List of Covered Drugs (NY IDD)...• PHP Care Complete FIDA-IDD Plan will cover all drugs on the...

You can find information on what the symbols and abbreviations in this table mean by going to page 11. If you have questions, please call PHP Care Complete FIDA-IDD Plan at 1-855-747-5483 and 711 for TTY users, 8AM to 8PM, seven days a week. The call is free. For more information, visit www.phpcares.org.

H9869_2019 Formulary Approved 1

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PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) | 2019 List of Covered Drugs (Formulary)

Introduction

This document is called the List of Covered Drugs (also known as the Drug List). It tells you which

prescription drugs41T and over-the-counter41T drugs 41Tand items41T are covered by PHP Care Complete

FIDA-IDD Plan. The Drug List also tells you if there are any special rules or restrictions on any

drugs covered by PHP Care Complete FIDA-IDD Plan. Key terms and their definitions appear in

the last chapter of the Participant Handbook.

Updated 12/2019

Table of Contents

33TA. 33T 33TDisclaimers 33T ............................................................................................................................... 3

33TB. 33T 33TFrequently Asked Questions (FAQ) 33T .......................................................................................... 3

33TB1. What prescription drugs are on the List of Covered Drugs? (We call the List of

Covered Drugs the “Drug List” for short.) 33T ........................................................................... 4

33TB2. Does the Drug List ever change?33T ....................................................................................... 4

33TB3. What happens when there is a change to the Drug List? 33T ................................................... 5

33TB4. Are there any restrictions or limits on drug coverage or any required actions to take

to get certain drugs?33T .......................................................................................................... 6

33TB5. How will you know if the drug you want has limitations or if there are required

actions to take to get the drug?33T ......................................................................................... 7

33TB6. What happens if we change our rules about some drugs (for example, prior

authorization (approval), quantity limits, and/or step therapy restrictions)? 33T ........................ 7

33TB7. How can you find a drug on the Drug List? 33T ......................................................................... 7

33TB8. What if the drug you want to take is not on the Drug List? 33T .................................................. 7

33TB9. What if you are a new PHP Care Complete FIDA-IDD Plan Participant and can’t

find your drug on the Drug List or have a problem getting your drug? 33T ................................ 8

33TB10. Can you ask for an exception to cover your drug? 33T ............................................................ 8

33TB11. How can you ask for an exception? 33T .................................................................................. 9

http://www.phpcares.org/



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33TB12. How long does it take to get an exception? 33T ...................................................................... 9

33TB13. What are generic drugs?33T .................................................................................................. 9

33TB14. What are OTC drugs? 33T ...................................................................................................... 9

33TB15. Does PHP Care Complete FIDA-IDD Plan cover OTC non-drug products?33T ...................... 9

33TB16. What is your copay? 33T ....................................................................................................... 10

33TB17. What are drug tiers? 33T ....................................................................................................... 10

33TC. 33T 33TList of Covered Drugs33T ............................................................................................................. 10

33TD. 33T 33TList of Drugs by Medical Condition 33T ......................................................................................... 11

33TE. 33T 33TIndex of Covered Drugs33T .........................................................................................................177




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A. Disclaimers

41TThis is a list of drugs that Participants can get in PHP Care Complete FIDA-IDD Plan.

❖ Partners Health Plan is a managed care plan that contracts with Medicare and the

New York State Department of Health (Medicaid) to provide benefits to Participants

through the Fully Integrated Duals Advantage for individuals with Intellectual and

Developmental Disabilities (FIDA-IDD) Demonstration.

❖ ATTENTION: If you speak a language other than English, language assistance

services, free of charge, are available to you. Call 41T1-855-747-5483 and 711 for TTY

users, 8AM to 8PM, seven days a week 41T. The call is free.

❖ Si usted habla español, se encuentran disponibles para usted servicios sin cargo de

asistencia con el idioma. Llame al 1-855-747-5483 y al 711 para los usuarios de TTY

de 8:00 a. m. a 8:00 p. m., los siete días de la semana. La llamada es gratuita.

❖ Если Вы говорите на русском языке, Вам доступна бесплатная языковая

поддержка. Звоните по телефону 1-855-747-5483 и 711 для пользователей линии

TTY/TDD с 08:00 до 20:00, без выходных. Звонок бесплатный.

❖ 如果您說中文，您可以獲得免費的語言協助服務。請致電 1-855-747-5483，TTY 使用

者請致電 711，服務時間為每週七天，上午 8 時至晚上 8 時。本電話為免付費電話。

❖ You can get this document for free in other formats, such as large print, braille, or

audio. Call 41T1-855-747-5483 and 711 for TTY users, 8AM to 8PM, seven days a week.41T

The call is free.

❖ If you would like to make or change a standing request for a preferred language or

format, call PHP Care Complete FIDA-IDD Plan Participant Services at 41T1-855-747-

5483 and 711 for TTY users, 8AM to 8PM, seven days a week. The call is free.

❖ The State of New York has created a Participant ombudsman program called the

Independent Consumer Advocacy Network (ICAN) to provide Participants free,

confidential assistance on any services offered by PHP Care Complete FIDA-IDD

Plan. ICAN may be reached toll-free at 1-844-614-8800 (TTY users call 711, then

follow the prompts to dial 844-614-8800) or online at 33TUicannys.org U33T.

B. Frequently Asked Questions (FAQ)

Find answers here to questions you have about this List of Covered Drugs. You can read all of

the FAQ to learn more, or look for a question and answer.




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B1. What prescription drugs are on the List of Covered Drugs? (We call the

List of Covered Drugs the “Drug List” for short.)

The drugs on the List of Covered Drugs that starts on page 12 are the drugs covered by PHP

Care Complete FIDA-IDD Plan. These drugs are available at pharmacies within our network. A

pharmacy is in our network if we have an agreement with them to work with us and provide you

services. We refer to these pharmacies as “network pharmacies.”

• PHP Care Complete FIDA-IDD Plan will cover all drugs on the Drug List if:

o your doctor or other prescriber says you need them to get better or stay

healthy,

o the drug is medically necessary for your condition, and

o you fill the prescription at a PHP Care Complete FIDA-IDD Plan network

pharmacy.

• PHP Care Complete FIDA-IDD Plan may have additional steps to access certain

drugs (see question B4 below). In some cases, you may have to do something

before you can get a drug, like try other drugs first.

You can also see an up-to-date list of drugs that we cover on our website at 33Twww.phpcares.org33T or

call Participant Services at 1-855-747-5483 and 711 for TTY users, 8AM to 8PM, seven days a

week.

B2. Does the Drug List ever change?

Yes. PHP Care Complete FIDA-IDD Plan may add or remove drugs on the Drug List during the

year.

We may also change our rules about drugs. For example, we could:

• Decide to require or not require prior approval for a drug. (Prior approval is

permission from PHP Care Complete FIDA-IDD Plan or your Interdisciplinary

Team (IDT) before you can get a drug.)

• Add or change the amount of a drug you can get (called quantity limits).

• Add or change step therapy restrictions on a drug. (Step therapy means you must

try one drug before we will cover another drug.)

For more information on these drug rules, see question B4.

If you are taking a drug that was covered at the beginning of the year, we will generally not

remove or change coverage of that drug during the rest of the year unless:





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• a new, cheaper drug comes along that works as well as a drug on the Drug List

now, or

• we learn that a drug is not safe, or

• a drug is removed from the market.

Questions B3 and B6 below have more information on what happens when the Drug List

changes.

• You can always check PHP Care Complete FIDA-IDD Plan’s up to date Drug List

online at www.phpcares.org.

• You can also call Participant Services to check the current Drug List at 1-855-747-

5483 and 711 for TTY users, 8AM to 8PM, seven days a week.

B3. What happens when there is a change to the Drug List?

Some changes to the Drug List will happen immediately. For example:

• A new generic drug becomes available. Sometimes, a new and cheaper drug

comes along that works as well as a drug on the Drug List now. When that

happens, we may remove the current drug, but your cost for the new drug will stay

the same. When we add the new generic drug, we may also decide to keep the

current drug on the list but change its coverage rules or limits.

o We may not tell you before we make this change, but we will send you

information about the specific change or changes we made.

o You or your provider can ask for an exception from these changes. We will

send you a notice with the steps you can take to ask for an exception. Please

see question B10 for more information on exceptions.

• A drug is taken off the market. If the Food and Drug Administration (FDA) says a

drug you are taking is not safe or the drug’s manufacturer takes a drug off the

market, we will take it off the Drug List. If you are taking the drug, we will also send

you a letter and call you to tell you that the unsafe drug was taken off the Drug List.

If a drug you are taking is unsafe and we send you a letter or call to inform you of

this, please contact the prescribing provider to choose an alternative medication.

We may make other changes that affect the drugs you take. We will tell you in advance about

these other changes to the Drug List. These changes might happen if:

• The FDA provides new guidance or there are new clinical guidelines about a drug.

• We add a generic drug that is not new to the market and




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o Replace a brand name drug currently on the Drug List or

o Change the coverage rules or limits for the brand name drug.

When these changes happen, we will tell you at least 30 days before we make the change to the

Drug List or when you ask for a refill. This will give you time to talk to your doctor or other

prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take

instead or whether to ask for an exception. Then you can:

• Get a 30-day supply of the drug before the change to the Drug List is made, or

• Ask for an exception from these changes. Please see question B10 for more

information about exceptions.

B4. Are there any restrictions or limits on drug coverage or any required

actions to take to get certain drugs?

Yes, some drugs have coverage rules or have limits on the amount you can get. In some cases

you or your doctor or other prescriber must do something before you can get the drug. For

example:

• Prior approval (or prior authorization): For some drugs, you or your doctor or

other prescriber must get approval from PHP Care Complete FIDA-IDD Plan or

your Interdisciplinary Team (IDT) before you fill your prescription. PHP Care

Complete FIDA-IDD Plan may not cover the drug if you do not get approval.

• Quantity limits: Sometimes PHP Care Complete FIDA-IDD Plan limits the amount

of a drug you can get.

• Step therapy: Sometimes PHP Care Complete FIDA-IDD Plan requires you to do

step therapy. This means you will have to try drugs in a certain order for your

medical condition. You might have to try one drug before we will cover another

drug. If your doctor thinks the first drug doesn’t work for you, then we will cover the

second.

You can find out if your drug has any additional requirements or limits by looking in the tables

beginning on page 12. You can also get more information by visiting our web site at

www.phpcares.org. 41TWe have posted online documents that explain our prior authorization and

step therapy restrictions.41T You may also ask us to send you a copy.

You can ask for an exception from these limits. This will give you time to talk to your doctor or

other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can

take instead or whether to ask for an exception. Please see questions B10-B12 for more

information about exceptions.




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B5. How will you know if the drug you want has limitations or if there are

required actions to take to get the drug?

The List of Covered Drugs on page 41T1241T has a column labeled “Necessary actions, restrictions, or

limits on use.”

B6. What happens if we change our rules about some drugs (for example,

prior authorization (approval), quantity limits, and/or step therapy

restrictions)?

In some cases, we will tell you in advance if we add or change prior approval, quantity limits,

and/or step therapy restrictions on a drug. See question B3 for more information about this

advance notice and situations where we may not be able to tell you in advance when our rules

about drugs on the Drug List change.

B7. How can you find a drug on the Drug List?

There are two ways to find a drug:

• You can search alphabetically (if you know how to spell the drug), or

• You can search by medical condition.

To search alphabetically, go to the Index of Covered Drugs section on page 177. Then look for

the name of your drug in the list.

To search by medical condition, find the section labeled “List of drugs by medical condition” on

page 41T12. 41T The drugs in this section are grouped into categories depending on the type of medical

conditions they are used to treat. For example, if you have a heart condition, you should look in

the category, Angiotensin-Converting Enzyme (ACE) Inhibitors. That is where you will find drugs

that treat heart conditions.

B8. What if the drug you want to take is not on the Drug List?

If you don’t see your drug on the Drug List, call Participant Services at 41T1-855-747-5483 and 711

for TTY users, 8AM to 8PM, seven days a week, 41T and ask about it. If you learn that 41TPHP Care

Complete FIDA-IDD Plan 41T will not cover the drug, you can do one of these things:

• Ask Participant Services for a list of drugs like the one you want to take. Then

show the list to your doctor or other prescriber. He or she can prescribe a drug on

the Drug List that is like the one you want to take. Or

• You can ask the plan or your Interdisciplinary Team (IDT) to make an exception to

cover your drug. Please see questions B10-B12 for more information about

exceptions.




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B9. What if you are a new PHP Care Complete FIDA-IDD Plan Participant and

can’t find your drug on the Drug List or have a problem getting your

drug?

We can help. We must cover a temporary 30-day supply of your drug, as needed, during the first

90 days you are a Participant of PHP Care Complete FIDA-IDD Plan. This will give you time to

talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on

the Drug List you can take instead or whether to ask for an exception.

If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum

of 30 days of medication.

We will cover a 30-day supply of your drug if:

• you are taking a drug that is not on our Drug List, or

• health plan rules do not let you get the amount ordered by your prescriber, or

• the drug requires prior approval by PHP Care Complete FIDA-IDD Plan or your

Interdisciplinary Team (IDT), or

• you are taking a drug that is part of a step therapy restriction.

If you are in an intermediate care facility or other long-term care facility and need a drug that is

not on the Drug List or if you cannot easily get the drug you need, we can help. If you have been

in the plan for more than 90 days, live in a long-term care facility, and need a supply right away:

• We will cover one 31-day supply of the drug you need (unless you have a

prescription for fewer days), whether or not you are a new PHP Care Complete

FIDA-IDD Plan Participant.

• This is in addition to the temporary supply during the first 90 days you are a

Participant of PHP Care Complete FIDA-IDD Plan.

If you have been in PHP Care Complete FIDA-IDD Plan for more than 90 days and have

to change your level of care, we will cover a transition supply of prescribed drugs.

B10. Can you ask for an exception to cover your drug?

Yes. You can ask 41TPHP Care Complete FIDA-IDD Plan or your 41TInterdisciplinary Team ( 41TIDT)41T to

make an exception to cover a drug that is not on the Drug List.

You can also ask PHP Care Complete FIDA-IDD Plan or your IDT to change the rules on your

drug.




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• For example, 41TPHP Care Complete FIDA-IDD Plan 41T may limit the amount of a drug

we will cover. If your drug has a limit, you can ask us or your IDT to change the

limit and cover more.

• Other examples: You can ask us or your IDT to drop step therapy restrictions or

prior approval requirements.

B11. How can you ask for an exception?

To ask for an exception, call 41Tyour Care Manager.41T 41TYour Care Manager41T will work with you and your

provider to help you ask for an exception. You can also read Chapter 9, Section 6.3, Page 183 of

the Participant Handbook to learn more about exceptions.

B12. How long does it take to get an exception?

First, PHP Care Complete FIDA-IDD Plan or your Interdisciplinary Team (IDT) must get a

statement from your prescriber supporting your request for an exception. After we get the

statement, you will get a decision on your exception request within 72 hours.

If you or your prescriber think your health may be harmed if you have to wait 72 hours for a

decision, you can ask for an expedited exception. This is a faster decision. If your prescriber

supports your request, you will get a decision within 24 hours of getting your prescriber’s

supporting statement.

B13. What are generic drugs?

Generic drugs are made up of the same active ingredients as brand name drugs. They usually

cost less than the brand name drug and usually don’t have well-known names. Generic drugs are

approved by the Food and Drug Administration (FDA).

41TPHP Care Complete FIDA-IDD Plan41T covers both brand name drugs and generic drugs.

B14. What are OTC drugs?

OTC stands for “over-the-counter”. PHP Care Complete FIDA-IDD Plan covers some OTC drugs

when they are written as prescriptions by your provider.

You can read the PHP Care Complete FIDA-IDD Plan Drug List to see what OTC drugs are

covered.

B15. Does PHP Care Complete FIDA-IDD Plan cover OTC non-drug

products?

PHP Care Complete FIDA-IDD Plan covers some OTC non-drug products when they are written

as prescriptions by your provider.




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Examples of OTC non-drug products include Bufferin Extra-Strength Oral Tablet and

Hydrocortisone Topical Cream.

You can read the PHP Care Complete FIDA-IDD Plan Drug List to see what OTC non-drug

products are covered.

B16. What is your copay?

As a PHP Care Complete FIDA-IDD Plan Participant, you have no copays for prescription and

OTC drugs as long as you follow PHP Care Complete FIDA-IDD Plan’s rules.

B17. What are drug tiers?

Tiers are groups of drugs on our Drug List. All tiers have no copay.

• 41TTier 1 drugs are generic drugs that are covered by Medicare Part D.

• 41TTier 2 drugs are brand name drugs that are covered by Medicare Part D.

• Tier 3 drugs are Medicaid-covered drugs and Medicaid-covered over-the-counter

drugs (both generic and brand).

C. List of Covered Drugs

The following list of covered drugs gives you information about the drugs covered by PHP Care

Complete FIDA-IDD Plan. If you have trouble finding your drug in the list, turn to the Index of

Covered Drugs that begins on page 177. The index alphabetically lists all drugs covered by PHP Care Complete FIDA-IDD Plan.

The first column of the chart lists the name of the drug. Brand name drugs are capitalized (e.g.,

PAXIL or LAMISIL) and generic drugs are listed in lower-case italics (e.g., ibuprofen).

The information in the necessary actions, restrictions, or limits on use column tells you if PHP

Care Complete FIDA-IDD Plan has any rules for covering your drug.

Note: The DP (Dual Program) next to a drug means the drug is not a “Part D drug.” These drugs

have different rules for appeals.

• An appeal is a formal way of asking for a review of and change to a coverage

decision if you think there was a mistake. For example, PHP Care Complete FIDA-

IDD Plan or your Interdisciplinary Team (IDT) might decide that a drug that you

want is not covered or is no longer covered by Medicare or Medicaid.

• If you or your doctor or other prescriber disagrees with the decision, you can

appeal. To ask for instructions on how to appeal:




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o Call Participant Services at 1-855-747-5483 and 711 for TTY users, 8AM to

8PM, seven days a week.

o Contact the Independent Consumer Advocacy Network (ICAN) toll-free at 1-

844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-

8800) or online at 33Ticannys.org33T.

o Read Chapter 9 of the Participant Handbook to learn how to appeal a decision.

D. List of Drugs by Medical Condition

The drugs in this section are grouped into categories depending on the type of medical conditions

they are used to treat. For example, if you have a heart condition, you should look in the category,

Angiotensin-Converting Enzyme (ACE) Inhibitors. That is where you will find drugs that treat heart

conditions.

Here are the meanings of the codes used in the “Necessary actions, restrictions, or limits on

use” column:

(g) = Only the generic version of this drug is covered. The brand name version is not covered.

M = The brand name version of this drug is in Tier 3. The generic version is in Tier 1.

PA = Prior authorization (approval): you must have approval from the plan before you can get

this drug.

ST = Step therapy: you must try another drug before you can get this one.


2019 3 Tier MMP-Partners Document: 2019 Member Formulary Formulary ID: 19410 Last Updated: 11/2019 Effective Date: 12/01/2019

12

CURRENT AS OF 12/1/2019

Name of Drug Drug Tier Necessary actions, restrictions, or limits on use

ANALGESICS

ANALGESICS, OTHER

8HR MUSCLE ACHE-PAIN ER 650 MG 650 MG

3 DP

ACEPHEN 120 MG SUPPOSITORY 120 MG 3 DP

ACEPHEN 120 MG SUPPOSITORY OUTER 120 MG

3 DP



3 DP



3 DP

acetaminophen 120 mg suppos 120 mg 3 DP

acetaminophen 120 mg suppos outer 120 mg 3 DP

acetaminophen 160 mg/5 ml liq a/f,s/f,cherry 160 mg/5 ml

3 DP

acetaminophen 325 mg tablet 325 mg 3 DP

acetaminophen 325 mg tablet u-d,25x30,uncoated 325 mg

3 DP

acetaminophen 325 mg/10.15 ml outer 325 mg/10.15 ml

3 DP

acetaminophen 500 mg caplet caplet,ex-strength 500 mg

3 DP

acetaminophen 500 mg tablet 500 mg 3 DP

acetaminophen 500 mg tablet asa-free,ex-str 500 mg

3 DP

acetaminophen 500 mg tablet extra strength 500 mg

3 DP

acetaminophen 650 mg suppos 650 mg 3 DP

13


acetaminophen 650 mg suppos outer 650 mg 3 DP

acetaminophen 650 mg/20.3 ml outer 650 mg/20.3 ml

3 DP

acetaminophen 80 mg tab chew fruit flavored 80 mg

3 DP

acetaminophen er 650 mg tablet outer 650 mg 3 DP

acetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 300 mg-30 mg /12.5 ml

1

acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg, 300-60 mg

1

ARTHRITIS PAIN ER 650 MG CAPLT 8 HOUR, CAPLET 650 MG

3 DP

ARTHRITIS PAIN ER 650 MG CAPLT CAPLET 650 MG

3 DP

ARTHRITIS PAIN ER 650 MG CAPLT CAPLET, 8 HOUR 650 MG

3 DP

ARTHRITIS PAIN RELIEF ER 650 MG CAPLET CAPLET 650 MG

3 DP

ascomp with codeine oral capsule 30-50-325-40 mg

1 PA

butalbital compound w/codeine oral capsule 30-50-325-40 mg

1 PA

butalbital-acetaminop-caf-cod oral capsule 50-325-40-30 mg

1 PA

butalbital-acetaminophen oral tablet 50-325 mg 1 PA

butalbital-acetaminophen-caff oral capsule 50-325-40 mg

1 PA

butalbital-acetaminophen-caff oral tablet 50-325-40 mg

1 PA

butalbital-aspirin-caffeine oral capsule 50-325-40 mg

1 PA

carisoprodol-asa-codeine oral tablet 200-325-16 mg

1 PA

carisoprodol-aspirin oral tablet 200-325 mg 1 PA

CHILD PAIN-FEVER 160 MG/5 ML 160 MG/5 ML

3 DP


14


CHILD PAIN-FEVER 160 MG/5 ML 160 MG/5 ML

3 DP

CHILD PAIN-FEVER 160 MG/5 ML A/F 160 MG/5 ML

3 DP

CHILD PAIN-FEVER 80 MG TAB CHW 80 MG 3 DP

CHILDREN'S MAPAP 80 MG TAB CHW 80 MG

3 DP

CHILDREN'S SILAPAP ELIXIR 160 MG/5 ML 3 DP

CHILD'S PAIN RELIEVER RAPID TB RAPID TAB'S 80 MG

3 DP

CHLD ACETAMINOPHEN 160 MG/5 ML A/F, GLUTEN/F, GRAPE 160 MG/5 ML

3 DP

CHLD ACETAMINOPHEN 160 MG/5 ML A/F,GLUTEN/F,CHERRY 160 MG/5 ML

3 DP

CHLD ACETAMINOPHEN 160 MG/5 ML INNER 160 MG/5 ML (5 ML)

3 DP

CHLD ACETAMINOPHEN 160 MG/5 ML OUTER 160 MG/5 ML (5 ML)

3 DP

codeine-butalbital-asa-caff oral capsule 30-50-325-40 mg

1 PA

FEVERALL 120 MG SUPPOSITORY CHILDRENS, OUTER 120 MG

3 DP

FEVERALL 120 MG SUPPOSITORY CHILDREN'S, OUTER 120 MG

3 DP

FEVERALL 325 MG SUPPOSITORY JUNIOR STR, OUTER 325 MG

3 DP

FEVERALL 650 MG SUPPOSITORY ADULT, OUTER 650 MG

3 DP

FEVERALL 80 MG SUPPOSITORY INFANT'S, OUTER 80 MG

3 DP

FEVERALL RECTAL SUPPOSITORY 325 MG, 650 MG

3

GS ARTHRITIS PAIN ER 650 MG CAPLET 650 MG

3 DP

15


GS INFANT PAIN-FEVER 160 MG/5 CHERRY, DYE-FREE 160 MG/5 ML

3 DP

GS PAIN RELIEF 500 MG CAPLET 500 MG 3 DP

GS PAIN RELIEF 500 MG TABLET 500 MG 3 DP

HM ARTHRITIS PAIN ER 650 MG CAPLET, 8 HOUR 650 MG

3 DP

HM CHLD PAIN-FEVER 160 MG/5 ML A/F, DYE-FREE 160 MG/5 ML

3 DP

HM CHLD PAIN-FEVER 160 MG/5 ML GLUTEN-F,A/F,ASA/F 160 MG/5 ML

3 DP

HM INFANT PAIN-FEVER 160 MG/5 A/F,GRAPE,W/SYRINGE 160 MG/5 ML

3 DP

HM PAIN RELIEF 500 MG CAPLET 500 MG 3 DP

HM PAIN RELIEF 500 MG CAPLET CAPLET, EX-STRENGTH 500 MG

3 DP

HM PAIN RELIEF 500 MG TABLET EX-STR, GLUTEN-FREE 500 MG

3 DP

HM PAIN RELIEVER 325 MG TABLET REGULAR STRENGTH 325 MG

3 DP

hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg

1

hydrocodone-ibuprofen oral tablet 10-200 mg, 7.5-200 mg

1

IBU ORAL TABLET 600 MG, 800 MG 1 MO

ibuprofen-oxycodone oral tablet 400-5 mg 1

INFANT PAIN-FEVER 160 MG/5 ML 160 MG/5 ML

3 DP

MAPAP 160 MG/5 ML LIQUID 160 MG/5 ML 3 DP

MAPAP 160 MG/5 ML SUSPENSION 160 MG/5 ML

3 DP

MAPAP 325 MG TABLET 325 MG 3 DP

MAPAP 325 MG TABLET BOXED 325 MG 3 DP

MAPAP 325 MG TABLET REGULAR STRENGTH 325 MG

3 DP

MAPAP 325 MG TABLET U-D 325 MG 3 DP

MAPAP 500 MG CAPLET CAPLET 500 MG 3 DP


16


MAPAP 500 MG CAPLET CAPLET,BOXED 500 MG

3 DP

MAPAP 500 MG CAPSULE 500 MG 3 DP

MAPAP 500 MG GELCAP GELCAP 500 MG 3 DP

MAPAP 500 MG TABLET 500 MG 3 DP

MAPAP 500 MG TABLET BOXED 500 MG 3 DP

MAPAP 500 MG TABLET U-D 500 MG 3 DP

MAPAP ARTHRITIS ER 650 MG CPLT 650 MG 3 DP

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1

oxycodone-aspirin oral tablet 4.8355-325 mg 1

PAIN & FEVER 325 MG TABLET 325 MG 3 DP

PAIN & FEVER 500 MG CAPLET CAPLET 500 MG

3 DP

PAIN & FEVER 500 MG CAPLET CAPTABS 500 MG

3 DP

PAIN & FEVER 500 MG TABLET EXTRA STRENGTH 500 MG

3 DP

PAIN & FEVER 500 MG TABLET WITHOUT ASPIRIN 500 MG

3 DP

PAIN RELIEF 500 MG CAPLET CAPLET, EX-STRENGTH 500 MG

3 DP

PAIN RELIEF 500 MG CAPLET CAPLET,EX-STRENGTH 500 MG

3 DP

PAIN RELIEF 500 MG CAPLET EXTRA STR, CAPLET 500 MG

3 DP

PAIN RELIEF 500 MG TABLET EX-STRENGTH 500 MG

3 DP

PAIN RELIEF 500 MG TABLET EXTRA STRENGTH 500 MG

3 DP

PAIN RELIEF ER 650 MG CAPLET ARTHRITIS PAIN 650 MG

3 DP

17


PAIN RELIEF ER 650 MG CAPLET CAPLET, 8 HOUR 650 MG

3 DP

PAIN RELIEF ER 650 MG CAPLET CAPLET, ARTHRITIS 650 MG

3 DP

PAIN RELIEVER 325 MG TABLET REGULAR STRENGTH 325 MG

3 DP

PAIN RELIEVER 500 MG CAPLET CAPLET, EX-STRENGTH 500 MG

3 DP

PAIN RELIEVER 500 MG CAPLET CAPLET, EX-STRENGTH 500 MG

3 DP

PAIN RELIEVER 500 MG CAPLET CAPLET,X-STRENGTH 500 MG

3 DP

PAIN RELIEVER 500 MG CAPLET EX-STR, CAPLET 500 MG

3 DP

PAIN RELIEVER 500 MG TABLET 500 MG 3 DP

PAIN RELIEVER 500 MG TABLET EX-STR,EASY TAB 500 MG

3 DP

pentazocine-naloxone oral tablet 50-0.5 mg 1 PA

PHARBETOL 325 MG TABLET REG STRENGTH, BULK 325 MG

3 DP

PHARBETOL 325 MG TABLET REGULAR STRENGTH 325 MG

3 DP

qc acetaminophen 8-hr 650 mg 650 mg 3 DP

QC ARTHRITIS PAIN ER 650 MG CAPLET 650 MG

3 DP

QC CHILD PAIN RLF 160 MG/5 ML 160 MG/5 ML

3 DP

QC INFNT PAIN RLF 160 MG/5 ML 160 MG/5 ML

3 DP

QC NON-ASPIRIN 500 MG CAPLET XTRA STRENGTH,CAPLET 500 MG

3 DP

QC NON-ASPIRIN 500 MG GELCAP GELCAP, EX-STR 500 MG

3 DP

QC NON-ASPIRIN PAIN RELIEF TB EXTRA STRENGTH 500 MG

3 DP

SB EX-STRENGTH NON-ASPIRIN TAB SAFETY SEALED 500 MG

3 DP


18


SB NON-ASPIRIN 325 MG TABLET REGULAR STR 325 MG

3 DP

SB NON-ASPIRIN 325 MG TABLET REGULAR STRENGTH 325 MG

3 DP

SB NON-ASPIRIN 500 MG CAPLET CAPLET 500 MG

3 DP

SB PAIN RELIEVER 500 MG CAPLET EXTRA-STR,NON-ASA 500 MG

3 DP

SB PAIN RELIEVER 500 MG GELCAP EX-STRENGTH, GELCAP 500 MG

3 DP

SM 8 HOUR PAIN RELIEF 650 MG CAPLET 650 MG

3 DP

SM ARTHRITIS PAIN ER 650 MG CAPLET 650 MG

3 DP

SM CHLD PAIN-FEVER 160 MG/5 ML A/F, ASA/F, GLUTEN-F 160 MG/5 ML

3 DP

SM PAIN RELIEVER 500 MG CAPLET CAPLET, EXTRA STR 500 MG

3 DP

SM PAIN RELIEVER 500 MG CAPLET CAPLET, EXTRA STR 500 MG

3 DP

SM PAIN RELIEVER 500 MG GELCAP GELCAP,EX STRENGTH 500 MG

3 DP

SM PAIN RELIEVER 500 MG TABLET EX-STR, GLUTEN-FREE 500 MG

3 DP

SM PAIN RELIEVER 500 MG TABLET EXTRA STRENGTH 500 MG

3 DP

TACTINAL 325 MG TABLET 325 MG 3 DP

TACTINAL 500 MG CAPLET CAPLET,X-STRENGTH 500 MG

3 DP

TACTINAL 500 MG TABLET EXTRA-STRENGTH 500 MG

3 DP

tramadol-acetaminophen oral tablet 37.5-325 mg 1

TRI-BUFFERED ASPIRIN 325 MG BOXED 325 MG

3 DP

19


NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

aspirin 300 mg suppository 300 mg 3 DP

aspirin 325 mg tablet 325 mg 3 DP

aspirin 325 mg tablet coated 325 mg 3 DP

aspirin 325 mg tablet regular strength 325 mg 3 DP

aspirin 600 mg suppository 600 mg 3 DP

aspirin ec 325 mg tablet 325 mg 3 DP

aspirin ec 325 mg tablet orange 325 mg 3 DP

aspirin ec 325 mg tablet regular strength 325 mg 3 DP

celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg

1 MO

CHILD IBUPROFEN 100 MG/5 ML 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML A/F 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML A/F, D/F 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML A/F, GLUTEN/F, BERRY 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML A/F, GLUTEN/F, GRAPE 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML A/F, GRAPE 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML A/F,BUBBLE GUM 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML A/F,GLUTEN/F,BUBBLE 100 MG/5 ML

3 DP

CHILDREN IBUPROFEN 100 MG/5 ML BERRY FLAVOR 100 MG/5 ML

3 DP

diclofenac potassium oral tablet 50 mg 1

diclofenac sodium oral tablet extended release 24 hr 100 mg

1

diclofenac sodium oral tablet,delayed release (dr/ec) 25 mg, 50 mg, 75 mg

1


20


DICLOZOR TOPICAL KIT 1 % 1

diflunisal oral tablet 500 mg 1

EC-NAPROXEN ORAL TABLET,DELAYED RELEASE (DR/EC) 375 MG, 500 MG

1 MO

ECPIRIN EC 325 MG TABLET 325 MG 3 DP

etodolac oral capsule 200 mg, 300 mg 1 MO

etodolac oral tablet 400 mg, 500 mg 1 MO

etodolac oral tablet extended release 24 hr 400 mg, 500 mg, 600 mg

1 MO

flurbiprofen oral tablet 100 mg, 50 mg 1

gs aspirin 325 mg tablet 325 mg 3 DP

GS CHILD IBUPROFEN 100 MG/5 ML D/F,A/F,BERRY FLAVOR 100 MG/5 ML

3 DP

gs ibuprofen 200 mg caplet 200 mg 3 DP

gs ibuprofen 200 mg tablet 200 mg 3 DP

hm aspirin 325 mg tablet 325 mg 3 DP

hm aspirin 325 mg tablet adult, gluten-free 325 mg 3 DP

hm aspirin ec 325 mg tablet reg strength 325 mg 3 DP

HM CHILD IBUPROFEN 100 MG/5 ML 100 MG/5 ML

3 DP

HM CHILD IBUPROFEN 100 MG/5 ML A/F, BERRY 100 MG/5 ML

3 DP

HM CHILD IBUPROFEN 100 MG/5 ML A/F, BUBBLE GUM 100 MG/5 ML

3 DP

HM CHILD IBUPROFEN 100 MG/5 ML A/F, GRAPE 100 MG/5 ML

3 DP

hm ibuprofen 200 mg caplet caplet 200 mg 3 DP

hm ibuprofen 200 mg capsule liquid filled sftgel 200 mg

3 DP

hm ibuprofen 200 mg tablet coated,gluten-free 200 mg

3 DP

21


HM IBUPROFEN IB 200 MG CAPLET COATED, GLUTEN-FREE 200 MG

3 DP

HM IBUPROFEN IB 200 MG TABLET COATED. GLUTEN-FREE 200 MG

3 DP

hydrocodone-ibuprofen oral tablet 5-200 mg 1

IBU-200 200 MG TABLET 200 MG 3 DP

ibuprofen 200 mg caplet caplet 200 mg 3 DP

ibuprofen 200 mg caplet caplet, coated 200 mg 3 DP

ibuprofen 200 mg caplet coated caplet 200 mg 3 DP

ibuprofen 200 mg softgel softgel 200 mg 3 DP

ibuprofen 200 mg tablet 200 mg 3 DP

ibuprofen 200 mg tablet coated 200 mg 3 DP

ibuprofen 200 mg tablet coated caplet 200 mg 3 DP

ibuprofen 200 mg/10 ml susp 100's, u-d cups (otc) 100 mg/5 ml

3 MO; DP

ibuprofen 200 mg/10 ml susp 30's, u-d cups (otc) 100 mg/5 ml

3 MO; DP

ibuprofen 200 mg/10 ml susp u-d (otc) 100 mg/5 ml

3 MO; DP

ibuprofen oral suspension 100 mg/5 ml 1 MO

ibuprofen oral tablet 400 mg, 600 mg, 800 mg 1 MO

indomethacin oral capsule 25 mg, 50 mg 1 PA

indomethacin oral capsule, extended release 75 mg

1 PA

ketorolac oral tablet 10 mg 1 PA; QL (20 EA per 30 days)

meclofenamate oral capsule 100 mg, 50 mg 1

meloxicam oral tablet 15 mg, 7.5 mg 1 MO

nabumetone oral tablet 500 mg, 750 mg 1

naproxen oral suspension 125 mg/5 ml 1 MO

naproxen oral tablet 250 mg, 375 mg, 500 mg 1 MO

naproxen oral tablet,delayed release (dr/ec) 375 mg, 500 mg

1 MO

naproxen sodium oral tablet 275 mg, 550 mg 1 MO

piroxicam oral capsule 10 mg, 20 mg 1

PROVIL 200 MG TABLET 200 MG 3 DP


22


qc aspirin 325 mg tablet 325 mg 3 DP

QC CHILD IBUPROFEN 100 MG/5 ML 100 MG/5 ML

3 MO; DP

QC CHILD IBUPROFEN 100 MG/5 ML A/F, BUBBLE GUM 100 MG/5 ML

3 DP

sb aspirin 325 mg tablet 325 mg 3 DP

sb aspirin 325 mg tablet na/f, caffeine-free 325 mg 3 DP

sb ibuprofen 200 mg caplet caplet 200 mg 3 DP

sb ibuprofen 200 mg tablet 200 mg 3 DP

sb ibuprofen 200 mg tablet safety sealed 200 mg 3 DP

sm aspirin 325 mg tablet 325 mg 3 DP

sm ibuprofen 100 mg/5 ml susp (otc) 100 mg/5 ml 3 MO; DP

sm ibuprofen 100 mg/5 ml susp a/f (otc) 100 mg/5 ml

3 MO; DP

sm ibuprofen 100 mg/5 ml susp children's (otc) 100 mg/5 ml

3 MO; DP

sm ibuprofen 200 mg caplet caplet 200 mg 3 DP

sm ibuprofen 200 mg tablet 200 mg 3 DP

SM IBUPROFEN IB 200 MG CAPLET CAPLET 200 MG

3 DP

SM IBUPROFEN IB 200 MG CAPLET CAPLET, GLUTEN-FREE 200 MG

3 DP

sulindac oral tablet 150 mg, 200 mg 1

OPIOID ANALGESICS, LONG-ACTING

buprenorphine transdermal patch weekly 10 mcg/hour, 15 mcg/hour, 20 mcg/hour, 5 mcg/hour, 7.5 mcg/hour

1 QL (4 EA per 28 days)

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 37.5 mcg/hour, 50 mcg/hr, 62.5 mcg/hour, 75 mcg/hr, 87.5 mcg/hour


methadone oral solution 10 mg/5 ml 1 QL (1200 ML per 30 days)

methadone oral solution 5 mg/5 ml 1 QL (2400 ML per 30 days)

23


methadone oral tablet 10 mg 1 QL (240 EA per 30 days)

methadone oral tablet 5 mg 1 QL (180 EA per 30 days)

morphine oral tablet extended release 100 mg, 15 mg, 200 mg, 30 mg, 60 mg


oxycodone oral tablet,oral only,ext.rel.12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg

1 PA

OPIOID ANALGESICS, SHORT-ACTING

butorphanol tartrate nasal spray,non-aerosol 10 mg/ml

1 QL (5 ML per 30 days)

duramorph (pf) injection solution 0.5 mg/ml, 1 mg/ml

1 B/D

fentanyl citrate buccal lozenge on a handle 1,200 mcg, 1,600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg

1 PA; QL (120 EA per 30 days)

hydromorphone (pf) injection solution 1 mg/ml, 10 (mg/ml) (5 ml), 10 mg/ml, 4 mg/ml

1

hydromorphone injection syringe 2 mg/ml 1

hydromorphone oral tablet 2 mg, 4 mg, 8 mg 1 QL (120 EA per 30 days)

LAZANDA NASAL SPRAY,NON-AEROSOL 100 MCG/SPRAY


LAZANDA NASAL SPRAY,NON-AEROSOL 300 MCG/SPRAY, 400 MCG/SPRAY


meperidine oral solution 50 mg/5 ml 1 PA; QL (900 ML per 30 days)

meperidine oral tablet 100 mg, 50 mg 1 PA; QL (180 EA per 30 days)

morphine oral tablet 15 mg, 30 mg 1 QL (120 EA per 30 days)

nalbuphine injection solution 10 mg/ml 1 B/D

oxycodone oral solution 5 mg/5 ml 1 QL (5400 ML per 30 days)

oxycodone oral tablet 10 mg, 15 mg, 20 mg, 30 mg, 5 mg


tramadol oral tablet 50 mg 1 QL (240 EA per 30 days)

ANESTHETICS

LOCAL ANESTHETICS

ANODYNE LPT TOPICAL KIT 2.5-2.5 % 1

dermacinrx empricaine topical kit 2.5-2.5 % 1

diclofenac sodium topical gel 1 % 1 MO


24


LEVA SET TOPICAL KIT 2.5-2.5 % 1

lidocaine hcl laryngotracheal solution 4 % 1

lidocaine hcl mucous membrane jelly 2 % 1

lidocaine hcl mucous membrane jelly in applicator 2 %

1

lidocaine hcl mucous membrane solution 4 % (40 mg/ml)

1

lidocaine topical adhesive patch,medicated 5 % 1 PA; QL (90 EA per 30 days)

lidocaine topical ointment 5 % 1

lidocaine-prilocaine topical cream 2.5-2.5 % 1

lidocaine-prilocaine topical kit 2.5-2.5 % 1

LIDOPAC TOPICAL KIT 5 % 1

lidopril topical kit 2.5-2.5 % 1

lidopril xr topical kit 2.5-2.5 % 1

LIDO-PRILO CAINE PACK TOPICAL KIT 2.5-2.5 %

1

liprozonepak topical kit 2.5-2.5 % 1

livixil pak topical kit 2.5-2.5 % 1

MEDOLOR PAK TOPICAL KIT 2.5-2.5 % 1

prilolid topical kit 2.5-2.5 % 1

PRILOVIX LITE PLUS TOPICAL KIT 2.5-2.5 % 1

PRILOVIX LITE TOPICAL KIT 2.5-2.5 % 1

PRILOVIX ULTRALITE PLUS TOPICAL KIT 2.5-2.5 %

1

PRILOVIX ULTRALITE TOPICAL KIT 2.5-2.5 %

1

ZTLIDO TOPICAL ADHESIVE PATCH,MEDICATED 1.8 %

2 PA

ANTI-ADDICTION/ SUBSTANCE ABUSE TREATMENT AGENTS

ALCOHOL DETERRENTS/ ANTI-CRAVING

25


acamprosate oral tablet,delayed release (dr/ec) 333 mg

1 MO

disulfiram oral tablet 250 mg, 500 mg 1 MO

OPIOID DEPENDENCE TREATMENTS

buprenorphine hcl sublingual tablet 2 mg, 8 mg 1

buprenorphine-naloxone sublingual tablet 2-0.5 mg, 8-2 mg

1 MO

LUCEMYRA ORAL TABLET 0.18 MG 2 PA; QL (224 EA per 14 days)

naltrexone oral tablet 50 mg 1

OPIOID REVERSAL AGENTS

naloxone injection solution 0.4 mg/ml 1

naloxone injection syringe 0.4 mg/ml, 1 mg/ml 1

NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION

2

SMOKING CESSATION AGENTS

bupropion hcl (smoking deter) oral tablet extended release 12 hr 150 mg

1

CHANTIX CONTINUING MONTH BOX ORAL TABLET 1 MG


CHANTIX ORAL TABLET 0.5 MG, 1 MG 2 QL (336 EA per 365 days)

CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK 0.5 MG (11)- 1 MG (42)


hm nicotine 14 mg/24hr patch step 2 (otc) 14 mg/24 hr

3 DP

hm nicotine 2 mg chewing gum mint 2 mg 3 DP

hm nicotine 2 mg lozenge mint, 3 quittube 2 mg 3 DP


3 DP


3 DP

NICODERM CQ 14 MG/24HR PATCH 14 MG/24 HR

3 DP

NICODERM CQ 14 MG/24HR PATCH OUTER 14 MG/24 HR

3 DP

NICODERM CQ 21 MG/24HR PATCH 21 MG/24 HR

3 DP


26


NICODERM CQ 21 MG/24HR PATCH CLEAR PATCH 21 MG/24 HR

3 DP


3 DP


3 DP

NICORELIEF 2 MG GUM 2 MG 3 DP

NICORELIEF 4 MG GUM 4 MG 3 DP

NICORETTE 2 MG CHEWING GUM CINNAMON SURGE 2 MG

3 DP

NICORETTE 2 MG CHEWING GUM FRESH MINT 2 MG

3 DP

NICORETTE 2 MG CHEWING GUM FRUIT CHILL 2 MG

3 DP

NICORETTE 2 MG CHEWING GUM MINT 2 MG

3 DP

NICORETTE 2 MG CHEWING GUM ORIGINAL FLAVOR 2 MG

3 DP

NICORETTE 2 MG CHEWING GUM STARTER KIT 2 MG

3 DP

NICORETTE 2 MG CHEWING GUM WHITE ICE MINT 2 MG

3 DP

NICORETTE 2 MG LOZENGE 2 MG 3 DP

NICORETTE 2 MG LOZENGE CHERRY 2 MG 3 DP

NICORETTE 2 MG LOZENGE MINT 2 MG 3 DP

NICORETTE 2 MG LOZENGE ORIGINAL 2 MG

3 DP

NICORETTE 2 MG MINI LOZENGE 2 MG 3 DP

NICORETTE 2 MG MINI LOZENGE MINT 2 MG

3 DP

NICORETTE 4 MG CHEWING GUM 4 MG 3 DP

NICORETTE 4 MG CHEWING GUM CINNAMON SURGE 4 MG

3 DP

27


NICORETTE 4 MG CHEWING GUM FRESH MINT 4 MG

3 DP

NICORETTE 4 MG CHEWING GUM FRUIT CHILL 4 MG

3 DP

NICORETTE 4 MG CHEWING GUM ORIGINAL 4 MG

3 DP

NICORETTE 4 MG CHEWING GUM ORIGINAL FLAVOR 4 MG

3 DP

NICORETTE 4 MG CHEWING GUM WHITE ICE MINT 4 MG

3 DP

NICORETTE 4 MG LOZENGE 4 MG 3 DP

NICORETTE 4 MG LOZENGE CHERRY 4 MG 3 DP

NICORETTE 4 MG LOZENGE MINT 4 MG 3 DP

NICORETTE 4 MG LOZENGE ORIGINAL 4 MG

3 DP

NICORETTE 4 MG MINI LOZENGE 4 MG 3 DP

nicotine 14 mg/24hr patch (otc) 14 mg/24 hr 3 DP

nicotine 14 mg/24hr patch clear, step 2, outer (otc) 14 mg/24 hr

3 DP

nicotine 14 mg/24hr patch outer (otc) 14 mg/24 hr 3 DP

nicotine 14 mg/24hr patch step 2 (otc) 14 mg/24 hr 3 DP

nicotine 2 mg chewing gum 2 mg 3 DP

nicotine 2 mg chewing gum coated,cinnamon,s/f 2 mg

3 DP

nicotine 2 mg chewing gum cool mint/coated 2 mg 3 DP

nicotine 2 mg chewing gum fruit wave, coated 2 mg

3 DP

nicotine 2 mg chewing gum mint 2 mg 3 DP

nicotine 2 mg chewing gum original 2 mg 3 DP

nicotine 2 mg chewing gum refill 2 mg 3 DP

nicotine 2 mg chewing gum s/f 2 mg 3 DP

nicotine 2 mg chewing gum s/f,coated 2 mg 3 DP

nicotine 2 mg chewing gum s/f,coated fruit 2 mg 3 DP

nicotine 2 mg chewing gum starter kit 2 mg 3 DP

nicotine 2 mg chewing gum sugar free 2 mg 3 DP


28


nicotine 2 mg lozenge mint, 3 quittube 2 mg 3 DP

nicotine 2 mg lozenge outer 2 mg 3 DP

nicotine 2 mg mini lozenge mini,mint,3 quittube 2 mg

3 DP



nicotine 21 mg/24hr patch outer, clear, step 1 (otc) 21 mg/24 hr

3 DP


nicotine 4 mg chewing gum 4 mg 3 DP

nicotine 4 mg chewing gum coated, mint 4 mg 3 DP

nicotine 4 mg chewing gum coated,cinnamon,s/f 4 mg

3 DP

nicotine 4 mg chewing gum cool mint/coated 4 mg 3 DP

nicotine 4 mg chewing gum fruit wave/coated 4 mg 3 DP

nicotine 4 mg chewing gum mint 4 mg 3 DP

nicotine 4 mg chewing gum original 4 mg 3 DP

nicotine 4 mg chewing gum refill kit,s/f 4 mg 3 DP

nicotine 4 mg chewing gum s/f,coated 4 mg 3 DP

nicotine 4 mg chewing gum s/f,coated fruit 4 mg 3 DP

nicotine 4 mg chewing gum starter kit 4 mg 3 DP

nicotine 4 mg lozenge 4 mg 3 DP

nicotine 4 mg lozenge mint 4 mg 3 DP

nicotine 4 mg lozenge mint, 3 quittube 4 mg 3 DP

nicotine 4 mg lozenge outer 4 mg 3 DP

nicotine 4 mg mini lozenge mini,mint,3 quittube 4 mg

3 DP



29


nicotine 7 mg/24hr patch outer, clear, step 3 (otc) 7 mg/24 hr

3 DP


NICOTROL INHALATION CARTRIDGE 10 MG

2

NICOTROL NS NASAL SPRAY,NON-AEROSOL 10 MG/ML

2

sm nicotine 14 mg/24hr patch step 2 (otc) 14 mg/24 hr

3 DP

sm nicotine 2 mg chewing gum 2 mg 3 DP

sm nicotine 2 mg lozenge 2 mg 3 DP

sm nicotine 21 mg/24hr patch outer (otc) 21 mg/24 hr

3 DP

sm nicotine 4 mg chewing gum 4 mg 3 DP

sm nicotine 4 mg lozenge 4 mg 3 DP

sm nicotine 7 mg/24hr patch step 3 (otc) 7 mg/24 hr

3 DP

ANTIBACTERIALS

AMINOGLYCOSIDES

amikacin injection solution 500 mg/2 ml 1

gentak ophthalmic (eye) ointment 0.3 % (3 mg/gram)

1

gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 60 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml

1

gentamicin injection solution 40 mg/ml 1

gentamicin ophthalmic (eye) drops 0.3 % 1

gentamicin ophthalmic (eye) ointment 0.3 % (3 mg/gram)

1

gentamicin topical cream 0.1 % 1

gentamicin topical ointment 0.1 % 1

neomycin oral tablet 500 mg 1

paromomycin oral capsule 250 mg 1

streptomycin intramuscular recon soln 1 gram 1

TOBRADEX OPHTHALMIC (EYE) OINTMENT 0.3-0.1 %

2


30


tobramycin ophthalmic (eye) drops 0.3 % 1

tobramycin sulfate injection recon soln 1.2 gram 1

tobramycin sulfate injection solution 10 mg/ml, 40 mg/ml

1

tobramycin-dexamethasone ophthalmic (eye) drops,suspension 0.3-0.1 %

1

ANTIBACTERIALS, OTHER

acetic acid otic (ear) solution 2 % 1

ak-poly-bac ophthalmic (eye) ointment 500-10,000 unit/gram

1

bacitracin 500 unit/gm ointmnt 500 unit/gram 3 DP

bacitracin 500 unit/gm ointmnt 500 unit/gram 3 DP

bacitracin ophthalmic (eye) ointment 500 unit/gram

1

bacitracin zn 500 unit/gm oint 500 unit/gram 3 DP

bacitracin zn 500 unit/gm oint u-d,144x.94gm pkt 500 unit/gram

3 DP

bacitracin zn 500 unit/gm oint usp 500 unit/gram 3 DP

bacitracin-polymyxin b ophthalmic (eye) ointment 500-10,000 unit/gram

1

BACTROBAN NASAL NASAL OINTMENT 2 %

2

CASTELLANI PAINT MODIFIED 1.5 % 3 DP

clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg

1

clindamycin in 0.9 % sod chlor intravenous piggyback 300 mg/50 ml, 600 mg/50 ml, 900 mg/50 ml

1

clindamycin in 5 % dextrose intravenous piggyback 300 mg/50 ml, 600 mg/50 ml, 900 mg/50 ml

1

clindamycin palmitate hcl oral recon soln 75 mg/5 ml

1

31


clindamycin pediatric oral recon soln 75 mg/5 ml 1

clindamycin phosphate injection solution 150 (mg/ml) (6 ml), 150 mg/ml

1

clindamycin phosphate intravenous solution 300 mg/2 ml, 600 mg/4 ml, 900 mg/6 ml

1

clindamycin phosphate topical gel 1 % 1

clindamycin phosphate topical lotion 1 % 1

clindamycin phosphate topical solution 1 % 1

clindamycin phosphate topical swab 1 % 1

clindamycin phosphate vaginal cream 2 % 1

colistin (colistimethate na) injection recon soln 150 mg

1

daptomycin intravenous recon soln 350 mg, 500 mg

1 PA

hm bacitracin zn 500 unit/gm 500 unit/gram 3 DP

linezolid in dextrose 5% intravenous piggyback 600 mg/300 ml

1 B/D

linezolid oral suspension for reconstitution 100 mg/5 ml

1

linezolid oral tablet 600 mg 1

linezolid-0.9% sodium chloride intravenous parenteral solution 600 mg/300 ml

1 B/D

methenamine hippurate oral tablet 1 gram 1

metro i.v. intravenous piggyback 500 mg/100 ml 1

metronidazole in nacl (iso-os) intravenous piggyback 500 mg/100 ml

1

metronidazole oral capsule 375 mg 1

metronidazole oral tablet 250 mg, 500 mg 1

metronidazole topical cream 0.75 % 1

metronidazole topical gel 0.75 %, 1 % 1

metronidazole topical gel with pump 1 % 1

metronidazole topical lotion 0.75 % 1

metronidazole vaginal gel 0.75 % 1

mupirocin topical ointment 2 % 1


32


neomycin-bacitracin-poly-hc ophthalmic (eye) ointment 3.5-400-10,000 mg-unit/g-1%

1

neomycin-bacitracin-polymyxin ophthalmic (eye) ointment 3.5-400-10,000 mg-unit-unit/g

1

neomycin-polymyxin b-dexameth ophthalmic (eye) drops,suspension 3.5mg/ml-10,000 unit/ml-0.1 %

1

neomycin-polymyxin b-dexameth ophthalmic (eye) ointment 3.5 mg/g-10,000 unit/g-0.1 %

1

neomycin-polymyxin-gramicidin ophthalmic (eye) drops 1.75 mg-10,000 unit-0.025mg/ml

1

neomycin-polymyxin-hc ophthalmic (eye) drops,suspension 3.5-10,000-10 mg-unit-mg/ml

1

nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg, 50 mg


nitrofurantoin monohyd/m-cryst oral capsule 100 mg


nitrofurantoin monohyd/m-cryst oral capsule 100 mg (75/25)


polymyxin b sulfate injection recon soln 500,000 unit

1

polymyxin b sulf-trimethoprim ophthalmic (eye) drops 10,000 unit- 1 mg/ml

1

SM ANTIBIOTIC 500 UNIT/GM OINT 500 UNIT/GRAM

3 DP

tinidazole oral tablet 250 mg, 500 mg 1

trimethoprim oral tablet 100 mg 1

TRIPLE ANTIBIOTIC OINTMENT 3.5MG-400 UNIT- 5,000 UNIT/GRAM

3 DP

vancomycin injection recon soln 100 gram 1

vancomycin intravenous recon soln 1,000 mg, 1.25 gram, 1.5 gram, 10 gram, 250 mg, 5 gram, 500 mg, 750 mg

1

vancomycin oral capsule 125 mg, 250 mg 1

33


BETA-LACTAM, CEPHALOSPORINS

cefaclor oral capsule 250 mg, 500 mg 1

cefaclor oral tablet extended release 12 hr 500 mg 1

cefadroxil oral capsule 500 mg 1

cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml

1

cefadroxil oral tablet 1 gram 1

cefazolin in dextrose (iso-os) intravenous piggyback 1 gram/50 ml

1

cefazolin injection recon soln 1 gram, 500 mg 1

cefazolin intravenous recon soln 1 gram 1

cefdinir oral capsule 300 mg 1

cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

1

cefepime in dextrose 5 % intravenous piggyback 1 gram/50 ml, 2 gram/50 ml

1

cefepime in dextrose,iso-osm intravenous piggyback 1 gram/50 ml, 2 gram/100 ml

1

cefepime injection recon soln 1 gram, 2 gram 1

cefixime oral capsule 400 mg 1

cefotaxime injection recon soln 1 gram, 2 gram, 500 mg

1

cefoxitin in dextrose, iso-osm intravenous piggyback 1 gram/50 ml, 2 gram/50 ml

1

cefoxitin intravenous recon soln 1 gram, 10 gram, 2 gram

1

cefpodoxime oral suspension for reconstitution 100 mg/5 ml, 50 mg/5 ml

1

cefpodoxime oral tablet 100 mg, 200 mg 1

cefprozil oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

1

cefprozil oral tablet 250 mg, 500 mg 1

ceftazidime in d5w intravenous piggyback 1 gram/50 ml, 2 gram/50 ml

1

ceftazidime injection recon soln 1 gram, 2 gram, 6 gram

1


34


ceftriaxone in dextrose,iso-os intravenous piggyback 1 gram/50 ml, 2 gram/50 ml

1

ceftriaxone injection recon soln 1 gram, 10 gram, 100 gram, 2 gram, 250 mg, 500 mg

1

ceftriaxone intravenous recon soln 1 gram, 2 gram 1

cefuroxime axetil oral tablet 250 mg, 500 mg 1

cefuroxime sodium injection recon soln 750 mg 1

cefuroxime sodium intravenous recon soln 1.5 gram, 7.5 gram

1

cephalexin oral capsule 250 mg, 500 mg 1

cephalexin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

1

cephalexin oral tablet 250 mg, 500 mg 1

TAZICEF INJECTION RECON SOLN 1 GRAM, 2 GRAM, 6 GRAM

1

TAZICEF INTRAVENOUS RECON SOLN 1 GRAM, 2 GRAM

1

TEFLARO INTRAVENOUS RECON SOLN 400 MG, 600 MG

2 PA

BETA-LACTAM, OTHER

aztreonam injection recon soln 1 gram 1

doripenem intravenous recon soln 500 mg 1 PA

ertapenem injection recon soln 1 gram 1 PA

imipenem-cilastatin intravenous recon soln 250 mg, 500 mg

1 B/D

meropenem intravenous recon soln 1 gram, 500 mg

1

meropenem-0.9% sodium chloride intravenous piggyback 1 gram/50 ml, 500 mg/50 ml

1

VABOMERE INTRAVENOUS RECON SOLN 2 GRAM

2 PA

BETA-LACTAM, PENICILLINS

35


amoxicillin oral capsule 250 mg, 500 mg 1

amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml

1

amoxicillin oral tablet 500 mg, 875 mg 1

amoxicillin oral tablet,chewable 125 mg, 250 mg 1

amoxicillin-pot clavulanate oral suspension for reconstitution 200-28.5 mg/5 ml, 250-62.5 mg/5 ml, 400-57 mg/5 ml, 600-42.9 mg/5 ml

1

amoxicillin-pot clavulanate oral tablet 250-125 mg, 500-125 mg, 875-125 mg

1

amoxicillin-pot clavulanate oral tablet extended release 12 hr 1,000-62.5 mg

1

amoxicillin-pot clavulanate oral tablet,chewable 200-28.5 mg, 400-57 mg

1

ampicillin oral capsule 500 mg 1

ampicillin sodium injection recon soln 1 gram, 10 gram, 125 mg

1

ampicillin sodium intravenous recon soln 1 gram 1

ampicillin-sulbactam injection recon soln 1.5 gram, 15 gram, 3 gram

1

ampicillin-sulbactam intravenous recon soln 1.5 gram, 3 gram

1

BICILLIN L-A INTRAMUSCULAR SYRINGE 1,200,000 UNIT/2 ML, 2,400,000 UNIT/4 ML, 600,000 UNIT/ML

2

dicloxacillin oral capsule 250 mg, 500 mg 1

nafcillin in dextrose iso-osm intravenous piggyback 1 gram/50 ml

1

nafcillin injection recon soln 1 gram 1

nafcillin intravenous recon soln 1 gram, 2 gram 1

penicillin g procaine intramuscular syringe 1.2 million unit/2 ml

1

penicillin g sodium injection recon soln 5 million unit

1

penicillin v potassium oral recon soln 125 mg/5 ml, 250 mg/5 ml

1

penicillin v potassium oral tablet 250 mg, 500 mg 1


36


piperacillin-tazobactam intravenous recon soln 13.5 gram, 2.25 gram, 3.375 gram, 4.5 gram, 40.5 gram

1

MACROLIDES

azithromycin intravenous recon soln 500 mg 1

azithromycin oral packet 1 gram 1

azithromycin oral suspension for reconstitution 100 mg/5 ml, 200 mg/5 ml

1

azithromycin oral tablet 250 mg, 250 mg (6 pack), 500 mg, 500 mg (3 pack), 600 mg

1

clarithromycin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

1

clarithromycin oral tablet 250 mg, 500 mg 1

clarithromycin oral tablet extended release 24 hr 500 mg

1

DIFICID ORAL TABLET 200 MG 2 PA

ery pads topical swab 2 % 1

erythrocin (as stearate) oral tablet 250 mg 1

ERYTHROCIN INTRAVENOUS RECON SOLN 500 MG

2

erythromycin ethylsuccinate oral suspension for reconstitution 200 mg/5 ml

1

erythromycin ethylsuccinate oral tablet 400 mg 1

erythromycin ophthalmic (eye) ointment 5 mg/gram (0.5 %)

1

erythromycin oral tablet 250 mg, 500 mg 1

erythromycin with ethanol topical gel 2 % 1

erythromycin with ethanol topical solution 2 % 1

QUINOLONES

ciprofloxacin hcl ophthalmic (eye) drops 0.3 % 1

37


ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg

1

ciprofloxacin in 5 % dextrose intravenous piggyback 200 mg/100 ml

1

ciprofloxacin oral suspension,microcapsule recon 250 mg/5 ml, 500 mg/5 ml

1

levofloxacin in d5w intravenous piggyback 500 mg/100 ml, 750 mg/150 ml

1

levofloxacin intravenous solution 25 mg/ml 1

levofloxacin oral solution 250 mg/10 ml 1

levofloxacin oral tablet 250 mg, 500 mg, 750 mg 1

moxifloxacin ophthalmic (eye) drops 0.5 % 1

moxifloxacin oral tablet 400 mg 1

moxifloxacin-sod.ace,sul-water intravenous piggyback 400 mg/250 ml

1

moxifloxacin-sod.chloride(iso) intravenous piggyback 400 mg/250 ml

1

ofloxacin ophthalmic (eye) drops 0.3 % 1

ofloxacin oral tablet 300 mg, 400 mg 1

SULFONAMIDES

silver sulfadiazine topical cream 1 % 1

ssd topical cream 1 % 1

sulfacetamide sodium (acne) topical suspension 10 %

1

sulfacetamide sodium ophthalmic (eye) drops 10 %

1

sulfacetamide sodium ophthalmic (eye) ointment 10 %

1

sulfadiazine oral tablet 500 mg 1

sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5 ml

1

sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800-160 mg

1

TETRACYCLINES

doxy-100 intravenous recon soln 100 mg 1

doxycycline hyclate oral capsule 100 mg, 50 mg 1


38


doxycycline hyclate oral tablet 100 mg, 20 mg 1

doxycycline monohydrate oral capsule 100 mg, 50 mg

1

doxycycline monohydrate oral tablet 100 mg, 150 mg, 50 mg, 75 mg

1

minocycline oral capsule 100 mg, 50 mg, 75 mg 1

minocycline oral tablet 100 mg, 50 mg, 75 mg 1

MORGIDOX 1X 50 KIT 50 MG 1

morgidox oral capsule 50 mg 1

tetracycline oral capsule 250 mg, 500 mg 1

ANTICONVULSANTS

ANTICONVULSANTS, OTHER

BRIVIACT ORAL SOLUTION 10 MG/ML 2 ST; MO

BRIVIACT ORAL TABLET 10 MG, 100 MG, 25 MG, 50 MG, 75 MG

2 ST; MO

DIACOMIT ORAL CAPSULE 250 MG, 500 MG 2 PA; MO

DIACOMIT ORAL POWDER IN PACKET 250 MG, 500 MG

2 PA; MO

EPIDIOLEX ORAL SOLUTION 100 MG/ML 2 PA; MO

levetiracetam oral solution 100 mg/ml, 500 mg/5 ml (5 ml)

1 MO

levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 mg

1 MO

levetiracetam oral tablet extended release 24 hr 500 mg, 750 mg

1 MO

ROWEEPRA ORAL TABLET 1,000 MG, 750 MG

1 MO

roweepra oral tablet 500 mg 1 MO

ROWEEPRA XR ORAL TABLET EXTENDED RELEASE 24 HR 500 MG, 750 MG

1 MO

39


SPRITAM ORAL TABLET FOR SUSPENSION 1,000 MG, 250 MG, 500 MG

2 ST; MO; QL (60 EA per 30 days)

SPRITAM ORAL TABLET FOR SUSPENSION 750 MG


CALCIUM CHANNEL MODIFYING AGENTS

CELONTIN ORAL CAPSULE 300 MG 2 MO

ethosuximide oral capsule 250 mg 1 MO

ethosuximide oral solution 250 mg/5 ml 1 MO

pregabalin oral capsule 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 300 mg, 50 mg, 75 mg

1 MO

pregabalin oral solution 20 mg/ml 1 MO

zonisamide oral capsule 100 mg, 25 mg, 50 mg 1 MO

GAMMA-AMINOBUTYRIC ACID (GABA) AUGMENTING AGENTS

clobazam oral suspension 2.5 mg/ml 1 PA; MO; QL (480 ML per 30 days)

clobazam oral tablet 10 mg, 20 mg 1 PA; MO; QL (60 EA per 30 days)

DIASTAT ACUDIAL RECTAL KIT 12.5-15-17.5-20 MG, 5-7.5-10 MG

2

DIASTAT RECTAL KIT 2.5 MG 2

diazepam rectal kit 12.5-15-17.5-20 mg, 2.5 mg, 5-7.5-10 mg

1 MO

divalproex oral capsule, delayed rel sprinkle 125 mg

1 MO

divalproex oral tablet extended release 24 hr 250 mg, 500 mg

1 MO

divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg, 500 mg

1 MO

gabapentin oral capsule 100 mg, 300 mg, 400 mg 1 MO

gabapentin oral solution 250 mg/5 ml, 250 mg/5 ml (5 ml), 300 mg/6 ml (6 ml)

1 MO

gabapentin oral tablet 600 mg, 800 mg 1 MO

phenobarbital oral elixir 20 mg/5 ml (4 mg/ml) 1 PA; MO

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg

1 PA; MO

primidone oral tablet 250 mg, 50 mg 1 MO

SYMPAZAN ORAL FILM 10 MG, 20 MG, 5 MG 2 PA; MO; QL (60 EA per 30 days)


40


tiagabine oral tablet 12 mg, 16 mg, 2 mg, 4 mg 1 MO

valproic acid (as sodium salt) oral solution 250 mg/5 ml, 250 mg/5 ml (5 ml), 500 mg/10 ml (10 ml)

1 MO

valproic acid oral capsule 250 mg 1 MO

vigabatrin oral powder in packet 500 mg 1 PA; MO

vigabatrin oral tablet 500 mg 1 PA; MO; QL (180 EA per 30 days)

VIGADRONE ORAL POWDER IN PACKET 500 MG

1 PA; MO

GLUTAMATE REDUCING AGENTS

felbamate oral suspension 600 mg/5 ml 1 MO

felbamate oral tablet 400 mg, 600 mg 1 MO

FYCOMPA ORAL SUSPENSION 0.5 MG/ML 2 ST; MO

FYCOMPA ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG


lamotrigine oral tablet extended release 24hr 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg

1 MO

lamotrigine oral tablet, chewable dispersible 25 mg, 5 mg

1 MO

SUBVENITE ORAL TABLET 100 MG, 150 MG, 200 MG, 25 MG

1 MO

SUBVENITE STARTER (BLUE) KIT ORAL TABLETS,DOSE PACK 25 MG (35)

1

SUBVENITE STARTER (GREEN) KIT ORAL TABLETS,DOSE PACK 25 MG (84) -100 MG (14)

1

SUBVENITE STARTER (ORANGE) KIT ORAL TABLETS,DOSE PACK 25 MG (42) -100 MG (7)

1

topiramate oral capsule, sprinkle 15 mg, 25 mg 1 MO

topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg

1 MO

41


SODIUM CHANNEL AGENTS

APTIOM ORAL TABLET 200 MG, 400 MG, 800 MG


APTIOM ORAL TABLET 600 MG 2 ST; MO; QL (60 EA per 30 days)

BANZEL ORAL SUSPENSION 40 MG/ML 2 PA; MO; QL (2400 ML per 30 days)

BANZEL ORAL TABLET 200 MG, 400 MG 2 PA; MO; QL (240 EA per 30 days)

carbamazepine oral suspension 100 mg/5 ml 1 MO

carbamazepine oral tablet 200 mg 1 MO

carbamazepine oral tablet extended release 12 hr 100 mg, 200 mg, 400 mg

1 MO

carbamazepine oral tablet,chewable 100 mg 1 MO

DILANTIN ORAL CAPSULE 30 MG 2 MO

epitol oral tablet 200 mg 1 MO

oxcarbazepine oral suspension 300 mg/5 ml (60 mg/ml)

1 MO

oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg 1 MO

PEGANONE ORAL TABLET 250 MG 2 MO

PHENYTEK ORAL CAPSULE 200 MG, 300 MG 2 MO

phenytoin oral suspension 100 mg/4 ml, 125 mg/5 ml

1 MO

phenytoin oral tablet,chewable 50 mg 1 MO

phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg

1 MO

VIMPAT ORAL SOLUTION 10 MG/ML 2 ST; MO; QL (1200 ML per 30 days)

VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG


ANTIDEMENTIA AGENTS

ANTIDEMENTIA AGENTS, OTHER

ergoloid oral tablet 1 mg 1 PA; MO

CHOLINESTERASE INHIBITORS

donepezil oral tablet 10 mg, 23 mg, 5 mg 1 MO

donepezil oral tablet,disintegrating 10 mg, 5 mg 1 MO

galantamine oral capsule,ext rel. pellets 24 hr 16 mg, 24 mg, 8 mg

1 MO


42


galantamine oral tablet 12 mg, 4 mg, 8 mg 1 MO

rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg

1 MO

rivastigmine transdermal patch 24 hour 13.3 mg/24 hour, 4.6 mg/24 hr, 9.5 mg/24 hr

1 MO

N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONIST

memantine oral capsule,sprinkle,er 24hr 14 mg, 21 mg, 28 mg, 7 mg

1 MO; QL (30 EA per 30 days)

memantine oral tablet 10 mg, 5 mg 1 MO

memantine oral tablets,dose pack 5-10 mg 1

NAMENDA XR ORAL CAP,SPRINKLE,ER 24HR DOSE PACK 7-14-21-28 MG

2

ANTIDEPRESSANTS

ANTIDEPRESSANTS, OTHER

bupropion hcl oral tablet 100 mg, 75 mg 1 MO

bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg, 450 mg

1 MO

bupropion hcl oral tablet sustained-release 12 hr 100 mg, 150 mg, 200 mg

1 MO

FORFIVO XL ORAL TABLET EXTENDED RELEASE 24 HR 450 MG

2 MO

mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg

1 MO

mirtazapine oral tablet,disintegrating 15 mg, 30 mg, 45 mg

1 MO

nefazodone oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg

1 MO

perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-10 mg, 4-25 mg, 4-50 mg

1 PA; MO

SPRAVATO NASAL SPRAY,NON-AEROSOL 56 MG (28 MG X 2), 84 MG (28 MG X 3)

2 PA

43


trazodone oral tablet 100 mg, 150 mg, 300 mg, 50 mg

1 MO

MONOAMINE OXIDASE INHIBITORS

EMSAM TRANSDERMAL PATCH 24 HOUR 12 MG/24 HR, 6 MG/24 HR, 9 MG/24 HR

2 MO

MARPLAN ORAL TABLET 10 MG 2 MO

phenelzine oral tablet 15 mg 1 MO

tranylcypromine oral tablet 10 mg 1 MO

SSRIS/ SNRIS

citalopram oral solution 10 mg/5 ml 1 MO

citalopram oral tablet 10 mg, 20 mg, 40 mg 1 MO

desvenlafaxine succinate oral tablet extended release 24 hr 100 mg, 25 mg, 50 mg

1 MO

escitalopram oxalate oral solution 5 mg/5 ml 1 MO

escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg

1 MO

FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK 20 MG (2)- 40 MG (26)

2 ST

FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR 120 MG, 20 MG, 40 MG, 80 MG

2 ST; MO

fluoxetine oral capsule 10 mg, 20 mg, 40 mg 1 MO

fluoxetine oral capsule,delayed release(dr/ec) 90 mg

1 MO

fluoxetine oral solution 20 mg/5 ml (4 mg/ml) 1 MO

fluoxetine oral tablet 10 mg, 20 mg 1 MO

fluvoxamine oral tablet 100 mg, 25 mg, 50 mg 1 MO

maprotiline oral tablet 25 mg, 50 mg, 75 mg 1 MO

paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg

1 MO

paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 25 mg, 37.5 mg

1 MO

PAXIL ORAL SUSPENSION 10 MG/5 ML 2 MO

sertraline oral concentrate 20 mg/ml 1 MO

sertraline oral tablet 100 mg, 25 mg, 50 mg 1 MO


44


TRINTELLIX ORAL TABLET 10 MG, 20 MG, 5 MG

2 ST; MO

venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg, 75 mg

1 MO

venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

1 MO

venlafaxine oral tablet extended release 24hr 150 mg, 225 mg, 37.5 mg, 75 mg

1 MO

VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG

2 ST; MO

VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23)

2 ST

TRICYCLICS

amitriptyline oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

1 PA; MO

amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg

1 MO

clomipramine oral capsule 25 mg, 50 mg, 75 mg 1 PA; MO

desipramine oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

1 MO

doxepin oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

1 PA; MO

doxepin oral concentrate 10 mg/ml 1 PA; MO

imipramine hcl oral tablet 10 mg, 25 mg, 50 mg 1 PA; MO

imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg

1 PA; MO

nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75 mg

1 MO

nortriptyline oral solution 10 mg/5 ml 1 MO

protriptyline oral tablet 10 mg, 5 mg 1 MO

trimipramine oral capsule 100 mg, 25 mg, 50 mg 1 PA; MO

ANTIEMETICS

45


ANTIEMETICS, OTHER

chlorpromazine oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg

1 MO

DRIMINATE 50 MG TABLET 50 MG 3 DP

meclizine 12.5 mg caplet caplet (otc) 12.5 mg 3 DP

meclizine 12.5 mg tablet (otc) 12.5 mg 3 DP

meclizine 25 mg tablet chew 25 mg 3 DP

meclizine 25 mg tablet chew raspberry 25 mg 3 DP

meclizine oral tablet 12.5 mg, 25 mg 1

metoclopramide hcl oral solution 5 mg/5 ml 1

metoclopramide hcl oral tablet 10 mg, 5 mg 1

MOTION SICKNESS 50 MG TABLET 50 MG 3 DP

MOTION-TIME 25 MG TABLET CHEW 25 MG 3 DP

perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg 1 MO

prochlorperazine maleate oral tablet 10 mg, 5 mg 1

prochlorperazine rectal suppository 25 mg 1

promethazine oral tablet 12.5 mg, 25 mg, 50 mg 1 PA

promethazine rectal suppository 12.5 mg, 25 mg 1 PA

promethazine rectal suppository 50 mg 1

promethegan rectal suppository 50 mg 1 PA

SB MOTION SICKNESS 50 MG TAB 50 MG 3 DP

scopolamine base transdermal patch 3 day 1 mg over 3 days

1

SM MOTION SICKNESS 50 MG TAB 50 MG 3 DP

TRAVEL SICKNESS 25 MG TAB CHEW 25 MG

3 DP

TRAVEL SICKNESS 50 MG TABLET 50 MG 3 DP

trimethobenzamide oral capsule 300 mg 1 PA

EMETOGENIC THERAPY ADJUNCTS

aprepitant oral capsule 125 mg, 40 mg, 80 mg 1 B/D

aprepitant oral capsule,dose pack 125 mg (1)- 80 mg (2)

1 B/D

dronabinol oral capsule 10 mg, 2.5 mg, 5 mg 1 B/D


46


EMEND ORAL SUSPENSION FOR RECONSTITUTION 125 MG (25 MG/ ML FINAL CONC.)

2 B/D

granisetron hcl oral tablet 1 mg 1 B/D

ondansetron hcl oral solution 4 mg/5 ml 1 B/D

ondansetron hcl oral tablet 24 mg, 4 mg, 8 mg 1 B/D

ondansetron oral tablet,disintegrating 4 mg, 8 mg 1 B/D

SYNDROS ORAL SOLUTION 5 MG/ML 2 PA

ANTIFUNGALS

ANTIFUNGALS

abelcet intravenous suspension 5 mg/ml 2 B/D

ALEVAZOL 1% OINTMENT 1 % 3 DP

AMBISOME INTRAVENOUS SUSPENSION FOR RECONSTITUTION 50 MG

2 B/D

amphotericin b injection recon soln 50 mg 1 B/D

ANTIFUNGAL 1% CREAM 1 % 3 DP


ANTI-FUNGAL 1% POWDER 1 % 3 DP


CARRINGTON ANTIFUNGAL 2% CREAM 2 % 3 DP

caspofungin intravenous recon soln 50 mg, 70 mg 1 PA

ciclopirox topical cream 0.77 % 1

ciclopirox topical solution 8 % 1

ciclopirox topical suspension 0.77 % 1

ciclopirox-ure-camph-menth-euc topical solution 8 %

1

clotrimazole 1% cream (otc) 1 % 3 DP

clotrimazole 1% cream 1 % 3 DP

clotrimazole mucous membrane troche 10 mg 1

clotrimazole topical cream 1 % 1

47


clotrimazole topical solution 1 % 1

econazole topical cream 1 % 1

ERAXIS(WATER DILUENT) INTRAVENOUS RECON SOLN 100 MG, 50 MG

2 PA

fluconazole in dextrose(iso-o) intravenous piggyback 200 mg/100 ml, 400 mg/200 ml

1

fluconazole in nacl (iso-osm) intravenous piggyback 200 mg/100 ml, 400 mg/200 ml

1

fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml

1

fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg

1

flucytosine oral capsule 250 mg, 500 mg 1

griseofulvin microsize oral suspension 125 mg/5 ml

1

INZO ANTIFUNGAL 2% CREAM 2 % 3 DP

itraconazole oral capsule 100 mg 1

itraconazole oral solution 10 mg/ml 1

ketoconazole oral tablet 200 mg 1

ketoconazole topical cream 2 % 1

ketoconazole topical shampoo 2 % 1

LAMISIL AF DEFENS 1% SPRAY PWD 1 % 3 DP

MENTAX TOPICAL CREAM 1 % 2

miconazole 100 mg vag supp 100 mg 3 DP

MICONAZOLE 7 100 MG VAG SUPP 100 MG 3 DP

MICONAZOLE 7 CREAM 2 % 3 DP

miconazole nitrate 2% cream 2 % 3 DP

miconazole nitrate 2% cream 2 % 3 DP

miconazole nitrate 2% cream w/applicator 2 % 3 DP

MYCAMINE INTRAVENOUS RECON SOLN 100 MG, 50 MG

2 PA

NOXAFIL ORAL SUSPENSION 200 MG/5 ML (40 MG/ML)

2 PA

nyamyc topical powder 100,000 unit/gram 1

nystatin oral suspension 100,000 unit/ml 1


48


nystatin oral tablet 500,000 unit 1

nystatin topical cream 100,000 unit/gram 1

nystatin topical ointment 100,000 unit/gram 1

nystatin topical powder 100,000 unit/gram 1

nystop topical powder 100,000 unit/gram 1

posaconazole oral suspension 200 mg/5 ml (40 mg/ml)

1 PA

posaconazole oral tablet,delayed release (dr/ec) 100 mg

1 PA

qc tolnaftate 1% cream 1 % 3 DP

SM ANTIFUNGAL 1% CREAM 1 % 3 DP

SM ANTIFUNGAL 1% CREAM 1 % 3 DP

SM ATHLETE'S 1% FOOT CREAM 1 % 3 DP

SM MICONAZOLE 7 100 MG VAG SUP 100 MG

3 DP

SM MICONAZOLE 7 CREAM W/REUSABLE APPLIC 2 %

3 DP

sm miconazole nitrate 2% cream w/disp applicators 2 %

3 DP

terbinafine 1% cream 1 % 3 DP

terbinafine 1% cream antifungal 1 % 3 DP

terbinafine hcl oral tablet 250 mg 1

terconazole vaginal cream 0.4 %, 0.8 % 1

terconazole vaginal suppository 80 mg 1

tolnaftate 1% cream 1 % 3 DP

tolnaftate 1% powder 1 % 3 DP

tolnaftate af 1% cream 1 % 3 DP

voriconazole intravenous recon soln 200 mg 1

voriconazole oral suspension for reconstitution 200 mg/5 ml (40 mg/ml)

1

49


voriconazole oral tablet 200 mg, 50 mg 1

ANTIGOUT AGENTS

ANTIGOUT AGENTS

allopurinol oral tablet 100 mg, 300 mg 1 MO

colchicine oral capsule 0.6 mg 1 MO

colchicine oral tablet 0.6 mg 1 MO

febuxostat oral tablet 40 mg, 80 mg 1 ST; MO

probenecid oral tablet 500 mg 1 MO

probenecid-colchicine oral tablet 500-0.5 mg 1 MO

ANTI-INFLAMMATORY AGENTS

GLUCOCORTICOIDS

ala-cort topical cream 1 %, 2.5 % 1

alclometasone topical cream 0.05 % 1

alclometasone topical ointment 0.05 % 1

betamethasone dipropionate topical cream 0.05 % 1

betamethasone dipropionate topical lotion 0.05 % 1

betamethasone dipropionate topical ointment 0.05 %

1

betamethasone valerate topical cream 0.1 % 1

betamethasone valerate topical lotion 0.1 % 1

betamethasone valerate topical ointment 0.1 % 1

betamethasone, augmented topical cream 0.05 % 1

betamethasone, augmented topical gel 0.05 % 1

betamethasone, augmented topical lotion 0.05 % 1

betamethasone, augmented topical ointment 0.05 %

1

clobetasol scalp solution 0.05 % 1

clobetasol topical cream 0.05 % 1

clobetasol topical gel 0.05 % 1

clobetasol topical ointment 0.05 % 1

clobetasol-emollient topical cream 0.05 % 1

desonide topical cream 0.05 % 1

desonide topical lotion 0.05 % 1


50


desonide topical ointment 0.05 % 1

desoximetasone topical cream 0.05 %, 0.25 % 1

desoximetasone topical gel 0.05 % 1

desoximetasone topical ointment 0.05 %, 0.25 % 1

dexamethasone intensol oral drops 1 mg/ml 1

dexamethasone oral elixir 0.5 mg/5 ml 1

dexamethasone oral solution 0.5 mg/5 ml 1

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

1

fluocinolone topical cream 0.01 %, 0.025 % 1

fluocinolone topical ointment 0.025 % 1

fluocinolone topical solution 0.01 % 1

fluocinonide topical gel 0.05 % 1

fluocinonide topical ointment 0.05 % 1

fluocinonide topical solution 0.05 % 1

fluocinonide-e topical cream 0.05 % 1

fluocinonide-emollient topical cream 0.05 % 1

fluticasone propionate topical cream 0.05 % 1

fluticasone propionate topical lotion 0.05 % 1

fluticasone propionate topical ointment 0.005 % 1

halobetasol propionate topical cream 0.05 % 1

halobetasol propionate topical ointment 0.05 % 1

hm hydrocortisone 1% cream max str, w/aloe (otc) 1 %

3 DP

hm hydrocortisone 1% cream plus 12 moisturizers (otc) 1 %

3 DP

hydrocortisone 1% cream (otc) 1 % 3 DP

hydrocortisone 1% cream carton (otc) 1 % 3 DP

hydrocortisone 1% cream maximum strength (otc) 1 %

3 DP

51


hydrocortisone 1% cream u-d, 48's, foil 1 % 3 DP

hydrocortisone 1% ointment (otc) 1 % 3 DP

hydrocortisone 1% ointment carton (otc) 1 % 3 DP

hydrocortisone 1% ointment maximum strength (otc) 1 %

3 DP

hydrocortisone butyrate topical cream 0.1 % 1

hydrocortisone butyrate topical ointment 0.1 % 1

hydrocortisone butyrate topical solution 0.1 % 1

hydrocortisone butyr-emollient topical cream 0.1 %

1

hydrocortisone plus 1% cream moisturizer,max. str (otc) 1 %

3 DP

hydrocortisone topical cream 1 %, 2.5 % 1

hydrocortisone topical cream with perineal applicator 1 %

1

hydrocortisone topical lotion 2.5 % 1

hydrocortisone topical ointment 1 %, 2.5 % 1

hydrocortisone valerate topical cream 0.2 % 1

hydrocortisone valerate topical ointment 0.2 % 1

hydrocortisone-aloe 1% cream 1 % 3 DP

HYDROSKIN 1% CREAM 1 % 3 DP

METHYLPRED DP ORAL TABLETS,DOSE PACK 4 MG

1

methylprednisolone oral tablets,dose pack 4 mg 1

mometasone topical cream 0.1 % 1

mometasone topical ointment 0.1 % 1

mometasone topical solution 0.1 % 1

prednisolone oral solution 15 mg/5 ml 1

prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml)

1

prednisone oral solution 5 mg/5 ml 1

prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg

1


52


prednisone oral tablets,dose pack 10 mg, 10 mg (48 pack), 5 mg, 5 mg (48 pack)

1

sb hydrocortisone 1% ointment maximum strength (otc) 1 %

3 DP

SB HYDROCORTISONE PLUS 1% CRM MAX STR, W/ALOE 1 %

3 DP

sm hydrocortisone 1% ointment maximum strength (otc) 1 %

3 DP

sm hydrocortisone-aloe 1% crm 1 % 3 DP

triamcinolone acetonide topical cream 0.025 %, 0.1 %, 0.5 %

1

triamcinolone acetonide topical lotion 0.025 %, 0.1 %

1

triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %

1

triderm topical cream 0.1 % 1

ANTIMIGRAINE AGENTS

ERGOT ALKALOIDS

dihydroergotamine injection solution 1 mg/ml 1 PA

dihydroergotamine nasal spray,non-aerosol 0.5 mg/pump act. (4 mg/ml)


ergotamine-caffeine oral tablet 1-100 mg 1

PROPHYLACTIC

AIMOVIG AUTOINJECTOR (2 PACK) SUBCUTANEOUS AUTO-INJECTOR 70 MG/ML

2 PA; MO

AIMOVIG AUTOINJECTOR SUBCUTANEOUS AUTO-INJECTOR 140 MG/ML, 70 MG/ML

2 PA; MO

EMGALITY PEN SUBCUTANEOUS PEN INJECTOR 120 MG/ML

2 PA; MO

EMGALITY SYRINGE SUBCUTANEOUS SYRINGE 120 MG/ML

2 PA; MO

53


EMGALITY SYRINGE SUBCUTANEOUS SYRINGE 300 MG/3 ML (100 MG/ML X 3)

2 PA

SEROTONIN (5-HT) 1B/1D RECEPTOR AGONISTS

rizatriptan oral tablet 10 mg, 5 mg 1 QL (12 EA per 30 days)

rizatriptan oral tablet,disintegrating 10 mg, 5 mg 1 QL (12 EA per 30 days)

sumatriptan nasal spray,non-aerosol 20 mg/actuation, 5 mg/actuation


sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg


sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml, 6 mg/0.5 ml


sumatriptan succinate subcutaneous pen injector 4 mg/0.5 ml, 6 mg/0.5 ml, 6 mg/0.5 ml (auto-injector)


sumatriptan succinate subcutaneous solution 6 mg/0.5 ml


sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml


ANTIMYASTHENIC AGENTS

PARASYMPATHOMIMETICS

guanidine oral tablet 125 mg 1

pyridostigmine bromide oral tablet 30 mg, 60 mg 1 MO

pyridostigmine bromide oral tablet extended release 180 mg

1 MO

ANTIMYCOBACTERIALS

ANTIMYCOBACTERIALS, OTHER

dapsone oral tablet 100 mg, 25 mg 1 MO

rifabutin oral capsule 150 mg 1

ANTITUBERCULARS

ethambutol oral tablet 100 mg, 400 mg 1

isoniazid oral tablet 100 mg, 300 mg 1

PASER ORAL GRANULES DR FOR SUSP IN PACKET 4 GRAM

2

PRIFTIN ORAL TABLET 150 MG 2

pyrazinamide oral tablet 500 mg 1


54


rifampin intravenous recon soln 600 mg 1

rifampin oral capsule 150 mg, 300 mg 1

RIFATER ORAL TABLET 50-120-300 MG 2

SIRTURO ORAL TABLET 100 MG 2 PA

TRECATOR ORAL TABLET 250 MG 2

ANTINEOPLASTICS

ALKYLATING AGENTS

cyclophosphamide oral capsule 25 mg, 50 mg 1 B/D

GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG

2 PA

HEXALEN ORAL CAPSULE 50 MG 2 PA

LEUKERAN ORAL TABLET 2 MG 2

MATULANE ORAL CAPSULE 50 MG 2

VALCHLOR TOPICAL GEL 0.016 % 2 MO

ANTIANDROGENS

abiraterone oral tablet 250 mg 1 PA; MO

bicalutamide oral tablet 50 mg 1 MO

ERLEADA ORAL TABLET 60 MG 2 PA; MO

flutamide oral capsule 125 mg 1 MO

nilutamide oral tablet 150 mg 1 MO

NUBEQA ORAL TABLET 300 MG 2 PA; MO

XTANDI ORAL CAPSULE 40 MG 2 PA; MO

YONSA ORAL TABLET 125 MG 2 PA; MO

ZYTIGA ORAL TABLET 500 MG 2 PA; MO

ANTIANGIOGENIC AGENTS

POMALYST ORAL CAPSULE 1 MG, 2 MG, 3 MG, 4 MG

2 PA; MO

REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG

2 PA; MO; LA

55


THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 MG, 50 MG

2 MO

ANTIESTROGENS/MODIFIERS

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

2 PA; MO

EMCYT ORAL CAPSULE 140 MG 2

SOLTAMOX ORAL SOLUTION 10 MG/5 ML 2 MO

tamoxifen oral tablet 10 mg, 20 mg 1 MO

toremifene oral tablet 60 mg 1 PA; MO

ANTIMETABOLITES

DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG

2 MO

fluorouracil topical cream 0.5 %, 5 % 1

fluorouracil topical solution 2 %, 5 % 1

hydroxyurea oral capsule 500 mg 1 MO

mercaptopurine oral tablet 50 mg 1 MO

PURIXAN ORAL SUSPENSION 20 MG/ML 2 MO

TABLOID ORAL TABLET 40 MG 2 PA

ANTINEOPLASTICS, OTHER

diclofenac sodium topical gel 3 % 1

leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg

1

LONSURF ORAL TABLET 15-6.14 MG, 20-8.19 MG

2 PA

LYNPARZA ORAL CAPSULE 50 MG 2 PA; MO

LYNPARZA ORAL TABLET 100 MG, 150 MG 2 PA; MO

MESNEX ORAL TABLET 400 MG 2

NINLARO ORAL CAPSULE 2.3 MG, 3 MG, 4 MG

2 PA; MO

ODOMZO ORAL CAPSULE 200 MG 2 PA; MO

SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG

2 PA; MO

SYNRIBO SUBCUTANEOUS RECON SOLN 3.5 MG

2 PA; MO


56


VENCLEXTA ORAL TABLET 10 MG, 100 MG, 50 MG

2 PA; MO

VENCLEXTA STARTING PACK ORAL TABLETS,DOSE PACK 10 MG-50 MG- 100 MG

2 PA

xpovio oral tablet 100 mg/week (20 mg x 5), 160 mg/week (20 mg x 8), 60 mg/week (20 mg x 3), 80 mg/week (20 mg x 4)

2 PA; MO

ZOLINZA ORAL CAPSULE 100 MG 2 PA

ZYDELIG ORAL TABLET 100 MG, 150 MG 2 PA; MO

AROMATASE INHIBITORS, 3RD GENERATION

anastrozole oral tablet 1 mg 1 MO

exemestane oral tablet 25 mg 1 MO

letrozole oral tablet 2.5 mg 1 MO

ENZYME INHIBITORS

COPIKTRA ORAL CAPSULE 15 MG, 25 MG 2 PA; MO

PIQRAY ORAL TABLET 200 MG/DAY (200 MG X 1), 250 MG/DAY (200 MG X1-50 MG X1), 300 MG/DAY (150 MG X 2)

2 PA; MO

TALZENNA ORAL CAPSULE 0.25 MG, 1 MG 2 PA

VIZIMPRO ORAL TABLET 15 MG, 30 MG, 45 MG

2 PA; MO

MOLECULAR TARGET INHIBITORS

AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 2 MG, 3 MG, 5 MG

2 PA; MO

AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG, 7.5 MG

2 PA; MO

ALECENSA ORAL CAPSULE 150 MG 2 PA; MO

ALUNBRIG ORAL TABLET 180 MG, 30 MG, 90 MG

2 PA; MO

ALUNBRIG ORAL TABLETS,DOSE PACK 90 MG (7)- 180 MG (23)

2 PA

57


BALVERSA ORAL TABLET 3 MG, 4 MG, 5 MG

2 PA; MO

BOSULIF ORAL TABLET 100 MG, 400 MG, 500 MG

2 PA; MO

BRAFTOVI ORAL CAPSULE 75 MG 2 PA; MO

CABOMETYX ORAL TABLET 20 MG, 40 MG, 60 MG

2 PA; MO

CALQUENCE ORAL CAPSULE 100 MG 2 PA; MO

CAPRELSA ORAL TABLET 100 MG, 300 MG 2 PA; MO

COMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG X1-20 MG X1), 140 MG/DAY(80 MG X1-20 MG X3), 60 MG/DAY (20 MG X 3/DAY)

