GlobalHealth Precision Federal

2018 Formulary Drug List

For Federal Employees Health Benefits Program Employees

MFEHBDF18 Lists Updated 11/2017

GlobalHealth, Inc. 701 NE 10th Street, Suite 300

Oklahoma City, OK 73104-5403 www.GlobalHealth.com/fehb

http://www.momentum-health.com/home.aspx

i

HELPFUL NUMBERS Plan Issuer: GlobalHealth, Inc. PO Box 2393 Oklahoma City, OK 73101-2393 GlobalHealth Customer Care, Language Assistance, and Disease Management: [email protected] 405.280.2989 (local) 1.877.280.2989 (toll-free) 711 (TTY) Monday – Friday, 9 a.m. – 5 p.m. Central www.GlobalHealth.com/fehb Behavioral Health and Substance Use: [email protected] 405.280.2989 (local) 1.877.280.2989 (toll-free) 711 (TTY) Monday – Friday, 9 a.m. – 5 p.m. Central www.GlobalHealth.com/fehb Pharmacy Benefits Manager: Magellan Rx Management, LLC Customer Service 1.800.424.1789 (toll-free) 711 (TTY)

Medication Prior Authorizations: [email protected] 918.878.7361 Mail Claims to: Magellan Rx Management, LLC PO Box 85042 Richmond, VA 23261-5042 Mail Order Pharmacy: Magellan Rx Management, LLC 1.800.424.1789 (toll-free) 711 (TTY) P.O. Box 620968 Orlando, FL 32862 24/7 Nurse Help Line: Information Line 1.877.280.2993 (toll-free) GlobalHealth Compliance Officer: 1.877.280.5852 (toll-free) 405.280.5852 [email protected] GlobalHealth Privacy Officer: 405.280.5524 [email protected]

mailto:[email protected]

http://www.globalhealth.com/fehb


http://www.globalhealth.com/fehb



ii

IMPORTANT INFORMATION This formulary applies to Members who enrolled through the Federal Employees Health Benefits Program.

Member Materials Your Member materials are three booklets. Each one has a different purpose. These documents are important legal documents. Keep them in a safe place.

Booklet Purpose

FEHB Brochure Tells you about your benefits. o What benefits are covered and how much you will pay. o How they are covered (including limitations and exclusions). o How to use them.

Physicians and Health Providers Directory (“Provider Directory”)

Lists our Network of doctors, Facilities, and pharmacies.

Tells you if a Facility is preferred or not.

Formulary Drug List for Federal Employee Health Benefits Program Employees (“Drug Formulary” or “Formulary”)

Lists drugs we cover.

Tells you what Tier a drug is in.

Tells you if there are any rules to getting a drug.

Member materials are available on our website. Contact Customer Care for printed copies at no charge. But, be aware that the most current Drug Formulary and Provider Directory lists are on the website. When this document says “we”, “us”, or “our”, it means GlobalHealth, Inc. For specific questions about your coverage, please call the phone number printed on your Member ID card.

Preferred Drugs Preferred drugs are listed in this Drug Formulary. Drugs on the list are selected based on quality (effectiveness and safety) as well as cost-effectiveness. Doctors and pharmacists have worked together to develop the Formulary, which includes generics and brand name drugs that are approved by the U. S. Food and Drug Administration (“FDA”). For the Member: Generic drugs contain the same active ingredients in the same amounts as brand name products. However, they may be a different color, shape, or size. For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. Thank you.

iii

THIS DOCUMENT LIST IS EFFECTIVE AS OF THE DATE ON THE COVER. THIS LIST IS SUBJECT TO CHANGE. You may find the most current list, including any

Utilization Management requirements, on our website. Contact Customer Care for printed copies.

TIER DESCRIPTION

0 Health Care Reform

1 Generics

2 Preferred Brands

3 Non-Preferred Brands

4 Preferred Specialty

5 Specialty

TYPE DESCRIPTION

QL Quantity LimitThere is a limit on the amount of this drug that is covered perprescription, or within a specific time frame.

PA Prior AuthorizationYour provider is required to get prior authorization before you fillyour prescription, which ensures appropriate use of the selecteddrug. Without prior approval, we may not cover this drug.

ST Step TherapyIn some cases, you may be required to first try certain drugs to treatyour medical condition before you move up a “step” to other drugoptions.

GL Gender Limit This prescription drug is restricted for a single gender. .

AL Age LimitThis prescription drug may only be covered if you meet theminimum or maximum age limit.

C Custom This drug has unique restrictions.

S Specialty DrugSpecialty drugs are high-cost drugs used to treat complex or rareconditions. Some examples of the diseases include; multiplesclerosis, rheumatoid arthritis, hepatitis C, and hemophilia.

MED Medical DrugThis medication is not on our drug list. Click on the THERAPEUTICCLASS or sub class to find covered alternative medications. If youhave questions, please contact member services.

PAGE 1 LAST UPDATED 10/2017

HCR Health Care Reform ProductsThe Affordable Care Act (ACA) requires certain preventive genericproducts to be covered at zero dollar copay. This does not includeplans that are grandfathered.

PS Preferred Specialty Preferred Specialty.

HCG High Cost Generic High Cost Generic.

LCG Low Cost Generic

Generic drugs available at the lowest cost. Please note the specificstrengths and dosage forms; other strengths and/or dosage formsof these products would be subject to the standard generic Cost-share.


LIST OF COVERED PRESCRIPTION MEDICATIONSPRODUCT DESCRIPTION TIER LIMITS & RESTRICTIONS

ADRENERGIC AGENTS

ALPHA AND BETA ADRENERGIC AGONIST(RESPR)

ADRENACLICK 3QL 2 / fill

PA

ADRENALIN 3

ADYPHREN 3 QL 2 / fill

ADYPHREN AMP 3 QL 2 / fill

ADYPHREN AMP II 3 QL 2 / fill

ADYPHREN II 3 QL 2 / fill

AUVI-Q 3QL 2 / fill

PA

ephedrine hcl 3

ephedrine sulfate powder 3

epinephrine 1 mg/ml ampul 1 HCG

epinephrine (0.15 mg auto-injct, 0.3 mg auto-inject) 1 QL 2 / fill

epinephrine (base powder, powder) 3

epinephrine (0.1 mg/ml syringe, 1 mg/ml vial) 1

epinephrine bitartrate 3

epinephrine hcl 3

EPINEPHRINESNAP-V 3 QL 2 / fill

EPIPEN 3QL 2 / fill

PA

EPIPEN 2-PAK 3QL 2 / fill

PA

EPIPEN JR 2-PAK 3QL 4 / fill

PA


PRODUCT DESCRIPTION TIER LIMITS & RESTRICTIONS

EPISNAP 3QL 2 / fill

HCG

EPY 3 QL 2 / fill

HYCOFENIX 3QL 40/ day

AL At least 18 yrs old

pseudoephedrine hcl 3

racepinephrine hcl 3

REZIRA 3QL 20 / day


NON-SELECT.BETA-ADRENERGIC AGONT(RESPIR)

isoproterenol hcl powder 3

ISUPREL 3

SELECT.BETA-2-ADRENERGIC AGONIST(RESPIR)

ADVAIR DISKUS 2 QL 2 / day

ADVAIR HFA 2 QL 0.4 / day

albuterol sulfate powder 3

albuterol 5 mg/ml solution 1 LCG

albuterol sulfate (sul 0.63 mg/3 ml sol, sul 1.25 mg/3 ml sol,sulf 2 mg/5 ml syrup, 2.5 mg/0.5 ml sol, sul 2.5 mg/3 ml soln,sulfate 2 mg tab, sulfate 4 mg tab, sulfate er 4 mg tab, sulfate er8 mg tab)

1

ANORO ELLIPTA 2 QL 2 / day

ARCAPTA NEOHALER 3QL 1 / day

ST

BEVESPI AEROSPHERE 3QL 0.357 / day

ST

BREO ELLIPTA 2 QL 2 / day



BROVANA 3 QL 4 / day

COMBIVENT RESPIMAT 2 QL 0.267 / day

fluticasone-salmeterol 1QL 0.04 / day


FORADIL 3 QL 3 / day

formoterol fumarate (micro pwdr, powder) 3

ipratropium-albuterol 1

levalbuterol concentrate 1 HCG

levalbuterol hcl (100% powder, powder) 3

levalbuterol hcl (0.31 mg/3 ml sol, 0.63 mg/3 ml sol, 1.25 mg/3ml sol) 1 HCG

metaproterenol sulfate powder 3

metaproterenol sulfate (10 mg tablet, 10 mg/5 ml syr, 20 mgtablet) 1

PERFOROMIST 3 QL 120 / 30 days

PROAIR HFA 2 QL .8 / day

PROAIR RESPICLICK 2QL 0.07 / day


SEREVENT DISKUS 2 QL 2 / day

STRIVERDI RESPIMAT 2QL .144 / day

ST

SYMBICORT 2 QL 0.4 / day

terbutaline sulfate powder 3

terbutaline sulfate (2.5 mg tab, 5 mg tab) 1 LCG

terbutaline sulf 1 mg/ml vial 1

UTIBRON NEOHALER 3

QL 2 / day

ST




VENTOLIN HFA 2 QL 1.5 / day

VOSPIRE ER 3

XOPENEX 3

XOPENEX CONCENTRATE 3

ALPHA-ADRENERGIC BLOCKING AGENT(SYMPATH)

NON-SEL.ALPHA-1-ADRENERGIC BLOCKING AGTS

CARDURA 3

CARDURA XL 3QL 1 / day

ST

doxazosin mesylate powder 3

doxazosin mesylate (1 mg tab, 2 mg tab, 4 mg tab, 8 mg tab) 1

MINIPRESS 3

prazosin hcl (1 mg capsule, 2 mg capsule, 5 mg capsule) 1

prazosin hcl powder 3

terazosin hcl 1

NON-SEL.ALPHA-ADRENERGIC BLOCKING AGENTS

CAFERGOT 3

D.H.E.45 3

DIBENZYLINE 3

dihydroergotamine mesylate (1 mg/ml am, 1 mg/ml vl) 1

dihydroergotamine powder 3

dihydroergotamine 4 mg/ml spry 1QL 8 / 30 days

HCG

ergoloid mesylates powder 3

ergoloid mesylates 1 mg tab 1

ERGOMAR 3

ergotamine tartrate 3



ergotamine-caffeine 1

methysergide maleate 3

MIGERGOT 3

MIGRANAL 3 QL 8 / 30 days

phenoxybenzamine hcl 10 mg cap 1

phenoxybenzamine hcl powder 3

phentolamine mesylate powder 3

phentolamine 5 mg vial 1

phentolamine-alprostadil 1

SELECTIVE ALPHA-1-ADRENERGIC BLOCK.AGENT

alfuzosin hcl er 1QL 1 / day

GL Male

carvedilol 1

COREG 3

COREG CR (CR 10 MG CAPSULE, CR 20 MG CAPSULE, CR 40 MGCAPSULE) 3

QL 2 / day

ST

COREG CR 80 MG CAPSULE 3QL 1 / day

ST

dutasteride-tamsulosin 1QL 1 / day

GL Male

FLOMAX 3 QL 2 / day

JALYN 3QL 1 / day

GL Male

labetalol hcl powder 3

labetalol hcl (100 mg tablet, 200 mg tablet, 300 mg tablet) 1

RAPAFLO 2QL 1 / day

GL Male



tamsulosin hcl 1 QL 2 / day

UROXATRAL 3QL 1 / day

GL Male

ANALGESICS AND ANTIPYRETICS

ANALGESICS AND ANTIPYRETICS, MISC.

acetamin-caff-dihydrocod 320.5 1QL 10 / day


acetamin-caff-dihydrocod 325 1 QL 10 / day

acetaminophen 3

acetaminophen-codeine (acetamin-codein 300-30 mg/12.5,acetaminop-codeine 120-12 mg/5) 1

QL 139 / day


acetaminophen-cod #2 tablet 1QL 22 / day






ALLZITAL 3QL 6 / day

HCG

BUPAP 3QL 6 / day

HCG

butalb-acetaminoph-caff-codein 1 QL 6 / day

butalb-caff-acetaminoph-codein 1 QL 6 / day

butalbital-acetaminophn 50-300 3QL 6 / day

HCG



butalbital-acetaminophn 50-325 3 QL 6 / day

butalbit-acetaminophen-caff cp 1QL 6 / day

HCG

butalbital-acetaminophen-caffe (50-300-40, 50-325-40) 1 QL 6 / day

CAPACET 1QL 6 / day

HCG

CAPITAL W-CODEINE 3QL 125 / day


ENDOCET 1QL 12 / day


ESGIC CAPSULE 1QL 6 / day

HCG

ESGIC 50-325-40 MG TABLET 3 QL 6 / day

FIORICET 3 QL 6 / day

FIORICET WITH CODEINE 3 QL 6 / day

gabapentin (100 mg capsule, 300 mg capsule, 400 mg capsule) 1 QL 9 / day

gabapentin powder 3

gabapentin (250 mg/5 ml soln, 300 mg/6 ml soln) 1 QL 72 / day

gabapentin 600 mg tablet 1 QL 6 / day

gabapentin 800 mg tablet 1 QL 5 / day

GRALISE 30-DAY STARTER PACK 3 ST

GRALISE ER 300 MG TABLET 3QL 1 / day

ST

GRALISE ER 600 MG TABLET 3QL 3 / day

ST



HORIZANT ER 300 MG TABLET 3 QL 4 / day

HORIZANT ER 600 MG TABLET 3 QL 2 / day

HYCET 3QL 140 / day


hydrocodone-acetamin 2.5-167/5 1QL 100 / day


hydrocodone-acetaminophen (hydrocodon-acetamin 7.5-325/15, hydrocodone-acetamin 2.5-108/5, hydrocodone-acetamin 5-217/10)

1QL 140 / day


hydrocodon-acetaminoph 2.5-325 1QL 20 / day


hydrocodon-acetaminoph 7.5-325 1QL 8 / day


hydrocodone-acetaminophen (hydrocodon-acetaminoph 7.5-300, hydrocodon-acetaminophen 5-300, hydrocodon-acetaminophn 10-300)

1QL 13 / day


hydrocodone-acetaminophen (hydrocodon-acetaminophen 5-325, hydrocodon-acetaminophn 10-325) 1

QL 12 / day


isomethept-caff-acetaminophen 1

isomethept-dichloralp-acetamin 1

LORCET 1QL 12 / day


LORCET HD 1QL 12 / day


LORCET PLUS 1QL 6 / day


LORTAB 10 MG-300 MG/15 ML ELXR 3QL 90 / day




LORTAB (5-325 MG TABLET, 7.5-325 MG TABLET, 10-325 MGTABLET) 1

QL 8 / day


MARGESIC 1QL 6 / day

HCG

MARTEN-TAB 1 QL 6 / day

NEURONTIN (100 MG CAPSULE, 300 MG CAPSULE, 400 MGCAPSULE) 3 QL 9 / day

NEURONTIN 250 MG/5 ML SOLN 3 QL 72 / day

NEURONTIN 600 MG TABLET 3 QL 6 / day

NEURONTIN 800 MG TABLET 3 QL 5 / day

NODOLOR 1

NORCO 3QL 12 / day


oxycodone-acetaminophn 5-325/5 1QL 62 / day


oxycodon-acetaminophen 7.5-300 1QL 4 / day


oxycodone-acetaminophen (oxycodon-acetaminophen 2.5-325,oxycodon-acetaminophen 7.5-325, oxycodone-acetaminophen5-325, oxycodone-acetaminophen 10-325)

1QL 12 / day


oxycodone-acetaminophen 10-300 1QL 3 / day


oxycodone-acetaminophen 5-300 1QL 7 / day


PERCOCET 3QL 12 / day


PRIMLEV 10-300 MG TABLET 3QL 3 / day




PRIMLEV 5-300 MG TABLET 3QL 7 / day


PRIMLEV 7.5-300 MG TABLET 3QL 4 / day


PRODRIN 3

TENCON 1 QL 6 / day

tramadol hcl-acetaminophen 1QL 8 / day


TREZIX 3QL 10 / day


TYLENOL-CODEINE NO.3 3QL 12 / day


TYLENOL-CODEINE NO.4 3QL 6 / day


ULTRACET 3QL 8 / day


VANATOL LQ 3

VERDROCET 1QL 20 / day


VICODIN 1QL 8 / day


VICODIN ES 1QL 13 / day


VICODIN HP 1QL 13 / day


XARTEMIS XR 3QL 12 / day




XODOL 10-300 3QL 13 / day


XODOL 5-300 3QL 13 / day


XODOL 7.5-300 3QL 13 / day


ZAMICET 3QL 90 / day


ZEBUTAL 1QL 6 / day

HCG

OPIATE AGONISTS

ACTIQ 3

QL 4 / day

PA


alfentanil 500 mcg/ml ampul 1

alfentanil 500 mcg/ml ampule 3

ARYMO ER 3QL 3 / day

PA

asa-butalb-caffeine-codeine 1QL 6 / day


ASCOMP WITH CODEINE 1QL 6 / day


ASTRAMORPH-PF (1 MG/ML AMPUL, 10 MG/10 ML VIAL) 1 QL 50 / day

ASTRAMORPH-PF (1 MG/2 ML AMPULE, 5 MG/10 ML VIAL) 1QL 100 / day

HCG

belladonna-opium 16.2-30 supp 1 QL 2 / day



belladonna-opium 16.2-60 supp 1 QL 1 / day

butalbital compound-codeine 1QL 6 / day


carisoprodol compound-codeine 1 QL 21 / day

carisoprodol-aspirin-codeine 1 QL 21 / day

codeine phosphate 3

codeine sulfate 1QL 6 / day


CONZIP (100 MG CAPSULE, 200 MG CAPSULE, 300 MGCAPSULE) 3

QL 1 / day

PA


DEMEROL (25 MG/0.5 ML AMPUL, 50 MG/ML AMPUL, 50 MG/MLCARPUJECT, 50 MG/ML VIAL, 75 MG/1.5 ML AMPUL, 100 MG/2ML AMPUL)

3QL 10 / day


DEMEROL 25 MG/ML CARPUJECT 3QL 20 / day


DEMEROL 75 MG/ML SYRINGE 3QL 7 / day


DEMEROL 100 MG TABLET 3QL 5 / day


DEMEROL 50 MG TABLET 3QL 10 / day


DEMEROL (100 MG/ML AMPUL, 100 MG/ML CARPUJECT, 100MG/ML VIAL) 3

QL 5 / day


dihydrocodeine bitartrate 3

DILAUDID 2 MG/ML AMPUL 3QL 6 / day




DILAUDID 4 MG/ML AMPUL 3QL 3 / day


DILAUDID 5 MG/5 ML ORAL LIQUID 3QL 13 / day


DILAUDID (0.5 MG/0.5 ML SYRINGE, 1 MG/ML SYRINGE, 2MG/ML SYRINGE, 4 MG/ML SYRINGE) 3 AL At least 18 yrs old

DILAUDID (2 MG TABLET, 4 MG TABLET, 8 MG TABLET) 3QL 6 / day


DILAUDID-HP 3QL 1 / day


DOLOPHINE HCL 3QL 3 / day

PA

DURAGESIC 3QL 0.5 / day

PA

DURAMORPH 10 MG/10 ML AMPUL 1 QL 5 / day

DURAMORPH 5 MG/10 ML AMPUL 1QL 10 / day

HCG

EMBEDA 2QL 2 / day

PA

EXALGO 3QL 2 / day

PA

fentanyl (12 mcg/hr patch, 25 mcg/hr patch, 50 mcg/hr patch,75 mcg/hr patch, 100 mcg/hr patch) 1

QL 0.5 / day

PA

fentanyl (37.5 mcg/hr patch, 62.5 mcg/hr patch, 87.5 mcg/hrpatch) 1

QL 0.5 / day

PA

HCG

fentanyl base 3



fentanyl citrate (0.05 mg/ml ampul, 100 mcg/2 ml ampul, 100mcg/2 ml vial, 1,000 mcg/20 ml ampul, 1,000 mcg/20 ml vial) 1

fentanyl citrate (cit 1,200 mcg, cit 1,600 mcg, citrate 200 mcg,citrate 400 mcg, citrate 600 mcg, citrate 800 mcg) 1

QL 4 / day

PA


HCG

fentanyl citrate powder 3

fentanyl citrate (250 mcg/5 ml vial, 2,500 mcg/50 ml vial) 1

fentanyl-bup-ns 4 mcg/ml-0.1% 1 QL 96 / day

fentanyl-bupivacaine-0.9% nacl (2 mcg-0.1%, 2 mcg-0.125%) 1 QL 192 / day

fentanyl 2mcg-bupiv 0.0625%-ns 1 QL 192 / day

fentanyl 2 mcg-ropiv 0.15%-ns 1 QL 192 / day

FIORINAL WITH CODEINE #3 3QL 6 / day


hydrocod-cpm-pseudoephedrine 1QL 20 / day


hydrocodone bitartrate (crys, powder) 3

hydrocodone-ibuprofen (2.5-200, 7.5-200, 10-200) 1QL 5 / day


hydrocodone-ibuprofen 5-200 mg 1

QL 6 / day


HCG

hydromorphone er 1

QL 2 / day

PA

HCG

hydromorphone hcl 1 mg/ml amp 1 QL 13 / day

hydromorphone hcl 10 mg/ml amp 1QL 1 / day




hydromorphone hcl (1 mg/ml solution, 5 mg/5 ml soln) 1QL 13 / day


hydromorphone hcl powder 3

hydromorphone 3 mg suppos 1 QL 4 / day

hydromorphone 0.5 mg/0.5 ml 1

QL 50 / day


HCG

hydromorphone 2 mg/ml carpujct 1QL 6 / day


hydromorphone 4 mg/ml carpujct 1QL 3 / day


hydromorphone hcl (1 mg/ml carpujct, 1 mg/ml syringe) 1QL 13 / day


hydromorphone hcl (2 mg tablet, 4 mg tablet, 8 mg tablet) 1QL 6 / day


hydromorphone hcl (10 mg/ml vial, hcl 10 mg/ml vl, 50 mg/5ml vial, 500 mg/50 ml via) 1 QL 1 / day

hydromorphone hcl (2 mg/ml vial, hcl 2 mg/ml amp) 1 QL 6 / day

IBUDONE 10-200 MG TABLET 3QL 5 / day


IBUDONE 5-200 MG TABLET 1

QL 6 / day


HCG

INFUMORPH 200 MG/20 ML AMPUL 3 QL 5 / day

INFUMORPH 500 MG/20 ML AMPUL 3 QL 2 / day

levorphanol tartrate powder 3 AL At least 18 yrs old



levorphanol 2 mg tablet 1QL 4 / day


meperidine 10 mg/ml cartrdge 1QL 50 / day


meperidine hcl powder 3 AL At least 18 yrs old

meperidine 50 mg/5 ml solution 1QL 50 / day


meperidine 100 mg tablet 1QL 5 / day


meperidine 50 mg tablet 1QL 10 / day


meperidine 100 mg/ml vial 1QL 5 / day






methadone hcl powder 3

methadone 10 mg/5 ml solution 1QL 8 / day

PA

methadone 5 mg/5 ml solution 1QL 18 / day

PA

methadone hcl (10 mg/ml oral conc, hcl 10 mg tablet) 1QL 2 / day

PA

methadone hcl 5 mg tablet 1QL 3 / day

PA



methadone hcl 10 mg/ml vial 1 QL 2 / day

METHADONE INTENSOL 1QL 2 / day

PA

METHADOSE 10 MG/ML ORAL CONC 3QL 2 / day

PA

morphine sulf 10 mg/0.7 ml syr 1

QL 3 / day

PA

HCG

morphine sulfate powder 3 PA

morphine sulf 10 mg/5 ml soln 1 QL 25 / day

morphine sulf 20 mg/5 ml soln 1 QL 13 / day

morphine sulf 10 mg suppos 1 QL 5 / day



morphine sulfate (20 mg suppos, 100 mg/5 ml soln) 1 QL 3 / day

morphine 10 mg/ml syringe 1QL 5 / day

PA


PA


PA


PA

morphine sulfate ir 15 mg tab 1QL 3 / day




morphine sulfate ir 30 mg tab 1QL 2 / day


morphine 0.5 mg/ml vial 1

QL 100 / day

PA

HCG

morphine 1 mg/ml vial p-f 1QL 50 / day

PA

morphine 15 mg/ml vial 1QL 3 / day

PA

morphine 8 mg/ml vial 1QL 6 / day

PA

morphine sulfate er (er 10 mg cap, er 20 mg cap, er 50 mg cap,er 100 mg cap) 1

QL 2 / day

PA

morphine sulfate er (er 30 mg cap, er 45 mg cap, er 60 mg cap,er 75 mg cap, er 80 mg cap, er 90 mg cap, er 120 mg cap) 1

QL 1 / day

PA

morphine sulfate er (er 15 mg tablet, er 30 mg tablet, er 60 mgtablet, er 100 mg tablet, er 200 mg tablet) 1

QL 3 / day

PA

MS CONTIN 3QL 3 / day

PA

NUCYNTA (50 MG TABLET, 75 MG TABLET) 3QL 6 / day


NUCYNTA 100 MG TABLET 3QL 7 / day


OPANA 1 MG/ML INJ AMPULE 3QL 17 / day


OPANA (5 MG TABLET, 10 MG TABLET) 3QL 12 / day




OPANA ER 3

QL 2 / day

PA


OXAYDO 3QL 8 / day


OXECTA 3 QL 8 / day

oxycodone hcl (5 mg capsule, 5 mg tablet, 15 mg tablet, 20 mgtablet, 30 mg tablet) 1

QL 8 / day


oxycodone hcl 100 mg/5 ml soln 1 QL 2 / day

oxycodone hcl 5 mg/5 ml soln 1 QL 33 / day

oxycodon 10 mg/0.5 ml oral syr 1 QL 4 / day

oxycodone hcl 10 mg tablet 1 QL 8 / day

oxycodone hcl er 1

QL 3 / day

PA

HCG

oxycodone hcl-aspirin 1QL 7 / day


oxycodone hcl-ibuprofen 1QL 4 / day


oxycodone hydrochloride 3

OXYCONTIN 3QL 3 / day

PA

oxymorphone hcl 1

QL 12 / day


HCG

oxymorphone hcl er 1

QL 2 / day

PA


HCG



promethazine vc-codeine 1QL 30 / day


promethazine-phenyleph-codeine 1QL 30 / day


REPREXAIN 10-200 MG TABLET 1QL 5 / day


REPREXAIN 2.5-200 MG TABLET 3QL 5 / day


REPREXAIN 5-200 MG TABLET 3QL 6 / day


ROXICODONE 3QL 8 / day


sufentanil citrate powder 3

tramadol hcl powder 3 AL At least 18 yrs old

tramadol hcl 50 mg tablet 1QL 8 / day


tramadol hcl er (er 100 mg tablet, er 200 mg tablet, er 300 mgtablet, hcl er 100 mg capsule, hcl er 100 mg tablet, hcl er 150mg capsule, hcl er 200 mg capsule, hcl er 200 mg tablet, hcl er300 mg capsule, hcl er 300 mg tablet)

1

QL 1 / day

PA


HCG

TUZISTRA XR 3QL 20 / day


ULTRAM 3QL 8 / day


ULTRAM ER 3

QL 1 / day

PA




VICOPROFEN 3QL 5 / day


XYLON 10 1

ZUTRIPRO 3QL 20 / day


OPIATE PARTIAL AGONISTS

BELBUCA 3

QL 2 / day

PA


BUNAVAIL (2.1-0.3 MG FILM, 6.3-1 MG FILM) 3QL 3 / day

PA

BUNAVAIL 4.2-0.7 MG FILM 3QL 2 / day

PA

BUPRENEX 3 QL 17 / day

buprenorphine 3QL 0.144 / day

PA

buprenorphine hcl powder 3

buprenorphine hcl (2 mg tablet, 8 mg tablet) 1QL 3 / day

PA

buprenorphine hcl (0.3 mg/ml syring, 0.3 mg/ml vial) 1 QL 17 / day

buprenorphine-naloxone 1

QL 3 / day

PA

HCG

butorphanol tartrate powder 3 AL At least 18 yrs old

butorphanol 10 mg/ml spray 1QL 0.3 / day




butorphanol 1 mg/ml vial 1QL 7 / day


butorphanol 2 mg/ml vial 1QL 4 / day


BUTRANS 3QL 0.144 / day

PA

nalbuphine hcl powder 3

nalbuphine hcl (10 mg/ml ampul, 100 mg/10 ml vial) 1 QL 5 / day

nalbuphine hcl (20 mg/ml ampul, 200 mg/10 ml vial) 1 QL 3 / day

pentazocine-naloxone hcl 1QL 12 / day


SUBOXONE (2 MG-0.5 MG FILM, 8 MG-2 MG FILM) 2QL 3 / day

PA

SUBOXONE (4 MG-1 MG FILM, 12 MG-3 MG FILM) 2QL 2 / day

PA

TALWIN (30 MG/ML AMPUL, 30 MG/ML VIAL) 3 QL 5 / day

ZUBSOLV 3QL 3 / day

PA

ANOREXIGENIC AGENTS

AMPHETAMINE DERIVATIVES

ADIPEX-P (37.5 MG CAPSULE, 37.5 MG TABLET) 3

QL 2 / day

PA


BONTRIL PDM 3

QL 3 / day

PA




diethylpropion hcl powder 3

diethylpropion 25 mg tablet 1

QL 3 / day

PA


diethylpropion hcl er 1QL 1 / day

PA

LOMAIRA 1

QL 3 / day

PA


HCG

phendimetrazine er 105 mg cap 1QL 1 / day

PA

phendimetrazine 35 mg tablet 1QL 3 / day

PA

phentermine hcl (15 mg capsule, 30 mg capsule) 1QL 1 / day

PA

phentermine hcl powder 3

phentermine hcl (37.5 mg capsule, 37.5 mg tablet) 1

QL 2 / day

PA


QSYMIA 3

QL 1 / day

PA


SUPRENZA ODT 3 PA

ANOREXIGENIC AGENTS, MISCELLANEOUS

CONTRAVE 3

QL 4 / day

PA




SELECTIVE SEROTONIN RECEPTOR AGONISTS

BELVIQ 3

QL 2 / day

PA


BELVIQ XR 3

QL 1 / day

PA


ANOREXIGENICS;RESPIRATORY,CNS STIMULANTS

AMPHETAMINES

ADDERALL 3QL 2 / day

ST

ADDERALL XR 3QL 2 / day

ST

ADZENYS XR-ODT 3

QL 1 / day

ST


benzphetamine hcl 25 mg tablet 1

QL 3 / day

PA


benzphetamine hcl 50 mg tablet 1QL 3 / day

PA

DESOXYN 3QL 5 / day

ST

DEXEDRINE SPANSULE 10 MG 3QL 5 / day

ST


ST




ST

DEXEDRINE 10 MG TABLET 1QL 6 / day

HCG

DEXEDRINE 5 MG TABLET 1QL 2 / day

HCG

dextroamphetamine 5 mg/5 ml 1QL 60 / day

HCG

dextroamphetamine 10 mg tab 1QL 6 / day

HCG

dextroamphetamine 5 mg tab 1QL 2 / day

HCG

d-amphetamine er 10 mg capsule 1QL 5 / day

HCG


HCG


HCG

dextroamphetamine-amphet er 1 QL 2 / day

dextroamphetamine-amphetamine 1 QL 2 / day

DYANAVEL XR 3

QL 8 / day

ST


EVEKEO 3QL 6 / day

ST

methamphetamine hcl 1 QL 5 / day



PROCENTRA 3QL 60 / day

ST

REGIMEX 3

QL 3 / day

PA


VYVANSE (10 MG CAPSULE, 20 MG CAPSULE, 30 MG CAPSULE,40 MG CAPSULE, 50 MG CAPSULE, 60 MG CAPSULE, 70 MGCAPSULE)

2 QL 1 / day

VYVANSE (10 MG TABLET, 20 MG TABLET, 30 MG TABLET, 40MG TABLET, 50 MG TABLET, 60 MG TABLET) 2 QL 1 / day

ZENZEDI (15 MG TABLET, 30 MG TABLET) 3QL 2 / day

ST

ZENZEDI (2.5 MG TABLET, 20 MG TABLET) 3QL 3 / day

ST

ZENZEDI 10 MG TABLET 1QL 6 / day

HCG

ZENZEDI 5 MG TABLET 1QL 2 / day

HCG

ZENZEDI 7.5 MG TABLET 3QL 8 / day

ST

ANOREXIGENIC AGENTS AND STIMULANTS, MISC

meclofenoxate hcl 3

RESPIRATORY AND CNS STIMULANTS

APTENSIO XR 3QL 1 / day

ST

caffeine 3

caffeine and sodium benzoate 1

caffeine citrate (citrate powder, citrated powder) 3



caffeine cit 60 mg/3 ml oral 1

CONCERTA (ER 18 MG TABLET, ER 27 MG TABLET, ER 36 MGTABLET) 3

QL 2 / day

ST

CONCERTA ER 54 MG TABLET 3QL 1 / day

ST

DAYTRANA 3QL 1 / day

ST

dexmethylphenidate 10 mg tab 1 QL 2 / day

dexmethylphenidate hcl (2.5 mg tab, 5 mg tab) 1 QL 3 / day

dexmethylphenidate er 20 mg cp 1QL 2 / day

HCG

dexmethylphenidate hcl er (er 5 mg cap, er 10 mg cp, er 15 mgcp, er 25 mg cp, er 30 mg cp, er 35 mg cp, er 40 mg cp) 1

QL 1 / day

HCG

FOCALIN 3QL 2 / day

ST

FOCALIN XR (5 MG CAPSULE, 10 MG CAPSULE, 15 MG CAPSULE,25 MG CAPSULE, 30 MG CAPSULE, 35 MG CAPSULE, 40 MGCAPSULE)

3QL 1 / day

ST

FOCALIN XR 20 MG CAPSULE 3QL 2 / day

ST

METADATE CD 3QL 1 / day

ST

METADATE ER 1QL 3 / day

LCG

METHYLIN 10 MG/5 ML SOLUTION 3QL 30 / day

ST

METHYLIN 5 MG/5 ML SOLUTION 3QL 60 / day

ST



METHYLIN (2.5 MG TAB, 5 MG TABLET, 10 MG TABLET) 3QL 3 / day

ST

methylphenidate er (er 20 mg cap, er 40 mg cap) 1QL 1 / day

HCG

methylphenidate er 30 mg cap 1QL 2 / day

HCG

methylphenidate er (er 18 mg tab, er 27 mg tab, er 36 mg tab) 1QL 2 / day

HCG

methylphenidate er 54 mg tab 1QL 1 / day

HCG

methylphenidate er 10 mg tab 1 QL 5 / day

methylphenidate er 20 mg tab 1 QL 3 / day

methylphenidate hcl powder 3

methylphenidate 10 mg/5 ml sol 1 QL 30 / day

methylphenidate 5 mg/5 ml soln 1 QL 60 / day

methylphenidate 2.5 mg chew tb 1

methylphenidate hcl (5 mg chew tab, 5 mg tablet, 10 mg chewtab, 20 mg tablet) 1 QL 3 / day

methylphenidate 10 mg tablet 1 QL 5 / day

methylphenidate hcl cd 1QL 1 / day

HCG

methylphenidate hcl er (er 10 mg cap, er 50 mg cap, er 60 mgcap) 1

QL 1 / day

HCG

methylphenidate la (20 mg cap, 40 mg cap) 1QL 1 / day

HCG

methylphenidate la 30 mg cap 1QL 2 / day

HCG



methylphenidate la 60 mg cap 1 QL 1 / day

QUILLICHEW ER (ER 20 MG CHEW TAB, ER 40 MG CHEW TAB) 3

QL 1 / day

ST


QUILLICHEW ER 30 MG CHEW TAB 3

QL 2 / day

ST


QUILLIVANT XR 3QL 12 / day

ST

RITALIN (5 MG TABLET, 20 MG TABLET) 3QL 3 / day

ST

RITALIN 10 MG TABLET 3QL 5 / day

ST

RITALIN LA (10 MG CAPSULE, 20 MG CAPSULE, 40 MG CAPSULE,60 MG CAPSULE) 3

QL 1 / day

ST

RITALIN LA 30 MG CAPSULE 3QL 2 / day

ST

WAKEFULNESS-PROMOTING AGENTS

armodafinil 1

QL 1 / day

PA

HCG

modafinil 1QL 1 / day

PA

NUVIGIL 3QL 1 / day

PA

PROVIGIL 3QL 1 / day

PA



ANTI-INFECTIVE AGENTS

ANTHELMINTICS

albendazole 3

ALBENZA 3QL 4 / day

PA

BILTRICIDE 3 PA

EMVERM 3 PA

ivermectin powder 3

ivermectin 3 mg tablet 1 PA

levamisole hcl 3

mebendazole 3

niclosamide 3

praziquantel 3

pyrantel pamoate 3

STROMECTOL 3 PA

thiabendazole 3

ANTI-INFECTIVES (SYSTEMIC), MISC.

diethylcarbamazine citrate 3

furazolidone 3

URINARY ANTI-INFECTIVES

AZUPHEN MB 1

FURADANTIN 3

HIPREX 3

HYOPHEN 1

INDIOMIN MB 1 HCG

MACROBID 3



MACRODANTIN 3

me-naphos-mb-hyo 1 1

methenamine 3

methenamine hippurate 1

methenamine mandelate powd 3

methenamine mandelate (md 1 gm tablet, md 500 mg tablet) 1

MONUROL 3

nitrofurantoin (25 mg/5 ml susp, mcr 25 mg cap, mcr 50 mgcap, mcr 100 mg cap) 1

nitrofurantoin powder 3

nitrofurantoin mono-macro 1

PHOSPHASAL 1

PRIMSOL 3

PROSED-DS 3

trimethoprim powder 3

trimethoprim 100 mg tablet 1

trimethoprim micronized 3

UR N-C 1

URELLE 1 HCG

URETRON D-S 1

URIBEL 1QL 4 / day

HCG

URIMAR-T 1

URIN D.S. 1

URO-458 1 HCG

URO-BLUE 1

URO-L 1 HCG



UROGESIC-BLUE 3

UROPHEN MB 1

UROQID-ACID NO.2 3

URYL 1

USTELL 1

UTA 1

UTIRA-C 1

ANTI-INFECTIVES (EENT)

ANTIBACTERIALS (EENT)

AK-POLY-BAC 1 QL 0.434 / day

AZASITE 3 QL 0.36/day

bacitracin 500 unit/gm ophth 1 QL 0.434 / day

bacitracin-polymyxin 1 QL 0.434 / day

BACTROBAN NASAL 2

BESIVANCE 3 QL 0.767 / day

BLEPH-10 3 QL 5 / fill

BLEPHAMIDE 3 QL 5 / fill

BLEPHAMIDE S.O.P. 3 QL 4 / fill

CETRAXAL 3 QL 0.567 / day

CILOXAN (EYE DROPS, OINTMENT) 3 QL 0.767 / day

CIPRO HC 3 QL 0.434 / day

CIPRODEX 2 QL 0.257 / day

ciprofloxacin 0.2% otic soln 1 QL 0.567 / day

ciprofloxacin 0.3% eye drop 1 QL 0.767 / day



COLY-MYCIN S 3 QL 10 / fill

CORTISPORIN-TC 3 QL 10 / fill

doxycycline hyclate 20 mg tab 1

erythromycin 0.5% eye ointment 1 QL 0.54 / day

FLOXIN 3 QL 10 / 30 days

gatifloxacin 1 QL 0.36/day

gatifloxacin sesquihydrate 3

GENTAK 1 QL 0.54 / day

gentamicin sulfate (0.3% drops, 3 mg/ml drops) 1 QL 2.143 / day

gentamicin 0.3% eye ointment 1 QL 0.54 / day

ILOTYCIN 1 QL 0.54 / day

levofloxacin 0.5% eye drops 1 QL 0.767 / day

MAXITROL EYE DROPS 3 QL 5 / fill

MAXITROL EYE OINTMENT 3 QL 4 / fill

MOXEZA 2 QL 0.434 / day

moxifloxacin 0.5% eye drops 1 QL 0.434 / day

mupirocin powder 3

NEO-POLYCIN 1 QL 0.124 / day

NEO-POLYCIN HC 1 QL 4 / fill

neomycin-bacitracin-poly-hc 1 QL 4 / fill

neomycin-bacitracin-polymyxin 1 QL 0.124 / day

neomyc-polym-dexameth eye drop 1 QL 5 / fill

neomyc-polym-dexamet eye ointm 1 QL 4 / fill



neomycin-polymyxin-gramicidin 1 QL 1.47 / day

neomycin-poly-hc eye drops 1 QL 10/ fill

neomycin-polymyxin-hc ear susp 1 QL 10 / fill

neomycin-polymyxin-hydrocort 1 QL 10 / fill

NEOSPORIN 3 QL 1.47 / day

OCUFLOX 3 QL 1.47 / day

ofloxacin 0.3% ear drops 1 QL 10 / 30 days

ofloxacin 0.3% eye drops 1 QL 1.47 / day

OTIPRIO 3

OTOVEL 3

POLYCIN 1 QL 0.434 / day

polymyxin b sul-trimethoprim 1 QL 1.47 / day

POLYTRIM 3 QL 1.47 / day

PRED-G 1% EYE DROPS 3 QL 5 / fill

PRED-G S.O.P. EYE OINTMENT 3 QL 4 / fill

sulfacetamide 10% eye drops 1 QL 5 / fill

sulfacetamide 10% eye ointment 1 QL 4 / fill

sulfacetamide-prednisolone 1 QL 5 / fill

TOBRADEX EYE DROPS 3 QL 5 / fill

TOBRADEX EYE OINTMENT 3 QL 4 / fill

TOBRADEX ST 3 QL 5 / fill

tobramycin 0.3% eye drops 1 QL 2.143 / day

tobramycin-dexamethasone 1 QL 5 / fill



TOBREX 0.3% EYE DROPS 3 QL 2.143 / day

TOBREX 0.3% EYE OINTMENT 3 QL 0.54 / day

VIGAMOX 2 QL 0.434 / day

ZYLET 3 QL 5 / fill

ZYMAXID 3 QL 0.36/day

ANTIFUNGALS (EENT)

NATACYN 3 QL 0.767 / day

ANTIVIRALS (EENT)

idoxuridine 3

trifluridine 1% eye drops 1

trifluridine powder 3

VIROPTIC 3

ZIRGAN 3 QL 0.167 / day

EENT ANTI-INFECTIVES, MISCELLANEOUS

ACETASOL HC 1

acetic acid 2% ear solution 1

acetic acid-aluminum 1

BETADINE 3

boric acid (granules, powder) 3

chlorhexidine 0.12% rinse 1

hydrocortisone-acetic acid 1

PAROEX 1

PERIDEX 3

PERIOGARD 1

povidone iodine 5% eye drop 1



ANTI-INFECTIVES (SKIN, MUCOUS MEMBRANE)

ANTIBACTERIALS (SKIN, MUCOUS MEMBRANE)

ALTABAX 3

bacitracin (5 million units pwd, powder) 3

bacitracin micronized 3

bacitracin zinc 3

BACTROBAN (CREAM, OINTMENT) 3

CENTANY 3

CENTANY AT 3

CLEOCIN 2% VAGINAL CREAM 3

CLEOCIN 100 MG VAGINAL OVULE 2

CLEOCIN T 1% GEL 3 QL 75 / 30 days

CLEOCIN T (LOION, PLEDGES, SOLUION) 3

CLINDACIN ETZ KIT 3

CLINDACIN ETZ 1% PLEDGET 1

CLINDACIN P 1

CLINDACIN PAC 3

CLINDAGEL 3 QL 75 / 30 days

clindamax 1

clindamycin phos-benzoyl perox 1QL 1.5 / day

HCG

clindamycin phos-tretinoin 1QL 2 / day

HCG

clindamycin phosphate 1% foam 1 QL 1.667 / day

clindamycin ph 1% gel 1 QL 75 / 30 days

clindamycin phosphate (ph 1% solution, phos 1% pledget,phosp 1% lotion, 2% vaginal cream) 1



clindamycin-benzoyl peroxide (clinda-benzoyl 1-5% pump,clindamycin-benzoyl 1-5%) 1

QL 1.667 / day

HCG

CLINDESSE 3

CORTISPORIN CREAM 3 QL 0.25 / day

CORTISPORIN OINTMENT 3 QL 0.5 / day

ERY 1

ERYGEL 3 QL 1 / day

erythromycin 2% gel 1 QL 1 / day

erythromycin (pledgets, solution) 1

erythromycin-benzoyl peroxide 1QL 1.60 / day

HCG

EVOCLIN 3 QL 1.667 / day

gentamicin sulfate (cream, ointment) 1

METROCREAM 3

METROGEL (GEL, PUMP) 3

METROGEL-VAGINAL 3

METROLOTION 3

metronidazole (0.75% cream, 0.75% lotion, topical 0.75% gl,topical 1% gel) 1 HCG

metronidazole (top 1% gel pump, vaginal 0.75% gl) 1

mupirocin (cream, ointment) 1

NEO-SYNALAR 0.5%-0.025% CREAM 3

NEUAC GEL 1QL 1.5 / day

HCG

NORITATE 3

NUVESSA 3

ONEXTON 1.2%-3.75% GEL 3 QL 1.667 / day



ONEXTON GEL PUMP 3 QL 1.967 / day

ROSADAN (CREAM, GEL) 1 HCG

ROSADAN (CREAM KIT, GEL KIT) 3

VANDAZOLE 1

ANTIVIRALS (SKIN AND MUCOUS MEMBRANE)

acyclovir 5% ointment 1 HCG

DENAVIR 3

QL 0.167 / day

PA


docosanol 3

XERESE 3

QL 0.167 / day

PA


ZOVIRAX 5% CREAM 2

QL 0.167 / day

PA


ZOVIRAX 5% OINTMENT 3

QL 30 / fill

PA


LOCAL ANTI-INFECTIVES, MISCELLANEOUS

arida 3

AVAR CLEANSER 1 HCG

AVAR 9.5-5% CLEANSING PADS 3

AVAR LS (10-2% CLEANSING PADS, CLEANSER) 3

AVAR LS 10%-2% FOAM 3

AVAR-E 1 HCG



AVAR-E GREEN 1 HCG

AVAR-E LS 3

AVC 3

benzalkonium chloride 3

BP 10-1 1

carbamide peroxide 3

chlorhexidine gluc 20% soln 3

CLARIFOAM EF 3

CLEANSING WASH 1

curity amd gauze 0.2% sponge 3

DERMAZENE 1

FEM PH 3

guaiacol 1

hydrocortisone-iodoquinol 1

hydrocortisone-iodoquinol-aloe 1

iodine 3

IODOFLEX 3

IODOSORB 3

kerlix amd 3

kerlix amd bandage 3

KLARON 3 QL 4 / day

LUGOL'S STRONG IODINE SOLUTION 1

mafenide acetate 3

nitrofurazone 3

OVACE 3 QL 12 / day

OVACE PLUS 10% WASH 3 QL 15.767 / day

OVACE PLUS 10% CREAM 3 QL 2 / day



OVACE PLUS 9.8% FOAM 3 QL 3.334 / day

OVACE PLUS 9.8% LOTION 3 QL 4 / day

OVACE PLUS 10% SHAMPOO 3 QL 8 / day

OVACE PLUS WASH 3 QL 12 / day

phenol (crystals, liquid) 3

phenol liquified 1

PLEXION (9.8-4.8% CLEANSER, 9.8-4.8% CLNSING CLOTH, 9.8-4.8% CREAM, 9.8-4.8% LOTION) 3

povidone iodine powder 3

RELAGARD 3

ROSANIL 1 HCG

SEB-PREV 1QL 12 / day

HCG

selenium sulfide (2.25% shampoo, 2.5% lotion) 1

selenium sulfide powder 3

SELRX 3

SILVADENE 3

silver nitrate crystals 3

silver nitrate (0.5% soln, 10% ointment, 25% solution, 50%solution) 1

silver protein 3

silver sulfadiazine 1% cream 1

silver sulfadiazine powder 3

silver sulphadiazine 3

sodium sulfacetamide (sod sulfacetam clnsng gel, sodiumsulfacetamide wash) 1

QL 12 / day

HCG

sod sulfacetamide 10% shampoo 1 QL 8 / day



sod sulfacet-sulfur 10-5% clsr 1 HCG

sodium sulf-sulfur cleanser 1

sulfacetamide-sulfur 10-5% crm 1 HCG

sodium sulfacetamide-sulfur (sod sulface-sulf 9.8-4.8% clsr, sodsulface-sulfur 9-4.5% wash, sod sulfacet-sulfur 10-2% clsr, sodsulfacet-sulfur 10-4% pad, sod sulfacet-sulfur 10-5% lotn, sodsulfacetamide-sulfur foam, sod sulfacetamide-sulfur lotn, sodsulfacetamide-sulfur susp, sodium sulfacet-sulfur wash,sulfacetamide-sulfur 8-4% susp, sulfacetamide-sulfur 10-2%crm)

1

SSD 1

SSS 10-5 CREAM 1 HCG

SSS 10-5 FOAM 1

sulfacetamide sodium (sod top susp, sodium lotn) 1 QL 4 / day

sulfacetamide sodium-sulfur 1

SULFACLEANSE 8-4 1 HCG

SULFAMYLON (8.5% CREAM, POWDER PACKET) 3

SUMADAN 9%-4.5% WASH 3

SUMAXIN (CLEANSING PADS, WASH) 3

SUMAXIN TS 3

TERSI FOAM 3

THERMAZENE 1

triclosan 3

ULESFIA 3 ST

VYTONE 3

ZENCIA 1

SCABICIDES AND PEDICULICIDES

benzyl benzoate 3



crotamiton 3

ELIMITE 3

EURAX (CREAM, LOTION) 3 ST

lindane (lotion, shampoo) 1

malathion 1 HCG

NATROBA 3 ST

OVIDE 3 ST

permethrin 5% cream 1

permethrin technical liquid 3

SKLICE 3 ST

spinosad 1 HCG

ANTI-INFLAMMATORY AGENTS (EENT)

CORTICOSTEROIDS (EENT)

ALREX 3 QL 0.5 / day

BECONASE AQ 3 QL 1.667 / day

budesonide 32 mcg nasal spray 1 QL 0.574 / day

budesonide micronized 3

CORTANE-B 3

DERMOTIC 3

dexamethasone 0.1% eye drop 1 QL 10 / fill

DUREZOL 3

FLAREX 3 QL 10 / fill

flunisolide 0.025% spray 1 QL .834 / day

fluocinolone acetonide oil 1 HCG

fluorometholone 1 QL 10 / fill



fluticasone prop 50 mcg spray 1 QL 0.6 / day

FML 3 QL 10 / fill

FML FORTE 3 QL 10 / fill

FML S.O.P. 3 QL 4 / fill

LOTEMAX 0.5% OPHTHALMIC GEL 3 QL 10 / fill

LOTEMAX 0.5% EYE DROPS 3 QL 21 / fill

LOTEMAX 0.5% EYE OINTMENT 3 QL 4 / fill

MAXIDEX 3 QL 10 / fill

mometasone furoate powder 3

mometasone furoate 50 mcg spry 1QL 0.567 / day

HCG

NASONEX 3 QL 0.567 / day

OMNARIS 3 QL 0.434 / day

OMNIPRED 3 QL 21 / fill

PRED FORTE 3 QL 21 / fill

PRED MILD 3 QL 21 / fill

prednisolone acetate 1 QL 21 / fill

prednisolone sod 1% eye drop 1

QNASL 3 QL 0.3 / day

QNASL CHILDREN 3

RHINOCORT AQUA 3 QL 0.574 / day

triamcinolone 55 mcg nasal spr 1 QL 0.55 / day

TRIESENCE 3 QL 1 / day

VERAMYST 3 QL 0.357 / day



VEXOL 3 QL 10 / fill

ZETONNA 3 QL 0.22 / day

EENT ANTI-INFLAMMATORY AGENTS, MISC.

RESTASIS 2 PA

RESTASIS MULTIDOSE 2 PA

XIIDRA 3

QL 2 / day

PA


EENT NONSTEROIDAL ANTI-INFLAM. AGENTS

ACULAR 3 QL 15 / 30 days

ACULAR LS 3 QL 5 / fill

ACUVAIL 2 QL 1 / day

bromfenac sodium 0.09% eye drp 1 QL 8 / rx

BROMSITE 3 QL 15/ 180 days

diclofenac 0.1% eye drops 1 QL 5 / fill

flurbiprofen sodium 1 QL 3/ fill

ILEVRO 3 QL 4 / fill

ketorolac 0.4% ophth solution 1 QL 5 / fill

ketorolac 0.5% ophth solution 1 QL 15 / 30 days

NEVANAC 3 QL 3/ fill

OCUFEN 3 QL 3/ fill

PROLENSA 3 QL 3/ fill



ANTI-INFLAMMATORY AGENTS (RESPIRATORY)

LEUKOTRIENE MODIFIERS

ACCOLATE 3 QL 2 / day

montelukast sodium powder 3

montelukast sodium (4 mg granules, 4 mg tab chew, 5 mg tabchew, 10 mg tablet) 1 QL 1 / day

SINGULAIR (4 MG GRANULES, 4 MG TABLET CHEW, 5 MGTABLET CHEW, 10 MG TABLET) 3 QL 1 / day

zafirlukast 1 QL 2 / day

zileuton er 3QL 4 / day

ST

ZYFLO 3QL 4 / day

ST

ZYFLO CR 3QL 4 / day

ST

MAST-CELL STABILIZERS

ALOCRIL 3 QL 5 / fill

cromolyn 20 mg/2 ml neb soln 1

cromolyn 4% eye drops 1 QL 10 / fill

cromolyn 100 mg/5 ml oral conc 1

cromolyn sodium powder 3

GASTROCROM 3

tranilast 3

ANTIANEMIA DRUGS

IRON PREPARATIONS

ACTIVE FE 3 GL Female



ATABEX EC 3 GL Female

CADEAU DHA 3

DIALYVITE 800 WITH IRON 3

DOTHELLE DHA 3

ELITE-OB 400 3 GL Female

ESCAVITE LQ 3

FEROCON 1

FEROTRINSIC 1

FERREX 150 FORTE 3

ferric sulfate 3

FERROCITE PLUS 1

ferrous fumarate 3

ferrous gluconate 3

ferrous sulfate 3

FOCALGIN 90 DHA 3

FOCALGIN CA 3 GL Female

FOCALGIN DSS 3 GL Female

FOLIVANE-PLUS 3

FORTAVIT 3

FUSION PLUS 3

FUSION SPRINKLES 3

HEMATINIC PLUS 1

HEMATINIC WITH FOLIC ACID 1 HCG

HEMATRON-AF 3

HEMAX 1 HCG

HEMOCYTE PLUS 3



HEMOCYTE-F 1 HCG

ICAR-C PLUS 3

INFED 5 S

levomefolate dha 3 GL Female

MACNATAL CN DHA 3 GL Female

MAXARON FORTE 3

MULTICHEW 3

MULTIGEN FOLIC 3

MULTIGEN PLUS 3

multivitamin-iron-fluoride 1

MYKIDZ IRON FL 3

MYNATAL CAPSULE 3 GL Female

MYNATAL ADVANCE 3 GL Female

MYNATAL PLUS 3 GL Female

MYNATAL-Z 3 GL Female

NEWGEN 3

NUTRICAP 3

O-CAL FA 3 GL Female

OBSTETRIX EC 3 GL Female

OBSTETRIX ONE 1GL Female

HCG

OBTREX DHA 3 GL Female

PNV 29-1 3 GL Female

PNV-DHA + DOCUSATE 3 GL Female

PNV-OMEGA 3 GL Female



POLY-VI-FLOR WITH IRON (0.25 MG, 0.5 MG) 3

POLYSACCHARIDE IRON FORTE 1

PRENA1 PEARL 3 GL Female

PRENA1 TRUE 3 GL Female

PRENATABS RX 3 GL Female

prenatal low iron 3 GL Female

prenatal plus multivitamin tab 3

PREPLUS 3 GL Female

PRETAB 3 GL Female

PROFERRIN-FORTE 3

PROTECT IRON 3

PROVIDA DHA 3

PROVIDA OB 3 GL Female

R-NATAL OB 3 GL Female

RULAVITE DHA 3

TEXAVITE LQ 3

THRIVITE 19 3

THRIVITE RX 3

TL FOLATE 3

TRI-TABS DHA 3 GL Female

TRICARE PRENATAL 3 GL Female

TRIFERIC 272 MG POWDER PACKET 5 S

TRINATE 3 GL Female

TRIVEEN-ONE 3 GL Female

VINATE DHA 3 GL Female



VINATE DHA RF 3 GL Female

VINATE GT 3 GL Female

VINATE II 3 GL Female

VINATE ONE 3 GL Female

VINATE ULTRA 3 GL Female

VIRT-ADVANCE 3 GL Female

VIRT-C DHA 3

VIRT-NATE 3 GL Female

VIRT-NATE DHA 3 GL Female

VIRT-PN 3 GL Female

VIRT-PN DHA 3 GL Female

VIRT-PN PLUS 3 GL Female

VITAFOL GUMMIES 3 GL Female

VITATRUE 3 GL Female

VIVA DHA 3 GL Female

VOL-TAB RX 3 GL Female

VP-CH-PNV 3 GL Female

VP-HEME OB 3 GL Female

VP-HEME ONE 3 GL Female

VP-PNV-DHA 3

VYNATAL-FA 1 GL Female



ANTIARRHYTHMIC AGENTS

ANTIARRHYTHMICS, MISCELLANEOUS

DIGITEK 1

DIGOX 1

digoxin (0.05 mg/ml solution, 0.125 mg tablet, 0.25 mg tablet,125 mcg tablet, 250 mcg tablet) 1

digoxin (0.25 mg/ml syringe, 500 mcg/2 ml ampule) 1

LANOXIN 500 MCG/2 ML AMPULE 2

LANOXIN (62.5 MCG TABLET, 125 MCG TABLET, 187.5 MCGTABLET, 250 MCG TABLET) 2

LANOXIN PEDIATRIC 2

magnesium sulfate crystals 3

magnesium sulfate (syringe, vial) 1

CLASS IA ANTIARRHYTHMICS

disopyramide phosphate 1

NORPACE 3

NORPACE CR 100 MG CAPSULE 2

NORPACE CR 150 MG CAPSULE 3

procainamide hcl powder 3

procainamide hcl (100 mg/ml vial, 500 mg/ml vial) 1

quinidine gluc er 324 mg tab 1

quinidine gluc 80 mg/ml vial 1

quinidine sulfate (crystals, powder) 3

quinidine sulfate (sulf er 300 mg tab, sulfate 200 mg tab,sulfate 300 mg tab) 1

CLASS IB ANTIARRHYTHMICS

DILANTIN (30 MG CAPSULE, 50 MG INFATAB, 100 MG CAPSULE) 2

DILANTIN-125 2



lidocaine hcl (1% syringe, 2% vial) 1 MED Medical Drug

lidocaine hcl (2% 100 mg/5 ml, 2% 40 mg/2 ml, 2% 40 mg/2ml vl, 30 mg/3 ml syr, 100 mg/10 ml syr) 1

mexiletine hcl (150 mg capsule, 200 mg capsule, 250 mgcapsule) 1

mexiletine hcl powder 3

PHENYTEK 2

phenytoin (50 mg infatab, 50 mg tablet chew, 100 mg/4 mlsusp, 125 mg/5 ml susp) 1

phenytoin powder 3

phenytoin sodium powder 3

phenytoin sodium extended 1

XYLOCAINE 2% VIAL 3

XYLOCAINE-MPF (AMPUL, VIAL) 3

CLASS IC ANTIARRHYTHMICS

flecainide acetate 1

propafenone hcl 1

propafenone hcl er 1 HCG

RYTHMOL 3

RYTHMOL SR 3

CLASS II ANTIARRHYTHMICS

acebutolol hcl (200 mg capsule, 400 mg capsule) 1

acebutolol hcl powder 3

atenolol powder 3

atenolol (25 mg tablet, 50 mg tablet) 1 LCG

atenolol 100 mg tablet 1

atenolol-chlorthalidone 1

BETAPACE 3



BETAPACE AF 3

betaxolol hcl (10 mg tablet, 20 mg tablet) 1

bisoprolol fumarate 1

bisoprolol-hctz 5-6.25 mg tab 1 LCG

bisoprolol-hydrochlorothiazide (2.5-6.25 mg tb, 10-6.25 mgtab) 1

CORGARD 3

CORZIDE 3

DUTOPROL 3 QL 2 / day

HEMANGEOL 5 S

INDERAL LA 3

INDERAL XL 3 ST

INNOPRAN XL 3 ST

LOPRESSOR (50 MG TABLET, 100 MG TABLET) 3

LOPRESSOR HCT 3

metoprolol succinate 1

metoprolol tartrate powder 3

metoprolol tartrate (25 mg tab, 50 mg tab) 1 LCG

metoprolol tartrate (37.5 mg tb, 75 mg tab) 1

metoprolol tartrate 100 mg tab 1

metoprolol-hydrochlorothiazide 1

nadolol powder 3

nadolol (20 mg tablet, 40 mg tablet, 80 mg tablet) 1

nadolol-bendroflumethiazide 1

pindolol 1

propranolol hcl powder 3



propranolol hcl (10 mg tablet, 20 mg tablet, 20 mg/5 ml soln,40 mg tablet, 40 mg/5 ml soln, 60 mg tablet, 80 mg tablet) 1

propranolol hcl er 1

propranolol-hydrochlorothiazid 1

SECTRAL 3

SORINE 1

sotalol 1

sotalol af 1

SOTYLIZE 3

TENORETIC 100 3

TENORETIC 50 3

TENORMIN 3

timolol maleate powder 3

timolol maleate (5 mg tablet, 10 mg tablet, 20 mg tablet) 1

TOPROL XL 3

ZEBETA 3

ZIAC 3

CLASS III ANTIARRHYTHMICS

amiodarone hcl (100 mg tablet, 200 mg tablet, 400 mg tablet) 1

CORDARONE 2

dofetilide 5 S

MULTAQ 3 PA

PACERONE 1

TIKOSYN 5 S

CLASS IV ANTIARRHYTHMICS

adenosine powder 3

CALAN 3 QL 3 / day



CALAN SR 3 QL 1 / day

CARDIZEM 3 QL 4 / day

CARDIZEM CD (180 MG CAPSULE, 240 MG CAPSULE, 300 MGCAPSULE, 360 MG CAPSULE) 3

CARDIZEM CD 120 MG CAPSULE 3 QL 1 / day

CARDIZEM LA (300 MG TABLET, 360 MG TABLET, 420 MGTABLET) 3 QL 1 / day

CARDIZEM LA 120 MG TABLET 3 QL 4 / day



CARTIA XT 1 QL 1 / day

DILT XR 120 MG CAPSULE 1 QL 1 / day

DILT-XR (180 MG CAPSULE, 240 MG CAPSULE) 1

diltiazem 12hr er 1

diltiazem 24hr cd (24hr 180 mg cap, 24hr 240 mg cap, 24hr300 mg cap, 24hr 360 mg cap) 1

diltiazem 24hr cd 120 mg cap 1 QL 1 / day

diltiazem 24hr er (24hr er 240 mg cap, 24hr er 300 mg cap,24hr er 360 mg cap, 24hr er 420 mg cap) 1

diltiazem 24hr er (24hr er 120 mg cap, 24hr er 180 mg cap,24hr er 300 mg tab, 24hr er 360 mg tab, 24hr er 420 mg tab) 1 QL 1 / day

diltiazem 24hr er 180 mg tab 1 QL 3 / day

diltiazem 24hr er 240 mg tab 1 QL 2 / day

diltiazem er (er 120 mg capsule, er 180 mg capsule) 1 QL 1 / day

diltiazem er 240 mg capsule 1

diltiazem hcl powder 3

diltiazem 90 mg tablet 1



diltiazem hcl (30 mg tablet, 60 mg tablet, 120 mg tablet) 1 QL 4 / day

MATZIM LA (300 MG TABLET, 360 MG TABLET, 420 MG TABLET) 1 QL 1 / day

MATZIM LA 180 MG TABLET 1 QL 3 / day

MATZIM LA 240 MG TABLET 1 QL 2 / day

TAZTIA XT (120 MG CAPSULE, 180 MG CAPSULE) 1 QL 1 / day

TAZTIA XT (240 MG CAPSULE, 300 MG CAPSULE, 360 MGCAPSULE) 1

TIAZAC (ER 120 MG CAPSULE, ER 180 MG CAPSULE) 3 QL 1 / day

TIAZAC (ER 240 MG CAPSULE, ER 300 MG CAPSULE, ER 360 MGCAPSULE, ER 420 MG CAPSULE) 3

verapamil er (er 120 mg capsule, er 120 mg tablet, er 180 mgcapsule, er 180 mg tablet, er 240 mg capsule, er 240 mg tablet) 1 QL 1 / day

verapamil er pm 1 QL 1 / day

verapamil 360 mg cap pellet 1 QL 1 / day

verapamil hcl powder 3

verapamil 40 mg tablet 1

verapamil hcl (80 mg tablet, 120 mg tablet) 1 QL 3 / day

verapamil sr 1 QL 1 / day

VERELAN 3 QL 1 / day

VERELAN PM 3 QL 1 / day

ANTIBACTERIALS

AMINOGLYCOSIDES

amikacin 3

amikacin sulfate powder 3

amikacin sulfate (1 gram/4 ml vial, 500 mg/2 ml vial, 1,000mg/4 ml vl) 1



BETHKIS 4

PA

S

PS

gentamicin sulfate powder 3

gentamicin sulfate (20 mg/2 ml vial, ped 20 mg/2 ml vial, 40mg/ml vial, 80 mg/2 ml vial, 800 mg/20 ml vial) 1

kanamycin sulfate 3

KITABIS PAK 5PA

S

neomycin sulfate powder 3

neomycin 500 mg tablet 1

paromomycin 250 mg capsule 1

paromomycin sulfate powder 3

streptomycin sulfate powder 3

streptomycin sulf 1 gm vial 1

TOBI 5PA

S

TOBI PODHALER 5PA

S

tobramycin (300 mg/5 ml ampule, pak 300 mg/5 ml) 5PA

S

tobramycin powder 3

tobramycin sulfate powder 3

tobramycin sulfate (1.2 gm vial, 1.2 gram/30 ml vial, 10 mg/mlvial, 40 mg/ml vial, 80 mg/2 ml vial, 1,200 mg/30 ml vial) 1

CHLORAMPHENICOL

chloramphenicol 3

chloramphenicol palmitate 3



MACROLIDES

clarithromycin powder 3

E.E.S. 200 3

E.E.S. 400 3

ERY-TAB 3

ERYPED 200 2

ERYPED 400 3

ERYTHROCIN STEARATE 3

erythromycin (dr 250 mg cap, ec 250 mg cap) 1

erythromycin (250 mg, 500 mg) 1 HCG

erythromycin 200 mg/5 ml gran 1

erythromycin es 400 mg tab 1 HCG

PCE 3

QUINOLONES

AVELOX 3 QL 21 / fill

AVELOX ABC PACK 3 QL 5 / day

CIPRO 10% SUSPENSION 3 QL 10 / day

CIPRO 5% SUSPENSION 3 QL 7 / day

CIPRO (250 MG TABLET, 500 MG TABLET) 3 QL 2 / day

CIPRO XR 1,000 MG TABLET 3 QL 14 / 1 rx

CIPRO XR 500 MG TABLET 3 QL 28 / fill

ciprofloxacin 250 mg/5 ml susp 1 QL 7 / day

ciprofloxacin 500 mg/5 ml susp 1 QL 10 / day

ciprofloxacin er 1,000 mg tab 1 QL 14 / 1 rx

ciprofloxacin er 500 mg tablet 1 QL 28 / fill



ciprofloxacin hcl (crystals, powder) 3

ciprofloxacin hcl (100 mg tab, 250 mg tab, 500 mg tab, 750 mgtab) 1 QL 2 / day

FACTIVE 3QL 7 / day

PA

LEVAQUIN 3 QL 30 / fill

levofloxacin powder 3

levofloxacin (25 mg/ml solution, 250 mg/10 ml soln, 500mg/20 ml soln) 1

levofloxacin (250 mg tablet, 500 mg tablet, 750 mg tablet) 1 QL 30 / fill

levofloxacin hemihydrate 3

moxifloxacin hcl powder 3

moxifloxacin hcl 400 mg tablet 1 QL 21 / fill

nalidixic acid 3

ofloxacin (300 mg tablet, 400 mg tablet) 1 QL 56 / fill

SULFONAMIDES (SYSTEMIC)

AZULFIDINE (500 MG TABLET, ENTAB 500 MG) 3

BACTRIM 3

BACTRIM DS 3

sulfacetamide 3

sulfacetamide sod monohydrate 3

sulfacetamide sodium powder 3

sulfadiazine powder 3

sulfadiazine 500 mg tablet 1

sulfadiazine sodium 3

sulfamethoxazole 3

sulfamethoxazole-trimethoprim (ds tablet, ss tablet, susp) 1



sulfanilamide 3

sulfapyridine 3

sulfasalazine powder 3

sulfasalazine 500 mg tablet 1

sulfasalazine dr 1

sulfathiazole 3

SULFATRIM 1

sulfisoxazole 3

TETRACYCLINES

ACTICLATE 3 ST

ADOXA 3 ST

AVIDOXY 1

demeclocycline hcl 1

DORYX DR 200 MG TABLET 3QL 7/ rx

ST

DORYX DR 50 MG TABLET 3 ST

DORYX MPC 3 ST

doxycycline hyclate (50 mg cap, 100 mg cap, 100 mg tab) 1

doxycycline hyclate powder 3

doxycycline hyclate (75 mg tab, 150 mg tab) 3 ST

doxycycline hyc dr 200 mg tab 1QL 7/ rx

HCG

doxycycline hyclate (dr 50 mg tab, dr 75 mg tab, dr 100 mg tab,dr 150 mg tab) 1 HCG

doxycycline ir-dr 1 QL 1 / day

doxycycline mono 150 mg cap 1 QL 30 / fill



doxycycline monohydrate powder 3

doxycycline monohydrate (25 mg/5 ml susp, mono 50 mg cap,mono 50 mg tablet, mono 75 mg capsule, mono 75 mg tablet,mono 100 mg cap, mono 100 mg tablet, mono 150 mg tablet)

1

MINOCIN (50 MG CAP, 75 MG CAP, 100 MG CAP) 3

minocycline hcl (50 mg capsule, hcl 50 mg tablet, 75 mgcapsule, hcl 75 mg tablet, 100 mg capsule, hcl 100 mg tablet) 1

minocycline hcl powder 3

minocycline er 45 mg tablet 1QL 3 / day

HCG

minocycline hcl er (er 90 mg tablet, er 135 mg tablet) 1QL 1 / day

HCG

MONDOXYNE NL 1

MONODOX 3

MORGIDOX (50 MG CAPSULE, 100 MG CAPSULE) 1

ORACEA 3QL 1 / day

ST

oxytetracycline hcl 3

PYLERA 2 QL 120 / 365 days

SOLODYN 3QL 1 / day

ST

TARGADOX 3 ST

tetracycline hcl (250 mg capsule, 500 mg capsule) 1 HCG

tetracycline hcl powder 3

VIBRAMYCIN (25 MG/5 ML SUSP, 50 MG/5 ML SYRUP, 100 MGCAPSULE) 3 ST



ANTIBACTERIALS, MISCELLANEOUS

BACITRACINS

BACIIM 1

bacitracin (unit vial, units vial) 1

GLYCOPEPTIDES

VANCOCIN HCL 3

vancomycin hcl (125 mg capsule, 250 mg capsule) 1 HCG

vancomycin hcl powder 3

vancomycin 125 mg/2.5 ml oral 1

LINCOMYCINS

CLEOCIN HCL 3 QL 4 / day

CLEOCIN PALMITATE 3 QL 70/ day

CLEOCIN PHOS 150 MG/ML VIAL 3 MED Medical Drug

CLEOCIN PHOSPHATE (9 G/60 ML VIAL, 300 MG/2 ML VIAL, 600MG/4 ML VIAL, 900 MG/6 ML VIAL) 3

clindamycin hcl (75 mg capsule, 150 mg capsule, 300 mgcapsule) 1 QL 4 / day

clindamycin hcl powder 3

clindamycin palmitate hcl 1 QL 70/ day

clindamycin pediatric 1 QL 70/ day

clindamycin phosphate (phos crystals, phosphate powder) 3

clindamycin phosphate (9 g/60 ml vial, 300 mg/2 ml vl, 600mg/4 ml vl, 900 mg/6 ml vl) 1

LINCOCIN 3

lincomycin hcl powder 3

lincomycin hcl (3 gm/10 ml vial, 600 mg/2 ml vl) 1 QL 10 / day



OXAZOLIDINONES

linezolid 100 mg/5 ml susp 1 QL 900 / rx

linezolid 600 mg tablet 1 QL 2 / day

SIVEXTRO 200 MG TABLET 3QL 6 / 30 days

PA

ZYVOX 100 MG/5 ML SUSPENSION 3QL 900 / rx

PA

ZYVOX 600 MG TABLET 3QL 2 / day

PA

POLYMYXINS

colistimethate 1

colistimethate sodium 3

colistin sulfate 3

COLY-MYCIN M PARENTERAL 3

polymyxin b sulfate (50 million unit, 100 million unit, sulfatepowder) 3

polymyxin b sulfate vial 1

RIFAMYCINS

MYCOBUTIN 3

PRIFTIN 3 QL 1.25 / day

rifabutin 1

RIFADIN (150 MG CAPSULE, 300 MG CAPSULE) 3

RIFAMATE 3

rifampin (150 mg capsule, 300 mg capsule) 1

rifampin powder 3

RIFATER 3



rifaximin 3

XIFAXAN 3 PA

ANTICHOLINERGIC AGENTS

ANTIMUSCARINICS/ANTISPASMODICS

ANASPAZ 3

ATROPEN 3

atropine sulfate powder 3

atropine sulfate (0.05 mg/ml syringe, 0.1 mg/ml abboject, 0.1mg/ml syringe, 0.4 mg/ml vial, 1 mg/ml vial, 8 mg/20 ml vial) 1

ATROVENT HFA 3 QL 1.29 / day

B-DONNA 1

belladonna 3

belladonna leaf powder 3

belladonna-phenobarbital 1

BENTYL 10 MG/ML AMPUL 3

BENTYL (10 MG CAPSULE, 20 MG TABLET) 3

CANTIL 3

chlordiazepoxide-clidinium 1

clidinium bromide 3

CUVPOSA 3

dicyclomine hcl (10 mg capsule, 10 mg/5 ml soln, 20 mg tablet) 1 LCG

dicyclomine hcl powder 3

dicyclomine 20 mg/2 ml vial 1

diphenoxylate-atropine (diphenoxylat-atrop 2.5-0.025/5,diphenoxylate-atrop 2.5-0.025) 1

DONNATAL (ELIXIR, TABLET) 3

DUODOTE 3



ED-SPAZ 1 HCG

glycopyrrolate powder 3

glycopyrrolate (1 mg tablet, 2 mg tablet) 1

hydrocodone-homatropine mbr (soln, syrup) 1QL 30 / day


hydrocod-homatrop 5-1.5 mg tab 1QL 6 / day


HYDROMET 1QL 30 / day


hyoscyamine sulfate (0.125 mg tab sl, 0.125 mg/5 ml elix,0.125 mg/ml drop, sulf 0.125 mg tab) 1

hyoscyamine sulfate powder 3

hyoscyamine 0.125 mg odt 1 HCG

hyoscyamine sulfate er 1

hyoscyamine sulfate sr 1

HYOSYNE (0.125 MG/ML DROP, 125 MCG/5 ML ELIXIR) 1

INCRUSE ELLIPTA 2 QL 1 / day

ipratropium bromide powder 3

ipratropium br 0.02% soln 1 QL 12.5 / day

LEVBID 3

LEVSIN 0.5 MG/ML AMPUL 3

LEVSIN 0.125 MG TABLET 3

LEVSIN-SL 3

LIBRAX 3

LOMOTIL 3

methscopolamine bromide powd 3

methscopolamine bromide (2.5 mg tb, 5 mg tab) 1



NULEV 1 HCG

OSCIMIN 0.125 MG TABLET 1

OSCIMIN 0.125 MG ODT 1 HCG

OSCIMIN SL 1

OSCIMIN SR 1

PHENOHYTRO 1

propantheline bromide powder 3

propantheline 15 mg tablet 1

ROBINUL 1 MG TABLET 3

ROBINUL (0.2 MG/ML VIAL, 0.4 MG/2 ML VIAL, 1 MG/5 ML VIAL,4 MG/20 ML VIAL) 3

ROBINUL FORTE 3

scopolamine hbr powder 3

scopolamine 0.4 mg/ml vial 1

scopolamine methyl nitrate 3

SEEBRI NEOHALER 3

QL 2 / day

PA


SPIRIVA 2 QL 1 / day

SPIRIVA RESPIMAT 2 QL 1 / day

STIOLTO RESPIMAT 2 QL 0.134 / day

SYMAX 1 HCG

SYMAX DUOTAB 3

SYMAX-SL 1

SYMAX-SR 1

TUSSIGON 1QL 6 / day




ANTIPARKINSONIAN AGENTS

benztropine mesylate (0.5 mg tab, 1 mg tablet, 2 mg tablet) 1

benztropine mesylate (2 mg/2 ml ampule, 2 mg/2 ml vial) 1

COGENTIN 3

trihexyphenidyl hcl (2 mg tablet, 2 mg/5 ml elx, 5 mg tablet) 1

ANTICOAGULANTS

ANTICOAGULANTS, MISCELLANEOUS

ACD-A 3

citrate phosphate dextrose 3

sodium citrate 4% soln 1

sodium citrate (lock flush, syringe) 1

COUMARIN DERIVATIVES

COUMADIN 2

dicumarol 3

JANTOVEN (1 MG TABLET, 3 MG TABLET, 4 MG TABLET) 1 LCG

JANTOVEN (2 MG TABLET, 2.5 MG TABLET, 5 MG TABLET, 6 MGTABLET, 7.5 MG TABLET, 10 MG TABLET) 1

warfarin sodium powder 3

warfarin sodium (1 mg tablet, 2 mg tablet, 2.5 mg tablet, 3 mgtablet, 4 mg tablet, 5 mg tablet) 1 LCG

warfarin sodium (6 mg tablet, 7.5 mg tablet, 10 mg tablet) 1

DIRECT FACTOR XA INHIBITORS

ARIXTRA (2.5 MG/0.5 ML SYRINGE, 5 MG/0.4 ML SYRINGE) 5 S

ARIXTRA (7.5 MG/0.6 ML SYRINGE, 10 MG/0.8 ML SYRINGE) 5 S

ELIQUIS 3QL 2 / day

PA

fondaparinux 5 mg/0.4 ml syr 5 S



fondaparinux sodium (2.5 mg/0.5 ml syr, 7.5 mg/0.6 ml syr, 10mg/0.8 ml syr) 5 S

SAVAYSA 3QL 1 / day

PA

XARELTO STARTER PACK 2

XARELTO (10 MG TABLET, 20 MG TABLET) 2 QL 1 / day

XARELTO 15 MG TABLET 2 QL 2 / day

DIRECT THROMBIN INHIBITORS

IPRIVASK 5 S

PRADAXA 2 QL 2 / day

HEPARINS

enoxaparin sodium (30 mg/0.3 ml syr, 40 mg/0.4 ml syr, 60mg/0.6 ml syr, 80 mg/0.8 ml syr, 100 mg/ml syringe, 120mg/0.8 ml syr, 150 mg/ml syringe, 300 mg/3 ml vial)

5 S

FRAGMIN (2,500 UNITS/0.2 ML SYR, 5,000 UNITS/0.2 ML SYR,7,500 UNITS/0.3 ML SYR, 10,000 UNITS/ML SYRING, 12,500UNITS/0.5 ML, 15,000 UNITS/0.6 ML, 18,000 UNITS/0.72 ML,95,000 UNITS/3.8 ML VL)

5 S

heparin sodium (sod 190 units/mg powd, sodium powder) 3

heparin sodium (2,000 unit/2 ml vial, 40,000 units/4 ml vial,50,000 units/10 ml vl, 50,000 units/5 ml vial) 1

heparin sodium (5,000 unit/ 0.5 ml, 5,000 unit/0.5 ml, 5,000unit/ml syr, 20,000 unit/ml vl) 1

LOVENOX (30 MG/0.3 ML SYRINGE, 40 MG/0.4 ML SYRINGE, 60MG/0.6 ML SYRINGE, 80 MG/0.8 ML SYRINGE, 100 MG/MLSYRINGE, 120 MG/0.8 ML SYRINGE, 150 MG/ML SYRINGE, 300MG/3 ML VIAL)

5 S

ANTICONVULSANTS

ANTICONVULSANTS, MISCELLANEOUS

APTIOM 3



BANZEL (40 MG/ML SUSPENSION, 200 MG TABLET, 400 MGTABLET) 3

BRIVIACT 10 MG/ML ORAL SOLN 3QL 20 / day

PA

BRIVIACT (10 MG TABLET, 50 MG TABLET) 3QL 4 / day

PA

BRIVIACT 100 MG TABLET 3QL 2 / day

PA


PA


PA

carbamazepine powder 3

carbamazepine (100 mg tab chew, 100 mg/5 ml susp, 200 mgtablet) 1

carbamazepine er (er 100 mg cap, er 200 mg cap, er 300 mgcap) 1

carbamazepine er (er 100 mg tablet, er 200 mg tablet, er 400mg tablet) 1 HCG

CARBATROL 2

DEPAKENE (250 MG CAPSULE, 250 MG/5 ML SOLUTION) 3

DEPAKOTE 3

DEPAKOTE ER 2

DEPAKOTE SPRINKLE 2

divalproex sodium (dr 125 mg cap sprnk, sod dr 125 mg tab, soddr 250 mg tab, sod dr 500 mg tab) 1

divalproex sodium er 1 HCG

EPITOL 1

EQUETRO 3



felbamate (400 mg tablet, 600 mg tablet, 600 mg/5 ml susp) 1

FELBATOL (400 MG TABLET, 600 MG TABLET, 600 MG/5 MLSUSP) 3 PA

FYCOMPA 0.5 MG/ML ORAL SUSP 3 QL 6 / day

FYCOMPA (2 MG TABLET, 2 MG-4 MG TABLET KIT, 4 MG TABLET,6 MG TABLET, 8 MG TABLET, 10 MG TABLET, 12 MG TABLET) 3 QL 1 / day

GABITRIL (12 MG TABLET, 16 MG TABLET) 2

GABITRIL (2 MG TABLET, 4 MG TABLET) 3

KEPPRA (100 MG/ML ORAL SOLN, 250 MG TABLET, 500 MGTABLET, 750 MG TABLET, 1,000 MG TABLET) 3

KEPPRA XR 3

LAMICTAL (5 MG DISPER TABLET, 25 MG DISPER TABLET, 25 MGTABLET, 100 MG TABLET, 150 MG TABLET, 200 MG TABLET) 3

LAMICTAL (BLUE) 3

LAMICTAL (GREEN) 3

LAMICTAL (ORANGE) 3

LAMICTAL ODT 3

LAMICTAL ODT (BLUE) 3

LAMICTAL ODT (GREEN) 3

LAMICTAL ODT (ORANGE) 3

LAMICTAL XR 3

LAMICTAL XR (BLUE) 3

LAMICTAL XR (GREEN) 3

LAMICTAL XR (ORANGE) 3

lamotrigine powder 3

lamotrigine (5 mg disper tablet, 25 mg disper tab, 25 mg tablet,25 mg tb start kit, 100 mg tablet, 150 mg tablet, 200 mg tablet) 1

lamotrigine (blue) 1

lamotrigine (green) 1



lamotrigine (orange) 1

lamotrigine er 1 HCG

lamotrigine odt 1

lamotrigine odt (blue) 1

lamotrigine odt (green) 1

lamotrigine odt (orange) 1

levetiracetam powder 3

levetiracetam 500 mg/5 ml soln 1 QL 946 / 30 days

levetiracetam (100 mg/ml soln, 250 mg tablet, 500 mg tablet,750 mg tablet, 1,000 mg tablet) 1

levetiracetam er 1

LYRICA (225 MG CAPSULE, 300 MG CAPSULE) 3QL 2 / day

PA

LYRICA (25 MG CAPSULE, 50 MG CAPSULE, 75 MG CAPSULE,100 MG CAPSULE, 150 MG CAPSULE, 200 MG CAPSULE) 3

QL 3 / day

PA

LYRICA 20 MG/ML ORAL SOLUTION 3QL 30 / day

PA

magnesium chl 200 mg/ml vial 1

oxcarbazepine (150 mg tablet, 300 mg tablet, 300 mg/5 mlsusp, 600 mg tablet) 1

OXTELLAR XR 3

POTIGA (200 MG TABLET, 300 MG TABLET, 400 MG TABLET) 3QL 3 / day

PA

POTIGA 50 MG TABLET 3QL 9 / day

PA

pregabalin 3

QUDEXY XR 3



ROWEEPRA 1

SABRIL (500 MG POWDER PACKET, 500 MG TABLET) 5

QL 6 / day

PA

S

sodium valproate 3

SPRITAM 3QL 3 / day


TEGRETOL (100 MG/5 ML SUSP, 200 MG TABLET) 3

TEGRETOL XR 2

tiagabine hcl 1

TOPAMAX (15 MG SPRINKLE CAP, 25 MG SPRINKLE CAP, 25 MGTABLET, 50 MG TABLET, 100 MG TABLET, 200 MG TABLET) 2

topiramate powder 3

topiramate (15 mg sprinkle cap, 25 mg sprinkle cap, 25 mgtablet, 50 mg tablet, 100 mg tablet, 200 mg tablet) 1

topiramate er 1 HCG

TRILEPTAL (150 MG TABLET, 300 MG TABLET, 300 MG/5 MLSUSP, 600 MG TABLET) 3

TROKENDI XR 3

valproic acid liquid 3

valproic acid (250 mg capsule, 250 mg/5 ml soln, 500 mg/10ml sol) 1

vigabatrin 5

QL 6 / day

PA

S

VIMPAT (10 MG/ML SOLUTION, 50 MG TABLET, 100 MG TABLET,150 MG TABLET, 200 MG TABLET, STARTER KIT) 3

ZONEGRAN 2

zonisamide (25 mg capsule, 50 mg capsule, 100 mg capsule) 1



zonisamide powder 3

BARBITURATES (ANTICONVULSANTS)

BREVITAL SODIUM 3

MYSOLINE 3

phenobarbital (15 mg tablet, 16.2 mg tablet, 20 mg/5 ml elix,20 mg/5 ml soln, 30 mg tablet, 32.4 mg tablet, 60 mg tablet,64.8 mg tablet, 97.2 mg tablet, 100 mg tablet)

1

phenobarbital sodium 1

primidone powder 3

primidone (50 mg tablet, 250 mg tablet) 1

BENZODIAZEPINES (ANTICONVULSANTS)

ATIVAN (0.5 MG TABLET, 1 MG TABLET) 3 QL 3 / day

ATIVAN 2 MG TABLET 3 QL 5 / day

ATIVAN (2 MG/ML VIAL, 4 MG/ML VIAL, 20 MG/10 ML VIAL, 40MG/10 ML VIAL) 3

clonazepam powder 3

clonazepam (2 mg odt, 2 mg tablet) 1 QL 10 / day

clonazepam (0.125 mg dis tab, 0.125 mg odt, 0.25 mg odt, 0.5mg dis tablet, 0.5 mg odt, 0.5 mg tablet, 1 mg dis tablet, 1 mgodt, 1 mg tablet)

1 QL 3 / day

clorazepate 15 mg tablet 1 QL 6 / day

clorazepate 3.75 mg tablet 1 QL 24 / day

clorazepate 7.5 mg tablet 1 QL 12 / day

DIASTAT 3 QL 0.07 / day

DIASTAT ACUDIAL 3 QL 0.07 / day

diazepam (2.5 mg rectal gel sys, 10 mg rectal gel syst, 20 mgrectal gel syst) 1 QL 0.07 / day

diazepam powder 3



diazepam (2 mg tablet, 5 mg tablet, 5 mg/5 ml oral soln, 5 mg/5ml solution, 5 mg/ml oral conc, 5 mg/ml vial, 10 mg tablet, 10mg/2 ml carpuject, 10 mg/2 ml isecure, 10 mg/2 ml syringe, 50mg/10 ml vial)

1

KLONOPIN (0.5 MG TABLET, 1 MG TABLET) 3 QL 3 / day

KLONOPIN 2 MG TABLET 3 QL 10 / day

lorazepam (2 mg tablet, 2 mg/ml oral concent) 1 QL 5 / day

lorazepam powder 3

lorazepam (0.5 mg tablet, 1 mg tablet) 1 QL 3 / day

lorazepam (2 mg/ml carpuject, 2 mg/ml syringe, 2 mg/ml vial, 4mg/ml carpuject, 4 mg/ml vial, 20 mg/10 ml vial, 40 mg/10 mlvial)

1

LORAZEPAM INTENSOL 1 QL 5 / day

ONFI (2.5 MG/ML SUSPENSION, 10 MG TABLET, 20 MG TABLET) 5PA

S

TRANXENE T-TAB 3.75 MG 3 QL 24 / day

TRANXENE T-TAB 7.5 MG 3 QL 12 / day

VALIUM 3

HYDANTOINS

CEREBYX 3

PEGANONE 3

SUCCINIMIDES

CELONTIN 3

ethosuximide (250 mg capsule, 250 mg/5 ml soln) 1

ethosuximide powder 3

ZARONTIN (250 MG CAPSULE, 250 MG/5 ML SOLUTION) 2



ANTIDEPRESSANTS

ANTIDEPRESSANTS, MISCELLANEOUS

APLENZIN 3 QL 1 / day

benactyzine hcl 3

BUPROBAN 1QL 2 / day

HCR

bupropion hcl powder 3

bupropion hcl 100 mg tablet 1 QL 5 / day

bupropion hcl 75 mg tablet 1 QL 6 / day

bupropion hcl sr 100 mg tablet 1 QL 4 / day

bupropion hcl sr 150 mg tablet 1QL 2 / day

HCR

bupropion hcl sr 200 mg tablet 1 QL 2 / day

bupropion hcl xl 150 mg tablet 1 QL 3 / day

bupropion hcl xl 300 mg tablet 1 QL 1 / day

FORFIVO XL 3 QL 1 / day

mirtazapine 7.5 mg tablet 1 QL 2 / day

mirtazapine (15 mg odt, 15 mg tablet, 30 mg odt, 30 mg tablet,45 mg odt, 45 mg tablet) 1 QL 1 / day

mirtazapine anhydrous 3

REMERON (15 MG SOLTAB, 15 MG TABLET, 30 MG SOLTAB, 30MG TABLET, 45 MG SOLTAB, 45 MG TABLET) 3 QL 1 / day

WELLBUTRIN 100 MG TABLET 3 QL 5 / day

WELLBUTRIN 75 MG TABLET 3 QL 6 / day

WELLBUTRIN SR (150 MG TABLET, 200 MG TABLET) 3 QL 2 / day



WELLBUTRIN SR 100 MG TABLET 3 QL 4 / day

WELLBUTRIN XL 150 MG TABLET 3 QL 3 / day

WELLBUTRIN XL 300 MG TABLET 3 QL 1 / day

ZYBAN 3 QL 2 / day

MONOAMINE OXIDASE INHIBITORS

AZILECT 3

ELDEPRYL 3

EMSAM 3 QL 1 / day

MARPLAN 3 QL 6 / day

NARDIL 3 QL 6 / day

PARNATE 3 QL 6 / day

phenelzine sulfate powder 3

phenelzine sulfate 15 mg tab 1 QL 6 / day

rasagiline mesylate powder 3

rasagiline mesylate (0.5 mg tab, 1 mg tab) 1

selegiline hcl (5 mg capsule, 5 mg tablet) 1

selegiline hcl powder 3

tranylcypromine sulfate 1 QL 6 / day

ZELAPAR 3

SEL.SEROTONIN,NOREPI REUPTAKE INHIBITOR

CYMBALTA (20 MG CAPSULE, 30 MG CAPSULE) 3 QL 1 / day

CYMBALTA 60 MG CAPSULE 3 QL 2 / day

desvenlafaxine er (er 50 mg tab, er 50 mg tablet) 1QL 1 / day

HCG

desvenlafaxine er 100 mg tab 1QL 1 / day

HCG



desvenlafaxine fumarate er 1QL 1 / day

HCG

desvenlafaxine succinate er 1QL 1 / day

HCG

duloxetine hcl (dr 20 mg cap, dr 30 mg cap) 1 QL 1 / day

duloxetine hcl (dr 40 mg cap, dr 60 mg cap) 1 QL 2 / day

duloxetine hcl powder 3

EFFEXOR XR (37.5 MG CAPSULE, 150 MG CAPSULE) 3 QL 1 / day

EFFEXOR XR 75 MG CAPSULE 3 QL 3 / day

FETZIMA (20-40 MG TITRATION PAK, ER 20 MG CAPSULE, ER 40MG CAPSULE, ER 80 MG CAPSULE, ER 120 MG CAPSULE) 3

QL 1 / day

ST

IRENKA 3 QL 2 / day

KHEDEZLA 3 QL 1 / day

PRISTIQ 3 QL 1 / day

SAVELLA (12.5 MG TABLET, 25 MG TABLET, 50 MG TABLET, 100MG TABLET, TITRATION PACK) 3

QL 2 / day

ST

venlafaxine hcl 1

venlafaxine hcl er 75 mg cap 1 QL 3 / day

venlafaxine hcl er (er 37.5 mg cap, er 37.5 mg tab, er 75 mg tab,er 150 mg cap, er 150 mg tab, er 225 mg tab) 1 QL 1 / day

SELECTIVE-SEROTONIN REUPTAKE INHIBITORS

BRISDELLE 3 QL 1 / day

CELEXA 3 QL 1 / day

citalopram hbr 10 mg/5 ml soln 1 QL 20 / day

citalopram hbr (10 mg tablet, 20 mg tablet, 40 mg tablet) 1QL 1 / day

LCG



escitalopram oxalate 5 mg/5 ml 1 QL 20 / day

escitalopram 20 mg tablet 1 QL 1 / day

escitalopram oxalate (5 mg tablet, 10 mg tablet) 1 QL 1.5 / day

fluoxetine dr 1 QL 0.142 / day

fluoxetine hcl (20 mg capsule, 20 mg tablet) 1 QL 4 / day

fluoxetine hcl 10 mg capsule 1 QL 1 / day

fluoxetine hcl 40 mg capsule 1 QL 2 / day

fluoxetine hcl powder 3

fluoxetine 20 mg/5 ml solution 1 QL 20 / day

fluoxetine hcl 10 mg tablet 1 QL 1.5 / day

fluoxetine hcl 60 mg tablet 1QL 1.5 / day

HCG

fluvoxamine maleate (25 mg tab, 50 mg tab) 1 QL 1 / day

fluvoxamine maleate 100 mg tab 1 QL 3 / day

fluvoxamine maleate er 1QL 2 / day

HCG

LEXAPRO 5 MG/5 ML SOLUTION 3 QL 20 / day

LEXAPRO (5 MG TABLET, 10 MG TABLET) 3 QL 1.5 / day

LEXAPRO 20 MG TABLET 3 QL 1 / day

olanzapine-fluoxetine hcl 1

QL 1 / day


HCG

paroxetine cr (cr 25 mg tablet, cr 37.5 mg tablet) 1 QL 2 / day

paroxetine cr 12.5 mg tablet 1 QL 1 / day



paroxetine er (er 25 mg tablet, er 37.5 mg tablet) 1 QL 2 / day

paroxetine er 12.5 mg tablet 1 QL 1 / day

paroxetine hcl (20 mg tablet, 40 mg tablet) 1 QL 1 / day

paroxetine hcl 10 mg tablet 1 QL 1.5 / day

paroxetine hcl 30 mg tablet 1 QL 2 / day

paroxetine mesylate 1 QL 1 / day

PAXIL 10 MG/5 ML SUSPENSION 3 QL 42 / day

PAXIL (20 MG TABLET, 40 MG TABLET) 3 QL 1 / day

PAXIL 10 MG TABLET 3 QL 1.5 / day

PAXIL 30 MG TABLET 3 QL 2 / day

PAXIL CR (CR 25 MG TABLET, CR 37.5 MG TABLET) 3 QL 2 / day

PAXIL CR 12.5 MG TABLET 3 QL 1 / day

PEXEVA 3 QL 1 / day

PROZAC 10 MG PULVULE 3

PROZAC 20 MG PULVULE 3 QL 4 / day

PROZAC 40 MG PULVULE 3 QL 2 / day

PROZAC WEEKLY 3 QL 0.15 / day

SARAFEM 10 MG TABLET 3 QL 1.5 / day

SARAFEM 20 MG TABLET 3 QL 4 / day

sertraline 20 mg/ml oral conc 1 QL 10 / day

sertraline hcl powder 3

sertraline hcl (25 mg tablet, 50 mg tablet) 1QL 1.5 / day

LCG

sertraline hcl 100 mg tablet 1QL 2 / day

LCG



SYMBYAX 3QL 1 / day


ZOLOFT 20 MG/ML ORAL CONC 3 QL 10 / day

ZOLOFT (25 MG TABLET, 50 MG TABLET) 3 QL 1.5 / day

ZOLOFT 100 MG TABLET 3 QL 2 / day

SEROTONIN MODULATORS

BRINTELLIX 3QL 1 / day

ST

nefazodone hcl 100 mg tablet 1 QL 6 / day



nefazodone hcl 250 mg tablet 1 QL 2.5 / day


trazodone hcl powder 3

trazodone 100 mg tablet 1QL 4 / day

LCG

trazodone 150 mg tablet 1 QL 2 / day

trazodone 300 mg tablet 1 QL 1 / day

trazodone 50 mg tablet 1QL 3 / day

LCG

TRINTELLIX (5 MG TABLET, 10 MG TABLET, 20 MG TABLET) 3QL 1 / day

ST

VIIBRYD 10-20 MG STARTER PACK 3

VIIBRYD (10 MG TABLET, 20 MG TABLET, 40 MG TABLET) 3 QL 1 / day



TRICYCLICS, OTHER NOREPI-RU INHIBITORS

amitriptyline hcl powder 3

amitriptyline hcl (10 mg tab, 25 mg tab, 50 mg tab, 75 mg tab,100 mg tab, 150 mg tab) 1 LCG

amoxapine 1

ANAFRANIL 3

chlordiazepoxide-amitriptyline 1

clomipramine hcl (25 mg capsule, 50 mg capsule, 75 mgcapsule) 1 HCG

clomipramine hcl powder 3

desipramine hcl powder 3

desipramine hcl (10 mg tablet, 25 mg tablet, 50 mg tablet, 75mg tablet, 100 mg tablet, 150 mg tablet) 1 HCG

doxepin hcl (10 mg capsule, 25 mg capsule) 1 LCG

doxepin hcl (10 mg/ml oral conc, 50 mg capsule, 75 mg capsule,100 mg capsule, 150 mg capsule) 1

doxepin hcl powder 3

imipramine hcl powder 3

imipramine hcl (10 mg tablet, 25 mg tablet, 50 mg tablet) 1 LCG

imipramine pamoate 1 HCG

maprotiline hcl 1

NORPRAMIN 3

nortriptyline hcl (10 mg/5 ml sol, hcl 10 mg cap, hcl 25 mg cap,hcl 50 mg cap, hcl 75 mg cap) 1

nortriptyline hcl powder 3

PAMELOR 3

perphenazine-amitriptyline 1

protriptyline hcl 1

SILENOR 3 QL 1 / day



SURMONTIL 3

TOFRANIL 3

TOFRANIL-PM 3

trimipramine maleate 1

ANTIDIABETIC AGENTS

ALPHA-GLUCOSIDASE INHIBITORS

acarbose 100 mg tablet 1 QL 3 / day



GLYSET 3 QL 3 / day

miglitol 1 QL 3 / day

PRECOSE 100 MG TABLET 3 QL 3 / day



AMYLINOMIMETICS

SYMLINPEN 120 2 QL 0.4 / day

SYMLINPEN 60 2 QL 0.2 / day

ANTIDIABETIC AGENTS, MISCELLANEOUS

KORLYM 5PA

S

WELCHOL 3.75G PACKET 2 QL 1 / day

WELCHOL 625 MG TABLET 2 QL 6 / day

BIGUANIDES

ACTOPLUS MET 3 QL 3 / day



ACTOPLUS MET XR 15-1,000 MG TB 2QL 3 / day

ST

ACTOPLUS MET XR 30-1,000 MG TB 2QL 1 / day

ST

AVANDAMET 2QL 2 / day

PA

glipizide-metformin (2.5-500 mg, 5-500 mg) 1 QL 4 / day

glipizide-metformin 2.5-250 mg 1 QL 8 / day

GLUCOPHAGE 1,000 MG TABLET 3 QL 2.5 / day

GLUCOPHAGE 500 MG TABLET 3 QL 5 / day

GLUCOPHAGE 850 MG TABLET 3 QL 3 / day

GLUCOPHAGE XR 500 MG TAB 3 QL 5 / day

GLUCOPHAGE XR 750 MG TAB 3 QL 3 / day

GLUCOVANCE 3 QL 4 / day

glyburid-metformin 1.25-250 mg 1 QL 8 / day

glyburide-metformin hcl (2.5-500 mg, 5-500 mg) 1 QL 4 / day

INVOKAMET 2QL 2 / day

ST

INVOKAMET XR 2QL 2 / day

ST

JANUMET 2QL 2 / day

ST

JANUMET XR (50-1,000 MG TABLET, 50-500 MG TABLET) 2QL 2 / day

ST

JANUMET XR 100-1,000 MG TABLET 2QL 1 / day

ST



JENTADUETO 2QL 2 / day

ST

JENTADUETO XR 2QL 1 / day

ST

metformin hcl powder 3

metformin hcl 1,000 mg tablet 1QL 2.5 / day

LCG

metformin hcl 500 mg tablet 1QL 5 / day

LCG

metformin hcl 850 mg tablet 1QL 3 / day

LCG

metformin hcl er 500 mg tablet 1QL 5 / day

C Only Glucophage ERgeneric covered

metformin hcl er 750 mg tablet 1QL 3 / day

C Only Glucophage ERgeneric covered

metformin hydrochloride 3

pioglitazone-metformin 1QL 3 / day

HCG

PRANDIMET 3 QL 5 / day

repaglinide-metformin hcl 1 QL 5 / day

RIOMET 3 QL 25 / day

SYNJARDY 2QL 2 / day

ST

SYNJARDY XR (5-1,000 MG TABLET, 10-1,000 MG TABLET, 12.5-1,000 MG TAB) 2

QL 2 / day

ST



SYNJARDY XR 25-1,000 MG TABLET 2QL 1 / day

ST

DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS

GLYXAMBI 3QL 1 / day

PA

JANUVIA 2QL 1 / day

ST

TRADJENTA 2QL 1 / day

ST

INCRETIN MIMETICS

BYDUREON 2QL 0.15 / day

ST

BYDUREON PEN 2QL .15 / day

ST

BYETTA 10 MCG DOSE PEN INJ 2QL 0.8 / day

ST

BYETTA 5 MCG DOSE PEN INJ 2QL 0.04 / day

ST

SAXENDA 3

QL 0.5 / day

PA


SOLIQUA 100-33 2QL 0.6 / day

PA

TRULICITY 2QL 0.08 / day

ST

VICTOZA 2-PAK 2QL 0.3 / day

ST



VICTOZA 3-PAK 2QL 0.3 / day

ST

INSULINS

AFREZZA 3 PA

HUMALOG (100 UNITS/ML CARTRIDGE, 100 UNITS/ML VIAL) 2

HUMALOG KWIKPEN U-100 2


HUMALOG MIX 50-50 2

HUMALOG MIX 50-50 KWIKPEN 2

HUMALOG MIX 75-25 2


HUMULIN R U-500 2

HUMULIN R U-500 KWIKPEN 2

LANTUS 2

LANTUS SOLOSTAR 2

TOUJEO SOLOSTAR 2

MEGLITINIDES

nateglinide 1 QL 3 / day

PRANDIN (0.5 MG TABLET, 1 MG TABLET) 3 QL 4 / day

PRANDIN 2 MG TABLET 3 QL 8 / day

repaglinide (0.5 mg tablet, 1 mg tablet) 1 QL 4 / day

repaglinide 2 mg tablet 1 QL 8 / day

STARLIX 3 QL 3 / day

SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB

INVOKANA 2QL 1 / day

ST



JARDIANCE 2QL 1 / day

ST

SULFONYLUREAS

AMARYL 3

chlorpropamide 100 mg tablet 1

chlorpropamide 250 mg tablet 1 QL 3 / day

DIABETA 3

DUETACT 3 QL 1 / day

glimepiride 1 LCG

glipizide powder 3

glipizide (5 mg tablet, 10 mg tablet) 1 LCG

glipizide er 1 LCG

glipizide xl 1

GLUCOTROL 3

GLUCOTROL XL 3

glyburide powder 3

glyburide (1.25 mg tablet, 2.5 mg tablet, 5 mg tablet) 1 LCG

glyburide micro 1.5 mg tab 1

glyburide micronized (3 mg tablet, 6 mg tablet) 1 LCG

GLYNASE 3

pioglitazone-glimepiride 1 QL 1 / day

tolazamide 250 mg tablet 1 QL 4 / day

tolazamide 500 mg tablet 1 QL 2 / day

tolbutamide 1 QL 6 / day



THIAZOLIDINEDIONES

ACTOS 3 QL 1 / day

AVANDIA 2 MG TABLET 2QL 3 / day

PA


PA


PA

pioglitazone hcl 1 QL 1 / day

ANTIEMETICS

5-HT3 RECEPTOR ANTAGONISTS

AKYNZEO 5

QL 0.15 / day

PA

S

ANZEMET (50 MG TABLET, 100 MG TABLET) 3 QL 0.15 / day

granisetron hcl 1 mg tablet 1 QL 6 / 30 days

ondansetron hcl (4 mg/2 ml isecure, hcl 4 mg/2 ml amp, hcl 4mg/2 ml syr, hcl 4 mg/2 ml vial) 5 S

ondansetron hcl powder 3

ondansetron 4 mg/5 ml solution 1 QL 20 / day

ondansetron hcl (4 mg tablet, 8 mg tablet) 1

QL 24 / 30 days

CMax allowable- 3/daywith max of 24 / 30days

ondansetron hcl 24 mg tablet 1 QL 3 days

ondansetron odt 1

QL 24 / 30 days




SANCUSO 5QL 0.144 / day

S

ZOFRAN 4 MG/5 ML ORAL SOLN 3 QL 20 / day

ZOFRAN (4 MG TABLET, 8 MG TABLET) 3

QL 24 / 30 days


ZOFRAN ODT 3

QL 24 / 30 days


ZUPLENZ 3 QL 24 / 30 days

ANTIEMETICS, MISCELLANEOUS

aprepitant 125-80-80 mg pack 1 QL 3/ fill

aprepitant (40 mg capsule, 125 mg capsule) 1 QL 0.08 / day

aprepitant 80 mg capsule 1 QL 0.15 / day

CESAMET 5

QL 0.67 / day

PA

S

DICLEGIS 3QL 4 / day

PA

diphenidol hcl 3

dronabinol 1QL 5 / day

HCG

EMEND TRIPACK 3 QL 3/ fill

EMEND (40 MG CAPSULE, 125 MG CAPSULE) 3 QL 0.08 / day

EMEND 80 MG CAPSULE 3 QL 0.15 / day

MARINOL 3QL 5 / day

PA



scopolamine 1

SYNDROS 3

QL 13 / day

PA


TRANSDERM-SCOP 2

VARUBI 5

QL 0.15 / day

PA

S

ANTIHISTAMINES (GI DRUGS)

ANTIVERT 3

COMPAZINE 25 MG SUPPOSITORY 1 HCG

COMPAZINE (5 MG TABLET, 10 MG TABLET) 3

COMPRO 1 HCG

dimenhydrinate 50 mg/ml vial 1

meclizine hcl powder 3

meclizine hcl (12.5 mg tablet, 25 mg tablet) 1

prochlorperazine 1 HCG

prochlorperazine edisylate pow 3

prochlorperazine edisylate (5 mg/ml vial, 10 mg/2 ml vl) 1

prochlorperazine mal powder 3

prochlorperazine maleate (5 mg tablet, 10 mg tab) 1

TIGAN 300 MG CAPSULE 3

TIGAN 100 MG/ML VIAL 3

trimethobenzamide 300 mg cap 1

trimethobenzamide hcl powder 3



ANTIFUNGAL (SYSTEMIC)

ALLYLAMINES

LAMISIL (125 MG GRANULES PACKET, 187.5 MG GRANULESPACK, 250 MG TABLET) 3

terbinafine hcl powder 3

terbinafine hcl 250 mg tablet 1

ANTIFUNGALS, MISCELLANEOUS

GRIFULVIN V 3

GRIS-PEG 3

griseofulvin powder 3

griseofulvin (125 mg/5 ml susp, micro 500 mg tab) 1 HCG

griseofulvin micronized 3

griseofulvin ultramicrosize 1

LUGOL'S SOLUTION 1

potassium iodide (crystals, granules) 3

sodium caprylate 3

SSKI 3

strong iodine 1

triacetin 1

AZOLES

CRESEMBA 186 MG CAPSULE 3 PA

DIFLUCAN (10 MG/ML SUSPENSION, 40 MG/ML SUSPENSION,50 MG TABLET, 100 MG TABLET, 200 MG TABLET) 3

DIFLUCAN 150 MG TABLET 3QL 0.4 / day

GL Female

fluconazole powder 3

fluconazole (10 mg/ml susp, 40 mg/ml susp, 50 mg tablet, 100mg tablet, 200 mg tablet) 1



fluconazole 150 mg tablet 1QL 0.4 / day

LCG

itraconazole 100 mg capsule 1

itraconazole powder 3

itraconazole micronized 3

ketoconazole powder 3

ketoconazole 200 mg tablet 1

ketoconazole micronized 3

NOXAFIL (40 MG/ML SUSPENSION, DR 100 MG TABLET) 3

ONMEL 3 PA

SPORANOX (10 MG/ML SOLUTION, 100 MG CAPSULE) 3

VFEND 40 MG/ML SUSPENSION 3 QL 20 / day

VFEND (50 MG TABLET, 200 MG TABLET) 3 QL 4 / day

voriconazole powder 3

voriconazole 40 mg/ml susp 1QL 20 / day

HCG

voriconazole (50 mg tablet, 200 mg tablet) 1QL 4 / day

HCG

POLYENES

amphotericin b powder 3

amphotericin b 50 mg vial 1

nystatin (100,000 unit/ml susp, 500,000 unit oral tab, 500,000unit/5 ml sus, 50,000,000 units pwd, 150,000,000 units pwd,500,000,000 units pwd)

1

PYRIMIDINES

ANCOBON 3

flucytosine (250 mg capsule, 500 mg capsule) 1



flucytosine powder 3

ANTIFUNGALS (SKIN AND MUCOUS MEMBRANE)

ALLYLAMINES (SKIN AND MUCOUS MEMBRANE)

naftifine hcl 1

NAFTIN (1% CREAM, 1% GEL, 2% CREAM, 2% GEL) 3

ANTIFULGALS (SKIN, MUCOUS MEMBRANE),MISC

ALA-QUIN 3

clioquinol 3

EXODERM 1 HCG

iodochlorohydroxyquinoline 3

sodium thiosulfate crystals 3

TRIPLE DYE 3

undecylenic acid 3

zinc undecylenate 3

AZOLES (SKIN AND MUCOUS MEMBRANE)

clotrimazole (crystalline, powder) 3

clotrimazole (1% cream, 1% solution, 10 mg troche) 1

clotrimazole-betamethasone (crm, lot) 1

econazole nitrate 1% cream 1 HCG

econazole nitrate powder 3

ECOZA 3

ERTACZO 3

EXELDERM (CREAM, SOLUTION) 3

EXTINA 3

GYNAZOLE 1 3

JUBLIA 3

QL 0.54 / day

PA




ketoconazole (cream, foam, shampoo) 1

LOTRISONE 3

LUZU 3QL 2 / day

PA

miconazole 3

miconazole 3 3 GL Female

miconazole nitrate 3

NIZORAL 3

ORAVIG 3

oxiconazole nitrate 1 HCG

OXISTAT (CREAM, LOTION) 3

TERAZOL 3 3QL 1.5 / day

GL Female

TERAZOL 7 3 QL 1.5 / day

terconazole (0.4% cream, 0.8% cream, 80 mg suppository) 1QL 1.5 / day

GL Female

VUSION 3

XOLEGEL 3

zazole 1QL 1.5 / day

GL Female

BENZYLAMINES (SKIN AND MUCOUS MEMBRANE)

MENTAX 3

HYDROXYPYRIDONES (SKIN, MUCOUS MEMBRANE)

CICLODAN 0.77% CREAM KIT 3

CICLODAN 0.77% CREAM 1

CICLODAN 8% SOLUTION 1 QL 0.22 / day



ciclopirox (0.77% cream, 0.77% gel, 0.77% topical susp, 1%shampoo) 1

ciclopirox 8% solution 1 QL 0.22 / day

ciclopirox olamine 3

CNL 8 3

LOPROX (0.77% TOPICAL SUSP, 1% SHAMPOO) 3

PENLAC 3 QL 0.22 / day

OXABOROLES

KERYDIN 3

QL 0.67 / day

PA


POLYENES (SKIN AND MUCOUS MEMBRANE)

NYAMYC 1

NYATA 100,000 UNIT/GM POWDER 1

nystatin (unit/gm cream, unit/gm powd, units/gm oint) 1

nystatin (1 billion unit powder, 2 billion unit powder, 5 billionunit powder, 10 billion unit powd, 15 billion unit powd, 50million unit pwd, 100 million units pwd, 150 million unit pwd,500 million unit pwd)

3

nystatin-triamcinolone (cream, ointm) 1 HCG

NYSTOP 1

PEDIADERM AF 3

ANTIGLAUCOMA AGENTS

ALPHA-ADRENERGIC AGONISTS (EENT)

ALPHAGAN P 0.1% DROPS 2 QL 21 / fill

ALPHAGAN P 0.15% EYE DROPS 3 QL 21 / fill

brimonidine tartrate (tartrate 0.15% drp, 0.2% eye drop) 1 QL 21 / fill



brimonidine tartrate powder 3

COMBIGAN 2 QL 21 / fill

SIMBRINZA 3 QL 10 / fill

BETA-ADRENERGIC BLOCKING AGENTS (EENT)

BETAGAN 3 QL 21 / fill

betaxolol hcl 0.5% eye drop 1 QL 21 / fill

BETIMOL 0.25% EYE DROPS 3 QL 5 / fill

BETIMOL 0.5% EYE DROPS 3 QL 21 / fill

BETOPTIC S 3 QL 21 / fill

carteolol hcl 1 QL 21 / fill

COSOPT 3 QL 10/ fill

COSOPT PF 3 QL 60 / fill

dorzolamide-timolol 1 QL 10/ fill

ISTALOL 3 QL 5 / fill

levobunolol hcl 1 QL 21 / fill

metipranolol 1 QL 5 / fill

timolol maleate (0.25% drops, 0.5% drops) 1 QL 21 / fill

timolol maleate (0.25%, 0.25% gfs, 0.5%, 0.5% gfs) 1 QL 5 / fill

TIMOPTIC 0.25% EYE DROPS 3 QL 5 / fill

TIMOPTIC 0.5% EYE DROPS 3 QL 10 / fill

TIMOPTIC OCUDOSE 3 QL 60 / fill

TIMOPTIC-XE 3 QL 5 / fill



CARBONIC ANHYDRASE INHIBITORS (EENT)

acetazolamide er 500 mg cap 1 HCG

acetazolamide powder 3

acetazolamide (125 mg tablet, 250 mg tablet) 1

acetazolamide sodium 1

AZOPT 2 QL 21 / fill

DIAMOX SEQUELS 3

dorzolamide hcl 1 QL 10 / fill

methazolamide powder 3

methazolamide (25 mg tablet, 50 mg tablet) 1

NEPTAZANE 3

TRUSOPT 3 QL 10 / fill

MIOTICS

acetylcholine chloride 3

carbachol 3

ISOPTO CARPINE 3 QL 21 / fill

MIOCHOL-E 3

MIOSTAT 3

PHOSPHOLINE IODIDE 3

pilocarpine hcl (1% drops, 2% drops, 4% drops) 1 QL 21 / fill

pilocarpine hcl powder 3

pilocarpine nitrate 3

OSMOTIC AGENTS

mannitol powder 3



PROSTAGLANDIN ANALOGS

bimatoprost 0.03% eye drops 1 QL 10/ fill

bimatoprost 0.03% eyelash soln 1

latanoprost 0.005% eye drops 1 QL 3/ fill

latanoprost oil 3

LATISSE 3

LUMIGAN 2 QL 10 / fill

TRAVATAN Z 2 QL 5 / fill

travoprost 1 QL 5 / fill

XALATAN 3 QL 3/ fill

ANTIHEMORRHAGIC AGENTS

ANTIHEPARIN AGENTS

protamine sulfate powder 3

HEMOSTATICS

AMICAR (0.25 GRAM/ML ORAL SOLN, 500 MG TABLET, 1,000MG TABLET) 3

aminocaproic acid (6-aminocaproic powder, aminocaproicpowder) 3

ASTRINGYN 3

AVITENE (FLOUR, SHEET 35MMX35MM, SHEET 70MMX35MM,SHEET 70MMX70MM) 3

DDAVP (0.1 MG TABLET, 0.2 MG TABLET, 10 MCG/0.1 MLSOLUTION) 3

DDAVP (4 MCG/ML AMPUL, 4 MCG/ML VIAL) 3

desmopressin acetate powder 3

desmopressin acetate (0.01% solution, 0.01% spray, 0.1 mg/mlsol, acetate 0.1 mg tb, acetate 0.2 mg tb) 1

desmopressin acetate (ac 4 mcg/ml ampul, ac 4 mcg/ml vial, 40mcg/10 ml vial) 1



ENDO-AVITENE 3

EVARREST 3

EVICEL FIBRIN 2X5 ML SEALANT 3

GELFOAM POWDER 3

LYSTEDA 3QL 6/ day plus 90/ 90 day

limitGL Female

MONSEL'S 3

OXYCEL 3

RECOTHROM (5,000 UNIT VIAL, 20,000 UNIT VIAL) 5 S

STIMATE 5 S

SYRINGE AVITENE 3

TACHOSIL 3

THROMBIN-JMI (5,000 EPIST, 5,000 SYR, 5,000 VIAL, 20,000PUMP, 20,000 SYR, 20,000 VIAL) 3

TISSEEL VHSD (2 ML KIT, FROZEN 2 ML SYR, 4 ML KIT, FROZEN 4ML SYR, 10 ML KIT, FROZEN 10 ML SYR) 3

tranexamic acid powder 3

tranexamic acid 650 mg tablet 1QL 6 / day

GL Female

ULTRAFOAM 3

ANTIHISTAMINE DRUGS

FIRST GENERATION ANTIHISTAMINES

ARBINOXA (4 MG TABLET, 4 MG/5 ML LIQUID) 1 AL At least 2 yrs old

brompheniramine maleate 3

carbinoxamine maleate (4 mg/5 ml liquid, maleate 4 mg tab) 1 AL At least 2 yrs old

chlorpheniramine maleate 3

clemastine fumarate powder 3 AL At least 2 yrs old



clemastine fum 2.68 mg tab 1 AL At least 2 yrs old

cyproheptadine hcl powder 3 AL At least 2 yrs old

cyproheptadine hcl (2 mg/5 ml syrup, 4 mg tablet, 4 mg/10 mlsyrp) 1 AL At least 2 yrs old

dimenhydrinate 100% powder 3

diphenhydramine hcl (12.5 mg/5 ml, 25 mg/10 ml) 1

diphenhydramine hcl powder 3

diphenhydramine hcl (50 mg/ml syrng, 50 mg/ml vial) 1

doxylamine succinate 3

KARBINAL ER 3 AL At least 2 yrs old

RYVENT 3 ST

triprolidine hcl 3

OTHER ANTIHISTAMINES

ketotifen fumarate 3

SECOND GENERATION ANTIHISTAMINES

cetirizine hcl 1 QL 10 / day

CLARINEX 0.5 MG/ML (2.5 MG/5) 3 QL 10 / day

CLARINEX 5 MG TABLET 3 QL 1 / day

CLARINEX-D 12 HOUR 3 QL 2 / day

desloratadine (2.5 mg odt, 5 mg odt, 5 mg tablet) 1 QL 1 / day

fexofenadine hcl powder 3

fexofenadine hcl 180 mg tablet 1 QL 1 / day

fexofenadine hcl 30 mg tablet 1

fexofenadine hcl 60 mg tablet 1 QL 2 / day

levocetirizine dihydrochl pwdr 3



levocetirizine 2.5 mg/5 ml sol 1 QL 30 / day

levocetirizine 5 mg tablet 1 QL 1 / day

loratadine 3

loratadine micronized 3

SEMPREX-D 3 QL 4 / day

XYZAL 2.5 MG/5 ML SOLUTION 3 QL 30 / day

XYZAL 5 MG TABLET 3 QL 1 / day

ANTIHISTAMINES (RESPIRATORY TRACT AGNTS)

FIRST GENERATION ANTIHIST.(RESPIR TRACT)

BROMFED DM 1AL At least 2 yrs old

HCG

brompheniramine-pseudoephed-dm 1AL At least 2 yrs old

HCG

CENTERGY 1

CENTERGY DM 1

hydrocodone-chlorpheniramne er 1QL 10 / day


PHENERGAN (25 MG/ML AMPUL, 25 MG/ML VIAL, 50 MG/MLAMPUL, 50 MG/ML VIAL) 3 AL At least 2 yrs old

promethazine hcl powder 3 AL At least 2 yrs old

promethazine 25 mg tablet 1AL At least 2 yrs old

LCG

promethazine hcl (6.25 mg/5 ml syrp, 12.5 mg tablet, 50 mgtablet) 1 AL At least 2 yrs old

promethazine hcl (25 mg/ml ampul, 25 mg/ml syringe, 25mg/ml vial, 50 mg/ml ampul, 50 mg/ml vial) 1 AL At least 2 yrs old

promethazine vc 1



promethazine-codeine 1

promethazine-dm solution 1 AL At least 2 yrs old

promethazine-dm syrup 1AL At least 2 yrs old

LCG

promethazine-phenylephrine 1

RESPA A.R. 3

TUSSICAPS 3QL 6 / day


TUSSIONEX 3QL 10 / day


VITUZ 3QL 4 / day


SECOND GENERATION ANTIHIST(RESPIR TRACT)

DYMISTA 2 QL 0.8 / day

ANTIHYPOGLYCEMIC AGENTS

ANTIHYPOGLYCEMIC AGENTS, MISCELLANEOUS

diazoxide 3

PROGLYCEM 3

GLYCOGENOLYTIC AGENTS

GLUCAGEN 2

GLUCAGON EMERGENCY KIT 2

glucagon hcl 1 HCG

ANTILIPEMIC AGENTS

ANTILIPEMIC AGENTS, MISCELLANEOUS

JUXTAPID (20 MG CAPSULE, 30 MG CAPSULE, 40 MG CAPSULE,60 MG CAPSULE) 5

QL 1 / day

PA

S



JUXTAPID (5 MG CAPSULE, 10 MG CAPSULE) 5

QL 2 / day

PA

S

KYNAMRO 5

QL 0.15 / day

PA

S

LOVAZA 3 QL 4 / day

niacin 3

niacin er (er 750 mg tablet, er 1,000 mg tablet) 1QL 2 / day

HCG

niacin er 500 mg tablet 1QL 3 / day

HCG

NIACOR 3 QL 12 / day

NIASPAN (ER 750 MG TABLET, ER 1,000 MG TABLET) 3 QL 2 / day

NIASPAN ER 500 MG TABLET 3 QL 3 / day

nicotinic acid 3

omega-3 acid ethyl esters 1QL 4 / day

HCG

TRIKLO 1QL 4 / day

HCG

VASCEPA 3QL 4 / day

ST

VIT 3 3

BILE ACID SEQUESTRANTS

cholestyramine powder 1 QL 24 / day

cholestyramine packet 1 QL 4 / day



cholestyramine light powder 1QL 24 / day

HCG

cholestyramine light packet 1QL 4 / day

HCG

cholestyramine resin 3

COLESTID (FLAVORED GRANULES, GRANULES, GRANULESPACKET) 3 QL 6 / day

COLESTID 1 GM TABLET 3 QL 4 / day

colestipol hcl (granules, granules packet) 1 QL 6 / day

colestipol hcl (hcl 1 gm tablet, micronized 1 gm tab) 1 QL 4 / day

PREVALITE POWDER 1QL 24 / day

HCG

PREVALITE PACKET 1QL 4 / day

HCG

QUESTRAN POWDER 3 QL 24 / day

QUESTRAN PACKET 3 QL 4 / day

QUESTRAN LIGHT 3 QL 24 / day

CHOLESTEROL ABSORPTION INHIBITORS

ezetimibe 1 QL 1 / day

ezetimibe-simvastatin 1 QL 1 / day

VYTORIN 3 QL 1 / day

ZETIA 3 QL 1 / day

FIBRIC ACID DERIVATIVES

ANTARA 30 MG CAPSULE 3 QL 2 / day

ANTARA 90 MG CAPSULE 3 QL 1 / day



fenofibrate (67 mg capsule, 130 mg capsule, 134 mg capsule,145 mg tablet, 160 mg tablet, 200 mg capsule) 1 QL 1 / day

fenofibrate 150 mg capsule 1QL 1 / day

HCG

fenofibrate 50 mg capsule 1QL 2 / day

HCG

fenofibrate (43 mg capsule, 48 mg tablet, 54 mg tablet) 1 QL 2 / day

fenofibrate 120 mg tablet 1 QL 1 / day

fenofibrate 40 mg tablet 1 QL 2 / day

fenofibric acid (105 mg tablet, dr 135 mg cap) 1 QL 1 / day

fenofibric acid (35 mg tablet, dr 45 mg cap) 1 QL 2 / day

FENOGLIDE 120 MG TABLET 3 QL 1 / day

FENOGLIDE 40 MG TABLET 3 QL 2 / day

FIBRICOR 105 MG TABLET 3 QL 1 / day

FIBRICOR 35 MG TABLET 3 QL 2 / day

gemfibrozil powder 3

gemfibrozil 600 mg tablet 1 QL 2 / day

LIPOFEN 150 MG CAPSULE 3 QL 1 / day

LIPOFEN 50 MG CAPSULE 3 QL 2 / day

LOFIBRA (67 MG CAPSULE, 134 MG CAPSULE, 160 MG TABLET,200 MG CAPSULE) 3 QL 1 / day

LOFIBRA 54 MG TABLET 3 QL 2 / day

LOPID 3 QL 2 / day

TRICOR 145 MG TABLET 3 QL 1 / day

TRICOR 48 MG TABLET 3 QL 2 / day



TRIGLIDE 3 QL 1 / day

TRILIPIX DR 135 MG CAPSULE 3 QL 1 / day

TRILIPIX DR 45 MG CAPSULE 3 QL 2 / day

HMG-COA REDUCTASE INHIBITORS

ADVICOR (500 MG TABLET, 750 MG TABLET, 1,000 MG TABLET) 3 QL 2 / day

ADVICOR 1,000 MG-40 MG TABLET 3 QL 1 / day

ALTOPREV 3 QL 1 / day

amlodipine-atorvastatin 1QL 1 / day

HCG

atorvastatin calcium 1 QL 1 / day

CADUET 3 QL 1 / day

CRESTOR 3 QL 1 / day

fluvastatin er 1 QL 1 / day

fluvastatin sodium 20 mg cap 1 QL 1 / day

fluvastatin sodium 40 mg cap 1 QL 2 / day

LESCOL 20 MG CAPSULE 3 QL 1 / day

LESCOL 40 MG CAPSULE 3 QL 2 / day

LESCOL XL 3

LIPITOR (10 MG TABLET, 20 MG TABLET, 40 MG TABLET) 3 QL 1 / day

LIPITOR 80 MG TABLET 3

LIVALO 3 QL 1 / day

lovastatin (10 mg tablet, 20 mg tablet) 1 QL 1 / day

lovastatin 40 mg tablet 1 QL 2 / day

PRAVACHOL 3 QL 1 / day



pravastatin sodium (10 mg tab, 20 mg tab) 1QL 1 / day

LCG

pravastatin sodium 40 mg tab 1 QL 1 / day

pravastatin sodium 80 mg tab 1

rosuvastatin calcium 1 QL 1 / day

SIMCOR (500-20 MG TABLET, 750-20 MG TABLET, 1,000-20 MGTABLET) 3 QL 2 / day

SIMCOR (500-40 MG TABLET, 1,000-40 MG TABLET) 3 QL 1 / day

simvastatin powder 3

simvastatin (20 mg tablet, 40 mg tablet) 1 QL 1.5 / day

simvastatin 10 mg tablet 1QL 1.5 / day

LCG

simvastatin 5 mg tablet 1QL 1 / day

LCG

simvastatin 80 mg tablet 1QL 1 / day

PA

ZOCOR (10 MG TABLET, 20 MG TABLET, 40 MG TABLET) 3 QL 1.5 / day

ZOCOR 5 MG TABLET 3 QL 1 / day

ZOCOR 80 MG TABLET 3QL 1 / day

PA

PCSK9 INHIBITORS

PRALUENT PEN 4

QL 0.08 / day

PA

S

PS

PRALUENT SYRINGE 4

QL 0.08 / day

PA

S

PS



REPATHA PUSHTRONEX 4

QL 0.13 / day

PA

S

PS

REPATHA SURECLICK 4

QL 0.08 / day

PA

S

PS

REPATHA SYRINGE 4

QL 0.08 / day

PA

S

PS

ANTIMIGRAINE AGENTS

SELECTIVE SEROTONIN AGONISTS

almotriptan malate 1QL 0.4 / day

HCG

ALSUMA 3 QL 0.167 / day

AMERGE 3 QL 0.3 / day

AXERT 3 QL 0.4 / day

eletriptan hbr 1QL 0.4 / day

HCG

FROVA 3 QL 0.6 / day

frovatriptan succinate 1QL 0.6 / day

HCG

IMITREX (4 MG/0.5 ML CARTRIDGES, 4 MG/0.5 ML PEN INJECT,6 MG/0.5 ML CARTRIDGES, 6 MG/0.5 ML PEN INJECT, 6 MG/0.5ML VIAL)

3 QL 0.167 / day



IMITREX (5 MG NASAL SPRAY, 20 MG NASAL SPRAY) 3 QL 6 / 30 days

IMITREX (25 MG TABLET, 50 MG TABLET, 100 MG TABLET) 3 QL 0.3 / day

MAXALT 3 QL 0.6 / day

MAXALT MLT 3 QL 0.6 / day

naratriptan 1 QL 0.6 / day

naratriptan hcl 1 QL 0.6 / day

ONZETRA XSAIL 3 ST

RELPAX 3 QL 0.4 / day

rizatriptan (5 mg odt, 5 mg tablet, 10 mg odt, 10 mg tablet) 1 QL 0.6 / day

sumatriptan powder 3

sumatriptan (5 mg nasal spray, 20 mg nasal spray) 1QL 6 / 30 days

HCG

sumatriptan succinate (4 mg/0.5 ml cart, 4 mg/0.5 ml inject, 6mg/0.5 ml inject, 6 mg/0.5 ml refill, 6 mg/0.5 ml vial) 1

QL 0.167 / day

HCG

sumatriptan succinate powder 3

sumatriptan 6 mg/0.5 ml syrng 1 QL 0.167 / day

sumatriptan succinate (25 mg tablet, 50 mg tablet, 100 mgtablet) 1 QL 0.3 / day

SUMAVEL DOSEPRO 3 QL 0.134 / day

TREXIMET 3QL 0.3 / day

ST

ZEMBRACE SYMTOUCH 3QL 0.134 / day

ST

zolmitriptan powder 3 QL 0.2 / day

zolmitriptan (2.5 mg tablet, 5 mg tablet) 1 QL 0.2 / day



zolmitriptan odt 1QL 0.2 / day

HCG

ZOMIG (2.5 MG NASAL SPRAY, 5 MG NASAL SPRAY) 2 QL 0.2 / day

ZOMIG (2.5 MG TABLET, 5 MG TABLET) 3 QL 0.2 / day

ZOMIG ZMT 3 QL 0.2 / day

ANTIMYCOBACTERIALS

ANTIMYCOBACTERIALS, MISCELLANEOUS

clofazimine 3

dapsone powder 3

dapsone (25 mg tablet, 100 mg tablet) 1

ANTITUBERCULOSIS AGENTS

aminosalicylic acid 3

BIAXIN (250 MG TABLET, 250 MG/5 ML SUSPENSION, 500 MGTABLET) 3

CAPASTAT SULFATE 3

clarithromycin (125 mg/5 ml sus, 250 mg tablet, 250 mg/5 mlsus, 500 mg tablet) 1

clarithromycin er 1

cycloserine 250 mg capsule 1 HCG

cycloserine powder 3

ethambutol hcl 1

isoniazid powder 3

isoniazid (50 mg/5 ml solution, 100 mg tablet, 300 mg tablet) 1

isoniazid 100 mg/ml vial 1

MYAMBUTOL 3

PASER 3

pyrazinamide powder 3



pyrazinamide 500 mg tablet 1

SIRTURO 3 PA

sodium 4-aminosalicylate 3

TRECATOR 3

ANTIPARKINSONIAN AGENTS (CNS)

ADAMANTANES (CNS)

amantadine (50 mg/5 ml solution, 100 mg capsule, 100 mgtablet, 100 mg/10 ml soln) 1

amantadine hcl 3

CATECHOL-O-METHYLTRANSFERASE(COMT)INHIB.

carbidopa-levodopa-entacapone 1

COMTAN 3

entacapone 1

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3

TASMAR 3

tolcapone 1

DOPAMINE PRECURSORS

carbidopa-levodopa (carbidopa-levo 10-100 mg odt, carbidopa-levo 25-100 mg odt, carbidopa-levo 25-250 mg odt, carbidopa-levodopa 10-100 tab, carbidopa-levodopa 25-100 tab,carbidopa-levodopa 25-250 tab)

1

carbidopa-levodopa er 1

DUOPA 5

QL 1 / day

PA

S



levodopa 3

RYTARY 3

SINEMET 10-100 3

SINEMET 25-100 3

SINEMET 25-250 3

SINEMET CR 3

MONOAMINE OXIDASE B INHIBITORS

XADAGO 3

QL 1 / day

PA


ANTIPROTOZOALS

AMEBICIDES

FLAGYL (250 MG TABLET, 375 CAPSULE, 500 MG TABLET) 3

FLAGYL ER 3

iodoquinol 3

metronidazole powder 3

metronidazole (250 mg tablet, 375 mg capsule, 500 mg tablet) 1

metronidazole benzoate 3

ANTIMALARIALS

atovaquone-proguanil hcl 1 PA

chloroquine phosphate powder 3

chloroquine phosphate (250 mg tablet, 500 mg tablet) 1

COARTEM 3

hydroxychloroquine sulf pwd 3

hydroxychloroquine 200 mg tab 1

MALARONE 3 PA



mefloquine hcl 1

PLAQUENIL 3

primaquine 1

pyrimethamine 3

QUALAQUIN 3QL 42 / 365 days

PA

quinacrine hcl 3

quinine hcl 3

quinine sulfate 324 mg capsule 1QL 42 / 365 days

PA

quinine sulfate powder 3

ANTIPROTOZOALS, MISCELLANEOUS

ALINIA (100 MG/5 ML SUSPENSION, 500 MG TABLET) 3 PA

antimony trichloride 3

atovaquone 1 PA

IMPAVIDO 5 S

MEPRON 3

NEBUPENT 3

PENTAM 300 3

TINDAMAX 3

tinidazole powder 3

tinidazole (250 mg tablet, 500 mg tablet) 1

ANTIPSYCHOTIC AGENTS

ANTIPSYCHOTICS, MISCELLANEOUS

ADASUVE 3 AL At least 18 yrs old

loxapine 1 AL At least 18 yrs old



molindone hcl 1

ORAP 3

pimozide 1

ATYPICAL ANTIPSYCHOTICS

ABILIFY 3QL 1 / day


ABILIFY MAINTENA (ER 300 MG SYR, ER 300 MG VL, ER 400 MGSYR, ER 400 MG VL) 3

QL 0.04 / day

PA


aripiprazole 1 mg/ml solution 1

QL 30 / day


HCG

aripiprazole (2 mg tablet, 5 mg tablet, 10 mg tablet, 15 mgtablet, 20 mg tablet, 30 mg tablet) 1

QL 1 / day


HCG

aripiprazole odt 1QL 1 / day


ARISTADA ER 1064 MG/3.9 ML SYR 3

QL 0.15 / day

PA


ARISTADA ER 441 MG/1.6 ML SYRN 3

QL 0.07 / day

PA



QL 0.08 / day

PA



QL 0.12 / day

PA




clozapine 100 mg tablet 1QL 9 / day








clozapine odt (odt 12.5 mg tablet, odt 25 mg tablet) 1QL 3 / day


clozapine odt (odt 150 mg tablet, odt 200 mg tablet) 1AL At least 18 yrs old

HCG

clozapine odt 100 mg tablet 1QL 9 / day


CLOZARIL 100 MG TABLET 3QL 9 / day


CLOZARIL 25 MG TABLET 3QL 18 / day


FANAPT TITRATION PACK 3QL 8 / rx


FANAPT (1 MG TABLET, 2 MG TABLET, 4 MG TABLET, 6 MGTABLET, 8 MG TABLET, 10 MG TABLET, 12 MG TABLET) 3

QL 2 / day

ST


FAZACLO (12.5 MG ODT, 25 MG ODT, 150 MG ODT, 200 MGODT) 3

QL 3 / day


FAZACLO 100 MG ODT 3QL 9 / day




GEODON (20 MG CAPSULE, 40 MG CAPSULE, 60 MG CAPSULE,80 MG CAPSULE) 3

QL 2 / day

ST


GEODON 20 MG/ML VIAL 3 ST

INVEGA 3ST


INVEGA SUSTENNA 117 MG/0.75 ML 3

QL 0.0333 / day

PA


INVEGA SUSTENNA 156 MG/ML SYRG 3

QL 0.04 / day

PA



QL 0.057 / day

PA



QL 0.0111 / day

PA



QL 0.02 / day

PA


INVEGA TRINZA 273 MG/0.875 ML 3

QL 0.0333 / day

PA



QL 0.057 / day

PA





QL 0.067 / day

PA



QL 0.1 / day

PA


LATUDA 3QL 1 / day


NUPLAZID 5

QL 2 / day

PA

S

olanzapine (2.5 mg tablet, 5 mg tablet) 1 QL 6 / day

olanzapine 10 mg tablet 1 QL 3 / day



olanzapine 7.5 mg tablet 1 QL 4 / day

olanzapine 10 mg vial 1

olanzapine odt 10 mg tablet 1QL 3 / day

HCG


HCG


HCG


HCG

paliperidone er 1AL At least 12 yrs old

HCG



quetiapine fumarate (25 mg tab, 50 mg tab) 1QL 6 / day


quetiapine fumarate 100 mg tab 1QL 3 / day


quetiapine fumarate 200 mg tab 1QL 1.5 / day






quetiapine er 150 mg tablet 1

QL 5 / day


HCG


QL 4 / day


HCG


QL 6 / day


HCG

quetiapine fumarate er (er 300 mg tablet, er 400 mg tablet) 1

QL 2 / day


HCG

REXULTI 3

QL 1 / day

PA


RISPERDAL 1 MG/ML SOLUTION 3QL 16/day




RISPERDAL (0.25 MG TABLET, 0.5 MG TABLET, 1 MG TABLET, 2MG TABLET) 3

QL 8 / day


RISPERDAL 3 MG TABLET 3QL 5 / day


RISPERDAL 4 MG TABLET 3QL 4 / day


RISPERDAL CONSTA 3

QL 0.1 / day

PA


RISPERDAL M-TAB (0.5 MG ODT, 1 MG ODT, 2 MG ODT) 3QL 8 / day


RISPERDAL M-TAB 3 MG ODT 3QL 5 / day


RISPERDAL M-TAB 4 MG ODT 3QL 4 / day


risperidone 1 mg/ml solution 1QL 16/day


risperidone (0.25 mg tablet, 0.5 mg tablet, 1 mg tablet, 2 mgtablet) 1

QL 8 / day


risperidone 3 mg tablet 1QL 5 / day


risperidone 4 mg tablet 1QL 4 / day


risperidone 3 mg odt 1

QL 5 / day


HCG



risperidone 4 mg odt 1

QL 4 / day


HCG

risperidone odt (0.25 mg odt, 0.5 mg odt, 1 mg odt, 2 mg odt) 1

QL 8 / day


HCG

SAPHRIS 3

QL 2 / day

ST


SEROQUEL (25 MG TABLET, 50 MG TABLET) 3QL 6 / day


SEROQUEL 100 MG TABLET 3QL 3 / day


SEROQUEL 200 MG TABLET 3QL 1.5 / day






SEROQUEL XR SAMPLE KIT 2 AL At least 10 yrs old

SEROQUEL XR (300 MG TABLET, 400 MG TABLET) 2QL 2 / day


SEROQUEL XR 150 MG TABLET 2QL 5 / day








VERSACLOZ 3QL 20 / day


VRAYLAR (1.5 MG CAPSULE, 1.5 MG-3 MG PACK, 3 MGCAPSULE, 4.5 MG CAPSULE, 6 MG CAPSULE) 3

QL 1 / day

PA


ziprasidone hcl 1QL 2 / day


ZYPREXA (2.5 MG TABLET, 5 MG TABLET) 3QL 6 / day


ZYPREXA 10 MG TABLET 3QL 3 / day






ZYPREXA 7.5 MG TABLET 3QL 4 / day


ZYPREXA 10 MG VIAL 3 AL At least 13 yrs old

ZYPREXA RELPREVV 3

QL 0.08 / day

PA


ZYPREXA ZYDIS 10 MG TABLET 3QL 3 / day










BUTYROPHENONES

HALDOL 3

HALDOL DECANOATE 100 3


haloperidol 5 mg/ml ampul 1

haloperidol powder 3

haloperidol (0.5 mg tablet, 1 mg tablet, 2 mg tablet, 5 mgtablet, 10 mg tablet, 20 mg tablet) 1

haloperidol decan 50 mg/ml amp 1

haloperidol decanoate powder 3

haloperidol decanoate (50 mg/ml vial, 100 mg/ml vial) 1

haloperidol decanoate 100 1

haloperidol lac 2 mg/ml conc 1

haloperidol lactate (5 mg/ml vial, 50 mg/10 ml vl) 1

PHENOTHIAZINES

acepromazine maleate 3

chlorpromazine 25 mg/ml amp 1

chlorpromazine hcl powder 3

chlorpromazine hcl (10 mg tablet, 25 mg tablet, 50 mg tablet,100 mg tablet, 200 mg tablet) 1 HCG

fluphenazine decanoate (liquid, oil) 3

fluphenazine dec 125 mg/5 ml 1

fluphenazine hcl (1 mg tablet, 2.5 mg tablet, 2.5 mg/5 ml elix, 5mg tablet, 5 mg/ml conc, 10 mg tablet) 1



fluphenazine 2.5 mg/ml vial 1

perphenazine powder 3 AL At least 18 yrs old

perphenazine (2 mg tablet, 4 mg tablet, 8 mg tablet, 16 mgtablet) 1 AL At least 18 yrs old

promazine hcl 3

thioridazine hcl 1

thioridazine hydrochloride 3

trifluoperazine hcl 1

THIOXANTHENES

thiothixene 1

ANTIRETROVIRALS

HIV ENTRY AND FUSION INHIBITORS

FUZEON 5QL 2 / day

S

SELZENTRY (20 MG/ML ORAL SOLN, 25 MG TABLET, 75 MGTABLET, 150 MG TABLET, 300 MG TABLET) 4

S

PS

HIV INTEGRASE INHIBITORS

GENVOYA 5 S

ISENTRESS 100 MG POWDER PACKET 4S

PS

ISENTRESS (25 MG TABLET CHEW, 100 MG TABLET CHEW, 400MG TABLET) 4

S

PS

ISENTRESS HD 4S

PS

STRIBILD 5 S

TIVICAY 5 S



TRIUMEQ 5 S

HIV NONNUCLEOSIDE REV.TRANSCRIP. INHIB.

ATRIPLA 4S

PS

COMPLERA 4S

PS

EDURANT 4S

PS

INTELENCE 4S

PS

nevirapine (50 mg/5 ml susp, 200 mg tablet) 5 S

nevirapine er 5 S

ODEFSEY 5 S

RESCRIPTOR (100 MG TABLET, 200 MG TABLET) 5 S

SUSTIVA (50 MG CAPSULE, 200 MG CAPSULE, 600 MG TABLET) 5 S

VIRAMUNE (50 MG/5 ML SUSP, 200 MG TABLET) 5 S

VIRAMUNE XR 5 S

HIV NUCLEOSIDE, NUCLEOTIDE RT INHIBITORS

abacavir (20 mg/ml solution, 300 mg tablet) 5 S

abacavir-lamivudine 5 S

abacavir-lamivudine-zidovudine 5 S

COMBIVIR 5 S

DESCOVY 5QL 1 / day

S



didanosine 5 S

EMTRIVA (10 MG/ML SOLUTION, 200 MG CAPSULE) 4S

PS

EPIVIR (10 MG/ML ORAL SOLN, 150 MG TABLET, 300 MGTABLET) 5 S

EPIVIR HBV (25 MG/5 ML SOLN, 100 MG TABLET) 5 S

EPZICOM 5 S

lamivudine 10 mg/ml oral soln 5 S

lamivudine (100 mg tablet, 150 mg tablet, 300 mg tablet) 5 S

lamivudine hbv 5 S

lamivudine-zidovudine 5 S

RETROVIR (10 MG/ML SYRUP, 100 MG CAPSULE) 5 S

stavudine (1 mg/ml solution, 15 mg capsule, 20 mg capsule, 30mg capsule, 40 mg capsule) 5 S

TRIZIVIR 5 S

TRUVADA 4S

PS

VIDEX 4S

PS

VIDEX EC 5 S

VIREAD POWDER 5 S

VIREAD (150 MG TABLET, 200 MG TABLET, 250 MG TABLET, 300MG TABLET) 4

S

PS

ZERIT (1 MG/ML SOLUTION, 15 MG CAPSULE, 20 MG CAPSULE,30 MG CAPSULE, 40 MG CAPSULE) 5 S

ZIAGEN (20 MG/ML SOLUTION, 300 MG TABLET) 5 S



zidovudine (50 mg/5 ml syrup, 100 mg capsule, 300 mg tablet) 5 S

HIV PROTEASE INHIBITORS

APTIVUS (100 MG/ML SOLUTION, 250 MG CAPSULE) 4S

PS

CRIXIVAN 4S

PS

EVOTAZ 5 S

fosamprenavir calcium 5 S

INVIRASE (200 MG CAPSULE, 500 MG TABLET) 4S

PS

KALETRA (80 MG-20 MG/ML SOLN, 100-25 MG TABLET, 200-50MG TABLET) 5 S

LEXIVA (50 MG/ML SUSPENSION, 700 MG TABLET) 5 S

lopinavir-ritonavir 4S

PS

NORVIR (80 MG/ML SOLUTION, 100 MG SOFTGEL CAP, 100 MGTABLET) 5 S

PREZCOBIX 5 S

PREZISTA (75 MG TABLET, 100 MG/ML SUSPENSION, 150 MGTABLET, 400 MG TABLET, 600 MG TABLET, 800 MG TABLET) 4

S

PS

REYATAZ (150 MG CAPSULE, 200 MG CAPSULE, 300 MGCAPSULE) 4

S

PS

REYATAZ 50 MG POWDER PACKET 4S

PS

TECHNIVIE 5

QL 2 / day

PA

S



VIEKIRA PAK 5

QL 4 / day

PA

S

VIEKIRA XR 5

QL 3 / day

PA

S

VIRACEPT 4S

PS

ANTITHROMBOTIC AGENTS

PLATELET-AGGREGATION INHIBITORS

acetyl salicylic acid 3

AGGRENOX 3 QL 2 / day

aspirin 3

aspirin-caffeine-dihydrocodein 1QL 10 / day


aspirin-dipyridamole er 1QL 2 / day

HCG

BRILINTA 2 QL 2 / day

butalbital-asa-caffeine cap 1 QL 6 / day

cilostazol 1 QL 2 / day

clopidogrel 1 QL 1 / day

clopidogrel bisulfate 3

dipyridamole powder 3

dipyridamole (25 mg tablet, 50 mg tablet, 75 mg tablet) 1 QL 4 / day

DURLAZA 3 QL 1 / day



EFFIENT 3 QL 1 / day

FIORINAL 3 QL 6 / day

LEVACET 3 PA

PERSANTINE 3 QL 4 / day

PLAVIX 3 QL 1 / day

PLETAL 3 QL 2 / day

prasugrel hcl 1 QL 1 / day

SYNALGOS-DC 3QL 10 / day


ticlopidine hcl 1 QL 2 / day

ZONTIVITY 3QL 1 / day

PA

PLATELET-REDUCING AGENTS

AGRYLIN 3 QL 4 / day

anagrelide hcl 1 QL 4 / day

THROMBOLYTIC AGENTS

CATHFLO ACTIVASE 5 S

ANTITOXINS,IMMUNE GLOB,TOXOIDS,VACCINES

ANTITOXINS AND IMMUNE GLOBULINS

antivenin latrodectus mactans 1

antivenin micrurus fulvius 1

CROFAB 3

CUVITRU 5PA

S



GAMMAGARD LIQUID 5PA

S

GAMMAKED 5PA

S

GAMUNEX-C 5PA

S

HIZENTRA 5PA

S

HYPERHEP B S-D (NEONATAL SYRIN., SYRINGE, VIAL) 5 S

HYPERRAB S-D 5 S

HYPERTET S-D 5 S

HYQVIA 5PA

S

HYQVIA IG COMPONENT 5PA

S

IMOGAM RABIES-HT 5 S

NABI-HB 5 S

VARIZIG (125 UNIT VIAL, 125 UNIT/1.2 ML VIAL) 5 S

TOXOIDS

ADACEL TDAP (SYRINGE, VIAL) 2 HCR

BOOSTRIX TDAP (SYRINGE, VIAL) 2 HCR

DAPTACEL DTAP 2 HCR

diphtheria-tetanus toxoids-ped 1

INFANRIX DTAP (SYRINGE, VIAL) 2

PEDIARIX 2



TENIVAC (SYRINGE, VIAL) 2 HCR

tetanus diphtheria toxoids 1 HCR

VACCINES

ACTHIB VACCINE WITH DILUENT 2

AFLURIA 2016-2017 (2016-2017 SYRINGE, 2016-2017 VIAL) 2 HCR

AFLURIA QUAD 2016-2017 (2016-2017 SYRINGE, 2016-2017VIAL) 2 HCR

bcg vaccine (tice strain) 3

BEXSERO 2

BIOTHRAX 2

CERVARIX 2 HCR

ENGERIX-B ADULT (20 MCG/ML SYRN, 20 MCG/ML VIAL) 2 HCR

ENGERIX-B PEDIATRIC-ADOLESCENT (10 MCG/0.5 ML PED VL,PEDI 10 MCG/0.5 SYRN) 2 HCR

EZ FLU 16-17 (FLUZON QUAD PED) 2 HCR

EZ FLU 2016-2017 (AFLURIA) 2 HCR

EZ FLU 2016-2017 (FLUVIRIN) 2 HCR

FLUAD 2016-2017 2 HCR

FLUARIX QUAD 2016-2017 2 HCR

FLUBLOK 2016-2017 2 HCR

FLUCELVAX QUAD 2016-2017 2 HCR

FLULAVAL QUAD 2016-2017 (2016-2017 SYR, 2016-2017VIAL) 2 HCR

FLUVIRIN 2016-2017 (2016-2017 SYRINGE, 2016-2017 VIAL) 2 HCR

FLUZONE HIGH-DOSE 2016-2017 2 HCR

FLUZONE INTRADERM QUAD 2016-17 2 HCR



FLUZONE QUAD 2016-2017 (2016-2017 SYRINGE, 2016-2017VIAL) 2 HCR

FLUZONE QUAD PEDI 2016-2017 2 HCR

GARDASIL (SYRINGE, VIAL) 2 HCR

GARDASIL 9 (9 SYRINGE, 9 VIAL) 2 HCR

HAVRIX (720 UNIT/0.5 ML SYRINGE, 720 UNITS/0.5 ML VIAL,1,440 UNITS/ML SYRINGE, 1,440 UNITS/ML VIAL) 2 HCR

HIBERIX VACCINE WITH DILUENT 2

IMOVAX RABIES VACCINE 2

IPOL VIAL 2

IXIARO 2

KINRIX (TIP-LOK SYRINGE, VIAL) 2

M-M-R II VACCINE 2 HCR

MENACTRA 2 HCR

MENHIBRIX 2

MENOMUNE-A-C-Y-W-135 2 HCR

MENVEO A-C-Y-W-135-DIP 2 HCR

MENVEO MENA COMPONENT 2

MENVEO MENCYW-135 COMPONENT 2

PEDVAXHIB 2

PENTACEL 2

PENTACEL ACTHIB COMPONENT 3

PENTACEL DTAP-IPV COMPONENT 2

PNEUMOVAX 23 (23 SYRINGE, 23 VIAL) 2 HCR

PREVNAR 13 2 HCR

PROQUAD 2



QUADRACEL DTAP-IPV 2

RABAVERT 2

RECOMBIVAX HB (5 MCG/0.5 ML SYR, 5 MCG/0.5 ML VL, 10MCG/ML SYR, 10 MCG/ML VIAL, 40 MCG/ML VIAL) 2 HCR

ROTARIX 2

ROTATEQ 2

STAMARIL 2

THERACYS 5 S

TRUMENBA 3

TWINRIX (SYRINGE, VIAL) 2 HCR

TYPHIM VI (25 MCG/0.5 ML AL, 25 MCG/0.5 ML SYRNG) 2

VAQTA (25 UNITS/0.5 ML SYRINGE, 25 UNITS/0.5 ML VIAL, 50UNITS/ML SYRINGE, 50 UNITS/ML VIAL) 2 HCR

VARIVAX VACCINE 2 HCR

VAXCHORA ACTIVE COMPONENT 2

VAXCHORA VACCINE 2

VIVOTIF 2

VIVOTIF BERNA 2

YF-VAX 2

ZOSTAVAX 2 HCR

ANTIULCER AGENTS AND ACID SUPPRESSANTS

HISTAMINE H2-ANTAGONISTS

cimetidine powder 3

cimetidine (200 mg tablet, 300 mg tablet, 300 mg/5 ml soln,400 mg tablet, 800 mg tablet) 1

famotidine powder 3

famotidine (20 mg tablet, 40 mg tablet, 40 mg/5 ml susp) 1

nizatidine (15 mg/ml solution, 300 mg capsule) 1



nizatidine 150 mg capsule 1 QL 2 / day

PEPCID (20 MG TABLET, 40 MG TABLET, 40 MG/5 ML ORALSUSP) 3

ranitidine hcl powder 3

ranitidine hcl (15 mg/ml syrup, 150 mg capsule, 150 mg tablet,150 mg/10 ml syrup, 300 mg capsule, 300 mg tablet) 1

ranitidine hcl (50 mg/2 ml vial, 150 mg/6 ml vl) 1

ZANTAC (150 MG TABLET, 300 MG TABLET) 3

ZANTAC (50 MG/2 ML VIAL, 150 MG/6 ML VIAL, 1,000 MG/40ML VIAL) 3

PROSTAGLANDINS

ARTHROTEC 50 3

ARTHROTEC 75 3

CYTOTEC 3

diclofenac sodium-misoprostol 1

misoprostol (hpmc powder, powder) 3

misoprostol (100 mcg tablet, 200 mcg tablet) 1

misoprostol hpmc 3

PROTECTANTS

CARAFATE 1 GM/10 ML SUSP 2

CARAFATE 1 GM TABLET 3

sucralfate powder 3

sucralfate 1 gm tablet 1

PROTON-PUMP INHIBITORS

ACIPHEX 3QL 2 / day

ST

ACIPHEX SPRINKLE 3 QL 1 / day

DEXILANT 3QL 1 / day

ST



esomeprazole mag dr 20 mg cap 1 QL 1 / day

esomeprazole mag dr 40 mg cap 1QL 1 / day

HCG

esomeprazole strontium 1QL 1 / day

HCG

lansoprazol-amoxicil-clarithro 1QL 112 / 365 days

HCG

lansoprazole dr 15 mg capsule 1

lansoprazole dr 30 mg capsule 1 QL 1 / day

lansoprazole powder 3

NEXIUM (DR 20 MG CAPSULE, DR 40 MG CAPSULE) 3 QL 1 / day

NEXIUM (DR 2.5 MG PACKET, DR 5 MG PACKET, DR 10 MGPACKET, DR 20 MG PACKET, DR 40 MG PACKET) 3 QL 2 / day

OMECLAMOX-PAK 3 QL 80 / 365 days

omeprazole (dr 10 mg capsule, dr 20 mg capsule, dr 40 mgcapsule) 1 QL 1 / day

omeprazole powder 3

omeprazole-bicarb 40-1,100 cap 1 HCG

omeprazole-sodium bicarbonate (20-1,100 cap, 20-1,680 pkt,40-1,680 pkt) 1

pantoprazole sodium (dr 20 mg tab, dr 40 mg tab) 1QL 1 / day

LCG

PREVACID (15 MG SOLUTAB, DR 15 MG CAPSULE, 30 MGSOLUTAB, DR 30 MG CAPSULE) 3

QL 1 / day

ST

PREVPAC 3 QL 112 / 365 days

PRILOSEC (DR 10 MG CAPSULE, DR 20 MG CAPSULE, DR 40 MGCAPSULE) 3

QL 1 / day

ST



PRILOSEC (DR 2.5 MG SUSPENSION, DR 10 MG SUSPENSION) 3 ST

PROTONIX 40 MG SUSPENSION 3 QL 1 / day

PROTONIX (DR 20 MG TABLET, DR 40 MG TABLET) 3QL 1 / day

ST

rabeprazole sodium 1 QL 2 / day

ZEGERID (20 MG CAPSULE, 20 MG PACKET, 40 MG CAPSULE) 3 ST

ZEGERID 40 MG PACKET 3QL 1 / day

ST

ANTIVIRALS (SYSTEMIC)

ADAMANTANES

FLUMADINE 3

rimantadine hcl 1

ANTIVIRALS, MISCELLANEOUS

2-deoxy-d-glucose 3

INTERFERONS

INTRON A (10 MILLION UNITS VIL, 18 MILLION UNIT/3 ML, 18MILLION UNITS VIL, 25 MILLION UNIT/2.5ML, 50 MILLION UNITSVIL)

5PA

S

PEGASYS (180 MCG/0.5 ML SYRINGE, 180 MCG/ML VIAL) 5PA

S

PEGASYS PROCLICK 5PA

S

PEGINTRON 4

PA

S

PS

PEGINTRON REDIPEN 4

PA

S

PS



SYLATRON 5PA

S

NEURAMINIDASE INHIBITORS

oseltamivir phosphate 1 QL 20 / 365 days

RELENZA 3 QL 40 / 365 days

TAMIFLU (30 MG CAPSULE, 45 MG CAPSULE, 75 MG CAPSULE) 3 QL 20 / 365 days

TAMIFLU 6 MG/ML SUSPENSION 3 QL 180 / 30 days

NUCLEOSIDES AND NUCLEOTIDES

acyclovir powder 3

acyclovir (200 mg capsule, 200 mg/5 ml susp, 400 mg tablet,800 mg tablet) 1

adefovir dipivoxil 5 S

BARACLUDE 0.05 MG/ML SOLUTION 5

QL 20 / day

PA

S

BARACLUDE (0.5 MG TABLET, 1 MG TABLET) 5

QL 1 / day

PA

S

cidofovir powder 3

COPEGUS 5

QL 6 / day

PA

S

entecavir 5QL 1 / day

S

famciclovir 1 HCG

FAMVIR 3



HEPSERA 5

QL 1 / day

PA

S

MODERIBA (200-400 MG DOSEPACK, 400-400 MG DOSEPACK,600-400 MG DOSEPACK, 600-600 MG DOSEPACK) 5

QL 2 / day

PA

S

MODERIBA 200 MG TABLET 5

QL 6 / day

PA

S

REBETOL 200 MG CAPSULE 5

QL 6 / day

PA

S

REBETOL 40 MG/ML SOLUTION 5

QL 30 / day

PA

S

RIBASPHERE (200 MG CAPSULE, 200 MG TABLET) 5

QL 6 / day

PA

S

RIBASPHERE 400 MG TABLET 5

QL 3 / day

PA

S

RIBASPHERE 600 MG TABLET 5

QL 2 / day

PA

S

RIBASPHERE RIBAPAK 5

QL 2 / day

PA

S



RIBATAB 5

QL 2 / day

PA

S

ribavirin (200 mg capsule, 200 mg tablet) 5

QL 6 / day

PA

S

ribavirin 6 gm inhalation vial 1

SITAVIG 3

QL 2 / fill

PA


TYZEKA 5

QL 1 / day

PA

S

valacyclovir 1 HCG

valacyclovir hcl 3

VALCYTE 50 MG/ML SOLUTION 3

VALCYTE 450 MG TABLET 3 QL 4 / day

valganciclovir hcl 50 mg/ml 1

valganciclovir 450 mg tablet 1 QL 4 / day

VALTREX 3

VEMLIDY 5

QL 1 / day

PA


S

vidarabine 3

vidarabine monohydrate 3

VIRAZOLE 3



ZOVIRAX (200 MG CAPSULE, 200 MG/5 ML SUSP, 400 MGTABLET, 800 MG TABLET) 3

ANXIOLYTICS, SEDATIVES AND HYPNOTICS

ANXIOLYTICS,SEDATIVES,AND HYPNOTICS,MISC

AMBIEN 3QL 1 / day

ST

AMBIEN CR 3QL 1 / day

ST

BELSOMRA 3 ST

buspirone hcl powder 3

buspirone hcl (5 mg tablet, 7.5 mg tablet, 10 mg tablet, 15 mgtablet, 30 mg tablet) 1

chloral hydrate 3 PA

dichloralphenazone 3

droperidol powder 3

droperidol (2.5 mg/ml ampul, 2.5 mg/ml vial) 1

EDLUAR 3QL 1 / day

ST

eszopiclone (1 mg tablet, 2 mg tablet) 1 QL 1 / day

eszopiclone 3 mg tablet 1QL 1 / day

AL Up to 65 yrs old

HETLIOZ 5

QL 1 / day

PA

S

hydroxyzine hcl powder 3 AL At least 2 yrs old

hydroxyzine hcl (10 mg/5 ml soln, 10 mg/5 ml syrup, hcl 10 mgtablet, hcl 25 mg tablet, 50 mg/25 ml syrup, hcl 50 mg tablet) 1 AL At least 2 yrs old



hydroxyzine hcl (25 mg/ml vial, 50 mg/ml vial, 100 mg/2 mlvial, 500 mg/10 ml vial) 1 AL At least 2 yrs old

hydroxyzine pam 100 mg cap 1

hydroxyzine pamoate (25 mg cap, 50 mg cap) 1 AL At least 2 yrs old

hydroxyzine pamoate powder 3

INTERMEZZO 3QL 1 / day

ST

LUNESTA (1 MG TABLET, 2 MG TABLET) 3QL 1 / day

ST

LUNESTA 3 MG TABLET 3

QL 1 / day

ST

AL Up to 65 yrs old

meprobamate 1

PHENADOZ 1 AL At least 2 yrs old

PHENERGAN (12.5 MG, 25 MG, 50 MG) 1 AL At least 2 yrs old

promethazine hcl (12.5 mg suppos, 25 mg suppository, 50 mgsuppository) 1 AL At least 2 yrs old

PROMETHEGAN 1 AL At least 2 yrs old

ROZEREM 3QL 1 / day

ST

SONATA 3QL 1 / day

ST

tryptophan (l) 3

VISTARIL 3 AL At least 2 yrs old

zaleplon 1 QL 1 / day

zolpidem tartrate (tart 1.75 mg tab sl, tart 3.5 mg tablet sl,tartrate 5 mg tablet, tartrate 10 mg tablet) 1 QL 1 / day



zolpidem tartrate er 1 QL 1 / day

ZOLPIMIST 3 QL 0.257 / day

BARBITURATES (ANXIOLYTIC, SEDATIVE/HYP)

AMYTAL SODIUM 3

butalbital 3

BUTISOL SODIUM 3

NEMBUTAL SODIUM 3

pentobarbital sodium powder 3

pentobarbital 1,000 mg/20 ml 1

phenobarbital powder 3

SECONAL SODIUM 3

BENZODIAZEPINES (ANXIOLYTIC,SEDATIV/HYP)

alprazolam powder 3

alprazolam (0.25 mg tablet, 0.5 mg tablet, 1 mg tablet) 1 QL 4 / day

alprazolam 2 mg tablet 1 QL 5 / day

alprazolam er (er 0.5 mg tablet, er 1 mg tablet) 1 QL 1 / day

alprazolam er 2 mg tablet 1 QL 5 / day

alprazolam er 3 mg tablet 1 QL 3 / day

ALPRAZOLAM INTENSOL 3 QL 10 / day

alprazolam odt (odt 0.25 mg tab, odt 0.5 mg tab, odt 1 mg tab) 1 QL 4 / day

alprazolam odt 2 mg tab 1 QL 5 / day

alprazolam xr (0.5 mg tablet, 1 mg tablet) 1 QL 1 / day

alprazolam xr 2 mg tablet 1 QL 5 / day

alprazolam xr 3 mg tablet 1 QL 3 / day

chlordiazepoxide 10 mg capsule 1 QL 30 / day





DORAL 3 QL 1 / day

estazolam 1 QL 1 / day

flurazepam hcl 1 QL 1 / day

HALCION 3 QL 2 / day

midazolam 3

midazolam hcl 2 mg/ml syrup 1

midazolam hcl (hcl 1 mg/ml vial, 2 mg/2 ml syringe, hcl 2 mg/2ml vial, 5 mg/ml isecure syr, 5 mg/ml syringe, hcl 5 mg/5 mlvial, hcl 5 mg/ml vial, hcl 10 mg/10 ml vial, hcl 10 mg/2 ml vial,hcl 25 mg/5 ml vial, hcl 50 mg/10 ml vial)

1

oxazepam 1 QL 4 / day

quazepam 1 QL 1 / day

RESTORIL 3 QL 1 / day

temazepam 1 QL 1 / day

triazolam 0.125 mg tablet 1 QL 1 / day

triazolam 0.25 mg tablet 1 QL 2 / day

XANAX (0.25 MG TABLET, 0.5 MG TABLET, 1 MG TABLET) 3 QL 4 / day

XANAX 2 MG TABLET 3 QL 5 / day

XANAX XR (0.5 MG TABLET, 1 MG TABLET) 3 QL 1 / day

XANAX XR 2 MG TABLET 3 QL 5 / day

XANAX XR 3 MG TABLET 3 QL 3 / day



AUTONOMIC DRUGS

AUTONOMIC DRUGS, MISCELLANEOUS

CHANTIX STARTING MONTH BOX 3 HCR

CHANTIX (0.5 MG TABLET, 1 MG CONT MONTH BOX, 1 MGTABLET) 3

QL 2 / day

HCR

nicotine polacrilex 3

NICOTROL 3 QL 16/day

NICOTROL NS 3 QL 20 / day

PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS)

ARICEPT (5 MG TABLET, 10 MG TABLET) 3 AL At least 40 yrs old

ARICEPT 23 MG TABLET 3ST


bethanechol chloride powder 3

bethanechol chloride (5 mg tablet, 10 mg tablet, 25 mg tablet,50 mg tablet) 1

cevimeline hcl 1 HCG

donepezil hcl 1 AL At least 40 yrs old

donepezil hcl odt 1 AL At least 40 yrs old

EVOXAC 3

EXELON (1.5 MG CAPSULE, 3 MG CAPSULE, 4.5 MG CAPSULE,4.6 MG/24HR PATCH, 6 MG CAPSULE, 9.5 MG/24HR PATCH,13.3 MG/24HR PATCH)

3 AL At least 40 yrs old

galantamine er 1 HCG

galantamine hbr 1

galantamine hydrobromide 1

guanidine hcl 1



MESTINON 60 MG/5 ML SYRUP 2

MESTINON (60 MG TABLET, 180 MG TIMESPAN) 3

NAMZARIC (7 MG-10 MG CAPSULE, 14 MG-10 MG CAPSULE, 21MG-10 MG CAPSULE, 28 MG-10 MG CAPSULE, TITRATION PACK) 3 ST

neostigmine methylsulfate powd 3

physostigmine salicylate 1

pilocarpine hcl (5 mg tablet, 7.5 mg tablet) 1

pyridostigmine bromide powder 3

pyridostigmine br 60 mg tablet 1

pyridostigmine bromide er 1

RAZADYNE 3

RAZADYNE ER 3

REGONOL 3

rivastigmine (1.5 mg capsule, 3 mg capsule, 4.5 mg capsule, 4.6mg/24hr patch, 6 mg capsule, 9.5 mg/24hr patch, 13.3 mg/24hrptch)

1 AL At least 40 yrs old

SALAGEN 3

URECHOLINE 3

SYMPATHOMIMETIC (ADRENERGIC) AGENTS

isometheptene mucate 3

BETA-3-ADRENERGIC AGONISTS

SELECTIVE BETA-3-ADRENERGIC AGONISTS

MYRBETRIQ 2 QL 1 / day

BETA-ADRENERGIC AGONISTS

SELECTIVE BETA-1-ADRENERGIC AGONISTS

dopamine hcl powder 3



BETA-ADRENERGIC BLOCKING AGENTS(SYMPATH)

NON-SEL. BETA-ADRENERGIC BLOCKING AGENTS

BYSTOLIC (5 MG TABLET, 10 MG TABLET) 2 QL 3 / day

BYSTOLIC 2.5 MG TABLET 2 QL 1 / day

BYSTOLIC 20 MG TABLET 2 QL 2 / day

BYVALSON 2 QL 1 / day

BLOOD FORMATION, COAGULATION, THROMBOSIS

HEMATOPOIETIC AGENTS

ARANESP (10 MCG/0.4 ML SYRINGE, 25 MCG/0.42 ML SYRING,25 MCG/ML VIAL, 40 MCG/0.4 ML SYRINGE, 40 MCG/ML VIAL,60 MCG/0.3 ML SYRINGE, 60 MCG/ML VIAL, 100 MCG/0.5 MLSYRINGE, 100 MCG/ML VIAL, 150 MCG/0.3 ML SYRINGE, 150MCG/0.75 ML VIAL, 200 MCG/0.4 ML SYRINGE, 200 MCG/MLVIAL, 300 MCG/0.6 ML SYRINGE, 300 MCG/ML VIAL, 500MCG/1 ML SYRINGE)

4

PA

S

PS

EPOGEN 5PA

S

GRANIX 5PA

S

LEUKINE 5PA

S

MIRCERA 5PA

S

MOZOBIL 5PA

S

NEULASTA (6 MG/0.6 ML SYRINGE, ONPRO 6 MG/0.6 ML KIT) 4

PA

S

PS



NEUPOGEN (300 MCG/0.5 ML SYR, 300 MCG/ML VIAL, 480MCG/0.8 ML SYR, 480 MCG/1.6 ML VIAL) 4

PA

S

PS

PROCRIT 4

PA

S

PS

PROMACTA 5PA

S

ZARXIO 5

QL 90 / 30 days

PA

S

HEMORRHEOLOGIC AGENTS

pentoxifylline powder 3

pentoxifylline er 400 mg tab 1

BRONCHODILATORS

XANTHINE DERIVATIVES

aminophylline (anhydrous pwd, powder) 3

dyphylline 3

ELIXOPHYLLIN 3

THEO-24 3

THEOCHRON 1

theophylline (80 mg/15 ml soln, er 400 mg tablet, er 600 mgtablet) 1

theophylline anhydrous powder 3

theophylline anhydrous (er 100 mg tablet, er 200 mg tablet, er300 mg tab, er 450 mg tab) 1



CALCIUM-CHANNEL BLOCKING AGENTS

DIHYDROPYRIDINES

felodipine er 1 QL 1 / day

isradipine 1 QL 2 / day

nisoldipine 1QL 1 / day

HCG

SULAR 3 QL 1 / day

CALCIUM-CHANNEL BLOCKING AGENTS(HYPOTEN)

CALCIUM-CHANNEL BLOCK.AGT,MISC(HYPOTEN)

TARKA 3 QL 1 / day

trandolapril-verapamil er 1

DIHYDROPYRIDINES (HYPOTENSIVE AGENTS)

ADALAT CC 30 MG TABLET 3 QL 1 / day

ADALAT CC 60 MG TABLET 3 QL 2 / day

ADALAT CC 90 MG TABLET 3

AFEDITAB CR 30 MG TABLET 1 QL 1 / day

AFEDITAB CR 60 MG TABLET 1 QL 2 / day

amlodipine besilate 3

amlodipine besylate powder 3

amlodipine besylate (2.5 mg tab, 5 mg tab, 10 mg tab) 1 QL 1 / day

amlodipine besylate-benazepril 1 QL 1 / day

amlodipine-olmesartan 1QL 1 / day

HCG

amlodipine-valsartan (5-320 mg, 10-160 mg, 10-320 mg) 1 QL 1 / day



amlodipine-valsartan 5-160 mg 1 QL 2 / day

amlodipine-valsartan-hctz 1QL 1 / day

HCG

AZOR 3 QL 1 / day

CARDENE SR 30 MG CAPSULE 3 QL 2 / day

EXFORGE 3 QL 1 / day

EXFORGE HCT 3 QL 1 / day

LOTREL 3 QL 1 / day

nicardipine hcl (20 mg capsule, 30 mg capsule) 1 HCG

NIFEDICAL XL 1 QL 1 / day

nifedipine (10 mg capsule, 20 mg capsule) 1 QL 4 / day

nifedipine powder 3

nifedipine er (er 30 mg tablet, er 90 mg tablet) 1 QL 1 / day

nifedipine er 60 mg tablet 1 QL 2 / day

nimodipine 30 mg capsule 1

nimodipine powder 3

NORVASC 3 QL 1 / day

NYMALIZE 60 MG/20 ML SOLUTION 3 QL 120 / day

PROCARDIA 3 QL 4 / day

PROCARDIA XL 3 QL 1 / day

TEKAMLO 3 QL 1 / day



CARDIAC DRUGS

CARDIAC DRUGS, MISCELLANEOUS

CORLANOR 2QL 2 / day

ST

RANEXA 2 QL 2 / day

CARDIOVASCULAR DRUGS

BETA-ADRENERGIC BLOCKING AGENTS

LEVATOL 3

CALCIUM-CHANNEL BLOCKING AGENTS

PRESTALIA 3QL 1 / day

ST

telmisartan-amlodipine 1 QL 1 / day

TWYNSTA 3 QL 1 / day

SCLEROSING AGENTS

SCLEROSOL 3

sodium tetradecyl sulfate (sul 27% soln, sulfate powd) 3

sterile talc 3

VASODILATING AGENTS

betahistine 3

betahistine hcl 3

cyclandelate 3

nylidrin hcl 3

CENTRAL NERVOUS SYSTEM AGENTS

ANTIMANIC AGENTS

lithium 1



lithium carbonate (150 mg cap, 300 mg cap, 300 mg tab, 600mg cap) 1

lithium carbonate powder 3

lithium carbonate er 1

LITHOBID 3

CENTRAL NERVOUS SYSTEM AGENTS, MISC.

acamprosate calcium 1 HCG

ADDYI 3

QL 1 / day

PA

GL Female

AL 18 to 60 yrs old

atomoxetine hcl 1QL 2 / day


AUSTEDO 5

QL 4 / day

PA


S

carbidopa powder 3

carbidopa 25 mg tablet 1

flibanserin 3

flumazenil powder 3

guanfacine hcl 1

guanfacine hcl er 1

idebenone 3

INGREZZA 40 MG CAPSULE 5

QL 2 / day

PA


S



INTUNIV 3 QL 1 / day

LODOSYN 3

memantine hcl powder 3 AL At least 40 yrs old

memantine hcl 2 mg/ml solution 1QL 360 / 30 days


memantine 5-10 mg titration pk 1AL At least 40 yrs old

HCG

memantine hcl 10 mg tablet 1QL 2 / day


memantine hcl 5 mg tablet 1QL 3 / day


NAMENDA (2 MG/ML SOLUTION, 5 MG TABLET, 5-10 MGTITRATION PK, 10 MG TABLET) 3 AL At least 40 yrs old

NAMENDA XR (7 MG CAPSULE, 14 MG CAPSULE, 21 MGCAPSULE, 28 MG CAPSULE, TITRATION PACK) 3

ST


NUEDEXTA 2 PA

RILUTEK 3

riluzole 1

STRATTERA 3QL 2 / day


TENEX 3

tetrabenazine 5PA

S

XENAZINE 5PA

S

XYREM 5

QL 18 / day

PA

S



OPIATE ANTAGONISTS

DEPADE 1

naloxone hcl powder 3

naloxone hcl (0.4 mg/ml carpuject, 0.4 mg/ml vial, 2 mg/2 mlsyringe, 4 mg/10 ml vial) 1

naltrexone hcl powder 3

naltrexone 50 mg tablet 1

naltrexone hcl dihydrate 3

NARCAN 2 MG NASAL SPRAY 3 QL 5 / 30 days

NARCAN 4 MG NASAL SPRAY 3 QL 2 / 30 days

REVIA 3

VIVITROL 380 MG VIAL 5PA

S

CEPHALOSPORINS

FIRST GENERATION CEPHALOSPORINS

cefadroxil (1 gm tablet, 250 mg/5 ml susp, 500 mg capsule, 500mg/5 ml susp) 1

cefazolin sodium (10 gm vial, 20 gm bulk vial, sod 100 gm bulkbag, sod 300 gm bulk bag, 500 mg vial) 1

cephalexin (125 mg/5 ml susp, 250 mg capsule, 250 mg tablet,250 mg/5 ml susp, 500 mg capsule, 500 mg tablet, 750 mgcapsule)

1

DAXBIA 3QL 4 / day

ST

KEFLEX 3

FOURTH GENERATION CEPHALOSPORINS

cefepime hcl 1

MAXIPIME (1 VIAL, 2 VIAL) 3



SECOND GENERATION CEPHALOSPORINS

cefaclor (125 mg/5 ml susp, 250 mg capsule, 250 mg/5 ml susp,375 mg/5 ml suspen, 500 mg capsule) 1

cefaclor er 1 QL 20 / 30 days

CEFOTAN 3

cefotetan (1 gm vial, 2 gm vial) 1

cefprozil (125 mg/5 ml susp, 250 mg tablet, 250 mg/5 ml susp,500 mg tablet) 1

CEFTIN (125 MG/5 ML ORAL SUSP, 250 MG/5 ML ORAL SUSP) 2

CEFTIN (250 MG TABLET, 500 MG TABLET) 3

cefuroxime 1

cefuroxime sod 750 mg vial 1

ZINACEF 750 MG VIAL 3

THIRD GENERATION CEPHALOSPORINS

CEDAX (180 MG/5 ML SUSPENSION, 400 MG CAPSULE) 3

cefdinir (125 mg/5 ml susp, 250 mg/5 ml susp, 300 mg capsule) 1

cefditoren pivoxil 1

cefixime 1QL 1200 / 90 days

HCG

cefotaxime sodium 1

cefpodoxime proxetil (50 mg/5 ml susp, 100 mg tablet, 100mg/5 ml susp, 200 mg tablet) 1

ceftazidime powder 3

ceftazidime (1 gm vial, 2 gm vial, 6 gm vial) 1 HCG

ceftazidime-sodium carbonate 3

ceftibuten (180 mg/5 ml susp, 400 mg capsule) 1 HCG

ceftriaxone 100 gram bulk bag 1 HCG



ceftriaxone (2 gm vial, 10 gm vial, 250 mg vial, 500 mg vial) 1

ceftriaxone 1 gm vial 1 MED Medical Drug

ceftriaxone sodium 3

CLAFORAN (1 GM VIAL, 2 GM VIAL, 10 GM VIAL, 500 MG VIAL) 3

FORTAZ (1 GM VIAL, 2 GM VIAL, 6 GM VIAL, 500 MG VIAL) 3

SPECTRACEF 3

SUPRAX (100 MG TABLET CHEWABLE, 200 MG TABLETCHEWABLE, 400 MG CAPSULE, 500 MG/5 ML SUSPENSION) 3

SUPRAX (100 MG/5 ML SUSPENSION, 200 MG/5 MLSUSPENSION) 3 QL 1200 / 90 days

TAZICEF (1 VIAL, 2 VIAL, 6 VIAL) 1 HCG

CORTICOSTEROIDS (RESPIRATORY TRACT)

ORALLY INHALED PREPARATIONS (STEROIDS)

AEROSPAN 2 QL 0.334 / day

ARNUITY ELLIPTA 100 MCG INH 2 QL 2 / day

ARNUITY ELLIPTA 200 MCG INH 2 QL 1 / day

budesonide (0.25 mg/2 ml susp, 0.5 mg/2 ml susp, 1 mg/2 mlinh susp) 1

FLOVENT 250 MCG DISKUS 2 QL 8 / day

FLOVENT DISKUS (50 MCG, 100 MCG) 2 QL 4 / day

FLOVENT HFA (HFA 110 MCG INHALER, HFA 220 MCG INHALER) 2 QL 0.8 / day

FLOVENT HFA 44 MCG INHALER 2 QL 0.767 / day

PULMICORT 3 QL 120 / 30 days

PULMICORT FLEXHALER 2 QL 0.07 / day



CYSTIC FIBROSIS (CFTR) MODULATORS

CYSTIC FIBROSIS (CFTR) CORRECTORS

ORKAMBI 5

QL 4 / day

PA

S

CYSTIC FIBROSIS (CFTR) POTENTIATORS

KALYDECO (50 MG GRANULES PACKET, 75 MG GRANULESPACKET, 150 MG TABLET) 5

QL 2 / day

PA

S

DEPIGMENTING AND PIGMENTING AGENTS

DEPIGMENTING AGENTS

ACLARO 3

ALPHAQUIN HP 1

BLANCHE 1

hydroquinone (cream, tl cream, tr cream) 1

hydroquinone (crystals, powder) 3

MELPAQUE HP 1

MELQUIN-3 3

mequinol 3

monobenzone 3

TRI-LUMA 3

PIGMENTING AGENTS

8-MOP 3

methoxsalen (10 mg capsule, 10 mg softgel) 1

methoxsalen (crystal, powder) 3

OXSORALEN 3

OXSORALEN-ULTRA 3



UVADEX 5 S

DIAGNOSTIC AGENTS

ADRENOCORTICAL INSUFFICIENCY

adrenocorticotrophic hormone 3

corticotrophin 3

CORTROSYN 3

cosyntropin 0.25 mg vial 1

H.P. ACTHAR 5PA

S

ALLERGENIC EXTRACTS (DIAGNOSTIC)

acacia 1:20 (w/v) vial 3

acremonium 3

alder 3

almond 3

alternaria 3

american beech 3

american cockroach extract 3

american elm 3

american sycamore 3

apple 3

arizona cypress 3

aspergillus fumigatus 3

aureobasidium 3

australian pine 3

avocado 3

bahia 3

bald cypress 3



banana 3

bayberry 3

beef 3

black walnut pollen 3

black willow 3

botrytis 3

box elder 3

brome 3

california pepper tree 3

candida albicans 3

cantaloupe 3

carelessweed 3

casein 3

cattle epithelium 3

cedar elm 3

chicken meat 3

cladosporium cladosporioides 3

cladosporium sphaerospermum 3

cocklebur 3

cocoa bean 3

corn pollen 3

corn smut 3

crab 3

curvularia 3

d.farinae mite extract 3

d.pteronyssinus mite extract 3

dog epithelium extract 3



dog fennel 3

drechslera 3

eastern cottonwood 3

egg white 3

english plantain 3

epicoccum 3

fire ant 3

fusarium 3

german cockroach 3

goldenrod 3

hackberry 3

honey bee venom protein 3

horse epithelium 3

johnson grass 3

kapok 3

kochia 3

lamb's quarters 3

melaleuca 3

mesquite 3

mixed aspergillus 3

mixed cockroach 3

mixed feathers 3

mixed ragweed extract 3

mixed vespid venom protein 3

mosquito 3

mountain cedar 3

mouse epithelium 3



mucor 3

mugwort 3

oat grain 3

olive tree 3

orange 3

peanut 3

pecan nut 3

pecan pollen 3

penicillium notatum 3

phoma 3

pistachio nut 3

pork 3

privet 3

quack grass 3

queen palm 3

rabbit epithelium 3

red birch 3

red cedar 3

red maple 3

red mulberry 3

red oak 3

rhizopus 3

rice 3

rough marsh elder 3

rough pigweed 3

russian thistle 3

saccharomyces cerevisiae 3



sagebrush 3

sesame seed 3

shagbark hickory 3

sheep sorrel 3

sheep sorrel-yellow dock 3

short ragweed 3

shrimp 3

soybean 3

spiny pigweed 3

standard bermuda grass pollen 3

standard mixed mite extract 3

standard rye grass pollen 3

standard sweet vernal grass 3

standardized cat hair 3

standardized june grass pollen 3

standardized meadow fescue 3

standardized orchard grass 3

standardized red top grass 3

std timothy grass 10,000/ml 3

std timothy grass 100,000/ml 3 QL 1 / day

strawberry 3

sweet corn 3

sweetgum 3

tall ragweed 3

trichophyton 3

virginia live oak 3

wasp venom protein 3



western juniper 3

western ragweed 3

white ash 3

white birch 3

white faced hornet venom 3

white mulberry 3

white oak extract 3

white pine 3

whole egg 3

yellow dock 3

yellow hornet venom protein 3

yellow jacket venom protein 3

CARDIAC FUNCTION

IC GREEN 3

indocyanine green 1

DRUG HYPERSENSITIVITY

PRE-PEN 3

FUNGI

CANDIN 3

SPHERUSOL 3

GALLBLADDER FUNCTION

KINEVAC 3

KIDNEY FUNCTION

INDIGO CARMINE 1

indigotindisulfonate sod-water 1



LYMPHATIC SYSTEM

LYMPHAZURIN 3

MYASTHENIA GRAVIS

edrophonium chloride 3

ENLON 3

OCULAR DISORDERS

BIOGLO 1

FLUCAINE 1

FLUOR-I-STRIP AT 1

fluorescein powder 3

fluorescein-proparacaine 1

FUL-GLO 1 MG OPTH STRIPS 1

FUL-GLO EYE STRIPS 3

MEMBRANEBLUE 3

PANCREATIC FUNCTION

secretin-mannitol 3

PITUITARY FUNCTION

METOPIRONE 3

ROENTGENOGRAPHY

barium sulfate 3

CONRAY 3

CYSTOGRAFIN 3

CYSTOGRAFIN-DILUTE 3

E-Z DISK 3

E-Z-CAT 3

E-Z-HD 3

E-Z-PAQUE 3



E-Z-PASTE 3

ENTERO VU 3

GASTROGRAFIN 3

ISOVUE-200 41% VIAL 3

LIQUID E-Z PAQUE 3

LIQUID POLIBAR PLUS 3

MD-76 R (R 66-10 INFUSION BOTTLE, R 66-10 VIAL) 3

MD-GASTROVIEW 1

POLIBAR ACB 3

READI-CAT 2 3

SINOGRAFIN 3

SITZMARKS 3

TAGITOL 3

ULTRAVIST 3

VARIBAR HONEY 3

VARIBAR NECTAR 3

VARIBAR PUDDING 3

VARIBAR THIN HONEY 3

VARIBAR THIN LIQUID 3

VOLUMEN 3

THYROID FUNCTION

protirelin 3

TUBERCULOSIS

APLISOL 3

TUBERSOL 3



DIURETICS

LOOP DIURETICS

bumetanide (0.5 mg tablet, 1 mg tablet, 2 mg tablet) 1

bumetanide (0.25 mg/ml vial, 1 mg/4 ml vial, 2.5 mg/10 mlvial) 1

DEMADEX 3

EDECRIN 3

ethacrynic acid 1

furosemide powder 3

furosemide (20 mg/2 ml vial, 40 mg/4 ml syringe, 40 mg/4 mlvial, 100 mg/10 ml syring, 100 mg/10 ml vial) 1

furosemide (10 mg/ml solution, 20 mg tablet, 40 mg tablet, 40mg/5 ml soln, 80 mg tablet) 1

LASIX 3

torsemide 1

OSMOTIC DIURETICS

sorbitol-mannitol 1 HCG

POTASSIUM-SPARING DIURETICS

amiloride hcl 1

amiloride-hydrochlorothiazide 1

DYAZIDE 3

DYRENIUM 3

MAXZIDE 3

MAXZIDE-25 MG 3

triamterene 3

triamterene-hydrochlorothiazid (37.5-25 mg cp, 37.5-25 mg tb,50-25 mg cap, 75-50 mg tab) 1



THIAZIDE DIURETICS

chlorothiazide 1

DIURIL 3

hydrochlorothiazide powder 3

hydrochlorothiazide (12.5 mg cp, 12.5 mg tb, 50 mg tab) 1

hydrochlorothiazide 25 mg tab 1 LCG

methyclothiazide 1

MICROZIDE 3

TEKTURNA HCT 3QL 1 / day

ST

trichlormethiazide 3

THIAZIDE-LIKE DIURETICS

chlorthalidone 1

indapamide 1

metolazone 1

VASOPRESSIN ANTAGONISTS

SAMSCA 15 MG TABLET 5

QL 1 / day

PA

S

SAMSCA 30 MG TABLET 5

QL 2 / day

PA

S

DIURETICS (HYPOTENSIVE AGENTS)

POTASSIUM-SPARING DIURETICS (HYPOTEN)

ALDACTAZIDE 3

ALDACTONE 3



eplerenone 1 HCG

INSPRA 3

spironolactone powder 3

spironolactone (25 mg tablet, 50 mg tablet, 100 mg tablet) 1

spironolactone-hctz 1

THIAZIDE DIURETICS(HYPOTENSIVE AGENTS)

ACCURETIC (10-12.5 MG TABLET, 20-12.5 MG TABLET) 3 QL 2 / day

ACCURETIC 20-25 MG TABLET 3 QL 1 / day

ATACAND HCT (32-12.5 MG TAB, 32-25 MG TABLET) 3 QL 1 / day

ATACAND HCT 16-12.5 MG TAB 3 QL 2 / day

AVALIDE 150-12.5 MG TABLET 3 QL 2 / day

AVALIDE 300-12.5 MG TABLET 3 QL 1 / day

benazepril-hydrochlorothiazide 1 QL 1 / day

BENICAR HCT 3 QL 1 / day

candesartan-hctz 16-12.5 mg tb 1 QL 2 / day

candesartan-hydrochlorothiazid (32-12.5 mg tb, 32-25 mg tab) 1 QL 1 / day

captopril-hydrochlorothiazide 1 QL 2 / day

DIOVAN HCT (320-12.5 MG TAB, 320-25 MG TABLET) 3 QL 1 / day

DIOVAN HCT (80-12.5 MG TABLET, 160-12.5 MG TAB, 160-25MG TABLET) 3 QL 2 / day

enalapril-hctz 10-25 mg tablet 1 QL 2 / day

enalapril-hctz 5-12.5 mg tab 1

fosinopril-hydrochlorothiazide 1 QL 2 / day

HYZAAR (100-12.5 TABLET, 100-25 TABLET) 3 QL 1 / day



HYZAAR 50-12.5 TABLET 3 QL 2 / day

irbesartan-hctz 150-12.5 mg tb 1 QL 2 / day

irbesartan-hctz 300-12.5 mg tb 1 QL 1 / day

lisinopril-hydrochlorothiazide 1 QL 2 / day

losartan-hctz 50-12.5 mg tab 1 QL 2 / day

losartan-hydrochlorothiazide (100-12.5 mg tab, 100-25 mgtab) 1 QL 1 / day

LOTENSIN HCT 3 QL 1 / day

methyldopa-hydrochlorothiazide 1

MICARDIS HCT (40-12.5 MG TABLET, 80-25 MG TABLET) 3 QL 1 / day

MICARDIS HCT 80-12.5 MG TABLET 3 QL 2 / day

moexipril-hydrochlorothiazide 1 QL 2 / day

olmesartan-amlodipine-hctz 1QL 1 / day

HCG

olmesartan-hydrochlorothiazide 1 QL 1 / day

quinapril-hctz 20-25 mg tab 1 QL 1 / day

quinapril-hydrochlorothiazide (10-12.5 mg tab, 20-12.5 mgtab) 1 QL 2 / day

telmisartan-hctz 80-12.5 mg tb 1QL 2 / day

HCG

telmisartan-hydrochlorothiazid (40-12.5 mg tb, 80-25 mg tab) 1QL 1 / day

HCG

TRIBENZOR 3 QL 1 / day

valsartan-hydrochlorothiazide (320-12.5 mg tab, 320-25 mgtab) 1 QL 1 / day

valsartan-hydrochlorothiazide (80-12.5 mg tab, 160-12.5 mgtab, 160-25 mg tab) 1 QL 2 / day



VASERETIC 3 QL 2 / day

ZESTORETIC 3 QL 2 / day

THIAZIDE-LIKE DIURETICS(HYPOTENSIVE AGT)

CLORPRES 3

EDARBYCLOR 3QL 1 / day

ST

DOPAMINE RECEPTOR AGONISTS

ERGOT-DERIV. DOPAMINE RECEPTOR AGONISTS

bromocriptine mesylate (2.5 mg tablet, 5 mg capsule) 1

bromocriptine mesylate powder 3

cabergoline 1

CYCLOSET 3QL 6 / day

PA

PARLODEL (2.5 MG TABLET, 5 MG CAPSULE) 3

NONERGOT-DERIV.DOPAMINE RECEPTOR AGONIST

APOKYN 5PA

S

apomorphine hcl 3

MIRAPEX 3

MIRAPEX ER 3 ST

NEUPRO 3

pramipexole dihydrochloride 1

pramipexole er 1 HCG

REQUIP 3

REQUIP XL 3 QL 1 / day

ropinirole er 1 QL 1 / day



ropinirole hcl 1

ELECTROLYTIC, CALORIC, AND WATER BALANCE

ACIDIFYING AGENTS

ammonium chloride granules 3

K-PHOS NEUTRAL 3

K-PHOS NO.2 3

K-PHOS ORIGINAL 3

PHOSPHA 250 NEUTRAL 1

VIRT-PHOS 250 NEUTRAL 1

ALKALINIZING AGENTS

CYTRA-2 1

CYTRA-3 3

CYTRA-K (CRYSTALS PACKET, ORAL SOLUTION) 1

ORACIT 3

potass cit-sod cit-citric acid 1

potassium citrate er 1

potassium cit-citric acid soln 1

SHOHL'S MODIFIED 3

sodium bicarbonate powder 3

sodium citrate powder 3

sodium citrate dihydrate 3

sodium citrate-citric acid 1

TARON-CRYSTALS 1

TRICITRASOL 3

TRICITRATES 1

UROCIT-K 3

VIRTRATE-2 1



VIRTRATE-3 1

VIRTRATE-K 1

AMMONIA DETOXICANTS

BUPHENYL (500 MG TABLET, POWDER) 5 S

CARBAGLU 5 S

CONSTULOSE 1

ENULOSE 1

GENERLAC 1

KRISTALOSE 1

lactulose 1

LITHOSTAT 3

RAVICTI 5

QL 20 / day

PA

S

sodium phenylbutyrate powder 3 S

sodium phenylbutyrate 500mg tb 5 S

CALORIC AGENTS

ACD 1

alanine 3

arginine (arginine 100% crystals, l-arginine powder) 3

arginine hcl 3

d-ribose 3

dextrose 3

l-alanine 3

l-citrulline 3

l-cysteine hydrochloride 3



l-leucine 3

leucine 3

lysine hcl 3

LYSIPLEX PLUS 1

phenylalanine 3

tyrosine powder 3

IRRIGATING SOLUTIONS

RESECTISOL 3

REPLACEMENT PREPARATIONS

calcium amino acid chelate 3

calcium carbonate 3

calcium chloride powder 3

calcium citrate 3

calcium glubionate 3

calcium gluconate monohydrate 3

calcium levulinate dihydrate 3

calcium phosphate 3

calcium saccharate 3

cardioplegia high potassium 3

cardioplegic 1

EFFER-K (10 TABLET EFF, 20 TABLET EFF) 3

EFFER-K 25 MEQ TABLET EFF 1

FOLBECAL 3 GL Female

FOLGARD OS 3

HYPER-SAL 3

K EFFERVESCENT 1

K-SOL 1



K-TAB ER 3

KLOR-CON 20 MEQ PACKET 1

KLOR-CON 25 MEQ PACKET 3

KLOR-CON 10 1

KLOR-CON 8 1

KLOR-CON M10 1

KLOR-CON M15 3

KLOR-CON M20 1

KLOR-CON SPRINKLE 1

KLOR-CON-EF 1

magnesium amino acid chelate 3

magnesium glycinate 3

manganese chloride 3

manganese gluconate 3

molybdenum 3

MONOJECT 0.9% SODIUM CHLORIDE 1

MONOJECT PREFILL 0.9% FLUSH 1

MONOJECT PREFILL ADVANCED 1

NEBUSAL 3% VIAL 1

NEBUSAL 6% VIAL 3

normal saline flush 1

PLEGISOL 3

potassium bicarbonate 1

potassium chloride (granules, powder) 3

potassium chloride (er 8 meq capsule, er 8 meq tablet, 10% (20meq/15 ml, 10% (40 meq/30 ml, er 10 meq capsule, er 10 meqtablet, 20 meq packet, 20% (40 meq/15 ml, er 20 meq tablet,25 meq tab eff)

1

potassium citrate 3



potassium citrate monohydrate 3

potassium phosphate powder 3

PRENAISSANCE NEXT 3 GL Female

PRISMASOL (B22GK 2/0, B22GK 4/0, BGK 0/2.5, BGK 2/0, BGK2/3.5, BGK 4/0/1.2, BGK 4/2.5, BK 0/0/1.2) 3

PULMOSAL 1

selenomethionine 3

sodium acetate trihydrate (crys, powd) 3

sodium cacodylate 3

sodium chloride granules 3

sodium chloride (bacteriostatic saline vial, sodium chloride0.9% vial) 1

sodium chloride (0.9% inhal vl, 0.9% syringe, 0.9% zr syr, 3%vial, 7% vial, 10% vial) 1

sodium l-aspartate monohydrate 3

SYREX 1

zinc chloride powder 3

zinc picolinate 3

zinc sulfate (heptahydrate powd, powder) 3

SALT AND SUGAR SUBSTITUTES

saccharin 1

URICOSURIC AGENTS

probenecid 1 QL 4 / day

probenecid-colchicine 1 QL 2 / day

ZURAMPIC 3

QL 1 / day

PA




EMOLLIENTS, DEMULCENTS, AND PROTECTANTS

BASIC LOTIONS AND LINIMENTS

ammonium lactate 12% lotion 1

ATOPICLAIR 3

calamine 3

lactic acid 10% lotion 1

PRUCLAIR 3

BASIC OILS AND OTHER SOLVENTS

AVO CREAM 3

BIAFINE 3

LUXAMEND 1

muri-lube mineral oil 3

PRUTECT 3

SONAFINE 3

SYNERDERM 3

BASIC OINTMENTS AND PROTECTANTS

ammonium lactate 12% cream 1

DEXERYL 3

ELETONE CREAM 3

lactic acid 10% e cream 1

TETRIX CREAM 3

VASELINE WHITE PETROLEUM 3

XCLAIR 3

ESTROGENS AND ANTIESTROGENS

ESTROGEN AGONIST-ANTAGONISTS

clomiphene citrate powder 3

clomiphene citrate 50 mg tab 1 GL Female



DUAVEE 2

EVISTA 3 QL 1 / day

OSPHENA 3

raloxifene hcl 1 HCR

SEROPHENE 1 GL Female

ESTROGENS

ACTIVELLA 3QL 1 / day

GL Female

ALORA 3QL 0.29 / day

GL Female

AMABELZ 1QL 1 / day

GL Female

ANGELIQ 3QL 1 / day

GL Female

CLIMARA 3QL 0.15 / day

GL Female

CLIMARA PRO 2QL 0.15 / day

GL Female

COMBIPATCH 3QL 0.29 / day

GL Female

COVARYX 1 GL Female

COVARYX H.S. 1 GL Female

DELESTROGEN 3 GL Female

DEPO-ESTRADIOL 3 GL Female

diethylstilbestrol 3



DIVIGEL (0.25 MG GEL PACKET, 0.5 MG GEL PACKET, 1 MG GELPACKET) 2 GL Female

EEMT 1 GL Female

EEMT H.S. 1 GL Female

ELESTRIN 3 GL Female

ENJUVIA 2QL 1 / day

GL Female

ESTRACE 0.01% CREAM 2 GL Female

ESTRACE (0.5 MG TABLET, 1 MG TABLET, 2 MG TABLET) 3QL 1 / day

GL Female

estradiol (0.025 mg patch, 0.0375 mg patch, 0.05 mg patch,0.075 mg patch, 0.1 mg patch) 1

QL 0.29 / day

GL Female

estradiol (tds 0.025 mg/day, 0.0375 mg/day patch, tds 0.0375mg/day, tds 0.05 mg/day, tds 0.06 mg/day, 0.075 mg/daypatch, tds 0.075 mg/day, tds 0.1 mg/day)

1QL 0.15 / day

GL Female

estradiol 0.06 mg/day patch 1QL .15 / day

GL Female

estradiol powder 3

estradiol (0.5 mg tablet, 1 mg tablet) 1

QL 1 / day

GL Female

LCG

estradiol 10 mcg vaginal insrt 1 GL Female

estradiol 2 mg tablet 1QL 1 / day

GL Female

estradiol benzoate 3

estradiol cypionate 3

estradiol micronized 3



estradiol valerate powder 3

estradiol valerate (20 mg/ml vl, 40 mg/ml vl) 1 GL Female

estradiol-norethindrone acetat 1QL 1 / day

GL Female

ESTRING 2QL 90 days

GL Female

estriol 3 GL Female

estriol micronized 3 GL Female

ESTROGEL 3QL 1.667 / day

GL Female

estrogen-methyltestosterone 1 GL Female

estrone (crystal, powder) 3

estropipate (0.625(0.75 tab, 1.25(1.5 tab) 1

QL 1 / day

GL Female

LCG

estropipate 2.5(3 mg) tab 1QL 1 / day

GL Female

EVAMIST 3QL 0.54 / day

GL Female

FEMHRT 3QL 1 / day

GL Female

FEMRING 3QL 0.02 / day

GL Female

FYAVOLV 1 GL Female

JEVANTIQUE LO 3 GL Female

JINTELI 1

QL 1 / day

GL Female

HCR



LOPREEZA 1QL 1 / day

GL Female

MENEST (0.625 MG TABLET, 1.25 MG TABLET, 2.5 MG TABLET) 3QL 1 / day

GL Female

MENEST 0.3 MG TABLET 2QL 1 / day

GL Female

MENOSTAR 3QL 0.15 / day

GL Female

MIMVEY 1QL 1 / day

GL Female

MIMVEY LO 1

MINIVELLE 3QL 0.29 / day

GL Female

norethindron-ethinyl estradiol (norethin-eth 1 mg-5 mcg,norethind-eth 0.5-2.5) 1 HCR

OGEN 3QL 1 / day

GL Female

PREFEST 3QL 1 / day

GL Female

PREMARIN VAGINAL CREAM-APPL 2 GL Female

PREMARIN (0.3 MG TABLET, 0.45 MG TABLET, 0.625 MG TABLET,0.9 MG TABLET, 1.25 MG TABLET) 2

QL 1 / day

GL Female

PREMARIN 25 MG VIAL 2

PREMPHASE 2QL 1 / day

GL Female

PREMPRO 2QL 1 / day

GL Female



VAGIFEM 3 GL Female

VIVELLE-DOT 3QL 8 / 28 days

GL Female

YUVAFEM 1 GL Female

EYE, EAR, NOSE AND THROAT (EENT) PREPS.

ANTIALLERGIC AGENTS

ALOMIDE 3 QL 10 / fill

ASTEPRO 3 QL 2 / day

azelastine hcl 0.05% drops 1 QL 10 / fill

azelastine hcl powder 3

azelastine hcl (0.1% (137 mcg) spry, 0.15% nasal spray) 1 QL 2 / day

BEPREVE 3 QL 5 / fill

ELESTAT 3 QL 5 / fill

EMADINE 3 QL 5 / fill

epinastine hcl 1 QL 5 / fill

LASTACAFT 3QL 3 / 30 days

ST

olopatadine hcl 0.1% eye drops 1QL 5 / 30 days

HCG

olopatadine hcl 0.2% eye drop 1 QL 3/ fill

olopatadine 665 mcg nasal spry 1QL 31 / 30 days

HCG

PATADAY 3 QL 3/ fill

PATANASE 3 QL 31 / 30 days



PATANOL 3 QL 5 / 30 days

PAZEO 3 QL 3/ fill

EENT DRUGS, MISCELLANEOUS

acetylcysteine-water 1 QL 10 / 30 days

apraclonidine hcl 1 QL 10/ fill

ATROVENT 3 QL 2 / day

balanced salt 1

BSS 1

BSS PLUS 3

CELLUGEL 3

CYSTARAN 5PA

S

GELFILM OPHTHALMIC 25X50MM 3

IOPIDINE 1% EYE DROPS 3 QL 28 / fill

IOPIDINE 0.5% EYE DROPS 3 QL 10/ fill

ipratropium bromide (0.03% spray, 0.06% spray) 1 QL 2 / day

LACRISERT 3

LUCENTIS (0.3 MG/0.05 ML VIAL, 0.5 MG/0.05 ML SYRING, 0.5MG/0.05 ML VIAL) 5

QL 0.04 / day

PA

S

OCUCOAT 1

LOCAL ANESTHETICS (EENT)

AKTEN 3

ALCAINE 3

ALTACAINE 1



ALTAFLUOR 1

BUCALSEP (SOLUTION, SPRAY) 3

cocaine hcl (hcl crystals, hcl powder, hydrochloride pwd) 3

cocaine 4% solution 1

cyclopentolate-lidoc-pe-tropic 1

dyclonine hcl 3

fluorescein-benoxinate 1

FLUROX 1

GLYDO 1

lidocaine hcl (2% jelly, 4% solution) 1

lidocaine hcl viscous 1

proparacaine 0.5% eye drops 1

proparacaine hcl powder 3

TETCAINE 1

tetracaine hcl (eye drops, steri-unit sol) 1

TETRAVISC 1 HCG

TETRAVISC FORTE 1

XYLOCAINE 4% SOLUTION 3

MYDRIATICS

atropine sulfate (drops, ointment) 1

atropine 0.01%-ns eye drops 1

CYCLOGYL 3

CYCLOMYDRIL 3

cyclopentolate hcl (0.5% eye drops, 1% eye drops, hcl 2%drops) 1

cyclopentolate hcl powder 3

cyclopentolate-tropicamide-pe 1



HOMATROPAIRE 1

homatropine hydrobromide 1

homatropine methylbromide 3

hydroxyamphetamine hbr 3

ISOPTO ATROPINE 3

MYDRIACYL 3

PAREMYD 3

tropicamide (0.5% drops, 1% drops) 1

tropicamide powder 3

VASOCONSTRICTORS

ADRENALIN CHLORIDE 3 PA

naphazoline hcl 1

oxymetazoline hcl 3

phenylephrine hcl (2.5% drop, 10% drops) 1

tetrahydrozoline hcl 3

TYZINE (PEDIATRIC 0.05% DROP, 0.1% NOSE DROPS, 0.1%NOSE SPRAY) 3

FIRST GENERATION ANTIHISTAMINES

ETHYLENEDIAMINE DERIVATIVES

pyrilamine maleate 3

tripelennamine hcl 3

PHENOTHIAZINE DERIVATIVES

trimeprazine tartrate 3

GASTROINTESTINAL DRUGS

ANTACIDS AND ADSORBENTS

aluminum hydroxide 3

magnesium oxide 3



ANTI-INFLAMMATORY AGENTS (GI DRUGS)

5-aminosalicylic acid 3

alosetron hcl 1GL Female


APRISO 2

balsalazide disodium 1

CANASA 2

COLAZAL 3

DIPENTUM 3

GIAZO 3 GL Male

LIALDA 2

LOTRONEX 3

PA

GL Female


mesalamine (4 gm/60 ml enema, 4 gm/60 ml kit) 1

mesalamine powder 3

mesalamine dr 1.2 gm tablet 1 HCG

PENTASA 3

ROWASA 3

SFROWASA 3

ANTIDIARRHEA AGENTS

acidophilus lactobacillus 3

attapulgite 3

bismuth subsalicylate 3

FULYZAQ 5 S

loperamide 2 mg capsule 1



loperamide hcl powder 3

MOTOFEN 3

MYTESI 5 S

opium tincture 1 QL 5 / day

paregoric 1

XERMELO 5

PA


S

ANTIFLATULENTS

simethicone 3

CATHARTICS AND LAXATIVES

AMITIZA 2QL 2 / day


bisacodyl 3

cascara sagrada 3

COLYTE WITH FLAVOR PACKETS 3

docusate sodium 3

GAVILYTE-C 1 HCR

GAVILYTE-G 1 HCR

GAVILYTE-N 1 HCR

GOLYTELY PACKET 3 HCR

GOLYTELY SOLUTION 3

karaya gum 3

MOVIPREP 3 HCR

NULYTELY WITH FLAVOR PACKS 3

OSMOPREP 3



peg 3350-electrolyte (3350 electrolyte soln, 3350-electrolytesolution) 1 HCR

peg 3350-grx 3

peg-3350 and electrolytes 1 HCR

peg-3350 with flavor packs 1 HCR

PEG-PREP 1

polyethylene glycol 3350 1 HCR

PREPOPIK 3 QL 2 / fill

sodium phosphate powder 3

sodium sulfate 3

sorbitol 70% solution 1

SUPREP 3 QL 354 / fill

TRILYTE WITH FLAVOR PACKETS 1 HCR

CHOLELITHOLYTIC AGENTS

ACTIGALL 3

CHENODAL 5 S

URSO 3

URSO FORTE 3

ursodiol powder 3

ursodiol (250 mg tablet, 300 mg capsule, 500 mg tablet) 1

DIGESTANTS

CREON 2

hydrochloric acid 3

pancreatin 3

pancreatin 8x 3

PANCRELIPASE 5,000 1



ZENPEP 2

GI DRUGS, MISCELLANEOUS

CHOLBAM 250 MG CAPSULE 5

QL 7 / day

PA

S

CHOLBAM 50 MG CAPSULE 5

QL 4 / day

PA

S

CIMZIA (200 MG VIAL KIT, 200 MG/ML SYRINGE KIT) 5

QL 0.08 / day

PA

S

CIMZIA 200 MG/ML STARTER KIT 5

QL 3/ fill

PA

S

ENDARI 3

ENTEREG 3

GATTEX 5PA

S

glutamine 3

HUMIRA (20 MG/0.4 ML SYRINGE, 40 MG/0.8 ML SYRINGE) 4

QL 0.22 / day

PA

S

PS

HUMIRA 10 MG/0.2 ML SYRINGE 4

QL 0.15 / day

PA

S

PS



HUMIRA PEDIATRIC CROHN'S 4

QL 0.22 / day

PA

S

PS

HUMIRA PEN 4

QL 0.22 / day

PA

S

PS

HUMIRA PEN CROHN-UC-HS STARTER 4

QL 0.22 / day

PA

S

PS

HUMIRA PEN PSORIASIS-UVEITIS 4

QL 0.22 / day

PA

S

PS

l-glutamine 3

LINZESS 2QL 1 / day

ST

NUTRESTORE 3

OCALIVA 5

QL 1 / day

PA

S

RELISTOR (8 MG/0.4 ML SYRINGE, 12 MG/0.6 ML SYRINGE, 12MG/0.6 ML VIAL) 3 PA

RELISTOR 150 MG TABLET 3 PA

RESTORA SPRINKLES 3

VIBERZI 2QL 2 / day

PA



XENICAL 3

LIPOTROPIC AGENTS

choline bitartrate 3

phosphatidylcholine 3

PROKINETIC AGENTS

metoclopramide hcl powder 3

metoclopramide 10 mg/10 ml sol 1

metoclopramide hcl (5 mg tablet, 5 mg/5 ml soln, 10 mg tablet) 1 LCG

metoclopramide hcl (10 mg/2 ml syr, 10 mg/2 ml vial) 1

metoclopramide hcl odt 1

METOZOLV ODT 3

REGLAN 3

GENERAL ANESTHETICS

GENERAL ANESTHETICS, MISCELLANEOUS

etomidate powder 3

KETALAR 3

ketamine hcl (100 mg/ml vial, 200 mg/20 ml vial, 500 mg/10ml vial, 500 mg/5 ml vial, 1,000 mg/10 ml vial) 1

ketamine hydrochloride 3

INHALATION ANESTHETICS

chloroform 3

COMPOUND 347 1

FORANE 3

isoflurane 1

sevoflurane 1

SOJOURN 1

SUPRANE 3



TERRELL 1

ULTANE 3

GENITOURINARY SMOOTH MUSCLE RELAXANTS

ANTIMUSCARINICS

darifenacin er 1QL 1 / day

HCG

DETROL 3 QL 2 / day

DETROL LA 3 QL 1 / day

DITROPAN XL (10 MG TABLET, 15 MG TABLET) 3 QL 2 / day

DITROPAN XL 5 MG TABLET 3 QL 1 / day

ENABLEX 3 QL 1 / day

flavoxate hcl 1

GELNIQUE 3% GEL 3QL 3.067 / day

ST

GELNIQUE (GEL PUMP, GEL SACHETS) 3QL 1 / day

ST

oxybutynin chloride powder 3

oxybutynin 5 mg/5 ml syrup 1 QL 20 / day

oxybutynin 5 mg tablet 1 QL 4 / day

oxybutynin chloride er (er 10 mg tablet, er 15 mg tablet) 1 QL 2 / day

oxybutynin cl er 5 mg tablet 1 QL 1 / day

OXYTROL 3QL 0.357 / day

ST

tolterodine tartrate 1 QL 2 / day

tolterodine tartrate er 1QL 1 / day

HCG



TOVIAZ 3 QL 1 / day

trospium chloride 1QL 2 / day

HCG

trospium chloride er 1QL 1 / day

HCG

VESICARE 2 QL 1 / day

HCV ANTIVIRALS

HCV POLYMERASE INHIBITORS

EPCLUSA 4

QL 1 / day

PA

S

PS

HARVONI 4

QL 1 / day

PA

S

PS

SOVALDI 4

QL 1 / day

PA

S

PS

HCV PROTEASE INHIBITORS

OLYSIO 5

QL 1 / day

PA

S

ZEPATIER 5

QL 1 / day

PA

S



HCV REPLICATION COMPLEX INHIBITORS

DAKLINZA 5

QL 1 / day

PA

S

HORMONES AND SYNTHETIC SUBSTITUTES

ADRENALS

A-HYDROCORT 3

A-METHAPRED 1

aldosterone 3

ARISTOSPAN 3

beclomethasone dipropionate 3

betamethasone acetate micro 3

betamethasone acetate-sod phos 1

betamethasone sodium phosphate 3

budesonide ec 1 HCG

CELESTONE 3

CORTEF 3

cortisone acetate powder 3

cortisone 25 mg tablet 1

DELTASONE 1

DEPO-MEDROL 3

desoxycorticosterone acetate 3

dexamethasone (0.5 mg tablet, 0.5 mg/5 ml elx, 0.5 mg/5 ml liq,0.75 mg tablet, 1 mg tablet, 1.5 mg tablet, 2 mg tablet, 4 mgtablet, 6 mg tablet)

1

dexamethasone acetate 3

dexamethasone acetate micro 3

DEXAMETHASONE INTENSOL 2



dexamethasone isonicotinate 3

dexamethasone micronized 3

dexamethasone sod ph powder 3

DEXPAK 3

EMFLAZA (6 MG TABLET, 18 MG TABLET, 22.75 MG/ML ORALSUSP, 30 MG TABLET, 36 MG TABLET) 5

PA


S

ENTOCORT EC 3

EZ USE JOINT-TUNNEL-TRIGGER 3

FLO-PRED 3

fludrocortisone acetate powder 3

fludrocortisone 0.1 mg tablet 1

flunisolide powder 3

fluticasone propionate powder 3

fluticasone propionate micro 3

hydrocortisone (5 mg tablet, 10 mg tablet, 20 mg tablet) 1

INTRAROSA 3QL 1 / day


KENALOG-10 3

KENALOG-40 3

MEDROL (4 MG DOSEPAK, 4 MG TABLET, 8 MG TABLET, 16 MGTABLET, 32 MG TABLET) 3

MEDROL 2 MG TABLET 2

methylprednisolone powder 3

methylprednisolone (4 mg dosepk, 4 mg tablet, 8 mg tab, 16 mgtab, 32 mg tab) 1

methylprednisolone ac micro 3

methylprednisolone acetate 1



methylprednisolone sodium succ (40 mg vl, 125 mg) 1

MILLIPRED (5 MG TABLET, 10 MG/5 ML SOLUTION) 3

MILLIPRED DP 3

ORAPRED ODT 3

PEDIAPRED 3

prednisolone (anhydrous powder, powder) 3

prednisolone (15 mg/5 ml soln, 15 mg/5 ml syrup) 1

prednisolone acetate micronize 3

prednisolone micronized 3

prednisolone sodium phos odt 1

prednisolone sod ph powder 3

prednisolone sodium phosphate (5 mg/5 ml soln, 10 mg/5 mlsoln, 20 mg/5 ml soln, sod ph 25 mg/5 ml) 1

prednisone powder 3

prednisone (1 mg tablet, 2.5 mg tablet, 5 mg tab dose pack, 5mg tablet, 5 mg/5 ml solution, 10 mg tab dose pack, 10 mgtablet, 20 mg tablet, 50 mg tablet)

1

PREDNISONE INTENSOL 2

prednisone micronized 3

RAYOS 3

SOLU-CORTEF 3

SOLU-MEDROL (40 MG VIAL, 125 MG VIAL) 3

triamcinolone 3

triamcinolone acetonide powder 3

triamcinolone acetonide (40mg/ml vl, 50mg/5ml vl) 1

triamcinolone diacetate 3

triamcinolone diacetate micro 3

triamcinolone hexacetonide 3

UCERIS (2 MG RECTAL FOAM, 9 MG ER TABLET) 3



VERIPRED 20 3

ZODEX 6 DAY 1.5 MG TABLET 3

ANDROGENS

ANADROL-50 3 GL Male

ANDRODERM 2

QL 1 / day

PA

GL Male

ANDROGEL (1.62% GEL PUMP, 1.62%(1.25G) GEL PCKT,1.62%(2.5G) GEL PCKT) 2

QL 5 / day

PA

GL Male

ANDROID 3PA

GL Male

androstenedione 3

ANDROXY 3PA

GL Male

danazol (50 mg capsule, 100 mg capsule, 200 mg capsule) 1

danazol powder 3

dehydroepiandrosterone 3

DELATESTRYL 3PA

GL Male

DEPO-TESTOSTERONE (100 MG/ML VL, 200 MG/ML) 3 GL Male

dhea micronized 3

fluoxymesterone 3

METHITEST 3PA

GL Male

methyltestosterone 10 mg cap 1



methyltestosterone powder 3

methyltestosterone micronized 3

nandrolone decanoate 3

NATESTO 3

QL 3 / day

PA

GL Male


OXANDRIN 3PA

GL Male

oxandrolone powder 3

oxandrolone (2.5 mg tablet, 10 mg tablet) 1PA

GL Male

stanozolol 3

stanozolol micronized 3

STRIANT 3PA

GL Male

testosterone powder 3 GL Male

testosterone cypionate powder 3 GL Male

testosterone cypionate (testosteron 1,000 mg/10 ml,testosteron 2,000 mg/10 ml, testosterone 100 mg/ml,testosterone 200 mg/ml)

1 GL Male

testosterone cypionate micro 3 GL Male

testosterone enanthate powder 3 GL Male

testosterone enanthate (testosteron 1,000 mg/5 ml,testosterone 200 mg/ml) 1

PA

GL Male

testosterone micronized 3 GL Male

testosterone propionate 3 GL Male



TESTRED 3PA

GL Male

CONTRACEPTIVES

ALTAVERA 1

QL 1 / day

GL Female

HCR

ALYACEN 1GL Female

HCR

AMETHIA 1

QL 91 days

GL Female

HCR

AMETHIA LO 1

QL 91 days

GL Female

HCR

AMETHYST 1

QL 1 / day

GL Female

HCR

APRI 1GL Female

HCR

ARANELLE 1GL Female

HCR

ASHLYNA 1GL Female

HCR

AUBRA 1

QL 1 / day

GL Female

HCR

AVIANE 1

QL 1 / day

GL Female

HCR



AZURETTE 1GL Female

HCR

BALZIVA 1GL Female

HCR

BEKYREE 1GL Female

HCR

BEYAZ 3 GL Female

BLISOVI 24 FE 1GL Female

HCR

BLISOVI FE 1GL Female

HCR

BREVICON 3 GL Female

BRIELLYN 1GL Female

HCR

CAMILA 1GL Female

HCR

CAMRESE 1

QL 91 days

GL Female

HCR

CAMRESE LO 1

QL 91 days

GL Female

HCR

CAZIANT 1GL Female

HCR

CHATEAL 1

QL 1 / day

GL Female

HCR



CRYSELLE 1GL Female

HCR

CYCLAFEM 1GL Female

HCR

CYCLESSA 3 GL Female

CYRED 1GL Female

HCR

DASETTA 1GL Female

HCR

DAYSEE 1

QL 91 days

GL Female

HCR

DEBLITANE 1GL Female

HCR

DELYLA 1

QL 1 / day

GL Female

HCR

DESOGEN 3 GL Female

desogestr-eth estrad eth estra 1GL Female

HCR

desogestrel-ethinyl estradiol 1GL Female

HCR

drospirenone-eth estra-levomef 1GL Female

HCR

drospirenone-ethinyl estradiol 1GL Female

HCR



ELINEST 1GL Female

HCR

ELLA 3

QL 1 / day

GL Female

HCR

EMOQUETTE 1GL Female

HCR

ENPRESSE 1GL Female

HCR

ENSKYCE 1GL Female

HCR

ERRIN 1GL Female

HCR

ESTARYLLA 1GL Female

HCR

ESTROSTEP FE 3 GL Female

ethynodiol-ethinyl estradiol 1GL Female

HCR

FALMINA 1

QL 1 / day

GL Female

HCR

FAYOSIM 1

QL 91 days

GL Female

HCR

FEMCON FE 3 GL Female

FEMYNOR 1GL Female

HCR



GENERESS FE 3 GL Female

GIANVI 1GL Female

HCR

GILDAGIA 1GL Female

HCR

GILDESS 1GL Female

HCR

GILDESS 24 FE 1GL Female

HCR

GILDESS FE 1GL Female

HCR

HEATHER 1GL Female

HCR

INTROVALE 1

QL 91 days

GL Female

HCR

ISIBLOOM 1GL Female

HCR

JENCYCLA 1GL Female

HCR

JOLESSA 1

QL 91 days

GL Female

HCR

JOLIVETTE 1GL Female

HCR

JULEBER 1GL Female

HCR



JUNEL 1GL Female

HCR

JUNEL FE 1GL Female

HCR

JUNEL FE 24 1GL Female

HCR

KAITLIB FE 1GL Female

HCR

KARIVA 1GL Female

HCR

KELNOR 1-35 1GL Female

HCR

KIMIDESS 1GL Female

HCR

KURVELO 1

QL 1 / day

GL Female

HCR

LARIN 1GL Female

HCR

LARIN 24 FE 1GL Female

HCR

LARIN FE 1GL Female

HCR

LARISSIA 1

QL 1 / day

GL Female

HCR



LAYOLIS FE 1GL Female

HCR

LEENA 1GL Female

HCR

LESSINA 1

QL 1 / day

GL Female

HCR

LEVONEST 1GL Female

HCR

levono-e estrad 0.15-0.03-0.01 1GL Female

HCR

levonorg-eth estrad eth estrad (levono-e estrad 0.10-0.02-0.01,levonorg 0.15mg-ee 20-25-30mcg) 1

QL 91 days

GL Female

HCR

levonorgestrel 1

QL 0.07 / day

GL Female

HCR

levonor-eth estrad 0.15-0.03 1

QL 91 days

GL Female

HCR

levonor-eth estrad triphasic 1GL Female

HCR

levonorgestrel-eth estradiol (estra 0.09-0.02 mg, estrad 0.1-0.02 mg) 1

QL 1 / day

GL Female

HCR

LEVORA-28 1

QL 1 / day

GL Female

HCR



LILLOW 1

QL 1 / day

GL Female

HCR

LO LOESTRIN FE 3GL Female

HCR

LOESTRIN 3 GL Female

LOESTRIN FE 1-20 TABLET 3 GL Female

LOESTRIN FE 1.5-30 TABLET 3GL Female

HCR

LOMEDIA 24 FE 1GL Female

HCR

LORYNA 1GL Female

HCR

LOSEASONIQUE 3QL 91 days

GL Female

LOW-OGESTREL 1GL Female

HCR

LUTERA 1

QL 1 / day

GL Female

HCR

LYZA 1GL Female

HCR

MARLISSA 1

QL 1 / day

GL Female

HCR

MELODETTA 24 FE 1GL Female

HCR



MIBELAS 24 FE 1GL Female

HCR

MICROGESTIN 1GL Female

HCR

MICROGESTIN 24 FE 1GL Female

HCR

MICROGESTIN FE 1GL Female

HCR

MINASTRIN 24 FE 3 GL Female

MIRCETTE 3 GL Female

MODICON 3 GL Female

MONO-LINYAH 1GL Female

HCR

MONONESSA 1GL Female

HCR

MYZILRA 1GL Female

HCR

NATAZIA 2 GL Female

NECON (0.5-35-28 TABLET, 1-35-28 TABLET, 10-11-28 TABLET) 1GL Female

HCR

NECON 1-50-28 TABLET 3GL Female

HCR

NECON 7-7-7-28 TABLET 1

QL 1 / day

GL Female

HCR

NIKKI 1GL Female

HCR



NOR-Q-D 3 GL Female

NORA-BE 1GL Female

HCR

noreth-estrad-fe 1-0.02(24)-75 3GL Female

HCR

norethin-eth estra-ferrous fum (noret-estr-fe 0.4-0.035(21)-75,noreth-estrad-fe 1-0.02(21)-75, norethin-estra-fe 0.8-0.025mg)

1GL Female

HCR

norethind-eth estrad 1-0.02 mg 1GL Female

HCR

norethindrone 0.35 mg tablet 1GL Female

HCR

norgestimate-ethinyl estradiol 1GL Female

HCR

NORINYL 1+50 3GL Female

HCR

NORINYL 1-35 3 GL Female

NORLYDA 1GL Female

HCR

NORLYROC 1GL Female

HCR

NORTREL 1GL Female

HCR

NUVARING 2GL Female

HCR

OCELLA 1GL Female

HCR



OGESTREL 1

QL 1 / day

GL Female

HCR

ORSYTHIA 1

QL 1 / day

GL Female

HCR

ORTHO MICRONOR 3 GL Female

ORTHO TRI-CYCLEN 3 GL Female

ORTHO TRI-CYCLEN LO 3 GL Female

ORTHO-CEPT 3 GL Female

ORTHO-CYCLEN 3 GL Female

ORTHO-NOVUM 3 GL Female

OVCON-35 3 GL Female

PHILITH 1GL Female

HCR

PIMTREA 1GL Female

HCR

PIRMELLA 1GL Female

HCR

PLAN B ONE-STEP 3QL 2 / 30 days

GL Female

PORTIA 1

QL 1 / day

GL Female

HCR

PREVIFEM 1GL Female

HCR



QUARTETTE 3 GL Female

QUASENSE 1

QL 91 days

GL Female

HCR

RAJANI 1GL Female

HCR

RECLIPSEN 1GL Female

HCR

RIVELSA 1

QL 91 days

GL Female

HCR

SAFYRAL 3 GL Female

SEASONIQUE 3QL 91 days

GL Female

SETLAKIN 1

QL 91 days

GL Female

HCR

SHAROBEL 1GL Female

HCR

SPRINTEC 1GL Female

HCR

SRONYX 1

QL 1 / day

GL Female

HCR

SYEDA 1GL Female

HCR



TARINA FE 1GL Female

HCR

TAYTULLA 3GL Female

HCR

TILIA FE 1GL Female

HCR

TRI FEMYNOR 1GL Female

HCR

TRI-ESTARYLLA 1GL Female

HCR

TRI-LEGEST FE 1GL Female

HCR

TRI-LINYAH 1GL Female

HCR

TRI-LO-ESTARYLLA 1GL Female

HCR

TRI-LO-MARZIA 1GL Female

HCR

TRI-LO-SPRINTEC 1GL Female

HCR

TRI-NORINYL 3 GL Female

TRI-PREVIFEM 1GL Female

HCR

TRI-SPRINTEC 1GL Female

HCR

TRINESSA 1GL Female

HCR



TRINESSA LO 1GL Female

HCR

TRIVORA-28 1GL Female

HCR

VELIVET 1GL Female

HCR

VESTURA 1GL Female

HCR

VIENVA 1

QL 1 / day

GL Female

HCR

VIORELE 1GL Female

HCR

VYFEMLA 1GL Female

HCR

WERA 1GL Female

HCR

WYMZYA FE 1GL Female

HCR

XULANE 1

QL 0.12 / day

GL Female

HCR

YASMIN 28 3 GL Female

YAZ 3 GL Female

ZARAH 1GL Female

HCR



ZENCHENT 1GL Female

HCR

ZENCHENT FE 1GL Female

HCR

ZEOSA 1GL Female

HCR

ZOVIA 1-35E 1GL Female

HCR

ZOVIA 1-50E 1GL Female

HCR

GONADOTROPINS

BRAVELLE 4

PA

GL Female

S

PS

chorionic gonadotropin (1 million unit, 2 million unit, 5 millionunit, 10mm unit, 10,000 unit vl) 5 S

chorionic gonadotropin powder 3

ELIGARD 5PA

S

FOLLISTIM AQ (75 UNIT VIAL, 300 UNIT CARTRIDG, 600 UNITCARTRIDG, 900 UNIT CARTRIDG) 5

PA

S

GONAL-F 4

PA

S

PS

GONAL-F RFF 4

PA

GL Female

S

PS



GONAL-F RFF REDI-JECT 4

PA

GL Female

S

PS

leuprolide acetate (1 mg/0.2 ml vial, 2wk 1 mg/0.2 ml kit) 5PA

S

leuprolide acetate (14 mg/2.8 ml kt, 14 mg/2.8 ml vl) 5PA

S

LUPANETA PACK 5 S

LUPRON DEPOT (DEPOT-4 MONTH KIT, DEPOT 7.5 MG KIT,DEPOT 11.25 MG 3MO KIT, DEPOT 22.5 MG 3MO KIT, DEPOT 45MG 6MO KIT)

5PA

S

LUPRON DEPOT 3.75 MG KIT 5PA

S

LUPRON DEPO 11.25MG (LUPANETA) 5PA

S

LUPRON DEPOT 3.75MG (LUPANETA) 5PA

S

LUPRON DEPOT-PED (7.5 MG KIT, 11.25 MG 3MO, 11.25 MGKIT, 15 MG KIT, 30 MG 3MO KIT) 5

PA

S

MENOPUR 4

PA

GL Female

S

PS

NOVAREL 10,000 UNITS VIAL 5PA

S

OVIDREL 4

PA

S

PS



PREGNYL 5PA

S

SYNAREL 5PA

S

LEPTINS

MYALEPT 5PA

S

PARATHYROID

calcitonin-salmon 1 QL 0.13 / day

FORTEO 5PA

S

FORTICAL 3 QL 0.13 / day

MIACALCIN 200 UNIT NASAL SPRAY 3 QL 0.13 / day

MIACALCIN 400 UNIT/2 ML VIAL 5 S

NATPARA 5PA

S

TYMLOS 5

QL 1.60 / day

PA


S

PITUITARY

DDAVP 0.01% NASAL SPRAY 3

desmopressin 10 mcg/0.1 ml spr 1



GENOTROPIN (MINIQUICK 0.2 MG, MINIQUICK 0.4 MG,MINIQUICK 0.6 MG, MINIQUICK 0.8 MG, MINIQUICK 1 MG,MINIQUICK 1.2 MG, MINIQUICK 1.4 MG, MINIQUICK 1.6 MG,MINIQUICK 1.8 MG, MINIQUICK 2 MG, 5 MG CARTRIDGE, 12 MGCARTRIDGE)

5PA

S

HUMATROPE (5 MG VIAL, 6 MG CARTRIDGE, 12 MG CARTRIDGE,24 MG CARTRIDGE) 5

PA

S

NORDITROPIN FLEXPRO 4

PA

S

PS

NUTROPIN AQ 5PA

S

NUTROPIN AQ NUSPIN 5PA

S

OMNITROPE (5 MG/1.5 ML CRTG, 5.8 MG VIAL, 10 MG/1.5 MLCRTG) 5

PA

S

SAIZEN (5 MG VIAL, 8.8 MG CLICK.EASY CARTG, 8.8 MG VIAL) 5PA

S

SAIZEN-SAIZENPREP 5PA

S

sermorelin acetate 3

SEROSTIM 5

QL 1 / day

PA

S

vasopressin 1

ZOMACTON 5PA

S

ZORBTIVE 5

QL 1 / day

PA

S



PROGESTINS

AYGESTIN 3 GL Female

CRINONE 4% GEL 3 GL Female

CRINONE 8% GEL 3 GL Female

DEPO-PROVERA (150 MG/ML SYRINGE, 150 MG/ML VIAL) 3 GL Female

DEPO-PROVERA 400 MG/ML VIAL 3

DEPO-SUBQ PROVERA 104 3

QL 90 days

GL Female

HCR

ENDOMETRIN 4

GL Female

S

PS

hydroxyprogesterone cap powder 3

hydroxyprogesterone 1.25 g/5ml 5

PA

GL Female

S

MAKENA (250 MG/ML VIAL, 1,250 MG/5 ML VIAL) 4

PA

GL Female

S

PS

medroxyprogesterone ac micro 3

medroxyprogesterone 150 mg/ml 1

QL 0.04 / day

GL Female

HCR

medroxyprogesterone 5 mg tab 1 GL Female

medroxyprogesterone acetate (2.5 mg tab, 10 mg tab) 1GL Female

LCG



norethindrone powder 3

norethindrone ac (lupaneta) 1 GL Female

norethindrone acetate powder 3

norethindrone 5 mg tablet 1 GL Female

progesterone (100 mg capsule, 200 mg capsule) 1 GL Female

progesterone powder 3

progesterone oil 50 mg/ml vl 1 GL Female

progesterone in oil 1 GL Female

progesterone micronized 3 GL Female

PROMETRIUM 3 GL Female

PROVERA 3 GL Female

HYPOTENSIVE AGENTS

CENTRAL ALPHA-AGONISTS

CATAPRES 3

CATAPRES-TTS 1 3 QL 0.15 / day



clonidine (0.2 mg/day patch, 0.3 mg/day patch) 1QL 0.29 / day

HCG

clonidine 0.1 mg/day patch 1QL 0.15 / day

HCG

clonidine hcl powder 3

clonidine hcl (0.1 mg tablet, 0.2 mg tablet, 0.3 mg tablet) 1 LCG

clonidine hcl er 1QL 4 / day

HCG



guanabenz acetate 3

KAPVAY 3QL 4 / day

ST

methyldopa 1

DIRECT VASODILATORS

BIDIL 3 QL 6 / day

hydralazine hcl powder 3

hydralazine hcl (10 mg tablet, 25 mg tablet, 50 mg tablet, 100mg tablet) 1

hydralazine 20 mg/ml vial 1

minoxidil powder 3

minoxidil (2.5 mg tablet, 10 mg tablet) 1

HYPOTENSIVE AGENTS, MISCELLANEOUS

guanethidine hemisulfate 3

mecamylamine hcl 3

VECAMYL 5PA

S

PERIPHERAL ADRENERGIC INHIBITORS

rauwolfia serpentina 3

reserpine powder 3

reserpine (0.1 mg tablet, 0.25 mg tablet) 1

ION-REMOVING AGENTS

OTHER ION-REMOVING AGENTS

RADIOGARDASE 3

PHOSPHATE-REMOVING AGENTS

AURYXIA 3

calcium acetate (667 mg capsule, 667 mg gelcap, 667 mgtablet) 1



ELIPHOS 3

FOSRENOL (750 MG POWDER PACKET, 1,000 MG POWDERPACK) 3

FOSRENOL (500 MG TABLET CHEW, 750 MG TABLET CHEW,1,000 MG TABLET CHEW) 2

lanthanum carbonate 1

PHOSLYRA 3

RENAGEL 3

RENVELA (0.8 GM POWDER PACKET, 2.4 GM POWDER PACKET) 3

RENVELA 800 MG TABLET 2

sevelamer carbonate (0.8 gm powder packet, 2.4 gm powderpacket, carbonate 800 mg tab) 1 HCG

VELPHORO 3

POTASSIUM-REMOVING AGENTS

KAYEXALATE 3

KIONEX (15 GM/60 ML SUSPENSION, POWDER) 1

sps 50 gm/200 ml enema 1 HCG

sodium polystyrene sulfonate (sod polystyren sulf 15 g/60 ml,sodium polystyrene sulf powder, sps 15 gm/60 ml suspension,sps 30 gm/120 ml enema)

1

SPS (15 GM/60 ML SUSPENSION, 30 GM/120 ML ENEMA) 1

VELTASSA 3QL 1 / day

PA

MACROLIDES

ERYTHROMYCINS

erythromycin powder 3

erythromycin estolate 3

erythromycin e.s. powder 3



KETOLIDES

KETEK 3

OTHER MACROLIDES

azithromycin powder 3

azithromycin (1 gm pwd packet, 100 mg/5 ml susp, 200 mg/5ml susp, 500 mg tablet, 600 mg tablet) 1

azithromycin 250 mg tablet 1 QL 6 / 5 days

DIFICID 3 PA

ZITHROMAX 100 MG/5 ML SUSP 3 QL 30 / fill

ZITHROMAX 200 MG/5 ML SUSP 3 QL 60 / fill

ZITHROMAX (1 GM POWDER PACKET, 250 MG Z-PAK TABLET) 3

ZITHROMAX 250 MG TABLET 3 QL 6 / 5 days

ZITHROMAX 500 MG TABLET 3 QL 5 / fill

ZITHROMAX 600 MG TABLET 3 QL 0.29 / day

ZITHROMAX TRI-PAK 3

ZMAX 2 QL 60 / fill

MISCELLANEOUS B-LACTAM ANTIBIOTICS

CARBAPENEMS

INVANZ 1 GM VIAL 3

MONOBACTAMS

AZACTAM 3

aztreonam 1

CAYSTON 5PA

S



MISCELLANEOUS THERAPEUTIC AGENTS

5-ALPHA-REDUCTASE INHIBITORS

AVODART 3QL 1 / day

GL Male

dutasteride 1

QL 1 / day

GL Male

HCG

finasteride powder 3

finasteride 5 mg tablet 1QL 1 / day

GL Male

PROSCAR 3QL 1 / day

GL Male

ALCOHOL DETERRENTS

ANTABUSE 3

disulfiram powder 3

disulfiram (250 mg tablet, 500 mg tablet) 1

ANTIDOTES

amyl nitrite 1

BAL IN OIL 3

calcium disodium versenate 1

CHEMET 3

deferoxamine mesylate 1

DESFERAL 3

DESFERAL MESYLATE 3

dmsa powder 3

edetate calcium disodium 3

leucovorin calcium (5 mg tab, 10 mg tab, 15 mg tab, 25 mg tab) 1



leucovorin calcium (50 mg vial, 100 mg vial, 200 mg vial, 350mg vial, 500 mg vl) 5 S

MEPHYTON 2

methylpyrazole 3

phytonadione 1 mg/0.5 ml syr 1

pralidoxime chloride 300 mg/ml 1

pralidoxime chloride powder 3

PROTOPAM CHLORIDE 3

succimer dmsa 3

VISTOGARD 5 S

vitamin k1 1

ANTIGOUT AGENTS

allopurinol powder 3

allopurinol 100 mg tablet 1QL 3 / day

LCG

allopurinol 300 mg tablet 1QL 2 / day

LCG

ANAPROX 3

ANAPROX DS 3

colchicine 0.6 mg capsule 1 QL 2 / day

colchicine powder 3

colchicine 0.6 mg tablet 1 QL 4 / day

COLCRYS 2 QL 4 / day

EC-NAPROSYN 3

INDOCIN 25 MG/5 ML SUSPENSION 3 QL 6 / day

INDOCIN 50 MG SUPPOSITORY 3 QL 4 / day



indomethacin 25 mg capsule 1 LCG

indomethacin 50 mg capsule 1

indomethacin er 1

MITIGARE 3QL 2 / day

ST

NAPRELAN (CR 375 MG TABLET, CR 500 MG TABLET) 3

NAPRELAN CR 750 MG TABLET 3 QL 1 / day

NAPROSYN (125 MG/5 ML SUSPEN, 250 MG TABLET, 375 MGTABLET, 500 MG TABLET) 3

naproxen 500 mg tablet 1 LCG

naproxen (125 mg/5 ml suspen, 250 mg tablet, 375 mg tablet,dr 375 mg tablet, 500 mg kit, dr 500 mg tablet, ec 375 mgtablet, ec 500 mg tablet)

1

naproxen sodium (275 mg tab, 550 mg tab) 1

naproxen sodium cr 1 HCG

naproxen sodium ds 1

naproxen sod er 375 mg tablet 1 HCG

TIVORBEX 3

ULORIC 2QL 1 / day

ST

ZYLOPRIM 100 MG TABLET 3 QL 3 / day

ZYLOPRIM 300 MG TABLET 3 QL 2 / day

BONE RESORPTION INHIBITORS

ACTONEL (5 MG TABLET, 30 MG TABLET) 3 QL 1 / day

ACTONEL 150 MG TABLET 3 QL 0.04 / day

ACTONEL 35 MG TABLET 3 QL 0.15 / day



alendronate sodium (5 mg tablet, 10 mg tab) 1 QL 1 / day

alendronate sodium (sod 70 mg/75 ml, sodium 35 mg tab,sodium 40 mg tab, sodium 70 mg tab) 1 QL .15 / day

ATELVIA 3QL 0.15 / day

ST

BINOSTO 3 QL .15 / day

BONIVA 150 MG TABLET 3 QL 0.04 / day

etidronate disodium 1

FOSAMAX 3 QL .15 / day

FOSAMAX PLUS D 3 QL 0.15 / day

ibandronate sodium 150 mg tab 1 QL 0.04 / day

risedronate sodium 150 mg tab 1QL 0.04 / day

HCG

risedronate sodium 30 mg tab 1 HCG

risedronate sodium 35 mg tab 1QL 0.15 / day

HCG

risedronate sodium 5 mg tablet 1QL 1 / day

HCG

risedronate sodium dr 1

CARIOSTATIC AGENTS

CLINPRO 5000 1

DENTA 5000 PLUS 1

DENTAGEL 1

FLUOR-A-DAY 2.5 MG/ML DROPS 1HCR

HCG

FLUOR-A-DAY (0.25 MG TAB CHEW, 0.5 MG TAB CHEW, 1 MGTABLET CHEW) 3



FLUORABON 3

fluoride 1 HCR

FLUORIDEX 1

FLUORIDEX DAILY DEFENSE 1

FLUORIDEX SENSITIVITY RELIEF 1

FLUORITAB 0.125 MG/DRP DROPS 1HCR

HCG

FLUORITAB (0.5 MG TABLET CHEW, 1 MG TABLET CHEW) 1 HCR

FLURA-DROPS 3 HCR

LUDENT FLUORIDE 1 HCR

multivitamin with fluoride (0.25 mg/ml drop, 0.5 mg/ml drop) 1

multivitamin with fluoride (multivit-fluor 0.25 mg tab chw,multivit-fluor 0.5 mg tab chew, multivit-fluoride 1 mg tab chw) 3

POLY-VI-FLOR (0.25 MG DROPS, 0.25 MG TAB CHEW, 0.5 MGTAB CHEW, 1 MG TAB CHEW) 3

PREVIDENT (0.2% RINSE, 1.1% GEL, 5000 BOOSTER PLUS,DENTAL RINSE) 3

PREVIDENT 5000 3

PREVIDENT 5000 ENAMEL PROTECT 3

PREVIDENT 5000 PLUS 3

PREVIDENT 5000 SENSITIVE 3

SF 1

SF 5000 PLUS 1

sodium fluoride powder 3

neutral sodium fluoride 1

sodium fluoride (0.5 mg(1.1 mg), 0.5 mg/ml drop, 1 mg (2.2mg)) 1 HCR

TRI-VI-FLOR 3



COMPLEMENT INHIBITORS

FIRAZYR 5PA

S

DISEASE-MODIFYING ANTIRHEUMATIC AGENTS

ACTEMRA 162 MG/0.9 ML SYRINGE 5

QL 0.15 / day

PA

S

ARAVA 3

AZASAN 3

azathioprine powder 3

azathioprine 50 mg tablet 1

azathioprine sodium 1

CUPRIMINE 3

cyclosporine (25 mg capsule, 100 mg capsule, 100 mg/ml soln) 5 S

cyclosporine modified 5 S

DEPEN 2

ENBREL 50 MG/ML SURECLICK SYR 4

QL 0.15 / day

PA

S

PS

ENBREL (25 MG KIT, 25 MG/0.5 ML SYRINGE, 50 MG/MLSYRINGE) 4

QL 0.29 / day

PA

S

PS

GENGRAF (25 MG CAPSULE, 50 MG CAPSULE, 100 MG CAPSULE,100 MG/ML SOLUTION) 5 S

gold sodium thiomalate 3



IMURAN 3

KEVZARA 5

QL 0.1 / day

PA


S

leflunomide 1

methotrexate (1 gm vial, 2.5 mg tablet, 50 mg/2 ml vial, 250mg/10 ml vial) 1

methotrexate sodium 1

NEORAL (25 MG GELATIN CAPSULE, 100 MG GELATIN CAPSULE,100 MG/ML SOLUTION) 5 S

ORENCIA (50 MG/0.4 ML SYRINGE, 87.5 MG/0.7 ML SYRINGE,125 MG/ML SYRINGE) 5

QL 0.15 / day

PA

S

ORENCIA CLICKJECT 5

QL 0.15 / day

PA

S

OTEZLA (28 DAY STARTER PACK, 30 MG TABLET, STARTERPACK) 5

QL 2 / day

PA

S

OTREXUP 3QL 0.08 / day

PA

penicillamine 3

penicillamine(d-) 3

RASUVO (10 MG/0.2 ML, 12.5 MG/0.25 ML) 3QL .08 / day

PA

RASUVO (7.5 MG/0.15 ML, 15 MG/0.3 ML, 17.5 MG/0.35 ML, 20MG/0.4 ML, 22.5 MG/0.45 ML, 25 MG/0.5 ML, 27.5 MG/0.55ML, 30 MG/0.6 ML)

3QL 0.08 / day

PA



RHEUMATREX 3

RIDAURA 2

SANDIMMUNE (25 MG CAPSULE, 100 MG CAPSULE) 5 S

SANDIMMUNE 100 MG/ML SOLN 4S

PS

SIMPONI (50 MG/0.5 ML PEN INJEC, 50 MG/0.5 ML SYRINGE,100 MG/ML PEN INJECTOR, 100 MG/ML SYRINGE) 5

QL 0.04 / day

PA

S

STELARA (45 MG/0.5 ML SYRINGE, 45 MG/0.5 ML VIAL, 90MG/ML SYRINGE) 5

QL 0.08 / day

PA

S

TREXALL 2

XATMEP 3

QL 4 / day

PA

AL Up to 18 yrs old

XELJANZ 5

QL 2 / day

PA

S

XELJANZ XR 5

QL 1 / day

PA

S

GONADOTROPIN-RELEASING HORMONE ANTAGNTS

CETROTIDE 4

PA

GL Female

S

PS

FIRMAGON 120 MG VIAL 5PA

S



ganirelix acetate 5GL Female

S

IMMUNOMODULATORY AGENTS

ACTIMMUNE 5 S

AUBAGIO 4

QL 1 / day

PA

S

PS

AVONEX (30 MCG VIAL KIT, PREFILLED SYR 30 MCG, PREFILLEDSYR 30 MCG KT) 4

QL 0.15 / day

PA

S

PS

AVONEX PEN (PEN 30 MCG/0.5 ML, PEN 30 MCG/0.5 ML KIT) 4

QL 0.15 / day

PA

S

PS

BETASERON (0.3 MG KIT, 0.3 MG VIAL) 5

QL 0.5 / day

PA

S

COPAXONE 4

QL 1 / day

PA

S

PS

EXTAVIA (0.3 MG KIT, 0.3 MG VIAL) 5

QL 0.5 / day

PA

S

GILENYA 4

QL 1 / day

PA

S

PS



GLATOPA 5

QL 1 / day

PA

S

PLEGRIDY 125 MCG/0.5 ML SYRING 4

QL 0.04 / day

PA

S

PS

PLEGRIDY SYRINGE STARTER PACK 4

QL 1 / lifetime

PA

S

PS

PLEGRIDY 125 MCG/0.5 ML PEN 4

QL 0.04 / day

PA

S

PS

PLEGRIDY PEN INJ STARTER PACK 4

QL 1 / lifetime

PA

S

PS

POMALYST 5

QL 1 / day

PA

S

REBIF (22 MCG/0.5 ML SYRINGE, 44 MCG/0.5 ML SYRINGE) 5

QL 0.22 / day

PA

S

REBIF TITRATION PACK 5

QL 4.2 / 365 days

PA

S



REBIF REBIDOSE (22 MCG/0.5 ML, 44 MCG/0.5 ML) 5

QL 0.22 / day

PA

S

REBIF REBIDOSE TITRATION PACK 5

QL 4.2 / 365 days

PA

S

REVLIMID 5

QL 1 / day

PA

S

TECFIDERA 4

QL 2 / day

PA

S

PS

THALOMID (150 MG CAPSULE, 200 MG CAPSULE) 5

QL 2 / day

PA

S

THALOMID (50 MG CAPSULE, 100 MG CAPSULE) 5

QL 1 / day

PA

S

ZINBRYTA 5

QL 1 / day

PA

S

IMMUNOSUPPRESSIVE AGENTS

ASTAGRAF XL 0.5 MG CAPSULE 5

QL 15 / day

PA

S

ASTAGRAF XL 1 MG CAPSULE 5

QL 30 / day

PA

S



ASTAGRAF XL 5 MG CAPSULE 5

QL 6 / day

PA

S

CELLCEPT (200 MG/ML ORAL SUSP, 250 MG CAPSULE, 500 MGTABLET) 5 S

cyclophosphamide (25 mg capsule, 50 mg capsule) 1 PA

cyclophosphamide powder 3

cyclophosphamide monohydrate 3

cyclosporine (a powder, powder) 3

ELIDEL 2

QL 2.5 / day

ST


ENVARSUS XR 5

QL 1 / day

PA

S

mercaptopurine powder 3

mercaptopurine 50 mg tablet 1

mycophenolate 200 mg/ml susp 5 S

mycophenolate mofetil (250 mg capsule, 500 mg tablet) 5 S

mycophenolic acid 5 S

MYFORTIC 5 S

PROGRAF (0.5 MG CAPSULE, 1 MG CAPSULE, 5 MG CAPSULE) 5 S

PURIXAN 5PA

S

RAPAMUNE (0.5 MG TABLET, 1 MG TABLET, 1 MG/ML ORALSOLN, 2 MG TABLET) 5 S

sirolimus powder 3



sirolimus (1 mg tablet, 2 mg tablet) 5 S

sirolimus 0.5 mg tablet 5 S

tacrolimus 0.5 mg capsule 5QL 2 / day

S

tacrolimus 1 mg capsule 5QL 8 / day

S

tacrolimus 5 mg capsule 5QL 4 / day

S

tacrolimus (monohydrate powder, powder) 3

tacrolimus micronized 3

ZORTRESS 5PA

S

OTHER MISCELLANEOUS THERAPEUTIC AGENTS

4-aminopyridine 3

acetyl-l-carnitine hcl 3

acetylcysteine powder 3

acetylcysteine (10% vial, 20% vial) 1

alcohol,dehydrated (ampule, vial) 1

aminobutyric acid 3

AMPYRA 4

QL 2 / day

PA

S

PS

ARCALYST 5PA

S

beta glucan (1-3) nq 3



betaine hydrochloride 3

BOTOX COSMETIC 5PA

S

butylated hydroxytoluene(bht) 3

calcium folinate 3

CARDIOVID PLUS 3

CARNITOR (100 MG/ML ORAL SOLN, 330 MG TABLET) 3

CARNITOR SF 3

CERDELGA 5

QL 2 / day

PA

S

chondroitin sulfate 3

chondroitin sulfate sodium 3

coenzyme q10 3

coumarin 3

cryoserv 3

curcumin 3

CYSTADANE 5 S

CYSTAGON 5 S

cysteamine hcl 3

DEMSER 3

diaminopyridine 3

dibutyl squarate 3

edetate disodium 3

EPIFIX AMNIOTIC MEMBRANE 3

ginkgo biloba 3

glucosamine hcl 3



glucosamine sulfate kcl 3

glucosamine sulfate sodium 3

GRAFIX CORE 5CM X 5CM MATRIX 3

GRAFIX PRIME 5CM X 5CM MATRIX 3

GRASTEK 3QL 1 / day

PA

ILARIS 150 MG/ML VIAL 5

QL 0.04 / day

PA

S

indole-3-carbinol 3

KEVEYIS 5

QL 4 / day

PA

S

KUVAN (100 MG POWDER PACKET, 100 MG TABLET, 500 MGPOWDER PACKET) 5

PA

S

l-carnitine 3

l-theanine 3

leucovorin calcium powder 3

levocarnitine (l-carnitine powder, levocarnitine powder) 3

levocarnitine (1 g/10 ml soln, 330 mg tablet) 1

lycopene 3

melatonin 3

NEXAVIR 3

nicotinamide adenine 3

ORALAIR (100-300 IR CHILD SAMPL, 300 IR ADULT SAMPLE KT,300 IR STARTER PACK, 300 IR SUBLINGUAL TAB) 5

PA

S

ORALAIR 100 IR STARTER PACK 5 S



ORFADIN (2 MG CAPSULE, 4 MG/ML SUSPENSION, 5 MGCAPSULE, 10 MG CAPSULE, 20 MG CAPSULE) 5

PA

S

POTABA 3

potassium perchlorate 3

PROCYSBI 5 S

pyruvic acid 3

RAGWITEK 3QL 1 / day

PA

resveratrol 3

SENSIPAR (30 MG TABLET, 60 MG TABLET) 5

QL 2 / day

PA

S

SENSIPAR 90 MG TABLET 5

QL 4 / day

PA

S

STRAVIX (STRAVI3CM 6CM, STRAVI4CM 7CM) 3

theanine 3

THIOLA 3

tiopronin 3

turmeric root 3

TYBOST 4S

PS

ubidecarenone 3

ubiquinol 3

VP-ZEL 3

XURIDEN 5 S

ZAVESCA 5PA

S



PROTECTIVE AGENTS

ELMIRON 3

MESNEX 400 MG TABLET 5 S

pentosan polysulfate sodium 3

NONSTEROIDAL ANTI-INFLAMMATORY AGENTS

CYCLOOXYGENASE-2 (COX-2) INHIBITORS

CELEBREX (50 MG CAPSULE, 200 MG CAPSULE) 3 QL 2 / day

CELEBREX 100 MG CAPSULE 3 QL 3 / day

CELEBREX 400 MG CAPSULE 3 QL 1 / day

celecoxib (50 mg capsule, 200 mg capsule) 1 QL 2 / day

celecoxib 100 mg capsule 1 QL 3 / day

celecoxib 400 mg capsule 1 QL 1 / day

celecoxib powder 3

OTHER NONSTEROIDAL ANTI-INFLAM. AGENTS

ANSAID 3

DAYPRO 3

diclofenac potassium 1

diclofenac 1.5% topical soln 1 HCG

diclofenac sodium 1% gel 1QL 1000/ 30 days

HCG

diclofenac sodium powder 3

diclofenac sodium (dr 25 mg tab, dr 50 mg tab, dr 75 mg tab, ec25 mg tab, ec 50 mg tab, ec 75 mg tab) 1

diclofenac sodium er 1

diclofenac sodium micronized 3

diflunisal 1



etodolac (200 mg capsule, 300 mg capsule, 400 mg tablet, 500mg tablet) 1

etodolac er 1

FELDENE 3

fenoprofen calcium (200 mg capsule, 400 mg capsule) 1 HCG

fenoprofen calcium powder 3

fenoprofen 600 mg tablet 1

FENORTHO 3

FLECTOR 3 QL 2 / day

flurbiprofen powder 3

flurbiprofen (50 mg tablet, 100 mg tablet) 1

ibuprofen 100 mg/5 ml susp 1

ibuprofen powder 3

ibuprofen (400 mg tablet, 600 mg tablet, 800 mg tablet) 1 LCG

indomethacin powder 3

ketoprofen (50 mg capsule, 75 mg capsule, er 200 mg capsule) 1 HCG

ketoprofen powder 3

ketoprofen micronized 3

ketorolac tromethamine (15 mg/ml carpuject, 15 mg/ml isecuresyr, 15 mg/ml vial) 1 QL 40 / 23 days

ketorolac tromethamine powder 3

ketorolac tromethamine (30 mg/ml isecure syr, 30 mg/mlsyringe, 30 mg/ml vial) 1 QL 20 / 23 days

ketorolac 10 mg tablet 1 QL 21 / fill

ketorolac tromethamine (30 mg/ml carpuject, 60 mg/2 mlcarpuject, 60 mg/2 ml syringe, 60 mg/2 ml vial, 300 mg/10 mlvial)

1 QL 20 / 30 days

KLOFENSAID II 1 HCG



LODINE 3

meclofenamate sodium (50 mg capsule, 100 mg capsule) 1

meclofenamate sodium powder 3

mefenamic acid 250 mg capsule 1QL 5 / day

HCG

mefenamic acid powder 3

meloxicam 7.5 mg/5 ml susp 1 QL 10 / day

meloxicam powder 3

meloxicam (7.5 mg tablet, 15 mg tablet) 1QL 1 / day

LCG

MOBIC 7.5 MG/5 ML SUSPENSION 3 QL 10 / day

MOBIC (7.5 MG TABLET, 15 MG TABLET) 3 QL 1 / day

nabumetone powder 3

nabumetone (500 mg tablet, 750 mg tablet) 1

nabumetone micronized 3

NALFON 3

naproxen powder 3

naproxen sodium powder 3

oxaprozin 1 HCG

PENNSAID 2% PUMP 3 QL 3.73 / day

phenylbutazone 3

piroxicam (10 mg capsule, 20 mg capsule) 1 AL Up to 75 yrs old

piroxicam powder 3

PONSTEL 3 QL 5 / day

SPRIX 3 QL 5 days

sulindac powder 3



sulindac (150 mg tablet, 200 mg tablet) 1

tolmetin sodium (200 mg tab, 400 mg cap, 600 mg tab) 1

TOXICOLOGY SALIVA COLLECTION 3

VIVLODEX 3

QL 1 / day

PA


VOLTAREN 3 QL 1000/ 30 days

VOLTAREN-XR 3

ZIPSOR 3 QL 4 / day

SALICYLATES

carisoprodol compound 1

carisoprodol-aspirin 1

choline mag trisalicylate 1

choline magnesium trisalicylat 3

DISALCID 3

salsalate powder 3

salsalate (500 mg tablet, 750 mg tablet) 1

PENICILLINS

AMINOPENICILLINS

amoxicillin (125 mg tab chew, 250 mg tab chew, 250 mg/5 mlsusp, 500 mg capsule, 500 mg tablet, 875 mg tablet) 1

amoxicillin (125 mg/5 ml susp, 200 mg/5 ml susp, 250 mgcapsule, 400 mg/5 ml susp) 1 LCG

amoxicillin er 1 HCG

amoxicillin trihydrate 3

amoxicillin-clavulanate pot 3

amoxicillin-clavulanate pot er 1 HCG



amoxicillin-clavulanate potass (200-28.5 mg tab chew, 200-28.5 mg/5 ml sus, 250-125 mg tablet, 250-62.5 mg/5 ml sus,400-57 mg tab chew, 400-57 mg/5 ml susp, 500-125 mg tablet,600-42.9 mg/5 ml sus, 875-125 mg tablet)

1

ampicillin sodium (1 gm vial, 2 gm vial, 10 gm vial, 125 mg vial,250 mg vial, 500 mg vial) 1

ampicillin trihydrate (125 mg/5 ml susp, 250 mg capsule, 250mg/5 ml susp, 500 mg capsule) 1

ampicillin-sulbactam (3 gm vial, 15 gm vl) 1

ampicillin-sulbactam 1.5 gm vl 1 MED Medical Drug

AUGMENTIN 125-31.25 MG/5 ML 2

AUGMENTIN (250-62.5 MG/5 ML, 500-125 TABLET, 875-125TABLET) 3

AUGMENTIN ES-600 3

AUGMENTIN XR 3

MOXATAG 3

UNASYN 3

EXTENDED-SPECTRUM PENICILLINS

ticarcillin disod-clavulanate 3

NATURAL PENICILLINS

BICILLIN C-R 3

BICILLIN L-A 3

penicillin g potassium 1

penicillin g procaine 1

penicillin g sodium 1

penicillin v potassium (125 mg/5 ml soln, 250 mg tablet, 250mg/5 ml soln, 500 mg tablet) 1 LCG

PFIZERPEN 3



PENICILLINASE-RESISTANT PENICILLINS

dicloxacillin sodium 1

nafcillin sodium (1 gm vial, 2 gm vial, 10 gm bulk vial, 10 gmvial) 1

oxacillin sodium (1 gm vial, 2 gm vial, 10 gm vial) 1

RENIN-ANGIOTENSIN-ALDOSTER.INHIB(HYPOTN)

ANGIOTENSIN II RECEPTOR ANTAGON.(HYPOTN)

ATACAND 3 QL 1 / day

AVAPRO 3 QL 1 / day

BENICAR 3 QL 3 / day

candesartan cilexetil 1 QL 1 / day

COZAAR (25 MG TABLET, 50 MG TABLET) 3 QL 2 / day

COZAAR 100 MG TABLET 3 QL 1 / day

DIOVAN (40 MG TABLET, 80 MG TABLET, 160 MG TABLET) 3 QL 2 / day

DIOVAN 320 MG TABLET 3 QL 1 / day

EDARBI 3QL 1 / day

ST

eprosartan mesylate 1 QL 1 / day

irbesartan 1 QL 1 / day

losartan potassium (25 mg tab, 50 mg tab) 1 QL 2 / day

losartan potassium 100 mg tab 1 QL 1 / day

MICARDIS 3 QL 1 / day

olmesartan medoxomil 1 QL 3 / day

telmisartan 1 QL 1 / day



valsartan (40 mg tablet, 80 mg tablet, 160 mg tablet) 1 QL 2 / day

valsartan 320 mg tablet 1 QL 1 / day

ANGIOTENSIN-CONVERT.ENZYME INHIB(HYPOTN)

ACCUPRIL 3 QL 2 / day

ACEON 3 QL 1 / day

ALTACE 3 QL 2 / day

benazepril hcl (10 mg tablet, 40 mg tablet) 1 QL 2 / day

benazepril hcl 20 mg tablet 1 QL 4 / day

benazepril hcl 5 mg tablet 1 QL 3 / day

captopril powder 3

captopril (12.5 mg tablet, 25 mg tablet, 50 mg tablet, 100 mgtablet) 1 QL 4 / day

enalapril maleate powder 3

enalapril maleate (2.5 mg tab, 5 mg tablet, 10 mg tab, 20 mgtab) 1 QL 2 / day

EPANED (1 MG/ML ORAL SOLUTION, 1 MG/ML SOLUTION) 3 QL 5 / day

fosinopril sodium 1 QL 2 / day

lisinopril 100% powder 3

lisinopril (2.5 mg tablet, 5 mg tablet, 10 mg tablet, 20 mgtablet, 30 mg tablet) 1 QL 1 / day

lisinopril 40 mg tablet 1 QL 2 / day

LOTENSIN 20 MG TABLET 3 QL 4 / day

LOTENSIN 40 MG TABLET 3 QL 2 / day

MAVIK 3 QL 2 / day

moexipril hcl 1 QL 1 / day



perindopril erbumine 1 QL 1 / day

PRINIVIL 3 QL 1 / day

QBRELIS 3 QL 40/ day

quinapril hcl 1 QL 2 / day

ramipril 1 QL 2 / day

trandolapril 1 QL 2 / day

VASOTEC 3 QL 2 / day

ZESTRIL 3 QL 1 / day

RENIN-ANGIOTENSIN-ALDOSTERONE SYS. INHIB

ANGIOTENSIN II RECEPTOR ANTAGONISTS

ENTRESTO 3QL 2 / day

PA

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS

benazepril hcl powder 3

RENIN INHIBITORS

TEKTURNA 3QL 1 / day

ST

RESPIRATORY TRACT AGENTS

ANTIFIBROTIC AGENTS

ESBRIET (267 MG CAPSULE, 267 MG TABLET) 5

QL 9 / day

PA

S

ESBRIET 801 MG TABLET 5

QL 3 / day

PA

S



OFEV 5

QL 2 / day

PA

S

ANTITUSSIVES

benzonatate 1 AL At least 11 yrs old

dextromethorphan hbr 3

FLOWTUSS 3QL 60 / day


TESSALON PERLE 3 AL At least 11 yrs old

ZONATUSS 3 AL At least 11 yrs old

EXPECTORANTS

bromhexine hcl 3

guaifenesin 3

terpin hydrate 3

MUCOLYTIC AGENTS

PULMOZYME 5

QL 5 / day

PA

S

PHOSPHODIESTERASE TYPE 4 INHIBITORS

DALIRESP 3QL 1 / day

PA

PULMONARY SURFACTANTS

CUROSURF 3

INFASURF 3

SURVANTA 3



VASODILATING AGENTS (RESPIRATORY TRACT)

ADCIRCA 5

QL 2 / day

PA

S

ADEMPAS 5

QL 3 / day

PA

S

LETAIRIS 4

QL 1 / day

PA

S

PS

OPSUMIT 5

QL 1 / day

PA

S

ORENITRAM ER 5

QL 3 / day

PA

S

REMODULIN 5PA

S

REVATIO 10 MG/ML ORAL SUSP 5

QL 6 / day

PA


S

REVATIO 20 MG TABLET 5

QL 3 / day

PA


S



sildenafil 5

QL 3 / day

PA

S

sildenafil citrate powder 3

TRACLEER 4

QL 2 / day

PA

S

PS

TYVASO 5

QL 1 / day

PA

S

TYVASO INSTITUTIONAL START KIT 5

QL 1 / day

PA

S

TYVASO REFILL KIT 5

QL 1 / day

PA

S

TYVASO STARTER KIT 5

QL 1 / day

PA

S

UPTRAVI 200-800 TITRATION PACK 5

PA


S

UPTRAVI (200 MCG TABLET, 400 MCG TABLET, 600 MCGTABLET, 800 MCG TABLET, 1,000 MCG TABLET, 1,200 MCGTABLET, 1,400 MCG TABLET, 1,600 MCG TABLET)

5

QL 2 / day

PA


S



SKELETAL MUSCLE RELAXANTS

CENTRALLY ACTING SKELETAL MUSCLE RELAXNT

AMRIX 3

carisoprodol powder 3

carisoprodol (250 mg tablet, 350 mg tablet) 1

chlorzoxazone 500 mg tablet 1

cyclobenzaprine hcl powder 3

cyclobenzaprine hcl (5 mg tablet, 7.5 mg tablet, 10 mg tablet) 1

FEXMID 3

LORZONE 3

METAXALL 1 HCG

metaxalone 1 HCG

methocarbamol powder 3

methocarbamol (500 mg tablet, 750 mg tablet) 1

methocarbamol 1,000 mg/10 ml 1

PARAFON FORTE DSC 3

ROBAXIN 500 MG TABLET 3

ROBAXIN 1,000 MG/10 ML VIAL 3

ROBAXIN-750 3

SKELAXIN 3

SOMA 3

tizanidine hcl (2 mg capsule, 2 mg tablet, 4 mg capsule, 4 mgtablet, 6 mg capsule) 1

tizanidine hcl powder 3

ZANAFLEX (2 MG CAPSULE, 4 MG CAPSULE, 4 MG TABLET, 6 MGCAPSULE) 3



DIRECT-ACTING SKELETAL MUSCLE RELAXANTS

DANTRIUM (25 MG CAPSULE, 50 MG CAPSULE) 3

dantrolene sodium (25 mg cap, 50 mg cap, 100 mg cap) 1

dantrolene sodium powder 3

GABA-DERIVATIVE SKELETAL MUSCLE RELAXANT

baclofen powder 3

baclofen (10 mg tablet, 20 mg tablet) 1

NEUROMUSCULAR BLOCKING AGENTS

pancuronium bromide powder 3

rocuronium bromide powder 3

succinylcholine chloride powd 3

vecuronium bromide powder 3

SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS

orphenadrine citrate powder 3

orphenadrine er 100 mg tablet 1

orphenadrine citrate (30 mg/ml vial, 60 mg/2 ml ampule, 60mg/2 ml vial) 1

SKIN AND MUCOUS MEMBRANE AGENTS

ANTI-INFLAMMATORY AGENTS (SKIN, MUCOUS)

ALA-CORT 1

ALA-SCALP 3

alclometasone dipropionate (dipr oint, dipro crm) 1

amcinonide (cream, lotion, ointment) 1

ANA-LEX 2-2% CREAM 3

ANALPRAM HC (1% CREAM, 2.5%-1% CREAM, 2.5%-1% CRMSINGLE, 2.5%-1% LOTION) 3

ANUCORT-HC 1



ANUSOL-HC 2.5% CREAM 3

ANUSOL-HC 25 MG SUPPOSITORY 1

APEXICON E 3

betamethasone dipropionate (aug crm, aug gel, aug lot, aug oin,crm, lot, oint) 1

betamethasone dp powder 3

betamethasone valerate (va 0.1% cream, va 0.1% lotion, valer0.1% ointm, valer 0.12% foam) 1

betamethasone valerate powder 3

calcipotriene-betamethasone dp 1 QL 3 / day

CAPEX SHAMPOO 3

clobetasol emollient (emollient crm, emollnt foam) 1

clobetasol emulsion 1

clobetasol propionate (cream, gel, ointment, prop foam, propspray, shampoo, solution, topical lotn) 1

clobetasol propionate micro 3

CLOBEX (SHAMPOO, SPRAY, TOPICAL LOTION) 3

clocortolone pivalate 1 HCG

CLODAN 0.05% SHAMPOO 1

CLODERM 3

COLOCORT 1

CORMAX 1

CORTENEMA 3

CORTIFOAM 3

CUTIVATE (CREAM, LOTION) 3

DERMA-SMOOTHE-FS (BODY OIL, SCALP OIL) 3

DERMATOP (EMOLLIENT CREAM, OINTMENT) 3

DESONATE 3



desonide (cream, lotion, ointment) 1 HCG

desonide micronized 3

DESOWEN (CREAM, LOTION) 3

desoximetasone (0.05% cream, 0.05% gel, 0.05% ointment,0.25% cream, 0.25% ointment) 1 HCG

desoximetasone powder 3

diflorasone diacetate (cream, ointment) 1

DIPROLENE (LOTION, OINTMENT) 3

DIPROLENE AF 3

ELOCON (CREAM, LOTION, OINTMENT) 3

ENSTILAR 3 QL 2 / day

EPIFOAM 3

EUCRISA 2

QL 2.143 / day

ST


fluocinolone acetonide (0.01% body oil, 0.01% cream, 0.01%scalp oil, 0.025% cream, 0.025% ointment) 1 HCG

fluocinolone acetonide powder 3

fluocinolone 0.01% solution 1

fluocinonide (0.05% cream, 0.05% gel, 0.05% ointment,0.05% solution, 0.1% cream) 1

fluocinonide micronized 3

fluocinonide-e 1

fluticasone propionate (0.005% oint, 0.05% cream, 0.05%lotion) 1

halobetasol propionate (cream, ointmnt) 1 HCG

HALOG (CREAM, OINTMENT) 3

HEMMOREX-HC 1



hydrocortisone (1% absorbase, 1% cream, 1% ointment, 2.5%cream, 2.5% lotion, 2.5% ointment, 100 mg/60 ml) 1

hydrocortisone (micronized pwd, powder) 3

hydrocortisone acetate powder 3

hydrocortisone acetate (25 mg, 30 mg) 1

hydrocortisone butyrate (hydrocort buty lipid crm, hydrocortbuty lipo cream, hydrocortisone buty cream, hydrocortisonebutyr oint, hydrocortisone butyr soln)

1

hydrocortisone valerate (cream, ointmt) 1

hydrocortisone-pramoxine (1%-1% crm, 2.5%-1% cm, 2.5-1%crm) 1

hydrocortisone-pramoxine hcl 1

KENALOG 3

lidocaine-hc 2.8-0.55% gel 1

lidocaine-hydrocortisone (lidocaine-hc 3-0.5% cream,lidocaine-hydrocort 3-2.5% gel) 1 HCG

LOCOID (CREAM, LOTION, OINTMENT, SOLUTION) 3

lokara 1 HCG

LUXIQ 3

MICORT-HC 3

mometasone furoate (cream, oint, soln) 1

NOVACORT GEL 3

OLUX 3

OLUX-E 3

ORALONE 1

PANDEL 3

PRAMCORT 1

PRAMOSONE (1% LOTION, 1%-1% CREAM, 1%-1%OINTMENT, 2.5%-1% CREAM, 2.5%-1% LOTION, 2.5%-1%OINTMENT)

3



PRAMOSONE E 3

prednicarbate (cream, ointment) 1

PROCORT 3

PROCTO-MED HC 1

PROCTO-PAK 1

PROCTOCORT (1% CREAM, 30 MG SUPPOSITORY) 3

PROCTOFOAM-HC 2

PROCTOSOL-HC 1

PROCTOZONE-HC 1

PSORCON 3

RIMSO-50 3

SANADERMRX 1 HCG

SCALACORT 1

SERNIVO 3

SYNALAR (0.01% SOLUTION, 0.025% CREAM) 3

SYNALAR TS 3

TACLONEX (0.005%-0.064% SUSPENS, OINTMENT) 3 QL 3 / day

TEMOVATE (CREAM, OINTMENT) 3

TEMOVATE EMOLLIENT 3

TEXACORT 3

TOPICORT (0.05% CREAM, 0.05% GEL, 0.05% OINTMENT,0.25% CREAM, 0.25% OINTMENT, 0.25% SPRAY) 3

triamcinolone acetonide (0.025% cream, 0.025% lotion,0.025% oint, 0.1% cream, 0.1% lotion, 0.1% ointment, 0.1%paste, 0.147 mg/g spray, 0.5% cream, 0.5% ointment)

1

TRIANEX 1

TRIDERM 1

TRIDESILON 3 HCG



ULTRAVATE (CREAM, LOTION, OINTMENT) 3

VANOS 3

VANOXIDE-HC 3 QL 0.84 / day

VERDESO 3

ANTIPRURITICS AND LOCAL ANESTHETICS

ANACAINE 3

ANASTIA 3

CETACAINE 3

CIDALEAZE 1

dibucaine hcl 3

doxepin 5% cream 1

EMLA 3

ethyl chloride 1

lidocaine 5% patch 1QL 3 / day

HCG

lidocaine 5% ointment 1

lidocaine hcl (cream, hcl lotion) 1

lidocaine-prilocaine 1

lidocaine-tetracaine 1 HCG

LIDODERM 3 QL 3 / day

LIDODEXTRAPINE 1 QL 4 / day

LIDOPIN 3% CREAM 1

LIDOPIN 3.25% CREAM 3

LIDOPRIL 1

LIDORX 2QL 1 / day

PA



LIDOTRAL 3

LIDOVEX 3

LIDTOPIC MAX 3

LP LITE PAK 1

NUMBONEX 3

PAIN EASE 3

phenazopyridine hcl 100% powdr 3

phenazopyridine hcl (100 mg tab, 200 mg tab) 1

PLIAGLIS 3

PONTOCAINE 3

pramoxine hcl 3

PRE-ATTACHED LTA KIT 3

PRUDOXIN 3

PYRIDIUM 3

REGENECARE 3

SPRAY AND STRETCH 3

SYNERA 3

ZONALON 3

ASTRINGENTS

DRYSOL 3

CELL STIMULANTS AND PROLIFERANTS

ATRALIN 3 QL 1.5 / day

AVITA 0.025% CREAM 1

AVITA 0.025% GEL 1 HCG

REFISSA 3

RENOVA 3

RENOVA PUMP 3



RETIN-A (0.01% GEL, 0.025% CREAM, 0.025% GEL, 0.05%CREAM, 0.1% CREAM) 3

RETIN-A MICRO 3 QL 50 / 30 days

RETIN-A MICRO PUMP 3 QL 50 / 30 days

retinoic acid 3

TRETIN-X (0.0375% CREAM, 0.075% CREAM) 3

tretinoin (0.01% gel, 0.025% cream, 0.05% cream, 0.05% gel,0.1% cream) 1

tretinoin 0.05% emollient crm 1

tretinoin 0.025% gel 1 HCG

tretinoin powder 3

tretinoin acid 3

tretinoin microsphere (gel 0.04% pump, gel 0.04% tube, gel0.1% pump, gel 0.1% tube) 1

QL 1.667 / day

HCG

EMOLLIENTS, DEMULCENTS, AND PROTECTANTS

ALEVICYN ANTIPRURITIC SG 3

KERATOLYTIC AGENTS

ALUVEA 3

BENSAL HP 3

BENZEFOAM 3 QL 2 / day

BENZEFOAM ULTRA 3 QL 3.334 / day

BENZEPRO (6% FOAMING CLOTHS, 7% CREAMY WASH) 1

pr benzoyl peroxide 7% wash 1

BP-50% UREA 1

BPO (4% GEL, 8% GEL) 3

BPO 6% FOAMING CLOTHS 1 QL 2 / day

CEM-UREA 3



GORDO-UREA 40% OINTMENT 3

HYDRO 35 3

HYDRO 40 3

KERAFOAM 3

KERALAC 3

KERALYT 3

lactic acid liquid 3

LATRIX 1

NUOX 3 QL 1.47 / day

PACNEX 1

PACNEX HP 3

PACNEX LP 3

podophyllum resin 3

potassium hydroxide pellets 3

potassium hydroxide 5% soln 1 HCG

PR BENZOYL PEROXIDE 1

REA LO 40 (40 CM, 40 TION) 1

REMEVEN 1

RYNODERM 3

SALACYN (CREAM, LOTION) 1

SALEX 6% SHAMPOO 3

salicylic acid (6% cream, 6% foam, 6% gel, 6% lotion, 6%shampoo, 26% liquid, 27.5% liquid) 1

salicylic acid powder 3

salicylic acid er 1

SALKERA 3

SALVAX 3



silver nitrate 10% solution 1

grafco silver nit applicator 1

silver nitrate applicator 3

sodium hydroxide (10% solution, flakes, granules, pellets) 3

sulfur (powder, sublimed powder) 3

ULTRASAL-ER 3

UMECTA (EMULSION, NAIL FILM PEN, NAIL FILM SUSP) 3

UMECTA 40% MOUSSE 1

UMECTA PD (PD EMULSION, PD SUSPENSION) 3

URAMAXIN (20% FOAM, 45% LOTION, 45% NAIL GEL, 45%UREA CREAM) 3

URAMAXIN GT 45% PRE-FILLED APP 3

URE-K 1

urea (35% foam, 39% cream, 40% cream, 40% gel, 40%lotion, 40% nail film susp, 45% cream, 45% lotion, 45% nailgel, 47% cream, 50% cream)

1

urea (50% nail stick, powder) 3

UREVAZ 3

UTOPIC 3

VIRASAL 3

KERATOPLASTIC AGENTS

anthralin 3

coal tar (tar, tar solution) 3

coal tar topical solution 1

DRITHOCREME HP 3

ZITHRANOL 3

ZITHRANOL-RR 3



SKIN AND MUCOUS MEMBRANE AGENTS, MISC.

ABSORICA 3 PA

acitretin (17.5 mg capsule, 25 mg capsule) 1QL 2 / day

HCG

acitretin 10 mg capsule 1QL 4 / day

HCG

ACZONE (5% GEL, 7.5% GEL PUMP) 3 QL 3 / day

adapalene (0.1% cream, 0.3% gel, 0.3% gel pump) 1QL 1.5 / day

HCG

adapalene 0.1% gel 1 QL 1.5 / day

adapalene 0.1% lotion 1QL 2 / day

HCG

adapalene-benzoyl peroxide 3 QL 1.5 / day

ALDARA 3QL 0.434 / day


AMNESTEEM 1PA

HCG

ARTISS 3

AVAGE 3 QL 1.47 / day

azelaic acid (flakes, powder) 3

AZELEX 3 QL 1.667 / day

calcipotriene (cream, ointment) 1QL 2 / day

HCG

calcipotriene 0.005% solution 1 QL 2 / day

CALCITRENE 1QL 2 / day

HCG



calcitriol 3 mcg/g ointment 1 QL 3.334 / day

camphor 3

capsaicin 3

capsaicin palmitate 3

capsicum oleoresin 3

CARAC 2

CLARAVIS 1PA

HCG

collagenase 3

CONDYLOX (GEL, TOPICAL SOLN) 3

COSENTYX (2 SYRINGES) 5

QL 0.357 / day

PA

S

COSENTYX PEN 5

QL 0.357 / day

PA

S

COSENTYX PEN (2 PENS) 5

QL 0.357 / day

PA

S

COSENTYX SYRINGE 5

QL 0.357 / day

PA

S

DEBACTEROL (SOLUTION, SWABSTICK) 3

diclofenac sodium 3% gel 1 QL 100 / 30 days

DIFFERIN (0.1% CREAM, 0.1% GEL, 0.3% GEL, 0.3% GELPUMP) 3 QL 1.5 / day

DIFFERIN 0.1% LOTION 3 QL 1.967 / day



DOVONEX 3 QL 2 / day

DUPIXENT 5

QL 0.15 / day

PA


S

EFUDEX 3

EPIDUO 0.1-2.5% GEL 3 QL 1.667 / day

EPIDUO 0.1-2.5% GEL PUMP 3 QL 1.5 / day

EPIDUO FORTE 3 QL 1.667 / day

FABIOR 3QL 3.73 / day

AL Up to 34 yrs old

FINACEA (FOAM, GEL) 3QL 50 / 30 days

PA

finasteride 1 mg tablet 1

FLUOROPLEX 2

fluorouracil (0.5% cream, 2% topical soln, 5% cream, 5%topical soln) 1

FORMADON 1

formaldehyde 1

GRANULEX 3

imiquimod 5% cream packet 1QL 0.434 / day


imiquimod powder 3

isotretinoin 3

LEVULAN 3

methyl 5-aminolevulinate hcl 3

MIRVASO (GEL, GEL PUMP) 2 QL 1 / day



MUCOTROL 3

MYORISAN 1PA

HCG

PANRETIN 3

PICATO 3 ST

PODOCON-25 3

podofilox 0.5% topical soln 1

PROPECIA 3

PROTOPIC 0.03% OINTMENT 3

QL 2.5 / day

ST


PROTOPIC 0.1% OINTMENT 3

QL 2.5 / day

ST


PYROGALLIC ACID 1

RECTIV 3

REGRANEX 3 QL 1 / day

RENOVO 3

RHOFADE 3QL 1.25 / day

PA

SANTYL 3

SINELEE 5%-0.05% PATCH 3

SOLARAZE 3 QL 100 / 30 days

SOOLANTRA 2 QL 1.5 / day

SORIATANE (17.5 MG CAPSULE, 25 MG CAPSULE) 3 QL 2 / day

SORIATANE 10 MG CAPSULE 3 QL 4 / day



SORILUX 3 QL 2 / day

tacrolimus (0.03% ointment, 0.1% ointment) 1

QL 100 / 30 days

ST

HCG

TALTZ AUTOINJECTOR 5

QL 0.15 / day

PA

S

TALTZ AUTOINJECTOR (2 PACK) 5

QL 0.15 / day

PA

S


QL 0.15 / day

PA

S

TALTZ SYRINGE 5

QL 0.15 / day

PA

S

TALTZ SYRINGE (2 PACK) 5

QL 0.15 / day

PA

S


QL 0.15 / day

PA

S

TARGRETIN 1% GEL 5PA

S

tazarotene 0.1% cream 1QL 1.47 / day

HCG

tazarotene powder 3



TAZORAC (0.05% CREAM, 0.1% CREAM) 3 QL 2 / day

TAZORAC (0.05% GEL, 0.1% GEL) 3 QL 3.334 / day

TOLAK 3QL 1.47 / day

ST

TRI-CHLOR 3

trichloroacetic acid (25%, 75%) 1

VALCHLOR 5

QL 3 / day

PA

S

VANIQA 3

VECTICAL 3 QL 3.334 / day

VENELEX (OINTMENT, OINTMENT PACKET) 3

VEREGEN 3

ZENATANE 1PA

HCG

ZYCLARA (CREAM, CREAM PUMP) 3QL 56 / 60 days


ZYCLARA 2.5% CREAM PUMP 3QL 56 / 30 days


SUNSCREEN AGENTS

zinc oxide 3



SOMATOSTATIN AGONISTS AND ANTAGONISTS

SOMATOSTATIN AGONISTS

octreotide acetate (acet 0.05 mg/ml vl, acet 50 mcg/ml amp,acet 50 mcg/ml syr, acet 50 mcg/ml vial, acet 100 mcg/ml amp,acet 100 mcg/ml syr, acet 100 mcg/ml vl, acet 200 mcg/ml vl,acet 500 mcg/ml amp, acet 500 mcg/ml syr, acet 500 mcg/mlvl, 1,000 mcg/5 ml vial, 1,000 mcg/ml vial, 5,000 mcg/5 mlvial)

5PA

S

SANDOSTATIN 0.05 MG/ML AMPUL 5

QL 30 / day

PA

S


QL 15 / day

PA

S


QL 3 / day

PA

S

SANDOSTATIN 0.2 MG/ML VIAL 5

QL 8 / day

PA

S

SANDOSTATIN 1 MG/ML VIAL 5

QL 1.5 / day

PA

S

SANDOSTATIN LAR DEPOT (10 MG KT, 10 MG VL, 30 MG KT, 30MG VL) 5

QL 0.04 / day

PA

S

SANDOSTATIN LAR DEPOT (20 MG KT, 20 MG VL) 5

QL 0.07 / day

PA

S



SIGNIFOR 5PA

S

SIGNIFOR LAR (20 MG KIT, 20 MG VIAL) 5

QL 0.1 / day

PA

S


QL 0.067 / day

PA

S


QL 0.04 / day

PA

S

SOMATOTROPIN AGONISTS AND ANTAGONISTS

SOMATOTROPIN AGONISTS

EGRIFTA 5

QL 2 / day

PA

S

INCRELEX 5PA

S

SOMATOTROPIN ANTAGONISTS

SOMAVERT 5 S

SYMPATHOLYTIC ADRENERGIC BLOCKING AGENTS

ALPHA-ADRENERGIC BLOCKING AGENT(SYMPATH)

yohimbine hcl powder 3



SYMPATHOMIMETIC (ADRENERGIC) AGENTS

ALPHA- AND BETA-ADRENERGIC AGONISTS

bupivacaine hcl-epinephrine 1

lidocaine hcl-epinephrine 1

lidocaine-epinephrine 1

MARCAINE-EPINEPHRINE 3

norepinephrine bitartrate powd 3

NORTHERA 5

QL 84 / 14 days

PA

S

phenylpropanolamine hcl 3

SENSORCAINE-EPINEPHRINE 1

SENSORC MPF 0.75%-EPI 1:200000 3

SENSORCAINE-MPF EPINEPHRINE (SENSORC MPF 0.25%-EPI,SENSORCN-MPF 0.5%-EPI) 1

XYLOCAINE DENTAL-EPINEPHRINE 1

XYLOCAINE WITH EPINEPHRINE (0.5%-EPI 1:200,000, 1%-EPI1:100,000, 2%-EPI 1:100,000, 2%-EPI 1:200,000) 3

XYLOCAINE-MPF WITH EPINEPHRINE 3

ALPHA-ADRENERGIC AGONISTS

midodrine hcl 1

phenylephrine hcl powder 3

phenylephrine 10 mg/ml vial 1

THYROID AND ANTITHYROID AGENTS

ANTITHYROID AGENTS

carbimazole 3

methimazole powder 3



methimazole (5 mg tablet, 10 mg tablet) 1

propylthiouracil powder 3

propylthiouracil 50 mg tablet 1

TAPAZOLE 3

THYROID AGENTS

ARMOUR THYROID 3

CYTOMEL 3

LEVO-T 1 HCG

levothyroxine sodium powder 3

levothyroxine sodium (25 mcg tablet, 50 mcg tablet, 100 mcgtablet, 112 mcg tablet, 125 mcg tablet, 137 mcg tablet, 150mcg tablet, 175 mcg tablet)

1HCG

LCG

levothyroxine sodium (75 mcg tablet, 88 mcg tablet, 200 mcgtablet, 300 mcg tablet) 1 HCG

LEVOXYL (25 MCG TABLET, 100 MCG TABLET) 1HCG

LCG

LEVOXYL (50 MCG TABLET, 75 MCG TABLET, 88 MCG TABLET,112 MCG TABLET, 125 MCG TABLET, 137 MCG TABLET, 150MCG TABLET, 175 MCG TABLET, 200 MCG TABLET)

1 HCG

liothyronine sodium powder 3

liothyronine sodium (5 mcg tab, 25 mcg tab, 50 mcg tab) 1

NATURE-THROID 3

NP THYROID 1

pcca t3 sodium dilution 3


SYNTHROID 2

thyroid (3x usp powder, 30 mg tablet, 60 mg tablet, 90 mgtablet, powder) 3

THYROLAR-1 3



THYROLAR-1/2 3

THYROLAR-1/4 3

THYROLAR-2 3

THYROLAR-3 3

TIROSINT 3 QL 1 / day

UNITHROID (25 MCG TABLET, 50 MCG TABLET, 100 MCGTABLET, 112 MCG TABLET) 1

HCG

LCG

UNITHROID (75 MCG TABLET, 88 MCG TABLET, 125 MCGTABLET, 137 MCG TABLET, 150 MCG TABLET, 175 MCG TABLET,200 MCG TABLET, 300 MCG TABLET)

1 HCG

WESTHROID 3

WP THYROID 3

Uncategorized

Unclassified

2-methoxyestradiol 3

4-aminobenzoic acid potassium 3

7-keto dhea 3

acacia powder 3

ace aerosol cloud enhancer 3

acetarsone 3

acetyl hexapeptide-8 3

acetyl-d-glucosamine 3

acticoat (2"x2", 4"x4", 5"x5") 3

acticoat (4"x48", 4"x8", 8"x16", 16"x16") 1

acticoat 7 3

acticoat flex 3 3

acticoat flex 7 3

acticoat surgical 1



ademetionine disulfate tosylat 3

advance plus intermittent 3

aerochamber mini 2

aerochamber mv 2

aerochamber plus flow-vu 2

aerochamber with flowsignal 2

aerochamber z-stat plus 2

aeroeclipse ii 3

aerogear asthma action kit 3

aeroneb go 3

aeroneb go nebulizer 3

aerotrach plus 3

aerovent plus 3

AFINITOR (5 MG TABLET, 7.5 MG TABLET, 10 MG TABLET) 5

QL 2 / day

PA

S

AFINITOR 2.5 MG TABLET 5

QL 1 / day

PA

S

AFINITOR DISPERZ 5PA

S

AFLURIA 2017-2018 (2017-2018 SYRINGE, 2017-2018 VIAL) 2 HCR

AFLURIA QUAD 2017-2018 (2017-2018 SYRINGE, 2017-2018VIAL) 2 HCR

air filter 1

ALECENSA 5

QL 8 / day

PA


S



alginic acid 3

ALKERAN 2 MG TABLET 3

all flow 1000 3

all flow 3000 kit 3

all flow 3000 pft 3

all flow 4000 3

all flow 5000 3

all flow 6000 3

allantoin 3

allergist syringe 3

allergist tray 3

allevyn 1

allevyn adhesive 1

allevyn ag 1

allevyn ag adhesive 3

allevyn ag gentle 1

allevyn heel 1

allevyn life (5 1/16"x5 1/16", 6 1/16"x 6 1/16", 8 1/4"x8 1/4") 1

allevyn life dressing 4"x4" 3

ALLFEN CDX 3

almond oil 3

aloe vera 3

alpha lipoic acid 3

altera nebulizer 3

aluminum acetate 3

aluminum chloride 3

aluminum chlorohydrate 3



aluminum sulfate 3

ALUNBRIG 5

QL 6 / day

PA


S

american ginseng root 3

ammonium lactate solution 3

ammonium sulfate 3

ammonium tetrathiomolybdate 3

AMVISC 3

AMVISC PLUS 3

anastrozole powder 3

anastrozole 1 mg tablet 1

anisindione 3

APLIGRAF 3

apogee hc intermittent 3

AQUORAL 3

argyle feeding tube-x-ray line 3

ARIMIDEX 3

arnica lg 3

AROMASIN 3

arsenic trioxide 3

ashwagandha extract 3

aspartic acid magnesium salt 3

assura 3

asthmapack children's 3

astragalus extract 3

ATRAPRO DERMAL SPRAY 3



ATRAPRO HYDROGEL 3

AURSTAT ANTI-ITCH HYDROGEL 3

AVAILNEX 3

AVENOVA 3

azacitidine 5 S

B-PLEX PLUS 1

baby conversion kit 3

baby conversion pack 1 3


baby nebulizer 3

BEAU RX 3

BENLYSTA (200 MG/ML AUTOINJECT, 200 MG/ML SYRINGE) 5PA

S

benzocaine 3

benzoic acid 3

benzoyl peroxide powder 3

benzyl alcohol 3

beta glucan 3

bexarotene 5PA

S

bicalutamide 1

BIONECT (CREAM, GEL) 3

biostep 3

biostep ag 3

biotin 3

biotin-d 3

bismuth citrate 3



bismuth subgallate 3

bitter melon extract 3

BLEO 15K 5 S

bleomycin sulfate 5 S

BOSULIF 100 MG TABLET 4

QL 4 / day

PA

S

PS

BOSULIF 500 MG TABLET 4

QL 1 / day

PA

S

PS

boswellia serrata extract 3

bovine serum albumin 3

breatherite 3

breathrite 3

bromelain 3

bromfenac sodium powder 3

buffered lidocaine 3

buflomedil hcl 3

bupivacaine hcl (0.25% ampul, 0.5% ampul, 0.75% ampul) 1

bupivacaine hcl powder 3

bupivacaine-dextrose 1

butalb-aspirin-caffe 50-325-40 1 QL 6 / day

CABOMETYX 20 MG TABLET 5

QL 4 / day

PA

S




QL 2 / day

PA

S


QL 1.5 / day

PA

S

calcipotriene powder 3

calcipotriene monohydrate 3

calcipotriol 3

calcitriol in almond oil 3

cantharidin (crystals, powder) 3

capecitabine 5 S

CAPHOSOL 3

CAPRELSA 100 MG TABLET 5

QL 2 / day

PA

S

CAPRELSA 300 MG TABLET 5

QL 1 / day

PA

S

caprylic acid 3

CARBOCAINE (1% VIAL, 1.5% VIAL, 2% VIAL) 3

CARDENE SR 45 MG CAPSULE 3 QL 2 / day

carrasyn hydrogel wound 3

CASODEX 3

catheter 1

CEDAX 90 MG/5 ML SUSPENSION 3

CERAMAX 1 HCG



CERVIDIL 3 GL Female

cesium chloride 3

cetyl myristoleate (40% oil, 40% wax, powder) 3

cetylpyridinium chloride 3

chlorambucil 3

chloroacetic acid 3

chlorobutanol 3

chloroprocaine hcl 1

chloroxine 3

chloroxylenol 3

chlorzoxazone 250 mg tablet 1

cholesterol 3

chromium picolinate 3

chromium polynicotinate 3

chrysin 3

chymotrypsin 3

citric acid (granules, powder) 3

citrus bergamot 3

clemizole hcl 3

clever choice holding chamber 3

clever choice nebulizer 3

clever choice whisper aire ped 3

coaguchek xs 3

cobalt gluconate 3

COMETRIQ 100 MG DAILY-DOSE PK 5

QL 2 / day

PA

S



COMETRIQ 140 MG DAILY-DOSE PK 5

QL 4 / day

PA

S

COMETRIQ 60 MG DAILY-DOSE PACK 5

QL 3 / day

PA

S

comp-air elite compressor syst 3

comp-air nebulizer compressor 3

compact space chamber 3

conception 1

copper peptide ghk-cu 3

COTELLIC 5

QL 2.5 / day

PA


S

COTEMPLA XR-ODT 3QL 1 / day

ST

creatine 3

creatine monohydrate 3

creatinine 3

curafil 3

curity 3

curity amd packing strips 3

curity iodoform 3

cyclodextrin-beta 3

cytarabine 5 S

dapiprazole hcl 3



demecarium bromide 3

deoxycholic acid 3

DERMAGRAFT 3

devil's claw 3

devilbiss traveler 3

dexchlorpheniramine maleate 1

dexpanthenol 3

dibucaine 3

dichloroacetic acid 3

diethanolamine 3

diethylen glycol m-ethyl ether 3

diindolylmethane 3

diiodo-l-thyronine 3

dimercaptopropanesulfonate sod (crystal, powder) 3

dimethyl sulfone 3

dimethyl sulfoxide 3

dimethylacetamide 3

dinitrochlorobenzene 3

diphenylcyclopropenone 3

DISCOVISC 3

dmae 3

dover advantage 3

dover advantage drainage 3

dover coated latex foley 3

dover latex foley catheter 3

dover premium 3

dover red rubber robibson cath 3



dover universal 3

DROXIA 3

DUOVISC 3

e-z spacer 3

e-z spacer pedspak 3

ear popper 1

easivent (holding chamber, mask-large, mask-medium, mask-small) 3

ebase controller 3

eclipse needle 3

eclipse syringe 3

egcg 3

EMCYT 5 S

EMULSION SB TOPICAL EMULSION 3

ENDOFORM (4" 5" TEMPLATE, FENESTRATED, FENESTRATED 4"5", TEMPLATE) 3

ENTTY 3

EPICERAM 3

EPISIL 3 HCG

erapid nebulizer 3

erapid nebulizer handset 3

ERIVEDGE 5

QL 1 / day

PA

S

ERWINAZE 5 S

ethoxy diglycol 3

ethyl acetate 1

ethyl oleate 3



etoposide 50 mg capsule 5 S

exemestane 1

EXJADE 5PA

S

EXPAREL 3

FARESTON 2

FARYDAK 5PA

S

female self catheter 1

FEMARA 3 PA

femcap (26 cap, 30 cap) 3

femcap 22 mm cervical cap 3 HCR

ferric ammonium citrate 3

ferric subsulfate 3

FERRIPROX (100 MG/ML SOLUTION, 500 MG TABLET) 5PA

S

fexofenadine-pse er 1 QL 1 / day

filter needle 19gx1-1/2" 3

filter needle 5 micron 3

filter, valve set for ll & lc 3

flexichamber 3

flexichamber mask 3

floxuridine powder 3

floxuridine 500 mg vial 5 S

FLUAD 2017-2018 2AL At least 65 yrs old

HCR



FLUARIX QUAD 2017-2018 2 HCR

FLUBLOK 2017-2018 2 HCR

FLUBLOK QUAD 2017-2018 2 HCR

FLUCELVAX QUAD 2017-2018 (2017-2018 SYR, 2017-2018VIAL) 2 HCR

FLULAVAL QUAD 2017-2018 (2017-2018 SYR, 2017-2018VIAL) 2 HCR

fluorouracil powder 3

flutamide 1

flutter 3

FLUVIRIN 2017-2018 (2017-2018 SYRINGE, 2017-2018 VIAL) 2 HCR

FLUZONE HIGH-DOSE 2017-2018 2AL At least 65 yrs old

HCR

FLUZONE INTRADERM QUAD 2017-18 2 HCR

FLUZONE QUAD 2017-2018 (2017-2018 SYRINGE, 2017-2018VIAL) 2 HCR

FLUZONE QUAD PEDI 2017-2018 2 HCR

FORMA-RAY 3

freedom derma-d 3

freedom precision airless 3

GALZIN 3

GASTROMARK 3

GELCLAIR 3

gelfilm 3

GELFOAM (DENTAL SPONGE SZ 4, 12-7MM SPONGE, SIZE 50SPONGE, SIZE 100 SPONGE, SIZE 200 SPONGE) 3

GELFOAM COMPRESSED 3

GELFOAM JMI SPONGE KIT 3



GELX 3

GENADUR NAIL LACQUER 3

GILOTRIF 5

QL 1 / day

PA

S

ginseng root 3

GLEEVEC 100 MG TABLET 4

QL 8 / day

PA

S

PS

GLEEVEC 400 MG TABLET 4

QL 2 / day

PA

S

PS

GLEOSTINE 3

gluconolactone 3

glutaraldehyde 1

glutathione 3

glutathione-l 3

glycine powder 3

glycolic acid (70% solution, crystals) 3

glycopyrrolate 1.5 mg tablet 1

glycosaminoglycans 3

glycyrrhizic acid 3

gramicidin d 3

guarana seed extract 3

guardian link 3 3

guardian sensor 3 3



HEMABATE 3

HEXALEN 5PA

S

HICON (500 MCI/0.5 ML KIT, 1,000 MCI/ML KIT) 3

histamine phosphate 3

histidine hcl 3

home nebulizer plus sidestream 3

HPR 3

HPR PLUS (CREAM, EMOLLIENT FOAM) 3

HUMALOG JUNIOR KWIKPEN 2

hyaluronic acid 3

hyaluronic acid sodium salt 3

hyaluronidase 3

HYCAMTIN (0.25 MG CAPSULE, 1 MG CAPSULE) 5PA

S

hydrazine sulfate 3

HYDREA 3

hydrofera blue 3

hydrofera blue ready 1

hydrogen peroxide 3

hydroxyethyl methacrylate 3

hydroxypropy-beta-cyclodextrin 3

hydroxytryptophan 3

hydroxyurea 500 mg capsule 1

hydroxyurea powder 3

HYGEL 3

HYLATOPIC 3



HYLATOPICPLUS (CREAM, EMOLLIENT FOAM, LOTION) 3

HYLENEX 3

hypodermic needle 3

HYQVIA HY COMPONENT 5PA

S

IBRANCE 100 MG CAPSULE 5

QL 1.25 / day

PA

S


QL 1 / day

PA

S


QL 1.667 / day

PA

S

ichthammol 3

ICLUSIG 15 MG TABLET 5

QL 2 / day

PA

S

ICLUSIG 45 MG TABLET 5

QL 1 / day

PA

S

IMBRUVICA 5

QL 4 / day

PA

S

INDICLOR 3

INGREZZA 80 MG CAPSULE 5

QL 1 / day

PA


S



INLYTA 4

QL 4 / day

PA

S

PS

innospire deluxe 3

innospire elegance 3

innospire essence compress neb 3

innospire mini 3

innospire replacement filter 3

inositol 3

inspirachamber 3

inspiration 3

inspiration elite 3

inspiration elite filter 1

insulin syringe (insulin syrin 0.5 ml 30gx1/2", insulin syrin 0.5ml 30gx5/16", insulin syringe 1 ml 30gx1/2", insulin syringe 1ml 30gx5/16", ulticare ins safety 1ml 29x1/2, ulticare safety 0.5ml 29gx1/2)

2

insulin syringe u-500 2

iodoform 3

iopanoic acid 3

IPOL SINGLE DOSE SYRINGE 2

IRESSA 5

QL 1 / day

PA

S

isoleucine 3

isopropamide iodide 3

isopropyl myristate 3

isoproterenol hcl (0.2 mg/ml vial, 1 mg/5 ml vial) 1



JADENU 5PA

S

JADENU SPRINKLE 5PA

S

JAKAFI 5

QL 2 / day

PA

S

jetco-spray cannula 3

kangaroo 924 safety screw 3

kangaroo epump set 3

kangaroo gravity set 3

kendall 0.9% nacl with cap 1 HCG

kenguard (add-a-foley cath tray, foley catheter) 3

KISQALI 200 MG DAILY DOSE 5

QL 3 / day

PA


S


QL 1.5 / day

PA


S


QL 1 / day

PA


S

KISQALI FEMARA 200 MG CO-PACK 5

QL 3 / day

PA


S




QL 1.5 / day

PA


S


QL 1 / day

PA


S

kojic acid 3

l-aspartic acid 3

l-glutamic acid 3

l-histidine 3

l-isoleucine 3

l-methionine 3

l-proline 3

l-serine 3

l-threonine 3

lc plus 3

lc sprint nebulizer 3

lc star 3

LENVIMA 5

QL 3 / day

PA

S

letrozole powder 3

letrozole 2.5 mg tablet 1

LEUKERAN 3

leuprolide acetate powder 3

lidocaine powder 3



lidocaine hcl powder 3

lidocaine hcl (1% 20 mg/2 ml, 1% 20 mg/2 ml vl, 1% 300mg/30 ml, 1% 50 mg/5 ml, 1% 50 mg/5 ml vl, 1% vial, 1.5%ampul, 10 mg/ml syringe, 50 mg/5 ml syrng, 200 mg/10 ml syr)

1

lidocaine hcl 0.5% vial 1 MED Medical Drug

lidocaine hcl 100 mg/10 ml-ns 1

lipoic acid 3

liteaire 3

litetouch 3

lomustine 1

LONSURF 15 MG-6.14 MG TABLET 5

QL 2.15 / day

PA

S

LONSURF 20 MG-8.19 MG TABLET 5

QL 3 / day

PA

S

LOUTREX 3

LUMINAL SODIUM 3

lutein 3

LYNPARZA (50 MG CAPSULE, 100 MG TABLET, 150 MG TABLET) 5PA

S

LYSODREN 5 S

maca root 3

magellan insulin safety syrng (syr 0.3 ml, syr 0.5 ml, syringe 1ml) 2

magellan insulin syringe (syringe 0.3 ml, syringe 0.5 ml) 2

magellan tuberculin syringe 3

magnesium chloride crystals 3



magnesium malate 3

malic acid 3

MARCAINE (0.25% VIAL, 0.5% VIAL, 0.75% VIAL) 3

MARCAINE SPINAL AMPUL 3

mask set with y-piece 3

MATULANE 5 S

MAVYRET 4

QL 3 / day

PA


S

PS

MAXIFED CDX 3

MAXIPHEN CD 3

MAXIPHEN CDX 3

mechlorethamine hcl 3

MEGACE 3

MEGACE ES 3 GL Female

megestrol acetate (acet 40 mg/ml susp, acet 400 mg/10 ml, 625mg/5 ml susp) 1

megestrol acetate powder 3

megestrol acetate (20 mg tablet, 40 mg tablet) 1

MEKINIST 0.5 MG TABLET 5

QL 4 / day

PA

S

MEKINIST 2 MG TABLET 5

QL 1 / day

PA

S

melphalan 1



menadione 3

menthol 3

mepivacaine hcl 1

methacholine chloride 3

methadone 5 mg/0.5 ml syringe 1QL 2 / day

PA

METHERGINE 1

methionine 3

methotrexate powder 3

methylergonovine 0.2 mg tablet 1

methylergonovine maleate (0.2 mg/ml amp, 0.2 mg/ml vl) 1

methylparaben 3

micro elite (micro elite lith-poly battery, microelite compressornebulize) 3

micro plus 3

microchamber 3

microcrystalline cellulose 3

MICROCYN 3

MICROCYN HYDROGEL 3

microspacer 3

MIFEPREX 3

milk thistle 3

mini plus nebulizer 3

mini-wright peak flow meter 3

minielite (compressor nebulizer, lithium ion battery) 3

minimed 630g guardian start kt 3

misterneb compressor 3

misterneb pediatric compressor 3



mitomycin (c powder, powder) 3

mitomycin c 3

mitotane 3

mono-flo 3

monoject 0.5 ml syrn 28gx1/2" 2

monoject 6cc safety syringe 3

monoject blood collection 3

monoject control syringe 3

monoject insulin syringe (insulin syr 0.3 ml, insulin syr 0.5 ml, 1ml syrn 28gx1/2", insulin syr 1 ml, insulin syr u-100, syringe 1ml)

2

monoject luer lock tb syringe 3

monoject magellan (syringe, syringe 1 ml) 3

monoject megellan tb syringe 3

monoject pharmacy tray 3

monoject safety syringe 3

monoject smartip cannula (3 ml, 6 ml, 12 ml) 3

monoject syringe (syringe 3 ml, 6 ml syrn 20gx11/2", 6 ml syrn21gx1", 6 ml syrn 21gx11/2", 6 ml syrn 22gx11/2", syringe 6ml, syringe 12 ml)

3

mouthpiece 3

MUGARD 3

MUSTARGEN 5 S

my mdi portable nebuliser 3

MYLERAN 5 S



NAROPIN (0.2% 20 MG/10 ML AMP, 0.2% 20 MG/10 ML VIAL,0.2% 200 MG/100 ML BAG, 0.2% 40 MG/20 ML AMP, 0.2% 40MG/20 ML VIAL, 0.2% 400 MG/200 ML BAG, 0.2% 400MG/200 ML BTL, 0.5% 100 MG/20 ML AMP, 0.5% 100 MG/20ML VIAL, 0.5% 150 MG/30 ML VIAL, 0.75% 150 MG/20 MLAMP, 0.75% 150 MG/20 ML VL, 1% 100 MG/10 ML AMPULE,1% 100 MG/10 ML VIAL, 1% 200 MG/20 ML AMPULE, 1% 200MG/20 ML VIAL, 2 MG/ML INFUSION BTL, 5 MG/ML INFUSIONBTL, 200 MG/100 ML INF BTL)

3

needle 3

NEOSALUS (CREAM, FOAM, LOTION) 3

NEOSALUS CP 3

NESACAINE 3

NESACAINE-MPF 3

nettle leaf 3

NEUTRASAL 538 MG POWDER PACKET 3

NEXAVAR 5

QL 4 / day

PA

S

NILANDRON 5 S

nilutamide 5PA

S

NINLARO 5

QL 0.124 / day

PA


S

NIVATOPIC PLUS 3

NOVAREL 5,000 UNIT VIAL 5PA

S

NUMOISYN (LIQUID, LOZENGE) 3



nutriport balloon 3

NUVAIL 3

NYMALIZE 30 MG/10 ML SOLUTION 3 QL 120 / day

oasis ultra (tri-layer sheet, ultra 3 x 3.5 cm, ultra 3 x 7 cm) 3

ODOMZO 5

QL 1 / day

PA

S

omega-3 dha 3

ONCASPAR 5 S

optichamber 1

optichamber diamond 3

ORAFATE 5 S

ORAMAGICRX 3

ornithine 3

oxytocin powder 3

oxytocin 10 units/ml vial 1

papain 3

parachlorophenol 3

pari lc plus nebulizer 3

pari lc sprint sinus 3

pari sinus aerosol system 3

pediatric dinosaur nebulizer 3

pediatric dog nebulizer 3

pediatric frog nebulizer 3

pen needle 2

pentylenetetrazole 3

pflex trainer 3



phaseal protector 3

phenindione 3

phenolsulfonic acid 3

phenylmercuric nitrate 3

phenyltoloxamine dihyd cit 3

phosphatidylserine 3

pillow mask for children 1

pine bark extract 3

PITOCIN 3

pocket chamber 3

podofilox powder 3

POLOCAINE (1% VIAL, 2% VIAL, 3% CARTRIDGE) 1

POLOCAINE-MPF 1

polyvinyl alcohol 3

portable nebulizer system 3

potassium bromide (crystals, powder) 3

potassium p-aminobenzoate 3

potassium permanganate (crys, gran) 3

potassium sorbate (crystals, powder) 3

povidone 3

povidone k-30 3

pregnenolone 3

pregnenolone micronized 3

PREPIDIL 3 GL Female

PRESERA 3

prilocaine hcl 3

primeaire 3



procaine hcl 3

procarbazine hcl 3

prochamber 3

prodigy mini-mist 3

PROMISEB 3

proneb ultra ii 3

propyl gallate 3

propylene glycol 3

PROSTIN E2 VAGINAL SUPPOSITORY 3 GL Female

PROTHELIAL 5 S

provent starter kit 3

PROVISC 3

PROVOCHOLINE 3

PRUMYX 3

pulmo-aide 3

pyridoxal-5-phosphate 3

quake 3

quaternium-15 3

quercetin dihydrate 3

RADIAPLEXRX 3

RADIGEL 3

rapport vacuum therapy 3

RECEDO 3

red yeast rice 3

replicare (4"x4", 6"x6", 8"x8") 1

replicare ultra 4"x4" dressing 3

replicare ultra 6"x6" dressing 1



replicare ultra sacrum 3

resorcinol (crystals, powder) 3

restore (1"x12" dressing, 2"x2" dressing, 4"x4" foam silver drsg,6"x8" foam silver drsg) 3

restore calcium alginate 3

restore contact layer silver 3

retinaldehyde 3

reusable nebulizer kit 1

riteflo 3

robinson clear vinyl catheter 3

ropivacaine hcl (20 mg/10 ml, autofuser pmp) 1

ropivacaine hcl powder 3

ropivacaine hcl (0.2% 40 mg/20 ml, 0.5% 150 mg/30 ml,0.75% 150 mg/20 ml, 1% 100 mg/10 ml vl, 1% 200 mg/20 mlvl)

1

ropivacaine-ns 0.1% on-q pump 1

rubber mouthpiece 2

RUBRACA (200 MG TABLET, 250 MG TABLET) 5

QL 2 / day

PA


S

RUBRACA 300 MG TABLET 5

QL 2 / day

PA


S

RYDAPT 5

QL 2 / day

PA


S



safety syringe with shield 3

safety syringe-needle 3

safetyglide allergy syringe 3

SALIVAMAX 3

SALIVATERX 3

sami the seal 3

sami the seal mask 3

saw palmetto 3

SEBUDERM 3

SENSORCAINE 1

SENSORCAINE WITH DEXTROSE 1

SENSORCAINE-MPF (0.25% AMPUL, 0.25% VIAL, 0.5% AMPUL,0.5% VIAL, 0.75% AMPUL, 0.75% VIAL) 1

sensura click ostomy pouch 3

sensura flex ostomy base plate 3

sensura flex ostomy pouch 3

sensura ostomy base plate 3

serotonin hcl 3

sidestream 3

sidestream mask 3

sidestream nebulizer 3

sidestream plus 3

silicone mask (mask-adult, mask-infant, mask-pediatric) 1

silverseal hydrogel 3

SILVRSTAT 3

sinustar (aerosol delivery syst, reusable nebulizer) 3

sodium benzoate 3

sodium butyrate 3



sodium deoxycholate 3

sodium dichloroacetate 3

sodium hyaluronate 3

sodium hyaluronic acid 3

sodium iodide 3

sodium metabisulfite (granules, powder) 3

sodium stearyl fumarate 3

sodium succinate 1

SOLTAMOX 3

sorbic acid 3

SP ANTIPRURITIC 3

spectragel 3

spirulina 3

SPRYCEL (100 MG TABLET, 140 MG TABLET) 5

QL 1 / day

PA

S

SPRYCEL (70 MG TABLET, 80 MG TABLET) 5

QL 2 / day

PA

S

SPRYCEL 20 MG TABLET 5

QL 9 / day

PA

S

SPRYCEL 50 MG TABLET 5

QL 3 / day

PA

S

STIVARGA 5

QL 4 / day

PA

S



STRENSIQ 4

PA

AL Up to 18 yrs old

S

PS

SUCRAID 5 S

sulfurated potash 3

sunrise compressor-nebulizer 1

SUTENT (37.5 MG CAPSULE, 50 MG CAPSULE) 4

QL 1 / day

PA

S

PS

SUTENT 12.5 MG CAPSULE 4

QL 7 / day

PA

S

PS

SUTENT 25 MG CAPSULE 4

QL 3 / day

PA

S

PS

SWABFLUSH 1 HCG

SYNRIBO 5PA

S

SYPRINE 5PA

S

bd luer-lok 5 ml syringe 3

syringe-needle 3

t.e.d. anti-embolism stocking (anti-embol, anti-embolism) 3



TABLOID 3

TAFINLAR 50 MG CAPSULE 5

QL 6 / day

PA

S

TAFINLAR 75 MG CAPSULE 5

QL 4 / day

PA

S

TAGRISSO 4

QL 1 / day

PA


S

PS

tamoxifen citrate powder 3

tamoxifen citrate (10 mg tablet, 20 mg tablet) 1 HCR

TARCEVA (100 MG TABLET, 150 MG TABLET) 5

QL 1 / day

PA

S

TARCEVA 25 MG TABLET 5

QL 6 / day

PA

S

TARGRETIN 75 MG CAPSULE 5PA

S

TASIGNA 4

QL 4 / day

PA

S

PS

TEMODAR (5 MG CAPSULE, 20 MG CAPSULE, 100 MG CAPSULE,140 MG CAPSULE, 180 MG CAPSULE, 250 MG CAPSULE) 5

PA

S



temozolomide 5PA

S

tens 502 3

tens 504 3

terumo surguard2 (ndl 21gx1 1.5, ndl 22x1-1/2", ndl 23x1-1/2", needle 18gx1", needle 18x1.5, needle 19gx1", needle19x1.5, needle 20gx1", needle 20x1.5, needle 21gx1", needle22gx1", needle 23gx1", needle 25gx1", needle 25x1.5, needle25x5/8, needle 26x1/2, needle 27x1/2, needle 30x1/2, syr 20g-10 ml, syr 20g-3 ml, syr 20g-5 ml, syr 21g 3 ml, syr 21g-10 ml,syr 21g-3 ml, syr 21g-5 ml, syr 22g 3 ml, syr 23g 3 ml, syr 25g 3ml, syr 25g-1 ml, syr 26g-1 ml, syr 27g-1 ml)

3

tetracaine 3

tetracaine hcl 1% ampul 1

tetracaine hcl powder 3

tetrahydro-l-biopterin di-hcl 3

tetrahydrobiopterin di-hcl 3

tetrahydrobiopterin hcl 3

theobromine 3

thioguanine 3

thiotepa powder 3

thiotepa 15 mg vial 5 S

threonine 3

threshold imt 3

threshold pep 3

THROMBI-GEL 3

THROMBI-PAD 3

titanium dioxide 3

TL-CERMIDE 3

toomey syringe 1



touch-trol 3

TREAGAN OTIC 3

trek s combo pack 3

trek s compact compressor 3

trek s portable pwr kit 3

tretinoin 10 mg capsule 5QL 90 / 365 days

S

trichloroacetic acid (crystal, powder) 3

trilostane 3

trioxsalen 3

trolamine 3

TROPAZONE 3

truneb nebulizer 3

truzone peak flow meter 3

trypsin 3

TYKERB 4

QL 6 / day

PA

S

PS

ulticare 3

unistik 2 normal 2

vacustim black 3

valine 3

VALSTAR 5 S

vapro plus intermitt catheter 3

vascuderm hydrogel wound 3

VAXCHORA BUFFER COMPONENT 2



VENATAL COMPLETE DHA 3 GL Female

VENCLEXTA 5

QL 4 / day

PA

S

VENCLEXTA STARTING PACK 5

QL 1.5 / day

PA

S

VIASPAN BELZER-UW 3

vios aerosol delivery system 3

VISCOAT 3

VITASPIRE 3 GL Female

VITRASE 3

vixone nebulizer 3

vortex 3

vortex vhc frog mask 3

vortex vhc ladybug mask 3

VOSEVI 4

QL 1 / day

PA


S

PS

VOTRIENT 5

QL 4 / day

PA

S

water (bacteriostatic vial, for injection ampul, for injection vial) 1

white willow bark 3

wide seal diaphragm 3 HCR



wound matrix 3

XALKORI 5

QL 2 / day

PA

S

xanthan gum 3

XELODA 5

QL 4 / day

PA

S

xeroform 3

xeroform petrolatum dressing 3

XTANDI 5

QL 4 / day

PA

S

XYLOCAINE (0.5% VIAL, 1% VIAL) 3

XYLOCAINE-MPF (0.5% VIAL, 1% AMPUL, 1% VIAL, 1.5%AMPUL, 4% AMPUL) 3

xylometazoline hcl 3

yohimbine 5.4 mg tablet 1

ZANABIN 3

zeaxanthin 3

ZEJULA 5

QL 3 / day

PA


S

ZELBORAF 5

QL 8 / day

PA

S

zinc acetate (crystals, dihydrate powder) 3



zinc pyrithione 3

ZINGO 3

ZODEX 12 DAY 1.5 MG TABLET 3

ZOLINZA 5

QL 4 / day

PA

S

ZOTEX-C 3

ZYDELIG 5

QL 2 / day

PA

S

ZYKADIA 5

QL 8 / day

PA


S

ZYTIGA 250 MG TABLET 4

QL 4 / day

PA

S

PS

ZYTIGA 500 MG TABLET 4

QL 2 / day

PA

S

PS

VASODILATING AGENTS

NITRATES AND NITRITES

DILATRATE-SR 3 QL 4 / day

GONITRO 3

QL 1.25 / day

PA




ISOCHRON 1QL 4 / day

HCG

ISORDIL 3 QL 12 / day

ISORDIL TITRADOSE 3 QL 12 / day

isosorbide 3

isosorbide dinitrate (5 mg tablet, 10 mg tablet, 20 mg tablet, 30mg tablet) 1 QL 12 / day

isosorbide dn er 40 mg tablet 1QL 4 / day

HCG

isosorbide mononitrate 1 QL 2 / day

isosorbide mononitrate er 1 QL 2 / day

MINITRAN 1QL 1 / day

HCG

NITRO-BID 2 QL 4 / day

NITRO-DUR 3 QL 1 / day

NITRO-TIME 1 QL 4 / day

nitroglycerin (er 2.5 mg cap, er 6.5 mg cap, er 9 mg capsule) 1 QL 4 / day

nitroglycerin 400 mcg spray 1QL 0.3 / day

HCG

nitroglycerin lingual 0.4 mg 1QL 0.8 / day

HCG

nitroglycerin (0.3 mg tablet, 0.4 mg tablet, 0.6 mg tablet) 1 QL 6 / day

nitroglycerin patch 1QL 1 / day

HCG

NITROLINGUAL 3 QL 0.8 / day



NITROMIST 3 QL 0.3 / day

NITROSTAT 3 QL 6 / day

sodium nitrite powder 3

PHOSPHODIESTERASE TYPE 5 INHIBITORS

CIALIS (10 MG TABLET, 20 MG TABLET) 2QL 0.2 / day

GL Male

CIALIS (2.5 MG TABLET, 5 MG TABLET) 2QL 1 / day

GL Male

VIAGRA 2

QL 0.2 / day

GL Male


VASODILATING AGENTS, MISCELLANEOUS

alprostadil powder 3

alprostadil 500 mcg/ml vial 1

CAVERJECT 40 MCG/2 ML AMPUL 3

CAVERJECT (IMPULSE 10 MCG KIT, 20 MCG VIAL, IMPULSE 20MCG KIT, 40 MCG VIAL) 3 GL Male

EDEX 3 GL Male

isoxsuprine hcl powder 3

isoxsuprine hcl (10 mg tablet, 20 mg tablet) 1

MUSE 3 GL Male

papaverine hcl powder 3

papaverine 60 mg/2 ml vial 1

papaverine-alprostadil 1

prostaglandin e1 3

PROSTIN VR PEDIATRIC 3

tolazoline hcl 3



VITAMINS

MULTIVITAMIN PREPARATIONS

ELDERCAPS 1 HCG

ELITE OB DHA 3 GL Female

ELITE-OB 3 GL Female

MATERNITY 1 GL Female

MAXINATE 3 GL Female

multivitamins-a,b,d,e,k,zn (pediatric drops, softgels) 1 HCG

multivitamins chewables tablet 1

MYNATAL ULTRACAPLET 3 GL Female

MYNATE 90 PLUS 3 GL Female

PNV-VP-U 3

PRENA1 CHEW 3 GL Female

prenatal-u 3 GL Female

REQ49+ 3

SUPERVITE EC 3

THERAPEUTIC VITAMIN W-MINERALS 1

TRIVEEN-U 3 GL Female

TRUST NATAL DHA 3 GL Female

UDAMIN SP 3

V-C FORTE 1

VIC-FORTE 1

VINATE PN CARE 3 GL Female

VINATE-M 3 GL Female



VITAMIN A

AQUASOL A 3

beta carotene 3

vitamin a acetate 3

vitamin a palmitate (1.7 million unit/gm, 18,000 units/ml liq,plmitte liquid) 3

vitamins a,c,d and fluoride 1

VITAMIN B COMPLEX

adenosylcobalamin 3

B-12 COMPLIANCE 3

B-12 KIT 1

b-complex 1

calcium pantothenate 3

CARDIOTEK-RX 3

cobamamide 3

cyanocobalamin 3

cyanocobalamin injection 1

FOLBEE 1

FOLBEE AR 3

FOLBEE PLUS CZ 1

FOLGARD RX 3

folic acid powder 3

folic acid 1 mg tablet 1

folic acid 5 mg/ml vial 1

folic acid-vit b6-vit b12 1

FOLPLEX 2.2 1

hydroxocobalamin powder 3

hydroxocobalamin 1,000 mcg/ml 1



l-5 methyltetrahydrofolate cal 3

l-methylfolate calcium 3

levomefolate calcium 3

methylcobalamin 3

methyltetrahydrofolate calcium 3

methyltetrahydrofolic acid 3

NASCOBAL 3

NEPHRO-VITE RX 3

NEURIN-SL 3

niacinamide 3

panthenol 3

pyridoxine hcl (crystals, powder) 3

pyridoxine 100 mg/ml vial 1

RENA-VITE RX 1

riboflavin 3

riboflavin-5-phosphate sodium 3

SUPERVITE 3

thiamine hcl powder 3

thiamine 200 mg/2 ml vial 1

VIRT-CAPS SOFTGEL 1

VIRT-GARD 1

VIRT-VITE 1

VIRT-VITE PLUS 1 HCG

VITA-RESPA 3

VP-VITE RX 1

ZOLATE 1



VITAMIN C

ascorbic acid powder 3

ascorbic acid 500 mg/ml vial 1

sodium ascorbate 3

VITAMIN D

calcitriol (0.25 mcg capsule, 0.5 mcg capsule, 1 mcg/mlsolution) 1

calcitriol (crystals, powder) 3

doxercalciferol (0.5 mcg cap, 1 mcg capsule, 2.5 mcg cap) 5 S

DRISDOL 3

ergocalciferol 3

HECTOROL (0.5 MCG CAPSULE, 1 MCG CAPSULE, 2.5 MCGCAPSULE) 5 S

paricalcitol (1 mcg capsule, 2 mcg capsule, 4 mcg capsule) 5 S

RAYALDEE 5 S

ROCALTROL (0.25 MCG CAPSULE, 0.5 MCG CAPSULE, 1 MCG/MLORAL SOLN) 3

vitamin d2 1

vitamin d3 (2,400 units/ml liq, 100,000 unit/gm pwd) 3

ZEMPLAR (1 MCG CAPSULE, 2 MCG CAPSULE) 5PA

S

VITAMIN E

natural mixed tocopherols 3

tocopheryl acid succinate 3

vitamin e acetate (vit actat125 units/ml liq, vitamin actat50%powdr, vitamin actatliquid) 3



VITAMIN K ACTIVITY

phytonadione liquid 3

vitamin k 3

vitamin k2 3


Index of Covered Drugs

22-deoxy-d-glucose 136

2-methoxyestradiol 268

44-aminobenzoic acid potassium 268

4-aminopyridine 232

55-aminosalicylic acid 184

77-keto dhea 268

88-MOP 156

AA-HYDROCORT 192

A-METHAPRED 192

abacavir 125

abacavir-lamivudine 125

abacavir-lamivudine-zidovudine 125

ABILIFY 115

ABILIFY MAINTENA 115

ABSORICA 258

acacia 157,268

acamprosate calcium 151

acarbose 83

ACCOLATE 47

ACCUPRIL 242

ACCURETIC 167

ACD 171

ACD-A 68

ace aerosol cloud enhancer 268

acebutolol hcl 53

ACEON 242

acepromazine maleate 123

acetamin-caff-dihydrocodeine 8

acetaminophen 8

acetaminophen-codeine 8

acetarsone 268

ACETASOL HC 37

acetazolamide 98

acetazolamide sodium 98

acetic acid 37

acetic acid-aluminum 37

acetyl hexapeptide-8 268

acetyl salicylic acid 128

acetyl-d-glucosamine 268

acetyl-l-carnitine hcl 232

acetylcholine chloride 98

acetylcysteine 232

acetylcysteine-water 181

acidophilus lactobacillus 184

ACIPHEX 134

ACIPHEX SPRINKLE 134

acitretin 258

ACLARO 156

acremonium 157

ACTEMRA 225

ACTHIB 131

ACTICLATE 61

acticoat 268

acticoat 7 268

acticoat flex 3 268

acticoat flex 7 268

acticoat surgical 268

ACTIGALL 186

ACTIMMUNE 228

ACTIQ 13

ACTIVE FE 47

ACTIVELLA 176

ACTONEL 222

ACTOPLUS MET 83

ACTOPLUS MET XR 84

ACTOS 89

ACULAR 46

ACULAR LS 46

ACUVAIL 46

acyclovir 40,137

ACZONE 258

ADACEL TDAP 130

ADALAT CC 148

adapalene 258

adapalene-benzoyl peroxide 258

ADASUVE 114

ADCIRCA 245

ADDERALL 26

ADDERALL XR 26

ADDYI 151

adefovir dipivoxil 137

ademetionine disulfate tosylat 269

ADEMPAS 245

adenosine 55

adenosylcobalamin 308

ADIPEX-P 24

ADOXA 61

ADRENACLICK 3

ADRENALIN 3

ADRENALIN CHLORIDE 183

adrenocorticotrophic hormone 157

ADVAIR DISKUS 4

ADVAIR HFA 4

advance plus intermittent 269

ADVICOR 107

ADYPHREN 3

ADYPHREN AMP 3

ADYPHREN AMP II 3

ADYPHREN II 3

ADZENYS XR-ODT 26

aerochamber mini 269

aerochamber mv 269

aerochamber plus flow-vu 269

aerochamber with flowsignal 269

aerochamber z-stat plus 269

aeroeclipse ii 269

aerogear asthma action kit 269

aeroneb go 269

aeroneb go nebulizer 269

AEROSPAN 155

aerotrach plus 269

aerovent plus 269

AFEDITAB CR 148

AFINITOR 269

AFINITOR DISPERZ 269

AFLURIA 2016-2017 131

AFLURIA 2017-2018 269

AFLURIA QUAD 2016-2017 131

AFLURIA QUAD 2017-2018 269

AFREZZA 87

AGGRENOX 128

AGRYLIN 129

air filter 269

AK-POLY-BAC 34

AKTEN 181

AKYNZEO 89

ALA-CORT 248

ALA-QUIN 94

ALA-SCALP 248

alanine 171

albendazole 32

ALBENZA 32

albuterol sulfate 4

ALCAINE 181

alclometasone dipropionate 248

alcohol,dehydrated 232

ALDACTAZIDE 166

ALDACTONE 166

ALDARA 258

alder 157

aldosterone 192

ALECENSA 269

alendronate sodium 223

ALEVICYN ANTIPRURITIC SG 255

alfentanil hcl 13

alfuzosin hcl er 7

alginic acid 270

ALINIA 114

ALKERAN 270

all flow 1000 270

all flow 3000 kit 270

all flow 3000 pft 270

all flow 4000 270

all flow 5000 270

all flow 6000 270

allantoin 270

allergist syringe 270

allergist tray 270

allevyn 270

allevyn adhesive 270

allevyn ag 270

allevyn ag adhesive 270

allevyn ag gentle 270

allevyn heel 270

allevyn life 270

ALLFEN CDX 270

allopurinol 221

ALLZITAL 8

almond 157

almond oil 270

almotriptan malate 109

ALOCRIL 47

aloe vera 270

ALOMIDE 180

ALORA 176

alosetron hcl 184

alpha lipoic acid 270

ALPHAGAN P 96

ALPHAQUIN HP 156

alprazolam 142

alprazolam er 142

ALPRAZOLAM INTENSOL 142

alprazolam odt 142

alprazolam xr 142

alprostadil 306

ALREX 44

ALSUMA 109

ALTABAX 38

ALTACAINE 181

ALTACE 242

ALTAFLUOR 182

ALTAVERA 197

altera nebulizer 270

alternaria 157

ALTOPREV 107

aluminum acetate 270

aluminum chloride 270

aluminum chlorohydrate 270

aluminum hydroxide 183

aluminum sulfate 271

ALUNBRIG 271

ALUVEA 255

ALYACEN 197

AMABELZ 176

amantadine 112

amantadine hcl 112

AMARYL 88

AMBIEN 140

AMBIEN CR 140

amcinonide 248

AMERGE 109

american beech 157

american cockroach extract 157

american elm 157

american ginseng root 271

american sycamore 157

AMETHIA 197

AMETHIA LO 197

AMETHYST 197

AMICAR 99

amikacin 57

amikacin sulfate 57

amiloride hcl 165

amiloride-hydrochlorothiazide 165

aminobutyric acid 232

aminocaproic acid 99

aminophylline 147

aminosalicylic acid 111

amiodarone hcl 55

AMITIZA 185

amitriptyline hcl 82

amlodipine besilate 148

amlodipine besylate 148

amlodipine besylate-benazepril 148

amlodipine-atorvastatin 107

amlodipine-olmesartan 148

amlodipine-valsartan 148,149

amlodipine-valsartan-hctz 149

ammonium chloride 170

ammonium lactate 175,271

ammonium sulfate 271

ammonium tetrathiomolybdate 271

AMNESTEEM 258

amoxapine 82

amoxicillin 239

amoxicillin er 239

amoxicillin trihydrate 239

amoxicillin-clavulanate pot 239

amoxicillin-clavulanate pot er 239

amoxicillin-clavulanate potass 240

amphotericin b 93

ampicillin sodium 240

ampicillin trihydrate 240

ampicillin-sulbactam 240

AMPYRA 232

AMRIX 247

AMVISC 271

AMVISC PLUS 271

amyl nitrite 220

AMYTAL SODIUM 142

ANA-LEX 248

ANACAINE 253

ANADROL-50 195

ANAFRANIL 82

anagrelide hcl 129

ANALPRAM HC 248

ANAPROX 221

ANAPROX DS 221

ANASPAZ 65

ANASTIA 253

anastrozole 271

ANCOBON 93

ANDRODERM 195

ANDROGEL 195

ANDROID 195

androstenedione 195

ANDROXY 195

ANGELIQ 176

anisindione 271

ANORO ELLIPTA 4

ANSAID 236

ANTABUSE 220

ANTARA 105

anthralin 257

antimony trichloride 114

antivenin latrodectus mactans 129

antivenin micrurus fulvius 129

ANTIVERT 91

ANUCORT-HC 248

ANUSOL-HC 249

ANZEMET 89

APEXICON E 249

APLENZIN 76

APLIGRAF 271

APLISOL 164

apogee hc intermittent 271

APOKYN 169

apomorphine hcl 169

apple 157

apraclonidine hcl 181

aprepitant 90

APRI 197

APRISO 184

APTENSIO XR 28

APTIOM 69

APTIVUS 127

AQUASOL A 308

AQUORAL 271

ARANELLE 197

ARANESP 146

ARAVA 225

ARBINOXA 100

ARCALYST 232

ARCAPTA NEOHALER 4

arginine 171

arginine hcl 171

argyle 271

ARICEPT 144

arida 40

ARIMIDEX 271

aripiprazole 115

aripiprazole odt 115

ARISTADA 115

ARISTOSPAN 192

ARIXTRA 68

arizona cypress 157

armodafinil 31

ARMOUR THYROID 267

arnica lg 271

ARNUITY ELLIPTA 155

AROMASIN 271

arsenic trioxide 271

ARTHROTEC 50 134

ARTHROTEC 75 134

ARTISS 258

ARYMO ER 13

asa-butalb-caffeine-codeine 13

ASCOMP WITH CODEINE 13

ascorbic acid 310

ASHLYNA 197

ashwagandha extract 271

aspartic acid magnesium salt 271

aspergillus fumigatus 157

aspirin 128

aspirin-caffeine-dihydrocodein 128

aspirin-dipyridamole er 128

assura 271

ASTAGRAF XL 230,231

ASTEPRO 180

asthmapack children's 271

astragalus extract 271

ASTRAMORPH-PF 13

ASTRINGYN 99

ATABEX EC 48

ATACAND 241

ATACAND HCT 167

ATELVIA 223

atenolol 53

atenolol-chlorthalidone 53

ATIVAN 74

atomoxetine hcl 151

ATOPICLAIR 175

atorvastatin calcium 107

atovaquone 114

atovaquone-proguanil hcl 113

ATRALIN 254

ATRAPRO DERMAL SPRAY 271

ATRAPRO HYDROGEL 272

ATRIPLA 125

ATROPEN 65

atropine sulfate 65,182

atropine sulfate-0.9% nacl 182

ATROVENT 181

ATROVENT HFA 65

attapulgite 184

AUBAGIO 228

AUBRA 197

AUGMENTIN 240

AUGMENTIN ES-600 240

AUGMENTIN XR 240

aureobasidium 157

AURSTAT 272

AURYXIA 217

AUSTEDO 151

australian pine 157

AUVI-Q 3

AVAGE 258

AVAILNEX 272

AVALIDE 167

AVANDAMET 84

AVANDIA 89

AVAPRO 241

AVAR 40

AVAR LS 40

AVAR-E 40

AVAR-E GREEN 41

AVAR-E LS 41

AVC 41

AVELOX 59

AVELOX ABC PACK 59

AVENOVA 272

AVIANE 197

AVIDOXY 61

AVITA 254

AVITENE 99

AVO CREAM 175

avocado 157

AVODART 220

AVONEX 228

AVONEX PEN 228

AXERT 109

AYGESTIN 215

azacitidine 272

AZACTAM 219

AZASAN 225

AZASITE 34

azathioprine 225

azathioprine sodium 225

azelaic acid 258

azelastine hcl 180

AZELEX 258

AZILECT 77

azithromycin 219

AZOPT 98

AZOR 149

aztreonam 219

AZULFIDINE 60

AZUPHEN MB 32

AZURETTE 198

BB-12 COMPLIANCE 308

B-12 KIT 308

b-complex 308

B-DONNA 65

B-PLEX PLUS 272

baby conversion kit 272



baby nebulizer 272

BACIIM 63

bacitracin 34,38,63

bacitracin micronized 38

bacitracin zinc 38

bacitracin-polymyxin 34

baclofen 248

BACTRIM 60

BACTRIM DS 60

BACTROBAN 38

BACTROBAN NASAL 34

bahia 157

BAL IN OIL 220

balanced salt 181

bald cypress 157

balsalazide disodium 184

BALZIVA 198

banana 158

BANZEL 70

BARACLUDE 137

barium sulfate 163

bayberry 158

bcg vaccine (tice strain) 131

BEAU RX 272

beclomethasone dipropionate 192

BECONASE AQ 44

beef 158

BEKYREE 198

BELBUCA 23

belladonna 65

belladonna leaf powder 65

belladonna-opium 13,14

belladonna-phenobarbital 65

BELSOMRA 140

BELVIQ 26

BELVIQ XR 26

benactyzine hcl 76

benazepril hcl 242,243

benazepril-hydrochlorothiazide 167

BENICAR 241

BENICAR HCT 167

BENLYSTA 272

BENSAL HP 255

BENTYL 65

benzalkonium chloride 41

BENZEFOAM 255

BENZEFOAM ULTRA 255

BENZEPRO 255

benzocaine 272

benzoic acid 272

benzonatate 244

benzoyl peroxide 255,272

benzphetamine hcl 26

benztropine mesylate 68

benzyl alcohol 272

benzyl benzoate 43

BEPREVE 180

BESIVANCE 34

beta carotene 308

beta glucan 272

beta glucan (1-3) nq 232

BETADINE 37

BETAGAN 97

betahistine 150

betahistine hcl 150

betaine hydrochloride 233

betamethasone acetate micro 192

betamethasone acetate-sod phos 192

betamethasone dipropionate 249

betamethasone sodium phosphate 192

betamethasone valerate 249

BETAPACE 53

BETAPACE AF 54

BETASERON 228

betaxolol hcl 54,97

bethanechol chloride 144

BETHKIS 58

BETIMOL 97

BETOPTIC S 97

BEVESPI AEROSPHERE 4

bexarotene 272

BEXSERO 131

BEYAZ 198

BIAFINE 175

BIAXIN 111

bicalutamide 272

BICILLIN C-R 240

BICILLIN L-A 240

BIDIL 217

BILTRICIDE 32

bimatoprost 99

BINOSTO 223

BIOGLO 163

BIONECT 272

biostep 272

biostep ag 272

BIOTHRAX 131

biotin 272

biotin-d 272

bisacodyl 185

bismuth citrate 272

bismuth subgallate 273

bismuth subsalicylate 184

bisoprolol fumarate 54

bisoprolol-hydrochlorothiazide 54

bitter melon extract 273

black walnut pollen 158

black willow 158

BLANCHE 156

BLEO 15K 273

bleomycin sulfate 273

BLEPH-10 34

BLEPHAMIDE 34

BLEPHAMIDE S.O.P. 34

BLISOVI 24 FE 198

BLISOVI FE 198

BONIVA 223

BONTRIL PDM 24

BOOSTRIX TDAP 130

boric acid 37

BOSULIF 273

boswellia serrata extract 273

BOTOX COSMETIC 233

botrytis 158

bovine serum albumin 273

box elder 158

BP 10-1 41

BP-50% UREA 255

BPO 255

BRAVELLE 211

breatherite 273

breathrite 273

BREO ELLIPTA 4

BREVICON 198

BREVITAL SODIUM 74

BRIELLYN 198

BRILINTA 128

brimonidine tartrate 96,97

BRINTELLIX 81

BRISDELLE 78

BRIVIACT 70

brome 158

bromelain 273

BROMFED DM 102

bromfenac sodium 46,273

bromhexine hcl 244

bromocriptine mesylate 169

brompheniramine maleate 100

brompheniramine-pseudoephed-dm 102

BROMSITE 46

BROVANA 5

BSS 181

BSS PLUS 181

BUCALSEP 182

budesonide 44,155

budesonide ec 192

budesonide micronized 44

buffered lidocaine 273

buflomedil hcl 273

bumetanide 165

BUNAVAIL 23

BUPAP 8

BUPHENYL 171

bupivacaine hcl 273

bupivacaine hcl-epinephrine 266

bupivacaine-dextrose 273

BUPRENEX 23

buprenorphine 23

buprenorphine hcl 23

buprenorphine-naloxone 23

BUPROBAN 76

bupropion hcl 76

bupropion hcl sr 76

bupropion xl 76

buspirone hcl 140

butalb-acetaminoph-caff-codein 8

butalb-caff-acetaminoph-codein 8

butalbital 142

butalbital compound-codeine 14

butalbital-acetaminophen 8,9

butalbital-acetaminophen-caffe 9

butalbital-aspirin-caffeine 128,273

BUTISOL SODIUM 142

butorphanol tartrate 23,24

BUTRANS 24

butylated hydroxytoluene(bht) 233

BYDUREON 86

BYDUREON PEN 86

BYETTA 86

BYSTOLIC 146

BYVALSON 146

Ccabergoline 169

CABOMETYX 273,274

CADEAU DHA 48

CADUET 107

CAFERGOT 6

caffeine 28

caffeine and sodium benzoate 28

caffeine citrate 28,29

calamine 175

CALAN 55

CALAN SR 56

calcipotriene 258,274

calcipotriene monohydrate 274

calcipotriene-betamethasone dp 249

calcipotriol 274

calcitonin-salmon 213

CALCITRENE 258

calcitriol 259,310

calcitriol in almond oil 274

calcium acetate 217

calcium amino acid chelate 172

calcium carbonate 172

calcium chloride 172

calcium citrate 172

calcium disodium versenate 220

calcium folinate 233

calcium glubionate 172

calcium gluconate monohydrate 172

calcium levulinate dihydrate 172

calcium pantothenate 308

calcium phosphate 172

calcium saccharate 172

california pepper tree 158

CAMILA 198

camphor 259

CAMRESE 198

CAMRESE LO 198

CANASA 184

candesartan cilexetil 241

candesartan-hydrochlorothiazid 167

candida albicans 158

CANDIN 162

cantaloupe 158

cantharidin 274

CANTIL 65

CAPACET 9

CAPASTAT SULFATE 111

capecitabine 274

CAPEX SHAMPOO 249

CAPHOSOL 274

CAPITAL W-CODEINE 9

CAPRELSA 274

caprylic acid 274

capsaicin 259

capsaicin palmitate 259

capsicum oleoresin 259

captopril 242

captopril-hydrochlorothiazide 167

CARAC 259

CARAFATE 134

carbachol 98

CARBAGLU 171

carbamazepine 70

carbamazepine er 70

carbamide peroxide 41

CARBATROL 70

carbidopa 151

carbidopa-levodopa 112

carbidopa-levodopa er 112

carbidopa-levodopa-entacapone 112

carbimazole 266

carbinoxamine maleate 100

CARBOCAINE 274

CARDENE SR 149,274

cardioplegia high potassium 172

cardioplegic 172

CARDIOTEK-RX 308

CARDIOVID PLUS 233

CARDIZEM 56

CARDIZEM CD 56

CARDIZEM LA 56

CARDURA 6

CARDURA XL 6

carelessweed 158

carisoprodol 247

carisoprodol compound 239

carisoprodol compound-codeine 14

carisoprodol-aspirin 239

carisoprodol-aspirin-codeine 14

CARNITOR 233

CARNITOR SF 233

carrasyn hydrogel wound 274

carteolol hcl 97

CARTIA XT 56

carvedilol 7

cascara sagrada 185

casein 158

CASODEX 274

CATAPRES 216

CATAPRES-TTS 1 216

CATAPRES-TTS 2 216

CATAPRES-TTS 3 216

catheter 274

CATHFLO ACTIVASE 129

cattle epithelium 158

CAVERJECT 306

CAYSTON 219

CAZIANT 198

cedar elm 158

CEDAX 154,274

cefaclor 154

cefaclor er 154

cefadroxil 153

cefazolin sodium 153

cefdinir 154

cefditoren pivoxil 154

cefepime hcl 153

cefixime 154

CEFOTAN 154

cefotaxime sodium 154

cefotetan 154

cefpodoxime proxetil 154

cefprozil 154

ceftazidime 154

ceftazidime-sodium carbonate 154

ceftibuten 154

CEFTIN 154

ceftriaxone 154,155

ceftriaxone sodium 155

cefuroxime 154

cefuroxime sodium 154

CELEBREX 236

celecoxib 236

CELESTONE 192

CELEXA 78

CELLCEPT 231

CELLUGEL 181

CELONTIN 75

CEM-UREA 255

CENTANY 38

CENTANY AT 38

CENTERGY 102

CENTERGY DM 102

cephalexin 153

CERAMAX 274

CERDELGA 233

CEREBYX 75

CERVARIX 131

CERVIDIL 275

CESAMET 90

cesium chloride 275

CETACAINE 253

cetirizine hcl 101

CETRAXAL 34

CETROTIDE 227

cetyl myristoleate 275

cetylpyridinium chloride 275

cevimeline hcl 144

CHANTIX 144

CHATEAL 198

CHEMET 220

CHENODAL 186

chicken meat 158

chloral hydrate 140

chlorambucil 275

chloramphenicol 58

chloramphenicol palmitate 58

chlordiazepoxide hcl 142,143

chlordiazepoxide-amitriptyline 82

chlordiazepoxide-clidinium 65

chlorhexidine gluconate 37,41

chloroacetic acid 275

chlorobutanol 275

chloroform 189

chloroprocaine hcl 275

chloroquine phosphate 113

chlorothiazide 166

chloroxine 275

chloroxylenol 275

chlorpheniramine maleate 100

chlorpromazine hcl 123

chlorpropamide 88

chlorthalidone 166

chlorzoxazone 247,275

CHOLBAM 187

cholesterol 275

cholestyramine 104

cholestyramine light 105

cholestyramine resin 105

choline bitartrate 189

choline mag trisalicylate 239

choline magnesium trisalicylat 239

chondroitin sulfate 233

chondroitin sulfate sodium 233

chorionic gonadotropin 211

chromium picolinate 275

chromium polynicotinate 275

chrysin 275

chymotrypsin 275

CIALIS 306

CICLODAN 95

ciclopirox 96

ciclopirox olamine 96

CIDALEAZE 253

cidofovir 137

cilostazol 128

CILOXAN 34

cimetidine 133

CIMZIA 187

CIPRO 59

CIPRO HC 34

CIPRO XR 59

CIPRODEX 34

ciprofloxacin 59

ciprofloxacin er 59

ciprofloxacin hcl 34,60

citalopram hbr 78

citrate phosphate dextrose 68

citric acid 275

citrus bergamot 275

cladosporium cladosporioides 158

cladosporium sphaerospermum 158

CLAFORAN 155

CLARAVIS 259

CLARIFOAM EF 41

CLARINEX 101

CLARINEX-D 12 HOUR 101

clarithromycin 59,111

clarithromycin er 111

CLEANSING WASH 41

clemastine fumarate 100,101

clemizole hcl 275

CLEOCIN 38

CLEOCIN HCL 63

CLEOCIN PALMITATE 63

CLEOCIN PHOSPHATE 63

CLEOCIN T 38

clever choice holding chamber 275

clever choice nebulizer 275

clever choice whisper aire ped 275

clidinium bromide 65

CLIMARA 176

CLIMARA PRO 176

CLINDACIN ETZ 38

CLINDACIN P 38

CLINDACIN PAC 38

CLINDAGEL 38

clindamax 38

clindamycin hcl 63

clindamycin palmitate hcl 63

clindamycin pediatric 63

clindamycin phos-benzoyl perox 38

clindamycin phos-tretinoin 38

clindamycin phosphate 38,63

clindamycin-benzoyl peroxide 39

CLINDESSE 39

CLINPRO 5000 223

clioquinol 94

clobetasol emollient 249

clobetasol emulsion 249

clobetasol propionate 249

clobetasol propionate micro 249

CLOBEX 249

clocortolone pivalate 249

CLODAN 249

CLODERM 249

clofazimine 111

clomiphene citrate 175

clomipramine hcl 82

clonazepam 74

clonidine 216

clonidine hcl 216

clonidine hcl er 216

clopidogrel 128

clopidogrel bisulfate 128

clorazepate dipotassium 74

CLORPRES 169

clotrimazole 94

clotrimazole-betamethasone 94

clozapine 116

clozapine odt 116

CLOZARIL 116

CNL 8 96

coaguchek xs 275

coal tar 257

COARTEM 113

cobalt gluconate 275

cobamamide 308

cocaine hcl 182

cocklebur 158

cocoa bean 158

codeine phosphate 14

codeine sulfate 14

coenzyme q10 233

COGENTIN 68

COLAZAL 184

colchicine 221

COLCRYS 221

COLESTID 105

colestipol hcl 105

colistimethate 64

colistimethate sodium 64

colistin sulfate 64

collagenase 259

COLOCORT 249

COLY-MYCIN M PARENTERAL 64

COLY-MYCIN S 35

COLYTE WITH FLAVOR PACKETS 185

COMBIGAN 97

COMBIPATCH 176

COMBIVENT RESPIMAT 5

COMBIVIR 125

COMETRIQ 275,276

comp-air elite compressor syst 276

comp-air nebulizer compressor 276

compact space chamber 276

COMPAZINE 91

COMPLERA 125

COMPOUND 347 189

COMPRO 91

COMTAN 112

conception 276

CONCERTA 29

CONDYLOX 259

CONRAY 163

CONSTULOSE 171

CONTRAVE 25

CONZIP 14

COPAXONE 228

COPEGUS 137

copper peptide ghk-cu 276

CORDARONE 55

COREG 7

COREG CR 7

CORGARD 54

CORLANOR 150

CORMAX 249

corn pollen 158

corn smut 158

CORTANE-B 44

CORTEF 192

CORTENEMA 249

corticotrophin 157

CORTIFOAM 249

cortisone acetate 192

CORTISPORIN 39

CORTISPORIN-TC 35

CORTROSYN 157

CORZIDE 54

COSENTYX (2 SYRINGES) 259

COSENTYX PEN 259

COSENTYX PEN (2 PENS) 259

COSENTYX SYRINGE 259

COSOPT 97

COSOPT PF 97

cosyntropin 157

COTELLIC 276

COTEMPLA XR-ODT 276

COUMADIN 68

coumarin 233

COVARYX 176

COVARYX H.S. 176

COZAAR 241

crab 158

creatine 276

creatine monohydrate 276

creatinine 276

CREON 186

CRESEMBA 92

CRESTOR 107

CRINONE 215

CRIXIVAN 127

CROFAB 129

cromolyn sodium 47

crotamiton 44

cryoserv 233

CRYSELLE 199

CUPRIMINE 225

curafil 276

curcumin 233

curity 276

curity amd 41,276

curity iodoform 276

CUROSURF 244

curvularia 158

CUTIVATE 249

CUVITRU 129

CUVPOSA 65

cyanocobalamin 308

cyanocobalamin injection 308

CYCLAFEM 199

cyclandelate 150

CYCLESSA 199

cyclobenzaprine hcl 247

cyclodextrin-beta 276

CYCLOGYL 182

CYCLOMYDRIL 182

cyclopentolate hcl 182

cyclopentolate-lidoc-pe-tropic 182

cyclopentolate-tropicamide-pe 182

cyclophosphamide 231

cyclophosphamide monohydrate 231

cycloserine 111

CYCLOSET 169

cyclosporine 225,231

cyclosporine modified 225

CYMBALTA 77

cyproheptadine hcl 101

CYRED 199

CYSTADANE 233

CYSTAGON 233

CYSTARAN 181

cysteamine hcl 233

CYSTOGRAFIN 163

CYSTOGRAFIN-DILUTE 163

cytarabine 276

CYTOMEL 267

CYTOTEC 134

CYTRA-2 170

CYTRA-3 170

CYTRA-K 170

Dd-ribose 171

d.farinae mite extract 158

D.H.E.45 6

d.pteronyssinus mite extract 158

DAKLINZA 192

DALIRESP 244

danazol 195

DANTRIUM 248

dantrolene sodium 248

dapiprazole hcl 276

dapsone 111

DAPTACEL DTAP 130

darifenacin er 190

DASETTA 199

DAXBIA 153

DAYPRO 236

DAYSEE 199

DAYTRANA 29

DDAVP 99,213

DEBACTEROL 259

DEBLITANE 199

deferoxamine mesylate 220

dehydroepiandrosterone 195

DELATESTRYL 195

DELESTROGEN 176

DELTASONE 192

DELYLA 199

DEMADEX 165

demecarium bromide 277

demeclocycline hcl 61

DEMEROL 14

DEMSER 233

DENAVIR 40

DENTA 5000 PLUS 223

DENTAGEL 223

deoxycholic acid 277

DEPADE 153

DEPAKENE 70

DEPAKOTE 70

DEPAKOTE ER 70

DEPAKOTE SPRINKLE 70

DEPEN 225

DEPO-ESTRADIOL 176

DEPO-MEDROL 192

DEPO-PROVERA 215

DEPO-SUBQ PROVERA 104 215

DEPO-TESTOSTERONE 195

DERMA-SMOOTHE-FS 249

DERMAGRAFT 277

DERMATOP 249

DERMAZENE 41

DERMOTIC 44

DESCOVY 125

DESFERAL 220

DESFERAL MESYLATE 220

desipramine hcl 82

desloratadine 101

desmopressin acetate 99,213

DESOGEN 199

desogestr-eth estrad eth estra 199

desogestrel-ethinyl estradiol 199

DESONATE 249

desonide 250

desonide micronized 250

DESOWEN 250

desoximetasone 250

desoxycorticosterone acetate 192

DESOXYN 26

desvenlafaxine er 77

desvenlafaxine fumarate er 78

desvenlafaxine succinate er 78

DETROL 190

DETROL LA 190

devil's claw 277

devilbiss traveler 277

dexamethasone 192

dexamethasone acetate 192

dexamethasone acetate micro 192

DEXAMETHASONE INTENSOL 192

dexamethasone isonicotinate 193

dexamethasone micronized 193

dexamethasone sodium phosphate 44,193

dexchlorpheniramine maleate 277

DEXEDRINE 26,27

DEXERYL 175

DEXILANT 134

dexmethylphenidate hcl 29

dexmethylphenidate hcl er 29

DEXPAK 193

dexpanthenol 277

dextroamphetamine sulfate 27

dextroamphetamine sulfate er 27

dextroamphetamine-amphet er 27

dextroamphetamine-amphetamine 27

dextromethorphan hbr 244

dextrose 171

dhea micronized 195

DIABETA 88

DIALYVITE 800 WITH IRON 48

diaminopyridine 233

DIAMOX SEQUELS 98

DIASTAT 74

DIASTAT ACUDIAL 74

diazepam 74,75

diazoxide 103

DIBENZYLINE 6

dibucaine 277

dibucaine hcl 253

dibutyl squarate 233

dichloralphenazone 140

dichloroacetic acid 277

DICLEGIS 90

diclofenac potassium 236

diclofenac sodium 46,236,259

diclofenac sodium er 236

diclofenac sodium micronized 236

diclofenac sodium-misoprostol 134

dicloxacillin sodium 241

dicumarol 68

dicyclomine hcl 65

didanosine 126

diethanolamine 277

diethylcarbamazine citrate 32

diethylen glycol m-ethyl ether 277

diethylpropion hcl 25

diethylpropion hcl er 25

diethylstilbestrol 176

DIFFERIN 259

DIFICID 219

diflorasone diacetate 250

DIFLUCAN 92

diflunisal 236

DIGITEK 52

DIGOX 52

digoxin 52

dihydrocodeine bitartrate 14

dihydroergotamine mesylate 6

diindolylmethane 277

diiodo-l-thyronine 277

DILANTIN 52

DILANTIN-125 52

DILATRATE-SR 304

DILAUDID 14,15

DILAUDID-HP 15

DILT-XR 56

diltiazem 12hr er 56

diltiazem 24hr cd 56

diltiazem 24hr er 56

diltiazem er 56

diltiazem hcl 56,57

dimenhydrinate 91,101

dimercaptopropanesulfonate sod 277

dimethyl sulfone 277

dimethyl sulfoxide 277

dimethylacetamide 277

dinitrochlorobenzene 277

DIOVAN 241

DIOVAN HCT 167

DIPENTUM 184

diphenhydramine hcl 101

diphenidol hcl 90

diphenoxylate-atropine 65

diphenylcyclopropenone 277

diphtheria-tetanus toxoids-ped 130

DIPROLENE 250

DIPROLENE AF 250

dipyridamole 128

DISALCID 239

DISCOVISC 277

disopyramide phosphate 52

disulfiram 220

DITROPAN XL 190

DIURIL 166

divalproex sodium 70

divalproex sodium er 70

DIVIGEL 177

dmae 277

dmsa 220

docosanol 40

docusate sodium 185

dofetilide 55

dog epithelium extract 158

dog fennel 159

DOLOPHINE HCL 15

donepezil hcl 144

donepezil hcl odt 144

DONNATAL 65

dopamine hcl 145

DORAL 143

DORYX 61

DORYX MPC 61

dorzolamide hcl 98

dorzolamide-timolol 97

DOTHELLE DHA 48

dover advantage 277

dover advantage drainage 277

dover coated latex foley 277

dover latex foley catheter 277

dover premium 277

dover red rubber robibson cath 277

dover universal 278

DOVONEX 260

doxazosin mesylate 6

doxepin hcl 82,253

doxercalciferol 310

doxycycline hyclate 35,61

doxycycline ir-dr 61

doxycycline monohydrate 61,62

doxylamine succinate 101

drechslera 159

DRISDOL 310

DRITHOCREME HP 257

dronabinol 90

droperidol 140

drospirenone-eth estra-levomef 199

drospirenone-ethinyl estradiol 199

DROXIA 278

DRYSOL 254

DUAVEE 176

DUETACT 88

duloxetine hcl 78

DUODOTE 65

DUOPA 112

DUOVISC 278

DUPIXENT 260

DURAGESIC 15

DURAMORPH 15

DUREZOL 44

DURLAZA 128

dutasteride 220

dutasteride-tamsulosin 7

DUTOPROL 54

DYANAVEL XR 27

DYAZIDE 165

dyclonine hcl 182

DYMISTA 103

dyphylline 147

DYRENIUM 165

EE-Z DISK 163

e-z spacer 278

e-z spacer pedspak 278

E-Z-CAT 163

E-Z-HD 163

E-Z-PAQUE 163

E-Z-PASTE 164

E.E.S. 200 59

E.E.S. 400 59

ear popper 278

easivent 278

eastern cottonwood 159

ebase controller 278

EC-NAPROSYN 221

eclipse needle 278

eclipse syringe 278

econazole nitrate 94

ECOZA 94

ED-SPAZ 66

EDARBI 241

EDARBYCLOR 169

EDECRIN 165

edetate calcium disodium 220

edetate disodium 233

EDEX 306

EDLUAR 140

edrophonium chloride 163

EDURANT 125

EEMT 177

EEMT H.S. 177

EFFER-K 172

EFFEXOR XR 78

EFFIENT 129

EFUDEX 260

egcg 278

egg white 159

EGRIFTA 265

ELDEPRYL 77

ELDERCAPS 307

ELESTAT 180

ELESTRIN 177

ELETONE 175

eletriptan hbr 109

ELIDEL 231

ELIGARD 211

ELIMITE 44

ELINEST 200

ELIPHOS 218

ELIQUIS 68

ELITE OB DHA 307

ELITE-OB 307

ELITE-OB 400 48

ELIXOPHYLLIN 147

ELLA 200

ELMIRON 236

ELOCON 250

EMADINE 180

EMBEDA 15

EMCYT 278

EMEND 90

EMFLAZA 193

EMLA 253

EMOQUETTE 200

EMSAM 77

EMTRIVA 126

EMULSION SB 278

EMVERM 32

ENABLEX 190

enalapril maleate 242

enalapril-hydrochlorothiazide 167

ENBREL 225

ENDARI 187

ENDO-AVITENE 100

ENDOCET 9

ENDOFORM 278

ENDOMETRIN 215

ENGERIX-B ADULT 131

ENGERIX-B PEDIATRIC-ADOLESCENT 131

english plantain 159

ENJUVIA 177

ENLON 163

enoxaparin sodium 69

ENPRESSE 200

ENSKYCE 200

ENSTILAR 250

entacapone 112

entecavir 137

ENTEREG 187

ENTERO VU 164

ENTOCORT EC 193

ENTRESTO 243

ENTTY 278

ENULOSE 171

ENVARSUS XR 231

EPANED 242

EPCLUSA 191

ephedrine hcl 3

ephedrine sulfate 3

EPICERAM 278

epicoccum 159

EPIDUO 260

EPIDUO FORTE 260

EPIFIX AMNIOTIC MEMBRANE 233

EPIFOAM 250

epinastine hcl 180

epinephrine 3

epinephrine bitartrate 3

epinephrine hcl 3

EPINEPHRINESNAP-V 3

EPIPEN 3

EPIPEN 2-PAK 3

EPIPEN JR 2-PAK 3

EPISIL 278

EPISNAP 4

EPITOL 70

EPIVIR 126

EPIVIR HBV 126

eplerenone 167

EPOGEN 146

eprosartan mesylate 241

EPY 4

EPZICOM 126

EQUETRO 70

erapid nebulizer 278

erapid nebulizer handset 278

ergocalciferol 310

ergoloid mesylates 6

ERGOMAR 6

ergotamine tartrate 6

ergotamine-caffeine 7

ERIVEDGE 278

ERRIN 200

ERTACZO 94

ERWINAZE 278

ERY 39

ERY-TAB 59

ERYGEL 39

ERYPED 200 59

ERYPED 400 59

ERYTHROCIN STEARATE 59

erythromycin 35,39,59,218

erythromycin estolate 218

erythromycin ethylsuccinate 59,218

erythromycin-benzoyl peroxide 39

ESBRIET 243

ESCAVITE LQ 48

escitalopram oxalate 79

ESGIC 9

esomeprazole magnesium 135

esomeprazole strontium 135

ESTARYLLA 200

estazolam 143

ESTRACE 177

estradiol 177

estradiol benzoate 177

estradiol cypionate 177

estradiol micronized 177

estradiol valerate 178

estradiol-norethindrone acetat 178

ESTRING 178

estriol 178

estriol micronized 178

ESTROGEL 178

estrogen-methyltestosterone 178

estrone 178

estropipate 178

ESTROSTEP FE 200

eszopiclone 140

ethacrynic acid 165

ethambutol hcl 111

ethosuximide 75

ethoxy diglycol 278

ethyl acetate 278

ethyl chloride 253

ethyl oleate 278

ethynodiol-ethinyl estradiol 200

etidronate disodium 223

etodolac 237

etodolac er 237

etomidate 189

etoposide 279

EUCRISA 250

EURAX 44

EVAMIST 178

EVARREST 100

EVEKEO 27

EVICEL 100

EVISTA 176

EVOCLIN 39

EVOTAZ 127

EVOXAC 144

EXALGO 15

EXELDERM 94

EXELON 144

exemestane 279

EXFORGE 149

EXFORGE HCT 149

EXJADE 279

EXODERM 94

EXPAREL 279

EXTAVIA 228

EXTINA 94

EZ FLU 16-17 (FLUZON QUAD PED) 131

EZ FLU 2016-2017 (AFLURIA) 131

EZ FLU 2016-2017 (FLUVIRIN) 131

EZ USE JOINT-TUNNEL-TRIGGER 193

ezetimibe 105

ezetimibe-simvastatin 105

FFABIOR 260

FACTIVE 60

FALMINA 200

famciclovir 137

famotidine 133

FAMVIR 137

FANAPT 116

FARESTON 279

FARYDAK 279

FAYOSIM 200

FAZACLO 116

felbamate 71

FELBATOL 71

FELDENE 237

felodipine er 148

FEM PH 41

female self catheter 279

FEMARA 279

femcap 279

FEMCON FE 200

FEMHRT 178

FEMRING 178

FEMYNOR 200

fenofibrate 106

fenofibric acid 106

FENOGLIDE 106

fenoprofen calcium 237

FENORTHO 237

fentanyl 15

fentanyl base 15

fentanyl citrate 16

fentanyl-bupivacaine-0.9% nacl 16

fentanyl-ropivacaine-0.9% nacl 16

FEROCON 48

FEROTRINSIC 48

FERREX 150 FORTE 48

ferric ammonium citrate 279

ferric subsulfate 279

ferric sulfate 48

FERRIPROX 279

FERROCITE PLUS 48

ferrous fumarate 48

ferrous gluconate 48

ferrous sulfate 48

FETZIMA 78

FEXMID 247

fexofenadine hcl 101

fexofenadine-pse er 279

FIBRICOR 106

filter needle 279

filter, valve set for ll & lc 279

FINACEA 260

finasteride 220,260

FIORICET 9

FIORICET WITH CODEINE 9

FIORINAL 129

FIORINAL WITH CODEINE #3 16

FIRAZYR 225

fire ant 159

FIRMAGON 227

FLAGYL 113

FLAGYL ER 113

FLAREX 44

flavoxate hcl 190

flecainide acetate 53

FLECTOR 237

flexichamber 279

flexichamber mask 279

flibanserin 151

FLO-PRED 193

FLOMAX 7

FLOVENT DISKUS 155

FLOVENT HFA 155

FLOWTUSS 244

FLOXIN 35

floxuridine 279

FLUAD 2016-2017 131

FLUAD 2017-2018 279

FLUARIX QUAD 2016-2017 131

FLUARIX QUAD 2017-2018 280

FLUBLOK 2016-2017 131

FLUBLOK 2017-2018 280

FLUBLOK QUAD 2017-2018 280

FLUCAINE 163

FLUCELVAX QUAD 2016-2017 131

FLUCELVAX QUAD 2017-2018 280

fluconazole 92,93

flucytosine 93,94

fludrocortisone acetate 193

FLULAVAL QUAD 2016-2017 131

FLULAVAL QUAD 2017-2018 280

FLUMADINE 136

flumazenil 151

flunisolide 44,193

fluocinolone acetonide 250

fluocinolone acetonide oil 44

fluocinonide 250

fluocinonide micronized 250

fluocinonide-e 250

FLUOR-A-DAY 223

FLUOR-I-STRIP AT 163

FLUORABON 224

fluorescein powder 163

fluorescein-benoxinate 182

fluorescein-proparacaine 163

fluoride 224

FLUORIDEX 224

FLUORIDEX DAILY DEFENSE 224

FLUORIDEX SENSITIVITY RELIEF 224

FLUORITAB 224

fluorometholone 44

FLUOROPLEX 260

fluorouracil 260,280

fluoxetine dr 79

fluoxetine hcl 79

fluoxymesterone 195

fluphenazine decanoate 123

fluphenazine hcl 123,124

FLURA-DROPS 224

flurazepam hcl 143

flurbiprofen 237

flurbiprofen sodium 46

FLUROX 182

flutamide 280

fluticasone propionate 45,193,250

fluticasone propionate micro 193

fluticasone-salmeterol 5

flutter 280

fluvastatin er 107

fluvastatin sodium 107

FLUVIRIN 2016-2017 131

FLUVIRIN 2017-2018 280

fluvoxamine maleate 79

fluvoxamine maleate er 79

FLUZONE HIGH-DOSE 2016-2017 131

FLUZONE HIGH-DOSE 2017-2018 280

FLUZONE INTRADERM QUAD 2016-17 131

FLUZONE INTRADERM QUAD 2017-18 280

FLUZONE QUAD 2016-2017 132

FLUZONE QUAD 2017-2018 280

FLUZONE QUAD PEDI 2016-2017 132

FLUZONE QUAD PEDI 2017-2018 280

FML 45

FML FORTE 45

FML S.O.P. 45

FOCALGIN 90 DHA 48

FOCALGIN CA 48

FOCALGIN DSS 48

FOCALIN 29

FOCALIN XR 29

FOLBECAL 172

FOLBEE 308

FOLBEE AR 308

FOLBEE PLUS CZ 308

FOLGARD OS 172

FOLGARD RX 308

folic acid 308

folic acid-vit b6-vit b12 308

FOLIVANE-PLUS 48

FOLLISTIM AQ 211

FOLPLEX 2.2 308

fondaparinux sodium 68,69

FORADIL 5

FORANE 189

FORFIVO XL 76

FORMA-RAY 280

FORMADON 260

formaldehyde 260

formoterol fumarate 5

FORTAVIT 48

FORTAZ 155

FORTEO 213

FORTICAL 213

FOSAMAX 223

FOSAMAX PLUS D 223

fosamprenavir calcium 127

fosinopril sodium 242

fosinopril-hydrochlorothiazide 167

FOSRENOL 218

FRAGMIN 69

freedom derma-d 280

freedom precision airless 280

FROVA 109

frovatriptan succinate 109

FUL-GLO 163

FULYZAQ 184

FURADANTIN 32

furazolidone 32

furosemide 165

fusarium 159

FUSION PLUS 48

FUSION SPRINKLES 48

FUZEON 124

FYAVOLV 178

FYCOMPA 71

Ggabapentin 9

GABITRIL 71

galantamine er 144

galantamine hbr 144

galantamine hydrobromide 144

GALZIN 280

GAMMAGARD LIQUID 130

GAMMAKED 130

GAMUNEX-C 130

ganirelix acetate 228

GARDASIL 132

GARDASIL 9 132

GASTROCROM 47

GASTROGRAFIN 164

GASTROMARK 280

gatifloxacin 35

gatifloxacin sesquihydrate 35

GATTEX 187

GAVILYTE-C 185

GAVILYTE-G 185

GAVILYTE-N 185

GELCLAIR 280

GELFILM 181

gelfilm 280

GELFOAM 100,280

GELFOAM COMPRESSED 280

GELFOAM JMI 280

GELNIQUE 190

GELX 281

gemfibrozil 106

GENADUR 281

GENERESS FE 201

GENERLAC 171

GENGRAF 225

GENOTROPIN 214

GENTAK 35

gentamicin sulfate 35,39,58

GENVOYA 124

GEODON 117

german cockroach 159

GIANVI 201

GIAZO 184

GILDAGIA 201

GILDESS 201

GILDESS 24 FE 201

GILDESS FE 201

GILENYA 228

GILOTRIF 281

ginkgo biloba 233

ginseng root 281

GLATOPA 229

GLEEVEC 281

GLEOSTINE 281

glimepiride 88

glipizide 88

glipizide er 88

glipizide xl 88

glipizide-metformin 84

GLUCAGEN 103

GLUCAGON EMERGENCY KIT 103

glucagon hcl 103

gluconolactone 281

GLUCOPHAGE 84

GLUCOPHAGE XR 84

glucosamine hcl 233

glucosamine sulfate kcl 234

glucosamine sulfate sodium 234

GLUCOTROL 88

GLUCOTROL XL 88

GLUCOVANCE 84

glutamine 187

glutaraldehyde 281

glutathione 281

glutathione-l 281

glyburide 88

glyburide micronized 88

glyburide-metformin hcl 84

glycine 281

glycolic acid 281

glycopyrrolate 66,281

glycosaminoglycans 281

glycyrrhizic acid 281

GLYDO 182

GLYNASE 88

GLYSET 83

GLYXAMBI 86

gold sodium thiomalate 225

goldenrod 159

GOLYTELY 185

GONAL-F 211

GONAL-F RFF 211

GONAL-F RFF REDI-JECT 212

GONITRO 304

GORDO-UREA 256

GRAFIX CORE 234

GRAFIX PRIME 234

GRALISE 9

gramicidin d 281

granisetron hcl 89

GRANIX 146

GRANULEX 260

GRASTEK 234

GRIFULVIN V 92

GRIS-PEG 92

griseofulvin 92

griseofulvin micronized 92

griseofulvin ultramicrosize 92

guaiacol 41

guaifenesin 244

guanabenz acetate 217

guanethidine hemisulfate 217

guanfacine hcl 151

guanfacine hcl er 151

guanidine hcl 144

guarana seed extract 281

guardian link 3 281

guardian sensor 3 281

GYNAZOLE 1 94

HH.P. ACTHAR 157

hackberry 159

HALCION 143

HALDOL 123



halobetasol propionate 250

HALOG 250

haloperidol 123

haloperidol decanoate 123

haloperidol decanoate 100 123

haloperidol lactate 123

HARVONI 191

HAVRIX 132

HEATHER 201

HECTOROL 310

HEMABATE 282

HEMANGEOL 54

HEMATINIC PLUS 48

HEMATINIC WITH FOLIC ACID 48

HEMATRON-AF 48

HEMAX 48

HEMMOREX-HC 250

HEMOCYTE PLUS 48

HEMOCYTE-F 49

heparin sodium 69

HEPSERA 138

HETLIOZ 140

HEXALEN 282

HIBERIX 132

HICON 282

HIPREX 32

histamine phosphate 282

histidine hcl 282

HIZENTRA 130

HOMATROPAIRE 183

homatropine hydrobromide 183

homatropine methylbromide 183

home nebulizer plus sidestream 282

honey bee venom protein 159

HORIZANT 10

horse epithelium 159

HPR 282

HPR PLUS 282

HUMALOG 87

HUMALOG JUNIOR KWIKPEN 282



HUMALOG MIX 50-50 87


HUMALOG MIX 75-25 87


HUMATROPE 214

HUMIRA 187

HUMIRA PEDIATRIC CROHN'S 188

HUMIRA PEN 188

HUMIRA PEN CROHN-UC-HS STARTER 188

HUMIRA PEN PSORIASIS-UVEITIS 188

HUMULIN R U-500 87

HUMULIN R U-500 KWIKPEN 87

hyaluronic acid 282

hyaluronic acid sodium salt 282

hyaluronidase 282

HYCAMTIN 282

HYCET 10

HYCOFENIX 4

hydralazine hcl 217

hydrazine sulfate 282

HYDREA 282

HYDRO 35 256

HYDRO 40 256

hydrochloric acid 186

hydrochlorothiazide 166

hydrocod-cpm-pseudoephedrine 16

hydrocodone bitartrate 16

hydrocodone-acetaminophen 10

hydrocodone-chlorpheniramne er 102

hydrocodone-homatropine mbr 66

hydrocodone-ibuprofen 16

hydrocortisone 193,251

hydrocortisone acetate 251

hydrocortisone butyrate 251

hydrocortisone valerate 251

hydrocortisone-acetic acid 37

hydrocortisone-iodoquinol 41

hydrocortisone-iodoquinol-aloe 41

hydrocortisone-pramoxine 251

hydrocortisone-pramoxine hcl 251

hydrofera blue 282

hydrofera blue ready 282

hydrogen peroxide 282

HYDROMET 66

hydromorphone er 16

hydromorphone hcl 16,17

hydroquinone 156

hydroxocobalamin 308

hydroxyamphetamine hbr 183

hydroxychloroquine sulfate 113

hydroxyethyl methacrylate 282

hydroxyprogesterone caproate 215

hydroxypropy-beta-cyclodextrin 282

hydroxytryptophan 282

hydroxyurea 282

hydroxyzine hcl 140,141

hydroxyzine pamoate 141

HYGEL 282

HYLATOPIC 282

HYLATOPICPLUS 283

HYLENEX 283

HYOPHEN 32

hyoscyamine sulfate 66

hyoscyamine sulfate er 66

hyoscyamine sulfate sr 66

HYOSYNE 66

HYPER-SAL 172

HYPERHEP B S-D 130

HYPERRAB S-D 130

HYPERTET S-D 130

hypodermic needle 283

HYQVIA 130

HYQVIA HY COMPONENT 283

HYQVIA IG COMPONENT 130

HYZAAR 167,168

Iibandronate sodium 223

IBRANCE 283

IBUDONE 17

ibuprofen 237

IC GREEN 162

ICAR-C PLUS 49

ichthammol 283

ICLUSIG 283

idebenone 151

idoxuridine 37

ILARIS 234

ILEVRO 46

ILOTYCIN 35

IMBRUVICA 283

imipramine hcl 82

imipramine pamoate 82

imiquimod 260

IMITREX 109,110

IMOGAM RABIES-HT 130

IMOVAX RABIES VACCINE 132

IMPAVIDO 114

IMURAN 226

INCRELEX 265

INCRUSE ELLIPTA 66

indapamide 166

INDERAL LA 54

INDERAL XL 54

INDICLOR 283

INDIGO CARMINE 162

indigotindisulfonate sod-water 162

INDIOMIN MB 32

INDOCIN 221

indocyanine green 162

indole-3-carbinol 234

indomethacin 222,237

indomethacin er 222

INFANRIX DTAP 130

INFASURF 244

INFED 49

INFUMORPH 17

INGREZZA 151,283

INLYTA 284

INNOPRAN XL 54

innospire deluxe 284

innospire elegance 284

innospire essence 284

innospire mini 284

innospire replacement filter 284

inositol 284

inspirachamber 284

inspiration 284

inspiration elite 284

inspiration elite filter 284

INSPRA 167

insulin syringe 284

insulin syringe u-500 284

INTELENCE 125

INTERMEZZO 141

INTRAROSA 193

INTRON A 136

INTROVALE 201

INTUNIV 152

INVANZ 219

INVEGA 117

INVEGA SUSTENNA 117

INVEGA TRINZA 117,118

INVIRASE 127

INVOKAMET 84

INVOKAMET XR 84

INVOKANA 87

iodine 41

iodochlorohydroxyquinoline 94

IODOFLEX 41

iodoform 284

iodoquinol 113

IODOSORB 41

iopanoic acid 284

IOPIDINE 181

IPOL 132,284

ipratropium bromide 66,181

ipratropium-albuterol 5

IPRIVASK 69

irbesartan 241

irbesartan-hydrochlorothiazide 168

IRENKA 78

IRESSA 284

ISENTRESS 124

ISENTRESS HD 124

ISIBLOOM 201

ISOCHRON 305

isoflurane 189

isoleucine 284

isomethept-caff-acetaminophen 10

isomethept-dichloralp-acetamin 10

isometheptene mucate 145

isoniazid 111

isopropamide iodide 284

isopropyl myristate 284

isoproterenol hcl 4,284

ISOPTO ATROPINE 183

ISOPTO CARPINE 98

ISORDIL 305

ISORDIL TITRADOSE 305

isosorbide 305

isosorbide dinitrate 305

isosorbide mononitrate 305

isosorbide mononitrate er 305

isotretinoin 260

ISOVUE-200 164

isoxsuprine hcl 306

isradipine 148

ISTALOL 97

ISUPREL 4

itraconazole 93

itraconazole micronized 93

ivermectin 32

IXIARO 132

JJADENU 285

JADENU SPRINKLE 285

JAKAFI 285

JALYN 7

JANTOVEN 68

JANUMET 84

JANUMET XR 84

JANUVIA 86

JARDIANCE 88

JENCYCLA 201

JENTADUETO 85

JENTADUETO XR 85

jetco-spray cannula 285

JEVANTIQUE LO 178

JINTELI 178

johnson grass 159

JOLESSA 201

JOLIVETTE 201

JUBLIA 94

JULEBER 201

JUNEL 202

JUNEL FE 202

JUNEL FE 24 202

JUXTAPID 103,104

KK EFFERVESCENT 172

K-PHOS NEUTRAL 170

K-PHOS NO.2 170

K-PHOS ORIGINAL 170

K-SOL 172

K-TAB ER 173

KAITLIB FE 202

KALETRA 127

KALYDECO 156

kanamycin sulfate 58

kangaroo 924 safety screw 285

kangaroo epump set 285

kangaroo gravity set 285

kapok 159

KAPVAY 217

karaya gum 185

KARBINAL ER 101

KARIVA 202

KAYEXALATE 218

KEFLEX 153

KELNOR 1-35 202

KENALOG 251

KENALOG-10 193

KENALOG-40 193

kendall 0.9% nacl with cap 285

kenguard 285

KEPPRA 71

KEPPRA XR 71

KERAFOAM 256

KERALAC 256

KERALYT 256

kerlix amd 41

kerlix amd bandage 41

KERYDIN 96

KETALAR 189

ketamine hcl 189

ketamine hydrochloride 189

KETEK 219

ketoconazole 93,95

ketoconazole micronized 93

ketoprofen 237

ketoprofen micronized 237

ketorolac tromethamine 46,237

ketotifen fumarate 101

KEVEYIS 234

KEVZARA 226

KHEDEZLA 78

KIMIDESS 202

KINEVAC 162

KINRIX 132

KIONEX 218

KISQALI 285

KISQALI FEMARA CO-PACK 285,286

KITABIS PAK 58

KLARON 41

KLOFENSAID II 237

KLONOPIN 75

KLOR-CON 173

KLOR-CON 10 173

KLOR-CON 8 173

KLOR-CON M10 173

KLOR-CON M15 173

KLOR-CON M20 173

KLOR-CON SPRINKLE 173

KLOR-CON-EF 173

kochia 159

kojic acid 286

KORLYM 83

KRISTALOSE 171

KURVELO 202

KUVAN 234

KYNAMRO 104

Ll-5 methyltetrahydrofolate cal 309

l-alanine 171

l-aspartic acid 286

l-carnitine 234

l-citrulline 171

l-cysteine hydrochloride 171

l-glutamic acid 286

l-glutamine 188

l-histidine 286

l-isoleucine 286

l-leucine 172

l-methionine 286

l-methylfolate calcium 309

l-proline 286

l-serine 286

l-theanine 234

l-threonine 286

labetalol hcl 7

LACRISERT 181

lactic acid 175,256

lactulose 171

lamb's quarters 159

LAMICTAL 71

LAMICTAL (BLUE) 71

LAMICTAL (GREEN) 71

LAMICTAL (ORANGE) 71

LAMICTAL ODT 71

LAMICTAL ODT (BLUE) 71

LAMICTAL ODT (GREEN) 71

LAMICTAL ODT (ORANGE) 71

LAMICTAL XR 71

LAMICTAL XR (BLUE) 71

LAMICTAL XR (GREEN) 71

LAMICTAL XR (ORANGE) 71

LAMISIL 92

lamivudine 126

lamivudine hbv 126

lamivudine-zidovudine 126

lamotrigine 71

lamotrigine (blue) 71

lamotrigine (green) 71

lamotrigine (orange) 72

lamotrigine er 72

lamotrigine odt 72

lamotrigine odt (blue) 72

lamotrigine odt (green) 72

lamotrigine odt (orange) 72

LANOXIN 52

LANOXIN PEDIATRIC 52

lansoprazol-amoxicil-clarithro 135

lansoprazole 135

lanthanum carbonate 218

LANTUS 87

LANTUS SOLOSTAR 87

LARIN 202

LARIN 24 FE 202

LARIN FE 202

LARISSIA 202

LASIX 165

LASTACAFT 180

latanoprost 99

LATISSE 99

LATRIX 256

LATUDA 118

LAYOLIS FE 203

lc plus 286

lc sprint nebulizer 286

lc star 286

LEENA 203

leflunomide 226

LENVIMA 286

LESCOL 107

LESCOL XL 107

LESSINA 203

LETAIRIS 245

letrozole 286

leucine 172

leucovorin calcium 220,221,234

LEUKERAN 286

LEUKINE 146

leuprolide acetate 212,286

LEVACET 129

levalbuterol concentrate 5

levalbuterol hcl 5

levamisole hcl 32

LEVAQUIN 60

LEVATOL 150

LEVBID 66

levetiracetam 72

levetiracetam er 72

LEVO-T 267

levobunolol hcl 97

levocarnitine 234

levocetirizine dihydrochloride 101,102

levodopa 113

levofloxacin 35,60

levofloxacin hemihydrate 60

levomefolate calcium 309

levomefolate dha 49

LEVONEST 203

levonorg-eth estrad eth estrad 203

levonorgestrel 203

levonorgestrel-eth estradiol 203

LEVORA-28 203

levorphanol tartrate 17,18

levothyroxine sodium 267

LEVOXYL 267

LEVSIN 66

LEVSIN-SL 66

LEVULAN 260

LEXAPRO 79

LEXIVA 127

LIALDA 184

LIBRAX 66

lidocaine 253,286

lidocaine hcl 53,182,253,287

lidocaine hcl viscous 182

lidocaine hcl-0.9% nacl 287

lidocaine hcl-epinephrine 266

lidocaine-epinephrine 266

lidocaine-hydrocortisone 251

lidocaine-prilocaine 253

lidocaine-tetracaine 253

LIDODERM 253

LIDODEXTRAPINE 253

LIDOPIN 253

LIDOPRIL 253

LIDORX 253

LIDOTRAL 254

LIDOVEX 254

LIDTOPIC MAX 254

LILLOW 204

LINCOCIN 63

lincomycin hcl 63

lindane 44

linezolid 64

LINZESS 188

liothyronine sodium 267

LIPITOR 107

LIPOFEN 106

lipoic acid 287

LIQUID E-Z PAQUE 164

LIQUID POLIBAR PLUS 164

lisinopril 242

lisinopril-hydrochlorothiazide 168

liteaire 287

litetouch 287

lithium 150

lithium carbonate 151

lithium carbonate er 151

LITHOBID 151

LITHOSTAT 171

LIVALO 107

LO LOESTRIN FE 204

LOCOID 251

LODINE 238

LODOSYN 152

LOESTRIN 204

LOESTRIN FE 204

LOFIBRA 106

lokara 251

LOMAIRA 25

LOMEDIA 24 FE 204

LOMOTIL 66

lomustine 287

LONSURF 287

loperamide 184,185

LOPID 106

lopinavir-ritonavir 127

LOPREEZA 179

LOPRESSOR 54

LOPRESSOR HCT 54

LOPROX 96

loratadine 102

loratadine micronized 102

lorazepam 75

LORAZEPAM INTENSOL 75

LORCET 10

LORCET HD 10

LORCET PLUS 10

LORTAB 10,11

LORYNA 204

LORZONE 247

losartan potassium 241

losartan-hydrochlorothiazide 168

LOSEASONIQUE 204

LOTEMAX 45

LOTENSIN 242

LOTENSIN HCT 168

LOTREL 149

LOTRISONE 95

LOTRONEX 184

LOUTREX 287

lovastatin 107

LOVAZA 104

LOVENOX 69

LOW-OGESTREL 204

loxapine 114

LP LITE PAK 254

LUCENTIS 181

LUDENT FLUORIDE 224

LUGOL'S 41,92

LUMIGAN 99

LUMINAL SODIUM 287

LUNESTA 141

LUPANETA PACK 212

LUPRON DEPOT 212

LUPRON DEPOT (LUPANETA) 212

LUPRON DEPOT-PED 212

lutein 287

LUTERA 204

LUXAMEND 175

LUXIQ 251

LUZU 95

lycopene 234

LYMPHAZURIN 163

LYNPARZA 287

LYRICA 72

lysine hcl 172

LYSIPLEX PLUS 172

LYSODREN 287

LYSTEDA 100

LYZA 204

MM-M-R II VACCINE 132

maca root 287

MACNATAL CN DHA 49

MACROBID 32

MACRODANTIN 33

mafenide acetate 41

magellan insulin safety syrng 287

magellan insulin syringe 287

magellan tuberculin syringe 287

magnesium amino acid chelate 173

magnesium chloride 72,287

magnesium glycinate 173

magnesium malate 288

magnesium oxide 183

magnesium sulfate 52

MAKENA 215

MALARONE 113

malathion 44

malic acid 288

manganese chloride 173

manganese gluconate 173

mannitol 98

maprotiline hcl 82

MARCAINE 288

MARCAINE SPINAL 288

MARCAINE-EPINEPHRINE 266

MARGESIC 11

MARINOL 90

MARLISSA 204

MARPLAN 77

MARTEN-TAB 11

mask set with y-piece 288

MATERNITY 307

MATULANE 288

MATZIM LA 57

MAVIK 242

MAVYRET 288

MAXALT 110

MAXALT MLT 110

MAXARON FORTE 49

MAXIDEX 45

MAXIFED CDX 288

MAXINATE 307

MAXIPHEN CD 288

MAXIPHEN CDX 288

MAXIPIME 153

MAXITROL 35

MAXZIDE 165

MAXZIDE-25 MG 165

MD-76 R 164

MD-GASTROVIEW 164

me-naphos-mb-hyo 1 33

mebendazole 32

mecamylamine hcl 217

mechlorethamine hcl 288

meclizine hcl 91

meclofenamate sodium 238

meclofenoxate hcl 28

MEDROL 193

medroxyprogesterone ac micro 215

medroxyprogesterone acetate 215

mefenamic acid 238

mefloquine hcl 114

MEGACE 288

MEGACE ES 288

megestrol acetate 288

MEKINIST 288

melaleuca 159

melatonin 234

MELODETTA 24 FE 204

meloxicam 238

MELPAQUE HP 156

melphalan 288

MELQUIN-3 156

memantine hcl 152

MEMBRANEBLUE 163

MENACTRA 132

menadione 289

MENEST 179

MENHIBRIX 132

MENOMUNE-A-C-Y-W-135 132

MENOPUR 212

MENOSTAR 179

MENTAX 95

menthol 289

MENVEO A-C-Y-W-135-DIP 132

MENVEO MENA COMPONENT 132

MENVEO MENCYW-135 COMPONENT 132

meperidine hcl 18

MEPHYTON 221

mepivacaine hcl 289

meprobamate 141

MEPRON 114

mequinol 156

mercaptopurine 231

mesalamine 184

MESNEX 236

mesquite 159

MESTINON 145

METADATE CD 29

METADATE ER 29

metaproterenol sulfate 5

METAXALL 247

metaxalone 247

metformin hcl 85

metformin hcl er 85

metformin hydrochloride 85

methacholine chloride 289

methadone hcl 18,19,289

METHADONE INTENSOL 19

METHADOSE 19

methamphetamine hcl 27

methazolamide 98

methenamine 33

methenamine hippurate 33

methenamine mandelate 33

METHERGINE 289

methimazole 266,267

methionine 289

METHITEST 195

methocarbamol 247

methotrexate 226,289

methotrexate sodium 226

methoxsalen 156

methscopolamine bromide 66

methyclothiazide 166

methyl 5-aminolevulinate hcl 260

methylcobalamin 309

methyldopa 217

methyldopa-hydrochlorothiazide 168

methylergonovine maleate 289

METHYLIN 29,30

methylparaben 289

methylphenidate er 30

methylphenidate hcl 30

methylphenidate hcl cd 30

methylphenidate hcl er 30

methylphenidate la 30,31

methylprednisolone 193

methylprednisolone ac micro 193

methylprednisolone acetate 193

methylprednisolone sodium succ 194

methylpyrazole 221

methyltestosterone 195,196

methyltestosterone micronized 196

methyltetrahydrofolate calcium 309

methyltetrahydrofolic acid 309

methysergide maleate 7

metipranolol 97

metoclopramide hcl 189

metoclopramide hcl odt 189

metolazone 166

METOPIRONE 163

metoprolol succinate 54

metoprolol tartrate 54

metoprolol-hydrochlorothiazide 54

METOZOLV ODT 189

METROCREAM 39

METROGEL 39

METROGEL-VAGINAL 39

METROLOTION 39

metronidazole 39,113

metronidazole benzoate 113

mexiletine hcl 53

MIACALCIN 213

MIBELAS 24 FE 205

MICARDIS 241

MICARDIS HCT 168

miconazole 95

miconazole 3 95

miconazole nitrate 95

MICORT-HC 251

micro elite 289

micro plus 289

microchamber 289

microcrystalline cellulose 289

MICROCYN 289

MICROCYN HYDROGEL 289

MICROGESTIN 205

MICROGESTIN 24 FE 205

MICROGESTIN FE 205

microspacer 289

MICROZIDE 166

midazolam 143

midazolam hcl 143

midodrine hcl 266

MIFEPREX 289

MIGERGOT 7

miglitol 83

MIGRANAL 7

milk thistle 289

MILLIPRED 194

MILLIPRED DP 194

MIMVEY 179

MIMVEY LO 179

MINASTRIN 24 FE 205

mini plus nebulizer 289

mini-wright peak flow meter 289

minielite 289

minimed 630g guardian start kt 289

MINIPRESS 6

MINITRAN 305

MINIVELLE 179

MINOCIN 62

minocycline hcl 62

minocycline hcl er 62

minoxidil 217

MIOCHOL-E 98

MIOSTAT 98

MIRAPEX 169

MIRAPEX ER 169

MIRCERA 146

MIRCETTE 205

mirtazapine 76

mirtazapine anhydrous 76

MIRVASO 260

misoprostol 134

misoprostol hpmc 134

misterneb compressor 289

misterneb pediatric compressor 289

MITIGARE 222

mitomycin 290

mitomycin c 290

mitotane 290

mixed aspergillus 159

mixed cockroach 159

mixed feathers 159

mixed ragweed extract 159

mixed vespid venom protein 159

MOBIC 238

modafinil 31

MODERIBA 138

MODICON 205

moexipril hcl 242

moexipril-hydrochlorothiazide 168

molindone hcl 115

molybdenum 173

mometasone furoate 45,251

MONDOXYNE NL 62

mono-flo 290

MONO-LINYAH 205

monobenzone 156

MONODOX 62

monoject 290

MONOJECT 0.9% SODIUM CHLORIDE 173

monoject blood collection 290

monoject control syringe 290

monoject insulin syringe 290

monoject luer lock tb syringe 290

monoject magellan 290

monoject megellan tb syringe 290

monoject pharmacy tray 290

MONOJECT PREFILL 173

MONOJECT PREFILL ADVANCED 173

monoject safety syringe 290

monoject smartip cannula 290

monoject syringe 290

MONONESSA 205

MONSEL'S 100

montelukast sodium 47

MONUROL 33

MORGIDOX 62

morphine sulfate 19,20

morphine sulfate er 20

mosquito 159

MOTOFEN 185

mountain cedar 159

mouse epithelium 159

mouthpiece 290

MOVIPREP 185

MOXATAG 240

MOXEZA 35

moxifloxacin 35

moxifloxacin hcl 60

MOZOBIL 146

MS CONTIN 20

mucor 160

MUCOTROL 261

MUGARD 290

mugwort 160

MULTAQ 55

MULTICHEW 49

MULTIGEN FOLIC 49

MULTIGEN PLUS 49

multivitamin with fluoride 224

multivitamin-iron-fluoride 49

multivitamins-a,b,d,e,k,zn 307

mupirocin 35,39

muri-lube mineral oil 175

MUSE 306

MUSTARGEN 290

my mdi portable nebuliser 290

MYALEPT 213

MYAMBUTOL 111

MYCOBUTIN 64

mycophenolate mofetil 231

mycophenolic acid 231

MYDRIACYL 183

MYFORTIC 231

MYKIDZ IRON FL 49

MYLERAN 290

MYNATAL 49,307

MYNATAL ADVANCE 49

MYNATAL PLUS 49

MYNATAL-Z 49

MYNATE 90 PLUS 307

MYORISAN 261

MYRBETRIQ 145

MYSOLINE 74

MYTESI 185

MYZILRA 205

NNABI-HB 130

nabumetone 238

nabumetone micronized 238

nadolol 54

nadolol-bendroflumethiazide 54

nafcillin sodium 241

naftifine hcl 94

NAFTIN 94

nalbuphine hcl 24

NALFON 238

nalidixic acid 60

naloxone hcl 153

naltrexone hcl 153

naltrexone hcl dihydrate 153

NAMENDA 152

NAMENDA XR 152

NAMZARIC 145

nandrolone decanoate 196

naphazoline hcl 183

NAPRELAN 222

NAPROSYN 222

naproxen 222,238

naproxen sodium 222,238

naproxen sodium cr 222

naproxen sodium ds 222

naproxen sodium er 222

naratriptan 110

naratriptan hcl 110

NARCAN 153

NARDIL 77

NAROPIN 291

NASCOBAL 309

NASONEX 45

NATACYN 37

NATAZIA 205

nateglinide 87

NATESTO 196

NATPARA 213

NATROBA 44

natural mixed tocopherols 310

NATURE-THROID 267

NEBUPENT 114

NEBUSAL 173

NECON 205

needle 291

nefazodone hcl 81

NEMBUTAL SODIUM 142

NEO-POLYCIN 35

NEO-POLYCIN HC 35

NEO-SYNALAR 39

neomycin sulfate 58

neomycin-bacitracin-poly-hc 35

neomycin-bacitracin-polymyxin 35

neomycin-polymyxin-dexameth 35

neomycin-polymyxin-gramicidin 36

neomycin-polymyxin-hc 36

neomycin-polymyxin-hydrocort 36

NEORAL 226

NEOSALUS 291

NEOSALUS CP 291

NEOSPORIN 36

neostigmine methylsulfate 145

NEPHRO-VITE RX 309

NEPTAZANE 98

NESACAINE 291

NESACAINE-MPF 291

nettle leaf 291

NEUAC 39

NEULASTA 146

NEUPOGEN 147

NEUPRO 169

NEURIN-SL 309

NEURONTIN 11

NEUTRASAL 291

NEVANAC 46

nevirapine 125

nevirapine er 125

NEWGEN 49

NEXAVAR 291

NEXAVIR 234

NEXIUM 135

niacin 104

niacin er 104

niacinamide 309

NIACOR 104

NIASPAN 104

nicardipine hcl 149

niclosamide 32

nicotinamide adenine 234

nicotine polacrilex 144

nicotinic acid 104

NICOTROL 144

NICOTROL NS 144

NIFEDICAL XL 149

nifedipine 149

nifedipine er 149

NIKKI 205

NILANDRON 291

nilutamide 291

nimodipine 149

NINLARO 291

nisoldipine 148

NITRO-BID 305

NITRO-DUR 305

NITRO-TIME 305

nitrofurantoin 33

nitrofurantoin mono-macro 33

nitrofurazone 41

nitroglycerin 305

nitroglycerin patch 305

NITROLINGUAL 305

NITROMIST 306

NITROSTAT 306

NIVATOPIC PLUS 291

nizatidine 133,134

NIZORAL 95

NODOLOR 11

NOR-Q-D 206

NORA-BE 206

NORCO 11

NORDITROPIN FLEXPRO 214

norepinephrine bitartrate 266

norethin-eth estra-ferrous fum 206

norethindron-ethinyl estradiol 179,206

norethindrone 206,216

norethindrone ac (lupaneta) 216

norethindrone acetate 216

norgestimate-ethinyl estradiol 206

NORINYL 1+50 206

NORINYL 1-35 206

NORITATE 39

NORLYDA 206

NORLYROC 206

normal saline flush 173

NORPACE 52

NORPACE CR 52

NORPRAMIN 82

NORTHERA 266

NORTREL 206

nortriptyline hcl 82

NORVASC 149

NORVIR 127

NOVACORT 251

NOVAREL 212,291

NOXAFIL 93

NP THYROID 267

NUCYNTA 20

NUEDEXTA 152

NULEV 67

NULYTELY WITH FLAVOR PACKS 185

NUMBONEX 254

NUMOISYN 291

NUOX 256

NUPLAZID 118

NUTRESTORE 188

NUTRICAP 49

nutriport balloon 292

NUTROPIN AQ 214

NUTROPIN AQ NUSPIN 214

NUVAIL 292

NUVARING 206

NUVESSA 39

NUVIGIL 31

NYAMYC 96

NYATA 96

nylidrin hcl 150

NYMALIZE 149,292

nystatin 93,96

nystatin-triamcinolone 96

NYSTOP 96

OO-CAL FA 49

oasis ultra 292

oat grain 160

OBSTETRIX EC 49

OBSTETRIX ONE 49

OBTREX DHA 49

OCALIVA 188

OCELLA 206

octreotide acetate 264

OCUCOAT 181

OCUFEN 46

OCUFLOX 36

ODEFSEY 125

ODOMZO 292

OFEV 244

ofloxacin 36,60

OGEN 179

OGESTREL 207

olanzapine 118

olanzapine odt 118

olanzapine-fluoxetine hcl 79

olive tree 160

olmesartan medoxomil 241

olmesartan-amlodipine-hctz 168

olmesartan-hydrochlorothiazide 168

olopatadine hcl 180

OLUX 251

OLUX-E 251

OLYSIO 191

OMECLAMOX-PAK 135

omega-3 acid ethyl esters 104

omega-3 dha 292

omeprazole 135

omeprazole-sodium bicarbonate 135

OMNARIS 45

OMNIPRED 45

OMNITROPE 214

ONCASPAR 292

ondansetron hcl 89

ondansetron odt 89

ONEXTON 39,40

ONFI 75

ONMEL 93

ONZETRA XSAIL 110

OPANA 20

OPANA ER 21

opium tincture 185

OPSUMIT 245

optichamber 292

optichamber diamond 292

ORACEA 62

ORACIT 170

ORAFATE 292

ORALAIR 234

ORALONE 251

ORAMAGICRX 292

orange 160

ORAP 115

ORAPRED ODT 194

ORAVIG 95

ORENCIA 226

ORENCIA CLICKJECT 226

ORENITRAM ER 245

ORFADIN 235

ORKAMBI 156

ornithine 292

orphenadrine citrate 248

ORSYTHIA 207

ORTHO MICRONOR 207

ORTHO TRI-CYCLEN 207

ORTHO TRI-CYCLEN LO 207

ORTHO-CEPT 207

ORTHO-CYCLEN 207

ORTHO-NOVUM 207

OSCIMIN 67

OSCIMIN SL 67

OSCIMIN SR 67

oseltamivir phosphate 137

OSMOPREP 185

OSPHENA 176

OTEZLA 226

OTIPRIO 36

OTOVEL 36

OTREXUP 226

OVACE 41

OVACE PLUS 41,42

OVACE PLUS WASH 42

OVCON-35 207

OVIDE 44

OVIDREL 212

oxacillin sodium 241

OXANDRIN 196

oxandrolone 196

oxaprozin 238

OXAYDO 21

oxazepam 143

oxcarbazepine 72

OXECTA 21

oxiconazole nitrate 95

OXISTAT 95

OXSORALEN 156

OXSORALEN-ULTRA 156

OXTELLAR XR 72

oxybutynin chloride 190

oxybutynin chloride er 190

OXYCEL 100

oxycodone hcl 21

oxycodone hcl er 21

oxycodone hcl-aspirin 21

oxycodone hcl-ibuprofen 21

oxycodone hydrochloride 21

oxycodone-acetaminophen 11

OXYCONTIN 21

oxymetazoline hcl 183

oxymorphone hcl 21

oxymorphone hcl er 21

oxytetracycline hcl 62

oxytocin 292

OXYTROL 190

PPACERONE 55

PACNEX 256

PACNEX HP 256

PACNEX LP 256

PAIN EASE 254

paliperidone er 118

PAMELOR 82

pancreatin 186

pancreatin 8x 186

PANCRELIPASE 5,000 186

pancuronium bromide 248

PANDEL 251

PANRETIN 261

panthenol 309

pantoprazole sodium 135

papain 292

papaverine hcl 306

papaverine-alprostadil 306

parachlorophenol 292

PARAFON FORTE DSC 247

paregoric 185

PAREMYD 183

pari lc plus nebulizer 292

pari lc sprint sinus 292

pari sinus aerosol system 292

paricalcitol 310

PARLODEL 169

PARNATE 77

PAROEX 37

paromomycin sulfate 58

paroxetine cr 79

paroxetine er 80

paroxetine hcl 80

paroxetine mesylate 80

PASER 111

PATADAY 180

PATANASE 180

PATANOL 181

PAXIL 80

PAXIL CR 80

PAZEO 181



PCE 59

peanut 160

pecan nut 160

pecan pollen 160

PEDIADERM AF 96

PEDIAPRED 194

PEDIARIX 130

pediatric dinosaur nebulizer 292

pediatric dog nebulizer 292

pediatric frog nebulizer 292

PEDVAXHIB 132

peg 3350-electrolyte 186

peg 3350-grx 186

peg-3350 and electrolytes 186

peg-3350 with flavor packs 186

PEG-PREP 186

PEGANONE 75

PEGASYS 136

PEGASYS PROCLICK 136

PEGINTRON 136

PEGINTRON REDIPEN 136

pen needle 292

penicillamine 226

penicillamine(d-) 226

penicillin g potassium 240

penicillin g procaine 240

penicillin g sodium 240

penicillin v potassium 240

penicillium notatum 160

PENLAC 96

PENNSAID 238

PENTACEL 132

PENTACEL ACTHIB COMPONENT 132

PENTACEL DTAP-IPV COMPONENT 132

PENTAM 300 114

PENTASA 184

pentazocine-naloxone hcl 24

pentobarbital sodium 142

pentosan polysulfate sodium 236

pentoxifylline 147

pentylenetetrazole 292

PEPCID 134

PERCOCET 11

PERFOROMIST 5

PERIDEX 37

perindopril erbumine 243

PERIOGARD 37

permethrin 44

perphenazine 124

perphenazine-amitriptyline 82

PERSANTINE 129

PEXEVA 80

PFIZERPEN 240

pflex trainer 292

phaseal protector 293

PHENADOZ 141

phenazopyridine hcl 254

phendimetrazine tartrate 25

phenelzine sulfate 77

PHENERGAN 102,141

phenindione 293

phenobarbital 74,142

phenobarbital sodium 74

PHENOHYTRO 67

phenol 42

phenolsulfonic acid 293

phenoxybenzamine hcl 7

phentermine hcl 25

phentolamine mesylate 7

phentolamine-alprostadil 7

phenylalanine 172

phenylbutazone 238

phenylephrine hcl 183,266

phenylmercuric nitrate 293

phenylpropanolamine hcl 266

phenyltoloxamine dihyd cit 293

PHENYTEK 53

phenytoin 53

phenytoin sodium 53

phenytoin sodium extended 53

PHILITH 207

phoma 160

PHOSLYRA 218

PHOSPHA 250 NEUTRAL 170

PHOSPHASAL 33

phosphatidylcholine 189

phosphatidylserine 293

PHOSPHOLINE IODIDE 98

physostigmine salicylate 145

phytonadione 221,311

PICATO 261

pillow mask for children 293

pilocarpine hcl 98,145

pilocarpine nitrate 98

pimozide 115

PIMTREA 207

pindolol 54

pine bark extract 293

pioglitazone hcl 89

pioglitazone-glimepiride 88

pioglitazone-metformin 85

PIRMELLA 207

piroxicam 238

pistachio nut 160

PITOCIN 293

PLAN B ONE-STEP 207

PLAQUENIL 114

PLAVIX 129

PLEGISOL 173

PLEGRIDY 229

PLEGRIDY PEN 229

PLETAL 129

PLEXION 42

PLIAGLIS 254

PNEUMOVAX 23 132

PNV 29-1 49

PNV-DHA + DOCUSATE 49

PNV-OMEGA 49

PNV-VP-U 307

pocket chamber 293

PODOCON-25 261

podofilox 261,293

podophyllum resin 256

POLIBAR ACB 164

POLOCAINE 293

POLOCAINE-MPF 293

POLY-VI-FLOR 224

POLY-VI-FLOR WITH IRON 50

POLYCIN 36

polyethylene glycol 3350 186

polymyxin b sul-trimethoprim 36

polymyxin b sulfate 64

POLYSACCHARIDE IRON FORTE 50

POLYTRIM 36

polyvinyl alcohol 293

POMALYST 229

PONSTEL 238

PONTOCAINE 254

pork 160

portable nebulizer system 293

PORTIA 207

POTABA 235

potass cit-sod cit-citric acid 170

potassium bicarbonate 173

potassium bromide 293

potassium chloride 173

potassium citrate 173

potassium citrate er 170

potassium citrate monohydrate 174

potassium citrate-citric acid 170

potassium hydroxide 256

potassium iodide 92

potassium p-aminobenzoate 293

potassium perchlorate 235

potassium permanganate 293

potassium phosphate 174

potassium sorbate 293

POTIGA 72

povidone 293

povidone iodine 37,42

povidone k-30 293

PR BENZOYL PEROXIDE 256

PRADAXA 69

pralidoxime chloride 221

PRALUENT PEN 108

PRALUENT SYRINGE 108

PRAMCORT 251

pramipexole dihydrochloride 169

pramipexole er 169

PRAMOSONE 251

PRAMOSONE E 252

pramoxine hcl 254

PRANDIMET 85

PRANDIN 87

prasugrel hcl 129

PRAVACHOL 107

pravastatin sodium 108

praziquantel 32

prazosin hcl 6

PRE-ATTACHED LTA KIT 254

PRE-PEN 162

PRECOSE 83

PRED FORTE 45

PRED MILD 45

PRED-G 36

prednicarbate 252

prednisolone 194

prednisolone acetate 45

prednisolone acetate micronize 194

prednisolone micronized 194

prednisolone sodium phos odt 194

prednisolone sodium phosphate 45,194

prednisone 194

PREDNISONE INTENSOL 194

prednisone micronized 194

PREFEST 179

pregabalin 72

pregnenolone 293

pregnenolone micronized 293

PREGNYL 213

PREMARIN 179

PREMPHASE 179

PREMPRO 179

PRENA1 CHEW 307

PRENA1 PEARL 50

PRENA1 TRUE 50

PRENAISSANCE NEXT 174

PRENATABS RX 50

prenatal low iron 50

prenatal plus 50

prenatal-u 307

PREPIDIL 293

PREPLUS 50

PREPOPIK 186

PRESERA 293

PRESTALIA 150

PRETAB 50

PREVACID 135

PREVALITE 105

PREVIDENT 224

PREVIDENT 5000 224

PREVIDENT 5000 ENAMEL PROTECT 224

PREVIDENT 5000 PLUS 224

PREVIDENT 5000 SENSITIVE 224

PREVIFEM 207

PREVNAR 13 132

PREVPAC 135

PREZCOBIX 127

PREZISTA 127

PRIFTIN 64

prilocaine hcl 293

PRILOSEC 135,136

primaquine 114

primeaire 293

primidone 74

PRIMLEV 11,12

PRIMSOL 33

PRINIVIL 243

PRISMASOL 174

PRISTIQ 78

privet 160

PROAIR HFA 5

PROAIR RESPICLICK 5

probenecid 174

probenecid-colchicine 174

procainamide hcl 52

procaine hcl 294

procarbazine hcl 294

PROCARDIA 149

PROCARDIA XL 149

PROCENTRA 28

prochamber 294

prochlorperazine 91

prochlorperazine edisylate 91

prochlorperazine maleate 91

PROCORT 252

PROCRIT 147

PROCTO-MED HC 252

PROCTO-PAK 252

PROCTOCORT 252

PROCTOFOAM-HC 252

PROCTOSOL-HC 252

PROCTOZONE-HC 252

PROCYSBI 235

prodigy mini-mist 294

PRODRIN 12

PROFERRIN-FORTE 50

progesterone 216

progesterone in oil 216

progesterone micronized 216

PROGLYCEM 103

PROGRAF 231

PROLENSA 46

PROMACTA 147

promazine hcl 124

promethazine hcl 102,141

promethazine vc 102

promethazine vc-codeine 22

promethazine-codeine 103

promethazine-dm 103

promethazine-phenyleph-codeine 22

promethazine-phenylephrine 103

PROMETHEGAN 141

PROMETRIUM 216

PROMISEB 294

proneb ultra ii 294

propafenone hcl 53

propafenone hcl er 53

propantheline bromide 67

proparacaine hcl 182

PROPECIA 261

propranolol hcl 54,55

propranolol hcl er 55

propranolol-hydrochlorothiazid 55

propyl gallate 294

propylene glycol 294

propylthiouracil 267

PROQUAD 132

PROSCAR 220

PROSED-DS 33

prostaglandin e1 306

PROSTIN E2 VAGINAL SUPPOSITORY 294

PROSTIN VR PEDIATRIC 306

protamine sulfate 99

PROTECT IRON 50

PROTHELIAL 294

protirelin 164

PROTONIX 136

PROTOPAM CHLORIDE 221

PROTOPIC 261

protriptyline hcl 82

provent 294

PROVERA 216

PROVIDA DHA 50

PROVIDA OB 50

PROVIGIL 31

PROVISC 294

PROVOCHOLINE 294

PROZAC 80

PROZAC WEEKLY 80

PRUCLAIR 175

PRUDOXIN 254

PRUMYX 294

PRUTECT 175

pseudoephedrine hcl 4

PSORCON 252

PULMICORT 155

PULMICORT FLEXHALER 155

pulmo-aide 294

PULMOSAL 174

PULMOZYME 244

PURIXAN 231

PYLERA 62

pyrantel pamoate 32

pyrazinamide 111,112

PYRIDIUM 254

pyridostigmine bromide 145

pyridostigmine bromide er 145

pyridoxal-5-phosphate 294

pyridoxine hcl 309

pyrilamine maleate 183

pyrimethamine 114

PYROGALLIC ACID 261

pyruvic acid 235

QQBRELIS 243

QNASL 45

QNASL CHILDREN 45

QSYMIA 25

quack grass 160

QUADRACEL DTAP-IPV 133

quake 294

QUALAQUIN 114

QUARTETTE 208

QUASENSE 208

quaternium-15 294

quazepam 143

QUDEXY XR 72

queen palm 160

quercetin dihydrate 294

QUESTRAN 105

QUESTRAN LIGHT 105

quetiapine fumarate 119

quetiapine fumarate er 119

QUILLICHEW ER 31

QUILLIVANT XR 31

quinacrine hcl 114

quinapril hcl 243

quinapril-hydrochlorothiazide 168

quinidine gluconate 52

quinidine sulfate 52

quinine hcl 114

quinine sulfate 114

RR-NATAL OB 50

RABAVERT 133

rabbit epithelium 160

rabeprazole sodium 136

racepinephrine hcl 4

RADIAPLEXRX 294

RADIGEL 294

RADIOGARDASE 217

RAGWITEK 235

RAJANI 208

raloxifene hcl 176

ramipril 243

RANEXA 150

ranitidine hcl 134

RAPAFLO 7

RAPAMUNE 231

rapport vacuum therapy 294

rasagiline mesylate 77

RASUVO 226

rauwolfia serpentina 217

RAVICTI 171

RAYALDEE 310

RAYOS 194

RAZADYNE 145

RAZADYNE ER 145

REA LO 40 256

READI-CAT 2 164

REBETOL 138

REBIF 229

REBIF REBIDOSE 230

RECEDO 294

RECLIPSEN 208

RECOMBIVAX HB 133

RECOTHROM 100

RECTIV 261

red birch 160

red cedar 160

red maple 160

red mulberry 160

red oak 160

red yeast rice 294

REFISSA 254

REGENECARE 254

REGIMEX 28

REGLAN 189

REGONOL 145

REGRANEX 261

RELAGARD 42

RELENZA 137

RELISTOR 188

RELPAX 110

REMERON 76

REMEVEN 256

REMODULIN 245

RENA-VITE RX 309

RENAGEL 218

RENOVA 254

RENOVA PUMP 254

RENOVO 261

RENVELA 218

repaglinide 87

repaglinide-metformin hcl 85

REPATHA PUSHTRONEX 109

REPATHA SURECLICK 109

REPATHA SYRINGE 109

replicare 294

replicare ultra 294

replicare ultra sacrum 295

REPREXAIN 22

REQ49+ 307

REQUIP 169

REQUIP XL 169

RESCRIPTOR 125

RESECTISOL 172

reserpine 217

resorcinol 295

RESPA A.R. 103

RESTASIS 46

RESTASIS MULTIDOSE 46

RESTORA SPRINKLES 188

restore 295

restore calcium alginate 295

restore contact layer silver 295

RESTORIL 143

resveratrol 235

RETIN-A 255

RETIN-A MICRO 255

RETIN-A MICRO PUMP 255

retinaldehyde 295

retinoic acid 255

RETROVIR 126

reusable nebulizer kit 295

REVATIO 245

REVIA 153

REVLIMID 230

REXULTI 119

REYATAZ 127

REZIRA 4

RHEUMATREX 227

RHINOCORT AQUA 45

rhizopus 160

RHOFADE 261

RIBASPHERE 138

RIBASPHERE RIBAPAK 138

RIBATAB 139

ribavirin 139

riboflavin 309

riboflavin-5-phosphate sodium 309

rice 160

RIDAURA 227

rifabutin 64

RIFADIN 64

RIFAMATE 64

rifampin 64

RIFATER 64

rifaximin 65

RILUTEK 152

riluzole 152

rimantadine hcl 136

RIMSO-50 252

RIOMET 85

risedronate sodium 223

risedronate sodium dr 223

RISPERDAL 119,120

RISPERDAL CONSTA 120

RISPERDAL M-TAB 120

risperidone 120

risperidone odt 120,121

RITALIN 31

RITALIN LA 31

riteflo 295

rivastigmine 145

RIVELSA 208

rizatriptan 110

ROBAXIN 247

ROBAXIN-750 247

robinson clear vinyl catheter 295

ROBINUL 67

ROBINUL FORTE 67

ROCALTROL 310

rocuronium bromide 248

ropinirole er 169

ropinirole hcl 170

ropivacaine hcl 295

ropivacaine hcl-0.9% nacl 295

ROSADAN 40

ROSANIL 42

rosuvastatin calcium 108

ROTARIX 133

ROTATEQ 133

rough marsh elder 160

rough pigweed 160

ROWASA 184

ROWEEPRA 73

ROXICODONE 22

ROZEREM 141

rubber mouthpiece 295

RUBRACA 295

RULAVITE DHA 50

russian thistle 160

RYDAPT 295

RYNODERM 256

RYTARY 113

RYTHMOL 53

RYTHMOL SR 53

RYVENT 101

SSABRIL 73

saccharin 174

saccharomyces cerevisiae 160

safety syringe with shield 296

safety syringe-needle 296

safetyglide allergy syringe 296

SAFYRAL 208

sagebrush 161

SAIZEN 214

SAIZEN-SAIZENPREP 214

SALACYN 256

SALAGEN 145

SALEX 256

salicylic acid 256

salicylic acid er 256

SALIVAMAX 296

SALIVATERX 296

SALKERA 256

salsalate 239

SALVAX 256

sami the seal 296

sami the seal mask 296

SAMSCA 166

SANADERMRX 252

SANCUSO 90

SANDIMMUNE 227

SANDOSTATIN 264

SANDOSTATIN LAR DEPOT 264

SANTYL 261

SAPHRIS 121

SARAFEM 80

SAVAYSA 69

SAVELLA 78

saw palmetto 296

SAXENDA 86

SCALACORT 252

SCLEROSOL 150

scopolamine 91

scopolamine hydrobromide 67

scopolamine methyl nitrate 67

SEASONIQUE 208

SEB-PREV 42

SEBUDERM 296

SECONAL SODIUM 142

secretin-mannitol 163

SECTRAL 55

SEEBRI NEOHALER 67

selegiline hcl 77

selenium sulfide 42

selenomethionine 174

SELRX 42

SELZENTRY 124

SEMPREX-D 102

SENSIPAR 235

SENSORCAINE 296

SENSORCAINE WITH DEXTROSE 296

SENSORCAINE-EPINEPHRINE 266

SENSORCAINE-MPF 296

SENSORCAINE-MPF EPINEPHRINE 266

sensura click ostomy pouch 296

sensura flex ostomy base plate 296

sensura flex ostomy pouch 296

sensura ostomy base plate 296

SEREVENT DISKUS 5

sermorelin acetate 214

SERNIVO 252

SEROPHENE 176

SEROQUEL 121

SEROQUEL XR 121,122

SEROSTIM 214

serotonin hcl 296

sertraline hcl 80

sesame seed 161

SETLAKIN 208

sevelamer carbonate 218

sevoflurane 189

SF 224

SF 5000 PLUS 224

SFROWASA 184

shagbark hickory 161

SHAROBEL 208

sheep sorrel 161

sheep sorrel-yellow dock 161

SHOHL'S MODIFIED 170

short ragweed 161

shrimp 161

sidestream 296

sidestream mask 296

sidestream nebulizer 296

sidestream plus 296

SIGNIFOR 265

SIGNIFOR LAR 265

sildenafil 246

sildenafil citrate 246

SILENOR 82

silicone mask 296

SILVADENE 42

silver nitrate 42,257

silver nitrate applicator 257

silver protein 42

silver sulfadiazine 42

silver sulphadiazine 42

silverseal hydrogel 296

SILVRSTAT 296

SIMBRINZA 97

SIMCOR 108

simethicone 185

SIMPONI 227

simvastatin 108

SINELEE 261

SINEMET 10-100 113

SINEMET 25-100 113

SINEMET 25-250 113

SINEMET CR 113

SINGULAIR 47

SINOGRAFIN 164

sinustar 296

sirolimus 231,232

SIRTURO 112

SITAVIG 139

SITZMARKS 164

SIVEXTRO 64

SKELAXIN 247

SKLICE 44

sodium 4-aminosalicylate 112

sodium acetate trihydrate 174

sodium ascorbate 310

sodium benzoate 296

sodium bicarbonate 170

sodium butyrate 296

sodium cacodylate 174

sodium caprylate 92

sodium chloride 174

sodium citrate 68,170

sodium citrate dihydrate 170

sodium citrate-citric acid 170

sodium deoxycholate 297

sodium dichloroacetate 297

sodium fluoride 224

sodium hyaluronate 297

sodium hyaluronic acid 297

sodium hydroxide 257

sodium iodide 297

sodium l-aspartate monohydrate 174

sodium metabisulfite 297

sodium nitrite 306

sodium phenylbutyrate 171

sodium phosphate 186

sodium polystyrene sulfonate 218

sodium stearyl fumarate 297

sodium succinate 297

sodium sulfacetamide 42

sodium sulfacetamide-sulfur 43

sodium sulfate 186

sodium tetradecyl sulfate 150

sodium thiosulfate 94

sodium valproate 73

SOJOURN 189

SOLARAZE 261

SOLIQUA 100-33 86

SOLODYN 62

SOLTAMOX 297

SOLU-CORTEF 194

SOLU-MEDROL 194

SOMA 247

SOMAVERT 265

SONAFINE 175

SONATA 141

SOOLANTRA 261

sorbic acid 297

sorbitol 186

sorbitol-mannitol 165

SORIATANE 261

SORILUX 262

SORINE 55

sotalol 55

sotalol af 55

SOTYLIZE 55

SOVALDI 191

soybean 161

SP ANTIPRURITIC 297

SPECTRACEF 155

spectragel 297

SPHERUSOL 162

spinosad 44

spiny pigweed 161

SPIRIVA 67

SPIRIVA RESPIMAT 67

spironolactone 167

spironolactone-hctz 167

spirulina 297

SPORANOX 93

SPRAY AND STRETCH 254

SPRINTEC 208

SPRITAM 73

SPRIX 238

SPRYCEL 297

SPS 218

SRONYX 208

SSD 43

SSKI 92

SSS 10-5 43

STALEVO 100 112

STALEVO 125 112

STALEVO 150 112

STALEVO 200 112

STALEVO 50 112

STALEVO 75 112

STAMARIL 133

standard bermuda grass pollen 161

standard mixed mite extract 161

standard rye grass pollen 161

standard sweet vernal grass 161

standardized cat hair 161

standardized june grass pollen 161

standardized meadow fescue 161

standardized orchard grass 161

standardized red top grass 161

standardized timothy grass 161

stanozolol 196

stanozolol micronized 196

STARLIX 87

stavudine 126

STELARA 227

sterile talc 150

STIMATE 100

STIOLTO RESPIMAT 67

STIVARGA 297

STRATTERA 152

STRAVIX 235

strawberry 161

STRENSIQ 298

streptomycin sulfate 58

STRIANT 196

STRIBILD 124

STRIVERDI RESPIMAT 5

STROMECTOL 32

strong iodine 92

SUBOXONE 24

succimer dmsa 221

succinylcholine chloride 248

SUCRAID 298

sucralfate 134

sufentanil citrate 22

SULAR 148

sulfacetamide 60

sulfacetamide sod monohydrate 60

sulfacetamide sodium 36,43,60

sulfacetamide sodium-sulfur 43

sulfacetamide-prednisolone 36

SULFACLEANSE 8-4 43

sulfadiazine 60

sulfadiazine sodium 60

sulfamethoxazole 60

sulfamethoxazole-trimethoprim 60

SULFAMYLON 43

sulfanilamide 61

sulfapyridine 61

sulfasalazine 61

sulfasalazine dr 61

sulfathiazole 61

SULFATRIM 61

sulfisoxazole 61

sulfur 257

sulfurated potash 298

sulindac 238,239

SUMADAN 43

sumatriptan 110

sumatriptan succinate 110

SUMAVEL DOSEPRO 110

SUMAXIN 43

SUMAXIN TS 43

sunrise compressor-nebulizer 298

SUPERVITE 309

SUPERVITE EC 307

SUPRANE 189

SUPRAX 155

SUPRENZA ODT 25

SUPREP 186

SURMONTIL 83

SURVANTA 244

SUSTIVA 125

SUTENT 298

SWABFLUSH 298

sweet corn 161

sweetgum 161

SYEDA 208

SYLATRON 137

SYMAX 67

SYMAX DUOTAB 67

SYMAX-SL 67

SYMAX-SR 67

SYMBICORT 5

SYMBYAX 81

SYMLINPEN 120 83

SYMLINPEN 60 83

SYNALAR 252

SYNALAR TS 252

SYNALGOS-DC 129

SYNAREL 213

SYNDROS 91

SYNERA 254

SYNERDERM 175

SYNJARDY 85

SYNJARDY XR 85,86

SYNRIBO 298

SYNTHROID 267

SYPRINE 298

SYREX 174

syringe 298

SYRINGE AVITENE 100

syringe-needle 298

Tt.e.d. anti-embolism stocking 298

TABLOID 299

TACHOSIL 100

TACLONEX 252

tacrolimus 232,262

tacrolimus micronized 232

TAFINLAR 299

TAGITOL 164

TAGRISSO 299

tall ragweed 161

TALTZ AUTOINJECTOR 262



TALTZ SYRINGE 262



TALWIN 24

TAMIFLU 137

tamoxifen citrate 299

tamsulosin hcl 8

TAPAZOLE 267

TARCEVA 299

TARGADOX 62

TARGRETIN 262,299

TARINA FE 209

TARKA 148

TARON-CRYSTALS 170

TASIGNA 299

TASMAR 112

TAYTULLA 209

tazarotene 262

TAZICEF 155

TAZORAC 263

TAZTIA XT 57

TECFIDERA 230

TECHNIVIE 127

TEGRETOL 73

TEGRETOL XR 73

TEKAMLO 149

TEKTURNA 243

TEKTURNA HCT 166

telmisartan 241

telmisartan-amlodipine 150

telmisartan-hydrochlorothiazid 168

temazepam 143

TEMODAR 299

TEMOVATE 252

TEMOVATE EMOLLIENT 252

temozolomide 300

TENCON 12

TENEX 152

TENIVAC 131

TENORETIC 100 55

TENORETIC 50 55

TENORMIN 55

tens 502 300

tens 504 300

TERAZOL 3 95

TERAZOL 7 95

terazosin hcl 6

terbinafine hcl 92

terbutaline sulfate 5

terconazole 95

terpin hydrate 244

TERRELL 190

TERSI FOAM 43

terumo surguard2 300

TESSALON PERLE 244

testosterone 196

testosterone cypionate 196

testosterone cypionate micro 196

testosterone enanthate 196

testosterone micronized 196

testosterone propionate 196

TESTRED 197

tetanus diphtheria toxoids 131

TETCAINE 182

tetrabenazine 152

tetracaine 300

tetracaine hcl 182,300

tetracycline hcl 62

tetrahydro-l-biopterin di-hcl 300

tetrahydrobiopterin di-hcl 300

tetrahydrobiopterin hcl 300

tetrahydrozoline hcl 183

TETRAVISC 182

TETRAVISC FORTE 182

TETRIX 175

TEXACORT 252

TEXAVITE LQ 50

THALOMID 230

theanine 235

THEO-24 147

theobromine 300

THEOCHRON 147

theophylline 147

theophylline anhydrous 147

THERACYS 133

THERAPEUTIC VITAMIN W-MINERALS 307

THERMAZENE 43

thiabendazole 32

thiamine hcl 309

thioguanine 300

THIOLA 235

thioridazine hcl 124

thioridazine hydrochloride 124

thiotepa 300

thiothixene 124

threonine 300

threshold imt 300

threshold pep 300

THRIVITE 19 50

THRIVITE RX 50

THROMBI-GEL 300

THROMBI-PAD 300

THROMBIN-JMI 100

thyroid 267

THYROLAR-1 267

THYROLAR-1/2 268

THYROLAR-1/4 268

THYROLAR-2 268

THYROLAR-3 268

tiagabine hcl 73

TIAZAC 57

ticarcillin disod-clavulanate 240

ticlopidine hcl 129

TIGAN 91

TIKOSYN 55

TILIA FE 209

timolol maleate 55,97

TIMOPTIC 97

TIMOPTIC OCUDOSE 97

TIMOPTIC-XE 97

TINDAMAX 114

tinidazole 114

tiopronin 235

TIROSINT 268

TISSEEL VHSD 100

titanium dioxide 300

TIVICAY 124

TIVORBEX 222

tizanidine hcl 247

TL FOLATE 50

TL-CERMIDE 300

TOBI 58

TOBI PODHALER 58

TOBRADEX 36

TOBRADEX ST 36

tobramycin 36,58

tobramycin sulfate 58

tobramycin-dexamethasone 36

TOBREX 37

tocopheryl acid succinate 310

TOFRANIL 83

TOFRANIL-PM 83

TOLAK 263

tolazamide 88

tolazoline hcl 306

tolbutamide 88

tolcapone 112

tolmetin sodium 239

tolterodine tartrate 190

tolterodine tartrate er 190

toomey syringe 300

TOPAMAX 73

TOPICORT 252

topiramate 73

topiramate er 73

TOPROL XL 55

torsemide 165

touch-trol 301

TOUJEO SOLOSTAR 87

TOVIAZ 191

TOXICOLOGY SALIVA COLLECTION 239

TRACLEER 246

TRADJENTA 86

tramadol hcl 22

tramadol hcl er 22

tramadol hcl-acetaminophen 12

trandolapril 243

trandolapril-verapamil er 148

tranexamic acid 100

tranilast 47

TRANSDERM-SCOP 91

TRANXENE T-TAB 75

tranylcypromine sulfate 77

TRAVATAN Z 99

travoprost 99

trazodone hcl 81

TREAGAN OTIC 301

TRECATOR 112

trek s combo pack 301

trek s compact compressor 301

trek s portable pwr kit 301

TRETIN-X 255

tretinoin 255,301

tretinoin acid 255

tretinoin microsphere 255

TREXALL 227

TREXIMET 110

TREZIX 12

TRI FEMYNOR 209

TRI-CHLOR 263

TRI-ESTARYLLA 209

TRI-LEGEST FE 209

TRI-LINYAH 209

TRI-LO-ESTARYLLA 209

TRI-LO-MARZIA 209

TRI-LO-SPRINTEC 209

TRI-LUMA 156

TRI-NORINYL 209

TRI-PREVIFEM 209

TRI-SPRINTEC 209

TRI-TABS DHA 50

TRI-VI-FLOR 224

triacetin 92

triamcinolone 194

triamcinolone acetonide 45,194,252

triamcinolone diacetate 194

triamcinolone diacetate micro 194

triamcinolone hexacetonide 194

triamterene 165

triamterene-hydrochlorothiazid 165

TRIANEX 252

triazolam 143

TRIBENZOR 168

TRICARE PRENATAL 50

trichlormethiazide 166

trichloroacetic acid 263,301

trichophyton 161

TRICITRASOL 170

TRICITRATES 170

triclosan 43

TRICOR 106

TRIDERM 252

TRIDESILON 252

TRIESENCE 45

TRIFERIC 50

trifluoperazine hcl 124

trifluridine 37

TRIGLIDE 107

trihexyphenidyl hcl 68

TRIKLO 104

TRILEPTAL 73

TRILIPIX 107

trilostane 301

TRILYTE WITH FLAVOR PACKETS 186

trimeprazine tartrate 183

trimethobenzamide hcl 91

trimethoprim 33

trimethoprim micronized 33

trimipramine maleate 83

TRINATE 50

TRINESSA 209

TRINESSA LO 210

TRINTELLIX 81

trioxsalen 301

tripelennamine hcl 183

TRIPLE DYE 94

triprolidine hcl 101

TRIUMEQ 125

TRIVEEN-ONE 50

TRIVEEN-U 307

TRIVORA-28 210

TRIZIVIR 126

TROKENDI XR 73

trolamine 301

TROPAZONE 301

tropicamide 183

trospium chloride 191

trospium chloride er 191

TRULICITY 86

TRUMENBA 133

truneb nebulizer 301

TRUSOPT 98

TRUST NATAL DHA 307

TRUVADA 126

truzone peak flow meter 301

trypsin 301

tryptophan (l) 141

TUBERSOL 164

turmeric root 235

TUSSICAPS 103

TUSSIGON 67

TUSSIONEX 103

TUZISTRA XR 22

TWINRIX 133

TWYNSTA 150

TYBOST 235

TYKERB 301

TYLENOL-CODEINE NO.3 12

TYLENOL-CODEINE NO.4 12

TYMLOS 213

TYPHIM VI 133

tyrosine 172

TYVASO 246

TYVASO INSTITUTIONAL START KIT 246

TYVASO REFILL KIT 246

TYVASO STARTER KIT 246

TYZEKA 139

TYZINE 183

Uubidecarenone 235

ubiquinol 235

UCERIS 194

UDAMIN SP 307

ULESFIA 43

ULORIC 222

ULTANE 190

ulticare 301

ULTRACET 12

ULTRAFOAM 100

ULTRAM 22

ULTRAM ER 22

ULTRASAL-ER 257

ULTRAVATE 253

ULTRAVIST 164

UMECTA 257

UMECTA PD 257

UNASYN 240

undecylenic acid 94

unistik 2 normal 301

UNITHROID 268

UPTRAVI 246

UR N-C 33

URAMAXIN 257

URAMAXIN GT 257

URE-K 257

urea 257

URECHOLINE 145

URELLE 33

URETRON D-S 33

UREVAZ 257

URIBEL 33

URIMAR-T 33

URIN D.S. 33

URO-458 33

URO-BLUE 33

URO-L 33

UROCIT-K 170

UROGESIC-BLUE 34

UROPHEN MB 34

UROQID-ACID NO.2 34

UROXATRAL 8

URSO 186

URSO FORTE 186

ursodiol 186

URYL 34

USTELL 34

UTA 34

UTIBRON NEOHALER 5

UTIRA-C 34

UTOPIC 257

UVADEX 157

VV-C FORTE 307

vacustim black 301

VAGIFEM 180

valacyclovir 139

valacyclovir hcl 139

VALCHLOR 263

VALCYTE 139

valganciclovir hcl 139

valine 301

VALIUM 75

valproic acid 73

valsartan 242

valsartan-hydrochlorothiazide 168

VALSTAR 301

VALTREX 139

VANATOL LQ 12

VANCOCIN HCL 63

vancomycin hcl 63

VANDAZOLE 40

VANIQA 263

VANOS 253

VANOXIDE-HC 253

vapro plus intermitt catheter 301

VAQTA 133

VARIBAR HONEY 164

VARIBAR NECTAR 164

VARIBAR PUDDING 164

VARIBAR THIN HONEY 164

VARIBAR THIN LIQUID 164

VARIVAX VACCINE 133

VARIZIG 130

VARUBI 91

VASCEPA 104

vascuderm hydrogel wound 301

VASELINE WHITE PETROLEUM 175

VASERETIC 169

vasopressin 214

VASOTEC 243

VAXCHORA ACTIVE COMPONENT 133

VAXCHORA BUFFER COMPONENT 301

VAXCHORA VACCINE 133

VECAMYL 217

VECTICAL 263

vecuronium bromide 248

VELIVET 210

VELPHORO 218

VELTASSA 218

VEMLIDY 139

VENATAL COMPLETE DHA 302

VENCLEXTA 302

VENCLEXTA STARTING PACK 302

VENELEX 263

venlafaxine hcl 78

venlafaxine hcl er 78

VENTOLIN HFA 6

VERAMYST 45

verapamil er 57

verapamil er pm 57

verapamil hcl 57

verapamil sr 57

VERDESO 253

VERDROCET 12

VEREGEN 263

VERELAN 57

VERELAN PM 57

VERIPRED 20 195

VERSACLOZ 122

VESICARE 191

VESTURA 210

VEXOL 46

VFEND 93

VIAGRA 306

VIASPAN BELZER-UW 302

VIBERZI 188

VIBRAMYCIN 62

VIC-FORTE 307

VICODIN 12

VICODIN ES 12

VICODIN HP 12

VICOPROFEN 23

VICTOZA 2-PAK 86

VICTOZA 3-PAK 87

vidarabine 139

vidarabine monohydrate 139

VIDEX 126

VIDEX EC 126

VIEKIRA PAK 128

VIEKIRA XR 128

VIENVA 210

vigabatrin 73

VIGAMOX 37

VIIBRYD 81

VIMPAT 73

VINATE DHA 50

VINATE DHA RF 51

VINATE GT 51

VINATE II 51

VINATE ONE 51

VINATE PN CARE 307

VINATE ULTRA 51

VINATE-M 307

VIORELE 210

vios aerosol delivery system 302

VIRACEPT 128

VIRAMUNE 125

VIRAMUNE XR 125

VIRASAL 257

VIRAZOLE 139

VIREAD 126

virginia live oak 161

VIROPTIC 37

VIRT-ADVANCE 51

VIRT-C DHA 51

VIRT-CAPS 309

VIRT-GARD 309

VIRT-NATE 51

VIRT-NATE DHA 51

VIRT-PHOS 250 NEUTRAL 170

VIRT-PN 51

VIRT-PN DHA 51

VIRT-PN PLUS 51

VIRT-VITE 309

VIRT-VITE PLUS 309

VIRTRATE-2 170

VIRTRATE-3 171

VIRTRATE-K 171

VISCOAT 302

VISTARIL 141

VISTOGARD 221

VIT 3 104

VITA-RESPA 309

VITAFOL GUMMIES 51

vitamin a acetate 308

vitamin a palmitate 308

vitamin d2 310

vitamin d3 310

vitamin e acetate 310

vitamin k 311

vitamin k1 221

vitamin k2 311

vitamins a,c,d and fluoride 308

VITASPIRE 302

VITATRUE 51

VITRASE 302

VITUZ 103

VIVA DHA 51

VIVELLE-DOT 180

VIVITROL 153

VIVLODEX 239

VIVOTIF 133

VIVOTIF BERNA 133

vixone nebulizer 302

VOL-TAB RX 51

VOLTAREN 239

VOLTAREN-XR 239

VOLUMEN 164

voriconazole 93

vortex 302

vortex vhc frog mask 302

vortex vhc ladybug mask 302

VOSEVI 302

VOSPIRE ER 6

VOTRIENT 302

VP-CH-PNV 51

VP-HEME OB 51

VP-HEME ONE 51

VP-PNV-DHA 51

VP-VITE RX 309

VP-ZEL 235

VRAYLAR 122

VUSION 95

VYFEMLA 210

VYNATAL-FA 51

VYTONE 43

VYTORIN 105

VYVANSE 28

Wwarfarin sodium 68

wasp venom protein 161

water 302

WELCHOL 83

WELLBUTRIN 76

WELLBUTRIN SR 76,77

WELLBUTRIN XL 77

WERA 210

western juniper 162

western ragweed 162

WESTHROID 268

white ash 162

white birch 162

white faced hornet venom 162

white mulberry 162

white oak extract 162

white pine 162

white willow bark 302

whole egg 162

wide seal diaphragm 302

wound matrix 303

WP THYROID 268

WYMZYA FE 210

XXADAGO 113

XALATAN 99

XALKORI 303

XANAX 143

XANAX XR 143

xanthan gum 303

XARELTO 69

XARTEMIS XR 12

XATMEP 227

XCLAIR 175

XELJANZ 227

XELJANZ XR 227

XELODA 303

XENAZINE 152

XENICAL 189

XERESE 40

XERMELO 185

xeroform 303

xeroform petrolatum dressing 303

XIFAXAN 65

XIIDRA 46

XODOL 10-300 13

XODOL 5-300 13

XODOL 7.5-300 13

XOLEGEL 95

XOPENEX 6

XOPENEX CONCENTRATE 6

XTANDI 303

XULANE 210

XURIDEN 235

XYLOCAINE 53,182,303

XYLOCAINE DENTAL-EPINEPHRINE 266

XYLOCAINE WITH EPINEPHRINE 266

XYLOCAINE-MPF 53,303

XYLOCAINE-MPF WITH EPINEPHRINE 266

xylometazoline hcl 303

XYLON 10 23

XYREM 152

XYZAL 102

YYASMIN 28 210

YAZ 210

yellow dock 162

yellow hornet venom protein 162

yellow jacket venom protein 162

YF-VAX 133

yohimbine hcl 265,303

YUVAFEM 180

Zzafirlukast 47

zaleplon 141

ZAMICET 13

ZANABIN 303

ZANAFLEX 247

ZANTAC 134

ZARAH 210

ZARONTIN 75

ZARXIO 147

ZAVESCA 235

zazole 95

zeaxanthin 303

ZEBETA 55

ZEBUTAL 13

ZEGERID 136

ZEJULA 303

ZELAPAR 77

ZELBORAF 303

ZEMBRACE SYMTOUCH 110

ZEMPLAR 310

ZENATANE 263

ZENCHENT 211

ZENCHENT FE 211

ZENCIA 43

ZENPEP 187

ZENZEDI 28

ZEOSA 211

ZEPATIER 191

ZERIT 126

ZESTORETIC 169

ZESTRIL 243

ZETIA 105

ZETONNA 46

ZIAC 55

ZIAGEN 126

zidovudine 127

zileuton er 47

ZINACEF 154

ZINBRYTA 230

zinc acetate 303

zinc chloride 174

zinc oxide 263

zinc picolinate 174

zinc pyrithione 304

zinc sulfate 174

zinc undecylenate 94

ZINGO 304

ziprasidone hcl 122

ZIPSOR 239

ZIRGAN 37

ZITHRANOL 257

ZITHRANOL-RR 257

ZITHROMAX 219

ZITHROMAX TRI-PAK 219

ZMAX 219

ZOCOR 108

ZODEX 195,304

ZOFRAN 90

ZOFRAN ODT 90

ZOLATE 309

ZOLINZA 304

zolmitriptan 110

zolmitriptan odt 111

ZOLOFT 81

zolpidem tartrate 141

zolpidem tartrate er 142

ZOLPIMIST 142

ZOMACTON 214

ZOMIG 111

ZOMIG ZMT 111

ZONALON 254

ZONATUSS 244

ZONEGRAN 73

zonisamide 73,74

ZONTIVITY 129

ZORBTIVE 214

ZORTRESS 232

ZOSTAVAX 133

ZOTEX-C 304

ZOVIA 1-35E 211

ZOVIA 1-50E 211

ZOVIRAX 40,140

ZUBSOLV 24

ZUPLENZ 90

ZURAMPIC 174

ZUTRIPRO 23

ZYBAN 77

ZYCLARA 263

ZYDELIG 304

ZYFLO 47

ZYFLO CR 47

ZYKADIA 304

ZYLET 37

ZYLOPRIM 222

ZYMAXID 37

ZYPREXA 122

ZYPREXA RELPREVV 122

ZYPREXA ZYDIS 122,123

ZYTIGA 304

ZYVOX 64

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

o Qualified sign language interpreters

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o Information written in other languages If you need these services, contact the Director of Compliance and Legal Services. If you believe that GlobalHealth has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: ATTN: Director of Compliance and Legal Services, 701 NE 10th St, Ste. 300, Oklahoma City, OK 73104-5403, Fax: (405) 280-5894, or E-mail: [email protected]. You can file a grievance in person or by mail, fax, or e-mail. If you need help filing a grievance, the Compliance Attorney is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Language Translation

Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-280-2989 (TTY: 711).

Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-877-280-2989 (TTY: 711).

Chinese 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-877-280-

2989 (TTY: 711).

Korean 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.

1-877-280-2989 OR (TTY: 711)번으로 전화해 주십시오.

German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche


https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

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

Language Translation

Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-877-280-2989 (TTY: 711).

Arabic 4692-082-778-1 117) .اتصل .إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان :ملحوظة (ھاتف الصم والبكم برقم

Burmese သတိျပဳရန ္- အကယ္၍ သင္သည္ ျမန္မာစကား ကို ေျပာပါက၊ ဘာသာစကား အကူအညီ၊ အခမ့ဲ၊

သင့္အတြက ္စီစဥ္ေဆာင္ရြက္ေပးပါမည္။ ဖုန္းနံပါတ္ 1-877-280-2989 (TTY: 711) သု႔ိ ေခၚဆိုပါ။

Hmong LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-877-280-2989 (TTY: 711).

Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-877-280-2989 (TTY: 711).

French ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-877-280-2989 (ATS: 711).

Laotian ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້ າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫ ຼື ອດ້ານພາສາ, ໂດຍບ່ໍເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້

ທ່ານ. ໂທຣ 1-877-280-2989 (TTY: 711).

Thai เรยีน: ถา้คณุพดูภาษาไทยคณุสามารถใชบ้รกิารชว่ยเหลอืทางภาษาไดฟ้ร ีโทร 1-877-280-2989 (TTY: 711).

Urdu 280-877-1 کریں کال ۔ ہیں دستیاب میں مفت خدمات کی مدد کی زبان کو آپ تو ہیں، بولتے اردو آپ اگر :خبردار-2989 (TTY: 711).

Cherokee Hagsesda: iyuhno hyiwoniha [tsalagi gawonihisdi]. Call 1-877-280-2989 (TTY: 711).

Persian اگر بھ زبان فارسی گفتگو می کنید، تسھیالت زبانی بصورت رایگان برای شما :توجھ

1-877-280-2989 (TTY: 711) با تماس بگیرید .فراھم می باشد.

MFEHBDF18

GlobalHealth, Inc.

PO Box 2393Oklahoma City, OK 73101-2393

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GlobalHealth Precision Federal

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