENSIQ 28MG/0.7ML INJECTION ASFOTASE ALFA Y Y02444631 STRENSIQ 40MG/1ML INJECTION ASFOTASE ALFA Y Y02444658 STRENSIQ 80MG/0.8ML INJECTION ASFOTASE ALFA Y Y02444747 DAKLINZA 30MG TABLET DACLATASVIR Y Y02444755 DAKLINZA 60MG TABLET DACLATASVIR Y Y02445018 ABILIFY MAINTENA 300MG/VIAL INJECTION ARIPIPRAZOLE Y Y02445026 ABILIFY MAINTENA 400MG/VIAL INJECTION ARIPIPRAZOLE Y Y02445158 CREON MINIMICROSPHERES MICRO GRANULES AMYLASE/LIPASE/PROTEASE Y N02445727 REVESTIVE 5MG VIAL TEDUGLUTIDE Y Y02445883 ATOMOXETINE 10MG CAPSULE ATOMOXETINE HCL Y Y02445905 ATOMOXETINE 18MG CAPSULE ATOMOXETINE HCL Y Y02445913 ATOMOXETINE 25MG CAPSULE ATOMOXETINE HCL Y Y02445948 ATOMOXETINE 40MG CAPSULE ATOMOXETINE HCL Y Y02445956 ATOMOXETINE 60MG CAPSULE ATOMOXETINE HCL Y Y02446049 MEMANTINE 10MG TABLET MEMANTINE HCL Y Y02446057 REPATHA 140MG/ML SINGLE USE PREFILLED SYRINGE AND AUTOINJECTOR EVOLOCUMAB Y Y02446081 MAR-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02446103 MAR-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02446324 QNASL (BECLOMETHASONE DIPROPIONATE) 40MCG/ACT NASAL SPRAY BECLOMETHASONE DIPROPIONATE Y Y02446332 QNASL (BECLOMETHASONE DIPROPIONATE) 80MCG/ACT NASAL SPRAY BECLOMETHASONE DIPROPIONATE Y Y02446375 AURO-SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02446383 AURO-SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02446731 EVOTAZ 300MG/150MG TABLET ATAZANAVIR/COBICISTAT Y Y02446928 ENTRESTO 25.7MG/24.3MG TABLET VALSARTAN/SACUBITRIL Y Y02446936 ENTRESTO 51.4MG/48.6MG TABLET VALSARTAN/SACUBITRIL Y Y02446944 ENTRESTO 102.8MG/97.2MG TABLET VALSARTAN/SACUBITRIL Y Y02447029 TORRENT-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02447037 TORRENT-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y






