Prime Detailed Formulary Guide - Universal Rxuniversalrx.com/universal/wp-content/uploads/2019/10/URX...2019/10/01 · Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty

Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program

Lower Case = generic drug INJ Injectable ST Step Therapy

Prime Detailed Formulary

Guide

v. 2019-10

Disclaimer: This information is confidential and proprietary and may not be reproduced or disclosed in whole or part unless authorized in

writing by an authorized representative of Universal Rx v. 2019-10

2

Prime Detailed Formulary Guide The Prime Formulary Guide outlines the tier coverage and suggested limitations of the most commonly prescribed medications. A formulary is the list of drugs available for certain conditions and organized by tiers (cost levels).

Drug Tier Types of Drugs Included Cost

1 Generic Drugs Lowest Copay

2 Preferred Brand Name Drugs Medium Copay

3 Non-Preferred Brand Name Drugs Higher Copay

Limits Description

INJ – Injectable Drug Product is administered via an injectable route of

administration and may be subject to a separate benefit.

QL – Quantity Limit Drug is subject to a specific quantity per days supply due to

patient safety or cost containment measures.

separate specialty benefit.

ST – Step Therapy A more cost-effective option must be tried before a Step

Therapy drug may be covered.

Preferred and non-preferred brand name medications are listed to help identify clinically appropriate and cost-effective options within drug categories. Unless specifically indicated, drug list products will include all dosage forms. This is not an all-inclusive list and does not guarantee coverage. Medications listed may change to a lower tier at any time. Medications may also be moved to non-preferred status twice a year on January 1 and July 1. A brand-name drug for which a generic product becomes available may be designated as a non-preferred option upon release of the generic product to the market. Products recently approved by the U.S. Food and Drug Administration (FDA) may not be covered upon release to the market. When a medication changes tiers, the member may have to pay a different amount for that medication. The

member's specific prescription benefit plan design may not cover certain products or categories regardless of their appearance in this document. For the most up-to-date list call customer service at the toll-free member phone number on the ID card.

Need assistance finding a drug on this formulary guide? An alphabetical index is included at the end of the

formulary listing. You may also press Control + F to search for the product name.

Drug is designated as a specialty drug and may be subject to a SP – Specialty Program

Drug Name Drug Tier Limits Drug Name Drug Tier Limits



3

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS

ADDERALL 3

ADDERALL XR 3

ADIPEX-P 3

ADZENYS ER 3

ADZENYS XR-ODT 3

amphetamine sulfate 1

amphetamine/dextroampheta 1

APTENSIO XR 3

armodafinil 1

atomoxetine 1

atomoxetine hydrochloride 1

BELVIQ 3

BELVIQ XR 3

caffeine citrate 1

clonidine hcl er 1

clonidine hydrochloride 1

clonidine hydrochloride e 1

CONCERTA 3

CONTRAVE 3

COTEMPLA XR-ODT 3

DAYTRANA 2

dexmethylphenidate hcl 1

dexmethylphenidate hcl er 1

dexmethylphenidate hydroc 1

dextroamphetamine sulfate 1

diethylpropion hcl 1

diethylpropion hcl er 1

DYANAVEL XR 2

EVEKEO 3

FOCALIN 3

FOCALIN XR 3

guanfacine er 1

guanfacine hydrochloride 1

INTUNIV 3

LOMAIRA 3

metadate er 1

methamphetamine hcl 1

METHYLIN 3

methylphenid cap 30mg er 1

METHYLPHENID CAP 60MG LA 2

modafinil 1

MYDAYIS 2

NUVIGIL 3

phendimetrazine tartrate 1

phentermine hcl 1

PROVIGIL 3

QSYMIA 3

QUILLICHEW ER 2

QUILLIVANT XR 2

RITALIN 3

RITALIN LA 3

SAXENDA 3 INJ

STRATTERA 3

VYVANSE 2

ZENZEDI 3

ALLERGENIC EXTRACTS/BIOLOGICALS MISC

GRASTEK 2

ODACTRA 2

RAGWITEK 2

Amebicides

SOLOSEC 3

Aminoglycosides

gentamicin sulfate 1 INJ

neomycin sulfate 1

paromomycin sulfate 1

TOBI PODHALER 2 SP

tobramycin 1 SP

ANALGESICS - ANTI-INFLAMMATORY

ACTEMRA 2 INJ SP

ARTHROTEC 75 3

CELEBREX 3

celecoxib 1

diclofenac potassium 1

diclofenac sodium dr 1

diclofenac sodium er 1

diclofenac sodium/misopro 1

DUEXIS 3

ENBREL 2 INJ SP

ENBREL MINI 2 INJ SP




4

ENBREL SURECLICK 2 INJ SP

etodolac 1

etodolac er 1

fenoprofen tab 600mg 1

FENOPROFEN CAP 400MG 3

FENORTHO 3

flurbiprofen 1

HUMIRA 2 INJ SP

HUMIRA PEDIATRIC CROHNS D 2 INJ SP

HUMIRA PEN 2 INJ SP

HUMIRA PEN-CD/UC/HS START 2 INJ SP

HUMIRA PEN-PS/UV STARTER 2 INJ SP

ibu 1

ibuprofen 1

ILARIS 2 INJ SP

INDOCIN 3

indomethacin 1

indomethacin er 1

KETOPROFEN 3

ketoprofen er 1

ketorolac tromethamine 1 QL

KEVZARA 3 INJ SP

KINERET 3 INJ SP

leflunomide 1

meclofenamate sodium 1

mefenamic acid 1

meloxicam 1

nabumetone 1

NAPRELAN 3

naproxen 1

naproxen dr 1

naproxen sodium 1

naproxen sodium cr 1

naproxen sodium er 1

OLUMIANT 2 SP

ORENCIA 3 INJ SP

ORENCIA CLICKJECT 3 INJ SP

OTEZLA 2 SP

OTREXUP 2 INJ

oxaprozin 1

piroxicam 1

RASUVO 2 INJ

RIDAURA 2

SIMPONI INJ 100MG/ML 2 INJ SP

SIMPONI INJ 50/0.5ML 3 INJ SP

SIMPONI ARIA 3 INJ SP

SPRIX 3

sulindac 1

TIVORBEX 3

tolmetin sodium 1

VIMOVO 3

VIVLODEX 3

XELJANZ 2 SP

XELJANZ XR 2 SP

ZIPSOR 3

ZORVOLEX 3

ANALGESICS - NonNarcotic

bupap 1

butalbital/acetaminophen 1

butalbital/acetaminophen/ 1

BUT/ASA/CAF TAB 2

diflunisal 1

esgic 1

FIORICET 3

FIORINAL 3

salsalate 1

VANATOL LQ 3

ANALGESICS - OPIOID

ABSTRAL 3

acetaminophen/caffeine/di 1

acetaminophen/codeine 1

acetaminophen/codeine #3 1

acetaminophen/codeine pho 1

ARYMO ER 3

ascomp/codeine 1

BELBUCA 2

BUNAVAIL 3

BUPRENORPHINE 3

buprenorphine hcl 1

buprenorphine hcl/naloxon 1

buprenorphine hydrochlori 1

but/asa/caf/ cap cod 30mg 1

butorphanol tartrate 1 QL

BUTRANS 3




5

codeine sulfate 1

CONZIP 3

DURAGESIC 3

EMBEDA 3

endocet 1

fentanyl 1

fentanyl citrate 1 INJ

fentanyl citrate oral tra 1

FENTORA 3

hydrocodone bitartrate/ac 1

hydrocodone/acetaminophen 1

hydrocodone/ibuprofen 1

hydromorphone hcl 1

hydromorphone hcl dosette 1 INJ

hydromorphone hcl er 1

HYSINGLA ER 2

IBUDONE 3

LEVORPHANOL TARTRATE 3

lorcet 1

lorcet hd 1

lorcet plus 1

LORTAB 3

meperidine hcl 1

METHADONE SOL 5MG/5ML 2

methadone tab 10mg 1

MORPHABOND ER 3

morphine sulfate 1

morphine sulfate er 1

NORCO 3

NUCYNTA 2

NUCYNTA ER 2

OXAYDO 3

oxycodone hcl 1

OXYCODONE HCL ER 3

oxycodone hydrochloride 1

oxycodone/acetaminophen 1

oxycodone/aspirin 1

OXYCONTIN 2

oxymorphone hydrochloride 1

pentazocine/naloxone hcl 1

PERCOCET 3

ROXICODONE 3

SUBOXONE 2

tramadol hcl 1

tramadol hcl tab 200mg er 1

TRAMADOL HCL CAP 150MG ER 3

tramadol hydrochloride/ac 1

TYLENOL/CODEINE #3 3

TYLENOL/CODEINE #4 3

ULTRAM 3

vicodin 1

vicodin es 1

vicodin hp 1

XTAMPZA ER 3

ZOHYDRO ER 3

ZUBSOLV 2

ANDROGENS-ANABOLIC

ANDRODERM 2

ANDROGEL GEL 1%(50MG) 3

ANDROGEL GEL 1.62% 3

ANDROGEL PUMP 3

AVEED 3 INJ SP

danazol 1

DEPO-TESTOSTERONE 3 INJ

FORTESTA 3

methyltestosterone 1

NATESTO 3

oxandrolone 1

STRIANT 3

TESTIM 3

TESTOPEL 3 INJ SP

testosterone cypionate 1 INJ

testosterone enanthate 1 INJ

testosterone topical solu 1

ANORECTAL AGENTS

ANALPRAM HC 3

ANALPRAM HC SINGLES 3

ANALPRAM-HC 3

anucort-hc 1

anusol-hc 1

colocort 1

CORTIFOAM 3

hemmorex-hc 1

hydrocortisone acetate 1




6

hydrocortisone acetate/pr 1

lidocaine hcl/hydrocortis 1

PROCTOCORT 3

PROCTOFOAM HC 3

procto-med hc 1

procto-pak 1

proctosol hc 1

proctozone-hc 1

RECTIV 2

UCERIS AER 2MG/ACT 3

Anthelmintics

albendazole 1

ALBENZA 3

BILTRICIDE 3

EMVERM 2

ivermectin 1

praziquantel 1

STROMECTOL 3

ANTIANGINAL AGENTS

isosorbide dinitrate 1

isosorbide mononitrate 1

isosorbide mononitrate er 1

NITRO-BID 2

NITRO-DUR 3

nitroglycerin 1

nitroglycerin er 1

nitroglycerin lingual 1

nitroglycerin transdermal 1

NITROSTAT 3

nitro-time 1

RANEXA 2

ANTIANXIETY AGENTS

alprazolam 1

alprazolam er 1

alprazolam odt 1

alprazolam xr 1

ATIVAN 3

buspirone hcl 1

buspirone hydrochloride 1

chlordiazepoxide hcl 1

clorazepate dipotassium 1

diazepam 1

diazepam intensol 1

hydroxyzine hcl 1

hydroxyzine hydrochloride 1

hydroxyzine pamoate 1

lorazepam 1

lorazepam intensol 1

oxazepam 1

VALIUM 3

XANAX 3

ANTIARRHYTHMICS

amiodarone hcl 1

amiodarone hydrochloride 1

disopyramide phosphate 1

dofetilide 1

flecainide acetate 1

mexiletine hcl 1

MULTAQ 3

NORPACE CR 3

pacerone 1

propafenone hcl 1

propafenone hcl er 1

propafenone hydrochloride 1

quinidine gluconate cr 1

RYTHMOL SR 3

TIKOSYN 3

ANTIASTHMATIC AND BRONCHODILATOR AGENTS

ADVAIR DISKUS 3

ADVAIR HFA 2

AIRDUO RESPICLICK 113/14 3



albuterol sulfate 1

albuterol sulfate er 1

ALVESCO 3

ANORO ELLIPTA 2

ARCAPTA NEOHALER 2

ARNUITY ELLIPTA 2

ASMANEX HFA 2

ASMANEX TWISTHALER 120 ME 2

ASMANEX TWISTHALER 14 MET 2





7


ATROVENT HFA 2

BEVESPI AEROSPHERE 2

BREO ELLIPTA 2

BROVANA 3

budesonide 1

COMBIVENT RESPIMAT 2

cromolyn sodium 1

DALIRESP 2

DULERA 2

FASENRA 2 INJ SP

FLOVENT DISKUS 2

FLOVENT HFA 2

FLUTICASONE PROPIONATE/SA 2

INCRUSE ELLIPTA 2

ipratropium bromide/albut 1

levalbuterol 1

levalbuterol hcl 1

levalbuterol hydrochlorid 1

LEVALBUTEROL TARTRATE HFA 3

montelukast sodium 1

NUCALA 2 INJ SP

PERFOROMIST 2

PROAIR HFA 2

PROAIR RESPICLICK 2

PROVENTIL HFA 3

PULMICORT 3

PULMICORT FLEXHALER 2

QVAR REDIHALER 2

SEEBRI NEOHALER 2

SEREVENT DISKUS 2

SINGULAIR 3

SPIRIVA HANDIHALER 2

SPIRIVA RESPIMAT 2

STIOLTO RESPIMAT 2

STRIVERDI RESPIMAT 2

SYMBICORT 2

terbutaline sulfate 1

THEO-24 3

theophylline er 1

TRELEGY ELLIPTA 2

TUDORZA PRESSAIR 2

UTIBRON NEOHALER 2

VENTOLIN HFA 2

XOLAIR 2 INJ SP

XOPENEX 3

XOPENEX HFA 3

YUPELRI 2

zafirlukast 1

zileuton er 1

ZYFLO 3 ST

ZYFLO CR 3 ST

ANTICOAGULANTS

COUMADIN 3

ELIQUIS 2

ELIQUIS STARTER PACK 2

enoxaparin sodium 1 INJ

fondaparinux sodium 1 INJ SP

FRAGMIN 2 INJ SP

heparin lock flush 1 INJ

heparin lock flush/nacl f 1 INJ

heparin sodium 1 INJ

heparin sodium dcu 1 INJ

heparin sodium lock flush 1 INJ

HEPARIN SODIUM/SODIUM CHL 3 INJ

jantoven 1

LOVENOX 3 INJ

PRADAXA 3

SAVAYSA 3

warfarin sodium 1

XARELTO 2

XARELTO STARTER PACK 2

ANTICONVULSANTS

APTIOM 3

BANZEL 2

BRIVIACT 3

carbamazepine 1

carbamazepine er 1

CARBATROL 3

CELONTIN 2

clobazam 1

clonazepam 1

clonazepam odt 1

DEPAKOTE 3




8

DEPAKOTE ER 3

DIACOMIT 2 SP

DIASTAT ACUDIAL 3

DIAZEPAM RECTAL GEL 2

DILANTIN CAP 100MG 3

DILANTIN CAP 30MG 2

DILANTIN INFATABS 3

divalproex sodium 1

divalproex sodium dr 1

divalproex sodium er 1

EPIDIOLEX 2 SP

epitol 1

ethosuximide 1

felbamate 1

FYCOMPA 2

gabapentin 1

KEPPRA 3

KEPPRA XR 3

KLONOPIN 3

LAMICTAL 3

LAMICTAL ODT 3

LAMICTAL XR 3

lamotrigine 1

lamotrigine er 1

lamotrigine odt 1

lamotrigine starter kit/o 1

levetiracetam 1

levetiracetam er 1

LYRICA 2

MYSOLINE 3

NEURONTIN 3

ONFI 3

oxcarbazepine 1

OXTELLAR XR 3

PHENYTEK 3

phenytoin 1

phenytoin infatabs 1

phenytoin sodium extended 1

primidone 1

QUDEXY XR 2

SABRIL 2 SP

SPRITAM 3

subvenite 1

TEGRETOL 3

TEGRETOL-XR 3

tiagabine hydrochloride 1

TOPAMAX 3

TOPAMAX SPRINKLE 3

topiramate 1

TOPIRAMATE ER 3

TRILEPTAL 3

TROKENDI XR 3

valproic acid 1

vigabatrin 1 SP

VIMPAT 2

ZARONTIN 3

ZONEGRAN 3

zonisamide 1

ANTIDEPRESSANTS

amitriptyline hcl 1

amitriptyline hydrochlori 1

APLENZIN 3 ST

bupropion hcl 1

bupropion hcl er 1

bupropion hcl sr 1

bupropion hcl xl 1

bupropion hydrochloride 1

bupropion hydrochloride e 1

bupropion hydrochloride s 1

bupropion hydrochloride x 1

CELEXA 3

citalopram 1

citalopram hydrobromide 1

clomipramine hcl 1

CYMBALTA 3

desipramine hcl 1

desipramine hydrochloride 1

desvenlafax tab 100mg er 1

DESVENLAFAX TAB 50MG ER 3

doxepin hcl 1

duloxetine hcl 1

duloxetine hydrochloride 1

EFFEXOR XR 3

EMSAM 3




9

escitalopram oxalate 1

FETZIMA 2 ST

FETZIMA TITRATION PACK 2 ST

fluoxetine dr 1

fluoxetine hcl 1

fluoxetine tab 10mg 1

FLUOXETINE TAB 60MG 2

fluvoxamine maleate 1

fluvoxamine maleate er 1

FORFIVO XL 3

imipramine hcl 1

imipramine hydrochloride 1

imipramine pamoate 1

LEXAPRO 3

maprotiline hcl 1

MARPLAN 3

mirtazapine 1

mirtazapine odt 1

nefazodone hcl 1

nefazodone hydrochloride 1

nortriptyline hcl 1

paroxetine hcl 1

paroxetine hcl er 1

paroxetine hydrochloride 1

PAXIL 3

PAXIL CR 3

phenelzine sulfate 1

PRISTIQ 3

protriptyline hcl 1

PROZAC 3

REMERON 3

sertraline hcl 1

sertraline hydrochloride 1

tranylcypromine sulfate 1

trazodone hydrochloride 1

trimipramine maleate 1

TRINTELLIX 3 ST

venlafaxine hcl 1

venlafaxine hcl er 1

venlafaxine hydrochloride 1

VIIBRYD 2 ST

VIIBRYD STARTER PACK 2 ST

WELLBUTRIN SR 3

WELLBUTRIN XL 3

ZOLOFT 3

ZULRESSO 2 INJ SP

ANTIDIABETICS

acarbose 1

ACTOPLUS MET XR 3

ADLYXIN 3 INJ

ADLYXIN STARTER PACK 3 INJ

ADMELOG 3 INJ

ADMELOG SOLOSTAR 3 INJ

AFREZZA 3

ALOGLIPTIN 3 ST

ALOGLIPTIN/METFORMIN HCL 3 ST

ALOGLIPTIN/PIOGLITAZONE 3

AMARYL 3

APIDRA 3 INJ

APIDRA SOLOSTAR 3 INJ

AVANDIA 3

BASAGLAR KWIKPEN 3 INJ

BYDUREON 2 INJ

BYDUREON BCISE 2 INJ

BYDUREON PEN 2 INJ

BYETTA 2 INJ

chlorpropamide 1

CYCLOSET 3

FARXIGA 2

FIASP 2 INJ

FIASP FLEXTOUCH 2 INJ

glimepiride 1

glipizide 1

glipizide er 1

glipizide xl 1

glipizide/metformin hcl 1

GLUCAGEN HYPOKIT 2 INJ

GLUCAGON EMERGENCY KIT 2 INJ

GLUCOPHAGE 3

GLUCOPHAGE XR 3

GLUCOTROL XL 3

GLUMETZA 3

glyburide 1

glyburide micronized 1




10

glyburide/metformin hcl 1

GLYXAMBI 2

HUMALOG 2 INJ

HUMALOG JUNIOR KWIKPEN 2 INJ

HUMALOG KWIKPEN 2 INJ

HUMALOG MIX 50/50 KWIKPEN 2 INJ

HUMALOG MIX 75/25 2 INJ

HUMALOG MIX 75/25 KWIKPEN 2 INJ

HUMULIN R U-500 (CONCENTR 2 INJ

HUMULIN R U-500 KWIKPEN 2 INJ

INSULIN LISPRO 3 INJ

INSULIN LISPRO KWIKPEN 3 INJ

INVOKAMET 2

INVOKAMET XR 2

INVOKANA 2

JANUMET 2

JANUMET XR 2

JANUVIA 2

JARDIANCE 2

JENTADUETO 2

JENTADUETO XR 2

KAZANO 3 ST

KOMBIGLYZE XR 3 ST

LANTUS 2 INJ

LANTUS SOLOSTAR 2 INJ

LEVEMIR 2 INJ

LEVEMIR FLEXTOUCH 2 INJ

metformin hcl 1

metformin hcl er 1

metformin hydrochloride 1

metformin hydrochloride e 1

miglitol 1

nateglinide 1

NESINA 3 ST

NOVOLOG 2 INJ

NOVOLOG FLEXPEN 2 INJ

NOVOLOG MIX 70/30 2 INJ

NOVOLOG MIX 70/30 PREFILL 2 INJ

NOVOLOG PENFILL 2 INJ

ONGLYZA 3 ST

OSENI 3

OZEMPIC 2 INJ

pioglitazone hcl 1

pioglitazone hcl/metformi 1

PROGLYCEM 2

QTERN 3

repaglinide 1

RIOMET 3

SEGLUROMET 2

SOLIQUA 100/33 2 INJ

STEGLATRO 2

STEGLUJAN 3

SYMLINPEN 120 2 INJ

SYMLINPEN 60 2 INJ

SYNJARDY 2

SYNJARDY XR 2

TOUJEO MAX SOLOSTAR 2 INJ

TOUJEO SOLOSTAR 2 INJ

TRADJENTA 2

TRESIBA FLEXTOUCH 2 INJ

TRULICITY 2 INJ

VICTOZA 2 INJ

XIGDUO XR 2

XULTOPHY 100/3.6 2 INJ

ANTIDIARRHEAL/PROBIOTIC AGENTS

diphenoxylate/atropine 1

loperamide hcl 1

MOTOFEN 3

MYTESI 3

opium 1

opium tincture 1

paregoric 1

RESTORA RX 3

VSL#3 DS 3

Antidotes and Specific Antagonists

CHEMET 2

EXJADE 2 SP

JADENU 2 SP

JADENU SPRINKLE 2 SP

naloxone hcl 1 INJ

naltrexone hcl 1

NARCAN 2




11

VIVITROL 2 INJ SP

ANTIEMETICS

AKYNZEO 2

aprepitant 1 QL

BONJESTA 3

DICLEGIS 3

dronabinol 1

EMEND 3 QL

granisetron hcl 1

meclizine hcl 1

meclizine hydrochloride 1

ondansetron hcl 1

ondansetron hydrochloride 1

ondansetron odt 1

SANCUSO 2

TRANSDERM-SCOP 3

trimethobenzamide hcl 1

VARUBI 2

ZOFRAN 3

ZUPLENZ 3

Antifungals

ABELCET 2 INJ

amphotericin b 1 INJ

CRESEMBA 2 SP

DIFLUCAN 3

fluconazole 1

griseofulvin microsize 1

griseofulvin ultramicrosi 1

itraconazole 1

ketoconazole 1

NOXAFIL 2

nystatin 1

SPORANOX 3

terbinafine hcl 1

terbinafine hydrochloride 1

voriconazole 1 INJ

ANTIHISTAMINES

carbinoxamine maleate 1

CLARINEX 3

clemastine fumarate 1

cyproheptadine hcl 1

desloratadine 1

desloratadine odt 1

diphenhydramine hcl 1

levocetirizine dihydrochl 1

phenadoz 1

promethazine hcl 1

promethazine hcl plain 1

promethazine hydrochlorid 1

promethegan 1

ryvent 1

ANTIHYPERLIPIDEMICS

ANTARA 3

atorvastatin calcium 1

cholestyramine 1

cholestyramine light 1

colesevelam hydrochloride 1

COLESTID 3

colestipol hcl 1

CRESTOR 3

ezetimibe 1

ezetimibe/simvastatin 1

fenofibrate tab 48mg 1

FENOFIBRATE CAP 50MG 3

fenofibrate micronized 1

FENOFIBRIC ACID 2

fenofibric acid dr 1

fluvastatin 1

fluvastatin sodium er 1

gemfibrozil 1

LESCOL XL 3

LIPITOR 3

LIPOFEN 2

LIVALO 2 ST

lovastatin 1

LOVAZA 3

niacin er 1

NIACOR 3

NIASPAN 3

omega-3-acid ethyl esters 1

PRALUENT 2 INJ SP

PRAVACHOL 3

pravastatin sodium 1

prevalite 1




12

QUESTRAN LIGHT 3

REPATHA 2 INJ SP

REPATHA PUSHTRONEX SYSTEM 2 INJ SP

REPATHA SURECLICK 2 INJ SP

rosuvastatin calcium 1

simvastatin 1

TRICOR 3

TRIGLIDE 3

TRILIPIX 3

VASCEPA 2

VYTORIN 3

WELCHOL 3

ZETIA 3

ANTIHYPERTENSIVES

ACCUPRIL 3

amlodipine besylate/benaz 1

amlodipine besylate/valsa 1

amlodipine/olmesartan med 1

amlodipine/valsartan/hctz 1

atenolol/chlorthalidone 1

AVAPRO 3

AZOR 3

benazepril hcl 1

benazepril hcl/hydrochlor 1

BENICAR 3

BENICAR HCT 3

bisoprolol fumarate/hydro 1

BYVALSON 2 ST

candesartan cilexetil 1

candesartan cilexetil/hyd 1

captopril 1

captopril/hydrochlorothia 1

CATAPRES-TTS-1 3

CATAPRES-TTS-3 3

clonidine hcl 1

COZAAR 3

DIOVAN 3

DIOVAN HCT 3

doxazosin mesylate 1

DUTOPROL 3

EDARBI 2 ST

EDARBYCLOR 2 ST

enalapril maleate 1

enalapril maleate/hydroch 1

EPANED 3

eplerenone 1

eprosartan mesylate 1

fosinopril sodium 1

fosinopril sodium/hydroch 1

guanfacine hcl 1

hydralazine hcl 1

HYZAAR 3

irbesartan 1

irbesartan/hydrochlorothi 1

lisinopril 1

lisinopril/hydrochlorothi 1

losartan potassium 1

losartan potassium/hydroc 1

LOTREL 3

methyldopa 1

methyldopa/hydrochlorothi 1

metoprolol/hydrochlorothi 1

MICARDIS 3

MICARDIS HCT 3

minoxidil 1

moexipril hcl 1

nadolol/bendroflumethiazi 1

olmesartan medoxomil 1

olmesartan medoxomil/amlo 1

olmesartan medoxomil/hydr 1

perindopril erbumine 1

prazosin hcl 1

propranolol/hydrochloroth 1

QBRELIS 3

quinapril hcl 1

quinapril hydrochloride 1

quinapril/hydrochlorothia 1

ramipril 1

TEKTURNA 2

TEKTURNA HCT 2

telmisartan 1

telmisartan/amlodipine 1

telmisartan/hydrochloroth 1

terazosin hcl 1




13

trandolapril 1

trandolapril/verapamil hc 1

TRIBENZOR 3

valsartan 1

valsartan/hydrochlorothia 1

ZESTRIL 3

Anti-infective Agents - Misc.

