MISSOURI ACA MEMBER PRESCRIPTION DRUG LIST...Tagalog: Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Blue KC, may karapatan ka na makakuha ng tulong at impormasyon

MISSOURI ACA MEMBER 2020

PRESCRIPTION DRUG LIST

HIX 2019 BCBSKC MO eff dte 01-01-2020

Please see the benefit schedule in your member certificate for member cost sharing

associated with Generic and Brand (Preferred and Non Preferred) drugs.

List of Abbreviations for Prescription Drugs Drug Category:

1 Generic Drug and Generic Specialty Drug

2 Preferred Drug and Non Preferred Generic Drug

3 Non Preferred Drug and Preferred Specialty Drug

4 Non Preferred Specialty Drug

5 Zero Cost Share Preventive Drug

6 Medical Service Drugs

ACA* Affordable Care Act is a zero cost share preventive drug.

M Maintenance drug.

MSD Medical Service Drug. This drug is only covered under the medical benefit.

OTC* Over the Counter drug.

PA Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs.

This means that you will need to get approval before you fill your prescriptions. If you don’t get

approval, we may not cover the drug.

QL Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

S Specialty drug.

ST Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical

condition before we will cover another drug for that condition. For example, if Drug A and Drug B both

treat your medical condition, we may not cover Drug B unless you try Drug A first.

*Your plan has tobacco use coverage through the Routine Preventive Care benefit. Tobacco use includes two tobacco cessation attempts per year (both prescription and over-the-counter medications) for a 90-day treatment regimen when prescribed by an in-network health care provider without prior authorization.

Discrimination is Against the Law

Blue KC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color,

national origin, age, disability, or sex. Blue KC does not exclude people or treat them differently because of race,

color, national origin, age, disability, or sex.

Blue KC:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

› Qualified sign language interpreters

› Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:

› Qualified interpreters

› Information written in other languages

If you need these services, contact Customer Service, 844-395-7126 (Toll free), [email protected].

If you believe that Blue KC has failed to provide these services or discriminated in another way on the basis

of race, color, national origin, age, disability, or sex, you can file a grievance with the Appeals Department, PO

Box 419169, Kansas City, MO 64141-6169, 816-395-3537, TTY: 816-842-5607, [email protected]. You can

file a grievance in person or by mail, or email. If you need help filing a grievance, the Appeals Department is

available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human

Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

If you, or someone you’re helping, has questions about Blue KC, you have the right to get help and information in

your language at no cost. To talk to an interpreter, call 1-844-395-7126.

Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Blue KC, tiene derecho a

obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-844-395-7126.

Chinese: 如果您，或是您正在協助的對象，有關於 Blue KC方面的問題，您有權利免費以您的母語得到幫

助和訊息。洽詢一位翻譯員，請撥電話1-844-395-7126。

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có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi 1-844-395-7126.

German: Falls Sie oder jemand, dem Sie helfen, Fragen zum Blue KC haben, haben Sie das Recht, kostenlose Hilfe

und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer

1-844-395-7126 an.

Korean: 만약 귀하 또는 귀하가 돕고 있는 어떤 사람이 [Blue KC]에 관해서 질문이 있다면 귀하는 그러한 도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다. 그렇게 통역사와 얘기하기 위해서는 1-844-395-7126 로 전화하십시오.

Serbo-Croatian: Ukoliko Vi ili neko kome Vi pomažete ima pitanje o Blue KC, imate pravo da besplatno dobijete pomoć

i informacije na Vašem jeziku. Da biste razgovarali sa prevodiocem, nazovite 1-844-395-7126.

mailto:[email protected]

mailto:[email protected]

http://www.hhs.gov/ocr/office/file/index.html

Arabic: فلديك الحق في الحصول على المساعدة والمعلومات الضرورية بلغتك من دون اية تكلفة. ، KC Blue إن كان لديك أو لدى شخص تساعده أسئلة بخصوص

للتحدث مع مترجم اتصل ب. 7126 -1-844-395.

Russian: Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Blue KC, то вы имеете

право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком

позвоните по телефону1-844-395-7126.

French: Si vous, ou quelqu’un que vous êtes en train d’aider, a des questions à propos de Blue KC, vous avez

le droit d’obtenir de l’aide et l’information dans votre langue à aucun coût. Pour parler à un interprète, appelez 1-

844-395-7126.

Tagalog: Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Blue KC, may karapatan ka

na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin,

tumawag sa1-844-395-7126.

Laotian: ຖ້ າທ່ ານ, ື ຫຼ ຄົ ນ ື່ືທທ່ ານກໍ າລັ ງຊ່ ວຍເຫ ືຼ ອ, ມ ືໍືຄາຖາມກ່ ຽວກັ ບ Blue KC, ທ່ ານມ ື ືສດ ື່ືທຈະໄດ້

ຮັ ບການຊ່ ວຍເຫ ືຼ ອແລະືໍືຂ້ ມູ ນຂ່ າວສານ ື່ືທເປັ ນພາສາຂອງທ່ າືໍນ ື່ືບມ ຄ່ າໃຊ້ ຈ່ າຍ. ການໂອ້ ລົ ມກັ ບນາຍພາສາ, ໃຫ້

ໂທຫາ 1-844-395-7126.

Pennsylvanian Dutch: Wann du hoscht en Froog, odder ebber, wu du helfscht, hot en Froog baut Blue KC, hoscht

du es Recht fer Hilf un Information in deinre eegne Schprooch griege, un die Hilf koschtet nix. Wann du mit me

Interpreter schwetze witt, kannscht du 1-844-395-7126 uffrufe.

Persian:

داشته باشيد حق اين را داريد که کمکو اطالعات به زبان خود را به طور ، KC Blue اگر شما، يا کسی که شما به او کمک ميکنيد ، سوال در مورد

.رايگان دريافت مناييد .1-844-395-7126متاس حاصل مناييد

Cushite: Isin yookan namni biraa isin deeggartan Blue KC irratti gaaffii yo qabaattan, kaffaltii irraa bilisa haala ta’een

afaan keessaniin odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabdu. Nama isiniif ibsu argachuuf, lakkoofsa

bilbilaa 1-844-395-7126 tiin bilbilaa.

Portuguese: Se você, ou alguém a quem você está ajudando, tem perguntas sobre o Blue KC, você tem o direito de

obter ajuda e informação em seu idioma e sem custos. Para falar com um intérprete, ligue para 1-844-395-7126.

For TTY services, please call 1-816-842-5607.

An Independent Licensee of the Blue Cross and Blue Shield Association

All Optum trademarks and logos are owned by Optum, Inc. All other trademarks are the property of their respective owners. M57313-B 9/19

5

Table of Contents

Analgesics - Drugs for Pain ................................................................................................................................. 7

Analgesics - Drugs for Pain and Inflammation ................................................................................................... 11

Anesthetics ........................................................................................................................................................ 13

Anti-Addiction / Substance Abuse Treatment Agents ......................................................................................... 16

Antibacterials ..................................................................................................................................................... 16

Anticoagulants ................................................................................................................................................... 21

Anticonvulsants - Drugs for Seizures ................................................................................................................. 22

Antidementia Agents - Drugs for Alzheimer's Disease and Dementia ................................................................ 24

Antidepressants ................................................................................................................................................. 24

Antiemetics - Drugs for Nausea and Vomiting.................................................................................................... 26

Antifungals ......................................................................................................................................................... 27

Antigout Agents ................................................................................................................................................. 28

Anti-inflammatory Agents ................................................................................................................................... 28

Antimigraine Agents ........................................................................................................................................... 29

Antimyasthenic Agents ...................................................................................................................................... 29

Antimycobacterials ............................................................................................................................................. 29

Antineoplastics - Drugs for Cancer .................................................................................................................... 30

Antiparasitics ..................................................................................................................................................... 34

Antiparkinson Agents ......................................................................................................................................... 35

Antiplatelets ....................................................................................................................................................... 36

Antipsychotics - Drugs for Mood Disorders ........................................................................................................ 36

Antivirals ............................................................................................................................................................ 37

Anxiolytics - Drugs for Anxiety ........................................................................................................................... 39

Bipolar Agents - Drugs for Mood Disorders ........................................................................................................ 40

Blood Products / Modifiers / Volume Expanders - Drugs for Bleeding Disorders ............................................... 40

Cardiovascular Agents - Drugs for Heart and Circulation Conditions ................................................................. 41

Central Nervous System Agents - Drugs for Attention Deficit Disorder ............................................................. 49

Central Nervous System Agents - Drugs for Multiple Sclerosis .......................................................................... 50

Central Nervous System Agents - Miscellaneous .............................................................................................. 50

Dental and Oral Agents - Drugs for Mouth and Throat Conditions ..................................................................... 51

Dermatological Agents - Drugs for Skin Conditions ........................................................................................... 52

Diabetes - Antidiabetic Agents ........................................................................................................................... 58

Diabetes - Glucose Monitoring ........................................................................................................................... 60

Diabetes - Glycemic Agents ............................................................................................................................... 63

Diabetes - Insulins ............................................................................................................................................. 63

Electrolytes / Minerals / Metals / Vitamins .......................................................................................................... 64

Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer ................................................................................. 72

Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions .................................................. 73

Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment ............................................... 75

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions ........................................................ 76

Genitourinary Agents - Drugs for Prostate Conditions........................................................................................ 77

Hormonal Agents - Adrenal ................................................................................................................................ 77

Hormonal Agents - Men's Health ....................................................................................................................... 79

Hormonal Agents - Osteoporosis ....................................................................................................................... 80

Hormonal Agents - Parathyroid .......................................................................................................................... 80

Hormonal Agents - Pituitary ............................................................................................................................... 80

Hormonal Agents - Prostaglandins..................................................................................................................... 81

Hormonal Agents - Sex Hormones and Birth Control ......................................................................................... 82

Hormonal Agents - Thyroid ................................................................................................................................ 86

Immunological Agents - Drugs for Immune System Stimulation or Suppression ................................................ 87

Immunological Agents - Drugs for Vaccination ................................................................................................... 90

6

Inflammatory Bowel Disease Agents.................................................................................................................. 91

Metabolic Bone Disease Agents - Drugs for Osteoporosis ................................................................................. 91

Miscellaneous Therapeutic Agents .................................................................................................................... 92

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation ...........................................................100

Ophthalmic Agents - Drugs for Glaucoma .........................................................................................................102

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions..........................................................................103

Otic Agents - Drugs for Ear Conditions .............................................................................................................104

Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold ........................................................105

Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions ....................................106

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis.....................................................................109

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension .....................................................109

Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm .......................................................................109

Sleep Disorder Agents ......................................................................................................................................111

Last Updated 10/1/19

7

Drug Name Drug

Category

Limits/

Required

butalbital-apap 1

butalbital-apap-caff-cod 1

butalbital-apap-caffeine 1

butalbital-asa-caff-

codeine 1

butalbital-aspirin-

caffeine 1

butorphanol tartrate

injection 6 MSD

butorphanol tartrate

nasal 1 QL

BUTRANS 3 ST; QL

carisoprodol-aspirin-

codeine 1

codeine sulfate 1 QL

CONZIP 3 ST; QL

DEMEROL 6 MSD

DILAUDID INJECTION 6 MSD

DILAUDID ORAL 3 QL

DOLOPHINE 1 ST

DSUVIA 3

DURAGESIC-100 3 ST; QL





duramorph 6 MSD

duraxin 1

DVORAH 1 QL

EMBEDA 3 ST; QL

endocet 1 QL

esgic oral capsule 1

ESGIC ORAL TABLET 3 ST

fentanyl 1 ST; QL

fentanyl citrate (pf)

injection solution 6 PA; MSD

fentanyl citrate (pf)

injection solution

cartridge

6

MSD

Drug Name Drug

Category

Limits/

Required

Analgesics - Drugs

for Pain

7T GUMMY ES 3

ABSTRAL 3 ST; QL

acetaminophen-

codeine 1 QL

acetaminophen-

codeine #2 1 QL

acetaminophen-

codeine #3 1 QL

acetaminophen-

codeine #4 1 QL

ACTIQ 3 ST; QL

alfentanil hcl 6 MSD

ALLZITAL 3 ST

APADAZ 3 QL

apap-caff-

dihydrocodeine 1 QL

ARYMO ER 3 ST; QL

ascomp-codeine 1

BELBUCA 2 ST; QL

BENZHYDROCODON

E-ACETAMINOPHEN 3 QL

BUPAP 3 ST

BUPRENEX 6 PA; MSD

buprenorphine hcl

injection 6 PA; MSD

buprenorphine

transdermal patch

weekly 10 mcg/hr, 15

mcg/hr, 20 mcg/hr, 5

mcg/hr

1

ST; QL

BUPRENORPHINE

TRANSDERMAL

PATCH WEEKLY 7.5

MCG/HR

3

ST; QL

BUTALBITAL-

ACETAMINOPHEN

ORAL CAPSULE

1

ST

butalbital-

acetaminophen oral

tablet

1


8

Drug Name Drug

Category

Limits/

Required

FIORINAL/CODEINE

#3 3

hydrocodone-

acetaminophen 1 QL

hydrocodone-ibuprofen 1 QL

hydromorphone hcl er 1 ST; QL

HYDROMORPHONE

HCL INJECTION

SOLUTION 0.2 MG/ML

3

hydromorphone hcl

injection solution 2

mg/ml, 4 mg/ml

6

MSD

hydromorphone hcl oral 1 QL

hydromorphone hcl pf 6 MSD

hydromorphone hcl

rectal 1 QL

HYDROMORPHONE

HCL SOLUTION 1

MG/ML INJECTION

6

MSD

hydromorphone hcl

solution 1 mg/ml

injection

6

MSD

HYDROMORPHONE

HCL-NACL INJECTION 6 MSD

HYDROMORPHONE

HCL-NACL

INTRAVENOUS

SOLUTION 10-0.9

MG/50ML-%, 100-0.9

MG/100ML-%, 15-0.9

MG/30ML-%, 20-0.9

MG/100ML-%, 25-0.9

MG/50ML-%, 30-0.9

MG/30ML-%, 50-0.9

MG/50ML-%, 6-0.9

MG/30ML-%

6

MSD

Drug Name Drug

Category

Limits/

Required

fentanyl citrate buccal

lozenge on a handle 1 ST; QL

FENTANYL CITRATE

BUCCAL TABLET 3 ST; QL

FENTANYL CITRATE

INJECTION

SOLUTION

PREFILLED SYRINGE

6

MSD

FENTANYL CITRATE

INTRAVENOUS

SOLUTION 5000

MCG/100ML

6

PA; MSD

FENTANYL CITRATE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

MSD

FENTANYL CITRATE-

NACL INTRAVENOUS

SOLUTION

6

MSD

FENTANYL CITRATE-

NACL INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

550-0.9 MCG/55ML-%

6

MSD

FENTANYL CIT-

ROPIVACAINE-NACL

EPIDURAL SOLUTION

0.2-0.2-0.9 MG/100ML-

%, 0.4-0.2-0.9

MG/200ML-%

6

MSD

FENTANYL-

BUPIVACAINE-NACL

EPIDURAL SOLUTION

0.2-0.08-0.9

MG/100ML-%, 0.2-0.1-

0.9 MG/100ML-%, 0.2-

0.125-0.9 MG/100ML-

%, 0.5-0.0625-0.9

MG/250ML-%, 0.5-0.1-

0.9 MG/250ML-%, 0.5-

0.125-0.9 MG/250ML-

%

6

MSD

FENTORA 3 ST; QL

FIORICET 3 ST

FIORICET/CODEINE 3

FIORINAL 3 ST


9

Drug Name Drug

Category

Limits/

Required

MORPHABOND ER 3 ST; QL

morphine sulfate

(concentrate) oral

solution 100 mg/5ml,

20 mg/ml

1

QL

morphine sulfate (pf) 6 MSD

morphine sulfate er 1 ST; QL

morphine sulfate er

beads 1 ST; QL

MORPHINE SULFATE

INJECTION 6 MSD

morphine sulfate

intramuscular 6 MSD

MORPHINE SULFATE

INTRAVENOUS

SOLUTION 0.5 MG/ML

6

MSD

morphine sulfate

intravenous solution

150 mg/30ml, 25

mg/ml, 50 mg/ml

6

MSD

morphine sulfate oral 1 QL

morphine sulfate rectal 1 QL

MORPHINE SULFATE

SOLUTION 1 MG/ML

INTRAVENOUS

6

MSD

morphine sulfate

solution 1 mg/ml

intravenous

6

MSD

MORPHINE SULFATE-

NACL INJECTION 3

MORPHINE SULFATE-

NACL INTRAVENOUS

SOLUTION 100-0.9

MG/100ML-%, 50-0.9

MG/50ML-%, 500-0.9

MG/100ML-%

6

MSD

Drug Name Drug

Category

Limits/

Required

HYDROMORPHONE

HCL-NACL

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

0.5-0.9 MG/ML-%, 1-

0.9 MG/5ML-%, 1-0.9

MG/ML-%, 10-0.9

MG/50ML-%, 15-0.9

MG/30ML-%, 2-0.9

MG/10ML-%, 2-0.9

MG/ML-%, 5-0.9

MG/25ML-%, 50-0.9

MG/50ML-%, 55-0.9

MG/55ML-%, 6-0.9

MG/30ML-%

6

MSD

HYSINGLA ER 2 ST; QL

INFUMORPH 200 6 MSD

INFUMORPH 500 6 MSD

IONSYS 6 MSD

KADIAN 3 ST; QL

LAZANDA 3 ST; QL

levorphanol tartrate oral

tablet 2 mg 1 QL

levorphanol tartrate oral

tablet 3 mg 3

lorcet 1 QL

lorcet hd 1 QL

lorcet plus 1 QL

LORTAB 1 QL

MEDROX-RX 3

meperidine hcl injection 6 MSD

meperidine hcl oral 1 QL

methadone hcl injection 6 ST; MSD

methadone hcl intensol 1 ST

methadone hcl oral 1 ST

methadose oral

concentrate 10 mg/ml 1 ST

methadose oral tablet

soluble 1 ST

methadose sugar-free 1 ST

mitigo 6 MSD


10

Drug Name Drug

Category

Limits/

Required

PRIALT

INTRATHECAL

SOLUTION 100

MCG/ML, 500

MCG/5ML

6

MSD

PRIMLEV 3 QL

PROBUPHINE

IMPLANT KIT 6 MSD

remifentanil hcl 6 MSD

ROXICODONE 3 QL

SUBSYS 3 ST; QL

SYNAPRYN FUSEPAQ 3

tencon 1

tramadol hcl er

(biphasic) 1 ST; QL

TRAMADOL HCL ER

ORAL CAPSULE

EXTENDED RELEASE

24 HOUR 100 MG, 200

MG, 300 MG

3

ST; QL

tramadol hcl er oral

capsule extended

release 24 hour 150 mg

1

ST; QL

tramadol hcl er oral

tablet extended release

24 hour

1

ST; QL

tramadol hcl ir 1 QL

tramadol-

acetaminophen 1 QL

TREZIX 3 QL

TYLENOL WITH

CODEINE #3 3 QL

TYLENOL WITH

CODEINE #4 3 QL

ULTIVA 6 MSD

ULTRACET 3 QL

ULTRAM 3 QL

VANATOL LQ 3 ST

VANATOL S 3 ST

vicodin es 1 QL

vicodin hp 1 QL

XTAMPZA ER 3 ST; QL

Drug Name Drug

Category

Limits/

Required

MORPHINE SULFATE-

NACL INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

0.5-0.9 MG/ML-%, 2-

0.9 MG/2ML-%, 2-0.9

MG/ML-%, 30-0.9

MG/30ML-%, 4-0.9

MG/ML-%, 5-0.9

MG/5ML-%, 50-0.9

MG/50ML-%, 55-0.9

MG/55ML-%

6

MSD

MS CONTIN 3 ST; QL

nalbuphine hcl injection 6 MSD

NALOCET 3 QL

NORCO 3 ST; QL

NUCYNTA 2 QL

NUCYNTA ER 2 ST; QL

OPANA 3 QL

OXAYDO 3 QL

OXYCODONE HCL ER 3 ST; QL

oxycodone hcl oral

capsule 1 QL

oxycodone hcl oral

concentrate 100

mg/5ml

1

QL

oxycodone hcl oral

solution 1 QL

oxycodone hcl oral

tablet 1 QL

oxycodone-

acetaminophen 1 QL

oxycodone-aspirin 1 QL

oxycodone-ibuprofen 1 QL

OXYCONTIN 2 ST; QL

oxymorphone hcl 1 QL

oxymorphone hcl er 1 ST; QL

pentazocine-naloxone

hcl 1 QL

PERCOCET 3 QL

phrenilin forte 1


11

Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

zebutal 1 DICLOFENAC

EPOLAMINE 3 ST; QL

ZOHYDRO ER 3 ST; QL

diclofenac potassium 1 M Analgesics - Drugs

for Pain and

Inflammation

diclofenac sodium er 1 M

diclofenac sodium oral 1 M

ACTIVE INJECTION

KET-L 3

diclofenac sodium

transdermal gel 1 % 1 QL

ACTIVE INJECTION

KETMARC-L 3

diclofenac sodium

transdermal solution 1

ACTIVE-

KETOPROFEN 3

diclofenac-misoprostol 1 M

diflunisal oral 1 M ACTIVE-PREP KIT I 3

DUAL COMPLEX

FORMULA 1 KIT 3

ACTIVE-PREP KIT II 3

ACTIVE-PREP KIT III 3

DUEXIS 3 ST; M; QL

AIF #2 DRUG

PREPARATION KIT 3

EC-NAPROSYN 3 ST; M

ec-naproxen 1 M AIF #3 DRUG

PREPARATION KIT 3

ENOVARX-

DICLOFENAC

SODIUM

3

ARTHROTEC 3 ST; M

aspirin adult 5 ACA; OTC

ENOVARX-

IBUPROFEN 3

aspirin adult low

strength oral tablet

delayed release

5

ACA; OTC ENOVARX-

NAPROXEN 3

aspirin childrens 5 ACA; OTC

etodolac 1 M

aspirin ec low dose 5 ACA; OTC

etodolac er 1 M

aspirin ec low strength 5 ACA; OTC

FBL KIT 3

aspirin low dose 5 ACA; OTC

FELDENE 3 ST; M

aspirin oral tablet 5 ACA; OTC

fenoprofen calcium oral

capsule 3 ST; M

aspirin oral tablet

delayed release 325

mg

5

ACA; OTC fenoprofen calcium oral

tablet 1 ST; M

bayer aspirin 5 ACA; OTC

fenortho 3 ST; M

bayer aspirin ec low

dose 5 ACA; OTC

FLECTOR 2 ST; QL

flurbiprofen oral 1 M


12

CAMBIA 3 ST; QL

ibu 1 M CELEBREX 3 ST; M; QL

ibuprofen lysine 6 MSD celecoxib oral 1 M; QL

ibuprofen oral

suspension 1

choline-mag

trisalicylate 1

ibuprofen oral tablet

400 mg, 600 mg, 800

mg

1

M DAYPRO 3 ST; M


13

Drug Name Drug

Category

Limits/

Required

meloxicam oral tablet

15 mg 1 M

meloxicam oral tablet

7.5 mg 1 M; QL

MOBIC ORAL TABLET

15 MG 3 ST; M

MOBIC ORAL TABLET

7.5 MG 3 ST; M; QL

nabumetone oral 1 M

NALFON 3 ST; M

NAPRELAN 3 ST; M

NAPRO 3

NAPROSYN ORAL

SUSPENSION 3 ST; M

naproxen dr 1 M

naproxen oral 1 M

naproxen sodium er 1 M

naproxen sodium oral

tablet 275 mg, 550 mg 1 M

NEOPROFEN 6 MSD

NP #2 DRUG

PREPARATION KIT 3

oxaprozin 1 M

PENNSAID 3 QL

piroxicam oral 1 M

PRASTERA 3

qc aspirin low dose oral

tablet delayed release 5 ACA; OTC

QMIIZ ODT 3 ST; M

READYSHARP

ANESTH +

KETOROLAC

3

READYSHARP

KETOROLAC 6 MSD

RELAFEN DS 3 M

salsalate oral 1 M

SPRIX 3 ST; S; QL

st joseph low dose oral

tablet delayed release 5 ACA; OTC

sulindac oral 1 M

Drug Name Drug

Category

Limits/

Required

IC 400 3

IC 800 3

INDOCIN ORAL 3 ST; M

INDOCIN RECTAL 3 M

indomethacin er 1 M

indomethacin oral 1 M

indomethacin sodium 6 MSD

K.B.G.L IN

TERODERM 3

KETOPHENE

RAPIDPAQ 3

ketoprofen er 1 M

ketoprofen oral 1 M

KETOROCAINE-L 3

KETOROCAINE-LM 3

KETOROLAC

TROMETHAMINE

EXTERNAL

3

ketorolac tromethamine

injection 6 MSD


oral 1 QL


solution 60 mg/2ml

intramuscular

6

MSD

KETOROLAC

TROMETHAMINE

SOLUTION 60

MG/2ML

INTRAMUSCULAR

4

S

KETOROLAC-BUPIV-

KETAMINE 6 MSD

KETOROLAC-ROPIV-

KETAMINE 6 MSD

LIDOPROFEN 3

LODINE 3 M

meclofenamate sodium

oral 1 M

medique aspirin 5 ACA; OTC

mefenamic acid oral 1 M


14

Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

TIVORBEX 3 BUPIVACAINE HCL-

NACL EPIDURAL 6 MSD

tolmetin sodium 1 M

BUPIVACAINE HCL-

NACL INJECTION

SOLUTION 0.1-0.9 %,

0.2-0.9 %

3

TORONOVA II SUIK 6 MSD

TORONOVA SUIK 6 MSD

TRIPLE COMPLEX

FORMULA 3 KIT 3

BUPIVACAINE HCL-

NACL INJECTION

SOLUTION 0.125-0.9

%

6

MSD

VIMOVO 3 ST; M; QL

VIVLODEX 3 ST; M

VOLTAREN 3 QL

BUPIVACAINE HCL-

NACL INJECTION

SOLUTION

PREFILLED SYRINGE

0.0625-0.9 % (50 ML),

0.1-0.9 % (50 ML),

0.125-0.9 % (50 ML),

0.375-0.9 %

3

VOPAC GB 3

VOPAC KT 3

VP FC KIT 3

VP GKL KIT 3

ZIPSOR 3 ST; QL

ZORVOLEX 3 M; QL

BUPIVACAINE HCL-

NACL INJECTION

SOLUTION

PREFILLED SYRINGE

0.25-0.9 % (30 ML)

6

MSD

Anesthetics

ACTIVE INJECTION

LM-2 3

bd pudendal/local

tray/1% lido 1

bupivacaine in dextrose

intrathecal 6 MSD

BUFFERED

LIDOCAINE 6 MSD

bupivacaine spinal 6 MSD

bupivacaine

fisiopharma 6 MSD

bupivacaine-

epinephrine 6 MSD

bupivacaine hcl (pf) 6 MSD

bupivacaine-

epinephrine (pf) 6 MSD

bupivacaine hcl

injection solution 0.5 % 1

CADIRAMD 6 MSD

BUPIVACAINE HCL

INJECTION

SOLUTION 312.5

MG/10ML

3

CARBOCAINE 3

CARBOCAINE

PRESERVATIVE-

FREE INJECTION

SOLUTION 1 %, 2 %

6

MSD

BUPIVACAINE HCL

INJECTION

SOLUTION

PREFILLED SYRINGE

0.125 % (50 ML), 0.5 %

(60 ML)

3

CARBOCAINE

PRESERVATIVE-

FREE INJECTION

SOLUTION 1.5 %

1

CETACAINE

EXTERNAL AEROSOL 3

BUPIVACAINE HCL

INJECTION

SOLUTION

6

MSD chloroprocaine hcl (pf) 6 MSD


15

PREFILLED SYRINGE

0.5 % (30 ML) CITANEST FORTE

DENTAL 3


16

Drug Name Drug

Category

Limits/

Required

LIDOCAINE HCL-

SODIUM CHLORIDE

INJECTION

SOLUTION

3

LIDOCAINE HCL-

SODIUM CHLORIDE

INJECTION

SOLUTION

PREFILLED SYRINGE

1-0.9 % (3 ML)

3

LIDOCAINE HCL-

SODIUM CHLORIDE

INJECTION

SOLUTION

PREFILLED SYRINGE

1-0.9 %, 1-0.9 % (1

ML)

6

MSD

lidocaine in d5w

intravenous solution 4-

5 mg/ml-%, 8-5 mg/ml-

%

6

MSD

LIDOCAINE IN

DEXTROSE 6 MSD

lidocaine-epinephrine

injection solution 0.5 %-

1:200000, 1 %-

1:100000, 1.5 %-

1:200000, 2 %-

1:100000, 2 %-

1:200000

6

MSD

lidocaine-prilocaine

external cream 1

LIDOCAINE-SODIUM

BICARBONATE 6 MSD

LIDOCAINE-

TETRACAINE 6 PA; MSD

LIDODERM 3 ST

MARCAINE

INJECTION

SOLUTION 0.25 %

3

MARCAINE

INJECTION

SOLUTION 0.75 %

6

MSD

MARCAINE

PRESERVATIVE

FREE

6

MSD

Drug Name Drug

Category

Limits/

Required

CITANEST PLAIN

DENTAL 3

CLOROTEKAL 6 MSD

cocaine hcl external 1

COCAINE HCL NASAL 6 MSD

ENOVARX-

LIDOCAINE HCL 3

ethyl chloride 1

EXPAREL 6 MSD

GEBAUERS PAIN

EASE 3

glydo external gel 2 % 1

GOPRELTO 6 MSD

L.E.T. 3

LETS 3

lido bdk 6 MSD

lidocaine external

ointment 1

lidocaine external patch 1

lidocaine hcl (pf) 6 MSD

lidocaine hcl external

solution 1

lidocaine hcl injection

solution 6 MSD

LIDOCAINE HCL

INJECTION

SOLUTION

PREFILLED SYRINGE

10 MG/ML, 100

MG/5ML, 200

MG/10ML, 400

MG/20ML

6

MSD

LIDOCAINE HCL

INJECTION

SOLUTION

PREFILLED SYRINGE

60 MG/3ML

3

LIDOCAINE HCL

INTRADERMAL 6 MSD

lidocaine hcl

urethral/mucosal

external gel

1


17

Drug Name Drug

Category

Limits/

Required

ROPIVACAINE HCL

INJECTION

SOLUTION 33.4

MG/ML

3

ROPIVACAINE HCL

INJECTION

SOLUTION

PREFILLED SYRINGE

0.5 %

6

MSD

ROPIVACAINE HCL-

NACL EPIDURAL

SOLUTION

6

MSD

ROPIVACAINE HCL-

NACL INJECTION

SOLUTION 0.2-0.9 %

6

MSD

ROPIVACAINE HCL-

NACL INJECTION

SOLUTION

PREFILLED SYRINGE

6

MSD

ROPIV-CLONIDINE-

KETOROLAC 6 MSD

sensorcaine injection

solution 0.5 % 1

sensorcaine/epinephrin

e 6 MSD

sensorcaine-mpf 6 MSD

sensorcaine-

mpf/epinephrine

injection solution 0.25%

-1:200000, 0.5% -

1:200000

6

MSD

SENSORCAINE-

MPF/EPINEPHRINE

INJECTION

SOLUTION 0.75-

1:200000 %

6

MSD

SX1 MEDICATED

POST-OPERATIVE 3

SYNERA 3

tetracaine hcl injection 1

VENIPUNCTURE PX1

PHLEBOTOMY 3

XYLOCAINE 6 MSD

xylocaine dental 6 MSD

Drug Name Drug

Category

Limits/

Required

MARCAINE SPINAL 6 MSD

MARCAINE/EPINEPH

RINE 6 MSD

MARCAINE/EPINEPH

RINE PF 6 MSD

marlido 1

MARLIDO-25 3

MARVONA SUIK 6 MSD

NAROPIN 6 MSD

NESACAINE 3

NESACAINE-MPF 6 MSD

P-CARE 100MX 3

P-CARE M 6 MSD

P-CARE MG 6 MSD

P-CARE X 6 MSD

PLIAGLIS 3 PA

POINT OF CARE LM-

2.2 3

POINT OF CARE LM-

2.5 3

polocaine injection

solution 1 % 1

polocaine injection

solution 2 % 2

polocaine-mpf injection

solution 1 %, 2 % 6 MSD

polocaine-mpf injection

solution 1.5 % 1

READYSHARP

LIDOCAINE 6 MSD

READYSHARP-A 3

RECK 6 MSD

relador pak 1

relador pak plus 1

ROPIVACAINE HCL

EPIDURAL 6 MSD

ropivacaine hcl


mg/ml, 2 mg/ml, 5

mg/ml, 7.5 mg/ml

6

MSD


18

Drug Name Drug

Category

Limits/

Required

nicotine step 1 5 ACA; OTC; QL



NICOTROL 5 ACA; QL

NICOTROL NS 5 ACA; QL

SUBLOCADE 6 MSD

SUBOXONE 1 QL

VIVITROL 6 MSD

ZUBSOLV 1 QL

Antibacterials

ACTICLATE 3 ST

AEMCOLO 3

ALTABAX 3

amikacin sulfate

injection 6 MSD

amoxicillin 1

amoxicillin-potassium

clavulanate er 1


clavulanate oral 1

ampicillin 1

ampicillin sodium 6 MSD

ampicillin-sulbactam

sodium 6 MSD

ARIKAYCE 3 PA; S

AUGMENTIN ES-600 3

AUGMENTIN ORAL

SUSPENSION

RECONSTITUTED

125-31.25 MG/5ML

2

AUGMENTIN ORAL

SUSPENSION

RECONSTITUTED

250-62.5 MG/5ML

3

AUGMENTIN ORAL

TABLET 3

AVELOX 6 MSD

avidoxy 1

AVYCAZ 6 MSD

AZACTAM 6 MSD

Drug Name Drug

Category

Limits/

Required

XYLOCAINE/EPINEPH

RINE 6 MSD

XYLOCAINE-MPF 6 MSD

XYLOCAINE-

MPF/EPINEPHRINE 6 MSD

ZINGO 6 MSD

ZTLIDO 2 ST

Anti-Addiction /

Substance Abuse

Treatment Agents

acamprosate calcium 1 M

ANTABUSE 3 M

BUNAVAIL 1 QL

buprenorphine hcl

sublingual 1 QL

buprenorphine hcl-

naloxone hcl 1 QL

bupropion hcl er

(smoking det) 5 ACA; QL

CHANTIX 5 ACA; QL

CHANTIX

CONTINUING MONTH

PAK

5

ACA; QL

CHANTIX STARTING

MONTH PAK 5 ACA; QL

disulfiram oral 1 M

EVZIO 1 ST

LUCEMYRA 3 QL

naloxone hcl injection 1

naltrexone hcl oral 1

NALTREXONE

SUBCUTANEOUS 1

NARCAN 1

NICORETTE

MOUTH/THROAT

GUM 2 MG

5

ACA; OTC; QL

nicotine polacrilex

mouth/throat gum 5 ACA; OTC; QL

nicotine polacrilex

mouth/throat lozenge 2

mg

5

ACA; OTC; QL


19

Drug Name Drug

Category

Limits/

Required

cefotetan disodium 6 MSD

cefoxitin sodium 6 MSD

cefpodoxime proxetil 1

cefprozil 1

ceftazidime and

dextrose 6 MSD

ceftriaxone sodium in

dextrose 6 MSD

ceftriaxone sodium

injection 6 MSD

ceftriaxone sodium

intravenous 6 MSD

ceftriaxone sodium-

dextrose 6 MSD

cefuroxime axetil 1

cefuroxime sodium 6 MSD

CENTANY 3

cephalexin 1

chloramphenicol sod

succinate 6 MSD

CIPRO 3

ciprofloxacin hcl oral 1

ciprofloxacin in d5w 6 MSD

ciprofloxacin oral 1

clarithromycin er 1

clarithromycin oral 1

CLEOCIN 3

CLEOCIN

PHOSPHATE 6 MSD

clindamycin hcl oral 1

clindamycin palmitate

hcl 1

clindamycin phosphate

in d5w 6 MSD

CLINDAMYCIN

PHOSPHATE IN NACL 6 MSD


injection 6 MSD


intravenous 6 MSD

Drug Name Drug

Category

Limits/

Required

azithromycin

intravenous 6 MSD

azithromycin oral 1

aztreonam 6 MSD

bacitracin intramuscular 6 MSD

BACTOCILL IN

DEXTROSE 6 MSD

BACTRIM 3

BACTRIM DS 3

BAXDELA

INTRAVENOUS 6 MSD

BAXDELA ORAL 3

benzalkonium chloride

external solution 2

BICILLIN C-R 6 MSD

BICILLIN C-R 900/300 6 MSD

BICILLIN L-A 6 MSD

cefaclor 1

cefaclor er 1

cefadroxil 1

cefazolin sodium

injection 6 MSD

CEFAZOLIN SODIUM

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

MSD

cefazolin sodium


reconstituted

6

MSD

cefazolin sodium-

dextrose 6 MSD

cefdinir 1

cefditoren pivoxil 1

cefepime hcl 6 MSD

cefepime-dextrose 6 MSD

cefixime 1

CEFOTAN 6 MSD

cefotaxime sodium

injection solution

reconstituted 1 gm, 500

mg

6

MSD


20

Drug Name Drug

Category

Limits/

Required

erythromycin

ethylsuccinate oral 1

FIRST-

METRONIDAZOLE 3

FIRST-VANCOMYCIN 3

FIRVANQ 3

FLAGYL 3

FURADANTIN 3

gentamicin sulfate

external 1

gentamicin sulfate


mg/ml

1

gentamicin sulfate


mg/ml

6

MSD

HIPREX 3

hydrogen peroxide 2

imipenem-cilastatin 6 MSD

INVANZ 6 MSD

KEFLEX 3

LEVAQUIN ORAL

TABLET 500 MG, 750

MG

3

levofloxacin in d5w 6 MSD

levofloxacin

intravenous 6 MSD

levofloxacin oral

solution 6 MSD

levofloxacin oral tablet 1

LINCOCIN 6 MSD

lincomycin hcl injection 6 MSD

linezolid intravenous 6 MSD

linezolid oral 1 PA; QL

lugols 1

MACROBID 3

MACRODANTIN 3

mafenide acetate

external 1

MAXIPIME 6 MSD

Drug Name Drug

Category

Limits/

Required


vaginal 1

CLINDESSE 3

colistimethate sodium

(cba) 1

COLY-MYCIN M 3

coremino 1

CUBICIN 6 MSD

CUBICIN RF 6 MSD

DALVANCE 6 MSD

daptomycin 6 MSD

demeclocycline hcl 1

dicloxacillin sodium 1

DIFICID 3

DORYX 3 ST

DORYX MPC 3 ST

doxy 100 6 MSD

doxycycline hyclate

intravenous 6 MSD

doxycycline hyclate oral 1

doxycycline

monohydrate oral 1

e.e.s. 400 1

E.E.S. GRANULES 3

ertapenem sodium 6 MSD

ERYPED 200 3

ERYPED 400 3

ERY-TAB 1

erythrocin lactobionate

solution reconstituted

500 mg intravenous

6

MSD

ERYTHROCIN

LACTOBIONATE

SOLUTION

RECONSTITUTED 500

MG INTRAVENOUS

6

MSD

ERYTHROCIN

STEARATE 1

erythromycin base 1


21

Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

meropenem 6 MSD NAFCILLIN SODIUM

IN DEXTROSE

INTRAVENOUS

SOLUTION 1

GM/50ML

6

MSD

MEROPENEM-

SODIUM CHLORIDE

INTRAVENOUS

SOLUTION

RECONSTITUTED 1

GM/50ML, 500-0.9 MG-

%

6

MSD

nafcillin sodium

injection solution


gm

6

MSD

MERREM 6 MSD

nafcillin sodium



gm

6

MSD

methenamine hippurate 1

methenamine

mandelate oral 1

METRONIDAZOLE

BENZO+SYRSPEND 3

neomycin sulfate oral 1

nitrofurantoin 1 metronidazole in nacl


0.79 mg/ml-%, 500-

0.79 mg/100ml-%

6

MSD

nitrofurantoin

macrocrystal oral 1

nitrofurantoin

monohydrate

macrocrystals

1

METRONIDAZOLE IN

NACL INTRAVENOUS

SOLUTION 500-0.74

MG/100ML-%

6

MSD

NUTRIDOX 3 ST

NUVESSA 3

METRONIDAZOLE

INTRAVENOUS 6 MSD

NUZYRA

INTRAVENOUS 6 MSD

metronidazole oral 1

NUZYRA ORAL 3

metronidazole vaginal 1

ofloxacin oral 1

MINOCIN

INTRAVENOUS 6 ST; MSD

okebo 1

ORBACTIV 6 MSD MINOCIN ORAL

CAPSULE 50 MG 3 ST

oxacillin sodium 6 MSD

paromomycin sulfate

oral 1

minocycline hcl er 1

minocycline hcl oral 1

PENICILLIN G POT IN

DEXTROSE 6 MSD MINOLIRA 2 ST

mondoxyne nl 1

penicillin g potassium 6 MSD

MONUROL 3

penicillin g procaine 6 MSD

morgidox oral 1

penicillin g sodium 6 MSD

moxifloxacin hcl in nacl 6 MSD

penicillin v potassium 1


22

MOXIFLOXACIN HCL

INTRAVENOUS 6 MSD

PFIZERPEN

INJECTION

SOLUTION

RECONSTITUTED

20000000 UNIT

6

MSD moxifloxacin hcl oral 1

mupirocin calcium 1

mupirocin external 1


23

Drug Name Drug

Category

Limits/

Required

tazicef injection 6 MSD

TAZICEF SOLUTION

RECONSTITUTED 1

GM INTRAVENOUS

6

MSD

tazicef solution

reconstituted 1 gm

intravenous

6

MSD

TAZICEF SOLUTION

RECONSTITUTED 2

GM INTRAVENOUS

6

MSD

tazicef solution

reconstituted 2 gm

intravenous

6

MSD

TEFLARO 6 MSD

tetracycline hcl oral 1

tigecycline 6 MSD

tinidazole oral 1

tobramycin sulfate

injection 6 MSD

trimethoprim oral 1

TYGACIL 6 MSD

UNASYN INJECTION 6 MSD

VABOMERE 6 MSD

VANCOCIN HCL 3

VANCOMYCIN HCL IN

DEXTROSE

INTRAVENOUS

SOLUTION 1-5

GM/100ML-%, 1-5

GM/250ML-%, 1.25-5

GM/250ML-%, 1.5-5

GM/250ML-%, 1.5-5

GM/500ML-%, 1.75-5

GM/500ML-%

6

MSD

vancomycin hcl in

dextrose intravenous

solution 1-5 gm/200ml-

%, 500-5 mg/100ml-%,

750-5 mg/150ml-%

6

MSD

vancomycin hcl in nacl


0.9 gm/200ml-%, 500-

0.9 mg/100ml-%

6

MSD

Drug Name Drug

Category

Limits/

Required

pfizerpen solution

reconstituted 5000000

unit injection

6

MSD

PFIZERPEN

SOLUTION

RECONSTITUTED

5000000 UNIT

INJECTION

6

MSD

piperacillin sod-

tazobactam so 6 MSD

polymyxin b sulfate

injection 6 MSD

PRIMAXIN IV 6 MSD

PRIMSOL 3

SEYSARA 3

SILVADENE 3

silver nitrate external 1

silver sulfadiazine

external 1

SIVEXTRO

INTRAVENOUS 6 MSD; QL

SIVEXTRO ORAL 3 PA; QL

SOLODYN 2 ST

SPECTRACEF 3

ssd 1

streptomycin sulfate

intramuscular 6 MSD

sulfadiazine oral 1

sulfamethoxazole-

trimethoprim

intravenous

6

MSD

sulfamethoxazole-

trimethoprim oral 1

SULFAMYLON

EXTERNAL CREAM 2

SULFAMYLON

EXTERNAL PACKET 3

sulfatrim pediatric 1

SUPRAX 3

SYNERCID 6 MSD

TARGADOX 3 ST


24

Drug Name Drug

Category

Limits/

Required

XIFAXAN ORAL

TABLET 200 MG 2

XIFAXAN ORAL

TABLET 550 MG 2 M

XIMINO 3 ST

ZEMDRI 6 MSD

ZERBAXA 6 MSD

ZITHROMAX

INTRAVENOUS 6 MSD

ZITHROMAX ORAL 3

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3

ZOSYN

INTRAVENOUS

SOLUTION

RECONSTITUTED

6

MSD

ZYVOX

INTRAVENOUS 6 MSD

ZYVOX ORAL 3 PA; QL

Anticoagulants

acd formula a 2

acd-a noclot-50 2

ANGIOMAX 6 MSD

anticoagulant cit dext

soln a 2

anticoagulant sodium

citrate 3

argatroban 6 MSD

argatroban in sodium

chloride intravenous

solution 50 mg/50ml

6

MSD

ARIXTRA 3 QL

BEVYXXA 3 M; QL

bivalirudin

trifluoroacetate 6 MSD

BIVALIRUDIN-

SODIUM CHLORIDE 6 MSD

CATHFLO ACTIVASE 2

COUMADIN 3 M

DEFITELIO 6 MSD

ELIQUIS 2 PA; M; QL

Drug Name Drug

Category

Limits/

Required

VANCOMYCIN HCL IN

NACL INTRAVENOUS

SOLUTION 1-0.9

GM/250ML-%, 1.25-0.9

GM/250ML-%, 1.5-0.9

GM/250ML-%, 1.5-0.9

GM/300ML-%, 1.5-0.9

GM/500ML-%, 1.75-0.9

GM/250ML-%, 1.75-0.9

GM/500ML-%, 2-0.9

GM/500ML-%

6

MSD

VANCOMYCIN HCL IN

NACL SOLUTION 750-

0.9 MG/150ML-%

INTRAVENOUS

6

MSD

vancomycin hcl in nacl

solution 750-0.9

mg/150ml-%

intravenous

6

MSD

vancomycin hcl


1000 mg/200ml, 1500

mg/300ml, 2000

mg/400ml

6

MSD

VANCOMYCIN HCL

INTRAVENOUS

SOLUTION 1250

MG/12.5ML, 1500

MG/15ML, 1750

MG/17.5ML, 2000

MG/20ML

6

MSD

vancomycin hcl


reconstituted 1 gm,

1.25 gm, 1.5 gm, 10

gm, 100 gm, 250 mg, 5

gm, 500 mg, 750 mg

6

MSD

vancomycin hcl oral 1

VANCOMYCIN+SYRS

PEND SF 3

vandazole 1

VIBATIV 6 MSD

VIBRAMYCIN 3 ST

XEPI 3 PA

XERAVA 6 MSD


25

Drug Name Drug

Category

Limits/

Required

SODIUM CITRATE

LOCK FLUSH 6 MSD

SODIUM CITRATE-

GENTAMICIN SULF 6 MSD

THROMBATE III

INTRAVENOUS

SOLUTION

RECONSTITUTED 500

UNIT

6

MSD

TRICITRASOL 2

warfarin sodium oral 1 M

XARELTO 2 PA; M; QL

XARELTO STARTER

PACK 2 PA; QL

Anticonvulsants -

Drugs for Seizures

APTIOM 3 M

BANZEL 2 M

BRIVIACT


BRIVIACT ORAL 3 ST; M

carbamazepine er 1 M

carbamazepine oral 1 M

CARBATROL 3 M

CELONTIN 2 M

CEREBYX 6 MSD

clobazam 1 M

DEPACON 6 MSD

DEPAKENE 3 ST; M

DEPAKOTE 3 ST; M

DEPAKOTE ER 3 ST; M

DEPAKOTE

SPRINKLES 3 ST; M

DIACOMIT 3 M

DIASTAT ACUDIAL 3 QL

DIASTAT PEDIATRIC 3 QL

diazepam rectal 1 QL

DILANTIN INFATABS 3 M

DILANTIN ORAL

CAPSULE 100 MG 3 M

Drug Name Drug

Category

Limits/

Required

ELIQUIS STARTER

PACK 2 PA; M; QL

enoxaparin sodium

injection 6 MSD; QL

enoxaparin sodium

subcutaneous 1 QL

fondaparinux sodium 1 QL

FRAGMIN 2 QL

heparin (porcine) in

nacl injection solution

100-0.45 unit/ml-%

6

MSD

heparin (porcine) in

nacl intravenous

solution 12500-0.45

ut/250ml-%, 25000-

0.45 ut/250ml-%,

25000-0.45 ut/500ml-%

6

MSD

HEPARIN (PORCINE)