2 PA; MO

COTELLIC ORAL TABLET 20 MG 2 PA; MO

DAURISMO ORAL TABLET 100 MG, 25 MG 2 PA; MO

ERIVEDGE ORAL CAPSULE 150 MG 2 PA; MO

erlotinib oral tablet 100 mg, 150 mg, 25 mg 1 PA; MO

FARYDAK ORAL CAPSULE 10 MG, 15 MG, 20 MG

2 PA

GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG

2 PA; MO

IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG

2 PA; MO

ICLUSIG ORAL TABLET 15 MG, 45 MG 2 PA; MO

IDHIFA ORAL TABLET 100 MG, 50 MG 2 PA; MO

imatinib oral tablet 100 mg, 400 mg 1 PA; MO

IMBRUVICA ORAL CAPSULE 140 MG, 70 MG 2 PA; MO

IMBRUVICA ORAL TABLET 140 MG, 280 MG, 420 MG, 560 MG

2 PA; MO

INLYTA ORAL TABLET 1 MG, 5 MG 2 PA; MO

inrebic oral capsule 100 mg 2 PA; MO

IRESSA ORAL TABLET 250 MG 2 PA

JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG

2 PA; MO


58


KISQALI FEMARA CO-PACK ORAL TABLET 200 MG/DAY(200 MG X 1)-2.5 MG, 400 MG/DAY(200 MG X 2)-2.5 MG, 600 MG/DAY(200 MG X 3)-2.5 MG

2 PA; MO

KISQALI ORAL TABLET 200 MG/DAY (200 MG X 1), 400 MG/DAY (200 MG X 2), 600 MG/DAY (200 MG X 3)

2 PA; MO

LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1), 12 MG/DAY (4 MG X 3), 14 MG/DAY(10 MG X 1-4 MG X 1), 18 MG/DAY (10 MG X 1-4 MG X2), 20 MG/DAY (10 MG X 2), 24 MG/DAY(10 MG X 2-4 MG X 1), 4 MG, 8 MG/DAY (4 MG X 2)

2 PA; MO

LORBRENA ORAL TABLET 100 MG, 25 MG 2 PA; MO

MEKINIST ORAL TABLET 0.5 MG, 2 MG 2 PA; MO

MEKTOVI ORAL TABLET 15 MG 2 PA; MO

NERLYNX ORAL TABLET 40 MG 2 PA

NEXAVAR ORAL TABLET 200 MG 2 PA

rozlytrek oral capsule 100 mg, 200 mg 2 PA; MO

RUBRACA ORAL TABLET 200 MG, 250 MG, 300 MG

2 PA; MO

RYDAPT ORAL CAPSULE 25 MG 2 PA; MO

SPRYCEL ORAL TABLET 100 MG, 140 MG, 20 MG, 50 MG, 70 MG, 80 MG

2 PA; MO

STIVARGA ORAL TABLET 40 MG 2 PA

SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 37.5 MG, 50 MG

2 PA

TAFINLAR ORAL CAPSULE 50 MG, 75 MG 2 PA; MO

TAGRISSO ORAL TABLET 40 MG, 80 MG 2 PA

TASIGNA ORAL CAPSULE 150 MG, 200 MG, 50 MG

2 PA; MO

TIBSOVO ORAL TABLET 250 MG 2 PA; MO

TURALIO ORAL CAPSULE 200 MG 2 PA; MO

59


TYKERB ORAL TABLET 250 MG 2 PA; MO

VERZENIO ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG

2 PA; MO

VITRAKVI ORAL CAPSULE 100 MG, 25 MG 2 PA; MO

VITRAKVI ORAL SOLUTION 20 MG/ML 2 PA; MO

VOTRIENT ORAL TABLET 200 MG 2 PA; MO

XALKORI ORAL CAPSULE 200 MG, 250 MG 2 PA; MO

XOSPATA ORAL TABLET 40 MG 2 PA; MO

ZEJULA ORAL CAPSULE 100 MG 2 PA; MO

ZELBORAF ORAL TABLET 240 MG 2 PA; MO

ZYKADIA ORAL CAPSULE 150 MG 2 PA; MO

ZYKADIA ORAL TABLET 150 MG 2 PA; MO

RETINOIDS

bexarotene oral capsule 75 mg 1 MO

PANRETIN TOPICAL GEL 0.1 % 2 PA

TARGRETIN TOPICAL GEL 1 % 2 PA

tretinoin (chemotherapy) oral capsule 10 mg 1

TREATMENT ADJUNCTS

LYSODREN ORAL TABLET 500 MG 2 MO

ANTIPARASITICS

ANTHELMINTICS

albendazole oral tablet 200 mg 1

ivermectin oral tablet 3 mg 1

praziquantel oral tablet 600 mg 1

ANTIPROTOZOALS

ALINIA ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML

2

ALINIA ORAL TABLET 500 MG 2

atovaquone oral suspension 750 mg/5 ml 1

atovaquone-proguanil oral tablet 250-100 mg, 62.5-25 mg

1

BENZNIDAZOLE ORAL TABLET 100 MG, 12.5 MG

1 PA


60


chloroquine phosphate oral tablet 250 mg, 500 mg 1

COARTEM ORAL TABLET 20-120 MG 2

DARAPRIM ORAL TABLET 25 MG 2

hydroxychloroquine oral tablet 200 mg 1 MO

mefloquine oral tablet 250 mg 1

NEBUPENT INHALATION RECON SOLN 300 MG

2 B/D; MO

PENTAM INJECTION RECON SOLN 300 MG 2 PA

pentamidine inhalation recon soln 300 mg 1 B/D; MO

pentamidine injection recon soln 300 mg 1 PA

PRIMAQUINE ORAL TABLET 26.3 MG 1

quinine sulfate oral capsule 324 mg 1

PEDICULICIDES/ SCABICIDES

GS LICE KILLING SHAMPOO W/NIT COMB 0.33-4 %

3 DP

HM LICE TREATMENT 1% CRM RINSE 1 % 3 DP

LICE KILLING SHAMPOO W/COMB 0.33-4 % 3 DP

LICE KILLING SHAMPOO W/NIT COMB 0.33-4 %

3 DP

LICE TREATMENT 1% CREME RINSE 1 NIT REMOVAL COMB 1 %

3 DP

LICE TREATMENT SHAMPOO 1 NIT COMB INCLUDED 0.33-4 %

3 DP

lindane topical shampoo 1 % 1

malathion topical lotion 0.5 % 1

permethrin topical cream 5 % 1

SB LICE KILLING SHAMPOO MAXIMUM STRENGTH 0.33-4 %

3 DP

SM LICE TREATMENT 1% CRM RINSE 1 % 3 DP

ANTIPARKINSON AGENTS

61


ANTICHOLINERGICS

benztropine oral tablet 0.5 mg, 1 mg, 2 mg 1 PA; MO

trihexyphenidyl oral elixir 0.4 mg/ml 1 PA; MO

trihexyphenidyl oral tablet 2 mg, 5 mg 1 PA; MO

ANTIPARKINSON AGENTS, OTHER

amantadine hcl oral capsule 100 mg 1 MO

amantadine hcl oral solution 50 mg/5 ml 1 MO

amantadine hcl oral tablet 100 mg 1 MO

entacapone oral tablet 200 mg 1 MO

GOCOVRI ORAL CAPSULE,EXTENDED RELEASE 24HR 137 MG, 68.5 MG

2 PA; MO

tolcapone oral tablet 100 mg 1 MO

DOPAMINE AGONISTS

APOKYN SUBCUTANEOUS CARTRIDGE 10 MG/ML

2 PA; MO

bromocriptine oral capsule 5 mg 1 MO

bromocriptine oral tablet 2.5 mg 1 MO

NEUPRO TRANSDERMAL PATCH 24 HOUR 1 MG/24 HOUR, 2 MG/24 HOUR, 3 MG/24 HOUR, 4 MG/24 HOUR, 6 MG/24 HOUR, 8 MG/24 HOUR

2 MO

pramipexole oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

1 MO

pramipexole oral tablet extended release 24 hr 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg

1 MO

ropinirole oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

1 MO

ropinirole oral tablet extended release 24 hr 12 mg, 2 mg, 4 mg, 6 mg, 8 mg

1 MO

DOPAMINE PRECURSORS/ L-AMINO ACID DECARBOXYLASE INHIBITORS

carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg

1 MO

carbidopa-levodopa oral tablet extended release 25-100 mg, 50-200 mg

1 MO


62


carbidopa-levodopa oral tablet,disintegrating 10-100 mg, 25-100 mg, 25-250 mg

1 MO

carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg, 18.75-75-200 mg, 25-100-200 mg, 31.25-125-200 mg, 37.5-150-200 mg, 50-200-200 mg

1 MO

MONOAMINE OXIDASE B (MAO-B) INHIBITORS

rasagiline oral tablet 0.5 mg, 1 mg 1 MO

selegiline hcl oral capsule 5 mg 1 MO

selegiline hcl oral tablet 5 mg 1 MO

ANTIPSYCHOTICS

1ST GENERATION/ TYPICAL

fluphenazine decanoate injection solution 25 mg/ml

1 MO

fluphenazine hcl injection solution 2.5 mg/ml 1

fluphenazine hcl oral concentrate 5 mg/ml 1

fluphenazine hcl oral elixir 2.5 mg/5 ml 1 MO

fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg

1 MO

haloperidol decanoate intramuscular solution 100 mg/ml, 50 mg/ml

1 MO

haloperidol lactate injection solution 5 mg/ml 1

haloperidol lactate intramuscular syringe 5 mg/ml 1

haloperidol lactate oral concentrate 2 mg/ml 1 MO

haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg

1 MO

loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg

1 MO

molindone oral tablet 10 mg, 25 mg, 5 mg 1 MO

pimozide oral tablet 1 mg, 2 mg 1 MO

63


thioridazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg

1 PA; MO

thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg 1 MO

trifluoperazine oral tablet 1 mg, 10 mg, 2 mg, 5 mg

1 MO

2ND GENERATION/ ATYPICAL

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 300 MG, 400 MG

2 PA; MO; QL (1 EA per 28 days)

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 300 MG, 400 MG


aripiprazole oral solution 1 mg/ml 1 MO; QL (900 ML per 30 days)

aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg


aripiprazole oral tablet,disintegrating 10 mg, 15 mg


ARISTADA INITIO INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 675 MG/2.4 ML

2 PA

ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 1,064 MG/3.9 ML

2 PA; MO; QL (3.9 ML per 56 days)

ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 441 MG/1.6 ML






FANAPT ORAL TABLET 1 MG, 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG


FANAPT ORAL TABLETS,DOSE PACK 1MG(2)-2MG(2)- 4MG(2)-6MG(2)

2 PA

GEODON INTRAMUSCULAR RECON SOLN 20 MG/ML (FINAL CONC.)

2 B/D; QL (6 EA per 3 days)


64


INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML


INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 156 MG/ML

2 PA; MO; QL (1 ML per 28 days)







INVEGA TRINZA INTRAMUSCULAR SYRINGE 273 MG/0.875 ML








LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG


LATUDA ORAL TABLET 80 MG 2 PA; MO; QL (60 EA per 30 days)

NUPLAZID ORAL CAPSULE 34 MG 2 PA; MO; QL (30 EA per 30 days)

NUPLAZID ORAL TABLET 10 MG 2 PA; MO; QL (30 EA per 30 days)

NUPLAZID ORAL TABLET 17 MG 2 PA; MO; QL (60 EA per 30 days)

olanzapine intramuscular recon soln 10 mg 1 QL (90 EA per 30 days)

olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg


olanzapine oral tablet,disintegrating 10 mg, 15 mg, 20 mg, 5 mg


paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 9 mg


paliperidone oral tablet extended release 24hr 6 mg


65


PERSERIS ABDOMINAL SUBCUTANEOUS SUSPENSION,EXTEND REL SYR KIT 120 MG, 90 MG

2 PA; MO

quetiapine oral tablet 100 mg, 200 mg, 300 mg, 400 mg


quetiapine oral tablet 25 mg, 50 mg 1 MO; QL (90 EA per 30 days)

quetiapine oral tablet extended release 24 hr 150 mg, 200 mg


quetiapine oral tablet extended release 24 hr 300 mg, 400 mg, 50 mg


REXULTI ORAL TABLET 0.25 MG, 0.5 MG, 1 MG, 2 MG, 3 MG, 4 MG


RISPERDAL CONSTA INTRAMUSCULAR SYRINGE 12.5 MG/2 ML, 25 MG/2 ML, 37.5 MG/2 ML, 50 MG/2 ML


risperidone oral solution 1 mg/ml 1 MO; QL (240 ML per 30 days)

risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg


risperidone oral tablet 4 mg 1 MO; QL (120 EA per 30 days)

risperidone oral tablet,disintegrating 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg


risperidone oral tablet,disintegrating 4 mg 1 MO; QL (120 EA per 30 days)

SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET 10 MG, 5 MG


SAPHRIS SUBLINGUAL TABLET 10 MG, 2.5 MG, 5 MG


VRAYLAR ORAL CAPSULE 1.5 MG, 3 MG, 4.5 MG, 6 MG


VRAYLAR ORAL CAPSULE,DOSE PACK 1.5 MG (1)- 3 MG (6)


ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg


ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG, 300 MG


ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 405 MG



66


TREATMENT-RESISTANT

clozapine oral tablet 100 mg 1 MO; QL (270 EA per 30 days)

clozapine oral tablet 200 mg 1 MO; QL (120 EA per 30 days)

clozapine oral tablet 25 mg, 50 mg 1 MO; QL (90 EA per 30 days)

clozapine oral tablet,disintegrating 100 mg 1 MO; QL (270 EA per 30 days)

clozapine oral tablet,disintegrating 12.5 mg, 25 mg

1 MO



VERSACLOZ ORAL SUSPENSION 50 MG/ML 2 MO; QL (540 ML per 30 days)

ANTISPASTICITY AGENTS

ANTISPASTICITY AGENTS

baclofen oral tablet 10 mg, 20 mg, 5 mg 1 MO

dantrolene oral capsule 100 mg, 25 mg, 50 mg 1 MO

tizanidine oral tablet 2 mg, 4 mg 1 MO

ANTIVIRALS

ANTI-CYTOMEGALOVIRUS (CMV) AGENTS

ganciclovir sodium intravenous solution 50 mg/ml 1 B/D

PREVYMIS ORAL TABLET 240 MG, 480 MG 2 PA

valganciclovir oral recon soln 50 mg/ml 1 MO

valganciclovir oral tablet 450 mg 1 MO

ZIRGAN OPHTHALMIC (EYE) GEL 0.15 % 2 ST

ANTI-HEPATITIS B (HBV) AGENTS

ADEFOVIR ORAL TABLET 10 MG 1 PA

BARACLUDE ORAL SOLUTION 0.05 MG/ML 2 MO

entecavir oral tablet 0.5 mg, 1 mg 1 MO

EPIVIR HBV ORAL SOLUTION 25 MG/5 ML (5 MG/ML)

2 MO

67


lamivudine oral solution 10 mg/ml 1 MO

lamivudine oral tablet 100 mg, 300 mg 1 MO; QL (30 EA per 30 days)

lamivudine oral tablet 150 mg 1 MO; QL (60 EA per 30 days)

PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 180 MCG/0.5 ML

2 PA

PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML

2 PA

PEGASYS SUBCUTANEOUS SYRINGE 180 MCG/0.5 ML

2 PA

tenofovir disoproxil fumarate oral tablet 300 mg 1 MO

VEMLIDY ORAL TABLET 25 MG 2 MO

VIREAD ORAL POWDER 40 MG/SCOOP (40 MG/GRAM)

2 MO

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

2 MO

ANTI-HEPATITIS C (HCV) AGENTS, DIRECT ACTING AGENTS

MAVYRET ORAL TABLET 100-40 MG 2 PA

sofosbuvir-velpatasvir oral tablet 400-100 mg 1 PA

VOSEVI ORAL TABLET 400-100-100 MG 2 PA

ANTI-HEPATITIS C (HCV) AGENTS, OTHER

INTRON A INJECTION RECON SOLN 10 MILLION UNIT (1 ML), 18 MILLION UNIT (1 ML), 50 MILLION UNIT (1 ML)

2 PA

INTRON A INJECTION SOLUTION 10 MILLION UNIT/ML, 6 MILLION UNIT/ML

2 PA

RIBAVIRIN ORAL CAPSULE 200 MG 1

RIBAVIRIN ORAL TABLET 200 MG 1

ANTIHERPETIC AGENTS

ABREVA 10% CREAM 10 % 3 DP

acyclovir oral capsule 200 mg 1 MO

acyclovir oral suspension 200 mg/5 ml 1 MO

acyclovir oral tablet 400 mg, 800 mg 1 MO

acyclovir sodium intravenous solution 50 mg/ml 1 B/D

acyclovir topical cream 5 % 1

acyclovir topical ointment 5 % 1


68


DENAVIR TOPICAL CREAM 1 % 2

famciclovir oral tablet 125 mg, 250 mg, 500 mg 1 MO

trifluridine ophthalmic (eye) drops 1 % 1

valacyclovir oral tablet 1 gram, 500 mg 1 MO

ANTI-HIV AGENTS, INTEGRASE INHIBITORS (INSTI)

DOVATO ORAL TABLET 50-300 MG 2 QL (30 EA per 30 days)

GENVOYA ORAL TABLET 150-150-200-10 MG


ISENTRESS HD ORAL TABLET 600 MG 2 MO; QL (60 EA per 30 days)

ISENTRESS ORAL POWDER IN PACKET 100 MG

2 MO

ISENTRESS ORAL TABLET 400 MG 2 MO; QL (120 EA per 30 days)

ISENTRESS ORAL TABLET,CHEWABLE 100 MG, 25 MG


JULUCA ORAL TABLET 50-25 MG 2 MO; QL (30 EA per 30 days)

STRIBILD ORAL TABLET 150-150-200-300 MG


TIVICAY ORAL TABLET 10 MG 2 MO; QL (300 EA per 30 days)



TRIUMEQ ORAL TABLET 600-50-300 MG 2 MO; QL (30 EA per 30 days)

ANTI-HIV AGENTS, NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTI)

ATRIPLA ORAL TABLET 600-200-300 MG 2 MO; QL (30 EA per 30 days)

COMPLERA ORAL TABLET 200-25-300 MG 2 MO; QL (30 EA per 30 days)

DELSTRIGO ORAL TABLET 100-300-300 MG 2 MO; QL (30 EA per 30 days)

EDURANT ORAL TABLET 25 MG 2 MO; QL (30 EA per 30 days)

efavirenz oral capsule 200 mg 1 MO; QL (120 EA per 30 days)

efavirenz oral capsule 50 mg 1 MO; QL (360 EA per 30 days)

efavirenz oral tablet 600 mg 1 MO; QL (30 EA per 30 days)

69


INTELENCE ORAL TABLET 100 MG, 25 MG 2 MO; QL (120 EA per 30 days)

INTELENCE ORAL TABLET 200 MG 2 MO; QL (60 EA per 30 days)

nevirapine oral suspension 50 mg/5 ml 1 MO

nevirapine oral tablet 200 mg 1 MO; QL (60 EA per 30 days)

nevirapine oral tablet extended release 24 hr 100 mg


nevirapine oral tablet extended release 24 hr 400 mg


ODEFSEY ORAL TABLET 200-25-25 MG 2 MO; QL (30 EA per 30 days)

PIFELTRO ORAL TABLET 100 MG 2 MO; QL (30 EA per 30 days)

RESCRIPTOR ORAL TABLET 200 MG 2 MO; QL (180 EA per 30 days)

SYMFI LO ORAL TABLET 400-300-300 MG 2 MO; QL (30 EA per 30 days)

ANTI-HIV AGENTS, NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)

abacavir oral solution 20 mg/ml 1 MO

abacavir oral tablet 300 mg 1 MO; QL (60 EA per 30 days)

abacavir-lamivudine oral tablet 600-300 mg 1 MO; QL (30 EA per 30 days)

abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg


CIMDUO ORAL TABLET 300-300 MG 2 MO; QL (30 EA per 30 days)

DESCOVY ORAL TABLET 200-25 MG 2 MO; QL (30 EA per 30 days)

didanosine oral capsule,delayed release(dr/ec) 125 mg


didanosine oral capsule,delayed release(dr/ec) 200 mg


didanosine oral capsule,delayed release(dr/ec) 250 mg, 400 mg


EMTRIVA ORAL CAPSULE 200 MG 2 MO; QL (30 EA per 30 days)

EMTRIVA ORAL SOLUTION 10 MG/ML 2 MO

lamivudine-zidovudine oral tablet 150-300 mg 1 MO; QL (60 EA per 30 days)

stavudine oral capsule 15 mg, 20 mg 1 MO; QL (120 EA per 30 days)

stavudine oral capsule 30 mg, 40 mg 1 MO; QL (60 EA per 30 days)

TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG, 200-300 MG



70


VIDEX 2 GRAM PEDIATRIC ORAL RECON SOLN 10 MG/ML (FINAL)

2 MO

VIDEX 4 GRAM PEDIATRIC ORAL RECON SOLN 10 MG/ML (FINAL)

2 MO

VIDEX EC ORAL CAPSULE,DELAYED RELEASE(DR/EC) 125 MG


ZERIT ORAL RECON SOLN 1 MG/ML 2 MO

zidovudine oral capsule 100 mg 1 MO; QL (180 EA per 30 days)

zidovudine oral syrup 10 mg/ml 1 MO

zidovudine oral tablet 300 mg 1 MO; QL (60 EA per 30 days)

ANTI-HIV AGENTS, OTHER

BIKTARVY ORAL TABLET 50-200-25 MG 2 MO; QL (30 EA per 30 days)

FUZEON SUBCUTANEOUS RECON SOLN 90 MG

2 MO

selzentry oral solution 20 mg/ml 2 MO

SELZENTRY ORAL TABLET 150 MG, 75 MG 2 MO; QL (60 EA per 30 days)

SELZENTRY ORAL TABLET 25 MG, 300 MG 2 MO; QL (120 EA per 30 days)

SYMFI ORAL TABLET 600-300-300 MG 2 MO; QL (30 EA per 30 days)

SYMTUZA ORAL TABLET 800-150-200-10 MG 2 MO; QL (30 EA per 30 days)

TYBOST ORAL TABLET 150 MG 2 MO; QL (30 EA per 30 days)

ANTI-HIV AGENTS, PROTEASE INHIBITORS

APTIVUS ORAL CAPSULE 250 MG 2 MO; QL (120 EA per 30 days)

APTIVUS ORAL SOLUTION 100 MG/ML 2 MO

atazanavir oral capsule 150 mg, 300 mg 1 MO; QL (30 EA per 30 days)

atazanavir oral capsule 200 mg 1 MO; QL (60 EA per 30 days)

CRIXIVAN ORAL CAPSULE 200 MG 2 MO; QL (360 EA per 30 days)

CRIXIVAN ORAL CAPSULE 400 MG 2 MO; QL (180 EA per 30 days)

EVOTAZ ORAL TABLET 300-150 MG 2 MO; QL (30 EA per 30 days)

fosamprenavir oral tablet 700 mg 1 MO; QL (120 EA per 30 days)

INVIRASE ORAL TABLET 500 MG 2 MO; QL (120 EA per 30 days)

71


KALETRA ORAL TABLET 100-25 MG 2 MO; QL (240 EA per 30 days)

KALETRA ORAL TABLET 200-50 MG 2 MO; QL (120 EA per 30 days)

LEXIVA ORAL SUSPENSION 50 MG/ML 2 MO

lopinavir-ritonavir oral solution 400-100 mg/5 ml 1 MO

NORVIR ORAL POWDER IN PACKET 100 MG 2 MO; QL (360 EA per 30 days)

NORVIR ORAL SOLUTION 80 MG/ML 2 MO

PREZCOBIX ORAL TABLET 800-150 MG-MG 2 MO; QL (30 EA per 30 days)

PREZISTA ORAL SUSPENSION 100 MG/ML 2 MO

PREZISTA ORAL TABLET 150 MG 2 MO; QL (180 EA per 30 days)




REYATAZ ORAL POWDER IN PACKET 50 MG

2 MO

ritonavir oral tablet 100 mg 1 MO; QL (360 EA per 30 days)

VIRACEPT ORAL TABLET 250 MG 2 MO; QL (300 EA per 30 days)

VIRACEPT ORAL TABLET 625 MG 2 MO; QL (120 EA per 30 days)

ANTI-INFLUENZA AGENTS

oseltamivir oral capsule 30 mg 1 QL (84 EA per 180 days)

oseltamivir oral capsule 45 mg, 75 mg 1 QL (42 EA per 180 days)

oseltamivir oral suspension for reconstitution 6 mg/ml


RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5 MG/ACTUATION


rimantadine oral tablet 100 mg 1

ANXIOLYTICS

ANXIOLYTICS, OTHER

buspirone oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg

1 MO

hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg

1 PA

BENZODIAZEPINES

ALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 MG/ML



72


alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg 1 QL (120 EA per 30 days)

alprazolam oral tablet 2 mg 1 QL (150 EA per 30 days)

alprazolam oral tablet extended release 24 hr 0.5 mg, 1 mg


alprazolam oral tablet extended release 24 hr 2 mg


alprazolam oral tablet extended release 24 hr 3 mg


clonazepam oral tablet 0.5 mg, 1 mg 1 PA; MO; QL (90 EA per 30 days)

clonazepam oral tablet 2 mg 1 PA; MO; QL (300 EA per 30 days)

clonazepam oral tablet,disintegrating 0.125 mg, 0.25 mg, 0.5 mg, 1 mg


clonazepam oral tablet,disintegrating 2 mg 1 PA; MO; QL (300 EA per 30 days)

clorazepate dipotassium oral tablet 15 mg 1 PA; QL (180 EA per 30 days)

clorazepate dipotassium oral tablet 3.75 mg, 7.5 mg


diazepam intensol oral concentrate 5 mg/ml 1 PA; QL (240 ML per 30 days)

diazepam oral concentrate 5 mg/ml 1 PA; QL (240 ML per 30 days)

diazepam oral solution 5 mg/5 ml (1 mg/ml), 5 mg/5 ml (1 mg/ml, 5 ml)

1 PA; QL (1200 ML per 30 days)

diazepam oral tablet 10 mg, 2 mg, 5 mg 1 PA; QL (120 EA per 30 days)

lorazepam intensol oral concentrate 2 mg/ml 1 QL (150 ML per 30 days)

lorazepam oral concentrate 2 mg/ml 1 QL (150 ML per 30 days)

lorazepam oral tablet 0.5 mg, 1 mg 1 QL (90 EA per 30 days)

lorazepam oral tablet 2 mg 1 QL (150 EA per 30 days)

BIPOLAR AGENTS

MOOD STABILIZERS

carbamazepine oral capsule, er multiphase 12 hr 100 mg, 200 mg, 300 mg

1 MO

73


EQUETRO ORAL CAPSULE, ER MULTIPHASE 12 HR 100 MG, 200 MG, 300 MG

2 MO

lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg

1 MO

lithium carbonate oral capsule 150 mg, 300 mg, 600 mg

1 MO

lithium carbonate oral tablet 300 mg 1 MO

lithium carbonate oral tablet extended release 300 mg, 450 mg

1 MO

lithium citrate oral solution 8 meq/5 ml 1 MO

BLOOD GLUCOSE REGULATORS

ANTIDIABETIC AGENTS

acarbose oral tablet 100 mg, 25 mg, 50 mg 1 ST; MO; QL (90 EA per 30 days)

alogliptin oral tablet 12.5 mg, 25 mg, 6.25 mg 1 ST; MO; QL (30 EA per 30 days)

alogliptin-metformin oral tablet 12.5-1,000 mg, 12.5-500 mg


alogliptin-pioglitazone oral tablet 12.5-15 mg, 12.5-30 mg, 12.5-45 mg, 25-15 mg, 25-30 mg, 25-45 mg


AVANDIA ORAL TABLET 2 MG, 4 MG 2 ST; MO; QL (60 EA per 30 days)

DM2 COMBO PACK, TABLET AND STRIP 500 MG


glimepiride oral tablet 1 mg 1 MO; QL (240 EA per 30 days)



glipizide oral tablet 10 mg 1 MO; QL (120 EA per 30 days)

glipizide oral tablet 5 mg 1 MO; QL (240 EA per 30 days)

glipizide oral tablet extended release 24hr 10 mg 1 MO; QL (60 EA per 30 days)

glipizide oral tablet extended release 24hr 2.5 mg 1 MO; QL (240 EA per 30 days)

glipizide oral tablet extended release 24hr 5 mg 1 MO; QL (90 EA per 30 days)

glipizide-metformin oral tablet 2.5-250 mg 1 MO; QL (240 EA per 30 days)

glipizide-metformin oral tablet 2.5-500 mg, 5-500 mg


glyburide micronized oral tablet 1.5 mg, 3 mg 1 PA; MO; QL (90 EA per 30 days)


74


glyburide micronized oral tablet 6 mg 1 PA; MO; QL (60 EA per 30 days)

glyburide oral tablet 1.25 mg, 2.5 mg 1 PA; MO; QL (60 EA per 30 days)

glyburide oral tablet 5 mg 1 PA; MO

glyburide-metformin oral tablet 1.25-250 mg 1 PA; MO; QL (240 EA per 30 days)

glyburide-metformin oral tablet 2.5-500 mg, 5-500 mg


INVOKAMET ORAL TABLET 150-1,000 MG, 150-500 MG, 50-1,000 MG


INVOKAMET ORAL TABLET 50-500 MG 2 ST; MO; QL (120 EA per 30 days)

INVOKAMET XR ORAL TABLET, IR - ER, BIPHASIC 24HR 150-1,000 MG, 150-500 MG, 50-1,000 MG, 50-500 MG


INVOKANA ORAL TABLET 100 MG, 300 MG 2 ST; MO; QL (30 EA per 30 days)

JANUMET ORAL TABLET 50-1,000 MG, 50-500 MG


JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG


JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 50-1,000 MG, 50-500 MG


JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG


JARDIANCE ORAL TABLET 10 MG, 25 MG 2 ST; MO; QL (30 EA per 30 days)

JENTADUETO ORAL TABLET 2.5-1,000 MG, 2.5-500 MG, 2.5-850 MG


JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG


JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 5-1,000 MG


KORLYM ORAL TABLET 300 MG 2 PA; MO

metformin oral tablet 1,000 mg 1 MO; QL (75 EA per 30 days)

metformin oral tablet 500 mg 1 MO; QL (150 EA per 30 days)

metformin oral tablet 850 mg 1 MO; QL (90 EA per 30 days)

75


metformin oral tablet extended release 24 hr 500 mg


metformin oral tablet extended release 24 hr 750 mg


nateglinide oral tablet 120 mg, 60 mg 1 ST; MO; QL (90 EA per 30 days)

OZEMPIC SUBCUTANEOUS PEN INJECTOR 0.25 MG OR 0.5 MG(2 MG/1.5 ML), 1 MG/DOSE (2 MG/1.5 ML)

2 ST; MO; QL (3 ML per 28 days)

pioglitazone oral tablet 15 mg, 30 mg, 45 mg 1 ST; MO; QL (30 EA per 30 days)

pioglitazone-metformin oral tablet 15-500 mg, 15-850 mg


repaglinide oral tablet 0.5 mg, 1 mg 1 ST; MO; QL (120 EA per 30 days)

repaglinide oral tablet 2 mg 1 ST; MO

SEGLUROMET ORAL TABLET 2.5-1,000 MG, 7.5-1,000 MG, 7.5-500 MG


SEGLUROMET ORAL TABLET 2.5-500 MG 2 ST; MO; QL (120 EA per 30 days)

STEGLATRO ORAL TABLET 15 MG, 5 MG 2 ST; MO; QL (30 EA per 30 days)

STEGLUJAN ORAL TABLET 15-100 MG, 5-100 MG


SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR 2,700 MCG/2.7 ML

2 PA; MO

SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR 1,500 MCG/1.5 ML

2 PA; MO

SYNJARDY ORAL TABLET 12.5-1,000 MG, 12.5-500 MG, 5-1,000 MG, 5-500 MG


SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.5-1,000 MG, 5-1,000 MG


SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 25-1,000 MG


TRADJENTA ORAL TABLET 5 MG 2 ST; MO; QL (30 EA per 30 days)

TRULICITY SUBCUTANEOUS PEN INJECTOR 0.75 MG/0.5 ML, 1.5 MG/0.5 ML


VICTOZA 2-PAK SUBCUTANEOUS PEN INJECTOR 0.6 MG/0.1 ML (18 MG/3 ML)


VICTOZA 3-PAK SUBCUTANEOUS PEN INJECTOR 0.6 MG/0.1 ML (18 MG/3 ML)



76


BLOOD GLUCOSE REGULATORS

alcohol pads topical pads, medicated 1

assure id insulin safety syringe 1 ml 29 gauge x 1/2"

1 MO

gauze pad topical bandage 2 x 2 " 1

insulin syringe-needle u-100 syringe 0.3 ml 29 gauge, 1/2 ml 28 gauge

1

insulin syringe-needle u-100 syringe 1 ml 29 gauge x 1/2"

1 MO

pen needle, diabetic needle 29 gauge x 1/2" 1

GLYCEMIC AGENTS

GLUCAGEN DIAGNOSTIC KIT INJECTION RECON SOLN 1 MG/ML


GLUCAGEN HYPOKIT INJECTION RECON SOLN 1 MG


GLUCAGON EMERGENCY KIT (HUMAN) INJECTION RECON SOLN 1 MG


GLUCAGON HCL INJECTION RECON SOLN 1 MG


hm glucose 4 gram tablet chew orange flavor (otc) 4 gram

3 DP

hm glucose 4 gram tablet chew raspberry flavor (otc) 4 gram

3 DP

PROGLYCEM ORAL SUSPENSION 50 MG/ML 2 MO

sm glucose 4 gram tab chew 6's (rx) 4 gram 3 DP

INSULINS

HUMALOG JUNIOR KWIKPEN U-100 SUBCUTANEOUS INSULIN PEN, HALF-UNIT 100 UNIT/ML

2 MO

HUMALOG KWIKPEN INSULIN SUBCUTANEOUS INSULIN PEN 200 UNIT/ML (3 ML)

2 MO

77


HUMALOG MIX 50-50 INSULN U-100 SUBCUTANEOUS SUSPENSION 100 UNIT/ML (50-50)

2 MO

HUMALOG MIX 50-50 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (50-50)

2 MO

HUMALOG MIX 75-25 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (75-25)

2 MO

HUMALOG MIX 75-25(U-100)INSULN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (75-25)

2 MO

HUMALOG U-100 INSULIN SUBCUTANEOUS CARTRIDGE 100 UNIT/ML

2 MO

HUMULIN 70/30 U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (70-30)

2 MO

HUMULIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML

2 MO

HUMULIN R REGULAR U-100 INSULN INJECTION SOLUTION 100 UNIT/ML

2 MO

HUMULIN R U-500 (CONC) INSULIN SUBCUTANEOUS SOLUTION 500 UNIT/ML

2 MO

HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNIT/ML (3 ML)

2 MO

insulin lispro subcutaneous insulin pen 100 unit/ml

1 MO

insulin lispro subcutaneous solution 100 unit/ml 1 MO

LANTUS SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

2 MO

LANTUS U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML

2 MO

LEVEMIR FLEXTOUCH U-100 INSULN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

2 MO

LEVEMIR U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML

2 MO


78


NOVOLIN 70/30 U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (70-30)

2 MO

NOVOLIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML

2 MO

NOVOLIN R REGULAR U-100 INSULN INJECTION SOLUTION 100 UNIT/ML

2 MO

NOVOLOG FLEXPEN U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

2 MO

NOVOLOG MIX 70-30 U-100 INSULN SUBCUTANEOUS SOLUTION 100 UNIT/ML (70-30)

2 MO

NOVOLOG MIX 70-30FLEXPEN U-100 SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (70-30)

2 MO

NOVOLOG PENFILL U-100 INSULIN SUBCUTANEOUS CARTRIDGE 100 UNIT/ML

2 MO

NOVOLOG U-100 INSULIN ASPART SUBCUTANEOUS SOLUTION 100 UNIT/ML

2 MO

TOUJEO MAX U-300 SOLOSTAR SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (3 ML)

2 MO

TOUJEO SOLOSTAR U-300 INSULIN SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (1.5 ML)

2 MO

BLOOD PRODUCTS/ MODIFIERS/ VOLUME EXPANDERS

ANTICOAGULANTS

COUMADIN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG

2 MO

ELIQUIS ORAL TABLET 2.5 MG, 5 MG 2 MO

ELIQUIS ORAL TABLETS,DOSE PACK 5 MG (74 TABS)

2

enoxaparin subcutaneous solution 300 mg/3 ml 1

79


enoxaparin subcutaneous syringe 100 mg/ml, 120 mg/0.8 ml, 150 mg/ml, 30 mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml

1

fondaparinux subcutaneous syringe 10 mg/0.8 ml, 2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml

1

FRAGMIN SUBCUTANEOUS SOLUTION 25,000 ANTI-XA UNIT/ML

2

FRAGMIN SUBCUTANEOUS SYRINGE 10,000 ANTI-XA UNIT/ML, 12,500 ANTI-XA UNIT/0.5 ML, 15,000 ANTI-XA UNIT/0.6 ML, 18,000 ANTI-XA UNIT/0.72 ML, 2,500 ANTI-XA UNIT/0.2 ML, 5,000 ANTI-XA UNIT/0.2 ML, 7,500 ANTI-XA UNIT/0.3 ML

2

heparin (porcine) injection cartridge 5,000 unit/ml (1 ml)

1

heparin (porcine) injection solution 1,000 unit/ml 1

heparin (porcine) injection solution 10,000 unit/ml, 5,000 unit/ml

1 B/D

heparin, porcine (pf) injection solution 1,000 unit/ml, 5,000 unit/0.5 ml

1

jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

1 MO

PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG

2 MO

warfarin oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

1 MO

XARELTO ORAL TABLET 10 MG, 15 MG, 2.5 MG, 20 MG

2 MO

XARELTO ORAL TABLETS,DOSE PACK 15 MG (42)- 20 MG (9)

2

BLOOD FORMATION MODIFIERS

anagrelide oral capsule 0.5 mg, 1 mg 1 MO

ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 150 MCG/0.75 ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML

2 PA; MO


80


ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 100 MCG/0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 25 MCG/0.42 ML, 300 MCG/0.6 ML, 40 MCG/0.4 ML, 500 MCG/ML, 60 MCG/0.3 ML

2 PA; MO

DOPTELET (10 TAB PACK) ORAL TABLET 20 MG

2 PA

DOPTELET (15 TAB PACK) ORAL TABLET 20 MG

2 PA

doptelet (30 tab pack) oral tablet 20 mg 2 PA

EPOGEN INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML

2 PA; MO

GRANIX SUBCUTANEOUS SOLUTION 300 MCG/ML, 480 MCG/1.6 ML

2 PA

GRANIX SUBCUTANEOUS SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML

2 PA

LEUKINE INJECTION RECON SOLN 250 MCG 2 PA

NEULASTA SUBCUTANEOUS SYRINGE 6 MG/0.6ML

2 PA

NEULASTA SUBCUTANEOUS SYRINGE, W/ WEARABLE INJECTOR 6 MG/0.6 ML

2 PA

NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6 ML

2 PA

NEUPOGEN INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML

2 PA

NIVESTYM SUBCUTANEOUS SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML

2 PA

PROCRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML, 40,000 UNIT/ML

2 PA; MO

PROMACTA ORAL POWDER IN PACKET 12.5 MG

2 PA; MO

81


PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG


RETACRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML, 40,000 UNIT/ML

2 PA; MO

ZARXIO INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML

2 PA

HEMOSTASIS AGENTS

MEPHYTON 5 MG TABLET 5 MG 3 DP

tranexamic acid oral tablet 650 mg 1 MO

VITAMIN K-1 1 MG/0.5 ML AMPUL LATEX-FREE, SDV 1 MG/0.5 ML

3 DP

VITAMIN K-1 1 MG/0.5 ML AMPUL SUV, L/F, OUTER 1 MG/0.5 ML

3 DP

VITAMIN K-1 10 MG/ML AMPUL LATEX-FREE, SDV 10 MG/ML

3 DP

VITAMIN K-1 10 MG/ML AMPUL SUV, L/F, OUTER 10 MG/ML

3 DP

PLATELET MODIFYING AGENTS

ASPIR EC 81 MG TABLET 81 MG 3 DP

aspirin 81 mg chewable tablet 81 mg 3 DP

aspirin 81 mg chewable tablet child low dose 81 mg

3 DP

aspirin 81 mg chewable tablet gluten-free, orange 81 mg

3 DP

aspirin 81 mg chewable tablet low dose 81 mg 3 DP

aspirin 81 mg chewable tablet low dose, cherry 81 mg

3 DP

aspirin 81 mg chewable tablet orange 81 mg 3 DP

aspirin 81 mg chewable tablet orange,gluten-free 81 mg

3 DP

aspirin 81 mg chewable tablet tab chew,orange 81 mg

3 DP

aspirin 81 mg chewable tablet u-d 81 mg 3 DP

aspirin ec 81 mg tablet 81 mg 3 DP

aspirin ec 81 mg tablet adult low dose 81 mg 3 DP


82


aspirin ec 81 mg tablet low dose 81 mg 3 DP

aspirin ec 81 mg tablet low dose sfty coated 81 mg 3 DP

aspirin ec 81 mg tablet u-d,10x10 81 mg 3 DP

aspirin ec 81 mg tablet u-d,25x30 81 mg 3 DP

aspirin-dipyridamole oral capsule, er multiphase 12 hr 25-200 mg

1 MO

ASPIR-LOW EC 81 MG TABLET 81 MG 3 DP

BRILINTA ORAL TABLET 60 MG, 90 MG 2 MO

CHILD ASPIRIN 81 MG CHEW TAB CHILDREN'S 81 MG

3 DP

cilostazol oral tablet 100 mg, 50 mg 1 MO

clopidogrel oral tablet 75 mg 1 MO

dipyridamole oral tablet 25 mg, 50 mg, 75 mg 1 PA; MO

gs aspirin 81 mg chewable tab 81 mg 3 DP

hm aspirin 81 mg chewable tab adlt low dose,orange 81 mg

3 DP

hm aspirin ec 81 mg tablet 81 mg 3 DP

hm aspirin ec 81 mg tablet low dose 81 mg 3 DP

prasugrel oral tablet 10 mg, 5 mg 1 MO

qc aspirin 81 mg chewable tab low dose, orange 81 mg

3 DP

qc aspirin ec 81 mg tablet 81 mg 3 DP

sb aspirin ec 81 mg tablet adult low strength 81 mg

3 DP

sb aspirin ec 81 mg tablet low dose,sfty coated 81 mg

3 DP

sm aspirin 81 mg chewable tab adult low strength 81 mg

3 DP

sm aspirin ec 81 mg tablet adult low strength 81 mg

3 DP

83


SM CHILD ASPIRIN 81 MG CHW TAB CHILDREN'S 81 MG

3 DP

CARDIOVASCULAR AGENTS

ALPHA-ADRENERGIC AGONISTS

clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg 1 MO

clonidine transdermal patch weekly 0.1 mg/24 hr, 0.2 mg/24 hr, 0.3 mg/24 hr

1 MO

guanfacine oral tablet 1 mg, 2 mg 1 PA; MO

methyldopa oral tablet 250 mg, 500 mg 1 PA; MO

midodrine oral tablet 10 mg, 2.5 mg, 5 mg 1

NORTHERA ORAL CAPSULE 100 MG, 200 MG, 300 MG

2 MO

ALPHA-ADRENERGIC BLOCKING AGENTS

doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg 1 MO

phenoxybenzamine oral capsule 10 mg 1 PA

prazosin oral capsule 1 mg, 2 mg, 5 mg 1 MO

terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg 1 MO

ANGIOTENSIN II RECEPTOR ANTAGONISTS

irbesartan oral tablet 150 mg, 300 mg, 75 mg 1 MO

losartan oral tablet 100 mg, 25 mg, 50 mg 1 MO

olmesartan oral tablet 20 mg, 40 mg, 5 mg 1 MO

valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg

1 MO

ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS

benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1 MO

captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg

1 MO

enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg

1 MO

fosinopril oral tablet 10 mg, 20 mg, 40 mg 1 MO

lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg

1 MO

moexipril oral tablet 15 mg, 7.5 mg 1 MO

quinapril oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1 MO


84


ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg

1 MO

trandolapril oral tablet 1 mg, 2 mg, 4 mg 1 MO

ANTIARRHYTHMICS

amiodarone oral tablet 100 mg, 200 mg, 400 mg 1 MO

disopyramide phosphate oral capsule 100 mg, 150 mg

1 PA; MO

dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg 1 MO

flecainide oral tablet 100 mg, 150 mg, 50 mg 1 MO

mexiletine oral capsule 150 mg, 200 mg, 250 mg 1 MO

MULTAQ ORAL TABLET 400 MG 2 MO

NORPACE CR ORAL CAPSULE, EXTENDED RELEASE 100 MG, 150 MG

2 PA; MO

propafenone oral tablet 150 mg, 225 mg, 300 mg 1 MO

quinidine gluconate oral tablet extended release 324 mg

1 MO

quinidine sulfate oral tablet 200 mg, 300 mg 1 MO

sorine oral tablet 120 mg, 160 mg, 240 mg, 80 mg 1 MO

sotalol af oral tablet 120 mg, 160 mg, 80 mg 1 MO

sotalol oral tablet 120 mg, 160 mg, 240 mg, 80 mg 1 MO

BETA-ADRENERGIC BLOCKING AGENTS

acebutolol oral capsule 200 mg, 400 mg 1 MO

atenolol oral tablet 100 mg, 25 mg, 50 mg 1 MO

betaxolol oral tablet 10 mg, 20 mg 1 MO

bisoprolol fumarate oral tablet 10 mg, 5 mg 1 MO

BYSTOLIC ORAL TABLET 10 MG, 2.5 MG, 20 MG, 5 MG

2 MO

carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg

1 MO

labetalol oral tablet 100 mg, 200 mg, 300 mg 1 MO

85


metoprolol succinate oral tablet extended release 24 hr 100 mg, 200 mg, 25 mg, 50 mg

1 MO

metoprolol ta-hydrochlorothiaz oral tablet 100-25 mg, 100-50 mg, 50-25 mg

1 MO

metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg

1 MO

nadolol oral tablet 20 mg, 40 mg, 80 mg 1 MO

pindolol oral tablet 10 mg, 5 mg 1 MO

propranolol oral capsule,extended release 24 hr 120 mg, 160 mg, 60 mg, 80 mg

1 MO

propranolol oral solution 20 mg/5 ml (4 mg/ml), 40 mg/5 ml (8 mg/ml)

1 MO

propranolol oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

1 MO

timolol maleate oral tablet 10 mg, 20 mg, 5 mg 1 MO

CALCIUM CHANNEL BLOCKING AGENTS

amlodipine oral tablet 10 mg, 2.5 mg, 5 mg 1 MO

cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg

1 MO

diltiazem hcl oral capsule,ext.rel 24h degradable 120 mg, 180 mg, 240 mg

1 MO

diltiazem hcl oral capsule,extended release 12 hr 120 mg, 60 mg, 90 mg

1 MO

diltiazem hcl oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

1 MO

diltiazem hcl oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

1 MO

diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg

1 MO

dilt-xr oral capsule,ext.rel 24h degradable 120 mg, 180 mg, 240 mg

1 MO

felodipine oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg

1 MO

isradipine oral capsule 2.5 mg, 5 mg 1 MO

nifedical xl oral tablet extended release 24hr 30 mg, 60 mg

1 MO

nifedipine oral capsule 10 mg, 20 mg 1 PA; MO


86


nifedipine oral tablet extended release 24hr 30 mg, 60 mg, 90 mg

1 MO

nifedipine oral tablet extended release 30 mg, 60 mg, 90 mg

1 MO

nimodipine oral capsule 30 mg 1 MO

taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

1 MO

verapamil oral capsule, 24 hr er pellet ct 100 mg, 200 mg, 300 mg

1 MO

verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg, 360 mg

1 MO

verapamil oral tablet 120 mg, 40 mg, 80 mg 1 MO

verapamil oral tablet extended release 120 mg, 120 mg (24 hours), 180 mg, 240 mg

1 MO

CARDIOVASCULAR AGENTS, OTHER

aliskiren oral tablet 150 mg, 300 mg 1 MO

amiloride-hydrochlorothiazide oral tablet 5-50 mg 1 MO

amlodipine-benazepril oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg

1 MO

amlodipine-olmesartan oral tablet 10-20 mg, 10-40 mg, 5-20 mg, 5-40 mg

1 MO

amlodipine-valsartan oral tablet 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg

1 MO

amlodipine-valsartan-hcthiazid oral tablet 10-160-12.5 mg, 10-160-25 mg, 10-320-25 mg, 5-160-12.5 mg, 5-160-25 mg

1 MO

atenolol-chlorthalidone oral tablet 100-25 mg, 50-25 mg

1 MO

benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg

1 MO

bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg

1 MO

87


captopril-hydrochlorothiazide oral tablet 25-15 mg, 25-25 mg, 50-15 mg, 50-25 mg

1 MO

CORLANOR ORAL TABLET 5 MG, 7.5 MG 2 PA; MO

DEMSER ORAL CAPSULE 250 MG 2 PA

digitek oral tablet 125 mcg (0.125 mg) 1 MO; QL (30 EA per 30 days)

digitek oral tablet 250 mcg (0.25 mg) 1 PA; MO

digox oral tablet 125 mcg (0.125 mg) 1 MO; QL (30 EA per 30 days)

digox oral tablet 250 mcg (0.25 mg) 1 PA; MO

digoxin oral solution 50 mcg/ml (0.05 mg/ml) 1 PA; MO

digoxin oral tablet 125 mcg (0.125 mg) 1 MO; QL (30 EA per 30 days)

digoxin oral tablet 250 mcg (0.25 mg) 1 PA; MO

enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg

1 MO

ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG

2 MO

fosinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg

1 MO

irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg

1 MO

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

1 MO

losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg

1 MO

methyldopa-hydrochlorothiazide oral tablet 250-15 mg, 250-25 mg

1 PA; MO

moexipril-hydrochlorothiazide oral tablet 15-12.5 mg, 15-25 mg, 7.5-12.5 mg

1 MO

olmesartan-amlodipin-hcthiazid oral tablet 20-5-12.5 mg, 40-10-12.5 mg, 40-10-25 mg, 40-5-12.5 mg, 40-5-25 mg

1 MO

olmesartan-hydrochlorothiazide oral tablet 20-12.5 mg, 40-12.5 mg, 40-25 mg

1 MO

pentoxifylline oral tablet extended release 400 mg 1 MO

propranolol-hydrochlorothiazid oral tablet 40-25 mg, 80-25 mg

1 MO

quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

1 MO


88


ranolazine oral tablet extended release 12 hr 1,000 mg, 500 mg

1 ST; MO

spironolacton-hydrochlorothiaz oral tablet 25-25 mg

1 MO

TEKTURNA HCT ORAL TABLET 150-12.5 MG, 150-25 MG, 300-12.5 MG, 300-25 MG

2 MO

triamterene-hydrochlorothiazid oral capsule 37.5-25 mg

1 MO

triamterene-hydrochlorothiazid oral tablet 37.5-25 mg, 75-50 mg

1 MO

valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg

1 MO

DIURETICS, CARBONIC ANHYDRASE INHIBITORS

acetazolamide oral capsule, extended release 500 mg

1 MO

acetazolamide oral tablet 125 mg, 250 mg 1 MO

KEVEYIS ORAL TABLET 50 MG 2 PA; MO

methazolamide oral tablet 25 mg, 50 mg 1 MO

DIURETICS, LOOP

bumetanide oral tablet 0.5 mg, 1 mg, 2 mg 1 MO

furosemide injection solution 10 mg/ml 1

furosemide injection syringe 10 mg/ml 1

furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml)

1 MO

furosemide oral tablet 20 mg, 40 mg, 80 mg 1 MO

torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg 1 MO

DIURETICS, POTASSIUM-SPARING

amiloride oral tablet 5 mg 1 MO

eplerenone oral tablet 25 mg, 50 mg 1 MO

spironolactone oral tablet 100 mg, 25 mg, 50 mg 1 MO

89


DIURETICS, THIAZIDE

chlorothiazide oral tablet 250 mg, 500 mg 1 MO

chlorthalidone oral tablet 25 mg, 50 mg 1 MO

hydrochlorothiazide oral capsule 12.5 mg 1 MO

hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg

1 MO

indapamide oral tablet 1.25 mg, 2.5 mg 1 MO

methyclothiazide oral tablet 5 mg 1 MO

metolazone oral tablet 10 mg, 2.5 mg, 5 mg 1 MO

DYSLIPIDEMICS, FIBRIC ACID DERIVATIVES

fenofibrate micronized oral capsule 134 mg, 200 mg, 43 mg, 67 mg

1 MO

fenofibrate nanocrystallized oral tablet 145 mg, 160 mg, 48 mg

1 MO

fenofibrate oral tablet 160 mg, 54 mg 1 MO

fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 mg, 45 mg

1 MO

fenofibric acid oral tablet 35 mg 1 MO

gemfibrozil oral tablet 600 mg 1 MO

DYSLIPIDEMICS, HMG COA REDUCTASE INHIBITORS

atorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg

1 MO

LIVALO ORAL TABLET 1 MG, 2 MG, 4 MG 2 MO

lovastatin oral tablet 10 mg, 20 mg, 40 mg 1 MO

pravastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg

1 MO

rosuvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

1 MO

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg, 80 mg

1 MO

DYSLIPIDEMICS, OTHER

cholestyramine (with sugar) oral powder 4 gram 1 MO

cholestyramine (with sugar) oral powder in packet 4 gram

1 MO

cholestyramine light oral powder 4 gram 1 MO


90


cholestyramine light oral powder in packet 4 gram 1 MO

colesevelam oral powder in packet 3.75 gram 1 MO

colesevelam oral tablet 625 mg 1 MO

colestipol oral granules 5 gram 1 MO

colestipol oral packet 5 gram 1 MO

colestipol oral tablet 1 gram 1 MO

ezetimibe oral tablet 10 mg 1 MO

ezetimibe-simvastatin oral tablet 10-10 mg, 10-20 mg, 10-40 mg, 10-80 mg

1 MO

JUXTAPID ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 5 MG, 60 MG

2 PA; MO

niacin 500 mg tablet (rx) 500 mg 3 DP

niacin oral tablet extended release 24 hr 1,000 mg, 500 mg, 750 mg

1 MO

niacin tr 500 mg caplet caplet (rx) 500 mg 3 DP

niacin tr 500 mg capsule (rx) 500 mg 3 DP

niacinamide 500 mg tablet (rx) 500 mg 3 DP

omega-3 acid ethyl esters oral capsule 1 gram 1 MO

prevalite oral powder 4 gram 1 MO

prevalite oral powder in packet 4 gram 1 MO

REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR 420 MG/3.5 ML

2 PA; MO

REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR 140 MG/ML

2 PA; MO

REPATHA SYRINGE SUBCUTANEOUS SYRINGE 140 MG/ML

2 PA; MO

TRIKLO ORAL CAPSULE 1 GRAM 1 MO

VASODILATORS, DIRECT-ACTING ARTERIAL

hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg

1 MO

minoxidil oral tablet 10 mg, 2.5 mg 1 MO

91


VASODILATORS, DIRECT-ACTING ARTERIAL/ VENOUS

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg

1 MO

isosorbide dinitrate oral tablet extended release 40 mg

1 MO

isosorbide mononitrate oral tablet 10 mg, 20 mg 1 MO

isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 mg, 60 mg

1 MO

NITRO-BID TRANSDERMAL OINTMENT 2 % 2 MO

NITRO-DUR TRANSDERMAL PATCH 24 HOUR 0.3 MG/HR, 0.8 MG/HR

2 MO

nitroglycerin sublingual tablet 0.3 mg, 0.4 mg, 0.6 mg

1 MO

nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr

1 MO

nitroglycerin translingual aerosol,spray 400 mcg/spray

1 MO

nitroglycerin translingual spray,non-aerosol 400 mcg/spray

1 MO

CENTRAL NERVOUS SYSTEM AGENTS

ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, AMPHETAMINES

dextroamphetamine oral capsule, extended release 10 mg






dextroamphetamine oral tablet 10 mg 1 PA; MO; QL (180 EA per 30 days)

dextroamphetamine oral tablet 5 mg 1 PA; MO; QL (60 EA per 30 days)

dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg


dextroamphetamine-amphetamine oral tablet 10 mg, 20 mg, 30 mg, 5 mg, 7.5 mg


dextroamphetamine-amphetamine oral tablet 12.5 mg



92


dextroamphetamine-amphetamine oral tablet 15 mg


ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, NON-AMPHETAMINES

atomoxetine oral capsule 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg

1 MO

clonidine hcl oral tablet extended release 12 hr 0.1 mg


dexmethylphenidate oral capsule,er biphasic 50-50 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg

1 PA; MO

dexmethylphenidate oral tablet 10 mg, 2.5 mg, 5 mg

1 PA; MO

guanfacine oral tablet extended release 24 hr 1 mg, 2 mg, 3 mg, 4 mg

1 MO

methylphenidate hcl oral capsule, er biphasic 30-70 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

1 PA; MO

methylphenidate hcl oral capsule,er biphasic 50-50 20 mg, 30 mg, 40 mg, 60 mg

1 PA; MO

methylphenidate hcl oral solution 10 mg/5 ml, 5 mg/5 ml

1 PA; MO

methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg

1 PA; MO

methylphenidate hcl oral tablet extended release 10 mg

1 PA; MO

methylphenidate hcl oral tablet extended release 20 mg


methylphenidate hcl oral tablet extended release 24hr 18 mg






93




methylphenidate hcl oral tablet,chewable 10 mg, 2.5 mg, 5 mg

1 PA; MO

CENTRAL NERVOUS SYSTEM, OTHER

AUSTEDO ORAL TABLET 12 MG, 6 MG, 9 MG

2 PA; MO

FIRDAPSE ORAL TABLET 10 MG 2 PA; MO

INGREZZA INITIATION PACK ORAL CAPSULE,DOSE PACK 40 MG (7)- 80 MG (21)

2 PA

INGREZZA ORAL CAPSULE 40 MG, 80 MG 2 PA; MO

NUEDEXTA ORAL CAPSULE 20-10 MG 2 PA

riluzole oral tablet 50 mg 1 MO

tetrabenazine oral tablet 12.5 mg, 25 mg 1 PA; MO

FIBROMYALGIA AGENTS

duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg

1 MO

SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 MG

2 MO

SAVELLA ORAL TABLETS,DOSE PACK 12.5 MG (5)-25 MG(8)-50 MG(42)

2

MULTIPLE SCLEROSIS AGENTS

AUBAGIO ORAL TABLET 14 MG, 7 MG 2 PA; MO

BETASERON SUBCUTANEOUS KIT 0.3 MG 2 PA; MO

BETASERON SUBCUTANEOUS RECON SOLN 0.3 MG

2 PA; MO

dalfampridine oral tablet extended release 12 hr 10 mg

1 PA; MO

EXTAVIA SUBCUTANEOUS RECON SOLN 0.3 MG

2 PA; MO

GILENYA ORAL CAPSULE 0.5 MG 2 PA; MO

glatiramer subcutaneous syringe 20 mg/ml, 40 mg/ml

1 PA; MO

GLATOPA SUBCUTANEOUS SYRINGE 20 MG/ML, 40 MG/ML

1 PA; MO

MAYZENT ORAL TABLET 0.25 MG, 2 MG 2 PA; MO


94


REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE 22 MCG/0.5 ML, 44 MCG/0.5 ML

2 PA; MO

REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML

2 PA; MO

REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 8.8MCG/0.2ML-22 MCG/0.5ML (6)

2 PA

REBIF TITRATION PACK SUBCUTANEOUS SYRINGE 8.8MCG/0.2ML-22 MCG/0.5ML (6)

2 PA

TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46)

2 PA

TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG, 240 MG

2 PA; MO

DENTAL AND ORAL AGENTS

DENTAL AND ORAL AGENTS

cevimeline oral capsule 30 mg 1 MO

chlorhexidine gluconate mucous membrane mouthwash 0.12 %

1

periogard mucous membrane mouthwash 0.12 % 1

pilocarpine hcl oral tablet 5 mg, 7.5 mg 1 MO

triamcinolone acetonide dental paste 0.1 % 1

DERMATOLOGICAL AGENTS

DERMATOLOGICAL AGENTS

acitretin oral capsule 10 mg, 17.5 mg, 25 mg 1 PA

ACNE MEDICATION 10% GEL 10 % 3 DP

ACNE MEDICATION 5% GEL 5 % 3 DP

adapalene topical gel 0.1 % 1

adapalene-benzoyl peroxide topical gel with pump 0.1-2.5 %

1

ammonium lactate topical cream 12 % 1

ammonium lactate topical lotion 12 % 1

95


AMNESTEEM ORAL CAPSULE 10 MG, 20 MG, 40 MG

1

benzoyl peroxide 10% gel aqueous (otc) 10 % 3 DP

calcipotriene scalp solution 0.005 % 1

calcipotriene topical cream 0.005 % 1

calcipotriene topical ointment 0.005 % 1

CLARAVIS ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG

1

clindamycin-benzoyl peroxide topical gel 1-5 %, 1.2 %(1 % base) -5 %

1

clindamycin-benzoyl peroxide topical gel with pump 1-5 %, 1.2-2.5 %

1

clotrimazole-betamethasone topical cream 1-0.05 %

1

clotrimazole-betamethasone topical lotion 1-0.05 %

1

COLEMAN BOTANICALS INSECT SPR 30 % 3 DP

COLEMAN HIGH-DRY 25% REPEL SPR 25 % 3 DP

COLEMAN SKINSMART INSECT REP 20 % 3 DP

COLEMAN SKINSMART INSECT REP 20 % 3 DP

COLEMAN SPORTSMN 40% REPEL SPR 40 % 3 DP

COSENTYX (2 SYRINGES) SUBCUTANEOUS SYRINGE 150 MG/ML

2 PA; MO

COSENTYX PEN (2 PENS) SUBCUTANEOUS PEN INJECTOR 150 MG/ML

2 PA; MO

COSENTYX PEN SUBCUTANEOUS PEN INJECTOR 150 MG/ML

2 PA; MO

COSENTYX SUBCUTANEOUS SYRINGE 150 MG/ML

2 PA; MO

CUTTER BACKWOODS 25% SPRAY 25 % 3 DP

CUTTER BACKWOODS 25% SPRAY 25 % 3 DP

CUTTER BACKWOODS DRY 25% SPRAY 25 %

3 DP

CUTTER LEMON EUCALYPTUS SPRAY 30 % 3 DP

CUTTER NATURAL REPELLENT2 SPRY 5-2 %

3 DP


96


CUTTER SKINSATIONS 7% SPRAY 7 % 3 DP

CVS INSECT REPELLENT 15% SPRAY 15 % 3 DP

CVS TOTAL HOME INSECT 30% SPR 30 % 3 DP

DOXEPIN TOPICAL CREAM 5 % 1

DUPIXENT SUBCUTANEOUS SYRINGE 200 MG/1.14 ML, 300 MG/2 ML

2 PA; MO

erythromycin-benzoyl peroxide topical gel 3-5 % 1

EUCRISA TOPICAL OINTMENT 2 % 2 PA

GS ANTI-ITCH 1% CREAM 1 % 3 DP

HYDRO SKIN 1% LOTION 1 % 3 DP

hydrocortisone 1% cream 1 % 3 DP

hydrocortisone-min oil-wht pet topical ointment 1 %

1

imiquimod topical cream in packet 5 % 1

isotretinoin oral capsule 10 mg, 20 mg, 30 mg, 40 mg

1

methoxsalen oral capsule,liqd-filled,rapid rel 10 mg

1 PA

myorisan oral capsule 10 mg, 20 mg, 30 mg, 40 mg

1

NATRAPEL 20% SPRAY 20 % 3 DP

nystatin-triamcinolone topical cream 100,000-0.1 unit/g-%

1

nystatin-triamcinolone topical ointment 100,000-0.1 unit/gram-%

1

OFF ACTIVE 15% SPRAY 15 % 3 DP

OFF DEEP WOODS 25% SPRAY 25 % 3 DP

OFF DEEP WOODS 25% SPRAY 25 % 3 DP

OFF DEEP WOODS DRY 25% SPRAY 25 % 3 DP

OFF DEEP WOODS SPORTMN 25% SPR 25 % 3 DP

OFF DEEP WOODS SPORTMN 30% SPR 30 % 3 DP

97


OFF DEEP WOODS SPORTMN 98.25% 98.25 % 3 DP

OFF FAMILYCARE 15% RPLNT I SPR 15 % 3 DP

OFF FAMILYCARE 5% RPLNT II SPR 5 % 3 DP

OFF FAMILYCARE 7% RPLNT SPRAY 7 % 3 DP

pimecrolimus topical cream 1 % 1 ST

podofilox topical solution 0.5 % 1

prednicarbate topical cream 0.1 % 1

prednicarbate topical ointment 0.1 % 1

REGRANEX TOPICAL GEL 0.01 % 2 PA; QL (15 GM per 30 days)

REPEL 100 98.11% SPRAY 98.11 % 3 DP

REPEL FAMILY 10% SPRAY 10 % 3 DP

REPEL FAMILY 15% SPRAY 15 % 3 DP

REPEL HUNTER'S 25% SPRAY 25 % 3 DP

REPEL LEMON EUCALYPTUS 30% SPR 30 % 3 DP

REPEL SPORTSMEN 25% SPRAY 25 % 3 DP

REPEL SPORTSMEN DRY 25% SPRAY 25 % 3 DP

REPEL SPORTSMEN MAX 40% LOTION 40 % 3 DP

REPEL SPORTSMEN MAX 40% SPRAY 40 % 3 DP

REPEL SPORTSMEN MAX 40% SPRAY 40 % 3 DP

REPEL TICK DEFENSE 15% SPRAY 15 % 3 DP

SANTYL TOPICAL OINTMENT 250 UNIT/GRAM

2

selenium sulfide topical lotion 2.5 % 1

STELARA SUBCUTANEOUS SOLUTION 45 MG/0.5 ML

2 PA; MO

STELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML, 90 MG/ML

2 PA; MO

tacrolimus topical ointment 0.03 %, 0.1 % 1 ST

tazarotene topical cream 0.1 % 1

TAZORAC TOPICAL CREAM 0.05 % 2

TAZORAC TOPICAL GEL 0.05 %, 0.1 % 2

TREMFYA SUBCUTANEOUS AUTO-INJECTOR 100 MG/ML

2 PA; MO


98


TREMFYA SUBCUTANEOUS SYRINGE 100 MG/ML

2 PA; MO

tretinoin (emollient) topical cream 0.05 % 1

tretinoin topical cream 0.025 %, 0.05 %, 0.1 % 1

tretinoin topical gel 0.01 %, 0.025 % 1

ULTRATHON 25% REPELLENT SPRAY (RX) 25 %

3 DP

ULTRATHON 34.34% REPEL LOTION 34.34 % 3 DP

ZENATANE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG

1

zinc oxide 20% ointment (otc) 20 % 3 DP

ELECTROLYTES/MINERALS/ METALS/ VITAMINS

ELECTROLYTE/MINERAL REPLACEMENT

AMINOSYN II 10 % INTRAVENOUS PARENTERAL SOLUTION 10 %

2 B/D

AMINOSYN II 15 % INTRAVENOUS PARENTERAL SOLUTION 15 %

2 B/D

AMINOSYN-PF 10 % INTRAVENOUS PARENTERAL SOLUTION 10 %

2 B/D

AMINOSYN-PF 7 % (SULFITE-FREE) INTRAVENOUS PARENTERAL SOLUTION 7 %

2 B/D

AQUADEKS PEDIATRIC LIQUID 400 MCG/ML

3 DP

BALANCED B-50 TABLET (RX) 3 DP

biotin 300 mcg tablet s/f,p/f,lactose-free (rx) 300 mcg

3 DP

biotin 5 mg tablet 5 mg 3 DP

CALCITRATE 200 MG (950 MG) TAB (RX) 200 MG (950 MG)

3 DP

calcium 600 mg tablet (rx) 600 mg calcium (1,500 mg)

3 DP

99


CALCIUM 600 MG TABLET (RX) 600 MG CALCIUM (1,500 MG)

3 DP

CALCIUM 600-VIT D3 200 TABLET (RX) 600 MG(1,500MG) -200 UNIT

3 DP

calcium carb 1,250 mg/5 ml sus (rx) 500 mg/5 ml (1,250 mg/5 ml)

3 DP

calcium carb 1,250 mg/5 ml sus 40's,u-d,a/f (otc) 500 mg/5 ml (1,250 mg/5 ml)

3 DP

calcium carb 1,250 mg/5 ml sus s/f, a/f, na/f (otc) 500 mg/5 ml (1,250 mg/5 ml)

3 DP

calcium carb 500 (1,250) mg tb (rx) 500 mg calcium (1,250 mg)

3 DP

calcium carbonate 1.25 gm tab (rx) 500 mg calcium (1,250 mg)

3 DP

calcium carbonate 648 mg tab 260 mg calcium (648 mg)

3 DP

calcium gluconate 500 mg tab 45 mg (500 mg) 3 DP

CARBAGLU ORAL TABLET, DISPERSIBLE 200 MG

2 PA; MO

CERTAVITE SR-ANTIOXIDANT TAB 0.4-300-250 MG-MCG-MCG

3 DP

CHILD CHEW + IRON TAB CHEW 3 DP

CHILD CHEW VITAMIN TABLET (RX) 3 DP

child ferrous sulfate 15 mg/ml (rx) 15 mg iron (75 mg)/ml

3 DP

clinimix 4.25%/d10w sulf free intravenous parenteral solution 4.25 %

1 B/D

clinimix 4.25%-d25w sulf-free intravenous parenteral solution 4.25 %

1 B/D

clinisol sf 15 % intravenous parenteral solution 15 %

1 B/D

d10 %-0.45 % sodium chloride intravenous parenteral solution

1

d2.5 %-0.45 % sodium chloride intravenous parenteral solution

1

d5 % and 0.9 % sodium chloride intravenous parenteral solution

1


100


d5 %-0.45 % sodium chloride intravenous parenteral solution

1

DEKAS ESSENTIAL CAPSULE 2,000 UNIT-2000 UNIT-1,000 MCG

3 DP

DEKAS ESSENTIAL LIQUID 2,000 UNIT- 2,000 MCG/ML

3 DP

DEKAS PLUS CHEWABLE TABLET 200 MCG-1,000 MCG-10 MG

3 DP

DEKAS PLUS LIQUID 500 MCG/ML 3 DP

DEKAS PLUS SOFTGEL 200 MCG-1,000 MCG-10 MG

3 DP

dextrose 10 % and 0.2 % nacl intravenous parenteral solution

1

dextrose 10 % in water (d10w) intravenous parenteral solution 10 %

1

dextrose 5 % in water (d5w) intravenous parenteral solution

1

dextrose 5 % in water (d5w) intravenous piggyback 5 %

1

dextrose 5%-0.2 % sod chloride intravenous parenteral solution

1

dextrose 5%-0.3 % sod.chloride intravenous parenteral solution

1

DEXTROSE WITH SODIUM CHLORIDE INTRAVENOUS PARENTERAL SOLUTION 5-0.2 %

1

ELDERTONIC ELIXIR 0.5-0.6-7-0.7 MG 3 DP

ENDARI ORAL POWDER IN PACKET 5 GRAM

2 PA

FERGON 27 MG TABLET (RX) 240 MG (27 MG IRON)

3 DP

FER-IN-SOL 15 MG/ML DROPS 15 MG IRON (75 MG)/ML

3 DP

101


FEROSUL 220 MG/5 ML ELIXIR 220 MG (44 MG IRON)/5 ML

3 DP

FEROSUL 325 MG TABLET F/C (RX) 325 MG (65 MG IRON)

3 DP

FEROSUL 325 MG TABLET F/C,BLISTER PACK (RX) 325 MG (65 MG IRON)

3 DP

FERRO-TIME 325 MG TABLET F/C, GREEN 325 MG (65 MG IRON)

3 DP

ferrous fumarate 324 mg tab 324 mg (106 mg iron)

3 DP

ferrous gluconate 324 mg tab (rx) 324 mg (37.5 mg iron), 324 mg (38 mg iron)

3 DP

ferrous sulf 15 mg iron/ml drp (rx) 15 mg iron (75 mg)/ml

3 DP

ferrous sulf 15 mg iron/ml drp gluten-free (rx) 15 mg iron (75 mg)/ml

3 DP

ferrous sulf 220 mg/5 ml elix (rx) 220 mg (44 mg iron)/5 ml

3 DP

ferrous sulf 220 mg/5 ml liq (rx) 220 mg (44 mg iron)/5 ml

3 DP

ferrous sulf 300 mg/5 ml liq 300 mg (60 mg iron)/5 ml

3 DP

ferrous sulf ec 324 mg tablet 324 mg (65 mg iron) 3 DP

ferrous sulf ec 325 mg tablet (rx) 325 mg (65 mg iron)

3 DP

ferrous sulf ec 325 mg tablet u-d, inner (rx) 325 mg (65 mg iron)

3 DP

ferrous sulf ec 325 mg tablet u-d, outer (rx) 325 mg (65 mg iron)

3 DP

ferrous sulfate 325 mg tablet (rx) 325 mg (65 mg iron)

3 DP

ferrous sulfate 325 mg tablet f/c (rx) 325 mg (65 mg iron)

3 DP

ferrous sulfate 325 mg tablet f/c, green (rx) 325 mg (65 mg iron)

3 DP

ferrous sulfate 325 mg tablet f/c, red (rx) 325 mg (65 mg iron)

3 DP


102


ferrous sulfate 325 mg tablet u-d,10x10, film coat (rx) 325 mg (65 mg iron)

3 DP

FERROUSUL 325 MG TABLET 325 MG (65 MG IRON)

3 DP

FLUORIDE (SODIUM) ORAL TABLET 1 MG (2.2 MG SOD. FLUORIDE)

1

folic acid 1 mg tablet (rx) 1 mg 3 MO; DP

folic acid 1 mg tablet 10x10, u-d, inner (rx) 1 mg 3 MO; DP

folic acid 1 mg tablet inner,u-d,robot-rdy (rx) 1 mg 3 MO; DP

folic acid 1 mg tablet outer,u-d,robot-rdy (rx) 1 mg 3 MO; DP

folic acid 1 mg tablet u-d,inner,10x10 (rx) 1 mg 3 MO; DP

folic acid 1 mg tablet u-d,outer,10x10 (rx) 1 mg 3 MO; DP

folic acid 400 mcg tablet (rx) 400 mcg 3 DP

folic acid 400 mcg tablet s/f,p/f,lactose-free (rx) 400 mcg

3 DP

folic acid 5 mg/ml vial latex-free, mdv 5 mg/ml 3 DP

HEMOCYTE TABLET 324 MG (106 MG IRON) 3 DP

hydroxocobalamin 1,000 mcg/ml 1,000 mcg/ml 3 DP

ICAPS MV TABLET (OTC) 100-1.66-0.83 MCG-MG-MG

3 DP

ICAPS MV TABLET (RX) 100-1.66-0.83 MCG-MG-MG

3 DP

IFEREX 150 CAPSULE 150 MG IRON 3 DP

INFED 100 MG/2 ML VIAL 10S,OUTER,L/F,SDV 50 MG/ML

3 DP

intralipid intravenous emulsion 20 % 2 B/D

INTRALIPID INTRAVENOUS EMULSION 30 %

2 B/D

IRON 325 MG TABLET (OTC) 325 MG (65 MG IRON)

3 DP

ISOLYTE S PH 7.4 INTRAVENOUS PARENTERAL SOLUTION

2

103


ISOLYTE-P IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION 5 %

2

ISOLYTE-S INTRAVENOUS PARENTERAL SOLUTION

2

klor-con 10 oral tablet extended release 10 meq 1 MO

klor-con 8 oral tablet extended release 8 meq 1 MO

klor-con m10 oral tablet,er particles/crystals 10 meq

1 MO

KLOR-CON M15 ORAL TABLET,ER PARTICLES/CRYSTALS 15 MEQ

2 MO

klor-con m20 oral tablet,er particles/crystals 20 meq

1 MO

KLOR-CON SPRINKLE ORAL CAPSULE, EXTENDED RELEASE 10 MEQ, 8 MEQ

1 MO

K-SOL ORAL LIQUID 20 MEQ/15 ML 1 MO

levocarnitine (with sugar) oral solution 100 mg/ml 1 MO

levocarnitine oral tablet 330 mg 1 MO

MAG64 DR 64 MG TABLET (RX) 64 MG 3 DP

MAGNEBIND 300 TABLET 250-300 MG 3 DP

magnesium 250 mg tablet (rx) 250 mg 3 DP

magnesium oxide 400 mg tablet (otc) 400 mg (241.3 mg magnesium)

3 DP

magnesium oxide 400 mg tablet (rx) 400 mg (241.3 mg magnesium)

3 DP

magnesium oxide 400 mg tablet p/f,soy-free (rx) 400 mg (241.3 mg magnesium)

3 DP

magnesium oxide 400 mg tablet s/f,p/f,gluten-free (otc) 400 mg (241.3 mg magnesium)

3 DP

magnesium oxide 420 mg tablet (rx) 420 mg 3 DP

magnesium oxide 500 mg tablet p/f,s/f,lactose-free (rx) 500 mg

3 DP

magnesium sulfate injection solution 4 meq/ml (50 %)

1

MERIBIN 5 MG CAPSULE 5 MG 3 DP

NASCOBAL 500 MCG NASAL SPRAY OUTER 500 MCG/SPRAY

3 MO; DP


104


normosol-r intravenous parenteral solution 1

normosol-r ph 7.4 intravenous parenteral solution 1

NU-MAG 71.5 MG TABLET 71.5 MG 3 DP

OCUVITE WITH LUTEIN TABLET 1,000 UNIT-200 MG-60 UNIT-2 MG

3 DP

ONCOVITE TABLET 3 DP

ONE DAILY TABLET (OTC) 3 DP

ONE DAILY TABLET MEN'S FORMULA (RX) 3 DP

OS-CAL 500-VIT D3 600 CAPLET 500MG (1,250MG) -600 UNIT

3 DP

OYSCO-500 TABLET 500 MG CALCIUM (1,250 MG)

3 DP

OYSTER SHELL CALCIUM 500 MG CAPLET,P/F,SOY-FREE (RX) 500 MG CALCIUM (1,250 MG)

3 DP

OYSTER SHELL CALCIUM 500 MG TB (RX) 500 MG CALCIUM (1,250 MG)

3 DP

OYSTER SHELL CALCIUM 500 MG TB 500MG ELEMENTAL (RX) 500 MG CALCIUM (1,250 MG)

3 DP

OYSTER SHELL CALCIUM 500 MG TB 500MG ELEMENTAL CA (RX) 500 MG CALCIUM (1,250 MG)

3 DP

PEDIALYTE ELECTROLYTE SINGLES 4'S (RX)

3 DP

PEDIALYTE FREEZER POPS 3 DP

PEDIALYTE SOLUTION (RX) 3 DP

PEDIALYTE SOLUTION READY-TO-USE (RX)

3 DP

plenamine intravenous parenteral solution 15 % 1 B/D

POLY-VI-SOL DROPS 750-35-400 UNIT-MG-UNIT/ML

3 DP

105


POLY-VI-SOL WITH IRON DROPS 750 UNIT-400 UNIT-10 MG/ML

3 DP

potassium chlorid-d5-0.45%nacl intravenous parenteral solution 20 meq/l

1

potassium chloride in water intravenous piggyback 40 meq/100 ml

1

potassium chloride oral capsule, extended release 10 meq, 8 meq

1 MO

potassium chloride oral liquid 20 meq/15 ml, 40 meq/15 ml

1 MO

potassium chloride oral tablet extended release 10 meq, 20 meq, 8 meq

1 MO

potassium chloride oral tablet,er particles/crystals 10 meq, 20 meq

1 MO

potassium citrate oral tablet extended release 10 meq (1,080 mg), 15 meq, 5 meq (540 mg)

1 MO

PROSIGHT TABLET 5,000-60-30 UNIT-MG-UNIT

3 DP

SM CALCIUM 500-VIT D3 400 TAB (RX) 500 MG(1,250MG) -400 UNIT

3 DP

sod fer gluc cplx 62.5 mg/5 ml 10's,sdv,outer 62.5 mg/5 ml

3 DP

sod fer gluc cplx 62.5 mg/5 ml sdv,inner 62.5 mg/5 ml

3 DP

sod fer gluc cplx 62.5 mg/5 ml sdv,outer 62.5 mg/5 ml

3 DP

sodium bicarb 10 grain tablet 650 mg 3 DP

sodium bicarb 650 mg tablet 10 gr 650 mg 3 DP

sodium chloride 0.45 % intravenous parenteral solution 0.45 %

1

sodium chloride 0.9 % injection solution 1

sodium chloride 0.9 % intravenous parenteral solution

1

sodium chloride 0.9 % intravenous piggyback 1

sodium chloride 1,000 mg tab inner (rx) 1,000 mg 3 DP

sodium chloride 1,000 mg tab outer (rx) 1,000 mg 3 DP


106


sodium chloride 3 % intravenous parenteral solution 3 %

1

sodium chloride irrigation solution 0.9 % 1

STRESS FORMULA WITH IRON TAB 500 MG-400 MCG- 18 MG IRON

3 DP

STRESS FORMULA WITH ZINC TAB (RX) 3 DP

THERA M PLUS TABLET 9 MG IRON-400 MCG

3 DP

TOTAL B WITH VIT C CAPLET 3 DP

TRI-VI-SOL DROPS 750 UNIT-35 MG -400 UNIT/ML

3 DP

VENOFER 200 MG/10 ML VIAL 200 MG IRON/10 ML

3 DP

VENOFER 50 MG/2.5 ML VIAL 10'S,SDV,P/F 50 MG IRON/2.5 ML

3 DP

VENOFER 50 MG/2.5 ML VIAL 10'S,SDV,P/F,L/F 50 MG IRON/2.5 ML

3 DP

VITA-BEE WITH C TABLET 3 DP

ELECTROLYTE/MINERAL/METAL MODIFIERS

biotin 5,000 mcg capsule mx-str (rx) 5 mg 3 DP

biotin 5,000 mcg softgel s/f, p/f,gluten-free (rx) 5 mg

3 DP

deferasirox oral tablet, dispersible 125 mg, 250 mg, 500 mg

1 PA; MO

ferriprox oral tablet 1,000 mg 2 PA; MO

FERRIPROX ORAL TABLET 500 MG 2 PA

FERRLECIT 62.5 MG/5 ML VIAL 10'S,SUV,NO LATEX 62.5 MG/5 ML

3 DP

FERRLECIT 62.5 MG/5 ML VIAL LATEX-FREE, SUV 62.5 MG/5 ML

3 DP

JADENU ORAL TABLET 180 MG, 360 MG, 90 MG

2 PA; MO

107


JADENU SPRINKLE ORAL GRANULES IN PACKET 180 MG, 360 MG, 90 MG

2 PA; MO

JYNARQUE ORAL TABLET 15 MG, 30 MG 2 PA; MO

JYNARQUE ORAL TABLETS, SEQUENTIAL 45 MG (AM)/ 15 MG (PM), 60 MG (AM)/ 30 MG (PM), 90 MG (AM)/ 30 MG (PM)

2 PA; MO

kionex (with sorbitol) oral suspension 15-19.3 gram/60 ml

1

kionex oral powder 1

SAMSCA ORAL TABLET 15 MG, 30 MG 2

sodium polystyrene (sorb free) oral suspension 15 gram/60 ml

1

sodium polystyrene sulfonate oral powder 1

sodium polystyrene sulfonate oral suspension 15 gram/60 ml

1

sodium polystyrene sulfonate rectal enema 30 gram/120 ml, 50 gram/200 ml

1

sps (with sorbitol) oral suspension 15-20 gram/60 ml

1

sps (with sorbitol) rectal enema 30-40 gram/120 ml

1

trientine oral capsule 250 mg 1 PA

VENOFER 100 MG/5 ML VIAL 10'S,SDV,P/F 100 MG IRON/5 ML

3 DP

VENOFER 100 MG/5 ML VIAL 25'S,SDV,P/F 100 MG IRON/5 ML

3 DP

VENOFER 100 MG/5 ML VIAL LATEX-FREE,SUV,P/F 100 MG IRON/5 ML

3 DP

VENOFER 100 MG/5 ML VIAL OUTER, L/F, SUV, P/F 100 MG IRON/5 ML

3 DP

PHOSPHATE BINDERS

calcium acetate oral capsule 667 mg 1 MO

FOSRENOL ORAL POWDER IN PACKET 1,000 MG, 750 MG

2 MO

lanthanum oral tablet,chewable 1,000 mg, 500 mg, 750 mg

1 MO


108


sevelamer carbonate oral powder in packet 0.8 gram, 2.4 gram

1 MO

sevelamer carbonate oral tablet 800 mg 1 MO

VITAMINS

ANIMAL SHAPES TABLET CHEW CHILDREN'S (RX)

3 DP

BALANCED B-100 TABLET 100 MG 3 DP

B-COMPLEX WITH B12 TABLET (RX) 3 DP

CALCITRATE + VIT D CAPLET 315 MG- 250 UNIT

3 DP

calcitriol oral capsule 0.25 mcg, 0.5 mcg 1 MO

calcitriol oral solution 1 mcg/ml 1 MO

calcitriol topical ointment 3 mcg/gram 1

calcium 500 mg chewable tablet p/f,s/f,gluten-f (rx) 500-100 mg-unit

3 DP

calcium 500-vit d3 400 chew tb 500 mg(1,250mg) -400 unit

3 DP

calcium 600-vit d3 400 tablet (rx) 600 mg(1,500mg) -400 unit

3 DP

CERTAVITE-ANTIOXIDANT TABLET (RX) 18-400 MG-MCG

3 DP

cyanocobalamin 1,000 mcg/ml inner,latex-free 1,000 mcg/ml

3 MO; DP

cyanocobalamin 1,000 mcg/ml latex-free,mdv,inner 1,000 mcg/ml

3 MO; DP

cyanocobalamin 1,000 mcg/ml latex-free,outer,mdv 1,000 mcg/ml

3 MO; DP

cyanocobalamin 1,000 mcg/ml mdv,5's 1,000 mcg/ml

3 MO; DP

cyanocobalamin 1,000 mcg/ml mdv,inner,latex-free 1,000 mcg/ml

3 MO; DP

cyanocobalamin 1,000 mcg/ml mdv,outer,latex-free 1,000 mcg/ml

3 MO; DP

109


cyanocobalamin 1,000 mcg/ml muv, outer 1,000 mcg/ml

3 MO; DP

cyanocobalamin 1,000 mcg/ml outer,latex-free 1,000 mcg/ml

3 MO; DP

cyanocobalamin 1,000 mcg/ml outer,latex-free,suv 1,000 mcg/ml

3 MO; DP

cyanocobalamin 10,000 mcg/10 inner,latex-free,mdv 1,000 mcg/ml

3 MO; DP

cyanocobalamin 10,000 mcg/10 mdv, inner, l/f 1,000 mcg/ml

3 MO; DP

cyanocobalamin 10,000 mcg/10 mdv, outer, l/f 1,000 mcg/ml

3 MO; DP

cyanocobalamin 10,000 mcg/10 outer,latex-free,mdv 1,000 mcg/ml

3 MO; DP

cyanocobalamin 10,000 mcg/10 outer,latex-free,muv 1,000 mcg/ml

3 MO; DP

cyanocobalamin 30,000 mcg/30 inner,latex-free,mdv 1,000 mcg/ml

3 MO; DP

cyanocobalamin 30,000 mcg/30 mdv, inner, l/f 1,000 mcg/ml

3 MO; DP

cyanocobalamin 30,000 mcg/30 mdv, outer, l/f 1,000 mcg/ml

3 MO; DP

cyanocobalamin 30,000 mcg/30 outer,latex-free,mdv 1,000 mcg/ml

3 MO; DP

ergocalciferol 8,000 units/ml (rx) 8,000 unit/ml 3 DP

OYSCO 500-VIT D3 200 TABLET 500 MG(1,250MG) -200 UNIT

3 DP

OYSTER SHELL 500-VIT D3 200 TB (RX) 500 MG(1,250MG) -200 UNIT

3 DP

OYSTER SHELL 500-VIT D3 200 TB CAPLET (RX) 500 MG(1,250MG) -200 UNIT

3 DP

OYSTER SHELL 500-VIT D3 200 TB U-D, 10X10 (RX) 500 MG(1,250MG) -200 UNIT

3 DP

paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg 1 MO

PRENATAL VITAMIN PLUS LOW IRON ORAL TABLET 27 MG IRON- 1 MG

2 MO

PRENATAL VITAMIN TABLET (RX) 27 MG IRON- 0.8 MG

3 DP


110


PRENATAL VITAMINS TABLET W/ FOLIC ACID 28 MG IRON- 800 MCG

3 DP

pyridoxine 100 mg/ml vial 25's, mdv 100 mg/ml 3 DP

pyridoxine 100 mg/ml vial inner,p/f,mdv,ltx-fr 100 mg/ml

3 DP

pyridoxine 100 mg/ml vial outer,p/f,mdv,ltx-fr 100 mg/ml

3 DP

RENAL VITAMIN TABLET 0.8 MG 3 DP

SM PEDIATRIC ELECTROLYTE SOLN (RX) 3 DP

SM VITAMIN B-1 100 MG TABLET (RX) 100 MG

3 DP

STRESS FORMULA TABLET (RX) 3 DP

SUPERPLEX-T TABLET (RX) 3 DP

TAB-A-VITE TABLET (RX) 3 DP

TAB-A-VITE WITH IRON TABLET (RX) 3 DP

THERA TABLET 400 MCG 3 DP

THERA-M TABLET W/BETA CAROTENE 9 MG IRON-400 MCG

3 DP

thiamine 200 mg/2 ml vial 25's, mdv 100 mg/ml 3 DP

thiamine 200 mg/2 ml vial mdv 100 mg/ml 3 DP

vitamin a 10,000 unit capsule soluble (rx) 10,000 unit

3 DP

VITAMIN AND MINERALS TABLET 3 DP

VITAMIN B COMPLEX CAPSULE (RX) 3 DP

VITAMIN B-1 100 MG TABLET (RX) 100 MG 3 DP

VITAMIN B-12 1,000 MCG TABLET (RX) 1,000 MCG

3 DP

VITAMIN B-12 1,000 MCG TABLET P/F,STARCH/SOY-FREE (RX) 1,000 MCG

3 DP



111


VITAMIN C 250 MG TABLET (RX) 250 MG 3 DP

VITAMIN C 250 MG TABLET CHEW (RX) 250 MG

3 DP

VITAMIN C 500 MG CAPLET COATED CAPLET (OTC) 500 MG

3 DP

VITAMIN C 500 MG TABLET (RX) 500 MG 3 DP

VITAMIN C 500 MG TABLET CHEW (RX) 500 MG

3 DP

VITAMIN C 500 MG TABLET U-D (RX) 500 MG

3 DP

VITAMIN D2 1.25 MG(50,000 UNIT) 50,000 UNIT

3 MO; DP

VITAMIN D2 1.25 MG(50,000 UNIT) CAPSULE 50,000 UNIT

3 MO; DP

vitamin d2 1.25 mg(50,000 unit) softgel 50,000 unit

3 MO; DP

VITAMIN D2 1.25 MG(50,000 UNIT) U-D,10X10,INNER 50,000 UNIT

3 MO; DP

VITAMIN D2 1.25 MG(50,000 UNIT) U-D,10X10,OUTER 50,000 UNIT

3 MO; DP

VITAMIN D3 1,000 UNIT TABLET (RX) 25 MCG (1,000 UNIT)

3 DP

vitamin d3 1,000 unit tablet gluten/f, d/f (rx) 25 mcg (1,000 unit)

3 DP

VITAMIN D3 1,000 UNIT TABLET S/F,P/F (RX) 25 MCG (1,000 UNIT)

3 DP

VITAMIN D3 2,000 UNIT SOFTGEL (RX) 50 MCG (2,000 UNIT)

3 DP

VITAMIN D3 2,000 UNIT SOFTGEL SOY-FREE,SOFTGEL (RX) 50 MCG (2,000 UNIT)

3 DP

vitamin d3 2,000 unit tablet (rx) 2,000 unit 3 DP

VITAMIN D3 2,000 UNIT TABLET (RX) 2,000 UNIT

3 DP

vitamin d3 400 unit/ml liquid supplement drop (rx) 10 mcg/ml (400 unit/ml)

3 DP

V-R VITAMIN C 250 MG TAB CHEW (RX) 250 MG

3 DP


112


V-R VITAMIN C 500 MG TAB CHEW (RX) 500 MG

3 DP

GASTROINTESTINAL AGENTS

ANTISPASMODICS, GASTROINTESTINAL

dicyclomine oral capsule 10 mg 1 MO

dicyclomine oral solution 10 mg/5 ml 1 MO

dicyclomine oral tablet 20 mg 1 MO

diphenoxylate-atropine oral liquid 2.5-0.025 mg/5 ml

1

diphenoxylate-atropine oral tablet 2.5-0.025 mg 1

glycopyrrolate oral tablet 1 mg, 2 mg 1 MO

GASTROINTESTINAL AGENTS, OTHER

ACID GONE ANTACID LIQUID 95-358 MG/15 ML

3 DP

ALMACONE CHEWABLE TABLET 200-200-25 MG

3 DP

ALMACONE SUSPENSION 200-200-20 MG/5 ML

3 DP

ALMACONE-2 LIQUID 400-400-40 MG/5 ML 3 DP

aluminum hydroxide gel sugar-free 320 mg/5 ml 3 DP

ANTACID 500 MG CHEWABLE TABLET INNER 200 MG CALCIUM (500 MG)

3 DP

ANTACID 500 MG CHEWABLE TABLET OUTER 200 MG CALCIUM (500 MG)

3 DP

ANTACID ANTI-GAS LIQUID MAXIMUM STRENGTH 400-400-40 MG/5 ML

3 DP

ANTACID EX-STR 750 MG TAB CHEW GLUTEN-F,ASSTD BERRY 300 MG (750 MG)

3 DP

ANTACID LIQUID 200-200-20 MG/5 ML 3 DP

ANTACID MAXIMUM STRENGTH LIQ 400-400-40 MG/5 ML

3 DP

113


ANTACID PLUS ANTI-GAS RELF LIQ MINT,REG-STRENGTH 200-200-20 MG/5 ML

3 DP

ANTACID PLUS ANTI-GAS RELF LIQ REGULAR STR,ORIGINAL 200-200-20 MG/5 ML

3 DP

ANTACID PLUS ANTI-GAS SUSP MAX STR, CHERRY 400-400-40 MG/5 ML

3 DP

ANTACID SUSPENSION 200-200-20 MG/5 ML 3 DP

ANTACID XTRA STRENGTH CHEW TAB EXTRA STRENGTH 300 MG (750 MG)