ALINIA 2

atovaquone 1

CAYSTON 2

clindamycin hcl 1

clindamycin hydrochloride 1

clindamycin palmitate hcl 1

dapsone 1

FIRST-METRONIDAZOLE 100 3

FIRST-METRONIDAZOLE 50 3

FIRST-VANCOMYCIN 25 3


FIRVANQ 3

LINCOCIN 3 INJ

linezolid 1

meropenem 1 INJ

SIVEXTRO 3 SP

sulfamethoxazole/trimetho 1

sulfatrim pediatric 1

tinidazole 1

trimethoprim 1

vancomycin hcl 1 INJ

XIFAXAN 2

Antimalarials

atovaquone/proguanil hcl 1

chloroquine phosphate 1

COARTEM 2

hydroxychloroquine sulfat 1

MALARONE 3

mefloquine hcl 1

PLAQUENIL 3

quinine sulfate 1

Antimyasthenic/Cholinergic Agents

MESTINON TIMESPAN 3

pyridostigmine bromide 1

pyridostigmine bromide er 1

Antimycobacterial Agents

ethambutol hcl 1

isoniazid 1

PRIFTIN 2

rifabutin 1

rifampin 1

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES

AFINITOR 2 SP

ALECENSA 2 SP

ALUNBRIG 3 SP

anastrozole 1

AROMASIN 3

AVASTIN 2 INJ SP

azacitidine 1 INJ SP

BALVERSA 2 SP

bicalutamide 1

BOSULIF 2 SP

BRAFTOVI 3 SP

CABOMETYX 2 SP

capecitabine 1 SP

CAPRELSA 2 SP

COMETRIQ 2 SP

CYCLOPHOSPH CAP 25MG 2

cyclophosph cap 50mg 1

ELIGARD 2 INJ SP

ERIVEDGE 2 SP

etoposide 1 SP

exemestane 1

FASLODEX 2 INJ SP

flutamide 1

GLEEVEC 3 SP

GLEOSTINE 2 SP

HERCEPTIN 2 INJ SP

hydroxyurea 1

IBRANCE 2 SP

ICLUSIG 2 SP

imatinib mesylate 1 SP

IMBRUVICA 2 SP

INLYTA 2 SP

INTRON A 2 INJ SP




14

JAKAFI 2 SP

KEYTRUDA 2 INJ SP

KISQALI 3 SP

KISQALI FEMARA 600 DOSE 3 SP

LENVIMA 12MG DAILY DOSE 2 SP

letrozole 1

leucovor ca tab 5mg 1

LEUCOVOR CA TAB 10MG 2

LEUKERAN 2

leuprolide acetate 1 INJ SP

LONSURF 2 SP

LUPRON DEPOT INJ 3.75MG 2 INJ SP




LUPRON DEPOT (4-MONTH) 3 INJ SP

LUPRON DEPOT (6-MONTH) 3 INJ SP

LYNPARZA 2 SP

MATULANE 2 SP

megestrol acetate 1

MEKINIST 2 SP

MEKTOVI 3 SP

mercaptopurine 1 SP

methotrexate 1

methotrexate sodium 1 INJ

NERLYNX 2 SP

NEXAVAR 2 SP

NINLARO 2 SP

OPDIVO 2 INJ SP

PERJETA 2 INJ SP

POMALYST 2 SP

PURIXAN 2 SP

RITUXAN 2 INJ SP

RUBRACA 2 SP

RYDAPT 2 SP

SPRYCEL 2 SP

STIVARGA 2 SP

SUTENT 2 SP

TABLOID 2 SP

TAFINLAR 2 SP

TAGRISSO 2 SP

TALZENNA 2 SP

tamoxifen citrate 1

TARCEVA 2 SP

TASIGNA 2 SP

temozolomide 1 SP

TREXALL 3

VELCADE 2 INJ SP

VENCLEXTA 2 SP

VENCLEXTA STARTING PACK 2 SP

VERZENIO 2 SP

VOTRIENT 2 SP

XALKORI 2 SP

XTANDI 2 SP

ZEJULA 2 SP

ZELBORAF 2 SP

ZOLADEX 2 INJ SP

ZYTIGA TAB 250MG 3 SP

ZYTIGA TAB 500MG 2 SP

ANTIPARKINSON AND RELATED THERAPY AGENTS

amantadine hcl 1

APOKYN 2 INJ SP

AZILECT 3

benztropine mesylate 1

bromocriptine mesylate 1

carbidopa 1

carbidopa/levodopa 1

carbidopa/levodopa er 1

carbidopa/levodopa odt 1

CARB/LEVO 75 TAB /ENTACAP 2

carb/levo100 tab /entacap 1

entacapone 1

GOCOVRI 3 SP

INBRIJA 2 SP

MIRAPEX 3

NEUPRO 3

pramipexole dihydrochlori 1

rasagiline mesylate 1

REQUIP 3

REQUIP XL 3

ropinirole er 1

ropinirole hcl 1

RYTARY 3




15

selegiline hcl 1

trihexyphenidyl hcl 1

ANTIPSYCHOTICS/ANTIMANIC AGENTS

ABILIFY 3

ABILIFY MAINTENA 2 INJ

aripiprazole 1

aripiprazole odt 1

ARISTADA 2 INJ SP

chlorpromazine hcl 1 INJ

clozapine 1

CLOZAPINE TAB 200/ODT 3

clozapine tab 25mg odt 1

compro 1

FANAPT 3 ST

fluphenazine decanoate 1 INJ

fluphenazine hcl 1

GEODON 3

haloperidol 1

haloperidol decanoate 1 INJ

haloperidol lactate 1 INJ

INVEGA 3

INVEGA SUSTENNA 3 INJ

INVEGA TRINZA 3 INJ

LATUDA 2 ST

lithium carbonate 1

lithium carbonate er 1

loxapine 1

loxapine succinate 1

olanzapine 1

olanzapine odt 1

paliperidone er 1

perphenazine 1

prochlorperazine 1

prochlorperazine maleate 1

quetiapine fumarate 1

quetiapine fumarate er 1

REXULTI 3

RISPERDAL 3

RISPERDAL CONSTA 2 INJ

risperidone 1

risperidone odt 1

SAPHRIS 3

SEROQUEL 3

SEROQUEL XR 3

thioridazine hcl 1

thiothixene 1

trifluoperazine hcl 1

VRAYLAR 3 SP ST

ziprasidone hcl 1

ZYPREXA 3

ZYPREXA ZYDIS 3

Antiseptics & Disinfectants

formaldehyde 1

HYDROGEN PEROXIDE 2

ANTIVIRALS

abacavir 1 SP

abacavir/lamivudine 1 SP

acyclovir 1

atazanavir 1 SP

atazanavir sulfate 1 SP

ATRIPLA 3 SP

BARACLUDE 3 SP

BIKTARVY 2 SP

cidofovir 1 INJ SP

COMPLERA 2 SP

DESCOVY 2 SP

DOVATO 2 SP

EDURANT 2 SP

efavirenz 1 SP

entecavir 1 SP

EPCLUSA 2 SP

EVOTAZ 3 SP

famciclovir 1

GENVOYA 2 SP

HARVONI 2 SP

ISENTRESS 2 SP

JULUCA 2 SP

KALETRA 2 SP

lamivudine 1 SP

lamivudine/zidovudine 1 SP

MAVYRET 2 SP

NORVIR 3 SP

ODEFSEY 2 SP




16

oseltamivir phosphate 1 QL

PEGASYS 2 INJ SP

PREZCOBIX 3 SP

PREZISTA 2 SP

RELENZA DISKHALER 2 QL

REYATAZ 3 SP

ribavirin 1 SP

ritonavir 1 SP

SITAVIG 3

STRIBILD 2 SP

SUSTIVA 3 SP

TAMIFLU 3 QL

tenofovir disoproxil fuma 1 SP

TIVICAY 2 SP

TRIUMEQ 2 SP

TRUVADA 2 SP

valacyclovir hcl 1

valacyclovir hydrochlorid 1

VALCYTE 3 SP

valganciclovir 1 SP

valganciclovir hydrochlor 1 SP

VALTREX 3

VEMLIDY 2 SP

VIREAD 3 SP

VOSEVI 2 SP

XOFLUZA 2

ZEPATIER 2 SP

zidovudine 1 SP

BETA BLOCKERS

acebutolol hcl 1

acebutolol hydrochloride 1

atenolol 1

BETAPACE 3

betaxolol hcl 1

bisoprolol fumarate 1

BYSTOLIC 2 ST

carvedilol 1

carvedilol phosphate 1

COREG 3

COREG CR 3

CORGARD 3

INDERAL LA 3

INDERAL XL 3 ST

INNOPRAN XL 3 ST

labetalol hcl 1

labetalol hydrochloride 1

metoprolol succinate er 1

metoprol tar tab 25mg 1

METOPROLOL TAB 75MG 2

nadolol 1

pindolol 1

propranolol hcl 1

propranolol hcl er 1

propranolol hydrochloride 1

sotalol hcl 1

sotalol hcl (af) 1

sotalol hydrochloride (af 1

sotalol hydrocholride 1

SOTYLIZE 2

TENORMIN 3

timolol maleate 1

TOPROL XL 3

Calcium Channel Blockers

amlodipine besylate 1

CARDIZEM LA 3

cartia xt 1

diltiazem hcl 1

diltiazem hcl cd 1

diltiazem hcl er 1

diltiazem hydrochloride e 1

dilt-xr 1

felodipine er 1

isradipine 1

matzim la 1

nifedipine 1

nifedipine er 1

nimodipine 1

nisoldipine er 1

NORVASC 3

PROCARDIA XL 3

taztia xt 1

TIAZAC 3

verapamil hcl 1

verapamil hcl er 1




17

verapamil hcl sr 1

verapamil hydrochloride 1

CARDIOTONICS

digitek 1

digox 1

digoxin 1

CARDIOVASCULAR AGENTS - MISC.