IN NACL

INTRAVENOUS

SOLUTION 30000-0.9

UNIT/L-%, 5000-0.9

UNIT/L-%, 5000-0.9

UT/500ML-%

6

MSD

heparin sod (porcine) in

d5w 6 MSD

heparin sodium

(porcine) 1

heparin sodium

(porcine) pf 1

jantoven 1 M

LOVENOX INJECTION 6 ST; MSD; QL

LOVENOX

SUBCUTANEOUS 3 ST; QL

PRADAXA 3 PA; M; QL

RETAVASE 6 MSD

RETAVASE HALF-KIT 6 MSD

SAVAYSA 3 M; QL

SODIUM CITRATE IN

VITRO 6 MSD

SODIUM CITRATE

INTRAVENOUS 6 MSD


26

Drug Name Drug

Category

Limits/

Required

lamotrigine starter kit-

orange 1

levetiracetam er 1 M

levetiracetam in nacl 6 MSD

levetiracetam

intravenous 6 MSD

levetiracetam oral 1 M

MYSOLINE 3 M

NEMBUTAL 6 MSD

NEURONTIN 3 ST; M

ONFI 3 M

oxcarbazepine 1 M

OXTELLAR XR 3 ST; M

PEGANONE 2 M

pentobarbital sodium

injection 6 MSD

phenobarbital oral 1 M

phenobarbital sodium

injection 1

PHENYTEK 3 M

phenytoin infatabs 1 M

phenytoin oral 1 M

phenytoin sodium

extended 1 M

phenytoin sodium

injection 6 MSD

primidone oral 1 M

QUDEXY XR 2 ST; M

roweepra 1 M

roweepra xr 1 M

SABRIL 3 PA; M; S

SPRITAM 3 ST; M

subvenite 1 M

subvenite starter kit-

blue 1


green 1


orange 1

SYMPAZAN 3 M

Drug Name Drug

Category

Limits/

Required

DILANTIN ORAL

CAPSULE 30 MG 2 M

DILANTIN ORAL

SUSPENSION 3 M

divalproex sodium er 1 M

divalproex sodium oral 1 M

EPIDIOLEX 3 PA; M; S

epitol 1 M

EQUETRO 3 M

ethosuximide oral 1 M

FANATREX FUSEPAQ 3

felbamate 1 M

FELBATOL 3 M

fosphenytoin sodium 6 MSD

FYCOMPA 2 M

gabapentin oral 1 M

GABITRIL 3 M

KEPPRA


KEPPRA ORAL 3 ST; M

KEPPRA XR 3 ST; M

LAMICTAL 3 ST; M

LAMICTAL ODT ORAL

KIT 3 ST

LAMICTAL ODT ORAL

TABLET

DISPERSIBLE

3

ST; M

LAMICTAL STARTER 3 ST

LAMICTAL XR ORAL

KIT 3 ST

LAMICTAL XR ORAL

TABLET EXTENDED

RELEASE 24 HOUR

3

ST; M

lamotrigine er 1 M

lamotrigine oral 1 M


blue 1


green 1


27

Drug Name Drug

Category

Limits/

Required

memantine hcl oral

tablet 10 mg, 5 mg 1 M

memantine hcl oral

tablet 28 x 5 mg & 21 x

10 mg

3

NAMENDA 3 ST; M

NAMENDA TITRATION

PAK 3 ST

NAMENDA XR 3 ST; M; QL

NAMENDA XR

TITRATION PACK 3 ST; QL

NAMZARIC ORAL

CAPSULE ER 24

HOUR THERAPY

PACK

2

ST; QL

NAMZARIC ORAL

CAPSULE EXTENDED

RELEASE 24 HOUR

2

ST; M; QL

RAZADYNE ER 3 ST; M; QL

RAZADYNE ORAL

TABLET 12 MG 3 ST; M

RAZADYNE ORAL

TABLET 4 MG, 8 MG 3 ST; M; QL

rivastigmine 1 M; QL

rivastigmine tartrate 1 M; QL

Antidepressants

amitriptyline hcl oral 1 M

amoxapine 1 M

ANAFRANIL 3 M

APLENZIN 3 ST; M; QL

BRISDELLE 3 ST; M; QL

bupropion hcl er (sr) 1 M; QL

bupropion hcl er (xl)

oral tablet extended

release 24 hour 150

mg, 300 mg

1

M; QL

BUPROPION HCL ER

(XL) ORAL TABLET

EXTENDED RELEASE

24 HOUR 450 MG

3

ST; M; QL

bupropion hcl oral 1 M

CELEXA 3 ST; M; QL

Drug Name Drug

Category

Limits/

Required

TEGRETOL 3 M

TEGRETOL-XR 3 M

tiagabine hcl 1 M

TOPAMAX 3 ST; M

TOPAMAX SPRINKLE 3 ST; M

topiramate er 3 M

topiramate oral 1 M

TRILEPTAL 3 ST; M

TROKENDI XR 3 ST; M

valproate sodium

intravenous 6 MSD

valproic acid oral 1 M

vigabatrin 1 PA; M; S

vigadrone 1 PA; M; S

VIMPAT

INTRAVENOUS 6 MSD

VIMPAT ORAL 2 M

ZARONTIN 3 M

ZONEGRAN 3 ST; M

zonisamide oral 1 M

Antidementia Agents

- Drugs for

Alzheimer's Disease

and Dementia

ARICEPT 3 ST; M

donepezil hcl 1 M

EXELON 3 ST; M; QL

galantamine

hydrobromide er 1 M; QL

galantamine

hydrobromide oral

solution

1

M; QL

galantamine

hydrobromide oral

tablet 12 mg

1

M

galantamine

hydrobromide oral

tablet 4 mg, 8 mg

1

M; QL

memantine hcl er 1 M; QL

memantine hcl oral

solution 1 M


28

Drug Name Drug

Category

Limits/

Required

fluoxetine hcl oral tablet

10 mg 1 M; QL

fluoxetine hcl oral tablet

20 mg, 60 mg 1 M

fluvoxamine maleate 1 M

fluvoxamine maleate er 1 M; QL

FORFIVO XL 3 ST; M; QL

imipramine hcl oral 1 M

imipramine pamoate 1 M

KHEDEZLA 3 ST; M; QL

LEXAPRO 3 ST; M; QL

maprotiline hcl 1 M

MARPLAN 3 M

mirtazapine oral 1 M; QL

NARDIL 3 M

nefazodone hcl 1 M

NORPRAMIN 3 M

nortriptyline hcl oral

capsule 1 M

nortriptyline hcl oral

solution 6 M; MSD

olanzapine-fluoxetine

hcl 1 M; QL

PAMELOR 3 M

PARNATE 3 M

paroxetine hcl 1 M; QL

paroxetine hcl er 1 M; QL

paroxetine mesylate 1 M; QL

PAXIL CR 3 ST; M; QL

PAXIL ORAL

SUSPENSION 3 ST; M

PAXIL ORAL TABLET 3 ST; M; QL

perphenazine-

amitriptyline 1 M

PEXEVA 3 ST; M; QL

phenelzine sulfate oral 1 M

PRISTIQ 3 ST; M; QL

protriptyline hcl 1 M

Drug Name Drug

Category

Limits/

Required

chlordiazepoxide-

amitriptyline 1 M

citalopram

hydrobromide oral

solution

1

M

citalopram

hydrobromide oral

tablet

1

M; QL

clomipramine hcl oral 1 M

CYMBALTA 3 ST; M; QL

desipramine hcl oral 1 M

DESVENLAFAXINE

ER 3 ST; M; QL

desvenlafaxine

succinate er 1 M; QL

doxepin hcl oral 1 M

duloxetine hcl oral 1 M; QL

EFFEXOR XR 3 ST; M; QL

EMSAM 3 M; QL

escitalopram oxalate

oral solution 1 M

escitalopram oxalate

oral tablet 1 M; QL

FETZIMA 2 ST; M; QL

FETZIMA TITRATION 2 ST; QL

fluoxetine hcl (pmdd)

oral capsule 10 mg 1 M; QL


oral capsule 20 mg 1 M


oral tablet 10 mg 1 M; QL


oral tablet 20 mg 1 M

fluoxetine hcl oral

capsule 10 mg, 40 mg 1 M; QL

fluoxetine hcl oral

capsule 20 mg 1 M

fluoxetine hcl oral

capsule delayed

release

1

M; QL

fluoxetine hcl oral

solution 1 M


29

Drug Name Drug

Category

Limits/

Required

ANZEMET 3 QL

aprepitant 1 QL

BONJESTA 3 QL

CINVANTI 6 MSD

compro 1

DICLEGIS 3 QL

dimenhydrinate

injection 1

doxylamine-pyridoxine 1 QL

dronabinol 1 QL

droperidol injection 1

EMEND

INTRAVENOUS 6 MSD

EMEND ORAL 3 QL

EMEND TRI-PACK 3 QL

granisetron hcl

intravenous 6 MSD

granisetron hcl oral 1 QL

MARINOL 3 QL

meclizine hcl oral tablet 1

metoclopramide hcl

injection 6 MSD

metoclopramide hcl

oral 1

ondansetron hcl


mg/20ml

6

MSD

ondansetron hcl oral 1 QL

ONDANSETRON HCL

SOLUTION 4 MG/2ML

INJECTION

3

ondansetron hcl

solution 4 mg/2ml

injection

6

MSD

ondansetron odt 1 QL

palonosetron hcl 6 MSD

perphenazine oral 1 M

prochlorperazine 1

prochlorperazine

edisylate injection 6 MSD

Drug Name Drug

Category

Limits/

Required

PROZAC ORAL

CAPSULE 10 MG, 40

MG

3

ST; M; QL

PROZAC ORAL

CAPSULE 20 MG 3 ST; M

REMERON 3 M; QL

REMERON SOLTAB 3 M; QL

SARAFEM ORAL

TABLET 10 MG 3 ST; M; QL

SARAFEM ORAL

TABLET 20 MG 3 ST; M

sertraline hcl oral

concentrate 1 M

sertraline hcl oral tablet 1 M; QL

SPRAVATO (56 MG

DOSE) 4 M; S

SPRAVATO (84 MG

DOSE) 4 M; S

SYMBYAX 3 M; QL

TOFRANIL 3 M

tranylcypromine sulfate 1 M

trazodone hcl oral 1 M

trimipramine maleate

oral 1 M

TRINTELLIX 3 ST; M; QL

venlafaxine hcl 1 M; QL

venlafaxine hcl er 1 M; QL

VIIBRYD 2 ST; M; QL

VIIBRYD STARTER

PACK 2 ST; QL

WELLBUTRIN SR 3 ST; M; QL

WELLBUTRIN XL 3 ST; M; QL

ZOLOFT 3 ST; M; QL

ZULRESSO 6 MSD

Antiemetics - Drugs

for Nausea and

Vomiting

AKYNZEO

INTRAVENOUS 6 MSD

AKYNZEO ORAL 2 QL

ALOXI 6 MSD


30

Drug Name Drug

Category

Limits/

Required

clotrimazole powder 3

CLOTRIMAZOLE

POWDER 3

CRESEMBA

INTRAVENOUS 6 MSD

CRESEMBA ORAL 2

DIFLUCAN ORAL

SUSPENSION

RECONSTITUTED

3

DIFLUCAN ORAL

TABLET 100 MG, 200

MG, 50 MG

3

DIFLUCAN ORAL

TABLET 150 MG 3 QL

econazole nitrate

external 1

ECOZA 3

ERAXIS 6 MSD

ERTACZO 3

EXELDERM 3

exoderm external lotion 3

EXTINA 3

fluconazole in sodium

chloride 6 MSD

fluconazole oral

suspension

reconstituted

1

fluconazole oral tablet

100 mg, 200 mg, 50 mg 1

fluconazole oral tablet

150 mg 1 QL

flucytosine oral 1

griseofulvin microsize

oral 1

griseofulvin

ultramicrosize 1

GYNAZOLE-1 3

itraconazole oral

capsule 1 QL

itraconazole oral

solution 1

JUBLIA 3 ST; QL

Drug Name Drug

Category

Limits/

Required

prochlorperazine

maleate oral 1 M

REGLAN 3

SANCUSO 2 QL

scopolamine 1

SUSTOL 6 MSD; QL

SYNDROS 3 QL

TIGAN

INTRAMUSCULAR 6 MSD

TIGAN ORAL 3

TRANSDERM SCOP

(1.5 MG) 3

TRANSDERM-SCOP

(1.5 MG) 3

trimethobenzamide hcl

oral 1

VARUBI 2 QL

ZOFRAN 3 QL

ZUPLENZ 3 QL

Antifungals

ABELCET 6 MSD

AMBISOME 6 MSD

amphotericin b

intravenous 6 MSD

ANCOBON 3

AVC VAGINAL 3

BIO-STATIN ORAL

CAPSULE 3

bio-statin oral powder 1

CANCIDAS 6 MSD

caspofungin acetate 6 MSD

ciclodan 1

CICLODAN SOLUTION 3 ST

ciclopirox 1

ciclopirox olamine

external 1

clotrimazole crystals 3

clotrimazole external 1

clotrimazole

mouth/throat 1


31

Drug Name Drug

Category

Limits/

Required

RECURA 3

SPORANOX ORAL

CAPSULE 3 QL

SPORANOX ORAL

SOLUTION 3

SPORANOX

PULSEPAK 3 QL

terbinafine hcl oral 1 QL

terconazole 1 QL

TOLSURA 3 ST

VFEND 3

VFEND IV 6 MSD

voriconazole

intravenous 6 MSD

voriconazole oral 1

VUSION 3

XOLEGEL 3

XOLEGEL COREPAK 3

XOLEGEL DUO/HEAD

& SHOULDERS 3

XOLEGEL

DUO/XOLEX 3

Antigout Agents

allopurinol oral 1 M

allopurinol sodium 6 MSD

ALOPRIM 6 MSD

COLCHICINE ORAL 3 ST

colchicine-probenecid 1 M

COLCRYS 2 ST

febuxostat 1 ST; M

KRYSTEXXA 6 MSD

MITIGARE 2 ST

probenecid 1 M

ULORIC 2 ST; M

ZYLOPRIM 3 M

Anti-inflammatory

Agents

EMFLAZA 3 PA; S

Drug Name Drug

Category

Limits/

Required

KERYDIN 3 ST; QL

ketoconazole external 1

ketoconazole oral 1

LOPROX EXTERNAL

CREAM 3

LOPROX EXTERNAL

KIT 0.77 % (SUSP) 3

LOPROX EXTERNAL

SHAMPOO 3

LOPROX EXTERNAL

SUSPENSION 3

LULICONAZOLE 3 QL

LUZU 3 QL

MENTAX 3

miconazole 3 vaginal

suppository 1 QL

MICONAZOLE-ZINC

OXIDE-PETROLAT 3

MYCAMINE 6 MSD

naftifine hcl 1

NAFTIN 3

NIZORAL 3

NOXAFIL

INTRAVENOUS 6 M; MSD

NOXAFIL ORAL 2 M

nyamyc 6 MSD

nystatin external cream 1

nystatin external

ointment 1

nystatin external

powder 6 MSD

nystatin mouth/throat 1

nystatin oral 1

nystatin-triamcinolone 1

nystop 6 MSD

ORAVIG 3

oxiconazole nitrate 1

OXISTAT 3

PENLAC 3 ST

posaconazole 1 M


32

Drug Name Drug

Category

Limits/

Required

sumatriptan-naproxen

sodium 1 QL

TREXIMET 3 ST; QL

ZEMBRACE

SYMTOUCH 3 ST; QL

zolmitriptan oral 1 QL

ZOMIG NASAL 2 ST; QL

ZOMIG ORAL 3 ST; QL

ZOMIG ZMT 3 ST; QL

Antimyasthenic

Agents

BLOXIVERZ 6 MSD

GUANIDINE HCL 1

MESTINON ORAL

SYRUP 60 MG/5ML 2

MESTINON ORAL

TABLET 3

MESTINON ORAL

TABLET EXTENDED

RELEASE

3

neostigmine

methylsulfate

intravenous solution 10

mg/10ml, 5 mg/10ml

6

MSD

NEOSTIGMINE

METHYLSULFATE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

MSD

pyridostigmine bromide

er 1

pyridostigmine bromide

oral 1

regonol solution 10

mg/2ml intravenous 6 MSD

REGONOL SOLUTION

10 MG/2ML

INTRAVENOUS

6

MSD

Antimycobacterials

CAPASTAT SULFATE 6 MSD

cycloserine oral 3

dapsone oral 1 M

Drug Name Drug

Category

Limits/

Required

Antimigraine Agents

AIMOVIG 2 PA; M

AJOVY 2 PA; M

almotriptan malate 1 QL

AMERGE 3 ST; QL

CAFERGOT 3

D.H.E. 45 3

dihydroergotamine

mesylate injection 1

dihydroergotamine

mesylate nasal 1 QL

eletriptan hydrobromide 1 QL

EMGALITY 2 PA; M

EMGALITY (300 MG

DOSE) 2 PA; M

ERGOMAR 3

ergotamine-caffeine 1

FROVA 3 ST; QL

frovatriptan succinate 1 QL

IMITREX 3 ST; QL

IMITREX STATDOSE

REFILL 3 ST; QL

IMITREX STATDOSE

SYSTEM 3 ST; QL

MAXALT 3 ST; QL

MAXALT-MLT 3 ST; QL

MIGERGOT 1

MIGRANAL 3 QL

naratriptan hcl 1 QL

ONZETRA XSAIL 3 ST; QL

RELPAX 3 ST; QL

rizatriptan benzoate 1 QL

sumatriptan nasal 1 QL

sumatriptan succinate

oral 1 QL


refill 1 QL


subcutaneous 1 QL


33

Drug Name Drug

Category

Limits/

Required

ARRANON 6 MSD

arsenic trioxide


mg/10ml

6

MSD

ARZERRA 6 MSD

AVASTIN 6 MSD

azacitidine 6 MSD

AZEDRA

DOSIMETRIC 6 MSD

AZEDRA

THERAPEUTIC 6 MSD

BALVERSA 3

BAVENCIO 6 PA; MSD

BELEODAQ 6 MSD

BELRAPZO 6 MSD

BENDAMUSTINE HCL 6 MSD

BENDEKA 6 MSD

BESPONSA 6 MSD

bexarotene 1 S

bicalutamide 1

BICNU 6 MSD

bleomycin sulfate 6 MSD

BLINCYTO 6 MSD

BORTEZOMIB 6 MSD

BOSULIF 3 S

BRAFTOVI 3 PA; S

busulfan 6 MSD

BUSULFEX 6 MSD

CABOMETYX 3 S; QL

CALQUENCE 3 S

CAMPATH 6 MSD

CAMPTOSAR 6 MSD

capecitabine 1 S

CAPRELSA 3 S; QL

carboplatin 6 MSD

carmustine 6 MSD

CASODEX 3

cisplatin intravenous

solution 6 MSD

Drug Name Drug

Category

Limits/

Required

ethambutol hcl oral 1

isoniazid injection 6 MSD

isoniazid oral 1 M

MYAMBUTOL 3

MYCOBUTIN 3

PASER 3

PRIFTIN 2

pyrazinamide oral 1

rifabutin 1

RIFADIN

INTRAVENOUS 6 MSD

RIFADIN ORAL 3

RIFAMATE 3

rifampin intravenous 6 MSD

rifampin oral 1

RIFAMPIN+SYRSPEN

D SF 3

RIFATER 3

SIRTURO 3 S

TRECATOR 3

Antineoplastics -

Drugs for Cancer

abiraterone acetate 1 PA; S; QL

ABRAXANE 6 MSD

ADCETRIS 6 MSD

adriamycin 6 MSD

adrucil 6 MSD

AFINITOR 3 S; QL

AFINITOR DISPERZ 3 S; QL

ALECENSA 3 S

ALIQOPA 6 MSD

ALKERAN

INTRAVENOUS 6 MSD

ALKERAN ORAL 3

ALUNBRIG 4 PA; S; QL

anastrozole oral 1 M

ARIMIDEX 3 ST; M

AROMASIN 3 M


34

Drug Name Drug

Category

Limits/

Required

ELLENCE 6 MSD

ELZONRIS 6 MSD

EMCYT 3 S

EMPLICITI 6 MSD

epirubicin hcl 6 MSD

ERBITUX 6 MSD

ERIVEDGE 3 S

ERLEADA 3 PA; S

erlotinib hcl oral tablet

100 mg, 150 mg 1

erlotinib hcl oral tablet

25 mg 1 QL

ERWINAZE 6 MSD

ETHYOL 6 MSD

ETOPOPHOS 6 MSD

etoposide intravenous 6 MSD

etoposide oral 1 S

EVOMELA 6 MSD

exemestane 1 M

FARESTON 4 M; S

FARYDAK 4 S

FASLODEX 6 MSD

FEMARA 3 M

floxuridine injection 6 MSD

fludarabine phosphate 6 MSD

fluorouracil intravenous 6 MSD

flutamide 1

FOLOTYN 6 MSD

fulvestrant 6 MSD

FUSILEV 6 MSD

GAZYVA 6 MSD

gemcitabine hcl 6 MSD

GILOTRIF 3 S; QL

GLEEVEC 4 ST; S; QL

GLEOSTINE 3 S

GLIADEL WAFER 6 MSD

HALAVEN 6 MSD

HERCEPTIN 6 PA; MSD

Drug Name Drug

Category

Limits/

Required

CISPLATIN

INTRAVENOUS

SOLUTION

RECONSTITUTED

6

MSD

cladribine 6 MSD

clofarabine 6 MSD

CLOLAR 6 MSD

COMETRIQ (100 MG

DAILY DOSE) 3 S; QL

COMETRIQ (140 MG

DAILY DOSE) 3 S; QL

COMETRIQ (60 MG

DAILY DOSE) 3 S; QL

COPIKTRA 4 PA; S

COSMEGEN 6 MSD

COTELLIC 3 S

cyclophosphamide

injection 6 MSD

cyclophosphamide oral 1

CYRAMZA 6 MSD

cytarabine 6 MSD

cytarabine (pf) 6 MSD

dacarbazine 6 MSD

DACOGEN 6 MSD

dactinomycin 6 MSD

DARZALEX 6 MSD

daunorubicin hcl 6 MSD

DAURISMO 4 S

decitabine 6 MSD

dexrazoxane hcl 6 MSD

dexrazoxane


reconstituted 500 mg

6

MSD

docetaxel 6 MSD

DOXIL 6 MSD

doxorubicin hcl 6 MSD

doxorubicin hcl

liposomal 6 MSD

DROXIA 3 M; S

ELITEK 6 MSD


35

Drug Name Drug

Category

Limits/

Required

KISQALI (400 MG

DOSE) 4 PA; S

KISQALI (600 MG

DOSE) 4 PA; S

KISQALI FEMARA

(400 MG DOSE) 4 PA; S

KISQALI FEMARA

(600 MG DOSE) 4 PA; S

KISQALI FEMARA(200

MG DOSE) 4 PA; S

KYPROLIS 6 MSD

LARTRUVO 6 MSD

LENVIMA (10 MG

DAILY DOSE) 3 S

LENVIMA (12 MG

DAILY DOSE) 3 S

LENVIMA (14 MG

DAILY DOSE) 3 S

LENVIMA (18 MG

DAILY DOSE) 3 S

LENVIMA (20 MG

DAILY DOSE) 3 S

LENVIMA (24 MG

DAILY DOSE) 3 S

LENVIMA (4 MG

DAILY DOSE) 3 S

LENVIMA (8 MG

DAILY DOSE) 3 S

letrozole oral 1 M

leucovorin calcium

injection 6 MSD

leucovorin calcium oral 1

LEUKERAN 2

levoleucovorin calcium 6 MSD

levoleucovorin calcium

pf 6 MSD

LIBTAYO 6 MSD

LONSURF 3 S

LORBRENA 3 S

LUMOXITI 6 MSD

LUTATHERA 6 MSD

Drug Name Drug

Category

Limits/

Required

HERCEPTIN

HYLECTA 6 PA; MSD

HYCAMTIN

INTRAVENOUS 6 MSD

HYCAMTIN ORAL 3 S

HYDREA 3

hydroxyurea oral 1

IBRANCE 3 S

ICLUSIG ORAL

TABLET 15 MG 3 S; QL

ICLUSIG ORAL

TABLET 45 MG 3 S

IDAMYCIN PFS 6 MSD

idarubicin hcl 6 MSD

IDHIFA 3 PA; S; QL

IFEX 6 MSD

ifosfamide 6 MSD

imatinib mesylate 1 S; QL

IMBRUVICA 3 S

IMFINZI 6 MSD

IMLYGIC 6 MSD

INFUGEM 6 MSD

INLYTA 3 S; QL

IRESSA 3 S

irinotecan hcl 6 MSD

ISTODAX (OVERFILL) 6 MSD

IXEMPRA KIT 6 MSD

JAKAFI ORAL TABLET

10 MG 3 S; QL

JAKAFI ORAL TABLET

15 MG, 20 MG, 25 MG,

5 MG

3

S

JEVTANA 6 MSD

KADCYLA 6 MSD

KANJINTI 6 MSD

KEYTRUDA 6 MSD

KHAPZORY 6 MSD

KISQALI (200 MG

DOSE) 4 PA; S


36

Drug Name Drug Limits/

Category Required

PIQRAY (250 MG

DAILY DOSE)

PIQRAY (300 MG

3

3

TAGRISSO ORAL

TABLET 40 MG

TAGRISSO ORAL

TABLET 80 MG

TALZENNA

tamoxifen citrate oral

TARCEVA ORAL

TABLET 100 MG, 150

MG

TARCEVA ORAL

TABLET 25 MG

3 S; QL

3 S

3

5

PA; S

M; ACA

3 S

3 S; QL

DAILY DOSE)

POLIVY 6 MSD

POMALYST 3 S; QL

PORTRAZZA 6 MSD

POTELIGEO 6 MSD

PROLEUKIN 6 MSD

PURIXAN 3 S

QUADRAMET 6 MSD

REVLIMID 3 S

RITUXAN 6 PA; MSD

RITUXAN HYCELA 6 PA; MSD

ROMIDEPSIN 6 MSD

RUBRACA 3 PA; S

RYDAPT 3 PA; S

SIKLOS 4 ST; S

SOLTAMOX 5 M; ACA

SPRYCEL 3 S; QL

STIVARGA 3 S

SUTENT 3 S; QL

SYLATRON 3 PA; M; S; QL

SYLVANT 6 MSD

SYNRIBO 6 MSD

TABLOID 3 S

TAFINLAR 3 S

Drug Name Drug

Category

Limits/

Required

LYNPARZA 3 S

LYSODREN 3 S

MARQIBO 6 MSD

MATULANE 3 S

MEKINIST 3 S

MEKTOVI 4 PA; S

melphalan 1

melphalan hcl 6 MSD

mercaptopurine oral 1

mesna 6 MSD

MESNEX

INTRAVENOUS 6 MSD

MESNEX ORAL 2

mitomycin intravenous 6 MSD

MITOMYCIN

INTRAVESICAL 6 MSD

mitoxantrone hcl 6 MSD

mutamycin 6 MSD

MVASI 6 MSD

MYLERAN 3 S

MYLOTARG 6 MSD

NAVELBINE 6 MSD

NERLYNX 3 PA; S; QL

NEXAVAR 3 S; QL

NILANDRON 4 S

nilutamide 1 S

NINLARO 3 S

NIPENT 6 MSD

ODOMZO 4 S

ONCASPAR 6 MSD

ONIVYDE 6 MSD

OPDIVO 6 MSD

oxaliplatin 6 MSD

paclitaxel 6 MSD

PANRETIN 3

PERJETA 6 MSD

PIQRAY (200 MG

DAILY DOSE) 3


37

Drug Name Drug

Category

Limits/

Required

VIZIMPRO 3 PA; S

VORAXAZE 6 MSD

VOTRIENT 3 S; QL

VYXEOS 6 MSD

XALKORI 3 S; QL

XELODA 4 S

XOFIGO 6 MSD

XOSPATA 3 S

XTANDI 3 S; QL

YERVOY 6 MSD

YESCARTA 6 MSD

YONDELIS 6 MSD

YONSA 3 PA; S

ZALTRAP 6 MSD

ZANOSAR 6 MSD

ZEJULA 3 PA; S

ZELBORAF 3 S; QL

ZEVALIN Y-90 6 MSD

ZINECARD 6 MSD

ZOLINZA 3 S; QL

ZYDELIG 3 S

ZYKADIA ORAL

CAPSULE 3 S

ZYKADIA ORAL

TABLET 3

ZYTIGA 3 PA; S; QL

Antiparasitics

albendazole oral 1

ALBENZA 3

ALINIA 2

ARAKODA 3

atovaquone oral 1

atovaquone-proguanil

hcl 1

BENZNIDAZOLE 2

BILTRICIDE 3

chloroquine phosphate

oral 1 M

Drug Name Drug

Category

Limits/

Required

TARGRETIN

EXTERNAL 2

TARGRETIN ORAL 4 S

TASIGNA 3 S; QL

TAXOTERE 6 MSD

TECENTRIQ 6 MSD

TEMODAR

INTRAVENOUS 6 MSD

TEMODAR ORAL 4 S

temozolomide 1 S

teniposide 6 MSD

TEPADINA 6 MSD

THALOMID 3 M; S

thiotepa injection 6 MSD

TIBSOVO 3 PA; S

toposar 6 MSD

topotecan hcl 6 MSD

toremifene citrate 1 M; S

TOTECT 6 MSD

TREANDA 6 MSD

tretinoin oral 1 S

TRISENOX 6 MSD

TYKERB 3 S; QL

UNITUXIN 6 MSD

VALCHLOR 3 S

valrubicin 6 MSD

VALSTAR 6 MSD

VECTIBIX 6 MSD

VELCADE 6 MSD

VENCLEXTA 3 S

VENCLEXTA

STARTING PACK 3 S

VERZENIO 3 S

VIDAZA 6 MSD

vinblastine sulfate 6 MSD

vincristine sulfate 6 MSD

vinorelbine tartrate 6 MSD

VITRAKVI 3 S


38

Drug Name Drug

Category

Limits/

Required

benztropine mesylate

injection 6 MSD

benztropine mesylate

oral 1 M

bromocriptine mesylate

oral 1 M

carbidopa oral 1 M

carbidopa-levodopa 1 M

carbidopa-levodopa er 1 M

carbidopa-levodopa-

entacapone 1 M

COGENTIN 6 MSD

COMTAN 3 M

DUOPA 6 M; MSD

entacapone 1 M

GOCOVRI 3 PA; M; S

INBRIJA 3 M

LODOSYN 3 M

MIRAPEX 3 M

MIRAPEX ER 3 M

NEUPRO 3 M

NOURIANZ 3 M

OSMOLEX ER 3 ST; M

PARLODEL 3 M

pramipexole

dihydrochloride 1 M

pramipexole

dihydrochloride er 1 M

rasagiline mesylate oral 1 M

REQUIP XL 3 M

ropinirole hcl 1 M

ropinirole hcl er 1 M

RYTARY 3 M

selegiline hcl oral 1 M

SINEMET 3 M

SINEMET CR 3 M

STALEVO 100 3 M

STALEVO 125 3 M

STALEVO 150 3 M

Drug Name Drug

Category

Limits/

Required

COARTEM 2

crotan 1

DARAPRIM 3 PA; S

EGATEN 3

ELIMITE 3

EMVERM 2

EURAX 3

hydroxychloroquine

sulfate oral 1 M

IMPAVIDO 3 S

ivermectin oral 1

KRINTAFEL 3

lindane 1 QL

MALARONE 3

malathion 1

mefloquine hcl 1 M

MEPRON 3

NATROBA 3 QL

NEBUPENT 2 QL

OVIDE 3

PENTAM 6 MSD

pentamidine isethionate 6 MSD

permethrin external 1

PLAQUENIL 3 M

praziquantel oral 1

primaquine phosphate 2

QUALAQUIN 3

quinine sulfate oral 1

SKLICE 3

SOLOSEC 3

spinosad 1 QL

STROMECTOL 3

sulfurated lime 1

ULESFIA 3

Antiparkinson Agents

amantadine hcl oral 1 M

APOKYN 3 S; QL

AZILECT 3 M


39

Drug Name Drug

Category

Limits/

Required

ARISTADA 2 M

ARISTADA INITIO 2

chlorpromazine hcl

injection 1

chlorpromazine hcl oral 1 M

clozapine oral tablet 1 QL

clozapine oral tablet

dispersible 100 mg,

12.5 mg, 25 mg

1

QL

clozapine oral tablet

dispersible 150 mg,

200 mg

3

QL

CLOZARIL 3 QL

FANAPT 3 QL

FANAPT TITRATION

PACK 3 QL

FAZACLO 3 QL

fluphenazine

decanoate injection 6 MSD

fluphenazine hcl

injection 1

fluphenazine hcl oral 1 M

GEODON

INTRAMUSCULAR 3

GEODON ORAL 3 M; QL

HALDOL 6 MSD

HALDOL DECANOATE 3

haloperidol decanoate

intramuscular 1

haloperidol lactate

injection 6 MSD

haloperidol lactate oral 1 M

haloperidol oral 1 M

INVEGA 3 M; QL

INVEGA SUSTENNA 3

INVEGA TRINZA 3

LATUDA 2 M; QL

loxapine succinate 1 M

molindone hcl 1 M

NUPLAZID 4 M; S

Drug Name Drug

Category

Limits/

Required

STALEVO 200 3 M

STALEVO 50 3 M

STALEVO 75 3 M

TASMAR 3 M

tolcapone 1 M

trihexyphenidyl hcl oral

elixir 1 M

trihexyphenidyl hcl oral

tablet 1 M

XADAGO 3 ST; M; QL

ZELAPAR 3 M

Antiplatelets

AGGRASTAT 6 MSD

AGGRENOX 3 M

aspirin-dipyridamole er 1 M

BRILINTA 2 M

cilostazol 1 M

clopidogrel bisulfate

oral tablet 300 mg 1

clopidogrel bisulfate

oral tablet 75 mg 1 M

dipyridamole oral 1 M

DURLAZA 3 ST; M

EFFIENT 3 ST; M

eptifibatide 6 MSD

INTEGRILIN 6 MSD

KENGREAL 6 MSD

PLAVIX 3 ST; M

prasugrel hcl 1 M

REOPRO 6 MSD

ZONTIVITY 2 M

Antipsychotics -

Drugs for Mood

Disorders

ABILIFY 4 ST; M; S; QL

ABILIFY MAINTENA 2 M

ABILIFY MYCITE 3 M; S; QL

ADASUVE 3

aripiprazole 1 M; QL


40

Drug Name Drug

Category

Limits/

Required

adefovir dipivoxil 1 M

APTIVUS 3 M; QL

atazanavir sulfate 1 M

ATRIPLA 3 M; QL

BARACLUDE ORAL

SOLUTION 2 M; QL

BARACLUDE ORAL

TABLET 3 M; QL

BIKTARVY 3 M

cidofovir intravenous 6 MSD

CIMDUO 3 M

COMBIVIR 4 M; QL

COMPLERA 3 M; QL

CRIXIVAN 3 M; QL

DELSTRIGO 4 M

DENAVIR 3

DESCOVY 3 M

didanosine 1 M; QL

DOVATO 3 M

EDURANT 3 M; QL

efavirenz 1 M; QL

EMTRIVA 3 M; QL

entecavir 1 M; QL

EPCLUSA 3 PA; S; QL

EPIVIR 4 M; QL

EPIVIR HBV ORAL

SOLUTION 2 M

EPIVIR HBV ORAL

TABLET 3 M; QL

EPZICOM 4 M; QL

EVOTAZ 4 M; QL

famciclovir 1

FLUMADINE 3

fosamprenavir calcium 1 M; QL

FOSCAVIR 6 MSD

FUZEON 3 M; S; QL

GANCICLOVIR 6 MSD

ganciclovir sodium

intravenous solution 6 M; MSD

Drug Name Drug

Category

Limits/

Required

olanzapine oral 1 M; QL

paliperidone er 1 M; QL

PERSERIS 3 M

pimozide 1 M

quetiapine fumarate 1 M; QL

quetiapine fumarate er 1 M; QL

REXULTI 3 M; QL

RISPERDAL 3 M; QL

RISPERDAL CONSTA

INTRAMUSCULAR

SUSPENSION

RECONSTITUTED

12.5 MG, 25 MG, 37.5

MG, 50 MG

2

risperidone 1 M; QL

SAPHRIS 3 M; QL

SEROQUEL 3 ST; M; QL

SEROQUEL XR 3 ST; M; QL

thioridazine hcl oral 1 M

thiothixene 1 M

trifluoperazine hcl 1 M

VERSACLOZ 3 QL

VRAYLAR ORAL

CAPSULE 3 M; QL

VRAYLAR ORAL

CAPSULE THERAPY

PACK

3

QL

ziprasidone hcl 1 M; QL

ZYPREXA ORAL 3 M; QL

ZYPREXA RELPREVV 3

ZYPREXA ZYDIS 3 M; QL

Antivirals

abacavir sulfate 1 M; QL

abacavir sulfate-

lamivudine 1 M; QL

abacavir-lamivudine-

zidovudine 1 M; QL

acyclovir external 1 QL

acyclovir oral 1

acyclovir sodium 6 MSD


41

Drug Name Drug

Category

Limits/

Required

PEGINTRON 4 S; QL

PIFELTRO 4 M

PREVYMIS

INTRAVENOUS 6 MSD

PREVYMIS ORAL 2 M

PREZCOBIX 4 M

PREZISTA 3 M; QL

RELENZA DISKHALER 2 QL

RESCRIPTOR 3 M; QL

RETROVIR

INTRAVENOUS 6 MSD

RETROVIR ORAL 4 M; QL

REYATAZ ORAL

CAPSULE 4 M

REYATAZ ORAL

PACKET 3 M

ribasphere 1

ribasphere ribapak oral

tablet 400 mg, 600 mg 1

RIBASPHERE

RIBAPAK ORAL

TABLET THERAPY

PACK 200 & 400 MG,

400 & 600 MG

1

ribavirin inhalation 1 S

ribavirin oral 1

rimantadine hcl 1

ritonavir 1 M; QL

SELZENTRY ORAL

SOLUTION 3 M

SELZENTRY ORAL

TABLET 150 MG, 300

MG

3

M; QL

SELZENTRY ORAL

TABLET 25 MG, 75

MG

3

M

SITAVIG 3 QL

SOVALDI 4 PA; S; QL

stavudine 1 M; QL

STRIBILD 3 M; QL

SUSTIVA 4 M; QL

Drug Name Drug

Category

Limits/

Required

ganciclovir sodium


reconstituted

6

MSD

GENVOYA 3 M

HARVONI 3 PA; S; QL

HEPSERA 3 M

INTELENCE 3 M; QL

INTRON A 3 M; S

INVIRASE 3 M; QL

ISENTRESS 3 M; QL

ISENTRESS HD 3 M

JULUCA 4 M

KALETRA ORAL

SOLUTION 4 M; QL

KALETRA ORAL

TABLET 3 M; QL

lamivudine oral solution 1 M; QL

lamivudine oral tablet

100 mg 1 M; QL

lamivudine oral tablet

150 mg, 300 mg 1 M; QL

lamivudine-zidovudine 1 M; QL

LEXIVA ORAL

SUSPENSION 3 M; QL

LEXIVA ORAL TABLET 4 M; QL

lopinavir-ritonavir 1 M; QL

MAVYRET 4 PA; S; QL

nevirapine 1 M; QL

nevirapine er 1 M; QL

NORVIR ORAL

PACKET 3 M

NORVIR ORAL

SOLUTION 3 M; QL

NORVIR ORAL

TABLET 4 M; QL

ODEFSEY 3 M

oseltamivir phosphate

oral 1 QL

PEGASYS 3 S; QL

PEGASYS PROCLICK 3 S; QL


42

Drug Name Drug

Category

Limits/

Required

ZIAGEN 4 M; QL

zidovudine 1 M; QL

ZOVIRAX EXTERNAL

CREAM 2 QL

ZOVIRAX EXTERNAL

OINTMENT 3 QL

ZOVIRAX ORAL 3

Anxiolytics - Drugs

for Anxiety

alprazolam er 1 QL

ALPRAZOLAM

INTENSOL 1 QL

alprazolam oral 1 QL

alprazolam xr 1 QL

ATIVAN INJECTION 6 MSD

ATIVAN ORAL 3 QL

buspirone hcl oral 1

chlordiazepoxide hcl 1 QL

clonazepam oral 1 QL

clorazepate

dipotassium 1 QL

diazepam intensol 1

diazepam

intramuscular 6 MSD

diazepam oral 1

diazepam solution 5

mg/ml injection 6 MSD

DIAZEPAM SOLUTION

5 MG/ML INJECTION 6 MSD

DORAL 3 QL

estazolam 1 QL

HALCION 3 QL

hydroxyzine hcl

intramuscular 6 MSD

hydroxyzine hcl oral 1

hydroxyzine pamoate

oral 1

KLONOPIN 3 QL

lorazepam injection 6 MSD

lorazepam intensol 1 QL

Drug Name Drug

Category

Limits/

Required

SYMFI 3 M

SYMFI LO 3 M

SYMTUZA 4 M

TAMIFLU 3 QL

TEMIXYS 3 M

tenofovir disoproxil

fumarate 1 M; QL

TIVICAY ORAL

TABLET 10 MG, 25

MG

3

M

TIVICAY ORAL

TABLET 50 MG 3 M; QL

TRIUMEQ 3 M; QL

TRIZIVIR 4 M; QL

TROGARZO 6 M; MSD

TRUVADA ORAL

TABLET 100-150 MG,

133-200 MG, 167-250

MG

3

M

TRUVADA ORAL

TABLET 200-300 MG 3 M; QL

TYBOST 4 M; QL

valacyclovir hcl oral 1 QL

VALCYTE 3 M

valganciclovir hcl 1 M

VALTREX 3 ST; QL

VEMLIDY 2 M

VIDEX 3 M; QL

VIDEX EC 4 M; QL

VIEKIRA PAK 4 PA; S; QL

VIRACEPT 3 M; QL

VIRAMUNE 4 M; QL

VIRAMUNE XR 4 M; QL

VIRAZOLE 4 S

VIREAD 3 M; QL

VOSEVI 3 PA; S

XERESE 3 ST; QL

XOFLUZA 2 QL

ZEPATIER 3 PA; S; QL


43

Drug Name Drug

Category

Limits/

Required

ARANESP (ALBUMIN

FREE) 6 MSD

BENEFIX 6 MSD

CEPROTIN 6 MSD

COAGADEX 6 MSD

CORIFACT 6 MSD

CYKLOKAPRON 6 MSD

DOPTELET 3 PA; S

ELOCTATE 6 MSD

EPOGEN 6 PA; MSD

FEIBA 6 MSD

FIBRYGA 6 MSD

FULPHILA 6 PA; MSD; QL

GRANIX 6 MSD

HEMLIBRA 6 M; MSD

hemofil m intravenous


1000 unit, 250 unit, 500

unit

6

MSD

HEMOFIL M

INTRAVENOUS

SOLUTION

RECONSTITUTED

1700 UNIT

6

MSD

HESPAN 6 MSD

hetastarch-nacl 6 MSD

HUMATE-P 6 MSD

IDELVION 6 MSD

IXINITY 6 MSD

JIVI 6 MSD

KCENTRA

INTRAVENOUS KIT

500 UNIT

6

MSD

KOATE 6 MSD

KOATE-DVI

INTRAVENOUS

SOLUTION

RECONSTITUTED

1000 UNIT, 500 UNIT

6

MSD

Drug Name Drug

Category

Limits/

Required

lorazepam oral 1 QL

meprobamate 1

midazolam hcl injection 6 MSD

MIDAZOLAM HCL-


MIDAZOLAM-SODIUM

CHLORIDE 6 MSD

oxazepam 1 QL

quazepam 1 QL

TRANXENE-T 3 QL

triazolam 1 QL

VALIUM 3 ST

VISTARIL 3

XANAX 3 ST; QL

XANAX XR 3 ST; QL

Bipolar Agents -

Drugs for Mood

Disorders

lithium 1 M

lithium carbonate er 1 M

lithium carbonate oral 1 M

LITHOBID 3 M

Blood Products /

Modifiers / Volume

Expanders - Drugs for

Bleeding Disorders

ADVATE 6 MSD

ADYNOVATE 6 MSD

AFSTYLA 6 MSD

AGRYLIN 3 M

ALPHANATE/VWF

COMPLEX/HUMAN 6 MSD

ALPHANINE SD 6 MSD

ALPROLIX 6 MSD

AMICAR 3

aminocaproic acid

intravenous 6 MSD

aminocaproic acid oral 1

anagrelide hcl 1 M


44

Drug Name Drug

Category

Limits/

Required

protamine sulfate

intravenous 6 MSD

REBINYN 6 MSD

RECOMBINATE 6 MSD

RECOTHROM 6 MSD

RECOTHROM SPRAY

KIT 6 MSD

RETACRIT 6 MSD

RIASTAP 6 MSD

RIXUBIS 6 MSD

SOLIRIS 6 MSD

TAVALISSE 3 PA; M; S

THROMBIN-JMI 3

THROMBIN-JMI

EPISTAXIS 3

THROMBOGEN 3

tranexamic acid

intravenous 6 MSD

tranexamic acid oral 1

TRETTEN 6 MSD

UDENYCA 6 PA; MSD; QL

ULTOMIRIS 6 MSD

VOLUVEN 6 MSD

VONVENDI 6 MSD

WILATE 6 MSD

XYNTHA 6 MSD

XYNTHA SOLOFUSE 6 MSD

ZARXIO 6 MSD

Cardiovascular

Agents - Drugs for

Heart and Circulation

Conditions

ABLYSINOL 6 MSD

ACCUPRIL 3 M

ACCURETIC 3 ST; M

acebutolol hcl oral 1 M

acetazolamide oral

tablet 125 mg 1 M

acetazolamide sodium 6 MSD

Drug Name Drug

Category

Limits/

Required

koate-dvi intravenous


250 unit

6

MSD

KOGENATE FS 6 MSD

KOVALTRY 6 MSD

LEUKINE

INTRAVENOUS

SOLUTION

RECONSTITUTED 250

MCG

6

MSD

lmd in d5w solution 10-

5 % intravenous 6 MSD

LMD IN D5W

SOLUTION 10-5 %

INTRAVENOUS

6

MSD

lmd in nacl solution 10-

0.9 % intravenous 6 MSD

LMD IN NACL

SOLUTION 10-0.9 %

INTRAVENOUS

6

MSD

LYSTEDA 3

MIRCERA 6 MSD

MONONINE 6 MSD

MONSELS FERRIC

SUBSULFATE 2

MOZOBIL 6 MSD; QL

MULPLETA 3 PA; S

NEULASTA 6 PA; MSD; QL

NEULASTA ONPRO 6 PA; MSD; QL

NEUPOGEN 6 PA; MSD

NIVESTYM 6 MSD

NOVOEIGHT 6 MSD

NOVOSEVEN RT 6 MSD

NPLATE 6 MSD

NUWIQ 6 MSD

OBIZUR 6 MSD

PANHEMATIN 6 MSD

PROCRIT 6 PA; MSD

PROFILNINE 6 MSD

PROFILNINE SD 6 MSD

PROMACTA 2 PA; M


45

Drug Name Drug

Category

Limits/

Required

atorvastatin calcium

oral tablet 10 mg, 20

mg

5

M; ACA; QL

atorvastatin calcium


mg

1

M; QL

AVALIDE 3 ST; M

AVAPRO 3 ST; M

AZOR 3 ST; M

benazepril hcl oral 1 M

benazepril-

hydrochlorothiazide 1 M

BENICAR 3 ST; M

BENICAR HCT 3 ST; M

BETAPACE 3 ST; M

BETAPACE AF 3 ST; M

betaxolol hcl oral 1 M

BIDIL 3 M

bisoprolol fumarate 1 M

bisoprolol-


BREVIBLOC IN NACL 6 ST; MSD

BREVIBLOC

PREMIXED 6 ST; MSD

BREVIBLOC

PREMIXED DS 6 ST; MSD

bumetanide injection 6 MSD

bumetanide oral 1 M

BUMEX 3 M

BYSTOLIC 2 ST; M

CADUET 3 ST; M; QL

CALAN 3 ST; M

CALAN SR 3 ST; M

candesartan cilexetil 1 M

candesartan cilexetil-

hctz 1 M

captopril oral 1 M

captopril-


CARDENE IV 6 ST; MSD

Drug Name Drug

Category

Limits/

Required

ADALAT CC 3 ST; M

ADENOCARD 6 MSD

adenosine intravenous

solution 12 mg/4ml, 6

mg/2ml

6

MSD

AKOVAZ 6 MSD

ALDACTAZIDE 3 M

ALDACTONE 3 M

aliskiren fumarate 1 M

alprostadil injection 6 MSD

ALTACE 3 M

ALTOPREV 3 ST; M; QL

amiloride hcl oral 1 M

amiloride-


AMIODARONE HCL IN

DEXTROSE 6 MSD

amiodarone hcl

intravenous 6 MSD

amiodarone hcl oral 1 M

AMLODIPINE

BES+SYRSPEND SF 3 ST; M

amlodipine besylate

oral 1 M

amlodipine besylate-

benazepril hcl 1 M

amlodipine besylate-

valsartan 1 M

amlodipine-atorvastatin 1 M; QL

amlodipine-olmesartan 1 M

amlodipine-valsartan-

hctz 1 M

ANTARA 3 ST; M; QL

ASCLERA 6 MSD

ATACAND 3 ST; M

ATACAND HCT 3 ST; M

atenolol oral 1 M

ATENOLOL+SYRSPE

ND SF 3 ST; M

atenolol-chlorthalidone 1 M


46

Drug Name Drug

Category

Limits/

Required

digoxin injection 6 MSD

digoxin oral 1 M

DILATRATE-SR 2 M

diltiazem hcl er beads 1 M

diltiazem hcl er coated

beads 1 M

diltiazem hcl er oral

capsule extended

release 12 hour

1

M

diltiazem hcl er oral

capsule extended

release 24 hour 180

mg, 240 mg

1

M

diltiazem hcl

intravenous 6 MSD

diltiazem hcl oral 1 M

DILTIAZEM HCL-

DEXTROSE 6 ST; MSD

DILTIAZEM HCL-

SODIUM CHLORIDE 6 ST; MSD

dilt-xr 1 M

DIOVAN 3 ST; M

DIOVAN HCT 3 ST; M

disopyramide

phosphate 1 M

DIURIL 3 M

dobutamine hcl 6 MSD

dofetilide 1 M

dopamine hcl

intravenous 6 MSD

dopamine in d5w 6 MSD

doxazosin mesylate

oral 1 M; QL

DUTOPROL 3 ST; M

DYAZIDE 3 M

DYRENIUM 3 M

EDARBI 2 ST; M

EDARBYCLOR 2 ST; M

EDECRIN 3 M

enalapril maleate oral 1 M

Drug Name Drug

Category

Limits/

Required

CARDIZEM 3 ST; M

CARDIZEM CD 3 ST; M

CARDIZEM LA 3 ST; M

CARDURA 3 ST; M; QL

CAROSPIR 3 ST; M

cartia xt 1 M

carvedilol 1 M

carvedilol phosphate er 1 M

CATAPRES 3 M

CATAPRES-TTS-1 3 M; QL



chlorothiazide 1 M

chlorothiazide sodium 6 MSD

chlorthalidone 1 M

cholestyramine light 1 M

cholestyramine oral 1 M

choline fenofibrate 1 M; QL

CLEVIPREX 6 ST; MSD

clonidine 1 M; QL

clonidine hcl oral 1 M

colesevelam hcl 1 M

COLESTID 3 ST; M

COLESTID

FLAVORED 3 ST; M

colestipol hcl 1 M

COREG 3 ST; M

COREG CR 3 ST; M

CORGARD 3 ST; M

CORLANOR ORAL

TABLET 2 M; QL

CORLOPAM 6 MSD

COZAAR 3 ST; M

CRESTOR 3 ST; M; QL

DEMSER 2

DIBENZYLINE 3

digitek 1 M

digox 1 M


47

Drug Name Drug

Category

Limits/

Required

epinephrine pf injection

solution prefilled

syringe

1

EPINEPHRINE-

DEXTROSE 6 MSD

EPINEPHRINE-NACL 6 MSD

eplerenone 1 M

eprosartan mesylate 1 M

esmolol hcl intravenous

solution 100 mg/10ml 6 MSD

ESMOLOL HCL

INTRAVENOUS

SOLUTION 2000

MG/100ML, 2500

MG/250ML

6

ST; MSD

esmolol hcl-sodium

chloride 6 MSD

ethacrynate sodium 6 MSD

ethacrynic acid 1 M

EXFORGE 3 ST; M

EXFORGE HCT 3 ST; M

EZALLOR SPRINKLE 3 ST; M

ezetimibe 1 M

ezetimibe-simvastatin 1 M; QL

felodipine er 1 M

fenofibrate micronized 1 M; QL

fenofibrate oral capsule

134 mg, 200 mg, 67 mg 1 M; QL

fenofibrate oral capsule

150 mg, 50 mg 3 M; QL

fenofibrate oral tablet 1 M; QL

fenofibric acid 1 M; QL

FENOGLIDE 3 ST; M; QL

FIBRICOR 3 ST; M; QL

FIRST -

METOPROLOL 3 ST; M

FIRST-ATENOLOL 3 ST; M

flecainide acetate 1 M

FLOLIPID 3 ST; M

fluvastatin sodium 5 M; ACA; QL

Drug Name Drug

Category

Limits/

Required

enalaprilat 6 MSD

enalapril-


ENTRESTO 2 M; QL

EPANED 3 M

EPHEDRINE

SULFATE

(PRESSORS)

