Harmony Health Plan PDL

Transcription

2014
Harmony Medicaid
Comprehensive Preferred Drug
List (List of Covered Drugs)
Harmony Health Plan
00
9
Please read: This document contains information about the drugs we cover in this
plan.
Please note that the Illinois Harmony Medicaid Preferred Drug List is updated
quarterly.
Providers, please visit our website at
https://www.harmonyhpi.com/provider/pharmacyservices
to view updates to the preferred drug list.
Members, please visit our website at
https://www.harmonyhpi.com/member/preferreddruglist
to view updates to the preferred drug list.
Last updated (01/01/2014)
Harmony Health Plan Cough & Cold Drug List
Non-Preferred Drugs
Preferred Drugs
ANTITUSSIVES,NON-NARCOTIC
Benzonatate
TESSALON 200 MG CAPSULE
BENZONATATE 100 MG CAPSULE
BENZONATATE 200 MG CAPSULE
Dextromethorphan Polistirex
DELSYM 30 MG/5 ML EXTENDED-RELEASE SUSPENSION
Dextromethorphan HBr
ROBITUSSIN PEDIATRIC COUGH SYP
Dextromethorphan HBr/Menthol
DELSYM COUGH RELIEF PLUS LOZENGE
NON-NARC ANTITUSS-1ST GEN. ANTIHISTAMINE-DECONGEST
Brompheniramine/Dextromethorphan HBr/Pseudoephedrine HCl
ALLANHIST PDX DROPS
BROMFED DM SYRUP
BROMHIST PDX DROPS
ENDACOF-PD DROPS
BROTAPP DM LIQUID
Q-TAPP DM ELIXIR
Brophenaramine/Dextromethorphan HBr/Phenylephrine HCl
COLD/COUGH CHILDRENS ELIXIR
RYNEX DM
DIMAPHEN DM ELIXIR
Chlorpheniramine/Dextromethorphan HBr/Phenylephrine HCl
C-PHEN DM
PD-COF SYRUP
RONDEX-DM SYRUP
SILDEC PE-DM SYRUP
DE-CHLOR DM LIQUID
CORFEN DM
NOHIST-DM
TRI-DEX PE
Chlorpheniramine/Dextromethorphan HBr/Pseudoephedrine HCl
PEDIATRIC COUGH-COLD LIQUID
KIDKARE COUGH/COLD
MESEHIST DM
Dexchlorpheniramine/Pseudoephedrine HCl/Chlophedianol HCl
VANACOF LIQUID
Chlorpheniramine/Dextromethorphan HBr
DIMETAPP LONG-ACTING COUGH LIQ
ROBITUSSIN LONG ACTING LIQUID
Promethazine HCl/Dextromethorphan HBr
PROMETHAZINE-DM SYRUP
NON-NARC ANTITUSS-1ST GEN. ANTIHIST-ANALGESIC COMBINATION
Dextromethorphan HBr/Acetaminophen/Doxylamine
DELSYM NIGHTTIME MULTI-SYMPTOM
EXPECTORANTS
DECONGESTANT-EXPECTORANT COMBINATIONS
Guaifenesin/Phenylephrine HCl
DONATUSSIN DROPS
PE-GUAI DROPS
DESPEC LIQUID
Last updated 01/01/14
RESCON-GG LIQUID
Page 1 of 2
Harmony Health Plan Cough & Cold Drug List
Non-Preferred Drugs
Preferred Drugs
NON-NARCOTIC DECONGESTANT-EXPECTORANT-ANTITUSSIVE
Guaifenesin/Dextromethorphan HBr/Phenylephreine
ROBAFEN CF SYRUP
NON-NARCOTIC ANTITUSSIVE AND EXPECTORANT COMB.
Dextromethorphan HBr/Guaifenesin
DURATUSS DM ELIXIR
SIMUC-DM ELIXIR
SU-TUSS DM ELIXIR
MUCUS RELIEF COUGH LIQUID
DIABETIC TUSSIN DM LIQUID
GUAIFENESIN DM SYRUP
Q-TUSSIN-DM SYRUP
EXTRA ACTION COUGH
SILTUSSIN DM COUGH SYRUP
REFENESEN DM
SILTUSSIN DM DAS COUGH SYRUP
MUCOSA DM
ROBITUSSIN COUGH CHEST CONGESTION DM LIQUID
NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE
Chlorpheniramine/Hydrocodone Polistirex
TUSSIONEX PENNKINETIC SUSP
TUSSICAPS (min. age 6 years old)
HYDROCODONE-CHLORPHENIRAMINE
SUSPENSION (min. age 6 years old)
Codeine Phosphate/Promethazine HCl
PROMETHAZINE-CODEINE SYRUP (min. age 6 years old)
NARCOTIC ANTITUSSIVE-1ST GEN. ANTIHISTAMINE-DECONGESTANT
Dexbrompheniramine/Hydrocodone Bit/Phenylephrine HCl
CYTUSS-HC NR SYRUP
HC 2.5-PE 5-DBROM 1 MG SYRUP
HC/PE/DBROM SYRUP
Codeine/Phenylephrine HCl/Promethazine
PROMETH VC W/COD SYRUP
PROMETHAZINE VC/COD SYRUP
Pseudoephedrine HCl/Codeine/Chlorpheniramine
PHENYLHISTINE DH
NARCOTIC ANTITUSSIVE-ANTICHOLINERGIC COMBINATION
Hydrocodone Bit/Homatropine
HYDROCODONE-HOMATROPINE
HYDROMET SYRUP
NARCOTIC ANTITUSSIVE-EXPECTORANT COMBINATION
Guaifenesin/Hydrocodone Bit
HYDROCODONE-GUAIFENESIN SYRUP
NARCOF SYRUP
Codeine Phosphate/Guaifenesin
TUSSICLEAR DH SYRUP
CHERATUSSIN AC SYRUP
GUAIFENESIN-CODEINE SYRUP
IOPHEN C-NR
NARCOTIC ANTITUSSIVE-DECONGESTANT-EXPECTORANT COMBINATIONS
Codeine Phosphate/Guaifenesin/Pseudoephedrine HCl
CHERATUSSIN DAC SYRUP
Last updated 01/01/14
Page 2 of 2
Vaccines: Vaccines are covered under the Vaccines for Children program for members through 18 years of age.
Coverage beyond the age of 18 is evaluated through the PA process.
UPPERCASE = Brand name drugs
italics = Generic drugs
Drug Name
Preference Details
P = Preferred
Dagger (†) = N/A
Asterisk (*) = N/A
Asterisk (**) = N/A
Asterisk (***) = N/A
XX = N/A
Coverage Details
PA = Prior Authorization
ST = Step Therapy
QL = Quantity Limit
AL = Age Limit
OTC = OTC- Covered w/Rx
Preference Details Coverage Details
*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexia
nts*
*Amphetamines**
*Amphetamine Mixtures***
ADDERALL XR ORAL CAPSULE
EXTENDED RELEASE 24 HOUR 10 MG,
15 MG, 20 MG, 25 MG, 30 MG, 5 MG
P
Amphetamine-Dextroamphetamine ORAL
TABLET 10 MG, 12.5 MG, 15 MG, 5 MG, 7.5
MG
P
TABLET 20 MG
P
QL (93 EA per 31 day(s))
TABLET 30 MG
P
QL (62 EA per 31 day(s)); AL
(Min 6 Years and Max 20 Years)
*Amphetamines***
Dextroamphetamine Sulfate ORAL TABLET
10 MG, 5 MG
P
Dextroamphetamine Sulfate ER ORAL
CAPSULE EXTENDED RELEASE 24
HOUR 10 MG, 15 MG, 5 MG
P
ST; QL (31 EA per 31 Day(s));
AL (Min 5 Years and Max 20
Years)
VYVANSE ORAL CAPSULE 20 MG, 30
MG, 40 MG, 50 MG, 60 MG, 70 MG
P
*Stimulants - Misc.**
1
Drug Name
*Stimulants - Misc.***
Dexmethylphenidate HCl ORAL TABLET 10
MG, 2.5 MG, 5 MG
P
(Min 6 Years)
METHYLIN ORAL TABLET CHEWABLE
10 MG, 2.5 MG, 5 MG
P
AL (Min 6 Years)
Methylphenidate HCl ORAL TABLET 10 MG,
5 MG
P
AL (Min 6 Years)
Methylphenidate HCl ORAL TABLET 20 MG
P
(Min 6 Years)
Methylphenidate HCl ER ORAL TABLET
EXTENDEDRELEASE* 10 MG
P
Years)
EXTENDEDRELEASE* 18 MG, 27 MG, 36
MG
P
P
P
P
OTC
*Alternative Medicines*
*Alternative Medicine - M's**
*Alternative Medicine - Me's***
Melatonin Maximum Strength ORAL
TABLET 5 MG
*Aminoglycosides*
*Aminoglycosides**
*Aminoglycosides***
TOBI INHALATION NEBULIZATION
SOLUTION 300 MG/5ML
P
*Analgesics - Anti-Inflammatory*
*Anti-Tnf-Alpha - Monoclonal Antibodies**
*Anti-Tnf-Alpha - Monoclonal Antibodies***
HUMIRA SUBCUTANEOUS* KIT 20
MG/0.4ML, 40 MG/0.8ML
P
PA
HUMIRA PEN SUBCUTANEOUS* KIT 40
MG/0.8ML
P
PA
HUMIRA PEN-CROHNS STARTER
SUBCUTANEOUS* KIT 40 MG/0.8ML
P
PA
SIMPONI SUBCUTANEOUS* SOLUTION
100 MG/ML, 50 MG/0.5ML
P
PA
2
Drug Name
*Gold Compounds**
*Gold Compounds***
RIDAURA ORAL CAPSULE 3 MG
P
*Nonsteroidal Anti-Inflammatory Agents
(Nsaids)**
*Cyclooxygenase 2 (Cox-2) Inhibitors***
CELEBREX ORAL CAPSULE 100 MG, 200
MG, 400 MG, 50 MG
P
ST; QL (31 EA per 31 day(s))
Childrens Ibuprofen ORAL SUSPENSION 40
MG/ML
P
OTC
Diclofenac Potassium ORAL TABLET 50 MG
P
Diclofenac Sodium ORAL TABLET
DELAYED RELEASE 25 MG, 50 MG, 75 MG
P
Diclofenac Sodium ER ORAL TABLET
EXTENDED RELEASE 24 HR* 100 MG
P
Etodolac ORAL CAPSULE 200 MG, 300 MG
P
Etodolac ORAL TABLET 400 MG, 500 MG
P
Fenoprofen Calcium ORAL TABLET 600 MG
P
Flurbiprofen ORAL TABLET 100 MG, 50 MG
P
Ibuprofen ORAL SUSPENSION 100
MG/5ML
P
OTC
Ibuprofen ORAL TABLET 200 MG
P
OTC
Ibuprofen ORAL TABLET 400 MG, 600 MG,
800 MG
P
Indomethacin ORAL CAPSULE 25 MG, 50
MG
P
Ketoprofen ORAL CAPSULE 50 MG, 75 MG
P
Ketorolac Tromethamine ORAL TABLET 10
MG
P
Meloxicam ORAL TABLET 15 MG, 7.5 MG
P
Nabumetone ORAL TABLET 500 MG, 750
MG
P
Naproxen ORAL SUSPENSION 125
MG/5ML
P
Naproxen ORAL TABLET 250 MG, 375 MG,
500 MG
P
*Nonsteroidal Anti-Inflammatory Agents
(Nsaids)***
QL (2000 ML per 31 day(s))
3
Drug Name
Naproxen DR ORAL TABLET DELAYED
RELEASE 500 MG
P
Naproxen Sodium ORAL TABLET 275 MG,
550 MG
P
Oxaprozin ORAL TABLET 600 MG
P
Piroxicam ORAL CAPSULE 10 MG, 20 MG
P
Sulindac ORAL TABLET 150 MG, 200 MG
P
Tolmetin Sodium ORAL CAPSULE 400 MG
P
*Pyrimidine Synthesis Inhibitors**
*Pyrimidine Synthesis Inhibitors***
Leflunomide ORAL TABLET 10 MG, 20 MG
P
*Analgesics - Nonnarcotic*
*Analgesic Combinations**
*Analgesics-Sedatives***
Butalbital-Acetaminophen ORAL TABLET
50-325 MG
P
Butalbital-APAP-Caffeine ORAL CAPSULE
50-325-40 MG
P
Butalbital-APAP-Caffeine ORAL TABLET
50-325-40 MG, 50-500-40 MG
P
Butalbital-ASA-Caffeine ORAL CAPSULE
50-325-40 MG
P
Marten-Tab ORAL TABLET 50-325 MG
P
Repan ORAL TABLET 50-325-40 MG
P
TENCON ORAL TABLET 50-650 MG
P
ZEBUTAL ORAL CAPSULE 50-500-40 MG
P
ACEPHEN RE SUPPOSITORY 120 MG, 325
MG
P
OTC
Acetaminophen ORAL SOLUTION 160
MG/5ML
P
OTC
Acetaminophen ORAL TABLET 325 MG
P
OTC; QL (279 EA per 31 day(s))
Acetaminophen ORAL TABLET 500 MG
P
Acetaminophen ORAL TABLET CHEWABLE
80 MG
P
OTC
Infants Silapap ORAL SOLUTION 100
MG/ML
P
OTC
*Analgesics Other**
*Analgesics Other***
4
Drug Name
Mapap ORAL LIQUID† 160 MG/5ML
P
OTC
Mapap Infants ORAL SUSPENSION 160
MG/5ML
P
OTC
Nortemp Infants ORAL SUSPENSION 80
MG/0.8ML
P
OTC
Pain & Fever Childrens ORAL SOLUTION
160 MG/5ML
P
OTC
Q-PAP Infants ORAL SOLUTION 80
MG/0.8ML
P
OTC
*Salicylates**
*Salicylate Combinations***
Choline & Mag Trisalicylate ORAL TABLET
1000 MG
P
Choline-Mag Trisalicylate ORAL LIQUID†
500 MG/5ML
P
*Salicylates***
Aspirin ORAL TABLET 325 MG, 81 MG
P
OTC
Aspirin ORAL TABLET CHEWABLE 81 MG
P
OTC
Aspirin RE SUPPOSITORY 300 MG, 600 MG
P
OTC
Diflunisal ORAL TABLET 500 MG
P
Salsalate ORAL TABLET 500 MG, 750 MG
P
*Analgesics - Opioid*
*Opioid Agonists**
*Opioid Agonists***
Codeine Phosphate INJECTION SOLUTION
15 MG/ML, 30 MG/ML
P
Codeine Sulfate ORAL TABLET 15 MG, 30
MG, 60 MG
P
FentaNYL TRANSDERMAL PATCH 72 HR
100 MCG/HR, 12 MCG/HR, 25 MCG/HR, 50
MCG/HR, 75 MCG/HR
P
PA; QL (10 EA per 30 day(s))
HYDROmorphone HCl ORAL LIQUID† 1
MG/ML
P
HYDROmorphone HCl ORAL TABLET 2
MG, 4 MG, 8 MG
P
HYDROmorphone HCl RE SUPPOSITORY 3
MG
P
Methadone HCl ORAL SOLUTION 10
MG/5ML, 5 MG/5ML
P
5
Drug Name
Methadone HCl ORAL TABLET 10 MG, 5
MG
P
METHADOSE ORAL TABLET 10 MG
P
Morphine Sulfate INJECTION SOLUTION 10
MG/ML, 15 MG/ML, 5 MG/ML, 8 MG/ML
P
Morphine Sulfate INTRAVENOUS*
SOLUTION 1 MG/ML, 25 MG/ML, 50
MG/ML
P
Morphine Sulfate ORAL SOLUTION 10
MG/5ML, 20 MG/5ML
P
Morphine Sulfate ORAL TABLET 15 MG, 30
MG
P
Morphine Sulfate RE SUPPOSITORY 10 MG,
20 MG, 30 MG, 5 MG
P
Morphine Sulfate (Concentrate) ORAL
SOLUTION 20 MG/ML
P
Morphine Sulfate (PF) INJECTION
SOLUTION 0.5 MG/ML
P
Morphine Sulfate (PF) INTRAVENOUS*
SOLUTION 8 MG/ML
P
Morphine Sulfate ER ORAL TABLET
EXTENDEDRELEASE* 100 MG, 15 MG, 200
MG, 30 MG, 60 MG
P
OxyCODONE HCl ORAL CAPSULE 5 MG
P
OxyCODONE HCl ORAL SOLUTION 5
MG/5ML
P
OxyCODONE HCl ORAL TABLET 10 MG,
15 MG, 20 MG, 5 MG
P
OxyCODONE HCl ORAL TABLET 30 MG
P
TraMADol HCl ORAL TABLET 50 MG
P
*Opioid Combinations**
*Codeine Combinations***
Acetaminophen-Codeine ORAL SOLUTION
120-12 MG/5ML
P
Acetaminophen-Codeine #2 ORAL TABLET
300-15 MG
P
300-30 MG
P
300-60 MG
P
6
Drug Name
ASCOMP-CODEINE ORAL CAPSULE
50-325-40-30 MG
P
Butalbital-APAP-Caff-Cod ORAL CAPSULE
50-325-40-30 MG
P
Butalbital-ASA-Caff-Codeine ORAL
CAPSULE 50-325-40-30 MG
P
*Hydrocodone Combinations***
Hydrocodone-Acetaminophen ORAL
SOLUTION 7.5-325 MG/15ML, 7.5-500
MG/15ML
P
Hydrocodone-Acetaminophen ORAL TABLET
10-325 MG, 10-500 MG, 10-650 MG, 10-660
MG, 10-750 MG, 2.5-500 MG, 5-325 MG,
5-500 MG, 7.5-325 MG, 7.5-500 MG, 7.5-650
MG, 7.5-750 MG
P
Hydrocodone-Ibuprofen ORAL TABLET
7.5-200 MG
P
HYDROGESIC ORAL CAPSULE 5-500 MG
P
ENDOCET ORAL TABLET 10-325 MG,
5-325 MG, 7.5-325 MG, 7.5-500 MG
P
ENDOCET ORAL TABLET 10-650 MG
P
Oxycodone-Acetaminophen ORAL CAPSULE
5-500 MG
P
Oxycodone-Acetaminophen ORAL TABLET
10-325 MG, 5-325 MG, 7.5-325 MG, 7.5-500
MG
P
Oxycodone-Acetaminophen ORAL TABLET
10-650 MG
P
Oxycodone-Aspirin ORAL TABLET
4.8355-325 MG
P
ROXICET ORAL TABLET 5-325 MG
P
Buprenorphine HCl SUBLINGUAL TABLET
SUBLINGUAL 2 MG, 8 MG
P
PA
Butorphanol Tartrate NASAL SOLUTION 10
MG/ML
P
Pentazocine-Naloxone HCl ORAL TABLET
50-0.5 MG
P
*Opioid Combinations***
*Opioid Partial Agonists**
*Opioid Partial Agonists***
7
Drug Name
SUBOXONE SUBLINGUAL FILM 12-3
MG, 2-0.5 MG, 4-1 MG, 8-2 MG
P
PA
P
PA
*Androgens-Anabolic*
*Anabolic Steroids**
*Anabolic Steroids***
Oxandrolone ORAL TABLET 10 MG, 2.5 MG
*Androgens**
*Androgens***
Danazol ORAL CAPSULE 100 MG, 200 MG,
50 MG
P
Methitest ORAL TABLET 10 MG
P
TESTIM TRANSDERMAL GEL 50
MG/5GM
P
Testosterone Cypionate INTRAMUSCULAR*
OIL 100 MG/ML, 200 MG/ML
P
Testosterone Enanthate INTRAMUSCULAR*
OIL 200 MG/ML
P
PA
*Anorectal Agents*
*Intrarectal Steroids**
*Intrarectal Steroids***
Hydrocortisone RE ENEMA 100 MG/60ML
P
*Rectal Steroids**
*Rectal Steroids***
PROCTOSOL HC RE CREAM 2.5 %
P
PROCTOZONE-HC RE CREAM 2.5 %
P
*Antacids*
*Antacid Combinations**
*Antacid & Simethicone***
Antacid ORAL SUSPENSION 200-200-20
MG/5ML
P
OTC
P
OTC
P
OTC
*Antacids - Aluminum Salts**
*Antacids - Aluminum Salts***
Aluminum Hydroxide Gel ORAL
SUSPENSION 320 MG/5ML
*Antacids - Bicarbonate**
*Antacids - Bicarbonate***
Sodium Bicarbonate ORAL TABLET 325 MG
8
Drug Name
*Antacids - Calcium Salts**
*Antacids - Calcium Salts***
Calcium Antacid Extra Strength ORAL
TABLET CHEWABLE 750 MG
P
OTC
Calcium Carbonate Antacid ORAL TABLET
CHEWABLE 500 MG
P
OTC
P
OTC
ALBENZA ORAL TABLET 200 MG
P
PA
BILTRICIDE ORAL TABLET 600 MG
P
PA
Reeses Pinworm Medicine ORAL
SUSPENSION 144 MG/ML
P
OTC
STROMECTOL ORAL TABLET 3 MG
P
*Antacids - Magnesium Salts**
*Antacids - Magnesium Salts***
Magnesium Oxide ORAL TABLET 250 MG,
400 MG, 420 MG
*Anthelmintics*
*Anthelmintics**
*Anthelmintics***
*Antianginal Agents*
*Nitrates**
*Nitrates***
Isosorbide Dinitrate ORAL TABLET 10 MG,
20 MG, 30 MG, 5 MG
P
Isosorbide Dinitrate ER ORAL TABLET
P
Isosorbide Mononitrate ORAL TABLET 10
MG, 20 MG
P
Isosorbide Mononitrate ER ORAL TABLET
EXTENDED RELEASE 24 HR* 120 MG, 30
MG, 60 MG
P
NITRO-BID TRANSDERMAL
OINTMENT 2 %
P
Nitroglycerin TRANSDERMAL PATCH 24
HR 0.1 MG/HR, 0.2 MG/HR, 0.4 MG/HR, 0.6
MG/HR
P
NITROSTAT SUBLINGUAL TABLET
SUBLINGUAL 0.3 MG, 0.4 MG, 0.6 MG
P
*Antianxiety Agents*
*Antianxiety Agents - Misc.**
9
Drug Name
*Antianxiety Agents - Misc.***
BusPIRone HCl ORAL TABLET 10 MG, 15
MG, 30 MG, 5 MG, 7.5 MG
P
HydrOXYzine HCl ORAL SOLUTION 10
MG/5ML
P
HydrOXYzine HCl ORAL SYRUP 10
MG/5ML
P
HydrOXYzine HCl ORAL TABLET 10 MG,
25 MG, 50 MG
P
HydrOXYzine Pamoate ORAL CAPSULE 100
MG, 25 MG, 50 MG
P
Meprobamate ORAL TABLET 200 MG, 400
MG
P
*Benzodiazepines**
*Benzodiazepines***
ALPRAZolam ORAL TABLET 0.25 MG, 0.5
MG, 1 MG, 2 MG
P
ChlordiazePOXIDE HCl ORAL CAPSULE 10
MG, 25 MG, 5 MG
P
Clorazepate Dipotassium ORAL TABLET 15
MG, 3.75 MG, 7.5 MG
P
Diazepam INJECTION SOLUTION 5
MG/ML
P
Diazepam ORAL SOLUTION 1 MG/ML
P
Diazepam ORAL TABLET 10 MG, 2 MG, 5
MG
P
LORazepam INJECTION SOLUTION 2
MG/ML, 4 MG/ML
P
LORazepam ORAL TABLET 0.5 MG, 1 MG,
2 MG
P
Oxazepam ORAL CAPSULE 10 MG, 15 MG,
30 MG
P
*Antiarrhythmics*
*Antiarrhythmics Type I-A**
*Antiarrhythmics Type I-A***
Disopyramide Phosphate ORAL CAPSULE
100 MG, 150 MG
P
Procainamide HCl INJECTION SOLUTION
100 MG/ML, 500 MG/ML
P
10
AL (Min 9 Years)
Drug Name
QuiNIDine Gluconate INJECTION
SOLUTION 80 MG/ML
P
QuiNIDine Gluconate ER ORAL TABLET
P
QuiNIDine Sulfate ORAL TABLET 300 MG
P
*Antiarrhythmics Type I-B**
*Antiarrhythmics Type I-B***
Lidocaine HCl (Cardiac) INTRAVENOUS*
SOLUTION 20 MG/ML
P
Mexiletine HCl ORAL CAPSULE 150 MG,
200 MG, 250 MG
P
*Antiarrhythmics Type I-C**
*Antiarrhythmics Type I-C***
Flecainide Acetate ORAL TABLET 100 MG,
150 MG, 50 MG
P
Propafenone HCl ORAL TABLET 150 MG,
225 MG, 300 MG
P
*Antiarrhythmics Type Iii**
*Antiarrhythmics Type Iii***
Amiodarone HCl INTRAVENOUS*
SOLUTION 150 MG/3ML
P
Amiodarone HCl ORAL TABLET 200 MG,
400 MG
P
PACERONE ORAL TABLET 200 MG, 400
MG
P
*Antiasthmatic And Bronchodilator Agents*
*Antiasthmatic - Monoclonal Antibodies**
*Anti-Ige Monoclonal Antibodies***
XOLAIR SUBCUTANEOUS* SOLUTION
RECONSTITUTED 150 MG
P
PA
*Anti-Inflammatory Agents**
*Anti-Inflammatory Agents***
Cromolyn Sodium INHALATION
NEBULIZATION SOLUTION 20 MG/2ML
P
*Bronchodilators - Anticholinergics**
*Bronchodilators - Anticholinergics***
ATROVENT HFA INHALATION
AEROSOL, SOLUTION 17 MCG/ACT
P
QL (25.8 GM per 31 day(s))
11
Drug Name
Ipratropium Bromide INHALATION
SOLUTION 0.02 %
P
TUDORZA PRESSAIR INHALATION
AEROSOL POWDER, BREATH
ACTIVATED 400 MCG/ACT
P
*Leukotriene Modulators**
*Leukotriene Receptor Antagonists***
Montelukast Sodium ORAL PACKET 4 MG
P
Montelukast Sodium ORAL TABLET 10 MG
P
Montelukast Sodium ORAL TABLET
CHEWABLE 4 MG, 5 MG
P
Zafirlukast ORAL TABLET 10 MG, 20 MG
P
*Steroid Inhalants**
*Steroid Inhalants***
ASMANEX 120 METERED DOSES
INHALATION AEROSOL POWDER,
BREATH ACTIVATED 220 MCG/INH
P
BREATH ACTIVATED 110 MCG/INH, 220
MCG/INH
P
BREATH ACTIVATED 220 MCG/INH
P
Budesonide INHALATION SUSPENSION
0.25 MG/2ML, 0.5 MG/2ML
P
QL (120 ML per 31 day(s)); AL
(Max 8 Years)
FLOVENT DISKUS INHALATION
ACTIVATED 100 MCG/BLIST, 250
MCG/BLIST, 50 MCG/BLIST
P
FLOVENT HFA INHALATION
AEROSOL† 110 MCG/ACT, 220 MCG/ACT
P
QL (12 GM per 30 day(s))
FLOVENT HFA INHALATION
AEROSOL† 44 MCG/ACT
P
PULMICORT INHALATION
SUSPENSION 1 MG/2ML
P
(Max 8 Years)
QVAR INHALATION AEROSOL,
SOLUTION 40 MCG/ACT
P
QVAR INHALATION AEROSOL,
SOLUTION 80 MCG/ACT
P
12
Drug Name
*Sympathomimetics**
*Adrenergic Combinations***
ADVAIR DISKUS INHALATION
ACTIVATED 100-50 MCG/DOSE, 250-50
MCG/DOSE, 500-50 MCG/DOSE
P
ADVAIR HFA INHALATION AEROSOL†
115-21 MCG/ACT, 230-21 MCG/ACT, 45-21
MCG/ACT
P
COMBIVENT INHALATION AEROSOL†
18-103 MCG/ACT
P
COMBIVENT RESPIMAT INHALATION
AEROSOL, SOLUTION 20-100 MCG/ACT
P
DULERA INHALATION AEROSOL† 100-5
MCG/ACT, 200-5 MCG/ACT
P
Ipratropium-Albuterol INHALATION
SOLUTION 0.5-2.5 (3) MG/3ML
P
SYMBICORT INHALATION AEROSOL†
160-4.5 MCG/ACT, 80-4.5 MCG/ACT
P
Albuterol Sulfate INHALATION
NEBULIZATION SOLUTION (2.5
MG/3ML) 0.083%
P
NEBULIZATION SOLUTION (5 MG/ML)
0.5%
P
NEBULIZATION SOLUTION 0.63
MG/3ML, 1.25 MG/3ML
P
Albuterol Sulfate ORAL SYRUP 2 MG/5ML
P
Albuterol Sulfate ORAL TABLET 2 MG, 4
MG
P
FORADIL AEROLIZER INHALATION
CAPSULE 12 MCG
P
Metaproterenol Sulfate ORAL SYRUP 10
MG/5ML
P
SEREVENT DISKUS INHALATION
ACTIVATED 50 MCG/DOSE
P
Terbutaline Sulfate INJECTION SOLUTION
1 MG/ML
P
*Beta Adrenergics***
13
Drug Name
Terbutaline Sulfate ORAL TABLET 2.5 MG, 5
MG
P
VENTOLIN HFA INHALATION
AEROSOL, SOLUTION 108 (90 BASE)
MCG/ACT
P
*Xanthines**
*Xanthines***
Aminophylline INTRAVENOUS* SOLUTION
25 MG/ML
P
Theophylline ORAL SOLUTION 80
MG/15ML
P
Theophylline ER ORAL TABLET
MG, 300 MG, 450 MG
P
Theophylline ER ORAL TABLET
MG
P
*Anticoagulants*
*Coumarin Anticoagulants**
*Coumarin Anticoagulants***
JANTOVEN ORAL TABLET 1 MG, 10 MG,
2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG,
7.5 MG
P
Warfarin Sodium ORAL TABLET 1 MG, 10
MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6
MG, 7.5 MG
P
*Direct Factor Xa Inhibitors**
*Direct Factor Xa Inhibitors***
XARELTO ORAL TABLET 10 MG
P
Enoxaparin Sodium INJECTION SOLUTION
300 MG/3ML
P
Enoxaparin Sodium SUBCUTANEOUS*
SOLUTION 100 MG/ML, 150 MG/ML
P
SOLUTION 120 MG/0.8ML, 80 MG/0.8ML
P
QL (22.4 ML per 31 day(s))
P
*Heparins And Heparinoid-Like Agents**
*Low Molecular Weight Heparins***
14
Drug Name
SOLUTION 60 MG/0.6ML
P
Fondaparinux Sodium SUBCUTANEOUS*
P
SOLUTION 2.5 MG/0.5ML
P
SOLUTION 5 MG/0.4ML
P
P
*Synthetic Heparinoid-Like Agents***
*Anticonvulsants*
*Anticonvulsants - Benzodiazepines**
*Anticonvulsants - Benzodiazepines***
ClonazePAM ORAL TABLET 0.5 MG, 1 MG,
2 MG
P
Diazepam RE GEL 10 MG, 2.5 MG, 20 MG
P
CarBAMazepine ORAL SUSPENSION 100
MG/5ML
P
CarBAMazepine ORAL TABLET 200 MG
P
CarBAMazepine ORAL TABLET
CHEWABLE 100 MG
P
EPITOL ORAL TABLET 200 MG
P
Gabapentin ORAL CAPSULE 100 MG
P
P
P
Gabapentin ORAL SOLUTION 250 MG/5ML
P
Gabapentin ORAL TABLET 600 MG, 800 MG
P
LamoTRIgine ORAL TABLET 100 MG, 150
MG, 200 MG
P
LamoTRIgine ORAL TABLET 25 MG
P
LamoTRIgine ORAL TABLET CHEWABLE
25 MG, 5 MG
P
LevETIRAcetam INTRAVENOUS*
SOLUTION 500 MG/5ML
P
*Anticonvulsants - Misc.**
*Anticonvulsants - Misc.***
15
Drug Name
LevETIRAcetam ORAL SOLUTION 100
MG/ML
P
LevETIRAcetam ORAL TABLET 1000 MG,
500 MG, 750 MG
P
LevETIRAcetam ORAL TABLET 250 MG
P
OXcarbazepine ORAL SUSPENSION 300
MG/5ML
P
OXcarbazepine ORAL TABLET 150 MG
P
P
P
Primidone ORAL TABLET 250 MG
P
Primidone ORAL TABLET 50 MG
P
Topiramate ORAL CAPSULE SPRINKLE 15
MG, 25 MG
P
Topiramate ORAL TABLET 100 MG, 25 MG,
50 MG
P
Topiramate ORAL TABLET 200 MG
P
Zonisamide ORAL CAPSULE 100 MG
P
P
P
*Gaba Modulators**
*Gaba Modulators***
GABITRIL ORAL TABLET 12 MG, 16 MG
P
TiaGABine HCl ORAL TABLET 2 MG, 4 MG
P
*Hydantoins**
*Hydantoins***
DILANTIN ORAL CAPSULE 30 MG
P
Fosphenytoin Sodium INJECTION
SOLUTION 100 MG PE/2ML
P
PEGANONE ORAL TABLET 250 MG
P
Phenytoin ORAL SUSPENSION 125
MG/5ML
P
Phenytoin ORAL TABLET CHEWABLE 50
MG
P
Phenytoin Sodium INJECTION SOLUTION
50 MG/ML
P
Phenytoin Sodium Extended ORAL CAPSULE
100 MG, 200 MG, 300 MG
P
16
Drug Name
*Succinimides**
*Succinimides***
Ethosuximide ORAL CAPSULE 250 MG
P
Ethosuximide ORAL SOLUTION 250
MG/5ML
P
Divalproex Sodium ORAL CAPSULE
SPRINKLE 125 MG
P
Divalproex Sodium ORAL TABLET
DELAYED RELEASE 125 MG, 250 MG
P
Divalproex Sodium ORAL TABLET
DELAYED RELEASE 500 MG
P
Divalproex Sodium ER ORAL TABLET
P
Divalproex Sodium ER ORAL TABLET
P
Valproic Acid ORAL CAPSULE 250 MG
P
Valproic Acid ORAL SOLUTION 250
MG/5ML
P
Valproic Acid ORAL SYRUP 250 MG/5ML
P
*Valproic Acid**
*Valproic Acid***
*Antidepressants*
*Alpha-2 Receptor Antagonists (Tetracyclics)**
*Alpha-2 Receptor Antagonists
(Tetracyclics)***
Mirtazapine ORAL TABLET 15 MG, 30 MG,
45 MG, 7.5 MG
P
Mirtazapine ORAL TABLET DISPERSIBLE
15 MG, 30 MG, 45 MG
P
*Antidepressants - Misc.**
*Antidepressants - Misc.***
BUDEPRION SR ORAL TABLET
P
BuPROPion HCl ORAL TABLET 100 MG, 75
MG
P
BuPROPion HCl ER (SR) ORAL TABLET
MG, 200 MG
P
17
Drug Name
BuPROPion HCl ER (XL) ORAL TABLET
MG
P
Maprotiline HCl ORAL TABLET 25 MG, 50
MG, 75 MG
P
*Modified Cyclics**
*Modified Cyclics***
Nefazodone HCl ORAL TABLET 100 MG, 150
MG, 200 MG, 250 MG, 50 MG
P
TraZODone HCl ORAL TABLET 100 MG,
150 MG, 50 MG
P
*Monoamine Oxidase Inhibitors (Maois)**
*Monoamine Oxidase Inhibitors (Maois)***
Phenelzine Sulfate ORAL TABLET 15 MG
P
Tranylcypromine Sulfate ORAL TABLET 10
MG
P
*Selective Serotonin Reuptake Inhibitors
(Ssris)**
*Selective Serotonin Reuptake Inhibitors
(Ssris)***
Citalopram Hydrobromide ORAL TABLET 10
MG, 20 MG, 40 MG
P
Escitalopram Oxalate ORAL TABLET 10 MG,
20 MG, 5 MG
P
FLUoxetine HCl ORAL CAPSULE 10 MG, 20
MG, 40 MG
P
FLUoxetine HCl ORAL SOLUTION 20
MG/5ML
P
FLUoxetine HCl ORAL TABLET 10 MG, 20
MG
P
FluvoxaMINE Maleate ORAL TABLET 100
MG, 25 MG, 50 MG
P
PARoxetine HCl ORAL TABLET 10 MG, 20
MG, 30 MG, 40 MG
P
Sertraline HCl ORAL TABLET 100 MG, 25
MG, 50 MG
P
*Serotonin-Norepinephrine Reuptake Inhibitors
(Snris)**
*Serotonin-Norepinephrine Reuptake Inhibitors
(Snris)***
18
Drug Name
Venlafaxine HCl ORAL TABLET 100 MG, 25
MG, 37.5 MG, 50 MG, 75 MG
P
Venlafaxine HCl ER ORAL CAPSULE
37.5 MG, 75 MG
P
*Tricyclic Agents**
*Tricyclic Agents***
Amitriptyline HCl ORAL TABLET 10 MG,
100 MG, 150 MG, 25 MG, 50 MG, 75 MG
P
Amoxapine ORAL TABLET 100 MG, 150 MG,
25 MG, 50 MG
P
ClomiPRAMINE HCl ORAL CAPSULE 25
MG, 50 MG, 75 MG
P
Desipramine HCl ORAL TABLET 10 MG, 100
MG, 150 MG, 25 MG, 50 MG, 75 MG
P
Doxepin HCl ORAL CAPSULE 10 MG, 100
MG, 25 MG, 50 MG, 75 MG
P
Doxepin HCl ORAL CONCENTRATE 10
MG/ML
P
Imipramine HCl ORAL TABLET 10 MG, 25
MG, 50 MG
P
Nortriptyline HCl ORAL CAPSULE 10 MG,
25 MG, 50 MG, 75 MG
P
Nortriptyline HCl ORAL SOLUTION 10
MG/5ML
P
Protriptyline HCl ORAL TABLET 10 MG, 5
MG
P
*Antidiabetics*
*Alpha-Glucosidase Inhibitors**
*Alpha-Glucosidase Inhibitors***
Acarbose ORAL TABLET 100 MG, 25 MG, 50
MG
P
*Antidiabetic Combinations**
*Dipeptidyl Peptidase-4 Inhibitor-Biguanide
Combinations***
JANUMET ORAL TABLET 50-1000 MG,
50-500 MG
P
ST
JANUMET XR ORAL TABLET
EXTENDED RELEASE 24 HR* 100-1000
MG, 50-1000 MG, 50-500 MG
P
ST
19
Drug Name
JENTADUETO ORAL TABLET 2.5-1000
MG, 2.5-500 MG, 2.5-850 MG
P
*Sulfonylurea-Biguanide Combinations***
GlipiZIDE-MetFORMIN HCl ORAL
TABLET 2.5-250 MG, 2.5-500 MG, 5-500 MG
P
GlyBURIDE-MetFORMIN ORAL TABLET
1.25-250 MG, 2.5-500 MG, 5-500 MG
P
*Sulfonylurea-Thiazolidinedione
Combinations***
AVANDARYL ORAL TABLET 4-1 MG, 4-2
MG, 4-4 MG, 8-2 MG, 8-4 MG
P
ST
AVANDAMET ORAL TABLET 2-1000 MG,
2-500 MG, 4-1000 MG, 4-500 MG
P
ST
Pioglitazone HCl-Metformin HCl ORAL
TABLET 15-500 MG, 15-850 MG
P
ST
*Thiazolidinedione-Biguanide Combinations***
*Biguanides**
*Biguanides***
MetFORMIN HCl ORAL TABLET 1000 MG,
500 MG, 850 MG
P
MetFORMIN HCl ER ORAL TABLET
MG
P
MetFORMIN HCl ER (OSM) ORAL
TABLET EXTENDED RELEASE 24 HR*
500 MG
P
RIOMET ORAL SOLUTION 500 MG/5ML
P
GLUCAGEN INJECTION SOLUTION
RECONSTITUTED 1 MG
P
GLUCAGEN HYPOKIT INJECTION
SOLUTION RECONSTITUTED 1 MG
P
GLUCAGON EMERGENCY INJECTION
KIT 1 MG
P
Glucose ORAL TABLET CHEWABLE 4 GM
P
OTC
GLUTOSE 15 ORAL GEL 40 %
P
OTC
*Diabetic Other**
*Diabetic Other***
*Dipeptidyl Peptidase-4 (Dpp-4) Inhibitors**
*Dipeptidyl Peptidase-4 (Dpp-4) Inhibitors***
20
Drug Name
JANUVIA ORAL TABLET 100 MG, 25 MG,
50 MG
P
ST
TRADJENTA ORAL TABLET 5 MG
P
P
AVANDIA ORAL TABLET 2 MG, 4 MG, 8
MG
P
ST
Pioglitazone HCl ORAL TABLET 15 MG, 30
MG, 45 MG
P
ST
APIDRA INJECTION SOLUTION 100
UNIT/ML
P
APIDRA SOLOSTAR SUBCUTANEOUS*
SOLUTION 100 UNIT/ML
P
HUMALOG SUBCUTANEOUS*
P
HUMALOG KWIKPEN
SUBCUTANEOUS* SOLUTION 100
UNIT/ML
P
HUMALOG MIX 50/50 SUBCUTANEOUS*
SUSPENSION (50-50) 100 UNIT/ML
P
HUMALOG MIX 50/50 KWIKPEN
SUBCUTANEOUS* SUSPENSION (50-50)
100 UNIT/ML
P
HUMALOG MIX 75/25 SUBCUTANEOUS*
P
HUMALOG MIX 75/25 KWIKPEN
SUBCUTANEOUS* SUSPENSION (75-25)
100 UNIT/ML
P
HUMULIN 70/30 SUBCUTANEOUS*
P
OTC; QL (60 ML per 31 day(s))
HUMULIN 70/30 PEN SUBCUTANEOUS*
P
*Incretin Mimetic Agents (Glp-1 Receptor
Agonists)**
*Incretin Mimetic Agents (Glp-1 Receptor
Agonists)***
BYDUREON SUBCUTANEOUS*
SUSPENSION RECONSTITUTED 2 MG
*Insulin Sensitizing Agents**
*Thiazolidinediones***
*Insulin**
*Human Insulin***
21
Drug Name
HUMULIN N SUBCUTANEOUS*
SUSPENSION 100 UNIT/ML
P
HUMULIN N PEN SUBCUTANEOUS*
P
HUMULIN R INJECTION SOLUTION 100
UNIT/ML
P
HUMULIN R U-500 (CONCENTRATED)
UNIT/ML
P
LANTUS SUBCUTANEOUS* SOLUTION
100 UNIT/ML
P
LANTUS SOLOSTAR SUBCUTANEOUS*
P
*Sulfonylureas**
*Sulfonylureas***
ChlorproPAMIDE ORAL TABLET 100 MG,
250 MG
P
Glimepiride ORAL TABLET 1 MG, 2 MG, 4
MG
P
GlipiZIDE ORAL TABLET 10 MG, 5 MG
P
GlipiZIDE ER ORAL TABLET EXTENDED
RELEASE 24 HR* 10 MG, 2.5 MG, 5 MG
P
GLIPIZIDE XL ORAL TABLET
EXTENDED RELEASE 24 HR* 10 MG, 2.5
MG, 5 MG
P
GlyBURIDE ORAL TABLET 1.25 MG, 2.5
MG, 5 MG
P
GlyBURIDE Micronized ORAL TABLET 1.5
MG, 3 MG, 6 MG
P
*Antidiarrheals*
*Antidiarrheal Agents - Misc.**
*Antidiarrheal Agents - Misc.***
Bismatrol ORAL SUSPENSION 262
MG/15ML
P
OTC
Pink Bismuth ORAL TABLET CHEWABLE
262 MG
P
OTC
P
OTC
*Antiperistaltic Agents**
*Antiperistaltic Agents***
Anti-Diarrheal ORAL TABLET 2 MG
22
Drug Name
Diphenoxylate-Atropine ORAL LIQUID†
2.5-0.025 MG/5ML
P
Diphenoxylate-Atropine ORAL TABLET
2.5-0.025 MG
P
LONOX ORAL TABLET 2.5-0.025 MG
P
Loperamide HCl ORAL CAPSULE 2 MG
P
Loperamide HCl ORAL LIQUID† 1 MG/5ML
P
OTC
P
PA
*Antidotes*
*Antidotes - Chelating Agents**
*Antidotes - Chelating Agents***
EXJADE ORAL TABLET SOLUBLE 125
MG, 250 MG, 500 MG
*Antidotes**
*Antidotes***
Deferoxamine Mesylate INJECTION
SOLUTION RECONSTITUTED 2 GM, 500
MG
P
*Opioid Antagonists**
*Opioid Antagonists***
Naltrexone HCl ORAL TABLET 50 MG
P
*Antiemetics*
*5-Ht3 Receptor Antagonists**
*5-Ht3 Receptor Antagonists***
Ondansetron ORAL TABLET DISPERSIBLE
4 MG, 8 MG
P
Ondansetron HCl ORAL SOLUTION 4
MG/5ML
P
Ondansetron HCl ORAL TABLET 4 MG, 8
MG
P
*Antiemetics - Anticholinergic**
*Antiemetics - Anticholinergic***
DimenhyDRINATE ORAL TABLET 50 MG
P
OTC
Meclizine HCl ORAL TABLET 12.5 MG, 25
MG
P
OTC
Meclizine HCl ORAL TABLET CHEWABLE
25 MG
P
OTC
Travel Sickness ORAL TABLET CHEWABLE
25 MG
P
OTC
23
Drug Name
*Antiemetics - Miscellaneous**
*Antiemetic Combinations***
Formula EM ORAL SOLUTION
1.87-1.87-21.5
P
OTC
Griseofulvin Microsize ORAL SUSPENSION
125 MG/5ML
P
Griseofulvin Microsize ORAL TABLET 500
MG
P
Griseofulvin Ultramicrosize ORAL TABLET
125 MG, 250 MG
P
Nystatin ORAL TABLET 500000 UNIT
P
Terbinafine HCl ORAL TABLET 250 MG
P
*Antifungals*
*Antifungals**
*Antifungals***
*Imidazole-Related Antifungals**
*Imidazoles***
Ketoconazole ORAL TABLET 200 MG
P
*Triazoles***
Fluconazole ORAL SUSPENSION
RECONSTITUTED 10 MG/ML, 40 MG/ML
P
Fluconazole ORAL TABLET 100 MG, 150
MG, 200 MG, 50 MG
P
*Antihistamines*
*Antihistamines - Alkylamines**
*Antihistamines - Alkylamines***
P
OTC
Aler-Dryl ORAL TABLET 50 MG
P
OTC
BENADRYL ALLERGY CHILDRENS
ORAL LIQUID† 12.5 MG/5ML
P
OTC
DiphenhydrAMINE HCl ORAL CAPSULE 25
MG, 50 MG
P
OTC
DiphenhydrAMINE HCl ORAL TABLET 25
MG
P
OTC
Allergy ORAL TABLET 4 MG
*Antihistamines - Ethanolamines**
*Antihistamines - Ethanolamines***
*Antihistamines - Non-Sedating**
*Antihistamines - Non-Sedating***
24
Drug Name
ALLEGRA ALLERGY CHILDRENS
ORAL TABLET 30 MG
P
OTC
Allergy ORAL TABLET DISPERSIBLE 10
MG
P
OTC
Cetirizine HCl ORAL SYRUP 1 MG/ML, 5
MG/5ML
P
Cetirizine HCl ORAL TABLET 10 MG, 5 MG
P
OTC
Cetirizine HCl Childrens ORAL SOLUTION 1
MG/ML
P
Childrens Loratadine ORAL SYRUP 5
MG/5ML
P
Fexofenadine HCl ORAL TABLET 180 MG,
60 MG
P
OTC
Loratadine ORAL TABLET 10 MG
P
OTC
*Antihistamines - Phenothiazines**
*Antihistamines - Phenothiazines***
Promethazine HCl ORAL SYRUP 6.25
MG/5ML
P
Promethazine HCl ORAL TABLET 12.5 MG,
25 MG, 50 MG
P
Promethazine HCl RE SUPPOSITORY 25
MG
P
PROMETHEGAN RE SUPPOSITORY 25
MG, 50 MG
P
*Antihistamines - Piperidines**
*Antihistamines - Piperidines***
Cyproheptadine HCl ORAL SYRUP 2
MG/5ML
P
Cyproheptadine HCl ORAL TABLET 4 MG
P
*Antihyperlipidemics*
*Antihyperlipidemics - Combinations**
*Intest Cholest Absorp Inhib-Hmg Coa
Reductase Inhib Comb***
VYTORIN ORAL TABLET 10-10 MG, 10-20
MG, 10-40 MG, 10-80 MG
P
PA
*Bile Acid Sequestrants**
*Bile Acid Sequestrants***
Cholestyramine ORAL PACKET 4 GM
P
25
Drug Name
Cholestyramine ORAL POWDER 4
GM/DOSE
P
Cholestyramine Light ORAL PACKET 4 GM
P
Cholestyramine Light ORAL POWDER 4
GM/DOSE
P
*Fibric Acid Derivatives**
*Fibric Acid Derivatives***
Fenofibrate ORAL TABLET 160 MG, 54 MG
P
Fenofibrate Micronized ORAL CAPSULE 134
MG, 200 MG, 67 MG
P
Gemfibrozil ORAL TABLET 600 MG
P
*Hmg Coa Reductase Inhibitors**
*Hmg Coa Reductase Inhibitors***
Atorvastatin Calcium ORAL TABLET 10 MG,
20 MG, 40 MG, 80 MG
P
Lovastatin ORAL TABLET 10 MG, 20 MG, 40
MG
P
Pravastatin Sodium ORAL TABLET 10 MG,
20 MG, 40 MG, 80 MG
P
Simvastatin ORAL TABLET 10 MG, 20 MG,
40 MG, 5 MG, 80 MG
P
ST
*Intestinal Cholesterol Absorption Inhibitors**
*Intestinal Cholesterol Absorption Inhibitors***
ZETIA ORAL TABLET 10 MG
P
*Nicotinic Acid Derivatives**
*Nicotinic Acid Derivatives***
NIACOR ORAL TABLET 500 MG
P
*Antihypertensives*
*Ace Inhibitors**
*Ace Inhibitors***
Benazepril HCl ORAL TABLET 10 MG, 20
MG, 40 MG, 5 MG
P
Captopril ORAL TABLET 100 MG, 12.5 MG,
25 MG, 50 MG
P
Enalapril Maleate ORAL TABLET 10 MG, 2.5
MG, 20 MG, 5 MG
P
Fosinopril Sodium ORAL TABLET 10 MG, 20
MG, 40 MG
P
26
PA
Drug Name
Lisinopril ORAL TABLET 10 MG, 2.5 MG, 20
MG, 30 MG, 40 MG, 5 MG
P
Quinapril HCl ORAL TABLET 10 MG, 20
MG, 40 MG, 5 MG
P
Ramipril ORAL CAPSULE 1.25 MG, 10 MG,
2.5 MG, 5 MG
P
*Angiotensin Ii Receptor Antagonists**
*Angiotensin Ii Receptor Antagonists***
Losartan Potassium ORAL TABLET 100 MG,
25 MG, 50 MG
P
*Antiadrenergic Antihypertensives**
*Antiadrenergics - Centrally Acting***
CloNIDine HCl ORAL TABLET 0.1 MG, 0.2
MG, 0.3 MG
P
GuanFACINE HCl ORAL TABLET 1 MG, 2
MG
P
Methyldopa ORAL TABLET 250 MG, 500 MG
P
*Antiadrenergics - Peripherally Acting***
Doxazosin Mesylate ORAL TABLET 1 MG, 2
MG, 4 MG, 8 MG
P
Prazosin HCl ORAL CAPSULE 1 MG, 2 MG,
5 MG
P
Terazosin HCl ORAL CAPSULE 1 MG, 10
MG, 2 MG, 5 MG
P
*Antihypertensive Combinations**
*Ace Inhibitors & Thiazide/Thiazide-Like***
Benazepril-Hydrochlorothiazide ORAL
TABLET 10-12.5 MG, 20-12.5 MG, 20-25 MG,
5-6.25 MG
P
Captopril-Hydrochlorothiazide ORAL
TABLET 25-15 MG, 25-25 MG, 50-15 MG,
50-25 MG
P
Enalapril-Hydrochlorothiazide ORAL
TABLET 10-25 MG, 5-12.5 MG
P
Lisinopril-Hydrochlorothiazide ORAL
TABLET 10-12.5 MG, 20-12.5 MG, 20-25 MG
P
*Angiotensin Ii Receptor Antag &
Thiazide/Thiazide-Like***
Losartan Potassium-HCTZ ORAL TABLET
100-12.5 MG, 100-25 MG, 50-12.5 MG
P
27
Drug Name
*Beta Blocker & Diuretic Combinations***
Atenolol-Chlorthalidone ORAL TABLET
100-25 MG, 50-25 MG
P
Bisoprolol-Hydrochlorothiazide ORAL
TABLET 10-6.25 MG, 2.5-6.25 MG, 5-6.25
MG
P
Propranolol-HCTZ ORAL TABLET 40-25
MG, 80-25 MG
P
*Vasodilators**
*Vasodilators***
HydrALAZINE HCl INJECTION
SOLUTION 20 MG/ML
P
HydrALAZINE HCl ORAL TABLET 10 MG,
100 MG, 25 MG, 50 MG
P
Minoxidil ORAL TABLET 10 MG, 2.5 MG
P
*Anti-Infective Agents - Misc.*
*Anti-Infective Agents - Misc.**
*Anti-Infective Agents - Misc.***
MetroNIDAZOLE ORAL TABLET 250 MG,
500 MG
P
Trimethoprim ORAL TABLET 100 MG
P
Vancomycin HCl INTRAVENOUS*
SOLUTION RECONSTITUTED 1000 MG,
500 MG, 750 MG
P
Vancomycin HCl ORAL CAPSULE 125 MG,
250 MG
P
*Anti-Infective Misc. - Combinations**
*Anti-Infective Misc. - Combinations***
Erythromycin-Sulfisoxazole ORAL
SUSPENSION RECONSTITUTED 200-600
MG/5ML
P
Sulfamethoxazole-TMP DS ORAL TABLET
800-160 MG
P
Sulfamethoxazole-Trimethoprim ORAL
SUSPENSION 200-40 MG/5ML
P
Sulfamethoxazole-Trimethoprim ORAL
TABLET 400-80 MG
P
*Antiprotozoal Agents**
*Antiprotozoal Agents***
28
Drug Name
MEPRON ORAL SUSPENSION 750
MG/5ML
P
*Leprostatics**
*Leprostatics***
Dapsone ORAL TABLET 100 MG, 25 MG
P
*Lincosamides**
*Lincosamides***
Clindamycin HCl ORAL CAPSULE 150 MG,
300 MG, 75 MG
P
Clindamycin Palmitate HCl ORAL
SOLUTION RECONSTITUTED 75 MG/5ML
P
Clindamycin Phosphate INJECTION
SOLUTION 300 MG/2ML, 600 MG/4ML, 9
GM/60ML, 900 MG/6ML
P
Clindamycin Phosphate INTRAVENOUS*
SOLUTION 300 MG/2ML
P
*Antimalarials*
*Antimalarial Combinations**
*Antimalarial Combinations***
Atovaquone-Proguanil HCl ORAL TABLET
250-100 MG, 62.5-25 MG
P
*Antimalarials**
*Antimalarials***
DARAPRIM ORAL TABLET 25 MG
P
Hydroxychloroquine Sulfate ORAL TABLET
200 MG
P
Mefloquine HCl ORAL TABLET 250 MG
P
Primaquine Phosphate ORAL TABLET 26.3
MG
P
*Antimyasthenic/Cholinergic Agents*
*Antimyasthenic/Cholinergic Agents**
*Antimyasthenic/Cholinergic Agents***
MESTINON ORAL SYRUP 60 MG/5ML
P
MESTINON ORAL TABLET
P
PROSTIGMIN ORAL TABLET 15 MG
P
Pyridostigmine Bromide ORAL TABLET 60
MG
P
29
Drug Name
*Antimycobacterial Agents*
*Antimycobacterial Agents**
*Antimycobacterial Agents***
Ethambutol HCl ORAL TABLET 100 MG, 400
MG
P
Isoniazid INJECTION SOLUTION 100
MG/ML
P
Isoniazid ORAL TABLET 100 MG, 300 MG
P
MYCOBUTIN ORAL CAPSULE 150 MG
P
Pyrazinamide ORAL TABLET 500 MG
P
Rifampin INTRAVENOUS* SOLUTION
P
Rifampin ORAL CAPSULE 150 MG, 300 MG
P
*Antineoplastics And Adjunctive Therapies*
*Alkylating Agents**
*Alkylating Agents***
HEXALEN ORAL CAPSULE 50 MG
P
PA
MYLERAN ORAL TABLET 2 MG
P
PA
P
PA
ALKERAN ORAL TABLET 2 MG
P
PA
Cyclophosphamide ORAL TABLET 25 MG, 50
MG
P
PA
LEUKERAN ORAL TABLET 2 MG
P
PA
P
PA
ADRUCIL INTRAVENOUS* SOLUTION
500 MG/10ML
P
PA
Fluorouracil INTRAVENOUS* SOLUTION
500 MG/10ML
P
PA
Gemcitabine HCl INTRAVENOUS*
SOLUTION 1 GM/26.3ML, 2 GM/52.6ML,
200 MG/5.26ML
P
PA
*Imidazotetrazines***
Temozolomide ORAL CAPSULE 100 MG, 140
MG, 180 MG, 20 MG, 250 MG, 5 MG
*Nitrogen Mustards***
*Nitrosoureas***
Lomustine ORAL CAPSULE 10 MG, 100 MG,
40 MG
*Antimetabolites**
*Antimetabolites***
30
Drug Name
Gemcitabine HCl INTRAVENOUS*
SOLUTION RECONSTITUTED 1 GM, 2
GM, 200 MG
P
Mercaptopurine ORAL TABLET 50 MG
P
Methotrexate ORAL TABLET 2.5 MG
P
Methotrexate Sodium INJECTION
SOLUTION 25 MG/ML
P
Methotrexate Sodium INJECTION
SOLUTION RECONSTITUTED 1 GM
P
Methotrexate Sodium (PF) INJECTION
SOLUTION 25 MG/ML
P
TABLOID ORAL TABLET 40 MG
P
PA
XELODA ORAL TABLET 150 MG, 500 MG
P
PA
P
PA
PA
*Antineoplastic - Angiogenesis Inhibitors**
*Vascular Endothelial Growth Factor (Vegf)
Inhibitors***
AVASTIN INTRAVENOUS* SOLUTION
100 MG/4ML, 400 MG/16ML
*Antineoplastic - Hedgehog Pathway
Inhibitors**
*Antineoplastic - Hedgehog Pathway
Inhibitors***
ERIVEDGE ORAL CAPSULE 150 MG
P
*Antineoplastic - Hormonal And Related
Agents**
*Antiadrenals***
LYSODREN ORAL TABLET 500 MG
P
PA
*Antiandrogens***
Bicalutamide ORAL TABLET 50 MG
P
XTANDI ORAL CAPSULE 40 MG
P
PA
*Antiestrogens***
Tamoxifen Citrate ORAL TABLET 10 MG, 20
MG
P
*Aromatase Inhibitors***
Anastrozole ORAL TABLET 1 MG
P
Letrozole ORAL TABLET 2.5 MG
P
*Estrogens-Antineoplastic***
EMCYT ORAL CAPSULE 140 MG
P
PA
31
Drug Name
*Lhrh Analogs***
TRELSTAR DEPOT INTRAMUSCULAR*
SUSPENSION RECONSTITUTED 3.75 MG
P
TRELSTAR DEPOT MIXJECT
INTRAMUSCULAR* SUSPENSION
RECONSTITUTED 3.75 MG
P
TRELSTAR LA INTRAMUSCULAR*
SUSPENSION RECONSTITUTED 11.25
MG
P
TRELSTAR LA MIXJECT
P
TRELSTAR MIXJECT
P
*Progestins-Antineoplastic***
Megestrol Acetate ORAL SUSPENSION 40
MG/ML
P
Megestrol Acetate ORAL TABLET 20 MG, 40
MG
P
*Antineoplastic Enzyme Inhibitors**
*Antineoplastic - Braf Kinase Inhibitors***
ZELBORAF ORAL TABLET 240 MG
P
PA
P
PA
P
PA
STIVARGA ORAL TABLET 40 MG
P
PA
SUTENT ORAL CAPSULE 12.5 MG, 25
MG, 50 MG
P
PA
BOSULIF ORAL TABLET 100 MG, 500 MG
P
PA
CAPRELSA ORAL TABLET 100 MG, 300
MG
P
PA
GILOTRIF ORAL TABLET 20 MG, 30 MG,
40 MG
P
*Antineoplastic - Histone Deacetylase
Inhibitors***
ZOLINZA ORAL CAPSULE 100 MG
*Antineoplastic - Mtor Kinase Inhibitors***
AFINITOR ORAL TABLET 10 MG, 2.5
MG, 5 MG, 7.5 MG
*Antineoplastic - Multikinase Inhibitors***
*Antineoplastic - Tyrosine Kinase Inhibitors***
32
Drug Name
GLEEVEC ORAL TABLET 100 MG, 400
MG
P
PA
ICLUSIG ORAL TABLET 15 MG, 45 MG
P
PA
SPRYCEL ORAL TABLET 100 MG, 140
MG, 20 MG, 50 MG, 70 MG, 80 MG
P
PA
TARCEVA ORAL TABLET 100 MG, 150
MG, 25 MG
P
TASIGNA ORAL CAPSULE 150 MG, 200
MG
P
PA
TYKERB ORAL TABLET 250 MG
P
PA
XALKORI ORAL CAPSULE 200 MG, 250
MG
P
PA
*Janus Associated Kinase (Jak) Inhibitors***
JAKAFI ORAL TABLET 10 MG, 15 MG, 20
MG, 25 MG, 5 MG
P
*Antineoplastic Enzymes**
*Antineoplastic Enzymes***
ERWINAZE INTRAMUSCULAR*
SOLUTION RECONSTITUTED 10000
UNIT
P
PA
*Antineoplastics Misc.**
*Antineoplastics Misc.***
Hydroxyurea ORAL CAPSULE 500 MG
P
*Chemotherapy Rescue/Antidote Agents**
*Folic Acid Antagonists Rescue Agents***
Leucovorin Calcium INJECTION SOLUTION
RECONSTITUTED 100 MG, 200 MG, 350
MG
P
Leucovorin Calcium INTRAVENOUS*
SOLUTION 10 MG/ML
P
Leucovorin Calcium ORAL TABLET 10 MG,
15 MG, 25 MG, 5 MG
P
*Mitotic Inhibitors**
*Mitotic Inhibitors***
Etoposide ORAL CAPSULE 50 MG
P
*Antiparkinson Agents*
*Antiparkinson Anticholinergics**
*Antiparkinson Anticholinergics***
33
Drug Name
Benztropine Mesylate ORAL TABLET 0.5
MG, 1 MG, 2 MG
P
Trihexyphenidyl HCl ORAL ELIXIR 0.4
MG/ML
P
Trihexyphenidyl HCl ORAL TABLET 2 MG, 5
MG
P
*Antiparkinson Dopaminergics**
*Antiparkinson Dopaminergics***
Amantadine HCl ORAL CAPSULE 100 MG
P
Amantadine HCl ORAL SYRUP 50 MG/5ML
P
Amantadine HCl ORAL TABLET 100 MG
P
Bromocriptine Mesylate ORAL CAPSULE 5
MG
P
Bromocriptine Mesylate ORAL TABLET 2.5
MG
P
*Levodopa Combinations***
Carbidopa-Levodopa ORAL TABLET 10-100
MG, 25-100 MG, 25-250 MG
P
Carbidopa-Levodopa ER ORAL TABLET
EXTENDEDRELEASE* 25-100 MG, 50-200
MG
P
*Nonergoline Dopamine Receptor Agonists***
Pramipexole Dihydrochloride ORAL TABLET
0.125 MG, 0.25 MG, 0.5 MG, 0.75 MG, 1 MG,
1.5 MG
P
ROPINIRole HCl ORAL TABLET 0.25 MG,
0.5 MG, 1 MG, 2 MG, 3 MG, 4 MG, 5 MG
P
*Antiparkinson Monoamine Oxidase
Inhibitors**
*Antiparkinson Monoamine Oxidase
Inhibitors***
Selegiline HCl ORAL CAPSULE 5 MG
P
Selegiline HCl ORAL TABLET 5 MG
P
*Antipsychotics/Antimanic Agents*
*Antimanic Agents**
*Antimanic Agents***
Lithium Carbonate ORAL CAPSULE 150 MG,
300 MG, 600 MG
P
Lithium Carbonate ORAL TABLET 300 MG
P
34
ST
Drug Name
Lithium Carbonate ER ORAL TABLET
EXTENDEDRELEASE* 300 MG, 450 MG
P
Lithium Citrate ORAL SOLUTION 8
MEQ/5ML
P
*Benzisoxazoles**
*Benzisoxazoles***
INVEGA SUSTENNA
INTRAMUSCULAR* SUSPENSION 117
MG/0.75ML, 156 MG/ML, 234 MG/1.5ML,
39 MG/0.25ML, 78 MG/0.5ML
P
PA; QL (1 ML per 28 day(s));
AL (Min 18 Years)
RisperiDONE ORAL SOLUTION 1 MG/ML
P
(Min 5 Years)
RisperiDONE ORAL TABLET 0.25 MG, 0.5
MG, 1 MG, 2 MG, 3 MG, 4 MG
P
(Min 5 Years)
RisperiDONE ORAL TABLET
DISPERSIBLE 0.25 MG, 0.5 MG, 1 MG, 2
MG, 3 MG, 4 MG
P
(Min 5 Years)
RISPERIDONE M-TAB ORAL TABLET
DISPERSIBLE 0.5 MG, 1 MG, 2 MG, 3 MG,
4 MG
P
(Min 5 Years)
Haloperidol ORAL TABLET 0.5 MG, 1 MG,
10 MG, 2 MG, 5 MG
P
AL (Min 3 Years)
Haloperidol Decanoate INTRAMUSCULAR*
P
AL (Min 18 Years)
Haloperidol Lactate INJECTION SOLUTION
5 MG/ML
P
AL (Min 3 Years)
Haloperidol Lactate ORAL CONCENTRATE
2 MG/ML
P
AL (Min 3 Years)
CloZAPine ORAL TABLET 100 MG, 200
MG, 25 MG, 50 MG
P
AL (Min 18 Years)
CloZAPine ORAL TABLET DISPERSIBLE
12.5 MG
P
(Min 18 Years)
P
ST; AL (Min 18 Years)
*Butyrophenones**
*Butyrophenones***
*Dibenzapines**
*Dibenzodiazepines***
*Dibenzo-Oxepino Pyrroles***
SAPHRIS SUBLINGUAL TABLET
*Dibenzothiazepines***
35
Drug Name
QUEtiapine Fumarate ORAL TABLET 100
MG, 200 MG, 25 MG, 300 MG, 400 MG, 50
MG
P
AL (Min 10 Years)
P
AL (Min 18 Years)
P
(Min 13 Years)
ChlorproMAZINE HCl ORAL TABLET 10
MG, 100 MG, 200 MG, 25 MG, 50 MG
P
AL (Min 6 Months)
FluPHENAZine Decanoate INJECTION
SOLUTION 25 MG/ML
P
AL (Min 12 Years)
FluPHENAZine HCl ORAL
CONCENTRATE 5 MG/ML
P
FluPHENAZine HCl ORAL ELIXIR 2.5
MG/5ML
P
FluPHENAZine HCl ORAL TABLET 1 MG,
10 MG, 2.5 MG, 5 MG
P
Perphenazine ORAL TABLET 16 MG, 2 MG,
4 MG, 8 MG
P
AL (Min 12 Years)
Prochlorperazine RE SUPPOSITORY 25 MG
P
AL (Min 2 Years)
Prochlorperazine Maleate ORAL TABLET 10
MG, 5 MG
P
AL (Min 2 Years)
Thioridazine HCl ORAL TABLET 10 MG, 100
MG, 25 MG, 50 MG
P
AL (Min 2 Years)
Trifluoperazine HCl ORAL TABLET 1 MG, 10
MG, 2 MG, 5 MG
P
AL (Min 6 Years)
P
AL (Min 12 Years)
P
*Dibenzoxazepines***
Loxapine Succinate ORAL CAPSULE 10 MG,
25 MG, 5 MG, 50 MG
*Thienbenzodiazepines***
OLANZapine ORAL TABLET 10 MG, 15
MG, 2.5 MG, 20 MG, 5 MG, 7.5 MG
*Phenothiazines**
*Phenothiazines***
*Thioxanthenes**
*Thioxanthenes***
Thiothixene ORAL CAPSULE 1 MG, 10 MG,
2 MG, 5 MG
*Antiseptics & Disinfectants*
*Chlorine Antiseptics**
*Chlorine Antiseptics***
Chlorhexidine Gluconate EXTERNAL
LIQUID† 4 %
36
Drug Name
*Antivirals*
*Antiretrovirals**
*Antiretroviral Combinations***
ATRIPLA ORAL TABLET 600-200-300 MG
P
COMPLERA ORAL TABLET 200-25-300
MG
P
EPZICOM ORAL TABLET 600-300 MG
P
KALETRA ORAL SOLUTION 400-100
MG/5ML
P
KALETRA ORAL TABLET 100-25 MG,
200-50 MG
P
Lamivudine-Zidovudine ORAL TABLET
150-300 MG
P
STRIBILD ORAL TABLET 150-150-200-300
MG
P
TRIZIVIR ORAL TABLET 300-150-300 MG
P
TRUVADA ORAL TABLET 200-300 MG
P
*Antiretrovirals - Ccr5 Antagonists (Entry
Inhibitor)***
SELZENTRY ORAL TABLET 150 MG, 300
MG
P
*Antiretrovirals - Fusion Inhibitors***
FUZEON SUBCUTANEOUS* SOLUTION
RECONSTITUTED 90 MG
P
*Antiretrovirals - Integrase Inhibitors***
ISENTRESS ORAL TABLET 400 MG
P
ISENTRESS ORAL TABLET CHEWABLE
100 MG, 25 MG
P
TIVICAY ORAL TABLET 50 MG
P
*Antiretrovirals - Protease Inhibitors***
APTIVUS ORAL CAPSULE 250 MG
P
CRIXIVAN ORAL CAPSULE 200 MG, 400
MG
P
INVIRASE ORAL CAPSULE 200 MG
P
INVIRASE ORAL TABLET 500 MG
P
LEXIVA ORAL SUSPENSION 50 MG/ML
P
LEXIVA ORAL TABLET 700 MG
P
NORVIR ORAL CAPSULE 100 MG
P
37
Drug Name
NORVIR ORAL SOLUTION 80 MG/ML
P
NORVIR ORAL TABLET 100 MG
P
PREZISTA ORAL SUSPENSION 100
MG/ML
P
PREZISTA ORAL TABLET 150 MG, 400
MG, 600 MG, 75 MG, 800 MG
P
REYATAZ ORAL CAPSULE 150 MG, 200
MG, 300 MG
P
VIRACEPT ORAL TABLET 250 MG, 625
MG
P
EDURANT ORAL TABLET 25 MG
P
INTELENCE ORAL TABLET 100 MG, 200
MG, 25 MG
P
Nevirapine ORAL SUSPENSION 50 MG/5ML
P
Nevirapine ORAL TABLET 200 MG
P
RESCRIPTOR ORAL TABLET 100 MG, 200
MG
P
SUSTIVA ORAL CAPSULE 200 MG, 50 MG
P
SUSTIVA ORAL TABLET 600 MG
P
*Antiretrovirals - Rti-Non-Nucleoside
Analogues***
*Antiretrovirals - Rti-Nucleoside
Analogues-Purines***
Abacavir Sulfate ORAL TABLET 300 MG
P
Didanosine ORAL CAPSULE DELAYED
RELEASE 125 MG, 200 MG, 250 MG, 400
MG
P
VIDEX ORAL SOLUTION
RECONSTITUTED 2 GM, 4 GM
P
ZIAGEN ORAL SOLUTION 20 MG/ML
P
Analogues-Pyrimidines***
EMTRIVA ORAL CAPSULE 200 MG
P
EMTRIVA ORAL SOLUTION 10 MG/ML
P
EPIVIR ORAL SOLUTION 10 MG/ML
P
EPIVIR HBV ORAL SOLUTION 5 MG/ML
P
EPIVIR HBV ORAL TABLET 100 MG
P
LamiVUDine ORAL TABLET 150 MG, 300
MG
P
38
Drug Name
Analogues-Thymidines***
Stavudine ORAL CAPSULE 15 MG, 20 MG,
30 MG, 40 MG
P
Stavudine ORAL SOLUTION
RECONSTITUTED 1 MG/ML
P
Zidovudine ORAL CAPSULE 100 MG
P
Zidovudine ORAL SYRUP 50 MG/5ML
P
Zidovudine ORAL TABLET 300 MG
P
*Antiretrovirals - Rti-Nucleotide Analogues***
VIREAD ORAL TABLET 150 MG, 200 MG,
250 MG, 300 MG
P
*Hepatitis Agents**
*Hepatitis B Agents***
BARACLUDE ORAL TABLET 0.5 MG, 1
MG
P
PA
INCIVEK ORAL TABLET 375 MG
P
PEGASYS SUBCUTANEOUS* KIT 180
MCG/0.5ML
P
PA
PEGASYS SUBCUTANEOUS* SOLUTION
180 MCG/0.5ML, 180 MCG/ML
P
PA
PEGASYS PROCLICK SUBCUTANEOUS*
SOLUTION 135 MCG/0.5ML, 180
MCG/0.5ML
P
PA
RIBASPHERE ORAL TABLET 200 MG
P
Ribavirin ORAL TABLET 200 MG
P
*Hepatitis C Agents***
*Herpes Agents**
*Herpes Agents - Purine Analogues***
Acyclovir ORAL CAPSULE 200 MG
P
Acyclovir ORAL SUSPENSION 200 MG/5ML
P
Acyclovir ORAL TABLET 400 MG, 800 MG
P
ValACYclovir HCl ORAL TABLET 1 GM,
500 MG
P
*Influenza Agents**
*Influenza Agents***
Rimantadine HCl ORAL TABLET 100 MG
P
*Neuraminidase Inhibitors***
39
Drug Name
RELENZA DISKHALER INHALATION
ACTIVATED 5 MG/BLISTER
P
(Min 7 Years)
TAMIFLU ORAL CAPSULE 30 MG
P
TAMIFLU ORAL CAPSULE 45 MG, 75 MG
P
TAMIFLU ORAL SUSPENSION
P
(Max 18 Years)
P
PA
P
PA
*Assorted Classes*
*Immunomodulators**
*Antileprotics***
THALOMID ORAL CAPSULE 100 MG, 150
MG, 200 MG, 50 MG
*Immunomodulators For Myelodysplastic
Syndromes***
REVLIMID ORAL CAPSULE 10 MG, 15
MG, 2.5 MG, 20 MG, 25 MG, 5 MG
*Immunosuppressive Agents**
*Cyclosporine Analogs***
CycloSPORINE ORAL CAPSULE 100 MG,
25 MG
P
CycloSPORINE Modified ORAL CAPSULE
100 MG, 25 MG, 50 MG
P
CycloSPORINE Modified ORAL SOLUTION
100 MG/ML
P
GENGRAF ORAL CAPSULE 100 MG, 25
MG
P
GENGRAF ORAL SOLUTION 100 MG/ML
P
SANDIMMUNE ORAL SOLUTION 100
MG/ML
P
*Inosine Monophosphate Dehydrogenase
Inhibitors***
CELLCEPT ORAL SUSPENSION
P
Mycophenolate Mofetil ORAL CAPSULE 250
MG
P
Mycophenolate Mofetil ORAL TABLET 500
MG
P
*Macrolide Immunosuppressants***
40
Drug Name
HECORIA ORAL CAPSULE 0.5 MG, 1 MG,
5 MG
P
Tacrolimus ORAL CAPSULE 0.5 MG, 1 MG,
5 MG
P
*Purine Analogs***
AzaTHIOprine ORAL TABLET 50 MG
P
*Potassium Removing Resins**
*Potassium Removing Resins***
Sodium Polystyrene Sulfonate ORAL
POWDER
P
SPS ORAL SUSPENSION 15 GM/60ML
P
*Beta Blockers*
*Alpha-Beta Blockers**
*Alpha-Beta Blockers***
Carvedilol ORAL TABLET 12.5 MG, 25 MG,
3.125 MG, 6.25 MG
P
Labetalol HCl INTRAVENOUS* SOLUTION
5 MG/ML
P
Labetalol HCl ORAL TABLET 100 MG, 200
MG, 300 MG
P
*Beta Blockers Cardio-Selective**
*Beta Blockers Cardio-Selective***
Atenolol ORAL TABLET 100 MG, 25 MG, 50
MG
P
Bisoprolol Fumarate ORAL TABLET 10 MG,
5 MG
P
Metoprolol Succinate ER ORAL TABLET
MG, 25 MG, 50 MG
P
Metoprolol Tartrate INTRAVENOUS*
SOLUTION 1 MG/ML
P
Metoprolol Tartrate ORAL TABLET 100 MG,
25 MG, 50 MG
P
*Beta Blockers Non-Selective**
*Beta Blockers Non-Selective***
Nadolol ORAL TABLET 20 MG, 40 MG, 80
MG
P
Pindolol ORAL TABLET 10 MG, 5 MG
P
41
Drug Name
Propranolol HCl INTRAVENOUS*
SOLUTION 1 MG/ML
P
Propranolol HCl ORAL TABLET 10 MG, 20
MG, 40 MG, 60 MG, 80 MG
P
Propranolol HCl ER ORAL CAPSULE
160 MG, 60 MG, 80 MG
P
SORINE ORAL TABLET 120 MG, 160 MG,
240 MG, 80 MG
P
Sotalol HCl ORAL TABLET 120 MG, 160
MG, 240 MG, 80 MG
P
Sotalol HCl (AF) ORAL TABLET 120 MG,
160 MG, 80 MG
P
Timolol Maleate ORAL TABLET 10 MG, 20
MG, 5 MG
P
*Calcium Channel Blockers*
*Calcium Channel Blockers**
*Calcium Channel Blockers***
AmLODIPine Besylate ORAL TABLET 10
MG, 2.5 MG, 5 MG
P
CARTIA XT ORAL CAPSULE
180 MG, 240 MG, 300 MG
P
Dilt-XR ORAL CAPSULE EXTENDED
RELEASE 24 HOUR 120 MG, 180 MG, 240
MG
P
Diltiazem HCl INTRAVENOUS* SOLUTION
125 MG/25ML, 25 MG/5ML, 50 MG/10ML
P
Diltiazem HCl ORAL TABLET 120 MG, 30
MG, 60 MG, 90 MG
P
Diltiazem HCl ER ORAL CAPSULE
60 MG, 90 MG
P
Diltiazem HCl ER Beads ORAL CAPSULE
180 MG, 240 MG, 300 MG, 360 MG, 420 MG
P
Diltiazem HCl ER Coated Beads ORAL
CAPSULE EXTENDED RELEASE 24
HOUR 120 MG, 180 MG, 240 MG, 300 MG,
360 MG
P
42
Drug Name
MATZIM LA ORAL TABLET EXTENDED
RELEASE 24 HR* 180 MG, 240 MG, 300
MG, 360 MG, 420 MG
P
NIFEDIAC CC ORAL TABLET
MG, 90 MG
P
NIFEDICAL XL ORAL TABLET
MG
P
NIFEdipine ORAL CAPSULE 10 MG
P
NIFEdipine ER Osmotic ORAL TABLET
MG, 90 MG
P
Verapamil HCl ORAL TABLET 120 MG, 40
MG, 80 MG
P
Verapamil HCl ER ORAL CAPSULE
120 MG, 180 MG, 200 MG, 240 MG, 300 MG,
360 MG
P
Verapamil HCl ER ORAL TABLET
EXTENDEDRELEASE* 120 MG, 180 MG,
240 MG
P
*Cardiotonics*
*Cardiac Glycosides**
*Cardiac Glycosides***
Digoxin INJECTION SOLUTION 0.25
MG/ML
P
Digoxin ORAL SOLUTION 0.05 MG/ML
P
Digoxin ORAL TABLET 0.125 MG, 0.25 MG
P
*Cardiovascular Agents - Misc.*
*Pulmonary Hypertension - Endothelin
Receptor Antagonists**
*Pulmonary Hypertension - Endothelin
Receptor Antagonists***
LETAIRIS ORAL TABLET 10 MG, 5 MG
P
PA
P
PA
*Pulmonary Hypertension - Phosphodiesterase
Inhibitors**
*Pulmonary Hypertension - Phosphodiesterase
Inhibitors***
Sildenafil Citrate ORAL TABLET 20 MG
43
Drug Name
*Cephalosporins*
*Cephalosporins - 1St Generation**
*Cephalosporins - 1St Generation***
Cefadroxil ORAL CAPSULE 500 MG
P
Cefadroxil ORAL SUSPENSION
RECONSTITUTED 250 MG/5ML, 500
MG/5ML
P
Cefadroxil ORAL TABLET 1 GM
P
Cephalexin ORAL CAPSULE 250 MG, 500
MG, 750 MG
P
Cephalexin ORAL SUSPENSION
RECONSTITUTED 125 MG/5ML
P
Cephalexin ORAL SUSPENSION
P
*Cephalosporins - 2Nd Generation**
*Cephalosporins - 2Nd Generation***
Cefaclor ORAL CAPSULE 250 MG, 500 MG
P
Cefprozil ORAL SUSPENSION
MG/5ML
P
Cefprozil ORAL TABLET 250 MG, 500 MG
P
Cefuroxime Axetil ORAL SUSPENSION
P
Cefuroxime Axetil ORAL TABLET 250 MG,
500 MG
P
*Cephalosporins - 3Rd Generation**
*Cephalosporins - 3Rd Generation***
Cefdinir ORAL CAPSULE 300 MG
P
Cefdinir ORAL SUSPENSION
MG/5ML
P
Cefpodoxime Proxetil ORAL SUSPENSION
MG/5ML
P
Cefpodoxime Proxetil ORAL TABLET 100
MG, 200 MG
P
*Contraceptives*
*Combination Contraceptives - Oral**
*Biphasic Contraceptives - Oral***
44
Drug Name
KARIVA ORAL TABLET 0.15-0.02/0.01 MG
(21/5)
P
*Combination Contraceptives - Oral***
ALTAVERA ORAL TABLET 0.15-30
MG-MCG
P
APRI ORAL TABLET 0.15-30 MG-MCG
P
AVIANE ORAL TABLET 0.1-20 MG-MCG
P
BALZIVA ORAL TABLET 0.4-35 MG-MCG
P
Briellyn ORAL TABLET 0.4-35 MG-MCG
P
CRYSELLE-28 ORAL TABLET 0.3-30
MG-MCG
P
EMOQUETTE ORAL TABLET 0.15-30
MG-MCG
P
ESTARYLLA ORAL TABLET 0.25-35
MG-MCG
P
GIANVI ORAL TABLET 3-0.02 MG
P
JUNEL 1.5/30 ORAL TABLET 1.5-30
MG-MCG
P
JUNEL 1/20 ORAL TABLET 1-20 MG-MCG
P
JUNEL FE 1.5/30 ORAL TABLET 1.5-30
MG-MCG
P
JUNEL FE 1/20 ORAL TABLET 1-20
MG-MCG
P
KELNOR 1/35 ORAL TABLET 1-35
MG-MCG
P
LESSINA ORAL TABLET 0.1-20 MG-MCG
P
LEVORA 0.15/30 (28) ORAL TABLET
0.15-30 MG-MCG
P
LORYNA ORAL TABLET 3-0.02 MG
P
LOW-OGESTREL ORAL TABLET 0.3-30
MG-MCG
P
LUTERA ORAL TABLET 0.1-20 MG-MCG
P
MICROGESTIN 1.5/30 ORAL TABLET
1.5-30 MG-MCG
P
MICROGESTIN 1/20 ORAL TABLET 1-20
MG-MCG
P
MICROGESTIN FE 1.5/30 ORAL TABLET
1.5-30 MG-MCG
P
45
Drug Name
MICROGESTIN FE 1/20 ORAL TABLET
1-20 MG-MCG
P
MONONESSA ORAL TABLET 0.25-35
MG-MCG
P
NECON 0.5/35 (28) ORAL TABLET 0.5-35
MG-MCG
P
NECON 1/35 (28) ORAL TABLET 1-35
MG-MCG
P
NECON 1/50 (28) ORAL TABLET 1-50
MG-MCG
P
NORTREL 0.5/35 (28) ORAL TABLET
0.5-35 MG-MCG
P
NORTREL 1/35 (21) ORAL TABLET 1-35
MG-MCG
P
NORTREL 1/35 (28) ORAL TABLET 1-35
MG-MCG
P
OCELLA ORAL TABLET 3-0.03 MG
P
PORTIA-28 ORAL TABLET 0.15-30
MG-MCG
P
PREVIFEM ORAL TABLET 0.25-35
MG-MCG
P
RECLIPSEN ORAL TABLET 0.15-30
MG-MCG
P
SOLIA ORAL TABLET 0.15-30 MG-MCG
P
SPRINTEC 28 ORAL TABLET 0.25-35
MG-MCG
P
SRONYX ORAL TABLET 0.1-20 MG-MCG
P
SYEDA ORAL TABLET 3-0.03 MG
P
ZOVIA 1/35E (28) ORAL TABLET 1-35
MG-MCG
P
ZOVIA 1/50E (28) ORAL TABLET 1-50
MG-MCG
P
*Extended-Cycle Contraceptives - Oral***
QUASENSE ORAL TABLET 0.15-0.03 MG
P
*Triphasic Contraceptives - Oral***
CAZIANT ORAL TABLET 0.1/0.125/0.15
-0.025 MG
P
ENPRESSE-28 ORAL TABLET
P
46
Drug Name
NECON 7/7/7 ORAL TABLET 0.5/0.75/1-35
MG-MCG
P
NORTREL 7/7/7 ORAL TABLET
0.5/0.75/1-35 MG-MCG
P
TRI-ESTARYLLA ORAL TABLET
0.18/0.215/0.25 MG-35 MCG
P
TRI-PREVIFEM ORAL TABLET
0.18/0.215/0.25 MG-35 MCG
P
TRI-SPRINTEC ORAL TABLET
0.18/0.215/0.25 MG-35 MCG
P
TRINESSA (28) ORAL TABLET
0.18/0.215/0.25 MG-35 MCG
P
TRIVORA (28) ORAL TABLET
P
VELIVET ORAL TABLET 0.1/0.125/0.15
-0.025 MG
P
*Combination Contraceptives - Vaginal**
*Combination Contraceptives - Vaginal***
NUVARING VAGINAL RING 0.12-0.015
MG/24HR
P
*Emergency Contraceptives**
*Emergency Contraceptives***
Levonorgestrel ORAL TABLET 0.75 MG
P
PLAN B ONE-STEP ORAL TABLET 1.5
MG
P
OTC
DEPO-PROVERA INTRAMUSCULAR*
P
MedroxyPROGESTERone Acetate
INTRAMUSCULAR* SUSPENSION 150
MG/ML
P
*Progestin Contraceptives - Injectable**
*Progestin Contraceptives - Injectable***
*Progestin Contraceptives - Oral**
*Progestin Contraceptives - Oral***
CAMILA ORAL TABLET 0.35 MG
P
ERRIN ORAL TABLET 0.35 MG
P
JOLIVETTE ORAL TABLET 0.35 MG
P
NORA-BE ORAL TABLET 0.35 MG
P
*Corticosteroids*
47
Drug Name
*Glucocorticosteroids**
*Glucocorticosteroids***
A-METHAPRED INJECTION SOLUTION
RECONSTITUTED 125 MG, 40 MG
P
CELESTONE ORAL SOLUTION 0.6
MG/5ML
P
Cortisone Acetate ORAL TABLET 25 MG
P
Dexamethasone ORAL ELIXIR 0.5 MG/5ML
P
Dexamethasone ORAL SOLUTION 0.5
MG/5ML
P
Dexamethasone ORAL TABLET 0.5 MG, 0.75
MG, 1 MG, 1.5 MG, 2 MG, 4 MG, 6 MG
P
Dexamethasone Sodium Phosphate
INJECTION SOLUTION 10 MG/ML, 4
MG/ML
P
Hydrocortisone ORAL TABLET 10 MG, 20
MG, 5 MG
P
MethylPREDNISolone ORAL TABLET 16
MG, 32 MG, 8 MG
P
MethylPREDNISolone (Pak) ORAL
TABLET 4 MG
P
MethylPREDNISolone Acetate INJECTION
SUSPENSION 40 MG/ML, 80 MG/ML
P
MethylPREDNISolone Sodium Succ
INJECTION SOLUTION
RECONSTITUTED 1 GM, 1000 MG, 125
MG, 40 MG
P
PrednisoLONE ORAL SOLUTION 15
MG/5ML
P
PrednisoLONE Sodium Phosphate ORAL
SOLUTION 15 MG/5ML, 6.7 (5 Base)
MG/5ML
P
PredniSONE ORAL SOLUTION 5 MG/5ML
P
PredniSONE ORAL TABLET 1 MG, 10 MG,
2.5 MG, 20 MG, 5 MG
P
*Mineralocorticoids**
*Mineralocorticoids***
Fludrocortisone Acetate ORAL TABLET 0.1
MG
*Cough/Cold/Allergy*
48
P
Drug Name
*Cough/Cold/Allergy Combinations**
*Decongestant & Antihistamine***
ALAVERT ALLERGY/SINUS ORAL
5-120 MG
P
OTC
ALLEGRA-D ALLERGY & CONGESTION
ORAL TABLET EXTENDED RELEASE 12
HR* 60-120 MG
P
OTC
Allergy Relief/Nasal Decongest ORAL
10-240 MG
P
OTC
Antihistamine Decongestant ORAL TABLET
2.5-60 MG
P
OTC
Cetirizine-Pseudoephedrine ER ORAL
5-120 MG
P
OTC
DELSYM NGHT TIME CGH/CLD CHILD
ORAL LIQUID† 12.5-5 MG/5ML
P
OTC
DELSYM NIGHT TIME COUGH/COLD
ORAL LIQUID† 6.25-2.5 MG/5ML
P
OTC
Fexofenadine-Pseudoephed ER ORAL
180-240 MG
P
OTC
Mucus Relief ORAL TABLET 400 MG
P
OTC
Refenesen ORAL TABLET 200 MG
P
OTC
Refenesen 400 ORAL TABLET 400 MG
P
OTC
Robafen ORAL SYRUP 100 MG/5ML
P
OTC
BRONCHO SALINE INHALATION
AEROSOL, SOLUTION 0.9 %
P
OTC
Sodium Chloride INHALATION
NEBULIZATION SOLUTION 0.9 %
P
OTC
*Expectorants**
*Expectorants***
*Misc. Respiratory Inhalants**
*Misc. Respiratory Inhalants***
*Mucolytics**
*Mucolytics***
Acetylcysteine INHALATION SOLUTION 10
%, 20 %
P
49
Drug Name
*Dermatologicals*
*Acne Products**
*Acne Antibiotics***
Clindamycin Phosphate EXTERNAL GEL 1 %
P
Clindamycin Phosphate EXTERNAL LOTION
1%
P
Clindamycin Phosphate EXTERNAL
SOLUTION 1 %
P
Ery EXTERNAL PAD 2 %
P
Erythromycin EXTERNAL GEL 2 %
P
Erythromycin EXTERNAL SOLUTION 2 %
P
Sulfacetamide Sodium EXTERNAL
SUSPENSION 10 %
P
*Acne Combinations***
Benzoyl Peroxide-Erythromycin EXTERNAL
GEL 5-3 %
P
*Acne Products***
Acne Medication EXTERNAL LOTION 10 %
P
OTC
Acne Medication 5 EXTERNAL LOTION 5 %
P
OTC
AMNESTEEM ORAL CAPSULE 10 MG, 20
MG, 40 MG
P
ST; QL (62 EA per 31 day(s));
Years)
AVITA EXTERNAL CREAM 0.025 %
P
QL (45 GM per 31 day(s)); AL
(Max 20 Years)
AVITA EXTERNAL GEL 0.025 %
P
(Max 20 Years)
Benzoyl Peroxide EXTERNAL GEL 10 %, 5 %
P
OTC
CLARAVIS ORAL CAPSULE 10 MG, 20
MG, 30 MG, 40 MG
P
ST; QL (62 EA per 31 day(s));
Years)
LAVOCLEN-4 CREAMY WASH
EXTERNAL LIQUID† 4 %
P
LAVOCLEN-8 CREAMY WASH
P
Tretinoin EXTERNAL CREAM 0.025 %, 0.05
%, 0.1 %
P
(Max 20 Years)
Tretinoin EXTERNAL GEL 0.01 %, 0.025 %
P
(Max 20 Years)
*Antibiotics - Topical**
50
Drug Name
*Antibiotic Mixtures Topical***
Double Antibiotic EXTERNAL OINTMENT
500-10000 UNIT/GM
P
OTC
Triple Antibiotic EXTERNAL OINTMENT
5-400-5000
P
OTC
*Antibiotic Steroid Combinations - Topical***
CORTISPORIN EXTERNAL OINTMENT 1
%
P
*Antibiotics - Topical***
Bacitracin EXTERNAL OINTMENT 500
UNIT/GM
P
OTC
Bacitracin Zinc EXTERNAL OINTMENT 500
UNIT/GM
P
OTC
Gentamicin Sulfate EXTERNAL CREAM 0.1
%
P
Gentamicin Sulfate EXTERNAL OINTMENT
0.1 %
P
Mupirocin EXTERNAL OINTMENT 2 %
P
*Antifungals - Topical**
*Antifungals - Topical***
Ciclopirox EXTERNAL SOLUTION 8 %
P
Ciclopirox Olamine EXTERNAL CREAM 0.77
%
P
Ciclopirox Olamine EXTERNAL
SUSPENSION 0.77 %
P
Nystatin EXTERNAL CREAM 100000
UNIT/GM
P
Nystatin EXTERNAL OINTMENT 100000
UNIT/GM
P
Nystatin EXTERNAL POWDER 100000
UNIT/GM
P
Terbinafine HCl EXTERNAL CREAM 1 %
P
OTC
Tolnaftate EXTERNAL CREAM 1 %
P
OTC
Baza Antifungal EXTERNAL CREAM 2 %
P
OTC
Clotrimazole EXTERNAL CREAM 1 %
P
OTC
Clotrimazole EXTERNAL SOLUTION 1 %
P
OTC
Econazole Nitrate EXTERNAL CREAM 1 %
P
*Imidazole-Related Antifungals - Topical***
51
Drug Name
Ketoconazole EXTERNAL CREAM 2 %
P
Ketoconazole EXTERNAL SHAMPOO 2 %
P
Miconazole Nitrate EXTERNAL CREAM 2 %
P
OTC
P
Fluorouracil EXTERNAL CREAM 5 %
P
PA
Fluorouracil EXTERNAL SOLUTION 2 %, 5
%
P
PA
*Anti-Inflammatory Agents - Topical**
*Anti-Inflammatory Agents - Topical***
VOLTAREN TRANSDERMAL GEL 1 %
*Antineoplastic Or Premalignant Lesion Agents
- Topical**
*Antineoplastic Antimetabolites - Topical***
*Antipsoriatics**
*Antipsoriatics***
Calcipotriene EXTERNAL CREAM 0.005 %
P
Calcipotriene EXTERNAL OINTMENT 0.005
%
P
Calcipotriene EXTERNAL SOLUTION 0.005
%
P
DRITHO-CREME HP EXTERNAL
CREAM 1 %
P
TAZORAC EXTERNAL CREAM 0.05 %,
0.1 %
P
(Max 20 Years)
TAZORAC EXTERNAL GEL 0.05 %, 0.1 %
P
(Max 20 Years)
*Antiseborrheic Products**
*Antiseborrheic Products***
Selenium Sulfide EXTERNAL LOTION 2.5 %
P
*Antivirals - Topical**
*Antivirals - Topical***
DENAVIR EXTERNAL CREAM 1 %
P
ST
ZOVIRAX EXTERNAL CREAM 5 %
P
ST
Silver Sulfadiazine EXTERNAL CREAM 1 %
P
SSD EXTERNAL CREAM 1 %
P
*Burn Products**
*Burn Products***
*Corticosteroids - Topical**
52
Drug Name
*Corticosteroids - Topical***
Alclometasone Dipropionate EXTERNAL
CREAM 0.05 %
P
Alclometasone Dipropionate EXTERNAL
OINTMENT 0.05 %
P
Betamethasone Dipropionate EXTERNAL
CREAM 0.05 %
P
LOTION 0.05 %
P
OINTMENT 0.05 %
P
Betamethasone Dipropionate Aug EXTERNAL
CREAM 0.05 %
P
Betamethasone Valerate EXTERNAL CREAM
0.1 %
P
Betamethasone Valerate EXTERNAL
LOTION 0.1 %
P
Betamethasone Valerate EXTERNAL
OINTMENT 0.1 %
P
Clobetasol Propionate EXTERNAL CREAM
0.05 %
P
Clobetasol Propionate EXTERNAL GEL 0.05
%
P
Clobetasol Propionate EXTERNAL
OINTMENT 0.05 %
P
Desonide EXTERNAL CREAM 0.05 %
P
Fluocinolone Acetonide EXTERNAL CREAM
0.01 %, 0.025 %
P
Fluocinolone Acetonide EXTERNAL
OINTMENT 0.025 %
P
Fluocinolone Acetonide EXTERNAL
SOLUTION 0.01 %
P
Fluocinolone Acetonide Body EXTERNAL OIL
0.01 %
P
Fluocinolone Acetonide Scalp EXTERNAL OIL
0.01 %
P
Fluocinonide EXTERNAL CREAM 0.05 %
P
Fluocinonide EXTERNAL GEL 0.05 %
P
Fluocinonide EXTERNAL OINTMENT 0.05
%
P
53
Drug Name
Fluocinonide EXTERNAL SOLUTION 0.05 %
P
Fluocinonide-E EXTERNAL CREAM 0.05 %
P
Fluticasone Propionate EXTERNAL CREAM
0.05 %
P
Fluticasone Propionate EXTERNAL
OINTMENT 0.005 %
P
Halobetasol Propionate EXTERNAL CREAM
0.05 %
P
Halobetasol Propionate EXTERNAL
OINTMENT 0.05 %
P
Hydrocortisone EXTERNAL CREAM 1 %
P
OTC
Hydrocortisone EXTERNAL LOTION 1 %
P
OTC
Hydrocortisone EXTERNAL LOTION 2.5 %
P
Hydrocortisone EXTERNAL OINTMENT 1 %
P
Hydrocortisone EXTERNAL OINTMENT 2.5
%
P
Hydrocortisone Valerate EXTERNAL
CREAM 0.2 %
P
Hydrocortisone Valerate EXTERNAL
OINTMENT 0.2 %
P
Mometasone Furoate EXTERNAL CREAM
0.1 %
P
Mometasone Furoate EXTERNAL
OINTMENT 0.1 %
P
Triamcinolone Acetonide EXTERNAL
CREAM 0.025 %, 0.1 %, 0.5 %
P
Triamcinolone Acetonide EXTERNAL
OINTMENT 0.1 %
P
OTC
*Emollient/Keratolytic Agents**
*Emollient/Keratolytic Agents***
REMEVEN EXTERNAL CREAM 50 %
P
Urea EXTERNAL CREAM 40 %
P
X-VIATE EXTERNAL CREAM 40 %
P
*Emollients**
*Emollients***
AMLACTIN EXTERNAL LOTION 12 %
P
OTC; QL (400 GM per 31
day(s))
Ammonium Lactate EXTERNAL CREAM 12
%
P
day(s))
54
Drug Name
Ammonium Lactate EXTERNAL LOTION 12
%
P
day(s))
Vitamins A & D EXTERNAL OINTMENT
P
OTC
P
PA
P
ST; QL (30 GM per 31 day(s))
CLEAR AWAY 1-STEP WART REMOVER
EXTERNAL PAD 40 %
P
OTC
COMPOUND W EXTERNAL LIQUID† 17
%
P
OTC
COMPOUND W MAXIMUM STRENGTH
EXTERNAL GEL 17 %
P
OTC
CONDYLOX EXTERNAL GEL 0.5 %
P
PA
FREEZONE EXTERNAL LIQUID† 17.6 %
P
OTC
Podofilox EXTERNAL SOLUTION 0.5 %
P
SALACTIC FILM EXTERNAL SOLUTION
17 %
P
OTC
Capsaicin EXTERNAL CREAM 0.025 %
P
OTC
Dibucaine EXTERNAL OINTMENT 1 %
P
OTC
Lidocaine EXTERNAL OINTMENT 5 %
P
Lidocaine HCl EXTERNAL GEL 2 %
P
Lidocaine HCl EXTERNAL SOLUTION 4 %
P
*Enzymes - Topical**
*Enzymes - Topical***
SANTYL EXTERNAL OINTMENT 250
UNIT/GM
*Immunosuppressive Agents - Topical**
*Macrolide Immunosuppressants - Topical***
ELIDEL EXTERNAL CREAM 1 %
*Keratolytic/Antimitotic Agents**
*Keratolytic/Antimitotic Agents***
*Local Anesthetics - Topical**
*Local Anesthetics - Topical***
*Topical Anesthetic Combinations***
Lidocaine-Prilocaine EXTERNAL CREAM
2.5-2.5 %
P
Lidocaine-Prilocaine EXTERNAL KIT 2.5-2.5
%
P
*Misc. Topical**
*Misc. Topical***
55
Drug Name
HYPERCARE EXTERNAL SOLUTION 20
%
P
*Skin Protectants***
4-N-1 EXTERNAL CREAM 1 %
P
OTC
BAZA PROTECT EXTERNAL CREAM
P
OTC
*Rosacea Agents**
*Rosacea Agents***
MetroNIDAZOLE EXTERNAL CREAM 0.75
%
P
MetroNIDAZOLE EXTERNAL GEL 1 %
P
*Scabicides & Pediculicides**
*Scabicide Combinations***
Complete Lice Treatment COMBINATION
KIT 0.33-4-0.5 %
P
OTC
Lice Killing Maximum Strength EXTERNAL
SHAMPOO 0.33-4 %
P
OTC
ACTICIN EXTERNAL CREAM 5 %
P
OVIDE EXTERNAL LOTION 0.5 %
P
(Min 6 Years)
Permethrin EXTERNAL CREAM 5 %
P
Permethrin EXTERNAL LOTION 1 %
P
*Scabicides & Pediculicides***
*Diagnostic Products*
*Diagnostic Drugs**
*Diagnostic Drugs***
Dipyridamole INTRAVENOUS* SOLUTION
5 MG/ML
P
*Diagnostic Tests**
*Diagnostic Tests***
ACCU-CHEK ACTIVE IN VITRO STRIP
P
ACCU-CHEK AVIVA PLUS IN VITRO
STRIP
P
ACCU-CHEK COMFORT CURVE IN
VITRO STRIP
P
ACCU-CHEK COMPACT IN VITRO STRIP
P
ACCU-CHEK COMPACT TEST DRUM IN
VITRO STRIP
P
56
Drug Name
ACCU-CHEK SMARTVIEW IN VITRO
STRIP
P
CLINISTIX IN VITRO STRIP
P
DIASTIX IN VITRO STRIP
P
FREESTYLE INSULINX TEST IN VITRO
STRIP
P
FREESTYLE LITE TEST IN VITRO STRIP
P
FREESTYLE TEST IN VITRO STRIP
P
KETOSTIX IN VITRO STRIP
P
PRECISION XTRA BLOOD GLUCOSE IN
VITRO STRIP
P
PRECISION XTRA KETONE IN VITRO
STRIP
P
OTC
*Digestive Aids*
*Digestive Enzymes**
*Digestive Enzymes***
CREON ORAL CAPSULE DELAYED
RELEASE PARTICLES 12000 UNIT, 24000
UNIT, 3000-9500 UNIT, 36000 UNIT, 6000
UNIT
P
Lactase Enzyme ORAL TABLET 3000 UNIT
P
PERTZYE ORAL CAPSULE DELAYED
RELEASE PARTICLES 16000 UNIT, 8000
UNIT
P
OTC
*Diuretics*
*Carbonic Anhydrase Inhibitors**
*Carbonic Anhydrase Inhibitors***
AcetaZOLAMIDE ORAL TABLET 125 MG,
250 MG
P
Methazolamide ORAL TABLET 25 MG, 50
MG
P
*Diuretic Combinations**
*Diuretic Combinations***
Amiloride-Hydrochlorothiazide ORAL
TABLET 5-50 MG
P
Spironolactone-HCTZ ORAL TABLET 25-25
MG
P
Triamterene-HCTZ ORAL CAPSULE 37.5-25
MG
P
57
Drug Name
Triamterene-HCTZ ORAL TABLET 37.5-25
MG, 75-50 MG
P
*Loop Diuretics**
*Loop Diuretics***
Bumetanide INJECTION SOLUTION 0.25
MG/ML
P
Bumetanide ORAL TABLET 0.5 MG, 1 MG, 2
MG
P
Furosemide ORAL SOLUTION 10 MG/ML, 8
MG/ML
P
Furosemide ORAL TABLET 20 MG, 40 MG,
80 MG
P
Torsemide ORAL TABLET 10 MG, 100 MG,
20 MG, 5 MG
P
*Potassium Sparing Diuretics**
*Potassium Sparing Diuretics***
Spironolactone ORAL TABLET 100 MG, 25
MG, 50 MG
P
*Thiazides And Thiazide-Like Diuretics**
*Thiazides And Thiazide-Like Diuretics***
Chlorothiazide ORAL TABLET 250 MG, 500
MG
P
Chlorthalidone ORAL TABLET 25 MG, 50
MG
P
Hydrochlorothiazide ORAL CAPSULE 12.5
MG
P
Hydrochlorothiazide ORAL TABLET 12.5
MG, 25 MG, 50 MG
P
Indapamide ORAL TABLET 1.25 MG, 2.5 MG
P
Metolazone ORAL TABLET 10 MG, 2.5 MG,
5 MG
P
*Endocrine And Metabolic Agents - Misc.*
*Bone Density Regulators**
*Bisphosphonates***
Alendronate Sodium ORAL TABLET 10 MG,
35 MG, 40 MG, 5 MG, 70 MG
P
*Calcitonins***
Calcitonin (Salmon) NASAL SOLUTION 200
UNIT/ACT
58
P
Drug Name
FORTICAL NASAL SOLUTION 200
UNIT/ACT
P
*Rank Ligand (Rankl) Inhibitors***
PROLIA SUBCUTANEOUS* SOLUTION
60 MG/ML
P
PA
P
PA
*Growth Hormones**
*Growth Hormones***
TEV-TROPIN SUBCUTANEOUS*
*Hormone Receptor Modulators**
*Selective Estrogen Receptor Modulators
(Serms)***
EVISTA ORAL TABLET 60 MG
P
*Metabolic Modifiers**
*Carnitine Replenisher - Agents***
LevOCARNitine INTRAVENOUS*
SOLUTION 200 MG/ML
P
LevOCARNitine ORAL SOLUTION 1
GM/10ML
P
LevOCARNitine ORAL TABLET 330 MG
P
*Gaa Deficiency Treatment - Agents***
LUMIZYME INTRAVENOUS*
P
PA
*Hyperparathyroid Treatment - Vitamin D
Analogs***
Calcitriol ORAL CAPSULE 0.25 MCG, 0.5
MCG
P
Calcitriol ORAL SOLUTION 1 MCG/ML
P
*Posterior Pituitary Hormones**
*Vasopressin***
Desmopressin Ace Rhinal Tube NASAL
SOLUTION 0.01 %
P
Desmopressin Ace Spray Refrig NASAL
SOLUTION 0.01 %
P
Desmopressin Acetate ORAL TABLET 0.1
MG, 0.2 MG
P
Desmopressin Acetate Spray NASAL
SOLUTION 0.01 %
P
*Estrogens*
59
Drug Name
*Estrogen Combinations**
*Estrogen & Progestin***
PREMPHASE ORAL TABLET 0.625-5 MG
P
PREMPRO ORAL TABLET 0.3-1.5 MG,
0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG
P
*Estrogens**
*Estrogens***
Estradiol ORAL TABLET 0.5 MG, 1 MG, 2
MG
P
Estradiol TRANSDERMAL PATCH
WEEKLY 0.025 MG/24HR, 0.0375 MG/24HR,
0.05 MG/24HR, 0.06 MG/24HR, 0.075
MG/24HR, 0.1 MG/24HR
P
Estropipate ORAL TABLET 0.75 MG, 1.5
MG, 3 MG
P
PREMARIN INJECTION SOLUTION
RECONSTITUTED 25 MG
P
PREMARIN ORAL TABLET 0.3 MG, 0.45
MG, 0.625 MG, 0.9 MG, 1.25 MG
P
*Fluoroquinolones*
*Fluoroquinolones**
*Fluoroquinolones***
Ciprofloxacin HCl ORAL TABLET 250 MG,
500 MG, 750 MG
P
Levofloxacin ORAL TABLET 250 MG, 500
MG, 750 MG
P
Simethicone ORAL SUSPENSION 40
MG/0.6ML
P
OTC
Simethicone ORAL TABLET CHEWABLE 80
MG
P
OTC
*Gastrointestinal Agents - Misc.*
*Antiflatulents**
*Antiflatulents***
*Gallstone Solubilizing Agents**
*Gallstone Solubilizing Agents***
Ursodiol ORAL CAPSULE 300 MG
*Gastrointestinal Stimulants**
*Gastrointestinal Stimulants***
60
P
Drug Name
Metoclopramide HCl ORAL SOLUTION 5
MG/5ML
P
Metoclopramide HCl ORAL TABLET 10 MG,
5 MG
P
*Inflammatory Bowel Agents**
*Inflammatory Bowel Agents***
APRISO ORAL CAPSULE EXTENDED
RELEASE 24 HOUR 0.375 GM
P
Balsalazide Disodium ORAL CAPSULE 750
MG
P
Mesalamine RE ENEMA 4 GM
P
SulfaSALAzine ORAL TABLET 500 MG
P
SulfaSALAzine ORAL TABLET DELAYED
RELEASE 500 MG
P
*Intestinal Acidifiers**
*Intestinal Acidifiers***
P
ELIPHOS ORAL TABLET 667 MG
P
RENVELA ORAL PACKET 0.8 GM, 2.4
GM
P
RENVELA ORAL TABLET 800 MG
P
Generlac ORAL SOLUTION 10 GM/15ML
*Phosphate Binder Agents**
*Phosphate Binder Agents***
*Genitourinary Agents - Miscellaneous*
*Alkalinizers**
*Citrates***
Cytra-2 ORAL SOLUTION 500-334 MG/5ML
P
CYTRA-3 ORAL SYRUP 550-500-334
MG/5ML
P
Sodium Citrate ORAL GRANULES
P
*Genitourinary Irrigants**
*Genitourinary Irrigants***
ARGYLE STERILE SALINE IRRIGATION
SOLUTION 0.9 %
P
Sodium Chloride IRRIGATION SOLUTION
0.9 %
P
*Prostatic Hypertrophy Agents**
*5-Alpha Reductase Inhibitors***
61
Drug Name
AVODART ORAL CAPSULE 0.5 MG
P
Finasteride ORAL TABLET 5 MG
P
*Alpha 1-Adrenoceptor Antagonists***
Tamsulosin HCl ORAL CAPSULE 0.4 MG
P
*Urinary Analgesics**
*Urinary Analgesics***
Phenazopyridine HCl ORAL TABLET 100
MG, 200 MG
P
*Gout Agents*
*Gout Agent Combinations**
*Gout Agent Combinations***
Colchicine-Probenecid ORAL TABLET 0.5-500
MG
P
*Gout Agents**
*Gout Agents***
Allopurinol ORAL TABLET 100 MG, 300 MG
P
COLCRYS ORAL TABLET 0.6 MG
P
*Uricosurics**
*Uricosurics***
Probenecid ORAL TABLET 500 MG
P
*Hematological Agents - Misc.*
*Bradykinin B2 Receptor Antagonists**
*Bradykinin B2 Receptor Antagonists***
FIRAZYR SUBCUTANEOUS* SOLUTION
30 MG/3ML
P
*Hematorheologic Agents**
*Hematorheologic Agents***
Pentoxifylline ER ORAL TABLET
P
*Platelet Aggregation Inhibitors**
*Phosphodiesterase Iii Inhibitors***
Cilostazol ORAL TABLET 100 MG, 50 MG
P
*Platelet Aggregation Inhibitors***
Dipyridamole ORAL TABLET 25 MG, 50 MG,
75 MG
*Quinazoline Agents***
62
P
PA
Drug Name
Anagrelide HCl ORAL CAPSULE 0.5 MG, 1
MG
P
*Thienopyridine Derivatives***
Clopidogrel Bisulfate ORAL TABLET 75 MG
P
*Hematopoietic Agents*
*Cobalamins**
*Cobalamins***
Cyanocobalamin INJECTION SOLUTION
1000 MCG/ML
P
Vitamin B-12 ORAL TABLET 1000 MCG
P
OTC
P
OTC
P
PA
P
PA
*Folic Acid/Folates**
*Folic Acid/Folates***
Folic Acid ORAL TABLET 1 MG, 400 MCG,
800 MCG
*Hematopoietic Growth Factors**
*Erythropoiesis-Stimulating Agents (Esas)***
PROCRIT INJECTION SOLUTION 10000
UNIT/ML, 2000 UNIT/ML, 20000
UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML,
40000 UNIT/ML
*Granulocyte Colony-Stimulating Factors
(G-Csf)***
NEUPOGEN INJECTION SOLUTION 300
MCG/0.5ML, 300 MCG/ML, 480
MCG/0.8ML, 480 MCG/1.6ML
*Hematopoietic Mixtures**
*Iron Combinations***
CENTRATEX ORAL CAPSULE 106-1 MG
P
Poly-Iron 150 Forte ORAL CAPSULE
150-25-1 MG-MCG-MG
P
*Iron**
*Iron***
Ferrous Gluconate ORAL TABLET 324 (38
Fe) MG
P
OTC
Ferrous Sulfate ORAL ELIXIR 220 (44 Fe)
MG/5ML
P
OTC
Ferrous Sulfate ORAL SOLUTION 75 (15 Fe)
MG/ML
P
OTC
63
Drug Name
Ferrous Sulfate ORAL SYRUP 300 (60 Fe)
MG/5ML
P
OTC
Ferrous Sulfate ORAL TABLET 325 (65 Fe)
MG
P
OTC
Ferrous Sulfate ORAL TABLET DELAYED
RELEASE 324 (65 Fe) MG, 325 (65 Fe) MG
P
OTC
POLY-IRON 150 ORAL CAPSULE 150 MG
P
OTC
Slow Release Iron ORAL TABLET
EXTENDEDRELEASE* 160 (50 Fe) MG
P
OTC
P
OTC
PHENobarbital ORAL ELIXIR 20 MG/5ML
P
PHENobarbital ORAL TABLET 100 MG, 30
MG, 32.4 MG, 60 MG, 64.8 MG, 97.2 MG
P
PHENobarbital ORAL TABLET 15 MG
P
PHENobarbital ORAL TABLET 16.2 MG
P
PHENobarbital Sodium INJECTION
P
*Hypnotics*
*Antihistamine Hypnotics**
*Antihistamine Hypnotics***
DiphenhydrAMINE HCl (Sleep) ORAL
TABLET 50 MG
*Barbiturate Hypnotics**
*Barbiturate Hypnotics***
*Non-Barbiturate Hypnotics**
*Benzodiazepine Hypnotics***
Estazolam ORAL TABLET 1 MG, 2 MG
P
Temazepam ORAL CAPSULE 15 MG, 30 MG
P
Triazolam ORAL TABLET 0.125 MG, 0.25
MG
P
AL (Min 18 Years)
P
(Min 18 Years)
Fiber Laxative ORAL TABLET 625 MG
P
OTC
METAMUCIL ORAL CAPSULE 0.52 GM
P
OTC
*Non-Benzodiazepine - Gaba-Receptor
Modulators***
Zolpidem Tartrate ORAL TABLET 10 MG, 5
MG
*Laxatives*
*Bulk Laxatives**
*Bulk Laxatives***
64
Drug Name
METAMUCIL ORAL WAFER
P
OTC
METAMUCIL SMOOTH TEXTURE ORAL
POWDER 28.3 %
P
OTC
GAVILYTE-G ORAL SOLUTION
RECONSTITUTED 236 GM
P
GAVILYTE-N WITH FLAVOR PACK
ORAL SOLUTION RECONSTITUTED 420
GM
P
GOLYTELY ORAL SOLUTION
RECONSTITUTED 227.1 GM
P
PEG 3350-KCl-Na Bicarb-NaCl ORAL
SOLUTION RECONSTITUTED 420 GM
P
PEG 3350/Electrolytes ORAL SOLUTION
P
PEG-3350/Electrolytes ORAL SOLUTION
P
TRILYTE ORAL SOLUTION
P
P
OTC
Lactulose ORAL SOLUTION 10 GM/15ML
P
Polyethylene Glycol 3350 ORAL POWDER
P
day(s))
SANI-SUPP PEDIATRIC RE
SUPPOSITORY 1.2 GM
P
OTC
Sorbitol ORAL SOLUTION 70 %
P
OTC
P
OTC
Laxative RE SUPPOSITORY 10 MG
P
OTC
Senna ORAL SYRUP 176 MG/5ML, 8.8
MG/5ML
P
OTC
*Laxative Combinations**
*Bowel Evacuant Combinations***
*Laxatives & Dss***
Senna S ORAL TABLET 8.6-50 MG
*Laxatives - Miscellaneous**
*Laxatives - Miscellaneous***
*Saline Laxatives**
*Saline Laxatives***
Milk of Magnesia ORAL SUSPENSION 400
MG/5ML
*Stimulant Laxatives**
*Stimulant Laxatives***
65
Drug Name
Senna Laxative ORAL TABLET 8.6 MG
P
OTC
Stimulant Laxative ORAL TABLET
P
OTC
Docusate Sodium ORAL TABLET 100 MG
P
OTC
RA Col-Rite ORAL CAPSULE 50 MG
P
OTC
Silace ORAL LIQUID† 150 MG/15ML
P
OTC
Stool Softener ORAL CAPSULE 100 MG, 250
MG
P
OTC
Stool Softener Laxative DC ORAL CAPSULE
240 MG
P
OTC
*Surfactant Laxatives**
*Surfactant Laxatives***
*Local Anesthetics-Parenteral*
*Local Anesthetics - Amides**
*Local Anesthetics - Amides***
Lidocaine HCl INJECTION SOLUTION 0.5
%, 1 %, 1.5 %
P
Lidocaine HCl (PF) INJECTION
SOLUTION 2 %
P
*Macrolides*
*Azithromycin**
*Azithromycin***
Azithromycin INTRAVENOUS* SOLUTION
P
Azithromycin ORAL SUSPENSION
MG/5ML
P
Azithromycin ORAL TABLET 250 MG
P
Azithromycin ORAL TABLET 500 MG, 600
MG
P
Azithromycin Hydrogencitrate
INTRAVENOUS* SOLUTION
P
*Clarithromycin**
*Clarithromycin***
Clarithromycin ORAL SUSPENSION
MG/5ML
66
P
Drug Name
Clarithromycin ORAL TABLET 250 MG, 500
MG
P
*Erythromycins**
*Erythromycins***
E.E.S. GRANULES ORAL SUSPENSION
P
ERY-TAB ORAL TABLET DELAYED
RELEASE 250 MG, 333 MG, 500 MG
P
ERYPED 200 ORAL SUSPENSION
P
ERYPED 400 ORAL SUSPENSION
P
ERYTHROCIN STEARATE ORAL
TABLET 250 MG
P
Erythromycin Base ORAL CAPSULE
DELAYED RELEASE PARTICLES 250 MG
P
Erythromycin Base ORAL TABLET 250 MG,
500 MG
P
Erythromycin Ethylsuccinate ORAL TABLET
400 MG
P
*Medical Devices*
*Diabetic Supplies**
*Glucose Monitoring Test Supplies***
ACCU-CHEK AVIVA PLUS XX KIT
W/DEVICE
P
ACCU-CHEK COMPACT PLUS CARE XX
KIT
P
ACCU-CHEK NANO SMARTVIEW XX
KIT W/DEVICE
P
FREESTYLE FREEDOM LITE XX KIT
W/DEVICE
P
FREESTYLE INSULINX SYSTEM XX KIT
W/DEVICE
P
FREESTYLE LITE XX DEVICE
P
Glucose Control IN VITRO SOLUTION
P
OTC
Lancet Device XX MISC
P
OTC
Lancets XX MISC
P
OTC
PRECISION XTRA XX DEVICE
P
*Misc. Devices**
67
Drug Name
*Applicators,Cotton Balls,Etc***
P
OTC
BD INSULIN SYRINGE ULTRAFINE XX
MISC 31G X 5/16" 1 ML
P
EXEL PEN NEEDLES 1/3" XX MISC 31G X
8 MM
P
Insulin Syringe XX MISC 29G X 1/2" 0.3 ML,
30G X 5/16" 0.3 ML
P
NOVOPEN 3 XX MISC
P
OTC
P
P
AEROCHAMBER PLUS FLO-VU XX
MISC
P
AEROCHAMBER PLUS FLO-VU LARGE
XX MISC
P
AEROCHAMBER PLUS FLO-VU SMALL
XX MISC
P
AEROCHAMBER PLUS FLO-VU
W/MASK XX MISC
P
E-Z SPACER XX DEVICE
P
MICROCHAMBER XX MISC
P
MICROSPACER XX MISC
P
OPTICHAMBER ADVANTAGE XX MISC
P
OPTICHAMBER ADVANTAGE-LG MASK
XX MISC
P
OPTICHAMBER ADVANTAGE-MED
MASK XX MISC
P
OPTICHAMBER ADVANTAGE-SM
MASK XX MISC
P
OPTICHAMBER FACE MASK-LARGE XX
MISC
P
Alcohol Pads XX PAD 70 %
*Parenteral Therapy Supplies**
*Needles & Syringes***
*Respiratory Therapy Supplies**
*Peak Flow Meters***
Peak Flow Meter XX DEVICE
*Respiratory Therapy Supplies***
IN-CHECK DIAL FLOW TRAINER XX
DEVICE
*Spacer/Aerosol-Holding Chambers &
Supplies***
68
Drug Name
OPTICHAMBER FACE MASK-MEDIUM
XX MISC
P
OPTICHAMBER FACE MASK-SMALL XX
MISC
P
OPTIHALER XX MISC
P
Naratriptan HCl ORAL TABLET 1 MG, 2.5
MG
P
SUMAtriptan NASAL SOLUTION 20
MG/ACT, 5 MG/ACT
P
SUMAtriptan Succinate ORAL TABLET 100
MG, 25 MG, 50 MG
P
SUMAtriptan Succinate SUBCUTANEOUS*
P
SUMAtriptan Succinate Refill
MG/0.5ML, 6 MG/0.5ML
P
Calcium Carbonate-Vitamin D ORAL
TABLET 600-400 MG-UNIT
P
OTC
Calcium-Vitamin D ORAL TABLET 500-200
MG-UNIT
P
OTC
Cal-Lac ORAL CAPSULE 500 MG
P
OTC
Calcium Acetate (Phos Binder) ORAL
TABLET 667 MG
P
Calcium Carbonate ORAL SUSPENSION
1250 MG/5ML
P
OTC
Calcium Carbonate ORAL TABLET 1250 MG,
600 MG
P
OTC
Calcium Lactate ORAL TABLET 648 MG
P
OTC
P
OTC; QL (4000 ML per 31
day(s))
*Migraine Products*
*Serotonin Agonists**
*Selective Serotonin Agonists 5-Ht(1)***
*Minerals & Electrolytes*
*Calcium**
*Calcium Combinations***
*Calcium***
*Electrolyte Mixtures**
*Electrolytes Oral***
ORALYTE ORAL SOLUTION
69
Drug Name
ORALYTE FREEZER POPS ORAL
SOLUTION
P
OTC; QL (4000 ML per 31
day(s))
*Fluoride**
*Fluoride Combinations***
FLUOR-A-DAY ORAL TABLET
CHEWABLE 0.25 (F)-236.79 MG, 0.5
(F)-236.79 MG, 1 (F)-236.79 MG
P
*Fluoride***
Sodium Fluoride ORAL SOLUTION 1.1 (0.5
F) MG/ML
P
Sodium Fluoride ORAL TABLET
CHEWABLE 0.55 (0.25 F) MG, 1.1 (0.5 F)
MG, 2.2 (1 F) MG
P
*Iodine Products**
*Iodine Products***
SSKI ORAL SOLUTION 1 GM/ML
P
*Magnesium**
*Magnesium***
Magnesium Oxide ORAL TABLET 500 MG
P
*Phosphate**
*Phosphate***
K-PHOS-NEUTRAL ORAL TABLET
155-852-130 MG
P
*Potassium**
*Potassium***
KLOR-CON ORAL TABLET
EXTENDEDRELEASE* 8 MEQ
P
KLOR-CON 10 ORAL TABLET
P
KLOR-CON M10 ORAL TABLET
P
KLOR-CON M20 ORAL TABLET
P
Potassium Chloride INTRAVENOUS*
SOLUTION 0.4 MEQ/ML, 10 MEQ/100ML,
2 MEQ/ML, 30 MEQ/100ML, 40
MEQ/100ML
P
Potassium Chloride ORAL LIQUID† 20
MEQ/15ML (10%), 40 MEQ/15ML (20%)
P
70
OTC
Drug Name
Potassium Chloride ORAL SOLUTION 20
MEQ/15ML (10%)
P
Potassium Chloride Crys ER ORAL TABLET
EXTENDEDRELEASE* 10 MEQ, 20 MEQ
P
Potassium Chloride ER ORAL TABLET
EXTENDEDRELEASE* 10 MEQ, 8 MEQ
P
*Sodium**
*Sodium***
Normal Saline Flush INTRAVENOUS*
SOLUTION 0.9 %
P
Saline Flush INTRAVENOUS* SOLUTION
0.9 %
P
Sodium Chloride INJECTION SOLUTION 0.9
%
P
Sodium Chloride INTRAVENOUS*
SOLUTION 0.9 %
P
Sodium Chloride ORAL TABLET 1 GM
P
OTC
P
OTC
*Zinc**
*Zinc***
Zinc Sulfate ORAL TABLET 220 (50 Zn) MG
*Mouth/Throat/Dental Agents*
*Anesthetics Topical Oral**
*Anesthetics Topical Oral***
Lidocaine Viscous MOUTH/THROAT
SOLUTION 2 %
P
*Anti-Infectives - Throat**
*Anti-Infectives - Throat***
Clotrimazole MOUTH/THROAT LOZENGE
10 MG
P
Clotrimazole MOUTH/THROAT TROCHE
10 MG
P
Nystatin MOUTH/THROAT SUSPENSION
100000 UNIT/ML
P
Chlorhexidine Gluconate MOUTH/THROAT
SOLUTION 0.12 %
P
PERIOGARD MOUTH/THROAT
SOLUTION 0.12 %
P
*Antiseptics - Mouth/Throat**
*Antiseptics - Mouth/Throat***
71
Drug Name
*Dental Products**
*Fluoride Dental Products***
CAVAREST DENTAL GEL 1.1 %
P
DENTAGEL DENTAL GEL 1.1 %
P
FLUORIDEX DAILY DEFENSE DENTAL
GEL 1.1 %
P
GEL-KAM MOUTH/THROAT GEL 0.4 %
P
KARIGEL DENTAL GEL 1.1 %
P
KARIGEL-N DENTAL GEL 1.1 %
P
NEUTRAGARD ADVANCED DENTAL
GEL 1.1 %
P
PHOS FLUR MOUTH/THROAT
SOLUTION 0.044 %
P
PHOS-FLUR DENTAL GEL 1.1 %
P
SF DENTAL GEL 1.1 %
P
OTC
OTC
*Steroids - Mouth/Throat**
*Steroids - Mouth/Throat***
Triamcinolone Acetonide MOUTH/THROAT
PASTE 0.1 %
P
*Throat Products - Misc.**
*Saliva Stimulants***
Pilocarpine HCl ORAL TABLET 5 MG, 7.5
MG
P
*Multivitamins*
*B-Complex W/ C**
*B-Complex W/ C***
Vitamin B Complex-C ORAL CAPSULE
P
OTC
P
OTC
P
OTC
P
OTC
*B-Complex W/ Folic Acid**
*B-Complex W/ C & Folic Acid***
Rena-Vite ORAL TABLET
*Multiple Vitamins W/ Iron**
*Multiple Vitamins W/ Iron***
Multi-Vitamin/Iron ORAL TABLET
*Multiple Vitamins W/ Minerals**
*Multiple Vitamins W/ Minerals***
Multi-Vitamin/Minerals ORAL TABLET
72
Drug Name
Thera-M ORAL TABLET
P
OTC
VitaTRUM ORAL TABLET CHEWABLE
P
OTC
P
OTC
P
AL (Max 16 Years)
P
AL (Max 16 Years)
Multi-Vit/Fluoride ORAL SOLUTION 0.25
MG/ML, 0.5 MG/ML
P
AL (Max 16 Years)
Multi-Vitamin/Fluoride ORAL TABLET
CHEWABLE 0.25 MG, 0.5 MG, 1 MG
P
AL (Max 16 Years)
Multivitamin/Fluoride ORAL TABLET
CHEWABLE 0.25 MG, 0.5 MG, 1 MG
P
AL (Max 16 Years)
Tri-Vit/Fluoride ORAL SOLUTION 0.25
MG/ML
P
AL (Max 16 Years)
Tri-Vitamin/Fluoride ORAL SOLUTION 0.5
MG/ML
P
AL (Max 16 Years)
Vitamins ACD-Fluoride ORAL SOLUTION
0.25 MG/ML
P
AL (Max 16 Years)
P
OTC
P
OTC
P
OTC
*Multivitamins**
*Multivitamins***
Multi-Vitamins ORAL TABLET
*Ped Multi Vitamins W/Fl & Fe**
*Ped Multi Vitamins W/Fl & Fe***
Multi-Vit/Fluoride/Iron ORAL SOLUTION
0.25-10 MG/ML
*Ped Vitamins Acd Fluoride & Iron***
Tri-Vit/Fluoride/Iron ORAL SOLUTION
0.25-10 MG/ML
*Ped Mv W/ Fluoride**
*Ped Mv W/ Fluoride***
*Ped Vitamins Acd W/ Fluoride***
*Ped Mv W/ Iron**
*Ped Mv W/ Iron***
Poly-Vitamin/Iron ORAL SOLUTION 10
MG/ML
*Pediatric Multiple Vitamins**
*Pediatric Multiple Vitamins W/ C***
Poly-Vitamin ORAL SOLUTION 35 MG/ML
*Pediatric Vitamins**
*Pediatric Vitamins A & D W/ C***
Tri-Vitamin ORAL SOLUTION 1500-400-35
*Prenatal Vitamins**
73
Drug Name
*Prenatal Mv & Min W/Fe-Fa***
ELITE-OB ORAL TABLET 50-1.25 MG
P
MYNATAL ADVANCE ORAL TABLET
P
Mynatal-Z ORAL TABLET
P
Mynate 90 Plus ORAL TABLET
EXTENDEDRELEASE*
P
Prenatabs OBN ORAL TABLET 29-1 MG
P
PRENATABS RX ORAL TABLET 29-1 MG
P
Prenatal ORAL TABLET 28-0.8 MG
P
Prenatal 19 ORAL TABLET CHEWABLE
P
Prenatal Low Iron ORAL TABLET 27-0.8 MG
P
Prenatal Plus ORAL TABLET 27-1 MG
P
Prenatal Plus Iron ORAL TABLET 29-1 MG
P
Trinatal Rx 1 ORAL TABLET 60-1 MG
P
TRINATE ORAL TABLET
P
TRIVEEN-U ORAL CAPSULE 106.5-1 MG
P
UltimateCare Combo ORAL MISC 30-1 MG
P
VINATE AZ ORAL TABLET 27-1 MG
P
VINATE AZ EXTRA ORAL TABLET 29-1
MG
P
VINATE GT ORAL TABLET 90-1 MG
P
VINATE II ORAL TABLET 29-1 MG
P
VINATE M ORAL TABLET 27-1 MG
P
OTC
OTC
*Prenatal Mv & Min W/Fe-Fa-Ca-Omega 3
Fish Oil***
PR NATAL 400 EC ORAL MISC 29-1-200 &
400 MG (DR)
P
*Prenatal Vitamins***
FOLBECAL ORAL TABLET 1 MG
P
*Musculoskeletal Therapy Agents*
*Central Muscle Relaxants**
*Central Muscle Relaxants***
Baclofen ORAL TABLET 10 MG, 20 MG
P
Carisoprodol ORAL TABLET 350 MG
P
Chlorzoxazone ORAL TABLET 500 MG
P
74
Drug Name
Cyclobenzaprine HCl ORAL TABLET 10 MG,
5 MG
P
Methocarbamol ORAL TABLET 500 MG, 750
MG
P
*Direct Muscle Relaxants**
*Direct Muscle Relaxants***
Dantrolene Sodium ORAL CAPSULE 100
MG, 25 MG, 50 MG
P
*Viscosupplements**
*Viscosupplements***
SUPARTZ INTRA-ARTICULAR*
P
PA
BABY AYR SALINE NASAL SOLUTION
0.65 %
P
OTC
Saline Nasal Spray NASAL SOLUTION 0.65
%
P
OTC
*Nasal Agents - Systemic And Topical*
*Nasal Agents - Misc.**
*Nasal Agents - Misc.***
*Nasal Antiallergy**
*Nasal Antihistamines***
Azelastine HCl NASAL SOLUTION 137
MCG/SPRAY
P
*Nasal Mast Cell Stabilizers***
Cromolyn Sodium NASAL AEROSOL,
SOLUTION 5.2 MG/ACT
P
OTC
*Nasal Anticholinergics**
*Nasal Anticholinergics***
Ipratropium Bromide NASAL SOLUTION
0.03 %, 0.06 %
P
*Nasal Steroids**
*Nasal Steroids***
Flunisolide NASAL SOLUTION 25
MCG/ACT (0.025%)
P
Fluticasone Propionate NASAL
SUSPENSION 50 MCG/ACT
P
*Sympathomimetic Decongestants**
*Systemic Decongestants***
75
Drug Name
Childrens Silfedrine ORAL LIQUID† 15
MG/5ML
P
OTC
Pseudoephedrine HCl ORAL TABLET 30 MG,
60 MG
P
OTC
P
OTC
P
OTC
P
*Ophthalmic Agents*
*Artificial Tears And Lubricants**
*Artificial Tear And Lubricant
Combinations***
Artificial Tears OPHTHALMIC OINTMENT
83-15 %
*Artificial Tear Ointments***
ALTALUBE OPHTHALMIC OINTMENT
85-15 %
*Artificial Tears And Lubricants***
Artificial Tears OPHTHALMIC SOLUTION
1.4 %
*Beta-Blockers - Ophthalmic**
*Beta-Blockers - Ophthalmic Combinations***
Dorzolamide HCl-Timolol Mal
OPHTHALMIC SOLUTION 22.3-6.8
MG/ML
P
*Beta-Blockers - Ophthalmic***
Betaxolol HCl OPHTHALMIC SOLUTION
0.5 %
P
BETOPTIC-S OPHTHALMIC
SUSPENSION 0.25 %
P
Carteolol HCl OPHTHALMIC SOLUTION 1
%
P
Levobunolol HCl OPHTHALMIC
SOLUTION 0.25 %, 0.5 %
P
Metipranolol OPHTHALMIC SOLUTION 0.3
%
P
Timolol Maleate OPHTHALMIC GEL
FORMING SOLUTION 0.25 %, 0.5 %
P
Timolol Maleate OPHTHALMIC SOLUTION
0.25 %, 0.5 %
P
*Cycloplegic Mydriatics**
*Cycloplegic Mydriatics***
76
Drug Name
Atropine Sulfate OPHTHALMIC
OINTMENT 1 %
P
Atropine Sulfate OPHTHALMIC SOLUTION
1%
P
Atropine-Care OPHTHALMIC SOLUTION 1
%
P
ISOPTO HYOSCINE OPHTHALMIC
SOLUTION 0.25 %
P
*Ophthalmic Adrenergic Agents**
*Ophthalmic Selective Alpha Adrenergic
Agonists***
Brimonidine Tartrate OPHTHALMIC
SOLUTION 0.2 %
P
*Ophthalmic Anti-Infectives**
*Ophthalmic Antibiotics***
Ciprofloxacin HCl OPHTHALMIC
SOLUTION 0.3 %
P
Erythromycin OPHTHALMIC OINTMENT 5
MG/GM
P
Gentamicin Sulfate OPHTHALMIC
OINTMENT 0.3 %
P
Gentamicin Sulfate OPHTHALMIC
SOLUTION 0.3 %
P
Ofloxacin OPHTHALMIC SOLUTION 0.3 %
P
Tobramycin Sulfate OPHTHALMIC
SOLUTION 0.3 %
P
*Ophthalmic Anti-Infective Combinations***
AK-Poly-Bac OPHTHALMIC OINTMENT
500-10000 UNIT/GM
P
Bacitracin-Polymyxin B OPHTHALMIC
OINTMENT 500-10000 UNIT/GM
P
Neomycin-Bacitracin Zn-Polymyx
OPHTHALMIC OINTMENT 5-400-10000
P
Neomycin-Polymyxin-Gramicidin
OPHTHALMIC SOLUTION 1.75-10000-0.25
P
Polycin B OPHTHALMIC OINTMENT
500-10000 UNIT/GM
P
Polymyxin B-Trimethoprim OPHTHALMIC
SOLUTION 10000-0.1 UNIT/ML-%
P
*Ophthalmic Antivirals***
77
Drug Name
Trifluridine OPHTHALMIC SOLUTION 1 %
P
*Ophthalmic Sulfonamides***
Sulfacetamide Sodium OPHTHALMIC
SOLUTION 10 %
P
*Ophthalmic Immunomodulators**
*Ophthalmic Immunomodulators***
RESTASIS OPHTHALMIC EMULSION
0.05 %
P
*Ophthalmic Steroids**
*Ophthalmic Steroid Combinations***
Neomycin-Polymyxin-Dexameth
OPHTHALMIC OINTMENT 3.5-10000-0.1
P
OPHTHALMIC SUSPENSION 3.5-10000-0.1
P
Neomycin-Polymyxin-HC OPHTHALMIC
SUSPENSION 3.5-10000-1
P
Poly-Dex OPHTHALMIC OINTMENT
3.5-10000-0.1
P
PRED-G OPHTHALMIC SUSPENSION
0.3-1 %
P
Sulfacetamide-Prednisolone OPHTHALMIC
SOLUTION 10-0.23 %
P
TOBRADEX OPHTHALMIC OINTMENT
0.3-0.1 %
P
*Ophthalmic Steroids***
Dexamethasone Sodium Phosphate
OPHTHALMIC SOLUTION 0.1 %
P
Fluorometholone OPHTHALMIC
SUSPENSION 0.1 %
P
FML FORTE OPHTHALMIC
SUSPENSION 0.25 %
P
LOTEMAX OPHTHALMIC SUSPENSION
0.5 %
P
MAXIDEX OPHTHALMIC SUSPENSION
0.1 %
P
PrednisoLONE Acetate OPHTHALMIC
SUSPENSION 1 %
P
VEXOL OPHTHALMIC SUSPENSION 1 %
P
*Ophthalmics - Misc.**
78
Drug Name
*Ophthalmic Antiallergic***
Cromolyn Sodium OPHTHALMIC
SOLUTION 4 %
P
Ketotifen Fumarate OPHTHALMIC
SOLUTION 0.025 %
P
OTC
*Ophthalmic Carbonic Anhydrase Inhibitors***
AZOPT OPHTHALMIC SUSPENSION 1 %
P
Dorzolamide HCl OPHTHALMIC
SOLUTION 2 %
P
*Ophthalmic Hyperosmolar Products***
MURO 128 OPHTHALMIC SOLUTION 2 %
P
OTC
Sodium Chloride (Hypertonic)
OPHTHALMIC OINTMENT 5 %
P
OTC
OPHTHALMIC SOLUTION 5 %
P
OTC
*Ophthalmic Nonsteroidal Anti-Inflammatory
Agents***
Diclofenac Sodium OPHTHALMIC
SOLUTION 0.1 %
P
Flurbiprofen Sodium OPHTHALMIC
SOLUTION 0.03 %
P
*Prostaglandins - Ophthalmic**
*Prostaglandins - Ophthalmic***
Latanoprost OPHTHALMIC SOLUTION
0.005 %
P
*Otic Agents*
*Otic Agents - Miscellaneous**
*Otic Agents - Miscellaneous***
Acetic Acid-Aluminum Acetate OTIC
SOLUTION 2 %
P
Earwax Treatment Drops OTIC SOLUTION
6.5 %
P
OTC
*Otic Anti-Infectives**
*Otic Anti-Infectives***
Ofloxacin OTIC SOLUTION 0.3 %
P
*Otic Combinations**
*Otic Analgesic Combinations***
79
Drug Name
Antipyrine-Benzocaine OTIC SOLUTION
5.4-1.4 %, 54-14 MG/ML
P
Oticin OTIC LIQUID† 1-0.1 %
P
*Otic Steroid-Anti-Infective Combinations***
CIPRODEX OTIC SUSPENSION 0.3-0.1 %
P
Neomycin-Polymyxin-HC OTIC SOLUTION
3.5-10000-1
P
Neomycin-Polymyxin-HC OTIC
P
ST; AL (Max 8 Years)
*Oxytocics*
*Oxytocics**
*Oxytocics***
Methylergonovine Maleate INJECTION
SOLUTION 0.2 MG/ML
P
Methylergonovine Maleate ORAL TABLET
0.2 MG
P
*Passive Immunizing Agents*
*Monoclonal Antibodies**
*Antiviral Monoclonal Antibodies***
SYNAGIS INTRAMUSCULAR*
SOLUTION 100 MG/ML, 50 MG/0.5ML
P
PA
*Penicillins*
*Aminopenicillins**
*Aminopenicillins***
Amoxicillin ORAL CAPSULE 250 MG, 500
MG
P
Amoxicillin ORAL SUSPENSION
MG/5ML, 250 MG/5ML, 400 MG/5ML
P
Amoxicillin ORAL TABLET 500 MG, 875 MG
P
Amoxicillin ORAL TABLET CHEWABLE
125 MG, 250 MG
P
Ampicillin ORAL CAPSULE 250 MG, 500 MG
P
Ampicillin ORAL SUSPENSION
MG/5ML
P
*Natural Penicillins**
*Natural Penicillins***
80
Drug Name
BICILLIN L-A INTRAMUSCULAR*
SUSPENSION 1200000 UNIT/2ML, 2400000
UNIT/4ML, 600000 UNIT/ML
P
Penicillin G Procaine INTRAMUSCULAR*
P
Penicillin V Potassium ORAL SOLUTION
MG/5ML
P
Penicillin V Potassium ORAL TABLET 250
MG, 500 MG
P
PFIZERPEN-G INJECTION SOLUTION
RECONSTITUTED 20000000 UNIT,
5000000 UNIT
P
*Penicillin Combinations**
*Penicillin Combinations***
Amoxicillin-Pot Clavulanate ORAL
SUSPENSION RECONSTITUTED 200-28.5
MG/5ML, 250-62.5 MG/5ML, 400-57
MG/5ML, 600-42.9 MG/5ML
P
Amoxicillin-Pot Clavulanate ORAL TABLET
250-125 MG, 500-125 MG, 875-125 MG
P
Amoxicillin-Pot Clavulanate ORAL TABLET
CHEWABLE 200-28.5 MG, 400-57 MG
P
BICILLIN C-R INTRAMUSCULAR*
SUSPENSION 1200000 UNIT/2ML
P
BICILLIN C-R 900/300
900000-300000 UNIT/2ML
P
*Penicillinase-Resistant Penicillins**
*Penicillinase-Resistant Penicillins***
Dicloxacillin Sodium ORAL CAPSULE 250
MG, 500 MG
P
Oxacillin Sodium INJECTION SOLUTION
RECONSTITUTED 1 GM, 10 GM, 2 GM
P
*Progestins*
*Progestins**
*Progestins***
MAKENA INTRAMUSCULAR* OIL 250
MG/ML
P
PA
81
Drug Name
MedroxyPROGESTERone Acetate ORAL
TABLET 10 MG, 2.5 MG, 5 MG
P
Norethindrone Acetate ORAL TABLET 5 MG
P
*Psychotherapeutic And Neurological Agents Misc.*
*Agents For Chemical Dependency**
*Alcohol Deterrents***
Acamprosate Calcium ORAL TABLET
P
Disulfiram ORAL TABLET 250 MG, 500 MG
P
*Antidementia Agents**
*Cholinomimetics - Ache Inhibitors***
Donepezil HCl ORAL TABLET 10 MG, 5 MG
P
EXELON TRANSDERMAL PATCH 24 HR
13.3 MG/24HR, 4.6 MG/24HR, 9.5
MG/24HR
P
Rivastigmine Tartrate ORAL CAPSULE 1.5
MG, 3 MG, 4.5 MG, 6 MG
P
*N-Methyl-D-Aspartate (Nmda) Receptor
Antagonists***
NAMENDA ORAL SOLUTION 10
MG/5ML
P
NAMENDA ORAL TABLET 10 MG, 5 MG
P
NAMENDA TITRATION PAK ORAL
TABLET 5 (28)-10 (21) MG
P
*Combination Psychotherapeutics**
*Benzodiazepines & Tricyclic Agents***
Chlordiazepoxide-Amitriptyline ORAL
TABLET 10-25 MG, 5-12.5 MG
P
*Phenothiazines & Tricyclic Agents***
Perphenazine-Amitriptyline ORAL TABLET
2-10 MG, 2-25 MG, 4-10 MG, 4-25 MG, 4-50
MG
P
*Fibromyalgia Agents**
*Fibromyalgia Agent - Snris***
SAVELLA ORAL TABLET 100 MG, 12.5
MG, 25 MG, 50 MG
P
SAVELLA TITRATION PACK ORAL
MISC 12.5 & 25 & 50 MG
P
82
Drug Name
*Multiple Sclerosis Agents**
*Ms Agents - Pyrimidine Synthesis
Inhibitors***
AUBAGIO ORAL TABLET 14 MG, 7 MG
P
PA
EXTAVIA SUBCUTANEOUS* KIT 0.3 MG
P
PA
REBIF SUBCUTANEOUS* SOLUTION 22
P
REBIF TITRATION PACK
SUBCUTANEOUS* SOLUTION 6X8.8 &
6X22 MCG
P
*Multiple Sclerosis Agents - Interferons***
*Multiple Sclerosis Agents***
COPAXONE SUBCUTANEOUS* KIT 20
MG/ML
P
*Psychotherapeutic And Neurological Agents Misc.**
*Psychotherapeutic And Neurological Agents Misc.***
ORAP ORAL TABLET 1 MG, 2 MG
P
AL (Min 12 Years)
Nicotine TRANSDERMAL PATCH 24 HR 14
MG/24HR, 21 MG/24HR, 7 MG/24HR
P
Nicotine Polacrilex MOUTH/THROAT GUM
2 MG, 4 MG
P
OTC; QL (2016 EA per 365
day(s))
Nicotine Polacrilex MOUTH/THROAT
LOZENGE 2 MG, 4 MG
P
OTC; QL (1680 EA per 365
day(s))
P
PA
P
PA
*Smoking Deterrents**
*Smoking Deterrents***
*Respiratory Agents - Misc.*
*Cystic Fibrosis Agents**
*Cftr Potentiators***
KALYDECO ORAL TABLET 150 MG
*Hydrolytic Enzymes***
PULMOZYME INHALATION SOLUTION
1 MG/ML
*Tetracyclines*
*Tetracyclines**
*Tetracyclines***
83
Drug Name
DOXY 100 INTRAVENOUS* SOLUTION
P
Doxycycline Hyclate ORAL CAPSULE 100
MG, 50 MG
P
PA
Doxycycline Hyclate ORAL TABLET 100 MG
P
PA
Doxycycline Hyclate ORAL TABLET 20 MG
P
Minocycline HCl ORAL CAPSULE 100 MG,
50 MG, 75 MG
P
Tetracycline HCl ORAL CAPSULE 250 MG,
500 MG
P
*Thyroid Agents*
*Antithyroid Agents**
*Antithyroid Agents***
Methimazole ORAL TABLET 10 MG, 5 MG
P
Propylthiouracil ORAL TABLET 50 MG
P
*Thyroid Hormones**
*Thyroid Hormones***
ARMOUR THYROID ORAL TABLET 120
MG, 15 MG, 180 MG, 240 MG, 30 MG, 300
MG, 60 MG, 90 MG
P
Levothyroxine Sodium INTRAVENOUS*
SOLUTION RECONSTITUTED 100 MCG,
500 MCG
P
Levothyroxine Sodium ORAL TABLET 100
MCG, 112 MCG, 125 MCG, 137 MCG, 150
MCG, 175 MCG, 200 MCG, 25 MCG, 300
MCG, 50 MCG, 75 MCG, 88 MCG
P
Liothyronine Sodium ORAL TABLET 25
MCG, 5 MCG, 50 MCG
P
NATURE-THROID ORAL TABLET 113.75
MG, 130 MG, 146.25 MG, 16.25 MG, 162.5
MG, 195 MG, 260 MG, 32.5 MG, 325 MG,
48.75 MG, 65 MG, 81.25 MG, 97.5 MG
P
NP Thyroid ORAL TABLET 30 MG, 60 MG,
90 MG
P
THYROLAR-1 ORAL TABLET 60 (12.5-50)
MG (MCG)
P
THYROLAR-1/2 ORAL TABLET 30
(6.25-25) MG (MCG)
P
84
Drug Name
THYROLAR-1/4 ORAL TABLET 15
(3.1-12.5) MG (MCG)
P
THYROLAR-2 ORAL TABLET 120 (25-100)
MG (MCG)
P
THYROLAR-3 ORAL TABLET 180
(37.5-150) MG (MCG)
P
UNITHROID ORAL TABLET 100 MCG,
112 MCG, 125 MCG, 137 MCG, 150 MCG,
175 MCG, 200 MCG, 25 MCG, 300 MCG, 50
MCG, 75 MCG, 88 MCG
P
WESTHROID ORAL TABLET 113.75 MG,
130 MG, 146.25 MG, 16.25 MG, 162.5 MG,
195 MG, 260 MG, 32.5 MG, 325 MG, 48.75
MG, 65 MG, 81.25 MG, 97.5 MG
P
*Ulcer Drugs*
*Antispasmodics**
*Antispasmodics***
Dicyclomine HCl ORAL CAPSULE 10 MG
P
Dicyclomine HCl ORAL SOLUTION 10
MG/5ML
P
Dicyclomine HCl ORAL TABLET 20 MG
P
*Quaternary Anticholinergics***
Glycopyrrolate ORAL TABLET 1 MG, 2 MG
P
Propantheline Bromide ORAL TABLET 15
MG
P
*H-2 Antagonists**
*H-2 Antagonists***
Acid Reducer ORAL TABLET 75 MG
P
OTC
Cimetidine ORAL TABLET 200 MG
P
OTC
Cimetidine ORAL TABLET 300 MG, 400 MG,
800 MG
P
Cimetidine HCl ORAL SOLUTION 300
MG/5ML
P
Famotidine INTRAVENOUS* SOLUTION 10
MG/ML
P
Famotidine ORAL TABLET 10 MG
P
Famotidine ORAL TABLET 20 MG, 40 MG
P
Famotidine Premixed INTRAVENOUS*
SOLUTION 20-0.9 MG/50ML-%
P
OTC
85
Drug Name
Ranitidine Acid Reducer ORAL TABLET 75
MG
P
Ranitidine HCl INJECTION SOLUTION 1000
MG/40ML, 150 MG/6ML, 50 MG/2ML
P
Ranitidine HCl ORAL CAPSULE 150 MG,
300 MG
P
Ranitidine HCl ORAL SYRUP 15 MG/ML
P
Ranitidine HCl ORAL TABLET 150 MG
P
OTC
Ranitidine HCl ORAL TABLET 300 MG
P
OTC
*Misc. Anti-Ulcer**
*Misc. Anti-Ulcer***
CARAFATE ORAL SUSPENSION 1
GM/10ML
P
Sucralfate ORAL TABLET 1 GM
P
*Proton Pump Inhibitors**
*Proton Pump Inhibitors***
Lansoprazole ORAL CAPSULE DELAYED
RELEASE 15 MG
P
ST; OTC
Lansoprazole ORAL CAPSULE DELAYED
RELEASE 30 MG
P
ST
Omeprazole ORAL CAPSULE DELAYED
RELEASE 10 MG, 20 MG, 40 MG
P
Omeprazole Magnesium ORAL CAPSULE
DELAYED RELEASE 20.6 (20 Base) MG
P
Pantoprazole Sodium ORAL TABLET
DELAYED RELEASE 20 MG, 40 MG
P
*Ulcer Drugs - Prostaglandins**
*Ulcer Drugs - Prostaglandins***
Misoprostol ORAL TABLET 100 MCG, 200
MCG
P
*Urinary Anti-Infectives*
*Urinary Anti-Infective Combinations**
*Urinary Antiseptic-Antispasmodic &/Or
Analgesics***
URETRON D/S ORAL TABLET
P
Uticap ORAL CAPSULE 120 MG
P
*Urinary Anti-Infectives**
*Urinary Anti-Infectives***
86
OTC
Drug Name
MACRODANTIN ORAL CAPSULE 25 MG
P
Nitrofurantoin Macrocrystal ORAL CAPSULE
100 MG, 50 MG
P
Nitrofurantoin Monohyd Macro ORAL
CAPSULE 100 MG
P
AL (Max 8 Years)
*Urinary Antispasmodics*
*Urinary Antispasmodics**
*Urinary Antispasmodics***
Bethanechol Chloride ORAL TABLET 10 MG,
25 MG, 5 MG, 50 MG
P
Oxybutynin Chloride ORAL SYRUP 5
MG/5ML
P
Oxybutynin Chloride ORAL TABLET 5 MG
P
Oxybutynin Chloride ER ORAL TABLET
MG, 5 MG
P
Trospium Chloride ORAL TABLET 20 MG
P
*Vaginal Products*
*Vaginal Anti-Infectives**
*Imidazole-Related Antifungals***
3 Day Vaginal VAGINAL CREAM 2 %
P
OTC
Clotrimazole VAGINAL CREAM 1 %
P
OTC
Miconazole 3 VAGINAL SUPPOSITORY 200
MG
P
Miconazole 3 Combo Pack VAGINAL KIT
200-2 MG-% (9GM)
P
OTC
Miconazole Nitrate VAGINAL CREAM 2 %
P
OTC
Miconazole Nitrate VAGINAL
SUPPOSITORY 100 MG
P
OTC
MONISTAT 3 VAGINAL CREAM 4 %
P
OTC
Terconazole VAGINAL CREAM 0.4 %, 0.8 %
P
Terconazole VAGINAL SUPPOSITORY 80
MG
P
*Vaginal Anti-Infectives***
Clindamycin Phosphate VAGINAL CREAM 2
%
P
MetroNIDAZOLE VAGINAL GEL 0.75 %
P
VANDAZOLE VAGINAL GEL 0.75 %
P
87
Drug Name
*Vaginal Estrogens**
*Vaginal Estrogens***
PREMARIN VAGINAL CREAM 0.625
MG/GM
P
*Vaginal Progestins**
*Vaginal Progestins***
ENDOMETRIN VAGINAL INSERT 100
MG
P
FIRST-PROGESTERONE VGS 100
VAGINAL SUPPOSITORY 100 MG
P
P
P
P
P
*Vasopressors*
*Anaphylaxis Therapy Agents**
*Anaphylaxis Therapy Agents***
EPIPEN 2-PAK INJECTION DEVICE 0.3
MG/0.3ML
P
EPIPEN JR 2-PAK INJECTION DEVICE
0.15 MG/0.3ML
P
*Vasopressors**
*Vasopressors***
Midodrine HCl ORAL TABLET 10 MG, 2.5
MG, 5 MG
P
*Vitamins*
*Oil Soluble Vitamins**
*Vitamin A***
Vitamin A ORAL CAPSULE 10000 UNIT,
8000 UNIT
P
OTC
Ergocalciferol ORAL SOLUTION 8000
UNIT/ML
P
OTC
Vitamin D (Ergocalciferol) ORAL CAPSULE
50000 UNIT
P
*Vitamin D***
88
Drug Name
Vitamin D3 ORAL TABLET 400 UNIT
P
OTC
*Vitamin K***
MEPHYTON ORAL TABLET 5 MG
P
Vitamin K (Phytonadione) ORAL TABLET
100 MCG
P
OTC
Biotin ORAL CAPSULE 5 MG, 5000 MCG
P
OTC
Biotin 5000 ORAL CAPSULE 5 MG
P
OTC
Biotin Maximum Strength ORAL CAPSULE
5000 MCG
P
OTC
*Water Soluble Vitamins**
*Biotin***
*Vitamin B-1***
Thiamine HCl INJECTION SOLUTION 100
MG/ML
P
Vitamin B-1 ORAL TABLET 100 MG, 250
MG, 50 MG
P
OTC
Niacin ORAL TABLET 100 MG, 250 MG, 50
MG, 500 MG
P
OTC
Niacin ER ORAL CAPSULE EXTENDED
RELEASE* 500 MG
P
OTC
Niacin ER ORAL TABLET
P
OTC
NIACOR ORAL TABLET 500 MG
P
*Vitamin B-3***
*Vitamin B-6***
Vitamin B-6 ORAL TABLET 100 MG, 25 MG,
250 MG, 50 MG, 500 MG
P
OTC
Vitamin B-6 ER ORAL TABLET
P
OTC
P
OTC
*Vitamin C***
Vitamin C ORAL TABLET 250 MG
89
90
Index
3 Day Vaginal VAGINAL
CREAM 2 % ...................................................... 87
4-N-1 EXTERNAL CREAM 1
% ......................................................................................... 56
Abacavir Sulfate ORAL
TABLET 300 MG ...................................... 38
Acamprosate Calcium ORAL
TABLET DELAYED RELEASE
333 MG ...................................................................... 82
Acarbose ORAL TABLET 100
MG, 25 MG, 50 MG ................................ 19
ACCU-CHEK ACTIVE IN
VITRO STRIP ............................................... 56
ACCU-CHEK AVIVA PLUS IN
VITRO STRIP ............................................... 56
ACCU-CHEK AVIVA PLUS
XX KIT W/DEVICE ............................ 67
ACCU-CHEK COMFORT
CURVE IN VITRO STRIP
................................................................................................ 56
ACCU-CHEK COMPACT IN
VITRO STRIP ............................................... 56
ACCU-CHEK COMPACT
PLUS CARE XX KIT ........................ 67
ACCU-CHEK COMPACT
TEST DRUM IN VITRO
STRIP .......................................................................... 56
ACCU-CHEK NANO
SMARTVIEW XX KIT
W/DEVICE ......................................................... 67
ACCU-CHEK SMARTVIEW
IN VITRO STRIP ..................................... 57
ACEPHEN RE SUPPOSITORY
120 MG, 325 MG ........................................... 4
Acetaminophen ORAL
SOLUTION 160 MG/5ML .............. 4
Acetaminophen ORAL TABLET
325 MG .......................................................................... 4
500 MG .......................................................................... 4
CHEWABLE 80 MG ................................ 4
Acetaminophen-Codeine #2
ORAL TABLET 300-15 MG
.................................................................................................... 6
.................................................................................................... 6
.................................................................................................... 6
Acetaminophen-Codeine ORAL
SOLUTION 120-12 MG/5ML
....................................................................................................
AcetaZOLAMIDE ORAL
TABLET 125 MG, 250 MG
................................................................................................
6
57
Acetic Acid-Aluminum Acetate
OTIC SOLUTION 2 % ...................... 79
Acetylcysteine INHALATION
SOLUTION 10 %, 20 % ................... 49
Acid Reducer ORAL TABLET 75
MG ................................................................................... 85
Acne Medication 5 EXTERNAL
LOTION 5 % .................................................... 50
Acne Medication EXTERNAL
LOTION 10 % ................................................. 50
ACTICIN EXTERNAL
CREAM 5 % ..................................................... 56
Acyclovir ORAL CAPSULE 200
MG ................................................................................... 39
Acyclovir ORAL SUSPENSION
200 MG/5ML .................................................... 39
Acyclovir ORAL TABLET 400
MG, 800 MG ...................................................... 39
ADDERALL XR ORAL
CAPSULE EXTENDED
RELEASE 24 HOUR 10 MG, 15
MG, 20 MG, 25 MG, 30 MG, 5
MG ...................................................................................... 1
ADRUCIL INTRAVENOUS*
SOLUTION 500 MG/10ML
................................................................................................ 30
ADVAIR DISKUS
INHALATION AEROSOL
POWDER, BREATH
ACTIVATED 100-50
MCG/DOSE, 250-50
MCG/DOSE, 500-50
MCG/DOSE ...................................................... 13
ADVAIR HFA INHALATION
AEROSOL† 115-21 MCG/ACT,
230-21 MCG/ACT, 45-21
MCG/ACT ........................................................... 13
AEROCHAMBER PLUS
FLO-VU LARGE XX MISC
................................................................................................ 68
AEROCHAMBER PLUS
FLO-VU SMALL XX MISC
................................................................................................ 68
AEROCHAMBER PLUS
FLO-VU W/MASK XX MISC
................................................................................................ 68
AEROCHAMBER PLUS
FLO-VU XX MISC ................................ 68
AFINITOR ORAL TABLET 10
MG, 2.5 MG, 5 MG, 7.5 MG
................................................................................................ 32
AK-Poly-Bac OPHTHALMIC
OINTMENT 500-10000
UNIT/GM .............................................................. 77
ALAVERT ALLERGY/SINUS
ORAL TABLET EXTENDED
RELEASE 12 HR* 5-120 MG
................................................................................................ 49
ALBENZA ORAL TABLET 200
MG ...................................................................................... 9
NEBULIZATION SOLUTION
(2.5 MG/3ML) 0.083% ...................... 13
(5 MG/ML) 0.5% ...................................... 13
0.63 MG/3ML, 1.25 MG/3ML
................................................................................................ 13
Albuterol Sulfate ORAL SYRUP
2 MG/5ML ........................................................... 13
Albuterol Sulfate ORAL
TABLET 2 MG, 4 MG ........................ 13
Alclometasone Dipropionate
EXTERNAL CREAM 0.05 %
................................................................................................ 53
Alclometasone Dipropionate
EXTERNAL OINTMENT 0.05
% ......................................................................................... 53
Alcohol Pads XX PAD 70 %
................................................................................................ 68
Alendronate Sodium ORAL
TABLET 10 MG, 35 MG, 40
MG, 5 MG, 70 MG ................................... 58
Aler-Dryl ORAL TABLET 50
MG ................................................................................... 24
ALKERAN ORAL TABLET 2
MG .................................................................................. 30
ALLEGRA ALLERGY
CHILDRENS ORAL TABLET
30 MG ......................................................................... 25
ALLEGRA-D ALLERGY &
CONGESTION ORAL
TABLET EXTENDED
................................................................................................ 49
91
Allergy ORAL TABLET 4 MG
................................................................................................
24
Allergy ORAL TABLET
DISPERSIBLE 10 MG ...................... 25
Allergy Relief/Nasal Decongest
................................................................................................ 49
Allopurinol ORAL TABLET 100
MG, 300 MG ...................................................... 62
ALPRAZolam ORAL TABLET
0.25 MG, 0.5 MG, 1 MG, 2 MG
................................................................................................ 10
ALTALUBE OPHTHALMIC
OINTMENT 85-15 % .......................... 76
ALTAVERA ORAL TABLET
0.15-30 MG-MCG .................................... 45
Aluminum Hydroxide Gel ORAL
.................................................................................................... 8
Amantadine HCl ORAL
CAPSULE 100 MG ................................. 34
Amantadine HCl ORAL SYRUP
50 MG/5ML ........................................................ 34
Amantadine HCl ORAL
TABLET 100 MG ...................................... 34
A-METHAPRED INJECTION
SOLUTION
RECONSTITUTED 125 MG, 40
MG .................................................................................. 48
Amiloride-Hydrochlorothiazide
ORAL TABLET 5-50 MG ............. 57
Aminophylline INTRAVENOUS*
SOLUTION 25 MG/ML .................. 14
Amiodarone HCl
150 MG/3ML .................................................... 11
Amiodarone HCl ORAL
................................................................................................ 11
Amitriptyline HCl ORAL
MG, 25 MG, 50 MG, 75 MG
................................................................................................ 19
AMLACTIN EXTERNAL
LOTION 12 % ................................................ 54
AmLODIPine Besylate ORAL
................................................................................................ 42
Ammonium Lactate EXTERNAL
CREAM 12 % .................................................. 54
Ammonium Lactate EXTERNAL
LOTION 12 % ................................................. 55
92
AMNESTEEM ORAL
CAPSULE 10 MG, 20 MG, 40
MG .................................................................................. 50
Amoxapine ORAL TABLET 100
MG, 150 MG, 25 MG, 50 MG
................................................................................................ 19
Amoxicillin ORAL CAPSULE
250 MG, 500 MG ......................................... 80
Amoxicillin ORAL
SUSPENSION
RECONSTITUTED 125
MG/5ML, 200 MG/5ML, 250
MG/5ML, 400 MG/5ML .................. 80
Amoxicillin ORAL TABLET 500
MG, 875 MG ...................................................... 80
Amoxicillin ORAL TABLET
CHEWABLE 125 MG, 250 MG
................................................................................................ 80
Amoxicillin-Pot Clavulanate
ORAL SUSPENSION
RECONSTITUTED 200-28.5
MG/5ML, 250-62.5 MG/5ML,
400-57 MG/5ML, 600-42.9
MG/5ML ................................................................. 81
ORAL TABLET 250-125 MG,
500-125 MG, 875-125 MG .............. 81
ORAL TABLET CHEWABLE
200-28.5 MG, 400-57 MG ............... 81
Amphetamine-Dextroamphetamin
e ORAL TABLET 10 MG, 12.5
MG, 15 MG, 5 MG, 7.5 MG
.................................................................................................... 1
e ORAL TABLET 20 MG ................. 1
e ORAL TABLET 30 MG ................. 1
Ampicillin ORAL CAPSULE 250
MG, 500 MG ...................................................... 80
Ampicillin ORAL SUSPENSION
RECONSTITUTED 125
MG/5ML, 250 MG/5ML .................. 80
Anagrelide HCl ORAL
CAPSULE 0.5 MG, 1 MG ............ 63
Anastrozole ORAL TABLET 1
MG ................................................................................... 31
Antacid ORAL SUSPENSION
200-200-20 MG/5ML ................................ 8
Anti-Diarrheal ORAL TABLET 2
MG ................................................................................... 22
Antihistamine Decongestant
ORAL TABLET 2.5-60 MG
................................................................................................ 49
Antipyrine-Benzocaine OTIC
SOLUTION 5.4-1.4 %, 54-14
MG/ML ..................................................................... 80
APIDRA INJECTION
................................................................................................ 21
APIDRA SOLOSTAR
SUBCUTANEOUS*
................................................................................................ 21
APRI ORAL TABLET 0.15-30
MG-MCG ............................................................. 45
APRISO ORAL CAPSULE
EXTENDED RELEASE 24
HOUR 0.375 GM ...................................... 61
APTIVUS ORAL CAPSULE
250 MG ..................................................................... 37
ARGYLE STERILE SALINE
IRRIGATION SOLUTION 0.9
% ......................................................................................... 61
ARMOUR THYROID ORAL
MG, 240 MG, 30 MG, 300 MG,
60 MG, 90 MG .............................................. 84
Artificial Tears OPHTHALMIC
OINTMENT 83-15 % ........................... 76
Artificial Tears OPHTHALMIC
SOLUTION 1.4 % .................................... 76
ASCOMP-CODEINE ORAL
CAPSULE 50-325-40-30 MG
.................................................................................................... 7
ASMANEX 120 METERED
DOSES INHALATION
AEROSOL POWDER,
BREATH ACTIVATED 220
MCG/INH ............................................................ 12
ASMANEX 30 METERED
DOSES INHALATION
AEROSOL POWDER,
MCG/INH, 220 MCG/INH
................................................................................................ 12
ASMANEX 60 METERED
DOSES INHALATION
AEROSOL POWDER,
MCG/INH ............................................................ 12
Aspirin ORAL TABLET 325
MG, 81 MG ............................................................. 5
Aspirin ORAL TABLET
CHEWABLE 81 MG ................................ 5
Aspirin RE SUPPOSITORY 300
MG, 600 MG ......................................................... 5
Atenolol ORAL TABLET 100
MG, 25 MG, 50 MG ................................ 41
Atenolol-Chlorthalidone ORAL
TABLET 100-25 MG, 50-25 MG
................................................................................................ 28
Atorvastatin Calcium ORAL
MG, 80 MG ......................................................... 26
Atovaquone-Proguanil HCl
62.5-25 MG .......................................................... 29
ATRIPLA ORAL TABLET
600-200-300 MG .......................................... 37
OINTMENT 1 % ........................................ 77
SOLUTION 1 % .......................................... 77
Atropine-Care OPHTHALMIC
SOLUTION 1 % .......................................... 77
ATROVENT HFA
INHALATION AEROSOL,
SOLUTION 17 MCG/ACT
................................................................................................ 11
AUBAGIO ORAL TABLET 14
MG, 7 MG ........................................................... 83
AVANDAMET ORAL
TABLET 2-1000 MG, 2-500
MG, 4-1000 MG, 4-500 MG
................................................................................................ 20
AVANDARYL ORAL
TABLET 4-1 MG, 4-2 MG, 4-4
MG, 8-2 MG, 8-4 MG ........................ 20
AVANDIA ORAL TABLET 2
MG, 4 MG, 8 MG ..................................... 21
AVASTIN INTRAVENOUS*
SOLUTION 100 MG/4ML, 400
MG/16ML ............................................................ 31
AVIANE ORAL TABLET
0.1-20 MG-MCG ........................................ 45
AVITA EXTERNAL CREAM
0.025 % ....................................................................... 50
AVITA EXTERNAL GEL 0.025
% ......................................................................................... 50
AVODART ORAL CAPSULE
0.5 MG ....................................................................... 62
AzaTHIOprine ORAL TABLET
50 MG .......................................................................... 41
Azelastine HCl NASAL
SOLUTION 137 MCG/SPRAY
................................................................................................ 75
Azithromycin Hydrogencitrate
................................................................................................ 66
Azithromycin INTRAVENOUS*
SOLUTION
................................................................................................ 66
Azithromycin ORAL
SUSPENSION
RECONSTITUTED 100
MG/5ML, 200 MG/5ML .................. 66
Azithromycin ORAL TABLET
250 MG ...................................................................... 66
Azithromycin ORAL TABLET
500 MG, 600 MG ......................................... 66
AZOPT OPHTHALMIC
SUSPENSION 1 % .................................. 79
BABY AYR SALINE NASAL
SOLUTION 0.65 % ................................ 75
Bacitracin EXTERNAL
OINTMENT 500 UNIT/GM
................................................................................................ 51
Bacitracin Zinc EXTERNAL
................................................................................................ 51
Bacitracin-Polymyxin B
OPHTHALMIC OINTMENT
500-10000 UNIT/GM ............................ 77
Baclofen ORAL TABLET 10
MG, 20 MG ......................................................... 74
Balsalazide Disodium ORAL
CAPSULE 750 MG ................................. 61
BALZIVA ORAL TABLET
0.4-35 MG-MCG ........................................ 45
BARACLUDE ORAL TABLET
0.5 MG, 1 MG ................................................ 39
Baza Antifungal EXTERNAL
CREAM 2 % ...................................................... 51
BAZA PROTECT EXTERNAL
CREAM ................................................................... 56
BD INSULIN SYRINGE
ULTRAFINE XX MISC 31G X
5/16" 1 ML ............................................................ 68
BENADRYL ALLERGY
CHILDRENS ORAL LIQUID†
12.5 MG/5ML ................................................. 24
Benazepril HCl ORAL TABLET
10 MG, 20 MG, 40 MG, 5 MG
................................................................................................ 26
Benazepril-Hydrochlorothiazide
ORAL TABLET 10-12.5 MG,
20-12.5 MG, 20-25 MG, 5-6.25
MG ................................................................................... 27
Benzoyl Peroxide EXTERNAL
GEL 10 %, 5 % ................................................ 50
Benzoyl Peroxide-Erythromycin
EXTERNAL GEL 5-3 % .................. 50
Benztropine Mesylate ORAL
TABLET 0.5 MG, 1 MG, 2 MG
................................................................................................ 34
Betamethasone Dipropionate Aug
................................................................................................ 53
Betamethasone Dipropionate
................................................................................................ 53
EXTERNAL LOTION 0.05 %
................................................................................................ 53
% ......................................................................................... 53
Betamethasone Valerate
................................................................................................ 53
EXTERNAL LOTION 0.1 %
................................................................................................ 53
EXTERNAL OINTMENT 0.1 %
................................................................................................ 53
Betaxolol HCl OPHTHALMIC
SOLUTION 0.5 % .................................... 76
Bethanechol Chloride ORAL
TABLET 10 MG, 25 MG, 5 MG,
50 MG .......................................................................... 87
BETOPTIC-S OPHTHALMIC
SUSPENSION 0.25 % ........................ 76
Bicalutamide ORAL TABLET 50
MG ................................................................................... 31
BICILLIN C-R 900/300
INTRAMUSCULAR*
SUSPENSION 900000-300000
UNIT/2ML .......................................................... 81
BICILLIN C-R
INTRAMUSCULAR*
SUSPENSION 1200000
UNIT/2ML .......................................................... 81
BICILLIN L-A
INTRAMUSCULAR*
SUSPENSION 1200000
UNIT/2ML, 2400000
UNIT/4ML, 600000 UNIT/ML
................................................................................................ 81
BILTRICIDE ORAL TABLET
600 MG ......................................................................... 9
Biotin 5000 ORAL CAPSULE 5
MG ................................................................................... 89
Biotin Maximum Strength ORAL
CAPSULE 5000 MCG ........................ 89
93
Biotin ORAL CAPSULE 5 MG,
5000 MCG ............................................................. 89
Bismatrol ORAL SUSPENSION
262 MG/15ML ................................................ 22
Bisoprolol Fumarate ORAL
TABLET 10 MG, 5 MG .................... 41
Bisoprolol-Hydrochlorothiazide
2.5-6.25 MG, 5-6.25 MG ................... 28
BOSULIF ORAL TABLET 100
MG, 500 MG .................................................... 32
Briellyn ORAL TABLET 0.4-35
MG-MCG ............................................................... 45
Brimonidine Tartrate
OPHTHALMIC SOLUTION
0.2 % .............................................................................. 77
Bromocriptine Mesylate ORAL
CAPSULE 5 MG ........................................ 34
Bromocriptine Mesylate ORAL
TABLET 2.5 MG ........................................ 34
BRONCHO SALINE
INHALATION AEROSOL,
SOLUTION 0.9 % .................................... 49
BUDEPRION SR ORAL
TABLET EXTENDED
RELEASE 12 HR* 150 MG
................................................................................................ 17
Budesonide INHALATION
SUSPENSION 0.25 MG/2ML,
0.5 MG/2ML ...................................................... 12
Bumetanide INJECTION
SOLUTION 0.25 MG/ML ............ 58
Bumetanide ORAL TABLET 0.5
MG, 1 MG, 2 MG ....................................... 58
Buprenorphine HCl
SUBLINGUAL TABLET
.................................................................................................... 7
BuPROPion HCl ER (SR)
RELEASE 12 HR* 100 MG, 150
MG, 200 MG ...................................................... 17
BuPROPion HCl ER (XL)
MG ................................................................................... 18
BuPROPion HCl ORAL
TABLET 100 MG, 75 MG ............. 17
BusPIRone HCl ORAL TABLET
10 MG, 15 MG, 30 MG, 5 MG,
7.5 MG ........................................................................ 10
Butalbital-Acetaminophen ORAL
TABLET 50-325 MG ................................ 4
94
Butalbital-APAP-Caff-Cod
ORAL CAPSULE 50-325-40-30
MG ....................................................................................... 7
Butalbital-APAP-Caffeine ORAL
CAPSULE 50-325-40 MG ................. 4
Butalbital-APAP-Caffeine ORAL
TABLET 50-325-40 MG,
50-500-40 MG ...................................................... 4
Butalbital-ASA-Caff-Codeine
ORAL CAPSULE 50-325-40-30
MG ....................................................................................... 7
Butalbital-ASA-Caffeine ORAL
CAPSULE 50-325-40 MG ................. 4
Butorphanol Tartrate NASAL
SOLUTION 10 MG/ML ..................... 7
BYDUREON
SUBCUTANEOUS*
SUSPENSION
RECONSTITUTED 2 MG
................................................................................................ 21
Calcipotriene EXTERNAL
CREAM 0.005 % ......................................... 52
OINTMENT 0.005 % ........................... 52
SOLUTION 0.005 % ............................. 52
Calcitonin (Salmon) NASAL
SOLUTION 200 UNIT/ACT
................................................................................................ 58
Calcitriol ORAL CAPSULE 0.25
MCG, 0.5 MCG ............................................. 59
Calcitriol ORAL SOLUTION 1
MCG/ML ............................................................... 59
Calcium Acetate (Phos Binder)
ORAL TABLET 667 MG ............... 69
Calcium Antacid Extra Strength
750 MG .......................................................................... 9
Calcium Carbonate Antacid
500 MG .......................................................................... 9
Calcium Carbonate ORAL
................................................................................................ 69
Calcium Carbonate ORAL
................................................................................................ 69
Calcium Carbonate-Vitamin D
ORAL TABLET 600-400
MG-UNIT ............................................................. 69
Calcium Lactate ORAL TABLET
648 MG ...................................................................... 69
Calcium-Vitamin D ORAL
TABLET 500-200 MG-UNIT
69
Cal-Lac ORAL CAPSULE 500
MG ................................................................................... 69
CAMILA ORAL TABLET 0.35
MG .................................................................................. 47
CAPRELSA ORAL TABLET
100 MG, 300 MG ....................................... 32
Capsaicin EXTERNAL CREAM
0.025 % ....................................................................... 55
Captopril ORAL TABLET 100
MG, 12.5 MG, 25 MG, 50 MG
................................................................................................ 26
Captopril-Hydrochlorothiazide
25-25 MG, 50-15 MG, 50-25 MG
................................................................................................ 27
CARAFATE ORAL
SUSPENSION 1 GM/10ML
................................................................................................ 86
CarBAMazepine ORAL
................................................................................................ 15
CarBAMazepine ORAL
TABLET 200 MG ...................................... 15
CarBAMazepine ORAL
TABLET CHEWABLE 100 MG
................................................................................................ 15
Carbidopa-Levodopa ER ORAL
TABLET
EXTENDEDRELEASE* 25-100
MG, 50-200 MG ............................................ 34
Carbidopa-Levodopa ORAL
TABLET 10-100 MG, 25-100
MG, 25-250 MG ............................................ 34
Carisoprodol ORAL TABLET
350 MG ...................................................................... 74
Carteolol HCl OPHTHALMIC
SOLUTION 1 % .......................................... 76
CARTIA XT ORAL CAPSULE
EXTENDED RELEASE 24
HOUR 120 MG, 180 MG, 240
MG, 300 MG .................................................... 42
Carvedilol ORAL TABLET 12.5
MG, 25 MG, 3.125 MG, 6.25 MG
................................................................................................ 41
CAVAREST DENTAL GEL 1.1
% ......................................................................................... 72
CAZIANT ORAL TABLET
0.1/0.125/0.15 -0.025 MG ................ 46
Cefaclor ORAL CAPSULE 250
MG, 500 MG ...................................................... 44
................................................................................................
Cefadroxil ORAL CAPSULE
500 MG ...................................................................... 44
Cefadroxil ORAL
SUSPENSION
RECONSTITUTED 250
MG/5ML, 500 MG/5ML .................. 44
Cefadroxil ORAL TABLET 1
GM ................................................................................... 44
Cefdinir ORAL CAPSULE 300
MG ................................................................................... 44
Cefdinir ORAL SUSPENSION
RECONSTITUTED 125
MG/5ML, 250 MG/5ML .................. 44
Cefpodoxime Proxetil ORAL
SUSPENSION
RECONSTITUTED 100
MG/5ML, 50 MG/5ML ..................... 44
Cefpodoxime Proxetil ORAL
................................................................................................ 44
Cefprozil ORAL SUSPENSION
RECONSTITUTED 125
MG/5ML, 250 MG/5ML .................. 44
Cefprozil ORAL TABLET 250
MG, 500 MG ...................................................... 44
Cefuroxime Axetil ORAL
SUSPENSION
RECONSTITUTED 125
MG/5ML ................................................................. 44
Cefuroxime Axetil ORAL
................................................................................................ 44
CELEBREX ORAL CAPSULE
100 MG, 200 MG, 400 MG, 50
MG ...................................................................................... 3
CELESTONE ORAL
SOLUTION 0.6 MG/5ML ........... 48
CELLCEPT ORAL
SUSPENSION
RECONSTITUTED 200
MG/ML .................................................................... 40
CENTRATEX ORAL
CAPSULE 106-1 MG .......................... 63
Cephalexin ORAL CAPSULE
250 MG, 500 MG, 750 MG ........... 44
Cephalexin ORAL
SUSPENSION
RECONSTITUTED 125
MG/5ML ................................................................. 44
Cephalexin ORAL
SUSPENSION
RECONSTITUTED 250
MG/5ML ................................................................. 44
Cetirizine HCl Childrens ORAL
SOLUTION 1 MG/ML ..................... 25
Cetirizine HCl ORAL SYRUP 1
MG/ML, 5 MG/5ML ............................. 25
Cetirizine HCl ORAL TABLET
10 MG, 5 MG .................................................... 25
Cetirizine-Pseudoephedrine ER
................................................................................................ 49
Childrens Ibuprofen ORAL
SUSPENSION 40 MG/ML
.................................................................................................... 3
Childrens Loratadine ORAL
SYRUP 5 MG/5ML ................................ 25
Childrens Silfedrine ORAL
LIQUID† 15 MG/5ML ...................... 76
ChlordiazePOXIDE HCl ORAL
MG ................................................................................... 10
Chlordiazepoxide-Amitriptyline
5-12.5 MG .............................................................. 82
Chlorhexidine Gluconate
................................................................................................ 36
Chlorhexidine Gluconate
MOUTH/THROAT SOLUTION
0.12 % ........................................................................... 71
Chlorothiazide ORAL TABLET
250 MG, 500 MG ......................................... 58
ChlorproMAZINE HCl ORAL
MG, 25 MG, 50 MG ................................ 36
ChlorproPAMIDE ORAL
................................................................................................ 22
Chlorthalidone ORAL TABLET
25 MG, 50 MG ................................................ 58
Chlorzoxazone ORAL TABLET
500 MG ...................................................................... 74
Cholestyramine Light ORAL
PACKET 4 GM ............................................. 26
Cholestyramine Light ORAL
POWDER 4 GM/DOSE ................... 26
Cholestyramine ORAL PACKET
4 GM ............................................................................. 25
Cholestyramine ORAL
POWDER 4 GM/DOSE ................... 26
Choline & Mag Trisalicylate
ORAL TABLET 1000 MG ............... 5
Choline-Mag Trisalicylate ORAL
LIQUID† 500 MG/5ML ...................... 5
Ciclopirox EXTERNAL
SOLUTION 8 % .......................................... 51
CREAM 0.77 % ............................................. 51
SUSPENSION 0.77 % ........................ 51
Cilostazol ORAL TABLET 100
MG, 50 MG ......................................................... 62
Cimetidine HCl ORAL
SOLUTION 300 MG/5ML .......... 85
Cimetidine ORAL TABLET 200
MG ................................................................................... 85
Cimetidine ORAL TABLET 300
MG, 400 MG, 800 MG ........................ 85
CIPRODEX OTIC
SUSPENSION 0.3-0.1 % ................ 80
Ciprofloxacin HCl
OPHTHALMIC SOLUTION
0.3 % .............................................................................. 77
Ciprofloxacin HCl ORAL
TABLET 250 MG, 500 MG, 750
MG ................................................................................... 60
Citalopram Hydrobromide ORAL
TABLET 10 MG, 20 MG, 40 MG
................................................................................................ 18
CLARAVIS ORAL CAPSULE
10 MG, 20 MG, 30 MG, 40 MG
................................................................................................ 50
Clarithromycin ORAL
SUSPENSION
RECONSTITUTED 125
MG/5ML, 250 MG/5ML .................. 66
Clarithromycin ORAL TABLET
250 MG, 500 MG ......................................... 67
CLEAR AWAY 1-STEP WART
REMOVER EXTERNAL PAD
40 % ................................................................................ 55
Clindamycin HCl ORAL
MG ................................................................................... 29
Clindamycin Palmitate HCl
ORAL SOLUTION
RECONSTITUTED 75
MG/5ML ................................................................. 29
Clindamycin Phosphate
EXTERNAL GEL 1 % ........................ 50
EXTERNAL LOTION 1 %
................................................................................................ 50
EXTERNAL SOLUTION 1 %
................................................................................................ 50
95
INJECTION SOLUTION 300
MG/2ML, 600 MG/4ML, 9
GM/60ML, 900 MG/6ML .............. 29
300 MG/2ML .................................................... 29
VAGINAL CREAM 2 % ................. 87
CLINISTIX IN VITRO STRIP
................................................................................................ 57
Clobetasol Propionate
................................................................................................ 53
EXTERNAL GEL 0.05 % .............. 53
% ......................................................................................... 53
ClomiPRAMINE HCl ORAL
MG ................................................................................... 19
ClonazePAM ORAL TABLET
0.5 MG, 1 MG, 2 MG ............................ 15
CloNIDine HCl ORAL TABLET
0.1 MG, 0.2 MG, 0.3 MG ................ 27
Clopidogrel Bisulfate ORAL
TABLET 75 MG .......................................... 63
Clorazepate Dipotassium ORAL
TABLET 15 MG, 3.75 MG, 7.5
MG ................................................................................... 10
Clotrimazole EXTERNAL
CREAM 1 % ...................................................... 51
Clotrimazole EXTERNAL
SOLUTION 1 % .......................................... 51
Clotrimazole MOUTH/THROAT
LOZENGE 10 MG ................................... 71
Clotrimazole MOUTH/THROAT
TROCHE 10 MG ........................................ 71
Clotrimazole VAGINAL
CREAM 1 % ...................................................... 87
CloZAPine ORAL TABLET 100
MG, 200 MG, 25 MG, 50 MG
................................................................................................ 35
CloZAPine ORAL TABLET
DISPERSIBLE 12.5 MG ................ 35
Codeine Phosphate INJECTION
SOLUTION 15 MG/ML, 30
MG/ML ........................................................................ 5
Codeine Sulfate ORAL TABLET
15 MG, 30 MG, 60 MG .......................... 5
Colchicine-Probenecid ORAL
TABLET 0.5-500 MG .......................... 62
96
COLCRYS ORAL TABLET 0.6
MG .................................................................................. 62
COMBIVENT INHALATION
AEROSOL† 18-103 MCG/ACT
................................................................................................ 13
COMBIVENT RESPIMAT
INHALATION AEROSOL,
SOLUTION 20-100 MCG/ACT
................................................................................................ 13
COMPLERA ORAL TABLET
200-25-300 MG .............................................. 37
Complete Lice Treatment
COMBINATION KIT 0.33-4-0.5
% ......................................................................................... 56
COMPOUND W EXTERNAL
LIQUID† 17 % .............................................. 55
COMPOUND W MAXIMUM
STRENGTH EXTERNAL GEL
17 % ................................................................................ 55
CONDYLOX EXTERNAL
GEL 0.5 % ............................................................ 55
COPAXONE
SUBCUTANEOUS* KIT 20
MG/ML .................................................................... 83
Cortisone Acetate ORAL
TABLET 25 MG .......................................... 48
CORTISPORIN EXTERNAL
OINTMENT 1 % ....................................... 51
CREON ORAL CAPSULE
DELAYED RELEASE
PARTICLES 12000 UNIT,
24000 UNIT, 3000-9500 UNIT,
36000 UNIT, 6000 UNIT ............... 57
CRIXIVAN ORAL CAPSULE
200 MG, 400 MG ....................................... 37
Cromolyn Sodium
INHALATION
20 MG/2ML ........................................................ 11
Cromolyn Sodium NASAL
AEROSOL, SOLUTION 5.2
MG/ACT ................................................................. 75
Cromolyn Sodium
OPHTHALMIC SOLUTION 4
% ......................................................................................... 79
CRYSELLE-28 ORAL
TABLET 0.3-30 MG-MCG
................................................................................................ 45
Cyanocobalamin INJECTION
SOLUTION 1000 MCG/ML
................................................................................................ 63
Cyclobenzaprine HCl ORAL
TABLET 10 MG, 5 MG .................... 75
Cyclophosphamide ORAL
TABLET 25 MG, 50 MG ................ 30
CycloSPORINE Modified ORAL
MG ................................................................................... 40
CycloSPORINE Modified ORAL
SOLUTION 100 MG/ML .............. 40
CycloSPORINE ORAL
CAPSULE 100 MG, 25 MG
................................................................................................ 40
Cyproheptadine HCl ORAL
SYRUP 2 MG/5ML ................................ 25
Cyproheptadine HCl ORAL
TABLET 4 MG .............................................. 25
Cytra-2 ORAL SOLUTION
500-334 MG/5ML ...................................... 61
CYTRA-3 ORAL SYRUP
550-500-334 MG/5ML ........................ 61
Danazol ORAL CAPSULE 100
MG, 200 MG, 50 MG ................................ 8
Dantrolene Sodium ORAL
MG ................................................................................... 75
Dapsone ORAL TABLET 100
MG, 25 MG ......................................................... 29
DARAPRIM ORAL TABLET
25 MG ......................................................................... 29
Deferoxamine Mesylate
INJECTION SOLUTION
RECONSTITUTED 2 GM, 500
MG ................................................................................... 23
DELSYM NGHT TIME
CGH/CLD CHILD ORAL
LIQUID† 12.5-5 MG/5ML
................................................................................................ 49
DELSYM NIGHT TIME
COUGH/COLD ORAL
LIQUID† 6.25-2.5 MG/5ML
................................................................................................ 49
DENAVIR EXTERNAL
CREAM 1 % ..................................................... 52
DENTAGEL DENTAL GEL
1.1 % .............................................................................. 72
DEPO-PROVERA
INTRAMUSCULAR*
................................................................................................ 47
Desipramine HCl ORAL
MG, 25 MG, 50 MG, 75 MG
................................................................................................ 19
Desmopressin Ace Rhinal Tube
NASAL SOLUTION 0.01 %
................................................................................................ 59
Desmopressin Ace Spray Refrig
................................................................................................
59
Desmopressin Acetate ORAL
TABLET 0.1 MG, 0.2 MG ............ 59
Desmopressin Acetate Spray
................................................................................................ 59
Desonide EXTERNAL CREAM
0.05 % ........................................................................... 53
Dexamethasone ORAL ELIXIR
0.5 MG/5ML ...................................................... 48
Dexamethasone ORAL
SOLUTION 0.5 MG/5ML ............ 48
Dexamethasone ORAL TABLET
0.5 MG, 0.75 MG, 1 MG, 1.5
MG, 2 MG, 4 MG, 6 MG ................. 48
Dexamethasone Sodium
Phosphate INJECTION
MG/ML ..................................................................... 48
Dexamethasone Sodium
Phosphate OPHTHALMIC
SOLUTION 0.1 % .................................... 78
Dexmethylphenidate HCl ORAL
.................................................................................................... 2
Dextroamphetamine Sulfate ER
ORAL CAPSULE EXTENDED
RELEASE 24 HOUR 10 MG, 15
MG, 5 MG ................................................................. 1
Dextroamphetamine Sulfate
ORAL TABLET 10 MG, 5 MG
.................................................................................................... 1
DIASTIX IN VITRO STRIP
................................................................................................ 57
Diazepam INJECTION
SOLUTION 5 MG/ML ..................... 10
Diazepam ORAL SOLUTION 1
MG/ML ..................................................................... 10
Diazepam ORAL TABLET 10
MG, 2 MG, 5 MG ....................................... 10
Diazepam RE GEL 10 MG, 2.5
MG, 20 MG ......................................................... 15
Dibucaine EXTERNAL
OINTMENT 1 % ........................................ 55
Diclofenac Potassium ORAL
TABLET 50 MG .............................................. 3
Diclofenac Sodium ER ORAL
TABLET EXTENDED
.................................................................................................... 3
Diclofenac Sodium
OPHTHALMIC SOLUTION
0.1 % .............................................................................. 79
Diclofenac Sodium ORAL
25 MG, 50 MG, 75 MG .......................... 3
Dicloxacillin Sodium ORAL
................................................................................................ 81
Dicyclomine HCl ORAL
CAPSULE 10 MG .................................... 85
SOLUTION 10 MG/5ML .............. 85
TABLET 20 MG .......................................... 85
Didanosine ORAL CAPSULE
DELAYED RELEASE 125 MG,
200 MG, 250 MG, 400 MG ........... 38
Diflunisal ORAL TABLET 500
MG ....................................................................................... 5
Digoxin INJECTION
SOLUTION 0.25 MG/ML ............ 43
Digoxin ORAL SOLUTION 0.05
MG/ML ..................................................................... 43
Digoxin ORAL TABLET 0.125
MG, 0.25 MG .................................................... 43
DILANTIN ORAL CAPSULE
30 MG ......................................................................... 16
Diltiazem HCl ER Beads ORAL
CAPSULE EXTENDED
RELEASE 24 HOUR 120 MG,
180 MG, 240 MG, 300 MG, 360
MG, 420 MG ...................................................... 42
Diltiazem HCl ER Coated Beads
ORAL CAPSULE EXTENDED
180 MG, 240 MG, 300 MG, 360
MG ................................................................................... 42
Diltiazem HCl ER ORAL
CAPSULE EXTENDED
60 MG, 90 MG ................................................ 42
Diltiazem HCl
125 MG/25ML, 25 MG/5ML, 50
MG/10ML ............................................................. 42
Diltiazem HCl ORAL TABLET
120 MG, 30 MG, 60 MG, 90 MG
................................................................................................ 42
Dilt-XR ORAL CAPSULE
EXTENDED RELEASE 24
HOUR 120 MG, 180 MG, 240
MG ................................................................................... 42
DimenhyDRINATE ORAL
TABLET 50 MG .......................................... 23
DiphenhydrAMINE HCl (Sleep)
ORAL TABLET 50 MG ................... 64
DiphenhydrAMINE HCl ORAL
CAPSULE 25 MG, 50 MG ........... 24
DiphenhydrAMINE HCl ORAL
TABLET 25 MG .......................................... 24
Diphenoxylate-Atropine ORAL
LIQUID† 2.5-0.025 MG/5ML
................................................................................................ 23
Diphenoxylate-Atropine ORAL
TABLET 2.5-0.025 MG ..................... 23
Dipyridamole INTRAVENOUS*
SOLUTION 5 MG/ML ..................... 56
Dipyridamole ORAL TABLET 25
MG, 50 MG, 75 MG ................................ 62
Disopyramide Phosphate ORAL
................................................................................................ 10
Disulfiram ORAL TABLET 250
MG, 500 MG ...................................................... 82
Divalproex Sodium ER ORAL
TABLET EXTENDED
................................................................................................ 17
Divalproex Sodium ER ORAL
TABLET EXTENDED
................................................................................................ 17
Divalproex Sodium ORAL
CAPSULE SPRINKLE 125 MG
................................................................................................ 17
125 MG, 250 MG ......................................... 17
500 MG ...................................................................... 17
Docusate Sodium ORAL
TABLET 100 MG ...................................... 66
Donepezil HCl ORAL TABLET
10 MG, 5 MG .................................................... 82
Dorzolamide HCl
% ......................................................................................... 79
Dorzolamide HCl-Timolol Mal
OPHTHALMIC SOLUTION
22.3-6.8 MG/ML .......................................... 76
Double Antibiotic EXTERNAL
OINTMENT 500-10000
UNIT/GM .............................................................. 51
97
Doxazosin Mesylate ORAL
TABLET 1 MG, 2 MG, 4 MG, 8
MG ................................................................................... 27
Doxepin HCl ORAL CAPSULE
10 MG, 100 MG, 25 MG, 50 MG,
75 MG .......................................................................... 19
Doxepin HCl ORAL
CONCENTRATE 10 MG/ML
................................................................................................ 19
DOXY 100 INTRAVENOUS*
SOLUTION
................................................................................................ 84
Doxycycline Hyclate ORAL
................................................................................................ 84
TABLET 100 MG ...................................... 84
TABLET 20 MG .......................................... 84
DRITHO-CREME HP
EXTERNAL CREAM 1 %
................................................................................................ 52
DULERA INHALATION
AEROSOL† 100-5 MCG/ACT,
200-5 MCG/ACT ........................................ 13
E.E.S. GRANULES ORAL
SUSPENSION
RECONSTITUTED 200
MG/5ML ................................................................ 67
Earwax Treatment Drops OTIC
SOLUTION 6.5 % .................................... 79
Econazole Nitrate EXTERNAL
CREAM 1 % ...................................................... 51
EDURANT ORAL TABLET 25
MG .................................................................................. 38
ELIDEL EXTERNAL CREAM
1 % .................................................................................... 55
ELIPHOS ORAL TABLET 667
MG .................................................................................. 61
ELITE-OB ORAL TABLET
50-1.25 MG ......................................................... 74
EMCYT ORAL CAPSULE 140
MG .................................................................................. 31
EMOQUETTE ORAL TABLET
0.15-30 MG-MCG .................................... 45
EMTRIVA ORAL CAPSULE
200 MG ..................................................................... 38
EMTRIVA ORAL SOLUTION
10 MG/ML ........................................................... 38
Enalapril Maleate ORAL
TABLET 10 MG, 2.5 MG, 20
MG, 5 MG ............................................................. 26
98
Enalapril-Hydrochlorothiazide
5-12.5 MG .............................................................. 27
ENDOCET ORAL TABLET
10-325 MG, 5-325 MG, 7.5-325
MG, 7.5-500 MG ............................................ 7
ENDOCET ORAL TABLET
10-650 MG ............................................................... 7
ENDOMETRIN VAGINAL
INSERT 100 MG ....................................... 88
Enoxaparin Sodium INJECTION
SOLUTION 300 MG/3ML .......... 14
Enoxaparin Sodium
SUBCUTANEOUS*
MG/ML ..................................................................... 14
Enoxaparin Sodium
SUBCUTANEOUS*
SOLUTION 120 MG/0.8ML, 80
MG/0.8ML ........................................................... 14
Enoxaparin Sodium
SUBCUTANEOUS*
MG/0.4ML ........................................................... 14
Enoxaparin Sodium
SUBCUTANEOUS*
................................................................................................ 15
ENPRESSE-28 ORAL TABLET
................................................................................................ 46
EPIPEN 2-PAK INJECTION
DEVICE 0.3 MG/0.3ML ................ 88
EPIPEN JR 2-PAK
INJECTION DEVICE 0.15
MG/0.3ML .......................................................... 88
EPITOL ORAL TABLET 200
MG .................................................................................. 15
EPIVIR HBV ORAL
SOLUTION 5 MG/ML .................... 38
EPIVIR HBV ORAL TABLET
100 MG ..................................................................... 38
EPIVIR ORAL SOLUTION 10
MG/ML .................................................................... 38
EPZICOM ORAL TABLET
600-300 MG ........................................................ 37
Ergocalciferol ORAL
................................................................................................ 88
ERIVEDGE ORAL CAPSULE
150 MG ..................................................................... 31
ERRIN ORAL TABLET 0.35
MG .................................................................................. 47
ERWINAZE
INTRAMUSCULAR*
SOLUTION
RECONSTITUTED 10000
UNIT ............................................................................ 33
Ery EXTERNAL PAD 2 %
................................................................................................ 50
ERYPED 200 ORAL
SUSPENSION
RECONSTITUTED 200
MG/5ML ................................................................ 67
ERYPED 400 ORAL
SUSPENSION
RECONSTITUTED 400
MG/5ML ................................................................ 67
ERY-TAB ORAL TABLET
333 MG, 500 MG ....................................... 67
ERYTHROCIN STEARATE
ORAL TABLET 250 MG ............. 67
Erythromycin Base ORAL
CAPSULE DELAYED
RELEASE PARTICLES 250
MG ................................................................................... 67
Erythromycin Base ORAL
................................................................................................ 67
Erythromycin Ethylsuccinate
ORAL TABLET 400 MG ............... 67
Erythromycin EXTERNAL GEL
2 % .................................................................................... 50
Erythromycin EXTERNAL
SOLUTION 2 % .......................................... 50
Erythromycin OPHTHALMIC
OINTMENT 5 MG/GM ................... 77
Erythromycin-Sulfisoxazole
ORAL SUSPENSION
RECONSTITUTED 200-600
MG/5ML ................................................................. 28
Escitalopram Oxalate ORAL
................................................................................................ 18
ESTARYLLA ORAL TABLET
0.25-35 MG-MCG .................................... 45
Estazolam ORAL TABLET 1
MG, 2 MG ............................................................. 64
Estradiol ORAL TABLET 0.5
MG, 1 MG, 2 MG ....................................... 60
Estradiol TRANSDERMAL
PATCH WEEKLY 0.025
MG/24HR, 0.0375 MG/24HR,
0.05 MG/24HR, 0.06 MG/24HR,
0.075 MG/24HR, 0.1 MG/24HR
................................................................................................ 60
Estropipate ORAL TABLET 0.75
MG, 1.5 MG, 3 MG ................................. 60
Ethambutol HCl ORAL TABLET
100 MG, 400 MG ......................................... 30
Ethosuximide ORAL CAPSULE
250 MG ...................................................................... 17
Ethosuximide ORAL
SOLUTION 250 MG/5ML .......... 17
Etodolac ORAL CAPSULE 200
MG, 300 MG ......................................................... 3
Etodolac ORAL TABLET 400
MG, 500 MG ......................................................... 3
Etoposide ORAL CAPSULE 50
MG ................................................................................... 33
EVISTA ORAL TABLET 60
MG .................................................................................. 59
EXEL PEN NEEDLES 1/3" XX
MISC 31G X 8 MM ............................... 68
EXELON TRANSDERMAL
PATCH 24 HR 13.3 MG/24HR,
4.6 MG/24HR, 9.5 MG/24HR
................................................................................................ 82
EXJADE ORAL TABLET
SOLUBLE 125 MG, 250 MG,
500 MG ..................................................................... 23
EXTAVIA SUBCUTANEOUS*
KIT 0.3 MG ....................................................... 83
E-Z SPACER XX DEVICE
................................................................................................ 68
Famotidine INTRAVENOUS*
SOLUTION 10 MG/ML .................. 85
Famotidine ORAL TABLET 10
MG ................................................................................... 85
Famotidine ORAL TABLET 20
MG, 40 MG ......................................................... 85
Famotidine Premixed
20-0.9 MG/50ML-% ................................ 85
Fenofibrate Micronized ORAL
MG ................................................................................... 26
Fenofibrate ORAL TABLET 160
MG, 54 MG ......................................................... 26
Fenoprofen Calcium ORAL
TABLET 600 MG .......................................... 3
FentaNYL TRANSDERMAL
PATCH 72 HR 100 MCG/HR,
12 MCG/HR, 25 MCG/HR, 50
MCG/HR, 75 MCG/HR ....................... 5
Ferrous Gluconate ORAL
TABLET 324 (38 Fe) MG ............ 63
Ferrous Sulfate ORAL ELIXIR
220 (44 Fe) MG/5ML .......................... 63
Ferrous Sulfate ORAL
SOLUTION 75 (15 Fe) MG/ML
................................................................................................ 63
Ferrous Sulfate ORAL SYRUP
300 (60 Fe) MG/5ML .......................... 64
Ferrous Sulfate ORAL TABLET
325 (65 Fe) MG ............................................ 64
Ferrous Sulfate ORAL TABLET
DELAYED RELEASE 324 (65
Fe) MG, 325 (65 Fe) MG .............. 64
Fexofenadine HCl ORAL
TABLET 180 MG, 60 MG ............. 25
Fexofenadine-Pseudoephed ER
................................................................................................ 49
Fiber Laxative ORAL TABLET
625 MG ...................................................................... 64
Finasteride ORAL TABLET 5
MG ................................................................................... 62
FIRAZYR SUBCUTANEOUS*
SOLUTION 30 MG/3ML ............. 62
FIRST-PROGESTERONE VGS
100 VAGINAL SUPPOSITORY
100 MG ..................................................................... 88
200 MG ..................................................................... 88
25 MG ......................................................................... 88
400 MG ..................................................................... 88
50 MG ......................................................................... 88
Flecainide Acetate ORAL
MG ................................................................................... 11
FLOVENT DISKUS
INHALATION AEROSOL
POWDER, BREATH
ACTIVATED 100 MCG/BLIST,
250 MCG/BLIST, 50
MCG/BLIST ..................................................... 12
FLOVENT HFA
INHALATION AEROSOL† 110
MCG/ACT, 220 MCG/ACT
................................................................................................ 12
FLOVENT HFA
INHALATION AEROSOL† 44
MCG/ACT ........................................................... 12
Fluconazole ORAL
SUSPENSION
RECONSTITUTED 10 MG/ML,
40 MG/ML ........................................................... 24
Fluconazole ORAL TABLET 100
MG, 150 MG, 200 MG, 50 MG
................................................................................................ 24
Fludrocortisone Acetate ORAL
TABLET 0.1 MG ........................................ 48
Flunisolide NASAL SOLUTION
25 MCG/ACT (0.025%) ................... 75
Fluocinolone Acetonide Body
EXTERNAL OIL 0.01 % ................ 53
Fluocinolone Acetonide
EXTERNAL CREAM 0.01 %,
0.025 % ....................................................................... 53
% ......................................................................................... 53
EXTERNAL SOLUTION 0.01 %
................................................................................................ 53
Fluocinolone Acetonide Scalp
EXTERNAL OIL 0.01 % ................ 53
Fluocinonide EXTERNAL
CREAM 0.05 % ............................................. 53
Fluocinonide EXTERNAL GEL
0.05 % ........................................................................... 53
OINTMENT 0.05 % ............................... 53
SOLUTION 0.05 % ................................. 54
Fluocinonide-E EXTERNAL
CREAM 0.05 % ............................................. 54
FLUOR-A-DAY ORAL
TABLET CHEWABLE 0.25
(F)-236.79 MG, 0.5 (F)-236.79
MG, 1 (F)-236.79 MG ......................... 70
FLUORIDEX DAILY
DEFENSE DENTAL GEL 1.1
% ......................................................................................... 72
Fluorometholone
OPHTHALMIC SUSPENSION
0.1 % .............................................................................. 78
Fluorouracil EXTERNAL
CREAM 5 % ...................................................... 52
Fluorouracil EXTERNAL
SOLUTION 2 %, 5 % ........................... 52
Fluorouracil INTRAVENOUS*
SOLUTION 500 MG/10ML
................................................................................................ 30
FLUoxetine HCl ORAL
MG ................................................................................... 18
99
FLUoxetine HCl ORAL
SOLUTION 20 MG/5ML .............. 18
FLUoxetine HCl ORAL
TABLET 10 MG, 20 MG ................ 18
FluPHENAZine Decanoate
MG/ML ..................................................................... 36
CONCENTRATE 5 MG/ML
................................................................................................ 36
ELIXIR 2.5 MG/5ML .......................... 36
TABLET 1 MG, 10 MG, 2.5 MG,
5 MG ............................................................................. 36
Flurbiprofen ORAL TABLET 100
MG, 50 MG ............................................................. 3
Flurbiprofen Sodium
OPHTHALMIC SOLUTION
0.03 % ........................................................................... 79
Fluticasone Propionate
................................................................................................ 54
Fluticasone Propionate
% ......................................................................................... 54
Fluticasone Propionate NASAL
SUSPENSION 50 MCG/ACT
................................................................................................ 75
FluvoxaMINE Maleate ORAL
MG ................................................................................... 18
FML FORTE OPHTHALMIC
SUSPENSION 0.25 % ........................ 78
FOLBECAL ORAL TABLET 1
MG .................................................................................. 74
Folic Acid ORAL TABLET 1
MG, 400 MCG, 800 MCG .............. 63
Fondaparinux Sodium
SUBCUTANEOUS*
................................................................................................ 15
Fondaparinux Sodium
SUBCUTANEOUS*
................................................................................................ 15
Fondaparinux Sodium
SUBCUTANEOUS*
SOLUTION 5 MG/0.4ML ............ 15
Fondaparinux Sodium
SUBCUTANEOUS*
................................................................................................ 15
100
FORADIL AEROLIZER
INHALATION CAPSULE 12
MCG ............................................................................. 13
Formula EM ORAL SOLUTION
1.87-1.87-21.5 .................................................. 24
FORTICAL NASAL
SOLUTION 200 UNIT/ACT
................................................................................................ 59
Fosinopril Sodium ORAL
................................................................................................ 26
Fosphenytoin Sodium
MG PE/2ML ..................................................... 16
FREESTYLE FREEDOM LITE
XX KIT W/DEVICE ............................ 67
FREESTYLE INSULINX
SYSTEM XX KIT W/DEVICE
................................................................................................ 67
FREESTYLE INSULINX TEST
IN VITRO STRIP ..................................... 57
FREESTYLE LITE TEST IN
VITRO STRIP ............................................... 57
FREESTYLE LITE XX
DEVICE .................................................................. 67
FREESTYLE TEST IN VITRO
STRIP .......................................................................... 57
FREEZONE EXTERNAL
LIQUID† 17.6 % ......................................... 55
Furosemide ORAL SOLUTION
10 MG/ML, 8 MG/ML ....................... 58
Furosemide ORAL TABLET 20
MG, 40 MG, 80 MG ................................ 58
FUZEON SUBCUTANEOUS*
SOLUTION
RECONSTITUTED 90 MG
................................................................................................ 37
Gabapentin ORAL CAPSULE
100 MG ...................................................................... 15
300 MG ...................................................................... 15
400 MG ...................................................................... 15
Gabapentin ORAL SOLUTION
250 MG/5ML .................................................... 15
Gabapentin ORAL TABLET 600
MG, 800 MG ...................................................... 15
GABITRIL ORAL TABLET 12
MG, 16 MG ........................................................ 16
GAVILYTE-G ORAL
SOLUTION
................................................................................................ 65
GAVILYTE-N WITH FLAVOR
PACK ORAL SOLUTION
................................................................................................ 65
GEL-KAM MOUTH/THROAT
GEL 0.4 % ............................................................ 72
Gemcitabine HCl
1 GM/26.3ML, 2 GM/52.6ML,
200 MG/5.26ML ........................................... 30
Gemcitabine HCl
GM, 200 MG ...................................................... 31
Gemfibrozil ORAL TABLET 600
MG ................................................................................... 26
Generlac ORAL SOLUTION 10
GM/15ML ............................................................. 61
GENGRAF ORAL CAPSULE
100 MG, 25 MG ........................................... 40
GENGRAF ORAL SOLUTION
100 MG/ML ....................................................... 40
Gentamicin Sulfate EXTERNAL
CREAM 0.1 % ................................................ 51
Gentamicin Sulfate EXTERNAL
OINTMENT 0.1 % .................................. 51
Gentamicin Sulfate
OPHTHALMIC OINTMENT
0.3 % .............................................................................. 77
Gentamicin Sulfate
OPHTHALMIC SOLUTION
0.3 % .............................................................................. 77
GIANVI ORAL TABLET 3-0.02
MG .................................................................................. 45
GILOTRIF ORAL TABLET 20
MG, 30 MG, 40 MG ............................. 32
GLEEVEC ORAL TABLET 100
MG, 400 MG .................................................... 33
Glimepiride ORAL TABLET 1
MG, 2 MG, 4 MG ....................................... 22
GlipiZIDE ER ORAL TABLET
EXTENDED RELEASE 24 HR*
10 MG, 2.5 MG, 5 MG ........................ 22
GlipiZIDE ORAL TABLET 10
MG, 5 MG ............................................................. 22
GLIPIZIDE XL ORAL
TABLET EXTENDED
RELEASE 24 HR* 10 MG, 2.5
MG, 5 MG ........................................................... 22
GlipiZIDE-MetFORMIN HCl
ORAL TABLET 2.5-250 MG,
2.5-500 MG, 5-500 MG ....................... 20
GLUCAGEN HYPOKIT
INJECTION SOLUTION
RECONSTITUTED 1 MG
................................................................................................
GLUCAGEN INJECTION
SOLUTION
RECONSTITUTED 1 MG
Haloperidol Lactate ORAL
CONCENTRATE 2 MG/ML
20
20
GLUCAGON EMERGENCY
INJECTION KIT 1 MG ................. 20
Glucose Control IN VITRO
SOLUTION .................................................... 67
Glucose ORAL TABLET
CHEWABLE 4 GM ................................ 20
GLUTOSE 15 ORAL GEL 40 %
................................................................................................ 20
GlyBURIDE Micronized ORAL
TABLET 1.5 MG, 3 MG, 6 MG
................................................................................................ 22
GlyBURIDE ORAL TABLET
1.25 MG, 2.5 MG, 5 MG .................. 22
GlyBURIDE-MetFORMIN
ORAL TABLET 1.25-250 MG,
2.5-500 MG, 5-500 MG ....................... 20
Glycopyrrolate ORAL TABLET
1 MG, 2 MG ....................................................... 85
GOLYTELY ORAL
SOLUTION
................................................................................................ 65
Griseofulvin Microsize ORAL
................................................................................................ 24
Griseofulvin Microsize ORAL
TABLET 500 MG ...................................... 24
Griseofulvin Ultramicrosize
ORAL TABLET 125 MG, 250
MG ................................................................................... 24
GuanFACINE HCl ORAL
TABLET 1 MG, 2 MG ........................ 27
Halobetasol Propionate
................................................................................................ 54
Halobetasol Propionate
% ......................................................................................... 54
Haloperidol Decanoate
INTRAMUSCULAR*
MG/ML ..................................................................... 35
Haloperidol Lactate INJECTION
SOLUTION 5 MG/ML ..................... 35
................................................................................................
35
Haloperidol ORAL TABLET 0.5
MG, 1 MG, 10 MG, 2 MG, 5 MG
................................................................................................ 35
HECORIA ORAL CAPSULE
0.5 MG, 1 MG, 5 MG ......................... 41
HEXALEN ORAL CAPSULE
50 MG ......................................................................... 30
HUMALOG KWIKPEN
SUBCUTANEOUS*
................................................................................................ 21
HUMALOG MIX 50/50
KWIKPEN
SUBCUTANEOUS*
SUSPENSION (50-50) 100
UNIT/ML ............................................................. 21
HUMALOG MIX 50/50
SUBCUTANEOUS*
UNIT/ML ............................................................. 21
HUMALOG MIX 75/25
KWIKPEN
SUBCUTANEOUS*
UNIT/ML ............................................................. 21
HUMALOG MIX 75/25
SUBCUTANEOUS*
UNIT/ML ............................................................. 21
HUMALOG
SUBCUTANEOUS*
................................................................................................ 21
HUMIRA PEN
SUBCUTANEOUS* KIT 40
MG/0.8ML .............................................................. 2
HUMIRA PEN-CROHNS
STARTER SUBCUTANEOUS*
KIT 40 MG/0.8ML ..................................... 2
HUMIRA SUBCUTANEOUS*
KIT 20 MG/0.4ML, 40
MG/0.8ML .............................................................. 2
HUMULIN 70/30 PEN
SUBCUTANEOUS*
UNIT/ML ............................................................. 21
HUMULIN 70/30
SUBCUTANEOUS*
UNIT/ML ............................................................. 21
................................................................................................
HUMULIN N PEN
SUBCUTANEOUS*
................................................................................................
HUMULIN N
SUBCUTANEOUS*
................................................................................................
HUMULIN R INJECTION
................................................................................................
HUMULIN R U-500
(CONCENTRATED)
SUBCUTANEOUS*
22
22
22
22
HydrALAZINE HCl
MG/ML ..................................................................... 28
HydrALAZINE HCl ORAL
MG, 50 MG ......................................................... 28
Hydrochlorothiazide ORAL
CAPSULE 12.5 MG ............................... 58
Hydrochlorothiazide ORAL
TABLET 12.5 MG, 25 MG, 50
MG ................................................................................... 58
Hydrocodone-Acetaminophen
ORAL SOLUTION 7.5-325
MG/15ML, 7.5-500 MG/15ML
.................................................................................................... 7
Hydrocodone-Acetaminophen
10-500 MG, 10-650 MG, 10-660
MG, 10-750 MG, 2.5-500 MG,
5-325 MG, 5-500 MG, 7.5-325
MG, 7.5-500 MG, 7.5-650 MG,
7.5-750 MG .............................................................. 7
Hydrocodone-Ibuprofen ORAL
TABLET 7.5-200 MG .............................. 7
Hydrocortisone EXTERNAL
CREAM 1 % ...................................................... 54
LOTION 1 % .................................................... 54
LOTION 2.5 % ............................................... 54
OINTMENT 1 % ........................................ 54
OINTMENT 2.5 % .................................. 54
Hydrocortisone ORAL TABLET
10 MG, 20 MG, 5 MG .......................... 48
Hydrocortisone RE ENEMA 100
MG/60ML ................................................................. 8
................................................................................................
101
Hydrocortisone Valerate
................................................................................................
54
Hydrocortisone Valerate
................................................................................................ 54
HYDROGESIC ORAL
CAPSULE 5-500 MG ............................. 7
HYDROmorphone HCl ORAL
LIQUID† 1 MG/ML ................................. 5
HYDROmorphone HCl ORAL
.................................................................................................... 5
HYDROmorphone HCl RE
SUPPOSITORY 3 MG ......................... 5
Hydroxychloroquine Sulfate
ORAL TABLET 200 MG ............... 29
Hydroxyurea ORAL CAPSULE
500 MG ...................................................................... 33
HydrOXYzine HCl ORAL
SOLUTION 10 MG/5ML .............. 10
SYRUP 10 MG/5ML ............................ 10
................................................................................................ 10
HydrOXYzine Pamoate ORAL
MG ................................................................................... 10
HYPERCARE EXTERNAL
SOLUTION 20 % ...................................... 56
Ibuprofen ORAL SUSPENSION
100 MG/5ML ........................................................ 3
Ibuprofen ORAL TABLET 200
MG ....................................................................................... 3
Ibuprofen ORAL TABLET 400
MG, 600 MG, 800 MG ............................ 3
ICLUSIG ORAL TABLET 15
MG, 45 MG ........................................................ 33
Imipramine HCl ORAL TABLET
10 MG, 25 MG, 50 MG ...................... 19
IN-CHECK DIAL FLOW
TRAINER XX DEVICE ............... 68
INCIVEK ORAL TABLET 375
MG .................................................................................. 39
Indapamide ORAL TABLET 1.25
MG, 2.5 MG ....................................................... 58
Indomethacin ORAL CAPSULE
25 MG, 50 MG .................................................... 3
Infants Silapap ORAL
SOLUTION 100 MG/ML .................. 4
Insulin Syringe XX MISC 29G X
1/2" 0.3 ML, 30G X 5/16" 0.3 ML
................................................................................................ 68
102
INTELENCE ORAL TABLET
100 MG, 200 MG, 25 MG ............. 38
INVEGA SUSTENNA
INTRAMUSCULAR*
SUSPENSION 117 MG/0.75ML,
156 MG/ML, 234 MG/1.5ML, 39
MG/0.25ML, 78 MG/0.5ML
................................................................................................ 35
INVIRASE ORAL CAPSULE
200 MG ..................................................................... 37
INVIRASE ORAL TABLET
500 MG ..................................................................... 37
Ipratropium Bromide
INHALATION SOLUTION 0.02
% ......................................................................................... 12
Ipratropium Bromide NASAL
SOLUTION 0.03 %, 0.06 %
................................................................................................ 75
Ipratropium-Albuterol
INHALATION SOLUTION
0.5-2.5 (3) MG/3ML ............................. 13
ISENTRESS ORAL TABLET
400 MG ..................................................................... 37
ISENTRESS ORAL TABLET
................................................................................................ 37
Isoniazid INJECTION
SOLUTION 100 MG/ML .............. 30
Isoniazid ORAL TABLET 100
MG, 300 MG ...................................................... 30
ISOPTO HYOSCINE
OPHTHALMIC SOLUTION
0.25 % ........................................................................... 77
Isosorbide Dinitrate ER ORAL
TABLET
.................................................................................................... 9
Isosorbide Dinitrate ORAL
MG, 5 MG ................................................................. 9
Isosorbide Mononitrate ER
MG, 60 MG ............................................................. 9
Isosorbide Mononitrate ORAL
TABLET 10 MG, 20 MG .................... 9
JAKAFI ORAL TABLET 10
MG, 15 MG, 20 MG, 25 MG, 5
MG .................................................................................. 33
JANTOVEN ORAL TABLET 1
MG, 10 MG, 2 MG, 2.5 MG, 3
MG, 4 MG, 5 MG, 6 MG, 7.5
MG .................................................................................. 14
JANUMET ORAL TABLET
50-1000 MG, 50-500 MG ................ 19
JANUMET XR ORAL
TABLET EXTENDED
RELEASE 24 HR* 100-1000
MG, 50-1000 MG, 50-500 MG
................................................................................................ 19
JANUVIA ORAL TABLET 100
MG, 25 MG, 50 MG ............................. 21
JENTADUETO ORAL
TABLET 2.5-1000 MG, 2.5-500
MG, 2.5-850 MG ........................................ 20
JOLIVETTE ORAL TABLET
0.35 MG ................................................................... 47
JUNEL 1.5/30 ORAL TABLET
1.5-30 MG-MCG ........................................ 45
JUNEL 1/20 ORAL TABLET
1-20 MG-MCG .............................................. 45
JUNEL FE 1.5/30 ORAL
................................................................................................ 45
JUNEL FE 1/20 ORAL
TABLET 1-20 MG-MCG ............. 45
KALETRA ORAL SOLUTION
400-100 MG/5ML ...................................... 37
KALETRA ORAL TABLET
100-25 MG, 200-50 MG ................... 37
KALYDECO ORAL TABLET
150 MG ..................................................................... 83
KARIGEL DENTAL GEL 1.1
% ......................................................................................... 72
KARIGEL-N DENTAL GEL
1.1 % .............................................................................. 72
KARIVA ORAL TABLET
0.15-0.02/0.01 MG (21/5) ................. 45
KELNOR 1/35 ORAL TABLET
1-35 MG-MCG .............................................. 45
Ketoconazole EXTERNAL
CREAM 2 % ...................................................... 52
Ketoconazole EXTERNAL
SHAMPOO 2 % ........................................... 52
Ketoconazole ORAL TABLET
200 MG ...................................................................... 24
Ketoprofen ORAL CAPSULE 50
MG, 75 MG ............................................................. 3
Ketorolac Tromethamine ORAL
TABLET 10 MG .............................................. 3
KETOSTIX IN VITRO STRIP
................................................................................................ 57
Ketotifen Fumarate
OPHTHALMIC SOLUTION
0.025 % ....................................................................... 79
KLOR-CON 10 ORAL
TABLET
EXTENDEDRELEASE* 10
MEQ .............................................................................. 70
KLOR-CON M10 ORAL
TABLET
EXTENDEDRELEASE* 10
MEQ .............................................................................. 70
KLOR-CON M20 ORAL
TABLET
EXTENDEDRELEASE* 20
MEQ .............................................................................. 70
KLOR-CON ORAL TABLET
EXTENDEDRELEASE* 8
MEQ .............................................................................. 70
K-PHOS-NEUTRAL ORAL
TABLET 155-852-130 MG .......... 70
Labetalol HCl INTRAVENOUS*
SOLUTION 5 MG/ML ..................... 41
Labetalol HCl ORAL TABLET
100 MG, 200 MG, 300 MG ........... 41
Lactase Enzyme ORAL TABLET
3000 UNIT ............................................................ 57
Lactulose ORAL SOLUTION 10
GM/15ML ............................................................. 65
LamiVUDine ORAL TABLET
150 MG, 300 MG ......................................... 38
Lamivudine-Zidovudine ORAL
TABLET 150-300 MG ......................... 37
LamoTRIgine ORAL TABLET
100 MG, 150 MG, 200 MG ........... 15
25 MG .......................................................................... 15
................................................................................................ 15
Lancet Device XX MISC .............. 67
Lancets XX MISC .................................. 67
Lansoprazole ORAL CAPSULE
................................................................................................ 86
Lansoprazole ORAL CAPSULE
................................................................................................ 86
LANTUS SOLOSTAR
SUBCUTANEOUS*
................................................................................................ 22
LANTUS SUBCUTANEOUS*
................................................................................................ 22
Latanoprost OPHTHALMIC
SOLUTION 0.005 % ............................. 79
LAVOCLEN-4 CREAMY
WASH EXTERNAL LIQUID†
4 % .................................................................................... 50
LAVOCLEN-8 CREAMY
WASH EXTERNAL LIQUID†
8 % .................................................................................... 50
Laxative RE SUPPOSITORY 10
MG ................................................................................... 65
Leflunomide ORAL TABLET 10
MG, 20 MG ............................................................. 4
LESSINA ORAL TABLET
0.1-20 MG-MCG ........................................ 45
LETAIRIS ORAL TABLET 10
MG, 5 MG ........................................................... 43
Letrozole ORAL TABLET 2.5
MG ................................................................................... 31
Leucovorin Calcium INJECTION
SOLUTION
RECONSTITUTED 100 MG,
200 MG, 350 MG ......................................... 33
Leucovorin Calcium
10 MG/ML ........................................................... 33
Leucovorin Calcium ORAL
MG, 5 MG ............................................................. 33
LEUKERAN ORAL TABLET 2
MG .................................................................................. 30
LevETIRAcetam
500 MG/5ML .................................................... 15
LevETIRAcetam ORAL
SOLUTION 100 MG/ML .............. 16
LevETIRAcetam ORAL
TABLET 1000 MG, 500 MG, 750
MG ................................................................................... 16
LevETIRAcetam ORAL
TABLET 250 MG ...................................... 16
Levobunolol HCl
OPHTHALMIC SOLUTION
0.25 %, 0.5 % ..................................................... 76
LevOCARNitine
200 MG/ML ........................................................ 59
LevOCARNitine ORAL
SOLUTION 1 GM/10ML .............. 59
LevOCARNitine ORAL
TABLET 330 MG ...................................... 59
Levofloxacin ORAL TABLET
250 MG, 500 MG, 750 MG ........... 60
Levonorgestrel ORAL TABLET
0.75 MG .................................................................... 47
LEVORA 0.15/30 (28) ORAL
................................................................................................
45
Levothyroxine Sodium
RECONSTITUTED 100 MCG,
500 MCG ................................................................. 84
Levothyroxine Sodium ORAL
TABLET 100 MCG, 112 MCG,
125 MCG, 137 MCG, 150 MCG,
175 MCG, 200 MCG, 25 MCG,
300 MCG, 50 MCG, 75 MCG, 88
MCG .............................................................................. 84
LEXIVA ORAL SUSPENSION
50 MG/ML ........................................................... 37
LEXIVA ORAL TABLET 700
MG .................................................................................. 37
Lice Killing Maximum Strength
EXTERNAL SHAMPOO 0.33-4
% ......................................................................................... 56
Lidocaine EXTERNAL
OINTMENT 5 % ........................................ 55
Lidocaine HCl (Cardiac)
20 MG/ML ........................................................... 11
Lidocaine HCl (PF)
INJECTION SOLUTION 2 %
................................................................................................ 66
Lidocaine HCl EXTERNAL GEL
2 % .................................................................................... 55
Lidocaine HCl EXTERNAL
SOLUTION 4 % .......................................... 55
Lidocaine HCl INJECTION
SOLUTION 0.5 %, 1 %, 1.5 %
................................................................................................ 66
Lidocaine Viscous
MOUTH/THROAT SOLUTION
2 % .................................................................................... 71
Lidocaine-Prilocaine
EXTERNAL CREAM 2.5-2.5 %
................................................................................................ 55
Lidocaine-Prilocaine
EXTERNAL KIT 2.5-2.5 %
................................................................................................ 55
Liothyronine Sodium ORAL
TABLET 25 MCG, 5 MCG, 50
MCG .............................................................................. 84
Lisinopril ORAL TABLET 10
MG, 2.5 MG, 20 MG, 30 MG, 40
MG, 5 MG ............................................................. 27
Lisinopril-Hydrochlorothiazide
20-12.5 MG, 20-25 MG ....................... 27
103
Lithium Carbonate ER ORAL
TABLET
EXTENDEDRELEASE* 300
MG, 450 MG ...................................................... 35
Lithium Carbonate ORAL
CAPSULE 150 MG, 300 MG,
600 MG ...................................................................... 34
Lithium Carbonate ORAL
TABLET 300 MG ...................................... 34
Lithium Citrate ORAL
SOLUTION 8 MEQ/5ML ............ 35
Lomustine ORAL CAPSULE 10
MG, 100 MG, 40 MG ............................ 30
LONOX ORAL TABLET
2.5-0.025 MG .................................................... 23
Loperamide HCl ORAL
CAPSULE 2 MG ........................................ 23
Loperamide HCl ORAL
LIQUID† 1 MG/5ML ......................... 23
Loratadine ORAL TABLET 10
MG ................................................................................... 25
LORazepam INJECTION
SOLUTION 2 MG/ML, 4
MG/ML ..................................................................... 10
LORazepam ORAL TABLET 0.5
MG, 1 MG, 2 MG ....................................... 10
LORYNA ORAL TABLET
3-0.02 MG ............................................................. 45
Losartan Potassium ORAL
MG ................................................................................... 27
Losartan Potassium-HCTZ
100-25 MG, 50-12.5 MG ................... 27
LOTEMAX OPHTHALMIC
SUSPENSION 0.5 % ............................ 78
Lovastatin ORAL TABLET 10
MG, 20 MG, 40 MG ................................ 26
LOW-OGESTREL ORAL
................................................................................................ 45
Loxapine Succinate ORAL
MG, 50 MG ......................................................... 36
LUMIZYME
RECONSTITUTED 50 MG
................................................................................................ 59
LUTERA ORAL TABLET
0.1-20 MG-MCG ........................................ 45
LYSODREN ORAL TABLET
500 MG ..................................................................... 31
MACRODANTIN ORAL
CAPSULE 25 MG .................................... 87
104
Magnesium Oxide ORAL
TABLET 250 MG, 400 MG, 420
MG ....................................................................................... 9
Magnesium Oxide ORAL
TABLET 500 MG ...................................... 70
MAKENA
INTRAMUSCULAR* OIL 250
MG/ML .................................................................... 81
Mapap Infants ORAL
.................................................................................................... 5
Mapap ORAL LIQUID† 160
MG/5ML ..................................................................... 5
Maprotiline HCl ORAL
................................................................................................ 18
Marten-Tab ORAL TABLET
50-325 MG ................................................................ 4
MATZIM LA ORAL TABLET
EXTENDED RELEASE 24
HR* 180 MG, 240 MG, 300 MG,
360 MG, 420 MG ....................................... 43
MAXIDEX OPHTHALMIC
SUSPENSION 0.1 % ............................ 78
Meclizine HCl ORAL TABLET
12.5 MG, 25 MG .......................................... 23
Meclizine HCl ORAL TABLET
CHEWABLE 25 MG ............................ 23
MedroxyPROGESTERone
Acetate INTRAMUSCULAR*
................................................................................................ 47
MedroxyPROGESTERone
Acetate ORAL TABLET 10 MG,
2.5 MG, 5 MG .................................................. 82
Mefloquine HCl ORAL TABLET
250 MG ...................................................................... 29
Megestrol Acetate ORAL
SUSPENSION 40 MG/ML
................................................................................................ 32
Megestrol Acetate ORAL
TABLET 20 MG, 40 MG ................ 32
Melatonin Maximum Strength
ORAL TABLET 5 MG .......................... 2
Meloxicam ORAL TABLET 15
MG, 7.5 MG ........................................................... 3
MEPHYTON ORAL TABLET
5 MG ............................................................................. 89
Meprobamate ORAL TABLET
200 MG, 400 MG ......................................... 10
MEPRON ORAL
................................................................................................ 29
Mercaptopurine ORAL TABLET
50 MG .......................................................................... 31
Mesalamine RE ENEMA 4 GM
................................................................................................ 61
MESTINON ORAL SYRUP 60
MG/5ML ................................................................ 29
MESTINON ORAL TABLET
MG .................................................................................. 29
METAMUCIL ORAL
CAPSULE 0.52 GM .............................. 64
METAMUCIL ORAL WAFER
................................................................................................ 65
METAMUCIL SMOOTH
TEXTURE ORAL POWDER
28.3 % ........................................................................... 65
Metaproterenol Sulfate ORAL
SYRUP 10 MG/5ML ............................ 13
MetFORMIN HCl ER (OSM)
................................................................................................ 20
MetFORMIN HCl ER ORAL
TABLET EXTENDED
MG ................................................................................... 20
MetFORMIN HCl ORAL
TABLET 1000 MG, 500 MG, 850
MG ................................................................................... 20
Methadone HCl ORAL
MG/5ML ..................................................................... 5
Methadone HCl ORAL TABLET
10 MG, 5 MG ....................................................... 6
METHADOSE ORAL TABLET
10 MG ............................................................................. 6
Methazolamide ORAL TABLET
25 MG, 50 MG ................................................ 57
Methimazole ORAL TABLET 10
MG, 5 MG ............................................................. 84
Methitest ORAL TABLET 10
MG ....................................................................................... 8
Methocarbamol ORAL TABLET
500 MG, 750 MG ......................................... 75
Methotrexate ORAL TABLET
2.5 MG ........................................................................ 31
Methotrexate Sodium (PF)
MG/ML ..................................................................... 31
Methotrexate Sodium
MG/ML ..................................................................... 31
Methotrexate Sodium
INJECTION SOLUTION
RECONSTITUTED 1 GM .......... 31
Methyldopa ORAL TABLET 250
MG, 500 MG ...................................................... 27
Methylergonovine Maleate
INJECTION SOLUTION 0.2
MG/ML ..................................................................... 80
Methylergonovine Maleate ORAL
TABLET 0.2 MG ........................................ 80
METHYLIN ORAL TABLET
CHEWABLE 10 MG, 2.5 MG, 5
MG ...................................................................................... 2
Methylphenidate HCl ER ORAL
TABLET
.................................................................................................... 2
TABLET
EXTENDEDRELEASE* 18
MG, 27 MG, 36 MG ................................... 2
TABLET
.................................................................................................... 2
TABLET
.................................................................................................... 2
Methylphenidate HCl ORAL
TABLET 10 MG, 5 MG ........................ 2
Methylphenidate HCl ORAL
TABLET 20 MG .............................................. 2
MethylPREDNISolone (Pak)
ORAL TABLET 4 MG ....................... 48
MethylPREDNISolone Acetate
INJECTION SUSPENSION 40
MG/ML, 80 MG/ML ............................. 48
MethylPREDNISolone ORAL
................................................................................................ 48
MethylPREDNISolone Sodium
Succ INJECTION SOLUTION
MG, 125 MG, 40 MG ............................ 48
Metipranolol OPHTHALMIC
SOLUTION 0.3 % .................................... 76
Metoclopramide HCl ORAL
SOLUTION 5 MG/5ML .................. 61
Metoclopramide HCl ORAL
TABLET 10 MG, 5 MG .................... 61
Metolazone ORAL TABLET 10
MG, 2.5 MG, 5 MG ................................. 58
Metoprolol Succinate ER ORAL
TABLET EXTENDED
MG, 25 MG, 50 MG ................................ 41
Metoprolol Tartrate
1 MG/ML ............................................................... 41
Metoprolol Tartrate ORAL
MG ................................................................................... 41
MetroNIDAZOLE EXTERNAL
CREAM 0.75 % ............................................. 56
MetroNIDAZOLE EXTERNAL
GEL 1 % ................................................................... 56
MetroNIDAZOLE ORAL
................................................................................................ 28
MetroNIDAZOLE VAGINAL
GEL 0.75 % .......................................................... 87
Mexiletine HCl ORAL
CAPSULE 150 MG, 200 MG,
250 MG ...................................................................... 11
Miconazole 3 Combo Pack
VAGINAL KIT 200-2 MG-%
(9GM) ........................................................................ 87
Miconazole 3 VAGINAL
SUPPOSITORY 200 MG .............. 87
Miconazole Nitrate EXTERNAL
CREAM 2 % ...................................................... 52
CREAM 2 % ...................................................... 87
SUPPOSITORY 100 MG .............. 87
MICROCHAMBER XX MISC
................................................................................................ 68
MICROGESTIN 1.5/30 ORAL
................................................................................................ 45
MICROGESTIN 1/20 ORAL
TABLET 1-20 MG-MCG ............. 45
MICROGESTIN FE 1.5/30
ORAL TABLET 1.5-30
MG-MCG ............................................................. 45
MICROGESTIN FE 1/20
ORAL TABLET 1-20 MG-MCG
................................................................................................ 46
MICROSPACER XX MISC
................................................................................................ 68
Midodrine HCl ORAL TABLET
10 MG, 2.5 MG, 5 MG ........................ 88
Milk of Magnesia ORAL
................................................................................................ 65
Minocycline HCl ORAL
MG ................................................................................... 84
Minoxidil ORAL TABLET 10
MG, 2.5 MG ....................................................... 28
Mirtazapine ORAL TABLET 15
MG, 30 MG, 45 MG, 7.5 MG
................................................................................................ 17
Mirtazapine ORAL TABLET
DISPERSIBLE 15 MG, 30 MG,
45 MG .......................................................................... 17
Misoprostol ORAL TABLET 100
MCG, 200 MCG ........................................... 86
Mometasone Furoate
................................................................................................ 54
Mometasone Furoate
................................................................................................ 54
MONISTAT 3 VAGINAL
CREAM 4 % ..................................................... 87
MONONESSA ORAL TABLET
0.25-35 MG-MCG .................................... 46
Montelukast Sodium ORAL
PACKET 4 MG ............................................. 12
TABLET 10 MG .......................................... 12
TABLET CHEWABLE 4 MG, 5
MG ................................................................................... 12
Morphine Sulfate (Concentrate)
ORAL SOLUTION 20 MG/ML
.................................................................................................... 6
Morphine Sulfate (PF)
INJECTION SOLUTION 0.5
MG/ML ........................................................................ 6
Morphine Sulfate (PF)
8 MG/ML ................................................................... 6
Morphine Sulfate ER ORAL
TABLET
MG, 15 MG, 200 MG, 30 MG, 60
MG ....................................................................................... 6
Morphine Sulfate INJECTION
MG/ML, 5 MG/ML, 8 MG/ML
.................................................................................................... 6
Morphine Sulfate
1 MG/ML, 25 MG/ML, 50
MG/ML ........................................................................ 6
105
Morphine Sulfate ORAL
MG/5ML ..................................................................... 6
Morphine Sulfate ORAL
TABLET 15 MG, 30 MG .................... 6
Morphine Sulfate RE
SUPPOSITORY 10 MG, 20 MG,
30 MG, 5 MG ....................................................... 6
Mucus Relief ORAL TABLET
400 MG ...................................................................... 49
Multi-Vit/Fluoride ORAL
SOLUTION 0.25 MG/ML, 0.5
MG/ML ..................................................................... 73
Multi-Vit/Fluoride/Iron ORAL
SOLUTION 0.25-10 MG/ML
................................................................................................ 73
Multivitamin/Fluoride ORAL
MG, 0.5 MG, 1 MG ................................. 73
Multi-Vitamin/Fluoride ORAL
MG, 0.5 MG, 1 MG ................................. 73
Multi-Vitamin/Iron ORAL
TABLET .............................................................. 72
Multi-Vitamin/Minerals ORAL
TABLET .............................................................. 72
Multi-Vitamins ORAL TABLET
................................................................................................ 73
Mupirocin EXTERNAL
OINTMENT 2 % ........................................ 51
MURO 128 OPHTHALMIC
SOLUTION 2 % .......................................... 79
MYCOBUTIN ORAL
CAPSULE 150 MG ................................ 30
Mycophenolate Mofetil ORAL
CAPSULE 250 MG ................................. 40
Mycophenolate Mofetil ORAL
TABLET 500 MG ...................................... 40
MYLERAN ORAL TABLET 2
MG .................................................................................. 30
MYNATAL ADVANCE ORAL
TABLET ................................................................. 74
Mynatal-Z ORAL TABLET
................................................................................................ 74
Mynate 90 Plus ORAL TABLET
EXTENDEDRELEASE* ........... 74
Nabumetone ORAL TABLET
500 MG, 750 MG ............................................ 3
Nadolol ORAL TABLET 20 MG,
40 MG, 80 MG ................................................ 41
Naltrexone HCl ORAL TABLET
50 MG .......................................................................... 23
NAMENDA ORAL
SOLUTION 10 MG/5ML ............. 82
106
NAMENDA ORAL TABLET
10 MG, 5 MG .................................................. 82
NAMENDA TITRATION PAK
ORAL TABLET 5 (28)-10 (21)
MG .................................................................................. 82
Naproxen DR ORAL TABLET
.................................................................................................... 4
Naproxen ORAL SUSPENSION
125 MG/5ML ........................................................ 3
Naproxen ORAL TABLET 250
MG, 375 MG, 500 MG ............................ 3
Naproxen Sodium ORAL
.................................................................................................... 4
Naratriptan HCl ORAL
TABLET 1 MG, 2.5 MG .................. 69
NATURE-THROID ORAL
TABLET 113.75 MG, 130 MG,
146.25 MG, 16.25 MG, 162.5
MG, 195 MG, 260 MG, 32.5
MG, 325 MG, 48.75 MG, 65
MG, 81.25 MG, 97.5 MG .............. 84
NECON 0.5/35 (28) ORAL
................................................................................................ 46
NECON 1/35 (28) ORAL
TABLET 1-35 MG-MCG ............. 46
NECON 1/50 (28) ORAL
TABLET 1-50 MG-MCG ............. 46
NECON 7/7/7 ORAL TABLET
0.5/0.75/1-35 MG-MCG ................... 47
Nefazodone HCl ORAL
TABLET 100 MG, 150 MG, 200
MG, 250 MG, 50 MG ............................ 18
Neomycin-Bacitracin Zn-Polymyx
OPHTHALMIC OINTMENT
5-400-10000 ........................................................ 77
OPHTHALMIC OINTMENT
3.5-10000-0.1 .................................................... 78
3.5-10000-0.1 .................................................... 78
Neomycin-Polymyxin-Gramicidin
OPHTHALMIC SOLUTION
1.75-10000-0.25 ............................................ 77
Neomycin-Polymyxin-HC
3.5-10000-1 ......................................................... 78
SOLUTION 3.5-10000-1 ................ 80
................................................................................................ 80
NEUPOGEN INJECTION
SOLUTION 300 MCG/0.5ML,
300 MCG/ML, 480
................................................................................................ 63
NEUTRAGARD ADVANCED
DENTAL GEL 1.1 % .......................... 72
Nevirapine ORAL
................................................................................................ 38
Nevirapine ORAL TABLET 200
MG ................................................................................... 38
Niacin ER ORAL CAPSULE
EXTENDED RELEASE* 500
MG ................................................................................... 89
Niacin ER ORAL TABLET
MG ................................................................................... 89
Niacin ORAL TABLET 100 MG,
250 MG, 50 MG, 500 MG ............... 89
NIACOR ORAL TABLET 500
MG .................................................................................. 26
NIACOR ORAL TABLET 500
MG .................................................................................. 89
Nicotine Polacrilex
MOUTH/THROAT GUM 2 MG,
4 MG ............................................................................. 83
Nicotine Polacrilex
MOUTH/THROAT LOZENGE
2 MG, 4 MG ....................................................... 83
Nicotine TRANSDERMAL
PATCH 24 HR 14 MG/24HR, 21
MG/24HR, 7 MG/24HR ................... 83
NIFEDIAC CC ORAL
TABLET EXTENDED
MG, 90 MG ........................................................ 43
NIFEDICAL XL ORAL
TABLET EXTENDED
MG .................................................................................. 43
NIFEdipine ER Osmotic ORAL
TABLET EXTENDED
MG, 90 MG ......................................................... 43
NIFEdipine ORAL CAPSULE 10
MG ................................................................................... 43
NITRO-BID TRANSDERMAL
OINTMENT 2 % ........................................... 9
Nitrofurantoin Macrocrystal
ORAL CAPSULE 100 MG, 50
MG ................................................................................... 87
Nitrofurantoin Monohyd Macro
ORAL CAPSULE 100 MG
................................................................................................ 87
Nitroglycerin TRANSDERMAL
PATCH 24 HR 0.1 MG/HR, 0.2
MG/HR, 0.4 MG/HR, 0.6
MG/HR ......................................................................... 9
NITROSTAT SUBLINGUAL
TABLET SUBLINGUAL 0.3
MG, 0.4 MG, 0.6 MG ............................. 9
NORA-BE ORAL TABLET
0.35 MG ................................................................... 47
Norethindrone Acetate ORAL
TABLET 5 MG .............................................. 82
Normal Saline Flush
0.9 % .............................................................................. 71
Nortemp Infants ORAL
SUSPENSION 80 MG/0.8ML
.................................................................................................... 5
NORTREL 0.5/35 (28) ORAL
................................................................................................ 46
NORTREL 1/35 (21) ORAL
TABLET 1-35 MG-MCG ............. 46
NORTREL 1/35 (28) ORAL
TABLET 1-35 MG-MCG ............. 46
NORTREL 7/7/7 ORAL
TABLET 0.5/0.75/1-35
MG-MCG ............................................................. 47
Nortriptyline HCl ORAL
MG, 75 MG ......................................................... 19
Nortriptyline HCl ORAL
SOLUTION 10 MG/5ML .............. 19
NORVIR ORAL CAPSULE 100
MG .................................................................................. 37
NORVIR ORAL SOLUTION
80 MG/ML ........................................................... 38
NORVIR ORAL TABLET 100
MG .................................................................................. 38
NOVOPEN 3 XX MISC ................. 68
NP Thyroid ORAL TABLET 30
MG, 60 MG, 90 MG ................................ 84
NUVARING VAGINAL RING
0.12-0.015 MG/24HR ........................... 47
Nystatin EXTERNAL CREAM
100000 UNIT/GM ...................................... 51
Nystatin EXTERNAL
................................................................................................ 51
Nystatin EXTERNAL POWDER
100000 UNIT/GM ...................................... 51
Nystatin MOUTH/THROAT
SUSPENSION 100000
UNIT/ML .............................................................. 71
Nystatin ORAL TABLET 500000
UNIT ............................................................................ 24
OCELLA ORAL TABLET
3-0.03 MG ............................................................. 46
Ofloxacin OPHTHALMIC
SOLUTION 0.3 % .................................... 77
Ofloxacin OTIC SOLUTION 0.3
% ......................................................................................... 79
OLANZapine ORAL TABLET
10 MG, 15 MG, 2.5 MG, 20 MG,
5 MG, 7.5 MG .................................................. 36
Omeprazole Magnesium ORAL
CAPSULE DELAYED
RELEASE 20.6 (20 Base) MG
................................................................................................ 86
Omeprazole ORAL CAPSULE
20 MG, 40 MG ................................................ 86
Ondansetron HCl ORAL
SOLUTION 4 MG/5ML .................. 23
Ondansetron HCl ORAL
TABLET 4 MG, 8 MG ........................ 23
Ondansetron ORAL TABLET
DISPERSIBLE 4 MG, 8 MG
................................................................................................ 23
OPTICHAMBER
ADVANTAGE XX MISC ........... 68
OPTICHAMBER
ADVANTAGE-LG MASK XX
MISC ............................................................................ 68
OPTICHAMBER
ADVANTAGE-MED MASK
XX MISC ............................................................... 68
OPTICHAMBER
ADVANTAGE-SM MASK XX
MISC ............................................................................ 68
OPTICHAMBER FACE
MASK-LARGE XX MISC
................................................................................................ 68
OPTICHAMBER FACE
MASK-MEDIUM XX MISC
................................................................................................ 69
OPTICHAMBER FACE
MASK-SMALL XX MISC
................................................................................................ 69
OPTIHALER XX MISC ................ 69
ORALYTE FREEZER POPS
ORAL SOLUTION ............................... 70
ORALYTE ORAL SOLUTION
................................................................................................ 69
ORAP ORAL TABLET 1 MG, 2
MG .................................................................................. 83
Oticin OTIC LIQUID† 1-0.1 %
................................................................................................ 80
OVIDE EXTERNAL LOTION
0.5 % .............................................................................. 56
Oxacillin Sodium INJECTION
SOLUTION
GM, 2 GM ............................................................. 81
Oxandrolone ORAL TABLET 10
MG, 2.5 MG ........................................................... 8
Oxaprozin ORAL TABLET 600
MG ....................................................................................... 4
Oxazepam ORAL CAPSULE 10
MG, 15 MG, 30 MG ................................ 10
OXcarbazepine ORAL
................................................................................................ 16
OXcarbazepine ORAL TABLET
150 MG ...................................................................... 16
300 MG ...................................................................... 16
600 MG ...................................................................... 16
Oxybutynin Chloride ER ORAL
TABLET EXTENDED
MG, 5 MG ............................................................. 87
Oxybutynin Chloride ORAL
SYRUP 5 MG/5ML ................................ 87
Oxybutynin Chloride ORAL
TABLET 5 MG .............................................. 87
OxyCODONE HCl ORAL
CAPSULE 5 MG ............................................ 6
OxyCODONE HCl ORAL
SOLUTION 5 MG/5ML ..................... 6
OxyCODONE HCl ORAL
MG, 5 MG ................................................................. 6
OxyCODONE HCl ORAL
TABLET 30 MG .............................................. 6
Oxycodone-Acetaminophen
ORAL CAPSULE 5-500 MG
.................................................................................................... 7
5-325 MG, 7.5-325 MG, 7.5-500
MG ....................................................................................... 7
.................................................................................................... 7
107
Oxycodone-Aspirin ORAL
TABLET 4.8355-325 MG ................... 7
PACERONE ORAL TABLET
200 MG, 400 MG ....................................... 11
Pain & Fever Childrens ORAL
SOLUTION 160 MG/5ML .............. 5
Pantoprazole Sodium ORAL
20 MG, 40 MG ................................................ 86
PARoxetine HCl ORAL
MG, 40 MG ......................................................... 18
Peak Flow Meter XX DEVICE
................................................................................................ 68
PEG 3350/Electrolytes ORAL
SOLUTION
................................................................................................ 65
PEG 3350-KCl-Na Bicarb-NaCl
ORAL SOLUTION
................................................................................................ 65
PEG-3350/Electrolytes ORAL
SOLUTION
................................................................................................ 65
PEGANONE ORAL TABLET
250 MG ..................................................................... 16
PEGASYS PROCLICK
SUBCUTANEOUS*
180 MCG/0.5ML ........................................ 39
PEGASYS SUBCUTANEOUS*
KIT 180 MCG/0.5ML ......................... 39
PEGASYS SUBCUTANEOUS*
180 MCG/ML .................................................. 39
Penicillin G Procaine
INTRAMUSCULAR*
SUSPENSION 600000
UNIT/ML .............................................................. 81
Penicillin V Potassium ORAL
SOLUTION
RECONSTITUTED 125
MG/5ML, 250 MG/5ML .................. 81
Penicillin V Potassium ORAL
................................................................................................ 81
Pentazocine-Naloxone HCl
ORAL TABLET 50-0.5 MG
.................................................................................................... 7
108
Pentoxifylline ER ORAL
TABLET
MG ................................................................................... 62
PERIOGARD
MOUTH/THROAT
SOLUTION 0.12 % ................................ 71
Permethrin EXTERNAL