ADCIRCA 3 SP

ADEMPAS 2 SP

amlodipine besylate/atorv 1

BIDIL 3

CADUET 3

CAVERJECT IMPULSE 2 INJ QL

CIALIS 3 QL

CORLANOR 2

EDEX 3 INJ QL

ENTRESTO 2

LETAIRIS 2 SP

LEVITRA 3 QL ST

MUSE 2 QL

OPSUMIT 2 SP

ORENITRAM 3 SP

papaverine hcl 1 INJ

REMODULIN 2 INJ SP

REVATIO 3 SP

sildenafil 1 SP

sildenafil citrate 1 QL

STAXYN 3 QL ST

STENDRA 3 QL ST

tadalafil 1 QL

TRACLEER 2 SP

TYVASO 2 SP

TYVASO REFILL 2 SP

UPTRAVI 2 SP

vardenafil hydrochloride 1 QL

VIAGRA 3 QL

VYNDAQEL 2 SP

CEPHALOSPORINS

cefaclor 1

cefadroxil 1

cefdinir 1

cefepime 1 INJ

cefixime 1

cefpodoxime proxetil 1

cefprozil 1

ceftriaxone sodium 1 INJ

cefuroxime axetil 1

CEPHALEXIN TAB 250MG 2

cephalexin tab 500mg 1

SUPRAX 3

TEFLARO 2 INJ

CONTRACEPTIVES

altavera 1

alyacen 1/35 1

alyacen 7/7/7 1

amethia 1

amethia lo 1

amethyst 1

apri 1

aranelle 1

ashlyna 1

aubra 1

aubra eq 1

aviane 1

azurette 1

BALCOLTRA 3

balziva 1

bekyree 1

BEYAZ 3

blisovi 24 fe 1

blisovi fe 1.5/30 1

blisovi fe 1/20 1

briellyn 1

camila 1

camrese 1

camrese lo 1

caziant 1

chateal 1

cryselle-28 1

cyclafem 1/35 1

cyclafem 7/7/7 1

cyred 1

cyred eq 1




18

dasetta 1/35 1

dasetta 7/7/7 1

daysee 1

deblitane 1

DEPO-PROVERA CONTRACEPTIV 3 INJ

DEPO-SUBQ PROVERA 104 3 INJ

desogestrel/ethinyl estra 1

drospirenone/ethinyl estr 1

elinest 1

ELLA 3

emoquette 1

enpresse-28 1

enskyce 1

errin 1

estarylla 1

ESTROSTEP FE 3

ethynodiol diacetate/ethi 1

falmina 1

fayosim 1

femynor 1

GENERESS FE 3

gianvi 1

heather 1

introvale 1

isibloom 1

jencycla 1

jolessa 1

jolivette 1

juleber 1

junel 1.5/30 1

junel 1/20 1

junel fe 1.5/30 1

junel fe 1/20 1

junel fe 24 1

kaitlib fe 1

kariva 1

kelnor 1/35 1

kelnor 1/50 1

kurvelo 1

KYLEENA 2

larin 1.5/30 1

larin 1/20 1

larin 24 fe 1

larin fe 1.5/30 1

larin fe 1/20 1

larissia 1

layolis fe 1

leena 1

lessina 1

levonest 1

levonorgestrel and ethiny 1

levonorgestrel/ethinyl es 1

levora 0.15/30-28 1

LILETTA 3

lillow 1

LO LOESTRIN FE 2

LOESTRIN 1.5/30-21 3

LOESTRIN 1/20-21 3

LOESTRIN FE 1.5/30 3

LOESTRIN FE 1/20 3

loryna 1

LOSEASONIQUE 3

low-ogestrel 1

lutera 1

lyza 1

marlissa 1

medroxyprogesterone aceta 1 INJ

melodetta 24 fe 1

mibelas 24 fe 1

microgestin 1.5/30 1

microgestin 1/20 1

microgestin fe 1

microgestin fe 1.5/30 1

mili 1

MINASTRIN 24 FE 3

MIRCETTE 3

MIRENA 2

mono-linyah 1

mononessa 1

myzilra 1

NATAZIA 3

necon 0.5/35-28 1

NEXPLANON 2 INJ

nikki 1




19

nora-be 1

norethindrone 1

norethindrone & ethinyl e 1

norethindrone acetate/eth 1

norethindrone/ethinyl est 1

norgestimate/ethinyl estr 1

norlyda 1

nortrel 0.5/35 (28) 1

nortrel 1/35 1

nortrel 7/7/7 1

NUVARING 2

ocella 1

ogestrel 1

orsythia 1

ORTHO MICRONOR 3

ORTHO TRI-CYCLEN LO 3

ORTHO-CYCLEN 3

ORTHO-NOVUM 1/35 3

PARAGARD INTRAUTERINE COP 3

philith 1

pimtrea 1

pirmella 1/35 1

pirmella 7/7/7 1

portia-28 1

previfem 1

QUARTETTE 3

quasense 1

rajani 1

reclipsen 1

rivelsa 1

SAFYRAL 3

SEASONIQUE 3

setlakin 1

sharobel 1

SKYLA 2

sprintec 28 1

sronyx 1

syeda 1

tarina fe 1/20 1

tarina fe 1/20 eq 1

TAYTULLA 2

tilia fe 1

tri femynor 1

tri-estarylla 1

tri-legest fe 1

tri-linyah 1

tri-lo-estarylla 1

tri-lo-marzia 1

tri-lo-sprintec 1

tri-previfem 1

tri-sprintec 1

trivora-28 1

tri-vylibra 1

tulana 1

tydemy 1

velivet 1

vienva 1

viorele 1

vyfemla 1

vylibra 1

wera 1

wymzya fe 1

XULANE 2

YASMIN 28 3

YAZ 3

zarah 1

zovia 1/35e 1

CORTICOSTEROIDS

betamethasone sodium phos 1 INJ

budesonide er 1

BUPIVILOG KIT 3 INJ

CORTEF 3

DEPO-MEDROL 3 INJ

DEXAMETHASON SOL 0.5/5ML 2

dexamethason tab 0.75mg 1

DEXAMETHASONE INTENSOL 2

DEXPAK 10 DAY 3

DEXPAK 6 DAY 3

EMFLAZA 3 SP

ENTOCORT EC 3

fludrocortisone acetate 1

hydrocortisone 1

KENALOG-10 3 INJ

KENALOG-40 3 INJ




20

MEDROL 3

MEDROL DOSEPAK 3

methylprednisolone 1

methylprednisolone acetat 1 INJ

methylprednisolone dose p 1

methylprednisolone sodium 1 INJ

MILLIPRED TAB 5MG 2

MILLIPRED SOL 10MG/5ML 3

ORAPRED ODT 3

PHYSICIANS EZ USE JOINT T 3

PHYSICIANS EZ USE M-PRED 3 INJ

prednisolone 1

prednisolone sol 15mg/5ml 1

PREDNISOLONE SOL 25MG/5ML 2

prednisone tab 20mg 1

PREDNISONE PAK 5MG 2

PREDNISONE INTENSOL 2

RAYOS 3

SOLU-CORTEF 2 INJ

SOLU-MEDROL 3 INJ

TAPERDEX 6-DAY 3

UCERIS TAB 9MG 3

VERIPRED 20 2

COUGH/COLD/ALLERGY

acetylcysteine 1

benzonatate 1

bromfed dm 1

bromphen/pseudoephedrine 1

CLARINEX-D 12 HOUR 3

GILTUSS TR 3

hydrocodone bitartrate/ch 1

hydrocodone bitartrate/ho 1

hydrocodone polistirex/ch 1

hydrocodone/homatropine 1

hydromet 1

HYPERSAL 3

nebusal 1

promethazine/codeine 1

promethazine/dextromethor 1

promethazine/phenylephrin 1

promethazine-dm 1

SEMPREX-D 3

SSKI 3

TUZISTRA XR 3

DERMATOLOGICALS

ABSORICA 2

ACANYA 2

acitretin 1 SP

ACUICYN DAILY EYELID & EY 2

ACZONE 3

adapalene 1

adapalene pump 1

adapalene/benzoyl peroxid 1

AKTIPAK 3

ALA SCALP 3

ALA-QUIN 3

alclometasone dipropionat 1

ALCORTIN A 3

ALDARA 3

ALEVICYN ANTIPRURITIC SG 3

ALTABAX 3

amcinonide 1

amnesteem 1

ARZOL SILVER NITRATE APP 2

ASTERO 3

augmented betamethasone d 1

avar cleanser 1

AVAR LS 3

AVAR LS CLEANSER 3

avar-e green 1

AVAR-E LS 3

AVENOVA 3

avita 1

AZELEX 3

BENSAL HP 3

BENZACLIN 3

BENZACLIN WITH PUMP 3

BENZEFOAM 3

BENZEFOAM ULTRA 3

benzepro 1

benzepro creamy wash 1

benzepro foaming cloths 1

benzepro short contact 1

betamethasone dipropionat 1




21

betamethasone valerate 1

BIAFINE 3

bimatoprost 1

BIONECT 3

BOTOX COSMETIC 3 INJ SP

bp 10-1 1

bp foam 1

bp wash 1

BPO 2

calcipotriene 1

calcipotriene/betamethaso 1

calcitrene 1

CAPEX 3

celacyn 1

CERACADE 3

ceramax 1

ciclopirox 1

ciclopirox nail lacquer 1

ciclopirox olamine 1

claravis 1

CLINDACIN PAC 3

CLINDAGEL 3

clindamycin phosphate 1

CLINDAMYCIN PHOSPHATE/BEN 3

clindamycin phosphate/tre 1

clindamycin/benzoyl perox 1

clobetasol propionate 1

clobetasol propionate e 1

clobetasol propionate emo 1

CLOBEX 3

CLOCORTOLONE PIVALATE 3

CLOCORTOLONE PIVALATE PUM 3

clodan 1

CLODERM 3

CLODERM PUMP 3

clotrimazole/betamethason 1

COAL TAR 2

CONDYLOX 3

CORDRAN 3

CORTISPORIN 3

COSENTYX 2 INJ SP

COSENTYX SENSOREADY PEN 2 INJ SP

DENAVIR 3

DERMACINRX LEXITRAL PHARM 3

dermacinrx prizopak 1

DERMACINRX ZRM PAK 3

DERMA-SMOOTHE/FS SCALP 3

DERMASORB HC 3

DERMASORB XM 3

dermazene 1

DESONATE 3

desonide 1

desoximetasone 1

diclofenac sodium 1

DIFFERIN 3

diflorasone diacetate 1

doxepin hydrochloride 1

DOXYCYCLINE CAP 40MG 3

DRITHO-CREME HP 2

DRYSOL 3

DUAC 3

DUPIXENT 2 INJ SP

econazole nitrate 1

ECOZA 3

EFUDEX 3

ELETONE 2

ELETONE TWINPACK 2

ELIDEL 2

ELOCON 3

EMULSION SB 2

ENSTILAR 2

ENTTY SPRAY EMULSION 3

EPICERAM 3

EPIDUO 3

EPIDUO FORTE 2

EPIFOAM 3

ERTACZO 3 ST

ery 1

erythromycin 1

erythromycin/benzoyl pero 1

ethyl chloride/medium jet 1

ethyl chloride/medium str 1

EUCRISA 3

FABIOR 3




22

FINACEA 3

FLECTOR 2

fluocinolone acetonide 1

fluocinolone acetonide bo 1

fluocinolone acetonide sc 1

fluocinonide 1

fluocinonide emulsified 1

fluocinonide emulsified b 1

FLUOROPLEX 3

fluorouracil 1

flurandrenolide 1

GENADUR 3

halobetasol propionate 1

HALOG 3

HPR PLUS 2

HPR PLUS HYDROGEL KIT 2

HYCLODEX 3

hydrocortisone acetate & 1

hydrocortisone butyrate 1

hydrocortisone butyrate ( 1

hydrocortisone valerate 1

hydrocortisone/iodoquinol 1

hydroquinone 1

hydroquinone time release 1

HYLATOPIC PLUS 3

imiquimod 1

IMIQUIMOD PUMP 3

IMPOYZ 3

isotretinoin 1

JUBLIA 3 ST

KAMDOY 3

KERALAC 3

KERALYT 3

KERALYT SCALP 3

KERYDIN 3 ST

LATISSE 3

LEVICYN 3

levicyn dermal spray 1

LEVULAN KERASTICK 3

lidocaine 1

LIDOCAINE AND TETRACAINE 3

lidocaine hcl 1

lidocaine hcl jelly 1

lidocaine/prilocaine 1

lidocaine-prilocaine-crea 1

LIDODERM 3

lidopril 1

LIDORX 3

LIDOTRAL 3

lidozion 1

LOCOID 3

LOYON 3

LULICONAZOLE 3 ST

LUXAMEND 2

LUXIQ 3

LUZU 3 ST

malathion 1

MENTAX 3

methoxsalen 1

METROGEL 3

metronidazole 1

MICORT-HC 3

MIRVASO 2

mometasone furoate 1

mupirocin 1

myorisan 1

naftifine hcl 1

naftifine hydrochloride 1

NAFTIN 3 ST

NATROBA 3

NEO-SYNALAR 3

NEUAC KIT 3

NIVATOPIC PLUS 2

nolix 1

NORITATE 3

NUVAIL 3

nyamyc 1

nystatin/triamcinolone 1

nystatin/triamcinolone ac 1

nystop 1

OLUX-E 3

ONEXTON 2

ORACEA 2

OVACE PLUS 3




23

OVACE PLUS WASH 3

OVACE WASH 3

oxiconazole nitrate 1

OXISTAT 3 ST

PENLAC NAIL LACQUER 3

PENNSAID 3

permethrin 1

PICATO 2

PLEXION 3

PLEXION CLEANSER 3

PODOCON 25 IN BENZOIN TIN 3

podofilox 1

PRAMOSONE 3

prednicarbate 1

PROMISEB 3

PROPECIA 3

PROTOPIC 3

PRUMYX 2

PSORCON 3

QBREXZA 2

RECEDO 2

REGENECARE 3

REGRANEX 2

RENOVA 3

RETIN-A 3

RETIN-A MICRO 3

RETIN-A MICRO PUMP 3

RHOFADE 3

RIAX 3

rosadan 1

SALEX 3

SALEX CREAM 3

SALEX LOTION 3

salicylic acid 1

salicylic acid er 1

salicylic acid wart remov 1

SANTYL 2

selenium sulfide 1

selenium sulfide shampoo 1

SERNIVO 3

SILIQ 3 INJ SP

SIL-K PAD/LARGE 3

SILVADENE 3

SILVASORB 2

sodium sulfacetamide wash 1

SOD SUL/SULF EMU 10-5% 2

sod sul/sulf pad 10-4% 1

SOOLANTRA 2

SORILUX 3

SPINOSAD 2

ssd 1

SSS 10-5 2

STELARA INJ 45MG/0.5 2 INJ SP

sulfacetamid lot 10% 1

sulfacetamide sodium/sulf 1

sulfacleanse 8/4 1

SUMADAN WASH 3

SUMAXIN 3

SYNALAR 3

SYNERA 3

SYNERDERM 3

TACLONEX 2

tacrolimus 1

TALTZ 2 INJ SP

tazarotene 1

TAZORAC GEL 0.1% 2

TAZORAC CRE 0.1% 3

TEMOVATE 3

TETRIX 3

TEXACORT 3

TOLAK 3

TOPICORT 3

TREMFYA 2 INJ SP

tretinoin 1

tretinoin microsphere 1

tretinoin microsphere pum 1

triamcinolone acetonide 1

TRIANEX 2

triderm 1

TRIDESILON 3

TRI-LUMA 3

silver sulfadiazine 1

SKLICE 3

SKYRIZI 2 INJ SP




24

ULESFIA 3

ULTRAVATE 3

urea 1

urea nail 1

URE-K 3

UTOPIC 3

VANIQA 3

vanoxide-hc 1

VECTICAL 3

VELTIN 3

VENELEX 3

VERDESO 3

VEREGEN 3

VIRASAL 3

VOLTAREN 3

VUSION 3

VYTONE 3

XERAC AC 3

XERESE 3

XEROFORM OCCLUSIVE PETROL 2

XOLEGEL 3 ST

XRYLIX 3

ZIANA 3

ZITHRANOL 3

ZONALON 3

ZOVIRAX 2

ZTLIDO 2

ZYCLARA 3

ZYCLARA PUMP 3

DIAGNOSTIC PRODUCTS

THYROGEN 2 INJ SP

TUBERSOL 2 INJ

DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS

CEREFOLIN NAC 3

DEPLIN 15 3

DEPLIN 7.5 3

ELFOLATE TAB 15MG 3

ELFOLATE TAB 7.5MG 2

ENLYTE 3

ENTERAGAM 3

folbic 1

FOLBIC RF 3

FOLTANX 2

FOLTANX RF 3

FOLTX 3

FOSTEUM PLUS 3

LEVOMEFOLATE CALCIUM ALGA 3

LEVOMEFOLATE CALCIUM/N-AC 3

LEVOMEFOLATE CALCIUM/PYRI 3

LIMBREL 3

L-METHYL-B6-B12 2

L-METHYLFOLATE 2

L-METHYLFOLATE CA/S-ALGAL 3

L-METHYLFOLATE CALCIUM 2

L-METHYLFOLATE FORTE 3

L-METHYL-MC NAC 2

MEBOLIC 3

METAFOLBIC PLUS 2

METAFOLBIC PLUS RF 3

METANX 3

NICAPRIN 3

niva-fol 1

PODIAPN 3

RHEUMATE 3

VASCULERA 3

VAYARIN 3

VAYARIN PLUS 3

VISBIOME 3

XYZBAC 3

ZYVIT 3

DIGESTIVE AIDS

CREON 2

PANCREAZE 3

PERTZYE 3

SUCRAID 2 SP

VIOKACE 2

ZENPEP 2

DIURETICS

acetazolamide 1

acetazolamide er 1

ALDACTAZIDE 3

ALDACTONE 3

amiloride hcl 1




25

amiloride/hydrochlorothia 1

bumetanide 1

CAROSPIR 3

chlorothiazide 1

chlorthalidone 1

DIURIL 3

DYAZIDE 3

DYRENIUM 3

ethacrynic acid 1

furosemide 1

hydrochlorothiazide 1

indapamide 1

LASIX 3

MAXZIDE 3

methazolamide 1

methyclothiazide 1

metolazone 1

spironolactone 1

spironolactone/hydrochlor 1

torsemide 1

triamterene/hydrochloroth 1

ENDOCRINE AND METABOLIC AGENTS - MISC.

ALENDRONATE TAB 40MG 2

alendronate tab 35mg 1

BONIVA 3

cabergoline 1

calcitonin salmon 1

calcitonin-salmon 1

calcitriol 1

CARNITOR 3

CETROTIDE 2 INJ SP

chorionic gonadotropin 1 INJ SP

clomiphene citrate 1

DDAVP 2

desmopressin acetate 1

doxercalciferol 1 SP

EVISTA 3

FABRAZYME 2 INJ SP

FOLLISTIM AQ 3 INJ SP

FORTEO 2 INJ SP

FOSAMAX PLUS D 3 ST

GANIRELIX ACETATE 3 INJ SP

GENOTROPIN 2 INJ SP

GENOTROPIN MINIQUICK 2 INJ SP

GONAL-F 2 INJ SP

GONAL-F RFF REDIJECT 2 INJ SP

H.P. ACTHAR 3 INJ SP

HUMATROPE 2 INJ SP

ibandronate sodium 1

KUVAN 2 SP

levocarnitine 1

LUPANETA PACK 2 SP

LUPRON DEPOT-PED (1-MONTH 2 INJ SP

LUPRON DEPOT-PED (3-MONTH 2 INJ SP

MENOPUR 2 INJ SP

NATPARA 2 INJ SP

NOCTIVA 3

NORDITROPIN FLEXPRO 2 INJ SP

NOVAREL 2 INJ SP

NUTROPIN AQ NUSPIN 10 3 INJ SP

NUTROPIN AQ NUSPIN 20 3 INJ SP

octreotide acetate 1 INJ SP

OMNITROPE 3 INJ SP

ORILISSA 2

OSPHENA 3

OVIDREL 2 INJ SP

PALYNZIQ 2 INJ

paricalcitol 1 SP

PREGNYL W/DILUENT BENZYL 3 INJ SP

PROLIA 3 INJ SP

raloxifene hydrochloride 1

RAVICTI 2 SP

RAYALDEE 3

risedronate sodium 1

risedronate sodium dr 1

ROCALTROL 3

SANDOSTATIN LAR DEPOT 2 INJ SP

SENSIPAR 2 SP

SOMATULINE DEPOT 2 INJ SP

SOMAVERT 2 INJ SP

STIMATE 2 SP

SUPPRELIN LA 3 INJ SP

SYNAREL 2 SP




26

TYMLOS 2 INJ SP

XGEVA 2 INJ SP

zoledronic acid 1 INJ SP

ZOMACTON 3 INJ SP

Estrogens

ALORA 3

amabelz 1

ANGELIQ 3

CLIMARA 3

CLIMARA PRO 3

COMBIPATCH 2

DELESTROGEN 3 INJ

DEPO-ESTRADIOL 2 INJ

DIVIGEL 2

DUAVEE 2

eemt 1

eemt hs 1

esterified estrogens/meth 1

estradiol valerate 1 INJ

estradiol/norethindrone a 1

ESTROGEL 3

EVAMIST 3

fyavolv 1

jevantique lo 1

jinteli 1

lopreeza 1

MENEST 3

MENOSTAR 3

mimvey 1

MINIVELLE 3

PREMARIN 2

PREMPHASE 2

PREMPRO 2

VIVELLE-DOT 3

Fluoroquinolones

BAXDELA 3

CIPRO 3

ciprofloxacin er 1

ciprofloxacin hcl 1

ciprofloxacin hydrochlori 1

LEVAQUIN 3

levofloxacin 1

levofloxacin in d5w 1 INJ

moxifloxacin hcl 1

GASTROINTESTINAL AGENTS - MISC.

alosetron hydrochloride 1

AMITIZA 2

APRISO 3

ASACOL HD 3

AURYXIA 3

AZULFIDINE EN-TABS 3

balsalazide disodium 1

calcium acetate 1

CANASA 2

CIMZIA 3 INJ SP

CIMZIA STARTER KIT 3 INJ SP

DELZICOL 2

DIPENTUM 3

ENTYVIO 2 INJ SP

enulose 1

FOSRENOL 3

generlac 1

INFLECTRA 2 INJ SP

lanthanum carbonate 1

LIALDA 3

LINZESS 2

mesalamine 1

mesalamine dr 1

metoclopramide hcl 1

metoclopramide hydrochlor 1

METOCLOPRAMIDE ODT 2

MOVANTIK 2

OCALIVA 2 SP

PENTASA 2

RELISTOR 3 SP QL

REMICADE 2 INJ SP

RENAGEL 3

RENVELA 3

sevelamer carbonate 1

STELARA INJ 5MG/ML 3 INJ SP

sulfasalazine 1

SYMPROIC 2

TRULANCE 3




27

URSO 250 3

URSO FORTE 3

ursodiol 1

VELPHORO 2 SP

VIBERZI 2

XERMELO 2 SP

GENERAL ANESTHETICS

ketamine hcl 1 INJ

GENITOURINARY AGENTS - MISCELLANEOUS

acetic acid 0.25% 1

alfuzosin hcl er 1

AVODART 3 QL

CARDURA XL 3

dutasteride 1 QL

dutasteride/tamsulosin hc 1

dutasteride/tamsulosin hy 1

ELMIRON 2

finasteride 1

FLOMAX 3

JALYN 3

K-PHOS NO 2 3

ORACIT 3

phenazopyridine hcl 1

phenazopyridine hydrochlo 1

potassium citrate er 1

potassium citrate/citric 1

PROSCAR 3

PYRIDIUM 3

RAPAFLO 3

RIMSO-50 3 INJ

sodium chloride 0.9% 1

sodium chloride 0.9% 1

sodium citrate/citric aci 1

tamsulosin hcl 1

tamsulosin hydrochloride 1

THIOLA 3

tricitrates 1

UROCIT-K 10 3

Gout Agents

allopurinol 1

COLCHICINE CAP 0.6MG 3

COLCHICINE TAB 0.6MG 3

COLCRYS 2

KRYSTEXXA 2 INJ SP

MITIGARE 2

probenecid 1

probenecid/colchicine 1

ULORIC 2 ST

HEMATOLOGICAL AGENTS - MISC.