3

ephedrine sulfate

injection 6 MSD

ephedrine sulfate

intravenous solution 6 MSD

EPHEDRINE

SULFATE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

MSD

EPHEDRINE

SULFATE-NACL 6 MSD

EPINEPHRINE HCL-

DEXTROSE 6 MSD

EPINEPHRINE HCL-

NACL INTRAVENOUS

SOLUTION 1-0.9

MG/250ML-%, 2-0.9

MG/250ML-%, 4-0.9

MG/250ML-%, 8-0.9

MG/250ML-%

6

MSD

EPINEPHRINE HCL-

NACL INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

100-0.9 MCG/10ML-%,

1000-0.9 MCG/10ML-

%, 160-0.9 MCG/10ML-

%

6

MSD

epinephrine injection

solution 1

EPINEPHRINE

INJECTION

SOLUTION

PREFILLED SYRINGE

3

epinephrine pf injection

solution 6 MSD


48

Drug Name Drug

Category

Limits/

Required

KAPSPARGO

SPRINKLE 3 ST; M

labetalol hcl


LABETALOL HCL

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

ST; MSD

labetalol hcl oral 1 M

LANOXIN INJECTION 6 MSD

LANOXIN ORAL 3 M

LANOXIN PEDIATRIC 6 MSD

LASIX 3 M

LESCOL XL 3 ST; M; QL

LEVOPHED 6 MSD

LIPITOR 3 ST; M; QL

LIPOFEN 2 ST; M; QL

lisinopril oral 1 M

lisinopril-


LIVALO 2 ST; M; QL

LOPID 3 ST; M; QL

LOPRESSOR 3 ST; M

LOPRESSOR HCT 3 ST; M

losartan potassium 1 M

losartan potassium-hctz 1 M

LOTENSIN 3 M

LOTENSIN HCT 3 ST; M

LOTREL 3 ST; M

lovastatin 5 M; ACA; QL

LOVAZA 3 PA; M

mannitol intravenous 6 MSD

matzim la 1 M

MAXZIDE 3 M

MAXZIDE-25 3 M

methyldopa 1 M

methyldopa-


metolazone 1 M

Drug Name Drug

Category

Limits/

Required

fluvastatin sodium er 5 M; ACA; QL

fosinopril sodium 1 M

fosinopril sodium-hctz 1 M

FUROSEMIDE IN


furosemide injection 6 MSD

furosemide oral 1 M

gemfibrozil oral 1 M; QL

GIAPREZA 6 MSD

GONITRO 3 M

guanfacine hcl 1 M

HEMANGEOL 3 ST; M; S

hydralazine hcl

injection 6 MSD

hydralazine hcl oral 1 M

hydrochlorothiazide

oral 1 M

HYZAAR 3 ST; M

indapamide 1 M

INDERAL LA 3 ST; M

INDERAL XL 3 ST; M

INNOPRAN XL 3 ST; M

INSPRA 3 M

irbesartan 1 M

irbesartan-


isoproterenol hcl

injection 6 MSD

ISORDIL TITRADOSE 3 M

isosorbide dinitrate 1 M

isosorbide dinitrate er 1 M

isosorbide mononitrate 1 M

isosorbide mononitrate

er 1 M

isoxsuprine hcl oral 1 M

isradipine 1 M

ISUPREL 6 MSD

JUXTAPID 3 PA; M; S; QL


49

Drug Name Drug

Category

Limits/

Required

nifedipine oral 1 M

nimodipine oral 1 M

NIPRIDE RTU 6 MSD

nisoldipine er 1 M

NITRO-BID 1 M

NITRO-DUR 3 M

nitroglycerin er oral

capsule extended

release 2.5 mg

1

M

nitroglycerin in d5w 6 MSD

nitroglycerin

intravenous 6 MSD

nitroglycerin sublingual 1 M

nitroglycerin

transdermal 1 M

nitroglycerin

translingual 1 M

NITROLINGUAL 3 M

NITROMIST 3 M

NITROPRESS 6 MSD

nitroprusside sodium 6 MSD

NITROSTAT 3 M

nitro-time 1 M

norepinephrine

bitartrate intravenous 6 MSD

NOREPINEPHRINE-

DEXTROSE

INTRAVENOUS

SOLUTION

6

MSD

NOREPINEPHRINE-

SODIUM CHLORIDE

INTRAVENOUS

SOLUTION 16-0.9

MG/250ML-%, 16-0.9

MG/500ML-%, 4-0.9

MG/250ML-%, 8-0.9

MG/250ML-%, 8-0.9

MG/500ML-%

6

MSD

Drug Name Drug

Category

Limits/

Required

metoprolol succinate er 1 M

metoprolol tartrate

intravenous 6 MSD

metoprolol tartrate oral 1 M

METOPROLOL-HCTZ

ER ORAL TABLET

EXTENDED RELEASE

24 HOUR 100-12.5

MG, 50-12.5 MG

3

ST; M

metoprolol-


mexiletine hcl oral 1 M

MICARDIS 3 ST; M

MICARDIS HCT 3 ST; M

midodrine hcl 1

milrinone lactate 6 MSD

milrinone lactate in

dextrose 6 MSD

MINIPRESS 3 M

minitran 1 M

minoxidil oral 1 M

moexipril hcl 1 M

MULTAQ 3 M

nadolol oral 1 M

NEXTERONE 6 MSD

niacin

(antihyperlipidemic) 1

niacin er

(antihyperlipidemic) 1 M

NIACOR 3

NIASPAN 3 M

NICARDIPINE HCL IN

NACL INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

ST; MSD

nicardipine hcl

intravenous 6 MSD

nicardipine hcl oral 1 M

nifedipine er 1 M

nifedipine er osmotic

release 1 M


50

Drug Name Drug

Category

Limits/

Required

PHENYLEPHRINE

HCL-DEXTROSE

INTRAVENOUS

SOLUTION 20-5

MG/250ML-%, 8-5

MG/100ML-%

6

MSD

PHENYLEPHRINE

HCL-NACL

INTRAVENOUS

SOLUTION 100-0.9

MG/100ML-%, 20-0.9

MG/250ML-%, 25-0.9

MG/250ML-%, 30-0.9

MG/250ML-%, 40-0.9

MG/250ML-%, 50-0.9

MG/250ML-%, 80-0.9

MG/250ML-%

6

MSD

PHENYLEPHRINE

HCL-NACL

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

0.2-0.9 MG/5ML-%,

0.4-0.9 MG/10ML-%,

0.5-0.9 MG/5ML-%,

0.8-0.9 MG/10ML-%, 1-

0.9 MG/10ML-%, 20-

0.9 MG/50ML-%, 5-0.9

MG/50ML-%

6

MSD

pindolol 1 M

PRALUENT 2 PA; M; QL

PRAVACHOL ORAL

TABLET 20 MG, 40

MG

3

ST; M; QL

pravastatin sodium 5 M; ACA; QL

prazosin hcl oral 1 M

PRESTALIA 3 ST; M

prevalite 1 M

PRINIVIL 3 M

procainamide hcl

injection 6 MSD

PROCARDIA 3 ST; M

PROCARDIA XL 3 ST; M

propafenone hcl 1 M

propafenone hcl er 1 M

Drug Name Drug

Category

Limits/

Required

NOREPINEPHRINE-

SODIUM CHLORIDE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

0.16-0.9 MG/10ML-%

6

MSD

NORPACE 3 M

NORPACE CR 3 M

NORTHERA 4 PA; S

NORVASC 3 ST; M

NYMALIZE 3 ST; M

olmesartan medoxomil

oral 1 M

olmesartan medoxomil-

hctz 1 M

olmesartan-amlodipine-

hctz 1 M

OMEGA-3/D-3

WELLNESS PACK 3 M

omega-3-acid ethyl

esters 1 PA; M

osmitrol 6 MSD

pacerone 1 M

papaverine hcl injection 1

pentoxifylline er 1 M

perindopril erbumine 1 M

phenoxybenzamine hcl

oral 1

phentolamine mesylate

injection 6 MSD

phenylephrine hcl


mg/ml

6

MSD

phenylephrine hcl


PHENYLEPHRINE

HCL INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

MSD


51

Drug Name Drug

Category

Limits/

Required

SOTALOL HCL


sotalol hcl oral 1 M

SOTRADECOL 6 MSD

SOTYLIZE 2 ST; M

spironolactone oral 1 M

spironolactone-hctz 1 M

SULAR 3 ST; M

SURE RESULT O3D3

SYSTEM 3 M

TARKA 3 ST; M

taztia xt 1 M

TEKTURNA 2 ST; M

TEKTURNA HCT 2 ST; M

telmisartan 1 M

telmisartan-amlodipine 1 M

telmisartan-hctz 1 M

TENORETIC 100 3 ST; M

TENORETIC 50 3 ST; M

TENORMIN 3 ST; M

TIAZAC 3 ST; M

TIKOSYN 3 ST; M

timolol maleate oral 1 M

TOPROL XL 3 ST; M

torsemide 1 M

trandolapril 1 M

trandolapril-verapamil

hcl er 1 M

triamterene oral 1 M

triamterene-hctz 1 M

TRIBENZOR 3 ST; M

TRICOR 3 ST; M; QL

TRILIPIX 3 ST; M; QL

TWYNSTA 3 ST; M

valsartan 1 M

valsartan-


VARITHENA 6 MSD

Drug Name Drug

Category

Limits/

Required

propranolol hcl er 1 M

propranolol hcl

intravenous 6 MSD

propranolol hcl oral 1 M

propranolol-hctz 1 M

PROSTIN VR 3

QBRELIS 3 M

QUESTRAN 3 ST; M

QUESTRAN LIGHT 3 ST; M

quinapril hcl 1 M

quinapril-


quinidine gluconate er 1 M

quinidine sulfate 1 M

ramipril 1 M

RANEXA 2 M

ranolazine er 1 M

RECTIV 2

REPATHA 3 PA; M; QL

REPATHA

PUSHTRONEX

SYSTEM

3

PA; M; QL

REPATHA

SURECLICK 3 PA; M; QL

rosuvastatin calcium

oral tablet 10 mg, 5 mg 5 M; ACA; QL

rosuvastatin calcium


mg

1

M; QL

RYTHMOL SR 3 M

simvastatin oral tablet

10 mg, 20 mg, 40 mg, 5

mg

5

M; ACA; QL

simvastatin oral tablet

80 mg 1 M; QL

SODIUM DIURIL 6 MSD

SODIUM EDECRIN 6 MSD

sorine 1 M

sotalol hcl (af) 1 M


52

Drug Name Drug

Category

Limits/

Required

DAYTRANA 2 ST; M; QL

DESOXYN 3 ST; M; QL

DEXEDRINE 3 ST; M; QL

dexmethylphenidate hcl 1 M; QL

dexmethylphenidate hcl

er 1 M; QL

dextroamphetamine

sulfate 1 M; QL

dextroamphetamine

sulfate er 1 M; QL

DYANAVEL XR 3 ST; M; QL

EVEKEO 3 ST; M; QL

EVEKEO ODT 3 ST; M; QL

FOCALIN 3 ST; M; QL

FOCALIN XR 3 ST; M; QL

guanfacine hcl er 1 M; QL

INTUNIV 3 ST; M; QL

JORNAY PM 3 ST; M; QL

KAPVAY 3 ST; M; QL

metadate er 1 M; QL

methamphetamine hcl 1 M; QL

METHYLIN 3 ST; M; QL

methylphenidate hcl er

(cd) 1 M; QL


(la) 1 M; QL



release 10 mg, 18 mg,

20 mg, 27 mg, 36 mg,

54 mg

1

M; QL



release 24 hour

1

M; QL



release 72 mg

3

M; QL

methylphenidate hcl

oral 1 M; QL

MYDAYIS 2 M; QL

PROCENTRA 1 ST; M; QL

Drug Name Drug

Category

Limits/

Required

VASCEPA 2 PA; M

VASERETIC 3 ST; M

VASOTEC 3 M

VAZCULEP 6 MSD

VECAMYL 3 M; S

verapamil hcl er 1 M

verapamil hcl

intravenous 6 MSD

verapamil hcl oral 1 M

VERELAN 3 ST; M

VERELAN PM 3 ST; M

VYNDAQEL 3 M; QL

VYTORIN 3 ST; M; QL

WELCHOL 3 ST; M

ZESTORETIC 3 ST; M

ZESTRIL 3 M

ZETIA 3 ST; M

ZIAC 3 ST; M

ZOCOR 3 ST; M; QL

ZYPITAMAG 3 ST; M

Central Nervous

System Agents -

Drugs for Attention

Deficit Disorder

ADDERALL 3 ST; M; QL

ADDERALL XR 3 ST; M; QL

ADHANSIA XR 3 ST; M; QL

ADZENYS ER 3 ST; M; QL

ADZENYS XR-ODT 3 ST; M; QL

amphetamine sulfate 1 PA; M; QL

amphetamine-

dextroamphetamine 1 M; QL

amphetamine-

dextroamphetamine er 1 M; QL

APTENSIO XR 3 ST; M; QL

atomoxetine hcl 1 M; QL

clonidine hcl er 1 M; QL

CONCERTA 3 ST; M; QL

COTEMPLA XR-ODT 3 ST; M; QL


53

Drug Name Drug

Category

Limits/

Required

MAVENCLAD (9

TABS) 3

MAYZENT 4 PA; M; S; QL

MAYZENT STARTER

PACK 4 PA; S; QL

OCREVUS 6 MSD; QL

PLEGRIDY 3 M; S; QL

PLEGRIDY STARTER

PACK 3 S; QL

REBIF 3 M; S; QL

REBIF REBIDOSE 3 M; S; QL

REBIF REBIDOSE

TITRATION PACK 3 M; S; QL

REBIF TITRATION

PACK 3 M; S; QL

TECFIDERA

STARTER PACK 3 S; QL

TECFIDERA ORAL

CAPSULE DELAYED

RELEASE

3

M; S; QL

TYSABRI 6 MSD; QL

Central Nervous

System Agents -

Miscellaneous

ADDYI 3 PA; M; QL

ANECTINE 6 MSD

atracurium besylate 6 MSD

AUSTEDO 3 PA; M; S; QL

CAFCIT 6 MSD

caffeine citrate

intravenous 6 MSD

caffeine citrate oral 1

CAFFEINE-SODIUM

BENZOATE 6 MSD

cisatracurium besylate

(pf) 6 MSD

cisatracurium besylate


mg/10ml

6

MSD

GRALISE 2 ST; M; QL

GRALISE STARTER 2 ST; QL

Drug Name Drug

Category

Limits/

Required

QUILLICHEW ER 2 ST; M; QL

QUILLIVANT XR 2 ST; M; QL

relexxii 3 M; QL

RITALIN 3 ST; M; QL

RITALIN LA 3 ST; M; QL

STRATTERA 3 ST; M; QL

VYVANSE 2 M; QL

zenzedi oral tablet 10

mg, 5 mg 1 M; QL

ZENZEDI ORAL

TABLET 15 MG, 2.5

MG, 20 MG, 30 MG,

7.5 MG

3

ST; M; QL

Central Nervous

System Agents -

Drugs for Multiple

Sclerosis

AMPYRA 4 ST; M; S; QL

AUBAGIO 4 M; S; QL

AVONEX PEN 3 M; S; QL

AVONEX PREFILLED 3 M; S; QL

BETASERON 3 ST; M; S; QL

COPAXONE 3 ST; M; S; QL

dalfampridine er 1 PA; M; S; QL

EXTAVIA 4 ST; M; S; QL

GILENYA 3 M; S; QL

glatiramer acetate 1 M; S; QL

glatopa 1 M; S; QL

LEMTRADA 6 MSD

MAVENCLAD (10

TABS) 3 PA

MAVENCLAD (4

TABS) 3

MAVENCLAD (5

TABS) 3

MAVENCLAD (6

TABS) 3

MAVENCLAD (7

TABS) 3

MAVENCLAD (8

TABS) 3


54

Drug Name Drug

Category

Limits/

Required

VECURONIUM

BROMIDE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

MSD

vecuronium bromide


reconstituted

6

MSD

XENAZINE 3 ST; M; S

Dental and Oral

Agents - Drugs for

Mouth and Throat

Conditions

ARESTIN 6 MSD

cavarest 1 M

cevimeline hcl 1 M

chlorhexidine gluconate

mouth/throat 1

clinpro 5000 3 M

DEBACTEROL 3

denta 5000 plus 1 M

dentagel 1 M

easygel 1

EVOXAC 3 M

FIRST-MOUTHWASH

BLM 2

fluoridex 3 M

fluoridex daily renewal 1 M

fluoridex enhanced

whitening 3 M

fluoridex sensitivity

relief 1

KEPIVANCE 6 MSD

lidocaine hcl

mouth/throat 1

lidocaine viscous

mouth/throat solution 2

%

1

NAFRINSE DAILY

ACIDULATED 3

NAFRINSE

DAILY/NEUTRAL 3 M

Drug Name Drug

Category

Limits/

Required

HORIZANT 3 ST; M; QL

INGREZZA ORAL

CAPSULE 3 PA; M; S; QL

INGREZZA ORAL

CAPSULE THERAPY

PACK

3

PA; QL

LYRICA 2 ST; M; QL

LYRICA CR 3 ST; M; QL

NIMBEX 6 MSD

NUEDEXTA 2 M

ONPATTRO 6 M; MSD

pancuronium bromide 6 MSD

pregabalin oral 1 M; QL

QUELICIN 6 MSD

RADICAVA 6 M; MSD

RILUTEK 3 M; QL

riluzole 1 M; QL

rocuronium bromide


ROCURONIUM

BROMIDE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

100 MG/10ML, 50

MG/5ML, 75 MG/7.5ML

6

MSD

SAVELLA 2 M; QL

SAVELLA TITRATION

PACK 2 QL

succinylcholine chloride

injection solution 6 MSD

SUCCINYLCHOLINE

CHLORIDE

INJECTION

SOLUTION

PREFILLED SYRINGE

3

SUCCINYLCHOLINE

CHLORIDE

INTRAVENOUS

6

MSD

TEGSEDI 4 PA; M; S

tetrabenazine 3 PA; M; S

TIGLUTIK 3 M; QL


55

Drug Name Drug

Category

Limits/

Required

acitretin 1

ACTIVE-PREP KIT IV 3

ACTIVE-PREP KIT V 3

ACTIVE-TRAMADOL 3

ACZONE 3 ST

adapalene external

cream 1 QL

adapalene external gel 1 QL

ADAPALENE

EXTERNAL LOTION 3 ST; QL

ADAPALENE

EXTERNAL PAD 3 ST

ADAPALENE

EXTERNAL

SOLUTION

1

ST

adapalene-benzoyl

peroxide 1 QL

AKTIPAK 3 ST

ALA SCALP 3 ST

ala-cort 1

alclometasone

dipropionate 1

ALCOHOL PREP

PADS EXTERNAL 70

%

2

ALDARA 3 QL

ALTRENO 3

amcinonide 1

AMELUZ 6 MSD

ammonium lactate

external 1

amnesteem 1 QL

APEXICON E 1 ST; QL

AQUACEL AG BURN 3

arzol silver nit

applicators 1

ATRALIN 3 QL

AVAR LS CLEANSER 3 ST

AVAR-E LS 3 ST

avita external cream 1 QL

Drug Name Drug

Category

Limits/

Required

NAFRINSE WEEKLY 3 M

neutral sodium fluoride 1 M

NUMOISYN

MOUTH/THROAT

LOZENGE

3

oralone 1

paroex 1

PERIDEX 3

periogard 1

pilocarpine hcl oral 1 M

PREVIDENT 5000

BOOSTER PLUS 3 M

PREVIDENT 5000

DRY MOUTH 3 M

PREVIDENT 5000

ENAMEL PROTECT 3

PREVIDENT 5000

ORTHO DEFENSE 3 M

PREVIDENT 5000

PLUS 3 M

PREVIDENT 5000

SENSITIVE 3

PREVIDENT DENTAL 3 M

prevident mouth/throat 1 M

REMESENSE 3

SALAGEN 3 M

sf 1 M

sf 5000 plus 1 M

sodium fluoride 5000

plus 1 M

sodium fluoride dental 1 M

topex topical anesthetic 1

triamcinolone acetonide

mouth/throat 1

Dermatological

Agents - Drugs for

Skin Conditions

A.A.G.C. KIT IN

TERODERM 3

ABSORICA 2 QL

ACANYA 2 ST; QL


56

Drug Name Drug

Category

Limits/

Required

bpo 1

BRYHALI 3 ST

calcipotriene 1 QL

calcipotriene-betameth

diprop 1 QL

calcitrene 1 QL

calcitriol external 1 QL

CANTHARIDIN

EXTERNAL 3

CAPEX 3 ST; QL

CARAC 2 QL

claravis 1 QL

CLEOCIN-T 3 ST

clindacin etz external

swab 1

clindacin-p 1

CLINDAGEL 3 ST

clindamycin phosphate-

benzoyl peroxide 1 QL


external foam 1


external lotion 1


external solution 1


external swab 1

CLINDAMYCIN

PHOSPHATE GEL 1 %

EXTERNAL

3

ST


gel 1 % external 1

clindamycin-tretinoin 1

CLINOIN 3

clobetasol prop

emollient base 1

clobetasol propionate e 1

clobetasol propionate

emulsion 1

clobetasol propionate

external 1

Drug Name Drug

Category

Limits/

Required

avita external gel 3

azelaic acid external 1

AZELEX 3 ST; QL

balsam peru-castor oil 3

BENZAC AC WASH 3 ST

BENZACLIN 3 ST; QL

BENZACLIN WITH

PUMP 3 ST; QL

BENZAMYCIN 3 ST

benzepro external foam

5.3 % 1

benzepro foaming

cloths 1

benzepro short contact 1

BENZIQ 3 ST

BENZIQ LS 3 ST

benziq wash 3

BENZOYL PEROX-

HYDROCORTISONE 3 ST

benzoyl peroxide

external foam 9.8 % 1

BENZOYL PEROXIDE

EXTERNAL GEL 6.5

%, 8 %

3

BENZOYL PEROXIDE

FORTE- HC 3

benzoyl peroxide-

erythromycin 1

beser external lotion 1

betamethasone

dipropionate aug 1

betamethasone

dipropionate external 1

betamethasone

valerate external 1

BOTOX COSMETIC 6 MSD

bp cleansing wash 1

bp foam 1

bp wash external liquid

2.5 % 3

BPCO 3


57

Drug Name Drug

Category

Limits/

Required

diclofenac sodium

transdermal gel 3 % 1 PA; QL

DIFFERIN 3 ST; QL

diflorasone diacetate

external cream 1 QL

diflorasone diacetate

external ointment 1

DIPROLENE 3 ST

DIPROLENE AF 3 ST

DOVONEX 3 QL

doxepin hcl external 1 QL

doxycycline 3 ST

dritho-creme hp 1

DRYSOL 3

DUAC 3 ST; QL

DUOBRII 3

DUPIXENT

SUBCUTANEOUS

SOLUTION

PREFILLED SYRINGE

200 MG/1.14ML

3

PA; M; S; QL

DUPIXENT

SUBCUTANEOUS

SOLUTION

PREFILLED SYRINGE

300 MG/2ML

3

PA; S; QL

EFUDEX 3

ELIDEL 2 ST; QL

ELOCON 3 ST

ENOVARX-

TRAMADOL 3

ENSTILAR 2 QL

ENZOCLEAR 3

EPIDUO 3 ST; QL

EPIDUO FORTE 2 ST

EPIFOAM 3 ST

ery 1

ERYGEL 1

erythromycin external 1

EUCRISA 3 ST; QL

Drug Name Drug

Category

Limits/

Required

CLOBEX 3 ST

CLOBEX SPRAY 3 ST

clocortolone pivalate 3 QL

clodan external

shampoo 1

CLODERM 3 ST; QL

clotrimazole-

betamethasone 1

coal tar external 2

CONDYLOX 3

CORDRAN

EXTERNAL CREAM 3 ST

CORDRAN

EXTERNAL LOTION 3 ST

CORDRAN

EXTERNAL

OINTMENT

3

ST

CORDRAN

EXTERNAL TAPE 3 ST; QL

CORTANE-B 3

CORTISPORIN 3

curad hydrocortisone 1 OTC

CUTIVATE 3 ST

dapsone external 1

DERMA-SMOOTHE/FS

BODY 3 ST; QL

DERMA-SMOOTHE/FS

SCALP 3 ST; QL

DERMULCERA 3

DESONATE 3 ST

desonide external 1 QL

DESOWEN 3 ST; QL

desoximetasone

external cream 1 QL

desoximetasone

external gel 1 QL

desoximetasone

external liquid 1

desoximetasone

external ointment 1 QL


58

Drug Name Drug

Category

Limits/

Required

GORDOFILM 3

grafco silver nit

applicator 1

halcinonide 1

halobetasol propionate

external cream 1 QL

HALOBETASOL

PROPIONATE

EXTERNAL FOAM

3

ST

halobetasol propionate


HALOG 3 ST

HYALUCIL-4 3

HYDRO 35 3

HYDRO 40 3

hydrocortisone ace-

pramoxine external 1

hydrocortisone butyr

lipo base 1

hydrocortisone butyrate 1

hydrocortisone external

cream 1 %, 2.5 % 1


lotion 2.5 % 1


ointment 1 %, 2.5 % 1

hydrocortisone valerate 1

imiquimod external 1 QL

IMIQUIMOD PUMP 3 ST; QL

IMPOYZ 3 ST

INOVA 4/1 ACNE

CONTROL THERAPY 3 ST

INOVA EXTERNAL KIT

4 & 5 % 3 ST

isotretinoin oral 1 QL

kelo-cote external gel 6 MSD; OTC

KENALOG EXTERNAL 3 ST

KERAGEL 6 MSD

KERALYT EXTERNAL

GEL 6 % 3

Drug Name Drug

Category

Limits/

Required

EVOCLIN 3 ST

FABIOR 3 PA; QL

FINACEA EXTERNAL

FOAM 2 ST

FINACEA EXTERNAL

GEL 3 ST

fluocinolone acetonide

body 1 QL


external cream 0.01 % 1


external cream 0.025 % 1 QL




external solution 1 QL


scalp 1 QL

fluocinonide emulsified

base 1

fluocinonide external

cream 0.05 % 1


cream 0.1 % 1 QL


gel 1


ointment 1


solution 1

FLUOROPLEX 3 QL

FLUOROURACIL

EXTERNAL CREAM

0.5 %

3

ST; QL

fluorouracil external

cream 5 % 1

fluorouracil external

solution 1 QL

flurandrenolide 1

fluticasone propionate

external 1

glycolic acid solution 2


59

Drug Name Drug

Category

Limits/

Required

ONEXTON 2 ST; QL

ORACEA 2 ST

OVACE PLUS

EXTERNAL LOTION 3 ST

OVACE PLUS

EXTERNAL

SHAMPOO

3

OVACE PLUS WASH

EXTERNAL LIQUID 3

OVACE WASH 3

OXSORALEN ULTRA 3

PANDEL 3 ST

PICATO 2 QL

pimecrolimus 1 QL

PLEXION CLEANSER 3 ST

PLEXION EXTERNAL

LOTION 3 ST

podocon 3

podofilox external 1

PRAMOSONE 3 ST

prednicarbate 1

PROTOPIC 3 ST; QL

PRUDOXIN 1 ST; QL

PSORCON 3 ST; QL

pyrogallic acid 3

QBREXZA 2 PA; QL

REGRANEX 2 QL

RETIN-A EXTERNAL

CREAM 0.025 % 3 QL

RETIN-A EXTERNAL

CREAM 0.05 %, 0.1 % 3

RETIN-A EXTERNAL

GEL 3

RETIN-A MICRO GEL

0.04 %, 0.1 % 3

RETIN-A MICRO

PUMP 3

RHOFADE 3 PA

RIAX 3

rosadan external cream 1

Drug Name Drug

Category

Limits/

Required

KERAMATRIX

REPLICINE 5CMX5CM 6 MSD

KLARON 3 ST

LAC-HYDRIN 3

lactic acid e 1

lactic acid external 1

latrix xm 1

LAVARE WOUND

WASH 3

LEVULAN KERASTICK 6 MSD

LEXETTE 3 ST

LOCOID 3 ST

LOCOID LIPOCREAM 3 ST

LOTRISONE 3

LUXIQ 3 ST

methoxsalen oral 1

methoxsalen rapid 1

methyl salicylate

external liquid 1

METROCREAM 3 ST

METROGEL 3 ST

METROLOTION 3 ST

metronidazole external 1

MICORT-HC 3 ST

MICROCYN

EXTERNAL GEL 3

MICROCYN SKIN AND

WOUND 3

MIRVASO 2 PA

mometasone furoate

external 1

myorisan 1 QL

NEO-SYNALAR

EXTERNAL CREAM 3

neuac external gel 1 QL

nolix 1

NORITATE 3 ST

OLUX 3 ST

OLUX-E 3 ST


60

Drug Name Drug

Category

Limits/

Required

sulfacetamide sodium-

sulfur external liquid

10-2 %, 9-4 %, 9.8-4.8

%

1


sulfur external lotion

10-5 %

1


sulfur external pad 1


sulfur external

suspension

1

sulfacetamide-sulfur in

urea 1

sulfacleanse 8/4 1

synalar external cream 1 QL

synalar external

ointment 3 QL

SYNALAR EXTERNAL

SOLUTION 3 ST; QL

TACLONEX

EXTERNAL

OINTMENT

3

QL

TACLONEX

EXTERNAL

SUSPENSION

2

QL

tacrolimus external 1 QL

tazarotene external 1 PA; QL

TAZORAC CREAM

0.05 % EXTERNAL 2 PA; QL

TAZORAC EXTERNAL

CREAM 0.1 % 3 PA; QL

TAZORAC EXTERNAL

GEL 2 PA; QL

TEMOVATE 3 ST

TEXACORT 3 ST

TOLAK 3 QL

TOPICORT 3 ST; QL

TOPICORT SPRAY 3 ST

tretinoin external cream

0.025 % 1 QL

Drug Name Drug

Category

Limits/

Required

rosadan external gel 1

SALEX 3

salicylic acid er 1

salicylic acid external

foam 1


gel 1


lotion 1


shampoo 1

salicylic acid-cleanser

external kit 6 % (lotion) 1

SALVAX 1

SALVAX DUO PLUS 3

SANTYL 2

selenium sulfide

external 1

SERNIVO 3 ST

sm hydrocortisone

external cream 1 % 1 OTC

sodium hyaluronate

external 1

sodium sulfacetamide 1

sodium sulfacetamide

wash liquid 10 %

external

1

SODIUM

SULFACETAMIDE

WASH LIQUID 10 %

EXTERNAL

1

SOOLANTRA 2 ST

SORIATANE 3

SORILUX 3 QL

sss 10-5 external foam 1

sulfacetamide sodium

(acne) 1


external 1


sulfur external cream

10-2 %

1


61

Drug Name Drug

Category

Limits/

Required

XEROFORM OIL

EMULSION STRIP 3

XEROFORM

PETROLAT GAUZE

1"X8"

3

XEROFORM

PETROLAT GAUZE

5"X9"

3

XEROFORM

PETROLAT PATCH

2"X2"

3

XEROFORM

PETROLAT PATCH

4"X4"

3

XEROFORM

PETROLATUM ROLL

4"X9'

3

ZACARE 3 ST

zaclir cleansing 1

zenatane 1 QL

ZIANA 3 ST

ZONALON 3 ST; QL

ZYCLARA 3 ST; QL

ZYCLARA PUMP 3 ST; QL

Diabetes -

Antidiabetic Agents

acarbose oral 1 M

ACTOPLUS MET 3 ST; M; QL

ACTOS 3 M; QL

ADLYXIN 3 M; QL

ADLYXIN STARTER

PACK 3 QL

ALOGLIPTIN

BENZOATE 3 ST; M; QL

ALOGLIPTIN-

METFORMIN HCL 3 ST; M; QL

ALOGLIPTIN-

PIOGLITAZONE 3 M; QL

AMARYL 3 M

AVANDIA 3 ST; M; QL

BYDUREON 2 ST; M; QL

Drug Name Drug

Category

Limits/

Required

tretinoin external cream

0.05 %, 0.1 % 1

tretinoin external gel

0.01 %, 0.025 % 1

tretinoin external gel

0.05 % 1 QL

tretinoin microsphere 1

tretinoin microsphere

pump 1

triamcinolone acetonide

external 1

TRIANEX 1

TRI-CHLOR 1

triderm 1

TRIDESILON 3 ST; QL

turpentine external 2

ULTRAVATE 3 ST

umecta mousse 1

urea external cream 39

%, 45 % 1

urea hydrating 1

urea in zn undecyl-

lactic acid 1

urea nail 1

VANOS 3 ST; QL

VANOXIDE-HC 3 ST

vashe cleansing 6 MSD

VECTICAL 3 QL

VELTIN 3 ST

VENELEX 3

VERDESO 3 ST

VEREGEN 3

VIRASAL 3

XERAC AC 3

XERFORM OIL

EMULSION ROLL 3

XEROFORM OIL

EMULSION 2"X2" 3

XEROFORM OIL

EMULSION GAUZE 3


62

Drug Name Drug

Category

Limits/

Required

METFORMIN HCL

ORAL SOLUTION 3 ST; M; QL

metformin hcl oral

tablet 1 M

miglitol 1 M

nateglinide 1 M

NESINA 3 ST; M; QL

ONGLYZA 3 ST; M; QL

OSENI 3 M; QL

OZEMPIC 2 ST; M; QL

pioglitazone hcl 1 M; QL

pioglitazone hcl-

glimepiride 1 M; QL

pioglitazone hcl-

metformin hcl 1 M; QL

PRECOSE 3 M

QTERN 3 ST; M

repaglinide 1 M

repaglinide-metformin

hcl 1 M; QL

RIOMET 3 ST; M; QL

SEGLUROMET 2 ST; M

SOLIQUA 2 ST; M; QL

STARLIX 3 M

STEGLATRO 2 ST; M

STEGLUJAN 3 ST; M

SYMLINPEN 120 2 ST; M; QL

SYMLINPEN 60 2 ST; M; QL

SYNJARDY 2 ST; M

SYNJARDY XR 2 ST; M

tolbutamide 1 M

TRADJENTA 2 ST; M; QL

TRULICITY 2 ST; M; QL

VICTOZA 3 M; QL

XIGDUO XR ORAL

TABLET EXTENDED

RELEASE 24 HOUR

10-1000 MG, 10-500

MG, 5-1000 MG, 5-500

MG

2

ST; M; QL

Drug Name Drug

Category

Limits/

Required

BYDUREON BCISE

AUTOINJECTOR 2 ST; M; QL

BYETTA 10 MCG PEN 2 ST; M; QL

BYETTA 5 MCG PEN 2 ST; M; QL

CYCLOSET 3 M; QL

DUETACT 3 ST; M; QL

FARXIGA 2 ST; M; QL

FORTAMET 3 ST; M

glimepiride 1 M

glipizide er 1 M

glipizide ir 1 M

glipizide xl 1 M

glipizide-metformin hcl 1 M

GLUCOPHAGE 3 ST; M

GLUCOPHAGE XR 3 ST; M

GLUCOTROL 3 M

GLUCOTROL XL 3 M

GLUMETZA 3 ST; M; QL

glyburide micronized 1 M

glyburide oral 1 M

glyburide-metformin 1 M

GLYNASE 3 M

GLYSET 3 M

GLYXAMBI 2 ST; M

INVOKAMET 2 ST; M; QL

INVOKAMET XR 2 ST; M; QL

INVOKANA 2 ST; M; QL

JANUMET 2 ST; M; QL

JANUMET XR 2 ST; M; QL

JANUVIA 2 ST; M; QL

JARDIANCE 2 ST; M; QL

JENTADUETO 2 ST; M; QL

JENTADUETO XR 2 ST; M

KAZANO 3 ST; M; QL

KOMBIGLYZE XR 3 ST; M; QL

metformin hcl er 1 M

metformin hcl er (mod) 1 ST; M; QL

metformin hcl er (osm) 1 ST; M


63

Drug Name Drug

Category

Limits/

Required

ACCU-CHEK

SMARTVIEW

CONTROL

3

OTC

ACCU-CHEK

SMARTVIEW TEST

STRIPS

3

ST; OTC; QL

ACCU-CHEK

SOFTCLIX LANCET

DEVICE KIT

2

OTC

AUTOLET LANCING

DEVICE 2 OTC

BAYER CONTOUR IN

VITRO LIQUID HIGH ,

LOW , NORMAL

3

OTC

BIOTEL CARE BLOOD

GLUCOSE SYST 3 ST; OTC; QL

CARETOUCH

LANCING/EJECTOR 2 OTC

CHEMSTRIP UGK 2 OTC

CONTOUR NEXT

CONTROL 3 OTC

CONTOUR NEXT

MONITOR 3 ST; OTC; QL

CONTOUR NEXT

TEST 3 ST; OTC; QL

CONTOUR TEST 3 ST; OTC; QL

DEXCOM G4 / G5 / G6

RECEIVER,

TRANSMITTER,

SENSOR (INCLUDING

PLATINUM,

PLATINUM

PEDIATRIC)

6

MSD; QL

DEXCOM G4 / G5 / G6

RECEIVER,

TRANSMITTER,

SENSOR (INCLUDING

PLATINUM,

PLATINUM

PEDIATRIC) DEVICE

6

MSD; QL

DIATHRIVE BLOOD

GLUCOSE METER 3 ST; OTC; QL

DIATHRIVE BLOOD

GLUCOSE TEST 3 ST; OTC; QL

Drug Name Drug

Category

Limits/

Required

XIGDUO XR ORAL

TABLET EXTENDED

RELEASE 24 HOUR

2.5-1000 MG

2

ST; M

XULTOPHY 2 ST; M; QL

Diabetes - Glucose

Monitoring

ACCU-CHEK AVIVA

DEVICE 3 OTC; QL

ACCU-CHEK AVIVA

CONNECT KIT

W/DEVICE

3

ST; OTC; QL

ACCU-CHEK AVIVA IN

VITRO 3 OTC

ACCU-CHEK AVIVA

PLUS 3 ST; OTC; QL

ACCU-CHEK

COMPACT PLUS

CARE KIT

3

OTC; QL

ACCU-CHEK

COMPACT PLUS

CONTROL

3

OTC

ACCU-CHEK

COMPACT PLUS

TEST STRIPS

3

ST; OTC; QL

ACCU-CHEK

FASTCLIX LANCET

KIT

2

OTC

ACCU-CHEK GUIDE 3 ST; OTC; QL

ACCU-CHEK GUIDE

CONTROL 3 OTC

ACCU-CHEK GUIDE

ME 3 ST; OTC; QL

ACCU-CHEK GUIDE

STRIP IN VITRO 3 OTC; QL

ACCU-CHEK GUIDE

STRIP IN VITRO 3 ST; OTC; QL

ACCU-CHEK

MULTICLIX LANCET

DEVICE KIT

2

OTC

ACCU-CHEK NANO

SMARTVIEW KIT

W/DEVICE

3

ST; OTC; QL


64

Drug Name Drug

Category

Limits/

Required

FREESTYLE LIBRE

SENSOR SYSTEM 6 MSD; QL

FREESTYLE LITE

TEST 3 ST; OTC; QL

FREESTYLE

PRECISION NEO

TEST

3

ST; OTC; QL

FREESTYLE TEST 3 ST; OTC; QL

GENTEEL LANCING

KIT (BLUE) 2 OTC

GLUCOCARD 01

SENSOR PLUS 3 ST; OTC; QL

GLUCOCARD

EXPRESSION TEST 3 ST; OTC; QL

GLUCOCARD SHINE

CONNEX 3 ST; OTC; QL

GLUCOCARD SHINE

EXPRESS 3 ST; OTC; QL

GLUCOCARD SHINE

TEST 3 ST; OTC; QL

GLUCOCARD VITAL

TEST 3 ST; OTC; QL

GUARDIAN CONNECT

TRANSMITTER 6 MSD; QL

GUARDIAN LINK 3


GUARDIAN REAL-

TIME SYSTEM 2 QL

HW EMBRACE PRO


HW EMBRACE PRO


HW EMBRACE TALK

BLOOD GLUCOSE 3 ST; OTC; QL

HW EMBRACE TALK


KETOCARE IN VITRO

STRIP 2 OTC

KETOSTIX 2 OTC

LANCETS 2 OTC

LANCETS KIT 2 OTC

Drug Name Drug

Category

Limits/

Required

DIATHRIVE GLUCOSE

CONTROL SOLN 3 ST; OTC

DIATHRIVE GLUCOSE

TEST 3 ST; OTC; QL

DIATHRIVE LANCING

DEVICE 2 ST; OTC

EASYMAX CONTROL 3 ST; OTC

EASYPLUS BLOOD


EMBRACE TALK


EMBRACE TALK

GLUCOSE CONTROL 3 ST; OTC

EMBRACE TALK


EMBRACE TALK

MONITORING

SYSTEM

3

ST; OTC; QL

ENLITE GLUCOSE

SENSOR 6 MSD; QL

EVERSENSE

SENSOR/HOLDER 6 MSD; QL

EVERSENSE SMART


FORA GTEL BLOOD

GLUCOSE SYSTEM 3 ST; OTC; QL

FORA GTEL BLOOD


FORTISCARE

CONTROL 3 ST; OTC

FREESTYLE

FREEDOM LITE 3 ST; OTC; QL

FREESTYLE

INSULINX SYSTEM 3 ST; OTC; QL

FREESTYLE

INSULINX TEST 3 ST; OTC; QL

FREESTYLE LIBRE 14

DAY READER 6 MSD; QL

FREESTYLE LIBRE 14

DAY SENSOR 6 MSD; QL

FREESTYLE LIBRE

READER 6 MSD; QL


65

Drug Name Drug

Category

Limits/

Required

PRECISION SOF-

TACT TEST 3 ST; OTC; QL

PRECISION XTRA


PRECISION XTRA

DEVICE 3 OTC; QL

PRECISION XTRA KIT 3 OTC; QL

PRECISION XTRA

MONITOR 3 OTC; QL

PRODIGY NO

CODING BLOOD

GLUC

3

OTC; QL

RELION BLOOD


RELION PREMIER

CLASSIC 3 OTC; QL

RELION PREMIER

TEST 3 ST; OTC; QL

RELION ULTIMA TEST 3 ST; OTC; QL

SOF-SENSOR 6 MSD; QL

SURESTEP PRO

HIGH GLUCOSE 3 OTC

SURESTEP PRO LOW

GLUCOSE 3 OTC

SURESTEP PRO

NORMAL GLUCOSE 3 OTC

TRUE FOCUS BLOOD


TRUE METRIX BLOOD


TRUE METRIX LEVEL

1 3 OTC

TRUE METRIX LEVEL

2 3 OTC

TRUE METRIX LEVEL

3 3 OTC

TRUETRACK TEST 3 ST; OTC; QL

UNISTRIP CONTROL

IN VITRO SOLUTION

LOW

3

OTC

V-GO 20 2 OTC

Drug Name Drug

Category

Limits/

Required

MICROLET NEXT

LANCING DEVICE 2 OTC

MINIMED GUARDIAN

SENSOR 3 6 MSD; QL

NOVOPEN ECHO 3

ONE DROP BLOOD

GLUCOSE MONITOR 3 ST; OTC; QL

ONE DROP TEST 3 ST; OTC; QL

ONETOUCH DELICA

LANCING DEV 2 OTC

ONETOUCH DELICA

PLUS LANCING 2 OTC

ONETOUCH ULTRA 2 2 OTC; QL

ONETOUCH ULTRA

BLUE TEST STRIPS 2 OTC; QL

ONETOUCH ULTRA

MINI 2 OTC; QL

ONE TOUCH VERIO

KIT W/DEVICE 2 OTC; QL

ONETOUCH VERIO

FLEX SYSTEM KIT

W/DEVICE

2

OTC; QL

ONETOUCH VERIO IN

VITRO SOLUTION

HIGH

2

OTC

ONETOUCH VERIO

TEST STRIPS 2 OTC; QL

ONETOUCH VERIO IQ

SYSTEM 2 OTC; QL

ONETOUCH VERIO

SYNC SYSTEM KIT

W/DEVICE

2

OTC; QL

PARADIGM REAL-

TIME STARTER 2 QL

PRECISION LINK 3 ST; OTC; QL

PRECISION PCX

PLUS TEST 3 ST; OTC; QL

PRECISION QID

MONITOR 3 OTC; QL

PRECISION QID TEST 3 ST; OTC; QL

PRECISION SOF-

TACT MONITOR 3 OTC; QL


66

Drug Name Drug

Category

Limits/

Required

BD ULTRA-FINE

INSULIN SYRINGES 2

BD ULTRA-FINE PEN

NEEDLES 2 ST; OTC

BD ULTRA-FINE PEN

NEEDLES 2 ST

FIASP 3 ST; M; QL

FIASP FLEXTOUCH 3 ST; M; QL

FIASP PENFILL 3 ST; M; QL

HUMALOG KWIKPEN 2 M; QL

HUMALOG MIX 50/50

KWIKPEN 2 M; QL

HUMALOG MIX 50/50

VIAL 2 M; QL

HUMALOG MIX 75/25

KWIKPEN 2 M; QL

HUMALOG MIX 75/25

VIAL 2 M; QL

HUMALOG U-100

JUNIOR KWIKPEN 2 M; QL

HUMALOG U-100 VIAL

AND CARTRIDGE 2 M; QL

HUMULIN 70/30

KWIKPEN 2 M; OTC; QL

HUMULIN 70/30 VIAL 2 M; OTC; QL

HUMULIN N KWIKPEN 2 M; OTC

HUMULIN N VIAL 2 M; OTC; QL

HUMULIN R U-500

KWIKPEN 2 M; QL

HUMULIN R U-500

VIAL

(CONCENTRATED)

2

M; QL

HUMULIN R VIAL 2 M; OTC; QL

INSULIN LISPRO 3 M; QL

INSULIN LISPRO

SUBCUTANEOUS

SOLUTION PEN-

INJECTOR 100

UNIT/ML

3

M; QL

Drug Name Drug

Category

Limits/

Required

VIVAGUARD INO

CONTROL SOLUTION 3 ST; OTC

VIVAGUARD INO


VIVAGUARD INO

TEST STRIPS 3 ST; OTC; QL

VIVAGUARD

LANCING DEVICE 2 ST; OTC

Diabetes - Glycemic

Agents

GLUCAGEN HYPOKIT 2

GLUCAGON

EMERGENCY 3

PROGLYCEM 2 M

Diabetes - Insulins

ADMELOG 3 ST; M; QL

ADMELOG

SOLOSTAR 3 ST; M; QL

AFREZZA

INHALATION

POWDER 12 UNIT, 4 &

8 & 12 UNIT, 8 UNIT,

90 X 4 UNIT & 90X8

UNIT, 90 X 8 UNIT &

90X12 UNIT

3

M

AFREZZA

INHALATION

POWDER 4 UNIT

3

M; QL

APIDRA SOLOSTAR 3 ST; M; QL

APIDRA VIAL 3 ST; M; QL

BASAGLAR KWIKPEN 2 M; QL

BD AUTOSHIELD DUO

PEN NEEDLES 2 ST; OTC

BD ULTRA-FINE

INSULIN SYRINGES

29G X 1/2" 1 ML, 30G

X 1/2" 0.3 ML, 30G X

1/2" 0.5 ML, 30G X 1/2"

1 ML, 31G X 15/64" 0.3

ML, 31G X 15/64" 0.5

ML, 31G X 15/64" 1

ML, 31G X 5/16" 0.3

ML, 31G X 5/16" 0.5

ML, 31G X 5/16" 1 ML

2

ST; OTC


67

Drug Name Drug

Category

Limits/

Required

NOVOLIN R RELION 3 ST; M; OTC;

QL

NOVOLIN R VIAL 3 ST; M; OTC;

QL

NOVOLOG FLEXPEN 3 ST; M; QL

NOVOLOG MIX 70/30

FLEXPEN 3 ST; M

NOVOLOG MIX 70/30

VIAL 3 ST; M

NOVOLOG PENFILL 3 ST; M; QL

NOVOLOG U-100 VIAL 3 ST; M

NOVOTWIST PEN

NEEDLE 2 ST; OTC

TOUJEO MAX

SOLOSTAR 2 M; QL

TOUJEO SOLOSTAR 2 M; QL

TRESIBA 2 M; QL

TRESIBA

FLEXTOUCH 2 M; QL

Electrolytes / Minerals

/ Metals / Vitamins

ACTIVE FE 3

adc/f (0.5mg/ml) 5 ACA

alcohol 6 MSD

AMINO ACID

INTRAVENOUS

SOLUTION 5 %

6

MSD

aminobenzoate

potassium 1 M

AMINOPROTECT 6 MSD

AMINOSYN II 6 MSD

AMINOSYN-PF 6 MSD

AQUASOL A 2

ARGININE HCL

INJECTION 3

ascorbic acid injection 6 MSD

AXIFOL 3

B-12 COMPLIANCE

INJECTION 6 MSD

BCAA INJECTION 3

CALCIFOL 3

Drug Name Drug

Category

Limits/

Required

INSULIN PEN

NEEDLES 29G X

12.7MM , 29G X 12MM

, 29G X 5MM , 29G X

8MM , 30G X 8 MM ,

31G X 5 MM , 31G X 6

MM , 31G X 8 MM ,

32G X 4 MM , 32G X 5

MM , 32G X 6 MM ,

33G X 4 MM , 33G X 5

MM , 33G X 6 MM

2

ST; OTC

INSULIN PEN

NEEDLES 29G X

12.7MM , 31G X 5 MM

, 31G X 6 MM , 31G X

8 MM , 32G X 4 MM

2

ST

INSULIN SYRINGES 2 ST; OTC

LANTUS SOLOSTAR 2 M; QL

LANTUS U-100 VIAL 2 M; QL

LEVEMIR U-100

FLEXTOUCH 2 M; QL

LEVEMIR U-100 VIAL 2 M; QL

MAXICOMFORT SYR

27G X 1/2" 2 ST; OTC

NOVOFINE

AUTOCOVER PEN

NEEDLE

2

ST; OTC

NOVOFINE PEN

NEEDLE 2 ST; OTC

NOVOFINE PLUS PEN

NEEDLE 2 ST; OTC

NOVOLIN 70/30

FLEXPEN 3

ST; M; OTC;

QL

NOVOLIN 70/30

FLEXPEN RELION 3

ST; M; OTC;

QL

NOVOLIN 70/30

RELION 3

ST; M; OTC;

QL

NOVOLIN 70/30 VIAL 3 ST; M; OTC;

QL

NOVOLIN N RELION 3 ST; M; OTC;

QL

NOVOLIN N VIAL 3 ST; M; OTC;

QL


68

Drug Name Drug

Category

Limits/

Required

CLINIMIX

E/DEXTROSE (5/15) 6 MSD

CLINIMIX

E/DEXTROSE (5/20) 6 MSD

CLINIMIX N14G30E 6 MSD



clinimix/dextrose

(4.25/10) solution 4.25

% intravenous

6

MSD

CLINIMIX/DEXTROSE

(4.25/10) SOLUTION

4.25 %

INTRAVENOUS

6

MSD

clinimix/dextrose

(4.25/25) 6 MSD

CLINIMIX/DEXTROSE

(4.25/5) 6 MSD

CLINIMIX/DEXTROSE

(5/15) 6 MSD

CLINIMIX/DEXTROSE

(5/20) 6 MSD

CLINIMIX/DEXTROSE

(5/25) 6 MSD

clinisol sf 6 MSD

COPPER CHLORIDE 6 MSD

corvita 150 1

CORVITE 150 3

CORVITE FE 3

cyanocobalamin


mcg/ml

1

CYANOCOBALAMIN

INJECTION

SOLUTION 2000

MCG/ML

2

cytra k crystals 1

deferasirox 1 M; S

dehydrated alcohol 6 MSD

delflex-lc/1.5%

dextrose 6 MSD

Drug Name Drug

Category

Limits/

Required

CALCIUM CHLORIDE

SOLUTION 10 %

INTRAVENOUS

6

MSD

calcium chloride

solution 10 %

intravenous

6

MSD

calcium gluconate 6 MSD

calcium gluconate

anhydrous 6 MSD

calcium gluconate


CALCIUM

GLUCONATE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

MSD

CALCIUM

GLUCONATE-NACL

INTRAVENOUS

SOLUTION 1-0.675

GM/50ML-%, 1-0.9

GM/100ML-%, 2-0.675

GM/100ML-%

6

MSD

calcium-folic acid plus d 1

CALM 3

CARBAGLU 3 PA; M; S

CARDIOPLEGIC 6 MSD

CARNITOR ORAL 3 M

CARNITOR SF 3 M

CENTRATEX 3

CHEMET 2

chromic chloride

intravenous 6 MSD

CITRANATAL

MEDLEY 3

CLINIMIX

E/DEXTROSE (2.75/5) 6 MSD

CLINIMIX

E/DEXTROSE

(4.25/10)

6

MSD

CLINIMIX

E/DEXTROSE (4.25/5) 6 MSD


69

Drug Name Drug

Category

Limits/

Required

ERGOCAL 3 M

ergocalciferol oral

capsule 1 M

ESCAVITE 3

ESCAVITE D 3

ESCAVITE LQ 3

EXJADE 3 M; S

FERIVA 21/7 3

FERIVAFA 3

ferocon 1

ferotrinsic 1

FERRALET 90 3

ferraplus 90 1

FERRIPROX 3 M; S

FERRLECIT 6 MSD

ferrocite plus 1

FERRO-PLEX

HEMATINIC 3

FERROTRIN 3

FLORIVA ORAL

LIQUID 5 ACA

floriva oral tablet

chewable 0.25 mg 3

FLORIVA ORAL

TABLET CHEWABLE

0.5 MG, 1 MG

3

FLORIVA PLUS 5 ACA

FLUORABON 5 M; ACA

fluoritab oral solution 5 M; ACA

fluoritab oral tablet

chewable 0.55 (0.25 f)

mg, 1.1 (0.5 f) mg

5

M; ACA

fluoritab oral tablet

chewable 2.2 (1 f) mg 1 M

FLURA-DROPS 5 M; ACA

folic acid injection 1

folic acid oral tablet 1

mg 1 M


mcg 5 ACA; OTC

Drug Name Drug

Category

Limits/

Required

delflex-lc/2.5%

dextrose 6 MSD

delflex-lc/4.25%

dextrose solution 483

mosm/l intraperitoneal

6

MSD

DELFLEX-LC/4.25%

DEXTROSE

SOLUTION 483

MOSM/L

INTRAPERITONEAL

6

MSD

delflex-sm/1.5%

dextrose 6 MSD

DEXPANTHENOL

INJECTION 3

dextrose intravenous

solution 10 %, 20 %, 30

%, 40 %, 5 %, 70 %

6

MSD

DEXTROSE

SOLUTION 250

MG/ML

INTRAVENOUS

6

MSD

dextrose solution 250

mg/ml intravenous 6 MSD

DEXTROSE

SOLUTION 50 %

INTRAVENOUS

6

MSD

dextrose solution 50 %

intravenous 6 MSD

DIANEAL LOW

CALCIUM/1.5% DEX 6 MSD

DIANEAL LOW


DIANEAL LOW


DRISDOL 3 M

EFFER-K ORAL

TABLET

EFFERVESCENT 10

MEQ, 20 MEQ

3

effer-k oral tablet

effervescent 25 meq 1 M

elite-ob 3

ELLIOTTS B 6 MSD

ENBRACE HR 3


70

Drug Name Drug

Category

Limits/

Required

infuvite pediatric

solution intravenous 6 MSD

INFUVITE PEDIATRIC

SOLUTION

INTRAVENOUS

6

MSD

INJECTAFER 6 MSD

INTEGRA F 3

intralipid intravenous

emulsion 20 % 6 MSD

INTRALIPID

INTRAVENOUS

EMULSION 30 %

6

MSD

iodine strong oral 1

IONOSOL-MB IN D5W 6 MSD

IROSPAN 24/6 3

IS 24/6 3

ISOLYTE-S 6 MSD

JADENU 3 M; S

JADENU SPRINKLE 3 M; S

JYNARQUE 3 PA; S; QL

KABIVEN 6 MSD

KCL (IN NACL 0.9%)

INTRAVENOUS

SOLUTION 10

MEQ/100ML, 20

MEQ/250ML

6

MSD

KCL-LIDOCAINE-

NACL 6 MSD

kionex 1

klor-con 1 M

klor-con 10 1 M

klor-con m10 1 M

KLOR-CON M15 1 M

klor-con m20 1 M

klor-con sprinkle 1 M

klor-con/ef 1 M

K-PHOS 2 M

K-PHOS NO 2 3

K-PHOS-NEUTRAL 1 M

k-prime 1 M

Drug Name Drug

Category

Limits/

Required


mcg 5 M; ACA; OTC

FOLI-D 3

FOLITE 3

FOLIVANE-F 3

foltrin 1

FOLVITE-D 3

FREAMINE HBC 6 MSD

FREAMINE III 6 MSD

FUSION PLUS 3

FUSION SPRINKLES 3

GABA 3

GALZIN 3

GENICIN VITA-D 3

glucose intravenous 6 MSD

GLUTATHIONE

INJECTION 3

GLYCINE INJECTION 3

gnp folic acid 5 ACA; OTC

hematinic plus

vit/minerals 1

hematogen fa 1

hematogen forte 1

HEMATRON-AF 3

HEMETAB 1

HEMOCYTE PLUS 3

hemocyte-plus 1

hepatamine 6 MSD

hydroxocobalamin

acetate 1

hyperlyte-cr 6 MSD

ICAR-C PLUS 3

iferex 150 forte 1

infuvite adult injectable

intravenous 6 MSD

INFUVITE ADULT

INJECTABLE

INTRAVENOUS

6

MSD


71

Drug Name Drug

Category

Limits/

Required

magnesium sulfate


gm/50ml, 20 gm/500ml,

4 gm/100ml, 4

gm/50ml, 40

gm/1000ml

6

MSD

MAGNESIUM

SULFATE SOLUTION

50 % INJECTION

3

magnesium sulfate

solution 50 % injection 6 MSD

MAGNESIUM

SULFATE-LACT

RINGERS

6

MSD

MAGNESIUM

SULFATE-NACL 6 MSD

MANGANESE

CHLORIDE 6 MSD

MAXFE ORAL TABLET 3

MEPHYTON 3

METHYLCOBALAMIN

INJECTION 3

M-NATAL PLUS 1

multi prenatal 5 ACA; OTC

multigen 1

multigen folic 1

multigen plus 1

multi-vit/iron/fluoride 5 ACA

multi-vitamin/fluoride 5 ACA

multivitamin/fluoride

oral solution 5 ACA


oral tablet chewable

0.25 mg, 0.5 mg

5

ACA

MULTIVITAMIN/FLUO

RIDE ORAL TABLET

CHEWABLE 0.25-0.3

MG, 0.5-0.3 MG, 1-0.3

MG

3


oral tablet chewable 1

mg

1

Drug Name Drug

Category

Limits/

Required

K-TAB 1 M

k-tan plus 1

lactated ringers

intravenous 6 MSD

LEVOCARNITINE

INJECTION 3

levocarnitine oral

solution 1 M

levocarnitine oral tablet 1 M

LIPO 3

LIPO-C 3

LIQUIVIDA

HYDRATION 6 MSD

LOKELMA 2 M

ludent oral tablet

chewable 0.55 (0.25 f)

mg, 1.1 (0.5 f) mg

5

M; ACA

ludent oral tablet

chewable 2.2 (1 f) mg 1 M

LYSINE HCL

INJECTION 3

M.V.I. ADULT 6 MSD

M.V.I. PEDIATRIC 6 MSD

MAGNEBIND 400 3

magnesium chloride

injection 1

magnesium sulfate in

d5w intravenous

solution 1-5 gm/100ml-

%

6

MSD

MAGNESIUM

SULFATE IN D5W

INTRAVENOUS

SOLUTION 1-5

GM/50ML-%, 2-5

GM/100ML-%, 2-5

GM/50ML-%, 3-5

GM/50ML-%, 4-5

GM/50ML-%, 50-5

GM/500ML-%, 6-5

GM/100ML-%, 6-5

GM/50ML-%

6

MSD


72

Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

multivitamin/fluoride/iro

n 5 ACA

plenamine 6 MSD

pnv prenatal plus

multivit+dha 3

multi-

vitamin/fluoride/iron 5 ACA

poly-iron 150 forte 1

multivitamins/fluoride 5 ACA

polysaccharide iron

forte 1

mvc-fluoride oral tablet

chewable 0.25 mg, 0.5

mg

5

ACA POLY-VI-FLOR 3

POLY-VI-FLOR FS 3 mvc-fluoride oral tablet

chewable 1 mg 1

POLY-VI-FLOR/IRON 3

pot bicarb-pot chloride 1 M myferon 150 forte 1

POTABA 3 M na ferric gluc cplx in

sucrose 6 MSD

potassium acetate

intravenous 6 MSD

n-acetyl-l-cysteine oral 2

potassium bicarbonate

oral 1 M nafrinse 1 M

nafrinse drops 5 M; ACA

potassium chloride crys

er 1 M NASCOBAL 2 M

NEOKE ALCAR 3

potassium chloride er 1 M

NEPHRAMINE 6 MSD

potassium chloride in

nacl intravenous

solution 20-0.9 meq/l-

%, 40-0.9 meq/l-%

6

MSD

NEPHRON FA 3

NESTABS 3

NEUT 6 MSD

potassium chloride

intravenous solution 6 MSD NICOMIDE 3

NIFEREX 3

POTASSIUM

CHLORIDE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

6

MSD

NUFERA 3

nutrilipid 6 MSD

NUTRIVIT 2

OMEGAVEN 6 MSD

potassium chloride oral 1 M

ONE-A-DAY WOMENS

PRENATAL 1 5 ACA; OTC

potassium citrate er 1

potassium citrate-citric

acid 1

ORACIT 3

PERIKABIVEN 6 MSD

potassium phosphates 6 MSD

phospha 250 neutral 1 M

PREGENNA 3

phosphorous 1 M

PREMASOL 6 MSD


73

phospho-trin 250

neutral 1 M

PRENAISSANCE 3

PRENATA 3 PHYSICIANS EZ USE

B-12 6 MSD

prenatal multi +dha 5 ACA; OTC

prenatal oral tablet 27-

0.8 mg 5 ACA phytonadione injection 6 MSD

phytonadione oral 1


74

Drug Name Drug

Category

Limits/

Required

SELECT-OB ORAL

TABLET CHEWABLE

29-1 MG

3

se-tan plus 1

SMOFLIPID 6 MSD

sod citrate-citric acid 1

sodium acetate

intravenous 6 MSD

sodium bicarbonate

intravenous solution 4.2

%, 7.5 %

6

MSD

SODIUM

BICARBONATE

SOLUTION 8.4 %

INTRAVENOUS

6

MSD

sodium bicarbonate

solution 8.4 %

intravenous

6

MSD

SODIUM

BICARBONATE-

DEXTROSE

6

MSD

sodium chloride

bacteriostatic 6 MSD

sodium chloride

injection 6 MSD

sodium chloride

intravenous 6 MSD

sodium fluoride oral

solution 5 M; ACA


tablet 1.1 (0.5 f) mg 5 M; ACA


tablet 2.2 (1 f) mg 1 M


tablet chewable 0.55

(0.25 f) mg, 1.1 (0.5 f)

mg

5

M; ACA


tablet chewable 2.2 (1

f) mg

1

M

sodium lactate

intravenous 6 MSD

Drug Name Drug

Category

Limits/

Required

prenatal oral tablet 27-1

mg 3

prenatal oral tablet 28-

0.8 mg 5 ACA; OTC

prenatal plus iron 1

PRISMASOL B22GK

4/0 6 MSD

PRISMASOL BGK

0/2.5 6 MSD

PRISMASOL BGK 2/0 6 MSD

PRISMASOL BGK

2/3.5 6 MSD

PRISMASOL BGK

4/2.5 6 MSD

PRISMASOL BK

0/0/1.2 6 MSD

PROCALAMINE 6 MSD

PROSOL 6 MSD

purevit dualfe plus 1

PYRIDOXINE HCL

SOLUTION 100

MG/ML INJECTION

3

pyridoxine hcl solution

100 mg/ml injection 1

QUFLORA FE 3

QUFLORA FE

PEDIATRIC 5 ACA

QUFLORA GUMMIES 3

quflora pediatric oral

solution 5 ACA


tablet chewable 0.25

mg, 0.5 mg

5

ACA


tablet chewable 1 mg 1

RELNATE DHA 3

RENATABS WITH

IRON 3

saline bacteriostatic 6 MSD

SALINE-PHENOL 3

SAMSCA 3 PA; S; QL


75

Drug Name Drug

Category

Limits/

Required

trientine hcl 1 PA; QL

TRIFERIC

HEMODIALYSIS

PACKET

6

MSD

trigels-f forte 1

trinate 1

TRINAZ 3

TRISODIUM

CITRATE/CRRT 6 MSD

TRI-VI-FLOR 3

TRI-VI-FLORO 3

tri-vitamin/fluoride 5 ACA

tri-vite/fluoride 5 ACA

TROPHAMINE 6 MSD

tryptophan oral 1

ULTRABAG/DIANEAL/

1.5% DEXTROSE 6 MSD

ULTRABAG/DIANEAL/

2.5% DEXTROSE 6 MSD

ULTRABAG/DIANEAL/

4.25% DEX 6 MSD

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3

VELTASSA 3 M; S

VENOFER 6 MSD

virt-phos 250 neutral 1 M

VITAFOL 3

VITAFOL-OB+DHA 3

vitamin b complex 100 6 MSD

vitamin b-complex 100 6 MSD

vitamin d

(ergocalciferol) oral

capsule 1.25 mg

(50000 ut)

1

M

vitamin k1 injection 6 MSD

vitamins acd-fluoride 5 ACA

vp-pnv-dha 3

wheat germ oil 2

ZINC TRACE METAL 6 MSD

Drug Name Drug

Category

Limits/

Required

SODIUM

PHOSPHATE-NACL

INTRAVENOUS

SOLUTION 15

MMOL/100ML, 15

MMOL/250ML, 30

MMOL/250ML

6

MSD

sodium phosphates 6 MSD

SODIUM

PHOSPHATES-

DEXTROSE

INTRAVENOUS

SOLUTION 15

MMOL/250ML

6

MSD

sodium polystyrene

sulfonate oral 1

sodium polystyrene

sulfonate rectal

suspension 30

gm/120ml

1

sodium polystyrene

sulfonate rectal

suspension 50

gm/200ml

3

sps 1

swabflush saline flush 6 MSD

SYNTHAMIN 17 6 MSD

SYPRINE 3 ST; QL

TARON FORTE 1

taron-crystals 1

TAURINE INJECTION 3

TEXAVITE LQ 3

thiamine hcl injection 1

tl icon 1

TL-FLUORIVITE 3

tpn electrolytes 6 MSD

TRAVASOL 6 MSD

TRI-AMINO 3

TRICARE PRENATAL

DHA ONE 3

tricitrates 1

tricon 1


76

Drug Name Drug

Category

Limits/

Required

NEXIUM ORAL

CAPSULE DELAYED

RELEASE 40 MG

3

ST; M; QL

NEXIUM ORAL

PACKET 2 ST; M; QL

nizatidine 1 M

omeppi 2 M; QL

omeprazole oral

capsule delayed

release

1

M; QL

omeprazole oral tablet

delayed release 1 OTC; QL

omeprazole oral tablet

delayed release

dispersible

1

OTC; QL

omeprazole-sodium

bicarbonate 2 M; QL

pantoprazole sodium

intravenous 6 MSD; QL

pantoprazole sodium

oral tablet delayed

release 20 mg

1

M; QL

pantoprazole sodium

tablet delayed release

40 mg oral

2

M; QL

pantoprazole sodium

tablet delayed release

40 mg oral

1

M; QL

PEPCID 3 M

PREVACID ORAL

CAPSULE DELAYED

RELEASE 30 MG

3

ST; M; QL

PREVACID SOLUTAB

ORAL TABLET

DISPERSIBLE 15 MG,

30 MG

3

ST; M; QL

PRILOSEC 3 ST; M; QL

PROTONIX

INTRAVENOUS 6 MSD; QL

PROTONIX ORAL 3 ST; M; QL

rabeprazole sodium

oral tablet delayed

release

1

M; QL

Drug Name Drug

Category

Limits/

Required

Gastrointestinal

Agents - Drugs for

Acid Reflux and Ulcer

ACIPHEX 3 ST; M; QL

ACIPHEX SPRINKLE 3 ST; M; QL

CARAFATE ORAL

SUSPENSION 2 M

CARAFATE ORAL

TABLET 3 M

cimetidine hcl 1 M

cimetidine oral tablet

200 mg 1

cimetidine oral tablet

300 mg, 400 mg, 800

mg

1

M

CYTOTEC 3 M

DEPRIZINE FUSEPAQ 3 M

DEXILANT 3 ST; M; QL

esomeprazole

magnesium 1 M; QL

esomeprazole sodium 6 MSD; QL

FAMOTIDINE IN NACL 6 MSD

famotidine intravenous 6 MSD

famotidine oral

suspension

reconstituted

1

M

famotidine oral tablet

20 mg, 40 mg 1 M

famotidine premixed 6 MSD

gnp lansoprazole 1 M; OTC; QL

heartburn treatment 24

hour 1 M; OTC; QL

lansoprazole oral

capsule delayed

release

1

M; QL

lansoprazole oral tablet

dispersible 15 mg, 30

mg

1

M; QL

misoprostol oral 1 M

NEXIUM I.V. 6 MSD; QL


77

Drug Name Drug

Category

Limits/

Required

citroma 5 ST; ACA; OTC

clearlax 5 ST; ACA; OTC

CLENPIQ 5 ACA

COLYTE WITH

FLAVOR PACKS 3

constulose 1 M

cromolyn sodium oral 1 M

CUVPOSA 3 M

dicyclomine hcl

intramuscular 6 MSD

dicyclomine hcl oral 1

diphenoxylate-atropine 1

DONNATAL 3

ENTEREG 3

enulose 1 M

ex-lax ultra 5 ST; ACA; OTC

GASTROCROM 3 M

GATTEX 4 M; S

gavilax oral powder 5 ST; ACA; OTC

gavilyte-c 5 ACA

gavilyte-g 5 ACA

gavilyte-h 5 ACA

gavilyte-n with flavor

pack 5 ACA

generlac 1 M

gentle laxative oral 5 ST; ACA; OTC

GIALAX 5 ACA

GLYCATE 3

glycolax 5 ST; ACA; OTC

glycopyrrolate injection

solution 6 MSD

GLYCOPYRROLATE

INJECTION

SOLUTION

PREFILLED SYRINGE

6

MSD

GLYCOPYRROLATE

INTRAVENOUS 6 MSD

glycopyrrolate oral

tablet 1 mg, 2 mg 1

Drug Name Drug

Category

Limits/

Required

ranitidine hcl injection 6 MSD

ranitidine hcl oral

capsule 1 M

ranitidine hcl oral syrup 1 M

ranitidine hcl oral tablet

150 mg, 300 mg 1 M

sm esomeprazole

magnesium 1 M; OTC; QL

sucralfate oral tablet 1 M

YOSPRALA 3 ST; M; QL

ZANTAC INJECTION 6 MSD

ZEGERID 3 ST; M; QL

Gastrointestinal

Agents - Drugs for

Bowel, Intestine and

Stomach Conditions

ACTIGALL 3 M

alosetron hcl 1 M

AMITIZA 2 M; QL

amoxicill-clarithro-

lansopraz 1 QL

ANASPAZ 1 M

ATROPEN 3

atropine sulfate

injection 6 MSD

ATROPINE SULFATE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

0.8 MG/2ML, 1

MG/2.5ML, 2 MG/5ML

6

MSD

belladonna alkaloids-

opium 1

BENTYL 6 MSD

bisacodyl ec 5 ST; ACA; OTC

cascara sagrada oral

fluid extract 3

CHENODAL 3 PA; S

chlordiazepoxide-

clidinium 1

CHOLBAM 3 PA; M; S


78

Drug Name Drug

Category

Limits/

Required

methscopolamine

bromide oral 1

milk of magnesia oral

suspension 1200

mg/15ml, 400 mg/5ml

5

ST; ACA; OTC

mineral oil heavy oral 2

MOTEGRITY 3 M

MOTOFEN 3

MOVANTIK 2 QL

MOVIPREP 5 ACA

MYTESI 3 M; QL

NULYTELY WITH

FLAVOR PACKS 3

OMECLAMOX-PAK 3 QL

opium 1

oscimin oral tablet 1 M

oscimin sr 1 M

oscimin sublingual 1 M

OSMOPREP 5 ACA

paregoric 1

PCP 100 3

peg 3350 oral packet 5 ST; ACA; OTC

peg 3350/electrolytes 5 ACA

peg 3350-kcl-na bicarb-

nacl 5 ACA

peg-3350/electrolytes 5 ACA

peg-prep 5 ACA

phenobarbital-

belladonna alk 1

phenohytro 1

PLENVU 5 ACA

polyethylene glycol

3350 oral packet 5 ST; ACA

PREPOPIK 5 ACA

PRODIGEN 3

propantheline bromide

oral 1

PYLERA 2

RELISTOR ORAL 3 QL

Drug Name Drug

Category

Limits/

Required

GLYCOPYRROLATE

ORAL TABLET 1.5 MG 1

glycopyrrolate pf 6 MSD

GLYRX-PF 6 MSD

GOLYTELY ORAL

SOLUTION

RECONSTITUTED

227.1 GM

5

ACA

GOLYTELY ORAL

SOLUTION

RECONSTITUTED 236

GM

3

healthylax 5 ST; ACA; OTC

hyoscyamine sulfate er 1 M

hyoscyamine sulfate

oral elixir 1 M

hyoscyamine sulfate

oral solution 1 M

hyoscyamine sulfate

oral tablet 1 M

hyoscyamine sulfate sl 1 M

hyoscyamine sulfate

sublingual 1 M

hyosyne 1 M

KRISTALOSE 3 M

lactulose 1 M

lactulose

encephalopathy 1 M

LEVBID 3 M

LEVSIN INJECTION 6 MSD

LEVSIN ORAL 3 M

LEVSIN/SL 3 M

LIBRAX 3 ST

LINZESS 2 M; QL

LOMOTIL 3

loperamide hcl oral

capsule 1

LOTRONEX 3 M

magnesium citrate oral

solution 5 ST; ACA; OTC


79

Drug Name Drug

Category

Limits/

Required

ELAPRASE 6 MSD

ELELYSO 6 MSD

ENZADYNE 3

EXONDYS 51 6 MSD

FABRAZYME 6 MSD

GALAFOLD 4 PA; M; S; QL

KANUMA 6 MSD

KUVAN 3 PA; M; S

LUMIZYME 6 MSD

MEPSEVII 6 MSD

miglustat 1 M; S

MYALEPT 3 PA; M; S

NAGLAZYME 6 MSD

nitisinone 1 M

NITYR 3 M; S

OCALIVA 3 PA; M; S; QL

ORFADIN 3 M; S

PALYNZIQ 3 PA; M; S; QL

PANCREAZE 3 ST; M

PERTZYE 3 ST; M

PROCYSBI 4 ST; M; S

RAVICTI 3 M; S

REVCOVI 3 S

sod benz-sod

phenylacet 6 MSD

sodium phenylbutyrate

oral 1 M

STRENSIQ 3 M; S

SUCRAID 3 M; S

VIMIZIM 6 MSD

VIOKACE 2 M

VPRIV 6 MSD

XURIDEN 3 M; S; QL

ZAVESCA 4 M; S

ZENPEP 2 M

Drug Name Drug

Category

Limits/

Required

RELISTOR

SUBCUTANEOUS 2 QL

RESTORA RX 3

SEROSTIM 3 PA; M; S

sodium bicarbonate

oral powder 1

SUPREP BOWEL

PREP KIT 5 ACA

SYMAX DUOTAB 3 M

symax-sl 1 M

symax-sr 1 M

SYMPROIC 2 QL

trilyte 5 ACA

TRULANCE 2 M; QL

URSO 250 3 M

URSO FORTE 3 M

ursodiol oral 1 M

URSODIOL+SYRSPE

ND SF 3 M

VIBERZI 2 M; QL

VSL#3 DS 3

XERMELO 3 PA; M; S; QL

ZELAC 3

ZORBTIVE 3 PA; M; S

Genetic or Enzyme

Disorder - Drugs for

Replacement,

Modification,

Treatment

ALDURAZYME 6 MSD

AMMONUL 6 MSD

BRINEURA 6 M; MSD

BUPHENYL 3 M

CERDELGA 3 M; S

CEREZYME 6 MSD

CREON 2 M

CRYSVITA 6 M; MSD

CYSTADANE 3 M; S

CYSTAGON 3 PA; M; S


80

Drug Name Drug

Category

Limits/

Required

oxybutynin chloride er


release 24 hour 5 mg

1

M; QL

oxybutynin chloride oral 1 M

OXYTROL 3 ST; M; QL

penicillamine oral 1

phenazo oral tablet 200

mg 1

phenazopyridine hcl


mg

1

PHOSLYRA 2 M

phosphasal 1

PYRIDIUM 3

RENACIDIN 6 MSD

RENAGEL 3 ST; M

RENVELA 3 M

sevelamer carbonate 1 M

sevelamer hcl 1 M

solifenacin succinate 1 M

THIOLA 4 M; S

THIOLA EC 3 M

tolterodine tartrate 1 M

tolterodine tartrate er 1 M

TOVIAZ 2 ST; M

trospium chloride 1 M

trospium chloride er 1 M

URECHOLINE 3

uretron d/s 1

urimar-t 1

urin ds 1

UROGESIC-BLUE 1

uryl 1

ustell 1

uticap 1

utira-c 1

utrona-c 1

VELPHORO 2 M

VESICARE 2 ST; M

Drug Name Drug

Category

Limits/

Required

Genitourinary Agents

- Drugs for Bladder,

Genital and Kidney

Conditions

AURYXIA 3 M

bethanechol chloride

oral 1

calcium acetate (phos

binder) 1 M

CUPRIMINE 3 ST

darifenacin

hydrobromide er 1 M

DEPEN TITRATABS 2

DETROL 3 ST; M

DETROL LA 3 ST; M

DITROPAN XL ORAL

TABLET EXTENDED

RELEASE 24 HOUR

10 MG

3

ST; M

DITROPAN XL ORAL

TABLET EXTENDED

RELEASE 24 HOUR 5

MG

3

ST; M; QL

D-PENAMINE 2

ELMIRON 2

ENABLEX 3 ST; M

FEM PH 1

flavoxate hcl 1 M

FOSRENOL 3 ST; M

GELNIQUE 2 ST; M; QL

GELNIQUE PUMP 2 ST; M; QL

hyophen 1

INTRAROSA 3 M

lanthanum carbonate 1 M

LITHOSTAT 3 M

me/naphos/mb/hyo1 1

MYRBETRIQ 2 ST; M

oxybutynin chloride er


release 24 hour 10 mg,

15 mg

1

M


81

Drug Name Drug

Category

Limits/

Required

BETAMETHASONE

SOD PHOS & ACET

INJECTION

SUSPENSION 7 (4-3)

MG/ML

6

MSD

BETAMETHASONE

SOD PHOS & ACET

SUSPENSION 6 (3-3)

MG/ML INJECTION

6

MSD

betamethasone sod

phos & acet

suspension 6 (3-3)

mg/ml injection

6

MSD

BETAMETHASONE

SODIUM PHOSPHATE

INJECTION

6

MSD

BUPIVILOG 3

CELESTONE

SOLUSPAN 6 MSD

CONTRAST ALLERGY

PREMED PACK 3

CORTEF 3

cortisone acetate oral 1

DECADRON ORAL

TABLET 1

DEPO-MEDROL 6 MSD

DEXAMETHASONE

(LA) 6 MSD

DEXAMETHASONE

ACE & SOD PHOS 6 MSD

DEXAMETHASONE

INTENSOL 1

dexamethasone oral

elixir 1

dexamethasone oral

solution 1

dexamethasone oral

tablet 1

dexamethasone oral

tablet therapy pack 1 ST

DEXAMETHASONE

SOD PHOS-BUPIV 3

Drug Name Drug

Category

Limits/

Required

Genitourinary Agents

- Drugs for Prostate

Conditions

alfuzosin hcl er 1 M

AVODART 3 ST; M

CARDURA XL 3 M; QL

dutasteride oral 1 M

dutasteride-tamsulosin

hcl 1 M

finasteride oral tablet 5

mg 1 M

FLOMAX 3 ST; M

JALYN 3 ST; M

PROSCAR 3 ST; M

RAPAFLO 3 ST; M

silodosin 1 M

tamsulosin hcl 1 M

terazosin hcl 1 M; QL

UROXATRAL 3 ST; M

Hormonal Agents -

Adrenal

ACTIVE INJECTION

BLM-1 3

ACTIVE INJECTION

BM 3

ACTIVE INJECTION

DL 3

ACTIVE INJECTION

DLM 3

ACTIVE INJECTION

KIT L 3

ACTIVE INJECTION

KM 3

ACTIVE INJECTION

LM-DEP-2 3

ACTIVE INJECTION

M-1 3

BETA 1 KIT 6 MSD

BETALIDO 3


82

Drug Name Drug

Category

Limits/

Required

METHYLPREDNISOL

ONE ACETATE

INJECTION

SUSPENSION 50

MG/ML

6

MSD

METHYLPREDNISOL

ONE ACETATE

SUSPENSION 40

MG/ML INJECTION

6

MSD

methylprednisolone

acetate suspension 40

mg/ml injection

6

MSD

METHYLPREDNISOL

ONE ACETATE

SUSPENSION 80

MG/ML INJECTION

6

MSD

methylprednisolone

acetate suspension 80

mg/ml injection

6

MSD

methylprednisolone

oral 1

methylprednisolone

sodium succ 6 MSD

METHYLPREDNISOL

ONE-BUPIVACAINE 6 MSD

MILLIPRED 1

MILLIPRED DP 1

MILLIPRED DP 12-

DAY 1

MULTI-SPECIALTY 3

ORAPRED ODT 3

P-CARE D40MX 3

P-CARE D80MX 3

P-CARE K40 6 MSD

P-CARE K40G 6 MSD

P-CARE K40MX 3

P-CARE K80 6 MSD

P-CARE K80G 6 MSD

P-CARE K80MX 3

PEDIAPRED 1

POD-CARE 100K 6 MSD

POINT OF CARE KM 3

Drug Name Drug

Category

Limits/

Required

DEXAMETHASONE

SOD PHOS-NACL

INTRAVENOUS

SOLUTION 10-0.9

MG/50ML-%

6

MSD

dexamethasone sod

phosphate pf 6 MSD

dexamethasone

sodium phosphate

injection

6

MSD

DEXLIDO 3

DEXLIDO-M 3

DEXOPIN 3

DEXPAK 10 DAY 3 ST

DEXPAK 13 DAY 3 ST

DEXPAK 6 DAY 3 ST

DXEVO 11-DAY 3

DYURAL-40 3

DYURAL-80 3

DYURAL-L 3

DYURAL-LM 3

fludrocortisone acetate

oral 1 M

HIDEX 6-DAY 2 ST

hydrocortisone oral 1

KENALOG INJECTION 6 MSD

KENALOG-80 6 MSD

lidolog 1

LT INJECTION KIT 3

MARBETA-25 3

MARBETA-L 3

MARDEX-25 3

MEDROL 3

MEDROLOAN II SUIK 6 MSD

MEDROLOAN SUIK 6 MSD

METHYLPREDNISOL

ONE ACE-LIDO 3


83

Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

POINT OF CARE L.2 3 triamcinolone acetonide

suspension 40 mg/ml

injection

6

MSD POINT OF CARE L.5 3

POINT OF CARE LM

DEP 2 3

TRIAMCINOLONE

DIACETATE

INJECTION

6

MSD

prednisolone oral

solution 1

TRIAMCINOLONE-

BUPIVACAINE 6 MSD prednisolone sodium

phosphate oral 1

TRILOAN II SUIK 6 MSD PREDNISONE

INTENSOL 1

TRILOAN SUIK 6 MSD

ZILRETTA 6 MSD prednisone oral 1

Hormonal Agents -

Men's Health

PRO-C-DURE 5 6 MSD

PRO-C-DURE 6 6 MSD

ANADROL-50 3 RAYOS 3 ST

ANDRODERM 2 PA; M READYSHARP

ANESTH +

BETAMETH

3

ANDROGEL PUMP 3 PA; M

ANDROGEL

TRANSDERMAL GEL

20.25 MG/1.25GM

(1.62%), 40.5

MG/2.5GM (1.62%)

3

PA; M

READYSHARP

ANESTH +

DEXAMETH

3

READYSHARP

ANESTH +

METHYLPRED

3

ANDROGEL

TRANSDERMAL GEL

25 MG/2.5GM (1%), 50

MG/5GM (1%)

3

ST; M

READYSHARP

BETAMETHASONE 6 MSD

AVEED 6 PA; MSD READYSHARP

DEXAMETHASONE 6 MSD

danazol oral 1

DEPO-

TESTOSTERONE 3 PA ROPIDEX 3

SOLU-CORTEF 6 MSD

EC-RX

TESTOSTERONE 3 M SOLU-MEDROL 6 MSD

TAPERDEX 12-DAY 3 ST

FORTESTA 3 ST; M

TAPERDEX 6-DAY 3 ST

METHITEST 2 M

TAPERDEX 7-DAY 3 ST

methyltestosterone oral 1 M

TRIAMCINOLONE

ACETONIDE

INJECTION

SUSPENSION 50

MG/ML

6

MSD

NANDROLONE

DECANOATE

INJECTION

3

NANDROLONE- 3


84

TRIAMCINOLONE

ACETONIDE

SUSPENSION 40

MG/ML INJECTION

6

MSD

TESTOSTERONE CYP

NATESTO 3 ST; M

oxandrolone oral 1 QL

STRIANT 3 PA; M


85

Drug Name Drug

Category

Limits/

Required

Hormonal Agents -

Parathyroid

cinacalcet hcl 1 M

SENSIPAR 2 M

Hormonal Agents -

Pituitary

ACTHAR 6 PA; MSD

cabergoline 1 QL

DDAVP INJECTION 6 MSD

DDAVP NASAL 3 M

DDAVP ORAL 3 M

DDAVP RHINAL TUBE 3 M

desmopressin ace

spray refrig 1 M

desmopressin acetate

injection 6 MSD


oral 1 M


spray 1 M

EGRIFTA 3 PA; M; S; QL

ELIGARD 3 S; QL

FIRMAGON 3 S; QL

GENOTROPIN 3 PA; M; S

GENOTROPIN

MINIQUICK 3 PA; M; S

GHRP2-GHRP6-

SERMORELIN 3

GHRP2-SERMORELIN 3

HUMATROPE 3 PA; M; S

INCRELEX 3 PA; M; S

IPAMORELIN

ACETATE 3

leuprolide acetate

injection 1 S

LEUPROLIDE

ACETATE-

BUPIVACAINE

3

LUPANETA PACK 2 QL

LUPRON DEPOT (1-

MONTH) 3 S

Drug Name Drug

Category

Limits/

Required

TESTIM 3 ST; M

TESTOPEL 3 PA

TESTOSTERONE

COMPOUNDING KIT 3 M

TESTOSTERONE

CYPIONATE & PROP 3

TESTOSTERONE

CYPIONATE

INJECTION

3

PA

testosterone cypionate

intramuscular 1 PA

TESTOSTERONE

ENANTHATE

INJECTION

1

PA

testosterone enanthate

intramuscular 1 PA

TESTOSTERONE

IMPLANT 3 PA

TESTOSTERONE

PROPIONATE

INJECTION

3

testosterone

transdermal gel 10

mg/act (2%), 12.5

mg/act (1%), 20.25

mg/1.25gm (1.62%),

20.25 mg/act (1.62%),

25 mg/2.5gm (1%),

40.5 mg/2.5gm

(1.62%), 50 mg/5gm

(1%)

1

PA; M

testosterone

transdermal solution 1 PA; M

VOGELXO 3 ST; M

VOGELXO PUMP 3 ST; M

XYOSTED 3 PA; M

Hormonal Agents -

Osteoporosis

EVISTA 3 PA; M

OSPHENA 3 M

raloxifene hcl 1 PA; M


86

Drug Name Drug

Category

Limits/

Required

OXYTOCIN-SODIUM

CHLORIDE

INTRAVENOUS

SOLUTION 20-0.9

UNT/L-%, 20-0.9

UT/500ML-%, 30-0.9

UNIT/L-%, 30-0.9

UT/500ML-%, 40-0.9

UNIT/L-%

6

MSD

PITOCIN 6 MSD

SAIZEN 3 PA; M; S

SAIZENPREP 3 PA; M; S

SANDOSTATIN 4 M; S

SANDOSTATIN LAR

DEPOT 6 MSD; QL

SIGNIFOR 6 M; MSD; QL

SIGNIFOR LAR 6 M; MSD; QL

SOMATULINE DEPOT 3 S

SOMAVERT 3 M; S

STIMATE 2 M

SUPPRELIN LA 6 MSD; QL

SYNAREL 2

TRELSTAR MIXJECT 6 MSD; QL

TRIPTODUR 6 MSD; QL

VANTAS 6 MSD; QL

VASOPRESSIN-

SODIUM CHLORIDE

INTRAVENOUS

SOLUTION 100-0.9

UT/100ML-%, 100-0.9

UT/250ML-%, 40-0.9

UT/100ML-%

6

MSD

VASOSTRICT 6 MSD

ZOLADEX 6 MSD; QL

ZOMACTON 3 PA; M; S

Hormonal Agents -

Prostaglandins

carboprost

tromethamine 6 MSD

CERVIDIL 3

HEMABATE 6 MSD

KORLYM 4 PA; M; S; QL

Drug Name Drug

Category

Limits/

Required

LUPRON DEPOT (3-

MONTH) 3 S

LUPRON DEPOT (4-

MONTH)

INTRAMUSCULAR KIT

30MG

3

S

LUPRON DEPOT (6-

MONTH)

INTRAMUSCULAR KIT

45MG

3

S

LUPRON DEPOT-PED

(1-MONTH) 3 PA; S

LUPRON DEPOT-PED

(3-MONTH) 2 PA

NOCDURNA 3 M

NOCTIVA 3 ST; M

NORDITROPIN

FLEXPRO 3 PA; M; S

NUTROPIN AQ

NUSPIN 10 4 PA; M; S

NUTROPIN AQ

NUSPIN 20 4 PA; M; S

NUTROPIN AQ

NUSPIN 5 4 PA; M; S

octreotide acetate 1 M; S

OMNITROPE

SUBCUTANEOUS

SOLUTION

4

PA; M; S

OMNITROPE

SUBCUTANEOUS

SOLUTION

RECONSTITUTED

3

PA; M; S

ORILISSA 2 PA; QL

oxytocin injection 6 MSD

OXYTOCIN-

DEXTROSE 6 MSD

OXYTOCIN-

LACTATED RINGERS 6 MSD


87

Drug Name Drug Limits/ Drug Name Drug Limits/

Category Required Category Required

Hormonal Agents - blisovi 24 fe 5 M; ACA Sex Hormones and

blisovi fe 1.5/30 5 M; ACA Birth Control

blisovi fe 1/20 5 M; ACA ACTIVELLA 3 M

briellyn 5 M; ACA afirmelle 5 M; ACA

camila 5 M; ACA ALORA 3 M; QL

camrese 5 M; ACA; QL altavera 5 M; ACA

camrese lo 5 M; ACA; QL alyacen 1/35 5 M; ACA

caziant 5 M; ACA alyacen 7/7/7 5 M; ACA

chateal 5 M; ACA amabelz 1 M

chateal eq 5 M; ACA amethia 5 M; ACA; QL

CLIMARA 3 M; QL amethia lo 5 M; ACA; QL

CLIMARA PRO 3 ST; M; QL amethyst 5 M; ACA

COMBIPATCH 2 M ANGELIQ 3 M

covaryx 1 M ANNOVERA 5 M; ACA

covaryx hs 1 M apri 5 M; ACA

CRINONE VAGINAL

GEL 4 % 2 QL aranelle 5 M; ACA

ashlyna 5 M; ACA; QL

cryselle-28 5 M; ACA

aubra 5 M; ACA

cyclafem 1/35 5 M; ACA

aubra eq 5 M; ACA

cyclafem 7/7/7 5 M; ACA

aurovela 1.5/30 5 M; ACA

cyred 5 M; ACA

aurovela 1/20 5 M; ACA

cyred eq 5 M; ACA

aurovela 24 fe 5 M; ACA

dasetta 1/35 5 M; ACA

aurovela fe 1.5/30 5 M; ACA

dasetta 7/7/7 5 M; ACA

aurovela fe 1/20 5 M; ACA

daysee 5 M; ACA; QL

aviane 5 M; ACA

deblitane 5 M; ACA

AYGESTIN 3 M

DELESTROGEN 3

ayuna 5 M; ACA

delyla 5 M; ACA

azurette 5 M; ACA

DEPO-ESTRADIOL 2


88

BALCOLTRA 5 M; ACA

DEPO-PROVERA

INTRAMUSCULAR

SUSPENSION 150

MG/ML

3

QL

balziva 5 M; ACA

bekyree 5 M; ACA

BEYAZ 3 ST; M

DEPO-PROVERA

INTRAMUSCULAR

SUSPENSION 400

6

MSD

BI-EST 80:20

PROGESTERONE 3

3 BIEST/PROGESTERO MG/ML

NE

BIJUVA 3 M


89

Drug Name Drug

Category

Limits/

Required

estradiol oral 1 M

estradiol transdermal 1 M; QL

estradiol vaginal 1 M

estradiol valerate

intramuscular 1

estradiol-norethindrone

acet 1 M

ESTRING 2 M; QL

ESTROGEL 3 ST; M; QL

ESTROSTEP FE 3 ST; M

ethynodiol diac-eth

estradiol 5 M; ACA

EVAMIST 3 M; QL

FALESSA 5 M; ACA

falmina 5 M; ACA

fayosim 5 M; ACA; QL

FEMHRT LOW DOSE 3 M

FEMRING 3 ST; M; QL

femynor 5 M; ACA

fyavolv 1 M

GENERESS FE 3 ST; M

gianvi 5 M; ACA

hailey 1.5/30 5 M; ACA

hailey 24 fe 5 M; ACA

heather 5 M; ACA

hydroxyprogesterone

caproate intramuscular 6 MSD

IMVEXXY

MAINTENANCE PACK 3 M

IMVEXXY STARTER

PACK 3 M

incassia 5 M; ACA

introvale 5 M; ACA; QL

isibloom 5 M; ACA

jasmiel 5 M; ACA

jencycla 5 M; ACA

jinteli 1 M

jolessa 5 M; ACA; QL

juleber 5 M; ACA

Drug Name Drug

Category

Limits/

Required

DEPO-PROVERA

INTRAMUSCULAR

SUSPENSION

PREFILLED SYRINGE

3

QL

DEPO-SUBQ

PROVERA 104 5 ACA; QL

desogestrel-ethinyl

estradiol 5 M; ACA

DIVIGEL

TRANSDERMAL GEL

0.25 MG/0.25GM, 0.5

MG/0.5GM, 1 MG/GM

2

M; QL

DIVIGEL

TRANSDERMAL GEL

0.75 MG/0.75GM

2

M

dotti 1 M; QL

drospiren-eth estrad-

levomefol 5 M; ACA

drospirenone-ethinyl

estradiol 5 M; ACA

DUAVEE 2 M

EC-RX ESTRADIOL 3 M

EC-RX

PROGESTERONE 3

eemt 1 M

eemt hs 1 M

ELESTRIN 3 M; QL

elinest 5 M; ACA

ELLA 5 ACA; QL

emoquette 5 M; ACA

enpresse-28 5 M; ACA

enskyce 5 M; ACA

errin 5 M; ACA

est estrogens-

methyltest 1 M

est estrogens-

methyltest ds 1 M

est estrogens-

methyltest hs 1 M

estarylla 5 M; ACA

ESTRACE 3 M


90

Drug Name Drug

Category

Limits/

Required

LOESTRIN FE 1/20 3 ST; M

lopreeza 1 M

loryna 5 M; ACA

LOSEASONIQUE 3 ST; M; QL

low-ogestrel 5 M; ACA

lo-zumandimine 5 M; ACA

lutera 5 M; ACA

lyza 5 M; ACA

MAKENA 6 MSD

marlissa 5 M; ACA

medroxyprogesterone

acetate intramuscular 5 ACA; QL

medroxyprogesterone

acetate oral 1 M

MEGACE ES 3 M

megestrol acetate oral

suspension 40 mg/ml,

400 mg/10ml

1


suspension 625 mg/5ml 1 M


tablet 1 S

melodetta 24 fe 5 M; ACA

MENEST 3 M

MENOSTAR 3 M; QL

mibelas 24 fe 5 M; ACA

microgestin 1.5/30 5 M; ACA

microgestin 1/20 5 M; ACA

microgestin fe 1.5/30 5 M; ACA

microgestin fe 1/20 5 M; ACA

mili 5 M; ACA

mimvey 1 M

mimvey lo 1 M

MINASTRIN 24 FE 3 ST; M

MINIVELLE 3 ST; M; QL

MIRCETTE 3 ST; M

MIRENA (52 MG) 6 MSD

mono-linyah 5 M; ACA

NATAZIA 5 M; ACA

Drug Name Drug

Category

Limits/

Required

junel 1.5/30 5 M; ACA

junel 1/20 5 M; ACA

junel fe 1.5/30 5 M; ACA

junel fe 1/20 5 M; ACA

junel fe 24 5 M; ACA

kaitlib fe 5 M; ACA

kalliga 5 M; ACA

kariva 5 M; ACA

kelnor 1/35 5 M; ACA

kelnor 1/50 5 M; ACA

kurvelo 5 M; ACA

KYLEENA 6 MSD

larin 1.5/30 5 M; ACA

larin 1/20 5 M; ACA

larin 24 fe 5 M; ACA

larin fe 1.5/30 5 M; ACA

larin fe 1/20 5 M; ACA

larissia 5 M; ACA

layolis fe 5 M; ACA

leena 5 M; ACA

lessina 5 M; ACA

levonest 5 M; ACA

levonorgest-eth est &

eth est 5 M; ACA; QL

levonorgest-eth estrad

91-day 5 M; ACA; QL

levonorgestrel 5 ACA; OTC; QL

levonorgestrel-ethinyl

estrad 5 M; ACA

levonorg-eth estrad

triphasic 5 M; ACA

levora 0.15/30 (28) 5 M; ACA

LILETTA (52 MG) 6 MSD

lillow 5 M; ACA

LO LOESTRIN FE 5 M; ACA

LOESTRIN 1.5/30 (21) 3 ST; M

LOESTRIN 1/20 (21) 3 ST; M

LOESTRIN FE 1.5/30 3 ST; M


91

Drug Name Drug

Category

Limits/

Required

pirmella 1/35 5 M; ACA

pirmella 7/7/7 5 M; ACA

portia-28 5 M; ACA

PREFEST 3 M

PREMARIN

INJECTION 6 MSD

PREMARIN ORAL 2 M

PREMARIN VAGINAL 2 M

PREMPHASE 2 M

PREMPRO 2 M

preventeza 5 ACA; OTC; QL

previfem 5 M; ACA

PROGESTERONE

COMPOUNDING KIT 3

progesterone

micronized oral 1 M

progesterone

micronized transdermal 1

PROMETRIUM 3 M

PROVERA 3 M

QUARTETTE 3 ST; M; QL

reclipsen 5 M; ACA

rivelsa 5 M; ACA; QL

SAFYRAL 3 ST; M

SEASONIQUE 3 ST; M; QL

setlakin 5 M; ACA; QL

sharobel 5 M; ACA

simliya 5 M; ACA

simpesse 5 M; ACA; QL

SKYLA 6 MSD

SLYND 5 M; ACA

sprintec 28 5 M; ACA

sronyx 5 M; ACA

syeda 5 M; ACA

tarina 24 fe 5 M; ACA

tarina fe 1/20 5 M; ACA

tarina fe 1/20 eq 5 M; ACA

TAYTULLA 5 M; ACA

Drug Name Drug

Category

Limits/

Required

necon 0.5/35 (28) 5 M; ACA

NEXPLANON 6 MSD

nikki 5 M; ACA

nora-be 5 M; ACA

norethin ace-eth

estrad-fe 5 M; ACA

norethindrone acetate

oral 1 M

norethindrone acet-

ethinyl est 5 M; ACA

norethindrone oral 5 M; ACA

norethindrone-eth

estradiol 1 M

norethin-eth estradiol-fe 5 M; ACA

norgestimate-eth

estradiol 5 M; ACA

norgestimate-ethinyl

estradiol triphasic 5 M; ACA

norlyda 5 M; ACA

norlyroc 5 M; ACA

nortrel 0.5/35 (28) 5 M; ACA

nortrel 1/35 (21) 5 M; ACA

nortrel 1/35 (28) 5 M; ACA

nortrel 7/7/7 5 M; ACA

NUVARING 5 M; ACA; QL

ocella 5 M; ACA

ogestrel 5 M; ACA

orsythia 5 M; ACA

ORTHO MICRONOR 3 ST; M

ORTHO TRI-CYCLEN

LO 3 ST; M

ORTHO-NOVUM 1/35

(28) 3 ST; M

ORTHO-NOVUM 7/7/7

(28) 3 ST; M

PARAGARD

INTRAUTERINE

COPPER

6

MSD

philith 5 M; ACA

pimtrea 5 M; ACA


92

Drug Name Drug

Category

Limits/

Required

levo-t 3 M

levothyroxine sodium

intravenous 6 MSD

levothyroxine sodium

oral 1 M

levothyroxine-

liothyronine oral tablet

120 mg, 15 mg, 30 mg,

60 mg, 90 mg

1

M

levoxyl 1 M

liothyronine sodium

intravenous 6 MSD

liothyronine sodium oral 1 M

methimazole oral 1 M

NATURE-THROID

ORAL TABLET 113.75

MG, 146.25 MG, 162.5

MG, 260 MG, 325 MG,

48.75 MG, 81.25 MG,

97.5 MG

1

M

nature-throid oral tablet

130 mg, 16.25 mg, 195

mg, 32.5 mg, 65 mg

1

M

np thyroid 1 M

PARSABIV 6 M; MSD

propylthiouracil oral 1 M

SYNTHROID 3 M

TAPAZOLE 3 M

TIROSINT 3 M

TIROSINT-SOL 6 M; MSD

TRIOSTAT 6 ST; MSD

unithroid 1 M

westhroid oral tablet

130 mg, 32.5 mg, 65

mg

1

M

WESTHROID ORAL

TABLET 195 MG, 97.5

MG

1

M

WP THYROID 1 M

Drug Name Drug

Category

Limits/

Required

tilia fe 5 M; ACA

tri femynor 5 M; ACA

tri-estarylla 5 M; ACA

tri-legest fe 5 M; ACA

tri-linyah 5 M; ACA

tri-lo-estarylla 5 M; ACA

tri-lo-marzia 5 M; ACA

tri-lo-mili 5 M; ACA

tri-lo-sprintec 5 M; ACA

tri-mili 5 M; ACA

tri-previfem 5 M; ACA

tri-sprintec 5 M; ACA

trivora (28) 5 M; ACA

tri-vylibra 5 M; ACA

tri-vylibra lo 5 M; ACA

tulana 5 M; ACA

tydemy 5 M; ACA

VAGIFEM 3 ST; M

velivet 5 M; ACA

vienva 5 M; ACA

viorele 5 M; ACA

VIVELLE-DOT 3 ST; M; QL

vyfemla 5 M; ACA

vylibra 5 M; ACA

wera 5 M; ACA

wymzya fe 5 M; ACA

xulane 5 M; ACA

YASMIN 28 3 ST; M

YAZ 3 ST; M

yuvafem 1 M

zarah 5 M; ACA

zovia 1/35e (28) 5 M; ACA

zumandimine 5 M; ACA

Hormonal Agents -

Thyroid

ARMOUR THYROID 1 M

CYTOMEL 3 ST; M

euthyrox 3 M


93

Drug Name Drug

Category

Limits/

Required

CIMZIA 3 PA; S

CIMZIA PREFILLED

KIT 3 PA; M; S

CIMZIA STARTER KIT 3 PA; M; S

CINRYZE 6 MSD

COSENTYX (300 MG

DOSE) 3 PA; M; S; QL

COSENTYX 150

MG/ML 3 PA; M; S; QL

COSENTYX

SENSOREADY (300

MG)

3

PA; M; S; QL

COSENTYX

SENSOREADY PEN 3 PA; M; S; QL

CUTAQUIG

SOLUTION 1 GM/6ML

SUBCUTANEOUS

3

PA

CUTAQUIG

SOLUTION 1 GM/6ML

SUBCUTANEOUS

6

PA; MSD

CUTAQUIG

SOLUTION 2

GM/12ML

SUBCUTANEOUS

3

PA

CUTAQUIG

SOLUTION 2

GM/12ML

SUBCUTANEOUS

6

PA; MSD

CUTAQUIG

SOLUTION 4

GM/24ML

SUBCUTANEOUS

3

PA

CUTAQUIG

SOLUTION 4

GM/24ML

SUBCUTANEOUS

6

PA; MSD

CUTAQUIG

SOLUTION 8

GM/48ML

SUBCUTANEOUS

3

PA

CUTAQUIG

SOLUTION 8

GM/48ML

SUBCUTANEOUS

6

PA; MSD

Drug Name Drug

Category

Limits/

Required

Immunological

Agents - Drugs for

Immune System

Stimulation or

Suppression

ACTEMRA ACTPEN 4 PA; M; S

ACTEMRA

INTRAVENOUS 6 PA; MSD

ACTEMRA

SUBCUTANEOUS 4 PA; M; S; QL

ACTIMMUNE 6 M; MSD

ALFERON N 6 MSD

ARAVA 3 M; QL

ARCALYST 4 PA; M; S

ASTAGRAF XL 3 ST; M

ATGAM 6 MSD

AZASAN 3 M

azathioprine oral 1 M

azathioprine sodium 6 MSD

BENLYSTA

INTRAVENOUS 6 MSD

BENLYSTA

SUBCUTANEOUS 3 PA; M; S

BERINERT 6 MSD

BIVIGAM 6 PA; MSD

CARIMUNE NF

SOLUTION

RECONSTITUTED 12

GM INTRAVENOUS

6

PA; MSD

carimune nf solution

reconstituted 12 gm

intravenous

6

PA; MSD

CARIMUNE NF

SOLUTION

RECONSTITUTED 6

GM INTRAVENOUS

6

PA; MSD

carimune nf solution

reconstituted 6 gm

intravenous

6

PA; MSD

CELLCEPT 3 M

CELLCEPT

INTRAVENOUS 6 MSD


94

Drug Name Drug

Category

Limits/

Required

HUMIRA PEDIATRIC

CROHNS START

SUBCUTANEOUS

PREFILLED SYRINGE

KIT 40 MG/0.8ML, 80

MG/0.8ML &

40MG/0.4ML

3

PA; M; S; QL

HUMIRA PEDIATRIC

CROHNS START

SUBCUTANEOUS

PREFILLED SYRINGE

KIT 80 MG/0.8ML

3

PA; M; S

HUMIRA PEN 3 PA; M; S; QL

HUMIRA PEN-

CD/UC/HS STARTER

SUBCUTANEOUS

PEN-INJECTOR KIT

40 MG/0.8ML

3

PA; M; S; QL

HUMIRA PEN-

CD/UC/HS STARTER

SUBCUTANEOUS

PEN-INJECTOR KIT

80 MG/0.8ML

3

PA; M; S

HUMIRA PEN-

PS/UV/ADOL HS

START

SUBCUTANEOUS

PEN-INJECTOR KIT

40 MG/0.8ML

3

PA; M; S; QL

HUMIRA PEN-

PS/UV/ADOL HS

START

SUBCUTANEOUS

PEN-INJECTOR KIT

80 MG/0.8ML &

40MG/0.4ML

3

PA; M; S

HYPERHEP B S/D 6 MSD

HYPERRAB 6 MSD

HYPERRAB S/D 6 MSD

HYPERRHO S/D 6 MSD

HYPERTET S/D 6 MSD

HYQVIA 6 PA; MSD

icatibant acetate 1 PA

ILARIS 6 PA; MSD; QL

ILUMYA 4 M; S

Drug Name Drug

Category

Limits/

Required

CUTAQUIG

SUBCUTANEOUS

SOLUTION 1.65

GM/10ML, 3.3

GM/20ML

6

PA; MSD

CUVITRU 6 PA; MSD

cyclosporine

intravenous 6 MSD

cyclosporine modified 1 M

cyclosporine oral 1 M

CYTOGAM 6 MSD

ENBREL 4 PA; M; S; QL

ENBREL MINI 4 PA; M; S; QL

ENBREL SURECLICK 4 PA; M; S; QL

ENTYVIO 6 MSD

ENVARSUS XR 3 ST; M

FIRAZYR 3 PA; S

FLEBOGAMMA DIF 6 PA; MSD

GAMASTAN 6 MSD

gamastan s/d injectable

intramuscular 6 MSD

GAMASTAN S/D

INJECTABLE

INTRAMUSCULAR

6

MSD

GAMIFANT 6 MSD

GAMMAGARD 6 PA; MSD

GAMMAGARD S/D

LESS IGA 6 PA; MSD

GAMMAKED 6 PA; MSD

GAMMAPLEX 6 PA; MSD

GAMUNEX-C 6 PA; MSD

gengraf 1 M

HAEGARDA 6 MSD

HEPAGAM B 6 MSD

HIZENTRA 6 PA; MSD

HUMIRA 3 PA; M; S; QL


95

Drug Name Drug

Category

Limits/

Required

PROGRAF

INTRAVENOUS 6 MSD

PROGRAF ORAL 3 M

PROVENGE 6 MSD

RAPAMUNE ORAL

SOLUTION 2 M

RAPAMUNE ORAL

TABLET 3 M

RASUVO 3 M; S; QL

REMICADE 6 PA; MSD

RENFLEXIS 6 PA; MSD

RHOGAM ULTRA-

FILTERED PLUS 6 MSD

RHOPHYLAC 6 MSD

RIDAURA 2 M

RUCONEST 6 MSD

SANDIMMUNE

INTRAVENOUS 6 MSD

SANDIMMUNE ORAL

CAPSULE 3 M

SANDIMMUNE ORAL

SOLUTION 2 M

SILIQ 4 PA; M; S

SIMPONI 3 PA; M; S; QL

SIMPONI ARIA 6 PA; M; MSD

SIMULECT 6 MSD

sirolimus oral 1 M

SKYRIZI (150 MG

DOSE) 3 PA; M

STELARA


STELARA


SYNAGIS 6 PA; MSD

tacrolimus oral 1 M

TALTZ 4 PA; M; S

temsirolimus 6 MSD

THYMOGLOBULIN 6 MSD

TICE BCG 6 MSD

TORISEL 6 MSD

Drug Name Drug

Category

Limits/

Required

IMOGAM RABIES-HT

INJECTION

SOLUTION 300

UNIT/2ML

6

MSD

IMURAN 3 M

INFLECTRA 6 PA; MSD

KEDRAB 6 MSD

KEVZARA 4 PA; M; S

KINERET 4 PA; M; S; QL

KYMRIAH 6 MSD

leflunomide oral 1 M; QL

methotrexate oral 1

methotrexate sodium 1

methotrexate sodium

(pf) 1

MICRHOGAM ULTRA-

FILTERED PLUS 6 MSD

mycophenolate mofetil 1 M

mycophenolate mofetil

hcl 6 MSD

mycophenolate sodium 1 M

MYFORTIC 3 M

nabi-hb 6 MSD

NEORAL 3 M

NULOJIX 6 MSD

OCTAGAM 6 PA; MSD

OLUMIANT 4 PA; M; S

ORENCIA CLICKJECT 4 PA; M; S

ORENCIA

INTRAVENOUS 6 PA; M; MSD

ORENCIA


OTEZLA ORAL

TABLET 3 PA; M; S; QL

OTEZLA ORAL

TABLET THERAPY

PACK

3

PA; S; QL

OTREXUP 3 M; S; QL

PANZYGA 6 PA; MSD

PRIVIGEN 6 PA; MSD


96

Drug Name Drug

Category

Limits/

Required

FLUZONE

QUADRIVALENT 5 ACA

GARDASIL 9 5 ACA

HAVRIX 5 ACA

HEPLISAV-B 5 ACA

HIBERIX 5 ACA

IMOVAX RABIES 6 MSD

INFANRIX 5 ACA

IPOL 5 ACA

IXIARO 6 MSD

KINRIX 5 ACA

MENACTRA 5 ACA

MENVEO 5 ACA

M-M-R II

SUBCUTANEOUS

INJECTABLE

5

ACA

PEDIARIX 5 ACA

PEDVAX HIB 5 ACA

PENTACEL 5 ACA

pneumovax 23

injectable 25 mcg/0.5ml

injection

5

ACA

PNEUMOVAX 23

INJECTABLE 25

MCG/0.5ML

INJECTION

5

ACA

PREVNAR 13 5 ACA

PROQUAD 5 ACA

QUADRACEL 5 ACA

RABAVERT 6 MSD

RECOMBIVAX HB 5 ACA

ROTARIX 5 ACA

ROTATEQ 5 ACA

SHINGRIX 5 ACA

STAMARIL 6 MSD

TDVAX 5 ACA

TENIVAC 5 ACA

TRUMENBA 5 ACA

TWINRIX 5 ACA

Drug Name Drug

Category

Limits/

Required

TREMFYA 3 PA; M; S

TREXALL 3

VARIZIG 2

WINRHO SDF 6 MSD

XATMEP 4 PA; S

XELJANZ 3 PA; M; S; QL

XELJANZ XR 3 PA; M; S; QL

ZINPLAVA 6 PA; MSD

ZORTRESS 2 M

Immunological

Agents - Drugs for

Vaccination

ACTHIB 5 ACA

ADACEL 5 ACA

AFLURIA

QUADRIVALENT 5 ACA

BCG VACCINE 6 MSD

BEXSERO 5 ACA

BIOTHRAX 6 MSD

BOOSTRIX 5 ACA

DAPTACEL 5 ACA

DIPHTHERIA-

TETANUS TOXOIDS

DT

5

ACA

ENGERIX-B 5 ACA

EZ FLU SHOT-

FLUCELVAX QUAD 5 ACA

FLUAD 5 ACA

FLUARIX

QUADRIVALENT 5 ACA

FLUBLOK

QUADRIVALENT 5 ACA

FLUCELVAX

QUADRIVALENT 5 ACA

FLULAVAL

QUADRIVALENT 5 ACA

FLUMIST

QUADRIVALENT 5 ACA

FLUZONE HIGH-

DOSE 5 ACA


97

Drug Name Drug Limits/

Category Required

hydrocortisone acetate 1

rectal

hydrocortisone rectal 1

LIALDA 3 M

mesalamine oral

capsule delayed 1 M

release

mesalamine oral tablet

delayed release 1.2 gm 1 M

mesalamine oral tablet

delayed release 800 1

mg

mesalamine rectal 1

mesalamine-cleanser 1

PENTASA 2 M

PROCORT 3

PROCTOCORT

RECTAL CREAM 3 ST

PROCTOCORT

RECTAL 3

SUPPOSITORY

PROCTOFOAM HC 3

procto-med hc 1

procto-pak 1

proctosol hc 1

proctozone-hc 1

ROWASA 3

SFROWASA 3

sulfasalazine oral 1 M

UCERIS ORAL 3

UCERIS RECTAL 2

Metabolic Bone

Disease Agents -

Drugs for

Osteoporosis

ACTONEL ORAL

TABLET 150 MG, 35 3 ST; M; QL

MG, 5 MG

ACTONEL ORAL

TABLET 30 MG

3

ST

Drug Name Drug

Category

Limits/

Required

TYPHIM VI 6 MSD

VAQTA 5 ACA

VARIVAX 5 ACA

VAXCHORA 6 MSD

VIVOTIF 6 MSD

yf-vax injectable

subcutaneous 6 MSD

YF-VAX INJECTABLE

SUBCUTANEOUS 6 MSD

ZOSTAVAX 5 ACA

Inflammatory Bowel

Disease Agents

ANALPRAM HC 3

ANALPRAM HC

SINGLES 3

ANALPRAM-HC 3

anucort-hc 1

ANUSOL-HC RECTAL

CREAM 3 ST

anusol-hc rectal

suppository 3

APRISO 2 M

ASACOL HD 3 ST

AZULFIDINE 3 M

AZULFIDINE EN-TABS 3 M

balsalazide disodium 1

budesonide er 1

budesonide oral 1

CANASA 3

COLAZAL 3

colocort 1

CORTENEMA 3

CORTIFOAM 3 ST

DELZICOL 3 ST; M

DIPENTUM 3 ST; M

ENTOCORT EC 3

hemmorex-hc 1

hydrocortisone ace-

pramoxine rectal 1


98

Drug Name Drug

Category

Limits/

Required

risedronate sodium oral

tablet 30 mg 1


tablet delayed release 1 M; QL

ROCALTROL 3 M

TYMLOS 3 PA; M; S

ZEMPLAR

INTRAVENOUS 6 MSD

ZEMPLAR ORAL 3 M

zoledronic acid

intravenous

concentrate

6

MSD

zoledronic acid

intravenous solution 6 PA; MSD

Miscellaneous

Therapeutic Agents

ACACIA

SUBCUTANEOUS 3

ACETADOTE 6 MSD

acetylcysteine

intravenous 6 MSD

ACREMONIUM 6 MSD

adenosine (diagnostic) 6 MSD

adenosine intravenous

solution 3 mg/ml 6 MSD

ALBUKED 25 6 MSD

ALBUKED 5 6 MSD

albumin human 6 MSD

ALBUMINEX 6 MSD

alburx 6 MSD

ALBUTEIN 6 MSD

alcohol prep pads pad

, 70 % 2 OTC

ALCOHOL PREP

PADS PAD 70 % 2 OTC

ALDER 3

ALPHA-LIPOIC ACID

INJECTION 3

ALTERNARIA 6 MSD

Drug Name Drug

Category

Limits/

Required

alendronate sodium

oral solution 1 M; QL

alendronate sodium


mg, 5 mg, 70 mg

1

M; QL

alendronate sodium

oral tablet 40 mg 1 QL

ATELVIA 3 ST; M; QL

BINOSTO 3 ST; M; QL

BONIVA

INTRAVENOUS 6 PA; MSD; QL

BONIVA ORAL 3 ST; M; QL

calcitonin (salmon) 1 M; QL

calcitriol intravenous 6 MSD

calcitriol oral 1 M

doxercalciferol

intravenous 6 MSD

doxercalciferol oral 1 M

etidronate disodium 1

EVENITY 6 MSD; QL

FORTEO 3 ST; M; S; QL

FOSAMAX 3 ST; M; QL

FOSAMAX PLUS D 3 ST; M; QL

HECTOROL 6 MSD

ibandronate sodium

intravenous 6 PA; MSD; QL

ibandronate sodium

oral 1 M; QL

MIACALCIN

INJECTION 6 MSD

NATPARA 3 PA; M; S; QL

pamidronate disodium 6 MSD

paricalcitol intravenous 6 MSD

paricalcitol oral 1 M

PROLIA 6 PA; MSD; QL

RAYALDEE 3 M

RECLAST 6 PA; MSD


tablet 150 mg, 35 mg, 5

mg

1

M; QL


99

Drug Name Drug

Category

Limits/

Required

bacteriostatic

water(benz alc) solution

injection

6

MSD

BAHIA 6 MSD

bal in oil 2

BALD CYPRESS 6 MSD

BANANA

(DIAGNOSTIC) 6 MSD

BAYBERRY (WAX

MYRTLE) 6 MSD

BD SYRINGE LUER-

LOK 30 ML 2

BEEF (DIAGNOSTIC) 6 MSD

BENTLEY THE BEAR

PED NEBULIZER 6 MSD

BERMUDA GRASS 6 MSD

BIOFREQUENCY

INSOLES 3

BIOGUARD ISLAND

DRESSINGS PAD

4"X10" , 4"X14"

3

BIOGUARD NON-

ADHERENT

DRESSING

3

BLACK WALNUT

POLLEN 6 MSD

BLACK WILLOW 6 MSD

BOTOX 6 PA; MSD

BOTRYTIS 6 MSD

BOX ELDER 6 MSD

BREATHERITE 6 MSD

BREATHERITE

VALVED MDI

CHAMBER

6

MSD

BREVITAL SODIUM 6 MSD

BRIDION 6 MSD

BROME 6 MSD

CALCIUM DISODIUM

VERSENATE 2

CALIFORNIA PEPPER

TREE 3

Drug Name Drug

Category

Limits/

Required

AMD FOAM

DRESSING PAD 3-

1/2"X3"

3

AMERICAN BEECH 3

AMERICAN

COCKROACH 6 MSD

AMERICAN ELM 6 MSD

AMERICAN

SYCAMORE 6 MSD

AMIDATE 6 MSD

AMINOPMRMS 3

AMPHADASE 6 MSD

ANASCORP 6 MSD

ANAVIP 6 MSD

ANDEXXA 6 MSD

ANESTHESIA S/I-40 6 MSD

ANESTHESIA S/I-40A 6 MSD

ANESTHESIA S/I-40H 6 MSD

ANESTHESIA S/I-40S 6 MSD

ANESTHESIA S/I-60 6 MSD

ANTIVENIN

LATRODECTUS

MACTANS

3

ANTIVENIN

MICRURUS FULVIUS 6 MSD

APP SLIM RMS 3

APPLE (DIAGNOSTIC) 6 MSD

ARIZONA CYPRESS 6 MSD

ARTISS 6 MSD

asilnasalrms 1

AURA PORTANEB 6 MSD

AUREOBASIDIUM 6 MSD

AUSTRALIAN PINE 6 MSD

AVOCADO

(DIAGNOSTIC) 6 MSD

AXUMIN 6 MSD

BACTERIOSTATIC

WATER(BENZ ALC)

SOLUTION

INJECTION

3


100

Drug Name Drug

Category

Limits/

Required

CYSVIEW 6 MSD

deferoxamine mesylate 6 MSD

DESFERAL 6 MSD

desflurane 6 MSD

dexmedetomidine hcl in

nacl 6 MSD

DEXMEDETOMIDINE

HCL INTRAVENOUS

SOLUTION 1000

MCG/10ML, 400

MCG/4ML

6

MSD

dexmedetomidine hcl


200 mcg/2ml

6

MSD

DEXMEDETOMIDINE

HCL-DEXTROSE 6 MSD

diluent for treprostinil 6 MSD

DIPRIVAN 6 MSD

DOG EPITHELIUM 6 MSD

DOG FENNEL 3

DOTAREM

INTRAVENOUS

SOLUTION 2.5

MMOL/5ML, 5

MMOL/10ML, 50

MMOL/100ML

6

MSD

DOVER URETHRAL

CATHETER 6 MSD

DRECHSLERA 6 MSD

DUODOTE 3

DUROLANE 6 MSD

DUST MITE MIXED

ALLERGEN EXT 6 MSD

DYSPORT 6 PA; MSD

EASIVENT 6 MSD

EASTERN

COTTONWOOD 6 MSD

EASY COMFORT

ALCOHOL PADS 2 OTC

EASY GLIDE LUER

LOCK SYRINGE 3 OTC

EC-RX DHEA 3

Drug Name Drug

Category

Limits/

Required

CANDIDA ALBICANS

EXTRACT 6 MSD

CANTALOUPE

(DIAGNOSTIC) 6 MSD

CAPTAIN EAGLE PED

NEBULIZER 6 MSD

CARDIOVID PLUS 3

CASEIN

(DIAGNOSTIC) 6 MSD

CAT HAIR EXTRACT 6 MSD

CATTLE EPITHELIUM 3

CAYA 5 ACA

CEDAR ELM 6 MSD

CEFALY KIT 6 MSD

CHICKEN MEAT

(DIAGNOSTIC) 6 MSD

chlorhexidine gluconate

solution 20 % 2

CHLORHEXIDINE

GLUCONATE

SOLUTION 20 %

3

CHOLETEC 6 MSD

CLADOSPORIUM

CLADOSPORIOIDES 6 MSD

CLADOSPORIUM

SPHAEROSPERMUM 6 MSD

COCKLEBUR 3

COCOA BEAN

(DIAGNOSTIC) 6 MSD

COENZYME Q-10

INJECTION 3

CORN POLLEN 6 MSD

CORTROSYN 6 MSD

cosyntropin 6 MSD

CRAB (DIAGNOSTIC) 6 MSD

CURITY AMD

ANTIMICROBIAL

STRIP

3

CURITY IODOFORM

PACKING STRIP 3

CURVULARIA 6 MSD


101

Drug Name Drug

Category

Limits/

Required

GELFOAM-JMI

SPONGE 6 MSD

GEL-ONE 6 MSD

GELSYN-3 6 MSD

GENTLECATH

URINARY CATHETER 6 MSD; OTC

GENVISC 850 6 MSD

GERMAN

COCKROACH 3

GLUCAGON HCL

(DIAGNOSTIC) 3

glutaraldehyde external 2

GOLDENROD 6 MSD

GRASTEK 2 M; QL

HACKBERRY 3

HCU EASY 3

HISTATROL

INJECTION 6 MSD

HONEY BEE VENOM 6 MSD

HONEY BEE VENOM

PROTEIN INJECTION

SOLUTION

RECONSTITUTED

1300 MCG

3

HONEY BEE VENOM

PROTEIN INJECTION

SOLUTION

RECONSTITUTED 550

MCG

6

MSD

HORSE EPITHELIUM 6 MSD

HYALGAN 6 MSD

HYLENEX 3

HYMOVIS 6 MSD

IC GREEN 6 MSD

indigo carmine 6 MSD

indocyanine green

intravenous 6 MSD

INFED 6 MSD

infusion set 6 MSD

Drug Name Drug

Category

Limits/

Required

EGG WHITE

(DIAGNOSTIC) 6 MSD

ELCYS 6 MSD

ENDARI 3 PA; S

ENGLISH PLANTAIN 6 MSD

EPICOCCUM 6 MSD

ergoloid mesylates oral 1 M

EROS-CTD 3

etomidate intravenous 6 MSD

EUFLEXXA 6 MSD

E-Z-DISK 6 MSD

E-Z-HD 6 MSD

E-Z-PAQUE 6 MSD

E-Z-PASTE 6 MSD

FEMCAP 5 ACA

FIRDAPSE 3 S

FIRE ANT 6 MSD

FLEXBUMIN 6 MSD

flumazenil intravenous 6 MSD

FLYP NEBULIZER 6 MSD

fomepizole 6 MSD

formaldehyde external

solution 37 % 2

FUSARIUM 6 MSD

GADAVIST 6 MSD

GEL-FLOW 6 MSD

GELFOAM

COMPRESSED SIZE

100

6

MSD

GELFOAM DENTAL

PACK SIZE 4 6 MSD

GELFOAM SPONGE 6 MSD

GELFOAM SPONGE

SIZE 100 6 MSD

GELFOAM SPONGE

SIZE 200 6 MSD

GELFOAM SPONGE

SIZE 50 6 MSD

GELFOAM-JMI

POWDER 6 MSD


102

Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

INNOSPIRE GO

PORTABLE MESH

NEB

6

MSD; OTC

MACRILEN 6 MSD

MAGNEVIST 6 MSD

MEADOW FESCUE

GRASS POLLEN 6 MSD INSPIREASE

RESERVOIR BAGS 3

MELALEUCA 3 insulin pump ir2020 3

MESQUITE 6 MSD isosulfan blue 6 MSD

methergine 1 JOHNSON GRASS 6 MSD

METHOHEXITAL

SODIUM 6 MSD J-TIP KIT W/VIAL

ADAPTERS 3

methylene blue

injection 6 MSD JUNE GRASS

POLLEN

STANDARDIZED

6

MSD

methylergonovine

maleate injection 6 MSD

KALBITOR 6 MSD

methylergonovine

maleate oral 1

KAPOK 6 MSD

kedbumin 6 MSD

MINIMED 530G

INSULIN PUMP 6 MSD

KERLIX AMD

ANTIMICROBIAL 3

MITE (D. FARINAE) 6 MSD

KERLIX AMD SUPER

SPONGES 3

MITE (D.

PTERONYSSINUS) 6 MSD

KETALAR 6 MSD

MIXED ASPERGILLUS 6 MSD

ketamine hcl injection

solution 10 mg/ml, 100

mg/ml, 50 mg/ml

6

MSD MIXED FEATHERS 6 MSD

MIXED RAGWEED 6 MSD

MIXED VESPID

VENOM PROTEIN

INJECTION

SOLUTION

RECONSTITUTED

1300-1300-1300 MCG

3

KETAMINE HCL

INJECTION

SOLUTION

PREFILLED SYRINGE

6

MSD

KETAMINE HCL

INTRAVENOUS 6 MSD

MIXED VESPID

VENOM PROTEIN

INJECTION

SOLUTION

RECONSTITUTED

550-550-550 MCG

6

MSD

KETAMINE HCL-


KOCHIA 6 MSD

LAMBS QUARTERS 6 MSD

l-cysteine hcl

intravenous 6 MSD

MIXED VESPID

VENOM PROTEIN

SUBCUTANEOUS

6

MSD

LENSCALE 3

LIPIODOL 6 MSD

mlk f1 1


103

LIQUID E-Z-PAQUE 6 MSD

mlk f2 1

LIQUID POLIBAR

PLUS 6 MSD

mlk f3 1

MLK F4 3 MACI 6 MSD


104

Drug Name Drug

Category

Limits/

Required

ORTHOVISC 6 MSD

PARI ALTERA

NEBULIZER

HANDSET

6

MSD

PARI TREK S COMBO

PACK 6 MSD

PEANUT

(DIAGNOSTIC) 6 MSD

PECAN NUT

(DIAGNOSTIC) 6 MSD

PECAN POLLEN 6 MSD

PENICILLIUM

NOTATUM 6 MSD

PENTETATE

CALCIUM TRISODIUM 6 MSD

PENTETATE ZINC

TRISODIUM 6 MSD

PERENNIAL RYE

GRASS POLLEN 3

PHOMA EXIGUA 6 MSD

PHOTREXA VISCOUS 6 MSD

PHOTREXA-

PHOTREXA VISCOUS

KIT

6

MSD

PISTACHIO NUT

(DIAGNOSTIC) 6 MSD

PKU EASY 3

PKU EASY

MICROTABS 3

PLASBUMIN-25 6 MSD

PLASBUMIN-5 6 MSD

PORK (DIAGNOSTIC) 6 MSD

pralidoxime chloride

intramuscular 3

PRAXBIND 6 MSD

PRECEDEX 6 MSD

PRIVET 6 MSD

PRO COMFORT

SPACER ADULT 6 MSD; OTC

PRO COMFORT

SPACER CHILD 6 MSD; OTC

Drug Name Drug

Category

Limits/

Required

MONOVISC 6 MSD

MOUNTAIN CEDAR 6 MSD

MOUSE EPITHELIUM 6 MSD

MSUD EASY 3

MUCOR 6 MSD

MUGWORT 6 MSD

MYOBLOC 6 PA; MSD

NEOKE RA LIPOIC 3

NETSPOT 6 MSD

NEXAVIR 3

NORM-JECT LUER

SLIP SYRINGE 2

OAT GRAIN

(DIAGNOSTIC) 6 MSD

ODACTRA 2 M; QL

OLIVE TREE 6 MSD

OMNIPAQUE

INTRAVENOUS

SOLUTION 350

MG/ML

6

MSD

OMNIPOD 5 PACK 6 MSD

OMNIPOD DASH 5

PACK 6 MSD

OMNIPOD STARTER 6 MSD

OPTIONS

CONCEPTROL 5 ACA; OTC

OPTIRAY 350 6 MSD

OPTISON 6 MSD

ORAFATE 4 S

ORALAIR 4 M; S; QL

ORALAIR ADULT

SAMPLE KIT 4 M; S; QL

ORALAIR ADULT

STARTER PACK 4 M; S; QL

ORALAIR CHILDRENS

STARTER PACK 4 M; S; QL

ORANGE

(DIAGNOSTIC) 6 MSD

ORCHARD GRASS

POLLEN 6 MSD


105

Drug Name Drug

Category

Limits/

Required

RICE (DIAGNOSTIC) 6 MSD

ROUGH MARSH

ELDER 3

ROUGH PIGWEED 6 MSD

RUSSIAN THISTLE 6 MSD

RUZURGI 3 M

SACCHAROMYCES

CEREVISIAE 6 MSD

SAGEBRUSH 6 MSD

SAPS HEALTH CARE

ALCOHOL PREP 2 OTC

sash kit 6 MSD

SESAME SEED

(DIAGNOSTIC) 6 MSD

sevoflurane 6 MSD

SHAGBARK HICKORY 6 MSD

SHEEP SORREL 6 MSD

SHORT RAGWEED

POLLEN EXT 6 MSD

SHRIMP

(DIAGNOSTIC) 6 MSD

SODIUM

HYALURONATE

INTRA-ARTICULAR

6

MSD

SOLESTA 6 MSD

SORREL/DOCK MIX 6 MSD

SOYBEAN

(DIAGNOSTIC) 6 MSD

SPARKY THE DOG

PED NEBULIZER 6 MSD

SPINRAZA 6 PA; M; MSD

SPINY PIGWEED 6 MSD

STEMPHYLIUM 3

STERILE DILUENT

FLOLAN PH 12 6 MSD

STERILE DILUENT

FOR FLOLAN 6 MSD

sterile

diluent/epoprostenol 6 MSD

sterile water for

injection 6 MSD

Drug Name Drug

Category

Limits/

Required

PRO COMFORT TENS

UNIT 6 MSD

PROCARE

COMPRESSOR

NEBULIZER

6

MSD; OTC

PROCARE

SPACER/ADULT

MASK

6

MSD; OTC

PROCARE

SPACER/CHILD MASK 6 MSD; OTC

PROFESSIONAL DNA

COLLECTION 6 MSD

PROMACTIN AA PLUS

20PE 3

propofol 6 MSD

PROTHELIAL 4 S

PROVAYBLUE 6 MSD

PROVOCHOLINE 6 MSD

QUEEN PALM 3

RABBIT EPITHELIUM 6 MSD

RADIOGARDASE 6 MSD

RAGWITEK 2 M; QL

READI-CAT 2 6 MSD

RED BIRCH 6 MSD

RED CEDAR 6 MSD

RED MAPLE 6 MSD

RED MULBERRY 6 MSD

RED TOP GRASS

POLLEN 6 MSD

RESET FOR

ANDROID APP 3

RESET FOR IOS APP 3

RESET FOR IOS OR

ANDROID APP 3

RESET-O FOR

ANDROID APP 3

RESET-O FOR IOS

APP 3

RESET-O FOR IOS

OR ANDROID APP 3

RHIZOPUS 6 MSD


106

Drug Name Drug

Category

Limits/

Required

toxicology saliva

collection 6 MSD

TRICHOPHYTON 6 MSD

TRIVISC 6 MSD

TRUE COMFORT

ALCOHOL PREP

PADS

2

OTC

TYR EASY 3

ULTANE 6 MSD

ULTRAVIST

INJECTION

SOLUTION 77 %

6

MSD

VARIBAR HONEY 6 MSD

VARIBAR NECTAR 6 MSD

VARIBAR PUDDING 6 MSD

VARIBAR THIN

HONEY 6 MSD

VARIBAR THIN

LIQUID 6 MSD

vcf vaginal

contraceptive vaginal

gel

5

ACA; OTC

VENOMIL HONEY

BEE VENOM 3

VENOMIL WASP

VENOM 3

VENOMIL WHITE

FACED HORNET 3

VENOMIL YELLOW

HORNET VENOM 3

VENOMIL YELLOW

JACKET VENOM 3

V-GO 20 6 MSD

V-GO 30 6 MSD

V-GO 40 6 MSD

VIRGINIA LIVE OAK 6 MSD

VISCO-3 6 MSD

VISIPAQUE

INTRAVENOUS

SOLUTION 320

MG/ML

6

MSD

VISTOGARD 3 S

Drug Name Drug

Category

Limits/

Required

STRAWBERRY

(DIAGNOSTIC) 6 MSD

SUPARTZ FX 6 MSD

SUPRANE 6 MSD

SURGISEAL 6 MSD

SURGISEAL STYLUS 6 MSD

SURGISEAL TWIST 6 MSD

SWEET CORN

(DIAGNOSTIC) 6 MSD

SWEET GUM 3

SWEET VERNAL

GRASS POLLEN 6 MSD

SYNVISC 6 MSD

SYNVISC ONE 6 MSD

TACHOSIL 6 MSD

TAGITOL V 6 MSD

TAKHZYRO 4 PA; M; S

TALL RAGWEED 6 MSD

TECHNET TC 99M

SULFUR COLLOID 6 MSD

technetium tc 99m

mebrofenin 6 MSD

TECHNETIUM TC 99M

MEDRONATE 6 MSD

TECHNETIUM TC 99M

PYROPHOS 6 MSD

technetium tc 99m

sestamibi 6 MSD

TELFA AMD NON-

ADHERENT 3

thallous chloride tl 201


mci/ml

6

MSD

THALLOUS

CHLORIDE TL 201

INTRAVENOUS

SOLUTION 2 MCI/ML

6

MSD

THYROGEN 6 MSD

TIMOTHY GRASS

POLLEN ALLERGEN 6 MSD

TISSEEL 6 MSD


107

Drug Name Drug

Category

Limits/

Required

XEOMIN

INTRAMUSCULAR

SOLUTION

RECONSTITUTED 200

UNIT

6

MSD

XIAFLEX 6 MSD

YELLOW DOCK 6 MSD

YELLOW HORNET

VENOM PROTEIN 6 MSD

YELLOW JACKET

VENOM PROTEIN

INJECTION

SOLUTION

RECONSTITUTED

1300 MCG

3

YELLOW JACKET

VENOM PROTEIN

INJECTION

SOLUTION

RECONSTITUTED 550

MCG

6

MSD

YELLOW JACKET

VENOM PROTEIN

SUBCUTANEOUS

6

MSD

Ophthalmic Agents -

Drugs for Eye Allergy,

Infection and

Inflammation

ACULAR 3

ACULAR LS 3

ACUVAIL 3

ALOCRIL 3

ALOMIDE 3

ALREX 2

AZASITE 2

azelastine hcl

ophthalmic 1

bacitracin ophthalmic 1

BEPREVE 2

BESIVANCE 3

BETADINE

OPHTHALMIC PREP 3

BLEPH-10 3

Drug Name Drug

Category

Limits/

Required

VITRASE 6 MSD

VOLUMEN 6 MSD

VORTEX HOLDING

CHAMBER/MASK 6 MSD

WASP VENOM

PROTEIN INJECTION

SOLUTION

RECONSTITUTED

1300 MCG

3

WASP VENOM

PROTEIN INJECTION

SOLUTION

RECONSTITUTED 550

MCG

6

MSD

WASP VENOM

PROTEIN

SUBCUTANEOUS

6

MSD

WESTERN JUNIPER 3

WHITE ASH 6 MSD

WHITE BIRCH 6 MSD

WHITE FACED

HORNET VENOM 6 MSD

WHITE MULBERRY 6 MSD

WHITE OAK 6 MSD

WHITE PINE 6 MSD

WHITE-FACED

HORNET VENOM

INJECTION

SOLUTION

RECONSTITUTED

1300 MCG

3

WHITE-FACED

HORNET VENOM

INJECTION

SOLUTION

RECONSTITUTED 550

MCG

6

MSD

WHOLE EGG

(DIAGNOSTIC) 6 MSD

WIDE-SEAL

DIAPHRAGM 60 5 ACA


108

Drug Name Drug

Category

Limits/

Required

levofloxacin ophthalmic 1

LOTEMAX

OPHTHALMIC GEL 2 QL

LOTEMAX

OPHTHALMIC

OINTMENT

2

QL

LOTEMAX

OPHTHALMIC

SUSPENSION

2

LOTEMAX SM 2

loteprednol etabonate 1

MAXIDEX 3

MITOSOL 3

MOXEZA 2

MOXIFLOXACIN HCL

INTRAOCULAR 6 MSD

moxifloxacin hcl

ophthalmic 1

NATACYN 2

NEVANAC 3 QL

OCUFLOX 3

ofloxacin ophthalmic 1

olopatadine hcl

ophthalmic 1

OZURDEX 6 MSD

PATADAY 3 ST

PATANOL 3 ST

PAZEO 2

POVIDONE-IODINE

OPHTHALMIC 3

PRED FORTE 3

PRED MILD 3

PREDNISOL ACE-

MOXIFLOX-BROMFEN 3

prednisolone acetate

ophthalmic 1

prednisolone acetate p-

f 1

prednisolone sodium

phosphate ophthalmic 1

Drug Name Drug

Category

Limits/

Required

bromfenac sodium

(once-daily) 1 QL

BROMSITE 3 QL

CEFUROXIME

SODIUM-NACL

INTRAVITREAL

6

MSD

CILOXAN 3

ciprofloxacin hcl

ophthalmic 1

cromolyn sodium

ophthalmic 1

dexamethasone

sodium phosphate

ophthalmic

1

DEXTENZA 6 MSD

DEXYCU 6 MSD

diclofenac sodium

ophthalmic 1

DUREZOL 3

epinastine hcl 1

erythromycin

ophthalmic 1

FLAREX 3

fluorometholone 1

flurbiprofen sodium 1

FML 3

FML FORTE 3

FML LIQUIFILM 3

gatifloxacin ophthalmic 1

gentak 1

gentamicin sulfate

ophthalmic 1

ILEVRO 2 QL

ILUVIEN 6 MSD

INVELTYS 2


ophthalmic 1

KLARITY-A 2

KLARITY-B 3

KLARITY-L 3


109

Drug Name Drug

Category

Limits/

Required

COSOPT PF

OPHTHALMIC

SOLUTION 22.3-6.8

MG/ML

3

M

DORZOLAMIDE HCL

SOLUTION 2 %

OPHTHALMIC

3

M

dorzolamide hcl

solution 2 % ophthalmic 1 M

dorzolamide hcl-timolol

mal pf ophthalmic

solution 22.3-6.8 mg/ml

1

M

DORZOLAMIDE HCL-

TIMOLOL MAL

SOLUTION 22.3-6.8

MG/ML OPHTHALMIC

3

ST; M

dorzolamide hcl-timolol

mal solution 22.3-6.8

mg/ml ophthalmic

1

M

IOPIDINE 3

ISOPTO CARPINE 3 M

ISTALOL 3 M

KEVEYIS 3 PA; S; QL

LATANOPROST

SOLUTION 0.005 %

OPHTHALMIC

3

ST; M

latanoprost solution

0.005 % ophthalmic 1 M

levobunolol hcl 1 M

LUMIGAN 2 M; QL

methazolamide oral 1 M

PHOSPHOLINE

IODIDE 2 M

pilocarpine hcl

ophthalmic 1 M

RHOPRESSA 2 M

ROCKLATAN 3 M

SIMBRINZA 3 M

timolol maleate

ophthalmic 1 M

TIMOPTIC 3 M

TIMOPTIC OCUDOSE 3 M

Drug Name Drug

Category

Limits/

Required

PREDNISOLON-

MOXIFLOX-

NEPAFENAC

3

PROLENSA 2 QL

RETISERT 6 MSD


ophthalmic 1

tobramycin ophthalmic 1

TOBREX 3

trifluridine 1

TRIPLE PMB 3

TRIPLE PMK 3

VIGAMOX 3

YUTIQ 6 MSD

ZIRGAN 3

ZYMAXID 3

Ophthalmic Agents -

Drugs for Glaucoma

acetazolamide er 1 M

acetazolamide oral

tablet 250 mg 1 M

ALPHAGAN P

OPHTHALMIC

SOLUTION 0.1 %

2

M

ALPHAGAN P

OPHTHALMIC

SOLUTION 0.15 %

3

M

apraclonidine hcl 1

AZOPT 3 M

betaxolol hcl

ophthalmic 1 M

BETIMOL 3 M

BETOPTIC-S 3 M

bimatoprost ophthalmic 1 M; QL

brimonidine tartrate

ophthalmic 1 M

carteolol hcl 1 M

COMBIGAN 2 M

COSOPT 3 ST; M


110

Drug Name Drug

Category

Limits/

Required

BLEPHAMIDE S.O.P. 3

CEQUA 3 PA

CYCLOGYL 3 M

CYCLOMYDRIL 3 M

cyclopentolate hcl

ophthalmic 1 M

CYSTARAN 3 PA; M; S; QL

DEXAMETHASONE-

MOXIFLOXACIN 6 MSD

DEXAMETH-

MOXIFLOX-

KETOROLAC

6

MSD

DOUBLE PM 3

EYLEA 6 MSD

GELFILM

OPHTHALMIC 3

homatropaire 1 M

homatropine hbr 1 M

HYALURONIDASE

(INTRAOCULAR) 6 MSD

ISOPTO ATROPINE 3 M

JETREA 6 MSD

LACRISERT 3

LASTACAFT 3

LIDOCAINE-

EPINEPHRINE

INTRAOCULAR

6

MSD

LIDOCAINE-

PHENYLEPHRINE 6 MSD

LIDOCAINE-

PHENYLEPHRINE-

BSS

6

MSD

LUCENTIS 6 MSD

LUXTURNA 6 MSD

MACUGEN 6 MSD

MAXITROL 3

MOXIFLOXACIN HCL-

BSS 6 MSD

MYDRIACYL 3 M

neomycin-bacitracin zn-

polymyx 1

Drug Name Drug

Category

Limits/

Required

TIMOPTIC-XE 3 M

TRAVATAN Z 2 M; QL

TRUSOPT 3 M

VYZULTA 3 M; QL

XALATAN 3 ST; M

XELPROS 3 ST; M; QL

ZIOPTAN 3 M; QL

Ophthalmic Agents -

Drugs for

Miscellaneous Eye

Conditions

ak-poly-bac 1

AKTEN 3

ALCAINE 3

altacaine 1

altafluor 6 MSD

altafluor benox 6 MSD

altafrin 1

AMVISC 6 MSD

AMVISC PLUS 6 MSD

ATROPINE SULFATE

OPHTHALMIC

EMULSION

3

M

atropine sulfate

ophthalmic ointment 1 M

atropine sulfate

ophthalmic solution 1 M

bacitracin-polymyxin b

ophthalmic 1

bacitra-neomycin-

polymyxin-hc 1

BEVACIZUMAB

INTRAOCULAR 6 MSD

BEVACIZUMAB

INTRAVITREAL

SOLUTION

PREFILLED SYRINGE

2.5 MG/0.1ML, 3.25

MG/0.13ML

6

MSD

BIOLON 6 MSD

BLEPHAMIDE 3


111

Drug Name Drug

Category

Limits/

Required

PREDNISOLON-

MOXIFLOX-

BROMFENAC

3

proparacaine hcl

ophthalmic 1

PROVISC 6 MSD

RESTASIS 2 PA; M; QL

RESTASIS

MULTIDOSE

OPHTHALMIC

EMULSION 0.05 %

2

PA; M; QL

sulfacetamide-

prednisolone

ophthalmic solution

1

tetcaine 1

tetracaine hcl solution

0.5 % ophthalmic 3

tetracaine hcl solution

0.5 % ophthalmic 1

tetravisc 3

tetravisc forte 3

TOBRADEX

OPHTHALMIC

OINTMENT

2

TOBRADEX

OPHTHALMIC

SUSPENSION

3

TOBRADEX ST 2

tobramycin-

dexamethasone 1

TRIAMCINOLONE-

MOXIFLOXACIN 6 MSD

tropicamide ophthalmic 1 M

TROPICAMIDE-

PHENYLEPHRINE 3 M

VISUDYNE 6 MSD

XIIDRA 2 M

ZYLET 2

Otic Agents - Drugs

for Ear Conditions

acetic acid otic 1

CETRAXAL 3

Drug Name Drug

Category

Limits/

Required

neomycin-polymyxin-

dexameth ophthalmic

ointment

1

neomycin-polymyxin-

dexameth ophthalmic

suspension 3.5-10000-

0.1

1

neomycin-polymyxin-

gramicidin 1

neomycin-polymyxin-hc

ophthalmic 1

neo-polycin 1

neo-polycin hc 1

OMIDRIA 6 MSD

OXERVATE 3 S; QL

phenylephrine hcl

ophthalmic 1

polycin 1

polymyxin b-

trimethoprim 1

POLYTRIM 3

PRED-G 3

PRED-G S.O.P. 3

PREDNISOLONE

ACETATE-

NEPAFENAC

3

PREDNISOLONE

ACET-MOXIFLOXACIN 3

PREDNISOLONE-

BROMFENAC

OPHTHALMIC

SOLUTION

3

PREDNISOLONE-

GATIFLOXACIN 3

PREDNISOLONE-

MOXIFLOXACIN 3

PREDNISOLON-

GATIFLOX-

BROMFENAC

OPHTHALMIC

SOLUTION

3


112

Drug Name Drug

Category

Limits/

Required

CLARINEX-D 12

HOUR 3 QL

clemastine fumarate

oral tablet 2.68 mg 1

cyproheptadine hcl oral 1

desloratadine 1 QL

dexchlorpheniramine

maleate oral 1

DICOPANOL

FUSEPAQ 3

DICOPANOL

RAPIDPAQ 3

diphenhydramine hcl

injection 6 MSD

diphenhydramine hcl

oral elixir 1

DYMISTA 2 QL

FASENRA 6 M; MSD

flunisolide nasal 1 QL

fluticasone propionate

nasal 2

GILPHEX TR 3

GILTUSS TR 3

guaiatussin ac 1 OTC; QL

guaifenesin ac 1 OTC; QL

hydrocodone polst-cpm

polst er 1 PA; QL

hydrocodone-

homatropine 1 QL

hydromet 1 QL

HYPERSAL 3

INFASURF 6 MSD

ipratropium bromide

nasal 1 M

KARBINAL ER 3

levocetirizine

dihydrochloride oral

solution

2

levocetirizine

dihydrochloride oral

tablet

2

QL

Drug Name Drug

Category

Limits/

Required

CIPRO HC 3

CIPRODEX 2

ciprofloxacin hcl otic 1

COLY-MYCIN S 3

cortic-nd 1

DERMOTIC 3

exotic-hc 1

flac 1

FLOXIN OTIC 1


otic 1

hydrocortisone-acetic

acid 1

neomycin-polymyxin-hc

otic 1

ofloxacin otic 1

OTICIN HC NR 3

OTIPRIO 3

OTOVEL 2

PRAMOTIC 3

Respiratory Tract /

Pulmonary Agents -

Drugs for Allergies,

Cough, Cold

ADRENALIN NASAL 3

ASTEPRO 3 QL

azelastine hcl nasal 1 QL

BECONASE AQ 3 QL

benzonatate 1

bromfed dm 1

BROMPHENIRAMINE

MALEATE

INTRAMUSCULAR

3

brompheniramine

tannate 1

carbinoxamine maleate 1

cetirizine hcl oral

solution 2 QL

CINQAIR 6 M; MSD

CLARINEX 3 QL


113

Drug Name Drug

Category

Limits/

Required

promethegan 1

pseudoeph-chlorphen-

hydrocod 1 QL

pseudoephedrine-

bromphen-dm 1

pulmosal 1

QNASL 2 QL

QNASL CHILDRENS 2 QL

RYCLORA 3

ryvent 3

SEMPREX-D 3

SINUVA 6 MSD

sodium chloride

inhalation 1

SSKI 3

SURVANTA 6 MSD

TESSALON PERLES 3

TUSSICAPS 3 PA; QL

TUXARIN ER 3 QL

TUZISTRA XR 3 PA; QL

XHANCE 3 QL

XOLAIR

SUBCUTANEOUS

SOLUTION

PREFILLED SYRINGE

6

PA; MSD

XOLAIR

SUBCUTANEOUS

SOLUTION

RECONSTITUTED

6

PA; MSD; QL

ZETONNA 3 QL

Z-TUSS AC 3 OTC; QL

Respiratory Tract /

Pulmonary Agents -

Drugs for Asthma and

Other Lung

Conditions

ACCOLATE 3 M; QL

acetylcysteine

inhalation 1

ADRENALIN

INJECTION 6 MSD

Drug Name Drug

Category

Limits/

Required

mometasone furoate

nasal 1 QL

NASONEX 3 ST; QL

nebusal inhalation

nebulization solution 3

%

1

NEBUSAL

INHALATION

NEBULIZATION

SOLUTION 6 %

3

NEOTUSS PLUS 2

NUCALA

SUBCUTANEOUS

SOLUTION AUTO-

INJECTOR

3

M; S; QL

NUCALA

SUBCUTANEOUS

SOLUTION

PREFILLED SYRINGE

3

M; S; QL

NUCALA

SUBCUTANEOUS

SOLUTION

RECONSTITUTED

6

M; MSD; QL

olopatadine hcl nasal 1 QL

OMNARIS 3 QL

PATANASE 3 QL

phenadoz 1

PHENERGAN 6 MSD

phenylephrine-

guaifenesin oral liquid 1

promethazine hcl

injection 6 MSD

promethazine hcl oral

syrup 1

promethazine hcl oral

tablet 1

promethazine hcl rectal 1

promethazine-codeine 1 QL

promethazine-dm 1

promethazine-

phenyleph-codeine 1 QL

promethazine-

phenylephrine 1


114

Drug Name Drug

Category

Limits/

Required

BEVESPI

AEROSPHERE 2 M; QL

BREO ELLIPTA 2 M; QL

BROVANA 3 M; QL

budesonide inhalation 1 M; QL

COMBIVENT

RESPIMAT 2 M; QL

cromolyn sodium

inhalation 1 M

DALIRESP ORAL

TABLET 250 MCG 2 PA; M

DALIRESP ORAL

TABLET 500 MCG 2 PA; M; QL

difil-g forte 1

DUAKLIR PRESSAIR 3 M

DULERA 2 M; QL

ELIXOPHYLLIN 3 M


solution 0.3 mg/0.3ml 3


solution auto-injector

0.15 mg/0.15ml

3



0.15 mg/0.3ml

2

QL



0.3 mg/0.3ml

1

EPIPEN 2-PAK 3

EPIPEN JR 2-PAK 2 QL

EPISNAP 6 MSD

ESBRIET ORAL

CAPSULE 3 PA; M; S; QL

ESBRIET ORAL

TABLET 267 MG 3 PA; M; S; QL

ESBRIET ORAL

TABLET 801 MG 3 PA; M; S

FLOVENT DISKUS 2 M; QL

FLOVENT HFA 2 M; QL

Drug Name Drug

Category

Limits/

Required

ADVAIR DISKUS 3 M; QL

ADVAIR HFA 2 M; QL

AIRDUO RESPICLICK

113/14 2 M; QL

AIRDUO RESPICLICK

232/14 2 M; QL

AIRDUO RESPICLICK

55/14 2 M; QL

albuterol sulfate er 1 M

ALBUTEROL

SULFATE HFA 3 M; QL

albuterol sulfate

inhalation 1 M; QL

albuterol sulfate oral 1 M

ALVESCO 3 M; QL

aminophylline

intravenous 6 MSD

ANORO ELLIPTA 2 M; QL

ARALAST NP 6 PA; MSD

ARCAPTA NEOHALER 2 M; QL

ARNUITY ELLIPTA 2 M; QL

ASMANEX (120

METERED DOSES) 2 M; QL

ASMANEX (14


ASMANEX (30


ASMANEX (60


ASMANEX (7


ASMANEX HFA 2 M; QL

ATROVENT HFA 2 M; QL

AUVI-Q INJECTION

SOLUTION AUTO-

INJECTOR 0.1

MG/0.1ML

3

QL

AUVI-Q INJECTION

SOLUTION AUTO-

INJECTOR 0.15

MG/0.15ML, 0.3

MG/0.3ML

3


115

Drug Name Drug

Category

Limits/

Required

PROLASTIN-C

INTRAVENOUS

SOLUTION

6

MSD

PROLASTIN-C

INTRAVENOUS

SOLUTION

RECONSTITUTED

6

PA; MSD

PROVENTIL HFA 3 M; QL

PULMICORT

FLEXHALER 2 M; QL

PULMICORT

SUSPENSION 3 ST; M; QL

QVAR REDIHALER 2 M; QL

SCLEROSOL

INTRAPLEURAL 6 MSD

SEEBRI NEOHALER 3 M; QL

SEREVENT DISKUS 2 M; QL

SINGULAIR ORAL

PACKET 3 ST; M

SINGULAIR ORAL

TABLET 3 ST; M; QL

SINGULAIR ORAL

TABLET CHEWABLE 3 ST; M; QL

SPIRIVA

HANDIHALER 2 M; QL

SPIRIVA RESPIMAT 2 M; QL

STERILE TALC

POWDER 6 MSD

STERITALC 6 MSD

STIOLTO RESPIMAT 2 M; QL

STRIVERDI

RESPIMAT 2 M; QL

SYMBICORT 2 M; QL

SYMJEPI 3

terbutaline sulfate

injection 6 MSD

terbutaline sulfate oral 1 M

THEO-24 3 M

theochron 1 M

theophylline 1 M

theophylline er 1 M

Drug Name Drug

Category

Limits/

Required

fluticasone-salmeterol

inhalation aerosol

powder breath

activated 100-50

mcg/dose, 250-50

mcg/dose, 500-50

mcg/dose

1

M; QL

FLUTICASONE-

SALMETEROL

INHALATION

AEROSOL POWDER

BREATH ACTIVATED

113-14 MCG/ACT, 232-

14 MCG/ACT, 55-14

MCG/ACT

2

M; QL

GLASSIA 6 MSD

INCRUSE ELLIPTA 2 M; QL

ipratropium bromide

inhalation 1 M; QL

ipratropium-albuterol 1 M; QL

levalbuterol hcl

inhalation 1 M; QL

LEVALBUTEROL HFA

INHALATION

AEROSOL 45

MCG/ACT

3

M; QL

LONHALA MAGNAIR

REFILL KIT 3 M; QL

LONHALA MAGNAIR

STARTER KIT 3 M; QL

metaproterenol sulfate

oral 1 M

montelukast sodium

oral packet 1 M

montelukast sodium

oral tablet 1 M; QL

montelukast sodium

oral tablet chewable 1 M; QL

OFEV 3 PA; M; S; QL

PERFOROMIST 2 M; QL

PROAIR DIGIHALER 2 M; QL

PROAIR HFA 1 M; QL

PROAIR RESPICLICK 2 M; QL


116

Drug Name Drug

Category

Limits/

Required

alyq 1 PA; M; S; QL

ambrisentan 1 PA; M; QL

bosentan 1 PA; M; QL

epoprostenol sodium 6 MSD

FLOLAN 6 MSD

LETAIRIS 3 PA; M; S; QL

OPSUMIT 3 PA; M; S; QL

ORENITRAM 4 PA; M; S

REMODULIN 6 PA; MSD; QL

REVATIO


REVATIO ORAL 4 PA; M; S; QL

sildenafil citrate

intravenous 6 PA; MSD

sildenafil citrate oral

suspension

reconstituted

1

PA; M; QL

sildenafil citrate oral

tablet 20 mg 1 PA; M; S; QL

tadalafil (pah) 1 PA; M; S; QL

TRACLEER 3 PA; M; S; QL

treprostinil 6 PA; MSD; QL

TYVASO 6 PA; M; MSD;

QL

TYVASO REFILL 6 PA; M; MSD;

QL

TYVASO STARTER 6 PA; M; MSD;

QL

UPTRAVI ORAL

TABLET 3 PA; M; S; QL

UPTRAVI ORAL

TABLET THERAPY

PACK

3

PA; S; QL

VELETRI 6 MSD

VENTAVIS 4 PA; M; S; QL

Skeletal Muscle

Relaxants - Drugs for

Muscle Pain and

Spasm

ACTIVE-

CYCLOBENZAPRINE 3

Drug Name Drug

Category

Limits/

Required

TRELEGY ELLIPTA 2 M; QL

TUDORZA PRESSAIR 2 M; QL

UTIBRON NEOHALER 3 M; QL

VENTOLIN HFA 2 M; QL

wixela inhub 1 M; QL

XOPENEX 3 M; QL

XOPENEX

CONCENTRATE 3 M; QL

XOPENEX HFA 3 M; QL

YUPELRI 2 M; QL

zafirlukast 1 M; QL

ZEMAIRA 6 PA; MSD

zileuton er 1 M; QL

ZYFLO 3 M

Respiratory Tract /

Pulmonary Agents -

Drugs for Cystic

Fibrosis

BETHKIS 6 M; MSD; QL

CAYSTON 3 S; QL

KALYDECO 3 PA; M; S

KITABIS PAK 2 M; QL

ORKAMBI 3 PA; M; S; QL

PULMOZYME 2 M

SYMDEKO 3 PA; M; S; QL

TOBI NEBULIZER 3 M; QL

TOBI PODHALER 2 M; QL

tobramycin nebulization

solution 300 mg/5ml

inhalation

1

M; QL

TOBRAMYCIN

NEBULIZATION

SOLUTION 300

MG/5ML INHALATION

3

M; QL

Respiratory Tract /

Pulmonary Agents -

Drugs for Pulmonary

Hypertension

ADCIRCA 4 PA; M; S; QL

ADEMPAS 3 PA; M; S; QL


117

Drug Name Drug

Category

Limits/

Required

GABLOFEN

INTRATHECAL

SOLUTION 20000

MCG/20ML

6

MSD

GABLOFEN

INTRATHECAL

SOLUTION

PREFILLED SYRINGE

6

MSD

LIORESAL

INTRATHECAL

INTRATHECAL

SOLUTION 2000

MCG/ML, 40

MG/20ML, 500

MCG/ML

6

MSD; QL

LIORESAL

INTRATHECAL

SOLUTION 0.05

MG/ML, 10 MG/20ML,

40 MG/20ML

6

MSD; QL

LORZONE 3 ST

METAXALL CP 3

metaxalone 1

methocarbamol

injection 6 MSD

methocarbamol oral 1

NORGESIC FORTE 3

orphenadrine citrate er 1

orphenadrine citrate

injection 6 MSD

orphenadrine-aspirin-

caffeine 1

ORPHENGESIC

FORTE 3

ROBAXIN 6 MSD

ROBAXIN-750 3 ST

RYANODEX 6 MSD

SKELAXIN 3 ST

SOMA 3 ST

TABRADOL FUSEPAQ 3

TABRADOL

RAPIDPAQ 3

tizanidine hcl oral 1

Drug Name Drug

Category

Limits/

Required

AMRIX 3 ST

baclofen external 1

baclofen intrathecal

solution 10 mg/20ml,

40 mg/20ml

6

MSD; QL

baclofen intrathecal

solution 20000

mcg/20ml

6

MSD

baclofen oral tablet 10

mg, 20 mg 1

baclofen oral tablet 5

mg 3

carisoprodol oral 1

carisoprodol-aspirin 1

chlorzoxazone 1 PA

cyclobenzaprine hcl er 1

cyclobenzaprine hcl

oral 1

CYCLOPHENE

RAPIDPAQ 3

DANTRIUM ORAL 3 ST

dantrolene sodium oral 1

ENOVARX-

BACLOFEN 3

enovarx-

cyclobenzaprine hcl

cream 20 mg/gm

transdermal

1

ENOVARX-

CYCLOBENZAPRINE

HCL CREAM 20

MG/GM

TRANSDERMAL

3

FEXMID 3 ST

FIRST-BACLOFEN 3

GABLOFEN

INTRATHECAL

SOLUTION 10000

MCG/20ML, 40000

MCG/20ML

6

MSD; QL


118

Drug Name Drug

Category

Limits/

Required

ZANAFLEX 3 ST

Sleep Disorder

Agents

AMBIEN 3 ST; QL

AMBIEN CR 3 ST; QL

AMYTAL SODIUM 2

armodafinil 1 PA; M; QL

BELSOMRA 3 ST; QL

BUTISOL SODIUM 3

EDLUAR 3 ST; QL

eszopiclone 1 QL

flurazepam hcl 1 QL

HETLIOZ 4 ST; M; S; QL

INTERMEZZO 3 ST; QL

LUNESTA 3 ST; QL

modafinil 1 PA; M; QL

NUVIGIL 3 PA; M; QL

PROVIGIL 3 PA; M; QL

ramelteon 1 QL

RESTORIL 3 QL

ROZEREM 2 ST; QL

SECONAL 1

SILENOR 3 ST; QL

temazepam 1 QL

WAKIX 3 M

XYREM 3 PA; S; QL

zaleplon 1 QL

zolpidem tartrate 1 QL

zolpidem tartrate er 1 QL

ZOLPIMIST 3 ST; QL


119

SMARTVIEW KIT W/DEVICE... 60

ACCU-CHEK SMARTVIEW

CONTROL ................................. 60

ACCU-CHEK SMARTVIEW

TEST STRIPS ........................... 60

ACCU-CHEK SOFTCLIX

LANCET DEVICE KIT ............... 60

ACCUPRIL ................................ 41

ACCURETIC .............................. 41

acd formula a ............................. 21

acd-a noclot-50 .......................... 21

acebutolol hcl ............................. 41

ACETADOTE ............................. 92

acetaminophen-codeine ............... 7

ACTIVE-PREP KIT II ................. 11

ACTIVE-PREP KIT III ................ 11

ACTIVE-PREP KIT IV ................ 52

ACTIVE-PREP KIT V ................. 52

ACTIVE-TRAMADOL ................. 52

ACTONEL .................................. 91

ACTOPLUS MET ....................... 58

ACTOS ...................................... 58

ACULAR .................................. 100

ACULAR LS ............................. 100

ACUVAIL ................................. 100

acyclovir ..................................... 37

acyclovir sodium ........................ 37

ACZONE .................................... 52

113

AGGRENOX ............................. 36

AGRYLIN .................................. 40

AIF #2 DRUG PREPARATION

KIT ............................................ 11

AIF #3 DRUG PREPARATION

KIT ............................................ 11

AIMOVIG................................... 29

AIRDUO RESPICLICK 113/14 107



AJOVY ...................................... 29

AKOVAZ ................................... 42

ak-poly-bac ............................. 103

AKTEN .................................... 103

Index of Drugs

7T GUMMY ES ............................ 7

A.A.G.C. KIT IN TERODERM .... 52

abacavir sulfate ......................... 37

abacavir sulfate-lamivudine ....... 37

abacavir-lamivudine-

zidovudine ................................. 37

ABELCET .................................. 27

ABILIFY ..................................... 36

ABILIFY MAINTENA .................. 36

ABILIFY MYCITE ....................... 36

abiraterone acetate .................... 30

ABLYSINOL ............................... 41

ABRAXANE ............................... 30

ABSORICA ................................ 52

ABSTRAL .................................... 7

ACACIA ..................................... 92

acamprosate calcium ................. 16

ACANYA .................................... 52

acarbose .................................... 58

ACCOLATE ............................. 106

ACCU-CHEK AVIVA

CONNECT KIT W/DEVICE ....... 60

ACCU-CHEK AVIVA DEVICE ... 60

ACCU-CHEK AVIVA PLUS ....... 60

ACCU-CHEK COMPACT

PLUS CARE KIT ....................... 60

ACCU-CHEK COMPACT

PLUS CONTROL ....................... 60

ACCU-CHEK COMPACT

PLUS TEST STRIPS ................. 60

ACCU-CHEK FASTCLIX

LANCET KIT .............................. 60

ACCU-CHEK GUIDE ................. 60

ACCU-CHEK GUIDE

CONTROL ................................. 60

ACCU-CHEK GUIDE ME .......... 60

ACCU-CHEK MULTICLIX

LANCET DEVICE KIT ............... 60

ACCU-CHEK NANO

acetaminophen-codeine #2 .......... 7



acetazolamide .................... 41, 102

acetazolamide er ..................... 102

acetazolamide sodium ............... 41

acetic acid ................................ 104

acetylcysteine .................... 92, 106

ACIPHEX ................................... 72

ACIPHEX SPRINKLE ................ 72

acitretin ...................................... 52

ACREMONIUM .......................... 92

ACTEMRA ................................. 87

ACTEMRA ACTPEN .................. 87

ACTHAR .................................... 80

ACTHIB...................................... 90

ACTICLATE ............................... 16

ACTIGALL ................................. 73

ACTIMMUNE ............................. 87

ACTIQ .......................................... 7

ACTIVE FE ................................ 64

ACTIVE INJECTION BLM-1 ...... 77

ACTIVE INJECTION BM ........... 77

ACTIVE INJECTION DL ............ 77

ACTIVE INJECTION DLM ......... 77

ACTIVE INJECTION KET-L ....... 11

ACTIVE INJECTION

KETMARC-L .............................. 11

ACTIVE INJECTION KIT L ........ 77

ACTIVE INJECTION KM ........... 77

ACTIVE INJECTION LM-2 ......... 13

ACTIVE INJECTION LM-DEP-

2 ................................................ 77

ACTIVE INJECTION M-1 ........... 77

ACTIVE-CYCLOBENZAPRINE

................................................ 109

ACTIVE-KETOPROFEN ............ 11

ACTIVELLA ............................... 82

ACTIVE-PREP KIT I .................. 11

ADACEL.................................... 90

ADALAT CC .............................. 42

adapalene ................................. 52

ADAPALENE ............................ 52

adapalene-benzoyl peroxide ..... 52

ADASUVE ................................. 36

adc/f (0.5mg/ml) ........................ 64

ADCETRIS ................................ 30

ADCIRCA ................................ 109

ADDERALL ............................... 49

ADDERALL XR ......................... 49

ADDYI ....................................... 50

adefovir dipivoxil........................ 37

ADEMPAS .............................. 109

ADENOCARD ........................... 42

adenosine ........................... 42, 92

adenosine (diagnostic) .............. 92

ADHANSIA XR .......................... 49

ADLYXIN ................................... 58

ADLYXIN STARTER PACK ...... 58

ADMELOG ................................ 63

ADMELOG SOLOSTAR ............ 63

ADRENALIN ................... 105, 106

adriamycin ................................. 30

adrucil ....................................... 30

ADVAIR DISKUS .................... 107

ADVAIR HFA .......................... 107

ADVATE.................................... 40

ADYNOVATE ............................ 40

ADZENYS ER ........................... 49

ADZENYS XR-ODT .................. 49

AEMCOLO ................................ 16

AFINITOR ................................. 30

AFINITOR DISPERZ ................. 30

afirmelle .................................... 82

AFLURIA QUADRIVALENT ...... 90

AFREZZA .................................. 63

AFSTYLA .................................. 40

AGGRASTAT ............................ 36

ALOGLIPTIN BENZOATE ......... 58

ALOGLIPTIN-METFORMIN

HCL ........................................... 58

ALOGLIPTIN-PIOGLITAZONE. 58

ALOMIDE ................................ 100

ALOPRIM .................................. 28

ALORA ...................................... 82

alosetron hcl .............................. 73

ALOXI ........................................ 26

ALPHAGAN P .......................... 102

ALPHA-LIPOIC ACID ................ 92

ALPHANATE/VWF

COMPLEX/HUMAN ................... 40

ALPHANINE SD ........................ 40

amethyst .................................... 82

AMICAR ..................................... 40

AMIDATE ................................... 93

amikacin sulfate ......................... 16

amiloride hcl............................... 42

amiloride-hydrochlorothiazide .... 42

AMINO ACID ............................. 64

aminobenzoate potassium ......... 64

aminocaproic acid ...................... 40

aminophylline ........................... 107

AMINOPMRMS .......................... 93

AMINOPROTECT ...................... 64

AMINOSYN II............................. 64

AMINOSYN-PF .......................... 64

ANADROL-50 ............................79

ANAFRANIL .............................. 24

anagrelide hcl ........................... 40

ANALPRAM HC .........................91

ANALPRAM HC SINGLES .........91

ANALPRAM-HC .........................91

ANASCORP ...............................93

ANASPAZ ................................. 73

anastrozole ............................... 30

ANAVIP ......................................93

ANCOBON ................................ 27

ANDEXXA ..................................93

ANDRODERM .......................... 79

ANDROGEL .............................. 79

114

AKTIPAK ................................... 52

AKYNZEO ................................. 26

ALA SCALP ............................... 52

ala-cort ...................................... 52

albendazole ............................... 34

ALBENZA .................................. 34

ALBUKED 25 ............................. 92

ALBUKED 5 ............................... 92

albumin human .......................... 92

ALBUMINEX .............................. 92

alburx ......................................... 92

ALBUTEIN ................................. 92

albuterol sulfate ....................... 107

albuterol sulfate er ................... 107

ALBUTEROL SULFATE HFA. 107

ALCAINE ................................. 103

alclometasone dipropionate ....... 52

alcohol ....................................... 64

ALCOHOL PREP PADS ...... 52, 92

alcohol prep pads ...................... 92

ALDACTAZIDE .......................... 42

ALDACTONE ............................. 42

ALDARA .................................... 52

ALDER ...................................... 92

ALDURAZYME .......................... 75

ALECENSA ............................... 30

alendronate sodium ................... 92

alfentanil hcl................................. 7

ALFERON N .............................. 87

alfuzosin hcl er .......................... 77

ALINIA ....................................... 34

ALIQOPA ................................... 30

aliskiren fumarate ...................... 42

ALKERAN .................................. 30

allopurinol .................................. 28

allopurinol sodium ...................... 28

ALLZITAL .................................... 7

almotriptan malate ..................... 29

ALOCRIL ................................. 100

alprazolam ................................. 39

alprazolam er ............................. 39

ALPRAZOLAM INTENSOL ........ 39

alprazolam xr ............................. 39

ALPROLIX ................................. 40

alprostadil .................................. 42

ALREX ..................................... 100

ALTABAX ................................... 16

altacaine .................................. 103

ALTACE ..................................... 42

altafluor .................................... 103

altafluor benox ......................... 103

altafrin ...................................... 103

altavera ...................................... 82

ALTERNARIA ............................ 92

ALTOPREV ................................ 42

ALTRENO .................................. 52

ALUNBRIG ................................ 30

ALVESCO ................................ 107

alyacen 1/35 .............................. 82

alyacen 7/7/7 ............................. 82

alyq .......................................... 109

amabelz ..................................... 82

amantadine hcl .......................... 35

AMARYL .................................... 58

AMBIEN ................................... 111

AMBIEN CR ............................. 111

AMBISOME ............................... 27

ambrisentan ............................. 109

amcinonide ................................ 52

AMD FOAM DRESSING ............ 93

AMELUZ .................................... 52

AMERGE ................................... 29

AMERICAN BEECH .................. 93

AMERICAN COCKROACH ........ 93

AMERICAN ELM ....................... 93

AMERICAN SYCAMORE .......... 93

amethia ...................................... 82

amethia lo .................................. 82

amiodarone hcl ......................... 42

AMIODARONE HCL IN

DEXTROSE .............................. 42

AMITIZA .................................... 73

amitriptyline hcl ......................... 24

AMLODIPINE

BES+SYRSPEND SF ............... 42

amlodipine besylate .................. 42

amlodipine besylate-benazepril

hcl ............................................. 42

amlodipine besylate-valsartan 42

amlodipine-atorvastatin ............. 42

amlodipine-olmesartan .............. 42

amlodipine-valsartan-hctz ......... 42

ammonium lactate ..................... 52

AMMONUL ................................ 75

amnesteem ............................... 52

amoxapine ................................ 24

amoxicill-clarithro-lansopraz ...... 73

amoxicillin ................................. 16


clavulanate ................................ 16


clavulanate er............................ 16

AMPHADASE ........................... 93

amphetamine sulfate ................. 49

amphetamine-

dextroamphetamine .................. 49

amphetamine-

dextroamphetamine er .............. 49

amphotericin b .......................... 27

ampicillin ................................... 16

ampicillin sodium ....................... 16

ampicillin-sulbactam sodium ..... 16

AMPYRA ................................... 50

AMRIX .................................... 110

AMVISC .................................. 103

AMVISC PLUS ........................ 103

AMYTAL SODIUM .................. 111

ANDROGEL PUMP ................... 79

ANECTINE ................................ 50

ANESTHESIA S/I-40 ................. 93

ANESTHESIA S/I-40A ............... 93

ANESTHESIA S/I-40H ............... 93

ANESTHESIA S/I-40S ............... 93

ANESTHESIA S/I-60 ................. 93

ANGELIQ ................................... 82

ANGIOMAX ............................... 21

ANNOVERA .............................. 82

ANORO ELLIPTA .................... 107

ANTABUSE ............................... 16

ANTARA .................................... 42

anticoagulant cit dext soln a ...... 21

anticoagulant sodium citrate ...... 21

ANTIVENIN LATRODECTUS

MACTANS ................................. 93

ANTIVENIN MICRURUS

FULVIUS ................................... 93

anucort-hc .................................. 91

ANUSOL-HC ............................. 91

anusol-hc ................................... 91

ANZEMET ................................. 26

APADAZ ...................................... 7

apap-caff-dihydrocodeine ............ 7

APEXICON E............................. 52

APIDRA SOLOSTAR ................. 63

APIDRA VIAL ............................ 63

APLENZIN ................................. 24

APOKYN .................................... 35

APP SLIM RMS ......................... 93

APPLE (DIAGNOSTIC) ............. 93

apraclonidine hcl ...................... 102

aprepitant ................................... 26

apri ............................................ 82

APRISO ..................................... 91

APTENSIO XR .......................... 49

APTIOM ..................................... 22

APTIVUS ................................... 37

AQUACEL AG BURN ................ 52

AQUASOL A .............................. 64

ARAKODA ................................. 34

ARALAST NP .......................... 107

aranelle ...................................... 82

ARANESP (ALBUMIN FREE) ... 40

ARAVA ...................................... 87

ARCALYST ................................ 87

ARCAPTA NEOHALER ........... 107

ARESTIN ................................... 51

argatroban ................................. 21

argatroban in sodium chloride 21

ARGININE HCL ......................... 64

ARICEPT ................................... 24

ARIKAYCE ................................. 16

ARIMIDEX ................................. 30

aripiprazole ................................ 36

ARISTADA ................................. 36

ARISTADA INITIO ..................... 36

ARIXTRA ................................... 21

ARIZONA CYPRESS ................. 93

armodafinil ............................... 111

ARMOUR THYROID .................. 86

ARNUITY ELLIPTA .................. 107

AROMASIN ................................ 30

ARRANON ................................. 30

arsenic trioxide ........................... 30

ARTHROTEC............................. 11

ARTISS ...................................... 93

ARYMO ER .................................. 7

ARZERRA .................................. 30

arzol silver nit applicators ........... 52

ASACOL HD .............................. 91

ASCLERA .................................. 42

ascomp-codeine ........................... 7

ascorbic acid .............................. 64

ashlyna ...................................... 82

asilnasalrms ............................... 93

ASMANEX (120 METERED

DOSES) ................................... 107

ASMANEX (14 METERED

DOSES) ................................... 107

ASMANEX (30 METERED

DOSES) ................................... 107

ASMANEX (60 METERED

DOSES) ................................... 107

ASMANEX (7 METERED

DOSES) ................................... 107

ASMANEX HFA ....................... 107

aspirin ........................................ 11

aspirin adult ............................... 11

aspirin adult low strength ........... 11

aspirin childrens ......................... 11

aspirin ec low dose .................... 11

aspirin ec low strength ............... 11

aspirin low dose ......................... 11

aspirin-dipyridamole er ............... 36

ASTAGRAF XL .......................... 87

ASTEPRO ................................ 105

ATACAND .................................. 42

ATACAND HCT ......................... 42

atazanavir sulfate ....................... 37

ATELVIA .................................... 92

atenolol ...................................... 42

ATENOLOL+SYRSPEND SF .... 42

atenolol-chlorthalidone ............... 42

ATGAM ...................................... 87

ATIVAN ..................................... 39

atomoxetine hcl ......................... 49

atorvastatin calcium .................. 42

atovaquone ............................... 34

atovaquone-proguanil hcl .......... 34

atracurium besylate ................... 50

ATRALIN ................................... 52

ATRIPLA ................................... 37

ATROPEN ................................. 73

atropine sulfate ................. 73, 103

ATROPINE SULFATE....... 73, 103

ATROVENT HFA .................... 107

AUBAGIO .................................. 50

aubra ......................................... 82

aubra eq .................................... 82

AUGMENTIN ............................ 16

AUGMENTIN ES-600 ............... 16

AURA PORTANEB ................... 93

AUREOBASIDIUM .................... 93

aurovela 1.5/30 ......................... 82

aurovela 1/20 ............................ 82

aurovela 24 fe ........................... 82

aurovela fe 1.5/30 ..................... 82

aurovela fe 1/20 ........................ 82

AURYXIA .................................. 76

AUSTEDO ................................. 50

AUSTRALIAN PINE .................. 93

AUTOLET LANCING DEVICE 60

AUVI-Q ................................... 107

AVALIDE ................................... 42

AVANDIA .................................. 58

AVAPRO ................................... 42

AVAR LS CLEANSER .............. 52

AVAR-E LS ............................... 52

AVASTIN ................................... 30

AVC VAGINAL .......................... 27

AVEED ...................................... 79

AVELOX.................................... 16

aviane ....................................... 82

avidoxy ...................................... 16

avita .................................... 52, 53

AVOCADO (DIAGNOSTIC) ...... 93

AVODART ................................. 77

AVONEX PEN........................... 50

AVONEX PREFILLED .............. 50

AVYCAZ.................................... 16

AXIFOL ..................................... 64

AXUMIN .................................... 93

AYGESTIN ................................ 82

ayuna ........................................ 82

azacitidine ................................. 30

AZACTAM ................................. 16

AZASAN.................................... 87

115

AZASITE .................................. 100

azathioprine ............................... 87

azathioprine sodium ................... 87

AZEDRA DOSIMETRIC ............. 30

AZEDRA THERAPEUTIC .......... 30

azelaic acid ................................ 53

azelastine hcl ................... 100, 105

AZELEX ..................................... 53

AZILECT .................................... 35

azithromycin .............................. 17

AZOPT .................................... 102

AZOR ........................................ 42

aztreonam .................................. 17

AZULFIDINE .............................. 91

AZULFIDINE EN-TABS ............. 91

azurette...................................... 82

B-12 COMPLIANCE

INJECTION ................................ 64

bacitracin ........................... 17, 100

bacitracin-polymyxin b ............. 103

bacitra-neomycin-polymyxin-hc

................................................ 103

baclofen ................................... 110

BACTERIOSTATIC

WATER(BENZ ALC) .................. 93

bacteriostatic water(benz alc) .... 93

BACTOCILL IN DEXTROSE ..... 17

BACTRIM .................................. 17

BACTRIM DS ............................ 17

BAHIA ........................................ 93

bal in oil ..................................... 93

BALCOLTRA ............................. 82

BALD CYPRESS ....................... 93

balsalazide disodium ................. 91

balsam peru-castor oil ............... 53

BALVERSA ................................ 30

balziva ....................................... 82

BANANA (DIAGNOSTIC) .......... 93

BANZEL..................................... 22

BARACLUDE ............................. 37

BASAGLAR KWIKPEN .............. 63

BAVENCIO ................................ 30

BAXDELA .................................. 17

BAYBERRY (WAX MYRTLE) .... 93

bayer aspirin .............................. 11

bayer aspirin ec low dose .......... 11

BAYER CONTOUR ................... 60

BCAA ......................................... 64

BCG VACCINE .......................... 90

BD AUTOSHIELD DUO PEN

NEEDLES .................................. 63

bd pudendal/local tray/1% lido 13

BD SYRINGE LUER-LOK .......... 93

BD ULTRA-FINE INSULIN

SYRINGES ................................ 63

BD ULTRA-FINE PEN

NEEDLES .................................. 63

BECONASE AQ ....................... 105

BEEF (DIAGNOSTIC) ................ 93

bekyree ...................................... 82

BELBUCA .................................... 7

BELEODAQ ............................... 30

belladonna alkaloids-opium ........ 73

BELRAPZO ................................ 30

BELSOMRA ............................. 111

benazepril hcl............................. 42

benazepril-hydrochlorothiazide. 42

BENDAMUSTINE HCL .............. 30

BENDEKA .................................. 30

BENEFIX ................................... 40

BENICAR ................................... 42

BENICAR HCT .......................... 42

BENLYSTA ................................ 87

BENTLEY THE BEAR PED

NEBULIZER ............................... 93

BENTYL ..................................... 73

BENZAC AC WASH .................. 53

BENZACLIN ............................... 53

BENZACLIN WITH PUMP ......... 53

benzalkonium chloride ............... 17

BENZAMYCIN ........................... 53

benzepro .................................... 53

benzepro foaming cloths ............ 53

benzepro short contact .............. 53

BENZHYDROCODONE-

ACETAMINOPHEN ...................... 7

BENZIQ ..................................... 53

BENZIQ LS ................................ 53

benziq wash ............................... 53

BENZNIDAZOLE ....................... 34

benzonatate ............................. 105

BENZOYL PEROX-

HYDROCORTISONE ................. 53

benzoyl peroxide ........................ 53

BENZOYL PEROXIDE............... 53

BENZOYL PEROXIDE

FORTE- HC ............................... 53

benzoyl peroxide-erythromycin. 53

benztropine mesylate ................. 35

BEPREVE ................................ 100

BERINERT ................................. 87

BERMUDA GRASS ................... 93

beser .......................................... 53

BESIVANCE ............................ 100

BESPONSA ............................... 30

BETA 1 KIT ................................ 77

BETADINE OPHTHALMIC

PREP ...................................... 100

BETALIDO ................................ 77

betamethasone dipropionate ..... 53

betamethasone dipropionate

aug ............................................ 53

BETAMETHASONE SOD

PHOS & ACET .......................... 77

betamethasone sod phos &

acet ........................................... 77

BETAMETHASONE SODIUM

PHOSPHATE ............................ 77

betamethasone valerate............ 53

BETAPACE ............................... 42

BETAPACE AF ......................... 42

BETASERON ............................ 50

betaxolol hcl ...................... 42, 102

bethanechol chloride ................. 76

BETHKIS ................................. 109

BETIMOL ................................ 102

BETOPTIC-S .......................... 102

BEVACIZUMAB ...................... 103

BEVESPI AEROSPHERE ....... 107

BEVYXXA ................................. 21

bexarotene ................................ 30

BEXSERO ................................. 90

BEYAZ ...................................... 82

bicalutamide .............................. 30

BICILLIN C-R ............................ 17

BICILLIN C-R 900/300 .............. 17

BICILLIN L-A ............................. 17

BICNU ....................................... 30

BIDIL ......................................... 42

BI-EST 80:20

PROGESTERONE .................... 82

BIEST/PROGESTERONE ......... 82

BIJUVA ..................................... 82

BIKTARVY ................................ 37

BILTRICIDE .............................. 34

bimatoprost ............................. 102

BINOSTO .................................. 92

BIOFREQUENCY INSOLES ..... 93

BIOGUARD ISLAND

DRESSINGS ............................. 93

BIOGUARD NON-ADHERENT

DRESSING ............................... 93

BIOLON .................................. 103

BIO-STATIN .............................. 27

bio-statin ................................... 27

BIOTEL CARE BLOOD

GLUCOSE SYST ...................... 60

BIOTHRAX ................................ 90

bisacodyl ec .............................. 73

116

bisoprolol fumarate .................... 42

bisoprolol-hydrochlorothiazide 42

bivalirudin trifluoroacetate .......... 21

BIVALIRUDIN-SODIUM

CHLORIDE ................................ 21

BIVIGAM .................................... 87

BLACK WALNUT POLLEN ....... 93

BLACK WILLOW ....................... 93

bleomycin sulfate ....................... 30

BLEPH-10 ................................ 100

BLEPHAMIDE.......................... 103

BLEPHAMIDE S.O.P. .............. 103

BLINCYTO ................................. 30

blisovi 24 fe ............................... 82

blisovi fe 1.5/30 ......................... 82

blisovi fe 1/20 ............................ 82

BLOXIVERZ .............................. 29

BONIVA ..................................... 92

BONJESTA ................................ 26

BOOSTRIX ................................ 90

BORTEZOMIB ........................... 30

bosentan .................................. 109

BOSULIF ................................... 30

BOTOX ...................................... 93

BOTOX COSMETIC .................. 53

BOTRYTIS ................................. 93

BOX ELDER .............................. 93

bp cleansing wash ..................... 53

bp foam ..................................... 53

bp wash ..................................... 53

BPCO ........................................ 53

bpo ............................................ 53

BRAFTOVI ................................. 30

BREATHERITE .......................... 93

BREATHERITE VALVED MDI

CHAMBER ................................. 93

BREO ELLIPTA ....................... 107

BREVIBLOC IN NACL ............... 42

BREVIBLOC PREMIXED .......... 42

BREVIBLOC PREMIXED DS .... 42

BREVITAL SODIUM .................. 93

BRIDION .................................... 93

briellyn ....................................... 82

BRILINTA .................................. 36

brimonidine tartrate .................. 102

BRINEURA ................................ 75

BRISDELLE ............................... 24

BRIVIACT .................................. 22

BROME ..................................... 93

bromfed dm ............................. 105

bromfenac sodium (once-daily)

