Great Plans Medicare Advantage Nebraska 2018 ... Plans Medicare Advantage Nebraska 2018...

Great Plans Medicare Advantage Nebraska

2018 Comprehensive Formulary

List of Covered Drugs

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN

HPMS Approved Formulary File Submission ID, 00018346 Version 10

This formulary was updated on 5/01/2018. For more recent information or other questions, please contact Great Plains Medicare Advantage Member Services at 1-844-637-4760 or, for TTY users, 711, Hours of operations: 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through February 14, and Monday to Friday (except holidays) from February 15 through September 30, or visit www.greatplainsmedicareadvantage.com.

Great Plains Medicare Select complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Great Plains Medicare Select cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

Great Plains Medicare Select tua n thu luạ t da n quyên hiẹ n hanh cu a Lie n bang va kho ng pha n biẹ t đôi xư dư a tre n chung tọ c, mau da, ngôn ôugc qôc ugia, đọ tuôi, khuyêt tạ t, hoạ c giơ i tınh.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-637-4760 TTY: 711.

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-844-637-4760 TTY: 711.Great Plains Medicare Advantage is an HMO plan with a Medicare contract. Enrollment in Great Plains Medicare Advantage depends on contract renewal.

H7511_2018_drug01 Accepted

http://www.greatplainsmedicareadvantage.com./

1

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 Great Plains Medicare Advantage. When it refers to “plan” or “our plan,” it means Great Plains Medicare Advantage.

This document includes a list of the drugs (formulary) for our plan which is current as of 5/01/2018. 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, 2018, and from time to time during the year.

2

What is the Great Lakes Medicare Advantage Formulary? A formulary is a list of covered drugs selected by Great Lakes Medicare Advantage 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. Great Lakes Medicare Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at an Great Lakes Medicare Advantage 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? Generally, if you are taking a drug on our 2018 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2018 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.

If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of 5/01/2018. To get updated information about the drugs covered by Great Lakes Medicare Advantage, please contact us. Our contact information appears on the front and back cover pages. In the event that Great Lakes Medicare Advantage has CMS-approved non-maintenance changes to the formulary throughout the plan year (i.e. remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, Great Lakes Medicare Advantage will update our formulary and post in on our website.

How do I use the Formulary? There are two ways to find your drug within the formulary:

Medical Condition The formulary begins on page 7. 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-Misc.” If you know what your drug is used for, look for the category name in the list that begins on page 7. 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 107. 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.

3

What are generic drugs? Great Plains Medicare Advantage 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 (PA): Great Plains Medicare Advantage requires you [or your physician] to getprior authorization for certain drugs. This means that you will need to get approval from Great PlainsMedicare Advantage before you fill your prescriptions. If you don’t get approval, Great PlainsMedicare Advantage may not cover the drug.

• Prior Authorization Restriction for Part B vs Part D Determination (PA BvD): This drug may beeligible for payment under Medicare Part B or Part D. You (or your physician) are required to get priorauthorization from Great Plains Medicare Advantage to determine that this drug is covered underMedicare Part D before you fill your prescription for this drug. Without prior approval, Great PlainsMedicare Advantage may not cover this drug.

• Prior Authorization Restriction for New Starts Only (PA NSO): If you are a new member, you (oryour physician) are required to get prior authorization from Great Plains Medicare Advantage beforeyou fill your prescription for this drug. Without prior approval, Great Plains Medicare Advantage maynot cover this drug.

• Quantity Limits (QL): For certain drugs, Great Plains Medicare Advantage limits the amount of thedrug that Great Plains Medicare Advantage will cover. For example, Great Plains Medicare Advantageprovides 9 tabs per prescription for sumatriptan tab. This may be in addition to a standard one month orthree-month supply.

• Step Therapy (ST): In some cases, Great Plains Medicare Advantage requires you to first try certaindrugs 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, Great Plains Medicare Advantage may notcover Drug B unless you try Drug A first. If Drug A does not work for you, Great Plains MedicareAdvantage will then cover Drug B.

• Non-Mail-Order Drug (NM): You may be able to receive greater than a 1-month supply of most of thedrugs on your Formulary via mail order at a reduced cost share. Drugs not available via your mail-orderbenefit are noted with “NM” in the notes column of your Formulary.

• Limited Distribution (LD): The symbol (LD) next to a drug name indicates that the drug has beennoted as being restricted to certain pharmacies by the Food and Drug Administration. These drugs canonly be obtained at specialty designated pharmacies able to appropriately handle the drugs.

You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 7. 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.

4

You can ask Great Plains Medicare Advantage 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 Great Plains Medicare Advantage’s formulary?” on this page 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. If you learn that Great Plains Medicare Advantage does not cover your drug, you have two options:

• You can ask Member Services for a list of similar drugs that are covered by Great Plains MedicareAdvantage. When you receive the list, show it to your doctor and ask him or her to prescribe asimilar drug that is covered by Great Plains Medicare Advantage.

• You can ask Great Plains Medicare Advantage to make an exception and cover your drug. Seebelow for information about how to request an exception.

How do I request an exception to the Great Plains Medicare Advantage Formulary? You can ask Great Plains Medicare Advantage 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 be coveredat a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at alower cost-sharing level.

• You can ask us to cover a formulary drug at a lower cost-sharing level if this drug is not on the specialtytier. If approved this would lower the amount you must pay for your drug.

• You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs,Great Plains Medicare Advantage limits the amount of the drug that we will cover. If your drug has aquantity limit, you can ask us to waive the limit and cover a greater amount.

Generally, Great Plains Medicare Advantage 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.

5

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 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 31-day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first 31-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, we will allow you to refill your prescription until we have provided you with a 91-98-day transition supply, consistent with dispensing increment, (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If 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 (unless you have a prescription for fewer days) while you pursue a formulary exception.

We will provide a one-time 31-day transition supply per drug, which will cover a temporary supply if you have a change in your medications due to a level-of-care change. A level of care change may include:

• Entering or leaving a LTC facility• Discharged from a hospital to a home• End a Medicare Part A skilled nursing facility stay• Give up Hospice status and revert back to standard Medicare benefits• End an LTC facility stay and return to their home

During the time when you are getting a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug.

For more information For more detailed information about your Great Plains Medicare Advantage prescription drug coverage, please review your Evidence of Coverage and other plan materials. If you have questions about Great Plains Medicare Advantage, 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.

http://www.medicare.gov/

6

Great Plains Medicare Advantage’s Formulary The formulary below provides coverage information about the drugs covered by Great Plains Medicare Advantage. If you have trouble finding your drug in the list, turn to the Index that begins on page 107. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., LIDODERM) and generic drugs are listed in lower-case italics (e.g., lidocaine).

The second column of the chart lists the Drug Tier.

The information in the Notes column tells you if Great Plains Medicare Advantage has any special requirements for coverage of your drug.

• The symbol LD in the Notes column next to a drug name indicates that the drug has been noted asbeing restricted to certain pharmacies by the Food and Drug Administration. These drugs can onlybe obtained at specialty designated pharmacies able to appropriately handle the drugs.

• The symbol PA in the Notes column indicates that prior authorization may apply.• The symbol PA BvD in the Notes column indicates that prior authorization may apply for

medications that could be eligible for payment under either Medicare Part B or Part D.• The symbol PA NSO in the Notes column indicates that prior authorization may apply on certain

medications for new members of the plan.• The symbol QL in the Notes column indicates that quantities dispensed may be limited.• The symbol ST in the Notes column indicates that step therapy may apply.• The symbol NM in the Notes column indicates that the drug is not available via your mail-order

benefit.

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 tab

1methamphetamine 5mg tab PA

1VYVANSE 10MG CAP

1VYVANSE 10MG CHEW TAB

1VYVANSE 20MG CAP


1VYVANSE 30MG CAP


1VYVANSE 40MG CAP


1VYVANSE 50MG CAP


1VYVANSE 60MG CAP


1VYVANSE 70MG CAPATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS

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







1guanfacine 1mg er tab




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

7


STIMULANTS - MISC.

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




1dexmethylphenidate 10mg er cap

1dexmethylphenidate 10mg tab


1dexmethylphenidate 2.5mg tab





1dexmethylphenidate 5mg tab

1metadate 20mg er tab

1methylphenidate 10mg cd cap

1methylphenidate 10mg chew tab

1methylphenidate 10mg er tab

1methylphenidate 10mg tab

1METHYLPHENIDATE 18MG SR TAB

1methylphenidate 1mg/ml oral soln

1methylphenidate 2.5mg chew tab


1methylphenidate 20mg er tab

1methylphenidate 20mg la cap



1methylphenidate 2mg/ml oral soln








1methylphenidate 5mg chew tab



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

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

AMINOGLYCOSIDESAMINOGLYCOSIDES

1amikacin 250mg/ml inj

1gentamicin 1.2mg/ml inj

1gentamicin 40mg/ml inj

1gentamicin sulfate 0.8mg/ml inj


8


1gentamicin sulfate 1.6mg/ml inj

1gentamicin sulfate 1mg/ml inj

1neomycin sulfate 500mg tab

1paromomycin 250mg cap

1STREPTOMYCIN 100MG INJ

1TOBI PODHALER KIT 28MG PACK NDS PA

1TOBRAMYCIN 10MG/ML INJ

1tobramycin 40mg/ml inj

1tobramycin 60mg/ml inh soln NDS PA

ANALGESICS - ANTI-INFLAMMATORYANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES

1HUMIRA 10MG/0.2ML SYRINGE NDS PA


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


1HUMIRA PEDIATRIC CROHN'S STARTER PACK (3) 40MG/0.8ML INJ

NDS PA

1HUMIRA PEDIATRIC CROHN'S STARTER PACK (6) 40MG/0.8ML INJ

NDS PA

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

NDS PA

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

NDS PA

1SIMPONI ARIA 50MG/4ML INJ NDS PAGOLD COMPOUNDS

1RIDAURA 3MG CAPINTERLEUKIN-1 BLOCKERS

1ARCALYST 220MG INJ NDS PAINTERLEUKIN-1BETA BLOCKERS

1ILARIS 180MG INJ NDS PANONSTEROIDAL 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 tab


1diclofenac sodium 75mg/misoprostol 0.2mg tab

1etodolac 200mg cap

1etodolac 300mg cap

1etodolac 400mg er tab

1etodolac 400mg tab


9



1etodolac 500mg tab


1FENOPROFEN 400MG CAP

1flurbiprofen 100mg tab

1flurbiprofen 50mg tab

1ibuprofen 20mg/ml oral susp

1ibuprofen 400mg tab



1INDOCIN 25MG/5ML ORAL SUSP

1indomethacin 25mg cap

1indomethacin 50mg cap

1indomethacin 75mg er cap

1ketoprofen 50mg cap

1ketoprofen 75mg cap

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

1ketorolac tromethamine 15mg/ml inj

1ketorolac tromethamine 30mg/ml cartridge

1ketorolac tromethamine 30mg/ml inj

1MECLOFENAMATE 100MG CAP

1MECLOFENAMATE 50MG CAP

1mefenamic acid 250mg cap

1meloxicam 15mg tab

1meloxicam 7.5mg tab

1nabumetone 500mg tab

1nabumetone 750mg tab

1naproxen 250mg tab

1naproxen 25mg/ml oral susp

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

1sulindac 200mg tabPYRIMIDINE SYNTHESIS INHIBITORS

1leflunomide 10mg tab

1leflunomide 20mg tabSELECTIVE COSTIMULATION MODULATORS

1ORENCIA 125MG/ML AUTO-INJECTOR NDS PA

1ORENCIA 125MG/ML SYRINGE NDS PA


10


1ORENCIA 250MG INJ 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 SURECLICK INJ 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



1duramorph 0.5mg/ml inj PA BvD

1duramorph 1mg/ml inj PA BvD

1EMBEDA 100-4MG ER CAP QL=60 EA/30 Days

1EMBEDA 20-0.8MG ER CAP QL=60 EA/30 Days


1EMBEDA 50-2MG ER CAP QL=60 EA/30 Days



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


1FENTANYL 0.0375MG/HR PATCH QL=10 EA/30 Days


1FENTANYL 0.0625MG/HR PATCH QL=10 EA/30 Days



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






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





1hydromorphone 10mg/ml (1ml) inj

1hydromorphone 10mg/ml (5ml) inj

1hydromorphone 12mg er tab QL=60 EA/30 Days



11


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

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

1hydromorphone 2mg/ml syringe





1HYSINGLA 100MG ER TAB QL=30 EA/30 Days







1LEVORPHANOL 2MG TAB QL=240 EA/30 Days

1meperidine 100mg tab QL=360 EA/30 Days

1meperidine 50mg tab QL=720 EA/30 Days

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

1methadone 1mg/ml oral soln QL=3600 ML/30 Days

1methadone 2mg/ml oral soln QL=1800 ML/30 Days

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

1morphine sulfate 100mg er cap QL=60 EA/30 Days

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


1MORPHINE SULFATE 120MG ER (24HR) CAP QL=60 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 2MG/ML SYRINGE

1MORPHINE SULFATE 30MG ER (24 HR) CAP QL=60 EA/30 Days



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




1MORPHINE SULFATE 5MG/ML SYRINGE

1MORPHINE SULFATE 60MG (24HR) ER CAP QL=60 EA/30 Days







12


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


1OXYCONTIN 10MG ER TAB QL=60 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





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


13


1acetaminophen 300mg/hydrocodone bitartrate 7.5mg tab

QL=390 EA/30 Days

1ACETAMINOPHEN 325MG/5ML/OXYCODONE 5MG/5ML ORAL SOLN

QL=1800 ML/30 Days


QL=360 EA/30 Days


QL=360 EA/30 Days


QL=360 EA/30 Days


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

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

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

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

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

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

1IBUPROFEN 400MG/OXYCODONE 5MG TAB QL=240 EA/30 Days

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

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

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

1vicodin 10-300mg tab QL=390 EA/30 Days

1vicodin 5-300mg tab QL=390 EA/30 Days

1vicodin 7.5-300mg tab QL=390 EA/30 DaysOPIOID PARTIAL AGONISTS

1BUNAVAIL 2.1-0.3MG FILM

1BUNAVAIL 4.2-0.7MG FILM

1BUNAVAIL 6.3-1MG FILM

1buprenorphine 0.3mg/ml cartridge

1buprenorphine 0.3mg/ml inj

1buprenorphine 2mg sl tab PA

1buprenorphine 8mg sl tab PA

1butorphanol tartrate 10mg/ml nasal spray QL=10 ML/30 Days

1BUTORPHANOL TARTRATE 1MG/ML INJ

1butorphanol tartrate 2mg/ml inj

1naloxone 0.5mg/pentazocine 50mg tab QL=360 EA/30 Days

1SUBOXONE 12-3MG STRIP

1SUBOXONE 2-0.5MG STRIP



14



1ZUBSOLV 11.4-2.9MG SL TAB QL=60 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

1ANDROGEL 1% (25MG) GEL PA QL=300 GM/30 Days

1ANDROGEL 1% (50MG) GEL PA QL=300 GM/30 Days

1ANDROGEL 1.62% (1.25GM) GEL PA QL=37.50 GM/30 Days

1ANDROGEL 1.62% (2.5GM) GEL PA QL=150 GM/30 Days

1ANDROGEL 1.62% GEL PA QL=150 GM/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% gel pump PA QL=300 GM/30 Days

1testosterone cypionate 100mg/ml inj

1testosterone cypionate 200mg/ml inj

1testosterone enanthate 200mg/ml inj

ANORECTAL AGENTSINTRARECTAL STEROIDS

1colocort 100mg/60ml enema

1hydrocortisone 1.67mg/ml enema

1UCERIS 2MG/ACT FOAM PARECTAL STEROIDS

1procto-med 2.5% cream

1procto-pak 1% rectal cream

1proctosol 2.5% cream

1proctozone hc 2.5% cream

ANTHELMINTICSANTHELMINTICS

1ALBENZA 200MG TAB NDS

1ivermectin 3mg tab

ANTIANGINAL AGENTSANTIANGINALS-OTHER

1RANEXA 1000MG ER TAB

1RANEXA 500MG ER TAB


15


NITRATES

1isosorbide dinitrate 10mg tab



1ISOSORBIDE DINITRATE 40MG ER TAB


1isosorbide mononitrate 10mg tab

1isosorbide mononitrate 120mg er tab

1isosorbide mononitrate 20mg tab



1minitran 0.1mg/hr patch




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 pump 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 25MG/ML INJ

1hydroxyzine 2mg/ml oral soln


1hydroxyzine 50mg/ml inj

1HYDROXYZINE PAMOATE 100MG CAP

1hydroxyzine pamoate 25mg cap

1hydroxyzine pamoate 50mg cap

1meprobamate 200mg tab

1meprobamate 400mg tabBENZODIAZEPINES

1alprazolam 0.25mg odt

1alprazolam 0.25mg tab


16


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 conc

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

1PROCAINAMIDE 100MG/ML INJ

1PROCAINAMIDE 500MG/ML INJ

1quinidine gluconate 324mg er tab

1QUINIDINE GLUCONATE 80MG/ML INJ

1QUINIDINE SULFATE 200MG TAB

1QUINIDINE SULFATE 300MG TABANTIARRHYTHMICS TYPE I-B

1mexiletine 150mg cap

1mexiletine 200mg cap

1mexiletine 250mg capANTIARRHYTHMICS TYPE I-C

1flecainide acetate 100mg tab


17




1propafenone 150mg tab

1propafenone 225mg er cap



1propafenone 325mg er cap

1propafenone 425mg er capANTIARRHYTHMICS TYPE III

1amiodarone 200mg tab

1amiodarone 400mg tab

1amiodarone 50mg/ml inj

1amiodarone hydrochloride 100mg tab

1dofetilide 125mcg cap



1MULTAQ 400MG TAB

1NEXTERONE 150MG/100ML INJ

1NEXTERONE 360MG/200ML INJ

1pacerone 200mg tab

1pacerone 400mg tab

ANTIASTHMATIC AND BRONCHODILATOR AGENTSANTIASTHMATIC - MONOCLONAL ANTIBODIES

1NUCALA 100MG INJ NDS PA

1XOLAIR 150MG INJ NDS PAANTI-INFLAMMATORY AGENTS

1CROMOLYN SODIUM 10MG/ML INH SOLN PA BvDBRONCHODILATORS - ANTICHOLINERGICS

1ATROVENT 17MCG INH

1INCRUSE 62.5MCG INH

1ipratropium bromide 0.02% inh soln PA BvD

1SPIRIVA 1.25MCG RESPIMAT INH ST QL=4 GM/30 Days

1SPIRIVA 18MCG HANDIHALER

1SPIRIVA 2.5MCG RESPIMAT INHLEUKOTRIENE MODULATORS

1montelukast 10mg tab

1montelukast 4mg chew tab

1montelukast 4mg granules

1montelukast 5mg chew tab

1zafirlukast 10mg tab

1zafirlukast 20mg tab

1zileuton 600mg er tabSELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS

1DALIRESP 500MCG TABSTEROID INHALANTS

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


18


1ARNUITY 200MCG INH QL=30 EA/30 Days

1ASMANEX 100MCG (120ACT) HFA INH QL=13 GM/30 Days

1ASMANEX 110MCG (30ACT) INH QL=1 EA/30 Days

1ASMANEX 200MCG (120ACT) HFA INH QL=13 GM/30 Days




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



1FLOVENT 100MCG DISKUS QL=60 EA/30 Days

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

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

1FLOVENT 250MCG DISKUS QL=60 EA/30 Days

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

1FLOVENT 50MCG DISKUS QL=60 EA/30 DaysSYMPATHOMIMETICS

1ADVAIR 100-50MCG DISKUS QL=60 EA/30 Days

1ADVAIR 115-21MCG HFA INH QL=12 GM/30 Days





1albuterol 0.21mg/ml (0.63mg/3ml) inh soln PA BvD

1albuterol 0.417mg/ml (1.25mg/3ml) inh soln PA BvD

1albuterol 0.4mg/ml (2mg/5ml) oral soln

1albuterol 0.83mg/ml (0.083%) inh soln PA BvD

1albuterol 1mg/ml (0.5%) inh soln PA BvD

1albuterol 2mg tab

1albuterol 4mg er tab

1albuterol 4mg tab

1albuterol 8mg er tab

1ANORO 62.5-25MCG ELLIPTA INH QL=60 EA/30 Days

1BREO 100-25MCG ELLIPTA INH QL=60 EA/30 Days

1BREO 200-25MCG ELLIPTA INH QL=60 EA/30 Days

1BROVANA 15MCG/2ML INH SOLN PA BvD

1COMBIVENT RESPIMAT 20-100MCG INH

1DULERA 100-5MCG INH QL=13 GM/30 Days

1DULERA 200-5MCG INH QL=13 GM/30 Days

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



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


19


1levalbuterol 0.31mg inh soln PA BvD




1METAPROTERENOL SULFATE 10MG TAB

1METAPROTERENOL SULFATE 20MG TAB

1METAPROTERENOL SULFATE 2MG/ML ORAL SOLN

1SEREVENT 50MCG/DOSE INH

1STIOLTO 2.5-2.5MCG INH QL=4 GM/30 Days

1terbutaline sulfate 1mg/ml inj

1terbutaline sulfate 2.5mg tab

1terbutaline sulfate 5mg tab

1TRELEGY 62.5-25MCG ELLIPTA INH

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

1aminophylline 25mg/ml inj

1theophylline 100mg er tab




1theophylline 5.33mg/ml oral soln


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

1ELIQUIS 2.5MG TAB

1ELIQUIS 30-DAY STARTER PACK


20


1ELIQUIS 5MG TAB

1XARELTO 10MG TAB

1XARELTO 15MG TAB

1XARELTO 20MG TAB

1XARELTO STARTER PACKHEPARINS AND HEPARINOID-LIKE AGENTS

1enoxaparin sodium 100mg/1ml syringe QL=34 ML/17 Days

1enoxaparin sodium 120mg/0.8ml syringe QL=27.20 ML/17 Days







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



1fondaparinux sodium 5mg/ml syringe PA

1FRAGMIN 10000UNIT/ML SYRINGE

1FRAGMIN 12500UNIT/0.5ML SYRINGE






1FRAGMIN 95000UNIT/3.8ML INJ NDS

1heparin sodium, porcine 10000unit/ml inj PA BvD


1HEPARIN SODIUM, PORCINE 100UNIT/ML INJ PA BvD




1heparin sodium, porcine 50unit/ml inj PA BvDTHROMBIN INHIBITORS

1argatroban 100mg/ml inj

1ARGATROBAN 1MG/ML INJ PA BvD

1PRADAXA 110MG CAP

1PRADAXA 150MG CAP

1PRADAXA 75MG CAP

ANTICONVULSANTSAMPA GLUTAMATE RECEPTOR ANTAGONISTS

1FYCOMPA 0.5MG/ML ORAL SUSP PA NSO

1FYCOMPA 10MG TAB PA NSO





21



1FYCOMPA 8MG TAB PA NSOANTICONVULSANTS - BENZODIAZEPINES

1clonazepam 0.125mg odt



1clonazepam 0.5mg tab

1clonazepam 1mg odt

1clonazepam 1mg tab

1clonazepam 2mg odt

1clonazepam 2mg tab

1DIASTAT 10MG APPLICATOR

1DIASTAT 2.5MG APPLICATOR

1DIASTAT 20MG PF APPLICATOR

1ONFI 10MG TAB PA NSO

1ONFI 2.5MG/ML ORAL SUSP PA NSO

1ONFI 20MG TAB PA NSOANTICONVULSANTS - MISC.

1APTIOM 200MG TAB PA NSO




1BANZEL 200MG TAB

1BANZEL 400MG TAB

1BANZEL 40MG/ML ORAL SUSP

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


1BRIVIACT 10MG/ML INJ PA NSO

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 oral susp



1epitol 200mg tab

1gabapentin 100mg cap



1gabapentin 50mg/ml oral soln


22


1gabapentin 600mg tab

1gabapentin 800mg tab

1LAMICTAL BLUE KIT

1LAMICTAL GREEN KIT

1LAMICTAL ORANGE KIT

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 5mg chew tab

1levetiracetam 1000mg tab

1levetiracetam 100mg/ml inj

1levetiracetam 100mg/ml oral soln




1levetiracetam 500mg er tab



1levetiracetam 750mg er tab


1LYRICA 100MG CAP

1LYRICA 150MG CAP

1LYRICA 200MG CAP

1LYRICA 20MG/ML ORAL SOLN

1LYRICA 225MG CAP

1LYRICA 25MG CAP

1LYRICA 300MG CAP

1LYRICA 50MG CAP

1LYRICA 75MG CAP

1oxcarbazepine 150mg tab



23



1oxcarbazepine 60mg/ml oral susp

1OXTELLAR 150MG XR TAB



1primidone 250mg tab

1primidone 50mg tab

1QUDEXY 100MG XR CAP PA NSO





1roweepra 1000mg tab

1roweepra 500mg er tab

1roweepra 500mg tab

1roweepra 750mg er tab

1roweepra 750mg tab

1SPRITAM 1000MG ODT PA NSO




1TOPIRAMATE 100MG ER CAP PA NSO

1topiramate 100mg tab


1topiramate 15mg cap



1topiramate 25mg cap





1TROKENDI 100MG XR CAP PA NSO




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

1VIMPAT 10MG/ML ORAL SOLN



1VIMPAT 200MG/20ML INJ


1zonisamide 100mg cap

1zonisamide 25mg cap

1zonisamide 50mg capCARBAMATES


24


1felbamate 120mg/ml oral susp

1felbamate 400mg tab

1felbamate 600mg tabGABA MODULATORS

1GABITRIL 12MG TAB

1GABITRIL 16MG TAB

1SABRIL 500MG ORAL SOLN NDS PA NSO

1SABRIL 500MG TAB NDS PA NSO

1tiagabine 2mg tab

1tiagabine 4mg tab

1vigabatrin 50mg/ml oral soln NDS PA NSOHYDANTOINS

1DILANTIN 30MG ER CAP

1fosphenytoin sodium 75mg/ml inj

1PEGANONE 250MG TAB

1phenytoin 25mg/ml oral susp

1phenytoin 50mg chew tab

1phenytoin sodium 100mg er cap



1phenytoin sodium 50mg/ml injSUCCINIMIDES

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 100mg/ml inj

1valproic acid 250mg cap

1valproic acid 50mg/ml oral soln

ANTIDEPRESSANTSALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)

1mirtazapine 15mg odt

1mirtazapine 15mg tab





1mirtazapine 7.5mg tabANTIDEPRESSANTS - MISC.

1APLENZIN 174MG ER TAB ST


25




1bupropion 100mg sr tab

1bupropion 100mg tab

1bupropion 150mg sr (12 hr) tab

1bupropion 150mg xl (24 hr) tab


1bupropion 300mg xl 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

1fluvoxamine maleate 100mg tab

1fluvoxamine maleate 150mg er cap ST



1paroxetine 10mg tab

1paroxetine 12.5mg er tab


1paroxetine 25mg er tab


1paroxetine 37.5mg er tab



26


1PAXIL 10MG/5ML ORAL SUSP

1PEXEVA 10MG TAB ST

1PEXEVA 20MG TAB ST

1PEXEVA 30MG TAB ST

1PEXEVA 40MG TAB ST

1sertraline 100mg tab

1sertraline 20mg/ml oral soln

1sertraline 25mg tab

1sertraline 50mg tabSEROTONIN MODULATORS

1NEFAZODONE 100MG TAB



1nefazodone 250mg tab

1nefazodone 50mg tab

1trazodone 100mg tab



1trazodone 50mg tab

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



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

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

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

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

1DESVENLAFAXINE FUMARATE 100MG ER TAB ST

1DESVENLAFAXINE FUMARATE 50MG ER TAB ST

1desvenlafaxine succinate 100mg er tab



1duloxetine 20mg dr cap


1DULOXETINE 40MG DR CAP ST QL=30 EA/30 Days


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




1FETZIMA PACK ST QL=30 EA/30 Days

1KHEDEZLA 100MG ER TAB ST

1KHEDEZLA 50MG ER TAB ST

1venlafaxine 100mg tab

1venlafaxine 150mg er cap

1venlafaxine 150mg er tab


27


1VENLAFAXINE 225MG ER TAB


1venlafaxine 37.5mg er cap

1venlafaxine 37.5mg er tab

1venlafaxine 37.5mg tab


1venlafaxine 75mg er cap

1venlafaxine 75mg er tab

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




1nortriptyline 10mg cap


1NORTRIPTYLINE 2MG/ML ORAL SOLN


28




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

1glimepiride 2mg/pioglitazone 30mg tab

1glimepiride 4mg/pioglitazone 30mg tab

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 100-1000MG XR TAB QL=30 EA/30 Days

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


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


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

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



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

1metformin 500mg/pioglitazone 15mg tab

1metformin 850mg/pioglitazone 15mg tab

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

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

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

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

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


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



29



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

1GLUCAGEN 1MG HYPOKIT

1GLUCAGON 1MG INJ

1KORLYM 300MG TAB NDS PA

1PROGLYCEM 50MG/ML ORAL SUSPDIPEPTIDYL 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 2.35MG/ML AUTO-INJECTOR

1BYDUREON 2MG INJ

1BYDUREON 2MG PEN INJ

1VICTOZA 18MG/3ML PEN INJINSULIN

1HUMULIN R 500UNIT/ML INJ

1HUMULIN R 500UNIT/ML PEN INJ

1LANTUS 100UNIT/ML INJ

1LANTUS 100UNIT/ML SOLOSTAR

1LEVEMIR 100UNIT/ML FLEXTOUCH

1LEVEMIR 100UNIT/ML INJ

1NOVOLIN 100UNIT/ML INJ

1NOVOLIN N 100UNIT/ML INJ

1NOVOLIN R 100UNIT/ML INJ

1NOVOLOG 100UNIT/ML FLEXPEN

1NOVOLOG 100UNIT/ML INJ

1NOVOLOG 100UNIT/ML PENFILL

1NOVOLOG MIX 100UNIT/ML FLEXPEN

1NOVOLOG MIX 100UNIT/ML INJ

1TOUJEO 300UNIT/ML PEN 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


30


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

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

1CHLORPROPAMIDE 100MG TAB

1CHLORPROPAMIDE 250MG TAB

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

1tolazamide 250mg tab

1tolazamide 500mg tab

1TOLBUTAMIDE 500MG TAB

ANTIDIARRHEALSANTIPERISTALTIC AGENTS

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

1atropine sulfate 0.025mg/diphenoxylate 2.5mg tab

1loperamide 2mg cap

ANTIDOTESANTIDOTES

1fomepizole 1000mg/ml injANTIDOTES - CHELATING AGENTS

1CHEMET 100MG CAP

1FERRIPROX 100MG/ML ORAL SOLN NDS PA

1FERRIPROX 500MG TAB NDS PA

1JADENU 180MG TAB NDS


31



ANTIDOTES AND SPECIFIC ANTAGONISTSANTIDOTES - CHELATING AGENTS

1EXJADE 125MG ORAL SUSP NDS



1JADENU 180MG GRANULE PACKET NDS

1JADENU 360MG GRANULE PACKET NDS


1JADENU 90MG GRANULE PACKET NDSOPIOID ANTAGONISTS

1NALOXONE 0.4MG/ML CARTRIDGE

1NALOXONE 1MG/ML SYRINGE QL=2 ML/2 Days

1naltrexone 50mg tab

1NARCAN 4MG/0.1ML NASAL SPRAY QL=2 EA/2 Days

ANTIEMETICS5-HT3 RECEPTOR ANTAGONISTS

1granisetron 0.1mg/ml inj

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

1granisetron 1mg/ml (1ml) inj

1granisetron 1mg/ml inj

1ondansetron 0.8mg/ml oral soln PA BvD

1ondansetron 24mg tab PA BvD

1ondansetron 2mg/ml inj

1ondansetron 2mg/ml syringe

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 1mg/3days patch

1TRANSDERM SCOP 1MG/3DAYS PATCH

1trimethobenzamide 300mg cap PAANTIEMETICS - MISCELLANEOUS

1CESAMET 1MG CAP PA

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/80mg pack PA BvD QL=3 EA/2 Days



1VARUBI 90MG TAB PA BvD QL=2 EA/14 Days


32


ANTIFUNGALSANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS)

1CANCIDAS 50MG INJ NDS

1CANCIDAS 70MG INJ NDS

1CASPOFUNGIN ACETATE 50MG INJ NDS

1CASPOFUNGIN ACETATE 70MG INJ NDS

1ERAXIS 100MG INJ

1ERAXIS 50MG INJ

1MYCAMINE 100MG INJ

1MYCAMINE 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 oral susp


1nystatin 500000unit tab

1terbinafine 250mg tabIMIDAZOLE-RELATED ANTIFUNGALS

1fluconazole 100mg tab

1fluconazole 10mg/ml oral susp



1fluconazole 2mg/ml (100ml) inj

1fluconazole 2mg/ml inj

1fluconazole 40mg/ml oral susp


1itraconazole 100mg cap PA

1ketoconazole 200mg tab

1NOXAFIL 100MG DR TAB NDS PA

1NOXAFIL 40MG/ML ORAL SUSP PA

1voriconazole 200mg inj PA

1voriconazole 200mg tab NDS PA

1voriconazole 40mg/ml oral susp PA

1voriconazole 50mg tab NDS PA

ANTIHISTAMINESANTIHISTAMINES - ETHANOLAMINES

1carbinoxamine maleate 0.8mg/ml oral soln

1carbinoxamine maleate 4mg tab

1CLEMASTINE FUMARATE 2.68MG TAB

1diphenhydramine 50mg/ml injANTIHISTAMINES - NON-SEDATING


33


1cetirizine 1mg/ml oral soln

1desloratadine 5mg tab

1levocetirizine 0.5mg/ml oral soln

1levocetirizine 5mg tabANTIHISTAMINES - PHENOTHIAZINES

1phenadoz 12.5mg rectal supp

1phenergan 12.5mg rectal supp

1phenergan 25mg rectal supp

1phenergan 50mg rectal supp

1promethazine 1.25mg/ml oral soln

1promethazine 12.5mg rectal supp

1promethazine 12.5mg tab

1promethazine 25mg rectal supp

1promethazine 25mg tab

1promethazine 25mg/ml inj

1promethazine 50mg rectal supp

1promethazine 50mg tab

1promethazine 50mg/ml inj

1promethegan 25mg rectal supp

1promethegan 50mg rectal suppANTIHISTAMINES - PIPERIDINES

1cyproheptadine 0.4mg/ml oral soln

1cyproheptadine 4mg tab

ANTIHYPERLIPIDEMICSANTIHYPERLIPIDEMICS - MISC.