ADVATE 2 INJ SP

AGGRENOX 3

anagrelide hydrochloride 1

aspirin/dipyridamole 1

BENEFIX 2 INJ SP

BRILINTA 2

cilostazol 1

clopidogrel 1

dipyridamole 1

EFFIENT 3

ELOCTATE 3 INJ SP

FIRAZYR 2 INJ SP

IDELVION 3 INJ SP

pentoxifylline er 1

PLAVIX 3

prasugrel 1

RUCONEST 2 INJ SP

TAVALISSE 3 SP

YOSPRALA 3

ZONTIVITY 2

HEMATOPOIETIC AGENTS

ARANESP ALBUMIN FREE 2 INJ SP

CENTRATEX 2

CERDELGA 2 SP

chromagen 1

corvita 150 1

CORVITE FE 3

cyanocobalamin 1 INJ

DROXIA 2

EPOGEN 3 INJ SP

fabb 1

FERAHEME 2 INJ

FERIVA 21/7 3




28

ferocon 1

FERRALET 90 3

FERRAPLUS 90 2

folbee 1

folic acid/vitamin b-6/vi 1

FOLIVANE-F 2

FOLIVANE-PLUS 2

FULPHILA 2 INJ SP

FUSION PLUS 3

GRANIX 2 INJ SP

HEMATOGEN FA 2

hematogen forte 1

HEMOCYTE PLUS 3

hemocyte-f 1

hydroxocobalamin 1 INJ

iferex 150 forte 1

INTEGRA F 3

INTEGRA PLUS 3

IROSPAN 24/6 3

MULPLETA 2 SP

MULTIGEN 2

MULTIGEN PLUS 2

NASCOBAL 2

NEULASTA 2 INJ SP

NEULASTA ONPRO KIT 2 INJ SP

NEUPOGEN 2 INJ SP

NIFEREX 3

NOXIFOL-D 3

PHYSICIANS EZ USE B-12 CO 3 INJ

poly-iron 150 forte 1

PROCRIT 2 INJ SP

PROMACTA 2 SP

REVESTA 3

se-tan plus 1

tl gard rx 1

trigels-f forte 1

UDENYCA 2 INJ SP

VENOFER 2 INJ SP

virt-gard 1

VPRIV 3 INJ SP

ZARXIO 2 INJ SP

HEMOSTATICS

AMICAR 3

tranexamic acid 1

HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS

AMBIEN 3 QL

AMBIEN CR 3 QL

BELSOMRA 3 QL ST

DORAL 3

EDLUAR 3 QL ST

estazolam 1

eszopiclone 1 QL

flurazepam hcl 1

HALCION 3 QL

INTERMEZZO 3 QL

LUNESTA 3 QL

midazolam hcl 1

phenobarbital 1

ROZEREM 2 QL ST

SILENOR 3 ST

temazepam 1

triazolam 1 QL

zaleplon 1 QL

zolpidem tartrate 1 QL

zolpidem tartrate er 1 QL

LAXATIVES

CLENPIQ 2

COLYTE-FLAVOR PACKS 3

constulose 1

gavilyte-c 1

gavilyte-g 1

gavilyte-n/flavor pack 1

GOLYTELY 3

KRISTALOSE 3

lactulose 1

MOVIPREP 3

NULYTELY/FLAVOR PACKS 3

OSMOPREP 3

peg-3350/electrolytes 1

peg-3350/nacl/na bicarbon 1

PLENVU 3

polyethylene glycol 3350 1

PREPOPIK 2




29

SUPREP BOWEL PREP KIT 2

trilyte 1

LOCAL ANESTHETICS-Parenteral

bupivacaine hcl 1 INJ

MARCAINE 3 INJ

MARLIDO KIT 3 INJ

XYLOCAINE 3 INJ

XYLOCAINE-MPF 3 INJ

MACROLIDES

azithromycin sus 200/5ml 1

AZITHROMYCIN POW 1GM PAK 2

clarithromycin 1

clarithromycin er 1

DIFICID 3

e.e.s. 400 1

E.E.S. GRANULES 3

ERYPED 400 3

ERY-TAB 2

ERYTHROCIN STEARATE 2

erythromycin base 1

erythromycin ethylsuccina 1

ZITHROMAX 3

ZITHROMAX Z-PAK 3

MEDICAL DEVICES AND SUPPLIES

CAYA 3

FREESTYLE LIBRE/SENSOR/FL 2

FREESTYLE LIBRE/READER/FL 2

Migraine Products

AIMOVIG 2 INJ QL

AJOVY 2 INJ QL

almotriptan 1 QL

almotriptan malate 1 QL

CAMBIA 3 QL

dihydroergot inj 1mg/ml 1 INJ QL

DIHYDROERGOT SPR 4MG/ML 2 QL

eletriptan hydrobromide 1 QL

EMGALITY 2 INJ

ERGOMAR 3

ergotamine tartrate/caffe 1

FROVA 3 QL

frovatriptan succinate 1 QL

IMITREX 3 QL

IMITREX STATDOSE REFILL 3 INJ QL

IMITREX STATDOSE SYSTEM 3 INJ QL

MAXALT 3 QL

MAXALT-MLT 3 QL

naratriptan hcl 1 QL

ONZETRA XSAIL 3 QL ST

RELPAX 3 QL

rizatriptan benzoate 1 QL

rizatriptan benzoate odt 1 QL

sumatriptan 1 QL

sumatriptan succinate 1 INJ QL

sumatriptan succinate ref 1 INJ QL

sumatriptan/naproxen sodi 1 QL

TREXIMET 3 QL

ZEMBRACE SYMTOUCH 3 INJ QL ST

zolmitriptan 1 QL

zolmitriptan odt 1 QL

ZOMIG TAB 5MG 3 QL

ZOMIG SPR 5MG 2 QL

ZOMIG ZMT 3 QL

MINERALS AND ELECTROLYTES

bd posiflush 1 INJ

effer-k tab 25meq ef 1

EFFER-K TAB 20MEQ 3

effervescent pot chloride 1

FLUORABON 3

fluoride 1

FLURA-DROPS 3

GALZIN 3

iodine strong 1

k-effervescent 1

klor-con 1

klor-con 10 1

klor-con 8 1

klor-con m10 1

KLOR-CON M15 2

klor-con m20 1

klor-con sprinkle 1

klor-con/ef 1

K-PHOS 2

K-TAB TAB 8MEQ CR 2

K-TAB TAB 20MEQ 3




30

k-vescent 1

lactated ringers 1 INJ

ludent 1

monoject pharma grade flu 1 INJ

normal saline flush 1 INJ

normal saline flush for f 1 INJ

normal saline i.v. flush 1 INJ

phospha 250 neutral 1

phosphorous 1

phospho-trin 250 neutral 1

potassium chloride 1

potassium chloride cr 1

pot chloride tab 10meq er 1

POT CHLORIDE TAB 20MEQ ER 2

potassium chloride sr 1

saline flush 1 INJ

sodium chloride flush 1 INJ

sodium fluoride 1

virt-phos 250 neutral 1

Miscellaneous Therapeutic Classes

ASTAGRAF XL 3 SP

AZASAN 3 SP

azathioprine 1

BENLYSTA 2 INJ SP

CELLCEPT 3 SP

cyclosporine 1

cyclosporine cap 25mg mod 1

CYCLOSPORINE CAP 50MG MOD 2

ENVARSUS XR 3 SP

gengraf 1

HYLAFEM 3

HYLENEX 3 INJ

kionex 1

mycophenolate mofetil 1 SP

mycophenolic acid dr 1 SP

MYFORTIC 3 SP

NEORAL 3

PROGRAF CAP 3 SP

PROGRAF GRA 2 SP

PROSTIN VR PEDIATRIC 3 INJ

RAPAMUNE TAB 1MG 3 SP

RAPAMUNE SOL 1MG/ML 2 SP

REVLIMID 2 SP

SANDIMMUNE 2

sirolimus 1 SP

sodium polystyrene sulfon 1

sps 1

sterile water irrigation 1

SYPRINE 3

trientine hydrochloride 1

VELTASSA 2

XIAFLEX 2 INJ SP

ZORTRESS 2 SP

MOUTH/THROAT/DENTAL AGENTS

ARESTIN 3

CAPHOSOL 3

cevimeline hcl 1

chlorhexidine gluconate 1

clinpro 5000 1

clotrimazole 1

DEBACTEROL 3

denta 5000 plus 1

dentagel 1

FIRST-MOUTHWASH BLM 2

GELCLAIR 3

lidocaine viscous 1

MUGARD 3

NEUTRASAL 3

ORAMAGICRX 3

paroex 1

pilocarpine hcl 1

pilocarpine hydrochloride 1

PREVIDENT 5000 BOOSTER PL 3

PREVIDENT 5000 DRY MOUTH 3

PREVIDENT 5000 ENAMEL PRO 3

PREVIDENT 5000 PLUS 3

PREVIDENT 5000 SENSITIVE 3

PREVIDENT FLUORIDE 3

PREVIDENT RINSE 3

SALAGEN 3

SALIVAMAX 3

sf 1




31

sf 5000 plus 1

triamcinolone acetonide d 1

MULTIVITAMINS

CITRANATAL 90 DHA 3

CITRANATAL ASSURE 3

CITRANATAL B-CALM 3

CITRANATAL BLOOM 3

CITRANATAL DHA 3

CITRANATAL HARMONY 3

CITRANATAL RX 3

complete natal dha 1

completenate 1

CONCEPT DHA 3

CONCEPT OB 3

dialyvite 1

DIALYVITE/ZINC 2

elite-ob 1

ENBRACE HR 3

FLORIVA PLUS 3

folbee plus 1

FOLGARD OS 3

multi-vit/iron/fluoride 1

multivitamin with fluorid 1

multivit/fl dro 0.25mg 1

MULTIVIT/FL CHW 0.5MG 3

MULTIVIT/FL CHW 0.25MG 2

multi-vitamin/fluoride dr 1

multi-vitamin/fluoride/ir 1

NEEVO DHA 3

NEPHRO-VITE RX 2

NESTABS DHA 3

NESTABS ONE 3

NICADAN 3

NICOMIDE 3

NIVA-PLUS 3

OB COMPLETE ONE 3

OB COMPLETE PETITE 3

OB COMPLETE PREMIER 3

OB COMPLETE/DHA 3

PNV PRENATAL TAB PLUS 2

PRENATAL PLS MIS MV + DHA 3

PNV TABS 29-1 2

pnv-dha 1

PNV-DHA+DOCUSATE 2

POLY-VI-FLOR 3

PRENA 1 TRUE 2

PRENA1 PEARL 2

PRENAISSANCE 2

PRENATA 3

prenatabs rx 1

PRENATAL 2

PRENATAL 19 TAB 29-1MG 3

prenatal 19 chw tab 1

PRENATAL PLUS 2

PRENATAL PLUS IRON 2

PRENATAL VITAMINS PLUS LO 2

PRENATE 3

PRENATE DHA 3

PRENATE ELITE 3

PRENATE ENHANCE 3

PRENATE ESSENTIAL 3

PRENATE MINI 3

PRENATE PIXIE 3

PRENATE RESTORE 3

PREPLUS 2

PRIMACARE 3

PROVIDA DHA 3

PROVIDA OB 3

renal caps 1

reno caps 1

SELECT-OB+DHA 3

se-natal 19 1

TARON-C DHA 2

THRIVITE RX 3

TL G-FOL OS 2

TRICARE PRENATAL DHA ONE/ 3

trinatal rx 1 1

triphrocaps 1

TRISTART DHA 3

tri-vitamin/fluoride 1

ultimatecare one 1

v-c forte 1

VINATE M 2

vinate one 1




32

VIRT-C DHA 2

virt-caps 1

VIRT-PN 2

VIRT-PN DHA 2

VITAFOL 3

VITAFOL FE+ 3

VITAFOL GUMMIES 3

VITAFOL ULTRA 3

VITAFOL-NANO 3

VITAFOL-OB 3

VITAFOL-OB+DHA 3

VITAFOL-ONE 3

VITAMEDMD ONE RX/QUATREFO 3

VITAMEDMD REDICHEW RX 3

vitamins a/c/d/fluoride 1

VITAPEARL 3

VITATRUE 3

VOL-PLUS 2

VOL-TAB RX 2

VP-PNV-DHA 3

ZATEAN-PN DHA 2

ZATEAN-PN PLUS 2

MUSCULOSKELETAL THERAPY AGENTS

AMRIX 3 QL

baclofen tab 20mg 1

BACLOFEN TAB 5MG 3

carisoprodol 1

chlorzoxazon tab 500mg 1

CHLORZOXAZON TAB 250MG 2

cyclobenzaprine hcl 1

cyclobenzaprine hydrochlo 1

dantrolene sodium 1

EUFLEXXA 2 INJ SP

FIRST-BACLOFEN 5 2

GABLOFEN 2 INJ

GEL-ONE 3 INJ SP

HYALGAN 3 INJ SP

HYMOVIS 3 INJ SP

LORZONE 3

METAXALONE TAB 400MG 2

metaxalone tab 800mg 1

methocarbamol 1

MONOVISC 2 INJ SP

orphenadrine citrate er 1

ORTHOVISC 2 INJ SP

ROBAXIN-750 3

SOMA 3

SUPARTZ FX 3 INJ SP

SYNVISC 3 INJ SP

SYNVISC ONE 3 INJ SP

tizanidine hcl 1

tizanidine hydrochloride 1

NASAL AGENTS - SYSTEMIC AND TOPICAL

ADRENALIN SOL 1:1000 3

ASTEPRO 3

azelastine hcl 1

azelastine hydrochloride 1

BECONASE AQ 3 ST

DYMISTA 2 ST

FLONASE 3

flunisolide 1

fluticasone propionate 1

ipratropium bromide 1

NASONEX 3

PATANASE 3 ST

QNASL 2 ST

QNASL CHILDRENS 2 ST

SINUVA 3 SP

XHANCE 3

ZETONNA 3 ST

NEUROMUSCULAR AGENTS

BOTOX 2 INJ SP

DYSPORT 3 INJ SP

MYOBLOC 2 INJ SP

riluzole 1 SP

SPINRAZA 2 INJ SP

NUTRIENTS

dextrose 20% 1 INJ

dextrose 5% 1 INJ

intralipid 1 INJ

OPHTHALMIC AGENTS

ACULAR 3




33

ACULAR LS 3

ACUVAIL 3

ALOCRIL 3

ALPHAGAN P SOL 0.15% 3


ALREX 2

apraclonidine 1

atropine sulfate 1

AZASITE 2

AZOPT 3

BACITRACIN 2

bacitracin/polymyxin b 1

BEPREVE 2

BESIVANCE 3

BETIMOL 3

BETOPTIC-S 3

BLEPHAMIDE 3

BLEPHAMIDE S.O.P. 3

brimonidine tartrate 1

bromfenac 1

BROMSITE 3

carteolol hcl 1

CILOXAN 3

COMBIGAN 2

COSOPT 3

COSOPT PF 3

CYCLOMYDRIL 3

cyclopentolate hcl 1

cyclopentolate hydrochlor 1

dorzolamide hcl 1

dorzolamide hcl/timolol m 1

dorzolamide hydrochloride 1

DUREZOL 3

epinastine hcl 1

EYLEA 2 SP

fluorometholone 1

flurbiprofen sodium 1

FML 3

FML FORTE 3

FML LIQUIFILM 3

gatifloxacin 1

GENTAK 2

homatropine hbr 1

ILEVRO 2

INVELTYS 2

IOPIDINE 3

ISTALOL 3

LACRISERT 3

LASTACAFT 3

latanoprost 1

levobunolol hcl 1

LOTEMAX 2

LUMIGAN 2

MAXIDEX 3

MOXEZA 2

moxifloxacin hydrochlorid 1

NATACYN 2

neomycin/bacitracin/polym 1

neomycin/polymyxin/bacitr 1

neomycin/polymyxin/dexame 1

neomycin/polymyxin/gramic 1

neo-polycin 1

neo-polycin hc 1

NEOSPORIN 3

NEVANAC 2

OCUFLOX 3

ofloxacin 1

olopatadine hcl 1

olopatadine hydrochloride 1

OXERVATE 2 SP

OZURDEX 2 SP

PATADAY 3

PATANOL 3

PAZEO 2

PHOSPHOLINE IODIDE 2

polycin 1

polymyxin b sulfate/trime 1

POLYTRIM 3

PRED FORTE 3

PRED MILD 3

PRED-G S.O.P. 3

prednisolone acetate 1

PROLENSA 2

proparacaine hcl 1




34

RESTASIS 2

RESTASIS MULTIDOSE 2

RHOPRESSA 2

SIMBRINZA 3

sodium sulfacetamide 1

SULFACET SOD OIN 10% OP 2

sulfacetamide sodium/pred 1

tetracaine hcl 1

tetracaine hydrochloride 1

TIMOLOL GEL SOL 0.5% OP 3

timolol gel sol 0.25% op 1

TIMOPTIC 3

TIMOPTIC OCUDOSE 3

TOBRADEX SUS 0.3-0.1% 3

TOBRADEX OIN 0.3-0.1% 2

TOBRADEX ST 2

tobramycin sulfate 1

tobramycin/dexamethasone 1

TOBREX 3

TRAVATAN Z 2

trifluridine 1

trimethoprim sulfate/poly 1

tropicamide 1

TRUSOPT 3

VIGAMOX 3

VYZULTA 3

XALATAN 3

XIIDRA 2

ZIOPTAN 3

ZIRGAN 3

ZYLET 2

ZYMAXID 3

OTIC AGENTS

acetic acid 1

CIPRO HC 3

CIPRODEX 2

CIPROFLOXACIN 2

COLY-MYCIN S 3

hydrocortisone/acetic aci 1

neomycin/polymyxin/hc 1

neomycin/polymyxin/hydroc 1

OTOVEL 2

Oxytocics

methergine 1

methylergonovine maleate 1

PASSIVE IMMUNIZING AND TREATMENT AGENTS

FLEBOGAMMA DIF 3 INJ SP

HIZENTRA 2 INJ SP

HYPERRHO S/D 2 INJ SP

RHOGAM ULTRA-FILTERED PLU 3 INJ SP

SYNAGIS 2 INJ SP

PENICILLINS

amoxicillin 1

amoxicillin/clavulanate p 1

ampicillin 1

AUGMENTIN 2

BICILLIN L-A 2 INJ

dicloxacillin sodium 1

MOXATAG 3

penicillin v potassium 1

piperacillin/tazobactam 1 INJ

Progestins

hydroxyprogesterone capro 1 INJ SP

MAKENA INJ 250MG/ML 3 INJ SP

MAKENA INJ 275MG 3 INJ SP

norethindrone acetate 1

progesterone 1

PROMETRIUM 3

PROVERA 3

Psychotherapeutic and Neurological Agents - Misc.

acamprosate calcium dr 1

ADDYI 3 SP

AMPYRA 3 SP

AUBAGIO 3 SP

AUSTEDO 2 SP

AVONEX 2 INJ SP

AVONEX PEN 2 INJ SP

BETASERON 2 INJ SP

BRISDELLE 3

CHANTIX 2 QL

CHANTIX CONTINUING MONTH 2 QL

CHANTIX STARTING MONTH PA 2 QL




35

chlordiazepoxide/amitript 1

COPAXONE INJ 40MG/ML 2 INJ SP

COPAXONE INJ 20MG/ML 3 INJ SP

dalfampridine er 1 SP

disulfiram 1

donepezil hcl 1

donepezil hydrochloride 1

EXTAVIA 2 INJ SP

fluoxetine 1

galantamine hydrobromide 1

GILENYA 2 SP

glatiramer acetate 1 INJ SP

glatopa 1 INJ SP

GRALISE 2

GRALISE STARTER 2

HORIZANT 3

INGREZZA 3 SP

LYRICA CR 3

MAYZENT 2 SP

memantine hcl 1

memantine hcl titration p 1

memantine hydrochloride 1

memantine hydrochloride e 1

NAMENDA 3

NAMENDA XR 3

NAMZARIC 2

NICOTROL INHALER 3

NICOTROL NS 3

NUEDEXTA 2

OCREVUS 2 INJ SP

olanzapine/fluoxetine 1

ORAP 3

paroxetine 1

perphenazine/amitriptylin 1

pimozide 1

PLEGRIDY 2 INJ SP

REBIF 2 INJ SP

REBIF REBIDOSE 2 INJ SP

REBIF REBIDOSE TITRATION 2 INJ SP

rivastigmine tartrate 1

rivastigmine transdermal 1

SAVELLA 2

SAVELLA TITRATION PACK 2

TECFIDERA 2 SP

TECFIDERA STARTER PACK 2 SP

tetrabenazine 1 SP

TYSABRI 2 INJ SP

XENAZINE 3 SP

XYREM 2 SP

Respiratory Agents - Misc.

