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
Formulary AGE (Min 18 Years)
ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 300 MG, 400 MG
Formulary AGE (Min 18 Years)
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 #3 oral tablet 300-30 mg Formulary PA; QL (140 EA per 7 days)
acetaminophen-codeine #4 oral tablet 300-60 mg Formulary PA; QL (70 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
Formulary AGE (Min 19 Years)
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
Formulary AGE (Min 19 Years)
AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION
Formulary AGE (Min 19 Years)
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
Formulary ST; AGE (Min 18 Years)
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
Formulary QL (170 EA per 34 days)
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
FormularyQL (60 EA per 30 days); AGE (Min 4 Years and Max 17 Years)
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
Formulary AGE (Min 18 Years)
ARISTADA INITIO INTRAMUSCULAR PREFILLED SYRINGE 675 MG/2.4ML
Formulary AGE (Min 18 Years)
ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML, 441 MG/1.6ML, 662 MG/2.4ML, 882 MG/3.2ML
Formulary AGE (Min 18 Years)
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
ASMANEX (14 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCG/INH
Formulary
11
Drug Name Formulary Status Requirements/LimitsASMANEX (30 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 110 MCG/INH, 220 MCG/INH
Formulary
ASMANEX (60 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCG/INH
Formulary
ASMANEX (7 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 110 MCG/INH
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
Formulary QL (30 EA per 30 days)
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
Formulary QL (30 ML per 30 days)
BAYER BACK & BODY ORAL TABLET 500-32.5 MG Formulary OTC
BAYER BREEZE 2 CONTROL LIQUID HIGH IN VITRO HIGH
Formulary OTC; QL (100 EA per 30 days)
BAYER BREEZE 2 CONTROL LIQUID LOW IN VITRO LOW
Formulary OTC; QL (100 EA per 30 days)
BAYER BREEZE 2 CONTROL LIQUID NORMAL IN VITRO NORMAL
Formulary OTC; QL (100 EA per 30 days)
BAYER BREEZE 2 SYSTEM KIT W/DEVICE W/DEVICE
Formulary OTC; QL (1 EA per 365 days)
BAYER BREEZE 2 TEST DISK IN VITRO Formulary OTC; QL (150 EA per 30 days)
BAYER CONTOUR LINK MONITOR KIT W/DEVICE W/DEVICE
Formulary OTC; QL (1 EA per 365 days)
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
BD INSULIN SYRINGE 26G X 1/2" 1 ML 26G X 1/2" 1 ML
Formulary OTC
BD INSULIN SYRINGE 27.5G X 5/8" 2 ML 27.5G X 5/8" 2 ML
Formulary OTC
BD INSULIN SYRINGE 27G X 1/2" 1 ML 27G X 1/2" 1 ML
Formulary OTC
BD INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
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
BD INSULIN SYRINGE U/F 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML
Formulary OTC
BD INSULIN SYRINGE U/F 30G X 1/2" 1 ML 30G X 1/2" 1 ML
Formulary OTC
BD INSULIN SYRINGE U/F 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
BD INSULIN SYRINGE U/F 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
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
BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML
Formulary OTC
BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML
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
BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
BD SAFETYGLIDE INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
BD SAFETYGLIDE INSULIN SYRINGE 31G X 15/64" 0.3 ML 31G X 15/64" 0.3 ML
Formulary
BD SAFETYGLIDE INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
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
FormularyQL (90 EA per 30 days); AGE (Min 16 Years)
buprenorphine transdermal patch weekly 10 mcg/hr, 5 mcg/hr, 7.5 mcg/hr
Formulary PA; QL (8 EA per 28 days)
buprenorphine transdermal patch weekly 15 mcg/hr, 20 mcg/hr
Formulary PA; QL (4 EA per 28 days)
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
Formulary PA; QL (140 EA per 7 days)
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
Formulary PA; QL (150 EA per 30 days)
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
Formulary QL (200 ML per 34 days)
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
Formulary AGE (Min 18 Years)
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
Formulary PA; QL (20 EA per 34 days)
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
COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
Formulary OTC
COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML
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
Formulary OTC; QL (150 EA per 30 days)
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
Formulary OTC; QL (100 EA per 30 days)
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
Formulary OTC; QL (100 EA per 30 days)
CONTOUR NEXT CONTROL SOLUTION NORMAL IN VITRO NORMAL
Formulary OTC; QL (100 EA per 30 days)
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
Formulary OTC; QL (1 EA per 365 days)
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
Formulary OTC; QL (68 EA per 34 days)
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
FormularyQL (30 EA per 30 days); AGE (Min 4 Years and Max 17 Years)
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
FormularyQL (30 EA per 30 days); AGE (Min 4 Years and Max 17 Years)
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
Formulary QL (136 ML per 34 days)
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
