L.A. Care Cal MediConnect Plan (Medicare-Medicaid … · L.A. Care Cal MediConnect Plan ... los servicios de asistencia con el idioma estarán disponibles para usted sin costo

L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)

List of Covered Drugs (Formulary)

2018

This formulary was updated on August 1, 2018.

If you have questions, please call L.A. Care Cal MediConnect Plan Member Services at 1-888-522-1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays. For more information, visit www.calmediconnectla.org.

H8258_15160_2018Formulary v2_ Accepted

Formulary ID: 00017452, Version 18

http://www.calmediconnectla.org

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If you have questions, please call L.A. Care Cal MediConnect Plan at 1.888.522.1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays. The call is free. For more information, visit www.calmediconnectla.org.

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This is a list of drugs that members can get in L.A. Care Cal MediConnect Plan.

• L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

• The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

• Benefits and/or copays may change on January 1 of each year.

• You can always check L.A. Care Cal MediConnect Plan’s up-to-date List of Covered Drugs online at www.calmediconnectla.org or by calling 1-888-522-1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays.

• Limitations, copays, and restrictions may apply. For more information, call L.A. Care Cal MediConnect Plan Member Services or read the L.A. Care Cal MediConnect Plan Member Handbook.

• Copays for prescription drugs may vary based on the level of Extra Help you get. Please contact the plan for more details.

• If you speak English, language assistance services, free of charge, are available to you. Call 1-888-522-1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays. The call is free.

• Si usted habla español, los servicios de asistencia con el idioma estarán disponibles para usted sin costo. Llame al 1-888-522-1298 (TTY: 711), las 24 horas del día, los 7 días de la semana, incluso los días festivos. La llamada es gratuita.

• 如果您說中文，您可免費獲得語言協助服務。請致電 11-888-522-1298（TTY：711），服務時間為每週 7 天，每天 24 小時（包含假日）。這是免費電話。

• Nếu quy vị nói Tiếng Việt, hiện có các dịch vụ hỗ trợ ngôn ngữ miễn phí cho quy vị. Gọi 1-888-522-1298 (TTY: 711), 24 giờ một ngày, 7 ngày một tuần, kể cả các ngày lễ. Cuộc gọi là miễn phí.

• 한국어를 사용하실 경우 언어지원서비스를 무료로 이용하실 수 있습니다. 연중무휴로 이용할 수 있는 1-888-522-1298 (TTY: 711 ) 번으로 전화하십시오. 통화료는 무료입니다.

• Եթե խոսում եք հայերեն, լեզվական աջակցության ծառայությունները հասանելի են Ձեզ անվճար։ Զանգահարեք 1-888-522-1298 հեռախոսահամարով (TTY՝ 711), օրը 24 ժամ, շաբաթը 7 օր, ներառյալ տոն օրերը։ Հեռախոսազանգն անվճար է:

اذإك نتتتحثدلا لغةلاعبري،ةفنإخ مدتالا مسعاةد لا لغيو،ةمتفوةر ل،كمجناا.تا صلعلى 1-888-522-1298• :TTY) 711 24 (س عاة فيلا يمو و7يأ ما ف يسألا ب،عو ب مافيلذ كيأ ما لا عط.تال ه هذلا مكلامةمجناي.ة


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• अगर आप हिदी बोलत ि, तो मफत म भाषा सिायता सवाए, आपक ललए उपलबध िl अवकाशक हदनो समत, हदन क 24 घट, सपाि क 7 हदन 1-888-522-1298 (TTY: 711) पर कॉलकर। कॉल लन:शलक िl

• Если вы говорите по-русски, вы можете воспользоваться бесплатными услугами переводчика. Звоните по телефону 1-888-522-1298 (TTY: 711), круглосуточно, без выходных, включая праздничные дни. Звонок бесплатный.

•• 日本語のサービスを無料でご利用いただけます。 1-888-522-1298（TTY:• 711）までお電話ください。このサービスは年中無休（祝祭日を含む）でご利用いただけます。通話料は無料です。

• ديناوت یم .دراد رارق امش رايتخا رد ناگيار روطب نابز هنيمز رد کمک تامدخ ،دينک یم تبحص یسراف نابز هب رگا•

اب ليطعت یاهزور یتح ،هتفه زور 7 و زور هنابش تعاس 24 مامت رد TTY: 1-888-522-1298) 711سامت (.دشاب یم ناگيار سامت .ديريگب

• अगर आप हिदी बोलत ि, तो मफत म भाषा सिायता सवाए, आपक ललए उपलबध िl अवकाश क हदनो समत, हदन क 24 घट, सपाि क 7 हदन 1-888-522-1298 (TTY: 711)पर कॉल कर। कॉल लन:शलक िl

• ប ើអនកនយាយភាសា ខមែរ, បេវាជនយផន កភាសា គមានបងលៃ គមានសផមាបជយអនក។ េមទរេពទផ ៅ 1-888-522-1298 (TTY: 711), 24 បមាោងកនងមយងៃ ន ផ 7 ថងៃកនងមយេបដាហរមទា ងផងៃឈបសផមាក។ ការៅទផ រេពទផនះគមនគតលៃផទ។

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• Kung nagsasalita ka ng Tagalog, magagamit mo ang mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kabilang ang mga piyesta opisyal. Libre ang pagtawag.

• หากทานพดภาษาไทย เรามบรการชวยเหลอดานภาษาใหคณโดยไมเสยคาใชจาย โปรดโทร ฟรทหมายเลข 1-888-522-1298 (TTY: 711) ไดตลอด 24 ชวโมง ทกวน ไมเวนวนหยด

ານເວາພາສາລາວ, ມ ລການຊວຍເຫ ານໂດຍບ 1-888-522-1298 (TTY: 711), ໄດຕະຫ ອດ 24 ຊ ວໂມງ, 7 ວນຕອາທດ, ລວມເຖງ

ນພກຕາງໆ. ເບໂທຣນແມນບເສຽຄາ. ວ

• Yog koj hais lus Hmoob, muaj kev pab txhais lus pub dawb rau koj, hu rau 1-888-522-1298 (TTY: 711), 24 teev hauv ib hnub, 7 hnub hauv ib asthiv, suav nrog cov hnub so tib si. Qhov hu no yog hu dawb xwb.

• ਜ ਤਸੀ ਪਜਾਬੀ ਬਲਦ ਹ, ਤਾ ਤਹਾਡ ਲਈ ਮਫਤ ਭਾਸਾ ਸਹਾਇਤਾ ਸਵਾਵਾ ਉਪਲਬਧ ਹਨ। ਛ ਟੀ ਵਾਲ ਦਦਨਾ ਸਮਤ 24 ਘਟ, 7 ਦਦਨ 1-888-522-1298 (TTY: 711) ‘ਤ ਕਾਲ ਕਰ।ਕਾਲ ਮਫਤ ਹ।

• You can get this information for free in other formats, such as large print, braille or audio. Call 1-888-522-1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays. The call is free.

• If you want to receive materials, now and in the future, in a language other than English or in an alternate format, call Member Services at 1-888-522-1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays. The call is free.

າວ າ ທຖ ບ ທອດ ານພາສາໃຫ ເສຽຄ າ. ໂທຣ •


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Frequently Asked Questions (FAQ) Find answers here to questions you have about this List of Covered Drugs. You can read all of the FAQ to learn more, or look for a question and answer.

1. What prescription drugs are on the List of Covered Drugs? (We call the List of Covered Drugs the “Drug List” for short.)

The drugs on the Drug List are the drugs covered by L.A. Care Cal MediConnect Plan. The drugs are available at pharmacies within our network. A pharmacy is in our network if we have an agreement with them to work with us and provide you services. We refer to these pharmacies as “network pharmacies.”

L.A. Care Cal MediConnect Plan will cover all medically necessary drugs on the Drug List if:

• your doctor or other prescriber says you need them to get better or stay healthy, and

• you fill the prescription at a L.A. Care Cal MediConnect Plan network pharmacy.

In some cases, you have to do something before you can get a drug (see question #5 below).

You can also see an up-to-date list of drugs that we cover on our website at www.calmediconnectla.org or call Member Services at 1.888.522.1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays.

2. Does the Drug List ever change?

Yes. L.A. Care Cal MediConnect Plan may add or remove drugs on the Drug List during the year. Generally, the Drug List will only change if:

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

• we learn that a drug is not safe.

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

• Decide to require or not require prior approval for a drug. (Prior approval is permission from L.A. Care Cal MediConnect Plan before you can get a drug.)

• Add or change the amount of a drug you can get (called “quantity limits”). • Add or change step therapy restrictions on a drug. (Step therapy means you must try one drug

before we will cover another drug.)

(For more information on these drug rules, see pages iv and v.)


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We will tell you when a drug you are taking is removed from the Drug List. We will also tell you when we change our rules for covering a drug. Questions 3, 4, and 7 below have more information on what happens when the Drug List changes.

► You can always check L.A. Care Cal MediConnect Plan’s up to date Drug List online at www.calmediconnectla.org. You can also call Member Services to check the current Drug List at 1.888.522.1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays.

3. What happens when a cheaper drug comes along that works as well as a drug on the Drug List now?

If you are taking a drug that is removed because a cheaper drug that works just as well comes along, we will tell you. We will tell you at least 60 days before we remove it from the Drug List or when you ask for a refill. Then you can get a 60-day supply of the drug before the drug is removed from the drug list. This gives you time to talk to your doctor or other prescriber about what to do next. We will tell you in a notice sent as part of the monthly Pharmacy Explanation of Benefits (EOB).

4. What happens when we find out a drug is not safe?

If the Food and Drug Administration (FDA) says a drug you are taking is not safe, we will take it off the Drug List right away. We will also send you a letter telling you that. If you get one of these letters, please speak with your physician to find an alternative that is safe for you.

5. Are there any restrictions or limits on drug coverage? Or are there any required actions to take in order to get certain drugs?

Yes, some drugs have coverage rules or have limits on the amount you can get. In some cases you or your doctor or other prescriber must do something before you can get the drug. For example:

• Prior approval (or prior authorization): For some drugs, you or your doctor or other prescriber must get approval from L.A. Care Cal MediConnect Plan before you fill your prescription. If you don’t get approval, L.A. Care Cal MediConnect Plan may not cover the drug.

• Quantity limits: Sometimes L.A. Care Cal MediConnect Plan limits the amount of a drug you can get.

• Step therapy: Sometimes L.A. Care Cal MediConnect Plan requires you to do step therapy. This means you will have to try drugs in a certain order for your medical condition.

You might have to try one drug before we will cover another drug. If your doctor thinks the first drug doesn’t work for you, then we will cover the second.



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You can find out if your drug has any additional requirements or limits by looking in the tables on pages 1-121. You can also get more information by visiting our web site at www.calmediconnectla.org. We have posted online documents that explain our prior authorization and step therapy restrictions. You may also ask us to send you a copy.

You can ask for an “exception” from these limits. Please see Question 11 for more information on exceptions.

► If you are in a nursing home or other long-term care facility and need a drug that is not on the Drug List, or if you cannot easily get the drug you need, we can help. We will cover a 31-day emergency supply of the drug you need (unless you have a prescription for fewer days), whether or not you are a new L.A. Care Cal MediConnect Plan member. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception. Please see Question 11 for more information about exceptions..

6. How will you know if the drug you want has limitations or if there are required actions to take to get the drug?

The List of Covered Drugs on page 1 has a column labeled “Necessary actions, restrictions, or limits on use.”

7. What happens if we change our rules on how we cover some of the drugs? For example, if we add prior authorization (approval), quantity limits, and/or step therapy restrictions on a drug.

We will tell you if we add prior approval, quantity limits, and/or step therapy restrictions on a drug. We will tell you at least 60 days before the restriction is added or when you next ask your pharmacy for a refill. Then, you can get a 60-day supply of the drug before the change to the coverage rules is made. This gives you time to talk to your doctor or other prescriber about what to do next.

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

There are two ways to find a drug: • You can search alphabetically (if you know how to spell the drug), or

• You can search by medical condition.

To search alphabetically, go to the Alphabetical Listing section. You can find it at the end of the drug list, it is called the Index. The medications are listed in alphabetical order.


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To search by medical condition, find the section labeled “List of drugs by medical condition” on page 122. The drugs in this section are grouped into categories depending on the type of medical conditions they are used to treat. For example, if you have a heart condition, you should look in the category, cardiovascular agents – Misc. That is where you will find drugs that treat heart conditions.

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

If you don’t see your drug on the Drug List, call Member Services at 1.888.522.1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays and ask about it. If you learn that L.A. Care Cal MediConnect Plan will not cover the drug, you can do one of these things:

• Ask Member Services for a list of drugs like the one you want to take. Then show the list to your doctor or other prescriber. He or she can prescribe a drug on the Drug List that is like the one you want to take. Or

• You can ask the health plan to make an exception to cover your drug. Please see question 11 for more information about exceptions.

10. What if you are a new L.A. Care Cal MediConnect Plan member and can’t find your drug on the Drug List or have a problem getting your drug?

We can help. We may cover a temporary 30-day supply of your drug during the first 90 days you are a member of L.A. Care Cal MediConnect Plan. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception.

We will cover a 30-day supply of your drug if: • you are taking a drug that is not on our Drug List, or

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

• the drug requires prior approval by L.A. Care Cal MediConnect Plan, or

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

If you live in a nursing home or other long-term care facility, you may refill your prescription for as long as 98 days. You may refill the drug multiple times during your first 90 days in the plan. This gives your prescriber time to change your drugs to those on the Drug List or ask for an exception.

Level of Care Changes

We will provide a transition supply of your drugs when you experience a change in level of care. Examples of level of care changes may include the following:


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1. Members who enter long-term care facilities from hospitals

2. Members who are discharged from a hospital to a home

3. Members who end their skilled nursing facility Medicare Part A stay and who need to revert to their Part D plan formulary

4. Members who give up hospice status to revert to standard Medicare Part A and B benefits

5. Members who end a long-term care facility stay and return to the community

6. Members who are discharged from psychiatric hospitals with drug regimens that are highly individualized

Pharmacies may contact L.A. Care Cal MediConnect Plan Pharmacy Services at 1-877-795-2227 to process point-of-sale overrides to ensure members receive access to their medications without any delays.

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

Yes. You can ask L.A. Care Cal MediConnect Plan to make an exception to cover a drug that is not on the Drug List.

You can also ask us to change the rules on your drug.

• For example, L.A. Care Cal MediConnect Plan may limit the amount of a drug we will cover. If your drug has a limit, you can ask us to change the limit and cover more.

• Other examples: You can ask us to drop step therapy restrictions or prior approval requirements.

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

First, we must get a statement from your prescriber supporting your request for an exception. After we get the statement, we will give you a decision on your exception request within 72 hours.

If you or your prescriber think your health may be harmed if you have to wait 72 hours for a decision, you can ask for an expedited exception. This is a faster decision. If your prescriber supports your request, we will give you a decision within 24 hours of getting your prescriber’s supporting statement.

13. How can you ask for an exception?

To ask for an exception, call Member Services. Member Services will work with you and your provider to help you ask for an exception.

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14. What are generic drugs?

Generic drugs are made up of the same ingredients as brand name drugs. They usually cost less than the brand name drug and their names are less commonly known. Generic drugs are approved by the Food and Drug Administration (FDA).

L.A. Care Cal MediConnect Plan covers both brand-name drugs and generic drugs.

15. What are OTC drugs?

OTC stands for “over-the-counter.” L.A. Care Cal MediConnect Plan covers some OTC drugs when they are written as prescriptions by your provider.

You can read the L.A. Care Cal MediConnect Plan Drug List to see what OTC drugs are covered.

16. Does L.A. Care Cal MediConnect Plan cover OTC non-drug products?

L.A. Care Cal MediConnect Plan covers some OTC non-drug products when they are written as prescriptions by your provider.

You can read the L.A. Care Cal MediConnect Plan Drug List to see what OTC non-drug products are covered.

17. What is your co-pay?

You can read the L.A. Care Cal MediConnect Plan Drug List to learn about the copay for each drug.

L.A. Care Cal MediConnect Plan members living in nursing homes or other long-term care facilities will have no copays. Some members getting long-term care in the community will also have no copays.

Copays are listed by tiers. Tiers are groups of drugs with the same copay.

• Tier 1 drugs. They are generic drugs. The co-pay will be $0.

• Tier 2 drugs. They are brand name drugs. The copay will be from $0 to $8.35, depending on your level of Medi-Cal eligibility.

• Tier 3 drugs. They are non-Medicare prescription drugs. The co-pay will be $0.

• Tier 4 drugs. They are non-Medicare over-the-counter drugs. The co-pay will be $0.

18. List of Covered Drugs

The list of covered drugs below gives you information about the drugs covered by L.A. Care Cal MediConnect Plan. If you have trouble finding your drug in the list, turn to the Index that begins on page 1.


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

The information in the “Necessary actions, restrictions, or limits on use” column tells you if L.A. Care Cal MediConnect Plan has any rules for covering your drug.

COVERAGE NOTES ABBREVIATIONS Utilization Management Restrictions

ABBREVIATION DESCRIP TION E XP L ANATION PA Prior Authorization

Restriction You (or your physician) are required to get prior authorization from L.A. Care Cal MediConnect Plan before you fill your prescription for this drug. Without prior approval, L.A. Care Cal MediConnect Plan may not cover this drug.

PA BvD Prior Authorization Restriction for Part B vs Part D Determination

This drug may be eligible for payment under Medicare Part B or Part D. You (or your physician) are required to get prior authorization from L.A. Care Cal MediConnect Plan to determine that this drug is covered under Medicare Part D before you fill your prescription for this drug. Without prior approval, L.A. Care Cal MediConnect Plan may not cover this drug.

PA NSO Prior Authorization Restriction for New Starts Only

If this is a new prescription for you, i.e., the first time this drug is prescribed for you, you (or your physician) are required to get prior authorization from L.A. Care Cal MediConnect Plan before you fill your prescription for this drug. Without prior approval, L.A. Care Cal MediConnect Plan may not cover this drug.

QL Quantity Limit Restriction L.A. Care Cal MediConnect Plan limits the quantity to be covered within a specific time frame for this drug.

ST Step Therapy Restriction

Before L.A. Care Cal MediConnect Plan will provide coverage for this drug, you must first try another drug(s) on the formulary to treat your medical condition. This drug may only be covered if the other drug(s) does not work for you.

Other Special Requirements for Coverage LD Limited Distribution Drug This prescription may be available only at certain pharmacies. For more

information consult your Provider/Pharmacy Directory or call Member Services at 1.888.522.1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays.

NDS Non-Extended Day Supply Drugs noted with “NDS” are limited to a 1-month supply for both Retail and Mail Order.

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Note: The asterisk (*) next to a drug means the drug is not a “Part D drug.” You will not be required to pay a copay for these drugs. These drugs also have different rules for appeals. An appeal is a formal way of asking us to review a decision we made about your coverage and to change it if you think we made a mistake. For example, we might decide that a drug that you want is not covered or is no longer covered by Medicare or Medi-Cal. If you or your doctor disagrees with our decision, you can appeal. If you ever have a question, call Member Services at 1.888.522.1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays. You can also read the Member Handbook to learn how to appeal a decision.

List of Drugs by Medical Condition The drugs in this section are grouped into categories depending on the type of medical conditions they are used to treat. For example, if you have a heart condition, you should look in the category, cardiovascular agents – Misc. That is where you will find drugs that treat heart conditions.



You can find information on what the symbols and abbreviations in this table mean by going to page ix.

1

Name of drug What the drug will cost you (tier level)

Necessary actions,restrictions, or limits on use

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

amphetamine 10mg er cap 1 amphetamine 10mg tab 1 amphetamine 12.5mg tab 1 amphetamine 15mg er cap 1 amphetamine 15mg tab 1 amphetamine 20mg er cap 1 amphetamine 20mg tab 1 amphetamine 25mg er cap 1 amphetamine 30mg er cap 1 amphetamine 30mg tab 1 amphetamine 5mg er cap 1 amphetamine 5mg tab 1 amphetamine 7.5mg tab 1 dextroamphetamine sulfate 10mg er cap 1 dextroamphetamine sulfate 10mg tab 1 dextroamphetamine sulfate 15mg er cap 1 dextroamphetamine sulfate 5mg er cap 1 dextroamphetamine sulfate 5mg tab 1 VYVANSE 10MG CAP 2 VYVANSE 10MG CHEW TAB 2 VYVANSE 20MG CAP 2 VYVANSE 20MG CHEW TAB 2 VYVANSE 30MG CAP 2 VYVANSE 30MG CHEW TAB 2 VYVANSE 40MG CAP 2 VYVANSE 40MG CHEW TAB 2 VYVANSE 50MG CAP 2 VYVANSE 50MG CHEW TAB 2 VYVANSE 60MG CAP 2 VYVANSE 60MG CHEW TAB 2 VYVANSE 70MG CAP 2

ANOREXIANTS NON-AMPHETAMINE phentermine cap 15mg* 3 PA phentermine cap 30mg* 3 PA phentermine cap 37.5mg* 3 PA phentermine tab 37.5mg* 3 PA QSYMIA CAP 11.25-69MG* 3 PA QSYMIA CAP 15-92MG* 3 PA QSYMIA CAP 3.75-23MG* 3 PA QSYMIA CAP 7.5-46MG* 3 PA

ANTI-OBESITY AGENTS


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BELVIQ TAB 10MG* 3 PA XENICAL CAP* 3 PA

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS atomoxetine 100mg cap 1 QL=60 EA/30 Days atomoxetine 10mg cap 1 QL=60 EA/30 Days atomoxetine 18mg cap 1 QL=60 EA/30 Days atomoxetine 25mg cap 1 QL=60 EA/30 Days atomoxetine 40mg cap 1 QL=60 EA/30 Days atomoxetine 60mg cap 1 QL=60 EA/30 Days atomoxetine 80mg cap 1 QL=60 EA/30 Days guanfacine 1mg er tab 1 guanfacine 2mg er tab 1 guanfacine 3mg er tab 1 guanfacine 4mg er tab 1

STIMULANTS - MISC. armodafinil 150mg tab 1 PA QL=30 EA/30 Days armodafinil 200mg tab 1 PA QL=30 EA/30 Days armodafinil 250mg tab 1 PA QL=30 EA/30 Days armodafinil 50mg tab 1 PA QL=30 EA/30 Days dexmethylphenidate 10mg er cap 1 dexmethylphenidate 10mg tab 1 dexmethylphenidate 15mg er cap 1 dexmethylphenidate 2.5mg tab 1 dexmethylphenidate 20mg er cap 1 dexmethylphenidate 30mg er cap 1 dexmethylphenidate 40mg er cap 1 dexmethylphenidate 5mg er cap 1 dexmethylphenidate 5mg tab 1 metadate 20mg er tab 1 methylphenidate 10mg cd cap 1 methylphenidate 10mg chew tab 1 methylphenidate 10mg er tab 1 methylphenidate 10mg la cap 1 methylphenidate 10mg tab 1 METHYLPHENIDATE 18MG SR TAB 1 methylphenidate 1mg/ml oral soln 1 methylphenidate 2.5mg chew tab 1 methylphenidate 20mg cd cap 1 methylphenidate 20mg er tab 1 methylphenidate 20mg la cap 1 methylphenidate 20mg tab 1 METHYLPHENIDATE 27MG SR TAB 1 methylphenidate 2mg/ml oral soln 1




3

methylphenidate 30mg cd cap 1 methylphenidate 30mg la cap 1 METHYLPHENIDATE 36MG SR TAB 1 methylphenidate 40mg cd cap 1 methylphenidate 40mg la cap 1 methylphenidate 50mg cd cap 1 METHYLPHENIDATE 54MG SR TAB 1 methylphenidate 5mg chew tab 1 methylphenidate 5mg tab 1 methylphenidate 60mg cd cap 1 modafinil 100mg tab 1 PA QL=60 EA/30 Days modafinil 200mg tab 1 PA QL=60 EA/30 Days



AMINOGLYCOSIDES AMINOGLYCOSIDES

amikacin 250mg/ml inj 1 gentamicin 1.2mg/ml inj 1 gentamicin 40mg/ml inj 1 gentamicin sulfate 0.8mg/ml inj 1 gentamicin sulfate 1.6mg/ml inj 1 gentamicin sulfate 1mg/ml inj 1 neomycin sulfate 500mg tab 1 paromomycin 250mg cap 1 STREPTOMYCIN 100MG INJ 2 TOBI PODHALER KIT 28MG PACK 2 NDS PA TOBRAMYCIN 10MG/ML INJ 1 tobramycin 40mg/ml inj 1 tobramycin 60mg/ml inh soln 1 PA

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

HUMIRA 10MG/0.1ML SYRINGE 2 NDS PA HUMIRA 10MG/0.2ML SYRINGE 2 NDS PA HUMIRA 20MG/0.2ML SYRINGE 2 NDS PA HUMIRA 20MG/0.4ML SYRINGE 2 NDS PA HUMIRA 40MG/0.4ML AUTO-INJECTOR 2 NDS PA HUMIRA 40MG/0.4ML SYRINGE 2 NDS PA HUMIRA 40MG/0.8ML AUTO-INJECTOR 2 NDS PA HUMIRA 40MG/0.8ML SYRINGE 2 NDS PA HUMIRA PEDIATRIC CROHN'S STARTER PACK (3) 40MG/0.8ML INJ

2 NDS PA

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

2 NDS PA


2 NDS PA


4

HUMIRA PEDIATRIC CROHN'S STARTER PACK SYRINGE (2) 40MG/0.4ML, 80MG/0.8ML

2 NDS PA

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

2 NDS PA

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

2 NDS PA

SIMPONI ARIA 50MG/4ML INJ 2 NDS PA GOLD COMPOUNDS

RIDAURA 3MG CAP 2 INTERLEUKIN-1 BLOCKERS

ARCALYST 220MG INJ 2 NDS PA INTERLEUKIN-1BETA BLOCKERS

ILARIS 150MG/ML INJ 2 NDS PA NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)

celecoxib 100mg cap 1 QL=60 EA/30 Days celecoxib 200mg cap 1 QL=60 EA/30 Days celecoxib 400mg cap 1 QL=60 EA/30 Days celecoxib 50mg cap 1 QL=60 EA/30 Days diclofenac potassium 50mg tab 1 diclofenac sodium 100mg er tab 1 diclofenac sodium 25mg dr tab 1 diclofenac sodium 50mg dr tab 1 diclofenac sodium 50mg/misoprostol 0.2mg tab 1 diclofenac sodium 75mg dr tab 1 diclofenac sodium 75mg/misoprostol 0.2mg tab 1 etodolac 200mg cap 1 etodolac 300mg cap 1 etodolac 400mg er tab 1 etodolac 400mg tab 1 etodolac 500mg er tab 1 etodolac 500mg tab 1 etodolac 600mg er tab 1 FENOPROFEN 400MG CAP 2 flurbiprofen 100mg tab 1 flurbiprofen 50mg tab 1 ibu 600mg tab 1 ibu 800mg tab 1 ibuprofen 20mg/ml oral susp 1 ibuprofen 400mg tab 1 ibuprofen 600mg tab 1 ibuprofen 800mg tab 1 ibuprofen cap 200mg* 4 ibuprofen chew tab 100mg* 4




5

ibuprofen susp 40mg/ml* 4 ibuprofen tab 100mg* 4 ibuprofen tab 200mg* 4 INDOCIN 25MG/5ML ORAL SUSP 2 indomethacin 25mg cap 1 indomethacin 50mg cap 1 indomethacin 75mg er cap 1 ketoprofen 50mg cap 1 ketoprofen 75mg cap 1 ketorolac tromethamine 10mg tab 1 QL=20 EA/5 Days ketorolac tromethamine 15mg/ml inj 1 ketorolac tromethamine 30mg/ml cartridge 1 ketorolac tromethamine 30mg/ml inj 1 MECLOFENAMATE 100MG CAP 2 MECLOFENAMATE 50MG CAP 2 mefenamic acid 250mg cap 1 meloxicam 15mg tab 1 meloxicam 7.5mg tab 1 nabumetone 500mg tab 1 nabumetone 750mg tab 1 naproxen 250mg tab 1 naproxen 25mg/ml oral susp 1 naproxen 375mg dr tab 1 naproxen 375mg tab 1 naproxen 500mg dr tab 1 naproxen 500mg tab 1 naproxen sodium 275mg tab 1 naproxen sodium 550mg tab 1 oxaprozin 600mg tab 1 piroxicam 10mg cap 1 piroxicam 20mg cap 1 sulindac 150mg tab 1 sulindac 200mg tab 1

PYRIMIDINE SYNTHESIS INHIBITORS leflunomide 10mg tab 1 leflunomide 20mg tab 1

SELECTIVE COSTIMULATION MODULATORS ORENCIA 125MG/ML AUTO-INJECTOR 2 NDS PA ORENCIA 125MG/ML SYRINGE 2 NDS PA ORENCIA 250MG INJ 2 NDS PA ORENCIA 50MG/0.4ML SYRINGE 2 NDS PA ORENCIA 87.5MG/0.7ML SYRINGE 2 NDS PA

SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS




6

ENBREL 25MG INJ 2 NDS PA ENBREL 25MG/0.5ML SYRINGE 2 NDS PA ENBREL 50MG/ML SURECLICK INJ 2 NDS PA ENBREL 50MG/ML SYRINGE 2 NDS PA



ANALGESICS - NONNARCOTIC ANALGESIC COMBINATIONS

aspirin/acetaminophen/caffeine tab 250-250-65mg* 4 ANALGESICS OTHER

acetaminophen cap 500mg* 4 acetaminophen chew tab 160mg* 4 acetaminophen chew tab 80mg* 4 acetaminophen CR tab 650mg* 4 acetaminophen dispersible tab 160mg* 4 acetaminophen dispersible tab 80mg* 4 acetaminophen elixir 160mg/5ml* 4 acetaminophen liquid 160mg/5ml* 4 acetaminophen liquid 167mg/5ml* 4 acetaminophen oral soln 160mg/5ml* 4 acetaminophen supp 120mg* 4 acetaminophen supp 325mg* 4 acetaminophen supp 650mg* 4 ACETAMINOPHEN SUPP 80MG* 4 acetaminophen susp 160mg/5ml* 4 acetaminophen susp 80mg/0.8ml* 4 ACETAMINOPHEN SYRUP 160 MG/5ML* 4 acetaminophen tab 325mg* 4 acetaminophen tab 500mg* 4

SALICYLATES ASCRIPTIN TAB 325MG* 4 aspirin chew tab 81mg* 4 aspirin EC tab 325mg* 4 aspirin EC tab 500mg* 4 aspirin EC tab 81mg* 4 aspirin tab 325mg* 4 aspirin tab 500mg* 4 diflunisal 500mg tab 1

ANALGESICS - OPIOID OPIOID AGONISTS

codeine sulfate 15mg tab 1 QL=240 EA/30 Days codeine sulfate 30mg tab 1 QL=240 EA/30 Days codeine sulfate 60mg tab 1 QL=180 EA/30 Days duramorph 0.5mg/ml inj 1 PA BvD duramorph 1mg/ml inj 1 PA BvD

You can can find information on what the symbols and abbreviations in this table mean by going to page ix.

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EMBEDA 100-4MG ER CAP 2 QL=60 EA/30 Days EMBEDA 20-0.8MG ER CAP 2 QL=60 EA/30 Days EMBEDA 30-1.2MG ER CAP 2 QL=60 EA/30 Days EMBEDA 50-2MG ER CAP 2 QL=60 EA/30 Days EMBEDA 60-2.4MG ER CAP 2 QL=60 EA/30 Days EMBEDA 80-3.2MG ER CAP 2 QL=60 EA/30 Days fentanyl 0.012mg/hr patch 1 QL=10 EA/30 Days fentanyl 0.025mg/hr patch 1 QL=10 EA/30 Days fentanyl 0.05mg/hr patch 1 QL=10 EA/30 Days fentanyl 0.075mg/hr patch 1 QL=10 EA/30 Days fentanyl 0.1mg/hr patch 1 QL=10 EA/30 Days fentanyl 0.2mg lozenge 1 PA QL=120 EA/30 Days fentanyl 0.4mg lozenge 1 PA QL=120 EA/30 Days fentanyl 0.6mg lozenge 1 PA QL=120 EA/30 Days fentanyl 0.8mg lozenge 1 PA QL=120 EA/30 Days fentanyl 1.2mg lozenge 1 PA QL=120 EA/30 Days fentanyl 1.6mg lozenge 1 PA QL=120 EA/30 Days FENTORA 100MCG BUCCAL TAB 2 PA QL=120 EA/30 Days FENTORA 200MCG BUCCAL TAB 2 PA QL=120 EA/30 Days FENTORA 400MCG BUCCAL TAB 2 PA QL=120 EA/30 Days FENTORA 600MCG BUCCAL TAB 2 PA QL=120 EA/30 Days FENTORA 800MCG BUCCAL TAB 2 PA QL=120 EA/30 Days hydromorphone 10mg/ml (1ml) inj 1 hydromorphone 10mg/ml (5ml) inj 1 hydromorphone 12mg er tab 1 QL=60 EA/30 Days hydromorphone 16mg er tab 1 QL=60 EA/30 Days hydromorphone 1mg/ml oral soln 1 QL=2400 ML/30 Days hydromorphone 2mg tab 1 QL=450 EA/30 Days hydromorphone 2mg/ml syringe 1 hydromorphone 32mg er tab 1 QL=60 EA/30 Days hydromorphone 4mg tab 1 QL=240 EA/30 Days hydromorphone 8mg er tab 1 QL=60 EA/30 Days hydromorphone 8mg tab 1 QL=120 EA/30 Days HYSINGLA 100MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 120MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 20MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 30MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 40MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 60MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 80MG ER TAB 2 QL=30 EA/30 Days LEVORPHANOL 2MG TAB 2 QL=240 EA/30 Days meperidine 100mg tab 1 QL=360 EA/30 Days meperidine 50mg tab 1 QL=720 EA/30 Days




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methadone 10mg tab 1 QL=360 EA/30 Days methadone 1mg/ml oral soln 1 QL=3600 ML/30 Days methadone 2mg/ml oral soln 1 QL=1800 ML/30 Days methadone 5mg tab 1 QL=360 EA/30 Days morphine sulfate 100mg er cap 1 QL=60 EA/30 Days morphine sulfate 100mg er tab 1 QL=120 EA/30 Days morphine sulfate 10mg er cap 1 QL=60 EA/30 Days MORPHINE SULFATE 120MG ER (24HR) CAP 2 QL=60 EA/30 Days morphine sulfate 15mg er tab 1 QL=120 EA/30 Days morphine sulfate 15mg tab 1 QL=180 EA/30 Days morphine sulfate 200mg er tab 1 QL=120 EA/30 Days morphine sulfate 20mg er cap 1 QL=60 EA/30 Days morphine sulfate 20mg/ml oral soln 1 QL=180 ML/30 Days morphine sulfate 2mg/ml oral soln 1 QL=1800 ML/30 Days MORPHINE SULFATE 2MG/ML SYRINGE 2 MORPHINE SULFATE 30MG ER (24 HR) CAP 2 QL=60 EA/30 Days morphine sulfate 30mg er cap 1 QL=60 EA/30 Days morphine sulfate 30mg er tab 1 QL=120 EA/30 Days morphine sulfate 30mg tab 1 QL=180 EA/30 Days MORPHINE SULFATE 45MG ER (24HR) CAP 2 QL=60 EA/30 Days morphine sulfate 4mg/ml oral soln 1 QL=900 ML/30 Days morphine sulfate 50mg er cap 1 QL=60 EA/30 Days MORPHINE SULFATE 5MG/ML SYRINGE 2 MORPHINE SULFATE 60MG (24HR) ER CAP 2 QL=60 EA/30 Days morphine sulfate 60mg er cap 1 QL=60 EA/30 Days morphine sulfate 60mg er tab 1 QL=120 EA/30 Days MORPHINE SULFATE 75MG ER (24HR) CAP 2 QL=60 EA/30 Days morphine sulfate 80mg er cap 1 QL=60 EA/30 Days MORPHINE SULFATE 90MG ER (24HR) CAP 2 QL=60 EA/30 Days NUCYNTA 100MG ER TAB 2 QL=60 EA/30 Days NUCYNTA 150MG ER TAB 2 QL=60 EA/30 Days NUCYNTA 200MG ER TAB 2 QL=60 EA/30 Days NUCYNTA 250MG ER TAB 2 QL=60 EA/30 Days NUCYNTA 50MG ER TAB 2 QL=60 EA/30 Days oxycodone 10mg tab 1 QL=180 EA/30 Days oxycodone 15mg tab 1 QL=180 EA/30 Days oxycodone 1mg/ml oral soln 1 QL=5400 ML/30 Days oxycodone 20mg tab 1 QL=180 EA/30 Days oxycodone 20mg/ml oral soln 1 QL=270 ML/30 Days oxycodone 30mg tab 1 QL=180 EA/30 Days oxycodone 5mg cap 1 QL=360 EA/30 Days oxycodone 5mg tab 1 QL=360 EA/30 Days OXYCONTIN 10MG ER TAB 2 QL=60 EA/30 Days




9

OXYCONTIN 15MG ER TAB 2 QL=60 EA/30 Days OXYCONTIN 20MG ER TAB 2 QL=60 EA/30 Days OXYCONTIN 30MG ER TAB 2 QL=60 EA/30 Days OXYCONTIN 40MG ER TAB 2 QL=60 EA/30 Days OXYCONTIN 60MG ER TAB 2 QL=60 EA/30 Days OXYCONTIN 80MG ER TAB 2 QL=120 EA/30 Days oxymorphone 10mg tab 1 QL=360 EA/30 Days oxymorphone 5mg tab 1 QL=360 EA/30 Days tramadol 100mg er tab 1 QL=60 EA/30 Days tramadol 100mg er tab (matrix delivery) 1 QL=60 EA/30 Days tramadol 200mg er tab 1 QL=60 EA/30 Days tramadol 200mg er tab (matrix delivery) 1 QL=60 EA/30 Days tramadol 300mg er tab 1 QL=60 EA/30 Days tramadol 300mg er tab (matrix delivery) 1 QL=60 EA/30 Days tramadol 50mg tab 1 QL=240 EA/30 Days XTAMPZA 13.5MG ER CAP 2 QL=120 EA/30 Days XTAMPZA 18MG ER CAP 2 QL=120 EA/30 Days XTAMPZA 27MG ER CAP 2 QL=120 EA/30 Days XTAMPZA 36MG ER CAP 2 QL=120 EA/30 Days XTAMPZA 9MG ER CAP 2 QL=120 EA/30 Days

OPIOID COMBINATIONS acetaminophen 21.7mg/ml/hydrocodone bitartrate 0.5mg/ml oral soln

1 QL=5400 ML/30 Days

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

1 QL=4980 ML/30 Days

acetaminophen 300mg/codeine phosphate 15mg tab 1 QL=390 EA/30 Days acetaminophen 300mg/codeine phosphate 30mg tab 1 QL=390 EA/30 Days acetaminophen 300mg/codeine phosphate 60mg tab 1 QL=390 EA/30 Days acetaminophen 300mg/hydrocodone bitartrate 10mg tab

1 QL=390 EA/30 Days

acetaminophen 300mg/hydrocodone bitartrate 5mg tab

1 QL=390 EA/30 Days

acetaminophen 300mg/hydrocodone bitartrate 7.5mg tab

1 QL=390 EA/30 Days


1 QL=360 EA/30 Days


1 QL=360 EA/30 Days


1 QL=360 EA/30 Days


1 QL=360 EA/30 Days

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




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acetaminophen 325mg/oxycodone 2.5mg tab 1 QL=360 EA/30 Days acetaminophen 325mg/oxycodone 5mg tab 1 QL=360 EA/30 Days acetaminophen 325mg/oxycodone 7.5mg tab 1 QL=360 EA/30 Days acetaminophen 325mg/tramadol 37.5mg tab 1 QL=360 EA/30 Days aspirin 325mg/oxycodone 4.84mg tab 1 QL=360 EA/30 Days endocet 10-325mg tab 1 QL=360 EA/30 Days endocet 5-325mg tab 1 QL=360 EA/30 Days endocet 7.5-325mg tab 1 QL=360 EA/30 Days hydrocodone 10mg/ibuprofen 200mg tab 1 QL=480 EA/30 Days hydrocodone 5mg/ibuprofen 200mg tab 1 QL=480 EA/30 Days hydrocodone bitartrate 7.5mg/ibuprofen 200mg tab 1 QL=480 EA/30 Days IBUPROFEN 400MG/OXYCODONE 5MG TAB 1 QL=240 EA/30 Days lorcet 10-325mg tab 1 QL=360 EA/30 Days lorcet 5-325mg tab 1 QL=360 EA/30 Days lorcet 7.5-325mg tab 1 QL=360 EA/30 Days vicodin 10-300mg tab 1 QL=390 EA/30 Days vicodin 5-300mg tab 1 QL=390 EA/30 Days vicodin 7.5-300mg tab 1 QL=390 EA/30 Days

OPIOID PARTIAL AGONISTS BUNAVAIL 2.1-0.3MG FILM 2 BUNAVAIL 4.2-0.7MG FILM 2 BUNAVAIL 6.3-1MG FILM 2 buprenorphine 0.3mg/ml cartridge 1 buprenorphine 0.3mg/ml inj 1 buprenorphine 2mg sl tab 1 PA buprenorphine 8mg sl tab 1 PA butorphanol tartrate 10mg/ml nasal spray 1 QL=10 ML/30 Days BUTORPHANOL TARTRATE 1MG/ML INJ 1 butorphanol tartrate 2mg/ml inj 1 naloxone 0.5mg/pentazocine 50mg tab 1 QL=360 EA/30 Days SUBOXONE 12-3MG STRIP 2 SUBOXONE 2-0.5MG STRIP 2 SUBOXONE 4-1MG STRIP 2 SUBOXONE 8-2MG STRIP 2



ANDROGENS-ANABOLIC ANABOLIC STEROIDS

ANADROL-50 50MG TAB 2 oxandrolone 10mg tab 1 oxandrolone 2.5mg tab 1

ANDROGENS ANDRODERM 2MG/24HR PATCH 2 PA QL=60 EA/30 Days ANDRODERM 4MG/24HR PATCH 2 PA QL=30 EA/30 Days ANDROGEL 1% (25MG) GEL 2 PA QL=300 GM/30 Days


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ANDROGEL 1% (50MG) GEL 2 PA QL=300 GM/30 Days ANDROGEL 1.62% (1.25GM) GEL 2 PA QL=37.50 GM/30 Days ANDROGEL 1.62% (2.5GM) GEL 2 PA QL=150 GM/30 Days ANDROGEL 1.62% GEL 2 PA QL=150 GM/30 Days danazol 100mg cap 1 danazol 200mg cap 1 danazol 50mg cap 1 testosterone 1% (25mg) gel 1 PA QL=300 GM/30 Days testosterone 1% (50mg) gel 1 PA QL=300 GM/30 Days testosterone 1% gel pump 1 PA QL=300 GM/30 Days testosterone cypionate 100mg/ml inj 1 testosterone cypionate 200mg/ml inj 1 testosterone enanthate 200mg/ml inj 1



ANORECTAL AGENTS INTRARECTAL STEROIDS

colocort 100mg/60ml enema 1 hydrocortisone 1.67mg/ml enema 1 UCERIS 2MG/ACT FOAM 2 PA

RECTAL COMBINATIONS hydrocortisone/pramoxine 1-1% rectal cream 1

RECTAL STEROIDS procto-med 2.5% cream 1 procto-pak 1% rectal cream 1 proctosol 2.5% cream 1 proctozone hc 2.5% cream 1

ANTACIDS ANTACID COMBINATIONS

aluminum hydroxide/magnesium carbonate chew tab 160-105mg*

4

aluminum hydroxide/magnesium trisilicate chew tab 80-20mg*

4

aluminum/magnesium hydroxide/simethicone chew tab 200-200-25mg*

4

aluminum/magnesium hydroxide/simethicone susp 200-200-20mg/5ml*

4


4

CALCIUM CARBONATE/SIMETHICONE CHEW TAB 1000-60MG*

4

ANTACIDS - ALUMINUM SALTS ALUMINUM HYDROXIDE GEL SUSP 320MG/5ML* 4

ANTACIDS - BICARBONATE sodium bicarbonate tab 650mg* 4


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ANTACIDS - CALCIUM SALTS calcium carbonate (antacid) chew tab 1000mg* 4 calcium carbonate (antacid) chew tab 400mg* 4 calcium carbonate (antacid) chew tab 420mg* 4 calcium carbonate (antacid) chew tab 500mg* 4 calcium carbonate (antacid) chew tab 750mg* 4 CALCIUM CARBONATE (ANTACID) TAB 648MG* 4

ANTACIDS - MAGNESIUM SALTS magnesium oxide tab 250mg* 4 magnesium oxide tab 400mg* 4 magnesium oxide tab 420mg* 4



ANTHELMINTICS ANTHELMINTICS

ALBENZA 200MG TAB 2 NDS ivermectin 3mg tab 1 pyrantel pamoate susp* 4

ANTIANGINAL AGENTS ANTIANGINALS-OTHER

RANEXA 1000MG ER TAB 2 RANEXA 500MG ER TAB 2

NITRATES isosorbide dinitrate 10mg tab 1 isosorbide dinitrate 20mg tab 1 isosorbide dinitrate 30mg tab 1 ISOSORBIDE DINITRATE 40MG ER TAB 2 isosorbide dinitrate 5mg tab 1 isosorbide mononitrate 10mg tab 1 isosorbide mononitrate 120mg er tab 1 isosorbide mononitrate 20mg tab 1 isosorbide mononitrate 30mg er tab 1 isosorbide mononitrate 60mg er tab 1 minitran 0.1mg/hr patch 1 minitran 0.2mg/hr patch 1 minitran 0.4mg/hr patch 1 minitran 0.6mg/hr patch 1 NITRO-DUR 0.3MG/HR PATCH 2 NITRO-DUR 0.8MG/HR PATCH 2 nitroglycerin 0.1mg/hr patch 1 nitroglycerin 0.2mg/hr patch 1 nitroglycerin 0.3mg sl tab 1 nitroglycerin 0.4mg sl tab 1 nitroglycerin 0.4mg/act pump spray 1 nitroglycerin 0.4mg/hr patch 1


13

nitroglycerin 0.6mg sl tab 1 nitroglycerin 0.6mg/hr patch 1



ANTIANXIETY AGENTS ANTIANXIETY AGENTS - MISC.

buspirone 10mg tab 1 buspirone 15mg tab 1 buspirone 30mg tab 1 buspirone 5mg tab 1 buspirone 7.5mg tab 1 hydroxyzine 10mg tab 1 hydroxyzine 25mg tab 1 HYDROXYZINE 25MG/ML INJ 1 hydroxyzine 2mg/ml oral soln 1 hydroxyzine 50mg tab 1 hydroxyzine 50mg/ml inj 1 HYDROXYZINE PAMOATE 100MG CAP 1 hydroxyzine pamoate 25mg cap 1 hydroxyzine pamoate 50mg cap 1

BENZODIAZEPINES alprazolam 0.25mg odt 1 alprazolam 0.25mg tab 1 alprazolam 0.5mg er tab 1 alprazolam 0.5mg odt 1 alprazolam 0.5mg tab 1 alprazolam 1mg er tab 1 alprazolam 1mg odt 1 alprazolam 1mg tab 1 alprazolam 2mg er tab 1 alprazolam 2mg odt 1 alprazolam 2mg tab 1 alprazolam 3mg er tab 1 chlordiazepoxide 10mg cap 1 chlordiazepoxide 25mg cap 1 chlordiazepoxide 5mg cap 1 clorazepate dipotassium 15mg tab 1 clorazepate dipotassium 3.75mg tab 1 clorazepate dipotassium 7.5mg tab 1 diazepam 10mg tab 1 DIAZEPAM 1MG/ML ORAL SOLN 1 diazepam 2mg tab 1 diazepam 5mg tab 1 diazepam 5mg/ml oral soln 1 lorazepam 0.5mg tab 1


14

lorazepam 1mg tab 1 lorazepam 2mg tab 1 lorazepam 2mg/ml oral conc 1 oxazepam 10mg cap 1 oxazepam 15mg cap 1 oxazepam 30mg cap 1



ANTIARRHYTHMICS ANTIARRHYTHMICS TYPE I-A

disopyramide 100mg cap 1 disopyramide 150mg cap 1 NORPACE 100MG ER CAP 2 NORPACE 150MG ER CAP 2 procainamide 100mg/ml inj 1 procainamide 500mg/ml inj 1 quinidine gluconate 324mg er tab 1 QUINIDINE GLUCONATE 80MG/ML INJ 2 QUINIDINE SULFATE 200MG TAB 1 QUINIDINE SULFATE 300MG TAB 1

ANTIARRHYTHMICS TYPE I-B mexiletine 150mg cap 1 mexiletine 200mg cap 1 mexiletine 250mg cap 1

ANTIARRHYTHMICS TYPE I-C flecainide acetate 100mg tab 1 flecainide acetate 150mg tab 1 flecainide acetate 50mg tab 1 propafenone 150mg tab 1 propafenone 225mg er cap 1 propafenone 225mg tab 1 propafenone 300mg tab 1 propafenone 325mg er cap 1 propafenone 425mg er cap 1

ANTIARRHYTHMICS TYPE III amiodarone 200mg tab 1 amiodarone 400mg tab 1 amiodarone 50mg/ml inj 1 dofetilide 125mcg cap 1 dofetilide 250mcg cap 1 dofetilide 500mcg cap 1 MULTAQ 400MG TAB 2 PA NEXTERONE 150MG/100ML INJ 2 NEXTERONE 360MG/200ML INJ 2 pacerone 200mg tab 1


15

pacerone 400mg tab 1



ANTIASTHMATIC AND BRONCHODILATOR AGENTS ANTIASTHMATIC - MONOCLONAL ANTIBODIES

NUCALA 100MG INJ 2 NDS PA XOLAIR 150MG INJ 2 NDS PA

ANTI-INFLAMMATORY AGENTS CROMOLYN SODIUM 10MG/ML INH SOLN 1 PA BvD

BRONCHODILATORS - ANTICHOLINERGICS ATROVENT 17MCG INH 2 INCRUSE 62.5MCG INH 2 ipratropium bromide 0.02% inh soln 1 PA BvD SPIRIVA 1.25MCG RESPIMAT INH 2 ST QL=4 GM/30 Days SPIRIVA 18MCG HANDIHALER 2 SPIRIVA 2.5MCG RESPIMAT INH 2

LEUKOTRIENE MODULATORS montelukast 10mg tab 1 montelukast 4mg chew tab 1 montelukast 4mg granules 1 montelukast 5mg chew tab 1 zafirlukast 10mg tab 1 zafirlukast 20mg tab 1 zileuton 600mg er tab 1

SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS DALIRESP 250MCG TAB 2 DALIRESP 500MCG TAB 2

STEROID INHALANTS ARNUITY 100MCG INH 2 QL=30 EA/30 Days ARNUITY 200MCG INH 2 QL=30 EA/30 Days ASMANEX 100MCG (120ACT) HFA INH 2 QL=13 GM/30 Days ASMANEX 110MCG (30ACT) INH 2 QL=1 EA/30 Days ASMANEX 200MCG (120ACT) HFA INH 2 QL=13 GM/30 Days ASMANEX 220MCG (120ACT) INH 2 QL=1 EA/30 Days ASMANEX 220MCG (30ACT) INH 2 QL=1 EA/30 Days ASMANEX 220MCG (60ACT) INH 2 QL=1 EA/30 Days budesonide 0.125mg/ml inh soln 1 PA BvD QL=120 ML/30 Days budesonide 0.25mg/ml inh soln 1 PA BvD QL=120 ML/30 Days budesonide 0.5mg/ml inh soln 1 PA BvD QL=120 ML/30 Days FLOVENT 100MCG DISKUS 2 QL=60 EA/30 Days FLOVENT 110MCG HFA INH 2 QL=24 GM/30 Days FLOVENT 220MCG HFA INH 2 QL=24 GM/30 Days FLOVENT 250MCG DISKUS 2 QL=60 EA/30 Days FLOVENT 44MCG HFA INH 2 QL=21.20 GM/30 Days FLOVENT 50MCG DISKUS 2 QL=60 EA/30 Days


16

SYMPATHOMIMETICS ADVAIR 100-50MCG DISKUS 2 QL=60 EA/30 Days ADVAIR 115-21MCG HFA INH 2 QL=12 GM/30 Days ADVAIR 230-21MCG HFA INH 2 QL=12 GM/30 Days ADVAIR 250-50MCG DISKUS 2 QL=60 EA/30 Days ADVAIR 45-21MCG HFA INH 2 QL=12 GM/30 Days ADVAIR 500-50MCG DISKUS 2 QL=60 EA/30 Days albuterol 0.21mg/ml (0.63mg/3ml) inh soln 1 PA BvD albuterol 0.417mg/ml (1.25mg/3ml) inh soln 1 PA BvD albuterol 0.4mg/ml (2mg/5ml) oral soln 1 albuterol 0.83mg/ml (0.083%) inh soln 1 PA BvD albuterol 1mg/ml (0.5%) inh soln 1 PA BvD albuterol 2mg tab 1 albuterol 4mg er tab 1 albuterol 4mg tab 1 albuterol 8mg er tab 1 ANORO 62.5-25MCG ELLIPTA INH 2 QL=60 EA/30 Days BREO 100-25MCG ELLIPTA INH 2 QL=60 EA/30 Days BREO 200-25MCG ELLIPTA INH 2 QL=60 EA/30 Days COMBIVENT RESPIMAT 20-100MCG INH 2 DULERA 100-5MCG INH 2 QL=13 GM/30 Days DULERA 200-5MCG INH 2 QL=13 GM/30 Days FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE 113-14MCG/ACT POWDER INH

1

FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE 232-14MCG/ACT POWDER INH

1

FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE 55-14MCG/ACT POWDER INH

1

ipratropium/albuterol 0.5-2.5mg/3ml inh soln 1 PA BvD levalbuterol 0.31mg inh soln 1 PA BvD levalbuterol 0.63mg inh soln 1 PA BvD levalbuterol 1.25mg inh soln 1 PA BvD levalbuterol 2.5mg inh soln 1 PA BvD METAPROTERENOL SULFATE 10MG TAB 2 METAPROTERENOL SULFATE 20MG TAB 2 METAPROTERENOL SULFATE 2MG/ML ORAL SOLN

2

SEREVENT 50MCG/DOSE INH 2 terbutaline sulfate 1mg/ml inj 1 terbutaline sulfate 2.5mg tab 1 terbutaline sulfate 5mg tab 1 TRELEGY 62.5-25MCG ELLIPTA INH 2 VENTOLIN 108MCG INH 2 QL=36 GM/30 Days




17

XANTHINES aminophylline 25mg/ml inj 1 theophylline 100mg er tab 1 theophylline 200mg er tab 1 theophylline 300mg er tab 1 theophylline 400mg er tab 1 theophylline 5.33mg/ml oral soln 1 theophylline 600mg er tab 1



ANTICOAGULANTS COUMARIN ANTICOAGULANTS

jantoven 10mg tab 1 jantoven 1mg tab 1 jantoven 2.5mg tab 1 jantoven 2mg tab 1 jantoven 3mg tab 1 jantoven 4mg tab 1 jantoven 5mg tab 1 jantoven 6mg tab 1 jantoven 7.5mg tab 1 warfarin sodium 10mg tab 1 warfarin sodium 1mg tab 1 warfarin sodium 2.5mg tab 1 warfarin sodium 2mg tab 1 warfarin sodium 3mg tab 1 warfarin sodium 4mg tab 1 warfarin sodium 5mg tab 1 warfarin sodium 6mg tab 1 warfarin sodium 7.5mg tab 1

DIRECT FACTOR XA INHIBITORS ELIQUIS 2.5MG TAB 2 ELIQUIS 30-DAY STARTER PACK 2 ELIQUIS 5MG TAB 2 XARELTO 10MG TAB 2 XARELTO 15MG TAB 2 XARELTO 20MG TAB 2 XARELTO STARTER PACK 2