ESBRIET 2 SP

GLASSIA 2 INJ SP

OFEV 2 SP

ORKAMBI 2 SP

PROLASTIN-C 2 INJ SP

PULMOZYME 2 SP

SYMDEKO 2 SP

Tetracyclines

ACTICLATE 3

demeclocycline hcl 1

DORYX MPC 3

doxycycline sus 25mg/5ml 1

doxycycline hyclate 1

doxycycline hyclate dr 1

doxycycline monohydrate 1

minocycline hcl 1

minocycline hcl er 1

minocycline hydrochloride 1

okebo 1

SOLODYN 2

TARGADOX 3

tetracycline hydrochlorid 1

VIBRAMYCIN 3

XIMINO 3

THYROID AGENTS

ARMOUR THYROID 2

CYTOMEL 3

levothyroxine sodium 1

levothyroxine/liothyronin 1

levoxyl 1

liothyronine sodium 1

methimazole 1

NATURE-THROID 2

NATURE-THROID NT-2.5 2




36

np thyroid 120 1

np thyroid 15 1

np thyroid 30 1

np thyroid 60 1

np thyroid 90 1

propylthiouracil 1

SYNTHROID 3

TIROSINT 3

unithroid 1

WESTHROID 2

WP THYROID 3

Toxoids

ADACEL 2 INJ

BOOSTRIX 2 INJ

INFANRIX 2 INJ

TENIVAC 3 INJ

TETANUS/DIPHTHERIA TOXOID 2 INJ

ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS

ACIPHEX 3 QL

belladonna & opium 1

belladonna alkaloids & op 1

CARAFATE 2

chlordiazepoxide hcl/clid 1

cimetidine 1

cimetidine hcl 1

CUVPOSA 3

CYTOTEC 3

DEXILANT 3 QL ST

dicyclomine hcl 1

dicyclomine hydrochloride 1

DONNATAL 3

esomeprazole magnesium 1 QL

esomeprazole magnesium dr 1 QL

ESOMEPRAZOLE STRONTIUM 3

famotidine 1

FIRST-LANSOPRAZOLE 2 QL

FIRST-OMEPRAZOLE 2 QL

glycopyrrolate 1

hyoscyamine sulfate 1

hyoscyamine sulfate er 1

hyoscyamine sulfate odt 1

hyoscyamine sulfate sr 1

hyosyne 1

lansoprazole 1 QL

lansoprazole/amoxicillin/ 1

LEVSIN 3

LEVSIN/SL 3

methscopolamine bromide 1

misoprostol 1

NEXIUM GRA 10MG DR 2 QL

NEXIUM CAP 40MG 3 QL

nizatidine cap 150mg 1

NIZATIDINE SOL 15MG/ML 2

OMECLAMOX-PAK 3

omeprazole 1 QL

omeprazole dr 1 QL

omeprazole/sodium bicarbo 1

oscimin 1

oscimin sr 1

pantoprazole sodium 1 QL

pantoprazole sodium dr 1 QL

phenohytro 1

PREVACID 3 QL

PREVACID SOLUTAB 3 QL

PRILOSEC 3 QL

propantheline bromide 1

PROTONIX 3 QL

PYLERA 2

rabeprazole sodium 1 QL

ranitidine hcl 1

ranitidine hydrochloride 1

sucralfate tab 1gm 1

SUCRALFATE SUS 1GM/10ML 2

SYMAX DUOTAB 3

ZEGERID 3

Urinary Anti-infectives

HYOPHEN 2

MACROBID 3

MACRODANTIN 3

me/naphos/mb/hyo 1 1

methenamine hippurate 1

methenamine mandelate 1




37

MONUROL 3

nitrofurantoin 1

nitrofurantoin macrocryst 1

nitrofurantoin monohydrat 1

phosphasal 1

urelle 1

uribel 1

URIMAR-T 2

uro-458 1

UROGESIC-BLUE 2

uro-mp 1

ustell 1

vilamit mb 1

Urinary Antispasmodics

bethanechol chloride 1

darifenacin hydrobromide 1 QL

DETROL 3 QL

DETROL LA 3 QL

flavoxate hcl 1

GELNIQUE 2

MYRBETRIQ 2

oxybutynin chloride 1

oxybutynin chloride er 1 QL

tolterodine tartrate 1 QL

tolterodine tartrate er 1 QL

TOVIAZ 2 QL

trospium chloride 1 QL

trospium chloride er 1 QL

VESICARE 2 QL

VACCINES

AFLURIA 2018-2019 2 INJ

AFLURIA PF 2018-2019 2 INJ

AFLURIA QUADRIVALENT 2018 2 INJ

BEXSERO 2 INJ

ENGERIX-B 2 INJ

FLUAD 2018-2019 2 INJ

FLUARIX QUADRIVALENT 2018 2 INJ

FLUBLOK QUADRIVALENT 2018 2 INJ

FLUCELVAX QUADRIVALENT 20 2 INJ

FLULAVAL QUADRIVALENT 201 2 INJ

FLUMIST QUADRIVALENT 2

FLUZONE HIGH-DOSE PF 2018 2 INJ

FLUZONE QUADRIVALENT 2018 2 INJ

GARDASIL 9 2 INJ

HAVRIX 2 INJ

IMOVAX RABIES (H.D.C.V.) 2 INJ

IPOL INACTIVATED IPV 2 INJ

IXIARO 2 INJ

MENACTRA 2 INJ

MENVEO 3 INJ

M-M-R II 2 INJ

PNEUMOVAX 23 2 INJ

PNEUMOVAX 23/1 DOSE 2 INJ

PREVNAR 13 2 INJ

RABAVERT 2 INJ

RECOMBIVAX HB 2 INJ

SHINGRIX 2 INJ

STAMARIL 2 INJ

TRUMENBA 2 INJ

TWINRIX 2 INJ

TYPHIM VI 2 INJ

VAQTA 3 INJ

VARIVAX 2 INJ

VAXCHORA 2

VIVOTIF 2

YF-VAX 2 INJ

ZOSTAVAX 3 INJ

VAGINAL PRODUCTS

AVC 3

CLEOCIN 3

CLINDESSE 3

CRINONE 2

ENDOMETRIN 3

ESTRACE 3

estradiol 1

ESTRING 2

FEM PH 2

FEMRING 3

FIRST-PROGESTERONE VGS 10 3

FIRST-PROGESTERONE VGS 20 3

GYNAZOLE-1 3

IMVEXXY MAINTENANCE PACK 3

IMVEXXY STARTER PACK 3

INTRAROSA 3




38

metronidazole vaginal 1

MICONAZOLE 3 2

NUVESSA 3

terconazole 1

VAGIFEM 3

vandazole 1

yuvafem 1

Vasopressors

ADRENALIN INJ 30/30ML 2 INJ

AUVI-Q 3 INJ SP

EPIPEN 2-PAK 2 INJ

EPIPEN-JR 2-PAK 2 INJ

midodrine hcl 1

midodrine hydrochloride 1

NORTHERA 3 SP

SYMJEPI 2 INJ

VITAMINS

ergocalciferol 1

MEPHYTON 3

phytonadione 1

vitamin k1 1 INJ

39

abacavir ______________ 15

abacavir/lamivudine ___ 15

ABELCET ______________ 11

ABILIFY _______________ 15

ABILIFY MAINTENA ____ 15

ABSORICA ____________ 20

ABSTRAL _______________ 4

acamprosate calcium dr 34

ACANYA ______________ 20

acarbose _______________ 9

ACCUPRIL _____________ 12

acebutolol hcl _________ 16

acebutolol hydrochloride

___________________ 16

acetaminophen/caffeine/di

____________________ 4

acetaminophen/codeine_ 4

acetaminophen/codeine

#3 __________________ 4

acetaminophen/codeine

pho_________________ 4

acetazolamide _________ 24

acetazolamide er ______ 24

acetic acid ________ 27, 34

acetic acid 0.25% ______ 27

acetylcysteine _________ 20

ACIPHEX ______________ 36

acitretin ______________ 20

ACTEMRA ______________ 3

ACTICLATE ____________ 35

ACTOPLUS MET XR _____ 9

ACUICYN DAILY EYELID &

EY _________________ 20

ACULAR __________ 32, 33

ACULAR LS ____________ 33

ACUVAIL ______________ 33

acyclovir ______________ 15

ACZONE ______________ 20

ADACEL_______________ 36

adapalene ____________ 20

adapalene pump_______ 20

adapalene/benzoyl peroxid

___________________ 20

ADCIRCA______________ 17

ADDERALL _____________ 3

ADDERALL XR __________ 3

ADDYI ________________ 34

ADEMPAS_____________ 17

ADHD/ANTI-

NARCOLEPSY/ANTI-

OBESITY/ANOREXIANTS

____________________ 3

ADIPEX-P ______________ 3

ADLYXIN _______________ 9

ADLYXIN STARTER PACK 9

ADMELOG _____________ 9

ADMELOG SOL OSTA R ___ 9

ADRENALIN INJ 30/30ML

___________________ 38

ADRENALIN SOL 1

1000 ______________ 32

ADVAIR DISKUS ________ 6

ADVAIR HFA ___________ 6

ADVATE ______________ 27

ADZENYS ER ___________ 3

ADZENYS XR-ODT ______ 3

AFINITOR _____________ 13

AFLURIA 2018-2019 ___ 37

AFLURIA PF 2018-2019_ 37

AFLURIA QUADRIVALENT

2018 ______________ 37

AFREZZA_______________ 9

AGGRENOX ___________ 27

AIMOVIG _____________ 29

AIRDUO RESPICLICK

113/14 _____________ 6

AIRDUO RESPICLICK

232/14 _____________ 6

AIRDUO RESPICLICK 55/14

____________________ 6

AJOVY________________ 29

AKTIPAK ______________ 20

AKYNZEO _____________ 11

ALA SCALP ____________ 20

ALA-QUIN ____________ 20

albendazole ____________ 6

ALBENZA ______________ 6

albuterol sulfate ________ 6

albuterol sulfate er _____ 6

alclometasone dipropionat

___________________ 20

ALCORTIN A __________ 20

ALDACTAZIDE _________ 24

ALDACTONE __________ 24

ALDARA ______________ 20

ALECENSA ____________ 13

alendronate tab 35mg _ 25

ALENDRONATE TAB 40MG

___________________ 25

ALEVICYN ANTIPRURITIC

SG_________________ 20

alfuzosin hcl er ________ 27

ALINIA _______________ 13

ALLERGENIC

EXTRACTS/BIOLOGICAL

S MISC ______________ 3

allopurinol ____________ 27

almotriptan ___________ 29

almotriptan malate ____ 29

ALOCRIL ______________ 33

ALOGLIPTIN____________ 9

ALOGLIPTIN/METFORMIN

HCL ________________ 9

ALOGLIPTIN/PIOGLITAZON

E ___________________ 9

ALORA _______________ 26

alosetron hydrochloride 26


ALPHAGAN P SOL 0.15%

___________________ 33

alprazolam ____________ 6

alprazolam er __________ 6

alprazolam odt _________ 6

alprazolam xr __________ 6

ALREX________________ 33

ALTABAX _____________ 20

altavera ______________ 17

ALUNBRIG ____________ 13

ALVESCO ______________ 6

alyacen 1/35 __________ 17

alyacen 7/7/7 _________ 17

amabelz ______________ 26

amantadine hcl _______ 14

AMARYL_______________ 9

AMBIEN ______________ 28

AMBIEN CR ___________ 28

amcinonide ___________ 20

Amebicides ____________ 3

amethia ______________ 17

amethia lo ____________ 17

amethyst _____________ 17

AMICAR ______________ 28

amiloride hcl __________ 24

amiloride/hydrochlorothia

___________________ 25

Aminoglycosides _______ 3

amiodarone hcl ________ 6

amiodarone hydrochloride

____________________ 6

AMITIZA______________ 26

amitriptyline hcl ________ 8

amitriptyline hydrochlori 8

amlodipine besylate 12, 16,

17

amlodipine besylate/atorv

___________________ 17

amlodipine besylate/benaz

___________________ 12

amlodipine besylate/valsa

___________________ 12

amlodipine/olmesartan

med _______________ 12

amlodipine/valsartan/hctz

___________________ 12

amnesteem ___________ 20

amoxicillin _________ 34, 36

amoxicillin/clavulanate p34

amphetamine sulfate ___ 3

amphetamine/dextroamph

eta _________________ 3

amphotericin b________ 11

ampicillin _____________ 34

AMPYRA _____________ 34

AMRIX _______________ 32

anagrelide hydrochloride

___________________ 27

ANALGESICS - ANTI-

INFLAMMATORY _____3

ANALGESICS - NonNarcotic

_____________________4

ANALGESICS - OPIOID ___4

ANALPRAM HC _________5

ANALPRAM HC SINGLES _5

ANALPRAM-HC _________5

anastrozole ___________ 13

ANDRODERM ___________5

ANDROGEL GEL

1%(50MG) ___________5

ANDROGEL GEL 1.62% _5

ANDROGEL PUMP_______5

ANDROGENS-ANABOLIC _5

ANGELIQ _____________ 26

ANORECTAL AGENTS ____5

ANORO ELLIPTA ________6

ANTARA _____________ 11

Anthelmintics __________6

ANTIANGINAL AGENTS __6

ANTIANXIETY AGENTS ___6

ANTIARRHY THMICS _____6

ANTIASTHMATIC AND

BRONCHODILATOR

AGENTS _____________6

ANTICOAGULANTS ______7

ANTICONVULSANTS _____7

ANTIDEPRESSANTS______8

ANTIDIABETICS _________9

ANTIDIARRHEAL/PROBIOT

IC AGENTS _________ 10

Antidotes and Specific

Antagonists________ 10

ANTIEM ETICS _________ 11

Antifungals ___________ 11

ANTIHISTAMINES _____ 11

ANTIHYPERLIPIDEMICS 11

ANTIHYPERTENSIVES __ 12

Anti-infective Agents -

Misc.______________ 13

Antimalarials _________ 13

Antimyasthenic/Cholinergi

c Agents ___________ 13

Antimycobacterial Agents

___________________ 13

ANTINEOPLASTICS AND

ADJUNCTIVE

THERAPIES ________ 13

ANTIPARKINSON AND

RELATED THERAPY

AGENTS ___________ 14

ANTIPSYCHOTICS/ANTIMA

NIC AGENTS _______ 15

40

Antiseptics & Disinfectants

___________________ 15

ANTIVIRALS ___________ 15

anucort-hc _____________ 5

anusol-hc ______________ 5

APIDRA ________________ 9

APIDRA SOLOSTAR _____ 9

APLENZIN ______________ 8

APOKYN ______________ 14

apraclonidine__________ 33

aprepitant ____________ 11

apri __________________ 17

APRISO _______________ 26

APTENSIO XR___________ 3

APTIOM _______________ 7

aranelle_______________ 17

ARANESP ALBUMIN FREE

___________________ 27

ARCAPTA NEOHAL ER ___ 6

ARESTIN ______________ 30

aripiprazole ___________ 15

aripiprazole odt________ 15

ARISTADA ____________ 15

armodafinil ____________ 3

ARMOUR THY ROID ____ 35

ARNUITY ELLIPTA _______ 6

AROMASIN ___________ 13

ARTHROTEC 75 _________ 3

ARYMO ER _____________ 4

ARZOL SILVER NITRATE

APP _______________ 20

ASACOL HD ___________ 26

ascomp/codeine ________ 4

ashlyna _______________ 17

ASMANEX HFA _________ 6

ASMANEX TWISTHALER

120 ME _____________ 6

ASMANEX TWISTHALER 14

MET ________________ 6


MET ________________ 6


MET ________________ 7

aspirin/dipyridamole ___ 27

ASTAGRAF XL _________ 30

ASTEPRO _____________ 32

ASTERO_______________ 20

atazanavir_____________ 15

atazanavir sulfate ______ 15

atenolol __________ 12, 16

atenolol/chlorthalidone 12

ATIVAN ________________ 6

atomoxetine ___________ 3

atomoxetine hydrochloride

____________________ 3

atorvastatin calcium ___ 11

atovaquone ___________ 13

atovaquone/proguanil hcl

___________________ 13

ATRIPLA ______________ 15

atropine sulfate _______ 33

ATROVENT HFA ________ 7

AUBAGIO _____________ 34

aubra ________________ 17

aubra eq______________ 17

augmented

betamethasone d ___ 20

AUGMENTIN __________ 34

AURYXIA _____________ 26

AUSTEDO _____________ 34

AUVI-Q _______________ 38

AVANDIA ______________ 9

AVAPRO ______________ 12

avar cleanser __________ 20

AVAR LS ______________ 20

AVAR LS CLEANSER ____ 20

avar-e green __________ 20

AVAR-E LS ____________ 20

AVASTIN _____________ 13

AVC __________________ 37

AVEED ________________ 5

AVENOVA ____________ 20

aviane ________________ 17

avita _________________ 20

AVODART ____________ 27

AVONEX ______________ 34

AVONEX PEN _________ 34

azacitidine ____________ 13

AZASAN ______________ 30

AZASITE ______________ 33

azathioprine __________ 30

azelastine hcl__________ 32

azelastine hydrochloride 32

AZELEX _______________ 20

AZILECT ______________ 14

AZITHROMYCIN POW 1GM

PAK _______________ 29

azithromycin sus 200/5ml

___________________ 29

AZOPT________________ 33

AZOR_________________ 12

AZULFIDINE EN-TABS __ 26

azurette ______________ 17

BACITRACIN __________ 33

bacitracin/polymyxin b _ 33

baclofen tab 20mg___ 32

BACLOFEN TAB 5MG_ 32

BALCOLTRA ___________ 17

balsalazide disodium ___ 26

BALVERSA ____________ 13

balziva________________ 17

BANZEL ________________ 7

BARACLUDE __________ 15

BASAGLAR KWIKPEN ___ 9

BAXDELA _____________ 26

bd posiflush ___________ 29

BECONASE AQ ________ 32

bekyree ______________ 17

BELBUCA ______________ 4

belladonna & opium ___ 36

belladonna alkaloids & op

___________________ 36

BELSOM RA ___________ 28

BELVIQ ________________ 3

BELVIQ XR _____________ 3

benazepril hcl _________ 12

benazepril hcl/hydrochlor

___________________ 12

BENEFIX ______________ 27

BENICAR _____________ 12

BENICAR HCT _________ 12

BENLYSTA ____________ 30

BENSAL HP ___________ 20

BENZACLIN ___________ 20

BENZACLIN WITH PUMP 20

BENZEFOAM __________ 20

BENZEFOAM UL TRA ___ 20

benzepro _____________ 20

benzepro creamy wash 20

benzepro foaming cloths20

benzepro short contact 20

benzonatate __________ 20

benztropine mesylate __ 14

BEPREVE _____________ 33

BESIVANCE ___________ 33

BETA BLOCKERS_______ 16

betamethasone

dipropionat ________ 20

betamethasone sodium

phos ______________ 19

betamethasone valerate 21

BETAPACE ____________ 16

BETASERON __________ 34

betaxolol hcl __________ 16

bethanechol chloride __ 37

BETIM OL _____________ 33

BETOPTIC-S ___________ 33

BEVESPI AEROSPHERE __ 7

BEXSERO _____________ 37

BEYAZ________________ 17

BIAFINE ______________ 21

bicalutamide __________ 13

BICILLIN L-A __________ 34

BIDIL _________________ 17

BIKTARVY ____________ 15

BILTRICIDE_____________ 6

bimatoprost __________ 21

BIONECT _____________ 21

bisoprolol fumarate 12, 16

bisoprolol fumarate/hydro

___________________ 12

BLEPHAMIDE _________ 33

BLEPHAMIDE S.O.P. ___ 33

blisovi 24 fe___________ 17

blisovi fe 1.5/30 _______ 17

blisovi fe 1/20_________ 17

BONIVA ______________ 25

BONJ ESTA ____________ 11

BOOSTRIX ____________ 36

BOSULIF ______________ 13

BOTOX ____________ 21, 32

BOTOX COSMETIC ____ 21

bp 10-1 ______________ 21

bp foam ______________ 21

bp wash ______________ 21

BPO _________________ 21

BRAFTOVI ____________ 13

BREO ELLIPTA __________7

briellyn_______________ 17

BRILINTA _____________ 27

brimonidine tartrate___ 33

BRISDELLE____________ 34

BRIVIACT_______________7

bromfed dm __________ 20

bromfenac ___________ 33

bromocriptine mesylate 14

bromphen/pseudoephedri

ne ________________ 20

BROMSITE____________ 33

BROVANA ______________7

budesonide_________ 7, 19

budesonide er ________ 19

bumetanide __________ 25

BUNAVAIL______________4

bupap__________________4

bupivacaine hcl _______ 29

BUPIVILOG KIT________ 19

BUPRENORPHINE _______4

buprenorphine hcl ______4

buprenorphine hcl/naloxon

_____________________4

buprenorphine hydrochlori

_____________________4

bupropion hcl___________8

bupropion hcl er ________8

bupropion hcl sr ________8

bupropion hcl xl_________8

bupropion hydrochloride_8

bupropion hydrochloride e

_____________________8

bupropion hydrochloride s

_____________________8

bupropion hydrochloride x

_____________________8

buspirone hcl ___________6

buspirone hydrochloride _6

BUT/ASA/CAF TA B _____4

but/asa/caf/ cap cod 30mg

_____________________4

butalbital/acetaminophen4

butalbital/acetaminophen/

_____________________4

butorphanol tartrate ____4

BUTRANS ______________4

BYDUREON _____________9

BYDUREON BCISE _______9

BYDUREON PEN ________9

BYETTA ________________9

BYSTOLIC_____________ 16

BYVALSON ___________ 12

41

cabergoline ___________ 25

CABOMETYX __________ 13

CADUET ______________ 17

caffeine citrate _________ 3

calcipotriene __________ 21

calcipotriene/betamethaso

___________________ 21

calcitonin salmon ______ 25

calcitonin-salmon ______ 25

calcitrene _____________ 21

calcitriol ______________ 25

calcium acetate________ 26

Calcium Channel Blockers

___________________ 16

CAMBIA ______________ 29

camila ________________ 17

camrese ______________ 17

camrese lo ____________ 17

CANASA ______________ 26

candesartan cilexetil ___ 12

candesartan cilexetil/hyd

___________________ 12

capecitabine __________ 13

CAPEX ________________ 21

CAPHOSOL ____________ 30

CAPRELSA_____________ 13

captopril ______________ 12

captopril/hydrochlorothia

___________________ 12

CARAFATE ____________ 36

CARB/LEVO 75 TAB

/ENTACAP _________ 14

carb/levo100 tab /entacap

___________________ 14

carbamazepine _________ 7

carbamazepine er_______ 7

CARBATROL ____________ 7

carbidopa _____________ 14

carbidopa/levodopa____ 14

carbidopa/levodopa er _ 14

carbidopa/levodopa odt 14

carbinoxamine maleate 11

CARDIOTONICS________ 17

CARDIOVASCULAR

AGENTS - MISC._____ 17

CARDIZEM LA _________ 16

CARDURA XL __________ 27

carisoprodol___________ 32

CARNITOR ____________ 25

CAROSPIR_____________ 25

carteolol hcl ___________ 33

cartia xt_______________ 16

carvedilol _____________ 16

carvedilol phosphate ___ 16

CATAPRES-TTS-1_______ 12

CATAPRES-TTS-3_______ 12

CAVERJECT IMPULSE ___ 17

CAYA _________________ 29

CAYSTON _____________ 13

caziant________________ 17

cefaclor_______________ 17

cefadroxil _____________ 17

cefdinir _______________ 17

cefepime _____________ 17

cefixime ______________ 17

cefpodoxime proxetil __ 17

cefprozil ______________ 17

ceftriaxone sodium ____ 17

cefuroxime axetil ______ 17

celacyn _______________ 21

CELEBREX______________ 3

celecoxib ______________ 3

CELEXA ________________ 8

CELLCEPT _____________ 30

CELONTIN _____________ 7

CENTRATEX ___________ 27

CEPHALEXIN TAB 250MG

___________________ 17

cephalexin tab 500mg_ 17

CEPHALOSPORINS _____ 17

CERACADE ____________ 21

ceramax ______________ 21

CERDELGA ____________ 27

CEREFOLIN NAC _______ 24

CETROTIDE ___________ 25

cevimeline hcl _________ 30

CHANTIX _____________ 34

CHANTIX CONTINUING

MONTH ___________ 34

CHANTIX STARTING

MONTH PA ________ 34

chateal _______________ 17

CHEMET ______________ 10

chlordiazepoxide hcl _ 6, 36

chlordiazepoxide hcl/clid36

chlordiazepoxide/amitript

___________________ 35

chlorhexidine gluconate 30

chloroquine phosphate_ 13

chlorothiazide _________ 25

chlorpromazine hcl ____ 15

chlorpropamide ________ 9

chlorthalidone _____12, 25

CHLORZOXAZON TAB

250MG ____________ 32

chlorzoxazon tab 500mg 32

cholestyramine ________ 11

cholestyramine light ___ 11

chorionic gonadotropin 25

chromagen ___________ 27

CIALIS ________________ 17

ciclopirox _____________ 21

ciclopirox nail lacquer __ 21

ciclopirox olamine _____ 21

cidofovir ______________ 15

cilostazol _____________ 27

CILOXAN _____________ 33

cimetidine ____________ 36

cimetidine hcl _________ 36

CIMZIA _______________ 26

CIMZIA STA RTER KIT___ 26

CIPRO _____________ 26, 34

CIPRO HC _____________ 34

CIPRODEX ____________ 34

CIPROFLOXACIN ______ 34

ciprofloxacin er _______ 26

ciprofloxacin hcl _______ 26

ciprofloxacin hydrochlori26

citalopram _____________ 8

citalopram hydrobromide 8

CITRANATAL 90 DHA __ 31

CITRANATAL ASSURE __ 31

CITRANATAL B-CALM __ 31

CITRANATAL BLOOM __ 31

CITRANATAL DHA _____ 31

CITRANATAL HARMONY 31

CITRANATAL RX _______ 31

claravis _______________ 21

CLARINEX _________ 11, 20

CLARINEX-D 12 HOUR _ 20

clarithromycin ________ 29

clarithromycin er ______ 29

clemastine fumarate___ 11

CLENPIQ______________ 28

CLEOCIN______________ 37

CLIMARA _____________ 26

CLIMARA PRO ________ 26

CLINDACIN PAC _______ 21

CLINDAGEL ___________ 21

clindamycin hcl________ 13

clindamycin hydrochloride

___________________ 13

clindamycin palmitate hcl

___________________ 13

clindamycin phosphate 21

CLINDAMYCIN

PHOSPHATE/BEN___ 21

clindamycin phosphate/tre

___________________ 21

clindamycin/benzoyl perox

___________________ 21

CLINDESSE____________ 37

clinpro 5000 __________ 30

clobazam ______________ 7

clobetasol propionate__ 21

clobetasol propionate e 21

clobetasol propionate emo

___________________ 21

CLOBEX ______________ 21

CLOCORTOLONE PIVALATE

___________________ 21

CLOCORTOLONE PIVALATE

PUM ______________ 21

clodan________________ 21

CLODERM ____________ 21

CLODERM PUMP ______ 21

clomiphene citrate ____ 25

clomipramine hcl _______ 8

clonazepam____________ 7

clonazepam odt ________ 7