02447363 AMITIZA 24MCG CAPSULE LUBIPROSTONE Y Y02447711 TECHNIVIE TABLET RITONAVIR/PARITAPREVIR/OMBITASVIR Y Y02448335 SOLIFENACIN SUCCINATE 5MG TABLET SOLIFENACIN SUCCINATE Y Y02448343 SOLIFENACIN SUCCINATE 10MG TABLET SOLIFENACIN SUCCINATE Y Y02448572 TRULICITY 0.75MG/0.5ML INJECTION DULAGLUTIDE Y Y02448580 TRULICITY 1.5MG/0.5ML INJECTION DULAGLUTIDE Y Y02448599 TRULICITY 0.75MG/0.5ML INJECTION DULAGLUTIDE Y Y02448602 TRULICITY 1.5MG/0.5ML INJECTION DULAGLUTIDE Y Y02448610 BYDUREON 2MG/DOSE SUSTAINED-RELEASE INJECTION EXENATIDE Y Y02448831 SOMAVERT 25MG VIAL PEGVISOMANT Y Y02448858 SOMAVERT 30MG VIAL PEGVISOMANT Y Y02449110 JAMP-VITAMIN D 50000U CAPSULE CHOLECALCIFEROL (VITAMIN D3) Y Y02449765 MYLAN-GLICLAZIDE MR 60MG TABLET GLICLAZIDE Y Y02449773 BETEFLAM 2.25MG/PATCH BETAMETHASONE VALERATE Y Y02449781 NUCALA 144MG/VIAL INJECTION MEPOLIZUMAB Y Y02449935 XIGDUO 5MG/850MG TABLET DAPAGLIFLOZIN/METFORMIN HCL Y Y02449943 XIGDUO 5MG/1000MG TABLET DAPAGLIFLOZIN/METFORMIN HCL Y Y02450267 AFINITOR 7.5MG TABLET EVEROLIMUS Y Y02450291 LENVIMA 4MG/10MG/10MG CAPSULE LENVATINIB MESYLATE/LENVATINIB MESYLATE/LENVATINIB MESYLATE Y Y02450305 LENVIMA 10MG/10MG CAPSULE LENVATINIB MESYLATE/LENVATINIB MESYLATE Y Y02450313 LENVIMA 10MG/4MG CAPSULE LENVATINIB MESYLATE/LENVATINIB MESYLATE Y Y02450321 LENVIMA 10MG CAPSULE LENVATINIB MESYLATE Y Y02450429 TARO-TRAMADOL 100MG ER TABLET TRAMADOL HCL Y Y02450437 TARO-TRAMADOL 200MG ER TABLET TRAMADOL HCL Y Y02450445 TARO-TRAMADOL 300MG ER TABLET TRAMADOL HCL Y Y02450771 BUTRANS 15MCG/HR PATCH BUPRENORPHINE Y Y02450968 SILDENAFIL R 20MG TABLET SILDENAFIL CITRATE Y Y02451077 RIVA-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02451085 RIVA-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02451131 ZEPATIER 100MG/50MG TABLET GRAZOPREVIR/ELBASVIR Y Y02451158 UPTRAVI 200MCG TABLET SELEXIPAG Y Y02451166 UPTRAVI 400MCG TABLET SELEXIPAG Y Y02451174 UPTRAVI 600MCG TABLET SELEXIPAG Y Y02451182 UPTRAVI 800MCG TABLET SELEXIPAG Y Y02451190 UPTRAVI 1000MCG TABLET SELEXIPAG Y Y02451204 UPTRAVI 1200MCG TABLET SELEXIPAG Y Y






02451212 UPTRAVI 1400MCG TABLET SELEXIPAG Y Y02451220 UPTRAVI 1600MCG TABLET SELEXIPAG Y Y02451379 ORKAMBI 125MG/200MG TABLET IVACAFTOR/LUMACAFTOR Y Y02451387 AURO-VORICONAZOLE 50MG TABLET VORICONAZOLE Y Y02451395 AURO-VORICONAZOLE 200MG TABLET VORICONAZOLE Y Y02451530 VIACORAM 2.5MG/3.5MG TABLET AMLODIPINE/PERINDOPRIL Y Y02451549 VIACORAM 5MG/7MG TABLET AMLODIPINE/PERINDOPRIL Y Y02451557 VIACORAM 10MG/14MG TABLET AMLODIPINE/PERINDOPRIL Y Y02451913 JAMP-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02451921 JAMP-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02452154 JETREA 1.25MG/ML OPH SOLUTION OCRIPLASMIN Y Y02452294 SUNVEPRA 100MG CAPSULE ASUNAPREVIR Y Y02452340 COTELLIC 20MG TABLET COBIMETINIB Y Y02452510 APO-DARIFENACIN 7.5MG TABLET DARIFENACIN Y Y02452529 APO-DARIFENACIN 15MG TABLET DARIFENACIN Y Y02452650 DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02452669 DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02452693 APO-CINACALCET 30MG TABLET CINACALCET HCL Y Y02452707 APO-CINACALCET 60MG TABLET CINACALCET HCL Y Y02452715 APO-CINACALCET 90MG TABLET CINACALCET HCL Y Y02452928 XTORO 0.3% OTIC SUSPENSION FINAFLOXACIN Y Y02452936 BRIVLERA 10MG TABLET BRIVARACETAM Y Y02452944 BRIVLERA 25MG TABLET BRIVARACETAM Y Y02452952 BRIVLERA 50MG TABLET BRIVARACETAM Y Y02452960 BRIVLERA 75MG TABLET BRIVARACETAM Y Y02452979 BRIVLERA 100MG TABLET BRIVARACETAM Y Y02452987 BRIVLERA 10MG/ML ORAL SOLUTION BRIVARACETAM Y Y02452995 BRIVLERA 10MG/ML IV SOLUTION BRIVARACETAM Y Y02453150 IBRANCE 75MG CAPSULE PALBOCICLIB Y Y02453169 IBRANCE 100MG CAPSULE PALBOCICLIB Y Y02453177 IBRANCE 125MG CAPSULE PALBOCICLIB Y Y02453207 LUNESTA 1MG TABLET ESZOPICLONE Y Y02453215 LUNESTA 2MG TABLET ESZOPICLONE Y Y02453223 LUNESTA 3MG TABLET ESZOPICLONE Y Y02453304 RAVICTI 1.1G/ML ORAL LIQUID GLYCEROL PHENYLBUTYRATE Y Y02453371 DOM-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y