................................................ 101

bromocriptine mesylate.............. 35

BROMPHENIRAMINE

MALEATE ................................ 105

brompheniramine tannate ........ 105

BROMSITE .............................. 101

BROVANA ............................... 107

BRYHALI ................................... 53

budesonide ........................ 91, 107

budesonide er ............................ 91

BUFFERED LIDOCAINE ........... 13

bumetanide ................................ 42

BUMEX ...................................... 42

BUNAVAIL ................................. 16

BUPAP ........................................ 7

BUPHENYL ............................... 75

bupivacaine fisiopharma ............ 13

bupivacaine hcl .......................... 13

BUPIVACAINE HCL .................. 13

bupivacaine hcl (pf).................... 13

BUPIVACAINE HCL-NACL ........ 13

bupivacaine in dextrose ............. 13

bupivacaine spinal ..................... 13

bupivacaine-epinephrine ............ 13

bupivacaine-epinephrine (pf) ..... 13

BUPIVILOG ............................... 77

BUPRENEX ................................. 7

buprenorphine .............................. 7

BUPRENORPHINE ...................... 7

buprenorphine hcl .................. 7, 16

buprenorphine hcl-naloxone

hcl .............................................. 16

bupropion hcl ............................. 24

bupropion hcl er (smoking det). 16

bupropion hcl er (sr) .................. 24

bupropion hcl er (xl) ................... 24

BUPROPION HCL ER (XL) ....... 24

buspirone hcl ............................. 39

busulfan ..................................... 30

BUSULFEX ................................ 30

BUTALBITAL-

ACETAMINOPHEN ...................... 7

butalbital-acetaminophen ............. 7

butalbital-apap ............................. 7

butalbital-apap-caff-cod ................ 7

butalbital-apap-caffeine ................ 7

butalbital-asa-caff-codeine ........... 7

butalbital-aspirin-caffeine ............. 7

BUTISOL SODIUM .................. 111

butorphanol tartrate ..................... 7

BUTRANS .................................... 7

BYDUREON .............................. 58

BYDUREON BCISE

AUTOINJECTOR ....................... 59

BYETTA 10 MCG PEN .............. 59

BYETTA 5 MCG PEN ............... 59

BYSTOLIC ................................ 42

cabergoline ............................... 80

CABOMETYX ........................... 30

CADIRAMD ............................... 13

CADUET ................................... 42

CAFCIT ..................................... 50

CAFERGOT .............................. 29

caffeine citrate........................... 50

CAFFEINE-SODIUM

BENZOATE ............................... 50

CALAN ...................................... 42

CALAN SR ................................ 42

CALCIFOL ................................ 64

calcipotriene .............................. 53

calcipotriene-betameth diprop ... 53

calcitonin (salmon) .................... 92

calcitrene ................................... 53

calcitriol ............................... 53, 92

calcium acetate (phos binder) ... 76

CALCIUM CHLORIDE .............. 65

calcium chloride ........................ 65

CALCIUM DISODIUM

VERSENATE ............................ 93

calcium gluconate ..................... 65

CALCIUM GLUCONATE ........... 65

calcium gluconate anhydrous ... 65

CALCIUM GLUCONATE-

NACL ........................................ 65

calcium-folic acid plus d ............ 65

CALIFORNIA PEPPER TREE 93

CALM ........................................ 65

CALQUENCE ............................ 30

CAMBIA .................................... 11

camila ....................................... 82

CAMPATH ................................ 30

CAMPTOSAR ........................... 30

camrese .................................... 82

camrese lo ................................ 82

CANASA ................................... 91

CANCIDAS ............................... 27

candesartan cilexetil ................. 42

candesartan cilexetil-hctz .......... 42

CANDIDA ALBICANS

EXTRACT ................................. 94

CANTALOUPE

(DIAGNOSTIC) ......................... 94

CANTHARIDIN .......................... 53

CAPASTAT SULFATE .............. 29

capecitabine .............................. 30

CAPEX ...................................... 53

CAPRELSA ............................... 30

117

CAPTAIN EAGLE PED

NEBULIZER .............................. 94

captopril ..................................... 42

captopril-hydrochlorothiazide ..... 42

CARAC ...................................... 53

CARAFATE ............................... 72

CARBAGLU ............................... 65

carbamazepine .......................... 22

carbamazepine er ...................... 22

CARBATROL ............................. 22

carbidopa ................................... 35

carbidopa-levodopa ................... 35

carbidopa-levodopa er ............... 35

carbidopa-levodopa-

entacapone ................................ 35

carbinoxamine maleate............ 105

CARBOCAINE ........................... 13

CARBOCAINE

PRESERVATIVE-FREE ............. 13

carboplatin ................................. 30

carboprost tromethamine ........... 81

CARDENE IV............................. 42

CARDIOPLEGIC ........................ 65

CARDIOVID PLUS .................... 94

CARDIZEM ................................ 43

CARDIZEM CD .......................... 43

CARDIZEM LA .......................... 43

CARDURA ................................. 43

CARDURA XL ........................... 77

CARETOUCH

LANCING/EJECTOR ................. 60

CARIMUNE NF .......................... 87

carimune nf ................................ 87

carisoprodol ............................. 110

carisoprodol-aspirin ................. 110

carisoprodol-aspirin-codeine ........ 7

carmustine ................................. 30

CARNITOR ................................ 65

CARNITOR SF .......................... 65

CAROSPIR ................................ 43

carteolol hcl ............................. 102

cartia xt ...................................... 43

carvedilol ................................... 43

carvedilol phosphate er ............. 43

cascara sagrada ........................ 73

CASEIN (DIAGNOSTIC) ............ 94

CASODEX ................................. 30

caspofungin acetate .................. 27

CAT HAIR EXTRACT ................ 94

CATAPRES ............................... 43

CATAPRES-TTS-1 .................... 43

CATAPRES-TTS-2 .................... 43

CATAPRES-TTS-3 .................... 43

CATHFLO ACTIVASE ............... 21

CATTLE EPITHELIUM............... 94

cavarest ..................................... 51

CAYA ......................................... 94

CAYSTON ............................... 109

caziant ....................................... 82

CEDAR ELM .............................. 94

cefaclor ...................................... 17

cefaclor er .................................. 17

cefadroxil ................................... 17

CEFALY KIT .............................. 94

cefazolin sodium ........................ 17

CEFAZOLIN SODIUM ............... 17

cefazolin sodium-dextrose ......... 17

cefdinir ....................................... 17

cefditoren pivoxil ........................ 17

cefepime hcl............................... 17

cefepime-dextrose ..................... 17

cefixime...................................... 17

CEFOTAN .................................. 17

cefotaxime sodium ..................... 17

cefotetan disodium ..................... 17

cefoxitin sodium ......................... 17

cefpodoxime proxetil .................. 17

cefprozil ..................................... 17

ceftazidime and dextrose ........... 17

ceftriaxone sodium ..................... 17

ceftriaxone sodium in dextrose. 17

ceftriaxone sodium-dextrose ...... 17

cefuroxime axetil ........................ 17

cefuroxime sodium ..................... 17

CEFUROXIME SODIUM-

NACL ....................................... 101

CELEBREX ................................ 11

celecoxib .................................... 11

CELESTONE SOLUSPAN ......... 77

CELEXA..................................... 24

CELLCEPT ................................ 87

CELLCEPT INTRAVENOUS ..... 87

CELONTIN ................................. 22

CENTANY .................................. 17

CENTRATEX ............................. 65

cephalexin .................................. 17

CEPROTIN ................................ 40

CEQUA .................................... 103

CERDELGA ............................... 75

CEREBYX .................................. 22

CEREZYME ............................... 75

CERVIDIL .................................. 81

CETACAINE .............................. 13

cetirizine hcl ............................. 105

CETRAXAL .............................. 104

cevimeline hcl ............................ 51

CHANTIX .................................. 16

CHANTIX CONTINUING

MONTH PAK............................. 16

CHANTIX STARTING MONTH

PAK ........................................... 16

chateal ...................................... 82

chateal eq ................................. 82

CHEMET ................................... 65

CHEMSTRIP UGK .................... 60

CHENODAL .............................. 73

CHICKEN MEAT

(DIAGNOSTIC) ......................... 94

chloramphenicol sod succinate. 17

chlordiazepoxide hcl ................. 39

chlordiazepoxide-amitriptyline ... 25

chlordiazepoxide-clidinium ........ 73

chlorhexidine gluconate ...... 51, 94

CHLORHEXIDINE

GLUCONATE ............................ 94

chloroprocaine hcl (pf) .............. 13

chloroquine phosphate .............. 34

chlorothiazide ............................ 43

chlorothiazide sodium ............... 43

chlorpromazine hcl .................... 36

chlorthalidone ............................ 43

chlorzoxazone ......................... 110

CHOLBAM ................................ 73

cholestyramine .......................... 43

cholestyramine light .................. 43

CHOLETEC .............................. 94

choline fenofibrate ..................... 43

choline-mag trisalicylate ............ 11

chromic chloride ........................ 65

ciclodan ..................................... 27

CICLODAN SOLUTION ............ 27

ciclopirox ................................... 27

ciclopirox olamine ..................... 27

cidofovir..................................... 37

cilostazol ................................... 36

CILOXAN ................................ 101

CIMDUO ................................... 37

cimetidine .................................. 72

cimetidine hcl ............................ 72

CIMZIA ...................................... 87

CIMZIA PREFILLED KIT ........... 87

CIMZIA STARTER KIT ............. 87

cinacalcet hcl ............................ 80

CINQAIR ................................. 105

CINRYZE .................................. 87

CINVANTI ................................. 26

CIPRO ...................................... 17

CIPRO HC .............................. 105

CIPRODEX ............................. 105

118

ciprofloxacin ............................... 17

ciprofloxacin hcl ......... 17, 101, 105

ciprofloxacin in d5w ................... 17

cisatracurium besylate ............... 50

cisatracurium besylate (pf) ........ 50

cisplatin...................................... 30

CISPLATIN ................................ 31

citalopram hydrobromide ........... 25

CITANEST FORTE DENTAL .... 13

CITANEST PLAIN DENTAL ...... 14

CITRANATAL MEDLEY ............. 65

citroma ....................................... 73

CLADOSPORIUM

CLADOSPORIOIDES ................ 94

CLADOSPORIUM

SPHAEROSPERMUM ............... 94

cladribine ................................... 31

claravis ...................................... 53

CLARINEX ............................... 105

CLARINEX-D 12 HOUR .......... 105

clarithromycin............................. 17

clarithromycin er ........................ 17

clearlax ...................................... 73

clemastine fumarate ................ 105

CLENPIQ ................................... 73

CLEOCIN ................................... 17

CLEOCIN PHOSPHATE ............ 17

CLEOCIN-T ............................... 53

CLEVIPREX .............................. 43

CLIMARA ................................... 82

CLIMARA PRO .......................... 82

clindacin etz ............................... 53

clindacin-p ................................. 53

CLINDAGEL .............................. 53

clindamycin hcl .......................... 17

clindamycin palmitate hcl ........... 17

clindamycin phosphate. 17, 18, 53

CLINDAMYCIN PHOSPHATE 53

clindamycin phosphate in d5w 17

CLINDAMYCIN PHOSPHATE

IN NACL .................................... 17

clindamycin phosphate-

benzoyl peroxide ....................... 53

clindamycin-tretinoin .................. 53

CLINDESSE .............................. 18

CLINIMIX E/DEXTROSE

(2.75/5) ...................................... 65

CLINIMIX E/DEXTROSE

(4.25/10) .................................... 65

CLINIMIX E/DEXTROSE

(4.25/5) ...................................... 65

CLINIMIX E/DEXTROSE

(5/15) ......................................... 65

CLINIMIX E/DEXTROSE

(5/20) ......................................... 65

CLINIMIX N14G30E .................. 65

CLINIMIX N9G15E .................... 65

CLINIMIX N9G20E .................... 65

clinimix/dextrose (4.25/10) ......... 65

CLINIMIX/DEXTROSE

(4.25/10) .................................... 65

clinimix/dextrose (4.25/25) ......... 65

CLINIMIX/DEXTROSE (4.25/5) 65

CLINIMIX/DEXTROSE (5/15) .... 65



clinisol sf .................................... 65

CLINOIN .................................... 53

clinpro 5000 ............................... 51

clobazam ................................... 22

clobetasol prop emollient base. 53

clobetasol propionate ................. 53

clobetasol propionate e .............. 53

clobetasol propionate emulsion 53

CLOBEX .................................... 54

CLOBEX SPRAY ....................... 54

clocortolone pivalate .................. 54

clodan ........................................ 54

CLODERM ................................. 54

clofarabine ................................. 31

CLOLAR .................................... 31

clomipramine hcl ........................ 25

clonazepam ............................... 39

clonidine..................................... 43

clonidine hcl ............................... 43

clonidine hcl er ........................... 49

clopidogrel bisulfate ................... 36

clorazepate dipotassium ............ 39

CLOROTEKAL ........................... 14

clotrimazole ................................ 27

CLOTRIMAZOLE ....................... 27

clotrimazole-betamethasone ...... 54

clozapine .................................... 36

CLOZARIL ................................. 36

COAGADEX .............................. 40

coal tar ....................................... 54

COARTEM ................................. 35

cocaine hcl ................................. 14

COCAINE HCL .......................... 14

COCKLEBUR ............................ 94

COCOA BEAN (DIAGNOSTIC) 94

codeine sulfate ............................. 7

COENZYME Q-10 ...................... 94

COGENTIN ................................ 35

COLAZAL .................................. 91

COLCHICINE ............................. 28

colchicine-probenecid................ 28

COLCRYS ................................. 28

colesevelam hcl ........................ 43

COLESTID ................................ 43

COLESTID FLAVORED ............ 43

colestipol hcl ............................. 43

colistimethate sodium (cba) ...... 18

colocort ..................................... 91

COLY-MYCIN M ....................... 18

COLY-MYCIN S ...................... 105

COLYTE WITH FLAVOR

PACKS ...................................... 73

COMBIGAN ............................ 102

COMBIPATCH .......................... 82

COMBIVENT RESPIMAT ....... 107

COMBIVIR ................................ 37

COMETRIQ (100 MG DAILY

DOSE) ...................................... 31


DOSE) ...................................... 31


DOSE) ...................................... 31

COMPLERA .............................. 37

compro ...................................... 26

COMTAN .................................. 35

CONCERTA .............................. 49

CONDYLOX .............................. 54

constulose ................................. 73

CONTOUR NEXT CONTROL ... 60

CONTOUR NEXT MONITOR ... 60

CONTOUR NEXT TEST ........... 60

CONTOUR TEST ...................... 60

CONTRAST ALLERGY

PREMED PACK ........................ 77

CONZIP ...................................... 7

COPAXONE .............................. 50

COPIKTRA ................................ 31

COPPER CHLORIDE ............... 65

CORDRAN ................................ 54

COREG ..................................... 43

COREG CR .............................. 43

coremino ................................... 18

CORGARD ................................ 43

CORIFACT ................................ 40

CORLANOR .............................. 43

CORLOPAM ............................. 43

CORN POLLEN ........................ 94

CORTANE-B ............................. 54

CORTEF ................................... 77

CORTENEMA ........................... 91

cortic-nd .................................. 105

CORTIFOAM ............................ 91

cortisone acetate ....................... 77

119

CURVULARIA ............................ 94

CUTAQUIG .......................... 87, 88

CUTIVATE ................................. 54

CUVITRU ................................... 88

CUVPOSA ................................. 73

cyanocobalamin ......................... 65

CYANOCOBALAMIN ................. 65

cyclafem 1/35............................. 82

cyclafem 7/7/7............................ 82

cyclobenzaprine hcl ................. 110

cyclobenzaprine hcl er ............. 110

CYCLOGYL ............................. 103

CYCLOMYDRIL ....................... 103

cyclopentolate hcl .................... 103

dasetta 7/7/7 .............................. 82

daunorubicin hcl ......................... 31

DAURISMO ............................... 31

DAYPRO .................................... 11

daysee ....................................... 82

DAYTRANA ............................... 49

DDAVP ...................................... 80

DDAVP RHINAL TUBE .............. 80

DEBACTEROL ........................... 51

deblitane .................................... 82

DECADRON .............................. 77

decitabine .................................. 31

deferasirox ................................. 65

deferoxamine mesylate .............. 94

desloratadine ........................... 105

desmopressin ace spray refrig 80

desmopressin acetate ................80

desmopressin acetate spray ......80

desogestrel-ethinyl estradiol.......83

DESONATE ...............................54

desonide ....................................54

DESOWEN ................................54

desoximetasone .........................54

DESOXYN .................................49

DESVENLAFAXINE ER .............25

desvenlafaxine succinate er .......25

DETROL ....................................76

DETROL LA ...............................76

120

CORTISPORIN .......................... 54

CORTROSYN ............................ 94

corvita 150 ................................. 65

CORVITE 150 ............................ 65

CORVITE FE ............................. 65

COSENTYX (300 MG DOSE) ... 87

COSENTYX 150 MG/ML ........... 87

COSENTYX SENSOREADY

(300 MG) ................................... 87

COSENTYX SENSOREADY

PEN ........................................... 87

COSMEGEN .............................. 31

COSOPT ................................. 102

COSOPT PF ............................ 102

cosyntropin ................................ 94

COTELLIC ................................. 31

COTEMPLA XR-ODT ................ 49

COUMADIN ............................... 21

covaryx ...................................... 82

covaryx hs ................................. 82

COZAAR .................................... 43

CRAB (DIAGNOSTIC) ............... 94

CREON...................................... 75

CRESEMBA .............................. 27

CRESTOR ................................. 43

CRINONE .................................. 82

CRIXIVAN .................................. 37

cromolyn sodium ....... 73, 101, 107

crotan ........................................ 35

cryselle-28 ................................. 82

CRYSVITA ................................. 75

CUBICIN .................................... 18

CUBICIN RF .............................. 18

CUPRIMINE .............................. 76

curad hydrocortisone ................. 54

CURITY AMD

ANTIMICROBIAL STRIP ........... 94

CURITY IODOFORM

PACKING STRIP ....................... 94

CYCLOPHENE RAPIDPAQ ..... 110

cyclophosphamide ..................... 31

cycloserine ................................. 29

CYCLOSET ............................... 59

cyclosporine ............................... 88

cyclosporine modified ................ 88

CYKLOKAPRON ........................ 40

CYMBALTA ............................... 25

cyproheptadine hcl ................... 105

CYRAMZA ................................. 31

cyred .......................................... 82

cyred eq ..................................... 82

CYSTADANE ............................. 75

CYSTAGON ............................... 75

CYSTARAN ............................. 103

CYSVIEW .................................. 94

cytarabine .................................. 31

cytarabine (pf) ............................ 31

CYTOGAM ................................. 88

CYTOMEL ................................. 86

CYTOTEC .................................. 72

cytra k crystals ........................... 65

D.H.E. 45 ................................... 29

dacarbazine ............................... 31

DACOGEN ................................. 31

dactinomycin .............................. 31

dalfampridine er ......................... 50

DALIRESP ............................... 107

DALVANCE ............................... 18

danazol ...................................... 79

DANTRIUM .............................. 110

dantrolene sodium ................... 110

dapsone ............................... 29, 54

DAPTACEL ................................ 90

daptomycin ................................ 18

DARAPRIM ................................ 35

darifenacin hydrobromide er ...... 76

DARZALEX ................................ 31

dasetta 1/35 ............................... 82

DEFITELIO ............................... 21

dehydrated alcohol .................... 65

DELESTROGEN ....................... 82

delflex-lc/1.5% dextrose ............ 65

delflex-lc/2.5% dextrose ............ 66

delflex-lc/4.25% dextrose .......... 66

DELFLEX-LC/4.25%

DEXTROSE .............................. 66

delflex-sm/1.5% dextrose .......... 66

DELSTRIGO ............................. 37

delyla ........................................ 82

DELZICOL ................................ 91

demeclocycline hcl .................... 18

DEMEROL .................................. 7

DEMSER ................................... 43

DENAVIR .................................. 37

denta 5000 plus ........................ 51

dentagel .................................... 51

DEPACON ................................ 22

DEPAKENE .............................. 22

DEPAKOTE .............................. 22

DEPAKOTE ER......................... 22

DEPAKOTE SPRINKLES .......... 22

DEPEN TITRATABS ................. 76

DEPO-ESTRADIOL .................. 82

DEPO-MEDROL ....................... 77

DEPO-PROVERA ............... 82, 83

DEPO-SUBQ PROVERA 104 ... 83

DEPO-TESTOSTERONE .......... 79

DEPRIZINE FUSEPAQ ............. 72

DERMA-SMOOTHE/FS BODY. 54

DERMA-SMOOTHE/FS

SCALP ...................................... 54

DERMOTIC ............................. 105

DERMULCERA ......................... 54

DESCOVY ................................ 37

DESFERAL ............................... 94

desflurane ................................. 94

desipramine hcl ......................... 25

DEXPANTHENOL ..................... 66

dexrazoxane .............................. 31

dexrazoxane hcl ........................ 31

DEXTENZA ............................. 101

dextroamphetamine sulfate ....... 49

dextroamphetamine sulfate er 49

dextrose ..................................... 66

DEXTROSE ............................... 66

DEXYCU .................................. 101

DIACOMIT ................................. 22

DIANEAL LOW

CALCIUM/1.5% DEX ................. 66

DIANEAL LOW

CALCIUM/2.5% DEX ................. 66

DILANTIN INFATABS ................ 22

DILATRATE-SR ......................... 43

DILAUDID .................................... 7

diltiazem hcl ............................... 43

diltiazem hcl er ........................... 43

diltiazem hcl er beads ................ 43

diltiazem hcl er coated beads .... 43

DILTIAZEM HCL-DEXTROSE 43

DILTIAZEM HCL-SODIUM

CHLORIDE ................................ 43

dilt-xr .......................................... 43

diluent for treprostinil .................. 94

dimenhydrinate .......................... 26

DIOVAN ..................................... 43

DOUBLE PM ............................ 103

DOVATO ....................................37

DOVER URETHRAL

CATHETER ................................94

DOVONEX .................................54

doxazosin mesylate ....................43

doxepin hcl .......................... 25, 54

doxercalciferol ............................92

DOXIL ........................................31

doxorubicin hcl ...........................31

doxorubicin hcl liposomal ...........31

doxy 100 ....................................18

doxycycline ................................54

doxycycline hyclate ....................18

121

dexamethasone ......................... 77

DEXAMETHASONE (LA) .......... 77

DEXAMETHASONE ACE &

SOD PHOS ............................... 77

DEXAMETHASONE

INTENSOL ................................. 77

DEXAMETHASONE SOD

PHOS-BUPIV............................. 77

DEXAMETHASONE SOD

PHOS-NACL .............................. 78

dexamethasone sod

phosphate pf .............................. 78

dexamethasone sodium

phosphate .......................... 78, 101

DEXAMETHASONE-

MOXIFLOXACIN ...................... 103

DEXAMETH-MOXIFLOX-

KETOROLAC........................... 103

dexchlorpheniramine maleate. 105

DEXCOM G4 / G5 / G6

RECEIVER, TRANSMITTER,

SENSOR (INCLUDING

PLATINUM, PLATINUM

PEDIATRIC) .............................. 60

DEXEDRINE .............................. 49

DEXILANT ................................. 72

DEXLIDO ................................... 78

DEXLIDO-M ............................... 78

DEXMEDETOMIDINE HCL ....... 94

dexmedetomidine hcl ................. 94

dexmedetomidine hcl in nacl ..... 94

DEXMEDETOMIDINE HCL-

DEXTROSE ............................... 94

dexmethylphenidate hcl ............. 49

dexmethylphenidate hcl er ......... 49

DEXOPIN .................................. 78

DEXPAK 10 DAY....................... 78

DEXPAK 13 DAY....................... 78

DEXPAK 6 DAY ........................ 78

DIANEAL LOW

CALCIUM/4.25% DEX ............... 66

DIASTAT ACUDIAL ................... 22

DIASTAT PEDIATRIC................ 22

DIATHRIVE BLOOD

GLUCOSE METER .................... 60

DIATHRIVE BLOOD

GLUCOSE TEST ....................... 60

DIATHRIVE GLUCOSE

CONTROL SOLN ...................... 61

DIATHRIVE GLUCOSE TEST 61

DIATHRIVE LANCING

DEVICE ..................................... 61

diazepam ............................. 22, 39

DIAZEPAM ................................ 39

diazepam intensol ...................... 39

DIBENZYLINE ........................... 43

DICLEGIS .................................. 26

DICLOFENAC EPOLAMINE ...... 11

diclofenac potassium ................. 11

diclofenac sodium ........11, 54, 101

diclofenac sodium er .................. 11

diclofenac-misoprostol ............... 11

dicloxacillin sodium .................... 18

DICOPANOL FUSEPAQ .......... 105

DICOPANOL RAPIDPAQ ........ 105

dicyclomine hcl .......................... 73

didanosine ................................. 37

DIFFERIN .................................. 54

DIFICID ...................................... 18

difil-g forte ................................ 107

diflorasone diacetate .................. 54

DIFLUCAN ................................. 27

diflunisal ..................................... 11

digitek ........................................ 43

digox .......................................... 43

digoxin ....................................... 43

dihydroergotamine mesylate ...... 29

DILANTIN ............................ 22, 23

DIOVAN HCT ............................ 43

DIPENTUM ............................... 91

diphenhydramine hcl ............... 105

diphenoxylate-atropine .............. 73

DIPHTHERIA-TETANUS

TOXOIDS DT ............................ 90

DIPRIVAN ................................. 94

DIPROLENE ............................. 54

DIPROLENE AF ........................ 54

dipyridamole .............................. 36

disopyramide phosphate ........... 43

disulfiram ................................... 16

DITROPAN XL .......................... 76

DIURIL ...................................... 43

divalproex sodium ..................... 23

divalproex sodium er ................. 23

DIVIGEL .................................... 83

dobutamine hcl .......................... 43

docetaxel ................................... 31

dofetilide.................................... 43

DOG EPITHELIUM ................... 94

DOG FENNEL........................... 94

DOLOPHINE ............................... 7

donepezil hcl ............................. 24

DONNATAL .............................. 73

dopamine hcl............................. 43

dopamine in d5w ....................... 43

DOPTELET ............................... 40

DORAL ..................................... 39

DORYX ..................................... 18

DORYX MPC ............................ 18

DORZOLAMIDE HCL ............. 102

dorzolamide hcl ....................... 102

DORZOLAMIDE HCL-

TIMOLOL MAL ........................ 102

dorzolamide hcl-timolol mal .... 102

dorzolamide hcl-timolol mal pf 102

DOTAREM ................................ 94

dotti ........................................... 83

doxycycline monohydrate .......... 18

doxylamine-pyridoxine ............... 26

D-PENAMINE ............................ 76

DRECHSLERA .......................... 94

DRISDOL ................................... 66

dritho-creme hp ......................... 54

dronabinol .................................. 26

droperidol ................................... 26

drospiren-eth estrad-levomefol. 83

drospirenone-ethinyl estradiol .... 83

DROXIA ..................................... 31

DRYSOL .................................... 54

DSUVIA ....................................... 7

DUAC ........................................ 54

DUAKLIR PRESSAIR .............. 107

DUAL COMPLEX FORMULA 1

KIT ............................................. 11

DUAVEE .................................... 83

DUETACT .................................. 59

DUEXIS ..................................... 11

DULERA .................................. 107

duloxetine hcl............................. 25

DUOBRII .................................... 54

DUODOTE ................................. 94

DUOPA ...................................... 35

DUPIXENT ................................ 54

DURAGESIC-100 ........................ 7

DURAGESIC-12 .......................... 7

DURAGESIC-25 .......................... 7

DURAGESIC-50 .......................... 7

DURAGESIC-75 .......................... 7

duramorph ................................... 7

duraxin ......................................... 7

DUREZOL ............................... 101

DURLAZA .................................. 36

DUROLANE ............................... 94

DUST MITE MIXED

ALLERGEN EXT ....................... 94

dutasteride ................................. 77

dutasteride-tamsulosin hcl ......... 77

DUTOPROL ............................... 43

DVORAH ..................................... 7

DXEVO 11-DAY ........................ 78

DYANAVEL XR ......................... 49

DYAZIDE ................................... 43

DYMISTA ................................. 105

DYRENIUM ............................... 43

DYSPORT ................................. 94

DYURAL-40 ............................... 78

DYURAL-80 ............................... 78

DYURAL-L ................................. 78

DYURAL-LM .............................. 78

e.e.s. 400 ................................... 18

E.E.S. GRANULES .................... 18

EASIVENT ................................. 94

EASTERN COTTONWOOD ...... 94

EASY COMFORT ALCOHOL

PADS ......................................... 94

EASY GLIDE LUER LOCK

SYRINGE ................................... 94

easygel ...................................... 51

EASYMAX CONTROL ............... 61

EASYPLUS BLOOD

GLUCOSE TEST ....................... 61

EC-NAPROSYN ......................... 11

ec-naproxen ............................... 11

econazole nitrate ....................... 27

ECOZA ...................................... 27

EC-RX DHEA............................. 94

EC-RX ESTRADIOL .................. 83

EC-RX PROGESTERONE ........ 83

EC-RX TESTOSTERONE ......... 79

EDARBI ..................................... 43

EDARBYCLOR .......................... 43

EDECRIN ................................... 43

EDLUAR .................................. 111

EDURANT ................................. 37

eemt ........................................... 83

eemt hs ...................................... 83

efavirenz .................................... 37

EFFER-K ................................... 66

effer-k ........................................ 66

EFFEXOR XR ............................ 25

EFFIENT .................................... 36

EFUDEX .................................... 54

EGATEN .................................... 35

EGG WHITE (DIAGNOSTIC) .... 95

EGRIFTA ................................... 80

ELAPRASE ................................ 75

ELCYS ....................................... 95

ELELYSO .................................. 75

ELESTRIN ................................. 83

eletriptan hydrobromide ............. 29

ELIDEL ...................................... 54

ELIGARD ................................... 80

ELIMITE ..................................... 35

elinest ........................................ 83

ELIQUIS..................................... 21

ELIQUIS STARTER PACK ........ 22

ELITEK ...................................... 31

elite-ob ....................................... 66

ELIXOPHYLLIN ....................... 107

ELLA .......................................... 83

ELLENCE .................................. 31

ELLIOTTS B .............................. 66

ELMIRON .................................. 76

ELOCON ................................... 54

ELOCTATE ............................... 40

ELZONRIS ................................ 31

EMBEDA ..................................... 7

EMBRACE TALK BLOOD

GLUCOSE ................................ 61

EMBRACE TALK GLUCOSE

CONTROL ................................ 61

EMBRACE TALK GLUCOSE

TEST ......................................... 61

EMBRACE TALK

MONITORING SYSTEM ........... 61

EMCYT ..................................... 31

EMEND ..................................... 26

EMEND TRI-PACK ................... 26

EMFLAZA ................................. 28

EMGALITY ................................ 29

EMGALITY (300 MG DOSE) .... 29

emoquette ................................. 83

EMPLICITI ................................ 31

EMSAM ..................................... 25

EMTRIVA .................................. 37

EMVERM .................................. 35

ENABLEX ................................. 76

enalapril maleate ....................... 43

enalaprilat ................................. 44

enalapril-hydrochlorothiazide ..... 44

ENBRACE HR .......................... 66

ENBREL.................................... 88

ENBREL MINI ........................... 88

ENBREL SURECLICK .............. 88

ENDARI .................................... 95

endocet ....................................... 7

ENGERIX-B .............................. 90

ENGLISH PLANTAIN ................ 95

ENLITE GLUCOSE SENSOR ... 61

ENOVARX-BACLOFEN .......... 110

enovarx-cyclobenzaprine hcl 110

ENOVARX-

CYCLOBENZAPRINE HCL ..... 110

ENOVARX-DICLOFENAC

SODIUM.................................... 11

ENOVARX-IBUPROFEN ........... 11

ENOVARX-LIDOCAINE HCL .... 14

ENOVARX-NAPROXEN ........... 11

ENOVARX-TRAMADOL ............ 54

enoxaparin sodium .................... 22

enpresse-28 .............................. 83

enskyce ..................................... 83

ENSTILAR ................................ 54

entacapone ............................... 35

entecavir ................................... 37

ENTEREG ................................. 73

122

ENTOCORT EC ........................ 91

ENTRESTO ............................... 44

ENTYVIO ................................... 88

enulose ...................................... 73

ENVARSUS XR ......................... 88

ENZADYNE ............................... 75

ENZOCLEAR ............................. 54

EPANED .................................... 44

EPCLUSA .................................. 37

ephedrine sulfate ....................... 44

EPHEDRINE SULFATE ............. 44

EPHEDRINE SULFATE

(PRESSORS) ............................ 44

EPHEDRINE SULFATE-NACL. 44

EPICOCCUM ............................. 95

EPIDIOLEX ................................ 23

EPIDUO ..................................... 54

EPIDUO FORTE ........................ 54

EPIFOAM .................................. 54

epinastine hcl........................... 101

epinephrine ........................ 44, 107

EPINEPHRINE .......................... 44

EPINEPHRINE HCL-

DEXTROSE ............................... 44

EPINEPHRINE HCL-NACL ....... 44

epinephrine pf ............................ 44

EPINEPHRINE-DEXTROSE ...... 44

EPINEPHRINE-NACL ................ 44

EPIPEN 2-PAK ........................ 107

EPIPEN JR 2-PAK................... 107

epirubicin hcl.............................. 31

EPISNAP ................................. 107

epitol .......................................... 23

EPIVIR ....................................... 37

EPIVIR HBV .............................. 37

eplerenone ................................. 44

EPOGEN ................................... 40

epoprostenol sodium ............... 109

eprosartan mesylate .................. 44

eptifibatide ................................. 36

EPZICOM .................................. 37

EQUETRO ................................. 23

ERAXIS ..................................... 27

ERBITUX ................................... 31

ERGOCAL ................................. 66

ergocalciferol ............................. 66

ergoloid mesylates ..................... 95

ERGOMAR ................................ 29

ergotamine-caffeine ................... 29

ERIVEDGE ................................ 31

ERLEADA .................................. 31

erlotinib hcl ................................ 31

EROS-CTD ................................ 95

errin ........................................... 83

ERTACZO .................................. 27

ertapenem sodium ..................... 18

ERWINAZE ................................ 31

ery .............................................. 54

ERYGEL .................................... 54

ERYPED 200 ............................. 18

ERYPED 400 ............................. 18

ERY-TAB ................................... 18

erythrocin lactobionate ............... 18

ERYTHROCIN

LACTOBIONATE ....................... 18

ERYTHROCIN STEARATE ....... 18

erythromycin ...................... 54, 101

erythromycin base ..................... 18

erythromycin ethylsuccinate ....... 18

ESBRIET ................................. 107

ESCAVITE ................................. 66

ESCAVITE D ............................. 66

ESCAVITE LQ ........................... 66

escitalopram oxalate .................. 25

esgic ............................................ 7

ESGIC ......................................... 7

esmolol hcl ................................. 44

ESMOLOL HCL ......................... 44

esmolol hcl-sodium chloride ...... 44

esomeprazole magnesium ......... 72

esomeprazole sodium ................ 72

est estrogens-methyltest ............ 83

est estrogens-methyltest ds ....... 83

est estrogens-methyltest hs ....... 83

estarylla ..................................... 83

estazolam .................................. 39

ESTRACE .................................. 83

estradiol ..................................... 83

estradiol valerate ....................... 83

estradiol-norethindrone acet ...... 83

ESTRING ................................... 83

ESTROGEL ............................... 83

ESTROSTEP FE ....................... 83

eszopiclone .............................. 111

ethacrynate sodium ................... 44

ethacrynic acid ........................... 44

ethambutol hcl ........................... 30

ethosuximide .............................. 23

ethyl chloride.............................. 14

ethynodiol diac-eth estradiol ...... 83

ETHYOL .................................... 31

etidronate disodium ................... 92

etodolac ..................................... 11

etodolac er ................................. 11

etomidate ................................... 95

ETOPOPHOS ............................ 31

etoposide .................................. 31

EUCRISA .................................. 54

EUFLEXXA ............................... 95

EURAX ..................................... 35

euthyrox .................................... 86

EVAMIST .................................. 83

EVEKEO ................................... 49

EVEKEO ODT........................... 49

EVENITY ................................... 92

EVERSENSE

SENSOR/HOLDER ................... 61

EVERSENSE SMART

TRANSMITTER ......................... 61

EVISTA ..................................... 80

EVOCLIN .................................. 55

EVOMELA ................................. 31

EVOTAZ.................................... 37

EVOXAC ................................... 51

EVZIO ....................................... 16

EXELDERM .............................. 27

EXELON ................................... 24

exemestane .............................. 31

EXFORGE ................................ 44

EXFORGE HCT ........................ 44

EXJADE .................................... 66

ex-lax ultra ................................ 73

exoderm .................................... 27

EXONDYS 51 ........................... 75

exotic-hc.................................. 105

EXPAREL ................................. 14

EXTAVIA ................................... 50

EXTINA ..................................... 27

EYLEA .................................... 103

EZ FLU SHOT-FLUCELVAX

QUAD ....................................... 90

EZALLOR SPRINKLE ............... 44

E-Z-DISK ................................... 95

ezetimibe ................................... 44

ezetimibe-simvastatin ................ 44

E-Z-HD ...................................... 95

E-Z-PAQUE .............................. 95

E-Z-PASTE ............................... 95

FABIOR..................................... 55

FABRAZYME ............................ 75

FALESSA .................................. 83

falmina ...................................... 83

famciclovir ................................. 37

famotidine ................................. 72

FAMOTIDINE IN NACL ............. 72

famotidine premixed .................. 72

FANAPT .................................... 36

FANAPT TITRATION PACK ..... 36

FANATREX FUSEPAQ ............. 23

123

FARESTON ............................... 31

FARXIGA ................................... 59

FARYDAK .................................. 31

FASENRA ................................ 105

FASLODEX ............................... 31

fayosim ...................................... 83

FAZACLO .................................. 36

FBL KIT ..................................... 11

febuxostat .................................. 28

FEIBA ........................................ 40

felbamate ................................... 23

FELBATOL ................................ 23

FELDENE .................................. 11

felodipine er ............................... 44

FEM PH ..................................... 76

FEMARA .................................... 31

FEMCAP .................................... 95

FEMHRT LOW DOSE ............... 83

FEMRING .................................. 83

femynor...................................... 83

fenofibrate .................................. 44

fenofibrate micronized ............... 44

fenofibric acid ............................ 44

FENOGLIDE .............................. 44

fenoprofen calcium .................... 11

fenortho ..................................... 11

fentanyl ........................................ 7

fentanyl citrate ............................. 8

FENTANYL CITRATE.................. 8

fentanyl citrate (pf) ....................... 7

FENTANYL CITRATE-NACL ....... 8

FENTANYL CIT-

ROPIVACAINE-NACL .................. 8

FENTANYL-BUPIVACAINE-

NACL ........................................... 8

FENTORA ................................... 8

FERIVA 21/7.............................. 66

FERIVAFA ................................. 66

ferocon ...................................... 66

ferotrinsic ................................... 66

FERRALET 90 ........................... 66

ferraplus 90 ............................... 66

FERRIPROX .............................. 66

FERRLECIT ............................... 66

ferrocite plus .............................. 66

FERRO-PLEX HEMATINIC ....... 66

FERROTRIN .............................. 66

FETZIMA ................................... 25

FETZIMA TITRATION ............... 25

FEXMID ................................... 110

FIASP ........................................ 63

FIASP FLEXTOUCH ................. 63

FIASP PENFILL ......................... 63

FIBRICOR .................................. 44

FIBRYGA ................................... 40

FINACEA ................................... 55

finasteride .................................. 77

FIORICET .................................... 8

FIORICET/CODEINE ................... 8

FIORINAL .................................... 8

FIORINAL/CODEINE #3 .............. 8

FIRAZYR ................................... 88

FIRDAPSE ................................. 95

FIRE ANT .................................. 95

FIRMAGON ............................... 80

FIRST - METOPROLOL ............ 44

FIRST-ATENOLOL .................... 44

FIRST-BACLOFEN .................. 110

FIRST-METRONIDAZOLE ......... 18

FIRST-MOUTHWASH BLM ....... 51

FIRST-VANCOMYCIN ............... 18

FIRVANQ ................................... 18

flac ........................................... 105

FLAGYL ..................................... 18

FLAREX ................................... 101

flavoxate hcl ............................... 76

FLEBOGAMMA DIF ................... 88

flecainide acetate ....................... 44

FLECTOR .................................. 11

FLEXBUMIN .............................. 95

FLOLAN ................................... 109

FLOLIPID ................................... 44

FLOMAX .................................... 77

FLORIVA ................................... 66

floriva ......................................... 66

FLORIVA PLUS ......................... 66

FLOVENT DISKUS .................. 107

FLOVENT HFA ........................ 107

FLOXIN OTIC .......................... 105

floxuridine .................................. 31

FLUAD ....................................... 90

FLUARIX QUADRIVALENT ....... 90

FLUBLOK QUADRIVALENT ...... 90

FLUCELVAX

QUADRIVALENT ....................... 90

fluconazole ................................. 27

fluconazole in sodium chloride 27

flucytosine .................................. 27

fludarabine phosphate ............... 31

fludrocortisone acetate .............. 78

FLULAVAL QUADRIVALENT .... 90

FLUMADINE .............................. 37

flumazenil ................................... 95

FLUMIST QUADRIVALENT ....... 90

flunisolide ................................. 105

fluocinolone acetonide ....... 55, 105

fluocinolone acetonide body ..... 55

fluocinolone acetonide scalp ..... 55

fluocinonide ............................... 55

fluocinonide emulsified base ..... 55

FLUORABON ............................ 66

fluoridex .................................... 51

fluoridex daily renewal .............. 51

fluoridex enhanced whitening ... 51

fluoridex sensitivity relief ........... 51

fluoritab ..................................... 66

fluorometholone ...................... 101

FLUOROPLEX .......................... 55

fluorouracil .......................... 31, 55

FLUOROURACIL ...................... 55

fluoxetine hcl ............................. 25

fluoxetine hcl (pmdd)................. 25

fluphenazine decanoate ............ 36

fluphenazine hcl ........................ 36

FLURA-DROPS ........................ 66

flurandrenolide .......................... 55

flurazepam hcl......................... 111

flurbiprofen ................................ 11

flurbiprofen sodium ................. 101

flutamide ................................... 31

fluticasone propionate ....... 55, 105

fluticasone-salmeterol ............. 108

FLUTICASONE-

SALMETEROL ........................ 108

fluvastatin sodium ..................... 44

fluvastatin sodium er ................. 45

fluvoxamine maleate ................. 25

fluvoxamine maleate er ............. 25

FLUZONE HIGH-DOSE ............ 90

FLUZONE QUADRIVALENT .... 90

FLYP NEBULIZER .................... 95

FML ......................................... 101

FML FORTE............................ 101

FML LIQUIFILM ...................... 101

FOCALIN .................................. 49

FOCALIN XR ............................ 49

folic acid .............................. 66, 67

FOLI-D ...................................... 67

FOLITE ..................................... 67

FOLIVANE-F ............................. 67

FOLOTYN ................................. 31

foltrin ......................................... 67

FOLVITE-D ............................... 67

fomepizole ................................. 95

fondaparinux sodium ................. 22

FORA GTEL BLOOD

GLUCOSE SYSTEM ................. 61

FORA GTEL BLOOD

GLUCOSE TEST ...................... 61

124

FORFIVO XL ............................. 25

formaldehyde ............................. 95

FORTAMET ............................... 59

FORTEO .................................... 92

FORTESTA ............................... 79

FORTISCARE CONTROL ......... 61

FOSAMAX ................................. 92

FOSAMAX PLUS D ................... 92

fosamprenavir calcium ............... 37

FOSCAVIR ................................ 37

fosinopril sodium ........................ 45

fosinopril sodium-hctz ................ 45

fosphenytoin sodium .................. 23

FOSRENOL ............................... 76

FRAGMIN .................................. 22

FREAMINE HBC ....................... 67

FREAMINE III ............................ 67

FREESTYLE FREEDOM LITE. 61

FREESTYLE INSULINX

SYSTEM .................................... 61

FREESTYLE INSULINX TEST. 61

FREESTYLE LIBRE 14 DAY

READER .................................... 61

FREESTYLE LIBRE 14 DAY

SENSOR ................................... 61

FREESTYLE LIBRE READER 61

FREESTYLE LIBRE SENSOR

SYSTEM .................................... 61

FREESTYLE LITE TEST ........... 61

FREESTYLE PRECISION

NEO TEST ................................ 61

FREESTYLE TEST ................... 61

FROVA ...................................... 29

frovatriptan succinate ................ 29

FULPHILA ................................. 40

fulvestrant .................................. 31

FURADANTIN............................ 18

furosemide ................................. 45

FUROSEMIDE IN SODIUM

CHLORIDE ................................ 45

FUSARIUM ................................ 95

FUSILEV .................................... 31

FUSION PLUS ........................... 67

FUSION SPRINKLES ................ 67

FUZEON .................................... 37

fyavolv ....................................... 83

FYCOMPA ................................. 23

GABA ........................................ 67

gabapentin ................................. 23

GABITRIL .................................. 23

GABLOFEN ............................. 110

GADAVIST ................................ 95

GALAFOLD ............................... 75

galantamine hydrobromide ........ 24

galantamine hydrobromide er .... 24

GALZIN ...................................... 67

GAMASTAN ............................... 88

gamastan s/d ............................. 88

GAMASTAN S/D ........................ 88

GAMIFANT ................................ 88

GAMMAGARD ........................... 88

GAMMAGARD S/D LESS IGA 88

GAMMAKED .............................. 88

GAMMAPLEX ............................ 88

GAMUNEX-C ............................. 88

GANCICLOVIR .......................... 37

ganciclovir sodium ............... 37, 38

GARDASIL 9.............................. 90

GASTROCROM ......................... 73

gatifloxacin ............................... 101

GATTEX .................................... 73

gavilax ....................................... 73

gavilyte-c .................................... 73

gavilyte-g ................................... 73

gavilyte-h ................................... 73

gavilyte-n with flavor pack.......... 73

GAZYVA .................................... 31

GEBAUERS PAIN EASE ........... 14

GELFILM ................................. 103

GEL-FLOW ................................ 95

GELFOAM COMPRESSED

SIZE 100 .................................... 95

GELFOAM DENTAL PACK

SIZE 4 ........................................ 95

GELFOAM SPONGE ................. 95

GELFOAM SPONGE SIZE

100 ............................................. 95

GELFOAM SPONGE SIZE

200 ............................................. 95

GELFOAM SPONGE SIZE 50 95

GELFOAM-JMI POWDER ......... 95

GELFOAM-JMI SPONGE .......... 95

GELNIQUE ................................ 76

GELNIQUE PUMP ..................... 76

GEL-ONE ................................... 95

GELSYN-3 ................................. 95

gemcitabine hcl .......................... 31

gemfibrozil ................................. 45

GENERESS FE ......................... 83

generlac ..................................... 73

gengraf ...................................... 88

GENICIN VITA-D ....................... 67

GENOTROPIN ........................... 80

GENOTROPIN MINIQUICK ....... 80

gentak ...................................... 101

gentamicin sulfate .............. 18, 101

GENTEEL LANCING KIT

(BLUE) ...................................... 61

gentle laxative ........................... 73

GENTLECATH URINARY

CATHETER ............................... 95

GENVISC 850 ........................... 95

GENVOYA ................................ 38

GEODON .................................. 36

GERMAN COCKROACH .......... 95

GHRP2-GHRP6-

SERMORELIN .......................... 80

GHRP2-SERMORELIN ............. 80

GIALAX ..................................... 73

gianvi ........................................ 83

GIAPREZA ................................ 45

GILENYA .................................. 50

GILOTRIF ................................. 31

GILPHEX TR........................... 105

GILTUSS TR ........................... 105

GLASSIA ................................. 108

glatiramer acetate ..................... 50

glatopa ...................................... 50

GLEEVEC ................................. 31

GLEOSTINE ............................. 31

GLIADEL WAFER ..................... 31

glimepiride ................................. 59

glipizide er ................................. 59

glipizide ir .................................. 59

glipizide xl ................................. 59

glipizide-metformin hcl .............. 59

GLUCAGEN HYPOKIT ............. 63

GLUCAGON EMERGENCY ..... 63

GLUCAGON HCL

(DIAGNOSTIC) ......................... 95

GLUCOCARD 01 SENSOR

PLUS ........................................ 61

GLUCOCARD EXPRESSION

TEST ......................................... 61

GLUCOCARD SHINE

CONNEX ................................... 61

GLUCOCARD SHINE

EXPRESS ................................. 61

GLUCOCARD SHINE TEST ..... 61

GLUCOCARD VITAL TEST ...... 61

GLUCOPHAGE ......................... 59

GLUCOPHAGE XR ................... 59

glucose ..................................... 67

GLUCOTROL ............................ 59

GLUCOTROL XL ...................... 59

GLUMETZA .............................. 59

glutaraldehyde........................... 95

GLUTATHIONE ......................... 67

glyburide ................................... 59

125

SYSTEM .................................... 61

GYNAZOLE-1 ............................ 27

HACKBERRY ............................ 95

HAEGARDA .............................. 88

hailey 1.5/30 .............................. 83

hailey 24 fe ................................ 83

HALAVEN .................................. 31

halcinonide ................................ 55

HALCION ................................... 39

HALDOL .................................... 36

HALDOL DECANOATE ............. 36

halobetasol propionate ............... 55

HETLIOZ .................................. 111

HIBERIX .................................... 90

HIDEX 6-DAY ............................ 78

HIPREX ..................................... 18

HISTATROL ............................... 95

HIZENTRA ................................. 88

homatropaire ............................ 103

homatropine hbr ....................... 103

HONEY BEE VENOM ................ 95

HONEY BEE VENOM

PROTEIN ................................... 95

HORIZANT ................................ 51

HORSE EPITHELIUM ................ 95

(INTRAOCULAR) ..................... 103

HYCAMTIN ............................... 32

hydralazine hcl .......................... 45

HYDREA ................................... 32

HYDRO 35 ................................ 55

HYDRO 40 ................................ 55

hydrochlorothiazide ................... 45

hydrocodone polst-cpm polst

er ............................................ 105

hydrocodone-acetaminophen ...... 8

hydrocodone-homatropine ...... 105

hydrocodone-ibuprofen ............... 8

hydrocortisone .............. 55, 78, 91

126

glyburide micronized .................. 59

glyburide-metformin ................... 59

GLYCATE .................................. 73

GLYCINE ................................... 67

glycolax...................................... 73

glycolic acid ............................... 55

glycopyrrolate ............................ 73

GLYCOPYRROLATE ........... 73, 74

glycopyrrolate pf ........................ 74

glydo .......................................... 14

GLYNASE .................................. 59

GLYRX-PF ................................. 74

GLYSET .................................... 59

GLYXAMBI ................................ 59

gnp folic acid ............................. 67

gnp lansoprazole ....................... 72

GOCOVRI .................................. 35

GOLDENROD............................ 95

GOLYTELY ................................ 74

GONITRO .................................. 45

GOPRELTO ............................... 14

GORDOFILM ............................. 55

grafco silver nit applicator .......... 55

GRALISE ................................... 50

GRALISE STARTER ................. 50

granisetron hcl ........................... 26

GRANIX ..................................... 40

GRASTEK ................................. 95

griseofulvin microsize ................ 27

griseofulvin ultramicrosize ......... 27

guaiatussin ac .......................... 105

guaifenesin ac ......................... 105

guanfacine hcl ........................... 45

guanfacine hcl er ....................... 49

GUANIDINE HCL ...................... 29

GUARDIAN CONNECT

TRANSMITTER ......................... 61

GUARDIAN LINK 3

TRANSMITTER ......................... 61

GUARDIAN REAL-TIME

HALOBETASOL

PROPIONATE ........................... 55

HALOG ...................................... 55

haloperidol ................................. 36

haloperidol decanoate ............... 36

haloperidol lactate ...................... 36

HARVONI .................................. 38

HAVRIX ..................................... 90

HCU EASY ................................ 95

healthylax ................................... 74

heartburn treatment 24 hour ...... 72

heather ...................................... 83

HECTOROL ............................... 92

HEMABATE ............................... 81

HEMANGEOL ............................ 45

hematinic plus vit/minerals ......... 67

hematogen fa ............................. 67

hematogen forte ......................... 67

HEMATRON-AF ......................... 67

HEMETAB ................................. 67

HEMLIBRA ................................ 40

hemmorex-hc ............................. 91

HEMOCYTE PLUS .................... 67

hemocyte-plus............................ 67

hemofil m ................................... 40

HEMOFIL M ............................... 40

HEPAGAM B ............................. 88

heparin (porcine) in nacl ............ 22

HEPARIN (PORCINE) IN

NACL ......................................... 22

heparin sod (porcine) in d5w ..... 22

heparin sodium (porcine) ........... 22

heparin sodium (porcine) pf ....... 22

hepatamine ................................ 67

HEPLISAV-B .............................. 90

HEPSERA .................................. 38

HERCEPTIN .............................. 31

HERCEPTIN HYLECTA............. 32

HESPAN .................................... 40

hetastarch-nacl .......................... 40

HUMALOG KWIKPEN .............. 63

HUMALOG MIX 50/50

KWIKPEN ................................. 63

HUMALOG MIX 50/50 VIAL...... 63

HUMALOG MIX 75/25

KWIKPEN ................................. 63

HUMALOG MIX 75/25 VIAL...... 63

HUMALOG U-100 JUNIOR

KWIKPEN ................................. 63

HUMALOG U-100 VIAL AND

CARTRIDGE ............................. 63

HUMATE-P ............................... 40

HUMATROPE ........................... 80

HUMIRA .................................... 88

HUMIRA PEDIATRIC

CROHNS START ...................... 88

HUMIRA PEN ........................... 88

HUMIRA PEN-CD/UC/HS

STARTER ................................. 88

HUMIRA PEN-PS/UV/ADOL

HS START ................................ 88

HUMULIN 70/30 KWIKPEN ...... 63

HUMULIN 70/30 VIAL ............... 63

HUMULIN N KWIKPEN ............ 63

HUMULIN N VIAL ..................... 63

HUMULIN R U-500 KWIKPEN 63

HUMULIN R U-500 VIAL

(CONCENTRATED) .................. 63

HUMULIN R VIAL ..................... 63

HW EMBRACE PRO

GLUCOSE METER ................... 61

HW EMBRACE PRO

GLUCOSE TEST ...................... 61

HW EMBRACE TALK BLOOD

GLUCOSE ................................ 61

HW EMBRACE TALK

GLUCOSE TEST ...................... 61

HYALGAN ................................. 95

HYALUCIL-4 ............................. 55

HYALURONIDASE

IBRANCE ................................... 32

ibu .............................................. 11

ibuprofen .................................... 11

ibuprofen lysine ......................... 11

IC 400 ........................................ 12

IC 800 ........................................ 12

IC GREEN ................................. 95

ICAR-C PLUS ............................ 67

icatibant acetate ........................ 88

ICLUSIG .................................... 32

IDAMYCIN PFS ......................... 32

idarubicin hcl .............................. 32

IDELVION .................................. 40

IDHIFA ....................................... 32

indomethacin er ......................... 12

indomethacin sodium ................. 12

INFANRIX .................................. 90

INFASURF ............................... 105

INFED ........................................ 95

INFLECTRA ............................... 89

INFUGEM .................................. 32

INFUMORPH 200 ........................ 9

INFUMORPH 500 ........................ 9

infusion set ................................. 95

infuvite adult ............................... 67

INFUVITE ADULT ...................... 67

infuvite pediatric ......................... 67

INFUVITE PEDIATRIC............... 67

IPAMORELIN ACETATE............80

IPOL ...........................................90

ipratropium bromide ........ 105, 108

ipratropium-albuterol ................ 108

irbesartan ...................................45

irbesartan-hydrochlorothiazide 45

IRESSA ......................................32

irinotecan hcl ..............................32

IROSPAN 24/6 ...........................67

IS 24/6 .......................................67

ISENTRESS ...............................38

ISENTRESS HD.........................38

isibloom ......................................83

ISOLYTE-S ................................67

127

hydrocortisone ace-pramoxine

............................................ 55, 91

hydrocortisone acetate............... 91

hydrocortisone butyr lipo base 55

hydrocortisone butyrate ............. 55

hydrocortisone valerate.............. 55

hydrocortisone-acetic acid ....... 105

hydrogen peroxide ..................... 18

hydromet .................................. 105

HYDROMORPHONE HCL ........... 8

hydromorphone hcl ...................... 8

hydromorphone hcl er .................. 8

hydromorphone hcl pf .................. 8

HYDROMORPHONE HCL-

NACL ....................................... 8, 9

hydroxocobalamin acetate ......... 67

hydroxychloroquine sulfate ........ 35

hydroxyprogesterone caproate. 83

hydroxyurea ............................... 32

hydroxyzine hcl .......................... 39

hydroxyzine pamoate ................. 39

HYLENEX .................................. 95

HYMOVIS .................................. 95

hyophen ..................................... 76

hyoscyamine sulfate .................. 74

hyoscyamine sulfate er .............. 74

hyoscyamine sulfate sl ............... 74

hyosyne ..................................... 74

HYPERHEP B S/D ..................... 88

hyperlyte-cr ................................ 67

HYPERRAB ............................... 88

HYPERRAB S/D ........................ 88

HYPERRHO S/D ....................... 88

HYPERSAL ............................. 105

HYPERTET S/D ......................... 88

HYQVIA ..................................... 88

HYSINGLA ER............................. 9

HYZAAR .................................... 45

ibandronate sodium ................... 92

iferex 150 forte ........................... 67

IFEX ........................................... 32

ifosfamide .................................. 32

ILARIS ....................................... 88

ILEVRO.................................... 101

ILUMYA ..................................... 88

ILUVIEN ................................... 101

imatinib mesylate ....................... 32

IMBRUVICA ............................... 32

IMFINZI ...................................... 32

imipenem-cilastatin .................... 18

imipramine hcl............................ 25

imipramine pamoate .................. 25

imiquimod .................................. 55

IMIQUIMOD PUMP .................... 55

IMITREX .................................... 29

IMITREX STATDOSE REFILL 29

IMITREX STATDOSE

SYSTEM .................................... 29

IMLYGIC .................................... 32

IMOGAM RABIES-HT ................ 89

IMOVAX RABIES ....................... 90

IMPAVIDO ................................. 35

IMPOYZ ..................................... 55

IMURAN..................................... 89

IMVEXXY MAINTENANCE

PACK ......................................... 83

IMVEXXY STARTER PACK ...... 83

INBRIJA ..................................... 35

incassia ...................................... 83

INCRELEX ................................. 80

INCRUSE ELLIPTA ................. 108

indapamide ................................ 45

INDERAL LA .............................. 45

INDERAL XL .............................. 45

indigo carmine ........................... 95

INDOCIN .................................... 12

indocyanine green ..................... 95

indomethacin ............................. 12

INGREZZA ................................ 51

INJECTAFER ............................ 67

INLYTA ..................................... 32

INNOPRAN XL .......................... 45

INNOSPIRE GO PORTABLE

MESH NEB ............................... 96

INOVA ....................................... 55

INOVA 4/1 ACNE CONTROL

THERAPY ................................. 55

INSPIREASE RESERVOIR

BAGS ........................................ 96

INSPRA..................................... 45

INSULIN LISPRO ...................... 63

INSULIN PEN NEEDLES .......... 64

insulin pump ir2020 ................... 96

INSULIN SYRINGES ................ 64

INTEGRA F ............................... 67

INTEGRILIN .............................. 36

INTELENCE .............................. 38

INTERMEZZO ......................... 111

intralipid..................................... 67

INTRALIPID .............................. 67

INTRAROSA ............................. 76

INTRON A ................................. 38

introvale .................................... 83

INTUNIV.................................... 49

INVANZ ..................................... 18

INVEGA .................................... 36

INVEGA SUSTENNA ................ 36

INVEGA TRINZA ...................... 36

INVELTYS ............................... 101

INVIRASE ................................. 38

INVOKAMET ............................. 59

INVOKAMET XR ....................... 59

INVOKANA ............................... 59

iodine strong ............................. 67

IONOSOL-MB IN D5W ............. 67

IONSYS ...................................... 9

IOPIDINE ................................ 102

JORNAY PM .............................. 49

J-TIP KIT W/VIAL ADAPTERS. 96

JUBLIA ...................................... 27

juleber ........................................ 83

JULUCA ..................................... 38

JUNE GRASS POLLEN

STANDARDIZED ....................... 96

junel 1.5/30 ................................ 84

junel 1/20 ................................... 84

junel fe 1.5/30 ............................ 84

junel fe 1/20 ............................... 84

junel fe 24 .................................. 84

JUXTAPID ................................. 45

SPONGES ................................. 96

KERYDIN ................................... 28

KETALAR .................................. 96

ketamine hcl ............................... 96

KETAMINE HCL ........................ 96

KETAMINE HCL-SODIUM

CHLORIDE ................................ 96

KETOCARE ............................... 61

ketoconazole .............................. 28

KETOPHENE RAPIDPAQ ......... 12

ketoprofen .................................. 12

ketoprofen er .............................. 12

KETOROCAINE-L ...................... 12

KOATE-DVI ................................40

koate-dvi ....................................41

KOCHIA .....................................96

KOGENATE FS .........................41

KOMBIGLYZE XR ......................59

KORLYM ....................................81

KOVALTRY ................................41

K-PHOS .....................................67

K-PHOS NO 2 ............................67

K-PHOS-NEUTRAL ...................67

k-prime .......................................67

KRINTAFEL ...............................35

KRISTALOSE ............................74

128

isoniazid..................................... 30

isoproterenol hcl ........................ 45

ISOPTO ATROPINE ................ 103

ISOPTO CARPINE .................. 102

ISORDIL TITRADOSE ............... 45

isosorbide dinitrate ..................... 45

isosorbide dinitrate er ................ 45

isosorbide mononitrate............... 45

isosorbide mononitrate er .......... 45

isosulfan blue ............................. 96

isotretinoin ................................. 55

isoxsuprine hcl ........................... 45

isradipine ................................... 45

ISTALOL .................................. 102

ISTODAX (OVERFILL) .............. 32

ISUPREL ................................... 45

itraconazole ............................... 27

ivermectin .................................. 35

IXEMPRA KIT ............................ 32

IXIARO ...................................... 90

IXINITY ...................................... 40

JADENU .................................... 67

JADENU SPRINKLE .................. 67

JAKAFI ...................................... 32

JALYN ....................................... 77

jantoven ..................................... 22

JANUMET .................................. 59

JANUMET XR ............................ 59

JANUVIA ................................... 59

JARDIANCE .............................. 59

jasmiel ....................................... 83

jencycla...................................... 83

JENTADUETO ........................... 59

JENTADUETO XR ..................... 59

JETREA ................................... 103

JEVTANA .................................. 32

jinteli .......................................... 83

JIVI ............................................ 40

JOHNSON GRASS .................... 96

jolessa ....................................... 83

JYNARQUE ............................... 67

K.B.G.L IN TERODERM ............ 12

KABIVEN ................................... 67

KADCYLA .................................. 32

KADIAN ....................................... 9

kaitlib fe ..................................... 84

KALBITOR ................................. 96

KALETRA .................................. 38

kalliga ........................................ 84

KALYDECO ............................. 109

KANJINTI ................................... 32

KANUMA ................................... 75

KAPOK ...................................... 96

KAPSPARGO SPRINKLE .......... 45

KAPVAY .................................... 49

KARBINAL ER ......................... 105

kariva ......................................... 84

KAZANO .................................... 59

KCENTRA .................................. 40

KCL (IN NACL 0.9%) ................. 67

KCL-LIDOCAINE-NACL ............. 67

kedbumin ................................... 96

KEDRAB .................................... 89

KEFLEX ..................................... 18

kelnor 1/35 ................................. 84

kelnor 1/50 ................................. 84

kelo-cote .................................... 55

KENALOG ........................... 55, 78

KENALOG-80 ............................ 78

KENGREAL ............................... 36

KEPIVANCE .............................. 51

KEPPRA .................................... 23

KEPPRA XR .............................. 23

KERAGEL .................................. 55

KERALYT .................................. 55

KERAMATRIX REPLICINE

5CMX5CM ................................. 56

KERLIX AMD

ANTIMICROBIAL ....................... 96

KERLIX AMD SUPER

KETOROCAINE-LM .................. 12

KETOROLAC

TROMETHAMINE ..................... 12

ketorolac tromethamine..... 12, 101

KETOROLAC-BUPIV-

KETAMINE ................................ 12

KETOROLAC-ROPIV-

KETAMINE ................................ 12

KETOSTIX ................................ 61

KEVEYIS ................................. 102

KEVZARA ................................. 89

KEYTRUDA .............................. 32

KHAPZORY .............................. 32

KHEDEZLA ............................... 25

KINERET .................................. 89

KINRIX ...................................... 90

kionex ....................................... 67

KISQALI (200 MG DOSE)......... 32

KISQALI (400 MG DOSE)......... 32

KISQALI (600 MG DOSE)......... 32

KISQALI FEMARA (400 MG

DOSE) ...................................... 32

KISQALI FEMARA (600 MG

DOSE) ...................................... 32

KISQALI FEMARA(200 MG

DOSE) ...................................... 32

KITABIS PAK .......................... 109

KLARITY-A ............................. 101

KLARITY-B ............................. 101

KLARITY-L .............................. 101

KLARON ................................... 56

KLONOPIN ............................... 39

klor-con ..................................... 67

klor-con 10 ................................ 67

klor-con m10 ............................. 67

KLOR-CON M15 ....................... 67

klor-con m20 ............................. 67

klor-con sprinkle ........................ 67

klor-con/ef ................................. 67

KOATE ...................................... 40

larin 24 fe ................................... 84

larin fe 1.5/30 ............................. 84

larin fe 1/20 ................................ 84

larissia ....................................... 84

LARTRUVO ............................... 32

LASIX ........................................ 45

LASTACAFT ............................ 103

LATANOPROST ...................... 102

latanoprost ............................... 102

latrix xm ..................................... 56

LATUDA .................................... 36

LAVARE WOUND WASH .......... 56

layolis fe ..................................... 84

LAZANDA .................................... 9

levetiracetam er ......................... 23

levetiracetam in nacl .................. 23

levobunolol hcl ......................... 102

LEVOCARNITINE ...................... 68

levocarnitine ............................... 68

levocetirizine dihydrochloride 105

levofloxacin ........................ 18, 101

levofloxacin in d5w..................... 18

levoleucovorin calcium ............... 32

levoleucovorin calcium pf ........... 32

levonest ..................................... 84

levonorgest-eth est & eth est ..... 84

levonorgest-eth estrad 91-day 84

levonorgestrel ............................ 84

LIDODERM ................................14

lidolog ........................................78

LIDOPROFEN ........................... 12

LILETTA (52 MG) .......................84

lillow ...........................................84

LINCOCIN ................................. 18

lincomycin hcl ........................... 18

lindane ...................................... 35

linezolid ......................................18

LINZESS ....................................74

LIORESAL ............................... 110

LIORESAL INTRATHECAL ...... 110

liothyronine sodium ................... 86

LIPIODOL ................................. 96

129

KRYSTEXXA ............................. 28

K-TAB ........................................ 68

k-tan plus ................................... 68

kurvelo ....................................... 84

KUVAN ...................................... 75

KYLEENA .................................. 84

KYMRIAH .................................. 89

KYPROLIS ................................. 32

L.E.T. ......................................... 14

labetalol hcl ............................... 45

LABETALOL HCL ...................... 45

LAC-HYDRIN ............................. 56

LACRISERT ............................ 103

lactated ringers .......................... 68

lactic acid ................................... 56

lactic acid e ................................ 56

lactulose .................................... 74

lactulose encephalopathy .......... 74

LAMBS QUARTERS .................. 96

LAMICTAL ................................. 23

LAMICTAL ODT ........................ 23

LAMICTAL STARTER ............... 23

LAMICTAL XR ........................... 23

lamivudine ................................. 38

lamivudine-zidovudine ............... 38

lamotrigine ................................. 23

lamotrigine er ............................. 23

lamotrigine starter kit-blue ......... 23

lamotrigine starter kit-green ....... 23

lamotrigine starter kit-orange ..... 23

LANCETS .................................. 61

LANOXIN ................................... 45

LANOXIN PEDIATRIC ............... 45

lansoprazole .............................. 72

lanthanum carbonate ................. 76

LANTUS SOLOSTAR ................ 64

LANTUS U-100 VIAL ................. 64

larin 1.5/30 ................................. 84

larin 1/20 .................................... 84

l-cysteine hcl .............................. 96

leena .......................................... 84

leflunomide ................................ 89

LEMTRADA ............................... 50

LENSCALE ................................ 96

LENVIMA (10 MG DAILY

DOSE) ....................................... 32


DOSE) ....................................... 32


DOSE) ....................................... 32


DOSE) ....................................... 32


DOSE) ....................................... 32


DOSE) ....................................... 32

LENVIMA (4 MG DAILY

DOSE) ....................................... 32

LENVIMA (8 MG DAILY

DOSE) ....................................... 32

LESCOL XL ............................... 45

lessina ....................................... 84

LETAIRIS ................................. 109

letrozole ..................................... 32

LETS .......................................... 14

leucovorin calcium ..................... 32

LEUKERAN ............................... 32

LEUKINE ................................... 41

leuprolide acetate ...................... 80

LEUPROLIDE ACETATE-

BUPIVACAINE ........................... 80

levalbuterol hcl ......................... 108

LEVALBUTEROL HFA............. 108

LEVAQUIN ................................. 18

LEVBID ...................................... 74

LEVEMIR U-100 FLEXTOUCH.64

LEVEMIR U-100 VIAL ............... 64

levetiracetam ............................. 23

levonorgestrel-ethinyl estrad ..... 84

levonorg-eth estrad triphasic ..... 84

LEVOPHED .............................. 45

levora 0.15/30 (28) .................... 84

levorphanol tartrate ..................... 9

levo-t ......................................... 86

levothyroxine sodium ................ 86

levothyroxine-liothyronine .......... 86

levoxyl ....................................... 86

LEVSIN ..................................... 74

LEVSIN/SL ................................ 74

LEVULAN KERASTICK ............ 56

LEXAPRO ................................. 25

LEXETTE .................................. 56

LEXIVA ..................................... 38

LIALDA ..................................... 91

LIBRAX ..................................... 74

LIBTAYO ................................... 32

lido bdk ..................................... 14

lidocaine .................................... 14

lidocaine hcl ........................ 14, 51

LIDOCAINE HCL ...................... 14

lidocaine hcl (pf) ........................ 14

lidocaine hcl urethral/mucosal ... 14

LIDOCAINE HCL-SODIUM

CHLORIDE ............................... 14

lidocaine in d5w ........................ 14

LIDOCAINE IN DEXTROSE ..... 14

lidocaine viscous ....................... 51

lidocaine-epinephrine ................ 14

LIDOCAINE-EPINEPHRINE .... 103

LIDOCAINE-

PHENYLEPHRINE .................. 103

LIDOCAINE-

PHENYLEPHRINE-BSS .......... 103

lidocaine-prilocaine ................... 14

LIDOCAINE-SODIUM

BICARBONATE ........................ 14

LIDOCAINE-TETRACAINE ....... 14

LIPITOR..................................... 45

LIPO .......................................... 68

LIPO-C ...................................... 68

LIPOFEN ................................... 45

LIQUID E-Z-PAQUE .................. 96

LIQUID POLIBAR PLUS ............ 96

LIQUIVIDA HYDRATION ........... 68

lisinopril...................................... 45

lisinopril-hydrochlorothiazide ...... 45

lithium ........................................ 40

lithium carbonate ....................... 40

lithium carbonate er ................... 40

LITHOBID .................................. 40

LITHOSTAT ............................... 76

LIVALO ...................................... 45

lmd in d5w ................................. 41

LMD IN D5W ............................. 41

lmd in nacl ................................. 41

LMD IN NACL ............................ 41

LO LOESTRIN FE ..................... 84

LOCOID ..................................... 56

LOCOID LIPOCREAM ............... 56

LODINE ..................................... 12

LODOSYN ................................. 35

LOESTRIN 1.5/30 (21) .............. 84

LOESTRIN 1/20 (21) ................. 84

LOESTRIN FE 1.5/30 ................ 84

LOESTRIN FE 1/20 ................... 84

LOKELMA .................................. 68

LOMOTIL ................................... 74

LONHALA MAGNAIR REFILL

KIT ........................................... 108

LONHALA MAGNAIR

STARTER KIT ......................... 108

LONSURF ................................. 32

loperamide hcl ........................... 74

LOPID ........................................ 45

lopinavir-ritonavir ....................... 38

lopreeza ..................................... 84

LOPRESSOR ............................ 45

LOPRESSOR HCT .................... 45

LOPROX .................................... 28

lorazepam ............................ 39, 40

lorazepam intensol .................... 39

LORBRENA ............................... 32

lorcet ............................................ 9

lorcet hd ....................................... 9

lorcet plus .................................... 9

LORTAB ...................................... 9

loryna ......................................... 84

LORZONE ............................... 110

losartan potassium .................... 45

losartan potassium-hctz ............. 45

LOSEASONIQUE ...................... 84

LOTEMAX ................................ 101

LOTEMAX SM ......................... 101

LOTENSIN ................................. 45

LOTENSIN HCT ........................ 45

loteprednol etabonate .............. 101

LOTREL ..................................... 45

LOTRISONE .............................. 56

LOTRONEX ............................... 74

lovastatin .................................... 45

LOVAZA..................................... 45

LOVENOX ................................. 22

low-ogestrel ............................... 84

loxapine succinate ..................... 36

lo-zumandimine .......................... 84

LT INJECTION KIT .................... 78

LUCEMYRA ............................... 16

LUCENTIS ............................... 103

ludent ......................................... 68

lugols ......................................... 18

LULICONAZOLE ........................ 28

LUMIGAN ................................ 102

LUMIZYME ................................ 75

LUMOXITI .................................. 32

LUNESTA ................................ 111

LUPANETA PACK ..................... 80

LUPRON DEPOT (1-MONTH) 80

LUPRON DEPOT (3-MONTH) 81

LUPRON DEPOT (4-MONTH)

INTRAMUSCULAR KIT 30MG 81

LUPRON DEPOT (6-MONTH)