1KYNAMRO 200MG/ML SYRINGE NDS PA

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

1VASCEPA 1GM CAP PA

1VASCEPA 500MG CAP PABILE ACID SEQUESTRANTS

1cholestyramine resin 4gm sf powder for oral susp

1cholestyramine resin 66.7mg/ml oral susp

1colestipol 1000mg tab

1colestipol 5000mg granules

1prevalite 4gm/dose oral susp

1WELCHOL 3.75GM ORAL SUSP

1WELCHOL 625MG TABFIBRIC ACID DERIVATIVES

1fenofibrate 130mg cap


1fenofibrate 145mg tab

1FENOFIBRATE 150MG CAP






34


1FENOFIBRATE 50MG CAP



1fenofibric acid 135mg dr cap

1fenofibric acid 45mg dr cap

1gemfibrozil 600mg 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 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





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 NDS PA QL=2 ML/28 Days

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


35


1REPATHA 120MG/ML CARTRIDGE NDS PA QL=3.50 ML/28 Days

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

1REPATHA 140MG/ML SYRINGE NDS PA QL=2 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

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 cap


36


ANGIOTENSIN II RECEPTOR ANTAGONISTS

1candesartan cilexetil 16mg tab




1EPROSARTAN 600MG TAB

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 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

1terazosin 10mg cap

1terazosin 1mg cap

1terazosin 2mg cap

1terazosin 5mg capANTIHYPERTENSIVE COMBINATIONS

1amlodipine 10mg/benazepril 20mg cap


37



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

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


1amlodipine 10mg/olmesartan medoxomil 20mg tab


1amlodipine 10mg/telmisartan 40mg 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


1bendroflumethiazide 5mg/nadolol 40mg tab

1bendroflumethiazide 5mg/nadolol 80mg tab

1bisoprolol fumarate 10mg/hydrochlorothiazide 6.25mg tab

1bisoprolol fumarate 2.5mg/hydrochlorothiazide 6.25mg tab

1bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mg tab

1candesartan cilexetil 16mg/hydrochlorothiazide 12.5mg tab

1candesartan cilexetil 32mg/hydrochlorothiazide 12.5mg tab


38


1candesartan cilexetil 32mg/hydrochlorothiazide 25mg tab

1captopril 25mg/hydrochlorothiazide 15mg tab

1CAPTOPRIL 25MG/HYDROCHLOROTHIAZIDE 25MG TAB

1captopril 50mg/hydrochlorothiazide 15mg tab

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/moexipril 15mg tab

1hydrochlorothiazide 12.5mg/moexipril 7.5mg 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/telmisartan 40mg tab

1hydrochlorothiazide 12.5mg/telmisartan 80mg 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



39


1hydrochlorothiazide 25mg/moexipril 15mg tab

1hydrochlorothiazide 25mg/olmesartan medoxomil 40mg tab

1hydrochlorothiazide 25mg/propranolol 40mg tab

1hydrochlorothiazide 25mg/propranolol 80mg tab

1hydrochlorothiazide 25mg/quinapril 20mg tab

1hydrochlorothiazide 25mg/telmisartan 80mg tab

1hydrochlorothiazide 25mg/valsartan 160mg tab

1hydrochlorothiazide 25mg/valsartan 320mg tab


1trandolapril 1mg/verapamil 240mg er tab



1trandolapril 4mg/verapamil 240mg er tabSELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)

1eplerenone 25mg tab

1eplerenone 50mg tabVASODILATORS

1hydralazine 100mg tab


1hydralazine 20mg/ml inj



1minoxidil 10mg tab

1minoxidil 2.5mg tab

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

1AZACTAM 1GM/50ML INJ

1AZACTAM 2GM/50ML INJ

1aztreonam 333mg/ml inj

1baci-im 50000unit inj

1bacitracin 5000unit/ml inj

1CAYSTON 75MG INH SOLN NDS PA

1colistin 75mg/ml inj

1DALVANCE 500MG INJ NDS

1metronidazole 250mg tab

1metronidazole 375mg cap

1metronidazole 500mg tab

1metronidazole 5mg/ml inj

1NEBUPENT 300MG INH SOLN PA BvD

1PENTAM 300MG INJ PA BvD

1tinidazole 250mg tab

1tinidazole 500mg tab

1trimethoprim 100mg tab

1vancomycin 1000mg inj


40


1vancomycin 100mg/ml inj

1vancomycin 125mg cap ST QL=56 EA/14 Days

1vancomycin 250mg cap ST QL=56 EA/14 Days

1vancomycin 500mg inj

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

1XIFAXAN 550MG TAB QL=3 EA/1 DaysANTI-INFECTIVE MISC. - COMBINATIONS

1sulfamethoxazole 400mg/trimethoprim 80mg tab

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

1sulfamethoxazole 800mg/trimethoprim 160mg tab

1SULFAMETHOXAZOLE 80MG/ML/TRIMETHOPRIM 16MG/ML INJ

ANTIPROTOZOAL AGENTS

1ALINIA 100MG/5ML ORAL SUSP

1ALINIA 500MG TAB

1atovaquone 150mg/ml oral suspCARBAPENEMS

1cilastatin 2.5mg/ml/imipenem 2.5mg/ml inj

1cilastatin 5mg/ml/imipenem 5mg/ml inj

1DORIPENEM 500MG INJ

1INVANZ 1GM INJ

1meropenem 1gm inj

1meropenem 500mg injCHLORAMPHENICOLS

1CHLORAMPHENICOL 100MG/ML INJCYCLIC LIPOPEPTIDES

1CUBICIN 500MG INJ NDS

1daptomycin 500mg inj NDSGLYCYLCYCLINES

1TIGECYCLINE 50MG INJ NDS

1TYGACIL 50MG INJ NDSLEPROSTATICS

1dapsone 100mg tab

1dapsone 25mg tabLINCOSAMIDES

1clindamycin 12mg/ml inj

1clindamycin 150mg cap

1clindamycin 150mg/ml (2ml) inj



1clindamycin 15mg/ml oral soln






41


1lincomycin 300mg/ml injOXAZOLIDINONES

1linezolid 20mg/ml oral susp PA

1linezolid 2mg/ml inj NDS PA

1linezolid 600mg tab PA

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

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

1polymyxin b 250000unit/ml injSTREPTOGRAMINS

1SYNERCID 500MG INJ NDS

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

1DARAPRIM 25MG TAB NDS

1hydroxychloroquine sulfate 200mg tab

1mefloquine 250mg tab

1PRIMAQUINE PHOSPHATE 26.3MG TAB

1quinine sulfate 324mg cap

ANTIMYASTHENIC/CHOLINERGIC AGENTSANTIMYASTHENIC/CHOLINERGIC AGENTS

1GUANIDINE 125MG TAB

1pyridostigmine bromide 180mg er tab

1pyridostigmine bromide 60mg tab

ANTIMYCOBACTERIAL AGENTSANTI TB COMBINATIONS

1RIFAMATE 150-300MG CAP

1RIFATER 50-120-300MG TABANTIMYCOBACTERIAL AGENTS

1CAPASTAT 1GM INJ

1ethambutol 100mg tab

1ethambutol 400mg tab

1isoniazid 100mg tab

1ISONIAZID 100MG/ML INJ

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


42


1rifampin 300mg cap

1rifampin 60mg/ml inj

1SIRTURO 100MG TAB NDS PA

1TRECATOR 250MG TAB

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIESALKYLATING AGENTS

1BICNU 100MG INJ NDS

1busulfan 6mg/ml inj

1carboplatin 10mg/ml inj

1cisplatin 1mg/ml inj

1CYCLOPHOSPHAMIDE 25MG CAP PA BvD

1CYCLOPHOSPHAMIDE 50MG CAP PA BvD

1GLEOSTINE 100MG CAP

1GLEOSTINE 10MG CAP

1GLEOSTINE 40MG CAP

1GLEOSTINE 5MG CAP

1HEXALEN 50MG CAP NDS

1ifosfamide 1000mg inj

1LEUKERAN 2MG TAB

1melphalan 5mg/ml inj NDS

1MUSTARGEN 10MG INJ

1oxaliplatin 100mg inj

1oxaliplatin 5mg/ml inj

1thiotepa 15mg inj

1TREANDA 100MG INJ NDS PA NSO

1TREANDA 25MG INJ NDS PA NSO

1YONDELIS 1MG INJ NDS PA NSO

1ZANOSAR 1GM INJANTIMETABOLITES

1adrucil 500mg/10ml inj PA BvD

1ALIMTA 500MG INJ NDS

1ARRANON 5MG/ML INJ

1azacitidine 100mg inj NDS

1cladribine 1mg/ml inj PA BvD

1clofarabine 1mg/ml inj

1CLOLAR 1MG/ML INJ

1cytarabine 100mg/ml inj PA BvD

1CYTARABINE 20MG/ML INJ PA BvD

1decitabine 5mg/ml inj NDS

1fludarabine phosphate 50mg inj

1fluorouracil 50mg/ml inj PA BvD

1FOLOTYN 40MG/2ML INJ NDS PA NSO

1gemcitabine 1000mg inj

1mercaptopurine 50mg tab

1methotrexate 1000mg inj

1methotrexate 2.5mg tab


43


1methotrexate 250mg/10ml inj

1METHOTREXATE 250MG/10ML INJ

1methotrexate 25mg/ml inj

1methotrexate 50mg/2ml inj

1PURIXAN 2000MG/100ML ORAL SUSP

1TABLOID 40MG TAB

1TREXALL 10MG TAB

1TREXALL 15MG TAB

1TREXALL 5MG TAB

1TREXALL 7.5MG TAB

1XATMEP 2.5MG/ML ORAL SOLN PAANTINEOPLASTIC - ANGIOGENESIS INHIBITORS

1AVASTIN 100MG/4ML INJ NDS

1AVASTIN 400MG/16ML INJ NDS

1CYRAMZA 100MG/10ML INJ NDS PA NSO

1CYRAMZA 500MG/50ML INJ NDS PA NSO

1ZALTRAP 100MG/4ML INJ NDS PA NSOANTINEOPLASTIC - ANTIBODIES

1BAVENCIO 20MG/ML INJ NDS

1DARZALEX 100MG/5ML INJ NDS PA NSO

1EMPLICITI 300MG INJ NDS PA NSO

1EMPLICITI 400MG INJ NDS PA NSO

1ERBITUX 100MG/50ML INJ NDS

1HERCEPTIN 150MG INJ NDS

1HERCEPTIN 440MG INJ NDS

1IMFINZI 120MG/2.4ML INJ NDS PA NSO

1IMFINZI 500MG/10ML INJ NDS PA NSO

1KADCYLA 100MG INJ NDS PA NSO

1KADCYLA 160MG INJ NDS PA NSO

1KEYTRUDA 100MG/4ML INJ NDS PA NSO

1KEYTRUDA 50MG INJ NDS PA NSO

1LARTRUVO 10MG/ML INJ NDS PA NSO

1LARTRUVO 190MG/19ML INJ NDS PA NSO

1MYLOTARG 4.5MG INJ NDS PA NSO

1OPDIVO 100MG/10ML INJ NDS PA NSO

1OPDIVO 40MG/4ML INJ NDS PA NSO

1PERJETA 420MG/14ML INJ NDS PA NSO

1RITUXAN 100MG/10ML INJ NDS PA NSO

1RITUXAN 500MG/50ML INJ NDS PA NSO

1TECENTRIQ 60MG/ML INJ NDS PA NSO

1VECTIBIX 100MG/5ML INJ NDS

1YERVOY 50MG/10ML INJ NDS PA NSOANTINEOPLASTIC - BCL-2 INHIBITORS

1VENCLEXTA 10/100/50MG STARTING PACK NDS PA NSO

1VENCLEXTA 100MG TAB NDS PA NSO

1VENCLEXTA 10MG TAB NDS PA NSO


44


1VENCLEXTA 50MG TAB NDS PA NSOANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS

1ERIVEDGE 150MG CAP NDS PA NSO

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

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

1FARESTON 60MG TAB

1FASLODEX 250MG/5ML SYRINGE NDS

1FIRMAGON 120MG INJ PA NSO

1FIRMAGON 80MG INJ PA NSO

1flutamide 125mg cap

1HYDROXYPROGESTERONE CAPROATE 250MG/ML INJ

NDS PA NSO

1letrozole 2.5mg tab

1leuprolide acetate 5mg/ml inj

1LUPRON 11.25MG (1.5ML) SYRINGE

1LUPRON 22.5MG 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 oral susp PA

1NILANDRON 150MG TAB

1nilutamide 150mg tab

1SOLTAMOX 10MG/5ML ORAL SOLN PA NSO

1tamoxifen 10mg tab

1tamoxifen 20mg tab

1TRELSTAR 11.25MG INJ



1XTANDI 40MG CAP NDS PA NSO QL=120 EA/30 Days

1ZYTIGA 250MG TAB NDS PA NSO QL=120 EA/30 DaysANTINEOPLASTIC - IMMUNOMODULATORS

1POMALYST 1MG CAP NDS PA NSO


45




1POMALYST 4MG CAP NDS PA NSOANTINEOPLASTIC ANTIBIOTICS

1adriamycin 2mg/ml inj PA BvD

1bleomycin 15unit/ml inj PA BvD

1COSMEGEN 0.5MG INJ NDS

1dactinomycin 0.5mg inj NDS

1daunorubicin 5mg/ml inj

1doxorubicin 2mg/ml liposome inj NDS

1doxorubicin hydrochloride 2mg/ml inj PA BvD

1epirubicin 2mg/ml inj

1idarubicin hydrochloride 1mg/ml inj

1mitomycin 20mg inj

1mitomycin 40mg inj

1MITOMYCIN 5MG INJ

1mitoxantrone 2mg/ml injANTINEOPLASTIC COMBINATIONS

1KISQALI/FEMARA TAB CO-PACK 200MG NDS PA NSO



1LONSURF 15-6.14MG TAB NDS PA NSO

1LONSURF 20-8.19MG TAB NDS PA NSO

1VYXEOS 44-100MG INJ NDS PA NSOANTINEOPLASTIC ENZYME INHIBITORS

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

1AFINITOR 2.5MG TAB NDS PA NSO QL=30 EA/30 Days

1AFINITOR 2MG ORAL SUSP NDS PA NSO



1AFINITOR 5MG TAB NDS PA NSO QL=30 EA/30 Days

1AFINITOR 7.5MG TAB NDS PA NSO QL=30 EA/30 Days

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

1ALIQOPA 60MG INJ NDS PA NSO

1ALUNBRIG 180MG TAB NDS PA NSO



1ALUNBRIG TAB STARTER PACK NDS PA NSO

1BELEODAQ 500MG INJ NDS PA NSO

1BORTEZOMIB 3.5MG INJ NDS

1BOSULIF 100MG TAB NDS PA NSO



1CABOMETYX 20MG TAB NDS PA NSO




46


1CALQUENCE 100MG CAP NDS PA NSO

1CAPRELSA 100MG TAB NDS PA NSO

1CAPRELSA 300MG TAB NDS PA NSO

1COMETRIQ 100MG DAILY DOSE CARTON PACK NDS PA NSO



1COTELLIC 20MG TAB NDS PA NSO

1FARYDAK 10MG CAP NDS PA NSO



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



1IBRANCE 100MG CAP NDS PA NSO



1ICLUSIG 15MG TAB NDS PA NSO

1ICLUSIG 45MG TAB NDS PA NSO

1IDHIFA 100MG TAB NDS PA NSO

1IDHIFA 50MG TAB NDS PA NSO

1imatinib 100mg tab PA NSO

1imatinib 400mg tab PA NSO

1IMBRUVICA 140MG CAP NDS PA NSO QL=120 EA/30 Days

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

1INLYTA 5MG TAB NDS PA NSO QL=240 EA/30 Days

1IRESSA 250MG TAB NDS PA NSO

1ISTODAX 10MG INJ NDS PA NSO

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





1KISQALI 200MG DAILY DOSE PACK NDS PA NSO



1KYPROLIS 30MG INJ NDS PA NSO

1KYPROLIS 60MG INJ NDS PA NSO

1LENVIMA (8) 4MG PACK NDS PA NSO

1LENVIMA 10 10MG PACK NDS PA NSO

1LENVIMA 14 PACK NDS PA NSO


1LENVIMA 20 10MG PACK NDS PA NSO


1LYNPARZA 100MG CAP NDS PA NSO




47


1MEKINIST 0.5MG TAB NDS PA NSO

1MEKINIST 2MG TAB NDS PA NSO

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

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

1RUBRACA 300MG 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=120 EA/30 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

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

1TAGRISSO 80MG TAB NDS PA NSO

1TARCEVA 100MG TAB NDS PA NSO



1TASIGNA 150MG CAP NDS PA NSO

1TASIGNA 200MG CAP NDS PA NSO

1TORISEL 25MG/ML INJ NDS

1TYKERB 250MG TAB NDS PA NSO

1VELCADE 3.5MG INJ NDS

1VERZENIO 100MG TAB NDS PA NSO




1VOTRIENT 200MG TAB NDS PA NSO

1XALKORI 200MG CAP NDS PA NSO

1XALKORI 250MG CAP NDS PA NSO

1ZEJULA 100MG CAP NDS PA NSO

1ZELBORAF 240MG TAB NDS PA NSO

1ZOLINZA 100MG CAP NDS PA NSO

1ZYDELIG 100MG TAB NDS PA NSO

1ZYDELIG 150MG TAB NDS PA NSO

1ZYKADIA 150MG CAP NDS PA NSO


48


ANTINEOPLASTIC ENZYMES

1ERWINAZE 10000UNIT INJ NDS PA NSOANTINEOPLASTICS MISC.

1ACTIMMUNE 2000000UNIT/0.5ML INJ NDS

1bexarotene 75mg cap NDS PA NSO

1dacarbazine 200mg inj

1hydroxyurea 500mg cap

1INTRON A 10MU INJ

1INTRON A 18MU INJ NDS

1INTRON A 50MU INJ NDS

1INTRON A 6000000UNIT/ML INJ

1MATULANE 50MG CAP NDS

1NIPENT 10MG INJ NDS

1PROLEUKIN 22000000UNIT INJ NDS

1SYLATRON 200MCG INJ NDS PA NSO



1SYNRIBO 3.5MG INJ NDS

1tretinoin 10mg cap

1TRISENOX 12MG/6ML INJCHEMOTHERAPY ADJUNCTS

1ELITEK 1.5MG INJ NDS

1ELITEK 7.5MG INJ NDS

1KEPIVANCE 6.25MG INJ NDSCHEMOTHERAPY RESCUE/ANTIDOTE AGENTS

1dexrazoxane 250mg inj NDS

1FUSILEV 50MG INJ NDS

1LEUCOVORIN 10MG TAB

1leucovorin 10mg/ml inj

1LEUCOVORIN 15MG TAB

1leucovorin 20mg/ml inj

1leucovorin 25mg tab

1leucovorin 5mg tab

1levoleucovorin 10mg/ml inj NDS

1mesna 100mg/ml inj

1MESNEX 400MG TABMITOTIC INHIBITORS

1ABRAXANE 100MG INJ NDS

1DOCETAXEL 10MG/ML INJ

1DOCETAXEL 20MG/ML INJ NDS

1ETOPOPHOS 100MG INJ

1etoposide 20mg/ml inj

1HALAVEN 1MG/2ML INJ NDS

1JEVTANA 60MG/1.5ML INJ NDS

1paclitaxel 6mg/ml inj

1toposar 1gm/50ml inj


49


1VINBLASTINE 1MG/ML INJ PA BvD

1vincasar 1mg/ml inj PA BvD

1vincristine sulfate 1mg/ml inj PA BvD

1vinorelbine 10mg/ml injTOPOISOMERASE I INHIBITORS

1irinotecan 20mg/ml inj

1topotecan 1mg/ml inj

ANTIPARKINSON AGENTSANTIPARKINSON ADJUVANTS

1carbidopa 25mg tabANTIPARKINSON ANTICHOLINERGICS

1benztropine mesylate 0.5mg tab

1benztropine mesylate 1mg tab

1benztropine mesylate 1mg/ml inj

1benztropine mesylate 2mg tab

1trihexyphenidyl 0.4mg/ml oral soln

1trihexyphenidyl 2mg tab

1trihexyphenidyl 5mg tabANTIPARKINSON COMT INHIBITORS

1entacapone 200mg tab

1tolcapone 100mg tabANTIPARKINSON DOPAMINERGICS

1amantadine 100mg cap

1amantadine 100mg tab

1amantadine 10mg/ml oral soln

1APOKYN 10MG/ML CARTRIDGE NDS

1bromocriptine 2.5mg tab

1bromocriptine 5mg cap

1carbidopa 10mg/levodopa 100mg odt

1carbidopa 10mg/levodopa 100mg tab

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


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

1carbidopa 25mg/levodopa 100mg er tab








50


1CARBIDOPA 50MG/ENTACAPONE 200MG/LEVODOPA 200MG 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 1mg tab


1ropinirole 2mg tab

1ropinirole 3mg tab


1ropinirole 4mg tab

1ropinirole 5mg tab



1STALEVO 12.5-50-200MG TAB


1STALEVO 25-100-200MG TAB



1STALEVO 50-200-200MG TABANTIPARKINSON MONOAMINE OXIDASE INHIBITORS

1rasagiline 0.5mg tab

1rasagiline 1mg tab

1selegiline 5mg cap

1selegiline 5mg tab

ANTIPSYCHOTICS/ANTIMANIC AGENTS


51


ANTIMANIC AGENTS

1lithium carbonate 150mg cap


1lithium carbonate 300mg er tab

1lithium carbonate 300mg tab

1lithium carbonate 450mg er tab


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

1EQUETRO 100MG ER CAP



1GEODON 20MG INJ

1LATUDA 120MG TAB PA NSO QL=30 EA/30 Days





1NUPLAZID 17MG TAB PA NSO

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 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 PA NSO

1INVEGA 156MG/ML SYRINGE PA NSO









52


1paliperidone 1.5mg er tab PA NSO

1paliperidone 3mg er tab PA NSO



1RISPERDAL 12.5MG INJ PA NSO

1RISPERDAL 25MG INJ PA NSO

1RISPERDAL 37.5MG INJ PA NSO

1RISPERDAL 50MG INJ PA NSO

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

1haloperidol 0.5mg tab

1haloperidol 10mg tab




1haloperidol 2mg/ml oral soln


1haloperidol 5mg/ml inj

1haloperidol 5mg/ml syringe

1haloperidol decanoate 100mg/ml inj

1haloperidol decanoate 500mg/5ml 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

1FAZACLO 12.5MG ODT

1FAZACLO 150MG ODT


53


1FAZACLO 200MG ODT

1loxapine 10mg cap

1loxapine 25mg cap

1loxapine 50mg cap

1loxapine 5mg cap

1olanzapine 10mg inj

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

1olanzapine 10mg tab QL=30 EA/30 Days



1olanzapine 2.5mg tab QL=30 EA/30 Days





1olanzapine 7.5mg tab QL=30 EA/30 Days

1quetiapine 100mg tab

1quetiapine 150mg xr tab QL=30 EA/30 Days





1quetiapine 300mg xr tab


1quetiapine 400mg xr 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

1VERSACLOZ 50MG/ML ORAL SUSP

1ZYPREXA 210MG INJPHENOTHIAZINES

1chlorpromazine 100mg tab




1CHLORPROMAZINE 25MG/ML INJ


1compro 25mg rectal supp

1FLUPHENAZINE 0.5MG/ML ORAL SOLN

1fluphenazine 10mg tab


1fluphenazine 2.5mg tab

1FLUPHENAZINE 2.5MG/ML INJ



54


1FLUPHENAZINE 5MG/ML ORAL SOLN

1fluphenazine decanoate 25mg/ml inj

1perphenazine 16mg tab




1prochlorperazine 10mg tab

1prochlorperazine 25mg rectal supp

1prochlorperazine 5mg tab

1prochlorperazine 5mg/ml inj

1thioridazine 100mg tab




1trifluoperazine 10mg tab



1trifluoperazine 5mg tabQUINOLINONE DERIVATIVES

1ABILIFY 300MG MAINTENA INJ NDS PA NSO

1ABILIFY 300MG MAINTENA PF SYRINGE NDS PA NSO

1ABILIFY 400MG MAINTENA PF SYRINGE NDS PA NSO

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

1aripiprazole 10mg tab QL=30 EA/30 Days

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


1aripiprazole 1mg/ml oral soln PA NSO





1ARISTADA 273MG/ML SYRINGE PA NSO

1ARISTADA 441MG/1.6ML SYRINGE NDS PA NSO



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

1thiothixene 10mg cap





55


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 NDS



1ATRIPLA 600-200-300MG TAB NDS

1BIKTARVY 50-200-25MG TAB NDS

1COMPLERA 200-25-300MG TAB NDS

1CRIXIVAN 200MG CAP

1CRIXIVAN 400MG CAP

1DESCOVY 200-25MG TAB NDS

1didanosine 200mg dr cap



1EDURANT 25MG TAB NDS

1efavirenz 200mg cap

1efavirenz 50mg cap

1efavirenz 600mg cap

1EMTRIVA 10MG/ML ORAL SOLN

1EMTRIVA 200MG CAP

1EPZICOM 600-300MG TAB NDS

1EVOTAZ 300-150MG TAB NDS

1fosamprenavir 700mg tab NDS

1FUZEON 90MG INJ NDS

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

1INTELENCE 100MG TAB NDS

1INTELENCE 200MG TAB NDS

1INTELENCE 25MG TAB

1INVIRASE 200MG CAP

1INVIRASE 500MG TAB NDS

1ISENTRESS 100MG CHEW TAB NDS

1ISENTRESS 100MG ORAL SUSP

1ISENTRESS 25MG CHEW TAB

1ISENTRESS 400MG TAB NDS

1JULUCA 50-25MG TAB NDS

1KALETRA 100-25MG TAB

1KALETRA 200-50MG TAB NDS

1KALETRA 400-100MG/5ML ORAL SOLN NDS

1lamivudine 10mg/ml oral soln


56


1lamivudine 150mg tab

1lamivudine 150mg/zidovudine 300mg tab NDS


1LEXIVA 50MG/ML ORAL SUSP

1LEXIVA 700MG TAB NDS

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

1nevirapine 100mg er tab

1NEVIRAPINE 10MG/ML ORAL SUSP

1nevirapine 200mg tab

1nevirapine 400mg er tab

1NORVIR 100MG CAP

1NORVIR 100MG TAB

1NORVIR 80MG/ML ORAL SOLN

1ODEFSEY 200-25-25MG TAB NDS

1PREZCOBIX 800-150MG TAB NDS

1PREZISTA 100MG/ML ORAL SUSP

1PREZISTA 150MG TAB

1PREZISTA 600MG TAB NDS

1PREZISTA 75MG TAB

1PREZISTA 800MG TAB NDS

1RESCRIPTOR 100MG TAB

1RESCRIPTOR 200MG TAB

1RETROVIR 10MG/ML INJ

1REYATAZ 150MG CAP NDS



1REYATAZ 50MG ORAL POWDER NDS

1SELZENTRY 150MG TAB NDS

1SELZENTRY 20MG/ML ORAL SOLN NDS




1stavudine 15mg cap

1stavudine 20mg cap

1stavudine 30mg cap

1stavudine 40mg cap

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

1SUSTIVA 200MG CAP

1SUSTIVA 50MG CAP

1SUSTIVA 600MG TAB

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


57





1TYBOST 150MG TAB

1VIDEX 125MG DR CAP

1VIDEX 2GM ORAL SOLN

1VIRACEPT 250MG TAB NDS

1VIRACEPT 625MG TAB NDS

1VIRAMUNE 50MG/5ML ORAL SUSP

1VIREAD 150MG TAB NDS




1VIREAD 40MG/GM ORAL POWDER

1ZERIT 1MG/ML ORAL SOLN

1ZIAGEN 20MG/ML ORAL SOLN

1zidovudine 100mg cap

1zidovudine 10mg/ml oral soln

1zidovudine 300mg tabCMV AGENTS

1cidofovir 75mg/ml inj

1ganciclovir 500mg inj PA BvD

1VALCYTE 50MG/ML ORAL SOLN NDS

1valganciclovir 450mg tab NDS

1valganciclovir 50mg/ml oral soln NDSHEPATITIS AGENTS

1adefovir dipivoxil 10mg tab

1BARACLUDE 0.05MG/ML ORAL SOLN

1entecavir 0.5mg tab

1entecavir 1mg tab

1EPCLUSA 400-100MG TAB NDS PA QL=30 EA/30 Days

1EPIVIR HBV 5MG/ML ORAL SOLN


1MAVYRET 100-40MG TAB NDS PA QL=84 EA/28 Days

1MODERIBA 1200/DAY DOSE PACK NDS

1moderiba 200mg tab

1MODERIBA 800/DAY DOSE PACK NDS

1PEGASYS 135MCG/0.5ML AUTO-INJECTOR NDS

1PEGASYS 180MCG/0.5ML AUTO-INJECTOR NDS

1PEGASYS 180MCG/0.5ML SYRINGE NDS

1PEGASYS 180MCG/ML INJ NDS

1ribasphere 200mg cap

1ribasphere 200mg tab

1ribasphere 400mg tab

1ribasphere 600mg tab NDS

1ribasphere ribapak 1200/day NDS


58


1ribasphere ribapak 800/day

1ribavirin 200mg cap

1ribavirin 200mg tab

1VEMLIDY 25MG TAB NDS

1ZEPATIER 50-100MG TAB NDS PA QL=30 EA/30 DaysHERPES AGENTS

1acyclovir 200mg cap

1acyclovir 400mg tab

1acyclovir 40mg/ml oral 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 oral susp QL=550 ML/180 Days


1RELENZA 5MG/BLISTER INH QL=56 EA/180 Days

1rimantadine 100mg tab

1TAMIFLU 6MG/ML ORAL SUSP QL=550 ML/180 Days

ASSORTED CLASSESCHELATING AGENTS

1DEPEN 250MG TAB

1SYPRINE 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 XL CAP PA BvD

1ASTAGRAF 1MG XL CAP PA BvD

1ASTAGRAF 5MG XL CAP PA BvD

1ATGAM 50MG/ML INJ NDS PA BvD

1AZASAN 100MG TAB PA BvD

1AZASAN 75MG TAB PA BvD


59


1azathioprine 50mg tab PA BvD

1cyclosporine 100mg cap PA BvD

1cyclosporine 25mg cap PA BvD

1cyclosporine 50mg/ml inj PA BvD

1cyclosporine, modified 100mg cap PA BvD

1cyclosporine, modified 100mg/ml oral soln PA BvD

1cyclosporine, modified 25mg cap PA BvD

1ENVARSUS 0.75MG ER TAB PA BvD

1ENVARSUS 1MG ER TAB PA BvD

1ENVARSUS 4MG ER TAB PA BvD

1gengraf 100mg cap PA BvD

1gengraf 100mg/ml oral soln PA BvD


1mycophenolate mofetil 200mg/ml oral susp PA BvD

1mycophenolate mofetil 250mg cap PA BvD

1mycophenolate mofetil 500mg tab PA BvD

1mycophenolic acid 180mg dr tab PA BvD

1mycophenolic acid 360mg dr tab PA BvD

1NULOJIX 250MG INJ NDS PA BvD

1PROGRAF 5MG/ML INJ PA BvD

1RAPAMUNE 1MG/ML ORAL SOLN PA BvD

1SANDIMMUNE 100MG/ML ORAL SOLN PA BvD

1SIMULECT 20MG INJ NDS

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

1THYMOGLOBULIN 25MG INJ NDS PA BvD

1ZORTRESS 0.25MG TAB PA BvD

1ZORTRESS 0.5MG TAB PA BvD

1ZORTRESS 0.75MG TAB PA BvDIRRIGATION SOLUTIONS

1calcium chloride 0.002 meq/ml/potassium chloride 0.004 meq/ml/sodium chloride 0.147 meq/ml soln

1lactated ringers irrigation

1physiolyte soln

1physiosol soln

1water 1000mg/ml solnLYMPHATIC AGENTS

1SYLVANT 100MG INJ NDSPOTASSIUM REMOVING RESINS

1kionex 250mg/ml oral susp

1sodium polystyrene sulfonate 250mg/ml oral susp

1sps 250mg/ml oral susp


60


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 120MG INJ NDS

1BENLYSTA 400MG INJ NDS

BETA BLOCKERSALPHA-BETA BLOCKERS

1carvedilol 12.5mg tab

1carvedilol 25mg tab



1labetalol 100mg tab



1labetalol 5mg/ml injBETA 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

1BYSTOLIC 2.5MG TAB

1BYSTOLIC 20MG TAB

1BYSTOLIC 5MG TAB

1metoprolol succinate 100mg er tab




1metoprolol tartrate 100mg tab

1metoprolol tartrate 1mg/ml cartridge

1metoprolol tartrate 1mg/ml inj

1metoprolol tartrate 25mg tab

1metoprolol tartrate 50mg tabBETA BLOCKERS NON-SELECTIVE

1INNOPRAN 120MG XL CAP

1INNOPRAN 80MG XL CAP

1nadolol 20mg tab

1nadolol 40mg tab

1nadolol 80mg tab

1pindolol 10mg tab


61


1pindolol 5mg tab

1propranolol 10mg tab

1propranolol 120mg er cap


1propranolol 1mg/ml inj



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

1timolol 10mg tab

1timolol 20mg tab

1timolol 5mg tab

BIOLOGICALS MISCBIOLOGICALS MISC

1ADAGEN 250UNIT/ML INJ NDS PA

CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS

1afeditab 30mg cr tab

1afeditab 60mg cr tab

1amlodipine 10mg tab

1amlodipine 2.5mg tab

1amlodipine 5mg tab

1CARDENE 20MG/200ML INJ

1CARDENE 40MG/200ML INJ

1cartia 120mg er cap




1dilt 120mg xr cap

1dilt 180mg xr cap

1dilt 240mg xr cap

1diltiazem 120mg er (12 hr) cap

1diltiazem 120mg er (24 hr) cap

1diltiazem 120mg tab


62


1diltiazem 180mg er cap

1DILTIAZEM 1MG/ML INJ



1diltiazem 30mg tab



1diltiazem 5mg/ml inj


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 2.5mg/ml inj

1nicardipine 20mg cap

1nicardipine 30mg cap

1nifedipine 10mg cap

1nifedipine 20mg cap

1nifedipine 30mg er tab

1nifedipine 30mg osmotic er tab





1nimodipine 30mg cap

1nisoldipine 17mg er tab





1nisoldipine 8.5mg er tab

1taztia 120mg er cap





1verapamil 100mg er cap


63



1verapamil 120mg er tab

1verapamil 120mg tab



1verapamil 2.5mg/ml inj





1verapamil 360mg sr cap

1verapamil 40mg tab

1verapamil 80mg tab

CARDIOTONICSCARDIAC GLYCOSIDES

1digitek 0.125mg tab

1digitek 0.25mg tab

1digox 0.125mg tab

1digox 0.25mg tab

1digoxin 0.05mg/ml oral soln

1digoxin 0.125mg tab

1digoxin 0.25mg tab

1digoxin 0.25mg/ml inj

CARDIOVASCULAR AGENTS - MISC.CARDIOVASCULAR AGENTS MISC. - COMBINATIONS

1amlodipine 10mg/atorvastatin 10mg tab




1amlodipine 2.5mg/atorvastatin 10mg tab







1BIDIL 20-37.5MG TAB

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

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

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

1REMODULIN 10MG/ML INJ NDS PA BvD


1REMODULIN 2.5MG/ML INJ NDS PA BvD


1VENTAVIS 10MCG/ML INH SOLN NDS PA


64


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

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

1LETAIRIS 5MG TAB NDS PA QL=30 EA/30 Days

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

1TRACLEER 125MG TAB NDS PA QL=60 EA/30 Days

1TRACLEER 32MG TAB FOR ORAL SUSP NDS PA QL=120 EA/30 Days

1TRACLEER 62.5MG TAB NDS PA QL=60 EA/30 DaysPULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS

1sildenafil 20mg tab PAPULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST

1UPTRAVI 1000MCG TAB NDS PA QL=60 EA/30 Days








1UPTRAVI TITRATION PACK NDS PA QL=200 EA/30 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 7.5MG TAB PA

CEPHALOSPORINSCEPHALOSPORIN COMBINATIONS

1AVYCAZ 2-0.5GM INJ NDS

1ZERBAXA 1.5GM INJ NDSCEPHALOSPORINS - 1ST GENERATION

1cefadroxil 1000mg tab

1cefadroxil 100mg/ml oral susp

1cefadroxil 500mg cap

1cefadroxil 50mg/ml oral susp

1cefazolin 1gm inj

1cefazolin 200mg/ml inj

1cefazolin 500mg inj

1cephalexin 250mg cap

1cephalexin 25mg/ml oral susp

1cephalexin 500mg cap

1cephalexin 50mg/ml oral suspCEPHALOSPORINS - 2ND GENERATION


65


1cefaclor 250mg cap

1CEFACLOR 25MG/ML ORAL SUSP

1cefaclor 500mg cap

1cefaclor 50mg/ml oral susp

1CEFACLOR 75MG/ML ORAL SUSP

1cefotetan 1000mg inj

1cefotetan 2000mg inj

1cefoxitin 1000mg inj

1cefoxitin 2000mg inj

1cefoxitin 200mg/ml inj

1cefprozil 250mg tab

1cefprozil 25mg/ml oral susp

1cefprozil 500mg tab

1cefprozil 50mg/ml oral susp

1cefuroxime 1.5gm inj

1cefuroxime 250mg tab

1cefuroxime 500mg tab

1cefuroxime 750mg inj

1cefuroxime 95mg/ml injCEPHALOSPORINS - 3RD GENERATION

1cefdinir 25mg/ml oral susp

1cefdinir 300mg cap

1cefdinir 50mg/ml oral susp

1cefixime 20mg/ml oral susp

1cefixime 40mg/ml oral susp

1CEFOTAXIME 1GM INJ

1CEFOTAXIME 2GM INJ

1CEFOTAXIME 500MG INJ

1cefpodoxime 100mg tab

1cefpodoxime 10mg/ml oral susp

1cefpodoxime 200mg tab

1cefpodoxime 20mg/ml oral susp

1ceftazidime 1000mg inj

1ceftazidime 2000mg inj

1ceftazidime 200mg/ml inj

1ceftriaxone 1000mg inj

1ceftriaxone 100mg/ml inj




1SUPRAX 400MG CAP

1tazicef 1gm inj

1tazicef 2gm inj

1tazicef 6gm injCEPHALOSPORINS - 4TH GENERATION

1cefepime 1gm inj


66


1cefepime 2gm 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

1amethia lo 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

1bekyree 28 day pack

1blisovi 21 fe 1.5/30 28 day

1blisovi 21 fe 1/20 28 day pack

1blisovi 24 fe 1/20 28 day pack

1briellyn 28 day pack

1camrese lo 91 day pack

1caziant 28 day pack

1cryselle 28 pack

1cyclafem 1/35 28 day pack

1cyclafem 7/7/7 28 day pack

1delyla 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 0.02mg/levomefolate calcium 0.451mg pack

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

1emoquette pack

1enpresse 28 day pack

1enskyce 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


67


1ethinyl estradiol 0.02mg/ferrous fumarate 75mg/norethindrone acetate 1mg pack

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

1ethinyl estradiol 0.02mg/levonorgestrel 0.09mg pack

1ethinyl estradiol 0.02mg/norethindrone 1mg 21 day 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

1gildagia pack

1introvale 91 day pack

1isibloom 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

1kimidess 28 day pack

1kurvelo 28 day 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


68


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

1mononessa 28 day pack

1NATAZIA 28 DAY PACK

1necon 0.5/35 28 day pack

1necon 7/7/7 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

1quasense 91 day pack

1reclipsen 28 day pack

1rivelsa 91 day pack

1setlakin 91 day pack

1sprintec 28 day pack

1sronyx 28 day pack

1tarina fe 1/20 28 day pack

1tri-legest 28 day pack

1tri-lo-estarylla 28 day pack

1tri-lo-sprintec 28 day pack

1tri-previfem 28 day pack

1tri-sprintec 28 day pack

1trinessa 28 day pack

1trivora 28 day pack

1velivet 28 day pack

1vestura 3-0.02mg pack

1vienva 28 day pack

1vyfemla 28 day pack

1wymzya fe 28 day pack


69


1zarah 3-0.03mg pack

1zenchent 28 day pack

1zovia 1/35e 28 day pack

1zovia 1/50e 28 day packCOMBINATION CONTRACEPTIVES - TRANSDERMAL

1XULANE 150-35MCG PATCHCOMBINATION CONTRACEPTIVES - VAGINAL

1NUVARING VAGINAL RINGPROGESTIN 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

1jolivette 28 day 0.35mg pack

1lyza 0.35mg pack

1nora-be 28 day 0.35mg pack

1norethindrone 0.35mg pack

1norlyroc 28 day 0.35mg pack

1sharobel 28 day 0.35mg pack

CORTICOSTEROIDSGLUCOCORTICOSTEROIDS

1budesonide 3mg dr cap NDS

1CORTISONE ACETATE 25MG TAB

1dexamethasone 0.1mg/ml oral soln

1dexamethasone 0.5mg tab



1DEXAMETHASONE 10MG/ML INJ

1DEXAMETHASONE 1MG TAB

1DEXAMETHASONE 1MG/ML ORAL SOLN

1DEXAMETHASONE 2MG TAB

1dexamethasone 4mg tab

1dexamethasone 6mg tab

1dexamethasone phosphate 4mg/ml inj

1hydrocortisone 10mg tab



1KENALOG 10MG/ML INJ

1KENALOG 40MG/ML INJ

1MEDROL 2MG TAB

1methylprednisolone 125mg inj PA BvD

1methylprednisolone 16mg tab


1methylprednisolone 40mg/ml inj PA BvD


70


1methylprednisolone 4mg pack


1methylprednisolone 62.5mg/ml inj PA BvD


1methylprednisolone acetate 40mg/ml inj

1methylprednisolone acetate 80mg/ml inj

1prednisolone 10mg odt


1prednisolone 1mg/ml oral soln


1prednisolone 3mg/ml oral soln

1PREDNISONE 10MG (21) TAB PACK


1prednisone 10mg tab

1prednisone 1mg tab

1PREDNISONE 1MG/ML ORAL SOLN

1prednisone 2.5mg tab

1prednisone 20mg tab

1PREDNISONE 50MG TAB



1prednisone 5mg tab

1PREDNISONE 5MG/ML ORAL SOLN

1SOLU-CORTEF 100MG INJ

1SOLU-CORTEF 250MG INJ

1UCERIS 9MG ER TAB PA QL=30 EA/30 DaysMINERALOCORTICOIDS

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 10% inh soln PA BvD

1acetylcysteine 20% 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


71


1avita 0.025% gel PA

1claravis 10mg cap

1claravis 20mg cap

1claravis 30mg cap

1claravis 40mg cap

1clindacin 1% pad

1clindamycin 1% foam

1clindamycin 1% gel

1clindamycin 1% lotion

1clindamycin 1% pad

1clindamycin 1% topical soln

1clindamycin/benzoyl peroxide 1-5% gel

1DIFFERIN 0.1% LOTION PA

1EPIDUO 0.3-2.5% GEL PA

1EPIDUO 0.1-2.5% 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 sulfate 0.1% cream

1gentamicin sulfate 0.1% ointment

1mupirocin 2% cream

1mupirocin 2% ointmentANTIFUNGALS - TOPICAL


72


1betamethasone/clotrimazole 1-0.05% cream

1betamethasone/clotrimazole 1-0.05% lotion

1ciclopirox 0.77% cream

1ciclopirox 0.77% gel

1ciclopirox 0.77% lotion

1ciclopirox 1% shampoo

1ciclopirox 8% topical soln

1clotrimazole 1% cream

1clotrimazole 1% topical soln

1econazole nitrate 1% cream

1ERTACZO 2% CREAM

1ketoconazole 2% cream

1ketoconazole 2% shampoo

1ketoconazole 20mg/ml foam

1naftifine 2% cream

1nyamyc 100000unit/gm powder

1nystatin 100000unit/ml cream

1nystatin 100000unit/ml/triamcinolone acetonide 1mg/ml cream

1nystatin 100unit/mg ointment

1nystatin 100unit/mg powder

1nystatin 100unit/mg/triamcinolone acetonide 0.001mg/mg ointment

1nystop 100000unit/gm powderANTI-INFLAMMATORY AGENTS - TOPICAL

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

1diclofenac sodium 1.5% topical solnANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL

1diclofenac sodium 3% gel PA NSO

1FLUOROURACIL 0.5% CREAM

1fluorouracil 2% topical soln

1fluorouracil 5% cream

1fluorouracil 5% topical soln

1PANRETIN 0.1% GEL NDS

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

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

1TARGRETIN 1% GEL NDS

1TOLAK 4% CREAM

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

1calcipotriene 0.005% ointment

1calcipotriene 0.005% topical soln


73


1COSENTYX 150MG/ML AUTO-INJECTOR NDS PA

1COSENTYX 150MG/ML SYRINGE NDS PA

1methoxsalen 10mg cap

1tazarotene 0.1% cream

1TAZORAC 0.05% CREAM

1TAZORAC 0.05% GEL

1TAZORAC 0.1% GELANTISEBORRHEIC PRODUCTS

1selenium sulfide 2.5% shampooANTIVIRALS - TOPICAL

1acyclovir 5% ointment

1DENAVIR 1% CREAMBURN PRODUCTS

1silver sulfadiazine 1% cream

1ssd 1% cream

1SULFAMYLON 85MG/GM CREAMCORTICOSTEROIDS - TOPICAL

1ala-cort 1% cream

1ala-cort 2.5% cream

1alclometasone dipropionate 0.05% cream

1alclometasone dipropionate 0.05% ointment

1AMCINONIDE 0.1% CREAM PA

1AMCINONIDE 0.1% OINTMENT PA

1betamethasone 0.05% aug cream

1betamethasone 0.05% aug gel

1betamethasone 0.05% aug lotion

1betamethasone 0.05% aug ointment

1betamethasone 0.05% cream

1betamethasone 0.05% lotion

1betamethasone 0.05% ointment

1betamethasone 0.1% cream

1betamethasone 0.1% lotion

1betamethasone 0.1% ointment

1betamethasone valerate 0.12% foam PA

1calcipotriene/betamethasone 0.005-0.064% ointment

1clobetasol propionate 0.05% cream PA

1clobetasol propionate 0.05% foam PA

1clobetasol propionate 0.05% gel PA

1clobetasol propionate 0.05% lotion PA

1clobetasol propionate 0.05% ointment PA

1clobetasol propionate 0.05% shampoo PA

1clobetasol propionate 0.05% spray PA

1clobetasol propionate 0.05% topical soln PA

1clodan 0.05% shampoo PA

1desonide 0.05% cream PA

1desonide 0.05% lotion PA


74


1desonide 0.05% ointment

1desoximetasone 0.05% cream

1desoximetasone 0.05% gel

1desoximetasone 0.25% cream

1desoximetasone 0.25% ointment

1DIFLORASONE DIACETATE 0.05% CREAM PA

1DIFLORASONE DIACETATE 0.05% OINTMENT PA

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

1fluticasone propionate 0.05% lotion PA

1halobetasol propionate 0.05% cream

1halobetasol propionate 0.05% ointment

1hydrocortisone 1% cream

1hydrocortisone 1% ointment

1hydrocortisone 2.5% cream

1hydrocortisone 2.5% lotion

1hydrocortisone 2.5% ointment

1hydrocortisone valerate 0.2% cream

1hydrocortisone valerate 0.2% ointment

1mometasone furoate 0.1% cream

1mometasone furoate 0.1% lotion

1mometasone furoate 0.1% ointment

1prednicarbate 0.1% cream

1prednicarbate 0.1% ointment

1PSORCON 0.05% CREAM PA

1TOPICORT 0.05% CREAM

1triamcinolone acetonide 0.025% cream

1triamcinolone acetonide 0.025% lotion

1triamcinolone acetonide 0.025% ointment


1triamcinolone acetonide 0.1% lotion


1triamcinolone acetonide 0.147mg/ml spray



1triderm 0.1% creamECZEMA AGENTS


75


1DUPIXENT 300MG/2ML SYRINGE NDS PAEMOLLIENTS

1ammonium lactate 12% cream

1ammonium lactate 12% lotionENZYMES - TOPICAL

1SANTYL 250UNIT/GM OINTMENTIMMUNOMODULATING AGENTS - TOPICAL

1imiquimod 5% cream

1ZYCLARA 2.5% CREAMIMMUNOSUPPRESSIVE AGENTS - TOPICAL

1ELIDEL 1% CREAM

1tacrolimus 0.03% ointment

1tacrolimus 0.1% ointmentKERATOLYTIC/ANTIMITOTIC AGENTS

1podofilox 0.5% topical solnLOCAL ANESTHETICS - TOPICAL

1lidocaine 2% gel

1lidocaine 4% topical soln

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

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

1lidocaine/prilocaine 2.5-2.5% creamROSACEA AGENTS

1FINACEA 15% FOAM

1FINACEA 15% GEL

1metronidazole 0.75% cream

1metronidazole 0.75% gel

1metronidazole 0.75% lotion

1metronidazole 1% gelSCABICIDES & PEDICULICIDES

1EURAX 10% CREAM

1lindane 1% shampoo

1malathion 0.5% lotion

1permethrin 5% creamWOUND CARE PRODUCTS

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

DIGESTIVE AIDSDIGESTIVE ENZYMES

1CREON 12000-38000-60000UNIT DR CAP

1CREON 24000-76000-120000UNIT DR CAP


1CREON 36000-114000-180000UNIT DR CAP


1PANCREAZE 10500-25000-43750UNIT DR CAP ST





76



1SUCRAID 8500UNIT/ML ORAL SOLN NDS PA

DIURETICSCARBONIC ANHYDRASE INHIBITORS

1acetazolamide 100mg/ml inj

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 25MG/TRIAMTERENE 50MG CAP

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

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

1DYRENIUM 100MG CAP

1DYRENIUM 50MG CAP

1spironolactone 100mg tab

1spironolactone 25mg tab

1spironolactone 50mg tabTHIAZIDES AND THIAZIDE-LIKE DIURETICS

1CHLOROTHIAZIDE 250MG TAB

1chlorothiazide 500mg inj

1chlorothiazide 500mg tab


77


1chlorthalidone 25mg tab

1chlorthalidone 50mg tab

1DIURIL 250MG/5ML ORAL SUSP

1hydrochlorothiazide 12.5mg cap

1hydrochlorothiazide 12.5mg tab

1hydrochlorothiazide 25mg tab

1hydrochlorothiazide 50mg tab

1indapamide 1.25mg tab

1indapamide 2.5mg tab

1METHYCLOTHIAZIDE 5MG TAB

1metolazone 10mg tab

1metolazone 2.5mg tab

1metolazone 5mg tab

ENDOCRINE AND METABOLIC AGENTS - MISC.BONE DENSITY REGULATORS

1ALENDRONATE 0.933MG/ML ORAL SOLN

1alendronate 10mg tab


1ALENDRONATE 40MG TAB



1etidronate disodium 200mg tab

1ETIDRONATE DISODIUM 400MG TAB

1FORTEO 600MCG/2.4ML PEN INJ NDS

1ibandronate 150mg tab QL=1 EA/30 Days

1ibandronate 1mg/ml inj PA BvD

1MIACALCIN 200UNIT/ML INJ PA BvD

1NATPARA 100MCG CARTRIDGE NDS PA




1pamidronate disodium 3mg/ml inj PA BvD

1PAMIDRONATE DISODIUM 6MG/ML INJ PA BvD

1pamidronate disodium 9mg/ml inj PA BvD

1PROLIA 60MG/ML SYRINGE

1risedronate sodium 150mg tab


1risedronate sodium 35mg (12) pack

1risedronate sodium 35mg (4) pack



1salmon calcitonin 200unit/act nasal spray

1TYMLOS 2MG/ML PEN INJECTOR NDS

1XGEVA 120MG/1.7ML INJ NDS PA

1zoledronic acid 0.05mg/ml inj

1zoledronic acid 0.8mg/ml inj


78


1ZOMETA 4MG/100ML INJ NDSGROWTH 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 PA

1NORDITROPIN 10MG/1.5ML PEN INJ NDS PA

1NORDITROPIN 15MG/1.5ML PEN INJ NDS PA

1NORDITROPIN 30MG/3ML PEN INJ NDS PA

1NORDITROPIN 5MG/1.5ML PEN INJ NDS PAHORMONE RECEPTOR MODULATORS

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

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

1LUPRON 11.25MG (1ML) SYRINGE NDS

1LUPRON 15MG SYRINGE NDS

1LUPRON 30MG SYRINGE (3 MONTH)

1SYNAREL 2MG/ML NASAL SPRAY NDSMETABOLIC MODIFIERS

1ALDURAZYME 2.9MG/5ML INJ NDS

1calcitriol 0.00025mg cap PA BvD

1calcitriol 0.0005mg cap PA BvD

1calcitriol 0.001mg/ml inj PA BvD

1calcitriol 0.001mg/ml oral soln PA BvD

1CARBAGLU 200MG ORAL SUSP PA

1doxercalciferol 0.0005mg cap PA BvD



1doxercalciferol 0.002mg/ml inj PA BvD

1ELAPRASE 6MG/3ML INJ NDS

1FABRAZYME 35MG INJ NDS


79


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 PA BvD

1levocarnitine 330mg tab PA BvD

1LUMIZYME 50MG INJ NDS

1NAGLAZYME 1MG/ML INJ NDS

1ORFADIN 10MG CAP NDS PA


1ORFADIN 4MG/ML ORAL SUSP NDS PA


1paricalcitol 0.001mg cap PA BvD


1paricalcitol 0.002mg/ml inj PA BvD


1paricalcitol 0.005mg/ml inj PA BvD

1RAVICTI 1.1GM/ML ORAL SOLN NDS PA

1SENSIPAR 30MG TAB PA BvD



1sodium phenylbutyrate 0.94mg/mg oral powder

1STRENSIQ 40MG/ML INJ NDS PA

1STRENSIQ 80MG/0.8ML INJ NDS PAPOSTERIOR PITUITARY HORMONES

1desmopressin acetate 0.004mg/ml inj

1desmopressin acetate 0.01% nasal soln

1desmopressin acetate 0.01% nasal spray

1desmopressin acetate 0.1mg tab

1desmopressin acetate 0.2mg tab

1STIMATE 1.5MG/ML NASAL SPRAYPROLACTIN 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



ESTROGENSESTROGEN COMBINATIONS


80


1amabelz 0.5/0.1mg 28 day pack

1amabelz 1/0.5mg 28 day pack

1COMBIPATCH 0.05-0.14MG PATCH

1COMBIPATCH 0.05-0.25MG PATCH

1estradiol 0.5mg/norethindrone acetate 0.1mg pack

1estradiol 1mg/norethindrone acetate 0.5mg pack

1ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mg tab

1ethinyl estradiol 0.005mg/norethindrone acetate 1mg tab

1fyavolv 0.5mg-2.5mcg tab

1fyavolv 1mg-5mcg tab

1jinteli tab

1mimvey lo 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

1estradiol 0.00104mg/hr twice weekly patch

1estradiol 0.00104mg/hr weekly patch










1estradiol 0.5mg tab

1estradiol 1mg tab

1estradiol 20mg/ml inj

1estradiol 2mg tab

1estradiol 40mg/ml inj

1ESTROPIPATE 0.75MG TAB

1ESTROPIPATE 1.5MG TAB

1ESTROPIPATE 3MG TAB

1PREMARIN 0.3MG TAB

1PREMARIN 0.45MG TAB


1PREMARIN 0.9MG TAB


FLUOROQUINOLONES


81


FLUOROQUINOLONES

1AVELOX 400MG/250ML INJ

1ciprofloxacin 100mg/ml oral susp

1CIPROFLOXACIN 10MG/ML INJ

1ciprofloxacin 250mg tab

1ciprofloxacin 2mg/ml inj


1ciprofloxacin 50mg/ml oral susp


1levofloxacin 250mg tab

1levofloxacin 25mg/ml inj

1levofloxacin 25mg/ml oral soln


1levofloxacin 5mg/ml (150ml) inj

1levofloxacin 5mg/ml inj


1MOXIFLOXACIN 1.6MG/ML INJ

1moxifloxacin 400mg tab

1ofloxacin 400mg tab

GASTROINTESTINAL AGENTS - MISC.BILE 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 tab

1metoclopramide 5mg/ml injINFLAMMATORY BOWEL AGENTS

1APRISO 0.375GM ER CAP

1balsalazide disodium 750mg cap

1CANASA 1000MG RECTAL SUPP

1DIPENTUM 250MG CAP

1LIALDA 1.2GM DR TAB

1mesalamine 66.7mg/ml enema

1sulfasalazine 500mg dr tab


82


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

1LINZESS 145MCG CAP PA

1LINZESS 290MCG CAP PA

1LINZESS 72MCG CAP 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 PAPHOSPHATE BINDER AGENTS

1AURYXIA 210MG TAB

1calcium acetate 667mg cap

1calcium acetate 667mg tab

1FOSRENOL 1000MG CHEW TAB

1FOSRENOL 1000MG ORAL POWDER



1FOSRENOL 750MG ORAL POWDER

1lanthanum carbonate 1000mg chew tab



1PHOSLYRA 667MG/5ML ORAL SOLN

1RENVELA 800MG TAB

1sevelamer carbonate 2400mg oral susp

1sevelamer carbonate 800mg 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 15 meq er tab

1potassium citrate 5 meq er tabCYSTINOSIS AGENTS

1CYSTAGON 150MG CAP PA

1CYSTAGON 50MG CAP PAGENITOURINARY IRRIGANTS

1neomycin 40mg/ml/polymyxin b 200000unit/ml soln

1sodium chloride 0.9% soln


83


INTERSTITIAL 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

1RAPAFLO 4MG CAP

1RAPAFLO 8MG CAP

1tamsulosin 0.4mg capURINARY STONE AGENTS

1LITHOSTAT 250MG TAB

1THIOLA 100MG TAB

GOUT AGENTSGOUT AGENT COMBINATIONS

1colchicine 0.5mg/probenecid 500mg tabGOUT AGENTS

1allopurinol 100mg tab

1allopurinol 300mg tab

1COLCHICINE 0.6MG CAP

1COLCHICINE 0.6MG TAB PA

1MITIGARE 0.6MG CAP

1ULORIC 40MG TAB ST

1ULORIC 80MG TAB STURICOSURICS

1probenecid 500mg tab

HEMATOLOGICAL AGENTS - MISC.BRADYKININ B2 RECEPTOR ANTAGONISTS

1FIRAZYR 30MG/3ML SYRINGE NDS PACOMPLEMENT INHIBITORS

1BERINERT 500UNIT INJ NDS PA

1CINRYZE 500UNIT INJ NDS PA

1RUCONEST 2100UNIT INJ NDS PAHEMATORHEOLOGIC AGENTS

1pentoxifylline 400mg er tabPLATELET AGGREGATION INHIBITORS

1anagrelide 0.5mg cap

1anagrelide 1mg cap

1aspirin 25mg/dipyridamole 200mg cap

1BRILINTA 60MG TAB

1BRILINTA 90MG TAB

1cilostazol 100mg tab

1cilostazol 50mg tab

1clopidogrel 75mg tab

1dipyridamole 25mg tab



84



1prasugrel 10mg tab

1prasugrel 5mg tab

HEMATOPOIETIC AGENTSAGENTS FOR GAUCHER DISEASE

1CEREZYME 400UNIT INJ NDS

1VPRIV 400UNIT INJ NDS

1ZAVESCA 100MG CAP NDS PAAGENTS FOR SICKLE CELL ANEMIA

1DROXIA 200MG CAP

1DROXIA 300MG CAP

1DROXIA 400MG CAPHEMATOPOIETIC GROWTH FACTORS

1ARANESP 100MCG/0.5ML SYRINGE PA BvD ST

1ARANESP 100MCG/ML INJ PA BvD ST











1ARANESP 500MCG/ML SYRINGE PA BvD ST



1EPOGEN 10000UNIT/ML INJ PA BvD





1GRANIX 300MCG/0.5ML SYRINGE NDS

1GRANIX 480MCG/0.8ML SYRINGE NDS

1LEUKINE 250MCG INJ NDS PA

1NEULASTA 6MG/0.6ML SYRINGE NDS

1PROCRIT 10000UNIT/ML INJ PA BvD






1PROMACTA 12.5MG TAB NDS PA

1PROMACTA 25MG TAB NDS PA



85



1ZARXIO 300MCG/0.5ML SYRINGE NDS

1ZARXIO 480MCG/0.8ML SYRINGE NDSSTEM CELL MOBILIZERS

1MOZOBIL 24MG/1.2ML INJ NDS

HEMOSTATICSHEMOSTATICS - SYSTEMIC

1tranexamic acid 100mg/ml inj

1tranexamic acid 650mg tab

HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTSBARBITURATE HYPNOTICS

1BUTISOL 30MG TAB

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

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

1ROZEREM 8MG TAB PA QL=30 EA/30 Days

LAXATIVESLAXATIVE COMBINATIONS

1gavilyte-c oral soln

1gavilyte-g oral soln


86


1gavilyte-n powder for oral soln

1MOVIPREP ORAL SOLN

1peg 3350/electrolyte oral soln

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

1polyethylene glycol 3350/kcl/sodium bicarbonate/sodium chloride/sodium sulfate powder for oral soln

1trilyte powder for oral solnLAXATIVES - MISCELLANEOUS

1constulose 10gm/15ml oral soln

1lactulose 667mg/ml oral soln

1polyethylene glycol 3350 142mg/ml oral soln

LOCAL ANESTHETICS-PARENTERALLOCAL ANESTHETICS - AMIDES

1lidocaine 0.5% inj

1lidocaine 1% inj

1lidocaine 2% inj

MACROLIDESAZITHROMYCIN

1azithromycin 20mg/ml oral susp

1azithromycin 250mg pack

1azithromycin 250mg tab

1azithromycin 2mg/ml inj

1azithromycin 40mg/ml oral susp

1azithromycin 500mg (3) tab pack

1azithromycin 500mg tab

1azithromycin 600mg tabCLARITHROMYCIN

1clarithromycin 250mg tab

1clarithromycin 25mg/ml oral susp

1clarithromycin 500mg er tab

1clarithromycin 500mg tab

1clarithromycin 50mg/ml oral suspERYTHROMYCINS

1ERY-TAB 250MG DR TAB



1ERYPED 400MG/5ML ORAL SUSP

1ERYTHROCIN LACTOBIONATE 500MG INJ

1erythromycin 250mg dr cap

1ERYTHROMYCIN 250MG TAB

1ERYTHROMYCIN 500MG TAB

1erythromycin ethylsuccinate 40mg/ml oral susp

MEDICAL DEVICESPARENTERAL THERAPY SUPPLIES


87


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

MEDICAL DEVICES AND SUPPLIESBANDAGES-DRESSINGS-TAPE

1GAUZE PADMISC. DEVICES

1ALCOHOL SWAB 1"X1" (DIABETIC)PARENTERAL THERAPY SUPPLIES

1INSULIN PEN NEEDLE

1INSULIN SYRINGE (DISP) U-100 0.3ML

1INSULIN SYRINGE (DISP) U-100 1ML

1INSULIN SYRINGE MIS 1ML/29G

MIGRAINE PRODUCTSMIGRAINE PRODUCTS

1DIHYDROERGOTAMINE MESYLATE 0.5MG/ACT NASAL SPRAY

QL=16 ML/30 Days

1MIGRANAL 4MG/ML NASAL SPRAY QL=16 ML/30 DaysSEROTONIN AGONISTS

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 inj QL=5 ML/30 Days

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


1sumatriptan 4mg cartridge QL=5 ML/30 Days


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

1sumatriptan 6mg cartridge QL=5 ML/30 Days

1sumatriptan 8mg/ml auto-injector 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 & ELECTROLYTESBICARBONATES

1sodium lactate 5 meq/ml injELECTROLYTE MIXTURES

1calcium chloride 0.002 meq/ml/potassium chloride 0.004 meq/ml/sodium chloride 0.147 meq/ml inj

1d5w/lactated ringers inj


88


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


1glucose 25mg/ml/sodium chloride 0.0769 meq/ml inj

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

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






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

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







1IONOSOL-MB INJ

1ISOLYTE P INJ

1ISOLYTE S INJ

1KCL/D5W/LR INJ 0.15%

1lactated ringers inj

1NORMOSOL-M INJ

1NORMOSOL-R IN 5% DEXTROSE 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

1tpn electrolytes injMAGNESIUM


89


1magnesium sulfate 50% inj

1magnesium sulfate 50% syringePOTASSIUM

1K-TAB 20MEQ ER TAB

1K-TAB 8MEQ ER TAB

1klor-con 10meq er cap

1klor-con 10meq er micro tab

1klor-con 10meq er tab

1KLOR-CON 15MEQ ER TAB

1klor-con 20meq er micro tab

1klor-con 8meq er cap

1klor-con 8meq er tab

1potassium chloride 0.1meq/ml inj

1potassium chloride 10% oral soln

1potassium chloride 10meq er cap

1potassium chloride 10meq er micro tab

1potassium chloride 10meq er tab

1potassium chloride 2 meq/ml inj

1potassium chloride 20% oral soln

1potassium chloride 20meq er micro tab

1POTASSIUM CHLORIDE 20MEQ ER TAB

1potassium chloride 40meq/20ml inj

1potassium chloride 8meq er cap

1potassium chloride 8meq er tabSODIUM

1sodium chloride 0.45% inj

1sodium chloride 0.9% inj

1sodium chloride 2.5 meq/ml inj

1sodium chloride 3% inj

1sodium chloride 5% inj

MISCELLANEOUS THERAPEUTIC CLASSESCHELATING AGENTS

1trientine 250mg tab PAIMMUNOSUPPRESSIVE AGENTS

1AZATHIOPRINE 10MG/ML INJ PA BvD


1mycophenolate mofetil 500mg inj PA BvD

MOUTH/THROAT/DENTAL AGENTSANESTHETICS TOPICAL ORAL

1lidocaine 2% topical solnANTI-INFECTIVES - THROAT

1clotrimazole 10mg lozenge

1nystatin 100000unit/ml oral suspANTISEPTICS - MOUTH/THROAT

1chlorhexidine gluconate 0.12% mouthwash

1periogard 0.12% mouthwash


90


STEROIDS - MOUTH/THROAT

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

1cyclobenzaprine 10mg tab

1cyclobenzaprine 5mg tab

1cyclobenzaprine 7.5mg tab

1metaxall 800mg tab

1METAXALONE 400MG TAB

1metaxalone 800mg tab

1methocarbamol 500mg tab

1methocarbamol 750mg tab

1orphenadrine citrate 100mg er tab

1orphenadrine citrate 30mg/ml inj

1tizanidine 2mg cap

1tizanidine 2mg tab

1tizanidine 4mg cap

1tizanidine 4mg tab

1tizanidine 6mg capDIRECT MUSCLE RELAXANTS

1dantrolene sodium 100mg cap

1dantrolene sodium 25mg cap

1dantrolene sodium 50mg capMUSCLE RELAXANT COMBINATIONS

1aspirin 325mg/carisoprodol 200mg tab

1aspirin 325mg/carisoprodol 200mg/codeine phosphate 16mg tab

NASAL AGENTS - SYSTEMIC AND TOPICALNASAL ANTIALLERGY

1azelastine 0.1% (137mcg) nasal inhaler

1azelastine 0.15% (205.5mcg) nasal inhaler

1olopatadine 0.6% nasal inhalerNASAL ANTICHOLINERGICS

1ipratropium bromide 0.03% nasal inhaler

1ipratropium bromide 0.06% nasal inhalerNASAL STEROIDS

1flunisolide 25mcg nasal inhaler QL=50 ML/15 Days

1fluticasone propionate 50mcg nasal inhaler QL=32 GM/15 Days


91


1triamcinolone 55mcg nasal spray QL=33 GM/15 Days

NEUROMUSCULAR AGENTSALS AGENTS

1riluzole 50mg tabMUSCULAR DYSTROPHY AGENTS

1EXONDYS 100MG/2ML INJ NDS PA

1EXONDYS 500MG/10ML INJ NDS PA

NUTRIENTSCARBOHYDRATES

1glucose 10% inj

1glucose 5% injLIPIDS

1intralipid 200mg/ml inj PA BvD

1nutrilipid 20% iv soln PA BvDPROTEINS

1AMINOSYN 7% WITH ELECTROLYTES, SULFITE-FREE INJ

PA BvD

1aminosyn 8.5% with electrolytes, sulfite-free inj PA BvD

1AMINOSYN II 10% INJ PA BvD

1aminosyn ii 8.5% with electrolytes, sulfite-free inj PA BvD

1AMINOSYN II 8.5%, SULFITE-FREE INJ PA BvD

1AMINOSYN-HBC 7%, SULFITE-FREE INJ PA BvD

1AMINOSYN-PF 10%, SULFITE-FREE INJ PA BvD

1AMINOSYN-PF 7% INJ PA BvD

1AMINOSYN-RF 5.2%, SULFITE-FREE INJ PA BvD

1CLINIMIX 4.25/10 INJ PA BvD




1CLINIMIX 5/15 INJ PA BvD



1CLINIMIX E 2.75/10 INJ PA BvD





1CLINIMIX E 5/15 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


92


1premasol 6% inj PA BvD

1PROCALAMINE 3% INJ PA BvD

1PROSOL 20% INJ PA BvD

1TRAVASOL 10% INJ PA BvD

1TROPHAMINE 10% INJ PA BvD

OPHTHALMIC AGENTSARTIFICIAL TEARS AND LUBRICANTS

1LACRISERT 5MG IMPLANTBETA-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 0.2-0.5% OPHTH SOLN

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

1ISTALOL 0.5% OPHTH SOLN

1levobunolol 0.5% ophth soln

1METIPRANOLOL 0.3% OPHTH SOLN

1timolol 0.25% ophth gel

1timolol 0.25% ophth soln

1timolol 0.5% 24hr ophth soln

1timolol 0.5% ophth gel

1timolol 0.5% ophth solnCYCLOPLEGIC 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 P 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 1-0.2% OPHTH SUSPOPHTHALMIC ANTI-INFECTIVES

1AZASITE 1% OPHTH SOLN

1BACITRACIN 0.5UNIT/MG OPHTH OINTMENT

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

1BESIVANCE 0.6% OPHTH SUSP ST

1ciprofloxacin 0.3% ophth soln

1erythromycin 0.005mg/mg ophth ointment


93


1gatifloxacin 0.5% ophth soln ST

1gentak 0.3% ophth ointment

1gentamicin sulfate 0.3% ophth soln

1gramicidin 0.025mg/ml/neomycin 1.75mg/ml/polymyxin b 10000unit/ml ophth soln

1levofloxacin 0.5% ophth soln

1moxifloxacin 0.5% ophth soln

1NATACYN 5% OPHTH SUSP

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

1ofloxacin 0.3% ophth soln

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

1SULFACETAMIDE SODIUM 10% OPHTH OINTMENT

1sulfacetamide sodium 10% ophth soln

1tobramycin 0.3% ophth soln

1trifluridine 1% soln

1VIGAMOX 0.5% OPHTH SOLN

1ZIRGAN 0.15% OPHTH GELOPHTHALMIC IMMUNOMODULATORS

1RESTASIS 0.05% OPHTH SUSPOPHTHALMIC LOCAL ANESTHETICS

1proparacaine 0.5% ophth solnOPHTHALMIC STEROIDS

1ALREX 0.2% OPHTH SUSP

1BLEPHAMIDE 10-0.2% OPHTH SUSP

1DEXAMETHASONE 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

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

1LOTEMAX 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


94


1prednisolone sodium phosphate 2.5mg/ml/sulfacetamide sodium 100mg/ml ophth soln

1TOBRADEX 0.3-0.1% 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

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

1TRAVATAN Z 0.004% OPHTH SOLN QL=5 ML/30 Days

OTIC AGENTSOTIC AGENTS - MISCELLANEOUS

1acetic acid 2% otic solnOTIC ANTI-INFECTIVES

1ofloxacin 0.3% otic solnOTIC COMBINATIONS

1CIPRODEX 0.3-0.1% OTIC SUSP

1COLY MYCIN S 3.3-3-10-0.5MG/ML 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

1fluocinolone acetonide 0.01% otic soln

PASSIVE IMMUNIZING AGENTSIMMUNE SERUMS

1BIVIGAM 10% INJ NDS PA

1CARIMUNE 6GM INJ NDS PA

1FLEBOGAMMA 10% INJ NDS PA


95


1GAMASTAN 1800UNIT/10ML INJ PA

1GAMASTAN 360UNIT/2ML INJ 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/200ML INJ NDS PA

1GAMUNEX 1GM/10ML INJ NDS PA

1OCTAGAM 25GM/500ML INJ NDS PA

1PRIVIGEN 20GM/200ML INJ NDS PAMONOCLONAL ANTIBODIES

1SYNAGIS 50MG/0.5ML INJ NDS PA

PASSIVE IMMUNIZING AND TREATMENT AGENTSIMMUNE SERUMS




1HYPERRAB 150UNIT/ML (10ML) INJ PA BvD

1HYPERRAB 150UNIT/ML (2ML) INJ PA BvD

1IMOGAM 150UNIT/ML (2ML) INJ PA BvD

1OCTAGAM 2GM/20ML INJ NDS PA

PENICILLINSAMINOPENICILLINS

1amoxicillin 125mg chew tab

1amoxicillin 250mg cap

1AMOXICILLIN 250MG CHEW TAB

1amoxicillin 25mg/ml oral susp


1amoxicillin 500mg cap

1amoxicillin 500mg tab



1amoxicillin 875mg tab

1ampicillin 100mg/ml inj

1AMPICILLIN 125MG/ML INJ

1ampicillin 250mg/ml 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


96


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 oral susp

1AMOXICILLIN 200MG/CLAVULANATE 28.5MG CHEW TAB

1amoxicillin 250mg/clavulanate 125mg tab

1AMOXICILLIN 400MG/CLAVULANATE 57MG CHEW TAB






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



1AUGMENTIN 125-31.25MG/5ML ORAL SUSP

1BICILLIN 300000-300000UNIT/ML SYRINGE

1BICILLIN 450000-150000UNIT/ML SYRINGE

1piperacillin 2000mg/tazobactam 250mg inj

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



1ZOSYN 40-5MG/ML INJ

1ZOSYN 60-7.5MG/ML INJPENICILLINASE-RESISTANT PENICILLINS

1dicloxacillin 250mg cap

1dicloxacillin 500mg cap

1nafcillin 100mg/ml inj

1nafcillin 1gm 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 oral susp PA


97


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 QL=60 EA/30 Days

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

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

1donepezil 5mg tab QL=60 EA/30 Days

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


1NAMENDA 14MG XR CAP


1NAMENDA 28 TITRATION PACK


1NAMENDA 7MG XR CAP

1NAMZARIC 10-21MG ER CAP ST




1NAMZARIC TITRATION PACK ST

1rivastigmine 1.5mg cap

1rivastigmine 13.3mg/24hr patch

1rivastigmine 3mg cap

1rivastigmine 4.5mg cap


98


1rivastigmine 4.6mg/24hr patch

1rivastigmine 6mg cap

1rivastigmine 9.5mg/24hr patchCOMBINATION 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



1tetrabenazine 12.5mg tab NDS PA

1tetrabenazine 25mg tab NDS PAMULTIPLE SCLEROSIS AGENTS

1AMPYRA 10MG ER TAB NDS PA QL=60 EA/30 Days

1AUBAGIO 14MG TAB NDS

1AUBAGIO 7MG TAB NDS

1AVONEX 30MCG/0.5ML AUTO-INJECTOR NDS

1AVONEX 30MCG/0.5ML SYRINGE NDS

1AVONEX 30MCG/VIAL INJ NDS

1COPAXONE 20MG/ML SYRINGE NDS

1COPAXONE 40MG/ML SYRINGE NDS

1EXTAVIA 0.3MG INJ NDS

1GILENYA 0.5MG CAP NDS

1glatiramer 20mg/ml syringe NDS

1glatiramer 40mg/ml syringe NDS

1glatopa 20mg/ml inj NDS

1PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR NDS

1PLEGRIDY 125MCG/0.5ML SYRINGE NDS

1PLEGRIDY PEN STARTER PACK NDS

1REBIF 22MCG/0.5ML AUTO-INJECTOR NDS


99


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 NDS

1TYSABRI 300MG/15ML INJ NDS PAPSEUDOBULBAR AFFECT (PBA) AGENTS

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

1ERGOLOID MESYLATES 1MG TAB

1pimozide 1mg tab

1pimozide 2mg tabSMOKING DETERRENTS


1CHANTIX 0.5MG TAB

1CHANTIX 1MG TAB

1CHANTIX CONTINUING MONTHS OF THERAPY 1MG PACK

1CHANTIX FIRST MONTH OF THERAPY PACK

1NICOTROL 10MG INHALER

1NICOTROL 10MG/ML NASAL INHALER

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

1ARALAST 500MG 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 50MG GRANULES PACKET NDS PA QL=60 EA/30 Days

1KALYDECO 75MG GRANULES PACKET NDS PA QL=60 EA/30 Days

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

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

1PULMOZYME 1MG/ML INH SOLN NDS PA BvDPULMONARY 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


100


TETRACYCLINESTETRACYCLINES

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 5mg/ml oral susp


1minocycline 100mg cap

1minocycline 100mg tab





1morgidox 50mg cap

1tetracycline 250mg cap

1tetracycline 500mg cap

THYROID AGENTSANTITHYROID AGENTS

1methimazole 10mg tab

1methimazole 5mg tab

1propylthiouracil 50mg tabTHYROID HORMONES

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 100mcg tab





101










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

1levoxyl 75mcg tab

1levoxyl 88mcg tab

1liothyronine sodium 0.005mg tab

1liothyronine sodium 0.01mg/ml inj



1SYNTHROID 100MCG TAB












1THYROLAR 120MG TAB

1THYROLAR 15MG TAB

1THYROLAR 180MG TAB

1THYROLAR 30MG TAB

1THYROLAR 60MG TAB

1unithroid 100mcg tab







102







TOXOIDSTOXOID COMBINATIONS

1ADACEL INJ

1ADACEL SYRINGE

1BOOSTRIX INJ

1BOOSTRIX SYRINGE

1DAPTACEL INJ

1DIPHTHERIA/TETANUS TOXOID INJ PA BvD

1INFANRIX INJ

1KINRIX 0.05 MG/ML INJ

1KINRIX INJ

1PEDIARIX INJ

1QUADRACEL INJ

1TENIVAC SYRINGE PA BvD

1TETANUS/DIPHTHERIA TOXOID INJ PA BvD

ULCER DRUGSANTISPASMODICS

1ATROPINE SULFATE 0.05MG/ML SYRINGE

1dicyclomine 10mg cap

1dicyclomine 20mg tab

1dicyclomine 2mg/ml oral soln

1glycopyrrolate 0.2mg/ml inj

1glycopyrrolate 1mg tab

1glycopyrrolate 2mg tab

1methscopolamine 2.5mg tab

1methscopolamine 5mg tab

1PROPANTHELINE 15MG TABH-2 ANTAGONISTS

1cimetidine 200mg tab



1cimetidine 60mg/ml oral soln


1FAMOTIDINE 0.4MG/ML INJ

1famotidine 10mg/ml inj

1famotidine 20mg tab

1famotidine 40mg tab

1famotidine 8mg/ml oral susp

1nizatidine 150mg cap

1NIZATIDINE 15MG/ML ORAL SOLN

1nizatidine 300mg cap


103


1ranitidine 150mg cap

1ranitidine 150mg tab

1ranitidine 15mg/ml oral soln

1ranitidine 25mg/ml inj

1ranitidine 300mg cap

1ranitidine 300mg tabMISC. ANTI-ULCER

1sucralfate 1000mg tabPROTON PUMP INHIBITORS

1esomeprazole 20mg dr cap

1ESOMEPRAZOLE 20MG INJ

1esomeprazole 40mg dr cap

1esomeprazole 40mg inj

1lansoprazole 15mg dr cap

1lansoprazole 30mg dr cap

1omeprazole 10mg dr cap



1pantoprazole 20mg dr tab

1pantoprazole 40mg dr tab

1pantoprazole 40mg inj

1rabeprazole sodium 20mg 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

1nitrofurantoin 5mg/ml oral susp

1nitrofurantoin macro 25mg cap

1nitrofurantoin monohydrate/macrocrystalline 100mg cap

1nitrofurantoin, macro 100mg cap

1nitrofurantoin, macro 50mg cap

URINARY ANTISPASMODICSURINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC)

1oxybutynin chloride 10mg er tab


1oxybutynin chloride 1mg/ml oral soln


1oxybutynin chloride 5mg tab

1tolterodine tartrate 1mg tab


104


1tolterodine tartrate 2mg er cap

1tolterodine tartrate 2mg tab

1tolterodine tartrate 4mg er cap

1trospium chloride 20mg tab

1trospium chloride 60mg er cap

1VESICARE 10MG TAB

1VESICARE 5MG TABURINARY 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/ML INJ

1BEXSERO SYRINGE

1HIBERIX 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 PA

1GARDASIL 9 SYRINGE PA

1HAVRIX 1440UNIT INJ

1HAVRIX 1440UNIT SYRINGE

1HAVRIX 720UNIT INJ

1HAVRIX 720UNIT SYRINGE

1IMOVAX 2.5UNIT/ML INJ PA BvD

1IPOL INJ

1IXIARO SYRINGE

1M-M-R II INJ

1PROQUAD INJ

1RABAVERT 2.5UNIT/ML INJ PA BvD

1RECOMBIVAX 10MCG/ML SYRINGE PA BvD

1RECOMBIVAX 40MCG/ML INJ PA BvD


105


1RECOMBIVAX 5MCG/0.5ML SYRINGE PA BvD

1RECOMBIVAX HB 10MCG/ML INJ PA BvD

1ROTARIX ORAL SUSP

1ROTATEQ ORAL SUSP

1SHINGRIX INJ PA

1TWINRIX 720UNIT SYRINGE

1VAQTA 25UNIT/0.5ML SYRINGE

1VAQTA 50UNIT/0.5ML INJ

1VAQTA 50UNIT/1ML INJ

1VAQTA 50UNIT/ML SYRINGE

1VARIVAX 1350PFU/0.5ML INJ

1YF-VAX 4000UNIT/ML INJ

1ZOSTAVAX 19400UNIT/0.65ML INJ PA

VAGINAL PRODUCTSVAGINAL ANTI-INFECTIVES

1AVC BRAND OF SULFANILAMIDE 15% VAGINAL CREAM

1clindamycin 2% vaginal cream

1metronidazole 0.75% vaginal gel

1terconazole 0.4% vaginal cream

1terconazole 0.8% vaginal cream

1terconazole 80mg vaginal supp

1vandazole 0.75% vaginal gelVAGINAL ESTROGENS

1estradiol 0.1mg/ml vaginal cream

1ESTRING 2MG VAGINAL RING ST

1PREMARIN 0.625MG/GM VAGINAL CREAMVAGINAL PROGESTINS

1CRINONE 4% VAGINAL GEL PA

1CRINONE 8% VAGINAL GEL PA

VASOPRESSORSANAPHYLAXIS THERAPY AGENTS

1EPINEPHRINE 0.15MG/0.3ML AUTO-INJECTOR QL=2 EA/15 Days

1EPINEPHRINE 0.3MG/0.3ML AUTO-INJECTOR QL=2 EA/15 DaysNEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS

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


106

ALPHABETICAL LISTING OF DRUGS

A

abacavir 20mg/ml oral soln

56

abacavir 300mg tab 56 abacavir 300mg/lamivudine 150mg/zidovudine 300mg tab

56

abacavir 600mg/lamivudine 300mg tab

56

ABELCET 5MG/ML INJ 33 ABILIFY 300MG MAINTENA INJ

55

ABILIFY 300MG MAINTENA PF SYRINGE

55

ABILIFY 400MG MAINTENA PF SYRINGE

55

ABRAXANE 100MG INJ 49 acamprosate calcium 333mg dr tab

98

acarbose 100mg tab 29 acarbose 25mg tab 29 acarbose 50mg tab 29 acebutolol 200mg cap 61 acebutolol 400mg cap 61 acetaminophen 21.7mg/ml/hydrocodone bitartrate 0.5mg/ml oral soln

13

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

13

acetaminophen 300mg/codeine phosphate 15mg tab

13


13


13

acetaminophen 300mg/hydrocodone bitartrate 10mg tab

13


13

acetaminophen 300mg/hydrocodone bitartrate 7.5mg tab

14

ACETAMINOPHEN 325MG/5ML/OXYCODONE 5MG/5ML ORAL SOLN

14


14


14


14


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 100mg/ml inj

77

acetazolamide 125mg tab 77 acetazolamide 250mg tab 77

acetazolamide 500mg er cap

77

acetic acid 2% otic soln 95 acetic acid/hydrocortisone 1-2% otic soln

95

acetylcysteine 10% inh soln

71

acetylcysteine 20% inh soln

71

acitretin 10mg cap 73 acitretin 17.5mg cap 73 acitretin 25mg cap 73 ACTHIB INJ 105 ACTIMMUNE 2000000UNIT/0.5ML INJ

49

acyclovir 200mg cap 59 acyclovir 400mg tab 59 acyclovir 40mg/ml oral susp

59

acyclovir 5% ointment 74 acyclovir 50mg/ml inj 59 acyclovir 800mg tab 59 ADACEL INJ 103 ADACEL SYRINGE 103 ADAGEN 250UNIT/ML INJ

62

adapalene 0.1% cream 71 adapalene 0.1% gel 71 adapalene 0.3% gel 71 adapalene/benzoyl peroxide 0.1-2.5% gel

71

adefovir dipivoxil 10mg tab

58

ADEMPAS 0.5MG TAB 65 ADEMPAS 1.5MG TAB 65 ADEMPAS 1MG TAB 65 ADEMPAS 2.5MG TAB 65 ADEMPAS 2MG TAB 65 adriamycin 2mg/ml inj 46 adrucil 500mg/10ml inj 43 ADVAIR 100-50MCG DISKUS

19


107


ADVAIR 115-21MCG HFA INH

19


19

ADVAIR 250-50MCG DISKUS

19


19

ADVAIR 500-50MCG DISKUS

19

afeditab 30mg cr tab 62 afeditab 60mg cr tab 62 AFINITOR 10MG TAB 46 AFINITOR 2.5MG TAB 46 AFINITOR 2MG ORAL SUSP

46

AFINITOR 3MG ORAL SUSP

46

AFINITOR 5MG ORAL SUSP

46

AFINITOR 5MG TAB 46 AFINITOR 7.5MG TAB 46 ala-cort 1% cream 74 ala-cort 2.5% cream 74 ALBENZA 200MG TAB 15 albuterol 0.21mg/ml (0.63mg/3ml) inh soln

19

albuterol 0.417mg/ml (1.25mg/3ml) inh soln

19

albuterol 0.4mg/ml (2mg/5ml) oral soln

19

albuterol 0.83mg/ml (0.083%) inh soln

19

albuterol 1mg/ml (0.5%) inh soln

19

albuterol 2mg tab 19 albuterol 4mg er tab 19 albuterol 4mg tab 19 albuterol 8mg er tab 19 alclometasone dipropionate 0.05% cream

74

alclometasone dipropionate 0.05% ointment

74

ALCOHOL SWAB 1"X1" (DIABETIC)

88

ALDURAZYME 2.9MG/5ML INJ

79

ALECENSA 150MG CAP 46 ALENDRONATE 0.933MG/ML ORAL SOLN

78

alendronate 10mg tab 78 alendronate 35mg tab 78 ALENDRONATE 40MG TAB

78

alendronate 5mg tab 78 alendronate 70mg tab 78 alfuzosin 10mg er tab 84 ALIMTA 500MG INJ 43 ALINIA 100MG/5ML ORAL SUSP

41

ALINIA 500MG TAB 41 ALIQOPA 60MG INJ 46 allopurinol 100mg tab 84 allopurinol 300mg tab 84 ALOCRIL 2% OPHTH SOLN

95

ALOMIDE 0.1% OPHTH SOLN

95

alosetron 0.5mg tab 83 alosetron 1mg tab 83 ALPHAGAN P 0.1% OPHTH SOLN

93

alprazolam 0.25mg odt 16 alprazolam 0.25mg tab 16 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

94

altavera 28 day pack 67

ALUNBRIG 180MG TAB 46 ALUNBRIG 30MG TAB 46 ALUNBRIG 90MG TAB 46 ALUNBRIG TAB STARTER PACK

46

alyacen 1/35 28 day pack 67 amabelz 0.5/0.1mg 28 day pack

81

amabelz 1/0.5mg 28 day pack

81

amantadine 100mg cap 50 amantadine 100mg tab 50 amantadine 10mg/ml oral soln

50

AMBISOME 50MG INJ 33 AMCINONIDE 0.1% CREAM

74

AMCINONIDE 0.1% OINTMENT

74

amethia 91 day pack 67 amethia lo 91 day pack 67 amikacin 250mg/ml inj 8 amiloride 5mg tab 77 amiloride 5mg/hydrochlorothiazide 50mg tab

77

aminophylline 25mg/ml inj

20

AMINOSYN 7% WITH ELECTROLYTES, SULFITE-FREE INJ

92

aminosyn 8.5% with electrolytes, sulfite-free inj

92

AMINOSYN II 10% INJ 92 aminosyn ii 8.5% with electrolytes, sulfite-free inj

92

AMINOSYN II 8.5%, SULFITE-FREE INJ

92

AMINOSYN-HBC 7%, SULFITE-FREE INJ

92

AMINOSYN-PF 10%, SULFITE-FREE INJ

92

AMINOSYN-PF 7% INJ 92


108


AMINOSYN-RF 5.2%, SULFITE-FREE INJ

92

amiodarone 200mg tab 18 amiodarone 400mg tab 18 amiodarone 50mg/ml inj 18 amiodarone hydrochloride 100mg tab

18

amitriptyline 100mg tab 28 amitriptyline 10mg tab 28 AMITRIPTYLINE 10MG/PERPHENAZINE 2MG TAB

99

AMITRIPTYLINE 10MG/PERPHENAZINE 4MG TAB

99

amitriptyline 12.5mg/chlordiazepoxide 5mg tab

99

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

99


99


99

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

99

amitriptyline 75mg tab 28 amlodipine 10mg tab 62 amlodipine 10mg/atorvastatin 10mg tab

64

amlodipine 10mg/atorvastatin 20mg tab

64


64


64

amlodipine 10mg/benazepril 20mg cap

37


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/telmisartan 40mg tab

38


38

amlodipine 10mg/valsartan 160mg tab

38


38

amlodipine 2.5mg tab 62 amlodipine 2.5mg/atorvastatin 10mg tab

64

amlodipine 2.5mg/atorvastatin 20mg tab

64

amlodipine 2.5mg/atorvastatin 40mg tab

64

amlodipine 2.5mg/benazepril 10mg cap

38

amlodipine 5mg tab 62 amlodipine 5mg/atorvastatin 10mg tab

64


64


64


64


38


38


38

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

38


38


38


38


38


109



38


38


38

ammonium lactate 12% cream

76

ammonium lactate 12% lotion

76

amnesteem 10mg cap 71 amnesteem 20mg cap 71 amnesteem 40mg cap 71 AMOXAPINE 100MG TAB

28

AMOXAPINE 150MG TAB

28

AMOXAPINE 25MG TAB 28 AMOXAPINE 50MG TAB 28 amoxicillin 1000mg/clavulanate 62.5mg er tab

97

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

97

amoxicillin 125mg chew tab

96

AMOXICILLIN 200MG/CLAVULANATE 28.5MG CHEW TAB

97

amoxicillin 250mg cap 96 AMOXICILLIN 250MG CHEW TAB

96

amoxicillin 250mg/clavulanate 125mg tab

97

amoxicillin 25mg/ml oral susp

96

AMOXICILLIN 400MG/CLAVULANATE 57MG CHEW TAB

97


96


97

amoxicillin 500mg cap 96 amoxicillin 500mg tab 96 amoxicillin 500mg/clarithromycin 500mg/lansoprazole 30mg pack

104

amoxicillin 500mg/clavulanate 125mg tab

97


96


97


96


97

amoxicillin 875mg tab 96 amoxicillin 875mg/clavulanate 125mg tab

97

amphetamine 10mg er cap

7

amphetamine 10mg tab 7 amphetamine 12.5mg tab 7 amphetamine 15mg er cap

7

amphetamine 15mg tab 7 amphetamine 20mg er cap

7

amphetamine 20mg tab 7 amphetamine 25mg er cap

7

amphetamine 30mg er cap

7

amphetamine 30mg tab 7 amphetamine 5mg er cap 7 amphetamine 5mg tab 7 amphetamine 7.5mg tab 7

AMPHOTERICIN B 50MG INJ

33

ampicillin 100mg/ml inj 96 ampicillin 100mg/ml/sulbactam 50mg/ml inj

97

AMPICILLIN 125MG/ML INJ

96

ampicillin 20mg/ml/sulbactam 10mg/ml inj

97

ampicillin 250mg/ml inj 96 ampicillin 250mg/ml/sulbactam 125mg/ml inj

97

ampicillin 500mg cap 96 AMPYRA 10MG ER TAB 99 ANADROL-50 50MG TAB

15

anagrelide 0.5mg cap 84 anagrelide 1mg cap 84 anastrozole 1mg tab 45 ANDRODERM 2MG/24HR PATCH

15

ANDRODERM 4MG/24HR PATCH

15

ANDROGEL 1% (25MG) GEL

15

ANDROGEL 1% (50MG) GEL

15

ANDROGEL 1.62% (1.25GM) GEL

15

ANDROGEL 1.62% (2.5GM) GEL

15

ANDROGEL 1.62% GEL 15 ANORO 62.5-25MCG ELLIPTA INH

19

APLENZIN 174MG ER TAB

25


26


26

APOKYN 10MG/ML CARTRIDGE

50


110


apraclonidine 0.5% ophth soln

93

aprepitant 125mg cap 32 aprepitant 125mg/80mg pack

32

aprepitant 40mg cap 32 aprepitant 80mg cap 32 apri 28 day pack 67 APRISO 0.375GM ER CAP

82

APTIOM 200MG TAB 22 APTIOM 400MG TAB 22 APTIOM 600MG TAB 22 APTIOM 800MG TAB 22 APTIVUS 100MG/ML ORAL SOLN

56

APTIVUS 250MG CAP 56 ARALAST 500MG INJ 100 aranelle 28 pack 67 ARANESP 100MCG/0.5ML SYRINGE

85

ARANESP 100MCG/ML INJ

85

ARANESP 10MCG/0.4ML SYRINGE

85


85


85


85


85


85


85


85


85


85

ARANESP 500MCG/ML SYRINGE

85


85


85

ARCALYST 220MG INJ 9 argatroban 100mg/ml inj 21 ARGATROBAN 1MG/ML INJ

21

aripiprazole 10mg odt 55 aripiprazole 10mg tab 55 aripiprazole 15mg odt 55 aripiprazole 15mg tab 55 aripiprazole 1mg/ml oral soln

55

aripiprazole 20mg tab 55 aripiprazole 2mg tab 55 aripiprazole 30mg tab 55 aripiprazole 5mg tab 55 ARISTADA 273MG/ML SYRINGE

55

ARISTADA 441MG/1.6ML SYRINGE

55


55


55

armodafinil 150mg tab 8 armodafinil 200mg tab 8 armodafinil 250mg tab 8 armodafinil 50mg tab 8 ARNUITY 100MCG INH 18 ARNUITY 200MCG INH 19 ARRANON 5MG/ML INJ 43 ashlyna 91 day pack 67 ASMANEX 100MCG (120ACT) HFA INH

19

ASMANEX 110MCG (30ACT) INH

19

ASMANEX 200MCG (120ACT) HFA INH

19


19


19


19

aspirin 25mg/dipyridamole 200mg cap

84

aspirin 325mg/carisoprodol 200mg tab

91

aspirin 325mg/carisoprodol 200mg/codeine phosphate 16mg tab

91

aspirin 325mg/oxycodone 4.84mg tab

14

ASTAGRAF 0.5MG XL CAP

59

ASTAGRAF 1MG XL CAP 59 ASTAGRAF 5MG XL CAP 59 atazanavir 150mg cap 56 atazanavir 200mg cap 56 atazanavir 300mg cap 56 atenolol 100mg tab 61 atenolol 100mg/chlorthalidone 25mg tab

38

atenolol 25mg tab 61 atenolol 50mg tab 61 atenolol 50mg/chlorthalidone 25mg tab

38

ATGAM 50MG/ML INJ 59 atomoxetine 100mg cap 7 atomoxetine 10mg cap 7 atomoxetine 18mg cap 7 atomoxetine 25mg cap 7 atomoxetine 40mg cap 7 atomoxetine 60mg cap 7 atomoxetine 80mg cap 7 atorvastatin 10mg tab 35


111


atorvastatin 20mg tab 35 atorvastatin 40mg tab 35 atorvastatin 80mg tab 35 atovaquone 150mg/ml oral susp

41

atovaquone 250mg/proguanil 100mg tab

42

atovaquone 62.5mg/proguanil 25mg tab

42

ATRIPLA 600-200-300MG TAB

56

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

31

atropine sulfate 0.025mg/diphenoxylate 2.5mg tab

31

ATROPINE SULFATE 0.05MG/ML SYRINGE

103

ATROPINE SULFATE 1% OPHTH SOLN

93

ATROVENT 17MCG INH 18 AUBAGIO 14MG TAB 99 AUBAGIO 7MG TAB 99 aubra 28 day pack 67 AUGMENTIN 125-31.25MG/5ML ORAL SUSP

97

AURYXIA 210MG TAB 83 AUSTEDO 12MG TAB 99 AUSTEDO 6MG TAB 99 AUSTEDO 9MG TAB 99 AVANDIA 2MG TAB 30 AVANDIA 4MG TAB 30 AVASTIN 100MG/4ML INJ

44

AVASTIN 400MG/16ML INJ

44

AVC BRAND OF SULFANILAMIDE 15% VAGINAL CREAM

106

AVELOX 400MG/250ML INJ

82

aviane 28 pack 67 avita 0.025% cream 71 avita 0.025% gel 72 AVONEX 30MCG/0.5ML AUTO-INJECTOR

99

AVONEX 30MCG/0.5ML SYRINGE

99

AVONEX 30MCG/VIAL INJ

99

AVYCAZ 2-0.5GM INJ 65 azacitidine 100mg inj 43 AZACTAM 1GM/50ML INJ

40

AZACTAM 2GM/50ML INJ

40

AZASAN 100MG TAB 59 AZASAN 75MG TAB 59 AZASITE 1% OPHTH SOLN

93

AZATHIOPRINE 10MG/ML INJ

90

azathioprine 50mg tab 60 azelastine 0.05% ophth soln

95

azelastine 0.1% (137mcg) nasal inhaler

91

azelastine 0.15% (205.5mcg) nasal inhaler

91

azithromycin 20mg/ml oral susp

87

azithromycin 250mg pack 87 azithromycin 250mg tab 87 azithromycin 2mg/ml inj 87 azithromycin 40mg/ml oral susp

87

azithromycin 500mg (3) tab pack

87

azithromycin 500mg tab 87 azithromycin 600mg tab 87 AZOPT 1% OPHTH SUSP 95 aztreonam 333mg/ml inj 40

B

baci-im 50000unit inj 40

BACITRACIN 0.5UNIT/MG OPHTH OINTMENT

93

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

93

bacitracin 5000unit/ml inj 40 baclofen 10mg tab 91 baclofen 20mg tab 91 balsalazide disodium 750mg cap

82

balziva 28 day pack 67 BANZEL 200MG TAB 22 BANZEL 400MG TAB 22 BANZEL 40MG/ML ORAL SUSP

22

BARACLUDE 0.05MG/ML ORAL SOLN

58

BAVENCIO 20MG/ML INJ

44

BCG, LIVE, TICE STRAIN 50MG/ML INJ

105

bekyree 28 day pack 67 BELEODAQ 500MG INJ 46 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

bendroflumethiazide 5mg/nadolol 40mg tab

38

bendroflumethiazide 5mg/nadolol 80mg tab

38

BENLYSTA 120MG INJ 61


112


BENLYSTA 400MG INJ 61 benztropine mesylate 0.5mg tab

50

benztropine mesylate 1mg tab

50

benztropine mesylate 1mg/ml inj

50

benztropine mesylate 2mg tab

50

BERINERT 500UNIT INJ 84 BESIVANCE 0.6% OPHTH SUSP

93

betamethasone 0.05% aug cream

74

betamethasone 0.05% aug gel

74

betamethasone 0.05% aug lotion

74

betamethasone 0.05% aug ointment

74

betamethasone 0.05% cream

74

betamethasone 0.05% lotion

74

betamethasone 0.05% ointment

74

betamethasone 0.1% cream

74

betamethasone 0.1% lotion

74

betamethasone 0.1% ointment

74

betamethasone valerate 0.12% foam

74

betamethasone/clotrimazole 1-0.05% cream

73

betamethasone/clotrimazole 1-0.05% lotion

73

betaxolol 0.5% ophth soln

93

betaxolol 10mg tab 61 betaxolol 20mg tab 61 bethanechol chloride 10mg tab

105

bethanechol chloride 25mg tab

105


105


105

BETIMOL 0.25% OPHTH SOLN

93

BETIMOL 0.5% OPHTH SOLN

93

BETOPTIC S 0.25% OPHTH SUSP

93

bexarotene 75mg cap 49 BEXSERO SYRINGE 105 bicalutamide 50mg tab 45 BICILLIN 300000-300000UNIT/ML SYRINGE

97

BICILLIN 450000-150000UNIT/ML SYRINGE

97

BICILLIN L-A 1200000UNIT/2ML SYRINGE

96

BICILLIN L-A 2400000UNIT/4ML SYRINGE

96

BICILLIN L-A 600000UNIT/ML SYRINGE

96

BICNU 100MG INJ 43 BIDIL 20-37.5MG TAB 64 BIKTARVY 50-200-25MG TAB

56

BIMATOPROST 0.03% OPHTH SOLN

95

bisoprolol fumarate 10mg tab

61

bisoprolol fumarate 10mg/hydrochlorothiazide 6.25mg tab

38

bisoprolol fumarate 2.5mg/hydrochlorothiazide 6.25mg tab

38

bisoprolol fumarate 5mg tab

61

bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mg tab

38

BIVIGAM 10% INJ 95 bleomycin 15unit/ml inj 46 BLEPHAMIDE 10-0.2% OPHTH SUSP

94

blisovi 21 fe 1.5/30 28 day

67

blisovi 21 fe 1/20 28 day pack

67

blisovi 24 fe 1/20 28 day pack

67

BOOSTRIX INJ 103 BOOSTRIX SYRINGE 103 BORTEZOMIB 3.5MG INJ

46

BOSULIF 100MG TAB 46 BOSULIF 400MG TAB 46 BOSULIF 500MG TAB 46 BREO 100-25MCG ELLIPTA INH

19

BREO 200-25MCG ELLIPTA INH

19

briellyn 28 day pack 67 BRILINTA 60MG TAB 84 BRILINTA 90MG TAB 84 brimonidine tartrate 0.15% ophth soln

93

brimonidine tartrate 0.2% ophth soln

93

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

22

BRIVIACT 25MG TAB 22 BRIVIACT 50MG TAB 22 BRIVIACT 75MG TAB 22 bromocriptine 2.5mg tab 50 bromocriptine 5mg cap 50 BROVANA 15MCG/2ML INH SOLN

19


113


budesonide 0.125mg/ml inh soln

19


19


19

budesonide 3mg dr cap 70 bumetanide 0.25mg/ml inj 77 bumetanide 0.5mg tab 77 bumetanide 1mg tab 77 bumetanide 2mg tab 77 BUNAVAIL 2.1-0.3MG FILM

14

BUNAVAIL 4.2-0.7MG FILM

14

BUNAVAIL 6.3-1MG FILM

14

buprenorphine 0.3mg/ml cartridge

14

buprenorphine 0.3mg/ml inj

14

buprenorphine 2mg sl tab 14 buprenorphine 8mg sl tab 14 bupropion 100mg sr tab 26 bupropion 100mg tab 26 bupropion 150mg sr (12 hr) tab

26

bupropion 150mg sr tab 100 bupropion 150mg xl (24 hr) tab

26

bupropion 200mg sr tab 26 bupropion 300mg xl 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 busulfan 6mg/ml inj 43 BUTISOL 30MG TAB 86 butorphanol tartrate 10mg/ml nasal spray

14

BUTORPHANOL TARTRATE 1MG/ML INJ

14

butorphanol tartrate 2mg/ml inj

14

BYDUREON 2.35MG/ML AUTO-INJECTOR

30

BYDUREON 2MG INJ 30 BYDUREON 2MG PEN INJ

30

BYSTOLIC 10MG TAB 61 BYSTOLIC 2.5MG TAB 61 BYSTOLIC 20MG TAB 61 BYSTOLIC 5MG TAB 61

C

cabergoline 0.5mg tab 80 CABOMETYX 20MG TAB

46

CABOMETYX 40MG TAB

46

CABOMETYX 60MG TAB

46

calcipotriene 0.005% cream

73

calcipotriene 0.005% ointment

73

calcipotriene 0.005% topical soln

73

calcipotriene/betamethasone 0.005-0.064% ointment

74

calcitriol 0.00025mg cap 79 calcitriol 0.0005mg cap 79 calcitriol 0.001mg/ml inj 79 calcitriol 0.001mg/ml oral soln

79

calcium acetate 667mg cap

83

calcium acetate 667mg tab

83

calcium chloride 0.002 meq/ml/potassium chloride 0.004 meq/ml/sodium chloride 0.147 meq/ml inj

88

calcium chloride 0.002 meq/ml/potassium chloride 0.004 meq/ml/sodium chloride 0.147 meq/ml soln

60

CALQUENCE 100MG CAP

47

camila 28 day 0.35mg pack

70

camrese lo 91 day pack 67 CANASA 1000MG RECTAL SUPP

82

CANCIDAS 50MG INJ 33 CANCIDAS 70MG INJ 33 candesartan cilexetil 16mg tab

37

candesartan cilexetil 16mg/hydrochlorothiazide 12.5mg tab

38

candesartan cilexetil 32mg tab

37

candesartan cilexetil 32mg/hydrochlorothiazide 12.5mg tab

38

candesartan cilexetil 32mg/hydrochlorothiazide 25mg tab

39


37


37

CAPASTAT 1GM INJ 42 CAPRELSA 100MG TAB 47 CAPRELSA 300MG TAB 47 captopril 100mg tab 36 captopril 12.5mg tab 36 captopril 25mg tab 36 captopril 25mg/hydrochlorothiazide 15mg tab

39

CAPTOPRIL 25MG/HYDROCHLOROTHIAZIDE 25MG TAB

39

captopril 50mg tab 36


114


captopril 50mg/hydrochlorothiazide 15mg tab

39

CAPTOPRIL 50MG/HYDROCHLOROTHIAZIDE 25MG TAB

39

CARBAGLU 200MG ORAL SUSP

79

carbamazepine 100mg chew tab

22

carbamazepine 100mg er cap

22

carbamazepine 100mg er tab

22


22


22

carbamazepine 200mg tab

22

carbamazepine 20mg/ml oral susp

22


22


22

carbidopa 10mg/levodopa 100mg odt

50

carbidopa 10mg/levodopa 100mg tab

50

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

50


50

carbidopa 25mg tab 50 CARBIDOPA 25MG/ENTACAPONE 200MG/LEVODOPA 100MG TAB

50

carbidopa 25mg/levodopa 100mg er tab

50


50


50


50


50


50


50

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

51

carbidopa 50mg/levodopa 200mg er tab

51

carbinoxamine maleate 0.8mg/ml oral soln

33

carbinoxamine maleate 4mg tab

33

carboplatin 10mg/ml inj 43 CARDENE 20MG/200ML INJ

62

CARDENE 40MG/200ML INJ

62

CARIMUNE 6GM INJ 95 carisoprodol 350mg tab 91 carteolol 1% ophth soln 93 cartia 120mg er cap 62 cartia 180mg er cap 62 cartia 240mg er cap 62

cartia 300mg er cap 62 carvedilol 12.5mg tab 61 carvedilol 25mg tab 61 carvedilol 3.125mg tab 61 carvedilol 6.25mg tab 61 CASPOFUNGIN ACETATE 50MG INJ

33

CASPOFUNGIN ACETATE 70MG INJ

33

CAYSTON 75MG INH SOLN

40

caziant 28 day pack 67 cefaclor 250mg cap 66 CEFACLOR 25MG/ML ORAL SUSP

66

cefaclor 500mg cap 66 cefaclor 50mg/ml oral susp

66

CEFACLOR 75MG/ML ORAL SUSP

66

cefadroxil 1000mg tab 65 cefadroxil 100mg/ml oral susp

65

cefadroxil 500mg cap 65 cefadroxil 50mg/ml oral susp

65

cefazolin 1gm inj 65 cefazolin 200mg/ml inj 65 cefazolin 500mg inj 65 cefdinir 25mg/ml oral susp

66

cefdinir 300mg cap 66 cefdinir 50mg/ml oral susp

66

cefepime 1gm inj 66 cefepime 2gm inj 67 cefixime 20mg/ml oral susp

66

cefixime 40mg/ml oral susp

66

CEFOTAXIME 1GM INJ 66 CEFOTAXIME 2GM INJ 66 CEFOTAXIME 500MG INJ

66

cefotetan 1000mg inj 66


115


cefotetan 2000mg inj 66 cefoxitin 1000mg inj 66 cefoxitin 2000mg inj 66 cefoxitin 200mg/ml inj 66 cefpodoxime 100mg tab 66 cefpodoxime 10mg/ml oral susp

66

cefpodoxime 200mg tab 66 cefpodoxime 20mg/ml oral susp

66

cefprozil 250mg tab 66 cefprozil 25mg/ml oral susp

66

cefprozil 500mg tab 66 cefprozil 50mg/ml oral susp

66

ceftazidime 1000mg inj 66 ceftazidime 2000mg inj 66 ceftazidime 200mg/ml inj 66 ceftriaxone 1000mg inj 66 ceftriaxone 100mg/ml inj 66 ceftriaxone 2000mg inj 66 ceftriaxone 250mg inj 66 ceftriaxone 500mg inj 66 cefuroxime 1.5gm inj 66 cefuroxime 250mg tab 66 cefuroxime 500mg tab 66 cefuroxime 750mg inj 66 cefuroxime 95mg/ml inj 66 celecoxib 100mg cap 9 celecoxib 200mg cap 9 celecoxib 400mg cap 9 celecoxib 50mg cap 9 CELONTIN 300MG CAP 25 cephalexin 250mg cap 65 cephalexin 25mg/ml oral susp

65

cephalexin 500mg cap 65 cephalexin 50mg/ml oral susp

65

CEREZYME 400UNIT INJ 85 CESAMET 1MG CAP 32 cetirizine 1mg/ml oral soln

34

cevimeline 30mg cap 91

CHANTIX 0.5MG TAB 100 CHANTIX 1MG TAB 100 CHANTIX CONTINUING MONTHS OF THERAPY 1MG PACK

100

CHANTIX FIRST MONTH OF THERAPY PACK

100

CHEMET 100MG CAP 31 CHENODAL 250MG TAB 82 CHLORAMPHENICOL 100MG/ML INJ

41

chlordiazepoxide 10mg cap

17


17


17

chlorhexidine gluconate 0.12% mouthwash

90

CHLOROQUINE PHOSPHATE 250MG TAB

42

chloroquine phosphate 500mg tab

42

CHLOROTHIAZIDE 250MG TAB

77

chlorothiazide 500mg inj 77 chlorothiazide 500mg tab 77 chlorpromazine 100mg tab

54

chlorpromazine 10mg tab 54 chlorpromazine 200mg tab

54

chlorpromazine 25mg tab 54 CHLORPROMAZINE 25MG/ML INJ

54

chlorpromazine 50mg tab 54 CHLORPROPAMIDE 100MG TAB

31

CHLORPROPAMIDE 250MG TAB

31

chlorthalidone 25mg tab 78 chlorthalidone 50mg tab 78 chlorzoxazone 500mg tab 91 CHOLBAM 250MG CAP 82

CHOLBAM 50MG CAP 82 cholestyramine resin 4gm sf powder for oral susp

34

cholestyramine resin 66.7mg/ml oral susp

34

ciclopirox 0.77% cream 73 ciclopirox 0.77% gel 73 ciclopirox 0.77% lotion 73 ciclopirox 1% shampoo 73 ciclopirox 8% topical soln 73 cidofovir 75mg/ml inj 58 cilastatin 2.5mg/ml/imipenem 2.5mg/ml inj

41

cilastatin 5mg/ml/imipenem 5mg/ml inj

41

cilostazol 100mg tab 84 cilostazol 50mg tab 84 cimetidine 200mg tab 103 cimetidine 300mg tab 103 cimetidine 400mg tab 103 cimetidine 60mg/ml oral soln

103

cimetidine 800mg tab 103 CINRYZE 500UNIT INJ 84 CIPRODEX 0.3-0.1% OTIC SUSP

95

ciprofloxacin 0.3% ophth soln

93

ciprofloxacin 100mg/ml oral susp

82

CIPROFLOXACIN 10MG/ML INJ

82

ciprofloxacin 250mg tab 82 ciprofloxacin 2mg/ml inj 82 ciprofloxacin 500mg tab 82 ciprofloxacin 50mg/ml oral susp

82

ciprofloxacin 750mg tab 82 cisplatin 1mg/ml inj 43 citalopram 10mg tab 26 citalopram 20mg tab 26 citalopram 2mg/ml oral soln

26


116


citalopram 40mg tab 26 cladribine 1mg/ml inj 43 claravis 10mg cap 72 claravis 20mg cap 72 claravis 30mg cap 72 claravis 40mg cap 72 CLARINEX-D 2.5-120MG ER TAB

71

clarithromycin 250mg tab 87 clarithromycin 25mg/ml oral susp

87

clarithromycin 500mg er tab

87

clarithromycin 500mg tab 87 clarithromycin 50mg/ml oral susp

87

CLEMASTINE FUMARATE 2.68MG TAB

33

clindacin 1% pad 72 clindamycin 1% foam 72 clindamycin 1% gel 72 clindamycin 1% lotion 72 clindamycin 1% pad 72 clindamycin 1% topical soln

72

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 clindamycin 2% vaginal cream

106

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

72

CLINIMIX 4.25/10 INJ 92 CLINIMIX 4.25/20 INJ 92

CLINIMIX 4.25/25 INJ 92 CLINIMIX 4.25/5 INJ 92 CLINIMIX 5/15 INJ 92 CLINIMIX 5/20 INJ 92 CLINIMIX 5/25 INJ 92 CLINIMIX E 2.75/10 INJ 92 CLINIMIX E 2.75/5 INJ 92 CLINIMIX E 4.25/10 INJ 92 CLINIMIX E 4.25/25 INJ 92 CLINIMIX E 4.25/5 INJ 92 CLINIMIX E 5/15 INJ 92 CLINIMIX E 5/20 INJ 92 CLINIMIX E 5/25 INJ 92 clinisol 15% inj 92 clobetasol propionate 0.05% cream

74

clobetasol propionate 0.05% foam

74

clobetasol propionate 0.05% gel

74

clobetasol propionate 0.05% lotion

74

clobetasol propionate 0.05% ointment

74

clobetasol propionate 0.05% shampoo

74

clobetasol propionate 0.05% spray

74

clobetasol propionate 0.05% topical soln

74

clodan 0.05% shampoo 74 clofarabine 1mg/ml inj 43 CLOLAR 1MG/ML INJ 43 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 patch

37


37


37

clonidine 0.1mg tab 37 clonidine 0.2mg tab 37 clonidine 0.3mg tab 37 clopidogrel 75mg tab 84 clorazepate dipotassium 15mg tab

17

clorazepate dipotassium 3.75mg tab

17

clorazepate dipotassium 7.5mg tab

17

clotrimazole 1% cream 73 clotrimazole 1% topical soln

73

clotrimazole 10mg lozenge

90

clozapine 100mg odt 53 clozapine 100mg tab 53 CLOZAPINE 12.5MG ODT

53

CLOZAPINE 150MG ODT

53

CLOZAPINE 200MG ODT

53

clozapine 200mg tab 53 clozapine 25mg odt 53 clozapine 25mg tab 53 clozapine 50mg tab 53 COARTEM 20-120MG TAB

42

codeine sulfate 15mg tab 11 codeine sulfate 30mg tab 11 codeine sulfate 60mg tab 11 colchicine 0.5mg/probenecid 500mg tab

84

COLCHICINE 0.6MG CAP

84

COLCHICINE 0.6MG TAB

84


117


colestipol 1000mg tab 34 colestipol 5000mg granules

34

colistin 75mg/ml inj 40 colocort 100mg/60ml enema

15

COLY MYCIN S 3.3-3-10-0.5MG/ML OTIC SUSP

95

COMBIGAN 0.2-0.5% OPHTH SOLN

93

COMBIPATCH 0.05-0.14MG PATCH

81

COMBIPATCH 0.05-0.25MG PATCH

81

COMBIVENT RESPIMAT 20-100MCG INH

19

COMETRIQ 100MG DAILY DOSE CARTON PACK

47


47


47

COMPLERA 200-25-300MG TAB

56

compro 25mg rectal supp 54 constulose 10gm/15ml oral soln

87

COPAXONE 20MG/ML SYRINGE

99

COPAXONE 40MG/ML SYRINGE

99

CORLANOR 5MG TAB 65 CORLANOR 7.5MG TAB 65 CORTISONE ACETATE 25MG TAB

70

COSENTYX 150MG/ML AUTO-INJECTOR

74

COSENTYX 150MG/ML SYRINGE

74

COSMEGEN 0.5MG INJ 46 COTELLIC 20MG TAB 47

CREON 12000-38000-60000UNIT DR CAP

76


76


76

CREON 36000-114000-180000UNIT DR CAP

76


76

CRINONE 4% VAGINAL GEL

106

CRINONE 8% VAGINAL GEL

106

CRIXIVAN 200MG CAP 56 CRIXIVAN 400MG CAP 56 CROMOLYN SODIUM 10MG/ML INH SOLN

18

cromolyn sodium 20mg/ml oral soln

82

cromolyn sodium 4% ophth soln

95

cryselle 28 pack 67 CUBICIN 500MG INJ 41 cyclafem 1/35 28 day pack

67

cyclafem 7/7/7 28 day pack

67

cyclobenzaprine 10mg tab

91

cyclobenzaprine 5mg tab 91 cyclobenzaprine 7.5mg tab

91

CYCLOPHOSPHAMIDE 25MG CAP

43

CYCLOPHOSPHAMIDE 50MG CAP

43

cyclosporine 100mg cap 60 cyclosporine 25mg cap 60 cyclosporine 50mg/ml inj 60

cyclosporine, modified 100mg cap

60

cyclosporine, modified 100mg/ml oral soln

60

cyclosporine, modified 25mg cap

60

cyproheptadine 0.4mg/ml oral soln

34

cyproheptadine 4mg tab 34 CYRAMZA 100MG/10ML INJ

44

CYRAMZA 500MG/50ML INJ

44

CYSTAGON 150MG CAP 83 CYSTAGON 50MG CAP 83 CYSTARAN 0.44% OPHTH SOLN

95

cytarabine 100mg/ml inj 43 CYTARABINE 20MG/ML INJ

43

D

d5w/lactated ringers inj 88 dacarbazine 200mg inj 49 dactinomycin 0.5mg inj 46 DALIRESP 500MCG TAB 18 DALVANCE 500MG INJ 40 danazol 100mg cap 15 danazol 200mg cap 15 danazol 50mg cap 15 dantrolene sodium 100mg cap

91

dantrolene sodium 25mg cap

91

dantrolene sodium 50mg cap

91

dapsone 100mg tab 41 dapsone 25mg tab 41 DAPTACEL INJ 103 daptomycin 500mg inj 41 DARAPRIM 25MG TAB 42 DARZALEX 100MG/5ML INJ

44

daunorubicin 5mg/ml inj 46


118


deblitane 28 day 0.35mg pack

70

decitabine 5mg/ml inj 43 delyla 28 day pack 67 demeclocycline 150mg tab

101

demeclocycline 300mg tab

101

DEMSER 250MG CAP 36 DENAVIR 1% CREAM 74 DEPEN 250MG TAB 59 DEPO-PROVERA 400MG/ML INJ

45

DESCOVY 200-25MG TAB

56

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 0.004mg/ml inj

80

desmopressin acetate 0.01% nasal soln

80

desmopressin acetate 0.01% nasal spray

80

desmopressin acetate 0.1mg tab

80

desmopressin acetate 0.2mg tab

80

desogestrel/ethinyl estradiol 28 day pack

67

desogestrel/ethinyl estradiol pack

67

desonide 0.05% cream 74 desonide 0.05% lotion 74 desonide 0.05% ointment 75 desoximetasone 0.05% cream

75

desoximetasone 0.05% gel

75

desoximetasone 0.25% cream

75

desoximetasone 0.25% ointment

75

DESVENLAFAXINE FUMARATE 100MG ER TAB

27

DESVENLAFAXINE FUMARATE 50MG ER TAB

27

desvenlafaxine succinate 100mg er tab

27


27


27

DEXAMETHASONE 0.1% OPHTH SOLN

94

dexamethasone 0.1mg/ml oral soln

70

dexamethasone 0.5mg tab 70 dexamethasone 0.75mg tab

70

dexamethasone 1.5mg tab 70 DEXAMETHASONE 10MG/ML INJ

70

DEXAMETHASONE 1MG TAB

70

DEXAMETHASONE 1MG/ML ORAL SOLN

70

DEXAMETHASONE 2MG TAB

70

dexamethasone 4mg tab 70 dexamethasone 6mg tab 70 dexamethasone phosphate 4mg/ml inj

70

dexamethasone/neomycin/polymyxin b 0.1% ophth ointment

94

dexamethasone/neomycin/polymyxin b 0.1% ophth susp

94

dexamethasone/tobramycin 0.3-0.1% ophth susp

94

dexmethylphenidate 10mg er cap

8

dexmethylphenidate 10mg tab

8


8

dexmethylphenidate 2.5mg tab

8


8


8


8


8

dexmethylphenidate 5mg tab

8

dexrazoxane 250mg inj 49 dextroamphetamine sulfate 10mg er cap

7

dextroamphetamine sulfate 10mg tab

7

dextroamphetamine sulfate 15mg er cap

7

dextroamphetamine sulfate 5mg er cap

7

dextroamphetamine sulfate 5mg tab

7

DIASTAT 10MG APPLICATOR

22

DIASTAT 2.5MG APPLICATOR

22

DIASTAT 20MG PF APPLICATOR

22

diazepam 10mg tab 17 DIAZEPAM 1MG/ML ORAL SOLN

17

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

17

diclofenac potassium 50mg tab

9

diclofenac sodium 0.1% ophth soln

95

diclofenac sodium 1% gel 73


119


diclofenac sodium 1.5% topical soln

73

diclofenac sodium 100mg er tab

9

diclofenac sodium 25mg dr tab

9

diclofenac sodium 3% gel 73 diclofenac sodium 50mg dr tab

9

diclofenac sodium 50mg/misoprostol 0.2mg tab

9

diclofenac sodium 75mg dr tab

9

diclofenac sodium 75mg/misoprostol 0.2mg tab

9

dicloxacillin 250mg cap 97 dicloxacillin 500mg cap 97 dicyclomine 10mg cap 103 dicyclomine 20mg tab 103 dicyclomine 2mg/ml oral soln

103

didanosine 200mg dr cap 56 didanosine 250mg dr cap 56 didanosine 400mg dr cap 56 DIFFERIN 0.1% LOTION 72 DIFLORASONE DIACETATE 0.05% CREAM

75

DIFLORASONE DIACETATE 0.05% OINTMENT

75

diflunisal 500mg tab 11 digitek 0.125mg tab 64 digitek 0.25mg tab 64 digox 0.125mg tab 64 digox 0.25mg tab 64 digoxin 0.05mg/ml oral soln

64

digoxin 0.125mg tab 64 digoxin 0.25mg tab 64 digoxin 0.25mg/ml inj 64

DIHYDROERGOTAMINE MESYLATE 0.5MG/ACT NASAL SPRAY

88

DILANTIN 30MG ER CAP

25

dilt 120mg xr cap 62 dilt 180mg xr cap 62 dilt 240mg xr cap 62 diltiazem 120mg er (12 hr) cap

62

diltiazem 120mg er (24 hr) cap

62

diltiazem 120mg tab 62 diltiazem 180mg er cap 63 DILTIAZEM 1MG/ML INJ 63 diltiazem 240mg er cap 63 diltiazem 300mg er cap 63 diltiazem 30mg tab 63 diltiazem 360mg er cap 63 diltiazem 420mg er cap 63 diltiazem 5mg/ml inj 63 diltiazem 60mg er cap 63 diltiazem 60mg tab 63 diltiazem 90mg er cap 63 diltiazem 90mg tab 63 DIPENTUM 250MG CAP 82 diphenhydramine 50mg/ml inj

33

DIPHTHERIA/TETANUS TOXOID INJ

103

dipyridamole 25mg tab 84 dipyridamole 50mg tab 84 dipyridamole 75mg tab 85 disopyramide 100mg cap 17 disopyramide 150mg cap 17 disulfiram 250mg tab 98 disulfiram 500mg tab 98 DIURIL 250MG/5ML ORAL SUSP

78

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

DOCETAXEL 10MG/ML INJ

49

DOCETAXEL 20MG/ML INJ

49

dofetilide 125mcg cap 18 dofetilide 250mcg cap 18 dofetilide 500mcg cap 18 donepezil 10mg odt 98 donepezil 10mg tab 98 donepezil 23mg tab 98 donepezil 5mg odt 98 donepezil 5mg tab 98 DORIPENEM 500MG INJ 41 dorzolamide 2% ophth soln

95

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

93

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

79

doxercalciferol 0.001mg cap

79

doxercalciferol 0.0025mg cap

79

doxercalciferol 0.002mg/ml inj

79


120


doxorubicin 2mg/ml liposome inj

46

doxorubicin hydrochloride 2mg/ml inj

46

doxy 100mg inj 101 doxycycline hyclate 100mg cap

101

doxycycline hyclate 100mg tab

101

doxycycline hyclate 20mg tab

101

doxycycline hyclate 50mg cap

101

doxycycline monohydrate 100mg cap

101

doxycycline monohydrate 100mg tab

101

doxycycline monohydrate 50mg cap

101


101

doxycycline monohydrate 5mg/ml oral susp

101


101

dronabinol 10mg cap 32 dronabinol 2.5mg cap 32 dronabinol 5mg cap 32 drospirenone 3mg/ethinyl estradiol 0.02mg/inert 1 mg pack

67

drospirenone 3mg/ethinyl estradiol 0.02mg/levomefolate calcium 0.451mg pack

67

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

67

DROXIA 200MG CAP 85 DROXIA 300MG CAP 85 DROXIA 400MG CAP 85 DULERA 100-5MCG INH 19 DULERA 200-5MCG INH 19 duloxetine 20mg dr cap 27 duloxetine 30mg dr cap 27

DULOXETINE 40MG DR CAP

27

duloxetine 60mg dr cap 27 DUPIXENT 300MG/2ML SYRINGE

76

duramorph 0.5mg/ml inj 11 duramorph 1mg/ml inj 11 DUREZOL 0.05% OPHTH SUSP

94

dutasteride 0.5mg cap 84 dutasteride 0.5mg/tamsulosin 0.4mg cap

84

DYRENIUM 100MG CAP 77 DYRENIUM 50MG CAP 77

E

econazole nitrate 1% cream

73

EDURANT 25MG TAB 56 efavirenz 200mg cap 56 efavirenz 50mg cap 56 efavirenz 600mg cap 56 ELAPRASE 6MG/3ML INJ

79

ELIDEL 1% CREAM 76 ELIGARD 22.5MG SYRINGE

45

ELIGARD 30MG SYRINGE

45

ELIGARD 45MG SYRINGE

45

ELIGARD 7.5MG SYRINGE

45

ELIQUIS 2.5MG TAB 20 ELIQUIS 30-DAY STARTER PACK

20

ELIQUIS 5MG TAB 21 ELITEK 1.5MG INJ 49 ELITEK 7.5MG INJ 49 ELMIRON 100MG CAP 84 EMBEDA 100-4MG ER CAP

11

EMBEDA 20-0.8MG ER CAP

11


11

EMBEDA 50-2MG ER CAP

11


11


11

EMCYT 140MG CAP 45 emoquette pack 67 EMPLICITI 300MG INJ 44 EMPLICITI 400MG INJ 44 EMSAM 12MG/24HR PATCH

26

EMSAM 6MG/24HR PATCH

26

EMSAM 9MG/24HR PATCH

26

EMTRIVA 10MG/ML ORAL SOLN

56

EMTRIVA 200MG CAP 56 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 11 ENBREL 25MG/0.5ML SYRINGE

11

ENBREL 50MG/ML SURECLICK INJ

11

ENBREL 50MG/ML SYRINGE

11

endocet 10-325mg tab 14 endocet 5-325mg tab 14 endocet 7.5-325mg tab 14


121


ENGERIX-B 10MCG/0.5ML SYRINGE

105

ENGERIX-B 20MCG/ML SYRINGE

105

enoxaparin sodium 100mg/1ml syringe

21

enoxaparin sodium 120mg/0.8ml syringe

21


21


21


21


21


21


21

enpresse 28 day pack 67 enskyce 28 day pack 67 entacapone 200mg tab 50 entecavir 0.5mg tab 58 entecavir 1mg tab 58 ENTRESTO 24-26MG TAB

64

ENTRESTO 49-51MG TAB

64

ENTRESTO 97-103MG TAB

64

enulose 10gm/15ml oral soln

83

ENVARSUS 0.75MG ER TAB

60

ENVARSUS 1MG ER TAB 60 ENVARSUS 4MG ER TAB 60 EPCLUSA 400-100MG TAB

58

EPIDUO 0.3-2.5% GEL 72 EPIDUO 0.1-2.5% GEL 72 epinastine 0.05% ophth soln

95

EPINEPHRINE 0.15MG/0.3ML AUTO-INJECTOR

106

EPINEPHRINE 0.3MG/0.3ML AUTO-INJECTOR

106

epirubicin 2mg/ml inj 46 epitol 200mg tab 22 EPIVIR HBV 5MG/ML ORAL SOLN

58

eplerenone 25mg tab 40 eplerenone 50mg tab 40 EPOGEN 10000UNIT/ML INJ

85

EPOGEN 20000UNIT/ML INJ

85


85


85


85

EPROSARTAN 600MG TAB

37

EPZICOM 600-300MG TAB

56

EQUETRO 100MG ER CAP

52


52


52

ERAXIS 100MG INJ 33 ERAXIS 50MG INJ 33 ERBITUX 100MG/50ML INJ

44

ERGOLOID MESYLATES 1MG TAB

100

ERIVEDGE 150MG CAP 45 ERLEADA 60MG TAB 45 errin 28 day 0.35mg pack 70 ERTACZO 2% CREAM 73 ERWINAZE 10000UNIT INJ

49

ery 2% pad 72

ERYPED 400MG/5ML ORAL SUSP

87

ERY-TAB 250MG DR TAB

87


87


87

ERYTHROCIN LACTOBIONATE 500MG INJ

87

erythromycin 0.005mg/mg ophth ointment

93

erythromycin 2% gel 72 erythromycin 2% topical soln

72

erythromycin 250mg dr cap

87

ERYTHROMYCIN 250MG TAB

87

ERYTHROMYCIN 500MG TAB

87

erythromycin ethylsuccinate 40mg/ml oral susp

87

erythromycin/benzoyl peroxide 5-3% gel

72

ESBRIET 267MG CAP 100 ESBRIET 267MG TAB 100 ESBRIET 801MG TAB 100 escitalopram 10mg tab 26 escitalopram 1mg/ml oral soln

26

escitalopram 20mg tab 26 escitalopram 5mg tab 26 esomeprazole 20mg dr cap 104 ESOMEPRAZOLE 20MG INJ

104

esomeprazole 40mg dr cap 104 esomeprazole 40mg inj 104 estazolam 1mg tab 86 estazolam 2mg tab 86 estradiol 0.00104mg/hr twice weekly patch

81


122


estradiol 0.00104mg/hr weekly patch

81

estradiol 0.00156mg/hr twice weekly patch

81


81


81


81


81


81


81


81


81

estradiol 0.1mg/ml vaginal cream

106

estradiol 0.5mg tab 81 estradiol 0.5mg/norethindrone acetate 0.1mg pack

81

estradiol 1mg tab 81 estradiol 1mg/norethindrone acetate 0.5mg pack

81

estradiol 20mg/ml inj 81 estradiol 2mg tab 81 estradiol 40mg/ml inj 81 ESTRING 2MG VAGINAL RING

106

ESTROPIPATE 0.75MG TAB

81

ESTROPIPATE 1.5MG TAB

81

ESTROPIPATE 3MG TAB 81 eszopiclone 1mg tab 86 eszopiclone 2mg tab 86 eszopiclone 3mg tab 86 ethacrynic acid 25mg tab 77 ethambutol 100mg tab 42

ethambutol 400mg tab 42 ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mg tab

81

ethinyl estradiol 0.005mg/norethindrone acetate 1mg tab

81

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

67

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

67

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

67

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

67

ethinyl estradiol 0.02mg/ferrous fumarate 75mg/norethindrone acetate 1mg pack

68

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

68

ethinyl estradiol 0.02mg/levonorgestrel 0.09mg pack

68

ethinyl estradiol 0.02mg/norethindrone 1mg 21 day pack

68

ethinyl estradiol 0.035mg/ethynodiol 1mg 28 day pack

68

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

68

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

68

ethinyl estradiol 0.035mg/norgestimate 0.25mg pack

68

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

68

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

68

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

68

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

68

ethinyl estradiol/levonorgestrel 91 day pack

68

ethosuximide 250mg cap 25 ethosuximide 50mg/ml oral soln

25

etidronate disodium 200mg tab

78

ETIDRONATE DISODIUM 400MG TAB

78

etodolac 200mg cap 9 etodolac 300mg cap 9 etodolac 400mg er tab 9 etodolac 400mg tab 9 etodolac 500mg er tab 10 etodolac 500mg tab 10 etodolac 600mg er tab 10


123


ETOPOPHOS 100MG INJ 49 etoposide 20mg/ml inj 49 EURAX 10% CREAM 76 EVOTAZ 300-150MG TAB

56

exemestane 25mg tab 45 EXJADE 125MG ORAL SUSP

32

EXJADE 250MG ORAL SUSP

32

EXJADE 500MG ORAL SUSP

32

EXONDYS 100MG/2ML INJ

92

EXONDYS 500MG/10ML INJ

92

EXTAVIA 0.3MG INJ 99 ezetimibe 10mg tab 35

F

FABRAZYME 35MG INJ 79 falmina 28 day pack 68 famciclovir 125mg tab 59 famciclovir 250mg tab 59 famciclovir 500mg tab 59 FAMOTIDINE 0.4MG/ML INJ

103

famotidine 10mg/ml inj 103 famotidine 20mg tab 103 famotidine 40mg tab 103 famotidine 8mg/ml oral susp

103

FANAPT 10MG TAB 52 FANAPT 12MG TAB 52 FANAPT 1MG TAB 52 FANAPT 2MG TAB 52 FANAPT 4MG TAB 52 FANAPT 6MG TAB 52 FANAPT 8MG TAB 52 FANAPT TITRATION PACK

52

FARESTON 60MG TAB 45 FARXIGA 10MG TAB 31 FARXIGA 5MG TAB 31 FARYDAK 10MG CAP 47

FARYDAK 15MG CAP 47 FARYDAK 20MG CAP 47 FASLODEX 250MG/5ML SYRINGE

45

fayosim 91 day pack 68 FAZACLO 12.5MG ODT 53 FAZACLO 150MG ODT 53 FAZACLO 200MG ODT 54 felbamate 120mg/ml oral susp

25

felbamate 400mg tab 25 felbamate 600mg tab 25 felodipine 10mg er tab 63 felodipine 2.5mg er tab 63 felodipine 5mg er tab 63 femynor 28 day pack 68 fenofibrate 130mg cap 34 fenofibrate 134mg cap 34 fenofibrate 145mg tab 34 FENOFIBRATE 150MG CAP

34

fenofibrate 160mg tab 34 fenofibrate 200mg cap 34 fenofibrate 43mg cap 34 fenofibrate 48mg tab 34 FENOFIBRATE 50MG CAP

35

fenofibrate 54mg tab 35 fenofibrate 67mg cap 35 fenofibric acid 135mg dr cap

35

fenofibric acid 45mg dr cap

35

FENOPROFEN 400MG CAP

10

fentanyl 0.012mg/hr patch

11


11

FENTANYL 0.0375MG/HR PATCH

11

fentanyl 0.05mg/hr patch 11 FENTANYL 0.0625MG/HR PATCH

11


11

fentanyl 0.1mg/hr patch 11 fentanyl 0.2mg lozenge 11 fentanyl 0.4mg lozenge 11 fentanyl 0.6mg lozenge 11 fentanyl 0.8mg lozenge 11 fentanyl 1.2mg lozenge 11 fentanyl 1.6mg lozenge 11 FENTORA 100MCG BUCCAL TAB