02453398 DOM-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02453584 VITAMIN A AND VITAMIN E 100000IU/20IU CAPSULE VITAMIN A/VITAMIN E Y Y02453592 VITAMIN A AND VITAMIN E 200000IU/40IU CAPSULE VITAMIN A/VITAMIN E Y Y02453630 DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02453649 DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02453754 PRALUENT (PFS) 75MG/ML PREFILLED SYRINGE ALIROCUMAB Y Y02453762 PRALUENT (PFS) 150MG/ML PREFILLED SYRINGE ALIROCUMAB Y Y02453819 PRALUENT (PFP) 75MG/ML PREFILLED PEN ALIROCUMAB Y Y02453835 PRALUENT (PFP) 150MG/ML PREFILLED PEN ALIROCUMAB Y Y02453908 ACT BUPRENORPHINE/NALOXONE 2MG/0.5MG SL TABLET BUPRENORPHINE HCL/NALOXONE HCL Y Y02453916 ACT BUPRENORPHINE/NALOXONE 8MG/2MG SL TABLET BUPRENORPHINE HCL/NALOXONE HCL Y Y02454130 BLEXTEN 20MG TABLET BILASTINE Y Y02454297 ACT ESCITALOPRAM ODT 10MG TABLET ESCITALOPRAM Y Y02454300 ACT ESCITALOPRAM ODT 20MG TABLET ESCITALOPRAM Y Y02454386 PMS-ERLOTINIB 100MG TABLET ERLOTINIB HCL Y Y02454394 PMS-ERLOTINIB 150MG TABLET ERLOTINIB HCL Y Y02454408 LYNPARZA 50MG CAPSULE OLAPARIB Y Y02454416 DESCOVY 200MG/10MG TABLET EMTRICITABINE/TENOFOVIR ALAFENAMIDE FUMARATE Y Y02454424 DESCOVY 200MG/25MG TABLET EMTRICITABINE/TENOFOVIR ALAFENAMIDE FUMARATE Y Y02454548 GRASTOFIL 480MCG/0.8ML INJECTION FILGRASTIM (R-METHUG-CSF) Y Y02454815 ZONTIVITY 2.5MG TABLET VORAPAXAR SULFATE Y Y02455102 TALTZ 80MG/ML PFS AUTO-INJECTOR IXEKIZUMAB Y Y02455110 TALTZ 80MG/ML PFS INJECTION IXEKIZUMAB Y Y02455323 BRENZYS (PFS) 50MG INJECTION ETANERCEPT Y Y02455331 BRENZYS (PEN) 50MG INJECTION ETANERCEPT Y Y02455404 INVOKAMET 50MG/500MG TABLET CANAGLIFLOZIN/METFORMIN HCL Y Y02455412 INVOKAMET 50MG/850MG TABLET CANAGLIFLOZIN/METFORMIN HCL Y Y02455420 INVOKAMET 50MG/1000MG TABLET CANAGLIFLOZIN/METFORMIN HCL Y Y02455439 INVOKAMET 150MG/500MG TABLET CANAGLIFLOZIN/METFORMIN HCL Y Y02455447 INVOKAMET 150MG/850MG TABLET CANAGLIFLOZIN/METFORMIN HCL Y Y02455455 INVOKAMET 150MG/1000MG TABLET CANAGLIFLOZIN/METFORMIN HCL Y Y02455609 CHOLESTYRAMINE-ODAN 4G PACKET CHOLESTYRAMINE RESIN Y N02455889 CORTIMENT 9MG ER TABLET BUDESONIDE Y Y02455943 INVEGA TRINZA 175MG SYRINGE PALIPERIDONE PALMITATE Y Y02455986 INVEGA TRINZA 263MG SYRINGE PALIPERIDONE PALMITATE Y Y02455994 INVEGA TRINZA 350MG SYRINGE PALIPERIDONE PALMITATE Y Y






02456001 INVEGA TRINZA 525MG SYRINGE PALIPERIDONE PALMITATE Y Y02456214 TAGRISSO 40MG TABLET OSIMERTINIB Y Y02456222 TAGRISSO 80MG TABLET OSIMERTINIB Y Y02456230 MONOPROST 0.005% OPHTHALMIC SOLUTION LATANOPROST Y Y02456257 SANDOZ MIGLUSTAT 100MG CAPSULE MIGLUSTAT Y Y02456419 CINQAIR 10MG/ML IV SOLUTION RESLIZUMAB Y Y02456451 RUPATADINE 10MG TABLET RUPATADINE FUMARATE Y Y02456478 RUPATADINE 1MG/ML SOLUTION RUPATADINE FUMARATE Y Y02456532 BEPREVE 1.5% OPH SOLUTION BEPOTASTINE BESILATE Y Y02456575 SYNJARDY 5MG/500MG TABLET EMPAGLIFLOZIN/METFORMIN HCL Y Y02456583 SYNJARDY 5MG/850MG TABLET EMPAGLIFLOZIN/METFORMIN HCL Y Y02456591 SYNJARDY 5MG/1000MG TABLET EMPAGLIFLOZIN/METFORMIN HCL Y Y02456605 SYNJARDY 12.5MG/500MG TABLET EMPAGLIFLOZIN/METFORMIN HCL Y Y02456613 SYNJARDY 12.5MG/850MG TABLET EMPAGLIFLOZIN/METFORMIN HCL Y Y02456621 SYNJARDY 12.5MG/1000MG TABLET EMPAGLIFLOZIN/METFORMIN HCL Y Y02456664 SELEXID 200MG TABLET PIVMECILLINAM HCL Y Y02456672 SELEXID 400MG TABLET PIVMECILLINAM HCL Y Y02456729 SANDOZ CINACALCET 30MG TABLET CINACALCET HCL Y Y02456737 SANDOZ CINACALCET 60MG TABLET CINACALCET HCL Y Y02456745 SANDOZ CINACALCET 90MG TABLET CINACALCET HCL Y Y02456753 ACT DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02456761 ACT DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02456796 NINLARO 2.3MG CAPSULE IXAZOMIB CITRATE Y Y02456818 NINLARO 3MG CAPSULE IXAZOMIB CITRATE Y Y02456826 NINLARO 4MG CAPSULE IXAZOMIB CITRATE Y Y02457008 GENTAMICIN 40MG/ML INJECTION GENTAMICIN SULFATE Y Y02457113 ZYTIGA 500MG TABLET ABIRATERONE ACETATE Y Y02457199 TARO-DULOXETINE 30MG DR CAPSULE DULOXETINE HCL Y Y02457202 TARO-DULOXETINE 60MG DR CAPSULE DULOXETINE HCL Y Y02457393 ENSTILAR 0.5MG/G-50MCG/G AEROSOL FOAM BETAMETHASONE DIPROPIONATE/CALCIPOTRIOL MONOHYDRATE Y Y02457547 BUPIVACAINE INJECTION BP 2.5MG/ML BUPIVACAINE HCL Y Y02457555 BUPIVACAINE INJECTION BP 5MG/ML BUPIVACAINE HCL Y Y02457717 MDK-NITISINONE 2MG CAPSULE NITISINONE Y Y02457725 MDK-NITISINONE 5MG CAPSULE NITISINONE Y Y02457733 MDK-NITISINONE 10MG CAPSULE NITISINONE Y Y02457857 HEMANGIOL 3.75MG/ML SOLUTION PROPRANOLOL HCL Y Y