INTRAMUSCULAR KIT 45MG 81

LUPRON DEPOT-PED (1-

MONTH) .................................... 81

LUPRON DEPOT-PED (3-

MONTH) .................................... 81

LUTATHERA ............................. 32

lutera .......................................... 84

LUXIQ ........................................ 56

LUXTURNA ............................. 103

LUZU ......................................... 28

LYNPARZA ................................ 33

LYRICA ...................................... 51

LYRICA CR ............................... 51

LYSINE HCL .............................. 68

LYSODREN ............................... 33

LYSTEDA .................................. 41

lyza ............................................ 84

M.V.I. ADULT............................. 68

M.V.I. PEDIATRIC ..................... 68

MACI .......................................... 96

MACRILEN ................................ 96

MACROBID ............................... 18

MACRODANTIN ....................... 18

MACUGEN .............................. 103

mafenide acetate ...................... 18

MAGNEBIND 400 ..................... 68

magnesium chloride .................. 68

magnesium citrate ..................... 74

magnesium sulfate .................... 68

MAGNESIUM SULFATE ........... 68

magnesium sulfate in d5w ........ 68

MAGNESIUM SULFATE IN

D5W .......................................... 68

MAGNESIUM SULFATE-LACT

RINGERS .................................. 68

MAGNESIUM SULFATE-

NACL ........................................ 68

MAGNEVIST ............................. 96

MAKENA ................................... 84

MALARONE .............................. 35

malathion .................................. 35

MANGANESE CHLORIDE ........ 68

mannitol .................................... 45

maprotiline hcl ........................... 25

MARBETA-25 ........................... 78

MARBETA-L ............................. 78

MARCAINE ............................... 14

MARCAINE PRESERVATIVE

FREE ........................................ 14

MARCAINE SPINAL ................. 15

MARCAINE/EPINEPHRINE ...... 15

MARCAINE/EPINEPHRINE

PF ............................................. 15

MARDEX-25 ............................. 78

MARINOL .................................. 26

marlido ...................................... 15

MARLIDO-25 ............................ 15

marlissa..................................... 84

MARPLAN ................................. 25

MARQIBO ................................. 33

MARVONA SUIK ...................... 15

MATULANE .............................. 33

matzim la................................... 45

MAVENCLAD (10 TABS) .......... 50

MAVENCLAD (4 TABS) ............ 50

MAVENCLAD (5 TABS) ............ 50

MAVENCLAD (6 TABS) ............ 50

MAVENCLAD (7 TABS) ............ 50

MAVENCLAD (8 TABS) ............ 50

MAVENCLAD (9 TABS) ............ 50

MAVYRET ................................. 38

MAXALT.................................... 29

MAXALT-MLT ........................... 29

MAXFE ..................................... 68

130

MAXICOMFORT SYR 27G X

1/2" ............................................ 64

MAXIDEX ................................ 101

MAXIPIME ................................. 18

MAXITROL .............................. 103

MAXZIDE ................................... 45

MAXZIDE-25 ............................. 45

MAYZENT ................................. 50

MAYZENT STARTER PACK ..... 50

me/naphos/mb/hyo1 .................. 76

MEADOW FESCUE GRASS

POLLEN .................................... 96

meclizine hcl .............................. 26

meclofenamate sodium.............. 12

medique aspirin ......................... 12

MEDROL ................................... 78

MEDROLOAN II SUIK ............... 78

MEDROLOAN SUIK .................. 78

MEDROX-RX ............................... 9

medroxyprogesterone acetate 84

mefenamic acid ......................... 12

mefloquine hcl ........................... 35

MEGACE ES ............................. 84

megestrol acetate ...................... 84

MEKINIST .................................. 33

MEKTOVI .................................. 33

MELALEUCA ............................. 96

melodetta 24 fe .......................... 84

meloxicam ................................. 12

melphalan .................................. 33

melphalan hcl ............................ 33

memantine hcl ........................... 24

memantine hcl er ....................... 24

MENACTRA .............................. 90

MENEST .................................... 84

MENOSTAR .............................. 84

MENTAX .................................... 28

MENVEO ................................... 90

meperidine hcl ............................. 9

MEPHYTON .............................. 68

meprobamate ............................ 40

MEPRON ................................... 35

MEPSEVII .................................. 75

mercaptopurine .......................... 33

meropenem ............................... 19

MEROPENEM-SODIUM

CHLORIDE ................................ 19

MERREM ................................... 19

mesalamine ............................... 91

mesalamine-cleanser ................. 91

mesna ........................................ 33

MESNEX ................................... 33

MESQUITE ................................ 96

MESTINON ................................ 29

metadate er ............................... 49

metaproterenol sulfate ............. 108

METAXALL CP ........................ 110

metaxalone .............................. 110

metformin hcl er ......................... 59

metformin hcl er (mod) .............. 59

metformin hcl er (osm) ............... 59

METFORMIN HCL IR ................ 59

metformin hcl ir .......................... 59

methadone hcl ............................. 9

methadone hcl intensol ................ 9

methadose ................................... 9

methadose sugar-free .................. 9

methamphetamine hcl ................ 49

methazolamide......................... 102

methenamine hippurate ............. 19

methenamine mandelate ........... 19

methergine ................................. 96

methimazole .............................. 86

METHITEST .............................. 79

methocarbamol ........................ 110

METHOHEXITAL SODIUM ........ 96

methotrexate .............................. 89

methotrexate sodium ................. 89

methotrexate sodium (pf) ........... 89

methoxsalen .............................. 56

methoxsalen rapid ..................... 56

methscopolamine bromide ......... 74

methyl salicylate ......................... 56

METHYLCOBALAMIN ............... 68

methyldopa ................................ 45

methyldopa-

hydrochlorothiazide .................... 45

methylene blue .......................... 96

methylergonovine maleate ......... 96

METHYLIN ................................. 49

methylphenidate hcl ................... 49

methylphenidate hcl er ............... 49

methylphenidate hcl er (cd) ....... 49

methylphenidate hcl er (la) ........ 49

methylprednisolone .................... 78

METHYLPREDNISOLONE

ACE-LIDO .................................. 78

METHYLPREDNISOLONE

ACETATE .................................. 78

methylprednisolone acetate ....... 78

methylprednisolone sodium

succ ........................................... 78

METHYLPREDNISOLONE-

BUPIVACAINE ........................... 78

methyltestosterone ..................... 79

metoclopramide hcl .................... 26

metolazone ............................... 45

metoprolol succinate er ............. 46

metoprolol tartrate ..................... 46

METOPROLOL-HCTZ ER ........ 46

metoprolol-hydrochlorothiazide. 46

METROCREAM ........................ 56

METROGEL .............................. 56

METROLOTION ........................ 56

METRONIDAZOLE ................... 19

metronidazole ..................... 19, 56

METRONIDAZOLE

BENZO+SYRSPEND ................ 19

metronidazole in nacl ................ 19

METRONIDAZOLE IN NACL .... 19

mexiletine hcl ............................ 46

MIACALCIN .............................. 92

mibelas 24 fe ............................ 84

MICARDIS ................................ 46

MICARDIS HCT ........................ 46

miconazole 3 ............................. 28

MICONAZOLE-ZINC OXIDE-

PETROLAT ............................... 28

MICORT-HC ............................. 56

MICRHOGAM ULTRA-

FILTERED PLUS ...................... 89

MICROCYN .............................. 56

MICROCYN SKIN AND

WOUND .................................... 56

microgestin 1.5/30 ..................... 84

microgestin 1/20 ........................ 84

microgestin fe 1.5/30................. 84

microgestin fe 1/20.................... 84

MICROLET NEXT LANCING

DEVICE..................................... 62

midazolam hcl ........................... 40

MIDAZOLAM HCL-SODIUM

CHLORIDE ............................... 40

MIDAZOLAM-SODIUM

CHLORIDE ............................... 40

midodrine hcl............................. 46

MIGERGOT .............................. 29

miglitol ....................................... 59

miglustat.................................... 75

MIGRANAL ............................... 29

mili ............................................ 84

milk of magnesia ....................... 74

MILLIPRED ............................... 78

MILLIPRED DP ......................... 78

MILLIPRED DP 12-DAY ........... 78

milrinone lactate ........................ 46

milrinone lactate in dextrose ..... 46

mimvey ..................................... 84

mimvey lo .................................. 84

131

MINASTRIN 24 FE .................... 84

mineral oil heavy ....................... 74

MINIMED 530G INSULIN

PUMP ........................................ 96

MINIMED GUARDIAN

SENSOR 3 ................................ 62

MINIPRESS ............................... 46

minitran ...................................... 46

MINIVELLE ................................ 84

MINOCIN ................................... 19

minocycline hcl .......................... 19

minocycline hcl er ...................... 19

MINOLIRA ................................. 19

minoxidil..................................... 46

MIRAPEX .................................. 35

MIRAPEX ER ............................ 35

MIRCERA .................................. 41

MIRCETTE ................................ 84

MIRENA (52 MG) ...................... 84

mirtazapine ................................ 25

MIRVASO .................................. 56

misoprostol ................................ 72

MITE (D. FARINAE) .................. 96

MITE (D. PTERONYSSINUS) ... 96

MITIGARE ................................. 28

mitigo ........................................... 9

mitomycin .................................. 33

MITOMYCIN .............................. 33

MITOSOL ................................ 101

mitoxantrone hcl ........................ 33

MIXED ASPERGILLUS ............. 96

MIXED FEATHERS ................... 96

MIXED RAGWEED .................... 96

MIXED VESPID VENOM

PROTEIN ................................... 96

mlk f1 ......................................... 96

mlk f2 ......................................... 96

mlk f3 ......................................... 96

MLK F4 ...................................... 96

M-M-R II .................................... 90

M-NATAL PLUS ........................ 68

MOBIC ....................................... 12

modafinil .................................. 111

moexipril hcl............................... 46

molindone hcl ............................ 36

mometasone furoate .......... 56, 106

mondoxyne nl ............................ 19

mono-linyah ............................... 84

MONONINE ............................... 41

MONOVISC ............................... 97

MONSELS FERRIC

SUBSULFATE ........................... 41

montelukast sodium ................. 108

MONUROL ................................ 19

morgidox .................................... 19

MORPHABOND ER ..................... 9

MORPHINE SULFATE ................ 9

morphine sulfate .......................... 9

morphine sulfate (concentrate) .... 9

morphine sulfate (pf) .................... 9

morphine sulfate er ...................... 9

morphine sulfate er beads ........... 9

MORPHINE SULFATE-NACL

.............................................. 9, 10

MOTEGRITY ............................. 74

MOTOFEN ................................. 74

MOUNTAIN CEDAR .................. 97

MOUSE EPITHELIUM ............... 97

MOVANTIK ................................ 74

MOVIPREP ................................ 74

MOXEZA .................................. 101

MOXIFLOXACIN HCL........ 19, 101

moxifloxacin hcl ................. 19, 101

moxifloxacin hcl in nacl .............. 19

MOXIFLOXACIN HCL-BSS ..... 103

MOZOBIL ................................... 41

MS CONTIN............................... 10

MSUD EASY.............................. 97

MUCOR ..................................... 97

MUGWORT ............................... 97

MULPLETA ................................ 41

MULTAQ .................................... 46

multi prenatal ............................. 68

multigen ..................................... 68

multigen folic .............................. 68

multigen plus.............................. 68

MULTI-SPECIALTY ................... 78

multi-vit/iron/fluoride ................... 68

multivitamin/fluoride ................... 68

MULTIVITAMIN/FLUORIDE ....... 68

multi-vitamin/fluoride .................. 68

multivitamin/fluoride/iron ............ 69

multi-vitamin/fluoride/iron ........... 69

multivitamins/fluoride.................. 69

mupirocin ................................... 19

mupirocin calcium ...................... 19

mutamycin ................................. 33

MVASI ....................................... 33

mvc-fluoride ............................... 69

MYALEPT .................................. 75

MYAMBUTOL ............................ 30

MYCAMINE ............................... 28

MYCOBUTIN ............................. 30

mycophenolate mofetil ............... 89

mycophenolate mofetil hcl ......... 89

mycophenolate sodium .............. 89

MYDAYIS .................................. 49

MYDRIACYL ........................... 103

myferon 150 forte ...................... 69

MYFORTIC ............................... 89

MYLERAN ................................. 33

MYLOTARG .............................. 33

MYOBLOC ................................ 97

myorisan ................................... 56

MYRBETRIQ ............................. 76

MYSOLINE ............................... 23

MYTESI..................................... 74

na ferric gluc cplx in sucrose .... 69

nabi-hb ...................................... 89

nabumetone .............................. 12

n-acetyl-l-cysteine ..................... 69

nadolol ...................................... 46

nafcillin sodium ......................... 19

NAFCILLIN SODIUM IN

DEXTROSE .............................. 19

nafrinse ..................................... 69

NAFRINSE DAILY

ACIDULATED ........................... 51

NAFRINSE DAILY/NEUTRAL ... 51

nafrinse drops ........................... 69

NAFRINSE WEEKLY ................ 52

naftifine hcl ................................ 28

NAFTIN ..................................... 28

NAGLAZYME ............................ 75

nalbuphine hcl ........................... 10

NALFON ................................... 12

NALOCET ................................. 10

naloxone hcl .............................. 16

NALTREXONE .......................... 16

naltrexone hcl............................ 16

NAMENDA ................................ 24

NAMENDA TITRATION PAK .... 24

NAMENDA XR .......................... 24

NAMENDA XR TITRATION

PACK ........................................ 24

NAMZARIC ............................... 24

NANDROLONE DECANOATE. 79

NANDROLONE-

TESTOSTERONE CYP ............ 79

NAPRELAN ............................... 12

NAPRO ..................................... 12

NAPROSYN .............................. 12

naproxen ................................... 12

naproxen dr ............................... 12

naproxen sodium ...................... 12

naproxen sodium er .................. 12

naratriptan hcl ........................... 29

NARCAN ................................... 16

NARDIL ..................................... 25

132

NAROPIN .................................. 15

NASCOBAL ............................... 69

NASONEX ............................... 106

NATACYN ............................... 101

NATAZIA ................................... 84

nateglinide ................................. 59

NATESTO .................................. 79

NATPARA .................................. 92

NATROBA ................................. 35

NATURE-THROID ..................... 86

nature-throid .............................. 86

NAVELBINE .............................. 33

NEBUPENT ............................... 35

nebusal .................................... 106

NEBUSAL ................................ 106

necon 0.5/35 (28) ...................... 85

nefazodone hcl .......................... 25

NEMBUTAL ............................... 23

NEOKE ALCAR ......................... 69

NEOKE RA LIPOIC ................... 97

neomycin sulfate ........................ 19

neomycin-bacitracin zn-

polymyx ................................... 103

neomycin-polymyxin-dexameth

................................................ 104

neomycin-polymyxin-

gramicidin ................................ 104

neomycin-polymyxin-hc 104, 105

neo-polycin .............................. 104

neo-polycin hc ......................... 104

NEOPROFEN ............................ 12

NEORAL .................................... 89

neostigmine methylsulfate ......... 29

NEOSTIGMINE

METHYLSULFATE .................... 29

NEO-SYNALAR ......................... 56

NEOTUSS PLUS ..................... 106

NEPHRAMINE ........................... 69

NEPHRON FA ........................... 69

NERLYNX .................................. 33

NESACAINE .............................. 15

NESACAINE-MPF ..................... 15

NESINA ..................................... 59

NESTABS .................................. 69

NETSPOT .................................. 97

neuac ......................................... 56

NEULASTA ................................ 41

NEULASTA ONPRO ................. 41

NEUPOGEN .............................. 41

NEUPRO ................................... 35

NEURONTIN ............................. 23

NEUT ......................................... 69

neutral sodium fluoride .............. 52

NEVANAC ............................... 101

nevirapine .................................. 38

nevirapine er .............................. 38

NEXAVAR .................................. 33

NEXAVIR ................................... 97

NEXIUM ..................................... 72

NEXIUM I.V. .............................. 72

NEXPLANON ............................. 85

NEXTERONE............................. 46

niacin (antihyperlipidemic) .......... 46

niacin er (antihyperlipidemic) ..... 46

NIACOR ..................................... 46

NIASPAN ................................... 46

nicardipine hcl ............................ 46

NICARDIPINE HCL IN NACL .... 46

NICOMIDE ................................. 69

NICORETTE .............................. 16

nicotine polacrilex ...................... 16

nicotine step 1 ........................... 16

nicotine step 2 ............................ 16

nicotine step 3 ............................ 16

NICOTROL ................................ 16

NICOTROL NS .......................... 16

nifedipine ................................... 46

nifedipine er ............................... 46

nifedipine er osmotic release ..... 46

NIFEREX ................................... 69

nikki ........................................... 85

NILANDRON .............................. 33

nilutamide .................................. 33

NIMBEX ..................................... 51

nimodipine ................................. 46

NINLARO ................................... 33

NIPENT...................................... 33

NIPRIDE RTU ............................ 46

nisoldipine er .............................. 46

nitisinone .................................... 75

NITRO-BID ................................ 46

NITRO-DUR ............................... 46

nitrofurantoin .............................. 19

nitrofurantoin macrocrystal ......... 19

nitrofurantoin monohydrate

macrocrystals ............................. 19

nitroglycerin ............................... 46

nitroglycerin er ........................... 46

nitroglycerin in d5w .................... 46

NITROLINGUAL ........................ 46

NITROMIST ............................... 46

NITROPRESS............................ 46

nitroprusside sodium .................. 46

NITROSTAT .............................. 46

nitro-time .................................... 46

NITYR ........................................ 75

NIVESTYM ................................ 41

nizatidine ................................... 72

NIZORAL .................................. 28

NOCDURNA ............................. 81

NOCTIVA .................................. 81

nolix .......................................... 56

nora-be ..................................... 85

NORCO..................................... 10

NORDITROPIN FLEXPRO ....... 81

norepinephrine bitartrate ........... 46

NOREPINEPHRINE-

DEXTROSE .............................. 46

NOREPINEPHRINE-SODIUM

CHLORIDE ......................... 46, 47

norethin ace-eth estrad-fe ......... 85

norethindrone ............................ 85

norethindrone acetate ............... 85

norethindrone acet-ethinyl est 85

norethindrone-eth estradiol ....... 85

norethin-eth estradiol-fe ............ 85

NORGESIC FORTE ................ 110

norgestimate-eth estradiol ......... 85

norgestimate-ethinyl estradiol

triphasic..................................... 85

NORITATE ................................ 56

norlyda ...................................... 85

norlyroc ..................................... 85

NORM-JECT LUER SLIP

SYRINGE .................................. 97

NORPACE ................................ 47

NORPACE CR .......................... 47

NORPRAMIN ............................ 25

NORTHERA .............................. 47

nortrel 0.5/35 (28) ..................... 85

nortrel 1/35 (21) ........................ 85

nortrel 1/35 (28) ........................ 85

nortrel 7/7/7 ............................... 85

nortriptyline hcl .......................... 25

NORVASC ................................ 47

NORVIR .................................... 38

NOURIANZ ............................... 35

NOVOEIGHT ............................ 41

NOVOFINE AUTOCOVER

PEN NEEDLE ........................... 64

NOVOFINE PEN NEEDLE ....... 64

NOVOFINE PLUS PEN

NEEDLE.................................... 64

NOVOLIN 70/30 FLEXPEN ...... 64

NOVOLIN 70/30 FLEXPEN

RELION..................................... 64

NOVOLIN 70/30 RELION ......... 64

NOVOLIN 70/30 VIAL ............... 64

NOVOLIN N RELION ................ 64

133

NOVOLIN N VIAL ...................... 64

NOVOLIN R RELION ................ 64

NOVOLIN R VIAL ...................... 64

NOVOLOG FLEXPEN ............... 64

NOVOLOG MIX 70/30

FLEXPEN .................................. 64

NOVOLOG MIX 70/30 VIAL ...... 64

NOVOLOG PENFILL ................. 64

NOVOLOG U-100 VIAL ............. 64

NOVOPEN ECHO ..................... 62

NOVOSEVEN RT ...................... 41

NOVOTWIST PEN NEEDLE ..... 64

NOXAFIL ................................... 28

NP #2 DRUG PREPARATION

KIT ............................................. 12

np thyroid ................................... 86

NPLATE..................................... 41

NUCALA .................................. 106

NUCYNTA ................................. 10

NUCYNTA ER ........................... 10

NUEDEXTA ............................... 51

NUFERA .................................... 69

NULOJIX ................................... 89

NULYTELY WITH FLAVOR

PACKS ...................................... 74

NUMOISYN ............................... 52

NUPLAZID ................................. 36

NUTRIDOX ................................ 19

nutrilipid ..................................... 69

NUTRIVIT .................................. 69

NUTROPIN AQ NUSPIN 10 ...... 81

NUTROPIN AQ NUSPIN 20 ...... 81

NUTROPIN AQ NUSPIN 5 ........ 81

NUVARING ................................ 85

NUVESSA ................................. 19

NUVIGIL .................................. 111

NUWIQ ...................................... 41

NUZYRA .................................... 19

nyamyc ...................................... 28

NYMALIZE ................................. 47

nystatin ...................................... 28

nystatin-triamcinolone ................ 28

nystop ........................................ 28

OAT GRAIN (DIAGNOSTIC) ..... 97

OBIZUR ..................................... 41

OCALIVA ................................... 75

ocella ......................................... 85

OCREVUS ................................. 50

OCTAGAM ................................ 89

octreotide acetate ...................... 81

OCUFLOX ............................... 101

ODACTRA ................................. 97

ODEFSEY ................................. 38

ODOMZO ................................... 33

OFEV ....................................... 108

ofloxacin.....................19, 101, 105

ogestrel ...................................... 85

okebo ......................................... 19

olanzapine ................................. 37

olanzapine-fluoxetine hcl ........... 25

OLIVE TREE .............................. 97

olmesartan medoxomil ............... 47

olmesartan medoxomil-hctz ....... 47

olmesartan-amlodipine-hctz ....... 47

olopatadine hcl .................101, 106

OLUMIANT ................................ 89

OLUX ......................................... 56

OLUX-E ..................................... 56

OMECLAMOX-PAK ................... 74

OMEGA-3/D-3 WELLNESS

PACK ......................................... 47

omega-3-acid ethyl esters ......... 47

OMEGAVEN .............................. 69

omeppi ....................................... 72

omeprazole ................................ 72

omeprazole-sodium

bicarbonate ................................ 72

OMIDRIA ................................. 104

OMNARIS ................................ 106

OMNIPAQUE ............................. 97

OMNIPOD 5 PACK .................... 97

OMNIPOD DASH 5 PACK ......... 97

OMNIPOD STARTER ................ 97

OMNITROPE ............................. 81

ONCASPAR ............................... 33

ondansetron hcl ......................... 26

ONDANSETRON HCL ............... 26

ondansetron odt ......................... 26

ONE DROP BLOOD

GLUCOSE MONITOR ............... 62

ONE DROP TEST ..................... 62

ONE TOUCH VERIO KIT

W/DEVICE ................................. 62

ONE-A-DAY WOMENS

PRENATAL 1 ............................. 69

ONETOUCH DELICA

LANCING DEV .......................... 62

ONETOUCH DELICA PLUS

LANCING ................................... 62

ONETOUCH ULTRA 2 .............. 62

ONETOUCH ULTRA BLUE

TEST STRIPS ............................ 62

ONETOUCH ULTRA MINI ......... 62

ONETOUCH VERIO FLEX

SYSTEM KIT W/DEVICE ........... 62

ONETOUCH VERIO IQ

SYSTEM ................................... 62

ONETOUCH VERIO SYNC

SYSTEM KIT W/DEVICE .......... 62

ONEXTON ................................ 56

ONFI ......................................... 23

ONGLYZA ................................. 59

ONIVYDE .................................. 33

ONPATTRO .............................. 51

ONZETRA XSAIL ...................... 29

OPANA ..................................... 10

OPDIVO .................................... 33

opium ........................................ 74

OPSUMIT ................................ 109

OPTIONS CONCEPTROL ........ 97

OPTIRAY 350 ........................... 97

OPTISON .................................. 97

ORACEA ................................... 56

ORACIT .................................... 69

ORAFATE ................................. 97

ORALAIR .................................. 97

ORALAIR ADULT SAMPLE

KIT ............................................ 97

ORALAIR ADULT STARTER

PACK ........................................ 97

ORALAIR CHILDRENS

STARTER PACK ...................... 97

oralone ...................................... 52

ORANGE (DIAGNOSTIC) ......... 97

ORAPRED ODT ........................ 78

ORAVIG .................................... 28

ORBACTIV ................................ 19

ORCHARD GRASS POLLEN ... 97

ORENCIA .................................. 89

ORENCIA CLICKJECT ............. 89

ORENITRAM .......................... 109

ORFADIN .................................. 75

ORILISSA ................................. 81

ORKAMBI ............................... 109

orphenadrine citrate ................ 110

orphenadrine citrate er ............ 110

orphenadrine-aspirin-caffeine. 110

ORPHENGESIC FORTE......... 110

orsythia ..................................... 85

ORTHO MICRONOR ................ 85

ORTHO TRI-CYCLEN LO ......... 85

ORTHO-NOVUM 1/35 (28) ....... 85

ORTHO-NOVUM 7/7/7 (28) ...... 85

ORTHOVISC ............................. 97

oscimin ...................................... 74

oscimin sr .................................. 74

oseltamivir phosphate ............... 38

OSENI ....................................... 59

134

CHLORIDE ................................ 81

OXYTROL ................................. 76

OZEMPIC .................................. 59

OZURDEX ............................... 101

pacerone .................................... 47

paclitaxel .................................... 33

paliperidone er ........................... 37

palonosetron hcl ........................ 26

PALYNZIQ ................................. 75

PAMELOR ................................. 25

pamidronate disodium................ 92

PANCREAZE ............................. 75

pancuronium bromide ................ 51

P-CARE MG .............................. 15

P-CARE X .................................. 15

PCP 100 .................................... 74

PEANUT (DIAGNOSTIC) ........... 97

PECAN NUT (DIAGNOSTIC) .... 97

PECAN POLLEN ....................... 97

PEDIAPRED .............................. 78

PEDIARIX .................................. 90

PEDVAX HIB ............................. 90

peg 3350 .................................... 74

peg 3350/electrolytes ................. 74

peg 3350-kcl-na bicarb-nacl ....... 74

peg-3350/electrolytes ................. 74

PERTZYE ..................................75

PEXEVA ................................... 25

PFIZERPEN ........................ 19, 20

pfizerpen ................................... 20

phenadoz ................................. 106

phenazo .................................... 76

phenazopyridine hcl .................. 76

phenelzine sulfate ..................... 25

PHENERGAN .......................... 106

phenobarbital ............................ 23

phenobarbital sodium ................ 23

phenobarbital-belladonna alk .... 74

phenohytro .................................74

135

osmitrol ...................................... 47

OSMOLEX ER ........................... 35

OSMOPREP .............................. 74

OSPHENA ................................. 80

OTEZLA..................................... 89

OTICIN HC NR ........................ 105

OTIPRIO .................................. 105

OTOVEL .................................. 105

OTREXUP ................................. 89

OVACE PLUS ............................ 56

OVACE PLUS WASH ................ 56

OVACE WASH .......................... 56

OVIDE ....................................... 35

oxacillin sodium ......................... 19

oxaliplatin ................................... 33

oxandrolone ............................... 79

oxaprozin ................................... 12

OXAYDO ................................... 10

oxazepam .................................. 40

oxcarbazepine ........................... 23

OXERVATE ............................. 104

oxiconazole nitrate ..................... 28

OXISTAT ................................... 28

OXSORALEN ULTRA................ 56

OXTELLAR XR .......................... 23

oxybutynin chloride .................... 76

oxybutynin chloride er ................ 76

oxycodone hcl ............................ 10

OXYCODONE HCL ER ............. 10

oxycodone-acetaminophen ........ 10

oxycodone-aspirin ...................... 10

oxycodone-ibuprofen ................. 10

OXYCONTIN ............................. 10

oxymorphone hcl ....................... 10

oxymorphone hcl er ................... 10

oxytocin ..................................... 81

OXYTOCIN-DEXTROSE ........... 81

OXYTOCIN-LACTATED

RINGERS .................................. 81

OXYTOCIN-SODIUM

PANDEL .................................... 56

PANHEMATIN ........................... 41

PANRETIN ................................. 33

pantoprazole sodium ................. 72

PANZYGA .................................. 89

papaverine hcl ........................... 47

PARADIGM REAL-TIME

STARTER .................................. 62

PARAGARD INTRAUTERINE

COPPER .................................... 85

paregoric .................................... 74

PARI ALTERA NEBULIZER

HANDSET .................................. 97

PARI TREK S COMBO PACK 97

paricalcitol .................................. 92

PARLODEL ................................ 35

PARNATE .................................. 25

paroex ........................................ 52

paromomycin sulfate .................. 19

paroxetine hcl ............................ 25

paroxetine hcl er ........................ 25

paroxetine mesylate ................... 25

PARSABIV ................................. 86

PASER ...................................... 30

PATADAY ................................ 101

PATANASE .............................. 106

PATANOL ................................ 101

PAXIL ........................................ 25

PAXIL CR .................................. 25

PAZEO .................................... 101

P-CARE 100MX ......................... 15

P-CARE D40MX ........................ 78

P-CARE D80MX ........................ 78

P-CARE K40 .............................. 78

P-CARE K40G ........................... 78

P-CARE K40MX ........................ 78

P-CARE K80 .............................. 78

P-CARE K80G ........................... 78

P-CARE K80MX ........................ 78

P-CARE M ................................. 15

PEGANONE .............................. 23

PEGASYS ................................. 38

PEGASYS PROCLICK.............. 38

PEGINTRON ............................. 38

peg-prep.................................... 74

penicillamine ............................. 76

PENICILLIN G POT IN

DEXTROSE .............................. 19

penicillin g potassium ................ 19

penicillin g procaine .................. 19

penicillin g sodium..................... 19

penicillin v potassium ................ 19

PENICILLIUM NOTATUM ......... 97

PENLAC.................................... 28

PENNSAID ................................ 12

PENTACEL ............................... 90

PENTAM ................................... 35

pentamidine isethionate ............ 35

PENTASA ................................. 91

pentazocine-naloxone hcl ......... 10

PENTETATE CALCIUM

TRISODIUM .............................. 97

PENTETATE ZINC

TRISODIUM .............................. 97

pentobarbital sodium ................. 23

pentoxifylline er ......................... 47

PEPCID..................................... 72

PERCOCET .............................. 10

PERENNIAL RYE GRASS

POLLEN .................................... 97

PERFOROMIST ...................... 108

PERIDEX .................................. 52

PERIKABIVEN .......................... 69

perindopril erbumine ................. 47

periogard ................................... 52

PERJETA .................................. 33

permethrin ................................. 35

perphenazine ............................ 26

perphenazine-amitriptyline ........ 25

PERSERIS ................................ 37

DOSE) ....................................... 33

PIQRAY (250 MG DAILY

DOSE) ....................................... 33


DOSE) ....................................... 33

pirmella 1/35 .............................. 85

pirmella 7/7/7 ............................. 85

piroxicam ................................... 12

PISTACHIO NUT

(DIAGNOSTIC) .......................... 97

PITOCIN .................................... 81

PKU EASY................................. 97

PKU EASY MICROTABS .......... 97

PLAQUENIL .............................. 35

posaconazole ............................. 28

pot bicarb-pot chloride ............... 69

POTABA .................................... 69

potassium acetate ...................... 69

potassium bicarbonate ............... 69

potassium chloride ..................... 69

POTASSIUM CHLORIDE .......... 69

potassium chloride crys er ......... 69

potassium chloride er ................. 69

potassium chloride in nacl .......... 69

potassium citrate er .................... 69

potassium citrate-citric acid ........ 69

potassium phosphates ............... 69

POTELIGEO .............................. 33

NEPAFENAC .......................... 104

PREDNISOLONE ACET-

MOXIFLOXACIN ..................... 104

prednisolone sodium

phosphate ......................... 79, 101

PREDNISOLONE-

BROMFENAC ......................... 104

PREDNISOLONE-

GATIFLOXACIN ...................... 104

PREDNISOLONE-

MOXIFLOXACIN ..................... 104

PREDNISOLON-GATIFLOX-

BROMFENAC ......................... 104

136

phenoxybenzamine hcl .............. 47

phentolamine mesylate .............. 47

phenylephrine hcl .............. 47, 104

PHENYLEPHRINE HCL ............ 47

PHENYLEPHRINE HCL-

DEXTROSE ............................... 47

PHENYLEPHRINE HCL-NACL.47

phenylephrine-guaifenesin ....... 106

PHENYTEK ............................... 23

phenytoin ................................... 23

phenytoin infatabs ..................... 23

phenytoin sodium ...................... 23

phenytoin sodium extended ....... 23

philith ......................................... 85

PHOMA EXIGUA ....................... 97

PHOSLYRA ............................... 76

phospha 250 neutral .................. 69

phosphasal ................................ 76

PHOSPHOLINE IODIDE ......... 102

phosphorous .............................. 69

phospho-trin 250 neutral ............ 69

PHOTREXA VISCOUS .............. 97

PHOTREXA-PHOTREXA

VISCOUS KIT ............................ 97

phrenilin forte ............................. 10

PHYSICIANS EZ USE B-12 ...... 69

phytonadione ............................. 69

PICATO ..................................... 56

PIFELTRO ................................. 38

pilocarpine hcl .................... 52, 102

pimecrolimus ............................. 56

pimozide .................................... 37

pimtrea ...................................... 85

pindolol ...................................... 47

pioglitazone hcl .......................... 59

pioglitazone hcl-glimepiride ....... 59

pioglitazone hcl-metformin hcl 59

piperacillin sod-tazobactam so 20


PLASBUMIN-25 ......................... 97

PLASBUMIN-5 ........................... 97

PLAVIX ...................................... 36

PLEGRIDY ................................. 50

PLEGRIDY STARTER PACK .... 50

plenamine .................................. 69

PLENVU .................................... 74

PLEXION ................................... 56

PLEXION CLEANSER ............... 56

PLIAGLIS ................................... 15

pneumovax 23 ........................... 90

PNEUMOVAX 23 ....................... 90

pnv prenatal plus multivit+dha 69

POD-CARE 100K ...................... 78

podocon ..................................... 56

podofilox .................................... 56

POINT OF CARE KM ................. 78

POINT OF CARE L.2 ................. 79

POINT OF CARE L.5 ................. 79

POINT OF CARE LM DEP 2 ..... 79

POINT OF CARE LM-2.2........... 15

POINT OF CARE LM-2.5........... 15

POLIVY ...................................... 33

polocaine ................................... 15

polocaine-mpf ............................ 15

polycin ..................................... 104

polyethylene glycol 3350 ........... 74

poly-iron 150 forte ...................... 69

polymyxin b sulfate .................... 20

polymyxin b-trimethoprim ......... 104

polysaccharide iron forte ............ 69

POLYTRIM .............................. 104

POLY-VI-FLOR .......................... 69

POLY-VI-FLOR FS .................... 69

POLY-VI-FLOR/IRON ................ 69

POMALYST ............................... 33

PORK (DIAGNOSTIC) ............... 97

portia-28..................................... 85

PORTRAZZA ............................. 33

POVIDONE-IODINE ................ 101

PRADAXA ................................. 22

pralidoxime chloride .................. 97

PRALUENT ............................... 47

pramipexole dihydrochloride ..... 35

pramipexole dihydrochloride er. 35

PRAMOSONE ........................... 56

PRAMOTIC ............................. 105

PRASTERA ............................... 12

prasugrel hcl ............................. 36

PRAVACHOL ............................ 47

pravastatin sodium .................... 47

PRAXBIND ................................ 97

praziquantel .............................. 35

prazosin hcl ............................... 47

PRECEDEX .............................. 97

PRECISION LINK ..................... 62

PRECISION PCX PLUS TEST. 62

PRECISION QID MONITOR ..... 62

PRECISION QID TEST ............. 62

PRECISION SOF-TACT

MONITOR ................................. 62

PRECISION SOF-TACT TEST. 62

PRECISION XTRA .................... 62

PRECISION XTRA BLOOD

GLUCOSE ................................ 62

PRECISION XTRA MONITOR 62

PRECOSE ................................ 59

PRED FORTE ......................... 101

PRED MILD ............................ 101

PRED-G .................................. 104

PRED-G S.O.P. ...................... 104

prednicarbate ............................ 56

PREDNISOL ACE-

MOXIFLOX-BROMFEN ........... 101

prednisolone ............................. 79

prednisolone acetate ............... 101

prednisolone acetate p-f ......... 101

PREDNISOLONE ACETATE-

PREDNISOLON-MOXIFLOX-

BROMFENAC .......................... 104

PREDNISOLON-MOXIFLOX-

NEPAFENAC ........................... 102

prednisone ................................. 79

PREDNISONE INTENSOL ........ 79

PREFEST .................................. 85

pregabalin .................................. 51

PREGENNA .............................. 69

PREMARIN ................................ 85

PREMASOL ............................... 69

PREMPHASE ............................ 85

PREMPRO ................................ 85

PRENAISSANCE ....................... 69

PRENATA .................................. 69

prenatal................................ 69, 70

prenatal multi +dha .................... 69

prenatal plus iron ....................... 70

PREPOPIK ................................ 74

PRESTALIA ............................... 47

PREVACID ................................ 72

PREVACID SOLUTAB............... 72

prevalite ..................................... 47

preventeza ................................. 85

PREVIDENT .............................. 52

prevident .................................... 52

PREVIDENT 5000 BOOSTER

PLUS ......................................... 52

PREVIDENT 5000 DRY

MOUTH ..................................... 52

PREVIDENT 5000 ENAMEL

PROTECT ................................. 52

PREVIDENT 5000 ORTHO

DEFENSE .................................. 52

PREVIDENT 5000 PLUS ........... 52

PREVIDENT 5000 SENSITIVE.52

previfem ..................................... 85

PREVNAR 13 ............................ 90

PREVYMIS ................................ 38

PREZCOBIX .............................. 38

PREZISTA ................................. 38

PRIALT ...................................... 10

PRIFTIN ..................................... 30

PRILOSEC ................................ 72

primaquine phosphate ............... 35

PRIMAXIN IV ............................. 20

primidone ................................... 23

PRIMLEV ................................... 10

PRIMSOL .................................. 20

PRINIVIL .................................... 47

PRISMASOL B22GK 4/0 ........... 70

PRISMASOL BGK 0/2.5 ............ 70

PRISMASOL BGK 2/0 ............... 70

PRISMASOL BGK 2/3.5 ............ 70

PRISMASOL BGK 4/2.5 ............ 70

PRISMASOL BK 0/0/1.2 ............ 70

PRISTIQ .................................... 25

PRIVET ...................................... 97

PRIVIGEN .................................. 89

PRO COMFORT SPACER

ADULT ....................................... 97

PRO COMFORT SPACER

CHILD ........................................ 97

PRO COMFORT TENS UNIT .... 98

PROAIR DIGIHALER ............... 108

PROAIR HFA ........................... 108

PROAIR RESPICLICK ............. 108

probenecid ................................. 28

PROBUPHINE IMPLANT KIT .... 10

procainamide hcl ........................ 47

PROCALAMINE ......................... 70

PROCARDIA ............................. 47

PROCARDIA XL ........................ 47

PROCARE COMPRESSOR

NEBULIZER ............................... 98

PROCARE SPACER/ADULT

MASK ........................................ 98

PROCARE SPACER/CHILD

MASK ........................................ 98

PRO-C-DURE 5 ......................... 79

PRO-C-DURE 6 ......................... 79

PROCENTRA ............................ 49

prochlorperazine ........................ 26

prochlorperazine edisylate ......... 26

prochlorperazine maleate ........... 27

PROCORT ................................. 91

PROCRIT ................................... 41

PROCTOCORT ......................... 91

PROCTOFOAM HC ................... 91

procto-med hc ............................ 91

procto-pak .................................. 91

proctosol hc ............................... 91

proctozone-hc ............................ 91

PROCYSBI ................................ 75

PRODIGEN ................................ 74

PRODIGY NO CODING

BLOOD GLUC ........................... 62

PROFESSIONAL DNA

COLLECTION ............................ 98

PROFILNINE ............................. 41

PROFILNINE SD ....................... 41

PROGESTERONE

COMPOUNDING KIT ................ 85

progesterone micronized ........... 85

PROGLYCEM ............................ 63

PROGRAF ................................. 89

PROLASTIN-C ........................ 108

PROLENSA ............................ 102

PROLEUKIN ............................. 33

PROLIA ..................................... 92

PROMACTA .............................. 41

PROMACTIN AA PLUS 20PE 98

promethazine hcl ..................... 106

promethazine-codeine ............. 106

promethazine-dm .................... 106

promethazine-phenyleph-

codeine ................................... 106

promethazine-phenylephrine 106

promethegan ........................... 106

PROMETRIUM .......................... 85

propafenone hcl ........................ 47

propafenone hcl er .................... 47

propantheline bromide .............. 74

proparacaine hcl...................... 104

propofol ..................................... 98

propranolol hcl .......................... 48

propranolol hcl er ...................... 48

propranolol-hctz ........................ 48

propylthiouracil .......................... 86

PROQUAD ................................ 90

PROSCAR ................................ 77

PROSOL ................................... 70

PROSTIN VR ............................ 48

protamine sulfate ....................... 41

PROTHELIAL ............................ 98

PROTONIX ............................... 72

PROTOPIC ............................... 56

protriptyline hcl .......................... 25

PROVAYBLUE .......................... 98

PROVENGE .............................. 89

PROVENTIL HFA .................... 108

PROVERA ................................ 85

PROVIGIL ............................... 111

PROVISC ................................ 104

PROVOCHOLINE ..................... 98

PROZAC ................................... 26

PRUDOXIN ............................... 56

pseudoeph-chlorphen-

hydrocod ................................. 106

pseudoephedrine-bromphen-

dm ........................................... 106

PSORCON ................................ 56

PULMICORT FLEXHALER ..... 108

PULMICORT SUSPENSION 108

pulmosal.................................. 106

PULMOZYME ......................... 109

purevit dualfe plus ..................... 70

PURIXAN .................................. 33

PYLERA .................................... 74

137

pyrazinamide ............................. 30

PYRIDIUM ................................. 76

pyridostigmine bromide.............. 29

pyridostigmine bromide er ......... 29

PYRIDOXINE HCL .................... 70

pyridoxine hcl............................. 70

pyrogallic acid ............................ 56

QBRELIS ................................... 48

QBREXZA ................................. 56

qc aspirin low dose .................... 12

QMIIZ ODT ................................ 12

QNASL .................................... 106

QNASL CHILDRENS ............... 106

QTERN ...................................... 59

QUADRACEL ............................ 90

QUADRAMET ............................ 33

QUALAQUIN ............................. 35

QUARTETTE ............................. 85

quazepam .................................. 40

QUDEXY XR ............................. 23

QUEEN PALM ........................... 98

QUELICIN .................................. 51

QUESTRAN ............................... 48

QUESTRAN LIGHT ................... 48

quetiapine fumarate ................... 37

quetiapine fumarate er ............... 37

QUFLORA FE ............................ 70

QUFLORA FE PEDIATRIC ....... 70

QUFLORA GUMMIES ............... 70

quflora pediatric ......................... 70

QUILLICHEW ER ...................... 50

QUILLIVANT XR ........................ 50

quinapril hcl ............................... 48

quinapril-hydrochlorothiazide ..... 48

quinidine gluconate er ............... 48

quinidine sulfate ......................... 48

quinine sulfate ........................... 35

QVAR REDIHALER ................. 108

RABAVERT ............................... 90

RABBIT EPITHELIUM ............... 98

rabeprazole sodium ................... 72

RADICAVA ................................ 51

RADIOGARDASE ...................... 98

RAGWITEK ............................... 98

raloxifene hcl ............................. 80

ramelteon ................................. 111

ramipril ....................................... 48

RANEXA .................................... 48

ranitidine hcl .............................. 73

ranolazine er .............................. 48

RAPAFLO .................................. 77

RAPAMUNE .............................. 89

rasagiline mesylate .................... 35

RASUVO .................................... 89

RAVICTI..................................... 75

RAYALDEE ................................ 92

RAYOS ...................................... 79

RAZADYNE ............................... 24

RAZADYNE ER ......................... 24

READI-CAT 2 ............................ 98

READYSHARP ANESTH +

BETAMETH ............................... 79

READYSHARP ANESTH +

DEXAMETH ............................... 79

READYSHARP ANESTH +

KETOROLAC ............................. 12

READYSHARP ANESTH +

METHYLPRED .......................... 79

READYSHARP

BETAMETHASONE ................... 79

READYSHARP

DEXAMETHASONE................... 79

READYSHARP KETOROLAC 12

READYSHARP LIDOCAINE ...... 15

READYSHARP-A ....................... 15

REBIF ........................................ 50

REBIF REBIDOSE ..................... 50

REBIF REBIDOSE

TITRATION PACK ..................... 50

REBIF TITRATION PACK ......... 50

REBINYN ................................... 41

RECK ......................................... 15

RECLAST .................................. 92

reclipsen .................................... 85

RECOMBINATE ......................... 41

RECOMBIVAX HB ..................... 90

RECOTHROM ........................... 41

RECOTHROM SPRAY KIT ....... 41

RECTIV...................................... 48

RECURA .................................... 28

RED BIRCH ............................... 98

RED CEDAR.............................. 98

RED MAPLE .............................. 98

RED MULBERRY ...................... 98

RED TOP GRASS POLLEN ...... 98

REGLAN .................................... 27

regonol ....................................... 29

REGONOL ................................. 29

REGRANEX ............................... 56

relador pak ................................. 15

relador pak plus ......................... 15

RELAFEN DS ............................ 12

RELENZA DISKHALER ............. 38

relexxii ....................................... 50

RELION BLOOD GLUCOSE

TEST ......................................... 62

RELION PREMIER CLASSIC... 62

RELION PREMIER TEST ......... 62

RELION ULTIMA TEST ............ 62

RELISTOR .......................... 74, 75

RELNATE DHA ......................... 70

RELPAX .................................... 29

REMERON ................................ 26

REMERON SOLTAB ................ 26

REMESENSE ........................... 52

REMICADE ............................... 89

remifentanil hcl .......................... 10

REMODULIN .......................... 109

RENACIDIN .............................. 76

RENAGEL ................................. 76

RENATABS WITH IRON .......... 70

RENFLEXIS .............................. 89

RENVELA ................................. 76

REOPRO .................................. 36

repaglinide ................................ 59

repaglinide-metformin hcl .......... 59

REPATHA ................................. 48

REPATHA PUSHTRONEX

SYSTEM ................................... 48

REPATHA SURECLICK............ 48

REQUIP XL ............................... 35

RESCRIPTOR........................... 38

RESET FOR ANDROID APP .... 98

RESET FOR IOS APP .............. 98

RESET FOR IOS OR

ANDROID APP ......................... 98

RESET-O FOR ANDROID

APP ........................................... 98

RESET-O FOR IOS APP .......... 98

RESET-O FOR IOS OR

ANDROID APP ......................... 98

RESTASIS .............................. 104

RESTASIS MULTIDOSE ........ 104

RESTORA RX........................... 75

RESTORIL .............................. 111

RETACRIT ................................ 41

RETAVASE ............................... 22

RETAVASE HALF-KIT .............. 22

RETIN-A.................................... 56

RETIN-A MICRO GEL 0.04 %,

0.1 % ......................................... 56

RETIN-A MICRO PUMP ........... 56

RETISERT .............................. 102

RETROVIR ............................... 38

REVATIO ................................ 109

REVCOVI .................................. 75

REVLIMID ................................. 33

REXULTI ................................... 37

REYATAZ ................................. 38

138

RHIZOPUS ................................ 98

RHOFADE ................................. 56

RHOGAM ULTRA-FILTERED

PLUS ......................................... 89

RHOPHYLAC ............................ 89

RHOPRESSA .......................... 102

RIASTAP ................................... 41

RIAX .......................................... 56

ribasphere .................................. 38

ribasphere ribapak ..................... 38

RIBASPHERE RIBAPAK ........... 38

ribavirin ...................................... 38

RICE (DIAGNOSTIC)................. 98

RIDAURA .................................. 89

rifabutin ...................................... 30

RIFADIN .................................... 30

RIFAMATE ................................ 30

rifampin ...................................... 30

RIFAMPIN+SYRSPEND SF ...... 30

RIFATER ................................... 30

RILUTEK ................................... 51

riluzole ....................................... 51

rimantadine hcl .......................... 38

RIOMET ..................................... 59

risedronate sodium .................... 92

RISPERDAL .............................. 37

RISPERDAL CONSTA .............. 37

risperidone ................................. 37

RITALIN ..................................... 50

RITALIN LA ............................... 50

ritonavir ...................................... 38

RITUXAN ................................... 33

RITUXAN HYCELA ................... 33

rivastigmine ............................... 24

rivastigmine tartrate ................... 24

rivelsa ........................................ 85

RIXUBIS .................................... 41

rizatriptan benzoate ................... 29

ROBAXIN ................................ 110

ROBAXIN-750 ......................... 110

ROCALTROL ............................. 92

ROCKLATAN ........................... 102

rocuronium bromide ................... 51

ROCURONIUM BROMIDE ........ 51

ROMIDEPSIN ............................ 33

ROPIDEX .................................. 79

ropinirole hcl .............................. 35

ropinirole hcl er .......................... 35

ROPIVACAINE HCL .................. 15

ropivacaine hcl ........................... 15

ROPIVACAINE HCL-NACL ....... 15

ROPIV-CLONIDINE-

KETOROLAC............................. 15

rosadan ................................ 56, 57

rosuvastatin calcium .................. 48

ROTARIX ................................... 90

ROTATEQ ................................. 90

ROUGH MARSH ELDER ........... 98

ROUGH PIGWEED .................... 98

ROWASA ................................... 91

roweepra .................................... 23

roweepra xr ................................ 23

ROXICODONE .......................... 10

ROZEREM ............................... 111

RUBRACA ................................. 33

RUCONEST ............................... 89

RUSSIAN THISTLE ................... 98

RUZURGI .................................. 98

RYANODEX ............................. 110

RYCLORA ............................... 106

RYDAPT .................................... 33

RYTARY .................................... 35

RYTHMOL SR ........................... 48

ryvent ....................................... 106

SABRIL ...................................... 23

SACCHAROMYCES

CEREVISIAE ............................. 98

SAFYRAL .................................. 85

SAGEBRUSH ............................ 98

SAIZEN ...................................... 81

SAIZENPREP ............................ 81

SALAGEN .................................. 52

SALEX ....................................... 57

salicylic acid ............................... 57

salicylic acid er ........................... 57

salicylic acid-cleanser ................ 57

saline bacteriostatic ................... 70

SALINE-PHENOL ...................... 70

salsalate..................................... 12

SALVAX ..................................... 57

SALVAX DUO PLUS ................. 57

SAMSCA .................................... 70

SANCUSO ................................. 27

SANDIMMUNE .......................... 89

SANDOSTATIN ......................... 81

SANDOSTATIN LAR DEPOT .... 81

SANTYL ..................................... 57

SAPHRIS ................................... 37

SAPS HEALTH CARE

ALCOHOL PREP ....................... 98

SARAFEM ................................. 26

sash kit ...................................... 98

SAVAYSA .................................. 22

SAVELLA ................................... 51

SAVELLA TITRATION PACK .... 51

SCLEROSOL

INTRAPLEURAL ..................... 108

scopolamine .............................. 27

SEASONIQUE .......................... 85

SECONAL ............................... 111

SEEBRI NEOHALER .............. 108

SEGLUROMET ......................... 59

SELECT-OB .............................. 70

selegiline hcl ............................. 35

selenium sulfide ........................ 57

SELZENTRY ............................. 38

SEMPREX-D ........................... 106

SENSIPAR ................................ 80

sensorcaine ............................... 15

sensorcaine/epinephrine ........... 15

sensorcaine-mpf ........................ 15

sensorcaine-mpf/epinephrine .... 15

SENSORCAINE-

MPF/EPINEPHRINE ................. 15

SEREVENT DISKUS .............. 108

SERNIVO .................................. 57

SEROQUEL .............................. 37

SEROQUEL XR ........................ 37

SEROSTIM ............................... 75

sertraline hcl.............................. 26

SESAME SEED

(DIAGNOSTIC) ......................... 98

se-tan plus ................................ 70

setlakin ...................................... 85

sevelamer carbonate ................ 76

sevelamer hcl ............................ 76

sevoflurane ............................... 98

SEYSARA ................................. 20

sf ............................................... 52

sf 5000 plus .............................. 52

SFROWASA ............................. 91

SHAGBARK HICKORY ............. 98

sharobel .................................... 85

SHEEP SORREL ...................... 98

SHINGRIX ................................. 90

SHORT RAGWEED POLLEN

EXT ........................................... 98

SHRIMP (DIAGNOSTIC) .......... 98

SIGNIFOR ................................. 81

SIGNIFOR LAR ......................... 81

SIKLOS ..................................... 33

sildenafil citrate ....................... 109

SILENOR ................................ 111

SILIQ ......................................... 89

silodosin .................................... 77

SILVADENE .............................. 20

silver nitrate ............................... 20

silver sulfadiazine ...................... 20

139

SIMBRINZA ............................. 102

simliya ....................................... 85

simpesse ................................... 85

SIMPONI ................................... 89

SIMPONI ARIA .......................... 89

SIMULECT ................................ 89

simvastatin ................................. 48

SINEMET ................................... 35

SINEMET CR ............................ 35

SINGULAIR ............................. 108

SINUVA ................................... 106

sirolimus .................................... 89

SIRTURO .................................. 30

SITAVIG .................................... 38

SIVEXTRO ................................ 20

SKELAXIN ............................... 110

SKLICE ...................................... 35

SKYLA ....................................... 85

SKYRIZI (150 MG DOSE) ......... 89

SLYND ...................................... 85

sm esomeprazole magnesium 73

sm hydrocortisone ..................... 57

SMOFLIPID ............................... 70

sod benz-sod phenylacet ........... 75

sod citrate-citric acid .................. 70

sodium acetate .......................... 70

sodium bicarbonate ............. 70, 75

SODIUM BICARBONATE .......... 70

SODIUM BICARBONATE-

DEXTROSE ............................... 70

sodium chloride ................. 70, 106

sodium chloride bacteriostatic ... 70

SODIUM CITRATE .................... 22

SODIUM CITRATE LOCK

FLUSH ....................................... 22

SODIUM CITRATE-

GENTAMICIN SULF .................. 22

SODIUM DIURIL ....................... 48

SODIUM EDECRIN ................... 48

sodium fluoride .................... 52, 70

sodium fluoride 5000 plus.......... 52

sodium hyaluronate ................... 57

SODIUM HYALURONATE ........ 98

sodium lactate ........................... 70

sodium phenylbutyrate............... 75

SODIUM PHOSPHATE-NACL 71

sodium phosphates ................... 71

SODIUM PHOSPHATES-

DEXTROSE ............................... 71

sodium polystyrene sulfonate .... 71

sodium sulfacetamide ................ 57

sodium sulfacetamide wash ...... 57

SODIUM SULFACETAMIDE

WASH ........................................ 57

SOF-SENSOR ........................... 62

SOLESTA .................................. 98

solifenacin succinate .................. 76

SOLIQUA ................................... 59

SOLIRIS..................................... 41

SOLODYN ................................. 20

SOLOSEC ................................. 35

SOLTAMOX ............................... 33

SOLU-CORTEF ......................... 79

SOLU-MEDROL ......................... 79

SOMA ...................................... 110

SOMATULINE DEPOT .............. 81

SOMAVERT ............................... 81

SOOLANTRA ............................. 57

SORIATANE .............................. 57

SORILUX ................................... 57

sorine ......................................... 48

SORREL/DOCK MIX ................. 98

SOTALOL HCL .......................... 48

sotalol hcl ................................... 48

sotalol hcl (af) ............................ 48

SOTRADECOL .......................... 48

SOTYLIZE ................................. 48

SOVALDI ................................... 38

SOYBEAN (DIAGNOSTIC) ........ 98

SPARKY THE DOG PED

NEBULIZER ............................... 98

SPECTRACEF ........................... 20

spinosad .................................... 35

SPINRAZA ................................. 98

SPINY PIGWEED ...................... 98

SPIRIVA HANDIHALER........... 108

SPIRIVA RESPIMAT ............... 108

spironolactone............................ 48

spironolactone-hctz .................... 48

SPORANOX .............................. 28

SPORANOX PULSEPAK ........... 28

SPRAVATO (56 MG DOSE) ...... 26

SPRAVATO (84 MG DOSE) ...... 26

sprintec 28 ................................. 85

SPRITAM ................................... 23

SPRIX ........................................ 12

SPRYCEL .................................. 33

sps ............................................. 71

sronyx ........................................ 85

ssd ............................................. 20

SSKI ........................................ 106

sss 10-5 ..................................... 57

st joseph low dose ..................... 12

STALEVO 100 ........................... 35

STALEVO 125 ........................... 35

STALEVO 150 .......................... 35

STALEVO 200 .......................... 36

STALEVO 50 ............................ 36

STALEVO 75 ............................ 36

STAMARIL ................................ 90

STARLIX ................................... 59

stavudine ................................... 38

STEGLATRO ............................ 59

STEGLUJAN ............................. 59

STELARA .................................. 89

STEMPHYLIUM ........................ 98

STERILE DILUENT FLOLAN

PH 12 ........................................ 98

STERILE DILUENT FOR

FLOLAN .................................... 98

sterile diluent/epoprostenol ....... 98

STERILE TALC POWDER ...... 108

sterile water for injection ........... 98

STERITALC ............................ 108

STIMATE .................................. 81

STIOLTO RESPIMAT ............. 108

STIVARGA ................................ 33

STRATTERA ............................. 50

STRAWBERRY

(DIAGNOSTIC) ......................... 99

STRENSIQ ................................ 75

streptomycin sulfate .................. 20

STRIANT ................................... 79

STRIBILD .................................. 38

STRIVERDI RESPIMAT.......... 108

STROMECTOL ......................... 35

SUBLOCADE ............................ 16

SUBOXONE .............................. 16

SUBSYS ................................... 10

subvenite ................................... 23

subvenite starter kit-blue ........... 23

subvenite starter kit-green ........ 23

subvenite starter kit-orange ...... 23

succinylcholine chloride ............ 51

SUCCINYLCHOLINE

CHLORIDE ............................... 51

SUCRAID .................................. 75

sucralfate .................................. 73

SULAR ...................................... 48

sulfacetamide sodium ....... 57, 102

sulfacetamide sodium (acne) .... 57

sulfacetamide sodium-sulfur ...... 57

sulfacetamide-prednisolone..... 104

sulfacetamide-sulfur in urea ...... 57

sulfacleanse 8/4 ........................ 57

sulfadiazine ............................... 20

sulfamethoxazole-trimethoprim. 20

SULFAMYLON .......................... 20

140

sulfasalazine .............................. 91

sulfatrim pediatric ...................... 20

sulfurated lime ........................... 35

sulindac ..................................... 12

sumatriptan ................................ 29

sumatriptan succinate ................ 29

sumatriptan succinate refill ........ 29

sumatriptan-naproxen sodium 29

SUPARTZ FX ............................ 99

SUPPRELIN LA ......................... 81

SUPRANE ................................. 99

SUPRAX .................................... 20

SUPREP BOWEL PREP KIT .... 75

SURE RESULT O3D3

SYSTEM .................................... 48

SURESTEP PRO HIGH

GLUCOSE ................................. 62

SURESTEP PRO LOW

GLUCOSE ................................. 62

SURESTEP PRO NORMAL

GLUCOSE ................................. 62

SURGISEAL .............................. 99

SURGISEAL STYLUS ............... 99

SURGISEAL TWIST .................. 99

SURVANTA ............................. 106

SUSTIVA ................................... 38

SUSTOL .................................... 27

SUTENT .................................... 33

swabflush saline flush ................ 71

SWEET CORN

(DIAGNOSTIC) .......................... 99

SWEET GUM ............................ 99

SWEET VERNAL GRASS

POLLEN .................................... 99

SX1 MEDICATED POST-

OPERATIVE .............................. 15

syeda ......................................... 85

SYLATRON ............................... 33

SYLVANT .................................. 33

SYMAX DUOTAB ...................... 75

symax-sl .................................... 75

symax-sr .................................... 75

SYMBICORT ........................... 108

SYMBYAX ................................. 26

SYMDEKO ............................... 109

SYMFI ....................................... 39

SYMFI LO .................................. 39

SYMJEPI ................................. 108

SYMLINPEN 120 ....................... 59

SYMLINPEN 60 ......................... 59

SYMPAZAN ............................... 23

SYMPROIC ............................... 75

SYMTUZA ................................. 39

SYNAGIS ................................... 89

synalar ....................................... 57

SYNALAR .................................. 57

SYNAPRYN FUSEPAQ ............. 10

SYNAREL .................................. 81

SYNDROS ................................. 27

SYNERA .................................... 15

SYNERCID ................................ 20

SYNJARDY ................................ 59

SYNJARDY XR .......................... 59

SYNRIBO ................................... 33

SYNTHAMIN 17 ......................... 71

SYNTHROID .............................. 86

SYNVISC ................................... 99

SYNVISC ONE .......................... 99

SYPRINE ................................... 71

TABLOID ................................... 33

TABRADOL FUSEPAQ............ 110

TABRADOL RAPIDPAQ .......... 110

TACHOSIL ................................. 99

TACLONEX ............................... 57

tacrolimus ............................ 57, 89

tadalafil (pah) ........................... 109

TAFINLAR ................................. 33

TAGITOL V ................................ 99

TAGRISSO ................................ 33

TAKHZYRO ............................... 99

TALL RAGWEED ....................... 99

TALTZ ........................................ 89

TALZENNA ................................ 33

TAMIFLU ................................... 39

tamoxifen citrate ......................... 33

tamsulosin hcl ............................ 77

TAPAZOLE ................................ 86

TAPERDEX 12-DAY .................. 79

TAPERDEX 6-DAY .................... 79

TAPERDEX 7-DAY .................... 79

TARCEVA .................................. 33

TARGADOX ............................... 20

TARGRETIN .............................. 34

tarina 24 fe ................................. 85

tarina fe 1/20 .............................. 85

tarina fe 1/20 eq ......................... 85

TARKA ....................................... 48

TARON FORTE ......................... 71

taron-crystals ............................. 71

TASIGNA ................................... 34

TASMAR .................................... 36

TAURINE ................................... 71

TAVALISSE ............................... 41

TAXOTERE ............................... 34

TAYTULLA ................................. 85

tazarotene .................................. 57

tazicef ....................................... 20

TAZICEF ................................... 20

TAZORAC ................................. 57

taztia xt ..................................... 48

TDVAX ...................................... 90

TECENTRIQ ............................. 34

TECFIDERA .............................. 50

TECHNET TC 99M SULFUR

COLLOID .................................. 99

technetium tc 99m mebrofenin 99

TECHNETIUM TC 99M

MEDRONATE ........................... 99

TECHNETIUM TC 99M

PYROPHOS .............................. 99

technetium tc 99m sestamibi .... 99

TEFLARO ................................. 20

TEGRETOL ............................... 24

TEGRETOL-XR ......................... 24

TEGSEDI .................................. 51

TEKTURNA ............................... 48

TEKTURNA HCT ...................... 48

TELFA AMD NON-

ADHERENT .............................. 99

telmisartan ................................ 48

telmisartan-amlodipine .............. 48

telmisartan-hctz ......................... 48

temazepam ............................. 111

TEMIXYS .................................. 39

TEMODAR ................................ 34

TEMOVATE .............................. 57

temozolomide ............................ 34

temsirolimus .............................. 89

tencon ....................................... 10

teniposide .................................. 34

TENIVAC .................................. 90

tenofovir disoproxil fumarate ..... 39

TENORETIC 100 ...................... 48

TENORETIC 50 ........................ 48

TENORMIN ............................... 48

TEPADINA ................................ 34

terazosin hcl .............................. 77

terbinafine hcl............................ 28

terbutaline sulfate .................... 108

terconazole ............................... 28

TESSALON PERLES .............. 106

TESTIM ..................................... 80

TESTOPEL ............................... 80

TESTOSTERONE ..................... 80

testosterone .............................. 80

TESTOSTERONE

COMPOUNDING KIT ................ 80

TESTOSTERONE

CYPIONATE ............................. 80

141

142

testosterone cypionate .............. 80

TESTOSTERONE

CYPIONATE & PROP ............... 80

TESTOSTERONE

ENANTHATE ............................. 80

testosterone enanthate .............. 80

TESTOSTERONE

PROPIONATE ........................... 80

tetcaine .................................... 104

tetrabenazine ............................. 51

tetracaine hcl ..................... 15, 104

tetracycline hcl ........................... 20

tetravisc ................................... 104

tetravisc forte ........................... 104

TEXACORT ............................... 57

TEXAVITE LQ ........................... 71

thallous chloride tl 201 ............... 99

THALLOUS CHLORIDE TL

201 ............................................ 99

THALOMID ................................ 34

THEO-24 ................................. 108

theochron ................................. 108

theophylline ............................. 108

theophylline er ......................... 108

thiamine hcl ............................... 71

THIOLA...................................... 76

THIOLA EC ............................... 76

thioridazine hcl ........................... 37

thiotepa ...................................... 34

thiothixene ................................. 37

THROMBATE III ........................ 22

THROMBIN-JMI ......................... 41

THROMBIN-JMI EPISTAXIS ..... 41

THROMBOGEN ......................... 41

THYMOGLOBULIN .................... 89

THYROGEN .............................. 99

tiagabine hcl .............................. 24

TIAZAC ...................................... 48

TIBSOVO ................................... 34

TICE BCG ................................. 89

TIGAN ....................................... 27

tigecycline .................................. 20

TIGLUTIK .................................. 51

TIKOSYN ................................... 48

tilia fe ......................................... 86

timolol maleate .................. 48, 102

TIMOPTIC ............................... 102

TIMOPTIC OCUDOSE ............ 102

TIMOPTIC-XE.......................... 103

TIMOTHY GRASS POLLEN

ALLERGEN ............................... 99

tinidazole ................................... 20

TIROSINT .................................. 86

TIROSINT-SOL .......................... 86

TISSEEL .................................... 99

TIVICAY ..................................... 39

TIVORBEX ................................. 13

tizanidine hcl ............................ 110

tl icon ......................................... 71

TL-FLUORIVITE ........................ 71

TOBI NEBULIZER ................... 109

TOBI PODHALER .................... 109

TOBRADEX ............................. 104

TOBRADEX ST ....................... 104

tobramycin .......................102, 109

TOBRAMYCIN ......................... 109

tobramycin sulfate ...................... 20

tobramycin-dexamethasone ..... 104

TOBREX .................................. 102

TOFRANIL ................................. 26

TOLAK ....................................... 57

tolbutamide ................................ 59

tolcapone ................................... 36

tolmetin sodium .......................... 13

TOLSURA .................................. 28

tolterodine tartrate ...................... 76

tolterodine tartrate er .................. 76

TOPAMAX ................................. 24

TOPAMAX SPRINKLE............... 24

topex topical anesthetic ............. 52

TOPICORT ................................ 57

TOPICORT SPRAY ................... 57

topiramate .................................. 24

topiramate er.............................. 24

toposar ....................................... 34

topotecan hcl ............................. 34

TOPROL XL ............................... 48

toremifene citrate ....................... 34

TORISEL ................................... 89

TORONOVA II SUIK .................. 13

TORONOVA SUIK ..................... 13

torsemide ................................... 48

TOTECT .................................... 34

TOUJEO MAX SOLOSTAR ....... 64

TOUJEO SOLOSTAR ................ 64

TOVIAZ ...................................... 76

toxicology saliva collection ......... 99

tpn electrolytes ........................... 71

TRACLEER .............................. 109

TRADJENTA .............................. 59

TRAMADOL HCL ER ................. 10

tramadol hcl er ........................... 10

tramadol hcl er (biphasic) ........... 10

tramadol hcl ir ............................ 10

tramadol-acetaminophen ........... 10

trandolapril ................................. 48

trandolapril-verapamil hcl er ...... 48

tranexamic acid ......................... 41

TRANSDERM SCOP (1.5 MG). 27

TRANSDERM-SCOP (1.5 MG).27

TRANXENE-T ........................... 40

tranylcypromine sulfate ............. 26

TRAVASOL ............................... 71

TRAVATAN Z.......................... 103

trazodone hcl ............................ 26

TREANDA ................................. 34

TRECATOR .............................. 30

TRELEGY ELLIPTA ................ 109

TRELSTAR MIXJECT ............... 81

TREMFYA ................................. 90

treprostinil ............................... 109

TRESIBA ................................... 64

TRESIBA FLEXTOUCH ............ 64

tretinoin ......................... 34, 57, 58

tretinoin microsphere ................ 58

tretinoin microsphere pump ...... 58

TRETTEN ................................. 41

TREXALL .................................. 90

TREXIMET ................................ 29

TREZIX ..................................... 10

tri femynor ................................. 86

triamcinolone acetonide 52, 58, 79

TRIAMCINOLONE

ACETONIDE ............................. 79

TRIAMCINOLONE

DIACETATE .............................. 79

TRIAMCINOLONE-

BUPIVACAINE .......................... 79

TRIAMCINOLONE-

MOXIFLOXACIN ..................... 104

TRI-AMINO ............................... 71

triamterene ................................ 48

triamterene-hctz ........................ 48

TRIANEX .................................. 58

triazolam ................................... 40

TRIBENZOR ............................. 48

TRICARE PRENATAL DHA

ONE .......................................... 71

TRI-CHLOR .............................. 58

TRICHOPHYTON ..................... 99

TRICITRASOL .......................... 22

tricitrates ................................... 71

tricon ......................................... 71

TRICOR .................................... 48

triderm ....................................... 58

TRIDESILON ............................ 58

trientine hcl ............................... 71

tri-estarylla ................................ 86

TRIFERIC ................................. 71

143

trifluoperazine hcl ...................... 37

trifluridine ................................. 102

trigels-f forte............................... 71

trihexyphenidyl hcl ..................... 36

tri-legest fe ................................. 86

TRILEPTAL ............................... 24

tri-linyah ..................................... 86

TRILIPIX .................................... 48

TRILOAN II SUIK....................... 79

TRILOAN SUIK .......................... 79

tri-lo-estarylla ............................. 86

tri-lo-marzia ................................ 86

tri-lo-mili ..................................... 86

tri-lo-sprintec .............................. 86

trilyte .......................................... 75

trimethobenzamide hcl............... 27

trimethoprim ............................... 20

tri-mili ......................................... 86

trimipramine maleate ................. 26

trinate ........................................ 71

TRINAZ...................................... 71

TRINTELLIX .............................. 26

TRIOSTAT ................................. 86

TRIPLE COMPLEX FORMULA

3 KIT .......................................... 13

TRIPLE PMB ........................... 102

TRIPLE PMK ........................... 102

tri-previfem ................................. 86

TRIPTODUR .............................. 81

TRISENOX ................................ 34

TRISODIUM CITRATE/CRRT 71

tri-sprintec .................................. 86

TRIUMEQ .................................. 39

TRI-VI-FLOR ............................. 71

TRI-VI-FLORO ........................... 71

TRIVISC .................................... 99

tri-vitamin/fluoride ...................... 71

tri-vite/fluoride ............................ 71

trivora (28) ................................. 86

tri-vylibra .................................... 86

tri-vylibra lo ................................ 86

TRIZIVIR .................................... 39

TROGARZO .............................. 39

TROKENDI XR .......................... 24

TROPHAMINE ........................... 71

tropicamide .............................. 104

TROPICAMIDE-

PHENYLEPHRINE .................. 104

trospium chloride ....................... 76

trospium chloride er ................... 76

TRUE COMFORT ALCOHOL

PREP PADS .............................. 99

TRUE FOCUS BLOOD

GLUCOSE METER .................... 62

TRUE METRIX BLOOD

GLUCOSE TEST ....................... 62

TRUE METRIX LEVEL 1 ........... 62



TRUETRACK TEST ................... 62

TRULANCE ............................... 75

TRULICITY ................................ 59

TRUMENBA ............................... 90

TRUSOPT ................................ 103

TRUVADA .................................. 39

tryptophan .................................. 71

TUDORZA PRESSAIR ............ 109

tulana ......................................... 86

turpentine ................................... 58

TUSSICAPS ............................ 106

TUXARIN ER ........................... 106

TUZISTRA XR ......................... 106

TWINRIX .................................... 90

TWYNSTA ................................. 48

TYBOST .................................... 39

tydemy ....................................... 86

TYGACIL ................................... 20

TYKERB .................................... 34

TYLENOL WITH CODEINE #3 . 10

TYLENOL WITH CODEINE #4 . 10

TYMLOS .................................... 92

TYPHIM VI ................................. 91

TYR EASY ................................. 99

TYSABRI ................................... 50

TYVASO .................................. 109

TYVASO REFILL ..................... 109

TYVASO STARTER ................ 109

UCERIS ..................................... 91

UDENYCA ................................. 41

ULESFIA .................................... 35

ULORIC ..................................... 28

ULTANE..................................... 99

ULTIVA ...................................... 10

ULTOMIRIS ............................... 41

ULTRABAG/DIANEAL/1.5%

DEXTROSE ............................... 71


DEXTROSE ............................... 71


DEX ........................................... 71

ULTRACET ................................ 10

ULTRAM .................................... 10

ULTRAVATE .............................. 58

ULTRAVIST ............................... 99

umecta mousse ......................... 58

UNASYN ................................... 20

UNISTRIP CONTROL ............... 62

unithroid .................................... 86

UNITUXIN ................................. 34

UPTRAVI ................................ 109

urea ........................................... 58

urea hydrating ........................... 58

urea in zn undecyl-lactic acid .... 58

urea nail .................................... 58

URECHOLINE........................... 76

uretron d/s ................................. 76

urimar-t ..................................... 76

urin ds ....................................... 76

UROCIT-K 10 ............................ 71

UROCIT-K 15 ............................ 71

UROCIT-K 5 .............................. 71

UROGESIC-BLUE .................... 76

UROXATRAL ............................ 77

URSO 250 ................................. 75

URSO FORTE .......................... 75

ursodiol ..................................... 75

URSODIOL+SYRSPEND SF .... 75

uryl ............................................ 76

ustell ......................................... 76

UTIBRON NEOHALER ........... 109

uticap ........................................ 76

utira-c ........................................ 76

utrona-c ..................................... 76

VABOMERE .............................. 20

VAGIFEM .................................. 86

valacyclovir hcl .......................... 39

VALCHLOR ............................... 34

VALCYTE .................................. 39

valganciclovir hcl ....................... 39

VALIUM..................................... 40

valproate sodium ....................... 24

valproic acid .............................. 24

valrubicin ................................... 34

valsartan ................................... 48

valsartan-hydrochlorothiazide .... 48

VALSTAR .................................. 34

VALTREX .................................. 39

VANATOL LQ ........................... 10

VANATOL S .............................. 10

VANCOCIN HCL ....................... 20

vancomycin hcl ......................... 21

VANCOMYCIN HCL .................. 21

VANCOMYCIN HCL IN

DEXTROSE .............................. 20

vancomycin hcl in dextrose ....... 20

vancomycin hcl in nacl ........ 20, 21

VANCOMYCIN HCL IN NACL 21

VANCOMYCIN+SYRSPEND

SF .............................................. 21

vandazole .................................. 21

VANOS ...................................... 58

VANOXIDE-HC .......................... 58

VANTAS .................................... 81

VAQTA ...................................... 91

VARIBAR HONEY ..................... 99

VARIBAR NECTAR ................... 99

VARIBAR PUDDING ................. 99

VARIBAR THIN HONEY ............ 99

VARIBAR THIN LIQUID ............ 99

VARITHENA .............................. 48

VARIVAX ................................... 91

VARIZIG .................................... 90

VARUBI ..................................... 27

VASCEPA .................................. 49

VASERETIC .............................. 49

vashe cleansing ......................... 58

VASOPRESSIN-SODIUM

CHLORIDE ................................ 81

VASOSTRICT ............................ 81

VASOTEC ................................. 49

VAXCHORA .............................. 91

VAZCULEP ................................ 49

vcf vaginal contraceptive ........... 99

VECAMYL ................................. 49

VECTIBIX .................................. 34

VECTICAL ................................. 58

VECURONIUM BROMIDE ......... 51

vecuronium bromide .................. 51

VELCADE .................................. 34

VELETRI .................................. 109

velivet ........................................ 86

VELPHORO ............................... 76

VELTASSA ................................ 71

VELTIN ...................................... 58

VEMLIDY ................................... 39

VENCLEXTA ............................. 34

VENCLEXTA STARTING

PACK ......................................... 34

VENELEX .................................. 58

VENIPUNCTURE PX1

PHLEBOTOMY .......................... 15

venlafaxine hcl ........................... 26

venlafaxine hcl er....................... 26

VENOFER ................................. 71

VENOMIL HONEY BEE

VENOM ..................................... 99

VENOMIL WASP VENOM ......... 99

VENOMIL WHITE FACED

HORNET ................................... 99

VENOMIL YELLOW HORNET

VENOM...................................... 99

VENOMIL YELLOW JACKET

VENOM...................................... 99

VENTAVIS ............................... 109

VENTOLIN HFA ....................... 109

verapamil hcl.............................. 49

verapamil hcl er ......................... 49

VERDESO ................................. 58

VEREGEN ................................. 58

VERELAN .................................. 49

VERELAN PM............................ 49

VERSACLOZ ............................. 37

VERZENIO ................................ 34

VESICARE ................................. 76

VFEND ...................................... 28

VFEND IV .................................. 28

V-GO 20 .............................. 62, 99

V-GO 30..................................... 99

V-GO 40..................................... 99

VIBATIV ..................................... 21

VIBERZI ..................................... 75

VIBRAMYCIN............................. 21

vicodin es ................................... 10

vicodin hp ................................... 10

VICTOZA ................................... 59

VIDAZA ...................................... 34

VIDEX ........................................ 39

VIDEX EC .................................. 39

VIEKIRA PAK ............................ 39

vienva ........................................ 86

vigabatrin ................................... 24

vigadrone ................................... 24

VIGAMOX ................................ 102

VIIBRYD .................................... 26

VIIBRYD STARTER PACK ........ 26

VIMIZIM ..................................... 75

VIMOVO .................................... 13

VIMPAT ..................................... 24

vinblastine sulfate ...................... 34

vincristine sulfate ....................... 34

vinorelbine tartrate ..................... 34

VIOKACE ................................... 75

viorele ........................................ 86

VIRACEPT ................................. 39

VIRAMUNE ................................ 39

VIRAMUNE XR .......................... 39

VIRASAL .................................... 58

VIRAZOLE ................................. 39

VIREAD ..................................... 39

VIRGINIA LIVE OAK .................. 99

virt-phos 250 neutral .................. 71

VISCO-3 .................................... 99

VISIPAQUE ............................... 99

VISTARIL .................................. 40

VISTOGARD ............................. 99

VISUDYNE .............................. 104

VITAFOL ................................... 71

VITAFOL-OB+DHA ................... 71

vitamin b complex 100 .............. 71

vitamin b-complex 100 .............. 71

vitamin d (ergocalciferol) ........... 71

vitamin k1 .................................. 71

vitamins acd-fluoride ................. 71

VITRAKVI .................................. 34

VITRASE ................................. 100

VIVAGUARD INO CONTROL

SOLUTION ................................ 63

VIVAGUARD INO GLUCOSE

METER ..................................... 63

VIVAGUARD INO TEST

STRIPS ..................................... 63

VIVAGUARD LANCING

DEVICE..................................... 63

VIVELLE-DOT ........................... 86

VIVITROL .................................. 16

VIVLODEX ................................ 13

VIVOTIF .................................... 91

VIZIMPRO ................................. 34

VOGELXO ................................ 80

VOGELXO PUMP ..................... 80

VOLTAREN ............................... 13

VOLUMEN .............................. 100

VOLUVEN ................................. 41

VONVENDI ............................... 41

VOPAC GB ............................... 13

VOPAC KT ................................ 13

VORAXAZE .............................. 34

voriconazole .............................. 28

VORTEX HOLDING

CHAMBER/MASK ................... 100

VOSEVI..................................... 39

VOTRIENT ................................ 34

VP FC KIT ................................. 13

VP GKL KIT .............................. 13

vp-pnv-dha ................................ 71

VPRIV ....................................... 75

VRAYLAR ................................. 37

VSL#3 DS ................................. 75

VUSION .................................... 28

vyfemla ..................................... 86

vylibra ....................................... 86

VYNDAQEL .............................. 49

VYTORIN .................................. 49

VYVANSE ................................. 50

VYXEOS ................................... 34

144

145

VYZULTA ................................ 103

WAKIX ..................................... 111

warfarin sodium ......................... 22

WASP VENOM PROTEIN ....... 100

WELCHOL ................................. 49

WELLBUTRIN SR ...................... 26

WELLBUTRIN XL ...................... 26

wera ........................................... 86

WESTERN JUNIPER .............. 100

westhroid ................................... 86

WESTHROID ............................. 86

wheat germ oil ........................... 71

WHITE ASH............................. 100

WHITE BIRCH ......................... 100

WHITE FACED HORNET

VENOM ................................... 100

WHITE MULBERRY ................ 100

WHITE OAK ............................ 100

WHITE PINE............................ 100

WHITE-FACED HORNET

VENOM ................................... 100

WHOLE EGG (DIAGNOSTIC) 100

WIDE-SEAL DIAPHRAGM 60 100

WILATE ..................................... 41

WINRHO SDF ........................... 90

wixela inhub ............................. 109

WP THYROID ............................ 86

wymzya fe ................................. 86

XADAGO ................................... 36

XALATAN ................................ 103

XALKORI ................................... 34

XANAX ...................................... 40

XANAX XR ................................ 40

XARELTO .................................. 22

XARELTO STARTER PACK ..... 22

XATMEP .................................... 90

XELJANZ ................................... 90

XELJANZ XR ............................. 90

XELODA .................................... 34

XELPROS ................................ 103

XENAZINE ................................. 51

XEOMIN .................................. 100

XEPI .......................................... 21

XERAC AC ................................ 58

XERAVA .................................... 21

XERESE .................................... 39

XERFORM OIL EMULSION

ROLL ......................................... 58

XERMELO ................................. 75

XEROFORM OIL EMULSION

2"X2" ......................................... 58


GAUZE ...................................... 58


STRIP ........................................ 58

XEROFORM PETROLAT

GAUZE 1"X8" ............................ 58

XEROFORM PETROLAT

GAUZE 5"X9" ............................ 58

XEROFORM PETROLAT

PATCH 2"X2" ............................. 58

XEROFORM PETROLAT

PATCH 4"X4" ............................. 58

XEROFORM PETROLATUM

ROLL 4"X9' ................................ 58

XHANCE .................................. 106

XIAFLEX .................................. 100

XIFAXAN ................................... 21

XIGDUO XR......................... 59, 60

XIIDRA ..................................... 104

XIMINO ...................................... 21

XOFIGO ..................................... 34

XOFLUZA .................................. 39

XOLAIR.................................... 106

XOLEGEL .................................. 28

XOLEGEL COREPAK................ 28

XOLEGEL DUO/HEAD &

SHOULDERS ............................ 28

XOLEGEL DUO/XOLEX ............ 28

XOPENEX ............................... 109

XOPENEX CONCENTRATE 109

XOPENEX HFA ....................... 109

XOSPATA .................................. 34

XTAMPZA ER ............................ 10

XTANDI...................................... 34

xulane ........................................ 86

XULTOPHY ............................... 60

XURIDEN ................................... 75

XYLOCAINE .............................. 15

xylocaine dental ......................... 15

XYLOCAINE/EPINEPHRINE ..... 16

XYLOCAINE-MPF ...................... 16

XYLOCAINE-

MPF/EPINEPHRINE .................. 16

XYNTHA .................................... 41

XYNTHA SOLOFUSE ................ 41

XYOSTED .................................. 80

XYREM .................................... 111

YASMIN 28 ................................ 86

YAZ ............................................ 86

YELLOW DOCK ...................... 100

YELLOW HORNET VENOM

PROTEIN ................................. 100

YELLOW JACKET VENOM

PROTEIN ................................. 100

YERVOY .................................... 34

YESCARTA ............................... 34

yf-vax ........................................ 91

YF-VAX ..................................... 91

YONDELIS ................................ 34

YONSA ..................................... 34

YOSPRALA ............................... 73

YUPELRI ................................. 109

YUTIQ ..................................... 102

yuvafem .................................... 86

ZACARE ................................... 58

zaclir cleansing ......................... 58

zafirlukast ................................ 109

zaleplon................................... 111

ZALTRAP .................................. 34

ZANAFLEX ............................. 111

ZANOSAR ................................. 34

ZANTAC.................................... 73

zarah ......................................... 86

ZARONTIN ................................ 24

ZARXIO..................................... 41

ZAVESCA ................................. 75

zebutal ...................................... 11

ZEGERID .................................. 73

ZEJULA..................................... 34

ZELAC ...................................... 75

ZELAPAR .................................. 36

ZELBORAF ............................... 34

ZEMAIRA ................................ 109

ZEMBRACE SYMTOUCH ......... 29

ZEMDRI .................................... 21

ZEMPLAR ................................. 92

zenatane ................................... 58

ZENPEP.................................... 75

zenzedi ..................................... 50

ZENZEDI ................................... 50

ZEPATIER ................................ 39

ZERBAXA ................................. 21

ZESTORETIC ........................... 49

ZESTRIL ................................... 49

ZETIA ........................................ 49

ZETONNA ............................... 106

ZEVALIN Y-90 .......................... 34

ZIAC .......................................... 49

ZIAGEN..................................... 39

ZIANA ....................................... 58

zidovudine ................................. 39

zileuton er ............................... 109

ZILRETTA ................................. 79

ZINC TRACE METAL ................ 71

ZINECARD ................................ 34

ZINGO ...................................... 16

ZINPLAVA ................................. 90

ZIOPTAN ................................ 103

146

ziprasidone hcl ........................... 37

ZIPSOR ..................................... 13

ZIRGAN ................................... 102

ZITHROMAX ............................. 21

ZITHROMAX TRI-PAK .............. 21

ZITHROMAX Z-PAK .................. 21

ZOCOR...................................... 49

ZOFRAN .................................... 27

ZOHYDRO ER ........................... 11

ZOLADEX .................................. 81

zoledronic acid ........................... 92

ZOLINZA ................................... 34

zolmitriptan ................................ 29

ZOLOFT .................................... 26

zolpidem tartrate ...................... 111

zolpidem tartrate er .................. 111

ZOLPIMIST .............................. 111

ZOMACTON .............................. 81

ZOMIG ....................................... 29

ZOMIG ZMT .............................. 29

ZONALON ................................. 58

ZONEGRAN .............................. 24

zonisamide ................................ 24

ZONTIVITY ................................ 36

ZORBTIVE ................................. 75

ZORTRESS ............................... 90

ZORVOLEX ............................... 13

ZOSTAVAX ............................... 91

ZOSYN ...................................... 21

zovia 1/35e (28) ......................... 86

ZOVIRAX ................................... 39

ZTLIDO ...................................... 16

Z-TUSS AC ............................. 106

ZUBSOLV .................................. 16

ZULRESSO ............................... 26

zumandimine ............................. 86

ZUPLENZ .................................. 27

ZYCLARA .................................. 58

ZYCLARA PUMP ....................... 58

ZYDELIG ................................... 34

ZYFLO ..................................... 109

ZYKADIA ................................... 34

ZYLET ..................................... 104

ZYLOPRIM ................................ 28

ZYMAXID ................................. 102

ZYPITAMAG .............................. 49

ZYPREXA .................................. 37

ZYPREXA RELPREVV .............. 37

ZYPREXA ZYDIS ...................... 37

ZYTIGA...................................... 34

ZYVOX ...................................... 21

Documents

MISSOURI ACA MEMBER PRESCRIPTION DRUG LIST...Tagalog: Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Blue KC, may karapatan ka na makakuha ng tulong at impormasyon