clonidine hcl ________ 3, 12

clonidine hcl er _________3

clonidine hydrochloride __3

clonidine hydrochloride e 3

clopidogrel ___________ 27

clorazepate dipotassium _6

clotrimazole _______ 21, 30

clotrimazole/betamethaso

n _________________ 21

clozapine _____________ 15

CLOZAPINE TAB

200/ODT __________ 15

clozapine tab 25mg odt

___________________ 15

COAL TAR ____________ 21

COARTEM ____________ 13

codeine sulfate _________5

COLCHICINE CAP 0.6MG

___________________ 27

COLCHICINE TAB 0.6MG

___________________ 27

COLCRYS _____________ 27

colesevelam hydrochloride

___________________ 11

COLESTID ____________ 11

colestipol hcl _________ 11

colocort ________________5

COLY-MYCIN S ________ 34

COLYTE-FLAVOR PACKS 28

COMBIGAN___________ 33

COMBIPATCH_________ 26

COMBIVENT RESPIMAT__7

COMETRIQ ___________ 13

COMPLERA ___________ 15

complete natal dha ____ 31

completenate_________ 31

compro ______________ 15

CONCEPT DHA ________ 31

CONCEPT OB _________ 31

CONCERTA _____________3

CONDYLOX ___________ 21

constulose____________ 28

CONTRACEPTIVES _____ 17

CONTRAVE _____________3

CONZIP ________________5

COPAXONE INJ

20MG/ML _________ 35

COPAXONE INJ

40MG/ML _________ 35

CORDRA N ____________ 21

COREG _______________ 16

COREG CR ____________ 16

CORGARD ____________ 16

CORLANOR ___________ 17

CORTEF ___________ 19, 20

CORTICOSTEROIDS ____ 19

CORTIFOAM ____________5

CORTISPORIN_________ 21

corvita 150 ___________ 27

CORVITE FE___________ 27

42

COSENTYX ____________ 21

COSENTYX SENSOREADY

PEN _______________ 21

COSOPT ______________ 33

COSOPT PF____________ 33

COTEMPLA XR-ODT _____ 3

COUGH/COLD/ALLERGY 20

COUMADIN ____________ 7

COZAAR ______________ 12

CREON _______________ 24

CRESEMBA ____________ 11

CRESTOR _____________ 11

CRINONE _____________ 37

cromolyn sodium _______ 7

cryselle-28 ____________ 17

CUVPOSA _____________ 36

cyanocobalamin _______ 27

cyclafem 1/35 _________ 17

cyclafem 7/7/7 ________ 17

cyclobenzaprine hcl ____ 32

cyclobenzaprine hydrochlo

___________________ 32

CYCLOMYDRIL_________ 33

cyclopentolate hcl _____ 33

cyclopentolate hydrochlor

___________________ 33

CYCLOPHOSPH CAP 25MG

___________________ 13

cyclophosph cap 50mg _ 13

CYCLOSET ______________ 9

cyclosporine___________ 30

cyclosporine cap 25mg

mod _______________ 30

CYCLOSPORINE CAP 50MG

MOD ______________ 30

CYMBALTA_____________ 8

cyproheptadine hcl ____ 11

cyred _________________ 17

cyred eq ______________ 17

CYTOMEL _____________ 35

CYTOTEC ______________ 36

dalfampridine er _______ 35

DALIRESP ______________ 7

danazol ________________ 5

dantrolene sodium_____ 32

dapsone ______________ 13

darifenacin hydrobromide

___________________ 37

dasetta 1/35 __________ 18

dasetta 7/7/7 _________ 18

daysee________________ 18

DAYTRANA ____________ 3

DDAVP _______________ 25

DEBACTEROL __________ 30

deblitane _____________ 18

DELESTROGEN ________ 26

DELZICOL _____________ 26

demeclocycline hcl _____ 35

DENAVIR _____________ 21

denta 5000 plus _______ 30

dentagel ______________ 30

DEPAKOTE ___________ 7, 8

DEPAKOTE ER __________ 8

DEPLIN 15 ____________ 24

DEPLIN 7.5 ____________ 24

DEPO-ESTRADIOL _____ 26

DEPO-MEDROL ________ 19

DEPO-PROVERA

CONTRACEPTIV_____ 18

DEPO-SUBQ PROVERA 104

___________________ 18

DEPO-TESTOSTERONE __ 5

DERMACINRX LEXITRAL

PHARM ____________ 21

dermacinrx prizopak ___ 21

DERMACINRX ZRM PAK 21

DERMA-SMOOTHE/FS

SCALP _____________ 21

DERMASORB HC ______ 21

DERMASORB XM ______ 21

DERMATOLOGICALS ___ 20

dermazene____________ 21

DESCOVY _____________ 15

desipramine hcl ________ 8

desipramine hydrochloride

____________________ 8

desloratadine _________ 11

desloratadine odt______ 11

desmopressin acetate __ 25

desogestrel/ethinyl estra18

DESONATE____________ 21

desonide _____________ 21

desoximetasone _______ 21

desvenlafax tab 100mg er

____________________ 8

DESVENLAFAX TAB 50MG

ER__________________ 8

DETROL ______________ 37

DETROL LA ____________ 37

DEXAMETHASON SOL

0.5/5ML ___________ 19

dexamethason tab 0.75mg

___________________ 19

DEXAMETHASONE

INTENSOL __________ 19

DEXILANT_____________ 36

dexmethylphenidate hcl_ 3

dexmethylphenidate hcl er

____________________ 3

dexmethylphenidate

hydroc______________ 3

DEXPAK 10 DAY _______ 19

DEXPAK 6 DAY ________ 19

dextroamphetamine

sulfate ______________ 3

dextrose 20% _________ 32

dextrose 5%___________ 32

DIACOMIT _____________ 8

DIAGNOSTIC PRODUCTS24

dialyvite ______________ 31

DIALYVITE/ZINC _______ 31

DIASTAT ACUDIAL ______ 8

diazepam ______________ 6

diazepam intensol ______ 6

DIAZEPAM RECTAL GEL _ 8

DICLEGIS _____________ 11

diclofenac potassium ___ 3

diclofenac sodium ___ 3, 21

diclofenac sodium dr____ 3

diclofenac sodium er____ 3

diclofenac sodium/misopro

____________________ 3

dicloxacillin sodium ____ 34

dicyclomine hcl________ 36

dicyclomine hydrochloride

___________________ 36

DIETARY

PRODUCTS/DIETARY

MANAGEMENT

PRODUCTS_________ 24

diethylpropion hcl ______ 3

diethylpropion hcl er____ 3

DIFFERIN _____________ 21

DIFICID _______________ 29

diflorasone diacetate __ 21

DIFLUCAN ____________ 11

diflunisal ______________ 4

DIGESTIVE AIDS _______ 24

digitek _______________ 17

digox_________________ 17

digoxin _______________ 17

dihydroergot inj 1mg/ml 29

DIHYDROERGOT SPR

4MG/ML __________ 29

DILANTIN CAP 100MG 8

DILANTIN CAP 30MG _ 8

DILANTIN INFA TABS ____ 8

diltiazem hcl __________ 16

diltiazem hcl cd _______ 16

diltiazem hcl er________ 16

diltiazem hydrochloride e

___________________ 16

dilt-xr ________________ 16

DIOVAN ______________ 12

DIOVAN HCT__________ 12

DIPENTUM ___________ 26

diphenhydramine hcl __ 11

diphenoxylate/atropine 10

dipyridamole__________ 27

disopyramide phosphate 6

disulfiram ____________ 35

DIURETICS ____________ 24

DIURIL _______________ 25

divalproex sodium ______ 8

divalproex sodium dr ___ 8

divalproex sodium er ___ 8

DIVIGEL ______________ 26

dofetilide ______________ 6

donepezil hcl__________ 35

donepezil hydrochloride 35

DONNATAL ___________ 36

DORAL _______________ 28

DORYX MPC __________ 35

dorzolamide hcl _______ 33

dorzolamide hcl/timolol m

___________________ 33

dorzolamide hydrochloride

___________________ 33

DOVATO _____________ 15

doxazosin mesylate____ 12

doxepin hcl _____________8

doxepin hydrochloride _ 21

doxercalciferol ________ 25

DOXYCYCLINE CAP 40MG

___________________ 21

doxycycline sus 25mg/5ml

___________________ 35

doxycycline hyclate____ 35

doxycycline hyclate dr _ 35

doxycycline monohydrate

___________________ 35

DRITHO-CREME HP ____ 21

dronabinol ___________ 11

drospirenone/ethinyl estr

___________________ 18

DROXIA ______________ 27

DRYSOL ______________ 21

DUAC ________________ 21

DUAVEE______________ 26

DUEXIS_________________3

DULERA ________________7

duloxetine hcl___________8

duloxetine hydrochloride 8

DUPIXENT ____________ 21

DURAGESIC ____________5

DUREZOL _____________ 33

dutasteride ___________ 27

dutasteride/tamsulosin hc

___________________ 27

dutasteride/tamsulosin hy

___________________ 27

DUTOPROL ___________ 12

DYANAVEL XR __________3

DYAZIDE _____________ 25

DYMISTA _____________ 32

DYRENIUM ___________ 25

DYSPORT_____________ 32

e.e.s. 400_____________ 29

E.E.S. GRA NULES ______ 29

econazole nitrate _____ 21

ECOZA _______________ 21

EDARBI ______________ 12

EDARBYCLOR _________ 12

EDEX_________________ 17

EDLUAR ______________ 28

EDURANT ____________ 15

eemt_________________ 26

eemt hs ______________ 26

efavirenz _____________ 15

EFFER-K TAB 20MEQ 29

43

effer-k tab 25meq ef_ 29

effervescent pot chloride

___________________ 29

EFFEXOR XR____________ 8

EFFIENT_______________ 27

EFUDEX_______________ 21

ELETONE______________ 21

ELETONE TWINPACK ___ 21

eletriptan hydrobromide29

ELFOLATE TAB 15MG 24

ELFOLATE TAB 7.5MG 24

ELIDEL ________________ 21

ELIGARD ______________ 13

elinest ________________ 18

ELIQUIS________________ 7

ELIQUIS STARTER PACK _ 7

elite-ob _______________ 31

ELLA__________________ 18

ELMIRON _____________ 27

ELOCON ______________ 21

ELOCTA TE_____________ 27

EMBEDA _______________ 5

EMEND _______________ 11

EMFLAZA _____________ 19

EMGALITY ____________ 29

emoquette ____________ 18

EMSAM________________ 8

EMULSION SB _________ 21

EMVERM ______________ 6

enalapril maleate ______ 12

enalapril maleate/hydroch

___________________ 12

ENBRACE HR __________ 31

ENBREL ______________ 3, 4

ENBREL MINI___________ 3

ENBREL SURECLICK _____ 4

endocet________________ 5

ENDOCRINE AND

METABOLIC AGENTS -

MISC. ______________ 25

ENDOMETRIN _________ 37

ENGERIX-B ____________ 37

ENLYTE _______________ 24

enoxaparin sodium _____ 7

enpresse-28 ___________ 18

enskyce _______________ 18

ENSTILAR _____________ 21

entacapone ___________ 14

entecavir _____________ 15

ENTERAGAM __________ 24

ENTOCORT EC _________ 19

ENTRESTO ____________ 17

ENTTY SPRAY EMULSION

___________________ 21

ENTYVIO______________ 26

enulose _______________ 26

ENVARSUS XR _________ 30

EPANED ______________ 12

EPCLUSA ______________ 15

EPICERAM ____________ 21

EPIDIOLEX _____________ 8

EPIDUO ______________ 21

EPIDUO FORTE ________ 21

EPIFOAM _____________ 21

epinastine hcl _________ 33

EPIPEN 2-PAK _________ 38

EPIPEN-JR 2 -PAK ______ 38

epitol__________________ 8

eplerenone ___________ 12

EPOGEN ______________ 27

eprosartan mesylate ___ 12

ergocalciferol _________ 38

ERGOMAR ____________ 29

ergotamine tartrate/caffe

___________________ 29

ERIVEDGE ____________ 13

errin _________________ 18

ERTACZO _____________ 21

ery ___________________ 21

ERYPED 400___________ 29

ERY-TAB ______________ 29

ERYTHROCIN STEARATE 29

erythromycin_______21, 29

erythromycin base _____ 29

erythromycin ethylsuccina

___________________ 29

erythromycin/benzoyl pero

___________________ 21

ESBRIET ______________ 35

escitalopram oxalate ____ 9

esgic __________________ 4

esomeprazole magnesium

___________________ 36

esomeprazole magnesium

dr _________________ 36

ESOMEPRAZOLE

STRONTIUM _______ 36

estarylla ___________18, 19

estazolam_____________ 28

esterified estrogens/meth

___________________ 26

ESTRACE______________ 37

estradiol ___________26, 37

estradiol valerate ______ 26

estradiol/norethindrone a

___________________ 26

ESTRING ______________ 37

ESTROGEL ____________ 26

Estrogens _____________ 26

ESTROSTEP FE_________ 18

eszopiclone ___________ 28

ethacrynic acid ________ 25

ethambutol hcl ________ 13

ethosuximide __________ 8

ethyl chloride/medium jet

___________________ 21

ethyl chloride/medium str

___________________ 21

ethynodiol diacetate/ethi

___________________ 18

etodolac_______________ 4

etodolac er ____________ 4

etoposide ____________ 13

EUCRISA ______________ 21

EUFLEXXA ____________ 32

EVAMIST _____________ 26

EVEKEO _______________ 3

EVISTA _______________ 25

EVOTA Z ______________ 15

exemestane __________ 13

EXJADE_______________ 10

EXTAVIA _____________ 35

EYLEA ________________ 33

ezetimibe_____________ 11

ezetimibe/simvastatin _ 11

fabb _________________ 27

FABIOR_______________ 21

FABRAZYME __________ 25

falmina _______________ 18

famciclovir____________ 15

famotidine____________ 36

FANAPT ______________ 15

FARXIGA ______________ 9

FASENRA ______________ 7

FASLODEX ____________ 13

fayosim ______________ 18

felbamate _____________ 8

felodipine er __________ 16

FEM PH ______________ 37

FEMRING _____________ 37

femynor ___________ 18, 19

FENOFIBRATE CAP 50MG

___________________ 11

fenofibrate tab 48mg__ 11

fenofibrate micronized_ 11

FENOFIBRIC ACID _____ 11

fenofibric acid dr ______ 11

FENOPROFEN CAP

400MG _____________ 4

fenoprofen tab 600mg _ 4

FENORTHO ____________ 4

fentanyl _______________ 5

fentanyl citrate_________ 5

fentanyl citrate oral tra _ 5

FENTORA ______________ 5

FERAHEM E ___________ 27

FERIVA 21/7 __________ 27

ferocon_______________ 28

FERRALET 90 __________ 28

FERRAPLUS 90 ________ 28

FETZIMA ______________ 9

FETZIMA TITRATION PACK

____________________ 9

FIASP _________________ 9

FIASP FLEXTOUCH ______ 9

FINACEA _____________ 22

finasteride ____________ 27

FIORICET ______________ 4

FIORINAL ______________ 4

FIRAZYR ______________ 27

FIRST-BACLOFEN 5 ____ 32

FIRST-LANSOPRAZOLE _ 36

FIRST-METRONIDAZOLE

100 _______________ 13

FIRST-METRONIDAZOLE 50

___________________ 13

FIRST-MOUTHWASH BLM

___________________ 30

FIRST-OM EPRAZOLE___ 36

FIRST-PROGESTERONE

VGS 10 ____________ 37

FIRST-PROGESTERONE

VGS 20 ____________ 37



FIRVANQ _____________ 13

flavoxate hcl __________ 37

FLEBOGAMMA DIF ____ 34

flecainide acetate _______6

FLECTOR _____________ 22

FLOMAX _____________ 27

FLONASE _____________ 32

FLORIVA PLUS ________ 31

FLOVENT DISKUS________7

FLOVENT HFA ___________7

FLUAD 2018-2019 _____ 37

FLUARIX QUADRIVALENT

2018 ______________ 37

FLUBLOK QUADRIVALENT

2018 ______________ 37

FLUCELVAX

QUADRIVALENT 20 _ 37

fluconazole ___________ 11

fludrocortisone acetate 19

FLULAVAL QUADRIVALENT

201 _______________ 37

FLUMIST QUADRIVALENT

___________________ 37

flunisolide ____________ 32

fluocinolone acetonide 22

fluocinolone acetonide bo

___________________ 22

fluocinolone acetonide sc

___________________ 22

fluocinonide __________ 22

fluocinonide emulsified 22

fluocinonide emulsified b

___________________ 22

FLUORABON__________ 29

fluoride ____ 29, 30, 31, 32

fluorometholone ______ 33

FLUOROPLEX _________ 22

Fluoroquinolones _____ 26

fluorouracil ___________ 22

fluoxetine __________ 9, 35

fluoxetine tab 10mg ____9

FLUOXETINE TAB 60MG 9

fluoxetine dr____________9

fluoxetine hcl ___________9

fluphenazine decanoate 15

44

fluphenazine hcl _______ 15

FLURA-DROPS _________ 29

flurandrenolide ________ 22

flurazepam hcl_________ 28

flurbiprofen _________4, 33

flurbiprofen sodium ____ 33

flutamide _____________ 13

fluticasone propionate _ 32

FLUTICASONE

PROPIONATE/SA ____ 7

fluvastatin ____________ 11

fluvastatin sodium er___ 11

fluvoxamine maleate ____ 9

fluvoxamine maleate er _ 9

FLUZONE HIGH-DOSE PF

2018_______________ 37

FLUZONE QUADRIVALENT

2018_______________ 37

FML __________________ 33

FML FORTE____________ 33

FML LIQUIFILM ________ 33

FOCALIN _______________ 3

FOCALIN XR ____________ 3

folbee ____________ 28, 31

folbee plus ____________ 31

folbic _________________ 24

FOLBIC RF_____________ 24

FOLGARD OS __________ 31

folic acid/vitamin b-6/vi 28

FOLIVANE-F ___________ 28

FOLIVANE-PLUS _______ 28

FOLLISTIM AQ _________ 25

FOLTANX _____________ 24

FOLTANX RF __________ 24

FOLTX ________________ 24

fondaparinux sodium____ 7

FORFIV O XL ____________ 9

formaldehyde _________ 15

FORTEO ______________ 25

FORTESTA _____________ 5

FOSAMAX PLUS D _____ 25

fosinopril sodium ______ 12

fosinopril sodium/hydroch

___________________ 12

FOSRENOL ____________ 26

FOSTEUM PLUS________ 24

FRAGMIN ______________ 7

FREESTYLE

LIBRE/READER/FL ___ 29

FREESTYLE

LIBRE/SENSOR/FL ___ 29

FROVA _______________ 29

frovatriptan succinate __ 29

FULPHILA _____________ 28

furosemide____________ 25

FUSION PLUS__________ 28

fyavolv _______________ 26

FYCOMPA______________ 8

gabapentin_____________ 8

GABLOFEN ____________ 32

galantamine hydrobromide

___________________ 35

GALZIN _______________ 29

GANIRELIX ACETATE ___ 25

GARDASIL 9 ___________ 37

GASTROINTESTINAL

AGENTS - MISC. ____ 26

gatifloxacin ___________ 33

gavilyte-c _____________ 28

gavilyte-g _____________ 28

gavilyte-n/flavor pack __ 28

GELCLAIR _____________ 30

GELNIQUE ____________ 37

GEL-ONE______________ 32

gemfibrozil____________ 11

GENADUR ____________ 22

GENERAL ANESTHETICS 27

GENERESS FE__________ 18

generlac ______________ 26

gengraf _______________ 30

GENITOURINARY AGENTS -

MISCELLANEOUS ___ 27

GENOTROPIN _________ 25

GENOTROPIN MINIQUICK

___________________ 25

GENTAK ______________ 33

gentamicin sulfate ______ 3

GENVOYA ____________ 15

GEODON _____________ 15

gianvi ________________ 18

GILENYA ______________ 35

GILTUSS TR ___________ 20

GLASSIA ______________ 35

glatiramer acetate _____ 35

glatopa _______________ 35

GLEEVEC______________ 13

GLEOSTINE ___________ 13

glimepiride ____________ 9

glipizide _______________ 9

glipizide er _____________ 9

glipizide xl _____________ 9

glipizide/metformin hcl _ 9

GLUCAGEN HYPOKIT____ 9

GLUCAGON EMERGENCY

KIT _________________ 9

GLUCOPHAGE __________ 9

GLUCOPHAGE XR _______ 9

GLUCOTROL XL _________ 9

GLUMETZA ____________ 9

glyburide ___________ 9, 10

glyburide micronized____ 9

glyburide/metformin hcl 10

glycopyrrolate_________ 36

GLYXAMBI ____________ 10

GOCOVRI _____________ 14

GOLYTELY ____________ 28

GONAL-F _____________ 25

GONAL-F RFF REDIJECT 25

Gout Agents __________ 27

GRALISE ______________ 35

GRALISE STARTER _____ 35

granisetron hcl ________ 11

GRANIX ______________ 28

GRASTEK ______________ 3

griseofulvin microsize __ 11

griseofulvin ultramicrosi 11

guanfacine er __________ 3

guanfacine hcl ________ 12

guanfacine hydrochloride 3

GYNAZOLE-1 __________ 37

H.P. ACTHAR__________ 25

HALCION _____________ 28

halobetasol propionate 22

HALOG _______________ 22

haloperidol ___________ 15

haloperidol decanoate _ 15

haloperidol lactate ____ 15

HARVONI_____________ 15

HAVRIX ______________ 37

heather ______________ 18

HEMATOGEN FA ______ 28

hematogen forte ______ 28

HEMATOLOGICAL AGENTS

- MISC. ____________ 27

HEMATOPOIETIC AGENTS

___________________ 27

hemmorex-hc __________ 5

HEMOCYTE PL US ______ 28

hemocyte-f ___________ 28

HEMOSTATICS ________ 28

heparin lock flush ______ 7

heparin lock flush/nacl f_ 7

heparin sodium ________ 7

heparin sodium dcu ____ 7

heparin sodium lock flush 7

HEPARIN

SODIUM/SODIUM CHL 7

HERCEPTIN ___________ 13

HIZENTRA ____________ 34

homatropine hbr ______ 33

HORIZA NT ____________ 35

HPR PLUS_____________ 22

HPR PLUS HYDROGEL KIT

___________________ 22

HUMALOG ___________ 10

HUMALOG JUNIOR

KWIKPEN __________ 10

HUMALOG KWIKPEN __ 10

HUMALOG MIX 50/50

KWIKPEN __________ 10

HUMALOG MIX 75/25 _ 10

HUMALOG MIX 75/25

KWIKPEN __________ 10

HUMATROPE _________ 25

HUMIRA_______________ 4

HUMIRA PEDIATRIC

CROHNS D __________ 4

HUMIRA PEN __________ 4

HUMIRA PEN-CD/UC/HS

START ______________ 4

HUMIRA PEN-PS/UV

STARTER ____________4

HUMULIN R U-500

(CONCENTR________ 10

HUMULIN R U-500

KWIKPEN __________ 10

HYALGAN ____________ 32

HYCLODEX ___________ 22

hydralazine hcl________ 12

hydrochlorothiazide ___ 25

hydrocodone bitartrate/ac

_____________________5

hydrocodone bitartrate/ch

___________________ 20

hydrocodone bitartrate/ho

___________________ 20

hydrocodone polistirex/ch

___________________ 20

hydrocodone/acetaminoph

en __________________5

hydrocodone/homatropine

___________________ 20

hydrocodone/ibuprofen _5

hydrocortisone 5, 6, 19, 22,

34

hydrocortisone acetate5, 6,

22

hydrocortisone acetate &

___________________ 22

hydrocortisone acetate/pr

_____________________6

hydrocortisone butyrate 22

hydrocortisone butyrate (

___________________ 22

hydrocortisone valerate 22

hydrocortisone/acetic aci

___________________ 34

hydrocortisone/iodoquinol

___________________ 22

HYDROGEN PEROXIDE_ 15

hydromet ____________ 20

hydromorphone hcl _____5

hydromorphone hcl

dosette______________5

hydromorphone hcl er ___5

hydroquinone ________ 22

hydroquinone time release

___________________ 22

hydroxocobalamin ____ 28

hydroxychloroquine sulfat

___________________ 13

hydroxyprogesterone

capro _____________ 34

hydroxyurea __________ 13

hydroxyzine hcl _________6

hydroxyzine hydrochloride

_____________________6

hydroxyzine pamoate____6

HYLAFEM ____________ 30

HYLATOPIC PLUS______ 22

45

HYLENEX______________ 30

HYMOVIS _____________ 32

HYOPHEN_____________ 36

hyoscyamine sulfate ___ 36

hyoscyamine sulfate er _ 36

hyoscyamine sulfate odt 36

hyoscyamine sulfate sr _ 36

hyosyne ______________ 36

HYPERRHO S/D________ 34

HYPERSAL ____________ 20

HYPNOTICS/SEDATIVES/SL

EEP DISORDER AGENTS

___________________ 28

HYSINGLA ER___________ 5

HYZAAR ______________ 12

ibandronate sodium____ 25

IBRANCE ______________ 13

ibu ____________________ 4

IBUDONE ______________ 5

ibuprofen ____________ 4, 5

ICLUSIG_______________ 13

IDELVION _____________ 27

iferex 150 forte ________ 28

ILARIS _________________ 4

ILEVRO _______________ 33

imatinib mesylate______ 13

IMBRUVICA ___________ 13

imipramine hcl _________ 9

imipramine hydrochloride9

imipramine pamoate ____ 9

imiquimod ____________ 22

IMIQUIMOD PUMP ____ 22

IMITREX ______________ 29

IMITREX STATDOSE REFILL

___________________ 29

IMITREX STATDOSE

SYSTEM ____________ 29

IMOVAX RABIES (H.D.C.V.)