02457997 IZBA 0.03MG/ML OPH SOLUTION TRAVOPROST Y Y02458039 VENCLEXTA 10MG TABLET VENETOCLAX Y Y02458047 VENCLEXTA 50MG TABLET VENETOCLAX Y Y02458055 VENCLEXTA 100MG TABLET VENETOCLAX Y Y02458063 VENCLEXTA 10MG/50MG/100MG TABLET VENETOCLAX Y Y02458071 VYVANSE 70MG CAPSULE LISDEXAMFETAMINE DIMESYLATE Y Y02458136 ALECENSARO 150MG CAPSULE ALECTINIB Y Y02458144 SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02458152 SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02458241 SOLIFENACIN 5MG TABLET SOLIFENACIN SUCCINATE Y Y02458268 SOLIFENACIN 10MG TABLET SOLIFENACIN SUCCINATE Y Y02458365 PMS-CHOLESTYRAMINE 4G/5G ORAL POWDER CHOLESTYRAMINE RESIN Y Y02458373 PMS-CHOLESTYRAMINE 4G/9G ORAL POWDER CHOLESTYRAMINE RESIN Y Y02458381 PMS-ABACAVIR-LAMIVUDINE 600MG/300MG TABLET ABACAVIR/LAMIVUDINE Y Y02458411 JAMP-OLOPATADINE 0.1% OPH SOLUTION OLOPATADINE HCL Y Y02458543 PMS-ZOPICLONE 3.75MG TABLET ZOPICLONE Y Y02458551 PAZEO 0.7% OPH SOLUTION OLOPATADINE HCL Y Y02458586 AURO-AMOXICILLIN 125/5ML ORAL SUSPENSION AMOXICILLIN TRIHYDRATE Y Y02458594 AURO-AMOXICILLIN 250/5ML ORAL SUSPENSION AMOXICILLIN TRIHYDRATE Y Y02458616 NITISINONE 2MG TABLETS NITISINONE Y Y02458624 NITISINONE 5MG TABLETS NITISINONE Y Y02458632 NITISINONE 10MG TABLETS NITISINONE Y Y02458640 LIXIANA 15MG TABLET EDOXABAN Y Y02458659 LIXIANA 30MG TABLET EDOXABAN Y Y02458667 LIXIANA 60MG TABLET EDOXABAN Y Y02458683 NORETHINDRONE TABLETS USP 28 0.35MG NORETHINDRONE Y Y02458721 APO-TRYPTOPHAN 750MG TABLET TRYPTOPHAN Y Y02458748 AA-CLOZAPINE 50MG TABLET CLOZAPINE Y Y02458756 AA-CLOZAPINE 200MG TABLET CLOZAPINE Y Y02458926 MYLAN-DIVALPROEX 125MG EC TABLET VALPROIC ACID Y Y02458934 MYLAN-DIVALPROEX 250MG EC TABLET VALPROIC ACID Y Y02459019 MYLAN-DIVALPROEX 500MG EC TABLET VALPROIC ACID Y Y09857384 SCOPOLAMINE HYDROBROMIDE INJECTION 0.4MG/ML INJ SOL-1ML PK (ODB)HYOSCINE HYDROBROMIDE Y Y09857385 SCOPOLAMINE HYDROBROMIDE INJECTION 0.6MG/ML INJ SOL-1ML PK (ODB)HYOSCINE HYDROBROMIDE Y Y09857463 ELIQUIS 2.5MG TABLET APIXABAN Y Y09857521 GLYCOPYRROLATE 0.2MG/ML INJECTION GLYCOPYYROALTE Y Y






