virginia premier health plan famis medicaid formulary

VIRGINIA PREMIER HEALTH PLAN

FAMIS MEDICAID FORMULARY

PLEASE NOTE: Check your benefit materials for the specific drugs covered and the

copayments for your prescription drug program. For specific questions about your

coverage, please call the phone number printed on your ID card. The list may not be all-

inclusive. THIS LIST IS SUBJECT TO CHANGE.

For the member: Generic medications contain the same active ingredients as their

corresponding brand-name medications, although they may look different in color or shape.

They have been FDA-approved under strict standards.

For the physician: Please prescribe preferred products and allow generic substitutions when

medically appropriate. Thank you.

CURRENT AS OF 3/1/2022

lowercase italics = Generic Formulary drugsUPPERCASE = Brand name Formulary drugs

Formulary StatusFormulary = Covered

Requirements/LimitsAGE = Age limit requirementCustom = Drug has unique restrictionsOTC = Over the CounterPA = Prior Authorization requiredQL = Quantity Level LimitSP = Specialty Drug. Preferred Specialty Pharmacy will be listed if applicableST = Step Therapy may apply to some or all strengths of the drug

Drug Name Formulary Status Requirements/Limits1st relief spray external liquid 4-1 % Formulary OTC

1st tier unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm

Formulary OTC; QL (200 EA per 30 days)

1st tier unilet comfortouch Formulary OTC; QL (150 EA per 30 days)

4-N-1 EXTERNAL CREAM 1 % Formulary OTC

50+ adult eye health oral capsule Formulary OTC

A & D ZINC OXIDE EXTERNAL CREAM Formulary OTC

a thru z advanced oral tablet Formulary OTC

a thru z advantage oral tablet Formulary OTC

a thru z select oral tablet chewable Formulary OTC

A+D CRACKED SKIN RELIEF EXTERNAL CREAM 2-0.13 %

Formulary OTC

a1c test at-home in vitro kit Formulary OTC

a-25 oral capsule 25000 unit Formulary OTC

abacavir sulfate oral solution 20 mg/ml Formulary

abacavir sulfate oral tablet 300 mg Formulary

abacavir sulfate-lamivudine oral tablet 600-300 mg Formulary

abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg

Formulary

ABANATUSS PED ORAL LIQUID 15-0.5-6.25 MG/ML, 60-2-25 MG/5ML

Formulary OTC

ABATRACE ORAL CAPSULE Formulary OTC

ABATREX ORAL TABLET 8-200-4-100-600 MG Formulary OTC

ABATRON AF ORAL TABLET 150-1 MG Formulary OTC

ABATRON ORAL LIQUID Formulary OTC

ABATUSS DMX ORAL LIQUID 30-1-15 MG/5ML Formulary OTC

ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE 300 MG, 400 MG

Formulary AGE (Min 18 Years)

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED 300 MG, 400 MG


ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 300 MG, 400 MG


ABILIFY MYCITE ORAL TABLET 10 MG, 15 MG, 2 MG, 20 MG, 30 MG, 5 MG

Formulary PA

abiraterone acetate oral tablet 250 mg Formulary

ABRAXANE INTRAVENOUS SUSPENSION RECONSTITUTED 100 MG

Formulary

1

Drug Name Formulary Status Requirements/LimitsABREVA EXTERNAL CREAM 10 % Formulary OTC

acamprosate calcium oral tablet delayed release 333 mg Formulary

acarbose oral tablet 100 mg, 25 mg, 50 mg Formulary

ACCU-CHEK FASTCLIX LANCET KIT Formulary OTC

ACCU-CHEK SOFT TOUCH LANCETS Formulary OTC; QL (150 EA per 30 days)

ACCU-CHEK SOFTCLIX LANCETS Formulary OTC; QL (150 EA per 30 days)

ACCUTANE ORAL CAPSULE 20 MG, 30 MG, 40 MG Formulary

ACCUTREND CHOLESTEROL CONTROL IN VITRO SOLUTION

Formulary OTC

ACCUTREND CHOLESTEROL IN VITRO STRIP Formulary OTC

ACCUTREND PLUS DEVICE Formulary OTC

ACE AEROSOL CLOUD ENHANCER Formulary QL (2 EA per 365 days)

acebutolol hcl oral capsule 200 mg, 400 mg Formulary

ACEROLA C 500 ORAL WAFER 500 MG Formulary OTC

ACETA-GESIC ORAL TABLET 12.5-325 MG Formulary OTC

acetaminophen extra strength oral liquid 500 mg/15ml Formulary OTC

acetaminophen junior strength oral tablet dispersible 160 mg

Formulary OTC

acetaminophen oral liquid 160 mg/5ml Formulary OTC

acetaminophen oral solution 160 mg/5ml Formulary OTC

acetaminophen oral tablet 325 mg Formulary OTC

acetaminophen rapid tabs child oral tablet dispersible 80 mg

Formulary OTC

acetaminophen rectal suppository 650 mg Formulary OTC

acetaminophen-codeine #2 oral tablet 300-15 mg Formulary PA; QL (280 EA per 7 days)



acetaminophen-codeine oral solution 120-12 mg/5ml Formulary PA; QL (1750 ML per 7 days)

ACETASOL HC OTIC SOLUTION 2-1 % Formulary

acetazolamide er oral capsule extended release 12 hour 500 mg

Formulary

acetazolamide oral tablet 250 mg Formulary

acetic acid irrigation solution 0.25 % Formulary

acetic acid otic solution 2 % Formulary

acetylcysteine inhalation solution 10 %, 20 % Formulary

ACID GONE ORAL SUSPENSION 95-358 MG/15ML Formulary OTC

acid reducer maximum strength oral tablet 20 mg Formulary OTC

acidophilus (probiotic) oral capsule Formulary OTC

acidophilus oral capsule Formulary OTC

acidophilus probiotic oral tablet 10 mg Formulary OTC

acidophilus/bifidus oral tablet chewable Formulary OTC

acidophilus/citrus pectin oral tablet Formulary OTC

acidophilus/pectin oral capsule Formulary OTC

acitretin oral capsule 10 mg, 17.5 mg, 25 mg Formulary PA; QL (68 EA per 34 days)

acne maximum strength external pad 2 % Formulary OTC

2

Drug Name Formulary Status Requirements/Limitsacne medication 10 external gel 10 % Formulary OTC; AGE (Max 18 Years)

acne medication 10 external lotion 10 % Formulary OTC; AGE (Max 18 Years)

acne medication 5 external gel 5 % Formulary AGE (Max 18 Years)

acne medication 5 external lotion 5 % Formulary OTC; AGE (Max 18 Years)

acne treatment external bar 10 % Formulary OTC; AGE (Max 18 Years)

ACNEFREE ACNE CLEARING SYSTEM EXTERNAL KIT 2.5 & 3.7 %

Formulary OTC

ACNEFREE SEVERE CLEARING SYST EXTERNAL KIT 2.5 & 10 %

Formulary OTC

ACT TOTAL CARE MOUTH/THROAT SOLUTION 0.05 %

Formulary OTC

ACTHIB INTRAMUSCULAR SOLUTION RECONSTITUTED


ACTICARNITINE SF ORAL SOLUTION 1 GM/10ML Formulary OTC

ACTICON ORAL SOLUTION 1-30 MG/5ML Formulary OTC

ACTICON ORAL TABLET 2-60 MG Formulary OTC

actidom dmx oral liquid 10-30-200 mg/5ml Formulary OTC

ACTIDOSE WITH SORBITOL ORAL LIQUID 50 GM/240ML

Formulary OTC

actidose-aqua oral liquid 15 gm/72ml Formulary OTC

ACTIFLOVIT EAR HEALTH ORAL TABLET Formulary OTC

ACTIFOAM COLLAGEN SPONGE EXTERNAL Formulary

acti-lance lite lancets 28g Formulary OTC; QL (150 EA per 30 days)

acti-lance special lancets 17g Formulary OTC; QL (150 EA per 30 days)

acti-lance universal 23g Formulary OTC; QL (150 EA per 30 days)

ACTIMARIS WOUND EXTERNAL GEL Formulary OTC

ACTIMMUNE SUBCUTANEOUS SOLUTION 2000000 UNIT/0.5ML

Formulary

ACTINEL ORAL LIQUID 30-15-200 MG/5ML Formulary OTC

ACTISEP MOUTH/THROAT SOLUTION 2-0.5-0.1 % Formulary OTC

ACTITROM ORAL CAPSULE Formulary OTC

ACTIVE Q MAXIMUM STRENGTH ORAL CAPSULE 300 MG

Formulary OTC

ACTIVE Q ORAL SYRUP 100 MG/5ML Formulary OTC

ACTIVE-Q EXTRA STRENGTH ORAL CAPSULE 200 MG

Formulary OTC

ACTIVE-Q ORAL CAPSULE 200-30 MG Formulary OTC

ACTIVITE EC ORAL TABLET 1 MG Formulary OTC

ACTIVON ARTHRITIS ULTRA ST EXTERNAL STICK 0.028-4.574 %

Formulary OTC

acyclovir external ointment 5 % Formulary

acyclovir oral capsule 200 mg Formulary

acyclovir oral suspension 200 mg/5ml Formulary

acyclovir oral tablet 400 mg, 800 mg Formulary

ADACEL INTRAMUSCULAR SUSPENSION 5-2-15.5 LF-MCG/0.5

Formulary

3

Drug Name Formulary Status Requirements/LimitsADAGEN INTRAMUSCULAR SOLUTION 250 UNIT/ML

Formulary PA

adapalene external cream 0.1 % Formulary AGE (Max 18 Years)

adapalene external gel 0.1 %, 0.3 % Formulary AGE (Max 18 Years)

adefovir dipivoxil oral tablet 10 mg Formulary

adhesive bandages sheer Formulary OTC

adjustable lancing device Formulary OTC; QL (1 EA per 365 days)

ADMELOG SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

Formulary

ADMELOG SUBCUTANEOUS SOLUTION 100 UNIT/ML

Formulary

ADRENAL C FORMULA ORAL TABLET Formulary

ADRENALIN INJECTION SOLUTION 1 MG/ML, 30 MG/30ML

Formulary

ADRUCIL INTRAVENOUS SOLUTION 2.5 GM/50ML, 5 GM/100ML, 500 MG/10ML

Formulary

ADULT ACNOMEL EXTERNAL CREAM 2-8 % Formulary OTC

adult gummy oral tablet chewable Formulary OTC

adult mask device Formulary QL (2 EA per 365 days)

adult wash cloths with aloe external 3 % Formulary OTC

adult-lock weekly pill remind Formulary OTC

advanced acne wash external liquid extended release 4.4 % Formulary OTC

ADVANCED CALCIUM/D/MAGNESIUM ORAL TABLET

Formulary OTC

advanced hand sanitizer external liquid 70 % Formulary OTC

advanced lubricant ophthalmic solution 0.05-1 % Formulary OTC

ADVIL ALLERGY & CONGESTION ORAL TABLET 4-10-200 MG

Formulary OTC

ADVIL ALLERGY SINUS ORAL TABLET 2-30-200 MG Formulary OTC

ADVIL COLD & SINUS LIQUI-GELS ORAL CAPSULE 30-200 MG

Formulary OTC

ADVIL COLD/SINUS ORAL TABLET 30-200 MG Formulary OTC

ADVIL ORAL CAPSULE 200 MG Formulary OTC

ADVIL ORAL TABLET 200 MG Formulary OTC

ADVIL PM ORAL CAPSULE 200-25 MG Formulary OTC

ADVIL PM ORAL TABLET 200-38 MG Formulary OTC

ADVIL SINUS CONGESTION & PAIN ORAL TABLET 10-200 MG

Formulary OTC

ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary OTC

ADVOCATE INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML

Formulary OTC

ADVOCATE INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC

ADVOCATE INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

AEROCHAMBER MINI CHAMBER DEVICE Formulary QL (2 EA per 365 days)

4

Drug Name Formulary Status Requirements/LimitsAFLURIA INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years)

AFLURIA PRESERVATIVE FREE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION


AFREZZA INHALATION POWDER 12 UNIT, 8 UNIT Formulary

AFRIN CHILDRENS NASAL SOLUTION 0.25 % Formulary OTC

AFRIN MENTHOL SPRAY NASAL SOLUTION 0.05 % Formulary OTC

AFTERA ORAL TABLET 1.5 MG Formulary OTC; QL (2 EA per 34 days)

AGAMATRIX ULTRA-THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

AHIST ORAL TABLET 25 MG Formulary OTC

aimsco lubricated Formulary OTC

AIRAVITE ORAL TABLET 2.5-25-1 MG Formulary

AIRBORNE ORAL LOZENGE Formulary OTC

AIRS DISPOSABLE NEBULIZER Formulary OTC; QL (2 EA per 365 days)

AIRS DISPOSABLE NEBULIZER KIT Formulary QL (2 EA per 365 days)

AIRZONE PEAK FLOW METER DEVICE Formulary OTC; QL (2 EA per 365 days)

AJOVY SUBCUTANEOUS SOLUTION AUTO-INJECTOR 225 MG/1.5ML

Formulary ST; AGE (Min 18 Years)

AJOVY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 225 MG/1.5ML


ak-poly-bac ophthalmic ointment 500-10000 unit/gm Formulary

AL12 EXTERNAL LOTION 12 % Formulary OTC

ALA SEB EXTERNAL SHAMPOO 2-2 % Formulary OTC

ALA SEB T EXTERNAL SHAMPOO 1-2-2 % Formulary OTC

ALAHIST DM ORAL LIQUID 7.5-2-15 MG/5ML Formulary OTC

ALA-HIST IR ORAL TABLET 2 MG Formulary OTC

ALA-HIST PE ORAL TABLET 2-10 MG Formulary OTC

alanine 1000 oral packet 1000 mg Formulary OTC

alba-lybe nr oral liquid 325-10-50 mg/5ml Formulary OTC

albendazole oral tablet 200 mg Formulary

ALBOLENE EXTERNAL CREAM Formulary OTC; QL (454 GM per 34 days)

albuterol sulfate er oral tablet extended release 12 hour 4 mg, 8 mg

Formulary

albuterol sulfate hfa inhalation aerosol solution 108 (90 base) mcg/act

Formulary

albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%, 0.63 mg/3ml, 1.25 mg/3ml

Formulary

albuterol sulfate oral syrup 2 mg/5ml Formulary

albuterol sulfate oral tablet 2 mg, 4 mg Formulary

alcohol (rubbing) solution 70 % Formulary OTC

alcohol prep pad 70 % Formulary OTC

alcohol prep pad 70 % 70 % Formulary OTC

alcohol swabs pad Formulary OTC

alcohol swabs pad 70 % 70 % Formulary OTC

5

Drug Name Formulary Status Requirements/Limitsalcohol wipes pad 70 % 70 % Formulary OTC

alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg, 70 mg

Formulary

aler-cap oral capsule 25 mg Formulary OTC

aler-dryl oral tablet 50 mg Formulary OTC

alertness aid oral tablet 200 mg Formulary OTC

alevazol external ointment 1 % Formulary OTC

ALEVE ORAL CAPSULE 220 MG Formulary OTC

ALEVE ORAL TABLET 220 MG Formulary OTC

ALFERON N INJECTION SOLUTION 5000000 UNIT/ML

Formulary PA

alfuzosin hcl er oral tablet extended release 24 hour 10 mg Formulary

alga oral capsule 0.225-2000 mg-unit Formulary OTC

ALGAL-900 DHA ORAL CAPSULE 300 MG Formulary OTC

ALIMTA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG, 500 MG

Formulary

ALIVE MULTI-VITAMIN CHILDRENS ORAL TABLET CHEWABLE 60 MG

Formulary OTC

ALIVIO EXTERNAL PATCH 0.03-5 % Formulary OTC

alka-aid oral tablet 180-360 mg Formulary OTC

ALKA-SELTZER HEARTBURN + GAS ORAL TABLET CHEWABLE 750-80 MG

Formulary OTC

ALKA-SELTZER ORAL TABLET EFFERVESCENT 325-1000-1916 MG

Formulary OTC

ALKA-SELTZER PLUS DAY/NIGHT ORAL CAPSULE Formulary OTC

all day allergy childrens oral solution 5 mg/5ml Formulary OTC

all day pain relief oral tablet 220 mg Formulary OTC

ALLEGRA ALLERGY CHILDRENS ORAL SUSPENSION 30 MG/5ML

Formulary OTC

ALLEGRA ALLERGY CHILDRENS ORAL TABLET DISPERSIBLE 30 MG

Formulary OTC

ALLEGRA ALLERGY ORAL TABLET 180 MG, 60 MG Formulary OTC

ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HOUR 60-120 MG

Formulary OTC

ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 24 HOUR 180-240 MG

Formulary OTC

aller-ease oral tablet 60 mg Formulary OTC; QL (68 EA per 34 days)

allergy childrens oral liquid 12.5 mg/5ml Formulary OTC

allergy eye ophthalmic solution 0.025-0.3 % Formulary OTC

allergy multi-symptom day/nght oral Formulary OTC

allergy multi-symptom night oral tablet 25-5-325 mg Formulary OTC

allergy relief childrens oral tablet dispersible 10 mg Formulary OTC

allergy relief oral syrup 5 mg/5ml Formulary OTC; AGE (Min 2 Years)

allergy relief oral tablet 5 mg Formulary OTC

allergy spray 24 hour aerosol 55 mcg/act nasal 55 mcg/act Formulary OTC

allevess external patch 0.05-5 % Formulary OTC

6

Drug Name Formulary Status Requirements/LimitsALLEVYN PLUS CAVITY PAD 6"X8" Formulary OTC

ALLI ORAL CAPSULE 60 MG Formulary OTC

allopurinol oral tablet 100 mg, 300 mg Formulary

ALMACONE ORAL TABLET CHEWABLE 200-200-25 MG

Formulary OTC

ALOCANE PLUS EXTERNAL GEL 4-0.13 % Formulary OTC

ALOE GRANDE EXTERNAL CREAM 100000-1500 UNIT/GM

Formulary OTC

ALOE GRANDE EXTERNAL LOTION 10000-1500 UNIT/30ML

Formulary OTC

aloe vera external cream 72 % Formulary OTC

aloe vera external gel 99.5 % Formulary OTC

aloe vera moisturizing external gel 99.5 % Formulary OTC

ALOE VESTA 2-N-1 PROTECTIVE EXTERNAL OINTMENT

Formulary OTC

ALOE VESTA CLEAR ANTIFUNGAL EXTERNAL OINTMENT 2 %

Formulary OTC

ALOE VESTA MULTI PURPOSE EXTERNAL FOAM Formulary OTC

ALOE VESTA PROTECTIVE EXTERNAL OINTMENT Formulary OTC

ALOE VESTA SKIN PROTECTANT EXTERNAL AEROSOL 36 %

Formulary OTC

aloe/lidocaine pain reliever external gel 0.5 % Formulary OTC

alosetron hcl oral tablet 0.5 mg, 1 mg Formulary PA

alp high3 oral capsule delayed release 600 mg Formulary OTC

ALPAWASH EXTERNAL OINTMENT Formulary

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % Formulary

alpha-lipoic acid oral capsule 100 mg Formulary OTC

alpha-lipoic acid oral tablet 200 mg Formulary OTC

ALPHANATE/VWF COMPLEX/HUMAN INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1500 UNIT, 250 UNIT, 500 UNIT

Formulary

ALPHANINE SD INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 500 UNIT

Formulary

alph-e oral capsule 400 unit Formulary OTC

alph-e-mixed 1000 oral capsule 1000 unit Formulary OTC

alph-e-mixed oral capsule 200 unit Formulary OTC

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

Formulary QL (170 EA per 30 days)

alprazolam er oral tablet extended release 24 hour 3 mg Formulary QL (170 EA per 34 days)

ALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 MG/ML

Formulary QL (170 ML per 34 days)

alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg Formulary QL (170 EA per 34 days)

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


ALTACAINE OPHTHALMIC SOLUTION 0.5 % Formulary

ALTAFLUOR OPHTHALMIC SOLUTION 0.25-0.4 % Formulary

altarussin-pe oral syrup 100-30 mg/5ml Formulary OTC

7

Drug Name Formulary Status Requirements/LimitsALTAVERA ORAL TABLET 0.15-30 MG-MCG Formulary QL (28 EA per 28 days)

aluminum acetate external solution Formulary OTC

aluminum bottle seal Formulary OTC

aluminum hydroxide gel oral suspension 320 mg/5ml Formulary OTC

ALWAYS MAXI MAXIMUM PROTECTION PAD Formulary OTC

alyacen 1/35 oral tablet 1-35 mg-mcg Formulary QL (28 EA per 28 days)

alyacen 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg Formulary QL (28 EA per 28 days)

ALYQ ORAL TABLET 20 MG Formulary PA; AGE (Min 18 Years)

amantadine hcl oral capsule 100 mg Formulary

amantadine hcl oral solution 50 mg/5ml Formulary

amantadine hcl oral syrup 50 mg/5ml Formulary

amantadine hcl oral tablet 100 mg Formulary

ambi 12.5cpd/100gfn/30pse oral liquid 30-12.5-100 mg/5ml Formulary OTC

ambi 12.5cpd/1dcpm/30pse oral liquid 30-1-12.5 mg/5ml Formulary OTC

ambi 40pse/400gfn oral tablet 40-400 mg Formulary OTC

ambi 60pse/400gfn oral tablet 60-400 mg Formulary OTC

ambi 60pse/4cpm oral tablet 60-4 mg Formulary OTC

AMBI FADE EXTERNAL CREAM 2 % Formulary OTC

ambrisentan oral tablet 10 mg, 5 mg Formulary AGE (Min 18 Years)

amcinonide external cream 0.1 % Formulary

AMERICERIN EXTERNAL CREAM Formulary OTC

AMERIGEL WOUND DRESSING EXTERNAL GEL Formulary OTC

AMERIWASH EXTERNAL LOTION Formulary OTC

AMETHIA LO ORAL TABLET 0.1-0.02 & 0.01 MG Formulary QL (91 EA per 91 days)

AMETHIA ORAL TABLET 0.15-0.03 &0.01 MG Formulary QL (91 EA per 91 days)

AMETHYST ORAL TABLET 90-20 MCG Formulary QL (28 EA per 28 days)

amiloride hcl oral tablet 5 mg Formulary

amiloride-hydrochlorothiazide oral tablet 5-50 mg Formulary

aminoacetic acid irrigation solution 1.5 % Formulary

aminocaproic acid oral solution 0.25 gm/ml Formulary

AMINORELIEFRMS ORAL CAPSULE Formulary

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

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

Formulary

amlodipine besy-benazepril hcl oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg

Formulary

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

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

Formulary

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

Formulary

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

Formulary

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

Formulary ST

8

Drug Name Formulary Status Requirements/Limitsammonia aromatic inhalation inhaler Formulary OTC

ammonia aromatic inhalation spirit Formulary OTC

ammonium lactate external cream 12 % Formulary

AMNESTEEM ORAL CAPSULE 10 MG, 20 MG, 40 MG Formulary

amoxicillin oral capsule 250 mg, 500 mg Formulary

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

Formulary

amoxicillin oral tablet 500 mg, 875 mg Formulary

amoxicillin oral tablet chewable 125 mg, 250 mg Formulary

amoxicillin-pot clavulanate oral suspension reconstituted200-28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml, 600-42.9 mg/5ml

Formulary

amoxicillin-pot clavulanate oral tablet 250-125 mg, 500-125 mg, 875-125 mg

Formulary

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

Formulary

amphetamine-dextroamphet er oral capsule extended release 24 hour 10 mg, 15 mg, 5 mg

FormularyQL (30 EA per 30 days); AGE (Min 4 Years and Max 17 Years)

amphetamine-dextroamphet er oral capsule extended release 24 hour 20 mg, 25 mg, 30 mg


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

Formulary AGE (Min 4 Years and Max 17 Years)

ampicillin oral capsule 500 mg Formulary

ANA-LEX RECTAL KIT 2-2 % Formulary

ANASEPT ANTIMICROBIAL EXTERNAL GEL 0.057 % Formulary OTC

ANASEPT EXTERNAL LIQUID 0.057 % Formulary OTC

anastrozole oral tablet 1 mg Formulary

ANBESOL COLD SORE THERAPY EXTERNAL OINTMENT

Formulary OTC

ANBESOL MAXIMUM STRENGTH MOUTH/THROAT LIQUID 20 %

Formulary OTC

ANBESOL MOUTH/THROAT LIQUID 10 % Formulary OTC

ANECREAM EXTERNAL CREAM 4 % Formulary OTC

animal chews oral tablet chewable Formulary OTC

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5-25 MCG/INH

Formulary

antacid anti-gas max strength oral suspension 400-400-40 mg/5ml

Formulary OTC

antacid anti-gas oral suspension 200-200-20 mg/5ml Formulary OTC

antacid extra strength oral tablet chewable 675-135 mg Formulary OTC

antacid multi-symptom oral tablet chewable 675-135-60 mg Formulary OTC

antacid oral tablet chewable 500 mg Formulary OTC

antacid soft chews oral tablet chewable 1177 mg Formulary OTC

ANTARA ORAL CAPSULE 30 MG, 90 MG Formulary

anthelios 50 mineral external liquid Formulary OTC

anti-allergy oral tablet 100-100-50 mg Formulary OTC

antibacterial liquid soap external liquid 0.15 % Formulary OTC

9

Drug Name Formulary Status Requirements/Limitsanti-diarrheal oral liquid 1 mg/5ml Formulary OTC

anti-diarrheal oral tablet 2 mg Formulary OTC

antifungal external aerosol 1 % Formulary OTC

antifungal external cream 2 % Formulary OTC

anti-fungal external powder 1 % Formulary OTC

anti-itch external cream 1-0.1 % Formulary OTC

anti-itch external lotion 0.5-0.5 % Formulary OTC

ANTI-ITCH INTENSIVE HEALING EXTERNAL LOTION 1 %

Formulary OTC

antioxidant formula sg oral capsule extended release Formulary OTC

anti-oxidant oral tablet Formulary OTC

antiseptic external aerosol 4.5-0.05-40.5 % Formulary OTC

ANTISEPTIC HAND RINSE EXTERNAL GEL 62 % Formulary OTC

antiseptic pain relief external liquid 10.8-4.7 % Formulary OTC

antiseptic skin cleanser external solution 4 % Formulary OTC

antiseptic wound/skin cleanser external liquid 0.1 % Formulary OTC

AO-SEPT CONTACT LENS HOLDER Formulary OTC

APETIGEN ORAL ELIXIR Formulary OTC

APETIGEN-PLUS ORAL SOLUTION Formulary OTC

APETIGEN-PLUS ORAL TABLET Formulary OTC

ap-hist dm oral liquid 7.5-4-15 mg/5ml Formulary OTC

APLICARE POVIDONE-IODINE EXTERNAL GEL 10 % Formulary OTC

APLIGRAF EXTERNAL DISK Formulary

apothesar external cream Formulary

apraclonidine hcl ophthalmic solution 0.5 % Formulary

aprepitant oral capsule 125 mg, 40 mg, 80 & 125 mg Formulary QL (1 EA per 34 days)

aprepitant oral capsule 80 mg Formulary QL (2 EA per 34 days)

APRI ORAL TABLET 0.15-30 MG-MCG Formulary QL (28 EA per 28 days)

APTIVUS ORAL CAPSULE 250 MG Formulary

APTIVUS ORAL SOLUTION 100 MG/ML Formulary

AQUA CARE EXTERNAL LOTION 10 % Formulary OTC

aquabase external ointment Formulary OTC

AQUADEKS ORAL LIQUID Formulary OTC

AQUAFRESH DR SEUSS EXTRA SOFT Formulary OTC

aquanaz oral tablet 10-15-400 mg Formulary OTC

AQUAPHILIC EXTERNAL OINTMENT Formulary OTC

AQUAPHILIC/CARBAMIDE EXTERNAL OINTMENT 10 %, 20 %

Formulary OTC

AQUASONIC 100 EXTERNAL GEL Formulary OTC

AQUEOUS SELENIUM ORAL LIQUID 95 MCG/DROP Formulary OTC

aqueous vitamin e oral solution 15 mg/0.67ml, 15 unit/0.3ml

Formulary OTC

AQUORAL MOUTH/THROAT SOLUTION Formulary

ARANELLE ORAL TABLET 0.5/1/0.5-35 MG-MCG Formulary QL (28 EA per 28 days)

10

Drug Name Formulary Status Requirements/LimitsARCALYST SUBCUTANEOUS SOLUTION RECONSTITUTED 220 MG

Formulary PA

ARCAPTA NEOHALER INHALATION CAPSULE 75 MCG

Formulary

arctic relief pain relieving external gel 0.2-3.5 % Formulary OTC

arformoterol tartrate inhalation nebulization solution 15 mcg/2ml

Formulary

ARGIMENT AT ORAL PACKET Formulary OTC

arginine oral packet 500 mg Formulary OTC

arginine oral tablet 500 mg Formulary OTC

arginine2000 oral packet 2000 mg Formulary OTC

ARGYLE STERILE SALINE IRRIGATION SOLUTION 0.9 %

Formulary

ARGYLE STERILE WATER IRRIGATION SOLUTION Formulary

aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg


ARISTADA INITIO INTRAMUSCULAR PREFILLED SYRINGE 675 MG/2.4ML


ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML, 441 MG/1.6ML, 662 MG/2.4ML, 882 MG/3.2ML


arkaliox oral capsule 200 mg Formulary OTC

ARMOUR THYROID ORAL TABLET 120 MG, 180 MG, 240 MG, 300 MG

Formulary

arnica external tincture 20 % Formulary OTC

arnicare arthritis oral tablet dispersible Formulary OTC

arnicare external gel Formulary OTC

arthritis pain relieving external cream 0.075 % Formulary OTC

artificial tears ophthalmic solution 0.2-0.2-1 %, 1 %, 1-0.3 %, 1.4 %

Formulary OTC

ARZERRA INTRAVENOUS CONCENTRATE 100 MG/5ML, 1000 MG/50ML

Formulary

ARZOL SILVER NIT APPLICATORS EXTERNAL 75-25 %

Formulary

asafetida tincture Formulary OTC

ascocid-iso-ph oral powder effervescent Formulary OTC

ASCOMP-CODEINE ORAL CAPSULE 50-325-40-30 MG Formulary PA

ascorbic acid oral tablet 1000 mg, 500 mg Formulary OTC

ascorbic acid oral tablet chewable 250 mg Formulary OTC

ASCRIPTIN ORAL TABLET 325 MG Formulary OTC

asepto oral thermometer kit Formulary OTC

ASMANEX (120 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCG/INH

Formulary


Formulary

11

Drug Name Formulary Status Requirements/LimitsASMANEX (30 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 110 MCG/INH, 220 MCG/INH

Formulary


Formulary


Formulary

aspartate mg & k oral capsule 90-90 mg Formulary OTC

ASPERCREME W/LIDOCAINE EXTERNAL CREAM 4 %

Formulary OTC

aspirin 81 oral tablet delayed release 81 mg Formulary OTC

aspirin oral tablet 325 mg Formulary OTC

aspirin oral tablet chewable 81 mg Formulary OTC

aspirin oral tablet delayed release 325 mg Formulary OTC

aspirin rectal suppository 300 mg, 600 mg Formulary OTC

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

Formulary

aspirtab maximum strength oral tablet 500 mg Formulary OTC

ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 0.5 ML (OTC) 29G X 1/2" 0.5 ML

Formulary

ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary

ASSURE LANCETS Formulary OTC; QL (150 EA per 30 days)

ASTHMANEFRIN REFILL INHALATION NEBULIZATION SOLUTION 2.25 %

Formulary OTC

ASTHMAPACK FOR CHILDREN KIT Formulary OTC; QL (2 EA per 365 days)

ATABEX OB ORAL TABLET 29-1 MG Formulary

atazanavir sulfate oral capsule 150 mg, 200 mg, 300 mg Formulary

atenolol oral tablet 100 mg, 25 mg, 50 mg Formulary

atenolol-chlorthalidone oral tablet 100-25 mg, 50-25 mg Formulary

athletes foot maximum strength external ointment Formulary OTC

atomoxetine hcl oral capsule 10 mg Formulary

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


ATOPICLAIR EXTERNAL CREAM Formulary

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

Formulary

atovaquone oral suspension 750 mg/5ml Formulary

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

Formulary

ATRAC-TAIN EXTERNAL CREAM 10 % Formulary OTC

ATRAC-TAIN EXTERNAL LOTION 5 % Formulary OTC

ATROVENT HFA INHALATION AEROSOL SOLUTION 17 MCG/ACT

Formulary

atuss da oral liquid 30-2-12.5 mg/5ml Formulary OTC

AUBRA ORAL TABLET 0.1-20 MG-MCG Formulary QL (28 EA per 28 days)

12

Drug Name Formulary Status Requirements/Limitsauraphene-b otic solution 6.5 % Formulary OTC

aurora lancet super thin 30g Formulary OTC; QL (150 EA per 30 days)

aurora lancet thin 23g Formulary OTC; QL (150 EA per 30 days)

AUROVELA FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary

AUSTEDO ORAL TABLET 12 MG, 6 MG, 9 MG Formulary PA; QL (120 EA per 30 days)

AUTOJECT 2 Formulary OTC; QL (1 EA per 365 days)

AUTOLET PLATFORMS Formulary OTC

autopen device Formulary OTC; QL (1 EA per 365 days)

avalin external patch 4-1 % Formulary OTC

AVAR CLEANSER EXTERNAL EMULSION 10-5 % Formulary

AVAR CLEANSER EXTERNAL LIQUID 10-5 % Formulary

AVAR-E EMOLLIENT EXTERNAL CREAM 10-5 % Formulary

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

Formulary PA

AVEENO BABY GENTLE CONDITION EXTERNAL SHAMPOO

Formulary OTC

AVEENO BABY SOOTHING WASH EXTERNAL LIQUID

Formulary OTC

AVEENO CREAMY MOISTURIZING EXTERNAL OIL Formulary OTC

AVEENO INTENSE RELIEF EXTERNAL CREAM 1.3 % Formulary OTC

AVEENO POSITIVELY RADIANT WASH EXTERNAL LIQUID

Formulary OTC

AVENOVA/NEUTROX EXTERNAL SOLUTION 0.01 % Formulary

AVERTEAX MOUTH/THROAT OINTMENT 1 % Formulary OTC

AVITENE EXTERNAL PAD Formulary

AVITENE FLOUR EXTERNAL POWDER Formulary

AVO CREAM EXTERNAL EMULSION Formulary

AVONEX INTRAMUSCULAR KIT 30 MCG Formulary

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

Formulary

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT 30 MCG/0.5ML

Formulary

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

axillary block needle 22g x 1" , 25g x 1" Formulary OTC

AXSAIN EXTERNAL CREAM 0.25 % Formulary OTC

AYR SALINE NASAL DROPS NASAL SOLUTION 0.65 %

Formulary OTC

AYR SALINE NASAL GEL NASAL SWAB Formulary OTC

AYR SALINE NASAL NASAL GEL Formulary OTC

AYR SALINE NASAL NO-DRIP NASAL GEL Formulary OTC

AYR SALINE NASAL RINSE NASAL PACKET 1.57 GM

Formulary OTC

azacitidine injection suspension reconstituted 100 mg Formulary

azathioprine oral tablet 100 mg, 50 mg, 75 mg Formulary

azec oral capsule Formulary OTC

azelastine hcl nasal solution 0.1 %, 0.15 % Formulary

13

Drug Name Formulary Status Requirements/Limitsazithromycin oral packet 1 gm Formulary

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

Formulary

azithromycin oral tablet 250 mg, 500 mg, 600 mg Formulary

azithromycin tablet 250 mg oral 250 mg Formulary

azithromycin tablet 500 mg oral 500 mg Formulary

AZURETTE ORAL TABLET 0.15-0.02/0.01 MG (21/5) Formulary QL (28 EA per 28 days)

b complete oral tablet Formulary OTC

b complex formula 1 (w/ fa) oral tablet Formulary OTC

b complex formula 1 oral tablet Formulary OTC

b complex oral capsule Formulary OTC

b complex oral tablet Formulary OTC

b complex vitamin oral tablet Formulary OTC

b complex-folic acid oral tablet 500-5-200 mcg-mg-mcg Formulary OTC

b-1 oral tablet 100 mg, 250 mg Formulary OTC

b-100 cr oral tablet extended release Formulary OTC

b-12 oral tablet 2000 mcg, 250 mcg Formulary OTC

b-12 sublingual tablet sublingual 1000 mcg, 2500 mcg, 5000 mcg

Formulary OTC

b-12 tr oral tablet extended release 2000 mcg Formulary OTC

b-2 oral tablet 100 mg Formulary OTC

B-2-400 ORAL CAPSULE 400 MG Formulary OTC

b-6 oral tablet 250 mg, 50 mg, 500 mg Formulary OTC

BABY ANBESOL MOUTH/THROAT GEL 7.5 % Formulary OTC

BABY DDROPS ORAL LIQUID 400 UNT/0.03ML Formulary OTC

baby diaper rash external cream 13 % Formulary OTC

baby lotion external lotion Formulary OTC

baby super daily d3 oral liquid 400 ut/0.028ml Formulary OTC

baby teething pain medicine mouth/throat gel 7.5 % Formulary OTC

baby thermometer Formulary OTC

baciim intramuscular solution reconstituted 50000 unit Formulary

bacitracin ophthalmic ointment 500 unit/gm Formulary

bacitracin zinc external ointment 500 unit/gm Formulary

bacitra-neomycin-polymyxin-hc ophthalmic ointment 1 % Formulary

back pain-off oral tablet 250-50-290 mg Formulary OTC

baclofen oral tablet 10 mg, 20 mg, 5 mg Formulary

BACTROBAN NASAL NASAL OINTMENT 2 % Formulary

balamine dm oral syrup 5-2-10 mg/5ml Formulary OTC

balanced b-50 complex oral capsule Formulary OTC

balanced b-50 oral tablet extended release Formulary OTC

BAL-CARE DHA ORAL 27-1 & 430 MG Formulary

BALNEOL EXTERNAL LOTION Formulary OTC

balsalazide disodium oral capsule 750 mg Formulary

BALZIVA ORAL TABLET 0.4-35 MG-MCG Formulary QL (28 EA per 28 days)

14

Drug Name Formulary Status Requirements/LimitsBAND-AID GAUZE SMALL PAD 2"X2" Formulary OTC

BAND-AID SURGIPAD SURGICAL PAD 5"X9" Formulary OTC

BANOPHEN ORAL CAPSULE 50 MG Formulary OTC

BAQSIMI ONE PACK NASAL POWDER 3 MG/DOSE Formulary QL (2 EA per 30 days)

BAQSIMI TWO PACK NASAL POWDER 3 MG/DOSE Formulary QL (2 EA per 30 days)

BARACLUDE ORAL SOLUTION 0.05 MG/ML Formulary

BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML


BAYER BACK & BODY ORAL TABLET 500-32.5 MG Formulary OTC

BAYER BREEZE 2 CONTROL LIQUID HIGH IN VITRO HIGH


BAYER BREEZE 2 CONTROL LIQUID LOW IN VITRO LOW


BAYER BREEZE 2 CONTROL LIQUID NORMAL IN VITRO NORMAL


BAYER BREEZE 2 SYSTEM KIT W/DEVICE W/DEVICE


BAYER BREEZE 2 TEST DISK IN VITRO Formulary OTC; QL (150 EA per 30 days)

BAYER CONTOUR LINK MONITOR KIT W/DEVICE W/DEVICE


BAYER CONTOUR MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

BAYER MICROLET 2 LANCING DEVIC Formulary OTC

BAYER MICROLET LANCETS Formulary OTC; QL (150 EA per 30 days)

BAYER WOMENS ORAL TABLET 81-777 MG Formulary OTC

BAZA CLEANSE & PROTECT EXTERNAL LOTION 2 %

Formulary OTC

BC FAST PAIN RELIEF ARTHRITIS ORAL PACKET 742-222-38 MG

Formulary OTC

BC FAST PAIN RELIEF ORAL PACKET 650-195-33.3 MG

Formulary OTC

b-caro-t oral capsule 15 mg Formulary OTC

b-complex high potency oral tablet extended release Formulary OTC

BD ALLERGY SYRINGE 28G X 1/2" 1 ML Formulary OTC

BD AUTOSHIELD 29G X 5MM , 29G X 8MM Formulary OTC

BD AUTOSHIELD DUO 30G X 5 MM Formulary OTC

BD BLUNT FILTER NEEDLE 18G X 1-1/2" Formulary OTC

BD DISP NEEDLE 22G X 3/4" , 23G X 1-1/4" , 27G X 1-1/4" , 30G X 1"

Formulary OTC

BD DISP NEEDLE TW 18G X 1" Formulary OTC

BD DISP NEEDLES 16G X 1-1/2" , 19G X 1" , 20G X 1" , 21G X 1-1/2" , 25G X 7/8" , 27G X 1/2" , 30G X 1/2"

Formulary OTC

BD ECLIPSE NEEDLE 22G X 1-1/2" , 23G X 1" , 25G X 1-1/2" , 25G X 5/8"

Formulary OTC

BD ECLIPSE SYRINGE 25G X 5/8" 1 ML, 30G X 1/2" 1 ML

Formulary OTC

BD HYPODERMIC NEEDLE 23G X 1-1/2" , 26G X 5/8" Formulary OTC

BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

15

Drug Name Formulary Status Requirements/LimitsBD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

BD INSULIN SYR ULTRAFINE II 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

BD INSULIN SYRINGE 25G X 1" 1 ML 25G X 1" 1 ML Formulary OTC

BD INSULIN SYRINGE 25G X 5/8" 1 ML 25G X 5/8" 1 ML

Formulary OTC


Formulary OTC

BD INSULIN SYRINGE 27.5G X 5/8" 2 ML 27.5G X 5/8" 2 ML

Formulary OTC


Formulary OTC


Formulary OTC

BD INSULIN SYRINGE HALF-UNIT 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML 27G X 5/8" 1 ML

Formulary OTC

BD INSULIN SYRINGE MICROFINE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

BD INSULIN SYRINGE MICROFINE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC

BD INSULIN SYRINGE U/F 1/2UNIT 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

BD INSULIN SYRINGE U/F 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

BD INSULIN SYRINGE U/F 30G X 1/2" 1 ML 30G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

BD INSULIN SYRINGE U/F 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

BD INSULIN SYRINGE U-100 1 ML U-100 1 ML Formulary OTC

BD INSULIN SYRINGE U-500 31G X 6MM 0.5 ML 31G X 6MM 0.5 ML

Formulary

BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

16

Drug Name Formulary Status Requirements/LimitsBD INSULIN SYRINGE ULTRAFINE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

BD LANCET ULTRAFINE 30G Formulary OTC; QL (150 EA per 30 days)

BD LANCET ULTRAFINE 33G Formulary OTC; QL (150 EA per 30 days)

BD LUER-LOK SYRINGE 18G X 1-1/2" 3 ML, 20G X 1" 1 ML, 20G X 1" 10 ML, 20G X 1" 3 ML, 20G X 1" 5 ML, 20G X 1-1/2" 10 ML, 20G X 1-1/2" 3 ML, 20G X 1-1/2" 5 ML, 21G X 1" 10 ML, 21G X 1" 3 ML, 21G X 1" 5 ML, 21G X 1-1/2" 3 ML, 22G X 1" 10 ML, 22G X 1" 3 ML, 22G X 1" 5 ML, 22G X 1-1/2" 5 ML, 23G X 1-1/2" 3 ML, 23G X 1-1/4" 10 ML, 25G X 1" 3 ML, 25G X 1-1/2" 3 ML, 25G X 5/8" 3 ML, 26G X 5/8" 3 ML

Formulary OTC

BD LUER-LOK SYRINGE 23G X 1" 3 ML Formulary

BD PEN NEEDLE ORIGINAL U/F 29G X 12.7MM Formulary OTC

BD PLASTIPAK SYRINGE 21G X 1" 3 ML Formulary OTC

BD PRECISIONGLIDE NEEDLE 23G X 1-1/2" Formulary OTC

BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary


Formulary OTC

BD SAFETYGLIDE NEEDLE 27G X 5/8" Formulary OTC

BD SAFETYGLIDE SHIELDED NEEDLE 22G X 1-1/2" 10 ML

Formulary

BD SAFETYGLIDE SYRINGE/NEEDLE 27G X 5/8" 1 ML

Formulary OTC

BD SAFETY-LOK INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

BD SHARPS COLLECTOR Formulary OTC

BD SWAB SINGLE USE REGULAR PAD Formulary OTC

BD SWABS SINGLE USE BUTTERFLY PAD Formulary OTC

BD SYRINGE 50 ML Formulary OTC

BD SYRINGE LUER-LOK 20 ML Formulary OTC

BD SYRINGE SLIP TIP 5 ML Formulary OTC

BD SYRINGE/NEEDLE SLIP TIP 26G X 5/8" 1 ML Formulary OTC

BD TB SYRINGE 21G X 1" 1 ML, 27G X 1/2" 0.5 ML Formulary OTC

BD VEO INSULIN SYR U/F 1/2UNIT 31G X 15/64" 0.3 ML 31G X 15/64" 0.3 ML

Formulary OTC

BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.3 ML 31G X 15/64" 0.3 ML

Formulary OTC

BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.5 ML 31G X 15/64" 0.5 ML

Formulary OTC

BD VEO INSULIN SYRINGE U/F 31G X 15/64" 1 ML 31G X 15/64" 1 ML

Formulary OTC

17

Drug Name Formulary Status Requirements/LimitsBEBULIN INTRAVENOUS SOLUTION RECONSTITUTED 200-1200 UNIT

Formulary

bec/zinc oral tablet Formulary OTC

bedding spray lice treatment aerosol 0.5 % Formulary OTC

bee pollen oral capsule 580 mg Formulary OTC

bee pollen oral tablet chewable 500 mg Formulary OTC

BEELITH ORAL TABLET 362-20 MG Formulary OTC

BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 MCG, 600 MCG, 75 MCG, 750 MCG, 900 MCG

Formulary PA; QL (68 EA per 34 days)

belladonna alkaloids-opium rectal suppository 16.2-60 mg Formulary

belladonna-opium rectal suppository 16.2-30 mg Formulary

BENADRYL ALLERGY CHILDRENS ORAL LIQUID 12.5 MG/5ML

Formulary OTC

BENADRYL ALLERGY CHILDRENS ORAL TABLET CHEWABLE 12.5 MG

Formulary OTC

BENADRYL ALLERGY CON ULTRATABS ORAL TABLET 25-10 MG

Formulary OTC

BENADRYL ALLERGY ORAL TABLET 25 MG Formulary OTC

BENADRYL ALLERGY ULTRATABS ORAL TABLET 25 MG

Formulary OTC

BENADRYL ITCH RELIEF EXTERNAL STICK 2-0.1 % Formulary OTC

BENADRYL ITCH STOPPING EXTERNAL CREAM 1-0.1 %

Formulary OTC

BENADRYL-D ALLERGY/SINUS CHILD ORAL SOLUTION 12.5-5 MG/5ML

Formulary OTC

benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary

benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg

Formulary

BENEFIBER FOR CHILDREN ORAL POWDER Formulary OTC

BENEFIBER ON THE GO ORAL PACKET Formulary OTC

BENEFIBER ORAL POWDER Formulary OTC

BENEFIBER PLUS B VITS & FA ORAL TABLET Formulary OTC

BENEFIBER PLUS CALCIUM ORAL POWDER Formulary OTC

BENEFIBER PLUS CALCIUM ORAL TABLET CHEWABLE

Formulary OTC

BENEFIBER PLUS HEART HEALTH ORAL POWDER Formulary OTC

benfotiamine multi-b oral capsule Formulary OTC

benzalkonium chloride external concentrate 50 % Formulary OTC

benzalkonium chloride external solution 50 % Formulary

BENZEDREX NASAL INHALER Formulary OTC

BENZEPRO CREAMY WASH EXTERNAL LIQUID 7 % Formulary

BENZEPRO EXTERNAL FOAM 5.3 % Formulary

BENZEPRO SHORT CONTACT EXTERNAL FOAM 9.8 %

Formulary

BENZODENT MOUTH/THROAT CREAM 20 % Formulary OTC

benzoin external tincture Formulary

benzonatate oral capsule 100 mg, 150 mg, 200 mg Formulary AGE (Min 6 Years)

18

Drug Name Formulary Status Requirements/LimitsBENZ-O-STHETIC MOUTH/THROAT SWAB 20 % Formulary OTC

benzoyl peroxide cleanser external lotion 6 % Formulary

benzoyl peroxide external gel 2.5 % Formulary OTC; AGE (Max 18 Years)

benzoyl peroxide wash external liquid 10 % Formulary AGE (Max 18 Years)

benzoyl peroxide wash external liquid 5 % Formulary OTC; AGE (Max 18 Years)

benzoyl peroxide-erythromycin external gel 5-3 % Formulary

benzphetamine hcl oral tablet 50 mg Formulary PA

BENZ-PROTECT EXTERNAL SWAB Formulary OTC

benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 mg Formulary

BERINERT INTRAVENOUS KIT 500 UNIT Formulary PA; QL (8 EA per 30 days)

BERRI-FREEZ PAIN RELIEVING EXTERNAL GEL 4.5 %

Formulary OTC

BERRI-FREEZ PAIN RELIEVING EXTERNAL LIQUID 10 %

Formulary OTC

BERRI-FREEZ PLUS EXTERNAL GEL 0.2-4-8 % Formulary OTC

BETA CARE BETATAR GEL EXTERNAL SHAMPOO 2.5 %

Formulary OTC

beta carotene provitamin a oral capsule 25000 unit Formulary OTC

BETADINE EXTERNAL SOLUTION 10 %, 5 % Formulary OTC

BETADINE SURGICAL SCRUB EXTERNAL SOLUTION 7.5 %

Formulary OTC

BETADINE SWABSTICKS EXTERNAL SWAB 10 % Formulary OTC

betaine hcl oral tablet 300 mg Formulary OTC

betamethasone dipropionate aug external cream 0.05 % Formulary

betamethasone dipropionate aug external gel 0.05 % Formulary

betamethasone dipropionate aug external lotion 0.05 % Formulary

betamethasone dipropionate aug external ointment 0.05 % Formulary

betamethasone dipropionate external cream 0.05 % Formulary

betamethasone dipropionate external lotion 0.05 % Formulary

betamethasone dipropionate external ointment 0.05 % Formulary

betamethasone valerate external cream 0.1 % Formulary

betamethasone valerate external lotion 0.1 % Formulary

betamethasone valerate external ointment 0.1 % Formulary

BETAQUIK ORAL EMULSION Formulary OTC

BETASERON SUBCUTANEOUS KIT 0.3 MG Formulary

betaxolol hcl ophthalmic solution 0.5 % Formulary

betaxolol hcl oral tablet 10 mg, 20 mg Formulary

bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg Formulary

BETHKIS INHALATION NEBULIZATION SOLUTION 300 MG/4ML

FormularyQL (280 ML per 28 days); AGE (Min 6 Years)

bexarotene oral capsule 75 mg Formulary PA

BIATAIN HEEL ADH FOAM DRESSING PAD 19CMX20CM

Formulary OTC

BIATAIN SACRAL FOAM DRESSING PAD 9"X9" Formulary OTC

bicalutamide oral tablet 50 mg Formulary

19

Drug Name Formulary Status Requirements/LimitsBICARSIM FORTE ORAL TABLET 125 MG Formulary OTC

BICARSIM ORAL TABLET 80 MG Formulary OTC

BICNU INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

Formulary

BIKTARVY ORAL TABLET 30-120-15 MG, 50-200-25 MG

Formulary

biobron sf oral syrup 10-15-350 mg/5ml Formulary OTC

biocotron oral liquid 10-100 mg/5ml Formulary OTC

biodesp dm oral syrup 5-15-100 mg/5ml Formulary OTC

bioflavonoid-1000 oral tablet 1000 mg Formulary OTC

BIO-FLAX ORAL CAPSULE 1000 MG Formulary OTC

BIOFLONEX ORAL TABLET 250-650 MG Formulary OTC

BIOFREEZE EXTERNAL AEROSOL 10.5 % Formulary OTC

BIOFREEZE ROLL-ON COLORLESS EXTERNAL GEL 4 %

Formulary OTC

BIOGAIA GASTRUS ORAL TABLET CHEWABLE Formulary OTC

biogtuss oral liquid 10-28-388 mg/5ml Formulary OTC

BIOGUARD NON-ADHERENT DRESSING PAD 3"X8" Formulary

BIOLLE GEL TEARS OPHTHALMIC GEL 1 % Formulary OTC

bionatuss dxp oral liquid 10-2-20 mg/5ml Formulary OTC

BIOPATCH PROTECTIVE DISK/CHG EXTERNAL (DRESSING)

Formulary OTC

biopetit oral elixir Formulary OTC

BIORX SPONIX ANTI-FUNGAL EXTERNAL SOLUTION 22 %

Formulary OTC

BIORX SPONIX ARTHR & MUSC EXTERNAL SOLUTION 4-10-0.035 %

Formulary OTC

biospec dmx oral liquid 15-25 mg/5ml Formulary OTC

biotalan clear oral liquid Formulary OTC

BIO-THERM PAIN RELIEVING EXTERNAL LOTION 0.002-10-20 %

Formulary OTC

biotin forte oral tablet 3 mg Formulary OTC

biotin oral capsule 10 mg, 2500 mcg Formulary OTC

biotin oral tablet 1000 mcg, 10000 mcg, 300 mcg, 800 mcg Formulary OTC

biotin plus keratin oral tablet 10000-100 mcg-mg Formulary OTC

biotuss oral liquid 10-15-300 mg/5ml Formulary

biovol oral syrup Formulary OTC

bisacodyl ec oral tablet delayed release 5 mg Formulary OTC

bismatrol maximum strength oral suspension 525 mg/15ml Formulary OTC

bismatrol oral tablet chewable 262 mg Formulary OTC

bisoprolol fumarate oral tablet 10 mg, 5 mg Formulary

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

Formulary

bite/itch external lotion 1-2 % Formulary OTC

BI-ZETS/BENZOTROCHES MOUTH/THROAT LOZENGE 15 MG

Formulary OTC

20

Drug Name Formulary Status Requirements/Limitsbleomycin sulfate injection solution reconstituted 15 unit, 30 unit

Formulary

BLINK TEARS OPHTHALMIC GEL 0.25 % Formulary OTC

BLINK TEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC

BLISOVI 24 FE ORAL TABLET 1-20 MG-MCG(24) Formulary

BLISOVI FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary

BLISOVI FE 1/20 ORAL TABLET 1-20 MG-MCG Formulary

BLISTEX MEDICATED EXTERNAL OINTMENT Formulary OTC

blood pressure monitor/wrist kit Formulary OTC

BOIL EASE MAXIMUM STRENGTH EXTERNAL OINTMENT 20 %

Formulary OTC

BONE DENSITY ORAL TABLET 300-200 MG-UNIT Formulary OTC

BOOSTRIX INTRAMUSCULAR SUSPENSION 5-2.5-18.5

Formulary

BOOSTRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 5-2.5-18.5 LF-MCG/0.5

Formulary

borage oral capsule 1000-240-378 mg Formulary OTC

boric acid external granules Formulary

boron oral capsule 3 mg Formulary OTC

boron oral tablet 6 mg Formulary OTC

BOTOX INJECTION SOLUTION RECONSTITUTED 100 UNIT, 200 UNIT

Formulary PA

BOUDREAUXS BABY KISSES EXTERNAL OINTMENT

Formulary OTC

BOUDREAUXS BUTT PASTE EXTERNAL OINTMENT 16 %, 40 %

Formulary OTC

BOUDREAUXS RASH PREVENTOR EXTERNAL LIQUID 10 %

Formulary OTC

bp 10-1 external emulsion 10-1 % Formulary QL (170.1 GM per 30 days)

bp cleansing wash external emulsion 10-4 % Formulary

bp wash external liquid 2.5 % Formulary OTC

BPROTECTED MULTI-VITE ORAL LIQUID Formulary OTC

BPROTECTED PEDIA IRON ORAL SOLUTION 75 (15 FE) MG/ML

Formulary OTC

BPROTECTED PEDIA POLY-VITE ORAL SOLUTION , 35 MG/ML

Formulary OTC

BRAINSTRONG PRENATAL ORAL 33-0.8 & 350 MG Formulary OTC

BRASIVOL EXTERNAL PASTE Formulary OTC

BREEZE 2 TEST DISK IN VITRO Formulary OTC; QL (150 EA per 30 days)

BREVIBLOC IN NACL INTRAVENOUS SOLUTION 2000 MG/100ML, 2500 MG/250ML

Formulary

brewers yeast oral tablet Formulary OTC

BREXAFEMME ORAL TABLET 150 MG Formulary ST; QL (4 EA per 1 day)

BRILINTA ORAL TABLET 60 MG, 90 MG Formulary

brimonidine tartrate ophthalmic solution 0.15 %, 0.2 % Formulary

brinzolamide ophthalmic suspension 1 % Formulary

brohist d oral tablet 4-10 mg Formulary OTC

21

Drug Name Formulary Status Requirements/Limitsbromi-lotion external lotion Formulary OTC

bromocriptine mesylate oral capsule 5 mg Formulary

bromocriptine mesylate oral tablet 2.5 mg Formulary

bronchial asthma relief oral tablet 12.5-200 mg Formulary OTC

BRONKAID ORAL TABLET 25-400 MG Formulary OTC

bronkids oral liquid 1.5-0.6-2.75 mg/ml, 10-4-10 mg/5ml Formulary OTC

brontuss dx oral liquid 10-20-200 mg/5ml Formulary OTC

brotapp dm oral liquid 15-1-5 mg/5ml Formulary OTC

btrex oral tablet extended release 8-200-4-100-600 mg Formulary OTC

BUCKLEYS CHEST CONGESTION ORAL LIQUID 100 MG/5ML

Formulary OTC

BUCKLEYS COUGH ORAL LIQUID 12.5 MG/5ML Formulary OTC

budesonide inhalation suspension 0.25 mg/2ml, 0.5 mg/2ml, 1 mg/2ml

Formulary

budesonide oral capsule delayed release particles 3 mg Formulary

budesonide suspension 32 mcg/act nasal (otc) 32 mcg/act Formulary OTC

budesonide-formoterol fumarate inhalation aerosol 160-4.5 mcg/act, 80-4.5 mcg/act

Formulary

BUFFERIN EXTRA STRENGTH ORAL TABLET 500 MG

Formulary OTC

BUFFERIN LOW DOSE ORAL TABLET 81 MG Formulary OTC

BUFFERIN ORAL TABLET 325 MG Formulary OTC

BULL FROG WATER ARMOR SPORT EXTERNAL GEL

Formulary OTC

bumetanide oral tablet 0.5 mg, 1 mg, 2 mg Formulary

buprenorphine hcl injection solution 0.3 mg/ml Formulary PA

buprenorphine hcl sublingual tablet sublingual 2 mg FormularyPA; QL (360 EA per 30 days); AGE (Min 16 Years)

buprenorphine hcl sublingual tablet sublingual 8 mg FormularyPA; QL (90 EA per 30 days); AGE (Min 16 Years)

buprenorphine hcl-naloxone hcl sublingual tablet sublingual 2-0.5 mg

FormularyQL (360 EA per 30 days); AGE (Min 16 Years)

buprenorphine hcl-naloxone hcl sublingual tablet sublingual 8-2 mg


buprenorphine transdermal patch weekly 10 mcg/hr, 5 mcg/hr, 7.5 mcg/hr


buprenorphine transdermal patch weekly 15 mcg/hr, 20 mcg/hr


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

Formulary

bupropion hcl er (sr) oral tablet extended release 12 hour100 mg, 150 mg, 200 mg

Formulary

bupropion hcl er (xl) oral tablet extended release 24 hour150 mg, 300 mg

Formulary

bupropion hcl oral tablet 100 mg, 75 mg Formulary

burn relief external aerosol 0.5 % Formulary OTC

burn relief/lidocaine/aloe external gel 0.5 % Formulary OTC

22

Drug Name Formulary Status Requirements/Limitsbuspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg

Formulary

busulfan intravenous solution 6 mg/ml Formulary

butalbital-acetaminophen oral tablet 50-325 mg Formulary

butalbital-apap-caff-cod oral capsule 50-300-40-30 mg, 50-325-40-30 mg


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

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

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

butorphanol tartrate nasal solution 10 mg/ml Formulary PA; QL (5 ML per 34 days)

BYDUREON SUBCUTANEOUS PEN-INJECTOR 2 MG Formulary

BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER 2 MG

Formulary

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

Formulary

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

Formulary

BYLVAY (PELLETS) ORAL CAPSULE SPRINKLE 200 MCG, 600 MCG


BYLVAY ORAL CAPSULE 1200 MCG, 400 MCG Formulary PA; QL (150 EA per 30 days)

c & e oral capsule Formulary OTC

c-1500/rose hips sr oral tablet extended release 1500 mg Formulary OTC

c1500/rose hips/bioflavonoid oral tablet extended release Formulary OTC

cabenuva intramuscular suspension extended release 400 & 600 mg/2ml, 600 & 900 mg/3ml

Formulary

cabergoline oral tablet 0.5 mg Formulary QL (10 EA per 34 days)

cadeau dha oral capsule 29-0.4-0.8-375 mg Formulary OTC

caffeine citrate oral solution 20 mg/ml Formulary

cal/mag oral tablet 200-100 mg Formulary OTC

CALADRYL CLEAR EXTERNAL LOTION 1-0.1 % Formulary OTC

CALADRYL EXTERNAL LOTION 1-8 % Formulary OTC

CALAGEL MAXIMUM STRENGTH EXTERNAL GEL Formulary OTC

CALAGESIC EXTERNAL LOTION 1-8 % Formulary OTC

calahist clear external lotion 1-0.1 % Formulary OTC

calamine external lotion , 8-8 % Formulary OTC

calamine phenolated external lotion Formulary OTC

calamine-zinc oxide external lotion Formulary OTC

calamine-zinc oxide external suspension 8-8 % Formulary OTC

CALAZIME SKIN PROTECTANT EXTERNAL PASTE Formulary OTC

CAL-CARB FORTE ORAL TABLET 1250 (500 CA) MG Formulary OTC

CALCET PETITES ORAL TABLET 200-250 MG-UNIT Formulary OTC

CALCI-CHEW ORAL TABLET CHEWABLE 1250 (500 CA) MG

Formulary OTC

calci-max oral capsule Formulary OTC

calcipotriene external cream 0.005 % Formulary

calcipotriene external ointment 0.005 % Formulary

23

Drug Name Formulary Status Requirements/Limitscalcipotriene external solution 0.005 % Formulary

calcitonin (salmon) nasal solution 200 unit/act Formulary

cal-citrate oral capsule 150 mg Formulary OTC

CALCITRATE ORAL TABLET 950 (200 CA) MG, 950 MG

Formulary OTC

calcitriol oral capsule 0.25 mcg, 0.5 mcg Formulary

calcitriol oral solution 1 mcg/ml Formulary

calcium + d3 oral tablet 600-800 mg-unit Formulary OTC

calcium 1200 oral tablet chewable 1200-1000 mg-unit Formulary OTC

calcium 500 + d3 oral tablet 500-600 mg-unit Formulary OTC

calcium 600 + d oral tablet 600-200 mg-unit Formulary OTC

calcium 600 oral tablet 1500 (600 ca) mg Formulary OTC

calcium 600+d3 oral tablet 600-400 mg-unit Formulary OTC

calcium 600+d3 plus minerals oral tablet 600-800 mg-unit Formulary OTC

calcium acetate (phos binder) oral capsule 667 mg Formulary

calcium acetate (phos binder) oral tablet 667 mg Formulary

calcium acetate oral tablet 668 (169 ca) mg Formulary OTC

calcium ascorbate oral tablet 500 mg Formulary OTC

calcium aspartate oral tablet 75 mg Formulary OTC

calcium carbonate antacid oral tablet 648 mg Formulary OTC

calcium carbonate oral powder 800 mg/2gm Formulary OTC

calcium carbonate oral tablet 1500 (600 ca) mg, 600 mg Formulary OTC

calcium carbonate w/vitamin d oral tablet 600-400 mg-unit Formulary OTC

calcium carbonate-vitamin d oral capsule 600-200 mg-unit Formulary OTC

calcium carbonate-vitamin d oral tablet 600-400 mg-unit Formulary OTC

calcium citrate + d3 oral tablet 250-200 mg-unit Formulary OTC

calcium citrate + oral tablet 315-200 mg-unit Formulary OTC

calcium citrate malate-vit d oral tablet 250-100 mg-unit Formulary OTC

calcium citrate oral tablet 1040 mg, 200 mg, 250 mg, 950 (200 ca) mg

Formulary OTC

calcium citrate plus oral tablet Formulary OTC

calcium citrate-vitamin d oral tablet 200-125 mg-unit Formulary OTC

calcium citrate-vitamin d3 oral liquid 1000-400 Formulary OTC

calcium citrate-vitamin d3 oral tablet 315-250 mg-unit Formulary OTC

calcium gluconate oral tablet 500 mg Formulary OTC

calcium gummies oral tablet chewable 250-100-500 mg-unit

Formulary OTC

calcium high potency/vitamin d oral tablet 600-200 mg-unit Formulary OTC

calcium lactate oral tablet 100 mg, 648 mg Formulary OTC

calcium oral tablet 500 mg, 500-125 mg-unit Formulary OTC

calcium oral tablet chewable 500-100 mg-unit, 600-400 mg-unit

Formulary OTC

calcium oyster shell oral tablet 500 mg Formulary OTC

calcium pantothenate oral tablet 100 mg, 200 mg, 500 mg Formulary OTC

calcium plus vitamin d3 oral capsule 600-500 mg-unit Formulary OTC

24

Drug Name Formulary Status Requirements/Limitscalcium soft chews oral tablet chewable 500-1000-40 mg-unt-mcg, 500-500-40 mg-unt-mcg

Formulary OTC

calcium-magnesium-zinc oral tablet 333-133-5 mg, 334-134-5 mg

Formulary OTC

calcium-vitamin d oral tablet 600-200 mg-unit Formulary OTC

calcium-vitamin d3 oral tablet 600-125 mg-unit Formulary OTC

calcium-vitamin d-minerals oral tablet chewable 600-400 mg-unit, 600-800 mg-unit

Formulary OTC

calendula external lotion Formulary OTC

calendula external ointment Formulary OTC

cal-glu oral capsule 500 mg Formulary OTC

cal-lac oral capsule 500 mg Formulary OTC

calmag thins oral tablet 200-50 mg Formulary OTC

cal-mint oral tablet chewable 260 mg Formulary OTC

CALMOL-4 RECTAL SUPPOSITORY 76-10 % Formulary OTC

calna oral tablet Formulary OTC

CALTRATE 600+D ORAL TABLET 600-800 MG-UNIT Formulary OTC

CALTRATE 600+D PLUS MINERALS ORAL TABLET 600-800 MG-UNIT

Formulary OTC

CALTRATE 600+D PLUS MINERALS ORAL TABLET CHEWABLE 600-800 MG-UNIT

Formulary OTC

CALTRATE 600+D3 SOFT ORAL TABLET CHEWABLE 600-800 MG-UNIT

Formulary OTC

CALTRATE GUMMY BITES ORAL TABLET CHEWABLE 250-400 MG-UNIT

Formulary OTC

CALTRATE MINIS PLUS MINERALS ORAL TABLET 300-800 MG-UNIT

Formulary OTC

CAMILA ORAL TABLET 0.35 MG Formulary QL (28 EA per 28 days)

CAMPHO-PHENIQUE EXTERNAL GEL 10.8-4.7 % Formulary OTC

CAMPHO-PHENIQUE EXTERNAL LIQUID 10.8-4.7 % Formulary OTC

CAMPHOTREX EXTERNAL GEL 10-4 % Formulary OTC

capcof oral syrup 5-2-10 mg/5ml Formulary OTC

capecitabine oral tablet 150 mg, 500 mg Formulary PA

capmist dm oral tablet 60-15-400 mg Formulary OTC

capron dm oral liquid 7.5-7.5 mg/5ml Formulary OTC

capron dmt oral tablet 30-30 mg Formulary OTC

capsaicin external cream 0.025 %, 0.1 % Formulary OTC

capsaicin hot patch external pad 0.025 % Formulary OTC

capsaicin hot patch external patch 0.025 % Formulary OTC

CAPSIDERM EXTERNAL PATCH 0.0375-5 % Formulary OTC

capsule 1 clear veggie capsule Formulary OTC

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

CAPZASIN-HP EXTERNAL CREAM 0.1 % Formulary OTC

CARBAGLU ORAL TABLET 200 MG Formulary

carbamazepine er oral capsule extended release 12 hour100 mg, 200 mg, 300 mg

Formulary

25

Drug Name Formulary Status Requirements/Limitscarbamazepine er oral tablet extended release 12 hour 100 mg, 200 mg, 400 mg

Formulary

carbamazepine oral suspension 100 mg/5ml Formulary

carbamazepine oral tablet 200 mg Formulary

carbamazepine oral tablet chewable 100 mg Formulary

CARBAPHEN CH ORAL SUSPENSION 10-4-24 MG/5ML

Formulary OTC

CARBAPHEN PED CH ORAL SUSPENSION 2.5-1.25-8 MG/ML

Formulary OTC

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

Formulary

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

Formulary

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

Formulary

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

carbinoxamine maleate oral solution 4 mg/5ml Formulary

carbinoxamine maleate oral tablet 4 mg Formulary

CARBOHOL 940 GEL Formulary

CARBZERO ORAL EMULSION Formulary OTC

CARDENZ ORAL TABLET Formulary OTC

CAREFINE PEN NEEDLES 32G X 5 MM , 32G X 6 MM Formulary OTC

careone insulin syringe 30g x 1/2" 0.3 ml 30g x 1/2" 0.3 ml Formulary OTC

careone insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml Formulary OTC

careone insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC

careone insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml

Formulary OTC

careone insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml

Formulary OTC

careone insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC

CAREONE LANCET SUPER THIN 30G Formulary OTC; QL (150 EA per 30 days)

careone lancet thin 23g Formulary OTC; QL (150 EA per 30 days)

CA-REZZ EXTERNAL LIQUID 0.25 % Formulary OTC

ca-rezz gentle external liquid 0.2 % Formulary OTC

ca-rezz norisc external cream 0.2 % Formulary OTC

carglumic acid oral tablet 200 mg Formulary

CARRACOLLOID 4"X4" EXTERNAL PAD Formulary OTC

CARRASMART EXTERNAL GEL Formulary OTC

CARRASORB H EXTERNAL Formulary OTC

CARRASYN V WOUND DRESSING EXTERNAL GEL Formulary OTC

CARRINGTON DERMAL WOUND EXTERNAL GEL Formulary OTC

carteolol hcl ophthalmic solution 1 % Formulary

CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG

Formulary

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

cascara sagrada oral capsule 450 mg Formulary OTC

26

Drug Name Formulary Status Requirements/Limitscastellani paint modified external liquid 1.5 % Formulary OTC

CASTIVA COOLING EXTERNAL LOTION 5-14 % Formulary OTC

CASTIVA WARMING EXTERNAL LOTION 0.035 % Formulary OTC

castor oil stimulant laxative oral oil 100 % Formulary OTC

CAVAREST DENTAL GEL 1.1 % Formulary

CAVILON EMOLLIENT EXTERNAL CREAM Formulary OTC

CAVILON FOOT & DRY SKIN EXTERNAL CREAM Formulary OTC

CAVILON NO STING BARRIER FILM EXTERNAL LIQUID

Formulary OTC

CAVILON ONE-STEP SKIN CARE EXTERNAL LOTION

Formulary OTC

CAVILON SKIN CLEANSER EXTERNAL LIQUID Formulary OTC

CAYA VAGINAL DIAPHRAGM Formulary

CAZIANT ORAL TABLET 0.1/0.125/0.15 -0.025 MG Formulary QL (28 EA per 28 days)

cefaclor oral capsule 250 mg, 500 mg Formulary

cefaclor oral suspension reconstituted 125 mg/5ml Formulary

cefadroxil oral capsule 500 mg Formulary

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

Formulary

cefadroxil oral tablet 1 gm Formulary

cefdinir oral capsule 300 mg Formulary

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

Formulary

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


cefpodoxime proxetil oral tablet 100 mg, 200 mg Formulary QL (28 EA per 34 days)