___________________ 37

IMPOYZ ______________ 22

IMVEXXY MAINTENANCE

PACK ______________ 37

IMVEXXY STARTER PACK

___________________ 37

INBRIJA _______________ 14

INCRUSE ELLIPTA _______ 7

indapamide ___________ 25

INDERAL LA ___________ 16

INDERAL XL ___________ 16

INDOCIN _______________ 4

indomethacin __________ 4

indomethacin er ________ 4

INFANRIX _____________ 36

INFLECTRA ____________ 26

INGREZZA _____________ 35

INLYTA _______________ 13

INNOPRAN XL _________ 16

INSULIN LISPRO _______ 10

INSULIN LISPRO KWIKPEN

___________________ 10

INTEGRA F ____________ 28

INTEGRA PLUS ________ 28

INTERMEZZO__________ 28

intralipid______________ 32

INTRAROSA ___________ 37

INTRON A ____________ 13

introvale______________ 18

INTUNIV _______________ 3

INVEGA ______________ 15

INVEGA SUSTENNA ____ 15

INVEGA TRINZA _______ 15

INVELTYS _____________ 33

INVOKAMET __________ 10

INVOKAMET XR _______ 10

INVOKANA ___________ 10

iodine strong __________ 29

IOPIDINE _____________ 33

IPOL INACTIVATED IPV _ 37

ipratropium bromide_ 7, 32

ipratropium bromide/albut

____________________ 7

irbesartan ____________ 12

irbesartan/hydrochlorothi

___________________ 12

IROSPAN 24/6 ________ 28

ISENTRESS ____________ 15

isibloom ______________ 18

isoniazid ______________ 13

isosorbide dinitrate _____ 6

isosorbide mononitrate _ 6

isosorbide mononitrate er6

isotretinoin ___________ 22

isradipine _____________ 16

ISTALOL ______________ 33

itraconazole___________ 11

ivermectin _____________ 6

IXIARO _______________ 37

JADENU ______________ 10

JADENU SPRINKLE _____ 10

JAKAFI _______________ 14

JALYN ________________ 27

jantoven _______________ 7

JANUMET_____________ 10

JANUMET XR__________ 10

JANUVIA _____________ 10

JARDIANCE ___________ 10

jencycla ______________ 18

JENTADUETO _________ 10

JENTADUETO XR ______ 10

jevantique lo __________ 26

jinteli_________________ 26

jolessa________________ 18

jolivette ______________ 18

JUBLIA _______________ 22

juleber _______________ 18

JULUCA_______________ 15

junel 1.5/30 ___________ 18

junel 1/20 ____________ 18

junel fe 1.5/30 ________ 18

junel fe 1/20 __________ 18

junel fe 24 ____________ 18

kaitlib fe______________ 18

KALETRA _____________ 15

KAMDOY _____________ 22

kariva ________________ 18

KAZANO______________ 10

k-effervescent ________ 29

kelnor 1/35 ___________ 18

kelnor 1/50 ___________ 18

KENALOG-10__________ 19

KENALOG-40__________ 19

KEPPRA _______________ 8

KEPPRA XR ____________ 8

KERALAC _____________ 22

KERALYT _____________ 22

KERALYT SCALP _______ 22

KERYDIN _____________ 22

ketamine hcl __________ 27

ketoconazole _________ 11

KETOPROFEN __________ 4

ketoprofen er __________ 4

ketorolac tromethamine 4

KEVZARA ______________ 4

KEYTRUDA ___________ 14

KINERET _______________ 4

kionex________________ 30

KISQALI ______________ 14

KISQALI FEMARA 600

DOSE______________ 14

KLONOPIN_____________ 8

klor-con ______________ 29

klor-con 10 ___________ 29

klor-con 8 ____________ 29

klor-con m10 _________ 29

KLOR-CON M15 _______ 29

klor-con m20 _________ 29

klor-con sprinkle ______ 29

klor-con/ef ___________ 29

KOMBIGLYZE XR ______ 10

K-PHOS ___________ 27, 29

K-PHOS NO 2 _________ 27

KRISTAL OSE __________ 28

KRYSTEXXA ___________ 27

K-TAB TAB 20MEQ _ 29

K-TAB TAB 8MEQ CR29

kurvelo _______________ 18

KUVAN _______________ 25

k-vescent _____________ 30

KYLEENA _____________ 18

labetalol hcl __________ 16

labetalol hydrochloride 16

LACRISERT____________ 33

lactated ringers _______ 30

lactulose _____________ 28

LAMICTAL _____________ 8

LAMICTAL ODT_________ 8

LAMICTAL XR __________ 8

lamivudine ___________ 15

lamivudine/zidovudine_ 15

lamotrigine ____________ 8

lamotrigine er __________8

lamotrigine odt _________8

lamotrigine starter kit/o _8

lansoprazole __________ 36

lansoprazole/amoxicillin/

___________________ 36

lanthanum carbonate__ 26

LANTUS ______________ 10

LANTUS SOLOSTAR____ 10

larin 1.5/30 ___________ 18

larin 1/20_____________ 18

larin 24 fe ____________ 18

larin fe 1.5/30_________ 18

larin fe 1/20 __________ 18

larissia _______________ 18

LASIX ________________ 25

LASTACAFT ___________ 33

latanoprost ___________ 33

LATISSE ______________ 22

LATUDA ______________ 15

LAXATIVES ___________ 28

layolis fe _____________ 18

leena ________________ 18

leflunomide ____________4

LENVIMA 12MG DAILY

DOSE _____________ 14

LESCOL XL ____________ 11

lessina _______________ 18

LETAIRIS _____________ 17

letrozole _____________ 14

LEUCOVOR CA TAB 10MG

___________________ 14

leucovor ca tab 5mg __ 14

LEUKERAN ___________ 14

leuprolide acetate _____ 14

levalbuterol ____________7

levalbuterol hcl _________7

levalbuterol hydrochlorid 7

LEVALBUTEROL TARTRATE

HFA _________________7

LEVAQUIN____________ 26

LEVEMIR _____________ 10

LEVEMIR FL EXTOUCH __ 10

levetiracetam ___________8

levetiracetam er ________8

LEVICYN______________ 22

levicyn dermal spray___ 22

LEVITRA ______________ 17

levobunolol hcl _______ 33

levocarnitine _________ 25

levocetirizine dihydrochl 11

levofloxacin __________ 26

levofloxacin in d5w ____ 26

LEVOMEFOLATE CALCIUM

ALGA _____________ 24

LEVOMEFOLATE

CALCIUM/N-AC ____ 24

LEVOMEFOLATE

CALCIUM/PYRI_____ 24

levonest______________ 18

46

levonorgestrel and ethiny

___________________ 18

levonorgestrel/ethinyl es18

levora 0.15/30-28______ 18

LEVORPHANOL TARTRATE

____________________ 5

levothyroxine sodium __ 35

levothyroxine/liothyronin

___________________ 35

levoxyl________________ 35

LEVSIN _______________ 36

LEVSIN/SL ____________ 36

LEVULAN KERASTICK___ 22

LEXAPRO ______________ 9

LIALDA _______________ 26

lidocaine ________ 6, 22, 30

LIDOCAINE AND

TETRACAINE________ 22

lidocaine hcl_________6, 22

lidocaine hcl jelly ______ 22

lidocaine hcl/hydrocortis 6

lidocaine viscous_______ 30

lidocaine/prilocaine ____ 22

lidocaine-prilocaine-crea22

LIDODERM ____________ 22

lidopril________________ 22

LIDORX _______________ 22

LIDOTRAL _____________ 22

lidozion _______________ 22

LILETTA _______________ 18

lillow _________________ 18

LIMBREL ______________ 24

LINCOCIN _____________ 13

linezolid ______________ 13

LINZESS_______________ 26

liothyronine sodium____ 35

LIPITOR _______________ 11

LIPOFEN ______________ 11

lisinopril ______________ 12

lisinopril/hydrochlorothi 12

lithium carbonate ______ 15

lithium carbonate er ___ 15

LIVALO _______________ 11

L-METHYL-B6-B12 _____ 24

L-METHYLFOLATE______ 24

L-METHYLFOLATE CA/S-

ALGAL _____________ 24

L-METHYLFOLATE

CALCIUM __________ 24

L-METHYLFOLATE FORTE

___________________ 24

L-METHYL-MC NAC ____ 24

LO LOESTRIN FE _______ 18

LOCAL ANESTHETICS-

Parenteral _________ 29

LOCOID _______________ 22

LOESTRIN 1.5/30-21 ___ 18

LOESTRIN 1/20-21 _____ 18

LOESTRIN FE 1.5/30____ 18

LOESTRIN FE 1/20 _____ 18

LOMAIRA ______________ 3

LONSURF _____________ 14

loperamide hcl ________ 10

lopreeza ______________ 26

lorazepam _____________ 6

lorazepam intensol _____ 6

lorcet _________________ 5

lorcet hd_______________ 5

lorcet plus _____________ 5

LORTAB _______________ 5

loryna ________________ 18

LORZONE _____________ 32

losartan potassium ____ 12

losartan potassium/hydroc

___________________ 12

LOSEASONIQUE _______ 18

LOTEMAX_____________ 33

LOTREL _______________ 12

lovastatin _____________ 11

LOVAZA ______________ 11

LOVENOX______________ 7

low-ogestrel __________ 18

loxapine ______________ 15

loxapine succinate _____ 15

LOYON _______________ 22

ludent ________________ 30

LULICONAZOLE________ 22

LUMIGAN_____________ 33

LUNESTA _____________ 28

LUPANETA PACK ______ 25

LUPRON DEPOT (4-

MONTH) ___________ 14

LUPRON DEPOT (6-

MONTH) ___________ 14

LUPRON DEPOT INJ

11.25MG __________ 14

LUPRON DEPOT INJ

22.5MG____________ 14

LUPRON DEPOT INJ

3.75MG____________ 14

LUPRON DEPOT INJ 7.5MG

___________________ 14

LUPRON DEPOT-PED (1-

MONTH ___________ 25

LUPRON DEPOT-PED (3-

MONTH ___________ 25

lutera ________________ 18

LUXAMEND ___________ 22

LUXIQ ________________ 22

LUZU _________________ 22

LYNPARZA ____________ 14

LYRICA _____________ 8, 35

LYRICA CR ____________ 35

lyza __________________ 18

MACROBID ___________ 36

MACRODANTIN _______ 36

MACROLIDES _________ 29

MAKENA INJ

250MG/ML ________ 34

MAKENA INJ 275MG 34

MALARONE___________ 13

malathion ____________ 22

maprotiline hcl _________ 9

MARCAINE ___________ 29

MARLIDO KIT _________ 29

marlissa ______________ 18

MARPLAN _____________ 9

MATULANE ___________ 14

matzim la_____________ 16

MAVYRET ____________ 15

MAXALT______________ 29

MAXALT-MLT _________ 29

MAXIDEX_____________ 33

MAXZIDE _____________ 25

MAYZENT ____________ 35

me/naphos/mb/hyo 1 _ 36

MEBOLIC _____________ 24

meclizine hcl __________ 11

meclizine hydrochloride 11

meclofenamate sodium _ 4

MEDICAL DEVICES AND

SUPPLIES __________ 29

MEDROL __________ 19, 20

MEDROL DOSEPAK ____ 20

medroxyprogesterone

aceta ______________ 18

mefenamic acid ________ 4

mefloquine hcl ________ 13

megestrol acetate _____ 14

MEKINIST ____________ 14

MEKTOVI _____________ 14

melodetta 24 fe _______ 18

meloxicam_____________ 4

memantine hcl ________ 35

memantine hcl titration p

___________________ 35

memantine hydrochloride

___________________ 35

memantine hydrochloride

e__________________ 35

MENACTRA ___________ 37

MENEST ______________ 26

MENOPUR____________ 25

MENOSTAR ___________ 26

MENTAX _____________ 22

MENVEO _____________ 37

meperidine hcl _________ 5

MEPHYTON___________ 38

mercaptopurine _______ 14

meropenem __________ 13

mesalamine___________ 26

mesalamine dr ________ 26

MESTINON TIMESPA N _ 13

metadate er ___________ 3

METAFOL BIC PLUS ____ 24

METAFOL BIC PLUS RF__ 24

METANX _____________ 24

METAXALONE TAB

400MG ____________ 32

metaxalone tab 800mg 32

metformin hcl ______ 9, 10

metformin hcl er ______ 10

metformin hydrochloride

___________________ 10

metformin hydrochloride e

___________________ 10

METHADONE SOL

5MG/5ML ___________5

methadone tab 10mg __5

methamphetamine hcl___3

methazolamide _______ 25

methenamine hippurate 36

methenamine mandelate

___________________ 36

methergine ___________ 34

methimazole _________ 35

methocarbamol _______ 32

methotrexate _________ 14

methotrexate sodium__ 14

methoxsalen__________ 22

methscopolamine bromide

___________________ 36

methyclothiazide______ 25

methyldopa __________ 12

methyldopa/hydrochloroth

i __________________ 12

methylergonovine maleate

___________________ 34

METHYLIN______________3

methylphenid cap 30mg er

_____________________3

METHYLPHENID CAP

60MG LA ____________3

methylprednisolone ___ 20

methylprednisolone acetat

___________________ 20

methylprednisolone dose p

___________________ 20

methylprednisolone

sodium ____________ 20

methyltestosterone _____5

metoclopramide hcl ___ 26

metoclopramide

hydrochlor_________ 26

METOCL OPRAMIDE ODT26

metolazone___________ 25

metoprol tar tab 25mg_ 16

METOPROLOL TAB 75MG

___________________ 16

metoprolol succinate er 16

metoprolol/hydrochlorothi

___________________ 12

METROGEL ___________ 22

metronidazole _____ 22, 38

metronidazole vaginal _ 38

mexiletine hcl___________6

mibelas 24 fe _________ 18

MICARDIS ____________ 12

MICARDIS HCT________ 12

MICONAZOLE 3 _______ 38

47

MICORT-HC ___________ 22

microgestin 1.5/30 _____ 18

microgestin 1/20 ______ 18

microgestin fe _________ 18

microgestin fe 1.5/30 __ 18

midazolam hcl _________ 28

midodrine hcl _________ 38

midodrine hydrochloride38

miglitol _______________ 10

Migraine Products _____ 29

mili___________________ 18

MILLIPRED SOL

10MG/5ML ________ 20

MILLIPRED TAB 5MG _ 20

mimvey _______________ 26

MINASTRIN 24 FE______ 18

MINERALS AND

ELECTROLYTES______ 29

MINIVELLE ____________ 26

minocycline hcl ________ 35

minocycline hcl er _____ 35

minocycline hydrochloride

___________________ 35

minoxidil______________ 12

MIRAPEX _____________ 14

MIRCETTE_____________ 18

MIRENA ______________ 18

mirtazapine ____________ 9

mirtazapine odt ________ 9

MIRVASO _____________ 22

Miscellaneous Therapeutic

Classes_____________ 30

misoprostol ___________ 36

MITIGARE_____________ 27

M-M-R II ______________ 37

modafinil ______________ 3

moexipril hcl __________ 12

mometasone furoate___ 22

monoject pharma grade flu

___________________ 30

mono-linyah __________ 18

mononessa____________ 18

MONOVISC ___________ 32

montelukast sodium ____ 7

MONUROL ____________ 37

MORPHABOND ER ______ 5

morphine sulfate _______ 5

morphine sulfate er _____ 5

MOTOFEN ____________ 10

MOUTH/THROAT/DENTAL

AGENTS____________ 30

MOVANTIK ___________ 26

MOVIPREP ____________ 28

MOXATAG ____________ 34

MOXEZA ______________ 33

moxifloxacin hcl _______ 26

moxifloxacin hydrochlorid

___________________ 33

MUGARD _____________ 30

MULPLETA ____________ 28

MULTAQ ______________ 6

MULTIGEN____________ 28

MULTIGEN PLUS ______ 28

MULTIVIT/FL CHW

0.25MG____________ 31

MULTIVIT/FL CHW 0.5MG

___________________ 31

multivit/fl dro 0.25mg _ 31

multi-vit/iron/fluoride _ 31

multivitamin with fluorid31

multi-vitamin/fluoride dr31

multi-vitamin/fluoride/ir31

MULTIVITAMINS ______ 31

mupirocin_____________ 22

MUSCULOSKELETAL

THERAPY AGENTS __ 32

MUSE ________________ 17

mycophenolate mofetil 30

mycophenolic acid dr __ 30

MYDAYIS ______________ 3

MYFORTIC ____________ 30

MYOBLOC ____________ 32

myorisan _____________ 22

MYRBETRIQ___________ 37

MYSOLINE _____________ 8

MYTESI _______________ 10

myzilra _______________ 18

nabumetone ___________ 4

nadolol ____________12, 16

nadolol/bendroflumethiazi

___________________ 12

naftifine hcl ___________ 22

naftifine hydrochloride _ 22

NAFTIN _______________ 22

naloxone hcl ________ 5, 10

naltrexone hcl _________ 10

NAMENDA ____________ 35

NAMENDA XR_________ 35

NAMZARIC ___________ 35

NAPRELAN_____________ 4

naproxen ___________ 4, 29

naproxen dr____________ 4

naproxen sodium _______ 4

naproxen sodium cr_____ 4

naproxen sodium er ____ 4

naratriptan hcl ________ 29

NARCAN______________ 10

NASAL AGENTS -

SYSTEMIC AND

TOPICAL ___________ 32

NASCOBAL ____________ 28

NASONEX_____________ 32

NATACYN_____________ 33

NATAZIA _____________ 18

nateglinide____________ 10

NATESTO ______________ 5

NATPARA _____________ 25

NATROBA ____________ 22

NATURE-THROID ______ 35

NATURE-THROID NT-2.5 35

nebusal ______________ 20

necon 0.5/35-28_______ 18

NEEV O DHA __________ 31

nefazodone hcl_________ 9

nefazodone hydrochloride

____________________ 9

neomycin sulfate _______ 3

neomycin/bacitracin/poly

m _________________ 33

neomycin/polymyxin/bacit

r __________________ 33

neomycin/polymyxin/dexa

me ________________ 33

neomycin/polymyxin/gram

ic _________________ 33

neomycin/polymyxin/hc 34

neomycin/polymyxin/hydr

oc_________________ 34

neo-polycin ___________ 33

neo-polycin hc ________ 33

NEORAL ______________ 30

NEOSPORIN __________ 33

NEO-SY NALAR ________ 22

NEPHRO-VITE RX ______ 31

NERLYNX _____________ 14

NESINA_______________ 10

NESTABS DHA ________ 31

NESTABS ONE_________ 31

NEUAC KIT____________ 22

NEULASTA ____________ 28

NEULASTA ONPRO KIT _ 28

NEUPOGEN ___________ 28

NEUPRO______________ 14

NEUROMUSCULAR

AGENTS ___________ 32

NEURONTIN ___________ 8

NEUTRASAL __________ 30

NEVANAC ____________ 33

NEXAVAR ____________ 14

NEXIUM CAP 40MG 36

NEXIUM GRA 10MG DR

___________________ 36

NEXPLANON __________ 18

niacin er ______________ 11

NIACOR ______________ 11

NIASPAN _____________ 11

NICADAN_____________ 31

NICAPRIN ____________ 24

NICOMIDE ____________ 31

NICOTROL INHALER ___ 35

NICOTROL NS _________ 35

nifedipine ____________ 16

nifedipine er __________ 16

NIFEREX ______________ 28

nikki _________________ 18

nimodipine ___________ 16

NINLARO _____________ 14

nisoldipine er _________ 16

NITRO-BID_____________ 6

NITRO-DUR ____________ 6

nitrofurantoin ________ 37

nitrofurantoin macrocryst

___________________ 37

nitrofurantoin monohydrat

___________________ 37

nitroglycerin ____________6

nitroglycerin er _________6

nitroglycerin lingual _____6

nitroglycerin transdermal 6

NITROSTAT _____________6

nitro-time ______________6

niva-fol_______________ 24

NIVA-PLUS ___________ 31

NIVATOPIC PLUS ______ 22

nizatidine cap 150mg _ 36

NIZATIDINE SOL

15MG/ML _________ 36

NOCTIVA _____________ 25

nolix _________________ 22

nora-be ______________ 19

NORCO ________________5

NORDITROPIN FLEXPRO 25

norethindrone __19, 26, 34

norethindrone & ethinyl e

___________________ 19

norethindrone acetate_ 19,

34

norethindrone acetate/eth

___________________ 19

norethindrone/ethinyl est

___________________ 19

norgestimate/ethinyl estr

___________________ 19

NORITATE ____________ 22

norlyda ______________ 19

normal saline flush ____ 30

normal saline flush for f 30

normal saline i.v. flush _ 30

NORPACE CR ___________6

NORTHERA ___________ 38

nortrel 0.5/35 (28) ____ 19

nortrel 1/35 __________ 19

nortrel 7/7/7 _________ 19

nortriptyline hcl _________9

NORVASC ____________ 16

NORVIR ______________ 15

NOVAREL ____________ 25

NOVOL OG____________ 10

NOVOL OG FLEXPEN ___ 10

NOVOL OG MIX 70/30 _ 10

NOVOLOG MIX 70/30

PREFILL____________ 10

NOVOL OG PENFILL ____ 10

NOXAFIL _____________ 11

NOXIFOL-D ___________ 28

np thyroid 120 ________ 36

np thyroid 15 _________ 36

np thyroid 30 _________ 36

np thyroid 60 _________ 36

np thyroid 90 _________ 36

48

NUCALA _______________ 7

NUCYNTA ______________ 5

NUCYNTA ER ___________ 5

NUEDEXTA ____________ 35

NULYTELY/FLAVOR PACKS

___________________ 28

NUTRIENTS ___________ 32

NUTROPIN AQ NUSPIN 10

___________________ 25

NUTROPIN AQ NUSPIN 20

___________________ 25

NUVAIL _______________ 22

NUVARING____________ 19

NUVESSA _____________ 38

NUVIGIL _______________ 3

nyamyc _______________ 22

nystatin___________ 11, 22

nystatin/triamcinolone _ 22

nystatin/triamcinolone ac

___________________ 22

nystop ________________ 22

OB COMPLETE ONE ____ 31

OB COMPLETE PETITE __ 31

OB COMPLETE PREMIER 31

OB COMPLETE/DHA ___ 31

OCALIVA______________ 26

ocella_________________ 19

OCREVUS _____________ 35

octreotide acetate _____ 25

OCUFLOX _____________ 33

ODACTRA ______________ 3

ODEFSEY ______________ 15

OFEV _________________ 35

ofloxacin ______________ 33

ogestrel___________ 18, 19

okebo ________________ 35

olanzapine ________ 15, 35

olanzapine odt ________ 15

olanzapine/fluoxetine __ 35

olmesartan medoxomil _ 12

olmesartan

medoxomil/amlo ___ 12

olmesartan

medoxomil/hydr ____ 12

olopatadine hcl ________ 33

olopatadine hydrochloride

___________________ 33

OLUMIANT_____________ 4

OLUX-E _______________ 22

OMECLAMOX-PAK _____ 36

omega-3-acid ethyl esters

___________________ 11

omeprazole ___________ 36

omeprazole dr_________ 36

omeprazole/sodium

bicarbo ____________ 36

OMNITROPE __________ 25

ondansetron hcl _______ 11

ondansetron hydrochloride

___________________ 11

ondansetron odt ______ 11

ONEXTON ____________ 22

ONFI __________________ 8

ONGLYZA _____________ 10

ONZETRA XSAIL _______ 29

OPDIVO ______________ 14

OPHTHALMIC AGENTS _ 32

opium _____________10, 36

opium tincture ________ 10

OPSUMIT _____________ 17

ORACEA ______________ 22

ORACIT _______________ 27

ORAMAGICRX_________ 30

ORAP ________________ 35

ORAPRED ODT ________ 20

ORENCIA ______________ 4

ORENCIA CLICKJECT ____ 4

ORENITRAM __________ 17

ORILISSA _____________ 25

ORKAMBI_____________ 35

orphenadrine citrate er 32

orsythia ______________ 19

ORTHO MICRONOR____ 19

ORTHO TRI-CYCLEN LO _ 19

ORTHO-CYCLEN _______ 19

ORTHO-NOVUM 1/35__ 19

ORTHOVISC ___________ 32

oscimin _______________ 36

oscimin sr_____________ 36

oseltamivir phosphate _ 16

OSENI ________________ 10

OSMOPREP ___________ 28

OSPHENA _____________ 25

OTEZLA ________________ 4

OTIC AGENTS _________ 34

OTOVEL ______________ 34

OTREXUP ______________ 4

OVACE PLUS _______22, 23

OVACE PLUS WASH ____ 23

OVACE WASH _________ 23

OVIDREL ______________ 25

oxandrolone ___________ 5

oxaprozin ______________ 4

OXAYDO_______________ 5

oxazepam _____________ 6

oxcarbazepine__________ 8

OXERVATE ____________ 33

oxiconazole nitrate ____ 23

OXISTAT ______________ 23

OXTELLAR XR __________ 8

oxybutynin chloride____ 37

oxybutynin chloride er _ 37

oxycodone hcl__________ 5

OXYCODONE HCL ER____ 5

oxycodone hydrochloride 5

oxycodone/acetaminophen

____________________ 5

oxycodone/aspirin ______ 5

OXYCONTIN ___________ 5

oxymorphone

hydrochloride _______ 5

Oxytocics_____________ 34

OZEMPIC _____________ 10

OZURDEX_____________ 33

pacerone ______________ 6

paliperidone er________ 15

PALYNZIQ ____________ 25

PANCREAZE __________ 24

pantoprazole sodium __ 36

pantoprazole sodium dr 36

papaverine hcl ________ 17

PARAGARD INTRAUTERINE

COP _______________ 19

paregoric _____________ 10

paricalcitol____________ 25

paroex _______________ 30

paromomycin sulfate ___ 3

paroxetine __________ 9, 35

paroxetine hcl__________ 9

paroxetine hcl er _______ 9

paroxetine hydrochloride 9

PASSIVE IMMUNIZING

AND TREATMENT

AGENTS ___________ 34

PATADAY_____________ 33

PATANASE____________ 32

PATANOL _____________ 33

PAXIL _________________ 9

PAXIL CR ______________ 9

PAZEO _______________ 33

peg-3350/electrolytes _ 28

peg-3350/nacl/na bicarbon

___________________ 28

PEGASYS _____________ 16

penicillin v potassium __ 34

PENICILLINS __________ 34

PENLAC NAIL LACQUER 23

PENNSAID ____________ 23

PENTA SA _____________ 26

pentazocine/naloxone hcl 5

pentoxifylline er _______ 27

PERCOCET _____________ 5

PERFOROMIST _________ 7

perindopril erbumine __ 12

PERJETA ______________ 14

permethrin ___________ 23

perphenazine ______ 15, 35

perphenazine/amitriptylin

___________________ 35

PERTZYE______________ 24

phenadoz_____________ 11

phenazopyridine hcl ___ 27

phenazopyridine hydrochlo

___________________ 27

phendimetrazine tartrate 3

phenelzine sulfate ______ 9

phenobarbital_________ 28

phenohytro ___________ 36

phentermine hcl________ 3

PHENYTEK______________8

phenytoin ______________8

phenytoin infatabs ______8

phenytoin sodium

extended ____________8

philith________________ 19

phospha 250 neutral __ 30

phosphasal ___________ 37

PHOSPHOLINE IODIDE _ 33

phosphorous _________ 30

phospho-trin 250 neutral

___________________ 30

PHYSICIANS EZ USE B-12

CO ________________ 28

PHYSICIANS EZ USE JOINT

T _________________ 20

PHYSICIANS EZ USE M-

PRED______________ 20

phytonadione_________ 38

PICATO ______________ 23

pilocarpine hcl ________ 30

pilocarpine hydrochloride

___________________ 30

pimozide _____________ 35

pimtrea ______________ 19

pindolol ______________ 16

pioglitazone hcl _______ 10

pioglitazone hcl/metformi

___________________ 10

piperacillin/tazobactam 34

pirmella 1/35 _________ 19

pirmella 7/7/7 ________ 19

piroxicam ______________4

PLAQUENIL ___________ 13

PLAVIX _______________ 27

PLEGRIDY ____________ 35

PLENVU ______________ 28

PLEXION _____________ 23

PLEXION CLEANSER ___ 23

PNEUM OVAX 23 ______ 37

PNEUMOVAX 23/1 DOSE

___________________ 37

PNV PRENATAL TAB PLUS

___________________ 31

PNV TABS 29-1 _______ 31

pnv-dha ______________ 31

PNV-DHA+DOCUSA TE _ 31

PODIAPN_____________ 24

PODOCON 25 IN BENZOIN

TIN _______________ 23

podofilox _____________ 23

polycin _______________ 33

polyethylene glycol 335028

poly-iron 150 forte ____ 28

polymyxin b sulfate/trime

___________________ 33

POLYTRIM ____________ 33

POLY-VI-FLOR ________ 31

POMALYST ___________ 14

portia-28 _____________ 19

49

pot chloride tab 10meq er

___________________ 30

POT CHLORIDE TAB

20MEQ ER _________ 30

potassium chloride_____ 30

potassium chloride cr __ 30

potassium chloride sr __ 30

potassium citrate er____ 27

potassium citrate/citric _ 27

PRADAXA ______________ 7

PRALUENT ____________ 11

pramipexole dihydrochlori

___________________ 14

PRAMOSONE__________ 23

prasugrel _____________ 27

PRAVACHOL __________ 11

pravastatin sodium ____ 11

praziquantel____________ 6

prazosin hcl ___________ 12

PRED FORTE __________ 33

PRED MILD____________ 33

PRED-G S.O.P. _________ 33

prednicarbate _________ 23

prednisolone ______ 20, 33

prednisolone acetate___ 33

prednisolone sol 15mg/5ml

___________________ 20

PREDNISOLONE SOL

25MG/5ML ________ 20

PREDNISONE PAK 5MG 20

prednisone tab 20mg _ 20

PREDNISONE INTENSOL 20

PREGNYL W/DILUENT

BENZYL ____________ 25

PREMARIN ____________ 26

PREMPHASE __________ 26

PREMPRO ____________ 26

PRENA 1 TRUE ________ 31

PRENA1 PEARL ________ 31

PRENAISSANCE ________ 31

PRENA TA _____________ 31

prenatabs rx __________ 31

PRENA TAL ____________ 31

prenatal 19 chw tab ___ 31

PRENATAL 19 TAB 29-

1MG_______________ 31

PRENATAL PLS MIS MV +

DHA _______________ 31

PRENA TAL PLUS _______ 31

PRENA TAL PLUS IRON__ 31

PRENATAL VITAMINS PLUS

LO _________________ 31

PRENA TE _____________ 31

PRENA TE DHA _________ 31

PRENA TE ELITE ________ 31

PRENA TE ENHANCE ____ 31

PRENA TE ESSENTIAL ___ 31

PRENA TE MINI ________ 31

PRENA TE PIXIE ________ 31

PRENA TE RESTORE ____ 31

PREPLUS______________ 31

PREPOPIK ____________ 28

PREVACID ____________ 36

PREVACID SOLUTA B ___ 36

prevalite ______________ 11

PREVIDENT 5000 BOOSTER

PL _________________ 30

PREVIDENT 5000 DRY

MOUTH____________ 30

PREVIDENT 5000 ENAMEL

PRO _______________ 30

PREVIDENT 5000 PLUS _ 30

PREVIDENT 5000

SENSITIVE__________ 30

PREVIDENT FLUORIDE _ 30

PREVIDENT RINSE _____ 30

previfem______________ 19

PREVNAR 13 __________ 37

PREZCOBIX ___________ 16

PREZISTA _____________ 16

PRIFTIN_______________ 13

PRILOSEC _____________ 36

PRIMACARE __________ 31

primidone _____________ 8

PRISTIQ _______________ 9

PROAIR HFA ___________ 7

PROAIR RESPICLICK _____ 7

probenecid ___________ 27

probenecid/colchicine _ 27

PROCARDIA XL ________ 16

prochlorperazine ______ 15

prochlorperazine maleate

___________________ 15

PROCRIT______________ 28

PROCTOCORT __________ 6

PROCTOFOAM HC ______ 6

procto-med hc _________ 6

procto-pak _____________ 6

proctosol hc____________ 6

proctozone-hc__________ 6

progesterone _________ 34

Progestins ____________ 34

PROGLYCEM __________ 10

PROGRAF CAP ______ 30

PROGRAF GRA ______ 30

PROLASTIN-C _________ 35

PROLENSA ____________ 33

PROLIA _______________ 25

PROMACTA ___________ 28

promethazine hcl ______ 11

promethazine hcl plain _ 11

promethazine hydrochlorid

___________________ 11

promethazine/codeine _ 20

promethazine/dextrometh

or _________________ 20

promethazine/phenylephri

n __________________ 20

promethazine-dm _____ 20

promethegan _________ 11

PROMETRIUM ________ 34

PROMISEB____________ 23

propafenone hcl________ 6

propafenone hcl er _____ 6

propafenone hydrochloride

____________________ 6

propantheline bromide 36

proparacaine hcl ______ 33

PROPECIA ____________ 23

propranolol hcl________ 16

propranolol hcl er _____ 16

propranolol hydrochloride

___________________ 16

propranolol/hydrochloroth

___________________ 12

propylthiouracil _______ 36

PROSCAR _____________ 27

PROSTIN VR PEDIATRIC 30

PROTONIX____________ 36

PROTOPIC ____________ 23

protriptyline hcl ________ 9

PROVENTIL HFA ________ 7

PROVERA __________ 18, 34

PROVIDA DHA ________ 31

PROVIDA OB__________ 31

PROVIGIL ______________ 3

PROZAC _______________ 9

PRUMYX _____________ 23

PSORCON ____________ 23

Psychotherapeutic and

Neurological Agents -

Misc. ______________ 34

PULMICORT ___________ 7

PULMICORT FLEXHALER 7

PULMOZYME _________ 35

PURIXAN _____________ 14

PYLERA_______________ 36

PYRIDIUM ____________ 27

pyridostigmine bromide 13

pyridostigmine bromide er

___________________ 13

QBRELIS ______________ 12

QBREXZA _____________ 23

QNASL _______________ 32

QNASL CHILDRENS ____ 32

QSYMIA _______________ 3

QTERN _______________ 10

QUARTETTE __________ 19

quasense _____________ 19

QUDEXY XR____________ 8

QUESTRAN LIGHT _____ 12

quetiapine fumarate ___ 15

quetiapine fumarate er 15

QUILLICHEW ER ________ 3

QUILLIVANT XR ________ 3

quinapril hcl __________ 12

quinapril hydrochloride 12

quinapril/hydrochlorothia

___________________ 12

quinidine gluconate cr __ 6

quinine sulfate ________ 13

QVAR REDIHALER _______7

RABAVERT ___________ 37

rabeprazole sodium ___ 36

RAGWITEK _____________3

rajani ________________ 19

raloxifene hydrochloride 25

ramipril ______________ 12

RANEXA ________________6

ranitidine hcl _________ 36

ranitidine hydrochloride 36

RAPAFLO _____________ 27

RAPAMUNE SOL

1MG/ML __________ 30

RAPAMUNE TAB 1MG 30

rasagiline mesylate ____ 14

RASUVO _______________4

RAVICTI ______________ 25

RAYALDEE____________ 25

RAYOS _______________ 20

REBIF ________________ 35

REBIF REBIDOSE ______ 35

REBIF REBIDOSE

TITRA TION ________ 35

RECEDO ______________ 23

reclipsen _____________ 19

RECOM BIVAX HB _____ 37

RECTIV _________________6

REGENECARE _________ 23

REGRA NEX ___________ 23

RELENZA DISKHALER __ 16

RELISTOR_____________ 26

RELPAX ______________ 29

REMERON ______________9

REMICADE ___________ 26

REMODULIN__________ 17

RENAGEL _____________ 26

renal caps ____________ 31

reno caps_____________ 31

RENOVA _____________ 23

RENVELA _____________ 26

repaglinide ___________ 10

REPATHA _____________ 12

REPATHA PUSHTRONEX

SYSTEM ___________ 12

REPATHA SURECLICK __ 12

REQUIP ______________ 14

REQUIP XL____________ 14

Respiratory Agents - Misc.