09857548 COSENTYX 150MG/ML PEN PREF INJ (ODB) SECUKINUMAB Y Y10988888 SCLEROTHERAPY - $10 ADMINISTRATIVE DIN Y Y11988888 CARRIER SCLEROTHERAPY-$15.00 ADMINISTRATIVE DIN Y Y12988888 SCLEROTHERAPY - $ UNLIMITED ADMINISTRATIVE DIN Y Y19888888 SCLEROTHERAPY - $15.00 ADMINISTRATIVE DIN Y Y29888888 SCLEROTHERAPY - $20.00 ADMINISTRATIVE DIN Y Y29988888 SCLEROTHERAPY - $25.00 ADMINISTRATIVE DIN Y Y37508888 SCLEROTHERAPY - $37.50 ADMINISTRATIVE DIN Y Y39888888 SCLEROTHERAPY - $35.00 ADMINISTRATIVE DIN Y Y49988888 SCLEROTHERAPY - $45.00 ADMINISTRATIVE DIN Y Y59288888 SCLEROTHERAPY - $200.00 ADMINISTRATIVE DIN Y Y59888888 SCLEROTHERAPY -$250.00 ADMINISTRATIVE DIN Y Y60988888 SCLEROTHERAPY - $60.00 ADMINISTRATIVE DIN Y Y66124085 DISULFIRAM 250MG CAPSULE(BC) COMPOUNDED DISULFIRAM Y Y66124087 DISULFIRAM 500MG CAPSULE(BC) COMPOUNDED DISULFIRAM Y Y66124089 DISULFIRAM 125MG CAPSULE(BC) COMPOUNDED DISULFIRAM Y Y67888888 SCLEROTHERAPY - $80 ADMINISTRATIVE DIN Y Y69888888 SCLEROTHERAPY - $100 ADMINISTRATIVE DIN Y Y77888888 SCLEROTHERAPY - $70.00 ADMINISTRATIVE DIN Y Y79888888 SCLEROTHERAPY - $50.00 ADMINISTRATIVE DIN Y Y89888888 SCLEROTHERAPY - $8 ADMINISTRATIVE DIN Y Y90261432 REIM: DARVON-N 100MG PULVULE CAPSULE PROPOXYPHENE NAPSYLATE Y Y92295636 REIM: THELIN 100MG TABLET SITAXSENTAN SODIUM Y Y92314150 REIM: CATENA 150MG TABLET IDEBENONE Y Y99002310 SODIUM CHL0.9% (PQ)(1000ML) SODIUM CHLORIDE Y Y99100163 ERYTHROMYCINE POWDER ERYTHROMYCIN Y N99100176 VANCOMYCINE POWDER VANCOMYCIN Y N99100387 CYCLOSPORINE INJ(PQ) CYCLOSPORINE Y N99100407 EAU POUR INJECTION LIQ WATER FOR INJECTION Y Y99100498 SODIUM CHLORIDE INJ 234MG/ML (PQ) SODIUM CHLORIDE Y N99100555 BETASERON-TROUSSE DE M (PQ) INTERFERON BETA-1B Y Y99100893 VICTRELIS TRIPLE KIT 200MG CAP + 200MG CAP + 150UG/0.5ML INJ(98) BOCEPREVIR/RIBAVIRIN/PEGINTERFERON ALFA-2B Y Y99100894 CHLORURE DE SODIUM 0.9% (PQ)(100ML) SODIUM CHLORIDE Y N99101086 PEGASYS PROCLICK 180MCG/0.5ML-200MG TROUSSE PEGINTERFERON/RIBAVIRIN Y Y99101087 PEGASYS RBV PROCLICK (28) 180MCG-200MG TROUSSE PEGINTERFERON/RIBAVIRIN Y Y99101088 PEGASYS RBV PROCLICK (35) 180MCG-200MG TROUSSE PEGINTERFERON/RIBAVIRIN Y Y






99101089 PEGASYS RBV PROCLICK (42) 180MCG-200MG TROUSSE PEGINTERFERON/RIBAVIRIN Y Y99101215 COSENTYX 150MG/ML STYLO (PEN) INJ (PQ) SECUKINUMAB Y Y99888888 SCLEROTHERAPY - $30.00 ADMINISTRATIVE DIN Y Y

Sheet1

FlexBenefits - Off Formulary Listing Level 4&5 Date: November 29, …€¦ · 14/12/2016 ·...

Documents

Transcript of FlexBenefits - Off Formulary Listing Level 4&5 Date: November 29, …€¦ · 14/12/2016 ·...