11

FENTORA 200MCG BUCCAL TAB

11


11


11


11

FERRIPROX 100MG/ML ORAL SOLN

31

FERRIPROX 500MG TAB 31 FETZIMA 120MG ER CAP

27

FETZIMA 20MG ER CAP 27 FETZIMA 40MG ER CAP 27 FETZIMA 80MG ER CAP 27 FETZIMA PACK 27 FINACEA 15% FOAM 76 FINACEA 15% GEL 76 finasteride 5mg tab 84 FIRAZYR 30MG/3ML SYRINGE

84

FIRMAGON 120MG INJ 45 FIRMAGON 80MG INJ 45 flavoxate 100mg tab 105 FLEBOGAMMA 10% INJ 95 flecainide acetate 100mg tab

17

flecainide acetate 150mg tab

18

flecainide acetate 50mg tab

18

FLOVENT 100MCG DISKUS

19


124


FLOVENT 110MCG HFA INH

19


19


19


19


19

fluconazole 100mg tab 33 fluconazole 10mg/ml oral susp

33

fluconazole 150mg tab 33 fluconazole 200mg tab 33 fluconazole 2mg/ml (100ml) inj

33

fluconazole 2mg/ml inj 33 fluconazole 40mg/ml oral susp

33

fluconazole 50mg tab 33 flucytosine 250mg cap 33 flucytosine 500mg cap 33 fludarabine phosphate 50mg inj

43

fludrocortisone 0.1mg tab 71 flunisolide 25mcg nasal inhaler

91

fluocinolone acetonide 0.01% cream

75

fluocinolone acetonide 0.01% otic soln

95

fluocinolone acetonide 0.01% topical soln

75

fluocinolone acetonide 0.025% cream

75

fluocinolone acetonide 0.025% ointment

75

fluocinolone acetonide 0.1mg/ml oil

75

fluocinonide 0.05% e cream

75

fluocinonide 0.05% gel 75 fluocinonide 0.05% ointment

75

fluocinonide 0.05% topical soln

75

fluorometholone 0.1% ophth susp

94

FLUOROURACIL 0.5% CREAM

73

fluorouracil 2% topical soln

73

fluorouracil 5% cream 73 fluorouracil 5% topical soln

73

fluorouracil 50mg/ml inj 43 fluoxetine 10mg cap 26 fluoxetine 10mg tab 26 fluoxetine 20mg cap 26 fluoxetine 20mg tab 26 fluoxetine 25mg/olanzapine 12mg cap

99

fluoxetine 25mg/olanzapine 3mg cap

99


99

fluoxetine 40mg cap 26 fluoxetine 4mg/ml oral soln

26


99


99

FLUPHENAZINE 0.5MG/ML ORAL SOLN

54

fluphenazine 10mg tab 54 fluphenazine 1mg tab 54 fluphenazine 2.5mg tab 54 FLUPHENAZINE 2.5MG/ML INJ

54

fluphenazine 5mg tab 54 FLUPHENAZINE 5MG/ML ORAL SOLN

55

fluphenazine decanoate 25mg/ml inj

55

FLURAZEPAM 15MG CAP

86

FLURAZEPAM 30MG CAP

86

flurbiprofen 100mg tab 10 flurbiprofen 50mg tab 10 flurbiprofen sodium 0.03% ophth soln

95

flutamide 125mg cap 45 fluticasone propionate 0.005% ointment

75

fluticasone propionate 0.05% cream

75

fluticasone propionate 0.05% lotion

75

fluticasone propionate 50mcg nasal inhaler

91

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

19


19


19

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


26


125



26

FOLOTYN 40MG/2ML INJ

43

fomepizole 1000mg/ml inj 31 fondaparinux sodium 12.5mg/ml (0.4ml) syringe

21

fondaparinux sodium 12.5mg/ml (0.6ml) syringe

21

fondaparinux sodium 12.5mg/ml (0.8ml) syringe

21

fondaparinux sodium 5mg/ml syringe

21

FORTEO 600MCG/2.4ML PEN INJ

78

fosamprenavir 700mg tab 56 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

fosphenytoin sodium 75mg/ml inj

25

FOSRENOL 1000MG CHEW TAB

83

FOSRENOL 1000MG ORAL POWDER

83


83


83

FOSRENOL 750MG ORAL POWDER

83

FRAGMIN 10000UNIT/ML SYRINGE

21

FRAGMIN 12500UNIT/0.5ML SYRINGE

21


21


21


21


21


21

FRAGMIN 95000UNIT/3.8ML INJ

21

FREAMINE 6.9% INJ 92 furosemide 10mg/ml inj 77 furosemide 10mg/ml oral soln

77

furosemide 10mg/ml syringe

77

furosemide 20mg tab 77 furosemide 40mg tab 77 furosemide 80mg tab 77 FUROSEMIDE 8MG/ML ORAL SOLN

77

FUSILEV 50MG INJ 49 FUZEON 90MG INJ 56 fyavolv 0.5mg-2.5mcg tab 81 fyavolv 1mg-5mcg tab 81 FYCOMPA 0.5MG/ML ORAL SUSP

21

FYCOMPA 10MG TAB 21 FYCOMPA 12MG TAB 21 FYCOMPA 2MG TAB 21 FYCOMPA 4MG TAB 21 FYCOMPA 6MG TAB 22 FYCOMPA 8MG TAB 22

G

gabapentin 100mg cap 22 gabapentin 300mg cap 22 gabapentin 400mg cap 22 gabapentin 50mg/ml oral soln

22

gabapentin 600mg tab 23 gabapentin 800mg tab 23 GABITRIL 12MG TAB 25 GABITRIL 16MG TAB 25 galantamine 12mg tab 98 galantamine 4mg tab 98 galantamine 8mg tab 98 galantamine hydrobromide 16mg er cap

98

galantamine hydrobromide 24mg er cap

98

GALANTAMINE HYDROBROMIDE 4MG/ML ORAL SOLN

98

galantamine hydrobromide 8mg er cap

98

GAMASTAN 1800UNIT/10ML INJ

96

GAMASTAN 360UNIT/2ML INJ

96

GAMMAGARD 10GM INJ

96

GAMMAGARD 2.5GM/25ML INJ

96

GAMMAGARD 5GM INJ 96 GAMMAKED 1GM/10ML INJ

96

GAMMAPLEX 10GM/100ML INJ

96


96


96


96

GAMUNEX 1GM/10ML INJ

96

ganciclovir 500mg inj 58


126


GARDASIL 9 INJ 105 GARDASIL 9 SYRINGE 105 gatifloxacin 0.5% ophth soln

94

GATTEX 5MG INJ 83 GAUZE PAD 88 gavilyte-c oral soln 86 gavilyte-g oral soln 86 gavilyte-n powder for oral soln

87

gemcitabine 1000mg inj 43 gemfibrozil 600mg tab 35 generlac 10gm/15ml oral soln

83

gengraf 100mg cap 60 gengraf 100mg/ml oral soln

60

gengraf 25mg cap 60 gengraf 50mg cap 90 GENOTROPIN 0.2MG SYRINGE

79

GENOTROPIN 0.4MG SYRINGE

79


79


79


79


79


79


79

GENOTROPIN 12MG CARTRIDGE

79

GENOTROPIN 1MG SYRINGE

79

GENOTROPIN 2MG SYRINGE

79

GENOTROPIN 5MG CARTRIDGE

79

gentak 0.3% ophth ointment

94

gentamicin 1.2mg/ml inj 8 gentamicin 40mg/ml inj 8 gentamicin sulfate 0.1% cream

72

gentamicin sulfate 0.1% ointment

72

gentamicin sulfate 0.3% ophth soln

94

gentamicin sulfate 0.8mg/ml inj

8

gentamicin sulfate 1.6mg/ml inj

9

gentamicin sulfate 1mg/ml inj

9

GENVOYA 150-150-200-10MG TAB

56

GEODON 20MG INJ 52 gianvi 28-day pack 68 gildagia pack 68 GILENYA 0.5MG CAP 99 GILOTRIF 20MG TAB 47 GILOTRIF 30MG TAB 47 GILOTRIF 40MG TAB 47 GLASSIA 1000MG/50ML INJ

100

glatiramer 20mg/ml syringe

99

glatiramer 40mg/ml syringe

99

glatopa 20mg/ml inj 99 GLEOSTINE 100MG CAP 43 GLEOSTINE 10MG CAP 43 GLEOSTINE 40MG CAP 43 GLEOSTINE 5MG CAP 43 glimepiride 1mg tab 31 glimepiride 2mg tab 31 glimepiride 2mg/pioglitazone 30mg tab

29

glimepiride 4mg tab 31 glimepiride 4mg/pioglitazone 30mg tab

29

glipizide 10mg er tab 31 glipizide 10mg tab 31

glipizide 2.5mg er tab 31 glipizide 2.5mg/metformin 250mg tab

29

glipizide 2.5mg/metformin 500mg tab

29

glipizide 5mg er tab 31 glipizide 5mg tab 31 glipizide 5mg/metformin 500mg tab

29

GLUCAGEN 1MG HYPOKIT

30

GLUCAGON 1MG INJ 30 glucose 10% inj 92 GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0342MEQ/ML INJ

89

GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0769MEQ/ML INJ

89

glucose 25mg/ml/sodium chloride 0.0769 meq/ml inj

89

glucose 5% inj 92 glucose 50mg/ml/potassium chloride 0.01meq/ml/sodium chloride 0.0769meq/ml inj

89

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

89

glucose 50mg/ml/potassium chloride 0.02meq/ml/sodium chloride 0.0342meq/ml inj

89


127



89


89


89


89

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

89

GLUCOSE 50MG/ML/POTASSIUM CHLORIDE 0.04MEQ/ML INJ

89


89


89

GLUCOSE 50MG/ML/SODIUM CHLORIDE 0.0385MEQ/ML INJ

89


89


89


89

glyburide 1.25mg tab 31 glyburide 1.25mg/metformin 250mg tab

29

glyburide 1.5mg tab 31 glyburide 2.5mg tab 31 glyburide 2.5mg/metformin 500mg tab

29

glyburide 3mg tab 31 glyburide 5mg tab 31 glyburide 5mg/metformin 500mg tab

29

glyburide 6mg tab 31 glycopyrrolate 0.2mg/ml inj

103

glycopyrrolate 1mg tab 103 glycopyrrolate 2mg tab 103 GLYXAMBI 10-5MG TAB

29

GLYXAMBI 25-5MG TAB

29

gramicidin 0.025mg/ml/neomycin 1.75mg/ml/polymyxin b 10000unit/ml ophth soln

94

granisetron 0.1mg/ml inj 32 granisetron 1mg tab 32 granisetron 1mg/ml (1ml) inj

32

granisetron 1mg/ml inj 32 GRANIX 300MCG/0.5ML SYRINGE

85

GRANIX 480MCG/0.8ML SYRINGE

85

griseofulvin 125mg tab 33 griseofulvin 250mg tab 33

griseofulvin 25mg/ml oral susp

33

griseofulvin 500mg tab 33 guanfacine 1mg er tab 7 guanfacine 1mg tab 37 guanfacine 2mg er tab 7 guanfacine 2mg tab 37 guanfacine 3mg er tab 7 guanfacine 4mg er tab 7 GUANIDINE 125MG TAB 42

H

HALAVEN 1MG/2ML INJ 49 halobetasol propionate 0.05% cream

75

halobetasol propionate 0.05% ointment

75

haloperidol 0.5mg tab 53 haloperidol 10mg tab 53 haloperidol 1mg tab 53 haloperidol 20mg tab 53 haloperidol 2mg tab 53 haloperidol 2mg/ml oral soln

53

haloperidol 5mg tab 53 haloperidol 5mg/ml inj 53 haloperidol 5mg/ml syringe

53

haloperidol decanoate 100mg/ml inj

53

haloperidol decanoate 500mg/5ml inj

53

haloperidol decanoate 50mg/ml inj

53

HAVRIX 1440UNIT INJ 105 HAVRIX 1440UNIT SYRINGE

105

HAVRIX 720UNIT INJ 105 HAVRIX 720UNIT SYRINGE

105

heparin sodium, porcine 10000unit/ml inj

21


21


128


HEPARIN SODIUM, PORCINE 100UNIT/ML INJ

21


21


21


21


21

HEPATAMINE 8% INJ 92 HERCEPTIN 150MG INJ 44 HERCEPTIN 440MG INJ 44 HETLIOZ 20MG CAP 86 HEXALEN 50MG CAP 43 HIBERIX INJ 105 HUMIRA 10MG/0.2ML SYRINGE

9

HUMIRA 20MG/0.4ML SYRINGE

9

HUMIRA 40MG/0.8ML AUTO-INJECTOR

9

HUMIRA 40MG/0.8ML SYRINGE

9

HUMIRA PEDIATRIC CROHN'S STARTER PACK (3) 40MG/0.8ML INJ

9

HUMIRA PEDIATRIC CROHN'S STARTER PACK (6) 40MG/0.8ML INJ

9

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

9

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

9

HUMULIN R 500UNIT/ML INJ

30

HUMULIN R 500UNIT/ML PEN INJ

30

hydralazine 100mg tab 40 hydralazine 10mg tab 40

hydralazine 20mg/ml inj 40 hydralazine 25mg tab 40 hydralazine 50mg tab 40 hydrochlorothiazide 12.5mg cap

78

hydrochlorothiazide 12.5mg tab

78

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/moexipril 15mg tab

39

hydrochlorothiazide 12.5mg/moexipril 7.5mg 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/telmisartan 40mg tab

39

hydrochlorothiazide 12.5mg/telmisartan 80mg tab

39

hydrochlorothiazide 12.5mg/valsartan 160mg tab

39


39


39

hydrochlorothiazide 15mg/methyldopa 250mg tab

39

hydrochlorothiazide 25mg tab

78

hydrochlorothiazide 25mg/lisinopril 20mg tab

39

hydrochlorothiazide 25mg/losartan potassium 100mg tab

39

hydrochlorothiazide 25mg/methyldopa 250mg tab

39

hydrochlorothiazide 25mg/metoprolol tartrate 100mg tab

39


39

hydrochlorothiazide 25mg/moexipril 15mg tab

40

hydrochlorothiazide 25mg/olmesartan medoxomil 40mg tab

40

hydrochlorothiazide 25mg/propranolol 40mg tab

40

hydrochlorothiazide 25mg/propranolol 80mg tab

40


129


hydrochlorothiazide 25mg/quinapril 20mg tab

40

hydrochlorothiazide 25mg/spironolactone 25mg tab

77

hydrochlorothiazide 25mg/telmisartan 80mg tab

40

hydrochlorothiazide 25mg/triamterene 37.5mg cap

77

hydrochlorothiazide 25mg/triamterene 37.5mg tab

77

HYDROCHLOROTHIAZIDE 25MG/TRIAMTERENE 50MG CAP

77

hydrochlorothiazide 25mg/valsartan 160mg tab

40

hydrochlorothiazide 25mg/valsartan 320mg tab

40

hydrochlorothiazide 50mg tab

78


40

hydrochlorothiazide 50mg/triamterene 75mg tab

77

hydrocodone 10mg/ibuprofen 200mg tab

14

hydrocodone 5mg/ibuprofen 200mg tab

14

hydrocodone bitartrate 7.5mg/ibuprofen 200mg tab

14

hydrocortisone 1% cream 75 hydrocortisone 1% ointment

75

hydrocortisone 1.67mg/ml enema

15

hydrocortisone 10mg tab 70 hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml ophth susp

94

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

95

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

95

hydrocortisone 2.5% cream

75

hydrocortisone 2.5% lotion

75

hydrocortisone 2.5% ointment

75

hydrocortisone 20mg tab 70 hydrocortisone 5mg tab 70 hydrocortisone valerate 0.2% cream

75

hydrocortisone valerate 0.2% ointment

75

hydromorphone 10mg/ml (1ml) inj

11

hydromorphone 10mg/ml (5ml) inj

11

hydromorphone 12mg er tab

11


11

hydromorphone 1mg/ml oral soln

12

hydromorphone 2mg tab 12 hydromorphone 2mg/ml syringe

12


12

hydromorphone 4mg tab 12 hydromorphone 8mg er tab

12

hydromorphone 8mg tab 12

hydroxychloroquine sulfate 200mg tab

42

HYDROXYPROGESTERONE CAPROATE 250MG/ML INJ

45

hydroxyurea 500mg cap 49 hydroxyzine 10mg tab 16 hydroxyzine 25mg tab 16 HYDROXYZINE 25MG/ML INJ

16

hydroxyzine 2mg/ml oral soln

16

hydroxyzine 50mg tab 16 hydroxyzine 50mg/ml inj 16 HYDROXYZINE PAMOATE 100MG CAP

16

hydroxyzine pamoate 25mg cap

16

hydroxyzine pamoate 50mg cap

16

HYPERRAB 150UNIT/ML (10ML) INJ

96

HYPERRAB 150UNIT/ML (2ML) INJ

96

HYSINGLA 100MG ER TAB

12


12


12


12


12


12


12

I

ibandronate 150mg tab 78 ibandronate 1mg/ml inj 78 IBRANCE 100MG CAP 47 IBRANCE 125MG CAP 47 IBRANCE 75MG CAP 47


130


ibuprofen 20mg/ml oral susp

10

ibuprofen 400mg tab 10 IBUPROFEN 400MG/OXYCODONE 5MG TAB

14

ibuprofen 600mg tab 10 ibuprofen 800mg tab 10 ICLUSIG 15MG TAB 47 ICLUSIG 45MG TAB 47 idarubicin hydrochloride 1mg/ml inj

46

IDHIFA 100MG TAB 47 IDHIFA 50MG TAB 47 ifosfamide 1000mg inj 43 ILARIS 180MG INJ 9 ILEVRO 0.3% OPHTH SUSP

95

imatinib 100mg tab 47 imatinib 400mg tab 47 IMBRUVICA 140MG CAP

47

IMFINZI 120MG/2.4ML INJ

44

IMFINZI 500MG/10ML INJ

44

imipramine 10mg tab 28 imipramine 25mg tab 28 imipramine 50mg tab 28 imipramine pamoate 100mg cap

28

imipramine pamoate 125mg cap

28


28


28

imiquimod 5% cream 76 IMOGAM 150UNIT/ML (2ML) INJ

96

IMOVAX 2.5UNIT/ML INJ

105

INCRELEX 40MG/4ML INJ

79

INCRUSE 62.5MCG INH 18

indapamide 1.25mg tab 78 indapamide 2.5mg tab 78 INDOCIN 25MG/5ML ORAL SUSP

10

indomethacin 25mg cap 10 indomethacin 50mg cap 10 indomethacin 75mg er cap

10

INFANRIX INJ 103 INLYTA 1MG TAB 47 INLYTA 5MG TAB 47 INNOPRAN 120MG XL CAP

61

INNOPRAN 80MG XL CAP

61

INSULIN PEN NEEDLE 88 INSULIN SYRINGE (DISP) U-100 0.3ML

88

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

88

INSULIN SYRINGE (DISP) U-100 1ML

88

INSULIN SYRINGE MIS 1ML/29G

88

INTELENCE 100MG TAB 56 INTELENCE 200MG TAB 56 INTELENCE 25MG TAB 56 intralipid 200mg/ml inj 92 INTRON A 10MU INJ 49 INTRON A 18MU INJ 49 INTRON A 50MU INJ 49 INTRON A 6000000UNIT/ML INJ

49

introvale 91 day pack 68 INVANZ 1GM INJ 41 INVEGA 117MG/0.75ML SYRINGE

52

INVEGA 156MG/ML SYRINGE

52

INVEGA 234MG/1.5ML SYRINGE

52


52


52


52


52


52


52

INVIRASE 200MG CAP 56 INVIRASE 500MG TAB 56 IONOSOL-MB INJ 89 IOPIDINE 1% OPHTH SOLN

93

IPOL INJ 105 ipratropium bromide 0.02% inh soln

18

ipratropium bromide 0.03% nasal inhaler

91

ipratropium bromide 0.06% nasal inhaler

91

ipratropium/albuterol 0.5-2.5mg/3ml inh soln

19

irbesartan 150mg tab 37 irbesartan 300mg tab 37 irbesartan 75mg tab 37 IRESSA 250MG TAB 47 irinotecan 20mg/ml inj 50 ISENTRESS 100MG CHEW TAB

56

ISENTRESS 100MG ORAL SUSP

56

ISENTRESS 25MG CHEW TAB

56

ISENTRESS 400MG TAB 56 isibloom 28 day pack 68 ISOLYTE P INJ 89 ISOLYTE S INJ 89 isoniazid 100mg tab 42 ISONIAZID 100MG/ML INJ

42


131


ISONIAZID 10MG/ML ORAL SOLN

42

isoniazid 300mg tab 42 isosorbide dinitrate 10mg tab

16

isosorbide dinitrate 20mg tab

16


16

ISOSORBIDE DINITRATE 40MG ER TAB

16


16

isosorbide mononitrate 10mg tab

16

isosorbide mononitrate 120mg er tab

16

isosorbide mononitrate 20mg tab

16


16


16

isotretinoin 10mg cap 72 isotretinoin 20mg cap 72 isotretinoin 30mg cap 72 isotretinoin 40mg cap 72 isradipine 2.5mg cap 63 isradipine 5mg cap 63 ISTALOL 0.5% OPHTH SOLN

93

ISTODAX 10MG INJ 47 itraconazole 100mg cap 33 ivermectin 3mg tab 15 IXIARO SYRINGE 105

J

JADENU 180MG GRANULE PACKET

32

JADENU 180MG TAB 31 JADENU 360MG GRANULE PACKET

32

JADENU 360MG TAB 32 JADENU 90MG GRANULE PACKET

32

JADENU 90MG TAB 32 JAKAFI 10MG TAB 47 JAKAFI 15MG TAB 47 JAKAFI 20MG TAB 47 JAKAFI 25MG TAB 47 JAKAFI 5MG TAB 47 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 100-1000MG XR TAB

29

JANUMET 50-1000MG TAB

29

JANUMET 50-1000MG XR TAB

29

JANUMET 50-500MG TAB

29

JANUMET 50-500MG XR TAB

29

JANUVIA 100MG TAB 30 JANUVIA 25MG TAB 30 JANUVIA 50MG TAB 30 JARDIANCE 10MG TAB 31 JARDIANCE 25MG TAB 31 JENTADUETO 2.5-1000MG TAB

29

JENTADUETO 2.5-1000MG XR TAB

29

JENTADUETO 2.5-500MG TAB

29

JENTADUETO 2.5-850MG TAB

29

JENTADUETO 5-1000MG XR TAB

29

JEVTANA 60MG/1.5ML INJ

49

jinteli tab 81 jolivette 28 day 0.35mg pack

70

juleber 28 day pack 68 JULUCA 50-25MG TAB 56 junel 1.5/30 21 day pack 68 junel 1/20 21 day pack 68 junel fe 1.5/30 28 day pack

68

junel fe 1/20 28 day pack 68 junel fe 24 1/20 28 day pack

68

JUXTAPID 10MG CAP 35 JUXTAPID 20MG CAP 35 JUXTAPID 30MG CAP 35 JUXTAPID 40MG CAP 35 JUXTAPID 5MG CAP 35 JUXTAPID 60MG CAP 35

K

KADCYLA 100MG INJ 44 KADCYLA 160MG INJ 44 kaitlib fe 28 day pack 68 KALETRA 100-25MG TAB

56

KALETRA 200-50MG TAB

56

KALETRA 400-100MG/5ML ORAL SOLN

56

KALYDECO 150MG TAB 100 KALYDECO 50MG GRANULES PACKET

100

KALYDECO 75MG GRANULES PACKET

100

kariva 28 day pack 68 KCL/D5W/LR INJ 0.15% 89 kelnor 1/35 28 day pack 68 KENALOG 10MG/ML INJ

70

KENALOG 40MG/ML INJ

70

KEPIVANCE 6.25MG INJ 49 ketoconazole 2% cream 73 ketoconazole 2% shampoo

73

ketoconazole 200mg tab 33


132


ketoconazole 20mg/ml foam

73

ketoprofen 50mg cap 10 ketoprofen 75mg cap 10 ketorolac tromethamine 0.4% ophth soln

95

ketorolac tromethamine 0.5% ophth soln

95

ketorolac tromethamine 10mg tab

10

ketorolac tromethamine 15mg/ml inj

10

ketorolac tromethamine 30mg/ml cartridge

10

ketorolac tromethamine 30mg/ml inj

10

KEYTRUDA 100MG/4ML INJ

44

KEYTRUDA 50MG INJ 44 KHEDEZLA 100MG ER TAB

27

KHEDEZLA 50MG ER TAB

27

kimidess 28 day pack 68 KINRIX 0.05 MG/ML INJ 103 KINRIX INJ 103 kionex 250mg/ml oral susp

60

KISQALI 200MG DAILY DOSE PACK

47


47


47

KISQALI/FEMARA TAB CO-PACK 200MG

46


46


46

klor-con 10meq er cap 90 klor-con 10meq er micro tab

90

klor-con 10meq er tab 90

KLOR-CON 15MEQ ER TAB

90

klor-con 20meq er micro tab

90

klor-con 8meq er cap 90 klor-con 8meq er tab 90 KORLYM 300MG TAB 30 K-TAB 20MEQ ER TAB 90 K-TAB 8MEQ ER TAB 90 kurvelo 28 day pack 68 KUVAN 100MG POWDER FOR ORAL SOLN

80

KUVAN 100MG TAB 80 KUVAN 500MG POWDER FOR ORAL SOLN

80

KYNAMRO 200MG/ML SYRINGE

34

KYPROLIS 30MG INJ 47 KYPROLIS 60MG INJ 47

L

labetalol 100mg tab 61 labetalol 200mg tab 61 labetalol 300mg tab 61 labetalol 5mg/ml inj 61 LACRISERT 5MG IMPLANT

93

lactated ringers inj 89 lactated ringers irrigation

60

lactulose 667mg/ml oral soln

87

LAMICTAL BLUE KIT 23 LAMICTAL GREEN KIT 23 LAMICTAL ORANGE KIT 23 LAMICTAL XR BLUE KIT

23

LAMICTAL XR GREEN KIT

23

LAMICTAL XR ORANGE KIT

23

lamivudine 100mg tab 58

lamivudine 10mg/ml oral soln

56

lamivudine 150mg tab 57 lamivudine 150mg/zidovudine 300mg tab

57

lamivudine 300mg tab 57 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 tab 23 lamotrigine 300mg er tab 23 lamotrigine 50mg er tab 23 lamotrigine 50mg odt 23 lamotrigine 5mg chew tab 23 lansoprazole 15mg dr cap 104 lansoprazole 30mg dr cap 104 lanthanum carbonate 1000mg chew tab

83

lanthanum carbonate 500mg chew tab

83

lanthanum carbonate 750mg chew tab

83

LANTUS 100UNIT/ML INJ

30

LANTUS 100UNIT/ML SOLOSTAR

30

larin 1.5/30 pack 68 larin 1/20 pack 68 larin fe 1.5/30 pack 68 larin fe 1/20 pack 68 larissia 28 day pack 68 LARTRUVO 10MG/ML INJ

44

LARTRUVO 190MG/19ML INJ

44


133


latanoprost 0.005% ophth soln

95

LATUDA 120MG TAB 52 LATUDA 20MG TAB 52 LATUDA 40MG TAB 52 LATUDA 60MG TAB 52 LATUDA 80MG TAB 52 layolis fe 28 pack 68 leena 28 day pack 69 leflunomide 10mg tab 10 leflunomide 20mg tab 10 LENVIMA (8) 4MG PACK

47

LENVIMA 10 10MG PACK

47

LENVIMA 14 PACK 47 LENVIMA 18 PACK 47 LENVIMA 20 10MG PACK

47

LENVIMA 24 PACK 47 lessina 28 day pack 69 LETAIRIS 10MG TAB 65 LETAIRIS 5MG TAB 65 letrozole 2.5mg tab 45 LEUCOVORIN 10MG TAB

49

leucovorin 10mg/ml inj 49 LEUCOVORIN 15MG TAB

49

leucovorin 20mg/ml inj 49 leucovorin 25mg tab 49 leucovorin 5mg tab 49 LEUKERAN 2MG TAB 43 LEUKINE 250MCG INJ 85 leuprolide acetate 5mg/ml inj

45

levalbuterol 0.31mg inh soln

20


20


20


20

LEVEMIR 100UNIT/ML FLEXTOUCH

30

LEVEMIR 100UNIT/ML INJ

30

levetiracetam 1000mg tab 23 levetiracetam 100mg/ml inj

23

levetiracetam 100mg/ml oral soln

23

levetiracetam 10mg/ml inj 23 levetiracetam 15mg/ml inj 23 levetiracetam 250mg tab 23 levetiracetam 500mg er tab

23

levetiracetam 500mg tab 23 levetiracetam 5mg/ml inj 23 levetiracetam 750mg er tab

23

levetiracetam 750mg tab 23 levobunolol 0.5% ophth soln

93

levocarnitine 100mg/ml oral soln

80

levocarnitine 330mg tab 80 levocetirizine 0.5mg/ml oral soln

34

levocetirizine 5mg tab 34 levofloxacin 0.5% ophth soln

94

levofloxacin 250mg tab 82 levofloxacin 25mg/ml inj 82 levofloxacin 25mg/ml oral soln

82

levofloxacin 500mg tab 82 levofloxacin 5mg/ml (150ml) inj

82

levofloxacin 5mg/ml inj 82 levofloxacin 750mg tab 82 levoleucovorin 10mg/ml inj

49

levonest 28 day pack 69 levora 0.15/30 28 day pack

69

LEVORPHANOL 2MG TAB

12

levo-t 100mcg tab 101 levo-t 112mcg tab 101 levo-t 125mcg tab 101 levo-t 137mcg tab 101 levo-t 150mcg tab 101 levo-t 175mcg tab 101 levo-t 200mcg tab 101 levo-t 25mcg tab 101 levo-t 300mcg tab 101 levo-t 50mcg tab 101 levo-t 75mcg tab 101 levo-t 88mcg tab 101 levothyroxine sodium 100mcg tab

101

levothyroxine sodium 112mcg tab

101


101


101


102


102


102


102


102


102


102


102

levoxyl 100mcg tab 102 levoxyl 112mcg tab 102 levoxyl 125mcg tab 102 levoxyl 137mcg tab 102 levoxyl 150mcg tab 102 levoxyl 175mcg tab 102 levoxyl 200mcg tab 102 levoxyl 25mcg tab 102 levoxyl 50mcg tab 102


134


levoxyl 75mcg tab 102 levoxyl 88mcg tab 102 LEXIVA 50MG/ML ORAL SUSP

57

LEXIVA 700MG TAB 57 LIALDA 1.2GM DR TAB 82 lidocaine 0.5% inj 87 lidocaine 1% inj 87 lidocaine 2% gel 76 lidocaine 2% inj 87 lidocaine 2% topical soln 90 lidocaine 4% topical soln 76 lidocaine 5% ointment 76 lidocaine 5% patch 76 lidocaine/prilocaine 2.5-2.5% cream

76

lincomycin 300mg/ml inj 42 lindane 1% shampoo 76 linezolid 20mg/ml oral susp

42

linezolid 2mg/ml inj 42 linezolid 600mg tab 42 LINZESS 145MCG CAP 83 LINZESS 290MCG CAP 83 LINZESS 72MCG CAP 83 liothyronine sodium 0.005mg tab

102

liothyronine sodium 0.01mg/ml inj

102

liothyronine sodium 0.025mg tab

102

liothyronine sodium 0.05mg tab

102

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

52

lithium carbonate 300mg cap

52

lithium carbonate 300mg er tab

52

lithium carbonate 300mg tab

52

lithium carbonate 450mg er tab

52

lithium carbonate 600mg cap

52

lithium citrate 60mg/ml oral soln

52

LITHOSTAT 250MG TAB 84 LONSURF 15-6.14MG TAB

46

LONSURF 20-8.19MG TAB

46

loperamide 2mg cap 31 lopinavir 80mg/ml/ritonavir 20mg/ml oral solution

57

lorazepam 0.5mg tab 17 lorazepam 1mg tab 17 lorazepam 2mg tab 17 lorazepam 2mg/ml oral conc

17

lorcet 10-325mg tab 14 lorcet 5-325mg tab 14 lorcet 7.5-325mg tab 14 loryna 28 day pack 69 losartan potassium 100mg tab

37

losartan potassium 25mg tab

37

losartan potassium 50mg tab

37

LOTEMAX 0.5% OPHTH GEL

94

LOTEMAX 0.5% OPHTH OINTMENT

94

LOTEMAX 0.5% OPHTH SUSP

94

lovastatin 10mg tab 35 lovastatin 20mg tab 35 lovastatin 40mg tab 35 low-ogestrel 28 day pack 69 loxapine 10mg cap 54 loxapine 25mg cap 54 loxapine 50mg cap 54

loxapine 5mg cap 54 LUMIGAN 0.01% OPHTH SOLN

95

LUMIZYME 50MG INJ 80 LUPRON 11.25MG (1.5ML) SYRINGE

45

LUPRON 11.25MG (1ML) SYRINGE

79

LUPRON 15MG SYRINGE

79

LUPRON 22.5MG SYRINGE

45


45

LUPRON 30MG SYRINGE

45

LUPRON 30MG SYRINGE (3 MONTH)

79

LUPRON 45MG SYRINGE

45


45

lutera 28 day pack 69 LYNPARZA 100MG CAP 47 LYNPARZA 150MG CAP 47 LYNPARZA 50MG CAP 47 LYRICA 100MG CAP 23 LYRICA 150MG CAP 23 LYRICA 200MG CAP 23 LYRICA 20MG/ML ORAL SOLN

23

LYRICA 225MG CAP 23 LYRICA 25MG CAP 23 LYRICA 300MG CAP 23 LYRICA 50MG CAP 23 LYRICA 75MG CAP 23 LYSODREN 500MG TAB 45 lyza 0.35mg pack 70

M

magnesium sulfate 50% inj

90

magnesium sulfate 50% syringe

90

malathion 0.5% lotion 76


135


MAPROTILINE 25MG TAB

26


26


26

marlissa 28 day pack 69 MARPLAN 10MG TAB 26 MATULANE 50MG CAP 49 matzim 180mg er tab 63 matzim 240mg er tab 63 matzim 300mg er tab 63 matzim 360mg er tab 63 matzim 420mg er tab 63 MAVYRET 100-40MG TAB