HEPARINS AND HEPARINOID-LIKE AGENTS enoxaparin sodium 100mg/1ml syringe 1 QL=34 ML/17 Days enoxaparin sodium 120mg/0.8ml syringe 1 QL=27.20 ML/17 Days enoxaparin sodium 150mg/1ml syringe 1 QL=34 ML/17 Days enoxaparin sodium 300mg/3ml syringe 1 QL=51 ML/17 Days enoxaparin sodium 30mg/0.3ml syringe 1 QL=10.20 ML/17 Days enoxaparin sodium 40mg/0.4ml syringe 1 QL=13.60 ML/17 Days


18

enoxaparin sodium 60mg/0.6ml syringe 1 QL=20.40 ML/17 Days enoxaparin sodium 80mg/0.8ml syringe 1 QL=27.20 ML/17 Days fondaparinux sodium 12.5mg/ml (0.4ml) syringe 1 PA fondaparinux sodium 12.5mg/ml (0.6ml) syringe 1 PA fondaparinux sodium 12.5mg/ml (0.8ml) syringe 1 PA fondaparinux sodium 5mg/ml syringe 1 PA FRAGMIN 10000UNIT/ML SYRINGE 2 FRAGMIN 12500UNIT/0.5ML SYRINGE 2 FRAGMIN 15000UNIT/0.6ML SYRINGE 2 FRAGMIN 18000UNIT/0.72ML SYRINGE 2 FRAGMIN 2500UNIT/0.2ML SYRINGE 2 FRAGMIN 5000UNIT/0.2ML SYRINGE 2 FRAGMIN 7500UNIT/0.3ML SYRINGE 2 FRAGMIN 95000UNIT/3.8ML INJ 2 NDS heparin sodium, porcine 10000unit/ml inj 1 PA BvD heparin sodium, porcine 1000unit/ml inj 1 PA BvD HEPARIN SODIUM, PORCINE 100UNIT/ML INJ 1 PA BvD heparin sodium, porcine 20000unit/ml inj 1 PA BvD heparin sodium, porcine 40unit/ml inj 1 PA BvD heparin sodium, porcine 5000unit/ml inj 1 PA BvD heparin sodium, porcine 50unit/ml inj 1 PA BvD

THROMBIN INHIBITORS argatroban 100mg/ml inj 1 ARGATROBAN 1MG/ML INJ 2 PA BvD PRADAXA 110MG CAP 2 PRADAXA 150MG CAP 2 PRADAXA 75MG CAP 2



ANTICONVULSANTS AMPA GLUTAMATE RECEPTOR ANTAGONISTS

FYCOMPA 0.5MG/ML ORAL SUSP 2 PA NSO FYCOMPA 10MG TAB 2 PA NSO FYCOMPA 12MG TAB 2 PA NSO FYCOMPA 2MG TAB 2 PA NSO FYCOMPA 4MG TAB 2 PA NSO FYCOMPA 6MG TAB 2 PA NSO FYCOMPA 8MG TAB 2 PA NSO

ANTICONVULSANTS - BENZODIAZEPINES clonazepam 0.125mg odt 1 clonazepam 0.25mg odt 1 clonazepam 0.5mg odt 1 clonazepam 0.5mg tab 1 clonazepam 1mg odt 1 clonazepam 1mg tab 1


19

clonazepam 2mg odt 1 clonazepam 2mg tab 1 DIASTAT 10MG APPLICATOR 2 DIASTAT 2.5MG APPLICATOR 2 DIASTAT 20MG PF APPLICATOR 2 ONFI 10MG TAB 2 PA NSO ONFI 2.5MG/ML ORAL SUSP 2 PA NSO ONFI 20MG TAB 2 PA NSO

ANTICONVULSANTS - MISC. APTIOM 200MG TAB 2 PA NSO APTIOM 400MG TAB 2 PA NSO APTIOM 600MG TAB 2 PA NSO APTIOM 800MG TAB 2 PA NSO BANZEL 200MG TAB 2 BANZEL 400MG TAB 2 BANZEL 40MG/ML ORAL SUSP 2 BRIVIACT 100MG TAB 2 PA NSO QL=60 EA/30 Days BRIVIACT 10MG TAB 2 PA NSO QL=60 EA/30 Days BRIVIACT 10MG/ML INJ 2 PA NSO BRIVIACT 10MG/ML ORAL SOLN 2 PA NSO BRIVIACT 25MG TAB 2 PA NSO QL=60 EA/30 Days BRIVIACT 50MG TAB 2 PA NSO QL=60 EA/30 Days BRIVIACT 75MG TAB 2 PA NSO QL=60 EA/30 Days carbamazepine 100mg chew tab 1 carbamazepine 100mg er cap 1 carbamazepine 100mg er tab 1 carbamazepine 200mg er cap 1 carbamazepine 200mg er tab 1 carbamazepine 200mg tab 1 carbamazepine 20mg/ml oral susp 1 carbamazepine 300mg er cap 1 carbamazepine 400mg er tab 1 epitol 200mg tab 1 gabapentin 100mg cap 1 gabapentin 300mg cap 1 gabapentin 400mg cap 1 gabapentin 50mg/ml oral soln 1 gabapentin 600mg tab 1 gabapentin 800mg tab 1 LAMICTAL BLUE KIT 2 LAMICTAL GREEN KIT 2 LAMICTAL ORANGE KIT 2 LAMICTAL XR BLUE KIT 2




20

LAMICTAL XR GREEN KIT 2 LAMICTAL XR ORANGE KIT 2 lamotrigine 100mg er tab 1 lamotrigine 100mg odt 1 lamotrigine 100mg tab 1 lamotrigine 150mg tab 1 lamotrigine 200mg er tab 1 lamotrigine 200mg odt 1 lamotrigine 200mg tab 1 lamotrigine 250mg er tab 1 lamotrigine 25mg (35) tab starter pack 1 lamotrigine 25mg (42)/100mg (7) tab starter pack 1 lamotrigine 25mg chew tab 1 lamotrigine 25mg er tab 1 lamotrigine 25mg odt 1 lamotrigine 25mg tab 1 lamotrigine 300mg er tab 1 lamotrigine 50mg er tab 1 lamotrigine 50mg odt 1 lamotrigine 5mg chew tab 1 lamotrigine tab 25mg (84)/100mg (14) starter pack 1 levetiracetam 1000mg tab 1 levetiracetam 100mg/ml inj 1 levetiracetam 100mg/ml oral soln 1 levetiracetam 10mg/ml inj 1 levetiracetam 15mg/ml inj 1 levetiracetam 250mg tab 1 levetiracetam 500mg er tab 1 levetiracetam 500mg tab 1 levetiracetam 5mg/ml inj 1 levetiracetam 750mg er tab 1 levetiracetam 750mg tab 1 LYRICA 100MG CAP 2 LYRICA 150MG CAP 2 LYRICA 200MG CAP 2 LYRICA 20MG/ML ORAL SOLN 2 LYRICA 225MG CAP 2 LYRICA 25MG CAP 2 LYRICA 300MG CAP 2 LYRICA 50MG CAP 2 LYRICA 75MG CAP 2 oxcarbazepine 150mg tab 1 oxcarbazepine 300mg tab 1




21

oxcarbazepine 600mg tab 1 oxcarbazepine 60mg/ml oral susp 1 OXTELLAR 150MG XR TAB 2 OXTELLAR 300MG XR TAB 2 OXTELLAR 600MG XR TAB 2 primidone 250mg tab 1 primidone 50mg tab 1 QUDEXY 100MG XR CAP 2 PA NSO QUDEXY 150MG XR CAP 2 PA NSO QUDEXY 200MG XR CAP 2 PA NSO QUDEXY 25MG XR CAP 2 PA NSO QUDEXY 50MG XR CAP 2 PA NSO roweepra 1000mg tab 1 roweepra 500mg er tab 1 roweepra 500mg tab 1 roweepra 750mg er tab 1 roweepra 750mg tab 1 SPRITAM 1000MG ODT 2 PA NSO SPRITAM 250MG ODT 2 PA NSO SPRITAM 500MG ODT 2 PA NSO SPRITAM 750MG ODT 2 PA NSO TOPIRAMATE 100MG ER CAP 2 PA NSO topiramate 100mg tab 1 TOPIRAMATE 150MG ER CAP 2 PA NSO topiramate 15mg cap 1 TOPIRAMATE 200MG ER CAP 2 PA NSO topiramate 200mg tab 1 topiramate 25mg cap 1 TOPIRAMATE 25MG ER CAP 2 PA NSO topiramate 25mg tab 1 TOPIRAMATE 50MG ER CAP 2 PA NSO topiramate 50mg tab 1 TROKENDI 100MG XR CAP 2 PA NSO TROKENDI 200MG XR CAP 2 PA NSO TROKENDI 25MG XR CAP 2 PA NSO TROKENDI 50MG XR CAP 2 PA NSO VIMPAT 100MG TAB 2 QL=60 EA/30 Days VIMPAT 10MG/ML ORAL SOLN 2 VIMPAT 150MG TAB 2 QL=60 EA/30 Days VIMPAT 200MG TAB 2 QL=60 EA/30 Days VIMPAT 200MG/20ML INJ 2 VIMPAT 50MG TAB 2 QL=60 EA/30 Days zonisamide 100mg cap 1




22

zonisamide 25mg cap 1 zonisamide 50mg cap 1

CARBAMATES felbamate 120mg/ml oral susp 1 felbamate 400mg tab 1 felbamate 600mg tab 1

GABA MODULATORS GABITRIL 12MG TAB 2 GABITRIL 16MG TAB 2 SABRIL 500MG TAB 2 NDS PA NSO tiagabine 12mg tab 1 tiagabine 16mg tab 1 tiagabine 2mg tab 1 tiagabine 4mg tab 1 vigabatrin 50mg/ml oral soln 1 PA NSO

HYDANTOINS DILANTIN 30MG ER CAP 2 fosphenytoin sodium 75mg/ml inj 1 PEGANONE 250MG TAB 2 phenytoin 25mg/ml oral susp 1 phenytoin 50mg chew tab 1 phenytoin sodium 100mg er cap 1 phenytoin sodium 200mg er cap 1 phenytoin sodium 300mg er cap 1 phenytoin sodium 50mg/ml inj 1

SUCCINIMIDES CELONTIN 300MG CAP 2 ethosuximide 250mg cap 1 ethosuximide 50mg/ml oral soln 1

VALPROIC ACID divalproex sodium 125mg dr cap 1 divalproex sodium 125mg dr tab 1 divalproex sodium 250mg dr tab 1 divalproex sodium 250mg er tab 1 divalproex sodium 500mg dr tab 1 divalproex sodium 500mg er tab 1 valproic acid 100mg/ml inj 1 valproic acid 250mg cap 1 valproic acid 50mg/ml oral soln 1



ANTIDEPRESSANTS ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)

mirtazapine 15mg odt 1 mirtazapine 15mg tab 1


23

mirtazapine 30mg odt 1 mirtazapine 30mg tab 1 mirtazapine 45mg odt 1 mirtazapine 45mg tab 1 mirtazapine 7.5mg tab 1

ANTIDEPRESSANTS - MISC. APLENZIN 174MG ER TAB 2 ST APLENZIN 348MG ER TAB 2 ST APLENZIN 522MG ER TAB 2 ST bupropion 100mg sr tab 1 bupropion 100mg tab 1 bupropion 150mg sr (12 hr) tab 1 bupropion 150mg xl (24 hr) tab 1 bupropion 200mg sr tab 1 bupropion 300mg xl tab 1 bupropion 75mg tab 1 MAPROTILINE 25MG TAB 1 MAPROTILINE 50MG TAB 1 MAPROTILINE 75MG TAB 1

MONOAMINE OXIDASE INHIBITORS (MAOIS) EMSAM 12MG/24HR PATCH 2 EMSAM 6MG/24HR PATCH 2 EMSAM 9MG/24HR PATCH 2 MARPLAN 10MG TAB 2 phenelzine 15mg tab 1 tranylcypromine 10mg tab 1

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) citalopram 10mg tab 1 citalopram 20mg tab 1 citalopram 2mg/ml oral soln 1 citalopram 40mg tab 1 escitalopram 10mg tab 1 escitalopram 1mg/ml oral soln 1 escitalopram 20mg tab 1 escitalopram 5mg tab 1 fluoxetine 10mg cap 1 fluoxetine 10mg tab 1 fluoxetine 20mg cap 1 fluoxetine 20mg tab 1 fluoxetine 40mg cap 1 fluoxetine 4mg/ml oral soln 1 fluvoxamine maleate 100mg er cap 1 ST fluvoxamine maleate 100mg tab 1




24

fluvoxamine maleate 150mg er cap 1 ST fluvoxamine maleate 25mg tab 1 fluvoxamine maleate 50mg tab 1 paroxetine 10mg tab 1 paroxetine 12.5mg er tab 1 paroxetine 20mg tab 1 paroxetine 25mg er tab 1 paroxetine 30mg tab 1 paroxetine 37.5mg er tab 1 paroxetine 40mg tab 1 PAXIL 10MG/5ML ORAL SUSP 2 PEXEVA 10MG TAB 2 ST PEXEVA 20MG TAB 2 ST PEXEVA 30MG TAB 2 ST PEXEVA 40MG TAB 2 ST sertraline 100mg tab 1 sertraline 20mg/ml oral soln 1 sertraline 25mg tab 1 sertraline 50mg tab 1

SEROTONIN MODULATORS NEFAZODONE 100MG TAB 2 NEFAZODONE 150MG TAB 2 NEFAZODONE 200MG TAB 2 nefazodone 250mg tab 1 nefazodone 50mg tab 1 trazodone 100mg tab 1 trazodone 150mg tab 1 trazodone 300mg tab 1 trazodone 50mg tab 1 TRINTELLIX 10MG TAB 2 ST QL=30 EA/30 Days TRINTELLIX 20MG TAB 2 ST QL=30 EA/30 Days TRINTELLIX 5MG TAB 2 ST QL=30 EA/30 Days VIIBRYD 10/20MG STARTER PACK 2 ST QL=30 EA/30 Days VIIBRYD 10MG TAB 2 ST QL=30 EA/30 Days VIIBRYD 20MG TAB 2 ST QL=30 EA/30 Days VIIBRYD 40MG TAB 2 ST QL=30 EA/30 Days

SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) desvenlafaxine succinate 100mg er tab 1 desvenlafaxine succinate 25mg er tab 1 desvenlafaxine succinate 50mg er tab 1 duloxetine 20mg dr cap 1 duloxetine 30mg dr cap 1 DULOXETINE 40MG DR CAP 2 ST QL=30 EA/30 Days




25

duloxetine 60mg dr cap 1 FETZIMA 120MG ER CAP 2 ST QL=30 EA/30 Days FETZIMA 20MG ER CAP 2 ST QL=30 EA/30 Days FETZIMA 40MG ER CAP 2 ST QL=30 EA/30 Days FETZIMA 80MG ER CAP 2 ST QL=30 EA/30 Days FETZIMA PACK 2 ST QL=30 EA/30 Days venlafaxine 100mg tab 1 venlafaxine 150mg er cap 1 venlafaxine 25mg tab 1 venlafaxine 37.5mg er cap 1 venlafaxine 37.5mg tab 1 venlafaxine 50mg tab 1 venlafaxine 75mg er cap 1 venlafaxine 75mg tab 1

TRICYCLIC AGENTS amitriptyline 100mg tab 1 amitriptyline 10mg tab 1 amitriptyline 150mg tab 1 amitriptyline 25mg tab 1 amitriptyline 50mg tab 1 amitriptyline 75mg tab 1 AMOXAPINE 100MG TAB 2 AMOXAPINE 150MG TAB 2 AMOXAPINE 25MG TAB 2 AMOXAPINE 50MG TAB 2 clomipramine 25mg cap 1 clomipramine 50mg cap 1 clomipramine 75mg cap 1 desipramine 100mg tab 1 desipramine 10mg tab 1 desipramine 150mg tab 1 desipramine 25mg tab 1 desipramine 50mg tab 1 desipramine 75mg tab 1 doxepin 100mg cap 1 doxepin 10mg cap 1 doxepin 10mg/ml oral soln 1 doxepin 150mg cap 1 doxepin 25mg cap 1 doxepin 50mg cap 1 DOXEPIN 75MG CAP 1 imipramine 10mg tab 1 imipramine 25mg tab 1




26

imipramine 50mg tab 1 imipramine pamoate 100mg cap 1 imipramine pamoate 125mg cap 1 imipramine pamoate 150mg cap 1 imipramine pamoate 75mg cap 1 nortriptyline 10mg cap 1 nortriptyline 25mg cap 1 NORTRIPTYLINE 2MG/ML ORAL SOLN 1 nortriptyline 50mg cap 1 nortriptyline 75mg cap 1 protriptyline 10mg tab 1 protriptyline 5mg tab 1 trimipramine 100mg cap 1 trimipramine 25mg cap 1 trimipramine 50mg cap 1



ANTIDIABETICS ALPHA-GLUCOSIDASE INHIBITORS

acarbose 100mg tab 1 acarbose 25mg tab 1 acarbose 50mg tab 1 miglitol 100mg tab 1 miglitol 25mg tab 1 miglitol 50mg tab 1

ANTIDIABETIC COMBINATIONS ALOGLIPTIN 12.5MG/METFORMIN 1000MG TAB 2 QL=60 EA/30 Days ALOGLIPTIN 12.5MG/METFORMIN 500MG TAB 2 QL=60 EA/30 Days ALOGLIPTIN 12.5MG/PIOGLITAZONE 15MG TAB 2 QL=30 EA/30 Days ALOGLIPTIN 12.5MG/PIOGLITAZONE 30MG TAB 2 QL=30 EA/30 Days ALOGLIPTIN 12.5MG/PIOGLITAZONE 45MG TAB 2 QL=30 EA/30 Days ALOGLIPTIN 25MG/PIOGLITAZONE 15MG TAB 2 QL=30 EA/30 Days ALOGLIPTIN 25MG/PIOGLITAZONE 30MG TAB 2 QL=30 EA/30 Days ALOGLIPTIN 25MG/PIOGLITAZONE 45MG TAB 2 QL=30 EA/30 Days glimepiride 2mg/pioglitazone 30mg tab 1 glimepiride 4mg/pioglitazone 30mg tab 1 glipizide 2.5mg/metformin 250mg tab 1 glipizide 2.5mg/metformin 500mg tab 1 glipizide 5mg/metformin 500mg tab 1 glyburide 1.25mg/metformin 250mg tab 1 glyburide 2.5mg/metformin 500mg tab 1 glyburide 5mg/metformin 500mg tab 1 JANUMET 100-1000MG XR TAB 2 QL=30 EA/30 Days JANUMET 50-1000MG TAB 2 QL=60 EA/30 Days JANUMET 50-1000MG XR TAB 2 QL=60 EA/30 Days


27

JANUMET 50-500MG TAB 2 QL=60 EA/30 Days JANUMET 50-500MG XR TAB 2 QL=60 EA/30 Days metformin 500mg/pioglitazone 15mg tab 1 metformin 850mg/pioglitazone 15mg tab 1 SYNJARDY 12.5-1000MG TAB 2 QL=60 EA/30 Days SYNJARDY 12.5-500MG TAB 2 QL=60 EA/30 Days SYNJARDY 5-1000MG TAB 2 QL=60 EA/30 Days SYNJARDY 5-500MG TAB 2 QL=60 EA/30 Days SYNJARDY XR 10-1000MG TAB 2 QL=30 EA/30 Days SYNJARDY XR 12.5-1000MG TAB 2 QL=60 EA/30 Days SYNJARDY XR 25-1000MG TAB 2 QL=30 EA/30 Days SYNJARDY XR 5-1000MG TAB 2 QL=60 EA/30 Days XIGDUO 10-1000MG XR TAB 2 QL=30 EA/30 Days XIGDUO 10-500MG XR TAB 2 QL=30 EA/30 Days XIGDUO 2.5-1000MG XR TAB 2 QL=60 EA/30 Days XIGDUO 5-1000MG XR TAB 2 QL=60 EA/30 Days XIGDUO 5-500MG XR TAB 2 QL=30 EA/30 Days XULTOPHY 100UNIT-3.6MG/ML PEN INJ 2 PA QL=15 ML/30 Days

BIGUANIDES metformin 1000mg tab 1 metformin 500mg er tab 1 metformin 500mg tab 1 metformin 750mg er tab 1 metformin 850mg tab 1

DIABETIC OTHER GLUCAGEN 1MG HYPOKIT 2 GLUCAGON 1MG INJ 2 GLUCOSE CHEW TAB 1GM* 4 GLUCOSE CHEW TAB 4GM* 4 GLUCOSE CHEW TAB 5GM* 4 glucose gel 40%* 4 KORLYM 300MG TAB 2 NDS PA PROGLYCEM 50MG/ML ORAL SUSP 2

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS ALOGLIPTIN 12.5MG TAB 2 QL=30 EA/30 Days ALOGLIPTIN 25MG TAB 2 QL=30 EA/30 Days ALOGLIPTIN 6.25MG TAB 2 QL=30 EA/30 Days JANUVIA 100MG TAB 2 QL=30 EA/30 Days JANUVIA 25MG TAB 2 QL=30 EA/30 Days JANUVIA 50MG TAB 2 QL=30 EA/30 Days

INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS) BYDUREON 2.35MG/ML AUTO-INJECTOR 2 BYDUREON 2MG INJ 2




28

BYDUREON 2MG PEN INJ 2 OZEMPIC 2MG/1.5ML PEN INJ 2 OZEMPIC 2MG/1.5ML PEN INJ (1MG DOSE) 2 VICTOZA 18MG/3ML PEN INJ 2

INSULIN BASAGLAR 100UNIT/ML PEN INJ 2 FIASP 100UNIT/ML INJ 2 FIASP 100UNIT/ML PEN INJ 2 HUMULIN R 500UNIT/ML INJ 2 HUMULIN R 500UNIT/ML PEN INJ 2 LEVEMIR 100UNIT/ML FLEXTOUCH 2 LEVEMIR 100UNIT/ML INJ 2 NOVOLIN 100UNIT/ML INJ 2 NOVOLIN N 100UNIT/ML INJ 2 NOVOLIN R 100UNIT/ML INJ 2 NOVOLOG 100UNIT/ML FLEXPEN 2 NOVOLOG 100UNIT/ML INJ 2 NOVOLOG MIX 100UNIT/ML FLEXPEN 2 NOVOLOG MIX 100UNIT/ML INJ 2

INSULIN SENSITIZING AGENTS AVANDIA 2MG TAB 2 AVANDIA 4MG TAB 2 pioglitazone 15mg tab 1 pioglitazone 30mg tab 1 pioglitazone 45mg tab 1

MEGLITINIDE ANALOGUES nateglinide 120mg tab 1 nateglinide 60mg tab 1 repaglinide 0.5mg tab 1 repaglinide 1mg tab 1 repaglinide 2mg tab 1

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS FARXIGA 10MG TAB 2 QL=30 EA/30 Days FARXIGA 5MG TAB 2 QL=30 EA/30 Days JARDIANCE 10MG TAB 2 QL=30 EA/30 Days JARDIANCE 25MG TAB 2 QL=30 EA/30 Days

SULFONYLUREAS CHLORPROPAMIDE 100MG TAB 1 CHLORPROPAMIDE 250MG TAB 1 glimepiride 1mg tab 1 glimepiride 2mg tab 1 glimepiride 4mg tab 1 glipizide 10mg er tab 1




29

glipizide 10mg tab 1 glipizide 2.5mg er tab 1 glipizide 5mg er tab 1 glipizide 5mg tab 1 glyburide 1.25mg tab 1 glyburide 1.5mg tab 1 glyburide 2.5mg tab 1 glyburide 3mg tab 1 glyburide 5mg tab 1 glyburide 6mg tab 1 tolazamide 250mg tab 1 tolazamide 500mg tab 1 TOLBUTAMIDE 500MG TAB 2



ANTIDIARRHEALS ANTIDIARRHEAL AGENTS - MISC.

bismuth subsalicylate chew tab 262mg* 4 bismuth subsalicylate susp 525mg/15ml* 4 bismuth subsalicylate tab 262mg* 4

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

1

atropine sulfate 0.025mg/diphenoxylate 2.5mg tab 1 loperamide 2mg cap 1 loperamide liquid 1mg/5ml* 4 loperamide liquid 1mg/7.5ml* 4 loperamide tab 2mg* 4

ANTIDOTES ANTIDOTES

fomepizole 1000mg/ml inj 1 ANTIDOTES - CHELATING AGENTS

CHEMET 100MG CAP 2 FERRIPROX 100MG/ML ORAL SOLN 2 NDS PA FERRIPROX 500MG TAB 2 NDS PA JADENU 180MG TAB 2 NDS JADENU 90MG TAB 2 NDS

ANTIDOTES AND SPECIFIC ANTAGONISTS ANTIDOTES - CHELATING AGENTS

EXJADE 125MG ORAL SUSP 2 NDS EXJADE 250MG ORAL SUSP 2 NDS EXJADE 500MG ORAL SUSP 2 NDS JADENU 180MG GRANULE PACKET 2 NDS JADENU 360MG GRANULE PACKET 2 NDS JADENU 360MG TAB 2 NDS


30

JADENU 90MG GRANULE PACKET 2 NDS OPIOID ANTAGONISTS

NALOXONE 0.4MG/ML CARTRIDGE 2 NALOXONE 1MG/ML SYRINGE 2 QL=2 ML/2 Days naltrexone 50mg tab 1 NARCAN 4MG/0.1ML NASAL SPRAY 2 QL=2 EA/2 Days



ANTIEMETICS 5-HT3 RECEPTOR ANTAGONISTS

granisetron 0.1mg/ml inj 1 granisetron 1mg tab 1 PA BvD QL=60 EA/30 Days granisetron 1mg/ml (1ml) inj 1 granisetron 1mg/ml inj 1 ondansetron 0.8mg/ml oral soln 1 PA BvD ondansetron 24mg tab 1 PA BvD ondansetron 2mg/ml inj 1 ondansetron 2mg/ml syringe 1 ondansetron 4mg odt 1 PA BvD ondansetron 4mg tab 1 PA BvD ondansetron 8mg odt 1 PA BvD ondansetron 8mg tab 1 PA BvD

ANTIEMETICS - ANTICHOLINERGIC dimenhydrinate tab 50mg* 4 meclizine 12.5mg tab 1 meclizine 25mg tab 1 meclizine chew tab 25mg* 4 scopolamine 1mg/3days patch 1 trimethobenzamide 300mg cap 1 PA

ANTIEMETICS - MISCELLANEOUS CESAMET 1MG CAP 2 PA dronabinol 10mg cap 1 PA dronabinol 2.5mg cap 1 PA dronabinol 5mg cap 1 PA

SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS aprepitant 125mg cap 1 PA BvD QL=3 EA/2 Days aprepitant 125mg/80mg pack 1 PA BvD QL=3 EA/2 Days aprepitant 40mg cap 1 PA BvD QL=3 EA/2 Days aprepitant 80mg cap 1 PA BvD QL=3 EA/2 Days VARUBI 90MG TAB 2 PA BvD QL=2 EA/14 Days

ANTIFUNGALS ANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS)

CANCIDAS 50MG INJ 2 NDS PA CANCIDAS 70MG INJ 2 NDS PA CASPOFUNGIN ACETATE 50MG INJ 2 NDS PA


31

CASPOFUNGIN ACETATE 70MG INJ 2 NDS PA ERAXIS 100MG INJ 2 PA ERAXIS 50MG INJ 2 MYCAMINE 100MG INJ 2 PA MYCAMINE 50MG INJ 2 PA

ANTIFUNGALS ABELCET 5MG/ML INJ 2 PA AMBISOME 50MG INJ 2 PA AMPHOTERICIN B 50MG INJ 2 PA BvD flucytosine 250mg cap 1 flucytosine 500mg cap 1 griseofulvin 125mg tab 1 griseofulvin 250mg tab 1 griseofulvin 25mg/ml oral susp 1 griseofulvin 500mg tab 1 nystatin 500000unit tab 1 terbinafine 250mg tab 1

IMIDAZOLE-RELATED ANTIFUNGALS fluconazole 100mg tab 1 fluconazole 10mg/ml oral susp 1 fluconazole 150mg tab 1 fluconazole 200mg tab 1 fluconazole 2mg/ml (100ml) inj 1 fluconazole 2mg/ml inj 1 fluconazole 40mg/ml oral susp 1 fluconazole 50mg tab 1 itraconazole 100mg cap 1 PA ketoconazole 200mg tab 1 NOXAFIL 100MG DR TAB 2 NDS PA NOXAFIL 40MG/ML ORAL SUSP 2 PA voriconazole 200mg inj 1 PA voriconazole 200mg tab 1 PA voriconazole 40mg/ml oral susp 1 PA voriconazole 50mg tab 1 PA



ANTIHISTAMINES ANTIHISTAMINES - ALKYLAMINES

chlorpheniramine maleate CR tab 12mg* 4 chlorpheniramine maleate syrup 2mg/5ml* 4 chlorpheniramine maleate tab 4mg* 4

ANTIHISTAMINES - ETHANOLAMINES carbinoxamine maleate 0.8mg/ml oral soln 1 carbinoxamine maleate 4mg tab 1 CLEMASTINE FUMARATE 2.68MG TAB 1


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clemastine fumarate tab 1.34mg* 4 diphenhydramine 50mg/ml inj 1 diphenhydramine cap 25mg* 4 diphenhydramine chew tab 12.5mg* 4 diphenhydramine disperse tab 12.5mg* 4 diphenhydramine liquid 12.5mg/5ml* 4 DIPHENHYDRAMINE ORAL STRIP 12.5MG* 4 diphenhydramine tab 25mg* 4

ANTIHISTAMINES - NON-SEDATING cetirizine 1mg/ml oral soln 1 cetirizine chew tab 10mg* 4 cetirizine chew tab 5mg* 4 cetirizine tab 10mg* 4 QL=30 EA/30 Days cetirizine tab 5mg* 4 QL=30 EA/30 Days desloratadine 5mg tab 1 levocetirizine 0.5mg/ml oral soln 1 levocetirizine 5mg tab 1 LORATADINE ODT 5MG* 4 QL=30 EA/30 Days loratadine rapidly-disintegrating tab 10mg* 4 QL=30 EA/30 Days loratadine syrup 5mg/5ml* 4 QL=300 ML/30 Days loratadine tab 10mg* 4 QL=30 EA/30 Days

ANTIHISTAMINES - PHENOTHIAZINES phenadoz 12.5mg rectal supp 1 promethazine 1.25mg/ml oral soln 1 promethazine 12.5mg rectal supp 1 promethazine 12.5mg tab 1 promethazine 25mg rectal supp 1 promethazine 25mg tab 1 promethazine 25mg/ml inj 1 promethazine 50mg rectal supp 1 promethazine 50mg tab 1 promethazine 50mg/ml inj 1 promethegan 25mg rectal supp 1 promethegan 50mg rectal supp 1

ANTIHISTAMINES - PIPERIDINES cyproheptadine 0.4mg/ml oral soln 1 cyproheptadine 4mg tab 1



ANTIHYPERLIPIDEMICS ANTIHYPERLIPIDEMICS - MISC.

KYNAMRO 200MG/ML SYRINGE 2 NDS PA omega-3 acid ethyl esters (usp) 1000mg cap 1 VASCEPA 1GM CAP 2 PA VASCEPA 500MG CAP 2 PA


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BILE ACID SEQUESTRANTS cholestyramine resin 4gm sf powder for oral susp 1 cholestyramine resin 66.7mg/ml oral susp 1 colestipol 1000mg tab 1 colestipol 5000mg granules 1 prevalite 4gm/dose oral susp 1 WELCHOL 3.75GM ORAL SUSP 2 WELCHOL 625MG TAB 1

FIBRIC ACID DERIVATIVES fenofibrate 130mg cap 1 fenofibrate 134mg cap 1 fenofibrate 145mg tab 1 FENOFIBRATE 150MG CAP 2 fenofibrate 160mg tab 1 fenofibrate 200mg cap 1 fenofibrate 43mg cap 1 fenofibrate 48mg tab 1 FENOFIBRATE 50MG CAP 2 fenofibrate 54mg tab 1 fenofibrate 67mg cap 1 fenofibric acid 135mg dr cap 1 fenofibric acid 45mg dr cap 1 gemfibrozil 600mg tab 1

HMG COA REDUCTASE INHIBITORS atorvastatin 10mg tab 1 atorvastatin 20mg tab 1 atorvastatin 40mg tab 1 atorvastatin 80mg tab 1 fluvastatin 20mg cap 1 fluvastatin 40mg cap 1 fluvastatin 80mg er tab 1 lovastatin 10mg tab 1 lovastatin 20mg tab 1 lovastatin 40mg tab 1 pravastatin sodium 10mg tab 1 pravastatin sodium 20mg tab 1 pravastatin sodium 40mg tab 1 pravastatin sodium 80mg tab 1 rosuvastatin 10mg tab 1 rosuvastatin 20mg tab 1 rosuvastatin 40mg tab 1 rosuvastatin 5mg tab 1 simvastatin 10mg tab 1




34

simvastatin 20mg tab 1 simvastatin 40mg tab 1 simvastatin 5mg tab 1 simvastatin 80mg tab 1

INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS ezetimibe 10mg tab 1 QL=30 EA/30 Days

MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN (MTP) INHIBITORS JUXTAPID 10MG CAP 2 NDS PA JUXTAPID 20MG CAP 2 NDS PA JUXTAPID 30MG CAP 2 NDS PA JUXTAPID 40MG CAP 2 NDS PA JUXTAPID 5MG CAP 2 NDS PA JUXTAPID 60MG CAP 2 NDS PA

NICOTINIC ACID DERIVATIVES niacin 1000mg er tab 1 niacin 500mg er tab 1 niacin 750mg er tab 1

PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS PRALUENT 150MG/ML AUTO-INJECTOR 2 NDS PA QL=2 ML/28 Days PRALUENT 75MG/ML AUTO-INJECTOR 2 NDS PA QL=2 ML/28 Days REPATHA 120MG/ML CARTRIDGE 2 NDS PA QL=3.50 ML/28 Days REPATHA 140MG/ML AUTO-INJECTOR 2 NDS PA QL=2 ML/28 Days REPATHA 140MG/ML SYRINGE 2 NDS PA QL=2 ML/28 Days



ANTIHYPERTENSIVES ACE INHIBITORS

benazepril 10mg tab 1 benazepril 20mg tab 1 benazepril 40mg tab 1 benazepril 5mg tab 1 captopril 100mg tab 1 captopril 12.5mg tab 1 captopril 25mg tab 1 captopril 50mg tab 1 enalapril maleate 10mg tab 1 enalapril maleate 2.5mg tab 1 enalapril maleate 20mg tab 1 enalapril maleate 5mg tab 1 fosinopril sodium 10mg tab 1 fosinopril sodium 20mg tab 1 fosinopril sodium 40mg tab 1 lisinopril 10mg tab 1 lisinopril 2.5mg tab 1 lisinopril 20mg tab 1


35

lisinopril 30mg tab 1 lisinopril 40mg tab 1 lisinopril 5mg tab 1 moexipril 15mg tab 1 moexipril 7.5mg tab 1 perindopril erbumine 2mg tab 1 perindopril erbumine 4mg tab 1 perindopril erbumine 8mg tab 1 QBRELIS 1MG/ML ORAL SOLN 2 PA quinapril 10mg tab 1 quinapril 20mg tab 1 quinapril 40mg tab 1 quinapril 5mg tab 1 ramipril 1.25mg cap 1 ramipril 10mg cap 1 ramipril 2.5mg cap 1 ramipril 5mg cap 1 trandolapril 1mg tab 1 trandolapril 2mg tab 1 trandolapril 4mg tab 1

AGENTS FOR PHEOCHROMOCYTOMA DEMSER 250MG CAP 2 NDS phenoxybenzamine 10mg cap 1

ANGIOTENSIN II RECEPTOR ANTAGONISTS candesartan cilexetil 16mg tab 1 candesartan cilexetil 32mg tab 1 candesartan cilexetil 4mg tab 1 candesartan cilexetil 8mg tab 1 EPROSARTAN 600MG TAB 1 irbesartan 150mg tab 1 irbesartan 300mg tab 1 irbesartan 75mg tab 1 losartan potassium 100mg tab 1 losartan potassium 25mg tab 1 losartan potassium 50mg tab 1 olmesartan medoxomil 20mg tab 1 olmesartan medoxomil 40mg tab 1 olmesartan medoxomil 5mg tab 1 telmisartan 20mg tab 1 telmisartan 40mg tab 1 telmisartan 80mg tab 1 valsartan 160mg tab 1 valsartan 320mg tab 1




36

valsartan 40mg tab 1 valsartan 80mg tab 1

ANTIADRENERGIC ANTIHYPERTENSIVES clonidine 0.00417mg/hr patch 1 clonidine 0.00833mg/hr patch 1 clonidine 0.0125mg/hr patch 1 clonidine 0.1mg tab 1 clonidine 0.2mg tab 1 clonidine 0.3mg tab 1 doxazosin 1mg tab 1 doxazosin 2mg tab 1 doxazosin 4mg tab 1 doxazosin 8mg tab 1 guanfacine 1mg tab 1 guanfacine 2mg tab 1 methyldopa 250mg tab 1 methyldopa 500mg tab 1 prazosin 1mg cap 1 prazosin 2mg cap 1 prazosin 5mg cap 1 terazosin 10mg cap 1 terazosin 1mg cap 1 terazosin 2mg cap 1 terazosin 5mg cap 1

ANTIHYPERTENSIVE COMBINATIONS amlodipine 10mg/benazepril 20mg cap 1 amlodipine 10mg/benazepril 40mg cap 1 amlodipine 10mg/hydrochlorothiazide 12.5mg/valsartan 160mg tab

1

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

1


1

amlodipine 10mg/olmesartan medoxomil 20mg tab 1 amlodipine 10mg/olmesartan medoxomil 40mg tab 1 amlodipine 10mg/telmisartan 40mg tab 1 amlodipine 10mg/telmisartan 80mg tab 1 amlodipine 10mg/valsartan 160mg tab 1 amlodipine 10mg/valsartan 320mg tab 1 amlodipine 2.5mg/benazepril 10mg cap 1 amlodipine 5mg/benazepril 10mg cap 1 amlodipine 5mg/benazepril 20mg cap 1 amlodipine 5mg/benazepril 40mg cap 1




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

1


1

amlodipine 5mg/olmesartan medoxomil 20mg tab 1 amlodipine 5mg/olmesartan medoxomil 40mg tab 1 amlodipine 5mg/telmisartan 40mg tab 1 amlodipine 5mg/telmisartan 80mg tab 1 amlodipine 5mg/valsartan 160mg tab 1 amlodipine 5mg/valsartan 320mg tab 1 atenolol 100mg/chlorthalidone 25mg tab 1 atenolol 50mg/chlorthalidone 25mg tab 1 benazepril 10mg/hydrochlorothiazide 12.5mg tab 1 benazepril 20mg/hydrochlorothiazide 12.5mg tab 1 benazepril 20mg/hydrochlorothiazide 25mg tab 1 benazepril 5mg/hydrochlorothiazide 6.25mg tab 1 bendroflumethiazide 5mg/nadolol 40mg tab 1 bendroflumethiazide 5mg/nadolol 80mg tab 1 bisoprolol fumarate 10mg/hydrochlorothiazide 6.25mg tab

1

bisoprolol fumarate 2.5mg/hydrochlorothiazide 6.25mg tab

1

bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mg tab

1

candesartan cilexetil 16mg/hydrochlorothiazide 12.5mg tab

1

candesartan cilexetil 32mg/hydrochlorothiazide 12.5mg tab

1

candesartan cilexetil 32mg/hydrochlorothiazide 25mg tab

1

captopril 25mg/hydrochlorothiazide 15mg tab 1 CAPTOPRIL 25MG/HYDROCHLOROTHIAZIDE 25MG TAB

1

captopril 50mg/hydrochlorothiazide 15mg tab 1 CAPTOPRIL 50MG/HYDROCHLOROTHIAZIDE 25MG TAB

1

enalapril maleate 10mg/hydrochlorothiazide 25mg tab

1

enalapril maleate 5mg/hydrochlorothiazide 12.5mg tab

1

fosinopril sodium 10mg/hydrochlorothiazide 12.5mg tab

1




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fosinopril sodium 20mg/hydrochlorothiazide 12.5mg tab

1

hydrochlorothiazide 12.5mg/irbesartan 150mg tab 1 hydrochlorothiazide 12.5mg/irbesartan 300mg tab 1 hydrochlorothiazide 12.5mg/lisinopril 10mg tab 1 hydrochlorothiazide 12.5mg/lisinopril 20mg tab 1 hydrochlorothiazide 12.5mg/losartan potassium 100mg tab

1

hydrochlorothiazide 12.5mg/losartan potassium 50mg tab

1

hydrochlorothiazide 12.5mg/moexipril 15mg tab 1 hydrochlorothiazide 12.5mg/moexipril 7.5mg tab 1 hydrochlorothiazide 12.5mg/olmesartan medoxomil 20mg tab

1

hydrochlorothiazide 12.5mg/olmesartan medoxomil 40mg tab

1

hydrochlorothiazide 12.5mg/quinapril 10mg tab 1 hydrochlorothiazide 12.5mg/quinapril 20mg tab 1 hydrochlorothiazide 12.5mg/telmisartan 40mg tab 1 hydrochlorothiazide 12.5mg/telmisartan 80mg tab 1 hydrochlorothiazide 12.5mg/valsartan 160mg tab 1 hydrochlorothiazide 12.5mg/valsartan 320mg tab 1 hydrochlorothiazide 12.5mg/valsartan 80mg tab 1 hydrochlorothiazide 15mg/methyldopa 250mg tab 1 hydrochlorothiazide 25mg/lisinopril 20mg tab 1 hydrochlorothiazide 25mg/losartan potassium 100mg tab

1

hydrochlorothiazide 25mg/methyldopa 250mg tab 1 hydrochlorothiazide 25mg/metoprolol tartrate 100mg tab

1

hydrochlorothiazide 25mg/metoprolol tartrate 50mg tab

1

hydrochlorothiazide 25mg/moexipril 15mg tab 1 hydrochlorothiazide 25mg/olmesartan medoxomil 40mg tab

1

hydrochlorothiazide 25mg/propranolol 40mg tab 1 hydrochlorothiazide 25mg/propranolol 80mg tab 1 hydrochlorothiazide 25mg/quinapril 20mg tab 1 hydrochlorothiazide 25mg/telmisartan 80mg tab 1 hydrochlorothiazide 25mg/valsartan 160mg tab 1 hydrochlorothiazide 25mg/valsartan 320mg tab 1 hydrochlorothiazide 50mg/metoprolol tartrate 100mg tab

1

Name of drug What the drug will cost you (tier le vel)

Necessary actions, restrictions, or limits on use


39

trandolapril 1mg/verapamil 240mg er tab 1 trandolapril 2mg/verapamil 180mg er tab 1 trandolapril 2mg/verapamil 240mg er tab 1 trandolapril 4mg/verapamil 240mg er tab 1

SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS) eplerenone 25mg tab 1 eplerenone 50mg tab 1

VASODILATORS hydralazine 100mg tab 1 hydralazine 10mg tab 1 hydralazine 20mg/ml inj 1 hydralazine 25mg tab 1 hydralazine 50mg tab 1 minoxidil 10mg tab 1 minoxidil 2.5mg tab 1



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

AZACTAM 1GM/50ML INJ 2 AZACTAM 2GM/50ML INJ 2 aztreonam 333mg/ml inj 1 baci-im 50000unit inj 1 bacitracin 5000unit/ml inj 1 CAYSTON 75MG INH SOLN 2 NDS PA colistin 75mg/ml inj 1 DALVANCE 500MG INJ 2 NDS metronidazole 250mg tab 1 metronidazole 375mg cap 1 metronidazole 500mg tab 1 metronidazole 5mg/ml inj 1 NEBUPENT 300MG INH SOLN 2 PA BvD PENTAM 300MG INJ 2 tinidazole 250mg tab 1 tinidazole 500mg tab 1 trimethoprim 100mg tab 1 vancomycin 1000mg inj 1 vancomycin 100mg/ml inj 1 vancomycin 125mg cap 1 ST QL=56 EA/14 Days vancomycin 250mg cap 1 ST QL=56 EA/14 Days vancomycin 500mg inj 1 XIFAXAN 200MG TAB 2 QL=9 EA/3 Days XIFAXAN 550MG TAB 2 QL=90 EA/30 Days

ANTI-INFECTIVE MISC. - COMBINATIONS sulfamethoxazole 400mg/trimethoprim 80mg tab 1


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

1

sulfamethoxazole 800mg/trimethoprim 160mg tab 1 sulfamethoxazole 80mg/ml/trimethoprim 16mg/ml inj 1

ANTIPROTOZOAL AGENTS ALINIA 100MG/5ML ORAL SUSP 2 ALINIA 500MG TAB 2 atovaquone 150mg/ml oral susp 1

CARBAPENEMS cilastatin 2.5mg/ml/imipenem 2.5mg/ml inj 1 cilastatin 5mg/ml/imipenem 5mg/ml inj 1 DORIPENEM 500MG INJ 2 INVANZ 1GM INJ 2 meropenem 1gm inj 1 meropenem 500mg inj 1

CHLORAMPHENICOLS CHLORAMPHENICOL 100MG/ML INJ 2

CYCLIC LIPOPEPTIDES daptomycin 500mg inj 1

GLYCYLCYCLINES TIGECYCLINE 50MG INJ 2 NDS TYGACIL 50MG INJ 2 NDS

LEPROSTATICS dapsone 100mg tab 1 dapsone 25mg tab 1

LINCOSAMIDES clindamycin 12mg/ml inj 1 clindamycin 150mg cap 1 clindamycin 150mg/ml (2ml) inj 1 clindamycin 150mg/ml (4ml) inj 1 clindamycin 150mg/ml (6ml) inj 1 clindamycin 15mg/ml oral soln 1 clindamycin 18mg/ml inj 1 clindamycin 300mg cap 1 clindamycin 6mg/ml inj 1 clindamycin 75mg cap 1 lincomycin 300mg/ml inj 1

OXAZOLIDINONES linezolid 20mg/ml oral susp 1 PA linezolid 2mg/ml inj 1 PA linezolid 600mg tab 1 PA SIVEXTRO 200MG INJ 2 NDS PA QL=6 EA/6 Days SIVEXTRO 200MG TAB 2 NDS PA QL=6 EA/6 Days




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POLYMYXINS polymyxin b 250000unit/ml inj 1

STREPTOGRAMINS SYNERCID 500MG INJ 2 NDS



ANTIMALARIALS ANTIMALARIAL COMBINATIONS

atovaquone 250mg/proguanil 100mg tab 1 atovaquone 62.5mg/proguanil 25mg tab 1 COARTEM 20-120MG TAB 2

ANTIMALARIALS CHLOROQUINE PHOSPHATE 250MG TAB 1 chloroquine phosphate 500mg tab 1 DARAPRIM 25MG TAB 2 NDS hydroxychloroquine sulfate 200mg tab 1 mefloquine 250mg tab 1 PRIMAQUINE PHOSPHATE 26.3MG TAB 2 quinine sulfate 324mg cap 1

ANTIMYASTHENIC/CHOLINERGIC AGENTS ANTIMYASTHENIC/CHOLINERGIC AGENTS

GUANIDINE 125MG TAB 2 pyridostigmine bromide 180mg er tab 1 pyridostigmine bromide 60mg tab 1

ANTIMYCOBACTERIAL AGENTS ANTI TB COMBINATIONS

RIFAMATE 150-300MG CAP 2 RIFATER 50-120-300MG TAB 2

ANTIMYCOBACTERIAL AGENTS CAPASTAT 1GM INJ 2 ethambutol 100mg tab 1 ethambutol 400mg tab 1 isoniazid 100mg tab 1 ISONIAZID 100MG/ML INJ 2 ISONIAZID 10MG/ML ORAL SOLN 2 isoniazid 300mg tab 1 PASER D/R 4GM GRANULES 2 PRIFTIN 150MG TAB 2 pyrazinamide 500mg tab 1 rifabutin 150mg cap 1 rifampin 150mg cap 1 rifampin 300mg cap 1 rifampin 60mg/ml inj 1 SIRTURO 100MG TAB 2 NDS PA TRECATOR 250MG TAB 2


42



ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES ALKYLATING AGENTS

BICNU 100MG INJ 2 NDS busulfan 6mg/ml inj 1 carboplatin 10mg/ml inj 1 cisplatin 1mg/ml inj 1 CYCLOPHOSPHAMIDE 25MG CAP 2 PA BvD CYCLOPHOSPHAMIDE 50MG CAP 2 PA BvD GLEOSTINE 100MG CAP 2 GLEOSTINE 10MG CAP 2 GLEOSTINE 40MG CAP 2 GLEOSTINE 5MG CAP 2 HEXALEN 50MG CAP 2 NDS ifosfamide 1000mg inj 1 LEUKERAN 2MG TAB 2 melphalan 5mg/ml inj 1 MUSTARGEN 10MG INJ 2 oxaliplatin 100mg inj 1 oxaliplatin 5mg/ml inj 1 thiotepa 15mg inj 1 TREANDA 100MG INJ 2 NDS PA NSO TREANDA 25MG INJ 2 NDS PA NSO YONDELIS 1MG INJ 2 NDS PA NSO ZANOSAR 1GM INJ 2

ANTIMETABOLITES adrucil 500mg/10ml inj 1 PA BvD ALIMTA 100MG INJ 2 NDS ALIMTA 500MG INJ 2 NDS ARRANON 5MG/ML INJ 2 azacitidine 100mg inj 1 cladribine 1mg/ml inj 1 PA BvD clofarabine 1mg/ml inj 1 cytarabine 100mg/ml inj 1 PA BvD CYTARABINE 20MG/ML INJ 1 PA BvD decitabine 5mg/ml inj 1 fludarabine phosphate 50mg inj 1 fluorouracil 50mg/ml inj 1 PA BvD FOLOTYN 40MG/2ML INJ 2 NDS PA NSO gemcitabine 1000mg inj 1 mercaptopurine 50mg tab 1 methotrexate 1000mg inj 1 methotrexate 2.5mg tab 1 methotrexate 250mg/10ml inj 1


43

METHOTREXATE 250MG/10ML INJ 1 methotrexate 50mg/2ml inj 1 PURIXAN 2000MG/100ML ORAL SUSP 2 TABLOID 40MG TAB 2 TREXALL 10MG TAB 2 TREXALL 15MG TAB 2 TREXALL 5MG TAB 2 TREXALL 7.5MG TAB 2 XATMEP 2.5MG/ML ORAL SOLN 2 PA

ANTINEOPLASTIC - ANGIOGENESIS INHIBITORS AVASTIN 100MG/4ML INJ 2 NDS AVASTIN 400MG/16ML INJ 2 NDS CYRAMZA 100MG/10ML INJ 2 NDS PA NSO CYRAMZA 500MG/50ML INJ 2 NDS PA NSO ZALTRAP 100MG/4ML INJ 2 NDS PA NSO

ANTINEOPLASTIC - ANTIBODIES BAVENCIO 20MG/ML INJ 2 NDS DARZALEX 100MG/5ML INJ 2 NDS PA NSO EMPLICITI 300MG INJ 2 NDS PA NSO EMPLICITI 400MG INJ 2 NDS PA NSO ERBITUX 100MG/50ML INJ 2 NDS HERCEPTIN 150MG INJ 2 NDS HERCEPTIN 440MG INJ 2 NDS IMFINZI 120MG/2.4ML INJ 2 NDS PA NSO IMFINZI 500MG/10ML INJ 2 NDS PA NSO KADCYLA 100MG INJ 2 NDS PA NSO KADCYLA 160MG INJ 2 NDS PA NSO KEYTRUDA 100MG/4ML INJ 2 NDS PA NSO LARTRUVO 10MG/ML INJ 2 NDS PA NSO LARTRUVO 190MG/19ML INJ 2 NDS PA NSO MYLOTARG 4.5MG INJ 2 NDS PA NSO OPDIVO 100MG/10ML INJ 2 NDS PA NSO OPDIVO 40MG/4ML INJ 2 NDS PA NSO PERJETA 420MG/14ML INJ 2 NDS PA NSO RITUXAN 100MG/10ML INJ 2 NDS PA NSO RITUXAN 500MG/50ML INJ 2 NDS PA NSO TECENTRIQ 60MG/ML INJ 2 NDS PA NSO VECTIBIX 100MG/5ML INJ 2 NDS YERVOY 50MG/10ML INJ 2 NDS PA NSO

ANTINEOPLASTIC - BCL-2 INHIBITORS VENCLEXTA 10/100/50MG STARTING PACK 2 NDS PA NSO VENCLEXTA 100MG TAB 2 NDS PA NSO VENCLEXTA 10MG TAB 2 NDS PA NSO




44

VENCLEXTA 50MG TAB 2 NDS PA NSO ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS

ERIVEDGE 150MG CAP 2 NDS PA NSO ODOMZO 200MG CAP 2 NDS PA NSO

ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS anastrozole 1mg tab 1 bicalutamide 50mg tab 1 DEPO-PROVERA 400MG/ML INJ 2 ELIGARD 22.5MG SYRINGE 2 ELIGARD 30MG SYRINGE 2 ELIGARD 45MG SYRINGE 2 ELIGARD 7.5MG SYRINGE 2 EMCYT 140MG CAP 2 ERLEADA 60MG TAB 2 NDS PA NSO QL=120 EA/30 Days exemestane 25mg tab 1 FARESTON 60MG TAB 2 FASLODEX 250MG/5ML SYRINGE 2 NDS FIRMAGON 120MG INJ 2 PA NSO FIRMAGON 80MG INJ 2 PA NSO flutamide 125mg cap 1 HYDROXYPROGESTERONE CAPROATE 250MG/ML INJ

2 NDS PA NSO

letrozole 2.5mg tab 1 leuprolide acetate 5mg/ml inj 1 LUPRON 11.25MG (1.5ML) SYRINGE 2 LUPRON 22.5MG SYRINGE 2 LUPRON 3.75MG SYRINGE 2 LUPRON 30MG SYRINGE 2 LUPRON 45MG SYRINGE 2 LUPRON 7.5MG SYRINGE 2 LYSODREN 500MG TAB 2 megestrol acetate 20mg tab 1 PA NSO megestrol acetate 40mg tab 1 PA NSO megestrol acetate 40mg/ml oral susp 1 PA nilutamide 150mg tab 1 SOLTAMOX 10MG/5ML ORAL SOLN 2 PA NSO tamoxifen 10mg tab 1 tamoxifen 20mg tab 1 TRELSTAR 11.25MG INJ 2 TRELSTAR 22.5MG INJ 2 TRELSTAR 3.75MG INJ 2 XTANDI 40MG CAP 2 NDS PA NSO QL=120 EA/30 Days ZYTIGA 250MG TAB 2 NDS PA NSO QL=120 EA/30 Days




45

ZYTIGA 500MG TAB 2 NDS PA NSO QL=60 EA/30 Days ANTINEOPLASTIC - IMMUNOMODULATORS

POMALYST 1MG CAP 2 NDS PA NSO POMALYST 2MG CAP 2 NDS PA NSO POMALYST 3MG CAP 2 NDS PA NSO POMALYST 4MG CAP 2 NDS PA NSO

ANTINEOPLASTIC ANTIBIOTICS adriamycin 2mg/ml inj 1 PA BvD bleomycin 15unit/ml inj 1 PA BvD dactinomycin 0.5mg inj 1 daunorubicin 5mg/ml inj 1 doxorubicin 2mg/ml liposome inj 1 doxorubicin hydrochloride 2mg/ml inj 1 PA BvD epirubicin 2mg/ml inj 1 idarubicin hydrochloride 1mg/ml inj 1 mitomycin 20mg inj 1 mitomycin 40mg inj 1 MITOMYCIN 5MG INJ 1 mitoxantrone 2mg/ml inj 1

ANTINEOPLASTIC COMBINATIONS KISQALI/FEMARA TAB CO-PACK 200MG 2 NDS PA NSO KISQALI/FEMARA TAB CO-PACK 400MG 2 NDS PA NSO KISQALI/FEMARA TAB CO-PACK 600MG 2 NDS PA NSO LONSURF 15-6.14MG TAB 2 NDS PA NSO LONSURF 20-8.19MG TAB 2 NDS PA NSO VYXEOS 44-100MG INJ 2 NDS PA NSO

