FORMULARY Q3 - Gold Coast Health Plan

To Improve the Health of Our Members Through the Provision of High Quality Care and Services Mejorar la salud de nuestros miembros a través del suministro de atención y servicio de alta calidad

F O R M U L A R Y

JULY

2018For Questions and Gold Coast Health Plan Information, Please Call 1-888-301-1228www.goldcoasthealthplan.org

Q3

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INTRODUCTION We are pleased to provide the Gold Coast Health Plan List of Covered Drugs as a useful reference and informational tool. The GCHP List of Covered Drugs can assist practitioners in selecting clinically appropriate and cost effective products for their patients.

The information contained in the GCHP List of Covered Drugs is provided solely for the convenience of medical providers. We do not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. This List of Covered Drugs is not intended to be a substitute for the knowledge, expertise, skill and judgment of the medical provider in his or her choice of prescription drugs. All the information in this List of Covered Drugs is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber.

We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information.

National guidelines can be found on the National Guideline Clearinghouse site at http://www.guideline.gov

PREFACE The GCHP List of Covered Drugs is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Unless exceptions are noted, generally all applicable dosage forms and strengths of the drug cited are included in the GCHP List of Covered Drugs. Generics should be considered the first line of prescribing.

Drugs represented in the GCHP List of Covered Drugs may have varying cost to the plan member based on the plans benefit structure. Generic medications typically are available at the lowest cost, brand-name medications on the GCHP List of Covered Drugs will generally cost more than generics, and brand-name medications not on the list will generally cost the most.

PHARMACY AND THERAPEUTICS (P&T) COMMITTEE The services of the GCHP Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an external advisory body of experts. The P&T Committee's voting members include physicians and pharmacists, all of whom have a broad background of clinical and academic expertise regarding prescription drugs. Employees with significant clinical expertise are invited to meet with the P&T Committee. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers.

GENERIC SUBSTITUTION Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. However, not all strengths or dosage forms of the generic name in may be generically available. The GCHP List of Covered Drugs is a mandatory generic drug list. So whenever a generic to a covered agent becomes available, it is added. And if the branded agent was part of the cover drug list, the branded agent will be removed from the covered drug list.

Generic drugs are usually priced lower than their brand-name equivalents. Generic drugs are:

• Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the

same strict standards that apply to brand-name drugs.

• Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug (bioequivalence). Generics may be different from the brand in size, color, and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug.

• Manufactured in the same strength and dosage form as the brand-name drugs.

• When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug (therapeutic equivalence).

http://www.guideline.gov/

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SPECIALTY PLAN DESIGN Specialty Guideline Management (SGM) SGM is our utilization management program that helps ensure appropriate utilization for specialty medication based on currently accepted evidence-based medicine guidelines. The utilization management program is available for all therapeutic areas dispensed by our specialty pharmacies. SGM is designed to ensure safety and efficacy while preventing off-guideline utilization. Medications which may be included in the SGM program are identified in the GCHP List of Covered Drugs under the heading of “Specialty” for your reference. SGM may also be combined with Inventory Management/ Dose Optimization and Optimal Drug Mix through High Performance Specialty Design to appropriately manage specialty medications.

PLAN DESIGN The GCHP List of Covered Drugs is a closed drug list plan design. The medications listed on the drug list are covered by the plan as represented. Certain medications on the list are covered if utilization management criteria are met (i.e. Step Therapy, LMN, CPA, Quantity Limits, etc); requests for use of such medications outside of their listed criteria will be reviewed for medical necessity.

Should it become necessary to write a prescription for a drug, which is not on the GCHP List of Covered Drugs, one must obtain clinical prior authorization.

LEGEND PA Prior Authorization QL Quantity Limit ST Step Therapy SP Specialty - Limited to Specialty Pharmacies

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EXCLUDED THERAPEUTIC CLASSES AND DRUGS FROM GCHP LIST OF COVERED DRUGS These therapeutic classes of drugs are carved out from the GCHP List of Covered Drugs. This means that when one of these medications is prescribed, it will be filled by the pharmacist, who in turn will bill the State of California for reimbursement.

DEPENDENCTY TREATMENT Acamprosate Calcium Buprenorphine HCl Buprenorphine HCl-Naloxone HCl

Buprenorphine Transdermal Patch Naltrexone Naltrexone HCl

Naltrexone Microsphere Injectable Suspension Naloxone HCL

HIV

Abacavir Sulfate Elvitegravir-Cobicistat-Emtricitabine- Lopinavir-Ritonavir Abacavir Sulfate-Lamivudine Tenofovir DF Maraviroc Abacavir Sulfate-Lamivudine-Zidovudine Elvitegravir-Cobicistat-Emtricitabine- Nevirapine Abacavir Sulfate-Dolutegravir-Lamivudine Tenofovir Alafenamide Nelfinavir Mesylate Atazanavir Sulfate Emtricitabine Raltegravir Potassium Atazanavir-Cobisitat Emtricitabine-Rilpivirine-Tenofovir DF Rilpirvirine Hydrochloride Cobicistat Emtricitabine-Rilpivirine-Tenofovir Alafen. Ritonavir Darunavir Ethanolate Emtricitabine-Tenofovir DF Saquinavir Darunavir-Cobicistat Enfuvirtide Saquinavir Mesylate Delavirdine Mesylate Etravirine Stavudine Dolutegravir Fosamprenavir Calcium Tenofovir Disoproxil Fumarate Efavirenz Indinavir Sulfate Tipranavir Efavirenz-Emtricitabine-Tenofovir DF Lamivudine Elvitegravir Lamivudine-Zidovudine ERECTILE DYSFUNCTION

COAGULATION FACTORS Antihemophilic Factor(Factor VIII) Factor VIIa Factor IX Factor IX Complex Factor XIIIa Factor XIII Antihemophilic Factor/Von Willebrand Complex Anti-inhibitor Coagulant Complex Von Willebrand Factor Complex PSYCHIATRIC Amantadine HCl Iloperidone Phenelzine Sulfate Aripiprazole Isocarboxazid Pimozide Asenapine Maleate Lithium Carbonate Quetiapine Benztropine Mesylate Lithium Citrate Risperidone Brexpiprazole Loxapine Succinate Selegiline TD Patch Cariprazine (pending) Lurasidone Hydrochloride Thioridazine HCl Chlorpromazine HCl Molindone HCl Thiothixene Clozapine Olanzapine Thiothixene HCl Fluphenazine Decanoate Olanzapine-Fluoxetine HCl Tranylcypromine Sulfate Fluphenazine HCl Olanzapine Pamoate Trifluoperazine HCl Haloperidol Paliperidone Trihexyphenidyl Haloperidol Decanoate Paliperidone Palmitate Ziprasidone HCl Haloperidol Lactate Perphenazine Ziprasidone Mesylate

NOTICE The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. All rights reserved.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with Gold Coast Health Plan.

When viewing the GCHP List of Covered Drugs via the Internet, please be advised that the GCHP List of Covered Drugs is updated periodically and changes may appear prior to their effective date to allow for client notification.

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Analgesics - Drugs for Pain ................................................................................................................................ 4

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

Anesthetics ........................................................................................................................................................... 14

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

Antibacterials ....................................................................................................................................................... 17

Anticoagulants ..................................................................................................................................................... 27

Anticonvulsants - Drugs for Seizures ............................................................................................................ 29

Antidementia Agents - Drugs for Alzheimer's Disease and Dementia ................................................. 32

Antidepressants .................................................................................................................................................. 33

Antiemetics - Drugs for Nausea and Vomiting ............................................................................................ 35

Antifungals ............................................................................................................................................................ 36

Antigout Agents ................................................................................................................................................... 39

Antimigraine Agents ........................................................................................................................................... 39

Antimyasthenic Agents ..................................................................................................................................... 40

Antimycobacterials ............................................................................................................................................. 41

Antineoplastics - Drugs for Cancer ................................................................................................................ 41

Antiparasitics ....................................................................................................................................................... 47

Antiparkinson Agents ........................................................................................................................................ 48

Antiplatelets .......................................................................................................................................................... 49

Antivirals ................................................................................................................................................................ 50

Anxiolytics - Drugs for Anxiety ....................................................................................................................... 52

Blood Products / Modifiers / Volume Expanders - Drugs for Bleeding Disorders ............................ 54

Cardiovascular Agents - Drugs for Heart and Circulation Conditions ................................................. 55

Central Nervous System Agents - Drugs for Attention Deficit Disorder ............................................. 67

Central Nervous System Agents - Drugs for Multiple Sclerosis ............................................................ 68

Central Nervous System Agents - Miscellaneous ...................................................................................... 70

Dental and Oral Agents - Drugs for Mouth and Throat Conditions ....................................................... 71

Dermatological Agents - Drugs for Skin Conditions ................................................................................. 72

Diabetes - Antidiabetic Agents ........................................................................................................................ 79

Diabetes - Glucose Monitoring ........................................................................................................................ 82

Table of Contents

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Diabetes - Glycemic Agents ............................................................................................................................. 82

Diabetes - Insulins .............................................................................................................................................. 82

Electrolytes / Minerals / Metals / Vitamins .................................................................................................... 86

Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer ................................................................... 105

Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions ............................. 107

Genetic or Enzyme Disorder: Drugs for Replacement, Modifiers, Treatment .................................. 110

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions ..................................... 111

Genitourinary Agents - Drugs for Prostate Conditions .......................................................................... 113

Hormonal Agents - Adrenal ............................................................................................................................ 113

Hormonal Agents - Men's Health .................................................................................................................. 119

Hormonal Agents - Osteoporosis ................................................................................................................. 119

Hormonal Agents - Parathyroid ..................................................................................................................... 119

Hormonal Agents - Pituitary ........................................................................................................................... 120

Hormonal Agents - Sex Hormones and Birth Control ............................................................................. 122

Hormonal Agents - Thyroid ............................................................................................................................ 130

Immunological Agents - Drugs for Immune System Stimulation or Suppression .......................... 131

Immunological Agents - Drugs for Vaccination ........................................................................................ 135

Inflammatory Bowel Disease Agents ........................................................................................................... 138

Metabolic Bone Disease Agents - Drugs for Osteoporosis ................................................................... 140

Miscellaneous Therapeutic Agents .............................................................................................................. 141

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation .......................................... 145

Ophthalmic Agents - Drugs for Glaucoma ................................................................................................. 147

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions ........................................................... 148

Otic Agents - Drugs for Ear Conditions ...................................................................................................... 150

Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold ...................................... 150

Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions .............. 154

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis ..................................................... 158

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension .................................. 159

Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm .......................................................... 160

Sleep Disorder Agents ..................................................................................................................................... 160

Effective July 1, 2018 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; SP=Specialty

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Drug Name Reference Brand-Generic Notes

Analgesics - Drugs for Pain

acetaminophen-codeine #2 oral tablet 300-15 mg

G QL (124 EA per 31 days)


Tylenol with Codeine #3 G QL (124 EA per 31 days)



acetaminophen-codeine oral solution 120-12 mg/5ml

G

acetaminophen-codeine oral tablet 300-15 mg


acetaminophen-codeine oral tablet 300-60 mg


alfentanil hcl intravenous solution 1000 mcg/2ml, 2500 mcg/5ml

G

apap-caff-dihydrocodeine oral capsule 320.5-30-16 mg

Trezix G

apap-caff-dihydrocodeine oral tablet 325-30-16 mg

G

ascomp-codeine oral capsule 50-325-40-30 mg

Ascomp-Codeine G

butalbital-acetaminophen oral tablet 50-300 mg

Bupap G

butalbital-acetaminophen oral tablet 50-325 mg

Tencon G

butalbital-apap oral tablet 50-325 mg Tencon G

butalbital-apap-caff-cod oral capsule 50-300-40-30 mg

Fioricet/Codeine G

butalbital-apap-caff-cod oral capsule 50-325-40-30 mg


butalbital-apap-caffeine oral capsule 50-300-40 mg

Fioricet G

butalbital-apap-caffeine oral capsule 50-325-40 mg

Esgic G QL (124 EA per 31 days)


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butalbital-apap-caffeine oral tablet 50-325-40 mg

Esgic G

butalbital-asa-caff-codeine oral capsule 50-325-40-30 mg

Ascomp-Codeine G

butalbital-asa-caffeine oral capsule 50-325-40 mg

Fiorinal G

butalbital-aspirin-caffeine oral capsule 50-325-40 mg

Fiorinal G

butalbital-aspirin-caffeine oral tablet 50-325-40 mg

G

butorphanol tartrate injection solution 1 mg/ml, 2 mg/ml

G

butorphanol tartrate nasal solution 10 mg/ml

G

capacet oral capsule 50-325-40 mg Esgic G QL (124 EA per 31 days)

carisoprodol-aspirin-codeine oral tablet 200-325-16 mg

G

codeine sulfate oral tablet 15 mg, 30 mg, 60 mg

G

DILAUDID ORAL TABLET 2 MG, 4 MG, 8 MG

Dilaudid B QL (186 EA per 31 days)

duramorph injection solution 0.5 mg/ml, 1 mg/ml

G

duraxin oral capsule 300-200-20 mg G

endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

Endocet G QL (124 EA per 31 days)

esgic oral capsule 50-325-40 mg Esgic G QL (124 EA per 31 days)

fentanyl citrate (pf) injection solution 100 mcg/2ml, 1000 mcg/20ml, 250 mcg/5ml, 2500 mcg/50ml, 500 mcg/10ml

G

fentanyl citrate (pf) injection solution cartridge 100 mcg/2ml

G

fentanyl citrate buccal lozenge on a handle 1200 mcg, 1600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg

Actiq G

fentanyl citrate intravenous solution prefilled syringe 100 mcg/2ml

G

fentanyl citrate-nacl epidural solution 1-0.9 mg/250ml-%

G

fentanyl citrate-nacl intravenous solution 1-0.9 mg/100ml-%, 1.25-0.9 mg/250ml-%, 2.5-0.9 mg/250ml-%, 250-0.9 mcg/50ml-%, 5-0.9 mg/250ml-%

G


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fentanyl citrate-nacl intravenous solution prefilled syringe 15-0.9 mcg/3ml-%, 50-0.9 mcg/5ml-%, 500-0.9 mcg/50ml-%

G

fentanyl cit-ropivacaine-nacl epidural solution 0.2-0.125-0.9 mg/100ml-%, 0.2-0.15-0.9 mg/100ml-%, 0.2-0.2-0.9 mg/100ml-%, 0.4-0.2-0.9 mg/200ml-%, 0.5-0.0625-0.9 mg/100ml-%, 0.625-0.2-0.9 mg/250ml-%, 1.25-0.2-0.9 mg/250ml-%

G

fentanyl cit-ropivacaine-nacl epidural solution prefilled syringe 0.1-0.125-0.9 mg/50ml-%, 0.1-0.2-0.9 mg/50ml-%

G

fentanyl transdermal patch 72 hour 100 mcg/hr

Duragesic-100 G QL (15 EA per 31 days)





fentanyl transdermal patch 72 hour 37.5 mcg/hr, 62.5 mcg/hr, 87.5 mcg/hr






fentanyl-bupivacaine-nacl epidural solution 0.2-0.1-0.9 mg/100ml-%, 0.2-0.125-0.9 mg/100ml-%, 0.25-0.08-0.9 mg/125ml-%, 0.4-0.15-0.9 mg/200ml-%, 0.5-0.0625-0.9 mg/100ml-%, 0.5-0.0625-0.9 mg/250ml-%, 0.5-0.1-0.9 mg/100ml-%, 0.6-0.125-0.9 mg/200ml-%, 0.75-0.1-0.9 mg/150ml-%, 0.75-0.125-0.9 mg/250ml-%, 1.25-0.0625-0.9 mg/250ml-%, 1.25-0.075-0.9 mg/250ml-%

G

FENTORA BUCCAL TABLET 100 MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG

B PA; QL (124 EA per 31 days)

hydrocodone-acetaminophen oral solution 10-325 mg/15ml, 2.5-108 mg/5ml, 5-217 mg/10ml, 7.5-325 mg/15ml

G

hydrocodone-acetaminophen oral tablet 10-300 mg

Vicodin HP G QL (124 EA per 31 days)


Lorcet HD G QL (124 EA per 31 days)

hydrocodone-acetaminophen oral tablet 2.5-325 mg

Verdrocet G


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Vicodin G


Lorcet G QL (124 EA per 31 days)


Vicodin ES G


Lorcet Plus G QL (124 EA per 31 days)

hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg

Ibudone G QL (186 EA per 31 days)

hydrocodone-ibuprofen oral tablet 7.5-200 mg


hydromorphone hcl er oral tablet er 24 hour abuse-deterrent 12 mg, 16 mg, 32 mg, 8 mg

Exalgo G

hydromorphone hcl injection solution 1 mg/ml, 2 mg/ml, 4 mg/ml

Dilaudid G

hydromorphone hcl oral liquid 1 mg/ml Dilaudid G QL (500 ML per 31 days)

hydromorphone hcl oral tablet 2 mg, 4 mg, 8 mg

Dilaudid G QL (186 EA per 31 days)

hydromorphone hcl pf injection solution 1 mg/ml, 10 mg/ml, 2 mg/ml, 4 mg/ml, 50 mg/5ml, 500 mg/50ml

G

hydromorphone hcl rectal suppository 3 mg

G

hydromorphone hcl-nacl intravenous solution 10-0.9 mg/100ml-%, 10-0.9 mg/50ml-%, 18-0.9 mg/30ml-%, 2-0.9 mg/50ml-%, 25-0.9 mg/50ml-%, 40-0.9 mg/100ml-%, 5-0.9 mg/50ml-%, 6-0.9 mg/30ml-%

G

hydromorphone hcl-nacl intravenous solution prefilled syringe 1-0.9 mg/5ml-%, 10-0.9 mg/25ml-%, 10-0.9 mg/50ml-%, 12-0.9 mg/60ml-%, 15-0.9 mg/30ml-%, 15-0.9 mg/50ml-%, 3-0.9 mg/30ml-%, 5-0.9 mg/25ml-%

G

hydromorphone-bupivacaine-nacl epidural solution 2.5-0.1-0.9 mg/250ml-%

G

hydromorphone-ropivacaine-nacl epidural solution 2-0.1-0.9 mg/200ml-%

G

ibudone oral tablet 5-200 mg Ibudone G QL (186 EA per 31 days)

levorphanol tartrate oral tablet 2 mg G


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lorcet hd oral tablet 10-325 mg Lorcet HD G QL (124 EA per 31 days)

lorcet oral tablet 5-325 mg Lorcet G QL (124 EA per 31 days)

lorcet plus oral tablet 7.5-325 mg Lorcet Plus G QL (124 EA per 31 days)

mapap oral liquid 160 mg/5ml Little Remedies for Fever G QL (248 EA per 31 days); AL (Max 10 Years)

marten-tab oral tablet 50-325 mg Tencon G

meperidine hcl injection solution 10 mg/ml G

meperidine hcl injection solution 100 mg/ml, 25 mg/ml, 50 mg/ml

Demerol G

meperidine hcl oral solution 50 mg/5ml G

meperidine hcl oral tablet 100 mg, 50 mg Demerol G

meperidine hcl-sodium chloride intravenous solution 1000-0.9 mg/100ml-%, 500-0.9 mg/50ml-%

G

meperidine-promethazine oral capsule 50-25 mg

G

methadone hcl injection solution 10 mg/ml G

methadone hcl intensol oral concentrate 10 mg/ml

Methadone HCl Intensol G QL (250 ML per 31 days)

methadone hcl oral concentrate 10 mg/ml Methadone HCl Intensol G QL (250 ML per 31 days)

methadone hcl oral solution 10 mg/5ml, 5 mg/5ml

G QL (500 ML per 31 days)

methadone hcl oral tablet 10 mg, 5 mg Dolophine G QL (124 EA per 31 days)

methadone hcl oral tablet soluble 40 mg Methadose G

methadose oral concentrate 10 mg/ml Methadone HCl Intensol G QL (250 ML per 31 days)

methadose oral tablet soluble 40 mg Methadose G

methadose sugar-free oral concentrate 10 mg/ml

Methadone HCl Intensol G QL (250 ML per 31 days)

morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml


morphine sulfate (pf) injection solution 0.5 mg/ml, 1 mg/ml, 10 mg/ml, 2 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml

G

morphine sulfate (pf) intravenous solution 10 mg/ml, 2 mg/ml, 4 mg/ml, 8 mg/ml

G


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morphine sulfate er beads oral capsule extended release 24 hour 120 mg, 30 mg, 45 mg, 60 mg, 75 mg, 90 mg

G

morphine sulfate er oral capsule extended release 24 hour 10 mg

Kadian G QL (93 EA per 31 days)

morphine sulfate er oral capsule extended release 24 hour 100 mg, 20 mg, 30 mg, 50 mg, 60 mg, 80 mg

Kadian G

morphine sulfate er oral tablet extended release 100 mg, 15 mg, 200 mg, 30 mg, 60 mg

MS Contin G QL (93 EA per 31 days)

morphine sulfate injection solution 10 mg/ml, 15 mg/ml, 2 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml

G

morphine sulfate intramuscular device 10 mg/0.7ml

G

morphine sulfate intravenous solution 1 mg/ml, 150 mg/30ml, 25 mg/ml, 50 mg/ml

G

morphine sulfate oral solution 10 mg/5ml, 20 mg/5ml

G

morphine sulfate oral tablet 15 mg, 30 mg G

morphine sulfate rectal suppository 10 mg, 20 mg, 30 mg, 5 mg

G

morphine sulfate-nacl intravenous solution 50-0.9 mg/50ml-%

G

morphine sulfate-nacl intravenous solution prefilled syringe 0.5-0.9 mg/ml-%, 50-0.9 mg/50ml-%

G

MS CONTIN ORAL TABLET EXTENDED RELEASE 100 MG

MS Contin B QL (93 EA per 31 days)

nalbuphine hcl injection solution 10 mg/ml, 20 mg/ml

G

NUCYNTA ORAL TABLET 50 MG B QL (30 EA per 30 days)

OPANA ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 5 MG, 7.5 MG

B ST; QL (62 EA per 31 days)

oxycodone hcl oral capsule 5 mg G QL (186 EA per 31 days)

oxycodone hcl oral concentrate 100 mg/5ml

G

oxycodone hcl oral solution 5 mg/5ml G

oxycodone hcl oral tablet 10 mg, 20 mg G QL (186 EA per 31 days)


10


oxycodone hcl oral tablet 15 mg, 30 mg, 5 mg

Roxicodone G QL (186 EA per 31 days)

oxycodone-acetaminophen oral solution 5-325 mg/5ml

G

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

Endocet G QL (124 EA per 31 days)

oxycodone-aspirin oral tablet 4.8355-325 mg

G

oxycodone-ibuprofen oral tablet 5-400 mg G

oxymorphone hcl er oral tablet extended release 12 hour 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 5 mg, 7.5 mg

G

oxymorphone hcl oral tablet 10 mg, 5 mg Opana G ST; QL (124 EA per 31 days)

panlor oral tablet 325-30-16 mg G

pentazocine-naloxone hcl oral tablet 50-0.5 mg

G

phrenilin forte oral capsule 50-300-40 mg Fioricet G

remifentanil hcl intravenous solution reconstituted 1 mg, 2 mg, 5 mg

Ultiva G

sufentanil citrate intravenous solution 100 mcg/2ml, 250 mcg/5ml, 50 mcg/ml

G

tencon oral tablet 50-325 mg Tencon G

tramadol hcl er (biphasic) oral tablet extended release 24 hour 100 mg, 200 mg, 300 mg


tramadol hcl er oral capsule extended release 24 hour 150 mg

G

tramadol hcl er oral tablet extended release 24 hour 100 mg, 300 mg


tramadol hcl er oral tablet extended release 24 hour 200 mg

G

tramadol hcl oral tablet 50 mg Ultram G QL (124 EA per 31 days)

tramadol-acetaminophen oral tablet 37.5-325 mg

Ultracet G QL (124 EA per 31 days)

vanatol lq oral solution 50-325-40 mg/15ml

G

vanatol s oral solution 50-325-40 mg/15ml G

verdrocet oral tablet 2.5-325 mg Verdrocet G

vicodin es oral tablet 7.5-300 mg Vicodin ES G


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vicodin hp oral tablet 10-300 mg Vicodin HP G QL (124 EA per 31 days)

vicodin oral tablet 5-300 mg Vicodin G

xylon oral tablet 10-200 mg Ibudone G QL (186 EA per 31 days)

zebutal oral capsule 50-325-40 mg Esgic G QL (124 EA per 31 days)

ZOHYDRO ER ORAL CAPSULE ER 12 HOUR ABUSE-DETERRENT 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 50 MG

B PA

Analgesics - Drugs for Pain and Inflammation

aspirin ec low dose oral tablet delayed release 81 mg

Aspir-Low G QL (122 EA per 31 days)

aspirin ec oral tablet delayed release 325 mg

Bayer Aspirin Regimen G QL (122 EA per 31 days)

aspirin low dose oral tablet delayed release 81 mg


aspirin oral tablet 325 mg Bayer Advanced Aspirin Reg St


aspirin oral tablet delayed release 325 mg Bayer Aspirin Regimen G QL (122 EA per 31 days)

bayer aspirin ec low dose oral tablet delayed release 81 mg


bayer aspirin oral tablet 325 mg Bayer Advanced Aspirin Reg St


celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg

CeleBREX G ST

choline-mag trisalicylate oral liquid 500 mg/5ml

G

diclofenac potassium oral tablet 50 mg G

diclofenac sodium er oral tablet extended release 24 hour 100 mg

G

diclofenac sodium oral tablet delayed release 25 mg, 50 mg, 75 mg

G

diclofenac sodium transdermal gel 1 % Voltaren G PA; QL (500 GM per 30 days)

diclofenac sodium transdermal solution 1.5 %

Klofensaid II G

diclofenac-misoprostol oral tablet delayed release 50-0.2 mg, 75-0.2 mg

Arthrotec G

diclofex dc combination therapy pack 1.5 & 0.025 %

DermacinRx Lexitral PharmaPak

G


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diclopak combination therapy pack 1.5 & 0.025 %


G

diclosaicin combination therapy pack 1.5 & 0.025 %


G

diclotral combination therapy pack 1.5 & 0.025 %


G

diflunisal oral tablet 500 mg G

etodolac er oral tablet extended release 24 hour 400 mg, 500 mg, 600 mg

G

etodolac oral capsule 200 mg, 300 mg G

etodolac oral tablet 400 mg Lodine G

etodolac oral tablet 500 mg G

fenoprofen calcium oral capsule 200 mg Fenortho G

fenoprofen calcium oral capsule 400 mg Nalfon G

fenoprofen calcium oral tablet 600 mg ProFeno G

fenortho oral capsule 200 mg Fenortho G

flurbiprofen oral tablet 100 mg, 50 mg G

gnp all day pain relief oral tablet 220 mg Aleve G QL (106 EA per 31 days)

ibuprofen childrens oral suspension 100 mg/5ml

Childrens Advil G QL (248 ML per 30 days); AL (Max 11 Years)

ibuprofen lysine intravenous solution 10 mg/ml

NeoProfen G

ibuprofen oral suspension 100 mg/5ml Childrens Advil G QL (248 ML per 30 days); AL (Max 11 Years)

ibuprofen oral tablet 200 mg Advil G QL (160 EA per 30 days)

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

IBU G

indomethacin er oral capsule extended release 75 mg

G

indomethacin oral capsule 25 mg, 50 mg G

indomethacin sodium intravenous solution reconstituted 1 mg

G

inflammacin combination therapy pack 75 & 0.025 mg-%

Inflammacin G

isometheptene-caffeine-apap oral tablet 65-20-325 mg

G

isometheptene-dichloral-apap oral capsule 65-100-325 mg

G


13


ketoprofen er oral capsule extended release 24 hour 200 mg

G

ketoprofen oral capsule 25 mg, 50 mg, 75 mg

G

ketorolac tromethamine injection solution 15 mg/ml, 30 mg/ml

G

ketorolac tromethamine intramuscular solution 60 mg/2ml

G

ketorolac tromethamine oral tablet 10 mg G

klofensaid ii transdermal solution 1.5 % Klofensaid II G

meclofenamate sodium oral capsule 100 mg, 50 mg

G

mefenamic acid oral capsule 250 mg Ponstel G

meloxicam oral tablet 15 mg, 7.5 mg Mobic G

nabumetone oral tablet 500 mg, 750 mg G

naproxen dr oral tablet delayed release 375 mg, 500 mg

EC-Naprosyn G

naproxen oral suspension 125 mg/5ml Naprosyn G

naproxen oral tablet 250 mg, 500 mg Naprosyn G

naproxen oral tablet 375 mg G

naproxen sodium er oral tablet extended release 24 hour 375 mg, 500 mg

Naprelan G

naproxen sodium oral capsule 220 mg Aleve G QL (106 EA per 31 days)

naproxen sodium oral tablet 220 mg Aleve G QL (106 EA per 31 days)

naproxen sodium oral tablet 275 mg G

naproxen sodium oral tablet 550 mg Anaprox DS G

nodolor oral capsule 325-65-100 mg G

nudiclo solupak combination therapy pack 1.5 & 0.025 %


G

nudiclo tabpak combination therapy pack 75 & 0.025 mg-%

Inflammacin G

oxaprozin oral tablet 600 mg Daypro G

piroxicam oral capsule 10 mg, 20 mg Feldene G

previdolrx plus analgesic combination therapy pack 75 & 0.025 mg-%

Inflammacin G

profeno oral tablet 600 mg ProFeno G

salsalate oral tablet 500 mg, 750 mg G

sulindac oral tablet 150 mg, 200 mg G


14


sure result dss premium pack combination therapy pack 1.5 & 0.025 %


G

tolmetin sodium oral capsule 400 mg G

tolmetin sodium oral tablet 200 mg, 600 mg

G

xelitral combination therapy pack 1.5 & 0.025 %


G

xenaflamm combination therapy pack 75 & 0.025 mg-%

Inflammacin G

Anesthetics

agoneaze external kit 2.5-2.5 % DermacinRx Empricaine G

anodyne lpt external kit 2.5-2.5 % DermacinRx Empricaine G

bd pudendal/local tray/1% lido injection kit 1 %

G

bupivacaine hcl (pf) injection solution 0.25 %, 0.5 %

Marcaine Preservative Free

G

bupivacaine hcl (pf) injection solution 0.75 %

Marcaine G

bupivacaine hcl injection solution 0.25 %, 0.5 %

Marcaine G

bupivacaine hcl-nacl injection solution 0.2-0.9 %

G

bupivacaine in dextrose intrathecal solution 0.75-8.25 %

Marcaine Spinal G

bupivacaine spinal intrathecal solution 0.75-8.25 %

Marcaine Spinal G

bupivacaine-epinephrine (pf) injection solution 0.25% -1:200000, 0.5% -1:200000

Marcaine/Epinephrine PF G

bupivacaine-epinephrine injection solution 0.25% -1:200000, 0.5% -1:200000

Marcaine/Epinephrine G

chloroprocaine hcl (pf) injection solution 2 %, 3 %

Nesacaine-MPF G

cocaine hcl external solution 4 % G

dermacinrx empricaine external kit 2.5-2.5 %

DermacinRx Empricaine G

dermacinrx prizopak external kit 2.5-2.5 % DermacinRx Empricaine G

ethyl chloride external aerosol G

glydo external gel 2 % Glydo G

leva set/occlusive dressing external kit 2.5-2.5 %

DermacinRx Empricaine G

lidenza external patch 4-1 % Endoxcin G


15


lido bdk external kit 2.5-2.5 % DermacinRx Empricaine G

lidocaine external ointment 5 % G

lidocaine external patch 5 % Lidoderm G ST; QL (3 EA per 1 day)

lidocaine hcl (cardiac) intravenous solution 10 mg/ml, 20 mg/ml

G

lidocaine hcl (pf) injection solution 0.5 %, 1 %, 1.5 %, 2 %

Xylocaine-MPF G

lidocaine hcl (pf) injection solution 4 % G

lidocaine hcl external cream 3 % G

lidocaine hcl external cream 3.88 % Lidotral G

lidocaine hcl external gel 2 % Glydo G

lidocaine hcl external lotion 3 % Lidozion G

lidocaine hcl external solution 4 % G

lidocaine hcl injection solution 0.5 %, 1 %, 2 %

Xylocaine G

lidocaine in d5w intravenous solution 4-5 mg/ml-%, 8-5 mg/ml-%

G

lidocaine pak external ointment 5 % G

lidocaine-epinephrine injection solution 0.5 %-1:200000, 1 %-1:100000

Xylocaine/Epinephrine G

lidocaine-epinephrine injection solution 1.5 %-1:200000, 2 %-1:200000

Xylocaine-MPF/Epinephrine

G

lidocaine-epinephrine injection solution 2 %-1:100000, 2 %-1:50000

Xylocaine Dental G

lidocaine-prilocaine external cream 2.5-2.5 %

G

lidocaine-prilocaine external kit 2.5-2.5 % DermacinRx Empricaine G

lido-k external lotion 3 % Lidozion G

lidopin external cream 3 % G

lidopril external kit 2.5-2.5 % DermacinRx Empricaine G

lidopril xr external kit 2.5-2.5 % DermacinRx Empricaine G

lido-prilo caine pack external kit 2.5-2.5 % DermacinRx Empricaine G

liprozonepak external kit 2.5-2.5 % DermacinRx Empricaine G

livixil pak external kit 2.5-2.5 % DermacinRx Empricaine G

lorenza external patch 4-1 % Endoxcin G

lp lite pak external kit 2.5-2.5 % DermacinRx Empricaine G

medolor pak external kit 2.5-2.5 % DermacinRx Empricaine G

polocaine injection solution 1 %, 2 % G


16


polocaine-mpf injection solution 1 %, 1.5 %, 2 %

G

port-prep external kit 2.5-2.5 % DermacinRx Empricaine G

premium lidocaine external ointment 5 % G

prikaan external kit 2.5-2.5 % DermacinRx Empricaine G

prikaan lite external kit 2.5-2.5 % DermacinRx Empricaine G

prilolid external kit 2.5-2.5 % DermacinRx Empricaine G

priloxx lp external kit 2.5-2.5 % DermacinRx Empricaine G

relador pak external kit 2.5-2.5 % DermacinRx Empricaine G

relador pak plus external kit 2.5-2.5 % DermacinRx Empricaine G

releevia ml external patch 4-1 % Endoxcin G

ropivacaine hcl injection solution 10 mg/ml, 2 mg/ml, 5 mg/ml, 7.5 mg/ml

Naropin G

ropivacaine hcl-nacl epidural solution prefilled syringe 0.2-0.9 %

G

sensorcaine injection solution 0.25 %, 0.5 %

Marcaine G

sensorcaine/epinephrine injection solution 0.25% -1:200000, 0.5% -1:200000

Marcaine/Epinephrine G

sensorcaine-mpf injection solution 0.25 %, 0.5 %

Marcaine Preservative Free

G

sensorcaine-mpf injection solution 0.75 % Marcaine G

sensorcaine-mpf spinal intrathecal solution 0.75-8.25 %

Marcaine Spinal G

sensorcaine-mpf/epinephrine injection solution 0.25% -1:200000, 0.5% -1:200000

Marcaine/Epinephrine PF G

soluline external kit 2.5-2.5 % DermacinRx Empricaine G

solupicc external kit 2.5-2.5 % DermacinRx Empricaine G

synvexia external patch 4-1 % Endoxcin G

tetracaine hcl injection solution 1 % G

xylocaine dental injection solution 2 %-1:100000, 2 %-1:50000

Xylocaine Dental G

zeruvia external patch 4-1 % Endoxcin G

Anti-Addiction / Substance Abuse Treatment Agents

bupropion hcl er (smoking det) oral tablet extended release 12 hour 150 mg

Zyban G

CHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MG

B PA

CHANTIX ORAL TABLET 0.5 MG, 1 MG B PA


17


CHANTIX STARTING MONTH PAK ORAL TABLET 0.5 MG X 11 & 1 MG X 42

B PA

disulfiram oral tablet 250 mg, 500 mg Antabuse G

NICORETTE MOUTH/THROAT GUM 2 MG

KLS Quit2 B

nicotine polacrilex mouth/throat gum 2 mg KLS Quit2 G

nicotine polacrilex mouth/throat gum 4 mg KLS Quit4 G

nicotine polacrilex mouth/throat lozenge 2 mg, 4 mg

Commit G

nicotine step 1 transdermal patch 24 hour 21 mg/24hr

Nicoderm CQ G


Nicoderm CQ G


Nicoderm CQ G

NICOTROL INHALATION INHALER 10 MG

B ST

NICOTROL NS NASAL SOLUTION 10 MG/ML

B ST

Antibacterials

amikacin sulfate injection solution 1 gm/4ml, 500 mg/2ml

G

amoxicillin oral capsule 250 mg, 500 mg G

amoxicillin oral suspension reconstituted 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml

G

amoxicillin oral tablet 500 mg, 875 mg G

amoxicillin oral tablet chewable 125 mg, 250 mg

G

amoxicillin-potassium clavulanate er oral tablet extended release 12 hour 1000-62.5 mg

Augmentin XR G

amoxicillin-potassium clavulanate oral suspension reconstituted 200-28.5 mg/5ml, 400-57 mg/5ml

G

amoxicillin-potassium clavulanate oral suspension reconstituted 250-62.5 mg/5ml

Augmentin G

amoxicillin-potassium clavulanate oral suspension reconstituted 600-42.9 mg/5ml

Augmentin ES-600 G

amoxicillin-potassium clavulanate oral tablet 250-125 mg

G


18


amoxicillin-potassium clavulanate oral tablet 500-125 mg, 875-125 mg

Augmentin G

amoxicillin-potassium clavulanate oral tablet chewable 200-28.5 mg, 400-57 mg

G

ampicillin oral capsule 500 mg G

ampicillin sodium injection solution reconstituted 1 gm, 10 gm, 125 mg, 2 gm, 250 mg, 500 mg

G PA

ampicillin sodium intravenous solution reconstituted 1 gm, 10 gm, 2 gm

G PA

ampicillin-sulbactam sodium injection solution reconstituted 1.5 (1-0.5) gm, 15 (10-5) gm, 3 (2-1) gm

Unasyn G PA

ampicillin-sulbactam sodium intravenous solution reconstituted 1.5 (1-0.5) gm, 15 (10-5) gm

G PA

avidoxy oral tablet 100 mg G

azithromycin intravenous solution reconstituted 500 mg

Zithromax G

azithromycin oral packet 1 gm Zithromax G

azithromycin oral suspension reconstituted 100 mg/5ml, 200 mg/5ml

Zithromax G

azithromycin oral tablet 250 mg, 600 mg Zithromax G

azithromycin oral tablet 500 mg Zithromax G QL (4 EA per 10 days)

aztreonam injection solution reconstituted 1 gm, 2 gm

Azactam G PA

baciim intramuscular solution reconstituted 50000 unit

G

bacitracin intramuscular solution reconstituted 50000 unit

G

BACTROBAN NASAL NASAL OINTMENT 2 %

B

benzalkonium chloride external solution , 50 %

G

BICILLIN L-A INTRAMUSCULAR SUSPENSION 1200000 UNIT/2ML, 2400000 UNIT/4ML, 600000 UNIT/ML

B PA

cefaclor er oral tablet extended release 12 hour 500 mg

G

cefaclor oral capsule 250 mg, 500 mg G

cefaclor oral suspension reconstituted 125 mg/5ml, 250 mg/5ml, 375 mg/5ml

G

cefadroxil oral capsule 500 mg G


19


cefadroxil oral suspension reconstituted 250 mg/5ml, 500 mg/5ml

G

cefadroxil oral tablet 1 gm G

cefazolin in d5w intravenous solution 3 gm/100ml

G

cefazolin in sodium chloride intravenous solution 2-0.9 gm/50ml-%

G

cefazolin sodium injection solution reconstituted 1 gm, 10 gm, 100 gm, 20 gm, 300 gm, 500 mg

G

cefazolin sodium intravenous solution reconstituted 1 gm

G

cefazolin sodium-dextrose intravenous solution 1-4 gm/50ml-%, 2-4 gm/100ml-%

G

cefazolin sodium-dextrose intravenous solution reconstituted 1-4 gm-%, 2-3 gm-%

G

cefdinir oral capsule 300 mg G

cefdinir oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

G

cefditoren pivoxil oral tablet 200 mg G

cefditoren pivoxil oral tablet 400 mg Spectracef G

cefepime hcl injection solution reconstituted 1 gm, 2 gm

Maxipime G PA

cefepime hcl intravenous solution 1 gm/50ml, 2 gm/100ml

G

cefepime-dextrose intravenous solution reconstituted 1 gm/50ml, 2 gm/50ml

G

cefixime oral suspension reconstituted 100 mg/5ml

Suprax G PA; QL (150 ML per 31 days)

cefixime oral suspension reconstituted 200 mg/5ml

Suprax G PA

CEFOTAN INJECTION SOLUTION RECONSTITUTED 1 GM, 2 GM

Cefotan B PA

cefotaxime sodium injection solution reconstituted 1 gm, 10 gm, 2 gm, 500 mg

G PA

cefotetan disodium injection solution reconstituted 1 gm, 2 gm

Cefotan G PA

cefotetan disodium injection solution reconstituted 10 gm

G PA

cefotetan disodium-dextrose intravenous solution reconstituted 1-3.58 gm-%, 2-2.08 gm-%

G


20


cefoxitin sodium injection solution reconstituted 10 gm

G PA

cefoxitin sodium intravenous solution reconstituted 1 gm, 2 gm

G PA

cefoxitin sodium-dextrose intravenous solution reconstituted 1-4 gm-%, 2-2.2 gm-%

G

cefpodoxime proxetil oral suspension reconstituted 100 mg/5ml, 50 mg/5ml

G

cefpodoxime proxetil oral tablet 100 mg, 200 mg

G

cefprozil oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

G

cefprozil oral tablet 250 mg, 500 mg G

ceftazidime injection solution reconstituted 1 gm, 2 gm, 6 gm

Tazicef G PA

ceftibuten oral capsule 400 mg G

ceftibuten oral suspension reconstituted 180 mg/5ml

G

ceftriaxone sodium in dextrose intravenous solution 20 mg/ml, 40 mg/ml

G

ceftriaxone sodium injection solution reconstituted 1 gm

Rocephin G

ceftriaxone sodium injection solution reconstituted 100 gm, 2 gm, 250 mg, 500 mg

G

ceftriaxone sodium intravenous solution reconstituted 1 gm, 10 gm, 2 gm

G

ceftriaxone sodium-dextrose intravenous solution reconstituted 1-3.74 gm-%, 2-2.22 gm-%

G

cefuroxime axetil oral tablet 250 mg, 500 mg


cefuroxime sodium injection solution reconstituted 7.5 gm, 750 mg

G

cefuroxime sodium intravenous solution reconstituted 1.5 gm

G

cephalexin oral capsule 250 mg, 500 mg, 750 mg

Keflex G

cephalexin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

G

cephalexin oral tablet 250 mg, 500 mg G

chloramphenicol sod succinate intravenous solution reconstituted 1 gm

G


21


CIPRO ORAL SUSPENSION RECONSTITUTED 250 MG/5ML (5%)

Cipro B

ciprofloxacin hcl oral tablet 100 mg, 750 mg

G

ciprofloxacin hcl oral tablet 250 mg, 500 mg

Cipro G

ciprofloxacin in d5w intravenous solution 200 mg/100ml

G

ciprofloxacin in d5w intravenous solution 400 mg/200ml

Cipro in D5W G

ciprofloxacin intravenous solution 200 mg/20ml, 400 mg/40ml

G

ciprofloxacin oral suspension reconstituted 250 mg/5ml (5%), 500 mg/5ml (10%)

Cipro G

ciprofloxacin-ciproflox hcl er oral tablet extended release 24 hour 1000 mg, 500 mg

Cipro XR G

CLAFORAN INJECTION SOLUTION RECONSTITUTED 10 GM, 2 GM, 500 MG

B PA

CLAFORAN INTRAVENOUS SOLUTION RECONSTITUTED 1 GM, 2 GM

B PA

clarithromycin er oral tablet extended release 24 hour 500 mg

G

clarithromycin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml


clarithromycin oral tablet 250 mg G QL (28 EA per 14 days)

clarithromycin oral tablet 500 mg Biaxin G QL (28 EA per 14 days)

clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg

Cleocin G

clindamycin palmitate hcl oral solution reconstituted 75 mg/5ml

Cleocin G

clindamycin phosphate in d5w intravenous solution 300 mg/50ml, 600 mg/50ml, 900 mg/50ml

Cleocin in D5W G

clindamycin phosphate injection solution 300 mg/2ml, 600 mg/4ml, 9 gm/60ml, 900 mg/6ml, 9000 mg/60ml

Cleocin Phosphate G PA

clindamycin phosphate intravenous solution 150 mg/ml, 300 mg/2ml, 600 mg/4ml, 900 mg/6ml

Cleocin Phosphate G PA

clindamycin phosphate vaginal cream 2 % Cleocin G


22


colistimethate sodium (cba) injection solution reconstituted 150 mg

Coly-Mycin M G PA

COLY-MYCIN M INJECTION SOLUTION RECONSTITUTED 150 MG

Coly-Mycin M B PA

coremino oral tablet extended release 24 hour 135 mg, 45 mg, 90 mg

CoreMino G

CUBICIN INTRAVENOUS SOLUTION RECONSTITUTED 500 MG

Cubicin B PA

CUBICIN RF INTRAVENOUS SOLUTION RECONSTITUTED 500 MG

Cubicin B PA

DALVANCE INTRAVENOUS SOLUTION RECONSTITUTED 500 MG

B PA

daptomycin intravenous solution reconstituted 500 mg

Cubicin G PA

demeclocycline hcl oral tablet 150 mg, 300 mg

G

dicloxacillin sodium oral capsule 250 mg, 500 mg

G

doxy 100 intravenous solution reconstituted 100 mg

Doxy 100 G

doxycycline hyclate intravenous solution reconstituted 100 mg

Doxy 100 G

doxycycline hyclate oral capsule 100 mg, 50 mg

Morgidox G

doxycycline hyclate oral tablet 100 mg, 20 mg

G

doxycycline hyclate oral tablet 150 mg, 75 mg

Acticlate G

doxycycline hyclate oral tablet 50 mg TargaDOX G

doxycycline hyclate oral tablet delayed release 100 mg, 75 mg

G

doxycycline hyclate oral tablet delayed release 150 mg

Soloxide G

doxycycline hyclate oral tablet delayed release 200 mg, 50 mg

Doryx G

doxycycline monohydrate oral capsule 100 mg, 50 mg, 75 mg

Mondoxyne NL G

doxycycline monohydrate oral capsule 150 mg

G

doxycycline monohydrate oral suspension reconstituted 25 mg/5ml

Vibramycin G

doxycycline monohydrate oral tablet 100 mg, 150 mg, 50 mg, 75 mg

G

e.e.s. 400 oral tablet 400 mg E.E.S. 400 G


23


ertapenem sodium injection solution reconstituted 1 gm

INVanz G PA

erythrocin lactobionate intravenous solution reconstituted 500 mg

G

erythromycin base oral capsule delayed release particles 250 mg

G

erythromycin base oral tablet 250 mg, 500 mg

G

erythromycin ethylsuccinate oral suspension reconstituted 200 mg/5ml

E.E.S. Granules G

erythromycin ethylsuccinate oral tablet 400 mg

E.E.S. 400 G

FIRVANQ ORAL SOLUTION RECONSTITUTED 25 MG/ML, 50 MG/ML

B AL (Max 11 Years)

gentamicin in saline intravenous solution 0.8-0.9 mg/ml-%, 0.9-0.9 mg/ml-%, 1-0.9 mg/ml-%, 1.2-0.9 mg/ml-%, 1.4-0.9 mg/ml-%, 1.6-0.9 mg/ml-%, 2-0.9 mg/ml-%

G

gentamicin sulfate external cream 0.1 % G

gentamicin sulfate external ointment 0.1 %

G

gentamicin sulfate injection solution 10 mg/ml, 40 mg/ml

G

hydrogen peroxide solution 30 % G

imipenem-cilastatin intravenous solution reconstituted 250 mg

G PA

imipenem-cilastatin intravenous solution reconstituted 500 mg

Primaxin IV G PA

INVANZ INJECTION SOLUTION RECONSTITUTED 1 GM

INVanz B PA

INVANZ INTRAVENOUS SOLUTION RECONSTITUTED 1 GM

B PA

iodine tincture external tincture 2 % G

iodoquinol-hc-aloe polysacch external gel 1-2-1 %

Alcortin A G

levofloxacin in d5w intravenous solution 250 mg/50ml, 500 mg/100ml, 750 mg/150ml

G

levofloxacin intravenous solution 25 mg/ml

G

levofloxacin oral solution 25 mg/ml G

levofloxacin oral tablet 250 mg, 500 mg, 750 mg

Levaquin G


24


lincomycin hcl injection solution 300 mg/ml

Lincocin G

linezolid in sodium chloride intravenous solution 600-0.9 mg/300ml-%

G

linezolid intravenous solution 600 mg/300ml

Zyvox G PA

linezolid oral suspension reconstituted 100 mg/5ml

Zyvox G PA

linezolid oral tablet 600 mg Zyvox G PA

lugols external solution G

MACRODANTIN ORAL CAPSULE 25 MG Macrodantin B

mafenide acetate external packet 5 % Sulfamylon G

meropenem intravenous solution reconstituted 1 gm, 500 mg

Merrem G PA

meropenem-sodium chloride intravenous solution reconstituted 1 gm/50ml, 500 mg/50ml