Formulary AGE (Min 19 Years)
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
Formulary QL (28 EA per 28 days)
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
EASY TOUCH FLIPLOCK INSULIN SY 30G X 1/2" 1 ML 30G X 1/2" 1 ML
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
EASY TOUCH FLIPLOCK INSULIN SY 31G X 5/16" 1 ML 31G X 5/16" 1 ML
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
EASY TOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 30G X 1/2" 1 ML 30G X 1/2" 1 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
Formulary OTC
EASY TOUCH INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML
Formulary OTC
EASY TOUCH LANCETS 26G Formulary OTC; QL (150 EA per 30 days)
EASY TOUCH LANCETS 28G Formulary OTC; QL (150 EA per 30 days)
EASY TOUCH LANCETS 28G/TWIST Formulary OTC; QL (150 EA per 30 days)
EASY TOUCH LANCETS 30G Formulary OTC; QL (150 EA per 30 days)
EASY TOUCH LANCETS 30G/TWIST Formulary OTC; QL (150 EA per 30 days)
EASY TOUCH LANCETS 32G 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 LANCETS 33G/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
EASY TOUCH SHEATHLOCK SYRINGE 30G X 1/2" 1 ML 30G X 1/2" 1 ML
Formulary OTC
EASY TOUCH SHEATHLOCK SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
EASY TOUCH SHEATHLOCK SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML
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
Formulary PA; QL (1 EA per 90 days)
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 28g x 5/16" 1 ml 28g x 5/16" 1 ml Formulary OTC
elite-thin insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC
elite-thin insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC
elite-thin insulin syringe 29g x 5/16" 0.5 ml 29g x 5/16" 0.5 ml
Formulary OTC
elite-thin insulin syringe 29g x 5/16" 1 ml 29g x 5/16" 1 ml Formulary OTC
elite-thin insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml
Formulary OTC
elite-thin insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC
elite-thin insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml
Formulary OTC
elite-thin insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml
Formulary OTC
elite-thin insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml 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
Formulary ST; AGE (Min 18 Years)
EMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 120 MG/ML
Formulary ST; AGE (Min 18 Years)
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
Formulary AGE (Min 2 Years)
ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG
Formulary AGE (Min 2 Years)
ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG/ML
Formulary AGE (Min 2 Years)
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
Formulary AGE (Min 19 Years)
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
Formulary QL (28 EA per 28 days)
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
Formulary QL (68 EA per 34 days)
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" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC
eql insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC
eql insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC
eql insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC
eql insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC
eql insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC
eql insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC
eql insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 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
Formulary QL (30 EA per 30 days)
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
Formulary QL (8 EA per 34 days)
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
Formulary QL (5 EA per 34 days)
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
EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML
Formulary OTC
EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
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
EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 1 ML 30G X 5/16" 1 ML
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)
EZ-LETS LANCETS 23G Formulary OTC; QL (150 EA per 30 days)
EZ-LETS LANCETS 28G 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
Formulary PA; QL (120 EA per 30 days)
fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr
Formulary PA; QL (10 EA per 34 days)
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
Formulary AGE (Min 19 Years)
FLUCAINE OPHTHALMIC SOLUTION 0.25-0.5 % Formulary
FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION
Formulary AGE (Min 19 Years)
FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML
Formulary AGE (Min 19 Years)
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
Formulary AGE (Min 19 Years)
FLUZONE HIGH-DOSE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.7 ML
Formulary AGE (Min 19 Years)
FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION , 0.5 ML
Formulary AGE (Min 19 Years)
FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.25 ML, 0.5 ML
Formulary AGE (Min 19 Years)
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
Formulary QL (120 ML per 30 days)
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
Formulary OTC; QL (1 EA per 365 days)
FREESTYLE INSULINX SYSTEM KIT W/DEVICE W/DEVICE
Formulary OTC; QL (1 EA per 365 days)
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
Formulary OTC; QL (1 EA per 365 days)
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