ANTINEOPLASTIC ENZYME INHIBITORS AFINITOR 10MG TAB 2 NDS PA NSO QL=30 EA/30 Days AFINITOR 2.5MG TAB 2 NDS PA NSO QL=30 EA/30 Days AFINITOR 2MG ORAL SUSP 2 NDS PA NSO AFINITOR 3MG ORAL SUSP 2 NDS PA NSO AFINITOR 5MG ORAL SUSP 2 NDS PA NSO AFINITOR 5MG TAB 2 NDS PA NSO QL=30 EA/30 Days AFINITOR 7.5MG TAB 2 NDS PA NSO QL=30 EA/30 Days ALECENSA 150MG CAP 2 NDS PA NSO QL=240 EA/30 Days ALIQOPA 60MG INJ 2 NDS PA NSO ALUNBRIG 180MG TAB 2 NDS PA NSO ALUNBRIG 30MG TAB 2 NDS PA NSO ALUNBRIG 90MG TAB 2 NDS PA NSO ALUNBRIG TAB STARTER PACK 2 NDS PA NSO BELEODAQ 500MG INJ 2 NDS PA NSO BORTEZOMIB 3.5MG INJ 2 NDS BOSULIF 100MG TAB 2 NDS PA NSO




46

BOSULIF 400MG TAB 2 NDS PA NSO BOSULIF 500MG TAB 2 NDS PA NSO CABOMETYX 20MG TAB 2 NDS PA NSO CABOMETYX 40MG TAB 2 NDS PA NSO CABOMETYX 60MG TAB 2 NDS PA NSO CALQUENCE 100MG CAP 2 NDS PA NSO CAPRELSA 100MG TAB 2 NDS PA NSO CAPRELSA 300MG TAB 2 NDS PA NSO COMETRIQ 100MG DAILY DOSE CARTON PACK 2 NDS PA NSO COMETRIQ 140MG DAILY DOSE CARTON PACK 2 NDS PA NSO COMETRIQ 60MG DAILY DOSE CARTON PACK 2 NDS PA NSO COTELLIC 20MG TAB 2 NDS PA NSO FARYDAK 10MG CAP 2 NDS PA NSO FARYDAK 15MG CAP 2 NDS PA NSO FARYDAK 20MG CAP 2 NDS PA NSO GILOTRIF 20MG TAB 2 NDS PA NSO QL=30 EA/30 Days GILOTRIF 30MG TAB 2 NDS PA NSO QL=30 EA/30 Days GILOTRIF 40MG TAB 2 NDS PA NSO QL=30 EA/30 Days IBRANCE 100MG CAP 2 NDS PA NSO IBRANCE 125MG CAP 2 NDS PA NSO IBRANCE 75MG CAP 2 NDS PA NSO ICLUSIG 15MG TAB 2 NDS PA NSO ICLUSIG 45MG TAB 2 NDS PA NSO IDHIFA 100MG TAB 2 NDS PA NSO IDHIFA 50MG TAB 2 NDS PA NSO imatinib 100mg tab 1 PA NSO imatinib 400mg tab 1 PA NSO IMBRUVICA 140MG CAP 2 NDS PA NSO QL=120 EA/30 Days IMBRUVICA 140MG TAB 2 NDS PA NSO QL=30 EA/30 Days IMBRUVICA 280MG TAB 2 NDS PA NSO QL=30 EA/30 Days IMBRUVICA 420MG TAB 2 NDS PA NSO QL=30 EA/30 Days IMBRUVICA 560MG TAB 2 NDS PA NSO QL=30 EA/30 Days IMBRUVICA 70MG CAP 2 NDS PA NSO QL=30 EA/30 Days INLYTA 1MG TAB 2 NDS PA NSO QL=240 EA/30 Days INLYTA 5MG TAB 2 NDS PA NSO QL=240 EA/30 Days IRESSA 250MG TAB 2 NDS PA NSO ISTODAX 10MG INJ 2 NDS PA NSO JAKAFI 10MG TAB 2 NDS PA NSO QL=60 EA/30 Days JAKAFI 15MG TAB 2 NDS PA NSO QL=60 EA/30 Days JAKAFI 20MG TAB 2 NDS PA NSO QL=60 EA/30 Days JAKAFI 25MG TAB 2 NDS PA NSO QL=60 EA/30 Days JAKAFI 5MG TAB 2 NDS PA NSO QL=60 EA/30 Days KISQALI 200MG DAILY DOSE PACK 2 NDS PA NSO




47

KISQALI 400MG DAILY DOSE PACK 2 NDS PA NSO KISQALI 600MG DAILY DOSE PACK 2 NDS PA NSO KYPROLIS 30MG INJ 2 NDS PA NSO KYPROLIS 60MG INJ 2 NDS PA NSO LENVIMA (8) 4MG PACK 2 NDS PA NSO LENVIMA 10 10MG PACK 2 NDS PA NSO LENVIMA 14 PACK 2 NDS PA NSO LENVIMA 18 PACK 2 NDS PA NSO LENVIMA 20 10MG PACK 2 NDS PA NSO LENVIMA 24 PACK 2 NDS PA NSO LYNPARZA 100MG CAP 2 NDS PA NSO LYNPARZA 150MG CAP 2 NDS PA NSO LYNPARZA 50MG CAP 2 NDS PA NSO MEKINIST 0.5MG TAB 2 NDS PA NSO MEKINIST 2MG TAB 2 NDS PA NSO NERLYNX 40MG TAB 2 NDS PA NSO NEXAVAR 200MG TAB 2 NDS PA NSO NINLARO 2.3MG CAP 2 NDS PA NSO NINLARO 3MG CAP 2 NDS PA NSO NINLARO 4MG CAP 2 NDS PA NSO RUBRACA 200MG TAB 2 NDS PA NSO QL=120 EA/30 Days RUBRACA 250MG TAB 2 NDS PA NSO QL=120 EA/30 Days RUBRACA 300MG TAB 2 NDS PA NSO QL=120 EA/30 Days RYDAPT 25MG CAP 2 NDS PA NSO SPRYCEL 100MG TAB 2 NDS PA NSO SPRYCEL 140MG TAB 2 NDS PA NSO SPRYCEL 20MG TAB 2 NDS PA NSO SPRYCEL 50MG TAB 2 NDS PA NSO SPRYCEL 70MG TAB 2 NDS PA NSO SPRYCEL 80MG TAB 2 NDS PA NSO STIVARGA 40MG TAB 2 NDS PA NSO QL=120 EA/30 Days SUTENT 12.5MG CAP 2 NDS PA NSO SUTENT 25MG CAP 2 NDS PA NSO SUTENT 37.5MG CAP 2 NDS PA NSO SUTENT 50MG CAP 2 NDS PA NSO TAFINLAR 50MG CAP 2 NDS PA NSO QL=120 EA/30 Days TAFINLAR 75MG CAP 2 NDS PA NSO QL=120 EA/30 Days TAGRISSO 40MG TAB 2 NDS PA NSO TAGRISSO 80MG TAB 2 NDS PA NSO TARCEVA 100MG TAB 2 NDS PA NSO TARCEVA 150MG TAB 2 NDS PA NSO TARCEVA 25MG TAB 2 NDS PA NSO TASIGNA 150MG CAP 2 NDS PA NSO




48

TASIGNA 200MG CAP 2 NDS PA NSO TASIGNA 50MG CAP 2 NDS PA NSO TORISEL 25MG/ML INJ 2 NDS TYKERB 250MG TAB 2 NDS PA NSO VELCADE 3.5MG INJ 2 NDS VERZENIO 100MG TAB 2 NDS PA NSO VERZENIO 150MG TAB 2 NDS PA NSO VERZENIO 200MG TAB 2 NDS PA NSO VERZENIO 50MG TAB 2 NDS PA NSO VOTRIENT 200MG TAB 2 NDS PA NSO XALKORI 200MG CAP 2 NDS PA NSO XALKORI 250MG CAP 2 NDS PA NSO ZEJULA 100MG CAP 2 NDS PA NSO ZELBORAF 240MG TAB 2 NDS PA NSO ZOLINZA 100MG CAP 2 NDS PA NSO ZYDELIG 100MG TAB 2 NDS PA NSO ZYDELIG 150MG TAB 2 NDS PA NSO ZYKADIA 150MG CAP 2 NDS PA NSO

ANTINEOPLASTIC ENZYMES ERWINAZE 10000UNIT INJ 2 NDS PA NSO

ANTINEOPLASTICS MISC. ACTIMMUNE 2000000UNIT/0.5ML INJ 2 NDS bexarotene 75mg cap 1 PA NSO dacarbazine 200mg inj 1 hydroxyurea 500mg cap 1 INTRON A 10MU INJ 2 INTRON A 18MU INJ 2 NDS INTRON A 25MU INJ 2 INTRON A 50MU INJ 2 NDS INTRON A 6000000UNIT/ML INJ 2 MATULANE 50MG CAP 2 NDS NIPENT 10MG INJ 2 NDS PROLEUKIN 22000000UNIT INJ 2 NDS SYLATRON 200MCG INJ 2 NDS PA NSO SYLATRON 300MCG INJ 2 NDS PA NSO SYLATRON 600MCG INJ 2 NDS PA NSO SYNRIBO 3.5MG INJ 2 NDS tretinoin 10mg cap 1 TRISENOX 12MG/6ML INJ 2

CHEMOTHERAPY ADJUNCTS ELITEK 1.5MG INJ 2 NDS ELITEK 7.5MG INJ 2 NDS KEPIVANCE 6.25MG INJ 2 NDS




49

CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS dexrazoxane 250mg inj 1 FUSILEV 50MG INJ 2 NDS LEUCOVORIN 10MG TAB 1 leucovorin 10mg/ml inj 1 LEUCOVORIN 15MG TAB 1 leucovorin 20mg/ml inj 1 leucovorin 25mg tab 1 leucovorin 5mg tab 1 levoleucovorin 10mg/ml inj 1 levoleucovorin 50mg inj 1 mesna 100mg/ml inj 1 MESNEX 400MG TAB 2

MITOTIC INHIBITORS ABRAXANE 100MG INJ 2 NDS DOCETAXEL 10MG/ML INJ 2 DOCETAXEL 20MG/ML INJ 2 NDS ETOPOPHOS 100MG INJ 2 etoposide 20mg/ml inj 1 HALAVEN 1MG/2ML INJ 2 NDS JEVTANA 60MG/1.5ML INJ 2 NDS paclitaxel 6mg/ml inj 1 toposar 1gm/50ml inj 1 VINBLASTINE 1MG/ML INJ 2 PA BvD vincasar 1mg/ml inj 1 PA BvD vincristine sulfate 1mg/ml inj 1 PA BvD vinorelbine 10mg/ml inj 1

TOPOISOMERASE I INHIBITORS irinotecan 20mg/ml inj 1 topotecan 1mg/ml inj 1



ANTIPARKINSON AGENTS ANTIPARKINSON ADJUVANTS

carbidopa 25mg tab 1 ANTIPARKINSON ANTICHOLINERGICS

benztropine mesylate 0.5mg tab 1 benztropine mesylate 1mg tab 1 benztropine mesylate 1mg/ml inj 1 benztropine mesylate 2mg tab 1 trihexyphenidyl 0.4mg/ml oral soln 1 trihexyphenidyl 2mg tab 1 trihexyphenidyl 5mg tab 1

ANTIPARKINSON COMT INHIBITORS entacapone 200mg tab 1


50

tolcapone 100mg tab 1 ANTIPARKINSON DOPAMINERGICS

amantadine 100mg cap 1 amantadine 100mg tab 1 amantadine 10mg/ml oral soln 1 APOKYN 10MG/ML CARTRIDGE 2 NDS bromocriptine 2.5mg tab 1 bromocriptine 5mg cap 1 carbidopa 10mg/levodopa 100mg odt 1 carbidopa 10mg/levodopa 100mg tab 1 CARBIDOPA 12.5MG/ENTACAPONE 200MG/LEVODOPA 50MG TAB

2

CARBIDOPA 18.75MG/ENTACAPONE 200MG/LEVODOPA 75MG TAB

2

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

2

carbidopa 25mg/levodopa 100mg er tab 1 carbidopa 25mg/levodopa 100mg odt 1 carbidopa 25mg/levodopa 100mg tab 1 carbidopa 25mg/levodopa 250mg odt 1 carbidopa 25mg/levodopa 250mg tab 1 CARBIDOPA 31.25MG/ENTACAPONE 200MG/LEVODOPA 125MG TAB

2


2


2

carbidopa 50mg/levodopa 200mg er tab 1 NEUPRO 1MG/24HR PATCH 2 NEUPRO 2MG/24HR PATCH 2 NEUPRO 3MG/24HR PATCH 2 NEUPRO 4MG/24HR PATCH 2 NEUPRO 6MG/24HR PATCH 2 NEUPRO 8MG/24HR PATCH 2 pramipexole 0.125mg tab 1 pramipexole 0.25mg tab 1 pramipexole 0.375mg er tab 1 pramipexole 0.5mg tab 1 pramipexole 0.75mg er tab 1 pramipexole 0.75mg tab 1 pramipexole 1.5mg er tab 1 pramipexole 1.5mg tab 1 pramipexole 1mg tab 1




51

pramipexole 2.25mg er tab 1 pramipexole 3.75mg er tab 1 pramipexole 3mg er tab 1 pramipexole 4.5mg er tab 1 ropinirole 0.25mg tab 1 ropinirole 0.5mg tab 1 ropinirole 12mg er tab 1 ropinirole 1mg tab 1 ropinirole 2mg er tab 1 ropinirole 2mg tab 1 ropinirole 3mg tab 1 ropinirole 4mg er tab 1 ropinirole 4mg tab 1 ropinirole 5mg tab 1 ropinirole 6mg er tab 1 ropinirole 8mg er tab 1 STALEVO 12.5-50-200MG TAB 2 STALEVO 18.75-75-200MG TAB 2 STALEVO 25-100-200MG TAB 2 STALEVO 31.25-125-200MG TAB 2 STALEVO 37.5-150-200MG TAB 2 STALEVO 50-200-200MG TAB 2

ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS rasagiline 0.5mg tab 1 rasagiline 1mg tab 1 selegiline 5mg cap 1 selegiline 5mg tab 1



ANTIPSYCHOTICS/ANTIMANIC AGENTS ANTIMANIC AGENTS

lithium carbonate 150mg cap 1 lithium carbonate 300mg cap 1 lithium carbonate 300mg er tab 1 lithium carbonate 300mg tab 1 lithium carbonate 450mg er tab 1 lithium carbonate 600mg cap 1 lithium citrate 60mg/ml oral soln 1

ANTIPSYCHOTICS - MISC. EQUETRO 100MG ER CAP 2 EQUETRO 200MG ER CAP 2 EQUETRO 300MG ER CAP 2 GEODON 20MG INJ 2 LATUDA 120MG TAB 2 PA NSO QL=30 EA/30 Days LATUDA 20MG TAB 2 PA NSO QL=30 EA/30 Days


52

LATUDA 40MG TAB 2 PA NSO QL=30 EA/30 Days LATUDA 60MG TAB 2 PA NSO QL=30 EA/30 Days LATUDA 80MG TAB 2 PA NSO QL=30 EA/30 Days NUPLAZID 17MG TAB 2 PA NSO VRAYLAR 1.5/3MG MIXED PACK 2 PA NSO QL=30 EA/30 Days VRAYLAR 1.5MG CAP 2 PA NSO QL=30 EA/30 Days VRAYLAR 3MG CAP 2 PA NSO QL=30 EA/30 Days VRAYLAR 4.5MG CAP 2 PA NSO QL=30 EA/30 Days VRAYLAR 6MG CAP 2 PA NSO QL=30 EA/30 Days ziprasidone 20mg cap 1 ziprasidone 40mg cap 1 ziprasidone 60mg cap 1 ziprasidone 80mg cap 1

BENZISOXAZOLES FANAPT 10MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 12MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 1MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 2MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 4MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 6MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 8MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT TITRATION PACK 2 PA NSO QL=60 EA/30 Days INVEGA 117MG/0.75ML SYRINGE 2 PA NSO INVEGA 156MG/ML SYRINGE 2 PA NSO INVEGA 234MG/1.5ML SYRINGE 2 PA NSO INVEGA 273MG/0.875ML SYRINGE 2 PA NSO INVEGA 39MG/0.25ML SYRINGE 2 PA NSO INVEGA 410MG/1.315ML SYRINGE 2 PA NSO INVEGA 546MG/1.75ML SYRINGE 2 PA NSO INVEGA 78MG/0.5ML SYRINGE 2 PA NSO INVEGA 819MG/2.625ML SYRINGE 2 PA NSO paliperidone 1.5mg er tab 1 PA NSO paliperidone 3mg er tab 1 PA NSO paliperidone 6mg er tab 1 PA NSO paliperidone 9mg er tab 1 PA NSO RISPERDAL 12.5MG INJ 2 PA NSO RISPERDAL 25MG INJ 2 PA NSO RISPERDAL 37.5MG INJ 2 PA NSO RISPERDAL 50MG INJ 2 PA NSO risperidone 0.25mg odt 1 risperidone 0.25mg tab 1 risperidone 0.5mg odt 1 risperidone 0.5mg tab 1




53

risperidone 1mg odt 1 risperidone 1mg tab 1 risperidone 1mg/ml oral soln 1 risperidone 2mg odt 1 risperidone 2mg tab 1 risperidone 3mg odt 1 risperidone 3mg tab 1 risperidone 4mg odt 1 risperidone 4mg tab 1

BUTYROPHENONES haloperidol 0.5mg tab 1 haloperidol 10mg tab 1 haloperidol 1mg tab 1 haloperidol 20mg tab 1 haloperidol 2mg tab 1 haloperidol 2mg/ml oral soln 1 haloperidol 5mg tab 1 haloperidol 5mg/ml inj 1 haloperidol 5mg/ml syringe 1 haloperidol decanoate 100mg/ml inj 1 haloperidol decanoate 500mg/5ml inj 1 haloperidol decanoate 50mg/ml inj 1

DIBENZAPINES clozapine 100mg odt 1 clozapine 100mg tab 1 CLOZAPINE 12.5MG ODT 2 CLOZAPINE 150MG ODT 2 CLOZAPINE 200MG ODT 2 clozapine 200mg tab 1 clozapine 25mg odt 1 clozapine 25mg tab 1 clozapine 50mg tab 1 FAZACLO 12.5MG ODT 2 FAZACLO 150MG ODT 2 FAZACLO 200MG ODT 2 loxapine 10mg cap 1 loxapine 25mg cap 1 loxapine 50mg cap 1 loxapine 5mg cap 1 olanzapine 10mg inj 1 olanzapine 10mg odt 1 olanzapine 10mg tab 1 olanzapine 15mg odt 1




54

olanzapine 15mg tab 1 olanzapine 2.5mg tab 1 olanzapine 20mg odt 1 olanzapine 20mg tab 1 olanzapine 5mg odt 1 olanzapine 5mg tab 1 olanzapine 7.5mg tab 1 quetiapine 100mg tab 1 quetiapine 150mg xr tab 1 quetiapine 200mg tab 1 quetiapine 200mg xr tab 1 quetiapine 25mg tab 1 quetiapine 300mg tab 1 quetiapine 300mg xr tab 1 quetiapine 400mg tab 1 quetiapine 400mg xr tab 1 quetiapine 50mg tab 1 quetiapine 50mg xr tab 1 SAPHRIS 10MG SL TAB 2 PA NSO QL=60 EA/30 Days SAPHRIS 2.5MG SL TAB 2 PA NSO QL=60 EA/30 Days SAPHRIS 5MG SL TAB 2 PA NSO QL=60 EA/30 Days VERSACLOZ 50MG/ML ORAL SUSP 2 ZYPREXA 210MG INJ 2

PHENOTHIAZINES chlorpromazine 100mg tab 1 chlorpromazine 10mg tab 1 chlorpromazine 200mg tab 1 chlorpromazine 25mg tab 1 CHLORPROMAZINE 25MG/ML INJ 1 chlorpromazine 50mg tab 1 compro 25mg rectal supp 1 FLUPHENAZINE 0.5MG/ML ORAL SOLN 1 fluphenazine 10mg tab 1 fluphenazine 1mg tab 1 fluphenazine 2.5mg tab 1 FLUPHENAZINE 2.5MG/ML INJ 2 fluphenazine 5mg tab 1 FLUPHENAZINE 5MG/ML ORAL SOLN 1 fluphenazine decanoate 25mg/ml inj 1 perphenazine 16mg tab 1 perphenazine 2mg tab 1 perphenazine 4mg tab 1 perphenazine 8mg tab 1




55

prochlorperazine 10mg tab 1 prochlorperazine 25mg rectal supp 1 prochlorperazine 5mg tab 1 prochlorperazine 5mg/ml inj 1 thioridazine 100mg tab 1 thioridazine 10mg tab 1 thioridazine 25mg tab 1 thioridazine 50mg tab 1 trifluoperazine 10mg tab 1 trifluoperazine 1mg tab 1 trifluoperazine 2mg tab 1 trifluoperazine 5mg tab 1

QUINOLINONE DERIVATIVES ABILIFY 300MG MAINTENA INJ 2 NDS PA NSO ABILIFY 300MG MAINTENA PF SYRINGE 2 NDS PA NSO ABILIFY 400MG MAINTENA INJ 2 NDS PA NSO ABILIFY 400MG MAINTENA PF SYRINGE 2 NDS PA NSO aripiprazole 10mg odt 1 PA NSO QL=60 EA/30 Days aripiprazole 10mg tab 1 aripiprazole 15mg odt 1 PA NSO QL=60 EA/30 Days aripiprazole 15mg tab 1 aripiprazole 1mg/ml oral soln 1 PA NSO aripiprazole 20mg tab 1 aripiprazole 2mg tab 1 aripiprazole 30mg tab 1 aripiprazole 5mg tab 1 ARISTADA 273MG/ML SYRINGE 2 PA NSO ARISTADA 441MG/1.6ML SYRINGE 2 NDS PA NSO ARISTADA 662MG/2.4ML SYRINGE 2 NDS PA NSO ARISTADA 882MG/3.2ML SYRINGE 2 NDS PA NSO REXULTI 0.25MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 0.5MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 1MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 2MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 3MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 4MG TAB 2 PA NSO QL=30 EA/30 Days

THIOXANTHENES thiothixene 10mg cap 1 thiothixene 1mg cap 1 thiothixene 2mg cap 1 thiothixene 5mg cap 1



ANTISEPTICS & DISINFECTANTS CHLORINE ANTISEPTICS


56

CHLORHEXIDINE GLUCONATE LIQUID 2%* 4 chlorhexidine gluconate liquid 4%* 4 CHLORHEXIDINE GLUCONATE PADS 2%* 4

IODINE ANTISEPTICS povidone-iodine soln 10%* 4 povidone/iodine topical soln 7.5%* 4



ANTIVIRALS ANTIRETROVIRALS

abacavir 20mg/ml oral soln 1 abacavir 300mg tab 1 abacavir 300mg/lamivudine 150mg/zidovudine 300mg tab

1

abacavir 600mg/lamivudine 300mg tab 1 APTIVUS 100MG/ML ORAL SOLN 2 NDS APTIVUS 250MG CAP 2 NDS atazanavir 150mg cap 1 atazanavir 200mg cap 1 atazanavir 300mg cap 1 ATRIPLA 600-200-300MG TAB 2 NDS BIKTARVY 50-200-25MG TAB 2 NDS COMPLERA 200-25-300MG TAB 2 NDS CRIXIVAN 200MG CAP 2 CRIXIVAN 400MG CAP 2 DESCOVY 200-25MG TAB 2 NDS didanosine 200mg dr cap 1 didanosine 250mg dr cap 1 didanosine 400mg dr cap 1 EDURANT 25MG TAB 2 NDS efavirenz 200mg cap 1 efavirenz 50mg cap 1 efavirenz 600mg cap 1 EMTRIVA 10MG/ML ORAL SOLN 2 EMTRIVA 200MG CAP 2 EVOTAZ 300-150MG TAB 2 NDS fosamprenavir 700mg tab 1 FUZEON 90MG INJ 2 NDS GENVOYA 150-150-200-10MG TAB 2 NDS INTELENCE 100MG TAB 2 NDS INTELENCE 200MG TAB 2 NDS INTELENCE 25MG TAB 2 INVIRASE 200MG CAP 2 INVIRASE 500MG TAB 2 NDS ISENTRESS 100MG CHEW TAB 2 NDS


57

ISENTRESS 100MG ORAL SUSP 2 ISENTRESS 25MG CHEW TAB 2 ISENTRESS 400MG TAB 2 NDS ISENTRESS 600MG TAB 2 NDS JULUCA 50-25MG TAB 2 NDS KALETRA 100-25MG TAB 2 KALETRA 200-50MG TAB 2 NDS KALETRA 400-100MG/5ML ORAL SOLN 2 NDS lamivudine 10mg/ml oral soln 1 lamivudine 150mg tab 1 lamivudine 150mg/zidovudine 300mg tab 1 lamivudine 300mg tab 1 LEXIVA 50MG/ML ORAL SUSP 2 lopinavir 80mg/ml/ritonavir 20mg/ml oral solution 1 nevirapine 100mg er tab 1 nevirapine 200mg tab 1 nevirapine 400mg er tab 1 NORVIR 100MG CAP 2 NORVIR 100MG POWDER PACKET 2 NORVIR 100MG TAB 2 NORVIR 80MG/ML ORAL SOLN 2 ODEFSEY 200-25-25MG TAB 2 NDS PREZCOBIX 800-150MG TAB 2 NDS PREZISTA 100MG/ML ORAL SUSP 2 PREZISTA 150MG TAB 2 PREZISTA 600MG TAB 2 NDS PREZISTA 75MG TAB 2 PREZISTA 800MG TAB 2 NDS RESCRIPTOR 100MG TAB 2 RESCRIPTOR 200MG TAB 2 RETROVIR 10MG/ML INJ 2 REYATAZ 150MG CAP 2 NDS REYATAZ 200MG CAP 2 NDS REYATAZ 300MG CAP 2 NDS REYATAZ 50MG ORAL POWDER 2 NDS ritonavir 100mg tab 1 SELZENTRY 150MG TAB 2 NDS SELZENTRY 20MG/ML ORAL SOLN 2 NDS SELZENTRY 25MG TAB 2 NDS SELZENTRY 300MG TAB 2 NDS SELZENTRY 75MG TAB 2 NDS stavudine 15mg cap 1 stavudine 20mg cap 1




58

stavudine 30mg cap 1 stavudine 40mg cap 1 STRIBILD 150-150-200-300MG TAB 2 NDS SUSTIVA 200MG CAP 2 SUSTIVA 600MG TAB 2 SYMFI 600-300-300MG TAB 2 SYMFI LO 400-300-300MG TAB 2 tenofovir disoproxil fumarate 300mg tab 1 TIVICAY 10MG TAB 2 TIVICAY 25MG TAB 2 TIVICAY 50MG TAB 2 NDS TRIUMEQ 600-50-300MG TAB 2 NDS TRUVADA 100-150MG TAB 2 NDS TRUVADA 133-200MG TAB 2 NDS TRUVADA 167-250MG TAB 2 NDS TRUVADA 200-300MG TAB 2 NDS TYBOST 150MG TAB 2 VIDEX 125MG DR CAP 2 VIDEX 2GM ORAL SOLN 2 VIRACEPT 250MG TAB 2 NDS VIRACEPT 625MG TAB 2 NDS VIRAMUNE 50MG/5ML ORAL SUSP 2 VIREAD 150MG TAB 2 NDS VIREAD 200MG TAB 2 NDS VIREAD 250MG TAB 2 NDS VIREAD 300MG TAB 2 NDS VIREAD 40MG/GM ORAL POWDER 2 ZERIT 1MG/ML ORAL SOLN 2 ZIAGEN 20MG/ML ORAL SOLN 2 zidovudine 100mg cap 1 zidovudine 10mg/ml oral soln 1 zidovudine 300mg tab 1

CMV AGENTS cidofovir 75mg/ml inj 1 ganciclovir 500mg inj 1 PA BvD valganciclovir 450mg tab 1 valganciclovir 50mg/ml oral soln 1

HEPATITIS AGENTS adefovir dipivoxil 10mg tab 1 BARACLUDE 0.05MG/ML ORAL SOLN 2 entecavir 0.5mg tab 1 entecavir 1mg tab 1 EPCLUSA 400-100MG TAB 2 NDS PA QL=30 EA/30 Days




59

EPIVIR HBV 5MG/ML ORAL SOLN 2 lamivudine 100mg tab 1 MAVYRET 100-40MG TAB 2 NDS PA QL=84 EA/28 Days MODERIBA 1200/DAY DOSE PACK 2 NDS moderiba 200mg tab 1 MODERIBA 800/DAY DOSE PACK 2 NDS PEGASYS 135MCG/0.5ML AUTO-INJECTOR 2 NDS PEGASYS 180MCG/0.5ML AUTO-INJECTOR 2 NDS PEGASYS 180MCG/0.5ML SYRINGE 2 NDS PEGASYS 180MCG/ML INJ 2 NDS ribasphere 200mg cap 1 ribasphere 200mg tab 1 ribasphere 400mg tab 1 ribasphere 600mg tab 1 ribasphere ribapak 1200/day 1 ribasphere ribapak 800/day 1 ribavirin 200mg cap 1 ribavirin 200mg tab 1 VEMLIDY 25MG TAB 2 NDS ZEPATIER 50-100MG TAB 2 NDS PA QL=30 EA/30 Days

HERPES AGENTS acyclovir 200mg cap 1 acyclovir 400mg tab 1 acyclovir 40mg/ml oral susp 1 acyclovir 50mg/ml inj 1 PA BvD acyclovir 800mg tab 1 famciclovir 125mg tab 1 famciclovir 250mg tab 1 famciclovir 500mg tab 1 valacyclovir 1000mg tab 1 valacyclovir 500mg tab 1

INFLUENZA AGENTS oseltamivir 30mg cap 1 QL=84 EA/180 Days oseltamivir 45mg cap 1 QL=28 EA/180 Days oseltamivir 6mg/ml oral susp 1 QL=550 ML/180 Days oseltamivir 75mg cap 1 QL=28 EA/180 Days RELENZA 5MG/BLISTER INH 2 QL=56 EA/180 Days rimantadine 100mg tab 1



ASSORTED CLASSES IMMUNOMODULATORS

REVLIMID 10MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 15MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 2.5MG CAP 2 NDS PA NSO QL=30 EA/30 Days


60

REVLIMID 20MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 25MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 5MG CAP 2 NDS PA NSO QL=30 EA/30 Days THALOMID 100MG CAP 2 NDS PA NSO THALOMID 150MG CAP 2 NDS PA NSO THALOMID 200MG CAP 2 NDS PA NSO THALOMID 50MG CAP 2 NDS PA NSO

IMMUNOSUPPRESSIVE AGENTS ASTAGRAF 0.5MG XL CAP 2 PA BvD ASTAGRAF 1MG XL CAP 2 PA BvD ASTAGRAF 5MG XL CAP 2 PA BvD ATGAM 50MG/ML INJ 2 NDS PA BvD AZASAN 100MG TAB 2 PA BvD AZASAN 75MG TAB 2 PA BvD azathioprine 50mg tab 1 PA BvD cyclosporine 100mg cap 1 PA BvD cyclosporine 25mg cap 1 PA BvD cyclosporine 50mg/ml inj 1 PA BvD cyclosporine, modified 100mg cap 1 PA BvD cyclosporine, modified 100mg/ml oral soln 1 PA BvD cyclosporine, modified 25mg cap 1 PA BvD ENVARSUS 0.75MG ER TAB 2 PA BvD ENVARSUS 1MG ER TAB 2 PA BvD ENVARSUS 4MG ER TAB 2 PA BvD gengraf 100mg cap 1 PA BvD gengraf 100mg/ml oral soln 1 PA BvD gengraf 25mg cap 1 PA BvD mycophenolate mofetil 200mg/ml oral susp 1 PA BvD mycophenolate mofetil 250mg cap 1 PA BvD mycophenolate mofetil 500mg tab 1 PA BvD mycophenolic acid 180mg dr tab 1 PA BvD mycophenolic acid 360mg dr tab 1 PA BvD NULOJIX 250MG INJ 2 NDS PA BvD PROGRAF 5MG/ML INJ 2 PA BvD RAPAMUNE 1MG/ML ORAL SOLN 2 PA BvD SANDIMMUNE 100MG/ML ORAL SOLN 2 PA BvD SIMULECT 20MG INJ 2 NDS sirolimus 0.5mg tab 1 PA BvD sirolimus 1mg tab 1 PA BvD sirolimus 2mg tab 1 PA BvD tacrolimus 0.5mg cap 1 PA BvD tacrolimus 1mg cap 1 PA BvD tacrolimus 5mg cap 1 PA BvD




61

THYMOGLOBULIN 25MG INJ 2 NDS PA BvD ZORTRESS 0.25MG TAB 2 PA BvD ZORTRESS 0.5MG TAB 2 PA BvD ZORTRESS 0.75MG TAB 2 PA BvD

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

1

lactated ringers irrigation 1 physiolyte soln 1 physiosol soln 1 water 1000mg/ml soln 1

LYMPHATIC AGENTS SYLVANT 100MG INJ 2 NDS SYLVANT 400MG INJ 2 NDS

POTASSIUM REMOVING RESINS kionex 250mg/ml oral susp 1 sodium polystyrene sulfonate 250mg/ml oral susp 1 sps 250mg/ml oral susp 1 VELTASSA 16.8GM POWDER FOR ORAL SUSP 2 PA VELTASSA 25.2GM POWDER FOR ORAL SUSP 2 PA VELTASSA 8.4GM POWDER FOR ORAL SUSP 2 PA

SYSTEMIC LUPUS ERYTHEMATOSUS AGENTS BENLYSTA 120MG INJ 2 NDS BENLYSTA 400MG INJ 2 NDS



BETA BLOCKERS ALPHA-BETA BLOCKERS

carvedilol 12.5mg tab 1 carvedilol 25mg tab 1 carvedilol 3.125mg tab 1 carvedilol 6.25mg tab 1 labetalol 100mg tab 1 labetalol 200mg tab 1 labetalol 300mg tab 1 labetalol 5mg/ml inj 1

BETA BLOCKERS CARDIO-SELECTIVE acebutolol 200mg cap 1 acebutolol 400mg cap 1 atenolol 100mg tab 1 atenolol 25mg tab 1 atenolol 50mg tab 1 betaxolol 10mg tab 1 betaxolol 20mg tab 1 bisoprolol fumarate 10mg tab 1


62

bisoprolol fumarate 5mg tab 1 BYSTOLIC 10MG TAB 2 BYSTOLIC 2.5MG TAB 2 BYSTOLIC 20MG TAB 2 BYSTOLIC 5MG TAB 2 metoprolol succinate 100mg er tab 1 metoprolol succinate 200mg er tab 1 metoprolol succinate 25mg er tab 1 metoprolol succinate 50mg er tab 1 metoprolol tartrate 100mg tab 1 metoprolol tartrate 1mg/ml cartridge 1 metoprolol tartrate 1mg/ml inj 1 metoprolol tartrate 25mg tab 1 metoprolol tartrate 50mg tab 1

BETA BLOCKERS NON-SELECTIVE INNOPRAN 120MG XL CAP 2 INNOPRAN 80MG XL CAP 2 nadolol 20mg tab 1 nadolol 40mg tab 1 nadolol 80mg tab 1 pindolol 10mg tab 1 pindolol 5mg tab 1 propranolol 10mg tab 1 propranolol 120mg er cap 1 propranolol 160mg er cap 1 propranolol 1mg/ml inj 1 propranolol 20mg tab 1 propranolol 40mg tab 1 PROPRANOLOL 4MG/ML ORAL SOLN 1 propranolol 60mg er cap 1 propranolol 60mg tab 1 propranolol 80mg er cap 1 propranolol 80mg tab 1 PROPRANOLOL 8MG/ML ORAL SOLN 1 sorine 120mg tab 1 sorine 160mg tab 1 sorine 240mg tab 1 sorine 80mg tab 1 sotalol 120mg tab 1 sotalol 160mg tab 1 sotalol 240mg tab 1 sotalol 80mg tab 1 timolol 10mg tab 1




63

timolol 20mg tab 1 timolol 5mg tab 1



BIOLOGICALS MISC BIOLOGICALS MISC

ADAGEN 250UNIT/ML INJ 2 NDS PA

CALCIUM CHANNEL BLOCKERS CALCIUM CHANNEL BLOCKERS

afeditab 30mg cr tab 1 afeditab 60mg cr tab 1 amlodipine 10mg tab 1 amlodipine 2.5mg tab 1 amlodipine 5mg tab 1 CARDENE 20MG/200ML INJ 2 CARDENE 40MG/200ML INJ 2 cartia 120mg er cap 1 cartia 180mg er cap 1 cartia 240mg er cap 1 cartia 300mg er cap 1 dilt 120mg xr cap 1 dilt 180mg xr cap 1 dilt 240mg xr cap 1 diltiazem 120mg er (12 hr) cap 1 diltiazem 120mg er (24 hr) cap 1 diltiazem 120mg tab 1 diltiazem 180mg er cap 1 DILTIAZEM 1MG/ML INJ 2 diltiazem 240mg er cap 1 diltiazem 300mg er cap 1 diltiazem 30mg tab 1 diltiazem 360mg er cap 1 diltiazem 420mg er cap 1 diltiazem 5mg/ml inj 1 diltiazem 60mg er cap 1 diltiazem 60mg tab 1 diltiazem 90mg er cap 1 diltiazem 90mg tab 1 felodipine 10mg er tab 1 felodipine 2.5mg er tab 1 felodipine 5mg er tab 1 isradipine 2.5mg cap 1 isradipine 5mg cap 1 matzim 180mg er tab 1 matzim 240mg er tab 1


64

matzim 300mg er tab 1 matzim 360mg er tab 1 matzim 420mg er tab 1 nicardipine 2.5mg/ml inj 1 nicardipine 20mg cap 1 nicardipine 30mg cap 1 nifedipine 10mg cap 1 nifedipine 20mg cap 1 nifedipine 30mg er tab 1 nifedipine 30mg osmotic er tab 1 nifedipine 60mg er tab 1 nifedipine 60mg osmotic er tab 1 nifedipine 90mg er tab 1 nifedipine 90mg osmotic er tab 1 nimodipine 30mg cap 1 nisoldipine 17mg er tab 1 nisoldipine 20mg er tab 1 nisoldipine 30mg er tab 1 nisoldipine 34mg er tab 1 nisoldipine 40mg er tab 1 nisoldipine 8.5mg er tab 1 taztia 120mg er cap 1 taztia 180mg er cap 1 taztia 240mg er cap 1 taztia 300mg er cap 1 taztia 360mg er cap 1 verapamil 100mg er cap 1 verapamil 120mg er cap 1 verapamil 120mg er tab 1 verapamil 120mg tab 1 verapamil 180mg er cap 1 verapamil 180mg er tab 1 verapamil 2.5mg/ml inj 1 verapamil 200mg er cap 1 verapamil 240mg er cap 1 verapamil 240mg er tab 1 verapamil 300mg er cap 1 verapamil 360mg sr cap 1 verapamil 40mg tab 1 verapamil 80mg tab 1



CARDIOTONICS CARDIAC GLYCOSIDES

digitek 0.125mg tab 1


65

digitek 0.25mg tab 1 digox 0.125mg tab 1 digox 0.25mg tab 1 digoxin 0.05mg/ml oral soln 1 digoxin 0.125mg tab 1 digoxin 0.25mg tab 1 digoxin 0.25mg/ml inj 1



CARDIOVASCULAR AGENTS - MISC. CARDIOVASCULAR AGENTS MISC. - COMBINATIONS

amlodipine 10mg/atorvastatin 10mg tab 1 amlodipine 10mg/atorvastatin 20mg tab 1 amlodipine 10mg/atorvastatin 40mg tab 1 amlodipine 10mg/atorvastatin 80mg tab 1 amlodipine 2.5mg/atorvastatin 10mg tab 1 amlodipine 2.5mg/atorvastatin 20mg tab 1 amlodipine 2.5mg/atorvastatin 40mg tab 1 amlodipine 5mg/atorvastatin 10mg tab 1 amlodipine 5mg/atorvastatin 20mg tab 1 amlodipine 5mg/atorvastatin 40mg tab 1 amlodipine 5mg/atorvastatin 80mg tab 1 BIDIL 20-37.5MG TAB 2 ENTRESTO 24-26MG TAB 2 PA QL=60 EA/30 Days ENTRESTO 49-51MG TAB 2 PA QL=60 EA/30 Days ENTRESTO 97-103MG TAB 2 PA QL=60 EA/30 Days

PROSTAGLANDIN VASODILATORS REMODULIN 10MG/ML INJ 2 NDS PA BvD REMODULIN 1MG/ML INJ 2 NDS PA BvD REMODULIN 2.5MG/ML INJ 2 NDS PA BvD REMODULIN 5MG/ML INJ 2 NDS PA BvD VENTAVIS 10MCG/ML INH SOLN 2 NDS PA VENTAVIS 20MCG/ML INH SOLN 2 NDS PA

PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS LETAIRIS 10MG TAB 2 NDS PA QL=30 EA/30 Days LETAIRIS 5MG TAB 2 NDS PA QL=30 EA/30 Days OPSUMIT 10MG TAB 2 NDS PA QL=30 EA/30 Days TRACLEER 125MG TAB 2 NDS PA QL=60 EA/30 Days TRACLEER 32MG TAB FOR ORAL SUSP 2 NDS PA QL=120 EA/30 Days TRACLEER 62.5MG TAB 2 NDS PA QL=60 EA/30 Days

PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS sildenafil 20mg tab 1 PA

PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST UPTRAVI 1000MCG TAB 2 NDS PA QL=60 EA/30 Days UPTRAVI 1200MCG TAB 2 NDS PA QL=60 EA/30 Days


66

UPTRAVI 1400MCG TAB 2 NDS PA QL=60 EA/30 Days UPTRAVI 1600MCG TAB 2 NDS PA QL=60 EA/30 Days UPTRAVI 200MCG TAB 2 NDS PA QL=60 EA/30 Days UPTRAVI 400MCG TAB 2 NDS PA QL=60 EA/30 Days UPTRAVI 600MCG TAB 2 NDS PA QL=60 EA/30 Days UPTRAVI 800MCG TAB 2 NDS PA QL=60 EA/30 Days UPTRAVI TITRATION PACK 2 NDS PA QL=200 EA/30 Days

PULMONARY HYPERTENSION - SOL GUANYLATE CYCLASE STIMULATOR ADEMPAS 0.5MG TAB 2 NDS PA ADEMPAS 1.5MG TAB 2 NDS PA ADEMPAS 1MG TAB 2 NDS PA ADEMPAS 2.5MG TAB 2 NDS PA ADEMPAS 2MG TAB 2 NDS PA

SINUS NODE INHIBITORS CORLANOR 5MG TAB 2 PA CORLANOR 7.5MG TAB 2 PA



CEPHALOSPORINS CEPHALOSPORIN COMBINATIONS

AVYCAZ 2-0.5GM INJ 2 NDS ZERBAXA 1.5GM INJ 2 NDS

CEPHALOSPORINS - 1ST GENERATION cefadroxil 1000mg tab 1 cefadroxil 100mg/ml oral susp 1 cefadroxil 500mg cap 1 cefadroxil 50mg/ml oral susp 1 cefazolin 1gm inj 1 cefazolin 200mg/ml inj 1 cefazolin 500mg inj 1 cephalexin 250mg cap 1 cephalexin 25mg/ml oral susp 1 cephalexin 500mg cap 1 cephalexin 50mg/ml oral susp 1

CEPHALOSPORINS - 2ND GENERATION cefaclor 250mg cap 1 CEFACLOR 25MG/ML ORAL SUSP 1 cefaclor 500mg cap 1 cefaclor 50mg/ml oral susp 1 CEFACLOR 75MG/ML ORAL SUSP 1 cefotetan 1000mg inj 1 cefotetan 2000mg inj 1 cefoxitin 1000mg inj 1 cefoxitin 2000mg inj 1 cefoxitin 200mg/ml inj 1


67

cefprozil 250mg tab 1 cefprozil 25mg/ml oral susp 1 cefprozil 500mg tab 1 cefprozil 50mg/ml oral susp 1 cefuroxime 1.5gm inj 1 cefuroxime 250mg tab 1 cefuroxime 500mg tab 1 cefuroxime 750mg inj 1 cefuroxime 95mg/ml inj 1

CEPHALOSPORINS - 3RD GENERATION cefdinir 25mg/ml oral susp 1 cefdinir 300mg cap 1 cefdinir 50mg/ml oral susp 1 cefixime 20mg/ml oral susp 1 cefixime 40mg/ml oral susp 1 CEFOTAXIME 1GM INJ 2 CEFOTAXIME 2GM INJ 2 CEFOTAXIME 500MG INJ 2 cefpodoxime 100mg tab 1 cefpodoxime 10mg/ml oral susp 1 cefpodoxime 200mg tab 1 cefpodoxime 20mg/ml oral susp 1 ceftazidime 1000mg inj 1 ceftazidime 2000mg inj 1 ceftazidime 200mg/ml inj 1 ceftriaxone 1000mg inj 1 ceftriaxone 100mg/ml inj 1 ceftriaxone 2000mg inj 1 ceftriaxone 250mg inj 1 ceftriaxone 500mg inj 1 SUPRAX 400MG CAP 2 tazicef 1gm inj 1 tazicef 2gm inj 1 tazicef 6gm inj 1

CEPHALOSPORINS - 4TH GENERATION cefepime 1gm inj 1 cefepime 2gm inj 1

CEPHALOSPORINS - 5TH GENERATION TEFLARO 400MG INJ 2 NDS TEFLARO 600MG INJ 2 NDS



CONTRACEPTIVES COMBINATION CONTRACEPTIVES - ORAL

altavera 28 day pack 1


68

alyacen 1/35 28 day pack 1 amethia 91 day pack 1 amethia lo 91 day pack 1 apri 28 day pack 1 aranelle 28 pack 1 ashlyna 91 day pack 1 aubra 28 day pack 1 aviane 28 pack 1 balziva 28 day pack 1 bekyree 28 day pack 1 blisovi 21 fe 1.5/30 28 day 1 blisovi 21 fe 1/20 28 day pack 1 blisovi 24 fe 1/20 28 day pack 1 briellyn 28 day pack 1 camrese lo 91 day pack 1 caziant 28 day pack 1 cryselle 28 pack 1 cyclafem 1/35 28 day pack 1 cyclafem 7/7/7 28 day pack 1 delyla 28 day pack 1 desogestrel/ethinyl estradiol 28 day pack 1 desogestrel/ethinyl estradiol pack 1 drospirenone 3mg/ethinyl estradiol 0.02mg/inert 1 mg pack

1

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

1

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

1

emoquette pack 1 enpresse 28 day pack 1 enskyce 28 day pack 1 estarylla 28 day pack 1 ethinyl estradiol 0.01mg/ethinyl estradiol 0.02mg/levonorgestrel 0.1mg 91 day pack

1

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

1

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

1

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

1

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

1




69

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

1

ethinyl estradiol 0.02mg/levonorgestrel 0.09mg pack 1 ethinyl estradiol 0.02mg/norethindrone 1mg 21 day pack

1

ethinyl estradiol 0.035mg/ethynodiol 1mg 28 day pack 1 ethinyl estradiol 0.035mg/ferrous fumarate 75mg/norethindrone 0.4mg pack

1

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

1

ethinyl estradiol 0.035mg/norgestimate 0.25mg pack 1 ethinyl estradiol 0.03mg/0.04mg /inert/levonorgestrel 0.05mg/ 0.075mg pack

1


1

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

1

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

1

ethinyl estradiol/levonorgestrel 91 day pack 1 falmina 28 day pack 1 fayosim 91 day pack 1 femynor 28 day pack 1 gianvi 28-day pack 1 introvale 91 day pack 1 isibloom 28 day pack 1 juleber 28 day pack 1 junel 1.5/30 21 day pack 1 junel 1/20 21 day pack 1 junel fe 1.5/30 28 day pack 1 junel fe 1/20 28 day pack 1 junel fe 24 1/20 28 day pack 1 kaitlib fe 28 day pack 1 kariva 28 day pack 1 kelnor 1/35 28 day pack 1 kelnor 1/50 28 day pack 1 kimidess 28 day pack 1 kurvelo 28 day pack 1 larin 1.5/30 pack 1 larin 1/20 pack 1 larin fe 1.5/30 pack 1 larin fe 1/20 pack 1 larissia 28 day pack 1




70

layolis fe 28 pack 1 leena 28 day pack 1 lessina 28 day pack 1 levonest 28 day pack 1 levora 0.15/30 28 day pack 1 loryna 28 day pack 1 low-ogestrel 28 day pack 1 lutera 28 day pack 1 marlissa 28 day pack 1 microgestin 1.5/30 21 day pack 1 microgestin 1/20 21 day pack 1 microgestin fe 1.5/30 28 day pack 1 microgestin fe 1/20 28 day pack 1 mili 28 day pack 1 mononessa 28 day pack 1 NATAZIA 28 DAY PACK 2 necon 0.5/35 28 day pack 1 necon 7/7/7 28 day pack 1 nikki 28 day pack 1 nortrel 0.5/35 28 day pack 1 nortrel 1/35 21 day pack 1 nortrel 1/35 28 day pack 1 nortrel 7/7/7 28 day pack 1 ocella 28 day pack 1 orsythia 28 day pack 1 pimtrea pack 1 pirmella 1/35 28 day pack 1 portia 28 day pack 1 previfem 28 day pack 1 quasense 91 day pack 1 reclipsen 28 day pack 1 rivelsa 91 day pack 1 setlakin 91 day pack 1 sprintec 28 day pack 1 sronyx 28 day pack 1 syeda 28 day pack 1 tarina fe 1/20 28 day pack 1 tri-legest 28 day pack 1 tri-lo-estarylla 28 day pack 1 tri-lo-sprintec 28 day pack 1 tri-mili 28 day pack 1 tri-previfem 28 day pack 1 tri-sprintec 28 day pack 1




71

tri-vylibra 28 day pack 1 trinessa 28 day pack 1 trivora 28 day pack 1 velivet 28 day pack 1 vestura 3-0.02mg pack 1 vienva 28 day pack 1 vyfemla 28 day pack 1 vylibra 28 day pack 1 wymzya fe 28 day pack 1 zarah 3-0.03mg pack 1 zenchent 28 day pack 1 zovia 1/35e 28 day pack 1

COMBINATION CONTRACEPTIVES - TRANSDERMAL XULANE 150-35MCG PATCH 2

COMBINATION CONTRACEPTIVES - VAGINAL NUVARING VAGINAL RING 2

EMERGENCY CONTRACEPTIVES levonorgestrel tab 1.5mg* 4

PROGESTIN CONTRACEPTIVES - INJECTABLE medroxyprogesterone acetate 150mg/ml inj 1 medroxyprogesterone acetate 150mg/ml syringe 1

PROGESTIN CONTRACEPTIVES - ORAL camila 28 day 0.35mg pack 1 deblitane 28 day 0.35mg pack 1 errin 28 day 0.35mg pack 1 jolivette 28 day 0.35mg pack 1 lyza 0.35mg pack 1 nora-be 28 day 0.35mg pack 1 norethindrone 0.35mg pack 1 norlyroc 28 day 0.35mg pack 1 sharobel 28 day 0.35mg pack 1



CORTICOSTEROIDS GLUCOCORTICOSTEROIDS

budesonide 3mg dr cap 1 CORTISONE ACETATE 25MG TAB 2 dexamethasone 0.1mg/ml oral soln 1 dexamethasone 0.5mg tab 1 dexamethasone 0.75mg tab 1 dexamethasone 1.5mg tab 1 DEXAMETHASONE 10MG/ML INJ 1 DEXAMETHASONE 1MG TAB 1 DEXAMETHASONE 1MG/ML ORAL SOLN 1 DEXAMETHASONE 2MG TAB 1


72

dexamethasone 4mg tab 1 dexamethasone 6mg tab 1 dexamethasone phosphate 4mg/ml inj 1 hydrocortisone 10mg tab 1 hydrocortisone 20mg tab 1 hydrocortisone 5mg tab 1 KENALOG 10MG/ML INJ 2 KENALOG 40MG/ML INJ 2 MEDROL 2MG TAB 2 methylprednisolone 125mg inj 1 PA BvD methylprednisolone 16mg tab 1 methylprednisolone 32mg tab 1 methylprednisolone 40mg/ml inj 1 PA BvD methylprednisolone 4mg pack 1 methylprednisolone 4mg tab 1 methylprednisolone 62.5mg/ml inj 1 PA BvD methylprednisolone 8mg tab 1 methylprednisolone acetate 40mg/ml inj 1 methylprednisolone acetate 80mg/ml inj 1 prednisolone 10mg odt 1 prednisolone 15mg odt 1 prednisolone 1mg/ml oral soln 1 prednisolone 30mg odt 1 prednisolone 3mg/ml oral soln 1 PREDNISONE 10MG (21) TAB PACK 2 PREDNISONE 10MG (48) TAB PACK 2 prednisone 10mg tab 1 prednisone 1mg tab 1 PREDNISONE 1MG/ML ORAL SOLN 1 prednisone 2.5mg tab 1 prednisone 20mg tab 1 PREDNISONE 50MG TAB 1 PREDNISONE 5MG (21) TAB PACK 2 PREDNISONE 5MG (48) TAB PACK 2 prednisone 5mg tab 1 PREDNISONE 5MG/ML ORAL SOLN 2 SOLU-CORTEF 100MG INJ 2 SOLU-CORTEF 250MG INJ 2 triamcinolone acetonide 40mg/ml inj 1 UCERIS 9MG ER TAB 2 PA QL=30 EA/30 Days

MINERALOCORTICOIDS fludrocortisone 0.1mg tab 1



COUGH/COLD/ALLERGY


73

ANTITUSSIVES benzonatate cap 100mg* 3 benzonatate cap 200mg* 3 dextromethorphan hbr cap 15mg* 4 dextromethorphan hbr liquid 15mg/15ml* 4 dextromethorphan hbr liquid 15mg/5ml* 4 dextromethorphan hbr liquid 7.5mg/5ml* 4 dextromethorphan hbr syrup 10mg/5ml* 4 dextromethorphan hbr syrup 15mg/5ml* 4 DEXTROMETHORPHAN HBR SYRUP 7.5MG/5ML* 4 hydrocodone w/ homatropine syrup 5-1.5mg/5ml* 3 hydrocodone/homatropine tab 5-1.5mg* 3

COUGH/COLD/ALLERGY COMBINATIONS brompheniramine/phenylephrine elixir 1-2.5mg/5ml* 4 BROMPHENIRAMINE/PHENYLEPHRINE TAB 4-10MG*

4

brompheniramine/pseudoephedrine elixir 1-15mg/5ml*

4

BROTAPP DM LIQUID 15-1-5 MG/5ML* 4 BROVEX LIQUID* 4 chlorpheniramine-DM liquid 2-15mg/5ml* 4 chlorpheniramine/DM tab 4-20mg* 4 chlorpheniramine/DM tab 4-30mg* 4 chlorpheniramine/phenylephrine liquid 4-10mg/5ml* 4 chlorpheniramine/phenylephrine tab 4-10mg* 4 chlorpheniramine/pseudoephedrine tab 4-60mg* 4 CLARINEX-D 2.5-120MG ER TAB 2 DEXCHLORPHENIRAMINE/PSEUDOEPHEDRINE/A CETAMINOPHEN/DOXYLAMINE LIQUID*

4

dextromethorphan-guaifenesin liquid 5-100mg/5ml* 4 dextromethorphan/guaifenesin cap 10-200mg* 4 DEXTROMETHORPHAN/GUAIFENESIN GRANULES PACKET 5-100MG*

4

dextromethorphan/guaifenesin liquid 10-100mg/5ml* 4 dextromethorphan/guaifenesin liquid 10-200mg/15ml*

4

dextromethorphan/guaifenesin liquid 10-200mg/5ml* 4 dextromethorphan/guaifenesin liquid 20-300mg/5ml* 4 dextromethorphan/guaifenesin liquid 30-200mg/5ml* 4 dextromethorphan/guaifenesin SR tab (12hr) 30-600mg*