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

Formulary

cefprozil oral tablet 250 mg, 500 mg Formulary

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

Formulary

ceftriaxone sodium injection solution reconstituted 1 gm, 2 gm, 250 mg, 500 mg

Formulary

ceftriaxone sodium intravenous solution reconstituted 10 gm, 2 gm

Formulary

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

Formulary

cefuroxime axetil oral tablet 250 mg, 500 mg Formulary

CELACYN EXTERNAL GEL Formulary

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

celery seed oil Formulary OTC

CENTRATEX ORAL CAPSULE 106-1 MG Formulary

centravites adults oral tablet Formulary OTC

CENTRUM FLAVOR BURST DRINK ORAL PACKET Formulary OTC

CENTRUM ORAL LIQUID Formulary OTC

CENTRUM SPECIALIST PRENATAL ORAL 27-0.8 & 200 MG

Formulary OTC

27

Drug Name Formulary Status Requirements/LimitsCEO-TWO RECTAL SUPPOSITORY Formulary OTC

CEPACOL ANTIBACTERIAL MOUTH/THROAT LIQUID 0.05 %

Formulary OTC

CEPACOL EXTRA STRENGTH MOUTH/THROAT LOZENGE 15-2.6 MG

Formulary OTC

CEPACOL SORE THROAT & COUGH MOUTH/THROAT LOZENGE 5-7.5 MG

Formulary OTC

CEPACOL SORE THROAT EX ST MOUTH/THROAT LOZENGE 15-3.6 MG

Formulary OTC

CEPACOL SORE THROAT MOUTH/THROAT LOZENGE 15-2.6 MG

Formulary OTC

CEPASTAT MOUTH/THROAT LOZENGE 5-6-10 MG Formulary OTC

cephalexin oral capsule 250 mg, 500 mg Formulary

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

Formulary

CERACADE EMULSION EXTERNAL Formulary

CERALYTE 70 ORAL PACKET Formulary OTC

CERAVE BABY EXTERNAL LOTION 1 % Formulary OTC

CERAVE ITCH RELIEF EXTERNAL CREAM 1 % Formulary OTC

CERAVE SUNSCREEN SPF50 EXTERNAL LOTION Formulary OTC

CEROVEL EXTERNAL LOTION 40 % Formulary

CESIUM 1000 ORAL CAPSULE 1000 MG Formulary OTC

cesium 500 oral capsule 500 mg Formulary OTC

cesium oral tablet 100 mg Formulary OTC

CETACAINE EXTERNAL LIQUID 2-2-14 % Formulary

CETAPHIL GENTLE CLEANSING EXTERNAL BAR Formulary OTC

cetirizine hcl oral tablet 5 mg Formulary OTC

CETRAXAL OTIC SOLUTION 0.2 % Formulary

CHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MG

Formulary

CHANTIX ORAL TABLET 0.5 MG Formulary

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

Formulary

CHAP-EX TROPICALS EXTERNAL STICK Formulary OTC

CHAPSTICK MOISTURIZER EXTERNAL OINTMENT Formulary OTC

CHAPSTICK ULTRA RENEWAL EXTERNAL CREAM 2 %

Formulary OTC

CHAR-FLO WITH SORBITOL ORAL SUSPENSION 25-48 GM/120ML

Formulary OTC

chelated calcium oral tablet 200 mg Formulary OTC

chelated magnesium oral tablet 100 mg Formulary OTC

chelated zinc oral tablet 50 mg Formulary OTC

CHEMSTRIP 10 MD IN VITRO STRIP Formulary OTC

CHEMSTRIP 10/SG IN VITRO STRIP Formulary OTC

CHEMSTRIP 2 GP IN VITRO STRIP Formulary OTC

CHEMSTRIP 5 OB IN VITRO STRIP Formulary OTC

28

Drug Name Formulary Status Requirements/LimitsCHEMSTRIP 7 IN VITRO STRIP Formulary OTC

CHEMSTRIP 9 IN VITRO STRIP Formulary OTC

CHEMSTRIP CALIBRATION IN VITRO STRIP Formulary OTC

CHEMSTRIP MICRAL IN VITRO STRIP Formulary OTC

CHEMSTRIP UGK IN VITRO STRIP Formulary OTC

CHENODAL ORAL TABLET 250 MG Formulary PA

CHERACOL-D COUGH ORAL LIQUID 10-100 MG/5ML Formulary OTC

cherry concentrate oral concentrate Formulary OTC

cherry oral syrup Formulary

chest rub external ointment 4.8-1.2-2.6 % Formulary OTC

CHEW Q ORAL TABLET CHEWABLE 100 MG, 30 MG, 600 MG

Formulary OTC

chewable iron oral tablet chewable 30-10-25 mg Formulary OTC

CHIGG AWAY EXTERNAL LOTION 5-10 % Formulary OTC

childrens aspirin free oral elixir 80 mg/2.5ml Formulary OTC

CHILDRENS MOTRIN ORAL SUSPENSION 100 MG/5ML

Formulary OTC

childrens pain reliever oral tablet chewable 80 mg Formulary OTC

childrens plus multi-sympt cld oral suspension 2.5-1-5-160 mg/5ml

Formulary OTC

childrens silfedrine oral liquid 15 mg/5ml Formulary OTC

CHILDRENS SOOTHE ORAL TABLET CHEWABLE 400 MG

Formulary OTC

chlo hist oral solution 12.5-1 mg/5ml Formulary OTC

CHLO TUSS ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC

chlophed oral liquid 5-12.5-100 mg/5ml Formulary OTC

CHLORASEPTIC MOUTH/THROAT LOZENGE 6-10 MG

Formulary OTC

chlordiazepoxide hcl oral capsule 10 mg, 5 mg Formulary QL (170 EA per 34 days)

chlordiazepoxide hcl oral capsule 25 mg Formulary QL (170 EA per 30 days)

chlorella oral capsule Formulary OTC

chlorhexidine gluconate cloth external pad 2 % Formulary OTC

chlorhexidine gluconate external liquid 2 %, 4 % Formulary OTC

chlorhexidine gluconate mouth/throat solution 0.12 % Formulary

chlorophyll oral tablet 3-0.6 mg Formulary OTC

chloroquine phosphate oral tablet 250 mg, 500 mg Formulary

chlorothiazide oral tablet 250 mg, 500 mg Formulary

CHLORPHEN SR ORAL TABLET EXTENDED RELEASE 12 MG

Formulary OTC

chlorpromazine hcl injection solution 25 mg/ml, 50 mg/2ml Formulary AGE (Min 18 Years)

chlorpromazine hcl oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg


chlorthalidone oral tablet 25 mg, 50 mg Formulary

CHLOR-TRIMETON ALLERGY ORAL TABLET EXTENDED RELEASE 12 MG

Formulary OTC

CHLOR-TRIMETON ORAL SYRUP 2 MG/5ML Formulary OTC

29

Drug Name Formulary Status Requirements/LimitsCHLOR-TRIMETON ORAL TABLET 4 MG Formulary OTC

chlorzoxazone oral tablet 250 mg, 375 mg, 500 mg, 750 mg Formulary

chocolated laxative oral tablet chewable 15 mg Formulary OTC

cholesterol acetate powder Formulary OTC

cholestyramine light oral packet 4 gm Formulary

cholestyramine light oral powder 4 gm/dose Formulary

cholestyramine oral packet 4 gm Formulary

cholestyramine oral powder 4 gm/dose Formulary

choline citrate oral tablet 650 mg Formulary OTC

choline oral capsule 648 mg Formulary OTC

choline sr oral tablet extended release 300 mg Formulary OTC

choline-mag trisalicylate oral liquid 500 mg/5ml Formulary

CHONDROITIN SULFATE COMPLEX ORAL CAPSULE 400-60-2.5 MG

Formulary OTC

CHROMACAPS ORAL CAPSULE 1 MG Formulary OTC

chromium aspartate oral tablet 1000 mcg Formulary OTC

chromium gtf oral tablet 200 mcg Formulary OTC

chromium oral tablet 1000 mcg, 400 mcg Formulary OTC

chromium picolinate oral capsule 200 mcg Formulary OTC

chromium picolinate oral tablet 1000 mcg, 200 mcg, 400 mcg

Formulary OTC

CICLODAN EXTERNAL CREAM 0.77 % Formulary

CICLODAN EXTERNAL SOLUTION 8 % Formulary PA

ciclopirox external gel 0.77 % Formulary PA

ciclopirox external shampoo 1 % Formulary

ciclopirox external solution 8 % Formulary PA

ciclopirox olamine external suspension 0.77 % Formulary

ciclopirox treatment external kit 8 % Formulary

cilostazol oral tablet 100 mg, 50 mg Formulary

CIMDUO ORAL TABLET 300-300 MG Formulary

cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg Formulary

cinnamon oral capsule 500 mg Formulary OTC

CINRYZE INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT


CIPRO ORAL SUSPENSION RECONSTITUTED 500 MG/5ML (10%)

Formulary

CIPRODEX OTIC SUSPENSION 0.3-0.1 % Formulary

ciprofloxacin hcl ophthalmic solution 0.3 % Formulary

ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg

Formulary

ciprofloxacin hcl otic solution 0.2 % Formulary

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

Formulary

ciprofloxacin-dexamethasone otic suspension 0.3-0.1 % Formulary

cisplatin intravenous solution 50 mg/50ml Formulary

30

Drug Name Formulary Status Requirements/Limitscitalopram hydrobromide oral solution 10 mg/5ml Formulary

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

CITRA PH ORAL SOLUTION 2.7 GM/30ML Formulary OTC

CITRANATAL 90 DHA ORAL 90-1 & 300 MG Formulary

CITRANATAL ASSURE ORAL 35-1 & 300 MG Formulary

CITRANATAL B-CALM ORAL 20-1 MG & 2 X 25 MG Formulary

CITRANATAL DHA ORAL 27-1 & 250 MG Formulary

CITRANATAL HARMONY ORAL CAPSULE 27-1-260 MG

Formulary

CITRANATAL RX ORAL TABLET 27-1 MG Formulary

CITRUCEL ORAL POWDER Formulary OTC

CITRUCEL ORAL TABLET 500 MG Formulary OTC

CITRULLINE 1000 ORAL PACKET 1 GM Formulary OTC

CITRULLINE200 ORAL PACKET 200 MG Formulary OTC

cladribine intravenous solution 10 mg/10ml Formulary

CLARAVIS ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG

Formulary

clarithromycin er oral tablet extended release 24 hour 500 mg

Formulary

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

Formulary

clarithromycin oral tablet 250 mg, 500 mg Formulary

CLARITIN CHILDRENS ORAL TABLET CHEWABLE 5 MG

Formulary OTC

CLARITIN ORAL CAPSULE 10 MG Formulary OTC

CLARITIN ORAL SYRUP 5 MG/5ML Formulary OTC

CLARITIN ORAL TABLET 10 MG Formulary OTC

CLARITIN REDITABS ORAL TABLET DISPERSIBLE 10 MG, 5 MG

Formulary OTC

CLARITIN-D 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR 5-120 MG

Formulary OTC

CLARITIN-D 24 HOUR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-240 MG

Formulary OTC

classic prenatal oral tablet 28-0.8 mg Formulary OTC

CLEAN & CLEAR ACNE CLEANSER EXTERNAL FOAM 2 %

Formulary OTC

CLEAN & CLEAR ACNE CLEANSER EXTERNAL LIQUID 2 %

Formulary OTC

CLEAN & CLEAR ADVANTAGE MARK EXTERNAL GEL 2 %

Formulary OTC

CLEAN ZING MOUTH/THROAT LIQUID 0.06 % Formulary OTC

CLEANLET LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

cleansing external cream Formulary OTC

CLEAR EYES REDNESS RELIEF OPHTHALMIC SOLUTION 0.012-0.2 %

Formulary OTC

clear zinc spf 50 external lotion Formulary OTC

CLEARASIL DAILY CLEAN EXTERNAL LIQUID 1 % Formulary OTC

31

Drug Name Formulary Status Requirements/LimitsCLEARASIL DAILY CLEAR ACNE EXTERNAL CREAM 10 %

Formulary OTC

CLEARASIL DAILY CLEAR EXTERNAL CREAM 2-8 %

Formulary OTC

CLEARCANAL EAR WAX REMOVAL OTIC KIT 6.5 % Formulary OTC

CLEARLAX ORAL POWDER 17 GM/SCOOP Formulary OTC

CLEARLIFE ALLERGY RELIEF NASAL LIQUID Formulary OTC

clemastine fumarate oral tablet 2.68 mg Formulary

CLEOCIN VAGINAL SUPPOSITORY 100 MG Formulary

CLERZ PLUS SOLUTION Formulary OTC

CLEVER CHOICE BP MONITOR/WRIST DEVICE Formulary OTC

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

clindamycin palmitate hcl oral solution reconstituted 75 mg/5ml

Formulary

clindamycin phos-benzoyl perox external gel 1.2-5 % Formulary

clindamycin phos-benzoyl perox external gel 1-5 % Formulary AGE (Max 18 Years)

clindamycin phosphate external foam 1 % Formulary AGE (Max 18 Years)

clindamycin phosphate external gel 1 % Formulary

clindamycin phosphate external lotion 1 % Formulary AGE (Max 18 Years)

clindamycin phosphate external solution 1 % Formulary AGE (Max 18 Years)

clindamycin phosphate swab 1 % external 1 % Formulary AGE (Max 18 Years)

clindamycin phosphate vaginal cream 2 % Formulary

CLINDESSE VAGINAL CREAM 2 % Formulary

clobazam oral suspension 2.5 mg/ml Formulary PA

clobazam oral tablet 10 mg, 20 mg Formulary PA; AGE (Min 2 Years)

clobetasol prop emollient base external cream 0.05 % Formulary

clobetasol propionate e external cream 0.05 % Formulary

clobetasol propionate emulsion external foam 0.05 % Formulary

clobetasol propionate external cream 0.05 % Formulary

clobetasol propionate external foam 0.05 % Formulary

clobetasol propionate external gel 0.05 % Formulary

clobetasol propionate external ointment 0.05 % Formulary

clobetasol propionate external solution 0.05 % Formulary

clofarabine intravenous solution 1 mg/ml Formulary

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

clonazepam oral tablet 0.5 mg, 1 mg, 2 mg Formulary AGE (Min 18 Years)

clonidine hcl (analgesia) epidural solution 100 mcg/ml Formulary

clonidine hcl er oral tablet extended release 12 hour 0.1 mg Formulary

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

clonidine hcl transdermal patch weekly 0.1 mg/24hr, 0.2 mg/24hr, 0.3 mg/24hr

Formulary

clopidogrel bisulfate oral tablet 300 mg, 75 mg Formulary

clotrimazole 3 vaginal cream 2 % Formulary OTC

clotrimazole anti-fungal external cream 1 % Formulary

clotrimazole external cream 1 % Formulary

32

Drug Name Formulary Status Requirements/Limitsclotrimazole mouth/throat lozenge 10 mg Formulary

clotrimazole solution 1 % external (otc) 1 % Formulary

clotrimazole vaginal cream 1 % Formulary OTC

clotrimazole-betamethasone external cream 1-0.05 % Formulary

clotrimazole-betamethasone external lotion 1-0.05 % Formulary

clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg Formulary AGE (Min 18 Years)

co q 10 oral capsule 10 mg Formulary OTC

co q-10 oral capsule 150 mg, 200 mg Formulary OTC

COAGUCHEK XS PLUS SYSTEM KIT Formulary OTC

COAGUCHEK XS PT TEST IN VITRO STRIP Formulary OTC

COARTEM ORAL TABLET 20-120 MG Formulary

COATS ALOE EXTERNAL CREAM 0.5 % Formulary OTC

COATS ALOE EXTERNAL GEL 0.5 % Formulary OTC

COATS ALOE EXTERNAL LIQUID Formulary OTC

COATS ALOE EXTERNAL LOTION 0.5 % Formulary OTC

COATS ALOE JUICE DRINK ORAL LIQUID Formulary OTC

COATS ALOE LINIMENT EXTERNAL LOTION 10 % Formulary OTC

cocoa butter skin external cream Formulary OTC

cod liver oil oral capsule Formulary OTC

cod liver oil oral oil Formulary

codeine sulfate oral tablet 15 mg, 30 mg, 60 mg Formulary PA; QL (180 EA per 7 days)

coditussin ac oral liquid 200-10 mg/5ml Formulary OTC

coditussin dac oral liquid 30-10-200 mg/5ml Formulary OTC

coenzyme q10 oral capsule 100 mg Formulary OTC

coenzyme q-10 oral capsule 60 mg Formulary OTC

coenzyme q10 oral liquid 30 mg/5ml Formulary OTC

coenzyme q10 oral tablet 100 mg, 25 mg Formulary OTC

coenzyme q10 oral tablet chewable 60 mg Formulary OTC

coenzyme q10-levocarnitine oral capsule 30-250 mg Formulary OTC

co-enzyme q10-vitamin e oral wafer 200-400 mg-unit Formulary OTC

cola syrup oral syrup Formulary OTC

COLACE ORAL CAPSULE 100 MG Formulary OTC

colchicine oral tablet 0.6 mg Formulary

colchicine-probenecid oral tablet 0.5-500 mg Formulary

cold & allergy oral tablet 4-10 mg Formulary OTC

cold & cough childrens oral liquid 2.5-1-5 mg/5ml Formulary OTC

cold & cough day/night child oral 2.5-5 &2.5-6.25 mg/5ml Formulary OTC

cold & flu relief nighttime d oral liquid 60-12.5-30-1000 mg/30ml

Formulary OTC

cold multi-symptom nighttime oral tablet 5-2-10-325 mg Formulary OTC

cold remedy oral tablet dispersible Formulary OTC

cold sore treatment external gel 10.8-4.7 % Formulary OTC

cold sore treatment external liquid Formulary OTC

cold therapy pain relief external gel 3.1 % Formulary OTC

33

Drug Name Formulary Status Requirements/Limitscold/cough childrens oral elixir 2.5-1-5 mg/5ml Formulary OTC

cold/flu relief day/night oral Formulary OTC

COLD-EEZE MOUTH/THROAT LOZENGE 13.3 MG Formulary OTC

colesevelam hcl oral tablet 625 mg Formulary

colestipol hcl oral packet 5 gm Formulary

colestipol hcl oral tablet 1 gm Formulary

collodion flexible external liquid Formulary

COLOCORT RECTAL ENEMA 100 MG/60ML Formulary

COMBIGAN OPHTHALMIC SOLUTION 0.2-0.5 % Formulary

COMBIVENT RESPIMAT INHALATION AEROSOL SOLUTION 20-100 MCG/ACT

Formulary

COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

comfort assured lancets 28g Formulary OTC; QL (150 EA per 30 days)

comfort assured lancets 33g Formulary OTC; QL (150 EA per 30 days)

COMFORT CLEAN/COMFORT SHIELD EXTERNAL 3 %

Formulary OTC

COMFORT EZ PEN NEEDLES 32G X 8 MM Formulary OTC

COMPAT STAY-PUT NJ DOUBLE LUME Formulary OTC

COMPLERA ORAL TABLET 200-25-300 MG Formulary

complete lice treatment combination kit 0.33-4-0.5 % Formulary OTC

complete natal dha oral 29-1-200 & 200 mg, 29-1-200 & 250 mg

Formulary

completenate oral tablet chewable 29-1 mg Formulary

COMPOUND W MAXIMUM STRENGTH EXTERNAL GEL 17 %

Formulary OTC

COMPOUND W ONE STEP INVISIBLE EXTERNAL STRIP 40 %

Formulary OTC

compoz oral capsule 50 mg Formulary OTC

COMPRO RECTAL SUPPOSITORY 25 MG Formulary

COMTREX COLD & COUGH MAX ST ORAL TABLET 10-5-325 MG

Formulary OTC

34

Drug Name Formulary Status Requirements/LimitsCOMTREX COLD/COUGH DAY/NITE MS ORAL 5-2-10-325 MG

Formulary OTC

COMTREX DEEP CHEST COLD ORAL TABLET 325-200 MG

Formulary OTC

CO-NATAL FA ORAL TABLET Formulary

CONCEPT DHA ORAL CAPSULE 53.5-38-1 MG Formulary

CONCEPT OB ORAL CAPSULE 130-92.4-1 MG Formulary

CONCEPTIONXR MOTILITY SUPPORT ORAL Formulary OTC

condoms Formulary OTC

constulose oral solution 10 gm/15ml Formulary

CONTAC COLD+FLU MAX ST ORAL TABLET 5-500 MG

Formulary OTC

CONTOUR BLOOD GLUCOSE SYSTEM KIT W/DEVICE W/DEVICE


CONTOUR CONTROL LIQUID HIGH IN VITRO HIGH Formulary OTC; QL (100 EA per 30 days)

CONTOUR CONTROL LIQUID LOW IN VITRO LOW Formulary OTC; QL (100 EA per 30 days)

CONTOUR CONTROL LIQUID NORMAL IN VITRO NORMAL


CONTOUR MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

CONTOUR MONITOR KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days)

CONTOUR NEXT CONTROL SOLUTION LOW IN VITRO LOW


CONTOUR NEXT CONTROL SOLUTION NORMAL IN VITRO NORMAL


CONTOUR NEXT EZ KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days)

CONTOUR NEXT LINK KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days)

CONTOUR NEXT MONITOR KIT W/DEVICE W/DEVICE


CONTOUR NEXT ONE KIT Formulary OTC; QL (1 EA per 365 days)

CONTOUR NEXT TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

CONTOUR TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

control denture adhesive cream Formulary OTC

control syringe disposable 10 ml Formulary OTC

convex eye protector Formulary OTC

cool n heat ex st external patch 5 % Formulary OTC

cool n heat maximum strength external liquid 16 % Formulary OTC

COPPERMIN ORAL TABLET 5 MG Formulary OTC

co-q 10 omega-3 fish oil oral capsule Formulary OTC

coq10 oral capsule 30 mg Formulary OTC

coq-10 oral capsule 50 mg Formulary OTC

coq10 oral powder 50 gm Formulary OTC

coral calcium oral capsule 185-50-100 mg-mg-unit, 200-100-100 mg-unit

Formulary OTC

CORICIDIN HBP COLD/FLU ORAL TABLET 2-325 MG Formulary OTC

CORICIDIN HBP COUGH/COLD ORAL TABLET 4-30 MG

Formulary OTC

35

Drug Name Formulary Status Requirements/LimitsCORICIDIN HBP DAY/NIGHT COLD ORAL 10-20 &15-200-2 MG

Formulary OTC

CORICIDIN HBP NIGHTTIME COLD ORAL LIQUID 15-6.25-500 MG/15ML

Formulary OTC

CORIFACT INTRAVENOUS KIT 1000-1600 UNIT Formulary

corn & callus remover external liquid 17 % Formulary OTC

corn oil oral oil Formulary OTC

CORN REMOVER WATERPROOF EXTERNAL PAD 40 %

Formulary OTC

corn/callus remover external solution 12.6 % Formulary OTC

CORRECTOL EXTRA GENTLE ORAL CAPSULE 100 MG

Formulary OTC

CORTIC-ND OTIC SOLUTION 10-10-1 MG/ML Formulary

CORTIFOAM RECTAL FOAM 10 % Formulary

cortisone acetate oral tablet 25 mg Formulary

CORTIZONE-10 EXTERNAL GEL 1 % Formulary OTC

CORTIZONE-10/ALOE EXTERNAL CREAM 1 % Formulary OTC

CORVITA 150 ORAL TABLET 150-1.25 MG Formulary

COSAMIN ASU FOR JOINT HEALTH ORAL CAPSULE Formulary OTC

COSAMIN VERDE FOR JOINT HEALTH ORAL TABLET

Formulary OTC

COTTONTAILS DIAPER RASH CREAMY EXTERNAL OINTMENT 10 %

Formulary OTC

cough & chest congestion dm oral liquid 5-100 mg/5ml Formulary OTC

cough & cold oral tablet 4-30 mg Formulary OTC

cough & sore throat nighttime oral liquid 30-12.5-1000 mg/30ml

Formulary OTC

cough drops mouth/throat lozenge 10 mg, 3.1 mg, 5 mg, 5.4 mg, 6.5 mg, 7.5 mg, 7.6 mg, 8 mg, 9.1 mg

Formulary OTC

cough relief oral liquid 15 mg/5ml Formulary OTC

coughtab oral tablet 200 mg Formulary OTC

cramp tabs oral tablet 325-25 mg Formulary OTC

cranberry oral capsule 250 mg, 405 mg, 500 mg Formulary OTC

cream base with liposome external cream Formulary

creatine oral powder Formulary OTC

creatine5000 oral packet 5000 mg Formulary OTC

CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000-38000 UNIT, 24000-76000 UNIT, 3000-9500 UNIT, 36000-114000 UNIT, 6000-19000 UNIT

Formulary PA

CR-GTF ORAL CAPSULE 200 MCG Formulary OTC

CRITIC-AID CLEAR AF EXTERNAL OINTMENT 2 % Formulary OTC

CRIXIVAN ORAL CAPSULE 200 MG, 400 MG Formulary

cromolyn sodium inhalation nebulization solution 20 mg/2ml

Formulary

cromolyn sodium nasal aerosol solution 5.2 mg/act Formulary OTC

cromolyn sodium ophthalmic solution 4 % Formulary ST

cromolyn sodium oral concentrate 100 mg/5ml Formulary

36

Drug Name Formulary Status Requirements/LimitsCROTAN EXTERNAL LOTION 10 % Formulary ST

CR-PLUS ORAL TABLET 500 MCG Formulary OTC

CRYSELLE-28 ORAL TABLET 0.3-30 MG-MCG Formulary QL (28 EA per 28 days)

cu-25 oral capsule 25 mg Formulary OTC

cu-5 oral capsule 5 mg Formulary OTC

CULTURELLE GENTLE-GO KIDS ORAL PACKET Formulary OTC

CULTURELLE KIDS ORAL PACKET Formulary OTC

CURAD GERM SHIELD EXTERNAL GEL Formulary OTC

CURAFIL WOUND DRESSING EXTERNAL GEL Formulary OTC

CURASOL WOUND DRESSING EXTERNAL GEL Formulary OTC

CURITY ALCOHOL PREPS PAD 70 % 70 % Formulary OTC

CURITY ALCOHOL SWABS PAD Formulary OTC

CURITY GAUZE SPONGE PAD 2"X2" Formulary OTC

CURITY GAUZE SPONGES PAD 3-1/2"X4" Formulary OTC

CURITY MESH GAUZE BNDG 4"X30' Formulary OTC

CURX ANTIMICROBIAL EXTERNAL GEL 0.13 % Formulary OTC

CUTINOVA HYDRO 2"X2-3/8" EXTERNAL Formulary OTC

cvs acetaminophen oral capsule 325 mg Formulary OTC

cvs adhesive gauze pad 2-3/8"x4" Formulary OTC

cvs aftersun aloe/lidocaine external gel 0.5 % Formulary OTC

CVS AIRSHIELD ORAL TABLET EFFERVESCENT Formulary OTC

cvs alcohol prep pads pad 70 % 70 % Formulary OTC

cvs allergy relief childrens oral tablet dispersible 12.5 mg Formulary OTC

cvs allergy relief d oral tablet extended release 12 hour 60-120 mg


cvs allergy relief oral tablet 5 mg Formulary OTC

cvs all-purpose skin protect external ointment Formulary OTC

cvs antacid childrens oral liquid 400 mg/5ml Formulary OTC

cvs antacid supreme oral suspension 400-135 mg/5ml Formulary OTC

cvs anti-diarrheal oral capsule 2 mg Formulary OTC

cvs anti-diarrheal oral suspension 262 mg/15ml Formulary OTC

cvs anti-itch sensitive external lotion 1 % Formulary OTC

cvs astringent solution external packet Formulary OTC

cvs b complex plus c oral tablet Formulary OTC

cvs b12 oral tablet chewable 2500 mcg Formulary OTC

cvs backache relief oral tablet 500 mg Formulary OTC

cvs beta carotene oral capsule 15 mg Formulary OTC

cvs calcium 600 plus oral tablet chewable Formulary OTC

cvs calcium oral tablet chewable 250-400 mg-unit Formulary OTC

cvs cherry menthol drops mouth/throat lozenge Formulary OTC

cvs chest rub medicated external ointment 4.7-1.2-2.6 % Formulary OTC

cvs cleansing eyelid wipes external pad Formulary OTC

cvs cleansing skin external cream Formulary OTC

cvs cold & sinus relief oral capsule 30-200 mg Formulary OTC

37

Drug Name Formulary Status Requirements/Limitscvs cold remedy oral tablet dispersible Formulary OTC

cvs corn/callus remover external kit 17 % Formulary OTC

cvs cortisone maximum strength external gel 1 % Formulary OTC

cvs creamy acne face wash external liquid 4 % Formulary OTC; AGE (Max 18 Years)

cvs d3 oral capsule 25 mcg (1000 ut) Formulary OTC

cvs dairy relief ex st oral tablet 4500 unit Formulary OTC

cvs daytime/nighttime cold/flu oral (liquid) Formulary OTC

cvs daytime/nighttime cough oral liquid therapy pack 6.25-15 & 15 mg/15ml

Formulary OTC

cvs diabetes health support oral Formulary OTC

cvs digestive probiotic oral capsule Formulary OTC

cvs diuretic maximum strength oral capsule 50 mg Formulary OTC

cvs e oil oral oil 100 unt/0.25ml, 45 mg/0.25ml Formulary OTC

cvs early result pregnancy in vitro diagnostic test Formulary OTC

cvs easy fiber/calcium oral tablet chewable Formulary OTC

cvs enema disposable rectal enema 19-7 gm/118ml Formulary OTC

cvs ethyl alcohol solution 70 % Formulary OTC

cvs eye pad Formulary OTC

cvs feminine wipes max st external 1 % Formulary OTC

cvs fiber gummies oral tablet chewable 2 gm Formulary OTC

cvs flu relief oral pellet Formulary OTC

cvs gas relief extra strength oral tablet chewable 125 mg Formulary OTC

cvs gas relief oral tablet chewable 80 mg Formulary OTC

cvs gauze sterile pad 4"x4" Formulary OTC

cvs gluco-chondroit plus uc-ii oral tablet 125-100-10 mg Formulary OTC

cvs glucosamine-chondroitin oral tablet chewable 750-600 mg

Formulary OTC

cvs glucosamine-chondroit-msm oral tablet 375-300-250 mg

Formulary OTC

cvs glucose bits oral tablet chewable 1 gm Formulary OTC

cvs glucose shot oral liquid Formulary OTC

cvs glycerin adult rectal suppository 2.1 gm Formulary OTC

cvs hair regrowth for women external foam 5 % Formulary OTC

cvs hand wash advanced antibac external solution 2 % Formulary OTC

cvs heartburn relief ex st oral suspension 254-237.5 mg/5ml Formulary OTC

cvs heatwraps/back/hip Formulary OTC

cvs hemorrhoidal rectal suppository 0.25-88.44 % Formulary OTC

cvs hot steam inhalation liquid 6.2 % Formulary OTC

cvs hydrocolloid pads pad Formulary OTC

cvs inner ear plus oral tablet Formulary OTC

cvs instant food thickener oral powder Formulary OTC

cvs iron oral tablet 325 (65 fe) mg Formulary OTC

cvs irritated eye ophthalmic solution Formulary OTC

cvs isopropyl alcohol wipes external 70 % Formulary OTC

38

Drug Name Formulary Status Requirements/Limitscvs itch relief external gel 2 % Formulary OTC

cvs lancets 21g Formulary OTC; QL (150 EA per 30 days)

cvs lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days)

cvs lancets original Formulary OTC; QL (150 EA per 30 days)

cvs lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

cvs lancets ultra thin 30g Formulary OTC; QL (150 EA per 30 days)

cvs lancets ultra-thin 30g Formulary OTC; QL (150 EA per 30 days)

cvs laxative dietary supplemnt oral tablet 500 mg Formulary OTC

CVS LICE SOLUTION 3-STEP COMBINATION KIT Formulary OTC

cvs l-lysine oral tablet 500 mg Formulary OTC

cvs lubricant drops ophthalmic gel 0.25-0.3 % Formulary OTC

cvs magnesium citrate oral capsule 125 mg Formulary OTC

cvs manuka honey wound external gel Formulary OTC

cvs melatonin extra strength oral liquid 5 mg/15ml Formulary OTC

cvs melatonin oral tablet chewable 5 mg Formulary OTC

cvs melatonin sublingual tablet sublingual 5 mg Formulary OTC

cvs miconazole 1 combo pack vaginal kit 1200 & 2 mg & % Formulary ST; OTC

cvs miconazole 3 combo pack vaginal kit 200 & 2 mg-% (9gm)

Formulary ST; OTC

cvs mineral oil enema rectal enema Formulary OTC

cvs mineral oil oral oil Formulary OTC

cvs mini enema kids rectal enema 100 mg/5ml Formulary OTC

cvs multi-purpose external ointment 15.5-53.4 % Formulary OTC

cvs nasal allergy spray aerosol 55 mcg/act nasal 55 mcg/act

Formulary OTC

cvs nasal decongestant inhalation inhaler 50 mg Formulary OTC

cvs nasal decongestant oral capsule 30 mg Formulary OTC

cvs nasal mist nasal aerosol solution 3 % Formulary OTC

cvs natural fiber supplement oral packet 58.6 % Formulary OTC

cvs natural fish oil oral capsule 1000 mg Formulary OTC

cvs nerve pain relief external ointment Formulary OTC

cvs non-drying sinus pe oral tablet 5-200 mg Formulary OTC

cvs omeprazole oral tablet delayed release 20 mg Formulary OTC

cvs oral pain reliever mouth/throat cream 20 % Formulary OTC

cvs pain relief external cream 4 % Formulary OTC

cvs phosphate saline laxative oral solution 2.7-7.2 gm/15ml Formulary OTC

cvs pinworm treatment oral suspension 144 (50 base) mg/ml

Formulary OTC

cvs potassium gluconate oral tablet 2 meq Formulary OTC

cvs prenatal gummy oral tablet chewable 0.4-113.5 mg Formulary OTC

cvs prenatal oral tablet 28-0.8 mg Formulary OTC

cvs prep pad 70 % 70 % Formulary OTC

cvs protective external powder 81-15 % Formulary OTC

cvs saline wound wash external solution 0.9 % Formulary OTC

39

Drug Name Formulary Status Requirements/Limitscvs selenium oral tablet 200 mcg Formulary OTC

cvs silver external gel Formulary OTC

cvs sinus pe oral tablet 5-10-100-325 mg Formulary OTC

cvs sinus relief day/night oral Formulary OTC

cvs sinus relief day/night oral tablet therapy pack 5-200-325 & 5-25-325mg

Formulary OTC

cvs skin relief external lotion 1.3 % Formulary OTC

cvs sore muscle rub external gel 2.5 % Formulary OTC

cvs sore throat max strength mouth/throat lozenge 15-2.6 mg

Formulary OTC

cvs sore throat relief pops mouth/throat lozenge on a handle20 mg

Formulary OTC

cvs steam inhaler Formulary OTC

cvs stool softener oral capsule 50 mg Formulary OTC

cvs stuffy nose & cold child oral liquid 2.5-100 mg/5ml Formulary OTC

cvs super cranberry urinary oral capsule 140-100 mg Formulary OTC

cvs tension headache oral capsule 500-65 mg Formulary OTC

cvs therapeutic dandruff external shampoo 1 % Formulary OTC

cvs therapeutic external shampoo 0.5 % Formulary OTC

cvs triacting cough/runny nose oral liquid 1-5 mg/5ml Formulary OTC

cvs triple magnesium complex oral capsule 400 mg Formulary OTC

cvs ultra thin lancets Formulary OTC; QL (150 EA per 30 days)

cvs vaporizer warm steam Formulary OTC

cvs wound wash advanced external liquid Formulary OTC

cvs yogurt+calcium gummies oral tablet chewable 250-100 mg-unit

Formulary OTC

cvs zinc oxide diaper external cream 1-10 % Formulary OTC

cyanocobalamin injection solution 1000 mcg/ml Formulary

cyclobenzaprine hcl oral tablet 10 mg, 5 mg, 7.5 mg Formulary

CYCLOMYDRIL OPHTHALMIC SOLUTION 0.2-1 % Formulary

cyclopentolate hcl ophthalmic solution 1 % Formulary

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

Formulary

cyclophosphamide oral capsule 25 mg, 50 mg Formulary

cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg Formulary

cyclosporine modified oral solution 100 mg/ml Formulary

cyclosporine oral capsule 100 mg, 25 mg Formulary

cyproheptadine hcl oral syrup 2 mg/5ml Formulary

cyproheptadine hcl oral tablet 4 mg Formulary

CYSTADANE ORAL POWDER Formulary PA

CYSTAGON ORAL CAPSULE 150 MG, 50 MG Formulary

CYSTECH ORAL CAPSULE 500 MG Formulary OTC

cystine oral packet 500 mg Formulary OTC

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

CYTO-Q MAX ORAL LIQUID 100 MG/ML Formulary OTC

40

Drug Name Formulary Status Requirements/Limitscytra k crystals oral packet 3300-1002 mg Formulary

d 1000 oral tablet 25 mcg (1000 ut) Formulary OTC

d 2000 oral tablet 50 mcg (2000 ut) Formulary OTC

dacarbazine intravenous solution reconstituted 100 mg, 200 mg

Formulary

daily care skin protectant external ointment 30 % Formulary OTC

daily ovulation predictor in vitro strip Formulary OTC

daily vite multivitamin/iron oral tablet Formulary OTC

dairy relief oral tablet 3000 unit Formulary OTC

dakins (1/2 strength) external solution 0.25 % Formulary OTC

dakins (1/4 strength) external solution 0.125 % Formulary OTC

dakins external solution 0.4-0.5 % Formulary OTC

DAKRINA OPHTHALMIC SOLUTION 2.7-2 % Formulary OTC

danazol oral capsule 100 mg, 200 mg, 50 mg Formulary

dandruff shampoo external lotion 1 % Formulary OTC

dantrolene sodium oral capsule 100 mg, 25 mg, 50 mg Formulary

dapsone oral tablet 100 mg, 25 mg Formulary

daunorubicin hcl intravenous injectable 5 mg/ml Formulary

day time multi-sympt cold/flu oral capsule 10-5-325 mg Formulary OTC

DAYTIME COLD MEDICINE ORAL LIQUID 325-15 MG/15ML

Formulary OTC

daytime cough oral liquid 15 mg/15ml Formulary OTC

daytime severe cold & flu oral liquid 5-10-200-325 mg/15ml

Formulary OTC

DAYTRANA TRANSDERMAL PATCH 10 MG/9HR, 15 MG/9HR, 20 MG/9HR, 30 MG/9HR


DDROPS ORAL LIQUID 2000 UNT/0.03ML, 2000 UT/0.028ML

Formulary OTC

DEBACTEROL MOUTH/THROAT SOLUTION 30-50 % Formulary

DECARA ORAL CAPSULE 625 MCG (25000 UT) Formulary OTC

DECONEX DMX ORAL TABLET 10-17.5-385 MG Formulary OTC

DECONEX IR ORAL TABLET 10-385 MG Formulary OTC

DEEP SLEEP ORAL LIQUID Formulary OTC

deferasirox oral tablet soluble 125 mg, 250 mg, 500 mg Formulary PA

del clens external gel Formulary OTC

DELBASE COMPOUNDING EXTERNAL OINTMENT Formulary OTC

DELSTRIGO ORAL TABLET 100-300-300 MG Formulary

DELSYM COUGH CHILDRENS ORAL SUSPENSION EXTENDED RELEASE 30 MG/5ML

Formulary OTC

DELTUSS DP ORAL LIQUID 1-30 MG/5ML Formulary OTC

DELZICOL ORAL CAPSULE DELAYED RELEASE 400 MG

Formulary

demeclocycline hcl oral tablet 150 mg, 300 mg Formulary

DEMEROL INJECTION SOLUTION 100 MG/2ML, 25 MG/0.5ML, 75 MG/1.5ML, 75 MG/ML

Formulary

DEMSER ORAL CAPSULE 250 MG Formulary

41

Drug Name Formulary Status Requirements/LimitsDENDRACIN NEURODENDRAXCIN EXTERNAL LOTION 0.0375-10-30 %

Formulary OTC

DENTA 5000 PLUS DENTAL CREAM 1.1 % Formulary

DENTAPAINE MOUTH/THROAT GEL 20 % Formulary OTC

DEPACON INTRAVENOUS SOLUTION 100 MG/ML Formulary

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

Formulary

DEQUASINE ORAL TABLET Formulary OTC

DERMA CIDOL 2000 EXTERNAL LIQUID 0.5 % Formulary OTC

dermacloud external cream Formulary OTC

dermacloud external ointment Formulary OTC

DERMAGESIC EXTERNAL CREAM 1-0.4-0.4 % Formulary OTC

DERMAGESIC EXTERNAL LIQUID 1-0.4-0.4 % Formulary OTC

DERMAGRAN EXTERNAL GEL Formulary OTC

DERMAGRAN HYDROGEL WOUND EXTERNAL GEL Formulary OTC

DERMAL THERAPY FINGER CARE EXTERNAL LOTION 20 %

Formulary OTC

DERMAMED EXTERNAL OINTMENT Formulary OTC

DERMAPLEX EXTERNAL GEL Formulary OTC

DERMAREST PSORIASIS EXTERNAL GEL 3 % Formulary OTC

DERMASTAT EXTERNAL FOAM 65 % Formulary OTC

DERMASYN EXTERNAL GEL Formulary OTC

DERMAZENE EXTERNAL CREAM 1-1 % Formulary

DERMOPLAST EXTERNAL AEROSOL 20-0.5 % Formulary OTC

dermovix external patch 2-30 % Formulary OTC

DESCOVY ORAL TABLET 200-25 MG Formulary

DESENEX FOOT/SNEAKER SPRAY EXTERNAL AEROSOL

Formulary OTC

DESGEN DM ORAL SYRUP 5-15-100 MG/5ML Formulary OTC

DESGEN DM ORAL TABLET 30-10-200 MG Formulary OTC

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

Formulary

DESITIN MAXIMUM STRENGTH EXTERNAL PASTE 40 %

Formulary OTC

desmopressin ace spray refrig nasal solution 0.01 % Formulary

desmopressin acetate oral tablet 0.1 mg, 0.2 mg Formulary

desmopressin acetate spray nasal solution 0.01 % Formulary

desonide external cream 0.05 % Formulary

desonide external lotion 0.05 % Formulary

desonide external ointment 0.05 % Formulary

despec dm-g oral syrup 5-10-100 mg/5ml Formulary OTC

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

Formulary ST

DEVROM ORAL TABLET CHEWABLE 200 MG Formulary OTC

DEWEES CARMINATIVE ORAL LIQUID 6-250 Formulary OTC

DEWITTS PAIN RELIEVER ORAL TABLET 325 MG Formulary OTC

42

Drug Name Formulary Status Requirements/LimitsDEXAMETHASONE INTENSOL ORAL CONCENTRATE 1 MG/ML

Formulary

dexamethasone oral elixir 0.5 mg/5ml Formulary

dexamethasone oral solution 0.5 mg/5ml Formulary

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

Formulary

dexamethasone sodium phosphate ophthalmic solution 0.1 %

Formulary

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


dexmethylphenidate hcl oral tablet 10 mg, 2.5 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years)

dexrazoxane intravenous solution reconstituted 250 mg, 500 mg

Formulary

dextroamphetamine sulfate oral tablet 10 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years)

dhea oral capsule 50 mg Formulary OTC

dhea oral tablet 25 mg Formulary OTC

DHS BODY WASH EXTERNAL LIQUID 0.5 % Formulary OTC

DHS ZINC EXTERNAL SHAMPOO 2 % Formulary OTC

DIAB DAILY CARE EXTERNAL GEL Formulary OTC

DIABETIC BASICS HEALTHY FOOT EXTERNAL LOTION 0.13 %

Formulary OTC

DIABETIC TUSSIN ALLERGY ORAL SYRUP 2 MG/5ML

Formulary OTC

DIABETIC TUSSIN COLD/FLU ORAL CAPSULE 325-4-15 MG

Formulary OTC

DIABETIC TUSSIN MAX ST ORAL LIQUID 10-200 MG/5ML

Formulary OTC

DIABETIC TUSSIN NIGHT COLD/FLU ORAL LIQUID 10-12.5-325 MG/5ML

Formulary OTC

DIABETIC TUSSIN ORAL LIQUID 100 MG/5ML Formulary OTC

diabet-x daily prevention external cream 0.3 % Formulary OTC

DIADERM FOOT REJUVENATING EXTERNAL CREAM

Formulary OTC

DIALYVITE 800 ORAL WAFER 0.8 MG Formulary OTC

DIALYVITE 800 PLUS D ORAL WAFER 800 MCG Formulary OTC

DIALYVITE 800/IRON ORAL TABLET 29-0.8 MG Formulary OTC

DIALYVITE ORAL TABLET Formulary

DIALYVITE/ZINC ORAL TABLET Formulary

diaper rash external cream 10 % Formulary OTC

diaper rash external paste 40 % Formulary OTC

DIASTAT ACUDIAL RECTAL GEL 10 MG, 20 MG Formulary AGE (Min 2 Years)

DIASTAT PEDIATRIC RECTAL GEL 2.5 MG Formulary AGE (Min 2 Years)

DIASTIX IN VITRO STRIP Formulary OTC

DIAZEPAM INTENSOL ORAL CONCENTRATE 5 MG/ML


diazepam oral solution 5 mg/5ml Formulary QL (136 ML per 34 days)

43

Drug Name Formulary Status Requirements/Limitsdiazepam oral tablet 10 mg Formulary QL (136 EA per 34 days)

diazepam oral tablet 2 mg, 5 mg Formulary QL (136 EA per 30 days)

diazoxide oral suspension 50 mg/ml Formulary

dibucaine external ointment 1 % Formulary OTC

dibucaine rectal ointment 1 % Formulary OTC

diclofenac potassium oral tablet 50 mg Formulary

diclofenac sodium er oral tablet extended release 24 hour100 mg

Formulary

diclofenac sodium external gel 1 % Formulary QL (200 GM per 30 days)

diclofenac sodium ophthalmic solution 0.1 % Formulary

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

Formulary

dicloxacillin sodium oral capsule 250 mg, 500 mg Formulary

dicyclomine hcl oral capsule 10 mg Formulary

dicyclomine hcl oral solution 10 mg/5ml Formulary

dicyclomine hcl oral tablet 20 mg Formulary

DI-DAK-SOL EXTERNAL SOLUTION 0.0125 % Formulary OTC

dieters super tea oral Formulary OTC

dietex forte oral capsule Formulary OTC

diethylpropion hcl er oral tablet extended release 24 hour75 mg

Formulary PA

diethylpropion hcl oral tablet 25 mg Formulary PA

DIFFERIN GEL 0.1 % EXTERNAL (OTC) 0.1 % Formulary AGE (Max 18 Years)

diflorasone diacetate external ointment 0.05 % Formulary

diflunisal oral tablet 500 mg Formulary

difluprednate ophthalmic emulsion 0.05 % Formulary

digestive enzyme ultra oral capsule Formulary OTC

DIGITEK ORAL TABLET 125 MCG, 250 MCG Formulary

digoxin oral solution 0.05 mg/ml Formulary

DILANTIN ORAL CAPSULE 30 MG Formulary

diltiazem cd oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg

Formulary

diltiazem hcl er beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

Formulary

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

Formulary

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

Formulary

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

Formulary

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

Formulary

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

Formulary

diltiazem hcl intravenous solution reconstituted 100 mg Formulary

diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg Formulary

44

Drug Name Formulary Status Requirements/Limitsdilt-xr oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

Formulary

dimenhydrinate oral tablet 50 mg Formulary OTC

DIMETAPP COLD/ALLERGY ORAL ELIXIR 1-2.5 MG/5ML

Formulary OTC

DIMETAPP DM COLD/COUGH ORAL LIQUID 2.5-1-5 MG/5ML

Formulary OTC

DIMETAPP LONG ACT COUGH/COLD ORAL SYRUP 1-7.5 MG/5ML

Formulary OTC

DIMETAPP MULTISYMPTOM COLD/FLU ORAL LIQUID 6.25-2.5-160 MG/5ML

Formulary OTC

DIMETAPP NIGHT COLD/CONGESTION ORAL LIQUID 6.25-2.5 MG/5ML

Formulary OTC

dimethyl fumarate oral capsule delayed release 120 mg, 240 mg

Formulary

dimethyl fumarate starter pack oral 120 & 240 mg Formulary

diphenhydramine hcl (sleep) oral tablet 50 mg Formulary OTC

diphenhydramine hcl oral capsule 25 mg, 50 mg Formulary

diphenhydramine hcl oral liquid 6.25 mg/ml Formulary OTC

diphenhydramine hcl oral tablet 25 mg Formulary OTC

diphenoxylate-atropine oral tablet 2.5-0.025 mg Formulary

diphtheria-tetanus toxoids dt intramuscular suspension 25-5 lfu/0.5ml


dipyridamole oral tablet 25 mg, 50 mg, 75 mg Formulary

disulfiram oral tablet 250 mg, 500 mg Formulary

divalproex sodium er oral tablet delayed release 500 mg Formulary

divalproex sodium er oral tablet extended release 24 hour250 mg, 500 mg

Formulary

divalproex sodium oral capsule delayed release sprinkle125 mg

Formulary

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

Formulary

dl-pa-500 oral capsule 500 mg Formulary OTC

DML EXTERNAL LOTION Formulary OTC

DOANS EXTRA STRENGTH ORAL TABLET 580 MG Formulary OTC

DOANS PILLS ORAL TABLET 325 MG Formulary OTC

DOANS PM EXTRA STRENGTH ORAL TABLET 580-25 MG

Formulary OTC

DOC OMEGA ORAL PACKET 200 MG Formulary OTC

docetaxel intravenous concentrate 160 mg/8ml, 20 mg/ml, 80 mg/4ml

Formulary

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

Formulary

docosanol cream 10 % external (otc) 10 % Formulary OTC

docusate sodium oral capsule 250 mg Formulary

docusate sodium oral liquid 50 mg/5ml Formulary OTC

docusate sodium oral tablet 100 mg Formulary OTC

DOCUSOL KIDS RECTAL ENEMA 100 MG/5ML Formulary OTC

45

Drug Name Formulary Status Requirements/LimitsDOCUSOL PLUS MINI-ENEMA RECTAL ENEMA 20-283 MG

Formulary OTC

dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg Formulary

DOLOGEN ORAL TABLET 1-325 MG Formulary OTC

dologesic-df oral tablet 1-500 mg Formulary OTC

dolorex oral tablet 25-325 mg Formulary OTC

DOMEBORO EXTERNAL PACKET Formulary OTC

dometuss-da/children oral liquid 1-2.5 mg/5ml Formulary OTC

donepezil hcl oral tablet 10 mg, 5 mg Formulary

donepezil hcl oral tablet 23 mg Formulary QL (30 EA per 30 days)

donepezil hcl oral tablet dispersible 10 mg, 5 mg Formulary

dorzolamide hcl ophthalmic solution 2 % Formulary

dorzolamide hcl-timolol mal ophthalmic solution 22.3-6.8 mg/ml

Formulary

DOUBLE-TUSSIN DM ORAL LIQUID 20-300 MG/5ML Formulary OTC

DOVATO ORAL TABLET 50-300 MG Formulary

DOVER IRRIGATION TRAY KIT Formulary OTC

doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg Formulary QL (34 EA per 34 days)

doxazosin mesylate oral tablet 8 mg Formulary QL (68 EA per 34 days)

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

Formulary

doxepin hcl oral concentrate 10 mg/ml Formulary

doxorubicin hcl intravenous solution 2 mg/ml Formulary

doxorubicin hcl intravenous solution reconstituted 10 mg, 50 mg

Formulary

doxycycline hyclate oral capsule 100 mg, 50 mg Formulary

doxycycline hyclate oral tablet 100 mg, 20 mg Formulary

doxycycline monohydrate oral capsule 100 mg, 50 mg Formulary

doxycycline monohydrate oral suspension reconstituted 25 mg/5ml

Formulary

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

DR BOLDTS HINEY HEALER EXTERNAL CREAM Formulary OTC

DR SMITHS DIAPER EXTERNAL OINTMENT 10 % Formulary OTC

DR SMITHS DIAPER RASH EXTERNAL AEROSOL 10 %

Formulary OTC

DR SMITHS RASH + SKIN EXTERNAL OINTMENT 16-57 %

Formulary OTC

DRAMAMINE ORAL TABLET 50 MG Formulary OTC

DRAMAMINE ORAL TABLET CHEWABLE 50 MG Formulary OTC

DRITHO-CREME HP EXTERNAL CREAM 1 % Formulary

DRIXORAL COLD/ALLERGY ORAL TABLET EXTENDED RELEASE 12 HOUR 6-120 MG

Formulary OTC

DRIXORAL COUGH/SORE THROAT ORAL CAPSULE 325-15 MG

Formulary OTC

dronabinol oral capsule 10 mg, 2.5 mg, 5 mg Formulary PA

DROPLET LANCETS ULTRA THIN 30G Formulary OTC; QL (150 EA per 30 days)

46

Drug Name Formulary Status Requirements/Limitsdrospirenone-ethinyl estradiol oral tablet 3-0.02 mg, 3-0.03 mg


DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG Formulary

drug mart lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

DRUG MART UNILET LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

DRUG MART UNILET LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

dry skin treatment adv therapy external ointment Formulary OTC

drymax extra pad 8"x8" Formulary OTC

DRYSOL EXTERNAL SOLUTION 20 % Formulary

DULCOLAX MILK OF MAGNESIA ORAL SUSPENSION 400 MG/5ML

Formulary OTC

DULCOLAX ORAL TABLET DELAYED RELEASE 5 MG

Formulary OTC

DULCOLAX RECTAL SUPPOSITORY 10 MG Formulary OTC

DULERA INHALATION AEROSOL 100-5 MCG/ACT, 200-5 MCG/ACT, 50-5 MCG/ACT

Formulary

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

Formulary

DUNLAP MOIST HEAT PACK COVER Formulary OTC

DUOFILM EXTERNAL SOLUTION 17 % Formulary OTC

DURAFLEX COMFORT EXTERNAL GEL Formulary OTC

DURAFLU ORAL TABLET 60-20-200-325 MG Formulary OTC

DURAPROXIN ES TRANSDERMAL PATCH 3-1.25-10 %

Formulary OTC

DURAPROXIN TRANSDERMAL PATCH 1.25-3 % Formulary OTC

DURASAFE SPINAL/EPIDURAL KIT Formulary

DURATION SPRAY NASAL SOLUTION 0.05 % Formulary OTC

DURAVENT DM ORAL TABLET 10-15-395 MG Formulary OTC

DURAVENT PE ORAL TABLET 10-395 MG Formulary OTC

DUREZOL OPHTHALMIC EMULSION 0.05 % Formulary

dutasteride oral capsule 0.5 mg Formulary

dutasteride-tamsulosin hcl oral capsule 0.5-0.4 mg Formulary

D-VI-SOL ORAL LIQUID 400 UNIT/ML Formulary OTC

d-xylose powder Formulary

DY-O-DERM VITILIGO STAIN EXTERNAL SOLUTION 6.55 %

Formulary OTC

ear wax cleansing otic kit 6.5 % Formulary OTC

easy fiber oral powder Formulary OTC

EASY TOUCH ALCOHOL PREP MEDIUM PAD 70 % 70 %

Formulary OTC

EASY TOUCH ALLERGY SYRINGE 26G X 3/8" 1 ML, 27G X 1/2" 1 ML

Formulary OTC

EASY TOUCH FLIPLOCK INSULIN SY 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC

47

Drug Name Formulary Status Requirements/LimitsEASY TOUCH FLIPLOCK INSULIN SY 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC


Formulary OTC

EASY TOUCH FLURINGE 25G X 1" 1 ML Formulary OTC

EASY TOUCH HYPODERMIC NEEDLE 24G X 1" Formulary OTC

EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary OTC

EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

EASY TOUCH INSULIN SAFETY SYR 30G X 1/2" 1 ML 30G X 1/2" 1 ML

Formulary OTC

EASY TOUCH INSULIN SAFETY SYR 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML

Formulary OTC

EASY TOUCH INSULIN SYRINGE 27G X 1/2" 0.5 ML 27G X 1/2" 0.5 ML

Formulary OTC

EASY TOUCH INSULIN SYRINGE 27G X 1/2" 1 ML 27G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

EASY TOUCH LANCETS 26G Formulary OTC; QL (150 EA per 30 days)


EASY TOUCH LANCETS 28G/TWIST Formulary OTC; QL (150 EA per 30 days)




48

Drug Name Formulary Status Requirements/LimitsEASY TOUCH LANCETS 32G/TWIST Formulary OTC; QL (150 EA per 30 days)


EASY TOUCH SHEATHLOCK SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

EASY TOUCH TB FLIPLOCK SYRINGE 26G X 5/8" 1 ML

Formulary OTC

EASY TWIST & CAP LANCETS Formulary OTC; QL (150 EA per 30 days)

EASYGEL DENTAL GEL 0.4 % Formulary

ecee plus oral tablet Formulary OTC

econazole nitrate external cream 1 % Formulary

ECOTRIN MAXIMUM STRENGTH ORAL TABLET DELAYED RELEASE 500 MG

Formulary OTC

ECOTRIN ORAL TABLET DELAYED RELEASE 325 MG

Formulary OTC

e-cream complex external cream Formulary OTC

ed a-hist dm oral tablet 10-4-10 mg Formulary OTC

ED A-HIST ORAL LIQUID 4-10 MG/5ML Formulary OTC

ed a-hist pse oral tablet 2.5-60 mg Formulary OTC

ed bron gp oral liquid 5-100 mg/5ml Formulary OTC

ED CHLORPED D ORAL LIQUID 2-5 MG/ML Formulary OTC

ED CHLORPED ORAL LIQUID 2 MG/ML Formulary OTC

ed-a-hist dm oral liquid 10-4-15 mg/5ml Formulary OTC

ed-spaz oral tablet dispersible 0.125 mg Formulary

EDURANT ORAL TABLET 25 MG Formulary

efavirenz oral capsule 200 mg, 50 mg Formulary

efavirenz oral tablet 600 mg Formulary

efavirenz-emtricitab-tenofovir oral tablet 600-200-300 mg Formulary

efavirenz-lamivudine-tenofovir oral tablet 400-300-300 mg, 600-300-300 mg

Formulary

EFFER-K ORAL TABLET EFFERVESCENT 25 MEQ Formulary

effervescent pain relief oral tablet effervescent 325 mg Formulary OTC

effervescent pot chloride oral tablet effervescent 25 meq Formulary

EGRIFTA SUBCUTANEOUS SOLUTION RECONSTITUTED 1 MG

Formulary PA

ELDERTONIC ORAL ELIXIR Formulary OTC

eletriptan hydrobromide oral tablet 20 mg, 40 mg Formulary QL (6 EA per 34 days)

ELIDEL EXTERNAL CREAM 1 % Formulary PA; AGE (Min 2 Years)

ELIGARD SUBCUTANEOUS KIT 22.5 MG, 30 MG, 45 MG, 7.5 MG


ELIQUIS ORAL TABLET 2.5 MG, 5 MG Formulary

49

Drug Name Formulary Status Requirements/Limitselite ca/mg oral tablet 100-50 mg Formulary OTC

elite calcium oral tablet 150 mg Formulary OTC

ELITE ZINC ORAL CAPSULE 15 MG Formulary OTC

ELITEK INTRAVENOUS SOLUTION RECONSTITUTED 1.5 MG, 7.5 MG

Formulary

ELITE-OB ORAL TABLET 50-1.25 MG Formulary

elite-thin insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

elite-thin insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC

elite-thin insulin syringe 28g x 5/16" 0.5 ml 28g x 5/16" 0.5 ml

Formulary OTC


elite-thin insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC



Formulary OTC



Formulary OTC



Formulary OTC


Formulary OTC


ELIXOPHYLLIN ORAL ELIXIR 80 MG/15ML Formulary

ELIXSURE COUGH ORAL GEL 7.5 MG/5ML Formulary OTC

ELIXSURE FEVER/PAIN ORAL GEL 160 MG/5ML Formulary OTC

ELLA ORAL TABLET 30 MG Formulary

ELLURA ORAL CAPSULE 200 MG Formulary OTC

ELMIRON ORAL CAPSULE 100 MG Formulary PA

ELTA DERMAL EXTERNAL GEL Formulary OTC

ELTA DERMAL WOUND EXTERNAL GEL Formulary OTC

ELURYNG VAGINAL RING 0.12-0.015 MG/24HR Formulary QL (1 EA per 28 days)

EMCYT ORAL CAPSULE 140 MG Formulary

EMETROL ORAL SOLUTION 1.87-1.87-21.5 Formulary OTC

EMGALITY SUBCUTANEOUS SOLUTION AUTO-INJECTOR 120 MG/ML


EMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 120 MG/ML


EMPAVELI SUBCUTANEOUS SOLUTION 1080 MG/20ML

Formulary PA; QL (160 ML per 28 days)

empty capsule size 1 clear capsule Formulary

emtricitabine oral capsule 200 mg Formulary

emtricitabine-tenofovir df oral tablet 100-150 mg, 133-200 mg, 167-250 mg, 200-300 mg

Formulary

EMTRIVA ORAL SOLUTION 10 MG/ML Formulary

50

Drug Name Formulary Status Requirements/LimitsEMULSION SB EMULSION EXTERNAL Formulary

enalapril maleate oral solution 1 mg/ml Formulary PA; AGE (Max 12 Years)

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

enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg

Formulary

ENBREL MINI SUBCUTANEOUS SOLUTION CARTRIDGE 50 MG/ML

Formulary

ENBREL SUBCUTANEOUS SOLUTION 25 MG/0.5ML Formulary AGE (Min 2 Years)

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/0.5ML, 50 MG/ML


ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG


ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG/ML


ENDOXCIN EXTERNAL PATCH 4-1 % Formulary OTC

ENDUR-ACIN ORAL TABLET EXTENDED RELEASE 500 MG

Formulary OTC

ENEMEEZ MINI RECTAL ENEMA 283 MG/5ML Formulary OTC

ENFAMIL ENFALYTE ORAL SOLUTION Formulary OTC

ENFAMIL EXPECTA ORAL 28-0.8 & 200 MG Formulary OTC

ENGERIX-B INJECTION SUSPENSION 10 MCG/0.5ML, 20 MCG/ML


ENLITE GLUCOSE SENSOR Formulary

enoxaparin sodium injection solution 300 mg/3ml Formulary

enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, 40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml

Formulary

ENPRESSE-28 ORAL TABLET 50-30/75-40/ 125-30 MCG


entecavir oral tablet 0.5 mg, 1 mg Formulary

ENTEX T ORAL TABLET 60-375 MG Formulary OTC

entre-hist pse oral liquid 0.938-10 mg/ml Formulary OTC

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


ENTSOL NASAL NASAL SOLUTION 3 % Formulary OTC

enulose oral solution 10 gm/15ml Formulary

e-oil external oil 30000 unit Formulary OTC

epa/gla oral capsule Formulary OTC

ephedrine hcl oral tablet 25 mg Formulary OTC

EPIDIOLEX ORAL SOLUTION 100 MG/ML Formulary PA

epidural needle 18g x 2" , 18g x 4" Formulary OTC

epinastine hcl ophthalmic solution 0.05 % Formulary

epinephrine injection solution 30 mg/30ml Formulary

epinephrine injection solution auto-injector 0.15 mg/0.3ml, 0.3 mg/0.3ml

Formulary

epinephrine injection solution prefilled syringe 1 mg/10ml Formulary

epinephrine pf injection solution 1 mg/ml Formulary

51

Drug Name Formulary Status Requirements/Limitsepinephrine pf injection solution prefilled syringe 1 mg/10ml

Formulary

epinephrine solution auto-injector 0.15 mg/0.15ml injection0.15 mg/0.15ml

Formulary

epinephrine solution auto-injector 0.3 mg/0.3ml injection0.3 mg/0.3ml

Formulary

EPIPEN 2-PAK SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML INJECTION 0.3 MG/0.3ML

Formulary

EPIPEN JR 2-PAK SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML INJECTION 0.15 MG/0.3ML

Formulary

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

Formulary

EPISORB TRANSDERMAL Formulary OTC

EPITOL ORAL TABLET 200 MG Formulary

EPIVIR HBV ORAL SOLUTION 5 MG/ML Formulary

eplerenone oral tablet 25 mg, 50 mg Formulary

eprosartan mesylate oral tablet 600 mg Formulary ST

epsom salt oral granules Formulary OTC

eq allergy relief childrens oral elixir 12.5 mg/5ml Formulary OTC

eq allergy relief childrens oral liquid 12.5 mg/5ml Formulary OTC

eq allergy relief oral tablet 10 mg Formulary OTC

eq allergy/sinus headache oral tablet 12.5-30-500 mg Formulary OTC

eq antibiotic + pain relief external cream 3.5-10000-10 Formulary OTC

eq aspirin oral tablet delayed release 500 mg Formulary OTC

EQ BABY CHEST RUB EXTERNAL CREAM Formulary OTC

eq calcium citrate+d3 petites oral tablet 200-250 mg-unit Formulary OTC

eq cough sugar free mouth/throat lozenge 5.8 mg Formulary OTC

eq cryogenic wart removal sys external aerosol Formulary OTC

eq daily fiber oral capsule 400 mg Formulary OTC

eq dairy digestive fast acting oral tablet 9000 unit Formulary OTC

eq dairy digestive fast acting oral tablet chewable 9000 unit Formulary OTC

eq feminine wash sensitive vaginal liquid Formulary OTC

eq ibuprofen pm oral tablet 200-38 mg Formulary OTC

EQ MUCUS ER ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG

Formulary OTC

eq omeprazole oral tablet delayed release 20 mg Formulary OTC

eq pain relief/rapid burst oral liquid 500 mg/15ml Formulary OTC

eq sinus relief max st oral tablet 30-500 mg Formulary OTC

eq tioconazole 1 vaginal ointment 6.5 % Formulary OTC

eq vitamins a & d external ointment Formulary OTC

eql 2 in 1 probiotic oral tablet Formulary OTC

eql advanced relief ophthalmic solution 0.05-0.1-1-1 % Formulary OTC

eql alcohol swabs pad 70 % 70 % Formulary OTC

eql aller-ease oral tablet 180 mg Formulary OTC; QL (34 EA per 34 days)

eql allergy oral tablet 4 mg Formulary OTC

eql aloe vera after sun external gel Formulary OTC

52

Drug Name Formulary Status Requirements/Limitseql antacid ultra strength oral tablet chewable 1000 mg Formulary OTC

eql antibacterial hand soap external liquid 0.13 % Formulary OTC

eql anti-nausea oral solution 1.87-1.87-21.5 Formulary OTC

eql biotin oral capsule 5000 mcg Formulary OTC

eql cold sore treatment external liquid 0.13-3 % Formulary OTC

eql color lancets 21g Formulary OTC; QL (150 EA per 30 days)

eql color lancets micro 33g Formulary OTC; QL (150 EA per 30 days)

eql congestion relief oral tablet 10-200 mg Formulary OTC

eql denture brush/pick Formulary OTC

eql denture cleanser tablet effervescent Formulary OTC

eql digestive enzymes oral tablet Formulary OTC

eql ear drops otic solution Formulary OTC

eql effervescent cold relief oral tablet effervescent 2-7.8-325 mg

Formulary OTC

eql ethyl alcohol (rubbing) solution 70 % Formulary OTC

eql everyday clean external shampoo 1 % Formulary OTC

eql eye drops ac ophthalmic solution 0.05-0.25 % Formulary OTC

eql fiber therapy oral powder 48.57 % Formulary OTC

eql gas prevention oral capsule Formulary OTC

eql gentle skin cleanser external liquid Formulary OTC

eql insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC


eql insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC







eql lutein oral capsule 20 mg Formulary OTC

eql mouthwash/gargle mouth/throat liquid Formulary OTC

eql mucus-dm oral tablet extended release 12 hour 30-600 mg

Formulary OTC

eql multi-purpose solution Formulary OTC

eql omega 3 fish oil oral capsule delayed release 1200 mg Formulary OTC

eql omeprazole oral tablet delayed release 20 mg Formulary OTC

eql one daily womens oral tablet Formulary OTC

eql redness relief ophthalmic solution 0.012-0.2 % Formulary OTC

eql scalp relief max strength external liquid 3 % Formulary OTC

eql super thin lancets 30g Formulary OTC; QL (150 EA per 30 days)

eql thin lancets 26g Formulary OTC; QL (150 EA per 30 days)

eql ultra protection spf50 external aerosol Formulary OTC

eql vitamin d3 oral capsule 10 mcg (400 unit) Formulary OTC

eql wet cleansing towelettes external Formulary OTC

53

Drug Name Formulary Status Requirements/Limitseql zinc cold relief mouth/throat lozenge Formulary OTC

EQUALACTIN ORAL TABLET CHEWABLE 625 MG Formulary OTC

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

Formulary PA

ergocalciferol oral capsule 1.25 mg (50000 ut) Formulary

ergocalciferol oral solution 8000 unit/ml Formulary OTC

ergoloid mesylates oral tablet 1 mg Formulary

ery external pad 2 % Formulary

erythromycin base oral capsule delayed release particles250 mg

Formulary

erythromycin ethylsuccinate oral suspension reconstituted200 mg/5ml

Formulary

erythromycin ethylsuccinate oral tablet 400 mg Formulary

erythromycin external gel 2 % Formulary

erythromycin external solution 2 % Formulary AGE (Max 18 Years)

erythromycin ophthalmic ointment 5 mg/gm Formulary

escavite lq oral liquid 0.25-6 mg/ml Formulary

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

esmolol hcl intravenous solution 100 mg/10ml Formulary

esomeprazole magnesium oral capsule delayed release 20 mg, 40 mg


ESOTERICA FADE NIGHTTIME EXTERNAL CREAM 2 %

Formulary OTC

ESOTERICA SENSITIVE SKIN EXTERNAL CREAM 1.5 %

Formulary OTC

ESTARYLLA ORAL TABLET 0.25-35 MG-MCG Formulary QL (28 EA per 28 days)

estazolam oral tablet 1 mg, 2 mg Formulary

estradiol oral tablet 0.5 mg, 1 mg, 2 mg Formulary

estradiol transdermal patch twice weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr


estradiol transdermal patch twice weekly 0.1 mg/24hr Formulary QL (8 EA per 28 days)

estradiol transdermal patch weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr


estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml Formulary

estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg

Formulary

estropipate oral tablet 0.75 mg Formulary

eszopiclone oral tablet 1 mg, 2 mg, 3 mg Formulary QL (30 EA per 30 days)

ethambutol hcl oral tablet 100 mg, 400 mg Formulary

ethosuximide oral capsule 250 mg Formulary

ethosuximide oral solution 250 mg/5ml Formulary

ethyl alcohol (rubbing) solution 70 % Formulary OTC

ethyl alcohol external solution 95 % Formulary OTC

ethyl chloride external aerosol Formulary

etidronate disodium oral tablet 200 mg, 400 mg Formulary

54

Drug Name Formulary Status Requirements/Limitsetodolac er oral tablet extended release 24 hour 400 mg, 500 mg, 600 mg

Formulary

etodolac oral capsule 200 mg, 300 mg Formulary

etodolac oral tablet 400 mg, 500 mg Formulary

ETOPOPHOS INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

Formulary

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

etoposide oral capsule 50 mg Formulary

etravirine oral tablet 100 mg, 200 mg Formulary

eucalyptus oil external oil Formulary OTC

EUCERIN ECZEMA RELIEF EXTERNAL CREAM 1 % Formulary OTC

EUCERIN EXTERNAL CREAM Formulary OTC

EUCERIN ORIGINAL HEALING EXTERNAL LOTION Formulary OTC

EUCRISA EXTERNAL OINTMENT 2 % Formulary PA

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 20 MG/2ML

Formulary PA

EULEXIN ORAL CAPSULE 125 MG Formulary

EURAX EXTERNAL CREAM 10 % Formulary ST

EVAC-U-GEN ORAL TABLET 8.6 MG Formulary OTC

evening primrose oil oral capsule 1000 mg, 500 mg Formulary OTC

everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg, 1 mg Formulary

EVOTAZ ORAL TABLET 300-150 MG Formulary

EXACTECH R-S-G TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

EXACTECH TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

EXACTUSS TR ORAL TABLET 10-28-388 MG Formulary OTC

EXAPHEN CH ORAL TABLET 10-3.5-24 MG Formulary OTC

EXAPHEN ORAL TABLET 3.5-10 MG Formulary OTC

EXAPHEX TR ORAL TABLET 10-388 MG Formulary OTC

EXCEDRIN EXTRA STRENGTH ORAL TABLET 250-250-65 MG

Formulary OTC

EXCEDRIN PM ORAL TABLET 500-38 MG Formulary OTC

EXCEDRIN TENSION HEADACHE ORAL TABLET 500-65 MG

Formulary OTC

EXCEL AP EXTERNAL SWAB 7.5-72 % Formulary OTC

EXEL COMFORT POINT INSULIN SYR 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