Formulary AGE (Min 19 Years)
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
GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 0.4 MG SUBCUTANEOUS 0.4 MG
Formulary PA
GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 0.6 MG SUBCUTANEOUS 0.6 MG
Formulary PA
GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 0.8 MG SUBCUTANEOUS 0.8 MG
Formulary PA
GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 1 MG SUBCUTANEOUS 1 MG
Formulary PA
GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 1.2 MG SUBCUTANEOUS 1.2 MG
Formulary PA
GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 1.4 MG SUBCUTANEOUS 1.4 MG
Formulary PA
GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 1.6 MG SUBCUTANEOUS 1.6 MG
Formulary PA
GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 1.8 MG SUBCUTANEOUS 1.8 MG
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
Formulary QL (2 EA per 34 days)
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)
GLUCOCOM LANCETS 30G Formulary OTC; QL (150 EA per 30 days)
GLUCOCOM LANCETS 33G 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
GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML
Formulary OTC
GLUCOPRO INSULIN SYRINGE 30G X 1/2" 1 ML 30G X 1/2" 1 ML
Formulary OTC
GLUCOPRO INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
GLUCOPRO INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
GLUCOPRO INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
GLUCOPRO INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
GLUCOPRO INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
Formulary OTC
GLUCOPRO INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML
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 insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC
gnp insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC
gnp insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC
gnp insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC
gnp insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC
gnp insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC
gnp insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC
gnp insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC
gnp insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 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
gnp ultra com insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml
Formulary OTC
gnp ultra com insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml
Formulary OTC
gnp ultra com insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml
Formulary OTC
gnp ultra com insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml
Formulary OTC
gnp ultra com insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml
Formulary OTC
gnp ultra com insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml
Formulary OTC
gnp ultra com insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml
Formulary OTC
gnp ultra com insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml
Formulary OTC
gnp ultra com insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml
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
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 19 Years)
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
Formulary OTC; QL (34 EA per 34 days)
h-e-b incontrol alcohol pad Formulary OTC
h-e-b incontrol lancets 28g Formulary OTC; QL (150 EA per 30 days)
h-e-b incontrol lancets 30g Formulary OTC; QL (150 EA per 30 days)
h-e-b incontrol lancets 33g 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
Formulary AGE (Min 2 Years)
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
FormularySP; QL (2 EA per 28 days); AGE (Min 2 Years)
HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML
FormularySP; QL (2 EA per 28 days); AGE (Min 2 Years)
HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.2ML, 20 MG/0.4ML
FormularySP; QL (2 EA per 28 days); AGE (Min 2 Years)
HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.4ML
Formulary QL (2 EA per 28 days)
HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML
Formulary AGE (Min 2 Years)
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
Formulary AGE (Min 6 Years)
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
Formulary PA; QL (63 EA per 7 days)
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
Formulary PA; QL (126 EA per 7 days)
hydrocodone-acetaminophen oral tablet 7.5-300 mg, 7.5-325 mg
Formulary PA; QL (84 EA per 7 days)
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 oral tablet 4 mg Formulary PA; QL (39 EA per 7 days)
hydromorphone hcl oral tablet 8 mg Formulary PA; QL (20 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
Formulary AGE (Min 19 Years)
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 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC
insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC
insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC
insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC
insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC
insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC
insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC
insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC
insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC
insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC
insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC
insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 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
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 18 Years)
INVEGA TRINZA INTRAMUSCULAR SUSPENSION 273 MG/0.875ML, 410 MG/1.315ML, 546 MG/1.75ML, 819 MG/2.625ML
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 18 Years)
INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150-1000 MG, 150-500 MG, 50-1000 MG, 50-500 MG
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 18 Years)
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" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC
kinray insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 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 0.3 ml u-100 0.3 ml Formulary OTC
kmart valu insulin syringe 30g u-100 0.5 ml u-100 0.5 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" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC
kroger insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC
kroger insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC
kroger insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC
kroger insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC
kroger insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC
kroger insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC
kroger insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 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
Formulary AGE (Min 18 Years)
laxative oral tablet 25 mg Formulary OTC
laxative pills oral tablet 15 mg Formulary OTC
LAZANDA NASAL SOLUTION 100 MCG/ACT, 400 MCG/ACT
Formulary PA; QL (120 EA per 30 days)
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
leader insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC
leader insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC
leader insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC
leader insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC
leader insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC
leader insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC
leader insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC
leader insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 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
LITETOUCH INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML
Formulary OTC
LITETOUCH INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
LITETOUCH INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
LITETOUCH INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
LITETOUCH INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
LITETOUCH INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
LITETOUCH INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
LITETOUCH INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
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
Formulary QL (28 EA per 28 days)
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
Formulary QL (170 ML per 30 days)
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
Formulary PA; QL (1 EA per 90 days)
LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT 11.25 MG, 22.5 MG
Formulary PA; QL (1 EA per 90 days)
LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30 MG
Formulary PA; QL (1 EA per 90 days)
LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45 MG
Formulary PA; QL (1 EA per 90 days)
LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 11.25 MG, 15 MG, 7.5 MG
Formulary PA; QL (1 EA per 90 days)
LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT 11.25 MG (PED), 30 MG (PED)
Formulary PA; QL (1 EA per 90 days)
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
MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary
MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary
MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary
MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
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
Formulary OTC; QL (100 EA per 30 days)
MEDISENSE HI/MID/LOW CONTROL LIQUID IN VITRO
Formulary OTC; QL (100 EA per 30 days)
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
Formulary QL (1 ML per 90 days)
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
Formulary AGE (Min 19 Years)
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
Formulary AGE (Min 10 Years)
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
Formulary PA; QL (120 ML per 30 days)
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
Formulary AGE (Min 4 Years and Max 17 Years)
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)
Formulary PA; QL (28 EA per 28 days)
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
Formulary QL (1 EA per 365 days)
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
MONOJECT INSULIN SYRINGE 28G X 1/2" 1 ML (OTC) 28G X 1/2" 1 ML
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
MONOJECT INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary
MONOJECT INSULIN SYRINGE 29G X 1/2" 1 ML (RX) 29G X 1/2" 1 ML
Formulary
MONOJECT INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary
MONOJECT INSULIN SYRINGE 30G X 5/16" 0.5 ML (RX) 30G X 5/16" 0.5 ML
Formulary
MONOJECT INSULIN SYRINGE 30G X 5/16" 1 ML (OTC) 30G X 5/16" 1 ML
Formulary
MONOJECT INSULIN SYRINGE 30G X 5/16" 1 ML (RX) 30G X 5/16" 1 ML
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
MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" 0.3 ML (OTC) 30G X 5/16" 0.3 ML
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
MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" 0.5 ML (OTC) 30G X 5/16" 0.5 ML
Formulary
MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" 0.5 ML (RX) 30G X 5/16" 0.5 ML
Formulary
MONOJECT ULTRA COMFORT SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
MONOJECT ULTRA COMFORT SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
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 15 mg Formulary PA; QL (204 EA per 34 days)
morphine sulfate er oral tablet extended release 200 mg Formulary PA; QL (15.3 EA per 34 days)
morphine sulfate er oral tablet extended release 30 mg Formulary PA; QL (102 EA per 34 days)
morphine sulfate er oral tablet extended release 60 mg Formulary PA; QL (47 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
Formulary PA; QL (2 ML per 34 days)
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
Formulary OTC; QL (68 EA per 34 days)
NEXIUM 24HR TABLET DELAYED RELEASE 20 MG ORAL 20 MG
Formulary OTC; QL (68 EA per 34 days)
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 step 2 transdermal patch 24 hour 14 mg/24hr Formulary OTC
nicotine step 3 transdermal patch 24 hour 7 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
NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 15 MG/1.5ML SUBCUTANEOUS 15 MG/1.5ML
Formulary PA
NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 30 MG/3ML SUBCUTANEOUS 30 MG/3ML
Formulary PA
NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 5 MG/1.5ML SUBCUTANEOUS 5 MG/1.5ML
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
Formulary QL (28 EA per 28 days)
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
Formulary AGE (Min 18 Years)
olanzapine oral tablet dispersible 10 mg, 15 mg, 20 mg, 5 mg
Formulary AGE (Min 18 Years)
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
Formulary QL (34 EA per 34 days)
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
Formulary OTC; QL (1 EA per 365 days)
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
Formulary QL (34 EA per 34 days)
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
Formulary PA; QL (68 EA per 34 days)
oxycodone hcl er oral tablet er 12 hour abuse-deterrent 15 mg, 30 mg, 60 mg, 80 mg
Formulary PA; QL (102 EA per 34 days)
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 hcl oral tablet 15 mg Formulary PA; QL (28 EA per 7 days)
oxycodone hcl oral tablet 20 mg Formulary PA; QL (21 EA per 7 days)
oxycodone hcl oral tablet 30 mg Formulary PA; QL (14 EA per 7 days)
oxycodone hcl oral tablet 5 mg Formulary PA; QL (84 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
Formulary PA; QL (68 EA per 34 days)
OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 15 MG, 30 MG, 60 MG, 80 MG
Formulary PA; QL (102 EA per 34 days)
oxymorphone hcl er oral tablet extended release 12 hour 10 mg, 15 mg, 20 mg, 5 mg, 7.5 mg
Formulary PA; QL (68 EA per 34 days)
oxymorphone hcl er oral tablet extended release 12 hour 30 mg
Formulary PA; QL (102 EA per 34 days)
oxymorphone hcl er oral tablet extended release 12 hour 40 mg
Formulary PA; QL (34 EA per 34 days)
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
Formulary QL (68 EA per 34 days)
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
Formulary AGE (Min 19 Years)
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
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 19 Years)
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
Formulary OTC; QL (150 EA per 30 days)
PRECISION GLUCOSE KETONE CONTR LIQUID IN VITRO
Formulary OTC; QL (100 EA per 30 days)
PRECISION GLUCOSE/KETONE CONTR LIQUID IN VITRO
Formulary OTC; QL (100 EA per 30 days)
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
PRECISION SURE-DOSE SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
PRECISION SURE-DOSE SYRINGE 30G X 3/8" 0.5 ML 30G X 3/8" 0.5 ML
Formulary OTC
PRECISION THINS GP LANCETS Formulary OTC; QL (150 EA per 30 days)
PRECISION XTRA BLOOD GLUCOSE STRIP IN VITRO
Formulary OTC; QL (150 EA per 30 days)
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
preferred plus insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml
Formulary OTC
preferred plus insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml
Formulary OTC
preferred plus insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml
Formulary OTC
preferred plus insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml
Formulary OTC
preferred plus insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml
Formulary OTC
preferred plus insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml
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
FormularyQL (30 EA per 30 days); AGE (Min 18 Years)
quetiapine fumarate er oral tablet extended release 24 hour300 mg, 400 mg, 50 mg
Formulary AGE (Min 18 Years)
quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg
Formulary AGE (Min 18 Years)
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
Formulary OTC; QL (34 EA per 34 days)
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
Formulary AGE (Min 19 Years)
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
Formulary AGE (Min 19 Years)
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
RELI-ON INSULIN SYRINGE 29G 0.5 ML 29G 0.5 ML Formulary OTC
RELION INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML
Formulary OTC
RELION INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
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 0.3 ML 30G 0.3 ML Formulary OTC