4

dextromethorphan/guaifenesin SR tab (12hr) 60-1200mg*

4




74

dextromethorphan/guaifenesin syrup 10-100mg/5ml* 4 dextromethorphan/guaifenesin tab 20-400mg* 4 doxylamine-DM liquid 6.25-15mg/15ml* 4 guaifenesin-codeine soln 100-10mg/5ml* 4 GUAIFENESIN/CODEINE LIQUID 200-8MG/5ML* 4 guaifenesin/codeine liquid 225-7.5mg/5ml* 4 guaifenesin/codeine soln 100-6.3mg/5ml* 4 LOHIST-D LIQUID 2-30MG/5ML* 4 loratadine/pseudoephedrine SR tab (12hr) 5-120mg* 4 QL=60 EA/30 Days loratadine/pseudoephedrine SR tab (24hr) 10-240mg* 4 QL=60 EA/30 Days phenylephrine 1mg/ml/promethazine 1.25mg/ml oral soln

1

phenylephrine w/ DM liquid 10-15-300mg/5ml* 4 phenylephrine w/ DM liquid 10-15-350mg/5ml* 4 phenylephrine w/ DM liquid 10-28-388mg/5ml* 4 phenylephrine w/ DM liquid 2.5-5-100mg/5ml* 4 phenylephrine w/ DM liquid 2.5-5-50mg/ml* 4 phenylephrine w/ DM liquid 2.5-5-75mg/5ml* 4 phenylephrine w/ DM liquid 2.5-7.5-88mg/ml* 4 phenylephrine w/ DM syrup 5-10-100mg/5ml* 4 phenylephrine w/ DM-gg liquid 5-10-100mg/5ml* 4 phenylephrine w/ DM-gg liquid 5-10-200mg/5ml* 4 phenylephrine/brompheniramine/DM elixir 2.5-1-5mg/5ml*

4

phenylephrine/brompheniramine/DM liquid 10-4-20mg/5ml*

4

phenylephrine/brompheniramine/DM liquid 2.5-1-5mg/5ml*

4

phenylephrine/brompheniramine/DM liquid 7.5-4-15mg/5ml*

4

PHENYLEPHRINE/CHLORPHEN/DM LIQUID 1.5-0.6-2.75MG/ML*

4

PHENYLEPHRINE/CHLORPHEN/DM LIQUID 10-4-12.5MG/5ML*

4

phenylephrine/chlorphen/DM liquid 10-4-15mg/5ml* 4 PHENYLEPHRINE/CHLORPHEN/DM SYRUP 10-4-20MG/5ML*

4

PHENYLEPHRINE/CHLORPHEN/DM SYRUP 5-2-10MG/5ML*

4

PHENYLEPHRINE/GUAIFENESIN 5-200MG TAB* 4 phenylephrine/guaifenesin liquid 2.5-100mg/5ml* 4 PHENYLEPHRINE/GUAIFENESIN LIQUID 5-100MG/5ML*

4




75

phenylephrine/guaifenesin tab 10-380mg* 4 phenylephrine/guaifenesin tab 10-400mg* 4 PHENYLEPHRINE/PROMETHAZINE W/ CODEINE SYRUP 5-6.25-10MG/5ML*

3

promethazine w/codeine syrup 6.25-10mg/5ml* 3 promethazine/DM syrup 6.25-15mg/5ml* 3 pseudoephed/bromphen/DM syrup 30-2-10mg/5ml* 3 pseudoephed/chlorphen/DM liquid 15-1-5mg/5ml* 4 pseudoephedrine w/ DM liquid 30-10-100mg/5ml* 4 PSEUDOEPHEDRINE W/ DM LIQUID 30-15-175MG/5ML*

4

PSEUDOEPHEDRINE W/ DM TAB 60-15-400MG* 4 PSEUDOEPHEDRINE W/ DM TAB 60-20-380MG* 4 PSEUDOEPHEDRINE/GUAIFENESIN LIQUID 7.5-50MG/ML*

4

PSEUDOEPHEDRINE/GUAIFENESIN SR TAB (12HR) 120-1200MG*

4

pseudoephedrine/guaifenesin SR tab (12hr) 60-600mg*

4


3


4

pseudoephedrine/guaifenesin syrup 30-100mg/5ml* 4 pseudoephedrine/guaifenesin tab 40-400mg* 4 RESCON DM SYRUP 30-2-10MG/5ML* 4 triprolidine/pseudoephedrine tab 2.5-60mg* 4

EXPECTORANTS guaifenesin liquid 100mg/5ml* 4 GUAIFENESIN LIQUID 200MG/5ML* 4 guaifenesin SR tab (12hr) 600mg* 4 guaifenesin syrup 100mg/5ml* 4 guaifenesin tab 200mg* 4 guaifenesin tab 400mg* 4

MUCOLYTICS acetylcysteine 10% inh soln 1 PA BvD acetylcysteine 20% inh soln 1 PA BvD



DERMATOLOGICALS ACNE PRODUCTS

adapalene/benzoyl peroxide 0.1-2.5% gel 1 PA amnesteem 10mg cap 1 amnesteem 20mg cap 1 amnesteem 40mg cap 1


76

avita 0.025% cream 1 PA avita 0.025% gel 1 PA benzoyl peroxide cream 10%* 4 QL=141 ML/30 Days benzoyl peroxide gel 10%* 4 benzoyl peroxide gel 5%* 4 benzoyl peroxide liquid 10%* 4 benzoyl peroxide liquid 5%* 4 BENZOYL PEROXIDE LOTION 10%* 4 BENZOYL PEROXIDE LOTION 5%* 4 benzoyl peroxide lotion 6%* 4 QL=341 ML/30 Days claravis 10mg cap 1 claravis 20mg cap 1 claravis 30mg cap 1 claravis 40mg cap 1 clindacin 1% pad 1 clindamycin 1% foam 1 clindamycin 1% gel 1 clindamycin 1% lotion 1 clindamycin 1% pad 1 clindamycin 1% topical soln 1 clindamycin/benzoyl peroxide 1-5% gel 1 ery 2% pad 1 erythromycin 2% gel 1 erythromycin 2% topical soln 1 erythromycin/benzoyl peroxide 5-3% gel 1 isotretinoin 10mg cap 1 isotretinoin 20mg cap 1 isotretinoin 30mg cap 1 isotretinoin 40mg cap 1 myorisan 10mg cap 1 myorisan 20mg cap 1 myorisan 30mg cap 1 myorisan 40mg cap 1 sulfacetamide sodium 10% lotion 1 tretinoin 0.01% gel 1 PA tretinoin 0.025% cream 1 PA tretinoin 0.025% gel 1 PA tretinoin 0.04% gel 1 PA tretinoin 0.05% cream 1 PA tretinoin 0.05% gel 1 PA tretinoin 0.1% cream 1 PA tretinoin 0.1% gel 1 PA zenatane 10mg cap 1




77

zenatane 20mg cap 1 zenatane 30mg cap 1 zenatane 40mg cap 1

ANTIBIOTICS - TOPICAL bacitracin ointment 500unit/gm* 4 bacitracin zinc ointment 500unit/gm* 4 bacitracin/polymyxin b ointment* 4 gentamicin sulfate 0.1% cream 1 gentamicin sulfate 0.1% ointment 1 mupirocin 2% cream 1 mupirocin 2% ointment 1 triple antibiotic ointment* 4

ANTIFUNGALS - TOPICAL betamethasone/clotrimazole 1-0.05% cream 1 betamethasone/clotrimazole 1-0.05% lotion 1 ciclopirox 0.77% cream 1 ciclopirox 0.77% gel 1 ciclopirox 0.77% lotion 1 ciclopirox 1% shampoo 1 ciclopirox 8% topical soln 1 clotrimazole 1% cream 1 clotrimazole 1% topical soln 1 ERTACZO 2% CREAM 2 ketoconazole 2% cream 1 ketoconazole 2% shampoo 1 ketoconazole 20mg/ml foam 1 miconazole nitrate cream 2%* 4 miconazole nitrate powder 2%* 4 naftifine 2% cream 1 nyamyc 100000unit/gm powder 1 nystatin 100000unit/ml cream 1 nystatin 100unit/mg ointment 1 nystatin 100unit/mg powder 1 nystop 100000unit/gm powder 1 terbinafine cream 1%* 4 tolnaftate aerosol 1%* 4 tolnaftate aerosol powder 1%* 4 tolnaftate cream 1%* 4 tolnaftate powder 1%* 4 tolnaftate soln 1%* 4

ANTIHISTAMINES-TOPICAL diphenhydramine cream 2%* 4 diphenhydramine gel 2%* 4




78

diphenhydramine soln 2%* 4 diphenhydramine/zinc acetate cream 1-0.1%* 4 diphenhydramine/zinc acetate cream 2-0.1%* 4 diphenhydramine/zinc acetate liquid 2-0.1%* 4

ANTI-INFLAMMATORY AGENTS - TOPICAL diclofenac sodium 1% gel 1 QL=1000 GM/30 Days diclofenac sodium 1.5% topical soln 1

ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL diclofenac sodium 3% gel 1 PA NSO FLUOROURACIL 0.5% CREAM 2 fluorouracil 2% topical soln 1 fluorouracil 5% cream 1 fluorouracil 5% topical soln 1 PANRETIN 0.1% GEL 2 NDS PICATO 0.015% GEL 2 NDS QL=3 EA/10 Days PICATO 0.05% GEL 2 NDS QL=2 EA/10 Days TARGRETIN 1% GEL 2 NDS TOLAK 4% CREAM 2 VALCHLOR 0.016% GEL 2 NDS PA NSO QL=240 GM/30 Days

ANTIPRURITICS - TOPICAL DOXEPIN 5% CREAM 2 PRUDOXIN 5% CREAM 2 ZONALON 5% CREAM 2

ANTIPSORIATICS acitretin 10mg cap 1 acitretin 17.5mg cap 1 acitretin 25mg cap 1 calcipotriene 0.005% cream 1 QL=120 GM/30 Days calcipotriene 0.005% ointment 1 QL=120 GM/30 Days calcipotriene 0.005% topical soln 1 QL=120 ML/30 Days COSENTYX 150MG/ML AUTO-INJECTOR 2 NDS PA COSENTYX 150MG/ML SYRINGE 2 NDS PA methoxsalen 10mg cap 1 tazarotene 0.1% cream 1 TAZORAC 0.05% GEL 2 TAZORAC 0.1% GEL 2

ANTISEBORRHEIC PRODUCTS selenium sulfide 2.5% shampoo 1 selenium sulfide lotion 1%* 4

ANTIVIRALS - TOPICAL ABREVA CREAM* 4 acyclovir 5% ointment 1 DENAVIR 1% CREAM 2




79

BURN PRODUCTS silver sulfadiazine 1% cream 1 ssd 1% cream 1 SULFAMYLON 85MG/GM CREAM 2

CORTICOSTEROIDS - TOPICAL ala-cort 1% cream 1 ala-cort 2.5% cream 1 alclometasone dipropionate 0.05% cream 1 alclometasone dipropionate 0.05% ointment 1 AMCINONIDE 0.1% CREAM 2 PA AMCINONIDE 0.1% OINTMENT 2 PA betamethasone 0.05% aug cream 1 betamethasone 0.05% aug gel 1 betamethasone 0.05% aug lotion 1 betamethasone 0.05% aug ointment 1 betamethasone 0.05% cream 1 betamethasone 0.05% lotion 1 betamethasone 0.05% ointment 1 betamethasone 0.1% cream 1 betamethasone 0.1% lotion 1 betamethasone 0.1% ointment 1 betamethasone valerate 0.12% foam 1 PA calcipotriene/betamethasone 0.005-0.064% ointment 1 QL=100 GM/7 Days clobetasol propionate 0.05% cream 1 PA clobetasol propionate 0.05% foam 1 PA clobetasol propionate 0.05% gel 1 PA clobetasol propionate 0.05% lotion 1 PA clobetasol propionate 0.05% ointment 1 PA clobetasol propionate 0.05% shampoo 1 PA clobetasol propionate 0.05% spray 1 PA clobetasol propionate 0.05% topical soln 1 PA clodan 0.05% shampoo 1 PA desonide 0.05% cream 1 PA desonide 0.05% lotion 1 PA desonide 0.05% ointment 1 desoximetasone 0.05% cream 1 desoximetasone 0.05% gel 1 desoximetasone 0.05% ointment 1 desoximetasone 0.25% cream 1 desoximetasone 0.25% ointment 1 DIFLORASONE DIACETATE 0.05% CREAM 2 PA DIFLORASONE DIACETATE 0.05% OINTMENT 2 PA fluocinolone acetonide 0.01% cream 1




80

fluocinolone acetonide 0.01% topical soln 1 fluocinolone acetonide 0.025% cream 1 fluocinolone acetonide 0.025% ointment 1 fluocinolone acetonide 0.1mg/ml oil 1 fluocinonide 0.05% e cream 1 fluocinonide 0.05% gel 1 fluocinonide 0.05% ointment 1 fluocinonide 0.05% topical soln 1 fluticasone propionate 0.005% ointment 1 fluticasone propionate 0.05% cream 1 fluticasone propionate 0.05% lotion 1 PA halobetasol propionate 0.05% cream 1 halobetasol propionate 0.05% ointment 1 hydrocortisone 1% cream 1 hydrocortisone 1% ointment 1 hydrocortisone 2.5% cream 1 hydrocortisone 2.5% lotion 1 hydrocortisone 2.5% ointment 1 hydrocortisone acetate cream 1%* 4 hydrocortisone cream 0.5%* 4 hydrocortisone gel 1%* 4 hydrocortisone ointment 0.5%* 4 hydrocortisone ointment 1%* 4 hydrocortisone soln 1%* 4 hydrocortisone valerate 0.2% cream 1 hydrocortisone valerate 0.2% ointment 1 hydrocortisone/aloe vera cream 0.5%* 4 hydrocortisone/aloe vera cream 1%* 4 mometasone furoate 0.1% cream 1 mometasone furoate 0.1% lotion 1 mometasone furoate 0.1% ointment 1 prednicarbate 0.1% cream 1 prednicarbate 0.1% ointment 1 PSORCON 0.05% CREAM 2 PA TOPICORT 0.05% CREAM 2 triamcinolone acetonide 0.025% cream 1 triamcinolone acetonide 0.025% lotion 1 triamcinolone acetonide 0.025% ointment 1 triamcinolone acetonide 0.1% cream 1 triamcinolone acetonide 0.1% lotion 1 triamcinolone acetonide 0.1% ointment 1 triamcinolone acetonide 0.147mg/ml spray 1 triamcinolone acetonide 0.5% cream 1




81

triamcinolone acetonide 0.5% ointment 1 triderm 0.1% cream 1

ECZEMA AGENTS DUPIXENT 300MG/2ML SYRINGE 2 NDS PA

EMOLLIENTS ammonium lactate 12% cream 1 ammonium lactate 12% lotion 1 lactic acid lotion 5%* 4

ENZYMES - TOPICAL SANTYL 250UNIT/GM OINTMENT 2

IMMUNOMODULATING AGENTS - TOPICAL imiquimod 5% cream 1 ZYCLARA 2.5% CREAM 2

IMMUNOSUPPRESSIVE AGENTS - TOPICAL ELIDEL 1% CREAM 2 tacrolimus 0.03% ointment 1 tacrolimus 0.1% ointment 1

KERATOLYTIC/ANTIMITOTIC AGENTS podofilox 0.5% topical soln 1 SALICYLIC ACID 12.6% SOLN* 4 salicylic acid gel 17%* 4 salicylic acid gel 2%* 4 salicylic acid liquid 17%* 4 salicylic acid liquid 2%* 4 salicylic acid liquid 3%* 4 salicylic acid pad 2%* 4 salicylic acid pad 40%* 4 SALICYLIC ACID SOLN 12.24%* 4 salicylic acid soln 17%* 4 salicylic acid strip 40%* 4

LOCAL ANESTHETICS - TOPICAL capsaicin cream 0.025%* 4 capsaicin cream 0.1%* 4 CAPZASIN-HP CREAM* 4 lidocaine 2% gel 1 lidocaine 4% topical soln 1 lidocaine 5% ointment 1 ST QL=107 GM/30 Days lidocaine 5% patch 1 PA QL=90 EA/30 Days lidocaine/prilocaine 2.5-2.5% cream 1

MISC. TOPICAL ALUMINUM ACETATE SOLN* 4 CALAMINE LOTION* 4 zinc oxide ointment 10%* 4




82

zinc oxide ointment 20%* 4 zinc oxide ointment 40%* 4 ZINC OXIDE PASTE 25%* 4 ZINC OXIDE PASTE 40%* 4

ROSACEA AGENTS FINACEA 15% FOAM 2 FINACEA 15% GEL 2 metronidazole 0.75% cream 1 metronidazole 0.75% gel 1 metronidazole 0.75% lotion 1 metronidazole 1% gel 1

SCABICIDES & PEDICULICIDES EURAX 10% CREAM 2 lice shampoo* 4 lindane 1% shampoo 1 malathion 0.5% lotion 1 permethrin 5% cream 1 permethrin aerosol 0.5%* 4 permethrin creme rinse 1%* 4 permethrin lotion 1%* 4 permethrin spray/pyrethins-piperonyl butoxide shampoo kit*

4

pyrethrins/piperonyl butoxide liquid 0.3-3%* 4 pyrethrins/piperonyl butoxide liquid 0.33-4%* 4 pyrethrins/piperonyl butoxide shampoo 0.33-4%* 4 PYRETHRINS/PIPERONYL BUTOXIDE SHAMPOO KIT 0.33-4%*

4

WOUND CARE PRODUCTS REGRANEX 0.01% GEL 2 NDS QL=30 GM/15 Days WOUND CLEANSER LIQUID* 4



DIAGNOSTIC PRODUCTS DIAGNOSTIC TESTS

ASSURE PLATINUM TEST STRIPS* 4 GLUCOSE URINE TEST-(GLUCOSE OXIDASE) STRIP*

4

DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS NUTRITIONAL SUPPLEMENTS

CHOLEXTRA POWDER* 4 PA NUTRITIONAL SUPPLEMENT FLAVOR PACK* 4 PA NUTRITIONAL SUPPLEMENT LIQUID* 4 PA NUTRITIONAL SUPPLEMENT PACK* 4 PA

DIGESTIVE AIDS DIGESTIVE ENZYMES


83

CREON 12000-38000-60000UNIT DR CAP 2 CREON 24000-76000-120000UNIT DR CAP 2 CREON 3000-9500-15000UNIT DR CAP 2 CREON 36000-114000-180000UNIT DR CAP 2 CREON 6000-19000-30000UNIT DR CAP 2 PANCREAZE 10500-25000-43750UNIT DR CAP 2 ST PANCREAZE 16800-40000-70000UNIT DR CAP 2 ST PANCREAZE 21000-37000-61000UNIT DR CAP 2 ST PANCREAZE 2600-6200-10850UNIT DR CAP 2 ST PANCREAZE 4200-10000-17500UNIT DR CAP 2 ST SUCRAID 8500UNIT/ML ORAL SOLN 2 NDS PA



DIURETICS CARBONIC ANHYDRASE INHIBITORS

acetazolamide 100mg/ml inj 1 acetazolamide 125mg tab 1 acetazolamide 250mg tab 1 acetazolamide 500mg er cap 1 methazolamide 25mg tab 1 methazolamide 50mg tab 1

DIURETIC COMBINATIONS amiloride 5mg/hydrochlorothiazide 50mg tab 1 hydrochlorothiazide 25mg/spironolactone 25mg tab 1 hydrochlorothiazide 25mg/triamterene 37.5mg cap 1 hydrochlorothiazide 25mg/triamterene 37.5mg tab 1 hydrochlorothiazide 50mg/triamterene 75mg tab 1

LOOP DIURETICS bumetanide 0.25mg/ml inj 1 bumetanide 0.5mg tab 1 bumetanide 1mg tab 1 bumetanide 2mg tab 1 ethacrynic acid 25mg tab 1 furosemide 10mg/ml inj 1 furosemide 10mg/ml oral soln 1 furosemide 10mg/ml syringe 1 furosemide 20mg tab 1 furosemide 40mg tab 1 furosemide 80mg tab 1 FUROSEMIDE 8MG/ML ORAL SOLN 1 torsemide 100mg tab 1 torsemide 10mg tab 1 torsemide 20mg tab 1 torsemide 5mg tab 1

POTASSIUM SPARING DIURETICS


84

amiloride 5mg tab 1 DYRENIUM 100MG CAP 2 DYRENIUM 50MG CAP 2 spironolactone 100mg tab 1 spironolactone 25mg tab 1 spironolactone 50mg tab 1

THIAZIDES AND THIAZIDE-LIKE DIURETICS CHLOROTHIAZIDE 250MG TAB 1 chlorothiazide 500mg inj 1 chlorothiazide 500mg tab 1 chlorthalidone 25mg tab 1 chlorthalidone 50mg tab 1 DIURIL 250MG/5ML ORAL SUSP 2 hydrochlorothiazide 12.5mg cap 1 hydrochlorothiazide 12.5mg tab 1 hydrochlorothiazide 25mg tab 1 hydrochlorothiazide 50mg tab 1 indapamide 1.25mg tab 1 indapamide 2.5mg tab 1 METHYCLOTHIAZIDE 5MG TAB 2 metolazone 10mg tab 1 metolazone 2.5mg tab 1 metolazone 5mg tab 1



ENDOCRINE AND METABOLIC AGENTS - MISC. BONE DENSITY REGULATORS

ALENDRONATE 0.933MG/ML ORAL SOLN 2 alendronate 10mg tab 1 alendronate 35mg tab 1 ALENDRONATE 40MG TAB 2 alendronate 5mg tab 1 alendronate 70mg tab 1 etidronate disodium 200mg tab 1 ETIDRONATE DISODIUM 400MG TAB 2 FORTEO 600MCG/2.4ML PEN INJ 2 NDS ibandronate 150mg tab 1 ST QL=1 EA/30 Days ibandronate 1mg/ml inj 1 PA BvD MIACALCIN 200UNIT/ML INJ 2 PA BvD NATPARA 100MCG CARTRIDGE 2 NDS PA NATPARA 25MCG CARTRIDGE 2 NDS PA NATPARA 50MCG CARTRIDGE 2 NDS PA NATPARA 75MCG CARTRIDGE 2 NDS PA pamidronate disodium 3mg/ml inj 1 PA BvD PAMIDRONATE DISODIUM 6MG/ML INJ 2 PA BvD


85

pamidronate disodium 9mg/ml inj 1 PA BvD PROLIA 60MG/ML SYRINGE 2 risedronate sodium 150mg tab 1 ST risedronate sodium 30mg tab 1 ST risedronate sodium 35mg (12) pack 1 ST risedronate sodium 35mg (4) pack 1 ST risedronate sodium 35mg tab 1 ST risedronate sodium 5mg tab 1 ST salmon calcitonin 200unit/act nasal spray 1 TYMLOS 2MG/ML PEN INJECTOR 2 NDS XGEVA 120MG/1.7ML INJ 2 NDS PA zoledronic acid 0.05mg/ml inj 1 zoledronic acid 0.8mg/ml inj 1 ZOMETA 4MG/100ML INJ 2 NDS

GROWTH HORMONE RECEPTOR ANTAGONISTS SOMAVERT 10MG INJ 2 NDS PA SOMAVERT 15MG INJ 2 NDS PA SOMAVERT 20MG INJ 2 NDS PA SOMAVERT 25MG INJ 2 NDS PA SOMAVERT 30MG INJ 2 NDS PA

GROWTH HORMONES GENOTROPIN 0.2MG SYRINGE 2 NDS PA GENOTROPIN 0.4MG SYRINGE 2 NDS PA GENOTROPIN 0.6MG SYRINGE 2 NDS PA GENOTROPIN 0.8MG SYRINGE 2 NDS PA GENOTROPIN 1.2MG SYRINGE 2 NDS PA GENOTROPIN 1.4MG SYRINGE 2 NDS PA GENOTROPIN 1.6MG SYRINGE 2 NDS PA GENOTROPIN 1.8MG SYRINGE 2 NDS PA GENOTROPIN 12MG CARTRIDGE 2 NDS PA GENOTROPIN 1MG SYRINGE 2 NDS PA GENOTROPIN 2MG SYRINGE 2 NDS PA GENOTROPIN 5MG CARTRIDGE 2 NDS PA NORDITROPIN 10MG/1.5ML PEN INJ 2 NDS PA NORDITROPIN 15MG/1.5ML PEN INJ 2 NDS PA NORDITROPIN 30MG/3ML PEN INJ 2 NDS PA NORDITROPIN 5MG/1.5ML PEN INJ 2 NDS PA

HORMONE RECEPTOR MODULATORS raloxifene 60mg tab 1

INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS) INCRELEX 40MG/4ML INJ 2 NDS PA

LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS LUPRON 11.25MG (1ML) SYRINGE 2 NDS




86

LUPRON 15MG SYRINGE 2 NDS LUPRON 30MG SYRINGE (3 MONTH) 2 SYNAREL 2MG/ML NASAL SPRAY 2 NDS

METABOLIC MODIFIERS ALDURAZYME 2.9MG/5ML INJ 2 NDS calcitriol 0.00025mg cap 1 PA BvD calcitriol 0.0005mg cap 1 PA BvD calcitriol 0.001mg/ml inj 1 PA BvD calcitriol 0.001mg/ml oral soln 1 PA BvD CARBAGLU 200MG ORAL SUSP 2 PA doxercalciferol 0.0005mg cap 1 PA BvD doxercalciferol 0.001mg cap 1 PA BvD doxercalciferol 0.0025mg cap 1 PA BvD doxercalciferol 0.002mg/ml inj 1 PA BvD ELAPRASE 6MG/3ML INJ 2 NDS FABRAZYME 35MG INJ 2 NDS FABRAZYME 5MG INJ 2 NDS KUVAN 100MG POWDER FOR ORAL SOLN 2 NDS PA KUVAN 100MG TAB 2 NDS PA KUVAN 500MG POWDER FOR ORAL SOLN 2 NDS PA levocarnitine 100mg/ml oral soln 1 PA BvD levocarnitine 330mg tab 1 PA BvD LUMIZYME 50MG INJ 2 NDS NAGLAZYME 1MG/ML INJ 2 NDS ORFADIN 10MG CAP 2 NDS PA ORFADIN 20MG CAP 2 NDS PA ORFADIN 2MG CAP 2 NDS PA ORFADIN 4MG/ML ORAL SUSP 2 NDS PA ORFADIN 5MG CAP 2 NDS PA paricalcitol 0.001mg cap 1 PA BvD paricalcitol 0.002mg cap 1 PA BvD paricalcitol 0.002mg/ml inj 1 PA BvD paricalcitol 0.004mg cap 1 PA BvD paricalcitol 0.005mg/ml inj 1 PA BvD RAVICTI 1.1GM/ML ORAL SOLN 2 NDS PA SENSIPAR 30MG TAB 2 PA BvD SENSIPAR 60MG TAB 2 PA BvD SENSIPAR 90MG TAB 2 PA BvD sodium phenylbutyrate 0.94mg/mg oral powder 1 STRENSIQ 40MG/ML INJ 2 NDS PA STRENSIQ 80MG/0.8ML INJ 2 NDS PA

POSTERIOR PITUITARY HORMONES desmopressin acetate 0.004mg/ml inj 1




87

desmopressin acetate 0.01% nasal soln 1 desmopressin acetate 0.01% nasal spray 1 desmopressin acetate 0.1mg tab 1 desmopressin acetate 0.2mg tab 1 STIMATE 1.5MG/ML NASAL SPRAY 2

PROLACTIN INHIBITORS cabergoline 0.5mg tab 1

SOMATOSTATIC AGENTS octreotide 0.05mg/ml inj 1 octreotide 0.1mg/ml inj 1 octreotide 0.2mg/ml inj 1 octreotide 0.5mg/ml inj 1 octreotide 1mg/ml inj 1 SIGNIFOR 0.3MG/ML INJ 2 NDS PA QL=60 ML/30 Days SIGNIFOR 0.6MG/ML INJ 2 NDS PA QL=60 ML/30 Days SIGNIFOR 0.9MG/ML INJ 2 NDS PA QL=60 ML/30 Days SOMATULINE 120MG/0.5ML SYRINGE 2 NDS SOMATULINE 60MG/0.2ML SYRINGE 2 NDS SOMATULINE 90MG/0.3ML SYRINGE 2 NDS

VASOPRESSIN RECEPTOR ANTAGONISTS JYNARQUE 45/15 THERAPY PACK 2 NDS PA QL=60 EA/30 Days JYNARQUE 60/30 THERAPY PACK 2 NDS PA QL=60 EA/30 Days JYNARQUE 90/30 THERAPY PACK 2 NDS PA QL=60 EA/30 Days



ESTROGENS ESTROGEN COMBINATIONS

amabelz 0.5/0.1mg 28 day pack 1 amabelz 1/0.5mg 28 day pack 1 COMBIPATCH 0.05-0.14MG PATCH 2 COMBIPATCH 0.05-0.25MG PATCH 2 estradiol 0.5mg/norethindrone acetate 0.1mg pack 1 estradiol 1mg/norethindrone acetate 0.5mg pack 1 ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mg tab

1

ethinyl estradiol 0.005mg/norethindrone acetate 1mg tab

1

fyavolv 0.5mg-2.5mcg tab 1 fyavolv 1mg-5mcg tab 1 jinteli tab 1 mimvey lo 28 day pack 1 mimvey pack 1 PREMPHASE 28 DAY PACK 2 PREMPRO 0.3/1.5MG 28 DAY PACK 2 PREMPRO 0.45/1.5 28 DAY PACK 2


88

PREMPRO 0.625/2.5MG 28 DAY PACK 2 PREMPRO 0.625/5MG 28 DAY PACK 2

ESTROGENS estradiol 0.00104mg/hr twice weekly patch 1 estradiol 0.00104mg/hr weekly patch 1 estradiol 0.00156mg/hr twice weekly patch 1 estradiol 0.00156mg/hr weekly patch 1 estradiol 0.00208mg/hr twice weekly patch 1 estradiol 0.00208mg/hr weekly patch 1 estradiol 0.0025mg/hr weekly patch 1 estradiol 0.00312mg/hr weekly patch 1 estradiol 0.00313mg/hr twice weekly patch 1 estradiol 0.00417mg/hr twice weekly patch 1 estradiol 0.00417mg/hr weekly patch 1 estradiol 0.5mg tab 1 estradiol 1mg tab 1 estradiol 20mg/ml inj 1 estradiol 2mg tab 1 estradiol 40mg/ml inj 1 ESTROPIPATE 0.75MG TAB 1 ESTROPIPATE 1.5MG TAB 1 ESTROPIPATE 3MG TAB 1 PREMARIN 0.3MG TAB 2 PREMARIN 0.45MG TAB 2 PREMARIN 0.625MG TAB 2 PREMARIN 0.9MG TAB 2 PREMARIN 1.25MG TAB 2



FLUOROQUINOLONES FLUOROQUINOLONES

AVELOX 400MG/250ML INJ 2 BAXDELA 450MG TAB 2 PA QL=60 EA/30 Days ciprofloxacin 100mg/ml oral susp 1 ciprofloxacin 250mg tab 1 ciprofloxacin 2mg/ml inj 1 ciprofloxacin 500mg tab 1 ciprofloxacin 50mg/ml oral susp 1 ciprofloxacin 750mg tab 1 levofloxacin 250mg tab 1 levofloxacin 25mg/ml inj 1 levofloxacin 25mg/ml oral soln 1 levofloxacin 500mg tab 1 levofloxacin 5mg/ml (150ml) inj 1 levofloxacin 5mg/ml inj 1


89

levofloxacin 750mg tab 1 MOXIFLOXACIN 1.6MG/ML INJ 2 moxifloxacin 400mg tab 1



GASTROINTESTINAL AGENTS - MISC. ANTIFLATULENTS

simethicone cap 125mg* 4 simethicone cap 180mg* 4 simethicone chew tab 125mg* 4 simethicone chew tab 80mg* 4 simethicone liquid 40mg/0.6ml* 4 SIMETHICONE LIQUID* 4 SIMETHICONE ORAL STRIP 62.5MG* 4 simethicone susp 40mg/0.6ml* 4

BILE ACID SYNTHESIS DISORDER AGENTS CHOLBAM 250MG CAP 2 NDS PA CHOLBAM 50MG CAP 2 NDS PA

FARNESOID X RECEPTOR (FXR) AGONISTS OCALIVA 10MG TAB 2 NDS PA QL=30 EA/30 Days OCALIVA 5MG TAB 2 NDS PA QL=30 EA/30 Days

GALLSTONE SOLUBILIZING AGENTS CHENODAL 250MG TAB 2 NDS ursodiol 250mg tab 1 ursodiol 300mg cap 1 ursodiol 500mg tab 1

GASTROINTESTINAL ANTIALLERGY AGENTS cromolyn sodium 20mg/ml oral soln 1

GASTROINTESTINAL STIMULANTS metoclopramide 10mg tab 1 metoclopramide 1mg/ml oral soln 1 metoclopramide 5mg tab 1 metoclopramide 5mg/ml inj 1

INFLAMMATORY BOWEL AGENTS APRISO 0.375GM ER CAP 2 balsalazide disodium 750mg cap 1 CANASA 1000MG RECTAL SUPP 2 DIPENTUM 250MG CAP 2 LIALDA 1.2GM DR TAB 2 mesalamine 66.7mg/ml enema 1 sulfasalazine 500mg dr tab 1 sulfasalazine 500mg tab 1

INTESTINAL ACIDIFIERS enulose 10gm/15ml oral soln 1 generlac 10gm/15ml oral soln 1


90

IRRITABLE BOWEL SYNDROME (IBS) AGENTS alosetron 0.5mg tab 1 alosetron 1mg tab 1 LINZESS 145MCG CAP 2 PA LINZESS 290MCG CAP 2 PA LINZESS 72MCG CAP 2 PA

PERIPHERAL OPIOID RECEPTOR ANTAGONISTS MOVANTIK 12.5MG TAB 2 PA MOVANTIK 25MG TAB 2 PA RELISTOR 12MG/0.6ML INJ 2 PA RELISTOR 12MG/0.6ML SYRINGE 2 PA RELISTOR 8MG/0.4ML SYRINGE 2 PA SYMPROIC 0.2MG TAB 2 PA

PHOSPHATE BINDER AGENTS AURYXIA 210MG TAB 2 calcium acetate 667mg cap 1 calcium acetate 667mg tab 1 FOSRENOL 1000MG ORAL POWDER 2 FOSRENOL 750MG ORAL POWDER 2 lanthanum carbonate 1000mg chew tab 1 lanthanum carbonate 500mg chew tab 1 lanthanum carbonate 750mg chew tab 1 PHOSLYRA 667MG/5ML ORAL SOLN 2 sevelamer carbonate 2400mg oral susp 1 sevelamer carbonate 800mg oral susp 1 sevelamer carbonate 800mg tab 1

SHORT BOWEL SYNDROME (SBS) AGENTS GATTEX 5MG INJ 2 NDS PA



GENITOURINARY AGENTS - MISCELLANEOUS ALKALINIZERS

potassium citrate 10meq er tab 1 potassium citrate 15 meq er tab 1 potassium citrate 5 meq er tab 1

CYSTINOSIS AGENTS CYSTAGON 150MG CAP 2 PA CYSTAGON 50MG CAP 2 PA

GENITOURINARY IRRIGANTS neomycin 40mg/ml/polymyxin b 200000unit/ml soln 1 sodium chloride 0.9% soln 1

INTERSTITIAL CYSTITIS AGENTS ELMIRON 100MG CAP 2

PROSTATIC HYPERTROPHY AGENTS alfuzosin 10mg er tab 1


91

dutasteride 0.5mg cap 1 dutasteride 0.5mg/tamsulosin 0.4mg cap 1 finasteride 5mg tab 1 RAPAFLO 4MG CAP 2 RAPAFLO 8MG CAP 2 tamsulosin 0.4mg cap 1

URINARY ANALGESICS phenazopyridine tab 95mg* 4 phenazopyridine tab 97.2mg* 4 phenazopyridine tab 97.5mg* 4

URINARY STONE AGENTS LITHOSTAT 250MG TAB 2 THIOLA 100MG TAB 2



GOUT AGENTS GOUT AGENT COMBINATIONS

colchicine 0.5mg/probenecid 500mg tab 1 GOUT AGENTS

allopurinol 100mg tab 1 allopurinol 300mg tab 1 COLCHICINE 0.6MG TAB 2 PA MITIGARE 0.6MG CAP 2 ULORIC 40MG TAB 2 ST ULORIC 80MG TAB 2 ST

URICOSURICS probenecid 500mg tab 1

HEMATOLOGICAL AGENTS - MISC. BRADYKININ B2 RECEPTOR ANTAGONISTS

FIRAZYR 30MG/3ML SYRINGE 2 NDS PA COMPLEMENT INHIBITORS

BERINERT 500UNIT INJ 2 NDS PA CINRYZE 500UNIT INJ 2 NDS PA HAEGARDA 2000UNT INJ 2 NDS PA HAEGARDA 3000UNT INJ 2 NDS PA RUCONEST 2100UNIT INJ 2 NDS PA

HEMATORHEOLOGIC AGENTS pentoxifylline 400mg er tab 1

PLATELET AGGREGATION INHIBITORS anagrelide 0.5mg cap 1 anagrelide 1mg cap 1 aspirin 25mg/dipyridamole 200mg cap 1 BRILINTA 60MG TAB 2 BRILINTA 90MG TAB 2 cilostazol 100mg tab 1


92

cilostazol 50mg tab 1 clopidogrel 75mg tab 1 dipyridamole 25mg tab 1 dipyridamole 50mg tab 1 dipyridamole 75mg tab 1 prasugrel 10mg tab 1 prasugrel 5mg tab 1



HEMATOPOIETIC AGENTS AGENTS FOR GAUCHER DISEASE

CEREZYME 400UNIT INJ 2 NDS VPRIV 400UNIT INJ 2 NDS ZAVESCA 100MG CAP 2 NDS PA

AGENTS FOR SICKLE CELL ANEMIA DROXIA 200MG CAP 2 DROXIA 300MG CAP 2 DROXIA 400MG CAP 2

COBALAMINS cyanocobalamin 1000mcg/ml inj* 3 docusate sodium enema 283mg* 4 vitamin B-12 1000mcg tab* 4 vitamin B-12 2000mcg tab* 4 vitamin B-12 500mcg tab* 4 vitamin B-12 50mcg tab* 4 vitamin B-12 CR tab 1000mg* 4 VITAMIN B-12 LOZENGE 250MCG* 4 vitamin B-12 lozenge 500mcg* 4 vitamin B-12 SL tab 2500mcg* 4 vitamin B-12 SL tab 3000mcg* 4 vitamin B-12 SL tab 5000mcg* 4 vitamin B-12 SL tab 500mcg* 4 vitamin B-12 tab 100mcg* 4 vitamin B-12 tab 2000mcg* 4 vitamin B-12 tab 250mcg* 4

FOLIC ACID/FOLATES FOLIC ACID 5MG/ML INJ* 3 folic acid tab 1mg* 3 folic acid tab 400mcg* 4 folic acid tab 800mcg* 4

HEMATOPOIETIC GROWTH FACTORS ARANESP 100MCG/0.5ML SYRINGE 2 PA BvD ST ARANESP 100MCG/ML INJ 2 PA BvD ST ARANESP 10MCG/0.4ML SYRINGE 2 PA BvD ST ARANESP 150MCG/0.3ML SYRINGE 2 PA BvD ST


93

ARANESP 200MCG/0.4ML SYRINGE 2 PA BvD ST ARANESP 200MCG/ML INJ 2 PA BvD ST ARANESP 25MCG/0.42ML SYRINGE 2 PA BvD ST ARANESP 25MCG/ML INJ 2 PA BvD ST ARANESP 300MCG/0.6ML SYRINGE 2 PA BvD ST ARANESP 300MCG/ML INJ 2 PA BvD ST ARANESP 40MCG/0.4ML SYRINGE 2 PA BvD ST ARANESP 40MCG/ML INJ 2 PA BvD ST ARANESP 500MCG/ML SYRINGE 2 PA BvD ST ARANESP 60MCG/0.3ML SYRINGE 2 PA BvD ST ARANESP 60MCG/ML INJ 2 PA BvD ST EPOGEN 10000UNIT/ML INJ 2 PA BvD EPOGEN 20000UNIT/ML INJ 2 PA BvD EPOGEN 2000UNIT/ML INJ 2 PA BvD EPOGEN 3000UNIT/ML INJ 2 PA BvD EPOGEN 4000UNIT/ML INJ 2 PA BvD GRANIX 300MCG/0.5ML SYRINGE 2 NDS GRANIX 480MCG/0.8ML SYRINGE 2 NDS LEUKINE 250MCG INJ 2 NDS PA NEULASTA 6MG/0.6ML SYRINGE 2 NDS PROCRIT 10000UNIT/ML INJ 2 PA BvD PROCRIT 20000UNIT/ML INJ 2 PA BvD PROCRIT 2000UNIT/ML INJ 2 PA BvD PROCRIT 3000UNIT/ML INJ 2 PA BvD PROCRIT 40000UNIT/ML INJ 2 PA BvD PROCRIT 4000UNIT/ML INJ 2 PA BvD PROMACTA 12.5MG TAB 2 NDS PA PROMACTA 25MG TAB 2 NDS PA PROMACTA 50MG TAB 2 NDS PA PROMACTA 75MG TAB 2 NDS PA ZARXIO 300MCG/0.5ML SYRINGE 2 NDS ZARXIO 480MCG/0.8ML SYRINGE 2 NDS

IRON ferrous sulfate CR tab 142mg* 4 ferrous sulfate CR tab 160mg* 4 ferrous sulfate CR tab 45mg* 4 ferrous sulfate CR tab 47.5mg* 4 ferrous sulfate CR tab 50mg* 4 FERROUS SULFATE EC TAB 324MG* 4 ferrous sulfate EC tab 325mg* 4 ferrous sulfate elixir 220mg/5ml* 4 FERROUS SULFATE LIQUID 220MG/5ML* 4 ferrous sulfate oral soln 75mg/ml* 4




94

FERROUS SULFATE SYRUP 300MG/5ML* 4 ferrous sulfate tab 27mg* 4 ferrous sulfate tab 325mg* 4 VENOFER 20MG/ML INJ* 3

STEM CELL MOBILIZERS MOZOBIL 24MG/1.2ML INJ 2 NDS



HEMOSTATICS HEMOSTATICS - SYSTEMIC

tranexamic acid 100mg/ml inj 1 tranexamic acid 650mg tab 1

HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS ANTIHISTAMINE HYPNOTICS

diphenhydramine cap 50mg* 4 diphenhydramine tab 25mg* 4 diphenhydramine tab 50mg* 4 doxylamine succinate tab 25mg* 4

BARBITURATE HYPNOTICS BUTISOL 30MG TAB 2 PHENOBARBITAL 100MG TAB 1 PHENOBARBITAL 15MG TAB 1 phenobarbital 16.2mg tab 1 PHENOBARBITAL 30MG TAB 1 phenobarbital 32.4mg tab 1 phenobarbital 4mg/ml oral soln 1 PHENOBARBITAL 60MG TAB 1 phenobarbital 64.8mg tab 1 phenobarbital 97.2mg tab 1

NON-BARBITURATE HYPNOTICS estazolam 1mg tab 1 estazolam 2mg tab 1 eszopiclone 1mg tab 1 QL=30 EA/30 Days eszopiclone 2mg tab 1 QL=30 EA/30 Days eszopiclone 3mg tab 1 QL=30 EA/30 Days FLURAZEPAM 15MG CAP 2 FLURAZEPAM 30MG CAP 2 temazepam 15mg cap 1 temazepam 22.5mg cap 1 temazepam 30mg cap 1 temazepam 7.5mg cap 1 TRIAZOLAM 0.125MG TAB 1 triazolam 0.25mg tab 1 zaleplon 10mg cap 1 QL=30 EA/30 Days zaleplon 5mg cap 1 QL=30 EA/30 Days


95

zolpidem tartrate 10mg tab 1 QL=30 EA/30 Days zolpidem tartrate 5mg tab 1 QL=60 EA/30 Days

SELECTIVE MELATONIN RECEPTOR AGONISTS HETLIOZ 20MG CAP 2 NDS PA QL=30 EA/30 Days ROZEREM 8MG TAB 2 PA QL=30 EA/30 Days



LAXATIVES BULK LAXATIVES

calcium polycarbophil tab 625mg* 4 fiber powder* 4 METAMUCIL WAFER* 4 psyllium cap 0.52gm* 4 psyllium powder 100%* 4 psyllium powder 28.3%* 4 psyllium powder 30%* 4 psyllium powder 30.9%* 4 psyllium powder 33%* 4 psyllium powder 48.57%* 4 psyllium powder 49%* 4 PSYLLIUM POWDER 52.3%* 4 psyllium powder 58.6%* 4 PSYLLIUM POWDER 60.3%* 4 PSYLLIUM POWDER 63%* 4 psyllium powder 68%* 4 PSYLLIUM POWDER 71.67%* 4 psyllium powder 95%* 4 PSYLLIUM POWDER PACKET 100%* 4 PSYLLIUM POWDER PACKET 28%* 4 PSYLLIUM POWDER PACKET 28.3%* 4 PSYLLIUM POWDER PACKET 58.12%* 4 PSYLLIUM POWDER PACKET 58.6%* 4 PSYLLIUM POWDER PACKET 60.3%* 4 PSYLLIUM POWDER PACKET 95%* 4

LAXATIVE COMBINATIONS gavilyte-c oral soln 1 gavilyte-g oral soln 1 gavilyte-n powder for oral soln 1 METAMUCIL PLUS CALCIUM CAP* 4 MOVIPREP ORAL SOLN 2 peg 3350/electrolyte oral soln 1 peg 3350/kcl/sodium bicarbonate/sodium chloride powder for oral soln

1


96

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

1

sennosides/docusate sodium tab 8.6-50mg* 4 trilyte powder for oral soln 1

LAXATIVES - MISCELLANEOUS constulose 10gm/15ml oral soln 1 glycerin supp 1 gm* 4 glycerin supp 1.2gm* 4 glycerin supp 2 gm* 4 glycerin supp 2.1gm* 4 glycerin supp 80.7%* 4 lactulose 667mg/ml oral soln 1 polyethylene glycol 3350 142mg/ml oral soln 1 polyethylene glycol 3350 powder packet (OTC)* 4 SORBITOL ORAL SOLUTION 70%* 4

LUBRICANT LAXATIVES MINERAL OIL (BULK)* 4 mineral oil enema* 4 MINERAL OIL LIGHT (BULK)* 4 mineral oil* 4

SALINE LAXATIVES magnesium citrate soln* 4 magnesium hydroxide susp 400mg/5ml* 4 sodium phosphates enema* 4

STIMULANT LAXATIVES bisacodyl supp 10mg* 4 bisacodyl tab delayed release 5mg* 4 sennosides syrup 8.8mg/5ml* 4 sennosides tab 15mg* 4 sennosides tab 17.2mg* 4 sennosides tab 25mg* 4 sennosides tab 8.6mg* 4

SURFACTANT LAXATIVES docusate calcium cap 240mg* 4 docusate sodium cap 100mg* 4 docusate sodium cap 250mg* 4 docusate sodium cap 50mg* 4 DOCUSATE SODIUM ENEMA 283MG* 4 docusate sodium liquid 150mg/15ml* 4 DOCUSATE SODIUM LIQUID 50MG/15ML* 4 docusate sodium syrup 60mg/15ml* 4 docusate sodium tab 100mg* 4


Necessary actions, restrictions, or limits on use


97



LOCAL ANESTHETICS-PARENTERAL LOCAL ANESTHETICS - AMIDES

lidocaine 0.5% inj 1 lidocaine 1% inj 1 lidocaine 2% inj 1

MACROLIDES AZITHROMYCIN

azithromycin 20mg/ml oral susp 1 azithromycin 250mg pack 1 azithromycin 250mg tab 1 azithromycin 2mg/ml inj 1 azithromycin 40mg/ml oral susp 1 azithromycin 500mg (3) tab pack 1 azithromycin 500mg tab 1 azithromycin 600mg tab 1

CLARITHROMYCIN clarithromycin 250mg tab 1 clarithromycin 25mg/ml oral susp 1 clarithromycin 500mg er tab 1 clarithromycin 500mg tab 1 clarithromycin 50mg/ml oral susp 1

ERYTHROMYCINS ERY-TAB 250MG DR TAB 2 ERY-TAB 333MG DR TAB 2 ERY-TAB 500MG DR TAB 2 ERYPED 400MG/5ML ORAL SUSP 2 ERYTHROCIN LACTOBIONATE 500MG INJ 2 erythromycin 250mg dr cap 1 erythromycin 250mg tab 1 erythromycin 500mg tab 1 erythromycin ethylsuccinate 40mg/ml oral susp 1

MEDICAL DEVICES PARENTERAL THERAPY SUPPLIES

INSULIN SYRINGE (DISP) U-100 1/2ML 1 MEDICAL DEVICES AND SUPPLIES

BANDAGES-DRESSINGS-TAPE GAUZE PAD 1

CONTRACEPTIVES CONDOMS LATEX LUBRICATED* 4 CONDOMS* 4

DIABETIC SUPPLIES LANCETS* 4

MISC. DEVICES


98

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

INSULIN PEN NEEDLE 2 INSULIN SYRINGE (DISP) U-100 0.3ML 1 INSULIN SYRINGE (DISP) U-100 1ML 1 INSULIN SYRINGE MIS 1ML/29G 1

RESPIRATORY THERAPY SUPPLIES AEROSOL MASK* 4 PEAK AIR PEAK FLOW METER* 4



MIGRAINE PRODUCTS MIGRAINE PRODUCTS

DIHYDROERGOTAMINE MESYLATE 0.5MG/ACT NASAL SPRAY

2 QL=16 ML/30 Days

MIGRANAL 4MG/ML NASAL SPRAY 2 QL=16 ML/30 Days SEROTONIN AGONISTS

naratriptan 1mg tab 1 QL=18 EA/30 Days naratriptan 2.5mg tab 1 QL=18 EA/30 Days rizatriptan 10mg odt 1 QL=36 EA/60 Days rizatriptan 10mg tab 1 QL=36 EA/60 Days rizatriptan 5mg odt 1 QL=36 EA/60 Days rizatriptan 5mg tab 1 QL=36 EA/60 Days sumatriptan 100mg tab 1 QL=18 EA/30 Days sumatriptan 12mg/ml auto-injector 1 QL=5 ML/30 Days sumatriptan 12mg/ml inj 1 QL=5 ML/30 Days sumatriptan 20mg/act nasal spray 1 QL=12 EA/30 Days sumatriptan 25mg tab 1 QL=18 EA/30 Days sumatriptan 4mg cartridge 1 QL=5 ML/30 Days sumatriptan 50mg tab 1 QL=18 EA/30 Days sumatriptan 5mg/act nasal spray 1 QL=12 EA/30 Days sumatriptan 6mg cartridge 1 QL=5 ML/30 Days sumatriptan 8mg/ml auto-injector 1 QL=5 ML/30 Days zolmitriptan 2.5mg odt 1 QL=18 EA/30 Days zolmitriptan 2.5mg tab 1 QL=18 EA/30 Days zolmitriptan 5mg odt 1 QL=18 EA/30 Days zolmitriptan 5mg tab 1 QL=18 EA/30 Days ZOMIG 2.5MG NASAL SPRAY 2 QL=16 EA/30 Days ZOMIG 5MG NASAL SPRAY 2 QL=12 EA/30 Days

MINERALS & ELECTROLYTES BICARBONATES

sodium lactate 5 meq/ml inj 1 CALCIUM

CALCIUM CARBONATE 260MG CHEW* 4 CALCIUM CARBONATE CAP 1250MG* 4


99

CALCIUM CARBONATE CHEW TAB 1250MG* 4 calcium carbonate susp 1250mg/5ml* 4 calcium carbonate tab 1250mg* 4 calcium carbonate tab 1500mg* 4 calcium carbonate tab 600mg* 4 calcium carbonate/cholecalciferol tab 600mg-200unit*

4

calcium carbonate/vitamin D cap 600mg-200unit* 4 calcium carbonate/vitamin D cap 600mg-500unit* 4 CALCIUM CARBONATE/VITAMIN D CHEW TAB 500MG-100UNIT*

4

calcium carbonate/vitamin D chew tab 500mg-400unit*

4


4

CALCIUM CARBONATE/VITAMIN D CHEW TAB 600MG-800UNIT*

4

calcium carbonate/vitamin D tab 200mg-250unit* 4 calcium carbonate/vitamin D tab 250mg-125unit* 4 calcium carbonate/vitamin D tab 250mg-200unit* 4 calcium carbonate/vitamin D tab 315mg-200unit* 4 calcium carbonate/vitamin D tab 315mg-250unit* 4 calcium carbonate/vitamin D tab 500mg-125unit* 4 calcium carbonate/vitamin D tab 500mg-200unit* 4 calcium carbonate/vitamin D tab 500mg-400unit* 4 calcium carbonate/vitamin D tab 500mg-600unit* 4 calcium carbonate/vitamin D tab 600mg-125unit* 4 calcium carbonate/vitamin D tab 600mg-200unit* 4 calcium carbonate/vitamin D tab 600mg-400unit* 4 calcium carbonate/vitamin D tab 600mg-800unit* 4 CALCIUM GLUBIONATE SYRUP 1.8GM/5ML* 4 CALCIUM GLUCONATE TAB 500MG* 4 CALCIUM GLUCONATE TAB 50MG* 4 calcium lactate tab 650mg* 4 calcium tab 500mg* 4 calcium tab 600mg* 4 CALCIUM/VITAMIN D TAB 600MG-200UNIT* 4 oyster shell calcium tab 500mg* 4 RISCAL-D TAB* 4

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

1

d5w/lactated ringers inj 1




100

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

1


1

glucose 25mg/ml/sodium chloride 0.0769 meq/ml inj 1 glucose 50mg/ml/potassium chloride 0.01meq/ml/sodium chloride 0.0769meq/ml inj

1

glucose 50mg/ml/potassium chloride 0.02 meq/ml inj 1 glucose 50mg/ml/potassium chloride 0.02meq/ml/sodium chloride 0.0342meq/ml inj

1

glucose 50mg/ml/potassium chloride 0.02meq/ml/sodium chloride 0.056meq/ml inj

1


1


1


1

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

2

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

1


1

glucose 50mg/ml/sodium chloride 0.0342 meq/ml inj 1 GLUCOSE 50MG/ML/SODIUM CHLORIDE 0.0385MEQ/ML INJ

1

glucose 50mg/ml/sodium chloride 0.0564 meq/ml inj 1 glucose 50mg/ml/sodium chloride 0.0769 meq/ml inj 1 glucose 50mg/ml/sodium chloride 0.154 meq/ml inj 1 IONOSOL-MB INJ 2 ISOLYTE P INJ 2 ISOLYTE S INJ 2 KCL/D5W/LR INJ 0.15% 2 lactated ringers inj 1 NORMOSOL-M INJ 1 NORMOSOL-R IN 5% DEXTROSE INJ 2 NORMOSOL-R INJ 2 oral electrolyte solution* 4 PLASMA-LYTE 148 INJ 2 PLASMALYTE A INJ 2 potassium chloride 0.02 meq/ml/sodium chloride 0.0769 meq/ml inj

1




101

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

1

tpn electrolytes inj 1 MAGNESIUM

magnesium oxide tab 250mg* 4 magnesium oxide tab 400mg* 4 magnesium oxide tab 500mg* 4 magnesium sulfate 50% inj 1 magnesium sulfate 50% syringe 1 magnesium tab 100mg* 4 MAGNESIUM TAB 200MG* 4 magnesium tab 250mg* 4

POTASSIUM K-TAB 20MEQ ER TAB 1 K-TAB 8MEQ ER TAB 1 klor-con 10meq er cap 1 klor-con 10meq er micro tab 1 klor-con 10meq er tab 1 KLOR-CON 15MEQ ER TAB 2 klor-con 20meq er micro tab 1 klor-con 8meq er cap 1 klor-con 8meq er tab 1 potassium chloride 0.1meq/ml inj 1 potassium chloride 10% oral soln 1 potassium chloride 10meq er cap 1 potassium chloride 10meq er micro tab 1 potassium chloride 10meq er tab 1 potassium chloride 2 meq/ml inj 1 potassium chloride 20% oral soln 1 potassium chloride 20meq er micro tab 1 POTASSIUM CHLORIDE 20MEQ ER TAB 1 potassium chloride 40meq/20ml inj 1 potassium chloride 8meq er cap 1 potassium chloride 8meq er tab 1