EXEL COMFORT POINT INSULIN SYR 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

55

Drug Name Formulary Status Requirements/LimitsEXEL COMFORT POINT INSULIN SYR 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML

Formulary OTC


Formulary OTC

exemestane oral tablet 25 mg Formulary

EXFOLIX EXFOLIATING FOOT SOAP EXTERNAL BAR

Formulary OTC

EXFORGE HCT ORAL TABLET 10-160-12.5 MG, 10-160-25 MG, 10-320-25 MG, 5-160-12.5 MG, 5-160-25 MG

Formulary ST

EXKIVITY ORAL CAPSULE 40 MG Formulary PA

EX-LAX MAXIMUM STRENGTH ORAL TABLET 25 MG

Formulary OTC

EX-LAX ORAL TABLET 15 MG Formulary OTC

EX-LAX ORAL TABLET CHEWABLE 15 MG Formulary OTC

exoten-c pain relief external lotion 0.001-10-20 %, 0.025-10-20 %

Formulary OTC

exotic-hc otic solution 10-10-1 mg/ml Formulary

EXTRESS-30 ORAL CAPSULE EXTENDED RELEASE Formulary OTC

eye allergy relief ophthalmic solution 0.027-0.315 % Formulary OTC

eye drops ophthalmic solution 0.012-0.2 % Formulary OTC

eye itch relief ophthalmic solution 0.025 % Formulary OTC

EYE STREAM OPHTHALMIC SOLUTION Formulary OTC

E-Z JECT LANCET MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days)

E-Z JECT LANCET SUPER THIN 30G Formulary OTC; QL (150 EA per 30 days)

E-Z JECT LANCETS Formulary OTC; QL (150 EA per 30 days)

E-Z JECT LANCETS 21G Formulary OTC; QL (150 EA per 30 days)

E-Z JECT LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days)

EZ SMART BLOOD GLUCOSE LANCETS Formulary OTC; QL (150 EA per 30 days)

ezetimibe oral tablet 10 mg Formulary

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

Formulary ST

EZFE 200 ORAL CAPSULE 434.8 (200 FE) MG Formulary OTC

ezfe forte oral capsule 155-1 mg Formulary OTC

E-Z-GAS II ORAL PACKET 2.21-1.53-0.04 GM Formulary OTC

EZ-LETS LANCETS 21G Formulary OTC; QL (150 EA per 30 days)



fabb oral tablet 2.2-25-1 mg Formulary

famciclovir oral tablet 125 mg, 250 mg, 500 mg Formulary

famotidine oral suspension reconstituted 40 mg/5ml Formulary

famotidine oral tablet 10 mg Formulary OTC

famotidine oral tablet 20 mg, 40 mg Formulary

FARESTON ORAL TABLET 60 MG Formulary

FARXIGA ORAL TABLET 10 MG, 5 MG Formulary AGE (Min 18 Years)

FAST FREEZE PRO STYLE THERAPY EXTERNAL GEL 3.5 %

Formulary OTC

56

Drug Name Formulary Status Requirements/LimitsFAST FREEZE PRO STYLE THERAPY EXTERNAL LIQUID 3.5 %

Formulary OTC

father johns medicine oral syrup 10 mg/5ml Formulary OTC

fa-vitamin b-6-vitamin b-12 oral tablet 2.2-25-0.5 mg Formulary

FAYOSIM ORAL TABLET 42-21-21-7 DAYS Formulary QL (91 EA per 91 days)

FC FEMALE CONDOM Formulary OTC

febuxostat oral tablet 40 mg, 80 mg Formulary QL (34 EA per 34 days)

feeding bottles/standard neck Formulary OTC

FEIBA INTRAVENOUS SOLUTION RECONSTITUTED , 1000 UNIT, 2500 UNIT, 500 UNIT

Formulary

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

Formulary

FEM PH VAGINAL GEL 0.9-0.025 % Formulary

FEMINEASE VAGINAL CREAM Formulary OTC

fenofibrate micronized oral capsule 134 mg, 200 mg, 30 mg, 67 mg, 90 mg

Formulary

fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg Formulary

fenofibric acid oral capsule delayed release 135 mg, 45 mg Formulary

fenofibric acid tablet 105 mg oral 105 mg Formulary

fenofibric acid tablet 35 mg oral 35 mg Formulary

fenoprofen calcium capsule 200 mg oral 200 mg Formulary

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

Formulary

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


fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr


FER-IN-SOL ORAL SOLUTION 75 (15 FE) MG/ML Formulary OTC

ferocon oral capsule Formulary

ferraplus 90 oral tablet 90-1 mg Formulary

ferretts chewable iron oral tablet chewable 18 mg Formulary OTC

ferretts ips oral solution 40 mg/15ml Formulary OTC

ferretts oral tablet 325 (106 fe) mg Formulary OTC

FERREX 150 FORTE PLUS ORAL CAPSULE 50-100 MG

Formulary OTC

FERREX 150 ORAL CAPSULE 150 MG Formulary OTC

FERREX 28 ORAL Formulary OTC

FERRIMIN 150 ORAL TABLET 150 MG Formulary OTC

FERROCITE ORAL TABLET 324 MG Formulary OTC

FERROCITE PLUS ORAL TABLET 106-1 MG Formulary

ferrous gluconate oral tablet 324 (37.5 fe) mg, 324 (38 fe) mg

Formulary OTC

ferrous sulfate er oral tablet extended release 140 (45 fe) mg

Formulary OTC

ferrous sulfate oral elixir 220 (44 fe) mg/5ml Formulary OTC

ferrous sulfate oral liquid 220 (44 fe) mg/5ml Formulary OTC

57

Drug Name Formulary Status Requirements/Limitsferrous sulfate oral syrup 300 (60 fe) mg/5ml Formulary OTC

ferrous sulfate oral tablet delayed release 324 (65 fe) mg, 325 (65 fe) mg

Formulary OTC

FEVERALL INFANTS RECTAL SUPPOSITORY 80 MG Formulary OTC

FEVERALL JUNIOR STRENGTH RECTAL SUPPOSITORY 325 MG

Formulary OTC

fexofenadine hcl childrens oral suspension 30 mg/5ml Formulary OTC

fiber laxative oral tablet 625 mg Formulary OTC

fiber oral powder Formulary OTC

fiber therapy oral tablet 500 mg Formulary OTC

FIBERCON ORAL TABLET 625 MG Formulary OTC

FIBEREX F15 ORAL LIQUID 15 GM/30ML Formulary OTC

FIFTY50 ALCOHOL PREP PAD 70 % 70 % Formulary OTC

FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

filter needle 18g x 1-1/2" Formulary

finasteride oral tablet 5 mg Formulary

FINE 30 Formulary OTC; QL (150 EA per 30 days)

first aid antibiotic external ointment 4 % Formulary OTC

first aid antiseptic external ointment 10 % Formulary OTC

first aid antiseptic spray external aerosol 20-0.13 % Formulary OTC

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

Formulary

fish oil + d3 oral capsule 1000-1000 mg-unit Formulary OTC

fish oil adult gummies oral tablet chewable 113.5 mg Formulary OTC

fish oil oral capsule 1200 mg, 500 mg, 600 mg Formulary OTC

fish oil oral capsule delayed release 1000 mg Formulary OTC

fish oil-flax oil-borage oil oral capsule Formulary OTC

flavor packets oral packet Formulary OTC

flavoxate hcl oral tablet 100 mg Formulary

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

FLEET BISACODYL RECTAL ENEMA 10 MG/30ML Formulary OTC

FLEET LIQUID GLYCERIN SUPP RECTAL ENEMA 5.4 GM/DOSE

Formulary OTC

FLEET NATURALS CLEANSING ENEMA RECTAL ENEMA

Formulary OTC

FLEET OIL RECTAL ENEMA Formulary OTC

FLEET PEDIATRIC RECTAL ENEMA 3.5-9.5 GM/59ML Formulary OTC

FLEXICHAMBER CHILD MASK/LARGE Formulary

FLINTSTONES COMPLETE ORAL TABLET CHEWABLE 10 MG

Formulary OTC

58

Drug Name Formulary Status Requirements/LimitsFLINTSTONES TODDLER ORAL TABLET CHEWABLE 40 MG

Formulary OTC

FLOGEN ORAL TABLET 250-650 MG Formulary OTC

FLONASE ALLERGY RELIEF SUSPENSION 50 MCG/ACT NASAL 50 MCG/ACT

Formulary OTC

FLONASE SENSIMIST NASAL SUSPENSION 27.5 MCG/SPRAY

Formulary OTC

FLORA ASSIST ORAL PACKET Formulary OTC

FLORANEX ORAL PACKET Formulary OTC

FLORASTOR KIDS ORAL PACKET 250 MG Formulary OTC

FLORASTOR ORAL CAPSULE 250 MG Formulary OTC

FLORICAL ORAL CAPSULE 8.3-364 MG Formulary OTC

FLORICAL ORAL TABLET 8.3-364 MG Formulary OTC

FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 250 MCG/BLIST, 50 MCG/BLIST

Formulary

FLOVENT HFA INHALATION AEROSOL 110 MCG/ACT, 220 MCG/ACT, 44 MCG/ACT

Formulary

flow-eze vented needle Formulary OTC

FLOWING VAPORS PAD Formulary OTC

FLOWING VAPORS/VAPOR FAN PAD Formulary OTC

floxuridine injection solution reconstituted 0.5 gm Formulary

flu hbp oral tablet 15-500-2 mg Formulary OTC

FLUAD QUADRIVALENT INTRAMUSCULAR PREFILLED SYRINGE 0.5 ML


FLUCAINE OPHTHALMIC SOLUTION 0.25-0.5 % Formulary

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION


FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


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

Formulary

fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg Formulary

fludarabine phosphate intravenous solution 50 mg/2ml Formulary

fludarabine phosphate intravenous solution reconstituted 50 mg

Formulary

fludrocortisone acetate oral tablet 0.1 mg Formulary

flunisolide nasal solution 25 mcg/act (0.025%) Formulary QL (25 ML per 34 days)

fluocinolone acetonide body external oil 0.01 % Formulary

fluocinolone acetonide external cream 0.01 %, 0.025 % Formulary

fluocinolone acetonide external ointment 0.025 % Formulary

fluocinolone acetonide external solution 0.01 % Formulary

fluocinolone acetonide otic oil 0.01 % Formulary

fluocinolone acetonide scalp external oil 0.01 % Formulary

fluocinonide emulsified base external cream 0.05 % Formulary

fluocinonide external cream 0.05 %, 0.1 % Formulary

fluocinonide external gel 0.05 % Formulary

59

Drug Name Formulary Status Requirements/Limitsfluocinonide external ointment 0.05 % Formulary

fluoride mouth rinse mouth/throat solution 0.0221 (0.01 f) %

Formulary OTC

fluoritab oral solution 0.275 (0.125 f) mg/drop Formulary

fluorometholone ophthalmic suspension 0.1 % Formulary

fluorouracil external cream 5 % Formulary

fluorouracil external solution 2 %, 5 % Formulary

fluorouracil intravenous solution 1 gm/20ml Formulary

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

fluoxetine hcl oral solution 20 mg/5ml Formulary

fluoxetine hcl oral tablet 10 mg Formulary QL (34 EA per 34 days)

fluphenazine decanoate injection solution 25 mg/ml Formulary AGE (Min 18 Years)

fluphenazine hcl injection solution 2.5 mg/ml Formulary AGE (Min 18 Years)

fluphenazine hcl oral concentrate 5 mg/ml Formulary AGE (Min 18 Years)

fluphenazine hcl oral elixir 2.5 mg/5ml Formulary AGE (Min 18 Years)

fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg Formulary AGE (Min 18 Years)

flurazepam hcl oral capsule 15 mg, 30 mg Formulary QL (68 EA per 34 days)

flurbiprofen oral tablet 100 mg, 50 mg Formulary

flurbiprofen sodium ophthalmic solution 0.03 % Formulary

flutamide oral capsule 125 mg Formulary

fluticasone propionate external cream 0.05 % Formulary

fluticasone propionate external ointment 0.005 % Formulary

fluticasone propionate nasal suspension 50 mcg/act Formulary

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

Formulary

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

FLUZONE HIGH-DOSE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


FLUZONE HIGH-DOSE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.7 ML


FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION , 0.5 ML


FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.25 ML, 0.5 ML


FOILLE EXTERNAL OINTMENT 5-0.1 % Formulary OTC

FOLET DHA ORAL THERAPY PACK 38-1 & 350 MG Formulary

FOLGARD ORAL TABLET Formulary OTC

FOLGARD OS ORAL TABLET 500-1.1 MG Formulary

FOLIC + B12 ORAL TABLET 800-1000 MCG Formulary OTC

folic acid oral capsule 0.8 mg, 20 mg, 5 mg Formulary OTC

folic acid oral tablet 1 mg Formulary

folic acid oral tablet 400 mcg, 800 mcg Formulary OTC

folinic-plus oral tablet 4-50-2 mg Formulary OTC

60

Drug Name Formulary Status Requirements/LimitsFOLITAB 500 ORAL TABLET EXTENDED RELEASE 105-500-0.8 MG

Formulary OTC

FOLIVANE-F ORAL CAPSULE 125-1 MG Formulary

FOLIVANE-PLUS ORAL CAPSULE Formulary

FOLOTYN INTRAVENOUS SOLUTION 20 MG/ML Formulary

foot powder external powder Formulary OTC

FORA D40 GLUCOSE/PRESSURE DEVICE Formulary OTC

FORA LANCETS Formulary OTC; QL (150 EA per 30 days)

FORADIL AEROLIZER INHALATION CAPSULE 12 MCG

Formulary

FORMADON EXTERNAL SOLUTION 10 % Formulary

formaldehyde external solution 37 % Formulary

FORMA-RAY EXTERNAL SOLUTION 20 % Formulary

formoterol fumarate inhalation nebulization solution 20 mcg/2ml


FORTEO SUBCUTANEOUS SOLUTION 600 MCG/2.4ML

Formulary PA; QL (2.4 ML per 28 days)

FORTEO SUBCUTANEOUS SOLUTION PEN-INJECTOR 620 MCG/2.48ML

Formulary QL (2.4 ML per 30 days)

fosamprenavir calcium oral tablet 700 mg Formulary

fosfomycin tromethamine oral packet 3 gm Formulary QL (3 EA per 30 days)

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

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

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

Formulary

freds pharmacy unilet lanc 28g Formulary OTC; QL (150 EA per 30 days)

FREE & CLEAR EXTERNAL LIQUID Formulary OTC

FREE & CLEAR EXTERNAL SHAMPOO Formulary OTC

FREESTYLE CONTROL SOLUTION LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days)

FREESTYLE FLASH SYSTEM KIT Formulary OTC; QL (1 EA per 365 days)

FREESTYLE FREEDOM KIT Formulary OTC; QL (1 EA per 365 days)

FREESTYLE FREEDOM LITE KIT W/DEVICE W/DEVICE


FREESTYLE INSULINX SYSTEM KIT W/DEVICE W/DEVICE


FREESTYLE INSULINX TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

FREESTYLE LANCETS Formulary OTC; QL (150 EA per 30 days)

FREESTYLE LIBRE 14 DAY READER DEVICE Formulary

FREESTYLE LIBRE 14 DAY SENSOR Formulary

FREESTYLE LIBRE 2 READER SYSTM DEVICE Formulary

FREESTYLE LIBRE 2 SENSOR SYSTM Formulary

FREESTYLE LIBRE READER DEVICE Formulary QL (1 EA per 365 days)

FREESTYLE LIBRE SENSOR SYSTEM Formulary QL (3 EA per 30 days)

FREESTYLE LITE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

FREESTYLE PRECISION INS SYR 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML

Formulary OTC

61

Drug Name Formulary Status Requirements/LimitsFREESTYLE PRECISION INS SYR 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC

FREESTYLE PRECISION INS SYR 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

FREESTYLE PRECISION INS SYR 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

FREESTYLE PRECISION NEO SYSTEM KIT W/DEVICE


FREESTYLE PRECISION NEO TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

FREESTYLE SIDEKICK II KIT Formulary OTC; QL (1 EA per 365 days)

FREESTYLE SYSTEM KIT Formulary OTC; QL (1 EA per 365 days)

FREESTYLE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

fruit c oral tablet chewable 100 mg Formulary OTC

fulvestrant intramuscular solution 250 mg/5ml Formulary

FUNGI-NAIL EXTERNAL SOLUTION 25 % Formulary OTC

FUNGI-NAIL TOE & FOOT EXTERNAL OINTMENT 5-20 %

Formulary OTC

FUNGOID TINCTURE EXTERNAL KIT 2 % Formulary OTC

FUNGOID TINCTURE EXTERNAL SOLUTION 2 % Formulary OTC

FUNGOID-D EXTERNAL CREAM 1 % Formulary OTC

furosemide oral solution 10 mg/ml Formulary

furosemide oral tablet 20 mg, 40 mg, 80 mg Formulary

FUSION ORAL CAPSULE 65-65-25-30 MG Formulary OTC

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED 90 MG

Formulary

FYAVOLV ORAL TABLET 1-5 MG-MCG Formulary

gabapentin oral capsule 100 mg, 300 mg, 400 mg Formulary

gabapentin oral solution 250 mg/5ml Formulary

gabapentin oral tablet 600 mg, 800 mg Formulary

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

Formulary

galantamine hydrobromide oral solution 4 mg/ml Formulary

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

GARDASIL 9 INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years)

GARDASIL 9 INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE


garlic/epa oral capsule 60-90-250 mg Formulary OTC

garlic-lecithin oral capsule 192-650 mg Formulary OTC

garlic-parsley oral tablet 100-175 mg Formulary OTC

gas relief oral liquid 40 mg/0.6ml Formulary OTC

GAS-X CHILDRENS ORAL STRIP 40 MG Formulary OTC

GAS-X EXTRA STRENGTH ORAL STRIP 62.5 MG Formulary OTC

GAS-X EXTRA STRENGTH ORAL TABLET CHEWABLE 125 MG

Formulary OTC

GAS-X ORAL TABLET CHEWABLE 80 MG Formulary OTC

GAS-X PREVENTION ORAL CAPSULE Formulary OTC

62

Drug Name Formulary Status Requirements/LimitsGAS-X WITH MAALOX EX ST ORAL TABLET CHEWABLE 500-125 MG

Formulary OTC

GAVILYTE-C ORAL SOLUTION RECONSTITUTED 240 GM

Formulary

GAVILYTE-G ORAL SOLUTION RECONSTITUTED 236 GM

Formulary

GAVILYTE-N WITH FLAVOR PACK ORAL SOLUTION RECONSTITUTED 420 GM

Formulary

GAVISCON EXTRA STRENGTH ORAL SUSPENSION 254-237.5 MG/5ML

Formulary OTC

GAVISCON EXTRA STRENGTH ORAL TABLET CHEWABLE 160-105 MG

Formulary OTC

GAVISCON ORAL SUSPENSION 95-358 MG/15ML Formulary OTC

GAVISCON ORAL TABLET CHEWABLE 80-14.2 MG Formulary OTC

G-BUCAL-C MOUTH/THROAT SOLUTION 0.15-0.1 % Formulary OTC

G-DOLOGEN ORAL TABLET 2-650 MG Formulary OTC

ge-150 oral capsule 150 mg Formulary OTC

GEBAUERS INSTANT ICE EXTERNAL AEROSOL Formulary OTC

gelatin oral capsule 650 mg Formulary OTC

GELFOAM SPONGE EXTERNAL 12-7 MM Formulary

GELFOAM SPONGE SIZE 100 EXTERNAL Formulary

GEL-KAM DENTAL GEL 0.4 % Formulary OTC

GELONASAL NASAL SOLUTION Formulary OTC

GELUSIL ORAL TABLET CHEWABLE 200-200-25 MG Formulary OTC

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

Formulary

gemcitabine hcl intravenous solution reconstituted 1 gm, 2 gm, 200 mg

Formulary

gemfibrozil oral tablet 600 mg Formulary

GENCONTUSS ORAL LIQUID 5-2-10 MG/5ML Formulary OTC

GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 0.2 MG SUBCUTANEOUS 0.2 MG

Formulary PA


Formulary PA


Formulary PA


Formulary PA

GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 1 MG SUBCUTANEOUS 1 MG

Formulary PA


Formulary PA


Formulary PA


Formulary PA


Formulary PA

63

Drug Name Formulary Status Requirements/LimitsGENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 2 MG SUBCUTANEOUS 2 MG

Formulary PA

GENOTROPIN SOLUTION RECONSTITUTED 12 MG SUBCUTANEOUS 12 MG

Formulary PA

GENOTROPIN SOLUTION RECONSTITUTED 5 MG SUBCUTANEOUS 5 MG

Formulary PA

gentamicin sulfate external cream 0.1 % Formulary

gentamicin sulfate external ointment 0.1 % Formulary

gentamicin sulfate ophthalmic solution 0.3 % Formulary

GENTEAL MILD OPHTHALMIC SOLUTION 0.2 % Formulary OTC

GENTEAL MILD TO MODERATE OPHTHALMIC SOLUTION 0.3 %

Formulary OTC

GENTEAL OPHTHALMIC GEL 0.25-0.3 % Formulary OTC

GENTEAL TEARS PF OPHTHALMIC SOLUTION 0.1-0.3 %

Formulary OTC

gentian violet external solution 1 %, 2 % Formulary OTC

gentle laxative rectal suppository 10 mg Formulary OTC

GENTLE RAIN EXTERNAL LIQUID 0.3 % Formulary OTC

gentle skin cleanser external lotion Formulary OTC

GENTLE-LET GP LANCETS Formulary OTC; QL (150 EA per 30 days)

GENTLE-LET LANCETS Formulary OTC; QL (150 EA per 30 days)

GENVOYA ORAL TABLET 150-150-200-10 MG Formulary

geravine oral elixir Formulary OTC

geriatric vitamin oral liquid 100-1-10 Formulary OTC

geri-lanta supreme oral suspension 400-135 mg/5ml Formulary OTC

gerisilk bath oil external oil Formulary OTC

GERMBLOC HEALTH EXTERNAL FOAM 0.1 % Formulary OTC

GILTUSS COUGH & COLD ORAL LIQUID 10-29-390 MG/5ML

Formulary OTC

ginger root oral capsule 500 mg Formulary OTC

ginseng oral capsule 100 mg, 250 mg, 50 mg Formulary OTC

gla-45 oral capsule 45 mg Formulary OTC

glass syringe 3 ml kit Formulary

glatiramer acetate subcutaneous solution prefilled syringe20 mg/ml, 40 mg/ml

Formulary

glen pe oral liquid 16-5 mg/5ml Formulary OTC

glenmax peb dm forte oral liquid 10-4-20 mg/5ml Formulary OTC

glenmax peb dm oral liquid 5-2-10 mg/5ml Formulary OTC; AGE (Min 2 Years)

glenmax peb oral liquid 4-10 mg/5ml Formulary OTC

glentuss oral liquid 30-6.25-15 mg/5ml Formulary OTC

g-levocarnitine s/f oral solution 1 gm/10ml Formulary OTC

glimepiride oral tablet 1 mg, 2 mg, 4 mg Formulary

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

Formulary

glipizide oral tablet 10 mg, 5 mg Formulary

64

Drug Name Formulary Status Requirements/Limitsglipizide xl oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

Formulary

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

Formulary

global inject ease insulin syr 29g x 1/2" 1 ml 29g x 1/2" 1 ml

Formulary OTC

global inject ease insulin syr 30g x 1/2" 1 ml 30g x 1/2" 1 ml

Formulary OTC

global insulin syringes 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml

Formulary OTC

GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED 1 MG


glucagon emergency injection kit 1 mg Formulary QL (2 EA per 34 days)

GLUCOCOM AUTOLINK TELEMONITOR Formulary OTC

GLUCOCOM LANCETS 28G Formulary OTC; QL (150 EA per 30 days)



GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

GLUCOPRO INSULIN SYRINGE 30G X 1/2" 1 ML 30G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

glucosamine chond complex/msm oral tablet Formulary OTC

glucosamine chondroit msm ds oral tablet Formulary OTC

glucosamine chondroitin complx oral capsule 500-250 mg Formulary OTC

glucosamine complex/vitamin d3 oral tablet Formulary OTC

glucosamine hcl oral tablet 1500 mg Formulary OTC

glucosamine sulfate oral capsule 1000 mg, 500 mg Formulary OTC

glucosamine sulfate oral tablet 1000 mg, 500 mg Formulary OTC

glucosamine-chondroitin oral capsule 250-200 mg, 500-400 mg

Formulary OTC

glucosamine-chondroitin oral liquid 1500-1200 mg/30ml Formulary OTC

glucosamine-chondroitin oral tablet 500-400 mg, 750-600 mg

Formulary OTC

glucosamine-chondroitin-msm oral tablet , 400-333.3-200 mg, 500-400-167 mg

Formulary OTC

65

Drug Name Formulary Status Requirements/Limitsglucosamine-chondroitin-vit d3 oral packet 1500-1200-800 mg-mg-unit

Formulary OTC

glucosamine-msm oral liquid 1500-500 mg/30ml Formulary OTC

GLUCOSE NURSETTE ORAL SOLUTION 5 % Formulary OTC

glucose oral gel 40 % Formulary OTC

glucose oral liquid 15 gm/59ml Formulary OTC

glucose oral tablet chewable 4 gm, 4-6 gm-mg Formulary OTC

glutamine oral capsule 500 mg Formulary OTC

glutathione oral tablet 50 mg Formulary OTC

glutol oral liquid Formulary OTC

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

glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg Formulary

glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 mg, 5-500 mg

Formulary

glycerin (adult) rectal suppository 2 gm Formulary OTC

glycerin (infants & children) rectal suppository 1 gm, 1.2 gm

Formulary OTC

glycerin external liquid Formulary OTC

glycine500 oral packet 500 mg Formulary OTC

glycolic acid solution 70 % Formulary

glycopyrrolate oral tablet 1 mg, 2 mg Formulary

GLYDO EXTERNAL GEL 2 % Formulary

GLY-OXIDE MOUTH/THROAT SOLUTION 10 % Formulary OTC

GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG Formulary AGE (Min 18 Years)

g-myco nail external solution Formulary OTC

gnp 24 hour nasal allergy aerosol 55 mcg/act nasal 55 mcg/act

Formulary OTC

gnp 4x probiotic oral tablet Formulary OTC

gnp advanced eye health oral capsule 250-2.5-0.5 mg Formulary OTC

gnp alcohol denatured solution Formulary OTC

gnp alcohol swabs pad 70 % 70 % Formulary OTC

gnp allergy & sinus headache oral tablet 25-10-650 mg Formulary OTC

gnp allergy pls sinus headache oral tablet 12.5-5-325 mg Formulary OTC

gnp animal shapes plus iron oral tablet chewable 15 mg Formulary OTC

gnp antacid & anti-gas oral tablet chewable 1000-60 mg Formulary OTC

gnp antacid oral tablet chewable 550-110 mg Formulary OTC

gnp b-50 complex oral tablet extended release Formulary OTC

gnp b-complex plus vitamin c oral tablet Formulary OTC

gnp calamine external lotion 8-8 % Formulary OTC

gnp calcium 600 plus d/mineral oral tablet 600-400 mg-unit Formulary OTC

gnp calcium plus 600 +d oral tablet 600-200 mg-unit Formulary OTC

gnp capsaicin external liquid 0.15 % Formulary OTC

gnp childrens chewables/ex c oral tablet chewable Formulary OTC

gnp cold & hot extra strength external ointment 7.6-29 % Formulary OTC

gnp cold sore treatment external liquid 0.13 % Formulary OTC

66

Drug Name Formulary Status Requirements/Limitsgnp coq-10 & fish oil oral capsule 120-180-50-30 Formulary OTC

gnp ethyl alcohol solution 70 % Formulary OTC

gnp fish oil oral capsule 435 mg Formulary OTC

gnp flu/severe cold daytime oral packet 10-650 mg Formulary OTC

gnp gentian violet external solution 1 % Formulary OTC

gnp glycerin/rose water external solution 10 % Formulary OTC

gnp headache relief extra str oral tablet 250-250-65 mg Formulary OTC

gnp hydrogen peroxide wipes external 3 % Formulary OTC

gnp insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

gnp insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC










gnp iodides external tincture Formulary OTC

gnp iodine external tincture Formulary OTC

gnp isopropyl alcohol wipes 70 % external 70 % Formulary OTC

gnp lancets Formulary OTC; QL (150 EA per 30 days)

gnp lancets 21g Formulary OTC; QL (150 EA per 30 days)

gnp lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days)

gnp lancets super thin 30g Formulary OTC; QL (150 EA per 30 days)

gnp lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

gnp lice egg remover external gel Formulary OTC

gnp liquid bandage external liquid 0.75-0.2 % Formulary OTC

gnp l-lysine oral tablet 600 mg Formulary OTC

gnp micro thin lancets 33g Formulary OTC; QL (150 EA per 30 days)

gnp natural fiber oral capsule 0.52 gm Formulary OTC

gnp niacin oral tablet 250 mg Formulary OTC

gnp night time cold & flu oral capsule 15-6.25-325 mg Formulary OTC

gnp omeprazole oral tablet delayed release 20 mg Formulary OTC

gnp pain relief/benzocaine external pad 6-70 % Formulary OTC

gnp potassium oral tablet 99 mg Formulary OTC

gnp shampoo & body wash external liquid Formulary OTC

gnp sinus wash refill nasal packet 2300-700 mg Formulary OTC

gnp super thin lancets 30g Formulary OTC; QL (150 EA per 30 days)

gnp terbinafine hydrochloride external cream 1 % Formulary OTC

gnp ultra com insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml

Formulary OTC

67

Drug Name Formulary Status Requirements/Limitsgnp ultra com insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC

gnp ultra com insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

gnp urinary pain relief oral tablet 97.5 mg Formulary OTC

gnp vitamin a & d external ointment 15.5-53.4 % Formulary OTC

gnp vitamin d super strength oral tablet 125 mcg (5000 ut) Formulary OTC

gnp vitamin d-400 oral tablet 90-400 mg-unit Formulary OTC

GOLD BOND FOOT POWDER MAX ST EXTERNAL POWDER

Formulary OTC

GOLD BOND MULTI-SYMPTOM EXTERNAL CREAM 4 %

Formulary OTC

GOLD BOND RAPID RELIEF EXTERNAL CREAM 1-1 %

Formulary OTC

GOLD BOND ULTIM SANITIZR/MOIST EXTERNAL LIQUID 0.2 %

Formulary OTC

GOLD BOND ULTIM SANITIZR/SHEER EXTERNAL LIQUID 0.2 %

Formulary OTC

GOLD BOND ULTIMATE EXTERNAL LOTION Formulary OTC

GONIOSOL OPHTHALMIC SOLUTION 2.5 % Formulary OTC

GONIOTAIRE OPHTHALMIC SOLUTION 2.5 % Formulary OTC

GONIOVISC OPHTHALMIC SOLUTION 2 % Formulary OTC

GOOD START 5% GLUCOSE WATER ORAL SOLUTION 5 %

Formulary OTC

goodsense all day allergy oral tablet 10 mg Formulary OTC

goodsense cough dm oral suspension extended release 30 mg/5ml

Formulary OTC

goodsense eye drops ophthalmic solution 0.05 % Formulary OTC

goodsense flu/cold/cough/night oral packet 25-10-650 mg Formulary OTC

goodsense flu/cold/daytime oral packet 20-10-500 mg Formulary OTC

goodsense ibuprofen childrens oral suspension 100 mg/5ml Formulary OTC

goodsense ibuprofen infants oral suspension 50 mg/1.25ml Formulary OTC

68

Drug Name Formulary Status Requirements/Limitsgoodsense ibuprofen oral tablet 200 mg Formulary OTC

goodsense lancets 30g Formulary OTC; QL (150 EA per 30 days)

goodsense lancets 33g Formulary OTC; QL (150 EA per 30 days)

goodsense lubricant eye drops ophthalmic solution 0.4-0.3 %

Formulary OTC

goodsense miconazole 1 vaginal kit 1200 & 2 mg & % Formulary ST; OTC

goodsense nicotine mouth/throat gum 4 mg Formulary OTC

goodsense nighttime cold & flu oral liquid 5-6.25-10-325 mg/15ml

Formulary OTC

goodsense redness relief plus ophthalmic solution 0.5-0.03 %

Formulary OTC

goodsense severe sinus congest oral capsule 5-6.25-10-325 mg

Formulary OTC

goodsense sinus congest/pain oral 2-5-325 & 5-325 mg Formulary OTC

goodsense sleeptime oral liquid 50 mg/30ml Formulary OTC

goodsense sore throat spray mouth/throat liquid 1.4 % Formulary OTC

gordomatic external crystals Formulary OTC

GORDONS NO 5 EXTERNAL AEROSOL POWDER Formulary OTC

gordons urea external ointment 22 % Formulary OTC

GORDONS-VITE A EXTERNAL CREAM 100000 UNIT/GM

Formulary OTC

GORDONS-VITE A EXTERNAL LOTION 100000 UNIT Formulary OTC

GORDO-POOL CONCENTRATE Formulary OTC

GRANDPAS OATMEAL SOAP EXTERNAL BAR Formulary OTC

GRANDPAS THYLOX SOAP EXTERNAL BAR 3 % Formulary OTC

GRANIX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML

Formulary PA

green soap external tincture Formulary OTC

griseofulvin microsize oral suspension 125 mg/5ml Formulary

griseofulvin microsize oral tablet 500 mg Formulary

grx hemorrhoidal rectal ointment 0.25-14-71.9 % Formulary OTC

grx wound external gel Formulary OTC

g-supress dx pediatric oral liquid 2.5-5-50 mg/ml Formulary OTC

G-TRON PED ORAL LIQUID 10-15-350 MG/5ML Formulary OTC

G-TRON PEDIATRIC DROPS ORAL LIQUID 2.5-5-100 MG/ML

Formulary OTC

G-TUSICOF ORAL LIQUID 10-20-400 MG/5ML Formulary OTC

guaifenesin oral tablet 400 mg Formulary OTC

guaifenesin-codeine oral solution 100-10 mg/5ml Formulary OTC; AGE (Min 6 Years)

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

Formulary

guanfacine hcl oral tablet 1 mg, 2 mg Formulary

guanidine hcl oral tablet 125 mg Formulary

gumsol mouth/throat liquid 5-0.1 % Formulary OTC

GYNE-LOTRIMIN 3 VAGINAL CREAM 2 % Formulary OTC

GYNE-LOTRIMIN VAGINAL CREAM 1 % Formulary OTC

69

Drug Name Formulary Status Requirements/LimitsH2Q ORAL POWDER 200 MG/GM Formulary OTC

HAILEY FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary

halobetasol propionate external cream 0.05 % Formulary

haloperidol decanoate intramuscular solution 100 mg/ml, 50 mg/ml


haloperidol lactate injection solution 5 mg/ml Formulary

haloperidol lactate oral concentrate 2 mg/ml Formulary AGE (Min 18 Years)

haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg


hand wipes external 0.13 % Formulary OTC

HARD NAILS ORAL CAPSULE 2.5 MG Formulary OTC

HAVRIX INTRAMUSCULAR SUSPENSION 1440 EL U/ML, 720 EL U/0.5ML


HC DERMAPAX EXTERNAL LIQUID 0.5-0.5 % Formulary OTC

H-CHLOR 12 EXTERNAL SOLUTION 0.125 % Formulary OTC

H-CHLOR 6 EXTERNAL SOLUTION 0.062 % Formulary OTC

headache relief pm oral tablet 500-38 mg Formulary OTC

healthy accents unilet lancets Formulary OTC; QL (150 EA per 30 days)

hearing aid batteries Formulary OTC

heartburn antacid ex st oral tablet chewable 160-105 mg Formulary OTC

heartburn treatment 24 hour oral capsule delayed release15 mg


h-e-b incontrol alcohol pad Formulary OTC

h-e-b incontrol lancets 28g Formulary OTC; QL (150 EA per 30 days)



HEET TRIPLE ACTION EXTERNAL LIQUID Formulary OTC

hematinic/folic acid oral tablet 324-1 mg Formulary

HEMATOGEN FA ORAL CAPSULE 200-250-0.01-1 MG Formulary

HEMATOGEN ORAL CAPSULE Formulary

HEMOCYTE ORAL TABLET 324 (106 FE) MG Formulary OTC

hemorrhoidal cooling rectal gel 0.25-50 % Formulary OTC

hemorrhoidal max st/aloe rectal cream 1-0.25-14.4-15 % Formulary OTC

hemorrhoidal rectal ointment 0.25-3-14-71.9 % Formulary OTC

hemorrhoidal rectal suppository 0.25-3-85.5 %, 0.25-85.39 %, 0.25-88.44 %

Formulary OTC

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

Formulary

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

Formulary

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

Formulary

HERCEPTIN INTRAVENOUS SOLUTION RECONSTITUTED 440 MG

Formulary

hetastarch-nacl intravenous solution 6-0.9 % Formulary

HETLIOZ LQ ORAL SUSPENSION 4 MG/ML Formulary PA

70

Drug Name Formulary Status Requirements/LimitsHEXALEN ORAL CAPSULE 50 MG Formulary

HIBICLENS EXTERNAL LIQUID 4 % Formulary OTC

high potency iron oral tablet 27 mg Formulary OTC

histaflex oral tablet 325-25 mg Formulary OTC

HISTEX ORAL SYRUP 2.5 MG/5ML Formulary OTC

HISTEX ORAL TABLET CHEWABLE 1.25 MG Formulary OTC

HISTEX PD ORAL LIQUID 0.938 MG/ML Formulary OTC

HISTEX PDX ORAL LIQUID 1.25 MG/ML Formulary OTC

HISTEX-AC ORAL SYRUP 10-2.5-10 MG/5ML Formulary OTC

HISTEX-DM ORAL SYRUP 10-2.5-20 MG/5ML Formulary OTC

HISTEX-PE ORAL SYRUP 2.5-10 MG/5ML Formulary OTC

hm 24 hour nasal allergy aerosol 55 mcg/act nasal 55 mcg/act

Formulary OTC

hm calamine external lotion 8-8 % Formulary OTC

hm clear fiber oral powder Formulary OTC

hm ethyl rubbing alcohol solution 70 % Formulary OTC

hm iodides external tincture Formulary OTC

hm iodine external tincture Formulary OTC

hm iron oral tablet 200 (65 fe) mg Formulary OTC

hm melatonin quick dissolve oral tablet dispersible 10 mg Formulary OTC

hm nighttime sleep aid oral tablet 25 mg Formulary OTC

hm omeprazole oral tablet delayed release 20 mg Formulary OTC

hm probiotic digestive health oral capsule Formulary OTC

HM SALONPAS PAIN RELIEF EXTERNAL PATCH 1.2-5.7-6.3 %

Formulary OTC

hm severe cold/cough/flu oral packet 20-10-650 mg Formulary OTC

hm vitamin b12 oral tablet extended release 1000 mcg Formulary OTC

hm z-sleep oral capsule 25 mg Formulary OTC

HOLD MOUTH/THROAT LOZENGE 5 MG Formulary OTC

HOMATROPAIRE OPHTHALMIC SOLUTION 5 % Formulary

HONEY BEARS W/IRON-ZINC ORAL TABLET CHEWABLE 30-200-3

Formulary OTC

HPR PLUS HYDROGEL EXTERNAL KIT Formulary

huber needle 19g x 1-1/4" , 19g x 3/4" , 20g x 1-1/4" , 20g x 3/4" , 22g x 1-1/4"

Formulary OTC

HUGGIES NATURAL CARE WIPES Formulary OTC

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

Formulary

HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

Formulary

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

Formulary

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

Formulary

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

Formulary

71

Drug Name Formulary Status Requirements/LimitsHUMALOG MIX 75/25 SUBCUTANEOUS SUSPENSION (75-25) 100 UNIT/ML

Formulary

HUMALOG SUBCUTANEOUS SOLUTION 100 UNIT/ML

Formulary

HUMALOG SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNIT/ML

Formulary

HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT, 250-600 UNIT, 500-1200 UNIT

Formulary

humidifier Formulary OTC; QL (2 EA per 365 days)

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML


HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.4ML, 40 MG/0.8ML

FormularySP; QL (2 EA per 28 days); AGE (Min 2 Years)

HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML, 80 MG/0.8ML


HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML


HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.2ML, 20 MG/0.4ML


HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.4ML


HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML


HUMPHREYS #1 SIMPLE FEVER ORAL PELLET Formulary OTC

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

Formulary OTC

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

Formulary OTC

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

Formulary OTC

HUMULIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML

Formulary OTC

HUMULIN R INJECTION SOLUTION 100 UNIT/ML Formulary OTC

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

Formulary

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

Formulary

HURRICAINE MOUTH/THROAT AEROSOL 20 % Formulary OTC

HURRICAINE MOUTH/THROAT SOLUTION 20 % Formulary OTC

HURRICAINE MOUTH/THROAT SWAB 20 % Formulary OTC

HURRICAINE ONE MOUTH/THROAT SOLUTION 20 %

Formulary OTC

HURRIVIEW DENTAL SWAB 1.5 % Formulary OTC

HURRIVIEW II DENTAL SWAB Formulary OTC

HYALGAN INTRA-ARTICULAR SOLUTION 20 MG/2ML

Formulary PA

72

Drug Name Formulary Status Requirements/LimitsHYCAMTIN ORAL CAPSULE 0.25 MG, 1 MG Formulary

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

HYDROCELL ADHESIVE DRESSING PAD 6"X6" Formulary OTC

hydrocerin external cream Formulary OTC

hydrocerin external lotion Formulary OTC

hydrochlorothiazide oral capsule 12.5 mg Formulary

hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg Formulary

hydrocod polst-cpm polst er oral suspension extended release 10-8 mg/5ml


hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml Formulary PA; QL (1260 ML per 7 days)

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg


hydrocodone-acetaminophen oral tablet 2.5-325 mg Formulary PA; QL (252 EA per 7 days)

hydrocodone-acetaminophen oral tablet 5-300 mg, 5-325 mg


hydrocodone-acetaminophen oral tablet 7.5-300 mg, 7.5-325 mg


hydrocodone-homatropine oral syrup 5-1.5 mg/5ml Formulary AGE (Min 6 Years)

hydrocodone-homatropine oral tablet 5-1.5 mg Formulary

hydrocodone-ibuprofen oral tablet 10-200 mg Formulary PA; QL (63 EA per 7 days)

hydrocodone-ibuprofen oral tablet 5-200 mg Formulary PA; QL (126 EA per 7 days)

hydrocodone-ibuprofen oral tablet 7.5-200 mg Formulary PA; QL (84 EA per 7 days)

hydrocortisone ace-pramoxine rectal cream 1-1 % Formulary

hydrocortisone butyrate external cream 0.1 % Formulary

hydrocortisone butyrate external ointment 0.1 % Formulary

hydrocortisone butyrate external solution 0.1 % Formulary

hydrocortisone external cream 0.5 % Formulary OTC

hydrocortisone external cream 1 %, 2.5 % Formulary

hydrocortisone external lotion 2.5 % Formulary

hydrocortisone external ointment 0.5 % Formulary OTC

hydrocortisone external ointment 1 %, 2.5 % Formulary

hydrocortisone oral tablet 10 mg, 20 mg, 5 mg Formulary

hydrocortisone rectal cream 1 % Formulary

hydrocortisone valerate external cream 0.2 % Formulary

hydrocortisone valerate external ointment 0.2 % Formulary

hydrocortisone-aloe external cream 0.5 % Formulary OTC

HYDROGEL AG EXTERNAL GEL Formulary OTC

HYDROGEL EXTERNAL GEL Formulary OTC

hydromet oral syrup 5-1.5 mg/5ml Formulary AGE (Min 6 Years)

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

Formulary

hydromorphone hcl oral tablet 2 mg Formulary PA; QL (79 EA per 7 days)



hydromorphone hcl pf injection solution 10 mg/ml Formulary

73

Drug Name Formulary Status Requirements/Limitshydrophilic external ointment Formulary OTC

hydrophilic petrolatum external ointment Formulary OTC

hydroxychloroquine sulfate oral tablet 200 mg Formulary

hydroxyurea oral capsule 500 mg Formulary

hydroxyzine hcl intramuscular solution 50 mg/ml Formulary

hydroxyzine hcl oral syrup 10 mg/5ml Formulary

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

hydroxyzine pamoate oral capsule 25 mg, 50 mg Formulary

HYLATOPIC PLUS EXTERNAL LOTION Formulary

hyoscyamine sulfate er oral tablet extended release 12 hour0.375 mg

Formulary

hyoscyamine sulfate oral elixir 0.125 mg/5ml Formulary

hyoscyamine sulfate oral solution 0.125 mg/ml Formulary

hyoscyamine sulfate oral tablet 0.125 mg Formulary

hyoscyamine sulfate sl sublingual tablet sublingual 0.125 mg

Formulary

HYPERCARE EXTERNAL SOLUTION 15 % Formulary OTC

HYPERRHO S/D INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 1500 UNIT, 250 UNIT

Formulary

hypodermic needle 21g x 1-1/4" , 25g x 3/4" , 26g x 3/8" Formulary OTC

HYPOTEARS OPHTHALMIC SOLUTION 1-1 % Formulary OTC

HYSEPT EXTERNAL SOLUTION 0.25 %, 0.5 % Formulary OTC

HYVEE ADVANCED ANTACID ORAL SUSPENSION 400-400-40 MG/5ML

Formulary OTC

HY-VEE LANCETS Formulary OTC; QL (150 EA per 30 days)

hy-vee thin lancets Formulary OTC; QL (150 EA per 30 days)

ibandronate sodium intravenous solution 3 mg/3ml Formulary PA; QL (1 ML per 90 days)

ibandronate sodium oral tablet 150 mg Formulary

ibuprofen 100 junior strength oral tablet chewable 100 mg Formulary OTC

ibuprofen oral capsule 200 mg Formulary OTC

ibuprofen oral tablet 400 mg, 600 mg, 800 mg Formulary

ibuprofen pm oral capsule 200-25 mg Formulary OTC

ICAR ORAL SUSPENSION 15 MG/1.25ML Formulary OTC

ICAR-C ORAL TABLET 100-250 MG Formulary OTC

icatibant acetate subcutaneous solution 30 mg/3ml Formulary PA; QL (24 ML per 14 days)

ice blue external gel 2 % Formulary OTC

ICY HOT EXTERNAL STICK 10-30 % Formulary OTC

ICY HOT LIDOCAINE PLUS MENTHOL EXTERNAL CREAM 4-1 %

Formulary OTC

ICY HOT LIDOCAINE PLUS MENTHOL EXTERNAL PATCH 4-1 %

Formulary OTC

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

Formulary

IFEX INTRAVENOUS SOLUTION RECONSTITUTED 3 GM

Formulary

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

74

Drug Name Formulary Status Requirements/Limitsifosfamide intravenous solution reconstituted 1 gm Formulary

imatinib mesylate oral tablet 100 mg, 400 mg Formulary PA

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

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

Formulary

imiquimod external cream 3.75 % Formulary

imiquimod external cream 5 % Formulary QL (12 EA per 34 days)

imiquimod pump external cream 3.75 % Formulary

immune support oral tablet chewable Formulary OTC

IMODIUM A-D ORAL CAPSULE 2 MG Formulary OTC

IMODIUM A-D ORAL LIQUID 1 MG/7.5ML Formulary OTC

IMODIUM A-D ORAL TABLET 2 MG Formulary OTC

IMODIUM MULTI-SYMPTOM RELIEF ORAL TABLET 2-125 MG

Formulary OTC

IMOVAX RABIES INTRAMUSCULAR INJECTABLE 2.5 UNIT/ML


IMPROVUE OPHTHALMIC SOLUTION PREFILLED SYRINGE 1.7 %

Formulary OTC

indapamide oral tablet 1.25 mg, 2.5 mg Formulary

indomethacin er oral capsule extended release 75 mg Formulary

indomethacin oral capsule 25 mg, 50 mg Formulary

INFANRIX INTRAMUSCULAR SUSPENSION 25-58-10 Formulary

infants gas relief oral suspension 40 mg/0.6ml Formulary OTC

INFED INJECTION SOLUTION 50 MG/ML Formulary

INFUMORPH 200 INJECTION SOLUTION 200 MG/20ML (10 MG/ML)

Formulary

INFUMORPH 500 INJECTION SOLUTION 500 MG/20ML (25 MG/ML)

Formulary

INGREZZA ORAL CAPSULE 60 MG Formulary

INGREZZA ORAL CAPSULE THERAPY PACK 40 & 80 MG

Formulary

inject-ease Formulary OTC

INJECT-EASE AUTOMATIC INJECTOR Formulary OTC

inositol oral tablet 500 mg, 650 mg Formulary OTC

INOSITOL-5 ORAL TABLET 324 MG Formulary OTC

INSTACLEAN EXTERNAL LIQUID Formulary OTC

INSTA-GLUCOSE ORAL GEL 77.4 % Formulary OTC

instant ear-dry otic liquid 95-5 % Formulary OTC

instant hand sanitizer external liquid 62 % Formulary OTC

INSTAT EXTERNAL PAD Formulary

INSUFLON 25G X 0.71" Formulary

insulin asp prot & asp flexpen suspension pen-injector (70-30) 100 unit/ml subcutaneous (70-30) 100 unit/ml

Formulary

insulin aspart flexpen solution pen-injector 100 unit/ml subcutaneous 100 unit/ml

Formulary

75

Drug Name Formulary Status Requirements/Limitsinsulin aspart penfill solution cartridge 100 unit/ml subcutaneous 100 unit/ml

Formulary

insulin aspart prot & aspart suspension (70-30) 100 unit/ml subcutaneous (70-30) 100 unit/ml

Formulary

insulin aspart subcutaneous solution 100 unit/ml Formulary

insulin glargine-yfgn solution 100 unit/ml subcutaneous 100 unit/ml

Formulary

insulin glargine-yfgn solution pen-injector 100 unit/ml subcutaneous 100 unit/ml

Formulary

insulin lispro (1 unit dial) subcutaneous solution pen-injector 100 unit/ml

Formulary

insulin lispro junior kwikpen subcutaneous solution pen-injector 100 unit/ml

Formulary

insulin lispro prot & lispro subcutaneous suspension pen-injector (75-25) 100 unit/ml

Formulary

insulin lispro subcutaneous solution 100 unit/ml Formulary

insulin syringe 27g x 1/2" 0.5 ml 27g x 1/2" 0.5 ml Formulary OTC

insulin syringe 27g x 1/2" 1 ml 27g x 1/2" 1 ml Formulary OTC













insulin syringe/needle 27g x 1/2" 0.5 ml 27g x 1/2" 0.5 ml Formulary OTC

insulin syringe/needle 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

insulin syringe/needle 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC

INSUPEN ULTRAFIN 30G X 8 MM Formulary OTC

INTEGRA ORAL CAPSULE 62.5-62.5-40-3 MG Formulary OTC

INTELENCE ORAL TABLET 25 MG Formulary

intense cough reliever ex st oral liquid 20-300 mg/5ml Formulary OTC

INTERDRY AG TEXTILE 10"X144" EXTERNAL SHEET

Formulary OTC

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

Formulary PA

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

Formulary PA

INTROVALE ORAL TABLET 0.15-0.03 MG Formulary QL (91 EA per 91 days)

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 117 MG/0.75ML, 156 MG/ML, 234 MG/1.5ML, 39 MG/0.25ML, 78 MG/0.5ML


76

Drug Name Formulary Status Requirements/LimitsINVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 117 MG/0.75ML, 156 MG/ML, 234 MG/1.5ML, 39 MG/0.25ML, 78 MG/0.5ML


INVEGA TRINZA INTRAMUSCULAR SUSPENSION 273 MG/0.875ML, 410 MG/1.315ML, 546 MG/1.75ML, 819 MG/2.625ML


INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 273 MG/0.875ML, 273 MG/0.88ML, 410 MG/1.315ML, 410 MG/1.32ML, 546 MG/1.75ML, 819 MG/2.625ML, 819 MG/2.63ML


INVIRASE ORAL CAPSULE 200 MG Formulary

INVIRASE ORAL TABLET 500 MG Formulary

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


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


INVOKANA ORAL TABLET 100 MG, 300 MG Formulary PA; AGE (Min 18 Years)

iodides tincture external tincture Formulary OTC

iodine external tincture , 2 % Formulary OTC

iodine strong external tincture 6.9-5 % Formulary OTC

iodine strong oral solution 5 % Formulary

iodine tincture external tincture Formulary OTC

iodine tincture external tincture 2 % Formulary

IONIL EXTERNAL SHAMPOO 2-0.2 % Formulary OTC

IONIL-T EXTERNAL SHAMPOO 1 % Formulary OTC

IONSYS TRANSDERMAL PATCH 40 MCG/ACT Formulary PA

IPOL INJECTION INJECTABLE Formulary AGE (Min 19 Years)

ipratropium bromide inhalation solution 0.02 % Formulary

ipratropium bromide nasal solution 0.03 % Formulary QL (60 ML per 34 days)

ipratropium bromide nasal solution 0.06 % Formulary QL (30 ML per 34 days)

ipratropium-albuterol inhalation solution 0.5-2.5 (3) mg/3ml

Formulary

irbesartan oral tablet 150 mg, 300 mg, 75 mg Formulary

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

Formulary

irinotecan hcl intravenous solution 100 mg/5ml, 300 mg/15ml, 40 mg/2ml, 500 mg/25ml

Formulary

IROFOL ORAL LIQUID 100-1000-15 MG-MCG/5ML Formulary OTC

IROFOL ORAL TABLET 150-0.025-1 MG Formulary OTC

iron (ferrous sulfate) oral tablet extended release 142 (45 fe) mg

Formulary OTC

iron 100 plus oral tablet 100-250-0.025-1 mg Formulary OTC

iron 100/c oral tablet 100-250 mg Formulary OTC

iron 21/7 oral Formulary OTC

iron 27 oral tablet 240 (27 fe) mg Formulary OTC

iron chews pediatric oral tablet chewable 15 mg Formulary OTC

77

Drug Name Formulary Status Requirements/Limitsiron oral tablet 28 mg Formulary OTC

iron slow release oral tablet extended release 143 (45 fe) mg

Formulary OTC

irrigating eyewash ophthalmic solution Formulary OTC

ISAGEL EXTERNAL GEL 60 % Formulary OTC

ISENTRESS HD ORAL TABLET 600 MG Formulary

ISENTRESS ORAL PACKET 100 MG Formulary

ISENTRESS ORAL TABLET 400 MG Formulary

ISENTRESS ORAL TABLET CHEWABLE 100 MG, 25 MG

Formulary

ISOLEUCINE 1000 ORAL PACKET 1 GM Formulary OTC

isoleucine oral packet 50 mg Formulary OTC

isoniazid oral syrup 50 mg/5ml Formulary

isoniazid oral tablet 100 mg, 300 mg Formulary

isopropyl alcohol (rubbing) solution 70 % Formulary OTC

isopropyl alcohol solution 50 % Formulary OTC

isopropyl alcohol solution 70 % Formulary

isopropyl alcohol wipes 70 % external 70 % Formulary OTC

ISOPTO TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC

isosorbide dinitrate er oral tablet extended release 40 mg Formulary

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 40 mg, 5 mg

Formulary

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

Formulary

isosorbide mononitrate oral tablet 10 mg, 20 mg Formulary

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

isradipine oral capsule 2.5 mg, 5 mg Formulary

itch relief external cream 2 % Formulary OTC

ITCH-X EXTERNAL GEL 1-10 % Formulary OTC

ITCH-X EXTERNAL SOLUTION 1-10 % Formulary OTC

itraconazole oral capsule 100 mg Formulary QL (34 EA per 34 days)

itraconazole oral solution 10 mg/ml Formulary

IVAREST MEDICATED POISON IVY EXTERNAL LIQUID 1 %

Formulary OTC

IVAREST POISON IVY ITCH EXTERNAL CREAM 2-14-10.5 %

Formulary OTC

ivermectin oral tablet 3 mg Formulary

ivy wash poison ivy cleanser external lotion 1 % Formulary OTC

IVY-RID EXTERNAL AEROSOL Formulary OTC

IXEMPRA KIT INTRAVENOUS SOLUTION RECONSTITUTED 15 MG, 45 MG

Formulary

IXIARO INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years)

J & J DENTAL FLOSS FOR KIDS Formulary OTC

JANTOVEN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG

Formulary

JANUMET ORAL TABLET 50-1000 MG, 50-500 MG Formulary AGE (Min 18 Years)

78

Drug Name Formulary Status Requirements/LimitsJANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG, 50-1000 MG, 50-500 MG


JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG Formulary AGE (Min 18 Years)

JARDIANCE ORAL TABLET 10 MG, 25 MG Formulary AGE (Min 18 Years)

JENTADUETO ORAL TABLET 2.5-1000 MG, 2.5-500 MG, 2.5-850 MG


jessners external solution Formulary OTC

jock itch spray external aerosol powder 1 % Formulary OTC

JOHNSONS BABY CORNSTARCH EXTERNAL POWDER

Formulary OTC

JOHNSONS BABY OIL GEL EXTERNAL GEL Formulary OTC

JOHNSONS BABY POWDER EXTERNAL POWDER Formulary OTC

JULUCA ORAL TABLET 50-25 MG Formulary

JUNEL 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary

JUNEL 1/20 ORAL TABLET 1-20 MG-MCG Formulary

JUNEL FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary

k 100 oral tablet 100 mcg Formulary OTC

k-99 oral capsule 595 mg Formulary OTC

KAITLIB FE ORAL TABLET CHEWABLE 0.8-25 MG-MCG

Formulary

KALBITOR SUBCUTANEOUS SOLUTION 10 MG/ML Formulary PA; QL (6 ML per 34 days)

KANGAROO ENTRIFLUSH PUMP SET Formulary

KANGAROO JOEY PUMP SET Formulary

KANK-A MOUTH PAIN MOUTH/THROAT SOLUTION 20 %

Formulary OTC

KANK-A SOFTBRUSH MOUTH/THROAT GEL 20-0.1 %

Formulary OTC

KAOPECTATE ORAL TABLET 262 MG Formulary OTC

KARBOZYME ORAL TABLET DELAYED RELEASE 167-173-346 MG

Formulary OTC

K-BICARB ORAL CAPSULE 99 MG Formulary OTC

KELNOR 1/35 ORAL TABLET 1-35 MG-MCG Formulary QL (28 EA per 28 days)

kelp oral tablet 150 mcg Formulary OTC

kelp-b6-lecithin-vinegar oral capsule 5-0.75-200-50 mg Formulary OTC

KENALOG INJECTION SUSPENSION 10 MG/ML Formulary

KENDALL ALGINATE DRESS 8"X8" EXTERNAL PAD Formulary OTC

KENDALL ANTIMICROBIAL BANDAGE EXTERNAL Formulary OTC

KENDALL CA ALGINATE 6"X10" EXTERNAL Formulary OTC

KENDALL HYDROPHILIC FOAM DRESS PAD 4"X8" , 5"X5"

Formulary OTC

KENDALL TRANSPARENT FILM DRESS Formulary OTC

KEPIVANCE INTRAVENOUS SOLUTION RECONSTITUTED 6.25 MG

Formulary

KERR TRIPLE DYE SWABS EXTERNAL SWAB Formulary OTC

KESIMPTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 20 MG/0.4ML

Formulary PA

79

Drug Name Formulary Status Requirements/Limitsketoconazole external cream 2 % Formulary

ketoconazole external foam 2 % Formulary

ketoconazole external shampoo 2 % Formulary

ketoconazole oral tablet 200 mg Formulary

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

Formulary

ketorolac tromethamine intramuscular solution 60 mg/2ml Formulary

ketorolac tromethamine ophthalmic solution 0.4 %, 0.5 % Formulary

ketorolac tromethamine oral tablet 10 mg Formulary QL (20 EA per 34 days)

KETOSTIX IN VITRO STRIP Formulary OTC

kettle neti pot sinus wash nasal kit 2300-700 mg Formulary OTC

KEY OMEGA ORAL PACKET 200-100 MG Formulary OTC

k-iii oral solution reconstituted 33.3-33.3-33.3 % Formulary OTC

kimono micro thin Formulary OTC

KINERASE EXTERNAL CREAM 0.1 %, 0.125 % Formulary OTC

KINERASE EXTERNAL LOTION 0.1 % Formulary OTC

kinney lancets Formulary OTC; QL (150 EA per 30 days)

kinney thin lancets Formulary OTC

kinray insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC



kinray insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC

KINRIX INTRAMUSCULAR SUSPENSION Formulary

KINRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

Formulary

KIONEX ORAL SUSPENSION 15 GM/60ML Formulary AGE (Min 19 Years)

KITABIS PAK NEBULIZATION SOLUTION 300 MG/5ML INHALATION 300 MG/5ML

FormularyQL (280 ML per 28 days); AGE (Min 6 Years)

KLOR-CON 10 ORAL TABLET EXTENDED RELEASE 10 MEQ

Formulary

KLOR-CON ORAL TABLET EXTENDED RELEASE 8 MEQ

Formulary

KLOR-CON SPRINKLE ORAL CAPSULE EXTENDED RELEASE 10 MEQ, 8 MEQ

Formulary

KLOXXADO NASAL LIQUID 8 MG/0.1ML Formulary

KLS ALLER-CORT AEROSOL 55 MCG/ACT NASAL 55 MCG/ACT

Formulary OTC

kls cold & flu ms day/night oral tablet therapy pack Formulary OTC

kls esomeprazole magnesium oral capsule delayed release20 mg

Formulary OTC

kls natural psyllium fiber oral powder 58.6 % Formulary OTC

kls omeprazole oral tablet delayed release 20 mg Formulary OTC

K-MAG ASPARTATE ORAL TABLET 250-250 MG Formulary OTC

K-MAG ORAL CAPSULE 40-40 MG Formulary OTC

K-MAG-70 ORAL CAPSULE 70-70 MG Formulary OTC

kmart valu insulin syringe 29g u-100 0.5 ml u-100 0.5 ml Formulary OTC

80

Drug Name Formulary Status Requirements/Limitskmart valu insulin syringe 29g u-100 1 ml u-100 1 ml Formulary OTC



kmart valu insulin syringe 30g u-100 1 ml u-100 1 ml Formulary OTC

konsyl daily fiber oral packet 100 % Formulary OTC

konsyl daily fiber oral powder 100 % Formulary OTC

KONSYL ORAL PACKET 28.3 %, 60.3 % Formulary OTC

KONSYL ORAL POWDER 60.3 %, 71.67 % Formulary OTC

KONSYL-D ORAL POWDER 52.3 % Formulary OTC

korean ginseng oral capsule 350 mg Formulary OTC

kp hydrocortisone-aloe external cream 0.5 % Formulary OTC

kp mag-oxide magnesium oral tablet 200 mg Formulary OTC

kp silicone scar therapy gel strip Formulary OTC

K-PHOS NO 2 ORAL TABLET 305-700 MG Formulary

K-PHOS ORAL TABLET 500 MG Formulary

kpn prenatal oral tablet 0.1 mg Formulary OTC

krill oil oral capsule 300 mg Formulary OTC

KROGER HEALTHPRO LANCET 26G Formulary OTC; QL (150 EA per 30 days)

kroger insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC


kroger insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC







kroger lancets Formulary OTC; QL (150 EA per 30 days)

kroger lancets 21g Formulary OTC; QL (150 EA per 30 days)

kroger lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days)

kroger lancets super thin Formulary OTC; QL (150 EA per 30 days)

kroger lancets thin Formulary OTC; QL (150 EA per 30 days)

kroger lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

kroger lancets ultrathin 30g Formulary OTC; QL (150 EA per 30 days)

K-TAN PLUS ORAL CAPSULE 162-115.2-1 MG Formulary

KWAN LOONG PAIN RELIEVING EXTERNAL OIL Formulary OTC

KYLEENA INTRAUTERINE INTRAUTERINE DEVICE 19.5 MG

Formulary

labetalol hcl intravenous solution 5 mg/ml Formulary

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

LAC-HYDRIN FIVE EXTERNAL LOTION 5 % Formulary OTC

LAC-HYDRIN TWELVE EXTERNAL LOTION 12 % Formulary OTC

lactated ringers irrigation solution Formulary

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

81

Drug Name Formulary Status Requirements/Limitslactic acid external lotion 10 % Formulary

lacto-bifidus-600 oral capsule Formulary OTC

LAMICTAL ODT ORAL KIT 21 X 25 MG & 7 X 50 MG, 42 X 50 MG & 14X100 MG

Formulary

LAMISIL ADVANCED EXTERNAL GEL 1 % Formulary OTC

LAMISIL AT EXTERNAL CREAM 1 % Formulary OTC

LAMISIL AT EXTERNAL POWDER Formulary OTC

LAMISIL AT SPRAY EXTERNAL SOLUTION 1 % Formulary OTC

LAMISILK PROTECT EXTERNAL LIQUID Formulary OTC

lamivudine oral solution 10 mg/ml Formulary

lamivudine oral tablet 100 mg, 150 mg, 300 mg Formulary

lamivudine-zidovudine oral tablet 150-300 mg Formulary

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

Formulary

lamotrigine oral kit 25 & 50 & 100 mg Formulary

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

lamotrigine oral tablet chewable 25 mg, 5 mg Formulary

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

Formulary

LANACANE ANTI-BACTERIAL EXTERNAL AEROSOL 20-0.2 %

Formulary OTC

LANACANE MAXIMUM STRENGTH EXTERNAL CREAM 20-0.2 %

Formulary OTC

LANACORT 10 EXTERNAL CREAM 1 % Formulary OTC

lancets Formulary OTC; QL (150 EA per 30 days)

lancets 28g Formulary OTC; QL (150 EA per 30 days)

lancets 30g Formulary OTC; QL (150 EA per 30 days)

lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days)

lancets super thin 28g Formulary OTC; QL (150 EA per 30 days)

lancets thin Formulary OTC; QL (150 EA per 30 days)

LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days)

lancets ultra thin 30g Formulary OTC; QL (150 EA per 30 days)

lanolin anhydrous external ointment Formulary

lanolin external ointment Formulary OTC

lanolin hydrous-grx external ointment 72 % Formulary OTC

lansoprazole oral capsule delayed release 15 mg Formulary

lansoprazole oral capsule delayed release 30 mg Formulary QL (34 EA per 34 days)

lansoprazole oral tablet dispersible 15 mg, 30 mg Formulary PA

LANTISEPTIC MULTI-PURPOSE EXTERNAL OINTMENT 0.45-20 %

Formulary OTC

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

Formulary

LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML Formulary

l-arginine oral capsule 500 mg Formulary OTC

l-arginine oral tablet 1000 mg Formulary OTC

LARIN 1/20 ORAL TABLET 1-20 MG-MCG Formulary

82

Drug Name Formulary Status Requirements/LimitsLARIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary

latanoprost ophthalmic solution 0.005 % Formulary

LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG, 80 MG


laxative oral tablet 25 mg Formulary OTC

laxative pills oral tablet 15 mg Formulary OTC

LAZANDA NASAL SOLUTION 100 MCG/ACT, 400 MCG/ACT


l-carnitine oral capsule 250 mg, 500 mg Formulary OTC

l-carnitine oral tablet 250 mg, 500 mg Formulary OTC

leader insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

leader insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC









lecithin-kelp-b6-cider vinegar oral capsule 200-0.075-5-50 mg

Formulary OTC

leflunomide oral tablet 10 mg, 20 mg Formulary

leg-gesic oral suspension Formulary OTC

lemon-glycerin mouth/throat swab Formulary OTC

LENZAPATCH EXTERNAL PATCH 4-1 % Formulary

letrozole oral tablet 2.5 mg Formulary

leucine oral packet 100 mg Formulary OTC

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

Formulary

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

LEUKERAN ORAL TABLET 2 MG Formulary

leuprolide acetate injection kit 1 mg/0.2ml Formulary PA

levalbuterol hcl inhalation nebulization solution 0.31 mg/3ml, 0.63 mg/3ml, 1.25 mg/0.5ml, 1.25 mg/3ml

Formulary PA

levalbuterol tartrate inhalation aerosol 45 mcg/act Formulary

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

Formulary

LEVEMIR SUBCUTANEOUS SOLUTION 100 UNIT/ML Formulary

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

Formulary

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

Formulary

levetiracetam intravenous solution 500 mg/5ml Formulary

levetiracetam oral solution 100 mg/ml Formulary

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

83

Drug Name Formulary Status Requirements/Limitslevobunolol hcl ophthalmic solution 0.5 % Formulary

levocarnitine (dietary) oral tablet 330 mg Formulary OTC

levocarnitine fumarate oral capsule 250 mg Formulary OTC

levocarnitine oral solution 1 gm/10ml Formulary

levocarnitine oral tablet 330 mg Formulary

levocarnitine-b5-taurine oral liquid 1000-10-150 mg/15ml Formulary OTC

levocetirizine dihydrochloride oral solution 2.5 mg/5ml Formulary

levocetirizine dihydrochloride oral tablet 5 mg Formulary

levofloxacin intravenous solution 25 mg/ml Formulary

levofloxacin ophthalmic solution 0.5 % Formulary

levofloxacin oral solution 25 mg/ml Formulary

levofloxacin oral tablet 250 mg, 500 mg, 750 mg Formulary

levoleucovorin calcium intravenous solution reconstituted50 mg

Formulary

LEVO-T ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

Formulary

LEXIVA ORAL SUSPENSION 50 MG/ML Formulary

l-glutamine oral capsule 500 mg Formulary OTC

l-glutamine oral tablet 500 mg Formulary OTC

LICE B GONE CAP SATURATED EXTERNAL KIT Formulary OTC

LICE B GONE EXTERNAL SHAMPOO Formulary OTC

lice cure external solution Formulary OTC

lice killing maximum strength external shampoo 0.33-4 % Formulary OTC

lice treatment external lotion 1 % Formulary OTC

LICEFREEE EXTERNAL SOLUTION Formulary OTC

LICEMD COMPLETE EXTERNAL KIT 0.33-4 % Formulary OTC

LICIDE TREATMENT COMBINATION KIT Formulary OTC

lidocaine external cream 5 % Formulary OTC; QL (60 GM per 30 days)

lidocaine external ointment 5 % Formulary ST; QL (30 GM per 34 days)

lidocaine external patch 5 % Formulary QL (90 EA per 30 days)

lidocaine hcl external cream 3 % Formulary

lidocaine hcl external solution 4 % Formulary

lidocaine hcl mouth/throat solution 4 % Formulary

lidocaine viscous mouth/throat solution 2 % Formulary

lidocaine-hydrocortisone ace rectal cream 3-0.5 % Formulary

lidocaine-hydrocortisone ace rectal kit 3-1 %, 3-2.5 % Formulary

lidocaine-prilocaine external cream 2.5-2.5 % Formulary

lidocaine-transparent dressing external kit 4 % Formulary OTC

LIDOPATCH PAIN RELIEF EXTERNAL PATCH 3.99-1.25 %

Formulary OTC

lidopin external cream 3 % Formulary

LIDOPRO TRANSDERMAL PATCH 4-4-5 % Formulary OTC

LILETTA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE 18.6 MCG/DAY, 19.5 MCG/DAY

Formulary

84

Drug Name Formulary Status Requirements/Limitslimencin external patch 4-4 % Formulary OTC

lindane external shampoo 1 % Formulary ST; QL (60 ML per 30 days)

linezolid oral suspension reconstituted 100 mg/5ml Formulary PA

linezolid oral tablet 600 mg Formulary PA

LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 MCG

Formulary PA; AGE (Min 18 Years)

liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg Formulary

lip balm external ointment Formulary OTC

lip balm external stick Formulary OTC

LIP MEDEX EXTERNAL OINTMENT Formulary OTC

lip-guard external ointment Formulary OTC

lipochol nr oral capsule Formulary OTC

lipochol plus oral tablet Formulary OTC

LIPO-GEL ORAL CAPSULE 100-30 MG-UNIT Formulary OTC

lipoic acid oral capsule 150 mg Formulary OTC

LIPOTRIAD ORAL TABLET Formulary OTC

LIPOTRIAD VISIONARY ORAL CAPSULE Formulary OTC

LIQ-10 ORAL SYRUP 100-1 MG-UNT/5ML, 50-15 Formulary OTC

LIQSORB ORAL LIQUID 100 MG/ML Formulary OTC

LIQUACEL ORAL LIQUID Formulary OTC

LIQUIMAT EXTERNAL LOTION 5 % Formulary OTC

lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg

Formulary

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

Formulary

LISTERINE NATURALS ANTISEPTIC MOUTH/THROAT LIQUID

Formulary OTC

lite touch lancets Formulary OTC; QL (150 EA per 30 days)

LITETOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

LITETOUCH INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

85

Drug Name Formulary Status Requirements/LimitsLITETOUCH INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

LITETOUCH LANCETS Formulary OTC; QL (150 EA per 30 days)

lithium carbonate er oral tablet extended release 300 mg, 450 mg

Formulary

lithium carbonate oral capsule 150 mg, 300 mg, 600 mg Formulary

lithium carbonate oral tablet 300 mg Formulary

lithium oral solution 8 meq/5ml Formulary

LITTLE COLDS COUGH FORMULA ORAL LIQUID 7.5 MG/ML

Formulary OTC

LITTLE COLDS DECONGESTANT ORAL LIQUID 2.5 MG/ML

Formulary OTC

LITTLE REMEDIES POISON TREAT ORAL SUSPENSION RECONSTITUTED 15 GM/120ML

Formulary OTC

LITTLE TUMMYS LAXATIVE ORAL LIQUID 8.8 MG/ML

Formulary OTC

live better lancet super thin Formulary OTC; QL (150 EA per 30 days)

live better lancet ultra thin Formulary OTC; QL (150 EA per 30 days)

liver extract oral tablet 455 mg Formulary OTC

liver oral capsule 500 mg Formulary OTC

LIVMARLI ORAL SOLUTION 9.5 MG/ML Formulary PA

l-lysine external ointment Formulary OTC

l-lysine hcl oral capsule 500 mg Formulary OTC

l-lysine hcl oral tablet 1000 mg Formulary OTC

l-lysine oral capsule 500 mg Formulary OTC

l-lysine oral tablet 1000 mg, 500 mg Formulary OTC

LMX 4 EXTERNAL CREAM 4 % Formulary OTC

LMX 4 PLUS EXTERNAL KIT 4 % Formulary OTC

LO LOESTRIN FE ORAL TABLET 1 MG-10 MCG / 10 MCG


local anesthesia needle 20g x 4" , 22 x 4" , 22g x 3" Formulary OTC

LODRANE D ORAL CAPSULE 4-60 MG Formulary OTC

LOESTRIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary

LOHIST-D ORAL LIQUID 2-30 MG/5ML Formulary OTC

lohist-dm oral syrup 5-2-10 mg/5ml Formulary OTC; AGE (Min 2 Years)

longs insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC

longs lancets thin Formulary OTC; QL (150 EA per 30 days)

loperamide hcl oral suspension 1 mg/7.5ml Formulary OTC

lopinavir-ritonavir oral solution 400-100 mg/5ml Formulary

lopinavir-ritonavir oral tablet 100-25 mg, 200-50 mg Formulary

loratadine childrens oral solution 5 mg/5ml Formulary OTC

loratadine oral capsule 10 mg Formulary OTC

loratadine-d 24hr oral tablet extended release 24 hour 10-240 mg

Formulary OTC

LORAZEPAM INTENSOL ORAL CONCENTRATE 2 MG/ML


86

Drug Name Formulary Status Requirements/Limitslorazepam oral tablet 0.5 mg, 1 mg, 2 mg Formulary QL (170 EA per 30 days)

LORTUSS DM ORAL LIQUID 30-6.25-15 MG/5ML Formulary OTC

LORTUSS EX ORAL LIQUID 30-10-100 MG/5ML Formulary OTC

LORTUSS LQ ORAL LIQUID 6.25-30 MG/5ML Formulary OTC

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

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

Formulary

LOTRIMIN AF EXTERNAL AEROSOL 2 % Formulary OTC

LOTRIMIN AF EXTERNAL CREAM 1 % Formulary OTC

LOTRIMIN ULTRA EXTERNAL CREAM 1 % Formulary OTC

lovastatin oral tablet 10 mg, 20 mg, 40 mg Formulary

loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg Formulary AGE (Min 18 Years)

LOZIBASE S Formulary

l-phenylalanine oral tablet 500 mg Formulary OTC

l-tyrosine oral capsule 500 mg Formulary OTC

l-tyrosine oral tablet 500 mg Formulary OTC

lubiprostone oral capsule 24 mcg, 8 mcg Formulary PA; AGE (Min 18 Years)

lubricant drops/dual-action ophthalmic solution 0.5-0.9 % Formulary OTC

lubricant eye drops ophthalmic solution 0.4-0.3 % Formulary OTC

LUBRISKIN EXTERNAL LOTION Formulary OTC

LUCENTIS INTRAVITREAL SOLUTION 0.5 MG/0.05ML

Formulary PA; QL (0.05 ML per 28 days)

LUDENS COUGH DROPS MOUTH/THROAT LOZENGE 3-60 MG

Formulary OTC

LUDENS THROAT DROPS MOUTH/THROAT LOZENGE 1 MG, 1.6 MG, 1.7 MG, 2.4 MG, 2.5 MG, 2.8 MG, 4 MG

Formulary OTC

LUMAKRAS ORAL TABLET 120 MG Formulary PA

LUPKYNIS ORAL CAPSULE 7.9 MG Formulary PA; QL (180 EA per 30 days)

LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 3.75 MG, 7.5 MG


LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT 11.25 MG, 22.5 MG


LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30 MG


LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45 MG


LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 11.25 MG, 15 MG, 7.5 MG


LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT 11.25 MG (PED), 30 MG (PED)


lutein oral capsule 15-0.7 mg, 40 mg, 6 mg Formulary OTC

lutein oral tablet 10 mg, 20 mg, 6 mg Formulary OTC

LUVENA FEMININE WIPES EXTERNAL 1 % Formulary OTC

LYCELLE EXTERNAL GEL Formulary OTC

lysine4000 oral packet 4000 mg Formulary OTC

LYSODREN ORAL TABLET 500 MG Formulary

87

Drug Name Formulary Status Requirements/LimitsM2 C ORAL CAPSULE EXTENDED RELEASE 500 MG Formulary OTC

MAALOX ADVANCED MAX ST ORAL TABLET CHEWABLE 1000-60 MG

Formulary OTC

MAALOX JUNIOR PLUS ANTIGAS ORAL TABLET CHEWABLE 400-24 MG

Formulary OTC

MAALOX ORAL TABLET CHEWABLE 600 MG Formulary OTC

MACUGEN INTRAOCULAR SOLUTION 0.3 MG Formulary

mafenide acetate external packet 5 % Formulary

MAG-200 ORAL TABLET 200 MG Formulary OTC

mag-al oral liquid 200-200 mg/5ml Formulary OTC

magdelay oral tablet delayed release 70 mg Formulary OTC

MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary


Formulary

MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary


Formulary


Formulary

MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary

MAGIMIN ORAL TABLET 80 MG Formulary OTC

magnacaps oral capsule 100 mg Formulary OTC

MAGNEBIND 200 ORAL TABLET 450-200 MG Formulary OTC

MAGNEBIND 300 ORAL TABLET 250-300 MG Formulary OTC

magnesium carbonate oral powder 250 mg/gm Formulary OTC

magnesium chloride oral tablet delayed release 64 mg Formulary OTC

magnesium chloride-calcium oral tablet 64-112 mg Formulary OTC

magnesium citrate oral solution 1.745 gm/30ml Formulary OTC

magnesium fizz-plus oral powder effervescent 300-500 mg/6.1gm

Formulary OTC

magnesium gluconate oral tablet 27.5 mg Formulary OTC

magnesium oral capsule 300 mg Formulary OTC

magnesium oral tablet 200 mg, 250 mg, 30 mg Formulary OTC

magnesium oxide oral capsule 500 mg Formulary OTC

magnesium oxide oral powder Formulary OTC

magnesium oxide oral tablet 400 (240 mg) mg, 400 (241.3 mg) mg, 400 mg, 420 mg, 500 mg

Formulary OTC

magnesium sulfate oral capsule 70 mg Formulary OTC

magnum-75 oral tablet extended release Formulary OTC

MAGONATE ORAL TABLET 500 (27 MG) MG Formulary OTC

mag-sr plus calcium oral tablet delayed release 64-106 mg Formulary OTC

MAG-TAB SR ORAL TABLET EXTENDED RELEASE 84 MG (7MEQ)

Formulary OTC

88

Drug Name Formulary Status Requirements/LimitsMAKENA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 275 MG/1.1ML

Formulary

malathion external lotion 0.5 % Formulary ST

manganese aspartate oral tablet 93 mg Formulary OTC

manganese gluconate oral tablet 50 mg Formulary OTC

manganese oral tablet 15 mg Formulary OTC

MANGIMIN ORAL TABLET 10 MG Formulary OTC

MAOX ORAL TABLET 420 MG Formulary OTC

MAPAP HEADACHE PLUS ORAL TABLET 500-250 MG

Formulary OTC

mapap oral capsule 500 mg Formulary OTC

MAR-COF BP ORAL LIQUID 30-2-7.5 MG/5ML Formulary OTC

MAR-COF CG EXPECTORANT ORAL LIQUID 225-7.5 MG/5ML

Formulary OTC

MASTISOL ADHESIVE EXTERNAL LIQUID Formulary OTC

MATULANE ORAL CAPSULE 50 MG Formulary

MAVYRET ORAL PACKET 50-20 MG Formulary QL (84 EA per 28 days)

MAVYRET ORAL TABLET 100-40 MG Formulary QL (84 EA per 28 days)

MAXI-COMFORT INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

MAXI-COMFORT INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC

MAXIMUM D3 ORAL CAPSULE 10000 UNIT Formulary OTC

ME-500 ORAL CAPSULE 500 MG Formulary OTC

mecholyl external ointment 0.25 % Formulary OTC

meclizine hcl oral tablet 12.5 mg, 25 mg Formulary

MEDADYNE ORAL PAIN RELIEF MOUTH/THROAT LIQUID 10-0.13-70 %

Formulary OTC

MEDERMA AG FACIAL CLEANSER EXTERNAL LIQUID

Formulary OTC

MEDERMA EXTERNAL GEL Formulary OTC

MEDERMA PM EXTERNAL CREAM 2 % Formulary OTC

medic insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC

medic insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC

medicated body external powder Formulary OTC

medicated douche vaginal solution 0.3 % Formulary OTC

medicated wipes external pad 50 % Formulary OTC

MEDICONE RECTAL SUPPOSITORY 0.25 % Formulary OTC

MEDI-DERM/L-RX EXTERNAL CREAM 2-0.035-5-20 %

Formulary

MEDI-DERM-RX EXTERNAL CREAM 0.035-5-20 % Formulary

MEDI-FIRST ANTISEPTIC CLEANER EXTERNAL GEL 66.5 %

Formulary OTC

medi-first hydrocortisone external cream 1 % Formulary OTC

MEDI-FIRST/LIDOCAINE EXTERNAL CREAM 0.5-0.13 %

Formulary OTC

89

Drug Name Formulary Status Requirements/LimitsMEDIHONEY WOUND/BURN DRESSING EXTERNAL GEL

Formulary

MEDIHONEY WOUND/BURN DRESSING EXTERNAL PASTE

Formulary

medi-laxx oral capsule 8.6-50 mg Formulary OTC

MEDI-LYTE ORAL TABLET 18-9-40 MG Formulary OTC

medi-patch-lidocaine external patch 0.5-0.035-5-20 % Formulary OTC

MEDIPLAST EXTERNAL 40 % Formulary OTC

MEDIPORE + PAD ADHESIVE DRESS PAD 2"X2-3/4" , 3-1/2"X10" , 3-1/2"X13-3/4"

Formulary OTC

MEDISENSE GLUCOSE KETONE CONTR LIQUID IN VITRO


MEDISENSE HI/MID/LOW CONTROL LIQUID IN VITRO


MEDISENSE HIGH/LOW CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days)

MEDISENSE MID CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days)

MEDISENSE THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

medi-tussin dm double strength oral liquid 30-200 mg/5ml Formulary OTC

MEDPURA ZINC OXIDE EXTERNAL OINTMENT 20 % Formulary OTC

MEDROX EXTERNAL OINTMENT 0.0375-5-20 % Formulary OTC

MEDROX EXTERNAL PATCH 0.0375-5-20 % Formulary OTC

medroxyprogesterone acetate intramuscular suspension 150 mg/ml


medroxyprogesterone acetate intramuscular suspension prefilled syringe 150 mg/ml

Formulary

medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 mg

Formulary

mefenamic acid oral capsule 250 mg Formulary

mefloquine hcl oral tablet 250 mg Formulary

mega coq10 oral capsule 400 mg Formulary OTC

MEGA MULTIVITAMIN ORAL POWDER Formulary OTC

megestrol acetate oral suspension 40 mg/ml Formulary

megestrol acetate oral tablet 20 mg, 40 mg Formulary

meijer alcohol swabs pad 70 % 70 % Formulary OTC

MEIJER LANCETS Formulary OTC; QL (150 EA per 30 days)

MEIJER LANCETS THIN Formulary OTC; QL (150 EA per 30 days)

MEIJER LANCETS UNIVERSAL 21G Formulary OTC; QL (150 EA per 30 days)

MEIJER LANCETS UNIVERSAL 33G Formulary OTC; QL (150 EA per 30 days)

MEIJER SUPER THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

melatonin er oral tablet extended release 3 mg Formulary OTC

melatonin oral capsule 1 mg, 10 mg, 3 mg, 5 mg Formulary OTC

melatonin oral tablet 1 mg, 10 mg, 3 mg, 300 mcg, 5 mg Formulary OTC

melatonin oral tablet dispersible 5 mg Formulary OTC

melatonin sublingual tablet sublingual 10 mg Formulary OTC

melatonin tr oral tablet extended release 1 mg Formulary OTC

melatonin-pyridoxine oral tablet 1-10 mg Formulary OTC

90

Drug Name Formulary Status Requirements/LimitsMELLOW-TONE ORAL STRIP Formulary OTC

meloxicam oral tablet 15 mg, 7.5 mg Formulary

melphalan oral tablet 2 mg Formulary

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

Formulary

memantine hcl oral solution 2 mg/ml Formulary

memantine hcl oral tablet 10 mg, 28 x 5 mg & 21 x 10 mg, 5 mg

Formulary

MENACTRA INTRAMUSCULAR INJECTABLE Formulary AGE (Min 19 Years)

MENACTRA INTRAMUSCULAR SOLUTION Formulary AGE (Min 19 Years)

mencaps external patch 0.0225-4.5 % Formulary OTC

m-end dmx oral liquid 20-0.667-10 mg/5ml Formulary OTC

M-END PE ORAL LIQUID 3.33-1.33-6.33 MG/5ML Formulary OTC

MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG Formulary

MENQUADFI INTRAMUSCULAR SOLUTION Formulary

menstrual pain relief oral tablet 500-25-15 mg Formulary OTC

menstrual relief max strength oral tablet 500-60-15 mg Formulary OTC

MENVEO INTRAMUSCULAR SOLUTION RECONSTITUTED


meperidine hcl injection solution 10 mg/ml, 100 mg/ml, 25 mg/ml, 50 mg/ml

Formulary

mercaptopurine oral tablet 50 mg Formulary

mesalamine er oral capsule extended release 24 hour 0.375 gm

Formulary

mesalamine oral tablet delayed release 1.2 gm Formulary

mesalamine rectal enema 4 gm Formulary

mesalamine rectal suppository 1000 mg Formulary

mesalamine-cleanser rectal kit 4 gm Formulary

mesna intravenous solution 100 mg/ml Formulary

MESNEX ORAL TABLET 400 MG Formulary

MESTINON ORAL SYRUP 60 MG/5ML Formulary

METAMUCIL MULTIHEALTH FIBER ORAL PACKET 58.12 %

Formulary OTC

METAMUCIL MULTIHEALTH FIBER ORAL POWDER 63 %

Formulary OTC

METAMUCIL ORAL CAPSULE 0.52 GM Formulary OTC

METAMUCIL ORAL POWDER 48.57 % Formulary OTC

METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 %

Formulary OTC

metaproterenol sulfate oral syrup 10 mg/5ml Formulary

METAXALL ORAL TABLET 800 MG Formulary ST

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


metformin hcl oral solution 500 mg/5ml Formulary ST; AGE (Min 10 Years)

metformin hcl oral tablet 1000 mg, 500 mg, 850 mg Formulary AGE (Min 10 Years)

91

Drug Name Formulary Status Requirements/LimitsMETHADONE HCL INTENSOL ORAL CONCENTRATE 10 MG/ML


methadone hcl oral concentrate 10 mg/ml Formulary PA; QL (120 EA per 30 days)

methadone hcl oral solution 10 mg/5ml Formulary PA; QL (450 ML per 30 days)

methadone hcl oral solution 5 mg/5ml Formulary PA; QL (1200 ML per 30 days)

methadone hcl oral tablet 10 mg Formulary PA; QL (90 EA per 30 days)

methadone hcl oral tablet 5 mg Formulary PA; QL (180 EA per 30 days)

methadone hcl oral tablet soluble 40 mg Formulary PA; QL (22.5 EA per 30 days)

methazolamide oral tablet 25 mg, 50 mg Formulary

methenamine hippurate oral tablet 1 gm Formulary

methenamine mandelate oral tablet 1 gm Formulary

methimazole oral tablet 10 mg, 5 mg Formulary

methionine oral packet 100 mg Formulary OTC

methionine oral tablet 500 mg Formulary OTC

methitest oral tablet 10 mg Formulary

methocarbamol injection solution 1000 mg/10ml Formulary

methocarbamol oral tablet 500 mg, 750 mg Formulary

methotrexate oral tablet 2.5 mg Formulary

methotrexate sodium (pf) injection solution 1 gm/40ml, 250 mg/10ml, 50 mg/2ml

Formulary

methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml

Formulary

methotrexate sodium injection solution reconstituted 1 gm Formulary

methoxsalen oral capsule 10 mg Formulary

methyl salicylate external liquid Formulary

methyl salicylate external oil Formulary OTC

methyldopa oral tablet 250 mg, 500 mg Formulary

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


methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years)

methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml

Formulary

methylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg Formulary

methylprednisolone oral tablet therapy pack 4 mg Formulary

methylprednisolone sodium succ injection solution reconstituted 1000 mg, 125 mg, 40 mg

Formulary

metipranolol ophthalmic solution 0.3 % Formulary

metoclopramide hcl oral solution 5 mg/5ml Formulary

metoclopramide hcl oral tablet 10 mg, 5 mg Formulary

metolazone oral tablet 10 mg, 2.5 mg, 5 mg Formulary

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

Formulary

metoprolol tartrate intravenous solution 5 mg/5ml Formulary

metoprolol tartrate intravenous solution cartridge 5 mg/5ml Formulary

metoprolol tartrate oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

Formulary

92

Drug Name Formulary Status Requirements/Limitsmetoprolol-hydrochlorothiazide oral tablet 100-25 mg, 100-50 mg, 50-25 mg

Formulary

metronidazole external cream 0.75 % Formulary

metronidazole external gel 0.75 %, 1 % Formulary

metronidazole external lotion 0.75 % Formulary

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

Formulary

metronidazole oral capsule 375 mg Formulary

metronidazole oral tablet 250 mg, 500 mg Formulary

metronidazole vaginal gel 0.75 % Formulary

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

MEXSANA EXTERNAL POWDER 10.8 % Formulary OTC

mg aspartate oral tablet 65 mg Formulary OTC

MG/TAURINE FORTE ORAL CAPSULE Formulary OTC

MG217 PSORIASIS ANIT-ITCH EXTERNAL GEL 1 % Formulary OTC

MI PASTE PLUS DENTAL PASTE Formulary

MIBELAS 24 FE ORAL TABLET CHEWABLE 1-20 MG-MCG(24)


MICATIN EXTERNAL CREAM 2 % Formulary OTC

miconazole 3 vaginal cream 4 % Formulary ST; OTC

miconazole 7 vaginal suppository 100 mg Formulary OTC

miconazole nitrate vaginal cream 2 % Formulary OTC; QL (45 GM per 34 days)

MICORT-HC EXTERNAL CREAM 2.5 % Formulary

microfiber cleaning cloths Formulary OTC

MICROGESTIN 1/20 ORAL TABLET 1-20 MG-MCG Formulary

MICROGESTIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG

Formulary

MICROKLENZ EXTERNAL LIQUID 0.1 % Formulary OTC

MICROLET LANCETS Formulary OTC; QL (150 EA per 30 days)

MICROLET NEXT LANCING DEVICE Formulary OTC

midazolam hcl oral syrup 2 mg/ml Formulary

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

MIDOL CAFFEINE FREE ORAL TABLET 500-25 MG Formulary OTC

MIDOL COMPLETE ORAL TABLET 500-60-15 MG Formulary OTC

MIGERGOT RECTAL SUPPOSITORY 2-100 MG Formulary

miglitol oral tablet 100 mg, 50 mg Formulary

miglustat oral capsule 100 mg Formulary

MIL-A-MULSION ORAL EMULSION 10-15000 UNIT/DROP

Formulary OTC

MILCO-ZYME ORAL TABLET Formulary OTC

milk of magnesia concentrate oral suspension 2400 mg/10ml

Formulary OTC

MILLGUARD ORAL TABLET 800-10-115 MCG-MG-MCG

Formulary OTC

MILTAB #1 ORAL TABLET Formulary OTC

mineral oil light external oil 100 % Formulary OTC

93

Drug Name Formulary Status Requirements/Limitsmineral oil-hydrophil petrolat external ointment Formulary OTC

MINIMED GUARDIAN LINK 3 Formulary

MINIMED PRO-SET INFUSION 42" Formulary

MINITRAN TRANSDERMAL PATCH 24 HOUR 0.1 MG/HR, 0.2 MG/HR, 0.4 MG/HR, 0.6 MG/HR

Formulary

minocycline hcl oral capsule 100 mg, 50 mg, 75 mg Formulary

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

minoxidil for women external solution 2 % Formulary OTC

minoxidil oral tablet 10 mg, 2.5 mg Formulary

MIRALAX ORAL PACKET 17 GM Formulary OTC

MIRALAX ORAL POWDER 17 GM/SCOOP Formulary OTC

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML, 200 MCG/0.3ML, 30 MCG/0.3ML

Formulary

MIRENA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE 20 MCG/24HR


mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg Formulary

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

misoprostol oral tablet 100 mcg, 200 mcg Formulary

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

Formulary

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

Formulary

M-M-R II SUBCUTANEOUS INJECTABLE Formulary AGE (Min 19 Years)

mn-50 oral capsule 16.67 mg Formulary OTC

MODERIBA ORAL TABLET 200 MG Formulary PA

moexipril hcl oral tablet 15 mg, 7.5 mg Formulary

moisture barrier external ointment , 0.44-20.6 % Formulary OTC

MOISTURE GUARD EXTERNAL CREAM 5 % Formulary OTC

MOISTUREL EXTERNAL LOTION 3 % Formulary OTC

moisturizing skin protectant external cream 8 % Formulary OTC

molybdenum oral capsule 30 mcg Formulary OTC

mometasone furoate external cream 0.1 % Formulary

mometasone furoate external ointment 0.1 % Formulary

mometasone furoate external solution 0.1 % Formulary

mometasone furoate nasal suspension 50 mcg/act Formulary QL (17 GM per 30 days)

MONOCAL ORAL TABLET 625-22.75 MG Formulary OTC

MONOJECT ALLERGIST TRAY KIT 28G X 1/2" 1 ML Formulary

MONOJECT BLUNTIP CANNULA 21G X 1" Formulary

MONOJECT HYPODERMIC NEEDLE 14G X 1-1/2" , 14G X 2" , 16G X 1" , 16G X 3/4" , 16G X 5/8" , 21G X 2" , 25G X 1-1/4" , 25G X 2" , 26G X 1-1/2" , 26G X 1/2" , 27G X 1-1/2" , 30G X 3/4"

Formulary

MONOJECT INSULIN SYRINGE 25G X 5/8" 1 ML 25G X 5/8" 1 ML

Formulary OTC

MONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML (OTC) 27G X 1/2" 1 ML

Formulary

94

Drug Name Formulary Status Requirements/LimitsMONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML (RX) 27G X 1/2" 1 ML

Formulary

MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML (OTC) 28G X 1/2" 0.5 ML

Formulary

MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML (RX) 28G X 1/2" 0.5 ML

Formulary


Formulary

MONOJECT INSULIN SYRINGE 28G X 1/2" 1 ML (RX) 28G X 1/2" 1 ML

Formulary

MONOJECT INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary


Formulary


Formulary


Formulary

MONOJECT INSULIN SYRINGE 30G X 5/16" 0.5 ML (RX) 30G X 5/16" 0.5 ML

Formulary


Formulary


Formulary

MONOJECT INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

MONOJECT INSULIN SYRINGE U-100 1 ML U-100 1 ML

Formulary

MONOJECT LIFESHIELD SYRINGE 18G X 1" 3 ML Formulary

MONOJECT MAGELLAN SAFETY NDL 21G X 5/8" , 23G X 5/8"

Formulary

MONOJECT MAGELLAN SYRINGE 20G X 1-1/2" 12 ML, 21G X 1" 12 ML, 21G X 1-1/2" 12 ML

Formulary

MONOJECT SYRINGE 18G X 1" 12 ML, 20G X 1-1/2" 6 ML, 20G X 3/4" 3 ML, 21G X 1-1/2" 6 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 0.5 ML (OTC) 28G X 1/2" 0.5 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 0.5 ML (RX) 28G X 1/2" 0.5 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 1 ML (OTC) 28G X 1/2" 1 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 1 ML (RX) 28G X 1/2" 1 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary

95

Drug Name Formulary Status Requirements/LimitsMONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" 0.3 ML (RX) 30G X 5/16" 0.3 ML

Formulary


Formulary

MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" 0.5 ML (RX) 30G X 5/16" 0.5 ML

Formulary


Formulary OTC


Formulary OTC

MONOLET LANCETS Formulary OTC; QL (150 EA per 30 days)

MONOLET OPD LANCETS Formulary OTC; QL (150 EA per 30 days)

MONONINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT

Formulary

MONOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 88 MG/4ML

Formulary PA

montelukast sodium oral packet 4 mg Formulary

montelukast sodium oral tablet 10 mg Formulary

montelukast sodium oral tablet chewable 4 mg, 5 mg Formulary

MORPHABOND ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 60 MG

Formulary PA

morphine sulfate (concentrate) oral solution 100 mg/5ml Formulary PA; QL (32 ML per 7 days)

morphine sulfate (pf) injection solution 0.5 mg/ml, 1 mg/ml Formulary

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

Formulary

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

Formulary PA

morphine sulfate er oral tablet extended release 100 mg Formulary PA; QL (34 EA per 34 days)


morphine sulfate er oral tablet extended release 200 mg Formulary PA; QL (15.3 EA per 34 days)



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

Formulary

morphine sulfate intravenous solution 1 mg/ml, 150 mg/30ml, 25 mg/ml, 4 mg/ml, 50 mg/ml, 8 mg/ml

Formulary

morphine sulfate oral solution 10 mg/5ml Formulary PA; QL (315 ML per 7 days)

morphine sulfate oral solution 20 mg/5ml Formulary PA; QL (158 ML per 7 days)

morphine sulfate oral tablet 15 mg Formulary PA; QL (42 EA per 7 days)

morphine sulfate oral tablet 30 mg Formulary PA; QL (21 EA per 7 days)

morphine sulfate rectal suppository 30 mg Formulary

MOTRIN INFANTS DROPS ORAL SUSPENSION 50 MG/1.25ML

Formulary OTC

mouth rinse mouth/throat liquid 0.07 % Formulary OTC

MOVANTIK ORAL TABLET 12.5 MG, 25 MG Formulary PA; AGE (Min 18 Years)

moxifloxacin hcl (2x day) ophthalmic solution 0.5 % Formulary

moxifloxacin hcl ophthalmic solution 0.5 % Formulary

96

Drug Name Formulary Status Requirements/Limitsmoxifloxacin hcl oral tablet 400 mg Formulary

MOZOBIL SUBCUTANEOUS SOLUTION 24 MG/1.2ML Formulary

ms insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC

ms insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC

ms insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC

MUCINEX COUGH CHILDRENS ORAL LIQUID 5-100 MG/5ML

Formulary OTC

MUCINEX COUGH FOR KIDS ORAL PACKET 5-100 MG

Formulary OTC

MUCINEX D MAX STRENGTH ORAL TABLET EXTENDED RELEASE 12 HOUR 120-1200 MG

Formulary OTC

MUCINEX D ORAL TABLET EXTENDED RELEASE 12 HOUR 60-600 MG

Formulary OTC

MUCINEX DM MAXIMUM STRENGTH ORAL TABLET EXTENDED RELEASE 12 HOUR 60-1200 MG

Formulary OTC

MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HOUR 30-600 MG

Formulary OTC

MUCINEX FAST-MAX COLD & SINUS ORAL LIQUID 10-650-400 MG/20ML

Formulary OTC

MUCINEX FAST-MAX COLD & SINUS ORAL TABLET 5-325-200 MG

Formulary OTC

MUCINEX FAST-MAX COLD FLU ORAL LIQUID 5-10-200-325 MG/10ML

Formulary OTC

MUCINEX FAST-MAX CONGEST COUGH ORAL LIQUID 2.5-5-100 MG/5ML

Formulary OTC

MUCINEX FAST-MAX CONGEST COUGH ORAL TABLET 5-10-200 MG

Formulary OTC

MUCINEX FAST-MAX DAY/NIGHT M/S ORAL (TABLET)

Formulary OTC

MUCINEX FAST-MAX DAY/NIGHT ORAL Formulary OTC

MUCINEX FAST-MAX DAY/NIGHT ORAL CAPSULE THERAPY PACK

Formulary OTC

MUCINEX FAST-MAX DAY/NIGHT TAB ORAL Formulary OTC

MUCINEX FAST-MAX ORAL CAPSULE 5-10-200-325 MG

Formulary OTC

MUCINEX FOR KIDS ORAL PACKET 100 MG Formulary OTC

MUCINEX MAXIMUM STRENGTH ORAL TABLET EXTENDED RELEASE 12 HOUR 1200 MG

Formulary OTC

MUCINEX ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG

Formulary OTC

MUCINEX SINUS-MAX CONGESTION ORAL TABLET 5-325-200 MG

Formulary OTC

MUCINEX SINUS-MAX DAY/NIGHT ORAL LIQUID Formulary OTC

MUCINEX SINUS-MAX DAY/NIGHT ORAL LIQUID THERAPY PACK

Formulary OTC

MUCINEX SINUS-MAX DAY/NIGHT ORAL TABLET THERAPY PACK 5-200-325 & 5- 12.5-325MG

Formulary OTC

MUCINEX SINUS-MAX PRESS & PAIN ORAL TABLET 5-325-200 MG

Formulary OTC

97

Drug Name Formulary Status Requirements/LimitsMUCINEX STUFFY NOSE/COLD CHILD ORAL LIQUID 2.5-100 MG/5ML

Formulary OTC

mucus congest & cough child oral liquid 2.5-5-100 mg/5ml Formulary OTC

mucus relief cold/sinus max st oral liquid 10-650-400 mg/20ml

Formulary OTC

mucus relief d oral tablet extended release 12 hour 60-600 mg

Formulary OTC

mucus relief er oral tablet extended release 12 hour 1200 mg

Formulary OTC

mucus relief pe oral tablet 10-400 mg Formulary OTC

mucus relief severe cong/cold oral tablet 5-10-200-325 mg Formulary OTC

mucus-dm max oral tablet extended release 12 hour 60-1200 mg

Formulary OTC

multi-delyn/iron oral liquid Formulary OTC

multi-draw needle 20g x 1" , 21g x 1" , 22g x 1" Formulary

MULTIGEN FOLIC ORAL TABLET 70-150-2-1 MG Formulary

MULTIGEN ORAL TABLET 70 MG Formulary

MULTIGEN PLUS ORAL TABLET 50-101-1 MG Formulary

multi-minerals oral tablet Formulary OTC

multi-purpose cold compress Formulary OTC

multi-symptom cold plus child oral liquid 2.5-5-100 mg/5ml Formulary OTC

multi-vit/fluoride oral solution 0.25 mg/ml Formulary

multivitamin gummies childrens oral tablet chewable Formulary OTC

multivitamin/fluoride oral solution 0.5 mg/ml Formulary

multivitamin/fluoride oral tablet chewable 0.25 mg, 1 mg Formulary

multivitamin/fluoride/iron oral solution 0.25-10 mg/ml Formulary

multivitamins/fluoride oral tablet chewable 0.5 mg Formulary

mupirocin external ointment 2 % Formulary

MURO 128 OPHTHALMIC OINTMENT 5 % Formulary OTC

MURO 128 OPHTHALMIC SOLUTION 2 %, 5 % Formulary OTC

muscle rub ultra strength external cream 4-10-30 % Formulary OTC

MUSTARGEN INJECTION SOLUTION RECONSTITUTED 10 MG

Formulary

M-VIT ORAL TABLET Formulary QL (34 EA per 34 days)

MYCOCIDE CX CALLUS EXFOLIATOR EXTERNAL CREAM 12-0.1 %

Formulary OTC

mycophenolate mofetil oral capsule 250 mg Formulary

mycophenolate mofetil oral suspension reconstituted 200 mg/ml

Formulary

mycophenolate mofetil oral tablet 500 mg Formulary

mycophenolate sodium oral tablet delayed release 180 mg, 360 mg

Formulary

MYGLUCOHEALTH LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

MYLANTA ORAL SUSPENSION 200-200-20 MG/5ML Formulary OTC

MYLERAN ORAL TABLET 2 MG Formulary

MYNATAL ORAL CAPSULE Formulary

98

Drug Name Formulary Status Requirements/Limitsmynate 90 plus oral tablet extended release Formulary

mynephrocaps oral capsule 1 mg Formulary

MYOBLOC INTRAMUSCULAR SOLUTION 10000 UNIT/2ML, 2500 UNIT/0.5ML, 5000 UNIT/ML

Formulary PA

MYORISAN ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG

Formulary

nabumetone oral tablet 500 mg, 750 mg Formulary

nac oral capsule 600 mg Formulary OTC

n-acetyl cysteine oral tablet 600 mg Formulary OTC

nadolol oral tablet 40 mg Formulary

NAIL SCRUB EXTERNAL LIQUID Formulary OTC

NAIL-EX ORAL TABLET 2.5 MG Formulary OTC

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

naloxone hcl injection solution 0.4 mg/ml, 4 mg/10ml Formulary

naloxone hcl injection solution cartridge 0.4 mg/ml Formulary

naloxone hcl injection solution prefilled syringe 2 mg/2ml Formulary

naltrexone hcl oral tablet 50 mg Formulary

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

Formulary

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR 14-10 MG

Formulary

NAPHCON-A OPHTHALMIC SOLUTION 0.025-0.3 % Formulary OTC

naproxen dr oral tablet delayed release 375 mg, 500 mg Formulary

naproxen oral suspension 125 mg/5ml Formulary

naproxen oral tablet 250 mg, 375 mg, 500 mg Formulary

naproxen sodium oral capsule 220 mg Formulary OTC

naratriptan hcl oral tablet 1 mg, 2.5 mg Formulary

NARCAN NASAL LIQUID 4 MG/0.1ML Formulary

NASACORT ALLERGY 24HR AEROSOL 55 MCG/ACT NASAL 55 MCG/ACT

Formulary OTC

NASACORT ALLERGY 24HR CHILDREN AEROSOL 55 MCG/ACT NASAL 55 MCG/ACT

Formulary OTC

nasal allergy 24 hour aerosol 55 mcg/act nasal 55 mcg/act Formulary OTC

nasal aspirator Formulary OTC

nasal decongestant oral liquid 30 mg/5ml Formulary OTC

nasal decongestant oral syrup 30 mg/5ml Formulary OTC

nasal decongestant spray nasal solution 0.05 % Formulary OTC

NASAL EASE ALLERGY RELIEVER NASAL POWDER Formulary OTC

nasal mist inhalation aerosol solution 0.9 % Formulary OTC

NASALCROM NASAL AEROSOL SOLUTION 5.2 MG/ACT

Formulary OTC

NASOGEL NASAL GEL Formulary OTC

NASONEB NEBULIZER STARTER Formulary OTC; QL (2 EA per 365 days)

NASOPEN PE ORAL LIQUID 50-10 MG/15ML Formulary OTC

NATACYN OPHTHALMIC SUSPENSION 5 % Formulary

nateglinide oral tablet 120 mg, 60 mg Formulary

99

Drug Name Formulary Status Requirements/LimitsNATELLE ONE ORAL CAPSULE 28-1-250 MG Formulary

NATROBA EXTERNAL SUSPENSION 0.9 % Formulary

natural fiber laxative oral powder 28.3 %, 30.9 % Formulary OTC

natural vitamin e moisturizing external gel Formulary OTC

natural vitamin e oral tablet 268 mg (400 unit) Formulary OTC

NATURAL WHEY ORAL POWDER Formulary OTC

NECON 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG Formulary QL (28 EA per 28 days)

neomycin sulfate oral tablet 500 mg Formulary

neomycin-bacitracin zn-polymyx ophthalmic ointment 5-400-10000

Formulary

neomycin-polymyxin b gu irrigation solution 40-200000 Formulary

neomycin-polymyxin-dexameth ophthalmic ointment 3.5-10000-0.1

Formulary

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

Formulary

neomycin-polymyxin-gramicidin ophthalmic solution 1.75-10000-.025

Formulary

neomycin-polymyxin-hc otic solution 3.5-10000-1 Formulary

neomycin-polymyxin-hc otic suspension 3.5-10000-1 Formulary

NEOSPORIN + PAIN RELIEF MAX ST EXTERNAL OINTMENT 1 %

Formulary OTC

NEOSPORIN ORIGINAL EXTERNAL OINTMENT 3.5-400-5000

Formulary OTC

NEOSPORIN PLUS MAX ST EXTERNAL OINTMENT 4 %

Formulary OTC

NEOSPORIN PLUS PAIN RELIEF MS EXTERNAL CREAM 3.5-10000-10

Formulary OTC

NEOSTRATA FACIAL CLEANSER EXTERNAL LIQUID 0.3 %

Formulary OTC

NEOTUSS-D ORAL LIQUID 7.5-30-200 MG/5ML Formulary OTC

NEPHRONEX ORAL LIQUID 0.9 MG/5ML Formulary OTC

NEPHRO-VITE ORAL TABLET 0.8 MG Formulary OTC

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG/0.6ML


NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6ML

Formulary PA

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

Formulary PA

NEURO-K-250 T.D. ORAL CAPSULE 250 MG Formulary OTC

neuromax external gel 20 % Formulary OTC

NEUROPEN KIT Formulary OTC

NEUROTIPS Formulary OTC

NEUTROGENA BODY EXTERNAL OIL Formulary OTC

NEUTROGENA CLEAR PORE EXTERNAL LIQUID 3.5 %

Formulary OTC

NEUTROGENA T/GEL EXTERNAL SHAMPOO 4 % Formulary OTC

NEUTROGENA T/GEL STUBBORN ITCH EXTERNAL SHAMPOO 0.5 %

Formulary OTC

100

Drug Name Formulary Status Requirements/Limitsnevirapine er oral tablet extended release 24 hour 100 mg, 400 mg

Formulary

nevirapine oral suspension 50 mg/5ml Formulary

nevirapine oral tablet 200 mg Formulary

NEW DIGNITY ODOR ELIMINATOR EXTERNAL SOLUTION

Formulary OTC

NEW SKIN EXTERNAL LIQUID 0.2 % Formulary OTC

new terocin external lotion 0.025-10-25 % Formulary OTC

NEXAFED ORAL TABLET ABUSE-DETERRENT 30 MG

Formulary OTC

NEXAFED SINUS PRESSURE + PAIN ORAL TABLET 30-325 MG

Formulary OTC

NEXAVAR ORAL TABLET 200 MG Formulary PA

NEXCARE PREMIUM ADHESIVE GAUZE PAD 3-1/2"X6" , 3-1/2"X8"

Formulary OTC

NEXIUM 24HR CAPSULE DELAYED RELEASE 20 MG ORAL 20 MG


NEXIUM 24HR TABLET DELAYED RELEASE 20 MG ORAL 20 MG


NEXPLANON SUBCUTANEOUS IMPLANT 68 MG Formulary

NEXT CHOICE ONE DOSE ORAL TABLET 1.5 MG Formulary OTC

niacin er (antihyperlipidemic) oral tablet extended release1000 mg, 500 mg, 750 mg

Formulary

niacin er oral capsule extended release 250 mg, 500 mg Formulary OTC

niacin er oral tablet extended release 1000 mg, 250 mg, 750 mg

Formulary OTC

niacin flush free oral capsule 400-100 mg, 500 mg Formulary OTC

niacin oral tablet 100 mg, 50 mg Formulary OTC

niacin oral tablet 500 mg Formulary

niacinamide oral tablet 100 mg, 500 mg Formulary OTC

nicardipine hcl in dextrose intravenous solution 25-5 mg/250ml-%

Formulary

nicardipine hcl intravenous solution 2.5 mg/ml Formulary

nicardipine hcl oral capsule 20 mg, 30 mg Formulary

NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 MG/24HR, 21 MG/24HR, 7 MG/24HR

Formulary OTC

NICORETTE MOUTH/THROAT GUM 2 MG, 4 MG Formulary OTC

NICORETTE MOUTH/THROAT LOZENGE 2 MG, 4 MG Formulary OTC

nicotine polacrilex mouth/throat gum 2 mg Formulary OTC

nicotine polacrilex mouth/throat lozenge 2 mg, 4 mg Formulary OTC

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



nicotine transdermal kit 21-14-7 mg/24hr Formulary OTC

NICOTROL INHALATION INHALER 10 MG Formulary

NIFEDICAL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG

Formulary

101

Drug Name Formulary Status Requirements/Limitsnifedipine er oral tablet extended release 24 hour 30 mg, 60 mg, 90 mg

Formulary

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

Formulary

nifedipine oral capsule 10 mg, 20 mg Formulary

nighttime cough oral liquid 12.5-30 mg/30ml Formulary OTC

nilutamide oral tablet 150 mg Formulary

nimodipine oral capsule 30 mg Formulary

NINJACOF ORAL LIQUID 12.5-12.5 MG/5ML Formulary OTC

NINJACOF-A ORAL LIQUID 12.5-12.5-160 MG/5ML Formulary OTC

NINJACOF-XG ORAL LIQUID 200-8 MG/5ML Formulary OTC

NIPENT INTRAVENOUS SOLUTION RECONSTITUTED 10 MG

Formulary

NISEKO SUNSCREEN SPF 25 EXTERNAL CREAM Formulary OTC

nisoldipine er oral tablet extended release 24 hour 17 mg, 25.5 mg, 34 mg, 8.5 mg

Formulary

NITEBITE ORAL BAR Formulary OTC

nite-time cold/flu relief oral liquid 5-6.25-15-500 mg/15ml Formulary OTC

NITRO-BID TRANSDERMAL OINTMENT 2 % Formulary

nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg Formulary

nitrofurantoin monohyd macro oral capsule 100 mg Formulary

nitrofurantoin oral suspension 25 mg/5ml Formulary

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

Formulary

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

Formulary

NIVANEX DMX ORAL TABLET 10-15-380 MG Formulary OTC

NIX CREME RINSE EXTERNAL LIQUID 1 % Formulary OTC

nizatidine oral capsule 150 mg, 300 mg Formulary

nizatidine oral solution 15 mg/ml Formulary

NIZORAL A-D EXTERNAL SHAMPOO 1 % Formulary OTC

NOBLE FORMULA EXTERNAL SHAMPOO 2 % Formulary OTC

NOBLE FORMULA HC EXTERNAL SOLUTION 1 % Formulary OTC

nohist-dm oral liquid 10-4-15 mg/5ml Formulary

nohist-lq oral liquid 4-10 mg/5ml Formulary OTC

NOKOR ADMIX NEEDLE 18G X 1-1/2" Formulary OTC

non-stick pad 2"x3" Formulary OTC

NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 10 MG/1.5ML SUBCUTANEOUS 10 MG/1.5ML

Formulary PA


Formulary PA

NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 30 MG/3ML SUBCUTANEOUS 30 MG/3ML

Formulary PA


Formulary PA

NOREL AD ORAL TABLET 4-10-325 MG Formulary OTC

102

Drug Name Formulary Status Requirements/LimitsNOREL CS ORAL LIQUID 10-4-12.5 MG/5ML Formulary OTC

norethin ace-eth estrad-fe oral tablet 1.5-30 mg-mcg Formulary

norethindrone acetate oral tablet 5 mg Formulary

norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg Formulary

norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 mg-35 mcg


NORMLSHIELD EXTERNAL CREAM 4.5 % Formulary OTC

nortemp infants oral suspension 80 mg/0.8ml Formulary OTC

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

NORVIR ORAL CAPSULE 100 MG Formulary

NORVIR ORAL PACKET 100 MG Formulary

NORVIR ORAL SOLUTION 80 MG/ML Formulary

nosebleed plugs/towelettes kit Formulary OTC

NO-STING SKIN-PREP EXTERNAL Formulary OTC

NOVA SUREFLEX LANCETS Formulary OTC; QL (150 EA per 30 days)

NOVAFERRUM 125 ORAL LIQUID 125-100 MG-UNT/5ML

Formulary OTC

NOVAFERRUM 50 ORAL CAPSULE 50 MG Formulary OTC

NOVAFERRUM PEDIATRIC DROPS ORAL LIQUID 15 MG/ML

Formulary OTC

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

Formulary OTC

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

Formulary OTC

NOVOLIN N FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNIT/ML

Formulary OTC

NOVOLIN N FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNIT/ML

Formulary OTC

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

Formulary

NOVOLOG FLEXPEN RELION SOLUTION PEN-INJECTOR 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

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

Formulary

NOVOLOG RELION SOLUTION 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

NOVOPEN ECHO DEVICE Formulary

NOXAFIL ORAL SUSPENSION 40 MG/ML Formulary

NOXICARE EXTERNAL CREAM Formulary OTC

NOZIN NASAL SANITIZER NASAL KIT 62 % Formulary OTC

np thyroid oral tablet 15 mg, 30 mg, 60 mg, 90 mg Formulary

NPLATE SUBCUTANEOUS SOLUTION RECONSTITUTED 250 MCG, 500 MCG

Formulary PA

NUEDEXTA ORAL CAPSULE 20-10 MG Formulary PA

NUFERA ORAL TABLET Formulary

NU-GEL EXTERNAL GEL Formulary OTC

103

Drug Name Formulary Status Requirements/LimitsNU-MAG ORAL TABLET DELAYED RELEASE 71.5-119 MG

Formulary OTC

NUPERCAINAL RECTAL OINTMENT 1 % Formulary OTC

NUTRATEAR OPHTHALMIC SOLUTION 0.6 % Formulary OTC

NUTR-E-SOL ORAL LIQUID 400 UNIT/15ML Formulary OTC

NUVESSA VAGINAL GEL 1.3 % Formulary

NYAMYC EXTERNAL POWDER 100000 UNIT/GM Formulary

NYMALIZE ORAL SOLUTION 30 MG/10ML, 60 MG/20ML

Formulary

nystatin external cream 100000 unit/gm Formulary

nystatin external ointment 100000 unit/gm Formulary

nystatin external powder 100000 unit/gm Formulary

nystatin mouth/throat suspension 100000 unit/ml Formulary

nystatin oral tablet 500000 unit Formulary

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

Formulary

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

Formulary

NYSTOP EXTERNAL POWDER 100000 UNIT/GM Formulary

NYTOL MAXIMUM STRENGTH ORAL TABLET 50 MG

Formulary OTC

OASIS MOISTURIZING MOUTHWASH MOUTH/THROAT LIQUID

Formulary OTC

OBSTETRIX DHA ORAL 29-1 & 387 MG Formulary

OBSTETRIX EC ORAL TABLET 29-1 MG Formulary

OC8 EXTERNAL GEL 7 % Formulary OTC

OCEAN BLUE MINICAPS D/OMEGA3 ORAL CAPSULE 350-1000 MG-UNIT

Formulary OTC

OCEAN BLUE MINICAPS OMEGA-3 ORAL CAPSULE 350 MG

Formulary OTC

OCEAN BLUE OPTIMAL HEALTH ORAL CAPSULE 250 MG

Formulary OTC

OCEAN COMPLETE SINUS RINSE NASAL AEROSOL SOLUTION

Formulary OTC

OCEAN NASAL SPRAY NASAL SOLUTION 0.65 % Formulary OTC

oceanic selenium oral tablet 50 mcg Formulary OTC

OCUSOFT LID SCRUB COMPLIANCE KIT Formulary OTC

ODEFSEY ORAL TABLET 200-25-25 MG Formulary

ODOR EATERS ANTIFUNGAL EXTERNAL POWDER 1 %

Formulary OTC

odor spray liquid Formulary OTC

OFF ACTIVE EXTERNAL AEROSOL 15 % Formulary OTC

OFF FAMILYCARE CLEAN FEEL EXTERNAL LIQUID 5 %

Formulary OTC

ofloxacin ophthalmic solution 0.3 % Formulary

ofloxacin oral tablet 400 mg Formulary QL (68 EA per 34 days)

ofloxacin otic solution 0.3 % Formulary

104

Drug Name Formulary Status Requirements/LimitsOGESTREL ORAL TABLET 0.5-50 MG-MCG Formulary

olanzapine intramuscular solution reconstituted 10 mg Formulary AGE (Min 18 Years)

olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg


olanzapine oral tablet dispersible 10 mg, 15 mg, 20 mg, 5 mg


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

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

Formulary

olopatadine hcl nasal solution 0.6 % Formulary

olopatadine hcl ophthalmic solution 0.1 %, 0.2 % Formulary

omega dha oral tablet chewable Formulary OTC

OMEGA POWER ORAL CAPSULE 1050 MG Formulary OTC

omega-3 fish oil ex st oral capsule 880 mg Formulary OTC

omega-3 fish oil oral capsule 300 mg Formulary OTC

omega-3 fish oil-vitamin d3 oral capsule 1200-1000 mg-unit

Formulary OTC

OMEGA-3 IQ ORAL TABLET CHEWABLE 240 MG Formulary OTC

omega-3 oral capsule 1400 mg Formulary OTC

omega-3-acid ethyl esters oral capsule 1 gm Formulary PA

omeprazole magnesium oral capsule delayed release 20.6 (20 base) mg

Formulary OTC

omeprazole magnesium oral tablet delayed release 20 mg Formulary OTC

omeprazole oral capsule delayed release 10 mg, 20 mg, 40 mg

Formulary

omeprazole oral tablet delayed release 20 mg Formulary OTC

omeprazole-sodium bicarbonate capsule 20-1100 mg oral (otc) 20-1100 mg


OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM Formulary

ONCASPAR INJECTION SOLUTION 750 UNIT/ML Formulary

ondansetron hcl oral solution 4 mg/5ml Formulary QL (150 ML per 30 days)

ondansetron hcl oral tablet 24 mg Formulary QL (1 EA per 30 days)

ondansetron hcl oral tablet 4 mg, 8 mg Formulary QL (15 EA per 34 days)

ondansetron oral tablet dispersible 4 mg, 8 mg Formulary QL (15 EA per 34 days)

one step pregnancy in vitro diagnostic test Formulary OTC

ONE-A-DAY ADULT VITACRAVES+DHA ORAL TABLET CHEWABLE

Formulary OTC

ONE-A-DAY WOMENS 50+ ADVANTAGE ORAL TABLET

Formulary OTC

ONETOUCH DELICA LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

ONETOUCH DELICA LANCETS 33G Formulary OTC; QL (150 EA per 30 days)

ONETOUCH FINEPOINT LANCETS Formulary OTC; QL (150 EA per 30 days)

ONETOUCH PING METER REMOTE SUPPLIES Formulary OTC

ONETOUCH ULTRASOFT LANCETS Formulary OTC; QL (150 EA per 30 days)

ONEXTON EXTERNAL GEL 1.2-3.75 % Formulary AGE (Max 19 Years)

opium oral tincture 10 mg/ml (1%) Formulary

105

Drug Name Formulary Status Requirements/LimitsOPSUMIT ORAL TABLET 10 MG Formulary PA

OPTIONS CONCEPTROL VAGINAL GEL 4 % Formulary OTC

OPTIONS GYNOL II CONTRACEPTIVE VAGINAL GEL 3 %

Formulary OTC

OPTIUM BLOOD GLUCOSE MONITOR KIT W/DEVICE W/DEVICE


OPTIUM GLUCOSE MONITOR SYSTEM DEVICE Formulary OTC; QL (150 EA per 30 days)

OPTIUM TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

OPTIUMEZ TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

ORA-FILM MOUTH/THROAT STRIP 6 % Formulary OTC

ORAJEL DENTURE MOUTH/THROAT GEL 10 % Formulary OTC

oral analgesic max st mouth/throat gel 20 % Formulary OTC

oral anesthetic mouth/throat paste 20 % Formulary OTC

oral electrolytes oral solution Formulary OTC

ORAL SWAB PETITE MOUTH/THROAT SWAB Formulary OTC

oral syringe bottle adapter Formulary OTC

ORALONE MOUTH/THROAT PASTE 0.1 % Formulary

ORAMAGIC PLUS MOUTH/THROAT SUSPENSION RECONSTITUTED 10 %

Formulary OTC

ORAZINC ORAL CAPSULE 220 (50 ZN) MG Formulary OTC

ORAZINC ORAL TABLET 110 MG Formulary OTC

ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG Formulary

ORILISSA ORAL TABLET 150 MG, 200 MG Formulary PA

ornithine oral capsule 500 mg Formulary OTC

orphenadrine citrate er oral tablet extended release 12 hour100 mg

Formulary

orphenadrine citrate injection solution 30 mg/ml Formulary

ORTHOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 30 MG/2ML

Formulary PA

OS-CAL EXTRA D3 ORAL TABLET 500-600 MG-UNIT Formulary OTC

OS-CAL ORAL TABLET CHEWABLE 500-600 MG-UNIT

Formulary OTC

OS-CAL ULTRA ORAL TABLET 600 MG Formulary OTC

oseltamivir phosphate oral capsule 30 mg, 45 mg, 75 mg Formulary

oseltamivir phosphate oral suspension reconstituted 6 mg/ml

Formulary

OSTEO-PORETICAL ORAL TABLET 600-1000 MG-UNIT

Formulary OTC

ostomy protective powder Formulary OTC

OUTGRO PAIN RELIEF EXTERNAL LIQUID 20 % Formulary OTC

ovulation predictor in vitro kit Formulary OTC

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

oxaliplatin intravenous solution reconstituted 100 mg Formulary

oxandrolone oral tablet 10 mg, 2.5 mg Formulary

oxaprozin oral tablet 600 mg Formulary

oxazepam oral capsule 10 mg, 15 mg, 30 mg Formulary QL (136 EA per 34 days)

106

Drug Name Formulary Status Requirements/Limitsoxcarbazepine oral tablet 150 mg, 300 mg, 600 mg Formulary

oxybutynin chloride er oral tablet extended release 24 hour10 mg, 15 mg

Formulary

oxybutynin chloride er oral tablet extended release 24 hour5 mg


oxybutynin chloride oral syrup 5 mg/5ml Formulary

oxybutynin chloride oral tablet 5 mg Formulary

oxycodone hcl er oral tablet er 12 hour abuse-deterrent 10 mg, 20 mg, 40 mg


oxycodone hcl er oral tablet er 12 hour abuse-deterrent 15 mg, 30 mg, 60 mg, 80 mg


oxycodone hcl oral capsule 5 mg Formulary PA; QL (84 EA per 7 days)

oxycodone hcl oral concentrate 10 mg/0.5ml, 100 mg/5ml Formulary PA

oxycodone hcl oral solution 5 mg/5ml Formulary PA; QL (420 ML per 7 days)

oxycodone hcl oral tablet 10 mg Formulary PA; QL (42 EA per 7 days)





oxycodone-acetaminophen oral tablet 10-325 mg Formulary PA; QL (42 EA per 7 days)

oxycodone-acetaminophen oral tablet 2.5-325 mg Formulary PA; QL (168 EA per 7 days)

oxycodone-acetaminophen oral tablet 5-325 mg Formulary PA; QL (84 EA per 7 days)

oxycodone-acetaminophen oral tablet 7.5-325 mg Formulary PA; QL (56 EA per 7 days)

oxycodone-ibuprofen oral tablet 5-400 mg Formulary PA

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 10 MG, 20 MG, 40 MG


OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 15 MG, 30 MG, 60 MG, 80 MG


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


oxymorphone hcl er oral tablet extended release 12 hour 30 mg


oxymorphone hcl er oral tablet extended release 12 hour 40 mg


oxymorphone hcl oral tablet 10 mg Formulary PA; QL (90 EA per 30 days)

oxymorphone hcl oral tablet 5 mg Formulary PA; QL (180 EA per 30 days)

OXYTROL FOR WOMEN TRANSDERMAL PATCH TWICE WEEKLY 3.9 MG/24HR

Formulary OTC

OXYZAL WET DRESSING EXTERNAL SOLUTION 1:2000

Formulary OTC

oyster calcium + d oral tablet 250-125 mg-unit Formulary OTC

oyster calcium/d3 oral tablet 500-200 mg-unit Formulary OTC

oyster shell calcium 250+d oral tablet 250-125 mg-unit Formulary OTC

oyster shell calcium 500 + d oral tablet 500-125 mg-unit Formulary OTC

oyster shell calcium 500+d oral tablet chewable 500-400 mg-unit

Formulary OTC

oyster shell calcium oral tablet 500-400 mg-unit Formulary OTC

107

Drug Name Formulary Status Requirements/Limitsoyster shell calcium plus d oral tablet 500-125 mg-unit Formulary OTC

oyster shell calcium w/d oral tablet 500-200 mg-unit Formulary OTC

oyster shell calcium/d oral tablet 250-250 mg-unit, 500-200 mg-unit

Formulary OTC

oyster shell calcium/d3 oral tablet 500-400 mg-unit Formulary OTC

P & S EXTERNAL LIQUID Formulary OTC

P & S EXTERNAL SHAMPOO 2 % Formulary OTC

p-1000 oral capsule 500 mg Formulary OTC

PA CLA ORAL CAPSULE 1000 MG Formulary OTC

pa fish oil/vit d3 triple st oral capsule delayed release 900-1000 mg-unit

Formulary OTC

pa glucosamine-chondroitin oral capsule 166.7-133.3 mg Formulary OTC

pa prenatal formula oral tablet 9-0.5 mg Formulary OTC

pa probiotic complex oral tablet Formulary OTC

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

Formulary

pain & fever childrens oral tablet chewable 160 mg Formulary OTC

pain relief day & night ex st oral 25-500 & 500 mg Formulary OTC

pain relief oral tablet Formulary OTC

pain relief roll-on external liquid 4 % Formulary OTC

pain reliever extra strength oral tablet 500 mg Formulary OTC

pain reliever pm ex st oral tablet 25-500 mg Formulary OTC

pain reliever pm oral tablet 25-500 mg Formulary OTC

pain reliever/fever reducer rectal suppository 120 mg Formulary OTC

pain relieving + lidocaine cream 4 % external 4 % Formulary OTC

pain relieving external gel 3.5 % Formulary OTC

PALADIN EXTERNAL OINTMENT Formulary OTC

pamidronate disodium intravenous solution 30 mg/10ml, 6 mg/ml, 90 mg/10ml

Formulary PA

pamidronate disodium intravenous solution reconstituted 30 mg, 90 mg

Formulary PA

pancreatin oral tablet 325 mg Formulary OTC

PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 4200-14200 UNIT

Formulary

PANOXYL EXTERNAL LIQUID 2.5 % Formulary OTC

PANOXYL WASH EXTERNAL LIQUID 10 % Formulary OTC; AGE (Max 18 Years)

PANOXYL-4 CREAMY WASH EXTERNAL LIQUID 4 %

Formulary OTC; AGE (Max 18 Years)

panto-250 oral capsule 250 mg Formulary OTC

pantoprazole sodium oral packet 40 mg Formulary

pantoprazole sodium oral tablet delayed release 20 mg, 40 mg

Formulary

pantothenic acid oral tablet 500 mg Formulary OTC

papaya and enzymes oral tablet chewable Formulary OTC

papaya enzyme oral tablet chewable Formulary OTC

papaya oral tablet Formulary OTC

108

Drug Name Formulary Status Requirements/Limitspapaya oral tablet chewable Formulary OTC

papaya/pineapple enzymes oral tablet chewable Formulary OTC

PARAGARD INTRAUTERINE COPPER INTRAUTERINE INTRAUTERINE DEVICE

Formulary

paricalcitol intravenous solution 2 mcg/ml, 5 mcg/ml Formulary PA

paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg Formulary PA

PARODONTAX MOUTH/THROAT PASTE 0.454 % Formulary OTC

paromomycin sulfate oral capsule 250 mg Formulary

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


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

parvenzyme digestive enzyme oral tablet Formulary OTC

PATADAY SOLUTION 0.1 % OPHTHALMIC 0.1 % Formulary OTC

PAZEO OPHTHALMIC SOLUTION 0.7 % Formulary

pc lancets super thin 30g Formulary OTC; QL (150 EA per 30 days)

PECGEN DMX ORAL LIQUID 10-187 MG/5ML, 15-125 MG/5ML

Formulary OTC

pedia relief cough/cold oral liquid 15-1-5 mg/5ml Formulary OTC

PEDIACARE CHILDRENS LONG-ACT ORAL LIQUID 7.5 MG/5ML

Formulary OTC

PEDIACARE CHILDRENS MULTI-SYMP ORAL LIQUID 2.5-5 MG/5ML

Formulary OTC

PEDIACARE MULTI-SYMPTOM ORAL LIQUID 2.5-1-5-160 MG/5ML

Formulary OTC

PEDIACLEAR PD CHILDRENS ORAL LIQUID 0.625 MG/ML

Formulary OTC

PEDIA-LAX FIBER GUMMIES ORAL TABLET CHEWABLE

Formulary OTC

PEDIA-LAX ORAL LIQUID 50 MG/15ML Formulary OTC

PEDIA-LAX ORAL TABLET CHEWABLE 400 MG Formulary OTC

PEDIA-LAX RECTAL SUPPOSITORY 1 GM, 2.8 GM Formulary OTC

PEDIALYTE ADVANCED CARE ORAL SOLUTION Formulary OTC

PEDIARIX INTRAMUSCULAR SUSPENSION Formulary

PEDIAVENT ORAL SYRUP 2 MG/5ML Formulary OTC

PEDIAVENT ORAL TABLET CHEWABLE 1 MG Formulary OTC

PEDIAVIT ORAL LIQUID Formulary OTC

PEDVAX HIB INTRAMUSCULAR SUSPENSION 7.5 MCG/0.5ML


PEGANONE ORAL TABLET 250 MG Formulary

PEG-INTRON REDIPEN PAK 4 SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML

Formulary

PEG-INTRON REDIPEN SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML

Formulary

PEGINTRON SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML

Formulary

109

Drug Name Formulary Status Requirements/LimitsPEG-INTRON SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML

Formulary

penicillamine oral tablet 250 mg Formulary PA

penicillin g potassium injection solution reconstituted20000000 unit, 5000000 unit

Formulary

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

Formulary

penicillin v potassium oral tablet 250 mg, 500 mg Formulary

PENTACEL INTRAMUSCULAR SUSPENSION RECONSTITUTED

Formulary

pentamidine isethionate inhalation solution reconstituted300 mg

Formulary

PENTASA ORAL CAPSULE EXTENDED RELEASE 250 MG, 500 MG

Formulary

pentoxifylline er oral tablet extended release 400 mg Formulary

PENTRAX GOLD EXTERNAL SHAMPOO 4 % Formulary OTC

PEPCID AC MAXIMUM STRENGTH ORAL TABLET 20 MG

Formulary OTC

PEPCID AC ORAL TABLET 10 MG Formulary OTC

PEPTO-BISMOL MAX STRENGTH ORAL SUSPENSION 525 MG/15ML

Formulary OTC

PEPTO-BISMOL ORAL SUSPENSION 262 MG/15ML Formulary OTC

PEPTO-BISMOL ORAL TABLET 262 MG Formulary OTC

PEPTO-BISMOL TO-GO ORAL TABLET CHEWABLE 262 MG

Formulary OTC

PERFORM ATOMIC HEAT EXTERNAL CREAM 0.034-10 %

Formulary OTC

PERFORM ATOMIC HEAT EXTERNAL LIQUID 0.034-10 %

Formulary OTC

PERFORM PAIN RELIEVING EXTERNAL LIQUID 10.4 %

Formulary OTC

PERFORM PAIN RELIEVING ROLL-ON EXTERNAL LIQUID 3.1 %

Formulary OTC

PERIDIN-C ORAL TABLET 200-50-150 MG Formulary OTC

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

PERIOMED MOUTH/THROAT CONCENTRATE 0.63 % Formulary OTC

permethrin external cream 5 % Formulary

PERNOX EXTERNAL LOTION 1.5-2 % Formulary OTC

PEROXYL EXTERNAL SOLUTION 1.5-6 % Formulary OTC

PEROXYL MOUTH/THROAT SOLUTION 1.5 % Formulary OTC

PEROXYL SPOT TREATMENT MOUTH/THROAT GEL 1.5 %

Formulary OTC

perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg Formulary AGE (Min 18 Years)

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


PERRY PRENATAL ORAL CAPSULE 13.5-0.4 MG Formulary OTC

petroleum jelly external aerosol Formulary OTC

petroleum jelly external ointment Formulary OTC

110

Drug Name Formulary Status Requirements/LimitsPHARMABASE BARRIER EXTERNAL OINTMENT 9.38 %

Formulary OTC

PHARMACY COUNTER LANCETS Formulary OTC; QL (150 EA per 30 days)

PHAZYME GAS & ACID MAX ST ORAL TABLET CHEWABLE 750-250 MG

Formulary OTC

PHAZYME MAXIMUM STRENGTH ORAL CAPSULE 250 MG

Formulary OTC

PHAZYME ULTRA STRENGTH ORAL CAPSULE 180 MG

Formulary OTC

PHENADOZ RECTAL SUPPOSITORY 12.5 MG, 25 MG Formulary AGE (Min 2 Years)

PHENAZO ORAL TABLET 200 MG Formulary

phenazopyridine hcl oral tablet 100 mg Formulary

phenazopyridine hcl oral tablet 95 mg Formulary OTC

phenelzine sulfate oral tablet 15 mg Formulary

phenobarbital oral elixir 20 mg/5ml Formulary

phenobarbital oral solution 20 mg/5ml Formulary

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

Formulary

phenol external liquid Formulary OTC

PHENOL EZ SWABS EXTERNAL SWAB 89 % Formulary OTC

phenoxybenzamine hcl oral capsule 10 mg Formulary

phentermine hcl oral capsule 15 mg, 30 mg, 37.5 mg Formulary PA

phentermine hcl oral tablet 37.5 mg Formulary PA

phenylalanine oral packet 50 mg Formulary OTC

phenylephrine hcl oral tablet 10 mg Formulary OTC

phenylephrine-dm-gg oral liquid 10-18-200 mg/15ml Formulary OTC

PHENYTOIN INFATABS ORAL TABLET CHEWABLE 50 MG

Formulary

phenytoin oral suspension 100 mg/4ml, 125 mg/5ml Formulary

phenytoin oral tablet chewable 50 mg Formulary

phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg

Formulary

phenytoin sodium injection solution 50 mg/ml Formulary

PHLEXY-10 ORAL TABLET Formulary OTC

PHOS-FLUR ORTHO DEFENSE MOUTH/THROAT SOLUTION 0.044 %

Formulary OTC

phos-nak oral packet 280-160-250 mg Formulary OTC

phosphatidyl choline oral tablet 65 mg Formulary OTC

PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION RECONSTITUTED 0.125 %

Formulary

PHOTOFRIN INTRAVENOUS SOLUTION RECONSTITUTED 75 MG

Formulary

phytonadione oral tablet 5 mg Formulary

PHYTOPLEX Z-GUARD EXTERNAL PASTE 57-17 % Formulary OTC

PIFELTRO ORAL TABLET 100 MG Formulary

pilocarpine hcl oral tablet 5 mg, 7.5 mg Formulary

111

Drug Name Formulary Status Requirements/Limitspimecrolimus external cream 1 % Formulary PA; AGE (Min 2 Years)

pindolol oral tablet 10 mg, 5 mg Formulary

pinworm medicine oral suspension 144 (50 base) mg/ml Formulary OTC

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

pioglitazone hcl-glimepiride oral tablet 30-2 mg, 30-4 mg Formulary ST; QL (34 EA per 34 days)

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

Formulary

piroxicam oral capsule 10 mg, 20 mg Formulary

PLAN B ONE-STEP ORAL TABLET 1.5 MG Formulary OTC; QL (2 EA per 34 days)

PLIAGEL GEL 0.5-0.5-0.25 % Formulary OTC

PLO ULTRAMAX EXTERNAL GEL Formulary OTC

PNEUMOVAX 23 INJECTION INJECTABLE 25 MCG/0.5ML


pnv-dha oral capsule 27-0.6-0.4-300 mg Formulary

pnv-dha+docusate oral capsule 27-1.25-300 mg Formulary

pnv-omega oral capsule 28-0.6-0.4-340 mg Formulary

pnv-select oral tablet 27-0.6-0.4 mg Formulary

podofilox external solution 0.5 % Formulary

poison ivy wash fast acting external Formulary OTC

POLAR FREEZE EXTERNAL GEL 3.5-0.8 % Formulary OTC

POLAR FROST EXTERNAL GEL 4 % Formulary OTC

poly bacitracin external ointment 500-10000 unit/gm Formulary OTC

POLY HIST FORTE ORAL TABLET 7.5-10 MG Formulary OTC

polyethylene glycol 3350 oral packet 17 gm Formulary

poly-hist dm oral liquid 5-25-10 mg/5ml Formulary OTC

poly-hist pd oral liquid 6.25-6.25 mg/ml Formulary OTC

poly-iron 150 forte oral capsule 150-25-1 mg-mcg-mg Formulary

polymyxin b-trimethoprim ophthalmic solution 10000-0.1 unit/ml-%

Formulary

POLYSPORIN EXTERNAL OINTMENT 500-10000 UNIT/GM

Formulary OTC

poly-tussin ac oral liquid 10-4-10 mg/5ml Formulary OTC

POLY-VENT DM ORAL TABLET 60-20-380 MG Formulary OTC

POLY-VENT IR ORAL TABLET 60-380 MG Formulary OTC

POLY-VI-SOL ORAL SOLUTION Formulary OTC

POLY-VI-SOL/IRON ORAL SOLUTION Formulary OTC

potassimin oral tablet 75 mg Formulary OTC

potassium chloride crys er oral tablet extended release 10 meq, 15 meq, 20 meq

Formulary

potassium chloride oral solution 20 meq/15ml (10%), 40 meq/15ml (20%)

Formulary

potassium citrate er oral tablet extended release 10 meq (1080 mg), 5 meq (540 mg)

Formulary

potassium citrate-citric acid oral solution 1100-334 mg/5ml Formulary

potassium gluconate oral tablet 2 meq, 2.5 meq, 595 (99 k) mg

Formulary OTC

112

Drug Name Formulary Status Requirements/Limitspotassium iodide (antidote) oral solution 65 mg/ml Formulary OTC

povidone-iodine external ointment 10 % Formulary OTC

povidone-iodine external solution 10 % Formulary OTC

povidone-iodine external swab 7.5 % Formulary OTC

povidone-iodine paint sponge external swab 10 % Formulary OTC

povidone-iodine prep external pad 10 % Formulary OTC

povidone-iodine scrub sponge external 10 % Formulary OTC

power oral care system mouth/throat kit Formulary OTC

PR NATAL 400 EC ORAL 29-1-200 & 400 MG (DR) Formulary

PR NATAL 400 ORAL 29-1-200 & 400 MG Formulary

PR NATAL 430 EC ORAL 29-1-200 & 430 MG (DR) Formulary

PR NATAL 430 ORAL 29-1-200 & 430 MG Formulary

PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG Formulary

PRALUENT SOLUTION AUTO-INJECTOR 150 MG/ML SUBCUTANEOUS 150 MG/ML

Formulary PA

PRALUENT SOLUTION AUTO-INJECTOR 75 MG/ML SUBCUTANEOUS 75 MG/ML

Formulary PA

PRALUENT SUBCUTANEOUS SOLUTION PEN-INJECTOR 150 MG/ML, 75 MG/ML

Formulary PA

PRAMEGEL EXTERNAL GEL 1 % Formulary OTC

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

Formulary

PRAMOX EXTERNAL GEL 1 % Formulary

pramoxine hcl rectal foam 1 % Formulary OTC

prasugrel hcl oral tablet 10 mg, 5 mg Formulary

pravastatin sodium oral tablet 10 mg, 20 mg, 40 mg, 80 mg Formulary

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

PRECISION GLUCOSE CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days)

PRECISION GLUCOSE CONTROL SOLN SOLUTION IN VITRO


PRECISION GLUCOSE KETONE CONTR LIQUID IN VITRO


PRECISION GLUCOSE/KETONE CONTR LIQUID IN VITRO


PRECISION LINK KIT Formulary OTC; QL (1 EA per 365 days)

PRECISION PCX PLUS TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION PCX STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION POINT OF CARE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION QID MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

PRECISION QID MONITOR DEVICE Formulary OTC; QL (150 EA per 30 days)

PRECISION QID TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION SOF-TACT MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

PRECISION SOF-TACT TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION SUREDOSE PLUS SYR 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC

113

Drug Name Formulary Status Requirements/LimitsPRECISION SUREDOSE PLUS SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

PRECISION SURE-DOSE SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

PRECISION SURE-DOSE SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

PRECISION THINS GP LANCETS Formulary OTC; QL (150 EA per 30 days)

PRECISION XTRA BLOOD GLUCOSE STRIP IN VITRO


PRECISION XTRA DEVICE Formulary OTC; QL (1 EA per 365 days)

PRECISION XTRA DEVICE Formulary OTC; QL (150 EA per 30 days)

PRECISION XTRA KETONE STRIP IN VITRO Formulary OTC; QL (100 EA per 30 days)

PRECISION XTRA KIT Formulary OTC; QL (1 EA per 365 days)

PRECISION XTRA MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

PRED MILD OPHTHALMIC SUSPENSION 0.12 % Formulary

prednicarbate external cream 0.1 % Formulary

prednicarbate external ointment 0.1 % Formulary

prednisolone acetate ophthalmic suspension 1 % Formulary

prednisolone oral solution 15 mg/5ml Formulary

prednisolone sodium phosphate oral solution 15 mg/5ml, 20 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml

Formulary

PREDNISONE INTENSOL ORAL CONCENTRATE 5 MG/ML

Formulary

prednisone oral solution 5 mg/5ml Formulary

prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg

Formulary

prednisone oral tablet therapy pack 10 mg (21), 10 mg (48), 5 mg (21), 5 mg (48)

Formulary

preferred plus insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml

Formulary OTC

preferred plus insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

preferred plus lancets colored Formulary OTC; QL (150 EA per 30 days)

114

Drug Name Formulary Status Requirements/Limitspreferred plus lancets thin Formulary OTC; QL (150 EA per 30 days)

pregabalin oral capsule 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 300 mg, 50 mg, 75 mg

Formulary

PREGNITUDE ORAL PACKET 2000-200 MG-MCG Formulary OTC

PREMARIN VAGINAL CREAM 0.625 MG/GM Formulary

PREMIER UROSTOMY POUCH Formulary OTC

PREMPHASE ORAL TABLET 0.625-5 MG Formulary

PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG

Formulary

prenatal (w/iron & fa) oral tablet 27-0.8 mg Formulary OTC

prenatal 19 oral tablet Formulary OTC

prenatal 19 oral tablet 29-1 mg Formulary

prenatal dha oral capsule 200 mg Formulary OTC

prenatal formula a-free oral tablet 9-0.267 mg Formulary OTC

prenatal formula oral capsule 28-0.8-235 mg Formulary OTC

prenatal low iron oral tablet 27-0.8 mg Formulary OTC

prenatal multi +dha oral capsule 27-0.8-200 mg Formulary OTC

prenatal multivitamin plus dha oral capsule 27-0.8-250 mg Formulary OTC

prenatal oral tablet 27-0.8 mg Formulary

prenatal oral tablet 28-0.8 mg, 6.75-0.2 mg Formulary OTC

PRENATAL-U ORAL CAPSULE 106.5-1 MG Formulary

PRENATE ORAL TABLET CHEWABLE 0.6-0.4 MG Formulary

prep protective skin barrier external pad 0.5 % Formulary OTC

PREPARATION H RECTAL CREAM 1-0.25-14.4-15 %, 5-14.4 %

Formulary OTC

PREPARATION H RECTAL GEL 0.25-50 % Formulary OTC

PREPARATION H RECTAL OINTMENT 0.25-14-74.9 % Formulary OTC

PREPARATION H TOTABLES RECTAL CREAM 1-0.25-14.4-15 %

Formulary OTC

pres gen pediatric oral liquid 2.5-5-75 mg/5ml Formulary OTC

PRESGEN B ORAL LIQUID 10-4-20 MG/5ML Formulary OTC

PRETZ NASAL SOLUTION Formulary OTC

PREVACARE ANTIMICROBIAL EXTERNAL GEL 60 %

Formulary OTC

PREVACARE EXTRA PROTECTIVE EXTERNAL OINTMENT

Formulary OTC

PREVACARE PERSONAL PROTECT EXTERNAL CREAM

Formulary OTC

PREVACARE TOTAL SKIN CARE EXTERNAL SOLUTION

Formulary OTC

PREVACID 24HR ORAL CAPSULE DELAYED RELEASE 15 MG

Formulary OTC

PREVIDENT MOUTH/THROAT SOLUTION 0.2 % Formulary

PREVNAR 13 INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years)

PREVNAR 20 INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

Formulary

115

Drug Name Formulary Status Requirements/LimitsPREZISTA ORAL SUSPENSION 100 MG/ML Formulary

PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG

Formulary

PRIFTIN ORAL TABLET 150 MG Formulary

PRILOSEC OTC ORAL TABLET DELAYED RELEASE 20 MG

Formulary OTC

PRIMATENE ASTHMA ORAL TABLET 12.5-200 MG Formulary OTC

primidone oral tablet 250 mg, 50 mg Formulary

PRO NUTRIENTS OMEGA 3 ORAL CAPSULE DELAYED RELEASE 332.5 MG

Formulary OTC

PROAIR HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT

Formulary

probenecid oral tablet 500 mg Formulary

PROBIOMAX PLUS DF ORAL PACKET Formulary OTC

probiotic digestive support oral capsule Formulary OTC

probiotic oral capsule 250 mg Formulary OTC

probiotic oral tablet delayed release Formulary OTC

probiotic-prebiotic oral capsule 1-250 billion-mg Formulary OTC

PROCARE PLUS UNDERWEAR MEDIUM Formulary OTC

PRO-CEPTION VAGINAL KIT Formulary OTC

prochlorperazine maleate oral tablet 10 mg, 5 mg Formulary

prochlorperazine rectal suppository 25 mg Formulary

PROCOMYCIN EXTERNAL CREAM 4 % Formulary OTC

PROCTOFOAM RECTAL FOAM 1 % Formulary OTC

PROCTOSOL HC RECTAL CREAM 2.5 % Formulary

PRODIGY INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC

PRODIGY INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

PRODIGY INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

PRODIGY NO CODING BLOOD GLUC STRIP IN VITRO

Formulary PA; OTC; QL (150 EA per 30 days)

PRODIGY TWIST TOP LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

PROFE ORAL CAPSULE 391.3 (180 FE) MG Formulary OTC

PROFERRIN ES ORAL TABLET 12 MG Formulary OTC

PROFERRIN-FORTE ORAL TABLET 12-1 MG Formulary OTC

PROFILNINE SD INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT

Formulary

progesterone intramuscular oil 50 mg/ml Formulary

progesterone micronized oral capsule 100 mg, 200 mg Formulary

progesterone oral capsule 100 mg, 200 mg Formulary

PROLENSA OPHTHALMIC SOLUTION 0.07 % Formulary

PROLIDA EXTERNAL PATCH 4-1 % Formulary OTC

PROMACTA ORAL TABLET 12.5 MG Formulary PA; QL (240 EA per 30 days)

PROMACTA ORAL TABLET 25 MG Formulary PA; QL (120 EA per 30 days)

116

Drug Name Formulary Status Requirements/LimitsPROMACTA ORAL TABLET 50 MG Formulary PA; QL (60 EA per 30 days)

PROMACTA ORAL TABLET 75 MG Formulary PA; QL (30 EA per 30 days)

promethazine hcl oral syrup 6.25 mg/5ml Formulary AGE (Min 2 Years)

promethazine hcl oral tablet 12.5 mg, 25 mg, 50 mg Formulary AGE (Min 2 Years)

promethazine hcl rectal suppository 12.5 mg, 50 mg Formulary AGE (Min 2 Years)

promethazine hcl rectal suppository 25 mg Formulary

promethazine vc/codeine oral syrup 6.25-5-10 mg/5ml Formulary AGE (Min 6 Years)

promethazine-codeine oral syrup 6.25-10 mg/5ml Formulary AGE (Min 6 Years)

promethazine-dm oral syrup 6.25-15 mg/5ml Formulary AGE (Min 6 Years)

promethazine-phenylephrine oral syrup 6.25-5 mg/5ml Formulary

PROMETHEGAN RECTAL SUPPOSITORY 25 MG Formulary

PROMETHEGAN RECTAL SUPPOSITORY 50 MG Formulary AGE (Min 2 Years)

PROMOLAXIN ORAL TABLET 100 MG Formulary OTC

PRONUTRIENTS CALCIUM+D3 ORAL TABLET 600-800 MG-UNIT

Formulary OTC

PRONUTRIENTS SUPER B COMPLEX ORAL TABLET Formulary OTC

propafenone hcl er oral capsule extended release 12 hour225 mg, 325 mg, 425 mg

Formulary

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

propranolol hcl er oral capsule extended release 24 hour120 mg, 160 mg, 60 mg, 80 mg

Formulary

propranolol hcl intravenous solution 1 mg/ml Formulary

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

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

Formulary

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

propylene glycol external solution Formulary

propylthiouracil oral tablet 50 mg Formulary

PRO-RED AC ORAL SYRUP 5-1-9 MG/5ML Formulary OTC

PROSHIELD SKIN CARE EXTERNAL KIT Formulary OTC

protein oral powder 80 % Formulary OTC

protein oral tablet 975 mg Formulary OTC

PROTEINEX ORAL LIQUID Formulary OTC

PROTEINEX P100 ORAL LIQUID Formulary OTC

protriptyline hcl oral tablet 10 mg, 5 mg Formulary

PROVENT SLEEP APNEA THERAPY Formulary

PROVIDA DHA ORAL CAPSULE 16-16-1.25-110 MG Formulary

PROVIEW KIT Formulary OTC

pseudoeph-bromphen-dm oral syrup 30-2-10 mg/5ml Formulary

pseudoephedrine hcl er oral tablet extended release 12 hour120 mg

Formulary OTC

pseudoephedrine hcl oral syrup 30 mg/5ml Formulary OTC

pseudoephedrine hcl oral tablet 30 mg Formulary OTC

pseudoephedrine hcl oral tablet 60 mg Formulary

psorcon external cream 0.05 % Formulary

117

Drug Name Formulary Status Requirements/LimitsPSS SELECT GP LANCETS Formulary OTC; QL (150 EA per 30 days)

PSS SELECT SAFETY LANCETS Formulary OTC; QL (150 EA per 30 days)

PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 180 MCG/ACT, 90 MCG/ACT

Formulary

PULMOZYME INHALATION SOLUTION 1 MG/ML, 2.5 MG/2.5ML

Formulary

PURACYN PLUS DUO-CARE EXTERNAL LIQUID Formulary OTC

pure l-citrulline oral capsule 600 mg Formulary OTC

pure l-citrulline oral powder Formulary OTC

purefe ob plus oral capsule 162-115.2-1 mg Formulary

purified water oral liquid Formulary

px allergy relief d oral tablet extended release 12 hour 5-120 mg

Formulary OTC

px allergy sinus pe oral tablet 2-5-325 mg Formulary OTC

px antacid extra strength oral tablet chewable 750 mg Formulary OTC

px artificial tears ophthalmic solution 5-6 mg/ml Formulary OTC

px daytime cold oral tablet 10-5-325 mg Formulary OTC

px daytime multi-symptom oral capsule 30-325-15 mg Formulary OTC

px gas relief extra strength oral capsule 125 mg Formulary OTC

px ibuprofen cold & sinus oral tablet 30-200 mg Formulary OTC

px insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml Formulary OTC

px lancets ultra thin Formulary OTC; QL (150 EA per 30 days)

px minoxidil for men external solution 5 % Formulary OTC

px nasal four nasal solution 1 % Formulary OTC

px nitetime multi-symptom oral capsule 30-6.25-15-325 mg Formulary OTC

px omeprazole oral tablet delayed release 20 mg Formulary OTC

PYLERA ORAL CAPSULE 140-125-125 MG Formulary

pyrazinamide oral tablet 500 mg Formulary

pyridostigmine bromide er oral tablet extended release 180 mg

Formulary

pyridostigmine bromide oral tablet 60 mg Formulary

pyridoxine hcl oral tablet 25 mg Formulary OTC

PYRIDOXINE/MINERALS ORAL CAPSULE 100-99-200 MG

Formulary OTC

pyrilamine-phenylephrine oral tablet 25-10 mg Formulary OTC

pyrimethamine oral tablet 25 mg Formulary PA

qc alcohol swabs pad 70 % 70 % Formulary OTC

qc arthritis external cream 10 % Formulary OTC

qc calamine external lotion Formulary OTC

qc iodides external tincture Formulary OTC

qc iodine tincture external tincture Formulary OTC

qc lancets super thin 30g Formulary OTC; QL (150 EA per 30 days)

qc lancets ultra thin Formulary OTC; QL (150 EA per 30 days)

QC MEDIFIN PE ORAL TABLET 10-400 MG Formulary OTC

118

Drug Name Formulary Status Requirements/Limitsqc natural vegetable oral powder 95 % Formulary OTC

qc non-adherent pad 3"x4" Formulary OTC

qc unilet lancets 28g Formulary OTC; QL (150 EA per 30 days)

qc unilet lancets micro thin Formulary OTC; QL (150 EA per 30 days)

Q-GEL ORAL CAPSULE 15 MG Formulary OTC

quercetin oral tablet 250 mg, 50 mg Formulary OTC

quetiapine fumarate er oral tablet extended release 24 hour150 mg, 200 mg


quetiapine fumarate er oral tablet extended release 24 hour300 mg, 400 mg, 50 mg


quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg


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

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

Formulary

quinidine gluconate er oral tablet extended release 324 mg Formulary

quinidine sulfate oral tablet 200 mg, 300 mg Formulary

quinine sulfate oral capsule 324 mg Formulary

ra 8 hour pain relief oral tablet extended release 650 mg Formulary OTC

ra acetaminophen flu cold oral tablet 30-500-15 mg Formulary OTC

ra acid reducer plus antacid oral tablet chewable 10-800-165 mg

Formulary OTC

ra acne maximum external pad 2 % Formulary OTC

ra advanced eye health oral capsule 250-2.5-0.5 mg, 500-5-1 mg

Formulary OTC

ra alcohol swabs pad 70 % 70 % Formulary OTC

ra anorectal external cream 5 % Formulary OTC

ra antifungal pen external liquid 25 % Formulary OTC

ra b-12 mouth/throat lozenge 1000-400 mcg Formulary OTC

ra baby care vit a&d to go external ointment Formulary OTC

ra back & body pain relief oral tablet 500-32.5 mg Formulary OTC

ra backache relief oral tablet 580 mg Formulary OTC

ra b-complex/vitamin c cr oral tablet extended release Formulary OTC

ra ca/mg/zn/cu oral tablet Formulary OTC

ra calamine external lotion 6.971-6.971 % Formulary OTC

ra calamine external suspension 8-8 % Formulary OTC

ra calcium hi-cal/vitamin d oral tablet 250-125 mg-unit, 500-125 mg-unit, 500-200 mg-unit

Formulary OTC

ra calcium high potency oral tablet 600 mg Formulary OTC

ra calcium oral tablet 500 mg Formulary OTC

ra calcium soft chews oral tablet chewable 500-200-40 mg-unt-mcg

Formulary OTC

ra calcium-boron oral tablet 500-1.5 mg Formulary OTC

ra cold remedy multi-symptom oral tablet dispersible Formulary OTC

ra cold sore treatment external liquid 0.13 % Formulary OTC

ra cold therapy gel external gel 4 % Formulary OTC

119

Drug Name Formulary Status Requirements/Limitsra cold/sinus max oral tablet 5-325-200 mg Formulary OTC

ra corn cushions small pad Formulary OTC

ra corn removers ultra thin external pad 40 % Formulary OTC

ra cranberry oral capsule 425 mg Formulary OTC

ra dark tanning external oil Formulary OTC

ra day/night/cold/flu relief oral Formulary OTC

ra daytime cold/flu relief oral liquid 10-5-325 mg/15ml Formulary OTC

ra ear wax cleansing system otic kit 6.5 % Formulary OTC

ra ethyl alcohol solution 70 % Formulary OTC

ra exfoliating moisturizer external ointment 5-10 % Formulary OTC

RA E-ZJECT COLOR LANCETS 33G Formulary OTC; QL (150 EA per 30 days)

RA E-ZJECT LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

RA E-ZJECT LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days)

RA E-ZJECT LANCETS THIN 28G Formulary OTC; QL (150 EA per 30 days)

RA E-ZJECT LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days)

ra feminine care douche vaginal solution Formulary OTC

ra fever reducer/pain reliever oral suspension 160 mg/5ml Formulary OTC

ra fiber weight management oral tablet chewable Formulary OTC

ra first aid iodine external tincture Formulary OTC

ra first aid non-stick pad Formulary OTC

ra first aid saline wound wash external liquid 0.13 % Formulary OTC

RA FISH OIL EXTRA STRENGTH ORAL CAPSULE 870 MG

Formulary OTC

ra fish oil oral capsule 900 mg Formulary OTC

ra fish oil oral capsule delayed release 1400 mg Formulary OTC

ra foaming hand soap refill external liquid 0.6 % Formulary OTC

ra glucosamine-chondroitin oral capsule 166.7-133.3 mg Formulary OTC

ra glucosamine-chondroitin-d3 oral tablet 750-600-500 mg-mg-unit

Formulary OTC

ra glucosamine-chondroit-msm oral tablet , 500-400-300 mg

Formulary OTC

ra glucos-chondroit-msm oral tablet Formulary OTC

ra glycerin child rectal suppository 80.7 % Formulary OTC

ra hemorrhoid relief rectal suppository 0.25-85.5 % Formulary OTC

ra hot & cold lidocaine external patch 4-1 % Formulary OTC

ra hot/cold gel sleeve Formulary OTC

ra hydrogen peroxide external solution 3 % Formulary OTC

ra hydrogen peroxide wipes external 3 % Formulary OTC

ra insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC

ra insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

ra insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC

ra insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC

ra intimacy gels/him/her external gel Formulary OTC

ra isopropyl alcohol wipes external 70 % Formulary OTC

120

Drug Name Formulary Status Requirements/Limitsra lice solution combination kit , 0.5-0.33-4 % Formulary OTC

RA LOTION EXTERNAL LOTION Formulary OTC

ra lubricant eye drops ophthalmic solution 0.6 % Formulary OTC

ra lutein oral capsule 20-1 mg Formulary OTC

RA LYCOPENE ORAL CAPSULE 15 MG Formulary OTC

ra melatonin sublingual tablet sublingual 1 mg Formulary OTC

ra miconazole 3 combo pack vaginal kit 200 & 2 mg-% (9gm)

Formulary ST; OTC

ra mouth pain anesthetic mouth/throat liquid 20 % Formulary OTC

ra mucus relief d max strength oral tablet extended release 12 hour 120-1200 mg

Formulary OTC

ra multihealth fiber oral powder 58.6 % Formulary OTC

ra nasal strip/drug free/large strip Formulary OTC

ra nighttime cold/flu relief oral liquid 30-12.5-650 mg/30ml Formulary OTC

ra oatmeal moisturizing external lotion 1.6 % Formulary OTC

ra omega 3-6-9 oral capsule Formulary OTC

ra omeprazole oral tablet delayed release 20 mg Formulary OTC

ra omeprazole-sodium bicarb capsule 20-1100 mg oral 20-1100 mg


ra oyster shell calcium/d oral tablet 250-125 mg-unit, 500-200 mg-unit

Formulary OTC

ra pain relief external cream 4 % Formulary OTC

ra personal lubricant external liquid Formulary OTC

ra prenatal oral tablet 28-0.8 mg Formulary OTC

ra probiotic complex oral tablet Formulary OTC

ra probiotic digestive care oral tablet Formulary OTC

ra probiotic gummies oral tablet chewable Formulary OTC

RA RENEWAL ACNE TREATMENT EXTERNAL GEL 10 %

Formulary OTC

RA RENEWAL DARK SPOT CORRECTOR EXTERNAL LIQUID

Formulary OTC

RA RENEWAL SHOWER & BATH EXTERNAL OIL Formulary OTC

ra renewal soothing bath external packet 100 % Formulary OTC

ra saline nasal spray nasal solution 0.65 % Formulary OTC

ra saline wound wash external solution 0.9 % Formulary OTC

ra sensitive anti-itch external lotion 1 % Formulary OTC

ra severe cold/night cold&flu oral Formulary OTC

ra severe congestion/cold max oral tablet 5-10-200-325 mg Formulary OTC

ra shower & bath body external powder Formulary OTC

ra silky lubricant moisturizer vaginal gel Formulary OTC

ra sinus wash nasal relief nasal packet 1685-515 mg Formulary OTC

ra sinus wash neti pot nasal packet 1685-515 mg Formulary OTC

ra skin treatment external oil Formulary OTC

ra slow release iron oral tablet extended release 45 mg Formulary OTC

ra stay awake oral tablet 100 mg Formulary OTC

121

Drug Name Formulary Status Requirements/Limitsra sterile saline nasal mist nasal solution 0.9 % Formulary OTC

ra triple antibiotic external aerosol 3.5-400-5000 Formulary OTC

RA TUGABOOS BABY EXTERNAL OIL Formulary OTC

ra tussin cough dm sugar free oral syrup 100-10 mg/5ml Formulary OTC

ra vagicaine external cream 5-2 % Formulary OTC

ra vagicaine vaginal cream 5-2 % Formulary OTC

ra vaginal infection screening in vitro kit Formulary OTC

ra vitamin b-12 oral liquid 1000 mcg/ml Formulary OTC

ra vitamin c oral tablet chewable 300 mg Formulary OTC

ra yeast relief plus oral tablet Formulary OTC

rabano yodado oral liquid Formulary OTC

RABAVERT INTRAMUSCULAR SUSPENSION RECONSTITUTED


rabeprazole sodium oral tablet delayed release 20 mg Formulary

RADIACARE POST HEALING EXTERNAL CREAM Formulary OTC

raloxifene hcl oral tablet 60 mg Formulary

ramelteon oral tablet 8 mg Formulary QL (30 EA per 30 days)

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

ranitidine hcl oral syrup 75 mg/5ml Formulary

ranitidine hcl oral tablet 150 mg, 300 mg Formulary

ranitidine hcl oral tablet 75 mg Formulary OTC

RASH AWAY EXTERNAL AEROSOL 33 % Formulary OTC

RASH RELIEF EXTERNAL LIQUID 20-25 % Formulary OTC

raspberry syrup oral syrup Formulary

reality insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

reality insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC

reality insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC

reality insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

reality lancets Formulary OTC; QL (150 EA per 30 days)

reality swabs pad Formulary OTC

reality trigger lancets Formulary OTC; QL (150 EA per 30 days)

REA-LO EXTERNAL CREAM 30 % Formulary OTC

REBETOL ORAL CAPSULE 200 MG Formulary PA

REBETOL ORAL SOLUTION 40 MG/ML Formulary PA

RECOMBIVAX HB INJECTION SUSPENSION 10 MCG/ML, 40 MCG/ML, 5 MCG/0.5ML


RECTICARE EXTERNAL CREAM 5 % Formulary OTC

red cross cotton sterile Formulary OTC

REDNESS RELIEF OPHTHALMIC SOLUTION 0.012-0.25 %

Formulary OTC

reeses pinworm medicine oral tablet 180 mg Formulary OTC

REFENESEN CHEST CONG/PAIN RLF ORAL TABLET 650-400 MG

Formulary OTC

REFENESEN CHST CONG/PAIN PE ORAL TABLET 10-650-400 MG

Formulary OTC

122

Drug Name Formulary Status Requirements/LimitsREFRESH LACRI-LUBE OPHTHALMIC OINTMENT Formulary OTC

REFRESH OPHTHALMIC SOLUTION 1.4-0.6 % Formulary OTC

REFRESH OPTIVE MEGA-3 OPHTHALMIC SOLUTION 0.5-1-0.5 %

Formulary OTC

REFRESH OPTIVE OPHTHALMIC GEL 1-0.9 % Formulary OTC

REFRESH OPTIVE OPHTHALMIC SOLUTION 0.5-0.9 %

Formulary OTC

REFRESH OPTIVE SENSITIVE OPHTHALMIC SOLUTION 0.5-0.9 %

Formulary OTC

REFRESH P.M. OPHTHALMIC OINTMENT Formulary OTC

REFRESH TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC

REGENECARE HA EXTERNAL LIQUID 2 % Formulary OTC

REGRANEX EXTERNAL GEL 0.01 % Formulary PA; QL (15 GM per 34 days)

relagesic oral tablet 29-500 mg Formulary OTC

relcof c oral solution 100-6.3 mg/5ml Formulary OTC; AGE (Min 6 Years)

RELIADERM EXTERNAL CREAM 0.035-10-25 % Formulary OTC

RELIEF PAIN RELIEVING EXTERNAL CREAM 3 % Formulary OTC

reliever external patch 0.05-5 % Formulary OTC

RELION ALCOHOL SWABS PAD Formulary OTC

RELION ALCOHOL SWABS PAD 70 % 70 % Formulary OTC

RELION ALL-IN-ONE DEVICE Formulary OTC

RELION BLOOD GLUCOSE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

RELION GLUCOSE SHOT ORAL LIQUID Formulary OTC

RELI-ON INSULIN SYRINGE 29G 0.3 ML 29G 0.3 ML Formulary OTC


RELION INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

RELION INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

RELI-ON INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC



RELI-ON INSULIN SYRINGE 30G 1 ML 30G 1 ML Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

123

Drug Name Formulary Status Requirements/LimitsRELION INSULIN SYRINGE 31G X 15/64" 1 ML 31G X 15/64" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

RELION LANCETS MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days)

RELION LANCETS STANDARD 21G Formulary OTC; QL (150 EA per 30 days)

RELION LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days)

RELION LANCETS ULTRA-THIN 30G Formulary OTC; QL (150 EA per 30 days)

RELION ULTRA THIN LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

RELION ULTRA THIN PLUS LANCETS Formulary OTC; QL (150 EA per 30 days)

RELISTOR ORAL TABLET 150 MG Formulary PA; QL (90 EA per 30 days)

RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML

Formulary PA

REMEDY ANTIMICROBIAL CLEANSER EXTERNAL LIQUID 0.12 %

Formulary OTC

REMEDY CALAZIME EXTERNAL PASTE 0.4-20.5 % Formulary OTC

REMEDY CLEANSING BODY EXTERNAL LOTION 1.5 %

Formulary OTC

REMEDY PHYTOPLEX ANTIFUNGAL EXTERNAL POWDER 2 %

Formulary OTC

REMEDY SKIN REPAIR EXTERNAL CREAM 1.5 % Formulary OTC

REMOVE ADHESIVE REMOVER WIPES EXTERNAL Formulary OTC

RENACIDIN IRRIGATION SOLUTION Formulary

renal vitamin oral tablet 0.8 mg Formulary OTC

RENFLEXIS INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

Formulary

repaglinide oral tablet 0.5 mg, 1 mg, 2 mg Formulary

REPATHA SOLUTION PREFILLED SYRINGE 140 MG/ML SUBCUTANEOUS 140 MG/ML

Formulary PA

REPATHA SURECLICK SOLUTION AUTO-INJECTOR 140 MG/ML SUBCUTANEOUS 140 MG/ML

Formulary PA

REPHRESH VAGINAL GEL Formulary OTC

REPLACE SR ORAL TABLET EXTENDED RELEASE Formulary OTC

RESCON ORAL TABLET 2-60 MG Formulary OTC

RESCRIPTOR ORAL TABLET 100 MG, 200 MG Formulary

resorcinol-sulfur external lotion 2-5 % Formulary

RESOURCE THICKENUP WATER ORAL LIQUID Formulary OTC

RESPAIRE-30 ORAL CAPSULE 30-150 MG Formulary OTC

RESTASIS MULTIDOSE OPHTHALMIC EMULSION 0.05 %

Formulary

RESTASIS OPHTHALMIC EMULSION 0.05 % Formulary

RESTORE CLEANSER & MOISTURIZER EXTERNAL LIQUID 2 %

Formulary OTC

124

Drug Name Formulary Status Requirements/LimitsRETAINE PM OPHTHALMIC OINTMENT Formulary OTC

RETROVIR ORAL CAPSULE 100 MG Formulary

RETROVIR ORAL SYRUP 50 MG/5ML Formulary

REVEAL COLON DISEASE IN VITRO DIAGNOSTIC TEST

Formulary OTC

REVEAL DNA PATERNITY TEST IN VITRO KIT Formulary OTC

REVEAL GET PREGNANT QUICK IN VITRO KIT Formulary OTC

REVEAL MULTI-DRUG TESTING CUP IN VITRO Formulary OTC

REVEAL URINARY TRACT IN VITRO STRIP Formulary OTC

REVITADERM WOUND CARE EXTERNAL GEL Formulary OTC

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

Formulary PA

REVONTO INTRAVENOUS SOLUTION RECONSTITUTED 20 MG

Formulary

REXALL LANCETS ULTRA THIN 30G Formulary OTC; QL (150 EA per 30 days)

REYATAZ ORAL PACKET 50 MG Formulary

REZAMID EXTERNAL LOTION 2-5 % Formulary OTC

REZUROCK ORAL TABLET 200 MG Formulary PA

RHINARIS NASAL SOLUTION 0.2 % Formulary OTC

RHINASE NASAL GEL Formulary OTC

RHINASE NASAL SOLUTION Formulary OTC

RHOPRESSA OPHTHALMIC SOLUTION 0.02 % Formulary

RIASTAP INTRAVENOUS SOLUTION RECONSTITUTED

Formulary

RIAX EXTERNAL FOAM 5.5 %, 9.5 % Formulary OTC; AGE (Max 19 Years)

RIBASPHERE ORAL TABLET 200 MG, 400 MG, 600 MG

Formulary PA

ribavirin oral tablet 200 mg Formulary PA

riboflavin oral capsule 50 mg Formulary OTC

RICOLA CHERRY HONEY HERB MOUTH/THROAT LOZENGE 2 MG

Formulary OTC

RICOLA HERB MOUTH/THROAT LOZENGE 1.1 MG, 2.6 MG

Formulary OTC

RICOLA LEMON MINT MOUTH/THROAT LOZENGE 1.5 MG

Formulary OTC

RICOLA W/ECHINACEA MOUTH/THROAT LOZENGE 3.5 MG

Formulary OTC

RIDAURA ORAL CAPSULE 3 MG Formulary

rifabutin oral capsule 150 mg Formulary

rifampin oral capsule 150 mg, 300 mg Formulary

RIGHTEST GL300 LANCETS Formulary OTC; QL (150 EA per 30 days)

riluzole oral tablet 50 mg Formulary

ringers irrigation irrigation solution Formulary

risacal-d oral tablet 105-81-120 mg-mg-unit Formulary OTC

RISAMINE EXTERNAL OINTMENT 0.44-20.625 % Formulary OTC

125

Drug Name Formulary Status Requirements/LimitsRISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED 12.5 MG, 25 MG, 37.5 MG, 50 MG


RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 12.5 MG, 25 MG, 37.5 MG, 50 MG


risperidone oral solution 1 mg/ml Formulary AGE (Min 18 Years)

risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg


risperidone oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg


ritonavir oral tablet 100 mg Formulary

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

Formulary PA

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

Formulary

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

Formulary

rixubis intravenous solution reconstituted 1000 unit, 2000 unit, 250 unit, 3000 unit, 500 unit

Formulary

rizatriptan benzoate oral tablet 10 mg, 5 mg Formulary QL (12 EA per 34 days)

rizatriptan benzoate oral tablet dispersible 10 mg, 5 mg Formulary QL (12 EA per 34 days)

ROBAFEN DM COUGH CLEAR ORAL SYRUP 100-10 MG/5ML

Formulary OTC

robafen oral syrup 100 mg/5ml Formulary OTC

ROBATHOL EXTERNAL OIL Formulary OTC

ROBITUSSIN CHILD COUGH/COLD CF ORAL LIQUID 2.5-5-50 MG/5ML

Formulary OTC

ROBITUSSIN CHILDRENS COUGH LA ORAL SYRUP 7.5 MG/5ML

Formulary OTC

ROBITUSSIN COLD+FLU DAYTIME ORAL CAPSULE 10-5-325 MG

Formulary OTC

ROBITUSSIN COUGH+CHEST CONG DM ORAL CAPSULE 10-200 MG

Formulary OTC

ROBITUSSIN DAY/NIGHT VALUE PAK ORAL Formulary OTC

ROBITUSSIN LINGERING COUGHGELS ORAL CAPSULE 15 MG

Formulary OTC

ROBITUSSIN MUCUS+CHEST CONGEST ORAL LIQUID 100 MG/5ML

Formulary OTC

ROBITUSSIN MULTI-SYMPTOM MAX ORAL LIQUID 5-10-200 MG/5ML

Formulary OTC

ROBITUSSIN NIGHTTIME COUGH DM ORAL LIQUID 12.5-30 MG/10ML

Formulary OTC

ROBITUSSIN NIGHTTIME COUGH ORAL LIQUID 1-7.5 MG/5ML

Formulary OTC

ROBITUSSIN PEAK COLD MULTI-SYM ORAL LIQUID 6.25-2.5-160 MG/5ML

Formulary OTC

ROBITUSSIN PK COLD DAY/NGHT DM ORAL Formulary OTC

ROBITUSSIN PK COLD DAY/NGHT MS ORAL Formulary OTC

126

Drug Name Formulary Status Requirements/LimitsROBITUSSIN SEVERE NIGHTTIME ORAL LIQUID 12.5-5-325 MG/10ML

Formulary OTC

ROBITUSSIN TO GO COUGH/COLD CF ORAL LIQUID 5-10-100 MG/5ML

Formulary OTC

ROCKLATAN OPHTHALMIC SOLUTION 0.02-0.005 % Formulary

ROLAIDS ORAL TABLET CHEWABLE 550-110 MG Formulary OTC

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

Formulary

rose water external liquid Formulary OTC

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

ROTARIX ORAL SUSPENSION RECONSTITUTED Formulary AGE (Min 19 Years)

ROTATEQ ORAL SOLUTION Formulary AGE (Min 19 Years)

rotex external cream 0.038-4-35 % Formulary OTC

ru-hist d oral tablet 4-10 mg Formulary OTC

RUKOBIA ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG

Formulary

rutin oral tablet 50 mg Formulary OTC

rydex g oral tablet 38.5-398 mg Formulary OTC

RYDEX ORAL LIQUID 10-1.33-6.33 MG/5ML Formulary OTC

RYLAZE INTRAMUSCULAR SOLUTION 10 MG/0.5ML Formulary PA

rymed oral tablet 2-10 mg Formulary OTC

rynex pe oral elixir 1-2.5 mg/5ml Formulary OTC

rynex pse oral liquid 1-15 mg/5ml Formulary OTC

S.S.S. TONIC ORAL LIQUID Formulary OTC

SAFE TUSSIN PM ORAL LIQUID 3.125-7.5 MG/5ML Formulary OTC

SAFELET IV CATHETER Formulary OTC

safety insulin syringes 27g x 1/2" 1 ml 27g x 1/2" 1 ml Formulary OTC

safety insulin syringes 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC



safety insulin syringes 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC

SAFETY SEAL LANCETS Formulary OTC; QL (150 EA per 30 days)

SAFETY-GARD NEEDLE 18G Formulary OTC

SAFETY-LOK SYRINGE 21G X 1-1/2" 10 ML, 21G X 1-1/2" 5 ML

Formulary OTC

SALEM SUMP TUBE 12FR Formulary

salicylic acid external cream 6 % Formulary

salicylic acid external foam 6 % Formulary

salicylic acid external gel 6 % Formulary

salicylic acid external lotion 6 % Formulary

salicylic acid wart remover external liquid 27.5 % Formulary

salicylic acid-cleanser external kit 6 % lotion Formulary

saline nasal gel Formulary OTC

saline solution Formulary OTC

SALMON ORAL CAPSULE 200 MG Formulary OTC

127

Drug Name Formulary Status Requirements/LimitsSAM-E COMPLETE ORAL TABLET DELAYED RELEASE 200 MG

Formulary OTC

sam-e oral tablet delayed release 400 mg Formulary OTC

sam-g.l.a. oral capsule 100-150-40 mg Formulary OTC

SAMSCA ORAL TABLET 15 MG Formulary PA; QL (34 EA per 34 days)

SAMSCA ORAL TABLET 30 MG Formulary PA; QL (68 EA per 34 days)

SANTYL EXTERNAL OINTMENT 250 UNIT/GM Formulary QL (60 GM per 34 days)

sapropterin dihydrochloride oral tablet 100 mg Formulary PA

sapropterin dihydrochloride oral tablet soluble 100 mg Formulary PA

SARNA EXTERNAL LOTION 0.5-0.5 % Formulary OTC

SASTID SOAP EXTERNAL BAR 3-5 % Formulary OTC

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


SAVELLA TITRATION PACK ORAL 12.5 & 25 & 50 MG


sb alcohol prep pad 70 % 70 % Formulary OTC

sb bacitracin external ointment 500 unit/gm Formulary OTC

sb childrens cough/runny nose oral suspension 5-160-1 mg/5ml

Formulary OTC

sb cold & flu hbp oral tablet 2-325 mg Formulary OTC

sb daytime sinus oral capsule 5-325 mg Formulary OTC

sb fib lax orange oral powder 30 % Formulary OTC

sb insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC

sb insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

sb insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC



sb lancets thin Formulary OTC; QL (150 EA per 30 days)

sb lancets ultra thin Formulary OTC; QL (150 EA per 30 days)

sb lice treatment external liquid 0.3-3 %, 1 % Formulary OTC

sb nighttime sinus multi-sympt oral capsule 6.25-5-325 mg Formulary OTC

sb omeprazole oral tablet delayed release 20 mg Formulary OTC

sb stool softener oral capsule 240 mg Formulary OTC

scarcin external cream Formulary OTC

scot-tussin expectorant oral liquid 100 mg/5ml Formulary OTC

SCYTERA EXTERNAL FOAM 2 % Formulary OTC

se-100 oral capsule 100 mcg Formulary OTC

SEBUDERM EXTERNAL GEL Formulary

SEBULEX EXTERNAL SHAMPOO 2-2 % Formulary OTC

SECONAL ORAL CAPSULE 100 MG Formulary

SECURA EXTRA PROTECTIVE EXTERNAL CREAM 30.6 %

Formulary OTC

SECURA MOISTURIZING CLEANSER EXTERNAL LIQUID 0.13 %

Formulary OTC

SECURA TWO-STEP EXTERNAL KIT 0.13 & 10 % Formulary OTC

128

Drug Name Formulary Status Requirements/LimitsSELECT-OB ORAL TABLET CHEWABLE 29-1 MG Formulary

selegiline hcl oral capsule 5 mg Formulary

selegiline hcl oral tablet 5 mg Formulary

selenicaps-200 oral capsule 200 mcg Formulary OTC

selenimin oral tablet 125 mcg Formulary OTC

selenium er oral tablet extended release 200 mcg Formulary OTC

selenium sulfide external lotion 2.5 % Formulary

SELSUN BLUE DEEP CLEANSING EXTERNAL SHAMPOO 3 %

Formulary OTC

SELZENTRY ORAL SOLUTION 20 MG/ML Formulary

SELZENTRY ORAL TABLET 150 MG, 25 MG, 300 MG, 75 MG

Formulary

SEMGLEE (YFGN) SOLUTION 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

SEMGLEE (YFGN) SOLUTION PEN-INJECTOR 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

SEMGLEE SOLUTION 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

SEMGLEE SOLUTION PEN-INJECTOR 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

se-natal 19 oral tablet 29-1 mg Formulary

senna laxative oral tablet 25 mg Formulary OTC

senna leaves oral leaves Formulary OTC

senna oral capsule 8.6 mg Formulary OTC

senna oral syrup 176 mg/5ml Formulary OTC

senna oral syrup 8.8 mg/5ml Formulary

senna oral tablet 8.6 mg Formulary OTC

SENNA PROMPT ORAL CAPSULE 9-500 MG Formulary OTC

senna s oral tablet 8.6-50 mg Formulary OTC

SENNA SMOOTH ORAL TABLET 15 MG Formulary OTC

SENOKOT EXTRA STRENGTH ORAL TABLET 17.2 MG

Formulary OTC

SENOKOT S ORAL TABLET 8.6-50 MG Formulary OTC

SENSI-CARE BODY EXTERNAL CREAM 1-30 % Formulary OTC

SENSI-CARE PERINEAL/SKIN EXTERNAL LIQUID Formulary OTC

SENSI-CARE PROTECTIVE BARRIER EXTERNAL OINTMENT 49-15 %

Formulary OTC

SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG Formulary PA

SENSITIVE EYES ENZYME CLEANER TABLET EFFERVESCENT

Formulary OTC

SENSODYNE MAXIMUM STRENGTH DENTAL GEL Formulary OTC

SE-PLUS PROTEIN ORAL TABLET 200 MCG Formulary OTC

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 50 MCG/DOSE

Formulary

sertraline hcl oral concentrate 20 mg/ml Formulary

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

129

Drug Name Formulary Status Requirements/Limitssevelamer carbonate oral packet 0.8 gm, 2.4 gm Formulary

sevelamer carbonate oral tablet 800 mg Formulary

sevelamer hcl oral tablet 800 mg Formulary

severe allergy oral tablet 12.5-500 mg Formulary OTC

severe cold & flu day/night oral liquid therapy pack Formulary OTC

sf 5000 plus dental cream 1.1 % Formulary

shampoo & body wash rinse-free external foam Formulary OTC

SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG, 50 MCG/0.5ML

Formulary

SHOPKO ALCOHOL SWABS PAD 70 % 70 % Formulary OTC

SHOPKO UNILET LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

SHUR-SEAL CONTRACEPTIVE VAGINAL GEL 2 % Formulary OTC

silace oral syrup 60 mg/15ml Formulary OTC

sildenafil citrate oral suspension reconstituted 10 mg/ml Formulary PA; AGE (Min 18 Years)

sildenafil citrate oral tablet 20 mg Formulary PA; AGE (Min 18 Years)

silodosin oral capsule 4 mg, 8 mg Formulary

silver nitrate external ointment 10 % Formulary

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

silver sulfadiazine external cream 1 % Formulary

SILVERMED EXTERNAL GEL Formulary OTC

SIMILAC STERILIZED WATER ORAL LIQUID Formulary OTC

SIMILASAN DRY EYE RELIEF OPHTHALMIC SOLUTION

Formulary OTC

SIMILASAN PINK EYE RELIEF OPHTHALMIC SOLUTION

Formulary OTC

SIMILASAN STYE EYE RELIEF OPHTHALMIC SOLUTION

Formulary OTC

simple syrup oral syrup Formulary

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg, 80 mg Formulary

SINADRIN PE COMPLETE SINUS REL ORAL TABLET 2-10-650 MG

Formulary OTC

sinus & cold-d oral tablet extended release 12 hour 120-220 mg

Formulary OTC

sinus & congestion day/night oral Formulary OTC

sinus congestion/pain daytime oral tablet 5-325 mg Formulary OTC

sinus relief sublingual tablet sublingual Formulary OTC

sirolimus oral solution 1 mg/ml Formulary

sirolimus oral tablet 0.5 mg, 1 mg, 2 mg Formulary

siterol external patch 3.99-1 % Formulary OTC

skin protectant external cream 12 % Formulary OTC

skin tag remover external liquid Formulary OTC

SKINTEGRITY HYDROGEL EXTERNAL GEL Formulary OTC

SKYLA INTRAUTERINE INTRAUTERINE DEVICE 13.5 MG

Formulary

sleep aid oral tablet 25 mg Formulary OTC

SLEEP-N-HEEL EXTERNAL KIT 20 % Formulary OTC

130

Drug Name Formulary Status Requirements/LimitsSLO-NIACIN ORAL TABLET EXTENDED RELEASE 500 MG, 750 MG

Formulary OTC

SLOW FE ORAL TABLET EXTENDED RELEASE 142 (45 FE) MG

Formulary OTC

slow iron oral tablet extended release 160 (50 fe) mg Formulary OTC

slow magnesium/calcium oral tablet delayed release 70-117 mg

Formulary OTC

slow release iron oral tablet extended release 47.5 mg Formulary OTC

sm alcohol prep pad Formulary OTC

sm alcohol prep pad 70 % 70 % Formulary OTC

sm allergy relief oral tablet 1.34 mg Formulary OTC

sm b super vitamin complex oral tablet Formulary OTC

sm biotin oral tablet 5000 mcg Formulary OTC

sm calamine external lotion Formulary OTC

sm calcium soft chews oral tablet chewable 500-100-40 Formulary OTC

sm chest congestion relief dm oral tablet 20-400 mg Formulary OTC

SM CORAL CALCIUM ORAL TABLET 1000 (390 CA) MG

Formulary OTC

sm cosmetic puffs jumbo Formulary OTC

sm cough drops mouth/throat lozenge 7 mg Formulary OTC

sm cough/sore throat daytime oral liquid 1000-30 mg/30ml Formulary OTC

sm daytime cold & cough child oral solution 2.5-5 mg/5ml Formulary OTC

sm dental rinse anti-plaque mouth/throat liquid Formulary OTC

sm ethyl alcohol (rubbing) solution 70 % Formulary OTC

sm foaming antacid oral tablet chewable 80-20 mg Formulary OTC

sm fruit coolers mouth/throat lozenge 7 mg Formulary OTC

sm glucosamine hcl-msm oral tablet 750-750 mg Formulary OTC

SM GLUCOSAMINE/CALCIUM + D ORAL TABLET 500-333-250 MG-MG-UNIT

Formulary OTC

sm hemorrhoidal rectal ointment 0.25-14-74.9 % Formulary OTC

sm ibuprofen jr oral tablet 100 mg Formulary OTC

sm iodides external tincture Formulary OTC

sm iodine tincture external tincture Formulary OTC

sm iron oral tablet 134 mg Formulary OTC

sm lancets 33g Formulary OTC; QL (150 EA per 30 days)

sm medicated chest rub external ointment 4.73-1.2-2.6 % Formulary OTC

sm melatonin oral tablet dispersible 5 mg Formulary OTC

sm natural herb cough drops mouth/throat lozenge 4.8 mg Formulary OTC

sm oatmeal bath external packet 100 % Formulary OTC

sm omega-3-6-9 fatty acids oral capsule Formulary OTC

sm omeprazole oral tablet delayed release 20 mg Formulary OTC

sm one daily prenatal oral 28-0.8 & 440 mg Formulary OTC

sm pain relief/menthol external gel Formulary OTC

sm prenatal vitamins oral tablet 28-0.8 mg Formulary OTC

131

Drug Name Formulary Status Requirements/Limitssm slow release iron oral tablet extended release 143 (45 fe) mg

Formulary OTC

sm tussin cf oral liquid 30-10-100 mg/5ml Formulary OTC

sm vitamin b1 oral tablet 100 mg Formulary OTC

SMART SENSE COLOR LANCETS 33G Formulary OTC; QL (150 EA per 30 days)

SMART SENSE STANDARD LANCETS Formulary OTC; QL (150 EA per 30 days)

SMART SENSE SUPER THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

SMART SENSE THIN LANCETS 26G Formulary OTC; QL (150 EA per 30 days)

smoothfit cuff Formulary OTC

sod citrate-citric acid oral solution 500-334 mg/5ml Formulary

sodium bicarbonate oral powder Formulary

sodium bicarbonate oral tablet 325 mg, 650 mg Formulary OTC

sodium chloride (hypertonic) ophthalmic ointment 5 % Formulary OTC

sodium chloride (hypertonic) ophthalmic solution 5 % Formulary OTC

sodium chloride inhalation nebulization solution 0.9 %, 3 %, 7 %

Formulary

sodium chloride oral solution 4 meq/ml Formulary OTC

sodium chloride oral tablet 1 gm Formulary OTC

sodium fluoride mouth/throat solution 0.2 % Formulary

sodium fluoride oral solution 1.1 (0.5 f) mg/ml Formulary

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg, 2.2 (1 f) mg

Formulary

sodium phenylbutyrate oral tablet 500 mg Formulary

sodium polystyrene sulfonate oral suspension 15 gm/60ml Formulary

sodium polystyrene sulfonate rectal suspension 30 gm/120ml

Formulary

sofosbuvir-velpatasvir oral tablet 400-100 mg Formulary QL (28 EA per 28 days)

solifenacin succinate oral tablet 10 mg, 5 mg Formulary

SOLIRIS INTRAVENOUS SOLUTION 300 MG/30ML Formulary PA

SOLUBLE FIBER THERAPY ORAL POWDER Formulary OTC

solvatech plus oral suspension Formulary

SOMBRA COOL THERAPY EXTERNAL GEL 6 % Formulary OTC

SOMBRA WARM THERAPY EXTERNAL GEL 3-3 % Formulary OTC

SOOTHE & COOL INZO BARRIER EXTERNAL CREAM 5-5 %

Formulary OTC

SOOTHE XP XTRA PROTECTION OPHTHALMIC SOLUTION

Formulary OTC

sorbitol oral solution 70 % Formulary OTC

sorbitol rectal solution 70 % Formulary OTC

sorbutuss nr oral liquid 15-150-127.5 mg/7.5ml Formulary OTC

sore throat lozenges mouth/throat lozenge 6-10 mg Formulary OTC

sore throat mouth/throat lozenge 15-3.6 mg Formulary OTC

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

sotalol hcl oral tablet 120 mg, 160 mg, 240 mg, 80 mg Formulary

soya lecithin oral capsule 1200 mg Formulary OTC

132

Drug Name Formulary Status Requirements/Limitsspinosad external suspension 0.9 % Formulary

SPIRIVA HANDIHALER INHALATION CAPSULE 18 MCG

Formulary

spironolactone oral tablet 100 mg, 25 mg, 50 mg Formulary

spironolactone-hctz oral tablet 25-25 mg Formulary

sportbalm external lotion Formulary OTC

SPORTSCREME EXTERNAL CREAM 10 % Formulary OTC

spot acne treatment external cream 2.5 % Formulary OTC

SPRAYZOIN EXTERNAL LIQUID Formulary OTC

SPS ORAL SUSPENSION 15 GM/60ML Formulary

SSD (SILVER SULFADIAZINE) EXTERNAL CREAM 1 %

Formulary

stahist ad oral liquid 25-60 mg/5ml Formulary OTC

stahist ad oral tablet 25-60 mg Formulary OTC

STALEVO 100 ORAL TABLET 25-100-200 MG Formulary

STALEVO 125 ORAL TABLET 31.25-125-200 MG Formulary


STALEVO 200 ORAL TABLET 50-200-200 MG Formulary


STANBACK HEADACHE POWDERS ORAL PACKET 650-200-32 MG

Formulary OTC

stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg Formulary

STERILANCE TL Formulary OTC; QL (150 EA per 30 days)

STERILE LUBRICANT OPHTHALMIC LIQUID 0.7 % Formulary OTC

STERI-STRIP COMPOUND BENZOIN EXTERNAL TINCTURE

Formulary OTC

STERI-TAMP SEALS BOTTLES/VIALS Formulary OTC

STERI-TAMP SEALS/BAGS Formulary OTC

STERI-TAMP SEALS/SYRINGES Formulary OTC

STIMATE NASAL SOLUTION 1.5 MG/ML Formulary

STIMEX INSULATED NEEDLE 22G X 2-1/8" , 22G X 4-1/4"

Formulary OTC

STIMULEN EXTERNAL GEL Formulary OTC

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 2.5-2.5 MCG/ACT

Formulary

STOMAHESIVE MOLDABLE ADHESIVE STRIP Formulary OTC

STOMAHESIVE PASTE PASTE Formulary OTC

stop lice maximum strength external liquid 0.33-4 % Formulary OTC

STRIANT BUCCAL 30 MG Formulary

STRIBILD ORAL TABLET 150-150-200-300 MG Formulary

STRIDEX ESSENTIAL EXTERNAL PAD 1 % Formulary OTC

STRI-DEX SENSITIVE SKIN EXTERNAL PAD 0.5 % Formulary OTC

STUART ONE ORAL CAPSULE 27-0.8-200 MG Formulary OTC

SUBLOCADE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/0.5ML, 300 MG/1.5ML

Formulary

133

Drug Name Formulary Status Requirements/Limits

SUBOXONE SUBLINGUAL FILM 12-3 MG FormularyQL (60 EA per 30 days); AGE (Min 16 Years)

SUBOXONE SUBLINGUAL FILM 2-0.5 MG FormularyQL (360 EA per 30 days); AGE (Min 16 Years)



SUBVENITE ORAL TABLET 100 MG, 150 MG, 200 MG, 25 MG

Formulary

sucralfate oral suspension 1 gm/10ml Formulary

sucralfate oral tablet 1 gm Formulary

SUDAFED 24 HOUR ORAL TABLET EXTENDED RELEASE 24 HOUR 240 MG

Formulary OTC

SUDAFED CHILDRENS ORAL LIQUID 15 MG/5ML Formulary OTC

SUDAFED ORAL TABLET 30 MG Formulary OTC

SUDAFED PE CHILDRENS ORAL SOLUTION 2.5 MG/5ML

Formulary OTC

SUDAFED PE COLD & COUGH CHILD ORAL SOLUTION 2.5-5 MG/5ML

Formulary OTC

SUDAFED PE DAY & NIGHT ORAL 25-10 & 10 MG Formulary OTC

SUDAFED PE MAXIMUM STRENGTH ORAL TABLET 10 MG

Formulary OTC

SUDAFED PRESSURE+PAIN 12 HR ORAL TABLET EXTENDED RELEASE 12 HOUR 120-220 MG

Formulary OTC

sulfacetamide sodium (acne) external lotion 10 % Formulary

sulfacetamide sodium ophthalmic ointment 10 % Formulary

sulfacetamide sodium ophthalmic solution 10 % Formulary

sulfacetamide sodium-sulfur external liquid 10-5 %, 9-4 % Formulary

sulfacetamide sodium-sulfur external lotion 10-5 % Formulary

sulfacetamide sodium-sulfur external pad 10-4 % Formulary

sulfacetamide sodium-sulfur external suspension 8-4 % Formulary

sulfacetamide-prednisolone ophthalmic solution 10-0.23 % Formulary

sulfadiazine oral tablet 500 mg Formulary

sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800-160 mg

Formulary

SULFAMYLON EXTERNAL CREAM 85 MG/GM Formulary

sulfasalazine oral tablet 500 mg Formulary

sulfasalazine oral tablet delayed release 500 mg Formulary

sulfo-lo external bar 5 % Formulary OTC

sulfur external bar 10 % Formulary OTC

sulindac oral tablet 150 mg, 200 mg Formulary

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

sumatriptan succinate oral tablet 100 mg Formulary QL (9 EA per 34 days)

sumatriptan succinate oral tablet 25 mg, 50 mg Formulary QL (18 EA per 34 days)

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

Formulary

134

Drug Name Formulary Status Requirements/Limitssumatriptan succinate refill solution cartridge 6 mg/0.5ml subcutaneous 6 mg/0.5ml

Formulary

sumatriptan succinate subcutaneous solution 6 mg/0.5ml Formulary

sumatriptan succinate subcutaneous solution auto-injector4 mg/0.5ml, 6 mg/0.5ml

Formulary

sumatriptan succinate subcutaneous solution prefilled syringe 6 mg/0.5ml

Formulary

SUMMERS EVE DEODORANT ULTRA EXTERNAL AEROSOL

Formulary OTC

sunitinib malate oral capsule 12.5 mg, 25 mg, 37.5 mg, 50 mg

Formulary PA

super b-50 complex oral capsule Formulary OTC

super c-500 complex oral tablet extended release Formulary OTC

super cal/mag oral tablet 333.333-166.667 mg Formulary OTC

super moleskin pad Formulary OTC

SUPER OMEGA-3 ORAL CAPSULE Formulary OTC

super thin lancets Formulary OTC; QL (150 EA per 30 days)

supposibase f powder Formulary OTC

SUPPRELIN LA SUBCUTANEOUS KIT 50 MG Formulary PA

SUPREP BOWEL PREP KIT ORAL SOLUTION 17.5-3.13-1.6 GM/177ML

Formulary

supress a pediatric oral liquid 5-1-10 mg/ml Formulary OTC

supress dm pediatric oral liquid 5-50 mg/ml Formulary OTC

SUPRESS-PE PEDIATRIC ORAL LIQUID 2.5-50 MG/ML

Formulary OTC

sure comfort alcohol prep pad 70 % 70 % Formulary OTC

sure comfort insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml

Formulary OTC

sure comfort insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC


Formulary OTC


Formulary OTC



Formulary OTC


Formulary OTC



Formulary OTC


Formulary OTC

sure comfort insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml

Formulary OTC


Formulary OTC

135

Drug Name Formulary Status Requirements/Limitssure comfort insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml

Formulary OTC


Formulary OTC

sure comfort insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml

Formulary OTC

sure comfort lancets 28g Formulary OTC; QL (150 EA per 30 days)

sure comfort lancets 30g Formulary OTC; QL (150 EA per 30 days)

SURE-JECT INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

SURE-JECT INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

SURE-LANCE ULTRA THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

SURELITE LANCETS Formulary OTC; QL (150 EA per 30 days)

SUSPENDOL-S LIQUID Formulary OTC

SUSTIVA ORAL CAPSULE 200 MG, 50 MG Formulary

SUSTIVA ORAL TABLET 600 MG Formulary

SWEEN EXTERNAL CREAM Formulary OTC

SWEEN PREP EXTERNAL SOLUTION Formulary OTC

SWIM EAR OTIC LIQUID 95 % Formulary OTC

swimmers instant ear dry otic liquid 95 % Formulary OTC

SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG

Formulary

SYMBICORT INHALATION AEROSOL 160-4.5 MCG/ACT, 80-4.5 MCG/ACT

Formulary

sympathetic nerve needle 19g x 5" , 20g x 5" Formulary OTC

SYMTUZA ORAL TABLET 800-150-200-10 MG Formulary

SYNAGIS INTRAMUSCULAR SOLUTION 100 MG/ML, 50 MG/0.5ML

Formulary PA

Synera External Patch 70-70 MG Benefit Exclusion

136

Drug Name Formulary Status Requirements/LimitsSYNJARDY ORAL TABLET 12.5-1000 MG, 12.5-500 MG, 5-1000 MG, 5-500 MG


SYNVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 16 MG/2ML

Formulary PA

SYNVISC ONE INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 48 MG/6ML

Formulary PA

syringe 10-12 ml 12 ml Formulary OTC


syringe 20g x 1" 12 ml, 20g x 1" 6 ml, 21g x 1" 6 ml, 21g x 1-1/4" 3 ml, 21g x 1-1/4" 6 ml, 22g x 1" 12 ml, 22g x 1" 6 ml, 22g x 1-1/2" 12 ml, 22g x 1-1/2" 6 ml, 22g x 1-1/4" 6 ml, 22g x 3/4" 3 ml, 27g x 1-1/4" 3 ml, 2g x 1-1/4" 3 ml

Formulary OTC





syringe luer slip 1 ml Formulary

syringe luer slip 26g x 3/8" 1 ml, 27g x 1/2" 1 ml Formulary OTC

syringe precisedose dispenser Formulary

SYRSPEND SF ORAL LIQUID Formulary

SYRSPEND SF PH4 ORAL SUSPENSION RECONSTITUTED

Formulary

syrup nf oral syrup 85 % Formulary OTC

SYSTANE BALANCE OPHTHALMIC SOLUTION 0.6 % Formulary OTC

SYSTANE LID WIPES EXTERNAL PAD Formulary OTC

SYSTANE OPHTHALMIC GEL 0.4-0.3 % Formulary OTC

SYSTANE OPHTHALMIC SOLUTION 0.4-0.3 % Formulary OTC

SYSTANE OVERNIGHT THERAPY OPHTHALMIC GEL 0.3 %

Formulary OTC

SYSTANE PRESERVATIVE FREE OPHTHALMIC SOLUTION 0.4-0.3 %

Formulary OTC

SYSTANE ULTRA OPHTHALMIC SOLUTION 0.4-0.3 %

Formulary OTC

SYSTANE ULTRA PF OPHTHALMIC SOLUTION 0.4-0.3 %

Formulary OTC

TABLOID ORAL TABLET 40 MG Formulary

tacrolimus external ointment 0.03 %, 0.1 % Formulary PA

tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg Formulary

tadalafil (pah) oral tablet 20 mg Formulary PA; AGE (Min 18 Years)

tamoxifen citrate oral tablet 10 mg, 20 mg Formulary

tamsulosin hcl oral capsule 0.4 mg Formulary

TANDEM ORAL CAPSULE 162-115.2 MG Formulary OTC

tangerine oil Formulary OTC

TARGRETIN EXTERNAL GEL 1 % Formulary

taron forte oral capsule Formulary

TARON-PREX ORAL CAPSULE 30-1.2-265 MG Formulary

TARSUM EXTERNAL SHAMPOO 10-5 % Formulary OTC

137

Drug Name Formulary Status Requirements/Limitstaurine oral capsule 500 mg Formulary OTC

tazarotene external cream 0.1 % Formulary PA

TAZORAC EXTERNAL CREAM 0.05 % Formulary PA

TAZORAC EXTERNAL GEL 0.05 %, 0.1 % Formulary PA

TAZTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG

Formulary

tb syringe 1 ml Formulary

tdm solution external solution Formulary

TEAR FLO OPHTHALMIC STRIP Formulary OTC

TEARS NATURALE PM OPHTHALMIC OINTMENT 3-94 %

Formulary OTC

TECHLITE AST LANCETS Formulary OTC; QL (150 EA per 30 days)

TECHLITE LANCETS Formulary OTC; QL (150 EA per 30 days)

TECHLITE LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

TECNU FIRST AID EXTERNAL GEL 0.2-2.5 % Formulary OTC

TEGADERM CONTACT LAYER PAD 8"X10" Formulary OTC

TEGADERM FOAM ADHESIVE PAD 2-3/4"X2-3/4" , 2-3/4"X3" , 4"X4-1/2" , 5-5/8"X5-5/8" , 5-5/8"X6-1/8" , 7-1/2"X8-3/4"

Formulary OTC

TEGADERM FOAM PAD 3-1/2"X3-1/2" Formulary OTC

TEGADERM HYDROGEL WOUND FILLER EXTERNAL GEL

Formulary OTC

telmisartan oral tablet 20 mg, 40 mg, 80 mg Formulary

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

Formulary

temazepam oral capsule 15 mg, 22.5 mg, 30 mg, 7.5 mg Formulary

TEMIXYS ORAL TABLET 300-300 MG Formulary

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

Formulary

temsirolimus intravenous solution 25 mg/ml Formulary

tenofovir disoproxil fumarate oral tablet 300 mg Formulary

tension headache oral tablet 500-65 mg Formulary OTC

terazosin hcl oral capsule 1 mg, 2 mg, 5 mg Formulary QL (34 EA per 34 days)

terazosin hcl oral capsule 10 mg Formulary QL (68 EA per 34 days)

terbinafine hcl oral tablet 250 mg Formulary

terbutaline sulfate oral tablet 2.5 mg, 5 mg Formulary

terconazole vaginal cream 0.4 % Formulary QL (45 GM per 30 days)

terconazole vaginal cream 0.8 % Formulary QL (20 GM per 30 days)

terconazole vaginal suppository 80 mg Formulary QL (3 EA per 30 days)

teriparatide (recombinant) subcutaneous solution pen-injector 620 mcg/2.48ml

Formulary QL (2.48 ML per 30 days)

terocin external lotion 2.5-0.025-10-25 % Formulary OTC

terocin external patch 4-4 % Formulary OTC

teroderm-plus external cream Formulary

TESTOPEL IMPLANT PELLET 75 MG Formulary

138

Drug Name Formulary Status Requirements/Limitstestosterone cypionate intramuscular solution 100 mg/ml, 200 mg/ml

Formulary

testosterone enanthate intramuscular solution 200 mg/ml Formulary

testosterone transdermal gel 12.5 mg/act (1%), 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 25 mg/2.5gm (1%), 40.5 mg/2.5gm (1.62%), 50 mg/5gm (1%)


tetanus-diphtheria toxoids td intramuscular suspension 2-2 lf/0.5ml


tetrabenazine oral tablet 12.5 mg, 25 mg Formulary PA; QL (120 EA per 30 days)

tetracycline hcl oral capsule 250 mg, 500 mg Formulary

TETRA-FORMULA CGH/SORE THROAT MOUTH/THROAT LOZENGE 10-15 MG

Formulary OTC

tgt alcohol swabs pad 70 % 70 % Formulary OTC

tgt first aid cleansing external liquid 2.5-0.13 % Formulary OTC

tgt lancet micro thin 33g Formulary OTC; QL (150 EA per 30 days)

tgt lancet thin 26g Formulary OTC; QL (150 EA per 30 days)

tgt lancet ultra thin 30g Formulary OTC; QL (150 EA per 30 days)

tgt lubricant eye drops ophthalmic solution 0.95 % Formulary OTC

tgt lubricant redness reliever ophthalmic solution 0.03-0.5 %

Formulary OTC

tgt omeprazole oral tablet delayed release 20 mg Formulary OTC

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

Formulary PA

THE ITCH ERASER EXTERNAL SOLUTION 2 % Formulary OTC

THEOCHRON ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG, 200 MG, 300 MG

Formulary

theophylline er oral tablet extended release 12 hour 450 mg Formulary

theophylline er oral tablet extended release 24 hour 400 mg, 600 mg

Formulary

THERACOF PLUS COUGH/COLD REL ORAL LIQUID 5-10-100-325 MG/5ML

Formulary OTC

THERACYS INTRAVESICAL SUSPENSION RECONSTITUTED 81 MG/VIAL

Formulary

THERA-D 4000 ORAL TABLET 100 MCG (4000 UT) Formulary OTC

THERAFLU COLD & COUGH ORAL PACKET 10-20-20 MG

Formulary OTC

THERAFLU EXPRESSMAX ORAL LIQUID 12.5-5-325 MG/15ML

Formulary OTC

THERAFLU FLU & SORE THROAT ORAL PACKET 20-10-650 MG

Formulary OTC

THERAFLU SEVERE COLD & COUGH ORAL PACKET Formulary OTC

THERAFLU SEVERE COLD DAYTIME ORAL TABLET 15-5-325 MG

Formulary OTC

THERAFLU SEVERE COLD NIGHTTIME ORAL PACKET 25-10-500 MG

Formulary OTC

THERAFLU SEVERE COLD NIGHTTIME ORAL TABLET 5-2-10-325 MG

Formulary OTC

THERAFLU SEVERE COLD ORAL PACKET 20-10-500 MG

Formulary OTC

139

Drug Name Formulary Status Requirements/LimitsTHERAFLU SEVERE COLD/CGH NIGHT ORAL PACKET 25-10-650 MG

Formulary OTC

THERAFLU WARMING RELIEF SINUS ORAL LIQUID 12.5-5-325 MG/15ML

Formulary OTC

THERA-GESIC EXTERNAL CREAM 0.5-15 % Formulary OTC

THERANATAL COMPLETE ORAL 27-1 & 300 MG Formulary OTC

THERANATAL OVAVITE ORAL THERAPY PACK 18-1 & 125 MG

Formulary OTC

THERAPLEX T EXTERNAL SHAMPOO 1 % Formulary OTC

THERASEAL HAND PROTECTION EXTERNAL LOTION 1 %

Formulary OTC

THERATEARS NUTRITION ORAL CAPSULE Formulary OTC

THERATEARS OPHTHALMIC GEL 1 % Formulary OTC

THERATEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC

thermometer covers Formulary OTC

thiamine oral capsule 50 mg Formulary OTC

THINLETS GP LANCETS Formulary OTC; QL (150 EA per 30 days)

thioridazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg Formulary AGE (Min 18 Years)

thiotepa injection solution reconstituted 15 mg Formulary

thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg Formulary AGE (Min 18 Years)

thrivite 19 oral tablet 29-1 mg Formulary

THYROLAR-1 ORAL TABLET 60 MG Formulary

THYROLAR-1/2 ORAL TABLET 30 MG Formulary

THYROLAR-1/4 ORAL TABLET 15 MG Formulary



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

TICOVAC INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 2.4 MCG/0.5ML

Formulary

TIELLE PAD 7"X7" Formulary OTC

TIGER BALM EXTRA STRENGTH EXTERNAL OINTMENT 11-10 %

Formulary OTC

TIGER BALM LINIMENT EXTERNAL LIQUID 16-28 % Formulary OTC

TIGER BALM MUSCLE RUB EXTERNAL CREAM 3-5-15 %

Formulary OTC

TIGER BALM NECK & SHOULDER RUB EXTERNAL CREAM 10-11 %

Formulary OTC

TIGER BALM PAIN RELIEVING EXTERNAL PATCH 80-24-16 MG

Formulary OTC

TIGER BALM PAIN RELIEVING LG EXTERNAL PATCH 70-230 MG

Formulary OTC

TIGER BALM RED EXTRA STRENGTH EXTERNAL OINTMENT

Formulary OTC

TIGER BALM REGULAR STRENGTH EXTERNAL OINTMENT 11-8 %

Formulary OTC

TIGER BALM ULTRA STRENGTH EXTERNAL OINTMENT

Formulary OTC

140

Drug Name Formulary Status Requirements/LimitsTILIA FE ORAL TABLET 1-20/1-30/1-35 MG-MCG Formulary QL (28 EA per 28 days)

timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 %

Formulary

timolol maleate ophthalmic solution 0.25 %, 0.5 % Formulary

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

TINACTIN EXTERNAL AEROSOL 1 % Formulary OTC

TINACTIN EXTERNAL AEROSOL POWDER 1 % Formulary OTC

TINACTIN JOCK ITCH EXTERNAL CREAM 1 % Formulary OTC

TITRALAC ORAL TABLET CHEWABLE 420 MG Formulary OTC

TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG Formulary

TIVICAY PD ORAL TABLET SOLUBLE 5 MG Formulary

tizanidine hcl oral capsule 2 mg, 4 mg, 6 mg Formulary

tizanidine hcl oral tablet 2 mg, 4 mg Formulary

TN DICKINSONS WITCH HAZEL EXTERNAL PAD Formulary OTC

TOBI PODHALER INHALATION CAPSULE 28 MG FormularyST; QL (224 EA per 28 days); AGE (Min 6 Years)

TOBRADEX OPHTHALMIC OINTMENT 0.3-0.1 % Formulary

tobramycin ophthalmic solution 0.3 % Formulary

tobramycin-dexamethasone ophthalmic suspension 0.3-0.1 %

Formulary

TODAY SPONGE VAGINAL 1000 MG Formulary OTC

todays health thin lancets 28g Formulary OTC; QL (150 EA per 30 days)

todays health thin lancets 30g Formulary OTC; QL (150 EA per 30 days)

tolazamide oral tablet 250 mg, 500 mg Formulary

tolbutamide oral tablet 500 mg Formulary

tolmetin sodium oral capsule 400 mg Formulary

tolnaftate external powder 1 % Formulary OTC

tolnaftate external solution 1 % Formulary OTC

tolterodine tartrate er oral capsule extended release 24 hour 2 mg, 4 mg


tolterodine tartrate oral tablet 1 mg, 2 mg Formulary QL (60 EA per 30 days)

toomey syringe 70 ml Formulary

topcare lancets micro-thin 33g Formulary OTC; QL (150 EA per 30 days)

topcare ultra comfort ins syr 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml

Formulary OTC


Formulary OTC

topcare ultra comfort ins syr 29g x 1/2" 1 ml 29g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

141

Drug Name Formulary Status Requirements/Limitstopcare ultra comfort ins syr 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml

Formulary OTC


Formulary OTC

TOPICAINE 5 EXTERNAL GEL 5 % Formulary OTC

topiramate oral capsule sprinkle 15 mg, 25 mg Formulary

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

topotecan hcl intravenous solution 4 mg/4ml Formulary

topotecan hcl intravenous solution reconstituted 4 mg Formulary

TOPROL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG, 25 MG

Formulary

torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg Formulary

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG, 8 MG

Formulary

TRACLEER ORAL TABLET 125 MG, 62.5 MG Formulary PA

TRACLEER ORAL TABLET SOLUBLE 32 MG Formulary PA

TRADJENTA ORAL TABLET 5 MG Formulary AGE (Min 18 Years)

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


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


tramadol hcl oral tablet 50 mg Formulary PA; QL (126 EA per 7 days)

tramadol-acetaminophen oral tablet 37.5-325 mg Formulary PA

trandolapril oral tablet 1 mg, 2 mg, 4 mg Formulary

tranexamic acid oral tablet 650 mg Formulary QL (30 EA per 30 days)

TRANQUILITY BRIEFS KIT Formulary OTC

TRANSANOSIL EXTERNAL LOTION 0.025-10-30 % Formulary OTC

transderm-iq external ointment 4-0.0375-10-20 % Formulary OTC

tranylcypromine sulfate oral tablet 10 mg Formulary

TRANZAREL EXTERNAL GEL 4 % Formulary

travel sickness oral tablet chewable 25 mg Formulary OTC

travoprost (bak free) ophthalmic solution 0.004 % Formulary

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

TREANDA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG, 25 MG

Formulary

T-RELIEF PAIN ARNICA + 12 EXTERNAL OINTMENT Formulary OTC

T-RELIEF PAIN ARNICA + 12 ORAL LIQUID Formulary OTC

T-RELIEF PAIN RELIEF COMBINATION THERAPY PACK TAB & CREA

Formulary OTC

T-RELIEF PAIN RELIEF EXTERNAL CREAM Formulary OTC

TRELSTAR MIXJECT INTRAMUSCULAR SUSPENSION RECONSTITUTED 11.25 MG, 22.5 MG, 3.75 MG

Formulary PA

treprostinil sodium injection solution 1 mg/ml, 10 mg/ml, 2.5 mg/ml, 5 mg/ml

Formulary PA

tretinoin external cream 0.025 %, 0.05 %, 0.1 % Formulary AGE (Max 18 Years)

tretinoin external gel 0.01 %, 0.025 % Formulary AGE (Max 18 Years)

142

Drug Name Formulary Status Requirements/Limitstretinoin oral capsule 10 mg Formulary

TREXALL ORAL TABLET 10 MG, 15 MG, 5 MG, 7.5 MG

Formulary

triacting nightime cold&cough oral liquid 6.25-2.5 mg/5ml Formulary OTC

triamcinolone acetonide aerosol 55 mcg/act nasal (otc) 55 mcg/act

Formulary

triamcinolone acetonide external cream 0.025 %, 0.1 %, 0.5 %

Formulary

triamcinolone acetonide external lotion 0.025 %, 0.1 % Formulary

triamcinolone acetonide external ointment 0.025 %, 0.05 %, 0.1 %, 0.5 %

Formulary

triamcinolone acetonide injection suspension 40 mg/ml Formulary

TRIAMINIC CHEST/NASAL CONGEST ORAL LIQUID 2.5-50 MG/5ML

Formulary OTC

TRIAMINIC COLD & ALLERGY ORAL SYRUP 1-2.5 MG/5ML

Formulary OTC

TRIAMINIC COLD/COUGH DAY TIME ORAL SYRUP 2.5-5 MG/5ML

Formulary OTC

TRIAMINIC COLD/COUGH ORAL 2.5-5 &2.5-6.25 MG/5ML

Formulary OTC

TRIAMINIC COUGH/RUNNY NOSE ORAL TABLET CHEWABLE 1-5 MG

Formulary OTC

TRIAMINIC COUGH/SORE THROAT ORAL TABLET CHEWABLE 160-5 MG

Formulary OTC

TRIAMINIC FEVER REDUCER ORAL SYRUP 160 MG/5ML

Formulary OTC

TRIAMINIC FLU COUGH & FEVER ORAL SYRUP 7.5-160-1 MG/5ML

Formulary OTC

TRIAMINIC FLU/COUGH/FEVER ORAL LIQUID 7.5-160-1 MG/5ML

Formulary OTC

TRIAMINIC LONG ACTING COUGH ORAL LIQUID 7.5 MG/5ML

Formulary OTC

TRIAMINIC LONG ACTING COUGH ORAL STRIP 7.5 MG

Formulary OTC

TRIAMINIC NIGHT TIME COLD/CGH ORAL SYRUP 6.25-2.5 MG/5ML

Formulary OTC

TRIAMINIC SORE THROAT MOUTH/THROAT SOLUTION 0.5 %

Formulary OTC

triamino oral tablet Formulary OTC

triamterene-hctz oral capsule 37.5-25 mg Formulary

triamterene-hctz oral tablet 37.5-25 mg, 75-50 mg Formulary

triazolam oral tablet 0.125 mg, 0.25 mg Formulary QL (34 EA per 34 days)

tri-buffered aspirin oral tablet 325 mg Formulary OTC

tricitrates oral solution 550-500-334 mg/5ml Formulary

trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg, 5 mg Formulary AGE (Min 18 Years)

trifluridine ophthalmic solution 1 % Formulary

trigels-f forte oral capsule 460-60-0.01-1 mg Formulary

trihexyphenidyl hcl oral elixir 0.4 mg/ml Formulary

143

Drug Name Formulary Status Requirements/Limitstrihexyphenidyl hcl oral tablet 2 mg, 5 mg Formulary

TRI-LO-SPRINTEC ORAL TABLET 0.18/0.215/0.25 MG-25 MCG

Formulary

trimethobenzamide hcl oral capsule 300 mg Formulary

trimethoprim oral tablet 100 mg Formulary

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

TRINATE ORAL TABLET Formulary

triple antibiotic external ointment 3.5-400-5000 Formulary OTC

TRIPLE FLEX ORAL TABLET 750-400-375 MG Formulary OTC

triple helix collagen external powder Formulary OTC

TRIPLE PASTE EXTERNAL OINTMENT 12.8 % Formulary OTC

triprolidine hcl oral liquid 0.313 mg/ml, 0.625 mg/ml Formulary OTC

TRISENOX INTRAVENOUS SOLUTION 12 MG/6ML Formulary

TRISPEC PSE PEDIATRIC ORAL LIQUID 30-10-187 MG/5ML

Formulary OTC

TRIUMEQ ORAL TABLET 600-50-300 MG Formulary

TRI-VI-SOL ORAL SOLUTION 750-400-35 UNIT-MG/ML

Formulary OTC

tri-vitamin/fluoride oral solution 0.5 mg/ml Formulary

TROCAINE THROAT MOUTH/THROAT LOZENGE 10 MG

Formulary OTC

TROCAL COUGH SUPPRESSANT MOUTH/THROAT LOZENGE 7.5 MG

Formulary OTC

trochibase s flakes Formulary OTC

TROMBONEX-D ORAL CAPSULE Formulary OTC

trospium chloride oral tablet 20 mg Formulary

TRUEPLUS GLUCOSE ORAL GEL Formulary OTC

TRUEPLUS GLUCOSE ORAL TABLET CHEWABLE Formulary OTC

TRUEPLUS INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

TRUEPLUS INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

144

Drug Name Formulary Status Requirements/LimitsTRUEPLUS INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

TRUEPLUS LANCETS 26G Formulary OTC; QL (150 EA per 30 days)




TRULICITY SUBCUTANEOUS SOLUTION PEN-INJECTOR 0.75 MG/0.5ML, 1.5 MG/0.5ML, 3 MG/0.5ML, 4.5 MG/0.5ML

Formulary

TRUSELTIQ (100MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 100 MG

Formulary PA

TRUSELTIQ (125MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 100 & 25 MG

Formulary PA


Formulary PA


Formulary PA

TRUSTEX NON-LUBRICATED Formulary OTC

TRUSTEX RIA NON-LUBRICATED Formulary OTC

trymine cg oral liquid 225-7.5 mg/5ml Formulary OTC

TUMS E-X 750 ORAL TABLET CHEWABLE 750 MG Formulary OTC

TUMS LASTING EFFECTS ORAL TABLET CHEWABLE 500 MG

Formulary OTC

TUMS ULTRA 1000 ORAL TABLET CHEWABLE 1000 MG

Formulary OTC

tuohy epidural needle tw 14g x 3" , 17g x 3-1/2" , 20g x 3-1/2"

Formulary OTC

TUSICOF ORAL TABLET 10-20-400 MG Formulary OTC

TUSNEL C ORAL SYRUP 30-10-100 MG/5ML Formulary OTC

TUSNEL PEDIATRIC ORAL LIQUID 15-5-50 MG/5ML, 7.5-50 MG/ML

Formulary OTC; AGE (Min 6 Years)

TUSNEL-DM PEDIATRIC ORAL LIQUID 7.5-2.5-25 MG/ML

Formulary OTC

tussin cf cough & cold oral liquid 5-10-100 mg/5ml Formulary OTC

tussin cf max multi-symptom oral liquid 5-10-200 mg/5ml Formulary OTC

tussin cough dm oral syrup 100-10 mg/5ml Formulary OTC

tussin cough long-acting oral syrup 15 mg/5ml Formulary OTC

tussin cough oral capsule 15 mg Formulary OTC

tussin cough oral syrup 15 mg/5ml Formulary OTC

tussin dm max oral liquid 10-200 mg/5ml Formulary OTC

tussin oral syrup 100 mg/5ml Formulary OTC

TUSSI-PRES ORAL LIQUID 5-10-200 MG/5ML Formulary OTC

TUSSI-PRES PE PEDIATRIC ORAL LIQUID 2.5-100 MG/5ML

Formulary OTC

TUSSI-PRES PEDIATRIC ORAL LIQUID 2.5-5-75 MG/5ML

Formulary OTC

TUSSLIN PEDIATRIC ORAL LIQUID 2.5-7.5-88 MG/ML

Formulary OTC

145

Drug Name Formulary Status Requirements/LimitsTWINRIX INTRAMUSCULAR SUSPENSION 720-20 Formulary AGE (Min 19 Years)

TYBOST ORAL TABLET 150 MG Formulary

TYLENOL 8 HOUR ORAL TABLET EXTENDED RELEASE 650 MG

Formulary OTC

TYLENOL CHILDRENS CLD+CGH ORAL SUSPENSION 5-160-1 MG/5ML

Formulary OTC

TYLENOL CHILDRENS PLUS MS COLD ORAL SUSPENSION 2.5-1-5-160 MG/5ML

Formulary OTC

TYLENOL COLD & HEAD ORAL TABLET 5-325-200 MG

Formulary OTC

TYLENOL COLD MAX ORAL LIQUID 10-5-325 MG/15ML

Formulary OTC

TYLENOL COLD MULTI-SYMPTOM ORAL LIQUID 5-6.25-10-325 MG/15ML

Formulary OTC

TYLENOL COLD/FLU SEVERE ORAL TABLET 5-10-200-325 MG

Formulary OTC

TYLENOL COLD/FLU SEVERE ORAL TABLET THERAPY PACK

Formulary OTC

TYLENOL EXTRA STRENGTH ORAL TABLET 500 MG

Formulary OTC

TYLENOL INFANTS ORAL SUSPENSION 160 MG/5ML

Formulary OTC

TYLENOL ORAL CAPSULE 325 MG Formulary OTC

TYLENOL ORAL TABLET 325 MG Formulary OTC

TYLENOL PM EXTRA STRENGTH ORAL TABLET 500-25 MG

Formulary OTC

TYLENOL SINUS SEVERE ORAL TABLET 5-325-200 MG

Formulary OTC

TYLENOL WARMING COUGH/CONGEST ORAL LIQUID 5-10-200-325 MG/15ML

Formulary OTC

TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG/0.5ML


tyrosine oral packet 1000 mg Formulary OTC

TYVASO REFILL INHALATION SOLUTION 0.6 MG/ML

Formulary PA

UBRELVY ORAL TABLET 100 MG, 50 MG Formulary ST

ULCEREASE MOUTH/THROAT LIQUID 0.6 % Formulary OTC

ULCEREASE MOUTH/THROAT SOLUTION 0.6-1.5 % Formulary OTC

ULTICARE ALCOHOL SWABS PAD Formulary OTC

ULTICARE ALCOHOL SWABS PAD 70 % 70 % Formulary OTC

ULTICARE INSULIN SAFETY SYR 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary

ULTICARE INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary

ULTICARE INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

ULTICARE INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC

146

Drug Name Formulary Status Requirements/LimitsULTICARE INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

ULTICARE SYRINGE 22G X 1-1/2" 3 ML Formulary OTC

ULTICARE TUBERCULIN SAFETY SYR 25G X 1" 1 ML, 25G X 5/8" 1 ML

Formulary OTC

ultilet alcohol swabs pad Formulary OTC

ULTILET CLASSIC LANCETS Formulary OTC; QL (150 EA per 30 days)

ULTILET INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML

Formulary OTC

ULTILET INSULIN SYRINGE 30G X 1/2" 1 ML 30G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

147

Drug Name Formulary Status Requirements/LimitsULTILET INSULIN SYRINGE 31G X 15/64" 0.3 ML (OTC) 31G X 15/64" 0.3 ML

Formulary

ULTILET INSULIN SYRINGE 31G X 15/64" 0.3 ML (RX) 31G X 15/64" 0.3 ML

Formulary


Formulary OTC


Formulary OTC


Formulary OTC

ULTILET INSULIN SYRINGE SHORT 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC


Formulary OTC

ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

ULTILET LANCETS Formulary OTC; QL (150 EA per 30 days)

ultra comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml

Formulary OTC

ULTRA FRESH OPHTHALMIC SOLUTION 0.5 % Formulary OTC

ULTRA FRESH PM OPHTHALMIC OINTMENT Formulary OTC

ULTRA MEGA GOLD ORAL TABLET EXTENDED RELEASE

Formulary OTC

ULTRA MIDE 25 EXTERNAL LOTION 25 % Formulary OTC

ULTRABAG/DIANEAL PD-2/4.25%DEX INTRAPERITONEAL SOLUTION 485 MOSM/L

Formulary

ultracin external lotion 0.025-10-28 % Formulary OTC

ULTRACIN M EXTERNAL GEL 5 % Formulary OTC

ULTRACIN T EXTERNAL LOTION 10 % Formulary OTC

ULTRACIN-M EXTERNAL GEL 10 % Formulary OTC

ultra-comfort insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml

Formulary OTC

ultra-comfort insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

148

Drug Name Formulary Status Requirements/Limitsultra-comfort insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

ultrasone external cream Formulary OTC

ULTRA-THIN II INS SYR SHORT 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML

Formulary OTC


Formulary OTC

ULTRA-THIN II INS SYR SHORT 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

ULTRA-THIN II INS SYR SHORT 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC

ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary OTC

ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

ULTRA-THIN II LANCETS Formulary OTC; QL (150 EA per 30 days)

UMCKA ELDERBERRY COLD+FLU ORAL SYRUP Formulary OTC

UMCKA FASTACTIVES COLD+FLU ORAL PACKET Formulary OTC

UMECTA MOUSSE EXTERNAL FOAM 40 % Formulary

UNDELENIC EXTERNAL TINCTURE Formulary OTC

unibase external cream Formulary OTC

UNILET COMFORTOUCH LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET EXCELITE Formulary OTC; QL (150 EA per 30 days)

UNILET EXCELITE II Formulary OTC; QL (150 EA per 30 days)

UNILET G.P. LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET G.P. SUPERLITE LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET GP 28 ULTRA THIN Formulary OTC; QL (150 EA per 30 days)

UNILET LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days)

UNILET SUPERLITE LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET SUPER-THIN 30G Formulary OTC; QL (150 EA per 30 days)

UNILET ULTRA-THIN 28G Formulary OTC; QL (150 EA per 30 days)

UNI-SOLVE EXTERNAL PAD Formulary OTC

UNIVERSAL 1 LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days)

149

Drug Name Formulary Status Requirements/LimitsUNIVERSAL 1 LANCETS THIN 33G Formulary OTC; QL (150 EA per 30 days)

UNIVERSAL 1 LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days)

universal ph in vitro strip Formulary OTC

UPTRAVI INTRAVENOUS SOLUTION RECONSTITUTED 1800 MCG

Formulary PA

UPTRAVI ORAL TABLET 1000 MCG, 1200 MCG, 1400 MCG, 1600 MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG

Formulary PA

UPTRAVI ORAL TABLET THERAPY PACK 200 & 800 MCG

Formulary PA

urea 20 intensive hydrating external cream 20 % Formulary OTC

urea external cream 40 %, 45 %, 50 % Formulary

urea external lotion 40 % Formulary

urea hydrating external foam 35 % Formulary

urea nail external gel 45 % Formulary

urinary pain relief oral tablet 95 mg Formulary OTC

URO-MAG ORAL CAPSULE 140 MG Formulary OTC

ursodiol oral capsule 300 mg Formulary

ursodiol oral tablet 250 mg, 500 mg Formulary

vagicaine external cream 20-3 % Formulary OTC

vagicaine vaginal cream 20-3 % Formulary OTC

VAGISIL EXTERNAL CREAM 5-2 % Formulary OTC

valacyclovir hcl oral tablet 1 gm, 500 mg Formulary

valerian oral capsule 500 mg Formulary OTC

valerian root oral capsule 450 mg Formulary OTC

valganciclovir hcl oral solution reconstituted 50 mg/ml Formulary

valganciclovir hcl oral tablet 450 mg Formulary

VALINE 1000 ORAL PACKET 1 GM Formulary OTC

valine oral packet 50 mg Formulary OTC

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

Formulary

valproate sodium oral solution 250 mg/5ml Formulary

valproic acid oral capsule 250 mg Formulary

valproic acid oral solution 250 mg/5ml Formulary

valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg Formulary QL (34 EA per 34 days)

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

Formulary

VALSTAR INTRAVESICAL SOLUTION 40 MG/ML Formulary

VALTOCO 10 MG DOSE NASAL LIQUID 10 MG/0.1ML Formulary PA

VALTOCO 15 MG DOSE NASAL LIQUID THERAPY PACK 7.5 MG/0.1ML

Formulary PA

VALTOCO 20 MG DOSE NASAL LIQUID THERAPY PACK 10 MG/0.1ML

Formulary PA

VALTOCO 5 MG DOSE NASAL LIQUID 5 MG/0.1ML Formulary PA

value health insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml

Formulary OTC

150

Drug Name Formulary Status Requirements/Limitsvalue health insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

value plus lancet standard 21g Formulary OTC; QL (150 EA per 30 days)

value plus lancets super thin Formulary OTC; QL (150 EA per 30 days)

value plus lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

valumark lancet super thin 30g Formulary OTC; QL (150 EA per 30 days)

valumark lancet ultra thin 28g Formulary OTC; QL (150 EA per 30 days)

VAMOUSSE LICE TREATMENT EXTERNAL FOAM Formulary OTC

VANACHOL ORAL CAPSULE Formulary OTC

VANACOF AC ORAL LIQUID 12.5-25 MG/30ML Formulary OTC

VANACOF DM ORAL LIQUID 10-18-200 MG/15ML Formulary OTC

VANACOF ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC

VANACOF-8 ORAL LIQUID 25-50 MG/15ML Formulary OTC

vanadium oral capsule 7.5 mg Formulary OTC

VANATAB AC ORAL TABLET 12.5-25 MG Formulary OTC

VANATAB DM ORAL TABLET 5-9-198 MG Formulary OTC

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

Formulary

vancomycin hcl in dextrose intravenous solution 1-5 gm/250ml-%

Formulary

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

Formulary

vancomycin hcl intravenous solution reconstituted 1 gm, 10 gm, 1000 mg, 500 mg, 5000 mg, 750 mg

Formulary

vancomycin hcl oral capsule 125 mg, 250 mg Formulary

VANDAZOLE VAGINAL GEL 0.75 % Formulary

VANICREAM DIAPER RASH EXTERNAL OINTMENT 1.1-40 %

Formulary OTC

VANIPLY EXTERNAL OINTMENT 1 % Formulary OTC

VANISHPOINT SAFETY SYRINGE 25G X 1-1/2" 10 ML, 25G X 1-1/2" 5 ML, 27G X 1-1/2" 10 ML, 27G X 1-1/2" 5 ML

Formulary OTC

VANTAS SUBCUTANEOUS KIT 50 MG Formulary PA

VAPOR PATCH EXTERNAL PATCH Formulary OTC

vaporizing steam inhalation liquid 6.2 % Formulary OTC

VAQTA INTRAMUSCULAR SUSPENSION 25 UNIT/0.5ML, 50 UNIT/ML


varenicline tartrate oral tablet 0.5 mg, 1 mg Formulary

VARIVAX SUBCUTANEOUS INJECTABLE 1350 PFU/0.5ML


VASHE WOUND THERAPY EXTERNAL SOLUTION Formulary OTC

VASOCLEAR-A OPHTHALMIC SOLUTION 0.02-0.25 %

Formulary OTC

VASOFLEX D1 ORAL TABLET 900-100 MG Formulary OTC

VAXNEUVANCE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

Formulary

VCF VAGINAL CONTRACEPTIVE VAGINAL FILM 28 %

Formulary OTC

151

Drug Name Formulary Status Requirements/LimitsVCF VAGINAL CONTRACEPTIVE VAGINAL FOAM 12.5 %

Formulary OTC

VCF VAGINAL CONTRACEPTIVE VAGINAL GEL 4 % Formulary OTC

VECTIBIX INTRAVENOUS SOLUTION 100 MG/5ML, 400 MG/20ML

Formulary

VELCADE INJECTION SOLUTION RECONSTITUTED 3.5 MG

Formulary

venaliv oral tablet 900-100-100 mg Formulary OTC

VENIA EXTERNAL PATCH 4-4 % Formulary OTC

venlafaxine hcl er oral capsule extended release 24 hour150 mg, 37.5 mg, 75 mg

Formulary

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

Formulary ST

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

Formulary

VENTAVIS INHALATION SOLUTION 10 MCG/ML, 20 MCG/ML

Formulary

VENTOLIN HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT

Formulary

verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 200 mg, 240 mg, 300 mg, 360 mg

Formulary

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

Formulary

verapamil hcl intravenous solution 2.5 mg/ml Formulary

verapamil hcl oral tablet 120 mg, 40 mg, 80 mg Formulary

VERELAN PM ORAL CAPSULE EXTENDED RELEASE 24 HOUR 200 MG

Formulary

VERQUVO ORAL TABLET 10 MG, 2.5 MG, 5 MG Formulary PA

VERSAPLUS ORAL SYRUP Formulary

VERSIVA XC PAD 5-1/2"X5-1/2" Formulary OTC

VH ESSENTIALS UTI RELIEF ORAL TABLET 97.2 MG Formulary OTC

VIBERZI ORAL TABLET 100 MG, 75 MG Formulary PA

VIBRAMYCIN ORAL SYRUP 50 MG/5ML Formulary

VICKS DAYQUIL MUCUS CONTROL DM ORAL LIQUID 10-200 MG/15ML

Formulary OTC

VICKS NYQUIL CHILDRENS CLD/CGH ORAL LIQUID 2-15 MG/15ML

Formulary OTC

VICKS NYQUIL COLD & FLU NIGHT ORAL LIQUID 15-6.25-325 MG/15ML, 30-650-4 MG/30ML

Formulary OTC

VICKS NYQUIL COUGH ORAL LIQUID 12.5-30 MG/30ML

Formulary OTC

VICKS NYQUIL SEVERE COLD & FLU ORAL TABLET 5-6.25-10-325 MG

Formulary OTC

VICKS SINEX DAYQUIL/NYQUIL ORAL Formulary OTC

VICKS SINEX DAYTIME ORAL CAPSULE 5-325 MG Formulary OTC

VICKS SINEX NIGHTTIME ORAL CAPSULE 6.25-5-325 MG

Formulary OTC

VICKS VAPO STEAM INHALATION LIQUID 6.2 % Formulary OTC

152

Drug Name Formulary Status Requirements/LimitsVICKS VAPODROPS MOUTH/THROAT LOZENGE 1.7 MG, 3.3 MG

Formulary OTC

VICKS VAPOINHALER INHALATION INHALER Formulary OTC

VICKS VAPOPADS PEDIATRIC PAD Formulary OTC

VICKS VAPORIZER SCENT PAD Formulary OTC

VICKS VAPORUB EXTERNAL OINTMENT 4.73-1.2-2.6 %

Formulary OTC

VICODIN ES ORAL TABLET 7.5-300 MG Formulary PA; QL (84 EA per 7 days)

VICODIN HP ORAL TABLET 10-300 MG Formulary PA; QL (63 EA per 7 days)

VICODIN ORAL TABLET 5-300 MG Formulary PA; QL (126 EA per 7 days)

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR 18 MG/3ML

Formulary

VIDA MIA UNILET LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

VIDEX EC ORAL CAPSULE DELAYED RELEASE 400 MG

Formulary

VIDEX ORAL SOLUTION RECONSTITUTED 2 GM, 4 GM

Formulary

VIIBRYD ORAL TABLET 10 MG Formulary PA; QL (68 EA per 34 days)

VIIBRYD ORAL TABLET 20 MG, 40 MG Formulary PA; QL (34 EA per 34 days)

VIMPAT INTRAVENOUS SOLUTION 200 MG/20ML Formulary

VIMPAT ORAL SOLUTION 10 MG/ML Formulary

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

Formulary

VINATE II ORAL TABLET 29-1 MG Formulary

VINATE M ORAL TABLET 27-1 MG Formulary

vinblastine sulfate intravenous solution 1 mg/ml Formulary

VINCASAR PFS INTRAVENOUS SOLUTION 1 MG/ML Formulary

VINCE DENTAL POWDER Formulary OTC

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

Formulary

VIRACEPT ORAL TABLET 250 MG, 625 MG Formulary

VIREAD ORAL POWDER 40 MG/GM Formulary

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG, 300 MG

Formulary

virtussin dac oral solution 30-10-100 mg/5ml Formulary OTC

VISI-FLOW IRRIGATION STARTER KIT Formulary OTC

vita-c oral crystals Formulary OTC

VITA-CALCIUM ORAL WAFER 333-133 MG-UNIT Formulary OTC

VITADYE EXTERNAL LOTION 5 % Formulary OTC

VITAFOL ULTRA ORAL CAPSULE 29-0.6-0.4-200 MG Formulary

VITALINE BIOTIN FORTE/ZINC ORAL TABLET 0.8 MG

Formulary OTC

VITALINE COQ10 ORAL TABLET 200 MG, 60 MG Formulary OTC

VITA-MAG ORAL TABLET 133-5-10 MG Formulary OTC

VITAMAX ORAL TABLET CHEWABLE 60 MG Formulary OTC

153

Drug Name Formulary Status Requirements/LimitsVITAMELTS ENERGY VITAMIN B-12 ORAL TABLET DISPERSIBLE 1500 MCG

Formulary OTC

vitamin a & d oral capsule 5000-400 unit Formulary OTC

vitamin a & d oral tablet 10000-400 unit Formulary OTC

VITAMIN A FISH ORAL CAPSULE 7500 UNIT Formulary OTC

vitamin a oral capsule 10000 unit, 8000 unit Formulary OTC

vitamin a palmitate oral tablet 10000 unit, 15000 unit Formulary OTC

vitamin a wrinkle treatment external gel Formulary OTC

vitamin a-beta carotene oral tablet 10000-1000 unit, 15000-10000 unit

Formulary OTC

vitamin b complex-c oral capsule Formulary OTC

vitamin b-1 oral tablet 50 mg Formulary OTC

vitamin b-12 oral liquid 1000 mcg/15ml Formulary OTC

vitamin b-12 oral lozenge 50 mcg, 500 mcg Formulary OTC

vitamin b-12 oral tablet 100 mcg, 1000 mcg, 500 mcg Formulary OTC

vitamin b12 sublingual liquid 3000 mcg/ml Formulary OTC

vitamin b-12 sublingual tablet sublingual 500 mcg Formulary OTC

vitamin b-2 oral tablet 25 mg, 50 mg Formulary OTC

vitamin b-6 er oral tablet extended release 200 mg Formulary OTC

vitamin b-6 oral tablet 100 mg Formulary OTC

vitamin c (calcium ascorbate) oral solution reconstituted Formulary OTC

vitamin c drops mouth/throat lozenge 60 mg Formulary OTC

vitamin c er oral capsule extended release 500 mg Formulary OTC

vitamin c gummies oral tablet chewable 125 mg Formulary OTC

vitamin c oral liquid , 500 mg/5ml Formulary OTC

vitamin c oral powder Formulary OTC

vitamin c oral tablet 100 mg, 250 mg, 500 mg Formulary OTC

vitamin c oral tablet chewable Formulary OTC

vitamin c plus wild rose hips oral tablet chewable 500 mg Formulary OTC

vitamin c-rose hips er oral tablet extended release 1000 mg, 500 mg

Formulary OTC

vitamin d2 oral tablet 50 mcg (2000 ut) Formulary OTC

vitamin d3 oral capsule 1.25 mg (50000 ut), 125 mcg (5000 ut), 250 mcg (10000 ut), 50 mcg (2000 ut)

Formulary OTC

vitamin d3 oral liquid 5000 unit/ml Formulary OTC

vitamin d3 oral tablet 1.25 mg (50000 ut) Formulary OTC

vitamin d3 oral tablet chewable 10 mcg (400 unit), 25 mcg (1000 ut), 50 mcg (2000 ut)

Formulary OTC

vitamin d-400 oral tablet 10 mcg (400 unit) Formulary OTC

VITAMIN E & C BEAUTY LOTION EXTERNAL LOTION

Formulary OTC

VITAMIN E & K BEAUTIFUL SKIN EXTERNAL OIL Formulary OTC

vitamin e beauty external oil 24000 unit/52ml Formulary OTC

vitamin e external cream Formulary OTC

vitamin e external liquid 24000 unit Formulary OTC

154

Drug Name Formulary Status Requirements/Limitsvitamin e oral capsule 100 unit, 45 mg (100 unit) Formulary OTC

vitamin e oral tablet 268 mg (400 unit), 400 unit Formulary OTC

vitamin e/selenium oral capsule 400-50 unit-mcg Formulary OTC

vitamins acd-fluoride oral solution 0.25 mg/ml Formulary

VITAMINS E & A BEAUTY OIL EXTERNAL OIL 1000-14000 UNIT/52ML

Formulary OTC

VITAMINS E & D BEAUTY OIL EXTERNAL OIL 400-14000 UNIT/52ML

Formulary OTC

VITA-RAY EXTERNAL CREAM 10-200000-3000 Formulary OTC

VITONIC ORAL LIQUID Formulary OTC

VIVA DROPS OPHTHALMIC SOLUTION 1 % Formulary OTC

viva external patch 2.5-4-2 % Formulary OTC

VIVABEN ORAL CAPSULE Formulary OTC

VIVITROL INTRAMUSCULAR SUSPENSION RECONSTITUTED 380 MG

Formulary

VIVOTIF ORAL CAPSULE DELAYED RELEASE Formulary AGE (Min 19 Years)

vocabria oral tablet 30 mg Formulary

voriconazole oral suspension reconstituted 40 mg/ml Formulary PA

voriconazole oral tablet 200 mg, 50 mg Formulary PA

vp insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC

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


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


WAL-DRYL ANTI-ITCH EXTERNAL LIQUID 2-0.1 % Formulary OTC

WAL-DRYL EXTERNAL CREAM 2-0.1 % Formulary OTC

WAL-DRYL PE ALLERGY & SINUS ORAL TABLET 25-10 MG

Formulary OTC

WAL-FEX D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 24 HOUR 180-240 MG

Formulary OTC

WAL-FLU COLD & SORE THROAT ORAL PACKET 20-10-325 MG

Formulary OTC

WAL-FLU SEV COLD/CGH DAY/NIGHT ORAL PACKET

Formulary OTC

WALGREENS LANCETS Formulary OTC; QL (150 EA per 30 days)

walgreens lancets micro thin Formulary OTC; QL (150 EA per 30 days)

walgreens lancets super thin Formulary OTC; QL (150 EA per 30 days)

WALGREENS THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

WALGREENS ULTRA THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

WAL-ITIN D ORAL TABLET EXTENDED RELEASE 12 HOUR 5-120 MG

Formulary OTC

WAL-MUCIL PLUS CALCIUM ORAL CAPSULE Formulary OTC

WAL-PHED PE DAYTIME/NIGHTTIME ORAL Formulary OTC

WAL-SLEEP Z LIQUID SHOTS ORAL LIQUID 50 MG/50ML

Formulary OTC

WAL-SLEEP Z ORAL TABLET DISPERSIBLE 25 MG Formulary OTC

wal-tap cold/allergy oral liquid 2-5 mg/10ml Formulary OTC

155

Drug Name Formulary Status Requirements/LimitsWAL-TUSSIN CF MAX ORAL LIQUID 5-10-200-325 MG/10ML

Formulary OTC

wal-tussin cf oral liquid 30-10-100 mg/5ml Formulary OTC

wal-tussin cough relief oral tablet chewable 7.5 mg Formulary OTC

WAL-ZYR CHILDRENS ORAL TABLET CHEWABLE 10 MG, 5 MG

Formulary OTC

WAL-ZYR ORAL CAPSULE 10 MG Formulary OTC

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

Formulary

wart remover maximum strength external gel 17 % Formulary OTC

wart remover maximum strength external liquid 17 % Formulary OTC

water tabs oral tablet Formulary OTC

wax for braces wax Formulary OTC

WEBCOL ALCOHOL PREP LARGE PAD 70 % 70 % Formulary OTC

WEBCOL ALCOHOL PREP MEDIUM PAD 70 % 70 % Formulary OTC

wee care oral suspension 15 mg/1.25ml Formulary OTC

wegmans complete prenatal+dha oral 28-0.975 & 200 mg Formulary OTC

WEISS EPIDURAL NEEDLE 20G X 2" Formulary OTC

WEISS EPIDURAL NEEDLE TW 17G X 5" , 18G X 3-1/2" , 18G X 5"

Formulary OTC

WELIREG ORAL TABLET 40 MG Formulary PA

WELLMIND MENTAL FOCUS ORAL TABLET CHEWABLE

Formulary OTC

WHITE PED ARTERIAL NEEDLE 19G X 1-1/2" , 20G X 1-1/2"

Formulary OTC

white petrolatum external ointment Formulary

white petroleum jelly external gel Formulary OTC

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM 2 %

Formulary


Formulary


Formulary


Formulary


Formulary


Formulary


Formulary


Formulary

WINGS MATERNITY PANTS 2X-3X Formulary OTC

WINRHO SDF INJECTION SOLUTION 1500 UNIT/1.3ML, 15000 UNIT/13ML, 2500 UNIT/2.2ML, 5000 UNIT/4.4ML

Formulary

witch hazel external liquid Formulary OTC

156

Drug Name Formulary Status Requirements/Limitswitch hazel external solution 86 % Formulary OTC

WIXELA INHUB INHALATION AEROSOL POWDER BREATH ACTIVATED 100-50 MCG/DOSE, 250-50 MCG/DOSE, 500-50 MCG/DOSE

Formulary

wound gel external gel Formulary OTC

wound gel spray external gel Formulary OTC

WYMZYA FE ORAL TABLET CHEWABLE 0.4-35 MG-MCG


XARELTO ORAL TABLET 10 MG, 15 MG, 2.5 MG, 20 MG

Formulary

XARELTO STARTER PACK ORAL TABLET THERAPY PACK 15 & 20 MG

Formulary

XEOMIN INTRAMUSCULAR SOLUTION RECONSTITUTED 100 UNIT, 200 UNIT, 50 UNIT

Formulary PA

XERAC AC EXTERNAL SOLUTION 6.25 % Formulary

XEROFORM PETROLAT GAUZE 1"X8" EXTERNAL Formulary

XGEVA SUBCUTANEOUS SOLUTION 120 MG/1.7ML Formulary

XIAFLEX INJECTION SOLUTION RECONSTITUTED 0.9 MG

Formulary PA

XIFAXAN ORAL TABLET 200 MG, 550 MG Formulary PA

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


XIIDRA OPHTHALMIC SOLUTION 5 % Formulary

XOFLUZA (40 MG DOSE) ORAL TABLET THERAPY PACK 2 X 20 MG


XOFLUZA (80 MG DOSE) ORAL TABLET THERAPY PACK 2 X 40 MG


XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML, 75 MG/0.5ML


XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED 150 MG


xolido external cream 2 % Formulary OTC

X-SEB T PEARL EXTERNAL SHAMPOO 10 % Formulary OTC

XTRA-CARE EXTERNAL LOTION Formulary OTC

XULANE TRANSDERMAL PATCH WEEKLY 150-35 MCG/24HR

Formulary

XYREM ORAL SOLUTION 500 MG/ML Formulary PA; QL (540 ML per 30 days)

YES FOR WOMEN EXTERNAL GEL Formulary OTC

YF-VAX SUBCUTANEOUS INJECTABLE Formulary AGE (Min 19 Years)

YUVAFEM VAGINAL TABLET 10 MCG Formulary

ZADITOR OPHTHALMIC SOLUTION 0.025 % Formulary OTC

ZAFEMY TRANSDERMAL PATCH WEEKLY 150-35 MCG/24HR

Formulary

zafirlukast oral tablet 10 mg, 20 mg Formulary

zaleplon oral capsule 10 mg Formulary QL (68 EA per 34 days)

zaleplon oral capsule 5 mg Formulary QL (34 EA per 34 days)

157

Drug Name Formulary Status Requirements/LimitsZANOSAR INTRAVENOUS SOLUTION RECONSTITUTED 1 GM

Formulary

ZANTAC 150 MAXIMUM STRENGTH ORAL TABLET 150 MG

Formulary OTC

ZANTAC 75 ORAL TABLET 75 MG Formulary OTC

Z-BUM EXTERNAL CREAM 22.5 % Formulary OTC

ZEASORB EXTERNAL POWDER Formulary OTC

ZEGERID OTC CAPSULE 20-1100 MG ORAL 20-1100 MG


ZELBORAF ORAL TABLET 240 MG Formulary

ZENATANE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG

Formulary

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT, 15000-47000 UNIT, 20000-63000 UNIT, 25000-79000 UNIT, 3000-10000 UNIT, 40000-126000 UNIT, 5000-24000 UNIT

Formulary PA

ZEPHREX-D ORAL TABLET ABUSE-DETERRENT 30 MG

Formulary OTC

ZE-PLUS ORAL CAPSULE Formulary OTC

ZERIT ORAL SOLUTION RECONSTITUTED 1 MG/ML Formulary

ZEVALIN Y-90 INTRAVENOUS KIT 3.2 MG/2ML Formulary

ZICAM ALLERGY RELIEF NASAL GEL Formulary OTC

ZICAM COLD REMEDY ORAL TABLET DISPERSIBLE Formulary OTC

zidovudine oral capsule 100 mg Formulary

zidovudine oral syrup 50 mg/5ml Formulary

zidovudine oral tablet 300 mg Formulary

ZIKS ARTHRITIS PAIN RELIEF EXTERNAL CREAM 0.025-1-12 %

Formulary OTC

ZILACTIN MOUTH/THROAT GEL 10 % Formulary OTC

ZIMS CRACK CREME DIABETIC EXTERNAL LIQUID Formulary OTC

ZIMS MAX-FREEZE EXTERNAL GEL 3.7 % Formulary OTC

zinc + vitamin c mouth/throat lozenge 20-120 mg Formulary OTC

ZINC 15 ORAL TABLET 66 MG Formulary OTC

zinc aspartate oral tablet 40 mg Formulary OTC

zinc gluconate oral tablet 15 mg, 50 mg Formulary OTC

zinc methionate oral capsule 50 mg Formulary OTC

zinc mouth/throat lozenge 10 mg Formulary OTC

zinc oral tablet 100 mg, 30 mg Formulary OTC

zinc oxide external ointment 20 % Formulary OTC

zinc oxide external paste 25 % Formulary OTC

zinc sulfate oral tablet 220 (50 zn) mg Formulary OTC

zinc-c-b6 mouth/throat lozenge 12-60-0.5 mg, 15-60-5 mg Formulary OTC

zincolate oral capsule 10-20 mg Formulary OTC

ZINC-OXYDE PLUS EXTERNAL OINTMENT 0.44-20 %

Formulary OTC

zinc-vitamin c oral tablet dispersible 15-60 mg Formulary OTC

158

Drug Name Formulary Status Requirements/Limitsziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg Formulary AGE (Min 18 Years)

ZITHROMAX ORAL PACKET 1 GM Formulary QL (8 EA per 34 days)

zn-50 oral capsule 50 mg Formulary OTC

ZOLADEX SUBCUTANEOUS IMPLANT 10.8 MG Formulary PA; QL (1 EA per 90 days)

ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG Formulary PA

zoledronic acid intravenous concentrate 4 mg/5ml Formulary PA

zoledronic acid intravenous solution 4 mg/100ml, 5 mg/100ml

Formulary PA

ZOLINZA ORAL CAPSULE 100 MG Formulary PA

zolmitriptan nasal solution 2.5 mg Formulary ST

zolmitriptan nasal solution 5 mg Formulary ST; QL (36 EA per 3 days)

zolmitriptan oral tablet 2.5 mg, 5 mg Formulary ST; QL (6 EA per 34 days)

zolmitriptan oral tablet dispersible 2.5 mg, 5 mg Formulary ST; QL (6 EA per 34 days)

zolpidem tartrate er oral tablet extended release 12.5 mg, 6.25 mg


zolpidem tartrate oral tablet 10 mg, 5 mg Formulary

ZOMIG NASAL SOLUTION 2.5 MG Formulary ST

zonisamide oral capsule 100 mg, 25 mg, 50 mg Formulary

ZOSTAVAX SUBCUTANEOUS SUSPENSION RECONSTITUTED 19400 UNT/0.65ML


ZOSTRIX HOT & COLD THERAPY EXTERNAL KIT 0.025 & 4 %

Formulary OTC

ZOSTRIX HP EXTERNAL CREAM 0.1 % Formulary OTC

ZOSTRIX NATURAL PAIN RELIEF EXTERNAL CREAM 0.033 %

Formulary OTC

ZOSTRIX-HP EXTERNAL STICK 0.075 % Formulary OTC

ZOVIRAX EXTERNAL CREAM 5 % Formulary QL (5 GM per 34 days)

Z-TUSS AC ORAL LIQUID 2-9 MG/5ML Formulary OTC

ZYCLARA EXTERNAL CREAM 3.75 % Formulary

ZYCLARA PUMP EXTERNAL CREAM 3.75 % Formulary

ZYLET OPHTHALMIC SUSPENSION 0.5-0.3 % Formulary

ZYNCOF ORAL SYRUP 20-400 MG/5ML Formulary OTC

ZYRTEC ALLERGY ORAL CAPSULE 10 MG Formulary OTC

ZYRTEC ALLERGY ORAL TABLET 10 MG Formulary OTC

ZYRTEC ALLERGY ORAL TABLET DISPERSIBLE 10 MG

Formulary OTC

ZYRTEC-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HOUR 5-120 MG

Formulary OTC

ZZZQUIL ORAL LIQUID 50 MG/30ML Formulary OTC

159

Index1st relief spray .......................................... 11st tier unifine pentips .............................. 11st tier unilet comfortouch ....................... 14-N-1........................................................ 150+ adult eye health .................................1A & D ZINC OXIDE............................... 1a thru z advanced ..................................... 1a thru z advantage .................................... 1a thru z select ............................................1A+D CRACKED SKIN RELIEF.............1a1c test at-home ........................................1a-25 ...........................................................1abacavir sulfate ........................................ 1abacavir sulfate-lamivudine ..................... 1abacavir-lamivudine-zidovudine .............. 1ABANATUSS PED................................. 1ABATRACE............................................ 1ABATREX............................................... 1ABATRON...............................................1ABATRON AF.........................................1ABATUSS DMX..................................... 1ABILIFY MAINTENA............................1ABILIFY MYCITE..................................1abiraterone acetate ...................................1ABRAXANE............................................1ABREVA..................................................2acamprosate calcium ................................2acarbose ................................................... 2ACCU-CHEK FASTCLIX LANCET......2ACCU-CHEK SOFT TOUCH LANCETS................................................ 2ACCU-CHEK SOFTCLIX LANCETS....2ACCUTANE............................................ 2ACCUTREND CHOLESTEROL............ 2ACCUTREND CHOLESTEROL CONTROL............................................... 2ACCUTREND PLUS...............................2ACE AEROSOL CLOUD ENHANCER............................................ 2acebutolol hcl ........................................... 2ACEROLA C 500.................................... 2ACETA-GESIC........................................2acetaminophen ..........................................2acetaminophen extra strength .................. 2acetaminophen junior strength .................2acetaminophen rapid tabs child ............... 2acetaminophen-codeine ............................2acetaminophen-codeine #2 .......................2acetaminophen-codeine #3 .......................2acetaminophen-codeine #4 .......................2ACETASOL HC.......................................2acetazolamide ...........................................2acetazolamide er .......................................2acetic acid .................................................2acetylcysteine ............................................2ACID GONE............................................ 2acid reducer maximum strength ............... 2acidophilus ............................................... 2acidophilus (probiotic) ............................. 2acidophilus probiotic ................................2acidophilus/bifidus ................................... 2

acidophilus/citrus pectin .......................... 2acidophilus/pectin .................................... 2acitretin .................................................... 2acne maximum strength ............................2acne medication 10 ...................................3acne medication 5 .....................................3acne treatment .......................................... 3ACNEFREE ACNE CLEARING SYSTEM.................................................. 3ACNEFREE SEVERE CLEARING SYST........................................................ 3ACT TOTAL CARE................................ 3ACTHIB................................................... 3ACTICARNITINE SF..............................3ACTICON................................................ 3actidom dmx ............................................. 3ACTIDOSE WITH SORBITOL.............. 3actidose-aqua ........................................... 3ACTIFLOVIT EAR HEALTH................ 3ACTIFOAM COLLAGEN SPONGE...... 3acti-lance lite lancets 28g .........................3acti-lance special lancets 17g .................. 3acti-lance universal 23g ........................... 3ACTIMARIS WOUND............................3ACTIMMUNE......................................... 3ACTINEL.................................................3ACTISEP..................................................3ACTITROM............................................. 3ACTIVE Q............................................... 3ACTIVE Q MAXIMUM STRENGTH....3ACTIVE-Q............................................... 3ACTIVE-Q EXTRA STRENGTH...........3ACTIVITE EC......................................... 3ACTIVON ARTHRITIS ULTRA ST...... 3acyclovir ................................................... 3ADACEL..................................................3ADAGEN................................................. 4adapalene ................................................. 4adefovir dipivoxil ......................................4adhesive bandages sheer .......................... 4adjustable lancing device ......................... 4ADMELOG.............................................. 4ADMELOG SOLOSTAR........................ 4ADRENAL C FORMULA.......................4ADRENALIN...........................................4ADRUCIL................................................ 4ADULT ACNOMEL................................4adult gummy ............................................. 4adult mask .................................................4adult wash cloths with aloe ...................... 4adult-lock weekly pill remind ................... 4advanced acne wash .................................4ADVANCED CALCIUM/D/MAGNESIUM..................4advanced hand sanitizer ...........................4advanced lubricant ................................... 4ADVIL......................................................4ADVIL ALLERGY & CONGESTION... 4ADVIL ALLERGY SINUS..................... 4ADVIL COLD & SINUS LIQUI-GELS........................................................ 4

ADVIL COLD/SINUS............................. 4ADVIL PM...............................................4ADVIL SINUS CONGESTION & PAIN.........................................................4ADVOCATE INSULIN SYRINGE.........4AEROCHAMBER MINI CHAMBER.... 4AFLURIA.................................................5AFLURIA PRESERVATIVE FREE....... 5AFLURIA QUADRIVALENT................ 5AFREZZA................................................ 5AFRIN CHILDRENS...............................5AFRIN MENTHOL SPRAY....................5AFTERA.................................................. 5AGAMATRIX ULTRA-THIN LANCETS................................................ 5AHIST...................................................... 5aimsco lubricated ..................................... 5AIRAVITE............................................... 5AIRBORNE..............................................5AIRS DISPOSABLE NEBULIZER........ 5AIRZONE PEAK FLOW METER.......... 5AJOVY.....................................................5ak-poly-bac ...............................................5AL12.........................................................5ALA SEB................................................. 5ALA SEB T.............................................. 5ALAHIST DM......................................... 5ALA-HIST IR...........................................5ALA-HIST PE..........................................5alanine 1000 ............................................. 5alba-lybe nr .............................................. 5albendazole ...............................................5ALBOLENE.............................................5albuterol sulfate ........................................5albuterol sulfate er ................................... 5albuterol sulfate hfa ..................................5alcohol (rubbing) ......................................5alcohol prep ..............................................5alcohol swabs ........................................... 5alcohol wipes ............................................6alendronate sodium .................................. 6aler-cap .................................................... 6aler-dryl ....................................................6alertness aid ............................................. 6alevazol .....................................................6ALEVE.....................................................6ALFERON N............................................6alfuzosin hcl er ......................................... 6alga ...........................................................6ALGAL-900 DHA................................... 6ALIMTA.................................................. 6ALIVE MULTI-VITAMIN CHILDRENS............................................6ALIVIO.................................................... 6alka-aid .....................................................6ALKA-SELTZER.................................... 6ALKA-SELTZER HEARTBURN + GAS.......................................................... 6ALKA-SELTZER PLUS DAY/NIGHT.. 6all day allergy childrens ...........................6all day pain relief ..................................... 6

161

ALLEGRA ALLERGY............................6ALLEGRA ALLERGY CHILDRENS.... 6ALLEGRA-D ALLERGY & CONGESTION........................................ 6aller-ease .................................................. 6allergy childrens .......................................6allergy eye ................................................ 6allergy multi-symptom day/nght ...............6allergy multi-symptom night .....................6allergy relief ............................................. 6allergy relief childrens ............................. 6allergy spray 24 hour ............................... 6allevess ..................................................... 6ALLEVYN PLUS CAVITY.................... 7ALLI.........................................................7allopurinol ................................................ 7ALMACONE........................................... 7ALOCANE PLUS.................................... 7ALOE GRANDE......................................7aloe vera ................................................... 7aloe vera moisturizing .............................. 7ALOE VESTA 2-N-1 PROTECTIVE..... 7ALOE VESTA CLEAR ANTIFUNGAL........................................ 7ALOE VESTA MULTI PURPOSE......... 7ALOE VESTA PROTECTIVE................ 7ALOE VESTA SKIN PROTECTANT.... 7aloe/lidocaine pain reliever ......................7alosetron hcl ............................................. 7alp high3 ...................................................7ALPAWASH............................................7ALPHAGAN P.........................................7alpha-lipoic acid .......................................7ALPHANATE/VWF COMPLEX/HUMAN...............................7ALPHANINE SD..................................... 7alph-e ........................................................7alph-e-mixed .............................................7alph-e-mixed 1000 ....................................7alprazolam ................................................7alprazolam er ........................................... 7ALPRAZOLAM INTENSOL.................. 7ALTACAINE........................................... 7ALTAFLUOR.......................................... 7altarussin-pe .............................................7ALTAVERA............................................ 8aluminum acetate ..................................... 8aluminum bottle seal ................................ 8aluminum hydroxide gel ........................... 8ALWAYS MAXI MAXIMUM PROTECTION......................................... 8alyacen 1/35 ............................................. 8alyacen 7/7/7 ............................................ 8ALYQ.......................................................8amantadine hcl ......................................... 8ambi 12.5cpd/100gfn/30pse ......................8ambi 12.5cpd/1dcpm/30pse ...................... 8ambi 40pse/400gfn ................................... 8ambi 60pse/400gfn ................................... 8ambi 60pse/4cpm ......................................8AMBI FADE............................................ 8ambrisentan .............................................. 8amcinonide ............................................... 8

AMERICERIN......................................... 8AMERIGEL WOUND DRESSING........ 8AMERIWASH......................................... 8AMETHIA................................................8AMETHIA LO......................................... 8AMETHYST............................................ 8amiloride hcl .............................................8amiloride-hydrochlorothiazide .................8aminoacetic acid .......................................8aminocaproic acid ....................................8AMINORELIEFRMS.............................. 8amiodarone hcl .........................................8amitriptyline hcl ....................................... 8amlodipine besy-benazepril hcl ................8amlodipine besylate ..................................8amlodipine besylate-valsartan ................. 8amlodipine-atorvastatin ........................... 8amlodipine-olmesartan .............................8amlodipine-valsartan-hctz ........................8ammonia aromatic ....................................9ammonium lactate .................................... 9AMNESTEEM......................................... 9amoxicillin ................................................ 9amoxicillin-pot clavulanate ......................9amphetamine-dextroamphet er .................9amphetamine-dextroamphetamine ........... 9ampicillin ..................................................9ANA-LEX................................................ 9ANASEPT................................................ 9ANASEPT ANTIMICROBIAL............... 9anastrozole ............................................... 9ANBESOL................................................9ANBESOL COLD SORE THERAPY..... 9ANBESOL MAXIMUM STRENGTH.... 9ANECREAM............................................9animal chews ............................................ 9ANORO ELLIPTA...................................9antacid ...................................................... 9antacid anti-gas ........................................9antacid anti-gas max strength .................. 9antacid extra strength ...............................9antacid multi-symptom ............................. 9antacid soft chews .................................... 9ANTARA................................................. 9anthelios 50 mineral .................................9anti-allergy ............................................... 9antibacterial liquid soap .......................... 9anti-diarrheal ......................................... 10antifungal ................................................10anti-fungal .............................................. 10anti-itch .................................................. 10ANTI-ITCH INTENSIVE HEALING... 10anti-oxidant ............................................ 10antioxidant formula sg ............................10antiseptic ................................................ 10ANTISEPTIC HAND RINSE................ 10antiseptic pain relief ...............................10antiseptic skin cleanser .......................... 10antiseptic wound/skin cleanser ...............10AO-SEPT CONTACT LENS HOLDER................................................10APETIGEN............................................ 10APETIGEN-PLUS................................. 10

ap-hist dm ............................................... 10APLICARE POVIDONE-IODINE........10APLIGRAF............................................ 10apothesar ................................................ 10apraclonidine hcl ....................................10aprepitant ............................................... 10APRI.......................................................10APTIVUS............................................... 10AQUA CARE.........................................10aquabase .................................................10AQUADEKS.......................................... 10AQUAFRESH DR SEUSS EXTRA SOFT...................................................... 10aquanaz .................................................. 10AQUAPHILIC........................................10AQUAPHILIC/CARBAMIDE.............. 10AQUASONIC 100................................. 10AQUEOUS SELENIUM........................10aqueous vitamin e ...................................10AQUORAL............................................ 10ARANELLE...........................................10ARCALYST...........................................11ARCAPTA NEOHALER.......................11arctic relief pain relieving ......................11arformoterol tartrate .............................. 11ARGIMENT AT.....................................11arginine .................................................. 11arginine2000 .......................................... 11ARGYLE STERILE SALINE................11ARGYLE STERILE WATER................11aripiprazole ............................................ 11ARISTADA............................................11ARISTADA INITIO...............................11arkaliox ...................................................11ARMOUR THYROID........................... 11arnica ......................................................11arnicare .................................................. 11arnicare arthritis .................................... 11arthritis pain relieving ............................11artificial tears ......................................... 11ARZERRA............................................. 11ARZOL SILVER NIT APPLICATORS..................................... 11asafetida ................................................. 11ascocid-iso-ph ........................................ 11ASCOMP-CODEINE.............................11ascorbic acid .......................................... 11ASCRIPTIN........................................... 11asepto oral thermometer ........................ 11ASMANEX (120 METERED DOSES).11ASMANEX (14 METERED DOSES)... 11ASMANEX (30 METERED DOSES)... 12ASMANEX (60 METERED DOSES)... 12ASMANEX (7 METERED DOSES)..... 12aspartate mg & k .................................... 12ASPERCREME W/LIDOCAINE.......... 12aspirin .....................................................12aspirin 81 ................................................12aspirin-dipyridamole er ..........................12aspirtab maximum strength .................... 12ASSURE ID INSULIN SAFETY SYR..12ASSURE LANCETS..............................12ASTHMANEFRIN REFILL.................. 12

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ASTHMAPACK FOR CHILDREN...... 12ATABEX OB......................................... 12atazanavir sulfate ................................... 12atenolol ...................................................12atenolol-chlorthalidone .......................... 12athletes foot maximum strength ..............12atomoxetine hcl .......................................12ATOPICLAIR........................................ 12atorvastatin calcium ............................... 12atovaquone ............................................. 12atovaquone-proguanil hcl ...................... 12ATRAC-TAIN........................................12ATROVENT HFA................................. 12atuss da ...................................................12AUBRA.................................................. 12auraphene-b ............................................13aurora lancet super thin 30g .................. 13aurora lancet thin 23g ............................13AUROVELA FE 1.5/30......................... 13AUSTEDO............................................. 13AUTOJECT 2.........................................13AUTOLET PLATFORMS..................... 13autopen ................................................... 13avalin ...................................................... 13AVAR CLEANSER............................... 13AVAR-E EMOLLIENT......................... 13AVASTIN.............................................. 13AVEENO BABY GENTLE CONDITION..........................................13AVEENO BABY SOOTHING WASH. 13AVEENO CREAMY MOISTURIZING................................... 13AVEENO INTENSE RELIEF............... 13AVEENO POSITIVELY RADIANT WASH.................................................... 13AVENOVA/NEUTROX........................ 13AVERTEAX.......................................... 13AVITENE...............................................13AVITENE FLOUR.................................13AVO CREAM........................................ 13AVONEX............................................... 13AVONEX PEN.......................................13AVONEX PREFILLED......................... 13av-phos 250 neutral ................................13axillary block needle .............................. 13AXSAIN.................................................13AYR SALINE NASAL.......................... 13AYR SALINE NASAL DROPS............ 13AYR SALINE NASAL GEL................. 13AYR SALINE NASAL NO-DRIP.........13AYR SALINE NASAL RINSE............. 13azacitidine .............................................. 13azathioprine ............................................13azec .........................................................13azelastine hcl .......................................... 13azithromycin ........................................... 14AZURETTE........................................... 14b complete ...............................................14b complex ................................................14b complex formula 1 ............................... 14b complex formula 1 (w/ fa) ................... 14b complex vitamin ...................................14b complex-folic acid ............................... 14

b-1 ...........................................................14b-100 cr .................................................. 14b-12 .........................................................14b-12 tr ..................................................... 14b-2 ...........................................................14B-2-400...................................................14b-6 ...........................................................14BABY ANBESOL................................. 14BABY DDROPS.................................... 14baby diaper rash .....................................14baby lotion ..............................................14baby super daily d3 ................................ 14baby teething pain medicine ...................14baby thermometer ...................................14baciim ..................................................... 14bacitracin ................................................14bacitracin zinc ........................................ 14bacitra-neomycin-polymyxin-hc .............14back pain-off ...........................................14baclofen .................................................. 14BACTROBAN NASAL......................... 14balamine dm ........................................... 14balanced b-50 ......................................... 14balanced b-50 complex ...........................14BAL-CARE DHA.................................. 14BALNEOL............................................. 14balsalazide disodium .............................. 14BALZIVA.............................................. 14BAND-AID GAUZE SMALL............... 15BAND-AID SURGIPAD SURGICAL.. 15BANOPHEN.......................................... 15BAQSIMI ONE PACK.......................... 15BAQSIMI TWO PACK......................... 15BARACLUDE........................................15BASAGLAR KWIKPEN....................... 15BAYER BACK & BODY......................15BAYER BREEZE 2 CONTROL........... 15BAYER BREEZE 2 SYSTEM...............15BAYER BREEZE 2 TEST.....................15BAYER CONTOUR LINK MONITOR............................................. 15BAYER CONTOUR MONITOR.......... 15BAYER MICROLET 2 LANCING DEVIC....................................................15BAYER MICROLET LANCETS.......... 15BAYER WOMENS................................15BAZA CLEANSE & PROTECT........... 15BC FAST PAIN RELIEF....................... 15BC FAST PAIN RELIEF ARTHRITIS. 15b-caro-t ...................................................15b-complex high potency ..........................15BD ALLERGY SYRINGE.................... 15BD AUTOSHIELD................................ 15BD AUTOSHIELD DUO...................... 15BD BLUNT FILTER NEEDLE............. 15BD DISP NEEDLE................................ 15BD DISP NEEDLE TW......................... 15BD DISP NEEDLES.............................. 15BD ECLIPSE NEEDLE......................... 15BD ECLIPSE SYRINGE....................... 15BD HYPODERMIC NEEDLE.............. 15BD INSULIN SYR ULTRAFINE II 15, 16BD INSULIN SYRINGE....................... 16

BD INSULIN SYRINGE HALF-UNIT.16BD INSULIN SYRINGE MICROFINE.......................................... 16BD INSULIN SYRINGE U/F................16BD INSULIN SYRINGE U/F 1/2UNIT 16BD INSULIN SYRINGE U-500............16BD INSULIN SYRINGE ULTRAFINE....................................16, 17BD LANCET ULTRAFINE 30G...........17BD LANCET ULTRAFINE 33G...........17BD LUER-LOK SYRINGE................... 17BD PEN NEEDLE ORIGINAL U/F......17BD PLASTIPAK SYRINGE..................17BD PRECISIONGLIDE NEEDLE........ 17BD SAFETYGLIDE INSULIN SYRINGE...............................................17BD SAFETYGLIDE NEEDLE..............17BD SAFETYGLIDE SHIELDED NEEDLE................................................ 17BD SAFETYGLIDE SYRINGE/NEEDLE.............................. 17BD SAFETY-LOK INSULIN SYRINGE...............................................17BD SHARPS COLLECTOR..................17BD SWAB SINGLE USE REGULAR.. 17BD SWABS SINGLE USE BUTTERFLY.........................................17BD SYRINGE........................................ 17BD SYRINGE LUER-LOK................... 17BD SYRINGE SLIP TIP........................17BD SYRINGE/NEEDLE SLIP TIP....... 17BD TB SYRINGE.................................. 17BD VEO INSULIN SYR U/F 1/2UNIT.17BD VEO INSULIN SYRINGE U/F.......17BEBULIN...............................................18bec/zinc ...................................................18bedding spray lice treatment .................. 18bee pollen ............................................... 18BEELITH............................................... 18BELBUCA............................................. 18belladonna alkaloids-opium ................... 18belladonna-opium ...................................18BENADRYL ALLERGY.......................18BENADRYL ALLERGY CHILDRENS..........................................18BENADRYL ALLERGY CON ULTRATABS........................................ 18BENADRYL ALLERGY ULTRATABS........................................ 18BENADRYL ITCH RELIEF................. 18BENADRYL ITCH STOPPING............18BENADRYL-D ALLERGY/SINUS CHILD....................................................18benazepril hcl ......................................... 18benazepril-hydrochlorothiazide ............. 18BENEFIBER.......................................... 18BENEFIBER FOR CHILDREN............ 18BENEFIBER ON THE GO....................18BENEFIBER PLUS B VITS & FA........18BENEFIBER PLUS CALCIUM............ 18BENEFIBER PLUS HEART HEALTH................................................ 18benfotiamine multi-b ...............................18

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benzalkonium chloride ........................... 18BENZEDREX........................................ 18BENZEPRO........................................... 18BENZEPRO CREAMY WASH............ 18BENZEPRO SHORT CONTACT......... 18BENZODENT........................................ 18benzoin ....................................................18benzonatate .............................................18BENZ-O-STHETIC................................19benzoyl peroxide .....................................19benzoyl peroxide cleanser ...................... 19benzoyl peroxide wash ............................19benzoyl peroxide-erythromycin .............. 19benzphetamine hcl .................................. 19BENZ-PROTECT.................................. 19benztropine mesylate .............................. 19BERINERT............................................ 19BERRI-FREEZ PAIN RELIEVING...... 19BERRI-FREEZ PLUS............................19BETA CARE BETATAR GEL..............19beta carotene provitamin a .....................19BETADINE............................................ 19BETADINE SURGICAL SCRUB.........19BETADINE SWABSTICKS..................19betaine hcl .............................................. 19betamethasone dipropionate .................. 19betamethasone dipropionate aug ........... 19betamethasone valerate ..........................19BETAQUIK............................................19BETASERON........................................ 19betaxolol hcl ........................................... 19bethanechol chloride .............................. 19BETHKIS............................................... 19bexarotene .............................................. 19BIATAIN HEEL ADH FOAM DRESSING............................................ 19BIATAIN SACRAL FOAM DRESSING............................................ 19bicalutamide ........................................... 19BICARSIM.............................................20BICARSIM FORTE............................... 20BICNU....................................................20BIKTARVY........................................... 20biobron sf ................................................20biocotron ................................................ 20biodesp dm ..............................................20bioflavonoid-1000 .................................. 20BIO-FLAX............................................. 20BIOFLONEX......................................... 20BIOFREEZE.......................................... 20BIOFREEZE ROLL-ON COLORLESS......................................... 20BIOGAIA GASTRUS............................20biogtuss ...................................................20BIOGUARD NON-ADHERENT DRESSING............................................ 20BIOLLE GEL TEARS........................... 20bionatuss dxp ..........................................20BIOPATCH PROTECTIVE DISK/CHG............................................. 20biopetit ....................................................20BIORX SPONIX ANTI-FUNGAL........ 20BIORX SPONIX ARTHR & MUSC..... 20

biospec dmx ............................................ 20biotalan clear ......................................... 20BIO-THERM PAIN RELIEVING......... 20biotin .......................................................20biotin forte .............................................. 20biotin plus keratin ...................................20biotuss .....................................................20biovol ...................................................... 20bisacodyl ec ............................................ 20bismatrol .................................................20bismatrol maximum strength .................. 20bisoprolol fumarate ................................ 20bisoprolol-hydrochlorothiazide ..............20bite/itch ...................................................20BI-ZETS/BENZOTROCHES................ 20bleomycin sulfate ....................................21BLINK TEARS...................................... 21BLISOVI 24 FE......................................21BLISOVI FE 1.5/30............................... 21BLISOVI FE 1/20.................................. 21BLISTEX MEDICATED....................... 21blood pressure monitor/wrist ................. 21BOIL EASE MAXIMUM STRENGTH........................................... 21BONE DENSITY................................... 21BOOSTRIX............................................ 21borage .....................................................21boric acid ................................................21boron ...................................................... 21BOTOX.................................................. 21BOUDREAUXS BABY KISSES.......... 21BOUDREAUXS BUTT PASTE............ 21BOUDREAUXS RASH PREVENTOR 21bp 10-1 ....................................................21bp cleansing wash .................................. 21bp wash ...................................................21BPROTECTED MULTI-VITE.............. 21BPROTECTED PEDIA IRON...............21BPROTECTED PEDIA POLY-VITE....21BRAINSTRONG PRENATAL..............21BRASIVOL............................................ 21BREEZE 2 TEST................................... 21BREVIBLOC IN NACL........................ 21brewers yeast ..........................................21BREXAFEMME.................................... 21BRILINTA............................................. 21brimonidine tartrate ............................... 21brinzolamide ...........................................21brohist d ..................................................21bromi-lotion ............................................22bromocriptine mesylate .......................... 22bronchial asthma relief .......................... 22BRONKAID...........................................22bronkids .................................................. 22brontuss dx ............................................. 22brotapp dm ............................................. 22btrex ........................................................22BUCKLEYS CHEST CONGESTION...22BUCKLEYS COUGH............................22budesonide ..............................................22budesonide-formoterol fumarate ............22BUFFERIN.............................................22BUFFERIN EXTRA STRENGTH........ 22

BUFFERIN LOW DOSE....................... 22BULL FROG WATER ARMOR SPORT....................................................22bumetanide ............................................. 22buprenorphine ........................................ 22buprenorphine hcl .................................. 22buprenorphine hcl-naloxone hcl ............ 22bupropion hcl ......................................... 22bupropion hcl er (smoking det) .............. 22bupropion hcl er (sr) .............................. 22bupropion hcl er (xl) ...............................22burn relief ............................................... 22burn relief/lidocaine/aloe ....................... 22buspirone hcl .......................................... 23busulfan .................................................. 23butalbital-acetaminophen .......................23butalbital-apap-caff-cod .........................23butalbital-apap-caffeine ......................... 23butalbital-aspirin-caffeine ......................23butorphanol tartrate ............................... 23BYDUREON..........................................23BYETTA 10 MCG PEN.........................23BYETTA 5 MCG PEN...........................23BYLVAY............................................... 23BYLVAY (PELLETS)........................... 23c & e ....................................................... 23c-1500/rose hips sr ................................. 23c1500/rose hips/bioflavonoid ................. 23cabenuva .................................................23cabergoline .............................................23cadeau dha ............................................. 23caffeine citrate ........................................23cal/mag ................................................... 23CALADRYL.......................................... 23CALADRYL CLEAR............................ 23CALAGEL MAXIMUM STRENGTH..23CALAGESIC..........................................23calahist clear .......................................... 23calamine ................................................. 23calamine phenolated ...............................23calamine-zinc oxide ................................23CALAZIME SKIN PROTECTANT...... 23CAL-CARB FORTE.............................. 23CALCET PETITES................................23CALCI-CHEW.......................................23calci-max ................................................ 23calcipotriene .....................................23, 24calcitonin (salmon) .................................24CALCITRATE....................................... 24cal-citrate ............................................... 24calcitriol ................................................. 24calcium ................................................... 24calcium + d3 ...........................................24calcium 1200 .......................................... 24calcium 500 + d3 ....................................24calcium 600 ............................................ 24calcium 600 + d ......................................24calcium 600+d3 ......................................24calcium 600+d3 plus minerals ...............24calcium acetate .......................................24calcium acetate (phos binder) ................ 24calcium ascorbate ...................................24calcium aspartate ................................... 24

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calcium carbonate .................................. 24calcium carbonate antacid ..................... 24calcium carbonate w/vitamin d .............. 24calcium carbonate-vitamin d ..................24calcium citrate ........................................24calcium citrate + .................................... 24calcium citrate + d3 ............................... 24calcium citrate malate-vit d ....................24calcium citrate plus ................................ 24calcium citrate-vitamin d ........................24calcium citrate-vitamin d3 ......................24calcium gluconate ...................................24calcium gummies .................................... 24calcium high potency/vitamin d ..............24calcium lactate ....................................... 24calcium oyster shell ................................ 24calcium pantothenate ............................. 24calcium plus vitamin d3 ..........................24calcium soft chews ..................................25calcium-magnesium-zinc ........................ 25calcium-vitamin d ................................... 25calcium-vitamin d3 ................................. 25calcium-vitamin d-minerals ....................25calendula ................................................ 25cal-glu .....................................................25cal-lac .....................................................25calmag thins ........................................... 25cal-mint ...................................................25CALMOL-4............................................25calna ....................................................... 25CALTRATE 600+D...............................25CALTRATE 600+D PLUS MINERALS............................................25CALTRATE 600+D3 SOFT.................. 25CALTRATE GUMMY BITES.............. 25CALTRATE MINIS PLUS MINERALS............................................25CAMILA................................................ 25CAMPHO-PHENIQUE..........................25CAMPHOTREX.................................... 25capcof ..................................................... 25capecitabine ............................................25capmist dm ..............................................25capron dm ...............................................25capron dmt ..............................................25capsaicin .................................................25capsaicin hot patch .................................25CAPSIDERM......................................... 25capsule 1 clear veggie ............................ 25captopril ................................................. 25CAPZASIN-HP...................................... 25CARBAGLU.......................................... 25carbamazepine ........................................26carbamazepine er ............................. 25, 26CARBAPHEN CH................................. 26CARBAPHEN PED CH.........................26carbidopa-levodopa ................................26carbidopa-levodopa er ........................... 26carbidopa-levodopa-entacapone ............26carbinoxamine maleate .......................... 26CARBOHOL 940................................... 26CARBZERO...........................................26CARDENZ............................................. 26

CAREFINE PEN NEEDLES................. 26careone insulin syringe .......................... 26CAREONE LANCET SUPER THIN 30G......................................................... 26careone lancet thin 23g .......................... 26CA-REZZ............................................... 26ca-rezz gentle ..........................................26ca-rezz norisc ......................................... 26carglumic acid ........................................26CARRACOLLOID 4"X4"..................... 26CARRASMART.................................... 26CARRASORB H....................................26CARRASYN V WOUND DRESSING. 26CARRINGTON DERMAL WOUND....26carteolol hcl ............................................26CARTIA XT...........................................26carvedilol ................................................26cascara sagrada ..................................... 26castellani paint modified ........................ 27CASTIVA COOLING............................27CASTIVA WARMING..........................27castor oil stimulant laxative ................... 27CAVAREST...........................................27CAVILON EMOLLIENT...................... 27CAVILON FOOT & DRY SKIN...........27CAVILON NO STING BARRIER FILM...................................................... 27CAVILON ONE-STEP SKIN CARE.... 27CAVILON SKIN CLEANSER.............. 27CAYA.....................................................27CAZIANT.............................................. 27cefaclor ...................................................27cefadroxil ................................................27cefdinir ....................................................27cefpodoxime proxetil .............................. 27cefprozil .................................................. 27ceftriaxone sodium ................................. 27ceftriaxone sodium in dextrose ...............27ceftriaxone sodium-dextrose ...................27cefuroxime axetil .................................... 27CELACYN............................................. 27celecoxib .................................................27celery seed .............................................. 27CENTRATEX........................................ 27centravites adults ....................................27CENTRUM............................................ 27CENTRUM FLAVOR BURST DRINK................................................... 27CENTRUM SPECIALIST PRENATAL........................................... 27CEO-TWO..............................................28CEPACOL ANTIBACTERIAL.............28CEPACOL EXTRA STRENGTH..........28CEPACOL SORE THROAT................. 28CEPACOL SORE THROAT & COUGH..................................................28CEPACOL SORE THROAT EX ST..... 28CEPASTAT............................................28cephalexin ...............................................28CERACADE.......................................... 28CERALYTE 70...................................... 28CERAVE BABY....................................28CERAVE ITCH RELIEF....................... 28

CERAVE SUNSCREEN SPF50............ 28CEROVEL..............................................28cesium .....................................................28CESIUM 1000........................................28cesium 500 ..............................................28CETACAINE......................................... 28CETAPHIL GENTLE CLEANSING.... 28cetirizine hcl ........................................... 28CETRAXAL...........................................28CHANTIX.............................................. 28CHANTIX CONTINUING MONTH PAK........................................................ 28CHANTIX STARTING MONTH PAK.28CHAP-EX TROPICALS........................28CHAPSTICK MOISTURIZER..............28CHAPSTICK ULTRA RENEWAL.......28CHAR-FLO WITH SORBITOL............ 28chelated calcium .....................................28chelated magnesium ............................... 28chelated zinc ........................................... 28CHEMSTRIP 10 MD............................. 28CHEMSTRIP 10/SG.............................. 28CHEMSTRIP 2 GP................................ 28CHEMSTRIP 5 OB................................ 28CHEMSTRIP 7.......................................29CHEMSTRIP 9.......................................29CHEMSTRIP CALIBRATION............. 29CHEMSTRIP MICRAL......................... 29CHEMSTRIP UGK................................29CHENODAL.......................................... 29CHERACOL-D COUGH....................... 29cherry ......................................................29cherry concentrate ..................................29chest rub ................................................. 29CHEW Q................................................ 29chewable iron ......................................... 29CHIGG AWAY......................................29childrens aspirin free ..............................29CHILDRENS MOTRIN.........................29childrens pain reliever ............................29childrens plus multi-sympt cld ................29childrens silfedrine ................................. 29CHILDRENS SOOTHE.........................29chlo hist .................................................. 29CHLO TUSS.......................................... 29chlophed ................................................. 29CHLORASEPTIC.................................. 29chlordiazepoxide hcl ...............................29chlorella ..................................................29chlorhexidine gluconate ......................... 29chlorhexidine gluconate cloth ................ 29chlorophyll ..............................................29chloroquine phosphate ........................... 29chlorothiazide .........................................29CHLORPHEN SR.................................. 29chlorpromazine hcl .................................29chlorthalidone ........................................ 29CHLOR-TRIMETON...................... 29, 30CHLOR-TRIMETON ALLERGY.........29chlorzoxazone .........................................30chocolated laxative .................................30cholesterol acetate ..................................30cholestyramine ........................................30

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cholestyramine light ............................... 30choline .................................................... 30choline citrate .........................................30choline sr ................................................ 30choline-mag trisalicylate ........................30CHONDROITIN SULFATE COMPLEX.............................................30CHROMACAPS.................................... 30chromium ................................................30chromium aspartate ................................30chromium gtf ...........................................30chromium picolinate ...............................30CICLODAN........................................... 30ciclopirox ................................................30ciclopirox olamine ..................................30ciclopirox treatment ............................... 30cilostazol .................................................30CIMDUO................................................30cimetidine ............................................... 30cinnamon ................................................ 30CINRYZE...............................................30CIPRO.................................................... 30CIPRODEX............................................ 30ciprofloxacin ...........................................30ciprofloxacin hcl .....................................30ciprofloxacin-dexamethasone .................30cisplatin .................................................. 30citalopram hydrobromide .......................31CITRA PH..............................................31CITRANATAL 90 DHA........................31CITRANATAL ASSURE...................... 31CITRANATAL B-CALM......................31CITRANATAL DHA.............................31CITRANATAL HARMONY.................31CITRANATAL RX................................31CITRUCEL............................................ 31CITRULLINE 1000............................... 31CITRULLINE200.................................. 31cladribine ................................................31CLARAVIS............................................ 31clarithromycin ........................................ 31clarithromycin er ....................................31CLARITIN............................................. 31CLARITIN CHILDRENS......................31CLARITIN REDITABS.........................31CLARITIN-D 12 HOUR........................31CLARITIN-D 24 HOUR........................31classic prenatal .......................................31CLEAN & CLEAR ACNE CLEANSER........................................... 31CLEAN & CLEAR ADVANTAGE MARK.................................................... 31CLEAN ZING........................................ 31CLEANLET LANCETS 28G................ 31cleansing .................................................31CLEAR EYES REDNESS RELIEF.......31clear zinc spf 50 ......................................31CLEARASIL DAILY CLEAN.............. 31CLEARASIL DAILY CLEAR.............. 32CLEARASIL DAILY CLEAR ACNE...32CLEARCANAL EAR WAX REMOVAL............................................ 32CLEARLAX...........................................32

CLEARLIFE ALLERGY RELIEF........ 32clemastine fumarate ............................... 32CLEOCIN...............................................32CLERZ PLUS.........................................32CLEVER CHOICE BP MONITOR/WRIST................................32clindamycin hcl .......................................32clindamycin palmitate hcl ...................... 32clindamycin phos-benzoyl perox ............ 32clindamycin phosphate ........................... 32CLINDESSE.......................................... 32clobazam .................................................32clobetasol prop emollient base ...............32clobetasol propionate ............................. 32clobetasol propionate e .......................... 32clobetasol propionate emulsion ..............32clofarabine ..............................................32clomipramine hcl ....................................32clonazepam .............................................32clonidine hcl ........................................... 32clonidine hcl (analgesia) ........................ 32clonidine hcl er .......................................32clopidogrel bisulfate ...............................32clotrimazole ...................................... 32, 33clotrimazole 3 ......................................... 32clotrimazole anti-fungal ......................... 32clotrimazole-betamethasone ...................33clozapine .................................................33co q 10 .................................................... 33co q-10 ....................................................33COAGUCHEK XS PLUS SYSTEM..... 33COAGUCHEK XS PT TEST.................33COARTEM............................................ 33COATS ALOE....................................... 33COATS ALOE JUICE DRINK..............33COATS ALOE LINIMENT...................33cocoa butter skin .................................... 33cod liver oil .............................................33codeine sulfate ........................................33coditussin ac ........................................... 33coditussin dac ......................................... 33coenzyme q10 ......................................... 33coenzyme q-10 ........................................ 33coenzyme q10-levocarnitine ................... 33co-enzyme q10-vitamin e ........................ 33cola syrup ............................................... 33COLACE................................................ 33colchicine ................................................33colchicine-probenecid ............................ 33cold & allergy .........................................33cold & cough childrens .......................... 33cold & cough day/night child ................. 33cold & flu relief nighttime d ................... 33cold multi-symptom nighttime ................ 33cold remedy ............................................ 33cold sore treatment .................................33cold therapy pain relief .......................... 33cold/cough childrens .............................. 34cold/flu relief day/night .......................... 34COLD-EEZE.......................................... 34colesevelam hcl .......................................34colestipol hcl ...........................................34collodion flexible .................................... 34

COLOCORT.......................................... 34COMBIGAN.......................................... 34COMBIVENT RESPIMAT................... 34COMFORT ASSIST INSULIN SYRINGE...............................................34comfort assured lancets 28g ...................34comfort assured lancets 33g ...................34COMFORT CLEAN/COMFORT SHIELD..................................................34COMFORT EZ PEN NEEDLES........... 34COMPAT STAY-PUT NJ DOUBLE LUME.....................................................34COMPLERA.......................................... 34complete lice treatment .......................... 34complete natal dha ................................. 34completenate ...........................................34COMPOUND W MAXIMUM STRENGTH........................................... 34COMPOUND W ONE STEP INVISIBLE............................................ 34compoz ....................................................34COMPRO............................................... 34COMTREX COLD & COUGH MAX ST........................................................... 34COMTREX COLD/COUGH DAY/NITE MS...................................... 35COMTREX DEEP CHEST COLD........35CO-NATAL FA..................................... 35CONCEPT DHA.................................... 35CONCEPT OB....................................... 35CONCEPTIONXR MOTILITY SUPPORT.............................................. 35condoms ..................................................35constulose ............................................... 35CONTAC COLD+FLU MAX ST..........35CONTOUR BLOOD GLUCOSE SYSTEM................................................ 35CONTOUR CONTROL.........................35CONTOUR MONITOR......................... 35CONTOUR NEXT CONTROL............. 35CONTOUR NEXT EZ........................... 35CONTOUR NEXT LINK...................... 35CONTOUR NEXT MONITOR............. 35CONTOUR NEXT ONE........................35CONTOUR NEXT TEST...................... 35CONTOUR TEST.................................. 35control denture adhesive ........................ 35control syringe disposable ......................35convex eye protector ...............................35cool n heat ex st ...................................... 35cool n heat maximum strength ................35COPPERMIN......................................... 35co-q 10 omega-3 fish oil .........................35coq10 ...................................................... 35coq-10 .....................................................35coral calcium ..........................................35CORICIDIN HBP COLD/FLU.............. 35CORICIDIN HBP COUGH/COLD....... 35CORICIDIN HBP DAY/NIGHT COLD..................................................... 36CORICIDIN HBP NIGHTTIME COLD..................................................... 36CORIFACT............................................ 36

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corn & callus remover ............................36corn oil ................................................... 36CORN REMOVER WATERPROOF.... 36corn/callus remover ................................36CORRECTOL EXTRA GENTLE......... 36CORTIC-ND.......................................... 36CORTIFOAM........................................ 36cortisone acetate .....................................36CORTIZONE-10.................................... 36CORTIZONE-10/ALOE........................ 36CORVITA 150....................................... 36COSAMIN ASU FOR JOINT HEALTH................................................ 36COSAMIN VERDE FOR JOINT HEALTH................................................ 36COTTONTAILS DIAPER RASH CREAMY...............................................36cough & chest congestion dm .................36cough & cold .......................................... 36cough & sore throat nighttime ............... 36cough drops ............................................ 36cough relief .............................................36coughtab ................................................. 36cramp tabs .............................................. 36cranberry ................................................ 36cream base with liposome ...................... 36creatine ...................................................36creatine5000 ...........................................36CREON.................................................. 36CR-GTF..................................................36CRITIC-AID CLEAR AF...................... 36CRIXIVAN............................................ 36cromolyn sodium .................................... 36CROTAN................................................37CR-PLUS................................................37CRYSELLE-28...................................... 37cu-25 .......................................................37cu-5 .........................................................37CULTURELLE GENTLE-GO KIDS.... 37CULTURELLE KIDS............................37CURAD GERM SHIELD...................... 37CURAFIL WOUND DRESSING.......... 37CURASOL WOUND DRESSING........ 37CURITY ALCOHOL PREPS................ 37CURITY ALCOHOL SWABS.............. 37CURITY GAUZE SPONGE.................. 37CURITY GAUZE SPONGES................37CURITY MESH GAUZE BNDG 4"X30' .....................................................37CURX ANTIMICROBIAL....................37CUTINOVA HYDRO 2"X2-3/8".......... 37cvs acetaminophen ................................. 37cvs adhesive gauze ..................................37cvs aftersun aloe/lidocaine .....................37CVS AIRSHIELD.................................. 37cvs alcohol prep pads ............................. 37cvs allergy relief ..................................... 37cvs allergy relief childrens ..................... 37cvs allergy relief d .................................. 37cvs all-purpose skin protect ....................37cvs antacid childrens .............................. 37cvs antacid supreme ............................... 37cvs anti-diarrheal ................................... 37

cvs anti-itch sensitive ..............................37cvs astringent solution ............................37cvs b complex plus c ............................... 37cvs b12 ....................................................37cvs backache relief ................................. 37cvs beta carotene .................................... 37cvs calcium ............................................. 37cvs calcium 600 plus ...............................37cvs cherry menthol drops ....................... 37cvs chest rub medicated ..........................37cvs cleansing eyelid wipes ......................37cvs cleansing skin ................................... 37cvs cold & sinus relief ............................ 37cvs cold remedy ...................................... 38cvs corn/callus remover ..........................38cvs cortisone maximum strength ............ 38cvs creamy acne face wash .....................38cvs d3 ......................................................38cvs dairy relief ex st ................................38cvs daytime/nighttime cold/flu ................38cvs daytime/nighttime cough .................. 38cvs diabetes health support .................... 38cvs digestive probiotic ............................ 38cvs diuretic maximum strength ...............38cvs e oil ...................................................38cvs early result pregnancy ......................38cvs easy fiber/calcium ............................ 38cvs enema disposable ............................. 38cvs ethyl alcohol ..................................... 38cvs eye .....................................................38cvs feminine wipes max st .......................38cvs fiber gummies ................................... 38cvs flu relief ............................................ 38cvs gas relief ...........................................38cvs gas relief extra strength ....................38cvs gauze sterile ......................................38cvs gluco-chondroit plus uc-ii ................ 38cvs glucosamine-chondroitin ..................38cvs glucosamine-chondroit-msm ............ 38cvs glucose bits .......................................38cvs glucose shot ...................................... 38cvs glycerin adult ....................................38cvs hair regrowth for women ..................38cvs hand wash advanced antibac ........... 38cvs heartburn relief ex st ........................ 38cvs heatwraps/back/hip .......................... 38cvs hemorrhoidal ....................................38cvs hot steam .......................................... 38cvs hydrocolloid pads .............................38cvs inner ear plus ................................... 38cvs instant food thickener ....................... 38cvs iron ................................................... 38cvs irritated eye ...................................... 38cvs isopropyl alcohol wipes ....................38cvs itch relief .......................................... 39cvs lancets 21g ........................................39cvs lancets micro thin 33g ...................... 39cvs lancets original .................................39cvs lancets thin 26g ................................ 39cvs lancets ultra thin 30g ........................39cvs lancets ultra-thin 30g ....................... 39cvs laxative dietary supplemnt ............... 39CVS LICE SOLUTION 3-STEP............39

cvs l-lysine .............................................. 39cvs lubricant drops ................................. 39cvs magnesium citrate ............................ 39cvs manuka honey wound ....................... 39cvs melatonin ..........................................39cvs melatonin extra strength ...................39cvs miconazole 1 combo pack ................ 39cvs miconazole 3 combo pack ................ 39cvs mineral oil ........................................ 39cvs mineral oil enema .............................39cvs mini enema kids ................................39cvs multi-purpose ................................... 39cvs nasal allergy spray ........................... 39cvs nasal decongestant ........................... 39cvs nasal mist ..........................................39cvs natural fiber supplement .................. 39cvs natural fish oil .................................. 39cvs nerve pain relief ............................... 39cvs non-drying sinus pe .......................... 39cvs omeprazole ....................................... 39cvs oral pain reliever ..............................39cvs pain relief ......................................... 39cvs phosphate saline laxative ................. 39cvs pinworm treatment ........................... 39cvs potassium gluconate .........................39cvs prenatal ............................................ 39cvs prenatal gummy ................................39cvs prep ...................................................39cvs protective ..........................................39cvs saline wound wash ........................... 39cvs selenium ............................................40cvs silver ................................................. 40cvs sinus pe .............................................40cvs sinus relief day/night ........................ 40cvs skin relief .......................................... 40cvs sore muscle rub ................................ 40cvs sore throat max strength .................. 40cvs sore throat relief pops ...................... 40cvs steam inhaler .................................... 40cvs stool softener .................................... 40cvs stuffy nose & cold child ....................40cvs super cranberry urinary ................... 40cvs tension headache .............................. 40cvs therapeutic ........................................40cvs therapeutic dandruff .........................40cvs triacting cough/runny nose ...............40cvs triple magnesium complex ................40cvs ultra thin lancets ...............................40cvs vaporizer warm steam ...................... 40cvs wound wash advanced ......................40cvs yogurt+calcium gummies .................40cvs zinc oxide diaper .............................. 40cyanocobalamin ......................................40cyclobenzaprine hcl ................................40CYCLOMYDRIL...................................40cyclopentolate hcl ...................................40cyclophosphamide .................................. 40cyclosporine ............................................40cyclosporine modified .............................40cyproheptadine hcl ................................. 40CYSTADANE........................................40CYSTAGON.......................................... 40CYSTECH..............................................40

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cystine .....................................................40cytarabine (pf) ........................................ 40CYTO-Q MAX.......................................40cytra k crystals ........................................41d 1000 ..................................................... 41d 2000 ..................................................... 41dacarbazine ............................................ 41daily care skin protectant ....................... 41daily ovulation predictor ........................ 41daily vite multivitamin/iron .................... 41dairy relief .............................................. 41dakins ......................................................41dakins (1/2 strength) ...............................41dakins (1/4 strength) ...............................41DAKRINA..............................................41danazol ................................................... 41dandruff shampoo ...................................41dantrolene sodium .................................. 41dapsone ...................................................41daunorubicin hcl .....................................41day time multi-sympt cold/flu ................. 41DAYTIME COLD MEDICINE............. 41daytime cough .........................................41daytime severe cold & flu .......................41DAYTRANA..........................................41DDROPS................................................ 41DEBACTEROL......................................41DECARA................................................41DECONEX DMX...................................41DECONEX IR........................................41DEEP SLEEP......................................... 41deferasirox ..............................................41del clens ..................................................41DELBASE COMPOUNDING............... 41DELSTRIGO..........................................41DELSYM COUGH CHILDRENS.........41DELTUSS DP........................................ 41DELZICOL............................................ 41demeclocycline hcl ................................. 41DEMEROL.............................................41DEMSER................................................41DENDRACIN NEURODENDRAXCIN........................42DENTA 5000 PLUS...............................42DENTAPAINE.......................................42DEPACON............................................. 42DEPO-PROVERA..................................42DEQUASINE......................................... 42DERMA CIDOL 2000........................... 42dermacloud .............................................42DERMAGESIC...................................... 42DERMAGRAN...................................... 42DERMAGRAN HYDROGEL WOUND.................................................42DERMAL THERAPY FINGER CARE.42DERMAMED.........................................42DERMAPLEX........................................42DERMAREST PSORIASIS...................42DERMASTAT........................................42DERMASYN..........................................42DERMAZENE....................................... 42DERMOPLAST..................................... 42dermovix ................................................. 42

DESCOVY............................................. 42DESENEX FOOT/SNEAKER SPRAY.42DESGEN DM.........................................42desipramine hcl ...................................... 42DESITIN MAXIMUM STRENGTH.....42desmopressin ace spray refrig ................42desmopressin acetate ..............................42desmopressin acetate spray ....................42desonide ..................................................42despec dm-g ............................................42desvenlafaxine succinate er ....................42DEVROM...............................................42DEWEES CARMINATIVE...................42DEWITTS PAIN RELIEVER................42dexamethasone ....................................... 43DEXAMETHASONE INTENSOL........43dexamethasone sodium phosphate ......... 43dexmethylphenidate hcl .......................... 43dexmethylphenidate hcl er ......................43dexrazoxane ............................................43dextroamphetamine sulfate .....................43dhea ........................................................ 43DHS BODY WASH...............................43DHS ZINC..............................................43DIAB DAILY CARE............................. 43DIABETIC BASICS HEALTHY FOOT......................................................43DIABETIC TUSSIN.............................. 43DIABETIC TUSSIN ALLERGY...........43DIABETIC TUSSIN COLD/FLU..........43DIABETIC TUSSIN MAX ST.............. 43DIABETIC TUSSIN NIGHT COLD/FLU............................................ 43diabet-x daily prevention ........................43DIADERM FOOT REJUVENATING...43DIALYVITE.......................................... 43DIALYVITE 800................................... 43DIALYVITE 800 PLUS D.....................43DIALYVITE 800/IRON.........................43DIALYVITE/ZINC................................ 43diaper rash ............................................. 43DIASTAT ACUDIAL............................43DIASTAT PEDIATRIC......................... 43DIASTIX................................................ 43diazepam ...........................................43, 44DIAZEPAM INTENSOL.......................43diazoxide .................................................44dibucaine ................................................ 44diclofenac potassium .............................. 44diclofenac sodium ...................................44diclofenac sodium er .............................. 44dicloxacillin sodium ............................... 44dicyclomine hcl .......................................44DI-DAK-SOL.........................................44dieters super tea ..................................... 44dietex forte ..............................................44diethylpropion hcl ...................................44diethylpropion hcl er .............................. 44DIFFERIN.............................................. 44diflorasone diacetate .............................. 44diflunisal .................................................44difluprednate .......................................... 44digestive enzyme ultra ............................ 44

DIGITEK................................................44digoxin .................................................... 44DILANTIN.............................................44diltiazem cd .............................................44diltiazem hcl ........................................... 44diltiazem hcl er ....................................... 44diltiazem hcl er beads .............................44diltiazem hcl er coated beads ................. 44dilt-xr ...................................................... 45dimenhydrinate .......................................45DIMETAPP COLD/ALLERGY............ 45DIMETAPP DM COLD/COUGH......... 45DIMETAPP LONG ACT COUGH/COLD......................................45DIMETAPP MULTISYMPTOM COLD/FLU............................................ 45DIMETAPP NIGHT COLD/CONGESTION.......................... 45dimethyl fumarate ...................................45dimethyl fumarate starter pack ...............45diphenhydramine hcl .............................. 45diphenhydramine hcl (sleep) .................. 45diphenoxylate-atropine ...........................45diphtheria-tetanus toxoids dt ..................45dipyridamole ...........................................45disulfiram ................................................45divalproex sodium .................................. 45divalproex sodium er .............................. 45dl-pa-500 ................................................ 45DML....................................................... 45DOANS EXTRA STRENGTH.............. 45DOANS PILLS.......................................45DOANS PM EXTRA STRENGTH....... 45DOC OMEGA........................................45docetaxel .................................................45docosanol ................................................45docusate sodium ..................................... 45DOCUSOL KIDS...................................45DOCUSOL PLUS MINI-ENEMA.........46dofetilide .................................................46DOLOGEN.............................................46dologesic-df ............................................ 46dolorex ....................................................46DOMEBORO......................................... 46dometuss-da/children ............................. 46donepezil hcl ...........................................46dorzolamide hcl ...................................... 46dorzolamide hcl-timolol mal .................. 46DOUBLE-TUSSIN DM......................... 46DOVATO............................................... 46DOVER IRRIGATION TRAY.............. 46doxazosin mesylate ................................. 46doxepin hcl ............................................. 46doxorubicin hcl .......................................46doxycycline hyclate .................................46doxycycline monohydrate ....................... 46DR BOLDTS HINEY HEALER............46DR SMITHS DIAPER........................... 46DR SMITHS DIAPER RASH................46DR SMITHS RASH + SKIN................. 46DRAMAMINE.......................................46DRITHO-CREME HP............................46DRIXORAL COLD/ALLERGY............46

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DRIXORAL COUGH/SORE THROAT................................................46dronabinol .............................................. 46DROPLET LANCETS ULTRA THIN 30G......................................................... 46drospirenone-ethinyl estradiol ............... 47DROXIA................................................ 47drug mart lancets thin 26g ..................... 47DRUG MART UNILET LANCETS 28G......................................................... 47DRUG MART UNILET LANCETS 30G......................................................... 47dry skin treatment adv therapy ...............47drymax extra ...........................................47DRYSOL................................................ 47DULCOLAX.......................................... 47DULCOLAX MILK OF MAGNESIA...47DULERA................................................47duloxetine hcl ......................................... 47DUNLAP MOIST HEAT PACK COVER.................................................. 47DUOFILM..............................................47DURAFLEX COMFORT...................... 47DURAFLU............................................. 47DURAPROXIN......................................47DURAPROXIN ES................................ 47DURASAFE SPINAL/EPIDURAL....... 47DURATION SPRAY............................. 47DURAVENT DM...................................47DURAVENT PE.................................... 47DUREZOL............................................. 47dutasteride .............................................. 47dutasteride-tamsulosin hcl ..................... 47D-VI-SOL...............................................47d-xylose ...................................................47DY-O-DERM VITILIGO STAIN..........47ear wax cleansing ...................................47easy fiber ................................................ 47EASY TOUCH ALCOHOL PREP MEDIUM............................................... 47EASY TOUCH ALLERGY SYRINGE.47EASY TOUCH FLIPLOCK INSULIN SY.....................................................47, 48EASY TOUCH FLURINGE.................. 48EASY TOUCH HYPODERMIC NEEDLE................................................ 48EASY TOUCH INSULIN SAFETY SYR........................................................ 48EASY TOUCH INSULIN SYRINGE... 48EASY TOUCH LANCETS 26G............48EASY TOUCH LANCETS 28G............48EASY TOUCH LANCETS 28G/TWIST............................................48EASY TOUCH LANCETS 30G............48EASY TOUCH LANCETS 30G/TWIST............................................48EASY TOUCH LANCETS 32G............48EASY TOUCH LANCETS 32G/TWIST............................................49EASY TOUCH LANCETS 33G/TWIST............................................49EASY TOUCH SHEATHLOCK SYRINGE...............................................49

EASY TOUCH TB FLIPLOCK SYRINGE...............................................49EASY TWIST & CAP LANCETS........ 49EASYGEL..............................................49ecee plus ................................................. 49econazole nitrate .................................... 49ECOTRIN...............................................49ECOTRIN MAXIMUM STRENGTH... 49e-cream complex .....................................49ED A-HIST.............................................49ed a-hist dm ............................................ 49ed a-hist pse ............................................49ed bron gp ...............................................49ED CHLORPED.....................................49ED CHLORPED D.................................49ed-a-hist dm ............................................49ed-spaz ....................................................49EDURANT.............................................49efavirenz ................................................. 49efavirenz-emtricitab-tenofovir ................49efavirenz-lamivudine-tenofovir .............. 49EFFER-K................................................49effervescent pain relief ........................... 49effervescent pot chloride ........................ 49EGRIFTA............................................... 49ELDERTONIC.......................................49eletriptan hydrobromide .........................49ELIDEL.................................................. 49ELIGARD.............................................. 49ELIQUIS................................................ 49elite ca/mg .............................................. 50elite calcium ........................................... 50ELITE ZINC...........................................50ELITEK.................................................. 50ELITE-OB.............................................. 50elite-thin insulin syringe .........................50ELIXOPHYLLIN...................................50ELIXSURE COUGH............................. 50ELIXSURE FEVER/PAIN.....................50ELLA......................................................50ELLURA................................................ 50ELMIRON..............................................50ELTA DERMAL....................................50ELTA DERMAL WOUND....................50ELURYNG.............................................50EMCYT.................................................. 50EMETROL............................................. 50EMGALITY........................................... 50EMPAVELI............................................50empty capsule size 1 clear ...................... 50emtricitabine ...........................................50emtricitabine-tenofovir df .......................50EMTRIVA..............................................50EMULSION SB..................................... 51enalapril maleate ....................................51enalapril-hydrochlorothiazide ................51ENBREL................................................ 51ENBREL MINI...................................... 51ENBREL SURECLICK......................... 51ENDOXCIN........................................... 51ENDUR-ACIN....................................... 51ENEMEEZ MINI................................... 51ENFAMIL ENFALYTE.........................51

ENFAMIL EXPECTA........................... 51ENGERIX-B.......................................... 51ENLITE GLUCOSE SENSOR.............. 51enoxaparin sodium ................................. 51ENPRESSE-28....................................... 51entecavir ................................................. 51ENTEX T............................................... 51entre-hist pse .......................................... 51ENTRESTO............................................51ENTSOL NASAL.................................. 51enulose ....................................................51e-oil .........................................................51epa/gla .................................................... 51ephedrine hcl .......................................... 51EPIDIOLEX........................................... 51epidural needle ....................................... 51epinastine hcl ..........................................51epinephrine .......................................51, 52epinephrine pf ...................................51, 52EPIPEN 2-PAK...................................... 52EPIPEN JR 2-PAK.................................52epirubicin hcl ..........................................52EPISORB................................................52EPITOL.................................................. 52EPIVIR HBV..........................................52eplerenone .............................................. 52eprosartan mesylate ............................... 52epsom salt ............................................... 52eq allergy relief ...................................... 52eq allergy relief childrens .......................52eq allergy/sinus headache ...................... 52eq antibiotic + pain relief .......................52eq aspirin ................................................52EQ BABY CHEST RUB........................52eq calcium citrate+d3 petites .................52eq cough sugar free ................................ 52eq cryogenic wart removal sys ............... 52eq daily fiber ...........................................52eq dairy digestive fast acting ..................52eq feminine wash sensitive ..................... 52eq ibuprofen pm ......................................52EQ MUCUS ER..................................... 52eq omeprazole .........................................52eq pain relief/rapid burst ........................52eq sinus relief max st .............................. 52eq tioconazole 1 ......................................52eq vitamins a & d ....................................52eql 2 in 1 probiotic ................................. 52eql advanced relief ................................. 52eql alcohol swabs ................................... 52eql aller-ease .......................................... 52eql allergy ...............................................52eql aloe vera after sun ............................ 52eql antacid ultra strength ....................... 53eql antibacterial hand soap ....................53eql anti-nausea ....................................... 53eql biotin .................................................53eql cold sore treatment ........................... 53eql color lancets 21g .............................. 53eql color lancets micro 33g .................... 53eql congestion relief ............................... 53eql denture brush/pick ............................ 53eql denture cleanser ............................... 53

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eql digestive enzymes ..............................53eql ear drops ...........................................53eql effervescent cold relief ......................53eql ethyl alcohol (rubbing) ..................... 53eql everyday clean .................................. 53eql eye drops ac ......................................53eql fiber therapy ..................................... 53eql gas prevention .................................. 53eql gentle skin cleanser .......................... 53eql insulin syringe .................................. 53eql lutein ................................................. 53eql mouthwash/gargle ............................ 53eql mucus-dm ..........................................53eql multi-purpose ....................................53eql omega 3 fish oil ................................ 53eql omeprazole ....................................... 53eql one daily womens ............................. 53eql redness relief .................................... 53eql scalp relief max strength .................. 53eql super thin lancets 30g .......................53eql thin lancets 26g .................................53eql ultra protection spf50 ....................... 53eql vitamin d3 ......................................... 53eql wet cleansing towelettes ................... 53eql zinc cold relief .................................. 54EQUALACTIN...................................... 54ERBITUX...............................................54ergocalciferol ......................................... 54ergoloid mesylates ..................................54ery ...........................................................54erythromycin ...........................................54erythromycin base .................................. 54erythromycin ethylsuccinate ...................54escavite lq ............................................... 54escitalopram oxalate .............................. 54esmolol hcl ..............................................54esomeprazole magnesium .......................54ESOTERICA FADE NIGHTTIME....... 54ESOTERICA SENSITIVE SKIN.......... 54ESTARYLLA.........................................54estazolam ................................................ 54estradiol ..................................................54estradiol valerate ....................................54estradiol-norethindrone acet ..................54estropipate .............................................. 54eszopiclone ............................................. 54ethambutol hcl ........................................ 54ethosuximide ...........................................54ethyl alcohol ........................................... 54ethyl alcohol (rubbing) ...........................54ethyl chloride ..........................................54etidronate disodium ................................54etodolac .................................................. 55etodolac er ..............................................55ETOPOPHOS.........................................55etoposide .................................................55etravirine ................................................ 55eucalyptus oil ..........................................55EUCERIN...............................................55EUCERIN ECZEMA RELIEF...............55EUCERIN ORIGINAL HEALING........55EUCRISA...............................................55EUFLEXXA...........................................55

EULEXIN...............................................55EURAX.................................................. 55EVAC-U-GEN....................................... 55evening primrose oil ...............................55everolimus .............................................. 55EVOTAZ................................................ 55EXACTECH R-S-G TEST.....................55EXACTECH TEST................................ 55EXACTUSS TR..................................... 55EXAPHEN............................................. 55EXAPHEN CH.......................................55EXAPHEX TR....................................... 55EXCEDRIN EXTRA STRENGTH........55EXCEDRIN PM..................................... 55EXCEDRIN TENSION HEADACHE...55EXCEL AP............................................. 55EXEL COMFORT POINT INSULIN SYR.................................................. 55, 56exemestane ..............................................56EXFOLIX EXFOLIATING FOOT SOAP......................................................56EXFORGE HCT.....................................56EXKIVITY.............................................56EX-LAX................................................. 56EX-LAX MAXIMUM STRENGTH......56exoten-c pain relief .................................56exotic-hc ................................................. 56EXTRESS-30......................................... 56eye allergy relief .....................................56eye drops .................................................56eye itch relief .......................................... 56EYE STREAM....................................... 56E-Z JECT LANCET MICRO-THIN 33G......................................................... 56E-Z JECT LANCET SUPER THIN 30G......................................................... 56E-Z JECT LANCETS.............................56E-Z JECT LANCETS 21G.....................56E-Z JECT LANCETS THIN 26G.......... 56EZ SMART BLOOD GLUCOSE LANCETS.............................................. 56ezetimibe .................................................56ezetimibe-simvastatin ............................. 56EZFE 200............................................... 56ezfe forte ................................................. 56E-Z-GAS II .............................................56EZ-LETS LANCETS 21G..................... 56EZ-LETS LANCETS 23G..................... 56EZ-LETS LANCETS 28G..................... 56fabb .........................................................56famciclovir ..............................................56famotidine ...............................................56FARESTON........................................... 56FARXIGA.............................................. 56FAST FREEZE PRO STYLE THERAPY........................................56, 57father johns medicine ............................. 57fa-vitamin b-6-vitamin b-12 ....................57FAYOSIM.............................................. 57FC FEMALE CONDOM....................... 57febuxostat ................................................57feeding bottles/standard neck .................57FEIBA.................................................... 57

felodipine er ............................................57FEM PH..................................................57FEMINEASE..........................................57fenofibrate .............................................. 57fenofibrate micronized ............................57fenofibric acid .........................................57fenoprofen calcium ................................. 57fentanyl ................................................... 57fentanyl citrate ........................................57fentanyl citrate (pf) .................................57FER-IN-SOL.......................................... 57ferocon ....................................................57ferraplus 90 ............................................ 57ferretts .................................................... 57ferretts chewable iron .............................57ferretts ips ...............................................57FERREX 150..........................................57FERREX 150 FORTE PLUS................. 57FERREX 28............................................57FERRIMIN 150......................................57FERROCITE.......................................... 57FERROCITE PLUS............................... 57ferrous gluconate ....................................57ferrous sulfate ...................................57, 58ferrous sulfate er .................................... 57FEVERALL INFANTS..........................58FEVERALL JUNIOR STRENGTH...... 58fexofenadine hcl childrens ......................58fiber ........................................................ 58fiber laxative ...........................................58fiber therapy ........................................... 58FIBERCON............................................ 58FIBEREX F15........................................ 58FIFTY50 ALCOHOL PREP.................. 58FIFTY50 SUPERIOR COMFORT SYR........................................................ 58filter needle .............................................58finasteride ...............................................58FINE 30.................................................. 58first aid antibiotic ................................... 58first aid antiseptic ...................................58first aid antiseptic spray ......................... 58FIRVANQ.............................................. 58fish oil ..................................................... 58fish oil + d3 ............................................ 58fish oil adult gummies .............................58fish oil-flax oil-borage oil .......................58flavor packets ......................................... 58flavoxate hcl ........................................... 58flecainide acetate ....................................58FLEET BISACODYL............................ 58FLEET LIQUID GLYCERIN SUPP..... 58FLEET NATURALS CLEANSING ENEMA..................................................58FLEET OIL............................................ 58FLEET PEDIATRIC.............................. 58FLEXICHAMBER CHILD MASK/LARGE...................................... 58FLINTSTONES COMPLETE............... 58FLINTSTONES TODDLER..................59FLOGEN................................................ 59FLONASE ALLERGY RELIEF............59FLONASE SENSIMIST........................ 59

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FLORA ASSIST.....................................59FLORANEX...........................................59FLORASTOR.........................................59FLORASTOR KIDS.............................. 59FLORICAL............................................ 59FLOVENT DISKUS.............................. 59FLOVENT HFA.....................................59flow-eze vented needle ............................59FLOWING VAPORS.............................59FLOWING VAPORS/VAPOR FAN..... 59floxuridine .............................................. 59flu hbp .....................................................59FLUAD QUADRIVALENT.................. 59FLUCAINE............................................ 59FLUCELVAX QUADRIVALENT........59fluconazole ..............................................59fludarabine phosphate ............................59fludrocortisone acetate ...........................59flunisolide ............................................... 59fluocinolone acetonide ........................... 59fluocinolone acetonide body ...................59fluocinolone acetonide scalp .................. 59fluocinonide ...................................... 59, 60fluocinonide emulsified base .................. 59fluoride mouth rinse ............................... 60fluoritab .................................................. 60fluorometholone ......................................60fluorouracil .............................................60fluoxetine hcl .......................................... 60fluphenazine decanoate .......................... 60fluphenazine hcl ......................................60flurazepam hcl ........................................ 60flurbiprofen .............................................60flurbiprofen sodium ................................ 60flutamide .................................................60fluticasone propionate ............................60fluticasone-salmeterol ............................ 60fluvoxamine maleate ...............................60FLUZONE HIGH-DOSE....................... 60FLUZONE HIGH-DOSE QUADRIVALENT................................ 60FLUZONE QUADRIVALENT............. 60FOILLE.................................................. 60FOLET DHA..........................................60FOLGARD............................................. 60FOLGARD OS....................................... 60FOLIC + B12......................................... 60folic acid ................................................. 60folinic-plus ..............................................60FOLITAB 500........................................ 61FOLIVANE-F........................................ 61FOLIVANE-PLUS.................................61FOLOTYN............................................. 61foot powder .............................................61FORA D40 GLUCOSE/PRESSURE..... 61FORA LANCETS.................................. 61FORADIL AEROLIZER....................... 61FORMADON......................................... 61formaldehyde .......................................... 61FORMA-RAY........................................ 61formoterol fumarate ............................... 61FORTEO................................................ 61fosamprenavir calcium ........................... 61

fosfomycin tromethamine ....................... 61fosinopril sodium ....................................61fosinopril sodium-hctz ............................ 61fosphenytoin sodium ............................... 61freds pharmacy unilet lanc 28g .............. 61FREE & CLEAR.................................... 61FREESTYLE CONTROL SOLUTION.61FREESTYLE FLASH SYSTEM........... 61FREESTYLE FREEDOM......................61FREESTYLE FREEDOM LITE............ 61FREESTYLE INSULINX SYSTEM..... 61FREESTYLE INSULINX TEST........... 61FREESTYLE LANCETS.......................61FREESTYLE LIBRE 14 DAY READER................................................ 61FREESTYLE LIBRE 14 DAY SENSOR.................................................61FREESTYLE LIBRE 2 READER SYSTM...................................................61FREESTYLE LIBRE 2 SENSOR SYSTM...................................................61FREESTYLE LIBRE READER............ 61FREESTYLE LIBRE SENSOR SYSTEM................................................ 61FREESTYLE LITE TEST......................61FREESTYLE PRECISION INS SYR.......................................................... 61, 62FREESTYLE PRECISION NEO SYSTEM................................................ 62FREESTYLE PRECISION NEO TEST 62FREESTYLE SIDEKICK II .................. 62FREESTYLE SYSTEM......................... 62FREESTYLE TEST............................... 62fruit c ...................................................... 62fulvestrant ...............................................62FUNGI-NAIL.........................................62FUNGI-NAIL TOE & FOOT.................62FUNGOID TINCTURE......................... 62FUNGOID-D..........................................62furosemide .............................................. 62FUSION..................................................62FUZEON................................................ 62FYAVOLV.............................................62gabapentin .............................................. 62galantamine hydrobromide .................... 62galantamine hydrobromide er ................ 62GARDASIL 9.........................................62garlic/epa ................................................62garlic-lecithin ......................................... 62garlic-parsley ......................................... 62gas relief ................................................. 62GAS-X....................................................62GAS-X CHILDRENS............................ 62GAS-X EXTRA STRENGTH................62GAS-X PREVENTION..........................62GAS-X WITH MAALOX EX ST..........63GAVILYTE-C........................................63GAVILYTE-G........................................63GAVILYTE-N WITH FLAVOR PACK..................................................... 63GAVISCON........................................... 63GAVISCON EXTRA STRENGTH....... 63G-BUCAL-C.......................................... 63

G-DOLOGEN........................................ 63ge-150 .....................................................63GEBAUERS INSTANT ICE................. 63gelatin .....................................................63GELFOAM SPONGE............................ 63GELFOAM SPONGE SIZE 100............63GEL-KAM..............................................63GELONASAL........................................ 63GELUSIL............................................... 63gemcitabine hcl .......................................63gemfibrozil ..............................................63GENCONTUSS......................................63GENOTROPIN...................................... 64GENOTROPIN MINIQUICK..........63, 64gentamicin sulfate ...................................64GENTEAL..............................................64GENTEAL MILD.................................. 64GENTEAL MILD TO MODERATE.....64GENTEAL TEARS PF.......................... 64gentian violet .......................................... 64gentle laxative .........................................64GENTLE RAIN......................................64gentle skin cleanser ................................ 64GENTLE-LET GP LANCETS...............64GENTLE-LET LANCETS.....................64GENVOYA............................................ 64geravine .................................................. 64geriatric vitamin ..................................... 64geri-lanta supreme ................................. 64gerisilk bath oil .......................................64GERMBLOC HEALTH.........................64GILTUSS COUGH & COLD................ 64ginger root ..............................................64ginseng ....................................................64gla-45 ......................................................64glass syringe 3 ml ................................... 64glatiramer acetate .................................. 64glen pe .................................................... 64glenmax peb ............................................64glenmax peb dm ......................................64glenmax peb dm forte ............................. 64glentuss ...................................................64g-levocarnitine s/f ...................................64glimepiride ..............................................64glipizide .................................................. 64glipizide er ..............................................64glipizide xl .............................................. 65glipizide-metformin hcl ...........................65global inject ease insulin syr .................. 65global insulin syringes ............................65GLUCAGEN HYPOKIT....................... 65glucagon emergency ...............................65GLUCOCOM AUTOLINK TELEMONITOR....................................65GLUCOCOM LANCETS 28G.............. 65GLUCOCOM LANCETS 30G.............. 65GLUCOCOM LANCETS 33G.............. 65GLUCOPRO INSULIN SYRINGE....... 65glucosamine chond complex/msm .......... 65glucosamine chondroit msm ds .............. 65glucosamine chondroitin complx ............65glucosamine complex/vitamin d3 ........... 65glucosamine hcl ......................................65

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glucosamine sulfate ................................ 65glucosamine-chondroitin ........................65glucosamine-chondroitin-msm ............... 65glucosamine-chondroitin-vit d3 ............. 66glucosamine-msm ................................... 66glucose ....................................................66GLUCOSE NURSETTE........................ 66glutamine ................................................ 66glutathione ..............................................66glutol .......................................................66glyburide .................................................66glyburide micronized ..............................66glyburide-metformin ...............................66glycerin ...................................................66glycerin (adult) ....................................... 66glycerin (infants & children) ..................66glycine500 .............................................. 66glycolic acid ........................................... 66glycopyrrolate ........................................ 66GLYDO.................................................. 66GLY-OXIDE.......................................... 66GLYXAMBI.......................................... 66g-myco nail ............................................. 66gnp 24 hour nasal allergy ...................... 66gnp 4x probiotic ......................................66gnp advanced eye health ........................ 66gnp alcohol denatured ............................66gnp alcohol swabs .................................. 66gnp allergy & sinus headache ................ 66gnp allergy pls sinus headache .............. 66gnp animal shapes plus iron ...................66gnp antacid ............................................. 66gnp antacid & anti-gas ...........................66gnp b-50 complex ................................... 66gnp b-complex plus vitamin c .................66gnp calamine .......................................... 66gnp calcium 600 plus d/mineral ............. 66gnp calcium plus 600 +d ........................66gnp capsaicin ..........................................66gnp childrens chewables/ex c ................. 66gnp cold & hot extra strength .................66gnp cold sore treatment ..........................66gnp coq-10 & fish oil ..............................67gnp ethyl alcohol .................................... 67gnp fish oil .............................................. 67gnp flu/severe cold daytime ....................67gnp gentian violet ................................... 67gnp glycerin/rose water ..........................67gnp headache relief extra str ..................67gnp hydrogen peroxide wipes .................67gnp insulin syringe ................................. 67gnp iodides ............................................. 67gnp iodine ............................................... 67gnp isopropyl alcohol wipes ...................67gnp lancets ..............................................67gnp lancets 21g .......................................67gnp lancets micro thin 33g ..................... 67gnp lancets super thin 30g ......................67gnp lancets thin 26g ............................... 67gnp lice egg remover .............................. 67gnp liquid bandage .................................67gnp l-lysine ............................................. 67gnp micro thin lancets 33g ..................... 67

gnp natural fiber .....................................67gnp niacin ............................................... 67gnp night time cold & flu ........................67gnp omeprazole ...................................... 67gnp pain relief/benzocaine ..................... 67gnp potassium .........................................67gnp shampoo & body wash .................... 67gnp sinus wash refill ...............................67gnp super thin lancets 30g ......................67gnp terbinafine hydrochloride ................67gnp ultra com insulin syringe ...........67, 68gnp urinary pain relief ........................... 68gnp vitamin a & d ...................................68gnp vitamin d super strength .................. 68gnp vitamin d-400 ...................................68GOLD BOND FOOT POWDER MAX ST........................................................... 68GOLD BOND MULTI-SYMPTOM......68GOLD BOND RAPID RELIEF............. 68GOLD BOND ULTIM SANITIZR/MOIST................................ 68GOLD BOND ULTIM SANITIZR/SHEER................................ 68GOLD BOND ULTIMATE................... 68GONIOSOL............................................68GONIOTAIRE....................................... 68GONIOVISC.......................................... 68GOOD START 5% GLUCOSE WATER..................................................68goodsense all day allergy ....................... 68goodsense cough dm ...............................68goodsense eye drops ...............................68goodsense flu/cold/cough/night ..............68goodsense flu/cold/daytime .................... 68goodsense ibuprofen ...............................69goodsense ibuprofen childrens ...............68goodsense ibuprofen infants ...................68goodsense lancets 30g ............................ 69goodsense lancets 33g ............................ 69goodsense lubricant eye drops ............... 69goodsense miconazole 1 ......................... 69goodsense nicotine ................................. 69goodsense nighttime cold & flu .............. 69goodsense redness relief plus ................. 69goodsense severe sinus congest ..............69goodsense sinus congest/pain .................69goodsense sleeptime ............................... 69goodsense sore throat spray ...................69gordomatic ..............................................69GORDONS NO 5...................................69gordons urea ...........................................69GORDONS-VITE A.............................. 69GORDO-POOL...................................... 69GRANDPAS OATMEAL SOAP...........69GRANDPAS THYLOX SOAP..............69GRANIX................................................ 69green soap .............................................. 69griseofulvin microsize .............................69grx hemorrhoidal ....................................69grx wound ............................................... 69g-supress dx pediatric ............................ 69G-TRON PED........................................ 69G-TRON PEDIATRIC DROPS............. 69

G-TUSICOF........................................... 69guaifenesin ..............................................69guaifenesin-codeine ................................69guanfacine hcl ........................................ 69guanfacine hcl er .................................... 69guanidine hcl .......................................... 69gumsol .................................................... 69GYNE-LOTRIMIN................................ 69GYNE-LOTRIMIN 3............................. 69H2Q........................................................ 70HAILEY FE 1.5/30................................ 70halobetasol propionate ...........................70haloperidol ............................................. 70haloperidol decanoate ............................70haloperidol lactate ................................. 70hand wipes ..............................................70HARD NAILS........................................70HAVRIX................................................ 70HC DERMAPAX................................... 70H-CHLOR 12......................................... 70H-CHLOR 6........................................... 70headache relief pm ................................. 70healthy accents unilet lancets .................70hearing aid batteries .............................. 70heartburn antacid ex st ...........................70heartburn treatment 24 hour .................. 70h-e-b incontrol alcohol ...........................70h-e-b incontrol lancets 28g .....................70h-e-b incontrol lancets 30g .....................70h-e-b incontrol lancets 33g .....................70HEET TRIPLE ACTION....................... 70hematinic/folic acid ................................ 70HEMATOGEN.......................................70HEMATOGEN FA.................................70HEMOCYTE..........................................70hemorrhoidal .......................................... 70hemorrhoidal cooling ............................. 70hemorrhoidal max st/aloe .......................70heparin (porcine) in nacl ........................70heparin sodium (porcine) ....................... 70heparin sodium (porcine) pf ................... 70HERCEPTIN.......................................... 70hetastarch-nacl .......................................70HETLIOZ LQ.........................................70HEXALEN............................................. 71HIBICLENS........................................... 71high potency iron ....................................71histaflex .................................................. 71HISTEX..................................................71HISTEX PD............................................71HISTEX PDX.........................................71HISTEX-AC...........................................71HISTEX-DM.......................................... 71HISTEX-PE............................................71hm 24 hour nasal allergy ........................71hm calamine ........................................... 71hm clear fiber ......................................... 71hm ethyl rubbing alcohol ........................71hm iodides ...............................................71hm iodine ................................................ 71hm iron ................................................... 71hm melatonin quick dissolve ...................71hm nighttime sleep aid ............................71

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hm omeprazole ....................................... 71hm probiotic digestive health ................. 71HM SALONPAS PAIN RELIEF........... 71hm severe cold/cough/flu ........................71hm vitamin b12 ....................................... 71hm z-sleep ............................................... 71HOLD.....................................................71HOMATROPAIRE................................ 71HONEY BEARS W/IRON-ZINC..........71HPR PLUS HYDROGEL...................... 71huber needle ........................................... 71HUGGIES NATURAL CARE WIPES..71HUMALOG............................................72HUMALOG JUNIOR KWIKPEN.........71HUMALOG KWIKPEN........................ 71HUMALOG MIX 50/50.........................71HUMALOG MIX 50/50 KWIKPEN..... 71HUMALOG MIX 75/25.........................72HUMALOG MIX 75/25 KWIKPEN..... 71HUMATE-P........................................... 72humidifier ............................................... 72HUMIRA................................................72HUMIRA PEDIATRIC CROHNS START................................................... 72HUMIRA PEN....................................... 72HUMIRA PEN-CD/UC/HS STARTER.72HUMIRA PEN-PS/UV/ADOL HS START................................................... 72HUMPHREYS #1 SIMPLE FEVER..... 72HUMULIN 70/30................................... 72HUMULIN 70/30 KWIKPEN................72HUMULIN N......................................... 72HUMULIN N KWIKPEN......................72HUMULIN R......................................... 72HUMULIN R U-500 (CONCENTRATED)............................. 72HUMULIN R U-500 KWIKPEN...........72HURRICAINE....................................... 72HURRICAINE ONE.............................. 72HURRIVIEW......................................... 72HURRIVIEW II ..................................... 72HYALGAN............................................ 72HYCAMTIN.......................................... 73hydralazine hcl ....................................... 73HYDROCELL ADHESIVE DRESSING............................................ 73hydrocerin .............................................. 73hydrochlorothiazide ................................73hydrocod polst-cpm polst er ................... 73hydrocodone-acetaminophen ................. 73hydrocodone-homatropine ..................... 73hydrocodone-ibuprofen .......................... 73hydrocortisone ........................................73hydrocortisone ace-pramoxine ...............73hydrocortisone butyrate ......................... 73hydrocortisone valerate ..........................73hydrocortisone-aloe ................................73HYDROGEL.......................................... 73HYDROGEL AG................................... 73hydromet .................................................73hydromorphone hcl .................................73hydromorphone hcl pf ............................ 73hydrophilic ..............................................74

hydrophilic petrolatum ........................... 74hydroxychloroquine sulfate .................... 74hydroxyurea ............................................74hydroxyzine hcl .......................................74hydroxyzine pamoate ..............................74HYLATOPIC PLUS...............................74hyoscyamine sulfate ................................74hyoscyamine sulfate er ........................... 74hyoscyamine sulfate sl ............................ 74HYPERCARE........................................ 74HYPERRHO S/D................................... 74hypodermic needle ..................................74HYPOTEARS........................................ 74HYSEPT.................................................74HYVEE ADVANCED ANTACID........ 74HY-VEE LANCETS.............................. 74hy-vee thin lancets .................................. 74ibandronate sodium ................................74ibuprofen ................................................ 74ibuprofen 100 junior strength .................74ibuprofen pm ...........................................74ICAR...................................................... 74ICAR-C.................................................. 74icatibant acetate ..................................... 74ice blue ................................................... 74ICY HOT................................................74ICY HOT LIDOCAINE PLUS MENTHOL............................................ 74idarubicin hcl ......................................... 74IFEX....................................................... 74ifosfamide ......................................... 74, 75imatinib mesylate ....................................75imipramine hcl ........................................75imipramine pamoate ...............................75imiquimod ...............................................75imiquimod pump ..................................... 75immune support ...................................... 75IMODIUM A-D..................................... 75IMODIUM MULTI-SYMPTOM RELIEF.................................................. 75IMOVAX RABIES................................ 75IMPROVUE........................................... 75indapamide ............................................. 75indomethacin .......................................... 75indomethacin er ......................................75INFANRIX.............................................75infants gas relief ..................................... 75INFED.................................................... 75INFUMORPH 200................................. 75INFUMORPH 500................................. 75INGREZZA............................................ 75inject-ease ...............................................75INJECT-EASE AUTOMATIC INJECTOR............................................. 75inositol .................................................... 75INOSITOL-5.......................................... 75INSTACLEAN.......................................75INSTA-GLUCOSE................................ 75instant ear-dry ........................................ 75instant hand sanitizer ............................. 75INSTAT..................................................75INSUFLON............................................ 75insulin asp prot & asp flexpen ................75

insulin aspart ..........................................76insulin aspart flexpen ............................. 75insulin aspart penfill ...............................76insulin aspart prot & aspart ...................76insulin glargine-yfgn .............................. 76insulin lispro ...........................................76insulin lispro (1 unit dial) .......................76insulin lispro junior kwikpen ..................76insulin lispro prot & lispro .....................76insulin syringe ........................................ 76insulin syringe/needle .............................76INSUPEN ULTRAFIN.......................... 76INTEGRA.............................................. 76INTELENCE.......................................... 76intense cough reliever ex st .................... 76INTERDRY AG TEXTILE 10"X144".. 76INTRON A............................................. 76INTROVALE......................................... 76INVEGA SUSTENNA.....................76, 77INVEGA TRINZA................................. 77INVIRASE............................................. 77INVOKAMET........................................77INVOKAMET XR................................. 77INVOKANA.......................................... 77iodides tincture ....................................... 77iodine ...................................................... 77iodine strong ...........................................77iodine tincture .........................................77IONIL..................................................... 77IONIL-T................................................. 77IONSYS..................................................77IPOL....................................................... 77ipratropium bromide .............................. 77ipratropium-albuterol .............................77irbesartan ............................................... 77irbesartan-hydrochlorothiazide ..............77irinotecan hcl ..........................................77IROFOL..................................................77iron ......................................................... 78iron (ferrous sulfate) .............................. 77iron 100 plus ...........................................77iron 100/c ............................................... 77iron 21/7 ................................................. 77iron 27 .................................................... 77iron chews pediatric ............................... 77iron slow release .................................... 78irrigating eyewash ..................................78ISAGEL..................................................78ISENTRESS........................................... 78ISENTRESS HD.................................... 78isoleucine ................................................78ISOLEUCINE 1000............................... 78isoniazid ..................................................78isopropyl alcohol ....................................78isopropyl alcohol (rubbing) ....................78isopropyl alcohol wipes ..........................78ISOPTO TEARS.................................... 78isosorbide dinitrate .................................78isosorbide dinitrate er ............................ 78isosorbide mononitrate ...........................78isosorbide mononitrate er ...................... 78isotretinoin ..............................................78isradipine ................................................78

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itch relief .................................................78ITCH-X.................................................. 78itraconazole ............................................ 78IVAREST MEDICATED POISON IVY.........................................................78IVAREST POISON IVY ITCH............. 78ivermectin ............................................... 78ivy wash poison ivy cleanser .................. 78IVY-RID.................................................78IXEMPRA KIT...................................... 78IXIARO.................................................. 78J & J DENTAL FLOSS FOR KIDS.......78JANTOVEN........................................... 78JANUMET............................................. 78JANUMET XR.......................................79JANUVIA...............................................79JARDIANCE..........................................79JENTADUETO...................................... 79jessners ................................................... 79jock itch spray ........................................ 79JOHNSONS BABY CORNSTARCH....79JOHNSONS BABY OIL GEL............... 79JOHNSONS BABY POWDER..............79JULUCA.................................................79JUNEL 1.5/30.........................................79JUNEL 1/20............................................79JUNEL FE 1.5/30................................... 79k 100 ....................................................... 79k-99 .........................................................79KAITLIB FE.......................................... 79KALBITOR............................................79KANGAROO ENTRIFLUSH PUMP SET.........................................................79KANGAROO JOEY PUMP SET.......... 79KANK-A MOUTH PAIN...................... 79KANK-A SOFTBRUSH........................ 79KAOPECTATE......................................79KARBOZYME.......................................79K-BICARB.............................................79KELNOR 1/35........................................79kelp ......................................................... 79kelp-b6-lecithin-vinegar ......................... 79KENALOG.............................................79KENDALL ALGINATE DRESS 8"X8"......................................................79KENDALL ANTIMICROBIAL BANDAGE............................................ 79KENDALL CA ALGINATE 6"X10".... 79KENDALL HYDROPHILIC FOAM DRESS....................................................79KENDALL TRANSPARENT FILM DRESS....................................................79KEPIVANCE......................................... 79KERR TRIPLE DYE SWABS...............79KESIMPTA............................................ 79ketoconazole ........................................... 80ketorolac tromethamine ..........................80KETOSTIX............................................ 80kettle neti pot sinus wash ........................80KEY OMEGA........................................ 80k-iii ..........................................................80kimono micro thin ...................................80KINERASE............................................ 80

kinney lancets ......................................... 80kinney thin lancets .................................. 80kinray insulin syringe ............................. 80KINRIX.................................................. 80KIONEX.................................................80KITABIS PAK....................................... 80KLOR-CON........................................... 80KLOR-CON 10...................................... 80KLOR-CON SPRINKLE....................... 80KLOXXADO......................................... 80KLS ALLER-CORT...............................80kls cold & flu ms day/night .....................80kls esomeprazole magnesium ................. 80kls natural psyllium fiber ........................80kls omeprazole ........................................80K-MAG.................................................. 80K-MAG ASPARTATE.......................... 80K-MAG-70............................................. 80kmart valu insulin syringe 29g ......... 80, 81kmart valu insulin syringe 30g ............... 81KONSYL................................................81konsyl daily fiber .................................... 81KONSYL-D............................................81korean ginseng ....................................... 81kp hydrocortisone-aloe ...........................81kp mag-oxide magnesium ....................... 81kp silicone scar therapy gel ....................81K-PHOS..................................................81K-PHOS NO 2........................................81kpn prenatal ............................................81krill oil .................................................... 81KROGER HEALTHPRO LANCET 26G......................................................... 81kroger insulin syringe .............................81kroger lancets ......................................... 81kroger lancets 21g .................................. 81kroger lancets micro thin 33g ................ 81kroger lancets super thin ........................81kroger lancets thin ..................................81kroger lancets thin 26g ...........................81kroger lancets ultrathin 30g ................... 81K-TAN PLUS.........................................81KWAN LOONG PAIN RELIEVING....81KYLEENA............................................. 81labetalol hcl ............................................81LAC-HYDRIN FIVE............................. 81LAC-HYDRIN TWELVE......................81lactated ringers .......................................81lactic acid ............................................... 82lactic acid e ............................................ 81lacto-bifidus-600 .................................... 82LAMICTAL ODT.................................. 82LAMISIL ADVANCED........................ 82LAMISIL AT......................................... 82LAMISIL AT SPRAY............................82LAMISILK PROTECT.......................... 82lamivudine .............................................. 82lamivudine-zidovudine ............................82lamotrigine ............................................. 82lamotrigine er ......................................... 82LANACANE ANTI-BACTERIAL........82LANACANE MAXIMUM STRENGTH........................................... 82

LANACORT 10..................................... 82lancets .....................................................82lancets 28g ..............................................82lancets 30g ..............................................82lancets micro thin 33g ............................ 82lancets super thin 28g .............................82lancets thin ............................................. 82LANCETS ULTRA THIN..................... 82lancets ultra thin 30g ..............................82lanolin .....................................................82lanolin anhydrous ...................................82lanolin hydrous-grx ................................ 82lansoprazole ........................................... 82LANTISEPTIC MULTI-PURPOSE...... 82LANTUS................................................ 82LANTUS SOLOSTAR...........................82l-arginine ................................................ 82LARIN 1/20............................................82LARIN FE 1.5/30................................... 83latanoprost ..............................................83LATUDA................................................83laxative ................................................... 83laxative pills ........................................... 83LAZANDA.............................................83l-carnitine ............................................... 83leader insulin syringe ............................. 83lecithin-kelp-b6-cider vinegar ................83leflunomide ............................................. 83leg-gesic ..................................................83lemon-glycerin ........................................83LENZAPATCH......................................83letrozole .................................................. 83leucine .................................................... 83leucovorin calcium ................................. 83LEUKERAN.......................................... 83leuprolide acetate ................................... 83levalbuterol hcl .......................................83levalbuterol tartrate ............................... 83LEVEMIR.............................................. 83LEVEMIR FLEXTOUCH..................... 83levetiracetam .......................................... 83levetiracetam er ......................................83levetiracetam in nacl .............................. 83levobunolol hcl ....................................... 84levocarnitine ...........................................84levocarnitine (dietary) ............................84levocarnitine fumarate ........................... 84levocarnitine-b5-taurine .........................84levocetirizine dihydrochloride ................84levofloxacin ............................................ 84levoleucovorin calcium ...........................84LEVO-T..................................................84LEXIVA................................................. 84l-glutamine ..............................................84LICE B GONE....................................... 84LICE B GONE CAP SATURATED......84lice cure .................................................. 84lice killing maximum strength ................ 84lice treatment ..........................................84LICEFREEE...........................................84LICEMD COMPLETE...........................84LICIDE TREATMENT..........................84lidocaine ................................................. 84

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lidocaine hcl ........................................... 84lidocaine viscous .................................... 84lidocaine-hydrocortisone ace ................. 84lidocaine-prilocaine ............................... 84lidocaine-transparent dressing ...............84LIDOPATCH PAIN RELIEF................ 84lidopin .....................................................84LIDOPRO...............................................84LILETTA (52 MG)................................ 84limencin .................................................. 85lindane .................................................... 85linezolid .................................................. 85LINZESS................................................ 85liothyronine sodium ................................85lip balm ...................................................85LIP MEDEX...........................................85lip-guard .................................................85lipochol nr .............................................. 85lipochol plus ........................................... 85LIPO-GEL.............................................. 85lipoic acid ............................................... 85LIPOTRIAD...........................................85LIPOTRIAD VISIONARY....................85LIQ-10.................................................... 85LIQSORB...............................................85LIQUACEL............................................ 85LIQUIMAT............................................ 85lisinopril ................................................. 85lisinopril-hydrochlorothiazide ................85LISTERINE NATURALS ANTISEPTIC......................................... 85lite touch lancets .....................................85LITETOUCH INSULIN SYRINGE 85, 86LITETOUCH LANCETS.......................86lithium .....................................................86lithium carbonate ................................... 86lithium carbonate er ............................... 86LITTLE COLDS COUGH FORMULA.86LITTLE COLDS DECONGESTANT... 86LITTLE REMEDIES POISON TREAT................................................... 86LITTLE TUMMYS LAXATIVE...........86live better lancet super thin .................... 86live better lancet ultra thin ..................... 86liver .........................................................86liver extract .............................................86LIVMARLI............................................ 86l-lysine .................................................... 86l-lysine hcl .............................................. 86LMX 4.................................................... 86LMX 4 PLUS......................................... 86LO LOESTRIN FE.................................86local anesthesia needle ...........................86LODRANE D......................................... 86LOESTRIN FE 1.5/30............................86LOHIST-D..............................................86lohist-dm .................................................86longs insulin syringe ...............................86longs lancets thin ....................................86loperamide hcl ........................................86lopinavir-ritonavir ..................................86loratadine ............................................... 86loratadine childrens ............................... 86

loratadine-d 24hr ................................... 86lorazepam ............................................... 87LORAZEPAM INTENSOL................... 86LORTUSS DM.......................................87LORTUSS EX........................................87LORTUSS LQ........................................87losartan potassium ................................. 87losartan potassium-hctz ..........................87LOTRIMIN AF...................................... 87LOTRIMIN ULTRA.............................. 87lovastatin ................................................ 87loxapine succinate .................................. 87LOZIBASE S......................................... 87l-phenylalanine .......................................87l-tyrosine .................................................87lubiprostone ............................................87lubricant drops/dual-action ....................87lubricant eye drops .................................87LUBRISKIN...........................................87LUCENTIS.............................................87LUDENS COUGH DROPS................... 87LUDENS THROAT DROPS................. 87LUMAKRAS..........................................87LUPKYNIS............................................ 87LUPRON DEPOT (1-MONTH)............ 87LUPRON DEPOT (3-MONTH)............ 87LUPRON DEPOT (4-MONTH)............ 87LUPRON DEPOT (6-MONTH)............ 87LUPRON DEPOT-PED (1-MONTH)....87LUPRON DEPOT-PED (3-MONTH)....87lutein .......................................................87LUVENA FEMININE WIPES.............. 87LYCELLE.............................................. 87lysine4000 ...............................................87LYSODREN...........................................87M2 C.......................................................88MAALOX.............................................. 88MAALOX ADVANCED MAX ST....... 88MAALOX JUNIOR PLUS ANTIGAS..88MACUGEN............................................88mafenide acetate .....................................88MAG-200............................................... 88mag-al .....................................................88magdelay ................................................ 88MAGELLAN INSULIN SAFETY SYR........................................................ 88MAGIMIN..............................................88magnacaps ..............................................88MAGNEBIND 200.................................88MAGNEBIND 300.................................88magnesium ..............................................88magnesium carbonate .............................88magnesium chloride ............................... 88magnesium chloride-calcium ................. 88magnesium citrate .................................. 88magnesium fizz-plus ............................... 88magnesium gluconate ............................. 88magnesium oxide .................................... 88magnesium sulfate .................................. 88magnum-75 .............................................88MAGONATE......................................... 88mag-sr plus calcium ............................... 88MAG-TAB SR....................................... 88

MAKENA.............................................. 89malathion ................................................89manganese .............................................. 89manganese aspartate ..............................89manganese gluconate ............................. 89MANGIMIN...........................................89MAOX....................................................89mapap ..................................................... 89MAPAP HEADACHE PLUS................ 89MAR-COF BP........................................89MAR-COF CG EXPECTORANT......... 89MASTISOL ADHESIVE....................... 89MATULANE..........................................89MAVYRET............................................ 89MAXI-COMFORT INSULIN SYRINGE...............................................89MAXIMUM D3..................................... 89ME-500...................................................89mecholyl ..................................................89meclizine hcl ........................................... 89MEDADYNE ORAL PAIN RELIEF.... 89MEDERMA............................................89MEDERMA AG FACIAL CLEANSER........................................... 89MEDERMA PM.....................................89medic insulin syringe ..............................89medicated body .......................................89medicated douche ................................... 89medicated wipes ..................................... 89MEDICONE...........................................89MEDI-DERM/L-RX.............................. 89MEDI-DERM-RX.................................. 89MEDI-FIRST ANTISEPTIC CLEANER..............................................89medi-first hydrocortisone ....................... 89MEDI-FIRST/LIDOCAINE...................89MEDIHONEY WOUND/BURN DRESSING............................................ 90medi-laxx ................................................ 90MEDI-LYTE.......................................... 90medi-patch-lidocaine ..............................90MEDIPLAST..........................................90MEDIPORE + PAD ADHESIVE DRESS....................................................90MEDISENSE GLUCOSE KETONE CONTR.................................................. 90MEDISENSE HI/MID/LOW CONTROL............................................. 90MEDISENSE HIGH/LOW CONTROL 90MEDISENSE MID CONTROL.............90MEDISENSE THIN LANCETS............ 90medi-tussin dm double strength ..............90MEDPURA ZINC OXIDE.....................90MEDROX...............................................90medroxyprogesterone acetate .................90mefenamic acid .......................................90mefloquine hcl ........................................ 90mega coq10 .............................................90MEGA MULTIVITAMIN..................... 90megestrol acetate ....................................90meijer alcohol swabs .............................. 90MEIJER LANCETS............................... 90MEIJER LANCETS THIN.................... 90

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MEIJER LANCETS UNIVERSAL 21G......................................................... 90MEIJER LANCETS UNIVERSAL 33G......................................................... 90MEIJER SUPER THIN LANCETS....... 90melatonin ................................................ 90melatonin er ............................................90melatonin tr ............................................ 90melatonin-pyridoxine ..............................90MELLOW-TONE.................................. 91meloxicam ...............................................91melphalan ............................................... 91memantine hcl .........................................91memantine hcl er .................................... 91MENACTRA..........................................91mencaps .................................................. 91m-end dmx .............................................. 91M-END PE............................................. 91MENEST................................................ 91MENQUADFI........................................ 91menstrual pain relief .............................. 91menstrual relief max strength .................91MENVEO...............................................91meperidine hcl ........................................ 91mercaptopurine ...................................... 91mesalamine .............................................91mesalamine er .........................................91mesalamine-cleanser .............................. 91mesna ......................................................91MESNEX................................................91MESTINON........................................... 91METAMUCIL........................................91METAMUCIL MULTIHEALTH FIBER.....................................................91METAMUCIL SMOOTH TEXTURE...91metaproterenol sulfate ............................91METAXALL.......................................... 91metformin hcl ..........................................91metformin hcl er ..................................... 91methadone hcl .........................................92METHADONE HCL INTENSOL......... 92methazolamide ........................................92methenamine hippurate .......................... 92methenamine mandelate ......................... 92methimazole ............................................92methionine .............................................. 92methitest ..................................................92methocarbamol .......................................92methotrexate ........................................... 92methotrexate sodium ...............................92methotrexate sodium (pf) ........................92methoxsalen ............................................ 92methyl salicylate ..................................... 92methyldopa ............................................. 92methylphenidate hcl ................................92methylphenidate hcl er ........................... 92methylprednisolone ................................ 92methylprednisolone acetate ....................92methylprednisolone sodium succ ............92metipranolol ........................................... 92metoclopramide hcl ................................ 92metolazone ..............................................92metoprolol succinate er .......................... 92

metoprolol tartrate ................................. 92metoprolol-hydrochlorothiazide .............93metronidazole ......................................... 93metronidazole in nacl ............................. 93mexiletine hcl ..........................................93MEXSANA............................................ 93mg aspartate ........................................... 93MG/TAURINE FORTE......................... 93MG217 PSORIASIS ANIT-ITCH......... 93MI PASTE PLUS................................... 93MIBELAS 24 FE....................................93MICATIN...............................................93miconazole 3 ...........................................93miconazole 7 ...........................................93miconazole nitrate .................................. 93MICORT-HC..........................................93microfiber cleaning cloths ......................93MICROGESTIN 1/20.............................93MICROGESTIN FE 1.5/30....................93MICROKLENZ......................................93MICROLET LANCETS.........................93MICROLET NEXT LANCING DEVICE................................................. 93midazolam hcl .........................................93midodrine hcl ..........................................93MIDOL CAFFEINE FREE.................... 93MIDOL COMPLETE.............................93MIGERGOT...........................................93miglitol ....................................................93miglustat ................................................. 93MIL-A-MULSION.................................93MILCO-ZYME...................................... 93milk of magnesia concentrate .................93MILLGUARD........................................ 93MILTAB #1............................................93mineral oil light ...................................... 93mineral oil-hydrophil petrolat ................94MINIMED GUARDIAN LINK 3.......... 94MINIMED PRO-SET INFUSION 42".. 94MINITRAN............................................ 94minocycline hcl .......................................94minoxidil .................................................94minoxidil for women ...............................94MIRALAX............................................. 94MIRCERA..............................................94MIRENA (52 MG)................................. 94mirtazapine .............................................94misoprostol ............................................. 94mitomycin ............................................... 94mitoxantrone hcl .....................................94M-M-R II ................................................94mn-50 ......................................................94MODERIBA...........................................94moexipril hcl ...........................................94moisture barrier ..................................... 94MOISTURE GUARD............................ 94MOISTUREL......................................... 94moisturizing skin protectant ................... 94molybdenum ............................................94mometasone furoate ............................... 94MONOCAL............................................94MONOJECT ALLERGIST TRAY........ 94MONOJECT BLUNTIP CANNULA.... 94

MONOJECT HYPODERMIC NEEDLE................................................ 94MONOJECT INSULIN SYRINGE. 94, 95MONOJECT LIFESHIELD SYRINGE.95MONOJECT MAGELLAN SAFETY NDL........................................................95MONOJECT MAGELLAN SYRINGE.95MONOJECT SYRINGE........................ 95MONOJECT ULTRA COMFORT SYRINGE.........................................95, 96MONOLET LANCETS......................... 96MONOLET OPD LANCETS................ 96MONONINE.......................................... 96MONOVISC...........................................96montelukast sodium ................................ 96MORPHABOND ER............................. 96morphine sulfate ..................................... 96morphine sulfate (concentrate) .............. 96morphine sulfate (pf) .............................. 96morphine sulfate er .................................96morphine sulfate er beads ...................... 96MOTRIN INFANTS DROPS................ 96mouth rinse ............................................. 96MOVANTIK.......................................... 96moxifloxacin hcl ............................... 96, 97moxifloxacin hcl (2x day) ....................... 96MOZOBIL..............................................97ms insulin syringe ...................................97MUCINEX............................................. 97MUCINEX COUGH CHILDRENS.......97MUCINEX COUGH FOR KIDS........... 97MUCINEX D......................................... 97MUCINEX D MAX STRENGTH......... 97MUCINEX DM......................................97MUCINEX DM MAXIMUM STRENGTH........................................... 97MUCINEX FAST-MAX........................97MUCINEX FAST-MAX COLD & SINUS.................................................... 97MUCINEX FAST-MAX COLD FLU... 97MUCINEX FAST-MAX CONGEST COUGH..................................................97MUCINEX FAST-MAX DAY/NIGHT.97MUCINEX FAST-MAX DAY/NIGHT M/S......................................................... 97MUCINEX FAST-MAX DAY/NIGHT TAB........................................................ 97MUCINEX FOR KIDS.......................... 97MUCINEX MAXIMUM STRENGTH..97MUCINEX SINUS-MAX CONGESTION...................................... 97MUCINEX SINUS-MAX DAY/NIGHT..........................................97MUCINEX SINUS-MAX PRESS & PAIN.......................................................97MUCINEX STUFFY NOSE/COLD CHILD....................................................98mucus congest & cough child .................98mucus relief cold/sinus max st ................98mucus relief d ......................................... 98mucus relief er ........................................ 98mucus relief pe ........................................98mucus relief severe cong/cold ................ 98

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mucus-dm max ........................................98multi-delyn/iron ...................................... 98multi-draw needle ...................................98MULTIGEN........................................... 98MULTIGEN FOLIC...............................98MULTIGEN PLUS................................ 98multi-minerals ........................................ 98multi-purpose cold compress ..................98multi-symptom cold plus child ................98multi-vit/fluoride .....................................98multivitamin gummies childrens .............98multivitamin/fluoride .............................. 98multivitamin/fluoride/iron ...................... 98multivitamins/fluoride ............................ 98mupirocin ................................................98MURO 128............................................. 98muscle rub ultra strength ....................... 98MUSTARGEN....................................... 98M-VIT.................................................... 98MYCOCIDE CX CALLUS EXFOLIATOR.......................................98mycophenolate mofetil ............................98mycophenolate sodium ........................... 98MYGLUCOHEALTH LANCETS 30G.98MYLANTA............................................ 98MYLERAN............................................ 98MYNATAL............................................ 98mynate 90 plus ........................................99mynephrocaps .........................................99MYOBLOC............................................ 99MYORISAN...........................................99nabumetone ............................................ 99nac .......................................................... 99n-acetyl cysteine ..................................... 99nadolol ....................................................99NAIL SCRUB........................................ 99NAIL-EX................................................99nalbuphine hcl ........................................ 99naloxone hcl ........................................... 99naltrexone hcl ......................................... 99NAMENDA XR TITRATION PACK...99NAMZARIC...........................................99NAPHCON-A........................................ 99naproxen .................................................99naproxen dr ............................................ 99naproxen sodium .................................... 99naratriptan hcl ........................................99NARCAN............................................... 99NASACORT ALLERGY 24HR............ 99NASACORT ALLERGY 24HR CHILDREN............................................99nasal allergy 24 hour ............................. 99nasal aspirator ....................................... 99nasal decongestant ................................. 99nasal decongestant spray ....................... 99NASAL EASE ALLERGY RELIEVER.............................................99nasal mist ................................................99NASALCROM.......................................99NASOGEL............................................. 99NASONEB NEBULIZER STARTER... 99NASOPEN PE........................................99NATACYN............................................ 99

nateglinide .............................................. 99NATELLE ONE...................................100NATROBA...........................................100natural fiber laxative ............................ 100natural vitamin e .................................. 100natural vitamin e moisturizing ............. 100NATURAL WHEY..............................100NECON 0.5/35 (28) ............................. 100neomycin sulfate ................................... 100neomycin-bacitracin zn-polymyx ..........100neomycin-polymyxin b gu .....................100neomycin-polymyxin-dexameth ............ 100neomycin-polymyxin-gramicidin .......... 100neomycin-polymyxin-hc ........................100NEOSPORIN + PAIN RELIEF MAX ST......................................................... 100NEOSPORIN ORIGINAL................... 100NEOSPORIN PLUS MAX ST.............100NEOSPORIN PLUS PAIN RELIEF MS........................................................ 100NEOSTRATA FACIAL CLEANSER. 100NEOTUSS-D........................................100NEPHRONEX......................................100NEPHRO-VITE....................................100NEULASTA.........................................100NEUPOGEN........................................ 100NEURO-K-250 T.D. ............................ 100neuromax .............................................. 100NEUROPEN.........................................100NEUROTIPS........................................ 100NEUTROGENA BODY...................... 100NEUTROGENA CLEAR PORE......... 100NEUTROGENA T/GEL...................... 100NEUTROGENA T/GEL STUBBORN ITCH.....................................................100nevirapine .............................................101nevirapine er .........................................101NEW DIGNITY ODOR ELIMINATOR..................................... 101NEW SKIN...........................................101new terocin ........................................... 101NEXAFED........................................... 101NEXAFED SINUS PRESSURE + PAIN.....................................................101NEXAVAR.......................................... 101NEXCARE PREMIUM ADHESIVE GAUZE................................................ 101NEXIUM 24HR................................... 101NEXPLANON......................................101NEXT CHOICE ONE DOSE...............101niacin .................................................... 101niacin er ................................................101niacin er (antihyperlipidemic) ..............101niacin flush free .................................... 101niacinamide .......................................... 101nicardipine hcl ......................................101nicardipine hcl in dextrose ................... 101NICODERM CQ.................................. 101NICORETTE........................................101nicotine ................................................. 101nicotine polacrilex ................................101nicotine step 1 .......................................101nicotine step 2 .......................................101

nicotine step 3 .......................................101NICOTROL..........................................101NIFEDICAL XL...................................101nifedipine .............................................. 102nifedipine er ..........................................102nifedipine er osmotic release ................102nighttime cough .................................... 102nilutamide .............................................102nimodipine ............................................ 102NINJACOF...........................................102NINJACOF-A...................................... 102NINJACOF-XG....................................102NIPENT................................................102NISEKO SUNSCREEN SPF 25.......... 102nisoldipine er ........................................102NITEBITE............................................ 102nite-time cold/flu relief ......................... 102NITRO-BID..........................................102nitrofurantoin ....................................... 102nitrofurantoin macrocrystal ................. 102nitrofurantoin monohyd macro ............ 102nitroglycerin ......................................... 102nitroglycerin er .....................................102NIVANEX DMX................................. 102NIX CREME RINSE............................102nizatidine .............................................. 102NIZORAL A-D.................................... 102NOBLE FORMULA............................ 102NOBLE FORMULA HC......................102nohist-dm .............................................. 102nohist-lq ................................................102NOKOR ADMIX NEEDLE.................102non-stick ............................................... 102NORDITROPIN FLEXPRO................ 102NOREL AD..........................................102NOREL CS...........................................103norethin ace-eth estrad-fe .................... 103norethindrone acetate ...........................103norethindrone acet-ethinyl est ..............103norgestim-eth estrad triphasic ..............103NORMLSHIELD................................. 103nortemp infants .....................................103nortriptyline hcl ....................................103NORVIR...............................................103nosebleed plugs/towelettes ................... 103NO-STING SKIN-PREP......................103NOVA SUREFLEX LANCETS.......... 103NOVAFERRUM 125........................... 103NOVAFERRUM 50............................. 103NOVAFERRUM PEDIATRIC DROPS.............................................................. 103NOVOLIN 70/30 FLEXPEN............... 103NOVOLIN 70/30 FLEXPEN RELION103NOVOLIN N FLEXPEN..................... 103NOVOLIN N FLEXPEN RELION......103NOVOLOG 70/30 FLEXPEN RELION............................................... 103NOVOLOG FLEXPEN RELION........ 103NOVOLOG MIX 70/30 RELION........103NOVOLOG RELION...........................103NOVOPEN ECHO............................... 103NOXAFIL............................................ 103NOXICARE......................................... 103

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NOZIN NASAL SANITIZER..............103np thyroid ............................................. 103NPLATE...............................................103NUEDEXTA........................................ 103NUFERA.............................................. 103NU-GEL............................................... 103NU-MAG..............................................104NUPERCAINAL..................................104NUTRATEAR......................................104NUTR-E-SOL...................................... 104NUVESSA............................................104NYAMYC............................................ 104NYMALIZE......................................... 104nystatin ................................................. 104nystatin-triamcinolone ..........................104NYSTOP.............................................. 104NYTOL MAXIMUM STRENGTH.....104OASIS MOISTURIZING MOUTHWASH....................................104OBSTETRIX DHA.............................. 104OBSTETRIX EC..................................104OC8...................................................... 104OCEAN BLUE MINICAPS D/OMEGA3......................................... 104OCEAN BLUE MINICAPS OMEGA-3............................................................ 104OCEAN BLUE OPTIMAL HEALTH.104OCEAN COMPLETE SINUS RINSE.104OCEAN NASAL SPRAY.................... 104oceanic selenium .................................. 104OCUSOFT LID SCRUB COMPLIANCE.................................... 104ODEFSEY............................................ 104ODOR EATERS ANTIFUNGAL........104odor spray .............................................104OFF ACTIVE....................................... 104OFF FAMILYCARE CLEAN FEEL...104ofloxacin ............................................... 104OGESTREL..........................................105olanzapine ............................................ 105olmesartan medoxomil ......................... 105olmesartan medoxomil-hctz ..................105olopatadine hcl ..................................... 105omega dha ............................................ 105OMEGA POWER................................ 105omega-3 ................................................ 105omega-3 fish oil .................................... 105omega-3 fish oil ex st ............................105omega-3 fish oil-vitamin d3 ..................105OMEGA-3 IQ.......................................105omega-3-acid ethyl esters .....................105omeprazole ........................................... 105omeprazole magnesium ........................ 105omeprazole-sodium bicarbonate .......... 105OMNIFLEX DIAPHRAGM................ 105ONCASPAR.........................................105ondansetron .......................................... 105ondansetron hcl .................................... 105one step pregnancy ...............................105ONE-A-DAY ADULT VITACRAVES+DHA..........................105ONE-A-DAY WOMENS 50+ ADVANTAGE.....................................105

ONETOUCH DELICA LANCETS 30G....................................................... 105ONETOUCH DELICA LANCETS 33G....................................................... 105ONETOUCH FINEPOINT LANCETS105ONETOUCH PING METER REMOTE..............................................105ONETOUCH ULTRASOFT LANCETS............................................ 105ONEXTON...........................................105opium .................................................... 105OPSUMIT............................................ 106OPTIONS CONCEPTROL..................106OPTIONS GYNOL II CONTRACEPTIVE............................. 106OPTIUM BLOOD GLUCOSE MONITOR........................................... 106OPTIUM GLUCOSE MONITOR SYSTEM.............................................. 106OPTIUM TEST.................................... 106OPTIUMEZ TEST............................... 106ORA-FILM...........................................106ORAJEL DENTURE........................... 106oral analgesic max st ............................106oral anesthetic ...................................... 106oral electrolytes ....................................106ORAL SWAB PETITE........................ 106oral syringe bottle adapter ................... 106ORALONE...........................................106ORAMAGIC PLUS............................. 106ORAZINC............................................ 106ORFADIN............................................ 106ORILISSA............................................ 106ornithine ............................................... 106orphenadrine citrate .............................106orphenadrine citrate er ........................ 106ORTHOVISC....................................... 106OS-CAL................................................106OS-CAL EXTRA D3........................... 106OS-CAL ULTRA................................. 106oseltamivir phosphate ...........................106OSTEO-PORETICAL..........................106ostomy protective ..................................106OUTGRO PAIN RELIEF.................... 106ovulation predictor ............................... 106oxaliplatin .............................................106oxandrolone ..........................................106oxaprozin .............................................. 106oxazepam .............................................. 106oxcarbazepine .......................................107oxybutynin chloride .............................. 107oxybutynin chloride er ..........................107oxycodone hcl ....................................... 107oxycodone hcl er ...................................107oxycodone-acetaminophen ................... 107oxycodone-ibuprofen ............................ 107OXYCONTIN...................................... 107oxymorphone hcl .................................. 107oxymorphone hcl er .............................. 107OXYTROL FOR WOMEN..................107OXYZAL WET DRESSING............... 107oyster calcium + d ................................107oyster calcium/d3 ................................. 107

oyster shell calcium .............................. 107oyster shell calcium 250+d .................. 107oyster shell calcium 500 + d ................ 107oyster shell calcium 500+d .................. 107oyster shell calcium plus d ................... 108oyster shell calcium w/d ....................... 108oyster shell calcium/d ...........................108oyster shell calcium/d3 .........................108P & S.................................................... 108p-1000 ...................................................108PA CLA................................................108pa fish oil/vit d3 triple st .......................108pa glucosamine-chondroitin .................108pa prenatal formula ..............................108pa probiotic complex ............................ 108paclitaxel .............................................. 108pain & fever childrens ..........................108pain relief ............................................. 108pain relief day & night ex st ................. 108pain relief roll-on ................................. 108pain reliever extra strength .................. 108pain reliever pm ....................................108pain reliever pm ex st ........................... 108pain reliever/fever reducer ...................108pain relieving ........................................108pain relieving + lidocaine .................... 108PALADIN............................................ 108pamidronate disodium ..........................108pancreatin .............................................108PANCREAZE...................................... 108PANOXYL...........................................108PANOXYL WASH.............................. 108PANOXYL-4 CREAMY WASH.........108panto-250 ..............................................108pantoprazole sodium ............................ 108pantothenic acid ................................... 108papaya .......................................... 108, 109papaya and enzymes .............................108papaya enzyme ..................................... 108papaya/pineapple enzymes ................... 109PARAGARD INTRAUTERINE COPPER...............................................109paricalcitol ........................................... 109PARODONTAX.................................. 109paromomycin sulfate ............................ 109paroxetine hcl ....................................... 109paroxetine hcl er ...................................109parvenzyme digestive enzyme ...............109PATADAY...........................................109PAZEO................................................. 109pc lancets super thin 30g ......................109PECGEN DMX.................................... 109pedia relief cough/cold .........................109PEDIACARE CHILDRENS LONG-ACT...................................................... 109PEDIACARE CHILDRENS MULTI-SYMP................................................... 109PEDIACARE MULTI-SYMPTOM.....109PEDIACLEAR PD CHILDRENS........109PEDIA-LAX.........................................109PEDIA-LAX FIBER GUMMIES........ 109PEDIALYTE ADVANCED CARE.....109PEDIARIX........................................... 109

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PEDIAVENT........................................109PEDIAVIT............................................109PEDVAX HIB......................................109PEGANONE........................................ 109PEGINTRON....................................... 109PEG-INTRON...................................... 110PEG-INTRON REDIPEN.................... 109PEG-INTRON REDIPEN PAK 4........ 109penicillamine ........................................ 110penicillin g potassium ...........................110penicillin v potassium ...........................110PENTACEL..........................................110pentamidine isethionate ........................110PENTASA............................................ 110pentoxifylline er ....................................110PENTRAX GOLD............................... 110PEPCID AC..........................................110PEPCID AC MAXIMUM STRENGTH......................................... 110PEPTO-BISMOL................................. 110PEPTO-BISMOL MAX STRENGTH. 110PEPTO-BISMOL TO-GO....................110PERFORM ATOMIC HEAT...............110PERFORM PAIN RELIEVING...........110PERFORM PAIN RELIEVING ROLL-ON............................................ 110PERIDIN-C.......................................... 110perindopril erbumine ............................110PERIOMED..........................................110permethrin ............................................ 110PERNOX.............................................. 110PEROXYL............................................110PEROXYL SPOT TREATMENT........110perphenazine ........................................ 110perphenazine-amitriptyline .................. 110PERRY PRENATAL........................... 110petroleum jelly ......................................110PHARMABASE BARRIER................ 111PHARMACY COUNTER LANCETS 111PHAZYME GAS & ACID MAX ST...111PHAZYME MAXIMUM STRENGTH.............................................................. 111PHAZYME ULTRA STRENGTH...... 111PHENADOZ........................................ 111PHENAZO........................................... 111phenazopyridine hcl ............................. 111phenelzine sulfate ................................. 111phenobarbital ....................................... 111phenol ................................................... 111PHENOL EZ SWABS..........................111phenoxybenzamine hcl ..........................111phentermine hcl .................................... 111phenylalanine ....................................... 111phenylephrine hcl ................................. 111phenylephrine-dm-gg ............................111phenytoin .............................................. 111PHENYTOIN INFATABS...................111phenytoin sodium ..................................111phenytoin sodium extended .................. 111PHLEXY-10.........................................111PHOS-FLUR ORTHO DEFENSE.......111phos-nak ............................................... 111phosphatidyl choline .............................111

PHOSPHOLINE IODIDE....................111PHOTOFRIN........................................111phytonadione ........................................ 111PHYTOPLEX Z-GUARD....................111PIFELTRO........................................... 111pilocarpine hcl ......................................111pimecrolimus ........................................ 112pindolol .................................................112pinworm medicine ................................ 112pioglitazone hcl .................................... 112pioglitazone hcl-glimepiride .................112pioglitazone hcl-metformin hcl .............112piroxicam ..............................................112PLAN B ONE-STEP............................ 112PLIAGEL............................................. 112PLO ULTRAMAX...............................112PNEUMOVAX 23............................... 112pnv-dha .................................................112pnv-dha+docusate ................................112pnv-omega ............................................ 112pnv-select ..............................................112podofilox ...............................................112poison ivy wash fast acting ...................112POLAR FREEZE................................. 112POLAR FROST................................... 112poly bacitracin ......................................112POLY HIST FORTE............................ 112polyethylene glycol 3350 ...................... 112poly-hist dm .......................................... 112poly-hist pd ........................................... 112poly-iron 150 forte ................................112polymyxin b-trimethoprim .................... 112POLYSPORIN..................................... 112poly-tussin ac ........................................112POLY-VENT DM................................ 112POLY-VENT IR...................................112POLY-VI-SOL..................................... 112POLY-VI-SOL/IRON.......................... 112potassimin .............................................112potassium chloride ............................... 112potassium chloride crys er ................... 112potassium citrate er .............................. 112potassium citrate-citric acid .................112potassium gluconate ............................. 112potassium iodide (antidote) .................. 113povidone-iodine .................................... 113povidone-iodine paint sponge .............. 113povidone-iodine prep ............................113povidone-iodine scrub sponge ..............113power oral care system .........................113PR NATAL 400....................................113PR NATAL 400 EC............................. 113PR NATAL 430....................................113PR NATAL 430 EC............................. 113PRADAXA...........................................113PRALUENT......................................... 113PRAMEGEL........................................ 113pramipexole dihydrochloride ............... 113PRAMOX.............................................113pramoxine hcl ....................................... 113prasugrel hcl .........................................113pravastatin sodium ............................... 113prazosin hcl .......................................... 113

PRECISION GLUCOSE CONTROL..113PRECISION GLUCOSE CONTROL SOLN....................................................113PRECISION GLUCOSE KETONE CONTR................................................ 113PRECISION GLUCOSE/KETONE CONTR................................................ 113PRECISION LINK...............................113PRECISION PCX.................................113PRECISION PCX PLUS TEST........... 113PRECISION POINT OF CARE TEST 113PRECISION QID MONITOR..............113PRECISION QID TEST.......................113PRECISION SOF-TACT MONITOR..113PRECISION SOF-TACT TEST...........113PRECISION SUREDOSE PLUS SYR...................................................... 113, 114PRECISION SURE-DOSE SYRINGE 114PRECISION THINS GP LANCETS... 114PRECISION XTRA............................. 114PRECISION XTRA BLOOD GLUCOSE............................................114PRECISION XTRA KETONE............ 114PRECISION XTRA MONITOR..........114PRED MILD.........................................114prednicarbate ....................................... 114prednisolone ......................................... 114prednisolone acetate .............................114prednisolone sodium phosphate ........... 114prednisone ............................................ 114PREDNISONE INTENSOL.................114preferred plus insulin syringe ...............114preferred plus lancets colored ..............114preferred plus lancets thin ....................115pregabalin ............................................ 115PREGNITUDE.....................................115PREMARIN......................................... 115PREMIER UROSTOMY..................... 115PREMPHASE...................................... 115PREMPRO........................................... 115prenatal ................................................ 115prenatal (w/iron & fa) .......................... 115prenatal 19 ........................................... 115prenatal dha ......................................... 115prenatal formula ...................................115prenatal formula a-free ........................ 115prenatal low iron .................................. 115prenatal multi +dha ............................. 115prenatal multivitamin plus dha .............115PRENATAL-U.....................................115PRENATE............................................ 115prep protective skin barrier ..................115PREPARATION H...............................115PREPARATION H TOTABLES......... 115pres gen pediatric .................................115PRESGEN B.........................................115PRETZ..................................................115PREVACARE ANTIMICROBIAL..... 115PREVACARE EXTRA PROTECTIVE.............................................................. 115PREVACARE PERSONAL PROTECT............................................ 115PREVACARE TOTAL SKIN CARE.. 115

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PREVACID 24HR............................... 115PREVIDENT........................................115PREVNAR 13...................................... 115PREVNAR 20...................................... 115PREZISTA........................................... 116PRIFTIN...............................................116PRILOSEC OTC.................................. 116PRIMATENE ASTHMA..................... 116primidone ..............................................116PRO NUTRIENTS OMEGA 3............ 116PROAIR HFA...................................... 116probenecid ............................................ 116PROBIOMAX PLUS DF..................... 116probiotic ............................................... 116probiotic digestive support ...................116probiotic-prebiotic ................................116PROCARE PLUS UNDERWEAR MEDIUM............................................. 116PRO-CEPTION.................................... 116prochlorperazine .................................. 116prochlorperazine maleate .....................116PROCOMYCIN................................... 116PROCTOFOAM...................................116PROCTOSOL HC................................ 116PRODIGY INSULIN SYRINGE.........116PRODIGY NO CODING BLOOD GLUC................................................... 116PRODIGY TWIST TOP LANCETS 28G....................................................... 116PROFE..................................................116PROFERRIN ES.................................. 116PROFERRIN-FORTE.......................... 116PROFILNINE SD.................................116progesterone .........................................116progesterone micronized ...................... 116PROLENSA......................................... 116PROLIDA.............................................116PROMACTA................................116, 117promethazine hcl .................................. 117promethazine vc/codeine ...................... 117promethazine-codeine .......................... 117promethazine-dm .................................. 117promethazine-phenylephrine ................ 117PROMETHEGAN................................117PROMOLAXIN................................... 117PRONUTRIENTS CALCIUM+D3..... 117PRONUTRIENTS SUPER B COMPLEX...........................................117propafenone hcl ....................................117propafenone hcl er ................................117propranolol hcl .....................................117propranolol hcl er ................................ 117propranolol-hctz ...................................117propylene glycol ................................... 117propylthiouracil ....................................117PRO-RED AC...................................... 117PROSHIELD SKIN CARE.................. 117protein .................................................. 117PROTEINEX........................................117PROTEINEX P100...............................117protriptyline hcl ....................................117PROVENT SLEEP APNEA THERAPY............................................117

PROVIDA DHA...................................117PROVIEW............................................117pseudoeph-bromphen-dm ..................... 117pseudoephedrine hcl .............................117pseudoephedrine hcl er ........................ 117psorcon ................................................. 117PSS SELECT GP LANCETS...............118PSS SELECT SAFETY LANCETS.....118PULMICORT FLEXHALER...............118PULMOZYME.....................................118PURACYN PLUS DUO-CARE.......... 118pure l-citrulline .....................................118purefe ob plus ....................................... 118purified water ....................................... 118px allergy relief d ................................. 118px allergy sinus pe ................................118px antacid extra strength ......................118px artificial tears .................................. 118px daytime cold .....................................118px daytime multi-symptom ....................118px gas relief extra strength ...................118px ibuprofen cold & sinus .................... 118px insulin syringe ..................................118px lancets ultra thin ..............................118px minoxidil for men .............................118px nasal four .........................................118px nitetime multi-symptom ....................118px omeprazole .......................................118PYLERA.............................................. 118pyrazinamide ........................................ 118pyridostigmine bromide ........................118pyridostigmine bromide er ................... 118pyridoxine hcl ....................................... 118PYRIDOXINE/MINERALS................ 118pyrilamine-phenylephrine .................... 118pyrimethamine ...................................... 118qc alcohol swabs .................................. 118qc arthritis ............................................ 118qc calamine ...........................................118qc iodides ..............................................118qc iodine tincture ..................................118qc lancets super thin 30g ......................118qc lancets ultra thin ..............................118QC MEDIFIN PE................................. 118qc natural vegetable ............................. 119qc non-adherent ....................................119qc unilet lancets 28g .............................119qc unilet lancets micro thin .................. 119Q-GEL.................................................. 119quercetin ...............................................119quetiapine fumarate ..............................119quetiapine fumarate er ......................... 119quinapril hcl ......................................... 119quinapril-hydrochlorothiazide ............. 119quinidine gluconate er ..........................119quinidine sulfate ................................... 119quinine sulfate ...................................... 119ra 8 hour pain relief ............................. 119ra acetaminophen flu cold ....................119ra acid reducer plus antacid ................ 119ra acne maximum ................................. 119ra advanced eye health .........................119ra alcohol swabs ...................................119

ra anorectal .......................................... 119ra antifungal pen .................................. 119ra b-12 .................................................. 119ra baby care vit a&d to go ................... 119ra back & body pain relief ................... 119ra backache relief .................................119ra b-complex/vitamin c cr .....................119ra ca/mg/zn/cu ...................................... 119ra calamine ...........................................119ra calcium .............................................119ra calcium hi-cal/vitamin d .................. 119ra calcium high potency ....................... 119ra calcium soft chews ........................... 119ra calcium-boron ..................................119ra cold remedy multi-symptom ............. 119ra cold sore treatment .......................... 119ra cold therapy gel ............................... 119ra cold/sinus max ..................................120ra corn cushions small ......................... 120ra corn removers ultra thin .................. 120ra cranberry ......................................... 120ra dark tanning .....................................120ra day/night/cold/flu relief ....................120ra daytime cold/flu relief ...................... 120ra ear wax cleansing system .................120ra ethyl alcohol .....................................120ra exfoliating moisturizer ..................... 120RA E-ZJECT COLOR LANCETS 33G.............................................................. 120RA E-ZJECT LANCETS 28G............. 120RA E-ZJECT LANCETS THIN 26G...120RA E-ZJECT LANCETS THIN 28G...120RA E-ZJECT LANCETS ULTRA THIN.................................................... 120ra feminine care douche ....................... 120ra fever reducer/pain reliever .............. 120ra fiber weight management .................120ra first aid iodine ..................................120ra first aid non-stick ............................. 120ra first aid saline wound wash ............. 120ra fish oil .............................................. 120RA FISH OIL EXTRA STRENGTH...120ra foaming hand soap refill .................. 120ra glucosamine-chondroitin ................. 120ra glucosamine-chondroitin-d3 ............120ra glucosamine-chondroit-msm ............120ra glucos-chondroit-msm ..................... 120ra glycerin child ................................... 120ra hemorrhoid relief ............................. 120ra hot & cold lidocaine ........................ 120ra hot/cold gel sleeve ............................120ra hydrogen peroxide ........................... 120ra hydrogen peroxide wipes ................. 120ra insulin syringe ..................................120ra intimacy gels/him/her .......................120ra isopropyl alcohol wipes ................... 120ra lice solution ......................................121RA LOTION.........................................121ra lubricant eye drops .......................... 121ra lutein ................................................ 121RA LYCOPENE...................................121ra melatonin ......................................... 121ra miconazole 3 combo pack ................ 121

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ra mouth pain anesthetic ...................... 121ra mucus relief d max strength ............. 121ra multihealth fiber ...............................121ra nasal strip/drug free/large ............... 121ra nighttime cold/flu relief ....................121ra oatmeal moisturizing ........................121ra omega 3-6-9 ..................................... 121ra omeprazole .......................................121ra omeprazole-sodium bicarb .............. 121ra oyster shell calcium/d ...................... 121ra pain relief .........................................121ra personal lubricant ............................121ra prenatal ............................................121ra probiotic complex ............................ 121ra probiotic digestive care ................... 121ra probiotic gummies ............................121RA RENEWAL ACNE TREATMENT.............................................................. 121RA RENEWAL DARK SPOT CORRECTOR...................................... 121RA RENEWAL SHOWER & BATH..121ra renewal soothing bath ......................121ra saline nasal spray ............................ 121ra saline wound wash ........................... 121ra sensitive anti-itch ............................. 121ra severe cold/night cold&flu ...............121ra severe congestion/cold max ............. 121ra shower & bath body .........................121ra silky lubricant moisturizer ............... 121ra sinus wash nasal relief .....................121ra sinus wash neti pot ...........................121ra skin treatment ...................................121ra slow release iron ..............................121ra stay awake ........................................121ra sterile saline nasal mist ....................122ra triple antibiotic ................................ 122RA TUGABOOS BABY......................122ra tussin cough dm sugar free .............. 122ra vagicaine ..........................................122ra vaginal infection screening ..............122ra vitamin b-12 ..................................... 122ra vitamin c ...........................................122ra yeast relief plus ................................ 122rabano yodado ......................................122RABAVERT........................................ 122rabeprazole sodium .............................. 122RADIACARE POST HEALING......... 122raloxifene hcl ........................................122ramelteon ..............................................122ramipril .................................................122ranitidine hcl ........................................ 122RASH AWAY......................................122RASH RELIEF.....................................122raspberry syrup .................................... 122reality insulin syringe ...........................122reality lancets ....................................... 122reality swabs .........................................122reality trigger lancets ........................... 122REA-LO............................................... 122REBETOL............................................ 122RECOMBIVAX HB.............................122RECTICARE........................................122red cross cotton sterile ......................... 122

REDNESS RELIEF..............................122reeses pinworm medicine ..................... 122REFENESEN CHEST CONG/PAIN RLF.......................................................122REFENESEN CHST CONG/PAIN PE 122REFRESH............................................ 123REFRESH LACRI-LUBE....................123REFRESH OPTIVE............................. 123REFRESH OPTIVE MEGA-3............. 123REFRESH OPTIVE SENSITIVE........ 123REFRESH P.M.....................................123REFRESH TEARS...............................123REGENECARE HA.............................123REGRANEX........................................ 123relagesic ............................................... 123relcof c ..................................................123RELIADERM.......................................123RELIEF PAIN RELIEVING................123reliever ..................................................123RELION ALCOHOL SWABS............ 123RELION ALL-IN-ONE....................... 123RELION BLOOD GLUCOSE TEST...123RELION GLUCOSE SHOT................ 123RELION INSULIN SYRINGE.... 123, 124RELI-ON INSULIN SYRINGE...........123RELION LANCETS MICRO-THIN 33G....................................................... 124RELION LANCETS STANDARD 21G....................................................... 124RELION LANCETS THIN 26G..........124RELION LANCETS ULTRA-THIN 30G....................................................... 124RELION ULTRA THIN LANCETS 30G....................................................... 124RELION ULTRA THIN PLUS LANCETS............................................ 124RELISTOR...........................................124REMEDY ANTIMICROBIAL CLEANSER......................................... 124REMEDY CALAZIME....................... 124REMEDY CLEANSING BODY......... 124REMEDY PHYTOPLEX ANTIFUNGAL.................................... 124REMEDY SKIN REPAIR....................124REMOVE ADHESIVE REMOVER WIPES.................................................. 124RENACIDIN........................................ 124renal vitamin .........................................124RENFLEXIS........................................ 124repaglinide ............................................124REPATHA............................................124REPATHA SURECLICK.................... 124REPHRESH..........................................124REPLACE SR...................................... 124RESCON.............................................. 124RESCRIPTOR......................................124resorcinol-sulfur ...................................124RESOURCE THICKENUP WATER.. 124RESPAIRE-30......................................124RESTASIS............................................124RESTASIS MULTIDOSE................... 124RESTORE CLEANSER & MOISTURIZER................................... 124

RETAINE PM...................................... 125RETROVIR.......................................... 125REVEAL COLON DISEASE.............. 125REVEAL DNA PATERNITY TEST...125REVEAL GET PREGNANT QUICK. 125REVEAL MULTI-DRUG TESTING CUP...................................................... 125REVEAL URINARY TRACT.............125REVITADERM WOUND CARE........125REVLIMID.......................................... 125REVONTO...........................................125REXALL LANCETS ULTRA THIN 30G....................................................... 125REYATAZ........................................... 125REZAMID............................................125REZUROCK........................................ 125RHINARIS........................................... 125RHINASE.............................................125RHOPRESSA.......................................125RIASTAP............................................. 125RIAX.................................................... 125RIBASPHERE......................................125ribavirin ................................................125riboflavin .............................................. 125RICOLA CHERRY HONEY HERB... 125RICOLA HERB................................... 125RICOLA LEMON MINT.....................125RICOLA W/ECHINACEA.................. 125RIDAURA............................................125rifabutin ................................................ 125rifampin ................................................ 125RIGHTEST GL300 LANCETS........... 125riluzole ..................................................125ringers irrigation ..................................125risacal-d ................................................125RISAMINE...........................................125RISPERDAL CONSTA....................... 126risperidone ............................................126ritonavir ................................................126RITUXAN............................................ 126rivastigmine .......................................... 126rivastigmine tartrate .............................126rixubis ...................................................126rizatriptan benzoate ..............................126robafen ..................................................126ROBAFEN DM COUGH CLEAR.......126ROBATHOL........................................ 126ROBITUSSIN CHILD COUGH/COLD CF..............................126ROBITUSSIN CHILDRENS COUGH LA.........................................................126ROBITUSSIN COLD+FLU DAYTIME............................................126ROBITUSSIN COUGH+CHEST CONG DM........................................... 126ROBITUSSIN DAY/NIGHT VALUE PAK...................................................... 126ROBITUSSIN LINGERING COUGHGELS......................................126ROBITUSSIN MUCUS+CHEST CONGEST............................................126ROBITUSSIN MULTI-SYMPTOM MAX.....................................................126

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ROBITUSSIN NIGHTTIME COUGH 126ROBITUSSIN NIGHTTIME COUGH DM........................................................126ROBITUSSIN PEAK COLD MULTI-SYM..................................................... 126ROBITUSSIN PK COLD DAY/NGHT DM........................................................126ROBITUSSIN PK COLD DAY/NGHT MS........................................................ 126ROBITUSSIN SEVERE NIGHTTIME.............................................................. 127ROBITUSSIN TO GO COUGH/COLD CF..............................127ROCKLATAN..................................... 127ROLAIDS.............................................127ropinirole hcl ........................................127rose water ............................................. 127rosuvastatin calcium .............................127ROTARIX............................................ 127ROTATEQ........................................... 127rotex ......................................................127ru-hist d ................................................ 127RUKOBIA............................................127rutin ...................................................... 127RYDEX................................................ 127rydex g .................................................. 127RYLAZE.............................................. 127rymed .................................................... 127rynex pe ................................................ 127rynex pse ...............................................127S.S.S. TONIC....................................... 127SAFE TUSSIN PM.............................. 127SAFELET IV CATHETER..................127safety insulin syringes .......................... 127SAFETY SEAL LANCETS.................127SAFETY-GARD NEEDLE 18G..........127SAFETY-LOK SYRINGE................... 127SALEM SUMP TUBE 12FR............... 127salicylic acid .........................................127salicylic acid wart remover .................. 127salicylic acid-cleanser ..........................127saline .................................................... 127SALMON............................................. 127sam-e .................................................... 128SAM-E COMPLETE........................... 128sam-g.l.a. .............................................. 128SAMSCA..............................................128SANTYL.............................................. 128sapropterin dihydrochloride .................128SARNA................................................ 128SASTID SOAP.....................................128SAVELLA............................................128SAVELLA TITRATION PACK..........128sb alcohol prep ..................................... 128sb bacitracin ......................................... 128sb childrens cough/runny nose ............. 128sb cold & flu hbp .................................. 128sb daytime sinus ....................................128sb fib lax orange ................................... 128sb insulin syringe ..................................128sb lancets thin .......................................128sb lancets ultra thin .............................. 128sb lice treatment ................................... 128

sb nighttime sinus multi-sympt ............. 128sb omeprazole .......................................128sb stool softener ....................................128scarcin .................................................. 128scot-tussin expectorant ......................... 128SCYTERA............................................128se-100 ................................................... 128SEBUDERM........................................ 128SEBULEX............................................ 128SECONAL............................................128SECURA EXTRA PROTECTIVE...... 128SECURA MOISTURIZING CLEANSER......................................... 128SECURA TWO-STEP......................... 128SELECT-OB........................................ 129selegiline hcl .........................................129selenicaps-200 ...................................... 129selenimin ...............................................129selenium er ........................................... 129selenium sulfide .................................... 129SELSUN BLUE DEEP CLEANSING.129SELZENTRY....................................... 129SEMGLEE............................................129SEMGLEE (YFGN)............................. 129se-natal 19 ............................................ 129senna .....................................................129senna laxative ....................................... 129senna leaves ..........................................129SENNA PROMPT................................129senna s .................................................. 129SENNA SMOOTH...............................129SENOKOT EXTRA STRENGTH....... 129SENOKOT S........................................ 129SENSI-CARE BODY...........................129SENSI-CARE PERINEAL/SKIN........ 129SENSI-CARE PROTECTIVE BARRIER.............................................129SENSIPAR........................................... 129SENSITIVE EYES ENZYME CLEANER............................................129SENSODYNE MAXIMUM STRENGTH......................................... 129SE-PLUS PROTEIN............................ 129SEREVENT DISKUS.......................... 129sertraline hcl .........................................129sevelamer carbonate .............................130sevelamer hcl ........................................130severe allergy ....................................... 130severe cold & flu day/night .................. 130sf 5000 plus ...........................................130shampoo & body wash rinse-free .........130SHINGRIX...........................................130SHOPKO ALCOHOL SWABS........... 130SHOPKO UNILET LANCETS 30G....130SHUR-SEAL CONTRACEPTIVE...... 130silace .....................................................130sildenafil citrate ....................................130silodosin ................................................130silver nitrate ......................................... 130silver sulfadiazine .................................130SILVERMED....................................... 130SIMILAC STERILIZED WATER.......130SIMILASAN DRY EYE RELIEF....... 130

SIMILASAN PINK EYE RELIEF.......130SIMILASAN STYE EYE RELIEF......130simple syrup ..........................................130simvastatin ............................................130SINADRIN PE COMPLETE SINUS REL...................................................... 130sinus & cold-d ...................................... 130sinus & congestion day/night ............... 130sinus congestion/pain daytime ..............130sinus relief ............................................ 130sirolimus ............................................... 130siterol ....................................................130skin protectant ...................................... 130skin tag remover ................................... 130SKINTEGRITY HYDROGEL.............130SKYLA.................................................130sleep aid ................................................130SLEEP-N-HEEL.................................. 130SLO-NIACIN....................................... 131SLOW FE............................................. 131slow iron ............................................... 131slow magnesium/calcium ......................131slow release iron .................................. 131sm alcohol prep .................................... 131sm allergy relief ....................................131sm b super vitamin complex ................. 131sm biotin ............................................... 131sm calamine ..........................................131sm calcium soft chews .......................... 131sm chest congestion relief dm ...............131SM CORAL CALCIUM...................... 131sm cosmetic puffs jumbo .......................131sm cough drops .....................................131sm cough/sore throat daytime .............. 131sm daytime cold & cough child ............ 131sm dental rinse anti-plaque .................. 131sm ethyl alcohol (rubbing) ................... 131sm foaming antacid .............................. 131sm fruit coolers .....................................131sm glucosamine hcl-msm ......................131SM GLUCOSAMINE/CALCIUM + D131sm hemorrhoidal ...................................131sm ibuprofen jr ..................................... 131sm iodides ............................................. 131sm iodine tincture ................................. 131sm iron ..................................................131sm lancets 33g ...................................... 131sm medicated chest rub ........................ 131sm melatonin .........................................131sm natural herb cough drops ................131sm oatmeal bath ....................................131sm omega-3-6-9 fatty acids .................. 131sm omeprazole ......................................131sm one daily prenatal ........................... 131sm pain relief/menthol .......................... 131sm prenatal vitamins ............................ 131sm slow release iron ............................. 132sm tussin cf ........................................... 132sm vitamin b1 ........................................132SMART SENSE COLOR LANCETS 33G....................................................... 132SMART SENSE STANDARD LANCETS............................................ 132

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SMART SENSE SUPER THIN LANCETS............................................ 132SMART SENSE THIN LANCETS 26G....................................................... 132smoothfit cuff ........................................ 132sod citrate-citric acid ........................... 132sodium bicarbonate .............................. 132sodium chloride .................................... 132sodium chloride (hypertonic) ............... 132sodium fluoride .....................................132sodium phenylbutyrate ......................... 132sodium polystyrene sulfonate ............... 132sofosbuvir-velpatasvir .......................... 132solifenacin succinate ............................ 132SOLIRIS...............................................132SOLUBLE FIBER THERAPY............ 132solvatech plus ....................................... 132SOMBRA COOL THERAPY..............132SOMBRA WARM THERAPY............132SOOTHE & COOL INZO BARRIER. 132SOOTHE XP XTRA PROTECTION.. 132sorbitol ..................................................132sorbutuss nr .......................................... 132sore throat ............................................ 132sore throat lozenges ..............................132sotalol hcl ............................................. 132sotalol hcl (af) ...................................... 132soya lecithin ..........................................132spinosad ................................................133SPIRIVA HANDIHALER................... 133spironolactone ...................................... 133spironolactone-hctz .............................. 133sportbalm ..............................................133SPORTSCREME..................................133spot acne treatment .............................. 133SPRAYZOIN........................................133SPS....................................................... 133SSD (SILVER SULFADIAZINE)....... 133stahist ad ...............................................133STALEVO 100.....................................133STALEVO 125.....................................133STALEVO 150.....................................133STALEVO 200.....................................133STALEVO 75.......................................133STANBACK HEADACHE POWDERS...........................................133stavudine ...............................................133STERILANCE TL................................133STERILE LUBRICANT...................... 133STERI-STRIP COMPOUND BENZOIN............................................ 133STERI-TAMP SEALS BOTTLES/VIALS................................133STERI-TAMP SEALS/BAGS............. 133STERI-TAMP SEALS/SYRINGES.....133STIMATE.............................................133STIMEX INSULATED NEEDLE....... 133STIMULEN..........................................133STIOLTO RESPIMAT.........................133STOMAHESIVE MOLDABLE ADHESIVE.......................................... 133STOMAHESIVE PASTE.....................133stop lice maximum strength ..................133

STRIANT............................................. 133STRIBILD............................................ 133STRIDEX ESSENTIAL.......................133STRI-DEX SENSITIVE SKIN............ 133STUART ONE..................................... 133SUBLOCADE...................................... 133SUBOXONE........................................ 134SUBVENITE........................................134sucralfate .............................................. 134SUDAFED............................................134SUDAFED 24 HOUR.......................... 134SUDAFED CHILDRENS.................... 134SUDAFED PE CHILDRENS.............. 134SUDAFED PE COLD & COUGH CHILD..................................................134SUDAFED PE DAY & NIGHT...........134SUDAFED PE MAXIMUM STRENGTH......................................... 134SUDAFED PRESSURE+PAIN 12 HR134sulfacetamide sodium ........................... 134sulfacetamide sodium (acne) ................ 134sulfacetamide sodium-sulfur .................134sulfacetamide-prednisolone ..................134sulfadiazine ...........................................134sulfamethoxazole-trimethoprim ............134SULFAMYLON...................................134sulfasalazine ......................................... 134sulfo-lo ..................................................134sulfur .....................................................134sulindac ................................................ 134sumatriptan ...........................................134sumatriptan succinate ...................134, 135sumatriptan succinate refill ..........134, 135SUMMERS EVE DEODORANT ULTRA.................................................135sunitinib malate .................................... 135super b-50 complex .............................. 135super c-500 complex .............................135super cal/mag ....................................... 135super moleskin ......................................135SUPER OMEGA-3...............................135super thin lancets ..................................135supposibase f ........................................ 135SUPPRELIN LA.................................. 135SUPREP BOWEL PREP KIT..............135supress a pediatric ................................135supress dm pediatric .............................135SUPRESS-PE PEDIATRIC................. 135sure comfort alcohol prep .................... 135sure comfort insulin syringe ......... 135, 136sure comfort lancets 28g ...................... 136sure comfort lancets 30g ...................... 136SURE-JECT INSULIN SYRINGE...... 136SURE-LANCE ULTRA THIN LANCETS............................................ 136SURELITE LANCETS........................ 136SUSPENDOL-S................................... 136SUSTIVA............................................. 136SWEEN................................................ 136SWEEN PREP......................................136SWIM EAR.......................................... 136swimmers instant ear dry ..................... 136SYLATRON.........................................136

SYMBICORT.......................................136sympathetic nerve needle ......................136SYMTUZA...........................................136SYNAGIS.............................................136Synera...................................................136SYNJARDY......................................... 137SYNVISC.............................................137SYNVISC ONE....................................137syringe .................................................. 137syringe 10-12 ml ...................................137syringe 20-25 ml ...................................137syringe 2-3 ml .......................................137syringe 30-35 ml ...................................137syringe 50-60 ml ...................................137syringe 5-6 ml .......................................137syringe luer slip .................................... 137syringe precisedose dispenser .............. 137SYRSPEND SF.................................... 137SYRSPEND SF PH4............................ 137syrup nf ................................................. 137SYSTANE............................................ 137SYSTANE BALANCE........................ 137SYSTANE LID WIPES....................... 137SYSTANE OVERNIGHT THERAPY 137SYSTANE PRESERVATIVE FREE...137SYSTANE ULTRA..............................137SYSTANE ULTRA PF........................ 137TABLOID............................................ 137tacrolimus .............................................137tadalafil (pah) .......................................137tamoxifen citrate ...................................137tamsulosin hcl .......................................137TANDEM.............................................137tangerine ...............................................137TARGRETIN....................................... 137taron forte .............................................137TARON-PREX.....................................137TARSUM............................................. 137taurine .................................................. 138tazarotene ............................................. 138TAZORAC........................................... 138TAZTIA XT......................................... 138tb syringe 1 ml ...................................... 138tdm solution .......................................... 138TEAR FLO........................................... 138TEARS NATURALE PM.................... 138TECHLITE AST LANCETS............... 138TECHLITE LANCETS........................138TECHLITE LANCETS 30G................ 138TECNU FIRST AID.............................138TEGADERM CONTACT LAYER......138TEGADERM FOAM........................... 138TEGADERM FOAM ADHESIVE...... 138TEGADERM HYDROGEL WOUND FILLER................................................ 138telmisartan ............................................138telmisartan-hctz .................................... 138temazepam ............................................ 138TEMIXYS............................................ 138temozolomide ........................................138temsirolimus ......................................... 138tenofovir disoproxil fumarate ...............138tension headache .................................. 138

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terazosin hcl ......................................... 138terbinafine hcl .......................................138terbutaline sulfate .................................138terconazole ........................................... 138teriparatide (recombinant) ................... 138terocin ...................................................138teroderm-plus ....................................... 138TESTOPEL.......................................... 138testosterone ...........................................139testosterone cypionate .......................... 139testosterone enanthate ..........................139tetanus-diphtheria toxoids td ................139tetrabenazine ........................................ 139tetracycline hcl ..................................... 139TETRA-FORMULA CGH/SORE THROAT..............................................139tgt alcohol swabs .................................. 139tgt first aid cleansing ............................139tgt lancet micro thin 33g ...................... 139tgt lancet thin 26g .................................139tgt lancet ultra thin 30g ........................ 139tgt lubricant eye drops ..........................139tgt lubricant redness reliever ............... 139tgt omeprazole ...................................... 139THALOMID.........................................139THE ITCH ERASER............................139THEOCHRON..................................... 139theophylline er ......................................139THERACOF PLUS COUGH/COLD REL...................................................... 139THERACYS.........................................139THERA-D 4000................................... 139THERAFLU COLD & COUGH..........139THERAFLU EXPRESSMAX..............139THERAFLU FLU & SORE THROAT 139THERAFLU SEVERE COLD............. 139THERAFLU SEVERE COLD & COUGH................................................139THERAFLU SEVERE COLD DAYTIME............................................139THERAFLU SEVERE COLD NIGHTTIME........................................139THERAFLU SEVERE COLD/CGH NIGHT..................................................140THERAFLU WARMING RELIEF SINUS.................................................. 140THERA-GESIC....................................140THERANATAL COMPLETE............. 140THERANATAL OVAVITE................ 140THERAPLEX T................................... 140THERASEAL HAND PROTECTION 140THERATEARS.................................... 140THERATEARS NUTRITION............. 140thermometer covers .............................. 140thiamine ................................................ 140THINLETS GP LANCETS..................140thioridazine hcl .....................................140thiotepa .................................................140thiothixene ............................................ 140thrivite 19 ............................................. 140THYROLAR-1.....................................140THYROLAR-1/2..................................140THYROLAR-1/4..................................140

THYROLAR-2.....................................140THYROLAR-3.....................................140tiagabine hcl ......................................... 140TICOVAC............................................ 140TIELLE................................................ 140TIGER BALM EXTRA STRENGTH. 140TIGER BALM LINIMENT................. 140TIGER BALM MUSCLE RUB........... 140TIGER BALM NECK & SHOULDER RUB......................................................140TIGER BALM PAIN RELIEVING..... 140TIGER BALM PAIN RELIEVING LG.............................................................. 140TIGER BALM RED EXTRA STRENGTH......................................... 140TIGER BALM REGULAR STRENGTH......................................... 140TIGER BALM ULTRA STRENGTH. 140TILIA FE..............................................141timolol maleate ..................................... 141TINACTIN........................................... 141TINACTIN JOCK ITCH......................141TITRALAC.......................................... 141TIVICAY..............................................141TIVICAY PD....................................... 141tizanidine hcl ........................................ 141TN DICKINSONS WITCH HAZEL... 141TOBI PODHALER.............................. 141TOBRADEX........................................ 141tobramycin ............................................141tobramycin-dexamethasone ..................141TODAY SPONGE............................... 141todays health thin lancets 28g .............. 141todays health thin lancets 30g .............. 141tolazamide ............................................ 141tolbutamide ...........................................141tolmetin sodium .................................... 141tolnaftate ...............................................141tolterodine tartrate ............................... 141tolterodine tartrate er ...........................141toomey syringe ......................................141topcare lancets micro-thin 33g .............141topcare ultra comfort ins syr ........ 141, 142TOPICAINE 5......................................142topiramate ............................................ 142topotecan hcl ........................................ 142TOPROL XL........................................ 142torsemide .............................................. 142TOVIAZ............................................... 142TRACLEER......................................... 142TRADJENTA.......................................142tramadol hcl ......................................... 142tramadol hcl er ..................................... 142tramadol hcl er (biphasic) ....................142tramadol-acetaminophen ......................142trandolapril .......................................... 142tranexamic acid .................................... 142TRANQUILITY BRIEFS.................... 142TRANSANOSIL.................................. 142transderm-iq ......................................... 142tranylcypromine sulfate ........................142TRANZAREL...................................... 142travel sickness .......................................142

travoprost (bak free) .............................142trazodone hcl ........................................ 142TREANDA...........................................142T-RELIEF PAIN ARNICA + 12..........142T-RELIEF PAIN RELIEF....................142TRELSTAR MIXJECT........................142treprostinil sodium ............................... 142tretinoin ........................................ 142, 143TREXALL............................................143triacting nightime cold&cough ............ 143triamcinolone acetonide ....................... 143TRIAMINIC CHEST/NASAL CONGEST............................................143TRIAMINIC COLD & ALLERGY..... 143TRIAMINIC COLD/COUGH..............143TRIAMINIC COLD/COUGH DAY TIME.................................................... 143TRIAMINIC COUGH/RUNNY NOSE.............................................................. 143TRIAMINIC COUGH/SORE THROAT..............................................143TRIAMINIC FEVER REDUCER........143TRIAMINIC FLU COUGH & FEVER143TRIAMINIC FLU/COUGH/FEVER... 143TRIAMINIC LONG ACTING COUGH................................................143TRIAMINIC NIGHT TIME COLD/CGH..........................................143TRIAMINIC SORE THROAT............ 143triamino ................................................ 143triamterene-hctz ....................................143triazolam ...............................................143tri-buffered aspirin ............................... 143tricitrates .............................................. 143trifluoperazine hcl ................................ 143trifluridine ............................................ 143trigels-f forte .........................................143trihexyphenidyl hcl ....................... 143, 144TRI-LO-SPRINTEC.............................144trimethobenzamide hcl ......................... 144trimethoprim .........................................144trimipramine maleate ........................... 144TRINATE.............................................144triple antibiotic ..................................... 144TRIPLE FLEX..................................... 144triple helix collagen ..............................144TRIPLE PASTE................................... 144triprolidine hcl ......................................144TRISENOX.......................................... 144TRISPEC PSE PEDIATRIC................ 144TRIUMEQ............................................144TRI-VI-SOL......................................... 144tri-vitamin/fluoride ............................... 144TROCAINE THROAT.........................144TROCAL COUGH SUPPRESSANT.. 144trochibase s ...........................................144TROMBONEX-D................................ 144trospium chloride ................................. 144TRUEPLUS GLUCOSE...................... 144TRUEPLUS INSULIN SYRINGE...................................................... 144, 145TRUEPLUS LANCETS 26G...............145TRUEPLUS LANCETS 28G...............145

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TRUEPLUS LANCETS 30G...............145TRUEPLUS LANCETS 33G...............145TRULICITY.........................................145TRUSELTIQ (100MG DAILY DOSE)145TRUSELTIQ (125MG DAILY DOSE)145TRUSELTIQ (50MG DAILY DOSE). 145TRUSELTIQ (75MG DAILY DOSE). 145TRUSTEX NON-LUBRICATED........145TRUSTEX RIA NON-LUBRICATED 145trymine cg ............................................. 145TUMS E-X 750.................................... 145TUMS LASTING EFFECTS............... 145TUMS ULTRA 1000............................145tuohy epidural needle tw ...................... 145TUSICOF............................................. 145TUSNEL C........................................... 145TUSNEL PEDIATRIC.........................145TUSNEL-DM PEDIATRIC................. 145tussin .....................................................145tussin cf cough & cold .......................... 145tussin cf max multi-symptom ................ 145tussin cough ..........................................145tussin cough dm .................................... 145tussin cough long-acting ...................... 145tussin dm max ....................................... 145TUSSI-PRES........................................ 145TUSSI-PRES PE PEDIATRIC............ 145TUSSI-PRES PEDIATRIC.................. 145TUSSLIN PEDIATRIC........................145TWINRIX.............................................146TYBOST.............................................. 146TYLENOL............................................146TYLENOL 8 HOUR............................ 146TYLENOL CHILDRENS CLD+CGH 146TYLENOL CHILDRENS PLUS MS COLD................................................... 146TYLENOL COLD & HEAD............... 146TYLENOL COLD MAX..................... 146TYLENOL COLD MULTI-SYMPTOM.......................................... 146TYLENOL COLD/FLU SEVERE.......146TYLENOL EXTRA STRENGTH....... 146TYLENOL INFANTS..........................146TYLENOL PM EXTRA STRENGTH.146TYLENOL SINUS SEVERE...............146TYLENOL WARMING COUGH/CONGEST............................ 146TYPHIM VI......................................... 146tyrosine ................................................. 146TYVASO REFILL............................... 146UBRELVY........................................... 146ULCEREASE.......................................146ULTICARE ALCOHOL SWABS....... 146ULTICARE INSULIN SAFETY SYR 146ULTICARE INSULIN SYRINGE...................................................... 146, 147ULTICARE SYRINGE........................147ULTICARE TUBERCULIN SAFETY SYR...................................................... 147ultilet alcohol swabs .............................147ULTILET CLASSIC LANCETS......... 147ULTILET INSULIN SYRINGE.. 147, 148

ULTILET INSULIN SYRINGE SHORT.................................................148ULTILET LANCETS...........................148ultra comfort insulin syringe ................ 148ULTRA FRESH................................... 148ULTRA FRESH PM............................ 148ULTRA MEGA GOLD........................148ULTRA MIDE 25................................ 148ULTRABAG/DIANEAL PD-2/4.25%DEX........................................ 148ultracin ................................................. 148ULTRACIN M..................................... 148ULTRACIN T...................................... 148ULTRACIN-M.....................................148ultra-comfort insulin syringe ........148, 149ultrasone ...............................................149ULTRA-THIN II INS SYR SHORT....149ULTRA-THIN II INSULIN SYRINGE.............................................................. 149ULTRA-THIN II LANCETS............... 149UMCKA ELDERBERRY COLD+FLU.............................................................. 149UMCKA FASTACTIVES COLD+FLU......................................... 149UMECTA MOUSSE............................149UNDELENIC....................................... 149unibase ..................................................149UNILET COMFORTOUCH LANCET.............................................................. 149UNILET EXCELITE........................... 149UNILET EXCELITE II ........................149UNILET G.P. LANCET.......................149UNILET G.P. SUPERLITE LANCET.149UNILET GP 28 ULTRA THIN............149UNILET LANCET...............................149UNILET MICRO-THIN 33G...............149UNILET SUPERLITE LANCET.........149UNILET SUPER-THIN 30G............... 149UNILET ULTRA-THIN 28G.............. 149UNI-SOLVE.........................................149UNIVERSAL 1 LANCETS THIN 26G.............................................................. 149UNIVERSAL 1 LANCETS THIN 33G.............................................................. 150UNIVERSAL 1 LANCETS ULTRA THIN.................................................... 150universal ph .......................................... 150UPTRAVI.............................................150urea .......................................................150urea 20 intensive hydrating ..................150urea hydrating ...................................... 150urea nail ............................................... 150urinary pain relief ................................ 150URO-MAG...........................................150ursodiol .................................................150vagicaine .............................................. 150VAGISIL.............................................. 150valacyclovir hcl .................................... 150valerian .................................................150valerian root ......................................... 150valganciclovir hcl ................................. 150valine .................................................... 150VALINE 1000...................................... 150

valproate sodium .................................. 150valproic acid .........................................150valsartan ...............................................150valsartan-hydrochlorothiazide ............. 150VALSTAR............................................150VALTOCO 10 MG DOSE................... 150VALTOCO 15 MG DOSE................... 150VALTOCO 20 MG DOSE................... 150VALTOCO 5 MG DOSE..................... 150value health insulin syringe ..........150, 151value plus lancet standard 21g .............151value plus lancets super thin ................ 151value plus lancets thin 26g ................... 151valumark lancet super thin 30g ............ 151valumark lancet ultra thin 28g ............. 151VAMOUSSE LICE TREATMENT.....151VANACHOL........................................151VANACOF...........................................151VANACOF AC.................................... 151VANACOF DM................................... 151VANACOF-8....................................... 151vanadium .............................................. 151VANATAB AC....................................151VANATAB DM................................... 151vancomycin hcl ..................................... 151vancomycin hcl in dextrose .................. 151vancomycin hcl in nacl ......................... 151VANDAZOLE..................................... 151VANICREAM DIAPER RASH...........151VANIPLY............................................ 151VANISHPOINT SAFETY SYRINGE.151VANTAS..............................................151VAPOR PATCH.................................. 151vaporizing steam ...................................151VAQTA................................................ 151varenicline tartrate ...............................151VARIVAX............................................151VASHE WOUND THERAPY.............151VASOCLEAR-A..................................151VASOFLEX D1................................... 151VAXNEUVANCE............................... 151VCF VAGINAL CONTRACEPTIVE...................................................... 151, 152VECTIBIX........................................... 152VELCADE........................................... 152venaliv .................................................. 152VENIA..................................................152venlafaxine hcl ......................................152venlafaxine hcl er ................................. 152VENTAVIS.......................................... 152VENTOLIN HFA.................................152verapamil hcl ........................................152verapamil hcl er ....................................152VERELAN PM.....................................152VERQUVO.......................................... 152VERSAPLUS....................................... 152VERSIVA XC...................................... 152VH ESSENTIALS UTI RELIEF......... 152VIBERZI.............................................. 152VIBRAMYCIN.................................... 152VICKS DAYQUIL MUCUS CONTROL DM....................................152

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VICKS NYQUIL CHILDRENS CLD/CGH............................................ 152VICKS NYQUIL COLD & FLU NIGHT..................................................152VICKS NYQUIL COUGH.................. 152VICKS NYQUIL SEVERE COLD & FLU...................................................... 152VICKS SINEX DAYQUIL/NYQUIL..152VICKS SINEX DAYTIME..................152VICKS SINEX NIGHTTIME.............. 152VICKS VAPO STEAM........................152VICKS VAPODROPS......................... 153VICKS VAPOINHALER.....................153VICKS VAPOPADS PEDIATRIC...... 153VICKS VAPORIZER SCENT.............153VICKS VAPORUB..............................153VICODIN............................................. 153VICODIN ES....................................... 153VICODIN HP....................................... 153VICTOZA............................................ 153VIDA MIA UNILET LANCETS 28G.153VIDEX..................................................153VIDEX EC........................................... 153VIIBRYD............................................. 153VIMPAT...............................................153VINATE II ........................................... 153VINATE M...........................................153vinblastine sulfate .................................153VINCASAR PFS..................................153VINCE..................................................153vinorelbine tartrate ...............................153VIRACEPT.......................................... 153VIREAD...............................................153virtussin dac ......................................... 153VISI-FLOW IRRIGATION STARTER.............................................................. 153vita-c .....................................................153VITA-CALCIUM.................................153VITADYE............................................ 153VITAFOL ULTRA...............................153VITALINE BIOTIN FORTE/ZINC.....153VITALINE COQ10..............................153VITA-MAG..........................................153VITAMAX........................................... 153VITAMELTS ENERGY VITAMIN B-12.......................................................... 154vitamin a ............................................... 154vitamin a & d ........................................154VITAMIN A FISH............................... 154vitamin a palmitate ...............................154vitamin a wrinkle treatment ..................154vitamin a-beta carotene ........................154vitamin b complex-c ..............................154vitamin b-1 ............................................154vitamin b12 ........................................... 154vitamin b-12 ..........................................154vitamin b-2 ............................................154vitamin b-6 ............................................154vitamin b-6 er ....................................... 154vitamin c ............................................... 154vitamin c (calcium ascorbate) .............. 154vitamin c drops ..................................... 154vitamin c er ...........................................154

vitamin c gummies ................................ 154vitamin c plus wild rose hips ................ 154vitamin c-rose hips er ........................... 154vitamin d2 ............................................. 154vitamin d3 ............................................. 154vitamin d-400 ........................................154vitamin e ....................................... 154, 155VITAMIN E & C BEAUTY LOTION 154VITAMIN E & K BEAUTIFUL SKIN 154vitamin e beauty ....................................154vitamin e/selenium ................................155vitamins acd-fluoride ............................155VITAMINS E & A BEAUTY OIL...... 155VITAMINS E & D BEAUTY OIL...... 155VITA-RAY...........................................155VITONIC..............................................155viva ....................................................... 155VIVA DROPS...................................... 155VIVABEN............................................ 155VIVITROL........................................... 155VIVOTIF.............................................. 155vocabria ................................................155voriconazole ......................................... 155vp insulin syringe ..................................155VYVANSE...........................................155WAL-DRYL.........................................155WAL-DRYL ANTI-ITCH................... 155WAL-DRYL PE ALLERGY & SINUS.............................................................. 155WAL-FEX D ALLERGY & CONGESTION.................................... 155WAL-FLU COLD & SORE THROAT155WAL-FLU SEV COLD/CGH DAY/NIGHT........................................155WALGREENS LANCETS.................. 155walgreens lancets micro thin ................155walgreens lancets super thin ................ 155WALGREENS THIN LANCETS........155WALGREENS ULTRA THIN LANCETS............................................ 155WAL-ITIN D........................................155WAL-MUCIL PLUS CALCIUM........ 155WAL-PHED PE DAYTIME/NIGHTTIME.................... 155WAL-SLEEP Z.................................... 155WAL-SLEEP Z LIQUID SHOTS........155wal-tap cold/allergy ............................. 155wal-tussin cf ..........................................156WAL-TUSSIN CF MAX..................... 156wal-tussin cough relief ......................... 156WAL-ZYR............................................156WAL-ZYR CHILDRENS.................... 156warfarin sodium ................................... 156wart remover maximum strength ..........156water tabs ............................................. 156wax for braces ...................................... 156WEBCOL ALCOHOL PREP LARGE 156WEBCOL ALCOHOL PREP MEDIUM............................................. 156wee care ................................................156wegmans complete prenatal+dha ........ 156WEISS EPIDURAL NEEDLE.............156WEISS EPIDURAL NEEDLE TW..... 156

WELIREG............................................ 156WELLMIND MENTAL FOCUS.........156WHITE PED ARTERIAL NEEDLE... 156white petrolatum ...................................156white petroleum jelly ............................ 156WIDE-SEAL DIAPHRAGM 60.......... 156WIDE-SEAL DIAPHRAGM 65.......... 156WIDE-SEAL DIAPHRAGM 70.......... 156WIDE-SEAL DIAPHRAGM 75.......... 156WIDE-SEAL DIAPHRAGM 80.......... 156WIDE-SEAL DIAPHRAGM 85.......... 156WIDE-SEAL DIAPHRAGM 90.......... 156WIDE-SEAL DIAPHRAGM 95.......... 156WINGS MATERNITY PANTS 2X-3X.............................................................. 156WINRHO SDF..................................... 156witch hazel ....................................156, 157WIXELA INHUB.................................157wound gel ............................................. 157wound gel spray ....................................157WYMZYA FE......................................157XARELTO........................................... 157XARELTO STARTER PACK.............157XEOMIN.............................................. 157XERAC AC..........................................157XEROFORM PETROLAT GAUZE 1"X8"....................................................157XGEVA................................................ 157XIAFLEX.............................................157XIFAXAN............................................ 157XIGDUO XR........................................157XIIDRA................................................ 157XOFLUZA (40 MG DOSE).................157XOFLUZA (80 MG DOSE).................157XOLAIR...............................................157xolido .................................................... 157X-SEB T PEARL................................. 157XTRA-CARE....................................... 157XULANE..............................................157XYREM................................................157YES FOR WOMEN............................. 157YF-VAX...............................................157YUVAFEM.......................................... 157ZADITOR............................................ 157ZAFEMY..............................................157zafirlukast ............................................. 157zaleplon ................................................ 157ZANOSAR........................................... 158ZANTAC 150 MAXIMUM STRENGTH......................................... 158ZANTAC 75.........................................158Z-BUM................................................. 158ZEASORB............................................158ZEGERID OTC....................................158ZELBORAF......................................... 158ZENATANE.........................................158ZENPEP............................................... 158ZEPHREX-D........................................158ZE-PLUS.............................................. 158ZERIT...................................................158ZEVALIN Y-90................................... 158ZICAM ALLERGY RELIEF...............158ZICAM COLD REMEDY................... 158

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zidovudine .............................................158ZIKS ARTHRITIS PAIN RELIEF...... 158ZILACTIN............................................158ZIMS CRACK CREME DIABETIC... 158ZIMS MAX-FREEZE.......................... 158zinc ........................................................158zinc + vitamin c .................................... 158ZINC 15................................................158zinc aspartate ....................................... 158zinc gluconate .......................................158zinc methionate .....................................158zinc oxide ..............................................158zinc sulfate ............................................158zinc-c-b6 ............................................... 158zincolate ................................................158ZINC-OXYDE PLUS...........................158zinc-vitamin c ....................................... 158ziprasidone hcl ..................................... 159ZITHROMAX...................................... 159zn-50 ..................................................... 159ZOLADEX........................................... 159zoledronic acid ..................................... 159ZOLINZA.............................................159zolmitriptan .......................................... 159zolpidem tartrate .................................. 159zolpidem tartrate er .............................. 159ZOMIG.................................................159zonisamide ............................................ 159ZOSTAVAX........................................ 159ZOSTRIX HOT & COLD THERAPY 159ZOSTRIX HP....................................... 159ZOSTRIX NATURAL PAIN RELIEF 159ZOSTRIX-HP.......................................159ZOVIRAX............................................ 159Z-TUSS AC..........................................159ZYCLARA........................................... 159ZYCLARA PUMP............................... 159ZYLET................................................. 159ZYNCOF.............................................. 159ZYRTEC ALLERGY...........................159ZYRTEC-D ALLERGY & CONGESTION.................................... 159ZZZQUIL............................................. 159

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virginia premier health plan famis medicaid formulary

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