58

MAXIDEX 0.1% OPHTH SUSP

94

meclizine 12.5mg tab 32 meclizine 25mg tab 32 MECLOFENAMATE 100MG CAP

10

MECLOFENAMATE 50MG CAP

10

MEDROL 2MG TAB 70 medroxyprogesterone acetate 10mg tab

97

medroxyprogesterone acetate 150mg/ml inj

70

medroxyprogesterone acetate 150mg/ml syringe

70

medroxyprogesterone acetate 2.5mg tab

97

medroxyprogesterone acetate 5mg tab

97

mefenamic acid 250mg cap

10

mefloquine 250mg tab 42 megestrol acetate 125mg/ml oral susp

97

megestrol acetate 20mg tab

45

megestrol acetate 40mg tab

45

megestrol acetate 40mg/ml oral susp

45

MEKINIST 0.5MG TAB 48 MEKINIST 2MG TAB 48 meloxicam 15mg tab 10 meloxicam 7.5mg tab 10 melphalan 5mg/ml inj 43 memantine 10mg tab 98 memantine 10mg/memantine 5mg pack

98

memantine 14mg er cap 98 memantine 21mg er cap 98 memantine 28mg er cap 98 memantine 2mg/ml oral soln

98

memantine 5mg tab 98 memantine 7mg er cap 98 MENACTRA INJ 105 MENVEO INJ 105 meperidine 100mg tab 12 meperidine 50mg tab 12 meprobamate 200mg tab 16 meprobamate 400mg tab 16 mercaptopurine 50mg tab 43 meropenem 1gm inj 41 meropenem 500mg inj 41 mesalamine 66.7mg/ml enema

82

mesna 100mg/ml inj 49 MESNEX 400MG TAB 49 metadate 20mg er tab 8 METAPROTERENOL SULFATE 10MG TAB

20

METAPROTERENOL SULFATE 20MG TAB

20

METAPROTERENOL SULFATE 2MG/ML ORAL SOLN

20

metaxall 800mg tab 91 METAXALONE 400MG TAB

91

metaxalone 800mg tab 91 metformin 1000mg tab 30 metformin 500mg er tab 30

metformin 500mg tab 30 metformin 500mg/pioglitazone 15mg tab

29

metformin 750mg er tab 30 metformin 850mg tab 30 metformin 850mg/pioglitazone 15mg tab

29

methadone 10mg tab 12 methadone 1mg/ml oral soln

12

methadone 2mg/ml oral soln

12

methadone 5mg tab 12 methamphetamine 5mg tab

7

methazolamide 25mg tab 77 methazolamide 50mg tab 77 methenamine hippurate 1000mg tab

104

methimazole 10mg tab 101 methimazole 5mg tab 101 methocarbamol 500mg tab

91

methocarbamol 750mg tab

91

methotrexate 1000mg inj 43 methotrexate 2.5mg tab 43 methotrexate 250mg/10ml inj

44

METHOTREXATE 250MG/10ML INJ

44

methotrexate 25mg/ml inj 44 methotrexate 50mg/2ml inj

44

methoxsalen 10mg cap 74 methscopolamine 2.5mg tab

103

methscopolamine 5mg tab 103 METHYCLOTHIAZIDE 5MG TAB

78

methyldopa 250mg tab 37 methyldopa 500mg tab 37


136


methylphenidate 10mg cd cap

8

methylphenidate 10mg chew tab

8

methylphenidate 10mg er tab

8

methylphenidate 10mg tab

8

METHYLPHENIDATE 18MG SR TAB

8

methylphenidate 1mg/ml oral soln

8

methylphenidate 2.5mg chew tab

8


8

methylphenidate 20mg er tab

8

methylphenidate 20mg la cap

8

methylphenidate 20mg tab

8


8

methylphenidate 2mg/ml oral soln

8


8


8


8


8


8


8


8

methylphenidate 5mg chew tab

8

methylphenidate 5mg tab 8 methylphenidate 60mg cd cap

8

methylprednisolone 125mg inj

70

methylprednisolone 16mg tab

70


70

methylprednisolone 40mg/ml inj

70

methylprednisolone 4mg pack

71


71

methylprednisolone 62.5mg/ml inj

71


71

methylprednisolone acetate 40mg/ml inj

71

methylprednisolone acetate 80mg/ml inj

71

METIPRANOLOL 0.3% OPHTH SOLN

93

metoclopramide 10mg tab 82 metoclopramide 1mg/ml oral soln

82

metoclopramide 5mg tab 82 metoclopramide 5mg/ml inj

82

metolazone 10mg tab 78 metolazone 2.5mg tab 78 metolazone 5mg tab 78 metoprolol succinate 100mg er tab

61

metoprolol succinate 200mg er tab

61


61


61

metoprolol tartrate 100mg tab

61

metoprolol tartrate 1mg/ml cartridge

61

metoprolol tartrate 1mg/ml inj

61


61


61

metronidazole 0.75% cream

76

metronidazole 0.75% gel 76 metronidazole 0.75% lotion

76

metronidazole 0.75% vaginal gel

106

metronidazole 1% gel 76 metronidazole 250mg tab 40 metronidazole 375mg cap 40 metronidazole 500mg tab 40 metronidazole 5mg/ml inj 40 mexiletine 150mg cap 17 mexiletine 200mg cap 17 mexiletine 250mg cap 17 MIACALCIN 200UNIT/ML INJ

78

microgestin 1.5/30 21 day pack

69

microgestin 1/20 21 day pack

69

microgestin fe 1.5/30 28 day pack

69

microgestin fe 1/20 28 day pack

69

midodrine 10mg tab 106 midodrine 2.5mg tab 106 midodrine 5mg tab 106 miglitol 100mg tab 29 miglitol 25mg tab 29 miglitol 50mg tab 29 MIGRANAL 4MG/ML NASAL SPRAY

88

mimvey lo 28 day pack 81 mimvey pack 81 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 101 minocycline 100mg tab 101


137


minocycline 50mg cap 101 minocycline 50mg tab 101 minocycline 75mg cap 101 minocycline 75mg tab 101 minoxidil 10mg tab 40 minoxidil 2.5mg tab 40 mirtazapine 15mg odt 25 mirtazapine 15mg tab 25 mirtazapine 30mg odt 25 mirtazapine 30mg tab 25 mirtazapine 45mg odt 25 mirtazapine 45mg tab 25 mirtazapine 7.5mg tab 25 misoprostol 0.1mg tab 104 misoprostol 0.2mg tab 104 MITIGARE 0.6MG CAP 84 mitomycin 20mg inj 46 mitomycin 40mg inj 46 MITOMYCIN 5MG INJ 46 mitoxantrone 2mg/ml inj 46 M-M-R II INJ 105 modafinil 100mg tab 8 modafinil 200mg tab 8 MODERIBA 1200/DAY DOSE PACK

58

moderiba 200mg tab 58 MODERIBA 800/DAY DOSE PACK

58

moexipril 15mg tab 36 moexipril 7.5mg tab 36 mometasone furoate 0.1% cream

75

mometasone furoate 0.1% lotion

75

mometasone furoate 0.1% ointment

75

mononessa 28 day pack 69 montelukast 10mg tab 18 montelukast 4mg chew tab

18

montelukast 4mg granules

18

montelukast 5mg chew tab

18

morgidox 50mg cap 101

morphine sulfate 100mg er cap

12

morphine sulfate 100mg er tab

12


12

MORPHINE SULFATE 120MG ER (24HR) CAP

12


12

morphine sulfate 15mg tab

12


12


12

morphine sulfate 20mg/ml oral soln

12


12

MORPHINE SULFATE 2MG/ML SYRINGE

12

MORPHINE SULFATE 30MG ER (24 HR) CAP

12


12


12

morphine sulfate 30mg tab

12


12


12


12

MORPHINE SULFATE 5MG/ML SYRINGE

12

MORPHINE SULFATE 60MG (24HR) ER CAP

12


12


12


12


12


12

MOVANTIK 12.5MG TAB 83 MOVANTIK 25MG TAB 83 MOVIPREP ORAL SOLN 87 moxifloxacin 0.5% ophth soln

94

MOXIFLOXACIN 1.6MG/ML INJ

82

moxifloxacin 400mg tab 82 MOZOBIL 24MG/1.2ML INJ

86

MULTAQ 400MG TAB 18 mupirocin 2% cream 72 mupirocin 2% ointment 72 MUSTARGEN 10MG INJ 43 MYCAMINE 100MG INJ 33 MYCAMINE 50MG INJ 33 mycophenolate mofetil 200mg/ml oral susp

60

mycophenolate mofetil 250mg cap

60

mycophenolate mofetil 500mg inj

90

mycophenolate mofetil 500mg tab

60

mycophenolic acid 180mg dr tab

60

mycophenolic acid 360mg dr tab

60

MYLOTARG 4.5MG INJ 44 myorisan 10mg cap 72 myorisan 20mg cap 72 myorisan 30mg cap 72 myorisan 40mg cap 72 MYRBETRIQ 25MG ER TAB

105

MYRBETRIQ 50MG ER TAB

105

N


138


nabumetone 500mg tab 10 nabumetone 750mg tab 10 nadolol 20mg tab 61 nadolol 40mg tab 61 nadolol 80mg tab 61 nafcillin 100mg/ml inj 97 nafcillin 1gm inj 97 naftifine 2% cream 73 NAGLAZYME 1MG/ML INJ

80

NALOXONE 0.4MG/ML CARTRIDGE

32

naloxone 0.5mg/pentazocine 50mg tab

14

NALOXONE 1MG/ML SYRINGE

32

naltrexone 50mg tab 32 NAMENDA 14MG XR CAP

98

NAMENDA 21MG XR CAP

98

NAMENDA 28 TITRATION PACK

98

NAMENDA 28MG XR CAP

98

NAMENDA 7MG XR CAP

98

NAMZARIC 10-21MG ER CAP

98


98


98


98

NAMZARIC TITRATION PACK

98

naproxen 250mg tab 10 naproxen 25mg/ml oral susp

10

naproxen 375mg dr tab 10 naproxen 375mg tab 10 naproxen 500mg dr tab 10 naproxen 500mg tab 10

naproxen sodium 275mg tab

10

naproxen sodium 550mg tab

10

naratriptan 1mg tab 88 naratriptan 2.5mg tab 88 NARCAN 4MG/0.1ML NASAL SPRAY

32

NATACYN 5% OPHTH SUSP

94

NATAZIA 28 DAY PACK 69 nateglinide 120mg tab 31 nateglinide 60mg tab 31 NATPARA 100MCG CARTRIDGE

78

NATPARA 25MCG CARTRIDGE

78


78


78

NEBUPENT 300MG INH SOLN

40

necon 0.5/35 28 day pack 69 necon 7/7/7 28 day pack 69 NEFAZODONE 100MG TAB

27

NEFAZODONE 150MG TAB

27

NEFAZODONE 200MG TAB

27

nefazodone 250mg tab 27 nefazodone 50mg tab 27 neomycin 40mg/ml/polymyxin b 200000unit/ml soln

83

neomycin sulfate 500mg tab

9

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

94

neomycin/polymyxin/bacitracin/hydrocortisone ophth ointmentment 1%

94

NEPHRAMINE 5.4% INJ 92 NERLYNX 40MG TAB 48 NEULASTA 6MG/0.6ML SYRINGE

85

NEUPRO 1MG/24HR PATCH

51


51


51


51


51


51

NEVANAC 0.1% OPHTH SUSP

95

nevirapine 100mg er tab 57 NEVIRAPINE 10MG/ML ORAL SUSP

57

nevirapine 200mg tab 57 nevirapine 400mg er tab 57 NEXAVAR 200MG TAB 48 NEXTERONE 150MG/100ML INJ

18

NEXTERONE 360MG/200ML INJ

18

niacin 1000mg er tab 35 niacin 500mg er tab 35 niacin 750mg er tab 35 nicardipine 2.5mg/ml inj 63 nicardipine 20mg cap 63 nicardipine 30mg cap 63 NICOTROL 10MG INHALER

100

NICOTROL 10MG/ML NASAL INHALER

100

nifedipine 10mg cap 63 nifedipine 20mg cap 63 nifedipine 30mg er tab 63 nifedipine 30mg osmotic er tab

63

nifedipine 60mg er tab 63


139


nifedipine 60mg osmotic er tab

63

nifedipine 90mg er tab 63 nifedipine 90mg osmotic er tab

63

nikki 28 day pack 69 NILANDRON 150MG TAB

45

nilutamide 150mg tab 45 nimodipine 30mg cap 63 NINLARO 2.3MG CAP 48 NINLARO 3MG CAP 48 NINLARO 4MG CAP 48 NIPENT 10MG INJ 49 nisoldipine 17mg er tab 63 nisoldipine 20mg er tab 63 nisoldipine 30mg er tab 63 nisoldipine 34mg er tab 63 nisoldipine 40mg er tab 63 nisoldipine 8.5mg er tab 63 NITRO-DUR 0.3MG/HR PATCH

16

NITRO-DUR 0.8MG/HR PATCH

16

nitrofurantoin 5mg/ml oral susp

104

nitrofurantoin macro 25mg cap

104

nitrofurantoin monohydrate/macrocrystalline 100mg cap

104

nitrofurantoin, macro 100mg cap

104

nitrofurantoin, macro 50mg cap

104

nitroglycerin 0.1mg/hr patch

16


16

nitroglycerin 0.3mg sl tab 16 nitroglycerin 0.4mg sl tab 16 nitroglycerin 0.4mg/act pump spray

16


16

nitroglycerin 0.6mg sl tab 16 nitroglycerin 0.6mg/hr patch

16

nizatidine 150mg cap 103 NIZATIDINE 15MG/ML ORAL SOLN

103

nizatidine 300mg cap 103 nora-be 28 day 0.35mg pack

70

NORDITROPIN 10MG/1.5ML PEN INJ

79


79

NORDITROPIN 30MG/3ML PEN INJ

79


79

norethindrone 0.35mg pack

70

norethindrone acetate 5mg tab

98

norlyroc 28 day 0.35mg pack

70

NORMOSOL-M INJ 89 NORMOSOL-R IN 5% DEXTROSE INJ

89

NORMOSOL-R INJ 89 NORPACE 100MG ER CAP

17

NORPACE 150MG ER CAP

17

NORTHERA 100MG CAP 106 NORTHERA 200MG CAP 106 NORTHERA 300MG CAP 106 nortrel 0.5/35 28 day pack

69

nortrel 1/35 21 day pack 69 nortrel 1/35 28 day pack 69 nortrel 7/7/7 28 day pack 69 nortriptyline 10mg cap 28 nortriptyline 25mg cap 28 NORTRIPTYLINE 2MG/ML ORAL SOLN

28

nortriptyline 50mg cap 29 nortriptyline 75mg cap 29

NORVIR 100MG CAP 57 NORVIR 100MG TAB 57 NORVIR 80MG/ML ORAL SOLN

57

NOVOLIN 100UNIT/ML INJ

30

NOVOLIN N 100UNIT/ML INJ

30

NOVOLIN R 100UNIT/ML INJ

30

NOVOLOG 100UNIT/ML FLEXPEN

30

NOVOLOG 100UNIT/ML INJ

30

NOVOLOG 100UNIT/ML PENFILL

30

NOVOLOG MIX 100UNIT/ML FLEXPEN

30

NOVOLOG MIX 100UNIT/ML INJ

30

NOXAFIL 100MG DR TAB

33

NOXAFIL 40MG/ML ORAL SUSP

33

NUCALA 100MG INJ 18 NUCYNTA 100MG ER TAB

13

NUCYNTA 150MG ER TAB

13


13


13

NUCYNTA 50MG ER TAB

13

NUEDEXTA 20-10MG CAP

100

NULOJIX 250MG INJ 60 NUPLAZID 17MG TAB 52 nutrilipid 20% iv soln 92 NUVARING VAGINAL RING

70

nyamyc 100000unit/gm powder

73


140


nystatin 100000unit/ml cream

73

nystatin 100000unit/ml oral susp

90

nystatin 100000unit/ml/triamcinolone acetonide 1mg/ml cream

73

nystatin 100unit/mg ointment

73

nystatin 100unit/mg powder

73

nystatin 100unit/mg/triamcinolone acetonide 0.001mg/mg ointment

73

nystatin 500000unit tab 33 nystop 100000unit/gm powder

73

O

OCALIVA 10MG TAB 82 OCALIVA 5MG TAB 82 ocella 28 day pack 69 OCTAGAM 25GM/500ML INJ

96

OCTAGAM 2GM/20ML INJ

96

octreotide 0.05mg/ml inj 80 octreotide 0.1mg/ml inj 80 octreotide 0.2mg/ml inj 80 octreotide 0.5mg/ml inj 80 octreotide 1mg/ml inj 80 ODEFSEY 200-25-25MG TAB

57

ODOMZO 200MG CAP 45 OFEV 100MG CAP 100 OFEV 150MG CAP 100 ofloxacin 0.3% ophth soln 94 ofloxacin 0.3% otic soln 95 ofloxacin 400mg tab 82 olanzapine 10mg inj 54 olanzapine 10mg odt 54 olanzapine 10mg tab 54 olanzapine 15mg odt 54

olanzapine 15mg tab 54 olanzapine 2.5mg tab 54 olanzapine 20mg odt 54 olanzapine 20mg tab 54 olanzapine 5mg odt 54 olanzapine 5mg tab 54 olanzapine 7.5mg tab 54 olmesartan medoxomil 20mg tab

37

olmesartan medoxomil 40mg tab

37

olmesartan medoxomil 5mg tab

37

olopatadine 0.1% ophth soln

95

olopatadine 0.2% ophth soln

95

olopatadine 0.6% nasal inhaler

91

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

34

omeprazole 10mg dr cap 104 omeprazole 20mg dr cap 104 omeprazole 40mg dr cap 104 ondansetron 0.8mg/ml oral soln

32

ondansetron 24mg tab 32 ondansetron 2mg/ml inj 32 ondansetron 2mg/ml syringe

32

ondansetron 4mg odt 32 ondansetron 4mg tab 32 ondansetron 8mg odt 32 ondansetron 8mg tab 32 ONFI 10MG TAB 22 ONFI 2.5MG/ML ORAL SUSP

22

ONFI 20MG TAB 22 OPDIVO 100MG/10ML INJ

44

OPDIVO 40MG/4ML INJ 44 OPSUMIT 10MG TAB 65 ORENCIA 125MG/ML AUTO-INJECTOR

10

ORENCIA 125MG/ML SYRINGE

10

ORENCIA 250MG INJ 11 ORENCIA 50MG/0.4ML SYRINGE

11

ORENCIA 87.5MG/0.7ML SYRINGE

11

ORFADIN 10MG CAP 80 ORFADIN 2MG CAP 80 ORFADIN 4MG/ML ORAL SUSP

80

ORFADIN 5MG CAP 80 ORKAMBI 100-125MG TAB

100

ORKAMBI 200-125MG TAB

100

orphenadrine citrate 100mg er tab

91

orphenadrine citrate 30mg/ml inj

91

orsythia 28 day pack 69 oseltamivir 30mg cap 59 oseltamivir 45mg cap 59 oseltamivir 6mg/ml oral susp

59

oseltamivir 75mg cap 59 oxacillin 100mg/ml inj 97 oxacillin 2000mg inj 97 OXACILLIN 20MG/ML INJ

97

OXACILLIN 40MG/ML INJ

97

oxaliplatin 100mg inj 43 oxaliplatin 5mg/ml inj 43 oxandrolone 10mg tab 15 oxandrolone 2.5mg tab 15 oxaprozin 600mg tab 10 oxazepam 10mg cap 17 oxazepam 15mg cap 17 oxazepam 30mg cap 17 oxcarbazepine 150mg tab 23 oxcarbazepine 300mg tab 23 oxcarbazepine 600mg tab 24 oxcarbazepine 60mg/ml oral susp

24


141


OXTELLAR 150MG XR TAB

24


24


24

oxybutynin chloride 10mg er tab

104


104

oxybutynin chloride 1mg/ml oral soln

104


104

oxybutynin chloride 5mg tab

104

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 OXYCONTIN 10MG ER TAB

13

OXYCONTIN 15MG ER TAB

13


13


13


13


13


13

oxymorphone 10mg tab 13 oxymorphone 5mg tab 13

P

pacerone 200mg tab 18

pacerone 400mg tab 18 paclitaxel 6mg/ml inj 49 paliperidone 1.5mg er tab 53 paliperidone 3mg er tab 53 paliperidone 6mg er tab 53 paliperidone 9mg er tab 53 pamidronate disodium 3mg/ml inj

78

PAMIDRONATE DISODIUM 6MG/ML INJ

78

pamidronate disodium 9mg/ml inj

78

PANCREAZE 10500-25000-43750UNIT DR CAP

76


76


76


76


77

PANRETIN 0.1% GEL 73 pantoprazole 20mg dr tab 104 pantoprazole 40mg dr tab 104 pantoprazole 40mg inj 104 paricalcitol 0.001mg cap 80 paricalcitol 0.002mg cap 80 paricalcitol 0.002mg/ml inj

80

paricalcitol 0.004mg cap 80 paricalcitol 0.005mg/ml inj

80

paromomycin 250mg cap 9 paroxetine 10mg tab 26 paroxetine 12.5mg er tab 26 paroxetine 20mg tab 26 paroxetine 25mg er tab 26 paroxetine 30mg tab 26 paroxetine 37.5mg er tab 26

paroxetine 40mg tab 26 PASER D/R 4GM GRANULES

42

PAXIL 10MG/5ML ORAL SUSP

27

PEDIARIX INJ 103 PEDVAXHIB 7.5MCG/0.5ML INJ

105

peg 3350/electrolyte oral soln

87

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

87

PEGANONE 250MG TAB 25 PEGASYS 135MCG/0.5ML AUTO-INJECTOR

58

PEGASYS 180MCG/0.5ML AUTO-INJECTOR

58

PEGASYS 180MCG/0.5ML SYRINGE

58

PEGASYS 180MCG/ML INJ

58

penicillin g potassium 1000000unit/ml inj

96

PENICILLIN G POTASSIUM 40000UNIT/ML INJ

96

PENICILLIN G POTASSIUM 60000UNIT/ML INJ

96

PENICILLIN G PROCAINE 600000UNIT/ML SYRINGE

96

PENICILLIN G SODIUM 100000UNIT/ML INJ

97

penicillin v potassium 250mg tab

97

penicillin v potassium 25mg/ml oral soln

97


142


penicillin v potassium 500mg tab

97

penicillin v potassium 50mg/ml oral soln

97

PENTAM 300MG INJ 40 pentoxifylline 400mg er tab

84

perindopril erbumine 2mg tab

36


36


36

periogard 0.12% mouthwash

90

PERJETA 420MG/14ML INJ

44

permethrin 5% cream 76 perphenazine 16mg tab 55 perphenazine 2mg tab 55 perphenazine 4mg tab 55 perphenazine 8mg tab 55 PEXEVA 10MG TAB 27 PEXEVA 20MG TAB 27 PEXEVA 30MG TAB 27 PEXEVA 40MG TAB 27 phenadoz 12.5mg rectal supp

34

phenelzine 15mg tab 26 phenergan 12.5mg rectal supp

34

phenergan 25mg rectal supp

34

phenergan 50mg rectal supp

34

PHENOBARBITAL 100MG TAB

86


86

phenobarbital 16.2mg tab 86 PHENOBARBITAL 30MG TAB

86

phenobarbital 32.4mg tab 86 phenobarbital 4mg/ml oral soln

86


86

phenobarbital 64.8mg tab 86 phenobarbital 97.2mg tab 86 phenoxybenzamine 10mg cap

36

phenylephrine 1mg/ml/promethazine 1.25mg/ml oral soln

71

phenytoin 25mg/ml oral 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

phenytoin sodium 50mg/ml inj

25

PHOSLYRA 667MG/5ML ORAL SOLN

83

PHOSPHOLINE IODIDE 0.125% OPHTH SOLN

93

physiolyte soln 60 physiosol soln 60 PICATO 0.015% GEL 73 PICATO 0.05% GEL 73 pilocarpine 1% ophth soln

93

pilocarpine 2% ophth soln

93

pilocarpine 4% ophth soln

93

pilocarpine 5mg tab 91 pilocarpine 7.5mg tab 91 pimozide 1mg tab 100 pimozide 2mg tab 100 pimtrea pack 69 pindolol 10mg tab 61 pindolol 5mg tab 62 pioglitazone 15mg tab 30 pioglitazone 30mg tab 30 pioglitazone 45mg tab 31

piperacillin 2000mg/tazobactam 250mg inj

97

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

97


97


97

pirmella 1/35 28 day pack 69 piroxicam 10mg cap 10 piroxicam 20mg cap 10 PLASMA-LYTE 148 INJ 89 PLASMALYTE A INJ 89 PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR

99

PLEGRIDY 125MCG/0.5ML SYRINGE

99

PLEGRIDY PEN STARTER PACK

99

plenamine 15% inj 92 podofilox 0.5% topical soln

76

polyethylene glycol 3350 142mg/ml oral soln

87

polyethylene glycol 3350/kcl/sodium bicarbonate/sodium chloride/sodium sulfate powder for oral soln

87

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

94

polymyxin b 250000unit/ml inj

42

POMALYST 1MG CAP 45 POMALYST 2MG CAP 46 POMALYST 3MG CAP 46 POMALYST 4MG CAP 46 portia 28 day pack 69


143


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

89

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

89

potassium chloride 0.1meq/ml inj

90

potassium chloride 10% oral soln

90

potassium chloride 10meq er cap

90

potassium chloride 10meq er micro tab

90

potassium chloride 10meq er tab

90

potassium chloride 2 meq/ml inj

90

potassium chloride 20% oral soln

90

potassium chloride 20meq er micro tab

90

POTASSIUM CHLORIDE 20MEQ ER TAB

90

potassium chloride 40meq/20ml inj

90

potassium chloride 8meq er cap

90

potassium chloride 8meq er tab

90

potassium citrate 10meq er tab

83

potassium citrate 15 meq er tab

83

potassium citrate 5 meq er tab

83

PRADAXA 110MG CAP 21 PRADAXA 150MG CAP 21 PRADAXA 75MG CAP 21 PRALUENT 150MG/ML AUTO-INJECTOR

35

PRALUENT 75MG/ML AUTO-INJECTOR

35

pramipexole 0.125mg tab 51 pramipexole 0.25mg tab 51

pramipexole 0.375mg er tab

51

pramipexole 0.5mg tab 51 pramipexole 0.75mg er tab

51

pramipexole 0.75mg tab 51 pramipexole 1.5mg er tab 51 pramipexole 1.5mg tab 51 pramipexole 1mg tab 51 pramipexole 2.25mg er tab

51

pramipexole 3.75mg er tab

51

pramipexole 3mg er tab 51 pramipexole 4.5mg er tab 51 prasugrel 10mg tab 85 prasugrel 5mg tab 85 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

94

PRED-G 0.3-1% OPHTH SUSP

94

prednicarbate 0.1% cream

75

prednicarbate 0.1% ointment

75

prednisolone 1% ophth soln

94

prednisolone 10mg odt 71 prednisolone 15mg odt 71 prednisolone 1mg/ml oral soln

71

prednisolone 30mg odt 71 prednisolone 3mg/ml oral soln

71

prednisolone acetate 1% ophth susp

94

prednisolone sodium phosphate 2.5mg/ml/sulfacetamide sodium 100mg/ml ophth soln

95

PREDNISONE 10MG (21) TAB PACK

71


71

prednisone 10mg tab 71 prednisone 1mg tab 71 PREDNISONE 1MG/ML ORAL SOLN

71

prednisone 2.5mg tab 71 prednisone 20mg tab 71 PREDNISONE 50MG TAB

71


71


71

prednisone 5mg tab 71 PREDNISONE 5MG/ML ORAL SOLN

71

PREMARIN 0.3MG TAB 81 PREMARIN 0.45MG TAB 81 PREMARIN 0.625MG TAB

81

PREMARIN 0.625MG/GM VAGINAL CREAM

106

PREMARIN 0.9MG TAB 81 PREMARIN 1.25MG TAB 81 PREMASOL 10% INJ 92 premasol 6% inj 93 PREMPHASE 28 DAY PACK

81

PREMPRO 0.3/1.5MG 28 DAY PACK

81

PREMPRO 0.45/1.5 28 DAY PACK

81

PREMPRO 0.625/2.5MG 28 DAY PACK

81


144


PREMPRO 0.625/5MG 28 DAY PACK

81

prevalite 4gm/dose oral susp

34

previfem 28 day pack 69 PREZCOBIX 800-150MG TAB

57

PREZISTA 100MG/ML ORAL SUSP

57

PREZISTA 150MG TAB 57 PREZISTA 600MG TAB 57 PREZISTA 75MG TAB 57 PREZISTA 800MG TAB 57 PRIFTIN 150MG TAB 42 PRIMAQUINE PHOSPHATE 26.3MG TAB

42

primidone 250mg tab 24 primidone 50mg tab 24 PRIVIGEN 20GM/200ML INJ

96

probenecid 500mg tab 84 PROCAINAMIDE 100MG/ML INJ

17

PROCAINAMIDE 500MG/ML INJ

17

PROCALAMINE 3% INJ 93 prochlorperazine 10mg tab

55

prochlorperazine 25mg rectal supp

55

prochlorperazine 5mg tab 55 prochlorperazine 5mg/ml inj

55

PROCRIT 10000UNIT/ML INJ

85


85


85


85


85


85

procto-med 2.5% cream 15 procto-pak 1% rectal cream

15

proctosol 2.5% cream 15 proctozone hc 2.5% cream

15

progesterone 100mg cap 98 progesterone 200mg cap 98 PROGLYCEM 50MG/ML ORAL SUSP

30

PROGRAF 5MG/ML INJ 60 PROLASTIN 1000MG INJ 100 PROLEUKIN 22000000UNIT INJ

49

PROLIA 60MG/ML SYRINGE

78

PROMACTA 12.5MG TAB

85

PROMACTA 25MG TAB 85 PROMACTA 50MG TAB 85 PROMACTA 75MG TAB 86 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 25mg/ml inj 34 promethazine 50mg rectal supp

34

promethazine 50mg tab 34 promethazine 50mg/ml inj 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

PROPANTHELINE 15MG TAB

103

proparacaine 0.5% ophth soln

94

propranolol 10mg tab 62 propranolol 120mg er cap

62

propranolol 160mg er cap

62

propranolol 1mg/ml inj 62 propranolol 20mg tab 62 propranolol 40mg tab 62 PROPRANOLOL 4MG/ML ORAL SOLN

62

propranolol 60mg er cap 62 propranolol 60mg tab 62 propranolol 80mg er cap 62 propranolol 80mg tab 62 PROPRANOLOL 8MG/ML ORAL SOLN

62

propylthiouracil 50mg tab

101

PROQUAD INJ 105 PROSOL 20% INJ 93 protriptyline 10mg tab 29 protriptyline 5mg tab 29 PSORCON 0.05% CREAM

75

PULMOZYME 1MG/ML INH SOLN

100

PURIXAN 2000MG/100ML ORAL SUSP

44

PYLERA 140-125-125MG CAP

104

pyrazinamide 500mg tab 42 pyridostigmine bromide 180mg er tab

42

pyridostigmine bromide 60mg tab

42

Q


145


QBRELIS 1MG/ML ORAL SOLN

36

QUADRACEL INJ 103 quasense 91 day pack 69 QUDEXY 100MG XR CAP

24

QUDEXY 150MG XR CAP

24

QUDEXY 200MG XR CAP

24

QUDEXY 25MG XR CAP 24 QUDEXY 50MG XR CAP 24 quetiapine 100mg tab 54 quetiapine 150mg xr tab 54 quetiapine 200mg tab 54 quetiapine 200mg xr tab 54 quetiapine 25mg tab 54 quetiapine 300mg tab 54 quetiapine 300mg xr tab 54 quetiapine 400mg tab 54 quetiapine 400mg xr tab 54 quetiapine 50mg tab 54 quetiapine 50mg xr tab 54 quinapril 10mg tab 36 quinapril 20mg tab 36 quinapril 40mg tab 36 quinapril 5mg tab 36 quinidine gluconate 324mg er tab

17

QUINIDINE GLUCONATE 80MG/ML INJ

17

QUINIDINE SULFATE 200MG TAB

17

QUINIDINE SULFATE 300MG TAB

17

quinine sulfate 324mg cap

42

R

RABAVERT 2.5UNIT/ML INJ

105

rabeprazole sodium 20mg dr tab

104

raloxifene 60mg tab 79

ramipril 1.25mg cap 36 ramipril 10mg cap 36 ramipril 2.5mg cap 36 ramipril 5mg cap 36 RANEXA 1000MG ER TAB

15

RANEXA 500MG ER TAB 15 ranitidine 150mg cap 104 ranitidine 150mg tab 104 ranitidine 15mg/ml oral soln

104

ranitidine 25mg/ml inj 104 ranitidine 300mg cap 104 ranitidine 300mg tab 104 RAPAFLO 4MG CAP 84 RAPAFLO 8MG CAP 84 RAPAMUNE 1MG/ML ORAL SOLN

60

rasagiline 0.5mg tab 51 rasagiline 1mg tab 51 RAVICTI 1.1GM/ML ORAL SOLN

80

REBIF 22MCG/0.5ML AUTO-INJECTOR

99

REBIF 22MCG/0.5ML SYRINGE

100

REBIF 44MCG/0.5ML AUTO-INJECTOR

100

REBIF 44MCG/0.5ML SYRINGE

100

REBIF REBIDOSE PACK 100 REBIF TITRATION PACK 100 reclipsen 28 day pack 69 RECOMBIVAX 10MCG/ML SYRINGE

105

RECOMBIVAX 40MCG/ML INJ

105

RECOMBIVAX 5MCG/0.5ML SYRINGE

106

RECOMBIVAX HB 10MCG/ML INJ

106

REGRANEX 0.01% GEL 76 RELENZA 5MG/BLISTER INH

59

RELISTOR 12MG/0.6ML INJ

83

RELISTOR 12MG/0.6ML SYRINGE

83

RELISTOR 8MG/0.4ML SYRINGE

83

REMODULIN 10MG/ML INJ

64


64

REMODULIN 2.5MG/ML INJ

64


64

RENVELA 800MG TAB 83 repaglinide 0.5mg tab 31 repaglinide 1mg tab 31 repaglinide 2mg tab 31 REPATHA 120MG/ML CARTRIDGE