RELI-ON INSULIN SYRINGE 30G 0.5 ML 30G 0.5 ML Formulary OTC
RELI-ON INSULIN SYRINGE 30G 1 ML 30G 1 ML Formulary OTC
RELION INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
RELION INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
RELION INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
RELION INSULIN SYRINGE 31G X 15/64" 0.3 ML 31G X 15/64" 0.3 ML
Formulary OTC
RELION INSULIN SYRINGE 31G X 15/64" 0.5 ML 31G X 15/64" 0.5 ML
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
RELION INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
RELION INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
Formulary OTC
RELION INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML
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
Formulary AGE (Min 18 Years)
RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 12.5 MG, 25 MG, 37.5 MG, 50 MG
Formulary AGE (Min 18 Years)
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
Formulary AGE (Min 18 Years)
risperidone oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
Formulary AGE (Min 18 Years)
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 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC
safety insulin syringes 30g x 1/2" 1 ml 30g x 1/2" 1 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
Formulary PA; QL (68 EA per 34 days)
SAVELLA TITRATION PACK ORAL 12.5 & 25 & 50 MG
Formulary PA; QL (55 EA per 30 days)
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 insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC
sb insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 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 150 ORAL TABLET 37.5-150-200 MG Formulary
STALEVO 200 ORAL TABLET 50-200-200 MG Formulary
STALEVO 75 ORAL TABLET 18.75-75-200 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)
SUBOXONE SUBLINGUAL FILM 4-1 MG FormularyQL (180 EA per 30 days); AGE (Min 16 Years)
SUBOXONE SUBLINGUAL FILM 8-2 MG FormularyQL (90 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
sure comfort insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml
Formulary OTC
sure comfort insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml
Formulary OTC
sure comfort insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC
sure comfort insulin syringe 30g x 1/2" 0.3 ml 30g x 1/2" 0.3 ml
Formulary OTC
sure comfort insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml
Formulary OTC
sure comfort insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC
sure comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml
Formulary OTC
sure comfort insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml
Formulary OTC
sure comfort insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml
Formulary OTC
sure comfort insulin syringe 31g x 1/4" 0.3 ml 31g x 1/4" 0.3 ml
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
sure comfort insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml
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
SURE-JECT INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML
Formulary OTC
SURE-JECT INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
SURE-JECT INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
SURE-JECT INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
SURE-JECT INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
SURE-JECT INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
SURE-JECT INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
SURE-JECT INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
Formulary OTC
SURE-JECT INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML
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
Formulary AGE (Min 18 Years)
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 20-25 ml 25 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 2-3 ml 3 ml Formulary OTC
syringe 30-35 ml 35 ml Formulary OTC
syringe 50-60 ml 60 ml Formulary OTC
syringe 5-6 ml 6 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%)
Formulary AGE (Min 18 Years)
tetanus-diphtheria toxoids td intramuscular suspension 2-2 lf/0.5ml
Formulary AGE (Min 19 Years)
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
THYROLAR-2 ORAL TABLET 120 MG Formulary
THYROLAR-3 ORAL TABLET 180 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
Formulary QL (30 EA per 30 days)
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
topcare ultra comfort ins syr 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml
Formulary OTC
topcare ultra comfort ins syr 29g x 1/2" 1 ml 29g x 1/2" 1 ml
Formulary OTC
topcare ultra comfort ins syr 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml
Formulary OTC
topcare ultra comfort ins syr 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml
Formulary OTC
topcare ultra comfort ins syr 30g x 5/16" 1 ml 30g x 5/16" 1 ml
Formulary OTC
topcare ultra comfort ins syr 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml
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
topcare ultra comfort ins syr 31g x 5/16" 1 ml 31g x 5/16" 1 ml
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
Formulary PA; QL (34 EA per 34 days)
tramadol hcl er oral tablet extended release 24 hour 100 mg, 200 mg, 300 mg
Formulary PA; QL (34 EA per 34 days)
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
TRUEPLUS INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML
Formulary OTC
TRUEPLUS INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
TRUEPLUS INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
