2019 MEDICAID DRUG FORMULARY Effective January 1 , 2019 · 2019 MEDICAID DRUG FORMULARY Effective January 1st, 2019 PLEASE READ: THIS DOCUMENT HAS INFORMATION ABOUT THE PRESCRIPTION

2019 MEDICAID DRUG FORMULARY

Effective January 1st, 2019

PLEASE READ: THIS DOCUMENT HAS INFORMATION ABOUT THE

PRESCRIPTION DRUGS WE COVER.

Please refer to your “Member Handbook or other plan materials” to determine if your drug is covered.

This Drug Formulary does not guarantee coverage and is subject to change without notice. Members

must use participating pharmacies to fill their prescription drugs.

For the most recent information or other questions, please contact Neighborhood Member Services at

401-443-5992 (TTY 711). This formulary is for members enrolled in ACCESS or TRUST health plans

effective on January 1st, 2019.

PA - Prior Authorization QL - Quantity Limits ST - Step Therapy OTC - Over the counter

1

NHPRI Medicaid 2019 Effective: 4/1/19

Last Updated: March 2019

Drug Name Requirements/Limits

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS AMPHETAMINES

amphetamine-dextroamphetamine cap er 24hr 5

mg


mg


mg

amphetamine-dextroamphetamine cap er 24hr 20 mg



amphetamine-dextroamphetamine tab 5 mg

amphetamine-dextroamphetamine tab 7.5 mg


amphetamine-dextroamphetamine tab 12.5 mg




dexedrine tab 5mg

ANOREXIANTS NON-AMPHETAMINE phendimetrazine tartrate tab 35 mg

phentermine hcl cap 15 mg

phentermine hcl cap 30 mg

phentermine hcl cap 37.5 mg

phentermine hcl tab 37.5 mg

QSYMIA CAP 3.75-23 PA

QSYMIA CAP 7.5-46MG PA

QSYMIA CAP 11.25-69 PA

QSYMIA CAP 15-92MG PA

ANTI-OBESITY AGENTS ALLI CAP 60MG OTC

BELVIQ TAB 10MG PA

BELVIQ XR TAB 20MG PA

CONTRAVE TAB 8-90MG PA

SAXENDA INJ 18MG/3ML PA

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS atomoxetine hcl cap 10 mg (base equiv) QL (1 cap / day)

atomoxetine hcl cap 18 mg (base equiv) QL (1 cap / day)



2






guanfacine hcl tab er 24hr 1 mg (base equiv)




STIMULANTS - MISC. armodafinil tab 50 mg QL (1 tab / day)

armodafinil tab 150 mg QL (1 tab / day)



dexmethylphenidate hcl cap er 24 hr 5 mg QL (1 cap / day)








dexmethylphenidate hcl tab 2.5 mg

dexmethylphenidate hcl tab 5 mg

dexmethylphenidate hcl tab 10 mg

methylphenidate hcl cap er 10 mg (cd) QL (1 cap / day)






methylphenidate hcl tab 5 mg



methylphenidate hcl tab er 10 mg

methylphenidate hcl tab er 20 mg

modafinil tab 100 mg QL (2 tabs / day)

modafinil tab 200 mg QL (2 tabs / day)

ALTERNATIVE MEDICINES ALTERNATIVE MEDICINE - M'S

melatonin cap 5mg OTC

MELATONIN LIQ 1MG/4ML OTC

melatonin liquid 1 mg/ml OTC

melatonin sub 5mg OTC

melatonin tab 1 mg OTC



3



melatonin tab 300 mcg OTC

ALTERNATIVE MEDICINE COMBINATIONS melatonin tr tab /vit-b6 OTC

melatonin/ tab vit b-6 OTC

AMINOGLYCOSIDES AMINOGLYCOSIDES

neomycin sulfate tab 500 mg

paromomycin sulfate cap 250 mg

tobramycin nebu soln 300 mg/5ml PA

ANALGESICS - ANTI-INFLAMMATORY ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES

HUMIRA INJ 10/0.1ML

HUMIRA INJ 10MG/0.2

HUMIRA INJ 20/0.2ML

HUMIRA INJ 40/0.4ML

HUMIRA KIT 20MG/0.4

HUMIRA KIT 40MG/0.8

HUMIRA PEDIA INJ CROHNS

HUMIRA PEN INJ 40/0.4ML

HUMIRA PEN INJ 40MG/0.8

HUMIRA PEN INJ CD/UC/HS

HUMIRA PEN INJ PS/UV

HUMIRA PEN KIT CD/UC/HS

HUMIRA PEN KIT PS/UV

ANTIRHEUMATIC - ENZYME INHIBITORS XELJANZ TAB 5MG QL (60 / 30 days), PA

XELJANZ TAB 10MG QL (60 / 30 days), PA

XELJANZ XR TAB 11MG QL (30 / 30 days), PA

INTERLEUKIN-6 RECEPTOR INHIBITORS KEVZARA INJ 150/1.14 QL (2 syringes / 28 days),

PA

KEVZARA INJ 200/1.14 QL (2 syringes / 28 days), PA

NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) celecoxib cap 50 mg

celecoxib cap 100 mg

celecoxib cap 200 mg

celecoxib cap 400 mg QL (1 cap / day)

diclofenac potassium tab 50 mg

diclofenac sodium tab delayed release 50 mg

diclofenac sodium tab delayed release 75 mg

diclofenac sodium tab er 24hr 100 mg

etodolac cap 200 mg

etodolac tab 400 mg


4


etodolac tab 500 mg

etodolac tab er 24hr 400 mg



flurbiprofen tab 50 mg

flurbiprofen tab 100 mg

ibuprofen dro 50/1.25 OTC

ibuprofen sus 100/5ml OTC

ibuprofen tab 200mg OTC

ibuprofen tab 400 mg



indomethacin cap 25 mg

indomethacin cap 50 mg

indomethacin cap er 75 mg

ketorolac tromethamine tab 10 mg QL (20 tabs / 30 days)

meloxicam tab 7.5 mg

meloxicam tab 15 mg

nabumetone tab 500 mg

nabumetone tab 750 mg

naproxen ec tab 375mg

naproxen ec tab 500mg

naproxen sod tab 220mg OTC

naproxen sodium tab 275 mg

naproxen sodium tab 550 mg

naproxen susp 125 mg/5ml

naproxen tab 250 mg

naproxen tab 375 mg

naproxen tab 500 mg

sulindac tab 150 mg

sulindac tab 200 mg

PYRIMIDINE SYNTHESIS INHIBITORS leflunomide tab 10 mg

leflunomide tab 20 mg

SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS ENBREL INJ 25/0.5ML

ENBREL INJ 25MG

ENBREL INJ 50MG/ML

ENBREL MINI INJ 50MG/ML

ENBREL SRCLK INJ 50MG/ML

ANALGESICS - NONNARCOTIC ANALGESIC COMBINATIONS

aspirin-acetaminophen-caffeine tab 250-250-65 mg

OTC

butalbital-acetaminophen tab 50-325 mg


5


butalbital-acetaminophen-caffeine tab 50-325-40 mg

ANALGESICS OTHER acetaminophe chw 160mg OTC

acetaminophe tab 160mg OTC

acetaminophen elixir 160 mg/5ml OTC

acetaminophen liquid 160 mg/5ml OTC

acetaminophen soln 160 mg/5ml OTC

acetaminophen tab 325 mg OTC

acetaminophen tab er 650 mg OTC

acetaminophn sus 160/5ml OTC

acetaminophn tab 500mg OTC

pain/fever sup 120mg OTC

SALICYLATES ALKA-SELTZER TAB 500MG OTC

aspirin low chw 81mg OTC

aspirin tab 325mg OTC

aspirin tab 500 mg OTC

aspirin tab delayed release 81 mg OTC; Available for 90 day fill

aspirin tab delayed release 325 mg OTC

BAYER PLUS TAB 500MG OTC

eq aspirin tab 500mg ec OTC

ANALGESICS - OPIOID OPIOID AGONISTS

codeine sulfate tab 15 mg QL (42 tabs / 30 days), PA; Age Restriction

codeine sulfate tab 30 mg QL (42 tabs / 30 days), PA;

Age Restriction

codeine sulfate tab 60 mg QL (42 tabs / 30 days), PA;

Age Restriction

fentanyl td patch 72hr 12 mcg/hr QL (10 patches / 30 days),

PA

fentanyl td patch 72hr 25 mcg/hr QL (10 patches / 30 days),

PA

fentanyl td patch 72hr 50 mcg/hr PA



HYDROMORPHON SUP 3MG QL (120 / 30 days), PA

hydromorphone hcl liqd 1 mg/ml QL (600 ml / 30 days), PA

hydromorphone hcl tab 2 mg QL (180 tabs / 30 days), PA



meperidine hcl tab 50 mg QL (18 tabs / 30 days)

meperidine hcl tab 100 mg QL (18 tabs / 30 days)

methadone hcl soln 5 mg/5ml QL (450 ml / 30 days), PA

methadone hcl soln 10 mg/5ml QL (300 ml / 30 days), PA


6


methadone hcl tab 5 mg QL (90 tabs / 30 days), PA

methadone hcl tab 10 mg QL (60 tabs / 30 days), PA

morphine sulfate oral soln 20 mg/5ml QL (675 ml / 30 days), PA

morphine sulfate oral soln 100 mg/5ml (20 mg/ml) QL (135 ml / 30 days), PA

morphine sulfate tab 15 mg QL (180 tabs / 30 days), PA

morphine sulfate tab 30 mg QL (90 tabs / 30 days), PA

morphine sulfate tab er 15 mg QL (90 tabs / 30 days), PA

morphine sulfate tab er 30 mg QL (90 tabs / 30 days), PA

morphine sulfate tab er 60 mg PA



oxycodone hcl cap 5 mg QL (180 caps / 30 days)

oxycodone hcl conc 100 mg/5ml (20 mg/ml) QL (90 ml / 30 days), PA

oxycodone hcl tab 5 mg QL (180 tabs / 30 days)

oxycodone hcl tab 10 mg QL (180 tabs / 30 days), PA




tramadol hcl tab 50 mg QL (180 tabs / 30 days)

tramadol hcl tab er 24hr 100 mg PA



tramadol hcl tab er 24hr biphasic release 100 mg PA



OPIOID COMBINATIONS acetaminophen w/ codeine soln 120-12 mg/5ml QL (2700 ml / 30 days), PA

acetaminophen w/ codeine tab 300-15 mg QL (400 tabs / 30 days)



butalbital-acetaminophen-caff w/ cod cap 50-325-

40-30 mg

hydrocodone-acetaminophen soln 7.5-325

mg/15ml

QL (2700 ml / 30 days)

hydrocodone-acetaminophen tab 5-325 mg QL (240 tabs / 30 days)

hydrocodone-acetaminophen tab 7.5-325 mg QL (180 tabs / 30 days)

hydrocodone-acetaminophen tab 10-325 mg QL (180 tabs / 30 days)

hydrocodone-ibuprofen tab 7.5-200 mg QL (50 tabs / 30 days)

oxycodone w/ acetaminophen tab 5-325 mg QL (360 tabs / 30 days)

oxycodone w/ acetaminophen tab 7.5-325 mg QL (240 tabs / 30 days)

oxycodone w/ acetaminophen tab 10-325 mg QL (180 tabs / 30 days), PA

oxycodone-aspirin tab 4.8355-325 mg QL (360 tabs / 30 days)

oxycodone-ibuprofen tab 5-400 mg QL (28 tabs / 30 days), PA

tramadol-acetaminophen tab 37.5-325 mg QL (40 tabs / 30 days)


7


OPIOID PARTIAL AGONISTS buprenorphine hcl sl tab 2 mg (base equiv) QL (12 tabs / day), PA

buprenorphine hcl sl tab 8 mg (base equiv) QL (3 tabs / day), PA

buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base equiv)

QL (3 tabs / day)

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base equiv)

QL (3 tabs / day)

buprenorphine td patch weekly 5 mcg/hr QL (4 patches / 30 days), PA

buprenorphine td patch weekly 7.5 mcg/hr QL (4 patches / 30 days), PA

buprenorphine td patch weekly 10 mcg/hr QL (4 patches / 30 days), PA

buprenorphine td patch weekly 15 mcg/hr PA

buprenorphine td patch weekly 20 mcg/hr PA

butorphanol tartrate nasal soln 10 mg/ml QL (1.2 ml / day), PA

pentazocine w/ naloxone tab 50-0.5 mg QL (120 tabs / 30 days), PA

SUBOXONE MIS 2-0.5MG QL (3 films / day)

SUBOXONE MIS 4-1MG QL (3 films / day)



ANDROGENS-ANABOLIC ANABOLIC STEROIDS

oxandrolone tab 2.5 mg

ANDROGENS danazol cap 100 mg

danazol cap 200 mg

FIRST-TESTOS CRE MC 2%

FIRST-TESTOS OIN 2%

testosterone cypionate im inj in oil 100 mg/ml

testosterone cypionate im inj in oil 200 mg/ml

testosterone enanthate im inj in oil 200 mg/ml

testosterone td gel 12.5 mg/act (1%) QL (75 gm / fill), PA

testosterone td gel 50 mg/5gm (1%) QL (150 gm / fill), PA

ANORECTAL AGENTS INTRARECTAL STEROIDS

hydrocortisone enema 100 mg/60ml

UCERIS AER 2MG/ACT PA

RECTAL STEROIDS hydrocortisone rectal cream 2.5%

ANTACIDS ANTACID COMBINATIONS

antacid sus OTC

ANTACIDS - ALUMINUM SALTS ALUM HYDROX SUS 320/5ML OTC


8


ANTACIDS - BICARBONATE sodium bicarbonate tab 650 mg OTC

ANTACIDS - CALCIUM SALTS CALCIUM CARB TAB 648MG OTC

calcium carbonate (antacid) chew tab 500 mg OTC

calcium carbonate (antacid) chew tab 750 mg OTC

calcium carbonate (antacid) susp 1250 mg/5ml OTC

stomach rlf chw 400mg OTC

ANTACIDS - MAGNESIUM SALTS magnesium oxide tab 250 mg OTC

magnesium oxide tab 400 mg OTC

ANTHELMINTICS ANTHELMINTICS

ivermectin tab 3 mg

pinworm med sus 144mg/ml OTC

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

FIRST-METRON SUS 100MG/ML

METRONIDAZOL SUS 50MG/ML

metronidazole tab 250 mg

metronidazole tab 500 mg

trimethoprim tab 100 mg

XIFAXAN TAB 200MG PA

XIFAXAN TAB 550MG PA

ANTI-INFECTIVE MISC. - COMBINATIONS sulfamethoxazole-trimethoprim susp 200-40

mg/5ml

sulfamethoxazole-trimethoprim tab 400-80 mg

sulfamethoxazole-trimethoprim tab 800-160 mg

GLYCOPEPTIDES FIRST-VANC SOL 25MG/ML

FIRST-VANC SOL 50MG/ML

vancomycin hcl cap 125 mg (base equivalent)

vancomycin hcl cap 250 mg (base equivalent)

LEPROSTATICS dapsone tab 25 mg

dapsone tab 100 mg

LINCOSAMIDES clindamycin hcl cap 150 mg

clindamycin hcl cap 300 mg

clindamycin palmitate hcl for soln 75 mg/5ml (base equiv)

Age Restriction

OXAZOLIDINONES linezolid for susp 100 mg/5ml PA


9


linezolid tab 600 mg PA

ANTIANGINAL AGENTS NITRATES

isosorbide mononitrate tab 10 mg

isosorbide mononitrate tab 20 mg

isosorbide mononitrate tab er 24hr 30 mg



nitroglycerin sl tab 0.3 mg



nitroglycerin td patch 24hr 0.1 mg/hr




ANTIANXIETY AGENTS ANTIANXIETY AGENTS - MISC.

buspirone hcl tab 5 mg

buspirone hcl tab 7.5 mg




hydroxyzine hcl syrup 10 mg/5ml

hydroxyzine hcl tab 10 mg



hydroxyzine pamoate cap 25 mg



BENZODIAZEPINES alprazolam tab 0.5 mg

alprazolam tab 0.25 mg

alprazolam tab 1 mg

alprazolam tab 2 mg

chlordiazepoxide hcl cap 5 mg



diazepam con 5mg/ml

diazepam oral soln 1 mg/ml

diazepam tab 2 mg

diazepam tab 5 mg

diazepam tab 10 mg

lorazepam tab 0.5 mg

lorazepam tab 1 mg

lorazepam tab 2 mg


10


oxazepam cap 10 mg

oxazepam cap 15 mg

oxazepam cap 30 mg

ANTIARRHYTHMICS ANTIARRHYTHMICS TYPE I-B

mexiletine hcl cap 150 mg

ANTIARRHYTHMICS TYPE I-C flecainide acetate tab 50 mg

flecainide acetate tab 100 mg

flecainide acetate tab 150 mg

propafenone hcl tab 150 mg

ANTIARRHYTHMICS TYPE III amiodarone hcl tab 200 mg

ANTIASTHMATIC AND BRONCHODILATOR AGENTS ANTI-INFLAMMATORY AGENTS

cromolyn sodium soln nebu 20 mg/2ml

ANTIASTHMATIC - MONOCLONAL ANTIBODIES CINQAIR INJ PA

FASENRA INJ 30MG/ML PA

NUCALA INJ 100MG PA

XOLAIR INJ 75/0.5 PA

XOLAIR INJ 150MG/ML PA

XOLAIR SOL 150MG PA

BRONCHODILATORS - ANTICHOLINERGICS ipratropium bromide inhal soln 0.02%

SPIRIVA AER 1.25MCG

SPIRIVA CAP HANDIHLR ST

SPIRIVA SPR 2.5MCG

LEUKOTRIENE MODULATORS montelukast sodium chew tab 4 mg (base equiv)

montelukast sodium chew tab 5 mg (base equiv)

montelukast sodium oral granules packet 4 mg (base equiv)

ST; Age Restriction

montelukast sodium tab 10 mg (base equiv)

SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS DALIRESP TAB 500MCG PA

STEROID INHALANTS ASMANEX 7 AER 110MCG QL (1 inhaler / 30 days)

ASMANEX 14 AER 220MCG QL (1 inhaler / 30 days)





ASMANEX HFA AER 100 MCG


11


ASMANEX HFA AER 200 MCG

budesonide inhalation susp 0.5 mg/2ml QL (60 ml / 30 days); Age Restriction

budesonide inhalation susp 0.25 mg/2ml QL (60 ml / 30 days); Age Restriction

budesonide inhalation susp 1 mg/2ml QL (60 ml / 30 days); Age Restriction

FLOVENT HFA AER 44MCG Age Restriction

PULMICORT INH 90MCG

PULMICORT INH 180MCG

QVAR AER 40MCG QL (34.8 gm / 30 days)

QVAR AER 80MCG

QVAR REDIHA AER 80MCG QL (21.2 gm / 30 days)

QVAR REDIHAL AER 40MCG QL (21.2 gm / 30 days)

SYMPATHOMIMETICS ADVAIR DISKU AER 100/50 ST

ADVAIR DISKU AER 250/50 ST

ADVAIR DISKU AER 500/50 ST

ADVAIR HFA AER 45/21 ST



albuterol sulfate soln nebu 0.5% (5 mg/ml)

albuterol sulfate soln nebu 0.63 mg/3ml (base equiv)

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)

albuterol sulfate soln nebu 1.25 mg/3ml (base

equiv)

albuterol sulfate syrup 2 mg/5ml

albuterol sulfate tab 2 mg

albuterol sulfate tab er 12hr 4 mg

COMBIVENT AER 20-100

DULERA AER 100-5MCG ST

DULERA AER 200-5MCG ST

fluticasone-salmeterol aer powder ba 55-14 mcg/act

QL (1 inhaler / 30 days)





ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

levalbuterol hcl soln nebu 0.31 mg/3ml (base

equiv)

QL (72 ml per fill)


equiv)

QL (72 ml per fill)


equiv)

QL (72 ml per fill)


12


levalbuterol tartrate inhal aerosol 45 mcg/act (base equiv)

QL (15 gm / 30 days)

metaproterenol sulfate syrup 10 mg/5ml

SEREVENT DIS AER 50MCG

STIOLTO AER 2.5-2.5

STRIVERDI AER 2.5MCG

SYMBICORT AER 80-4.5 ST

SYMBICORT AER 160-4.5 ST

terbutaline sulfate tab 2.5 mg

terbutaline sulfate tab 5 mg

VENTOLIN HFA AER

XANTHINES theophylline tab er 12hr 100 mg

theophylline tab er 12hr 200 mg





ANTICOAGULANTS COUMARIN ANTICOAGULANTS

warfarin sodium tab 1 mg


warfarin sodium tab 2.5 mg





warfarin sodium tab 7.5 mg


DIRECT FACTOR XA INHIBITORS ELIQUIS TAB 2.5MG

ELIQUIS TAB 5MG

XARELTO STAR TAB 15/20MG

XARELTO TAB 10MG

XARELTO TAB 15MG

XARELTO TAB 20MG

HEPARINS AND HEPARINOID-LIKE AGENTS enoxaparin sodium inj 30 mg/0.3ml QL (Max 10 days supply / 3

months)

enoxaparin sodium inj 40 mg/0.4ml QL (Max 10 days supply / 3 months)




13


enoxaparin sodium inj 100 mg/ml QL (Max 10 days supply / 3 months)


enoxaparin sodium inj 150 mg/ml QL (Max 10 days supply / 3 months)

heparin sodium (porcine) inj 5000 unit/ml

heparin sodium (porcine) inj 10000 unit/ml

THROMBIN INHIBITORS PRADAXA CAP 75MG

PRADAXA CAP 110MG

PRADAXA CAP 150MG

ANTICONVULSANTS ANTICONVULSANTS - BENZODIAZEPINES

clobazam suspension 2.5 mg/ml PA

clobazam tab 10 mg PA

clobazam tab 20 mg PA

clonazepam tab 0.5 mg

clonazepam tab 1 mg

clonazepam tab 2 mg

diazepam rectal gel delivery system 2.5 mg QL (2 kits / fill)

diazepam rectal gel delivery system 10 mg QL (2 kits / fill)

diazepam rectal gel delivery system 20 mg QL (2 kits / fill)

ANTICONVULSANTS - MISC. carbamazepine cap er 12hr 100 mg

carbamazepine cap er 12hr 200 mg

carbamazepine cap er 12hr 300 mg

carbamazepine chew tab 100 mg

carbamazepine susp 100 mg/5ml

carbamazepine tab 200 mg

carbamazepine tab er 12hr 100 mg



gabapentin cap 100 mg



gabapentin oral soln 250 mg/5ml

gabapentin tab 600 mg

gabapentin tab 800 mg

lamotrigine tab 25 mg




lamotrigine tab chewable dispersible 5 mg

lamotrigine tab chewable dispersible 25 mg


14


lamotrigine tab er 24hr 25 mg






levetiracetam oral soln 100 mg/ml

levetiracetam tab 250 mg




levetiracetam tab er 24hr 500 mg

levetiracetam tab er 24hr 750 mg

LYRICA CAP 25MG QL (2 caps / day), PA








LYRICA SOL 20MG/ML PA

oxcarbazepine susp 300 mg/5ml (60 mg/ml)

oxcarbazepine tab 150 mg



primidone tab 50 mg

primidone tab 250 mg

topiramate sprinkle cap 15 mg

topiramate sprinkle cap 25 mg

topiramate tab 25 mg




VIMPAT SOL 10MG/ML PA

VIMPAT TAB 50MG PA

VIMPAT TAB 100MG PA

VIMPAT TAB 150MG PA

VIMPAT TAB 200MG PA

zonisamide cap 25 mg



HYDANTOINS phenytoin chew tab 50 mg Age Restriction

phenytoin sodium extended cap 100 mg


15


phenytoin susp 125 mg/5ml

SUCCINIMIDES ethosuximide cap 250 mg

ethosuximide soln 250 mg/5ml

VALPROIC ACID divalproex sodium tab delayed release 125 mg

divalproex sodium tab delayed release 250 mg

divalproex sodium tab delayed release 500 mg

divalproex sodium tab er 24 hr 250 mg

divalproex sodium tab er 24 hr 500 mg

valproate sodium oral soln 250 mg/5ml (base equiv)

valproic acid cap 250 mg

ANTIDEPRESSANTS ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)

mirtazapine orally disintegrating tab 15 mg



mirtazapine tab 7.5 mg

mirtazapine tab 15 mg



ANTIDEPRESSANTS - MISC. bupropion hcl tab 75 mg

bupropion hcl tab 100 mg

bupropion hcl tab er 12hr 100 mg





SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) citalopram hydrobromide oral soln 10 mg/5ml QL (600 ml / 30 days)

citalopram hydrobromide tab 10 mg (base equiv) QL (4 tabs / day)

citalopram hydrobromide tab 20 mg (base equiv) QL (2 tabs / day)

citalopram hydrobromide tab 40 mg (base equiv) QL (1 tab / day)

escitalopram oxalate tab 5 mg (base equiv)



fluoxetine hcl cap 10 mg



fluoxetine hcl solution 20 mg/5ml

fluoxetine hcl tab 10 mg

fluoxetine hcl tab 20 mg

fluvoxamine maleate tab 25 mg


16




paroxetine hcl tab 10 mg




sertraline hcl oral concentrate for solution 20 mg/ml

sertraline hcl tab 25 mg



SEROTONIN MODULATORS nefazodone hcl tab 50 mg

nefazodone hcl tab 100 mg




trazodone hcl tab 50 mg



SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) desvenlafaxine succinate tab er 24hr 25 mg (base

equiv) QL (1 tab / day)

desvenlafaxine succinate tab er 24hr 50 mg (base equiv)

QL (1 tab / day)

desvenlafaxine succinate tab er 24hr 100 mg (base equiv)

QL (1 tab / day)

duloxetine hcl cap 20 mg QL (2 caps / day)



venlafaxine hcl cap er 24hr 37.5 mg (base equivalent)

venlafaxine hcl cap er 24hr 75 mg (base equivalent)

venlafaxine hcl cap er 24hr 150 mg (base equivalent)

venlafaxine hcl tab 25 mg

venlafaxine hcl tab 37.5 mg




TRICYCLIC AGENTS amitriptyline hcl tab 10 mg

amitriptyline hcl tab 25 mg




17




clomipramine hcl cap 25 mg QL (10 caps / day); Age Restriction

clomipramine hcl cap 50 mg QL (5 caps / day); Age

Restriction

clomipramine hcl cap 75 mg QL (3 caps / day); Age

Restriction

desipramine hcl tab 10 mg





doxepin hcl cap 10 mg






doxepin hcl conc 10 mg/ml

imipramine hcl tab 10 mg



nortriptyline hcl cap 10 mg




ANTIDIABETICS ALPHA-GLUCOSIDASE INHIBITORS

acarbose tab 25 mg

acarbose tab 50 mg

acarbose tab 100 mg

ANTIDIABETIC COMBINATIONS alogliptin-metformin hcl tab 12.5-500 mg PA

alogliptin-metformin hcl tab 12.5-1000 mg PA

alogliptin-pioglitazone tab 12.5-15 mg PA



alogliptin-pioglitazone tab 25-15 mg PA



glipizide-metformin hcl tab 2.5-250 mg


glipizide-metformin hcl tab 5-500 mg

glyburide-metformin tab 1.25-250 mg


18


glyburide-metformin tab 2.5-500 mg

glyburide-metformin tab 5-500 mg

INVOKAMET TAB 50-500MG PA

INVOKAMET TAB 50-1000 PA



INVOKAMET XR TAB 50-500MG PA

INVOKAMET XR TAB 50-1000 PA



JANUMET TAB 50-500MG PA

JANUMET TAB 50-1000 PA

JANUMET XR TAB 50-500MG PA

JANUMET XR TAB 50-1000 PA

JANUMET XR TAB 100-1000 PA

JENTADUETO TAB 2.5-500 PA



JENTADUETO TAB XR PA

BIGUANIDES metformin hcl tab 500 mg

metformin hcl tab 850 mg

metformin hcl tab 1000 mg

metformin hcl tab er 24hr 500 mg

metformin hcl tab er 24hr 750 mg

DIABETIC OTHER BD GLUCOSE CHW 5GM OTC

GLUCAGEN INJ HYPOKIT QL (2 / 30 days)

GLUCAGON KIT 1MG

GLUCOSE BITS CHW 1GM OTC

GLUCOSE CHW 4GM OTC

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS alogliptin benzoate tab 6.25 mg (base equiv) PA

alogliptin benzoate tab 12.5 mg (base equiv) PA

alogliptin benzoate tab 25 mg (base equiv) PA

JANUVIA TAB 25MG PA

JANUVIA TAB 50MG PA

JANUVIA TAB 100MG PA

TRADJENTA TAB 5MG PA

INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS) BYDUREON BC INJ 2/0.85ML ST

BYDUREON INJ 2MG ST

BYDUREON PEN INJ 2MG ST

BYETTA INJ 5MCG ST

BYETTA INJ 10MCG ST


19


TRULICITY INJ 0.75/0.5 ST

TRULICITY INJ 1.5/0.5 ST

VICTOZA INJ 18MG/3ML ST

INSULIN ADMELOG INJ 100U/ML

ADMELOG SOLO INJ 100U/ML

APIDRA INJ U-100

BASAGLAR KWIKPEN QL (30 ml / 30 days)

HUMALOG MIX INJ 50/50 QL (30 ml / fill)

HUMALOG MIX SUS 75/25 QL (30 ml / fill)

HUMULIN INJ 70/30 OTC, QL (30 ml / fill)

HUMULIN N INJ U-100 OTC, QL (30 ml / fill)

HUMULIN R INJ U-100 OTC, QL (30 ml / 30 days)

NOVOLIN70/30 INJ RELION OTC, QL (30 ml / fill)

NOVOLIN INJ 70/30 OTC, QL (30 ml / fill)

NOVOLIN N INJ RELION OTC, QL (30 ml / fill)

NOVOLIN N INJ U-100 OTC, QL (30 ml / fill)

NOVOLIN R INJ RELION OTC, QL (30 ml / 30 days)

NOVOLIN R INJ U-100 OTC, QL (30 ml / 30 days)

NOVOLOG MIX INJ 70/30

INSULIN SENSITIZING AGENTS pioglitazone hcl tab 15 mg (base equiv)

pioglitazone hcl tab 30 mg (base equiv)

pioglitazone hcl tab 45 mg (base equiv)

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS FARXIGA TAB 5MG PA

FARXIGA TAB 10MG PA

INVOKANA TAB 100MG PA

INVOKANA TAB 300MG PA

JARDIANCE TAB 10MG PA

JARDIANCE TAB 25MG PA

SULFONYLUREAS glimepiride tab 1 mg

glimepiride tab 2 mg

glimepiride tab 4 mg

glipizide tab 5 mg

glipizide tab 10 mg

glipizide tab er 24hr 2.5 mg

glipizide tab er 24hr 5 mg

glipizide tab er 24hr 10 mg

glyburide micronized tab 1.5 mg

glyburide micronized tab 3 mg

glyburide micronized tab 6 mg

glyburide tab 1.25 mg

glyburide tab 2.5 mg


20


glyburide tab 5 mg

ANTIDIARRHEAL/PROBIOTIC AGENTS ANTIDIARRHEAL/PROBIOTIC AGENTS - MISC.