CREAM 5 % ...................................................... 56
Permethrin EXTERNAL
LOTION 1 % .................................................... 56
Perphenazine ORAL TABLET 16
MG, 2 MG, 4 MG, 8 MG ................. 36
Perphenazine-Amitriptyline
ORAL TABLET 2-10 MG, 2-25
MG, 4-10 MG, 4-25 MG, 4-50
MG ................................................................................... 82
PERTZYE ORAL CAPSULE
DELAYED RELEASE
PARTICLES 16000 UNIT, 8000
UNIT ............................................................................ 57
PFIZERPEN-G INJECTION
SOLUTION
RECONSTITUTED 20000000
UNIT, 5000000 UNIT ........................ 81
Phenazopyridine HCl ORAL
................................................................................................ 62
Phenelzine Sulfate ORAL
TABLET 15 MG .......................................... 18
PHENobarbital ORAL ELIXIR
20 MG/5ML ........................................................ 64
PHENobarbital ORAL TABLET
100 MG, 30 MG, 32.4 MG, 60
MG, 64.8 MG, 97.2 MG .................... 64
15 MG .......................................................................... 64
16.2 MG .................................................................... 64
PHENobarbital Sodium
MG/ML, 65 MG/ML ............................. 64
Phenytoin ORAL SUSPENSION
125 MG/5ML .................................................... 16
Phenytoin ORAL TABLET
CHEWABLE 50 MG ............................ 16
Phenytoin Sodium Extended
ORAL CAPSULE 100 MG, 200
MG, 300 MG ...................................................... 16
Phenytoin Sodium INJECTION
SOLUTION 50 MG/ML .................. 16
PHOS FLUR
MOUTH/THROAT
SOLUTION 0.044 % ............................. 72
PHOS-FLUR DENTAL GEL
1.1 % .............................................................................. 72
Pilocarpine HCl ORAL TABLET
5 MG, 7.5 MG .................................................. 72
Pindolol ORAL TABLET 10
MG, 5 MG ............................................................. 41
Pink Bismuth ORAL TABLET
CHEWABLE 262 MG ........................ 22
Pioglitazone HCl ORAL
................................................................................................ 21
Pioglitazone HCl-Metformin HCl
15-850 MG ............................................................ 20
Piroxicam ORAL CAPSULE 10
MG, 20 MG ............................................................. 4
PLAN B ONE-STEP ORAL
TABLET 1.5 MG ....................................... 47
Podofilox EXTERNAL
SOLUTION 0.5 % .................................... 55
Polycin B OPHTHALMIC
OINTMENT 500-10000
UNIT/GM .............................................................. 77
Poly-Dex OPHTHALMIC
OINTMENT 3.5-10000-0.1
................................................................................................ 78
Polyethylene Glycol 3350 ORAL
POWDER .......................................................... 65
Poly-Iron 150 Forte ORAL
CAPSULE 150-25-1
MG-MCG-MG ............................................... 63
POLY-IRON 150 ORAL
CAPSULE 150 MG ................................ 64
Polymyxin B-Trimethoprim
OPHTHALMIC SOLUTION
10000-0.1 UNIT/ML-% ..................... 77
Poly-Vitamin ORAL
SOLUTION 35 MG/ML .................. 73
Poly-Vitamin/Iron ORAL
SOLUTION 10 MG/ML .................. 73
PORTIA-28 ORAL TABLET
0.15-30 MG-MCG .................................... 46
Potassium Chloride Crys ER
ORAL TABLET
EXTENDEDRELEASE* 10
MEQ, 20 MEQ ............................................... 71
Potassium Chloride ER ORAL
TABLET
EXTENDEDRELEASE* 10
MEQ, 8 MEQ .................................................. 71
Potassium Chloride
0.4 MEQ/ML, 10 MEQ/100ML,
2 MEQ/ML, 30 MEQ/100ML, 40
MEQ/100ML .................................................... 70
Potassium Chloride ORAL
LIQUID† 20 MEQ/15ML
(10%), 40 MEQ/15ML (20%)
................................................................................................ 70
Potassium Chloride ORAL
SOLUTION 20 MEQ/15ML
(10%) ........................................................................... 71
PR NATAL 400 EC ORAL
MISC 29-1-200 & 400 MG (DR)
................................................................................................ 74
Pramipexole Dihydrochloride
ORAL TABLET 0.125 MG, 0.25
MG, 0.5 MG, 0.75 MG, 1 MG,
1.5 MG ........................................................................ 34
Pravastatin Sodium ORAL
MG, 80 MG ......................................................... 26
Prazosin HCl ORAL CAPSULE
1 MG, 2 MG, 5 MG ................................. 27
PRECISION XTRA BLOOD
GLUCOSE IN VITRO STRIP
................................................................................................ 57
PRECISION XTRA KETONE
IN VITRO STRIP ..................................... 57
PRECISION XTRA XX
DEVICE .................................................................. 67
PRED-G OPHTHALMIC
SUSPENSION 0.3-1 % ...................... 78
PrednisoLONE Acetate
1 % .................................................................................... 78
PrednisoLONE ORAL
SOLUTION 15 MG/5ML .............. 48
PrednisoLONE Sodium
Phosphate ORAL SOLUTION 15
MG/5ML, 6.7 (5 Base) MG/5ML
................................................................................................ 48
PredniSONE ORAL SOLUTION
5 MG/5ML ........................................................... 48
PredniSONE ORAL TABLET 1
MG, 10 MG, 2.5 MG, 20 MG, 5
MG ................................................................................... 48
PREMARIN INJECTION
SOLUTION
RECONSTITUTED 25 MG
................................................................................................ 60
PREMARIN ORAL TABLET
0.3 MG, 0.45 MG, 0.625 MG, 0.9
MG, 1.25 MG .................................................. 60
PREMARIN VAGINAL
CREAM 0.625 MG/GM ................. 88
PREMPHASE ORAL TABLET
0.625-5 MG ......................................................... 60
PREMPRO ORAL TABLET
0.3-1.5 MG, 0.45-1.5 MG,
0.625-2.5 MG, 0.625-5 MG
................................................................................................ 60
Prenatabs OBN ORAL TABLET
29-1 MG .................................................................... 74
PRENATABS RX ORAL
TABLET 29-1 MG ................................... 74
Prenatal 19 ORAL TABLET
CHEWABLE ................................................ 74
Prenatal Low Iron ORAL
TABLET 27-0.8 MG .............................. 74
Prenatal ORAL TABLET 28-0.8
MG ................................................................................... 74
Prenatal Plus Iron ORAL
TABLET 29-1 MG .................................... 74
Prenatal Plus ORAL TABLET
27-1 MG .................................................................... 74
PREVIFEM ORAL TABLET
0.25-35 MG-MCG .................................... 46
PREZISTA ORAL
................................................................................................ 38
PREZISTA ORAL TABLET
150 MG, 400 MG, 600 MG, 75
MG, 800 MG .................................................... 38
Primaquine Phosphate ORAL
TABLET 26.3 MG .................................... 29
Primidone ORAL TABLET 250
MG ................................................................................... 16
Primidone ORAL TABLET 50
MG ................................................................................... 16
Probenecid ORAL TABLET 500
MG ................................................................................... 62
Procainamide HCl INJECTION
MG/ML ..................................................................... 10
Prochlorperazine Maleate ORAL
TABLET 10 MG, 5 MG .................... 36
Prochlorperazine RE
SUPPOSITORY 25 MG .................. 36
PROCRIT INJECTION
SOLUTION 10000 UNIT/ML,
2000 UNIT/ML, 20000
UNIT/ML, 3000 UNIT/ML,
4000 UNIT/ML, 40000
UNIT/ML ............................................................. 63
PROCTOSOL HC RE CREAM
2.5 % .................................................................................. 8
PROCTOZONE-HC RE
CREAM 2.5 % ................................................... 8
PROLIA SUBCUTANEOUS*
SOLUTION 60 MG/ML ................. 59
Promethazine HCl ORAL
SYRUP 6.25 MG/5ML ...................... 25
Promethazine HCl ORAL
TABLET 12.5 MG, 25 MG, 50
MG ................................................................................... 25
Promethazine HCl RE
SUPPOSITORY 25 MG .................. 25
PROMETHEGAN RE
SUPPOSITORY 25 MG, 50 MG
................................................................................................ 25
Propafenone HCl ORAL
TABLET 150 MG, 225 MG, 300
MG ................................................................................... 11
Propantheline Bromide ORAL
TABLET 15 MG .......................................... 85
Propranolol HCl ER ORAL
CAPSULE EXTENDED
160 MG, 60 MG, 80 MG ................... 42
Propranolol HCl
1 MG/ML ............................................................... 42
Propranolol HCl ORAL
MG, 60 MG, 80 MG ................................ 42
Propranolol-HCTZ ORAL
TABLET 40-25 MG, 80-25 MG
................................................................................................ 28
Propylthiouracil ORAL TABLET
50 MG .......................................................................... 84
PROSTIGMIN ORAL TABLET
15 MG ......................................................................... 29
Protriptyline HCl ORAL
TABLET 10 MG, 5 MG .................... 19
Pseudoephedrine HCl ORAL
TABLET 30 MG, 60 MG ................ 76
PULMICORT INHALATION
SUSPENSION 1 MG/2ML
................................................................................................ 12
PULMOZYME INHALATION
SOLUTION 1 MG/ML .................... 83
Pyrazinamide ORAL TABLET
500 MG ...................................................................... 30
Pyridostigmine Bromide ORAL
TABLET 60 MG .......................................... 29
Q-PAP Infants ORAL
.................................................................................................... 5
QUASENSE ORAL TABLET
0.15-0.03 MG .................................................... 46
109
QUEtiapine Fumarate ORAL
MG, 300 MG, 400 MG, 50 MG
................................................................................................ 36
Quinapril HCl ORAL TABLET
10 MG, 20 MG, 40 MG, 5 MG
................................................................................................ 27
QuiNIDine Gluconate ER ORAL
TABLET
MG ................................................................................... 11
QuiNIDine Gluconate
MG/ML ..................................................................... 11
QuiNIDine Sulfate ORAL
TABLET 300 MG ...................................... 11
QVAR INHALATION
AEROSOL, SOLUTION 40
MCG/ACT ........................................................... 12
QVAR INHALATION
AEROSOL, SOLUTION 80
MCG/ACT ........................................................... 12
RA Col-Rite ORAL CAPSULE
50 MG .......................................................................... 66
Ramipril ORAL CAPSULE 1.25
MG, 10 MG, 2.5 MG, 5 MG
................................................................................................ 27
Ranitidine Acid Reducer ORAL
TABLET 75 MG .......................................... 86
Ranitidine HCl INJECTION
SOLUTION 1000 MG/40ML,
150 MG/6ML, 50 MG/2ML
................................................................................................ 86
Ranitidine HCl ORAL
................................................................................................ 86
Ranitidine HCl ORAL SYRUP
15 MG/ML ........................................................... 86
Ranitidine HCl ORAL TABLET
150 MG ...................................................................... 86
Ranitidine HCl ORAL TABLET
300 MG ...................................................................... 86
REBIF SUBCUTANEOUS*
SOLUTION 22 MCG/0.5ML, 44
MCG/0.5ML ..................................................... 83
REBIF TITRATION PACK
SUBCUTANEOUS*
SOLUTION 6X8.8 & 6X22
MCG ............................................................................. 83
RECLIPSEN ORAL TABLET
0.15-30 MG-MCG .................................... 46
Reeses Pinworm Medicine ORAL
.................................................................................................... 9
110
Refenesen 400 ORAL TABLET
400 MG ...................................................................... 49
Refenesen ORAL TABLET 200
MG ................................................................................... 49
RELENZA DISKHALER
INHALATION AEROSOL
POWDER, BREATH
ACTIVATED 5 MG/BLISTER
................................................................................................ 40
REMEVEN EXTERNAL
CREAM 50 % ................................................. 54
Rena-Vite ORAL TABLET
................................................................................................ 72
RENVELA ORAL PACKET 0.8
GM, 2.4 GM ...................................................... 61
RENVELA ORAL TABLET
800 MG ..................................................................... 61
Repan ORAL TABLET
50-325-40 MG ...................................................... 4
RESCRIPTOR ORAL TABLET
100 MG, 200 MG ....................................... 38
RESTASIS OPHTHALMIC
EMULSION 0.05 % ............................... 78
REVLIMID ORAL CAPSULE
10 MG, 15 MG, 2.5 MG, 20 MG,
25 MG, 5 MG .................................................. 40
REYATAZ ORAL CAPSULE
150 MG, 200 MG, 300 MG
................................................................................................ 38
RIBASPHERE ORAL TABLET
200 MG ..................................................................... 39
Ribavirin ORAL TABLET 200
MG ................................................................................... 39
RIDAURA ORAL CAPSULE 3
MG ...................................................................................... 3
Rifampin INTRAVENOUS*
SOLUTION
................................................................................................ 30
Rifampin ORAL CAPSULE 150
MG, 300 MG ...................................................... 30
Rimantadine HCl ORAL
TABLET 100 MG ...................................... 39
RIOMET ORAL SOLUTION
500 MG/5ML ................................................... 20
RISPERIDONE M-TAB ORAL
TABLET DISPERSIBLE 0.5
MG, 1 MG, 2 MG, 3 MG, 4 MG
................................................................................................ 35
RisperiDONE ORAL
SOLUTION 1 MG/ML ..................... 35
0.25 MG, 0.5 MG, 1 MG, 2 MG,
3 MG, 4 MG ....................................................... 35
DISPERSIBLE 0.25 MG, 0.5
MG, 1 MG, 2 MG, 3 MG, 4 MG
................................................................................................ 35
Rivastigmine Tartrate ORAL
CAPSULE 1.5 MG, 3 MG, 4.5
MG, 6 MG ............................................................. 82
Robafen ORAL SYRUP 100
MG/5ML ................................................................. 49
ROPINIRole HCl ORAL
TABLET 0.25 MG, 0.5 MG, 1
MG, 2 MG, 3 MG, 4 MG, 5 MG
................................................................................................ 34
ROXICET ORAL TABLET
5-325 MG ................................................................... 7
SALACTIC FILM EXTERNAL
SOLUTION 17 % ...................................... 55
Saline Flush INTRAVENOUS*
SOLUTION 0.9 % .................................... 71
Saline Nasal Spray NASAL
SOLUTION 0.65 % ................................. 75
Salsalate ORAL TABLET 500
MG, 750 MG ......................................................... 5
SANDIMMUNE ORAL
SOLUTION 100 MG/ML ............. 40
SANI-SUPP PEDIATRIC RE
SUPPOSITORY 1.2 GM ............... 65
SANTYL EXTERNAL
................................................................................................ 55
SAPHRIS SUBLINGUAL
TABLET SUBLINGUAL 10
MG, 5 MG ........................................................... 35
SAVELLA ORAL TABLET 100
MG, 12.5 MG, 25 MG, 50 MG
................................................................................................ 82
SAVELLA TITRATION PACK
ORAL MISC 12.5 & 25 & 50
MG .................................................................................. 82
Selegiline HCl ORAL CAPSULE
5 MG ............................................................................. 34
Selegiline HCl ORAL TABLET 5
MG ................................................................................... 34
Selenium Sulfide EXTERNAL
LOTION 2.5 % ............................................... 52
SELZENTRY ORAL TABLET
150 MG, 300 MG ....................................... 37
Senna Laxative ORAL TABLET
8.6 MG ........................................................................ 66
Senna ORAL SYRUP 176
MG/5ML, 8.8 MG/5ML ................... 65
Senna S ORAL TABLET 8.6-50
MG ................................................................................... 65
SEREVENT DISKUS
INHALATION AEROSOL
POWDER, BREATH
ACTIVATED 50 MCG/DOSE
................................................................................................ 13
Sertraline HCl ORAL TABLET
100 MG, 25 MG, 50 MG ................... 18
SF DENTAL GEL 1.1 % ................. 72
Silace ORAL LIQUID† 150
MG/15ML ............................................................. 66
Sildenafil Citrate ORAL
TABLET 20 MG .......................................... 43
Silver Sulfadiazine EXTERNAL
CREAM 1 % ...................................................... 52
Simethicone ORAL
SUSPENSION 40 MG/0.6ML
................................................................................................ 60
Simethicone ORAL TABLET
CHEWABLE 80 MG ............................ 60
SIMPONI SUBCUTANEOUS*
MG/0.5ML .............................................................. 2
Simvastatin ORAL TABLET 10
MG, 20 MG, 40 MG, 5 MG, 80
MG ................................................................................... 26
Slow Release Iron ORAL
TABLET
(50 Fe) MG ......................................................... 64
Sodium Bicarbonate ORAL
TABLET 325 MG .......................................... 8
OPHTHALMIC OINTMENT 5
% ......................................................................................... 79
% ......................................................................................... 79
Sodium Chloride INHALATION
0.9 % .............................................................................. 49
Sodium Chloride INJECTION
SOLUTION 0.9 % .................................... 71
Sodium Chloride
0.9 % .............................................................................. 71
Sodium Chloride IRRIGATION
SOLUTION 0.9 % .................................... 61
Sodium Chloride ORAL
TABLET 1 GM .............................................. 71
Sodium Citrate ORAL
GRANULES .................................................. 61
Sodium Fluoride ORAL
SOLUTION 1.1 (0.5 F) MG/ML
................................................................................................ 70
Sodium Fluoride ORAL TABLET
CHEWABLE 0.55 (0.25 F) MG,
1.1 (0.5 F) MG, 2.2 (1 F) MG
................................................................................................ 70
Sodium Polystyrene Sulfonate
ORAL POWDER ................................... 41
SOLIA ORAL TABLET 0.15-30
MG-MCG ............................................................. 46
Sorbitol ORAL SOLUTION 70
% ......................................................................................... 65
SORINE ORAL TABLET 120
MG, 160 MG, 240 MG, 80 MG
................................................................................................ 42
Sotalol HCl (AF) ORAL
MG ................................................................................... 42
Sotalol HCl ORAL TABLET 120
MG, 160 MG, 240 MG, 80 MG
................................................................................................ 42
Spironolactone ORAL TABLET
100 MG, 25 MG, 50 MG ................... 58
Spironolactone-HCTZ ORAL
TABLET 25-25 MG ................................ 57
SPRINTEC 28 ORAL TABLET
0.25-35 MG-MCG .................................... 46
SPRYCEL ORAL TABLET 100
MG, 140 MG, 20 MG, 50 MG,
70 MG, 80 MG .............................................. 33
SPS ORAL SUSPENSION 15
GM/60ML ............................................................ 41
SRONYX ORAL TABLET
0.1-20 MG-MCG ........................................ 46
SSD EXTERNAL CREAM 1 %
................................................................................................ 52
SSKI ORAL SOLUTION 1
GM/ML .................................................................... 70
Stavudine ORAL CAPSULE 15
MG, 20 MG, 30 MG, 40 MG
................................................................................................ 39
Stavudine ORAL SOLUTION
................................................................................................ 39
Stimulant Laxative ORAL
5 MG ............................................................................. 66
STIVARGA ORAL TABLET 40
MG .................................................................................. 32
Stool Softener Laxative DC
ORAL CAPSULE 240 MG
................................................................................................ 66
Stool Softener ORAL CAPSULE
100 MG, 250 MG ......................................... 66
STRIBILD ORAL TABLET
150-150-200-300 MG ............................. 37
STROMECTOL ORAL
TABLET 3 MG ................................................ 9
SUBOXONE SUBLINGUAL
FILM 12-3 MG, 2-0.5 MG, 4-1
MG, 8-2 MG ......................................................... 8
Sucralfate ORAL TABLET 1
GM ................................................................................... 86
Sulfacetamide Sodium
EXTERNAL SUSPENSION 10
% ......................................................................................... 50
Sulfacetamide Sodium
% ......................................................................................... 78
Sulfacetamide-Prednisolone
OPHTHALMIC SOLUTION
10-0.23 % ................................................................. 78
Sulfamethoxazole-TMP DS
................................................................................................ 28
Sulfamethoxazole-Trimethoprim
ORAL SUSPENSION 200-40
MG/5ML ................................................................. 28
Sulfamethoxazole-Trimethoprim
................................................................................................ 28
SulfaSALAzine ORAL TABLET
500 MG ...................................................................... 61
SulfaSALAzine ORAL TABLET
................................................................................................ 61
Sulindac ORAL TABLET 150
MG, 200 MG ......................................................... 4
SUMAtriptan NASAL
SOLUTION 20 MG/ACT, 5
MG/ACT ................................................................. 69
SUMAtriptan Succinate ORAL
MG ................................................................................... 69
SUMAtriptan Succinate Refill
SUBCUTANEOUS*
MG/0.5ML ........................................................... 69
SUMAtriptan Succinate
SUBCUTANEOUS*
MG/0.5ML ........................................................... 69
SUPARTZ
INTRA-ARTICULAR*
................................................................................................ 75
SUSTIVA ORAL CAPSULE
200 MG, 50 MG ........................................... 38
SUSTIVA ORAL TABLET 600
MG .................................................................................. 38
111
SUTENT ORAL CAPSULE
12.5 MG, 25 MG, 50 MG .............. 32
SYEDA ORAL TABLET 3-0.03
MG .................................................................................. 46
SYMBICORT INHALATION
AEROSOL† 160-4.5 MCG/ACT,
80-4.5 MCG/ACT ...................................... 13
SYNAGIS
INTRAMUSCULAR*
MG/0.5ML .......................................................... 80
TABLOID ORAL TABLET 40
MG .................................................................................. 31
Tacrolimus ORAL CAPSULE
0.5 MG, 1 MG, 5 MG ............................ 41
TAMIFLU ORAL CAPSULE
30 MG ......................................................................... 40
TAMIFLU ORAL CAPSULE
45 MG, 75 MG .............................................. 40
TAMIFLU ORAL
SUSPENSION
................................................................................................ 40
Tamoxifen Citrate ORAL
TABLET 10 MG, 20 MG ................ 31
Tamsulosin HCl ORAL
CAPSULE 0.4 MG .................................. 62
TARCEVA ORAL TABLET
100 MG, 150 MG, 25 MG ............. 33
TASIGNA ORAL CAPSULE
150 MG, 200 MG ....................................... 33
TAZORAC EXTERNAL
CREAM 0.05 %, 0.1 % ....................... 52
TAZORAC EXTERNAL GEL
0.05 %, 0.1 % ..................................................... 52
Temazepam ORAL CAPSULE
15 MG, 30 MG ................................................ 64
Temozolomide ORAL CAPSULE
100 MG, 140 MG, 180 MG, 20
MG, 250 MG, 5 MG ................................ 30
TENCON ORAL TABLET
50-650 MG ............................................................... 4
Terazosin HCl ORAL CAPSULE
1 MG, 10 MG, 2 MG, 5 MG
................................................................................................ 27
Terbinafine HCl EXTERNAL
CREAM 1 % ...................................................... 51
Terbinafine HCl ORAL TABLET
250 MG ...................................................................... 24
Terbutaline Sulfate INJECTION
SOLUTION 1 MG/ML ..................... 13
Terbutaline Sulfate ORAL
TABLET 2.5 MG, 5 MG .................. 14
112
Terconazole VAGINAL CREAM
0.4 %, 0.8 % ......................................................... 87
Terconazole VAGINAL
SUPPOSITORY 80 MG .................. 87
TESTIM TRANSDERMAL
GEL 50 MG/5GM ........................................ 8
Testosterone Cypionate
MG/ML, 200 MG/ML ............................. 8
Testosterone Enanthate
MG/ML ........................................................................ 8
Tetracycline HCl ORAL
................................................................................................ 84
TEV-TROPIN
SUBCUTANEOUS*
SOLUTION
RECONSTITUTED 5 MG
................................................................................................ 59
THALOMID ORAL CAPSULE
100 MG, 150 MG, 200 MG, 50
MG .................................................................................. 40
Theophylline ER ORAL
TABLET EXTENDED
MG, 300 MG, 450 MG ........................ 14
Theophylline ER ORAL
TABLET EXTENDED
MG ................................................................................... 14
Theophylline ORAL SOLUTION
80 MG/15ML .................................................... 14
Thera-M ORAL TABLET
................................................................................................ 73
Thiamine HCl INJECTION
SOLUTION 100 MG/ML .............. 89
Thioridazine HCl ORAL
MG, 50 MG ......................................................... 36
Thiothixene ORAL CAPSULE 1
MG, 10 MG, 2 MG, 5 MG ............. 36
THYROLAR-1 ORAL
TABLET 60 (12.5-50) MG
(MCG) ........................................................................ 84
THYROLAR-1/2 ORAL
TABLET 30 (6.25-25) MG
(MCG) ........................................................................ 84
THYROLAR-1/4 ORAL
TABLET 15 (3.1-12.5) MG
(MCG) ........................................................................ 85
THYROLAR-2 ORAL
TABLET 120 (25-100) MG
(MCG) ........................................................................ 85
THYROLAR-3 ORAL
TABLET 180 (37.5-150) MG
(MCG) ........................................................................ 85
TiaGABine HCl ORAL TABLET
2 MG, 4 MG ....................................................... 16
Timolol Maleate
OPHTHALMIC GEL
FORMING SOLUTION 0.25 %,
0.5 % .............................................................................. 76
Timolol Maleate
OPHTHALMIC SOLUTION
0.25 %, 0.5 % ..................................................... 76
Timolol Maleate ORAL
................................................................................................ 42
TIVICAY ORAL TABLET 50
MG .................................................................................. 37
TOBI INHALATION
300 MG/5ML ....................................................... 2
TOBRADEX OPHTHALMIC
OINTMENT 0.3-0.1 % ...................... 78
Tobramycin Sulfate
OPHTHALMIC SOLUTION
0.3 % .............................................................................. 77
Tolmetin Sodium ORAL
CAPSULE 400 MG .................................... 4
Tolnaftate EXTERNAL CREAM
1 % .................................................................................... 51
Topiramate ORAL CAPSULE
SPRINKLE 15 MG, 25 MG
................................................................................................ 16
Topiramate ORAL TABLET 100
MG, 25 MG, 50 MG ................................ 16
Topiramate ORAL TABLET 200
MG ................................................................................... 16
Torsemide ORAL TABLET 10
MG, 100 MG, 20 MG, 5 MG
................................................................................................ 58
TRADJENTA ORAL TABLET
5 MG ............................................................................. 21
TraMADol HCl ORAL TABLET
50 MG ............................................................................. 6
Tranylcypromine Sulfate ORAL
TABLET 10 MG .......................................... 18
Travel Sickness ORAL TABLET
CHEWABLE 25 MG ............................ 23
TraZODone HCl ORAL
MG ................................................................................... 18
TRELSTAR DEPOT
INTRAMUSCULAR*
SUSPENSION
32
TRELSTAR DEPOT MIXJECT
INTRAMUSCULAR*
SUSPENSION
................................................................................................ 32
TRELSTAR LA
INTRAMUSCULAR*
SUSPENSION
................................................................................................ 32
TRELSTAR LA MIXJECT
INTRAMUSCULAR*
SUSPENSION
................................................................................................ 32
TRELSTAR MIXJECT
INTRAMUSCULAR*
SUSPENSION
................................................................................................ 32
Tretinoin EXTERNAL CREAM
0.025 %, 0.05 %, 0.1 % ......................... 50
Tretinoin EXTERNAL GEL 0.01
%, 0.025 % ............................................................. 50
Triamcinolone Acetonide
EXTERNAL CREAM 0.025 %,
0.1 %, 0.5 % ......................................................... 54
................................................................................................ 54
MOUTH/THROAT PASTE 0.1
% ......................................................................................... 72
Triamterene-HCTZ ORAL
CAPSULE 37.5-25 MG ..................... 57
Triamterene-HCTZ ORAL
TABLET 37.5-25 MG, 75-50 MG
................................................................................................ 58
Triazolam ORAL TABLET 0.125
MG, 0.25 MG .................................................... 64
TRI-ESTARYLLA ORAL
TABLET 0.18/0.215/0.25 MG-35
MCG ............................................................................. 47
Trifluoperazine HCl ORAL
TABLET 1 MG, 10 MG, 2 MG, 5
MG ................................................................................... 36
Trifluridine OPHTHALMIC
SOLUTION 1 % .......................................... 78
................................................................................................
Trihexyphenidyl HCl ORAL
ELIXIR 0.4 MG/ML ............................. 34
Trihexyphenidyl HCl ORAL
TABLET 2 MG, 5 MG ........................ 34
TRILYTE ORAL SOLUTION
................................................................................................ 65
Trimethoprim ORAL TABLET
100 MG ...................................................................... 28
Trinatal Rx 1 ORAL TABLET
60-1 MG .................................................................... 74
TRINATE ORAL TABLET
................................................................................................ 74
TRINESSA (28) ORAL
TABLET 0.18/0.215/0.25 MG-35
MCG ............................................................................. 47
Triple Antibiotic EXTERNAL
OINTMENT 5-400-5000 ............... 51
TRI-PREVIFEM ORAL
TABLET 0.18/0.215/0.25 MG-35
MCG ............................................................................. 47
TRI-SPRINTEC ORAL
TABLET 0.18/0.215/0.25 MG-35
MCG ............................................................................. 47
TRIVEEN-U ORAL CAPSULE
106.5-1 MG ......................................................... 74
Tri-Vit/Fluoride ORAL
SOLUTION 0.25 MG/ML ............ 73
Tri-Vit/Fluoride/Iron ORAL
SOLUTION 0.25-10 MG/ML
................................................................................................ 73
Tri-Vitamin ORAL SOLUTION
1500-400-35 ........................................................ 73
Tri-Vitamin/Fluoride ORAL
SOLUTION 0.5 MG/ML ................ 73
TRIVORA (28) ORAL TABLET
................................................................................................ 47
TRIZIVIR ORAL TABLET
300-150-300 MG .......................................... 37
Trospium Chloride ORAL
TABLET 20 MG .......................................... 87
TRUVADA ORAL TABLET
200-300 MG ........................................................ 37
TUDORZA PRESSAIR
INHALATION AEROSOL
POWDER, BREATH
ACTIVATED 400 MCG/ACT
................................................................................................ 12
TYKERB ORAL TABLET 250
MG .................................................................................. 33
UltimateCare Combo ORAL
MISC 30-1 MG .............................................. 74
UNITHROID ORAL TABLET
100 MCG, 112 MCG, 125 MCG,
137 MCG, 150 MCG, 175 MCG,
200 MCG, 25 MCG, 300 MCG,
50 MCG, 75 MCG, 88 MCG
................................................................................................ 85
Urea EXTERNAL CREAM 40 %
................................................................................................ 54
URETRON D/S ORAL
TABLET ................................................................. 86
Ursodiol ORAL CAPSULE 300
MG ................................................................................... 60
Uticap ORAL CAPSULE 120
MG ................................................................................... 86
ValACYclovir HCl ORAL
TABLET 1 GM, 500 MG ................ 39
Valproic Acid ORAL CAPSULE
250 MG ...................................................................... 17
Valproic Acid ORAL
SOLUTION 250 MG/5ML .......... 17
Valproic Acid ORAL SYRUP 250
MG/5ML ................................................................. 17
Vancomycin HCl
RECONSTITUTED 1000 MG,
500 MG, 750 MG ......................................... 28
Vancomycin HCl ORAL
................................................................................................ 28
VANDAZOLE VAGINAL GEL
0.75 % ........................................................................... 87
VELIVET ORAL TABLET
0.1/0.125/0.15 -0.025 MG ................ 47
Venlafaxine HCl ER ORAL
CAPSULE EXTENDED
37.5 MG, 75 MG .......................................... 19
Venlafaxine HCl ORAL
TABLET 100 MG, 25 MG, 37.5
MG, 50 MG, 75 MG ................................ 19
VENTOLIN HFA
INHALATION AEROSOL,
SOLUTION 108 (90 BASE)
MCG/ACT ........................................................... 14
Verapamil HCl ER ORAL
CAPSULE EXTENDED
120 MG, 180 MG, 200 MG, 240
MG, 300 MG, 360 MG ........................ 43
Verapamil HCl ER ORAL
TABLET
MG, 180 MG, 240 MG ........................ 43
113
Verapamil HCl ORAL TABLET
120 MG, 40 MG, 80 MG ................... 43
VEXOL OPHTHALMIC
SUSPENSION 1 % .................................. 78
VIDEX ORAL SOLUTION
GM .................................................................................. 38
VINATE AZ EXTRA ORAL
TABLET 29-1 MG ................................... 74
VINATE AZ ORAL TABLET
27-1 MG ................................................................... 74
VINATE GT ORAL TABLET
90-1 MG ................................................................... 74
VINATE II ORAL TABLET
29-1 MG ................................................................... 74
VINATE M ORAL TABLET
27-1 MG ................................................................... 74
VIRACEPT ORAL TABLET
250 MG, 625 MG ....................................... 38
VIREAD ORAL TABLET 150
MG, 200 MG, 250 MG, 300 MG
................................................................................................ 39
Vitamin A ORAL CAPSULE
10000 UNIT, 8000 UNIT ................. 88
Vitamin B Complex-C ORAL
CAPSULE ........................................................ 72
Vitamin B-1 ORAL TABLET 100
MG, 250 MG, 50 MG ............................ 89
Vitamin B-12 ORAL TABLET
1000 MCG ............................................................. 63
Vitamin B-6 ER ORAL TABLET
MG ................................................................................... 89
Vitamin B-6 ORAL TABLET 100
MG, 25 MG, 250 MG, 50 MG,
500 MG ...................................................................... 89
Vitamin C ORAL TABLET 250
MG ................................................................................... 89
Vitamin D (Ergocalciferol)
ORAL CAPSULE 50000 UNIT
................................................................................................ 88
Vitamin D3 ORAL TABLET 400
UNIT ............................................................................ 89
Vitamin K (Phytonadione)
ORAL TABLET 100 MCG
................................................................................................ 89
Vitamins A & D EXTERNAL
OINTMENT .................................................. 55
Vitamins ACD-Fluoride ORAL
SOLUTION 0.25 MG/ML ............ 73
VitaTRUM ORAL TABLET
CHEWABLE ................................................ 73
VOLTAREN TRANSDERMAL
GEL 1 % .................................................................. 52
114
VYTORIN ORAL TABLET
10-10 MG, 10-20 MG, 10-40
MG, 10-80 MG .............................................. 25
VYVANSE ORAL CAPSULE
20 MG, 30 MG, 40 MG, 50 MG,
60 MG, 70 MG .................................................. 1
Warfarin Sodium ORAL
TABLET 1 MG, 10 MG, 2 MG,
2.5 MG, 3 MG, 4 MG, 5 MG, 6
MG, 7.5 MG ....................................................... 14
WESTHROID ORAL TABLET
113.75 MG, 130 MG, 146.25
MG, 16.25 MG, 162.5 MG, 195
MG, 260 MG, 32.5 MG, 325
MG, 48.75 MG, 65 MG, 81.25
MG, 97.5 MG .................................................. 85
XALKORI ORAL CAPSULE
200 MG, 250 MG ....................................... 33
XARELTO ORAL TABLET 10
MG .................................................................................. 14
XELODA ORAL TABLET 150
MG, 500 MG .................................................... 31
XOLAIR SUBCUTANEOUS*
SOLUTION
................................................................................................ 11
XTANDI ORAL CAPSULE 40
MG .................................................................................. 31
X-VIATE EXTERNAL
CREAM 40 % ................................................. 54
Zafirlukast ORAL TABLET 10
MG, 20 MG ......................................................... 12
ZEBUTAL ORAL CAPSULE
50-500-40 MG ..................................................... 4
ZELBORAF ORAL TABLET
240 MG ..................................................................... 32
ZETIA ORAL TABLET 10 MG
................................................................................................ 26
ZIAGEN ORAL SOLUTION 20
MG/ML .................................................................... 38
Zidovudine ORAL CAPSULE
100 MG ...................................................................... 39
Zidovudine ORAL SYRUP 50
MG/5ML ................................................................. 39
Zidovudine ORAL TABLET 300
MG ................................................................................... 39
Zinc Sulfate ORAL TABLET 220
(50 Zn) MG ....................................................... 71
ZOLINZA ORAL CAPSULE
100 MG ..................................................................... 32
Zolpidem Tartrate ORAL
TABLET 10 MG, 5 MG .................... 64
Zonisamide ORAL CAPSULE
100 MG ...................................................................... 16
Zonisamide ORAL CAPSULE 25
MG ................................................................................... 16
Zonisamide ORAL CAPSULE 50
MG ................................................................................... 16
ZOVIA 1/35E (28) ORAL
TABLET 1-35 MG-MCG ............. 46
ZOVIA 1/50E (28) ORAL
TABLET 1-50 MG-MCG ............. 46
ZOVIRAX EXTERNAL
CREAM 5 % ..................................................... 52

Harmony Health Plan PDL

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