3 DP

ANTACID-ANTIGAS LIQUID 200-200-20 MG/5 ML

3 DP

ANTACID-SIMETHICONE LIQUID 400-400-40 MG/5 ML

3 DP

ANTI-DIARRHEAL 2 MG CAPLET 2 MG 3 DP

ANTI-DIARRHEAL 2 MG CAPLET CAPLET 2 MG

3 DP

ANTI-DIARRHEAL 2 MG CAPLET CPLT EASY TO SWALLOW 2 MG

3 DP

ANTI-DIARRHEAL 2 MG SOFTGEL SOFTGEL 2 MG

3 DP

ANTI-DIARRHEAL 2 MG TABLET 2 MG 3 DP

BISMATROL 525 MG/30 ML SUSP 262 MG/15 ML

3 DP

BISMATROL TABLET CHEW 262 MG 3 DP

bismuth 262 mg tablet chew 262 mg 3 DP

CALCIUM ANTACID 1,000 MG TAB ULTRA, MAX-STR 400 MG CALCIUM (1,000 MG)

3 DP

CALCIUM ANTACID 500 MG CHW TAB ASSORTED FRUIT 200 MG CALCIUM (500 MG)

3 DP

CALCIUM ANTACID 500 MG CHW TAB GLUTEN-F, PEPPERMINT 200 MG CALCIUM (500 MG)

3 DP

CALCIUM ANTACID 500 MG CHW TAB REG STR, PEPPERMINT 200 MG CALCIUM (500 MG)

3 DP


114


CALCIUM ANTACID 750 MG TB CHEW GLUTEN-FREE 300 MG (750 MG)

3 DP

CAL-GEST 500 MG TABLET CHEW 200 MG CALCIUM (500 MG)

3 DP

enulose oral solution 10 gram/15 ml 1 MO

GAS RELIEF 125 MG SOFTGEL SOFTGEL 125 MG

3 DP

GATTEX 30-VIAL SUBCUTANEOUS KIT 5 MG

2 PA; MO

GATTEX ONE-VIAL SUBCUTANEOUS KIT 5 MG

2 PA; MO

gavilyte-c oral recon soln 240-22.72-6.72 -5.84 gram

1

GAVISCON 80-14.2 MG TAB CHEW 80-14.2 MG

3 DP

GAVISCON ES TABLET CHEW EXTRA STRENGTH 160-105 MG

3 DP

GAVISCON EXTRA STRENGTH LIQUID 254-237.5 MG/5 ML

3 DP

GAVISCON LIQUID 95-358 MG/15 ML 3 DP

generlac oral solution 10 gram/15 ml 1 MO

GS ADV ANTACID-ANTIGAS LIQUID 200-200-20 MG/5 ML

3 DP

GS ANTACID 500 MG CHEWABLE TAB 215 MG CALCIUM (500 MG)

3 DP

GS ANTACID PLUS ANTI-GAS LIQ 200-200-20 MG/5 ML

3 DP

GS ANTI-DIARRHEAL 2 MG CAPLET 2 MG 3 DP

GS CAL ANTACID 500 MG CHEW TAB 200 MG CALCIUM (500 MG)

3 DP

GS STOMACH RLF 262 MG CHEW TAB GLUTEN-FREE 262 MG

3 DP

115


HM ADV ANTACID-ANTIGAS SUSP MAX-STRENGTH, CHERRY 400-400-40 MG/5 ML

3 DP

HM ANTACID ANTI-GAS SUSPENSION ORIGINAL, MAX STR 400-400-40 MG/5 ML

3 DP

HM ANTACID-ANTIGAS SUSPENSION 200-200-20 MG/5 ML

3 DP

HM ANTACID-ANTIGAS SUSPENSION REG STR, MINT 200-200-20 MG/5 ML

3 DP

HM ANTACID-ANTIGAS SUSPENSION REG STR, ORIGINAL 200-200-20 MG/5 ML

3 DP

HM ANTI-DIARRHEAL 2 MG CAPLET CAPLET, GLUTEN-FREE 2 MG

3 DP

HM CAL ANTACID 500 MG CHEW TAB ASSORTED FRUIT 200 MG CALCIUM (500 MG)

3 DP

HM CAL ANTACID 750 MG CHEW TAB 320 MG CALCIUM (750 MG)

3 DP

HM CAL ANTACID 750 MG CHEW TAB EXTRA STRENGTH 300 MG (750 MG)

3 DP

HM CAL ANTACID 750 MG CHEW TAB S/F,EX-STR, ORANGE 300 MG (750 MG)

3 DP

LIQUID ANTACID SUSPENSION REGULAR STRENGTH 200-200-20 MG/5 ML

3 DP

loperamide 1 mg/5 ml liquid 1 mg/5 ml 3 DP

loperamide oral capsule 2 mg 1 MO

MAG-AL PLUS SUSPENSION 200-200-20 MG/5 ML

3 DP

MI ACID SUSPENSION 200-200-20 MG/5 ML, 400-400-40 MG/5 ML

3 DP

MI-ACID DS TABLET 700-300 MG 3 DP

MINTOX PLUS TABLET CHEWABLE 200-200-25 MG

3 DP

MINTOX SUSPENSION MINT CREME 200-200-20 MG/5 ML

3 DP

OCALIVA ORAL TABLET 10 MG, 5 MG 2 PA; MO

PEPTIC RELIEF 262 MG CHEW TAB 262 MG 3 DP

PEPTIC RELIEF 262 MG/15 ML 262 MG/15 ML 3 DP


116


QC ANTACID 500 MG CHEW TABLET 200 MG CALCIUM (500 MG)

3 DP

QC ANTACID SUSPENSION REGULAR STRENGTH 200-200-20 MG/5 ML

3 DP

QC ANTACID-ANTIGAS SUSPENSION REGULAR STRENGTH 200-200-20 MG/5 ML

3 DP

QC ANTI-DIARRHEAL 2 MG CAPLET CAPLET 2 MG

3 DP

RECTIV RECTAL OINTMENT 0.4 % (W/W) 2

RELISTOR ORAL TABLET 150 MG 2 PA

RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6 ML

2 PA

RELISTOR SUBCUTANEOUS SYRINGE 12 MG/0.6 ML, 8 MG/0.4 ML

2 PA

RULOX SUSPENSION 200-200-20 MG/5 ML 3 DP

SB ANTACID 500 MG CHEW TABLET 200 MG CALCIUM (500 MG)

3 DP

SB ANTACID XTRA STR CHEW TAB EXTRA STRENGTH 300 MG (750 MG)

3 DP

SB ANTI-DIARRHEA 2 MG CAPLET 2 MG 3 DP

SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 MG, 6 MG

2 PA; MO

SM ADV ANTACID-ANTIGAS LIQUID 200-200-20 MG/5 ML

3 DP

SM ANTACID MAX STRENGTH SUSP ORIGINAL 400-400-40 MG/5 ML

3 DP

SM ANTACID SUSPENSION 200-200-20 MG/5 ML

3 DP

SM ANTACID-ANTIGAS LIQUID 200-200-20 MG/5 ML

3 DP

SM ANTI-DIARRHEAL 2 MG CAPLET 2 MG 3 DP

SM ANTI-DIARRHEAL 2 MG CAPLET CAPLET 2 MG

3 DP

117


SM CAL ANTACID 500 MG CHEW TAB 215 MG CALCIUM (500 MG)

3 DP

SM CAL ANTACID 750 MG CHEW TAB 320 MG CALCIUM (750 MG)

3 DP

SM CAL ANTACID 750 MG CHEW TAB EXTRA STRENGTH 300 MG (750 MG)

3 DP

SM GAS RELIEF 125 MG SOFTGEL SOFTGEL 125 MG

3 DP

SM STOMACH RELIEF 262 MG/15 ML REGULAR STRENGTH 262 MG/15 ML

3 DP

SM STOMACH RLF 262 MG CHEW TAB 262 MG

3 DP

STOMACH RLF 262 MG/15 ML SUSP ORIGINAL STRENGTH 262 MG/15 ML

3 DP

TUMS 750 MG CHEWY BITES 300 MG (750 MG)

3 DP

TUMS E-X TABLET CHEWABLE ASSORTED FRUIT 300 MG (750 MG)

3 DP

TUMS E-X TABLET CHEWABLE E-X 300 MG (750 MG)

3 DP

TUMS E-X TABLET CHEWABLE E-X 300 MG (750 MG)

3 DP

TUMS E-X TABLET CHEWABLE E-X, SINGLE ROLL 300 MG (750 MG)

3 DP

TUMS E-X TABLET CHEWABLE E-X,3-ROLL 300 MG (750 MG)

3 DP

TUMS E-X TABLET CHEWABLE S/F, ORANGE CREAM 300 MG (750 MG)

3 DP

TUMS KIDS 300 MG (750) CHEWTAB CHERRY BLAST 300 MG (750 MG)

3 DP

TUMS SMOOTHIES CHEW TABLET 300 MG (750 MG)

3 DP

TUMS SMOOTHIES CHEW TABLET ASSTD TROPICAL FRUIT 300 MG (750 MG)

3 DP

TUMS SMOOTHIES CHEW TABLET BERRY FUSION, EX-STR 300 MG (750 MG)

3 DP

TUMS SMOOTHIES CHEW TABLET PEPPERMINT, EX-STR 300 MG (750 MG)

3 DP


118


TUMS TABLET CHEWABLE 200 MG CALCIUM (500 MG)

3 DP

TUMS TABLET CHEWABLE 3-ROLL, PEPPERMINT 200 MG CALCIUM (500 MG)

3 DP

TUMS TABLET CHEWABLE ASSORTED FRUIT 200 MG CALCIUM (500 MG)

3 DP

TUMS TABLET CHEWABLE PEPPERMINT 200 MG CALCIUM (500 MG)

3 DP

TUMS ULTRA TABLET CHEWABLE 400 MG CALCIUM (1,000 MG)

3 DP

TUMS ULTRA TABLET CHEWABLE ASSORTED BERRIES 400 MG CALCIUM (1,000 MG)

3 DP

TUMS ULTRA TABLET CHEWABLE ASSORTED FRUIT 400 MG CALCIUM (1,000 MG)

3 DP

TUMS ULTRA TABLET CHEWABLE TROP FRUIT,GLUTEN-F 400 MG CALCIUM (1,000 MG)

3 DP

TUMS X-STR 750 TABLET CHEWABLE ASST'D FRUIT FLAVOR 300 MG (750 MG)

3 DP

ursodiol oral capsule 300 mg 1 MO

ursodiol oral tablet 250 mg, 500 mg 1 MO

XERMELO ORAL TABLET 250 MG 2 PA

HISTAMINE2 (H2) RECEPTOR ANTAGONISTS

ACID CONTROLLER 20 MG TABLET MAXIMUM STRENGTH 20 MG

3 DP

ACID REDUCER 10 MG TABLET 10 MG 3 DP

ACID REDUCER 10 MG TABLET ORIGINAL STRENGTH 10 MG

3 DP

ACID REDUCER 20 MG TABLET MAX STRENGTH 20 MG

3 DP

ACID REDUCER 20 MG TABLET MAXIMUM STRENGTH 20 MG

3 DP

119


ACID REDUCER 20 MG TABLET MAX-STR 20 MG

3 DP

cimetidine 200 mg tablet blister pack (otc) 200 mg 3 MO; DP

cimetidine hcl oral solution 300 mg/5 ml 1 MO

cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg

1 MO

famotidine 10 mg tablet 10 mg 3 DP

famotidine oral tablet 20 mg, 40 mg 1 MO

HEARTBURN RELIEF 10 MG TABLET 10 MG 3 DP

HM ACID REDUCER 150 MG TABLET MAXIMUM STRENGTH 150 MG

3 DP

HM ACID REDUCER 75 MG TABLET REGULAR STRENGTH 75 MG

3 DP

hm famotidine 10 mg tablet original strength 10 mg

3 DP

ranitidine 150 mg tablet maximum strength (otc) 150 mg

3 MO; DP

ranitidine 75 mg tablet s/f, sodium-free 75 mg 3 DP

ranitidine hcl oral syrup 15 mg/ml 1 MO

ranitidine hcl oral tablet 150 mg, 300 mg 1 MO

SB ACID REDUCER 150 MG TABLET MAXIMUM STRENGTH 150 MG

3 DP

SM ACID REDUCER 10 MG TABLET 10 MG 3 DP


SM ACID REDUCER 150 MG TABLET MAXIMUM STRENGTH 150 MG

3 DP



SM ACID REDUCER 75 MG TABLET REGULAR STRENGTH 75 MG

3 DP

SM HEARTBURN RELIEF 200 MG TAB 200 MG

3 DP

IRRITABLE BOWEL SYNDROME AGENTS

alosetron oral tablet 0.5 mg, 1 mg 1 QL (60 EA per 30 days)

AMITIZA ORAL CAPSULE 24 MCG, 8 MCG 2 MO; QL (60 EA per 30 days)


120


LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 MCG


XIFAXAN ORAL TABLET 200 MG 2 PA

XIFAXAN ORAL TABLET 550 MG 2 PA; MO

LAXATIVES

BISAC-EVAC 10 MG SUPPOSITORY 10 MG 3 DP

BISAC-EVAC 10 MG SUPPOSITORY OUTER 10 MG

3 DP

bisacodyl 10 mg suppository 10 mg 3 DP

bisacodyl ec 5 mg tablet 5 mg 3 DP

BISA-LAX EC 5 MG TABLET 5 MG 3 DP

BISCOLAX 10 MG SUPPOSITORY 10 MG 3 DP

calcium polycarbophil 625 mg 625 mg 3 DP

CITRUCEL 500 MG CAPLET 500 MG 3 DP

CITRUCEL POWDER 3 DP

CITRUCEL POWDER S-F S/F 3 DP

CLEARLAX POWDER 14 ONCE-DAILY DOSES 17 GRAM/DOSE

3 DP

CLEARLAX POWDER 17 GRAM/DOSE 3 DP


3 DP


3 DP

constulose oral solution 10 gram/15 ml 1 MO

DOC-Q-LACE 100 MG SOFTGEL 100 MG 3 DP

DOCU LIQUID 100 MG/10 ML INNER 50 MG/5 ML

3 DP

DOCU LIQUID 100 MG/10 ML OUTER 50 MG/5 ML

3 DP

DOCU LIQUID 50 MG/5 ML 50 MG/5 ML 3 DP

121


docusate sodium 100 mg softgel inner, softgel 100 mg

3 DP

docusate sodium 100 mg softgel outer, softgel 100 mg

3 DP

docusate sodium 100 mg softgel softgel 100 mg 3 DP

docusate sodium 50 mg/5 ml liq 100's, u-d 50 mg/5 ml

3 DP

DOCUSATE SODIUM-SENNA TABLET 8.6-50 MG

3 DP

DOCUSIL 100 MG SOFTGEL 100 MG 3 DP

DOCUSOL MINI-ENEMA OUTER 283 MG 3 DP

DOK 100 MG SOFTGEL SOFTGEL 100 MG 3 DP

DOK 100 MG TABLET 100 MG 3 DP

DUCODYL EC 5 MG TABLET 5 MG 3 DP

ENEMA DISPOSABLE 19-7 GRAM/118 ML 3 DP

ENEMA READY TO USE LATEX-FREE 19-7 GRAM/118 ML

3 DP

ENEMEEZ MINI ENEMA 5CC TUBES, OUTER 283 MG/5 ML

3 DP

ENEMEEZ PLUS MINI ENEMA OUTER 283-20 MG/5 ML

3 DP

EX-LAX MAXIMUM STR 25 MG TAB 25 MG 3 DP

FIBER LAXATIVE 625 MG CAPLET CAPLET 625 MG

3 DP

FIBER LAXATIVE 625 MG TABLET 625 MG 3 DP

FIBER TABLET UNBOXED 625 MG 3 DP

FIBER TABS 625 MG 3 DP

FIBER THERAPY POWDER 2 GRAM/19 GRAM

3 DP

FIBER-LAX CAPTABS 500MG POLYCARBOPHIL 625 MG

3 DP

FLEET BISACODYL 10 MG ENEMA 10 MG/30 ML

3 DP

FLEET ENEMA 2X133ML, TWIN PACK 19-7 GRAM/118 ML

3 DP


122


FLEET PEDIA-LAX ENEMA 9.5-3.5 GRAM/59 ML

3 DP

FLEET PEDIA-LAX SUPPOSITORIES 3 DP

GAVILAX POWDER 14 DAY 17 GRAM/DOSE 3 DP

GAVILAX POWDER 30 DAY 17 GRAM/DOSE 3 DP

gavilyte-g oral recon soln 236-22.74-6.74 -5.86 gram

1

gavilyte-n oral recon soln 420 gram 1

glycerin pediatric suppository infants & children 3 DP

GLYCOLAX POWDER 15 DOSES (OTC) 17 GRAM/DOSE

3 DP


3 DP


3 DP

GS MILK OF MAGNESIA SUSPENSION 400 MG/5 ML

3 DP

HEALTHYLAX POWDER PACKET 14X17GM, INNER 17 GRAM

3 DP

HEALTHYLAX POWDER PACKET 14X17GM, OUTER 17 GRAM

3 DP

HM CLEARLAX POWDER 14 ONCE-DAILY DOSES 17 GRAM/DOSE

3 DP


3 DP


3 DP

HM ENEMA READY TO USE 19-7 GRAM/118 ML

3 DP

HM ENEMA READY TO USE TWIN PAK LATEX-FREE 19-7 GRAM/118 ML

3 DP

HM FIBER 500 MG CAPLET 500 MG 3 DP

HM FIBER POWDER 3.4 GRAM/5.8 GRAM 3 DP

123


HM LAXATIVE EC 5 MG TABLET 5 MG 3 DP

HM MILK OF MAGNESIA SUSPENSION MINT 400 MG/5 ML

3 DP

HM MILK OF MAGNESIA SUSPENSION ORIGINAL 400 MG/5 ML

3 DP

HM SENNA 8.6 MG TABLET 8.6 MG 3 DP

HM STOOL SOFTENER 100 MG SFTGL SOFTGEL 100 MG

3 DP

HM STOOL SOFTENER 100 MG TAB 100 MG 3 DP

KAO-TIN 240 MG SOFTGEL 240 MG 3 DP

KONSYL 6 GM PACKET S/F, GLUTEN-F, OUTER 6 GRAM

3 DP

KONSYL EASY MIX FIBER POWDER 4.3 GRAM/6 GRAM

3 DP

KONSYL FIBER 625 MG CAPLET CAPLET 625 MG

3 DP

KONSYL FIBER 625 MG CAPLET CAPLET, S/F 625 MG

3 DP

KONSYL FORMULA-D FIBER POWDER GLUTEN FREE,61 DOSES 3.4 GRAM/ 6.5 GRAM

3 DP

KONSYL ORIGINAL FIBER POWDER S/F, GLUTEN FREE 6 GRAM/6 GRAM

3 DP

KONSYL ORIGINAL FIBER POWDER S/F,GLUTN-F,75 DOSES 6 GRAM/6 GRAM

3 DP

KONSYL PSYLLIUM FIBER POWDER GLUTEN FREE, ORANGE 3.4 GRAM/11 GRAM

3 DP

KONSYL PSYLLIUM FIBER POWDER S/F,GLUTEN/F,ORANGE 3.5 GRAM/5.8 GRAM

3 DP

KRISTALOSE ORAL PACKET 20 GRAM 2 ST; MO

lactulose oral packet 10 gram 1 ST; MO

lactulose oral solution 10 gram/15 ml, 10 gram/15 ml (15 ml), 20 gram/30 ml

1 MO

LAXATIVE EC 5 MG TABLET 5 MG 3 DP

magnesium citrate solution lemon 3 DP


124


MILK OF MAGNESIA SUSPENSION 100'S, U-D 400 MG/5 ML

3 DP

MILK OF MAGNESIA SUSPENSION 400 MG/5 ML

3 DP

MILK OF MAGNESIA SUSPENSION CHERRY 400 MG/5 ML

3 DP

MILK OF MAGNESIA SUSPENSION MINT 400 MG/5 ML

3 DP

MILK OF MAGNESIA SUSPENSION NA/F 400 MG/5 ML

3 DP

MILK OF MAGNESIA SUSPENSION REGULAR 400 MG/5 ML

3 DP

MILK OF MAGNESIA SUSPENSION STIMULANT FREE 400 MG/5 ML

3 DP

mineral oil usp 3 DP

NATURAL FIBER LAX POWDER 3 DP

NATURAL FIBER LAX POWDER ORIGINAL TEXTURE 3.4 GRAM/7 GRAM

3 DP

peg 3350-electrolytes oral recon soln 240-22.72-6.72 -5.84 gram

1

peg-3350 with flavor packs oral recon soln 420 gram

1

peg-electrolyte soln oral recon soln 420 gram 1

polyethylene glycol 3350 oral powder 17 gram/dose

1

polyethylene glycol 3350 oral powder in packet 17 gram

1

polyethylene glycol 3350 powd 14 once-daily doses (otc) 17 gram/dose

3 DP


3 DP


3 DP

125


polyethylene glycol 3350 powd inner (otc) 17 gram

3 DP

polyethylene glycol 3350 powd outer (otc) 17 gram

3 DP

QC MILK OF MAGNESIA SUSPENSION 400 MG/5 ML

3 DP

QC NATURAL VEG LAXATIVE TABLET 8.6 MG

3 DP

QC NATURA-LAX 17 GM POWDER 17 GRAM/DOSE

3 DP

QC READY TO USE ENEMA LATEX-FREE 19-7 GRAM/118 ML

3 DP

QC READY TO USE ENEMA TWIN PACK 19-7 GRAM/118 ML

3 DP

REGULOID LAXATIVE POWDER 3 DP

sb bisacodyl ec 5 mg tablet 5 mg 3 DP

SENEXON 8.6 MG TABLET 8.6 MG 3 DP

SENEXON-S TABLET 8.6-50 MG 3 DP

SENNA 8.6 MG TABLET 8.6 MG 3 DP

SENNA 8.8 MG/5 ML SYRUP A/F, CHOCOLATE 8.8 MG/5 ML

3 DP

SENNA LAXATIVE 8.6 MG TABLET 8.6 MG 3 DP

SENNA PLUS TABLET 8.6-50 MG 3 DP

SENNA-LAX 8.6 MG TABLET 8.6 MG 3 DP

SENNA-TIME 8.6 MG TABLET 8.6 MG 3 DP

SENNA-TIME S TABLET 8.6-50 MG 3 DP

SENNO TABLET 8.6 MG 3 DP

sennosides-docusate sodium tab 8.6-50 mg 3 DP

SENOKOT 8.6 MG TABLET 8.6 MG 3 DP

SILACE 50 MG/5 ML LIQUID 50 MG/5 ML 3 DP

SILACE 60 MG/15 ML SYRUP 60 MG/15 ML 3 DP

SM CLEARLAX POWDER 14 ONCE-DAILY DOSES 17 GRAM/DOSE

3 DP

SM CLEARLAX POWDER 17 GRAM/DOSE 3 DP


3 DP


126



3 DP

SM FIBER 625 MG CAPLET 625 MG 3 DP

SM FIBER LAXATIVE 500 MG CPLT 500 MG 3 DP

SM FIBER LAXATIVE 625 MG TAB CAPLET 625 MG

3 DP

SM FIBER POWDER 3 DP

SM FIBER POWDER 3.4 GRAM/11 GRAM 3 DP

SM GENTLE LAXATIVE EC 5 MG TAB 5 MG 3 DP

SM MILK OF MAGNESIA SUSPENSION 400 MG/5 ML

3 DP

SM NAT LAX PLUS STOOL SOFTENER 8.6-50 MG

3 DP

SM SENNA LAXATIVE 8.6 MG TAB 8.6 MG 3 DP

SM STOOL SOFTENER 100 MG SFTGL GLUTEN-FREE, SOFTGEL 100 MG

3 DP

SM STOOL SOFTENER 100 MG SFTGL SOFTGEL 100 MG

3 DP

SM STOOL SOFTENER 240 MG SFTGL SOFTGEL,GLUTEN-FREE 240 MG

3 DP

SM STOOL SOFTENER 250 MG SFTGL SOFTGEL, EX-STR 250 MG

3 DP

SM STOOL SOFTENER-LAXATIVE TAB 8.6-50 MG

3 DP

STOOL SOFTENER 100 MG CAPSULE 100 MG 3 DP

STOOL SOFTENER 100 MG CAPSULE ORIGINAL 100 MG

3 DP

STOOL SOFTENER 100 MG SOFTGEL SOFTGEL 100 MG

3 DP

STOOL SOFTENER 240 MG SOFTGEL SOFTGEL 240 MG

3 DP

STOOL SOFTENER 250 MG SOFTGEL SOFTGEL, EX-STR 250 MG

3 DP

127


STOOL SOFTENER-LAXATIVE TABLET 8.6-50 MG

3 DP

STOOL SOFTENER-STIM LAX TABLET 8.6-50 MG

3 DP

trilyte with flavor packets oral recon soln 420 gram

1

WOMEN'S LAXATIVE 5 MG TABLET 5 MG 3 DP

PROTECTANTS

misoprostol oral tablet 100 mcg, 200 mcg 1 MO

sucralfate oral tablet 1 gram 1 MO

PROTON PUMP INHIBITORS

gs omeprazole dr 20 mg tablet 14 day course 20 mg

3 DP

HEARTBURN TREATMNT 24 HR 15 MG 1X14, SODIUM FREE 15 MG

3 DP

HEARTBURN TREATMNT 24 HR 15 MG 3X14, SODIUM FREE 15 MG

3 DP

hm lansoprazole dr 15 mg cap gluten-free,1 bottle (otc) 15 mg

3 MO; DP


3 MO; DP


3 MO; DP

hm omeprazole dr 20 mg tablet 2x14 day course 20 mg

3 DP

hm omeprazole dr 20 mg tablet 3x14 day course 20 mg

3 DP

lansoprazole dr 15 mg capsule (otc) 15 mg 3 MO; DP

lansoprazole dr 15 mg capsule 1x14 day course (otc) 15 mg

3 MO; DP

lansoprazole dr 15 mg capsule 1x14 day course,na/f (otc) 15 mg

3 MO; DP

lansoprazole dr 15 mg capsule 2-14 day treatment (otc) 15 mg

3 MO; DP

lansoprazole dr 15 mg capsule 24hr, 3 bottles (otc) 15 mg

3 MO; DP


128



3 MO; DP


3 MO; DP

lansoprazole dr 15 mg capsule 3x14 day course,na/f (otc) 15 mg

3 MO; DP

lansoprazole dr 15 mg capsule na/f (otc) 15 mg 3 MO; DP

lansoprazole oral capsule,delayed release(dr/ec) 15 mg, 30 mg

1 MO

omeprazole dr 20 mg tablet 14 day course 20 mg 3 DP

omeprazole dr 20 mg tablet 1x14 day course 20 mg

3 DP

omeprazole dr 20 mg tablet 20 mg 3 DP


3 DP


3 DP

omeprazole oral capsule,delayed release(dr/ec) 10 mg, 20 mg, 40 mg

1 MO

pantoprazole oral tablet,delayed release (dr/ec) 20 mg, 40 mg

1 MO

PREVACID 24HR DR 15 MG CAPSULE NA/F 15 MG

3 DP

PREVACID 24HR DR 15 MG CAPSULE NA/F, 2 BOTTLES 15 MG

3 DP

PREVACID 24HR DR 15 MG CAPSULE NA/F, 3 BOTTLES 15 MG

3 DP

sm lansoprazole dr 15 mg cap gluten-free,1 bottle (otc) 15 mg

3 MO; DP

sm lansoprazole dr 15 mg cap gluten-free,3 bottle (otc) 15 mg

3 MO; DP

sm omeprazole dr 20 mg tablet 14 day course 20 mg

3 DP

129


sm omeprazole dr 20 mg tablet 2x14 day course 20 mg

3 DP

sm omeprazole dr 20 mg tablet 3x14 day course 20 mg

3 DP

GENETIC OR ENZYME DISORDER: REPLACEMENT, MODIFIERS, TREATMENT

GENETIC OR ENZYME DISORDER: REPLACEMENT, MODIFIERS, TREATMENT

ARALAST NP INTRAVENOUS RECON SOLN 1,000 MG, 500 MG

2 PA; MO

CERDELGA ORAL CAPSULE 84 MG 2 PA; MO

CHOLBAM ORAL CAPSULE 250 MG, 50 MG 2 PA; MO

CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000-38,000 -60,000 UNIT, 24,000-76,000 -120,000 UNIT, 3,000-9,500- 15,000 UNIT, 36,000-114,000- 180,000 UNIT, 6,000-19,000 -30,000 UNIT

2 MO

CYSTADANE ORAL POWDER 1 GRAM/1.7 ML

2 MO

CYSTAGON ORAL CAPSULE 150 MG, 50 MG 2 PA; MO

GALAFOLD ORAL CAPSULE 123 MG 2 PA; MO

GLASSIA INTRAVENOUS SOLUTION 1 GRAM/50 ML (2 %)

2 PA; MO

KUVAN ORAL POWDER IN PACKET 100 MG, 500 MG

2 PA; MO

KUVAN ORAL TABLET,SOLUBLE 100 MG 2 PA; MO

NITYR ORAL TABLET 10 MG, 2 MG, 5 MG 2 PA; MO

ORFADIN ORAL CAPSULE 10 MG, 2 MG, 20 MG, 5 MG

2 PA; MO

ORFADIN ORAL SUSPENSION 4 MG/ML 2 PA; MO

PROLASTIN-C INTRAVENOUS RECON SOLN 1,000 MG

2 PA; MO

PROLASTIN-C INTRAVENOUS SOLUTION 1,000 MG (+/-)/20 ML

2 PA; MO

RAVICTI ORAL LIQUID 1.1 GRAM/ML 2 PA; MO

sodium phenylbutyrate oral powder 0.94 gram/gram

1 PA; MO

sodium phenylbutyrate oral tablet 500 mg 1 PA; MO

SUCRAID ORAL SOLUTION 8,500 UNIT/ML 2 PA; MO


130


XURIDEN ORAL GRANULES IN PACKET 2 GRAM

2 PA; MO

ZEMAIRA INTRAVENOUS RECON SOLN 1,000 MG

2 PA; MO

ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-32,000 -42,000 UNIT, 15,000-47,000 -63,000 UNIT, 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 3,000-10,000 -14,000-UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT

2 MO

GENITOURINARY AGENTS

ANTISPASMODICS, URINARY

darifenacin oral tablet extended release 24 hr 15 mg, 7.5 mg

1 ST; MO

flavoxate oral tablet 100 mg 1 MO

MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG, 50 MG


oxybutynin chloride oral syrup 5 mg/5 ml 1 MO

oxybutynin chloride oral tablet 5 mg 1 MO

oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg, 5 mg

1 MO

tolterodine oral capsule,extended release 24hr 2 mg, 4 mg

1 MO

tolterodine oral tablet 1 mg, 2 mg 1 MO

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HR 4 MG, 8 MG

2 MO

BENIGN PROSTATIC HYPERTROPHY AGENTS

alfuzosin oral tablet extended release 24 hr 10 mg 1 MO

dutasteride oral capsule 0.5 mg 1 MO

finasteride oral tablet 5 mg 1 MO

tamsulosin oral capsule 0.4 mg 1 MO

GENITOURINARY AGENTS, OTHER

131


bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg

1

ELMIRON ORAL CAPSULE 100 MG 2

THIOLA ORAL TABLET 100 MG 2 PA

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (ADRENAL)

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (ADRENAL)

ACTHAR H.P. INJECTION GEL 80 UNIT/ML 2 PA

ACTHAR INJECTION GEL 80 UNIT/ML 2 PA

cortisone oral tablet 25 mg 1

dexamethasone sodium phosphate injection solution 4 mg/ml

1 B/D

fludrocortisone oral tablet 0.1 mg 1 MO

hydrocortisone oral tablet 10 mg, 20 mg, 5 mg 1 MO

hydrocortisone topical cream with perineal applicator 2.5 %

1

methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml

1

prednisone intensol oral concentrate 5 mg/ml 1

procto-med hc topical cream with perineal applicator 2.5 %

1

procto-pak topical cream with perineal applicator 1 %

1

proctosol hc topical cream with perineal applicator 2.5 %

1

proctozone-hc topical cream with perineal applicator 2.5 %

1

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (SEX HORMONES/ MODIFIERS)

ANABOLIC STEROIDS

ANADROL-50 ORAL TABLET 50 MG 2 PA

oxandrolone oral tablet 10 mg, 2.5 mg 1 MO

ANDROGENS

DANAZOL ORAL CAPSULE 100 MG, 200 MG, 50 MG

1

methyltestosterone oral capsule 10 mg 1 PA; MO


132


testosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml

1 MO

testosterone enanthate intramuscular oil 200 mg/ml

1

testosterone transdermal gel 50 mg/5 gram (1 %) 1 PA; MO

testosterone transdermal gel in metered-dose pump 12.5 mg/ 1.25 gram (1 %)

1 PA; MO

testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1 % (50 mg/5 gram), 1.62 % (20.25 mg/1.25 gram), 1.62 % (40.5 mg/2.5 gram)

1 PA; MO

testosterone transdermal solution in metered pump w/app 30 mg/actuation (1.5 ml)

1 PA; MO

ESTROGENS

estradiol oral tablet 0.5 mg, 1 mg, 2 mg 1 MO

estradiol transdermal patch semiweekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

1 MO

estradiol transdermal patch weekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.06 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

1 MO

estradiol vaginal cream 0.01 % (0.1 mg/gram) 1 MO

estradiol vaginal tablet 10 mcg 1 MO

estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml

1

ESTRING VAGINAL RING 2 MG (7.5 MCG /24 HOUR)

2 MO

estropipate oral tablet 0.75 mg 1 PA; MO

MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG

2 PA; MO

PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG, 1.25 MG

2 MO

PREMARIN VAGINAL CREAM 0.625 MG/GRAM

2 MO

133


yuvafem vaginal tablet 10 mcg 1 MO

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (SEX HORMONES/ MODIFIERS)

AFIRMELLE ORAL TABLET 0.1-20 MG-MCG 1 MO

AFTERA 1.5 MG TABLET 1.5 MG 3 DP

ALTAVERA (28) ORAL TABLET 0.15-0.03 MG 1 MO

alyacen 1/35 (28) oral tablet 1-35 mg-mcg 1 MO

amabelz oral tablet 0.5-0.1 mg, 1-0.5 mg 1 MO

apri oral tablet 0.15-0.03 mg 1 MO

aranelle (28) oral tablet 0.5/1/0.5-35 mg-mcg 1 MO

AUBRA EQ ORAL TABLET 0.1-20 MG-MCG 1 MO

aubra oral tablet 0.1-20 mg-mcg 1 MO

AUROVELA 1.5/30 (21) ORAL TABLET 1.5-30 MG-MCG

1 MO

AUROVELA FE 1.5/30 (28) ORAL TABLET 1.5 MG-30 MCG (21)/75 MG (7)

1 MO

AUROVELA FE 1-20 (28) ORAL TABLET 1 MG-20 MCG (21)/75 MG (7)

1 MO

aviane oral tablet 0.1-20 mg-mcg 1 MO

AYUNA ORAL TABLET 0.15-0.03 MG 1 MO

balziva (28) oral tablet 0.4-35 mg-mcg 1 MO

blisovi fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7)

1 MO

blisovi fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7)

1 MO

briellyn oral tablet 0.4-35 mg-mcg 1 MO

caziant (28) oral tablet 0.1/.125/.15-25 mg-mcg 1 MO

CHATEAL EQ (28) ORAL TABLET 0.15-0.03 MG

1 MO

COMBIPATCH TRANSDERMAL PATCH SEMIWEEKLY 0.05-0.14 MG/24 HR, 0.05-0.25 MG/24 HR

2 MO

cryselle (28) oral tablet 0.3-30 mg-mcg 1 MO

cyclafem 1/35 (28) oral tablet 1-35 mg-mcg 1 MO


134


cyclafem 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg

1 MO

CYRED EQ ORAL TABLET 0.15-0.03 MG 1 MO

CYRED ORAL TABLET 0.15-0.03 MG 1 MO

delyla (28) oral tablet 0.1-20 mg-mcg 1 MO

desog-e.estradiol/e.estradiol oral tablet 0.15-0.02 mgx21 /0.01 mg x 5

1 MO

desogestrel-ethinyl estradiol oral tablet 0.15-0.03 mg

1 MO

drospirenone-ethinyl estradiol oral tablet 3-0.03 mg

1 MO

ECONTRA EZ 1.5 MG TABLET INNER 1.5 MG 3 DP

ECONTRA EZ 1.5 MG TABLET OUTER 1.5 MG

3 DP

emoquette oral tablet 0.15-0.03 mg 1 MO

enpresse oral tablet 50-30 (6)/75-40 (5)/125-30(10)

1 MO

ENSKYCE ORAL TABLET 0.15-0.03 MG 1 MO

ESTARYLLA ORAL TABLET 0.25-35 MG-MCG

1 MO

estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg

1 MO

ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg, 1-50 mg-mcg

1 MO

falmina (28) oral tablet 0.1-20 mg-mcg 1 MO

femynor oral tablet 0.25-35 mg-mcg 1 MO

FYAVOLV ORAL TABLET 0.5-2.5 MG-MCG 1 MO

fyavolv oral tablet 1-5 mg-mcg 1 MO

HAILEY 24 FE ORAL TABLET 1 MG-20 MCG (24)/75 MG (4)

1 MO

HAILEY ORAL TABLET 1.5-30 MG-MCG 1 MO

135


introvale oral tablets,dose pack,3 month 0.15 mg-30 mcg (91)

1 MO

ISIBLOOM ORAL TABLET 0.15-0.03 MG 1 MO

jinteli oral tablet 1-5 mg-mcg 1 MO

juleber oral tablet 0.15-0.03 mg 1 MO

junel 1.5/30 (21) oral tablet 1.5-30 mg-mcg 1 MO

junel 1/20 (21) oral tablet 1-20 mg-mcg 1 MO

junel fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7)

1 MO

junel fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7)

1 MO

KALLIGA ORAL TABLET 0.15-0.03 MG 1 MO

kariva (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5

1 MO

kelnor 1/35 (28) oral tablet 1-35 mg-mcg 1 MO

KELNOR 1-50 ORAL TABLET 1-50 MG-MCG 1 MO

kimidess (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5

1 MO

KURVELO (28) ORAL TABLET 0.15-0.03 MG 1 MO

larin 1.5/30 (21) oral tablet 1.5-30 mg-mcg 1 MO

larin 1/20 (21) oral tablet 1-20 mg-mcg 1 MO

larin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7)

1 MO

larin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7)

1 MO

larissia oral tablet 0.1-20 mg-mcg 1 MO

leena 28 oral tablet 0.5/1/0.5-35 mg-mcg 1 MO

lessina oral tablet 0.1-20 mg-mcg 1 MO

levonest (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10)

1 MO

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-0.03 mg

1 MO

levonorgestrel-ethinyl estrad oral tablets,dose pack,3 month 0.15 mg-30 mcg (91)

1 MO

levonorg-eth estrad triphasic oral tablet 50-30 (6)/75-40 (5)/125-30(10)

1 MO


136


levora-28 oral tablet 0.15-0.03 mg 1 MO

LILLOW (28) ORAL TABLET 0.15-0.03 MG 1 MO

LOESTRIN 1.5/30 (21) ORAL TABLET 1.5-30 MG-MCG

1 MO

lopreeza oral tablet 1-0.5 mg 1 MO

low-ogestrel (28) oral tablet 0.3-30 mg-mcg 1 MO

lutera (28) oral tablet 0.1-20 mg-mcg 1 MO

marlissa (28) oral tablet 0.15-0.03 mg 1 MO

microgestin 1.5/30 (21) oral tablet 1.5-30 mg-mcg 1 MO

microgestin 1/20 (21) oral tablet 1-20 mg-mcg 1 MO

microgestin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7)

1 MO

microgestin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7)

1 MO

MILI ORAL TABLET 0.25-35 MG-MCG 1 MO

mimvey lo oral tablet 0.5-0.1 mg 1 MO

MIMVEY ORAL TABLET 1-0.5 MG 1 MO

mononessa (28) oral tablet 0.25-35 mg-mcg 1 MO

MY WAY 1.5 MG TABLET (OTC) 1.5 MG 3 DP

necon 0.5/35 (28) oral tablet 0.5-35 mg-mcg 1 MO

necon 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 1 MO

norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg, 1-5 mg-mcg, 1.5-30 mg-mcg

1 MO

norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1 mg-20 mcg (24)/75 mg (4)

1 MO

norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-35 mcg (28), 0.25-35 mg-mcg

1 MO

NORLYDA ORAL TABLET 0.35 MG 1 MO

nortrel 0.5/35 (28) oral tablet 0.5-35 mg-mcg 1 MO

nortrel 1/35 (21) oral tablet 1-35 mg-mcg (21) 1 MO

137


nortrel 1/35 (28) oral tablet 1-35 mg-mcg 1 MO

nortrel 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg

1 MO

NUVARING VAGINAL RING 0.12-0.015 MG/24 HR

2 MO

ocella oral tablet 3-0.03 mg 1 MO

OPCICON ONE-STEP 1.5 MG TABLET 1.5 MG 3 DP

OPTION 2 1.5 MG TABLET 1.5 MG 3 DP

orsythia oral tablet 0.1-20 mg-mcg 1 MO

pimtrea (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5

1 MO

pirmella oral tablet 1-35 mg-mcg 1 MO

PLAN B ONE-STEP 1.5 MG TABLET (OTC) 1.5 MG

3 DP

portia 28 oral tablet 0.15-0.03 mg 1 MO

PREMPHASE ORAL TABLET 0.625 MG (14)/ 0.625MG-5MG(14)

2 MO

PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG

2 MO

previfem oral tablet 0.25-35 mg-mcg 1 MO

quasense oral tablets,dose pack,3 month 0.15 mg-30 mcg (91)

1 MO

REACT 1.5 MG TABLET 1.5 MG 3 DP

reclipsen (28) oral tablet 0.15-0.03 mg 1 MO

setlakin oral tablets,dose pack,3 month 0.15 mg-30 mcg (91)

1 MO

SIMLIYA (28) ORAL TABLET 0.15-0.02 MGX21 /0.01 MG X 5

1 MO

sprintec (28) oral tablet 0.25-35 mg-mcg 1 MO

sronyx oral tablet 0.1-20 mg-mcg 1 MO

TAKE ACTION 1.5 MG TABLET 1.5 MG 3 DP

tarina fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7)

1 MO

TARINA FE 1-20 EQ (28) ORAL TABLET 1 MG-20 MCG (21)/75 MG (7)

1 MO


138


TRI FEMYNOR ORAL TABLET 0.18/0.215/0.25 MG-35 MCG (28)

1 MO

TRI-ESTARYLLA ORAL TABLET 0.18/0.215/0.25 MG-35 MCG (28)

1 MO

tri-legest fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9)

1 MO

TRI-MILI ORAL TABLET 0.18/0.215/0.25 MG-35 MCG (28)

1 MO

trinessa (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28)

1 MO

tri-previfem (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28)

1 MO

tri-sprintec (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28)

1 MO

trivora (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10)

1 MO

tri-vylibra oral tablet 0.18/0.215/0.25 mg-35 mcg (28)

1 MO

velivet triphasic regimen (28) oral tablet 0.1/.125/.15-25 mg-mcg

1 MO

vienva oral tablet 0.1-20 mg-mcg 1 MO

vyfemla (28) oral tablet 0.4-35 mg-mcg 1 MO

vylibra oral tablet 0.25-35 mg-mcg 1 MO

xulane transdermal patch weekly 150-35 mcg/24 hr

1 MO

zarah oral tablet 3-0.03 mg 1 MO

zovia 1/35e (28) oral tablet 1-35 mg-mcg 1 MO

PROGESTINS

camila oral tablet 0.35 mg 1 MO

deblitane oral tablet 0.35 mg 1 MO

DEPO-SUBQ PROVERA 104 SUBCUTANEOUS SYRINGE 104 MG/0.65 ML

2 MO

139


errin oral tablet 0.35 mg 1 MO

INCASSIA ORAL TABLET 0.35 MG 1 MO

jolivette oral tablet 0.35 mg 1 MO

lyza oral tablet 0.35 mg 1 MO

medroxyprogesterone intramuscular suspension 150 mg/ml

1 MO

medroxyprogesterone intramuscular syringe 150 mg/ml

1 MO

medroxyprogesterone oral tablet 10 mg, 2.5 mg, 5 mg

1 MO

megestrol oral suspension 400 mg/10 ml (10 ml), 400 mg/10 ml (40 mg/ml), 625 mg/5 ml

1 PA; MO

megestrol oral tablet 20 mg, 40 mg 1 PA

nora-be oral tablet 0.35 mg 1 MO

norethindrone (contraceptive) oral tablet 0.35 mg 1 MO

norethindrone acetate oral tablet 5 mg 1 MO

norlyroc oral tablet 0.35 mg 1 MO

progesterone micronized oral capsule 100 mg, 200 mg

1 MO

sharobel oral tablet 0.35 mg 1 MO

TULANA ORAL TABLET 0.35 MG 1 MO

SELECTIVE ESTROGEN RECEPTOR MODIFYING AGENTS

DUAVEE ORAL TABLET 0.45-20 MG 2 MO

raloxifene oral tablet 60 mg 1 MO

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (PITUITARY)

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (PITUITARY)

desmopressin nasal spray with pump 10 mcg/spray (0.1 ml)

1 MO

desmopressin nasal spray,non-aerosol 10 mcg/spray (0.1 ml)

1 MO

desmopressin oral tablet 0.1 mg, 0.2 mg 1 MO

EGRIFTA SUBCUTANEOUS RECON SOLN 1 MG, 2 MG

2 PA; MO


140


GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.2 MG/0.25 ML, 0.4 MG/0.25 ML, 0.6 MG/0.25 ML, 0.8 MG/0.25 ML, 1 MG/0.25 ML, 1.2 MG/0.25 ML, 1.4 MG/0.25 ML, 1.6 MG/0.25 ML, 1.8 MG/0.25 ML, 2 MG/0.25 ML

2 PA; MO

GENOTROPIN SUBCUTANEOUS CARTRIDGE 12 MG/ML (36 UNIT/ML), 5 MG/ML (15 UNIT/ML)

2 PA; MO

HUMATROPE INJECTION CARTRIDGE 12 MG (36 UNIT), 24 MG (72 UNIT), 6 MG (18 UNIT)

2 PA; MO

HUMATROPE INJECTION RECON SOLN 5 (15 UNIT) MG

2 PA; MO

INCRELEX SUBCUTANEOUS SOLUTION 10 MG/ML

2 PA

NOCTIVA NASAL SPRAY,NON-AEROSOL 0.83 MCG/SPRAY (0.1 ML), 1.66 MCG/SPRAY (0.1 ML)

2 PA; MO

NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 10 MG/1.5 ML (6.7 MG/ML), 15 MG/1.5 ML (10 MG/ML), 30 MG/3 ML (10 MG/ML), 5 MG/1.5 ML (3.3 MG/ML)

2 PA; MO

NUTROPIN AQ NUSPIN SUBCUTANEOUS PEN INJECTOR 10 MG/2 ML (5 MG/ML), 20 MG/2 ML (10 MG/ML), 5 MG/2 ML (2.5 MG/ML)

2 PA; MO

OMNITROPE SUBCUTANEOUS CARTRIDGE 10 MG/1.5 ML (6.7 MG/ML), 5 MG/1.5 ML (3.3 MG/ML)

2 PA; MO

OMNITROPE SUBCUTANEOUS RECON SOLN 5.8 MG

2 PA; MO

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (THYROID)

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (THYROID)

141


LEVO-T ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

2 MO

levothyroxine oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

1 MO

levoxyl oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg

2 MO

liothyronine oral tablet 25 mcg, 5 mcg, 50 mcg 1 MO

SYNTHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

2 MO

unithroid oral tablet 100 mcg, 112 mcg, 125 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

2 MO

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)

cabergoline oral tablet 0.5 mg 1 MO

ELIGARD (3 MONTH) SUBCUTANEOUS SYRINGE 22.5 MG

2 PA; MO

ELIGARD (4 MONTH) SUBCUTANEOUS SYRINGE 30 MG

2 PA; MO

ELIGARD (6 MONTH) SUBCUTANEOUS SYRINGE 45 MG

2 PA; MO

ELIGARD SUBCUTANEOUS SYRINGE 7.5 MG (1 MONTH)

2 PA; MO

FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 120 MG

2 PA

FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG

2 PA; MO

FIRMAGON SUBCUTANEOUS RECON SOLN 120 MG

2 PA

leuprolide subcutaneous kit 1 mg/0.2 ml 1 MO

leuprolide subcutaneous solution 1 mg/0.2 ml 1 MO

LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG

2 PA


142


LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 22.5 MG

2 PA; MO

LUPRON DEPOT (4 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG

2 PA; MO

LUPRON DEPOT (6 MONTH) INTRAMUSCULAR SYRINGE KIT 45 MG

2 PA; MO

LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 3.75 MG

2 PA

LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 7.5 MG

2 PA; MO

LUPRON DEPOT-PED (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG

2 PA; MO

LUPRON DEPOT-PED INTRAMUSCULAR KIT 7.5 MG (PED)

2 PA; MO

octreotide acetate injection solution 1,000 mcg/ml, 500 mcg/ml

1 PA; MO

OCTREOTIDE ACETATE INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 50 MCG/ML

1 PA; MO

ORILISSA ORAL TABLET 150 MG 2 PA; MO

ORILISSA ORAL TABLET 200 MG 2 PA

SIGNIFOR SUBCUTANEOUS SOLUTION 0.3 MG/ML (1 ML), 0.6 MG/ML (1 ML), 0.9 MG/ML (1 ML)

2 PA; MO

SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 120 MG/0.5 ML, 60 MG/0.2 ML, 90 MG/0.3 ML

2 PA; MO

SOMAVERT SUBCUTANEOUS RECON SOLN 10 MG, 15 MG, 20 MG, 25 MG, 30 MG

2 PA; MO

SYNAREL NASAL SPRAY,NON-AEROSOL 2 MG/ML

2 PA

TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 11.25 MG

2 PA

143


TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 22.5 MG, 3.75 MG

2 PA; MO

TRELSTAR INTRAMUSCULAR SYRINGE 11.25 MG/2 ML, 3.75 MG/2 ML

2 PA; MO

TRELSTAR INTRAMUSCULAR SYRINGE 22.5 MG/2 ML

2 PA

HORMONAL AGENTS, SUPPRESSANT (THYROID)

ANTITHYROID AGENTS

methimazole oral tablet 10 mg, 5 mg 1 MO

propylthiouracil oral tablet 50 mg 1 MO

IMMUNOLOGICAL AGENTS

ANGIOEDEMA AGENTS

CINRYZE INTRAVENOUS RECON SOLN 500 UNIT (5 ML)

2 PA; MO

HAEGARDA SUBCUTANEOUS RECON SOLN 2,000 UNIT, 3,000 UNIT

2 PA; MO

icatibant subcutaneous syringe 30 mg/3 ml 1 PA

IMMUNE SUPPRESSANTS

ASTAGRAF XL ORAL CAPSULE,EXTENDED RELEASE 24HR 0.5 MG, 1 MG, 5 MG

2 B/D; MO

azathioprine oral tablet 50 mg 1 B/D; MO

CIMZIA POWDER FOR RECONST SUBCUTANEOUS KIT 400 MG (200 MG X 2 VIALS)

2 PA; MO

CIMZIA STARTER KIT SUBCUTANEOUS SYRINGE KIT 400 MG/2 ML (200 MG/ML X 2)

2 PA; MO

CIMZIA SUBCUTANEOUS SYRINGE KIT 400 MG/2 ML (200 MG/ML X 2)

2 PA; MO

cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg

1 B/D; MO

cyclosporine modified oral solution 100 mg/ml 1 B/D; MO

cyclosporine oral capsule 100 mg, 25 mg 1 B/D; MO

DEPEN TITRATABS ORAL TABLET 250 MG 2 PA; MO

enbrel mini subcutaneous cartridge 50 mg/ml (1 ml)

2 PA; MO


144


ENBREL SUBCUTANEOUS RECON SOLN 25 MG (1 ML)

2 PA; MO

ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5 ML (0.5), 50 MG/ML (1 ML)

2 PA; MO

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR 50 MG/ML (1 ML)

2 PA; MO

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HR 0.75 MG, 1 MG, 4 MG

2 B/D; MO

gengraf oral capsule 100 mg, 25 mg 1 B/D; MO

gengraf oral solution 100 mg/ml 1 B/D; MO

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML

2 PA; MO

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML (6 PACK)

2 PA

HUMIRA PEN CROHNS-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML

2 PA; MO

HUMIRA PEN PSOR-UVEITS-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML

2 PA; MO

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML

2 PA; MO

HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML, 40 MG/0.8 ML

2 PA; MO

HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML

2 PA; MO

HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML-40 MG/0.4 ML

2 PA

HUMIRA(CF) PEN CROHNS-UC-HS SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML

2 PA

145


HUMIRA(CF) PEN PSOR-UV-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML-40 MG/0.4 ML

2 PA

HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.4 ML

2 PA; MO

HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML

2 PA

HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 20 MG/0.2 ML, 40 MG/0.4 ML

2 PA; MO

KINERET SUBCUTANEOUS SYRINGE 100 MG/0.67 ML

2 PA; MO

methotrexate sodium (pf) injection solution 25 mg/ml

1

methotrexate sodium injection solution 25 mg/ml 1

methotrexate sodium oral tablet 2.5 mg 1 MO

mycophenolate mofetil oral capsule 250 mg 1 B/D; MO

mycophenolate mofetil oral suspension for reconstitution 200 mg/ml

1 B/D; MO

mycophenolate mofetil oral tablet 500 mg 1 B/D; MO

mycophenolate sodium oral tablet,delayed release (dr/ec) 180 mg, 360 mg

1 B/D; MO

ORENCIA CLICKJECT SUBCUTANEOUS AUTO-INJECTOR 125 MG/ML

2 PA; MO

ORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML, 50 MG/0.4 ML, 87.5 MG/0.7 ML

2 PA; MO

PROGRAF ORAL GRANULES IN PACKET 0.2 MG, 1 MG

2 B/D; MO

SANDIMMUNE ORAL SOLUTION 100 MG/ML 2 B/D; MO

SIMPONI SUBCUTANEOUS PEN INJECTOR 100 MG/ML, 50 MG/0.5 ML

2 PA; MO

SIMPONI SUBCUTANEOUS SYRINGE 100 MG/ML, 50 MG/0.5 ML

2 PA; MO

sirolimus oral solution 1 mg/ml 1 B/D; MO

sirolimus oral tablet 0.5 mg, 1 mg, 2 mg 1 B/D; MO

tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg 1 B/D; MO


146


TREXALL ORAL TABLET 10 MG, 15 MG, 5 MG, 7.5 MG

2 ST; MO

XATMEP ORAL SOLUTION 2.5 MG/ML 2 PA; MO

ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG, 1 MG

2 B/D; MO

IMMUNIZING AGENTS, PASSIVE

CARIMUNE NF NANOFILTERED INTRAVENOUS RECON SOLN 6 GRAM

2 B/D; MO

FLEBOGAMMA DIF INTRAVENOUS SOLUTION 10 %

2 B/D; MO

GAMMAGARD LIQUID INJECTION SOLUTION 10 %

2 B/D; MO

GAMMAGARD S-D (IGA < 1 MCG/ML) INTRAVENOUS RECON SOLN 10 GRAM, 5 GRAM

2 B/D; MO

GAMMAKED INJECTION SOLUTION 1 GRAM/10 ML (10 %)

2 B/D; MO

GAMMAPLEX (WITH SORBITOL) INTRAVENOUS SOLUTION 5 %

2 B/D; MO

GAMMAPLEX INTRAVENOUS SOLUTION 10 %

2 B/D; MO

GAMMAPLEX INTRAVENOUS SOLUTION 10 % (100 ML), 10 % (200 ML)

2 B/D

GAMUNEX-C INJECTION SOLUTION 1 GRAM/10 ML (10 %)

2 B/D; MO

HYPERRAB (PF) INTRAMUSCULAR SOLUTION 300 UNIT/ML

2

HYPERRAB S/D (PF) INTRAMUSCULAR SOLUTION 150 UNIT/ML, 150 UNIT/ML (10 ML)

2

PRIVIGEN INTRAVENOUS SOLUTION 10 % 2 B/D; MO

IMMUNOMODULATORS

147


ACTEMRA ACTPEN SUBCUTANEOUS PEN INJECTOR 162 MG/0.9 ML

2 PA; MO

ACTEMRA SUBCUTANEOUS SYRINGE 162 MG/0.9 ML

2 PA; MO

ACTIMMUNE SUBCUTANEOUS SOLUTION 100 MCG/0.5 ML

2 PA

ARCALYST SUBCUTANEOUS RECON SOLN 220 MG

2 PA; MO

BENLYSTA SUBCUTANEOUS AUTO-INJECTOR 200 MG/ML

2 PA; MO

BENLYSTA SUBCUTANEOUS SYRINGE 200 MG/ML

2 PA; MO

leflunomide oral tablet 10 mg, 20 mg 1 MO

OTEZLA ORAL TABLET 30 MG 2 PA; MO

OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG (47), 10 MG (4)-20 MG (4)-30 MG(19)

2 PA

XOLAIR SUBCUTANEOUS RECON SOLN 150 MG

2 PA; MO

XOLAIR SUBCUTANEOUS SYRINGE 150 MG/ML, 75 MG/0.5 ML

2 PA; MO

VACCINES

ACTHIB (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML

2

ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SUSPENSION 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML

2

ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SYRINGE 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML

2

BCG VACCINE, LIVE (PF) PERCUTANEOUS SUSPENSION FOR RECONSTITUTION 50 MG

2

BEXSERO INTRAMUSCULAR SYRINGE 50-50-50-25 MCG/0.5 ML

2

BOOSTRIX TDAP INTRAMUSCULAR SUSPENSION 2.5-8-5 LF-MCG-LF/0.5ML

2

BOOSTRIX TDAP INTRAMUSCULAR SYRINGE 2.5-8-5 LF-MCG-LF/0.5ML

2


148


DAPTACEL (DTAP PEDIATRIC) (PF) INTRAMUSCULAR SUSPENSION 15-10-5 LF-MCG-LF/0.5ML

2

ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 20 MCG/ML

2 B/D

ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 10 MCG/0.5 ML

2 B/D

GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION 0.5 ML

2

GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE 0.5 ML

2

HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML, 720 ELISA UNIT/0.5 ML

2

HAVRIX (PF) INTRAMUSCULAR SYRINGE 1,440 ELISA UNIT/ML, 720 ELISA UNIT/0.5 ML

2

HEPLISAV-B (PF) INTRAMUSCULAR SOLUTION 20 MCG/0.5 ML

2 B/D

HEPLISAV-B (PF) INTRAMUSCULAR SYRINGE 20 MCG/0.5 ML

2 B/D

HIBERIX (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML

2

IMOVAX RABIES VACCINE (PF) INTRAMUSCULAR RECON SOLN 2.5 UNIT

2

INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION 25-58-10 LF-MCG-LF/0.5ML

2

INFANRIX (DTAP) (PF) INTRAMUSCULAR SYRINGE 25-58-10 LF-MCG-LF/0.5ML

2

IPOL INJECTION SUSPENSION 40-8-32 UNIT/0.5 ML

2

IXIARO (PF) INTRAMUSCULAR SYRINGE 6 MCG/0.5 ML

2

KEDRAB (PF) INTRAMUSCULAR SOLUTION 150 UNIT/ML

2

149


KINRIX (PF) INTRAMUSCULAR SUSPENSION 25 LF-58 MCG-10 LF/0.5 ML

2

KINRIX (PF) INTRAMUSCULAR SYRINGE 25 LF-58 MCG-10 LF/0.5 ML

2

MENACTRA (PF) INTRAMUSCULAR SOLUTION 4 MCG/0.5 ML

2

MENVEO A-C-Y-W-135-DIP (PF) INTRAMUSCULAR KIT 10-5 MCG/0.5 ML

2

M-M-R II (PF) SUBCUTANEOUS RECON SOLN 1,000-12,500 TCID50/0.5 ML

2

PEDIARIX (PF) INTRAMUSCULAR SYRINGE 10 MCG-25LF-25 MCG-10LF/0.5 ML

2

PEDVAX HIB (PF) INTRAMUSCULAR SOLUTION 7.5 MCG/0.5 ML

2

PENTACEL ACTHIB COMPONENT (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML

2

PROQUAD (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10EXP3-4.3-3- 3.99 TCID50/0.5

2

QUADRACEL (PF) INTRAMUSCULAR SUSPENSION 15 LF-48 MCG- 5 LF UNIT/0.5ML

2

RABAVERT (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 2.5 UNIT

2

RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10 MCG/ML, 40 MCG/ML

2 B/D

RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCG/ML, 5 MCG/0.5 ML

2 B/D

ROTARIX ORAL SUSPENSION FOR RECONSTITUTION 10EXP6 CCID50/ML

2

ROTATEQ VACCINE ORAL SOLUTION 2 ML 2

SHINGRIX (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 50 MCG/0.5 ML


SHINGRIX GE ANTIGEN COMPONENT INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 50 MCG

2


150


tdvax intramuscular suspension 2-2 lf unit/0.5 ml 1

TENIVAC (PF) INTRAMUSCULAR SUSPENSION 5 LF UNIT- 2 LF UNIT/0.5ML

2

TENIVAC (PF) INTRAMUSCULAR SYRINGE 5-2 LF UNIT/0.5 ML

2

tetanus,diphtheria tox ped(pf) intramuscular suspension 5-25 lf unit/0.5 ml

1

tetanus-diphtheria toxoids-td intramuscular suspension 2-2 lf unit/0.5 ml

1

TICE BCG INTRAVESICAL SUSPENSION FOR RECONSTITUTION 50 MG

2

TRUMENBA INTRAMUSCULAR SYRINGE 120 MCG/0.5 ML

2

TWINRIX (PF) INTRAMUSCULAR SYRINGE 720 ELISA UNIT- 20 MCG/ML

2

TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG/0.5 ML

2

TYPHIM VI INTRAMUSCULAR SYRINGE 25 MCG/0.5 ML

2

VAQTA (PF) INTRAMUSCULAR SUSPENSION 25 UNIT/0.5 ML, 50 UNIT/ML

2

VAQTA (PF) INTRAMUSCULAR SYRINGE 25 UNIT/0.5 ML, 50 UNIT/ML

2

VARIVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 1,350 UNIT/0.5 ML

2

VARIZIG INTRAMUSCULAR RECON SOLN 125 UNIT

2

VARIZIG INTRAMUSCULAR SOLUTION 125 UNIT/1.2 ML

2

VAXCHORA BUFFER COMPONENT ORAL SUSPENSION FOR RECONSTITUTION

2

151


VAXCHORA VACCINE ORAL SUSPENSION FOR RECONSTITUTION 4X10EXP8 TO 2X 10EXP9 CF UNIT

2

YF-VAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10 EXP4.74 UNIT/0.5 ML

2

ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 19,400 UNIT/0.65 ML


INFLAMMATORY BOWEL DISEASE AGENTS

AMINOSALICYLATES

balsalazide oral capsule 750 mg 1

DELZICOL ORAL CAPSULE (WITH DEL REL TABLETS) 400 MG

2 MO

DIPENTUM ORAL CAPSULE 250 MG 2 MO

mesalamine oral capsule (with del rel tablets) 400 mg

1 MO

mesalamine oral tablet,delayed release (dr/ec) 1.2 gram

1 MO

mesalamine rectal enema 4 gram/60 ml 1 MO

mesalamine rectal suppository 1,000 mg 1 MO

mesalamine with cleansing wipe rectal enema kit 4 gram/60 ml

1 MO

PENTASA ORAL CAPSULE, EXTENDED RELEASE 250 MG, 500 MG

2 MO

GLUCOCORTICOIDS

BUDESONIDE ORAL CAPSULE,DELAYED,EXTEND.RELEASE 3 MG

1

hydrocortisone rectal enema 100 mg/60 ml 1

methylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg

1

SULFONAMIDES

sulfasalazine oral tablet 500 mg 1 MO

sulfasalazine oral tablet,delayed release (dr/ec) 500 mg

1 MO

METABOLIC BONE DISEASE AGENTS


152


METABOLIC BONE DISEASE AGENTS

alendronate oral tablet 10 mg, 35 mg, 40 mg, 5 mg, 70 mg

1 MO

calcitonin (salmon) nasal spray,non-aerosol 200 unit/actuation

1 MO

cinacalcet oral tablet 30 mg, 60 mg 1 MO; QL (60 EA per 30 days)

cinacalcet oral tablet 90 mg 1 MO; QL (120 EA per 30 days)

doxercalciferol intravenous solution 4 mcg/2 ml 1 MO

doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg

1 MO

etidronate disodium oral tablet 200 mg, 400 mg 1 MO

FORTEO SUBCUTANEOUS PEN INJECTOR 20 MCG/DOSE - 600 MCG/2.4 ML

2 PA; MO

ibandronate oral tablet 150 mg 1 MO

NATPARA SUBCUTANEOUS CARTRIDGE 100 MCG/DOSE, 25 MCG/DOSE, 50 MCG/DOSE, 75 MCG/DOSE

2 PA; MO

PROLIA SUBCUTANEOUS SYRINGE 60 MG/ML

2 PA; MO

risedronate oral tablet 150 mg, 35 mg, 5 mg 1 MO

risedronate oral tablet 30 mg, 35 mg (12 pack), 35 mg (4 pack)

1

TYMLOS SUBCUTANEOUS PEN INJECTOR 80 MCG (3,120 MCG/1.56 ML)

2 PA; MO

XGEVA SUBCUTANEOUS SOLUTION 120 MG/1.7 ML (70 MG/ML)

2 PA

OPHTHALMIC AGENTS

OPHTHALMIC PROSTAGLANDIN AND PROSTAMIDE ANALOGS

latanoprost ophthalmic (eye) drops 0.005 % 1 MO

LUMIGAN OPHTHALMIC (EYE) DROPS 0.01 %

2 MO

153


TRAVATAN Z OPHTHALMIC (EYE) DROPS 0.004 %

2 MO

OPHTHALMIC AGENTS, OTHER

ARTIFICIAL TEARS 1.4% DROPS 1.4 % 3 DP

ARTIFICIAL TEARS EYE OINTMENT 83-15 % 3 DP

CYSTARAN OPHTHALMIC (EYE) DROPS 0.44 %

2 MO

GENTEAL GEL DROPS 0.25-0.3 % 3 DP

GENTEAL MILD-MODERATE EYE DROP P/F, DRY EYE RELIEF 0.3 %

3 DP

GENTEAL TEARS 0.1%-0.2%-0.3% 0.1-0.3-0.2 %

3 DP

GENTEAL TEARS 0.1%-0.3% DROP 0.1-0.3 % 3 DP

GENTEAL TEARS 0.1%-0.3% DROP 0.1-0.3 % 3 DP

GENTEAL TEARS SEVERE 0.3% GEL OUTER 0.3 %

3 DP

GS LUBRICAT PLUS 0.5% EYE DRPS P/F, 30X0.4ML 0.5 %

3 DP

HM LUBRICAT PLUS 0.5% EYE DRPS P/F, SUV, STERILE 0.5 %

3 DP

HM LUBRICATING TEARS EYE DROPS 0.4-0.3 %

3 DP

LIQUITEARS 1.4% DROPS 1.4 % 3 DP

LUBRICANT 0.5-0.9% EYE DROPS 0.5-0.9 % 3 DP

LUBRICANT EYE 0.4%-0.3% DROP P/F 0.4-0.3 %

3 DP

LUBRICANT EYE DROPS 0.4-0.3 % 3 DP

LUBRICANT EYE DROPS DRY EYE THERAPY 0.4-0.3 %

3 DP

LUBRICANT PM EYE OINTMENT P/F 57.3-42.5 %

3 DP

LUBRICATING PLUS 0.5% EYE DRPS P/F, 30X0.4ML 0.5 %

3 DP

LUBRIFRESH PM EYE OINTMENT 83-15 % 3 DP

MURO-128 2% EYE DROPS 2 % 3 DP

MURO-128 5% EYE DROPS 5 % 3 DP


154


MURO-128 5% EYE OINTMENT 5 % 3 DP

NATACYN OPHTHALMIC (EYE) DROPS,SUSPENSION 5 %

2

NATURE'S TEARS EYE DROPS 0.1-0.3 % 3 DP

OXERVATE OPHTHALMIC (EYE) DROPS 0.002 %

2 PA

proparacaine ophthalmic (eye) drops 0.5 % 1

REFRESH CELLUVISC 1% EYE DROPS 1 % 3 DP

REFRESH CLASSIC EYE DROPS U-D,P/F,30X.4ML 1.4-0.6 %

3 DP

REFRESH CLASSIC EYE DROPS U-D,P/F,50X.4ML 1.4-0.6 %

3 DP

REFRESH LACRI-LUBE OINTMENT 56.8-42.5 %

3 DP

REFRESH OPTIVE ADVANCED DROPS 0.5-1-0.5 %

3 DP

REFRESH OPTIVE EYE DROPS 0.5-0.9 % 3 DP

REFRESH OPTIVE SENSITIVE DROPS 30X0.4ML, P/F 0.5-0.9 %

3 DP

REFRESH OPTIVE SENSITIVE DROPS 60X0.4ML, P/F 0.5-0.9 %

3 DP

REFRESH PLUS 0.5% EYE DROPS 30X0.4ML 0.5 %

3 DP

REFRESH PLUS 0.5% EYE DROPS 70X0.4ML,U-D 0.5 %

3 DP

REFRESH PLUS 0.5% EYE DROPS U-D,50X.4ML 0.5 %

3 DP

REFRESH TEARS 0.5% EYE DROP 0.5 % 3 DP

RESTASIS MULTIDOSE OPHTHALMIC (EYE) DROPS 0.05 %

2 MO; QL (11 ML per 30 days)

RESTASIS OPHTHALMIC (EYE) DROPPERETTE 0.05 %


SM LUBRICANT EYE DROPS STRL 0.4-0.3 % 3 DP

155


SM LUBRICATING TEARS EYE DROPS STERILE 0.4-0.3 %

3 DP

sodium chloride 5% eye drop 5 % 3 DP

sodium chloride 5% eye oint 5 % 3 DP

sodium chloride 5% eye oint sterile 5 % 3 DP

sulfacetamide-prednisolone ophthalmic (eye) drops 10 %-0.23 % (0.25 %)

1

SYSTANE 0.3% EYE GEL 0.3 % 3 DP

SYSTANE 0.3-0.4% EYE DROP P/F 0.4-0.3 % 3 DP

SYSTANE 0.3-0.4% EYE DROP U-D,P/F,0.014X28 VL 0.4-0.3 %

3 DP

SYSTANE 0.3-0.4% EYE DROPS 0.4-0.3 % 3 DP

SYSTANE 0.3-0.4% EYE DROPS POCKET PACK, 2X5ML 0.4-0.3 %

3 DP

SYSTANE 0.3-0.4% EYE DROPS TWIN PACK, 2X20ML 0.4-0.3 %

3 DP

SYSTANE BALANCE 0.6% EYE DROP CLINICAL STRENGTH 0.6 %

3 DP

SYSTANE ULTRA 0.4-0.3% EYE DRP 0.4-0.3 %

3 DP

TEARS NATURALE FREE DROPS U-D,36X.9ML,P/F 0.1-0.3 %

3 DP

ULTRA LUBRICANT EYE DROPS 0.4-0.3 % 3 DP

XIIDRA OPHTHALMIC (EYE) DROPPERETTE 5 %


OPHTHALMIC ANTI-ALLERGY AGENTS

azelastine ophthalmic (eye) drops 0.05 % 1

cromolyn ophthalmic (eye) drops 4 % 1

epinastine ophthalmic (eye) drops 0.05 % 1

olopatadine ophthalmic (eye) drops 0.1 % 1

OPHTHALMIC ANTIGLAUCOMA AGENTS

ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.1 %

2 MO

atropine ophthalmic (eye) drops 1 % 1 MO

AZOPT OPHTHALMIC (EYE) DROPS,SUSPENSION 1 %

2 ST; MO


156


brimonidine ophthalmic (eye) drops 0.15 %, 0.2 % 1 MO

carteolol ophthalmic (eye) drops 1 % 1 MO

COMBIGAN OPHTHALMIC (EYE) DROPS 0.2-0.5 %

2 MO

dorzolamide ophthalmic (eye) drops 2 % 1 MO

dorzolamide-timolol ophthalmic (eye) drops 22.3-6.8 mg/ml

1 MO

FML FORTE OPHTHALMIC (EYE) DROPS,SUSPENSION 0.25 %

2

levobunolol ophthalmic (eye) drops 0.5 % 1 MO

PHOSPHOLINE IODIDE OPHTHALMIC (EYE) DROPS 0.125 %

2 MO

pilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4 %

1 MO

SIMBRINZA OPHTHALMIC (EYE) DROPS,SUSPENSION 1-0.2 %

2 MO

timolol maleate ophthalmic (eye) drops 0.25 %, 0.5 %

1 MO

timolol maleate ophthalmic (eye) gel forming solution 0.25 %, 0.5 %

1 MO

OPHTHALMIC ANTI-INFLAMMATORIES

dexamethasone sodium phosphate ophthalmic (eye) drops 0.1 %

1

diclofenac sodium ophthalmic (eye) drops 0.1 % 1

DUREZOL OPHTHALMIC (EYE) DROPS 0.05 %

2

fluorometholone ophthalmic (eye) drops,suspension 0.1 %

1

flurbiprofen sodium ophthalmic (eye) drops 0.03 %

1

ketorolac ophthalmic (eye) drops 0.4 %, 0.5 % 1

prednisolone acetate ophthalmic (eye) drops,suspension 1 %

1

157


prednisolone sodium phosphate ophthalmic (eye) drops 1 %

1

OTIC AGENTS

OTIC AGENTS

acetic acid-aluminum acetate otic (ear) drops 2 % 1

CIPRODEX OTIC (EAR) DROPS,SUSPENSION 0.3-0.1 %

2

hydrocortisone-acetic acid otic (ear) drops 1-2 % 1

neomycin-polymyxin-hc otic (ear) drops,suspension 3.5-10,000-1 mg/ml-unit/ml-%

1

neomycin-polymyxin-hc otic (ear) solution 3.5-10,000-1 mg/ml-unit/ml-%

1

ofloxacin otic (ear) drops 0.3 % 1

RESPIRATORY TRACT/ PULMONARY AGENTS

ANTIHISTAMINES

ALL DAY ALLERGY 10 MG CHEW TAB 10 MG

3 DP

ALL DAY ALLERGY 10 MG TABLET 10 MG 3 DP

ALL DAY ALLERGY 10 MG TABLET INDOOR/OUTDOOR 10 MG

3 DP

ALL DAY ALLERGY 10 MG TABLET INDOOR/OUTDOOR 24 HR 10 MG

3 DP

ALLER-CHLOR 4 MG TABLET 4 MG 3 DP

ALLERGY (LORATADINE) 10 MG TAB 10 MG 3 DP

ALLERGY 25 MG CAPSULE 25 MG 3 DP

ALLERGY 4 MG TABLET 4 MG 3 DP

ALLERGY RELIEF 10 MG TABLET 10 MG 3 DP

ALLERGY RELIEF 10 MG TABLET NON-DROWSY,24 HOUR 10 MG

3 DP

ALLERGY RELIEF 180 MG TABLET 180 MG 3 DP

ALLERGY RELIEF 25 MG SOFTGEL SOFTGEL 25 MG

3 DP

ALLERGY RELIEF 5 MG/5 ML SOLN A/F 5 MG/5 ML

3 DP

ALLERGY RELIEF SYRUP A/F 5 MG/5 ML 3 DP


158


ALLERGY-TIME 4 MG TABLET 4 MG 3 DP

azelastine nasal aerosol,spray 137 mcg (0.1 %) 1 MO

azelastine nasal spray,non-aerosol 0.15 % (205.5 mcg)

1 MO

BANOPHEN 12.5 MG/5 ML SOLUTION 12.5 MG/5 ML

3 DP

BANOPHEN 25 MG CAPSULE 25 MG 3 DP

BANOPHEN 25 MG TABLET 25 MG 3 DP

BANOPHEN 50 MG CAPSULE 50 MG 3 DP

cetirizine hcl 1 mg/ml soln (otc) 1 mg/ml 3 DP

cetirizine hcl 1 mg/ml soln children, s/f, grape (otc) 1 mg/ml

3 DP

cetirizine hcl 1 mg/ml soln children's (otc) 1 mg/ml 3 DP

cetirizine hcl 10 mg tablet 10 mg 3 DP

cetirizine hcl 10 mg tablet f/c,u-d,10x10,inner 10 mg

3 DP

cetirizine hcl 10 mg tablet f/c,u-d,10x10,outer 10 mg

3 DP

cetirizine hcl 10 mg tablet indoor & outdoor 10 mg

3 DP

cetirizine hcl 10 mg tablet indoor/outdoor 24 hr 10 mg

3 DP

cetirizine hcl 10 mg tablet indoor-outdoor,24hr 10 mg

3 DP

cetirizine hcl 10 mg tablet outer 10 mg 3 DP

cetirizine hcl 10 mg tablet u-d,10x10 10 mg 3 DP

cetirizine hcl 5 mg tablet 5 mg 3 DP

cetirizine hcl 5 mg tablet indoor & outdoor 5 mg 3 DP

cetirizine hcl 5 mg/5 ml soln inner 5 mg/5 ml 3 DP

cetirizine hcl 5 mg/5 ml soln outer 5 mg/5 ml 3 DP

159


cetirizine hcl 5 mg/5 ml syrup 40's, u-d cups 5 mg/5 ml

3 DP

cetirizine oral solution 1 mg/ml 1

cetirizine-pse er 5-120 mg tab 12 hr relief 5-120 mg

3 DP

cetirizine-pse er 5-120 mg tab 5-120 mg 3 DP

CHILD ALL DAY ALLERGY 1 MG/ML 1 MG/ML

3 DP

CHILD ALL DAY ALLERGY 1 MG/ML 1 MG/ML

3 DP

CHILD ALL DAY ALLERGY 1 MG/ML BUBBLE GUM 1 MG/ML

3 DP

CHILD ALL DAY ALLERGY 1 MG/ML D/F,GLUTEN/F,GRAPE 1 MG/ML

3 DP

CHILD ALLERGY 5 MG/5 ML SOLN 5 MG/5 ML

3 DP

CHILD ALLERGY RELIEF 1 MG/ML S/F,D/F,GLUTEN-FREE 1 MG/ML

3 DP

CHILD ALLERGY RLF 12.5 MG/5 ML 12.5 MG/5 ML

3 DP

CHILD CETIRIZINE 10 MG CHEW TB CHEWABLE, ALLERGY 10 MG

3 DP

child loratadine 5 mg/5 ml syr 5 mg/5 ml 3 DP

child loratadine 5 mg/5 ml syr grape, s/f 5 mg/5 ml 3 DP

CHILD'S ALLERGY 12.5 MG/5 ML A/F,CHERRY,CHILD 12.5 MG/5 ML

3 DP

chlorpheniramine 4 mg tablet 4 mg 3 DP

clemastine oral tablet 2.68 mg 1 PA

cyproheptadine oral syrup 2 mg/5 ml 1 PA

cyproheptadine oral tablet 4 mg 1 PA

DIPHEDRYL ALLERGY CAPSULE 25 MG 3 DP

DIPHENHIST 12.5 MG/5 ML SOLN 12.5 MG/5 ML

3 DP

DIPHENHIST 25 MG CAPTAB CAPTAB 25 MG

3 DP

diphenhydramine 25 mg caplet caplet 25 mg 3 DP


160


diphenhydramine 25 mg capsule (otc) 25 mg 3 DP

diphenhydramine 25 mg capsule u-d, 10x10 (otc) 25 mg

3 DP

diphenhydramine 50 mg capsule (otc) 50 mg 3 DP

diphenhydramine hcl injection solution 50 mg/ml 1 B/D

ED-A-HIST 4 MG-10 MG TABLET 4-10 MG 3 DP

fexofenadine hcl 180 mg tablet 24 hour, non-drowsy (otc) 180 mg

3 DP

fexofenadine hcl 180 mg tablet 24 hour, outer (otc) 180 mg

3 DP

fexofenadine hcl 180 mg tablet 24hr,original str (otc) 180 mg

3 DP

fexofenadine hcl 180 mg tablet allergy, 24hr (otc) 180 mg

3 DP

fexofenadine hcl 180 mg tablet f/c, 10x10,u-d,inner (otc) 180 mg

3 DP

fexofenadine hcl 180 mg tablet f/c, 10x10,u-d,outer (otc) 180 mg

3 DP

fexofenadine hcl 180 mg tablet non-drowsy, 24hr (otc) 180 mg

3 DP

fexofenadine hcl 30 mg/5 ml 30 mg/5 ml 3 DP

fexofenadine hcl 60 mg tablet (otc) 60 mg 3 DP

fexofenadine hcl 60 mg tablet 12 hour, non-drowsy (otc) 60 mg

3 DP

fexofenadine hcl 60 mg tablet indoor/outdoor (otc) 60 mg

3 DP

fexofenadine hcl 60 mg tablet u-d, 10x10,outer (otc) 60 mg

3 DP

GS ALL DAY ALLERGY 10 MG TAB 10 MG 3 DP

GS ALLER-EASE 180 MG TABLET 180 MG 3 DP

GS NIGHTTIME SLEEP AID 25 MG 25 MG 3 DP

161


HM ALL DAY ALLERGY 10 MG TAB INDOOR/OUTDOOR 24 HR 10 MG

3 DP

HM ALLERGY 25 MG CAPSULE MULTI-SYMPTOM 25 MG

3 DP

HM ALLERGY 25 MG TABLET MINITABS 25 MG

3 DP

HM ALLERGY RELIEF 25 MG CAP 25 MG 3 DP

HM ALLERGY RELIEF 4 MG TABLET 4 HOUR, GLUTEN-FREE 4 MG

3 DP

HM CHILD ALLERGY 12.5 MG/5 ML A/F,CHERRY 12.5 MG/5 ML

3 DP

HM CHILD CETIRIZINE 1 MG/ML D/F, S/F, BUBBLEGUM 1 MG/ML

3 DP

HM CHILD CETIRIZINE 1 MG/ML D/F,GRAPE,S/F,GLUT-F 1 MG/ML

3 DP

hm child loratadine 5 mg/5 ml a/f, grape 5 mg/5 ml

3 DP

hm child loratadine 5 mg/5 ml a/f, s/f, grape 5 mg/5 ml

3 DP

hm fexofenadine hcl 180 mg tab (otc) 180 mg 3 DP

hm fexofenadine hcl 180 mg tab 24 hour, gluten-free (otc) 180 mg

3 DP

hm fexofenadine hcl 180 mg tab 24 hour, non-drowsy (otc) 180 mg

3 DP

hm fexofenadine hcl 60 mg tab 12 hour, non-drowsy (otc) 60 mg

3 DP

hm loratadine 10 mg tablet 10 mg 3 DP

hydroxyzine hcl oral solution 10 mg/5 ml 1 PA

hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg 1 PA

levocetirizine oral solution 2.5 mg/5 ml 1 MO

levocetirizine oral tablet 5 mg 1 MO

loratadine 10 mg softgel 10 mg 3 DP

loratadine 10 mg tablet 10 mg 3 DP

loratadine 10 mg tablet 10x10,u-d,outer 10 mg 3 DP

loratadine 10 mg tablet non-drowsy 10 mg 3 DP

loratadine 10 mg tablet non-drowsy, 24hr 10 mg 3 DP


162


loratadine 5 mg/5 ml soln child's,a/f,s/f,d/f 5 mg/5 ml

3 DP

loratadine 5 mg/5 ml syrup children's 5 mg/5 ml 3 DP

loratadine 5 mg/5 ml syrup children's, a/f, d/f 5 mg/5 ml

3 DP

loratadine allergy 5 mg/5 ml d/f, a/f, s/f 5 mg/5 ml 3 DP

NIGHTTIME SLEEP AID 25 MG CPLT MINI-CAPLET 25 MG

3 DP

NON-DROWSY ALLERGY 10 MG TAB 10 MG 3 DP

PHARBEDRYL 25 MG CAPSULE 25 MG 3 DP

promethazine oral syrup 6.25 mg/5 ml 1 PA

QC CHILD ALLERGY 12.5 MG/5 ML 12.5 MG/5 ML

3 DP

qc loratadine 10 mg tablet non-drowsy 10 mg 3 DP

QC NIGHTTIME SLEEP 25 MG TAB 25 MG 3 DP

SB ALLERGY 10 MG TABLET ORIGINAL STRENGTH 10 MG

3 DP

SB ALLERGY MED 25 MG TABLET MINITABS 25 MG

3 DP

SB ALLERGY MEDICINE 25 MG CAP 25 MG 3 DP

sb chlorpheniramine 4 mg tab 4 mg 3 DP

SB SLEEP TABLET 25 MG 3 DP

SILADRYL 12.5 MG/5 ML LIQUID 12.5 MG/5 ML

3 DP

SLEEP TABS 25 MG TABLET 25 MG 3 DP

SM ALL DAY ALLERGY 10 MG TAB INDOOR/OUTDOOR 24 HR 10 MG

3 DP

SM ALLERGY 4-HR 4 MG TABLET 4 MG 3 DP

SM ALLERGY RELIEF 12.5 MG/5 ML 12.5 MG/5 ML

3 DP

SM ALLERGY RELIEF 12.5 MG/5 ML CHILDREN'S, CHERRY 12.5 MG/5 ML

3 DP

163


SM ALLERGY RELIEF 25 MG CAP 25 MG 3 DP

SM ALLERGY RELIEF 25 MG CAP GLUTEN FREE 25 MG

3 DP

SM CHILD ALL DAY ALLER 1 MG/ML CHERRY 1 MG/ML

3 DP

SM CHILD ALL DAY ALLER 1 MG/ML S/F, GRAPE 1 MG/ML

3 DP

sm child loratadine 5 mg/5 ml s/f, a/f, gluten/f 5 mg/5 ml

3 DP

sm fexofenadine hcl 180 mg tab 24hr, gluten-free (otc) 180 mg

3 DP

sm loratadine 10 mg tablet 10 mg 3 DP

sm loratadine 10 mg tablet non-drowsy 10 mg 3 DP

sm loratadine 10 mg tablet non-drowsy,gluten-f 10 mg

3 DP

sm loratadine 5 mg/5 ml syrup 5 mg/5 ml 3 DP

SM SLEEP AID NIGHT TIME CAPLET CAPLET 25 MG

3 DP

SUDOGEST SINUS AND ALLERGY TAB 4-60 MG

3 DP

ANTI-INFLAMMATORIES, INHALED CORTICOSTEROIDS

ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 200 MCG/ACTUATION, 50 MCG/ACTUATION

2 MO

budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml, 1 mg/2 ml

1 B/D; MO

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 250 MCG/ACTUATION, 50 MCG/ACTUATION

2 MO

FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION, 220 MCG/ACTUATION, 44 MCG/ACTUATION

2 MO

flunisolide nasal spray,non-aerosol 25 mcg (0.025 %)

1 MO

fluticasone propionate nasal spray,suspension 50 mcg/actuation

1 MO

mometasone nasal spray,non-aerosol 50 mcg/actuation

1 MO


164


QVAR INHALATION AEROSOL 40 MCG/ACTUATION, 80 MCG/ACTUATION

2 MO

QVAR REDIHALER INHALATION HFA AEROSOL BREATH ACTIVATED 40 MCG/ACTUATION, 80 MCG/ACTUATION

2 MO

ANTILEUKOTRIENES

montelukast oral granules in packet 4 mg 1 MO

montelukast oral tablet 10 mg 1 MO

montelukast oral tablet,chewable 4 mg, 5 mg 1 MO

XYREM ORAL SOLUTION 500 MG/ML 2 PA; LA

zafirlukast oral tablet 10 mg, 20 mg 1 ST; MO

BRONCHODILATORS, ANTICHOLINERGIC

INCRUSE ELLIPTA INHALATION BLISTER WITH DEVICE 62.5 MCG/ACTUATION

2 MO

ipratropium bromide inhalation solution 0.02 % 1 B/D; MO

SPIRIVA RESPIMAT INHALATION MIST 1.25 MCG/ACTUATION, 2.5 MCG/ACTUATION

2 MO

SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE 18 MCG

2 MO

TUDORZA PRESSAIR INHALATION AEROSOL POWDR BREATH ACTIVATED 400 MCG/ACTUATION

2 MO

TUDORZA PRESSAIR INHALATION AEROSOL POWDR BREATH ACTIVATED 400 MCG/ACTUATION (30 ACTUAT)

2

BRONCHODILATORS, SYMPATHOMIMETIC

albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation, 90 mcg/actuation (nda020983)

1 MO

albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 2.5 mg/0.5 ml, 5 mg/ml

1 B/D; MO

albuterol sulfate oral syrup 2 mg/5 ml 1 MO

165


albuterol sulfate oral tablet 2 mg, 4 mg 1 MO

albuterol sulfate oral tablet extended release 12 hr 4 mg, 8 mg

1 MO

epinephrine injection auto-injector 0.15 mg/0.15 ml, 0.15 mg/0.3 ml, 0.3 mg/0.3 ml


levalbuterol hcl inhalation solution for nebulization 0.31 mg/3 ml, 0.63 mg/3 ml, 1.25 mg/3 ml

1 B/D; MO

metaproterenol oral syrup 10 mg/5 ml 1 MO

metaproterenol oral tablet 10 mg, 20 mg 1 MO

SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50 MCG/DOSE

2 MO

STRIVERDI RESPIMAT INHALATION MIST 2.5 MCG/ACTUATION

2 MO

terbutaline oral tablet 2.5 mg, 5 mg 1 MO

VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION

2 MO

CYSTIC FIBROSIS AGENTS

KALYDECO ORAL GRANULES IN PACKET 25 MG, 50 MG, 75 MG

2 PA; MO

KALYDECO ORAL TABLET 150 MG 2 PA; MO

ORKAMBI ORAL GRANULES IN PACKET 100-125 MG, 150-188 MG

2 PA; MO

ORKAMBI ORAL TABLET 100-125 MG, 200-125 MG

2 PA; MO

PULMOZYME INHALATION SOLUTION 1 MG/ML

2 B/D; MO

SYMDEKO ORAL TABLETS, SEQUENTIAL 100-150 MG (D)/ 150 MG (N)

2 PA; MO

symdeko oral tablets, sequential 50-75 mg (d)/ 75 mg (n)

2 PA; MO

tobramycin in 0.225 % nacl inhalation solution for nebulization 300 mg/5 ml

1 B/D; MO

tobramycin with nebulizer inhalation solution for nebulization 300 mg/5 ml

1 B/D; MO

MAST CELL STABILIZERS


166


cromolyn inhalation solution for nebulization 20 mg/2 ml

1 B/D; MO

cromolyn sodium nasal spray 5.2 mg/spray (4 %) 3 DP

PHOSPHODIESTERASE INHIBITORS, AIRWAYS DISEASE

DALIRESP ORAL TABLET 250 MCG, 500 MCG

2 MO

theophylline oral elixir 80 mg/15 ml 1 MO

theophylline oral solution 80 mg/15 ml 1 MO

theophylline oral tablet extended release 12 hr 300 mg, 450 mg

1 MO

theophylline oral tablet extended release 24 hr 400 mg, 600 mg

1 MO

PULMONARY ANTIHYPERTENSIVES

ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG

2 PA; MO

ambrisentan oral tablet 10 mg, 5 mg 1 PA; MO

sildenafil (pulm.hypertension) oral suspension for reconstitution 10 mg/ml

1 PA; MO

sildenafil (pulm.hypertension) oral tablet 20 mg 1 PA; MO

VENTAVIS INHALATION SOLUTION FOR NEBULIZATION 10 MCG/ML, 20 MCG/ML

2 PA; MO

PULMONARY FIBROSIS AGENTS

ESBRIET ORAL CAPSULE 267 MG 2 PA; MO

ESBRIET ORAL TABLET 267 MG, 801 MG 2 PA; MO

OFEV ORAL CAPSULE 100 MG, 150 MG 2 PA; MO

RESPIRATORY TRACT AGENTS, OTHER

acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 %)

1 B/D

ADVAIR HFA INHALATION HFA AEROSOL INHALER 115-21 MCG/ACTUATION, 230-21 MCG/ACTUATION, 45-21 MCG/ACTUATION

2 MO

167


ALL DAY ALLERGY-D TABLET 12 HOUR 5-120 MG

3 DP

ALL DAY ALLERGY-D TABLET 5-120 MG 3 DP

ALL DAY ALLERGY-D TABLET INDOOR & OUTDOOR 5-120 MG

3 DP

ALLERGY D-12 TABLET TAB.SR 12H 5-120 MG

3 DP

ALLERGY RELIEF D-24HR TABLET 10-240 MG

3 DP

ALLERGY RELIEF-NASAL DECONG TB NON-DROWSY 10-240 MG

3 DP

ALLERGY-CONGESTION RLF 12H TAB NON-DROWSY 5-120 MG

3 DP

ANORO ELLIPTA INHALATION BLISTER WITH DEVICE 62.5-25 MCG/ACTUATION

2 MO

APRODINE TABLET 2.5-60 MG 3 DP

benzonatate 100 mg capsule 100 mg 3 DP

benzonatate 100 mg capsule softgel 100 mg 3 DP

benzonatate 200 mg capsule 200 mg 3 DP

benzonatate 200 mg capsule softgel 200 mg 3 DP

BREO ELLIPTA INHALATION BLISTER WITH DEVICE 100-25 MCG/DOSE, 200-25 MCG/DOSE

2 MO

BROTAPP DM LIQUID 1-15-5 MG/5 ML 3 DP

CHEST CONGST-COUGH RELIEF TAB 20-400 MG

3 DP

CHEST-SINUS CONGST RLF TABLET 10-400 MG

3 DP

CHILD MUCUS RELIEF COUGH LIQ A/F, CHERRY 5-100 MG/5 ML

3 DP

CHILD MUCUS RELIEF COUGH LIQ A/F,CHERRY,CHILD 5-100 MG/5 ML

3 DP

CHILDREN'S COLD-ALLERGY ELIXIR A/F,GRAPE,CHILD 1-2.5 MG/5 ML

3 DP

CHILDREN'S COLD-COUGH ELIXIR A/F,RED GRAPE,CHILD 1-2.5-5 MG/5 ML

3 DP


168


CHILDREN'S MUCUS RELIEF LIQ A/F 100 MG/5 ML

3 DP

CHILDREN'S MUCUS RELIEF LIQ A/F,GRAPE,CHILD 100 MG/5 ML

3 DP

CHILDREN'S SILFEDRINE LIQ 15 MG/5 ML 3 DP

CHL MUCINEX CHEST CONGEST LIQ A/F 100 MG/5 ML

3 DP

COLD-ALLERGY ELIXIR CHILDRENS, A/F 1-2.5 MG/5 ML

3 DP

COLD-ALLERGY ELIXIR CHILDREN'S,A/F 1-2.5 MG/5 ML

3 DP

COLD-COUGH ELIXIR 1-2.5-5 MG/5 ML 3 DP

COMBIVENT RESPIMAT INHALATION MIST 20-100 MCG/ACTUATION

2 ST; MO

COUGH DM ER 30 MG/5 ML SUSP 12 HOUR, A/F 30 MG/5 ML

3 DP

COUGH DM ER 30 MG/5 ML SUSP 12HR,A/F,GLUTEN-FREE 30 MG/5 ML

3 DP

COUGH SYRUP 10-100 MG/5 ML 3 DP

COUGH SYRUP 200 MG/10 ML 100 MG/5 ML 3 DP

COUGH-COLD TABLET 4-30 MG 3 DP

COUGHTAB 200 MG TABLET 200 MG 3 DP

cromolyn oral concentrate 100 mg/5 ml 1

CUVPOSA ORAL SOLUTION 1 MG/5 ML (0.2 MG/ML)

2 MO

DEEP SEA 0.65% NOSE SPRAY 0.65 % 3 DP

dextromethorphan er 30 mg/5 ml 30 mg/5 ml 3 DP

DIABETIC SILTUSSIN DAS-NA LIQ 100 MG/5 ML

3 DP

DIABETIC SILTUSSIN-DM LIQUID 10-100 MG/5 ML

3 DP

169


DIMAPHEN DM ELIXIR GRAPE, A/F,GLUTEN-F 1-2.5-5 MG/5 ML

3 DP

DIMAPHEN ELIXIR A/F, GRAPE, GLUTEN-F 1-2.5 MG/5 ML

3 DP

DIMAPHEN ELIXIR GRAPE,A/F,GLUTEN-F 1-2.5 MG/5 ML

3 DP

DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION, 200-5 MCG/ACTUATION

2 MO

ENDACOF-DM LIQUID 1-2.5-5 MG/5 ML 3 DP

EXTRA ACTION COUGH SYRUP 10-100 MG/5 ML

3 DP

fluticasone propion-salmeterol inhalation aerosol powdr breath activated 113-14 mcg/actuation, 232-14 mcg/actuation, 55-14 mcg/actuation

1 MO

fluticasone propion-salmeterol inhalation blister with device 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

1 MO

GNP ALL DAY ALLERGY-D TABLET 5-120 MG

3 DP

GS CHILD COLD-ALLERGY SOLUTION 1-2.5 MG/5 ML

3 DP

GS CHILD MUCUS RLF COUGH LIQ 5-100 MG/5 ML

3 DP

GS NASAL DECONG PE 10 MG TAB 10 MG 3 DP

GS NASAL SPRAY 0.05% 0.05 % 3 DP

GS TUSSIN DM COUGH SYRUP 10-100 MG/5 ML

3 DP

GS TUSSIN DM COUGH-CHEST SOLN 10-100 MG/5 ML

3 DP

GS TUSSIN DM MAX LIQUID 10-200 MG/5 ML

3 DP

GS TUSSIN MUCUS-CONG 100 MG/5 100 MG/5 ML

3 DP

GS TUSSIN MUCUS-CONG 200 MG/10 100 MG/5 ML

3 DP

guaifenesin 100 mg/5 ml liquid 100 mg/5 ml 3 DP

guaifenesin 100 mg/5 ml soln outer 100 mg/5 ml 3 DP


170


guaifenesin 100 mg/5 ml syrup 100 mg/5 ml 3 DP

guaifenesin 200 mg/10 ml soln 100's,u-d, outer,a/f 100 mg/5 ml

3 DP

guaifenesin 200 mg/10 ml soln inner 100 mg/5 ml 3 DP


guaifenesin 300 mg/15 ml soln 100's,u-d,outer, a/f 100 mg/5 ml

3 DP

guaifenesin 300 mg/15 ml soln inner 100 mg/5 ml 3 DP


guaifenesin dm syrup (otc) 10-100 mg/5 ml 3 DP

guaifenesin dm syrup inner (otc) 10-100 mg/5 ml 3 DP

guaifenesin dm syrup outer (otc) 10-100 mg/5 ml 3 DP

guaifenesin er 1,200 mg tablet 1,200 mg 3 DP

HM ADT TUSSIN COUGH CONG DM LQ 10-100 MG/5 ML

3 DP

HM ADULT TUSSIN CHEST CONG LIQ A/F,CHERRY,NO-DROWSY 100 MG/5 ML

3 DP

HM ADULT TUSSIN CHEST CONG LIQ A/F,GLUTEN-FREE 100 MG/5 ML

3 DP

HM ADULT TUSSIN DM SYRUP 10-100 MG/5 ML

3 DP

HM ALLERGY COMPLETE-D TABLET 5-120 MG

3 DP

HM ALLERGY RLF-NASAL DECONG TB NON-DROWSY,24 HR RLF 10-240 MG

3 DP

HM CHEST CONGEST RLF 400 MG TB CAPLET,D/F 400 MG

3 DP

HM MUCUS ER 1,200 MG TABLET 1,200 MG 3 DP

HM MUCUS ER 600 MG TABLET GLUTEN-FREE, 12 HOUR 600 MG

3 DP

HM NASAL DECONGEST 30 MG TAB NON-DROWSY, MAX STR 30 MG

3 DP

171


ipratropium bromide nasal spray,non-aerosol 0.03 %

1 MO

ipratropium bromide nasal spray,non-aerosol 42 mcg (0.06 %)

1

ipratropium-albuterol inhalation solution for nebulization 0.5 mg-3 mg(2.5 mg base)/3 ml

1 B/D; MO

KIDKARE COUGH & COLD LIQUID 1-15-5 MG/5 ML

3 DP

LORATADINE-D 12 HOUR TABLET 12 HOUR 5-120 MG

3 DP

LORATADINE-D 12 HOUR TABLET NON-DROWSY 5-120 MG

3 DP

LORATADINE-D 24HR TABLET 10-240 MG 3 DP

LORATADINE-D 24HR TABLET NON-DROWSY 10-240 MG

3 DP

MUCINEX DM ER 1,200-60 MG TAB BI-LAYER, MAX-STR 60-1,200 MG

3 DP

MUCINEX DM ER 600-30 MG TABLET 30-600 MG

3 DP

MUCINEX ER 1,200 MG TABLET MAX STR, BI-LAYER 1,200 MG

3 DP

MUCINEX ER 600 MG TABLET 600 MG 3 DP

MUCINEX ER 600 MG TABLET BI-LAYER, 12 HOURS 600 MG

3 DP

MUCINEX ER 600 MG TABLET INNER 600 MG

3 DP

MUCINEX ER 600 MG TABLET OUTER 600 MG

3 DP

MUCINEX FAST-MAX DM MAX LIQUID MAXIMUM STRENGTH 5-100 MG/5 ML

3 DP

MUCUS RELIEF 400 MG TABLET 400 MG 3 DP

MUCUS RELIEF 400 MG TABLET D/F 400 MG 3 DP

MUCUS RELIEF DM TABLET D/F 20-400 MG 3 DP

MUCUS RELIEF SINUS TABLET 10-400 MG 3 DP

NASAL DECONGESTANT 0.05% SPRAY 0.05 %

3 DP


172


NASAL DECONGESTANT 0.05% SPRAY 12HR, MAXIMUM STR. 0.05 %

3 DP

NASAL DECONGESTANT 30 MG TAB 30 MG 3 DP

NASAL DECONGESTANT 30 MG TAB NON-DROWSY,MAX-STR 30 MG

3 DP

NASAL DECONGESTANT PE 10 MG TB 10 MG

3 DP

NASAL DECONGESTANT PE 10 MG TB MAX-STR 10 MG

3 DP

NASAL DECONGESTANT PE 10 MG TB NON-DROWSY, MAX STR. 10 MG

3 DP

NASAL DECONGESTANT(PSEUDOEPHEDRINE)30 MG/5 ML 30 MG/5 ML

3 DP

NASAL SPRAY 0.05% 12 HOUR RELIEF 0.05 %

3 DP

NASAL SPRAY 0.05% 12 HOUR,NO DRIP 0.05 %

3 DP

NASAL SPRAY 0.05% 12 HOUR,ORIGINAL 0.05 %

3 DP

NASAL SPRAY 0.05% 12 HOUR,SINUS 0.05 % 3 DP

NASAL SPRAY 0.05% 12HR, ORIGINAL 0.05 %

3 DP

PEDIA RELIEF COUGH-COLD LIQUID 1-15-5 MG/5 ML

3 DP

PEDIATRIC COUGH-COLD LIQUID 1-15-5 MG/5 ML

3 DP

promethazine vc oral syrup 6.25-5 mg/5 ml 1 PA

promethazine-phenylephrine oral syrup 6.25-5 mg/5 ml

1 PA

pseudoephed 30 mg/5 ml soln 30 mg/5 ml 3 DP

pseudoephedrine 30 mg tablet 30 mg 3 DP

QC MUCUS RELIEF 400 MG CAPLET 400 MG 3 DP

173


QC MUCUS RELIEF DM TABLET 20-400 MG 3 DP

QC TUSSIN CF LIQUID 5-10-100 MG/5 ML 3 DP

ROBAFEN 100 MG/5 ML SYRUP 100 MG/5 ML 3 DP

ROBAFEN CF LIQUID A/F,MULTI-CLD SYMPTM 5-10-100 MG/5 ML

3 DP

ROBAFEN DM CGH-CHEST CONG SYRP 10-100 MG/5 ML

3 DP

ROBAFEN DM COUGH LIQUID 10-100 MG/5 ML

3 DP

ROBAFEN-DM SYRUP A/F, NON-NARCOTIC 10-100 MG/5 ML

3 DP

ROBAFEN-DM SYRUP A/F,NON-DROWSY 10-100 MG/5 ML

3 DP

SB 12HR NASAL SPRAY 0.05% 0.05 % 3 DP

SB ALLERFED COLD-ALLERGY TAB 4-10 MG

3 DP

SB COUGH CONTROL SYRUP 100 MG/5 ML 3 DP

SB MUCUS RELIEF DM TABLET DYE-FREE 20-400 MG

3 DP

SILTUSSIN DM COUGH SYRUP 10-100 MG/5 ML

3 DP

SILTUSSIN DM DAS LIQUID 10-100 MG/5 ML 3 DP

SILTUSSIN SA 100 MG/5 ML SYR 100 MG/5 ML

3 DP

SINUS RELIEF 0.05% NASAL SPRAY ULTRA FINE,12 HOUR 0.05 %

3 DP

SM ALL DAY ALLERGY-D TABLET 5-120 MG

3 DP

SM CHEST CONG RELIEF PE CAPLET 10-400 MG

3 DP

SM CHEST CONGEST RLF DM CAPLET CAPLET,D/F 20-400 MG

3 DP

SM CHEST CONGESTION RELIEF CAP CAPLET,D/F 400 MG

3 DP

SM CHILD COLD-ALLERGY LIQUID CHILDRENS 1-2.5 MG/5 ML

3 DP


174


SM LORATA-DINE D 24HR TABLET 10-240 MG

3 DP

SM MUCUS RELIEF COUGH LIQUID CHILDRENS, A/F 5-100 MG/5 ML

3 DP

SM NASAL 0.05% SPRAY 12 HOUR, ORIGINAL 0.05 %

3 DP

SM NASAL DECONGEST 30 MG TAB 30 MG 3 DP

SM NASAL SPRAY 0.05% 0.05 % 3 DP

SM TUSSIN CF SYRUP A/F 5-10-100 MG/5 ML 3 DP

SM TUSSIN DM LIQUID 10-100 MG/5 ML 3 DP

SM TUSSIN DM SYRUP 10-100 MG/5 ML 3 DP

SM TUSSIN DM SYRUP A/F 10-100 MG/5 ML 3 DP

STIOLTO RESPIMAT INHALATION MIST 2.5-2.5 MCG/ACTUATION

2 MO

SUDOGEST 30 MG TABLET 30 MG 3 DP

SUDOGEST 30 MG TABLET BOXED 30 MG 3 DP

SUDOGEST PE 10 MG TABLET 10 MG 3 DP

SUPHEDRIN 30 MG TABLET 30 MG 3 DP

SUPHEDRINE SINUS CONG 30 MG TB 30 MG 3 DP

SYMBICORT INHALATION HFA AEROSOL INHALER 160-4.5 MCG/ACTUATION, 80-4.5 MCG/ACTUATION

2 MO

TESSALON PERLE 100 MG CAP 100 MG 3 DP

TRELEGY ELLIPTA INHALATION BLISTER WITH DEVICE 100-62.5-25 MCG

2 MO

TUSNEL DIABETIC LIQUID (OTC) 10-100 MG/5 ML

3 DP

TUSSIN CF COUGH-COLD LIQUID A/F,NON-DROWSY 5-10-100 MG/5 ML

3 DP

TUSSIN CF COUGH-COLD SYRUP A/F 5-10-100 MG/5 ML

3 DP

175


TUSSIN CF COUGH-COLD SYRUP A/F, NON-DROWSY 5-10-100 MG/5 ML

3 DP

TUSSIN CF COUGH-COLD SYRUP A/F,NON-DROWSY 5-10-100 MG/5 ML

3 DP

TUSSIN DM LIQUID A/F 10-100 MG/5 ML 3 DP

TUSSIN DM LIQUID S/F,A/F 10-100 MG/5 ML 3 DP

TUSSIN DM MAX LIQUID A/F 10-200 MG/5 ML

3 DP

TUSSIN DM MAX LIQUID A/F, NON-DROWSY 10-200 MG/5 ML

3 DP

TUSSIN DM SYRUP 10-100 MG/5 ML 3 DP

TUSSIN MUCUS-CONG 200 MG/10 100 MG/5 ML

3 DP

WIXELA INHUB INHALATION BLISTER WITH DEVICE 100-50 MCG/DOSE, 250-50 MCG/DOSE, 500-50 MCG/DOSE

1

SKELETAL MUSCLE RELAXANTS

SKELETAL MUSCLE RELAXANTS

carisoprodol oral tablet 250 mg, 350 mg 1 PA

chlorzoxazone oral tablet 500 mg 1 PA

cyclobenzaprine oral tablet 10 mg, 5 mg 1 PA

metaxalone oral tablet 800 mg 1

methocarbamol oral tablet 500 mg, 750 mg 1 PA

orphenadrine citrate oral tablet extended release 100 mg

1 PA

SLEEP DISORDER AGENTS

GABA RECEPTOR MODULATORS

temazepam oral capsule 15 mg, 22.5 mg, 30 mg, 7.5 mg


zaleplon oral capsule 10 mg, 5 mg 1 QL (90 EA per 365 days)

zolpidem oral tablet 10 mg, 5 mg 1 QL (90 EA per 365 days)

SLEEP DISORDERS, OTHER

armodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mg

1 PA; MO

HETLIOZ ORAL CAPSULE 20 MG 2 PA; MO


176


MODAFINIL ORAL TABLET 100 MG, 200 MG 1 PA; MO

ramelteon oral tablet 8 mg 1 QL (30 EA per 30 days)

SILENOR ORAL TABLET 3 MG, 6 MG 2

177

E. Index of Covered Drugs 1 12 HOUR NASAL SPRAY 173 8 8 HOUR PAIN RELIEVER . 18 8HR MUSCLE ACHES-PAIN

.......................................... 12 A abacavir ................................ 69 abacavir-lamivudine ............. 69 abacavir-lamivudine-

zidovudine ........................ 69 abelcet................................... 46 ABILIFY MAINTENA ........ 63 abiraterone ............................ 54 ABREVA ............................. 67 acamprosate .......................... 25 acarbose ................................ 73 acebutolol ............................. 84 ACEPHEN ........................... 12 acetaminophen .......... 12, 13, 17 acetaminophen-codeine ........ 13 acetazolamide ....................... 88 acetic acid ............................. 30 acetic acid-aluminum acetate

........................................ 157 acetylcysteine ..................... 166 ACID CONTROLLER ....... 118 ACID GONE ANTACID ... 112 ACID REDUCER

(CIMETIDINE) .............. 119 ACID REDUCER

(FAMOTIDINE) .... 118, 119 ACID REDUCER

(RANITIDINE) .............. 119 acitretin ................................. 94 ACNE MEDICATION ......... 94 ACTEMRA ........................ 147 ACTEMRA ACTPEN ........ 147 ACTHAR ........................... 131 ACTHAR H.P. ................... 131 ACTHIB (PF) ..................... 147 ACTIMMUNE ................... 147 acyclovir ............................... 67 acyclovir sodium .................. 67 ADACEL(TDAP

ADOLESN/ADULT)(PF) ........................................ 147

adapalene .............................. 94

adapalene-benzoyl peroxide . 94 ADEFOVIR .......................... 66 ADEMPAS ......................... 166 ADULT TUSSIN CHEST

CONGESTION ...... 169, 170 ADULT TUSSIN COUGH

CONGEST DM .............. 170 ADULT TUSSIN DM ........ 170 ADVAIR HFA ................... 166 ADVANCED ANTACID-

ANTIGAS ...... 114, 115, 116 AFINITOR ........................... 56 AFINITOR DISPERZ .......... 56 AFIRMELLE...................... 133 AFTERA ............................ 133 AIMOVIG AUTOINJECTOR

.......................................... 52 AIMOVIG AUTOINJECTOR

(2 PACK) .......................... 52 ak-poly-bac ........................... 30 ala-cort .................................. 49 albendazole ........................... 59 albuterol sulfate .......... 164, 165 alclometasone ....................... 49 alcohol pads .......................... 76 ALECENSA ......................... 56 alendronate ......................... 152 ALEVAZOL ......................... 46 alfuzosin ............................. 130 ALINIA ................................ 59 aliskiren ................................ 86 ALL DAY ALLERGY

(CETIRIZINE) ...... 157, 159, 160, 161, 162

ALL DAY ALLERGY-D .. 167, 169, 173

ALLER-CHLOR ................ 157 ALLER-EASE .................... 160 ALLERFED COLD AND

ALLERGY ..................... 173 ALLERGY

(CHLORPHENIRAMINE) ........................................ 157

ALLERGY (DIPHENHYDRAMINE) ................................ 157, 161

ALLERGY 4-HOUR .......... 162

ALLERGY AND CONGESTION RELIEF 167

ALLERGY COMPLETE-D ........................................ 170

ALLERGY D-12 ................ 167 ALLERGY MEDICINE ..... 162 ALLERGY RELIEF

(CETIRIZINE) ............... 162 ALLERGY RELIEF

(FEXOFENADINE) ....... 157 ALLERGY RELIEF

(LORATADINE) ............ 157 ALLERGY RELIEF D-24HR

........................................ 167 ALLERGY

RELIEF(CHLORPHENIRAMN) ................................ 161

ALLERGY RELIEF(DIPHENHYDRAMIN) ............... 157, 162, 163

ALLERGY RELIEF,NASAL DECONGEST ........ 167, 170

ALLERGY-TIME .............. 158 allopurinol ............................. 49 ALMACONE ..................... 112 ALMACONE-2 .................. 112 alogliptin ............................... 73 alogliptin-metformin ............. 73 alogliptin-pioglitazone .......... 73 alosetron ............................. 119 ALPHAGAN P ................... 155 alprazolam ............................ 72 ALPRAZOLAM INTENSOL

.......................................... 71 ALTAVERA (28) ............... 133 aluminum hydroxide gel ..... 112 ALUNBRIG ......................... 56 alyacen 1/35 (28) ................ 133 amabelz ............................... 133 amantadine hcl ...................... 61 AMBISOME ......................... 46 ambrisentan ......................... 166 amikacin ............................... 29 amiloride ............................... 88 amiloride-hydrochlorothiazide

.......................................... 86 AMINOSYN II 10 % ............ 98 AMINOSYN II 15 % ............ 98


178

AMINOSYN-PF 10 % ......... 98 AMINOSYN-PF 7 %

(SULFITE-FREE) ............ 98 amiodarone ........................... 84 AMITIZA ........................... 119 amitriptyline ......................... 44 amlodipine ............................ 85 amlodipine-benazepril .......... 86 amlodipine-olmesartan ......... 86 amlodipine-valsartan ............ 86 amlodipine-valsartan-hcthiazid

.......................................... 86 ammonium lactate ................ 94 AMNESTEEM ..................... 95 amoxapine ............................ 44 amoxicillin ............................ 35 amoxicillin-pot clavulanate .. 35 amphotericin b ...................... 46 ampicillin .............................. 35 ampicillin sodium ................. 35 ampicillin-sulbactam ............ 35 ANADROL-50 ................... 131 anagrelide ............................. 79 anastrozole ............................ 56 ANIMAL SHAPE VITAMINS

........................................ 108 ANODYNE LPT .................. 23 ANORO ELLIPTA ............ 167 ANTACID .................. 112, 116 ANTACID (CALCIUM

CARBONATE) ..... 112, 114, 116

ANTACID ANTI-GAS ..... 112, 113, 115, 116

ANTACID CALCIUM ...... 117 ANTACID EXT STR

(CALCIUM CARB) ....... 112 ANTACID EXTRA-

STRENGTH ........... 113, 116 ANTACID MAXIMUM

STRENGTH ........... 112, 116 ANTACID PLUS ANTI-GAS

................................ 113, 114 ANTACID-ANTIGAS ...... 115,

116

ANTACID-SIMETHICONE ........................................ 113

ANTIBIOTIC (BACITRACIN ZINC) ............................... 32

ANTI-DIARRHEA ............ 116 ANTI-DIARRHEAL

(LOPERAMIDE)... 113, 114, 115, 116

ANTIFUNGAL (CLOTRIMAZOLE) .. 46, 48

ANTIFUNGAL (TOLNAFTATE) ....... 46, 48

ANTIFUNGAL CREAM (MICONAZOLE) ............. 46

ANTI-ITCH (HC)................. 96 APOKYN ............................. 61 aprepitant .............................. 45 apri ...................................... 133 APRODINE ........................ 167 APTIOM ............................... 41 APTIVUS ............................. 70 AQUADEKS PEDIATRIC .. 98 ARALAST NP ................... 129 aranelle (28) ........................ 133 ARANESP (IN

POLYSORBATE) ...... 79, 80 ARCALYST ....................... 147 aripiprazole ........................... 63 ARISTADA .......................... 63 ARISTADA INITIO............. 63 armodafinil ......................... 175 ARNUITY ELLIPTA ......... 163 ARTHRITIS PAIN RELIEF

(ACETAM) ... 13, 14, 15, 17, 18

ARTIFICIAL TEARS (PETRO/MIN) ................ 153

ARTIFICIAL TEARS (POLYVIN ALC) ........... 153

ascomp with codeine ............ 13 ASPIR-81 ............................. 81 aspirin ........... 19, 20, 22, 81, 82 aspirin-dipyridamole ............ 82 ASPIR-LOW ........................ 82 assure id insulin safety ......... 76

ASTAGRAF XL ................. 143 atazanavir .............................. 70 atenolol ................................. 84 atenolol-chlorthalidone ......... 86 ATHLETE'S FOOT

(TERBINAFINE) ............. 48 atomoxetine .......................... 92 atorvastatin ........................... 89 atovaquone ............................ 59 atovaquone-proguanil ........... 59 ATRIPLA ............................. 68 atropine ............................... 155 AUBAGIO ............................ 93 aubra ................................... 133 AUBRA EQ ........................ 133 AUROVELA 1.5/30 (21) ... 133 AUROVELA FE 1.5/30 (28)

........................................ 133 AUROVELA FE 1-20 (28) 133 AUSTEDO ........................... 93 AVANDIA ........................... 73 aviane .................................. 133 AYUNA .............................. 133 azathioprine ........................ 143 azelastine .................... 155, 158 azithromycin ......................... 36 AZOPT ............................... 155 aztreonam ............................. 34 B B COMPLEX-VITAMIN B12

........................................ 108 bacitracin .............................. 30 bacitracin zinc ................. 30, 31 bacitracin-polymyxin b ......... 30 baclofen ................................ 66 BACTROBAN NASAL ....... 30 BALANCED B-100 ........... 108 BALANCED B-50 ............... 98 balsalazide .......................... 151 BALVERSA ......................... 57 balziva (28) ......................... 133 BANOPHEN ...................... 158 BANZEL .............................. 41 BARACLUDE ...................... 66

179

BCG VACCINE, LIVE (PF) ........................................ 147

benazepril ............................. 83 benazepril-hydrochlorothiazide

.......................................... 86 BENLYSTA ....................... 147 BENZNIDAZOLE ............... 59 benzonatate ......................... 167 benzoyl peroxide .................. 95 benztropine ........................... 61 betamethasone dipropionate . 49 betamethasone valerate ........ 49 betamethasone, augmented... 49 BETASERON ...................... 93 betaxolol ............................... 84 bethanechol chloride .......... 131 bexarotene ............................ 59 BEXSERO .......................... 147 bicalutamide ......................... 54 BICILLIN L-A ..................... 35 BIKTARVY ......................... 70 biotin ............................ 98, 106 BISAC-EVAC .................... 120 bisacodyl..................... 120, 125 BISA-LAX ......................... 120 BISCOLAX ........................ 120 BISMATROL ..................... 113 bismuth subsalicylate ......... 113 bisoprolol fumarate .............. 84 bisoprolol-hydrochlorothiazide

.......................................... 86 blisovi fe 1.5/30 (28) .......... 133 blisovi fe 1/20 (28) ............. 133 BOOSTRIX TDAP ............ 147 BOSULIF ............................. 57 BRAFTOVI .......................... 57 BREO ELLIPTA ................ 167 briellyn ............................... 133 BRILINTA ........................... 82 brimonidine ........................ 156 BRIVIACT ........................... 38 bromocriptine ....................... 61 BROTAPP DM .................. 167 budesonide .......................... 163 BUDESONIDE .................. 151 bumetanide ........................... 88 buprenorphine ...................... 22 buprenorphine hcl ................. 25 buprenorphine-naloxone....... 25 bupropion hcl........................ 42

bupropion hcl (smoking deter) .......................................... 25

buspirone .............................. 71 butalbital compound w/codeine

.......................................... 13 butalbital-acetaminop-caf-cod

.......................................... 13 butalbital-acetaminophen ..... 13 butalbital-acetaminophen-caff

.......................................... 13 butalbital-aspirin-caffeine .... 13 butorphanol tartrate .............. 23 BYSTOLIC .......................... 84 C cabergoline ......................... 141 CABOMETYX ..................... 57 calcipotriene ......................... 95 calcitonin (salmon) ............. 152 CALCITRATE ..................... 98 CALCITRATE-VITAMIN D

........................................ 108 calcitriol .............................. 108 CALCIUM 500 WITH D ... 105 CALCIUM 600..................... 99 CALCIUM 600 + D(3) ......... 99 calcium acetate ................... 107 CALCIUM ANTACID...... 113,

114, 115, 117 CALCIUM ANTACID

ULTRA MAX ST ........... 113 calcium carbonate ........... 98, 99 calcium carbonate-vitamin d3

........................................ 108 calcium gluconate ................. 99 calcium polycarbophil ........ 120 CAL-GEST ANTACID ...... 114 CALQUENCE ...................... 57 camila ................................. 138 CAPRELSA.......................... 57 captopril ................................ 83 captopril-hydrochlorothiazide

.......................................... 87 CARBAGLU ........................ 99 carbamazepine ................ 41, 72 carbidopa-levodopa ........ 61, 62 carbidopa-levodopa-

entacapone ........................ 62 CARIMUNE NF

NANOFILTERED.......... 146 carisoprodol ........................ 175

carisoprodol-asa-codeine ...... 13 carisoprodol-aspirin .............. 13 carteolol .............................. 156 cartia xt ................................. 85 carvedilol .............................. 84 caspofungin ........................... 46 CASTELLANI PAINT

MODIFIED ....................... 30 caziant (28) ......................... 133 cefaclor ................................. 33 cefadroxil .............................. 33 cefazolin ............................... 33 cefazolin in dextrose (iso-os) 33 cefdinir .................................. 33 cefepime ............................... 33 cefepime in dextrose 5 % ..... 33 cefepime in dextrose,iso-osm

.......................................... 33 cefixime ................................ 33 cefotaxime ............................ 33 cefoxitin ................................ 33 cefoxitin in dextrose, iso-osm

.......................................... 33 cefpodoxime ......................... 33 cefprozil ................................ 33 ceftazidime ........................... 33 ceftazidime in d5w ............... 33 ceftriaxone ............................ 34 ceftriaxone in dextrose,iso-os

.......................................... 34 cefuroxime axetil .................. 34 cefuroxime sodium ............... 34 celecoxib ............................... 19 CELONTIN .......................... 39 cephalexin ............................. 34 CERDELGA ....................... 129 CERTAVITE SENIOR-

ANTIOXIDANT .............. 99 CERTAVITE-

ANTIOXIDANT ............ 108 cetirizine ..................... 158, 159 cetirizine-pseudoephedrine . 159 cevimeline ............................. 94 CHANTIX ............................ 25 CHANTIX CONTINUING

MONTH BOX .................. 25 CHANTIX STARTING

MONTH BOX .................. 25 CHATEAL EQ (28) ........... 133


180

CHEST CONGESTION RELIEF .................. 170, 173

CHEST CONGESTION RELIEF DM ................... 173

CHEST CONGESTION RELIEF PE ..................... 173

CHEST CONGESTION-COUGH RELIEF ........... 167

CHEST-SINUS CONGESTION RELIEF 167

CHILD ALLERGY RELF(CETIRIZINE) ..... 159

CHILD IBUPROFEN .......... 19 CHILD MUCINEX CHEST

CONGESTION .............. 168 CHILD MUCUS RELIEF

COUGH .................. 167, 169 CHILD MUCUS RELIEF

EXPECTORANT ........... 168 CHILDREN'S

ACETAMINOPHEN ....... 14 CHILDREN'S ALLERGY

(DIPHENHYD) ..... 159, 161, 162

CHILDREN'S ALLERGY RELIEF(LOR) ................ 159

CHILDREN'S ASPIRIN 82, 83 CHILDREN'S CETIRIZINE

................................ 159, 161 CHILDREN'S COLD AND

COUGH (PE) ................. 167 CHILDREN'S COLD-

ALLERGY (PE) ..... 167, 169 CHILDREN'S IBUPROFEN

.............................. 19, 20, 22 CHILDREN'S MAPAP ........ 14 CHILDREN'S PAIN RELIEF

.......................................... 17 CHILDREN'S PAIN

RELIEVER....................... 14 CHILDREN'S PAIN-FEVER

RELIEF .......... 13, 14, 15, 18 CHILDREN'S SILAPAP ..... 14 CHILDREN'S SILFEDRINE

........................................ 168

CHILD'S ALL DAY ALLERGY(CETIR) ...... 159, 163

CHILDS CHEW VITE ......... 99 CHILDS/IRON ..................... 99 chlorhexidine gluconate ....... 94 chloroquine phosphate .......... 60 chlorothiazide ....................... 89 chlorpheniramine maleate . 159,

162 chlorpromazine ..................... 45 chlorthalidone ....................... 89 chlorzoxazone ..................... 175 CHOLBAM ........................ 129 cholecalciferol (vitamin d3) 111 cholestyramine (with sugar) . 89 cholestyramine light ....... 89, 90 ciclopirox .............................. 46 ciclopirox-ure-camph-menth-

euc .................................... 46 cilostazol ............................... 82 CIMDUO .............................. 69 cimetidine ........................... 119 cimetidine hcl ..................... 119 CIMZIA .............................. 143 CIMZIA POWDER FOR

RECONST ...................... 143 CIMZIA STARTER KIT ... 143 cinacalcet ............................ 152 CINRYZE ........................... 143 CIPRODEX ........................ 157 ciprofloxacin ......................... 37 ciprofloxacin hcl ............. 36, 37 ciprofloxacin in 5 % dextrose

.......................................... 37 citalopram ............................. 43 CITRUCEL ........................ 120 CITRUCEL (SUCROSE) ... 120 CITRUCEL SUGAR FREE

........................................ 120 CLARAVIS .......................... 95 clarithromycin ...................... 36 CLEARLAX ...... 120, 122, 125,

126 clemastine ........................... 159

clindamycin hcl .................... 30 clindamycin in 0.9 % sod chlor

.......................................... 30 clindamycin in 5 % dextrose 30 clindamycin palmitate hcl ..... 30 clindamycin pediatric ........... 31 clindamycin phosphate ......... 31 clindamycin-benzoyl peroxide

.......................................... 95 clinimix 4.25%/d10w sulf free

.......................................... 99 clinimix 4.25%-d25w sulf-free

.......................................... 99 clinisol sf 15 % ..................... 99 clobazam ............................... 39 clobetasol .............................. 49 clobetasol-emollient ............. 49 clomipramine ........................ 44 clonazepam ........................... 72 clonidine ............................... 83 clonidine hcl ................... 83, 92 clopidogrel ............................ 82 clorazepate dipotassium ........ 72 clotrimazole .................... 46, 47 clotrimazole-betamethasone . 95 clozapine ............................... 66 COARTEM ........................... 60 codeine-butalbital-asa-caff ... 14 colchicine .............................. 49 COLD AND ALLERGY

(BROMPHEN-PE) . 168, 173 COLD AND COUGH ELIXIR

........................................ 168 COLEMAN BOTANICALS

INSECT ............................ 95 COLEMAN HIGH-DRY

INSECT REPEL ............... 95 COLEMAN SKINSMART

INSECT REP .................... 95 COLEMAN SPORTSMEN

INSECT REPEL ............... 95 colesevelam .......................... 90 colestipol ............................... 90 colistin (colistimethate na) ... 31 COMBIGAN ...................... 156

181

COMBIPATCH .................. 133 COMBIVENT RESPIMAT 168 COMETRIQ ......................... 57 COMPLERA ........................ 68 constulose ........................... 120 COPIKTRA .......................... 56 CORLANOR ........................ 87 cortisone ............................. 131 COSENTYX......................... 95 COSENTYX (2 SYRINGES)

.......................................... 95 COSENTYX PEN ................ 95 COSENTYX PEN (2 PENS) 95 COTELLIC........................... 57 COUGH AND COLD

(CHLORPHEN-DM) ..... 168 COUGH CONTROL

(GUAIFENESIN) ........... 173 COUGH DM ER ................ 168 COUGH SUPPRESSANT-

EXPECTORANT ........... 168 COUGH SYRUP ................ 168 COUGH SYRUP DM ........ 169 COUGHTAB ...................... 168 COUMADIN ........................ 78 CREON .............................. 129 CRIXIVAN .......................... 70 cromolyn............. 155, 166, 168 cryselle (28) ........................ 133 CUTTER BACKWOODS ... 95 CUTTER BACKWOODS

DRY ................................. 95 CUTTER LEMON

EUCALYPTUS ................ 95 CUTTER NATURAL

REPELLENT2 ................. 95 CUTTER SKINSATIONS ... 96 CUVPOSA ......................... 168 cyanocobalamin (vitamin b-12)

................................ 108, 109 cyclafem 1/35 (28) ............. 133 cyclafem 7/7/7 (28) ............ 134 cyclobenzaprine .................. 175 cyclophosphamide ................ 54 cyclosporine ....................... 143 cyclosporine modified ........ 143 cyproheptadine ................... 159 CYRED .............................. 134 CYRED EQ ........................ 134 CYSTADANE .................... 129

CYSTAGON ...................... 129 CYSTARAN ...................... 153 D d10 %-0.45 % sodium chloride

.......................................... 99 d2.5 %-0.45 % sodium

chloride ............................. 99 d5 % and 0.9 % sodium

chloride ............................. 99 d5 %-0.45 % sodium chloride

........................................ 100 dalfampridine........................ 93 DALIRESP ......................... 166 DANAZOL ......................... 131 dantrolene ............................. 66 dapsone ................................. 53 DAPTACEL (DTAP

PEDIATRIC) (PF) .......... 148 daptomycin ........................... 31 DARAPRIM ......................... 60 darifenacin .......................... 130 DAURISMO ......................... 57 deblitane ............................. 138 DEEP SEA NASAL ........... 168 deferasirox .......................... 106 DEKAS ESSENTIAL ........ 100 DEKAS PLUS (FOLIC ACID)

........................................ 100 DEKAS PLUS LIQUID ..... 100 DELSTRIGO ........................ 68 delyla (28)........................... 134 DELZICOL ........................ 151 DEMSER .............................. 87 DENAVIR ............................ 68 DEPEN TITRATABS ........ 143 DEPO-PROVERA................ 55 DEPO-SUBQ PROVERA 104

........................................ 138 dermacinrx empricaine ......... 23 DESCOVY ........................... 69 desipramine .......................... 44 desmopressin ...................... 139 desog-e.estradiol/e.estradiol

........................................ 134 desogestrel-ethinyl estradiol

........................................ 134 desonide .......................... 49, 50 desoximetasone .................... 50 desvenlafaxine succinate ...... 43 dexamethasone ..................... 50

dexamethasone intensol ........ 50 dexamethasone sodium

phosphate ................ 131, 156 dexmethylphenidate .............. 92 dextroamphetamine .............. 91 dextroamphetamine-

amphetamine ............... 91, 92 dextromethorphan polistirex

........................................ 168 dextromethorphan-guaifenesin

........................................ 170 dextrose 10 % and 0.2 % nacl

........................................ 100 dextrose 10 % in water (d10w)

........................................ 100 dextrose 5 % in water (d5w)

........................................ 100 dextrose 5%-0.2 % sod

chloride ........................... 100 dextrose 5%-0.3 %

sod.chloride .................... 100 DEXTROSE WITH SODIUM

CHLORIDE .................... 100 DIABETIC SILTUSSIN DAS-

NA .................................. 168 DIABETIC SILTUSSIN-DM

........................................ 168 DIACOMIT .......................... 38 DIASTAT ............................. 39 DIASTAT ACUDIAL .......... 39 diazepam ......................... 39, 72 diazepam intensol ................. 72 diclofenac potassium ............ 19 diclofenac sodium .... 19, 23, 55,

156 dicloxacillin .......................... 35 DICLOZOR .......................... 20 dicyclomine ........................ 112 didanosine ............................. 69 DIFICID ............................... 36 diflunisal ............................... 20 digitek ................................... 87 digox ..................................... 87 digoxin .................................. 87 dihydroergotamine ................ 52 DILANTIN ........................... 41 diltiazem hcl ......................... 85 dilt-xr .................................... 85 DIMAPHEN (PE) ............... 169 DIMAPHEN DM ................ 169


182

DIPENTUM ....................... 151 DIPHEDRYL ..................... 159 DIPHENHIST .................... 159 diphenhydramine hcl .. 159, 160 diphenoxylate-atropine ....... 112 dipyridamole ........................ 82 disopyramide phosphate ....... 84 disulfiram ............................. 25 divalproex ............................. 39 DM2 ..................................... 73 DOC-Q-LACE ................... 120 DOCU ................................ 120 docusate sodium ................. 121 DOCUSIL .......................... 121 DOCUSOL ......................... 121 dofetilide............................... 84 DOK ................................... 121 donepezil .............................. 41 DOPTELET (10 TAB PACK)

.......................................... 80 DOPTELET (15 TAB PACK)

.......................................... 80 doptelet (30 tab pack) ........... 80 doripenem ............................. 34 dorzolamide ........................ 156 dorzolamide-timolol ........... 156 DOVATO ............................. 68 doxazosin .............................. 83 doxepin ................................. 44 DOXEPIN ............................ 96 doxercalciferol .................... 152 doxy-100 .............................. 37 doxycycline hyclate ........ 37, 38 doxycycline monohydrate .... 38 DRIMINATE ....................... 45 dronabinol............................. 45 drospirenone-ethinyl estradiol

........................................ 134 DROXIA .............................. 55 DUAVEE ........................... 139 DUCODYL ........................ 121 DULERA ............................ 169 duloxetine ............................. 93 DUPIXENT .......................... 96 duramorph (pf) ..................... 23

DUREZOL ......................... 156 dutasteride .......................... 130 E E.C. PRIN ............................. 20 EC-NAPROXEN .................. 20 econazole .............................. 47 ECONTRA EZ ................... 134 ED A-HIST......................... 160 EDURANT ........................... 68 efavirenz ............................... 68 EGRIFTA ........................... 139 ELDERTONIC ................... 100 ELIGARD .......................... 141 ELIGARD (3 MONTH) ..... 141 ELIGARD (4 MONTH) ..... 141 ELIGARD (6 MONTH) ..... 141 ELIQUIS .............................. 78 ELMIRON .......................... 131 EMCYT ................................ 55 EMEND ................................ 46 EMGALITY PEN................. 52 EMGALITY SYRINGE . 52, 53 emoquette ........................... 134 EMSAM ............................... 43 EMTRIVA ............................ 69 enalapril maleate ................... 83 enalapril-hydrochlorothiazide

.......................................... 87 ENBREL ............................ 144 enbrel mini .......................... 143 ENBREL SURECLICK ..... 144 ENDACOF - DM ............... 169 ENDARI ............................. 100 ENEMA ...................... 121, 125 ENEMA DISPOSABLE..... 121 ENEMEEZ ......................... 121 ENEMEEZ PLUS............... 121 ENGERIX-B (PF) .............. 148 ENGERIX-B PEDIATRIC

(PF) ................................. 148 enoxaparin ...................... 78, 79 enpresse .............................. 134 ENSKYCE.......................... 134 entacapone ............................ 61 entecavir ............................... 66

ENTRESTO .......................... 87 enulose ................................ 114 ENVARSUS XR ................ 144 EPIDIOLEX ......................... 38 epinastine ............................ 155 epinephrine ......................... 165 epitol ..................................... 41 EPIVIR HBV ........................ 66 eplerenone ............................. 88 EPOGEN .............................. 80 EQUETRO ........................... 73 ERAXIS(WATER DILUENT)

.......................................... 47 ergocalciferol (vitamin d2) 109,

111 ergoloid ................................. 41 ergotamine-caffeine .............. 52 ERIVEDGE .......................... 57 ERLEADA ........................... 54 erlotinib ................................. 57 errin ..................................... 139 ertapenem ............................. 34 ery pads ................................. 36 ERYTHROCIN .................... 36 erythrocin (as stearate) ......... 36 erythromycin ......................... 36 erythromycin ethylsuccinate . 36 erythromycin with ethanol .... 36 erythromycin-benzoyl peroxide

.......................................... 96 ESBRIET ............................ 166 escitalopram oxalate ............. 43 ESTARYLLA ..................... 134 estradiol .............................. 132 estradiol valerate ................. 132 estradiol-norethindrone acet

........................................ 134 ESTRING ........................... 132 estropipate ........................... 132 ethambutol ............................ 53 ethosuximide ......................... 39 ethynodiol diac-eth estradiol

........................................ 134 etidronate disodium ............ 152 etodolac ................................. 20

183

EUCRISA ............................. 96 EVOTAZ .............................. 70 exemestane ........................... 56 EX-LAX MAXIMUM

STRENGTH ................... 121 EXTAVIA ............................ 93 ezetimibe .............................. 90 ezetimibe-simvastatin ........... 90 F falmina (28) ........................ 134 famciclovir ........................... 68 famotidine........................... 119 FANAPT .............................. 63 FARYDAK .......................... 57 febuxostat ............................. 49 felbamate .............................. 40 felodipine .............................. 85 femynor .............................. 134 fenofibrate ............................ 89 fenofibrate micronized ......... 89 fenofibrate nanocrystallized . 89 fenofibric acid ...................... 89 fenofibric acid (choline) ....... 89 fentanyl ................................. 22 fentanyl citrate ...................... 23 FERGON ............................ 100 FER-IN-SOL ...................... 100 FEROSUL .......................... 101 ferriprox .............................. 106 FERRIPROX ...................... 106 FERRLECIT....................... 106 FERRO-TIME .................... 101 ferrous fumarate ................. 101 ferrous gluconate ................ 101 ferrous sulfate ....... 99, 101, 102 FERROUSUL .................... 102 FETZIMA ............................ 43 FEVERALL ......................... 14 fexofenadine ....... 160, 161, 163 FIBER ................................ 126 FIBER (CALCIUM

POLYCARBOPHIL) .... 121, 126

FIBER (PSYLLIUM HUSK/SUGAR) ............. 126

FIBER (WITH ASPARTAME) ........................................ 122

FIBER LAXATIVE (CA POLYCARBO) ...... 121, 126

FIBER LAXATIVE (METHYLCELLULO) . 122, 126

FIBER THERAPY (M-CELL/SUGAR) .............. 121

FIBER-LAX ....................... 121 FIBER-TABS ..................... 121 finasteride ........................... 130 FIRDAPSE ........................... 93 FIRMAGON ....................... 141 FIRMAGON KIT W

DILUENT SYRINGE .... 141 flavoxate ............................. 130 FLEBOGAMMA DIF ........ 146 flecainide .............................. 84 FLEET BISACODYL ........ 121 FLEET ENEMA ................. 121 FLEET GLYCERIN (CHILD)

........................................ 122 FLEET PEDIATRIC .......... 122 FLOVENT DISKUS .......... 163 FLOVENT HFA ................. 163 fluconazole ........................... 47 fluconazole in dextrose(iso-o)

.......................................... 47 fluconazole in nacl (iso-osm)47 flucytosine ............................ 47 fludrocortisone.................... 131 flunisolide ........................... 163 fluocinolone .......................... 50 fluocinonide .......................... 50 fluocinonide-e ....................... 50 fluocinonide-emollient ......... 50 FLUORIDE (SODIUM) ..... 102 fluorometholone ................. 156 fluorouracil ........................... 55 fluoxetine .............................. 43 fluphenazine decanoate ........ 62 fluphenazine hcl ................... 62 flurbiprofen ........................... 20 flurbiprofen sodium ............ 156 flutamide ............................... 54 fluticasone propionate .. 50, 163 fluticasone propion-salmeterol

........................................ 169 fluvoxamine .......................... 43 FML FORTE ...................... 156 folic acid ............................. 102 fondaparinux ......................... 79 FORFIVO XL ...................... 42

FORTEO ............................. 152 fosamprenavir ....................... 70 fosinopril ............................... 83 fosinopril-hydrochlorothiazide

.......................................... 87 FOSRENOL ....................... 107 FRAGMIN ............................ 79 furosemide ............................ 88 FUZEON .............................. 70 fyavolv ................................ 134 FYAVOLV ......................... 134 FYCOMPA ........................... 40 G gabapentin ............................. 39 GALAFOLD ....................... 129 galantamine ..................... 41, 42 GAMMAGARD LIQUID .. 146 GAMMAGARD S-D (IGA < 1

MCG/ML) ....................... 146 GAMMAKED .................... 146 GAMMAPLEX .................. 146 GAMMAPLEX (WITH

SORBITOL) ................... 146 GAMUNEX-C .................... 146 ganciclovir sodium ............... 66 GARDASIL 9 (PF) ............. 148 GAS RELIEF ...................... 114 GAS RELIEF EXTRA

STRENGTH ................... 117 GATTEX 30-VIAL ............ 114 GATTEX ONE-VIAL ........ 114 gauze pad .............................. 76 GAVILAX .......................... 122 gavilyte-c ............................ 114 gavilyte-g ............................ 122 gavilyte-n ............................ 122 GAVISCON ....................... 114 GAVISCON EXTRA

STRENGTH ................... 114 gemfibrozil ........................... 89 generlac ............................... 114 gengraf ................................ 144 GENOTROPIN ................... 140 GENOTROPIN MINIQUICK

........................................ 140 gentak ................................... 29 gentamicin ............................ 29 gentamicin in nacl (iso-osm) 29 GENTEAL MILD TO

MODERATE .................. 153


184

GENTEAL GEL ................. 153 GENTEAL TEARS MILD 153 GENTEAL TEARS

MODERATE .................. 153 GENTEAL TEARS

MODERATE (PF) ......... 153 GENTEAL TEARS SEVERE

GEL ................................ 153 GENTLE LAXATIVE ....... 126 GENVOYA .......................... 68 GEODON ............................. 63 GILENYA ............................ 93 GILOTRIF ............................ 57 GLASSIA ........................... 129 glatiramer ............................. 93 GLATOPA ........................... 93 GLEOSTINE ........................ 54 glimepiride ........................... 73 glipizide ................................ 73 glipizide-metformin .............. 73 GLUCAGEN DIAGNOSTIC

KIT ................................... 76 GLUCAGEN HYPOKIT ..... 76 GLUCAGON EMERGENCY

KIT (HUMAN) ................ 76 GLUCAGON HCL .............. 76 glucose .................................. 76 glyburide............................... 74 glyburide micronized...... 73, 74 glyburide-metformin ............ 74 glycerin (child) ................... 122 GLYCOLAX ...................... 122 glycopyrrolate..................... 112 GOCOVRI ............................ 61 granisetron hcl ...................... 46 GRANIX .............................. 80 griseofulvin microsize .......... 47 guaifenesin ................. 169, 170 guanfacine ...................... 83, 92 guanidine .............................. 53 H HAEGARDA ..................... 143 HAILEY ............................. 134 HAILEY 24 FE .................. 134 halobetasol propionate.......... 50

haloperidol ............................ 62 haloperidol decanoate ........... 62 haloperidol lactate ................ 62 HAVRIX (PF) .................... 148 HEALTHYLAX ................. 122 HEARTBURN RELIEF

(CIMETIDINE) .............. 119 HEARTBURN RELIEF

(FAMOTIDINE) ............ 119 HEARTBURN TREATMENT

24 HOUR ........................ 127 HEMOCYTE ...................... 102 heparin (porcine) .................. 79 heparin, porcine (pf) ............. 79 HEPLISAV-B (PF) ............ 148 HETLIOZ ........................... 175 HEXALEN ........................... 54 HIBERIX (PF) .................... 148 HUMALOG JUNIOR

KWIKPEN U-100 ............ 76 HUMALOG KWIKPEN

INSULIN .......................... 76 HUMALOG MIX 50-50

INSULN U-100 ................ 77 HUMALOG MIX 50-50

KWIKPEN........................ 77 HUMALOG MIX 75-25

KWIKPEN........................ 77 HUMALOG MIX 75-25(U-

100)INSULN .................... 77 HUMALOG U-100 INSULIN

.......................................... 77 HUMATROPE ................... 140 HUMIRA ............................ 144 HUMIRA PEDIATRIC

CROHNS START .......... 144 HUMIRA PEN ................... 144 HUMIRA PEN CROHNS-UC-

HS START ..................... 144 HUMIRA PEN PSOR-

UVEITS-ADOL HS ....... 144 HUMIRA(CF) .................... 145 HUMIRA(CF) PEDI

CROHNS STARTER ..... 144 HUMIRA(CF) PEN ............ 145

HUMIRA(CF) PEN CROHNS-UC-HS ........... 144

HUMIRA(CF) PEN PSOR-UV-ADOL HS ................ 145

HUMULIN 70/30 U-100 INSULIN .......................... 77

HUMULIN N NPH U-100 INSULIN .......................... 77

HUMULIN R REGULAR U-100 INSULN .................... 77

HUMULIN R U-500 (CONC) INSULIN .......................... 77

HUMULIN R U-500 (CONC) KWIKPEN ........................ 77

hydralazine ........................... 90 hydrochlorothiazide .............. 89 hydrocodone-acetaminophen 15 hydrocodone-ibuprofen .. 15, 21 hydrocortisone . 50, 51, 52, 131,

151 hydrocortisone acetate .......... 96 hydrocortisone butyrate ........ 51 hydrocortisone butyr-emollient

.......................................... 51 HYDROCORTISONE PLUS

.......................................... 52 hydrocortisone valerate ........ 51 hydrocortisone-acetic acid .. 157 hydrocortisone-aloe vera 51, 52 hydrocortisone-min oil-wht pet

.......................................... 96 hydromorphone ..................... 23 hydromorphone (pf) .............. 23 HYDROSKIN ....................... 96 HYDROSKIN WITH ALOE 51 hydroxocobalamin .............. 102 hydroxychloroquine .............. 60 hydroxyurea .......................... 55 hydroxyzine hcl .................. 161 hydroxyzine pamoate ............ 71 HYPERRAB (PF) ............... 146 HYPERRAB S/D (PF) ....... 146 I ibandronate ......................... 152 IBRANCE ............................. 57

185

IBU ....................................... 15 IBU-200 ................................ 21 ibuprofen .................. 20, 21, 22 IBUPROFEN IB ............. 21, 22 ibuprofen-oxycodone ........... 15 ICAPS MV ......................... 102 icatibant .............................. 143 ICLUSIG .............................. 57 IDHIFA ................................ 57 IFEREX 150 ....................... 102 imatinib ................................ 57 IMBRUVICA ....................... 57 imipenem-cilastatin .............. 34 imipramine hcl...................... 44 imipramine pamoate ............. 44 imiquimod ............................ 96 IMOVAX RABIES VACCINE

(PF) ................................. 148 INCASSIA ......................... 139 INCRELEX ........................ 140 INCRUSE ELLIPTA ......... 164 indapamide ........................... 89 indomethacin ........................ 21 INFANRIX (DTAP) (PF) .. 148 INFANTS' PAIN AND

FEVER ............................. 15 INFANTS' PAIN RELIEF .. 15,

17 INFED ................................ 102 INGREZZA .......................... 93 INGREZZA INITIATION

PACK ............................... 93 INLYTA ............................... 57 inrebic ................................... 57 INSECT REPELLENT

(DEET) ............................. 96 insulin lispro ......................... 77 insulin syringe-needle u-100 76 INTELENCE ........................ 69 intralipid ............................. 102 INTRALIPID ..................... 102 INTRON A ........................... 67 introvale .............................. 135 INVEGA SUSTENNA ......... 64 INVEGA TRINZA ............... 64 INVIRASE ........................... 70 INVOKAMET ...................... 74 INVOKAMET XR ............... 74 INVOKANA ........................ 74 INZO ANTIFUNGAL.......... 47

IPOL ................................... 148 ipratropium bromide ... 164, 171 ipratropium-albuterol.......... 171 irbesartan .............................. 83 irbesartan-hydrochlorothiazide

.......................................... 87 IRESSA ................................ 57 IRON .................................. 102 ISENTRESS ......................... 68 ISENTRESS HD .................. 68 ISIBLOOM ......................... 135 ISOLYTE S PH 7.4 ............ 102 ISOLYTE-P IN 5 %

DEXTROSE ................... 103 ISOLYTE-S ........................ 103 isoniazid................................ 53 isosorbide dinitrate ............... 91 isosorbide mononitrate ......... 91 isotretinoin ............................ 96 isradipine .............................. 85 itraconazole .......................... 47 ivermectin ............................. 59 IXIARO (PF) ...................... 148 J JADENU ............................ 106 JADENU SPRINKLE ........ 107 JAKAFI ................................ 57 jantoven ................................ 79 JANUMET ........................... 74 JANUMET XR ..................... 74 JANUVIA ............................. 74 JARDIANCE ........................ 74 JENTADUETO .................... 74 JENTADUETO XR .............. 74 jinteli ................................... 135 jolivette ............................... 139 juleber ................................. 135 JULUCA ............................... 68 junel 1.5/30 (21) ................. 135 junel 1/20 (21) .................... 135 junel fe 1.5/30 (28) ............. 135 junel fe 1/20 (28) ................ 135 JUXTAPID ........................... 90 JYNARQUE ....................... 107 K KALETRA ........................... 71 KALLIGA .......................... 135 KALYDECO ...................... 165 KAO-TIN (DOCUSATE

CALCIUM) .................... 123

kariva (28) .......................... 135 KEDRAB (PF) .................... 148 kelnor 1/35 (28) .................. 135 KELNOR 1-50 .................... 135 ketoconazole ......................... 47 ketorolac ....................... 21, 156 KEVEYIS ............................. 88 KIDKARE COUGH/COLD

........................................ 171 kimidess (28) ...................... 135 KINERET ........................... 145 KINRIX (PF) ...................... 149 kionex ................................. 107 kionex (with sorbitol) ......... 107 KISQALI .............................. 58 KISQALI FEMARA CO-

PACK ............................... 58 klor-con 10 .......................... 103 klor-con 8 ............................ 103 klor-con m10 ...................... 103 KLOR-CON M15 ............... 103 klor-con m20 ...................... 103 KLOR-CON SPRINKLE ... 103 KONSYL (SUGAR) ........... 123 KONSYL EASY MIX ........ 123 KONSYL FIBER ................ 123 KONSYL FORMULA-D ... 123 KONSYL SUGAR-FREE .. 123 KONSYL SUGAR-FREE

(ASPARTAME) ............. 123 KORLYM ............................. 74 KRISTALOSE .................... 123 K-SOL ................................ 103 KURVELO (28) ................. 135 KUVAN .............................. 129 L labetalol ................................ 84 lactulose .............................. 123 LAMISIL AF ........................ 47 lamivudine ............................ 67 lamivudine-zidovudine ......... 69 lamotrigine ...................... 40, 73 lansoprazole ................ 127, 128 lanthanum ........................... 107 LANTUS SOLOSTAR U-100

INSULIN .......................... 77 LANTUS U-100 INSULIN .. 77 larin 1.5/30 (21) .................. 135 larin 1/20 (21) ..................... 135 larin fe 1.5/30 (28) .............. 135


186

larin fe 1/20 (28) ................. 135 larissia................................. 135 latanoprost .......................... 152 LATUDA ............................. 64 LAXATIVE (BISACODYL)

........................................ 123 LAXATIVE PLUS STOOL

SOFTENER .................... 126 LAZANDA........................... 23 leena 28 .............................. 135 leflunomide......................... 147 LENVIMA ........................... 58 lessina ................................. 135 letrozole ................................ 56 leucovorin calcium ............... 55 LEUKERAN ........................ 54 LEUKINE............................. 80 leuprolide ............................ 141 LEVA SET ........................... 24 levalbuterol hcl ................... 165 LEVEMIR FLEXTOUCH U-

100 INSULN .................... 77 LEVEMIR U-100 INSULIN 77 levetiracetam ........................ 38 levobunolol ......................... 156 levocarnitine ....................... 103 levocarnitine (with sugar)... 103 levocetirizine ...................... 161 levofloxacin .......................... 37 levofloxacin in d5w .............. 37 levonest (28) ....................... 135 levonorgestrel-ethinyl estrad

........................................ 135 levonorg-eth estrad triphasic

........................................ 135 levora-28............................. 136 LEVO-T ............................. 141 levothyroxine ...................... 141 levoxyl ................................ 141 LEXIVA ............................... 71 LICE KILLING .................... 60 LICE TREATMENT ............ 60 LICE TREATMENT

(PERMETHRIN) .............. 60 lidocaine ............................... 24

lidocaine hcl ......................... 24 lidocaine-prilocaine .............. 24 LIDOPAC ............................. 24 lidopril .................................. 24 lidopril xr .............................. 24 LIDO-PRILO CAINE PACK

.......................................... 24 LILLOW (28) ..................... 136 lindane .................................. 60 linezolid ................................ 31 linezolid in dextrose 5% ....... 31 linezolid-0.9% sodium chloride

.......................................... 31 LINZESS ............................ 120 liothyronine ........................ 141 liprozonepak ......................... 24 LIQUID ANTACID ........... 115 LIQUITEARS .................... 153 lisinopril................................ 83 lisinopril-hydrochlorothiazide

.......................................... 87 lithium carbonate .................. 73 lithium citrate ....................... 73 LIVALO ............................... 89 livixil pak .............................. 24 LOESTRIN 1.5/30 (21) ...... 136 LONSURF ............................ 55 loperamide .......................... 115 lopinavir-ritonavir ................ 71 lopreeza .............................. 136 loratadine .... 159, 161, 162, 163 LORATA-DINE D ............. 174 LORATADINE-D .............. 171 lorazepam ............................. 72 lorazepam intensol ................ 72 LORBRENA ........................ 58 losartan ................................. 83 losartan-hydrochlorothiazide 87 lovastatin .............................. 89 low-ogestrel (28) ................ 136 loxapine succinate ................ 62 LUBRICANT EYE ............ 153 LUBRICANT EYE (CMC-

GLYCERIN) .................. 153

LUBRICANT EYE (PG-PEG 400) ................. 153, 154, 155

LUBRICANT EYE (PG-PEG 400)(PF) .......................... 153

LUBRICATING PLUS ...... 153 LUBRIFRESH PM ............. 153 LUCEMYRA ........................ 25 LUMIGAN ......................... 152 LUPRON DEPOT .............. 142 LUPRON DEPOT (3

MONTH) ................ 141, 142 LUPRON DEPOT (4

MONTH) ........................ 142 LUPRON DEPOT (6

MONTH) ........................ 142 LUPRON DEPOT-PED ..... 142 LUPRON DEPOT-PED (3

MONTH) ........................ 142 lutera (28) ........................... 136 LYNPARZA ......................... 55 LYSODREN ......................... 59 lyza ..................................... 139 M MAG 64 .............................. 103 MAG-AL PLUS ................. 115 MAGNEBIND 300 ............. 103 magnesium .......................... 103 magnesium citrate ............... 123 magnesium oxide ................ 103 magnesium sulfate .............. 103 malathion .............................. 60 MAPAP

(ACETAMINOPHEN) .... 15, 16

MAPAP ARTHRITIS PAIN 16 MAPAP EXTRA STRENGTH

.................................... 15, 16 maprotiline ............................ 43 marlissa (28) ....................... 136 MARPLAN ........................... 43 MATULANE ........................ 54 MAVYRET .......................... 67 MAYZENT ........................... 93 meclizine ............................... 45 meclofenamate ...................... 21

187

MEDOLOR PAK ................. 24 medroxyprogesterone ......... 139 mefloquine ............................ 60 megestrol ............................ 139 MEKINIST ........................... 58 MEKTOVI ........................... 58 meloxicam ............................ 21 memantine ............................ 42 MENACTRA (PF) ............. 149 MENEST ............................ 132 MENTAX ............................. 47 MENVEO A-C-Y-W-135-DIP

(PF) ................................. 149 meperidine ............................ 23 MEPHYTON ........................ 81 mercaptopurine ..................... 55 MERIBIN ........................... 103 meropenem ........................... 34 meropenem-0.9% sodium

chloride ............................. 34 mesalamine ......................... 151 mesalamine with cleansing

wipe ................................ 151 MESNEX ............................. 55 metaproterenol .................... 165 metaxalone ......................... 175 metformin ....................... 74, 75 methadone ...................... 22, 23 methazolamide ..................... 88 methenamine hippurate ........ 31 methimazole ....................... 143 methocarbamol ................... 175 methotrexate sodium .......... 145 methotrexate sodium (pf) ... 145 methoxsalen .......................... 96 methyclothiazide .................. 89 methyldopa ........................... 83 methyldopa-

hydrochlorothiazide .......... 87 methylphenidate hcl ....... 92, 93 METHYLPRED DP ............. 51 methylprednisolone ...... 51, 151 methylprednisolone acetate 131 methyltestosterone .............. 131 metoclopramide hcl .............. 45 metolazone ........................... 89 metoprolol succinate ............ 85 metoprolol ta-hydrochlorothiaz

.......................................... 85 metoprolol tartrate ................ 85

metro i.v................................ 31 metronidazole ....................... 31 metronidazole in nacl (iso-os)

.......................................... 31 mexiletine ............................. 84 MI-ACID ............................ 115 MI-ACID(CALCIUM CARB-

MAG HYDR) ................. 115 MICONAZOLE 7........... 47, 48 miconazole nitrate .......... 47, 48 microgestin 1.5/30 (21) ...... 136 microgestin 1/20 (21) ......... 136 microgestin fe 1.5/30 (28) .. 136 microgestin fe 1/20 (28) ..... 136 midodrine.............................. 83 MILI ................................... 136 MILK OF MAGNESIA..... 122,

123, 124, 125, 126 MIMVEY ........................... 136 mimvey lo ........................... 136 mineral oil........................... 124 minocycline .......................... 38 minoxidil .............................. 90 MINTOX ............................ 115 MINTOX PLUS ................. 115 mirtazapine ........................... 42 misoprostol ......................... 127 M-M-R II (PF) .................... 149 MODAFINIL...................... 176 moexipril .............................. 83 moexipril-hydrochlorothiazide

.......................................... 87 molindone ............................. 62 mometasone .................. 51, 163 mononessa (28)................... 136 montelukast ........................ 164 morgidox .............................. 38 MORGIDOX 1X 50 ............. 38 morphine ............................... 23 MOTION SICKNESS .......... 45 MOTION SICKNESS RELIEF

.......................................... 45 MOTION-TIME ................... 45 moxifloxacin ......................... 37 moxifloxacin-sod.ace,sul-water

.......................................... 37 moxifloxacin-sod.chloride(iso)

.......................................... 37 MUCINEX ......................... 171 MUCINEX DM .................. 171

MUCINEX FAST-MAX DM MAX ............................... 171

MUCUS RELIEF ....... 171, 172 MUCUS RELIEF COUGH 174 MUCUS RELIEF DM 171, 173 MUCUS RELIEF ER ......... 170 MUCUS RELIEF SINUS ... 171 MULTAQ ............................. 84 mupirocin .............................. 31 MURO 128 ................. 153, 154 MY WAY ........................... 136 MYCAMINE ........................ 47 mycophenolate mofetil ....... 145 mycophenolate sodium ....... 145 myorisan ............................... 96 MYRBETRIQ ..................... 130 N nabumetone ........................... 21 nadolol .................................. 85 nafcillin ................................. 35 nafcillin in dextrose iso-osm 35 nalbuphine ............................ 23 naloxone ............................... 25 naltrexone ............................. 25 NAMENDA XR ................... 42 naproxen ............................... 21 naproxen sodium .................. 21 NARCAN ............................. 25 NASAL DECONGESTANT

(OXYMETAZL) ............. 171 NASAL DECONGESTANT

(PE) ......................... 169, 172 NASAL DECONGESTANT

(PSEUDOEPH) ..... 170, 172, 174

NASAL SPRAY (OXYMETAZOLINE) .. 169, 172

NASAL SPRAY 12 HOUR ................................ 172, 174

NASCOBAL ....................... 103 NATACYN ......................... 154 nateglinide ............................ 75 NATPARA ......................... 152 NATRAPEL ......................... 96 NATURAL FIBER

LAXATIVE (SUGAR) ... 124 NATURAL FIBER

LAXATIVE THERAPY 124


188

NATURAL VEG LAXATIVE(SENNOSID) ........................................ 125

NATURA-LAX .................. 125 NATURE'S TEARS ........... 154 NEBUPENT ......................... 60 necon 0.5/35 (28)................ 136 necon 7/7/7 (28) ................. 136 nefazodone ........................... 42 neomycin .............................. 29 neomycin-bacitracin-poly-hc 32 neomycin-bacitracin-

polymyxin ........................ 32 neomycin-polymyxin b-

dexameth .......................... 32 neomycin-polymyxin-

gramicidin......................... 32 neomycin-polymyxin-hc ..... 32,

157 NERLYNX ........................... 58 NEULASTA ......................... 80 NEUPOGEN ........................ 80 NEUPRO .............................. 61 nevirapine ............................. 69 NEXAVAR .......................... 58 niacin .................................... 90 niacinamide .......................... 90 NICODERM CQ ............ 25, 26 NICORELIEF....................... 26 NICORETTE .................. 26, 27 nicotine ............... 25, 27, 28, 29 nicotine (polacrilex) 25, 27, 28,

29 NICOTROL .......................... 29 NICOTROL NS ................... 29 nifedical xl ............................ 85 nifedipine ........................ 85, 86 NIGHTTIME SLEEP AID

(DIPHEN)....................... 162 nilutamide ............................. 54 nimodipine ............................ 86 NINLARO ............................ 55 NITRO-BID ......................... 91 NITRO-DUR ........................ 91 nitrofurantoin macrocrystal .. 32

nitrofurantoin monohyd/m-cryst .................................. 32

nitroglycerin ......................... 91 NITYR ................................ 129 NIVESTYM ......................... 80 NOCTIVA .......................... 140 NON-ASPIRIN .................... 18 NON-ASPIRIN EXTRA

STRENGTH ............... 17, 18 NON-ASPIRIN PAIN RELIEF

.......................................... 17 NON-DROWSY ALLERGY

........................................ 162 nora-be ................................ 139 NORDITROPIN FLEXPRO

........................................ 140 norethindrone (contraceptive)

........................................ 139 norethindrone acetate ......... 139 norethindrone ac-eth estradiol

........................................ 136 norethindrone-e.estradiol-iron

........................................ 136 norgestimate-ethinyl estradiol

........................................ 136 NORLYDA ........................ 136 norlyroc .............................. 139 normosol-r .......................... 104 normosol-r ph 7.4 ............... 104 NORPACE CR ..................... 84 NORTHERA ........................ 83 nortrel 0.5/35 (28)............... 136 nortrel 1/35 (21).................. 136 nortrel 1/35 (28).................. 137 nortrel 7/7/7 (28) ................ 137 nortriptyline .......................... 44 NORVIR ............................... 71 NOVOLIN 70/30 U-100

INSULIN .......................... 78 NOVOLIN N NPH U-100

INSULIN .......................... 78 NOVOLIN R REGULAR U-

100 INSULN .................... 78 NOVOLOG FLEXPEN U-100

INSULIN .......................... 78

NOVOLOG MIX 70-30 U-100 INSULN ........................... 78

NOVOLOG MIX 70-30FLEXPEN U-100 ......... 78

NOVOLOG PENFILL U-100 INSULIN .......................... 78

NOVOLOG U-100 INSULIN ASPART ........................... 78

NOXAFIL ............................. 47 NUBEQA ............................. 54 NUEDEXTA ........................ 93 NU-MAG ............................ 104 NUPLAZID .......................... 64 NUTROPIN AQ NUSPIN .. 140 NUVARING ....................... 137 nyamyc ................................. 47 nystatin ........................... 47, 48 nystatin-triamcinolone .......... 96 nystop ................................... 48 O OCALIVA .......................... 115 ocella ................................... 137 octreotide acetate ................ 142 OCTREOTIDE ACETATE 142 OCUVITE WITH LUTEIN 104 ODEFSEY ............................ 69 ODOMZO ............................. 55 OFEV .................................. 166 OFF ACTIVE ....................... 96 OFF DEEP WOODS ............ 96 OFF DEEP WOODS DRY ... 96 OFF DEEP WOODS

SPORTSMEN ............. 96, 97 OFF FAMILYCARE (WITH

DEET) ............................... 97 OFF FAMILYCARE(WITH

PICARIDIN) ..................... 97 ofloxacin ....................... 37, 157 olanzapine ............................. 64 olmesartan ............................. 83 olmesartan-amlodipin-

hcthiazid ........................... 87 olmesartan-

hydrochlorothiazide .......... 87 olopatadine ......................... 155

189

omega-3 acid ethyl esters ..... 90 omeprazole ......... 127, 128, 129 OMNITROPE..................... 140 ONCOVITE ....................... 104 ondansetron .......................... 46 ondansetron hcl .................... 46 ONE DAILY ...................... 104 OPCICON ONE-STEP ...... 137 OPTION-2 .......................... 137 ORENCIA .......................... 145 ORENCIA CLICKJECT .... 145 ORFADIN .......................... 129 ORILISSA .......................... 142 ORKAMBI ......................... 165 orphenadrine citrate ............ 175 orsythia ............................... 137 OS-CAL 500 + D3 ............. 104 oseltamivir ............................ 71 OTEZLA ............................ 147 OTEZLA STARTER ......... 147 oxandrolone ........................ 131 oxcarbazepine ....................... 41 OXERVATE ...................... 154 oxybutynin chloride............ 130 oxycodone ............................ 23 oxycodone-acetaminophen ... 16 oxycodone-aspirin ................ 16 OYSCO 500/D ................... 109 OYSCO-500 ....................... 104 OYSTER SHELL CALCIUM

500 .................................. 104 OYSTER SHELL CALCIUM-

VIT D3 ........................... 109 OZEMPIC ............................ 75 P PAIN AND FEVER ............. 16 PAIN RELIEF .......... 15, 16, 17 PAIN RELIEF EXTRA

STRENGTH ............... 15, 16 PAIN RELIEVER .... 15, 17, 18 PAIN RELIEVER EXTRA

STRENGTH ............... 17, 18 paliperidone .......................... 64 PANRETIN .......................... 59 pantoprazole ....................... 128 paricalcitol .......................... 109 paromomycin ........................ 29 paroxetine hcl ....................... 43 PASER ................................. 53 PAXIL .................................. 43

PEDIA RELIEF COUGH-COLD ............................. 172

PEDIALYTE ...................... 104 PEDIALYTE FREEZER

POPS .............................. 104 PEDIALYTE SINGLES..... 104 PEDIARIX (PF) ................. 149 PEDIATRIC COUGH AND

COLD ............................. 172 PEDIATRIC ELECTROLYTE

........................................ 110 PEDVAX HIB (PF) ............ 149 peg 3350-electrolytes ......... 124 peg-3350 with flavor packs 124 PEGANONE ........................ 41 PEGASYS ............................ 67 PEGASYS PROCLICK ....... 67 peg-electrolyte soln ............ 124 pen needle, diabetic .............. 76 penicillin g procaine ............. 35 penicillin g sodium ............... 35 penicillin v potassium ........... 35 PENTACEL ACTHIB

COMPONENT (PF) ....... 149 PENTAM.............................. 60 pentamidine .......................... 60 PENTASA .......................... 151 pentazocine-naloxone ........... 17 pentoxifylline........................ 87 PEPTIC RELIEF ................ 115 periogard ............................... 94 permethrin ............................ 60 perphenazine ......................... 45 perphenazine-amitriptyline ... 42 PERSERIS ............................ 65 PHARBEDRYL ................. 162 PHARBETOL ...................... 17 phenelzine ............................. 43 phenobarbital ........................ 39 phenoxybenzamine ............... 83 PHENYTEK ......................... 41 phenytoin .............................. 41 phenytoin sodium extended .. 41 PHOSPHOLINE IODIDE .. 156 PIFELTRO ........................... 69 pilocarpine hcl .............. 94, 156 pimecrolimus ........................ 97 pimozide ............................... 62 pimtrea (28) ........................ 137 pindolol ................................. 85

pioglitazone .......................... 75 pioglitazone-metformin ........ 75 piperacillin-tazobactam ........ 36 PIQRAY ............................... 56 pirmella ............................... 137 piroxicam .............................. 21 PLAN B ONE-STEP .......... 137 plenamine ........................... 104 podofilox ............................... 97 polyethylene glycol 3350 .. 124,

125 polymyxin b sulfate .............. 32 polymyxin b sulf-trimethoprim

.......................................... 32 POLY-VI-SOL ................... 104 POLY-VI-SOL WITH IRON

........................................ 105 POMALYST ......................... 54 portia 28 .............................. 137 posaconazole ......................... 48 potassium chlorid-d5-

0.45%nacl ....................... 105 potassium chloride .............. 105 potassium chloride in water 105 potassium citrate ................. 105 PRADAXA ........................... 79 pramipexole .......................... 61 prasugrel ............................... 82 pravastatin ............................. 89 praziquantel .......................... 59 prazosin ................................. 83 prednicarbate ........................ 97 prednisolone ......................... 51 prednisolone acetate ........... 156 prednisolone sodium phosphate

.................................. 51, 157 prednisone ....................... 51, 52 prednisone intensol ............. 131 pregabalin ............................. 39 PREMARIN ....................... 132 PREMPHASE ..................... 137 PREMPRO ......................... 137 PRENATAL ....................... 110 PRENATAL VITAMIN ..... 109 PRENATAL VITAMIN PLUS

LOW IRON .................... 109 PREVACID 24HR .............. 128 prevalite ................................ 90 previfem .............................. 137 PREVYMIS .......................... 66


190

PREZCOBIX ........................ 71 PREZISTA ........................... 71 PRIFTIN ............................... 53 prilolid .................................. 24 PRILOVIX LITE.................. 24 PRILOVIX LITE PLUS ....... 24 PRILOVIX ULTRALITE .... 24 PRILOVIX ULTRALITE

PLUS ................................ 24 PRIMAQUINE ..................... 60 primidone ............................. 39 PRIVIGEN ......................... 146 probenecid ............................ 49 probenecid-colchicine .......... 49 prochlorperazine ................... 45 prochlorperazine maleate ..... 45 PROCRIT ............................. 80 procto-med hc ..................... 131 procto-pak........................... 131 proctosol hc ........................ 131 proctozone-hc ..................... 131 progesterone micronized .... 139 PROGLYCEM ..................... 76 PROGRAF ......................... 145 PROLASTIN-C .................. 129 PROLIA ............................. 152 PROMACTA .................. 80, 81 promethazine ................ 45, 162 promethazine vc ................. 172 promethazine-phenylephrine

........................................ 172 promethegan ......................... 45 propafenone .......................... 84 proparacaine ....................... 154 propranolol ........................... 85 propranolol-hydrochlorothiazid

.......................................... 87 propylthiouracil .................. 143 PROQUAD (PF) ................ 149 PROSIGHT ........................ 105 protriptyline .......................... 44 PROVIL ............................... 21 pseudoephedrine hcl ........... 172 PULMOZYME .................. 165 PURIXAN ............................ 55

pyrazinamide ........................ 53 pyridostigmine bromide ....... 53 pyridoxine (vitamin b6) ...... 110 Q QUADRACEL (PF) ........... 149 quasense.............................. 137 quetiapine ............................. 65 quinapril................................ 83 quinapril-hydrochlorothiazide

.......................................... 87 quinidine gluconate .............. 84 quinidine sulfate ................... 84 quinine sulfate ...................... 60 QVAR ................................. 164 QVAR REDIHALER ......... 164 R RABAVERT (PF) .............. 149 raloxifene ............................ 139 ramelteon ............................ 176 ramipril ................................. 84 ranitidine hcl ....................... 119 ranolazine ............................. 88 rasagiline .............................. 62 RAVICTI ............................ 129 REACT ............................... 137 READY-TO-USE ENEMA 122 REBIF (WITH ALBUMIN) . 94 REBIF REBIDOSE .............. 94 REBIF TITRATION PACK . 94 reclipsen (28) ...................... 137 RECOMBIVAX HB (PF) .. 149 RECTIV.............................. 116 REFRESH CELLUVISC ... 154 REFRESH CLASSIC (PF) . 154 REFRESH LACRI-LUBE .. 154 REFRESH OPTIVE ........... 154 REFRESH OPTIVE

ADVANCED.................. 154 REFRESH OPTIVE

SENSITIVE (PF) ............ 154 REFRESH PLUS ................ 154 REFRESH TEARS ............. 154 REGRANEX ........................ 97 REGULOID, SUGAR FREE

........................................ 125

RELENZA DISKHALER .... 71 RELISTOR ......................... 116 RENAL VITAMIN ............ 110 repaglinide ............................ 75 REPATHA PUSHTRONEX 90 REPATHA SURECLICK .... 90 REPATHA SYRINGE ......... 90 REPEL 100 ........................... 97 REPEL FAMILY .................. 97 REPEL HUNTER'S .............. 97 REPEL LEMON

EUCALYPTUS ................ 97 REPEL SPORTSMEN ......... 97 REPEL SPORTSMEN DRY 97 REPEL SPORTSMEN MAX

.......................................... 97 REPEL TICK DEFENSE ..... 97 RESCRIPTOR ...................... 69 RESTASIS .......................... 154 RESTASIS MULTIDOSE .. 154 RETACRIT ........................... 81 REVLIMID ........................... 54 REXULTI ............................. 65 REYATAZ ........................... 71 RIBAVIRIN ......................... 67 rifabutin ................................ 53 rifampin ................................ 54 RIFATER ............................. 54 riluzole .................................. 93 rimantadine ........................... 71 risedronate .......................... 152 RISPERDAL CONSTA ....... 65 risperidone ............................ 65 ritonavir ................................ 71 rivastigmine .......................... 42 rivastigmine tartrate .............. 42 rizatriptan .............................. 53 ROBAFEN ......................... 173 ROBAFEN CF

(PHENYLEPHRINE) ..... 173 ROBAFEN DM .................. 173 ROBAFEN DM COUGH ... 173 ROBAFEN DM COUGH-

CHEST CONGEST ........ 173 ropinirole .............................. 61

191

rosuvastatin........................... 89 ROTARIX .......................... 149 ROTATEQ VACCINE ...... 149 roweepra ............................... 38 ROWEEPRA ........................ 38 ROWEEPRA XR ................. 38 rozlytrek ............................... 58 RUBRACA .......................... 58 RULOX .............................. 116 RYDAPT .............................. 58 S SAMSCA ........................... 107 SANDIMMUNE ................ 145 SANTYL .............................. 97 SAPHRIS ............................. 65 SAPHRIS (BLACK

CHERRY) ........................ 65 SAVELLA ............................ 93 scopolamine base.................. 45 SEGLUROMET ................... 75 selegiline hcl ......................... 62 selenium sulfide.................... 97 selzentry ............................... 70 SELZENTRY ....................... 70 SENEXON ......................... 125 SENEXON-S ...................... 125 SENNA ...................... 123, 125 SENNA LAX ..................... 125 SENNA LAXATIVE . 125, 126 SENNA PLUS .................... 125 SENNA WITH DOCUSATE

SODIUM ........................ 121 SENNA-TIME S ................ 125 SENNO .............................. 125 sennosides-docusate sodium

........................................ 125 SENOKOT ......................... 125 SEREVENT DISKUS ........ 165 SEROSTIM ........................ 116 sertraline ............................... 43 setlakin ............................... 137 sevelamer carbonate ........... 108 sharobel .............................. 139 SHINGRIX (PF) ................. 149 SHINGRIX GE ANTIGEN

COMPONENT ............... 149 SIGNIFOR ......................... 142 SILACE .............................. 125 SILADRYL SA .................. 162

sildenafil (pulm.hypertension) ........................................ 166

SILENOR ........................... 176 SILTUSSIN DM DAS........ 173 SILTUSSIN SA .................. 173 SILTUSSIN-DM ................ 173 silver sulfadiazine ................. 37 SIMBRINZA ...................... 156 SIMLIYA (28) .................... 137 SIMPONI............................ 145 simvastatin ............................ 89 SINUS RELIEF

(OXYMETAZOLINE) ... 173 sirolimus ............................. 145 SIRTURO ............................. 54 SLEEP ................................ 162 SLEEP AID

(DIPHENHYDRAMINE) ................................ 160, 163

SLEEP-TABS ..................... 162 sodium bicarbonate............. 105 sodium chloride .. 105, 106, 155 sodium chloride 0.45 % ...... 105 sodium chloride 0.9 % ........ 105 sodium chloride 3 % ........... 106 sodium ferric gluconat-sucrose

........................................ 105 sodium phenylbutyrate ....... 129 sodium polystyrene (sorb free)

........................................ 107 sodium polystyrene sulfonate

........................................ 107 sofosbuvir-velpatasvir .......... 67 SOLTAMOX ........................ 55 SOMATULINE DEPOT .... 142 SOMAVERT ...................... 142 sorine .................................... 84 sotalol ................................... 84 sotalol af ............................... 84 SPIRIVA RESPIMAT ........ 164 SPIRIVA WITH

HANDIHALER .............. 164 spironolactone ...................... 88 spironolacton-hydrochlorothiaz

.......................................... 88 SPRAVATO ......................... 42 sprintec (28) ........................ 137 SPRITAM ............................. 39 SPRYCEL ............................ 58 sps (with sorbitol) ............... 107

sronyx ................................. 137 ssd ......................................... 37 stavudine ............................... 69 STEGLATRO ....................... 75 STEGLUJAN ....................... 75 STELARA ............................ 97 STIOLTO RESPIMAT ....... 174 STIVARGA .......................... 58 STOMACH RELIEF .. 114, 117 STOMACH RELIEF

ORIGINAL ..................... 117 STOOL SOFTENER .. 123, 126 STOOL SOFTENER

(DOCUSATE CAL) ....... 126 STOOL SOFTENER-

LAXATIVE ............ 126, 127 STOOL SOFTENER-

STIMULANT LAXAT .. 127 streptomycin ......................... 29 STRESS FORMULA ......... 110 STRESS FORMULA WITH

IRON .............................. 106 STRESS FORMULA WITH

ZINC ............................... 106 STRIBILD ............................ 68 STRIVERDI RESPIMAT .. 165 SUBVENITE ........................ 40 SUBVENITE STARTER

(BLUE) KIT ..................... 40 SUBVENITE STARTER

(GREEN) KIT .................. 40 SUBVENITE STARTER

(ORANGE) KIT ............... 40 SUCRAID ........................... 129 sucralfate ............................. 127 SUDOGEST ....................... 174 SUDOGEST PE .................. 174 SUDOGEST SINUS AND

ALLERGY ..................... 163 sulfacetamide sodium ........... 37 sulfacetamide sodium (acne) 37 sulfacetamide-prednisolone 155 sulfadiazine ........................... 37 sulfamethoxazole-trimethoprim

.......................................... 37 sulfasalazine ....................... 151 sulindac ................................. 22 sumatriptan ........................... 53 sumatriptan succinate ........... 53 SUPERPLEX-T .................. 110


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SUPHEDRIN ..................... 174 SUPHEDRINE ................... 174 SUTENT .............................. 58 SYLATRON......................... 55 SYMBICORT .................... 174 symdeko ............................. 165 SYMDEKO ........................ 165 SYMFI .................................. 70 SYMFI LO ........................... 69 SYMLINPEN 120 ................ 75 SYMLINPEN 60 .................. 75 SYMPAZAN ........................ 39 SYMTUZA .......................... 70 SYNAREL ......................... 142 SYNDROS ........................... 46 SYNJARDY ......................... 75 SYNJARDY XR .................. 75 SYNRIBO ............................ 55 SYNTHROID ..................... 141 SYSTANE (PF) .................. 155 SYSTANE (PROPYLENE

GLYCOL) ...................... 155 SYSTANE BALANCE ...... 155 SYSTANE GEL ................. 155 SYSTANE ULTRA ........... 155 T TAB-A-VITE ..................... 110 TAB-A-VITE/IRON .......... 110 TABLOID ............................ 55 tacrolimus ..................... 97, 145 TACTINAL .......................... 18 TACTINAL EXTRA

STRENGTH ..................... 18 TAFINLAR .......................... 58 TAGRISSO .......................... 58 TAKE ACTION ................. 137 TALZENNA......................... 56 tamoxifen .............................. 55 tamsulosin .......................... 130 TARGRETIN ....................... 59 tarina fe 1/20 (28) ............... 137 TARINA FE 1-20 EQ (28) . 137 TASIGNA ............................ 58 tazarotene ............................. 97 TAZICEF ............................. 34

TAZORAC ........................... 97 taztia xt ................................. 86 tdvax ................................... 150 TEARS NATURALE FREE

(PF) ................................. 155 TECFIDERA ........................ 94 TEFLARO ............................ 34 TEKTURNA HCT ............... 88 temazepam .......................... 175 TENIVAC (PF) .................. 150 tenofovir disoproxil fumarate

.......................................... 67 terazosin................................ 83 terbinafine hcl ....................... 48 terbutaline ........................... 165 terconazole............................ 48 TESSALON PERLES ........ 174 testosterone ......................... 132 testosterone cypionate ........ 132 testosterone enanthate ......... 132 tetanus,diphtheria tox ped(pf)

........................................ 150 tetanus-diphtheria toxoids-td

........................................ 150 tetrabenazine ......................... 93 tetracycline ........................... 38 THALOMID ......................... 55 theophylline ........................ 166 THERA ............................... 110 THERA M PLUS (FERROUS

FUMARAT) ................... 106 THERA-M .......................... 110 thiamine hcl (vitamin b1) ... 110 THIOLA ............................. 131 thioridazine ........................... 63 thiothixene ............................ 63 tiagabine ............................... 40 TIBSOVO ............................. 58 TICE BCG .......................... 150 timolol maleate ............. 85, 156 tinidazole .............................. 32 TIVICAY.............................. 68 tizanidine .............................. 66 TOBRADEX ........................ 29 tobramycin ............................ 30

tobramycin in 0.225 % nacl 165 tobramycin sulfate ................ 30 tobramycin with nebulizer .. 165 tobramycin-dexamethasone .. 30 tolcapone ............................... 61 tolnaftate ............................... 48 tolterodine ........................... 130 topiramate ............................. 40 toremifene ............................. 55 torsemide .............................. 88 TOTAL B/C ........................ 106 TOTAL HOME INSECT

REPELLENT .................... 96 TOUJEO MAX U-300

SOLOSTAR ..................... 78 TOUJEO SOLOSTAR U-300

INSULIN .......................... 78 TOVIAZ ............................. 130 TRADJENTA ....................... 75 tramadol ................................ 23 tramadol-acetaminophen ...... 18 trandolapril ........................... 84 tranexamic acid ..................... 81 tranylcypromine .................... 43 TRAVATAN Z ................... 153 TRAVEL SICKNESS .......... 45 TRAVEL SICKNESS

(MECLIZINE) .................. 45 trazodone .............................. 43 TRECATOR ......................... 54 TRELEGY ELLIPTA ......... 174 TRELSTAR ................ 142, 143 TREMFYA ..................... 97, 98 tretinoin ................................. 98 tretinoin (chemotherapy) ...... 59 tretinoin (emollient) .............. 98 TREXALL .......................... 146 TRI FEMYNOR ................. 138 triamcinolone acetonide .. 52, 94 triamterene-hydrochlorothiazid

.......................................... 88 TRI-BUFFERED ASPIRIN . 18 triderm .................................. 52 trientine ............................... 107 TRI-ESTARYLLA ............. 138

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trifluoperazine ...................... 63 trifluridine............................. 68 trihexyphenidyl .................... 61 TRIKLO ............................... 90 tri-legest fe.......................... 138 trilyte with flavor packets ... 127 trimethobenzamide ............... 45 trimethoprim ......................... 32 TRI-MILI ........................... 138 trimipramine ......................... 44 trinessa (28) ........................ 138 TRINTELLIX....................... 44 TRIPLE ANTIBIOTIC ........ 32 tri-previfem (28) ................. 138 tri-sprintec (28) ................... 138 TRIUMEQ ............................ 68 TRI-VI-SOL ....................... 106 trivora (28).......................... 138 tri-vylibra ............................ 138 TRULICITY ......................... 75 TRUMENBA ..................... 150 TRUVADA .......................... 69 TUDORZA PRESSAIR ..... 164 TULANA ........................... 139 TUMS ......................... 117, 118 TUMS E-X ................. 117, 118 TUMS EXTRA STRENGTH

SMOOTHIES ................. 117 TUMS ULTRA .................. 118 TURALIO ............................ 58 TUSNEL DIABETIC ......... 174 TUSSIN CF (PE-DM-GUAIF)

........................ 173, 174, 175 TUSSIN CF COUGH-COLD

........................................ 174 TUSSIN DM ...... 169, 174, 175 TUSSIN DM COUGH AND

CHEST ........................... 169 TUSSIN DM MAX .... 169, 175 TUSSIN MUCUS-CHEST

CONGESTION .............. 175 TWINRIX (PF) .................. 150 TYBOST .............................. 70 TYKERB .............................. 59 TYMLOS ........................... 152 TYPHIM VI ....................... 150 U ULTRA LUBRICANT EYE

........................................ 155 ULTRATHON ..................... 98

unithroid ............................. 141 ursodiol ............................... 118 V VABOMERE........................ 34 valacyclovir .......................... 68 VALCHLOR ........................ 54 valganciclovir ....................... 66 valproic acid ......................... 40 valproic acid (as sodium salt)

.......................................... 40 valsartan................................ 83 valsartan-hydrochlorothiazide

.......................................... 88 vancomycin .......................... 32 VAQTA (PF) ...................... 150 VARIVAX (PF) ................. 150 VARIZIG............................ 150 VAXCHORA BUFFER

COMPONENT ............... 150 VAXCHORA VACCINE... 151 velivet triphasic regimen (28)

........................................ 138 VEMLIDY............................ 67 VENCLEXTA ...................... 56 VENCLEXTA STARTING

PACK ............................... 56 venlafaxine ........................... 44 VENOFER.................. 106, 107 VENTAVIS ........................ 166 VENTOLIN HFA ............... 165 verapamil .............................. 86 VERSACLOZ ...................... 66 VERZENIO .......................... 59 VICTOZA 2-PAK ................ 75 VICTOZA 3-PAK ................ 75 VIDEX 2 GRAM PEDIATRIC

.......................................... 70 VIDEX 4 GRAM PEDIATRIC

.......................................... 70 VIDEX EC ........................... 70 vienva ................................. 138 vigabatrin .............................. 40 VIGADRONE ...................... 40 VIIBRYD ............................. 44 VIMPAT ............................... 41 VIRACEPT .......................... 71 VIREAD ............................... 67 VITA-BEE WITH C .......... 106 vitamin a ............................. 110 VITAMIN B-1 .................... 110

VITAMIN B-12 .................. 110 VITAMIN B-6 .................... 110 VITAMIN C ............... 111, 112 VITAMIN D2 ..................... 111 VITAMIN D3 ..................... 111 VITAMIN K ......................... 81 VITAMIN K1 ....................... 81 VITAMINS AND MINERALS

........................................ 110 VITAMINS B COMPLEX . 110 VITRAKVI ........................... 59 VIZIMPRO ........................... 56 voriconazole ................... 48, 49 VOSEVI ............................... 67 VOTRIENT .......................... 59 VRAYLAR ........................... 65 vyfemla (28) ....................... 138 vylibra ................................. 138 W warfarin ................................. 79 WIXELA INHUB ............... 175 WOMEN'S LAXATIVE

(BISACODYL) ............... 127 X XALKORI ............................ 59 XARELTO ........................... 79 XATMEP ............................ 146 XERMELO ......................... 118 XGEVA .............................. 152 XIFAXAN .......................... 120 XIIDRA .............................. 155 XOLAIR ............................. 147 XOSPATA ............................ 59 xpovio ................................... 56 XTANDI ............................... 54 xulane ................................. 138 XURIDEN .......................... 130 XYREM .............................. 164 Y YF-VAX (PF) ..................... 151 YONSA ................................ 54 yuvafem .............................. 133 Z zafirlukast ........................... 164 zaleplon ............................... 175 zarah ................................... 138 ZARXIO ............................... 81 ZEJULA ............................... 59 ZELBORAF ......................... 59 ZEMAIRA .......................... 130


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ZENATANE......................... 98 ZENPEP ............................. 130 ZERIT................................... 70 zidovudine ............................ 70 zinc oxide ............................. 98 ziprasidone hcl...................... 65

ZIRGAN ............................... 66 ZOLINZA ............................. 56 zolpidem ............................. 175 zonisamide ............................ 39 ZORTRESS ........................ 146 ZOSTAVAX (PF) .............. 151

zovia 1/35e (28) .................. 138 ZTLIDO ................................ 24 ZYDELIG ............................. 56 ZYKADIA ............................ 59 ZYPREXA RELPREVV ...... 65 ZYTIGA ............................... 54

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