G

methenamine hippurate oral tablet 1 gm Hiprex G

methenamine mandelate oral tablet 0.5 gm, 1 gm

G

metronidazole in nacl intravenous solution 5-0.79 mg/ml-%, 500-0.79 mg/100ml-%

G

metronidazole oral capsule 375 mg Flagyl G

metronidazole oral tablet 250 mg, 500 mg Flagyl G

metronidazole vaginal gel 0.75 % MetroGel-Vaginal G

minocycline hcl er oral tablet extended release 24 hour 115 mg, 65 mg

Solodyn G

minocycline hcl er oral tablet extended release 24 hour 135 mg, 45 mg, 90 mg

CoreMino G

minocycline hcl oral capsule 100 mg, 50 mg

Minocin G

minocycline hcl oral capsule 75 mg G

minocycline hcl oral tablet 100 mg, 50 mg, 75 mg

G

mondoxyne nl oral capsule 100 mg, 50 mg, 75 mg

Mondoxyne NL G

morgidox oral capsule 100 mg, 50 mg Morgidox G

moxifloxacin hcl in nacl intravenous solution 400 mg/250ml

Avelox G

moxifloxacin hcl intravenous solution 400 mg/250ml

G PA

moxifloxacin hcl oral tablet 400 mg Avelox G PA


25


mupirocin calcium external cream 2 % Bactroban G

mupirocin external ointment 2 % Centany G

nafcillin sodium in dextrose intravenous solution 1 gm/50ml, 2 gm/100ml

G

nafcillin sodium injection solution reconstituted 1 gm, 2 gm

G PA

nafcillin sodium intravenous solution reconstituted 1 gm, 10 gm, 2 gm

G PA

neomycin sulfate oral tablet 500 mg G QL (2 EA per 31 days)

neomycin-polymyxin b gu irrigation solution 40-200000

G

nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg, 50 mg

Macrodantin G

nitrofurantoin monohydrate macrocrystals oral capsule 100 mg

Macrobid G

nitrofurantoin oral suspension 25 mg/5ml Furadantin G

ofloxacin oral tablet 300 mg, 400 mg G

okebo oral capsule 75 mg Mondoxyne NL G

oxacillin sodium injection solution reconstituted 1 gm, 10 gm, 2 gm

G

paromomycin sulfate oral capsule 250 mg G

penicillin g potassium injection solution reconstituted 20000000 unit, 5000000 unit

Pfizerpen G PA

penicillin g procaine intramuscular suspension 600000 unit/ml

G

penicillin g sodium injection solution reconstituted 5000000 unit

G

penicillin v potassium oral solution reconstituted 125 mg/5ml, 250 mg/5ml

G

penicillin v potassium oral tablet 250 mg, 500 mg

G

pfizerpen injection solution reconstituted 5000000 unit

Pfizerpen G PA

piperacillin sod-tazobactam so intravenous solution reconstituted 13.5 (12-1.5) gm

G PA

piperacillin sod-tazobactam so intravenous solution reconstituted 2.25 (2-0.25) gm, 3.375 (3-0.375) gm, 4.5 (4-0.5) gm, 40.5 (36-4.5) gm

Zosyn G PA

polymyxin b sulfate injection solution reconstituted 500000 unit

G

silver nitrate external ointment 10 % G


26


silver nitrate external solution 0.5 %, 10 %, 25 %, 50 %

G

silver sulfadiazine external cream 1 % Silvadene G

soloxide oral tablet delayed release 150 mg

Soloxide G

ssd external cream 1 % Silvadene G

streptomycin sulfate intramuscular solution reconstituted 1 gm

G

sulfadiazine oral tablet 500 mg G

sulfamethoxazole-trimethoprim intravenous solution 400-80 mg/5ml

G

sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5ml

Sulfatrim Pediatric G

sulfamethoxazole-trimethoprim oral tablet 400-80 mg

Bactrim G

sulfamethoxazole-trimethoprim oral tablet 800-160 mg

Bactrim DS G

sulfatrim pediatric oral suspension 200-40 mg/5ml

Sulfatrim Pediatric G

SUPRAX ORAL CAPSULE 400 MG B PA; QL (2 EA per 31 days)

SUPRAX ORAL SUSPENSION RECONSTITUTED 100 MG/5ML

Suprax B PA; QL (150 ML per 31 days)

tazicef injection solution reconstituted 1 gm, 2 gm, 6 gm

Tazicef G PA

tazicef intravenous solution reconstituted 1 gm, 2 gm

G PA

tetracycline hcl oral capsule 250 mg, 500 mg

G

tigecycline intravenous solution reconstituted 50 mg

Tygacil G PA

tinidazole oral tablet 250 mg G

tinidazole oral tablet 500 mg Tindamax G

tobramycin sulfate injection solution 1.2 gm/30ml, 10 mg/ml, 2 gm/50ml, 80 mg/2ml

G

tobramycin sulfate injection solution reconstituted 1.2 gm

G

trimethoprim oral tablet 100 mg G

triple dye external liquid G

TYGACIL INTRAVENOUS SOLUTION RECONSTITUTED 50 MG

Tygacil B PA


27


UNASYN INJECTION SOLUTION RECONSTITUTED 1.5 (1-0.5) GM, 15 (10-5) GM, 3 (2-1) GM

Unasyn B PA

VANCOCIN HCL ORAL CAPSULE 125 MG, 250 MG

Vancocin HCl B PA

vancomycin hcl in dextrose intravenous solution 1-5 gm/100ml-%, 1-5 gm/200ml-%, 1-5 gm/250ml-%, 1.5-5 gm/250ml-%, 2-5 gm/500ml-%, 500-5 mg/100ml-%, 750-5 mg/150ml-%

G

vancomycin hcl in nacl intravenous solution 1-0.9 gm/150ml-%, 1-0.9 gm/200ml-%, 1-0.9 gm/250ml-%, 1.5-0.9 gm/150ml-%, 1.5-0.9 gm/250ml-%, 1.5-0.9 gm/500ml-%, 1.75-0.9 gm/250ml-%, 1.75-0.9 gm/300ml-%, 2-0.9 gm/250ml-%, 500-0.9 mg/100ml-%, 750-0.9 mg/150ml-%

G

vancomycin hcl intravenous solution reconstituted 10 gm, 100 gm, 1000 mg, 500 mg, 5000 mg, 750 mg

G PA; SP

vancomycin hcl oral capsule 125 mg, 250 mg

Vancocin HCl G PA

VANCOMYCIN+SYRSPEND SF PH4 ORAL SUSPENSION 50 MG/ML

B PA

vandazole vaginal gel 0.75 % MetroGel-Vaginal G

VIBATIV INTRAVENOUS SOLUTION RECONSTITUTED 750 MG

B ST

XIFAXAN ORAL TABLET 200 MG, 550 MG

B PA

Anticoagulants

acd formula a in vitro solution 0.73-2.45-2.2 gm/100ml

ACD-A noClot-50 G

acd formula b in vitro solution 440-1.47-1.32

G

acd-a noclot-50 in vitro solution 0.73-2.45-2.2 gm/100ml

ACD-A noClot-50 G

anticoagulant cit dext soln a in vitro solution 0.8-2.45-2.2 gm/100ml

ACD-A noClot-50 G

anticoagulant sodium citrate in vitro solution 4 gm/100ml

G

argatroban in sodium chloride intravenous solution 250 mg/250ml

G

argatroban intravenous solution 125 mg/125ml, 250 mg/2.5ml, 50 mg/50ml

G


28


bivalirudin trifluoroacetate intravenous solution reconstituted 250 mg

Angiomax G

CATHFLO ACTIVASE INJECTION SOLUTION RECONSTITUTED 2 MG

B SP; QL (2 EA per 31 days)

ELIQUIS ORAL TABLET 2.5 MG, 5 MG B

ELIQUIS STARTER PACK ORAL TABLET 5 MG

B

enoxaparin sodium injection solution 300 mg/3ml

Lovenox G

enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml

Lovenox G QL (2 ML per 1 day)

enoxaparin sodium subcutaneous solution 30 mg/0.3ml

Lovenox G QL (1 ML per 1 day)

fondaparinux sodium subcutaneous solution 10 mg/0.8ml, 2.5 mg/0.5ml, 5 mg/0.4ml, 7.5 mg/0.6ml

Arixtra G QL (1 ML per 1 day)

FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNIT/ML, 12500 UNIT/0.5ML, 15000 UNIT/0.6ML, 18000 UNT/0.72ML, 2500 UNIT/0.2ML, 5000 UNIT/0.2ML, 7500 UNIT/0.3ML

B PA; QL (1 ML per 1 day)

FRAGMIN SUBCUTANEOUS SOLUTION 95000 UNIT/3.8ML

B PA; QL (10 ML per 30 days)

heparin (porcine) in d5w intravenous solution 40-5 unit/ml-%, 50-5 unit/ml-%

G

heparin (porcine) in nacl injection solution 100-0.45 unit/ml-%, 2-0.9 unit/ml-%, 50-0.45 unit/ml-%

G

heparin (porcine) in nacl intravenous solution 2000-0.9 ut/500ml-%, 25000-0.45 ut/500ml-%, 30000-0.9 unit/l-%, 4000-0.9 unit/l-%, 500-0.45 ut/250ml-%

G

heparin (porcine) in nacl intravenous solution prefilled syringe 20-0.9 unt/20ml-%, 50-0.45 unt/50ml-%

G

heparin sod (porcine) in d5w intravenous solution 100 unit/ml

G

heparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 20000 unit/ml, 5000 unit/ml

G

heparin sodium (porcine) intravenous solution prefilled syringe 10000 unit/10ml, 3000 unit/3ml, 5000 unit/5ml

G

heparin sodium (porcine) pf injection solution 5000 unit/0.5ml

G


29


heparin sodium/d5w intravenous solution 50-5 unit/ml-%

G

jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

Coumadin G

PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG

B

SAVAYSA ORAL TABLET 15 MG, 30 MG, 60 MG

B ST

THROMBATE III INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 500 UNIT

B PA; SP

warfarin sodium oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

Coumadin G

XARELTO ORAL TABLET 10 MG, 15 MG, 20 MG

B

XARELTO STARTER PACK ORAL TABLET THERAPY PACK 15 & 20 MG

B

Anticonvulsants - Drugs for Seizures

BANZEL ORAL SUSPENSION 40 MG/ML B PA

BANZEL ORAL TABLET 200 MG, 400 MG

B PA

BRIVIACT INTRAVENOUS SOLUTION 50 MG/5ML

B ST

BRIVIACT ORAL SOLUTION 10 MG/ML B ST

BRIVIACT ORAL TABLET 10 MG, 100 MG, 25 MG, 50 MG, 75 MG

B ST

carbamazepine er oral capsule extended release 12 hour 100 mg, 200 mg, 300 mg

Carbatrol G

carbamazepine er oral tablet extended release 12 hour 100 mg, 200 mg, 400 mg

TEGretol-XR G

carbamazepine oral suspension 100 mg/5ml

TEGretol G

carbamazepine oral tablet 200 mg Epitol G

carbamazepine oral tablet chewable 100 mg

G

CARBATROL ORAL CAPSULE EXTENDED RELEASE 12 HOUR 100 MG, 200 MG, 300 MG

Carbatrol B

diazepam rectal gel 10 mg, 20 mg Diastat AcuDial G

diazepam rectal gel 2.5 mg Diastat Pediatric G

divalproex sodium er oral tablet extended release 24 hour 250 mg, 500 mg

Depakote ER G


30


divalproex sodium oral capsule delayed release sprinkle 125 mg

Depakote Sprinkles G

divalproex sodium oral tablet delayed release 125 mg, 250 mg, 500 mg

Depakote G

epitol oral tablet 200 mg Epitol G

ethosuximide oral capsule 250 mg Zarontin G

ethosuximide oral solution 250 mg/5ml Zarontin G

felbamate oral suspension 600 mg/5ml Felbatol G

felbamate oral tablet 400 mg, 600 mg Felbatol G

fosphenytoin sodium injection solution 100 mg pe/2ml, 500 mg pe/10ml

Cerebyx G

gabapentin oral capsule 100 mg, 300 mg, 400 mg

Neurontin G

gabapentin oral solution 250 mg/5ml, 300 mg/6ml

Neurontin G

gabapentin oral tablet 600 mg, 800 mg Neurontin G

KEPPRA XR ORAL TABLET EXTENDED RELEASE 24 HOUR 500 MG, 750 MG

Keppra XR B

lamotrigine er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg

LaMICtal XR G

lamotrigine oral kit 25 & 50 & 100 mg, 25 (21)-50 (7) mg, 50 (42)-100(14) mg

LaMICtal ODT G

lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg

LaMICtal G

lamotrigine oral tablet chewable 25 mg, 5 mg

LaMICtal G

lamotrigine oral tablet dispersible 100 mg, 200 mg, 25 mg, 50 mg

LaMICtal ODT G

lamotrigine starter kit-blue oral kit 25 (35) mg

LaMICtal Starter G

lamotrigine starter kit-green oral kit 25 (84)-100(14) mg

LaMICtal Starter G

lamotrigine starter kit-orange oral kit 25 (42)-100 (7) mg

LaMICtal Starter G

levetiracetam er oral tablet extended release 24 hour 500 mg, 750 mg

Keppra XR G

levetiracetam in nacl intravenous solution 1000 mg/100ml, 1500 mg/100ml, 500 mg/100ml

G

levetiracetam intravenous solution 500 mg/5ml

Keppra G

levetiracetam oral solution 100 mg/ml Keppra G


31


levetiracetam oral tablet 1000 mg, 250 mg, 500 mg, 750 mg

Keppra G

oxcarbazepine oral suspension 300 mg/5ml

Trileptal G

oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg

Trileptal G

pentobarbital sodium injection solution 50 mg/ml

Nembutal G

phenobarbital oral elixir 20 mg/5ml G

phenobarbital oral solution 20 mg/5ml G

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg

G

phenobarbital sodium injection solution 130 mg/ml, 65 mg/ml

G

phenytoin infatabs oral tablet chewable 50 mg

Dilantin Infatabs G

phenytoin oral suspension 125 mg/5ml Dilantin G

phenytoin oral tablet chewable 50 mg Dilantin Infatabs G

phenytoin sodium extended oral capsule 100 mg

Dilantin G

phenytoin sodium extended oral capsule 200 mg, 300 mg

Phenytek G

phenytoin sodium injection solution 50 mg/ml

G

primidone oral tablet 250 mg, 50 mg Mysoline G

roweepra oral tablet 1000 mg, 500 mg, 750 mg

Keppra G

roweepra xr oral tablet extended release 24 hour 500 mg, 750 mg

Keppra XR G

subvenite oral tablet 100 mg, 150 mg, 200 mg, 25 mg

LaMICtal G

subvenite starter kit-blue oral kit 25 (35) mg

LaMICtal Starter G

subvenite starter kit-green oral kit 25 (84)-100(14) mg

LaMICtal Starter G

subvenite starter kit-orange oral kit 25 (42)-100 (7) mg

LaMICtal Starter G

tiagabine hcl oral tablet 12 mg, 16 mg, 2 mg, 4 mg

Gabitril G

topiramate er oral capsule er 24 hour sprinkle 100 mg, 150 mg, 200 mg, 25 mg, 50 mg

Qudexy XR G


32


topiramate oral capsule sprinkle 15 mg, 25 mg

Topamax Sprinkle G

topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg

Topamax G

valproate sodium intravenous solution 100 mg/ml, 500 mg/5ml

Depacon G

valproate sodium oral solution 250 mg/5ml

Depakene G

valproic acid oral capsule 250 mg Depakene G

valproic acid oral solution 250 mg/5ml Depakene G

vigabatrin oral packet 500 mg Sabril G

vigadrone oral packet 500 mg Sabril G

VIMPAT INTRAVENOUS SOLUTION 200 MG/20ML

B PA

VIMPAT ORAL SOLUTION 10 MG/ML B PA

VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG

B PA

zonisamide oral capsule 100 mg, 25 mg Zonegran G

zonisamide oral capsule 50 mg G

Antidementia Agents - Drugs for Alzheimer's Disease and Dementia

donepezil hcl oral tablet 10 mg, 23 mg, 5 mg

Aricept G

donepezil hcl oral tablet dispersible 10 mg, 5 mg

G

galantamine hydrobromide er oral capsule extended release 24 hour 16 mg, 24 mg, 8 mg

Razadyne ER G

galantamine hydrobromide oral solution 4 mg/ml

G

galantamine hydrobromide oral tablet 12 mg, 4 mg, 8 mg

Razadyne G

memantine hcl er oral capsule extended release 24 hour 14 mg, 21 mg, 28 mg, 7 mg

Namenda XR G

memantine hcl oral solution 2 mg/ml G

memantine hcl oral tablet 10 mg, 5 mg Namenda G

memantine hcl oral tablet 5 (28)-10 (21) mg

Namenda Titration Pak G

NAMENDA XR TITRATION PACK ORAL CAPSULE EXTENDED RELEASE 24 HOUR 7 & 14 & 21 &28 MG

B


33


rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg

G

rivastigmine transdermal patch 24 hour 13.3 mg/24hr, 4.6 mg/24hr, 9.5 mg/24hr

Exelon G

Antidepressants

amitriptyline hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

G

amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg

G

ANAFRANIL ORAL CAPSULE 25 MG, 50 MG, 75 MG

Anafranil B PA

APLENZIN ORAL TABLET EXTENDED RELEASE 24 HOUR 174 MG, 348 MG, 522 MG

B

BRISDELLE ORAL CAPSULE 7.5 MG Brisdelle B PA

bupropion hcl er (sr) oral tablet extended release 12 hour 100 mg, 150 mg, 200 mg

Wellbutrin SR G

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

Wellbutrin XL G

bupropion hcl oral tablet 100 mg, 75 mg G

chlordiazepoxide-amitriptyline oral tablet 10-25 mg, 5-12.5 mg

G

citalopram hydrobromide oral solution 10 mg/5ml

G

citalopram hydrobromide oral tablet 10 mg, 20 mg, 40 mg

CeleXA G

clomipramine hcl oral capsule 25 mg, 50 mg, 75 mg

Anafranil G PA

desipramine hcl oral tablet 10 mg, 25 mg Norpramin G

desipramine hcl oral tablet 100 mg, 150 mg, 50 mg, 75 mg

G

desvenlafaxine succinate er oral tablet extended release 24 hour 100 mg, 25 mg, 50 mg

Pristiq G

doxepin hcl oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

G

doxepin hcl oral concentrate 10 mg/ml G

duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg

Cymbalta G

duloxetine hcl oral capsule delayed release particles 40 mg

G

escitalopram oxalate oral solution 5 mg/5ml

G


34


escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg

Lexapro G

fluoxetine hcl (pmdd) oral capsule 10 mg, 20 mg

G

fluoxetine hcl (pmdd) oral tablet 10 mg, 20 mg

Sarafem G

fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg

PROzac G

fluoxetine hcl oral capsule delayed release 90 mg

G ST

fluoxetine hcl oral solution 20 mg/5ml G

fluoxetine hcl oral tablet 10 mg, 20 mg, 60 mg

G

fluvoxamine maleate er oral capsule extended release 24 hour 100 mg, 150 mg

G

fluvoxamine maleate oral tablet 100 mg, 25 mg, 50 mg

G

imipramine hcl oral tablet 10 mg, 25 mg, 50 mg

Tofranil G

imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg

G

maprotiline hcl oral tablet 25 mg, 50 mg, 75 mg

G

mirtazapine oral tablet 15 mg, 30 mg Remeron G

mirtazapine oral tablet 45 mg, 7.5 mg G

mirtazapine oral tablet dispersible 15 mg, 30 mg, 45 mg

Remeron SolTab G

nefazodone hcl oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg

G

nortriptyline hcl oral capsule 10 mg, 25 mg, 50 mg, 75 mg

Pamelor G

nortriptyline hcl oral solution 10 mg/5ml G

paroxetine hcl er oral tablet extended release 24 hour 12.5 mg, 25 mg, 37.5 mg

Paxil CR G

paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg

Paxil G

paroxetine mesylate oral capsule 7.5 mg Brisdelle G PA

perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-10 mg, 4-25 mg, 4-50 mg

G

protriptyline hcl oral tablet 10 mg, 5 mg G

sertraline hcl oral concentrate 20 mg/ml Zoloft G


35


sertraline hcl oral tablet 100 mg, 25 mg, 50 mg

Zoloft G

trazodone hcl oral tablet 100 mg, 150 mg, 300 mg, 50 mg

G

trimipramine maleate oral capsule 100 mg, 25 mg, 50 mg

Surmontil G

venlafaxine hcl er oral capsule extended release 24 hour 150 mg, 37.5 mg, 75 mg

Effexor XR G

venlafaxine hcl er oral tablet extended release 24 hour 150 mg, 225 mg, 37.5 mg, 75 mg

G

venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

G

VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG

B ST

ZOLOFT ORAL TABLET 100 MG, 25 MG, 50 MG

Zoloft B

Antiemetics - Drugs for Nausea and Vomiting

ALOXI INTRAVENOUS SOLUTION 0.25 MG/5ML

Aloxi B QL (1 ML per 31 days)

anti-nausea oral solution 1.87-1.87-21.5 Emetrol G QL (240 ML per 31 days)

anti-nausea/rekematol oral solution 1.87-1.87-21.5

Emetrol G QL (240 ML per 31 days)

aprepitant oral capsule 125 mg, 40 mg, 80 mg

Emend G PA

aprepitant oral capsule 80 & 125 mg Emend Tri-Pack G

compro rectal suppository 25 mg Compro G

dimenhydrinate injection solution 50 mg/ml

G

dronabinol oral capsule 10 mg, 2.5 mg, 5 mg

Marinol G

droperidol injection solution 2.5 mg/ml G

EMEND ORAL CAPSULE 125 MG, 40 MG, 80 MG

Emend B PA

formula em oral solution 1.87-1.87-21.5 Emetrol G QL (240 ML per 31 days)

granisetron hcl intravenous solution 0.1 mg/ml, 4 mg/4ml

G PA

granisetron hcl intravenous solution 1 mg/ml

G PA; QL (2 ML per 30 days)

granisetron hcl oral tablet 1 mg G PA; QL (2 EA per 31 days)


36


little tummys nausea relief oral solution 1.87-1.87-21.5

Emetrol G QL (240 ML per 31 days)

meclizine hcl oral tablet 12.5 mg G

meclizine hcl oral tablet 25 mg Dramamine Less Drowsy G

metoclopramide hcl injection solution 5 mg/ml

G

metoclopramide hcl oral solution 10 mg/10ml, 5 mg/5ml

G

metoclopramide hcl oral tablet 10 mg, 5 mg

Reglan G

metoclopramide hcl oral tablet dispersible 10 mg, 5 mg

G

nausatrol oral solution 1.87-1.87-21.5 Emetrol G QL (240 ML per 31 days)

ondansetron hcl injection solution 4 mg/2ml, 40 mg/20ml

G PA

ondansetron hcl oral solution 4 mg/5ml Zofran G PA

ondansetron hcl oral tablet 24 mg G QL (3 EA per 31 days)

ondansetron hcl oral tablet 4 mg, 8 mg Zofran G QL (31 EA per 31 days)

ondansetron hcl-nacl intravenous solution 12-0.9 mg/50ml-%, 16-0.9 mg/50ml-%, 8-0.9 mg/50ml-%

G

ondansetron odt oral tablet dispersible 4 mg, 8 mg

Zofran ODT G

palonosetron hcl intravenous solution 0.25 mg/2ml

G

palonosetron hcl intravenous solution 0.25 mg/5ml

Aloxi G QL (1 ML per 31 days)

prochlorperazine edisylate injection solution 5 mg/ml

G

prochlorperazine maleate oral tablet 10 mg, 5 mg

G

prochlorperazine rectal suppository 25 mg Compro G

scopolamine transdermal patch 72 hour 1 mg/3days

Transderm-Scop (1.5 MG)

G

trimethobenzamide hcl oral capsule 300 mg

Tigan G

VARUBI ORAL TABLET 90 MG B PA

Antifungals

ABELCET INTRAVENOUS SUSPENSION 5 MG/ML

B PA


37


AMBISOME INTRAVENOUS SUSPENSION RECONSTITUTED 50 MG

B PA

amphotericin b injection solution reconstituted 50 mg

G

bio-statin oral powder G

CANCIDAS INTRAVENOUS SOLUTION RECONSTITUTED 50 MG, 70 MG

Cancidas B PA

caspofungin acetate intravenous solution reconstituted 50 mg, 70 mg

Cancidas G PA

ciclodan external cream 0.77 % Ciclodan G

ciclodan external solution 8 % Ciclodan G

ciclopirox external gel 0.77 % G

ciclopirox external shampoo 1 % Loprox G

ciclopirox external solution 8 % Ciclodan G

ciclopirox olamine external cream 0.77 % Ciclodan G

ciclopirox olamine external suspension 0.77 %

Loprox G

ciclopirox treatment external kit 8 % Ciclodan Solution G

clotrimazole external cream 1 % Clotrimazole GRx G

clotrimazole external solution 1 % FungiCure Intensive/NailGuard

G

clotrimazole mouth/throat lozenge 10 mg G

clotrimazole mouth/throat troche 10 mg G

clotrimazole vaginal cream 1 % Gyne-Lotrimin G

CRESEMBA INTRAVENOUS SOLUTION RECONSTITUTED 372 MG

B PA

CRESEMBA ORAL CAPSULE 186 MG B PA

econazole nitrate external cream 1 % G

exoderm external lotion 25-1 % G

fluconazole in dextrose intravenous solution 200 mg/100ml, 400 mg/200ml

G

fluconazole in sodium chloride intravenous solution 100-0.9 mg/50ml-%, 200-0.9 mg/100ml-%, 400-0.9 mg/200ml-%

G

fluconazole oral suspension reconstituted 10 mg/ml, 40 mg/ml

Diflucan G

fluconazole oral tablet 100 mg, 200 mg, 50 mg

Diflucan G

fluconazole oral tablet 150 mg Diflucan G QL (2 EA per 31 days)

flucytosine oral capsule 250 mg, 500 mg Ancobon G PA


38


griseofulvin microsize oral suspension 125 mg/5ml

G

griseofulvin microsize oral tablet 500 mg G

griseofulvin ultramicrosize oral tablet 125 mg, 250 mg

G

GRIS-PEG ORAL TABLET 125 MG, 250 MG

B

itraconazole oral capsule 100 mg Sporanox G PA

JUBLIA EXTERNAL SOLUTION 10 % B PA

ketoconazole external cream 2 % G

ketoconazole external foam 2 % Extina G

ketoconazole external shampoo 2 % Nizoral G

ketoconazole oral tablet 200 mg G

miconazole 3 vaginal suppository 200 mg G

MYCAMINE INTRAVENOUS SOLUTION RECONSTITUTED 100 MG, 50 MG

B PA

naftifine hcl external cream 1 % G

naftifine hcl external cream 2 % Naftin G

NOXAFIL ORAL SUSPENSION 40 MG/ML

B ST

NOXAFIL ORAL TABLET DELAYED RELEASE 100 MG

B ST

nyamyc external powder 100000 unit/gm Nyamyc G

nyata external powder 100000 unit/gm Nyamyc G

nystatin external cream 100000 unit/gm G

nystatin external ointment 100000 unit/gm G

nystatin external powder 100000 unit/gm Nyamyc G

nystatin mouth/throat suspension 100000 unit/ml

G

nystatin oral tablet 500000 unit G

nystatin-triamcinolone external cream 100000-0.1 unit/gm-%

G

nystatin-triamcinolone external ointment 100000-0.1 unit/gm-%

G

nystop external powder 100000 unit/gm Nyamyc G

oxiconazole nitrate external cream 1 % Oxistat G

terbinafine hcl oral tablet 250 mg LamISIL G

terconazole vaginal cream 0.4 % Terazol 7 G

terconazole vaginal cream 0.8 % G


39


terconazole vaginal suppository 80 mg G

tgt clotrimazole external cream 1 % Clotrimazole GRx G

VFEND IV INTRAVENOUS SOLUTION RECONSTITUTED 200 MG

Vfend IV B ST

VFEND ORAL SUSPENSION RECONSTITUTED 40 MG/ML

Vfend B ST

VFEND ORAL TABLET 200 MG, 50 MG Vfend B ST

voriconazole intravenous solution reconstituted 200 mg

Vfend IV G ST

voriconazole oral suspension reconstituted 40 mg/ml

Vfend G ST

voriconazole oral tablet 200 mg, 50 mg Vfend G ST

Antigout Agents

allopurinol oral tablet 100 mg, 300 mg Zyloprim G

allopurinol sodium intravenous solution reconstituted 500 mg

Aloprim G

COLCHICINE ORAL TABLET 0.6 MG Colcrys B PA

colchicine-probenecid oral tablet 0.5-500 mg

G

COLCRYS ORAL TABLET 0.6 MG Colcrys B PA

probenecid oral tablet 500 mg G

ULORIC ORAL TABLET 40 MG, 80 MG B ST

ZURAMPIC ORAL TABLET 200 MG B PA

Antimigraine Agents

almotriptan malate oral tablet 12.5 mg G ST; QL (12 EA per 31 days)

almotriptan malate oral tablet 6.25 mg G ST; QL (6 EA per 31 days)

AXERT ORAL TABLET 12.5 MG B ST; QL (12 EA per 31 days)

AXERT ORAL TABLET 6.25 MG B ST; QL (6 EA per 31 days)

dihydroergotamine mesylate injection solution 1 mg/ml

D.H.E. 45 G

dihydroergotamine mesylate nasal solution 4 mg/ml

Migranal G

eletriptan hydrobromide oral tablet 20 mg, 40 mg

Relpax G ST; QL (9 EA per 31 days)

ergotamine-caffeine oral tablet 1-100 mg Cafergot G

frovatriptan succinate oral tablet 2.5 mg Frova G

naratriptan hcl oral tablet 1 mg, 2.5 mg Amerge G


40


RELPAX ORAL TABLET 20 MG, 40 MG Relpax B ST; QL (9 EA per 31 days)

rizatriptan benzoate oral tablet 10 mg Maxalt G ST; QL (9 EA per 31 days)

rizatriptan benzoate oral tablet 5 mg G ST; QL (9 EA per 31 days)

rizatriptan benzoate oral tablet dispersible 10 mg

Maxalt-MLT G QL (11 EA per 31 days)

rizatriptan benzoate oral tablet dispersible 5 mg

Maxalt-MLT G QL (10 EA per 31 days)

sumatriptan nasal solution 20 mg/act, 5 mg/act

Imitrex G QL (6 EA per 31 days)

sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg

Imitrex G ST; QL (9 EA per 31 days)

sumatriptan succinate refill subcutaneous solution cartridge 4 mg/0.5ml, 6 mg/0.5ml

Imitrex STATdose Refill G ST

sumatriptan succinate subcutaneous solution 6 mg/0.5ml

Imitrex G ST; QL (9 ML per 31 days)

sumatriptan succinate subcutaneous solution auto-injector 4 mg/0.5ml, 6 mg/0.5ml

Imitrex STATdose System

G ST

sumatriptan-naproxen sodium oral tablet 85-500 mg

Treximet G

zolmitriptan oral tablet 2.5 mg, 5 mg Zomig G ST; QL (9 EA per 31 days)

zolmitriptan oral tablet dispersible 2.5 mg, 5 mg

Zomig ZMT G ST; QL (9 EA per 31 days)

ZOMIG NASAL SOLUTION 2.5 MG, 5 MG


Antimyasthenic Agents

guanidine hcl oral tablet 125 mg G

MESTINON ORAL SYRUP 60 MG/5ML B

MESTINON ORAL TABLET 60 MG Mestinon B

MESTINON ORAL TABLET EXTENDED RELEASE 180 MG

Mestinon B

neostigmine methylsulfate injection solution 0.5 mg/ml, 1 mg/ml

G

neostigmine methylsulfate intravenous solution 10 mg/10ml, 5 mg/10ml

Bloxiverz G

pyridostigmine bromide er oral tablet extended release 180 mg

Mestinon G

pyridostigmine bromide oral tablet 60 mg Mestinon G

regonol intravenous solution 10 mg/2ml G


41


Antimycobacterials

cycloserine oral capsule 250 mg Seromycin G

dapsone oral tablet 100 mg, 25 mg G

ethambutol hcl oral tablet 100 mg, 400 mg Myambutol G

isoniazid injection solution 100 mg/ml G

isoniazid oral syrup 50 mg/5ml G

isoniazid oral tablet 100 mg, 300 mg G

pyrazinamide oral tablet 500 mg G

rifabutin oral capsule 150 mg Mycobutin G

rifampin intravenous solution reconstituted 600 mg

Rifadin G

rifampin oral capsule 150 mg, 300 mg Rifadin G

Antineoplastics - Drugs for Cancer

adriamycin intravenous solution 2 mg/ml Adriamycin G SP

adrucil intravenous solution 2.5 gm/50ml, 5 gm/100ml, 500 mg/10ml

Adrucil G SP

AFINITOR DISPERZ ORAL TABLET SOLUBLE 2 MG, 3 MG, 5 MG

B SP

AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG, 7.5 MG

B SP

ALECENSA ORAL CAPSULE 150 MG B PA; SP

ALIMTA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG, 500 MG

B SP

ALUNBRIG ORAL TABLET 180 MG, 30 MG, 90 MG

B PA; SP

amifostine intravenous solution reconstituted 500 mg

Ethyol G PA; SP

anastrozole oral tablet 1 mg Arimidex G

AVASTIN INTRAVENOUS SOLUTION 100 MG/4ML, 400 MG/16ML

B SP

azacitidine injection suspension reconstituted 100 mg

Vidaza G SP

bexarotene capsule 75 mg oral 75 mg Targretin G

bexarotene capsule 75 mg oral 75 mg Targretin G SP

bicalutamide oral tablet 50 mg Casodex G

BICNU INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

B SP

bleomycin sulfate injection solution reconstituted 15 unit, 30 unit

G SP

busulfan intravenous solution 6 mg/ml Busulfex G


42


CABOMETYX ORAL TABLET 20 MG, 40 MG, 60 MG

B PA; SP

CALQUENCE ORAL CAPSULE 100 MG B PA; SP

CAMPATH INTRAVENOUS SOLUTION 30 MG/ML

B SP

capecitabine tablet 150 mg oral 150 mg Xeloda G

capecitabine tablet 150 mg oral 150 mg Xeloda G SP

capecitabine tablet 500 mg oral 500 mg Xeloda G

capecitabine tablet 500 mg oral 500 mg Xeloda G SP

carboplatin intravenous solution 150 mg/15ml, 450 mg/45ml, 50 mg/5ml, 600 mg/60ml

G PA; SP

cisplatin intravenous solution 100 mg/100ml, 200 mg/200ml, 50 mg/50ml

G SP

cladribine intravenous solution 10 mg/10ml

G SP

clofarabine intravenous solution 1 mg/ml Clolar G

COTELLIC ORAL TABLET 20 MG B PA; SP

cyclophosphamide injection solution reconstituted 1 gm, 2 gm, 500 mg

G

cyclophosphamide oral capsule 25 mg, 50 mg

G

cytarabine (pf) injection solution 100 mg/ml, 20 mg/ml

G

cytarabine injection solution 20 mg/ml G

dacarbazine intravenous solution reconstituted 100 mg, 200 mg

G SP

dactinomycin intravenous solution reconstituted 0.5 mg

Cosmegen G

daunorubicin hcl intravenous injectable 5 mg/ml

G SP

daunorubicin hcl intravenous solution 20 mg/4ml, 50 mg/10ml

G

decitabine intravenous solution reconstituted 50 mg

Dacogen G

dexrazoxane intravenous solution reconstituted 250 mg

Zinecard G PA; SP

dexrazoxane intravenous solution reconstituted 500 mg

Totect G PA; SP

docetaxel (non-alcohol) intravenous solution 160 mg/8ml, 20 mg/ml, 80 mg/4ml

G SP


43


docetaxel intravenous concentrate 160 mg/8ml, 20 mg/0.5ml, 80 mg/2ml

G SP

docetaxel intravenous concentrate 20 mg/ml, 80 mg/4ml

Taxotere G SP

docetaxel intravenous concentrate 200 mg/10ml

G

docetaxel intravenous solution 160 mg/16ml, 20 mg/2ml, 80 mg/8ml

G SP

doxorubicin hcl intravenous solution 2 mg/ml

Adriamycin G SP

doxorubicin hcl intravenous solution reconstituted 10 mg, 50 mg

G SP

doxorubicin hcl liposomal intravenous injectable 2 mg/ml

Doxil G SP

epirubicin hcl intravenous solution 200 mg/100ml, 50 mg/25ml

Ellence G PA; SP

ERBITUX INTRAVENOUS SOLUTION 100 MG/50ML, 200 MG/100ML

B SP

ERLEADA ORAL TABLET 60 MG B PA; SP

etoposide intravenous solution 1 gm/50ml, 100 mg/5ml, 500 mg/25ml

Toposar G SP

etoposide oral capsule 50 mg G SP

exemestane oral tablet 25 mg Aromasin G

FARYDAK ORAL CAPSULE 10 MG, 15 MG, 20 MG

B PA; SP

FASLODEX INTRAMUSCULAR SOLUTION 250 MG/5ML

B SP

floxuridine injection solution reconstituted 0.5 gm

G

fludarabine phosphate intravenous solution 50 mg/2ml

G SP

fludarabine phosphate intravenous solution reconstituted 50 mg

G SP

fluorouracil intravenous solution 1 gm/20ml

G SP

fluorouracil intravenous solution 2.5 gm/50ml, 5 gm/100ml, 500 mg/10ml

Adrucil G SP

flutamide oral capsule 125 mg G

gemcitabine hcl intravenous solution 1 gm/26.3ml, 2 gm/52.6ml, 200 mg/5.26ml

G SP

gemcitabine hcl intravenous solution reconstituted 1 gm, 200 mg

Gemzar G SP

gemcitabine hcl intravenous solution reconstituted 2 gm

G SP


44


GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG

B PA; SP

HALAVEN INTRAVENOUS SOLUTION 1 MG/2ML

B SP

HERCEPTIN INTRAVENOUS SOLUTION RECONSTITUTED 440 MG

B SP

HYCAMTIN ORAL CAPSULE 0.25 MG, 1 MG

B SP

hydroxyurea oral capsule 500 mg Hydrea G

IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG

B PA; SP

idarubicin hcl intravenous solution 10 mg/10ml, 20 mg/20ml, 5 mg/5ml

Idamycin PFS G

IDHIFA ORAL TABLET 100 MG, 50 MG B PA; SP

ifosfamide intravenous solution 1 gm/20ml, 3 gm/60ml

G SP

ifosfamide intravenous solution reconstituted 1 gm, 3 gm

Ifex G SP

imatinib mesylate oral tablet 100 mg, 400 mg

Gleevec G SP

IMBRUVICA ORAL CAPSULE 140 MG, 70 MG

B PA; SP

IMBRUVICA ORAL TABLET 140 MG, 280 MG, 420 MG, 560 MG

B PA; SP

irinotecan hcl intravenous solution 100 mg/5ml, 40 mg/2ml

Camptosar G SP

irinotecan hcl intravenous solution 500 mg/25ml

G SP

IXEMPRA KIT INTRAVENOUS SOLUTION RECONSTITUTED 15 MG, 45 MG

B SP

KISQALI 200 DOSE ORAL TABLET 200 MG

B PA


B PA


B PA

LENVIMA 10 MG DAILY DOSE ORAL CAPSULE THERAPY PACK 10 MG

B PA; SP

LENVIMA 14 MG DAILY DOSE ORAL CAPSULE THERAPY PACK 10 & 4 MG

B PA; SP

LENVIMA 18 MG DAILY DOSE ORAL CAPSULE THERAPY PACK 10 & 4 (2) MG

B PA; SP


45


LENVIMA 20 MG DAILY DOSE ORAL CAPSULE THERAPY PACK 10 (2) MG

B PA; SP

LENVIMA 24 MG DAILY DOSE ORAL CAPSULE THERAPY PACK 10 (2) & 4 MG

B PA; SP

LENVIMA 8 MG DAILY DOSE ORAL CAPSULE THERAPY PACK 4 (2) MG

B PA; SP

letrozole oral tablet 2.5 mg Femara G

leucovorin calcium injection solution reconstituted 100 mg, 200 mg, 350 mg, 50 mg, 500 mg

G

leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg

G

levoleucovorin calcium intravenous solution 175 mg/17.5ml

G

levoleucovorin calcium intravenous solution reconstituted 175 mg

G

levoleucovorin calcium intravenous solution reconstituted 50 mg

Fusilev G SP

levoleucovorin calcium pf intravenous solution 250 mg/25ml

G

lipodox 50 intravenous injectable 2 mg/ml Doxil G SP

LONSURF ORAL TABLET 15-6.14 MG, 20-8.19 MG

B PA; SP

LYNPARZA ORAL CAPSULE 50 MG B PA; SP

LYNPARZA ORAL TABLET 100 MG, 150 MG

B PA; SP

MATULANE ORAL CAPSULE 50 MG B SP

MEKINIST ORAL TABLET 0.5 MG, 2 MG B PA; SP

melphalan hcl intravenous solution reconstituted 50 mg

Alkeran G SP

melphalan oral tablet 2 mg Alkeran G

mercaptopurine oral tablet 50 mg G SP

mesna intravenous solution 100 mg/ml Mesnex G SP

mitomycin intravenous solution reconstituted 20 mg, 40 mg, 5 mg

Mutamycin G SP

mitoxantrone hcl intravenous concentrate 20 mg/10ml, 25 mg/12.5ml, 30 mg/15ml

G

mutamycin intravenous solution reconstituted 20 mg

Mutamycin G SP

mutamycin intravenous solution reconstituted 40 mg, 5 mg

Mutamycin G SP

NERLYNX ORAL TABLET 40 MG B PA; SP


46


NEXAVAR ORAL TABLET 200 MG B PA; SP

nilutamide oral tablet 150 mg Nilandron G SP

NINLARO ORAL CAPSULE 2.3 MG, 3 MG, 4 MG

B PA; SP

ODOMZO ORAL CAPSULE 200 MG B PA; SP

oxaliplatin intravenous solution 100 mg/20ml, 50 mg/10ml

G SP

oxaliplatin intravenous solution reconstituted 100 mg, 50 mg

G SP

paclitaxel intravenous concentrate 100 mg/16.7ml, 150 mg/25ml, 30 mg/5ml, 300 mg/50ml

G SP

POMALYST ORAL CAPSULE 1 MG, 2 MG, 3 MG, 4 MG

B PA; SP

REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG

B PA; SP

RITUXAN INTRAVENOUS SOLUTION 100 MG/10ML, 500 MG/50ML

B SP

RUBRACA ORAL TABLET 200 MG, 250 MG, 300 MG

B PA; SP

RYDAPT ORAL CAPSULE 25 MG B PA; SP

SPRYCEL ORAL TABLET 100 MG, 140 MG, 20 MG, 50 MG, 70 MG, 80 MG

B SP

STIVARGA ORAL TABLET 40 MG B PA; SP

SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 37.5 MG, 50 MG

B SP

TAFINLAR ORAL CAPSULE 50 MG, 75 MG

B PA; SP

TAGRISSO ORAL TABLET 40 MG, 80 MG

B PA; SP

tamoxifen citrate oral tablet 10 mg, 20 mg G

TARCEVA ORAL TABLET 100 MG, 150 MG, 25 MG

B SP

TARGRETIN EXTERNAL GEL 1 % B

TASIGNA ORAL CAPSULE 150 MG, 200 MG

B SP

TASIGNA ORAL CAPSULE 50 MG B

TECENTRIQ INTRAVENOUS SOLUTION 1200 MG/20ML

B SP

temozolomide oral capsule 100 mg, 140 mg, 180 mg, 20 mg, 250 mg, 5 mg

Temodar G SP

teniposide intravenous solution 10 mg/ml G


47


THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 MG, 50 MG

B SP

thiotepa injection solution reconstituted 15 mg

Tepadina G

toposar intravenous solution 1 gm/50ml, 100 mg/5ml, 500 mg/25ml

Toposar G SP

topotecan hcl intravenous solution 4 mg/4ml

G SP

topotecan hcl intravenous solution reconstituted 4 mg

Hycamtin G SP

TREANDA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG, 25 MG

B

tretinoin oral capsule 10 mg G SP

TYKERB ORAL TABLET 250 MG B SP

VALCHLOR EXTERNAL GEL 0.016 % B PA; SP

VELCADE INJECTION SOLUTION RECONSTITUTED 3.5 MG

B SP

VENCLEXTA ORAL TABLET 10 MG, 100 MG, 50 MG

B PA

VERZENIO ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG

B PA; SP

vinblastine sulfate intravenous solution 1 mg/ml

G SP

vincasar pfs intravenous solution 1 mg/ml Vincasar PFS G

vincristine sulfate intravenous solution 1 mg/ml

Vincasar PFS G

vinorelbine tartrate intravenous solution 10 mg/ml, 50 mg/5ml

Navelbine G SP

VOTRIENT ORAL TABLET 200 MG B SP

ZEJULA ORAL CAPSULE 100 MG B PA; SP

ZYDELIG ORAL TABLET 100 MG, 150 MG

B PA; SP

ZYKADIA ORAL CAPSULE 150 MG B PA; SP

Antiparasitics

ALBENZA ORAL TABLET 200 MG B

ALINIA ORAL TABLET 500 MG B

atovaquone oral suspension 750 mg/5ml Mepron G

atovaquone-proguanil hcl oral tablet 250-100 mg, 62.5-25 mg

Malarone G

BENZNIDAZOLE ORAL TABLET 100 MG, 12.5 MG

B


48


chloroquine phosphate oral tablet 250 mg, 500 mg

G

crotan external lotion 10 % G ST

EMVERM ORAL TABLET CHEWABLE 100 MG

B

EURAX EXTERNAL CREAM 10 % B ST

EURAX EXTERNAL LOTION 10 % B ST

hydroxychloroquine sulfate oral tablet 200 mg

Plaquenil G

IMPAVIDO ORAL CAPSULE 50 MG B PA

ivermectin oral tablet 3 mg Stromectol G

lice treatment external liquid 1 % Nix Creme Rinse G QL (148 ML per 31 days)

lice treatment external lotion 1 % G QL (240 ML per 31 days)

lindane external shampoo 1 % G

malathion external lotion 0.5 % Ovide G QL (60 ML per 30 days)

mefloquine hcl oral tablet 250 mg G

OVIDE EXTERNAL LOTION 0.5 % Ovide B QL (60 ML per 30 days)

permethrin external cream 5 % Elimite G QL (240 GM per 31 days)

praziquantel oral tablet 600 mg Biltricide G

primaquine phosphate oral tablet 26.3 mg G

quinine sulfate oral capsule 324 mg Qualaquin G

SOLOSEC ORAL PACKET 2 GM B ST

spinosad external suspension 0.9 % Natroba G

sulfurated lime external solution G

Antiparkinson Agents

APOKYN SUBCUTANEOUS SOLUTION CARTRIDGE 30 MG/3ML

B PA; SP

AZILECT ORAL TABLET 0.5 MG, 1 MG Azilect B ST

bromocriptine mesylate oral capsule 5 mg Parlodel G

bromocriptine mesylate oral tablet 2.5 mg Parlodel G

carbidopa oral tablet 25 mg Lodosyn G ST

carbidopa-levodopa er oral tablet extended release 25-100 mg, 50-200 mg

Sinemet CR G

carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg

Sinemet G


49


carbidopa-levodopa oral tablet dispersible 10-100 mg, 25-100 mg, 25-250 mg

G

carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg

Stalevo 50 G


Stalevo 75 G

carbidopa-levodopa-entacapone oral tablet 25-100-200 mg

Stalevo 100 G


Stalevo 125 G


Stalevo 150 G

carbidopa-levodopa-entacapone oral tablet 50-200-200 mg

Stalevo 200 G

ELDEPRYL ORAL CAPSULE 5 MG Eldepryl B

entacapone oral tablet 200 mg Comtan G ST

LODOSYN ORAL TABLET 25 MG Lodosyn B ST

pramipexole dihydrochloride er oral tablet extended release 24 hour 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg

Mirapex ER G ST

pramipexole dihydrochloride oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

Mirapex G ST

rasagiline mesylate oral tablet 0.5 mg, 1 mg

Azilect G ST

REQUIP XL ORAL TABLET EXTENDED RELEASE 24 HOUR 12 MG, 2 MG, 4 MG, 6 MG, 8 MG

Requip XL B

ropinirole hcl er oral tablet extended release 24 hour 12 mg, 2 mg, 4 mg, 6 mg, 8 mg

Requip XL G

ropinirole hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

Requip G

selegiline hcl oral capsule 5 mg Eldepryl G

selegiline hcl oral tablet 5 mg G

tolcapone oral tablet 100 mg Tasmar G

Antiplatelets

aspirin-dipyridamole er oral capsule extended release 12 hour 25-200 mg

Aggrenox G ST

BRILINTA ORAL TABLET 60 MG, 90 MG B ST

cilostazol oral tablet 100 mg, 50 mg G


50


clopidogrel bisulfate oral tablet 300 mg, 75 mg

Plavix G

dipyridamole oral tablet 25 mg, 50 mg, 75 mg

G

eptifibatide intravenous solution 20 mg/10ml, 200 mg/100ml, 75 mg/100ml

Integrilin G

prasugrel hcl oral tablet 10 mg, 5 mg Effient G ST

Antivirals

acyclovir external ointment 5 % Zovirax G

acyclovir oral capsule 200 mg Zovirax G

acyclovir oral suspension 200 mg/5ml Zovirax G

acyclovir oral tablet 400 mg, 800 mg Zovirax G

acyclovir sodium intravenous solution 50 mg/ml

G

acyclovir sodium intravenous solution reconstituted 500 mg

G PA

adefovir dipivoxil oral tablet 10 mg Hepsera G PA; SP

BARACLUDE ORAL SOLUTION 0.05 MG/ML

B PA; SP

cidofovir intravenous solution 75 mg/ml G

DAKLINZA ORAL TABLET 30 MG, 60 MG, 90 MG

B PA; SP

entecavir oral tablet 0.5 mg, 1 mg Baraclude G PA; SP

EPCLUSA ORAL TABLET 400-100 MG B PA; SP

famciclovir oral tablet 125 mg, 250 mg, 500 mg

G

ganciclovir sodium intravenous solution 500 mg/10ml

G

ganciclovir sodium intravenous solution reconstituted 500 mg

Cytovene G PA

HARVONI ORAL TABLET 90-400 MG B PA; SP

INTRON A INJECTION SOLUTION 10000000 UNIT/ML, 6000000 UNIT/ML

B SP

INTRON A INJECTION SOLUTION RECONSTITUTED 10000000 UNIT, 18000000 UNIT, 50000000 UNIT

B SP

lamivudine oral tablet 100 mg Epivir HBV G

MAVYRET ORAL TABLET 100-40 MG B PA; SP

MODERIBA 1200 DOSE PACK ORAL TABLET 600 MG

B SP

MODERIBA 800 DOSE PACK ORAL TABLET 400 MG

B SP


51


moderiba oral tablet 200 mg Moderiba G SP

OLYSIO ORAL CAPSULE 150 MG B PA; SP

oseltamivir phosphate oral capsule 30 mg Tamiflu G QL (20 EA per 31 days)

oseltamivir phosphate oral capsule 45 mg, 75 mg

Tamiflu G QL (10 EA per 31 days)

oseltamivir phosphate oral suspension reconstituted 6 mg/ml

Tamiflu G QL (180 ML per 31 days)