SODIUM sodium chloride 0.45% inj 1 sodium chloride 0.9% inj 1 sodium chloride 2.5 meq/ml inj 1 sodium chloride 3% inj 1 sodium chloride 5% inj 1 sodium chloride flush 0.9%* 3



MISCELLANEOUS THERAPEUTIC CLASSES CHELATING AGENTS


102

DEPEN 250MG TAB 2 SYPRINE 250MG CAP 2 PA trientine 250mg tab 1 PA

IMMUNOSUPPRESSIVE AGENTS AZATHIOPRINE 10MG/ML INJ 2 PA BvD mycophenolate mofetil 500mg inj 1 PA BvD

SYSTEMIC LUPUS ERYTHEMATOSUS AGENTS BENLYSTA 200MG/ML AUTO-INJECTOR 2 NDS PA QL=4 ML/28 Days BENLYSTA 200MG/ML SYRINGE 2 NDS PA QL=4 ML/28 Days



MOUTH/THROAT/DENTAL AGENTS ANESTHETICS TOPICAL ORAL

lidocaine 2% topical soln 1 ANTI-INFECTIVES - THROAT

clotrimazole 10mg lozenge 1 nystatin 100000unit/ml oral susp 1

ANTISEPTICS - MOUTH/THROAT chlorhexidine gluconate 0.12% mouthwash 1 periogard 0.12% mouthwash 1

STEROIDS - MOUTH/THROAT triamcinolone acetonide 0.1% oral paste 1

THROAT PRODUCTS - MISC. cevimeline 30mg cap 1 pilocarpine 5mg tab 1 pilocarpine 7.5mg tab 1

MULTIVITAMINS B-COMPLEX W/ C

B-complex w/vitamin C cap* 4 MULTIPLE VITAMINS W/ MINERALS

MULTIPLE VITAMINS W/MINERALS TAB* 4 multiple vitamins w/minerals tab* 4

MULTIVITAMINS multiple vitamin tab* 4

PED MV W/ IRON pediatric multiple vitamins w/iron drops 10mg/ml* 4

PEDIATRIC MULTIPLE VITAMINS pediatric multiple vitamin w/vitamin C soln 35mg/ml* 4

PEDIATRIC VITAMINS pediatric vitamin A/D/C drops 1500unit-400unit-35mg/ml*

4

PRENATAL VITAMINS PRENATAL VITAMIN (OTC)* 4 PRENATAL VITAMINS W/IRON (OTC)* 4


103



MUSCULOSKELETAL THERAPY AGENTS CENTRAL MUSCLE RELAXANTS

baclofen 10mg tab 1 baclofen 20mg tab 1 carisoprodol 350mg tab 1 chlorzoxazone 500mg tab 1 cyclobenzaprine 10mg tab 1 cyclobenzaprine 5mg tab 1 cyclobenzaprine 7.5mg tab 1 metaxall 800mg tab 1 METAXALONE 400MG TAB 2 metaxalone 800mg tab 1 methocarbamol 500mg tab 1 methocarbamol 750mg tab 1 orphenadrine citrate 100mg er tab 1 orphenadrine citrate 30mg/ml inj 1 tizanidine 2mg cap 1 tizanidine 2mg tab 1 tizanidine 4mg cap 1 tizanidine 4mg tab 1 tizanidine 6mg cap 1

DIRECT MUSCLE RELAXANTS dantrolene sodium 100mg cap 1 dantrolene sodium 25mg cap 1 dantrolene sodium 50mg cap 1

NASAL AGENTS - SYSTEMIC AND TOPICAL NASAL AGENTS - MISC.

saline nasal spray 0.65%* 4 NASAL ANTIALLERGY

azelastine 0.1% (137mcg) nasal inhaler 1 azelastine 0.15% (205.5mcg) nasal inhaler 1 olopatadine 0.6% nasal inhaler 1

NASAL ANTICHOLINERGICS ipratropium bromide 0.03% nasal inhaler 1 ipratropium bromide 0.06% nasal inhaler 1

NASAL STEROIDS flunisolide 25mcg nasal inhaler 1 QL=50 ML/15 Days fluticasone propionate 50mcg nasal inhaler 1 QL=32 GM/15 Days NASACORT OTC NASAL SPRAY* 4 triamcinolone 55mcg nasal spray 1 QL=33 GM/15 Days TRIAMCINOLONE ACETONIDE NASAL AEROSOL SUSPENSION 55MCG*

4

SYMPATHOMIMETIC DECONGESTANTS


104

pseudoephedrine liquid 15mg/5ml* 4 pseudoephedrine SR tab (12hr) 120mg* 4 PSEUDOEPHEDRINE SR TAB (24HR) 240MG* 4 QL=30 EA/30 Days pseudoephedrine tab 30mg* 4 pseudoephedrine tab 60mg* 4



NEUROMUSCULAR AGENTS ALS AGENTS

riluzole 50mg tab 1 MUSCULAR DYSTROPHY AGENTS

EXONDYS 100MG/2ML INJ 2 NDS PA EXONDYS 500MG/10ML INJ 2 NDS PA

NUTRIENTS CARBOHYDRATES

glucose 10% inj 1 glucose 5% inj 1

LIPIDS intralipid 200mg/ml inj 1 PA BvD nutrilipid 20% iv soln 1 PA BvD

MISC. NUTRITIONAL SUBSTANCES omega-3 fatty acids cap 1000mg* 4 omega-3 fatty acids cap 1200mg* 4

PROTEINS AMINO ACIDS ORAL POWDER* 4 PA AMINOSYN 7% WITH ELECTROLYTES, SULFITE-FREE INJ

2 PA BvD

aminosyn 8.5% with electrolytes, sulfite-free inj 1 PA BvD AMINOSYN II 10% INJ 2 PA BvD aminosyn ii 8.5% with electrolytes, sulfite-free inj 1 PA BvD AMINOSYN II 8.5%, SULFITE-FREE INJ 2 PA BvD AMINOSYN-HBC 7%, SULFITE-FREE INJ 2 PA BvD AMINOSYN-PF 10%, SULFITE-FREE INJ 2 PA BvD AMINOSYN-PF 7% INJ 2 PA BvD AMINOSYN-RF 5.2%, SULFITE-FREE INJ 2 PA BvD CLINIMIX 4.25/10 INJ 2 PA BvD CLINIMIX 4.25/20 INJ 2 PA BvD CLINIMIX 4.25/25 INJ 2 PA BvD CLINIMIX 4.25/5 INJ 2 PA BvD CLINIMIX 5/15 INJ 2 PA BvD CLINIMIX 5/20 INJ 2 PA BvD CLINIMIX 5/25 INJ 2 PA BvD CLINIMIX E 2.75/10 INJ 2 PA BvD CLINIMIX E 2.75/5 INJ 2 PA BvD CLINIMIX E 4.25/10 INJ 2 PA BvD


105

CLINIMIX E 4.25/25 INJ 2 PA BvD CLINIMIX E 4.25/5 INJ 2 PA BvD CLINIMIX E 5/15 INJ 2 PA BvD CLINIMIX E 5/20 INJ 2 PA BvD CLINIMIX E 5/25 INJ 2 PA BvD clinisol 15% inj 1 PA BvD FREAMINE 6.9% INJ 2 PA BvD HEPATAMINE 8% INJ 1 PA BvD NEPHRAMINE 5.4% INJ 2 PA BvD PERIFLEX PKU LIQUID* 4 PA plenamine 15% inj 1 PA BvD PREMASOL 10% INJ 2 PA BvD premasol 6% inj 1 PA BvD PROCALAMINE 3% INJ 2 PA BvD PROSOL 20% INJ 2 PA BvD TRAVASOL 10% INJ 2 PA BvD TROPHAMINE 10% INJ 2 PA BvD



OPHTHALMIC AGENTS ARTIFICIAL TEARS AND LUBRICANTS

artificial tear ophth soln* 4 artificial tears ophth soln 1.4%* 4 GENTEAL TEAR SOLN* 4 LACRISERT 5MG IMPLANT 2 white petrolatum/mineral oil ophth ointment* 4

BETA-BLOCKERS - OPHTHALMIC betaxolol 0.5% ophth soln 1 BETIMOL 0.25% OPHTH SOLN 2 BETIMOL 0.5% OPHTH SOLN 2 BETOPTIC S 0.25% OPHTH SUSP 2 carteolol 1% ophth soln 1 COMBIGAN 0.2-0.5% OPHTH SOLN 2 dorzolamide 20mg/ml/timolol 5mg/ml ophth soln 1 levobunolol 0.5% ophth soln 1 METIPRANOLOL 0.3% OPHTH SOLN 1 timolol 0.25% ophth gel 1 timolol 0.25% ophth soln 1 timolol 0.5% ophth gel 1 timolol 0.5% ophth soln 1 timolol 5mg/ml ophth 24hr ophth soln 1 TIMOPTIC-XE 0.25% OPHTH GEL 1

CYCLOPLEGIC MYDRIATICS ATROPINE SULFATE 1% OPHTH SOLN 1

MIOTICS


106

PHOSPHOLINE IODIDE 0.125% OPHTH SOLN 2

pilocarpine 1% ophth soln 1 pilocarpine 2% ophth soln 1 pilocarpine 4% ophth soln 1

OPHTHALMIC ADRENERGIC AGENTS ALPHAGAN P 0.1% OPHTH SOLN 2 apraclonidine 0.5% ophth soln 1 brimonidine tartrate 0.15% ophth soln 1 brimonidine tartrate 0.2% ophth soln 1 IOPIDINE 1% OPHTH SOLN 2 SIMBRINZA 1-0.2% OPHTH SUSP 2

OPHTHALMIC ANTI-INFECTIVES AZASITE 1% OPHTH SOLN 2 BACITRACIN 0.5UNIT/MG OPHTH OINTMENT 1 bacitracin 0.5unit/mg/polymyxin b 10unit/mg ophth ointment

1

BESIVANCE 0.6% OPHTH SUSP 2 ST ciprofloxacin 0.3% ophth soln 1 erythromycin 0.005mg/mg ophth ointment 1 gatifloxacin 0.5% ophth soln 1 ST

gentak 0.3% ophth ointment 1 gentamicin sulfate 0.3% ophth soln 1 gramicidin 0.025mg/ml/neomycin 1.75mg/ml/polymyxin b 10000unit/ml ophth soln

1

levofloxacin 0.5% ophth soln 1 moxifloxacin 0.5% ophth soln 1 NATACYN 5% OPHTH SUSP 2 neomycin/bacitracin/polymyxin ophth ointment 5(3.5)mg-400unit-10000unit

1

ofloxacin 0.3% ophth soln 1 polymyxin b 10000unit/ml/trimethoprim 1mg/ml ophth

soln 1

SULFACETAMIDE SODIUM 10% OPHTH OINTMENT 1 sulfacetamide sodium 10% ophth soln 1 tobramycin 0.3% ophth soln 1 trifluridine 1% soln 1 ZIRGAN 0.15% OPHTH GEL 2

OPHTHALMIC DECONGESTANTS naphazoline w/pheniramine ophth soln 0.025-0.3%* 4 naphazoline w/pheniramine ophth soln 0.027-0.315% *

4

NAPHAZOLINE/GLYCERIN OPHTH SOLN 0.012-0.2%*

4




107

OPHTHALMIC IMMUNOMODULATORS RESTASIS 0.05% OPHTH SUSP 2

OPHTHALMIC LOCAL ANESTHETICS proparacaine 0.5% ophth soln 1

OPHTHALMIC STEROIDS ALREX 0.2% OPHTH SUSP 2 BLEPHAMIDE 10-0.2% OPHTH SUSP 2 DEXAMETHASONE 0.1% OPHTH SOLN 1 dexamethasone/neomycin/polymyxin b 0.1% ophth ointment

1

dexamethasone/neomycin/polymyxin b 0.1% ophth susp

1

dexamethasone/tobramycin 0.3-0.1% ophth susp 1 DUREZOL 0.05% OPHTH SUSP 2 fluorometholone 0.1% ophth susp 1 LOTEMAX 0.5% OPHTH GEL 2 LOTEMAX 0.5% OPHTH OINTMENT 2 LOTEMAX 0.5% OPHTH SUSP 2 MAXIDEX 0.1% OPHTH SUSP 2 neomycin/polymyxin/bacitracin/hydrocortisone ophth ointmentment 1%

1

PRED MILD 0.12% OPHTH SUSP 2 PRED-G 0.3-1% OPHTH SUSP 2 prednisolone 1% ophth soln 1 prednisolone acetate 1% ophth susp 1 prednisolone sodium phosphate 2.5mg/ml/sulfacetamide sodium 100mg/ml ophth soln

1

TOBRADEX 0.3-0.1% OPHTH OINTMENT 2 ZYLET 0.5-0.3% OPHTH SUSP 2

OPHTHALMICS - MISC. ALOCRIL 2% OPHTH SOLN 2 ALOMIDE 0.1% OPHTH SOLN 2 azelastine 0.05% ophth soln 1 AZOPT 1% OPHTH SUSP 2 cromolyn sodium 4% ophth soln 1 CYSTARAN 0.44% OPHTH SOLN 2 NDS PA QL=60 ML/30 Days diclofenac sodium 0.1% ophth soln 1 dorzolamide 2% ophth soln 1 epinastine 0.05% ophth soln 1 eye wash soln* 4 flurbiprofen sodium 0.03% ophth soln 1 ILEVRO 0.3% OPHTH SUSP 2 ketorolac tromethamine 0.4% ophth soln 1




108

ketorolac tromethamine 0.5% ophth soln 1 ketotifen fumarate ophth soln 0.025%* 4 NEVANAC 0.1% OPHTH SUSP 2 olopatadine 0.1% ophth soln 1 olopatadine 0.2% ophth soln 1 sodium chloride hypertonic ophth ointment 5%* 4 sodium chloride hypertonic ophth soln 5%* 4 TYLOXAPOL OPHTH SOLN 0.25%* 4

PROSTAGLANDINS - OPHTHALMIC BIMATOPROST 0.03% OPHTH SOLN 2 QL=5 ML/30 Days latanoprost 0.005% ophth soln 1 QL=5 ML/30 Days LUMIGAN 0.01% OPHTH SOLN 2 QL=5 ML/30 Days TRAVATAN Z 0.004% OPHTH SOLN 2 QL=5 ML/30 Days



OTIC AGENTS OTIC AGENTS - MISCELLANEOUS

acetic acid 2% otic soln 1 carbamide peroxide 6.5% otic soln* 4

OTIC ANTI-INFECTIVES CETRAXAL 0.2% OTIC SOLN 2 CIPROFLOXACIN 0.2% OTIC SOLN 2 ofloxacin 0.3% otic soln 1

OTIC COMBINATIONS CIPRODEX 0.3-0.1% OTIC SUSP 2 COLY MYCIN S 3.3-3-10-0.5MG/ML OTIC SUSP 2 hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic soln

1

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

1

OTIC STEROIDS acetic acid/hydrocortisone 1-2% otic soln 1 fluocinolone acetonide 0.01% otic soln 1

PASSIVE IMMUNIZING AGENTS IMMUNE SERUMS

BIVIGAM 10% INJ 2 NDS PA CARIMUNE 6GM INJ 2 NDS PA FLEBOGAMMA 10% INJ 2 NDS PA GAMASTAN 1800UNIT/10ML INJ 2 PA GAMASTAN 360UNIT/2ML INJ 2 PA GAMMAGARD 10GM INJ 2 NDS PA GAMMAGARD 2.5GM/25ML INJ 2 NDS PA GAMMAGARD 5GM INJ 2 NDS PA GAMMAKED 1GM/10ML INJ 2 NDS PA GAMMAPLEX 10GM/200ML INJ 2 NDS PA


109

GAMUNEX 1GM/10ML INJ 2 NDS PA OCTAGAM 25GM/500ML INJ 2 NDS PA PRIVIGEN 20GM/200ML INJ 2 NDS PA

MONOCLONAL ANTIBODIES SYNAGIS 100MG/1ML INJ 2 NDS PA SYNAGIS 50MG/0.5ML INJ 2 NDS PA



PASSIVE IMMUNIZING AND TREATMENT AGENTS IMMUNE SERUMS

GAMMAPLEX 10GM/100ML INJ 2 NDS PA GAMMAPLEX 20GM/200ML INJ 2 NDS PA GAMMAPLEX 5GM/50ML INJ 2 NDS PA HYPERRAB 150UNIT/ML (10ML) INJ 2 PA BvD HYPERRAB 150UNIT/ML (2ML) INJ 2 PA BvD IMOGAM 150UNIT/ML (2ML) INJ 2 PA BvD OCTAGAM 2GM/20ML INJ 2 NDS PA

PENICILLINS AMINOPENICILLINS

amoxicillin 125mg chew tab 1 amoxicillin 250mg cap 1 AMOXICILLIN 250MG CHEW TAB 1 amoxicillin 25mg/ml oral susp 1 amoxicillin 40mg/ml oral susp 1 amoxicillin 500mg cap 1 amoxicillin 500mg tab 1 amoxicillin 50mg/ml oral susp 1 amoxicillin 80mg/ml oral susp 1 amoxicillin 875mg tab 1 ampicillin 100mg/ml inj 1 AMPICILLIN 125MG/ML INJ 2 ampicillin 250mg/ml inj 1 ampicillin 500mg cap 1

NATURAL PENICILLINS BICILLIN L-A 1200000UNIT/2ML SYRINGE 2 BICILLIN L-A 2400000UNIT/4ML SYRINGE 2 BICILLIN L-A 600000UNIT/ML SYRINGE 2 penicillin g potassium 1000000unit/ml inj 1 PENICILLIN G POTASSIUM 40000UNIT/ML INJ 2 PENICILLIN G POTASSIUM 60000UNIT/ML INJ 2 PENICILLIN G PROCAINE 600000UNIT/ML SYRINGE

2

PENICILLIN G SODIUM 100000UNIT/ML INJ 2 penicillin v potassium 250mg tab 1 penicillin v potassium 25mg/ml oral soln 1


110

penicillin v potassium 500mg tab 1 penicillin v potassium 50mg/ml oral soln 1

PENICILLIN COMBINATIONS amoxicillin 1000mg/clavulanate 62.5mg er tab 1 amoxicillin 120mg/ml/clavulanate 8.58mg/ml oral susp

1

AMOXICILLIN 200MG/CLAVULANATE 28.5MG CHEW TAB

2

amoxicillin 250mg/clavulanate 125mg tab 1 AMOXICILLIN 400MG/CLAVULANATE 57MG CHEW TAB

2

amoxicillin 40mg/ml/clavulanate 5.7mg/ml oral susp 1 amoxicillin 500mg/clavulanate 125mg tab 1 amoxicillin 50mg/ml/clavulanate 12.5mg/ml oral susp 1 amoxicillin 80mg/ml/clavulanate 11.4mg/ml oral susp 1 amoxicillin 875mg/clavulanate 125mg tab 1 ampicillin 100mg/ml/sulbactam 50mg/ml inj 1 ampicillin 20mg/ml/sulbactam 10mg/ml inj 1 ampicillin 250mg/ml/sulbactam 125mg/ml inj 1 AUGMENTIN 125-31.25MG/5ML ORAL SUSP 2 BICILLIN 300000-300000UNIT/ML SYRINGE 2 BICILLIN 450000-150000UNIT/ML SYRINGE 2 piperacillin 2000mg/tazobactam 250mg inj 1 piperacillin 200mg/ml/tazobactam 25mg/ml inj 1 piperacillin 3000mg/tazobactam 375mg inj 1 piperacillin 4000mg/tazobactam 500mg inj 1 ZOSYN 40-5MG/ML INJ 2 ZOSYN 60-7.5MG/ML INJ 2

PENICILLINASE-RESISTANT PENICILLINS dicloxacillin 250mg cap 1 dicloxacillin 500mg cap 1 nafcillin 100mg/ml inj 1 nafcillin 1gm inj 1 oxacillin 100mg/ml inj 1 oxacillin 2000mg inj 1 OXACILLIN 20MG/ML INJ 2 OXACILLIN 40MG/ML INJ 2



PROGESTINS PROGESTINS

medroxyprogesterone acetate 10mg tab 1 medroxyprogesterone acetate 2.5mg tab 1 medroxyprogesterone acetate 5mg tab 1 megestrol acetate 125mg/ml oral susp 1 PA


111

norethindrone acetate 5mg tab 1 progesterone 100mg cap 1 progesterone 200mg cap 1



PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. AGENTS FOR CHEMICAL DEPENDENCY

acamprosate calcium 333mg dr tab 1 disulfiram 250mg tab 1 disulfiram 500mg tab 1

ANTI-CATAPLECTIC AGENTS XYREM 500MG/ML ORAL SOLN 2 NDS PA QL=540 ML/30 Days

ANTIDEMENTIA AGENTS donepezil 10mg odt 1 QL=30 EA/30 Days donepezil 10mg tab 1 QL=60 EA/30 Days donepezil 23mg tab 1 ST QL=30 EA/30 Days donepezil 5mg odt 1 QL=30 EA/30 Days donepezil 5mg tab 1 QL=60 EA/30 Days galantamine 12mg tab 1 galantamine 4mg tab 1 galantamine 8mg tab 1 galantamine hydrobromide 16mg er cap 1 galantamine hydrobromide 24mg er cap 1 GALANTAMINE HYDROBROMIDE 4MG/ML ORAL SOLN

2

galantamine hydrobromide 8mg er cap 1 memantine 10mg tab 1 memantine 10mg/memantine 5mg pack 1 memantine 14mg er cap 1 memantine 21mg er cap 1 memantine 28mg er cap 1 memantine 2mg/ml oral soln 1 memantine 5mg tab 1 memantine 7mg er cap 1 NAMENDA 14MG XR CAP 2 NAMENDA 21MG XR CAP 2 NAMENDA 28 TITRATION PACK 2 NAMENDA 28MG XR CAP 2 NAMENDA 7MG XR CAP 2 NAMZARIC 10-21MG ER CAP 2 ST NAMZARIC 10-7MG ER CAP 2 ST NAMZARIC 14-10MG ER CAP 2 ST NAMZARIC 28-10MG ER CAP 2 ST NAMZARIC TITRATION PACK 2 ST rivastigmine 1.5mg cap 1


112

rivastigmine 13.3mg/24hr patch 1 rivastigmine 3mg cap 1 rivastigmine 4.5mg cap 1 rivastigmine 4.6mg/24hr patch 1 rivastigmine 6mg cap 1 rivastigmine 9.5mg/24hr patch 1

COMBINATION PSYCHOTHERAPEUTICS AMITRIPTYLINE 10MG/PERPHENAZINE 2MG TAB 1 AMITRIPTYLINE 10MG/PERPHENAZINE 4MG TAB 1 amitriptyline 12.5mg/chlordiazepoxide 5mg tab 1 amitriptyline 25mg/chlordiazepoxide 10mg tab 1 AMITRIPTYLINE 25MG/PERPHENAZINE 2MG TAB 1 AMITRIPTYLINE 25MG/PERPHENAZINE 4MG TAB 1 AMITRIPTYLINE 50MG/PERPHENAZINE 4MG TAB 1 fluoxetine 25mg/olanzapine 12mg cap 1 fluoxetine 25mg/olanzapine 3mg cap 1 fluoxetine 25mg/olanzapine 6mg cap 1 fluoxetine 50mg/olanzapine 12mg cap 1 fluoxetine 50mg/olanzapine 6mg cap 1

FIBROMYALGIA AGENTS SAVELLA 100MG TAB 2 QL=60 EA/30 Days SAVELLA 12.5MG TAB 2 QL=60 EA/30 Days SAVELLA 25MG TAB 2 QL=60 EA/30 Days SAVELLA 4-WEEK TITRATION PACK 2 SAVELLA 50MG TAB 2 QL=60 EA/30 Days

MOVEMENT DISORDER DRUG THERAPY AUSTEDO 12MG TAB 2 NDS PA AUSTEDO 6MG TAB 2 NDS PA AUSTEDO 9MG TAB 2 NDS PA tetrabenazine 12.5mg tab 1 PA tetrabenazine 25mg tab 1 PA

MULTIPLE SCLEROSIS AGENTS AMPYRA 10MG ER TAB 2 NDS PA QL=60 EA/30 Days AUBAGIO 14MG TAB 2 NDS AUBAGIO 7MG TAB 2 NDS AVONEX 30MCG/0.5ML AUTO-INJECTOR 2 NDS AVONEX 30MCG/0.5ML SYRINGE 2 NDS AVONEX 30MCG/VIAL INJ 2 NDS COPAXONE 20MG/ML SYRINGE 2 NDS COPAXONE 40MG/ML SYRINGE 2 NDS EXTAVIA 0.3MG INJ 2 NDS GILENYA 0.5MG CAP 2 NDS glatiramer 20mg/ml syringe 1




113

glatiramer 40mg/ml syringe 1 glatopa 20mg/ml inj 1 glatopa 40mg/ml syringe 1 PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR 2 NDS PLEGRIDY 125MCG/0.5ML SYRINGE 2 NDS PLEGRIDY PEN STARTER PACK 2 NDS PLEGRIDY STARTER PACK 2 NDS REBIF 22MCG/0.5ML AUTO-INJECTOR 2 NDS REBIF 22MCG/0.5ML SYRINGE 2 NDS REBIF 44MCG/0.5ML AUTO-INJECTOR 2 NDS REBIF 44MCG/0.5ML SYRINGE 2 NDS REBIF REBIDOSE PACK 2 NDS REBIF TITRATION PACK 2 NDS TECFIDERA 120MG DR CAP 2 NDS TECFIDERA 240MG DR CAP 2 NDS TECFIDERA 30-DAY STARTER PACK 2 NDS TYSABRI 300MG/15ML INJ 2 NDS PA

PSEUDOBULBAR AFFECT (PBA) AGENTS NUEDEXTA 20-10MG CAP 2 QL=60 EA/30 Days

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. ERGOLOID MESYLATES 1MG TAB 2 pimozide 1mg tab 1 pimozide 2mg tab 1

SMOKING DETERRENTS bupropion 150mg sr tab 1 CHANTIX 0.5MG TAB 2 CHANTIX 1MG TAB 2 CHANTIX CONTINUING MONTHS OF THERAPY 1MG PACK

2

CHANTIX FIRST MONTH OF THERAPY PACK 2 nicotine patch 14mg/24hr* 4 QL=182 EA/365 Days nicotine patch 21mg/24hr* 4 QL=182 EA/365 Days nicotine patch 7mg/24hr* 4 QL=182 EA/365 Days NICOTINE PATCH KIT* 4 QL=182 EA/365 Days nicotine polacrilex gum 2mg* 4 QL=4320 EA/365 Days nicotine polacrilex gum 4mg* 4 QL=4320 EA/365 Days nicotine polacrilex lozenge 2mg* 4 QL=3600 EA/365 Days nicotine polacrilex lozenge 4mg* 4 QL=3600 EA/365 Days NICOTROL 10MG INHALER 2 NICOTROL 10MG/ML NASAL INHALER 2



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

ARALAST 500MG INJ 2 NDS


114

GLASSIA 1000MG/50ML INJ 2 NDS PROLASTIN 1000MG INJ 2 NDS ZEMAIRA 1000MG INJ 2 NDS

CYSTIC FIBROSIS AGENTS KALYDECO 150MG TAB 2 NDS PA QL=60 EA/30 Days KALYDECO 50MG GRANULES PACKET 2 NDS PA QL=60 EA/30 Days KALYDECO 75MG GRANULES PACKET 2 NDS PA QL=60 EA/30 Days ORKAMBI 100-125MG TAB 2 NDS PA QL=120 EA/30 Days ORKAMBI 200-125MG TAB 2 NDS PA QL=120 EA/30 Days PULMOZYME 1MG/ML INH SOLN 2 NDS PA BvD

PULMONARY FIBROSIS AGENTS ESBRIET 267MG CAP 2 NDS PA ESBRIET 267MG TAB 2 NDS PA ESBRIET 801MG TAB 2 NDS PA OFEV 100MG CAP 2 NDS PA OFEV 150MG CAP 2 NDS PA



SULFONAMIDES SULFONAMIDES

SULFADIAZINE 500MG TAB 1 TETRACYCLINES TETRACYCLINES

doxy 100mg inj 1 doxycycline hyclate 100mg cap 1 doxycycline hyclate 100mg tab 1 doxycycline hyclate 20mg tab 1 doxycycline hyclate 50mg cap 1 doxycycline monohydrate 100mg cap 1 doxycycline monohydrate 100mg tab 1 doxycycline monohydrate 50mg cap 1 doxycycline monohydrate 50mg tab 1 doxycycline monohydrate 5mg/ml oral susp 1 doxycycline monohydrate 75mg tab 1 minocycline 100mg cap 1 minocycline 100mg tab 1 minocycline 50mg cap 1 minocycline 50mg tab 1 minocycline 75mg cap 1 minocycline 75mg tab 1 morgidox 50mg cap 1 tetracycline 250mg cap 1 tetracycline 500mg cap 1

THYROID AGENTS ANTITHYROID AGENTS


115

methimazole 10mg tab 1 methimazole 5mg tab 1 propylthiouracil 50mg tab 1

THYROID HORMONES levo-t 100mcg tab 1 levo-t 112mcg tab 1 levo-t 125mcg tab 1 levo-t 137mcg tab 1 levo-t 150mcg tab 1 levo-t 175mcg tab 1 levo-t 200mcg tab 1 levo-t 25mcg tab 1 levo-t 300mcg tab 1 levo-t 50mcg tab 1 levo-t 75mcg tab 1 levo-t 88mcg tab 1 levothyroxine sodium 100mcg tab 1 levothyroxine sodium 112mcg tab 1 levothyroxine sodium 125mcg tab 1 levothyroxine sodium 137mcg tab 1 levothyroxine sodium 150mcg tab 1 levothyroxine sodium 175mcg tab 1 levothyroxine sodium 200mcg tab 1 levothyroxine sodium 25mcg tab 1 levothyroxine sodium 300mcg tab 1 levothyroxine sodium 50mcg tab 1 levothyroxine sodium 75mcg tab 1 levothyroxine sodium 88mcg tab 1 levoxyl 100mcg tab 1 levoxyl 112mcg tab 1 levoxyl 125mcg tab 1 levoxyl 137mcg tab 1 levoxyl 150mcg tab 1 levoxyl 175mcg tab 1 levoxyl 200mcg tab 1 levoxyl 25mcg tab 1 levoxyl 50mcg tab 1 levoxyl 75mcg tab 1 levoxyl 88mcg tab 1 liothyronine sodium 0.005mg tab 1 liothyronine sodium 0.01mg/ml inj 1 liothyronine sodium 0.025mg tab 1 liothyronine sodium 0.05mg tab 1




116

THYROLAR 120MG TAB 2 THYROLAR 15MG TAB 2 THYROLAR 180MG TAB 2 THYROLAR 30MG TAB 2 THYROLAR 60MG TAB 2 unithroid 100mcg tab 1 unithroid 112mcg tab 1 unithroid 125mcg tab 1 unithroid 150mcg tab 1 unithroid 175mcg tab 1 unithroid 200mcg tab 1 unithroid 25mcg tab 1 unithroid 300mcg tab 1 unithroid 50mcg tab 1 unithroid 75mcg tab 1 unithroid 88mcg tab 1



TOXOIDS TOXOID COMBINATIONS

ADACEL INJ 2 ADACEL SYRINGE 2 BOOSTRIX INJ 2 BOOSTRIX SYRINGE 2 DAPTACEL INJ 2 DIPHTHERIA/TETANUS TOXOID INJ 2 PA BvD INFANRIX INJ 2 KINRIX 0.05 MG/ML INJ 2 KINRIX INJ 2 PEDIARIX INJ 2 QUADRACEL INJ 2 TENIVAC SYRINGE 2 PA BvD TETANUS/DIPHTHERIA TOXOID INJ 2 PA BvD

ULCER DRUGS ANTISPASMODICS

ATROPINE SULFATE 0.05MG/ML SYRINGE 1 dicyclomine 10mg cap 1 dicyclomine 20mg tab 1 dicyclomine 2mg/ml oral soln 1 glycopyrrolate 0.2mg/ml inj 1 glycopyrrolate 1mg tab 1 glycopyrrolate 2mg tab 1 methscopolamine 2.5mg tab 1 methscopolamine 5mg tab 1 PROPANTHELINE 15MG TAB 2


117

H-2 ANTAGONISTS cimetidine 200mg tab 1 cimetidine 300mg tab 1 cimetidine 400mg tab 1 cimetidine 60mg/ml oral soln 1 cimetidine 800mg tab 1 FAMOTIDINE 0.4MG/ML INJ 2 famotidine 10mg/ml inj 1 famotidine 20mg tab 1 famotidine 40mg tab 1 famotidine 8mg/ml oral susp 1 famotidine tab 10mg* 4 nizatidine 150mg cap 1 NIZATIDINE 15MG/ML ORAL SOLN 2 nizatidine 300mg cap 1 ranitidine 150mg cap 1 ranitidine 150mg tab 1 ranitidine 15mg/ml oral soln 1 ranitidine 25mg/ml inj 1 ranitidine 300mg cap 1 ranitidine 300mg tab 1

MISC. ANTI-ULCER sucralfate 1000mg tab 1

PROTON PUMP INHIBITORS ESOMEPRAZOLE 20MG INJ 2 esomeprazole 40mg inj 1 lansoprazole 15mg dr cap 1 lansoprazole 30mg dr cap 1 omeprazole 10mg dr cap 1 omeprazole 20mg dr cap 1 omeprazole 40mg dr cap 1 pantoprazole 20mg dr tab 1 pantoprazole 40mg dr tab 1 pantoprazole 40mg inj 1 rabeprazole sodium 20mg dr tab 1

ULCER DRUGS - PROSTAGLANDINS misoprostol 0.1mg tab 1 misoprostol 0.2mg tab 1

ULCER THERAPY COMBINATIONS amoxicillin 500mg/clarithromycin 500mg/lansoprazole 30mg pack

1

PYLERA 140-125-125MG CAP 2



URINARY ANTI-INFECTIVES


118

URINARY ANTI-INFECTIVES methenamine hippurate 1000mg tab 1 nitrofurantoin 5mg/ml oral susp 1 nitrofurantoin macro 25mg cap 1 nitrofurantoin monohydrate/macrocrystalline 100mg cap

1

nitrofurantoin, macro 100mg cap 1 nitrofurantoin, macro 50mg cap 1



URINARY ANTISPASMODICS URINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC)

oxybutynin chloride 10mg er tab 1 oxybutynin chloride 15mg er tab 1 oxybutynin chloride 1mg/ml oral soln 1 oxybutynin chloride 5mg er tab 1 oxybutynin chloride 5mg tab 1 tolterodine tartrate 1mg tab 1 tolterodine tartrate 2mg er cap 1 tolterodine tartrate 2mg tab 1 tolterodine tartrate 4mg er cap 1 trospium chloride 20mg tab 1 trospium chloride 60mg er cap 1 VESICARE 10MG TAB 2 VESICARE 5MG TAB 2

URINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS MYRBETRIQ 25MG ER TAB 2 MYRBETRIQ 50MG ER TAB 2

URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS bethanechol chloride 10mg tab 1 bethanechol chloride 25mg tab 1 bethanechol chloride 50mg tab 1 bethanechol chloride 5mg tab 1

URINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS flavoxate 100mg tab 1

VACCINES BACTERIAL VACCINES

ACTHIB INJ 2 BCG, LIVE, TICE STRAIN 50MG/ML INJ 2 BEXSERO SYRINGE 2 HIBERIX INJ 2 MENACTRA INJ 2 MENVEO INJ 2 PEDVAXHIB 7.5MCG/0.5ML INJ 2 TRUMENBA SYRINGE 2


119

TYPHIM VI 25MCG/0.5ML INJ 2 TYPHIM VI 25MCG/0.5ML SYRINGE 2

VIRAL VACCINES ENGERIX-B 10MCG/0.5ML SYRINGE 2 PA BvD ENGERIX-B 20MCG/ML SYRINGE 2 PA BvD GARDASIL 9 INJ 2 PA GARDASIL 9 SYRINGE 2 PA HAVRIX 1440UNIT INJ 2 HAVRIX 1440UNIT SYRINGE 2 HAVRIX 720UNIT INJ 2 HAVRIX 720UNIT SYRINGE 2 IMOVAX 2.5UNIT/ML INJ 2 PA BvD IPOL INJ 2 IXIARO SYRINGE 2 M-M-R II INJ 2 PROQUAD INJ 2 RABAVERT 2.5UNIT/ML INJ 2 PA BvD RECOMBIVAX 10MCG/ML SYRINGE 2 PA BvD RECOMBIVAX 40MCG/ML INJ 2 PA BvD RECOMBIVAX 5MCG/0.5ML SYRINGE 2 PA BvD RECOMBIVAX HB 10MCG/ML INJ 2 PA BvD ROTARIX ORAL SUSP 2 ROTATEQ ORAL SUSP 2 SHINGRIX INJ 2 PA TWINRIX 720UNIT SYRINGE 2 VAQTA 25UNIT/0.5ML SYRINGE 2 VAQTA 50UNIT/0.5ML INJ 2 VAQTA 50UNIT/1ML INJ 2 VAQTA 50UNIT/ML SYRINGE 2 VARIVAX 1350PFU/0.5ML INJ 2 YF-VAX 4000UNIT/ML INJ 2 ZOSTAVAX 19400UNIT/0.65ML INJ 2 PA



VAGINAL PRODUCTS SPERMICIDES

NONOXYNOL-9 FILM 28%* 4 NONOXYNOL-9 FOAM 12.5%* 4 NONOXYNOL-9 GEL 3%* 4 NONOXYNOL-9 GEL 4%* 4

VAGINAL ANTI-INFECTIVES AVC BRAND OF SULFANILAMIDE 15% VAGINAL CREAM

2

clindamycin 2% vaginal cream 1 clotrimazole vaginal cream 1%* 4


120

clotrimazole vaginal cream 2%* 4 metronidazole 0.75% vaginal gel 1 miconazole nitrate vaginal cream 2%* 4 miconazole nitrate vaginal cream 4%* 4 miconazole nitrate vaginal kit* 4 MICONAZOLE NITRATE VAGINAL KIT* 4 miconazole nitrate vaginal supp 100mg* 4 miconazole nitrate vaginal supp 1200mg/2% cream kit*

4

miconazole nitrate vaginal supp 200mg/2% cream 9 gm kit*

4

terconazole 0.4% vaginal cream 1 terconazole 0.8% vaginal cream 1 terconazole 80mg vaginal supp 1 tioconazole vaginal ointment 6.5%* 4 vandazole 0.75% vaginal gel 1

VAGINAL ESTROGENS estradiol 0.1mg/ml vaginal cream 1 ESTRING 2MG VAGINAL RING 2 ST PREMARIN 0.625MG/GM VAGINAL CREAM 2

VAGINAL PROGESTINS CRINONE 4% VAGINAL GEL 2 PA CRINONE 8% VAGINAL GEL 2 PA



VASOPRESSORS ANAPHYLAXIS THERAPY AGENTS

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

NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS NORTHERA 100MG CAP 2 NDS PA NORTHERA 200MG CAP 2 NDS PA NORTHERA 300MG CAP 2 NDS PA

VASOPRESSORS midodrine 10mg tab 1 midodrine 2.5mg tab 1 midodrine 5mg tab 1

VITAMINS OIL SOLUBLE VITAMINS

AQUASOL A INJ 50000/ML* 3 cholecalciferol cap 2000unit* 4 cholecalciferol cap 400unit* 4 cholecalciferol drops 2000unit/0.03ml* 4 cholecalciferol drops 400unit/0.03ml* 4 cholecalciferol tab 2000unit* 4


121

ergocalciferol cap 50000unit* 3 ergocalciferol soln 8000unit/ml* 4 ERGOCALCIFEROL TAB 2000UNIT* 4 ERGOCALCIFEROL TAB 400UNIT* 4 MEPHYTON TAB 5MG* 3 phytonadione tab 100mcg* 4 vitamin D cap 1000unit* 4 vitamin D3 cap 10000unit* 4 vitamin D3 cap 50000unit* 4 vitamin D3 cap 5000unit* 4 vitamin D3 drops 5000unit/ml* 4 vitamin D3 oral liquid 400unit/ml* 4 vitamin D3 tab 1000unit* 4 vitamin D3 tab 400unit* 4 vitamin D3 tab 5000unit* 4 vitamin E 200unit cap* 4 vitamin E cap 1000unit* 4 vitamin E cap 100unit* 4 vitamin E cap 600unit* 4 vitamin E cap* 4

WATER SOLUBLE VITAMINS ASCORBIC ACID WAFER 500MG* 4 niacin CR cap 250mg* 4 niacin CR cap 500mg* 4 NIACIN CR TAB 1000MG* 4 niacin CR tab 250mg* 4 niacin CR tab 500mg* 4 niacin CR tab 750mg* 4 niacin tab 100mg* 4 niacin tab 250mg* 4 niacin tab 500mg* 4 niacin tab 50mg* 4 vitamin B-1 tab 100mg* 4 vitamin B-1 tab 50mg* 4 vitamin B-2 50mg tab* 4 vitamin B-2 tab 100mg* 4 vitamin B-2 tab 25mg* 4 vitamin B-6 tab 500mg* 4 vitamin B-6 CR tab 200mg* 4 vitamin B-6 tab 100mg* 4 vitamin B-6 tab 250mg* 4 vitamin B-6 tab 25mg* 4 vitamin B-6 tab 50mg* 4




122

vitamin C 100mg chew tab* 4 vitamin C 100mg tab* 4 vitamin C cap 500mg* 4 vitamin C chew tab 250mg* 4 vitamin C chew tab 500mg* 4 vitamin C drops 60mg* 4 VITAMIN C SYRUP 500/5ML* 4 vitamin C tab 1000mg* 4 vitamin C tab 1500mg* 4 vitamin C tab 250mg* 4 vitamin C tab 500mg* 4



ALPHABETICAL LISTING OF DRUGS

123

A

abacavir 20mg/ml oral soln

56

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

56

abacavir 600mg/lamivudine 300mg tab

56

ABELCET 5MG/ML INJ 31 ABILIFY 300MG MAINTENA INJ

55

ABILIFY 300MG MAINTENA PF SYRINGE

55

ABILIFY 400MG MAINTENA INJ

55

ABILIFY 400MG MAINTENA PF SYRINGE

55

ABRAXANE 100MG INJ 49 ABREVA CREAM* 78 acamprosate calcium 333mg dr tab

111

acarbose 100mg tab 26 acarbose 25mg tab 26 acarbose 50mg tab 26 acebutolol 200mg cap 61 acebutolol 400mg cap 61 acetaminophen 21.7mg/ml/hydrocodone bitartrate 0.5mg/ml oral soln

9

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

9

acetaminophen 300mg/codeine phosphate 15mg tab

9


9


9


9


9


9


9


9


9


9

acetaminophen 325mg/oxycodone 10mg tab

9

acetaminophen 325mg/oxycodone 2.5mg tab

10

acetaminophen 325mg/oxycodone 5mg tab

10

acetaminophen 325mg/oxycodone 7.5mg tab

10

acetaminophen 325mg/tramadol 37.5mg tab

10

acetaminophen cap 500mg*

6

acetaminophen chew tab 160mg*

6

acetaminophen chew tab 80mg*

6

acetaminophen CR tab 650mg*

6

acetaminophen dispersible tab 160mg*

6

acetaminophen dispersible tab 80mg*

6

acetaminophen elixir 160mg/5ml*

6

acetaminophen liquid 160mg/5ml*

6

acetaminophen liquid 167mg/5ml*

6

acetaminophen oral soln 160mg/5ml*

6

acetaminophen supp 120mg*

6


6


6

ACETAMINOPHEN SUPP 80MG*

6

acetaminophen susp 160mg/5ml*

6

acetaminophen susp 80mg/0.8ml*

6

ACETAMINOPHEN SYRUP 160 MG/5ML*

6

acetaminophen tab 325mg*

6

acetaminophen tab 500mg*

6

acetazolamide 100mg/ml inj

83

acetazolamide 125mg tab 83acetazolamide 250mg tab 83acetazolamide 500mg er cap

83

acetic acid 2% otic soln 108acetic acid/hydrocortisone 1-2%otic soln

108


124

acetylcysteine 10% inh soln

75

acetylcysteine 20% inh soln

75

acitretin 10mg cap 78 acitretin 17.5mg cap 78 acitretin 25mg cap 78 ACTHIB INJ 118 ACTIMMUNE 2000000UNIT/0.5ML INJ

48

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

59

acyclovir 5% ointment 78 acyclovir 50mg/ml inj 59 acyclovir 800mg tab 59 ADACEL INJ 116 ADACEL SYRINGE 116 ADAGEN 250UNIT/ML INJ

63

adapalene/benzoyl peroxide 0.1-2.5% gel

75

adefovir dipivoxil 10mg tab

58

ADEMPAS 0.5MG TAB 66 ADEMPAS 1.5MG TAB 66 ADEMPAS 1MG TAB 66 ADEMPAS 2.5MG TAB 66 ADEMPAS 2MG TAB 66 adriamycin 2mg/ml inj 45 adrucil 500mg/10ml inj 42 ADVAIR 100-50MCG DISKUS

16

ADVAIR 115-21MCG HFA INH

16


16

ADVAIR 250-50MCG DISKUS

16


16

ADVAIR 500-50MCG DISKUS

16

AEROSOL MASK* 98

afeditab 30mg cr tab 63 afeditab 60mg cr tab 63 AFINITOR 10MG TAB 45 AFINITOR 2.5MG TAB 45 AFINITOR 2MG ORAL SUSP

45

AFINITOR 3MG ORAL SUSP

45

AFINITOR 5MG ORAL SUSP

45

AFINITOR 5MG TAB 45 AFINITOR 7.5MG TAB 45 ala-cort 1% cream 79 ala-cort 2.5% cream 79 ALBENZA 200MG TAB 12 albuterol 0.21mg/ml (0.63mg/3ml) inh soln

16

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

16

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

16

albuterol 0.83mg/ml (0.083%) inh soln

16

albuterol 1mg/ml (0.5%) inh soln

16

albuterol 2mg tab 16 albuterol 4mg er tab 16 albuterol 4mg tab 16 albuterol 8mg er tab 16 alclometasone dipropionate 0.05% cream

79

alclometasone dipropionate 0.05% ointment

79

ALCOHOL SWAB 1"X1" (DIABETIC)

98

ALDURAZYME 2.9MG/5ML INJ

86

ALECENSA 150MG CAP 45 ALENDRONATE 0.933MG/ML ORAL SOLN

84

alendronate 10mg tab 84 alendronate 35mg tab 84

ALENDRONATE 40MG TAB

84

alendronate 5mg tab 84 alendronate 70mg tab 84 alfuzosin 10mg er tab 90 ALIMTA 100MG INJ 42 ALIMTA 500MG INJ 42 ALINIA 100MG/5ML ORAL SUSP

40

ALINIA 500MG TAB 40 ALIQOPA 60MG INJ 45 allopurinol 100mg tab 91 allopurinol 300mg tab 91 ALOCRIL 2% OPHTH SOLN

107

ALOGLIPTIN 12.5MG TAB

27

ALOGLIPTIN 12.5MG/METFORMIN 1000MG TAB

26

ALOGLIPTIN 12.5MG/METFORMIN 500MG TAB

26

ALOGLIPTIN 12.5MG/PIOGLITAZONE 15MG TAB

26


26


26

ALOGLIPTIN 25MG TAB 27 ALOGLIPTIN 25MG/PIOGLITAZONE 15MG TAB

26

ALOGLIPTIN 25MG/PIOGLITAZONE 30MG TAB

26

ALOGLIPTIN 25MG/PIOGLITAZONE 45MG TAB

26

ALOGLIPTIN 6.25MG TAB

27


125

ALOMIDE 0.1% OPHTH SOLN

107

alosetron 0.5mg tab 90 alosetron 1mg tab 90 ALPHAGAN P 0.1% OPHTH SOLN

106

alprazolam 0.25mg odt 13 alprazolam 0.25mg tab 13 alprazolam 0.5mg er tab 13 alprazolam 0.5mg odt 13 alprazolam 0.5mg tab 13 alprazolam 1mg er tab 13 alprazolam 1mg odt 13 alprazolam 1mg tab 13 alprazolam 2mg er tab 13 alprazolam 2mg odt 13 alprazolam 2mg tab 13 alprazolam 3mg er tab 13 ALREX 0.2% OPHTH SUSP

107

altavera 28 day pack 67 ALUMINUM ACETATE SOLN*

81

ALUMINUM HYDROXIDE GEL SUSP 320MG/5ML*

11

aluminum hydroxide/magnesium carbonate chew tab 160-105mg*

11

aluminum hydroxide/magnesium trisilicate chew tab 80-20mg*

11

aluminum/magnesium hydroxide/simethicone chew tab 200-200-25mg*

11


11


11

ALUNBRIG 180MG TAB 45 ALUNBRIG 30MG TAB 45

ALUNBRIG 90MG TAB 45 ALUNBRIG TAB STARTER PACK

45

alyacen 1/35 28 day pack 68 amabelz 0.5/0.1mg 28 day pack

87

amabelz 1/0.5mg 28 day pack

87

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

50

AMBISOME 50MG INJ 31 AMCINONIDE 0.1% CREAM

79

AMCINONIDE 0.1% OINTMENT

79

amethia 91 day pack 68 amethia lo 91 day pack 68 amikacin 250mg/ml inj 3 amiloride 5mg tab 84 amiloride 5mg/hydrochlorothiazide 50mg tab

83

AMINO ACIDS ORAL POWDER*

104

aminophylline 25mg/ml inj

17

AMINOSYN 7% WITH ELECTROLYTES, SULFITE-FREE INJ

104

aminosyn 8.5% with electrolytes, sulfite-free inj

104

AMINOSYN II 10% INJ 104 aminosyn ii 8.5% with electrolytes, sulfite-free inj

104

AMINOSYN II 8.5%, SULFITE-FREE INJ

104

AMINOSYN-HBC 7%, SULFITE-FREE INJ

104

AMINOSYN-PF 10%, SULFITE-FREE INJ

104

AMINOSYN-PF 7% INJ 104

AMINOSYN-RF 5.2%, SULFITE-FREE INJ

104

amiodarone 200mg tab 14 amiodarone 400mg tab 14 amiodarone 50mg/ml inj 14 amitriptyline 100mg tab 25 amitriptyline 10mg tab 25 AMITRIPTYLINE 10MG/PERPHENAZINE 2MG TAB

112

AMITRIPTYLINE 10MG/PERPHENAZINE 4MG TAB

112

amitriptyline 12.5mg/chlordiazepoxide 5mg tab

112

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

112


112


112

amitriptyline 50mg tab 25 AMITRIPTYLINE 50MG/PERPHENAZINE 4MG TAB

112

amitriptyline 75mg tab 25 amlodipine 10mg tab 63 amlodipine 10mg/atorvastatin 10mg tab

65

amlodipine 10mg/atorvastatin 20mg tab

65


65


65


126

amlodipine 10mg/benazepril 20mg cap

36


36

amlodipine 10mg/hydrochlorothiazid e 12.5mg/valsartan 160mg tab

36

amlodipine 10mg/hydrochlorothiazid e 25mg/valsartan 160mg tab

36

amlodipine 10mg/hydrochlorothiazid e 25mg/valsartan 320mg tab

36

amlodipine 10mg/olmesartan medoxomil 20mg tab

36


36

amlodipine 10mg/telmisartan 40mg tab

36


36

amlodipine 10mg/valsartan 160mg tab

36


36

amlodipine 2.5mg tab 63 amlodipine 2.5mg/atorvastatin 10mg tab

65

amlodipine 2.5mg/atorvastatin 20mg tab

65

amlodipine 2.5mg/atorvastatin 40mg tab

65

amlodipine 2.5mg/benazepril 10mg cap

36

amlodipine 5mg tab 63 amlodipine 5mg/atorvastatin 10mg tab

65


65


65


65


36


36


36

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

37


37


37


37


37


37


37


37

ammonium lactate 12% cream

81

ammonium lactate 12% lotion

81

amnesteem 10mg cap 75 amnesteem 20mg cap 75 amnesteem 40mg cap 75 AMOXAPINE 100MG TAB

25

AMOXAPINE 150MG TAB

25

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

110

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

110

amoxicillin 125mg chew tab

109

AMOXICILLIN 200MG/CLAVULANATE 28.5MG CHEW TAB

110

amoxicillin 250mg cap 109 AMOXICILLIN 250MG CHEW TAB

109

amoxicillin 250mg/clavulanate 125mg tab

110

amoxicillin 25mg/ml oral susp

109

AMOXICILLIN 400MG/CLAVULANATE 57MG CHEW TAB

110


109


110

amoxicillin 500mg cap 109


127

amoxicillin 500mg tab 109 amoxicillin 500mg/clarithromycin 500mg/lansoprazole 30mg pack

117

amoxicillin 500mg/clavulanate 125mg tab

110


109


110


109


110

amoxicillin 875mg tab 109 amoxicillin 875mg/clavulanate 125mg tab

110

amphetamine 10mg er cap

1

amphetamine 10mg tab 1 amphetamine 12.5mg tab 1 amphetamine 15mg er cap

1

amphetamine 15mg tab 1 amphetamine 20mg er cap

1

amphetamine 20mg tab 1 amphetamine 25mg er cap

1

amphetamine 30mg er cap

1

amphetamine 30mg tab 1 amphetamine 5mg er cap 1 amphetamine 5mg tab 1 amphetamine 7.5mg tab 1 AMPHOTERICIN B 50MG INJ

31

ampicillin 100mg/ml inj 109

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

110

AMPICILLIN 125MG/ML INJ

109

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

110

ampicillin 250mg/ml inj 109 ampicillin 250mg/ml/sulbactam 125mg/ml inj

110

ampicillin 500mg cap 109 AMPYRA 10MG ER TAB 112 ANADROL-50 50MG TAB

10

anagrelide 0.5mg cap 91 anagrelide 1mg cap 91 anastrozole 1mg tab 44 ANDRODERM 2MG/24HR PATCH

10

ANDRODERM 4MG/24HR PATCH

10

ANDROGEL 1% (25MG) GEL

10

ANDROGEL 1% (50MG) GEL

11

ANDROGEL 1.62% (1.25GM) GEL

11

ANDROGEL 1.62% (2.5GM) GEL

11

ANDROGEL 1.62% GEL 11 ANORO 62.5-25MCG ELLIPTA INH

16

APLENZIN 174MG ER TAB

23


23


23

APOKYN 10MG/ML CARTRIDGE

50

apraclonidine 0.5% ophth soln

106

aprepitant 125mg cap 30

aprepitant 125mg/80mg pack

30

aprepitant 40mg cap 30 aprepitant 80mg cap 30 apri 28 day pack 68 APRISO 0.375GM ER CAP

89

APTIOM 200MG TAB 19 APTIOM 400MG TAB 19 APTIOM 600MG TAB 19 APTIOM 800MG TAB 19 APTIVUS 100MG/ML ORAL SOLN

56

APTIVUS 250MG CAP 56 AQUASOL A INJ 50000/ML*

120

ARALAST 500MG INJ 113 aranelle 28 pack 68 ARANESP 100MCG/0.5ML SYRINGE

92

ARANESP 100MCG/ML INJ

92

ARANESP 10MCG/0.4ML SYRINGE

92


92


93


93


93


93


93


93


93


128


93

ARANESP 500MCG/ML SYRINGE

93


93


93

ARCALYST 220MG INJ 4 argatroban 100mg/ml inj 18 ARGATROBAN 1MG/ML INJ

18

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

55

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

55

ARISTADA 441MG/1.6ML SYRINGE

55


55


55

armodafinil 150mg tab 2 armodafinil 200mg tab 2 armodafinil 250mg tab 2 armodafinil 50mg tab 2 ARNUITY 100MCG INH 15 ARNUITY 200MCG INH 15 ARRANON 5MG/ML INJ 42 artificial tear ophth soln* 105 artificial tears ophth soln 1.4%*