bismuth subsalicylate chew tab 262 mg OTC

ANTIPERISTALTIC AGENTS diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml

diphenoxylate w/ atropine tab 2.5-0.025 mg

loperamide hcl cap 2 mg

loperamide hcl liq 1 mg/5ml (0.2 mg/ml) OTC

loperamide hcl tab 2 mg OTC

ANTIDOTES AND SPECIFIC ANTAGONISTS ANTIDOTES AND SPECIFIC ANTAGONISTS

IPECAC SYP OTC

OPIOID ANTAGONISTS naloxone hcl inj 0.4 mg/ml

naloxone hcl soln cartridge 0.4 mg/ml

naloxone hcl soln prefilled syringe 2 mg/2ml

naltrexone hcl tab 50 mg

NARCAN SPR QL (1 kit / fill)

VIVITROL INJ 380MG PA

ANTIEMETICS 5-HT3 RECEPTOR ANTAGONISTS

granisetron hcl tab 1 mg ST

ondansetron hcl oral soln 4 mg/5ml QL (50 ml / 30 days)

ondansetron hcl tab 4 mg

ondansetron hcl tab 8 mg

ondansetron hcl tab 24 mg QL (6 tabs / 30 days, max 2 fills every 30 days)

ondansetron orally disintegrating tab 4 mg

ondansetron orally disintegrating tab 8 mg

ANTIEMETICS - ANTICHOLINERGIC dimenhydrinate tab 50 mg OTC

meclizine hcl chew tab 25 mg OTC

meclizine hcl tab 12.5 mg

meclizine hcl tab 25 mg

trimethobenzamide hcl cap 300 mg

ANTIEMETICS - MISCELLANEOUS DICLEGIS TAB 10-10MG QL (4 per day), PA

dronabinol cap 2.5 mg PA

dronabinol cap 5 mg PA

dronabinol cap 10 mg PA

SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS aprepitant capsule 40 mg PA

aprepitant capsule 80 mg PA


21


aprepitant capsule 125 mg PA

aprepitant capsule therapy pack 80 & 125 mg PA

EMEND SOL 150MG PA

EMEND SUS 125MG PA

ANTIFUNGALS ANTIFUNGALS

griseofulvin microsize susp 125 mg/5ml

nystatin tab 500000 unit

terbinafine hcl tab 250 mg

IMIDAZOLE-RELATED ANTIFUNGALS CRESEMBA CAP 186 MG PA

CRESEMBA INJ 372MG PA

fluconazole for susp 10 mg/ml

fluconazole for susp 40 mg/ml

fluconazole tab 50 mg




itraconazole cap 100 mg PA

ANTIHISTAMINES ANTIHISTAMINES - ALKYLAMINES

aller-chlor syp 2mg/5ml OTC

chlorpheniramine maleate tab 4 mg OTC

chlorpheniramine maleate tab er 12 mg OTC

ANTIHISTAMINES - ETHANOLAMINES diphenhydram cap 50mg OTC

diphenhydramine hcl cap 25 mg OTC

diphenhydramine hcl elixir 12.5 mg/5ml

diphenhydramine hcl liquid 12.5 mg/5ml OTC

diphenhydramine hcl tab 25 mg OTC

ANTIHISTAMINES - NON-SEDATING ALLEGRA ALRG TAB 30MG OTC, ST

cetirizine sol 1mg/ml OTC

cetirizine tab 5mg OTC

cetirizine tab 10mg OTC; Available for 90 day fill

desloratadine tab 5 mg

fexofenadine sus 30mg/5ml OTC

fexofenadine tab 180mg OTC

levocetirizine dihydrochloride tab 5 mg

loratadine sol 5mg/5ml OTC

loratadine tab 10 mg OTC; Available for 90 day fill

ANTIHISTAMINES - PHENOTHIAZINES promethazine hcl suppos 12.5 mg

promethazine hcl suppos 25 mg


22


promethazine hcl syrup 6.25 mg/5ml

promethazine hcl tab 12.5 mg

promethazine hcl tab 25 mg

promethazine hcl tab 50 mg

ANTIHISTAMINES - PIPERIDINES cyproheptadine hcl syrup 2 mg/5ml

cyproheptadine hcl tab 4 mg

ANTIHYPERLIPIDEMICS BILE ACID SEQUESTRANTS

cholestyramine light powder 4 gm/dose

cholestyramine light powder packets 4 gm

cholestyramine powder 4 gm/dose

cholestyramine powder packets 4 gm

colesevelam hcl tab 625 mg

colestipol hcl granule packets 5 gm

colestipol hcl granules 5 gm

colestipol hcl tab 1 gm

FIBRIC ACID DERIVATIVES fenofibrate micronized cap 67 mg

fenofibrate micronized cap 134 mg

fenofibrate micronized cap 200 mg

fenofibrate tab 54 mg

fenofibrate tab 145 mg

gemfibrozil tab 600 mg

HMG COA REDUCTASE INHIBITORS atorvastatin calcium tab 10 mg (base equivalent)

atorvastatin calcium tab 20 mg (base equivalent)



lovastatin tab 10 mg



pravastatin sodium tab 10 mg




rosuvastatin calcium tab 5 mg




simvastatin tab 5 mg Available for 90 day fill





23


INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS ezetimibe tab 10 mg

NICOTINIC ACID DERIVATIVES niacin tab er 1000 mg (antihyperlipidemic)

PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS REPATHA INJ 140MG/ML PA

REPATHA PUSH INJ 420/3.5 PA

REPATHA SURE INJ 140MG/ML PA

ANTIHYPERTENSIVES ACE INHIBITORS

benazepril hcl tab 5 mg Available for 90 day fill




enalapril maleate tab 2.5 mg Available for 90 day fill

enalapril maleate tab 5 mg Available for 90 day fill



fosinopril sodium tab 10 mg



lisinopril tab 2.5 mg Available for 90 day fill

lisinopril tab 5 mg Available for 90 day fill





moexipril hcl tab 7.5 mg

moexipril hcl tab 15 mg

quinapril hcl tab 5 mg




ramipril cap 1.25 mg

ramipril cap 2.5 mg

ramipril cap 5 mg

ramipril cap 10 mg

trandolapril tab 1 mg



ANGIOTENSIN II RECEPTOR ANTAGONISTS irbesartan tab 75 mg

irbesartan tab 150 mg

irbesartan tab 300 mg

losartan potassium tab 25 mg


24




olmesartan medoxomil tab 5 mg



telmisartan tab 20 mg



valsartan tab 40 mg

valsartan tab 80 mg

valsartan tab 160 mg

valsartan tab 320 mg

ANTIADRENERGIC ANTIHYPERTENSIVES clonidine hcl tab 0.1 mg

clonidine hcl tab 0.2 mg

clonidine hcl tab 0.3 mg

doxazosin mesylate tab 1 mg




guanfacine hcl tab 1 mg

guanfacine hcl tab 2 mg

methyldopa tab 250 mg

methyldopa tab 500 mg

prazosin hcl cap 1 mg



terazosin hcl cap 1 mg (base equivalent)




ANTIHYPERTENSIVE COMBINATIONS amlodipine besylate-benazepril hcl cap 2.5-10 mg

amlodipine besylate-benazepril hcl cap 5-10 mg





amlodipine besylate-olmesartan medoxomil tab 5-

20 mg

amlodipine besylate-olmesartan medoxomil tab 5-

40 mg

amlodipine besylate-olmesartan medoxomil tab 10-20 mg

amlodipine besylate-olmesartan medoxomil tab 10-40 mg


25


amlodipine besylate-valsartan tab 5-160 mg




atenolol & chlorthalidone tab 50-25 mg

atenolol & chlorthalidone tab 100-25 mg

benazepril & hydrochlorothiazide tab 10-12.5 mg

benazepril & hydrochlorothiazide tab 20-12.5 mg

benazepril & hydrochlorothiazide tab 20-25 mg

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg

bisoprolol & hydrochlorothiazide tab 5-6.25 mg

bisoprolol & hydrochlorothiazide tab 10-6.25 mg

enalapril maleate & hydrochlorothiazide tab 5-12.5

mg

enalapril maleate & hydrochlorothiazide tab 10-25 mg

fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg

fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg

irbesartan-hydrochlorothiazide tab 150-12.5 mg

irbesartan-hydrochlorothiazide tab 300-12.5 mg

lisinopril & hydrochlorothiazide tab 10-12.5 mg Available for 90 day fill

lisinopril & hydrochlorothiazide tab 20-12.5 mg Available for 90 day fill

lisinopril & hydrochlorothiazide tab 20-25 mg Available for 90 day fill

losartan potassium & hydrochlorothiazide tab 50-12.5 mg

losartan potassium & hydrochlorothiazide tab 100-12.5 mg

losartan potassium & hydrochlorothiazide tab 100-25 mg

moexipril-hydrochlorothiazide tab 7.5-12.5 mg

moexipril-hydrochlorothiazide tab 15-12.5 mg

moexipril-hydrochlorothiazide tab 15-25 mg

olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg

olmesartan medoxomil-hydrochlorothiazide tab 40-12.5 mg

olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg

olmesartan-amlodipine-hydrochlorothiazide tab 20-5-12.5 mg


olmesartan-amlodipine-hydrochlorothiazide tab

40-5-25 mg


26



olmesartan-amlodipine-hydrochlorothiazide tab 40-10-25 mg

propranolol & hydrochlorothiazide tab 40-25 mg

propranolol & hydrochlorothiazide tab 80-25 mg

quinapril-hydrochlorothiazide tab 10-12.5 mg

quinapril-hydrochlorothiazide tab 20-12.5 mg

quinapril-hydrochlorothiazide tab 20-25 mg

valsartan-hydrochlorothiazide tab 80-12.5 mg


valsartan-hydrochlorothiazide tab 160-25 mg


valsartan-hydrochlorothiazide tab 320-25 mg

VASODILATORS hydralazine hcl tab 10 mg

hydralazine hcl tab 25 mg



minoxidil tab 2.5 mg

minoxidil tab 10 mg

ANTIMALARIALS ANTIMALARIALS

hydroxychloroquine sulfate tab 200 mg

ANTIMYASTHENIC/CHOLINERGIC AGENTS ANTIMYASTHENIC/CHOLINERGIC AGENTS

pyridostigmine bromide tab 60 mg

ANTIMYCOBACTERIAL AGENTS ANTIMYCOBACTERIAL AGENTS

ethambutol hcl tab 400 mg

isoniazid syrup 50 mg/5ml

isoniazid tab 100 mg

isoniazid tab 300 mg

pyrazinamide tab 500 mg

rifampin cap 150 mg

rifampin cap 300 mg

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES ALKYLATING AGENTS

LEUKERAN TAB 2MG

temozolomide cap 5 mg







27


ANTIMETABOLITES capecitabine tab 150 mg

capecitabine tab 500 mg

mercaptopurine tab 50 mg

methotrexate sodium inj 50 mg/2ml (25 mg/ml)

methotrexate sodium inj pf 50 mg/2ml (25 mg/ml)

methotrexate sodium tab 2.5 mg (base equiv)

TABLOID TAB 40MG

ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS anastrozole tab 1 mg

bicalutamide tab 50 mg

exemestane tab 25 mg

flutamide cap 125 mg

letrozole tab 2.5 mg

LUPRON DEPOT INJ 3.75MG PA




LUPRON DEPOT INJ 30MG PA

LUPRON DEPOT INJ 45MG PA

megestrol acetate susp 40 mg/ml

megestrol acetate tab 20 mg

megestrol acetate tab 40 mg

tamoxifen citrate tab 10 mg (base equivalent)

tamoxifen citrate tab 20 mg (base equivalent)

XTANDI CAP 40MG PA

ANTINEOPLASTIC COMBINATIONS KISQALI 200 PAK FEMARA PA

KISQALI 400 PAK FEMARA PA

KISQALI 600 PAK FEMARA PA

ANTINEOPLASTIC ENZYME INHIBITORS AFINITOR TAB 2.5MG

AFINITOR TAB 5MG

AFINITOR TAB 7.5MG

AFINITOR TAB 10MG

IBRANCE CAP 75MG QL (21 caps / 28 days), PA



imatinib mesylate tab 100 mg (base equivalent)

imatinib mesylate tab 400 mg (base equivalent)

NERLYNX TAB 40MG QL (180 / 30 days), PA

NEXAVAR TAB 200MG PA

SPRYCEL TAB 50MG PA

STIVARGA TAB 40MG

SUTENT CAP 12.5MG


28


SUTENT CAP 25MG

SUTENT CAP 50MG

TARCEVA TAB 25MG

TARCEVA TAB 100MG

TARCEVA TAB 150MG

TYKERB TAB 250MG

VERZENIO TAB 50MG QL (56 / 28 days), PA




VOTRIENT TAB 200MG PA

ANTINEOPLASTICS MISC. hydroxyurea cap 500 mg

INTRON A INJ 10MU PA




MATULANE CAP 50MG

tretinoin cap 10 mg

CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS leucovorin calcium tab 5 mg

leucovorin calcium tab 25 mg

mesna inj 100 mg/ml

MESNEX TAB 400MG

MITOTIC INHIBITORS etoposide cap 50 mg

TOPOISOMERASE I INHIBITORS HYCAMTIN CAP 0.25MG

HYCAMTIN CAP 1MG

ANTIPARKINSON AND RELATED THERAPY AGENTS ANTIPARKINSON ANTICHOLINERGICS

benztropine mesylate tab 0.5 mg

benztropine mesylate tab 1 mg

benztropine mesylate tab 2 mg

trihexyphenidyl hcl elixir 0.4 mg/ml

trihexyphenidyl hcl tab 2 mg

trihexyphenidyl hcl tab 5 mg

ANTIPARKINSON DOPAMINERGICS amantadine hcl cap 100 mg

amantadine hcl syrup 50 mg/5ml

amantadine hcl tab 100 mg

bromocriptine mesylate cap 5 mg (base equivalent)

bromocriptine mesylate tab 2.5 mg (base equivalent)


29


carbidopa & levodopa tab 10-100 mg



carbidopa & levodopa tab er 25-100 mg

pramipexole dihydrochloride tab 0.5 mg




pramipexole dihydrochloride tab 1 mg


ropinirole hydrochloride tab 0.5 mg

ropinirole hydrochloride tab 0.25 mg

ropinirole hydrochloride tab 1 mg





ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS selegiline hcl tab 5 mg

ANTIPSYCHOTICS/ANTIMANIC AGENTS ANTIMANIC AGENTS

lithium carbonate cap 150 mg



lithium carbonate tab 300 mg

lithium carbonate tab er 300 mg

lithium carbonate tab er 450 mg

LITHIUM SOL 8MEQ/5ML

ANTIPSYCHOTICS - MISC. NUPLAZID TAB 17MG PA

ziprasidone hcl cap 20 mg




BENZISOXAZOLES INVEGA SUST INJ 39/0.25 PA

INVEGA SUST INJ 78/0.5ML PA

INVEGA SUST INJ 117/0.75 PA

INVEGA SUST INJ 156MG/ML PA

INVEGA SUST INJ 234/1.5 PA

INVEGA TRINZ INJ 273MG PA




paliperidone tab er 24hr 1.5 mg


30


paliperidone tab er 24hr 3 mg



RISPERDAL INJ 12.5MG PA

RISPERDAL INJ 25MG PA

RISPERDAL INJ 37.5MG PA

RISPERDAL INJ 50MG PA

risperidone soln 1 mg/ml

risperidone tab 0.5 mg

risperidone tab 0.25 mg

risperidone tab 1 mg




BUTYROPHENONES haloperidol decanoate im soln 50 mg/ml

haloperidol decanoate im soln 100 mg/ml

haloperidol lactate oral conc 2 mg/ml

haloperidol tab 0.5 mg

haloperidol tab 1 mg





DIBENZAPINES clozapine tab 25 mg

clozapine tab 50 mg

clozapine tab 100 mg

clozapine tab 200 mg

loxapine succinate cap 5 mg




olanzapine for im inj 10 mg

olanzapine orally disintegrating tab 5 mg




olanzapine tab 2.5 mg

olanzapine tab 5 mg

olanzapine tab 7.5 mg

olanzapine tab 10 mg



quetiapine fumarate tab 25 mg


31







quetiapine fumarate tab er 24hr 50 mg





PHENOTHIAZINES chlorpromazine hcl tab 10 mg

chlorpromazine hcl tab 25 mg




fluphenazine decanoate inj 25 mg/ml

perphenazine tab 2 mg




prochlorperazine maleate tab 5 mg (base equivalent)

prochlorperazine maleate tab 10 mg (base equivalent)

prochlorperazine suppos 25 mg QL (12 / fill)

thioridazine hcl tab 25 mg



trifluoperazine hcl tab 1 mg (base equivalent)




QUINOLINONE DERIVATIVES aripiprazole tab 2 mg

aripiprazole tab 5 mg





THIOXANTHENES thiothixene cap 5 mg

thiothixene cap 10 mg


32


ANTISEPTICS & DISINFECTANTS IODINE ANTISEPTICS

NUPREP 5% SOL POV-IODI OTC

povidone-iod sol 7.5% OTC

povidone-iodine oint 10% OTC

povidone-iodine soln 10% OTC

ANTIVIRALS ANTIRETROVIRALS

abacavir sulfate soln 20 mg/ml (base equiv)

abacavir sulfate tab 300 mg (base equiv)

abacavir sulfate-lamivudine tab 600-300 mg

abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg

APTIVUS CAP 250MG

APTIVUS SOL

atazanavir sulfate cap 150 mg (base equiv)



ATRIPLA TAB

BIKTARVY TAB

COMPLERA TAB

CRIXIVAN CAP 200MG

CRIXIVAN CAP 400MG

DESCOVY TAB 200/25

didanosine delayed release capsule 200 mg



EDURANT TAB 25MG

efavirenz cap 50 mg

efavirenz cap 200 mg

efavirenz tab 600 mg

EMTRIVA CAP 200MG

EMTRIVA SOL 10MG/ML

EVOTAZ TAB 300-150

fosamprenavir calcium tab 700 mg (base equiv)

FUZEON INJ 90MG

GENVOYA TAB

INTELENCE TAB 25MG

INTELENCE TAB 100MG

INTELENCE TAB 200MG

INVIRASE CAP 200MG

INVIRASE TAB 500MG

ISENTRESS CHW 25MG

ISENTRESS CHW 100MG

ISENTRESS TAB 400MG


33


JULUCA TAB 50-25MG

KALETRA TAB 100-25MG

KALETRA TAB 200-50MG

lamivudine oral soln 10 mg/ml

lamivudine tab 150 mg

lamivudine tab 300 mg

lamivudine-zidovudine tab 150-300 mg

LEXIVA SUS 50MG/ML

lopinavir-ritonavir soln 400-100 mg/5ml (80-20

mg/ml)

nevirapine susp 50 mg/5ml

nevirapine tab 200 mg

nevirapine tab er 24hr 400 mg

NORVIR SOL 80MG/ML

ODEFSEY TAB

PREZCOBIX TAB 800-150

PREZISTA SUS 100MG/ML

PREZISTA TAB 75MG

PREZISTA TAB 150MG

PREZISTA TAB 600MG

PREZISTA TAB 800MG

RESCRIPTOR TAB 100 MG

RESCRIPTOR TAB 200MG

ritonavir tab 100 mg

SELZENTRY TAB 25MG

SELZENTRY TAB 75MG

SELZENTRY TAB 150MG

SELZENTRY TAB 300MG

stavudine cap 15 mg

stavudine cap 20 mg

stavudine cap 30 mg

stavudine cap 40 mg

STRIBILD TAB

tenofovir disoproxil fumarate tab 300 mg

TIVICAY TAB 50MG

TRIUMEQ TAB

TRUVADA TAB

TRUVADA TAB 100-150

TRUVADA TAB 133-200

TRUVADA TAB 167-250

VIDEX EC CAP 125MG

VIDEX SOL 4GM

VIRACEPT TAB 250MG

VIRACEPT TAB 625MG

zidovudine cap 100 mg

zidovudine syrup 10 mg/ml


34


zidovudine tab 300 mg

CMV AGENTS valganciclovir hcl for soln 50 mg/ml (base equiv) Age Restriction

valganciclovir hcl tab 450 mg (base equivalent)

HEPATITIS AGENTS adefovir dipivoxil tab 10 mg

entecavir tab 0.5 mg

entecavir tab 1 mg

lamivudine tab 100 mg (hbv)

MAVYRET TAB 100-40MG PA

ribavirin cap 200 mg PA

ribavirin tab 200 mg PA

VOSEVI TAB PA

HERPES AGENTS acyclovir cap 200 mg

acyclovir susp 200 mg/5ml

acyclovir tab 400 mg

acyclovir tab 800 mg

famciclovir tab 125 mg



valacyclovir hcl tab 1 gm

valacyclovir hcl tab 500 mg

INFLUENZA AGENTS oseltamivir phosphate cap 30 mg (base equiv)

oseltamivir phosphate cap 45 mg (base equiv)

oseltamivir phosphate cap 75 mg (base equiv)

oseltamivir phosphate for susp 6 mg/ml (base

equiv)

RELENZA MIS DISKHALE QL (1 inhaler / 90 days)

rimantadine hydrochloride tab 100 mg

BETA BLOCKERS ALPHA-BETA BLOCKERS

carvedilol tab 3.125 mg



carvedilol tab 25 mg

labetalol hcl tab 100 mg



BETA BLOCKERS CARDIO-SELECTIVE acebutolol hcl cap 200 mg

acebutolol hcl cap 400 mg

atenolol tab 25 mg Available for 90 day fill



35



bisoprolol fumarate tab 5 mg

bisoprolol fumarate tab 10 mg

FIRST - METO SOL 10MG/ML

metoprolol succinate tab er 24hr 25 mg (tartrate equiv)




metoprolol tartrate tab 25 mg



BETA BLOCKERS NON-SELECTIVE nadolol tab 20 mg

nadolol tab 40 mg

nadolol tab 80 mg

propranolol hcl cap er 24hr 60 mg




propranolol hcl oral soln 20 mg/5ml

propranolol hcl oral soln 40 mg/5ml

propranolol hcl tab 10 mg





sotalol hcl tab 80 mg



CALCIUM CHANNEL BLOCKERS CALCIUM CHANNEL BLOCKERS

amlodipine besylate tab 2.5 mg (base equivalent) Available for 90 day fill

amlodipine besylate tab 5 mg (base equivalent) Available for 90 day fill

amlodipine besylate tab 10 mg (base equivalent) Available for 90 day fill

diltiazem hcl cap er 24hr 120 mg



diltiazem hcl coated beads cap er 24hr 120 mg






36


diltiazem hcl coated beads tab er 24hr 360 mg

diltiazem hcl extended release beads cap er 24hr 120 mg





diltiazem hcl tab 30 mg




felodipine tab er 24hr 2.5 mg

felodipine tab er 24hr 5 mg

felodipine tab er 24hr 10 mg

nifedipine cap 10 mg

nifedipine cap 20 mg

nifedipine tab er 24hr 30 mg



nifedipine tab er 24hr osmotic release 30 mg



nimodipine cap 30 mg

verapamil hcl cap er 24hr 120 mg






verapamil hcl tab 40 mg



verapamil hcl tab er 120 mg



CARDIOTONICS CARDIAC GLYCOSIDES

digoxin oral soln 0.05 mg/ml

digoxin tab 125 mcg (0.125 mg)

digoxin tab 250 mcg (0.25 mg)


37


CARDIOVASCULAR AGENTS - MISC. CARDIOVASCULAR AGENTS MISC. - COMBINATIONS

ENTRESTO TAB 24-26MG PA



PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR

ANTAGONISTS LETAIRIS TAB 5MG PA

LETAIRIS TAB 10MG PA

PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS sildenafil citrate tab 20 mg PA

tadalafil tab 20 mg (pah) PA

CEPHALOSPORINS CEPHALOSPORINS - 1ST GENERATION

cefadroxil cap 500 mg

cefadroxil for susp 250 mg/5ml

cefadroxil for susp 500 mg/5ml

cefadroxil tab 1 gm

cephalexin cap 250 mg

cephalexin cap 500 mg

cephalexin for susp 125 mg/5ml

cephalexin for susp 250 mg/5ml

CEPHALOSPORINS - 2ND GENERATION cefprozil for susp 125 mg/5ml

cefprozil for susp 250 mg/5ml

cefprozil tab 250 mg

cefprozil tab 500 mg

cefuroxime axetil tab 250 mg

cefuroxime axetil tab 500 mg

CEPHALOSPORINS - 3RD GENERATION cefdinir cap 300 mg

cefdinir for susp 125 mg/5ml

cefdinir for susp 250 mg/5ml

CHEMICALS BULK CHEMICALS - M'S

MECLOFENOXAT POW HCL

LIQUIDS GLYCERIN LIQ OTC

CONTRACEPTIVES COMBINATION CONTRACEPTIVES - ORAL

aranelle tab

cryselle-28 tab

desogest-eth estrad & eth estrad tab 0.15-

0.02/0.01 mg(21/5)


38


desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg

drospirenone-ethinyl estradiol tab 3-0.03 mg

ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg

ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg

levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg

levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg

levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg

levonorgestrel-eth estra tab 0.05-30/0.075-

40/0.125-30mg-mcg

microgestin tab 1.5/30

microgestin tab 1/20

necon tab 1/50-28

NECON TAB 10/11-28

norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg

norethindrone ace & ethinyl estradiol-fe tab 1 mg-

20 mcg

norgestimate & ethinyl estradiol tab 0.25 mg-35

mcg

norgestimate-eth estrad tab 0.18-25/0.215-

25/0.25-25 mg-mcg

norgestimate-eth estrad tab 0.18-35/0.215-

35/0.25-35 mg-mcg

nortrel tab 1/35

ogestrel tab

velivet pak

COMBINATION CONTRACEPTIVES - TRANSDERMAL xulane dis 150-35 QL (3 / 28 days)

COMBINATION CONTRACEPTIVES - VAGINAL NUVARING MIS

EMERGENCY CONTRACEPTIVES ELLA TAB 30MG

levonorgestrel tab 1.5 mg OTC

PROGESTIN CONTRACEPTIVES - INJECTABLE medroxyprogesterone acetate im susp 150 mg/ml

medroxyprogesterone acetate im susp prefilled syr 150 mg/ml

QL (1 syringe / 90 days)

PROGESTIN CONTRACEPTIVES - ORAL norethindrone tab 0.35 mg


39


CORTICOSTEROIDS GLUCOCORTICOSTEROIDS

budesonide delayed release particles cap 3 mg

budesonide tab er 24hr 9 mg PA

DEXAMETHASON CON 1MG/ML

dexamethasone elixir 0.5 mg/5ml

dexamethasone sodium phosphate inj 4 mg/ml

dexamethasone soln 0.5 mg/5ml

dexamethasone tab 0.5 mg


dexamethasone tab 1 mg





hydrocortisone tab 5 mg



methylprednisolone tab 4 mg




methylprednisolone tab therapy pack 4 mg (21)

prednisolone sod phosphate oral soln 15 mg/5ml (base equiv)

prednisolone syrup 15 mg/5ml (usp solution equivalent)

PREDNISONE CON 5MG/ML

prednisone oral soln 5 mg/5ml

prednisone tab 1 mg

prednisone tab 2.5 mg

prednisone tab 5 mg

prednisone tab 10 mg



prednisone tab therapy pack 5 mg (21)

prednisone tab therapy pack 10 mg (21)

MINERALOCORTICOIDS fludrocortisone acetate tab 0.1 mg

COUGH/COLD/ALLERGY ANTITUSSIVES

benzonatate cap 100 mg

benzonatate cap 200 mg

COUGH/COLD/ALLERGY COMBINATIONS cetirizine-pseudoephedrine tab er 12hr 5-120 mg OTC


40


cold/allergy elx OTC

cold/allergy tab pe OTC

dextromethorphan-guaifenesin syrup 10-100 mg/5ml

OTC

DOUBLE-TUSSN LIQ DM OTC

intense coug liq reliever OTC

LOHIST-D LIQ OTC

loratadine & pseudoephedrine tab er 24hr 10-240 mg

OTC

loratadine-d tab 5-120mg OTC

mucus rel dm liq 5-100/5 OTC

prometh vc syp 6.25-5/5

promethazine w/ codeine syrup 6.25-10 mg/5ml Age Restriction

promethazine-dm syrup 6.25-15 mg/5ml

promethazine-phenylephrine-codeine syrup 6.25-

5-10 mg/5ml

Age Restriction

pseudoephed-bromphen-dm syrup 30-2-10

mg/5ml

sinus congst tab /pain dt OTC

tussin dm liq OTC

tussin dm liq max OTC

ZYNCOF SYP 20-400/5 OTC

EXPECTORANTS guaifenesin liquid 100 mg/5ml OTC

guaifenesin tab 200 mg OTC

MISC. RESPIRATORY INHALANTS sodium chloride soln nebu 0.9%

sodium chloride soln nebu 3%

sodium chloride soln nebu 7%

MUCOLYTICS acetylcysteine inhal soln 10%

acetylcysteine inhal soln 20%

DERMATOLOGICALS ACNE PRODUCTS

ABSORICA CAP 10MG PA




ACNE MEDICAT LOT 5% OTC

ACNE MEDICAT LOT 10% OTC

adapalene gel 0.1%

amnesteem cap 10mg PA



benzoyl peroxide-erythromycin gel 5-3% QL (23.3 gm / 30 days)


41


bp gel gel 5% OTC, QL (1 fill / 30 days)

bp gel gel 10% OTC, QL (1 fill / 30 days)

bp wash liq 5% OTC, QL (240 gm / fill)

claravis cap 10mg PA




clindamycin phosph-benzoyl peroxide (refrig) gel

1.2 (1)-5%

QL (45 gm / 30 days)

clindamycin phosphate gel 1% QL (30 gm / 30 days)

clindamycin phosphate lotion 1% QL (60 ml / 30 days)

clindamycin phosphate soln 1% QL (30 ml / 30 days)

clindamycin phosphate swab 1% QL (60 / 30 days)

erythromycin gel 2% QL (30 gm / 30 days)

erythromycin soln 2% QL (60 ml / 30 days)

isotretinoin cap 10 mg PA




myorisan cap 10mg PA




panoxyl wash liq 4% OTC, QL (170.1 gm / 30 days)

tretinoin cream 0.1% QL (20 gm / 30 days); Age Restriction



tretinoin gel 0.01% QL (15 gm / 30 days); Age Restriction

tretinoin gel 0.025% QL (15 gm / 30 days); Age Restriction

zenatane cap 10mg PA




ANTI-INFLAMMATORY AGENTS - TOPICAL diclofenac sodium gel 1% QL (100 gm / 30 days)

ANTIBIOTICS - TOPICAL bacitracin oint 500 unit/gm OTC

bacitracin zinc oint 500 unit/gm OTC

bacitracin-polymyxin b oint OTC

gentamicin sulfate cream 0.1%


42


gentamicin sulfate oint 0.1%

mupirocin oint 2%

neomycin-bacitracin-polymyxin oint OTC

triple antib oin plus OTC

ANTIFUNGALS - TOPICAL antifungal cre 1% OTC

athlete foot cre 1% OTC

ciclodan cre 0.77% QL (30 gm / fill)

ciclodan sol 8%

clotrimazole cream 1%

clotrimazole soln 1%

clotrimazole w/ betamethasone cream 1-0.05% Age Restriction

clotrimazole w/ betamethasone lotion 1-0.05% Age Restriction

ketoconazole cream 2%

ketoconazole shampoo 2%

miconazole cre 2% OTC

nystatin cream 100000 unit/gm

nystatin oint 100000 unit/gm

nystatin topical powder 100000 unit/gm QL (60 gm / fill)

ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL fluorouracil cream 5%

fluorouracil soln 2%

fluorouracil soln 5%

ANTIPSORIATICS acitretin cap 10 mg PA

acitretin cap 17.5 mg PA

acitretin cap 25 mg PA

calcipotriene oint 0.005% QL (60 gm per fill)

calcipotriene soln 0.005% (50 mcg/ml) QL (60 ml per fill)

STELARA INJ 45MG/0.5 PA

STELARA INJ 90MG/ML PA

ANTISEBORRHEIC PRODUCTS selenium sulfide lotion 2.5%

ANTIVIRALS - TOPICAL acyclovir oint 5% QL (5 gm / fill)

BURN PRODUCTS silver sulfadiazine cream 1%

CORTICOSTEROIDS - TOPICAL betamethasone dipropionate augmented cream

0.05%

betamethasone dipropionate augmented gel

0.05%

betamethasone dipropionate augmented lotion

0.05%


43


betamethasone dipropionate augmented oint 0.05%

betamethasone dipropionate cream 0.05%

betamethasone dipropionate lotion 0.05%

betamethasone valerate cream 0.1% (base

equivalent)

betamethasone valerate lotion 0.1% (base

equivalent)

betamethasone valerate oint 0.1% (base

equivalent)

clobetasol e cre 0.05%

clobetasol propionate cream 0.05%

clobetasol propionate oint 0.05%

clobetasol propionate soln 0.05%

desonide cream 0.05% QL (15 gm per fill)

desonide oint 0.05% QL (15 gm per fill)

fluocinolone acetonide cream 0.01%

fluocinolone acetonide cream 0.025%

fluocinolone acetonide oint 0.025%

fluocinolone acetonide soln 0.01%

fluocinonide cream 0.05%

fluocinonide emulsified base cream 0.05%

fluocinonide gel 0.05%

fluocinonide oint 0.05%

fluocinonide soln 0.05%

fluticasone propionate cream 0.05%

fluticasone propionate oint 0.005%

hydrocortisone cream 0.5% OTC

hydrocortisone cream 1%

hydrocortisone cream 2.5%

hydrocortisone lotion 1% OTC

hydrocortisone oint 0.5% OTC

hydrocortisone oint 1%

hydrocortisone oint 2.5%

mometasone furoate oint 0.1%

triamcinolone acetonide cream 0.1%



triamcinolone acetonide lotion 0.1%

triamcinolone acetonide lotion 0.025%

triamcinolone acetonide oint 0.1%



ECZEMA AGENTS DUPIXENT INJ 300/2ML PA


44


EMOLLIENTS AQUAPHOR OIN OTC

geri-hydrola lot 5% OTC

lactic acid (ammonium lactate) cream 12% OTC

lactic acid (ammonium lactate) lotion 12% OTC

soothng bath pow treatmnt OTC

THERAPEUTIC CRE MOISTUR OTC

ENZYMES - TOPICAL SANTYL OIN 250/GM QL (30 gm per fill, max 2

fills / 30 days), PA

IMMUNOMODULATING AGENTS - TOPICAL imiquimod cream 5% QL (12 per fill, max 4 fills /

year)

IMMUNOSUPPRESSIVE AGENTS - TOPICAL tacrolimus oint 0.1% QL (May fill 3-30gram tubes

per year); Age Restriction

tacrolimus oint 0.03% QL (May fill 3-30gram tubes per year)

KERATOLYTIC/ANTIMITOTIC AGENTS podofilox soln 0.5%

wart remover gel 17% OTC

wart remover liq 17% OTC

wart remover sol 17% OTC

LINIMENTS arthricream cre 10% OTC

icy hot cre ex st OTC

pain relieve cre rub OTC

LOCAL ANESTHETICS - TOPICAL anti-itch lot sens 1% OTC

ARTH PAIN CRE 0.075% OTC

capsaicin cream 0.1% OTC

capsaicin cream 0.025% OTC

CAPZASIN-P CRE 0.035% OTC

lidocaine hcl gel 2%

lidocaine hcl soln 4%

lidocaine patch 5% QL (60 / 30 days)

ZOSTRIX NAT CRE 0.033% OTC

MISC. TOPICAL ALUMINUM SOL ACETATE OTC

CALAMINE LOT OTC

CALAMINE LOT 8-8% OTC

dermacerin cre OTC

DRYSOL SOL 20%

hemorrhoidal pad hygiene OTC

MOISTURE GUA CRE OTC


45


RISAMINE OIN OTC

ZINC OXIDE PST 25% OTC

ROSACEA AGENTS metronidazole cream 0.75%

metronidazole gel 0.75%

SCABICIDES & PEDICULICIDES complete kit lice OTC

lice killing sha OTC

lice treatmt lot 1% OTC

lice trtmnt liq 1% OTC

malathion lotion 0.5% ST

permethrin cream 5%

spinosad susp 0.9% ST

DIAGNOSTIC PRODUCTS DIAGNOSTIC PRODUCTS, MISC.

URINE TEST STRIPS OTC

DIAGNOSTIC TESTS ACCU-CHEK BLOOD GLUCOSE TEST STRIPS OTC, QL (50 test strips / 50

days)

ALBUSTIX TES OTC

GLUCOSE URINE TEST STRIPS OTC

KETONE TEST TES OTC, QL (100 strips / 30 days)

KETONE URINE TEST STRIPS OTC, QL (100 strips / 30 days)

MULTISTIX TES OTC

DIGESTIVE AIDS DIGESTIVE ENZYMES

CREON CAP 3000UNIT

CREON CAP 6000UNIT

CREON CAP 12000UNT

CREON CAP 24000UNT

CREON CAP 36000UNT

lactase enz tab 3000unit OTC

DIURETICS CARBONIC ANHYDRASE INHIBITORS

acetazolamide cap er 12hr 500 mg

acetazolamide tab 125 mg

acetazolamide tab 250 mg

IURETIC COMBINATIONS amiloride & hydrochlorothiazide tab 5-50 mg

spironolactone & hydrochlorothiazide tab 25-25 mg

triamterene & hydrochlorothiazide cap 37.5-25 mg


46


triamterene & hydrochlorothiazide tab 37.5-25 mg

triamterene & hydrochlorothiazide tab 75-50 mg

LOOP DIURETICS bumetanide tab 0.5 mg

bumetanide tab 1 mg

bumetanide tab 2 mg

furosemide oral soln 10 mg/ml

furosemide tab 20 mg Available for 90 day fill

furosemide tab 40 mg

furosemide tab 80 mg

torsemide tab 5 mg

torsemide tab 10 mg

torsemide tab 20 mg

torsemide tab 100 mg

POTASSIUM SPARING DIURETICS amiloride hcl tab 5 mg

spironolactone tab 25 mg



THIAZIDES AND THIAZIDE-LIKE DIURETICS chlorothiazide tab 250 mg

chlorothiazide tab 500 mg

chlorthalidone tab 25 mg Available for 90 day fill

chlorthalidone tab 50 mg Available for 90 day fill

hydrochlorothiazide cap 12.5 mg

hydrochlorothiazide tab 12.5 mg

hydrochlorothiazide tab 25 mg Available for 90 day fill

hydrochlorothiazide tab 50 mg Available for 90 day fill

indapamide tab 1.25 mg

indapamide tab 2.5 mg

metolazone tab 2.5 mg

metolazone tab 5 mg

metolazone tab 10 mg

ENDOCRINE AND METABOLIC AGENTS - MISC. BONE DENSITY REGULATORS

alendronate sodium tab 10 mg



ibandronate sodium tab 150 mg (base equivalent)

PROLIA SOL 60MG/ML PA

CORTICOTROPIN H.P. ACTHAR INJ 80UNIT

GROWTH HORMONES NUTROPIN AQ INJ 10MG/2ML PA

NUTROPIN AQ INJ 20MG/2ML PA


47


NUTROPIN AQ INJ NUSPIN 5 PA

HORMONE RECEPTOR MODULATORS raloxifene hcl tab 60 mg

LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS LUPR DEP-PED INJ 3M 30MG PA

LUPR DEP-PED INJ 7.5MG PA

LUPR DEP-PED INJ 11.25MG PA

LUPR DEP-PED INJ 15MG PA

METABOLIC MODIFIERS calcitriol cap 0.5 mcg

calcitriol cap 0.25 mcg

calcitriol oral soln 1 mcg/ml

KANUMA INJ 20/10ML PA

KUVAN POW 100MG PA

KUVAN POW 500MG PA

KUVAN TAB 100MG PA

levocarnitine oral soln 1 gm/10ml (10%)

levocarnitine tab 330 mg

STRENSIQ INJ 18/0.45 PA

STRENSIQ INJ 80/0.8ML PA

POSTERIOR PITUITARY HORMONES DDAVP SOL 0.01%

desmopressin acetate nasal spray soln 0.01%

desmopressin acetate tab 0.1 mg

desmopressin acetate tab 0.2 mg

PROLACTIN INHIBITORS cabergoline tab 0.5 mg

SOMATOSTATIC AGENTS octreotide acetate inj 50 mcg/ml (0.05 mg/ml)

octreotide acetate inj 100 mcg/ml (0.1 mg/ml)

octreotide acetate inj 200 mcg/ml (0.2 mg/ml)

ESTROGENS ESTROGEN COMBINATIONS

estradiol & norethindrone acetate tab 1-0.5 mg

PREMPHASE TAB

PREMPRO TAB 0.3-1.5

PREMPRO TAB 0.45-1.5

PREMPRO TAB 0.625-5

PREMPRO TAB .625-2.5

ESTROGENS estradiol tab 0.5 mg

estradiol tab 1 mg

estradiol tab 2 mg

estradiol td patch weekly 0.1 mg/24hr


48






estropipate tab 0.75 mg

estropipate tab 1.5 mg

estropipate tab 3 mg

PREMARIN TAB 0.3MG

PREMARIN TAB 0.9MG

PREMARIN TAB 0.45MG

PREMARIN TAB 0.625MG

PREMARIN TAB 1.25MG

FLUOROQUINOLONES FLUOROQUINOLONES

ciprofloxacin hcl tab 100 mg (base equiv)




levofloxacin oral soln 25 mg/ml

levofloxacin tab 250 mg



moxifloxacin hcl tab 400 mg (base equiv)

GASTROINTESTINAL AGENTS - MISC. ANTIFLATULENTS

simethicone chew tab 80 mg OTC

simethicone susp 40 mg/0.6ml OTC

GALLSTONE SOLUBILIZING AGENTS ursodiol cap 300 mg

ursodiol tab 250 mg

ursodiol tab 500 mg

GASTROINTESTINAL STIMULANTS metoclopramide hcl soln 5 mg/5ml (10 mg/10ml)

(base equiv)

metoclopramide hcl tab 5 mg (base equivalent)

metoclopramide hcl tab 10 mg (base equivalent)

INFLAMMATORY BOWEL AGENTS APRISO CAP 0.375GM

balsalazide disodium cap 750 mg

ENTYVIO INJ 300MG PA

INFLECTRA INJ 100MG

mesalamine enema 4 gm

PENTASA CAP 250MG CR

PENTASA CAP 500MG CR

RENFLEXIS INJ 100MG


49


sulfasalazine tab delayed release 500 mg

sulfazine tab 500mg

INTESTINAL ACIDIFIERS lactulose (encephalopathy) solution 10 gm/15ml

IRRITABLE BOWEL SYNDROME (IBS) AGENTS LINZESS CAP 72MCG PA

LINZESS CAP 145MCG PA

LINZESS CAP 290MCG PA

PERIPHERAL OPIOID RECEPTOR ANTAGONISTS MOVANTIK TAB 12.5MG PA

MOVANTIK TAB 25MG PA

RELISTOR INJ 8/0.4ML PA

RELISTOR INJ 12/0.6ML PA

RELISTOR TAB 150MG PA

PHOSPHATE BINDER AGENTS calcium acetate (phosphate binder) cap 667 mg

(169 mg ca)

lanthanum carbonate chew tab 500 mg (elemental)

ST


ST


ST

RENAGEL TAB 400MG ST

sevelamer carbonate packet 0.8 gm ST

sevelamer carbonate packet 2.4 gm ST

sevelamer carbonate tab 800 mg ST

GENITOURINARY AGENTS - MISCELLANEOUS ALKALINIZERS

potassium citrate & citric acid soln 1100-334 mg/5ml

potassium citrate tab er 5 meq (540 mg)


sodium citrate & citric acid soln 500-334 mg/5ml

PROSTATIC HYPERTROPHY AGENTS alfuzosin hcl tab er 24hr 10 mg

dutasteride cap 0.5 mg

finasteride tab 5 mg

tamsulosin hcl cap 0.4 mg

GOUT AGENTS GOUT AGENT COMBINATIONS

colchicine w/ probenecid tab 0.5-500 mg

GOUT AGENTS allopurinol tab 100 mg

allopurinol tab 300 mg


50


colchicine tab 0.6 mg

KRYSTEXXA INJ 8MG/ML PA

URICOSURICS probenecid tab 500 mg

HEMATOLOGICAL AGENTS - MISC. BRADYKININ B2 RECEPTOR ANTAGONISTS

FIRAZYR INJ 30MG/3ML QL (9ml per fill per 23 days)

HEMATORHEOLOGIC AGENTS pentoxifylline tab er 400 mg

PLATELET AGGREGATION INHIBITORS cilostazol tab 50 mg

cilostazol tab 100 mg

clopidogrel bisulfate tab 75 mg (base equiv)

dipyridamole tab 25 mg



HEMATOPOIETIC AGENTS AGENTS FOR SICKLE CELL ANEMIA

DROXIA CAP 200MG

DROXIA CAP 300MG

DROXIA CAP 400MG

COBALAMINS vitamin b-12 injection

vitamin b-12 tab 100mcg OTC




FOLIC ACID/FOLATES folic acid tab 1 mg Available for 90 day fill

folic acid tab 400 mcg OTC

folic acid tab 800mcg OTC

HEMATOPOIETIC GROWTH FACTORS EPOGEN INJ 2000/ML

EPOGEN INJ 3000/ML

EPOGEN INJ 4000/ML

EPOGEN INJ 10000/ML

EPOGEN INJ 20000/ML

GRANIX INJ 300/0.5

GRANIX INJ 300/1ML

GRANIX INJ 480/0.8

GRANIX INJ 480/1.6

NEULASTA INJ 6MG/0.6M PA

NEUPOGEN INJ 300/0.5

NEUPOGEN INJ 300MCG


51


NEUPOGEN INJ 480/0.8

NEUPOGEN INJ 480MCG

ZARXIO INJ 300/0.5

ZARXIO INJ 480/0.8

HEMATOPOIETIC MIXTURES folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5

mg

IRON ferrous gluconate tab 240 mg (27 mg elemental

fe) OTC

FERROUS SUL LIQ 220/5ML OTC

FERROUS SULF SYP 300/5ML OTC

FERROUS SULF TAB 324MG EC OTC

ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elemental fe)

OTC

ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe)

OTC

ferrous sulfate tab ec 325 mg (65 mg fe equivalent)

OTC; Available for 90 day fill

HEMOSTATICS HEMOSTATICS - SYSTEMIC

tranexamic acid tab 650 mg QL (1 fill / 30 days)

HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS ANTIHISTAMINE HYPNOTICS

sleep aid tab 25mg OTC

BARBITURATE HYPNOTICS phenobarbital elixir 20 mg/5ml

phenobarbital tab 15 mg

phenobarbital tab 16.2 mg







NON-BARBITURATE HYPNOTICS estazolam tab 1 mg

estazolam tab 2 mg

eszopiclone tab 1 mg



flurazepam hcl cap 15 mg

flurazepam hcl cap 30 mg

temazepam cap 15 mg

temazepam cap 30 mg


52


zaleplon cap 5 mg

zaleplon cap 10 mg

zolpidem tartrate tab 5 mg

zolpidem tartrate tab 10 mg

zolpidem tartrate tab er 6.25 mg QL (1 tab / day)

zolpidem tartrate tab er 12.5 mg QL (1 tab / day)

SELECTIVE MELATONIN RECEPTOR AGONISTS HETLIOZ CAP 20MG PA

LAXATIVES BULK LAXATIVES

calcium polycarbophil tab 625 mg OTC

fiber oral powder OTC

fiber tab 500mg OTC

nat fiber pow 28.3% OTC

nat fiber pow 48.57% OTC

naturl fiber pow 58.6% OTC

LAXATIVE COMBINATIONS peg 3350-kcl-na bicarb-nacl-na sulfate for soln

240 gm

peg 3350-kcl-sod bicarb-nacl for soln 420 gm

LAXATIVES - MISCELLANEOUS glycerin suppos 2 gm OTC

glycerin suppos 80.7% OTC

lactulose solution 10 gm/15ml

LUBRICANT LAXATIVES mineral oil OTC

SALINE LAXATIVES mag citrate sol OTC

milk of magn sus OTC

STIMULANT LAXATIVES bisacodyl suppos 10 mg OTC

bisacodyl tab 5mg ec OTC

sennosides syrup 8.8 mg/5ml OTC

sennosides tab 8.6 mg OTC

SURFACTANT LAXATIVES docusate calcium cap 240 mg OTC

docusate sodium cap 250 mg OTC

docusate sodium liquid 150 mg/15ml OTC

PEDIA-LAX LIQ 50MG OTC

MACROLIDES AZITHROMYCIN

azithromycin for susp 100 mg/5ml

azithromycin for susp 200 mg/5ml

azithromycin powd pack for susp 1 gm


53


azithromycin tab 250 mg



CLARITHROMYCIN clarithromycin for susp 125 mg/5ml

clarithromycin for susp 250 mg/5ml

clarithromycin tab 250 mg

clarithromycin tab 500 mg

MEDICAL DEVICES AND SUPPLIES CONTRACEPTIVES

CONDOMS OTC

DIABETIC SUPPLIES ACCU-CHEK BLOOD GLUCOSE TEST KITS OTC

ACCU-CHEK LIQ GUIDE OTC

BLOOD GLUCOSE CALIBRATION SOLUTION OTC

LANCETS OTC

URINE GLUCOSE MONITORING SUPPLIES OTC

INFANT CARE PRODUCTS AVEENO BABY KIT BATHTIME OTC

MISC. DEVICES ALCOHOL PAD OTC

PARENTERAL THERAPY SUPPLIES INSULIN PEN NEEDLES/SYRINGES OTC

RESPIRATORY THERAPY SUPPLIES ADULT RESPIRATORY MASK Age Restriction

DISPOSABLE MIS MTHPIECE OTC

POCKET PEAK MIS METER OTC

MIGRAINE PRODUCTS SEROTONIN AGONISTS

naratriptan hcl tab 1 mg (base equiv) QL (6 tabs / 30 days)

naratriptan hcl tab 2.5 mg (base equiv) QL (6 tabs / 30 days)

rizatriptan benzoate oral disintegrating tab 5 mg (base eq)

QL (9 tabs / 30 days)

rizatriptan benzoate oral disintegrating tab 10 mg (base eq)

QL (9 tabs / 30 days)

rizatriptan benzoate tab 5 mg (base equivalent) QL (9 tabs / 30 days)

rizatriptan benzoate tab 10 mg (base equivalent) QL (9 tabs / 30 days)

sumatriptan nasal spray 5 mg/act QL (6 / 30 days)

sumatriptan nasal spray 20 mg/act QL (6 / 30 days)

sumatriptan succinate inj 6 mg/0.5ml QL (2.5 ml / 30 days)

sumatriptan succinate solution auto-injector 4

mg/0.5ml

QL (3 ml / 30 days)

sumatriptan succinate solution auto-injector 6

mg/0.5ml

QL (3 ml / 30 days)


54


sumatriptan succinate solution cartridge 4 mg/0.5ml

QL (3 ml / 30 days)

sumatriptan succinate solution cartridge 6 mg/0.5ml

QL (3 ml / 30 days)

sumatriptan succinate tab 25 mg QL (9 tabs / fill, max 2 fills every 30 days)



MINERALS & ELECTROLYTES CALCIUM

CA CITRATE TAB 250MG OTC

CA GLUCONATE TAB 50MG OTC

CA LACTATE TAB 100MG OTC

calc cit+d3 tab 200-250 OTC

calcium OTC

calcium + d tab 600mg OTC

calcium carbonate tab 1250 mg (500 mg

elemental ca)

OTC

calcium carbonate tab 1500 mg (600 mg

elemental ca)

OTC

calcium carbonate-vitamin d cap 600 mg-200 unit OTC

calcium carbonate-vitamin d tab 600 mg-200 unit OTC; Available for 90 day fill

CALCIUM CHW 500MG OTC

CALCIUM CIT TAB 1040MG OTC

CALCIUM CITR TAB 200MG OTC

calcium citrate tab 950 mg (200 mg elemental ca) OTC

calcium citrate-vitamin d tab 315 mg-250 unit (elemental ca)

OTC

CALCIUM GLUC TAB 500MG OTC

CALCIUM LACT TAB 648MG OTC

CALCIUM LACT TAB 750MG OTC

CALCIUM TAB 333MG OTC

calcium+d tab 600-800 OTC

calcium/d chw 500-400 OTC

CHEWABLE CHW CALCIUM OTC

oyster shell calcium tab 500 mg OTC

ELECTROLYTE MIXTURES EQUALYTE SOL OTC

FLUORIDE sodium fluoride chew tab 0.5 mg f (from 1.1 mg

naf)

sodium fluoride chew tab 0.25 mg f (from 0.55 mg

naf)

sodium fluoride chew tab 1 mg f (from 2.2 mg naf) Available for 90 day fill


55


sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)

MAGNESIUM MAG64 TAB 64MG OTC

magnesium oxide tab 400 mg (240 mg elemental

mg)

OTC

magnesium oxide tab 400 mg (241.3 mg elemental mg)

OTC

magnesium tab 250mg OTC

POTASSIUM klor-con pow 20meq

potassium chloride microencapsulated crys er tab 10 meq

potassium chloride microencapsulated crys er tab 20 meq

potassium chloride oral soln 10% (20 meq/15ml)

potassium chloride oral soln 20% (40 meq/15ml)

potassium chloride tab er 8 meq (600 mg)

potassium chloride tab er 10 meq

TRACE MINERALS SELENIUM TAB 200MCG OTC

ZINC zinc gluconate tab 30 mg OTC

zinc gluconate tab 50 mg (elemental zn) OTC

zinc sulfate cap 220 mg (50 mg elemental zn) OTC

MISCELLANEOUS THERAPEUTIC CLASSES IMMUNOSUPPRESSIVE AGENTS

azathioprine tab 50 mg

cyclosporine cap 25 mg

cyclosporine modified cap 25 mg



cyclosporine modified oral soln 100 mg/ml Age Restriction

mycophenolate mofetil cap 250 mg

mycophenolate mofetil for oral susp 200 mg/ml Age Restriction

mycophenolate mofetil tab 500 mg

mycophenolate sodium tab dr 360 mg (mycophenolic acid equiv)

RAPAMUNE SOL 1MG/ML Age Restriction

sirolimus tab 0.5 mg

sirolimus tab 1 mg

sirolimus tab 2 mg

tacrolimus cap 0.5 mg

tacrolimus cap 1 mg

tacrolimus cap 5 mg


56


POTASSIUM REMOVING AGENTS VELTASSA POW 8.4GM PA

VELTASSA POW 16.8GM PA

VELTASSA POW 25.2GM PA

SYSTEMIC LUPUS ERYTHEMATOSUS AGENTS BENLYSTA INJ 120MG PA

BENLYSTA INJ 200MG/ML PA

BENLYSTA INJ 400MG PA

MOUTH/THROAT/DENTAL AGENTS ANESTHETICS TOPICAL ORAL

baby teethng gel 7.5% OTC

cvs sore loz throat OTC

FIRST-MOUTHW SUS BLM

lidocaine hcl viscous soln 2%

ultra throat loz cherry OTC

zilactin gel baby 10% OTC

ANTI-INFECTIVES - THROAT clotrimazole troche 10 mg

nystatin susp 100000 unit/ml

ANTISEPTICS - MOUTH/THROAT chlorhexidine gluconate soln 0.12%

DENTAL PRODUCTS act fluoride sol 0.05% OTC

act total sol dry mout OTC

denta 5000 cre plus

fluoridex gel 1.1%

mouth rinse sol OTC

prevident sol 0.2%

STEROIDS - MOUTH/THROAT triamcinolone acetonide dental paste 0.1%

THROAT PRODUCTS - MISC. pilocarpine hcl tab 5 mg

MULTIVITAMINS B-COMPLEX VITAMINS

b-complex vitamin cap OTC

b-complex vitamin tab OTC

B-COMPLEX W/ C b complex tab plus c OTC

B-COMPLEX W/ FOLIC ACID B-COMPLEX TAB C/FA/BIO OTC

NEPHROCAPS TAB QT

MULTIPLE VITAMINS W/ IRON daily multi tab vit/iron OTC; Available for 90 day fill


57


MULTIPLE VITAMINS W/ MINERALS MULTIVITAMIN CHW ADULT OTC

MULTIVITAMINS multi-vitamn tab OTC; Available for 90 day fill

PED MULTI VITAMINS W/FL & FE tri-vit/fe dro /fl 0.25

PED MULTIPLE VITAMINS W/ MINERALS vitamax ped dro

PED MV W/ FLUORIDE tri-vit/fl dro 0.25mg

PED MV W/ IRON pediatric multiple vitamins w/ iron chew tab 15 mg OTC; Available for 90 day fill

polyvitamin dro /iron OTC; Available for 90 day fill

PEDIATRIC MULTIPLE VITAMINS childrens chw multivit OTC; Available for 90 day fill

polyvitamin dro OTC

PEDIATRIC VITAMINS bprotected sol tri-vite OTC

TRI-VITAMIN DRO OTC

PRENATAL VITAMINS ACTIVE OB CAP

ATABEX CHW PRENATAL OTC; Available for 90 day fill

ATABEX EC TAB

BAL-CARE MIS DHA

BE WELL PAK ROUNDED OTC

BRAINSTRONG MIS PRENATAL OTC

CADEAU DHA CAP OTC

CENTRUM SPEC PAK PRENATAL OTC

CITRANATAL CAP HARMONY

CITRANATAL CAP MEDLEY

CITRANATAL MIS

CITRANATAL MIS B-CALM

CITRANATAL PAK ASSURE

CITRANATAL TAB BLOOM

CITRANATAL TAB RX

COMPLETE NAT PAK DHA

CONCEPT DHA CAP

CVS PRENATAL CHW GUMMY OTC; Available for 90 day fill

DUET DHA 400 MIS 25-1-400

DUET DHA MIS BALANCED

elite-ob tab

ENBRACE HR CAP

EZFE FORTE CAP OTC

FOLCAL DHA CAP


58


FOLCAPS CAP OMEGA 3

FOLET DHA PAK

FOLET ONE CAP 38-1-225

FOLIVANE-OB CAP

HEMENATAL OB MIS + DHA

HEMENATAL OB TAB 28-6-1MG

KOSHR PRENAT TAB 30-1MG

MACNATAL CN CAP DHA

MARNATAL-F CAP

MTERYTI TAB OTC

MTERYTI TAB FOLIC 5 OTC

MYNATE 90 TAB PLUS

NATACHEW CHW

NATALVIT TAB 75-1MG

NATELLE ONE CAP

NESTABS ABC MIS

NESTABS DHA PAK

NESTABS ONE CAP

NESTABS TAB

NUTRIENTS TAB PRENATAL OTC; Available for 90 day fill

O-CAL TAB PRENATAL

OB COMPLETE CAP GOLD

OB COMPLETE CAP ONE

OB COMPLETE CAP PETITE

OB COMPLETE TAB PREMIER

OB COMPLETE/ CAP DHA

OBSTETRIX PAK DHA

OBTREX TAB OTC; Available for 90 day fill

ONE A DAY CAP PRENATAL OTC

ONE A DAY MIS PRENATAL OTC

PERRY PRENAT CAP OTC

PNV OB+DHA PAK

PNV-OMEGA CAP

PR NATAL 400 PAK

PR NATAL 400 PAK EC

PR NATAL 430 PAK

PR NATAL 430 PAK EC

PRENA 1 TRUE MIS

PRENATA CHW 29-1MG

prenatal 19 chw tab

PRENATAL 19 TAB 29-1MG

PRENATAL CAP FORMULA OTC

PRENATAL CAP OMEGA-3 OTC

PRENATAL DHA PAK 27-1-250

PRENATAL DHA PAK MULTI OTC

PRENATAL FRM TAB A-FREE OTC; Available for 90 day fill


59


PRENATAL MIS COMPLEAT

PRENATAL MUL CAP +DHA OTC

PRENATAL MUL CAP DHA OTC

PRENATAL MV MIS + DHA OTC

PRENATAL PLS MIS MV + DHA

PRENATAL TAB Available for 90 day fill

PRENATAL TAB OTC; Available for 90 day fill

PRENATAL TAB 27-1MG Available for 90 day fill

PRENATAL TAB 28-0.8MG OTC; Available for 90 day fill

PRENATAL TAB COMPLETE OTC; Available for 90 day fill

PRENATAL TAB FORMULA OTC; Available for 90 day fill

PRENATAL+DHA MIS OTC

PRENATAL+FE TAB 29-1MG

PRENATAL-U CAP 106.5-1

PRENATE CAP ENHANCE

PRENATE CAP PIXIE

PRENATE CAP RESTORE

PRENATE DHA CAP

PRENATE MINI CAP

PRENATE TAB ELITE

PRENATL MULT CAP + DHA OTC

PRETAB TAB 29-1MG

PRIMACARE CAP

PROVIDA DHA CAP

PROVIDA OB CAP

PUREFE OB CAP PLUS

SELECT-OB CHW

SELECT-OB+ PAK DHA

STUART ONE CAP OTC

TARON-BC MIS

TARON-PREX CAP

THERANATAL CAP ONE OTC

THERANATAL MIS COMPLETE OTC

THERANATAL PAK OVAVITE OTC

TL FOLATE TAB

TL-CARE DHA CAP 27-1-500

TL-SELECT CAP

TRICARE CHW PRENATAL

TRINATAL GT TAB

TRINATAL RX TAB 1

trinate tab

TRISTART DHA CAP

TRISTART ONE CAP 35-1-215

VINATE DHA CAP 27-1.13

VINATE II TAB

VINATE M TAB


60


VIRT-PN TAB

VITAFOL CAP ULTRA

VITAFOL CHW GUMMIES

VITAFOL FE+ CAP

VITAFOL-NANO TAB

VITAFOL-OB PAK +DHA

VITAFOL-ONE CAP

VITAMEDMD CAP ONE RX

VITAPEARL CAP

VIVA DHA CAP

VP-PNV-DHA CAP

MUSCULOSKELETAL THERAPY AGENTS CENTRAL MUSCLE RELAXANTS

baclofen tab 10 mg

baclofen tab 20 mg

chlorzoxazone tab 500 mg

cyclobenzaprine hcl tab 5 mg

FIRST-BACLOF SUS 1

FIRST-BACLOF SUS 5 KIT

methocarbamol tab 500 mg

methocarbamol tab 750 mg

tizanidine hcl tab 2 mg (base equivalent)

tizanidine hcl tab 4 mg (base equivalent)

DIRECT MUSCLE RELAXANTS dantrolene sodium cap 25 mg

NASAL AGENTS - SYSTEMIC AND TOPICAL NASAL ANTIALLERGY

azelastine hcl nasal spray 0.1% (137 mcg/spray)

cromolyn sodium nasal aerosol soln 5.2 mg/act (4%)

OTC

NASAL ANTICHOLINERGICS ipratropium bromide nasal soln 0.03% (21

mcg/spray)

ipratropium bromide nasal soln 0.06% (42

mcg/spray)

NASAL STEROIDS fluticasone propionate nasal susp 50 mcg/act

triamcinolone acetonide nasal aerosol suspension

55 mcg/act

SYMPATHOMIMETIC DECONGESTANTS AFRIN CHILD SPR 0.25% OTC

decongestant sol 1% OTC

LITTLE NOSES DRO 0.125% OTC

pseudoephedrine hcl tab 30 mg OTC

pseudoephedrine hcl tab 60 mg OTC


61


sinus nasal spr 0.05% OTC

NEUROMUSCULAR AGENTS ALS AGENTS

riluzole tab 50 mg

NEUROMUSCULAR BLOCKING AGENT - NEUROTOXINS BOTOX INJ 100UNIT PA

BOTOX INJ 200UNIT PA

NUTRIENTS MISC. NUTRITIONAL SUBSTANCES

alp high3 cap 600mg OTC

fish oil cap 435mg OTC



omega 3 500 cap 500mg OTC

omega essent liq basic OTC

omega-3 fatty acids cap 300 mg OTC




omega-3 fatty acids cap delayed release 1200 mg OTC

PROTEINS levocarnitine (dietary) oral soln 1 gm/10ml OTC

levocarnitine tab 500 mg OTC

OPHTHALMIC AGENTS ARTIFICIAL TEARS AND LUBRICANTS

artifi tears oin op OTC

artifi tears sol 1.4% op OTC

carboxymethylcellulose sodium ophth soln 0.5% OTC

lubricnt eye dro 0.4-0.3% OTC

BETA-BLOCKERS - OPHTHALMIC dorzolamide hcl-timolol maleate ophth soln 22.3-

6.8 mg/ml

levobunolol hcl ophth soln 0.5%

timolol maleate ophth gel forming soln 0.5%

timolol maleate ophth gel forming soln 0.25%

timolol maleate ophth soln 0.5%

timolol maleate ophth soln 0.25%

CYCLOPLEGIC MYDRIATICS ATROPINE SUL OIN 1% OP

atropine sulfate ophth soln 1%

cyclopentolate hcl ophth soln 1%

tropicamide ophth soln 1%

MIOTICS pilocarpine hcl ophth soln 1%


62


pilocarpine hcl ophth soln 4%

OPHTHALMIC ADRENERGIC AGENTS brimonidine tartrate ophth soln 0.2%

OPHTHALMIC ANTI-INFECTIVES bacitracin-polymyxin b ophth oint

ciprofloxacin hcl ophth soln 0.3%

erythromycin ophth oint 5 mg/gm

gentamicin sulfate ophth oint 0.3%

gentamicin sulfate ophth soln 0.3%

neo-polycin oin op

neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml

ofloxacin ophth soln 0.3%

polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1%

sulfacetamide sodium ophth soln 10%

tobramycin ophth soln 0.3%

trifluridine ophth soln 1%

OPHTHALMIC IMMUNOMODULATORS RESTASIS EMU 0.05% QL (30 vials / fill), PA

OPHTHALMIC STEROIDS dexamethasone sodium phosphate ophth soln

0.1%

fluorometholone ophth susp 0.1%

neomycin-polymyxin-dexamethasone ophth oint

0.1%

neomycin-polymyxin-dexamethasone ophth susp 0.1%

PRED SOD PHO SOL 1% OP

prednisolone acetate ophth susp 1% QL (5 ml / fill)

sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)%

OPHTHALMICS - MISC. azelastine hcl ophth soln 0.05%

claritin eye dro 0.025%op OTC

cromolyn sodium ophth soln 4%

diclofenac sodium ophth soln 0.1%

dorzolamide hcl ophth soln 2%

flurbiprofen sodium ophth soln 0.03%

ketorolac tromethamine ophth soln 0.4% QL (5 ml per fill)

ketorolac tromethamine ophth soln 0.5% QL (5 ml / fill)

olopatadine hcl ophth soln 0.1% (base equivalent) QL (5 ml per fill)

sodium chloride hypertonic ophth soln 5% OTC

PROSTAGLANDINS - OPHTHALMIC latanoprost ophth soln 0.005% QL (2.5 ml / 30 days)


63


OTIC AGENTS OTIC AGENTS - MISCELLANEOUS

acetic acid 2% in aluminum acetate otic soln

acetic acid otic soln 2%

ear drops dro 6.5% OTC

OTIC ANTI-INFECTIVES ofloxacin otic soln 0.3%

OTIC COMBINATIONS neomycin-polymyxin-hc otic soln 1%

neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1%

OTIC STEROIDS fluocinolone acetonide (otic) oil 0.01%

PASSIVE IMMUNIZING AND TREATMENT AGENTS MONOCLONAL ANTIBODIES

SYNAGIS INJ 50MG PA

SYNAGIS INJ 100MG/ML PA

PENICILLINS AMINOPENICILLINS

amoxicillin (trihydrate) cap 250 mg

amoxicillin (trihydrate) cap 500 mg

amoxicillin (trihydrate) chew tab 125 mg

amoxicillin (trihydrate) for susp 125 mg/5ml




amoxicillin (trihydrate) tab 875 mg

ampicillin cap 250 mg

ampicillin cap 500 mg

ampicillin for susp 125 mg/5ml

ampicillin for susp 250 mg/5ml

NATURAL PENICILLINS penicillin v potassium for soln 125 mg/5ml

penicillin v potassium for soln 250 mg/5ml

penicillin v potassium tab 250 mg

penicillin v potassium tab 500 mg

PENICILLIN COMBINATIONS amoxicillin & k clavulanate chew tab 200-28.5 mg

amoxicillin & k clavulanate for susp 200-28.5

mg/5ml

amoxicillin & k clavulanate for susp 400-57

mg/5ml

amoxicillin & k clavulanate for susp 600-42.9

mg/5ml


64


amoxicillin & k clavulanate tab 500-125 mg

amoxicillin & k clavulanate tab 875-125 mg

PENICILLINASE-RESISTANT PENICILLINS dicloxacillin sodium cap 250 mg

dicloxacillin sodium cap 500 mg

PHARMACEUTICAL ADJUVANTS INTERNAL VEHICLE INGREDIENTS/AGENTS

food thicknr pow instant OTC

RESOURCE POW THICKENU OTC

SIMPLYTHICK GEL OTC

THICK-IT POW ORIGINAL OTC

THICKENUP POW CLEAR OTC

SEMI SOLID VEHICLES PETROLATUM OIN WHITE OTC

white petrolatum gel OTC

white petrolatum topical gel OTC

PROGESTINS PROGESTINS

hydroxyprogesterone caproate im in oil 250 mg/ml PA

medroxyprogesterone acetate tab 2.5 mg

medroxyprogesterone acetate tab 5 mg

medroxyprogesterone acetate tab 10 mg

norethindrone acetate tab 5 mg

progesterone micronized cap 100 mg

progesterone micronized cap 200 mg

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. AGENTS FOR CHEMICAL DEPENDENCY

acamprosate calcium tab delayed release 333 mg

disulfiram tab 250 mg

disulfiram tab 500 mg

ANTI-CATAPLECTIC AGENTS XYREM SOL 500MG/ML PA

ANTIDEMENTIA AGENTS donepezil hydrochloride orally disintegrating tab 5

mg

donepezil hydrochloride orally disintegrating tab 10

mg

donepezil hydrochloride tab 5 mg



galantamine hydrobromide cap er 24hr 8 mg



galantamine hydrobromide tab 8 mg


65


memantine hcl tab 5 mg

memantine hcl tab 10 mg

rivastigmine tartrate cap 1.5 mg (base equivalent)

rivastigmine tartrate cap 3 mg (base equivalent)

rivastigmine tartrate cap 4.5 mg (base equivalent)

rivastigmine tartrate cap 6 mg (base equivalent)

MOVEMENT DISORDER DRUG THERAPY tetrabenazine tab 12.5 mg QL (8 tabs / day), PA

tetrabenazine tab 25 mg QL (4 tabs / day), PA

MULTIPLE SCLEROSIS AGENTS AUBAGIO TAB 7MG

AUBAGIO TAB 14MG

AVONEX KIT 30MCG

AVONEX PEN KIT 30MCG

AVONEX PREFL KIT 30MCG

dalfampridine tab er 12hr 10 mg QL (2 tabs / day)

EXTAVIA INJ 0.3MG

GILENYA CAP 0.5MG

glatiramer acetate soln prefilled syringe 20 mg/ml

glatiramer acetate soln prefilled syringe 40 mg/ml

glatopa inj 40mg/ml

TECFIDERA CAP 120MG

TECFIDERA CAP 240MG

TECFIDERA MIS STARTER

PREMENSTRUAL DYSPHORIC DISORDER (PMDD) AGENTS fluoxetine hcl (pmdd) cap 10 mg

fluoxetine hcl (pmdd) cap 20 mg

fluoxetine hcl (pmdd) tab 10 mg

PSEUDOBULBAR AFFECT (PBA) AGENTS NUEDEXTA CAP 20-10MG PA

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. pimozide tab 1 mg

pimozide tab 2 mg

SMOKING DETERRENTS bupropion hcl (smoking deterrent) tab er 12hr 150

mg

CHANTIX PAK 0.5& 1MG ST

CHANTIX TAB 0.5MG ST

CHANTIX TAB 1MG ST

nicotine loz 4mg mint OTC

nicotine loz mini 2mg OTC

nicotine polacrilex gum 2 mg OTC

nicotine polacrilex gum 4 mg OTC

nicotine td patch 24hr 7 mg/24hr OTC



66



NICOTROL INH PA

NICOTROL NS SPR 10MG/ML PA

RESPIRATORY AGENTS - MISC. CYSTIC FIBROSIS AGENTS

KALYDECO PAK 50MG PA

KALYDECO PAK 75MG PA

KALYDECO TAB 150MG PA

ORKAMBI TAB 100-125 PA

ORKAMBI TAB 200-125 PA

PULMOZYME SOL 1MG/ML

SULFONAMIDES SULFONAMIDES

SULFADIAZINE TAB 500MG

TETRACYCLINES TETRACYCLINES

doxycycline hyclate cap 100 mg

doxycycline hyclate tab 20 mg

doxycycline hyclate tab 100 mg

doxycycline monohydrate cap 50 mg

doxycycline monohydrate cap 100 mg

doxycycline monohydrate tab 50 mg

doxycycline monohydrate tab 100 mg

minocycline hcl cap 50 mg



minocycline hcl tab 75 mg

THYROID AGENTS ANTITHYROID AGENTS

methimazole tab 5 mg

methimazole tab 10 mg

propylthiouracil tab 50 mg

THYROID HORMONES levothyroxine sodium tab 25 mcg

levothyroxine sodium tab 50 mcg











67



liothyronine sodium tab 5 mcg



np thyroid tab 15mg

np thyroid tab 30mg

np thyroid tab 60mg

np thyroid tab 120mg

ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS ANTISPASMODICS

dicyclomine hcl cap 10 mg

dicyclomine hcl oral soln 10 mg/5ml

dicyclomine hcl tab 20 mg

glycopyrrolate tab 1 mg

glycopyrrolate tab 2 mg

hyoscyamine sulfate elixir 0.125 mg/5ml

hyoscyamine sulfate sl tab 0.125 mg

hyoscyamine sulfate soln 0.125 mg/ml

hyoscyamine sulfate tab 0.125 mg

methscopolamine bromide tab 5 mg

propantheline bromide tab 15 mg

H-2 ANTAGONISTS cimetidine tab 200mg OTC

cimetidine tab 300 mg



famotidine tab 10 mg OTC

famotidine tab 40 mg

ranitidine hcl syrup 15 mg/ml (75 mg/5ml)

ranitidine hcl tab 75 mg OTC

ranitidine hcl tab 150 mg

ranitidine hcl tab 300 mg

MISC. ANTI-ULCER sucralfate tab 1 gm

PROTON PUMP INHIBITORS esomeprazole magnesium cap delayed release 20

mg (base eq)

QL (1 cap / day)

esomeprazole magnesium cap delayed release 40 mg (base eq)

lansoprazole cap delayed release 15 mg


OMEPRAZOLE + SUS SYRSPEND

omeprazole cap delayed release 10 mg

omeprazole cap delayed release 20 mg OTC

omeprazole cap delayed release 40 mg


68


pantoprazole sodium ec tab 20 mg (base equiv)

pantoprazole sodium ec tab 40 mg (base equiv)

rabeprazole sodium ec tab 20 mg

ULCER DRUGS - PROSTAGLANDINS misoprostol tab 100 mcg

misoprostol tab 200 mcg

URINARY ANTI-INFECTIVES URINARY ANTI-INFECTIVES

methenamine hippurate tab 1 gm

nitrofurantoin macrocrystalline cap 50 mg

nitrofurantoin macrocrystalline cap 100 mg

nitrofurantoin monohydrate macrocrystalline cap 100 mg

nitrofurantoin susp 25 mg/5ml

URINARY ANTISPASMODICS URINARY ANTISPASMODIC - ANTIMUSCARINICS

(ANTICHOLINERGIC) oxybutynin chloride syrup 5 mg/5ml

oxybutynin chloride tab 5 mg

oxybutynin chloride tab er 24hr 5 mg



tolterodine tartrate cap er 24hr 2 mg QL (1 cap / day)

tolterodine tartrate cap er 24hr 4 mg QL (1 cap / day)

tolterodine tartrate tab 1 mg QL (2 tabs / day)

tolterodine tartrate tab 2 mg QL (2 tabs / day)

trospium chloride tab 20 mg QL (60 tabs / 30 days), ST

URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS bethanechol chloride tab 10 mg

bethanechol chloride tab 25 mg

VACCINES VIRAL VACCINES

AFLURIA INJ 2018-19

AFLURIA INJ PF 18-19

AFLURIA QUAD INJ 2018-19

AFLURIA QUAD INJ PF 18-19

FLUAD INJ 2018-19

FLUARIX QUAD INJ 2018-19

FLUBLOK QUAD INJ 2018-19

FLUCELVAX INJ 2015-16

FLUCLVX QUAD INJ 2018-19

FLULAVAL QUA INJ 2018-19

FLUMIST QUAD SUS 2018-19

FLUZONE HD INJ PF 18-19


69


FLUZONE QUAD INJ 2018-19

SHINGRIX INJ 50MCG QL (2 injections per lifetime); Age Restriction

VAGINAL PRODUCTS SPERMICIDES

ENCARE SUP 100MG OTC

GYNOL II GEL 3% OTC

SHUR-SEAL GEL 2% OTC

TODAY SPONGE MIS OTC

vcf vaginal gel contrace OTC

VCF VAGINAL MIS CONTRACP OTC

VAGINAL ANTI-INFECTIVES clindamycin phosphate vaginal cream 2%

clotrimazole vaginal cream 1% OTC

metronidazole vaginal gel 0.75%

miconazole 3 kit combo pk OTC

miconazole nitrate vaginal cream 2% OTC

miconazole nitrate vaginal suppos 100 mg OTC

terconazole vaginal cream 0.4% QL (45 gm / 30 days)

terconazole vaginal cream 0.8% ST

terconazole vaginal suppos 80 mg ST

VAGINAL ESTROGENS estradiol vaginal cream 0.1 mg/gm ST

estradiol vaginal tab 10 mcg

VASOPRESSORS ANAPHYLAXIS THERAPY AGENTS

epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000)

QL (2 pens / 30 days)





EPIPEN 2-PAK INJ 0.3MG QL (2 pens / 30 days)

EPIPEN-JR INJ 0.15MG QL (2 pens / 30 days)

VASOPRESSORS midodrine hcl tab 2.5 mg

midodrine hcl tab 5 mg

midodrine hcl tab 10 mg

VITAMINS OIL SOLUBLE VITAMINS

VIT A FISH CAP 7500UNIT OTC

vitamin a cap 8000 unit OTC

vitamin a cap 10000 unit OTC

VITAMIN A CAP 25000UNT OTC

vitamin d3 cap 400unit OTC; Available for 90 day fill


70


vitamin d3 cap 2000unit OTC

vitamin d3 cap 5000unit OTC

vitamin d3 cap 10000 OTC

vitamin d3 cap 50000unt OTC

vitamin d3 chw 400unit OTC




vitamin d3 dro 400unit OTC

vitamin d3 sol 8000/ml OTC

vitamin d3 tab 1000unit OTC



vitamin d3 tab 50000unt OTC

vitamin d cap 50000unt

vitamin d tab 400unit OTC; Available for 90 day fill

vitamin d-3 cap 1000unit OTC

vitamin e cap 100 unit OTC





WATER SOLUBLE VITAMINS biotin cap 5 mg OTC

biotin tab 5 mg OTC

LIQUID C 500 LIQ 500/15ML OTC

niacin cap er 500 mg OTC

niacin tab 100 mg OTC



niacin tab er 500 mg OTC

vitamin b6 tab 100mg OTC

vitamin b-1 tab 50mg OTC


vitamin b-1 tab 100mg OTC; Available for 90 day fill






vitamin b-6 tab 200mg cr OTC


vitamin c chw 250mg OTC

vitamin c chw 500mg OTC

vitamin c liq 500/5ml OTC


71


VITAMIN C SYP 500/5ML OTC

vitamin c tab 250mg OTC

vitamin c tab 1000mg OTC

72

Index

A abacavir sulfate soln 20 mg/ml (base equiv) ............................................. 32

abacavir sulfate tab 300 mg (base equiv) ...................................................... 32

abacavir sulfate-lamivudine tab 600-300 mg .................................................. 32

abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg ......................... 32

ABSORICA CAP 10MG ........................ 40

ABSORICA CAP 20MG ........................ 40 ABSORICA CAP 30MG ........................ 40

ABSORICA CAP 40MG ........................ 40 acamprosate calcium tab delayed release

333 mg ........................................... 64 acarbose tab 100 mg ......................... 17

acarbose tab 25 mg .......................... 17 acarbose tab 50 mg .......................... 17

ACCU-CHEK BLOOD GLUCOSE TEST KITS ...................................................... 53

ACCU-CHEK BLOOD GLUCOSE TEST STRIPS ............................................ 45

ACCU-CHEK LIQ GUIDE ..................... 53 acebutolol hcl cap 200 mg ................. 34

acebutolol hcl cap 400 mg ................. 34

acetaminophe chw 160mg .................. 5 acetaminophe tab 160mg ................... 5

acetaminophen elixir 160 mg/5ml ........ 5 acetaminophen liquid 160 mg/5ml ....... 5

acetaminophen soln 160 mg/5ml ......... 5 acetaminophen tab 325 mg ................. 5

acetaminophen tab er 650 mg ............. 5 acetaminophen w/ codeine soln 120-12

mg/5ml ............................................ 6 acetaminophen w/ codeine tab 300-15

mg ................................................... 6 acetaminophen w/ codeine tab 300-30

mg ................................................... 6 acetaminophen w/ codeine tab 300-60

mg ................................................... 6

acetaminophn sus 160/5ml ................. 5 acetaminophn tab 500mg ................... 5

acetazolamide cap er 12hr 500 mg ..... 45 acetazolamide tab 125 mg ................. 45

acetazolamide tab 250 mg ................. 45 acetic acid 2% in aluminum acetate otic

soln ................................................ 63

acetic acid otic soln 2% ..................... 63 acetylcysteine inhal soln 10% ............ 40

acetylcysteine inhal soln 20% ............ 40 acitretin cap 10 mg .......................... 42

acitretin cap 17.5 mg ........................ 42 acitretin cap 25 mg .......................... 42

ACNE MEDICAT LOT 10% .................. 40 ACNE MEDICAT LOT 5% .................... 40

act fluoride sol 0.05% ....................... 56

act total sol dry mout ....................... 56 ACTIVE OB CAP ................................ 57

acyclovir cap 200 mg ........................ 34 acyclovir oint 5% ............................. 42

acyclovir susp 200 mg/5ml ................ 34 acyclovir tab 400 mg ........................ 34

acyclovir tab 800 mg ........................ 34 adapalene gel 0.1% .......................... 40

adefovir dipivoxil tab 10 mg .............. 34 ADMELOG INJ 100U/ML ..................... 19

ADMELOG SOLO INJ 100U/ML ............ 19 ADULT RESPIRATORY MASK .............. 53

ADVAIR DISKU AER 100/50 ............... 11 ADVAIR DISKU AER 250/50 ............... 11

ADVAIR DISKU AER 500/50 ............... 11

ADVAIR HFA AER 115/21 .................. 11 ADVAIR HFA AER 230/21 .................. 11

ADVAIR HFA AER 45/21 .................... 11 AFINITOR TAB 10MG ........................ 27

AFINITOR TAB 2.5MG ....................... 27 AFINITOR TAB 5MG .......................... 27

AFINITOR TAB 7.5MG ....................... 27 AFLURIA INJ 2018-19 ....................... 68

AFLURIA INJ PF 18-19 ...................... 68 AFLURIA QUAD INJ 2018-19 .............. 68

AFLURIA QUAD INJ PF 18-19 ............. 68 AFRIN CHILD SPR 0.25% .................. 60

ALBUSTIX TES ................................. 45 albuterol sulfate soln nebu 0.083% (2.5

mg/3ml) ......................................... 11

albuterol sulfate soln nebu 0.5% (5 mg/ml) ........................................... 11

albuterol sulfate soln nebu 0.63 mg/3ml (base equiv) .................................... 11

albuterol sulfate soln nebu 1.25 mg/3ml (base equiv) .................................... 11

73

albuterol sulfate syrup 2 mg/5ml ........ 11

albuterol sulfate tab 2 mg .................. 11 albuterol sulfate tab er 12hr 4 mg ....... 11

ALCOHOL PAD .................................. 53 alendronate sodium tab 10 mg ........... 46

alendronate sodium tab 35 mg ........... 46 alendronate sodium tab 70 mg ........... 46

alfuzosin hcl tab er 24hr 10 mg .......... 49 ALKA-SELTZER TAB 500MG ................. 5

ALLEGRA ALRG TAB 30MG ................. 21 aller-chlor syp 2mg/5ml ..................... 21

ALLI CAP 60MG.................................. 1 allopurinol tab 100 mg....................... 49

allopurinol tab 300 mg....................... 49 alogliptin benzoate tab 12.5 mg (base

equiv) ............................................. 18

alogliptin benzoate tab 25 mg (base equiv) ............................................. 18

alogliptin benzoate tab 6.25 mg (base equiv) ............................................. 18

alogliptin-metformin hcl tab 12.5-1000 mg .................................................. 17

alogliptin-metformin hcl tab 12.5-500 mg ...................................................... 17

alogliptin-pioglitazone tab 12.5-15 mg. 17 alogliptin-pioglitazone tab 12.5-30 mg. 17

alogliptin-pioglitazone tab 12.5-45 mg. 17 alogliptin-pioglitazone tab 25-15 mg ... 17

alogliptin-pioglitazone tab 25-30 mg ... 17 alogliptin-pioglitazone tab 25-45 mg ... 17

alp high3 cap 600mg ......................... 61

alprazolam tab 0.25 mg ...................... 9 alprazolam tab 0.5 mg........................ 9

alprazolam tab 1 mg .......................... 9 alprazolam tab 2 mg .......................... 9

ALUM HYDROX SUS 320/5ML .............. 7 ALUMINUM SOL ACETATE .................. 44

amantadine hcl cap 100 mg ............... 28 amantadine hcl syrup 50 mg/5ml ........ 28

amantadine hcl tab 100 mg ................ 28 amiloride & hydrochlorothiazide tab 5-50

mg .................................................. 45 amiloride hcl tab 5 mg ....................... 46

amiodarone hcl tab 200 mg ................ 10 amitriptyline hcl tab 10 mg ................ 16

amitriptyline hcl tab 100 mg .............. 17

amitriptyline hcl tab 150 mg .............. 17 amitriptyline hcl tab 25 mg ................ 16

amitriptyline hcl tab 50 mg ................ 16

amitriptyline hcl tab 75 mg ................ 16 amlodipine besylate tab 10 mg (base

equivalent) ...................................... 35 amlodipine besylate tab 2.5 mg (base

equivalent) ...................................... 35 amlodipine besylate tab 5 mg (base

equivalent) ...................................... 35 amlodipine besylate-benazepril hcl cap

10-20 mg ........................................ 24 amlodipine besylate-benazepril hcl cap

10-40 mg ........................................ 24 amlodipine besylate-benazepril hcl cap

2.5-10 mg ....................................... 24 amlodipine besylate-benazepril hcl cap 5-

10 mg ............................................. 24

amlodipine besylate-benazepril hcl cap 5-20 mg ............................................. 24

amlodipine besylate-benazepril hcl cap 5-40 mg ............................................. 24

amlodipine besylate-olmesartan medoxomil tab 10-20 mg .................. 24

amlodipine besylate-olmesartan medoxomil tab 10-40 mg .................. 24

amlodipine besylate-olmesartan medoxomil tab 5-20 mg .................... 24

amlodipine besylate-olmesartan medoxomil tab 5-40 mg .................... 24

amlodipine besylate-valsartan tab 10-160 mg ........................................... 25

amlodipine besylate-valsartan tab 10-

320 mg ........................................... 25 amlodipine besylate-valsartan tab 5-160

mg ................................................. 25 amlodipine besylate-valsartan tab 5-320

mg ................................................. 25 amnesteem cap 10mg ...................... 40

amnesteem cap 20mg ...................... 40 amnesteem cap 40mg ...................... 40

amoxicillin & k clavulanate chew tab 200-28.5 mg .......................................... 63

amoxicillin & k clavulanate for susp 200-28.5 mg/5ml ................................... 63

amoxicillin & k clavulanate for susp 400-57 mg/5ml ...................................... 63

amoxicillin & k clavulanate for susp 600-

42.9 mg/5ml ................................... 63 amoxicillin & k clavulanate tab 500-125

74

mg .................................................. 63

amoxicillin & k clavulanate tab 875-125 mg .................................................. 64

amoxicillin (trihydrate) cap 250 mg ..... 63 amoxicillin (trihydrate) cap 500 mg ..... 63

amoxicillin (trihydrate) chew tab 125 mg ...................................................... 63

amoxicillin (trihydrate) for susp 125 mg/5ml ........................................... 63




amoxicillin (trihydrate) tab 875 mg ..... 63

amphetamine-dextroamphetamine cap er 24hr 10 mg ....................................... 1





amphetamine-dextroamphetamine cap er 24hr 5 mg ......................................... 1

amphetamine-dextroamphetamine tab 10 mg .............................................. 1

amphetamine-dextroamphetamine tab

12.5 mg ........................................... 1 amphetamine-dextroamphetamine tab

15 mg .............................................. 1 amphetamine-dextroamphetamine tab

20 mg .............................................. 1 amphetamine-dextroamphetamine tab

30 mg .............................................. 1 amphetamine-dextroamphetamine tab 5

mg ................................................... 1 amphetamine-dextroamphetamine tab

7.5 mg ............................................. 1 ampicillin cap 250 mg ........................ 63

ampicillin cap 500 mg ........................ 63 ampicillin for susp 125 mg/5ml ........... 63

ampicillin for susp 250 mg/5ml ........... 63

anastrozole tab 1 mg ........................ 27 antacid sus ....................................... 7

antifungal cre 1% ............................. 42

anti-itch lot sens 1% ........................ 44 APIDRA INJ U-100 ............................ 19

aprepitant capsule 125 mg ................ 21 aprepitant capsule 40 mg .................. 20

aprepitant capsule 80 mg .................. 20 aprepitant capsule therapy pack 80 &

125 mg ........................................... 21 APRISO CAP 0.375GM ....................... 48

APTIVUS CAP 250MG ........................ 32 APTIVUS SOL ................................... 32

AQUAPHOR OIN ............................... 44 aranelle tab ..................................... 37

aripiprazole tab 10 mg ...................... 31 aripiprazole tab 15 mg ...................... 31

aripiprazole tab 2 mg ........................ 31

aripiprazole tab 20 mg ...................... 31 aripiprazole tab 30 mg ...................... 31

aripiprazole tab 5 mg ........................ 31 armodafinil tab 150 mg ....................... 2

armodafinil tab 200 mg ....................... 2 armodafinil tab 250 mg ....................... 2

armodafinil tab 50 mg ........................ 2 ARTH PAIN CRE 0.075% ................... 44

arthricream cre 10% ........................ 44 artifi tears oin op ............................. 61

artifi tears sol 1.4% op ..................... 61 ASMANEX 120 AER 220MCG .............. 10

ASMANEX 14 AER 220MCG ................ 10 ASMANEX 30 AER 110MCG ................ 10

ASMANEX 30 AER 220MCG ................ 10

ASMANEX 60 AER 220MCG ................ 10 ASMANEX 7 AER 110MCG .................. 10

ASMANEX HFA AER 100 MCG ............. 10 ASMANEX HFA AER 200 MCG ............. 11

aspirin low chw 81mg ......................... 5 aspirin tab 325mg .............................. 5

aspirin tab 500 mg ............................. 5 aspirin tab delayed release 325 mg ...... 5

aspirin tab delayed release 81 mg ........ 5 aspirin-acetaminophen-caffeine tab 250-

250-65 mg ........................................ 4 ATABEX CHW PRENATAL ................... 57

ATABEX EC TAB ............................... 57 atazanavir sulfate cap 150 mg (base

equiv) ............................................. 32

atazanavir sulfate cap 200 mg (base equiv) ............................................. 32

75

atazanavir sulfate cap 300 mg (base

equiv) ............................................. 32 atenolol & chlorthalidone tab 100-25 mg

...................................................... 25 atenolol & chlorthalidone tab 50-25 mg

...................................................... 25 atenolol tab 100 mg .......................... 35

atenolol tab 25 mg ............................ 34 atenolol tab 50 mg ............................ 34

athlete foot cre 1% ........................... 42 atomoxetine hcl cap 10 mg (base equiv)

....................................................... 1 atomoxetine hcl cap 100 mg (base

equiv) .............................................. 2 atomoxetine hcl cap 18 mg (base equiv)

....................................................... 1

atomoxetine hcl cap 25 mg (base equiv) ....................................................... 1




atorvastatin calcium tab 10 mg (base equivalent) ...................................... 22



atorvastatin calcium tab 80 mg (base

equivalent) ...................................... 22 ATRIPLA TAB .................................... 32

ATROPINE SUL OIN 1% OP ................ 61 atropine sulfate ophth soln 1% ........... 61

AUBAGIO TAB 14MG ......................... 65 AUBAGIO TAB 7MG ........................... 65

AVEENO BABY KIT BATHTIME ............. 53 AVONEX KIT 30MCG .......................... 65

AVONEX PEN KIT 30MCG ................... 65 AVONEX PREFL KIT 30MCG ................ 65

azathioprine tab 50 mg ...................... 55 azelastine hcl nasal spray 0.1% (137

mcg/spray) ...................................... 60 azelastine hcl ophth soln 0.05% ......... 62

azithromycin for susp 100 mg/5ml ...... 52

azithromycin for susp 200 mg/5ml ...... 52 azithromycin powd pack for susp 1 gm 52

azithromycin tab 250 mg .................. 53

azithromycin tab 500 mg .................. 53 azithromycin tab 600 mg .................. 53

B b complex tab plus c ......................... 56

baby teethng gel 7.5% ..................... 56 bacitracin oint 500 unit/gm ............... 41

bacitracin zinc oint 500 unit/gm ......... 41 bacitracin-polymyxin b oint ............... 41

bacitracin-polymyxin b ophth oint ...... 62 baclofen tab 10 mg .......................... 60

baclofen tab 20 mg .......................... 60 BAL-CARE MIS DHA .......................... 57

balsalazide disodium cap 750 mg ....... 48 BASAGLAR KWIKPEN ........................ 19

BAYER PLUS TAB 500MG ..................... 5

B-COMPLEX TAB C/FA/BIO ................ 56 b-complex vitamin cap ...................... 56

b-complex vitamin tab ...................... 56 BD GLUCOSE CHW 5GM .................... 18

BE WELL PAK ROUNDED .................... 57 BELVIQ TAB 10MG .............................. 1

BELVIQ XR TAB 20MG ......................... 1 benazepril & hydrochlorothiazide tab 10-

12.5 mg .......................................... 25 benazepril & hydrochlorothiazide tab 20-

12.5 mg .......................................... 25 benazepril & hydrochlorothiazide tab 20-

25 mg ............................................. 25 benazepril hcl tab 10 mg ................... 23

benazepril hcl tab 20 mg ................... 23

benazepril hcl tab 40 mg ................... 23 benazepril hcl tab 5 mg ..................... 23

BENLYSTA INJ 120MG ....................... 56 BENLYSTA INJ 200MG/ML .................. 56

BENLYSTA INJ 400MG ....................... 56 benzonatate cap 100 mg ................... 39

benzonatate cap 200 mg ................... 39 benzoyl peroxide-erythromycin gel 5-3%

...................................................... 40 benztropine mesylate tab 0.5 mg ....... 28

benztropine mesylate tab 1 mg .......... 28 benztropine mesylate tab 2 mg .......... 28

betamethasone dipropionate augmented cream 0.05% ................................... 42

betamethasone dipropionate augmented

gel 0.05% ....................................... 42 betamethasone dipropionate augmented

76

lotion 0.05% .................................... 42

betamethasone dipropionate augmented oint 0.05% ....................................... 43

betamethasone dipropionate cream 0.05% ............................................. 43

betamethasone dipropionate lotion 0.05% ............................................. 43

betamethasone valerate cream 0.1% (base equivalent) .............................. 43

betamethasone valerate lotion 0.1% (base equivalent) .............................. 43

betamethasone valerate oint 0.1% (base equivalent) ...................................... 43

bethanechol chloride tab 10 mg .......... 68 bethanechol chloride tab 25 mg .......... 68

bicalutamide tab 50 mg ..................... 27

BIKTARVY TAB .................................. 32 biotin cap 5 mg ................................ 70

biotin tab 5 mg ................................. 70 bisacodyl suppos 10 mg ..................... 52

bisacodyl tab 5mg ec ......................... 52 bismuth subsalicylate chew tab 262 mg

...................................................... 20 bisoprolol & hydrochlorothiazide tab 10-

6.25 mg .......................................... 25 bisoprolol & hydrochlorothiazide tab 2.5-

6.25 mg .......................................... 25 bisoprolol & hydrochlorothiazide tab 5-

6.25 mg .......................................... 25 bisoprolol fumarate tab 10 mg ............ 35

bisoprolol fumarate tab 5 mg ............. 35

BLOOD GLUCOSE CALIBRATION SOLUTION ....................................... 53

BOTOX INJ 100UNIT.......................... 61 BOTOX INJ 200UNIT.......................... 61

bp gel gel 10% ................................. 41 bp gel gel 5% ................................... 41

bp wash liq 5% ................................. 41 bprotected sol tri-vite ........................ 57

BRAINSTRONG MIS PRENATAL ........... 57 brimonidine tartrate ophth soln 0.2% .. 62

bromocriptine mesylate cap 5 mg (base equivalent) ...................................... 28

bromocriptine mesylate tab 2.5 mg (base equivalent) ...................................... 28

budesonide delayed release particles cap

3 mg ............................................... 39 budesonide inhalation susp 0.25 mg/2ml

...................................................... 11

budesonide inhalation susp 0.5 mg/2ml...................................................... 11

budesonide inhalation susp 1 mg/2ml . 11 budesonide tab er 24hr 9 mg ............. 39

bumetanide tab 0.5 mg ..................... 46 bumetanide tab 1 mg ....................... 46

bumetanide tab 2 mg ....................... 46 buprenorphine hcl sl tab 2 mg (base

equiv) ............................................... 7 buprenorphine hcl sl tab 8 mg (base

equiv) ............................................... 7 buprenorphine hcl-naloxone hcl sl tab 2-

0.5 mg (base equiv) ........................... 7 buprenorphine hcl-naloxone hcl sl tab 8-

2 mg (base equiv) .............................. 7

buprenorphine td patch weekly 10 mcg/hr ............................................. 7



buprenorphine td patch weekly 5 mcg/hr........................................................ 7

buprenorphine td patch weekly 7.5 mcg/hr ............................................. 7

bupropion hcl (smoking deterrent) tab er 12hr 150 mg ................................... 65

bupropion hcl tab 100 mg ................. 15 bupropion hcl tab 75 mg ................... 15

bupropion hcl tab er 12hr 100 mg ...... 15

bupropion hcl tab er 12hr 150 mg ...... 15 bupropion hcl tab er 12hr 200 mg ...... 15

bupropion hcl tab er 24hr 150 mg ...... 15 bupropion hcl tab er 24hr 300 mg ...... 15

buspirone hcl tab 10 mg ..................... 9 buspirone hcl tab 15 mg ..................... 9

buspirone hcl tab 30 mg ..................... 9 buspirone hcl tab 5 mg ....................... 9

buspirone hcl tab 7.5 mg .................... 9 butalbital-acetaminophen tab 50-325 mg

........................................................ 4 butalbital-acetaminophen-caff w/ cod cap

50-325-40-30 mg .............................. 6 butalbital-acetaminophen-caffeine tab

50-325-40 mg ................................... 5

butorphanol tartrate nasal soln 10 mg/ml........................................................ 7

77

BYDUREON BC INJ 2/0.85ML .............. 18

BYDUREON INJ 2MG .......................... 18 BYDUREON PEN INJ 2MG ................... 18

BYETTA INJ 10MCG ........................... 18 BYETTA INJ 5MCG ............................. 18

C CA CITRATE TAB 250MG .................... 54

CA GLUCONATE TAB 50MG ................. 54 CA LACTATE TAB 100MG .................... 54

cabergoline tab 0.5 mg ...................... 47 CADEAU DHA CAP ............................. 57

CALAMINE LOT ................................. 44 CALAMINE LOT 8-8% ........................ 44

calc cit+d3 tab 200-250 .................... 54 calcipotriene oint 0.005% .................. 42

calcipotriene soln 0.005% (50 mcg/ml)

...................................................... 42 calcitriol cap 0.25 mcg ....................... 47

calcitriol cap 0.5 mcg ........................ 47 calcitriol oral soln 1 mcg/ml ............... 47

calcium ............................................ 54 calcium + d tab 600mg...................... 54

calcium acetate (phosphate binder) cap 667 mg (169 mg ca) ......................... 49

CALCIUM CARB TAB 648MG ................ 8 calcium carbonate (antacid) chew tab

500 mg ............................................ 8 calcium carbonate (antacid) chew tab

750 mg ............................................ 8 calcium carbonate (antacid) susp 1250

mg/5ml ............................................ 8

calcium carbonate tab 1250 mg (500 mg elemental ca) ................................... 54

calcium carbonate tab 1500 mg (600 mg elemental ca) ................................... 54

calcium carbonate-vitamin d cap 600 mg-200 unit ..................................... 54

calcium carbonate-vitamin d tab 600 mg-200 unit ........................................... 54

CALCIUM CHW 500MG ....................... 54 CALCIUM CIT TAB 1040MG ................ 54

CALCIUM CITR TAB 200MG ................ 54 calcium citrate tab 950 mg (200 mg

elemental ca) ................................... 54 calcium citrate-vitamin d tab 315 mg-

250 unit (elemental ca) ..................... 54

CALCIUM GLUC TAB 500MG ............... 54 CALCIUM LACT TAB 648MG ................ 54

CALCIUM LACT TAB 750MG ............... 54

calcium polycarbophil tab 625 mg ...... 52 CALCIUM TAB 333MG ....................... 54

calcium/d chw 500-400 ..................... 54 calcium+d tab 600-800 ..................... 54

capecitabine tab 150 mg ................... 27 capecitabine tab 500 mg ................... 27

capsaicin cream 0.025% ................... 44 capsaicin cream 0.1% ....................... 44

CAPZASIN-P CRE 0.035% ................. 44 carbamazepine cap er 12hr 100 mg .... 13

carbamazepine cap er 12hr 200 mg .... 13 carbamazepine cap er 12hr 300 mg .... 13

carbamazepine chew tab 100 mg ....... 13 carbamazepine susp 100 mg/5ml ....... 13

carbamazepine tab 200 mg ............... 13

carbamazepine tab er 12hr 100 mg .... 13 carbamazepine tab er 12hr 200 mg .... 13

carbamazepine tab er 12hr 400 mg .... 13 carbidopa & levodopa tab 10-100 mg . 29

carbidopa & levodopa tab 25-100 mg . 29 carbidopa & levodopa tab 25-250 mg . 29

carbidopa & levodopa tab er 25-100 mg...................................................... 29

carboxymethylcellulose sodium ophth soln 0.5% ....................................... 61

carvedilol tab 12.5 mg ...................... 34 carvedilol tab 25 mg ......................... 34

carvedilol tab 3.125 mg .................... 34 carvedilol tab 6.25 mg ...................... 34

cefadroxil cap 500 mg....................... 37

cefadroxil for susp 250 mg/5ml .......... 37 cefadroxil for susp 500 mg/5ml .......... 37

cefadroxil tab 1 gm .......................... 37 cefdinir cap 300 mg .......................... 37

cefdinir for susp 125 mg/5ml ............. 37 cefdinir for susp 250 mg/5ml ............. 37

cefprozil for susp 125 mg/5ml ........... 37 cefprozil for susp 250 mg/5ml ........... 37

cefprozil tab 250 mg ......................... 37 cefprozil tab 500 mg ......................... 37

cefuroxime axetil tab 250 mg ............ 37 cefuroxime axetil tab 500 mg ............ 37

celecoxib cap 100 mg ......................... 3 celecoxib cap 200 mg ......................... 3

celecoxib cap 400 mg ......................... 3

celecoxib cap 50 mg ........................... 3 CENTRUM SPEC PAK PRENATAL .......... 57

78

cephalexin cap 250 mg ...................... 37

cephalexin cap 500 mg ...................... 37 cephalexin for susp 125 mg/5ml ......... 37

cephalexin for susp 250 mg/5ml ......... 37 cetirizine sol 1mg/ml ......................... 21

cetirizine tab 10mg ........................... 21 cetirizine tab 5mg ............................. 21

cetirizine-pseudoephedrine tab er 12hr 5-120 mg ........................................ 39

CHANTIX PAK 0.5& 1MG .................... 65 CHANTIX TAB 0.5MG ......................... 65

CHANTIX TAB 1MG ............................ 65 CHEWABLE CHW CALCIUM ................. 54

childrens chw multivit ........................ 57 chlordiazepoxide hcl cap 10 mg ........... 9

chlordiazepoxide hcl cap 25 mg ........... 9

chlordiazepoxide hcl cap 5 mg ............. 9 chlorhexidine gluconate soln 0.12% .... 56

chlorothiazide tab 250 mg .................. 46 chlorothiazide tab 500 mg .................. 46

chlorpheniramine maleate tab 4 mg .... 21 chlorpheniramine maleate tab er 12 mg

...................................................... 21 chlorpromazine hcl tab 10 mg ............ 31

chlorpromazine hcl tab 100 mg ........... 31 chlorpromazine hcl tab 200 mg ........... 31

chlorpromazine hcl tab 25 mg ............ 31 chlorpromazine hcl tab 50 mg ............ 31

chlorthalidone tab 25 mg ................... 46 chlorthalidone tab 50 mg ................... 46

chlorzoxazone tab 500 mg ................. 60

cholestyramine light powder 4 gm/dose ...................................................... 22

cholestyramine light powder packets 4 gm .................................................. 22

cholestyramine powder 4 gm/dose ...... 22 cholestyramine powder packets 4 gm .. 22

ciclodan cre 0.77% ........................... 42 ciclodan sol 8% ................................ 42

cilostazol tab 100 mg ........................ 50 cilostazol tab 50 mg .......................... 50

cimetidine tab 200mg ........................ 67 cimetidine tab 300 mg ....................... 67

cimetidine tab 400 mg ....................... 67 cimetidine tab 800 mg ....................... 67

CINQAIR INJ .................................... 10

ciprofloxacin hcl ophth soln 0.3% ........ 62 ciprofloxacin hcl tab 100 mg (base equiv)

...................................................... 48

ciprofloxacin hcl tab 250 mg (base equiv)...................................................... 48



citalopram hydrobromide oral soln 10 mg/5ml ........................................... 15

citalopram hydrobromide tab 10 mg (base equiv) .................................... 15



CITRANATAL CAP HARMONY .............. 57

CITRANATAL CAP MEDLEY ................. 57 CITRANATAL MIS ............................. 57

CITRANATAL MIS B-CALM ................. 57 CITRANATAL PAK ASSURE ................. 57

CITRANATAL TAB BLOOM .................. 57 CITRANATAL TAB RX ........................ 57

claravis cap 10mg ............................ 41 claravis cap 20mg ............................ 41

claravis cap 30mg ............................ 41 claravis cap 40mg ............................ 41

clarithromycin for susp 125 mg/5ml ... 53 clarithromycin for susp 250 mg/5ml ... 53

clarithromycin tab 250 mg ................ 53 clarithromycin tab 500 mg ................ 53

claritin eye dro 0.025%op ................. 62

clindamycin hcl cap 150 mg ................. 8 clindamycin hcl cap 300 mg ................. 8

clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) .......................... 8

clindamycin phosphate gel 1% ........... 41 clindamycin phosphate lotion 1% ....... 41

clindamycin phosphate soln 1% ......... 41 clindamycin phosphate swab 1% ........ 41

clindamycin phosphate vaginal cream 2%...................................................... 69

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 (1)-5% ...................... 41

clobazam suspension 2.5 mg/ml ........ 13 clobazam tab 10 mg ......................... 13

clobazam tab 20 mg ......................... 13

clobetasol e cre 0.05% ..................... 43 clobetasol propionate cream 0.05% .... 43

79

clobetasol propionate oint 0.05% ........ 43

clobetasol propionate soln 0.05% ....... 43 clomipramine hcl cap 25 mg ............... 17

clomipramine hcl cap 50 mg ............... 17 clomipramine hcl cap 75 mg ............... 17

clonazepam tab 0.5 mg ..................... 13 clonazepam tab 1 mg ........................ 13

clonazepam tab 2 mg ........................ 13 clonidine hcl tab 0.1 mg..................... 24

clonidine hcl tab 0.2 mg..................... 24 clonidine hcl tab 0.3 mg..................... 24

clopidogrel bisulfate tab 75 mg (base equiv) ............................................. 50

clotrimazole cream 1% ...................... 42 clotrimazole soln 1% ......................... 42

clotrimazole troche 10 mg .................. 56

clotrimazole vaginal cream 1% ........... 69 clotrimazole w/ betamethasone cream 1-

0.05% ............................................. 42 clotrimazole w/ betamethasone lotion 1-

0.05% ............................................. 42 clozapine tab 100 mg ........................ 30

clozapine tab 200 mg ........................ 30 clozapine tab 25 mg .......................... 30

clozapine tab 50 mg .......................... 30 codeine sulfate tab 15 mg ................... 5

codeine sulfate tab 30 mg ................... 5 codeine sulfate tab 60 mg ................... 5

colchicine tab 0.6 mg ........................ 50 colchicine w/ probenecid tab 0.5-500 mg

...................................................... 49

cold/allergy elx ................................. 40 cold/allergy tab pe ............................ 40

colesevelam hcl tab 625 mg ............... 22 colestipol hcl granule packets 5 gm ..... 22

colestipol hcl granules 5 gm ............... 22 colestipol hcl tab 1 gm ....................... 22

COMBIVENT AER 20-100 .................... 11 COMPLERA TAB ................................ 32

complete kit lice ............................... 45 COMPLETE NAT PAK DHA ................... 57

CONCEPT DHA CAP ........................... 57 CONDOMS ....................................... 53

CONTRAVE TAB 8-90MG ..................... 1 CREON CAP 12000UNT ...................... 45

CREON CAP 24000UNT ...................... 45

CREON CAP 3000UNIT ....................... 45 CREON CAP 36000UNT ...................... 45

CREON CAP 6000UNIT ...................... 45

CRESEMBA CAP 186 MG .................... 21 CRESEMBA INJ 372MG ...................... 21

CRIXIVAN CAP 200MG ...................... 32 CRIXIVAN CAP 400MG ...................... 32

cromolyn sodium nasal aerosol soln 5.2 mg/act (4%) ................................... 60

cromolyn sodium ophth soln 4% ........ 62 cromolyn sodium soln nebu 20 mg/2ml

...................................................... 10 cryselle-28 tab ................................. 37

CVS PRENATAL CHW GUMMY ............. 57 cvs sore loz throat ............................ 56

cyclobenzaprine hcl tab 5 mg ............. 60 cyclopentolate hcl ophth soln 1% ....... 61

cyclosporine cap 25 mg ..................... 55

cyclosporine modified cap 100 mg ...... 55 cyclosporine modified cap 25 mg ........ 55

cyclosporine modified cap 50 mg ........ 55 cyclosporine modified oral soln 100

mg/ml ............................................ 55 cyproheptadine hcl syrup 2 mg/5ml .... 22

cyproheptadine hcl tab 4 mg ............. 22 D daily multi tab vit/iron ...................... 56 dalfampridine tab er 12hr 10 mg ........ 65

DALIRESP TAB 500MCG .................... 10 danazol cap 100 mg ........................... 7

danazol cap 200 mg ........................... 7 dantrolene sodium cap 25 mg ............ 60

dapsone tab 100 mg ........................... 8

dapsone tab 25 mg ............................ 8 DDAVP SOL 0.01% ........................... 47

decongestant sol 1% ........................ 60 denta 5000 cre plus .......................... 56

dermacerin cre ................................ 44 DESCOVY TAB 200/25 ...................... 32

desipramine hcl tab 10 mg ................ 17 desipramine hcl tab 100 mg .............. 17

desipramine hcl tab 25 mg ................ 17 desipramine hcl tab 50 mg ................ 17

desipramine hcl tab 75 mg ................ 17 desloratadine tab 5 mg ..................... 21

desmopressin acetate nasal spray soln 0.01% ............................................ 47

desmopressin acetate tab 0.1 mg ....... 47

desmopressin acetate tab 0.2 mg ....... 47 desogest-eth estrad & eth estrad tab

80

0.15-0.02/0.01 mg(21/5) .................. 37

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg ...................................... 38

desonide cream 0.05% ...................... 43 desonide oint 0.05% ......................... 43

desvenlafaxine succinate tab er 24hr 100 mg (base equiv) ............................... 16



DEXAMETHASON CON 1MG/ML ........... 39 dexamethasone elixir 0.5 mg/5ml ....... 39

dexamethasone sodium phosphate inj 4 mg/ml ............................................. 39

dexamethasone sodium phosphate ophth

soln 0.1% ........................................ 62 dexamethasone soln 0.5 mg/5ml ........ 39

dexamethasone tab 0.5 mg ................ 39 dexamethasone tab 0.75 mg .............. 39

dexamethasone tab 1 mg .................. 39 dexamethasone tab 1.5 mg ................ 39

dexamethasone tab 2 mg .................. 39 dexamethasone tab 4 mg .................. 39

dexamethasone tab 6 mg .................. 39 dexedrine tab 5mg ............................. 1

dexmethylphenidate hcl cap er 24 hr 10 mg ................................................... 2

dexmethylphenidate hcl cap er 24 hr 15 mg ................................................... 2

dexmethylphenidate hcl cap er 24 hr 20

mg ................................................... 2 dexmethylphenidate hcl cap er 24 hr 25





mg ................................................... 2 dexmethylphenidate hcl tab 10 mg ...... 2

dexmethylphenidate hcl tab 2.5 mg ..... 2 dexmethylphenidate hcl tab 5 mg ........ 2

dextromethorphan-guaifenesin syrup 10-

100 mg/5ml ..................................... 40 diazepam con 5mg/ml ........................ 9

diazepam oral soln 1 mg/ml ................ 9

diazepam rectal gel delivery system 10 mg ................................................. 13

diazepam rectal gel delivery system 2.5 mg ................................................. 13

diazepam rectal gel delivery system 20 mg ................................................. 13

diazepam tab 10 mg ........................... 9 diazepam tab 2 mg............................. 9

diazepam tab 5 mg............................. 9 DICLEGIS TAB 10-10MG ................... 20

diclofenac potassium tab 50 mg ........... 3 diclofenac sodium gel 1% .................. 41

diclofenac sodium ophth soln 0.1% .... 62 diclofenac sodium tab delayed release 50

mg ................................................... 3

diclofenac sodium tab delayed release 75 mg ................................................... 3

diclofenac sodium tab er 24hr 100 mg .. 3 dicloxacillin sodium cap 250 mg ......... 64

dicloxacillin sodium cap 500 mg ......... 64 dicyclomine hcl cap 10 mg ................ 67

dicyclomine hcl oral soln 10 mg/5ml ... 67 dicyclomine hcl tab 20 mg ................. 67

didanosine delayed release capsule 200 mg ................................................. 32



digoxin oral soln 0.05 mg/ml ............. 36

digoxin tab 125 mcg (0.125 mg) ........ 36 digoxin tab 250 mcg (0.25 mg) .......... 36

diltiazem hcl cap er 24hr 120 mg ....... 35 diltiazem hcl cap er 24hr 180 mg ....... 35

diltiazem hcl cap er 24hr 240 mg ....... 35 diltiazem hcl coated beads cap er 24hr

120 mg ........................................... 35 diltiazem hcl coated beads cap er 24hr




360 mg ........................................... 35

diltiazem hcl coated beads tab er 24hr 360 mg ........................................... 36

81

diltiazem hcl extended release beads cap

er 24hr 120 mg ................................ 36 diltiazem hcl extended release beads cap




er 24hr 420 mg ................................ 36 diltiazem hcl tab 120 mg ................... 36

diltiazem hcl tab 30 mg ..................... 36 diltiazem hcl tab 60 mg ..................... 36

diltiazem hcl tab 90 mg ..................... 36 dimenhydrinate tab 50 mg ................. 20

diphenhydram cap 50mg ................... 21

diphenhydramine hcl cap 25 mg ......... 21 diphenhydramine hcl elixir 12.5 mg/5ml

...................................................... 21 diphenhydramine hcl liquid 12.5 mg/5ml

...................................................... 21 diphenhydramine hcl tab 25 mg .......... 21

diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml ........................................... 20

diphenoxylate w/ atropine tab 2.5-0.025 mg .................................................. 20

dipyridamole tab 25 mg ..................... 50 dipyridamole tab 50 mg ..................... 50

dipyridamole tab 75 mg ..................... 50 DISPOSABLE MIS MTHPIECE .............. 53

disulfiram tab 250 mg ....................... 64

disulfiram tab 500 mg ....................... 64 divalproex sodium tab delayed release

125 mg ........................................... 15 divalproex sodium tab delayed release

250 mg ........................................... 15 divalproex sodium tab delayed release

500 mg ........................................... 15 divalproex sodium tab er 24 hr 250 mg

...................................................... 15 divalproex sodium tab er 24 hr 500 mg

...................................................... 15 docusate calcium cap 240 mg ............. 52

docusate sodium cap 250 mg ............. 52 docusate sodium liquid 150 mg/15ml .. 52

donepezil hydrochloride orally

disintegrating tab 10 mg .................... 64 donepezil hydrochloride orally

disintegrating tab 5 mg ..................... 64

donepezil hydrochloride tab 10 mg ..... 64 donepezil hydrochloride tab 23 mg ..... 64

donepezil hydrochloride tab 5 mg ....... 64 dorzolamide hcl ophth soln 2% .......... 62

dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml ......................... 61

DOUBLE-TUSSN LIQ DM .................... 40 doxazosin mesylate tab 1 mg ............ 24

doxazosin mesylate tab 2 mg ............ 24 doxazosin mesylate tab 4 mg ............ 24

doxazosin mesylate tab 8 mg ............ 24 doxepin hcl cap 10 mg ...................... 17

doxepin hcl cap 100 mg .................... 17 doxepin hcl cap 150 mg .................... 17

doxepin hcl cap 25 mg ...................... 17

doxepin hcl cap 50 mg ...................... 17 doxepin hcl cap 75 mg ...................... 17

doxepin hcl conc 10 mg/ml ................ 17 doxycycline hyclate cap 100 mg ......... 66

doxycycline hyclate tab 100 mg ......... 66 doxycycline hyclate tab 20 mg ........... 66

doxycycline monohydrate cap 100 mg 66 doxycycline monohydrate cap 50 mg .. 66

doxycycline monohydrate tab 100 mg . 66 doxycycline monohydrate tab 50 mg .. 66

dronabinol cap 10 mg ....................... 20 dronabinol cap 2.5 mg ...................... 20

dronabinol cap 5 mg ......................... 20 drospirenone-ethinyl estradiol tab 3-0.03

mg ................................................. 38

DROXIA CAP 200MG ......................... 50 DROXIA CAP 300MG ......................... 50

DROXIA CAP 400MG ......................... 50 DRYSOL SOL 20% ............................ 44

DUET DHA 400 MIS 25-1-400 ............ 57 DUET DHA MIS BALANCED ................ 57

DULERA AER 100-5MCG .................... 11 DULERA AER 200-5MCG .................... 11

duloxetine hcl cap 20 mg .................. 16 duloxetine hcl cap 30 mg .................. 16

duloxetine hcl cap 60 mg .................. 16 DUPIXENT INJ 300/2ML .................... 43

dutasteride cap 0.5 mg ..................... 49 E ear drops dro 6.5% .......................... 63

EDURANT TAB 25MG ........................ 32 efavirenz cap 200 mg ....................... 32

82

efavirenz cap 50 mg .......................... 32

efavirenz tab 600 mg ........................ 32 ELIQUIS TAB 2.5MG .......................... 12

ELIQUIS TAB 5MG ............................. 12 elite-ob tab ...................................... 57

ELLA TAB 30MG ................................ 38 EMEND SOL 150MG ........................... 21

EMEND SUS 125MG ........................... 21 EMTRIVA CAP 200MG ........................ 32

EMTRIVA SOL 10MG/ML ..................... 32 enalapril maleate & hydrochlorothiazide

tab 10-25 mg ................................... 25 enalapril maleate & hydrochlorothiazide

tab 5-12.5 mg .................................. 25 enalapril maleate tab 10 mg ............... 23

enalapril maleate tab 2.5 mg .............. 23

enalapril maleate tab 20 mg ............... 23 enalapril maleate tab 5 mg ................ 23

ENBRACE HR CAP ............................. 57 ENBREL INJ 25/0.5ML......................... 4

ENBREL INJ 25MG .............................. 4 ENBREL INJ 50MG/ML ......................... 4

ENBREL MINI INJ 50MG/ML ................. 4 ENBREL SRCLK INJ 50MG/ML .............. 4

ENCARE SUP 100MG ......................... 69 enoxaparin sodium inj 100 mg/ml ....... 13

enoxaparin sodium inj 120 mg/0.8ml .. 13 enoxaparin sodium inj 150 mg/ml ....... 13

enoxaparin sodium inj 30 mg/0.3ml .... 12 enoxaparin sodium inj 40 mg/0.4ml .... 12

enoxaparin sodium inj 60 mg/0.6ml .... 12

enoxaparin sodium inj 80 mg/0.8ml .... 12 entecavir tab 0.5 mg ......................... 34

entecavir tab 1 mg ............................ 34 ENTRESTO TAB 24-26MG ................... 37

ENTRESTO TAB 49-51MG ................... 37 ENTRESTO TAB 97-103MG ................. 37

ENTYVIO INJ 300MG ......................... 48 epinephrine solution auto-injector 0.15

mg/0.15ml (1:1000) ......................... 69 epinephrine solution auto-injector 0.15

mg/0.3ml (1:2000) ........................... 69 epinephrine solution auto-injector 0.3

mg/0.3ml (1:1000) ........................... 69 EPIPEN 2-PAK INJ 0.3MG ................... 69

EPIPEN-JR INJ 0.15MG ...................... 69

EPOGEN INJ 10000/ML ...................... 50 EPOGEN INJ 2000/ML ........................ 50

EPOGEN INJ 20000/ML ..................... 50

EPOGEN INJ 3000/ML ....................... 50 EPOGEN INJ 4000/ML ....................... 50

eq aspirin tab 500mg ec ...................... 5 EQUALYTE SOL ................................ 54

erythromycin gel 2% ........................ 41 erythromycin ophth oint 5 mg/gm ...... 62

erythromycin soln 2% ....................... 41 escitalopram oxalate tab 10 mg (base

equiv) ............................................. 15 escitalopram oxalate tab 20 mg (base

equiv) ............................................. 15 escitalopram oxalate tab 5 mg (base

equiv) ............................................. 15 esomeprazole magnesium cap delayed

release 20 mg (base eq) ................... 67

esomeprazole magnesium cap delayed release 40 mg (base eq) ................... 67

estazolam tab 1 mg .......................... 51 estazolam tab 2 mg .......................... 51

estradiol & norethindrone acetate tab 1-0.5 mg ............................................ 47

estradiol tab 0.5 mg ......................... 47 estradiol tab 1 mg ............................ 47

estradiol tab 2 mg ............................ 47 estradiol td patch weekly 0.025 mg/24hr

...................................................... 48 estradiol td patch weekly 0.05 mg/24hr

...................................................... 48 estradiol td patch weekly 0.06 mg/24hr

...................................................... 48

estradiol td patch weekly 0.075 mg/24hr...................................................... 48

estradiol td patch weekly 0.1 mg/24hr 47 estradiol vaginal cream 0.1 mg/gm .... 69

estradiol vaginal tab 10 mcg .............. 69 estropipate tab 0.75 mg .................... 48

estropipate tab 1.5 mg ..................... 48 estropipate tab 3 mg ........................ 48

eszopiclone tab 1 mg ........................ 51 eszopiclone tab 2 mg ........................ 51

eszopiclone tab 3 mg ........................ 51 ethambutol hcl tab 400 mg................ 26

ethosuximide cap 250 mg ................. 15 ethosuximide soln 250 mg/5ml .......... 15

ethynodiol diacetate & ethinyl estradiol

tab 1 mg-35 mcg ............................. 38 ethynodiol diacetate & ethinyl estradiol

83

tab 1 mg-50 mcg .............................. 38

etodolac cap 200 mg .......................... 3 etodolac tab 400 mg .......................... 3

etodolac tab 500 mg .......................... 4 etodolac tab er 24hr 400 mg ............... 4

etodolac tab er 24hr 500 mg ............... 4 etodolac tab er 24hr 600 mg ............... 4

etoposide cap 50 mg ......................... 28 EVOTAZ TAB 300-150........................ 32

exemestane tab 25 mg ...................... 27 EXTAVIA INJ 0.3MG .......................... 65

ezetimibe tab 10 mg ......................... 23 EZFE FORTE CAP............................... 57

F famciclovir tab 125 mg ...................... 34

famciclovir tab 250 mg ...................... 34

famciclovir tab 500 mg ...................... 34 famotidine tab 10 mg ........................ 67

famotidine tab 40 mg ........................ 67 FARXIGA TAB 10MG .......................... 19

FARXIGA TAB 5MG ............................ 19 FASENRA INJ 30MG/ML ..................... 10

felodipine tab er 24hr 10 mg .............. 36 felodipine tab er 24hr 2.5 mg ............. 36

felodipine tab er 24hr 5 mg ................ 36 fenofibrate micronized cap 134 mg ..... 22

fenofibrate micronized cap 200 mg ..... 22 fenofibrate micronized cap 67 mg ....... 22

fenofibrate tab 145 mg ...................... 22 fenofibrate tab 54 mg ........................ 22

fentanyl td patch 72hr 100 mcg/hr ....... 5

fentanyl td patch 72hr 12 mcg/hr ........ 5 fentanyl td patch 72hr 25 mcg/hr ........ 5

fentanyl td patch 72hr 50 mcg/hr ........ 5 fentanyl td patch 72hr 75 mcg/hr ........ 5

ferrous gluconate tab 240 mg (27 mg elemental fe) .................................... 51

FERROUS SUL LIQ 220/5ML ............... 51 FERROUS SULF SYP 300/5ML ............. 51

FERROUS SULF TAB 324MG EC ........... 51 ferrous sulfate elixir 220 mg/5ml (44

mg/5ml elemental fe) ........................ 51 ferrous sulfate soln 75 mg/ml (15 mg/ml

elemental fe) .................................... 51 ferrous sulfate tab ec 325 mg (65 mg fe

equivalent) ...................................... 51

fexofenadine sus 30mg/5ml ............... 21 fexofenadine tab 180mg .................... 21

fiber oral powder .............................. 52

fiber tab 500mg ............................... 52 finasteride tab 5 mg ......................... 49

FIRAZYR INJ 30MG/3ML .................... 50 FIRST - METO SOL 10MG/ML ............. 35

FIRST-BACLOF SUS 1 ....................... 60 FIRST-BACLOF SUS 5 KIT .................. 60

FIRST-METRON SUS 100MG/ML ........... 8 FIRST-MOUTHW SUS BLM ................. 56

FIRST-TESTOS CRE MC 2% ................. 7 FIRST-TESTOS OIN 2% ....................... 7

FIRST-VANC SOL 25MG/ML ................. 8 FIRST-VANC SOL 50MG/ML ................. 8

fish oil cap 1000mg .......................... 61 fish oil cap 435mg ............................ 61

fish oil cap 645mg ............................ 61

flecainide acetate tab 100 mg ............ 10 flecainide acetate tab 150 mg ............ 10

flecainide acetate tab 50 mg .............. 10 FLOVENT HFA AER 44MCG ................. 11

FLUAD INJ 2018-19 .......................... 68 FLUARIX QUAD INJ 2018-19 .............. 68

FLUBLOK QUAD INJ 2018-19 ............. 68 FLUCELVAX INJ 2015-16 ................... 68

FLUCLVX QUAD INJ 2018-19 ............. 68 fluconazole for susp 10 mg/ml ........... 21

fluconazole for susp 40 mg/ml ........... 21 fluconazole tab 100 mg ..................... 21

fluconazole tab 150 mg ..................... 21 fluconazole tab 200 mg ..................... 21

fluconazole tab 50 mg....................... 21

fludrocortisone acetate tab 0.1 mg ..... 39 FLULAVAL QUA INJ 2018-19 .............. 68

FLUMIST QUAD SUS 2018-19 ............ 68 fluocinolone acetonide (otic) oil 0.01% 63

fluocinolone acetonide cream 0.01% .. 43 fluocinolone acetonide cream 0.025% . 43

fluocinolone acetonide oint 0.025% .... 43 fluocinolone acetonide soln 0.01% ..... 43

fluocinonide cream 0.05% ................. 43 fluocinonide emulsified base cream

0.05% ............................................ 43 fluocinonide gel 0.05% ..................... 43

fluocinonide oint 0.05% .................... 43 fluocinonide soln 0.05% .................... 43

fluoridex gel 1.1% ............................ 56

fluorometholone ophth susp 0.1% ...... 62 fluorouracil cream 5% ...................... 42

84

fluorouracil soln 2% .......................... 42

fluorouracil soln 5% .......................... 42 fluoxetine hcl (pmdd) cap 10 mg ........ 65

fluoxetine hcl (pmdd) cap 20 mg ........ 65 fluoxetine hcl (pmdd) tab 10 mg ......... 65

fluoxetine hcl cap 10 mg .................... 15 fluoxetine hcl cap 20 mg .................... 15

fluoxetine hcl cap 40 mg .................... 15 fluoxetine hcl solution 20 mg/5ml ....... 15

fluoxetine hcl tab 10 mg .................... 15 fluoxetine hcl tab 20 mg .................... 15

fluphenazine decanoate inj 25 mg/ml .. 31 flurazepam hcl cap 15 mg .................. 51

flurazepam hcl cap 30 mg .................. 51 flurbiprofen sodium ophth soln 0.03% . 62

flurbiprofen tab 100 mg ...................... 4

flurbiprofen tab 50 mg ........................ 4 flutamide cap 125 mg ........................ 27

fluticasone propionate cream 0.05% ... 43 fluticasone propionate nasal susp 50

mcg/act ........................................... 60 fluticasone propionate oint 0.005% ..... 43

fluticasone-salmeterol aer powder ba 113-14 mcg/act ................................ 11

fluticasone-salmeterol aer powder ba 232-14 mcg/act ................................ 11

fluticasone-salmeterol aer powder ba 55-14 mcg/act ...................................... 11

fluvoxamine maleate tab 100 mg ........ 16 fluvoxamine maleate tab 25 mg .......... 15

fluvoxamine maleate tab 50 mg .......... 16

FLUZONE HD INJ PF 18-19 ................. 68 FLUZONE QUAD INJ 2018-19.............. 68

FOLCAL DHA CAP .............................. 57 FOLCAPS CAP OMEGA 3 ..................... 58

FOLET DHA PAK ................................ 58 FOLET ONE CAP 38-1-225 .................. 58

folic acid tab 1 mg ............................ 50 folic acid tab 400 mcg ....................... 50

folic acid tab 800mcg ........................ 50 folic acid-vitamin b6-vitamin b12 tab

2.2-25-0.5 mg .................................. 51 FOLIVANE-OB CAP ............................ 58

food thicknr pow instant .................... 64 fosamprenavir calcium tab 700 mg (base

equiv) ............................................. 32

fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg ................................ 25

fosinopril sodium & hydrochlorothiazide

tab 20-12.5 mg ................................ 25 fosinopril sodium tab 10 mg .............. 23

fosinopril sodium tab 20 mg .............. 23 fosinopril sodium tab 40 mg .............. 23

furosemide oral soln 10 mg/ml .......... 46 furosemide tab 20 mg ....................... 46

furosemide tab 40 mg ....................... 46 furosemide tab 80 mg ....................... 46

FUZEON INJ 90MG ........................... 32 G gabapentin cap 100 mg .................... 13 gabapentin cap 300 mg .................... 13

gabapentin cap 400 mg .................... 13 gabapentin oral soln 250 mg/5ml ....... 13

gabapentin tab 600 mg ..................... 13

gabapentin tab 800 mg ..................... 13 galantamine hydrobromide cap er 24hr

16 mg ............................................. 64 galantamine hydrobromide cap er 24hr

24 mg ............................................. 64 galantamine hydrobromide cap er 24hr 8

mg ................................................. 64 galantamine hydrobromide tab 8 mg .. 64

gemfibrozil tab 600 mg ..................... 22 gentamicin sulfate cream 0.1% .......... 41

gentamicin sulfate oint 0.1% ............. 42 gentamicin sulfate ophth oint 0.3% .... 62

gentamicin sulfate ophth soln 0.3% .... 62 GENVOYA TAB ................................. 32

geri-hydrola lot 5% .......................... 44

GILENYA CAP 0.5MG ......................... 65 glatiramer acetate soln prefilled syringe

20 mg/ml ........................................ 65 glatiramer acetate soln prefilled syringe

40 mg/ml ........................................ 65 glatopa inj 40mg/ml ......................... 65

glimepiride tab 1 mg ........................ 19 glimepiride tab 2 mg ........................ 19

glimepiride tab 4 mg ........................ 19 glipizide tab 10 mg ........................... 19

glipizide tab 5 mg ............................. 19 glipizide tab er 24hr 10 mg................ 19

glipizide tab er 24hr 2.5 mg............... 19 glipizide tab er 24hr 5 mg ................. 19


...................................................... 17 glipizide-metformin hcl tab 2.5-500 mg

85

...................................................... 17

glipizide-metformin hcl tab 5-500 mg .. 17 GLUCAGEN INJ HYPOKIT .................... 18

GLUCAGON KIT 1MG ......................... 18 GLUCOSE BITS CHW 1GM .................. 18

GLUCOSE CHW 4GM .......................... 18 GLUCOSE URINE TEST STRIPS ........... 45

glyburide micronized tab 1.5 mg ......... 19 glyburide micronized tab 3 mg ........... 19

glyburide micronized tab 6 mg ........... 19 glyburide tab 1.25 mg ....................... 19

glyburide tab 2.5 mg ......................... 19 glyburide tab 5 mg ............................ 20

glyburide-metformin tab 1.25-250 mg . 17 glyburide-metformin tab 2.5-500 mg .. 18

glyburide-metformin tab 5-500 mg ..... 18

GLYCERIN LIQ .................................. 37 glycerin suppos 2 gm ........................ 52

glycerin suppos 80.7% ...................... 52 glycopyrrolate tab 1 mg ..................... 67

glycopyrrolate tab 2 mg ..................... 67 granisetron hcl tab 1 mg .................... 20

GRANIX INJ 300/0.5 ......................... 50 GRANIX INJ 300/1ML ........................ 50

GRANIX INJ 480/0.8 ......................... 50 GRANIX INJ 480/1.6 ......................... 50

griseofulvin microsize susp 125 mg/5ml ...................................................... 21

guaifenesin liquid 100 mg/5ml ............ 40 guaifenesin tab 200 mg ..................... 40

guanfacine hcl tab 1 mg .................... 24

guanfacine hcl tab 2 mg .................... 24 guanfacine hcl tab er 24hr 1 mg (base

equiv) .............................................. 2 guanfacine hcl tab er 24hr 2 mg (base



equiv) .............................................. 2 GYNOL II GEL 3% ............................. 69

H H.P. ACTHAR INJ 80UNIT ................... 46

haloperidol decanoate im soln 100 mg/ml ...................................................... 30

haloperidol decanoate im soln 50 mg/ml

...................................................... 30 haloperidol lactate oral conc 2 mg/ml .. 30

haloperidol tab 0.5 mg ...................... 30

haloperidol tab 1 mg......................... 30 haloperidol tab 10 mg ....................... 30

haloperidol tab 2 mg......................... 30 haloperidol tab 20 mg ....................... 30

haloperidol tab 5 mg......................... 30 HEMENATAL OB MIS + DHA ............... 58

HEMENATAL OB TAB 28-6-1MG .......... 58 hemorrhoidal pad hygiene ................. 44

heparin sodium (porcine) inj 10000 unit/ml ........................................... 13

heparin sodium (porcine) inj 5000 unit/ml ........................................... 13

HETLIOZ CAP 20MG .......................... 52 HUMALOG MIX INJ 50/50 .................. 19

HUMALOG MIX SUS 75/25 ................. 19

HUMIRA INJ 10/0.1ML ........................ 3 HUMIRA INJ 10MG/0.2 ........................ 3

HUMIRA INJ 20/0.2ML ........................ 3 HUMIRA INJ 40/0.4ML ........................ 3

HUMIRA KIT 20MG/0.4 ....................... 3 HUMIRA KIT 40MG/0.8 ....................... 3

HUMIRA PEDIA INJ CROHNS ................ 3 HUMIRA PEN INJ 40/0.4ML .................. 3

HUMIRA PEN INJ 40MG/0.8 ................. 3 HUMIRA PEN INJ CD/UC/HS ................. 3

HUMIRA PEN INJ PS/UV ...................... 3 HUMIRA PEN KIT CD/UC/HS ................ 3

HUMIRA PEN KIT PS/UV ...................... 3 HUMULIN INJ 70/30 ......................... 19

HUMULIN N INJ U-100 ...................... 19

HUMULIN R INJ U-100 ...................... 19 HYCAMTIN CAP 0.25MG .................... 28

HYCAMTIN CAP 1MG ......................... 28 hydralazine hcl tab 10 mg ................. 26

hydralazine hcl tab 100 mg ............... 26 hydralazine hcl tab 25 mg ................. 26

hydralazine hcl tab 50 mg ................. 26 hydrochlorothiazide cap 12.5 mg ........ 46

hydrochlorothiazide tab 12.5 mg ........ 46 hydrochlorothiazide tab 25 mg ........... 46

hydrochlorothiazide tab 50 mg ........... 46 hydrocodone-acetaminophen soln 7.5-

325 mg/15ml ..................................... 6 hydrocodone-acetaminophen tab 10-325

mg ................................................... 6

hydrocodone-acetaminophen tab 5-325 mg ................................................... 6

86

hydrocodone-acetaminophen tab 7.5-325

mg ................................................... 6 hydrocodone-ibuprofen tab 7.5-200 mg 6

hydrocortisone cream 0.5% ............... 43 hydrocortisone cream 1% .................. 43

hydrocortisone cream 2.5% ............... 43 hydrocortisone enema 100 mg/60ml .... 7

hydrocortisone lotion 1% ................... 43 hydrocortisone oint 0.5% ................... 43

hydrocortisone oint 1% ..................... 43 hydrocortisone oint 2.5% ................... 43

hydrocortisone rectal cream 2.5%........ 7 hydrocortisone tab 10 mg .................. 39

hydrocortisone tab 20 mg .................. 39 hydrocortisone tab 5 mg .................... 39

HYDROMORPHON SUP 3MG ................. 5

hydromorphone hcl liqd 1 mg/ml ......... 5 hydromorphone hcl tab 2 mg .............. 5

hydromorphone hcl tab 4 mg .............. 5 hydromorphone hcl tab 8 mg .............. 5

hydroxychloroquine sulfate tab 200 mg ...................................................... 26

hydroxyprogesterone caproate im in oil 250 mg/ml ....................................... 64

hydroxyurea cap 500 mg ................... 28 hydroxyzine hcl syrup 10 mg/5ml ........ 9

hydroxyzine hcl tab 10 mg .................. 9 hydroxyzine hcl tab 25 mg .................. 9

hydroxyzine hcl tab 50 mg .................. 9 hydroxyzine pamoate cap 100 mg ........ 9

hydroxyzine pamoate cap 25 mg ......... 9

hydroxyzine pamoate cap 50 mg ......... 9 hyoscyamine sulfate elixir 0.125 mg/5ml

...................................................... 67 hyoscyamine sulfate sl tab 0.125 mg ... 67

hyoscyamine sulfate soln 0.125 mg/ml 67 hyoscyamine sulfate tab 0.125 mg ...... 67

I ibandronate sodium tab 150 mg (base

equivalent) ...................................... 46 IBRANCE CAP 100MG ........................ 27

IBRANCE CAP 125MG ........................ 27 IBRANCE CAP 75MG .......................... 27

ibuprofen dro 50/1.25 ........................ 4 ibuprofen sus 100/5ml ........................ 4

ibuprofen tab 200mg .......................... 4

ibuprofen tab 400 mg ......................... 4 ibuprofen tab 600 mg ......................... 4

ibuprofen tab 800 mg ......................... 4

icy hot cre ex st ............................... 44 imatinib mesylate tab 100 mg (base

equivalent) ...................................... 27 imatinib mesylate tab 400 mg (base

equivalent) ...................................... 27 imipramine hcl tab 10 mg ................. 17

imipramine hcl tab 25 mg ................. 17 imipramine hcl tab 50 mg ................. 17

imiquimod cream 5% ........................ 44 indapamide tab 1.25 mg ................... 46

indapamide tab 2.5 mg ..................... 46 indomethacin cap 25 mg ..................... 4

indomethacin cap 50 mg ..................... 4 indomethacin cap er 75 mg ................. 4

INFLECTRA INJ 100MG ...................... 48

INSULIN PEN NEEDLES/SYRINGES ..... 53 INTELENCE TAB 100MG .................... 32

INTELENCE TAB 200MG .................... 32 INTELENCE TAB 25MG ...................... 32

intense coug liq reliever .................... 40 INTRON A INJ 10MU ......................... 28

INTRON A INJ 18MU ......................... 28 INTRON A INJ 25MU ......................... 28

INTRON A INJ 50MU ......................... 28 INVEGA SUST INJ 117/0.75 ............... 29

INVEGA SUST INJ 156MG/ML ............. 29 INVEGA SUST INJ 234/1.5 ................ 29

INVEGA SUST INJ 39/0.25 ................ 29 INVEGA SUST INJ 78/0.5ML .............. 29

INVEGA TRINZ INJ 273MG................. 29

INVEGA TRINZ INJ 410MG................. 29 INVEGA TRINZ INJ 546MG................. 29

INVEGA TRINZ INJ 819MG................. 29 INVIRASE CAP 200MG ...................... 32

INVIRASE TAB 500MG ...................... 32 INVOKAMET TAB 150-1000 ............... 18

INVOKAMET TAB 150-500 ................. 18 INVOKAMET TAB 50-1000 ................. 18

INVOKAMET TAB 50-500MG .............. 18 INVOKAMET XR TAB 150-1000 ........... 18

INVOKAMET XR TAB 150-500 ............ 18 INVOKAMET XR TAB 50-1000 ............ 18

INVOKAMET XR TAB 50-500MG .......... 18 INVOKANA TAB 100MG ..................... 19

INVOKANA TAB 300MG ..................... 19

IPECAC SYP ..................................... 20 ipratropium bromide inhal soln 0.02% 10

87

ipratropium bromide nasal soln 0.03%

(21 mcg/spray) ................................ 60 ipratropium bromide nasal soln 0.06%

(42 mcg/spray) ................................ 60 ipratropium-albuterol nebu soln 0.5-

2.5(3) mg/3ml ................................. 11 irbesartan tab 150 mg ....................... 23

irbesartan tab 300 mg ....................... 23 irbesartan tab 75 mg ......................... 23

irbesartan-hydrochlorothiazide tab 150-12.5 mg .......................................... 25

irbesartan-hydrochlorothiazide tab 300-12.5 mg .......................................... 25

ISENTRESS CHW 100MG .................... 32 ISENTRESS CHW 25MG ..................... 32

ISENTRESS TAB 400MG ..................... 32

isoniazid syrup 50 mg/5ml ................. 26 isoniazid tab 100 mg ......................... 26

isoniazid tab 300 mg ......................... 26 isosorbide mononitrate tab 10 mg ........ 9

isosorbide mononitrate tab 20 mg ........ 9 isosorbide mononitrate tab er 24hr 120

mg ................................................... 9 isosorbide mononitrate tab er 24hr 30

mg ................................................... 9 isosorbide mononitrate tab er 24hr 60

mg ................................................... 9 isotretinoin cap 10 mg ....................... 41

isotretinoin cap 20 mg ....................... 41 isotretinoin cap 30 mg ....................... 41

isotretinoin cap 40 mg ....................... 41

itraconazole cap 100 mg .................... 21 ivermectin tab 3 mg ........................... 8

J JANUMET TAB 50-1000 ...................... 18

JANUMET TAB 50-500MG ................... 18 JANUMET XR TAB 100-1000 ............... 18

JANUMET XR TAB 50-1000 ................. 18 JANUMET XR TAB 50-500MG .............. 18

JANUVIA TAB 100MG ......................... 18 JANUVIA TAB 25MG .......................... 18

JANUVIA TAB 50MG .......................... 18 JARDIANCE TAB 10MG ....................... 19

JARDIANCE TAB 25MG ....................... 19 JENTADUETO TAB 2.5-1000 ............... 18

JENTADUETO TAB 2.5-500 ................. 18

JENTADUETO TAB 2.5-850 ................. 18 JENTADUETO TAB XR ........................ 18

JULUCA TAB 50-25MG....................... 33

K KALETRA TAB 100-25MG ................... 33

KALETRA TAB 200-50MG ................... 33 KALYDECO PAK 50MG ....................... 66

KALYDECO PAK 75MG ....................... 66 KALYDECO TAB 150MG ..................... 66

KANUMA INJ 20/10ML ....................... 47 ketoconazole cream 2% .................... 42

ketoconazole shampoo 2% ................ 42 KETONE TEST TES ............................ 45

KETONE URINE TEST STRIPS ............. 45 ketorolac tromethamine ophth soln 0.4%

...................................................... 62 ketorolac tromethamine ophth soln 0.5%

...................................................... 62

ketorolac tromethamine tab 10 mg ....... 4 KEVZARA INJ 150/1.14 ....................... 3

KEVZARA INJ 200/1.14 ....................... 3 KISQALI 200 PAK FEMARA ................. 27

KISQALI 400 PAK FEMARA ................. 27 KISQALI 600 PAK FEMARA ................. 27

klor-con pow 20meq ......................... 55 KOSHR PRENAT TAB 30-1MG ............. 58

KRYSTEXXA INJ 8MG/ML ................... 50 KUVAN POW 100MG ......................... 47

KUVAN POW 500MG ......................... 47 KUVAN TAB 100MG .......................... 47

L labetalol hcl tab 100 mg .................... 34

labetalol hcl tab 200 mg .................... 34

labetalol hcl tab 300 mg .................... 34 lactase enz tab 3000unit ................... 45

lactic acid (ammonium lactate) cream 12% ............................................... 44

lactic acid (ammonium lactate) lotion 12% ............................................... 44

lactulose (encephalopathy) solution 10 gm/15ml ......................................... 49

lactulose solution 10 gm/15ml ........... 52 lamivudine oral soln 10 mg/ml ........... 33

lamivudine tab 100 mg (hbv) ............. 34 lamivudine tab 150 mg ..................... 33

lamivudine tab 300 mg ..................... 33 lamivudine-zidovudine tab 150-300 mg

...................................................... 33

lamotrigine tab 100 mg ..................... 13 lamotrigine tab 150 mg ..................... 13

88

lamotrigine tab 200 mg ..................... 13

lamotrigine tab 25 mg ....................... 13 lamotrigine tab chewable dispersible 25

mg .................................................. 13 lamotrigine tab chewable dispersible 5

mg .................................................. 13 lamotrigine tab er 24hr 100 mg .......... 14

lamotrigine tab er 24hr 200 mg .......... 14 lamotrigine tab er 24hr 25 mg ............ 14

lamotrigine tab er 24hr 250 mg .......... 14 lamotrigine tab er 24hr 300 mg .......... 14

lamotrigine tab er 24hr 50 mg ............ 14 LANCETS ......................................... 53

lansoprazole cap delayed release 15 mg ...................................................... 67


...................................................... 67 lanthanum carbonate chew tab 1000 mg

(elemental) ...................................... 49 lanthanum carbonate chew tab 500 mg

(elemental) ...................................... 49 lanthanum carbonate chew tab 750 mg

(elemental) ...................................... 49 latanoprost ophth soln 0.005% ........... 62

leflunomide tab 10 mg ........................ 4 leflunomide tab 20 mg ........................ 4

LETAIRIS TAB 10MG .......................... 37 LETAIRIS TAB 5MG ........................... 37

letrozole tab 2.5 mg .......................... 27 leucovorin calcium tab 25 mg ............. 28

leucovorin calcium tab 5 mg ............... 28

LEUKERAN TAB 2MG.......................... 26 levalbuterol hcl soln nebu 0.31 mg/3ml

(base equiv) ..................................... 11 levalbuterol hcl soln nebu 0.63 mg/3ml

(base equiv) ..................................... 11 levalbuterol hcl soln nebu 1.25 mg/3ml

(base equiv) ..................................... 11 levalbuterol tartrate inhal aerosol 45

mcg/act (base equiv) ........................ 12 levetiracetam oral soln 100 mg/ml ...... 14

levetiracetam tab 1000 mg ................ 14 levetiracetam tab 250 mg .................. 14

levetiracetam tab 500 mg .................. 14 levetiracetam tab 750 mg .................. 14

levetiracetam tab er 24hr 500 mg ....... 14

levetiracetam tab er 24hr 750 mg ....... 14 levobunolol hcl ophth soln 0.5% ......... 61

levocarnitine (dietary) oral soln 1

gm/10ml ......................................... 61 levocarnitine oral soln 1 gm/10ml (10%)

...................................................... 47 levocarnitine tab 330 mg ................... 47

levocarnitine tab 500 mg ................... 61 levocetirizine dihydrochloride tab 5 mg 21

levofloxacin oral soln 25 mg/ml.......... 48 levofloxacin tab 250 mg .................... 48

levofloxacin tab 500 mg .................... 48 levofloxacin tab 750 mg .................... 48

levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg ..................... 38

levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg ..................................... 38

levonorgestrel & ethinyl estradiol tab

0.15 mg-30 mcg .............................. 38 levonorgestrel tab 1.5 mg ................. 38

levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg .......... 38

levothyroxine sodium tab 100 mcg ..... 66 levothyroxine sodium tab 112 mcg ..... 66



levothyroxine sodium tab 200 mcg ..... 66 levothyroxine sodium tab 25 mcg ....... 66

levothyroxine sodium tab 300 mcg ..... 66 levothyroxine sodium tab 50 mcg ....... 66

levothyroxine sodium tab 75 mcg ....... 66

levothyroxine sodium tab 88 mcg ....... 66 LEXIVA SUS 50MG/ML ...................... 33

lice killing sha .................................. 45 lice treatmt lot 1% ........................... 45

lice trtmnt liq 1% ............................. 45 lidocaine hcl gel 2% ......................... 44

lidocaine hcl soln 4% ........................ 44 lidocaine hcl viscous soln 2% ............. 56

lidocaine patch 5% ........................... 44 linezolid for susp 100 mg/5ml .............. 8

linezolid tab 600 mg ........................... 9 LINZESS CAP 145MCG ...................... 49

LINZESS CAP 290MCG ...................... 49 LINZESS CAP 72MCG ........................ 49

liothyronine sodium tab 25 mcg ......... 67

liothyronine sodium tab 5 mcg ........... 67 liothyronine sodium tab 50 mcg ......... 67

89

LIQUID C 500 LIQ 500/15ML .............. 70

lisinopril & hydrochlorothiazide tab 10-12.5 mg .......................................... 25

lisinopril & hydrochlorothiazide tab 20-12.5 mg .......................................... 25

lisinopril & hydrochlorothiazide tab 20-25 mg .................................................. 25

lisinopril tab 10 mg ........................... 23 lisinopril tab 2.5 mg .......................... 23

lisinopril tab 20 mg ........................... 23 lisinopril tab 30 mg ........................... 23

lisinopril tab 40 mg ........................... 23 lisinopril tab 5 mg ............................. 23

lithium carbonate cap 150 mg ............ 29 lithium carbonate cap 300 mg ............ 29

lithium carbonate cap 600 mg ............ 29

lithium carbonate tab 300 mg ............. 29 lithium carbonate tab er 300 mg ......... 29

lithium carbonate tab er 450 mg ......... 29 LITHIUM SOL 8MEQ/5ML .................... 29

LITTLE NOSES DRO 0.125% ............... 60 LOHIST-D LIQ .................................. 40

loperamide hcl cap 2 mg .................... 20 loperamide hcl liq 1 mg/5ml (0.2 mg/ml)

...................................................... 20 loperamide hcl tab 2 mg .................... 20

lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) ................................. 33

loratadine & pseudoephedrine tab er 24hr 10-240 mg ............................... 40

loratadine sol 5mg/5ml ...................... 21

loratadine tab 10 mg ......................... 21 loratadine-d tab 5-120mg .................. 40

lorazepam tab 0.5 mg ........................ 9 lorazepam tab 1 mg ........................... 9

lorazepam tab 2 mg ........................... 9 losartan potassium & hydrochlorothiazide

tab 100-12.5 mg .............................. 25 losartan potassium & hydrochlorothiazide

tab 100-25 mg ................................. 25 losartan potassium & hydrochlorothiazide

tab 50-12.5 mg ................................ 25 losartan potassium tab 100 mg .......... 24

losartan potassium tab 25 mg ............ 23 losartan potassium tab 50 mg ............ 24

lovastatin tab 10 mg ......................... 22

lovastatin tab 20 mg ......................... 22 lovastatin tab 40 mg ......................... 22

loxapine succinate cap 10 mg ............ 30

loxapine succinate cap 25 mg ............ 30 loxapine succinate cap 5 mg .............. 30

loxapine succinate cap 50 mg ............ 30 lubricnt eye dro 0.4-0.3% ................. 61

LUPR DEP-PED INJ 11.25MG .............. 47 LUPR DEP-PED INJ 15MG .................. 47

LUPR DEP-PED INJ 3M 30MG ............. 47 LUPR DEP-PED INJ 7.5MG ................. 47

LUPRON DEPOT INJ 11.25MG ............. 27 LUPRON DEPOT INJ 22.5MG .............. 27

LUPRON DEPOT INJ 3.75MG .............. 27 LUPRON DEPOT INJ 30MG ................. 27

LUPRON DEPOT INJ 45MG ................. 27 LUPRON DEPOT INJ 7.5MG ................ 27

LYRICA CAP 100MG .......................... 14

LYRICA CAP 150MG .......................... 14 LYRICA CAP 200MG .......................... 14

LYRICA CAP 225MG .......................... 14 LYRICA CAP 25MG ............................ 14

LYRICA CAP 300MG .......................... 14 LYRICA CAP 50MG ............................ 14

LYRICA CAP 75MG ............................ 14 LYRICA SOL 20MG/ML ....................... 14

M MACNATAL CN CAP DHA .................... 58

mag citrate sol ................................. 52 MAG64 TAB 64MG ............................ 55

magnesium oxide tab 250 mg .............. 8 magnesium oxide tab 400 mg .............. 8

magnesium oxide tab 400 mg (240 mg

elemental mg) ................................. 55 magnesium oxide tab 400 mg (241.3 mg

elemental mg) ................................. 55 magnesium tab 250mg ..................... 55

malathion lotion 0.5% ...................... 45 MARNATAL-F CAP ............................. 58

MATULANE CAP 50MG ....................... 28 MAVYRET TAB 100-40MG .................. 34

meclizine hcl chew tab 25 mg ............ 20 meclizine hcl tab 12.5 mg ................. 20

meclizine hcl tab 25 mg .................... 20 MECLOFENOXAT POW HCL ................ 37

medroxyprogesterone acetate im susp 150 mg/ml ...................................... 38

medroxyprogesterone acetate im susp

prefilled syr 150 mg/ml ..................... 38 medroxyprogesterone acetate tab 10 mg

90

...................................................... 64

medroxyprogesterone acetate tab 2.5 mg .................................................. 64

medroxyprogesterone acetate tab 5 mg ...................................................... 64

megestrol acetate susp 40 mg/ml ....... 27 megestrol acetate tab 20 mg .............. 27

megestrol acetate tab 40 mg .............. 27 melatonin cap 5mg ............................ 2

MELATONIN LIQ 1MG/4ML .................. 2 melatonin liquid 1 mg/ml .................... 2

melatonin sub 5mg ............................ 2 melatonin tab 1 mg ............................ 2

melatonin tab 3 mg ............................ 2 melatonin tab 300 mcg ....................... 3

melatonin tab 5 mg ............................ 3

melatonin tr tab /vit-b6 ...................... 3 melatonin/ tab vit b-6 ........................ 3

meloxicam tab 15 mg ......................... 4 meloxicam tab 7.5 mg ........................ 4

memantine hcl tab 10 mg .................. 65 memantine hcl tab 5 mg .................... 64

meperidine hcl tab 100 mg ................. 5 meperidine hcl tab 50 mg ................... 5

mercaptopurine tab 50 mg ................. 27 mesalamine enema 4 gm ................... 48

mesna inj 100 mg/ml ........................ 28 MESNEX TAB 400MG ......................... 28

metaproterenol sulfate syrup 10 mg/5ml ...................................................... 12

metformin hcl tab 1000 mg ................ 18

metformin hcl tab 500 mg .................. 18 metformin hcl tab 850 mg .................. 18

metformin hcl tab er 24hr 500 mg ...... 18 metformin hcl tab er 24hr 750 mg ...... 18

methadone hcl soln 10 mg/5ml ........... 5 methadone hcl soln 5 mg/5ml ............. 5

methadone hcl tab 10 mg ................... 6 methadone hcl tab 5 mg ..................... 6

methenamine hippurate tab 1 gm ....... 68 methimazole tab 10 mg ..................... 66

methimazole tab 5 mg ....................... 66 methocarbamol tab 500 mg ............... 60

methocarbamol tab 750 mg ............... 60 methotrexate sodium inj 50 mg/2ml (25

mg/ml) ............................................ 27

methotrexate sodium inj pf 50 mg/2ml (25 mg/ml) ...................................... 27

methotrexate sodium tab 2.5 mg (base

equiv) ............................................. 27 methscopolamine bromide tab 5 mg ... 67

methyldopa tab 250 mg .................... 24 methyldopa tab 500 mg .................... 24

methylphenidate hcl cap er 10 mg (cd) . 2 methylphenidate hcl cap er 20 mg (cd) . 2



methylphenidate hcl tab 10 mg ............ 2 methylphenidate hcl tab 20 mg ............ 2

methylphenidate hcl tab 5 mg .............. 2 methylphenidate hcl tab er 10 mg ........ 2

methylphenidate hcl tab er 20 mg ........ 2

methylprednisolone tab 16 mg ........... 39 methylprednisolone tab 32 mg ........... 39

methylprednisolone tab 4 mg ............ 39 methylprednisolone tab 8 mg ............ 39

methylprednisolone tab therapy pack 4 mg (21) .......................................... 39

metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base equiv) ..................... 48

metoclopramide hcl tab 10 mg (base equivalent) ...................................... 48

metoclopramide hcl tab 5 mg (base equivalent) ...................................... 48

metolazone tab 10 mg ...................... 46 metolazone tab 2.5 mg ..................... 46

metolazone tab 5 mg ........................ 46

metoprolol succinate tab er 24hr 100 mg (tartrate equiv) ................................ 35




metoprolol tartrate tab 100 mg .......... 35 metoprolol tartrate tab 25 mg ............ 35

metoprolol tartrate tab 50 mg ............ 35 METRONIDAZOL SUS 50MG/ML ............ 8

metronidazole cream 0.75% .............. 45 metronidazole gel 0.75% .................. 45

metronidazole tab 250 mg ................... 8

metronidazole tab 500 mg ................... 8 metronidazole vaginal gel 0.75% ....... 69

91

mexiletine hcl cap 150 mg ................. 10

miconazole 3 kit combo pk ................. 69 miconazole cre 2% ............................ 42

miconazole nitrate vaginal cream 2% .. 69 miconazole nitrate vaginal suppos 100

mg .................................................. 69 microgestin tab 1.5/30 ...................... 38

microgestin tab 1/20 ......................... 38 midodrine hcl tab 10 mg .................... 69

midodrine hcl tab 2.5 mg ................... 69 midodrine hcl tab 5 mg ...................... 69

milk of magn sus .............................. 52 mineral oil ....................................... 52

minocycline hcl cap 100 mg ............... 66 minocycline hcl cap 50 mg ................. 66

minocycline hcl cap 75 mg ................. 66

minocycline hcl tab 75 mg ................. 66 minoxidil tab 10 mg .......................... 26

minoxidil tab 2.5 mg ......................... 26 mirtazapine orally disintegrating tab 15

mg .................................................. 15 mirtazapine orally disintegrating tab 30

mg .................................................. 15 mirtazapine orally disintegrating tab 45

mg .................................................. 15 mirtazapine tab 15 mg ...................... 15

mirtazapine tab 30 mg ...................... 15 mirtazapine tab 45 mg ...................... 15

mirtazapine tab 7.5 mg ..................... 15 misoprostol tab 100 mcg ................... 68

misoprostol tab 200 mcg ................... 68

modafinil tab 100 mg ......................... 2 modafinil tab 200 mg ......................... 2

moexipril hcl tab 15 mg ..................... 23 moexipril hcl tab 7.5 mg .................... 23

moexipril-hydrochlorothiazide tab 15-12.5 mg .......................................... 25

moexipril-hydrochlorothiazide tab 15-25 mg .................................................. 25

moexipril-hydrochlorothiazide tab 7.5-12.5 mg .......................................... 25

MOISTURE GUA CRE ......................... 44 mometasone furoate oint 0.1% .......... 43

montelukast sodium chew tab 4 mg (base equiv) ..................................... 10

montelukast sodium chew tab 5 mg

(base equiv) ..................................... 10 montelukast sodium oral granules packet

4 mg (base equiv) ............................ 10

montelukast sodium tab 10 mg (base equiv) ............................................. 10

morphine sulfate oral soln 100 mg/5ml (20 mg/ml) ....................................... 6

morphine sulfate oral soln 20 mg/5ml ... 6 morphine sulfate tab 15 mg ................. 6

morphine sulfate tab 30 mg ................. 6 morphine sulfate tab er 100 mg ........... 6

morphine sulfate tab er 15 mg ............. 6 morphine sulfate tab er 200 mg ........... 6

morphine sulfate tab er 30 mg ............. 6 morphine sulfate tab er 60 mg ............. 6

mouth rinse sol ................................ 56 MOVANTIK TAB 12.5MG .................... 49

MOVANTIK TAB 25MG ....................... 49

moxifloxacin hcl tab 400 mg (base equiv)...................................................... 48

MTERYTI TAB ................................... 58 MTERYTI TAB FOLIC 5....................... 58

mucus rel dm liq 5-100/5 .................. 40 MULTISTIX TES ................................ 45

MULTIVITAMIN CHW ADULT .............. 57 multi-vitamn tab .............................. 57

mupirocin oint 2% ............................ 42 mycophenolate mofetil cap 250 mg .... 55

mycophenolate mofetil for oral susp 200 mg/ml ............................................ 55

mycophenolate mofetil tab 500 mg..... 55 mycophenolate sodium tab dr 360 mg

(mycophenolic acid equiv) ................. 55

MYNATE 90 TAB PLUS ....................... 58 myorisan cap 10mg .......................... 41

myorisan cap 20mg .......................... 41 myorisan cap 30mg .......................... 41

myorisan cap 40mg .......................... 41 N nabumetone tab 500 mg ..................... 4 nabumetone tab 750 mg ..................... 4

nadolol tab 20 mg ............................ 35 nadolol tab 40 mg ............................ 35

nadolol tab 80 mg ............................ 35 naloxone hcl inj 0.4 mg/ml ................ 20

naloxone hcl soln cartridge 0.4 mg/ml 20 naloxone hcl soln prefilled syringe 2

mg/2ml ........................................... 20

naltrexone hcl tab 50 mg .................. 20 naproxen ec tab 375mg ...................... 4

92

naproxen ec tab 500mg ...................... 4

naproxen sod tab 220mg .................... 4 naproxen sodium tab 275 mg .............. 4

naproxen sodium tab 550 mg .............. 4 naproxen susp 125 mg/5ml ................. 4

naproxen tab 250 mg ......................... 4 naproxen tab 375 mg ......................... 4

naproxen tab 500 mg ......................... 4 naratriptan hcl tab 1 mg (base equiv).. 53

naratriptan hcl tab 2.5 mg (base equiv) ...................................................... 53

NARCAN SPR .................................... 20 nat fiber pow 28.3% ......................... 52

nat fiber pow 48.57% ........................ 52 NATACHEW CHW .............................. 58

NATALVIT TAB 75-1MG ...................... 58

NATELLE ONE CAP ............................ 58 naturl fiber pow 58.6% ...................... 52

necon tab 1/50-28 ............................ 38 NECON TAB 10/11-28 ........................ 38

nefazodone hcl tab 100 mg ................ 16 nefazodone hcl tab 150 mg ................ 16

nefazodone hcl tab 200 mg ................ 16 nefazodone hcl tab 250 mg ................ 16

nefazodone hcl tab 50 mg .................. 16 neomycin sulfate tab 500 mg .............. 3

neomycin-bacitracin-polymyxin oint .... 42 neomycin-polymy-gramicid op sol 1.75-

10000-0.025mg-unt-mg/ml ............... 62 neomycin-polymyxin-dexamethasone

ophth oint 0.1% ............................... 62

neomycin-polymyxin-dexamethasone ophth susp 0.1% .............................. 62

neomycin-polymyxin-hc otic soln 1% .. 63 neomycin-polymyxin-hc otic susp 3.5

mg/ml-10000 unit/ml-1% .................. 63 neo-polycin oin op ............................ 62

NEPHROCAPS TAB QT ........................ 56 NERLYNX TAB 40MG .......................... 27

NESTABS ABC MIS ............................ 58 NESTABS DHA PAK ........................... 58

NESTABS ONE CAP ............................ 58 NESTABS TAB ................................... 58

NEULASTA INJ 6MG/0.6M .................. 50 NEUPOGEN INJ 300/0.5 ..................... 50

NEUPOGEN INJ 300MCG .................... 50

NEUPOGEN INJ 480/0.8 ..................... 51 NEUPOGEN INJ 480MCG .................... 51

nevirapine susp 50 mg/5ml ............... 33

nevirapine tab 200 mg ...................... 33 nevirapine tab er 24hr 400 mg........... 33

NEXAVAR TAB 200MG ....................... 27 niacin cap er 500 mg ........................ 70

niacin tab 100 mg ............................ 70 niacin tab 250 mg ............................ 70

niacin tab 500 mg ............................ 70 niacin tab er 1000 mg

(antihyperlipidemic) ......................... 23 niacin tab er 500 mg ........................ 70

nicotine loz 4mg mint ....................... 65 nicotine loz mini 2mg ........................ 65

nicotine polacrilex gum 2 mg ............. 65 nicotine polacrilex gum 4 mg ............. 65

nicotine td patch 24hr 14 mg/24hr ..... 65

nicotine td patch 24hr 21 mg/24hr ..... 65 nicotine td patch 24hr 7 mg/24hr ....... 65

NICOTROL INH ................................ 66 NICOTROL NS SPR 10MG/ML ............. 66

nifedipine cap 10 mg ........................ 36 nifedipine cap 20 mg ........................ 36

nifedipine tab er 24hr 30 mg ............. 36 nifedipine tab er 24hr 60 mg ............. 36

nifedipine tab er 24hr 90 mg ............. 36 nifedipine tab er 24hr osmotic release 30

mg ................................................. 36 nifedipine tab er 24hr osmotic release 60

mg ................................................. 36 nifedipine tab er 24hr osmotic release 90

mg ................................................. 36

nimodipine cap 30 mg ...................... 36 nitrofurantoin macrocrystalline cap 100

mg ................................................. 68 nitrofurantoin macrocrystalline cap 50

mg ................................................. 68 nitrofurantoin monohydrate

macrocrystalline cap 100 mg ............. 68 nitrofurantoin susp 25 mg/5ml ........... 68

nitroglycerin sl tab 0.3 mg................... 9 nitroglycerin sl tab 0.4 mg................... 9

nitroglycerin sl tab 0.6 mg................... 9 nitroglycerin td patch 24hr 0.1 mg/hr ... 9

nitroglycerin td patch 24hr 0.2 mg/hr ... 9 nitroglycerin td patch 24hr 0.4 mg/hr ... 9

nitroglycerin td patch 24hr 0.6 mg/hr ... 9

norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg ................................... 38

93

norethindrone ace & ethinyl estradiol-fe

tab 1 mg-20 mcg .............................. 38 norethindrone acetate tab 5 mg .......... 64

norethindrone tab 0.35 mg ................ 38 norgestimate & ethinyl estradiol tab 0.25

mg-35 mcg ...................................... 38 norgestimate-eth estrad tab 0.18-

25/0.215-25/0.25-25 mg-mcg ............ 38 norgestimate-eth estrad tab 0.18-

35/0.215-35/0.25-35 mg-mcg ............ 38 nortrel tab 1/35 ................................ 38

nortriptyline hcl cap 10 mg ................ 17 nortriptyline hcl cap 25 mg ................ 17

nortriptyline hcl cap 50 mg ................ 17 nortriptyline hcl cap 75 mg ................ 17

NORVIR SOL 80MG/ML ...................... 33

NOVOLIN INJ 70/30 .......................... 19 NOVOLIN N INJ RELION ..................... 19

NOVOLIN N INJ U-100 ....................... 19 NOVOLIN R INJ RELION ..................... 19

NOVOLIN R INJ U-100 ....................... 19 NOVOLIN70/30 INJ RELION ................ 19

NOVOLOG MIX INJ 70/30 ................... 19 np thyroid tab 120mg ........................ 67

np thyroid tab 15mg ......................... 67 np thyroid tab 30mg ......................... 67

np thyroid tab 60mg ......................... 67 NUCALA INJ 100MG ........................... 10

NUEDEXTA CAP 20-10MG ................... 65 NUPLAZID TAB 17MG ........................ 29

NUPREP 5% SOL POV-IODI ................ 32

NUTRIENTS TAB PRENATAL ................ 58 NUTROPIN AQ INJ 10MG/2ML ............. 46

NUTROPIN AQ INJ 20MG/2ML ............. 46 NUTROPIN AQ INJ NUSPIN 5 .............. 47

NUVARING MIS ................................. 38 nystatin cream 100000 unit/gm .......... 42

nystatin oint 100000 unit/gm ............. 42 nystatin susp 100000 unit/ml ............. 56

nystatin tab 500000 unit .................... 21 nystatin topical powder 100000 unit/gm

...................................................... 42 O OB COMPLETE CAP GOLD ................... 58 OB COMPLETE CAP ONE ..................... 58

OB COMPLETE CAP PETITE ................. 58

OB COMPLETE TAB PREMIER .............. 58 OB COMPLETE/ CAP DHA ................... 58

OBSTETRIX PAK DHA ........................ 58

OBTREX TAB .................................... 58 O-CAL TAB PRENATAL ....................... 58

octreotide acetate inj 100 mcg/ml (0.1 mg/ml) ........................................... 47



ODEFSEY TAB .................................. 33 ofloxacin ophth soln 0.3% ................. 62

ofloxacin otic soln 0.3% .................... 63 ogestrel tab ..................................... 38

olanzapine for im inj 10 mg ............... 30 olanzapine orally disintegrating tab 10

mg ................................................. 30

olanzapine orally disintegrating tab 15 mg ................................................. 30

olanzapine orally disintegrating tab 20 mg ................................................. 30

olanzapine orally disintegrating tab 5 mg...................................................... 30

olanzapine tab 10 mg ....................... 30 olanzapine tab 15 mg ....................... 30

olanzapine tab 2.5 mg ...................... 30 olanzapine tab 20 mg ....................... 30

olanzapine tab 5 mg ......................... 30 olanzapine tab 7.5 mg ...................... 30

olmesartan medoxomil tab 20 mg ...... 24 olmesartan medoxomil tab 40 mg ...... 24

olmesartan medoxomil tab 5 mg ........ 24

olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg ... 25

olmesartan medoxomil-hydrochlorothiazide tab 40-12.5 mg ... 25

olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg ...... 25

olmesartan-amlodipine-hydrochlorothiazide tab 20-5-12.5 mg 25


...................................................... 26 olmesartan-amlodipine-

hydrochlorothiazide tab 40-10-25 mg . 26 olmesartan-amlodipine-

hydrochlorothiazide tab 40-5-12.5 mg 25

olmesartan-amlodipine-hydrochlorothiazide tab 40-5-25 mg ... 25

94

olopatadine hcl ophth soln 0.1% (base

equivalent) ...................................... 62 omega 3 500 cap 500mg ................... 61

omega essent liq basic ...................... 61 omega-3 fatty acids cap 1000 mg ....... 61

omega-3 fatty acids cap 1200 mg ....... 61 omega-3 fatty acids cap 300 mg ......... 61

omega-3 fatty acids cap 600 mg ......... 61 omega-3 fatty acids cap delayed release

1200 mg .......................................... 61 OMEPRAZOLE + SUS SYRSPEND ......... 67

omeprazole cap delayed release 10 mg67 omeprazole cap delayed release 20 mg67

omeprazole cap delayed release 40 mg67 ondansetron hcl oral soln 4 mg/5ml .... 20

ondansetron hcl tab 24 mg ................ 20

ondansetron hcl tab 4 mg .................. 20 ondansetron hcl tab 8 mg .................. 20

ondansetron orally disintegrating tab 4 mg .................................................. 20

ondansetron orally disintegrating tab 8 mg .................................................. 20

ONE A DAY CAP PRENATAL ................. 58 ONE A DAY MIS PRENATAL ................. 58

ORKAMBI TAB 100-125 ..................... 66 ORKAMBI TAB 200-125 ..................... 66

oseltamivir phosphate cap 30 mg (base equiv) ............................................. 34

oseltamivir phosphate cap 45 mg (base equiv) ............................................. 34

oseltamivir phosphate cap 75 mg (base

equiv) ............................................. 34 oseltamivir phosphate for susp 6 mg/ml

(base equiv) ..................................... 34 oxandrolone tab 2.5 mg ...................... 7

oxazepam cap 10 mg ........................ 10 oxazepam cap 15 mg ........................ 10

oxazepam cap 30 mg ........................ 10 oxcarbazepine susp 300 mg/5ml (60

mg/ml) ............................................ 14 oxcarbazepine tab 150 mg ................. 14

oxcarbazepine tab 300 mg ................. 14 oxcarbazepine tab 600 mg ................. 14

oxybutynin chloride syrup 5 mg/5ml ... 68 oxybutynin chloride tab 5 mg ............. 68

oxybutynin chloride tab er 24hr 10 mg 68

oxybutynin chloride tab er 24hr 15 mg 68 oxybutynin chloride tab er 24hr 5 mg .. 68

oxycodone hcl cap 5 mg ...................... 6

oxycodone hcl conc 100 mg/5ml (20 mg/ml) ............................................. 6

oxycodone hcl tab 10 mg .................... 6 oxycodone hcl tab 15 mg .................... 6

oxycodone hcl tab 20 mg .................... 6 oxycodone hcl tab 30 mg .................... 6

oxycodone hcl tab 5 mg ...................... 6 oxycodone w/ acetaminophen tab 10-325

mg ................................................... 6 oxycodone w/ acetaminophen tab 5-325

mg ................................................... 6 oxycodone w/ acetaminophen tab 7.5-

325 mg ............................................. 6 oxycodone-aspirin tab 4.8355-325 mg .. 6

oxycodone-ibuprofen tab 5-400 mg ...... 6

oyster shell calcium tab 500 mg ......... 54 P pain relieve cre rub .......................... 44 pain/fever sup 120mg ......................... 5

paliperidone tab er 24hr 1.5 mg ......... 29 paliperidone tab er 24hr 3 mg............ 30

paliperidone tab er 24hr 6 mg............ 30 paliperidone tab er 24hr 9 mg............ 30

panoxyl wash liq 4%......................... 41 pantoprazole sodium ec tab 20 mg (base

equiv) ............................................. 67 pantoprazole sodium ec tab 40 mg (base

equiv) ............................................. 68 paromomycin sulfate cap 250 mg ......... 3

paroxetine hcl tab 10 mg .................. 16

paroxetine hcl tab 20 mg .................. 16 paroxetine hcl tab 30 mg .................. 16

paroxetine hcl tab 40 mg .................. 16 PEDIA-LAX LIQ 50MG ....................... 52

pediatric multiple vitamins w/ iron chew tab 15 mg ....................................... 57

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm ............................... 52

peg 3350-kcl-sod bicarb-nacl for soln 420 gm ........................................... 52

penicillin v potassium for soln 125 mg/5ml ........................................... 63

penicillin v potassium for soln 250 mg/5ml ........................................... 63

penicillin v potassium tab 250 mg ...... 63

penicillin v potassium tab 500 mg ...... 63 PENTASA CAP 250MG CR .................. 48

95

PENTASA CAP 500MG CR ................... 48

pentazocine w/ naloxone tab 50-0.5 mg 7 pentoxifylline tab er 400 mg ............... 50

permethrin cream 5% ....................... 45 perphenazine tab 16 mg .................... 31

perphenazine tab 2 mg ...................... 31 perphenazine tab 4 mg ...................... 31

perphenazine tab 8 mg ...................... 31 PERRY PRENAT CAP ........................... 58

PETROLATUM OIN WHITE................... 64 phendimetrazine tartrate tab 35 mg ..... 1

phenobarbital elixir 20 mg/5ml ........... 51 phenobarbital tab 100 mg .................. 51

phenobarbital tab 15 mg .................... 51 phenobarbital tab 16.2 mg ................. 51

phenobarbital tab 30 mg .................... 51

phenobarbital tab 32.4 mg ................. 51 phenobarbital tab 60 mg .................... 51

phenobarbital tab 64.8 mg ................. 51 phenobarbital tab 97.2 mg ................. 51

phentermine hcl cap 15 mg ................. 1 phentermine hcl cap 30 mg ................. 1

phentermine hcl cap 37.5 mg .............. 1 phentermine hcl tab 37.5 mg .............. 1

phenytoin chew tab 50 mg ................. 14 phenytoin sodium extended cap 100 mg

...................................................... 14 phenytoin susp 125 mg/5ml ............... 15

pilocarpine hcl ophth soln 1% ............. 61 pilocarpine hcl ophth soln 4% ............. 62

pilocarpine hcl tab 5 mg .................... 56

pimozide tab 1 mg ............................ 65 pimozide tab 2 mg ............................ 65

pinworm med sus 144mg/ml ............... 8 pioglitazone hcl tab 15 mg (base equiv)

...................................................... 19 pioglitazone hcl tab 30 mg (base equiv)

...................................................... 19 pioglitazone hcl tab 45 mg (base equiv)

...................................................... 19 PNV OB+DHA PAK ............................. 58

PNV-OMEGA CAP .............................. 58 POCKET PEAK MIS METER .................. 53

podofilox soln 0.5% .......................... 44 polymyxin b-trimethoprim ophth soln

10000 unit/ml-0.1% ......................... 62

polyvitamin dro ................................ 57 polyvitamin dro /iron ......................... 57

potassium chloride microencapsulated

crys er tab 10 meq ........................... 55 potassium chloride microencapsulated

crys er tab 20 meq ........................... 55 potassium chloride oral soln 10% (20

meq/15ml) ...................................... 55 potassium chloride oral soln 20% (40

meq/15ml) ...................................... 55 potassium chloride tab er 10 meq ...... 55

potassium chloride tab er 8 meq (600 mg) ................................................ 55

potassium citrate & citric acid soln 1100-334 mg/5ml .................................... 49

potassium citrate tab er 10 meq (1080 mg) ................................................ 49


...................................................... 49 povidone-iod sol 7.5% ...................... 32

povidone-iodine oint 10% ................. 32 povidone-iodine soln 10% ................. 32

PR NATAL 400 PAK ........................... 58 PR NATAL 400 PAK EC ...................... 58

PR NATAL 430 PAK ........................... 58 PR NATAL 430 PAK EC ...................... 58

PRADAXA CAP 110MG ....................... 13 PRADAXA CAP 150MG ....................... 13

PRADAXA CAP 75MG ......................... 13 pramipexole dihydrochloride tab 0.125

mg ................................................. 29 pramipexole dihydrochloride tab 0.25 mg

...................................................... 29

pramipexole dihydrochloride tab 0.5 mg...................................................... 29

pramipexole dihydrochloride tab 0.75 mg...................................................... 29

pramipexole dihydrochloride tab 1 mg 29 pramipexole dihydrochloride tab 1.5 mg

...................................................... 29 pravastatin sodium tab 10 mg ........... 22

pravastatin sodium tab 20 mg ........... 22 pravastatin sodium tab 40 mg ........... 22

pravastatin sodium tab 80 mg ........... 22 prazosin hcl cap 1 mg ....................... 24

prazosin hcl cap 2 mg ....................... 24 prazosin hcl cap 5 mg ....................... 24

PRED SOD PHO SOL 1% OP ............... 62

prednisolone acetate ophth susp 1% .. 62 prednisolone sod phosphate oral soln 15

96

mg/5ml (base equiv) ......................... 39

prednisolone syrup 15 mg/5ml (usp solution equivalent)........................... 39

PREDNISONE CON 5MG/ML ................ 39 prednisone oral soln 5 mg/5ml ........... 39

prednisone tab 1 mg ......................... 39 prednisone tab 10 mg ....................... 39

prednisone tab 2.5 mg ...................... 39 prednisone tab 20 mg ....................... 39

prednisone tab 5 mg ......................... 39 prednisone tab 50 mg ....................... 39

prednisone tab therapy pack 10 mg (21) ...................................................... 39

prednisone tab therapy pack 5 mg (21) ...................................................... 39

PREMARIN TAB 0.3MG ....................... 48

PREMARIN TAB 0.45MG ..................... 48 PREMARIN TAB 0.625MG ................... 48

PREMARIN TAB 0.9MG ....................... 48 PREMARIN TAB 1.25MG ..................... 48

PREMPHASE TAB ............................... 47 PREMPRO TAB .625-2.5 ..................... 47

PREMPRO TAB 0.3-1.5 ....................... 47 PREMPRO TAB 0.45-1.5 ..................... 47

PREMPRO TAB 0.625-5 ...................... 47 PRENA 1 TRUE MIS ........................... 58

PRENATA CHW 29-1MG ..................... 58 prenatal 19 chw tab .......................... 58

PRENATAL 19 TAB 29-1MG ................. 58 PRENATAL CAP FORMULA ................... 58

PRENATAL CAP OMEGA-3 ................... 58

PRENATAL DHA PAK 27-1-250 ............ 58 PRENATAL DHA PAK MULTI ................ 58

PRENATAL FRM TAB A-FREE ............... 58 PRENATAL MIS COMPLEAT ................. 59

PRENATAL MUL CAP +DHA ................. 59 PRENATAL MUL CAP DHA ................... 59

PRENATAL MV MIS + DHA .................. 59 PRENATAL PLS MIS MV + DHA ............ 59

PRENATAL TAB ................................. 59 PRENATAL TAB 27-1MG ..................... 59

PRENATAL TAB 28-0.8MG .................. 59 PRENATAL TAB COMPLETE ................. 59

PRENATAL TAB FORMULA ................... 59 PRENATAL+DHA MIS ......................... 59

PRENATAL+FE TAB 29-1MG ................ 59

PRENATAL-U CAP 106.5-1 .................. 59 PRENATE CAP ENHANCE .................... 59

PRENATE CAP PIXIE .......................... 59

PRENATE CAP RESTORE .................... 59 PRENATE DHA CAP ........................... 59

PRENATE MINI CAP .......................... 59 PRENATE TAB ELITE ......................... 59

PRENATL MULT CAP + DHA ............... 59 PRETAB TAB 29-1MG ........................ 59

prevident sol 0.2% ........................... 56 PREZCOBIX TAB 800-150 .................. 33

PREZISTA SUS 100MG/ML ................. 33 PREZISTA TAB 150MG ...................... 33

PREZISTA TAB 600MG ...................... 33 PREZISTA TAB 75MG ........................ 33

PREZISTA TAB 800MG ...................... 33 PRIMACARE CAP .............................. 59

primidone tab 250 mg ...................... 14

primidone tab 50 mg ........................ 14 probenecid tab 500 mg ..................... 50

prochlorperazine maleate tab 10 mg (base equivalent) ............................. 31

prochlorperazine maleate tab 5 mg (base equivalent) ...................................... 31

prochlorperazine suppos 25 mg.......... 31 progesterone micronized cap 100 mg . 64

progesterone micronized cap 200 mg . 64 PROLIA SOL 60MG/ML ...................... 46

prometh vc syp 6.25-5/5 .................. 40 promethazine hcl suppos 12.5 mg ...... 21

promethazine hcl suppos 25 mg ......... 21 promethazine hcl syrup 6.25 mg/5ml.. 22

promethazine hcl tab 12.5 mg ........... 22

promethazine hcl tab 25 mg .............. 22 promethazine hcl tab 50 mg .............. 22

promethazine w/ codeine syrup 6.25-10 mg/5ml ........................................... 40

promethazine-dm syrup 6.25-15 mg/5ml...................................................... 40

promethazine-phenylephrine-codeine syrup 6.25-5-10 mg/5ml ................... 40

propafenone hcl tab 150 mg .............. 10 propantheline bromide tab 15 mg ...... 67

propranolol & hydrochlorothiazide tab 40-25 mg ........................................ 26

propranolol & hydrochlorothiazide tab 80-25 mg ........................................ 26

propranolol hcl cap er 24hr 120 mg .... 35

propranolol hcl cap er 24hr 160 mg .... 35 propranolol hcl cap er 24hr 60 mg ...... 35

97

propranolol hcl cap er 24hr 80 mg ...... 35

propranolol hcl oral soln 20 mg/5ml .... 35 propranolol hcl oral soln 40 mg/5ml .... 35

propranolol hcl tab 10 mg .................. 35 propranolol hcl tab 20 mg .................. 35

propranolol hcl tab 40 mg .................. 35 propranolol hcl tab 60 mg .................. 35

propranolol hcl tab 80 mg .................. 35 propylthiouracil tab 50 mg ................. 66

PROVIDA DHA CAP ............................ 59 PROVIDA OB CAP .............................. 59

pseudoephed-bromphen-dm syrup 30-2-10 mg/5ml ....................................... 40

pseudoephedrine hcl tab 30 mg .......... 60 pseudoephedrine hcl tab 60 mg .......... 60

PULMICORT INH 180MCG ................... 11

PULMICORT INH 90MCG .................... 11 PULMOZYME SOL 1MG/ML .................. 66

PUREFE OB CAP PLUS ........................ 59 pyrazinamide tab 500 mg .................. 26

pyridostigmine bromide tab 60 mg ...... 26 Q QSYMIA CAP 11.25-69 ........................ 1 QSYMIA CAP 15-92MG ........................ 1

QSYMIA CAP 3.75-23 ......................... 1 QSYMIA CAP 7.5-46MG ....................... 1

quetiapine fumarate tab 100 mg ......... 31 quetiapine fumarate tab 200 mg ......... 31

quetiapine fumarate tab 25 mg ........... 30 quetiapine fumarate tab 300 mg ......... 31

quetiapine fumarate tab 400 mg ......... 31

quetiapine fumarate tab 50 mg ........... 31 quetiapine fumarate tab er 24hr 150 mg

...................................................... 31 quetiapine fumarate tab er 24hr 200 mg




...................................................... 31 quinapril hcl tab 10 mg ...................... 23

quinapril hcl tab 20 mg ...................... 23 quinapril hcl tab 40 mg ...................... 23

quinapril hcl tab 5 mg........................ 23

quinapril-hydrochlorothiazide tab 10-12.5 mg .................................................. 26

quinapril-hydrochlorothiazide tab 20-12.5

mg ................................................. 26 quinapril-hydrochlorothiazide tab 20-25

mg ................................................. 26 QVAR AER 40MCG ............................ 11

QVAR AER 80MCG ............................ 11 QVAR REDIHA AER 80MCG ................ 11

QVAR REDIHAL AER 40MCG ............... 11 R rabeprazole sodium ec tab 20 mg ....... 68 raloxifene hcl tab 60 mg ................... 47

ramipril cap 1.25 mg ........................ 23 ramipril cap 10 mg ........................... 23

ramipril cap 2.5 mg .......................... 23 ramipril cap 5 mg ............................. 23

ranitidine hcl syrup 15 mg/ml (75

mg/5ml) ......................................... 67 ranitidine hcl tab 150 mg .................. 67

ranitidine hcl tab 300 mg .................. 67 ranitidine hcl tab 75 mg .................... 67

RAPAMUNE SOL 1MG/ML ................... 55 RELENZA MIS DISKHALE ................... 34

RELISTOR INJ 12/0.6ML .................... 49 RELISTOR INJ 8/0.4ML ..................... 49

RELISTOR TAB 150MG ...................... 49 RENAGEL TAB 400MG ....................... 49

RENFLEXIS INJ 100MG ...................... 48 REPATHA INJ 140MG/ML ................... 23

REPATHA PUSH INJ 420/3.5 .............. 23 REPATHA SURE INJ 140MG/ML ........... 23

RESCRIPTOR TAB 100 MG ................. 33

RESCRIPTOR TAB 200MG .................. 33 RESOURCE POW THICKENU ............... 64

RESTASIS EMU 0.05% ...................... 62 ribavirin cap 200 mg ......................... 34

ribavirin tab 200 mg ......................... 34 rifampin cap 150 mg ........................ 26

rifampin cap 300 mg ........................ 26 riluzole tab 50 mg ............................ 61

rimantadine hydrochloride tab 100 mg 34 RISAMINE OIN ................................. 45

RISPERDAL INJ 12.5MG .................... 30 RISPERDAL INJ 25MG ....................... 30

RISPERDAL INJ 37.5MG .................... 30 RISPERDAL INJ 50MG ....................... 30

risperidone soln 1 mg/ml .................. 30

risperidone tab 0.25 mg .................... 30 risperidone tab 0.5 mg ...................... 30

98

risperidone tab 1 mg ......................... 30

risperidone tab 2 mg ......................... 30 risperidone tab 3 mg ......................... 30

risperidone tab 4 mg ......................... 30 ritonavir tab 100 mg ......................... 33

rivastigmine tartrate cap 1.5 mg (base equivalent) ...................................... 65

rivastigmine tartrate cap 3 mg (base equivalent) ...................................... 65

rivastigmine tartrate cap 4.5 mg (base equivalent) ...................................... 65

rivastigmine tartrate cap 6 mg (base equivalent) ...................................... 65

rizatriptan benzoate oral disintegrating tab 10 mg (base eq) ......................... 53

rizatriptan benzoate oral disintegrating

tab 5 mg (base eq) ........................... 53 rizatriptan benzoate tab 10 mg (base

equivalent) ...................................... 53 rizatriptan benzoate tab 5 mg (base

equivalent) ...................................... 53 ropinirole hydrochloride tab 0.25 mg ... 29

ropinirole hydrochloride tab 0.5 mg ..... 29 ropinirole hydrochloride tab 1 mg ....... 29

ropinirole hydrochloride tab 2 mg ....... 29 ropinirole hydrochloride tab 3 mg ....... 29

ropinirole hydrochloride tab 4 mg ....... 29 ropinirole hydrochloride tab 5 mg ....... 29

rosuvastatin calcium tab 10 mg .......... 22 rosuvastatin calcium tab 20 mg .......... 22

rosuvastatin calcium tab 40 mg .......... 22

rosuvastatin calcium tab 5 mg ............ 22 S SANTYL OIN 250/GM ......................... 44 SAXENDA INJ 18MG/3ML .................... 1

SELECT-OB CHW .............................. 59 SELECT-OB+ PAK DHA ...................... 59

selegiline hcl tab 5 mg ....................... 29 selenium sulfide lotion 2.5% .............. 42

SELENIUM TAB 200MCG .................... 55 SELZENTRY TAB 150MG ..................... 33

SELZENTRY TAB 25MG ...................... 33 SELZENTRY TAB 300MG ..................... 33

SELZENTRY TAB 75MG ...................... 33 sennosides syrup 8.8 mg/5ml ............. 52

sennosides tab 8.6 mg ...................... 52

SEREVENT DIS AER 50MCG ................ 12 sertraline hcl oral concentrate for

solution 20 mg/ml ............................ 16

sertraline hcl tab 100 mg .................. 16 sertraline hcl tab 25 mg .................... 16

sertraline hcl tab 50 mg .................... 16 sevelamer carbonate packet 0.8 gm ... 49

sevelamer carbonate packet 2.4 gm ... 49 sevelamer carbonate tab 800 mg ....... 49

SHINGRIX INJ 50MCG ....................... 69 SHUR-SEAL GEL 2% ......................... 69

sildenafil citrate tab 20 mg ................ 37 silver sulfadiazine cream 1% ............. 42

simethicone chew tab 80 mg ............. 48 simethicone susp 40 mg/0.6ml .......... 48

SIMPLYTHICK GEL ............................ 64 simvastatin tab 10 mg ...................... 22

simvastatin tab 20 mg ...................... 22

simvastatin tab 40 mg ...................... 22 simvastatin tab 5 mg ........................ 22

sinus congst tab /pain dt ................... 40 sinus nasal spr 0.05% ...................... 61

sirolimus tab 0.5 mg ......................... 55 sirolimus tab 1 mg ........................... 55

sirolimus tab 2 mg ........................... 55 sleep aid tab 25mg ........................... 51

sodium bicarbonate tab 650 mg ........... 8 sodium chloride hypertonic ophth soln

5% ................................................. 62 sodium chloride soln nebu 0.9% ........ 40

sodium chloride soln nebu 3% ........... 40 sodium chloride soln nebu 7% ........... 40

sodium citrate & citric acid soln 500-334

mg/5ml ........................................... 49 sodium fluoride chew tab 0.25 mg f

(from 0.55 mg naf) .......................... 54 sodium fluoride chew tab 0.5 mg f (from

1.1 mg naf) ..................................... 54 sodium fluoride chew tab 1 mg f (from

2.2 mg naf) ..................................... 54 sodium fluoride soln 0.5 mg/ml f (from

1.1 mg/ml naf) ................................ 55 soothng bath pow treatmnt ............... 44

sotalol hcl tab 120 mg ...................... 35 sotalol hcl tab 160 mg ...................... 35

sotalol hcl tab 80 mg ........................ 35 spinosad susp 0.9% ......................... 45

SPIRIVA AER 1.25MCG ...................... 10

SPIRIVA CAP HANDIHLR ................... 10 SPIRIVA SPR 2.5MCG ....................... 10

99

spironolactone & hydrochlorothiazide tab

25-25 mg ........................................ 45 spironolactone tab 100 mg ................. 46

spironolactone tab 25 mg .................. 46 spironolactone tab 50 mg .................. 46

SPRYCEL TAB 50MG .......................... 27 stavudine cap 15 mg ......................... 33

stavudine cap 20 mg ......................... 33 stavudine cap 30 mg ......................... 33

stavudine cap 40 mg ......................... 33 STELARA INJ 45MG/0.5 ..................... 42

STELARA INJ 90MG/ML ...................... 42 STIOLTO AER 2.5-2.5 ........................ 12

STIVARGA TAB 40MG ........................ 27 stomach rlf chw 400mg ...................... 8

STRENSIQ INJ 18/0.45 ...................... 47

STRENSIQ INJ 80/0.8ML .................... 47 STRIBILD TAB .................................. 33

STRIVERDI AER 2.5MCG .................... 12 STUART ONE CAP.............................. 59

SUBOXONE MIS 12-3MG ..................... 7 SUBOXONE MIS 2-0.5MG .................... 7

SUBOXONE MIS 4-1MG ....................... 7 SUBOXONE MIS 8-2MG ....................... 7

sucralfate tab 1 gm ........................... 67 sulfacetamide sodium ophth soln 10% . 62

sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)% ................ 62

SULFADIAZINE TAB 500MG ................ 66 sulfamethoxazole-trimethoprim susp

200-40 mg/5ml ................................. 8

sulfamethoxazole-trimethoprim tab 400-80 mg .............................................. 8

sulfamethoxazole-trimethoprim tab 800-160 mg ............................................ 8

sulfasalazine tab delayed release 500 mg ...................................................... 49

sulfazine tab 500mg .......................... 49 sulindac tab 150 mg ........................... 4

sulindac tab 200 mg ........................... 4 sumatriptan nasal spray 20 mg/act ..... 53

sumatriptan nasal spray 5 mg/act ....... 53 sumatriptan succinate inj 6 mg/0.5ml . 53

sumatriptan succinate solution auto-injector 4 mg/0.5ml .......................... 53

sumatriptan succinate solution auto-

injector 6 mg/0.5ml .......................... 53 sumatriptan succinate solution cartridge

4 mg/0.5ml ..................................... 54

sumatriptan succinate solution cartridge 6 mg/0.5ml ..................................... 54

sumatriptan succinate tab 100 mg ..... 54 sumatriptan succinate tab 25 mg ....... 54

sumatriptan succinate tab 50 mg ....... 54 SUTENT CAP 12.5MG ........................ 27

SUTENT CAP 25MG ........................... 28 SUTENT CAP 50MG ........................... 28

SYMBICORT AER 160-4.5 .................. 12 SYMBICORT AER 80-4.5 .................... 12

SYNAGIS INJ 100MG/ML ................... 63 SYNAGIS INJ 50MG .......................... 63

T TABLOID TAB 40MG ......................... 27

tacrolimus cap 0.5 mg ...................... 55

tacrolimus cap 1 mg ......................... 55 tacrolimus cap 5 mg ......................... 55

tacrolimus oint 0.03% ...................... 44 tacrolimus oint 0.1% ........................ 44

tadalafil tab 20 mg (pah) .................. 37 tamoxifen citrate tab 10 mg (base

equivalent) ...................................... 27 tamoxifen citrate tab 20 mg (base

equivalent) ...................................... 27 tamsulosin hcl cap 0.4 mg ................. 49

TARCEVA TAB 100MG ....................... 28 TARCEVA TAB 150MG ....................... 28

TARCEVA TAB 25MG ......................... 28 TARON-BC MIS ................................ 59

TARON-PREX CAP ............................. 59

TECFIDERA CAP 120MG .................... 65 TECFIDERA CAP 240MG .................... 65

TECFIDERA MIS STARTER ................. 65 telmisartan tab 20 mg ...................... 24

telmisartan tab 40 mg ...................... 24 telmisartan tab 80 mg ...................... 24

temazepam cap 15 mg ..................... 51 temazepam cap 30 mg ..................... 51

temozolomide cap 100 mg ................ 26 temozolomide cap 140 mg ................ 26

temozolomide cap 180 mg ................ 26 temozolomide cap 20 mg .................. 26

temozolomide cap 250 mg ................ 26 temozolomide cap 5 mg .................... 26

tenofovir disoproxil fumarate tab 300 mg

...................................................... 33 terazosin hcl cap 1 mg (base equivalent)

100

...................................................... 24

terazosin hcl cap 10 mg (base equivalent) ...................................... 24

terazosin hcl cap 2 mg (base equivalent) ...................................................... 24

terazosin hcl cap 5 mg (base equivalent) ...................................................... 24

terbinafine hcl tab 250 mg ................. 21 terbutaline sulfate tab 2.5 mg ............ 12

terbutaline sulfate tab 5 mg ............... 12 terconazole vaginal cream 0.4% ......... 69

terconazole vaginal cream 0.8% ......... 69 terconazole vaginal suppos 80 mg ...... 69

testosterone cypionate im inj in oil 100 mg/ml .............................................. 7

testosterone cypionate im inj in oil 200

mg/ml .............................................. 7 testosterone enanthate im inj in oil 200

mg/ml .............................................. 7 testosterone td gel 12.5 mg/act (1%) .. 7

testosterone td gel 50 mg/5gm (1%) ... 7 tetrabenazine tab 12.5 mg ................. 65

tetrabenazine tab 25 mg .................... 65 theophylline tab er 12hr 100 mg ......... 12

theophylline tab er 12hr 200 mg ......... 12 theophylline tab er 12hr 300 mg ......... 12

theophylline tab er 12hr 450 mg ......... 12 theophylline tab er 24hr 400 mg ......... 12

theophylline tab er 24hr 600 mg ......... 12 THERANATAL CAP ONE ...................... 59

THERANATAL MIS COMPLETE ............. 59

THERANATAL PAK OVAVITE ................ 59 THERAPEUTIC CRE MOISTUR .............. 44

THICKENUP POW CLEAR .................... 64 THICK-IT POW ORIGINAL................... 64

thioridazine hcl tab 100 mg ................ 31 thioridazine hcl tab 25 mg .................. 31

thioridazine hcl tab 50 mg .................. 31 thiothixene cap 10 mg ....................... 31

thiothixene cap 5 mg ......................... 31 timolol maleate ophth gel forming soln

0.25% ............................................. 61 timolol maleate ophth gel forming soln

0.5% ............................................... 61 timolol maleate ophth soln 0.25% ....... 61

timolol maleate ophth soln 0.5% ........ 61

TIVICAY TAB 50MG ........................... 33 tizanidine hcl tab 2 mg (base equivalent)

...................................................... 60

tizanidine hcl tab 4 mg (base equivalent)...................................................... 60

TL FOLATE TAB ................................ 59 TL-CARE DHA CAP 27-1-500 .............. 59

TL-SELECT CAP ................................ 59 tobramycin nebu soln 300 mg/5ml ....... 3

tobramycin ophth soln 0.3% .............. 62 TODAY SPONGE MIS ......................... 69

tolterodine tartrate cap er 24hr 2 mg .. 68 tolterodine tartrate cap er 24hr 4 mg .. 68

tolterodine tartrate tab 1 mg ............. 68 tolterodine tartrate tab 2 mg ............. 68

topiramate sprinkle cap 15 mg ........... 14 topiramate sprinkle cap 25 mg ........... 14

topiramate tab 100 mg ..................... 14

topiramate tab 200 mg ..................... 14 topiramate tab 25 mg ....................... 14

topiramate tab 50 mg ....................... 14 torsemide tab 10 mg ........................ 46

torsemide tab 100 mg ...................... 46 torsemide tab 20 mg ........................ 46

torsemide tab 5 mg .......................... 46 TRADJENTA TAB 5MG ....................... 18

tramadol hcl tab 50 mg ....................... 6 tramadol hcl tab er 24hr 100 mg .......... 6

tramadol hcl tab er 24hr 200 mg .......... 6 tramadol hcl tab er 24hr 300 mg .......... 6

tramadol hcl tab er 24hr biphasic release 100 mg ............................................. 6

tramadol hcl tab er 24hr biphasic release

200 mg ............................................. 6 tramadol hcl tab er 24hr biphasic release

300 mg ............................................. 6 tramadol-acetaminophen tab 37.5-325

mg ................................................... 6 trandolapril tab 1 mg ........................ 23

trandolapril tab 2 mg ........................ 23 trandolapril tab 4 mg ........................ 23

tranexamic acid tab 650 mg .............. 51 trazodone hcl tab 100 mg ................. 16

trazodone hcl tab 150 mg ................. 16 trazodone hcl tab 50 mg ................... 16

tretinoin cap 10 mg .......................... 28 tretinoin cream 0.025% .................... 41

tretinoin cream 0.05% ...................... 41

tretinoin cream 0.1% ........................ 41 tretinoin gel 0.01% .......................... 41

101

tretinoin gel 0.025% ......................... 41

triamcinolone acetonide cream 0.025% ...................................................... 43

triamcinolone acetonide cream 0.1% ... 43 triamcinolone acetonide cream 0.5% ... 43

triamcinolone acetonide dental paste 0.1% ............................................... 56

triamcinolone acetonide lotion 0.025% 43 triamcinolone acetonide lotion 0.1% .... 43

triamcinolone acetonide nasal aerosol suspension 55 mcg/act ...................... 60

triamcinolone acetonide oint 0.025%... 43 triamcinolone acetonide oint 0.1% ...... 43

triamcinolone acetonide oint 0.5% ...... 43 triamterene & hydrochlorothiazide cap

37.5-25 mg ...................................... 45

triamterene & hydrochlorothiazide tab 37.5-25 mg ...................................... 46

triamterene & hydrochlorothiazide tab 75-50 mg ........................................ 46

TRICARE CHW PRENATAL ................... 59 trifluoperazine hcl tab 1 mg (base

equivalent) ...................................... 31 trifluoperazine hcl tab 10 mg (base



equivalent) ...................................... 31 trifluridine ophth soln 1% .................. 62

trihexyphenidyl hcl elixir 0.4 mg/ml .... 28

trihexyphenidyl hcl tab 2 mg .............. 28 trihexyphenidyl hcl tab 5 mg .............. 28

trimethobenzamide hcl cap 300 mg ..... 20 trimethoprim tab 100 mg .................... 8

TRINATAL GT TAB ............................. 59 TRINATAL RX TAB 1 .......................... 59

trinate tab ....................................... 59 triple antib oin plus ........................... 42

TRISTART DHA CAP ........................... 59 TRISTART ONE CAP 35-1-215 ............. 59

TRIUMEQ TAB ................................... 33 tri-vit/fe dro /fl 0.25 .......................... 57

tri-vit/fl dro 0.25mg .......................... 57 TRI-VITAMIN DRO ............................. 57

tropicamide ophth soln 1% ................ 61

trospium chloride tab 20 mg .............. 68 TRULICITY INJ 0.75/0.5 ..................... 19

TRULICITY INJ 1.5/0.5 ...................... 19

TRUVADA TAB.................................. 33 TRUVADA TAB 100-150 ..................... 33

TRUVADA TAB 133-200 ..................... 33 TRUVADA TAB 167-250 ..................... 33

tussin dm liq .................................... 40 tussin dm liq max ............................. 40

TYKERB TAB 250MG ......................... 28 U UCERIS AER 2MG/ACT ........................ 7 ultra throat loz cherry ....................... 56

URINE GLUCOSE MONITORING SUPPLIES...................................................... 53

URINE TEST STRIPS ......................... 45 ursodiol cap 300 mg ......................... 48

ursodiol tab 250 mg ......................... 48

ursodiol tab 500 mg ......................... 48 V valacyclovir hcl tab 1 gm ................... 34 valacyclovir hcl tab 500 mg ............... 34

valganciclovir hcl for soln 50 mg/ml (base equiv) .................................... 34

valganciclovir hcl tab 450 mg (base equivalent) ...................................... 34

valproate sodium oral soln 250 mg/5ml (base equiv) .................................... 15

valproic acid cap 250 mg ................... 15 valsartan tab 160 mg ....................... 24

valsartan tab 320 mg ....................... 24 valsartan tab 40 mg ......................... 24

valsartan tab 80 mg ......................... 24

valsartan-hydrochlorothiazide tab 160-12.5 mg .......................................... 26

valsartan-hydrochlorothiazide tab 160-25 mg ................................................. 26


valsartan-hydrochlorothiazide tab 320-25 mg ................................................. 26


vancomycin hcl cap 125 mg (base equivalent) ........................................ 8

vancomycin hcl cap 250 mg (base equivalent) ........................................ 8

vcf vaginal gel contrace .................... 69

VCF VAGINAL MIS CONTRACP ............ 69 velivet pak ...................................... 38

102

VELTASSA POW 16.8GM .................... 56

VELTASSA POW 25.2GM .................... 56 VELTASSA POW 8.4GM ...................... 56

venlafaxine hcl cap er 24hr 150 mg (base equivalent) .............................. 16

venlafaxine hcl cap er 24hr 37.5 mg (base equivalent) .............................. 16

venlafaxine hcl cap er 24hr 75 mg (base equivalent) ...................................... 16

venlafaxine hcl tab 100 mg ................ 16 venlafaxine hcl tab 25 mg .................. 16

venlafaxine hcl tab 37.5 mg ............... 16 venlafaxine hcl tab 50 mg .................. 16

venlafaxine hcl tab 75 mg .................. 16 VENTOLIN HFA AER ........................... 12

verapamil hcl cap er 24hr 120 mg ....... 36

verapamil hcl cap er 24hr 180 mg ....... 36 verapamil hcl cap er 24hr 200 mg ....... 36

verapamil hcl cap er 24hr 240 mg ....... 36 verapamil hcl cap er 24hr 300 mg ....... 36

verapamil hcl cap er 24hr 360 mg ....... 36 verapamil hcl tab 120 mg .................. 36

verapamil hcl tab 40 mg .................... 36 verapamil hcl tab 80 mg .................... 36

verapamil hcl tab er 120 mg .............. 36 verapamil hcl tab er 180 mg .............. 36

verapamil hcl tab er 240 mg .............. 36 VERZENIO TAB 100MG ...................... 28

VERZENIO TAB 150MG ...................... 28 VERZENIO TAB 200MG ...................... 28

VERZENIO TAB 50MG ........................ 28

VICTOZA INJ 18MG/3ML .................... 19 VIDEX EC CAP 125MG ....................... 33

VIDEX SOL 4GM ............................... 33 VIMPAT SOL 10MG/ML ....................... 14

VIMPAT TAB 100MG .......................... 14 VIMPAT TAB 150MG .......................... 14

VIMPAT TAB 200MG .......................... 14 VIMPAT TAB 50MG ............................ 14

VINATE DHA CAP 27-1.13 .................. 59 VINATE II TAB .................................. 59

VINATE M TAB .................................. 59 VIRACEPT TAB 250MG ....................... 33

VIRACEPT TAB 625MG ....................... 33 VIRT-PN TAB .................................... 60

VIT A FISH CAP 7500UNIT ................. 69

VITAFOL CAP ULTRA .......................... 60 VITAFOL CHW GUMMIES .................... 60

VITAFOL FE+ CAP ............................ 60

VITAFOL-NANO TAB.......................... 60 VITAFOL-OB PAK +DHA .................... 60

VITAFOL-ONE CAP ............................ 60 vitamax ped dro ............................... 57

VITAMEDMD CAP ONE RX .................. 60 vitamin a cap 10000 unit................... 69

VITAMIN A CAP 25000UNT ................ 69 vitamin a cap 8000 unit .................... 69

vitamin b-1 tab 100mg ..................... 70 vitamin b-1 tab 250mg ..................... 70

vitamin b-1 tab 50mg ....................... 70 vitamin b-12 injection ....................... 50

vitamin b-12 tab 1000mcg ................ 50 vitamin b-12 tab 100mcg .................. 50

vitamin b-12 tab 250mcg .................. 50

vitamin b-12 tab 500mcg .................. 50 vitamin b-2 tab 100mg ..................... 70

vitamin b-2 tab 25mg ....................... 70 vitamin b6 tab 100mg ...................... 70

vitamin b-6 tab 200mg cr .................. 70 vitamin b-6 tab 250mg ..................... 70

vitamin b-6 tab 25mg ....................... 70 vitamin b-6 tab 50mg ....................... 70

vitamin c chw 250mg ........................ 70 vitamin c chw 500mg ........................ 70

vitamin c liq 500/5ml ........................ 70 VITAMIN C SYP 500/5ML ................... 70

vitamin c tab 1000mg ....................... 71 vitamin c tab 250mg ......................... 71

vitamin d cap 50000unt .................... 70

vitamin d tab 400unit ....................... 70 vitamin d3 cap 10000 ....................... 70

vitamin d-3 cap 1000unit .................. 70 vitamin d3 cap 2000unit ................... 69

vitamin d3 cap 400unit ..................... 69 vitamin d3 cap 50000unt .................. 70

vitamin d3 cap 5000unit ................... 70 vitamin d3 chw 1000unit ................... 70

vitamin d3 chw 2000unit ................... 70 vitamin d3 chw 400unit ..................... 70

vitamin d3 chw 5000unit ................... 70 vitamin d3 dro 400unit ..................... 70

vitamin d3 sol 8000/ml ..................... 70 vitamin d3 tab 1000unit .................... 70

vitamin d3 tab 2000unit .................... 70

vitamin d3 tab 50000unt ................... 70 vitamin d3 tab 5000unit .................... 70

103

vitamin e cap 100 unit ....................... 70

vitamin e cap 1000 unit ..................... 70 vitamin e cap 200 unit ....................... 70

vitamin e cap 400 unit ....................... 70 vitamin e cap 600 unit ....................... 70

VITAPEARL CAP ................................ 60 VIVA DHA CAP .................................. 60

VIVITROL INJ 380MG ........................ 20 VOSEVI TAB ..................................... 34

VOTRIENT TAB 200MG ...................... 28 VP-PNV-DHA CAP .............................. 60

W warfarin sodium tab 1 mg .................. 12

warfarin sodium tab 10 mg ................ 12 warfarin sodium tab 2 mg .................. 12

warfarin sodium tab 2.5 mg ............... 12

warfarin sodium tab 3 mg .................. 12 warfarin sodium tab 4 mg .................. 12

warfarin sodium tab 5 mg .................. 12 warfarin sodium tab 6 mg .................. 12

warfarin sodium tab 7.5 mg ............... 12 wart remover gel 17% ....................... 44

wart remover liq 17% ........................ 44 wart remover sol 17% ....................... 44

white petrolatum gel ......................... 64 white petrolatum topical gel ............... 64

X XARELTO STAR TAB 15/20MG ............. 12

XARELTO TAB 10MG .......................... 12 XARELTO TAB 15MG .......................... 12

XARELTO TAB 20MG .......................... 12

XELJANZ TAB 10MG ........................... 3 XELJANZ TAB 5MG ............................. 3

XELJANZ XR TAB 11MG....................... 3 XIFAXAN TAB 200MG ......................... 8

XIFAXAN TAB 550MG ......................... 8 XOLAIR INJ 150MG/ML ...................... 10

XOLAIR INJ 75/0.5 ........................... 10

XOLAIR SOL 150MG ......................... 10 XTANDI CAP 40MG ........................... 27

xulane dis 150-35 ............................ 38 XYREM SOL 500MG/ML ..................... 64

Z zaleplon cap 10 mg .......................... 52

zaleplon cap 5 mg ............................ 52 ZARXIO INJ 300/0.5 ......................... 51

ZARXIO INJ 480/0.8 ......................... 51 zenatane cap 10mg .......................... 41

zenatane cap 20mg .......................... 41 zenatane cap 30mg .......................... 41

zenatane cap 40mg .......................... 41 zidovudine cap 100 mg ..................... 33

zidovudine syrup 10 mg/ml ............... 33

zidovudine tab 300 mg ..................... 34 zilactin gel baby 10% ....................... 56

zinc gluconate tab 30 mg .................. 55 zinc gluconate tab 50 mg (elemental zn)

...................................................... 55 ZINC OXIDE PST 25%....................... 45

zinc sulfate cap 220 mg (50 mg elemental zn) .................................. 55

ziprasidone hcl cap 20 mg ................. 29 ziprasidone hcl cap 40 mg ................. 29

ziprasidone hcl cap 60 mg ................. 29 ziprasidone hcl cap 80 mg ................. 29

zolpidem tartrate tab 10 mg .............. 52 zolpidem tartrate tab 5 mg ................ 52

zolpidem tartrate tab er 12.5 mg ....... 52

zolpidem tartrate tab er 6.25 mg ....... 52 zonisamide cap 100 mg .................... 14

zonisamide cap 25 mg ...................... 14 zonisamide cap 50 mg ...................... 14

ZOSTRIX NAT CRE 0.033%................ 44 ZYNCOF SYP 20-400/5 ...................... 40

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2019 MEDICAID DRUG FORMULARY Effective January 1 , 2019 · 2019 MEDICAID DRUG FORMULARY Effective January 1st, 2019 PLEASE READ: THIS DOCUMENT HAS INFORMATION ABOUT THE PRESCRIPTION