PEGASYS PROCLICK SUBCUTANEOUS SOLUTION 135 MCG/0.5ML, 180 MCG/0.5ML

B PA; SP

PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/0.5ML, 180 MCG/ML

B PA; SP

PEG-INTRON REDIPEN PAK 4 SUBCUTANEOUS KIT 120 MCG/0.5ML

B PA; SP

PEGINTRON SUBCUTANEOUS KIT 120 MCG/0.5ML

B PA; SP

PREVYMIS ORAL TABLET 240 MG, 480 MG

B PA; SP

RELENZA DISKHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 5 MG/BLISTER

B QL (20 EA per 31 days)

RETROVIR INTRAVENOUS SOLUTION 10 MG/ML

B SP

RETROVIR ORAL CAPSULE 100 MG Retrovir B PA; SP

ribasphere oral capsule 200 mg Rebetol G SP

ribasphere oral tablet 200 mg Moderiba G SP

ribasphere oral tablet 400 mg, 600 mg G SP

ribasphere ribapak oral tablet 400 mg, 600 mg

G SP

ribavirin inhalation solution reconstituted 6 gm

Virazole G

ribavirin oral capsule 200 mg Rebetol G SP

ribavirin oral tablet 200 mg Moderiba G SP

rimantadine hcl oral tablet 100 mg Flumadine G

SOVALDI ORAL TABLET 400 MG B PA; SP

TAMIFLU ORAL CAPSULE 30 MG Tamiflu B QL (20 EA per 31 days)

TAMIFLU ORAL CAPSULE 45 MG, 75 MG

Tamiflu B QL (10 EA per 31 days)

TECHNIVIE ORAL TABLET 12.5-75-50 MG

B PA; SP


52


valacyclovir hcl oral tablet 1 gm, 500 mg Valtrex G

valganciclovir hcl oral solution reconstituted 50 mg/ml

Valcyte G PA

valganciclovir hcl oral tablet 450 mg Valcyte G PA

VIEKIRA PAK ORAL TABLET THERAPY PACK 12.5-75-50 &250 MG

B PA; SP

ZEPATIER ORAL TABLET 50-100 MG B PA; SP

zidovudine oral capsule 100 mg Retrovir G PA; SP

zidovudine oral syrup 50 mg/5ml Retrovir G SP

zidovudine oral tablet 300 mg G SP

Anxiolytics - Drugs for Anxiety

alprazolam er oral tablet extended release 24 hour 0.5 mg, 1 mg, 2 mg, 3 mg

Xanax XR G

alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg

Xanax G ST; QL (124 EA per 31 days)

alprazolam oral tablet 2 mg Xanax G ST; QL (62 EA per 31 days)

alprazolam oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 mg

G

alprazolam xr oral tablet extended release 24 hour 0.5 mg, 1 mg, 2 mg, 3 mg

Xanax XR G

buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg

G

chlordiazepoxide hcl oral capsule 10 mg, 25 mg, 5 mg


clonazepam oral tablet 0.5 mg, 1 mg KlonoPIN G QL (124 EA per 31 days)

clonazepam oral tablet 2 mg KlonoPIN G QL (62 EA per 31 days)

clonazepam oral tablet dispersible 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg

G

clorazepate dipotassium oral tablet 15 mg, 3.75 mg

G ST; QL (93 EA per 31 days)

clorazepate dipotassium oral tablet 7.5 mg

Tranxene-T G ST; QL (93 EA per 31 days)

diazepam injection solution 5 mg/ml G

diazepam intensol oral concentrate 5 mg/ml

Diazepam Intensol G

diazepam intramuscular solution auto-injector 10 mg/2ml

G

diazepam oral concentrate 5 mg/ml Diazepam Intensol G

diazepam oral solution 1 mg/ml G


53


diazepam oral tablet 10 mg Valium G QL (31 EA per 31 days)

diazepam oral tablet 2 mg, 5 mg Valium G QL (124 EA per 31 days)

estazolam oral tablet 1 mg, 2 mg G

hydroxyzine hcl intramuscular solution 25 mg/ml, 50 mg/ml

G

hydroxyzine hcl oral syrup 10 mg/5ml G

hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg

G

hydroxyzine pamoate oral capsule 100 mg

G

hydroxyzine pamoate oral capsule 25 mg, 50 mg

Vistaril G

lorazepam injection solution 2 mg/ml, 4 mg/ml

Ativan G

lorazepam intensol oral concentrate 2 mg/ml

LORazepam Intensol G

lorazepam oral concentrate 2 mg/ml LORazepam Intensol G

lorazepam oral tablet 0.5 mg, 1 mg Ativan G QL (124 EA per 31 days)

lorazepam oral tablet 2 mg Ativan G QL (62 EA per 31 days)

lorazepam-dextrose intravenous solution 100-5 mg/100ml-%

G

lorazepam-sodium chloride intravenous solution 100-0.9 mg/100ml-%

G

meprobamate oral tablet 200 mg, 400 mg G

midazolam hcl injection solution 10 mg/10ml, 10 mg/2ml, 2 mg/2ml, 25 mg/5ml, 5 mg/5ml, 5 mg/ml, 50 mg/10ml

G

midazolam hcl oral syrup 2 mg/ml G

midazolam hcl-nacl intravenous solution 50-0.9 mg/100ml-%

G

midazolam hcl-sodium chloride intravenous solution 25-0.9 mg/100ml-%

G

midazolam hcl-sodium chloride intravenous solution prefilled syringe 2-0.9 mg/2ml-%

G

oxazepam oral capsule 10 mg, 15 mg, 30 mg

G

quazepam oral tablet 15 mg Doral G

triazolam oral tablet 0.125 mg G


54


triazolam oral tablet 0.25 mg Halcion G

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

aminocaproic acid intravenous solution 250 mg/ml

G PA

anagrelide hcl oral capsule 0.5 mg Agrylin G

anagrelide hcl oral capsule 1 mg G

ARANESP (ALBUMIN FREE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML

B QL (2 ML per 28 days)

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 10 MCG/0.4ML

B

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 100 MCG/0.5ML, 150 MCG/0.3ML, 200 MCG/0.4ML, 25 MCG/0.42ML, 300 MCG/0.6ML, 40 MCG/0.4ML, 60 MCG/0.3ML


ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 500 MCG/ML


EPOGEN INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML


hetastarch-nacl intravenous solution 6-0.9 %

Hespan G

lmd in d5w intravenous solution 10-5 % G

lmd in nacl intravenous solution 10-0.9 % G

NEULASTA ONPRO SUBCUTANEOUS PREFILLED SYRINGE KIT 6 MG/0.6ML

B

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG/0.6ML

B

NEUPOGEN INJECTION SOLUTION 300 MCG/ML


NEUPOGEN INJECTION SOLUTION 480 MCG/1.6ML

B QL (22.4 ML per 30 days)

NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML


NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE 480 MCG/0.8ML

B QL (11.2 ML per 30 days)


55


NPLATE SUBCUTANEOUS SOLUTION RECONSTITUTED 250 MCG, 500 MCG

B SP

PROCRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML


PROCRIT INJECTION SOLUTION 40000 UNIT/ML


protamine sulfate intravenous solution 10 mg/ml

G

tranexamic acid intravenous solution 1000 mg/10ml

Cyklokapron G

tranexamic acid oral tablet 650 mg Lysteda G

ZARXIO INJECTION SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML


Cardiovascular Agents - Drugs for Heart and Circulation Conditions

acebutolol hcl oral capsule 200 mg, 400 mg

G

acetazolamide er oral capsule extended release 12 hour 500 mg

G

acetazolamide oral tablet 125 mg, 250 mg G

acetazolamide sodium injection solution reconstituted 500 mg

G

adenosine intravenous solution 12 mg/4ml, 6 mg/2ml

Adenocard G

adenosine intravenous solution prefilled syringe 60 mg/20ml, 90 mg/30ml

G

afeditab cr oral tablet extended release 24 hour 30 mg, 60 mg

Adalat CC G

amiloride hcl oral tablet 5 mg G ST

amiloride-hydrochlorothiazide oral tablet 5-50 mg

G

amiodarone hcl in dextrose intravenous solution 150-5 mg/100ml-%

G

amiodarone hcl intravenous solution 150 mg/3ml, 450 mg/9ml, 900 mg/18ml

G

amiodarone hcl oral tablet 100 mg, 200 mg, 400 mg

Pacerone G

amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg

Norvasc G

amlodipine besylate-benazepril hcl oral capsule 10-20 mg, 10-40 mg, 5-10 mg, 5-20 mg

Lotrel G


56


amlodipine besylate-benazepril hcl oral capsule 2.5-10 mg, 5-40 mg

G

amlodipine besylate-valsartan oral tablet 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg

Exforge G

amlodipine-atorvastatin oral tablet 10-10 mg, 10-20 mg, 10-40 mg, 10-80 mg, 5-10 mg, 5-20 mg, 5-40 mg, 5-80 mg

Caduet G

amlodipine-atorvastatin oral tablet 2.5-10 mg, 2.5-20 mg, 2.5-40 mg

G

amlodipine-olmesartan oral tablet 10-20 mg, 10-40 mg, 5-20 mg, 5-40 mg

Azor G ST

amlodipine-valsartan-hctz oral tablet 10-160-12.5 mg, 10-160-25 mg, 10-320-25 mg, 5-160-12.5 mg, 5-160-25 mg

Exforge HCT G

atenolol oral tablet 100 mg, 25 mg, 50 mg Tenormin G

atenolol-chlorthalidone oral tablet 100-25 mg

Tenoretic 100 G

atenolol-chlorthalidone oral tablet 50-25 mg

Tenoretic 50 G

atorvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 80 mg

Lipitor G

benazepril hcl oral tablet 10 mg, 20 mg, 40 mg

Lotensin G

benazepril hcl oral tablet 5 mg G

benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

Lotensin HCT G

benazepril-hydrochlorothiazide oral tablet 5-6.25 mg

G

betaxolol hcl oral tablet 10 mg, 20 mg G

bisoprolol fumarate oral tablet 10 mg, 5 mg

G

bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg

Ziac G

bumetanide injection solution 0.25 mg/ml G

bumetanide oral tablet 0.5 mg, 1 mg, 2 mg

Bumex G

candesartan cilexetil oral tablet 16 mg, 32 mg, 4 mg, 8 mg

Atacand G

candesartan cilexetil-hctz oral tablet 16-12.5 mg, 32-12.5 mg, 32-25 mg

Atacand HCT G

captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg

G


57


captopril-hydrochlorothiazide oral tablet 25-15 mg, 25-25 mg, 50-15 mg, 50-25 mg

G

cartia xt oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

Cardizem CD G

cartia xt oral capsule extended release 24 hour 300 mg

Cartia XT G

carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg

Coreg G

carvedilol phosphate er oral capsule extended release 24 hour 10 mg, 20 mg, 40 mg, 80 mg

Coreg CR G

chlorothiazide oral tablet 250 mg, 500 mg G

chlorothiazide sodium intravenous solution reconstituted 500 mg

Sodium Diuril G

chlorthalidone oral tablet 25 mg, 50 mg G

cholestyramine light oral packet 4 gm Prevalite G

cholestyramine light oral powder 4 gm/dose

Prevalite G

cholestyramine oral packet 4 gm Questran G

cholestyramine oral powder 4 gm/dose Questran G

choline fenofibrate oral capsule delayed release 135 mg

Trilipix G ST

clonidine hcl (analgesia) epidural solution 100 mcg/ml

Duraclon G

clonidine hcl (analgesia) epidural solution 500 mcg/ml

G

clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg

Catapres G

clonidine hcl transdermal patch weekly 0.1 mg/24hr

Catapres-TTS-1 G


Catapres-TTS-2 G


Catapres-TTS-3 G

colesevelam hcl oral packet 3.75 gm Welchol G

colesevelam hcl oral tablet 625 mg Welchol G

COLESTID FLAVORED ORAL GRANULES 5 GM

Colestid B ST

COLESTID FLAVORED ORAL PACKET 5 GM

Colestid B ST

COLESTID ORAL GRANULES 5 GM Colestid B ST

COLESTID ORAL PACKET 5 GM Colestid B ST

COLESTID ORAL TABLET 1 GM Colestid B ST


58


colestipol hcl oral granules 5 gm Colestid G ST

colestipol hcl oral packet 5 gm Colestid G ST

colestipol hcl oral tablet 1 gm Colestid G ST

CORLANOR ORAL TABLET 5 MG, 7.5 MG

B PA

digitek oral tablet 125 mcg, 250 mcg Digitek G

digox oral tablet 125 mcg, 250 mcg Digitek G

digoxin injection solution 0.25 mg/ml Lanoxin G

digoxin oral solution 0.05 mg/ml G

digoxin oral tablet 125 mcg, 250 mcg Digitek G

diltiazem cd oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

Cardizem CD G

diltiazem cd oral capsule extended release 24 hour 300 mg

Cartia XT G

diltiazem hcl er beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

Taztia XT G

diltiazem hcl er beads oral capsule extended release 24 hour 420 mg

Tiazac G

diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg

Cardizem CD G

diltiazem hcl er coated beads oral capsule extended release 24 hour 300 mg

Cartia XT G

diltiazem hcl er coated beads oral tablet extended release 24 hour 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

Cardizem LA G

diltiazem hcl er oral capsule extended release 12 hour 120 mg, 60 mg, 90 mg

G

diltiazem hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

G

diltiazem hcl intravenous solution 125 mg/25ml, 25 mg/5ml, 50 mg/10ml

G

diltiazem hcl intravenous solution reconstituted 100 mg

G

diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg

Cardizem G

diltiazem hcl oral tablet 90 mg G

diltiazem hcl-dextrose intravenous solution 100-5 mg/100ml-%, 125-5 mg/125ml-%, 250-5 mg/250ml-%

G


59


diltiazem hcl-sodium chloride intravenous solution 100-0.9 mg/100ml-%, 125-0.9 mg/125ml-%

G

dilt-xr oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

G

disopyramide phosphate oral capsule 100 mg, 150 mg

Norpace G

dobutamine hcl intravenous solution 250 mg/20ml, 500 mg/40ml

G

dobutamine in d5w intravenous solution 1-5 mg/ml-%, 2 mg/ml, 4-5 mg/ml-%

G

dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg

Tikosyn G

dopamine hcl intravenous solution 160 mg/ml, 40 mg/ml, 80 mg/ml

G

dopamine in d5w intravenous solution 0.8-5 mg/ml-%, 1.6-5 mg/ml-%, 3.2-5 mg/ml-%

G

doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg, 8 mg

Cardura G

EDECRIN ORAL TABLET 25 MG Edecrin B PA

enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg

Vasotec G

enalaprilat intravenous injectable 1.25 mg/ml

G

enalapril-hydrochlorothiazide oral tablet 10-25 mg

Vaseretic G

enalapril-hydrochlorothiazide oral tablet 5-12.5 mg

G

ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG

B PA

ephedrine sulfate injection solution 50 mg/ml

G

ephedrine sulfate intravenous solution 50 mg/ml

Akovaz G

epinephrine injection solution 30 mg/30ml G

epinephrine pf injection solution 1 mg/ml G

epinephrine pf injection solution prefilled syringe 1 mg/10ml

G

eplerenone oral tablet 25 mg, 50 mg Inspra G

eprosartan mesylate oral tablet 600 mg G

esmolol hcl intravenous solution 100 mg/10ml

Brevibloc G


60


ethacrynate sodium intravenous solution reconstituted 50 mg

Sodium Edecrin G

ethacrynic acid oral tablet 25 mg Edecrin G PA

ezetimibe oral tablet 10 mg Zetia G PA

ezetimibe-simvastatin oral tablet 10-10 mg, 10-20 mg, 10-40 mg, 10-80 mg

Vytorin G

felodipine er oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

G

fenofibrate micronized oral capsule 130 mg, 134 mg, 200 mg, 43 mg, 67 mg

G ST

fenofibrate oral capsule 150 mg, 50 mg Lipofen G

fenofibrate oral tablet 120 mg, 40 mg Fenoglide G

fenofibrate oral tablet 145 mg, 48 mg Tricor G

fenofibrate oral tablet 160 mg Triglide G

fenofibrate oral tablet 54 mg G

fenofibric acid oral capsule delayed release 135 mg, 45 mg

Trilipix G ST

fenofibric acid oral tablet 105 mg, 35 mg Fibricor G

flecainide acetate oral tablet 100 mg, 150 mg, 50 mg

G

fluvastatin sodium er oral tablet extended release 24 hour 80 mg

Lescol XL G

fluvastatin sodium oral capsule 20 mg Lescol G

fluvastatin sodium oral capsule 40 mg G

fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg

G

fosinopril sodium-hctz oral tablet 10-12.5 mg, 20-12.5 mg

G

furosemide injection solution 10 mg/ml G

furosemide oral solution 10 mg/ml, 8 mg/ml

G

furosemide oral tablet 20 mg, 40 mg, 80 mg

Lasix G

gemfibrozil oral tablet 600 mg Lopid G

guanfacine hcl oral tablet 1 mg, 2 mg G

HEMANGEOL ORAL SOLUTION 4.28 MG/ML

B PA

hydralazine hcl injection solution 20 mg/ml

G

hydralazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg

G


61


hydrochlorothiazide oral capsule 12.5 mg Microzide G

hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg

G

ibutilide fumarate intravenous solution 1 mg/10ml

Corvert G

indapamide oral tablet 1.25 mg, 2.5 mg G

irbesartan oral tablet 150 mg, 300 mg, 75 mg

Avapro G ST

irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg

Avalide G ST

isoproterenol hcl injection solution 0.2 mg/ml

Isuprel G

isosorbide dinitrate er oral tablet extended release 40 mg

G

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg

G

isosorbide dinitrate oral tablet 5 mg Isordil Titradose G

isosorbide mononitrate er oral tablet extended release 24 hour 120 mg, 30 mg, 60 mg

G

isosorbide mononitrate oral tablet 10 mg, 20 mg

G

isoxsuprine hcl oral tablet 10 mg, 20 mg G

isradipine oral capsule 2.5 mg, 5 mg G

KYNAMRO SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/ML

B PA; SP

labetalol hcl intravenous solution 5 mg/ml G

labetalol hcl oral tablet 100 mg, 200 mg, 300 mg

G

lisinopril oral tablet 10 mg, 20 mg, 5 mg Prinivil G

lisinopril oral tablet 2.5 mg, 30 mg, 40 mg Zestril G

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

Zestoretic G

losartan potassium oral tablet 100 mg, 25 mg, 50 mg

Cozaar G

losartan potassium-hctz oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg

Hyzaar G

lovastatin oral tablet 10 mg, 20 mg G

lovastatin oral tablet 40 mg Mevacor G

mannitol intravenous solution 20 % Osmitrol G

mannitol intravenous solution 25 % G


62


matzim la oral tablet extended release 24 hour 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

Cardizem LA G

methyclothiazide oral tablet 5 mg G

methyldopa oral tablet 250 mg, 500 mg G

methyldopa-hydrochlorothiazide oral tablet 250-15 mg, 250-25 mg

G

methyldopate hcl intravenous solution 250 mg/5ml

G

metolazone oral tablet 10 mg, 2.5 mg, 5 mg

G

metoprolol succinate er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 50 mg

Toprol XL G

metoprolol tartrate intravenous solution 5 mg/5ml

G

metoprolol tartrate intravenous solution cartridge 5 mg/5ml

G

metoprolol tartrate oral tablet 100 mg, 50 mg

Lopressor G

metoprolol tartrate oral tablet 25 mg, 37.5 mg, 75 mg

G

metoprolol-hydrochlorothiazide oral tablet 100-25 mg, 100-50 mg

G

metoprolol-hydrochlorothiazide oral tablet 50-25 mg

Lopressor HCT G

mexiletine hcl oral capsule 150 mg, 200 mg, 250 mg

G

midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg

G

milrinone lactate in dextrose intravenous solution 20-5 mg/100ml-%, 40-5 mg/200ml-%

G

milrinone lactate intravenous solution 10 mg/10ml, 20 mg/20ml, 50 mg/50ml

G

minitran transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr

Minitran G ST

minoxidil oral tablet 10 mg, 2.5 mg G

moexipril hcl oral tablet 15 mg, 7.5 mg G

moexipril-hydrochlorothiazide oral tablet 15-12.5 mg, 15-25 mg, 7.5-12.5 mg

G

nadolol oral tablet 20 mg, 40 mg, 80 mg Corgard G

nadolol-bendroflumethiazide oral tablet 40-5 mg, 80-5 mg

Corzide G


63


niacin er (antihyperlipidemic) oral tablet extended release 1000 mg, 500 mg, 750 mg

Niaspan G

niacor oral tablet 500 mg G

NIASPAN ORAL TABLET EXTENDED RELEASE 1000 MG, 500 MG, 750 MG

Niaspan B

nicardipine hcl intravenous solution 2.5 mg/ml

G

nicardipine hcl oral capsule 20 mg, 30 mg G

nifedical xl oral tablet extended release 24 hour 60 mg

Nifedical XL G

nifedipine er oral tablet extended release 24 hour 30 mg, 60 mg, 90 mg

Adalat CC G

nifedipine er osmotic release oral tablet extended release 24 hour 30 mg, 90 mg

Procardia XL G

nifedipine er osmotic release oral tablet extended release 24 hour 60 mg

Nifedical XL G

nifedipine oral capsule 10 mg Procardia G

nifedipine oral capsule 20 mg G

nimodipine oral capsule 30 mg G

nisoldipine er oral tablet extended release 24 hour 17 mg, 34 mg, 8.5 mg

Sular G

nisoldipine er oral tablet extended release 24 hour 20 mg, 25.5 mg, 30 mg, 40 mg

G

nitroglycerin er oral capsule extended release 2.5 mg, 6.5 mg, 9 mg

Nitro-Time G

nitroglycerin in d5w intravenous solution 100-5 mcg/ml-%, 200-5 mcg/ml-%, 400-5 mcg/ml-%

G

nitroglycerin intravenous solution 5 mg/ml G

nitroglycerin sublingual tablet sublingual 0.3 mg, 0.4 mg, 0.6 mg

Nitrostat G

nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr

Minitran G ST

nitroglycerin translingual solution 0.4 mg/spray

Nitrolingual G

nitroprusside sodium intravenous solution 25 mg/ml

Nitropress G

NITROSTAT SUBLINGUAL TABLET SUBLINGUAL 0.3 MG, 0.4 MG, 0.6 MG

Nitrostat B

nitro-time oral capsule extended release 2.5 mg, 6.5 mg, 9 mg

Nitro-Time G


64


norepinephrine bitartrate intravenous solution 1 mg/ml

Levophed G

norepinephrine-dextrose intravenous solution 4-5 mg/250ml-%, 4-5 mg/500ml-%

G

norepinephrine-sodium chloride intravenous solution 16-0.9 mg/250ml-%, 16-0.9 mg/500ml-%, 4-0.9 mg/250ml-%, 8-0.9 mg/250ml-%

G

norepinephrine-sodium chloride intravenous solution prefilled syringe 0.08-0.9 mg/10ml-%, 0.16-0.9 mg/10ml-%, 0.8-0.9 mg/50ml-%

G

NORTHERA ORAL CAPSULE 100 MG, 200 MG, 300 MG

B PA; SP

olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg

Benicar G ST

olmesartan medoxomil-hctz oral tablet 20-12.5 mg, 40-12.5 mg, 40-25 mg

Benicar HCT G

olmesartan-amlodipine-hctz oral tablet 20-5-12.5 mg, 40-10-12.5 mg, 40-10-25 mg, 40-5-12.5 mg, 40-5-25 mg

Tribenzor G

omega-3-acid ethyl esters oral capsule 1 gm

Lovaza G PA

osmitrol intravenous solution 10 %, 15 %, 5 %

G

osmitrol intravenous solution 20 % Osmitrol G

pacerone oral tablet 100 mg, 200 mg, 400 mg

Pacerone G

papaverine hcl injection solution 30 mg/ml G

pentoxifylline er oral tablet extended release 400 mg

G

perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg

G

phenoxybenzamine hcl oral capsule 10 mg

Dibenzyline G

phentolamine mesylate injection solution reconstituted 5 mg

G

phenylephrine hcl injection solution 10 mg/ml

G

phenylephrine hcl intravenous solution 10 mg/ml

Vazculep G

phenylephrine hcl-nacl intravenous solution prefilled syringe 20-0.9 mg/50ml-%, 5-0.9 mg/50ml-%

G


65


pindolol oral tablet 10 mg, 5 mg G

pravastatin sodium oral tablet 10 mg G

pravastatin sodium oral tablet 20 mg, 40 mg, 80 mg

Pravachol G

prazosin hcl oral capsule 1 mg, 2 mg, 5 mg

Minipress G

prevalite oral packet 4 gm Prevalite G

prevalite oral powder 4 gm/dose Prevalite G

procainamide hcl injection solution 100 mg/ml, 500 mg/ml

G

propafenone hcl er oral capsule extended release 12 hour 225 mg, 325 mg, 425 mg

Rythmol SR G

propafenone hcl oral tablet 150 mg, 225 mg, 300 mg

G

propranolol hcl er oral capsule extended release 24 hour 120 mg, 160 mg, 60 mg, 80 mg

Inderal LA G

propranolol hcl intravenous solution 1 mg/ml

G

propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml

G

propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

G

propranolol-hctz oral tablet 40-25 mg, 80-25 mg

G

quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg

Accupril G

quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

Accuretic G

quinidine gluconate er oral tablet extended release 324 mg

G

quinidine gluconate injection solution 80 mg/ml

G

quinidine sulfate oral tablet 200 mg, 300 mg

G

ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg

Altace G

RANEXA ORAL TABLET EXTENDED RELEASE 12 HOUR 1000 MG, 500 MG

B PA

rosuvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 5 mg

Crestor G ST

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

Zocor G

simvastatin oral tablet 80 mg Zocor G PA


66


sorine oral tablet 120 mg, 160 mg, 80 mg Betapace G

sorine oral tablet 240 mg Sorine G

sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg

Betapace AF G

sotalol hcl intravenous solution 150 mg/10ml

G

sotalol hcl oral tablet 120 mg, 160 mg, 80 mg

Betapace G

sotalol hcl oral tablet 240 mg Sorine G

spironolactone oral tablet 100 mg, 25 mg, 50 mg

Aldactone G

spironolactone-hctz oral tablet 25-25 mg Aldactazide G

taztia xt oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

Taztia XT G

telmisartan oral tablet 20 mg, 40 mg, 80 mg

Micardis G ST

telmisartan-amlodipine oral tablet 40-10 mg, 40-5 mg, 80-10 mg, 80-5 mg

Twynsta G

telmisartan-hctz oral tablet 40-12.5 mg, 80-12.5 mg, 80-25 mg

Micardis HCT G

timolol maleate oral tablet 10 mg, 20 mg, 5 mg

G

torsemide oral tablet 10 mg, 20 mg Demadex G

torsemide oral tablet 100 mg, 5 mg G

trandolapril oral tablet 1 mg, 2 mg G

trandolapril oral tablet 4 mg Mavik G

trandolapril-verapamil hcl er oral tablet extended release 1-240 mg

G

trandolapril-verapamil hcl er oral tablet extended release 2-180 mg, 2-240 mg, 4-240 mg

Tarka G

triamterene-hctz oral capsule 37.5-25 mg Dyazide G

triamterene-hctz oral capsule 50-25 mg G

triamterene-hctz oral tablet 37.5-25 mg Maxzide-25 G

triamterene-hctz oral tablet 75-50 mg Maxzide G

triklo oral capsule 1 gm Lovaza G PA

valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg

Diovan G

valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg

Diovan HCT G


67


verapamil hcl er oral capsule extended release 24 hour 100 mg, 200 mg, 300 mg

Verelan PM G

verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg

Verelan G

verapamil hcl er oral tablet extended release 120 mg, 180 mg, 240 mg

Calan SR G

verapamil hcl intravenous solution 2.5 mg/ml

G

verapamil hcl oral tablet 120 mg, 80 mg Calan G

verapamil hcl oral tablet 40 mg G

ZETIA ORAL TABLET 10 MG Zetia B

Central Nervous System Agents - Drugs for Attention Deficit Disorder

amphetamine-dextroamphetamine er oral capsule extended release 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg

Adderall XR G PA

amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

Adderall G PA

atomoxetine hcl oral capsule 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg

Strattera G PA

clonidine hcl er oral tablet extended release 12 hour 0.1 mg

Kapvay G

dexmethylphenidate hcl er oral capsule extended release 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg

Focalin XR G AL (Max 22 Years)

dexmethylphenidate hcl oral tablet 10 mg, 2.5 mg, 5 mg

Focalin G PA

dextroamphetamine sulfate er oral capsule extended release 24 hour 10 mg, 15 mg, 5 mg

Dexedrine G

dextroamphetamine sulfate oral solution 5 mg/5ml

ProCentra G

dextroamphetamine sulfate oral tablet 10 mg, 5 mg

Zenzedi G

FOCALIN ORAL TABLET 10 MG, 2.5 MG, 5 MG

Focalin B PA

guanfacine hcl er oral tablet extended release 24 hour 1 mg, 2 mg, 3 mg, 4 mg

Intuniv G PA

INTUNIV ORAL TABLET EXTENDED RELEASE 24 HOUR 1 MG, 2 MG, 3 MG, 4 MG

Intuniv B PA


68


metadate er oral tablet extended release 20 mg

Metadate ER G PA

methamphetamine hcl oral tablet 5 mg Desoxyn G

methylphenidate hcl er (cd) oral capsule extended release 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

G PA

methylphenidate hcl er (la) oral capsule extended release 24 hour 10 mg, 20 mg, 30 mg, 40 mg

Ritalin LA G

methylphenidate hcl er (la) oral capsule extended release 24 hour 60 mg

G

methylphenidate hcl er oral tablet extended release 10 mg

G PA

methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 36 mg, 54 mg

Concerta G PA


Metadate ER G PA

methylphenidate hcl er oral tablet extended release 24 hour 18 mg, 27 mg, 36 mg, 54 mg

G PA


Relexxii G PA

methylphenidate hcl oral solution 10 mg/5ml, 5 mg/5ml

Methylin G PA

methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg

Ritalin G PA

methylphenidate hcl oral tablet chewable 10 mg, 2.5 mg, 5 mg

G PA

relexxii oral tablet extended release 72 mg

Relexxii G PA

VYVANSE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG, 70 MG

B PA

VYVANSE ORAL TABLET CHEWABLE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG

B PA

zenzedi oral tablet 10 mg, 5 mg Zenzedi G

Central Nervous System Agents - Drugs for Multiple Sclerosis

AMPYRA ORAL TABLET EXTENDED RELEASE 12 HOUR 10 MG

B PA; SP

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT 30 MCG/0.5ML

B PA; SP


69


AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT 30 MCG/0.5ML

B PA; SP

AVONEX VIAL INTRAMUSCULAR KIT INTRAMUSCULAR KIT 30 MCG

B PA; SP

BETASERON SUBCUTANEOUS KIT 0.3 MG

B ST; SP

EXTAVIA SUBCUTANEOUS KIT 0.3 MG B PA; SP

GILENYA ORAL CAPSULE 0.5 MG B PA; SP

glatiramer acetate subcutaneous solution prefilled syringe 20 mg/ml, 40 mg/ml

Copaxone G PA; SP

glatopa subcutaneous solution prefilled syringe 20 mg/ml, 40 mg/ml

Copaxone G PA; SP

PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PEN-INJECTOR 63 & 94 MCG/0.5ML

B PA; SP

PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 63 & 94 MCG/0.5ML

B PA; SP

PLEGRIDY SUBCUTANEOUS SOLUTION PEN-INJECTOR 125 MCG/0.5ML

B PA; SP

PLEGRIDY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 125 MCG/0.5ML

B PA; SP

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR 22 MCG/0.5ML, 44 MCG/0.5ML

B PA; SP

REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 6X8.8 & 6X22 MCG

B PA; SP

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 22 MCG/0.5ML, 44 MCG/0.5ML

B PA; SP

REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6X8.8 & 6X22 MCG

B PA; SP

TECFIDERA ORAL 120 & 240 MG B PA; SP

TECFIDERA ORAL CAPSULE DELAYED RELEASE 120 MG, 240 MG

B PA; SP

TYSABRI INTRAVENOUS CONCENTRATE 300 MG/15ML

B PA; SP


70


ZINBRYTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML

B ST

Central Nervous System Agents - Miscellaneous

atracurium besylate intravenous solution 100 mg/10ml, 50 mg/5ml

G

BELVIQ ORAL TABLET 10 MG B PA

BELVIQ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 20 MG

B PA

benzphetamine hcl oral tablet 25 mg Regimex G

benzphetamine hcl oral tablet 50 mg Didrex G PA

caffeine citrate intravenous solution 60 mg/3ml

Cafcit G

caffeine citrate oral solution 20 mg/ml, 60 mg/3ml

G

caffeine-sodium benzoate injection solution 125-125 mg/ml

G

cisatracurium besylate intravenous solution 10 mg/5ml, 20 mg/10ml, 200 mg/20ml

Nimbex G

CONTRAVE ORAL TABLET EXTENDED RELEASE 12 HOUR 8-90 MG

B PA

diethylpropion hcl er oral tablet extended release 24 hour 75 mg

G

diethylpropion hcl oral tablet 25 mg G PA

LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 225 MG, 25 MG, 300 MG, 50 MG, 75 MG

B ST

pancuronium bromide intravenous solution 1 mg/ml, 2 mg/ml

G

phendimetrazine tartrate er oral capsule extended release 24 hour 105 mg

G PA

phendimetrazine tartrate oral tablet 35 mg G PA

phentermine hcl oral capsule 15 mg, 30 mg

G PA

phentermine hcl oral capsule 37.5 mg Adipex-P G PA

phentermine hcl oral tablet 37.5 mg Adipex-P G PA

QSYMIA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 11.25-69 MG, 15-92 MG, 3.75-23 MG, 7.5-46 MG

B PA

RADICAVA INTRAVENOUS SOLUTION 30 MG/100ML

B PA; SP


71


riluzole oral tablet 50 mg Rilutek G

rocuronium bromide intravenous solution 100 mg/10ml, 50 mg/5ml

G

SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 MG

B ST

SAVELLA TITRATION PACK ORAL 12.5 & 25 & 50 MG

B ST

succinylcholine chloride injection solution 20 mg/ml

Anectine G

tetrabenazine oral tablet 12.5 mg, 25 mg Xenazine G PA; SP

vecuronium bromide intravenous solution reconstituted 10 mg, 20 mg

G

XENICAL ORAL CAPSULE 120 MG B PA

Dental and Oral Agents - Drugs for Mouth and Throat Conditions

cavarest dental gel 1.1 % Cavarest G

cevimeline hcl oral capsule 30 mg Evoxac G PA

chlorhexidine gluconate mouth/throat solution 0.12 %

Paroex G

clinpro 5000 dental paste 1.1 % G

denta 5000 plus dental cream 1.1 % Denta 5000 Plus G

dentagel dental gel 1.1 % Cavarest G

easygel dental gel 0.4 % G

fluoridex daily renewal mouth/throat concentrate 0.63 %

G

fluoridex dental paste 1.1 % G

fluoridex enhanced whitening dental paste 1.1 %

G

fluoridex sensitivity relief dental paste 1.1-5 %

G

lidocaine hcl mouth/throat solution 4 % G

lidocaine viscous mouth/throat solution 2 %

G

neutragard advanced dental gel 1.1 % Cavarest G

neutral sodium fluoride mouth/throat solution 0.2 %

PreviDent G

numoisyn mouth/throat liquid G

oralone mouth/throat paste 0.1 % Oralone G

paroex mouth/throat solution 0.12 % Paroex G

periogard mouth/throat solution 0.12 % Paroex G

phos-flur dental gel 1.1 % Cavarest G


72


pilocarpine hcl oral tablet 5 mg, 7.5 mg Salagen G

prevident mouth/throat solution 0.2 % PreviDent G

SALAGEN ORAL TABLET 5 MG, 7.5 MG Salagen B

sf 5000 plus dental cream 1.1 % Denta 5000 Plus G

sf dental gel 1.1 % Cavarest G

topex topical anesthetic mouth/throat aerosol 20 %

G

triamcinolone acetonide mouth/throat paste 0.1 %

Oralone G

Dermatological Agents - Drugs for Skin Conditions

acitretin oral capsule 10 mg, 25 mg Soriatane G

acitretin oral capsule 17.5 mg G

acne medication 5 external gel 5 % G QL (90 GM per 31 days)

adapalene external cream 0.1 % Differin G

adapalene external gel 0.1 %, 0.3 % Differin G PA

adapalene-benzoyl peroxide external gel 0.1-2.5 %

Epiduo G

alevicyn dermal spray external solution G

ammonium lactate external lotion 12 % AL12 G

amnesteem oral capsule 10 mg, 20 mg, 40 mg

Absorica G

arzol silver nit applicators external 75-25 %

G

avar cleanser external emulsion 10-5 % Avar Cleanser G

avar-e emollient external cream 10-5 % Avar-e Emollient G

avar-e green external cream 10-5 % Avar-e Emollient G

avita external cream 0.025 % Avita G

avita external gel 0.025 % Avita G

beau rx external gel Celacyn G

benzepro creamy wash external liquid 7 %

BenzePrO Creamy Wash G

benzepro external foam 5.3 % BenzEFoam G

benzepro foaming cloths external 6 % BenzePrO Foaming Cloths

G

benzepro short contact external foam 9.8 %

BenzEFoamUltra G

benziq wash external liquid 5.25 % G


73


benzoin compound external tincture Steri-Strip Compound Benzoin

G

benzoin external tincture G

benzoyl peroxide external foam 9.8 % BenzEFoamUltra G

benzoyl peroxide external gel 5 % G QL (90 GM per 31 days)

benzoyl peroxide-erythromycin external gel 5-3 %

Benzamycin G

bp 10-1 external emulsion 10-1 % G

bp cleansing wash external emulsion 10-4 %

G

bp foam external foam 5.3 % BenzEFoam G

bp foam external foam 9.8 % BenzEFoamUltra G

bp foaming wash external liquid 10 % PanOxyl Wash G

bp gel external gel 5 % G QL (90 GM per 31 days)

bp wash external liquid 2.5 % PanOxyl G

bp wash external liquid 7 % BenzePrO Creamy Wash G

bpo foaming cloths external 6 % BenzePrO Foaming Cloths

G

calcipotriene external cream 0.005 % Dovonex G PA

calcipotriene external ointment 0.005 % Calcitrene G PA

calcipotriene external solution 0.005 % G PA

calcipotriene-betameth diprop external ointment 0.005-0.064 %

Taclonex G PA

calcitrene external ointment 0.005 % Calcitrene G PA

calcitriol external ointment 3 mcg/gm Vectical G PA

CARAC EXTERNAL CREAM 0.5 % Carac B

celacyn external gel Celacyn G

cem-urea external solution 45 % G

ceramax external cream G

cerisa wash external emulsion 10-1 % G

cerovel external lotion 40 % Cerovel G

cicatrace pad external kit Rexasil Patch & Vitamin E Liq

G

claravis oral capsule 10 mg, 20 mg, 30 mg, 40 mg

Absorica G

clindacin etz external swab 1 % Cleocin-T G

clindacin-p external swab 1 % Cleocin-T G


74


clindamycin phos-benzoyl perox external gel 1.2-5 %

Duac G

clindamycin phosphate-benzoyl peroxide external gel 1-5 %

BenzaClin G

clindamycin phosphate external foam 1 % Evoclin G

clindamycin phosphate external gel 1 % Cleocin-T G

clindamycin phosphate external lotion 1 % Cleocin-T G

clindamycin phosphate external solution 1 %

Cleocin-T G

clindamycin phosphate external swab 1 % Cleocin-T G

clindamycin-tretinoin external gel 1.2-0.025 %

Veltin G

clotrimazole-betamethasone external cream 1-0.05 %

Lotrisone G

clotrimazole-betamethasone external lotion 1-0.05 %

G

coal tar external solution 20 % G

COSENTYX 150 MG/ML SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML

B PA; SP

COSENTYX 300 DOSE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML

B PA; SP

COSENTYX SENSOREADY 300 DOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML

B PA; SP

COSENTYX SENSOREADY PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML

B PA; SP

dapsone external gel 5 % Aczone G

dermazene external cream 1-1 % Dermazene G

diab external gel G

diab f.d.g. freeze-dried external gel G

diclofenac sodium transdermal gel 3 % G

doxepin hcl external cream 5 % Prudoxin G

doxycycline oral capsule delayed release 40 mg

Oracea G

dritho-creme hp external cream 1 % G

ELIDEL EXTERNAL CREAM 1 % B PA

EPIDUO FORTE EXTERNAL GEL 0.3-2.5 %

B

ery external pad 2 % G


75


erythromycin external gel 2 % Erygel G

erythromycin external pad 2 % G

erythromycin external solution 2 % G

EUCRISA EXTERNAL OINTMENT 2 % B PA

FINACEA EXTERNAL FOAM 15 % B ST

FINACEA EXTERNAL GEL 15 % B ST

FLUOROURACIL EXTERNAL CREAM 0.5 %

Carac B

fluorouracil external cream 5 % Efudex G

fluorouracil external solution 2 %, 5 % G SP

glycolic acid solution 70 % G

halac external kit 0.05 & 12 % G

hydrocortisone ace-pramoxine external cream 2.5-1 %

Pramosone G

hydrocortisone-iodoquinol external cream 1-1 %

Dermazene G

imiquimod external cream 5 % Aldara G PA

iodoquinol-hydrocortisone-aloe external cream 1-1.9 %

Vytone G

isotretinoin oral capsule 10 mg, 20 mg, 30 mg, 40 mg

Absorica G

lac-hydrin external cream 12 % G

lactic acid e external cream 10-3500 %-unt/30gm

G

lactic acid external lotion 10 % G

latrix external suspension 50 % G

latrix xm external emulsion 45 % G

levicyn dermal spray external solution G

lidocaine-hydrocortisone ace external cream 1-1 %

G

luxamend external cream G

methoxsalen oral capsule 10 mg G

methoxsalen rapid oral capsule 10 mg Oxsoralen Ultra G

methyl salicylate external liquid G

metopic external cream 41 % MeTopic G

metronidazole external cream 0.75 % MetroCream G

metronidazole external gel 0.75 % Rosadan G

metronidazole external gel 1 % Metrogel G

metronidazole external lotion 0.75 % MetroLotion G


76


MIRVASO EXTERNAL GEL 0.33 % B PA

myorisan oral capsule 10 mg, 20 mg, 30 mg, 40 mg

Absorica G

neuac external gel 1.2-5 % Duac G

podocon external solution 25 % G

podofilox external solution 0.5 % G

pr benzoyl peroxide wash external liquid 7 %

BenzePrO Creamy Wash G

pramox external gel 1 % G

prutect external emulsion G

pyrogallic acid external ointment 25-2 % G

radiagel external gel G

rea lo 39 external cream 39 % Uredeb G

rea lo 40 external cream 40 % Rea Lo 40 G

rea lo 40 external lotion 40 % Cerovel G

recedo external gel Celacyn G

remeven external cream 50 % G

restizan external gel Celacyn G

RETIN-A EXTERNAL CREAM 0.025 % Avita B

RETIN-A EXTERNAL CREAM 0.05 %, 0.1 %

Retin-A B

rosadan external cream 0.75 % MetroCream G

rosadan external gel 0.75 % Rosadan G

rosanil cleanser external emulsion 10-5 % Avar Cleanser G

salacyn external cream 6 % G

salacyn external lotion 6 % G

salicylic acid er external solution 28.5 % UltraSal-ER G

salicylic acid external cream 6 % G

salicylic acid external foam 6 % Salvax G

salicylic acid external gel 6 % Keralyt G

salicylic acid external liquid 26 % G

salicylic acid external liquid 27.5 % Virasal G

salicylic acid external lotion 6 % G

salicylic acid external shampoo 6 % Salex G

salicylic acid external solution 26 % G

salicylic acid wart remover external liquid 27.5 %

Virasal G


77


salicylic acid-cleanser external kit 6 % (cream), 6 % (lotion)

Salex G

salimez external cream 6 % G

salisol forte external solution 26 % G

salitech forte external lotion 6 % G

salvax external foam 6 % Salvax G

seb-prev wash external liquid 10 % Ovace Plus Wash G

selenium sulfide external lotion 2.5 % G

selenium sulfide external shampoo 2.25 %

G

selenium sulfide external shampoo 2.3 % SelRx G

selenium sulf-pyrithione-urea external shampoo 2.25 %

G

sodium hyaluronate external gel 0.2 % Hylira G

sodium sulfacetamide external shampoo 10 %

Ovace Plus G

sonafine external emulsion G

SOOLANTRA EXTERNAL CREAM 1 % B PA

sss 10-5 external cream 10-5 % Avar-e Emollient G

sss 10-5 external foam 10-5 % G

sulfacetamide sodium (acne) external lotion 10 %

Klaron G ST

sulfacetamide sodium external gel 10 % (cleans)

Ovace Plus Wash G

sulfacetamide sodium external liquid 10 % Ovace Plus Wash G

sulfacetamide sodium-sulfur external cream 10-2 %

Avar-e LS G

sulfacetamide sodium-sulfur external cream 10-5 %

Avar-e Emollient G

sulfacetamide sodium-sulfur external cream 9.8-4.8 %

Plexion G

sulfacetamide sodium-sulfur external emulsion 10-5 %

Avar Cleanser G

sulfacetamide sodium-sulfur external liquid 10-2 %

Avar LS Cleanser G

sulfacetamide sodium-sulfur external liquid 9.8-4.8 %

Plexion Cleanser G

sulfacetamide sodium-sulfur external liquid 9-4 %

Sumaxin Wash G

sulfacetamide sodium-sulfur external liquid 9-4.5 %

Sumadan Wash G


78


sulfacetamide sodium-sulfur external lotion 10-5 %

G

sulfacetamide sodium-sulfur external lotion 9.8-4.8 %

Plexion G

sulfacetamide sodium-sulfur external pad 10-4 %

Sumaxin G

sulfacetamide sodium-sulfur external suspension 10-5 %

G

sulfacetamide sodium-sulfur external suspension 8-4 %

SulfaCleanse 8/4 G

sulfacetamide sod-sulfur wash external kit 9-4.5 %

Sumadan G

sulfacetamide-sulfur in urea external emulsion 10-5 %

G

sulfacetamide-sulfur-sunscreen external kit 9-4.5 %

Sumadan XLT G

sulfacleanse 8/4 external suspension 8-4 %

SulfaCleanse 8/4 G

sulfamez wash external emulsion 10-1 % G

tacrolimus external ointment 0.03 %, 0.1 %

Protopic G PA

tazarotene external cream 0.1 % Tazorac G PA

TAZORAC EXTERNAL CREAM 0.05 % B PA

TAZORAC EXTERNAL CREAM 0.1 % Tazorac B PA

TAZORAC EXTERNAL GEL 0.05 %, 0.1 %

B PA

tetrix external cream G

tretinoin external cream 0.025 % Avita G

tretinoin external cream 0.05 %, 0.1 % Retin-A G

tretinoin external gel 0.01 % Retin-A G

tretinoin external gel 0.025 % Avita G

tretinoin external gel 0.05 % Atralin G

tretinoin microsphere external gel 0.04 %, 0.1 %

RETIN-A MICRO GEL 0.04 %, 0.1 %

G

tretinoin microsphere pump external gel 0.04 %, 0.1 %

RETIN-A MICRO GEL 0.04 %, 0.1 %

G

TRETIN-X EXTERNAL CREAM 0.075 % B

turpentine external spirit G

umecta mousse external foam 40 % G

uramaxin external foam 20 % G

urea external cream 39 % Uredeb G


79


urea external cream 40 % Rea Lo 40 G

urea external cream 41 % MeTopic G

urea external cream 45 %, 50 % G

urea external cream 47 % Keralac G

urea external emulsion 50 % G

urea external lotion 40 % Cerovel G

urea external lotion 45 % G

urea external suspension 40 %, 50 % G

urea hydrating external foam 35 % Hydro 35 G

urea in zn undecyl-lactic acid external emulsion 50 %

G

urea nail external gel 45 % Uramaxin G

urea nail external kit 40 & 0.2 % G

urea-c40 external lotion 40 % Cerovel G

uredeb external cream 39 % Uredeb G

ure-k external cream 50 % G

uremez-40 external cream 40 % Rea Lo 40 G

vashe cleansing external solution G

VECTICAL EXTERNAL OINTMENT 3 MCG/GM

Vectical B PA

zaclir cleansing external lotion 8 % G

zenatane oral capsule 10 mg, 20 mg, 30 mg, 40 mg

Absorica G

zencia external liquid 9-4 % Sumaxin Wash G

Diabetes - Antidiabetic Agents

acarbose oral tablet 100 mg, 25 mg, 50 mg

Precose G

ACTOPLUS MET ORAL TABLET 15-500 MG, 15-850 MG

Actoplus Met B ST

ADLYXIN SUBCUTANEOUS SOLUTION PEN-INJECTOR 20 MCG/0.2ML

B ST

BYDUREON BCISE AUTOINJECTOR SUBCUTANEOUS AUTO-INJECTOR 2 MG/0.85ML

B ST

BYDUREON SUBCUTANEOUS PEN-INJECTOR 2 MG

B ST

BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER 2 MG

B ST


80


BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MCG/0.04ML

B ST

BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 5 MCG/0.02ML

B ST

chlorpropamide oral tablet 100 mg, 250 mg

G

FARXIGA ORAL TABLET 10 MG, 5 MG B ST

FORTAMET ORAL TABLET EXTENDED RELEASE 24 HOUR 1000 MG, 500 MG

Fortamet B PA

glimepiride oral tablet 1 mg, 2 mg, 4 mg Amaryl G

glipizide er oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

Glucotrol XL G

glipizide oral tablet 10 mg, 5 mg Glucotrol G

glipizide xl oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

Glucotrol XL G

glipizide-metformin hcl oral tablet 2.5-250 mg, 2.5-500 mg, 5-500 mg

G

GLUCOPHAGE ORAL TABLET 1000 MG, 500 MG, 850 MG

Glucophage B

GLUMETZA ORAL TABLET EXTENDED RELEASE 24 HOUR 1000 MG, 500 MG

Glumetza B PA

glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg

Glynase G

glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg

G

glyburide-metformin oral tablet 1.25-250 mg

G

glyburide-metformin oral tablet 2.5-500 mg, 5-500 mg

Glucovance G

GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG

B ST

INVOKAMET ORAL TABLET 150-1000 MG, 150-500 MG, 50-1000 MG, 50-500 MG

B ST

INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150-1000 MG, 150-500 MG, 50-1000 MG, 50-500 MG

B ST

INVOKANA ORAL TABLET 100 MG, 300 MG

B ST

JANUMET ORAL TABLET 50-1000 MG, 50-500 MG

B ST


81


JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG, 50-1000 MG, 50-500 MG

B ST

JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG

B ST

JARDIANCE ORAL TABLET 10 MG, 25 MG

B ST

metformin hcl er (mod) oral tablet extended release 24 hour 1000 mg, 500 mg

Glumetza G PA

metformin hcl er (osm) oral tablet extended release 24 hour 1000 mg, 500 mg

Fortamet G PA

metformin hcl er oral tablet extended release 24 hour 500 mg, 750 mg

Glucophage XR G

metformin hcl oral tablet 1000 mg, 500 mg, 850 mg

Glucophage G

miglitol oral tablet 100 mg, 25 mg, 50 mg Glyset G

nateglinide oral tablet 120 mg, 60 mg Starlix G

ONGLYZA ORAL TABLET 2.5 MG, 5 MG B ST

pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg

Actos G ST

pioglitazone hcl-glimepiride oral tablet 30-2 mg, 30-4 mg

Duetact G ST

pioglitazone hcl-metformin hcl oral tablet 15-500 mg, 15-850 mg

Actoplus Met G ST

repaglinide oral tablet 0.5 mg G

repaglinide oral tablet 1 mg, 2 mg Prandin G

repaglinide-metformin hcl oral tablet 1-500 mg, 2-500 mg

G

RIOMET ORAL SOLUTION 500 MG/5ML B

SOLIQUA SUBCUTANEOUS SOLUTION PEN-INJECTOR 100-33 UNT-MCG/ML

B PA

STEGLATRO ORAL TABLET 15 MG, 5 MG

B ST

STEGLUJAN ORAL TABLET 15-100 MG, 5-100 MG

B ST

SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN-INJECTOR 2700 MCG/2.7ML


SYMLINPEN 60 SUBCUTANEOUS SOLUTION PEN-INJECTOR 1500 MCG/1.5ML



82


SYNJARDY ORAL TABLET 12.5-1000 MG, 12.5-500 MG, 5-1000 MG, 5-500 MG

B ST

SYNJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 12.5-1000 MG, 25-1000 MG, 5-1000 MG

B ST

TANZEUM SUBCUTANEOUS PEN-INJECTOR 30 MG, 50 MG

B ST

tolazamide oral tablet 250 mg, 500 mg G

tolbutamide oral tablet 500 mg G

TRULICITY SUBCUTANEOUS SOLUTION PEN-INJECTOR 0.75 MG/0.5ML, 1.5 MG/0.5ML

B ST

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR 18 MG/3ML

B ST

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 10-500 MG, 2.5-1000 MG, 5-1000 MG, 5-500 MG

B ST

Diabetes - Glucose Monitoring

LANCETS Accu-Chek FastClix Lancets


Diabetes - Glycemic Agents

GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED 1 MG

B

GLUCAGON EMERGENCY INJECTION KIT 1 MG

B PA; QL (1 EA per 365 days)

Diabetes - Insulins

ADMELOG SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

B PA

ADMELOG SUBCUTANEOUS SOLUTION 100 UNIT/ML

B

AFREZZA INHALATION POWDER 12 UNIT, 4 & 8 & 12 UNIT, 4 (30) & 8 (60) UNIT, 4 (60) & 8 (30) UNIT, 4 (90) & 8 (90) UNIT, 4 UNIT, 8 (60)& 12 (30) UNIT, 8 UNIT

B PA

APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

B PA

APIDRA VIAL INJECTION SOLUTION 100 UNIT/ML

B

ASSURE ID SAFETY PEN NEEDLES 30G X 5 MM



83



Assure ID Safety Pen Needles




BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML


FIASP FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

B PA

FIASP SUBCUTANEOUS SOLUTION 100 UNIT/ML

B

HUMALOG U-100 AND U-200 KWIKPEN B PA

HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (50-50) 100 UNIT/ML

B PA

HUMALOG MIX 50/50 VIAL SUBCUTANEOUS SUSPENSION (50-50) 100 UNIT/ML

B

HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (75-25) 100 UNIT/ML

B PA

HUMALOG MIX 75/25 VIAL SUBCUTANEOUS SUSPENSION (75-25) 100 UNIT/ML

B

HUMALOG U-100 JUNIOR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

B PA

HUMALOG U-100 VIAL AND CARTRIDGE SUBCUTANEOUS SOLUTION 100 UNIT/ML

B

HUMALOG U-100 VIAL AND CARTRIDGE SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNIT/ML

B PA

HUMULIN 70/30 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

B PA

HUMULIN 70/30 VIAL SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

B

HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNIT/ML

B PA

HUMULIN N VIAL SUBCUTANEOUS SUSPENSION 100 UNIT/ML

B


84


HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 500 UNIT/ML

B PA

HUMULIN R U-500 VIAL (CONCENTRATED) SUBCUTANEOUS SOLUTION 500 UNIT/ML

B

HUMULIN R VIAL INJECTION SOLUTION 100 UNIT/ML

B

INSULIN PEN NEEDLES 29G X 12.7MM B QL (200 EA per 31 days)

INSULIN PEN NEEDLES 30G X 8 MM Assure ID Safety Pen Needles


INSULIN PEN NEEDLES 31G X 5 MM B QL (200 EA per 31 days)

INSULIN PEN NEEDLES 31G X 6 MM CareFine Pen Needles B QL (200 EA per 31 days)



INSULIN SYRINGES 28G X 1/2" 1 ML, 29G X 1/2" 1 ML


INSULIN SYRINGES 30G X 1/2" 0.5 ML B QL (110 EA per 31 days)

INSULIN SYRINGES 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML


INSULIN SYRINGES 31G X 5/16" 0.3 ML, 31G X 5/16" 1 ML


INSULIN SYRINGES 31G X 5/16" 0.5 ML B QL (110 EA per 31 days)

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

B PA

LANTUS U-100 VIAL SUBCUTANEOUS SOLUTION 100 UNIT/ML

B

LEVEMIR U-100 FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

B PA

LEVEMIR U-100 VIAL SUBCUTANEOUS SOLUTION 100 UNIT/ML

B

NOVOFINE AUTOCOVER PEN NEEDLE 30G X 8 MM

Assure ID Safety Pen Needles


NOVOFINE PEN NEEDLE 32G X 6 MM B QL (200 EA per 31 days)


85


NOVOFINE PLUS PEN NEEDLE 32G X 4 MM


NOVOLIN 70/30 RELION SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

B

NOVOLIN 70/30 VIAL SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

B

NOVOLIN N RELION SUBCUTANEOUS SUSPENSION 100 UNIT/ML

B

NOVOLIN N VIAL SUBCUTANEOUS SUSPENSION 100 UNIT/ML

B

NOVOLIN R RELION INJECTION SOLUTION 100 UNIT/ML

B

NOVOLIN R VIAL INJECTION SOLUTION 100 UNIT/ML

B

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

B PA

NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

B PA

NOVOLOG MIX 70/30 VIAL SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

B

NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNIT/ML

B PA

NOVOLOG U-100 VIAL SUBCUTANEOUS SOLUTION 100 UNIT/ML

B

NOVOTWIST PEN NEEDLE 32G X 5 MM B QL (200 EA per 31 days)

PRO COMFORT INSULIN SYRINGE 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML


PRO COMFORT INSULIN SYRINGE 30G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


PRO COMFORT INSULIN SYRINGE 30G X 5/16" 1 ML


TOUJEO MAX SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 UNIT/ML


TOUJEO SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 UNIT/ML


TRESIBA FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML, 200 UNIT/ML

B


86


Electrolytes / Minerals / Metals / Vitamins

ACTIVE OB ORAL CAPSULE 20-1-320 MG

R-Natal OB B ST; QL (100 EA per 31 days)

airavite oral tablet 2.5-25-1 mg Airavite G

alcohol intravenous solution 98 % G

aminoam rms oral capsule G

aminobenzoate potassium oral packet 2 gm

G

aminorelief rms oral capsule G

AMINOSYN II INTRAVENOUS SOLUTION 10 %

B PA

aminosyn ii/electrolytes intravenous solution 8.5 %

G

AMINOSYN INTRAVENOUS SOLUTION 10 %

B PA

aminosyn/electrolytes intravenous solution 8.5 %

G

AMINOSYN-PF INTRAVENOUS SOLUTION 10 %

B PA

argyle sterile saline irrigation solution 0.9 %

Argyle Sterile Saline G

ascorbic acid injection solution 500 mg/ml G

ATABEX EC ORAL TABLET DELAYED RELEASE 29-1 MG


ATABEX OB ORAL TABLET 29-1 MG B ST; QL (100 EA per 31 days)

av-phos 250 neutral oral tablet 155-852-130 mg

K-Phos-Neutral G

av-vite fb oral tablet 2.5-25-1 mg Airavite G

b complex vitamins injection solution G

b-6 folic acid oral capsule 400-1000-50 mcg-mcg-mg

G

BAL-CARE DHA ORAL 27-1 & 430 MG Bal-Care DHA B ST; QL (100 EA per 31 days)

bd posiflush intravenous solution 0.9 % BD PosiFlush G

biocel oral tablet ABC Plus Senior G

bp folinatal plus b oral tablet 1 mg G ST; QL (100 EA per 31 days)

bp multinatal plus oral tablet 30-1 mg G ST; QL (100 EA per 31 days)


87


bp multinatal plus oral tablet chewable 40-1 mg

G ST

bp vit 3 oral capsule 1 mg Taliva G

b-plex oral tablet Milco-B-Forte G

b-plex plus oral tablet ABC Plus Senior G

calcium chloride intravenous solution 10 %

G

calcium gluconate intravenous solution 10 %

G

calcium gluconate-dextrose intravenous solution 1-5 gm/100ml-%, 1-5 gm/50ml-%, 2-5 gm/100ml-%

G

calcium gluconate-nacl intravenous solution 1-0.9 gm/100ml-%, 2-0.9 gm/100ml-%, 2-0.9 gm/50ml-%, 3-0.9 gm/100ml-%

G

calcium gluconate-nacl intravenous solution prefilled syringe 2-0.9 gm/50ml-%

G

CALCIUM PNV ORAL CAPSULE 28-1-250 MG

Natelle ONE B ST; QL (100 EA per 31 days)

calcium-folic acid plus d oral wafer 1342-1 mg

G

cardioplegic perfusion solution Plegisol G

CHEMET ORAL CAPSULE 100 MG B PA

chloromag injection solution 200 mg/ml G

chromagen oral capsule G

chromic chloride intravenous solution 40 mcg/10ml

G

CITRANATAL 90 DHA ORAL 90-1 & 300 MG


CITRANATAL ASSURE ORAL 35-1 & 300 MG


CITRANATAL B-CALM ORAL 20-1 & 25 (2) MG


CITRANATAL BLOOM DHA ORAL 90-1 & 300 MG


CITRANATAL BLOOM ORAL TABLET 90-1 MG

B ST

CITRANATAL DHA ORAL 27-1 & 250 MG CitraNatal DHA B ST; QL (100 EA per 31 days)

CITRANATAL HARMONY ORAL CAPSULE 27-1-260 MG



88


CITRANATAL MEDLEY ORAL CAPSULE 27-1-200 MG

B ST

CITRANATAL RX ORAL TABLET 27-1 MG


clinimix e/dextrose (4.25/25) intravenous solution 4.25 %

G

clinimix/dextrose (4.25/10) intravenous solution 4.25 %

G


G


G

clinisol sf intravenous solution 15 % G

C-NATE DHA ORAL CAPSULE 28-1-200 MG

Viva DHA B ST; QL (100 EA per 31 days)

cod liver oil oral oil G

complete natal dha oral 29-1-200 & 250 mg


completenate oral tablet chewable 29-1 mg


co-natal fa oral tablet Co-Natal FA G ST; QL (100 EA per 31 days)

CONCEPT DHA ORAL CAPSULE 53.5-38-1 MG

Concept DHA B ST; QL (100 EA per 31 days)

CONCEPT OB ORAL CAPSULE 130-92.4-1 MG


copper chloride intravenous solution 0.4 mg/ml

G

corvita 150 oral tablet 150-1.25 mg G

corvita oral tablet 1.25 mg G

corvite free oral tablet ABC Plus Senior G

curity sterile saline irrigation solution 0.9 %

Argyle Sterile Saline G

cyanocobalamin injection solution 1000 mcg/ml

G

cytra k crystals oral packet 3300-1002 mg Taron-Crystals G

dehydrated alcohol intravenous solution 98 %

G

dexifol oral tablet 5 mg Dexifol G

dextrose in lactated ringers intravenous solution 5 %

G

dextrose intravenous solution 10 %, 20 %, 250 mg/ml, 30 %, 40 %, 5 %, 50 %, 70 %

G


89


dextrose-nacl intravenous solution 10-0.2 %, 10-0.225 %, 10-0.45 %, 2.5-0.45 %, 5-0.2 %, 5-0.225 %, 5-0.3 %, 5-0.33 %, 5-0.45 %, 5-0.9 %

G

dialyvite oral tablet Dialyvite G

DOTHELLE DHA ORAL CAPSULE 53.5-38-1 MG


DUET DHA 400 ORAL 25-1 & 400 MG B ST; QL (100 EA per 31 days)

DUET DHA BALANCED ORAL 25-1 & 267 MG


effer-k oral tablet effervescent 25 meq Effer-K G

effervescent pot chloride oral tablet effervescent 25 meq

G

elite-ob oral tablet 50-1.25 mg G ST; QL (100 EA per 31 days)

ENBRACE HR ORAL CAPSULE B ST; QL (100 EA per 31 days)

EXJADE ORAL TABLET SOLUBLE 125 MG, 250 MG, 500 MG

B SP

fabb oral tablet 2.2-25-1 mg Folgard RX G

fa-vitamin b-6-vitamin b-12 oral tablet 2.2-25-0.5 mg

G

ferocon oral capsule Tricon G

ferosul oral elixir 220 (44 fe) mg/5ml FeroSul G QL (480 ML per 31 days)

ferotrinsic oral capsule Tricon G

ferraplus 90 oral tablet 90-1 mg G

ferrocite plus oral tablet 106-1 mg Ferrocite Plus G

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

FeroSul G QL (480 ML per 31 days)

ferrous sulfate oral liquid 220 (44 fe) mg/5ml


ferrous sulfate oral tablet delayed release 325 (65 fe) mg


floriva oral tablet chewable 0.25 mg G

floriva plus oral solution 0.25 mg/ml Floriva Plus G

fluor-a-day oral solution 0.275 (0.125 f) mg/drop

NaFrinse Drops G

fluoritab oral solution 0.275 (0.125 f) mg/drop

NaFrinse Drops G

fluoritab oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg, 2.2 (1 f) mg

Ludent G


90


FOCALGIN 90 DHA ORAL 90-1 & 300 MG


FOCALGIN CA ORAL 35-1 & 300 MG B ST; QL (100 EA per 31 days)

folbee oral tablet 2.5-25-1 mg Airavite G

folbee plus cz oral tablet 5 mg G

folbee plus oral tablet Dexifol G

FOLCAL DHA ORAL CAPSULE 27-1.25-300 MG


FOLCAPS OMEGA 3 ORAL CAPSULE 27-1 MG


FOLET DHA ORAL THERAPY PACK 38-1 & 350 MG


FOLET ONE ORAL CAPSULE 38-1-225 MG


folic acid injection solution 5 mg/ml G

folic acid oral tablet 1 mg G

FOLIVANE-OB ORAL CAPSULE 130-92.4-1 MG


folplex 2.2 oral tablet 2.2-25-0.5 mg G

foltrin oral capsule Tricon G

FREAMINE III INTRAVENOUS SOLUTION 10 %

B PA

glucose intravenous solution 5 % G

hematinic plus vit/minerals oral tablet 106-1 mg

Ferrocite Plus G

hematinic/folic acid oral tablet 324-1 mg Hemocyte-F G

hematogen fa oral capsule 200-250-0.01-1 mg

G

hematogen forte oral capsule 460-60-0.01-1 mg

Hematogen Forte G

hematogen oral capsule G

HEMENATAL OB + DHA ORAL 28-6-1 & 203 MG


HEMENATAL OB ORAL TABLET 28-6-1 MG


hemocyte-f oral tablet 324-1 mg Hemocyte-F G

hemocyte-plus oral tablet 106-1 mg Ferrocite Plus G

hepatamine intravenous solution 8 % G

hydroxocobalamin intramuscular solution 1000 mcg/ml

G


91


hyperlyte-cr intravenous solution G

iferex 150 forte oral capsule 150-25-1 mg-mcg-mg

iFerex 150 Forte G

inatal gt oral tablet Inatal GT G ST; QL (100 EA per 31 days)

INFANATE BALANCE ORAL CAPSULE 29-1-265 MG


infuvite adult intravenous injectable G

infuvite pediatric intravenous solution G

intralipid intravenous emulsion 20 % Intralipid G

INTRALIPID INTRAVENOUS EMULSION 30 %

B

iodine strong oral solution 5 % G

kcl in d5w lactated ringers intravenous solution 40 meq/l

G

kcl in dextrose-nacl intravenous solution 10-5-0.45 meq/l-%-%, 20-5-0.2 meq/l-%-%, 20-5-0.225 meq/l-%-%, 20-5-0.33 meq/l-%-%, 20-5-0.45 meq/l-%-%, 20-5-0.9 meq/l-%-%, 30-5-0.45 meq/l-%-%, 40-5-0.45 meq/l-%-%, 40-5-0.9 meq/l-%-%

G

kcl-lactated ringers-d5w intravenous solution 20 meq/l

G

kcl-lidocaine in d5w intravenous solution 20-10 meq-mg /100ml

G

kcl-lidocaine-nacl intravenous solution 10-10 meq-mg /100ml

G

k-effervescent oral tablet effervescent 25 meq

Effer-K G

klor-con 10 oral tablet extended release 10 meq

K-Tab G

klor-con m10 oral tablet extended release 10 meq

Klor-Con M10 G

klor-con m20 oral tablet extended release 20 meq

Klor-Con M20 G

klor-con oral packet 20 meq Klor-Con G

klor-con oral tablet extended release 8 meq

K-Tab G

klor-con sprinkle oral capsule extended release 10 meq, 8 meq

Klor-Con Sprinkle G

klor-con/ef oral tablet effervescent 25 meq Effer-K G

KOSHER PRENATAL PLUS IRON ORAL TABLET 30-1 MG



92


k-prime oral tablet effervescent 25 meq Effer-K G

k-tan plus oral capsule 162-115.2-1 mg K-Tan Plus G

k-vescent oral tablet effervescent 25 meq Effer-K G

lactated ringers intravenous solution G

lecithin oral granules G

levocarnitine oral solution 1 gm/10ml Carnitor G

levocarnitine oral tablet 330 mg Carnitor G

LEVOMEFOLATE DHA ORAL CAPSULE 27-1.13-0.4 MG


l-methylfolate ca me-cbl nac oral tablet 6-90.314-2-600 mg

Cerefolin NAC G

l-methylfolate formula 15 oral capsule 15-90.314 mg

Deplin 15 G

l-methylfolate forte oral capsule 15-90.314 mg

Deplin 15 G

l-methylfolate-algae oral capsule 15-90.314 mg

Deplin 15 G

l-methylfolate-algae-b12-b6 oral capsule 3-90.314-2-35 mg

Foltanx RF G

l-methylfolate-b6-b12 oral tablet 1.13-25-2 mg

Folbic RF G

l-methylfolate-b6-b12 oral tablet 3-35-2 mg

Foltanx G

ludent oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg, 2.2 (1 f) mg

Ludent G

lysiplex plus oral tablet ABC Plus Senior G

magnesium chloride injection solution 200 mg/ml

G

magnesium sulfate in d5w intravenous solution 1-5 gm/100ml-%, 2-5 gm/100ml-%, 3-5 gm/50ml-%

G

magnesium sulfate injection solution 50 % G

magnesium sulfate intravenous solution 2 gm/50ml, 20 gm/500ml, 4 gm/100ml, 4 gm/50ml, 40 gm/1000ml

G

magnesium sulfate-lact ringers intravenous solution 20 gm/250ml

G

magnesium sulfate-nacl intravenous solution 2-0.9 gm/50ml-%, 4-0.9 gm/100ml-%, 40-0.9 gm/l-%, 6-0.9 gm/150ml-%

G

manganese chloride intravenous solution 0.1 mg/ml

G


93


manganese sulfate intravenous solution 0.1 mg/ml

G

MARNATAL-F ORAL CAPSULE 60-1 MG B ST; QL (100 EA per 31 days)

mega-c/a plus injection solution 500 mg/ml

G

MEPHYTON ORAL TABLET 5 MG Mephyton B

metafolbic plus rf oral tablet 6-90.314-2-600 mg

Cerefolin NAC G

methylfol-algae-b12-acetylcyst oral tablet 6-90.314-2-600 mg

Cerefolin NAC G

monoject flush syringe intravenous solution 0.9 %

BD PosiFlush G

monoject sodium chloride flush intravenous solution 0.9 %

BD PosiFlush G

multi vitamin/fluoride oral tablet chewable 0.25 mg, 1 mg

MVC-Fluoride G

multigen folic oral tablet 70-150-2-1 mg G

multigen oral tablet 70 mg G

multigen plus oral tablet 50-101-1 mg G

multitrace-4 concentrate intravenous solution 0.01-1-0.5-5 mg/ml

G

multitrace-4 intravenous solution 4-400-100-1000 mcg/ml

G

multitrace-4 neonatal intravenous solution 100-25-1500 mcg/ml

G

multitrace-5 concentrate intravenous solution 10-1000-500-60 mcg/ml

G

multitrace-5 intravenous solution 4-400-100-20 mcg/ml

G

multi-vit/fluoride oral solution 0.25 mg/ml Floriva Plus G

multi-vit/fluoride oral solution 0.5 mg/ml Quflora Pediatric G

multi-vit/fluoride/iron oral solution 0.25-10 mg/ml

G

multi-vit/iron/fluoride oral solution 0.25-10 mg/ml

G

multivitamin/fluoride oral solution 0.25 mg/ml

Floriva Plus G

multi-vitamin/fluoride oral solution 0.25 mg/ml

Floriva Plus G

multivitamin/fluoride oral solution 0.5 mg/ml

Quflora Pediatric G


94


multi-vitamin/fluoride oral solution 0.5 mg/ml

Quflora Pediatric G

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg

MVC-Fluoride G

multivitamin/fluoride/iron oral solution 0.25-10 mg/ml

G

multi-vitamin/fluoride/iron oral solution 0.25-10 mg/ml

G

multivitamins/fluoride oral tablet chewable 0.5 mg

MVC-Fluoride G

mvc-fluoride oral tablet chewable 0.25 mg MVC-Fluoride G

mvc-fluoride oral tablet chewable 0.5 mg MVC-Fluoride G

mvc-fluoride oral tablet chewable 1 mg MVC-Fluoride G

m-vit oral tablet M-Vit G ST

myferon 150 forte oral capsule 150-25-1 mg-mcg-mg

iFerex 150 Forte G

mynatal advance oral tablet Inatal GT G ST; QL (100 EA per 31 days)

MYNATAL ORAL CAPSULE B ST; QL (100 EA per 31 days)

mynatal oral tablet 90-1 mg Inatal GT G ST; QL (100 EA per 31 days)

mynatal plus oral tablet Vitafol-OB G ST; QL (100 EA per 31 days)

mynatal-z oral tablet Vitafol-OB G ST; QL (100 EA per 31 days)

mynate 90 plus oral tablet extended release


mynephrocaps oral capsule 1 mg Mynephron G

mynephron oral capsule 1 mg Mynephron G

na ferric gluc cplx in sucrose intravenous solution 12.5 mg/ml

Ferrlecit G

n-acetyl-l-cysteine oral capsule 600 mg NF Formulas NAC G

nafrinse drops oral solution 0.275 (0.125 f) mg/drop

NaFrinse Drops G

nafrinse oral tablet chewable 2.2 (1 f) mg Ludent G

NATACHEW ORAL TABLET CHEWABLE 28-1 MG


NATALVIT ORAL TABLET B ST; QL (100 EA per 31 days)

NATELLE ONE ORAL CAPSULE 28-1-250 MG

Natelle ONE B ST; QL (100 EA per 31 days)


95


NEEVO DHA ORAL CAPSULE 27-1.13 MG


nephronex oral tablet Dialyvite G

NESTABS ABC ORAL 32-1-200 MG B ST; QL (100 EA per 31 days)

NESTABS DHA ORAL 32-1 MG Nestabs DHA B ST; QL (100 EA per 31 days)

NESTABS ONE ORAL CAPSULE 38-1-225 MG

B ST

NESTABS ORAL TABLET 32-1 MG B ST; QL (100 EA per 31 days)

NEWGEN ORAL TABLET 32-1 MG B ST; QL (100 EA per 31 days)

NEXA PLUS ORAL CAPSULE 29-1.25-350 MG


NIVA-PLUS ORAL TABLET 27-1 MG M-Vit B ST

normal saline flush intravenous solution 0.9 %

BD PosiFlush G

normosol-m in d5w intravenous solution G

normosol-r in d5w intravenous solution G

normosol-r intravenous solution G

nufol oral tablet 2.5-25-1 mg Airavite G

nutricap oral tablet ABC Plus Senior G

nutrifac zx oral tablet ABC Plus Senior G

nutrilipid intravenous emulsion 20 % Intralipid G

nutrilyte intravenous concentrate TPN Electrolytes G

OB COMPLETE ADVANCED ORAL CAPSULE 27-1-385 MG

B ST

OB COMPLETE GOLD ORAL CAPSULE 27.5-1-200 MG


OB COMPLETE ONE ORAL CAPSULE 50-1-476 MG


OB COMPLETE ORAL TABLET 50-1.25 MG


OB COMPLETE PETITE ORAL CAPSULE 35-5-1-200 MG


OB COMPLETE PREMIER ORAL TABLET 30-20-1 MG


OB COMPLETE/DHA ORAL CAPSULE 30-10-1-200 MG


OBSTETRIX DHA ORAL 29-1 & 387 MG B ST

obstetrix ec oral tablet 29-1 mg G ST


96


OBSTETRIX ONE ORAL CAPSULE 38-1-225 MG


O-CAL FA ORAL TABLET 27-1 MG M-Vit B ST

O-CAL PRENATAL ORAL TABLET B ST; QL (100 EA per 31 days)

ONE-A-DAY WOMENS PRENATAL ORAL 28-0.8 & 440 MG


ortho-cs 250 injection solution 250 mg/ml G

phospha 250 neutral oral tablet 155-852-130 mg

K-Phos-Neutral G

phosphorous oral tablet 155-852-130 mg K-Phos-Neutral G

phospho-trin 250 neutral oral tablet 155-852-130 mg

K-Phos-Neutral G

phytonadione injection solution 1 mg/0.5ml

G

phytonadione oral tablet 5 mg Mephyton G

plenamine intravenous solution 15 % G

PNV FOLIC ACID + IRON ORAL TABLET 27-1 MG

M-Vit B ST

PNV OB+DHA ORAL 27-1 & 250 MG CitraNatal DHA B ST; QL (100 EA per 31 days)

PNV PRENATAL PLUS MULTIVIT+DHA ORAL 27-1 & 312 MG


PNV PRENATAL PLUS MULTIVITAMIN ORAL TABLET 27-1 MG

M-Vit B ST

PNV TABS 29-1 ORAL TABLET 29-1 MG Prenatabs Rx B ST; QL (100 EA per 31 days)

pnv-dha oral capsule 27-0.6-0.4-300 mg Zatean-Pn DHA G ST; QL (100 EA per 31 days)

PNV-DHA+DOCUSATE ORAL CAPSULE 27-1.25-300 MG


PNV-OMEGA ORAL CAPSULE 28-0.6-0.4-340 MG

Zatean-Pn Plus B ST; QL (100 EA per 31 days)

pnv-select oral tablet 27-0.6-0.4 mg G ST; QL (100 EA per 31 days)

PNV-TOTAL ORAL CAPSULE 35-5-1.2 MG


PNV-VP-U ORAL CAPSULE 106.5-1 MG Prenatal-U B ST; QL (100 EA per 31 days)

poly-iron 150 forte oral capsule 150-25-1 mg-mcg-mg

iFerex 150 Forte G

polysaccharide iron forte oral capsule 150-25-1 mg-mcg-mg

iFerex 150 Forte G


97


pot bicarb-pot chloride oral tablet effervescent 25 meq

G

potassium acetate intravenous solution 2 meq/ml

G

potassium bicarbonate oral tablet effervescent 25 meq

Effer-K G

potassium chloride crys er oral tablet extended release 10 meq

Klor-Con M10 G

potassium chloride crys er oral tablet extended release 20 meq

Klor-Con M20 G

potassium chloride er oral capsule extended release 10 meq, 8 meq

Klor-Con Sprinkle G

potassium chloride er oral tablet extended release 10 meq, 20 meq, 8 meq

K-Tab G

potassium chloride in dextrose intravenous solution 20-5 meq/l-%, 40-5 meq/l-%

G

potassium chloride in nacl intravenous solution 10 meq/100ml, 20-0.45 meq/l-%, 20-0.9 meq/l-%, 30 meq/100ml, 40-0.9 meq/l-%

G

potassium chloride intravenous solution 0.4 meq/ml, 10 meq/100ml, 10 meq/50ml, 2 meq/ml, 20 meq/100ml, 20 meq/50ml, 40 meq/100ml

G

potassium chloride oral packet 20 meq Klor-Con G

potassium chloride oral solution 20 meq/15ml (10%), 40 meq/15ml (20%)

G

potassium citrate er oral tablet extended release 10 meq (1080 mg)

Urocit-K 10 G


Urocit-K 15 G


Urocit-K 5 G

potassium citrate-citric acid oral packet 3300-1002 mg

Taron-Crystals G

potassium citrate-citric acid oral solution 1100-334 mg/5ml

G

potassium phosphates intravenous solution 15 mmole/5ml, 150 mmole/50ml, 45 mmole/15ml

G

pr natal 400 ec oral 29-1-200 & 400 mg (dr)


pr natal 400 oral 29-1-200 & 400 mg G ST; QL (100 EA per 31 days)


98


pr natal 430 ec oral 29-1-200 & 430 mg (dr)


pr natal 430 oral 29-1-200 & 430 mg G ST; QL (100 EA per 31 days)

PREFERA OB ORAL TABLET 34-1 MG B ST; QL (100 EA per 31 days)

PREFERAOB +DHA ORAL 28-6-1 & 200 MG


PREFERAOB ONE ORAL CAPSULE 22-6-1-200 MG

PreferaOB One B ST; QL (100 EA per 31 days)

PREMASOL INTRAVENOUS SOLUTION 10 %

B PA

premasol intravenous solution 6 % G

PREMESISRX ORAL TABLET 1 MG B ST; QL (100 EA per 31 days)

PRENA 1 TRUE ORAL 30-1.4 & 300 MG VitaTrue B ST; QL (100 EA per 31 days)

PRENA1 ORAL TABLET CHEWABLE 1.4 MG

VitaMedMD RediChew Rx


PRENA1 PEARL ORAL CAPSULE EXTENDED RELEASE 30-1.4-200 MG

VitaPearl B ST; QL (100 EA per 31 days)

PRENAISSANCE BALANCE ORAL CAPSULE 30-1-260 MG


PRENAISSANCE HARMONY DHA ORAL 27-1 & 380 MG


PRENAISSANCE NEXT ORAL TABLET 1.2 MG


PRENAISSANCE NEXT-B ORAL TABLET 1.22 MG


PRENAISSANCE ORAL CAPSULE 29-1.25-325 MG


prenaissance plus oral capsule 28-1-250 mg


PRENATA ORAL TABLET CHEWABLE 29-1 MG


prenatabs rx oral tablet 29-1 mg Prenatabs Rx G ST; QL (100 EA per 31 days)

PRENATAL + DHA ORAL THERAPY PACK 27-1 & 250 MG

B ST

prenatal 19 oral tablet G ST; QL (100 EA per 31 days)

PRENATAL 19 ORAL TABLET 29-1 MG B ST; QL (100 EA per 31 days)


99


prenatal 19 oral tablet chewable G ST; QL (100 EA per 31 days)

PRENATAL 19 ORAL TABLET CHEWABLE 29-1 MG


prenatal low iron oral tablet 27-0.8 mg Right Step Prenatal G QL (100 EA per 31 days)

PRENATAL MULTI +DHA ORAL CAPSULE 27-0.8-228 MG


PRENATAL ORAL TABLET 27-1 MG M-Vit B ST

PRENATAL PLUS IRON ORAL TABLET 29-1 MG

Prenatabs Rx B ST; QL (100 EA per 31 days)

PRENATAL PLUS ORAL TABLET 27-1 MG

M-Vit B ST

PRENATAL TABLET 27-0.8 MG ORAL (OTC) 27-0.8 MG

Right Step Prenatal B QL (100 EA per 31 days)

prenatal tablet 27-0.8 mg oral (otc) 27-0.8 mg

Right Step Prenatal G QL (100 EA per 31 days)

PRENATAL VITAMIN PLUS LOW IRON ORAL TABLET 27-1 MG

M-Vit B ST

prenatal-u oral capsule 106.5-1 mg Prenatal-U G ST; QL (100 EA per 31 days)

PRENATE AM ORAL TABLET 1 MG B ST; QL (100 EA per 31 days)

PRENATE DHA ORAL CAPSULE 18-0.6-0.4-300 MG, 28-0.6-0.4-300 MG


PRENATE ELITE ORAL TABLET 20-0.6-0.4 MG, 26-0.6-0.4 MG


PRENATE ENHANCE ORAL CAPSULE 28-0.6-0.4-400 MG


PRENATE ESSENTIAL ORAL CAPSULE 18-0.6-0.4-300 MG, 29-0.6-0.4-340 MG


PRENATE MINI ORAL CAPSULE 18-0.6-0.4-350 MG, 29-0.6-0.4-350 MG


PRENATE ORAL TABLET CHEWABLE 0.6-0.4 MG


PRENATE PIXIE ORAL CAPSULE 10-0.6-0.4-200 MG


PRENATE RESTORE ORAL CAPSULE 27-0.6-0.4-400 MG


PREPLUS ORAL TABLET 27-1 MG M-Vit B ST

PRETAB ORAL TABLET 29-1 MG Co-Natal FA B ST; QL (100 EA per 31 days)

PRIMACARE ORAL CAPSULE 30-1-470 MG



100


PROVIDA DHA ORAL CAPSULE 16-16-1.25-110 MG


PROVIDA OB ORAL CAPSULE 20-20-1.25 MG


PUREFE OB PLUS ORAL CAPSULE 162-115.2-1 MG


purevit dualfe plus oral capsule 162-115.2-1 mg

K-Tan Plus G

pyridoxine hcl injection solution 100 mg/ml

G

quflora pediatric oral solution 0.25 mg/ml Floriva Plus G

quflora pediatric oral solution 0.5 mg/ml Quflora Pediatric G

quflora pediatric oral tablet chewable 0.25 mg

MVC-Fluoride G

quflora pediatric oral tablet chewable 0.5 mg

MVC-Fluoride G

quflora pediatric oral tablet chewable 1 mg

MVC-Fluoride G

ra iron oral tablet 325 (65 fe) mg GoodSense Iron G QL (100 EA per 31 days)

RELNATE DHA ORAL CAPSULE 28-1-200 MG


renal oral capsule 1 mg Mynephron G

rena-vite rx oral tablet 1 mg Dialyvite G

ringers intravenous solution G

R-NATAL OB ORAL CAPSULE 20-1-320 MG

R-Natal OB B ST; QL (100 EA per 31 days)

saline flush intravenous solution 0.9 % BD PosiFlush G

saline flush zr intravenous solution 0.9 % BD PosiFlush G

SELECT-OB ORAL TABLET CHEWABLE 29-0.6-0.4 MG, 29-1 MG


SELECT-OB+DHA ORAL 29-1 & 250 MG B ST; QL (100 EA per 31 days)

selenium intravenous solution 40 mcg/ml G

se-natal 19 oral tablet 29-1 mg G ST; QL (100 EA per 31 days)

se-natal 19 oral tablet chewable 29-1 mg G ST; QL (100 EA per 31 days)

se-tan plus oral capsule 162-115.2-1 mg K-Tan Plus G

siderol oral tablet ABC Plus Senior G

sod citrate-citric acid oral solution 500-334 mg/5ml

Shohls Modified G


101


sodium acetate intravenous solution 2 meq/ml, 4 meq/ml

G

sodium ascorbate injection solution 250 mg/ml

G

sodium bicarbonate intravenous solution 4.2 %, 7.5 %, 8.4 %

G

sodium chloride flush intravenous solution 0.9 %

BD PosiFlush G

sodium chloride injection solution 0.9 %, 2.5 meq/ml

G

sodium chloride intravenous solution 0.45 %, 0.9 %, 3 %, 4 meq/ml, 5 %

G

sodium chloride irrigation solution 0.9 % Argyle Sterile Saline G

sodium fluoride oral solution 1.1 (0.5 f) mg/ml

G

sodium fluoride oral tablet 1.1 (0.5 f) mg, 2.2 (1 f) mg

G

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg, 2.2 (1 f) mg

Ludent G

sodium lactate intravenous solution 5 meq/ml

G

sodium phosphate-nacl intravenous solution 15 mmol/250ml

G

sodium phosphates intravenous solution 15 mmole/5ml, 45 mmole/15ml

G

strovite forte oral tablet ABC Plus Senior G

swabflush saline flush intravenous solution 0.9 %

BD PosiFlush G

SYNTHAMIN 17 INTRAVENOUS SOLUTION 10 %

B PA

tandem f oral capsule 162-115.2-1 mg G

TARON-BC ORAL 20-1 & 25 (2) MG B ST; QL (100 EA per 31 days)

TARON-C DHA ORAL CAPSULE 53.5-38-1 MG


taron-crystals oral packet 3300-1002 mg Taron-Crystals G

taron-prex oral capsule 30-1.2-265 mg G ST; QL (100 EA per 31 days)

thiamine hcl injection solution 100 mg/ml G

THRIVITE 19 ORAL TABLET 29-1 MG B ST; QL (100 EA per 31 days)

THRIVITE RX ORAL TABLET 29-1 MG Prenatabs Rx B ST; QL (100 EA per 31 days)


102


TL FOLATE ORAL TABLET 27-0.5-0.5 MG


tl gard rx oral tablet 2.2-25-1 mg Folgard RX G

tl icon oral capsule Tricon G

TL-CARE DHA ORAL CAPSULE 27-1-500 MG

TriCare Prenatal DHA ONE


tl-hem 150 oral tablet 150-1 mg Abatron AF G

TL-SELECT ORAL CAPSULE 29-1.25-325 MG


tpn electrolytes intravenous solution TPN Electrolytes G

TRAVASOL INTRAVENOUS SOLUTION 10 %

B PA

tricare oral tablet M-Vit G ST

TRICARE PRENATAL 1 ORAL TABLET CHEWABLE 4.5-1 MG


TRICARE PRENATAL COMPLEAT ORAL 27-1 MG


TRICARE PRENATAL DHA ONE ORAL CAPSULE 0.8 MG

B ST

TRICARE PRENATAL DHA ONE ORAL CAPSULE 27-1-500 MG

TriCare Prenatal DHA ONE


TRICARE PRENATAL ORAL TABLET CHEWABLE 4.5-1 MG


tricitrates oral solution 550-500-334 mg/5ml

G

tricon oral capsule Tricon G

trigels-f forte oral capsule 460-60-0.01-1 mg

Hematogen Forte G

TRINATAL GT ORAL TABLET 90-1 MG Inatal GT B ST; QL (100 EA per 31 days)

trinatal rx 1 oral tablet 60-1 mg Vinate One G ST; QL (100 EA per 31 days)

trinate oral tablet Trinate G ST; QL (100 EA per 31 days)

triphrocaps oral capsule 1 mg Mynephron G

TRISTART DHA ORAL CAPSULE 31-0.6-0.4-200 MG


TRISTART ONE ORAL CAPSULE 35-1-215 MG

B ST

TRI-TABS DHA ORAL 32-1 MG Nestabs DHA B ST; QL (100 EA per 31 days)

TRIVEEN-DUO DHA ORAL 29-1-200 & 400 MG



103


tri-vit/fluoride oral solution 0.25 mg/ml, 0.5 mg/ml

G

tri-vit/fluoride/iron oral solution 0.25-10 mg/ml

G

tri-vitamin/fluoride oral solution 0.25 mg/ml, 0.5 mg/ml

G

tronvite oral tablet 1 mg Dialyvite G

TROPHAMINE INTRAVENOUS SOLUTION 10 %

B PA

tryptophan oral capsule 500 mg G

ultimatecare one oral capsule 27-1 mg G ST; QL (100 EA per 31 days)

urosex oral tablet Allerwell Allergy Formula G

v-c forte oral capsule ActivNutrients G

VEMAVITE-PRX 2 ORAL CAPSULE 27-1.25-300 MG


VENA-BAL DHA ORAL 27-1 & 430 MG Bal-Care DHA B ST; QL (100 EA per 31 days)

vic-forte oral capsule ActivNutrients G

VINATE DHA RF ORAL CAPSULE 27-1.13 MG


vinate ii oral tablet 29-1 mg G ST; QL (100 EA per 31 days)

vinate m oral tablet 27-1 mg G ST; QL (100 EA per 31 days)

vinate one oral tablet 60-1 mg Vinate One G ST; QL (100 EA per 31 days)

VIRT NATE ORAL TABLET 28-1 MG Trinate B ST; QL (100 EA per 31 days)

VIRT-ADVANCE ORAL TABLET 90-1 MG Inatal GT B ST; QL (100 EA per 31 days)

VIRT-C DHA ORAL CAPSULE 53.5-38-1 MG


virt-caps oral capsule 1 mg Mynephron G

virt-gard oral tablet 2.2-25-1 mg Folgard RX G

VIRT-NATE DHA ORAL CAPSULE 28-1-200 MG


virt-phos 250 neutral oral tablet 155-852-130 mg

K-Phos-Neutral G

VIRT-PN DHA ORAL CAPSULE 27-0.6-0.4-300 MG

Zatean-Pn DHA B ST; QL (100 EA per 31 days)

VIRT-PN ORAL TABLET 27-0.6-0.4 MG B ST; QL (100 EA per 31 days)


104


VIRT-PN PLUS ORAL CAPSULE 28-0.6-0.4-340 MG


VIRTPREX ORAL CAPSULE 26-1.2-300 MG


virtrate-2 oral solution 500-334 mg/5ml Shohls Modified G

virtrate-3 oral solution 550-500-334 mg/5ml

G

virtrate-k oral solution 1100-334 mg/5ml G

VIRT-SELECT ORAL CAPSULE 29-1.25-325 MG


VIRT-VITE GT ORAL TABLET 90-1 MG Inatal GT B ST; QL (100 EA per 31 days)

virt-vite oral tablet 2.5-25-1 mg Airavite G

virt-vite plus oral tablet 5 mg Dexifol G

vit b12-methionine-inos-chol intramuscular solution

G

vita s forte oral tablet ABC Plus Senior G

vitacel oral tablet ABC Plus Senior G

VITAFOL FE+ ORAL CAPSULE THERAPY PACK 90-1-200 & 50 MG


VITAFOL GUMMIES ORAL TABLET CHEWABLE 3.33-0.333-34.8 MG


VITAFOL ULTRA ORAL CAPSULE 29-0.6-0.4-200 MG


VITAFOL-NANO ORAL TABLET 18-0.6-0.4 MG


vitafol-ob oral tablet Vitafol-OB G ST; QL (100 EA per 31 days)

VITAFOL-OB+DHA ORAL 65-1 & 250 MG B ST; QL (100 EA per 31 days)

VITAFOL-ONE ORAL CAPSULE 29-1-200 MG


vitamax pediatric oral solution G

VITAMEDMD ONE RX/QUATREFOLIC ORAL CAPSULE 30-0.6-0.4-200 MG


VITAMEDMD PLUS RX/QUATREFOLIC ORAL 30-0.6-0.4 &300 MG

B ST

VITAMEDMD REDICHEW RX ORAL TABLET CHEWABLE 1.4 MG

VitaMedMD RediChew Rx


vitamin b complex 100 injection injectable G

vitamin b-6 oral tablet 100 mg G QL (2 EA per 1 day)

vitamin b-complex 100 injection injectable G


105


vitamin d (ergocalciferol) oral capsule 50000 unit

Drisdol G

vitamin k1 injection solution 1 mg/0.5ml, 10 mg/ml

G

vita-min oral capsule ActivNutrients G

vitamins acd-fluoride oral solution 0.25 mg/ml

G

VITAPEARL ORAL CAPSULE EXTENDED RELEASE 30-1.4-200 MG

VitaPearl B ST; QL (100 EA per 31 days)

VITA-PREN ORAL TABLET B ST; QL (100 EA per 31 days)

VITATRUE ORAL 30-1.4 & 300 MG VitaTrue B ST; QL (100 EA per 31 days)

VIVA DHA ORAL CAPSULE 28-1-200 MG


VOL-PLUS ORAL TABLET 27-1 MG M-Vit B ST

VOL-TAB RX ORAL TABLET 29-1 MG Prenatabs Rx B ST; QL (100 EA per 31 days)

VP-CH-PNV ORAL CAPSULE 30-1-260 MG


VP-GGR-B6 PRENATAL ORAL TABLET 1.2 MG


VP-HEME OB + DHA ORAL 28-6-1 & 203 MG


VP-HEME OB ORAL TABLET 28-6-1 MG B ST; QL (100 EA per 31 days)

VP-HEME ONE ORAL CAPSULE 22-6-1-200 MG

PreferaOB One B ST; QL (100 EA per 31 days)

VP-PNV-DHA ORAL CAPSULE 28-1-215.8 MG


vp-vite rx oral tablet 1 mg Dialyvite G

wheat germ oil oral oil G

ZATEAN-PN DHA ORAL CAPSULE 27-0.6-0.4-300 MG

Zatean-Pn DHA B ST; QL (100 EA per 31 days)

ZATEAN-PN PLUS ORAL CAPSULE 28-0.6-0.4-340 MG


zinc sulfate intravenous solution 1 mg/ml, 5 mg/ml

G

zinc trace metal intravenous solution 1 mg/ml

G

Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer

acid reducer oral tablet 150 mg Wal-Zan 150 Maximum Strength



106


CARAFATE ORAL SUSPENSION 1 GM/10ML

B

cimetidine hcl oral solution 300 mg/5ml G

cimetidine oral tablet 200 mg Tagamet HB G

cimetidine oral tablet 300 mg, 400 mg, 800 mg

G

DEXILANT ORAL CAPSULE DELAYED RELEASE 30 MG, 60 MG

B ST; QL (1 EA per 1 day)

esomeprazole magnesium oral capsule delayed release 20 mg

GoodSense Esomeprazole

G

esomeprazole magnesium oral capsule delayed release 40 mg

NexIUM G

esomeprazole sodium intravenous solution reconstituted 20 mg

G

esomeprazole sodium intravenous solution reconstituted 40 mg

NexIUM I.V. G

famotidine intravenous solution 20 mg/2ml, 200 mg/20ml, 40 mg/4ml

G

famotidine oral suspension reconstituted 40 mg/5ml

Pepcid G QL (150 ML per 31 days)

famotidine oral tablet 10 mg Pepcid AC G QL (3 EA per 1 day)

famotidine oral tablet 20 mg Pepcid G QL (3 EA per 1 day)

famotidine oral tablet 40 mg Pepcid G

famotidine premixed intravenous solution 20-0.9 mg/50ml-%

G

goodsense acid reducer oral tablet 150 mg

Wal-Zan 150 Maximum Strength


heartburn relief 150 max st oral tablet 150 mg

Wal-Zan 150 Maximum Strength


lansoprazole oral capsule delayed release 15 mg, 30 mg

Prevacid G

lansoprazole oral tablet dispersible 15 mg, 30 mg

Prevacid SoluTab G PA

misoprostol oral tablet 100 mcg, 200 mcg Cytotec G QL (372 EA per 365 days)

nizatidine oral capsule 150 mg, 300 mg G

nizatidine oral solution 15 mg/ml G

omeppi oral capsule 20-1100 mg OmePPi G

omeppi oral capsule 40-1100 mg OmePPi G

omeprazole oral capsule delayed release 10 mg, 20 mg, 40 mg

G QL (1 EA per 1 day)

omeprazole-sodium bicarbonate oral capsule 20-1100 mg, 40-1100 mg

OmePPi G


107


omeprazole-sodium bicarbonate oral packet 20-1680 mg, 40-1680 mg

Zegerid G

pantoprazole sodium intravenous solution reconstituted 40 mg

Protonix G

pantoprazole sodium oral tablet delayed release 20 mg, 40 mg

Protonix G QL (1 EA per 1 day)

pepcid ac maximum strength oral tablet 20 mg

Pepcid G QL (3 EA per 1 day)

PREVACID SOLUTAB ORAL TABLET DISPERSIBLE 15 MG, 30 MG

Prevacid SoluTab B PA

PRILOSEC OTC ORAL TABLET DELAYED RELEASE 20 MG

B

rabeprazole sodium oral tablet delayed release 20 mg

Aciphex G

ranitidine acid reducer oral tablet 75 mg Wal-Zan 75 G QL (62 EA per 31 days)

ranitidine hcl injection solution 150 mg/6ml, 50 mg/2ml

Zantac G

ranitidine hcl oral capsule 150 mg G QL (67 EA per 31 days)

ranitidine hcl oral capsule 300 mg G

ranitidine hcl oral syrup 15 mg/ml, 150 mg/10ml, 75 mg/5ml


ranitidine hcl oral tablet 150 mg Wal-Zan 150 Maximum Strength


ranitidine hcl oral tablet 300 mg Zantac G

ranitidine hcl oral tablet 75 mg Wal-Zan 75 G QL (62 EA per 31 days)

sucralfate oral tablet 1 gm Carafate G

Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions

alosetron hcl oral tablet 0.5 mg, 1 mg Lotronex G

AMITIZA ORAL CAPSULE 24 MCG, 8 MCG

B PA; QL (2 EA per 1 day)

amoxicill-clarithro-lansopraz oral Prevpac G

anti-diarrheal oral tablet 2 mg Imodium A-D G

atropine sulfate (pf) injection solution 0.4 mg/0.5ml

G

atropine sulfate injection solution 0.4 mg/ml, 1 mg/ml, 8 mg/20ml

G


108


atropine sulfate injection solution prefilled syringe 0.25 mg/5ml, 0.5 mg/5ml, 1 mg/10ml

G

atropine sulfate intravenous solution prefilled syringe 2 mg/5ml

G

belladonna alkaloids-opium rectal suppository 16.2-60 mg

G

belladonna-opium rectal suppository 16.2-30 mg

G

cascara sagrada oral fluid extract 1 gm/ml G

chlordiazepoxide-clidinium oral capsule 5-2.5 mg

Librax G

CHOLBAM ORAL CAPSULE 250 MG, 50 MG

B PA; SP

clearlax oral powder ClearLax G

constulose oral solution 10 gm/15ml G

cromolyn sodium oral concentrate 100 mg/5ml

Gastrocrom G

dicyclomine hcl intramuscular solution 10 mg/ml

Bentyl G

dicyclomine hcl oral capsule 10 mg Bentyl G

dicyclomine hcl oral solution 10 mg/5ml G

dicyclomine hcl oral tablet 20 mg G

diphenoxylate-atropine oral liquid 2.5-0.025 mg/5ml

G

diphenoxylate-atropine oral tablet 2.5-0.025 mg

Lomotil G

docusate sodium oral capsule 250 mg DOK G QL (62 EA per 31 days)

ed-spaz oral tablet dispersible 0.125 mg Anaspaz G

enulose oral solution 10 gm/15ml G

gavilax oral powder ClearLax G

gavilyte-c oral solution reconstituted 240 gm

Colyte with Flavor Packs G

gavilyte-g oral solution reconstituted 236 gm

GaviLyte-G G

gavilyte-h oral kit 5-210 mg-gm G

gavilyte-n with flavor pack oral solution reconstituted 420 gm

GaviLyte-N with Flavor Pack

G

generlac oral solution 10 gm/15ml G

glycolax oral powder ClearLax G


109


glycopyrrolate injection solution 0.2 mg/ml, 0.4 mg/2ml, 1 mg/5ml, 4 mg/20ml

Robinul G

glycopyrrolate oral tablet 1 mg Robinul G

glycopyrrolate oral tablet 2 mg Robinul-Forte G

hyoscyamine sulfate er oral tablet extended release 12 hour 0.375 mg

Levbid G

hyoscyamine sulfate oral elixir 0.125 mg/5ml

G

hyoscyamine sulfate oral solution 0.125 mg/ml

G

hyoscyamine sulfate oral tablet 0.125 mg Levsin G

hyoscyamine sulfate oral tablet dispersible 0.125 mg

Anaspaz G

hyoscyamine sulfate sl sublingual tablet sublingual 0.125 mg

Levsin/SL G

hyoscyamine sulfate sublingual tablet sublingual 0.125 mg

Levsin/SL G

hyosyne oral elixir 0.125 mg/5ml G

hyosyne oral solution 0.125 mg/ml G

lactulose encephalopathy oral solution 10 gm/15ml

G

lactulose oral solution 10 gm/15ml, 20 gm/30ml

G

LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 MCG


loperamide hcl oral capsule 2 mg Imodium A-D G

loperamide hcl oral tablet 2 mg Imodium A-D G

methscopolamine bromide oral tablet 2.5 mg, 5 mg

G

mineral oil heavy oral oil G

mm anti-diarrheal oral tablet 2 mg Imodium A-D G

nulev oral tablet dispersible 0.125 mg Anaspaz G

opium oral tincture 10 mg/ml (1%) G

oscimin oral tablet 0.125 mg Levsin G

oscimin oral tablet dispersible 0.125 mg Anaspaz G

oscimin sr oral tablet extended release 12 hour 0.375 mg

Levbid G

oscimin sublingual tablet sublingual 0.125 mg

Levsin/SL G

paregoric oral tincture 2 mg/5ml G


110


pb-hyoscy-atropine-scopolamine oral tablet 16.2 mg

Donnatal G

peg 3350/electrolytes oral solution reconstituted 240 gm

Colyte with Flavor Packs G

peg 3350-kcl-na bicarb-nacl oral solution reconstituted 420 gm

GaviLyte-N with Flavor Pack

G

peg-3350/electrolytes oral solution reconstituted 236 gm

GaviLyte-G G

peg-prep oral kit 5-210 mg-gm G

pegylax oral powder ClearLax G

phenobarbital-belladonna alk oral elixir 16.2 mg/5ml

Donnatal G

phenohytro oral elixir 16.2 mg/5ml Donnatal G

phenohytro oral tablet 16.2 mg Donnatal G

polyethylene glycol 3350 oral packet CVS Purelax G

polyethylene glycol 3350 oral powder ClearLax G

propantheline bromide oral tablet 15 mg G

SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED 4 MG, 5 MG, 6 MG

B SP

sodium bicarbonate oral powder G

stool softener oral capsule 100 mg Colace G QL (124 EA per 31 days)

stool softener oral capsule 250 mg DOK G QL (62 EA per 31 days)

symax-sl sublingual tablet sublingual 0.125 mg

Levsin/SL G

symax-sr oral tablet extended release 12 hour 0.375 mg

Levbid G

trilyte oral solution reconstituted 420 gm GaviLyte-N with Flavor Pack

G

ursodiol oral capsule 300 mg Actigall G

ursodiol oral tablet 250 mg Urso 250 G

ursodiol oral tablet 500 mg Urso Forte G

XERMELO ORAL TABLET 250 MG B PA; SP

ZORBTIVE SUBCUTANEOUS SOLUTION RECONSTITUTED 8.8 MG

B SP

Genetic or Enzyme Disorder: Drugs for Replacement, Modifiers, Treatment

ALDURAZYME INTRAVENOUS SOLUTION 2.9 MG/5ML

B PA; SP

CERDELGA ORAL CAPSULE 84 MG B PA; SP


111


CEREZYME INTRAVENOUS SOLUTION RECONSTITUTED 400 UNIT

B PA; SP

CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000 UNIT, 24000-76000 UNIT, 3000-9500 UNIT, 36000 UNIT, 6000 UNIT

B PA

CRYSVITA SUBCUTANEOUS SOLUTION 10 MG/ML, 20 MG/ML, 30 MG/ML

B PA; SP

ELAPRASE INTRAVENOUS SOLUTION 6 MG/3ML

B PA; SP

FABRAZYME INTRAVENOUS SOLUTION RECONSTITUTED 35 MG, 5 MG

B PA; SP

KUVAN ORAL PACKET 100 MG, 500 MG B PA; SP

KUVAN ORAL TABLET SOLUBLE 100 MG

B PA; SP

LUMIZYME INTRAVENOUS SOLUTION RECONSTITUTED 50 MG

B PA; SP

MEPSEVII INTRAVENOUS SOLUTION 10 MG/5ML

B PA; SP

miglustat oral capsule 100 mg Zavesca G

NAGLAZYME INTRAVENOUS SOLUTION 1 MG/ML

B PA; SP

PROCYSBI ORAL CAPSULE DELAYED RELEASE 25 MG, 75 MG

B PA; SP

RAVICTI ORAL LIQUID 1.1 GM/ML B PA; SP

sod benz-sod phenylacet intravenous solution 10-10 %

Ammonul G

sodium phenylbutyrate oral powder 3 gm/tsp

Buphenyl G SP

sodium phenylbutyrate oral tablet 500 mg Buphenyl G

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions

acetic acid irrigation solution 0.25 % G

aminoacetic acid irrigation solution 1.5 % G

azuphen mb oral capsule 120 mg Ustell G

bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg

Urecholine G

calcium acetate (phos binder) oral capsule 667 mg

PhosLo G

calcium acetate (phos binder) oral tablet 667 mg

Calphron G


112


calcium acetate oral capsule 667 mg PhosLo G

darifenacin hydrobromide er oral tablet extended release 24 hour 15 mg, 7.5 mg

Enablex G ST

flavoxate hcl oral tablet 100 mg G

GELNIQUE PUMP TRANSDERMAL GEL 10 %

B

GELNIQUE TRANSDERMAL GEL 10 % B

glycine irrigation solution 1.5 % G

glycine urologic irrigation solution 1.5 % G

hyolev mb oral tablet 81 mg Urelle G

hyophen oral tablet 81.6 mg G

indiomin mb oral capsule 120 mg G

lanthanum carbonate oral tablet chewable 1000 mg, 500 mg, 750 mg

Fosrenol G

me/naphos/mb/hyo1 oral tablet 81.6 mg Urogesic-Blue G

MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HOUR 25 MG, 50 MG

B ST

oxybutynin chloride er oral tablet extended release 24 hour 10 mg, 15 mg, 5 mg

Ditropan XL G

oxybutynin chloride oral syrup 5 mg/5ml G

oxybutynin chloride oral tablet 5 mg G

OXYTROL FOR WOMEN TRANSDERMAL PATCH TWICE WEEKLY 3.9 MG/24HR

B ST

OXYTROL TRANSDERMAL PATCH TWICE WEEKLY 3.9 MG/24HR

B ST

phenazo oral tablet 200 mg Phenazo G

phenazopyridine hcl oral tablet 100 mg Pyridium G

phenazopyridine hcl oral tablet 200 mg Phenazo G

phosphasal oral tablet 81.6 mg Phosphasal G

RENAGEL ORAL TABLET 400 MG, 800 MG

B

sevelamer carbonate oral packet 0.8 gm, 2.4 gm

Renvela G

sevelamer carbonate oral tablet 800 mg Renvela G

tolterodine tartrate er oral capsule extended release 24 hour 2 mg, 4 mg

Detrol LA G ST

tolterodine tartrate oral tablet 1 mg, 2 mg Detrol G ST

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG, 8 MG

B


113


trospium chloride er oral capsule extended release 24 hour 60 mg

G ST

trospium chloride oral tablet 20 mg G ST

ur n-c oral tablet 81.6 mg Phosphasal G

uramit mb oral capsule 118 mg Uribel G

urelle oral tablet 81 mg Urelle G

uretron d/s oral tablet G

uribel oral capsule 118 mg Uribel G

urimar-t oral tablet 120 mg G

urin ds oral tablet Phosphasal G

uro-458 oral tablet 81 mg Urelle G

uroav-81 oral tablet 81 mg Urelle G

uroav-b oral capsule 118 mg Uribel G

uro-mp oral capsule 118 mg Uribel G

urophen mb oral tablet 81.6 mg G

uryl oral tablet 81.6 mg Urogesic-Blue G

ustell oral capsule 120 mg Ustell G

uta oral capsule 120 mg G

uticap oral capsule 120 mg Ustell G

utira-c oral tablet 81.6 mg Phosphasal G

utrona-c oral tablet 81.6 mg Phosphasal G

VESICARE ORAL TABLET 10 MG, 5 MG B ST

vilamit mb oral capsule 118 mg Uribel G

vilevev mb oral tablet 81 mg Urelle G

Genitourinary Agents - Drugs for Prostate Conditions

alfuzosin hcl er oral tablet extended release 24 hour 10 mg

Uroxatral G

AVODART ORAL CAPSULE 0.5 MG Avodart B ST

dutasteride oral capsule 0.5 mg Avodart G ST

dutasteride-tamsulosin hcl oral capsule 0.5-0.4 mg

Jalyn G

finasteride oral tablet 5 mg Proscar G

RAPAFLO ORAL CAPSULE 4 MG, 8 MG B ST

tamsulosin hcl oral capsule 0.4 mg Flomax G

terazosin hcl oral capsule 1 mg, 10 mg, 2 mg, 5 mg

G

Hormonal Agents - Adrenal


114


ala-cort external cream 1 % Aveeno Anti-Itch Max St G

ala-cort external cream 2.5 % G

alclometasone dipropionate external cream 0.05 %

G

alclometasone dipropionate external ointment 0.05 %

G

amcinonide external cream 0.1 % G

amcinonide external lotion 0.1 % G

amcinonide external ointment 0.1 % G

apexicon e external cream 0.05 % G

betamethasone dipropionate aug external cream 0.05 %

Diprolene AF G

betamethasone dipropionate aug external gel 0.05 %

G

betamethasone dipropionate aug external lotion 0.05 %

Diprolene G

betamethasone dipropionate aug external ointment 0.05 %

Diprolene G

betamethasone dipropionate external cream 0.05 %

G

betamethasone dipropionate external lotion 0.05 %

G

betamethasone dipropionate external ointment 0.05 %

G

betamethasone sod phos & acet injection suspension 6 (3-3) mg/ml

Celestone Soluspan G

betamethasone valerate external cream 0.1 %

G

betamethasone valerate external foam 0.12 %

Luxiq G

betamethasone valerate external lotion 0.1 %

G

betamethasone valerate external ointment 0.1 %

G

clobetasol prop emollient base external cream 0.05 %

G

clobetasol propionate e external cream 0.05 %

G

clobetasol propionate emulsion external foam 0.05 %

Olux-E G

clobetasol propionate external cream 0.05 %

Temovate G


115


clobetasol propionate external foam 0.05 %

Olux G

clobetasol propionate external gel 0.05 % G

clobetasol propionate external liquid 0.05 %

Clobex Spray G

clobetasol propionate external lotion 0.05 %

Clobex G

clobetasol propionate external ointment 0.05 %

Temovate G

clobetasol propionate external shampoo 0.05 %

Clobex G

clobetasol propionate external solution 0.05 %

G

clocortolone pivalate external cream 0.1 %

Cloderm G

clocortolone pivalate pump external cream 0.1 %

Cloderm G

clodan external shampoo 0.05 % Clobex G

cormax scalp application external solution 0.05 %

G

cortisone acetate oral tablet 25 mg G

deltasone oral tablet 20 mg Deltasone G

derma silkrx sds pak external kit 0.1 & 5 %

NuTriaRx CreamPak G

dermawerx sds external kit 0.1 & 5 % NuTriaRx CreamPak G

desonide external cream 0.05 % DesOwen G PA

desonide external lotion 0.05 % DesOwen G PA

desonide external ointment 0.05 % G PA

desoximetasone external cream 0.05 %, 0.25 %

Topicort G

desoximetasone external gel 0.05 % Topicort G

desoximetasone external liquid 0.25 % Topicort Spray G

desoximetasone external ointment 0.05 %, 0.25 %

Topicort G

dexamethasone oral elixir 0.5 mg/5ml Decadron G

dexamethasone oral solution 0.5 mg/5ml G

dexamethasone oral tablet 0.5 mg, 0.75 mg, 4 mg, 6 mg

Decadron G

dexamethasone oral tablet 1 mg, 1.5 mg, 2 mg

G

dexamethasone sod phos-nacl intravenous solution 12-0.9 mg/50ml-%

G


116


dexamethasone sod phosphate pf injection solution 10 mg/ml

G

dexamethasone sodium phosphate injection solution 10 mg/ml, 100 mg/10ml, 120 mg/30ml, 20 mg/5ml, 4 mg/ml

G

diflorasone diacetate external cream 0.05 %

G

diflorasone diacetate external ointment 0.05 %

G

fludrocortisone acetate oral tablet 0.1 mg G

fluocinolone acetonide body external oil 0.01 %

Derma-Smoothe/FS Body G

fluocinolone acetonide external cream 0.01 %

G

fluocinolone acetonide external cream 0.025 %

Synalar G

fluocinolone acetonide external ointment 0.025 %

Synalar G

fluocinolone acetonide external solution 0.01 %

Synalar G

fluocinolone acetonide scalp external oil 0.01 %

Derma-Smoothe/FS Scalp

G

fluocinonide emulsified base external cream 0.05 %

G

fluocinonide external cream 0.05 % G

fluocinonide external cream 0.1 % Vanos G

fluocinonide external gel 0.05 % G

fluocinonide external ointment 0.05 % G

fluocinonide external solution 0.05 % G

flurandrenolide external cream 0.05 % Cordran G

flurandrenolide external lotion 0.05 % Cordran G

flurandrenolide external ointment 0.05 % Cordran G

fluticasone propionate external cream 0.05 %

G

fluticasone propionate external lotion 0.05 %

Cutivate G

fluticasone propionate external ointment 0.005 %

G

halobetasol propionate external cream 0.05 %

Ultravate G

halobetasol propionate external ointment 0.05 %

Ultravate G


117


hydrocortisone butyr lipo base external cream 0.1 %

Locoid Lipocream G

hydrocortisone butyrate external cream 0.1 %

Locoid G

hydrocortisone butyrate external lotion 0.1 %

Locoid G

hydrocortisone butyrate external ointment 0.1 %

G

hydrocortisone butyrate external solution 0.1 %

Locoid G

hydrocortisone external cream 1 % Aveeno Anti-Itch Max St G

hydrocortisone external cream 2.5 % G

hydrocortisone external lotion 2.5 % G

hydrocortisone external ointment 1 % Cortizone-10 G

hydrocortisone external ointment 2.5 % G

hydrocortisone in absorbase external ointment 1 %

Cortizone-10 G

hydrocortisone oral tablet 10 mg, 20 mg, 5 mg

Cortef G

hydrocortisone valerate external cream 0.2 %

G

hydrocortisone valerate external ointment 0.2 %

G

methylprednisolone ace-lido injection suspension 40-10 mg/ml, 80-10 mg/ml

G

methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml

Depo-Medrol G

methylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg

Medrol G

methylprednisolone oral tablet therapy pack 4 mg

Medrol G

methylprednisolone sodium succ injection solution reconstituted 1000 mg

Solu-MEDROL G

methylprednisolone sodium succ injection solution reconstituted 125 mg, 40 mg

SOLU-medrol G

mometasone furoate external cream 0.1 %

Elocon G

mometasone furoate external ointment 0.1 %

Elocon G

mometasone furoate external solution 0.1 %

G

nolix external cream 0.05 % Cordran G

nolix external lotion 0.05 % Cordran G


118


nutriarx creampak external kit 0.1 & 5 % NuTriaRx CreamPak G

prednicarbate external cream 0.1 % G

prednicarbate external ointment 0.1 % G

prednisolone oral solution 15 mg/5ml G

prednisolone oral syrup 15 mg/5ml G

prednisolone sodium phosphate oral solution 10 mg/5ml

Millipred G

prednisolone sodium phosphate oral solution 15 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml

G

prednisolone sodium phosphate oral solution 20 mg/5ml

Veripred 20 G

prednisolone sodium phosphate oral tablet dispersible 10 mg, 15 mg, 30 mg

Orapred ODT G

prednisone oral solution 5 mg/5ml G

prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg, 50 mg

G

prednisone oral tablet 20 mg Deltasone G

prednisone oral tablet therapy pack 10 mg (21), 10 mg (48), 5 mg (21), 5 mg (48)

G

sanadermrx skin repair external kit 0.1 & 5 %

NuTriaRx CreamPak G

scalacort external lotion 2 % Ala Scalp G

SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED 100 MG, 1000 MG, 250 MG, 500 MG

B PA

synalar external cream 0.025 % Synalar G

synalar external ointment 0.025 % Synalar G

triamcinolone acetonide external aerosol solution 0.147 mg/gm

Kenalog G

triamcinolone acetonide external cream 0.025 %

G

triamcinolone acetonide external cream 0.1 %, 0.5 %

Triderm G

triamcinolone acetonide external lotion 0.025 %, 0.1 %

G

triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 %

G

triamcinolone acetonide injection suspension 40 mg/ml

Kenalog G

triderm external cream 0.1 %, 0.5 % Triderm G

tri-sila external kit 0.1 & 5 % NuTriaRx CreamPak G


119


VERIPRED 20 ORAL SOLUTION 20 MG/5ML

Veripred 20 B

Hormonal Agents - Men's Health

ANDRODERM TRANSDERMAL PATCH 24 HOUR 2 MG/24HR, 4 MG/24HR

B PA

ANDROGEL PUMP TRANSDERMAL GEL 20.25 MG/ACT (1.62%)

B

ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 40.5 MG/2.5GM (1.62%)

B

ANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%), 50 MG/5GM (1%)

AndroGel B

danazol oral capsule 100 mg, 200 mg, 50 mg

G

FORTESTA TRANSDERMAL GEL 10 MG/ACT (2%)

Fortesta B

methyltestosterone oral capsule 10 mg G

NATESTO NASAL GEL 5.5 MG/ACT B

oxandrolone oral tablet 10 mg Oxandrin G

oxandrolone oral tablet 2.5 mg G

TESTIM TRANSDERMAL GEL 50 MG/5GM (1%)

AndroGel B

testosterone cypionate intramuscular solution 100 mg/ml, 200 mg/ml

Depo-Testosterone G

testosterone enanthate intramuscular solution 200 mg/ml

G

TESTOSTERONE TRANSDERMAL GEL 10 MG/ACT (2%)

Fortesta B

testosterone transdermal gel 12.5 mg/act (1%)

Vogelxo Pump G PA

testosterone transdermal gel 25 mg/2.5gm (1%), 50 mg/5gm (1%)

AndroGel G

testosterone transdermal solution 30 mg/act

G PA

VOGELXO PUMP TRANSDERMAL GEL 12.5 MG/ACT (1%)

Vogelxo Pump B

VOGELXO TRANSDERMAL GEL 50 MG/5GM (1%)

AndroGel B

Hormonal Agents - Osteoporosis

raloxifene hcl oral tablet 60 mg Evista G ST

Hormonal Agents - Parathyroid

SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG

B PA


120


Hormonal Agents - Pituitary

cabergoline oral tablet 0.5 mg G PA

DDAVP INJECTION SOLUTION 4 MCG/ML

DDAVP B PA

DDAVP ORAL TABLET 0.1 MG, 0.2 MG DDAVP B PA

desmopressin ace spray refrig nasal solution 0.01 %

G

desmopressin acetate injection solution 4 mcg/ml

DDAVP G PA

desmopressin acetate oral tablet 0.1 mg, 0.2 mg

DDAVP G PA

desmopressin acetate spray nasal solution 0.01 %

DDAVP G

ELIGARD SUBCUTANEOUS KIT 22.5 MG, 30 MG, 45 MG, 7.5 MG

B PA; SP

GENOTROPIN MINIQUICK SUBCUTANEOUS SOLUTION RECONSTITUTED 0.2 MG, 0.4 MG, 0.6 MG, 0.8 MG, 1 MG, 1.2 MG, 1.4 MG, 1.6 MG, 1.8 MG, 2 MG

B PA; SP

GENOTROPIN SUBCUTANEOUS SOLUTION RECONSTITUTED 12 MG, 5 MG

B PA; SP

HP ACTHAR INJECTION GEL 80 UNIT/ML

B ST

HUMATROPE INJECTION SOLUTION RECONSTITUTED 12 MG, 24 MG, 5 MG, 6 MG

B PA; SP

INCRELEX SUBCUTANEOUS SOLUTION 40 MG/4ML

B PA; SP

leuprolide acetate injection kit 1 mg/0.2ml G PA; SP

LUPANETA PACK COMBINATION KIT 11.25 & 5 MG, 3.75 & 5 MG

B PA

LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 3.75 MG, 7.5 MG

B PA; SP

LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT 11.25 MG, 22.5 MG

B PA; SP

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG INTRAMUSCULAR KIT 30 MG

B PA; SP

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG INTRAMUSCULAR KIT 45 MG

B PA; SP


121


LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 11.25 MG, 15 MG, 7.5 MG

B PA; SP

LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT 11.25 MG (PED), 30 MG (PED)

B PA; SP

NOCTIVA NASAL EMULSION 0.83 MCG/0.1ML, 1.66 MCG/0.1ML

B PA

NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION 10 MG/1.5ML, 15 MG/1.5ML, 30 MG/3ML, 5 MG/1.5ML

B PA; SP

NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS SOLUTION 10 MG/2ML

B PA; SP


B PA; SP


B PA; SP

octreotide acetate injection solution 100 mcg/ml, 50 mcg/ml, 500 mcg/ml

SandoSTATIN G PA; SP

octreotide acetate injection solution 1000 mcg/ml, 200 mcg/ml

G PA; SP

OMNITROPE SUBCUTANEOUS SOLUTION 10 MG/1.5ML, 5 MG/1.5ML

B PA; SP

OMNITROPE SUBCUTANEOUS SOLUTION RECONSTITUTED 5.8 MG

B PA; SP

oxytocin injection solution 10 unit/ml Pitocin G

oxytocin-dextrose intravenous solution 10-5 unt/l-%, 20-5 unt/l-%

G

oxytocin-sodium chloride intravenous solution 20-0.45 unit/l-%

G

SAIZEN CLICK.EASY INJECTION SOLUTION RECONSTITUTED 8.8 MG

B SP

SAIZEN INJECTION SOLUTION RECONSTITUTED 5 MG, 8.8 MG

B SP

SAIZENPREP INJECTION SOLUTION RECONSTITUTED 8.8 MG

B SP

SOMAVERT SUBCUTANEOUS SOLUTION RECONSTITUTED 10 MG, 15 MG, 20 MG, 25 MG, 30 MG

B PA; SP

STIMATE NASAL SOLUTION 1.5 MG/ML B PA

SUPPRELIN LA SUBCUTANEOUS KIT 50 MG

B PA; SP


122


SYNAREL NASAL SOLUTION 2 MG/ML B PA

TRELSTAR MIXJECT INTRAMUSCULAR SUSPENSION RECONSTITUTED 11.25 MG, 22.5 MG, 3.75 MG

B SP

VANTAS SUBCUTANEOUS KIT 50 MG B SP

vasopressin-sodium chloride intravenous solution 40-0.9 ut/100ml-%, 50-0.9 ut/50ml-%, 60-0.9 ut/100ml-%

G

ZOLADEX SUBCUTANEOUS IMPLANT 10.8 MG, 3.6 MG

B SP

ZOMACTON SUBCUTANEOUS SOLUTION RECONSTITUTED 10 MG, 5 MG

B PA; SP

Hormonal Agents - Sex Hormones and Birth Control

altavera oral tablet 0.15-30 mg-mcg Altavera G

alyacen 1/35 oral tablet 1-35 mg-mcg Cyclafem 1/35 G

alyacen 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg

Cyclafem 7/7/7 G

amabelz oral tablet 0.5-0.1 mg, 1-0.5 mg Activella G

amethia lo oral tablet 0.1-0.02 & 0.01 mg Amethia Lo G

amethia oral tablet 0.15-0.03 &0.01 mg Amethia G

ANGELIQ ORAL TABLET 0.25-0.5 MG, 0.5-1 MG

B

apri oral tablet 0.15-30 mg-mcg Apri G

aranelle oral tablet 0.5/1/0.5-35 mg-mcg G

ashlyna oral tablet 0.15-0.03 &0.01 mg Amethia G

aubra oral tablet 0.1-20 mg-mcg Aubra G

aviane oral tablet 0.1-20 mg-mcg Aubra G

azurette oral tablet 0.15-0.02/0.01 mg (21/5)

Azurette G

balziva oral tablet 0.4-35 mg-mcg Balziva G

bekyree oral tablet 0.15-0.02/0.01 mg (21/5)

Azurette G

blisovi 24 fe oral tablet 1-20 mg-mcg(24) Blisovi 24 Fe G

blisovi fe 1.5/30 oral tablet 1.5-30 mg-mcg G

blisovi fe 1/20 oral tablet 1-20 mg-mcg Blisovi FE 1/20 G

briellyn oral tablet 0.4-35 mg-mcg Balziva G

camila oral tablet 0.35 mg Camila G

camrese lo oral tablet 0.1-0.02 & 0.01 mg Amethia Lo G


123


camrese oral tablet 0.15-0.03 &0.01 mg Amethia G

caziant oral tablet 0.1/0.125/0.15 -0.025 mg

G

chateal oral tablet 0.15-30 mg-mcg Altavera G

CLIMARA PRO TRANSDERMAL PATCH WEEKLY 0.045-0.015 MG/DAY


CLIMARA 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

Climara B QL (4 EA per 28 days)

COMBIPATCH TRANSDERMAL PATCH TWICE WEEKLY 0.05-0.14 MG/DAY, 0.05-0.25 MG/DAY


covaryx hs oral tablet 0.625-1.25 mg Covaryx HS G

covaryx oral tablet 1.25-2.5 mg Covaryx G

cryselle-28 oral tablet 0.3-30 mg-mcg G

cyclafem 1/35 oral tablet 1-35 mg-mcg Cyclafem 1/35 G

cyclafem 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg

Cyclafem 7/7/7 G

cyred oral tablet 0.15-30 mg-mcg Apri G

dasetta 1/35 oral tablet 1-35 mg-mcg Cyclafem 1/35 G

dasetta 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg

Cyclafem 7/7/7 G

daysee oral tablet 0.15-0.03 &0.01 mg Amethia G

deblitane oral tablet 0.35 mg Camila G

delyla oral tablet 0.1-20 mg-mcg Aubra G

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

B

desogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5)

Azurette G

desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg

Apri G

drospiren-eth estrad-levomefol oral tablet 3-0.02-0.451 mg

Beyaz G

drospirenone-ethinyl estradiol oral tablet 3-0.02 mg

Gianvi G

drospirenone-ethinyl estradiol oral tablet 3-0.03 mg

Ocella G

DUAVEE ORAL TABLET 0.45-20 MG B ST

eemt hs oral tablet 0.625-1.25 mg Covaryx HS G

eemt oral tablet 1.25-2.5 mg Covaryx G


124


elinest oral tablet 0.3-30 mg-mcg G

ELLA ORAL TABLET 30 MG B

emoquette oral tablet 0.15-30 mg-mcg Apri G

enpresse-28 oral tablet Enpresse-28 G

enskyce oral tablet 0.15-30 mg-mcg Apri G

errin oral tablet 0.35 mg Camila G

est estrogens-methyltest ds oral tablet 1.25-2.5 mg

Covaryx G

est estrogens-methyltest hs oral tablet 0.625-1.25 mg

Covaryx HS G

est estrogens-methyltest oral tablet 1.25-2.5 mg

Covaryx G

estarylla oral tablet 0.25-35 mg-mcg Estarylla G

estradiol oral tablet 0.5 mg, 1 mg, 2 mg Estrace G

estradiol transdermal patch twice weekly 0.025 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr

Alora G

estradiol transdermal patch twice weekly 0.0375 mg/24hr

Minivelle G

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

Climara G QL (4 EA per 28 days)

estradiol vaginal cream 0.1 mg/gm Estrace G

estradiol vaginal tablet 10 mcg Vagifem G

estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml

Delestrogen G

estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg

Activella G

ESTROGEL TRANSDERMAL GEL 0.75 MG/1.25 GM (0.06%)

B QL (2 GM per 31 days)

estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg

G

ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg

Kelnor 1/35 G

ethynodiol diac-eth estradiol oral tablet 1-50 mg-mcg

Kelnor 1/50 G

falmina oral tablet 0.1-20 mg-mcg Aubra G

fayosim oral tablet 42-21-21-7 days Fayosim G

femynor oral tablet 0.25-35 mg-mcg Estarylla G

fyavolv oral tablet 0.5-2.5 mg-mcg Femhrt Low Dose G


125


fyavolv oral tablet 1-5 mg-mcg Fyavolv G

gianvi oral tablet 3-0.02 mg Gianvi G

gildagia oral tablet 0.4-35 mg-mcg Balziva G

gildess fe 1.5/30 oral tablet 1.5-30 mg-mcg

G

gildess fe 1/20 oral tablet 1-20 mg-mcg Blisovi FE 1/20 G

heather oral tablet 0.35 mg Camila G

hydroxyprogesterone caproate intramuscular oil 250 mg/ml

Makena G

hydroxyprogesterone caproate intramuscular solution 1.25 gm/5ml

G

incassia oral tablet 0.35 mg Camila G

introvale oral tablet 0.15-0.03 mg Introvale G

isibloom oral tablet 0.15-30 mg-mcg Apri G

jencycla oral tablet 0.35 mg Camila G

jevantique lo oral tablet 0.5-2.5 mg-mcg Femhrt Low Dose G

jinteli oral tablet 1-5 mg-mcg Fyavolv G

jolessa oral tablet 0.15-0.03 mg Introvale G

jolivette oral tablet 0.35 mg Camila G

juleber oral tablet 0.15-30 mg-mcg Apri G

junel 1.5/30 oral tablet 1.5-30 mg-mcg G

junel 1/20 oral tablet 1-20 mg-mcg Junel 1/20 G

junel fe 1.5/30 oral tablet 1.5-30 mg-mcg G

junel fe 1/20 oral tablet 1-20 mg-mcg Blisovi FE 1/20 G

junel fe 24 oral tablet 1-20 mg-mcg(24) Blisovi 24 Fe G

kaitlib fe oral tablet chewable 0.8-25 mg-mcg

Generess FE G

kariva oral tablet 0.15-0.02/0.01 mg (21/5) Azurette G

kelnor 1/35 oral tablet 1-35 mg-mcg Kelnor 1/35 G

kelnor 1/50 oral tablet 1-50 mg-mcg Kelnor 1/50 G

kimidess oral tablet 0.15-0.02/0.01 mg (21/5)

Azurette G

kurvelo oral tablet 0.15-30 mg-mcg Altavera G

larin 1.5/30 oral tablet 1.5-30 mg-mcg G

larin 1/20 oral tablet 1-20 mg-mcg Junel 1/20 G

larin 24 fe oral tablet 1-20 mg-mcg(24) Blisovi 24 Fe G

larin fe 1.5/30 oral tablet 1.5-30 mg-mcg G

larin fe 1/20 oral tablet 1-20 mg-mcg Blisovi FE 1/20 G


126


larissia oral tablet 0.1-20 mg-mcg Aubra G

layolis fe oral tablet chewable 0.8-25 mg-mcg

Generess FE G

leena oral tablet 0.5/1/0.5-35 mg-mcg G

lessina oral tablet 0.1-20 mg-mcg Aubra G

levonest oral tablet Enpresse-28 G

levonorgest-eth est & eth est oral tablet 42-21-21-7 days

Fayosim G

levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg

Amethia Lo G

levonorgest-eth estrad 91-day oral tablet 0.15-0.03 &0.01 mg

Amethia G

levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg

Introvale G

levonorgestrel oral tablet 1.5 mg Aftera G QL (1 EA per 31 days)

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg

Aubra G

levonorgestrel-ethinyl estrad oral tablet 0.15-30 mg-mcg

Altavera G

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg

Amethyst G

levonorg-eth estrad triphasic oral tablet Enpresse-28 G

levora 0.15/30 (28) oral tablet 0.15-30 mg-mcg

Altavera G

lillow oral tablet 0.15-30 mg-mcg Altavera G

lomedia 24 fe oral tablet 1-20 mg-mcg(24) Blisovi 24 Fe G

lopreeza oral tablet 0.5-0.1 mg, 1-0.5 mg Activella G

loryna oral tablet 3-0.02 mg Gianvi G

low-ogestrel oral tablet 0.3-30 mg-mcg G

lutera oral tablet 0.1-20 mg-mcg Aubra G

lyza oral tablet 0.35 mg Camila G

MAKENA INTRAMUSCULAR OIL 250 MG/ML

Makena B

MAKENA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 275 MG/1.1ML

B

marlissa oral tablet 0.15-30 mg-mcg Altavera G

medroxyprogesterone acetate intramuscular suspension 150 mg/ml

Depo-Provera G

medroxyprogesterone acetate intramuscular suspension prefilled syringe 150 mg/ml

Depo-Provera G


127


medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 mg

Provera G

megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml

G

megestrol acetate oral suspension 625 mg/5ml

Megace ES G

megestrol acetate oral tablet 20 mg, 40 mg

G

melodetta 24 fe oral tablet chewable 1-20 mg-mcg(24)

Melodetta 24 Fe G

MENOSTAR TRANSDERMAL PATCH WEEKLY 14 MCG/24HR


mibelas 24 fe oral tablet chewable 1-20 mg-mcg(24)

Melodetta 24 Fe G

microgestin 1.5/30 oral tablet 1.5-30 mg-mcg

G

microgestin 1/20 oral tablet 1-20 mg-mcg Junel 1/20 G

microgestin fe 1.5/30 oral tablet 1.5-30 mg-mcg

G

microgestin fe 1/20 oral tablet 1-20 mg-mcg

Blisovi FE 1/20 G

mili oral tablet 0.25-35 mg-mcg Estarylla G

mimvey lo oral tablet 0.5-0.1 mg Activella G

mimvey oral tablet 1-0.5 mg Activella G

mono-linyah oral tablet 0.25-35 mg-mcg Estarylla G

mononessa oral tablet 0.25-35 mg-mcg Estarylla G

myzilra oral tablet Enpresse-28 G

necon 0.5/35 (28) oral tablet 0.5-35 mg-mcg

G

necon 1/35 (28) oral tablet 1-35 mg-mcg Cyclafem 1/35 G

necon 1/50 (28) oral tablet 1-50 mg-mcg G

necon 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg

Cyclafem 7/7/7 G

nikki oral tablet 3-0.02 mg Gianvi G

nora-be oral tablet 0.35 mg Camila G

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg

Blisovi FE 1/20 G

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg(24)

Blisovi 24 Fe G

norethin ace-eth estrad-fe oral tablet chewable 1-20 mg-mcg(24)

Melodetta 24 Fe G

norethindrone acetate oral tablet 5 mg Aygestin G


128


norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg

Junel 1/20 G

norethindrone acet-ethinyl est oral tablet chewable 1-20 mg-mcg(24)

Melodetta 24 Fe G

norethindrone oral tablet 0.35 mg Camila G

norethindrone-eth estradiol oral tablet 0.5-2.5 mg-mcg

Femhrt Low Dose G

norethindrone-eth estradiol oral tablet 1-5 mg-mcg

Fyavolv G

norethin-eth estradiol-fe oral tablet chewable 0.4-35 mg-mcg

Wymzya Fe G

norethin-eth estradiol-fe oral tablet chewable 0.8-25 mg-mcg

Generess FE G

norgestimate-eth estradiol oral tablet 0.25-35 mg-mcg

Estarylla G

norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/0.25 mg-25 mcg

Ortho Tri-Cyclen Lo G

norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/0.25 mg-35 mcg

Ortho Tri-Cyclen (28) G

norlyda oral tablet 0.35 mg Camila G

norlyroc oral tablet 0.35 mg Camila G

nortrel 0.5/35 (28) oral tablet 0.5-35 mg-mcg

G

nortrel 1/35 (21) oral tablet 1-35 mg-mcg Cyclafem 1/35 G

nortrel 1/35 (28) oral tablet 1-35 mg-mcg Cyclafem 1/35 G

nortrel 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg

Cyclafem 7/7/7 G

NUVARING VAGINAL RING 0.12-0.015 MG/24HR

B

ocella oral tablet 3-0.03 mg Ocella G

ogestrel oral tablet 0.5-50 mg-mcg G

orsythia oral tablet 0.1-20 mg-mcg Aubra G

philith oral tablet 0.4-35 mg-mcg Balziva G

pimtrea oral tablet 0.15-0.02/0.01 mg (21/5)

Azurette G

pirmella 1/35 oral tablet 1-35 mg-mcg Cyclafem 1/35 G

pirmella 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg

Cyclafem 7/7/7 G

PLAN B ONE-STEP ORAL TABLET 1.5 MG

Aftera B QL (1 EA per 31 days)

portia-28 oral tablet 0.15-30 mg-mcg Altavera G


129


PREFEST ORAL TABLET 1/1-0.09 MG (15/15)

B

PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG, 1.25 MG

B

PREMARIN VAGINAL CREAM 0.625 MG/GM

B

PREMPHASE ORAL TABLET 0.625-5 MG

B

PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG

B

previfem oral tablet 0.25-35 mg-mcg Estarylla G

progesterone intramuscular oil 50 mg/ml G

progesterone micronized oral capsule 100 mg, 200 mg

Prometrium G

progesterone micronized transdermal cream 10 %

G

quasense oral tablet 0.15-0.03 mg Introvale G

rajani oral tablet 3-0.02-0.451 mg Beyaz G

reclipsen oral tablet 0.15-30 mg-mcg Apri G

rivelsa oral tablet 42-21-21-7 days Fayosim G

setlakin oral tablet 0.15-0.03 mg Introvale G

sharobel oral tablet 0.35 mg Camila G

sprintec 28 oral tablet 0.25-35 mg-mcg Estarylla G

sronyx oral tablet 0.1-20 mg-mcg Aubra G

syeda oral tablet 3-0.03 mg Ocella G

tarina fe 1/20 oral tablet 1-20 mg-mcg Blisovi FE 1/20 G

tilia fe oral tablet 1-20/1-30/1-35 mg-mcg G

tri femynor oral tablet 0.18/0.215/0.25 mg-35 mcg


tri-estarylla oral tablet 0.18/0.215/0.25 mg-35 mcg


tri-legest fe oral tablet 1-20/1-30/1-35 mg-mcg

G

tri-linyah oral tablet 0.18/0.215/0.25 mg-35 mcg


tri-lo-estarylla oral tablet 0.18/0.215/0.25 mg-25 mcg


tri-lo-marzia oral tablet 0.18/0.215/0.25 mg-25 mcg


tri-lo-sprintec oral tablet 0.18/0.215/0.25 mg-25 mcg



130


tri-mili oral tablet 0.18/0.215/0.25 mg-35 mcg


trinessa (28) oral tablet 0.18/0.215/0.25 mg-35 mcg


trinessa lo oral tablet 0.18/0.215/0.25 mg-25 mcg


tri-previfem oral tablet 0.18/0.215/0.25 mg-35 mcg


tri-sprintec oral tablet 0.18/0.215/0.25 mg-35 mcg


trivora (28) oral tablet Enpresse-28 G

tri-vylibra oral tablet 0.18/0.215/0.25 mg-35 mcg


tulana oral tablet 0.35 mg Camila G

tydemy oral tablet 3-0.03-0.451 mg G

VAGIFEM VAGINAL TABLET 10 MCG Vagifem B

velivet oral tablet 0.1/0.125/0.15 -0.025 mg

G

vestura oral tablet 3-0.02 mg Gianvi G

vienva oral tablet 0.1-20 mg-mcg Aubra G

viorele oral tablet 0.15-0.02/0.01 mg (21/5)

Azurette G

VIVELLE-DOT TRANSDERMAL PATCH TWICE WEEKLY 0.025 MG/24HR, 0.05 MG/24HR, 0.075 MG/24HR, 0.1 MG/24HR

Alora B QL (8 EA per 28 days)

VIVELLE-DOT TRANSDERMAL PATCH TWICE WEEKLY 0.0375 MG/24HR

Minivelle B QL (8 EA per 28 days)

vyfemla oral tablet 0.4-35 mg-mcg Balziva G

vylibra oral tablet 0.25-35 mg-mcg Estarylla G

wera oral tablet 0.5-35 mg-mcg G

wymzya fe oral tablet chewable 0.4-35 mg-mcg

Wymzya Fe G

xulane transdermal patch weekly 150-35 mcg/24hr


yuvafem vaginal tablet 10 mcg Vagifem G

zarah oral tablet 3-0.03 mg Ocella G

zenchent oral tablet 0.4-35 mg-mcg Balziva G

zovia 1/35e (28) oral tablet 1-35 mg-mcg Kelnor 1/35 G

zovia 1/50e (28) oral tablet 1-50 mg-mcg Kelnor 1/50 G

Hormonal Agents - Thyroid


131


levo-t 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

Levo-T G

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

Levo-T G

levothyroxine-liothyronine oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

Armour Thyroid G

levoxyl oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg

Levo-T G

liothyronine sodium intravenous solution 10 mcg/ml

Triostat G

liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg

Cytomel G

methimazole oral tablet 10 mg, 5 mg Tapazole G

nature-throid oral tablet 130 mg, 16.25 mg, 195 mg, 32.5 mg

G

nature-throid oral tablet 65 mg G

np thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

Armour Thyroid G

propylthiouracil oral tablet 50 mg G

SYNTHROID 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

Levo-T B

unithroid direct oral tablet 100 mcg, 112 mcg, 125 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

Levo-T G

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

Levo-T G

westhroid oral tablet 130 mg, 32.5 mg G

westhroid oral tablet 65 mg G

Immunological Agents - Drugs for Immune System Stimulation or Suppression

ACTIMMUNE SUBCUTANEOUS SOLUTION 2000000 UNIT/0.5ML

B PA; SP

ALFERON N INJECTION SOLUTION 5000000 UNIT/ML

B SP


132


ARCALYST SUBCUTANEOUS SOLUTION RECONSTITUTED 220 MG

B PA

azathioprine oral tablet 50 mg Imuran G

azathioprine sodium injection solution reconstituted 100 mg

G

BENLYSTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 200 MG/ML

B PA; SP

BENLYSTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/ML

B PA; SP

BIVIGAM INTRAVENOUS SOLUTION 10 GM/100ML, 5 GM/50ML

B PA; SP

carimune nf intravenous solution reconstituted 12 gm, 6 gm

G PA; SP

CIMZIA PREFILLED KIT SUBCUTANEOUS KIT 2 X 200 MG/ML

B SP

CIMZIA STARTER KIT SUBCUTANEOUS KIT 6 X 200 MG/ML

B SP

CIMZIA VIAL KIT B SP

CINRYZE INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT

B PA; SP

CUVITRU SUBCUTANEOUS SOLUTION 1 GM/5ML, 2 GM/10ML, 4 GM/20ML, 8 GM/40ML

B PA; SP

cyclosporine intravenous solution 50 mg/ml

SandIMMUNE G

cyclosporine modified oral capsule 100 mg, 25 mg

Gengraf G

cyclosporine modified oral capsule 50 mg G

cyclosporine modified oral solution 100 mg/ml

Gengraf G

cyclosporine oral capsule 100 mg, 25 mg SandIMMUNE G

CYTOGAM INTRAVENOUS INJECTABLE 50 MG/ML

B PA; SP

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/0.5ML, 50 MG/ML

B PA; SP

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG

B PA; SP

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG/ML

B PA; SP


133


FLEBOGAMMA DIF INTRAVENOUS SOLUTION 0.5 GM/10ML, 10 GM/100ML, 10 GM/200ML, 2.5 GM/50ML, 20 GM/200ML, 20 GM/400ML, 5 GM/100ML, 5 GM/50ML

B PA; SP

GAMASTAN INTRAMUSCULAR INJECTABLE

B PA; SP

gamastan s/d injectable intramuscular G PA; SP

GAMASTAN S/D INJECTABLE INTRAMUSCULAR

B PA; SP

GAMMAGARD INJECTION SOLUTION 1 GM/10ML, 10 GM/100ML, 2.5 GM/25ML, 20 GM/200ML, 30 GM/300ML, 5 GM/50ML

B PA; SP

GAMMAGARD S/D LESS IGA INTRAVENOUS SOLUTION RECONSTITUTED 10 GM, 5 GM

B PA; SP

GAMMAKED INJECTION SOLUTION 1 GM/10ML, 10 GM/100ML, 2.5 GM/25ML, 20 GM/200ML, 5 GM/50ML

B PA; SP

GAMMAPLEX INTRAVENOUS SOLUTION 10 GM/100ML, 10 GM/200ML, 20 GM/200ML, 20 GM/400ML, 5 GM/100ML, 5 GM/50ML

B PA; SP

GAMUNEX-C INJECTION SOLUTION 1 GM/10ML, 10 GM/100ML, 2.5 GM/25ML, 20 GM/200ML, 40 GM/400ML, 5 GM/50ML

B PA; SP

gengraf oral capsule 100 mg, 25 mg Gengraf G

gengraf oral capsule 50 mg G

gengraf oral solution 100 mg/ml Gengraf G

HIZENTRA SUBCUTANEOUS SOLUTION 1 GM/5ML, 10 GM/50ML, 2 GM/10ML, 4 GM/20ML

B PA; SP

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML

B PA; SP

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML

B PA; SP

HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML

B PA; SP

HUMIRA PEN-PS/UV STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML

B PA; SP


134


HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.2ML, 20 MG/0.4ML, 40 MG/0.8ML

B PA; SP

HYPERHEP B S/D INTRAMUSCULAR SOLUTION

B PA

HYPERRHO S/D INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 1500 UNIT, 250 UNIT

B PA; SP

INFLECTRA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

B PA; SP

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/0.67ML

B PA; SP

leflunomide oral tablet 10 mg, 20 mg Arava G

methotrexate oral tablet 2.5 mg G

methotrexate sodium (pf) injection solution 1 gm/40ml, 200 mg/8ml, 250 mg/10ml, 50 mg/2ml

G

methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml

G

methotrexate sodium injection solution reconstituted 1 gm

G

methotrexate sodium oral tablet 2.5 mg G

MICRHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 250 UNIT

B PA; SP

mycophenolate mofetil hcl intravenous solution reconstituted 500 mg

CellCept Intravenous G

mycophenolate mofetil oral capsule 250 mg

CellCept G

mycophenolate mofetil oral suspension reconstituted 200 mg/ml

CellCept G

mycophenolate mofetil oral tablet 500 mg CellCept G

mycophenolate sodium oral tablet delayed release 180 mg, 360 mg

Myfortic G

nabi-hb intramuscular solution G PA

OCTAGAM INTRAVENOUS SOLUTION 1 GM/20ML, 10 GM/100ML, 10 GM/200ML, 2 GM/20ML, 2.5 GM/50ML, 20 GM/200ML, 25 GM/500ML, 5 GM/100ML, 5 GM/50ML

B PA; SP

OTEZLA ORAL TABLET 30 MG B ST; SP


135


OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.4ML, 12.5 MG/0.4ML, 15 MG/0.4ML, 17.5 MG/0.4ML, 20 MG/0.4ML, 22.5 MG/0.4ML, 25 MG/0.4ML, 7.5 MG/0.4ML

B PA

PRIVIGEN INTRAVENOUS SOLUTION 10 GM/100ML, 20 GM/200ML, 40 GM/400ML, 5 GM/50ML

B PA; SP

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.2ML, 12.5 MG/0.25ML, 15 MG/0.3ML, 17.5 MG/0.35ML, 20 MG/0.4ML, 22.5 MG/0.45ML, 25 MG/0.5ML, 27.5 MG/0.55ML, 30 MG/0.6ML, 7.5 MG/0.15ML

B PA

REMICADE INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

B PA; SP

RHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 1500 UNIT

B PA; SP

RHOPHYLAC INJECTION SOLUTION PREFILLED SYRINGE 1500 UNIT/2ML

B PA; SP

RIDAURA ORAL CAPSULE 3 MG B PA

SILIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 210 MG/1.5ML

B PA; SP

sirolimus oral tablet 0.5 mg, 1 mg, 2 mg Rapamune G

tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg

Prograf G

THYMOGLOBULIN INTRAVENOUS SOLUTION RECONSTITUTED 25 MG

B PA

TICE BCG INTRAVESICAL SUSPENSION RECONSTITUTED 50 MG

B PA; SP

TORISEL INTRAVENOUS SOLUTION 25 MG/ML

B SP

WINRHO SDF INJECTION SOLUTION 1500 UNIT/1.3ML, 15000 UNIT/13ML, 2500 UNIT/2.2ML, 5000 UNIT/4.4ML

B PA; SP

Immunological Agents - Drugs for Vaccination

ADACEL INTRAMUSCULAR SUSPENSION 5-2-15.5 LF-MCG/0.5

B PA

AFLURIA INTRAMUSCULAR SUSPENSION

B


136


AFLURIA PRESERVATIVE FREE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION

B

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

bcg vaccine injection injectable G

BOOSTRIX INTRAMUSCULAR SUSPENSION 5-2.5-18.5

B PA

DAPTACEL INTRAMUSCULAR SUSPENSION 15-23-5 LF-MCG/0.5

B PA

diphtheria-tetanus toxoids dt intramuscular suspension 25-5 lfu/0.5ml

G

ENGERIX-B INTRAMUSCULAR INJECTABLE 10 MCG/0.5ML, 20 MCG/ML

B PA

EZ FLU SHOT-FLUCELVAX INTRAMUSCULAR PREFILLED SYRINGE KIT 0.5 ML

B

EZ FLU SHOT-FLUVIRIN INTRAMUSCULAR PREFILLED SYRINGE KIT 0.5 ML

B

FLUAD INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

FLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

FLUBLOK INTRAMUSCULAR SOLUTION

B

FLUBLOK QUADRIVALENT INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 0.5 ML

B

FLUCELVAX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION

B

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION

B


137


FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

FLUVIRIN INTRAMUSCULAR SUSPENSION

B

FLUVIRIN INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

FLUZONE HIGH-DOSE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

B

FLUZONE QUADRIVALENT INTRADERMAL SUSPENSION PEN-INJECTOR 9 MCG/STRAIN

B

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION , 0.5 ML

B

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.25 ML, 0.5 ML

B

GARDASIL 9 INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

B PA

GARDASIL INTRAMUSCULAR SUSPENSION

B PA

HAVRIX INTRAMUSCULAR SUSPENSION 1440 EL U/ML, 720 EL U/0.5ML

B PA

INFANRIX INTRAMUSCULAR SUSPENSION 25-58-10

B PA

MEDICAL PROVIDER EZ AFLURIA PF INTRAMUSCULAR PREFILLED SYRINGE KIT 0.5 ML

B

MEDICAL PROVIDER EZ FLU PF INTRAMUSCULAR PREFILLED SYRINGE KIT 0.5 ML

B

MEDICAL PROVIDER EZ FLU SHOT INTRAMUSCULAR PREFILLED SYRINGE KIT 0.25 ML

B

MEDICAL PROVIDER EZ FLUVIRIN INTRAMUSCULAR PREFILLED SYRINGE KIT 0.5 ML

B

MENACTRA INTRAMUSCULAR INJECTABLE

B PA

MENOMUNE SUBCUTANEOUS INJECTABLE

B PA


138


MENVEO INTRAMUSCULAR SOLUTION RECONSTITUTED

B PA

pneumovax 23 injectable 25 mcg/0.5ml injection 25 mcg/0.5ml

G

PNEUMOVAX 23 INJECTABLE 25 MCG/0.5ML INJECTION 25 MCG/0.5ML

B

PREVNAR 13 INTRAMUSCULAR SUSPENSION

B PA

RABAVERT INTRAMUSCULAR SUSPENSION RECONSTITUTED

B PA

SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG

B QL (2 EA per 1 day)

TENIVAC INTRAMUSCULAR INJECTABLE 5-2 LFU

B

tetanus-diphtheria toxoids td intramuscular suspension 2-2 lf/0.5ml

G

TRUMENBA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

B PA

TWINRIX INTRAMUSCULAR SUSPENSION 720-20

B PA

VAQTA INTRAMUSCULAR SUSPENSION 25 UNIT/0.5ML, 50 UNIT/ML

B PA

VARIVAX SUBCUTANEOUS INJECTABLE 1350 PFU/0.5ML

B

yf-vax subcutaneous injectable G

ZOSTAVAX SUBCUTANEOUS SUSPENSION RECONSTITUTED 19400 UNT/0.65ML

B PA

Inflammatory Bowel Disease Agents

ana-lex rectal kit 2-2 % Ana-Lex G

anucort-hc rectal suppository 25 mg Anusol-HC G

anusol-hc rectal suppository 25 mg Anusol-HC G

ASACOL HD ORAL TABLET DELAYED RELEASE 800 MG

Asacol HD B PA

balsalazide disodium oral capsule 750 mg Colazal G

budesonide er oral tablet extended release 24 hour 9 mg

Uceris G

budesonide oral capsule delayed release particles 3 mg

Entocort EC G

CANASA RECTAL SUPPOSITORY 1000 MG

B PA


139


colocort rectal enema 100 mg/60ml Colocort G

DELZICOL ORAL CAPSULE DELAYED RELEASE 400 MG

B PA

DIPENTUM ORAL CAPSULE 250 MG B PA

hemmorex-hc rectal suppository 25 mg Anusol-HC G

hemmorex-hc rectal suppository 30 mg Proctocort G

hydrocortisone ace-pramoxine rectal cream 1-1 %

Analpram-HC G

hydrocortisone ace-pramoxine rectal cream 2.5-1 %

Analpram HC G

hydrocortisone acetate rectal suppository 25 mg

Anusol-HC G

hydrocortisone acetate rectal suppository 30 mg

Proctocort G

hydrocortisone rectal cream 1 % Procto-Pak G

hydrocortisone rectal cream 2.5 % Anusol-HC G

hydrocortisone rectal enema 100 mg/60ml Colocort G

lidocaine-hydrocortisone ace rectal cream 3-0.5 %

G

lidocaine-hydrocortisone ace rectal gel 2.8-0.55 %

G

lidocaine-hydrocortisone ace rectal kit 2-2 %

Ana-Lex G

lidocaine-hydrocortisone ace rectal kit 3-0.5 %, 3-1 %, 3-2.5 %

G

mesalamine oral tablet delayed release 1.2 gm

Lialda G PA

mesalamine oral tablet delayed release 800 mg

Asacol HD G PA

mesalamine rectal enema 4 gm G

mesalamine-cleanser rectal kit 4 gm Rowasa G

PENTASA ORAL CAPSULE EXTENDED RELEASE 250 MG, 500 MG

B PA

pramcort rectal cream 1-1 % Analpram-HC G

procto-med hc rectal cream 2.5 % Anusol-HC G

procto-pak rectal cream 1 % Procto-Pak G

proctosol hc rectal cream 2.5 % Anusol-HC G

proctozone-hc rectal cream 2.5 % Anusol-HC G

sulfasalazine oral tablet 500 mg Azulfidine G

sulfasalazine oral tablet delayed release 500 mg

Azulfidine EN-tabs G


140


UCERIS RECTAL FOAM 2 MG/ACT B ST

Metabolic Bone Disease Agents - Drugs for Osteoporosis

ACTONEL ORAL TABLET 150 MG, 30 MG, 35 MG, 5 MG

Actonel B

alendronate sodium oral solution 70 mg/75ml

G

alendronate sodium oral tablet 10 mg, 40 mg, 5 mg

G

alendronate sodium oral tablet 35 mg G QL (4 EA per 28 days)

alendronate sodium oral tablet 70 mg Fosamax G QL (4 EA per 28 days)

BONIVA ORAL TABLET 150 MG Boniva B

calcitonin (salmon) nasal solution 200 unit/act

Miacalcin G PA

calcitriol intravenous solution 1 mcg/ml G

calcitriol oral capsule 0.25 mcg, 0.5 mcg Rocaltrol G

calcitriol oral solution 1 mcg/ml Rocaltrol G

doxercalciferol intravenous solution 4 mcg/2ml

Hectorol G ST

doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg

G ST

etidronate disodium oral tablet 200 mg, 400 mg

G PA

FORTEO SUBCUTANEOUS SOLUTION 600 MCG/2.4ML

B PA; SP

ibandronate sodium intravenous solution 3 mg/3ml

Boniva G PA

ibandronate sodium oral tablet 150 mg Boniva G

MIACALCIN INJECTION SOLUTION 200 UNIT/ML

B PA

NATPARA SUBCUTANEOUS CARTRIDGE 100 MCG, 25 MCG, 50 MCG, 75 MCG

B PA; SP

pamidronate disodium intravenous solution 30 mg/10ml, 6 mg/ml, 90 mg/10ml

G PA; SP

pamidronate disodium intravenous solution reconstituted 30 mg, 90 mg

G PA; SP

paricalcitol intravenous solution 2 mcg/ml, 5 mcg/ml

Zemplar G PA

paricalcitol oral capsule 1 mcg, 2 mcg Zemplar G PA

paricalcitol oral capsule 4 mcg G PA


141


PROLIA SUBCUTANEOUS SOLUTION 60 MG/ML

B PA; SP

risedronate sodium oral tablet 150 mg, 30 mg, 35 mg, 5 mg

Actonel G

risedronate sodium oral tablet delayed release 35 mg

Atelvia G

TYMLOS SUBCUTANEOUS SOLUTION PEN-INJECTOR 3120 MCG/1.56ML

B PA; SP

zoledronic acid intravenous concentrate 4 mg/5ml

Zometa G PA; SP

zoledronic acid intravenous solution 4 mg/100ml

Zometa G SP

zoledronic acid intravenous solution 5 mg/100ml

Reclast G PA; SP

zoledronic acid intravenous solution reconstituted 4 mg

G SP

Miscellaneous Therapeutic Agents

acetylcysteine intravenous solution 200 mg/ml

Acetadote G

ACTHREL INTRAVENOUS SOLUTION RECONSTITUTED 100 MCG

B PA; SP

adenosine (diagnostic) intravenous solution 3 mg/ml

Adenoscan G

adenosine intravenous solution 3 mg/ml Adenoscan G

albuked 25 intravenous solution 25 % Albuked 25 G

albuked 5 intravenous solution 5 % Albuked 5 G

albumin human intravenous solution 25 % Albuked 25 G

albumin human intravenous solution 5 % Albuked 5 G

albuminar-25 intravenous solution 25 % Albuked 25 G

albuminar-5 intravenous solution 5 % Albuked 5 G

albumin-zlb intravenous solution 25 % Albuked 25 G

albumin-zlb intravenous solution 5 % Albuked 5 G

alburx intravenous solution 5 % Albuked 5 G

albutein intravenous solution 25 % Albuked 25 G

albutein intravenous solution 5 % Albuked 5 G

anesthesia needle 23gx1-3/8" BD Filter Needle/5 Micron G

antivenin latrodectus mactans injection kit G

antivenin micrurus fulvius intravenous solution reconstituted

G

arnica flower tincture G

asilnasal rms oral capsule G


142


av-vite fb forte oral tablet 2.5-25-2 mg Folbic G

boric acid external granules G

BOTOX INJECTION SOLUTION RECONSTITUTED 100 UNIT, 200 UNIT

B PA; SP

BREATHERITE B QL (1 EA per 365 days)

buminate intravenous solution 25 % Albuked 25 G

buminate intravenous solution 5 % Albuked 5 G

calcium disodium versenate injection solution 1 gm/5ml

G

chlorhexidine gluconate solution 20 % G

condoms LifeStyles Assorted Colors


cosyntropin injection solution reconstituted 0.25 mg

Cortrosyn G

deferoxamine mesylate injection solution reconstituted 2 gm

G

deferoxamine mesylate injection solution reconstituted 500 mg

Desferal G

dexmedetomidine hcl intravenous solution 1000 mcg/10ml, 400 mcg/4ml

G

dexmedetomidine hcl intravenous solution 200 mcg/2ml

Precedex G

dipyridamole intravenous solution 5 mg/ml G

dover vinyl urethral cath 16fr Active Cath Male External

G

DUREX EXTRA SENSITIVE DEVICE Durex Extra Sensitive B QL (14 EA per 30 days)

DUREX REALFEEL DEVICE B QL (14 EA per 30 days)

EASIVENT B QL (1 EA per 365 days)

ergoloid mesylates oral tablet 1 mg G

etomidate intravenous solution 2 mg/ml Amidate G

face mask resp n-100 part CPR Microshield G

face mask respirator r-95 part CPR Microshield G

flexbumin intravenous solution 25 % Albuked 25 G

flexbumin intravenous solution 5 % Albuked 5 G

flumazenil intravenous solution 0.5 mg/5ml, 1 mg/10ml

G

folbic oral tablet 2.5-25-2 mg Folbic G


143


foley catheter 2-way Active Cath Male External

G

fomepizole intravenous solution 1 gm/ml, 1.5 gm/1.5ml

Antizol G

formadon external solution 10 % Formadon G

formaldehyde external solution 10 % Formadon G

formaldehyde external solution 37 % G

forma-ray external solution 20 % G

fresenius propoven intravenous emulsion 1000 mg/100ml, 200 mg/20ml, 500 mg/50ml

Diprivan G

glucagon hcl (diagnostic) injection solution reconstituted 1 mg

G PA; QL (1 EA per 365 days)

glutaraldehyde external solution 25 % G

heparin lock flush intravenous solution 1 unit/ml, 10 unit/ml, 100 unit/ml

G

heparin sodium flush intravenous kit 10-0.9 unit/ml-%, 100-0.9 unit/ml-%

G

heparin sodium lock flush intravenous solution 100 unit/ml

G

human albumin grifols intravenous solution 25 %

Albuked 25 G

indigo carmine injection solution 8 mg/ml G

indocyanine green intravenous solution reconstituted 25 mg

IC Green G

infed injection solution 50 mg/ml G

infusion needle 15gx2" BD Filter Needle/5 Micron G

insulin pump ir2020 kit Accu-Chek Combo G

inulin intravenous solution 100-0.9 mg/ml-%

G

isoflurane inhalation solution Forane G

isosulfan blue subcutaneous solution 1 % G

karaya gum powder G

kedbumin intravenous solution 25 % Albuked 25 G

ketamine hcl injection solution 10 mg/ml, 100 mg/ml, 50 mg/ml

Ketalar G

ketamine hcl intravenous solution prefilled syringe 100 mg/2ml

G

ketamine hcl-sodium chloride intravenous solution prefilled syringe 100-0.9 mg/10ml-%, 20-0.9 mg/2ml-%

G


144


KIMONO MICRO THIN Trustex Non-Lubricated B QL (14 EA per 30 days)

l-cysteine hcl intravenous solution 50 mg/ml

G

l-methylfolate calcium oral tablet 15 mg, 7.5 mg

Elfolate G

l-methylfolate oral tablet 15 mg, 7.5 mg Elfolate G

methergine oral tablet 0.2 mg G

methohexital sodium intravenous solution prefilled syringe 50 mg/5ml

G

methylene blue injection solution 1 % G

methylergonovine maleate injection solution 0.2 mg/ml

G

monoject flush syr/hep lock intravenous solution 10 unit/ml, 100 unit/ml

G

monoject prefill adv heparin intravenous solution 10 unit/ml

G

MYALEPT SUBCUTANEOUS SOLUTION RECONSTITUTED 11.3 MG

B PA; SP

niva-fol oral tablet 2.5-25-2 mg Folbic G

piston irrigation syringe Bard Irrigation Syringe/Bulb

G

plasbumin-25 intravenous solution 25 % Albuked 25 G

plasbumin-5 intravenous solution 5 % Albuked 5 G

pocket spacer device G QL (1 EA per 365 days)

pralidoxime chloride intramuscular solution auto-injector 600 mg/2ml

G

premium condoms lubricated Durex Extra Sensitive G QL (14 EA per 30 days)

propofol intravenous emulsion 1000 mg/100ml, 200 mg/20ml, 500 mg/50ml

Diprivan G

reusable syringe barrel 1.5oz BD Filter Needle/5 Micron G

reusable syringe barrel 1oz BD Filter Needle/5 Micron G




robb-type angio syringe 80cc BD Filter Needle/5 Micron G

sash kit intravenous kit 10-0.9 unit/ml-%, 100-0.9 unit/ml-%

G

sevoflurane inhalation solution Ultane G


145


sharps container BD Nestable Sharps Collector

G

sodium nitrite intravenous solution 30 mg/ml

G

sodium saccharin dihydrate powder G

sodium saccharin powder G

sodium thiosulfate intravenous solution 25 %

G

sorbitol irrigation solution 3.3 % G

sorbitol-mannitol irrigation solution 2.7-0.54 gm/100ml

G

tb syringe 1 ml BD Filter Needle/5 Micron G

terrell inhalation solution Forane G

THYROGEN INTRAMUSCULAR SOLUTION RECONSTITUTED 1.1 MG

B PA; SP

titus needle 18gx1-1/4" BD Filter Needle/5 Micron G

TODAY SPONGE VAGINAL 1000 MG B

tonsil ndl curved 23gx1/2" BD Filter Needle/5 Micron G

tonsil ndl straight 23gx3/4 BD Filter Needle/5 Micron G

TRUSTEX NON-LUBRICATED Trustex Non-Lubricated B QL (14 EA per 30 days)

TRUSTEX RIA NON-LUBRICATED Trustex Non-Lubricated B QL (14 EA per 30 days)

vcf vaginal contraceptive vaginal foam 12.5 %

G

virt-vite forte oral tablet 2.5-25-2 mg Folbic G

VISTOGARD ORAL PACKET 10 GM B PA

vp-precip oral capsule 1000-500-40 mg, 250-125-10 mg

G

XURIDEN ORAL PACKET 2 GM B PA; SP

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation

ALREX OPHTHALMIC SUSPENSION 0.2 %

B

AZASITE OPHTHALMIC SOLUTION 1 % B

azelastine hcl ophthalmic solution 0.05 % G

bacitracin ophthalmic ointment 500 unit/gm

G

bromfenac sodium (once-daily) ophthalmic solution 0.09 %

G


146


ciprofloxacin hcl ophthalmic solution 0.3 %

Ciloxan G

cromolyn sodium ophthalmic solution 4 % G

dexamethasone sodium phosphate ophthalmic solution 0.1 %

G

diclofenac sodium ophthalmic solution 0.1 %

G

epinastine hcl ophthalmic solution 0.05 % Elestat G

erythromycin ophthalmic ointment 5 mg/gm

G

fluorometholone ophthalmic suspension 0.1 %

FML Liquifilm G

flurbiprofen sodium ophthalmic solution 0.03 %

G

FML FORTE OPHTHALMIC SUSPENSION 0.25 %

B

gatifloxacin ophthalmic solution 0.5 % Zymaxid G

gentak ophthalmic ointment 0.3 % G

gentamicin sulfate ophthalmic solution 0.3 %

G

ketorolac tromethamine ophthalmic solution 0.4 %

Acular LS G

ketorolac tromethamine ophthalmic solution 0.5 %

Acular G

levofloxacin ophthalmic solution 0.5 % G

LOTEMAX OPHTHALMIC GEL 0.5 % B

LOTEMAX OPHTHALMIC SUSPENSION 0.5 %

B

moxifloxacin hcl ophthalmic solution 0.5 %

Vigamox G

ofloxacin ophthalmic solution 0.3 % Ocuflox G

olopatadine hcl ophthalmic solution 0.1 % Patanol G

olopatadine hcl ophthalmic solution 0.2 % Pataday G

prednisolone acetate ophthalmic suspension 1 %

Omnipred G

prednisolone acetate p-f ophthalmic suspension 1 %

Omnipred G

prednisolone sodium phosphate ophthalmic solution 1 %

G

prednisolon-moxiflox-bromfenac ophthalmic solution 1-0.5-0.09 %

G


147


sulfacetamide sodium ophthalmic ointment 10 %

G

sulfacetamide sodium ophthalmic solution 10 %

Bleph-10 G

tobramycin ophthalmic solution 0.3 % Tobrex G

trifluridine ophthalmic solution 1 % Viroptic G

VIGAMOX OPHTHALMIC SOLUTION 0.5 %

Vigamox B

VIROPTIC OPHTHALMIC SOLUTION 1 %

Viroptic B

ZIRGAN OPHTHALMIC GEL 0.15 % B ST

Ophthalmic Agents - Drugs for Glaucoma

apraclonidine hcl ophthalmic solution 0.5 %

Iopidine G

betaxolol hcl ophthalmic solution 0.5 % G

bimatoprost ophthalmic solution 0.03 % G

brimonidine tartrate ophthalmic solution 0.15 %

Alphagan P G

brimonidine tartrate ophthalmic solution 0.2 %

G

carteolol hcl ophthalmic solution 1 % G

dorzolamide hcl ophthalmic solution 2 % Trusopt G

dorzolamide hcl-timolol mal ophthalmic solution 22.3-6.8 mg/ml

Cosopt G

dorzolamide hcl-timolol mal pf ophthalmic solution 22.3-6.8 mg/ml

Cosopt PF G

latanoprost ophthalmic solution 0.005 % Xalatan G

levobunolol hcl ophthalmic solution 0.5 % Betagan G

LUMIGAN OPHTHALMIC SOLUTION 0.01 %

B

methazolamide oral tablet 25 mg, 50 mg G

metipranolol ophthalmic solution 0.3 % G

pilocarpine hcl ophthalmic solution 1 %, 2 %, 4 %

Isopto Carpine G

timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 %

Timoptic-XE G

timolol maleate ophthalmic solution 0.25 %, 0.5 %

Timoptic G

timolol maleate ophthalmic solution 0.5 % (daily)

Istalol G


148


Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions

ak-fluor intravenous solution 10 % Fluorescite G

ak-fluor intravenous solution 25 % G

altacaine ophthalmic solution 0.5 % Altacaine G

altafluor benox ophthalmic solution 0.25-0.4 %

Altafluor G

altafluor ophthalmic solution 0.25-0.4 % Altafluor G

altafrin ophthalmic solution 10 %, 2.5 % Altafrin G

atropine sulfate ophthalmic ointment 1 % G

atropine sulfate ophthalmic solution 1 % Isopto Atropine G

bacitracin-polymyxin b ophthalmic ointment 500-10000 unit/gm

Polycin G

bacitra-neomycin-polymyxin-hc ophthalmic ointment 1 %

Neo-Polycin HC G

balanced salt intraocular solution BSS G

bio glo ophthalmic strip 1 mg G

bss intraocular solution BSS G

bss plus intraocular solution BSS G

cyclopentolate hcl ophthalmic solution 0.5 %, 1 %, 2 %

Cyclogyl G

flucaine ophthalmic solution 0.25-0.5 % Flucaine G

fluorescein-benoxinate ophthalmic solution 0.25-0.4 %

Altafluor G

fluor-i-strips a.t. ophthalmic strip 1 mg G

flurox ophthalmic solution 0.25-0.4 % Altafluor G

ful-glo ophthalmic strip 1 mg G

green glo lissamine green ophthalmic strip 1.5 mg

Green Glo Lissamine Green

G

homatropaire ophthalmic solution 5 % Homatropaire G

homatropine hbr ophthalmic solution 5 % Homatropaire G

LASTACAFT OPHTHALMIC SOLUTION 0.25 %

B

lissamine green ophthalmic strip 1.5 mg Green Glo Lissamine Green

G

LUCENTIS INTRAVITREAL SOLUTION 0.3 MG/0.05ML, 0.5 MG/0.05ML

B PA; SP

LUCENTIS INTRAVITREAL SOLUTION PREFILLED SYRINGE 0.5 MG/0.05ML

B SP

MACUGEN INTRAOCULAR SOLUTION 0.3 MG

B PA; SP


149


neomycin-bacitracin zn-polymyx ophthalmic ointment 3.5-400-10000 , 5-400-10000

Neo-Polycin G

neomycin-polymyxin-dexameth ophthalmic ointment 3.5-10000-0.1

Maxitrol G

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

Maxitrol G

neomycin-polymyxin-gramicidin ophthalmic solution 1.75-10000-.025

Neosporin G

neomycin-polymyxin-hc ophthalmic suspension 3.5-10000-1

G

neo-polycin hc ophthalmic ointment 1 % Neo-Polycin HC G

neo-polycin ophthalmic ointment 3.5-400-10000

Neo-Polycin G

ocucoat viscoadherent intraocular solution 2 %

G

phenylephrine hcl ophthalmic solution 10 %, 2.5 %

Altafrin G

polycin ophthalmic ointment 500-10000 unit/gm

Polycin G

polymyxin b-trimethoprim ophthalmic solution 10000-0.1 unit/ml-%

Polytrim G

prednisolone-moxifloxacin ophthalmic solution 1-0.5 %

G

proparacaine hcl ophthalmic solution 0.5 %

Alcaine G

proparacaine-fluorescein ophthalmic solution 0.5-0.25 %

Flucaine G

RESTASIS MULTIDOSE OPHTHALMIC EMULSION 0.05 %


RESTASIS OPHTHALMIC EMULSION 0.05 %


sulfacetamide-prednisolone ophthalmic solution 10-0.23 %

G

tetcaine ophthalmic solution 0.5 % Altacaine G

tetracaine hcl ophthalmic solution 0.5 % Altacaine G

tetravisc forte ophthalmic solution 0.5 % Altacaine G

tetravisc ophthalmic solution 0.5 % Altacaine G

tobramycin-dexamethasone ophthalmic suspension 0.3-0.1 %

TobraDex G

tropicamide ophthalmic solution 0.5 % G

tropicamide ophthalmic solution 1 % Mydriacyl G


150


tropicamide-cyclopentolate-pe ophthalmic solution 1-1-2.5 %

G

VISUDYNE INTRAVENOUS SOLUTION RECONSTITUTED 15 MG

B PA; SP

Otic Agents - Drugs for Ear Conditions

acetasol hc otic solution 2-1 % Acetasol HC G

acetic acid otic solution 2 % G

CIPRODEX OTIC SUSPENSION 0.3-0.1 %

B

ciprofloxacin hcl otic solution 0.2 % Cetraxal G

COLY-MYCIN S OTIC SUSPENSION 3.3-3-10-0.5 MG/ML

B PA

cortic-nd otic solution 10-10-1 mg/ml Cortane-B G

cyotic otic solution 10-10-1 mg/ml Cortane-B G

exotic-hc otic solution 10-10-1 mg/ml Cortane-B G

fluocinolone acetonide otic oil 0.01 % DermOtic G

hydrocortisone-acetic acid otic solution 1-2 %

Acetasol HC G

neomycin-polymyxin-hc otic solution 1 %, 3.5-10000-1

G

neomycin-polymyxin-hc otic suspension 3.5-10000-1

G

ofloxacin otic solution 0.3 % Floxin Otic G

otomax-hc otic solution 10-10-1 mg/ml Cortane-B G

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

12 hour allergy-d oral tablet extended release 12 hour 5-120 mg

KLS Aller-Tec D G ST; QL (31 EA per 31 days)

all day allergy d-12 oral tablet extended release 12 hour 5-120 mg

KLS Aller-Tec D G ST; QL (31 EA per 31 days)

all day allergy oral capsule 10 mg Wal-Zyr G

allergy 24hour indoor/outdoor oral tablet 10 mg

KLS Aller-Tec G QL (1 EA per 1 day)

allergy 24-hr oral tablet 180 mg Allegra Allergy G QL (1 EA per 1 day)

allergy childrens oral syrup 5 mg/5ml Claritin G QL (10 ML per 1 day)

allergy relief childrens oral tablet chewable 10 mg

Wal-Zyr Childrens G

allergy relief oral capsule 25 mg Banophen G QL (4 EA per 1 day)

allergy relief oral tablet dispersible 10 mg Alavert G QL (1 EA per 1 day)

ASTEPRO NASAL SOLUTION 0.15 % Astepro B QL (2 ML per 31 days)


151


azelastine hcl nasal solution 0.1 %, 137 mcg/spray


azelastine hcl nasal solution 0.15 % Astepro G QL (2 ML per 31 days)

banophen oral capsule 25 mg Banophen G QL (4 EA per 1 day)

banophen oral liquid 12.5 mg/5ml Banophen G QL (240 ML per 31 days); AL (Max 12 Years)

BECONASE AQ NASAL SUSPENSION 42 MCG/SPRAY

B ST

benadryl-d allergy/sinus child oral solution 12.5-5 mg/5ml

G QL (248 ML per 31 days); AL (Max 12 Years)

benzonatate oral capsule 100 mg Tessalon Perles G

benzonatate oral capsule 150 mg, 200 mg G

biotuss oral liquid 10-15-300 mg/5ml Giltuss Cough & Cold G

biotuss pediatric oral liquid 2.5-5-50 mg/ml

G

bromfed dm oral syrup 30-2-10 mg/5ml Bromfed DM G

brompheniramine maleate intramuscular solution 10 mg/ml

G

brompheniramine tannate oral tablet chewable 12 mg

G

budesonide nasal suspension 32 mcg/act Rhinocort Allergy G

carbinoxamine maleate oral solution 4 mg/5ml

G

carbinoxamine maleate oral tablet 4 mg G

carbinoxamine maleate oral tablet 6 mg RyVent G

cetirizine hcl childrens alrgy oral syrup 1 mg/ml

KLS Aller-Tec Childrens G QL (10 ML per 1 day)

cetirizine hcl childrens oral tablet chewable 5 mg

Wal-Zyr Childrens G

cetirizine hcl oral solution 1 mg/ml, 5 mg/5ml

KLS Aller-Tec Childrens G QL (10 ML per 1 day)

cetirizine hcl oral tablet 10 mg KLS Aller-Tec G QL (1 EA per 1 day)

cetirizine hcl oral tablet 5 mg G

childrens allergy oral liquid 12.5 mg/5ml Banophen G QL (240 ML per 31 days); AL (Max 12 Years)

CLARITIN REDITABS ORAL TABLET DISPERSIBLE 5 MG

B QL (1 EA per 1 day)

clemastine fumarate oral tablet 2.68 mg G


152


cough dm oral suspension extended release 30 mg/5ml

Delsym G QL (148 ML per 31 days)

cyproheptadine hcl oral syrup 2 mg/5ml G

cyproheptadine hcl oral tablet 4 mg G

desloratadine oral tablet 5 mg Clarinex G

desloratadine oral tablet dispersible 2.5 mg, 5 mg

G

diphenhydramine hcl injection solution 50 mg/ml

G

diphenhydramine hcl oral capsule 25 mg Banophen G QL (4 EA per 1 day)

diphenhydramine hcl oral elixir 12.5 mg/5ml

G

fexofenadine hcl oral tablet 180 mg Allegra Allergy G QL (1 EA per 1 day)

fexofenadine hcl oral tablet 60 mg Allegra Allergy G QL (2 EA per 1 day)

fexofenadine-pseudoephed er oral tablet extended release 12 hour 60-120 mg

Allegra-D Allergy & Congestion


fexofenadine-pseudoephed er oral tablet extended release 24 hour 180-240 mg



flunisolide nasal solution 25 mcg/act (0.025%)


fluticasone propionate nasal suspension 50 mcg/act

ClariSpray G QL (1 GM per 31 days)

giltuss pediatric oral liquid 2.5-7.5-88 mg/ml

G

hydrocodone polst-cpm polst er oral suspension extended release 10-8 mg/5ml

Tussionex Pennkinetic ER

G

hydrocodone-homatropine oral syrup 5-1.5 mg/5ml

G

hydrocodone-homatropine oral tablet 5-1.5 mg

G

hydromet oral syrup 5-1.5 mg/5ml G

ipratropium bromide nasal solution 0.03 %, 0.06 %

G

levocetirizine dihydrochloride oral solution 2.5 mg/5ml

Xyzal Allergy 24HR Childrens

G

levocetirizine dihydrochloride oral tablet 5 mg

Xyzal Allergy 24HR G

loratadine oral tablet 10 mg Claritin G QL (1 EA per 1 day)

mometasone furoate nasal suspension 50 mcg/act

Nasonex G PA

NASONEX NASAL SUSPENSION 50 MCG/ACT

Nasonex B PA


153


nebusal inhalation nebulization solution 3 %

Nebusal G

nortuss-ex oral liquid 20-200 mg/5ml G

olopatadine hcl nasal solution 0.6 % Patanase G ST

OMNARIS NASAL SUSPENSION 50 MCG/ACT

B ST

phenadoz rectal suppository 12.5 mg, 25 mg

Phenadoz G

phenergan rectal suppository 12.5 mg, 25 mg

Phenadoz G

phenergan rectal suppository 50 mg Promethegan G

phenylephrine-guaifenesin oral liquid 1.5-20 mg/ml

G

promethazine hcl injection solution 25 mg/ml, 50 mg/ml

Phenergan G

promethazine hcl oral solution 6.25 mg/5ml

G

promethazine hcl oral syrup 6.25 mg/5ml G

promethazine hcl oral tablet 12.5 mg, 25 mg, 50 mg

G

promethazine hcl rectal suppository 12.5 mg, 25 mg

Phenadoz G

promethazine hcl rectal suppository 50 mg

Promethegan G

promethazine vc plain oral solution 6.25-5 mg/5ml

G

promethazine vc/codeine oral syrup 6.25-5-10 mg/5ml

G

promethazine-codeine oral syrup 6.25-10 mg/5ml

G

promethazine-dm oral syrup 6.25-15 mg/5ml

G

promethazine-phenyleph-codeine oral syrup 6.25-5-10 mg/5ml

G

promethazine-phenylephrine oral syrup 6.25-5 mg/5ml

G

promethegan rectal suppository 12.5 mg, 25 mg

Phenadoz G

promethegan rectal suppository 50 mg Promethegan G

pseudoeph-chlorphen-hydrocod oral solution 60-4-5 mg/5ml

G

pseudoephedrine-bromphen-dm oral syrup 30-2-10 mg/5ml

Bromfed DM G


154


pulmosal inhalation nebulization solution 7 %

HyperSal G

robitussin 12 hour cough child oral suspension extended release 30 mg/5ml

Delsym G QL (148 ML per 31 days)

ryvent oral tablet 6 mg RyVent G

sodium chloride inhalation nebulization solution 0.9 %, 10 %

G

sodium chloride inhalation nebulization solution 3 %

Nebusal G

sodium chloride inhalation nebulization solution 7 %

HyperSal G

triamcinolone acetonide nasal aerosol 55 mcg/act

Nasacort Allergy 24HR G

tussigon oral tablet 5-1.5 mg G

wal-dryl allergy oral capsule 25 mg Banophen G QL (4 EA per 1 day)

wal-dryl allergy oral liquid 12.5 mg/5ml Banophen G QL (240 ML per 31 days); AL (Max 12 Years)

wal-fex d allergy & congestion oral tablet extended release 24 hour 180-240 mg



wal-zyr oral capsule 10 mg Wal-Zyr G

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED 150 MG

B PA; SP

ZYRTEC ALLERGY CHILDRENS ORAL TABLET DISPERSIBLE 10 MG

B

ZYRTEC ALLERGY ORAL TABLET DISPERSIBLE 10 MG

B

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

acetylcysteine inhalation solution 10 %, 20 %

G

ADRENACLICK INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.15ML

Auvi-Q B QL (4 EA per 31 days)

ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100-50 MCG/DOSE, 250-50 MCG/DOSE, 500-50 MCG/DOSE


ADVAIR HFA INHALATION AEROSOL 115-21 MCG/ACT, 230-21 MCG/ACT, 45-21 MCG/ACT


AEROSPAN INHALATION AEROSOL SOLUTION 80 MCG/ACT

B


155


albuterol sulfate er oral tablet extended release 12 hour 4 mg, 8 mg

G

albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%, 0.63 mg/3ml, 1.25 mg/3ml

G

albuterol sulfate oral syrup 2 mg/5ml G

albuterol sulfate oral tablet 2 mg, 4 mg G

aminophylline intravenous solution 25 mg/ml

G

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5-25 MCG/INH

B PA

ARALAST NP INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG, 500 MG

B PA; SP

ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/ACT, 200 MCG/ACT, 50 MCG/ACT

B

ASMANEX 120 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCG/INH

B ST


B ST

ASMANEX 30 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED 110 MCG/INH, 220 MCG/INH

B ST


B ST


B ST

ATROVENT HFA INHALATION AEROSOL SOLUTION 17 MCG/ACT


AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.15ML, 0.3 MG/0.3ML


BEVESPI AEROSPHERE INHALATION AEROSOL 9-4.8 MCG/ACT

B

BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-25 MCG/INH, 200-25 MCG/INH

B


156


BROVANA INHALATION NEBULIZATION SOLUTION 15 MCG/2ML

B ST

budesonide inhalation suspension 0.25 mg/2ml, 0.5 mg/2ml, 1 mg/2ml

Pulmicort G PA

cromolyn sodium inhalation nebulization solution 20 mg/2ml

G

DALIRESP ORAL TABLET 250 MCG, 500 MCG

B ST

difil-g forte oral liquid 100-100 mg/5ml G

EPINEPHRINE INJECTION SOLUTION 0.3 MG/0.3ML


EPINEPHRINE INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.15ML, 0.3 MG/0.3ML


EPINEPHRINE INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML

EpiPen Jr 2-Pak B QL (4 EA per 31 days)

EPIPEN 2-PAK INJECTION SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML


EPIPEN JR 2-PAK INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML

EpiPen Jr 2-Pak B QL (4 EA per 31 days)

ESBRIET ORAL CAPSULE 267 MG B PA; SP

ESBRIET ORAL TABLET 267 MG, 801 MG

B PA; SP

FLOVENT HFA INHALATION AEROSOL 110 MCG/ACT, 220 MCG/ACT, 44 MCG/ACT

B PA; QL (1 GM per 31 days)

FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT

AirDuo RespiClick 113/14 B





INCRUSE ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5 MCG/INH

B

ipratropium bromide inhalation solution 0.02 %

G

ipratropium-albuterol inhalation solution 0.5-2.5 (3) mg/3ml

G


157


levalbuterol hcl inhalation nebulization solution 0.31 mg/3ml, 0.63 mg/3ml, 1.25 mg/3ml

Xopenex G ST

levalbuterol hcl inhalation nebulization solution 1.25 mg/0.5ml

Xopenex Concentrate G ST

LEVALBUTEROL HFA INHALATION AEROSOL 45 MCG/ACT

Xopenex HFA B QL (30 GM per 30 days)

LONHALA MAGNAIR REFILL KIT INHALATION SOLUTION 25 MCG/ML

B PA

LONHALA MAGNAIR STARTER KIT INHALATION SOLUTION 25 MCG/ML

B PA

metaproterenol sulfate oral syrup 10 mg/5ml

G

metaproterenol sulfate oral tablet 10 mg, 20 mg

G

montelukast sodium oral packet 4 mg Singulair G

montelukast sodium oral tablet 10 mg Singulair G

montelukast sodium oral tablet chewable 4 mg, 5 mg

Singulair G

OFEV ORAL CAPSULE 100 MG, 150 MG B PA; SP

PERFOROMIST INHALATION NEBULIZATION SOLUTION 20 MCG/2ML


PROAIR HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT


PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG

B PA; SP

PROVENTIL HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT


PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 180 MCG/ACT, 90 MCG/ACT


PULMICORT SUSPENSION INHALATION SUSPENSION 0.25 MG/2ML, 0.5 MG/2ML, 1 MG/2ML

Pulmicort B PA

QVAR INHALATION AEROSOL SOLUTION 40 MCG/ACT, 80 MCG/ACT

B

QVAR REDIHALER INHALATION AEROSOL BREATH ACTIVATED 40 MCG/ACT, 80 MCG/ACT

B

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 50 MCG/DOSE

B ST


158


SPIRIVA HANDIHALER INHALATION CAPSULE 18 MCG


SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 1.25 MCG/ACT, 2.5 MCG/ACT

B

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 2.5-2.5 MCG/ACT

B PA

STRIVERDI RESPIMAT INHALATION AEROSOL SOLUTION 2.5 MCG/ACT

B

SYMBICORT INHALATION AEROSOL 160-4.5 MCG/ACT, 80-4.5 MCG/ACT


terbutaline sulfate injection solution 1 mg/ml

G

terbutaline sulfate oral tablet 2.5 mg, 5 mg G

theochron oral tablet extended release 12 hour 100 mg, 200 mg, 300 mg

Theochron G

theophylline er oral tablet extended release 12 hour 100 mg, 200 mg, 300 mg

Theochron G

theophylline er oral tablet extended release 12 hour 450 mg

G

theophylline er oral tablet extended release 24 hour 400 mg, 600 mg

G

theophylline in d5w intravenous solution 0.8-5 mg/ml-%

G

theophylline oral solution 80 mg/15ml G

TRELEGY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-62.5-25 MCG/INH

B ST

TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED 400 MCG/ACT


VENTOLIN HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT


XOPENEX HFA INHALATION AEROSOL 45 MCG/ACT

Xopenex HFA B QL (30 GM per 30 days)

zafirlukast oral tablet 10 mg, 20 mg Accolate G PA

ZEMAIRA INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG

B PA; SP

zileuton er oral tablet extended release 12 hour 600 mg

Zyflo CR G

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis

KITABIS PAK INHALATION NEBULIZATION SOLUTION 300 MG/5ML

Kitabis Pak B


159


ORKAMBI ORAL TABLET 100-125 MG, 200-125 MG

B PA; SP

PULMOZYME INHALATION SOLUTION 1 MG/ML

B PA; SP

TOBI NEBULIZER INHALATION NEBULIZATION SOLUTION 300 MG/5ML

Kitabis Pak B ST

TOBI PODHALER INHALATION CAPSULE 28 MG

B PA

tobramycin nebulization solution 300 mg/5ml inhalation 300 mg/5ml

Kitabis Pak G

TOBRAMYCIN NEBULIZATION SOLUTION 300 MG/5ML INHALATION 300 MG/5ML

Kitabis Pak B

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension

ADCIRCA ORAL TABLET 20 MG B SP

ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG

B PA; SP

epoprostenol sodium intravenous solution reconstituted 0.5 mg, 1.5 mg

Flolan G PA; SP

LETAIRIS ORAL TABLET 10 MG, 5 MG B PA; SP

OPSUMIT ORAL TABLET 10 MG B PA; SP

ORENITRAM ORAL TABLET EXTENDED RELEASE 0.125 MG, 0.25 MG, 1 MG, 2.5 MG, 5 MG

B PA; SP

REMODULIN INJECTION SOLUTION 1 MG/ML, 10 MG/ML, 2.5 MG/ML, 5 MG/ML

B PA; SP

REVATIO ORAL SUSPENSION RECONSTITUTED 10 MG/ML

B SP

sildenafil citrate intravenous solution 10 mg/12.5ml

Revatio G PA; SP

sildenafil citrate oral tablet 20 mg Revatio G PA; SP

TRACLEER ORAL TABLET 125 MG, 62.5 MG

B PA; SP

TRACLEER ORAL TABLET SOLUBLE 32 MG

B PA; SP

UPTRAVI ORAL TABLET 1000 MCG, 1200 MCG, 1400 MCG, 1600 MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG

B PA; SP

UPTRAVI ORAL TABLET THERAPY PACK 200 & 800 MCG

B PA; SP

VENTAVIS INHALATION SOLUTION 10 MCG/ML, 20 MCG/ML

B PA; SP


160


Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm

baclofen external cream 2 % G

baclofen oral tablet 10 mg, 20 mg, 5 mg G

carisoprodol oral tablet 250 mg Soma G ST

carisoprodol oral tablet 350 mg Soma G ST; QL (45 EA per 31 days)

carisoprodol-aspirin oral tablet 200-325 mg

G

chlorzoxazone oral tablet 500 mg G

cyclobenzaprine hcl oral tablet 10 mg, 5 mg


cyclobenzaprine hcl oral tablet 7.5 mg Fexmid G

dantrolene sodium oral capsule 100 mg G

dantrolene sodium oral capsule 25 mg, 50 mg

Dantrium G

enovarx-cyclobenzaprine hcl transdermal cream 20 mg/gm

G

metaxall oral tablet 800 mg Metaxall G

metaxalone oral tablet 400 mg G

metaxalone oral tablet 800 mg Metaxall G

methocarbamol injection solution 1000 mg/10ml

Robaxin G

methocarbamol oral tablet 500 mg Robaxin G

methocarbamol oral tablet 750 mg Robaxin-750 G

orphenadrine citrate er oral tablet extended release 12 hour 100 mg

G

orphenadrine citrate injection solution 30 mg/ml

G

revonto intravenous solution reconstituted 20 mg

G

tizanidine hcl oral capsule 2 mg, 4 mg Zanaflex G QL (63 EA per 31 days)

tizanidine hcl oral capsule 6 mg Zanaflex G

tizanidine hcl oral tablet 2 mg G

tizanidine hcl oral tablet 4 mg Zanaflex G

vecuronium bromide-nacl intravenous solution 100-0.9 mg/100ml-%

G

Sleep Disorder Agents

armodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mg

Nuvigil G PA


161


BELSOMRA ORAL TABLET 10 MG, 15 MG, 20 MG, 5 MG

B ST

eszopiclone oral tablet 1 mg, 2 mg, 3 mg Lunesta G

flurazepam hcl oral capsule 15 mg, 30 mg G

HETLIOZ ORAL CAPSULE 20 MG B PA; SP

modafinil oral tablet 100 mg, 200 mg Provigil G PA

NUVIGIL ORAL TABLET 150 MG, 200 MG, 250 MG, 50 MG

Nuvigil B PA

PROVIGIL ORAL TABLET 100 MG, 200 MG

Provigil B PA

RESTORIL ORAL CAPSULE 15 MG, 30 MG, 7.5 MG

Restoril B QL (1 EA per 1 day)

ROZEREM ORAL TABLET 8 MG B ST; QL (1 EA per 1 day)

temazepam oral capsule 15 mg, 30 mg, 7.5 mg

Restoril G QL (1 EA per 1 day)

temazepam oral capsule 22.5 mg Restoril G

zaleplon oral capsule 10 mg, 5 mg Sonata G

zolpidem tartrate er oral tablet extended release 12.5 mg, 6.25 mg

Ambien CR G QL (1 EA per 1 day)

zolpidem tartrate oral tablet 10 mg, 5 mg Ambien G QL (1 EA per 1 day)

zolpidem tartrate sublingual tablet sublingual 1.75 mg, 3.5 mg

Intermezzo G

162

1 12 hour allergy-d .................. 150 A ABELCET .............................. 36 acarbose ................................ 79 acd formula a ......................... 27 acd formula b ......................... 27 acd-a noclot-50 ...................... 27 acebutolol hcl ......................... 55 acetaminophen-codeine ...........4 acetaminophen-codeine #2 ......4 acetaminophen-codeine #3 ......4 acetaminophen-codeine #4 ......4 acetasol hc .......................... 150 acetazolamide........................ 55 acetazolamide er ................... 55 acetazolamide sodium ........... 55 acetic acid .................... 111, 150 acetylcysteine .............. 141, 154 acid reducer ......................... 105 acitretin .................................. 72 acne medication 5 .................. 72 ACTHREL ............................ 141 ACTIMMUNE ....................... 131 ACTIVE OB ........................... 86 ACTONEL ............................ 140 ACTOPLUS MET ................... 79 acyclovir................................. 50 acyclovir sodium .................... 50 ADACEL .............................. 135 adapalene .............................. 72 adapalene-benzoyl peroxide .. 72 ADCIRCA ............................ 159 adefovir dipivoxil .................... 50 ADEMPAS ........................... 159 adenosine ...................... 55, 141 adenosine (diagnostic) ......... 141 ADLYXIN ............................... 79 ADMELOG ............................. 82 ADMELOG SOLOSTAR ........ 82 ADRENACLICK ................... 154 adriamycin ............................. 41 adrucil .................................... 41 ADVAIR DISKUS ................. 154 ADVAIR HFA ....................... 154 AEROSPAN ......................... 154 afeditab cr .............................. 55 AFINITOR .............................. 41 AFINITOR DISPERZ.............. 41 AFLURIA ............................. 135

AFLURIA PRESERVATIVE FREE ............................... 136

AFLURIA QUADRIVALENT . 136 AFREZZA .............................. 82 agoneaze .............................. 14 airavite .................................. 86 ak-fluor ................................ 148 ala-cort ................................ 114 ALBENZA .............................. 47 albuked 25 ........................... 141 albuked 5 ............................. 141 albumin human .................... 141 albuminar-25 ....................... 141 albuminar-5 ......................... 141 albumin-zlb .......................... 141 alburx .................................. 141 albutein................................ 141 albuterol sulfate ................... 155 albuterol sulfate er ............... 155 alclometasone dipropionate . 114 alcohol ................................... 86 ALDURAZYME .................... 110 ALECENSA ........................... 41 alendronate sodium ............. 140 alevicyn dermal spray ............ 72 alfentanil hcl ............................ 4 ALFERON N ........................ 131 alfuzosin hcl er .................... 113 ALIMTA ................................. 41 ALINIA ................................... 47 all day allergy ...................... 150 all day allergy d-12 .............. 150 allergy 24hour indoor/outdoor

........................................ 150 allergy 24-hr ........................ 150 allergy childrens .................. 150 allergy relief ......................... 150 allergy relief childrens .......... 150 allopurinol .............................. 39 allopurinol sodium ................. 39 almotriptan malate ................. 39 alosetron hcl ........................ 107 ALOXI ................................... 35 alprazolam ............................. 52 alprazolam er......................... 52 alprazolam xr ......................... 52 ALREX ................................ 145 altacaine .............................. 148 altafluor ............................... 148 altafluor benox ..................... 148 altafrin ................................. 148

altavera ............................... 122 ALUNBRIG ........................... 41 alyacen 1/35 ....................... 122 alyacen 7/7/7....................... 122 amabelz .............................. 122 AMBISOME .......................... 37 amcinonide ......................... 114 amethia ............................... 122 amethia lo ........................... 122 amifostine ............................. 41 amikacin sulfate .................... 17 amiloride hcl .......................... 55 amiloride-hydrochlorothiazide 55 aminoacetic acid ................. 111 aminoam rms ........................ 86 aminobenzoate potassium .... 86 aminocaproic acid ................. 54 aminophylline ...................... 155 aminorelief rms ..................... 86 AMINOSYN ........................... 86 AMINOSYN II ........................ 86 aminosyn ii/electrolytes ......... 86 aminosyn/electrolytes ............ 86 AMINOSYN-PF ..................... 86 amiodarone hcl ..................... 55 amiodarone hcl in dextrose ... 55 AMITIZA .............................. 107 amitriptyline hcl ..................... 33 amlodipine besylate .............. 55 amlodipine besylate-benazepril

hcl ............................... 55, 56 amlodipine besylate-valsartan 56 amlodipine-atorvastatin ......... 56 amlodipine-olmesartan .......... 56 amlodipine-valsartan-hctz ..... 56 ammonium lactate ................. 72 amnesteem ........................... 72 amoxapine ............................ 33 amoxicill-clarithro-lansopraz 107 amoxicillin ............................. 17 amoxicillin-potassium

clavulanate .................. 17, 18 amoxicillin-potassium

clavulanate er .................... 17 amphetamine-

dextroamphetamine .......... 67 amphetamine-

dextroamphetamine er ...... 67 amphotericin b ...................... 37 ampicillin ............................... 18 ampicillin sodium ................... 18

Index of Drugs

163

ampicillin-sulbactam sodium .. 18 AMPYRA ............................... 68 ANAFRANIL .......................... 33 anagrelide hcl ........................ 54 ana-lex ................................. 138 anastrozole ............................ 41 ANDRODERM ..................... 119 ANDROGEL ........................ 119 ANDROGEL PUMP ............. 119 anesthesia needle 23gx1-3/8

........................................ 141 ANGELIQ ............................. 122 anodyne lpt ............................ 14 ANORO ELLIPTA ................ 155 anticoagulant cit dext soln a ... 27 anticoagulant sodium citrate .. 27 anti-diarrheal ........................ 107 anti-nausea ............................ 35 anti-nausea/rekematol ........... 35 antivenin latrodectus mactans

........................................ 141 antivenin micrurus fulvius ..... 141 anucort-hc ............................ 138 anusol-hc ............................. 138 apap-caff-dihydrocodeine ........4 apexicon e ........................... 114 APIDRA SOLOSTAR ............. 82 APIDRA VIAL ........................ 82 APLENZIN ............................. 33 APOKYN ................................ 48 apraclonidine hcl .................. 147 aprepitant ............................... 35 apri ...................................... 122 ARALAST NP ...................... 155 aranelle ................................ 122 ARANESP (ALBUMIN FREE) 54 ARCALYST .......................... 132 argatroban ............................. 27 argatroban in sodium chloride 27 argyle sterile saline ................ 86 armodafinil ........................... 160 arnica flower ........................ 141 ARNUITY ELLIPTA .............. 155 arzol silver nit applicators ....... 72 ASACOL HD ........................ 138 ascomp-codeine ......................4 ascorbic acid .......................... 86 ashlyna ................................ 122 asilnasal rms ........................ 141 ASMANEX 120 METERED

DOSES ............................ 155 ASMANEX 14 METERED

DOSES ............................ 155 ASMANEX 30 METERED

DOSES ............................ 155

ASMANEX 60 METERED DOSES ............................ 155

ASMANEX 7 METERED DOSES ............................ 155

aspirin ................................... 11 aspirin ec ............................... 11 aspirin ec low dose ................ 11 aspirin low dose ..................... 11 aspirin-dipyridamole er .......... 49 ASSURE ID SAFETY PEN

NEEDLES .................... 82, 83 ASTEPRO ........................... 150 ATABEX EC .......................... 86 ATABEX OB .......................... 86 atenolol.................................. 56 atenolol-chlorthalidone .......... 56 atomoxetine hcl ..................... 67 atorvastatin calcium ............... 56 atovaquone ........................... 47 atovaquone-proguanil hcl ...... 47 atracurium besylate ............... 70 atropine sulfate .... 107, 108, 148 atropine sulfate (pf) ............. 107 ATROVENT HFA ................. 155 aubra ................................... 122 AUVI-Q ................................ 155 avar cleanser ......................... 72 avar-e emollient ..................... 72 avar-e green .......................... 72 AVASTIN ............................... 41 aviane ................................. 122 avidoxy .................................. 18 avita ...................................... 72 AVODART ........................... 113 AVONEX PEN ....................... 68 AVONEX PREFILLED ........... 69 AVONEX VIAL

INTRAMUSCULAR KIT .... 69 av-phos 250 neutral ............... 86 av-vite fb ................................ 86 av-vite fb forte...................... 142 AXERT .................................. 39 azacitidine ............................. 41 AZASITE ............................. 145 azathioprine ......................... 132 azathioprine sodium ............ 132 azelastine hcl............... 145, 151 AZILECT ............................... 48 azithromycin .......................... 18 aztreonam ............................. 18 azuphen mb ........................ 111 azurette ............................... 122 B b complex vitamins ................ 86 b-6 folic acid .......................... 86

baciim ................................... 18 bacitracin ...................... 18, 145 bacitracin-polymyxin b ......... 148 bacitra-neomycin-polymyxin-hc

........................................ 148 baclofen .............................. 160 BACTROBAN NASAL ........... 18 balanced salt ....................... 148 BAL-CARE DHA ................... 86 balsalazide disodium ........... 138 balziva................................. 122 banophen ............................ 151 BANZEL ................................ 29 BARACLUDE ........................ 50 BASAGLAR KWIKPEN ......... 83 bayer aspirin ......................... 11 bayer aspirin ec low dose ...... 11 bcg vaccine ......................... 136 bd posiflush ........................... 86 bd pudendal/local tray/1% lido

.......................................... 14 beau rx .................................. 72 BECONASE AQ .................. 151 bekyree ............................... 122 belladonna alkaloids-opium . 108 belladonna-opium ............... 108 BELSOMRA ........................ 161 BELVIQ ................................. 70 BELVIQ XR ........................... 70 benadryl-d allergy/sinus child

........................................ 151 benazepril hcl ........................ 56 benazepril-hydrochlorothiazide

.......................................... 56 BENLYSTA ......................... 132 benzalkonium chloride .......... 18 benzepro ............................... 72 benzepro creamy wash ......... 72 benzepro foaming cloths ....... 72 benzepro short contact .......... 72 benziq wash .......................... 72 BENZNIDAZOLE .................. 47 benzoin ................................. 73 benzoin compound ................ 73 benzonatate ........................ 151 benzoyl peroxide ................... 73 benzoyl peroxide-erythromycin

.......................................... 73 benzphetamine hcl ................ 70 betamethasone dipropionate 114 betamethasone dipropionate

aug .................................. 114 betamethasone sod phos & acet

........................................ 114 betamethasone valerate ...... 114

164

BETASERON......................... 69 betaxolol hcl ................... 56, 147 bethanechol chloride ............ 111 BEVESPI AEROSPHERE .... 155 bexarotene ............................. 41 bicalutamide .......................... 41 BICILLIN L-A ......................... 18 BICNU ................................... 41 bimatoprost .......................... 147 bio glo .................................. 148 biocel ..................................... 86 bio-statin ................................ 37 biotuss ................................. 151 biotuss pediatric ................... 151 bisoprolol fumarate ................ 56 bisoprolol-hydrochlorothiazide56 bivalirudin trifluoroacetate ...... 28 BIVIGAM .............................. 132 bleomycin sulfate ................... 41 blisovi 24 fe .......................... 122 blisovi fe 1.5/30 .................... 122 blisovi fe 1/20 ....................... 122 BONIVA ............................... 140 BOOSTRIX .......................... 136 boric acid ............................. 142 BOTOX ................................ 142 bp 10-1 .................................. 73 bp cleansing wash ................. 73 bp foam.................................. 73 bp foaming wash .................... 73 bp folinatal plus b ................... 86 bp gel ..................................... 73 bp multinatal plus ............. 86, 87 bp vit 3 ................................... 87 bp wash ................................. 73 b-plex ..................................... 87 b-plex plus ............................. 87 bpo foaming cloths ................. 73 BREATHERITE .................... 142 BREO ELLIPTA ................... 155 briellyn ................................. 122 BRILINTA .............................. 49 brimonidine tartrate .............. 147 BRISDELLE ........................... 33 BRIVIACT .............................. 29 bromfed dm ......................... 151 bromfenac sodium (once-daily)

........................................ 145 bromocriptine mesylate .......... 48 brompheniramine maleate ... 151 brompheniramine tannate .... 151 BROVANA ........................... 156 bss ....................................... 148 bss plus ............................... 148 budesonide .......... 138, 151, 156

budesonide er...................... 138 bumetanide ........................... 56 buminate ............................. 142 bupivacaine hcl ...................... 14 bupivacaine hcl (pf) ............... 14 bupivacaine hcl-nacl .............. 14 bupivacaine in dextrose ......... 14 bupivacaine spinal ................. 14 bupivacaine-epinephrine ....... 14 bupivacaine-epinephrine (pf) . 14 bupropion hcl ......................... 33 bupropion hcl er (smoking det)

.......................................... 16 bupropion hcl er (sr) .............. 33 bupropion hcl er (xl) ............... 33 buspirone hcl ......................... 52 busulfan................................. 41 butalbital-acetaminophen ........ 4 butalbital-apap ......................... 4 butalbital-apap-caff-cod ........... 4 butalbital-apap-caffeine ....... 4, 5 butalbital-asa-caff-codeine....... 5 butalbital-asa-caffeine ............. 5 butalbital-aspirin-caffeine ......... 5 butorphanol tartrate ................. 5 BYDUREON .......................... 79 BYDUREON BCISE

AUTOINJECTOR ............... 79 BYETTA 10 MCG PEN .......... 80 BYETTA 5 MCG PEN ............ 80 C cabergoline .......................... 120 CABOMETYX ........................ 42 caffeine citrate ....................... 70 caffeine-sodium benzoate ..... 70 calcipotriene .......................... 73 calcipotriene-betameth diprop 73 calcitonin (salmon) .............. 140 calcitrene ............................... 73 calcitriol ......................... 73, 140 calcium acetate ................... 112 calcium acetate (phos binder)

........................................ 111 calcium chloride ..................... 87 calcium disodium versenate 142 calcium gluconate .................. 87 calcium gluconate-dextrose ... 87 calcium gluconate-nacl .......... 87 CALCIUM PNV ...................... 87 calcium-folic acid plus d ......... 87 CALQUENCE ........................ 42 camila .................................. 122 CAMPATH ............................. 42 camrese .............................. 123 camrese lo ........................... 122

CANASA ............................. 138 CANCIDAS ........................... 37 candesartan cilexetil.............. 56 candesartan cilexetil-hctz ...... 56 capacet ................................... 5 capecitabine .......................... 42 captopril ................................ 56 captopril-hydrochlorothiazide 57 CARAC ................................. 73 CARAFATE ......................... 106 carbamazepine ..................... 29 carbamazepine er ................. 29 CARBATROL ........................ 29 carbidopa .............................. 48 carbidopa-levodopa......... 48, 49 carbidopa-levodopa er .......... 48 carbidopa-levodopa-entacapone

.......................................... 49 carbinoxamine maleate ....... 151 carboplatin ............................ 42 cardioplegic ........................... 87 carimune nf ......................... 132 carisoprodol ........................ 160 carisoprodol-aspirin ............. 160 carisoprodol-aspirin-codeine ... 5 carteolol hcl ......................... 147 cartia xt ................................. 57 carvedilol ............................... 57 carvedilol phosphate er ......... 57 cascara sagrada ................. 108 caspofungin acetate .............. 37 CATHFLO ACTIVASE ........... 28 cavarest ................................ 71 caziant ................................ 123 cefaclor ................................. 18 cefaclor er ............................. 18 cefadroxil ........................ 18, 19 cefazolin in d5w .................... 19 cefazolin in sodium chloride .. 19 cefazolin sodium ................... 19 cefazolin sodium-dextrose..... 19 cefdinir .................................. 19 cefditoren pivoxil ................... 19 cefepime hcl .......................... 19 cefepime-dextrose ................ 19 cefixime ................................. 19 CEFOTAN ............................. 19 cefotaxime sodium ................ 19 cefotetan disodium ................ 19 cefotetan disodium-dextrose . 19 cefoxitin sodium .................... 20 cefoxitin sodium-dextrose...... 20 cefpodoxime proxetil ............. 20 cefprozil ................................ 20 ceftazidime ............................ 20

165

ceftibuten ............................... 20 ceftriaxone sodium ................. 20 ceftriaxone sodium in dextrose

.......................................... 20 ceftriaxone sodium-dextrose .. 20 cefuroxime axetil .................... 20 cefuroxime sodium ................. 20 celacyn .................................. 73 celecoxib ................................ 11 cem-urea ............................... 73 cephalexin ............................. 20 ceramax ................................. 73 CERDELGA ......................... 110 CEREZYME ......................... 111 cerisa wash ............................ 73 cerovel ................................... 73 cetirizine hcl ......................... 151 cetirizine hcl childrens .......... 151 cetirizine hcl childrens alrgy . 151 cevimeline hcl ........................ 71 CHANTIX ............................... 16 CHANTIX CONTINUING

MONTH PAK ..................... 16 CHANTIX STARTING MONTH

PAK ................................... 17 chateal ................................. 123 CHEMET ............................... 87 childrens allergy ................... 151 chloramphenicol sod succinate

.......................................... 20 chlordiazepoxide hcl .............. 52 chlordiazepoxide-amitriptyline 33 chlordiazepoxide-clidinium ... 108 chlorhexidine gluconate . 71, 142 chloromag .............................. 87 chloroprocaine hcl (pf) ........... 14 chloroquine phosphate ........... 48 chlorothiazide ........................ 57 chlorothiazide sodium ............ 57 chlorpropamide ...................... 80 chlorthalidone ........................ 57 chlorzoxazone...................... 160 CHOLBAM ........................... 108 cholestyramine....................... 57 cholestyramine light ............... 57 choline fenofibrate ................. 57 choline-mag trisalicylate ......... 11 chromagen ............................. 87 chromic chloride ..................... 87 cicatrace pad ......................... 73 ciclodan ................................. 37 ciclopirox ................................ 37 ciclopirox olamine .................. 37 ciclopirox treatment ................ 37 cidofovir ................................. 50

cilostazol ............................... 49 cimetidine ............................ 106 cimetidine hcl....................... 106 CIMZIA ................................ 132 CIMZIA PREFILLED KIT ..... 132 CIMZIA STARTER KIT ........ 132 CINRYZE ............................ 132 CIPRO ................................... 21 CIPRODEX ......................... 150 ciprofloxacin .......................... 21 ciprofloxacin hcl ..... 21, 146, 150 ciprofloxacin in d5w ............... 21 ciprofloxacin-ciproflox hcl er .. 21 cisatracurium besylate ........... 70 cisplatin ................................. 42 citalopram hydrobromide ....... 33 CITRANATAL 90 DHA ........... 87 CITRANATAL ASSURE ........ 87 CITRANATAL B-CALM .......... 87 CITRANATAL BLOOM .......... 87 CITRANATAL BLOOM DHA .. 87 CITRANATAL DHA ............... 87 CITRANATAL HARMONY ..... 87 CITRANATAL MEDLEY ........ 88 CITRANATAL RX .................. 88 cladribine ............................... 42 CLAFORAN ........................... 21 claravis .................................. 73 clarithromycin ........................ 21 clarithromycin er .................... 21 CLARITIN REDITABS ......... 151 clearlax ................................ 108 clemastine fumarate ............ 151 CLIMARA ............................ 123 CLIMARA PRO .................... 123 clindacin etz .......................... 73 clindacin-p ............................. 73 clindamycin hcl ...................... 21 clindamycin palmitate hcl ....... 21 clindamycin phos-benzoyl perox

.......................................... 74 clindamycin phosphate .... 21, 74 clindamycin phosphate in d5w

.......................................... 21 clindamycin-tretinoin .............. 74 clinimix e/dextrose (4.25/25) .. 88 clinimix/dextrose (4.25/10) ..... 88 clinimix/dextrose (4.25/20) ..... 88 clinimix/dextrose (4.25/25) ..... 88 clinisol sf ................................ 88 clinpro 5000 ........................... 71 clobetasol prop emollient base

........................................ 114 clobetasol propionate .. 114, 115 clobetasol propionate e ....... 114

clobetasol propionate emulsion ........................................ 114

clocortolone pivalate ........... 115 clocortolone pivalate pump .. 115 clodan ................................. 115 clofarabine ............................ 42 clomipramine hcl ................... 33 clonazepam .......................... 52 clonidine hcl .......................... 57 clonidine hcl (analgesia) ........ 57 clonidine hcl er ...................... 67 clopidogrel bisulfate .............. 50 clorazepate dipotassium ....... 52 clotrimazole ........................... 37 clotrimazole-betamethasone . 74 C-NATE DHA ........................ 88 coal tar .................................. 74 cocaine hcl ............................ 14 cod liver oil ............................ 88 codeine sulfate ........................ 5 COLCHICINE ........................ 39 colchicine-probenecid ........... 39 COLCRYS ............................ 39 colesevelam hcl .................... 57 COLESTID ............................ 57 COLESTID FLAVORED ........ 57 colestipol hcl ......................... 58 colistimethate sodium (cba) ... 22 colocort ............................... 139 COLY-MYCIN M ................... 22 COLY-MYCIN S .................. 150 COMBIPATCH .................... 123 complete natal dha ................ 88 completenate ........................ 88 compro .................................. 35 co-natal fa ............................. 88 CONCEPT DHA .................... 88 CONCEPT OB ...................... 88 condoms ............................. 142 constulose ........................... 108 CONTRAVE .......................... 70 copper chloride ..................... 88 coremino ............................... 22 CORLANOR ......................... 58 cormax scalp application ..... 115 cortic-nd .............................. 150 cortisone acetate ................. 115 corvita ................................... 88 corvita 150 ............................ 88 corvite free ............................ 88 COSENTYX 150 MG/ML ....... 74 COSENTYX 300 DOSE ........ 74 COSENTYX SENSOREADY

300 DOSE ......................... 74

166

COSENTYX SENSOREADY PEN ................................... 74

cosyntropin .......................... 142 COTELLIC ............................. 42 cough dm ............................. 152 covaryx ................................ 123 covaryx hs ........................... 123 CREON................................ 111 CRESEMBA .......................... 37 cromolyn sodium .. 108, 146, 156 crotan .................................... 48 cryselle-28 ........................... 123 CRYSVITA ........................... 111 CUBICIN ................................ 22 CUBICIN RF .......................... 22 curity sterile saline ................. 88 CUVITRU ............................. 132 cyanocobalamin ..................... 88 cyclafem 1/35 ...................... 123 cyclafem 7/7/7...................... 123 cyclobenzaprine hcl ............. 160 cyclopentolate hcl ................ 148 cyclophosphamide ................. 42 cycloserine ............................. 41 cyclosporine ......................... 132 cyclosporine modified .......... 132 cyotic ................................... 150 cyproheptadine hcl ............... 152 cyred .................................... 123 cytarabine .............................. 42 cytarabine (pf) ........................ 42 CYTOGAM .......................... 132 cytra k crystals ....................... 88 D dacarbazine ........................... 42 dactinomycin .......................... 42 DAKLINZA ............................. 50 DALIRESP ........................... 156 DALVANCE ........................... 22 danazol ................................ 119 dantrolene sodium ............... 160 dapsone ........................... 41, 74 DAPTACEL .......................... 136 daptomycin ............................ 22 darifenacin hydrobromide er 112 dasetta 1/35 ......................... 123 dasetta 7/7/7 ........................ 123 daunorubicin hcl ..................... 42 daysee ................................. 123 DDAVP ................................ 120 deblitane .............................. 123 decitabine .............................. 42 deferoxamine mesylate ........ 142 dehydrated alcohol ................ 88 deltasone ............................. 115

delyla ................................... 123 DELZICOL ........................... 139 demeclocycline hcl ................ 22 denta 5000 plus ..................... 71 dentagel ................................ 71 DEPO-PROVERA ............... 123 derma silkrx sds pak ............ 115 dermacinrx empricaine .......... 14 dermacinrx prizopak .............. 14 dermawerx sds .................... 115 dermazene ............................ 74 desipramine hcl ..................... 33 desloratadine ....................... 152 desmopressin ace spray refrig

........................................ 120 desmopressin acetate ......... 120 desmopressin acetate spray 120 desogestrel-ethinyl estradiol 123 desonide .............................. 115 desoximetasone .................. 115 desvenlafaxine succinate er .. 33 dexamethasone ................... 115 dexamethasone sod phos-nacl

........................................ 115 dexamethasone sod phosphate

pf ..................................... 116 dexamethasone sodium

phosphate ................ 116, 146 dexifol .................................... 88 DEXILANT ........................... 106 dexmedetomidine hcl ........... 142 dexmethylphenidate hcl ......... 67 dexmethylphenidate hcl er ..... 67 dexrazoxane .......................... 42 dextroamphetamine sulfate ... 67 dextroamphetamine sulfate er 67 dextrose ................................ 88 dextrose in lactated ringers .... 88 dextrose-nacl ......................... 89 diab ....................................... 74 diab f.d.g. freeze-dried ........... 74 dialyvite ................................. 89 diazepam ................... 29, 52, 53 diazepam intensol ................. 52 diclofenac potassium ............. 11 diclofenac sodium .... 11, 74, 146 diclofenac sodium er.............. 11 diclofenac-misoprostol ........... 11 diclofex dc ............................. 11 diclopak ................................. 12 diclosaicin .............................. 12 diclotral .................................. 12 dicloxacillin sodium ................ 22 dicyclomine hcl .................... 108 diethylpropion hcl .................. 70

diethylpropion hcl er .............. 70 difil-g forte ........................... 156 diflorasone diacetate ........... 116 diflunisal ................................ 12 digitek ................................... 58 digox ..................................... 58 digoxin .................................. 58 dihydroergotamine mesylate . 39 DILAUDID ............................... 5 diltiazem cd ........................... 58 diltiazem hcl .......................... 58 diltiazem hcl er ...................... 58 diltiazem hcl er beads ........... 58 diltiazem hcl er coated beads 58 diltiazem hcl-dextrose ........... 58 diltiazem hcl-sodium chloride 59 dilt-xr ..................................... 59 dimenhydrinate ..................... 35 DIPENTUM ......................... 139 diphenhydramine hcl ........... 152 diphenoxylate-atropine ........ 108 diphtheria-tetanus toxoids dt 136 dipyridamole ................. 50, 142 disopyramide phosphate ....... 59 disulfiram .............................. 17 divalproex sodium ................. 30 divalproex sodium er ............. 29 dobutamine hcl ...................... 59 dobutamine in d5w ................ 59 docetaxel .............................. 43 docetaxel (non-alcohol) ......... 42 docusate sodium ................. 108 dofetilide ............................... 59 donepezil hcl ......................... 32 dopamine hcl......................... 59 dopamine in d5w ................... 59 dorzolamide hcl ................... 147 dorzolamide hcl-timolol mal . 147 dorzolamide hcl-timolol mal pf

........................................ 147 DOTHELLE DHA .................. 89 dover vinyl urethral cath 16fr 142 doxazosin mesylate............... 59 doxepin hcl ...................... 33, 74 doxercalciferol ..................... 140 doxorubicin hcl ...................... 43 doxorubicin hcl liposomal ...... 43 doxy 100 ............................... 22 doxycycline ........................... 74 doxycycline hyclate ............... 22 doxycycline monohydrate ...... 22 dritho-creme hp ..................... 74 dronabinol ............................. 35 droperidol .............................. 35

167

drospiren-eth estrad-levomefol ........................................ 123

drospirenone-ethinyl estradiol ........................................ 123

DUAVEE .............................. 123 DUET DHA 400 ..................... 89 DUET DHA BALANCED ........ 89 duloxetine hcl ......................... 33 duramorph ...............................5 duraxin .....................................5 DUREX EXTRA SENSITIVE 142 DUREX REALFEEL ............. 142 dutasteride ........................... 113 dutasteride-tamsulosin hcl ... 113 E e.e.s. 400 ............................... 22 EASIVENT ........................... 142 easygel .................................. 71 econazole nitrate ................... 37 EDECRIN .............................. 59 ed-spaz ................................ 108 eemt .................................... 123 eemt hs ................................ 123 effer-k .................................... 89 effervescent pot chloride ........ 89 ELAPRASE .......................... 111 ELDEPRYL ............................ 49 eletriptan hydrobromide ......... 39 ELIDEL .................................. 74 ELIGARD ............................. 120 elinest .................................. 124 ELIQUIS ................................ 28 ELIQUIS STARTER PACK .... 28 elite-ob ................................... 89 ELLA .................................... 124 EMEND.................................. 35 emoquette ............................ 124 EMVERM ............................... 48 enalapril maleate ................... 59 enalaprilat .............................. 59 enalapril-hydrochlorothiazide . 59 ENBRACE HR ....................... 89 ENBREL .............................. 132 ENBREL SURECLICK ......... 132 endocet ....................................5 ENGERIX-B ......................... 136 enovarx-cyclobenzaprine hcl 160 enoxaparin sodium ................ 28 enpresse-28 ......................... 124 enskyce ............................... 124 entacapone ............................ 49 entecavir ................................ 50 ENTRESTO ........................... 59 enulose ................................ 108 EPCLUSA .............................. 50

ephedrine sulfate ................... 59 EPIDUO FORTE ................... 74 epinastine hcl ...................... 146 epinephrine ........................... 59 EPINEPHRINE .................... 156 epinephrine pf........................ 59 EPIPEN 2-PAK .................... 156 EPIPEN JR 2-PAK .............. 156 epirubicin hcl ......................... 43 epitol ..................................... 30 eplerenone ............................ 59 EPOGEN ............................... 54 epoprostenol sodium ........... 159 eprosartan mesylate .............. 59 eptifibatide ............................. 50 ERBITUX ............................... 43 ergoloid mesylates .............. 142 ergotamine-caffeine ............... 39 ERLEADA ............................. 43 errin ..................................... 124 ertapenem sodium ................. 23 ery ......................................... 74 erythrocin lactobionate .......... 23 erythromycin .................. 75, 146 erythromycin base ................. 23 erythromycin ethylsuccinate .. 23 ESBRIET ............................. 156 escitalopram oxalate........ 33, 34 esgic ........................................ 5 esmolol hcl ............................ 59 esomeprazole magnesium... 106 esomeprazole sodium ......... 106 est estrogens-methyltest ..... 124 est estrogens-methyltest ds . 124 est estrogens-methyltest hs . 124 estarylla ............................... 124 estazolam .............................. 53 estradiol............................... 124 estradiol valerate ................. 124 estradiol-norethindrone acet 124 ESTROGEL ......................... 124 estropipate .......................... 124 eszopiclone ......................... 161 ethacrynate sodium ............... 60 ethacrynic acid ...................... 60 ethambutol hcl ....................... 41 ethosuximide ......................... 30 ethyl chloride ......................... 14 ethynodiol diac-eth estradiol 124 etidronate disodium ............. 140 etodolac................................. 12 etodolac er ............................ 12 etomidate ............................ 142 etoposide ............................... 43 EUCRISA .............................. 75

EURAX ................................. 48 exemestane .......................... 43 EXJADE ................................ 89 exoderm ................................ 37 exotic-hc ............................. 150 EXTAVIA ............................... 69 EZ FLU SHOT-FLUCELVAX 136 EZ FLU SHOT-FLUVIRIN ... 136 ezetimibe .............................. 60 ezetimibe-simvastatin ............ 60 F fabb ....................................... 89 FABRAZYME ...................... 111 face mask resp n-100 part... 142 face mask respirator r-95 part

........................................ 142 falmina ................................ 124 famciclovir ............................. 50 famotidine ........................... 106 famotidine premixed ............ 106 FARXIGA .............................. 80 FARYDAK ............................. 43 FASLODEX ........................... 43 fa-vitamin b-6-vitamin b-12 .... 89 fayosim ............................... 124 felbamate .............................. 30 felodipine er .......................... 60 femynor ............................... 124 fenofibrate ............................. 60 fenofibrate micronized ........... 60 fenofibric acid ........................ 60 fenoprofen calcium ................ 12 fenortho ................................. 12 fentanyl ................................... 6 fentanyl citrate ......................... 5 fentanyl citrate (pf) .................. 5 fentanyl citrate-nacl ............. 5, 6 fentanyl cit-ropivacaine-nacl .... 6 fentanyl-bupivacaine-nacl........ 6 FENTORA ............................... 6 ferocon .................................. 89 ferosul ................................... 89 ferotrinsic .............................. 89 ferraplus 90 ........................... 89 ferrocite plus ......................... 89 ferrous sulfate ....................... 89 fexofenadine hcl .................. 152 fexofenadine-pseudoephed er

........................................ 152 FIASP ................................... 83 FIASP FLEXTOUCH ............. 83 FINACEA .............................. 75 finasteride ........................... 113 FIRVANQ .............................. 23 flavoxate hcl ........................ 112

168

FLEBOGAMMA DIF ............. 133 flecainide acetate ................... 60 flexbumin ............................. 142 floriva ..................................... 89 floriva plus ............................. 89 FLOVENT HFA .................... 156 floxuridine .............................. 43 FLUAD ................................. 136 FLUARIX QUADRIVALENT . 136 FLUBLOK ............................ 136 FLUBLOK QUADRIVALENT 136 flucaine ................................ 148 FLUCELVAX ........................ 136 FLUCELVAX QUADRIVALENT

........................................ 136 fluconazole ............................ 37 fluconazole in dextrose .......... 37 fluconazole in sodium chloride

.......................................... 37 flucytosine .............................. 37 fludarabine phosphate ........... 43 fludrocortisone acetate ......... 116 FLULAVAL QUADRIVALENT

................................ 136, 137 flumazenil ............................ 142 flunisolide ............................. 152 fluocinolone acetonide . 116, 150 fluocinolone acetonide body. 116 fluocinolone acetonide scalp 116 fluocinonide ......................... 116 fluocinonide emulsified base 116 fluor-a-day ............................. 89 fluorescein-benoxinate ......... 148 fluoridex ................................. 71 fluoridex daily renewal ........... 71 fluoridex enhanced whitening . 71 fluoridex sensitivity relief ........ 71 fluor-i-strips a.t. .................... 148 fluoritab .................................. 89 fluorometholone ................... 146 fluorouracil ....................... 43, 75 FLUOROURACIL ................... 75 fluoxetine hcl .......................... 34 fluoxetine hcl (pmdd).............. 34 flurandrenolide ..................... 116 flurazepam hcl ..................... 161 flurbiprofen ............................. 12 flurbiprofen sodium .............. 146 flurox .................................... 148 flutamide ................................ 43 fluticasone propionate .. 116, 152 FLUTICASONE-SALMETEROL

........................................ 156 fluvastatin sodium .................. 60 fluvastatin sodium er .............. 60

FLUVIRIN ............................ 137 fluvoxamine maleate.............. 34 fluvoxamine maleate er ......... 34 FLUZONE HIGH-DOSE ...... 137 FLUZONE QUADRIVALENT137 FML FORTE ........................ 146 FOCALGIN 90 DHA............... 90 FOCALGIN CA ...................... 90 FOCALIN ............................... 67 folbee .................................... 90 folbee plus ............................. 90 folbee plus cz ........................ 90 folbic .................................... 142 FOLCAL DHA ........................ 90 FOLCAPS OMEGA 3 ............ 90 FOLET DHA .......................... 90 FOLET ONE .......................... 90 foley catheter 2-way ............ 143 folic acid ................................ 90 FOLIVANE-OB ...................... 90 folplex 2.2 .............................. 90 foltrin ..................................... 90 fomepizole ........................... 143 fondaparinux sodium ............. 28 formadon ............................. 143 formaldehyde....................... 143 forma-ray ............................. 143 formula em ............................ 35 FORTAMET .......................... 80 FORTEO ............................. 140 FORTESTA ......................... 119 fosinopril sodium ................... 60 fosinopril sodium-hctz ............ 60 fosphenytoin sodium.............. 30 FRAGMIN .............................. 28 FREAMINE III ........................ 90 fresenius propoven .............. 143 frovatriptan succinate ............ 39 ful-glo .................................. 148 furosemide ............................ 60 fyavolv ......................... 124, 125 G gabapentin ............................ 30 galantamine hydrobromide .... 32 galantamine hydrobromide er 32 GAMASTAN ........................ 133 gamastan s/d ....................... 133 GAMASTAN S/D ................. 133 GAMMAGARD .................... 133 GAMMAGARD S/D LESS IGA

........................................ 133 GAMMAKED ....................... 133 GAMMAPLEX...................... 133 GAMUNEX-C ...................... 133 ganciclovir sodium ................. 50

GARDASIL .......................... 137 GARDASIL 9 ....................... 137 gatifloxacin .......................... 146 gavilax................................. 108 gavilyte-c ............................. 108 gavilyte-g ............................ 108 gavilyte-h ............................ 108 gavilyte-n with flavor pack ... 108 GELNIQUE ......................... 112 GELNIQUE PUMP .............. 112 gemcitabine hcl ..................... 43 gemfibrozil ............................ 60 generlac .............................. 108 gengraf................................ 133 GENOTROPIN .................... 120 GENOTROPIN MINIQUICK 120 gentak ................................. 146 gentamicin in saline............... 23 gentamicin sulfate ......... 23, 146 gianvi .................................. 125 gildagia ............................... 125 gildess fe 1.5/30 .................. 125 gildess fe 1/20 ..................... 125 GILENYA .............................. 69 GILOTRIF ............................. 44 giltuss pediatric ................... 152 glatiramer acetate ................. 69 glatopa .................................. 69 glimepiride ............................ 80 glipizide ................................. 80 glipizide er ............................. 80 glipizide xl ............................. 80 glipizide-metformin hcl .......... 80 GLUCAGEN HYPOKIT ......... 82 GLUCAGON EMERGENCY .. 82 glucagon hcl (diagnostic) .... 143 GLUCOPHAGE ..................... 80 glucose ................................. 90 GLUMETZA .......................... 80 glutaraldehyde .................... 143 glyburide ............................... 80 glyburide micronized ............. 80 glyburide-metformin .............. 80 glycine................................. 112 glycine urologic ................... 112 glycolax ............................... 108 glycolic acid .......................... 75 glycopyrrolate...................... 109 glydo ..................................... 14 GLYXAMBI ........................... 80 gnp all day pain relief ............ 12 goodsense acid reducer ...... 106 granisetron hcl ...................... 35 green glo lissamine green ... 148 griseofulvin microsize ............ 38

169

griseofulvin ultramicrosize ...... 38 GRIS-PEG ............................. 38 guanfacine hcl........................ 60 guanfacine hcl er ................... 67 guanidine hcl ......................... 40 H halac ...................................... 75 HALAVEN .............................. 44 halobetasol propionate ......... 116 HARVONI .............................. 50 HAVRIX ............................... 137 heartburn relief 150 max st .. 106 heather ................................ 125 HEMANGEOL ........................ 60 hematinic plus vit/minerals ..... 90 hematinic/folic acid ................ 90 hematogen ............................. 90 hematogen fa ......................... 90 hematogen forte ..................... 90 HEMENATAL OB ................... 90 HEMENATAL OB + DHA ....... 90 hemmorex-hc ....................... 139 hemocyte-f ............................. 90 hemocyte-plus ....................... 90 heparin (porcine) in d5w ........ 28 heparin (porcine) in nacl ........ 28 heparin lock flush ................. 143 heparin sod (porcine) in d5w .. 28 heparin sodium (porcine) ....... 28 heparin sodium (porcine) pf ... 28 heparin sodium flush ............ 143 heparin sodium lock flush .... 143 heparin sodium/d5w ............... 29 hepatamine ............................ 90 HERCEPTIN .......................... 44 hetastarch-nacl ...................... 54 HETLIOZ ............................. 161 HIZENTRA ........................... 133 homatropaire ....................... 148 homatropine hbr ................... 148 HP ACTHAR ........................ 120 HUMALOG KWIKPEN ........... 83 HUMALOG MIX 50/50

KWIKPEN .......................... 83 HUMALOG MIX 50/50 VIAL ... 83 HUMALOG MIX 75/25

KWIKPEN .......................... 83 HUMALOG MIX 75/25 VIAL ... 83 HUMALOG U-100 JUNIOR

KWIKPEN .......................... 83 HUMALOG U-100 VIAL AND

CARTRIDGE ...................... 83 human albumin grifols .......... 143 HUMATROPE ...................... 120 HUMIRA .............................. 134

HUMIRA PEDIATRIC CROHNS START ............................ 133

HUMIRA PEN ...................... 133 HUMIRA PEN-CD/UC/HS

STARTER ........................ 133 HUMIRA PEN-PS/UV

STARTER ........................ 133 HUMULIN 70/30 KWIKPEN ... 83 HUMULIN 70/30 VIAL ........... 83 HUMULIN N KWIKPEN ......... 83 HUMULIN N VIAL .................. 83 HUMULIN R U-500 KWIKPEN

.......................................... 84 HUMULIN R U-500 VIAL

(CONCENTRATED) .......... 84 HUMULIN R VIAL .................. 84 HYCAMTIN ........................... 44 hydralazine hcl ...................... 60 hydrochlorothiazide ............... 61 hydrocodone polst-cpm polst er

........................................ 152 hydrocodone-acetaminophen . 6,

7 hydrocodone-homatropine ... 152 hydrocodone-ibuprofen ............ 7 hydrocortisone ............. 117, 139 hydrocortisone ace-pramoxine

.................................. 75, 139 hydrocortisone acetate ........ 139 hydrocortisone butyr lipo base

........................................ 117 hydrocortisone butyrate ....... 117 hydrocortisone in absorbase 117 hydrocortisone valerate ....... 117 hydrocortisone-acetic acid ... 150 hydrocortisone-iodoquinol...... 75 hydrogen peroxide ................. 23 hydromet ............................. 152 hydromorphone hcl .................. 7 hydromorphone hcl er .............. 7 hydromorphone hcl pf .............. 7 hydromorphone hcl-nacl .......... 7 hydromorphone-bupivacaine-

nacl ...................................... 7 hydromorphone-ropivacaine-

nacl ...................................... 7 hydroxocobalamin ................. 90 hydroxychloroquine sulfate .... 48 hydroxyprogesterone caproate

........................................ 125 hydroxyurea .......................... 44 hydroxyzine hcl ...................... 53 hydroxyzine pamoate ............ 53 hyolev mb ............................ 112 hyophen .............................. 112

hyoscyamine sulfate............ 109 hyoscyamine sulfate er ....... 109 hyoscyamine sulfate sl ........ 109 hyosyne .............................. 109 HYPERHEP B S/D .............. 134 hyperlyte-cr ........................... 91 HYPERRHO S/D ................. 134 I ibandronate sodium............. 140 IBRANCE .............................. 44 ibudone ................................... 7 ibuprofen ............................... 12 ibuprofen childrens ................ 12 ibuprofen lysine ..................... 12 ibutilide fumarate ................... 61 idarubicin hcl ......................... 44 IDHIFA .................................. 44 iferex 150 forte ...................... 91 ifosfamide ............................. 44 imatinib mesylate .................. 44 IMBRUVICA .......................... 44 imipenem-cilastatin ............... 23 imipramine hcl ....................... 34 imipramine pamoate.............. 34 imiquimod ............................. 75 IMPAVIDO ............................ 48 inatal gt ................................. 91 incassia ............................... 125 INCRELEX .......................... 120 INCRUSE ELLIPTA............. 156 indapamide ........................... 61 indigo carmine ..................... 143 indiomin mb ........................ 112 indocyanine green ............... 143 indomethacin......................... 12 indomethacin er .................... 12 indomethacin sodium ............ 12 INFANATE BALANCE ........... 91 INFANRIX ........................... 137 infed .................................... 143 inflammacin ........................... 12 INFLECTRA ........................ 134 infusion needle 15gx2 ......... 143 infuvite adult .......................... 91 infuvite pediatric .................... 91 INSULIN PEN NEEDLES ...... 84 insulin pump ir2020 ............. 143 INSULIN SYRINGES ............ 84 intralipid ................................ 91 INTRALIPID .......................... 91 INTRON A ............................. 50 introvale .............................. 125 INTUNIV ............................... 67 inulin ................................... 143 INVANZ ................................. 23

170

INVOKAMET ......................... 80 INVOKAMET XR .................... 80 INVOKANA ............................ 80 iodine strong .......................... 91 iodine tincture ........................ 23 iodoquinol-hc-aloe polysacch . 23 iodoquinol-hydrocortisone-aloe

.......................................... 75 ipratropium bromide ..... 152, 156 ipratropium-albuterol ............ 156 irbesartan ............................... 61 irbesartan-hydrochlorothiazide

.......................................... 61 irinotecan hcl ......................... 44 isibloom ............................... 125 isoflurane ............................. 143 isometheptene-caffeine-apap . 12 isometheptene-dichloral-apap 12 isoniazid................................. 41 isoproterenol hcl .................... 61 isosorbide dinitrate ................. 61 isosorbide dinitrate er ............. 61 isosorbide mononitrate ........... 61 isosorbide mononitrate er ...... 61 isosulfan blue ....................... 143 isotretinoin ............................. 75 isoxsuprine hcl ....................... 61 isradipine ............................... 61 itraconazole ........................... 38 ivermectin .............................. 48 IXEMPRA KIT ........................ 44 J jantoven ................................. 29 JANUMET .............................. 80 JANUMET XR ........................ 81 JANUVIA ............................... 81 JARDIANCE .......................... 81 jencycla................................ 125 jevantique lo ........................ 125 jinteli .................................... 125 jolessa ................................. 125 jolivette ................................ 125 JUBLIA .................................. 38 juleber .................................. 125 junel 1.5/30 .......................... 125 junel 1/20 ............................. 125 junel fe 1.5/30 ...................... 125 junel fe 1/20 ......................... 125 junel fe 24 ............................ 125 K kaitlib fe ............................... 125 karaya gum .......................... 143 kariva ................................... 125 kcl in d5w lactated ringers ...... 91 kcl in dextrose-nacl ................ 91

kcl-lactated ringers-d5w ......... 91 kcl-lidocaine in d5w ............... 91 kcl-lidocaine-nacl ................... 91 kedbumin ............................. 143 k-effervescent ........................ 91 kelnor 1/35 .......................... 125 kelnor 1/50 .......................... 125 KEPPRA XR .......................... 30 ketamine hcl ........................ 143 ketamine hcl-sodium chloride

........................................ 143 ketoconazole ......................... 38 ketoprofen ............................. 13 ketoprofen er ......................... 13 ketorolac tromethamine . 13, 146 kimidess .............................. 125 KIMONO MICRO THIN ........ 144 KINERET ............................. 134 KISQALI 200 DOSE .............. 44 KISQALI 400 DOSE .............. 44 KISQALI 600 DOSE .............. 44 KITABIS PAK ...................... 158 klofensaid ii ........................... 13 klor-con ................................. 91 klor-con 10 ............................ 91 klor-con m10 ......................... 91 klor-con m20 ......................... 91 klor-con sprinkle .................... 91 klor-con/ef ............................. 91 KOSHER PRENATAL PLUS

IRON ................................. 91 k-prime .................................. 92 k-tan plus ............................... 92 kurvelo ................................ 125 KUVAN ................................ 111 k-vescent ............................... 92 KYNAMRO ............................ 61 L labetalol hcl ........................... 61 lac-hydrin ............................... 75 lactated ringers ...................... 92 lactic acid .............................. 75 lactic acid e ........................... 75 lactulose .............................. 109 lactulose encephalopathy .... 109 lamivudine ............................. 50 lamotrigine ............................. 30 lamotrigine er......................... 30 lamotrigine starter kit-blue ..... 30 lamotrigine starter kit-green ... 30 lamotrigine starter kit-orange . 30 LANCETS .............................. 82 lansoprazole ........................ 106 lanthanum carbonate ........... 112 LANTUS SOLOSTAR ............ 84

LANTUS U-100 VIAL ............ 84 larin 1.5/30 .......................... 125 larin 1/20 ............................. 125 larin 24 fe ............................ 125 larin fe 1.5/30 ...................... 125 larin fe 1/20 ......................... 125 larissia................................. 126 LASTACAFT ....................... 148 latanoprost .......................... 147 latrix ...................................... 75 latrix xm ................................ 75 layolis fe .............................. 126 l-cysteine hcl ....................... 144 lecithin................................... 92 leena ................................... 126 leflunomide ......................... 134 LENVIMA 10 MG DAILY DOSE

.......................................... 44 LENVIMA 14 MG DAILY DOSE





.......................................... 45 lessina................................. 126 LETAIRIS ............................ 159 letrozole ................................ 45 leucovorin calcium ................ 45 leuprolide acetate ................ 120 leva set/occlusive dressing .... 14 levalbuterol hcl .................... 157 LEVALBUTEROL HFA ........ 157 LEVEMIR U-100 FLEXTOUCH

.......................................... 84 LEVEMIR U-100 VIAL ........... 84 levetiracetam................... 30, 31 levetiracetam er .................... 30 levetiracetam in nacl ............. 30 levicyn dermal spray ............. 75 levobunolol hcl .................... 147 levocarnitine .......................... 92 levocetirizine dihydrochloride

........................................ 152 levofloxacin ................... 23, 146 levofloxacin in d5w ................ 23 levoleucovorin calcium .......... 45 levoleucovorin calcium pf ...... 45 LEVOMEFOLATE DHA ......... 92 levonest .............................. 126 levonorgest-eth est & eth est126

171

levonorgest-eth estrad 91-day ........................................ 126

levonorgestrel ...................... 126 levonorgestrel-ethinyl estrad 126 levonorg-eth estrad triphasic 126 levora 0.15/30 (28) ............... 126 levorphanol tartrate ..................7 levo-t .................................... 131 levothyroxine sodium ........... 131 levothyroxine-liothyronine .... 131 levoxyl ................................. 131 lice treatment ......................... 48 lidenza ................................... 14 lido bdk .................................. 15 lidocaine ................................ 15 lidocaine hcl ..................... 15, 71 lidocaine hcl (cardiac) ............ 15 lidocaine hcl (pf) ..................... 15 lidocaine in d5w ..................... 15 lidocaine pak .......................... 15 lidocaine viscous .................... 71 lidocaine-epinephrine ............. 15 lidocaine-hydrocortisone ace 75,

139 lidocaine-prilocaine ................ 15 lido-k ...................................... 15 lidopin .................................... 15 lidopril .................................... 15 lidopril xr ................................ 15 lido-prilo caine pack ............... 15 lillow ..................................... 126 lincomycin hcl ........................ 24 lindane ................................... 48 linezolid.................................. 24 linezolid in sodium chloride .... 24 LINZESS .............................. 109 liothyronine sodium .............. 131 lipodox 50 .............................. 45 liprozonepak .......................... 15 lisinopril.................................. 61 lisinopril-hydrochlorothiazide .. 61 lissamine green .................... 148 little tummys nausea relief...... 36 livixil pak ................................ 15 lmd in d5w ............................. 54 lmd in nacl ............................. 54 l-methylfolate ....................... 144 l-methylfolate ca me-cbl nac .. 92 l-methylfolate calcium .......... 144 l-methylfolate formula 15 ........ 92 l-methylfolate forte ................. 92 l-methylfolate-algae ............... 92 l-methylfolate-algae-b12-b6 ... 92 l-methylfolate-b6-b12 ............. 92 LODOSYN ............................. 49

lomedia 24 fe ....................... 126 LONHALA MAGNAIR REFILL

KIT................................... 157 LONHALA MAGNAIR

STARTER KIT ................. 157 LONSURF ............................. 45 loperamide hcl ..................... 109 lopreeza .............................. 126 loratadine ............................ 152 lorazepam ............................. 53 lorazepam intensol ................ 53 lorazepam-dextrose ............... 53 lorazepam-sodium chloride.... 53 lorcet ....................................... 8 lorcet hd .................................. 8 lorcet plus ................................ 8 lorenza .................................. 15 loryna .................................. 126 losartan potassium ................ 61 losartan potassium-hctz ......... 61 LOTEMAX ........................... 146 lovastatin ............................... 61 low-ogestrel ......................... 126 lp lite pak ............................... 15 LUCENTIS .......................... 148 ludent .................................... 92 lugols ..................................... 24 LUMIGAN ............................ 147 LUMIZYME .......................... 111 LUPANETA PACK ............... 120 LUPRON DEPOT (1-MONTH)

........................................ 120 LUPRON DEPOT (3-MONTH)

........................................ 120 LUPRON DEPOT (4-MONTH)

INTRAMUSCULAR KIT 30MG .............................. 120

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG .............................. 120

LUPRON DEPOT-PED (1-MONTH) .......................... 121

LUPRON DEPOT-PED (3-MONTH) .......................... 121

lutera ................................... 126 luxamend ............................... 75 LYNPARZA ........................... 45 LYRICA ................................. 70 lysiplex plus ........................... 92 lyza ...................................... 126 M MACRODANTIN .................... 24 MACUGEN .......................... 148 mafenide acetate ................... 24 magnesium chloride .............. 92

magnesium sulfate ................ 92 magnesium sulfate in d5w ..... 92 magnesium sulfate-lact ringers

.......................................... 92 magnesium sulfate-nacl ........ 92 MAKENA ............................. 126 malathion .............................. 48 manganese chloride .............. 92 manganese sulfate ................ 93 mannitol ................................ 61 mapap ..................................... 8 maprotiline hcl ....................... 34 marlissa .............................. 126 MARNATAL-F ....................... 93 marten-tab .............................. 8 MATULANE .......................... 45 matzim la .............................. 62 MAVYRET ............................ 50 me/naphos/mb/hyo1............ 112 meclizine hcl ......................... 36 meclofenamate sodium ......... 13 MEDICAL PROVIDER EZ

AFLURIA PF ................... 137 MEDICAL PROVIDER EZ FLU

PF ................................... 137 MEDICAL PROVIDER EZ FLU

SHOT .............................. 137 MEDICAL PROVIDER EZ

FLUVIRIN ........................ 137 medolor pak .......................... 15 medroxyprogesterone acetate

.................................126, 127 mefenamic acid ..................... 13 mefloquine hcl ....................... 48 mega-c/a plus ....................... 93 megestrol acetate ............... 127 MEKINIST ............................. 45 melodetta 24 fe ................... 127 meloxicam ............................. 13 melphalan ............................. 45 melphalan hcl ........................ 45 memantine hcl ....................... 32 memantine hcl er .................. 32 MENACTRA ........................ 137 MENOMUNE....................... 137 MENOSTAR ....................... 127 MENVEO ............................ 138 meperidine hcl ......................... 8 meperidine hcl-sodium chloride8 meperidine-promethazine ....... 8 MEPHYTON ......................... 93 meprobamate ........................ 53 MEPSEVII ........................... 111 mercaptopurine ..................... 45 meropenem ........................... 24

172

meropenem-sodium chloride .. 24 mesalamine ......................... 139 mesalamine-cleanser ........... 139 mesna .................................... 45 MESTINON ............................ 40 metadate er ........................... 68 metafolbic plus rf .................... 93 metaproterenol sulfate ......... 157 metaxall ............................... 160 metaxalone .......................... 160 metformin hcl ......................... 81 metformin hcl er ..................... 81 metformin hcl er (mod) ........... 81 metformin hcl er (osm) ........... 81 methadone hcl .........................8 methadone hcl intensol ............8 methadose ...............................8 methadose sugar-free ..............8 methamphetamine hcl ............ 68 methazolamide .................... 147 methenamine hippurate ......... 24 methenamine mandelate ....... 24 methergine ........................... 144 methimazole ........................ 131 methocarbamol .................... 160 methohexital sodium ............ 144 methotrexate ........................ 134 methotrexate sodium ........... 134 methotrexate sodium (pf) ..... 134 methoxsalen .......................... 75 methoxsalen rapid ................. 75 methscopolamine bromide ... 109 methyclothiazide .................... 62 methyl salicylate .................... 75 methyldopa ............................ 62 methyldopa-hydrochlorothiazide

.......................................... 62 methyldopate hcl .................... 62 methylene blue .................... 144 methylergonovine maleate ... 144 methylfol-algae-b12-acetylcyst

.......................................... 93 methylphenidate hcl ............... 68 methylphenidate hcl er ........... 68 methylphenidate hcl er (cd) .... 68 methylphenidate hcl er (la) ..... 68 methylprednisolone .............. 117 methylprednisolone ace-lido 117 methylprednisolone acetate . 117 methylprednisolone sodium

succ ................................. 117 methyltestosterone .............. 119 metipranolol ......................... 147 metoclopramide hcl ................ 36 metolazone ............................ 62

metopic.................................. 75 metoprolol succinate er ......... 62 metoprolol tartrate ................. 62 metoprolol-hydrochlorothiazide

.......................................... 62 metronidazole .................. 24, 75 metronidazole in nacl ............. 24 mexiletine hcl......................... 62 MIACALCIN ......................... 140 mibelas 24 fe ....................... 127 miconazole 3 ......................... 38 MICRHOGAM ULTRA-

FILTERED PLUS ............. 134 microgestin 1.5/30 ............... 127 microgestin 1/20 .................. 127 microgestin fe 1.5/30 ........... 127 microgestin fe 1/20 .............. 127 midazolam hcl ....................... 53 midazolam hcl-nacl ................ 53 midazolam hcl-sodium chloride

.......................................... 53 midodrine hcl ......................... 62 miglitol ................................... 81 miglustat .............................. 111 mili ....................................... 127 milrinone lactate .................... 62 milrinone lactate in dextrose .. 62 mimvey ................................ 127 mimvey lo ............................ 127 mineral oil heavy ................. 109 minitran ................................. 62 minocycline hcl ...................... 24 minocycline hcl er .................. 24 minoxidil ................................ 62 mirtazapine ............................ 34 MIRVASO .............................. 76 misoprostol .......................... 106 mitomycin .............................. 45 mitoxantrone hcl .................... 45 mm anti-diarrheal ................ 109 modafinil .............................. 161 moderiba ............................... 51 MODERIBA 1200 DOSE PACK

.......................................... 50 MODERIBA 800 DOSE PACK

.......................................... 50 moexipril hcl .......................... 62 moexipril-hydrochlorothiazide 62 mometasone furoate.... 117, 152 mondoxyne nl ........................ 24 monoject flush syr/hep lock . 144 monoject flush syringe ........... 93 monoject prefill adv heparin . 144 monoject sodium chloride flush

.......................................... 93

mono-linyah ........................ 127 mononessa ......................... 127 montelukast sodium ............ 157 morgidox ............................... 24 morphine sulfate ..................... 9 morphine sulfate (concentrate) 8 morphine sulfate (pf) ............... 8 morphine sulfate er ................. 9 morphine sulfate er beads ....... 9 morphine sulfate-nacl .............. 9 moxifloxacin hcl ............. 24, 146 moxifloxacin hcl in nacl ......... 24 MS CONTIN ............................ 9 multi vitamin/fluoride ............. 93 multigen ................................ 93 multigen folic ......................... 93 multigen plus ......................... 93 multitrace-4 ........................... 93 multitrace-4 concentrate ........ 93 multitrace-4 neonatal ............. 93 multitrace-5 ........................... 93 multitrace-5 concentrate ........ 93 multi-vit/fluoride ..................... 93 multi-vit/fluoride/iron .............. 93 multi-vit/iron/fluoride .............. 93 multivitamin/fluoride ........ 93, 94 multi-vitamin/fluoride ............. 93 multi-vitamin/fluoride ............. 94 multivitamin/fluoride/iron ....... 94 multi-vitamin/fluoride/iron ...... 94 multivitamins/fluoride ............. 94 mupirocin .............................. 25 mupirocin calcium ................. 25 mutamycin ............................ 45 mvc-fluoride .......................... 94 m-vit ...................................... 94 MYALEPT ........................... 144 MYCAMINE .......................... 38 mycophenolate mofetil ........ 134 mycophenolate mofetil hcl ... 134 mycophenolate sodium ....... 134 myferon 150 forte .................. 94 mynatal ................................. 94 MYNATAL ............................. 94 mynatal advance ................... 94 mynatal plus .......................... 94 mynatal-z .............................. 94 mynate 90 plus ...................... 94 mynephrocaps ...................... 94 mynephron ............................ 94 myorisan ............................... 76 MYRBETRIQ....................... 112 myzilra ................................ 127 N na ferric gluc cplx in sucrose . 94

173

nabi-hb ................................ 134 nabumetone ........................... 13 n-acetyl-l-cysteine .................. 94 nadolol ................................... 62 nadolol-bendroflumethiazide .. 62 nafcillin sodium ...................... 25 nafcillin sodium in dextrose .... 25 nafrinse .................................. 94 nafrinse drops ........................ 94 naftifine hcl ............................ 38 NAGLAZYME....................... 111 nalbuphine hcl..........................9 NAMENDA XR TITRATION

PACK ................................. 32 naproxen ................................ 13 naproxen dr ........................... 13 naproxen sodium ................... 13 naproxen sodium er ............... 13 naratriptan hcl ........................ 39 NASONEX ........................... 152 NATACHEW .......................... 94 NATALVIT ............................. 94 nateglinide ............................. 81 NATELLE ONE ...................... 94 NATESTO ............................ 119 NATPARA ............................ 140 nature-throid ........................ 131 nausatrol ................................ 36 nebusal ................................ 153 necon 0.5/35 (28) ................. 127 necon 1/35 (28) .................... 127 necon 1/50 (28) .................... 127 necon 7/7/7 .......................... 127 NEEVO DHA ......................... 95 nefazodone hcl ...................... 34 neomycin sulfate .................... 25 neomycin-bacitracin zn-polymyx

........................................ 149 neomycin-polymyxin b gu ...... 25 neomycin-polymyxin-dexameth

........................................ 149 neomycin-polymyxin-gramicidin

........................................ 149 neomycin-polymyxin-hc 149, 150 neo-polycin .......................... 149 neo-polycin hc...................... 149 neostigmine methylsulfate ..... 40 nephronex .............................. 95 NERLYNX .............................. 45 NESTABS .............................. 95 NESTABS ABC ...................... 95 NESTABS DHA ..................... 95 NESTABS ONE ..................... 95 neuac ..................................... 76 NEULASTA ............................ 54

NEULASTA ONPRO ............. 54 NEUPOGEN .......................... 54 neutragard advanced ............. 71 neutral sodium fluoride .......... 71 NEWGEN .............................. 95 NEXA PLUS .......................... 95 NEXAVAR ............................. 46 niacin er (antihyperlipidemic) . 63 niacor .................................... 63 NIASPAN .............................. 63 nicardipine hcl ....................... 63 NICORETTE ......................... 17 nicotine polacrilex .................. 17 nicotine step 1 ....................... 17 nicotine step 2 ....................... 17 nicotine step 3 ....................... 17 NICOTROL ............................ 17 NICOTROL NS ...................... 17 nifedical xl ............................. 63 nifedipine ............................... 63 nifedipine er ........................... 63 nifedipine er osmotic release . 63 nikki ..................................... 127 nilutamide .............................. 46 nimodipine ............................. 63 NINLARO .............................. 46 nisoldipine er ......................... 63 nitrofurantoin ......................... 25 nitrofurantoin macrocrystal .... 25 nitrofurantoin monohydrate

macrocrystals .................... 25 nitroglycerin ........................... 63 nitroglycerin er ....................... 63 nitroglycerin in d5w ................ 63 nitroprusside sodium ............. 63 NITROSTAT .......................... 63 nitro-time ............................... 63 niva-fol ................................ 144 NIVA-PLUS ........................... 95 nizatidine ............................. 106 NOCTIVA ............................ 121 nodolor .................................. 13 nolix ..................................... 117 nora-be ................................ 127 NORDITROPIN FLEXPRO .. 121 norepinephrine bitartrate ....... 64 norepinephrine-dextrose ........ 64 norepinephrine-sodium chloride

.......................................... 64 norethin ace-eth estrad-fe ... 127 norethindrone ...................... 128 norethindrone acetate .......... 127 norethindrone acet-ethinyl est

........................................ 128 norethindrone-eth estradiol .. 128

norethin-eth estradiol-fe ...... 128 norgestimate-eth estradiol ... 128 norgestimate-ethinyl estradiol

triphasic........................... 128 norlyda ................................ 128 norlyroc ............................... 128 normal saline flush ................ 95 normosol-m in d5w ................ 95 normosol-r ............................. 95 normosol-r in d5w ................. 95 NORTHERA .......................... 64 nortrel 0.5/35 (28) ............... 128 nortrel 1/35 (21) .................. 128 nortrel 1/35 (28) .................. 128 nortrel 7/7/7 ......................... 128 nortriptyline hcl ...................... 34 nortuss-ex ........................... 153 NOVOFINE AUTOCOVER PEN

NEEDLE............................ 84 NOVOFINE PEN NEEDLE .... 84 NOVOFINE PLUS PEN

NEEDLE............................ 85 NOVOLIN 70/30 RELION ...... 85 NOVOLIN 70/30 VIAL ........... 85 NOVOLIN N RELION ............ 85 NOVOLIN N VIAL ................. 85 NOVOLIN R RELION ............ 85 NOVOLIN R VIAL ................. 85 NOVOLOG FLEXPEN ........... 85 NOVOLOG MIX 70/30

FLEXPEN .......................... 85 NOVOLOG MIX 70/30 VIAL .. 85 NOVOLOG PENFILL ............ 85 NOVOLOG U-100 VIAL ........ 85 NOVOTWIST PEN NEEDLE . 85 NOXAFIL .............................. 38 np thyroid ............................ 131 NPLATE ................................ 55 NUCYNTA .............................. 9 nudiclo solupak ..................... 13 nudiclo tabpak ....................... 13 nufol ...................................... 95 nulev ................................... 109 numoisyn .............................. 71 nutriarx creampak ............... 118 nutricap ................................. 95 nutrifac zx ............................. 95 nutrilipid ................................ 95 nutrilyte ................................. 95 NUTROPIN AQ NUSPIN 10 121 NUTROPIN AQ NUSPIN 20 121 NUTROPIN AQ NUSPIN 5 .. 121 NUVARING ......................... 128 NUVIGIL ............................. 161 nyamyc ................................. 38

174

nyata ...................................... 38 nystatin .................................. 38 nystatin-triamcinolone ............ 38 nystop .................................... 38 O OB COMPLETE ..................... 95 OB COMPLETE ADVANCED 95 OB COMPLETE GOLD .......... 95 OB COMPLETE ONE ............ 95 OB COMPLETE PETITE ....... 95 OB COMPLETE PREMIER .... 95 OB COMPLETE/DHA ............ 95 OBSTETRIX DHA .................. 95 obstetrix ec ............................ 95 OBSTETRIX ONE .................. 96 O-CAL FA .............................. 96 O-CAL PRENATAL ................ 96 ocella ................................... 128 OCTAGAM .......................... 134 octreotide acetate ................ 121 ocucoat viscoadherent ......... 149 ODOMZO .............................. 46 OFEV ................................... 157 ofloxacin ................ 25, 146, 150 ogestrel ................................ 128 okebo ..................................... 25 olmesartan medoxomil ........... 64 olmesartan medoxomil-hctz ... 64 olmesartan-amlodipine-hctz ... 64 olopatadine hcl............. 146, 153 OLYSIO ................................. 51 omega-3-acid ethyl esters ...... 64 omeppi ................................. 106 omeprazole .......................... 106 omeprazole-sodium bicarbonate

................................ 106, 107 OMNARIS ............................ 153 OMNITROPE ....................... 121 ondansetron hcl ..................... 36 ondansetron hcl-nacl.............. 36 ondansetron odt ..................... 36 ONE-A-DAY WOMENS

PRENATAL ........................ 96 ONGLYZA ............................. 81 OPANA ER ..............................9 opium ................................... 109 OPSUMIT ............................ 159 oralone .................................. 71 ORENITRAM ....................... 159 ORKAMBI ............................ 159 orphenadrine citrate ............. 160 orphenadrine citrate er ......... 160 orsythia ................................ 128 ortho-cs 250 ........................... 96 oscimin ................................ 109

oscimin sr ............................ 109 oseltamivir phosphate ............ 51 osmitrol.................................. 64 OTEZLA .............................. 134 otomax-hc ........................... 150 OTREXUP ........................... 135 OVIDE ................................... 48 oxacillin sodium ..................... 25 oxaliplatin .............................. 46 oxandrolone ........................ 119 oxaprozin ............................... 13 oxazepam .............................. 53 oxcarbazepine ....................... 31 oxiconazole nitrate ................ 38 oxybutynin chloride .............. 112 oxybutynin chloride er .......... 112 oxycodone hcl ................... 9, 10 oxycodone-acetaminophen.... 10 oxycodone-aspirin ................. 10 oxycodone-ibuprofen ............. 10 oxymorphone hcl ................... 10 oxymorphone hcl er ............... 10 oxytocin ............................... 121 oxytocin-dextrose ................ 121 oxytocin-sodium chloride ..... 121 OXYTROL ........................... 112 OXYTROL FOR WOMEN .... 112 P pacerone ............................... 64 paclitaxel ............................... 46 palonosetron hcl .................... 36 pamidronate disodium ......... 140 pancuronium bromide ............ 70 panlor .................................... 10 pantoprazole sodium ........... 107 papaverine hcl ....................... 64 paregoric ............................. 109 paricalcitol ........................... 140 paroex ................................... 71 paromomycin sulfate ............. 25 paroxetine hcl ........................ 34 paroxetine hcl er .................... 34 paroxetine mesylate .............. 34 pb-hyoscy-atropine-

scopolamine .................... 110 peg 3350/electrolytes .......... 110 peg 3350-kcl-na bicarb-nacl 110 peg-3350/electrolytes .......... 110 PEGASYS ............................. 51 PEGASYS PROCLICK .......... 51 PEGINTRON ......................... 51 PEG-INTRON REDIPEN PAK 4

.......................................... 51 peg-prep .............................. 110 pegylax ................................ 110

penicillin g potassium ............ 25 penicillin g procaine............... 25 penicillin g sodium ................. 25 penicillin v potassium ............ 25 PENTASA ........................... 139 pentazocine-naloxone hcl...... 10 pentobarbital sodium ............. 31 pentoxifylline er ..................... 64 pepcid ac maximum strength

........................................ 107 PERFOROMIST .................. 157 perindopril erbumine ............. 64 periogard ............................... 71 permethrin ............................. 48 perphenazine-amitriptyline .... 34 pfizerpen ............................... 25 phenadoz ............................ 153 phenazo .............................. 112 phenazopyridine hcl ............ 112 phendimetrazine tartrate ....... 70 phendimetrazine tartrate er ... 70 phenergan ........................... 153 phenobarbital ........................ 31 phenobarbital sodium ............ 31 phenobarbital-belladonna alk

........................................ 110 phenohytro .......................... 110 phenoxybenzamine hcl ......... 64 phentermine hcl .................... 70 phentolamine mesylate ......... 64 phenylephrine hcl .......... 64, 149 phenylephrine hcl-nacl .......... 64 phenylephrine-guaifenesin .. 153 phenytoin .............................. 31 phenytoin infatabs ................. 31 phenytoin sodium .................. 31 phenytoin sodium extended .. 31 philith .................................. 128 phos-flur ................................ 71 phospha 250 neutral ............. 96 phosphasal ......................... 112 phosphorous ......................... 96 phospho-trin 250 neutral ....... 96 phrenilin forte ........................ 10 phytonadione ........................ 96 pilocarpine hcl ............... 72, 147 pimtrea ................................ 128 pindolol ................................. 65 pioglitazone hcl ..................... 81 pioglitazone hcl-glimepiride ... 81 pioglitazone hcl-metformin hcl 81 piperacillin sod-tazobactam so

.......................................... 25 pirmella 1/35 ....................... 128 pirmella 7/7/7 ...................... 128

175

piroxicam ............................... 13 piston irrigation syringe ........ 144 PLAN B ONE-STEP ............. 128 plasbumin-25 ....................... 144 plasbumin-5 ......................... 144 PLEGRIDY ............................ 69 PLEGRIDY STARTER PACK 69 plenamine .............................. 96 pneumovax 23 ..................... 138 PNEUMOVAX 23 ................. 138 PNV FOLIC ACID + IRON ..... 96 PNV OB+DHA ....................... 96 PNV PRENATAL PLUS

MULTIVIT+DHA ................. 96 PNV PRENATAL PLUS

MULTIVITAMIN.................. 96 PNV TABS 29-1 ..................... 96 pnv-dha.................................. 96 PNV-DHA+DOCUSATE ......... 96 PNV-OMEGA ......................... 96 pnv-select .............................. 96 PNV-TOTAL .......................... 96 PNV-VP-U ............................. 96 pocket spacer ...................... 144 podocon ................................. 76 podofilox ................................ 76 polocaine ............................... 15 polocaine-mpf ........................ 16 polycin ................................. 149 polyethylene glycol 3350 ...... 110 poly-iron 150 forte .................. 96 polymyxin b sulfate ................ 25 polymyxin b-trimethoprim ..... 149 polysaccharide iron forte ........ 96 POMALYST ........................... 46 portia-28 .............................. 128 port-prep ................................ 16 pot bicarb-pot chloride ........... 97 potassium acetate .................. 97 potassium bicarbonate ........... 97 potassium chloride ................. 97 potassium chloride crys er ..... 97 potassium chloride er ............. 97 potassium chloride in dextrose

.......................................... 97 potassium chloride in nacl ...... 97 potassium citrate er ............... 97 potassium citrate-citric acid .... 97 potassium phosphates ........... 97 pr benzoyl peroxide wash ...... 76 pr natal 400 ............................ 97 pr natal 400 ec ....................... 97 pr natal 430 ............................ 98 pr natal 430 ec ....................... 98 PRADAXA ............................. 29

pralidoxime chloride............. 144 pramcort .............................. 139 pramipexole dihydrochloride .. 49 pramipexole dihydrochloride er

.......................................... 49 pramox .................................. 76 prasugrel hcl .......................... 50 pravastatin sodium ................ 65 praziquantel ........................... 48 prazosin hcl ........................... 65 prednicarbate ...................... 118 prednisolone ........................ 118 prednisolone acetate ........... 146 prednisolone acetate p-f ...... 146 prednisolone sodium phosphate

................................ 118, 146 prednisolone-moxifloxacin ... 149 prednisolon-moxiflox-bromfenac

........................................ 146 prednisone .......................... 118 PREFERA OB ....................... 98 PREFERAOB +DHA .............. 98 PREFERAOB ONE ............... 98 PREFEST ............................ 129 PREMARIN ......................... 129 premasol ............................... 98 PREMASOL .......................... 98 PREMESISRX ....................... 98 premium condoms lubricated

........................................ 144 premium lidocaine ................. 16 PREMPHASE ...................... 129 PREMPRO .......................... 129 PRENA 1 TRUE .................... 98 PRENA1 ................................ 98 PRENA1 PEARL ................... 98 PRENAISSANCE .................. 98 PRENAISSANCE BALANCE . 98 PRENAISSANCE HARMONY

DHA ................................... 98 PRENAISSANCE NEXT ........ 98 PRENAISSANCE NEXT-B .... 98 prenaissance plus ................. 98 PRENATA ............................. 98 prenatabs rx .......................... 98 prenatal ................................. 99 PRENATAL ........................... 99 PRENATAL + DHA ................ 98 prenatal 19 ...................... 98, 99 PRENATAL 19 ................ 98, 99 prenatal low iron .................... 99 PRENATAL MULTI +DHA ..... 99 PRENATAL PLUS ................. 99 PRENATAL PLUS IRON ....... 99

PRENATAL VITAMIN PLUS LOW IRON ........................ 99

prenatal-u .............................. 99 PRENATE ............................. 99 PRENATE AM ....................... 99 PRENATE DHA .................... 99 PRENATE ELITE .................. 99 PRENATE ENHANCE ........... 99 PRENATE ESSENTIAL ........ 99 PRENATE MINI .................... 99 PRENATE PIXIE ................... 99 PRENATE RESTORE ........... 99 PREPLUS ............................. 99 PRETAB ............................... 99 PREVACID SOLUTAB ........ 107 prevalite ................................ 65 prevident ............................... 72 previdolrx plus analgesic ....... 13 previfem .............................. 129 PREVNAR 13...................... 138 PREVYMIS ........................... 51 prikaan .................................. 16 prikaan lite ............................ 16 prilolid ................................... 16 PRILOSEC OTC ................. 107 priloxx lp ................................ 16 PRIMACARE......................... 99 primaquine phosphate ........... 48 primidone .............................. 31 PRIVIGEN ........................... 135 PRO COMFORT INSULIN

SYRINGE .......................... 85 PROAIR HFA ...................... 157 probenecid ............................ 39 procainamide hcl ................... 65 prochlorperazine ................... 36 prochlorperazine edisylate .... 36 prochlorperazine maleate ...... 36 PROCRIT .............................. 55 procto-med hc ..................... 139 procto-pak ........................... 139 proctosol hc ........................ 139 proctozone-hc ..................... 139 PROCYSBI ......................... 111 profeno.................................. 13 progesterone ....................... 129 progesterone micronized ..... 129 PROLASTIN-C .................... 157 PROLIA ............................... 141 promethazine hcl ................. 153 promethazine vc plain ......... 153 promethazine vc/codeine .... 153 promethazine-codeine ......... 153 promethazine-dm ................ 153

176

promethazine-phenyleph-codeine ............................ 153

promethazine-phenylephrine 153 promethegan ....................... 153 propafenone hcl ..................... 65 propafenone hcl er ................. 65 propantheline bromide ......... 110 proparacaine hcl .................. 149 proparacaine-fluorescein ..... 149 propofol................................ 144 propranolol hcl ....................... 65 propranolol hcl er ................... 65 propranolol-hctz ..................... 65 propylthiouracil..................... 131 protamine sulfate ................... 55 protriptyline hcl....................... 34 PROVENTIL HFA ................ 157 PROVIDA DHA .................... 100 PROVIDA OB ...................... 100 PROVIGIL ............................ 161 prutect ................................... 76 pseudoeph-chlorphen-hydrocod

........................................ 153 pseudoephedrine-bromphen-dm

........................................ 153 PULMICORT FLEXHALER .. 157 PULMICORT SUSPENSION157 pulmosal .............................. 154 PULMOZYME ...................... 159 PUREFE OB PLUS .............. 100 purevit dualfe plus ................ 100 pyrazinamide ......................... 41 pyridostigmine bromide .......... 40 pyridostigmine bromide er ...... 40 pyridoxine hcl ....................... 100 pyrogallic acid ........................ 76 Q QSYMIA................................. 70 quasense ............................. 129 quazepam .............................. 53 quflora pediatric ................... 100 quinapril hcl ........................... 65 quinapril-hydrochlorothiazide . 65 quinidine gluconate ................ 65 quinidine gluconate er ............ 65 quinidine sulfate ..................... 65 quinine sulfate........................ 48 QVAR .................................. 157 QVAR REDIHALER ............. 157 R ra iron .................................. 100 RABAVERT ......................... 138 rabeprazole sodium ............. 107 radiagel .................................. 76 RADICAVA ............................ 70

rajani ................................... 129 raloxifene hcl ....................... 119 ramipril .................................. 65 RANEXA ............................... 65 ranitidine acid reducer ......... 107 ranitidine hcl ........................ 107 RAPAFLO ........................... 113 rasagiline mesylate ................ 49 RASUVO ............................. 135 RAVICTI .............................. 111 rea lo 39 ................................ 76 rea lo 40 ................................ 76 REBIF ................................... 69 REBIF REBIDOSE ................ 69 REBIF REBIDOSE TITRATION

PACK ................................ 69 REBIF TITRATION PACK ..... 69 recedo ................................... 76 reclipsen .............................. 129 regonol .................................. 40 relador pak ............................ 16 relador pak plus ..................... 16 releevia ml ............................. 16 RELENZA DISKHALER ......... 51 relexxii ................................... 68 RELNATE DHA ................... 100 RELPAX ................................ 40 remeven ................................ 76 REMICADE ......................... 135 remifentanil hcl ...................... 10 REMODULIN ....................... 159 RENAGEL ........................... 112 renal .................................... 100 rena-vite rx .......................... 100 repaglinide ............................. 81 repaglinide-metformin hcl ...... 81 REQUIP XL ........................... 49 RESTASIS .......................... 149 RESTASIS MULTIDOSE ..... 149 restizan.................................. 76 RESTORIL .......................... 161 RETIN-A ................................ 76 RETROVIR ............................ 51 reusable syringe barrel 1.5oz

........................................ 144 reusable syringe barrel 1oz . 144 reusable syringe barrel 2oz . 144 reusable syringe barrel 3oz . 144 reusable syringe barrel 4oz . 144 REVATIO ............................ 159 REVLIMID ............................. 46 revonto ................................ 160 RHOGAM ULTRA-FILTERED

PLUS ............................... 135 RHOPHYLAC ...................... 135

ribasphere ............................. 51 ribasphere ribapak ................ 51 ribavirin ................................. 51 RIDAURA ............................ 135 rifabutin ................................. 41 rifampin ................................. 41 riluzole .................................. 71 rimantadine hcl ...................... 51 ringers ................................. 100 RIOMET ................................ 81 risedronate sodium ............. 141 RITUXAN .............................. 46 rivastigmine ........................... 33 rivastigmine tartrate............... 33 rivelsa ................................. 129 rizatriptan benzoate............... 40 R-NATAL OB ...................... 100 robb-type angio syringe 80cc

........................................ 144 robitussin 12 hour cough child

........................................ 154 rocuronium bromide .............. 71 ropinirole hcl ......................... 49 ropinirole hcl er ..................... 49 ropivacaine hcl ...................... 16 ropivacaine hcl-nacl .............. 16 rosadan ................................. 76 rosanil cleanser ..................... 76 rosuvastatin calcium .............. 65 roweepra ............................... 31 roweepra xr ........................... 31 ROZEREM .......................... 161 RUBRACA ............................ 46 RYDAPT ............................... 46 ryvent .................................. 154 S SAIZEN ............................... 121 SAIZEN CLICK.EASY ......... 121 SAIZENPREP ..................... 121 salacyn.................................. 76 SALAGEN ............................. 72 salicylic acid .......................... 76 salicylic acid er ...................... 76 salicylic acid wart remover .... 76 salicylic acid-cleanser ........... 77 salimez.................................. 77 saline flush .......................... 100 saline flush zr ...................... 100 salisol forte ............................ 77 salitech forte ......................... 77 salsalate ................................ 13 salvax ................................... 77 sanadermrx skin repair ........ 118 sash kit................................ 144 SAVAYSA ............................. 29

177

SAVELLA ............................... 71 SAVELLA TITRATION PACK 71 scalacort .............................. 118 scopolamine .......................... 36 seb-prev wash ....................... 77 SELECT-OB ........................ 100 SELECT-OB+DHA ............... 100 selegiline hcl .......................... 49 selenium .............................. 100 selenium sulfide ..................... 77 selenium sulf-pyrithione-urea . 77 se-natal 19 ........................... 100 SENSIPAR .......................... 119 sensorcaine ........................... 16 sensorcaine/epinephrine ........ 16 sensorcaine-mpf .................... 16 sensorcaine-mpf spinal .......... 16 sensorcaine-mpf/epinephrine . 16 SEREVENT DISKUS ........... 157 SEROSTIM .......................... 110 sertraline hcl .................... 34, 35 se-tan plus ........................... 100 setlakin ................................ 129 sevelamer carbonate ........... 112 sevoflurane .......................... 144 sf 72 sf 5000 plus ........................... 72 sharobel ............................... 129 sharps container .................. 145 SHINGRIX ........................... 138 siderol .................................. 100 sildenafil citrate .................... 159 SILIQ ................................... 135 silver nitrate ..................... 25, 26 silver sulfadiazine .................. 26 simvastatin ............................. 65 sirolimus .............................. 135 sod benz-sod phenylacet ..... 111 sod citrate-citric acid ............ 100 sodium acetate .................... 101 sodium ascorbate ................ 101 sodium bicarbonate ..... 101, 110 sodium chloride ............ 101, 154 sodium chloride flush ........... 101 sodium fluoride .................... 101 sodium hyaluronate ............... 77 sodium lactate...................... 101 sodium nitrite ....................... 145 sodium phenylbutyrate ......... 111 sodium phosphate-nacl ........ 101 sodium phosphates .............. 101 sodium saccharin ................. 145 sodium saccharin dihydrate . 145 sodium sulfacetamide ............ 77 sodium thiosulfate ................ 145

SOLIQUA .............................. 81 SOLOSEC ............................. 48 soloxide ................................. 26 SOLU-CORTEF ................... 118 soluline .................................. 16 solupicc ................................. 16 SOMAVERT ........................ 121 sonafine................................. 77 SOOLANTRA ........................ 77 sorbitol ................................ 145 sorbitol-mannitol .................. 145 sorine .................................... 66 sotalol hcl .............................. 66 sotalol hcl (af) ........................ 66 SOVALDI ............................... 51 spinosad ................................ 48 SPIRIVA HANDIHALER ...... 158 SPIRIVA RESPIMAT ........... 158 spironolactone ....................... 66 spironolactone-hctz ............... 66 sprintec 28 ........................... 129 SPRYCEL ............................. 46 sronyx ................................. 129 ssd ........................................ 26 sss 10-5 ................................. 77 STEGLATRO......................... 81 STEGLUJAN ......................... 81 STIMATE ............................. 121 STIOLTO RESPIMAT .......... 158 STIVARGA ............................ 46 stool softener ....................... 110 streptomycin sulfate............... 26 STRIVERDI RESPIMAT ...... 158 strovite forte ........................ 101 subvenite ............................... 31 subvenite starter kit-blue ....... 31 subvenite starter kit-green ..... 31 subvenite starter kit-orange ... 31 succinylcholine chloride ......... 71 sucralfate ............................. 107 sufentanil citrate .................... 10 sulfacetamide sodium .... 77, 147 sulfacetamide sodium (acne) . 77 sulfacetamide sodium-sulfur . 77,

78 sulfacetamide sod-sulfur wash

.......................................... 78 sulfacetamide-prednisolone . 149 sulfacetamide-sulfur in urea ... 78 sulfacetamide-sulfur-sunscreen

.......................................... 78 sulfacleanse 8/4 .................... 78 sulfadiazine ........................... 26 sulfamethoxazole-trimethoprim

.......................................... 26

sulfamez wash ...................... 78 sulfasalazine ....................... 139 sulfatrim pediatric .................. 26 sulfurated lime ....................... 48 sulindac ................................. 13 sumatriptan ........................... 40 sumatriptan succinate ........... 40 sumatriptan succinate refill .... 40 sumatriptan-naproxen sodium 40 SUPPRELIN LA .................. 121 SUPRAX ............................... 26 sure result dss premium pack 14 SUTENT ............................... 46 swabflush saline flush ......... 101 syeda .................................. 129 symax-sl .............................. 110 symax-sr ............................. 110 SYMBICORT....................... 158 SYMLINPEN 120 .................. 81 SYMLINPEN 60 .................... 81 synalar ................................ 118 SYNAREL ........................... 122 SYNJARDY ........................... 82 SYNJARDY XR ..................... 82 SYNTHAMIN 17 .................. 101 SYNTHROID ....................... 131 synvexia ................................ 16 T tacrolimus ..................... 78, 135 TAFINLAR ............................ 46 TAGRISSO ........................... 46 TAMIFLU .............................. 51 tamoxifen citrate .................... 46 tamsulosin hcl ..................... 113 tandem f .............................. 101 TANZEUM ............................ 82 TARCEVA ............................. 46 TARGRETIN ......................... 46 tarina fe 1/20 ....................... 129 TARON-BC ......................... 101 TARON-C DHA ................... 101 taron-crystals ...................... 101 taron-prex ........................... 101 TASIGNA .............................. 46 tazarotene ............................. 78 tazicef ................................... 26 TAZORAC ............................. 78 taztia xt ................................. 66 tb syringe 1 ml ..................... 145 TECENTRIQ ......................... 46 TECFIDERA ......................... 69 TECHNIVIE ........................... 51 telmisartan ............................ 66 telmisartan-amlodipine .......... 66 telmisartan-hctz ..................... 66

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temazepam .......................... 161 temozolomide ........................ 46 tencon .................................... 10 teniposide .............................. 46 TENIVAC ............................. 138 terazosin hcl ........................ 113 terbinafine hcl ........................ 38 terbutaline sulfate ................ 158 terconazole ...................... 38, 39 terrell ................................... 145 TESTIM ............................... 119 testosterone ......................... 119 TESTOSTERONE ............... 119 testosterone cypionate ......... 119 testosterone enanthate ........ 119 tetanus-diphtheria toxoids td 138 tetcaine ................................ 149 tetrabenazine ......................... 71 tetracaine hcl ................. 16, 149 tetracycline hcl ....................... 26 tetravisc ............................... 149 tetravisc forte ....................... 149 tetrix ....................................... 78 tgt clotrimazole ....................... 39 THALOMID ............................ 47 theochron ............................. 158 theophylline ......................... 158 theophylline er ..................... 158 theophylline in d5w .............. 158 thiamine hcl ......................... 101 thiotepa .................................. 47 THRIVITE 19 ....................... 101 THRIVITE RX ...................... 101 THROMBATE III .................... 29 THYMOGLOBULIN .............. 135 THYROGEN ........................ 145 tiagabine hcl .......................... 31 TICE BCG ............................ 135 tigecycline .............................. 26 tilia fe ................................... 129 timolol maleate............... 66, 147 tinidazole ............................... 26 titus needle 18gx1-1/4 .......... 145 tizanidine hcl ........................ 160 TL FOLATE ......................... 102 tl gard rx............................... 102 tl icon ................................... 102 TL-CARE DHA ..................... 102 tl-hem 150 ............................ 102 TL-SELECT ......................... 102 TOBI NEBULIZER ............... 159 TOBI PODHALER ................ 159 tobramycin ................... 147, 159 TOBRAMYCIN ..................... 159 tobramycin sulfate .................. 26

tobramycin-dexamethasone 149 TODAY SPONGE ................ 145 tolazamide ............................. 82 tolbutamide ............................ 82 tolcapone ............................... 49 tolmetin sodium ..................... 14 tolterodine tartrate ............... 112 tolterodine tartrate er ........... 112 tonsil ndl curved 23gx1/2 ..... 145 tonsil ndl straight 23gx3/4 .... 145 topex topical anesthetic ......... 72 topiramate ............................. 32 topiramate er ......................... 31 toposar .................................. 47 topotecan hcl ......................... 47 TORISEL ............................. 135 torsemide .............................. 66 TOUJEO MAX SOLOSTAR ... 85 TOUJEO SOLOSTAR ........... 85 TOVIAZ ............................... 112 tpn electrolytes .................... 102 TRACLEER ......................... 159 tramadol hcl ........................... 10 tramadol hcl er ....................... 10 tramadol hcl er (biphasic) ...... 10 tramadol-acetaminophen ....... 10 trandolapril ............................ 66 trandolapril-verapamil hcl er .. 66 tranexamic acid ..................... 55 TRAVASOL ......................... 102 trazodone hcl ......................... 35 TREANDA ............................. 47 TRELEGY ELLIPTA ............ 158 TRELSTAR MIXJECT ......... 122 TRESIBA FLEXTOUCH ........ 85 tretinoin ........................... 47, 78 tretinoin microsphere ............. 78 tretinoin microsphere pump ... 78 TRETIN-X .............................. 78 tri femynor ........................... 129 triamcinolone acetonide 72, 118,

154 triamterene-hctz .................... 66 triazolam .......................... 53, 54 tricare .................................. 102 TRICARE PRENATAL ......... 102 TRICARE PRENATAL 1 ...... 102 TRICARE PRENATAL

COMPLEAT ..................... 102 TRICARE PRENATAL DHA

ONE ................................ 102 tricitrates .............................. 102 tricon ................................... 102 triderm ................................. 118 tri-estarylla ........................... 129

trifluridine ............................ 147 trigels-f forte ........................ 102 triklo ...................................... 66 tri-legest fe .......................... 129 tri-linyah .............................. 129 tri-lo-estarylla ...................... 129 tri-lo-marzia ......................... 129 tri-lo-sprintec ....................... 129 trilyte ................................... 110 trimethobenzamide hcl .......... 36 trimethoprim .......................... 26 tri-mili .................................. 130 trimipramine maleate ............. 35 TRINATAL GT ..................... 102 trinatal rx 1 .......................... 102 trinate .................................. 102 trinessa (28) ........................ 130 trinessa lo ........................... 130 triphrocaps .......................... 102 triple dye ............................... 26 tri-previfem .......................... 130 tri-sila .................................. 118 tri-sprintec ........................... 130 TRISTART DHA .................. 102 TRISTART ONE .................. 102 TRI-TABS DHA ................... 102 TRIVEEN-DUO DHA ........... 102 tri-vit/fluoride ....................... 103 tri-vit/fluoride/iron ................ 103 tri-vitamin/fluoride ................ 103 trivora (28) .......................... 130 tri-vylibra ............................. 130 tronvite ................................ 103 TROPHAMINE .................... 103 tropicamide ......................... 149 tropicamide-cyclopentolate-pe

........................................ 150 trospium chloride ................. 113 trospium chloride er............. 113 TRULICITY ........................... 82 TRUMENBA ........................ 138 TRUSTEX NON-LUBRICATED

........................................ 145 TRUSTEX RIA NON-

LUBRICATED ................. 145 tryptophan ........................... 103 TUDORZA PRESSAIR ........ 158 tulana .................................. 130 turpentine .............................. 78 tussigon .............................. 154 TWINRIX ............................. 138 tydemy ................................ 130 TYGACIL .............................. 26 TYKERB ............................... 47 TYMLOS ............................. 141

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TYSABRI ............................... 69 U UCERIS ............................... 140 ULORIC ................................. 39 ultimatecare one .................. 103 umecta mousse ..................... 78 UNASYN ................................ 27 unithroid ............................... 131 unithroid direct ..................... 131 UPTRAVI ............................. 159 ur n-c ................................... 113 uramaxin ................................ 78 uramit mb ............................. 113 urea ................................. 78, 79 urea hydrating ........................ 79 urea in zn undecyl-lactic acid . 79 urea nail ................................. 79 urea-c40 ................................ 79 uredeb ................................... 79 ure-k ...................................... 79 urelle .................................... 113 uremez-40 ............................. 79 uretron d/s ........................... 113 uribel .................................... 113 urimar-t ................................ 113 urin ds .................................. 113 uro-458 ................................ 113 uroav-81 .............................. 113 uroav-b ................................ 113 uro-mp ................................. 113 urophen mb ......................... 113 urosex .................................. 103 ursodiol ................................ 110 uryl ....................................... 113 ustell .................................... 113 uta ....................................... 113 uticap ................................... 113 utira-c .................................. 113 utrona-c ............................... 113 V VAGIFEM ............................ 130 valacyclovir hcl ....................... 52 VALCHLOR ........................... 47 valganciclovir hcl .................... 52 valproate sodium ................... 32 valproic acid ........................... 32 valsartan ................................ 66 valsartan-hydrochlorothiazide 66 vanatol lq ............................... 10 vanatol s ................................ 10 VANCOCIN HCL .................... 27 vancomycin hcl ...................... 27 vancomycin hcl in dextrose .... 27 vancomycin hcl in nacl ........... 27

VANCOMYCIN+SYRSPEND SF PH4 ................................... 27

vandazole .............................. 27 VANTAS .............................. 122 VAQTA ................................ 138 VARIVAX ............................. 138 VARUBI ................................. 36 vashe cleansing ..................... 79 vasopressin-sodium chloride 122 v-c forte ............................... 103 vcf vaginal contraceptive ..... 145 VECTICAL ............................. 79 vecuronium bromide .............. 71 vecuronium bromide-nacl .... 160 VELCADE ............................. 47 velivet .................................. 130 VEMAVITE-PRX 2 ............... 103 VENA-BAL DHA .................. 103 VENCLEXTA ......................... 47 venlafaxine hcl ....................... 35 venlafaxine hcl er .................. 35 VENTAVIS .......................... 159 VENTOLIN HFA .................. 158 verapamil hcl ......................... 67 verapamil hcl er ..................... 67 verdrocet ............................... 10 VERIPRED 20 ..................... 119 VERZENIO ............................ 47 VESICARE .......................... 113 vestura ................................ 130 VFEND .................................. 39 VFEND IV .............................. 39 VIBATIV ................................ 27 vic-forte ............................... 103 vicodin ................................... 11 vicodin es .............................. 10 vicodin hp .............................. 11 VICTOZA ............................... 82 VIEKIRA PAK ........................ 52 vienva .................................. 130 vigabatrin ............................... 32 vigadrone .............................. 32 VIGAMOX ........................... 147 VIIBRYD ................................ 35 vilamit mb ............................ 113 vilevev mb ........................... 113 VIMPAT ................................. 32 VINATE DHA RF ................. 103 vinate ii ................................ 103 vinate m ............................... 103 vinate one ............................ 103 vinblastine sulfate .................. 47 vincasar pfs ........................... 47 vincristine sulfate ................... 47 vinorelbine tartrate ................. 47

viorele ................................. 130 VIROPTIC ........................... 147 VIRT NATE ......................... 103 VIRT-ADVANCE ................. 103 VIRT-C DHA ....................... 103 virt-caps .............................. 103 virt-gard ............................... 103 VIRT-NATE DHA ................ 103 virt-phos 250 neutral ........... 103 VIRT-PN ............................. 103 VIRT-PN DHA ..................... 103 VIRT-PN PLUS ................... 104 VIRTPREX .......................... 104 virtrate-2 .............................. 104 virtrate-3 .............................. 104 virtrate-k .............................. 104 VIRT-SELECT ..................... 104 virt-vite ................................ 104 virt-vite forte ........................ 145 VIRT-VITE GT ..................... 104 virt-vite plus ......................... 104 VISTOGARD ....................... 145 VISUDYNE ......................... 150 vit b12-methionine-inos-chol 104 vita s forte ........................... 104 vitacel ................................. 104 VITAFOL FE+ ..................... 104 VITAFOL GUMMIES ........... 104 VITAFOL ULTRA ................ 104 VITAFOL-NANO ................. 104 vitafol-ob ............................. 104 VITAFOL-OB+DHA ............. 104 VITAFOL-ONE .................... 104 vitamax pediatric ................. 104 VITAMEDMD ONE

RX/QUATREFOLIC ......... 104 VITAMEDMD PLUS

RX/QUATREFOLIC ......... 104 VITAMEDMD REDICHEW RX

........................................ 104 vita-min ............................... 105 vitamin b complex 100 ........ 104 vitamin b-6 .......................... 104 vitamin b-complex 100 ........ 104 vitamin d (ergocalciferol) ..... 105 vitamin k1 ............................ 105 vitamins acd-fluoride ........... 105 VITAPEARL ........................ 105 VITA-PREN ......................... 105 VITATRUE .......................... 105 VIVA DHA ........................... 105 VIVELLE-DOT ..................... 130 VOGELXO .......................... 119 VOGELXO PUMP ............... 119 VOL-PLUS .......................... 105

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VOL-TAB RX ....................... 105 voriconazole .......................... 39 VOTRIENT ............................ 47 VP-CH-PNV ......................... 105 VP-GGR-B6 PRENATAL ..... 105 VP-HEME OB ...................... 105 VP-HEME OB + DHA ........... 105 VP-HEME ONE .................... 105 VP-PNV-DHA....................... 105 vp-precip .............................. 145 vp-vite rx .............................. 105 vyfemla ................................ 130 vylibra .................................. 130 VYVANSE .............................. 68 W wal-dryl allergy ..................... 154 wal-fex d allergy & congestion

........................................ 154 wal-zyr ................................. 154 warfarin sodium ..................... 29 wera ..................................... 130 westhroid ............................. 131 wheat germ oil ..................... 105 WINRHO SDF...................... 135 wymzya fe ............................ 130 X XARELTO .............................. 29 XARELTO STARTER PACK .. 29 xelitral .................................... 14

xenaflamm ............................. 14 XENICAL ............................... 71 XERMELO ........................... 110 XIFAXAN ............................... 27 XIGDUO XR .......................... 82 XOLAIR ............................... 154 XOPENEX HFA ................... 158 xulane ................................. 130 XURIDEN ............................ 145 xylocaine dental ..................... 16 xylon ...................................... 11 Y yf-vax .................................. 138 yuvafem ............................... 130 Z zaclir cleansing ...................... 79 zafirlukast ............................ 158 zaleplon ............................... 161 zarah ................................... 130 ZARXIO ................................. 55 ZATEAN-PN DHA ............... 105 ZATEAN-PN PLUS .............. 105 zebutal .................................. 11 ZEJULA ................................. 47 ZEMAIRA ............................ 158 zenatane ............................... 79 zenchent .............................. 130 zencia .................................... 79 zenzedi .................................. 68

ZEPATIER ............................ 52 zeruvia .................................. 16 ZETIA ................................... 67 zidovudine ............................. 52 zileuton er ........................... 158 ZINBRYTA ............................ 70 zinc sulfate .......................... 105 zinc trace metal ................... 105 ZIRGAN .............................. 147 ZOHYDRO ER ...................... 11 ZOLADEX ........................... 122 zoledronic acid .................... 141 zolmitriptan ........................... 40 ZOLOFT ................................ 35 zolpidem tartrate ................. 161 zolpidem tartrate er ............. 161 ZOMACTON ....................... 122 ZOMIG .................................. 40 zonisamide ............................ 32 ZORBTIVE .......................... 110 ZOSTAVAX ......................... 138 zovia 1/35e (28) .................. 130 zovia 1/50e (28) .................. 130 ZURAMPIC ........................... 39 ZYDELIG .............................. 47 ZYKADIA .............................. 47 ZYRTEC ALLERGY ............ 154 ZYRTEC ALLERGY

CHILDRENS ................... 154

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GCHP_Formulary_English_Effective 7/2018

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JULY 2018 Q3

FORMULARY Q3 - Gold Coast Health Plan

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