105

ASCORBIC ACID WAFER 121 500MG* ASCRIPTIN TAB 325MG* 6 ashlyna 91 day pack 68

ASMANEX 100MCG (120ACT) HFA INH

15

ASMANEX 110MCG (30ACT) INH

15

ASMANEX 200MCG (120ACT) HFA INH

15


15


15


15

aspirin 25mg/dipyridamole 200mg cap

91

aspirin 325mg/oxycodone 4.84mg tab

10

aspirin chew tab 81mg* 6 aspirin EC tab 325mg* 6 aspirin EC tab 500mg* 6 aspirin EC tab 81mg* 6 aspirin tab 325mg* 6 aspirin tab 500mg* 6 aspirin/acetaminophen/ca ffeine tab 250-250-65mg*

6

ASSURE PLATINUM TEST STRIPS*

82

ASTAGRAF 0.5MG XL CAP

60

ASTAGRAF 1MG XL CAP 60 ASTAGRAF 5MG XL CAP 60 atazanavir 150mg cap 56 atazanavir 200mg cap 56 atazanavir 300mg cap 56 atenolol 100mg tab 61 atenolol 100mg/chlorthalidone 25mg tab

37

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

37

ATGAM 50MG/ML INJ 60 atomoxetine 100mg cap 2

atomoxetine 10mg cap 2 atomoxetine 18mg cap 2 atomoxetine 25mg cap 2 atomoxetine 40mg cap 2 atomoxetine 60mg cap 2 atomoxetine 80mg cap 2 atorvastatin 10mg tab 33 atorvastatin 20mg tab 33 atorvastatin 40mg tab 33 atorvastatin 80mg tab 33 atovaquone 150mg/ml oral susp

40

atovaquone 250mg/proguanil 100mg tab

41

atovaquone 62.5mg/proguanil 25mg tab

41

ATRIPLA 600-200-300MG TAB

56

atropine sulfate 0.005mg/ml/diphenoxylat e 0.5mg/ml oral soln

29

atropine sulfate 0.025mg/diphenoxylate 2.5mg tab

29

ATROPINE SULFATE 0.05MG/ML SYRINGE

116

ATROPINE SULFATE 1% 105 OPHTH SOLN ATROVENT 17MCG INH 15 AUBAGIO 14MG TAB 112 AUBAGIO 7MG TAB 112 aubra 28 day pack 68 AUGMENTIN 125-31.25MG/5ML ORAL SUSP

110

AURYXIA 210MG TAB 90 AUSTEDO 12MG TAB 112 AUSTEDO 6MG TAB 112 AUSTEDO 9MG TAB 112 AVANDIA 2MG TAB 28 AVANDIA 4MG TAB 28 AVASTIN 100MG/4ML INJ

43


129

AVASTIN 400MG/16ML INJ

43

AVC BRAND OF SULFANILAMIDE 15% VAGINAL CREAM

119

AVELOX 400MG/250ML INJ

88

aviane 28 pack 68 avita 0.025% cream 76 avita 0.025% gel 76 AVONEX 30MCG/0.5ML AUTO-INJECTOR

112

AVONEX 30MCG/0.5ML SYRINGE

112

AVONEX 30MCG/VIAL INJ

112

AVYCAZ 2-0.5GM INJ 66 azacitidine 100mg inj 42 AZACTAM 1GM/50ML INJ

39

AZACTAM 2GM/50ML INJ

39

AZASAN 100MG TAB 60 AZASAN 75MG TAB 60 AZASITE 1% OPHTH SOLN

106

AZATHIOPRINE 10MG/ML INJ

102

azathioprine 50mg tab 60 azelastine 0.05% ophth soln

107

azelastine 0.1% (137mcg) nasal inhaler

103

azelastine 0.15% (205.5mcg) nasal inhaler

103

azithromycin 20mg/ml oral susp

97

azithromycin 250mg pack 97 azithromycin 250mg tab 97 azithromycin 2mg/ml inj 97 azithromycin 40mg/ml oral susp

97

azithromycin 500mg (3) tab pack

97

azithromycin 500mg tab 97

azithromycin 600mg tab 97 AZOPT 1% OPHTH SUSP 107 aztreonam 333mg/ml inj 39

B

baci-im 50000unit inj 39 BACITRACIN 0.5UNIT/MG OPHTH OINTMENT

106

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

106

bacitracin 5000unit/ml inj 39 bacitracin ointment 500unit/gm*

77

bacitracin zinc ointment 500unit/gm*

77

bacitracin/polymyxin b ointment*

77

baclofen 10mg tab 103 baclofen 20mg tab 103 balsalazide disodium 750mg cap

89

balziva 28 day pack 68 BANZEL 200MG TAB 19 BANZEL 400MG TAB 19 BANZEL 40MG/ML ORAL SUSP

19

BARACLUDE 0.05MG/ML ORAL SOLN

58

BASAGLAR 100UNIT/ML PEN INJ

28

BAVENCIO 20MG/ML INJ

43

BAXDELA 450MG TAB 88 BCG, LIVE, TICE STRAIN 118 50MG/ML INJ B-complex w/vitamin C cap*

102

bekyree 28 day pack 68 BELEODAQ 500MG INJ 45 BELVIQ TAB 10MG* 2 benazepril 10mg tab 34

benazepril 10mg/hydrochlorothiazid e 12.5mg tab

37

benazepril 20mg tab 34 benazepril 20mg/hydrochlorothiazid e 12.5mg tab

37

benazepril 20mg/hydrochlorothiazid e 25mg tab

37

benazepril 40mg tab 34 benazepril 5mg tab 34 benazepril 5mg/hydrochlorothiazide 6.25mg tab

37

bendroflumethiazide 5mg/nadolol 40mg tab

37

bendroflumethiazide 5mg/nadolol 80mg tab

37

BENLYSTA 120MG INJ 61 BENLYSTA 200MG/ML AUTO-INJECTOR

102

BENLYSTA 200MG/ML SYRINGE

102

BENLYSTA 400MG INJ 61 benzonatate cap 100mg* 73 benzonatate cap 200mg* 73 benzoyl peroxide cream 10%*

76

benzoyl peroxide gel 10% *

76

benzoyl peroxide gel 5%* 76 benzoyl peroxide liquid 10%*

76

benzoyl peroxide liquid 5%*

76

BENZOYL PEROXIDE LOTION 10%*

76

BENZOYL PEROXIDE LOTION 5%*

76

benzoyl peroxide lotion 6%*

76

benztropine mesylate 0.5mg tab

49


130

benztropine mesylate 1mg tab

49

benztropine mesylate 1mg/ml inj

49

benztropine mesylate 2mg tab

49

BERINERT 500UNIT INJ 91 BESIVANCE 0.6% OPHTH SUSP

106

betamethasone 0.05% aug cream

79

betamethasone 0.05% aug gel

79

betamethasone 0.05% aug lotion

79

betamethasone 0.05% aug ointment

79

betamethasone 0.05% cream

79

betamethasone 0.05% lotion

79

betamethasone 0.05% ointment

79

betamethasone 0.1% cream

79

betamethasone 0.1% lotion

79

betamethasone 0.1% ointment

79

betamethasone valerate 0.12% foam

79

betamethasone/clotrimaz ole 1-0.05% cream

77

betamethasone/clotrimaz ole 1-0.05% lotion

77

betaxolol 0.5% ophth soln

105

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

118

bethanechol chloride 25mg tab

118


118


118

BETIMOL 0.25% OPHTH SOLN

105

BETIMOL 0.5% OPHTH SOLN

105

BETOPTIC S 0.25% OPHTH SUSP

105

bexarotene 75mg cap 48 BEXSERO SYRINGE 118 bicalutamide 50mg tab 44 BICILLIN 300000-300000UNIT/ML SYRINGE

110

BICILLIN 450000-150000UNIT/ML SYRINGE

110

BICILLIN L-A 1200000UNIT/2ML SYRINGE

109

BICILLIN L-A 2400000UNIT/4ML SYRINGE

109

BICILLIN L-A 600000UNIT/ML SYRINGE

109

BICNU 100MG INJ 42 BIDIL 20-37.5MG TAB 65 BIKTARVY 50-200-25MG TAB

56

BIMATOPROST 0.03% OPHTH SOLN

108

bisacodyl supp 10mg* 96 bisacodyl tab delayed release 5mg*

96

bismuth subsalicylate chew tab 262mg*

29

bismuth subsalicylate susp 525mg/15ml*

29

bismuth subsalicylate tab 262mg*

29

bisoprolol fumarate 10mg tab

61

bisoprolol fumarate 10mg/hydrochlorothiazid e 6.25mg tab

37

bisoprolol fumarate 2.5mg/hydrochlorothiazid e 6.25mg tab

37

bisoprolol fumarate 5mg tab

62

bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mg tab

37

BIVIGAM 10% INJ 108 bleomycin 15unit/ml inj 45 BLEPHAMIDE 10-0.2% OPHTH SUSP

107

blisovi 21 fe 1.5/30 28 day

68

blisovi 21 fe 1/20 28 day pack

68

blisovi 24 fe 1/20 28 day pack

68

BOOSTRIX INJ 116 BOOSTRIX SYRINGE 116 BORTEZOMIB 3.5MG INJ

45

BOSULIF 100MG TAB 45 BOSULIF 400MG TAB 46 BOSULIF 500MG TAB 46 BREO 100-25MCG ELLIPTA INH

16

BREO 200-25MCG ELLIPTA INH

16

briellyn 28 day pack 68 BRILINTA 60MG TAB 91 BRILINTA 90MG TAB 91 brimonidine tartrate 0.15% ophth soln

106

brimonidine tartrate 0.2% ophth soln

106

BRIVIACT 100MG TAB 19 BRIVIACT 10MG TAB 19 BRIVIACT 10MG/ML INJ 19 BRIVIACT 10MG/ML ORAL SOLN

19

BRIVIACT 25MG TAB 19


131

BRIVIACT 50MG TAB 19 BRIVIACT 75MG TAB 19 bromocriptine 2.5mg tab 50 bromocriptine 5mg cap 50 brompheniramine/phenyl ephrine elixir 1-2.5mg/5ml*

73

BROMPHENIRAMINE/P HENYLEPHRINE TAB 4-10MG*

73

brompheniramine/pseudo ephedrine elixir 1-15mg/5ml*

73

BROTAPP DM LIQUID 15-1-5 MG/5ML*

73

BROVEX LIQUID* 73 budesonide 0.125mg/ml inh soln

15

budesonide 0.25mg/ml inh soln

15

budesonide 0.5mg/ml inh soln

15

budesonide 3mg dr cap 71 bumetanide 0.25mg/ml inj 83 bumetanide 0.5mg tab 83 bumetanide 1mg tab 83 bumetanide 2mg tab 83 BUNAVAIL 2.1-0.3MG FILM

10

BUNAVAIL 4.2-0.7MG FILM

10

BUNAVAIL 6.3-1MG FILM

10

buprenorphine 0.3mg/ml cartridge

10

buprenorphine 0.3mg/ml inj

10

buprenorphine 2mg sl tab 10 buprenorphine 8mg sl tab 10 bupropion 100mg sr tab 23 bupropion 100mg tab 23 bupropion 150mg sr (12 hr) tab

23

bupropion 150mg sr tab 113

bupropion 150mg xl (24 hr) tab

23

bupropion 200mg sr tab 23 bupropion 300mg xl tab 23 bupropion 75mg tab 23 buspirone 10mg tab 13 buspirone 15mg tab 13 buspirone 30mg tab 13 buspirone 5mg tab 13 buspirone 7.5mg tab 13 busulfan 6mg/ml inj 42 BUTISOL 30MG TAB 94 butorphanol tartrate 10mg/ml nasal spray

10

BUTORPHANOL TARTRATE 1MG/ML INJ

10

butorphanol tartrate 2mg/ml inj

10

BYDUREON 2.35MG/ML AUTO-INJECTOR

27

BYDUREON 2MG INJ 27 BYDUREON 2MG PEN INJ

28

BYSTOLIC 10MG TAB 62 BYSTOLIC 2.5MG TAB 62 BYSTOLIC 20MG TAB 62 BYSTOLIC 5MG TAB 62

C

cabergoline 0.5mg tab 87 CABOMETYX 20MG TAB

46

CABOMETYX 40MG TAB

46

CABOMETYX 60MG TAB

46

CALAMINE LOTION* 81 calcipotriene 0.005% cream

78

calcipotriene 0.005% ointment

78

calcipotriene 0.005% topical soln

78

calcipotriene/betamethas one 0.005-0.064% ointment

79

calcitriol 0.00025mg cap 86 calcitriol 0.0005mg cap 86 calcitriol 0.001mg/ml inj 86 calcitriol 0.001mg/ml oral soln

86

calcium acetate 667mg cap

90

calcium acetate 667mg tab

90

calcium carbonate (antacid) chew tab 1000mg*

12


12


12


12


12

CALCIUM CARBONATE (ANTACID) TAB 648MG*

12

CALCIUM CARBONATE 260MG CHEW*

98

CALCIUM CARBONATE CAP 1250MG*

98

CALCIUM CARBONATE CHEW TAB 1250MG*

99

calcium carbonate susp 1250mg/5ml*

99

calcium carbonate tab 1250mg*

99


99


99


132

calcium carbonate/cholecalciferol tab 600mg-200unit*

99

CALCIUM CARBONATE/SIMETHIC ONE CHEW TAB 1000-60MG*

11

calcium carbonate/vitamin D cap 600mg-200unit*

99

calcium carbonate/vitamin D cap 600mg-500unit*

99


99


99


99


99

calcium carbonate/vitamin D tab 200mg-250unit*

99


99


99


99


99


99


99


99


99


99


99


99


99

calcium chloride 0.002 meq/ml/potassium

99

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

61

chloride 0.004 meq/ml/sodium chloride 0.147 meq/ml soln CALCIUM GLUBIONATE SYRUP 1.8GM/5ML*

99

CALCIUM GLUCONATE TAB 500MG*

99

CALCIUM GLUCONATE TAB 50MG*

99

calcium lactate tab 650mg*

99

calcium polycarbophil tab 625mg*

95

calcium tab 500mg* 99 calcium tab 600mg* 99 CALCIUM/VITAMIN D TAB 600MG-200UNIT*

99

CALQUENCE 100MG CAP

46

camila 28 day 0.35mg pack

71

camrese lo 91 day pack 68 CANASA 1000MG RECTAL SUPP

89

CANCIDAS 50MG INJ 30 CANCIDAS 70MG INJ 30 candesartan cilexetil 16mg tab

35

candesartan cilexetil 16mg/hydrochlorothiazid e 12.5mg tab

37

candesartan cilexetil 32mg tab

35

candesartan cilexetil 32mg/hydrochlorothiazid e 12.5mg tab

37

candesartan cilexetil 32mg/hydrochlorothiazid e 25mg tab

37


35


35

CAPASTAT 1GM INJ 41 CAPRELSA 100MG TAB 46 CAPRELSA 300MG TAB 46 capsaicin cream 0.025%* 81 capsaicin cream 0.1%* 81 captopril 100mg tab 34 captopril 12.5mg tab 34 captopril 25mg tab 34 captopril 25mg/hydrochlorothiazid e 15mg tab

37

CAPTOPRIL 25MG/HYDROCHLOROT HIAZIDE 25MG TAB

37

captopril 50mg tab 34 captopril 50mg/hydrochlorothiazid e 15mg tab

37


133

CAPTOPRIL 50MG/HYDROCHLOROT HIAZIDE 25MG TAB

37

CAPZASIN-HP CREAM* 81 CARBAGLU 200MG ORAL SUSP

86

carbamazepine 100mg chew tab

19

carbamazepine 100mg er cap

19

carbamazepine 100mg er tab

19


19


19

carbamazepine 200mg tab

19

carbamazepine 20mg/ml oral susp

19


19


19

carbamide peroxide 6.5% otic soln*

108

carbidopa 10mg/levodopa 100mg odt

50

carbidopa 10mg/levodopa 100mg tab

50


50


50

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

50

carbidopa 25mg/levodopa 100mg er tab

50


50


50


50


50


50


50


50

carbidopa 50mg/levodopa 200mg er tab

50

carbinoxamine maleate 0.8mg/ml oral soln

31

carbinoxamine maleate 4mg tab

31

carboplatin 10mg/ml inj 42 CARDENE 20MG/200ML INJ

63

CARDENE 40MG/200ML INJ

63

CARIMUNE 6GM INJ 108 carisoprodol 350mg tab 103 carteolol 1% ophth soln 105 cartia 120mg er cap 63 cartia 180mg er cap 63 cartia 240mg er cap 63

cartia 300mg er cap 63 carvedilol 12.5mg tab 61 carvedilol 25mg tab 61 carvedilol 3.125mg tab 61 carvedilol 6.25mg tab 61 CASPOFUNGIN ACETATE 50MG INJ

30

CASPOFUNGIN ACETATE 70MG INJ

31

CAYSTON 75MG INH SOLN

39

caziant 28 day pack 68 cefaclor 250mg cap 66 CEFACLOR 25MG/ML ORAL SUSP

66

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

66

CEFACLOR 75MG/ML ORAL SUSP

66

cefadroxil 1000mg tab 66 cefadroxil 100mg/ml oral susp

66

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

66

cefazolin 1gm inj 66 cefazolin 200mg/ml inj 66 cefazolin 500mg inj 66 cefdinir 25mg/ml oral susp

67

cefdinir 300mg cap 67 cefdinir 50mg/ml oral susp

67

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

67

cefixime 40mg/ml oral susp

67

CEFOTAXIME 1GM INJ 67 CEFOTAXIME 2GM INJ 67 CEFOTAXIME 500MG INJ

67

cefotetan 1000mg inj 66


134

cefotetan 2000mg inj 66 cefoxitin 1000mg inj 66 cefoxitin 2000mg inj 66 cefoxitin 200mg/ml inj 66 cefpodoxime 100mg tab 67 cefpodoxime 10mg/ml oral susp

67

cefpodoxime 200mg tab 67 cefpodoxime 20mg/ml oral susp

67

cefprozil 250mg tab 67 cefprozil 25mg/ml oral susp

67

cefprozil 500mg tab 67 cefprozil 50mg/ml oral susp

67

ceftazidime 1000mg inj 67 ceftazidime 2000mg inj 67 ceftazidime 200mg/ml inj 67 ceftriaxone 1000mg inj 67 ceftriaxone 100mg/ml inj 67 ceftriaxone 2000mg inj 67 ceftriaxone 250mg inj 67 ceftriaxone 500mg inj 67 cefuroxime 1.5gm inj 67 cefuroxime 250mg tab 67 cefuroxime 500mg tab 67 cefuroxime 750mg inj 67 cefuroxime 95mg/ml inj 67 celecoxib 100mg cap 4 celecoxib 200mg cap 4 celecoxib 400mg cap 4 celecoxib 50mg cap 4 CELONTIN 300MG CAP 22 cephalexin 250mg cap 66 cephalexin 25mg/ml oral susp

66

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

66

CEREZYME 400UNIT INJ 92 CESAMET 1MG CAP 30 cetirizine 1mg/ml oral soln

32

cetirizine chew tab 10mg* 32

cetirizine chew tab 5mg* 32 cetirizine tab 10mg* 32 cetirizine tab 5mg* 32 CETRAXAL 0.2% OTIC SOLN

108

cevimeline 30mg cap 102 CHANTIX 0.5MG TAB 113 CHANTIX 1MG TAB 113 CHANTIX CONTINUING MONTHS OF THERAPY 1MG PACK

113

CHANTIX FIRST MONTH 113 OF THERAPY PACK CHEMET 100MG CAP 29 CHENODAL 250MG TAB 89 CHLORAMPHENICOL 100MG/ML INJ

40

chlordiazepoxide 10mg cap

13


13


13

chlorhexidine gluconate 0.12% mouthwash

102

CHLORHEXIDINE GLUCONATE LIQUID 2%*

56

chlorhexidine gluconate liquid 4%*

56

CHLORHEXIDINE GLUCONATE PADS 2%*

56

CHLOROQUINE PHOSPHATE 250MG TAB

41

chloroquine phosphate 500mg tab

41

CHLOROTHIAZIDE 250MG TAB

84

chlorothiazide 500mg inj 84 chlorothiazide 500mg tab 84 chlorpheniramine maleate CR tab 12mg*

31

chlorpheniramine maleate syrup 2mg/5ml*

31

chlorpheniramine maleate tab 4mg*

31

chlorpheniramine/DM tab 4-20mg*

73

chlorpheniramine/DM tab 4-30mg*

73

chlorpheniramine/phenyl ephrine liquid 4-10mg/5ml*

73

chlorpheniramine/phenyl ephrine tab 4-10mg*

73

chlorpheniramine/pseudo ephedrine tab 4-60mg*

73

chlorpheniramine-DM liquid 2-15mg/5ml*

73

chlorpromazine 100mg tab

54

chlorpromazine 10mg tab 54 chlorpromazine 200mg tab

54

chlorpromazine 25mg tab 54 CHLORPROMAZINE 25MG/ML INJ

54

chlorpromazine 50mg tab 54 CHLORPROPAMIDE 100MG TAB

28

CHLORPROPAMIDE 250MG TAB

28

chlorthalidone 25mg tab 84 chlorthalidone 50mg tab 84 chlorzoxazone 500mg tab 103 CHOLBAM 250MG CAP 89 CHOLBAM 50MG CAP 89 cholecalciferol cap 2000unit*

120

cholecalciferol cap 400unit*

120

cholecalciferol drops 2000unit/0.03ml*

120

cholecalciferol drops 400unit/0.03ml*

120

cholecalciferol tab 2000unit*

120

cholestyramine resin 4gm sf powder for oral susp

33


135

cholestyramine resin 66.7mg/ml oral susp

33

CHOLEXTRA POWDER* 82 ciclopirox 0.77% cream 77 ciclopirox 0.77% gel 77 ciclopirox 0.77% lotion 77 ciclopirox 1% shampoo 77 ciclopirox 8% topical soln 77 cidofovir 75mg/ml inj 58 cilastatin 2.5mg/ml/imipenem 2.5mg/ml inj

40

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

40

cilostazol 100mg tab 91 cilostazol 50mg tab 92 cimetidine 200mg tab 117 cimetidine 300mg tab 117 cimetidine 400mg tab 117 cimetidine 60mg/ml oral soln

117

cimetidine 800mg tab 117 CINRYZE 500UNIT INJ 91 CIPRODEX 0.3-0.1% OTIC SUSP

108

CIPROFLOXACIN 0.2% OTIC SOLN

108

ciprofloxacin 0.3% ophth soln

106

ciprofloxacin 100mg/ml oral susp

88

ciprofloxacin 250mg tab 88 ciprofloxacin 2mg/ml inj 88 ciprofloxacin 500mg tab 88 ciprofloxacin 50mg/ml oral susp

88

ciprofloxacin 750mg tab 88 cisplatin 1mg/ml inj 42 citalopram 10mg tab 23 citalopram 20mg tab 23 citalopram 2mg/ml oral soln

23

citalopram 40mg tab 23 cladribine 1mg/ml inj 42

claravis 10mg cap 76 claravis 20mg cap 76 claravis 30mg cap 76 claravis 40mg cap 76 CLARINEX-D 2.5-120MG ER TAB

73

clarithromycin 250mg tab 97 clarithromycin 25mg/ml oral susp

97

clarithromycin 500mg er tab

97

clarithromycin 500mg tab 97 clarithromycin 50mg/ml oral susp

97

CLEMASTINE FUMARATE 2.68MG TAB

31

clemastine fumarate tab 1.34mg*

32

clindacin 1% pad 76 clindamycin 1% foam 76 clindamycin 1% gel 76 clindamycin 1% lotion 76 clindamycin 1% pad 76 clindamycin 1% topical soln

76

clindamycin 12mg/ml inj 40 clindamycin 150mg cap 40 clindamycin 150mg/ml (2ml) inj

40

clindamycin 150mg/ml (4ml) inj

40

clindamycin 150mg/ml (6ml) inj

40

clindamycin 15mg/ml oral soln

40

clindamycin 18mg/ml inj 40 clindamycin 2% vaginal cream

119

clindamycin 300mg cap 40 clindamycin 6mg/ml inj 40 clindamycin 75mg cap 40 clindamycin/benzoyl peroxide 1-5% gel

76

CLINIMIX 4.25/10 INJ 104 CLINIMIX 4.25/20 INJ 104

CLINIMIX 4.25/25 INJ 104 CLINIMIX 4.25/5 INJ 104 CLINIMIX 5/15 INJ 104 CLINIMIX 5/20 INJ 104 CLINIMIX 5/25 INJ 104 CLINIMIX E 2.75/10 INJ 104 CLINIMIX E 2.75/5 INJ 104 CLINIMIX E 4.25/10 INJ 104 CLINIMIX E 4.25/25 INJ 105 CLINIMIX E 4.25/5 INJ 105 CLINIMIX E 5/15 INJ 105 CLINIMIX E 5/20 INJ 105 CLINIMIX E 5/25 INJ 105 clinisol 15% inj 105 clobetasol propionate 0.05% cream

79

clobetasol propionate 0.05% foam

79

clobetasol propionate 0.05% gel

79

clobetasol propionate 0.05% lotion

79

clobetasol propionate 0.05% ointment

79

clobetasol propionate 0.05% shampoo

79

clobetasol propionate 0.05% spray

79

clobetasol propionate 0.05% topical soln

79

clodan 0.05% shampoo 79 clofarabine 1mg/ml inj 42 clomipramine 25mg cap 25 clomipramine 50mg cap 25 clomipramine 75mg cap 25 clonazepam 0.125mg odt 18 clonazepam 0.25mg odt 18 clonazepam 0.5mg odt 18 clonazepam 0.5mg tab 18 clonazepam 1mg odt 18 clonazepam 1mg tab 18 clonazepam 2mg odt 19 clonazepam 2mg tab 19 clonidine 0.00417mg/hr patch

36


136

clonidine 0.00833mg/hr patch

36

clonidine 0.0125mg/hr patch

36

clonidine 0.1mg tab 36 clonidine 0.2mg tab 36 clonidine 0.3mg tab 36 clopidogrel 75mg tab 92 clorazepate dipotassium 15mg tab

13

clorazepate dipotassium 3.75mg tab

13

clorazepate dipotassium 7.5mg tab

13

clotrimazole 1% cream 77 clotrimazole 1% topical soln

77

clotrimazole 10mg lozenge

102

clotrimazole vaginal cream 1%*

119

clotrimazole vaginal cream 2%*

120

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

53

CLOZAPINE 150MG ODT

53

CLOZAPINE 200MG ODT

53

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

41

codeine sulfate 15mg tab 6 codeine sulfate 30mg tab 6 codeine sulfate 60mg tab 6 colchicine 0.5mg/probenecid 500mg tab

91

COLCHICINE 0.6MG TAB

91

colestipol 1000mg tab 33 colestipol 5000mg granules

33

colistin 75mg/ml inj 39 colocort 100mg/60ml enema

11

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

108

COMBIGAN 0.2-0.5% OPHTH SOLN

105

COMBIPATCH 0.05-0.14MG PATCH

87

COMBIPATCH 0.05-0.25MG PATCH

87

COMBIVENT RESPIMAT 20-100MCG INH

16

COMETRIQ 100MG DAILY DOSE CARTON PACK

46


46


46

COMPLERA 200-25-300MG TAB

56

compro 25mg rectal supp 54 CONDOMS LATEX LUBRICATED*

97

CONDOMS* 97 constulose 10gm/15ml oral soln

96

COPAXONE 20MG/ML SYRINGE

112

COPAXONE 40MG/ML SYRINGE

112

CORLANOR 5MG TAB 66 CORLANOR 7.5MG TAB 66 CORTISONE ACETATE 25MG TAB

71

COSENTYX 150MG/ML AUTO-INJECTOR

78

COSENTYX 150MG/ML SYRINGE

78

COTELLIC 20MG TAB 46 CREON 12000-38000-60000UNIT DR CAP

83

CREON 24000-76000-120000UNI T DR CAP

83

CREON 3000-9500-15000UNIT DR CAP

83

CREON 36000-114000-180000U NIT DR CAP

83

CREON 6000-19000-30000UNIT DR CAP

83

CRINONE 4% VAGINAL GEL

120

CRINONE 8% VAGINAL GEL

120

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

15

cromolyn sodium 20mg/ml oral soln

89

cromolyn sodium 4% ophth soln

107

cryselle 28 pack 68 cyanocobalamin 1000mcg/ml inj*

92

cyclafem 1/35 28 day pack

68

cyclafem 7/7/7 28 day pack

68

cyclobenzaprine 10mg tab

103

cyclobenzaprine 5mg tab 103 cyclobenzaprine 7.5mg tab

103

CYCLOPHOSPHAMIDE 25MG CAP

42


137

CYCLOPHOSPHAMIDE 50MG CAP

42

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

60

cyclosporine, modified 100mg/ml oral soln

60

cyclosporine, modified 25mg cap

60

cyproheptadine 0.4mg/ml oral soln

32

cyproheptadine 4mg tab 32 CYRAMZA 100MG/10ML INJ

43

CYRAMZA 500MG/50ML INJ

43

CYSTAGON 150MG CAP 90 CYSTAGON 50MG CAP 90 CYSTARAN 0.44% OPHTH SOLN

107

cytarabine 100mg/ml inj 42 CYTARABINE 20MG/ML INJ

42

D

d5w/lactated ringers inj 99 dacarbazine 200mg inj 48 dactinomycin 0.5mg inj 45 DALIRESP 250MCG TAB 15 DALIRESP 500MCG TAB 15 DALVANCE 500MG INJ 39 danazol 100mg cap 11 danazol 200mg cap 11 danazol 50mg cap 11 dantrolene sodium 100mg cap

103

dantrolene sodium 25mg cap

103

dantrolene sodium 50mg cap

103

dapsone 100mg tab 40 dapsone 25mg tab 40 DAPTACEL INJ 116

daptomycin 500mg inj 40 DARAPRIM 25MG TAB 41 DARZALEX 100MG/5ML INJ

43

daunorubicin 5mg/ml inj 45 deblitane 28 day 0.35mg pack

71

decitabine 5mg/ml inj 42 delyla 28 day pack 68 DEMSER 250MG CAP 35 DENAVIR 1% CREAM 78 DEPEN 250MG TAB 102 DEPO-PROVERA 400MG/ML INJ

44

DESCOVY 200-25MG TAB

56

desipramine 100mg tab 25 desipramine 10mg tab 25 desipramine 150mg tab 25 desipramine 25mg tab 25 desipramine 50mg tab 25 desipramine 75mg tab 25 desloratadine 5mg tab 32 desmopressin acetate 0.004mg/ml inj

86

desmopressin acetate 0.01% nasal soln

87

desmopressin acetate 0.01% nasal spray

87

desmopressin acetate 0.1mg tab

87

desmopressin acetate 0.2mg tab

87

desogestrel/ethinyl estradiol 28 day pack

68

desogestrel/ethinyl estradiol pack

68

desonide 0.05% cream 79 desonide 0.05% lotion 79 desonide 0.05% ointment 79 desoximetasone 0.05% cream

79

desoximetasone 0.05% gel

79

desoximetasone 0.05% ointment

79

desoximetasone 0.25% cream

79

desoximetasone 0.25% ointment

79

desvenlafaxine succinate 100mg er tab

24


24


24

DEXAMETHASONE 0.1% 107 OPHTH SOLN dexamethasone 0.1mg/ml oral soln

71

dexamethasone 0.5mg tab 71 dexamethasone 0.75mg tab

71

dexamethasone 1.5mg tab 71 DEXAMETHASONE 10MG/ML INJ

71

DEXAMETHASONE 1MG TAB

71

DEXAMETHASONE 1MG/ML ORAL SOLN

71

DEXAMETHASONE 2MG TAB

71

dexamethasone 4mg tab 72 dexamethasone 6mg tab 72 dexamethasone phosphate 4mg/ml inj

72

dexamethasone/neomycin /polymyxin b 0.1% ophth ointment

107

dexamethasone/neomycin /polymyxin b 0.1% ophth susp

107

dexamethasone/tobramyc in 0.3-0.1% ophth susp

107

DEXCHLORPHENIRAMI NE/PSEUDOEPHEDRINE /ACETAMINOPHEN/DO XYLAMINE LIQUID*

73


138

dexmethylphenidate 10mg er cap

2

dexmethylphenidate 10mg tab

2


2

dexmethylphenidate 2.5mg tab

2


2


2


2


2

dexmethylphenidate 5mg tab

2

dexrazoxane 250mg inj 49 dextroamphetamine sulfate 10mg er cap

1

dextroamphetamine sulfate 10mg tab

1

dextroamphetamine sulfate 15mg er cap

1

dextroamphetamine sulfate 5mg er cap

1

dextroamphetamine sulfate 5mg tab

1

dextromethorphan hbr cap 15mg*

73

dextromethorphan hbr liquid 15mg/15ml*

73

dextromethorphan hbr liquid 15mg/5ml*

73

dextromethorphan hbr liquid 7.5mg/5ml*

73

dextromethorphan hbr syrup 10mg/5ml*

73

dextromethorphan hbr syrup 15mg/5ml*

73

DEXTROMETHORPHAN HBR SYRUP 7.5MG/5ML*

73

dextromethorphan/guaife nesin cap 10-200mg*

73

DEXTROMETHORPHAN/ GUAIFENESIN GRANULES PACKET 5-100MG*

73

dextromethorphan/guaife nesin liquid 10-100mg/5ml*

73


73


73


73


73

dextromethorphan/guaife nesin SR tab (12hr) 30-600mg*

73

dextromethorphan/guaife nesin SR tab (12hr) 60-1200mg*

73

dextromethorphan/guaife nesin syrup 10-100mg/5ml*

74

dextromethorphan/guaife nesin tab 20-400mg*

74

dextromethorphan-guaife nesin liquid 5-100mg/5ml*

73

DIASTAT 10MG APPLICATOR

19

DIASTAT 2.5MG APPLICATOR

19

DIASTAT 20MG PF APPLICATOR

19

diazepam 10mg tab 13 DIAZEPAM 1MG/ML ORAL SOLN

13

diazepam 2mg tab 13

diazepam 5mg tab 13 diazepam 5mg/ml oral soln

13

diclofenac potassium 50mg tab

4

diclofenac sodium 0.1% ophth soln

107

diclofenac sodium 1% gel 78 diclofenac sodium 1.5% topical soln

78

diclofenac sodium 100mg er tab

4

diclofenac sodium 25mg dr tab

4

diclofenac sodium 3% gel 78 diclofenac sodium 50mg dr tab

4

diclofenac sodium 50mg/misoprostol 0.2mg tab

4

diclofenac sodium 75mg dr tab

4

diclofenac sodium 75mg/misoprostol 0.2mg tab

4

dicloxacillin 250mg cap 110 dicloxacillin 500mg cap 110 dicyclomine 10mg cap 116 dicyclomine 20mg tab 116 dicyclomine 2mg/ml oral soln

116

didanosine 200mg dr cap 56 didanosine 250mg dr cap 56 didanosine 400mg dr cap 56 DIFLORASONE DIACETATE 0.05% CREAM

79

DIFLORASONE DIACETATE 0.05% OINTMENT

79

diflunisal 500mg tab 6 digitek 0.125mg tab 64 digitek 0.25mg tab 65 digox 0.125mg tab 65 digox 0.25mg tab 65


139

digoxin 0.05mg/ml oral soln

65

digoxin 0.125mg tab 65 digoxin 0.25mg tab 65 digoxin 0.25mg/ml inj 65 DIHYDROERGOTAMINE MESYLATE 0.5MG/ACT NASAL SPRAY

98

DILANTIN 30MG ER CAP

22

dilt 120mg xr cap 63 dilt 180mg xr cap 63 dilt 240mg xr cap 63 diltiazem 120mg er (12 hr) cap

63

diltiazem 120mg er (24 hr) cap

63

diltiazem 120mg tab 63 diltiazem 180mg er cap 63 DILTIAZEM 1MG/ML INJ 63 diltiazem 240mg er cap 63 diltiazem 300mg er cap 63 diltiazem 30mg tab 63 diltiazem 360mg er cap 63 diltiazem 420mg er cap 63 diltiazem 5mg/ml inj 63 diltiazem 60mg er cap 63 diltiazem 60mg tab 63 diltiazem 90mg er cap 63 diltiazem 90mg tab 63 dimenhydrinate tab 50mg*

30

DIPENTUM 250MG CAP 89 diphenhydramine 50mg/ml inj

32

diphenhydramine cap 25mg*

32

diphenhydramine cap 50mg*

94

diphenhydramine chew tab 12.5mg*

32

diphenhydramine cream 2%*

77

diphenhydramine disperse tab 12.5mg*

32

diphenhydramine gel 2% *

77

diphenhydramine liquid 12.5mg/5ml*

32

DIPHENHYDRAMINE ORAL STRIP 12.5MG*

32

diphenhydramine soln 2%*

78

diphenhydramine tab 25mg*

32


32


94

diphenhydramine/zinc acetate cream 1-0.1%*

78

diphenhydramine/zinc acetate cream 2-0.1%*

78

diphenhydramine/zinc acetate liquid 2-0.1%*

78

DIPHTHERIA/TETANUS TOXOID INJ

116

dipyridamole 25mg tab 92 dipyridamole 50mg tab 92 dipyridamole 75mg tab 92 disopyramide 100mg cap 14 disopyramide 150mg cap 14 disulfiram 250mg tab 111 disulfiram 500mg tab 111 DIURIL 250MG/5ML ORAL SUSP

84

divalproex sodium 125mg dr cap

22

divalproex sodium 125mg dr tab

22


22

divalproex sodium 250mg er tab

22


22

divalproex sodium 500mg er tab

22

DOCETAXEL 10MG/ML INJ

49

DOCETAXEL 20MG/ML INJ

49

docusate calcium cap 240mg*

96

docusate sodium cap 100mg*

96


96


96

docusate sodium enema 283mg*

92

DOCUSATE SODIUM ENEMA 283MG*

92

docusate sodium liquid 150mg/15ml*

96

DOCUSATE SODIUM LIQUID 50MG/15ML*

96

docusate sodium syrup 60mg/15ml*

96

docusate sodium tab 100mg*

96

dofetilide 125mcg cap 14 dofetilide 250mcg cap 14 dofetilide 500mcg cap 14 donepezil 10mg odt 111 donepezil 10mg tab 111 donepezil 23mg tab 111 donepezil 5mg odt 111 donepezil 5mg tab 111 DORIPENEM 500MG INJ 40 dorzolamide 2% ophth soln

107

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

105

doxazosin 1mg tab 36 doxazosin 2mg tab 36 doxazosin 4mg tab 36 doxazosin 8mg tab 36 doxepin 100mg cap 25 doxepin 10mg cap 25 doxepin 10mg/ml oral soln

25

doxepin 150mg cap 25


140

doxepin 25mg cap 25 DOXEPIN 5% CREAM 78 doxepin 50mg cap 25 DOXEPIN 75MG CAP 25 doxercalciferol 0.0005mg cap

86

doxercalciferol 0.001mg cap

86

doxercalciferol 0.0025mg cap

86

doxercalciferol 0.002mg/ml inj

86

doxorubicin 2mg/ml liposome inj

45

doxorubicin hydrochloride 2mg/ml inj

45

doxy 100mg inj 114 doxycycline hyclate 100mg cap

114

doxycycline hyclate 100mg tab

114

doxycycline hyclate 20mg tab

114

doxycycline hyclate 50mg cap

114

doxycycline monohydrate 100mg cap

114

doxycycline monohydrate 100mg tab

114

doxycycline monohydrate 50mg cap

114


114

doxycycline monohydrate 5mg/ml oral susp

114


114

doxylamine succinate tab 25mg*

94

doxylamine-DM liquid 6.25-15mg/15ml*

74

dronabinol 10mg cap 30 dronabinol 2.5mg cap 30 dronabinol 5mg cap 30

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

68

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

68

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

68

DROXIA 200MG CAP 92 DROXIA 300MG CAP 92 DROXIA 400MG CAP 92 DULERA 100-5MCG INH 16 DULERA 200-5MCG INH 16 duloxetine 20mg dr cap 24 duloxetine 30mg dr cap 24 DULOXETINE 40MG DR CAP

24

duloxetine 60mg dr cap 25 DUPIXENT 300MG/2ML SYRINGE

81

duramorph 0.5mg/ml inj 6 duramorph 1mg/ml inj 6 DUREZOL 0.05% OPHTH SUSP

107

dutasteride 0.5mg cap 91 dutasteride 0.5mg/tamsulosin 0.4mg cap

91

DYRENIUM 100MG CAP 84 DYRENIUM 50MG CAP 84

E

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

86

ELIDEL 1% CREAM 81 ELIGARD 22.5MG SYRINGE

44

ELIGARD 30MG SYRINGE

44

ELIGARD 45MG SYRINGE

44

ELIGARD 7.5MG SYRINGE

44

ELIQUIS 2.5MG TAB 17 ELIQUIS 30-DAY STARTER PACK

17

ELIQUIS 5MG TAB 17 ELITEK 1.5MG INJ 48 ELITEK 7.5MG INJ 48 ELMIRON 100MG CAP 90 EMBEDA 100-4MG ER CAP

7

EMBEDA 20-0.8MG ER CAP

7


7

EMBEDA 50-2MG ER CAP

7


7


7

EMCYT 140MG CAP 44 emoquette pack 68 EMPLICITI 300MG INJ 43 EMPLICITI 400MG INJ 43 EMSAM 12MG/24HR PATCH

23

EMSAM 6MG/24HR PATCH

23

EMSAM 9MG/24HR PATCH

23

EMTRIVA 10MG/ML ORAL SOLN

56

EMTRIVA 200MG CAP 56 enalapril maleate 10mg tab

34

enalapril maleate 10mg/hydrochlorothiazid e 25mg tab

37

enalapril maleate 2.5mg tab

34

enalapril maleate 20mg tab

34


141

enalapril maleate 5mg tab

34

enalapril maleate 5mg/hydrochlorothiazide 12.5mg tab

37

ENBREL 25MG INJ 6 ENBREL 25MG/0.5ML SYRINGE

6

ENBREL 50MG/ML SURECLICK INJ

6

ENBREL 50MG/ML SYRINGE

6

endocet 10-325mg tab 10 endocet 5-325mg tab 10 endocet 7.5-325mg tab 10 ENGERIX-B 10MCG/0.5ML SYRINGE

119

ENGERIX-B 20MCG/ML SYRINGE

119

enoxaparin sodium 100mg/1ml syringe

17

enoxaparin sodium 120mg/0.8ml syringe

17


17


17


17


17


18


18

enpresse 28 day pack 68 enskyce 28 day pack 68 entacapone 200mg tab 49 entecavir 0.5mg tab 58 entecavir 1mg tab 58 ENTRESTO 24-26MG TAB

65

ENTRESTO 49-51MG TAB

65

ENTRESTO 97-103MG TAB

65

enulose 10gm/15ml oral soln

89

ENVARSUS 0.75MG ER TAB

60

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

58

epinastine 0.05% ophth soln

107

EPINEPHRINE 0.15MG/0.3ML AUTO-INJECTOR

120

EPINEPHRINE 0.3MG/0.3ML AUTO-INJECTOR

120

epirubicin 2mg/ml inj 45 epitol 200mg tab 19 EPIVIR HBV 5MG/ML ORAL SOLN

59

eplerenone 25mg tab 39 eplerenone 50mg tab 39 EPOGEN 10000UNIT/ML INJ

93

EPOGEN 20000UNIT/ML INJ

93


93


93


93

EPROSARTAN 600MG TAB

35

EQUETRO 100MG ER CAP

51


51


51

ERAXIS 100MG INJ 31 ERAXIS 50MG INJ 31

ERBITUX 100MG/50ML INJ

43

ergocalciferol cap 50000unit*

121

ergocalciferol soln 8000unit/ml*

121

ERGOCALCIFEROL TAB 2000UNIT*

121

ERGOCALCIFEROL TAB 400UNIT*

121

ERGOLOID MESYLATES 113 1MG TAB ERIVEDGE 150MG CAP 44 ERLEADA 60MG TAB 44 errin 28 day 0.35mg pack 71 ERTACZO 2% CREAM 77 ERWINAZE 10000UNIT INJ

48

ery 2% pad 76 ERYPED 400MG/5ML ORAL SUSP

97

ERY-TAB 250MG DR TAB

97


97


97

ERYTHROCIN LACTOBIONATE 500MG INJ

97

erythromycin 0.005mg/mg ophth ointment

106

erythromycin 2% gel 76 erythromycin 2% topical soln

76

erythromycin 250mg dr cap

97

erythromycin 250mg tab 97 erythromycin 500mg tab 97 erythromycin ethylsuccinate 40mg/ml oral susp

97

erythromycin/benzoyl peroxide 5-3% gel

76

ESBRIET 267MG CAP 114


142

ESBRIET 267MG TAB 114 ESBRIET 801MG TAB 114 escitalopram 10mg tab 23 escitalopram 1mg/ml oral soln

23

escitalopram 20mg tab 23 escitalopram 5mg tab 23 ESOMEPRAZOLE 20MG INJ

117

esomeprazole 40mg inj 117 estarylla 28 day pack 68 estazolam 1mg tab 94 estazolam 2mg tab 94 estradiol 0.00104mg/hr twice weekly patch

88

estradiol 0.00104mg/hr weekly patch

88

estradiol 0.00156mg/hr twice weekly patch

88


88


88


88


88


88


88


88


88

estradiol 0.1mg/ml vaginal cream

120

estradiol 0.5mg tab 88 estradiol 0.5mg/norethindrone acetate 0.1mg pack

87

estradiol 1mg tab 88 estradiol 1mg/norethindrone acetate 0.5mg pack

87

estradiol 20mg/ml inj 88 estradiol 2mg tab 88 estradiol 40mg/ml inj 88 ESTRING 2MG VAGINAL 120 RING ESTROPIPATE 0.75MG TAB

88

ESTROPIPATE 1.5MG TAB

88

ESTROPIPATE 3MG TAB 88 eszopiclone 1mg tab 94 eszopiclone 2mg tab 94 eszopiclone 3mg tab 94 ethacrynic acid 25mg tab 83 ethambutol 100mg tab 41 ethambutol 400mg tab 41 ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mg tab

87

ethinyl estradiol 0.005mg/norethindrone acetate 1mg tab

87

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

68

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

68


68

ethinyl estradiol 0.025mg/inert/norgestima te 0.18mg/0.215mg/0.25mg pack

68

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

68


69

ethinyl estradiol 0.02mg/levonorgestrel 0.09mg pack

69

ethinyl estradiol 0.02mg/norethindrone 1mg 21 day pack

69

ethinyl estradiol 0.035mg/ethynodiol 1mg 28 day pack

69


69

ethinyl estradiol 0.035mg/inert/norgestima te 0.18mg/0.215mg/0.25mg pack

69

ethinyl estradiol 0.035mg/norgestimate 0.25mg pack

69

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

69


69

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

69

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

69

ethinyl estradiol/levonorgestrel 91 day pack

69

ethosuximide 250mg cap 22


143

ethosuximide 50mg/ml oral soln

22

etidronate disodium 200mg tab

84

ETIDRONATE DISODIUM 400MG TAB

84

etodolac 200mg cap 4 etodolac 300mg cap 4 etodolac 400mg er tab 4 etodolac 400mg tab 4 etodolac 500mg er tab 4 etodolac 500mg tab 4 etodolac 600mg er tab 4 ETOPOPHOS 100MG INJ 49 etoposide 20mg/ml inj 49 EURAX 10% CREAM 82 EVOTAZ 300-150MG TAB

56

exemestane 25mg tab 44 EXJADE 125MG ORAL SUSP

29

EXJADE 250MG ORAL SUSP

29

EXJADE 500MG ORAL SUSP

29

EXONDYS 100MG/2ML INJ

104

EXONDYS 500MG/10ML INJ

104

EXTAVIA 0.3MG INJ 112 eye wash soln* 107 ezetimibe 10mg tab 34

F

FABRAZYME 35MG INJ 86 FABRAZYME 5MG INJ 86 falmina 28 day pack 69 famciclovir 125mg tab 59 famciclovir 250mg tab 59 famciclovir 500mg tab 59 FAMOTIDINE 0.4MG/ML INJ

117

famotidine 10mg/ml inj 117 famotidine 20mg tab 117 famotidine 40mg tab 117

famotidine 8mg/ml oral susp

117

famotidine tab 10mg* 117 FANAPT 10MG TAB 52 FANAPT 12MG TAB 52 FANAPT 1MG TAB 52 FANAPT 2MG TAB 52 FANAPT 4MG TAB 52 FANAPT 6MG TAB 52 FANAPT 8MG TAB 52 FANAPT TITRATION PACK

52

FARESTON 60MG TAB 44 FARXIGA 10MG TAB 28 FARXIGA 5MG TAB 28 FARYDAK 10MG CAP 46 FARYDAK 15MG CAP 46 FARYDAK 20MG CAP 46 FASLODEX 250MG/5ML SYRINGE

44

fayosim 91 day pack 69 FAZACLO 12.5MG ODT 53 FAZACLO 150MG ODT 53 FAZACLO 200MG ODT 53 felbamate 120mg/ml oral susp

22

felbamate 400mg tab 22 felbamate 600mg tab 22 felodipine 10mg er tab 63 felodipine 2.5mg er tab 63 felodipine 5mg er tab 63 femynor 28 day pack 69 fenofibrate 130mg cap 33 fenofibrate 134mg cap 33 fenofibrate 145mg tab 33 FENOFIBRATE 150MG CAP

33

fenofibrate 160mg tab 33 fenofibrate 200mg cap 33 fenofibrate 43mg cap 33 fenofibrate 48mg tab 33 FENOFIBRATE 50MG CAP

33

fenofibrate 54mg tab 33 fenofibrate 67mg cap 33

fenofibric acid 135mg dr cap

33

fenofibric acid 45mg dr cap

33

FENOPROFEN 400MG CAP

4

fentanyl 0.012mg/hr patch

7

fentanyl 0.025mg/hr patch

7

fentanyl 0.05mg/hr patch 7 fentanyl 0.075mg/hr patch

7

fentanyl 0.1mg/hr patch 7 fentanyl 0.2mg lozenge 7 fentanyl 0.4mg lozenge 7 fentanyl 0.6mg lozenge 7 fentanyl 0.8mg lozenge 7 fentanyl 1.2mg lozenge 7 fentanyl 1.6mg lozenge 7 FENTORA 100MCG BUCCAL TAB

7

FENTORA 200MCG BUCCAL TAB

7


7


7


7

FERRIPROX 100MG/ML ORAL SOLN

29

FERRIPROX 500MG TAB 29 ferrous sulfate CR tab 142mg*

93

ferrous sulfate CR tab 160mg*

93


93

ferrous sulfate CR tab 47.5mg*

93


93

FERROUS SULFATE EC TAB 324MG*

93


144

ferrous sulfate EC tab 325mg*

93

ferrous sulfate elixir 220mg/5ml*

93

FERROUS SULFATE LIQUID 220MG/5ML*

93

ferrous sulfate oral soln 75mg/ml*

93

FERROUS SULFATE SYRUP 300MG/5ML*

94

ferrous sulfate tab 27mg* 94 ferrous sulfate tab 325mg*

94

FETZIMA 120MG ER CAP

25

FETZIMA 20MG ER CAP 25 FETZIMA 40MG ER CAP 25 FETZIMA 80MG ER CAP 25 FETZIMA PACK 25 FIASP 100UNIT/ML INJ 28 FIASP 100UNIT/ML PEN INJ

28

fiber powder* 95 FINACEA 15% FOAM 82 FINACEA 15% GEL 82 finasteride 5mg tab 91 FIRAZYR 30MG/3ML SYRINGE

91

FIRMAGON 120MG INJ 44 FIRMAGON 80MG INJ 44 flavoxate 100mg tab 118 FLEBOGAMMA 10% INJ 108 flecainide acetate 100mg tab

14

flecainide acetate 150mg tab

14

flecainide acetate 50mg tab

14

FLOVENT 100MCG DISKUS

15

FLOVENT 110MCG HFA INH

15


15


15


15


15

fluconazole 100mg tab 31 fluconazole 10mg/ml oral susp

31

fluconazole 150mg tab 31 fluconazole 200mg tab 31 fluconazole 2mg/ml (100ml) inj

31

fluconazole 2mg/ml inj 31 fluconazole 40mg/ml oral susp

31

fluconazole 50mg tab 31 flucytosine 250mg cap 31 flucytosine 500mg cap 31 fludarabine phosphate 50mg inj

42

fludrocortisone 0.1mg tab 72 flunisolide 25mcg nasal inhaler

103

fluocinolone acetonide 0.01% cream

79

fluocinolone acetonide 0.01% otic soln

108

fluocinolone acetonide 0.01% topical soln

80

fluocinolone acetonide 0.025% cream

80

fluocinolone acetonide 0.025% ointment

80

fluocinolone acetonide 0.1mg/ml oil

80

fluocinonide 0.05% e cream

80

fluocinonide 0.05% gel 80 fluocinonide 0.05% ointment

80

fluocinonide 0.05% topical soln

80

fluorometholone 0.1% ophth susp

107

FLUOROURACIL 0.5% CREAM

78

fluorouracil 2% topical soln

78

fluorouracil 5% cream 78 fluorouracil 5% topical soln

78

fluorouracil 50mg/ml inj 42 fluoxetine 10mg cap 23 fluoxetine 10mg tab 23 fluoxetine 20mg cap 23 fluoxetine 20mg tab 23 fluoxetine 25mg/olanzapine 12mg cap

112

fluoxetine 25mg/olanzapine 3mg cap

112


112

fluoxetine 40mg cap 23 fluoxetine 4mg/ml oral soln

23


112


112

FLUPHENAZINE 0.5MG/ML ORAL SOLN

54

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

54

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

54

fluphenazine decanoate 25mg/ml inj

54

FLURAZEPAM 15MG CAP

94


145

FLURAZEPAM 30MG CAP

94

flurbiprofen 100mg tab 4 flurbiprofen 50mg tab 4 flurbiprofen sodium 0.03% ophth soln

107

flutamide 125mg cap 44 fluticasone propionate 0.005% ointment

80

fluticasone propionate 0.05% cream

80

fluticasone propionate 0.05% lotion

80

fluticasone propionate 50mcg nasal inhaler

103

FLUTICASONE PROPIONATE/SALMETE ROL XINAFOATE 113-14MCG/ACT POWDER INH

16


16


16

fluvastatin 20mg cap 33 fluvastatin 40mg cap 33 fluvastatin 80mg er tab 33 fluvoxamine maleate 100mg er cap

23

fluvoxamine maleate 100mg tab

23

fluvoxamine maleate 150mg er cap

24


24


24

FOLIC ACID 5MG/ML INJ*

92

folic acid tab 1mg* 92 folic acid tab 400mcg* 92 folic acid tab 800mcg* 92 FOLOTYN 40MG/2ML INJ

42

fomepizole 1000mg/ml inj 29 fondaparinux sodium 12.5mg/ml (0.4ml) syringe

18

fondaparinux sodium 12.5mg/ml (0.6ml) syringe

18

fondaparinux sodium 12.5mg/ml (0.8ml) syringe

18

fondaparinux sodium 5mg/ml syringe

18

FORTEO 600MCG/2.4ML PEN INJ

84

fosamprenavir 700mg tab 56 fosinopril sodium 10mg tab

34

fosinopril sodium 10mg/hydrochlorothiazid e 12.5mg tab

37

fosinopril sodium 20mg tab

34

fosinopril sodium 20mg/hydrochlorothiazid e 12.5mg tab

38

fosinopril sodium 40mg tab

34

fosphenytoin sodium 75mg/ml inj

22

FOSRENOL 1000MG ORAL POWDER

90

FOSRENOL 750MG ORAL POWDER

90

FRAGMIN 10000UNIT/ML SYRINGE

18

FRAGMIN 12500UNIT/0.5ML SYRINGE

18


18


18


18


18


18

FRAGMIN 95000UNIT/3.8ML INJ

18

FREAMINE 6.9% INJ 105 furosemide 10mg/ml inj 83 furosemide 10mg/ml oral soln

83

furosemide 10mg/ml syringe

83

furosemide 20mg tab 83 furosemide 40mg tab 83 furosemide 80mg tab 83 FUROSEMIDE 8MG/ML ORAL SOLN

83

FUSILEV 50MG INJ 49 FUZEON 90MG INJ 56 fyavolv 0.5mg-2.5mcg tab 87 fyavolv 1mg-5mcg tab 87 FYCOMPA 0.5MG/ML ORAL SUSP

18

FYCOMPA 10MG TAB 18 FYCOMPA 12MG TAB 18 FYCOMPA 2MG TAB 18 FYCOMPA 4MG TAB 18 FYCOMPA 6MG TAB 18 FYCOMPA 8MG TAB 18

G

gabapentin 100mg cap 19 gabapentin 300mg cap 19 gabapentin 400mg cap 19 gabapentin 50mg/ml oral soln

19

gabapentin 600mg tab 19


146

gabapentin 800mg tab 19 GABITRIL 12MG TAB 22 GABITRIL 16MG TAB 22 galantamine 12mg tab 111 galantamine 4mg tab 111 galantamine 8mg tab 111 galantamine hydrobromide 16mg er cap

111

galantamine hydrobromide 24mg er cap

111

GALANTAMINE HYDROBROMIDE 4MG/ML ORAL SOLN

111

galantamine hydrobromide 8mg er cap

111

GAMASTAN 1800UNIT/10ML INJ

108

GAMASTAN 360UNIT/2ML INJ

108

GAMMAGARD 10GM INJ

108

GAMMAGARD 2.5GM/25ML INJ

108

GAMMAGARD 5GM INJ 108 GAMMAKED 1GM/10ML INJ

108

GAMMAPLEX 10GM/100ML INJ

109


108


109


109

GAMUNEX 1GM/10ML INJ

109

ganciclovir 500mg inj 58 GARDASIL 9 INJ 119 GARDASIL 9 SYRINGE 119 gatifloxacin 0.5% ophth soln

106

GATTEX 5MG INJ 90 GAUZE PAD 97

gavilyte-c oral soln 95 gavilyte-g oral soln 95 gavilyte-n powder for oral soln

95

gemcitabine 1000mg inj 42 gemfibrozil 600mg tab 33 generlac 10gm/15ml oral soln

89

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

60

gengraf 25mg cap 60 GENOTROPIN 0.2MG SYRINGE

85

GENOTROPIN 0.4MG SYRINGE

85


85


85


85


85


85


85

GENOTROPIN 12MG CARTRIDGE

85

GENOTROPIN 1MG SYRINGE

85

GENOTROPIN 2MG SYRINGE

85

GENOTROPIN 5MG CARTRIDGE

85

gentak 0.3% ophth ointment

106

gentamicin 1.2mg/ml inj 3 gentamicin 40mg/ml inj 3 gentamicin sulfate 0.1% cream

77

gentamicin sulfate 0.1% ointment

77

gentamicin sulfate 0.3% ophth soln

106

gentamicin sulfate 0.8mg/ml inj

3

gentamicin sulfate 1.6mg/ml inj

3

gentamicin sulfate 1mg/ml inj

3

GENTEAL TEAR SOLN* 105 GENVOYA 150-150-200-10MG TAB

56

GEODON 20MG INJ 51 gianvi 28-day pack 69 GILENYA 0.5MG CAP 112 GILOTRIF 20MG TAB 46 GILOTRIF 30MG TAB 46 GILOTRIF 40MG TAB 46 GLASSIA 1000MG/50ML INJ

114

glatiramer 20mg/ml syringe

112

glatiramer 40mg/ml syringe

113

glatopa 20mg/ml inj 113 glatopa 40mg/ml syringe 113 GLEOSTINE 100MG CAP 42 GLEOSTINE 10MG CAP 42 GLEOSTINE 40MG CAP 42 GLEOSTINE 5MG CAP 42 glimepiride 1mg tab 28 glimepiride 2mg tab 28 glimepiride 2mg/pioglitazone 30mg tab

26

glimepiride 4mg tab 28 glimepiride 4mg/pioglitazone 30mg tab

26

glipizide 10mg er tab 28 glipizide 10mg tab 29 glipizide 2.5mg er tab 29 glipizide 2.5mg/metformin 250mg tab

26


147

glipizide 2.5mg/metformin 500mg tab

26

glipizide 5mg er tab 29 glipizide 5mg tab 29 glipizide 5mg/metformin 500mg tab

26

GLUCAGEN 1MG HYPOKIT

27

GLUCAGON 1MG INJ 27 glucose 10% inj 104 GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0342MEQ/ML INJ

100


100

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

100

glucose 5% inj 104 glucose 50mg/ml/potassium chloride 0.01meq/ml/sodium chloride 0.0769meq/ml inj

100

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

100


100


100


100


100


100

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

100

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

100


100


100


100


100


100


100

GLUCOSE CHEW TAB 1GM*

27


27


27

glucose gel 40%* 27 GLUCOSE URINE TEST-(GLUCOSE OXIDASE) STRIP*

82

glyburide 1.25mg tab 29 glyburide 1.25mg/metformin 250mg tab

26

glyburide 1.5mg tab 29 glyburide 2.5mg tab 29 glyburide 2.5mg/metformin 500mg tab

26

glyburide 3mg tab 29 glyburide 5mg tab 29 glyburide 5mg/metformin 500mg tab

26

glyburide 6mg tab 29 glycerin supp 1 gm* 96 glycerin supp 1.2gm* 96 glycerin supp 2 gm* 96 glycerin supp 2.1gm* 96 glycerin supp 80.7%* 96 glycopyrrolate 0.2mg/ml inj

116

glycopyrrolate 1mg tab 116 glycopyrrolate 2mg tab 116 gramicidin 0.025mg/ml/neomycin 1.75mg/ml/polymyxin b 10000unit/ml ophth soln

106

granisetron 0.1mg/ml inj 30 granisetron 1mg tab 30


148

granisetron 1mg/ml (1ml) inj

30

granisetron 1mg/ml inj 30 GRANIX 300MCG/0.5ML SYRINGE

93

GRANIX 480MCG/0.8ML SYRINGE

93

griseofulvin 125mg tab 31 griseofulvin 250mg tab 31 griseofulvin 25mg/ml oral susp

31

griseofulvin 500mg tab 31 guaifenesin liquid 100mg/5ml*

75

GUAIFENESIN LIQUID 200MG/5ML*

75

guaifenesin SR tab (12hr) 600mg*

75

guaifenesin syrup 100mg/5ml*

75

guaifenesin tab 200mg* 75 guaifenesin tab 400mg* 75 GUAIFENESIN/CODEINE LIQUID 200-8MG/5ML*

74

guaifenesin/codeine liquid 225-7.5mg/5ml*

74

guaifenesin/codeine soln 100-6.3mg/5ml*

74

guaifenesin-codeine soln 100-10mg/5ml*

74

guanfacine 1mg er tab 2 guanfacine 1mg tab 36 guanfacine 2mg er tab 2 guanfacine 2mg tab 36 guanfacine 3mg er tab 2 guanfacine 4mg er tab 2 GUANIDINE 125MG TAB 41

H

HAEGARDA 2000UNT INJ

91

HAEGARDA 3000UNT INJ

91

HALAVEN 1MG/2ML INJ 49

halobetasol propionate 0.05% cream

80

halobetasol propionate 0.05% ointment

80

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

53

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

53

haloperidol decanoate 100mg/ml inj

53

haloperidol decanoate 500mg/5ml inj

53

haloperidol decanoate 50mg/ml inj

53

HAVRIX 1440UNIT INJ 119 HAVRIX 1440UNIT SYRINGE

119

HAVRIX 720UNIT INJ 119 HAVRIX 720UNIT SYRINGE

119

heparin sodium, porcine 10000unit/ml inj

18


18

HEPARIN SODIUM, PORCINE 100UNIT/ML INJ

18


18


18


18


18

HEPATAMINE 8% INJ 105 HERCEPTIN 150MG INJ 43 HERCEPTIN 440MG INJ 43

HETLIOZ 20MG CAP 95 HEXALEN 50MG CAP 42 HIBERIX INJ 118 HUMIRA 10MG/0.1ML SYRINGE

3

HUMIRA 10MG/0.2ML SYRINGE

3


3


3

HUMIRA 40MG/0.4ML AUTO-INJECTOR

3


3

HUMIRA 40MG/0.8ML AUTO-INJECTOR

3


3


3


3


3

HUMIRA PEDIATRIC CROHN'S STARTER PACK SYRINGE (2) 40MG/0.4ML, 80MG/0.8ML

4

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

4

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

4

HUMULIN R 500UNIT/ML INJ

28


149

HUMULIN R 500UNIT/ML PEN INJ

28

hydralazine 100mg tab 39 hydralazine 10mg tab 39 hydralazine 20mg/ml inj 39 hydralazine 25mg tab 39 hydralazine 50mg tab 39 hydrochlorothiazide 12.5mg cap

84

hydrochlorothiazide 12.5mg tab

84

hydrochlorothiazide 12.5mg/irbesartan 150mg tab

38

hydrochlorothiazide 12.5mg/irbesartan 300mg tab

38

hydrochlorothiazide 12.5mg/lisinopril 10mg tab

38

hydrochlorothiazide 12.5mg/lisinopril 20mg tab

38


38


38

hydrochlorothiazide 12.5mg/moexipril 15mg tab

38

hydrochlorothiazide 12.5mg/moexipril 7.5mg tab

38


38


38

hydrochlorothiazide 12.5mg/quinapril 10mg tab

38

hydrochlorothiazide 12.5mg/quinapril 20mg tab

38

hydrochlorothiazide 12.5mg/telmisartan 40mg tab

38

hydrochlorothiazide 12.5mg/telmisartan 80mg tab

38

hydrochlorothiazide 12.5mg/valsartan 160mg tab

38


38


38

hydrochlorothiazide 15mg/methyldopa 250mg tab

38

hydrochlorothiazide 25mg tab

84

hydrochlorothiazide 25mg/lisinopril 20mg tab

38

hydrochlorothiazide 25mg/losartan potassium 100mg tab

38

hydrochlorothiazide 25mg/methyldopa 250mg tab

38


38


38

hydrochlorothiazide 25mg/moexipril 15mg tab

38

hydrochlorothiazide 25mg/olmesartan medoxomil 40mg tab

38

hydrochlorothiazide 25mg/propranolol 40mg tab

38

hydrochlorothiazide 25mg/propranolol 80mg tab

38

hydrochlorothiazide 25mg/quinapril 20mg tab

38

hydrochlorothiazide 25mg/spironolactone 25mg tab

83

hydrochlorothiazide 25mg/telmisartan 80mg tab

38

hydrochlorothiazide 25mg/triamterene 37.5mg cap

83

hydrochlorothiazide 25mg/triamterene 37.5mg tab

83

hydrochlorothiazide 25mg/valsartan 160mg tab

38

hydrochlorothiazide 25mg/valsartan 320mg tab

38

hydrochlorothiazide 50mg tab

84


38

hydrochlorothiazide 50mg/triamterene 75mg tab

83

hydrocodone 10mg/ibuprofen 200mg tab

10

hydrocodone 5mg/ibuprofen 200mg tab

10

hydrocodone bitartrate 7.5mg/ibuprofen 200mg tab

10

hydrocodone w/ homatropine syrup 5-1.5mg/5ml*

73

hydrocodone/homatropin e tab 5-1.5mg*

73

hydrocortisone 1% cream 80


150

hydrocortisone 1% ointment

80

hydrocortisone 1.67mg/ml enema

11

hydrocortisone 10mg tab 72 hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic soln

108

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

108

hydrocortisone 2.5% cream

80

hydrocortisone 2.5% lotion

80

hydrocortisone 2.5% ointment

80

hydrocortisone 20mg tab 72 hydrocortisone 5mg tab 72 hydrocortisone acetate cream 1%*

80

hydrocortisone cream 0.5%*

80

hydrocortisone gel 1%* 80 hydrocortisone ointment 0.5%*

80

hydrocortisone ointment 1%*

80

hydrocortisone soln 1%* 80 hydrocortisone valerate 0.2% cream

80

hydrocortisone valerate 0.2% ointment

80

hydrocortisone/aloe vera cream 0.5%*

80

hydrocortisone/aloe vera cream 1%*

80

hydrocortisone/pramoxin e 1-1% rectal cream

11

hydromorphone 10mg/ml (1ml) inj

7

hydromorphone 10mg/ml (5ml) inj

7

hydromorphone 12mg er tab

7


7

hydromorphone 1mg/ml oral soln

7

hydromorphone 2mg tab 7 hydromorphone 2mg/ml syringe

7


7

hydromorphone 4mg tab 7 hydromorphone 8mg er tab

7

hydromorphone 8mg tab 7 hydroxychloroquine sulfate 200mg tab

41

HYDROXYPROGESTER ONE CAPROATE 250MG/ML INJ

44

hydroxyurea 500mg cap 48 hydroxyzine 10mg tab 13 hydroxyzine 25mg tab 13 HYDROXYZINE 25MG/ML INJ

13

hydroxyzine 2mg/ml oral soln

13

hydroxyzine 50mg tab 13 hydroxyzine 50mg/ml inj 13 HYDROXYZINE PAMOATE 100MG CAP

13

hydroxyzine pamoate 25mg cap

13

hydroxyzine pamoate 50mg cap

13

HYPERRAB 150UNIT/ML (10ML) INJ

109

HYPERRAB 150UNIT/ML (2ML) INJ

109

HYSINGLA 100MG ER TAB

7


7


7


7


7


7


7

I

ibandronate 150mg tab 84 ibandronate 1mg/ml inj 84 IBRANCE 100MG CAP 46 IBRANCE 125MG CAP 46 IBRANCE 75MG CAP 46 ibu 600mg tab 4 ibu 800mg tab 4 ibuprofen 20mg/ml oral susp

4

ibuprofen 400mg tab 4 IBUPROFEN 400MG/OXYCODONE 5MG TAB

10

ibuprofen 600mg tab 4 ibuprofen 800mg tab 4 ibuprofen cap 200mg* 4 ibuprofen chew tab 100mg*

4

ibuprofen susp 40mg/ml* 5 ibuprofen tab 100mg* 5 ibuprofen tab 200mg* 5 ICLUSIG 15MG TAB 46 ICLUSIG 45MG TAB 46 idarubicin hydrochloride 1mg/ml inj

45

IDHIFA 100MG TAB 46 IDHIFA 50MG TAB 46 ifosfamide 1000mg inj 42 ILARIS 150MG/ML INJ 4 ILEVRO 0.3% OPHTH SUSP

107

imatinib 100mg tab 46 imatinib 400mg tab 46 IMBRUVICA 140MG CAP

46


151

IMBRUVICA 140MG TAB 46 IMBRUVICA 280MG TAB 46 IMBRUVICA 420MG TAB 46 IMBRUVICA 560MG TAB 46 IMBRUVICA 70MG CAP 46 IMFINZI 120MG/2.4ML INJ

43

IMFINZI 500MG/10ML INJ

43

imipramine 10mg tab 25 imipramine 25mg tab 25 imipramine 50mg tab 26 imipramine pamoate 100mg cap

26

imipramine pamoate 125mg cap

26


26


26

imiquimod 5% cream 81 IMOGAM 150UNIT/ML (2ML) INJ

109

IMOVAX 2.5UNIT/ML INJ

119

INCRELEX 40MG/4ML INJ

85

INCRUSE 62.5MCG INH 15 indapamide 1.25mg tab 84 indapamide 2.5mg tab 84 INDOCIN 25MG/5ML ORAL SUSP

5

indomethacin 25mg cap 5 indomethacin 50mg cap 5 indomethacin 75mg er cap

5

INFANRIX INJ 116 INLYTA 1MG TAB 46 INLYTA 5MG TAB 46 INNOPRAN 120MG XL CAP

62

INNOPRAN 80MG XL CAP

62

INSULIN PEN NEEDLE 98

INSULIN SYRINGE (DISP) U-100 0.3ML

98

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

97

INSULIN SYRINGE (DISP) U-100 1ML

98

INSULIN SYRINGE MIS 1ML/29G

98

INTELENCE 100MG TAB 56 INTELENCE 200MG TAB 56 INTELENCE 25MG TAB 56 intralipid 200mg/ml inj 104 INTRON A 10MU INJ 48 INTRON A 18MU INJ 48 INTRON A 25MU INJ 48 INTRON A 50MU INJ 48 INTRON A 6000000UNIT/ML INJ

48

introvale 91 day pack 69 INVANZ 1GM INJ 40 INVEGA 117MG/0.75ML SYRINGE

52

INVEGA 156MG/ML SYRINGE

52

INVEGA 234MG/1.5ML SYRINGE

52


52


52


52


52


52


52

INVIRASE 200MG CAP 56 INVIRASE 500MG TAB 56 IONOSOL-MB INJ 100

IOPIDINE 1% OPHTH SOLN

106

IPOL INJ 119 ipratropium bromide 0.02% inh soln

15

ipratropium bromide 0.03% nasal inhaler

103

ipratropium bromide 0.06% nasal inhaler

103

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

16

irbesartan 150mg tab 35 irbesartan 300mg tab 35 irbesartan 75mg tab 35 IRESSA 250MG TAB 46 irinotecan 20mg/ml inj 49 ISENTRESS 100MG CHEW TAB

56

ISENTRESS 100MG ORAL SUSP

57

ISENTRESS 25MG CHEW TAB

57

ISENTRESS 400MG TAB 57 ISENTRESS 600MG TAB 57 isibloom 28 day pack 69 ISOLYTE P INJ 100 ISOLYTE S INJ 100 isoniazid 100mg tab 41 ISONIAZID 100MG/ML INJ

41

ISONIAZID 10MG/ML ORAL SOLN

41

isoniazid 300mg tab 41 isosorbide dinitrate 10mg tab

12

isosorbide dinitrate 20mg tab

12

isosorbide dinitrate 30mg tab

12

ISOSORBIDE DINITRATE 12 40MG ER TABisosorbide dinitrate 5mg tab

12

isosorbide mononitrate 10mg tab

12


152

isosorbide mononitrate 120mg er tab

12

isosorbide mononitrate 20mg tab

12


12


12

isotretinoin 10mg cap 76 isotretinoin 20mg cap 76 isotretinoin 30mg cap 76 isotretinoin 40mg cap 76 isradipine 2.5mg cap 63 isradipine 5mg cap 63 ISTODAX 10MG INJ 46 itraconazole 100mg cap 31 ivermectin 3mg tab 12 IXIARO SYRINGE 119

J

JADENU 180MG GRANULE PACKET

29

JADENU 180MG TAB 29 JADENU 360MG GRANULE PACKET

29

JADENU 360MG TAB 29 JADENU 90MG GRANULE PACKET

30

JADENU 90MG TAB 29 JAKAFI 10MG TAB 46 JAKAFI 15MG TAB 46 JAKAFI 20MG TAB 46 JAKAFI 25MG TAB 46 JAKAFI 5MG TAB 46 jantoven 10mg tab 17 jantoven 1mg tab 17 jantoven 2.5mg tab 17 jantoven 2mg tab 17 jantoven 3mg tab 17 jantoven 4mg tab 17 jantoven 5mg tab 17 jantoven 6mg tab 17 jantoven 7.5mg tab 17 JANUMET 100-1000MG XR TAB

26

JANUMET 50-1000MG TAB

26

JANUMET 50-1000MG XR TAB

26

JANUMET 50-500MG TAB

27

JANUMET 50-500MG XR TAB

27

JANUVIA 100MG TAB 27 JANUVIA 25MG TAB 27 JANUVIA 50MG TAB 27 JARDIANCE 10MG TAB 28 JARDIANCE 25MG TAB 28 JEVTANA 60MG/1.5ML INJ

49

jinteli tab 87 jolivette 28 day 0.35mg pack

71

juleber 28 day pack 69 JULUCA 50-25MG TAB 57 junel 1.5/30 21 day pack 69 junel 1/20 21 day pack 69 junel fe 1.5/30 28 day pack

69

junel fe 1/20 28 day pack 69 junel fe 24 1/20 28 day pack

69

JUXTAPID 10MG CAP 34 JUXTAPID 20MG CAP 34 JUXTAPID 30MG CAP 34 JUXTAPID 40MG CAP 34 JUXTAPID 5MG CAP 34 JUXTAPID 60MG CAP 34 JYNARQUE 45/15 THERAPY PACK

87

JYNARQUE 60/30 THERAPY PACK

87

JYNARQUE 90/30 THERAPY PACK

87

K

KADCYLA 100MG INJ 43 KADCYLA 160MG INJ 43 kaitlib fe 28 day pack 69

KALETRA 100-25MG TAB

57

KALETRA 200-50MG TAB

57

KALETRA 400-100MG/5ML ORAL SOLN

57

KALYDECO 150MG TAB 114 KALYDECO 50MG GRANULES PACKET

114

KALYDECO 75MG GRANULES PACKET

114

kariva 28 day pack 69 KCL/D5W/LR INJ 0.15% 100 kelnor 1/35 28 day pack 69 kelnor 1/50 28 day pack 69 KENALOG 10MG/ML INJ

72

KENALOG 40MG/ML INJ

72

KEPIVANCE 6.25MG INJ 48 ketoconazole 2% cream 77 ketoconazole 2% shampoo

77

ketoconazole 200mg tab 31 ketoconazole 20mg/ml foam

77

ketoprofen 50mg cap 5 ketoprofen 75mg cap 5 ketorolac tromethamine 0.4% ophth soln

107

ketorolac tromethamine 0.5% ophth soln

108

ketorolac tromethamine 10mg tab

5

ketorolac tromethamine 15mg/ml inj

5

ketorolac tromethamine 30mg/ml cartridge

5

ketorolac tromethamine 30mg/ml inj

5

ketotifen fumarate ophth soln 0.025%*

108

KEYTRUDA 100MG/4ML INJ

43


153

kimidess 28 day pack 69 KINRIX 0.05 MG/ML INJ 116 KINRIX INJ 116 kionex 250mg/ml oral susp

61

KISQALI 200MG DAILY DOSE PACK

46


47


47

KISQALI/FEMARA TAB CO-PACK 200MG

45


45


45

klor-con 10meq er cap 101 klor-con 10meq er micro tab

101

klor-con 10meq er tab 101 KLOR-CON 15MEQ ER TAB

101

klor-con 20meq er micro tab

101

klor-con 8meq er cap 101 klor-con 8meq er tab 101 KORLYM 300MG TAB 27 K-TAB 20MEQ ER TAB 101 K-TAB 8MEQ ER TAB 101 kurvelo 28 day pack 69 KUVAN 100MG POWDER FOR ORAL SOLN

86

KUVAN 100MG TAB 86 KUVAN 500MG POWDER FOR ORAL SOLN

86

KYNAMRO 200MG/ML SYRINGE

32

KYPROLIS 30MG INJ 47 KYPROLIS 60MG INJ 47

L

labetalol 100mg tab 61

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

105

lactated ringers inj 100 lactated ringers irrigation

61

lactic acid lotion 5%* 81 lactulose 667mg/ml oral soln

96

LAMICTAL BLUE KIT 19 LAMICTAL GREEN KIT 19 LAMICTAL ORANGE KIT 19 LAMICTAL XR BLUE KIT

19

LAMICTAL XR GREEN KIT

20

LAMICTAL XR ORANGE KIT

20

lamivudine 100mg tab 59 lamivudine 10mg/ml oral soln

57

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

57

lamivudine 300mg tab 57 lamotrigine 100mg er tab 20 lamotrigine 100mg odt 20 lamotrigine 100mg tab 20 lamotrigine 150mg tab 20 lamotrigine 200mg er tab 20 lamotrigine 200mg odt 20 lamotrigine 200mg tab 20 lamotrigine 250mg er tab 20 lamotrigine 25mg (35) tab starter pack

20

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

20

lamotrigine 25mg chew tab

20

lamotrigine 25mg er tab 20 lamotrigine 25mg odt 20

lamotrigine 25mg tab 20 lamotrigine 300mg er tab 20 lamotrigine 50mg er tab 20 lamotrigine 50mg odt 20 lamotrigine 5mg chew tab 20 lamotrigine tab 25mg (84)/100mg (14) starter pack

20

LANCETS* 97 lansoprazole 15mg dr cap 117 lansoprazole 30mg dr cap 117 lanthanum carbonate 1000mg chew tab

90

lanthanum carbonate 500mg chew tab

90

lanthanum carbonate 750mg chew tab

90

larin 1.5/30 pack 69 larin 1/20 pack 69 larin fe 1.5/30 pack 69 larin fe 1/20 pack 69 larissia 28 day pack 69 LARTRUVO 10MG/ML INJ

43

LARTRUVO 190MG/19ML INJ

43

latanoprost 0.005% ophth soln

108

LATUDA 120MG TAB 51 LATUDA 20MG TAB 51 LATUDA 40MG TAB 52 LATUDA 60MG TAB 52 LATUDA 80MG TAB 52 layolis fe 28 pack 70 leena 28 day pack 70 leflunomide 10mg tab 5 leflunomide 20mg tab 5 LENVIMA (8) 4MG PACK

47

LENVIMA 10 10MG PACK

47

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

47


154

LENVIMA 24 PACK 47 lessina 28 day pack 70 LETAIRIS 10MG TAB 65 LETAIRIS 5MG TAB 65 letrozole 2.5mg tab 44 LEUCOVORIN 10MG TAB

49

leucovorin 10mg/ml inj 49 LEUCOVORIN 15MG TAB

49

leucovorin 20mg/ml inj 49 leucovorin 25mg tab 49 leucovorin 5mg tab 49 LEUKERAN 2MG TAB 42 LEUKINE 250MCG INJ 93 leuprolide acetate 5mg/ml inj

44

levalbuterol 0.31mg inh soln

16


16


16


16

LEVEMIR 100UNIT/ML FLEXTOUCH

28

LEVEMIR 100UNIT/ML INJ

28

levetiracetam 1000mg tab 20 levetiracetam 100mg/ml inj

20

levetiracetam 100mg/ml oral soln

20

levetiracetam 10mg/ml inj 20 levetiracetam 15mg/ml inj 20 levetiracetam 250mg tab 20 levetiracetam 500mg er tab

20

levetiracetam 500mg tab 20 levetiracetam 5mg/ml inj 20 levetiracetam 750mg er tab

20

levetiracetam 750mg tab 20

levobunolol 0.5% ophth soln

105

levocarnitine 100mg/ml oral soln

86

levocarnitine 330mg tab 86 levocetirizine 0.5mg/ml oral soln

32

levocetirizine 5mg tab 32 levofloxacin 0.5% ophth soln

106

levofloxacin 250mg tab 88 levofloxacin 25mg/ml inj 88 levofloxacin 25mg/ml oral soln

88

levofloxacin 500mg tab 88 levofloxacin 5mg/ml (150ml) inj

88

levofloxacin 5mg/ml inj 88 levofloxacin 750mg tab 89 levoleucovorin 10mg/ml inj

49

levoleucovorin 50mg inj 49 levonest 28 day pack 70 levonorgestrel tab 1.5mg*

71

levora 0.15/30 28 day pack

70

LEVORPHANOL 2MG TAB

7

levo-t 100mcg tab 115 levo-t 112mcg tab 115 levo-t 125mcg tab 115 levo-t 137mcg tab 115 levo-t 150mcg tab 115 levo-t 175mcg tab 115 levo-t 200mcg tab 115 levo-t 25mcg tab 115 levo-t 300mcg tab 115 levo-t 50mcg tab 115 levo-t 75mcg tab 115 levo-t 88mcg tab 115 levothyroxine sodium 100mcg tab

115

levothyroxine sodium 112mcg tab

115


115


115


115


115


115


115


115


115


115


115

levoxyl 100mcg tab 115 levoxyl 112mcg tab 115 levoxyl 125mcg tab 115 levoxyl 137mcg tab 115 levoxyl 150mcg tab 115 levoxyl 175mcg tab 115 levoxyl 200mcg tab 115 levoxyl 25mcg tab 115 levoxyl 50mcg tab 115 levoxyl 75mcg tab 115 levoxyl 88mcg tab 115 LEXIVA 50MG/ML ORAL SUSP

57

LIALDA 1.2GM DR TAB 89 lice shampoo* 82 lidocaine 0.5% inj 97 lidocaine 1% inj 97 lidocaine 2% gel 81 lidocaine 2% inj 97 lidocaine 2% topical soln 102 lidocaine 4% topical soln 81 lidocaine 5% ointment 81 lidocaine 5% patch 81 lidocaine/prilocaine 2.5-2.5% cream

81


155

lincomycin 300mg/ml inj 40 lindane 1% shampoo 82 linezolid 20mg/ml oral susp

40

linezolid 2mg/ml inj 40 linezolid 600mg tab 40 LINZESS 145MCG CAP 90 LINZESS 290MCG CAP 90 LINZESS 72MCG CAP 90 liothyronine sodium 0.005mg tab

115

liothyronine sodium 0.01mg/ml inj

115

liothyronine sodium 0.025mg tab

115

liothyronine sodium 0.05mg tab

115

lisinopril 10mg tab 34 lisinopril 2.5mg tab 34 lisinopril 20mg tab 34 lisinopril 30mg tab 35 lisinopril 40mg tab 35 lisinopril 5mg tab 35 lithium carbonate 150mg cap

51

lithium carbonate 300mg cap

51

lithium carbonate 300mg er tab

51

lithium carbonate 300mg tab

51

lithium carbonate 450mg er tab

51

lithium carbonate 600mg cap

51

lithium citrate 60mg/ml oral soln

51

LITHOSTAT 250MG TAB 91 LOHIST-D LIQUID 2-30MG/5ML*

74

LONSURF TAB

15-6.14MG 45

LONSURF 20-8.19MG TAB

45

loperamide 2mg cap 29

loperamide liquid 1mg/5ml*

29

loperamide liquid 1mg/7.5ml*

29

loperamide tab 2mg* 29 lopinavir 80mg/ml/ritonavir 20mg/ml oral solution

57

LORATADINE ODT 5MG*

32

loratadine rapidly-disintegrating tab 10mg*

32

loratadine syrup 5mg/5ml*

32

loratadine tab 10mg* 32 loratadine/pseudoephedr ine SR tab (12hr) 5-120mg*

74

loratadine/pseudoephedr ine SR tab (24hr) 10-240mg*

74

lorazepam 0.5mg tab 13 lorazepam 1mg tab 14 lorazepam 2mg tab 14 lorazepam 2mg/ml oral conc

14

lorcet 10-325mg tab 10 lorcet 5-325mg tab 10 lorcet 7.5-325mg tab 10 loryna 28 day pack 70 losartan potassium 100mg tab

35

losartan potassium 25mg tab

35

losartan potassium 50mg tab

35

LOTEMAX 0.5% OPHTH GEL

107

LOTEMAX 0.5% OPHTH OINTMENT

107

LOTEMAX 0.5% OPHTH SUSP

107

lovastatin 10mg tab 33 lovastatin 20mg tab 33

lovastatin 40mg tab 33 low-ogestrel 28 day pack 70 loxapine 10mg cap 53 loxapine 25mg cap 53 loxapine 50mg cap 53 loxapine 5mg cap 53 LUMIGAN 0.01% OPHTH SOLN

108

LUMIZYME 50MG INJ 86 LUPRON 11.25MG (1.5ML) SYRINGE

44

LUPRON 11.25MG (1ML) SYRINGE

85

LUPRON 15MG SYRINGE

86

LUPRON 22.5MG SYRINGE

44


44

LUPRON 30MG SYRINGE

44

LUPRON 30MG SYRINGE (3 MONTH)

86

LUPRON 45MG SYRINGE

44


44

lutera 28 day pack 70 LYNPARZA 100MG CAP 47 LYNPARZA 150MG CAP 47 LYNPARZA 50MG CAP 47 LYRICA 100MG CAP 20 LYRICA 150MG CAP 20 LYRICA 200MG CAP 20 LYRICA 20MG/ML ORAL SOLN

20

LYRICA 225MG CAP 20 LYRICA 25MG CAP 20 LYRICA 300MG CAP 20 LYRICA 50MG CAP 20 LYRICA 75MG CAP 20 LYSODREN 500MG TAB 44 lyza 0.35mg pack 71

M


156

magnesium citrate soln* 96 magnesium hydroxide susp 400mg/5ml*

96

magnesium oxide tab 250mg*

12


12


12


12


12


101

magnesium sulfate 50% inj

101

magnesium sulfate 50% syringe

101

magnesium tab 100mg* 101 MAGNESIUM TAB 200MG*

101

magnesium tab 250mg* 101 malathion 0.5% lotion 82 MAPROTILINE 25MG TAB

23

MAPROTILINE 50MG TAB

23

MAPROTILINE 75MG TAB

23

marlissa 28 day pack 70 MARPLAN 10MG TAB 23 MATULANE 50MG CAP 48 matzim 180mg er tab 63 matzim 240mg er tab 63 matzim 300mg er tab 64 matzim 360mg er tab 64 matzim 420mg er tab 64 MAVYRET 100-40MG TAB

59

MAXIDEX 0.1% OPHTH SUSP

107

meclizine 12.5mg tab 30 meclizine 25mg tab 30 meclizine chew tab 25mg* 30

MECLOFENAMATE 100MG CAP

5

MECLOFENAMATE 50MG CAP

5

MEDROL 2MG TAB 72 medroxyprogesterone acetate 10mg tab

110

medroxyprogesterone acetate 150mg/ml inj

71

medroxyprogesterone acetate 150mg/ml syringe

71

medroxyprogesterone acetate 2.5mg tab

110

medroxyprogesterone acetate 5mg tab

110

mefenamic acid 250mg cap

5

mefloquine 250mg tab 41 megestrol acetate 125mg/ml oral susp

110

megestrol acetate 20mg tab

44

megestrol acetate 40mg tab

44

megestrol acetate 40mg/ml oral susp

44

MEKINIST 0.5MG TAB 47 MEKINIST 2MG TAB 47 meloxicam 15mg tab 5 meloxicam 7.5mg tab 5 melphalan 5mg/ml inj 42 memantine 10mg tab 111 memantine 10mg/memantine 5mg pack

111

memantine 14mg er cap 111 memantine 21mg er cap 111 memantine 28mg er cap 111 memantine 2mg/ml oral soln

111

memantine 5mg tab 111 memantine 7mg er cap 111 MENACTRA INJ 118 MENVEO INJ 118 meperidine 100mg tab 7

meperidine 50mg tab 7 MEPHYTON TAB 5MG* 121 mercaptopurine 50mg tab 42 meropenem 1gm inj 40 meropenem 500mg inj 40 mesalamine 66.7mg/ml enema

89

mesna 100mg/ml inj 49 MESNEX 400MG TAB 49 metadate 20mg er tab 2 METAMUCIL PLUS CALCIUM CAP*

95

METAMUCIL WAFER* 95 METAPROTERENOL SULFATE 10MG TAB

16

METAPROTERENOL SULFATE 20MG TAB

16

METAPROTERENOL SULFATE 2MG/ML ORAL SOLN

16

metaxall 800mg tab 103 METAXALONE 400MG TAB

103

metaxalone 800mg tab 103 metformin 1000mg tab 27 metformin 500mg er tab 27 metformin 500mg tab 27 metformin 500mg/pioglitazone 15mg tab

27

metformin 750mg er tab 27 metformin 850mg tab 27 metformin 850mg/pioglitazone 15mg tab

27

methadone 10mg tab 8 methadone 1mg/ml oral soln

8

methadone 2mg/ml oral soln

8

methadone 5mg tab 8 methazolamide 25mg tab 83 methazolamide 50mg tab 83 methenamine hippurate 1000mg tab

118


157

methimazole 10mg tab 115 methimazole 5mg tab 115 methocarbamol 500mg tab

103

methocarbamol 750mg tab

103

methotrexate 1000mg inj 42 methotrexate 2.5mg tab 42 methotrexate 250mg/10ml inj

42

METHOTREXATE 250MG/10ML INJ

42

methotrexate 50mg/2ml inj

43

methoxsalen 10mg cap 78 methscopolamine 2.5mg tab

116

methscopolamine 5mg tab 116 METHYCLOTHIAZIDE 5MG TAB

84

methyldopa 250mg tab 36 methyldopa 500mg tab 36 methylphenidate 10mg cd cap

2

methylphenidate 10mg chew tab

2

methylphenidate 10mg er tab

2

methylphenidate 10mg la cap

2

methylphenidate 10mg tab

2

METHYLPHENIDATE 18MG SR TAB

2

methylphenidate 1mg/ml oral soln

2

methylphenidate 2.5mg chew tab

2

methylphenidate 20mg cd cap

2

methylphenidate 20mg er tab

2


2

methylphenidate 20mg tab

2


2

methylphenidate 2mg/ml oral soln

2


3


3


3


3


3


3


3

methylphenidate 5mg chew tab

3

methylphenidate 5mg tab 3 methylphenidate 60mg cd cap

3

methylprednisolone 125mg inj

72

methylprednisolone 16mg tab

72


72

methylprednisolone 40mg/ml inj

72

methylprednisolone 4mg pack

72


72

methylprednisolone 62.5mg/ml inj

72


72

methylprednisolone acetate 40mg/ml inj

72

methylprednisolone acetate 80mg/ml inj

72

METIPRANOLOL 0.3% OPHTH SOLN

105

metoclopramide 10mg tab 89 metoclopramide 1mg/ml oral soln

89

metoclopramide 5mg tab 89 metoclopramide 5mg/ml inj

89

metolazone 10mg tab 84 metolazone 2.5mg tab 84 metolazone 5mg tab 84 metoprolol succinate 100mg er tab

62

metoprolol succinate 200mg er tab

62


62


62

metoprolol tartrate 100mg tab

62

metoprolol tartrate 1mg/ml cartridge

62

metoprolol tartrate 1mg/ml inj

62


62


62

metronidazole 0.75% cream

82

metronidazole 0.75% gel 82 metronidazole 0.75% lotion

82

metronidazole 0.75% vaginal gel

120

metronidazole 1% gel 82 metronidazole 250mg tab 39 metronidazole 375mg cap 39 metronidazole 500mg tab 39 metronidazole 5mg/ml inj 39 mexiletine 150mg cap 14 mexiletine 200mg cap 14 mexiletine 250mg cap 14


158

MIACALCIN 200UNIT/ML INJ

84

miconazole nitrate cream 2%*

77

miconazole nitrate powder 2%*

77

miconazole nitrate vaginal cream 2%*

120

miconazole nitrate vaginal cream 4%*

120

miconazole nitrate vaginal kit*

120

MICONAZOLE NITRATE VAGINAL KIT*

120

miconazole nitrate vaginal supp 100mg*

120

miconazole nitrate vaginal supp 1200mg/2% cream kit*

120

miconazole nitrate vaginal supp 200mg/2% cream 9 gm kit*

120

microgestin 1.5/30 21 day pack

70

microgestin 1/20 21 day pack

70

microgestin fe 1.5/30 28 day pack

70

microgestin fe 1/20 28 day pack

70

midodrine 10mg tab 120 midodrine 2.5mg tab 120 midodrine 5mg tab 120 miglitol 100mg tab 26 miglitol 25mg tab 26 miglitol 50mg tab 26 MIGRANAL 4MG/ML NASAL SPRAY

98

mili 28 day pack 70 mimvey lo 28 day pack 87 mimvey pack 87 MINERAL OIL (BULK)* 96 mineral oil enema* 96 MINERAL OIL LIGHT (BULK)*

96

mineral oil* 96 minitran 0.1mg/hr patch 12 minitran 0.2mg/hr patch 12 minitran 0.4mg/hr patch 12 minitran 0.6mg/hr patch 12 minocycline 100mg cap 114 minocycline 100mg tab 114 minocycline 50mg cap 114 minocycline 50mg tab 114 minocycline 75mg cap 114 minocycline 75mg tab 114 minoxidil 10mg tab 39 minoxidil 2.5mg tab 39 mirtazapine 15mg odt 22 mirtazapine 15mg tab 22 mirtazapine 30mg odt 23 mirtazapine 30mg tab 23 mirtazapine 45mg odt 23 mirtazapine 45mg tab 23 mirtazapine 7.5mg tab 23 misoprostol 0.1mg tab 117 misoprostol 0.2mg tab 117 MITIGARE 0.6MG CAP 91 mitomycin 20mg inj 45 mitomycin 40mg inj 45 MITOMYCIN 5MG INJ 45 mitoxantrone 2mg/ml inj 45 M-M-R II INJ 119 modafinil 100mg tab 3 modafinil 200mg tab 3 MODERIBA 1200/DAY DOSE PACK

59

moderiba 200mg tab 59 MODERIBA 800/DAY DOSE PACK

59

moexipril 15mg tab 35 moexipril 7.5mg tab 35 mometasone furoate 0.1% cream

80

mometasone furoate 0.1% lotion

80

mometasone furoate 0.1% ointment

80

mononessa 28 day pack 70 montelukast 10mg tab 15

montelukast 4mg chew tab

15

montelukast 4mg granules

15

montelukast 5mg chew tab

15

morgidox 50mg cap 114 morphine sulfate 100mg er cap

8

morphine sulfate 100mg er tab

8

morphine sulfate 10mg er cap

8

MORPHINE SULFATE 120MG ER (24HR) CAP

8


8

morphine sulfate 15mg tab

8


8


8

morphine sulfate 20mg/ml oral soln

8


8

MORPHINE SULFATE 2MG/ML SYRINGE

8

MORPHINE SULFATE 30MG ER (24 HR) CAP

8


8


8

morphine sulfate 30mg tab

8


8


8


8

MORPHINE SULFATE 5MG/ML SYRINGE

8


159

MORPHINE SULFATE 60MG (24HR) ER CAP

8


8


8


8


8


8

MOVANTIK 12.5MG TAB 90 MOVANTIK 25MG TAB 90 MOVIPREP ORAL SOLN 95 moxifloxacin 0.5% ophth soln

106

MOXIFLOXACIN 1.6MG/ML INJ

89

moxifloxacin 400mg tab 89 MOZOBIL 24MG/1.2ML INJ

94

MULTAQ 400MG TAB 14 multiple vitamin tab* 102 MULTIPLE VITAMINS W/MINERALS TAB*

102

multiple vitamins w/minerals tab*

102

mupirocin 2% cream 77 mupirocin 2% ointment 77 MUSTARGEN 10MG INJ 42 MYCAMINE 100MG INJ 31 MYCAMINE 50MG INJ 31 mycophenolate mofetil 200mg/ml oral susp

60

mycophenolate mofetil 250mg cap

60

mycophenolate mofetil 500mg inj

102

mycophenolate mofetil 500mg tab

60

mycophenolic acid 180mg dr tab

60

mycophenolic acid 360mg dr tab

60

MYLOTARG 4.5MG INJ 43 myorisan 10mg cap 76 myorisan 20mg cap 76 myorisan 30mg cap 76 myorisan 40mg cap 76 MYRBETRIQ 25MG ER TAB

118

MYRBETRIQ 50MG ER TAB

118

N

nabumetone 500mg tab 5 nabumetone 750mg tab 5 nadolol 20mg tab 62 nadolol 40mg tab 62 nadolol 80mg tab 62 nafcillin 100mg/ml inj 110 nafcillin 1gm inj 110 naftifine 2% cream 77 NAGLAZYME 1MG/ML INJ

86

NALOXONE 0.4MG/ML CARTRIDGE

30

naloxone 0.5mg/pentazocine 50mg tab

10

NALOXONE 1MG/ML SYRINGE

30

naltrexone 50mg tab 30 NAMENDA 14MG XR CAP

111

NAMENDA 21MG XR CAP

111

NAMENDA 28 TITRATION PACK

111

NAMENDA 28MG XR CAP

111

NAMENDA 7MG XR CAP

111

NAMZARIC 10-21MG ER CAP

111


111


111


111

NAMZARIC TITRATION 111 PACK naphazoline w/pheniramine ophth soln 0.025-0.3%*

106

naphazoline w/pheniramine ophth soln 0.027-0.315%*

106

NAPHAZOLINE/GLYCER 106 IN OPHTH SOLN 0.012-0.2%* naproxen 250mg tab 5 naproxen 25mg/ml oral susp

5

naproxen 375mg dr tab 5 naproxen 375mg tab 5 naproxen 500mg dr tab 5 naproxen 500mg tab 5 naproxen sodium 275mg tab

5

naproxen sodium 550mg tab

5

naratriptan 1mg tab 98 naratriptan 2.5mg tab 98 NARCAN 4MG/0.1ML NASAL SPRAY

30

NASACORT OTC NASAL 103 SPRAY* NATACYN 5% OPHTH SUSP

106

NATAZIA 28 DAY PACK 70 nateglinide 120mg tab 28 nateglinide 60mg tab 28 NATPARA 100MCG CARTRIDGE

84

NATPARA 25MCG CARTRIDGE

84


84


84

NEBUPENT 300MG INH SOLN

39


160

necon 0.5/35 28 day pack 70 necon 7/7/7 28 day pack 70 NEFAZODONE 100MG TAB

24

NEFAZODONE 150MG TAB

24

NEFAZODONE 200MG TAB

24

nefazodone 250mg tab 24 nefazodone 50mg tab 24 neomycin 40mg/ml/polymyxin b 200000unit/ml soln

90

neomycin sulfate 500mg tab

3

neomycin/bacitracin/poly myxin ophth ointment 5(3.5)mg-400unit-10000u nit

106

neomycin/polymyxin/bacit racin/hydrocortisone ophth ointmentment 1%

107

NEPHRAMINE 5.4% INJ 105 NERLYNX 40MG TAB 47 NEULASTA 6MG/0.6ML SYRINGE

93

NEUPRO 1MG/24HR PATCH

50


50


50


50


50


50

NEVANAC 0.1% OPHTH SUSP

108

nevirapine 100mg er tab 57 nevirapine 200mg tab 57 nevirapine 400mg er tab 57 NEXAVAR 200MG TAB 47

NEXTERONE 150MG/100ML INJ

14

NEXTERONE 360MG/200ML INJ

14

niacin 1000mg er tab 34 niacin 500mg er tab 34 niacin 750mg er tab 34 niacin CR cap 250mg* 121 niacin CR cap 500mg* 121 NIACIN CR TAB 1000MG*

121

niacin CR tab 250mg* 121 niacin CR tab 500mg* 121 niacin CR tab 750mg* 121 niacin tab 100mg* 121 niacin tab 250mg* 121 niacin tab 500mg* 121 niacin tab 50mg* 121 nicardipine 2.5mg/ml inj 64 nicardipine 20mg cap 64 nicardipine 30mg cap 64 nicotine patch 14mg/24hr*

113

nicotine patch 21mg/24hr*

113

nicotine patch 7mg/24hr* 113 NICOTINE PATCH KIT* 113 nicotine polacrilex gum 2mg*

113

nicotine polacrilex gum 4mg*

113

nicotine polacrilex lozenge 2mg*

113

nicotine polacrilex lozenge 4mg*

113

NICOTROL 10MG INHALER

113

NICOTROL 10MG/ML NASAL INHALER

113

nifedipine 10mg cap 64 nifedipine 20mg cap 64 nifedipine 30mg er tab 64 nifedipine 30mg osmotic er tab

64

nifedipine 60mg er tab 64

nifedipine 60mg osmotic er tab

64

nifedipine 90mg er tab 64 nifedipine 90mg osmotic er tab

64

nikki 28 day pack 70 nilutamide 150mg tab 44 nimodipine 30mg cap 64 NINLARO 2.3MG CAP 47 NINLARO 3MG CAP 47 NINLARO 4MG CAP 47 NIPENT 10MG INJ 48 nisoldipine 17mg er tab 64 nisoldipine 20mg er tab 64 nisoldipine 30mg er tab 64 nisoldipine 34mg er tab 64 nisoldipine 40mg er tab 64 nisoldipine 8.5mg er tab 64 NITRO-DUR 0.3MG/HR PATCH

12

NITRO-DUR 0.8MG/HR PATCH

12

nitrofurantoin 5mg/ml oral susp

118

nitrofurantoin macro 25mg cap

118

nitrofurantoin monohydrate/macrocryst alline 100mg cap

118

nitrofurantoin, macro 100mg cap

118

nitrofurantoin, macro 50mg cap

118

nitroglycerin 0.1mg/hr patch

12


12

nitroglycerin 0.3mg sl tab 12 nitroglycerin 0.4mg sl tab 12 nitroglycerin 0.4mg/act pump spray

12


12

nitroglycerin 0.6mg sl tab 13


161


13

nizatidine 150mg cap 117 NIZATIDINE 15MG/ML ORAL SOLN

117

nizatidine 300mg cap 117 NONOXYNOL-9 FILM 28%*

119

NONOXYNOL-9 FOAM 12.5%*

119

NONOXYNOL-9 GEL 3% *

119

NONOXYNOL-9 GEL 4% *

119

nora-be 28 day 0.35mg pack

71

NORDITROPIN 10MG/1.5ML PEN INJ

85


85

NORDITROPIN 30MG/3ML PEN INJ

85


85

norethindrone 0.35mg pack

71

norethindrone acetate 5mg tab

111

norlyroc 28 day 0.35mg pack

71

NORMOSOL-M INJ 100 NORMOSOL-R IN 5% DEXTROSE INJ

100

NORMOSOL-R INJ 100 NORPACE 100MG ER CAP

14

NORPACE 150MG ER CAP

14

NORTHERA 100MG CAP 120 NORTHERA 200MG CAP 120 NORTHERA 300MG CAP 120 nortrel 0.5/35 28 day pack

70

nortrel 1/35 21 day pack 70 nortrel 1/35 28 day pack 70

nortrel 7/7/7 28 day pack 70 nortriptyline 10mg cap 26 nortriptyline 25mg cap 26 NORTRIPTYLINE 2MG/ML ORAL SOLN

26

nortriptyline 50mg cap 26 nortriptyline 75mg cap 26 NORVIR 100MG CAP 57 NORVIR 100MG POWDER PACKET

57

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

57

NOVOLIN 100UNIT/ML INJ

28

NOVOLIN N 100UNIT/ML INJ

28

NOVOLIN R 100UNIT/ML INJ

28

NOVOLOG 100UNIT/ML FLEXPEN

28

NOVOLOG 100UNIT/ML INJ

28

NOVOLOG MIX 100UNIT/ML FLEXPEN

28

NOVOLOG MIX 100UNIT/ML INJ

28

NOXAFIL 100MG DR TAB

31

NOXAFIL 40MG/ML ORAL SUSP

31

NUCALA 100MG INJ 15 NUCYNTA 100MG ER TAB

8

NUCYNTA 150MG ER TAB

8


8


8

NUCYNTA 50MG ER TAB

8

NUEDEXTA 20-10MG CAP

113

NULOJIX 250MG INJ 60

NUPLAZID 17MG TAB 52 nutrilipid 20% iv soln 104 NUTRITIONAL SUPPLEMENT FLAVOR PACK*

82

NUTRITIONAL SUPPLEMENT LIQUID*

82

NUTRITIONAL SUPPLEMENT PACK*

82

NUVARING VAGINAL RING

71

nyamyc 100000unit/gm powder

77

nystatin 100000unit/ml cream

77

nystatin 100000unit/ml oral susp

102

nystatin 100unit/mg ointment

77

nystatin 100unit/mg powder

77

nystatin 500000unit tab 31 nystop 100000unit/gm powder

77

O

OCALIVA 10MG TAB 89 OCALIVA 5MG TAB 89 ocella 28 day pack 70 OCTAGAM 25GM/500ML INJ

109

OCTAGAM 2GM/20ML INJ

109

octreotide 0.05mg/ml inj 87 octreotide 0.1mg/ml inj 87 octreotide 0.2mg/ml inj 87 octreotide 0.5mg/ml inj 87 octreotide 1mg/ml inj 87 ODEFSEY 200-25-25MG TAB

57

ODOMZO 200MG CAP 44 OFEV 100MG CAP 114 OFEV 150MG CAP 114 ofloxacin 0.3% ophth soln 106 ofloxacin 0.3% otic soln 108


162

olanzapine 10mg inj 53 olanzapine 10mg odt 53 olanzapine 10mg tab 53 olanzapine 15mg odt 53 olanzapine 15mg tab 54 olanzapine 2.5mg tab 54 olanzapine 20mg odt 54 olanzapine 20mg tab 54 olanzapine 5mg odt 54 olanzapine 5mg tab 54 olanzapine 7.5mg tab 54 olmesartan medoxomil 20mg tab

35

olmesartan medoxomil 40mg tab

35

olmesartan medoxomil 5mg tab

35

olopatadine 0.1% ophth soln

108

olopatadine 0.2% ophth soln

108

olopatadine 0.6% nasal inhaler

103

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

32

omega-3 fatty acids cap 1000mg*

104

omega-3 fatty acids cap 1200mg*

104

omeprazole 10mg dr cap 117 omeprazole 20mg dr cap 117 omeprazole 40mg dr cap 117 ondansetron 0.8mg/ml oral soln

30

ondansetron 24mg tab 30 ondansetron 2mg/ml inj 30 ondansetron 2mg/ml syringe

30

ondansetron 4mg odt 30 ondansetron 4mg tab 30 ondansetron 8mg odt 30 ondansetron 8mg tab 30 ONFI 10MG TAB 19 ONFI 2.5MG/ML ORAL SUSP

19

ONFI 20MG TAB 19 OPDIVO 100MG/10ML INJ

43

OPDIVO 40MG/4ML INJ 43 OPSUMIT 10MG TAB 65 oral electrolyte solution* 100 ORENCIA 125MG/ML AUTO-INJECTOR

5

ORENCIA 125MG/ML SYRINGE

5

ORENCIA 250MG INJ 5 ORENCIA 50MG/0.4ML SYRINGE

5

ORENCIA 87.5MG/0.7ML SYRINGE

5

ORFADIN 10MG CAP 86 ORFADIN 20MG CAP 86 ORFADIN 2MG CAP 86 ORFADIN 4MG/ML ORAL SUSP

86

ORFADIN 5MG CAP 86 ORKAMBI 100-125MG TAB

114

ORKAMBI 200-125MG TAB

114

orphenadrine citrate 100mg er tab

103

orphenadrine citrate 30mg/ml inj

103

orsythia 28 day pack 70 oseltamivir 30mg cap 59 oseltamivir 45mg cap 59 oseltamivir 6mg/ml oral susp

59

oseltamivir 75mg cap 59 oxacillin 100mg/ml inj 110 oxacillin 2000mg inj 110 OXACILLIN 20MG/ML INJ

110

OXACILLIN 40MG/ML INJ

110

oxaliplatin 100mg inj 42 oxaliplatin 5mg/ml inj 42 oxandrolone 10mg tab 10 oxandrolone 2.5mg tab 10

oxaprozin 600mg tab 5 oxazepam 10mg cap 14 oxazepam 15mg cap 14 oxazepam 30mg cap 14 oxcarbazepine 150mg tab 20 oxcarbazepine 300mg tab 20 oxcarbazepine 600mg tab 21 oxcarbazepine 60mg/ml oral susp

21

OXTELLAR 150MG XR TAB

21


21


21

oxybutynin chloride 10mg er tab

118


118

oxybutynin chloride 1mg/ml oral soln

118


118

oxybutynin chloride 5mg tab

118

oxycodone 10mg tab 8 oxycodone 15mg tab 8 oxycodone 1mg/ml oral soln

8

oxycodone 20mg tab 8 oxycodone 20mg/ml oral soln

8

oxycodone 30mg tab 8 oxycodone 5mg cap 8 oxycodone 5mg tab 8 OXYCONTIN 10MG ER TAB

8

OXYCONTIN 15MG ER TAB

9


9


9


9


163


9


9

oxymorphone 10mg tab 9 oxymorphone 5mg tab 9 oyster shell calcium tab 500mg*

99

OZEMPIC 2MG/1.5ML PEN INJ

28

OZEMPIC 2MG/1.5ML PEN INJ (1MG DOSE)

28

P

pacerone 200mg tab 14 pacerone 400mg tab 15 paclitaxel 6mg/ml inj 49 paliperidone 1.5mg er tab 52 paliperidone 3mg er tab 52 paliperidone 6mg er tab 52 paliperidone 9mg er tab 52 pamidronate disodium 3mg/ml inj

84

PAMIDRONATE DISODIUM 6MG/ML INJ

84

pamidronate disodium 9mg/ml inj

85

PANCREAZE 10500-25000-43750UNIT DR CAP

83


83


83


83


83

PANRETIN 0.1% GEL 78 pantoprazole 20mg dr tab 117 pantoprazole 40mg dr tab 117

pantoprazole 40mg inj 117 paricalcitol 0.001mg cap 86 paricalcitol 0.002mg cap 86 paricalcitol 0.002mg/ml inj

86

paricalcitol 0.004mg cap 86 paricalcitol 0.005mg/ml inj

86

paromomycin 250mg cap 3 paroxetine 10mg tab 24 paroxetine 12.5mg er tab 24 paroxetine 20mg tab 24 paroxetine 25mg er tab 24 paroxetine 30mg tab 24 paroxetine 37.5mg er tab 24 paroxetine 40mg tab 24 PASER D/R 4GM GRANULES

41

PAXIL 10MG/5ML ORAL SUSP

24

PEAK AIR PEAK FLOW METER*

98

PEDIARIX INJ 116 pediatric multiple vitamin w/vitamin C soln 35mg/ml*

102

pediatric multiple vitamins w/iron drops 10mg/ml*

102

pediatric vitamin A/D/C drops 1500unit-400unit-35mg/ ml*

102

PEDVAXHIB 7.5MCG/0.5ML INJ

118

peg 3350/electrolyte oral soln

95

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

95

PEGANONE 250MG TAB 22 PEGASYS 135MCG/0.5ML AUTO-INJECTOR

59

PEGASYS 180MCG/0.5ML AUTO-INJECTOR

59

PEGASYS 180MCG/0.5ML SYRINGE

59

PEGASYS 180MCG/ML INJ

59

penicillin g potassium 1000000unit/ml inj

109

PENICILLIN G POTASSIUM 40000UNIT/ML INJ

109

PENICILLIN G POTASSIUM 60000UNIT/ML INJ

109

PENICILLIN G PROCAINE 600000UNIT/ML SYRINGE

109

PENICILLIN G SODIUM 100000UNIT/ML INJ

109

penicillin v potassium 250mg tab

109

penicillin v potassium 25mg/ml oral soln

109

penicillin v potassium 500mg tab

110

penicillin v potassium 50mg/ml oral soln

110

PENTAM 300MG INJ 39 pentoxifylline 400mg er tab

91

PERIFLEX PKU LIQUID* 105 perindopril erbumine 2mg tab

35

perindopril erbumine 4mg tab

35

perindopril erbumine 8mg tab

35

periogard 0.12% mouthwash

102

PERJETA 420MG/14ML INJ

43

permethrin 5% cream 82


164

permethrin aerosol 0.5% *

82

permethrin creme rinse 1%*

82

permethrin lotion 1%* 82 permethrin spray/pyrethins-piperony l butoxide shampoo kit*

82

perphenazine 16mg tab 54 perphenazine 2mg tab 54 perphenazine 4mg tab 54 perphenazine 8mg tab 54 PEXEVA 10MG TAB 24 PEXEVA 20MG TAB 24 PEXEVA 30MG TAB 24 PEXEVA 40MG TAB 24 phenadoz 12.5mg rectal supp

32

phenazopyridine tab 95mg*

91

phenazopyridine tab 97.2mg*

91

phenazopyridine tab 97.5mg*

91

phenelzine 15mg tab 23 PHENOBARBITAL 100MG TAB

94

PHENOBARBITAL 15MG TAB

94

phenobarbital 16.2mg tab 94 PHENOBARBITAL 30MG TAB

94

phenobarbital 32.4mg tab 94 phenobarbital 4mg/ml oral soln

94

PHENOBARBITAL 60MG TAB

94

phenobarbital 64.8mg tab 94 phenobarbital 97.2mg tab 94 phenoxybenzamine 10mg cap

35

phentermine cap 15mg* 1 phentermine cap 30mg* 1 phentermine cap 37.5mg* 1 phentermine tab 37.5mg* 1

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

74

phenylephrine w/ DM liquid 10-15-300mg/5ml*

74


74


74

phenylephrine w/ DM liquid 2.5-5-100mg/5ml*

74

phenylephrine w/ DM liquid 2.5-5-50mg/ml*

74

phenylephrine w/ DM liquid 2.5-5-75mg/5ml*

74

phenylephrine w/ DM liquid 2.5-7.5-88mg/ml*

74

phenylephrine w/ DM syrup 5-10-100mg/5ml*

74

phenylephrine w/ DM-gg liquid 5-10-100mg/5ml*

74

phenylephrine w/ DM-gg liquid 5-10-200mg/5ml*

74

phenylephrine/brompheni ramine/DM elixir 2.5-1-5mg/5ml*

74

phenylephrine/brompheni ramine/DM liquid 10-4-20mg/5ml*

74

phenylephrine/brompheni ramine/DM liquid 2.5-1-5mg/5ml*

74

phenylephrine/brompheni ramine/DM liquid 7.5-4-15mg/5ml*

74

PHENYLEPHRINE/CHLO RPHEN/DM LIQUID 1.5-0.6-2.75MG/ML*

74

PHENYLEPHRINE/CHLO RPHEN/DM LIQUID 10-4-12.5MG/5ML*

74

phenylephrine/chlorphen/ DM liquid 10-4-15mg/5ml*

74

PHENYLEPHRINE/CHLO RPHEN/DM SYRUP 10-4-20MG/5ML*

74

PHENYLEPHRINE/CHLO RPHEN/DM SYRUP 5-2-10MG/5ML*

74

PHENYLEPHRINE/GUAI FENESIN 5-200MG TAB*

74

phenylephrine/guaifenesi n liquid 2.5-100mg/5ml*

74

PHENYLEPHRINE/GUAI FENESIN LIQUID 5-100MG/5ML*

74

phenylephrine/guaifenesi n tab 10-380mg*

75

phenylephrine/guaifenesi n tab 10-400mg*

75

PHENYLEPHRINE/PROM ETHAZINE W/ CODEINE SYRUP 5-6.25-10MG/5ML*

75

phenytoin 25mg/ml oral susp

22

phenytoin 50mg chew tab 22 phenytoin sodium 100mg er cap

22

phenytoin sodium 200mg er cap

22

phenytoin sodium 300mg er cap

22

phenytoin sodium 50mg/ml inj

22

PHOSLYRA 667MG/5ML ORAL SOLN

90

PHOSPHOLINE IODIDE 0.125% OPHTH SOLN

106

physiolyte soln 61 physiosol soln 61 phytonadione tab 100mcg*

121

PICATO 0.015% GEL 78 PICATO 0.05% GEL 78 pilocarpine 1% ophth soln

106


165

pilocarpine 2% ophth soln

106

pilocarpine 4% ophth soln

106

pilocarpine 5mg tab 102 pilocarpine 7.5mg tab 102 pimozide 1mg tab 113 pimozide 2mg tab 113 pimtrea pack 70 pindolol 10mg tab 62 pindolol 5mg tab 62 pioglitazone 15mg tab 28 pioglitazone 30mg tab 28 pioglitazone 45mg tab 28 piperacillin 2000mg/tazobactam 250mg inj

110

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

110

piperacillin 3000mg/tazobactam 375mg inj

110

piperacillin 4000mg/tazobactam 500mg inj

110

pirmella 1/35 28 day pack 70 piroxicam 10mg cap 5 piroxicam 20mg cap 5 PLASMA-LYTE 148 INJ 100 PLASMALYTE A INJ 100 PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR

113

PLEGRIDY 125MCG/0.5ML SYRINGE

113

PLEGRIDY PEN STARTER PACK

113

PLEGRIDY STARTER PACK

113

plenamine 15% inj 105 podofilox 0.5% topical soln

81

polyethylene glycol 3350 142mg/ml oral soln

96

polyethylene glycol 3350 powder packet (OTC)*

96

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

96

polymyxin b 10000unit/ml/trimethopri m 1mg/ml ophth soln

106

polymyxin b 250000unit/ml inj

41

POMALYST 1MG CAP 45 POMALYST 2MG CAP 45 POMALYST 3MG CAP 45 POMALYST 4MG CAP 45 portia 28 day pack 70 potassium chloride 0.02 meq/ml/sodium chloride 0.0769 meq/ml inj

100

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

101

potassium chloride 0.1meq/ml inj

101

potassium chloride 10% oral soln

101

potassium chloride 10meq er cap

101

potassium chloride 10meq er micro tab

101

potassium chloride 10meq er tab

101

potassium chloride 2 meq/ml inj

101

potassium chloride 20% oral soln

101

potassium chloride 20meq er micro tab

101

POTASSIUM CHLORIDE 20MEQ ER TAB

101

potassium chloride 40meq/20ml inj

101

potassium chloride 8meq er cap

101

potassium chloride 8meq er tab

101

potassium citrate 10meq er tab

90

potassium citrate 15 meq er tab

90

potassium citrate 5 meq er tab

90

povidone/iodine topical soln 7.5%*

56

povidone-iodine soln 10%*

56

PRADAXA 110MG CAP 18 PRADAXA 150MG CAP 18 PRADAXA 75MG CAP 18 PRALUENT 150MG/ML AUTO-INJECTOR

34

PRALUENT 75MG/ML AUTO-INJECTOR

34

pramipexole 0.125mg tab 50 pramipexole 0.25mg tab 50 pramipexole 0.375mg er tab

50

pramipexole 0.5mg tab 50 pramipexole 0.75mg er tab

50

pramipexole 0.75mg tab 50 pramipexole 1.5mg er tab 50 pramipexole 1.5mg tab 50 pramipexole 1mg tab 50 pramipexole 2.25mg er tab

51

pramipexole 3.75mg er tab

51

pramipexole 3mg er tab 51 pramipexole 4.5mg er tab 51 prasugrel 10mg tab 92 prasugrel 5mg tab 92 pravastatin sodium 10mg tab

33

pravastatin sodium 20mg tab

33


166


33


33

prazosin 1mg cap 36 prazosin 2mg cap 36 prazosin 5mg cap 36 PRED MILD 0.12% OPHTH SUSP

107

PRED-G 0.3-1% OPHTH SUSP

107

prednicarbate 0.1% cream

80

prednicarbate 0.1% ointment

80

prednisolone 1% ophth soln

107

prednisolone 10mg odt 72 prednisolone 15mg odt 72 prednisolone 1mg/ml oral soln

72

prednisolone 30mg odt 72 prednisolone 3mg/ml oral soln

72

prednisolone acetate 1% ophth susp

107

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

107

PREDNISONE 10MG (21) TAB PACK

72


72

prednisone 10mg tab 72 prednisone 1mg tab 72 PREDNISONE 1MG/ML ORAL SOLN

72

prednisone 2.5mg tab 72 prednisone 20mg tab 72 PREDNISONE 50MG TAB

72


72


72

prednisone 5mg tab 72 PREDNISONE 5MG/ML ORAL SOLN

72

PREMARIN 0.3MG TAB 88 PREMARIN 0.45MG TAB 88 PREMARIN 0.625MG TAB

88

PREMARIN 0.625MG/GM VAGINAL CREAM

120

PREMARIN 0.9MG TAB 88 PREMARIN 1.25MG TAB 88 PREMASOL 10% INJ 105 premasol 6% inj 105 PREMPHASE 28 DAY PACK

87

PREMPRO 0.3/1.5MG 28 DAY PACK

87

PREMPRO 0.45/1.5 28 DAY PACK

87

PREMPRO 0.625/2.5MG 28 DAY PACK

88

PREMPRO 0.625/5MG 28 DAY PACK

88

PRENATAL VITAMIN (OTC)*

102

PRENATAL VITAMINS W/IRON (OTC)*

102

prevalite 4gm/dose oral susp

33

previfem 28 day pack 70 PREZCOBIX 800-150MG TAB

57

PREZISTA 100MG/ML ORAL SUSP

57

PREZISTA 150MG TAB 57 PREZISTA 600MG TAB 57 PREZISTA 75MG TAB 57 PREZISTA 800MG TAB 57 PRIFTIN 150MG TAB 41 PRIMAQUINE PHOSPHATE 26.3MG TAB

41

primidone 250mg tab 21 primidone 50mg tab 21 PRIVIGEN 20GM/200ML INJ

109

probenecid 500mg tab 91 procainamide 100mg/ml inj

14

procainamide 500mg/ml inj

14

PROCALAMINE 3% INJ 105 prochlorperazine 10mg tab

55

prochlorperazine 25mg rectal supp

55

prochlorperazine 5mg tab 55 prochlorperazine 5mg/ml inj

55

PROCRIT 10000UNIT/ML INJ

93


93


93


93


93


93

procto-med 2.5% cream 11 procto-pak 1% rectal cream

11

proctosol 2.5% cream 11 proctozone hc 2.5% cream

11

progesterone 100mg cap 111 progesterone 200mg cap 111 PROGLYCEM 50MG/ML ORAL SUSP

27

PROGRAF 5MG/ML INJ 60 PROLASTIN 1000MG INJ 114 PROLEUKIN 22000000UNIT INJ

48

PROLIA 60MG/ML SYRINGE

85


167

PROMACTA 12.5MG TAB

93

PROMACTA 25MG TAB 93 PROMACTA 50MG TAB 93 PROMACTA 75MG TAB 93 promethazine 1.25mg/ml oral soln

32

promethazine 12.5mg rectal supp

32

promethazine 12.5mg tab 32 promethazine 25mg rectal supp

32

promethazine 25mg tab 32 promethazine 25mg/ml inj 32 promethazine 50mg rectal supp

32

promethazine 50mg tab 32 promethazine 50mg/ml inj 32 promethazine w/codeine syrup 6.25-10mg/5ml*

75

promethazine/DM syrup 6.25-15mg/5ml*

75

promethegan 25mg rectal supp

32

promethegan 50mg rectal supp

32

propafenone 150mg tab 14 propafenone 225mg er cap

14

propafenone 225mg tab 14 propafenone 300mg tab 14 propafenone 325mg er cap

14

propafenone 425mg er cap

14

PROPANTHELINE 15MG TAB

116

proparacaine 0.5% ophth soln

107

propranolol 10mg tab 62 propranolol 120mg er cap

62

propranolol 160mg er cap

62

propranolol 1mg/ml inj 62

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

62

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

62

propylthiouracil 50mg tab

115

PROQUAD INJ 119 PROSOL 20% INJ 105 protriptyline 10mg tab 26 protriptyline 5mg tab 26 PRUDOXIN 5% CREAM 78 pseudoephed/bromphen/ DM syrup 30-2-10mg/5ml*

75

pseudoephed/chlorphen/ DM liquid 15-1-5mg/5ml*

75

pseudoephedrine liquid 15mg/5ml*

104

pseudoephedrine SR tab (12hr) 120mg*

104

PSEUDOEPHEDRINE SR TAB (24HR) 240MG*

104

pseudoephedrine tab 30mg*

104

pseudoephedrine tab 60mg*

104

pseudoephedrine w/ DM liquid 30-10-100mg/5ml*

75

PSEUDOEPHEDRINE W/ DM LIQUID 30-15-175MG/5ML*

75

PSEUDOEPHEDRINE W/ DM TAB 60-15-400MG*

75

PSEUDOEPHEDRINE W/ DM TAB 60-20-380MG*

75

PSEUDOEPHEDRINE/G UAIFENESIN LIQUID 7.5-50MG/ML*

75

PSEUDOEPHEDRINE/G UAIFENESIN SR TAB (12HR) 120-1200MG*

75

pseudoephedrine/guaifen esin SR tab (12hr) 60-600mg*

75


75


75

pseudoephedrine/guaifen esin syrup 30-100mg/5ml*

75

pseudoephedrine/guaifen esin tab 40-400mg*

75

PSORCON 0.05% CREAM

80

psyllium cap 0.52gm* 95 psyllium powder 100%* 95 psyllium powder 28.3%* 95 psyllium powder 30%* 95 psyllium powder 30.9%* 95 psyllium powder 33%* 95 psyllium powder 48.57%* 95 psyllium powder 49%* 95 PSYLLIUM POWDER 52.3%*

95

psyllium powder 58.6%* 95 PSYLLIUM POWDER 60.3%*

95

PSYLLIUM POWDER 63%*

95

psyllium powder 68%* 95 PSYLLIUM POWDER 71.67%*

95

psyllium powder 95%* 95 PSYLLIUM POWDER PACKET 100%*

95

PSYLLIUM POWDER PACKET 28%*

95

PSYLLIUM POWDER PACKET 28.3%*

95


168


95


95


95

PSYLLIUM POWDER PACKET 95%*

95

PULMOZYME 1MG/ML INH SOLN

114

PURIXAN 2000MG/100ML ORAL SUSP

43

PYLERA 140-125-125MG CAP

117

pyrantel pamoate susp* 12 pyrazinamide 500mg tab 41 pyrethrins/piperonyl butoxide liquid 0.3-3%*

82

pyrethrins/piperonyl butoxide liquid 0.33-4%*

82

pyrethrins/piperonyl butoxide shampoo 0.33-4%*

82

PYRETHRINS/PIPERON YL BUTOXIDE SHAMPOO KIT 0.33-4%*

82

pyridostigmine bromide 180mg er tab

41

pyridostigmine bromide 60mg tab

41

Q

QBRELIS 1MG/ML ORAL SOLN

35

QSYMIA CAP 11.25-69MG*

1

QSYMIA CAP 15-92MG* 1 QSYMIA CAP 3.75-23MG*

1

QSYMIA CAP 7.5-46MG* 1 QUADRACEL INJ 116 quasense 91 day pack 70 QUDEXY 100MG XR CAP

21

QUDEXY 150MG XR CAP

21

QUDEXY 200MG XR CAP

21

QUDEXY 25MG XR CAP 21 QUDEXY 50MG XR CAP 21 quetiapine 100mg tab 54 quetiapine 150mg xr tab 54 quetiapine 200mg tab 54 quetiapine 200mg xr tab 54 quetiapine 25mg tab 54 quetiapine 300mg tab 54 quetiapine 300mg xr tab 54 quetiapine 400mg tab 54 quetiapine 400mg xr tab 54 quetiapine 50mg tab 54 quetiapine 50mg xr tab 54 quinapril 10mg tab 35 quinapril 20mg tab 35 quinapril 40mg tab 35 quinapril 5mg tab 35 quinidine gluconate 324mg er tab

14

QUINIDINE GLUCONATE 80MG/ML INJ

14

QUINIDINE SULFATE 200MG TAB

14

QUINIDINE SULFATE 300MG TAB

14

quinine sulfate 324mg cap

41

R

RABAVERT 2.5UNIT/ML 119 INJ rabeprazole sodium 20mg dr tab

117

raloxifene 60mg tab 85 ramipril 1.25mg cap 35 ramipril 10mg cap 35 ramipril 2.5mg cap 35 ramipril 5mg cap 35 RANEXA 1000MG ER TAB

12

RANEXA 500MG ER TAB 12 ranitidine 150mg cap 117 ranitidine 150mg tab 117 ranitidine 15mg/ml oral soln

117

ranitidine 25mg/ml inj 117 ranitidine 300mg cap 117 ranitidine 300mg tab 117 RAPAFLO 4MG CAP 91 RAPAFLO 8MG CAP 91 RAPAMUNE 1MG/ML ORAL SOLN

60

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

86

REBIF 22MCG/0.5ML AUTO-INJECTOR

113

REBIF 22MCG/0.5ML SYRINGE

113

REBIF 44MCG/0.5ML AUTO-INJECTOR

113

REBIF 44MCG/0.5ML SYRINGE

113

REBIF REBIDOSE PACK 113 REBIF TITRATION PACK 113 reclipsen 28 day pack 70 RECOMBIVAX 10MCG/ML SYRINGE

119

RECOMBIVAX 40MCG/ML INJ

119

RECOMBIVAX 5MCG/0.5ML SYRINGE

119

RECOMBIVAX HB 10MCG/ML INJ

119

REGRANEX 0.01% GEL 82 RELENZA 5MG/BLISTER INH

59

RELISTOR 12MG/0.6ML INJ

90

RELISTOR 12MG/0.6ML SYRINGE

90

RELISTOR 8MG/0.4ML SYRINGE

90


169

REMODULIN 10MG/ML INJ

65


65

REMODULIN 2.5MG/ML INJ

65


65

repaglinide 0.5mg tab 28 repaglinide 1mg tab 28 repaglinide 2mg tab 28 REPATHA 120MG/ML CARTRIDGE

34

REPATHA 140MG/ML AUTO-INJECTOR

34

REPATHA 140MG/ML SYRINGE

34

RESCON DM SYRUP 30-2-10MG/5ML*

75

RESCRIPTOR 100MG TAB

57

RESCRIPTOR 200MG TAB

57

RESTASIS 0.05% OPHTH SUSP

107

RETROVIR 10MG/ML INJ

57

REVLIMID 10MG CAP 59 REVLIMID 15MG CAP 59 REVLIMID 2.5MG CAP 59 REVLIMID 20MG CAP 60 REVLIMID 25MG CAP 60 REVLIMID 5MG CAP 60 REXULTI 0.25MG TAB 55 REXULTI 0.5MG TAB 55 REXULTI 1MG TAB 55 REXULTI 2MG TAB 55 REXULTI 3MG TAB 55 REXULTI 4MG TAB 55 REYATAZ 150MG CAP 57 REYATAZ 200MG CAP 57 REYATAZ 300MG CAP 57 REYATAZ 50MG ORAL POWDER

57

ribasphere 200mg cap 59

ribasphere 200mg tab 59 ribasphere 400mg tab 59 ribasphere 600mg tab 59 ribasphere ribapak 1200/day

59

ribasphere ribapak 800/day

59

ribavirin 200mg cap 59 ribavirin 200mg tab 59 RIDAURA 3MG CAP 4 rifabutin 150mg cap 41 RIFAMATE 150-300MG CAP

41

rifampin 150mg cap 41 rifampin 300mg cap 41 rifampin 60mg/ml inj 41 RIFATER 50-120-300MG TAB

41

riluzole 50mg tab 104 rimantadine 100mg tab 59 RISCAL-D TAB* 99 risedronate sodium 150mg tab

85

risedronate sodium 30mg tab

85

risedronate sodium 35mg (12) pack

85

risedronate sodium 35mg (4) pack

85


85


85

RISPERDAL 12.5MG INJ 52 RISPERDAL 25MG INJ 52 RISPERDAL 37.5MG INJ 52 RISPERDAL 50MG INJ 52 risperidone 0.25mg odt 52 risperidone 0.25mg tab 52 risperidone 0.5mg odt 52 risperidone 0.5mg tab 52 risperidone 1mg odt 53 risperidone 1mg tab 53 risperidone 1mg/ml oral soln

53

risperidone 2mg odt 53 risperidone 2mg tab 53 risperidone 3mg odt 53 risperidone 3mg tab 53 risperidone 4mg odt 53 risperidone 4mg tab 53 ritonavir 100mg tab 57 RITUXAN 100MG/10ML INJ

43

RITUXAN 500MG/50ML INJ

43

rivastigmine 1.5mg cap 111 rivastigmine 13.3mg/24hr patch

112

rivastigmine 3mg cap 112 rivastigmine 4.5mg cap 112 rivastigmine 4.6mg/24hr patch

112

rivastigmine 6mg cap 112 rivastigmine 9.5mg/24hr patch

112

rivelsa 91 day pack 70 rizatriptan 10mg odt 98 rizatriptan 10mg tab 98 rizatriptan 5mg odt 98 rizatriptan 5mg tab 98 ropinirole 0.25mg tab 51 ropinirole 0.5mg tab 51 ropinirole 12mg er tab 51 ropinirole 1mg tab 51 ropinirole 2mg er tab 51 ropinirole 2mg tab 51 ropinirole 3mg tab 51 ropinirole 4mg er tab 51 ropinirole 4mg tab 51 ropinirole 5mg tab 51 ropinirole 6mg er tab 51 ropinirole 8mg er tab 51 rosuvastatin 10mg tab 33 rosuvastatin 20mg tab 33 rosuvastatin 40mg tab 33 rosuvastatin 5mg tab 33 ROTARIX ORAL SUSP 119 ROTATEQ ORAL SUSP 119 roweepra 1000mg tab 21


170

roweepra 500mg er tab 21 roweepra 500mg tab 21 roweepra 750mg er tab 21 roweepra 750mg tab 21 ROZEREM 8MG TAB 95 RUBRACA 200MG TAB 47 RUBRACA 250MG TAB 47 RUBRACA 300MG TAB 47 RUCONEST 2100UNIT INJ

91

RYDAPT 25MG CAP 47

S

SABRIL 500MG TAB 22 SALICYLIC ACID 12.6% SOLN*

81

salicylic acid gel 17%* 81 salicylic acid gel 2%* 81 salicylic acid liquid 17%* 81 salicylic acid liquid 2%* 81 salicylic acid liquid 3%* 81 salicylic acid pad 2%* 81 salicylic acid pad 40%* 81 SALICYLIC ACID SOLN 12.24%*

81

salicylic acid soln 17%* 81 salicylic acid strip 40%* 81 saline nasal spray 0.65% *

103

salmon calcitonin 200unit/act nasal spray

85

SANDIMMUNE 100MG/ML ORAL SOLN

60

SANTYL 250UNIT/GM OINTMENT

81

SAPHRIS 10MG SL TAB 54 SAPHRIS 2.5MG SL TAB 54 SAPHRIS 5MG SL TAB 54 SAVELLA 100MG TAB 112 SAVELLA 12.5MG TAB 112 SAVELLA 25MG TAB 112 SAVELLA 4-WEEK TITRATION PACK

112

SAVELLA 50MG TAB 112

scopolamine 1mg/3days patch

30

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

78

selenium sulfide lotion 1%*

78

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

57

SELZENTRY 25MG TAB 57 SELZENTRY 300MG TAB 57 SELZENTRY 75MG TAB 57 sennosides syrup 8.8mg/5ml*

96

sennosides tab 15mg* 96 sennosides tab 17.2mg* 96 sennosides tab 25mg* 96 sennosides tab 8.6mg* 96 sennosides/docusate sodium tab 8.6-50mg*

96

SENSIPAR 30MG TAB 86 SENSIPAR 60MG TAB 86 SENSIPAR 90MG TAB 86 SEREVENT 50MCG/DOSE INH

16

sertraline 100mg tab 24 sertraline 20mg/ml oral soln

24

sertraline 25mg tab 24 sertraline 50mg tab 24 setlakin 91 day pack 70 sevelamer carbonate 2400mg oral susp

90

sevelamer carbonate 800mg oral susp

90

sevelamer carbonate 800mg tab

90

sharobel 28 day 0.35mg pack

71

SHINGRIX INJ 119 SIGNIFOR 0.3MG/ML INJ

87

SIGNIFOR 0.6MG/ML INJ

87

SIGNIFOR 0.9MG/ML INJ

87

sildenafil 20mg tab 65 silver sulfadiazine 1% cream

79

SIMBRINZA 1-0.2% OPHTH SUSP

106

simethicone cap 125mg* 89 simethicone cap 180mg* 89 simethicone chew tab 125mg*

89

simethicone chew tab 80mg*

89

simethicone liquid 40mg/0.6ml*

89

SIMETHICONE LIQUID* 89 SIMETHICONE ORAL STRIP 62.5MG*

89

simethicone susp 40mg/0.6ml*

89

SIMPONI ARIA 50MG/4ML INJ

4

SIMULECT 20MG INJ 60 simvastatin 10mg tab 33 simvastatin 20mg tab 34 simvastatin 40mg tab 34 simvastatin 5mg tab 34 simvastatin 80mg tab 34 sirolimus 0.5mg tab 60 sirolimus 1mg tab 60 sirolimus 2mg tab 60 SIRTURO 100MG TAB 41 SIVEXTRO 200MG INJ 40 SIVEXTRO 200MG TAB 40 sodium bicarbonate tab 650mg*

11

sodium chloride 0.45% inj

101

sodium chloride 0.9% inj 101 sodium chloride 0.9% soln

90

sodium chloride 2.5 meq/ml inj

101


171

sodium chloride 3% inj 101 sodium chloride 5% inj 101 sodium chloride flush 0.9%*

101

sodium chloride hypertonic ophth ointment 5%*

108

sodium chloride hypertonic ophth soln 5% *

108

sodium lactate 5 meq/ml inj

98

sodium phenylbutyrate 0.94mg/mg oral powder

86

sodium phosphates enema*

96

sodium polystyrene sulfonate 250mg/ml oral susp

61

SOLTAMOX 10MG/5ML ORAL SOLN

44

SOLU-CORTEF 100MG INJ

72

SOLU-CORTEF 250MG INJ

72

SOMATULINE 120MG/0.5ML SYRINGE

87


87


87

SOMAVERT 10MG INJ 85 SOMAVERT 15MG INJ 85 SOMAVERT 20MG INJ 85 SOMAVERT 25MG INJ 85 SOMAVERT 30MG INJ 85 SORBITOL ORAL SOLUTION 70%*

96

sorine 120mg tab 62 sorine 160mg tab 62 sorine 240mg tab 62 sorine 80mg tab 62 sotalol 120mg tab 62 sotalol 160mg tab 62 sotalol 240mg tab 62

sotalol 80mg tab 62 SPIRIVA 1.25MCG RESPIMAT INH

15

SPIRIVA 18MCG HANDIHALER

15

SPIRIVA 2.5MCG RESPIMAT INH

15

spironolactone 100mg tab

84

spironolactone 25mg tab 84 spironolactone 50mg tab 84 sprintec 28 day pack 70 SPRITAM 1000MG ODT 21 SPRITAM 250MG ODT 21 SPRITAM 500MG ODT 21 SPRITAM 750MG ODT 21 SPRYCEL 100MG TAB 47 SPRYCEL 140MG TAB 47 SPRYCEL 20MG TAB 47 SPRYCEL 50MG TAB 47 SPRYCEL 70MG TAB 47 SPRYCEL 80MG TAB 47 sps 250mg/ml oral susp 61 sronyx 28 day pack 70 ssd 1% cream 79 STALEVO 12.5-50-200MG TAB

51

STALEVO 18.75-75-200MG TAB

51

STALEVO 25-100-200MG TAB

51


51


51

STALEVO 50-200-200MG TAB

51

stavudine 15mg cap 57 stavudine 20mg cap 57 stavudine 30mg cap 58 stavudine 40mg cap 58 STIMATE 1.5MG/ML NASAL SPRAY

87

STIVARGA 40MG TAB 47 STRENSIQ 40MG/ML INJ 86

STRENSIQ 80MG/0.8ML INJ

86

STREPTOMYCIN 100MG INJ

3

STRIBILD 150-150-200-300MG TAB

58

SUBOXONE 12-3MG STRIP

10

SUBOXONE 2-0.5MG STRIP

10


10


10

SUCRAID 8500UNIT/ML ORAL SOLN

83

sucralfate 1000mg tab 117 sulfacetamide sodium 10% lotion

76

SULFACETAMIDE SODIUM 10% OPHTH OINTMENT

106

sulfacetamide sodium 10% ophth soln

106

SULFADIAZINE 500MG TAB

114

sulfamethoxazole 400mg/trimethoprim 80mg tab

39

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

40

sulfamethoxazole 800mg/trimethoprim 160mg tab

40

sulfamethoxazole 80mg/ml/trimethoprim 16mg/ml inj

40

SULFAMYLON 85MG/GM CREAM

79

sulfasalazine 500mg dr tab

89

sulfasalazine 500mg tab 89 sulindac 150mg tab 5


172

sulindac 200mg tab 5 sumatriptan 100mg tab 98 sumatriptan 12mg/ml auto-injector

98

sumatriptan 12mg/ml inj 98 sumatriptan 20mg/act nasal spray

98

sumatriptan 25mg tab 98 sumatriptan 4mg cartridge

98

sumatriptan 50mg tab 98 sumatriptan 5mg/act nasal spray

98

sumatriptan 6mg cartridge

98

sumatriptan 8mg/ml auto-injector

98

SUPRAX 400MG CAP 67 SUSTIVA 200MG CAP 58 SUSTIVA 600MG TAB 58 SUTENT 12.5MG CAP 47 SUTENT 25MG CAP 47 SUTENT 37.5MG CAP 47 SUTENT 50MG CAP 47 syeda 28 day pack 70 SYLATRON 200MCG INJ 48 SYLATRON 300MCG INJ 48 SYLATRON 600MCG INJ 48 SYLVANT 100MG INJ 61 SYLVANT 400MG INJ 61 SYMFI 600-300-300MG TAB

58

SYMFI LO 400-300-300MG TAB

58

SYMPROIC 0.2MG TAB 90 SYNAGIS 100MG/1ML INJ

109

SYNAGIS 50MG/0.5ML INJ

109

SYNAREL 2MG/ML NASAL SPRAY

86

SYNERCID 500MG INJ 41 SYNJARDY 12.5-1000MG TAB

27

SYNJARDY 12.5-500MG TAB

27

SYNJARDY 5-1000MG TAB

27

SYNJARDY 5-500MG TAB

27

SYNJARDY XR 10-1000MG TAB

27

SYNJARDY XR 12.5-1000MG TAB

27


27


27

SYNRIBO 3.5MG INJ 48 SYPRINE 250MG CAP 102

T

TABLOID 40MG TAB 43 tacrolimus 0.03% ointment

81

tacrolimus 0.1% ointment 81 tacrolimus 0.5mg cap 60 tacrolimus 1mg cap 60 tacrolimus 5mg cap 60 TAFINLAR 50MG CAP 47 TAFINLAR 75MG CAP 47 TAGRISSO 40MG TAB 47 TAGRISSO 80MG TAB 47 tamoxifen 10mg tab 44 tamoxifen 20mg tab 44 tamsulosin 0.4mg cap 91 TARCEVA 100MG TAB 47 TARCEVA 150MG TAB 47 TARCEVA 25MG TAB 47 TARGRETIN 1% GEL 78 tarina fe 1/20 28 day pack

70

TASIGNA 150MG CAP 47 TASIGNA 200MG CAP 48 TASIGNA 50MG CAP 48 tazarotene 0.1% cream 78 tazicef 1gm inj 67 tazicef 2gm inj 67 tazicef 6gm inj 67

TAZORAC 0.05% GEL 78 TAZORAC 0.1% GEL 78 taztia 120mg er cap 64 taztia 180mg er cap 64 taztia 240mg er cap 64 taztia 300mg er cap 64 taztia 360mg er cap 64 TECENTRIQ 60MG/ML INJ

43

TECFIDERA 120MG DR CAP

113

TECFIDERA 240MG DR CAP

113

TECFIDERA 30-DAY STARTER PACK

113

TEFLARO 400MG INJ 67 TEFLARO 600MG INJ 67 telmisartan 20mg tab 35 telmisartan 40mg tab 35 telmisartan 80mg tab 35 temazepam 15mg cap 94 temazepam 22.5mg cap 94 temazepam 30mg cap 94 temazepam 7.5mg cap 94 TENIVAC SYRINGE 116 tenofovir disoproxil fumarate 300mg tab

58

terazosin 10mg cap 36 terazosin 1mg cap 36 terazosin 2mg cap 36 terazosin 5mg cap 36 terbinafine 250mg tab 31 terbinafine cream 1%* 77 terbutaline sulfate 1mg/ml inj

16

terbutaline sulfate 2.5mg tab

16

terbutaline sulfate 5mg tab

16

terconazole 0.4% vaginal cream

120

terconazole 0.8% vaginal cream

120

terconazole 80mg vaginal supp

120


173

testosterone 1% (25mg) gel

11

testosterone 1% (50mg) gel

11

testosterone 1% gel pump 11 testosterone cypionate 100mg/ml inj

11

testosterone cypionate 200mg/ml inj

11

testosterone enanthate 200mg/ml inj

11

TETANUS/DIPHTHERIA TOXOID INJ

116

tetrabenazine 12.5mg tab 112 tetrabenazine 25mg tab 112 tetracycline 250mg cap 114 tetracycline 500mg cap 114 THALOMID 100MG CAP 60 THALOMID 150MG CAP 60 THALOMID 200MG CAP 60 THALOMID 50MG CAP 60 theophylline 100mg er tab

17

theophylline 200mg er tab

17


17


17

theophylline 5.33mg/ml oral soln

17


17

THIOLA 100MG TAB 91 thioridazine 100mg tab 55 thioridazine 10mg tab 55 thioridazine 25mg tab 55 thioridazine 50mg tab 55 thiotepa 15mg inj 42 thiothixene 10mg cap 55 thiothixene 1mg cap 55 thiothixene 2mg cap 55 thiothixene 5mg cap 55 THYMOGLOBULIN 25MG INJ

61

THYROLAR 120MG TAB 116 THYROLAR 15MG TAB 116 THYROLAR 180MG TAB 116 THYROLAR 30MG TAB 116 THYROLAR 60MG TAB 116 tiagabine 12mg tab 22 tiagabine 16mg tab 22 tiagabine 2mg tab 22 tiagabine 4mg tab 22 TIGECYCLINE 50MG INJ 40 timolol 0.25% ophth gel 105 timolol 0.25% ophth soln 105 timolol 0.5% ophth gel 105 timolol 0.5% ophth soln 105 timolol 10mg tab 62 timolol 20mg tab 63 timolol 5mg tab 63 timolol 5mg/ml ophth 24hr ophth soln

105

TIMOPTIC-XE 0.25% OPHTH GEL

105

tinidazole 250mg tab 39 tinidazole 500mg tab 39 tioconazole vaginal ointment 6.5%*

120

TIVICAY 10MG TAB 58 TIVICAY 25MG TAB 58 TIVICAY 50MG TAB 58 tizanidine 2mg cap 103 tizanidine 2mg tab 103 tizanidine 4mg cap 103 tizanidine 4mg tab 103 tizanidine 6mg cap 103 TOBI PODHALER KIT 28MG PACK

3

TOBRADEX 0.3-0.1% OPHTH OINTMENT

107

tobramycin 0.3% ophth soln

106

TOBRAMYCIN 10MG/ML INJ

3

tobramycin 40mg/ml inj 3 tobramycin 60mg/ml inh soln

3

TOLAK 4% CREAM 78

tolazamide 250mg tab 29 tolazamide 500mg tab 29 TOLBUTAMIDE 500MG TAB

29

tolcapone 100mg tab 50 tolnaftate aerosol 1%* 77 tolnaftate aerosol powder 1%*

77

tolnaftate cream 1%* 77 tolnaftate powder 1%* 77 tolnaftate soln 1%* 77 tolterodine tartrate 1mg tab

118

tolterodine tartrate 2mg er cap

118

tolterodine tartrate 2mg tab

118

tolterodine tartrate 4mg er cap

118

TOPICORT 0.05% CREAM

80

TOPIRAMATE 100MG ER CAP

21

topiramate 100mg tab 21 TOPIRAMATE 150MG ER CAP

21

topiramate 15mg cap 21 TOPIRAMATE 200MG ER CAP

21

topiramate 200mg tab 21 topiramate 25mg cap 21 TOPIRAMATE 25MG ER CAP

21

topiramate 25mg tab 21 TOPIRAMATE 50MG ER CAP

21

topiramate 50mg tab 21 toposar 1gm/50ml inj 49 topotecan 1mg/ml inj 49 TORISEL 25MG/ML INJ 48 torsemide 100mg tab 83 torsemide 10mg tab 83 torsemide 20mg tab 83 torsemide 5mg tab 83 tpn electrolytes inj 101


174

TRACLEER 125MG TAB 65 TRACLEER 32MG TAB FOR ORAL SUSP

65

TRACLEER 62.5MG TAB 65 tramadol 100mg er tab 9 tramadol 100mg er tab (matrix delivery)

9

tramadol 200mg er tab 9 tramadol 200mg er tab (matrix delivery)

9

tramadol 300mg er tab 9 tramadol 300mg er tab (matrix delivery)

9

tramadol 50mg tab 9 trandolapril 1mg tab 35 trandolapril 1mg/verapamil 240mg er tab

39

trandolapril 2mg tab 35 trandolapril 2mg/verapamil 180mg er tab

39

trandolapril 2mg/verapamil 240mg er tab

39

trandolapril 4mg tab 35 trandolapril 4mg/verapamil 240mg er tab

39

tranexamic acid 100mg/ml inj

94

tranexamic acid 650mg tab

94

tranylcypromine 10mg tab

23

TRAVASOL 10% INJ 105 TRAVATAN Z 0.004% OPHTH SOLN

108

trazodone 100mg tab 24 trazodone 150mg tab 24 trazodone 300mg tab 24 trazodone 50mg tab 24 TREANDA 100MG INJ 42 TREANDA 25MG INJ 42 TRECATOR 250MG TAB 41

TRELEGY 62.5-25MCG ELLIPTA INH

16

TRELSTAR 11.25MG INJ 44 TRELSTAR 22.5MG INJ 44 TRELSTAR 3.75MG INJ 44 tretinoin 0.01% gel 76 tretinoin 0.025% cream 76 tretinoin 0.025% gel 76 tretinoin 0.04% gel 76 tretinoin 0.05% cream 76 tretinoin 0.05% gel 76 tretinoin 0.1% cream 76 tretinoin 0.1% gel 76 tretinoin 10mg cap 48 TREXALL 10MG TAB 43 TREXALL 15MG TAB 43 TREXALL 5MG TAB 43 TREXALL 7.5MG TAB 43 triamcinolone 55mcg nasal spray

103

triamcinolone acetonide 0.025% cream

80

triamcinolone acetonide 0.025% lotion

80

triamcinolone acetonide 0.025% ointment

80


80

triamcinolone acetonide 0.1% lotion

80


80

triamcinolone acetonide 0.1% oral paste

102

triamcinolone acetonide 0.147mg/ml spray

80


80


81

triamcinolone acetonide 40mg/ml inj

72

TRIAMCINOLONE ACETONIDE NASAL AEROSOL SUSPENSION 55MCG*

103

TRIAZOLAM 0.125MG TAB

94

triazolam 0.25mg tab 94 triderm 0.1% cream 81 trientine 250mg tab 102 trifluoperazine 10mg tab 55 trifluoperazine 1mg tab 55 trifluoperazine 2mg tab 55 trifluoperazine 5mg tab 55 trifluridine 1% soln 106 trihexyphenidyl 0.4mg/ml oral soln

49

trihexyphenidyl 2mg tab 49 trihexyphenidyl 5mg tab 49 tri-legest 28 day pack 70 tri-lo-estarylla 28 day pack

70

tri-lo-sprintec 28 day pack

70

trilyte powder for oral soln

96

trimethobenzamide 300mg cap

30

trimethoprim 100mg tab 39 tri-mili 28 day pack 70 trimipramine 100mg cap 26 trimipramine 25mg cap 26 trimipramine 50mg cap 26 trinessa 28 day pack 71 TRINTELLIX 10MG TAB 24 TRINTELLIX 20MG TAB 24 TRINTELLIX 5MG TAB 24 triple antibiotic ointment*

77

tri-previfem 28 day pack 70 triprolidine/pseudoephed rine tab 2.5-60mg*

75

TRISENOX 12MG/6ML INJ

48

tri-sprintec 28 day pack 70


175

TRIUMEQ 600-50-300MG TAB

58

trivora 28 day pack 71 tri-vylibra 28 day pack 71 TROKENDI 100MG XR CAP

21

TROKENDI 200MG XR CAP

21


21


21

TROPHAMINE 10% INJ 105 trospium chloride 20mg tab

118

trospium chloride 60mg er cap

118

TRUMENBA SYRINGE 118 TRUVADA 100-150MG TAB

58

TRUVADA 133-200MG TAB

58


58


58

TWINRIX 720UNIT SYRINGE

119

TYBOST 150MG TAB 58 TYGACIL 50MG INJ 40 TYKERB 250MG TAB 48 TYLOXAPOL OPHTH SOLN 0.25%*

108

TYMLOS 2MG/ML PEN INJECTOR

85

TYPHIM VI 25MCG/0.5ML INJ

119

TYPHIM VI 25MCG/0.5ML SYRINGE

119

TYSABRI 300MG/15ML INJ

113

U

UCERIS 2MG/ACT FOAM 11 UCERIS 9MG ER TAB 72

ULORIC 40MG TAB 91 ULORIC 80MG TAB 91 unithroid 100mcg tab 116 unithroid 112mcg tab 116 unithroid 125mcg tab 116 unithroid 150mcg tab 116 unithroid 175mcg tab 116 unithroid 200mcg tab 116 unithroid 25mcg tab 116 unithroid 300mcg tab 116 unithroid 50mcg tab 116 unithroid 75mcg tab 116 unithroid 88mcg tab 116 UPTRAVI 1000MCG TAB 65 UPTRAVI 1200MCG TAB 65 UPTRAVI 1400MCG TAB 66 UPTRAVI 1600MCG TAB 66 UPTRAVI 200MCG TAB 66 UPTRAVI 400MCG TAB 66 UPTRAVI 600MCG TAB 66 UPTRAVI 800MCG TAB 66 UPTRAVI TITRATION PACK

66

ursodiol 250mg tab 89 ursodiol 300mg cap 89 ursodiol 500mg tab 89

V

valacyclovir 1000mg tab 59 valacyclovir 500mg tab 59 VALCHLOR 0.016% GEL 78 valganciclovir 450mg tab 58 valganciclovir 50mg/ml oral soln

58

valproic acid 100mg/ml inj

22

valproic acid 250mg cap 22 valproic acid 50mg/ml oral soln

22

valsartan 160mg tab 35 valsartan 320mg tab 35 valsartan 40mg tab 36 valsartan 80mg tab 36 vancomycin 1000mg inj 39 vancomycin 100mg/ml inj 39

vancomycin 125mg cap 39 vancomycin 250mg cap 39 vancomycin 500mg inj 39 vandazole 0.75% vaginal gel

120

VAQTA 25UNIT/0.5ML SYRINGE

119

VAQTA 50UNIT/0.5ML INJ

119

VAQTA 50UNIT/1ML INJ 119 VAQTA 50UNIT/ML SYRINGE

119

VARIVAX 1350PFU/0.5ML INJ

119

VARUBI 90MG TAB 30 VASCEPA 1GM CAP 32 VASCEPA 500MG CAP 32 VECTIBIX 100MG/5ML INJ

43

VELCADE 3.5MG INJ 48 velivet 28 day pack 71 VELTASSA 16.8GM POWDER FOR ORAL SUSP

61

VELTASSA 25.2GM POWDER FOR ORAL SUSP

61

VELTASSA 8.4GM POWDER FOR ORAL SUSP

61

VEMLIDY 25MG TAB 59 VENCLEXTA 10/100/50MG STARTING PACK

43

VENCLEXTA 100MG TAB

43

VENCLEXTA 10MG TAB 43 VENCLEXTA 50MG TAB 44 venlafaxine 100mg tab 25 venlafaxine 150mg er cap 25 venlafaxine 25mg tab 25 venlafaxine 37.5mg er cap

25

venlafaxine 37.5mg tab 25 venlafaxine 50mg tab 25


176

venlafaxine 75mg er cap 25 venlafaxine 75mg tab 25 VENOFER 20MG/ML INJ*

94

VENTAVIS 10MCG/ML INH SOLN

65

VENTAVIS 20MCG/ML INH SOLN

65

VENTOLIN 108MCG INH 16 verapamil 100mg er cap 64 verapamil 120mg er cap 64 verapamil 120mg er tab 64 verapamil 120mg tab 64 verapamil 180mg er cap 64 verapamil 180mg er tab 64 verapamil 2.5mg/ml inj 64 verapamil 200mg er cap 64 verapamil 240mg er cap 64 verapamil 240mg er tab 64 verapamil 300mg er cap 64 verapamil 360mg sr cap 64 verapamil 40mg tab 64 verapamil 80mg tab 64 VERSACLOZ 50MG/ML ORAL SUSP

54

VERZENIO 100MG TAB 48 VERZENIO 150MG TAB 48 VERZENIO 200MG TAB 48 VERZENIO 50MG TAB 48 VESICARE 10MG TAB 118 VESICARE 5MG TAB 118 vestura 3-0.02mg pack 71 vicodin 10-300mg tab 10 vicodin 5-300mg tab 10 vicodin 7.5-300mg tab 10 VICTOZA 18MG/3ML PEN INJ

28

VIDEX 125MG DR CAP 58 VIDEX 2GM ORAL SOLN 58 vienva 28 day pack 71 vigabatrin 50mg/ml oral soln

22

VIIBRYD 10/20MG STARTER PACK

24

VIIBRYD 10MG TAB 24

VIIBRYD 20MG TAB 24 VIIBRYD 40MG TAB 24 VIMPAT 100MG TAB 21 VIMPAT 10MG/ML ORAL SOLN

21

VIMPAT 150MG TAB 21 VIMPAT 200MG TAB 21 VIMPAT 200MG/20ML INJ

21

VIMPAT 50MG TAB 21 VINBLASTINE 1MG/ML INJ

49

vincasar 1mg/ml inj 49 vincristine sulfate 1mg/ml inj

49

vinorelbine 10mg/ml inj 49 VIRACEPT 250MG TAB 58 VIRACEPT 625MG TAB 58 VIRAMUNE 50MG/5ML ORAL SUSP

58

VIREAD 150MG TAB 58 VIREAD 200MG TAB 58 VIREAD 250MG TAB 58 VIREAD 300MG TAB 58 VIREAD 40MG/GM ORAL POWDER

58

vitamin B-1 tab 100mg* 121 vitamin B-1 tab 50mg* 121 vitamin B-12 1000mcg tab*

92

vitamin B-12 2000mcg tab*

92

vitamin B-12 500mcg tab*

92

vitamin B-12 50mcg tab* 92 vitamin B-12 CR tab 1000mg*

92

VITAMIN B-12 LOZENGE 250MCG*

92

vitamin B-12 lozenge 500mcg*

92

vitamin B-12 SL tab 2500mcg*

92


92


92


92

vitamin B-12 tab 100mcg*

92


92


92

vitamin B-2 50mg tab* 121 vitamin B-2 tab 100mg* 121 vitamin B-2 tab 25mg* 121 vitamin B-6 tab 500mg* 121 vitamin B-6 CR tab 200mg*

121

vitamin B-6 tab 100mg* 121 vitamin B-6 tab 250mg* 121 vitamin B-6 tab 25mg* 121 vitamin B-6 tab 50mg* 121 vitamin C 100mg chew tab*

122

vitamin C 100mg tab* 122 vitamin C cap 500mg* 122 vitamin C chew tab 250mg*

122

vitamin C chew tab 500mg*

122

vitamin C drops 60mg* 122 VITAMIN C SYRUP 500/5ML*

122

vitamin C tab 1000mg* 122 vitamin C tab 1500mg* 122 vitamin C tab 250mg* 122 vitamin C tab 500mg* 122 vitamin D cap 1000unit* 121 vitamin D3 cap 10000unit*

121

vitamin D3 cap 50000unit*

121

vitamin D3 cap 5000unit* 121 vitamin D3 drops 5000unit/ml*

121

vitamin D3 oral liquid 400unit/ml*

121


177

vitamin D3 tab 1000unit* 121 vitamin D3 tab 400unit* 121 vitamin D3 tab 5000unit* 121 vitamin E 200unit cap* 121 vitamin E cap 1000unit* 121 vitamin E cap 100unit* 121 vitamin E cap 600unit* 121 vitamin E cap* 121 voriconazole 200mg inj 31 voriconazole 200mg tab 31 voriconazole 40mg/ml oral susp

31

voriconazole 50mg tab 31 VOTRIENT 200MG TAB 48 VPRIV 400UNIT INJ 92 VRAYLAR 1.5/3MG MIXED PACK

52

VRAYLAR 1.5MG CAP 52 VRAYLAR 3MG CAP 52 VRAYLAR 4.5MG CAP 52 VRAYLAR 6MG CAP 52 vyfemla 28 day pack 71 vylibra 28 day pack 71 VYVANSE 10MG CAP 1 VYVANSE 10MG CHEW TAB

1

VYVANSE 20MG CAP 1 VYVANSE 20MG CHEW TAB

1


1


1


1


1

VYVANSE 70MG CAP 1 VYXEOS 44-100MG INJ 45

W

warfarin sodium 10mg tab

17

warfarin sodium 1mg tab 17 warfarin sodium 2.5mg tab

17

warfarin sodium 2mg tab 17 warfarin sodium 3mg tab 17 warfarin sodium 4mg tab 17 warfarin sodium 5mg tab 17 warfarin sodium 6mg tab 17 warfarin sodium 7.5mg tab

17

water 1000mg/ml soln 61 WELCHOL 3.75GM ORAL SUSP

33

WELCHOL 625MG TAB 33 white petrolatum/mineral oil ophth ointment*

105

WOUND CLEANSER LIQUID*

82

wymzya fe 28 day pack 71

X

XALKORI 200MG CAP 48 XALKORI 250MG CAP 48 XARELTO 10MG TAB 17 XARELTO 15MG TAB 17 XARELTO 20MG TAB 17 XARELTO STARTER PACK

17

XATMEP 2.5MG/ML ORAL SOLN

43

XENICAL CAP* 2 XGEVA 120MG/1.7ML INJ

85

XIFAXAN 200MG TAB 39 XIFAXAN 550MG TAB 39 XIGDUO 10-1000MG XR TAB

27

XIGDUO 10-500MG XR TAB

27

XIGDUO 2.5-1000MG XR TAB

27


27


27

XOLAIR 150MG INJ 15 XTAMPZA 13.5MG ER CAP

9

XTAMPZA 18MG ER CAP

9

XTAMPZA 27MG ER CAP

9

XTAMPZA 36MG ER CAP

9

XTAMPZA 9MG ER CAP 9 XTANDI 40MG CAP 44 XULANE 150-35MCG PATCH

71

XULTOPHY 100UNIT-3.6MG/ML PEN INJ

27

XYREM 500MG/ML ORAL SOLN

111

Y

YERVOY 50MG/10ML INJ

43

YF-VAX 4000UNIT/ML INJ

119

YONDELIS 1MG INJ 42

Z

zafirlukast 10mg tab 15 zafirlukast 20mg tab 15 zaleplon 10mg cap 94 zaleplon 5mg cap 94 ZALTRAP 100MG/4ML INJ

43

ZANOSAR 1GM INJ 42 zarah 3-0.03mg pack 71 ZARXIO 300MCG/0.5ML SYRINGE

93

ZARXIO 480MCG/0.8ML SYRINGE

93

ZAVESCA 100MG CAP 92 ZEJULA 100MG CAP 48 ZELBORAF 240MG TAB 48 ZEMAIRA 1000MG INJ 114 zenatane 10mg cap 76


178

zenatane 20mg cap 77 zenatane 30mg cap 77 zenatane 40mg cap 77 zenchent 28 day pack 71 ZEPATIER 50-100MG TAB

59

ZERBAXA 1.5GM INJ 66 ZERIT 1MG/ML ORAL SOLN

58

ZIAGEN 20MG/ML ORAL SOLN

58

zidovudine 100mg cap 58 zidovudine 10mg/ml oral soln

58

zidovudine 300mg tab 58 zileuton 600mg er tab 15 zinc oxide ointment 10%* 81 zinc oxide ointment 20%* 82 zinc oxide ointment 40%* 82 ZINC OXIDE PASTE 25% *

82

ZINC OXIDE PASTE 40% *

82

ziprasidone 20mg cap 52 ziprasidone 40mg cap 52 ziprasidone 60mg cap 52 ziprasidone 80mg cap 52 ZIRGAN 0.15% OPHTH GEL

106

zoledronic acid 0.05mg/ml inj

85

zoledronic acid 0.8mg/ml inj

85

ZOLINZA 100MG CAP 48 zolmitriptan 2.5mg odt 98 zolmitriptan 2.5mg tab 98 zolmitriptan 5mg odt 98 zolmitriptan 5mg tab 98 zolpidem tartrate 10mg tab

95

zolpidem tartrate 5mg tab 95 ZOMETA 4MG/100ML INJ

85

ZOMIG 2.5MG NASAL SPRAY

98

ZOMIG 5MG NASAL SPRAY

98

ZONALON 5% CREAM 78 zonisamide 100mg cap 21 zonisamide 25mg cap 22 zonisamide 50mg cap 22 ZORTRESS 0.25MG TAB 61 ZORTRESS 0.5MG TAB 61 ZORTRESS 0.75MG TAB 61 ZOSTAVAX 19400UNIT/0.65ML INJ

119

ZOSYN 40-5MG/ML INJ 110 ZOSYN 60-7.5MG/ML INJ

110

zovia 1/35e 28 day pack 71 ZYCLARA 2.5% CREAM 81 ZYDELIG 100MG TAB 48 ZYDELIG 150MG TAB 48 ZYKADIA 150MG CAP 48 ZYLET 0.5-0.3% OPHTH SUSP

107

ZYPREXA 210MG INJ 54 ZYTIGA 250MG TAB 44 ZYTIGA 500MG TAB 45

Toll Free: 1.888.522.1298 | TTY: 711 lacare.org

This formulary was updated on August 1, 2018.

LA0959 08/18

http://lacare.org

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