TRUEPLUS INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
TRUEPLUS INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
TRUEPLUS INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
TRUEPLUS INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
TRUEPLUS INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
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)
TRUEPLUS LANCETS 28G Formulary OTC; QL (150 EA per 30 days)
TRUEPLUS LANCETS 30G Formulary OTC; QL (150 EA per 30 days)
TRUEPLUS LANCETS 33G 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
TRUSELTIQ (50MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 25 MG
Formulary PA
TRUSELTIQ (75MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 25 MG
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
Formulary AGE (Min 19 Years)
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
ULTICARE INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 30G X 1/2" 1 ML 30G X 1/2" 1 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 31G X 1/4" 0.3 ML 31G X 1/4" 0.3 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 31G X 1/4" 0.5 ML 31G X 1/4" 0.5 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 31G X 1/4" 1 ML 31G X 1/4" 1 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
Formulary OTC
ULTICARE INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML
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
ULTILET INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
ULTILET INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
ULTILET INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
ULTILET INSULIN SYRINGE 31G X 1/4" 0.3 ML 31G X 1/4" 0.3 ML
Formulary OTC
ULTILET INSULIN SYRINGE 31G X 1/4" 1 ML 31G X 1/4" 1 ML
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
ULTILET INSULIN SYRINGE 31G X 15/64" 0.5 ML 31G X 15/64" 0.5 ML
Formulary OTC
ULTILET INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
ULTILET INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML
Formulary OTC
ULTILET INSULIN SYRINGE SHORT 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML
Formulary OTC
ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML
Formulary OTC
ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
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
ultra-comfort insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml
Formulary OTC
ultra-comfort insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml
Formulary OTC
ultra-comfort insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml
Formulary OTC
ultra-comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml
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
ultra-comfort insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml
Formulary OTC
ultra-comfort insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml
Formulary OTC
ultra-comfort insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml
Formulary OTC
ultra-comfort insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml
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
ULTRA-THIN II INS SYR SHORT 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML
Formulary OTC
ULTRA-THIN II INS SYR SHORT 30G X 5/16" 1 ML 30G X 5/16" 1 ML
Formulary OTC
ULTRA-THIN II INS SYR SHORT 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML
Formulary OTC
ULTRA-THIN II INS SYR SHORT 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML
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
Formulary AGE (Min 19 Years)
varenicline tartrate oral tablet 0.5 mg, 1 mg Formulary
VARIVAX SUBCUTANEOUS INJECTABLE 1350 PFU/0.5ML
Formulary AGE (Min 19 Years)
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
FormularyQL (30 EA per 30 days); AGE (Min 4 Years and Max 17 Years)
VYVANSE ORAL TABLET CHEWABLE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG
Formulary AGE (Min 4 Years and Max 17 Years)
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
WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM 2 %
Formulary
WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM 2 %
Formulary
WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM 2 %
Formulary
WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM 2 %
Formulary
WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM 2 %
Formulary
WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM 2 %
Formulary
WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM 2 %
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
Formulary QL (28 EA per 28 days)
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
Formulary AGE (Min 18 Years)
XIIDRA OPHTHALMIC SOLUTION 5 % Formulary
XOFLUZA (40 MG DOSE) ORAL TABLET THERAPY PACK 2 X 20 MG
Formulary QL (2 EA per 180 days)
XOFLUZA (80 MG DOSE) ORAL TABLET THERAPY PACK 2 X 40 MG
Formulary QL (2 EA per 180 days)
XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML, 75 MG/0.5ML
Formulary PA; QL (2 EA per 28 days)
XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED 150 MG
Formulary PA; QL (2 EA per 30 days)
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
Formulary OTC; QL (34 EA per 34 days)
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
Formulary QL (30 EA per 30 days)
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
Formulary AGE (Min 19 Years)
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
162
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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