36

REPATHA 140MG/ML AUTO-INJECTOR

36

REPATHA 140MG/ML SYRINGE

36

RESCRIPTOR 100MG TAB

57

RESCRIPTOR 200MG TAB

57

RESTASIS 0.05% OPHTH SUSP

94

RETROVIR 10MG/ML INJ

57

REVLIMID 10MG CAP 59 REVLIMID 15MG CAP 59 REVLIMID 2.5MG CAP 59 REVLIMID 20MG CAP 59 REVLIMID 25MG CAP 59 REVLIMID 5MG CAP 59 REXULTI 0.25MG TAB 55 REXULTI 0.5MG TAB 55 REXULTI 1MG TAB 55 REXULTI 2MG TAB 55 REXULTI 3MG TAB 55 REXULTI 4MG TAB 55 REYATAZ 150MG CAP 57


146


REYATAZ 200MG CAP 57 REYATAZ 300MG CAP 57 REYATAZ 50MG ORAL POWDER

57

ribasphere 200mg cap 58 ribasphere 200mg tab 58 ribasphere 400mg tab 58 ribasphere 600mg tab 58 ribasphere ribapak 1200/day

58

ribasphere ribapak 800/day

59

ribavirin 200mg cap 59 ribavirin 200mg tab 59 RIDAURA 3MG CAP 9 rifabutin 150mg cap 42 RIFAMATE 150-300MG CAP

42

rifampin 150mg cap 42 rifampin 300mg cap 43 rifampin 60mg/ml inj 43 RIFATER 50-120-300MG TAB

42

riluzole 50mg tab 92 rimantadine 100mg tab 59 risedronate sodium 150mg tab

78

risedronate sodium 30mg tab

78

risedronate sodium 35mg (12) pack

78

risedronate sodium 35mg (4) pack

78


78


78

RISPERDAL 12.5MG INJ 53 RISPERDAL 25MG INJ 53 RISPERDAL 37.5MG INJ 53 RISPERDAL 50MG INJ 53 risperidone 0.25mg odt 53 risperidone 0.25mg tab 53 risperidone 0.5mg odt 53 risperidone 0.5mg tab 53

risperidone 1mg odt 53 risperidone 1mg tab 53 risperidone 1mg/ml oral soln

53

risperidone 2mg odt 53 risperidone 2mg tab 53 risperidone 3mg odt 53 risperidone 3mg tab 53 risperidone 4mg odt 53 risperidone 4mg tab 53 RITUXAN 100MG/10ML INJ

44

RITUXAN 500MG/50ML INJ

44

rivastigmine 1.5mg cap 98 rivastigmine 13.3mg/24hr patch

98

rivastigmine 3mg cap 98 rivastigmine 4.5mg cap 98 rivastigmine 4.6mg/24hr patch

99

rivastigmine 6mg cap 99 rivastigmine 9.5mg/24hr patch

99

rivelsa 91 day pack 69 rizatriptan 10mg odt 88 rizatriptan 10mg tab 88 rizatriptan 5mg odt 88 rizatriptan 5mg tab 88 ropinirole 0.25mg tab 51 ropinirole 0.5mg tab 51 ropinirole 12mg er tab 51 ropinirole 1mg tab 51 ropinirole 2mg er tab 51 ropinirole 2mg tab 51 ropinirole 3mg tab 51 ropinirole 4mg er tab 51 ropinirole 4mg tab 51 ropinirole 5mg tab 51 ropinirole 6mg er tab 51 ropinirole 8mg er tab 51 rosuvastatin 10mg tab 35 rosuvastatin 20mg tab 35 rosuvastatin 40mg tab 35 rosuvastatin 5mg tab 35

ROTARIX ORAL SUSP 106 ROTATEQ ORAL SUSP 106 roweepra 1000mg tab 24 roweepra 500mg er tab 24 roweepra 500mg tab 24 roweepra 750mg er tab 24 roweepra 750mg tab 24 ROZEREM 8MG TAB 86 RUBRACA 200MG TAB 48 RUBRACA 300MG TAB 48 RUCONEST 2100UNIT INJ

84

RYDAPT 25MG CAP 48

S

SABRIL 500MG ORAL SOLN

25

SABRIL 500MG TAB 25 salmon calcitonin 200unit/act nasal spray

78

SANDIMMUNE 100MG/ML ORAL SOLN

60

SANTYL 250UNIT/GM OINTMENT

76

SAPHRIS 10MG SL TAB 54 SAPHRIS 2.5MG SL TAB 54 SAPHRIS 5MG SL TAB 54 SAVELLA 100MG TAB 99 SAVELLA 12.5MG TAB 99 SAVELLA 25MG TAB 99 SAVELLA 4-WEEK TITRATION PACK

99

SAVELLA 50MG TAB 99 scopolamine 1mg/3days patch

32

selegiline 5mg cap 51 selegiline 5mg tab 51 selenium sulfide 2.5% shampoo

74

SELZENTRY 150MG TAB 57 SELZENTRY 20MG/ML ORAL SOLN

57

SELZENTRY 25MG TAB 57 SELZENTRY 300MG TAB 57 SELZENTRY 75MG TAB 57


147


SENSIPAR 30MG TAB 80 SENSIPAR 60MG TAB 80 SENSIPAR 90MG TAB 80 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 69 sevelamer carbonate 2400mg oral susp

83

sevelamer carbonate 800mg oral susp

83

sevelamer carbonate 800mg tab

83

sharobel 28 day 0.35mg pack

70

SHINGRIX INJ 106 SIGNIFOR 0.3MG/ML INJ

80

SIGNIFOR 0.6MG/ML INJ

80

SIGNIFOR 0.9MG/ML INJ

80

sildenafil 20mg tab 65 silver sulfadiazine 1% cream

74

SIMBRINZA 1-0.2% OPHTH SUSP

93

SIMPONI ARIA 50MG/4ML INJ

9

SIMULECT 20MG INJ 60 simvastatin 10mg tab 35 simvastatin 20mg tab 35 simvastatin 40mg tab 35 simvastatin 5mg tab 35 simvastatin 80mg tab 35 sirolimus 0.5mg tab 60 sirolimus 1mg tab 60 sirolimus 2mg tab 60 SIRTURO 100MG TAB 43 SIVEXTRO 200MG INJ 42 SIVEXTRO 200MG TAB 42

sodium chloride 0.45% inj

90

sodium chloride 0.9% inj 90 sodium chloride 0.9% soln

83

sodium chloride 2.5 meq/ml inj

90

sodium chloride 3% inj 90 sodium chloride 5% inj 90 sodium lactate 5 meq/ml inj

88

sodium phenylbutyrate 0.94mg/mg oral powder

80

sodium polystyrene sulfonate 250mg/ml oral susp

60

SOLTAMOX 10MG/5ML ORAL SOLN

45

SOLU-CORTEF 100MG INJ

71

SOLU-CORTEF 250MG INJ

71

SOMATULINE 120MG/0.5ML SYRINGE

80


80


80

SOMAVERT 10MG INJ 79 SOMAVERT 15MG INJ 79 SOMAVERT 20MG INJ 79 SOMAVERT 25MG INJ 79 SOMAVERT 30MG INJ 79 sorine 120mg tab 62 sorine 160mg tab 62 sorine 240mg tab 62 sorine 80mg tab 62 sotalol 120mg tab 62 sotalol 160mg tab 62 sotalol 240mg tab 62 sotalol 80mg tab 62 SPIRIVA 1.25MCG RESPIMAT INH

18

SPIRIVA 18MCG HANDIHALER

18

SPIRIVA 2.5MCG RESPIMAT INH

18

spironolactone 100mg tab

77

spironolactone 25mg tab 77 spironolactone 50mg tab 77 sprintec 28 day pack 69 SPRITAM 1000MG ODT 24 SPRITAM 250MG ODT 24 SPRITAM 500MG ODT 24 SPRITAM 750MG ODT 24 SPRYCEL 100MG TAB 48 SPRYCEL 140MG TAB 48 SPRYCEL 20MG TAB 48 SPRYCEL 50MG TAB 48 SPRYCEL 70MG TAB 48 SPRYCEL 80MG TAB 48 sps 250mg/ml oral susp 60 sronyx 28 day pack 69 ssd 1% cream 74 STALEVO 12.5-50-200MG TAB

51

STALEVO 18.75-75-200MG TAB

51

STALEVO 25-100-200MG TAB

51


51


51

STALEVO 50-200-200MG TAB

51

stavudine 15mg cap 57 stavudine 20mg cap 57 stavudine 30mg cap 57 stavudine 40mg cap 57 STIMATE 1.5MG/ML NASAL SPRAY

80

STIOLTO 2.5-2.5MCG INH

20

STIVARGA 40MG TAB 48 STRENSIQ 40MG/ML INJ 80 STRENSIQ 80MG/0.8ML INJ

80


148


STREPTOMYCIN 100MG INJ

9

STRIBILD 150-150-200-300MG TAB

57

SUBOXONE 12-3MG STRIP

14

SUBOXONE 2-0.5MG STRIP

14


14


15

SUCRAID 8500UNIT/ML ORAL SOLN

77

sucralfate 1000mg tab 104 sulfacetamide sodium 10% lotion

72

SULFACETAMIDE SODIUM 10% OPHTH OINTMENT

94

sulfacetamide sodium 10% ophth soln

94

SULFADIAZINE 500MG TAB

100

sulfamethoxazole 400mg/trimethoprim 80mg tab

41

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

41

sulfamethoxazole 800mg/trimethoprim 160mg tab

41

SULFAMETHOXAZOLE 80MG/ML/TRIMETHOPRIM 16MG/ML INJ

41

SULFAMYLON 85MG/GM CREAM

74

sulfasalazine 500mg dr tab

82

sulfasalazine 500mg tab 83 sulindac 150mg tab 10 sulindac 200mg tab 10 sumatriptan 100mg tab 88

sumatriptan 12mg/ml auto-injector

88

sumatriptan 12mg/ml inj 88 sumatriptan 20mg/act nasal spray

88

sumatriptan 25mg tab 88 sumatriptan 4mg cartridge

88

sumatriptan 50mg tab 88 sumatriptan 5mg/act nasal spray

88

sumatriptan 6mg cartridge

88

sumatriptan 8mg/ml auto-injector

88

SUPRAX 400MG CAP 66 SUSTIVA 200MG CAP 57 SUSTIVA 50MG CAP 57 SUSTIVA 600MG TAB 57 SUTENT 12.5MG CAP 48 SUTENT 25MG CAP 48 SUTENT 37.5MG CAP 48 SUTENT 50MG CAP 48 SYLATRON 200MCG INJ 49 SYLATRON 300MCG INJ 49 SYLATRON 600MCG INJ 49 SYLVANT 100MG INJ 60 SYNAGIS 50MG/0.5ML INJ

96

SYNAREL 2MG/ML NASAL SPRAY

79

SYNERCID 500MG INJ 42 SYNJARDY 12.5-1000MG TAB

29

SYNJARDY 12.5-500MG TAB

29

SYNJARDY 5-1000MG TAB

29

SYNJARDY 5-500MG TAB

29

SYNRIBO 3.5MG INJ 49 SYNTHROID 100MCG TAB

102

SYNTHROID 112MCG TAB

102


102


102


102


102


102

SYNTHROID 25MCG TAB

102


102

SYNTHROID 50MCG TAB

102

SYNTHROID 75MCG TAB

102

SYNTHROID 88MCG TAB

102

SYPRINE 250MG CAP 59

T

TABLOID 40MG TAB 44 tacrolimus 0.03% ointment

76

tacrolimus 0.1% ointment 76 tacrolimus 0.5mg cap 60 tacrolimus 1mg cap 60 tacrolimus 5mg cap 60 TAFINLAR 50MG CAP 48 TAFINLAR 75MG CAP 48 TAGRISSO 40MG TAB 48 TAGRISSO 80MG TAB 48 TAMIFLU 6MG/ML ORAL SUSP

59

tamoxifen 10mg tab 45 tamoxifen 20mg tab 45 tamsulosin 0.4mg cap 84 TARCEVA 100MG TAB 48 TARCEVA 150MG TAB 48 TARCEVA 25MG TAB 48 TARGRETIN 1% GEL 73 tarina fe 1/20 28 day pack

69


149


TASIGNA 150MG CAP 48 TASIGNA 200MG CAP 48 tazarotene 0.1% cream 74 tazicef 1gm inj 66 tazicef 2gm inj 66 tazicef 6gm inj 66 TAZORAC 0.05% CREAM

74

TAZORAC 0.05% GEL 74 TAZORAC 0.1% GEL 74 taztia 120mg er cap 63 taztia 180mg er cap 63 taztia 240mg er cap 63 taztia 300mg er cap 63 taztia 360mg er cap 63 TECENTRIQ 60MG/ML INJ

44

TECFIDERA 120MG DR CAP

100

TECFIDERA 240MG DR CAP

100

TECFIDERA 30-DAY STARTER PACK

100

TEFLARO 400MG INJ 67 TEFLARO 600MG INJ 67 telmisartan 20mg tab 37 telmisartan 40mg tab 37 telmisartan 80mg tab 37 temazepam 15mg cap 86 temazepam 22.5mg cap 86 temazepam 30mg cap 86 temazepam 7.5mg cap 86 TENIVAC SYRINGE 103 tenofovir disoproxil fumarate 300mg tab

57

terazosin 10mg cap 37 terazosin 1mg cap 37 terazosin 2mg cap 37 terazosin 5mg cap 37 terbinafine 250mg tab 33 terbutaline sulfate 1mg/ml inj

20

terbutaline sulfate 2.5mg tab

20

terbutaline sulfate 5mg tab

20

terconazole 0.4% vaginal cream

106

terconazole 0.8% vaginal cream

106

terconazole 80mg vaginal supp

106

testosterone 1% (25mg) gel

15

testosterone 1% (50mg) gel

15

testosterone 1% gel pump 15 testosterone cypionate 100mg/ml inj

15

testosterone cypionate 200mg/ml inj

15

testosterone enanthate 200mg/ml inj

15

TETANUS/DIPHTHERIA TOXOID INJ

103

tetrabenazine 12.5mg tab 99 tetrabenazine 25mg tab 99 tetracycline 250mg cap 101 tetracycline 500mg cap 101 THALOMID 100MG CAP 59 THALOMID 150MG CAP 59 THALOMID 200MG CAP 59 THALOMID 50MG CAP 59 theophylline 100mg er tab

20

theophylline 200mg er tab

20


20


20

theophylline 5.33mg/ml oral soln

20


20

THIOLA 100MG TAB 84 thioridazine 100mg tab 55 thioridazine 10mg tab 55 thioridazine 25mg tab 55

thioridazine 50mg tab 55 thiotepa 15mg inj 43 thiothixene 10mg cap 55 thiothixene 1mg cap 55 thiothixene 2mg cap 55 thiothixene 5mg cap 55 THYMOGLOBULIN 25MG INJ

60

THYROLAR 120MG TAB 102 THYROLAR 15MG TAB 102 THYROLAR 180MG TAB 102 THYROLAR 30MG TAB 102 THYROLAR 60MG TAB 102 tiagabine 2mg tab 25 tiagabine 4mg tab 25 TIGECYCLINE 50MG INJ 41 timolol 0.25% ophth gel 93 timolol 0.25% ophth soln 93 timolol 0.5% 24hr ophth soln

93

timolol 0.5% ophth gel 93 timolol 0.5% ophth soln 93 timolol 10mg tab 62 timolol 20mg tab 62 timolol 5mg tab 62 tinidazole 250mg tab 40 tinidazole 500mg tab 40 TIVICAY 10MG TAB 57 TIVICAY 25MG TAB 57 TIVICAY 50MG TAB 57 tizanidine 2mg cap 91 tizanidine 2mg tab 91 tizanidine 4mg cap 91 tizanidine 4mg tab 91 tizanidine 6mg cap 91 TOBI PODHALER KIT 28MG PACK

9

TOBRADEX 0.3-0.1% OPHTH OINTMENT

95

tobramycin 0.3% ophth soln

94

TOBRAMYCIN 10MG/ML INJ

9

tobramycin 40mg/ml inj 9


150


tobramycin 60mg/ml inh soln

9

TOLAK 4% CREAM 73 tolazamide 250mg tab 31 tolazamide 500mg tab 31 TOLBUTAMIDE 500MG TAB

31

tolcapone 100mg tab 50 tolterodine tartrate 1mg tab

104

tolterodine tartrate 2mg er cap

105

tolterodine tartrate 2mg tab

105

tolterodine tartrate 4mg er cap

105

TOPICORT 0.05% CREAM

75

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 toposar 1gm/50ml inj 49 topotecan 1mg/ml inj 50 TORISEL 25MG/ML INJ 48 torsemide 100mg tab 77 torsemide 10mg tab 77 torsemide 20mg tab 77 torsemide 5mg tab 77 TOUJEO 300UNIT/ML PEN INJ

30

tpn electrolytes inj 89 TRACLEER 125MG TAB 65

TRACLEER 32MG TAB FOR ORAL SUSP

65

TRACLEER 62.5MG TAB 65 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 13 tramadol 300mg er tab (matrix delivery)

13

tramadol 50mg tab 13 trandolapril 1mg tab 36 trandolapril 1mg/verapamil 240mg er tab

40

trandolapril 2mg tab 36 trandolapril 2mg/verapamil 180mg er tab

40

trandolapril 2mg/verapamil 240mg er tab

40

trandolapril 4mg tab 36 trandolapril 4mg/verapamil 240mg er tab

40

tranexamic acid 100mg/ml inj

86

tranexamic acid 650mg tab

86

TRANSDERM SCOP 1MG/3DAYS PATCH

32

tranylcypromine 10mg tab

26

TRAVASOL 10% INJ 93 TRAVATAN Z 0.004% OPHTH SOLN

95

trazodone 100mg tab 27 trazodone 150mg tab 27 trazodone 300mg tab 27 trazodone 50mg tab 27 TREANDA 100MG INJ 43

TREANDA 25MG INJ 43 TRECATOR 250MG TAB 43 TRELEGY 62.5-25MCG ELLIPTA INH

20

TRELSTAR 11.25MG INJ 45 TRELSTAR 22.5MG INJ 45 TRELSTAR 3.75MG INJ 45 TRESIBA 100UNIT/ML PEN INJ

30

TRESIBA 200UNIT/ML PEN INJ

30

tretinoin 0.01% gel 72 tretinoin 0.025% cream 72 tretinoin 0.025% gel 72 tretinoin 0.04% gel 72 tretinoin 0.05% cream 72 tretinoin 0.05% gel 72 tretinoin 0.1% cream 72 tretinoin 0.1% gel 72 tretinoin 10mg cap 49 TREXALL 10MG TAB 44 TREXALL 15MG TAB 44 TREXALL 5MG TAB 44 TREXALL 7.5MG TAB 44 triamcinolone 55mcg nasal spray

92

triamcinolone acetonide 0.025% cream

75

triamcinolone acetonide 0.025% lotion

75

triamcinolone acetonide 0.025% ointment

75


75

triamcinolone acetonide 0.1% lotion

75


75

triamcinolone acetonide 0.1% oral paste

91

triamcinolone acetonide 0.147mg/ml spray

75


75


151



75

TRIAZOLAM 0.125MG TAB

86

triazolam 0.25mg tab 86 triderm 0.1% cream 75 trientine 250mg tab 90 trifluoperazine 10mg tab 55 trifluoperazine 1mg tab 55 trifluoperazine 2mg tab 55 trifluoperazine 5mg tab 55 trifluridine 1% soln 94 trihexyphenidyl 0.4mg/ml oral soln

50

trihexyphenidyl 2mg tab 50 trihexyphenidyl 5mg tab 50 tri-legest 28 day pack 69 tri-lo-estarylla 28 day pack

69

tri-lo-sprintec 28 day pack

69

trilyte powder for oral soln

87

trimethobenzamide 300mg cap

32

trimethoprim 100mg tab 40 trimipramine 100mg cap 29 trimipramine 25mg cap 29 trimipramine 50mg cap 29 trinessa 28 day pack 69 TRINTELLIX 10MG TAB 27 TRINTELLIX 20MG TAB 27 TRINTELLIX 5MG TAB 27 tri-previfem 28 day pack 69 TRISENOX 12MG/6ML INJ

49

tri-sprintec 28 day pack 69 TRIUMEQ 600-50-300MG TAB

57

trivora 28 day pack 69 TROKENDI 100MG XR CAP

24

TROKENDI 200MG XR CAP

24


24


24

TROPHAMINE 10% INJ 93 trospium chloride 20mg tab

105

trospium chloride 60mg er cap

105

TRUMENBA SYRINGE 105 TRUVADA 100-150MG TAB

57

TRUVADA 133-200MG TAB

58


58


58

TWINRIX 720UNIT SYRINGE

106

TYBOST 150MG TAB 58 TYGACIL 50MG INJ 41 TYKERB 250MG TAB 48 TYMLOS 2MG/ML PEN INJECTOR

78

TYPHIM VI 25MCG/0.5ML INJ

105

TYPHIM VI 25MCG/0.5ML SYRINGE

105

TYSABRI 300MG/15ML INJ

100

U

UCERIS 2MG/ACT FOAM 15 UCERIS 9MG ER TAB 71 ULORIC 40MG TAB 84 ULORIC 80MG TAB 84 unithroid 100mcg tab 102 unithroid 112mcg tab 102 unithroid 125mcg tab 102 unithroid 150mcg tab 102 unithroid 175mcg tab 102 unithroid 200mcg tab 102 unithroid 25mcg tab 103 unithroid 300mcg tab 103

unithroid 50mcg tab 103 unithroid 75mcg tab 103 unithroid 88mcg tab 103 UPTRAVI 1000MCG TAB 65 UPTRAVI 1200MCG TAB 65 UPTRAVI 1400MCG TAB 65 UPTRAVI 1600MCG TAB 65 UPTRAVI 200MCG TAB 65 UPTRAVI 400MCG TAB 65 UPTRAVI 600MCG TAB 65 UPTRAVI 800MCG TAB 65 UPTRAVI TITRATION PACK

65

ursodiol 250mg tab 82 ursodiol 300mg cap 82 ursodiol 500mg tab 82

V

valacyclovir 1000mg tab 59 valacyclovir 500mg tab 59 VALCHLOR 0.016% GEL 73 VALCYTE 50MG/ML ORAL SOLN

58

valganciclovir 450mg tab 58 valganciclovir 50mg/ml oral soln

58

valproic acid 100mg/ml inj

25

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 vancomycin 1000mg inj 40 vancomycin 100mg/ml inj 41 vancomycin 125mg cap 41 vancomycin 250mg cap 41 vancomycin 500mg inj 41 vandazole 0.75% vaginal gel

106

VAQTA 25UNIT/0.5ML SYRINGE

106


152


VAQTA 50UNIT/0.5ML INJ

106

VAQTA 50UNIT/1ML INJ 106 VAQTA 50UNIT/ML SYRINGE

106

VARIVAX 1350PFU/0.5ML INJ

106

VARUBI 90MG TAB 32 VASCEPA 1GM CAP 34 VASCEPA 500MG CAP 34 VECTIBIX 100MG/5ML INJ

44

VELCADE 3.5MG INJ 48 velivet 28 day pack 69 VELTASSA 16.8GM POWDER FOR ORAL SUSP

61

VELTASSA 25.2GM POWDER FOR ORAL SUSP

61

VELTASSA 8.4GM POWDER FOR ORAL SUSP

61

VEMLIDY 25MG TAB 59 VENCLEXTA 10/100/50MG STARTING PACK

44

VENCLEXTA 100MG TAB

44

VENCLEXTA 10MG TAB 44 VENCLEXTA 50MG TAB 45 venlafaxine 100mg tab 27 venlafaxine 150mg er cap 27 venlafaxine 150mg er tab 27 VENLAFAXINE 225MG ER TAB

28

venlafaxine 25mg tab 28 venlafaxine 37.5mg er cap

28

venlafaxine 37.5mg er tab 28 venlafaxine 37.5mg tab 28 venlafaxine 50mg tab 28 venlafaxine 75mg er cap 28 venlafaxine 75mg er tab 28 venlafaxine 75mg tab 28

VENTAVIS 10MCG/ML INH SOLN

64

VENTAVIS 20MCG/ML INH SOLN

65

VENTOLIN 108MCG INH 20 verapamil 100mg er cap 63 verapamil 120mg er cap 64 verapamil 120mg er tab 64 verapamil 120mg tab 64 verapamil 180mg er cap 64 verapamil 180mg er tab 64 verapamil 2.5mg/ml inj 64 verapamil 200mg er cap 64 verapamil 240mg er cap 64 verapamil 240mg er tab 64 verapamil 300mg er cap 64 verapamil 360mg sr cap 64 verapamil 40mg tab 64 verapamil 80mg tab 64 VERSACLOZ 50MG/ML ORAL SUSP

54

VERZENIO 100MG TAB 48 VERZENIO 150MG TAB 48 VERZENIO 200MG TAB 48 VERZENIO 50MG TAB 48 VESICARE 10MG TAB 105 VESICARE 5MG TAB 105 vestura 3-0.02mg pack 69 vicodin 10-300mg tab 14 vicodin 5-300mg tab 14 vicodin 7.5-300mg tab 14 VICTOZA 18MG/3ML PEN INJ

30

VIDEX 125MG DR CAP 58 VIDEX 2GM ORAL SOLN 58 vienva 28 day pack 69 vigabatrin 50mg/ml oral soln

25

VIGAMOX 0.5% OPHTH SOLN

94

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 200MG/20ML INJ

24

VIMPAT 50MG TAB 24 VINBLASTINE 1MG/ML INJ

50

vincasar 1mg/ml inj 50 vincristine sulfate 1mg/ml inj

50

vinorelbine 10mg/ml inj 50 VIRACEPT 250MG TAB 58 VIRACEPT 625MG TAB 58 VIRAMUNE 50MG/5ML ORAL SUSP

58

VIREAD 150MG TAB 58 VIREAD 200MG TAB 58 VIREAD 250MG TAB 58 VIREAD 300MG TAB 58 VIREAD 40MG/GM ORAL POWDER

58

voriconazole 200mg inj 33 voriconazole 200mg tab 33 voriconazole 40mg/ml oral susp

33

voriconazole 50mg tab 33 VOTRIENT 200MG TAB 48 VPRIV 400UNIT INJ 85 VRAYLAR 1.5/3MG MIXED PACK

52

VRAYLAR 1.5MG CAP 52 VRAYLAR 3MG CAP 52 VRAYLAR 4.5MG CAP 52 VRAYLAR 6MG CAP 52 vyfemla 28 day pack 69 VYVANSE 10MG CAP 7 VYVANSE 10MG CHEW TAB

7

VYVANSE 20MG CAP 7 VYVANSE 20MG CHEW TAB

7

VYVANSE 30MG CAP 7


153


VYVANSE 30MG CHEW TAB

7


7


7


7

VYVANSE 70MG CAP 7 VYXEOS 44-100MG INJ 46

W

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

water 1000mg/ml soln 60 WELCHOL 3.75GM ORAL SUSP

34

WELCHOL 625MG TAB 34 wymzya fe 28 day pack 69

X

XALKORI 200MG CAP 48 XALKORI 250MG CAP 48 XARELTO 10MG TAB 21 XARELTO 15MG TAB 21 XARELTO 20MG TAB 21 XARELTO STARTER PACK

21

XATMEP 2.5MG/ML ORAL SOLN

44

XGEVA 120MG/1.7ML INJ

78

XIFAXAN 200MG TAB 41

XIFAXAN 550MG TAB 41 XIGDUO 10-1000MG XR TAB

29

XIGDUO 10-500MG XR TAB

29

XIGDUO 2.5-1000MG XR TAB

29


29


30

XOLAIR 150MG INJ 18 XTAMPZA 13.5MG ER CAP

13

XTAMPZA 18MG ER CAP

13

XTAMPZA 27MG ER CAP

13

XTAMPZA 36MG ER CAP

13

XTAMPZA 9MG ER CAP 13 XTANDI 40MG CAP 45 XULANE 150-35MCG PATCH

70

XULTOPHY 100UNIT-3.6MG/ML PEN INJ

30

XYREM 500MG/ML ORAL SOLN

98

Y

YERVOY 50MG/10ML INJ

44

YF-VAX 4000UNIT/ML INJ

106

YONDELIS 1MG INJ 43

Z

zafirlukast 10mg tab 18 zafirlukast 20mg tab 18 zaleplon 10mg cap 86 zaleplon 5mg cap 86 ZALTRAP 100MG/4ML INJ

44

ZANOSAR 1GM INJ 43 zarah 3-0.03mg pack 70

ZARXIO 300MCG/0.5ML SYRINGE

86

ZARXIO 480MCG/0.8ML SYRINGE

86

ZAVESCA 100MG CAP 85 ZEJULA 100MG CAP 48 ZELBORAF 240MG TAB 48 ZEMAIRA 1000MG INJ 100 zenatane 10mg cap 72 zenatane 20mg cap 72 zenatane 30mg cap 72 zenatane 40mg cap 72 zenchent 28 day pack 70 ZEPATIER 50-100MG TAB

59

ZERBAXA 1.5GM INJ 65 ZERIT 1MG/ML ORAL SOLN

58

ZIAGEN 20MG/ML ORAL SOLN

58

zidovudine 100mg cap 58 zidovudine 10mg/ml oral soln

58

zidovudine 300mg tab 58 zileuton 600mg er tab 18 ziprasidone 20mg cap 52 ziprasidone 40mg cap 52 ziprasidone 60mg cap 52 ziprasidone 80mg cap 52 ZIRGAN 0.15% OPHTH GEL

94

zoledronic acid 0.05mg/ml inj

78

zoledronic acid 0.8mg/ml inj

78

ZOLINZA 100MG CAP 48 zolmitriptan 2.5mg odt 88 zolmitriptan 2.5mg tab 88 zolmitriptan 5mg odt 88 zolmitriptan 5mg tab 88 zolpidem tartrate 10mg tab

86

zolpidem tartrate 5mg tab 86 ZOMETA 4MG/100ML INJ

79


154


ZOMIG 2.5MG NASAL SPRAY

88

ZOMIG 5MG NASAL SPRAY

88

zonisamide 100mg cap 24 zonisamide 25mg cap 24 zonisamide 50mg cap 24 ZORTRESS 0.25MG TAB 60 ZORTRESS 0.5MG TAB 60 ZORTRESS 0.75MG TAB 60 ZOSTAVAX 19400UNIT/0.65ML INJ

106

ZOSYN 40-5MG/ML INJ 97 ZOSYN 60-7.5MG/ML INJ

97

zovia 1/35e 28 day pack 70 zovia 1/50e 28 day pack 70 ZUBSOLV 11.4-2.9MG SL TAB

15

ZUBSOLV 1.4-0.36MG SL TAB

15


15


15


15

ZYCLARA 2.5% CREAM 76 ZYDELIG 100MG TAB 48 ZYDELIG 150MG TAB 48 ZYKADIA 150MG CAP 48 ZYLET 0.5-0.3% OPHTH SUSP

95

ZYPREXA 210MG INJ 54 ZYTIGA 250MG TAB 45


155

Great Plains Medicare Advantage is required by federal law to provide the following information.

Discrimination is Against the Law

Great Plains Medicare Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Great Plains Medicare Advantage does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Great Plains Medicare Advantage:

• Provides free aids and services to people with disabilities to communicate effectivelywith us, such as: o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronicformats, other

formats) • Provides free language services to people whose primary language is not English, suchas:

o Qualified interpreters o Information written in other languages

If you need these services, contact our Corporate Compliance Officer.

If you believe that Great Plains Medicare Advantage has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Corporate Compliance Officer, Great Plains Medicare Advantage, 10900 Nuckols Road, Suite 110, Glen Allen, VA 23060, phone: 844-317-9059, TTY 711, fax: 804-299-4059, [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance out Corporate Compliance Officer is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

http://www.hhs.gov/ocr/office/file/index.html

Language Assistance:

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-637-4760 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-1-844-637-4760 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-844-637-4760（TTY：711）。

(رقم ھاتف الصم والبكم: 4760-637-844-1ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 711 .(

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-844-637-4760 (ATS : 1-844-637-4760).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-844-637-4760 (TTY: 711).

XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-844-637-4760 (TTY: 711). 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-844-637-4760 (TTY:

711)번으로 전화해 주십시오.

धयान �दनहोस: तपाइ�ल नपाल� बोलनहनछ भन तपाइ�को �निमत भाषा सहायता सवाहर �नःशलक रपमा उपलबध छ । फोन गनरहोस 1-844-637-4760 (�ट�टवाइ: 711) ।

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-844-637-4760 (телетайп: 711).

ໂປດຊາບ: ຖາວາ ທານເວ າພາສາ ລາວ, ການບ ລ ການຊວຍເຫ ອດານພາສາ, ໂດຍບ ເສຽຄາ, ແມນມ ພອມໃຫທານ. ໂທຣ 1-844-637-4760 (TTY: 711).

1 بھ پھیوەندی. بھردەستھ تۆ بۆ، بھخۆڕایی، زمان یارمھتی خزمھتگوزاریھکانی، دەکھیت قھسھ کوردی زمانی بھ ئھگھر: ئاگاداری - 844-637-4760 (TTY (711 بکھ.

1 با. باشد می فراھم شما برای رایگان بصورت زبانی تسھیالت، کنید می گفتگو فارسی زبان بھ اگر: توجھ -844-637-4760 (TTY: 711) تماس .بگیرید

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-844-637-4760（TTY:711）まで、お電話にてご連絡ください。

This formulary was updated on 5/01/2018. For more recent information or other questions, please contact Great Plains Medicare Advantage Member Services at 1-844-637-4760 or, for TTY users, 711, Hours of operations: 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through February 14, and Monday to Friday (except holidays) from February 15 through September 30, or visit www.greatplainsmedicareadvantage.com.

Great Plains Medicare Select complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Great Plains Medicare Select cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

Great Plains Medicare Select tua n thu luạ t da n quyên hiẹ n hanh cu a Lie n bang va kho ng pha n biẹ t đôi xư dư a tre n chung tọ c, mau da, nguôn gôc quôc gia, đọ tuôi, khuyêt tạ t, hoạ c giơ i tınh.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-637-4760 TTY: 711.

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-844-637-4760 TTY: 711.

http://www.greatplainsmedicareadvantage.com./

Great Plans Medicare Advantage Nebraska 2018 ... Plans Medicare Advantage Nebraska 2018...

Documents

Transcript of Great Plans Medicare Advantage Nebraska 2018 ... Plans Medicare Advantage Nebraska 2018...