___________________ 35

RESTASIS _____________ 34

RESTASIS MULTIDOSE _ 34

RESTORA RX__________ 10

RETIN-A ______________ 23

RETIN-A MICRO _______ 23

RETIN-A MICRO PUMP 23

REVATIO _____________ 17

REVESTA _____________ 28

REVLIMID ____________ 30

REXUL TI______________ 15

50

REYATAZ______________ 16

RHEUMATE ___________ 24

RHOFADE _____________ 23

RHOGAM ULTRA-FILTERED

PLU________________ 34

RHOPRESSA ___________ 34

RIAX__________________ 23

ribavirin ______________ 16

RIDAURA ______________ 4

rifabutin ______________ 13

rifampin ______________ 13

riluzole _______________ 32

RIMSO-50_____________ 27

RIOMET ______________ 10

risedronate sodium ____ 25

risedronate sodium dr__ 25

RISPERDAL ____________ 15

RISPERDAL CONSTA____ 15

risperidone____________ 15

risperidone odt ________ 15

RITALIN________________ 3

RITALIN LA _____________ 3

ritonavir ______________ 16

RITUXA N _____________ 14

rivastigmine tartrate ___ 35

rivastigmine transdermal35

rivelsa ________________ 19

rizatriptan benzoate ___ 29

rizatriptan benzoate odt 29

ROBAXIN-750 _________ 32

ROCALTROL ___________ 25

ropinirole er___________ 14

ropinirole hcl __________ 14

rosadan_______________ 23

rosuvastatin calcium ___ 12

ROXICODONE __________ 5

ROZEREM _____________ 28

RUBRACA _____________ 14

RUCONEST ____________ 27

RYDAPT ______________ 14

RYTARY _______________ 14

RYTHMOL SR ___________ 6

ryvent ________________ 11

SABRIL ________________ 8

SAFYRAL ______________ 19

SALAGEN _____________ 30

SALEX ________________ 23

SALEX CREAM _________ 23

SALEX LOTION_________ 23

salicylic acid ___________ 23

salicylic acid er ________ 23

salicylic acid wart remov 23

saline flush ____________ 30

SALIVAMAX ___________ 30

salsalate _______________ 4

SANCUSO _____________ 11

SANDIMMUNE ________ 30

SANDOSTATIN LAR DEPOT

___________________ 25

SANTYL _______________ 23

SAPHRIS ______________ 15

SAVAYSA ______________ 7

SAVELLA______________ 35

SAVELLA TITRATION PACK

___________________ 35

SAXENDA ______________ 3

SEASONIQUE _________ 19

SEEBRI NEOHALER ______ 7

SEGLUROMET _________ 10

SELECT-OB+DHA ______ 31

selegiline hcl __________ 15

selenium sulfide _______ 23

selenium sulfide shampoo

___________________ 23

SEMPREX-D ___________ 20

se-natal 19 ____________ 31

SENSIPAR_____________ 25

SEREVENT DISKUS ______ 7

SERNIVO _____________ 23

SEROQUEL ____________ 15

SEROQUEL XR _________ 15

sertraline hcl ___________ 9

sertraline hydrochloride _ 9

se-tan plus ____________ 28

setlakin _______________ 19

sevelamer carbonate___ 26

sf 30, 31

sf 5000 plus ___________ 31

sharobel ______________ 19

SHINGRIX_____________ 37

sildenafil______________ 17

sildenafil citrate _______ 17

SILENOR ______________ 28

SILIQ _________________ 23

SIL-K PAD/LARGE______ 23

SILVADENE ___________ 23

SILVASORB ___________ 23

silver sulfadiazine______ 23

SIMBRINZA ___________ 34

SIMPONI INJ

100MG/ML _________ 4

SIMPONI INJ 50/0.5ML4

SIMPONI ARIA _________ 4

simvastatin ________11, 12

SINGULAIR_____________ 7

SINUVA ______________ 32

sirolimus______________ 30

SITAVIG ______________ 16

SIVEXTRO_____________ 13

SKLICE________________ 23

SKYLA ________________ 19

SKYRIZI _______________ 23

SOD SUL/SULF EMU 10-5%

___________________ 23

sod sul/sulf pad 10-4% _ 23

sodium chloride 0.9%__ 27

sodium chloride 0.9% __ 27

sodium chloride flush __ 30

sodium citrate/citric aci 27

sodium fluoride _______ 30

sodium polystyrene sulfon

___________________ 30

sodium sulfacetamide _23,

34

sodium sulfacetamide

wash ______________ 23

SOLIQUA 100/33 ______ 10

SOLODY N ____________ 35

SOLOSEC ______________ 3

SOLU-CORTEF_________ 20

SOLU-M EDROL ________ 20

SOMA ________________ 32

SOMATULINE DEPOT __ 25

SOMAVERT ___________ 25

SOOLANTRA __________ 23

SORILUX _____________ 23

sotalol hcl ____________ 16

sotalol hcl (af)_________ 16

sotalol hydrochloride (af 16

sotalol hydrocholride __ 16

SOTYLIZE _____________ 16

SPINOSAD ____________ 23

SPINRAZA ____________ 32

SPIRIVA HANDIHALER __ 7

SPIRIVA RESPIMAT _____ 7

spironolactone ________ 25

spironolactone/hydrochlor

___________________ 25

SPORANOX ___________ 11

sprintec 28 ___________ 19

SPRITAM ______________ 8

SPRIX _________________ 4

SPRYCEL ______________ 14

sps___________________ 30

sronyx________________ 19

ssd___________________ 23

SSKI__________________ 20

SSS 10-5 ______________ 23

STAMARIL ____________ 37

STAXYN ______________ 17

STEGLATRO___________ 10

STEGLUJAN ___________ 10

STELARA INJ 45MG/0.5

___________________ 23

STELARA INJ 5MG/ML

___________________ 26

STENDRA _____________ 17

sterile water irrigation _ 30

STIMATE _____________ 25

STIOL TO RESPIMAT_____ 7

STIVARGA ____________ 14

STRA TTERA ____________ 3

STRIANT_______________ 5

STRIBILD _____________ 16

STRIVERDI RESPIMA T___ 7

STROMECTOL __________ 6

SUBOXONE ____________ 5

subvenite______________ 8

SUCRAID _____________ 24

SUCRALFATE SUS

1GM/10ML ________ 36

sucralfate tab 1gm ___ 36

SULFACET SOD OIN 10%

OP ________________ 34

sulfacetamid lot 10% __ 23

sulfacetamide

sodium/pred _______ 34

sulfacetamide sodium/sulf

___________________ 23

sulfacleanse 8/4_______ 23

sulfamethoxazole/trimetho

___________________ 13

sulfasalazine __________ 26

sulfatrim pediatric_____ 13

sulindac ________________4

SUMADAN WA SH _____ 23

sumatriptan __________ 29

sumatriptan succinate _ 29

sumatriptan succinate ref

___________________ 29

sumatriptan/naproxen sodi

___________________ 29

SUMAXIN ____________ 23

SUPARTZ FX __________ 32

SUPPRELIN LA ________ 25

SUPRAX ______________ 17

SUPREP BOWEL PREP KIT

___________________ 29

SUSTIVA _____________ 16

SUTENT ______________ 14

syeda ________________ 19

SYMAX DUOTAB ______ 36

SYMBICORT ____________7

SYMDEKO ____________ 35

SYMJEPI______________ 38

SYMLINPEN 120 ______ 10

SYMLINPEN 60________ 10

SYMPROIC ___________ 26

SYNAGIS _____________ 34

SYNALAR __________ 22, 23

SYNAREL _____________ 25

SYNERA ______________ 23

SYNERDERM __________ 23

SYNJARDY ____________ 10

SYNJARDY XR _________ 10

SYNTHROID __________ 36

SYNVISC______________ 32

SYNVISC ONE _________ 32

SYPRINE______________ 30

TABLOID _____________ 14

TACLONEX ___________ 23

tacrolimus ____________ 23

tadalafil ______________ 17

TAFINLAR ____________ 14

TAGRISSO ____________ 14

TALTZ ________________ 23

TALZENNA ___________ 14

TAMIFLU _____________ 16

tamoxifen citrate______ 14

51

tamsulosin hcl _________ 27

tamsulosin hydrochloride

___________________ 27

TAPERDEX 6-DAY ______ 20

TARCEVA _____________ 14

TARGADOX ___________ 35

tarina fe 1/20 _________ 19

tarina fe 1/20 eq_______ 19

TARON-C DHA _________ 31

TASIGNA ______________ 14

TAVALISSE ____________ 27

TAYTULLA_____________ 19

tazarotene ____________ 23

TAZORAC CRE 0.1% _ 23

TAZORAC GEL 0.1%__ 23

taztia xt_______________ 16

TECFIDERA ____________ 35

TECFIDERA STARTER PACK

___________________ 35

TEFLARO______________ 17

TEGRETOL _____________ 8

TEGRETOL-XR __________ 8

TEKTURNA ____________ 12

TEKTURNA HCT________ 12

telmisartan____________ 12

telmisartan/amlodipine 12

telmisartan/hydrochloroth

___________________ 12

temazepam ___________ 28

TEMOVA TE ___________ 23

temozolomide _________ 14

TENIVAC ______________ 36

tenofovir disoproxil fuma

___________________ 16

TENORMIN ___________ 16

terazosin hcl __________ 12

terbinafine hcl _________ 11

terbinafine hydrochloride

___________________ 11

terbutaline sulfate ______ 7

terconazole ___________ 38

TESTIM ________________ 5

TESTOPEL ______________ 5

testosterone cypionate __ 5

testosterone enanthate _ 5

testosterone topical solu 5

TETANUS/DIPHTHERIA

TOXOID ____________ 36

tetrabenazine _________ 35

tetracaine hcl__________ 34

tetracaine hydrochloride34

tetracycline hydrochlorid

___________________ 35

Tetracyclines __________ 35

TETRIX________________ 23

TEXACORT ____________ 23

THEO-24 _______________ 7

theophylline er _________ 7

THIOLA _______________ 27

thioridazine hcl ________ 15

thiothixene ___________ 15

THRIVITE RX __________ 31

THYROGEN ___________ 24

THYROID AGENTS _____ 35

tiagabine hydrochloride _ 8

TIAZAC _______________ 16

TIKOSYN_______________ 6

tilia fe ________________ 19

timolol gel sol 0.25% op 34

TIMOLOL GEL SOL 0.5%

OP ________________ 34

timolol maleate _______ 16

TIMOPTIC ____________ 34

TIMOPTIC OCUDOSE ___ 34

tinidazole _____________ 13

TIROSINT _____________ 36

TIVICAY ______________ 16

TIVORBEX _____________ 4

tizanidine hcl __________ 32

tizanidine hydrochloride 32

tl gard rx______________ 28

TL G-FOL OS___________ 31

TOBI PODHALER________ 3

TOBRADEX OIN 0.3-0.1%

___________________ 34

TOBRADEX SUS 0.3-0.1%

___________________ 34

TOBRADEX ST _________ 34

tobramycin _________ 3, 34

tobramycin sulfate_____ 34

tobramycin/dexamethason

e __________________ 34

TOBREX ______________ 34

TOLAK________________ 23

tolmetin sodium ________ 4

tolterodine tartrate ____ 37

tolterodine tartrate er _ 37

TOPAMAX _____________ 8

TOPAMAX SPRINKLE____ 8

TOPICORT ____________ 23

topiramate_____________ 8

TOPIRAMA TE ER _______ 8

TOPROL XL____________ 16

torsemide ____________ 25

TOUJEO MAX SOLOSTAR

___________________ 10

TOUJEO SOLOSTAR ____ 10

TOVIAZ _______________ 37

Toxoids_______________ 36

TRACLEER ____________ 17

TRADJENTA ___________ 10

tramadol hcl ___________ 5

TRAMADOL HCL CAP

150MG ER __________ 5

tramadol hcl tab 200mg er

____________________ 5

tramadol hydrochloride/ac

____________________ 5

trandolapril ___________ 13

trandolapril/verapamil hc

___________________ 13

tranexamic acid _______ 28

TRANSDERM -SCOP ____ 11

tranylcypromine sulfate _ 9

TRAVATAN Z__________ 34

trazodone hydrochloride 9

TREL EGY ELLIPTA _______ 7

TREMFYA _____________ 23

TRESIBA FLEXTOUCH __ 10

tretinoin______________ 23

tretinoin microsphere__ 23

tretinoin microsphere pum

___________________ 23

TREXALL______________ 14

TREXIMET ____________ 29

tri femynor ___________ 19

triamcinolone acetonide

________________ 23, 31

triamcinolone acetonide d

___________________ 31

triamterene/hydrochloroth

___________________ 25

TRIANEX _____________ 23

triazolam _____________ 28

TRIBENZOR ___________ 13

TRICARE PRENATAL DHA

ONE/ ______________ 31

tricitrates _____________ 27

TRICOR_______________ 12

triderm_______________ 23

TRIDESILON __________ 23

trientine hydrochloride 30

tri-estarylla ___________ 19

trifluoperazine hcl _____ 15

trifluridine ____________ 34

trigels-f forte__________ 28

TRIGLIDE _____________ 12

trihexyphenidyl hcl ____ 15

tri-legest fe ___________ 19

TRILEPTAL _____________ 8

tri-linyah _____________ 19

TRILIPIX ______________ 12

tri-lo-estarylla _________ 19

tri-lo-marzia __________ 19

tri-lo-sprintec _________ 19

TRI-LUMA ____________ 23

trilyte ________________ 29

trimethobenzamide hcl 11

trimethoprim ______ 13, 34

trimethoprim sulfate/poly

___________________ 34

trimipramine maleate___ 9

trinatal rx 1 ___________ 31

TRINTELLIX ____________ 9

triphrocaps ___________ 31

tri-previfem___________ 19

tri-sprintec ___________ 19

TRISTART DHA ________ 31

TRIUM EQ_____________ 16

tri-vitamin/fluoride ____ 31

trivora-28 ____________ 19

tri-vylibra_____________ 19

TROKENDI XR___________8

tropicamide __________ 34

trospium chloride _____ 37

trospium chloride er ___ 37

TRULANCE ___________ 26

TRULICITY ____________ 10

TRUM ENBA __________ 37

TRUSOPT_____________ 34

TRUVADA ____________ 16

TUBERSOL ____________ 24

TUDORZA PRESSAIR _____7

tulana________________ 19

TUZISTRA XR _________ 20

TWINRIX _____________ 37

tydemy_______________ 19

TYLENOL/CODEINE #3 ___5

TYLENOL/CODEINE #4 ___5

TYMLOS______________ 26

TYPHIM VI ___________ 37

TYSABRI______________ 35

TYVASO ______________ 17

TYVASO REFILL _______ 17

UCERIS A ER 2MG/ACT 6

UCERIS TAB 9MG __ 20

UDENYCA ____________ 28

ULCER

DRUGS/ANTISPASMODI

CS/ANTICHOLINERGICS

___________________ 36

ULESFIA ______________ 24

ULORIC ______________ 27

ultimatecare one ______ 31

ULTRAM _______________5

ULTRAVATE __________ 24

unithroid _____________ 36

UPTRAVI _____________ 17

urea _________________ 24

urea nail _____________ 24

URE-K________________ 24

urelle ________________ 37

uribel ________________ 37

URIMAR-T____________ 37

Urinary Anti-infectives 36

Urinary Antispasmodics 37

uro-458 ______________ 37

UROCIT-K 10__________ 27

UROGESIC -BLUE ______ 37

uro-mp_______________ 37

URSO 250 ____________ 27

URSO FORTE__________ 27

ursodiol ______________ 27

ustell ________________ 37

UTIBRON NEOHALER ____7

UTOPIC ______________ 24

VACCINES ____________ 37

VAGIFEM_____________ 38

VAGINAL PRODUCTS __ 37

52

valacyclovir hcl ________ 16

valacyclovir hydrochlorid16

VALCYTE ______________ 16

valganciclovir__________ 16

valganciclovir hydrochlor16

VALIUM _______________ 6

valproic acid____________ 8

valsartan__________ 12, 13

valsartan/hydrochlorothia

___________________ 13

VALTREX______________ 16

VANATOL LQ ___________ 4

vancomycin hcl ________ 13

vandazole _____________ 38

VANIQA ______________ 24

vanoxide-hc ___________ 24

VAQTA _______________ 37

vardenafil hydrochloride 17

VARIVAX______________ 37

VARUBI _______________ 11

VASCEPA _____________ 12

VASCULERA ___________ 24

Vasopressors__________ 38

VAXCHORA ___________ 37

VAYARIN _____________ 24

VAYARIN PLUS ________ 24

v-c forte ______________ 31

VECTICAL _____________ 24

VELCADE______________ 14

velivet ________________ 19

VELPHORO____________ 27

VELTASSA _____________ 30

VELTIN _______________ 24

VEMLIDY _____________ 16

VENCLEXTA ___________ 14

VENCLEXTA STARTING

PACK ______________ 14

VENELEX ______________ 24

venlafaxine hcl _________ 9

venlafaxine hcl er _______ 9

venlafaxine hydrochloride9

VENOFER _____________ 28

VENTOLIN HFA _________ 7

verapamil hcl ______ 16, 17

verapamil hcl er _______ 16

verapamil hcl sr________ 17

verapamil hydrochloride 17

VERDESO _____________ 24

VEREGEN _____________ 24

VERIPRED 20 __________ 20

VERZENIO_____________ 14

VESICARE _____________ 37

VIAGRA_______________ 17

VIBERZI _______________ 27

VIBRAMYCIN __________ 35

vicodin ________________ 5

vicodin es ______________ 5

vicodin hp______________ 5

VICTOZA ______________ 10

vienva ________________ 19

vigabatrin______________ 8

VIGAMOX ____________ 34

VIIBRYD _______________ 9

VIIBRYD STARTER PACK _ 9

vilamit mb ____________ 37

VIMOVO_______________ 4

VIMPAT _______________ 8

VINATE M ____________ 31

vinate one ____________ 31

VIOKACE _____________ 24

viorele________________ 19

VIRASAL ______________ 24

VIREAD _______________ 16

VIRT-C DHA ___________ 32

virt-caps ______________ 32

virt-gard ______________ 28

virt-phos 250 neutral___ 30

VIRT-PN ______________ 32

VIRT-PN DHA _________ 32

VISBIOME ____________ 24

VITAFOL ______________ 32

VITAFOL FE+ __________ 32

VITAFOL GUMMIES ____ 32

VITAFOL UL TRA _______ 32

VITAFOL-NA NO _______ 32

VITAFOL-OB __________ 32

VITAFOL-OB+DHA _____ 32

VITAFOL-ONE _________ 32

VITAMEDMD ONE

RX/QUATREFO _____ 32

VITAMEDMD REDICHEW

RX ________________ 32

vitamin k1 ____________ 38

VITAMINS _________31, 38

vitamins a/c/d/fluoride_ 32

VITAPEARL____________ 32

VITATRUE ____________ 32

VIVELLE-DOT__________ 26

VIVITROL _____________ 11

VIVLODEX _____________ 4

VIVOTIF ______________ 37

VOL-PLUS_____________ 32

VOL-TAB RX___________ 32

VOLTAREN____________ 24

voriconazole __________ 11

VOSEVI _______________ 16

VOTRIENT ____________ 14

VP-PNV-DHA __________ 32

VPRIV ________________ 28

VRAYLAR _____________ 15

VSL#3 DS _____________ 10

VUSION ______________ 24

vyfemla_______________ 19

vylibra________________ 19

VYNDAQEL ___________ 17

VYTONE ______________ 24

VYTORIN _____________ 12

VYVANSE ______________ 3

VYZULTA _____________ 34

warfarin sodium________ 7

WELCHOL ____________ 12

WELLBUTRIN SR________ 9

WELLBUTRIN XL ________ 9

wera _________________ 19

WESTHROID __________ 36

WP THY ROID _________ 36

wymzya fe ____________ 19

XALATAN _____________ 34

XALKORI _____________ 14

XANAX ________________ 6

XARELTO ______________ 7

XARELTO STARTER PACK 7

XELJANZ_______________ 4

XELJANZ XR____________ 4

XENAZINE ____________ 35

XERAC AC ____________ 24

XERESE _______________ 24

XERMEL O ____________ 27

XEROFORM OCCLUSIVE

PETROL ____________ 24

XGEVA _______________ 26

XHANCE ______________ 32

XIAFLEX ______________ 30

XIFAXAN _____________ 13

XIGDUO XR ___________ 10

XIIDRA _______________ 34

XIMINO ______________ 35

XOFLUZA _____________ 16

XOLAIR________________ 7

XOLEGEL _____________ 24

XOPENEX ______________ 7

XOPENEX HFA _________ 7

XRYLIX _______________ 24

XTAMPZA ER __________ 5

XTANDI ______________ 14

XULANE ______________ 19

XULTOPHY 100/3.6 ____ 10

XYLOCAINE ___________ 29

XYLOCAINE-MPF ______ 29

XYREM _______________ 35

XYZBAC ______________ 24

YASMIN 28 ___________ 19

YAZ __________________ 19

YF-VAX _______________ 37

YOSPRALA ____________ 27

YUPELRI _______________ 7

yuvafem ______________ 38

zafirlukast _____________ 7

zaleplon ______________ 28

zarah_________________ 19

ZARONTIN_____________ 8

ZARXIO_______________ 28

ZATEAN-PN DHA ______ 32

ZATEAN-PN PLUS______ 32

ZEGERID _____________ 36

ZEJULA _______________ 14

ZELBORAF ____________ 14

ZEMBRACE SYM TOUCH 29

ZENPEP ______________ 24

ZENZEDI________________3

ZEPATIER_____________ 16

ZESTRIL ______________ 13

ZETIA ________________ 12

ZETONNA ____________ 32

ZIANA________________ 24

zidovudine ________ 15, 16

zileuton er______________7

ZIOPTAN _____________ 34

ziprasidone hcl ________ 15

ZIPSOR_________________4

ZIRGAN ______________ 34

ZITHRA NOL ___________ 24

ZITHROMAX __________ 29

ZITHROMAX Z-PAK ____ 29

ZOFRA N______________ 11

ZOHYDRO ER ___________5

ZOLADEX _____________ 14

zoledronic acid________ 26

zolmitriptan __________ 29

zolmitriptan odt_______ 29

ZOLOFT ________________9

zolpidem tartrate _____ 28

zolpidem tartrate er ___ 28

ZOMACTON __________ 26

ZOMIG SPR 5MG __ 29

ZOMIG TAB 5MG __ 29

ZOMIG ZMT __________ 29

ZONAL ON ____________ 24

ZONEGRA N_____________8

zonisamide _____________8

ZONTIVITY ___________ 27

ZORTRESS ____________ 30

ZORV OLEX _____________4

ZOSTAVAX ___________ 37

zovia 1/35e ___________ 19

ZOVIRAX _____________ 24

ZTLIDO _______________ 24

ZUBSOLV _______________5

ZULRESSO ______________9

ZUPLENZ _____________ 11

ZYCLARA _____________ 24

ZYCLARA PUMP _______ 24

ZYFLO__________________7

ZYFLO CR_______________7

ZYLET ________________ 34

ZYMAXID_____________ 34

ZYPREXA _____________ 15

ZYPREXA ZYDIS _______ 15

ZYTIGA TAB 250MG 14

ZYTIGA TAB 500MG 14

ZYVIT ________________ 24

Documents

Prime Detailed Formulary Guide - Universal Rxuniversalrx.com/universal/wp-content/uploads/2019/10/URX...2019/10/01 · Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty