2020 UHP SNP Formulary - Ultimate Health Plans · H2962_2020 C-SNP Formulary_v120_C. 0020481, Version 20. 2020 formulary. list of covered drugs. PLEASE READ: THIS DOCUMENT CONTAINS

2020 formularylist of covered drugs

Citrus Advantage Care by Ultimate (HMO C-SNP 021)

Hernando Advantage Care by Ultimate (HMO C-SNP) 019-1

Pasco Advantage Care by Ultimate (HMO C-SNP) 019-2

H2962_2020 C-SNP Formulary_v120_C

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

This formulary was updated on 07/01/2020. For more recent information or other questions, please contact Ultimate Health Plans Member Services at 1-888-657-4170 or, for TTY users, 711, Monday through Sunday from 8 a.m. to 8 p.m. (during certain times of the year we may use alternative technologies to answer your call on weekends and Federal holidays), or visit www.chooseultimate.com.

020481, Version 21

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Note to existing members: This formulary has changed since last year. Please review this document to make

sure that it still contains the drugs you take.

When this drug list (formulary) refers to “we,” “us”, or “our,” it means Ultimate Health Plans. When it refers to

“plan” or “our plan,” it means Advantage Care by Ultimate (HMO C-SNP).

This document includes a list of the drugs (formulary) for our plan which is current as of 7/1/2020. For an

updated formulary, please contact us. Our contact information, along with the date we last updated the

formulary, appears on the front and back cover pages.

You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary,

pharmacy network, and/or copayments/coinsurance may change on January 1, 2021, and from time to time

during the year.

What is the Advantage Care by Ultimate Formulary?

A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers,

which represents the prescription therapies believed to be a necessary part of a quality treatment program. We

will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription

is filled at a plan network pharmacy, and other plan rules are followed. For more information on how to fill

your prescriptions, please review your Evidence of Coverage.

Can the Formulary (drug list) change?

Most changes in drug coverage happen on January 1, but we may add or remove drugs on the Drug List during

the year, move them to different cost-sharing tiers, or add new restrictions. We must follow Medicare rules in

making these changes.

Changes that can affect you this year: In the below cases, you will be affected by coverage changes during

the year:

• New generic drugs. We may immediately remove a brand name drug on our Drug List if we are

replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with the

same or fewer restrictions. Also, when adding the new generic drug, we may decide to keep the brand

name drug on our Drug List, but immediately move it to a different cost-sharing tier or add new

restrictions. If you are currently taking that brand name drug, we may not tell you in advance before we

make that change, but we will later provide you with information about the specific change(s) we have

made.

o If we make such a change, you or your prescriber can ask us to make an exception and continue

to cover the brand name drug for you. The notice we provide you will also include information

on how to request an exception, and you can also find information in the section below entitled“How do I request an exception to the Advantage Care by Ultimate Formulary?”

• Drugs removed from the market. If the Food and Drug Administration deems a drug on our formulary

to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove

the drug from our formulary and provide notice to members who take the drug.

• Other changes. We may make other changes that affect members currently taking a drug. For instance,

we may add a generic drug that is not new to market to replace a brand name drug currently on the

formulary or add new restrictions to the brand name drug or move it to a different cost-sharing tier. Or

we may make changes based on new clinical guidelines. If we remove drugs from our formulary, add

prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher

cost-sharing tier, we must notify affected members of the change at least 30 days before the change

becomes effective, or at the time the member requests a refill of the drug, at which time the member will

receive a 30-day supply of the drug.

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o If we make these other changes, you or your prescriber can ask us to make an exception and

continue to cover the brand name drug for you. The notice we provide you will also include information on how to request an exception, and you can also find information in the section

below entitled “How do I request an exception to the Advantage Care by Ultimate Formulary?”

Changes that will not affect you if you are currently taking the drug. Generally, if you are taking a drug on

our 2020 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of

the drug during the 2020 coverage year except as described above. This means these drugs will remain

available at the same cost-sharing and with no new restrictions for those members taking them for the remainder

of the coverage year.

The enclosed formulary is current as of 7/1/2020. To get updated information about the drugs covered by our

plan, please contact us. Our contact information appears on the front and back cover pages. In the event of mid-

year non-maintenance formulary changes, we update our printed formularies at the next printing and we also

publish a monthly summary of all drug list changes, which is available for download from our website or in

printed format upon request.

How do I use the Formulary?

There are two ways to find your drug within the formulary:

Medical Condition

The formulary begins on page 7. The drugs in this formulary are grouped into categories depending on the

type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are

listed under the category, Cardiovascular Agents. If you know what your drug is used for, look for the

category name in the list that begins below. Then look under the category name for your drug.

Alphabetical Listing

If you are not sure what category to look under, you should look for your drug in the Index that begins on

page 114. The Index provides an alphabetical list of all of the drugs included in this document. Both

brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next

to your drug, you will see the page number where you can find coverage information. Turn to the page

listed in the Index and find the name of your drug in the first column of the list.

What are generic drugs?

Our plan covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as

having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand

name drugs.

Are there any restrictions on my coverage?

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits

may include:

• Prior Authorization: Our plan requires you or your physician to get prior authorization for certain

drugs. This means that you will need to get approval from us before you fill your prescriptions. If you

don’t get approval, we may not cover the drug.

• Quantity Limits: For certain drugs, our plan limits the amount of the drug that we will cover. For

example, our plan provides 30 tablets per prescription for alprazolam ER 1 mg tablets. This may be in

addition to a standard one-month or three-month supply.

• Step Therapy: In some cases, our plan requires you to first try certain drugs to treat your medical

condition before we will cover another drug for that condition. For example, if Drug A and Drug B both

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treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not

work for you, we will then cover Drug B.

You can find out if your drug has any additional requirements or limits by looking in the formulary that begins

on page 7. You can also get more information about the restrictions applied to specific covered drugs by

visiting our Web site. We have posted online documents that explain our prior authorization and step therapy

restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last

updated the formulary, appears on the front and back cover pages.

You can ask us to make an exception to these restrictions or limits or for a list of other, similar drugs that may

treat your health condition. See the section, “How do I request an exception to the Advantage Care by Ultimate

formulary?” on page iii for information about how to request an exception.

What if my drug is not on the Formulary?

If your drug is not included in this formulary (list of covered drugs), you should first contact Member Services

and ask if your drug is covered.

If you learn that our plan does not cover your drug, you have two options:

• You can ask Member Services for a list of similar drugs that are covered by our plan. When you receive

the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by our plan.

• You can ask us to make an exception and cover your drug. See below for information about how to

request an exception.

How do I request an exception to the Advantage Care by Ultimate Formulary?

You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can

ask us to make.

• You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered

at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a

lower cost-sharing level.

• You can ask us to cover a formulary drug at a lower cost-sharing level if this drug is not on the specialty

tier. If approved this would lower the amount you must pay for your drug.

• You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs,

our plan limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask

us to waive the limit and cover a greater amount.

Generally, we will only approve your request for an exception if the alternative drugs included on the plan’s

formulary, the lower cost-sharing drug or additional utilization restrictions would not be as effective in treating

your condition and/or would cause you to have adverse medical effects.

You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction

exception. When you request a formulary, tiering or utilization restriction exception you should submit a

statement from your prescriber or physician supporting your request. Generally, we must make our

decision within 72 hours of getting your prescriber’s supporting statement. You can request an expedited (fast)

exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for

a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we

get a supporting statement from your doctor or other prescriber.

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What do I do before I can talk to my doctor about changing my drugs or requesting an

exception?

As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may

be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior

authorization from us before you can fill your prescription. You should talk to your doctor to decide if you

should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the

drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your

drug in certain cases during the first 90 days you are a member of our plan.

For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a

temporary 30-day supply. If your prescription is written for fewer days, we’ll allow refills to provide up to a

maximum 30-day supply of medication. After your first 30-day supply, we will not pay for these drugs, even if

you have been a member of the plan less than 90 days.

If you are a resident of a long-term care facility and you need a drug that is not on our formulary or if your

ability to get your drugs is limited, but you are past the first 98 days of membership in our plan, we will cover a

31-day emergency supply of that drug while you pursue a formulary exception.

We will cover a Transition Supply for enrollees who have a level of care change, which is defined as when

enrollees:

• Enter a Long-Term-Care (LTC) facility from a hospital or other setting

• Leave a Long-Term-Care (LTC) facility and return to the community

• Are discharged from a hospital to a home

• End a skilled nursing facility (SNF) stay covered under Medicare Part A (where all pharmacy charges

are covered), and must revert to coverage under their Part D plan Formulary

• Revert from hospice status to standard Medicare Part A and Part B benefits; or

• Are discharged from a psychiatric hospital with a medication regimen that is highly individualized

We will provide you with a written notice after we cover the Transition Supply. This notice will explain the

steps you can take to request an exception and how to work with your doctor to decide if you should switch to

an appropriate drug that Ultimate Health Plans covers.

For more information

For more detailed information about your plan’s prescription drug coverage, please review your Evidence of

Coverage and other plan materials.

If you have questions about our plan, please contact us. Our contact information, along with the date we last

updated the formulary, appears on the front and back cover pages.

If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-

MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users should call 1-877-486-2048. Or,

visit http://www.medicare.gov.

http://www.medicare.gov/

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Our Plan’s Formulary

The formulary that begins on the next page provides coverage information about the drugs covered by our plan.

If you have trouble finding your drug in the list, turn to the Index that begins on page 114.

The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., ADVAIR) and generic

drugs are listed in lower-case italics (e.g., lisinopril).

The information in the Requirements/Limits column tells you if our plan has any special requirements for

coverage of your drug. Below is a list of abbreviations that may appear in the Requirements/Limits column.

B/D: This prescription drug may be covered under our medical benefit. For more information, call Member

Services at 1-888-657-4170, Monday through Sunday from 8 a.m. to 8 p.m. TTY users should call 711.

E: Excluded Drug. This prescription drug is not normally covered in a Medicare Prescription Drug Plan. The

amount you pay when you fill a prescription for this drug does not count towards your total drug costs (that is,

the amount you pay does not help you qualify for catastrophic coverage). In addition, if you are receiving extra

help to pay for your prescriptions, you will not get any extra help to pay for this drug.

CG: Coverage in the Gap. We provide additional coverage of this prescription drug in the coverage gap. Please

refer to our Evidence of Coverage for more information about this coverage.

HI: Home Infusion. This prescription drug may be covered under our medical benefit. For more information,

call Member Services at 1-888-657-4170, Monday through Sunday from 8 a.m. to 8 p.m. TTY users should call

711.

MO: Mail Order Drug. This prescription drug is available through our mail order service, as well as through our

retail network pharmacies. Generally, the drugs provided through mail order are drugs that you take on a regular

basis, for a chronic or long-term medical condition. Our plan’s mail-order service requires you to order a 90-day

supply. Usually a mail-order pharmacy order will get to you in no more than 14 days. However, if your order is

delayed, immediately contact us) so we can make arrangements for you to pick up your prescription at your

local pharmacy. You may contact us 24 hours a day, 7 days a week at 1-800-311-7517 (TTY users dial 711).

PA: Prior Authorization. We require you or your physician to get prior authorization for certain drugs. This

means that you will need to get approval before you fill your prescriptions. If you don’t get approval, we may

not cover the drug.

QL: Quantity Limit. For certain drugs we limit the amount of the drug that we will cover.

ST: Step Therapy. In some cases, we require you to first try certain drugs to treat your medical condition before

we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical

condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then

cover Drug B.

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The Formulary is Divided into Six (6) Tiers

Every drug on the plan’s Drug List is in one of 6 cost-sharing tiers with a corresponding cost sharing amount

depending on the plan as shown below. In general, the higher the cost-sharing tier, the higher your cost for the

drug:

• Cost-Sharing Tier 1 includes preferred generic drugs. This is the lowest tier.

• Cost-Sharing Tier 2 includes generic drugs.

• Cost-Sharing Tier 3 includes preferred brand drugs.

• Cost-Sharing Tier 4 includes non-preferred drugs.

• Cost-Sharing Tier 5 includes specialty drugs. This is the highest tier.

• Cost-Sharing Tier 6 includes select care drugs.

For Advantage Care by Ultimate-019:

Cost

Sharing

Tier

Copay or coinsurance

for a 30-day supply at

a Retail Pharmacy



a Retail Pharmacy



a Retail Pharmacy


for a 90-day supply

through the Mail

Order Pharmacy

Tier 1 $0 $0 $0 $0

Tier 2 $0 $0 $0 $0

Tier 3 $20 $40 $60 $40

Tier 4 $60 $120 $180 $120

Tier 5 33% coinsurance 33% coinsurance 33% coinsurance 33% coinsurance

Tier 6 $10 $20 $30 $20

For Advantage Care by Ultimate-021:

Cost

Sharing

Tier



a Retail Pharmacy



a Retail Pharmacy



a Retail Pharmacy


for a 90-day supply

through the Mail

Order Pharmacy Tier 1 $0 $0 $0 $0

Tier 2 $0 $0 $0 $0

Tier 3 $25 $50 $75 $50

Tier 4 $60 $120 $180 $120

Tier 5 33% coinsurance 33% coinsurance 33% coinsurance 33% coinsurance

Tier 6 $10 $20 $30 $20

Please consult your Evidence of Coverage or Summary of Benefits for additional information on the applicable

co-pays or co-insurance amounts in each formulary tier.

You can find information on what the symbols and abbreviations on this table mean by going to page V.

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DRUG NAME TIER REQUIREMENTS/LIMITS

ANALGESICS

Analgesics

butalbital-acetaminophen tab 50-325 mg 1 CG; MO

butalbital-acetaminophen-caffeine cap 50-300-40 mg 2 CG; MO

butalbital-acetaminophen-caffeine cap 50-325-40 mg 2 CG; MO

butalbital-acetaminophen-caffeine tab 50-325-40 mg 1 CG; MO

butalbital-aspirin-caffeine cap 50-325-40 mg 2 CG; MO

esgic tab 50-325-40 mg 1 CG; MO

tencon tab 50-325 mg 1 CG; MO

VANATOL LQ SOL 4 MO

zebutal cap 50-325-40 mg 1 CG; MO

Opioid Analgesics, Long-acting

fentanyl td patch 72hr 100 mcg/hr 3 MO



fentanyl td patch 72hr 37.5 mcg/hr 4 MO





hydromorphone hcl tab er 12 mg 4 MO




levorphanol tartrate tab 2 mg 4 MO

methadone hcl soln 10 mg/5ml 2 CG; MO

methadone hcl soln 5 mg/5ml 2 CG; MO

methadone hcl tab 10 mg 1 CG; MO

methadone hcl tab 5 mg 1 CG; MO

morphine sulfate beads cap er 120 mg 4 MO






morphine sulfate cap er 10 mg 4 MO





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morphine sulfate oral soln 20 mg/5ml 2 CG; MO

morphine sulfate tab er 100 mg 2 CG; MO





oxymorphone hcl tab er 10 mg 4 MO






oxymorphone hcl tab er 7.5 mg 4 MO

tramadol hcl tab er 100 mg 2 CG; MO



Opioid Analgesics, Short-acting

acetaminophen w/ codeine soln 120-12 mg/5ml 1 CG; MO

acetaminophen w/ codeine tab 300-15 mg 2 CG; MO



ascomp/codeine cap 50-325-40-30 mg 2 CG; MO

butalbital-acetaminophen-caff w/ cod cap 50-300-40-30 mg 2 CG; MO

butalbital-acetaminophen-caff w/ cod cap 50-325-40-30 mg 2 CG; MO

butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg 2 CG; MO

butorphanol tartrate nasal soln 10 mg/ml 2 CG; MO

CODEINE SULF TAB 30MG 2 CG; MO

CODEINE SULF TAB 60MG 3 MO

duramorph inj pf 0.5 mg/ml 2 CG; MO

duramorph inj pf 1 mg/ml 2 CG; MO

endocet tab 10-325 mg 2 CG; MO

endocet tab 5-325 mg 2 CG; MO

endocet tab 7.5-325 mg 2 CG; MO

fentanyl citrate lozenge 1200 mcg 5 MO; PA




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hydrocodone-acetaminophen soln 7.5-325 mg/15ml 2 CG; MO

hydrocodone-acetaminophen tab 10-300 mg 2 CG; MO




hydrocodone-acetaminophen tab 7.5-300 mg 2 CG; MO

hydrocodone-acetaminophen tab 7.5-325 mg 1 CG; MO

hydrocodone-ibuprofen tab 10-200 mg 2 CG; MO

hydrocodone-ibuprofen tab 5-200 mg 2 CG; MO

hydrocodone-ibuprofen tab 7.5-200 mg 2 CG; MO

hydromorphone hcl liqd 1 mg/ml 2 CG; MO

hydromorphone hcl preservative free (pf) inj 10 mg/ml 2 CG; MO

hydromorphone hcl tab 2 mg 2 CG; MO



lorcet hd tab 10-325 mg 1 CG; MO

lorcet plus tab 7.5-325 mg 1 CG; MO

lorcet tab 5-325 mg 1 CG; MO



morphine sulfate tab 15 mg 2 CG; MO

morphine sulfate tab 30 mg 2 CG; MO

norco tab 10-325 mg 1 CG; MO

norco tab 5-325 mg 1 CG; MO

norco tab 7.5-325 mg 1 CG; MO

oxycodone hcl cap 5 mg 2 CG; MO

oxycodone hcl conc 100 mg/5ml 4 MO

oxycodone hcl soln 5 mg/5ml 2 CG; MO

oxycodone hcl tab 10 mg 2 CG; MO





oxycodone w/ acetaminophen tab 10-325 mg 2 CG; MO

oxycodone w/ acetaminophen tab 2.5-325 mg 2 CG; MO

oxycodone w/ acetaminophen tab 5-325 mg 2 CG; MO

oxycodone w/ acetaminophen tab 7.5-325 mg 2 CG; MO


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oxycodone-aspirin tab 4.8355-325 mg 2 CG; MO

oxycodone-ibuprofen tab 5-400 mg 2 CG; MO

oxymorphone hcl tab 10 mg 2 CG; MO

oxymorphone hcl tab 5 mg 2 CG; MO

pentazocine w/ naloxone tab 50-0.5 mg 4 MO

primlev tab 10-300 mg 4 MO

primlev tab 5-300 mg 4 MO

primlev tab 7.5-300 mg 4 MO

prolate tab 10-300 mg 4 MO

prolate tab 5-300 mg 4 MO

prolate tab 7.5-300 mg 4 MO

tramadol hcl tab 50 mg 1 CG; MO

tramadol-acetaminophen tab 37.5-325 mg 2 CG; MO

ANESTHETICS

Local Anesthetics

lidocaine hcl soln 4% 2 CG; MO

lidocaine hcl urethral/mucosal gel 2% 2 CG; MO

lidocaine hcl viscous soln 2% 1 CG; MO

lidocaine oint 5% 3 MO; QL 120 PER 30 DAYS; PA

lidocaine patch 5% 3 MO; PA

lidocaine-prilocaine cream 2.5-2.5% 2 CG; MO; QL 30 PER 30 DAYS

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS

Alcohol Deterrents/Anti-craving

acamprosate calcium tab dr 333 mg 2 CG; MO

disulfiram tab 250 mg 2 CG; MO

disulfiram tab 500 mg 2 CG; MO

LUCEMYRA TAB 0.18MG 4 MO; QL 480 PER 30 DAYS

naltrexone hcl tab 50 mg 2 CG; MO

Opioid Dependence Treatments

buprenorphine hcl sl tab 2 mg 1 CG; MO

buprenorphine hcl sl tab 8 mg 1 CG; MO

buprenorphine hcl-naloxone hcl sl film 12-3 mg 1 CG; MO; QL 60 PER 30 DAYS

buprenorphine hcl-naloxone hcl sl film 2-0.5 mg 1 CG; MO; QL 360 PER 30 DAYS



buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg 1 CG; MO; QL 360 PER 30 DAYS

buprenorphine hcl-naloxone hcl sl tab 8-2 mg 1 CG; MO; QL 90 PER 30 DAYS

VIVITROL INJ 380MG 5 MO; PA

ZUBSOLV SUB 1.4-0.36 4 MO; QL 360 PER 30 DAYS



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Opioid Reversal Agents

naloxone hcl inj 0.4 mg/ml 1 CG; MO

naloxone hcl soln cartridge 0.4 mg/ml 1 CG; MO

naloxone hcl soln prefilled syringe 2 mg/2ml 2 CG; MO

NARCAN SPR 3 MO

Smoking Cessation Agents

bupropion hcl (smoking deterrent) tab er 150 mg 1 CG; MO; QL 60 PER 30 DAYS

CHANTIX PAK 0.5& 1MG 4 MO; QL 504 PER 365 DAYS

CHANTIX PAK 1MG 4 MO; QL 504 PER 365 DAYS

CHANTIX TAB 0.5MG 4 MO; QL 504 PER 365 DAYS

CHANTIX TAB 1MG 4 MO; QL 504 PER 365 DAYS

NICOTROL INH 4 MO; QL 2688 PER 365 DAYS

NICOTROL NS SPR 10MG/ML 3 MO; QL 360 PER 365 DAYS

ANTIBACTERIALS

Aminoglycosides

amikacin sulfate inj 500 mg/2ml 2 CG; HI; MO

gentak oint 0.3% 2 CG; MO

gentamicin in saline inj 0.8 mg/ml 2 CG; HI; MO

gentamicin in saline inj 1 mg/ml 2 CG; HI; MO



gentamicin sulfate cream 0.1% 2 CG; MO

gentamicin sulfate inj 40 mg/ml 2 CG; HI; MO

gentamicin sulfate oint 0.1% 2 CG; MO

gentamicin sulfate ophth soln 0.3% 1 CG; MO

neomycin sulfate tab 500 mg 2 CG; MO

paromomycin sulfate cap 250 mg 2 CG; MO

streptomycin sulfate for inj 1 gm 4 MO

TOBRADEX OIN 0.3-0.1% 3 MO

tobramycin ophth soln 0.3% 1 CG; MO

tobramycin sulfate inj 10 mg/ml 2 CG; HI; MO

tobramycin sulfate inj 40 mg/ml 2 CG; HI; MO

TOBREX OIN 0.3% OP 4 MO

Antibacterials, Other

acetic acid otic soln 2% 2 CG; MO

bacitracin ophth oint 500 unit/gm 2 CG; MO

CLEOCIN SUP 100MG 4 MO


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clindacin-p pad 1% 2 CG; MO

clindamycin hcl cap 150 mg 2 CG; MO



clindamycin palmitate hcl for soln 75 mg/5ml 2 CG; MO

clindamycin phosphate foam 1% 4 MO

clindamycin phosphate gel 1% 4 MO

clindamycin phosphate in d5w iv soln 300 mg/50ml 2 CG; HI; MO



clindamycin phosphate inj 300 mg/2ml 2 CG; HI; MO



clindamycin phosphate lotion 1% 2 CG; MO

clindamycin phosphate soln 1% 2 CG; MO

clindamycin phosphate swab 1% 2 CG; MO

clindamycin phosphate vaginal cream 2% 2 CG; MO

clindamycin phosphate-tretinoin gel 1.2-0.025% 4 MO; PA

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 (1)-5% 4 MO

CLINDESSE CRE2% 4 MO

colistimethate sod for inj 150 mg 4 HI; MO

DALVANCE SOL 500MG 5 HI; MO

daptomycin for iv soln 500 mg 5 MO

linezolid for susp 100 mg/5ml 4 MO; QL 1800 PER 30 DAYS

linezolid inj 2 mg/ml 4 HI; MO

linezolid tab 600 mg 1 CG; MO; QL 56 PER 28 DAYS

methenamine hippurate tab 1 gm 2 CG; MO

metronidazole cap 375 mg 2 CG; MO

metronidazole cream 0.75% 2 CG; MO

metronidazole gel 0.75% 2 CG; MO

metronidazole gel 1% 2 CG; MO

metronidazole in nacl 0.79% iv soln 500 mg/100ml 2 CG; HI; MO

metronidazole lotion 0.75% 2 CG; MO

metronidazole tab 250 mg 2 CG; MO

metronidazole tab 500 mg 1 CG; MO

metronidazole vaginal gel 0.75% 2 CG; MO

MONUROL PAK GRANULES 3 MO

mupirocin cream 2% 3 MO

mupirocin oint 2% 2 CG; MO


13


nitrofurantoin macrocrystalline cap 100 mg 1 CG; MO; QL 360 PER

365 DAYS nitrofurantoin macrocrystalline cap 25 mg 1 CG; MO; QL 1440 PER

365 DAYS nitrofurantoin macrocrystalline cap 50 mg 1 CG; MO; QL 720 PER

365 DAYS

nitrofurantoin monohydrate macrocrystalline cap 100 mg 1 CG; MO; QL 180 PER

365 DAYS

nitrofurantoin susp 25 mg/5ml 4 MO; QL 7200 PER 365 DAYS

NORITATE CRE 1% 5 MO

polymyxin b sulfate for inj 500000 unit 2 CG; MO

SIVEXTRO INJ 200MG 5 HI; MO; QL 6 PER 30 DAYS

SIVEXTRO TAB 200MG 5 MO; QL 6 PER 30 DAYS

SULFAMYLON CRE 85MG/GM 4 MO

tigecycline for iv soln 50 mg 5 MO

tinidazole tab 250 mg 2 CG; MO

tinidazole tab 500 mg 2 CG; MO

trimethoprim tab 100 mg 1 CG; MO

vancomycin hcl cap 125 mg 4 MO

vancomycin hcl cap 250 mg 5 MO

vancomycin hcl for iv soln 1 gm 2 CG; HI; MO

vancomycin hcl for iv soln 10 gm 2 CG; HI; MO

vancomycin hcl for iv soln 500 mg 2 CG; HI; MO

Beta-lactam, Cephalosporins

AVYCAZ INJ 2-0.5GM 5 HI; MO

CEFACLOR SUS 125/5ML 3 MO



cefaclor cap 250 mg 1 CG; MO

cefaclor cap 500 mg 1 CG; MO

cefaclor monohydrate tab er 500 mg 1 CG; MO

cefadroxil cap 500 mg 2 CG; MO

cefadroxil for susp 250 mg/5ml 2 CG; MO

cefadroxil for susp 500 mg/5ml 2 CG; MO

cefadroxil tab 1 gm 2 CG; MO

cefazolin sodium for inj 1 gm 2 CG; HI; MO

cefazolin sodium for inj 10 gm 2 CG; HI; MO

cefazolin sodium for inj 500 mg 2 CG; HI; MO

cefdinir cap 300 mg 1 CG; MO

cefdinir for susp 125 mg/5ml 2 CG; MO

cefdinir for susp 250 mg/5ml 2 CG; MO


14


cefepime hcl for inj 1 gm 2 CG; HI; MO

cefepime hcl for inj 2 gm 2 CG; HI; MO

cefixime cap 400mg 3 MO

cefixime chew tab 100 mg 3 MO

cefixime chew tab 200 mg 3 MO

cefixime for susp 100 mg/5ml 4 MO

cefixime for susp 200 mg/5ml 4 MO

cefotetan disodium for inj 1 gm 2 CG; HI; MO

cefotetan disodium for inj 2 gm 2 CG; HI; MO

cefoxitin sodium for inj 10 gm 2 CG; HI; MO

cefoxitin sodium for iv soln 1 gm 2 CG; HI; MO

cefoxitin sodium for iv soln 2 gm 2 CG; HI; MO

cefpodoxime proxetil for susp 100 mg/5ml 2 CG; MO

cefpodoxime proxetil for susp 50 mg/5ml 2 CG; MO

cefpodoxime proxetil tab 100 mg 2 CG; MO

cefpodoxime proxetil tab 200 mg 2 CG; MO

cefprozil for susp 125 mg/5ml 2 CG; MO

cefprozil for susp 250 mg/5ml 2 CG; MO

cefprozil tab 250 mg 2 CG; MO

cefprozil tab 500 mg 2 CG; MO

ceftazidime for inj 1 gm 2 CG; HI; MO



ceftriaxone sodium for inj 1 gm 2 CG; HI; MO



ceftriaxone sodium for inj 250 mg 2 CG; HI; MO

ceftriaxone sodium for inj 500 mg 2 CG; HI; MO

cefuroxime axetil tab 250 mg 1 CG; MO

cefuroxime axetil tab 500 mg 1 CG; MO

cefuroxime sodium for inj 7.5 gm 2 CG; HI; MO

cefuroxime sodium for inj 750 mg 2 CG; HI; MO

cefuroxime sodium for iv soln 1.5 gm 2 CG; HI; MO

cephalexin cap 250 mg 1 CG; MO



cephalexin for susp 125 mg/5ml 2 CG; MO

cephalexin for susp 250 mg/5ml 2 CG; MO

cephalexin tab 250 mg 2 CG; MO

cephalexin tab 500 mg 2 CG; MO


15


SUPRAX CAP 400MG 3 MO

SUPRAX SUS 500/5ML 3 MO

tazicef inj 1 gm 2 HI; CG; MO



TEFLARO INJ 400MG 5 HI; MO

TEFLARO INJ 600MG 5 HI; MO

Beta-lactam, Other

aztreonam for inj 1 gm 4 HI; MO

CAYSTON INH 75MG 5 MO; PA

ertapenem sodium for inj 1 gm 3 MO

imipenem-cilastatin intravenous for soln 250 mg 4 HI; MO

imipenem-cilastatin intravenous for soln 500 mg 4 HI; MO

meropenem iv for soln 500 mg 2 CG; HI; MO

Beta-lactam, Penicillins

amoxicillin & k clavulanate chew tab 200-28.5 mg 1 CG; MO

amoxicillin & k clavulanate chew tab 400-57 mg 1 CG; MO

amoxicillin & k clavulanate for susp 200-28.5 mg/5ml 1 CG; MO


amoxicillin & k clavulanate for susp 400-57 mg/5ml 1 CG; MO


amoxicillin & k clavulanate tab 250-125 mg 1 CG; MO



amoxicillin (trihydrate) cap 250 mg 1 CG; MO

amoxicillin (trihydrate) cap 500 mg 1 CG; MO

amoxicillin (trihydrate) chew tab 125 mg 1 CG; MO

amoxicillin (trihydrate) chew tab 250 mg 1 CG; MO

amoxicillin (trihydrate) for susp 125 mg/5ml 1 CG; MO




amoxicillin (trihydrate) tab 500 mg 1 CG; MO

amoxicillin (trihydrate) tab 875 mg 1 CG; MO

AMOX-POT CLA TAB ER 3 MO

ampicillin & sulbactam sodium for inj 1-0.5 gm 2 CG; HI; MO

ampicillin & sulbactam sodium for inj 15 gm 2 CG; HI; MO

ampicillin & sulbactam sodium for inj 2-1 gm 2 CG; HI; MO

ampicillin cap 500 mg 1 CG; MO

ampicillin sodium for inj 1 gm 2 CG; HI; MO


16


ampicillin sodium for inj 125 mg 2 CG; HI; MO

ampicillin sodium for iv soln 10 gm 2 CG; HI; MO

BACTOCILL INJ DEX 1GM 4 HI; MO

BACTOCILL INJ DEX 2GM 4 HI; MO

BICILLIN C-R INJ 1200000 4 MO

BICILLIN C-R INJ 900/300 4 MO

BICILLIN L-A INJ 1200000 4 MO



dicloxacillin sodium cap 250 mg 2 CG; MO

dicloxacillin sodium cap 500 mg 2 CG; MO

nafcillin sodium for inj 1 gm 4 HI; MO

nafcillin sodium for inj 2 gm 1 HI; MO

nafcillin sodium for iv soln 10 gm 4 HI; MO

oxacillin sodium for inj 10 gm 5 HI; MO

oxacillin sodium for inj 2 gm 4 HI; MO

PENICILL GK/INJ DEX 2MU 3 HI; MO

PENICILL GK/INJ DEX 3MU 3 HI; MO

penicillin g potassium for inj 20000000 unit 2 CG; HI; MO

penicillin g sodium for inj 5000000 unit 2 CG; HI; MO

penicillin v potassium for soln 125 mg/5ml 1 CG; MO

penicillin v potassium for soln 250 mg/5ml 1 CG; MO

penicillin v potassium tab 250 mg 1 CG; MO

penicillin v potassium tab 500 mg 1 CG; MO

piperacillin sod-tazobactam na for inj 3-0.375 gm 2 CG; HI; MO

piperacillin sod-tazobactam sod for inj 2-0.25 gm 1 CG; HI; MO



ZOSYN SOL 2-0.25GM 4 HI; MO

ZOSYN SOL 3-0.375G 4 HI; MO

Macrolides

AZASITE SOL 1% 4 MO

azithromycin iv for soln 500 mg 2 CG; HI; MO

azithromycin powd pack for susp 1 gm 2 CG; MO

azithromycin susp 100 mg/5ml 2 CG; MO

azithromycin susp 200 mg/5ml 2 CG; MO

azithromycin tab 250 mg 1 CG; MO



clarithromycin for susp 125 mg/5ml 2 CG; MO


17


clarithromycin for susp 250 mg/5ml 2 CG; MO

clarithromycin tab 250 mg 2 CG; MO

clarithromycin tab 500 mg 2 CG; MO

clarithromycin tab er 500 mg 2 CG; MO

DIFICID TAB 200MG 5 MO

ERYTHROCIN INJ 500MG 4 HI; MO

erythromycin ethylsuccinate for susp 200 mg/5ml 2 CG; MO

erythromycin ethylsuccinate for susp 400 mg/5ml 3 MO

erythromycin ethylsuccinate tab 400 mg 2 CG; MO

erythromycin gel 2% 2 CG; MO

erythromycin ophth oint 5 mg/gm 1 CG; MO

erythromycin pads 2% 2 CG; MO

erythromycin soln 2% 2 CG; MO

erythromycin stearate tab 250 mg 2 CG; MO

erythromycin tab 250 mg bs 2 CG; MO

erythromycin tab 500 mg bs 2 CG; MO

erythromycin tab dr 250 mg 2 CG; MO



erythromycin w/ delayed release particles cap 250 mg 2 CG; MO

Quinolones

BESIVANCE SUS 0.6% 3 MO

CILOXAN OIN 0.3% OP 4 MO

ciprofloxacin 200 mg/100ml in d5w 2 CG; HI; MO

ciprofloxacin hcl ophth soln 0.3% 1 CG; MO

ciprofloxacin hcl tab 100 mg 1 CG; MO




gatifloxacin ophth soln 0.5% 2 CG; MO

levofloxacin in d5w iv soln 500 mg/100ml 2 CG; HI; MO

levofloxacin in d5w iv soln 750 mg/150ml 2 CG; HI; MO

levofloxacin iv soln 25 mg/ml 4 HI; MO

levofloxacin ophth soln 0.5% 2 CG; MO

levofloxacin oral soln 25 mg/ml 4 MO

levofloxacin tab 250 mg 1 CG; MO



MOXEZA SOL 0.5% 3 MO

moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8% inj 4 HI; MO


18


moxifloxacin hcl ophth soln 0.5% 2 CG; MO

moxifloxacin hcl tab 400 mg 2 CG; MO

ofloxacin ophth soln 0.3% 1 CG; MO

ofloxacin otic soln 0.3% 2 CG; MO

ofloxacin tab 300 mg 2 CG; MO

ofloxacin tab 400 mg 2 CG; MO

Sulfonamides

silver sulfadiazine cream 1% 1 CG; MO

sulfacetamide sodium lotion 10% (acne) 4 MO

sulfacetamide sodium ophth soln 10% 2 CG; MO

sulfadiazine tab 500 mg 4 MO

sulfamethoxazole-trimethoprim susp 200-40 mg/5ml 2 CG; MO

sulfamethoxazole-trimethoprim tab 400-80 mg 1 CG; MO

sulfamethoxazole-trimethoprim tab 800-160 mg 1 CG; MO

Tetracyclines

demeclocycline hcl tab 150 mg 2 CG; MO

demeclocycline hcl tab 300 mg 2 CG; MO

DORYX MPC TAB 120MG 4 MO

doxycycline hyclate cap 100 mg 1 CG; MO

doxycycline hyclate cap 50 mg 1 CG; MO

doxycycline hyclate for inj 100 mg 2 CG; HI; MO

doxycycline hyclate tab 100 mg 1 CG; MO

doxycycline hyclate tab delayed release 150 mg 2 CG; MO

doxycycline hyclate tab dr 100 mg 2 CG; MO


doxycycline hyclate tab dr 50 mg 4 MO


doxycycline monohydrate cap 100 mg 2 CG; MO



doxycycline monohydrate for susp 25 mg/5ml 2 CG; MO

doxycycline monohydrate tab 100 mg 2 CG; MO




minocycline hcl cap 100 mg 1 CG; MO



minocycline hcl tab 100 mg 1 CG; MO



19



tetracycline hcl cap 250 mg 4 MO

tetracycline hcl cap 500 mg 4 MO

VIBRAMYCIN SYP 50MG/5ML 4 MO

ANTICONVULSANTS

Anticonvulsants, Other

BRIVIACT SOL 10MG/ML 5 MO

BRIVIACT TAB 100MG 5 MO





EPIDIOLEX SOL 100MG/ML 5 MO

levetiracetam oral soln 100 mg/ml 2 CG; MO

levetiracetam tab 1000 mg 1 CG; MO




levetiracetam tab er 500 mg 2 CG; MO

levetiracetam tab er 750 mg 2 CG; MO

SPRITAM TAB 1000MG 4 MO




Calcium Channel Modifying Agents

CELONTIN CAP 300MG 4 MO

ethosuximide cap 250 mg 2 CG; MO

ethosuximide soln 250 mg/5ml 2 CG; MO

zonisamide cap 100 mg 2 CG; MO



Gamma-aminobutyric Acid (GABA) Augmenting Agents

clobazam suspension 2.5 mg/ml 5 MO

clobazam tab 10 mg 4 MO

clobazam tab 20 mg 5 MO

DIASTAT ACDL GEL 12.5-20 4 MO

DIASTAT ACDL GEL 5-10MG 4 MO

DIASTAT PED GEL 2.5M GEL 4 MO

diazepam conc 5 mg/ml 2 CG; MO

DIAZEPAM GEL 10MG 4 MO


20


DIAZEPAM GEL 2.5MG 4 MO

DIAZEPAM GEL 20MG 4 MO

diazepam oral soln 1 mg/ml 2 CG; MO

diazepam tab 10 mg 1 CG; MO



gabapentin cap 100 mg 1 CG; MO



gabapentin oral soln 250 mg/5ml 2 CG; MO

gabapentin tab 600 mg 1 CG; MO

gabapentin tab 800 mg 1 CG; MO

NAYZILAM SPRAY 5 MG 4 MO; QL 10 PER 30 DAYS

phenobarbital elixir 20 mg/5ml 2 CG; MO

phenobarbital tab 100 mg 2 CG; MO


phenobarbital tab 16.2 mg 2 CG; MO






primidone tab 250 mg 1 CG; MO

primidone tab 50 mg 1 CG; MO

SYMPAZAN MIS 10MG 4 MO; QL 120 PER 30 DAYS



tiagabine hcl tab 12 mg 4 MO




VALTOCO LIQ 15MG 4 MO; QL 10 PER 30 DAYS

VALTOCO LIQ 20MG 4 MO; QL 10 PER 30 DAYS

VALTOCO SPR 10MG 4 MO; QL 10 PER 30 DAYS

VALTOCO SPR 5MG 4 MO; QL 10 PER 30 DAYS

vigabatrin powd pack 500 mg 5 MO

vigabatrin tab 500 mg 5 MO; QL 180 PER 30 DAYS

vigadrone powd pack 500 mg 5 MO; QL 180 PER 30 DAYS

Glutamate Reducing Agents

felbamate susp 600 mg/5ml 5 MO


21


felbamate tab 400 mg 4 MO

felbamate tab 600 mg 4 MO

FYCOMPA SUS 0.5MG/ML 4 MO

FYCOMPA TAB 10MG 4 MO






TOPIRAMATE CAP ER 100MG 4 MO





topiramate sprinkle cap 15 mg 2 CG; MO

topiramate sprinkle cap 25 mg 2 CG; MO

Sodium Channel Agents

APTIOM TAB 200MG 4 MO




BANZEL SUS 40MG/ML 5 MO

BANZEL TAB 200MG 5 MO

BANZEL TAB 400MG 5 MO

carbamazepine cap er 100 mg 2 CG; MO



carbamazepine chew tab 100 mg 2 CG; MO

carbamazepine susp 100 mg/5ml 2 CG; MO

carbamazepine tab 200 mg 1 CG; MO

carbamazepine tab er 100 mg 2 CG; MO



dilantin cap 30 mg 4 MO

epitol tab 200 mg 1 CG; MO

oxcarbazepine susp 300 mg/5ml 4 MO

oxcarbazepine tab 150 mg 1 CG; MO




22


PEGANONE TAB 250MG 4 MO

phenytoin chew tab 50 mg 2 CG; MO

phenytoin sodium extended cap 100 mg 1 CG; MO



phenytoin susp 125 mg/5ml 2 CG; MO

VIMPAT SOL 10MG/ML 4 MO

VIMPAT TAB 100MG 4 MO




ANTIDEMENTIA AGENTS

Antidementia Agents, Other

ergoloid mesylates tab 1 mg 3 MO

Cholinesterase Inhibitors

donepezil hydrochloride odt tab 10 mg 1 CG; MO

donepezil hydrochloride odt tab 5 mg 1 CG; MO

donepezil hydrochloride tab 10 mg 1 CG; MO



galantamine hydrobromide cap er 16 mg 2 CG; MO



galantamine hydrobromide oral soln 4 mg/ml 4 MO

galantamine hydrobromide tab 12 mg 2 CG; MO



rivastigmine tartrate cap 1.5 mg 2 CG; MO

rivastigmine tartrate cap 3 mg 2 CG; MO

rivastigmine tartrate cap 4.5 mg 2 CG; MO

rivastigmine tartrate cap 6 mg 2 CG; MO

rivastigmine td patch 24hr 13.3 mg/24hr 3 MO



N-methyl-D-aspartate (NMDA) Receptor Antagonist

memantine hcl cap er 14 mg 3 MO; QL 30 PER 30 DAYS




memantine hcl oral solution 2 mg/ml 2 CG; MO


23


memantine hcl tab 10 mg 1 CG; MO

memantine hcl tab 5 mg 1 CG; MO

memantine hcl tab 5 mg (28) & 10 mg (21) titration pak 2 CG; MO

NAMENDA XR CAP TITRATION 3 MO; QL 56 PER 365 DAYS

ANTIDEPRESSANTS

Antidepressants, Other

APLENZIN TAB 174MG 5 MO; QL 30 PER 30 DAYS



BUPROPION TAB 450MG XL 3 MO; QL 30 PER 30 DAYS

bupropion hcl tab 100 mg 1 CG; MO

bupropion hcl tab 75 mg 1 CG; MO

bupropion hcl tab er 100 mg 1 CG; MO; QL 90 PER 30 DAYS

bupropion hcl tab er 12hr 200 mg 1 CG; MO; QL 90 PER 30 DAYS


bupropion hcl tab er 150 mg xl 2 CG; MO; QL 90 PER 30 DAYS


chlordiazepoxide-amitriptyline tab 10-25 mg 2 CG; MO

chlordiazepoxide-amitriptyline tab 5-12.5 mg 2 CG; MO

FORFIVO XL TAB 450MG 3 MO; QL 30 PER 30 DAYS

mirtazapine odt tab 15 mg 2 CG; MO



mirtazapine tab 15 mg 1 CG; MO



mirtazapine tab 7.5 mg 2 CG; MO

olanzapine-fluoxetine hcl cap 12-25 mg 4 MO; QL 30 PER 30 DAYS





perphenazine-amitriptyline tab 2-10 mg 4 MO

perphenazine-amitriptyline tab 2-25 mg 2 CG; MO




Monoamine Oxidase Inhibitors

EMSAM DIS 12MG/24H 5 MO; QL 30 PER 30 DAYS

EMSAM DIS 6MG/24HR 5 MO; QL 30 PER 30 DAYS


24


EMSAM DIS 9MG/24HR 5 MO; QL 30 PER 30 DAYS

MARPLAN TAB 10MG 4 MO

phenelzine sulfate tab 15 mg 2 CG; MO

tranylcypromine sulfate tab 10 mg 4 MO

SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors)

citalopram hydrobromide oral soln 10 mg/5ml 2 CG; MO

citalopram hydrobromide tab 10 mg 1 CG; MO



DRIZALMA CAP 20 MG DR 4 MO; QL 180 PER 30 DAYS




DESVENLAFAX TAB 100MG ER 4 MO; QL 120 PER 30 DAYS

DESVENLAFAX TAB 50MG ER 2 CG; MO; QL 30 PER 30 DAYS

desvenlafaxine succinate tab er 100 mg 2 CG; MO; QL 120 PER 30 DAYS



FETZIMA CAP 120MG 4 MO; QL 30 PER 30 DAYS




FETZIMA CAP TITRATION 4 MO; QL 56 PER 365 DAYS

fluoxetine hcl cap 10 mg 1 CG; MO



fluoxetine hcl cap dr 90 mg 2 CG; MO; QL 4 PER 28 DAYS

fluoxetine hcl solution 20 mg/5ml 2 CG; MO

fluoxetine hcl tab 10 mg 2 CG; MO

fluoxetine hcl tab 20 mg 2 CG; MO

fluvoxamine maleate cap er 100 mg 2 CG; MO; QL 60 PER 30 DAYS

fluvoxamine maleate cap er 150 mg 2 CG; MO; QL 60 PER 30 DAYS

fluvoxamine maleate tab 100 mg 2 CG; MO



maprotiline hcl tab 25 mg 2 CG; MO



nefazodone hcl tab 100 mg 2 CG; MO

nefazodone hcl tab 150 mg 4 MO


25





trazodone hcl tab 100 mg 1 CG; MO




TRINTELLIX TAB 10MG 4 MO; QL 30 PER 30 DAYS



VIIBRYD KIT STARTER 4 MO; QL 60 PER 365 DAYS

VIIBRYD TAB 10MG 4 MO; QL 30 PER 30 DAYS



Tricyclics

amitriptyline hcl tab 10 mg 1 CG; MO






amoxapine tab 100 mg 2 CG; MO




clomipramine hcl cap 25 mg 4 MO



desipramine hcl tab 10 mg 2 CG; MO






imipramine hcl tab 10 mg 1 CG; MO



imipramine pamoate cap 100 mg 1 CG; MO




26



nortriptyline hcl cap 10 mg 1 CG; MO




nortriptyline hcl soln 10 mg/5ml 2 CG; MO

protriptyline hcl tab 10 mg 2 CG; MO

protriptyline hcl tab 5 mg 2 CG; MO

trimipramine maleate cap 100 mg 4 MO



ANTIEMETICS

Antiemetics, Other

compro suppos 25 mg 2 CG; MO

meclizine hcl tab 12.5 mg 1 CG; MO

meclizine hcl tab 25 mg 1 CG; MO

metoclopramide hcl odt tab 10 mg 4 MO

prochlorperazine suppos 25 mg 2 CG; MO

scopolamine td patch 72hr 1 mg/3days 1 CG; MO; QL 10 PER 30 DAYS

trimethobenzamide hcl cap 300 mg 2 CG; MO; B/D PA

Emetogenic Therapy Adjuncts

aprepitant capsule 125 mg 2 CG; MO; QL 2 PER 30

DAYS; B/D PA aprepitant capsule 40 mg 2 CG; MO; QL 1 PER 30

DAYS; B/D PA aprepitant capsule 80 mg 2 CG; MO; QL 8 PER 30

DAYS; B/D PA

aprepitant capsule therapy pack 80 & 125 mg 2 CG; MO; QL 6 PER 30

DAYS; B/D PA dronabinol cap 10 mg 4 MO; QL 60 PER 30 DAYS;

B/D PA dronabinol cap 2.5 mg 4 MO; QL 60 PER 30 DAYS;

B/D PA

dronabinol cap 5 mg 4 MO; QL 60 PER 30 DAYS;

B/D PA EMEND SUS 125MG 4 MO; QL 6 PER 30 DAYS;

B/D PA

granisetron hcl tab 1 mg 2 CG; MO; QL 30 PER 30

DAYS; B/D PA


27


ondansetron hcl oral soln 4 mg/5ml 2 CG; MO; QL 450 PER 30 DAYS; B/D PA

ondansetron hcl tab 24 mg 2 QL 14 PER 28 DAYS; B/D PA

ondansetron hcl tab 4 mg 2 CG; MO; B/D PA

ondansetron hcl tab 8 mg 2 CG; MO; B/D PA

ondansetron odt tab 4 mg 1 CG; MO; B/D PA

ondansetron odt tab 8 mg 1 CG; MO; B/D PA

SANCUSO DIS 3.1MG 5 MO; QL 2 PER 30 DAYS

ANTIFUNGALS

Antifungals

ABELCET INJ 5MG/ML 5 HI; MO; B/D PA

AMBISOME INJ 50MG 5 MO; B/D PA

amphotericin b for iv soln 50 mg 4 MO; B/D PA

caspofungin acetate for iv soln 50 mg 3 HI; MO

caspofungin acetate for iv soln 70 mg 3 HI; MO

ciclopirox gel 0.77% 2 CG; MO

ciclopirox olamine cream 0.77% 2 CG; MO

ciclopirox olamine susp 0.77% 2 CG; MO

ciclopirox shampoo 1% 2 CG; MO

ciclopirox solution 8% 2 CG; MO; PA

clotrimazole cream 1% 1 CG; MO

clotrimazole soln 1% 2 CG; MO

clotrimazole troche 10 mg 2 CG; MO

CRESEMBA CAP 186 MG 5 MO

econazole nitrate cream 1% 2 CG; MO

ERAXIS INJ 100MG 5 HI; MO

ERAXIS INJ 50MG 4 HI; MO

fluconazole for susp 10 mg/ml 2 CG; MO

fluconazole for susp 40 mg/ml 2 CG; MO

fluconazole in nacl 0.9% inj 200 mg/100ml 2 CG; HI; MO

fluconazole in nacl 0.9% inj 400 mg/200ml 2 CG; HI; MO

fluconazole tab 100 mg 1 CG; MO




flucytosine cap 250 mg 5 MO

flucytosine cap 500 mg 5 MO

griseofulvin microsize susp 125 mg/5ml 2 CG; MO

griseofulvin microsize tab 500 mg 4 MO

griseofulvin ultramicrosize tab 125 mg 4 MO


28


griseofulvin ultramicrosize tab 250 mg 4 MO

itraconazole cap 100 mg 4 MO; PA

itraconazole oral soln 10 mg/ml 3 MO; PA

ketoconazole cream 2% 2 CG; MO

ketoconazole foam 2% 4 MO

ketoconazole shampoo 2% 1 CG; MO

ketoconazole tab 200 mg 2 CG; MO

MENTAX CRE 1% 4 MO

miconazole nitrate vaginal suppos 200 mg 2 CG; MO

MYCAMINE INJ 100MG 5 HI; MO

MYCAMINE INJ 50MG 4 HI; MO

naftifine hcl cream 1% 4 MO

naftifine hcl cream 2% 4 MO

NAFTIN GEL 1% 4 MO

NAFTIN GEL 2% 4 MO

NATACYN SUS 5% OP 4 MO

NOXAFIL SUS 40MG/ML 5 MO

NOXAFIL TAB 100MG 5 MO

nyamyc powder 100000 unit/gm 2 CG; MO

nystatin cream 100000 unit/gm 2 CG; MO

nystatin oint 100000 unit/gm 2 CG; MO

nystatin susp 100000 unit/ml 1 CG; MO

nystatin tab 500000 unit 2 CG; MO

nystatin topical powder 100000 unit/gm 2 CG; MO

nystatin-triamcinolone cream 100000-0.1 unit/gm-% 2 CG; MO

nystatin-triamcinolone oint 100000-0.1 unit/gm-% 2 CG; MO

nystop powder 100000 unit/gm 2 CG; MO

oxiconazole nitrate cream 1% 2 CG; MO

OXISTAT LOT 1% 4 MO

posaconazole tab 100 mg dr 5 MO

terbinafine hcl tab 250 mg 1 CG; MO; QL 84 PER 180 DAYS

terconazole vaginal cream 0.4% 2 CG; MO

terconazole vaginal cream 0.8% 2 CG; MO

terconazole vaginal suppos 80 mg 2 CG; MO

voriconazole for inj 200 mg 4 HI; MO

voriconazole for susp 40 mg/ml 5 MO

voriconazole tab 200 mg 4 MO

voriconazole tab 50 mg 4 MO

ANTIGOUT AGENTS

Antigout Agents


29


allopurinol tab 300 mg 1 CG; MO

COLCHICINE TAB0.6MG 3 MO

COLCRYS TAB 0.6MG 3 MO

febuxostat tab 40 mg 3 MO

febuxostat tab 80 mg 3 MO

probenecid tab 500 mg 2 CG; MO

probenecid/colchicine tab 0.5-500 mg 2 CG; MO

ULORIC TAB 40MG 3 MO; ST

ULORIC TAB 80MG 3 MO; ST

ANTI-INFLAMMATORY AGENTS

Nonsteroidal Anti-inflammatory Drugs

celecoxib cap 100 mg 2 CG; MO; QL 60 PER 30 DAYS




diclofenac potassium tab 50 mg 2 CG; MO

diclofenac sodium tab dr 25 mg 2 CG; MO



diclofenac sodium tab er 100 mg 2 CG; MO

diclofenac w/ misoprostol tab delayed release 50-0.2 mg 4 MO

diclofenac w/ misoprostol tab delayed release 75-0.2 mg 4 MO

diflunisal tab 500 mg 2 CG; MO

etodolac cap 200 mg 2 CG; MO

etodolac cap 300 mg 2 CG; MO

etodolac tab 400 mg 2 CG; MO

etodolac tab 500 mg 2 CG; MO

etodolac tab er 400 mg 2 CG; MO



FENOPROFEN CAP 400MG 4 MO

fenoprofen calcium tab 600 mg 4 MO

flurbiprofen tab 100 mg 1 CG; MO

ibuprofen susp 100 mg/5ml 2 CG; MO

ibuprofen tab 400 mg 1 CG; MO



indomethacin cap 25 mg 1 CG; MO

indomethacin cap 50 mg 1 CG; MO

indomethacin cap er 75 mg 1 CG; MO


30


ketoprofen cap er 200 mg 4 MO

ketorolac tromethamine tab 10 mg 1 CG; MO; QL 20 PER 30 DAYS

lodine tab 400 mg 2 CG; MO

meclofenamate sodium cap 100 mg 4 MO

meclofenamate sodium cap 50 mg 4 MO

mefenamic acid cap 250 mg 4 MO

meloxicam tab 15 mg 1 CG; MO

meloxicam tab 7.5 mg 1 CG; MO

nabumetone tab 500 mg 1 CG; MO

nabumetone tab 750 mg 1 CG; MO

naproxen sodium tab 275 mg 2 CG; MO

naproxen sodium tab 550 mg 2 CG; MO

naproxen susp 125 mg/5ml 2 CG; MO

naproxen tab 250 mg 1 CG; MO



naproxen tab ec 375 mg 1 CG; MO

naproxen tab ec 500 mg 1 CG; MO

oxaprozin tab 600 mg 2 CG; MO

piroxicam cap 10 mg 2 CG; MO

piroxicam cap 20 mg 2 CG; MO

sulindac tab 150 mg 1 CG; MO

sulindac tab 200 mg 1 CG; MO

tolmetin sodium cap 400 mg 2 CG; MO

tolmetin sodium tab 600 mg 2 CG; MO

ZIPSOR CAP 25MG 4 MO

ANTIMIGRAINE AGENTS

Antimigraine Agents

AJOVY INJ 225/1.5 4 MO; QL 4.5 PER 90 DAYS; PA

EMGALITY INJ 100MG/ML 4 MO; PA

EMGALITY INJ 120MG/ML 4 MO; PA

UBRELVY TAB 100MG 4 MO; QL 16 PER 30 DAYS; ST

UBRELVY TAB 50MG 4 MO; QL 16 PER 30 DAYS; ST

Ergot Alkaloids

cafergot tab 1-100 mg 2 CG; MO

DIHYDROERGOT SPR 4MG/ML 5 MO; QL 8 PER 30 DAYS

ergotamine w/ caffeine tab 1-100 mg 2 CG; MO

migergot suppos 2-100 mg 4 MO

Prophylactic

timolol maleate tab 10 mg 2 CG; MO


31




topiramate tab 100 mg 1 CG; MO




Serotonin (5-HT) 1b/1d Receptor Agonists

almotriptan malate tab 12.5 mg 4 MO; QL 12 PER 30 DAYS

almotriptan malate tab 6.25 mg 4 MO; QL 12 PER 30 DAYS

frovatriptan succinate tab 2.5 mg 4 MO; QL 12 PER 30 DAYS

naratriptan hcl tab 1 mg 2 CG; MO; QL 9 PER 30 DAYS

naratriptan hcl tab 2.5 mg 2 CG; MO; QL 9 PER 30 DAYS

REYVOW TAB 100MG 4 MO; QL 8 PER 30 DAYS

REYVOW TAB 50MG 4 MO; QL 4 PER 30 DAYS

rizatriptan benzoate odt tab 10 mg 2 CG; MO; QL 18 PER 30 DAYS

rizatriptan benzoate odt tab 5 mg 2 CG; MO; QL 18 PER 30 DAYS

rizatriptan benzoate tab 10 mg 2 CG; MO; QL 18 PER 30 DAYS

rizatriptan benzoate tab 5 mg 2 CG; MO; QL 18 PER 30 DAYS

sumatriptan nasal spray 20 mg/act 4 MO; QL 12 PER 30 DAYS

sumatriptan nasal spray 5 mg/act 4 MO; QL 12 PER 30 DAYS

sumatriptan succinate inj 6 mg/0.5ml 4 MO; QL 5 PER 30 DAYS

sumatriptan succinate solution auto-injector 4 mg/0.5ml 4 MO; QL 8 PER 30 DAYS

sumatriptan succinate solution auto-injector 6 mg/0.5ml 4 MO; QL 5 PER 30 DAYS

sumatriptan succinate solution cartridge 4 mg/0.5ml 4 MO; QL 8 PER 30 DAYS

sumatriptan succinate tab 100 mg 1 CG; MO; QL 9 PER 30 DAYS



zolmitriptan odt tab 2.5 mg 2 CG; MO; QL 12 PER 30 DAYS

zolmitriptan odt tab 5 mg 2 CG; MO; QL 9 PER 30 DAYS

zolmitriptan tab 2.5 mg 2 CG; MO; QL 12 PER 30 DAYS

zolmitriptan tab 5 mg 2 CG; MO; QL 12 PER 30 DAYS

ANTIMYASTHENIC AGENTS

Parasympathomimetics

FIRDAPSE TAB 10 MG 5 MO; QL 240 PER 30 DAYS; PA

GUANIDINE TAB 125MG 4 MO

MESTINON SYP 60MG/5ML 5 MO

pyridostigmine bromide tab 60 mg 2 CG; MO

pyridostigmine bromide tab er 180 mg 4 MO

RUZURGI TAB 10 MG 5 MO; QL 300 PER 30 DAYS; PA

ANTIMYCOBACTERIALS


32


Antimycobacterials, Other

dapsone tab 100 mg 2 CG; MO

dapsone tab 25 mg 2 CG; MO

paser granules packet 4 gm 4 MO

rifabutin cap 150 mg 2 CG; MO

Antituberculars

ethambutol hcl tab 100 mg 2 CG; MO

ethambutol hcl tab 400 mg 2 CG; MO

isoniazid syrup 50 mg/5ml 4 MO

isoniazid tab 100 mg 1 CG; MO

isoniazid tab 300 mg 1 CG; MO

PRETOMANID TAB 200MG 4 MO; QL 26 PER 26 DAYS; PA

PRIFTIN TAB 150MG 4 MO

pyrazinamide tab 500 mg 2 CG; MO

rifampin cap 150 mg 2 CG; MO

rifampin cap 300 mg 2 CG; MO

rifampin inj 600 mg 4 HI; MO

RIFATER TAB 4 MO

SIRTURO TAB 100MG 5 MO

TRECATOR TAB 250MG 4 MO

ANTINEOPLASTICS

Alkylating Agents

CYCLOPHOSPH CAP 25MG 3 MO; B/D PA

CYCLOPHOSPH CAP 50MG 3 MO; B/D PA

GLEOSTINE CAP 100MG 4 MO



LEUKERAN TAB 2MG 4 MO

MATULANE CAP 50MG 5 MO

VALCHLOR GEL 0.016% 5 MO

Antiandrogens

abiraterone acetate tab 250 mg 5 MO

bicalutamide tab 50 mg 1 CG; MO

ERLEADA TAB 60MG 5 MO; QL 120 PER 30 DAYS

flutamide cap 125 mg 2 CG; MO

nilutamide tab 150 mg 5 MO

NUBEQA TAB 300MG 5 MO; QL 120 PER 30 DAYS

XTANDI CAP 40MG 5 MO

YONSA TAB 125MG 5 MO; QL 120 PER 30 DAYS

ZYTIGA TAB 500MG 5 MO


33


Antiangiogenic Agents

POMALYST CAP 1MG 5 MO




REVLIMID CAP 10MG 5 MO


REVLIMID CAP 2.5MG 5 MO




THALOMID CAP 100MG 5 MO




Antiestrogens/Modifiers

EMCYT CAP 140MG 5 MO

SOLTAMOX SOL 10MG/5ML 4 MO

tamoxifen citrate tab 10 mg 1 CG; MO

tamoxifen citrate tab 20 mg 1 CG; MO

toremifene citrate tab 60 mg 5 MO; QL 30 PER 30 DAYS

Antimetabolites

DROXIA CAP 200MG 4 MO



hydroxyurea cap 500 mg 1 CG; MO

PURIXAN SUS 20MG/ML 5 MO

SIKLOS TAB 1000MG 4 MO

SIKLOS TAB 100MG 4 MO

TABLOID TAB 40MG 4 MO

Antineoplastics, Other

KISQALI 200 PAK FEMARA 5 MO; QL 49 PER 28 DAYS



leucovorin calcium tab 10 mg 2 CG; MO




LONSURF TAB 15-6.14 5 MO; QL 100 PER 28 DAYS

LONSURF TAB 20-8.19 5 MO; QL 80 PER 28 DAYS


34


NINLARO CAP 2.3MG 5 MO

NINLARO CAP 3MG 5 MO

NINLARO CAP 4MG 5 MO

RUBRACA TAB 200MG 5 MO; QL 120 PER 30 DAYS



SYNRIBO INJ 3.5MG 5 MO

TALZENNA CAP 0.25MG 5 MO; QL 120 PER 30 DAYS

TALZENNA CAP 1MG 5 MO; QL 30 PER 30 DAYS

VERZENIO TAB 100MG 5 MO; QL 112 PER 28 DAYS




XPOVIO PAK 100MG 5 MO; QL 20 PER 28 DAYS



ZOLINZA CAP 100MG 5 MO

Aromatase Inhibitors, 3rd Generation

anastrozole tab 1 mg 1 CG; MO

exemestane tab 25 mg 4 MO

letrozole tab 2.5 mg 1 CG; MO

Molecular Target Inhibitors

AFINITOR TAB 10MG 5 MO; QL 30 PER 30 DAYS

AFINITOR TAB 2.5MG 5 MO; QL 30 PER 30 DAYS

AFINITOR TAB 5MG 5 MO; QL 30 PER 30 DAYS

AFINITOR TAB 7.5MG 5 MO; QL 30 PER 30 DAYS

AFINITOR DIS TAB 2MG 5 MO



ALECENSA CAP 150MG 5 MO; QL 240 PER 30 DAYS

ALUNBRIG PAK 5 MO; QL 30 PER 30 DAYS

ALUNBRIG TAB 180MG 5 MO; QL 30 PER 30 DAYS



AYVAKIT TAB 100MG 5 MO



BALVERSA TAB 3MG 5 MO; QL 84 PER 28 DAYS




35


BOSULIF TAB 100MG 5 MO



BRAFTOVI CAP 75MG 5 MO; QL 180 PER 30 DAYS

BRUKINSA CAP 80MG 5 MO; QL 120 PER 30 DAYS

CABOMETYX TAB 20MG 5 MO



CALQUENCE CAP 100MG 5 MO; QL 60 PER 30 DAYS

CAPRELSA TAB 100MG 5 MO; QL 60 PER 30 DAYS

CAPRELSA TAB 300MG 5 MO

COMETRIQ KIT 100MG 5 MO



COPIKTRA CAP 15MG 5 MO; QL 56 PER 28 DAYS

COPIKTRA CAP 25MG 5 MO; QL 56 PER 28 DAYS

COTELLIC TAB 20MG 5 MO; QL 90 PER 30 DAYS

DAURISMO TAB 100MG 5 MO; QL 30 PER 30 DAYS

DAURISMO TAB 25MG 5 MO; QL 120 PER 30 DAYS

ERIVEDGE CAP 150MG 5 MO

erlotinib hcl tab 100 mg 5 MO; QL 30 PER 30 DAYS



everolimus tab 2.5mg 5 MO; QL 30 PER 30 DAYS

everolimus tab 5mg 5 MO; QL 30 PER 30 DAYS

everolimus tab 7.5mg 5 MO; QL 30 PER 30 DAYS

FARYDAK CAP 10MG 5 MO; QL 6 PER 21 DAYS

FARYDAK CAP 20MG 5 MO; QL 6 PER 21 DAYS

GILOTRIF TAB 20MG 5 MO; QL 30 PER 30 DAYS



IBRANCE CAP 100MG 5 MO



IBRANCE TAB 100MG 5 MO



ICLUSIG TAB 15MG 5 MO; QL 60 PER 30 DAYS

ICLUSIG TAB 45MG 5 MO

IDHIFA TAB 100MG 5 MO; QL 30 PER 30 DAYS


36


IDHIFA TAB 50MG 5 MO; QL 60 PER 30 DAYS

imatinib mesylate tab 100 mg 5 MO

imatinib mesylate tab 400 mg 5 MO

IMBRUVICA CAP 140MG 5 MO

IMBRUVICA CAP 70MG 5 MO; QL 240 PER 30 DAYS

IMBRUVICA TAB 140MG 5 MO; QL 120 PER 30 DAYS




INLYTA TAB 1MG 5 MO

INLYTA TAB 5MG 5 MO

INREBIC CAP 100MG 5 MO; QL 120 PER 30 DAYS

IRESSA TAB 250MG 5 MO

JAKAFI TAB 10MG 5 MO; QL 60 PER 30 DAYS





KISQALI TAB 200DOSE 5 MO; QL 63 PER 28 DAYS



KOSELUGO CAP 10MG 5 MO

KOSELUGO CAP 25MG 5 MO

LENVIMA CAP 10 MG 5 MO

LENVIMA CAP 12MG 5 MO







LORBRENA TAB 100MG 5 MO; QL 30 PER 30 DAYS

LORBRENA TAB 25MG 5 MO; QL 120 PER 30 DAYS

LYNPARZA TAB 100MG 5 MO; QL 180 PER 30 DAYS

LYNPARZA TAB 150MG 5 MO; QL 120 PER 30 DAYS

MEKINIST TAB 0.5MG 5 MO

MEKINIST TAB 2MG 5 MO

MEKTOVI TAB 15MG 5 MO; QL 180 PER 30 DAYS

NERLYNX TAB 40MG 5 MO; QL 180 PER 30 DAYS

NEXAVAR TAB 200MG 5 MO


37


ODOMZO CAP 200MG 5 MO

PEMAZYRE TAB 13.5MG 5 MO; QL 30 PER 30 DAYS

PEMAZYRE TAB 4.5MG 5 MO; QL 30 PER 30 DAYS

PEMAZYRE TAB 9MG 5 MO; QL 30 PER 30 DAYS

PIQRAY 200MG TAB DOSE 5 MO; QL 28 PER 28 DAYS



ROZLYTREK CAP 100 MG 5 MO; QL 180 PER 30 DAYS

ROZLYTREK CAP 200 MG 5 MO; QL 90 PER 30 DAYS

RYDAPT CAP 25MG 5 MO; QL 224 PER 28 DAYS

SPRYCEL TAB 100MG 5 MO






STIVARGA TAB 40MG 5 MO

SUTENT CAP 12.5MG 5 MO

SUTENT CAP 25MG 5 MO

SUTENT CAP 37.5MG 5 MO

SUTENT CAP 50MG 5 MO

TAFINLAR CAP 50MG 5 MO

TAFINLAR CAP 75MG 5 MO

TAGRISSO TAB 40MG 5 MO; QL 30 PER 30 DAYS

TAGRISSO TAB 80MG 5 MO; QL 30 PER 30 DAYS

TARCEVA TAB 100MG 5 MO; QL 30 PER 30 DAYS



TASIGNA CAP 150MG 5 MO

TASIGNA CAP 200MG 5 MO

TASIGNA CAP 50MG 5 MO; QL 360 PER 30 DAYS

TAZVERIK TAB 200MG 5 MO; QL 240 PER 30 DAYS

TIBSOVO TAB 250MG 5 MO; QL 60 PER 30 DAYS

TURALIO CAP 200MG 5 MO; QL 120 PER 30 DAYS

TYKERB TAB 250MG 5 MO

VENCLEXTA TAB 100MG 5 MO



VENCLEXTA TAB START PK 5 MO

VITRAKVI CAP 100MG 5 MO; QL 60 PER 30 DAYS


38


VITRAKVI CAP 25MG 5 MO; QL 240 PER 30 DAYS

VITRAKVI SOL 20MG/ML 5 MO; QL 300 PER 30 DAYS

VIZIMPRO TAB 15MG 5 MO



VOTRIENT TAB 200MG 5 MO

XALKORI CAP 200MG 5 MO

XALKORI CAP 250MG 5 MO

XOSPATA TAB 40MG 5 MO; QL 90 PER 30 DAYS

ZEJULA CAP 100MG 5 MO; QL 90 PER 30 DAYS

ZELBORAF TAB 240MG 5 MO

ZYDELIG TAB 100MG 5 MO

ZYDELIG TAB 150MG 5 MO

ZYKADIA TAB 150MG 5 MO

Retinoids

bexarotene cap 75 mg 5 MO

PANRETIN GEL 0.1% 5 MO

TARGRETIN GEL 1% 5 MO

tretinoin cap 10 mg 5 MO

Treatment Adjuncts

allopurinol tab 100 mg 1 CG; MO

MESNEX TAB 400MG 5 MO

ANTIPARASITICS

Antihelminthics

albendazole tab 200 mg 5 MO

benznidazole tab 100mg 2 CG; MO

benznidazole tab 12.5mg 2 CG; MO

ivermectin cream 1% 4 MO

ivermectin tab 3 mg 2 CG; MO

praziquantel tab 600 mg 3 MO

SKLICE LOT 0.5% 4 MO

Antiprotozoals

ALINIA SUS 100/5ML 4 MO

ALINIA TAB 500MG 4 MO

atovaquone susp 750 mg/5ml 5 MO

atovaquone-proguanil hcl tab 250-100 mg 2 CG; MO

atovaquone-proguanil hcl tab 62.5-25 mg 2 CG; MO

chloroquine phosphate tab 250 mg 2 CG; MO

chloroquine phosphate tab 500 mg 2 CG; MO

COARTEM TAB 20-120MG 4 MO


39


DARAPRIM TAB 25MG 5 MO; PA

hydroxychloroquine sulfate tab 200 mg 2 CG; MO

mefloquine hcl tab 250 mg 2 CG; MO

PENTAM 300 INJ 300MG 4 HI; MO

pentamidine inh 300 mg 2 CG; MO; B/D PA

PRIMAQUINE TAB 26.3MG 2 CG; MO

quinine sulfate cap 324 mg 2 CG; MO; PA

Pediculicides/Scabicides

lindane shampoo 1% 4 MO

malathion lotion 0.5% 4 MO

permethrin cream 5% 2 CG; MO

ANTIPARKINSON AGENTS

Anticholinergics

benztropine mesylate tab 0.5 mg 1 CG; MO

benztropine mesylate tab 1 mg 1 CG; MO

benztropine mesylate tab 2 mg 1 CG; MO

trihexyphenidyl hcl elixir 0.4 mg/ml 4 MO

trihexyphenidyl hcl tab 2 mg 1 CG; MO

trihexyphenidyl hcl tab 5 mg 1 CG; MO

Antiparkinson Agents, Other

amantadine hcl syrup 50 mg/5ml 1 CG; MO

CARB/LEVO 50TAB/ENTACAP 3 MO

CARB/LEVO 75TAB/ENTACAP 3 MO

CARB/LEVO100TAB/ENTACAP 4 MO




entacapone tab 200 mg 2 CG; MO

STALEVO 100 TAB 4 MO




STALEVO 50 TAB 4 MO

STALEVO 75 TAB 4 MO

tolcapone tab 100 mg 5 MO

Dopamine Agonists

APOKYN INJ 10MG/ML 5 MO; QL 60 PER 30 DAYS; PA

NEUPRO DIS 1MG/24HR 4 MO; ST




40





pramipexole tab 0.125 mg 1 CG; MO




pramipexole tab 1 mg 1 CG; MO


pramipexole tab er 0.375 mg 4 MO




pramipexole tab er 3 mg 4 MO

pramipexole tab er 3.75 mg 2 CG; MO


ropinirole hydrochloride tab 0.25 mg 1 CG; MO

ropinirole hydrochloride tab 0.5 mg 1 CG; MO

ropinirole hydrochloride tab 1 mg 1 CG; MO





ropinirole hydrochloride tab er 12 mg 2 CG; MO





Dopamine Precursors/ L-Amino Acid Decarboxylase Inhibitors

carbidopa & levodopa odt tab 10-100 mg 1 CG; MO



carbidopa & levodopa tab 10-100 mg 1 CG; MO



carbidopa & levodopa tab er 25-100 mg 1 CG; MO

carbidopa & levodopa tab er 50-200 mg 1 CG; MO

carbidopa tab 25 mg 4 MO

NOURIANZ TAB 20 MG 5 MO; QL 30 PER 30 DAYS; PA

NOURIANZ TAB 40 MG 5 MO; QL 30 PER 30 DAYS; PA


41


RYTARY CAP 145MG 4 MO; ST




Monoamine Oxidase B (MAO-B) Inhibitors

rasagiline mesylate tab 0.5 mg 2 CG; MO

rasagiline mesylate tab 1 mg 2 CG; MO

selegiline hcl cap 5 mg 2 CG; MO

selegiline hcl tab 5 mg 2 CG; MO

ZELAPAR TAB 1.25MG 5 MO

ANTIPSYCHOTICS

1st Generation/Typical

chlorpromazine hcl tab 10 mg 4 MO





fluphenazine decanoate inj 25 mg/ml 2 CG; MO

fluphenazine hcl elixir 2.5 mg/5ml 2 CG; MO

fluphenazine hcl inj 2.5 mg/ml 2 CG; MO

fluphenazine hcl oral conc 5 mg/ml 2 CG; MO

fluphenazine hcl tab 1 mg 1 CG; MO


fluphenazine hcl tab 2.5 mg 1 CG; MO


haloperidol decanoate im soln 100 mg/ml 2 CG; MO

haloperidol decanoate im soln 50 mg/ml 2 CG; MO

haloperidol lactate inj 5 mg/ml 2 CG; MO

haloperidol lactate oral conc 2 mg/ml 1 CG; MO

haloperidol tab 0.5 mg 1 CG; MO

haloperidol tab 1 mg 1 CG; MO





loxapine succinate cap 10 mg 2 CG; MO




MOLINDONE TAB HCL 10MG 4 MO


42




perphenazine tab 16 mg 2 CG; MO




pimozide tab 1 mg 4 MO

pimozide tab 2 mg 4 MO

prochlorperazine maleate tab 10 mg 1 CG; MO

prochlorperazine maleate tab 5 mg 1 CG; MO

thioridazine hcl tab 10 mg 1 CG; MO




thiothixene cap 1 mg 2 CG; MO




trifluoperazine hcl tab 1 mg 2 CG; MO




2nd Generation/Atypical

ARISTADA INJ 1064MG 5 MO; QL 3.9 PER 56 DAYS

ARISTADA INJ 441MG/1. 5 MO

ARISTADA INJ 662MG/2 5 MO

ARISTADA INJ 882MG/3 5 MO

ARISTADA INJ INITIO 5 MO; QL 2.4 PER 28 DAYS

CAPLYTA CAP 42MG 5 MO; QL 30 PER 30 DAYS

FANAPT PAK 4 MO; QL 8 PER 180 DAYS

FANAPT TAB 10MG 5 MO; QL 60 PER 30 DAYS







INVEGA SUST INJ 117/0.75 5 MO

INVEGA SUST INJ 156MG/ML 5 MO



43



INVEGA SUST INJ 78/0.5ML 4 MO

INVEGA TRINZINJ 273MG 5 MO




LATUDA TAB 120MG 5 MO; QL 30 PER 30 DAYS





NUPLAZID CAP 34MG 5 MO; QL 30 PER 30 DAYS

NUPLAZID TAB 10MG 5 MO; QL 30 PER 30 DAYS

olanzapine for im inj 10 mg 2 CG; MO

olanzapine odt tab 10 mg 2 CG; MO; QL 30 PER 30 DAYS




olanzapine tab 10 mg 1 CG; MO; QL 30 PER 30 DAYS


olanzapine tab 2.5 mg 1 CG; MO; QL 30 PER 30 DAYS



olanzapine tab 7.5 mg 1 CG; MO; QL 30 PER 30 DAYS

paliperidone tab er 1.5 mg 4 MO; QL 30 PER 30 DAYS

paliperidone tab er 3 mg 4 MO; QL 30 PER 30 DAYS



PERSERIS INJ 120MG 5 MO; QL 1 PER 30 DAYS

PERSERIS INJ 90MG 5 MO; QL 1 PER 30 DAYS

quetiapine fumarate tab 100 mg 1 CG; MO; QL 90 PER 30 DAYS






quetiapine fumarate tab er 150 mg 2 CG; MO; QL 60 PER 30 DAYS

quetiapine fumarate tab er 200 mg 2 CG; MO




44



REXULTI TAB 0.25MG 5 MO; QL 30 PER 30 DAYS

REXULTI TAB 0.5MG 5 MO; QL 30 PER 30 DAYS

REXULTI TAB 1MG 5 MO; QL 30 PER 30 DAYS




risperidone odt tab 2 mg 2 CG; MO; QL 60 PER 30 DAYS



SAPHRIS SUB 10MG 4 MO; QL 60 PER 30 DAYS

SAPHRIS SUB 2.5MG 4 MO; QL 60 PER 30 DAYS

SAPHRIS SUB 5MG 4 MO; QL 60 PER 30 DAYS

SECUADO DIS 3.8MG 5 MO; QL 60 PER 30 DAYS



VRAYLAR CAP 1.5-3MG 4 MO; QL 14 PER 365 DAYS

VRAYLAR CAP 1.5MG 5 MO; QL 30 PER 30 DAYS

VRAYLAR CAP 3MG 5 MO; QL 30 PER 30 DAYS

VRAYLAR CAP 4.5MG 5 MO; QL 30 PER 30 DAYS

VRAYLAR CAP 6MG 5 MO; QL 30 PER 30 DAYS

ZYPREXA RELP INJ 210MG 4 MO

Treatment-Resistant

CLOZAPINE TAB 150/ODT 4 MO; QL 180 PER 30 DAYS

CLOZAPINE TAB 200/ODT 5 MO; QL 120 PER 30 DAYS

clozapine odt tab 100 mg 4 MO; QL 270 PER 30 DAYS

clozapine odt tab 12.5 mg 4 MO; QL 90 PER 30 DAYS

clozapine odt tab 25 mg 4 MO; QL 270 PER 30 DAYS

clozapine tab 100 mg 2 CG; MO; QL 270 PER 30 DAYS




VERSACLOZ SUS 50MG/ML 5 MO; QL 540 PER 30 DAYS

ANTISPASTICITY AGENTS

Antispasticity Agents

baclofen tab 10 mg 1 CG; MO



dantrolene sodium cap 100 mg 2 CG; MO



45



tizanidine hcl tab 2 mg 1 CG; MO

tizanidine hcl tab 4 mg 1 CG; MO

ANTIVIRALS

Anti-cytomegalovirus (CMV) Agents

valganciclovir hcl for soln 50 mg/ml 5 MO

valganciclovir hcl tab 450 mg 5 MO

ZIRGAN GEL 0.15% 4 MO

Anti-hepatitis B (HBV) Agents

adefovir dipivoxil tab 10 mg 5 MO

BARACLUDE SOL.05 MG/ML 4 MO; QL 600 PER 30 DAYS

entecavir tab 0.5 mg 4 MO; QL 30 PER 30 DAYS

entecavir tab 1 mg 4 MO; QL 30 PER 30 DAYS

EPIVIR HBV SOL 5MG/ML 4 MO

INTRON A INJ 10MU 5 MO

INTRON A INJ 18MU (POWDER) 5 MO


lamivudine tab 100 mg (hbv) 2 CG; MO

VIREAD POW 40MG/GM 5 MO

VIREAD TAB 150MG 4 MO



Anti-hepatitis C (HCV) Agents

MAVYRET TAB100-40MG 5 MO; PA

Anti-hepatitis C (HCV) Agents, Other

INTRON A INJ 18MU (SOLUTION) 5 MO


PEGASYS INJ 5 MO; PA

PEGASYS INJ 180MCG/M 5 MO; PA

PEGASYS INJ PROCLICK 5 MO; PA

ribavirin cap 200 mg 2 CG; MO

ribavirin tab 200 mg 4 MO

SYLATRON KIT 200MCG 5 MO

SYLATRON KIT 300MCG 5 MO

Anti-hepatitis C (HCV) Direct Acting Agents

EPCLUSA TAB 400-100 5 MO; QL 84 PER 365 DAYS; PA

HARVONI TAB 90-400MG 5 MO; QL 168 PER 365

DAYS; PA LEDIPASVIR/SOFOSBUVIR TAB 90-400MG 5 MO; QL 168 PER 365

DAYS; PA


46


SOVALDI TAB400MG 5 MO; QL 336 PER 365

DAYS; PA

Antiherpetic Agents

acyclovir cap 200 mg 1 CG; MO

acyclovir cream 5% 4 MO

acyclovir oint 5% 4 MO

acyclovir sodium iv soln 50 mg/ml 4 HI; MO; B/D PA

acyclovir susp 200 mg/5ml 4 MO

acyclovir tab 400 mg 1 CG; MO

acyclovir tab 800 mg 1 CG; MO

DENAVIR CRE 1% 5 MO

famciclovir tab 125 mg 2 CG; MO



trifluridine ophth soln 1% 2 CG; MO

valacyclovir hcl tab 1 gm 2 CG; MO; QL 120 PER 30 DAYS

valacyclovir hcl tab 500 mg 2 CG; MO; QL 120 PER 30 DAYS

Anti-HIV Agents, Integrase Inhibitors (INSTI)

GENVOYA TAB 5 MO; QL 30 PER 30 DAYS

ISENTRESS CHW 100MG 5 MO

ISENTRESS CHW 25MG 3 MO

ISENTRESS POW 100MG 5 MO

ISENTRESS TAB 400MG 5 MO

ISENTRESS HD TAB 600MG 5 MO

STRIBILD TAB 5 MO; QL 30 PER 30 DAYS

SYMTUZA TAB 5 MO; QL 30 PER 30 DAYS

TIVICAY TAB 10MG 4 MO



TRIUMEQ TAB 5 MO; QL 30 PER 30 DAYS

ATRIPLA TAB 5 MO; QL 30 PER 30 DAYS

BIKTARVY TAB 5 MO; QL 30 PER 30 DAYS

COMPLERA TAB 5 MO; QL 30 PER 30 DAYS

DELSTRIGO TAB 5 MO; QL 30 PER 30 DAYS

EDURANT TAB 25MG 5 MO

efavirenz cap 200 mg 2 CG; MO

efavirenz cap 50 mg 2 CG; MO; QL 360 PER 30 DAYS

efavirenz tab 600 mg 5 MO

INTELENCE TAB 100MG 5 MO



47



nevirapine susp 50 mg/5ml 4 MO

nevirapine tab 200 mg 2 CG; MO

nevirapine tab er 100 mg 4 MO

nevirapine tab er 400 mg 4 MO

ODEFSEY TAB 5 MO; QL 30 PER 30 DAYS

PIFELTRO TAB 100MG 5 MO; QL 30 PER 30 DAYS

SYMFI TAB 5 MO; QL 30 PER 30 DAYS

SYMFI LO TAB 5 MO; QL 30 PER 30 DAYS

VIRAMUNE SUS 50MG/5ML 4 MO; QL 1200 PER 30 DAYS

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)

abacavir sulfate soln 20 mg/ml 4 MO

abacavir sulfate tab 300 mg 4 MO

abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg 5 MO; QL 60 PER 30 DAYS

CIMDUO TAB 300-300 5 MO; QL 30 PER 30 DAYS

didanosine dr capsule 200 mg 2 CG; MO



EMTRIVA CAP 200MG 4 MO

EMTRIVA SOL 10MG/ML 4 MO

JULUCA TAB 50-25MG 5 MO; QL 30 PER 30 DAYS

lamivudine oral soln 10 mg/ml 2 CG; MO

lamivudine tab 150 mg 2 CG; MO

lamivudine tab 300 mg 2 CG; MO

lamivudine-zidovudine tab 150-300 mg 2 CG; MO; QL 60 PER 30 DAYS

stavudine cap 15 mg 2 CG; MO




tenofovir disoproxil fumarate tab 300 mg 4 MO; QL 30 PER 30 DAYS

TRUVADA TAB 100-150 5 MO; QL 30 PER 30 DAYS




zidovudine cap 100 mg 2 CG; MO

zidovudine syrup 10 mg/ml 2 CG; MO

zidovudine tab 300 mg 2 CG; MO

Anti-HIV Agents, Other

abacavir sulfate-lamivudine tab 600-300 mg 4 MO; QL 30 PER 30 DAYS

DESCOVY TAB 200/25 5 MO; QL 30 PER 30 DAYS


48


FUZEON INJ 90MG 5 MO; QL 60 PER 30 DAYS

lopinavir-ritonavir soln 80-20 mg/ml 1 CG; MO

SELZENTRY SOL 20MG/ML 3 MO

SELZENTRY TAB 150MG 5 MO




TYBOST TAB 150MG 3 MO

Anti-HIV Agents, Protease Inhibitors

APTIVUS CAP 250MG 5 MO

APTIVUS SOL 5 MO

atazanavir sulfate cap 150 mg 5 MO; QL 60 PER 30 DAYS



CRIXIVAN CAP 200MG 3 MO

CRIXIVAN CAP 400MG 3 MO

DOVATO TAB 50-300MG 5 MO; QL 30 PER 30 DAYS

EVOTAZ TAB 300-150 5 MO; QL 30 PER 30 DAYS

fosamprenavir calcium tab 700 mg 4 MO

INVIRASE TAB 500MG 5 MO

KALETRA TAB 100-25MG 4 MO

KALETRA TAB 200-50MG 5 MO

LEXIVA SUS 50MG/ML 4 MO

NORVIR POW 100MG 4 MO

NORVIR SOL 80MG/ML 4 MO

PREZCOBIX TAB 800-150 5 MO; QL 30 PER 30 DAYS

PREZISTA SUS 100MG/ML 5 MO

PREZISTA TAB 150MG 4 MO




REYATAZ POW 50MG 3 MO

ritonavir tab 100 mg 4 MO; QL 360 PER 30 DAYS

VIRACEPT TAB 250MG 5 MO

VIRACEPT TAB 625MG 5 MO

Anti-influenza Agents

amantadine hcl cap 100 mg 2 CG; MO

amantadine hcl tab 100 mg 2 CG; MO

oseltamivir phosphate cap 30 mg 2 CG; MO

oseltamivir phosphate cap 45 mg 2 CG; MO


49


oseltamivir phosphate cap 75 mg 2 CG; MO; QL 110 PER

365 DAYS oseltamivir phosphate for susp 6 mg/ml 2 CG; MO; QL 900 PER

180 DAYS

RELENZA MISDISKHALE 4 MO; QL 240 PER 365 DAYS

rimantadine hydrochloride tab 100 mg 2 CG; MO

ANXIOLYTICS

Anxiolytics, Other

buspirone hcl tab 10 mg 1 CG; MO




buspirone hcl tab 7.5 mg 1 CG; MO

doxepin hcl cap 10 mg 1 CG; MO






doxepin hcl conc 10 mg/ml 1 CG; MO

hydroxyzine hcl tab 10 mg 1 CG; MO



hydroxyzine pamoate cap 100 mg 1 CG; MO



Benzodiazepines

alprazolam conc 1 mg/ml 2 CG; MO

alprazolam odt tab 0.25 mg 2 CG; MO; QL 120 PER 30 DAYS

alprazolam odt tab 0.5 mg 2 CG; MO; QL 120 PER 30 DAYS

alprazolam odt tab 1 mg 2 CG; MO; QL 120 PER 30 DAYS

alprazolam odt tab 2 mg 2 CG; MO; QL 150 PER 30 DAYS

alprazolam tab 0.25 mg 1 CG; MO; QL 120 PER 30 DAYS

alprazolam tab 0.5 mg 1 CG; MO; QL 120 PER 30 DAYS

alprazolam tab 1 mg 1 CG; MO; QL 120 PER 30 DAYS

alprazolam tab 2 mg 1 CG; MO; QL 150 PER 30 DAYS

alprazolam tab er 1 mg 1 CG; MO; QL 30 PER 30 DAYS


alprazolam tab er 24hr 0.5 mg 1 CG; MO; QL 30 PER 30 DAYS


chlordiazepoxide hcl cap 10 mg 1 CG; MO; QL 900 PER 30 DAYS


50




clonazepam odt tab 0.125 mg 2 CG; MO



clonazepam odt tab 1 mg 2 CG; MO

clonazepam odt tab 2 mg 2 CG; MO

clonazepam tab 0.5 mg 1 CG; MO

clonazepam tab 1 mg 1 CG; MO

clonazepam tab 2 mg 1 CG; MO

clorazepate dipotassium tab 15 mg 2 CG; MO; QL 180 PER 30 DAYS

clorazepate dipotassium tab 3.75 mg 2 CG; MO; QL 720 PER 30 DAYS

clorazepate dipotassium tab 7.5 mg 2 CG; MO; QL 360 PER 30 DAYS

estazolam tab 1 mg 2 CG; MO; QL 30 PER 30 DAYS

estazolam tab 2 mg 2 CG; MO; QL 30 PER 30 DAYS

lorazepam conc 2 mg/ml 2 CG; MO

lorazepam tab 0.5 mg 1 CG; MO; QL 90 PER 30 DAYS

lorazepam tab 1 mg 1 CG; MO; QL 90 PER 30 DAYS

lorazepam tab 2 mg 1 CG; MO; QL 150 PER 30 DAYS

oxazepam cap 10 mg 2 CG; MO; QL 120 PER 30 DAYS



SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors)

escitalopram oxalate soln 5 mg/5ml 1 CG; MO

escitalopram oxalate tab 10 mg 1 CG; MO



paroxetine hcl tab 10 mg 1 CG; MO




paroxetine hcl tab er 12.5 mg 2 CG; MO

paroxetine hcl tab er 25 mg 2 CG; MO

paroxetine hcl tab er 37.5 mg 2 CG; MO

PAXIL SUS 10MG/5ML 4 MO

PEXEVA TAB 10MG 4 MO; QL 30 PER 30 DAYS




sertraline hcl oral concentrate for solution 20 mg/ml 2 CG; MO


51


sertraline hcl tab 100 mg 1 CG; MO



venlafaxine hcl cap er 150 mg 1 CG; MO

venlafaxine hcl cap er 37.5 mg 1 CG; MO

venlafaxine hcl cap er 75 mg 1 CG; MO

venlafaxine hcl tab 100 mg 1 CG; MO


venlafaxine hcl tab 37.5 mg 1 CG; MO



venlafaxine hcl tab er 150 mg 3 MO


venlafaxine hcl tab er 37.5 mg 3 MO


BIPOLAR AGENTS

Bipolar Agents, Other

ABILIFY MAININJ300MG 5 MO

ABILIFY MAININJ400MG 5 MO

aripiprazole odt tab 10 mg 5 MO; QL 60 PER 30 DAYS

aripiprazole odt tab 15 mg 5 MO; QL 60 PER 30 DAYS

aripiprazole oral solution 1 mg/ml 2 CG; MO

aripiprazole tab 10 mg 2 CG; MO; QL 30 PER 30 DAYS






GEODON INJ 20MG 4 MO; QL 60 PER 30 DAYS

RISPERDAL INJ 12.5MG 4 MO

RISPERDAL INJ 25MG 4 MO

RISPERDAL INJ 37.5MG 5 MO

RISPERDAL INJ 50MG 5 MO

risperidone odt tab 0.25 mg 2 CG; MO; QL 60 PER 30 DAYS

risperidone odt tab 0.5 mg 2 CG; MO; QL 60 PER 30 DAYS


risperidone soln 1 mg/ml 2 CG; MO; QL 240 PER 30 DAYS

risperidone tab 0.25 mg 1 CG; MO; QL 60 PER 30 DAYS

risperidone tab 0.5 mg 1 CG; MO; QL 60 PER 30 DAYS

risperidone tab 1 mg 1 CG; MO; QL 60 PER 30 DAYS


52





ziprasidone hcl cap 20 mg 2 CG; MO; QL 60 PER 30 DAYS




Mood Stabilizers

divalproex sodium cap dr sprinkle 125 mg 2 CG; MO

divalproex sodium tab dr 125 mg 1 CG; MO



divalproex sodium tab er 250 mg 2 CG; MO

divalproex sodium tab er 500 mg 2 CG; MO

EQUETRO CAP 100MG 4 MO



lamotrigine odt tab 100 mg 4 MO




lamotrigine tab 100 mg 1 CG; MO




lamotrigine tab 25 mg (35) starter kit 4 MO

lamotrigine tab 25 mg (42) & 100 mg (7) starter kit 4 MO

lamotrigine tab 25 mg (84) & 100 mg (14) starter kit 4 MO

lamotrigine tab chewable dispersible 25 mg 2 CG; MO

lamotrigine tab chewable dispersible 5 mg 2 CG; MO

lamotrigine tab er 100 mg 3 MO






LITHIUM SOL 8MEQ/5ML 3 MO

lithium carbonate cap 150 mg 1 CG; MO




53


lithium carbonate tab 300 mg 1 CG; MO

lithium carbonate tab er 300 mg 1 CG; MO

lithium carbonate tab er 450 mg 1 CG; MO

valproate sodium oral soln 250 mg/5ml 2 CG; MO

valproic acid cap 250 mg 2 CG; MO

BLOOD GLUCOSE REGULATORS

Antidiabetic Agents

acarbose tab 100 mg 2 CG; MO



CYCLOSET TAB 0.8MG 6 CG; MO

glimepiride tab 1 mg 1 CG; MO; QL 240 PER 30 DAYS



glipizide tab 10 mg 1 CG; MO; QL 120 PER 30 DAYS

glipizide tab 5 mg 1 CG; MO; QL 240 PER 30 DAYS

glipizide tab er 10 mg 1 CG; MO; QL 60 PER 30 DAYS

glipizide tab er 2.5 mg 1 CG; MO; QL 240 PER 30 DAYS

glipizide tab er 5 mg 1 CG; MO; QL 120 PER 30 DAYS

glipizide-metformin hcl tab 2.5-250 mg 1 CG; MO; QL 240 PER 30 DAYS

glipizide-metformin hcl tab 2.5-500 mg 1 CG; MO; QL 120 PER 30 DAYS

glipizide-metformin hcl tab 5-500 mg 1 CG; MO; QL 120 PER 30 DAYS

glyburide micronized tab 1.5 mg 1 CG; MO; QL 240 PER 30 DAYS

glyburide micronized tab 3 mg 1 CG; MO; QL 120 PER 30 DAYS

glyburide micronized tab 6 mg 1 CG; MO; QL 60 PER 30 DAYS

glyburide tab 1.25 mg 1 CG; MO; QL 480 PER 30 DAYS

glyburide tab 2.5 mg 1 CG; MO; QL 240 PER 30 DAYS

glyburide tab 5 mg 1 CG; MO; QL 120 PER 30 DAYS

glyburide-metformin tab 1.25-250 mg 1 CG; MO; QL 240 PER 30 DAYS

glyburide-metformin tab 2.5-500 mg 1 CG; MO; QL 120 PER 30 DAYS

glyburide-metformin tab 5-500 mg 1 CG; MO; QL 120 PER 30 DAYS

INVOKAMET TAB150-1000 6 CG; MO; QL 60 PER 30 DAYS; ST



INVOKAMET TAB50-500MG 6 CG; MO; QL 120 PER 30 DAYS; ST

INVOKAMET XRTAB150-1000 6 CG; MO; QL 60 PER 30 DAYS; ST

INVOKAMET XRTAB150-500 6 CG; MO; QL 60 PER 30 DAYS;


54


ST

INVOKAMET XRTAB50-1000 6 CG; MO; QL 60 PER 30 DAYS; ST

INVOKAMET XRTAB50-500MG 6 CG; MO; QL 60 PER 30 DAYS; ST

INVOKANA TAB 100MG 6 CG; MO; QL 90 PER 30 DAYS; ST

INVOKANA TAB 300MG 6 CG; MO; QL 30 PER 30 DAYS; ST

JANUMET TAB 50-1000MG 6 CG; MO; QL 60 PER 30 DAYS; ST

JANUMET TAB 50-500MG 6 CG; MO; QL 60 PER 30 DAYS; ST

JANUMET XR TAB 100-1000MG 6 CG; MO; QL 30 PER 30 DAYS; ST



JANUVIA TAB 100MG 6 CG; MO; ST



JARDIANCE TAB 10MG 6 CG; MO; QL 60 PER 30 DAYS; ST

JARDIANCE TAB 25MG 6 CG; MO; QL 30 PER 30 DAYS; ST

JENTADUETO TAB 2.5-1000MG 6 CG; MO; QL 60 PER 30 DAYS; ST



JENTADUETO TAB XR 5-1000MG 6 CG; MO; QL 30 PER 30 DAYS; ST

JENTADUETO TAB XR 2.5-1000MG 6 CG; MO; QL 60 PER 30 DAYS; ST

metformin hcl tab 1000 mg 1 CG; MO; QL 60 PER 30 DAYS



metformin hcl tab er 500 mg 1 CG; MO; QL 120 PER 30 DAYS

metformin hcl tab er 750 mg 1 CG; MO; QL 60 PER 30 DAYS

miglitol tab 100 mg 6 CG; MO



nateglinide tab 120 mg 1 CG; MO


55


nateglinide tab 60 mg 1 CG; MO

OZEMPIC INJ2/1.5ML 5 MO; QL 3 PER 28 DAYS

pioglitazone hcl tab 15 mg 1 CG; MO; QL 60 PER 30 DAYS



pioglitazone hcl-glimepiride tab 30-2 mg 2 CG; MO; QL 45 PER 30 DAYS

pioglitazone hcl-glimepiride tab 30-4 mg 2 CG; MO; QL 45 PER 30 DAYS

pioglitazone hcl-metformin hcl tab 15-500 mg 2 CG; MO; QL 90 PER 30 DAYS

pioglitazone hcl-metformin hcl tab 15-850 mg 2 CG; MO; QL 90 PER 30 DAYS

repaglinide tab 0.5 mg 1 CG; MO

repaglinide tab 1 mg 1 CG; MO

repaglinide tab 2 mg 1 CG; MO

RIOMET SOL 6 CG; MO; QL 765 PER 30 DAYS

SYMLINPEN 60 INJ 1000MCG 5 MO; PA

SYMLNPEN 120 INJ 1000MCG 5 MO; PA

SYNJARDY TAB 6 CG; MO; QL 60 PER 30 DAYS; ST

SYNJARDY TAB 12.5-500MG 6 CG; MO; QL 120 PER 30 DAYS; ST

SYNJARDY TAB5-1000MG 6 CG; MO; QL 60 PER 30 DAYS; ST

SYNJARDY TAB5-500MG 6 CG; MO; QL 120 PER 30 DAYS; ST

TRADJENTA TAB 5MG 6 CG; MO; ST

TRULICITY INJ 0.75/0.5 6 CG; MO; QL 2 PER 28 DAYS; ST

TRULICITY INJ 1.5/0.5 6 CG; MO; QL 2 PER 28 DAYS; ST

VICTOZA INJ 18MG/3ML 6 CG; MO; QL 9 PER 30 DAYS; ST

Glycemic Agents

BAQSIMI TWO POW 3MG/DOSE 4 MO

GLUCAGEN INJ HYPOKIT 6 CG; MO

GLUCAGON KIT 1MG 6 CG; MO

KORLYM TAB 300MG 5 MO; QL 120 PER 30 DAYS; PA

PROGLYCEM SUS 50MG/ML 5 MO

Insulins

BASAGLAR INJ 100UNIT 6 CG; MO

HUMALOG INJ 100/ML 6 CG; MO

HUMALOG JR INJ 100/ML 6 CG; MO

HUMALOG KWIK INJ 100/ML 6 CG; MO


56


HUMALOG KWIK INJ 200/ML 6 CG; MO

HUMALOG MIX INJ 50/50 6 CG; MO

HUMALOG MIX INJ 50/50 KWP 6 CG; MO

HUMALOG MIX INJ 75/25 KWP 6 CG; MO

HUMALOG MIX SUS 75/25 6 CG; MO

HUMULIN INJ 70/30 6 CG; MO

HUMULIN INJ 70/30 KWP 6 CG; MO

HUMULIN N INJ U-100 6 CG; MO

HUMULIN N INJ U-100 KWP 6 CG; MO

HUMULIN R INJ U-100 6 CG; MO

HUMULIN R INJ U-500 6 CG; MO

INS ASP PROT INJ FLEXPEN 6 CG; MO

INSULIN ASPA INJ 100/ML 6 CG; MO

INSULIN ASPA INJ 70/30 6 CG; MO

INSULIN ASPA INJ FLEXPEN 6 CG; MO

INSULIN ASPA INJ PENFILL 6 CG; MO

LANTUS INJ 100/ML 6 CG; MO

LANTUS SOLOSTAR INJ 100/ML 6 CG; MO

LEVEMIR INJ 6 CG; MO

LEVEMIR INJ FLEXTOUCH 6 CG; MO

NOVOLIN INJ 70/30 6 CG; MO

NOVOLIN INJ 70/30 RELION 6 CG; MO

NOVOLIN INJ FLEXPEN 6 CG; MO

NOVOLIN N INJ 100 UNIT 6 CG; MO

NOVOLIN N INJ U-100 6 CG; MO

NOVOLIN N INJ U-100 RELION 6 CG; MO

NOVOLIN R INJ 100 UNIT 6 CG; MO

NOVOLIN R INJ U-100 6 CG; MO

NOVOLIN R INJ U-100 RELION 6 CG; MO

NOVOLOG INJ 100/ML 6 CG; MO

NOVOLOG INJ FLEXPEN 6 CG; MO

NOVOLOG INJ PENFILL 6 CG; MO

NOVOLOG MIX INJ 70/30 6 CG; MO

NOVOLOG MIX INJ FLEXPEN 6 CG; MO

TOUJEO MAX INJ 300IU/ML 6 CG; MO

TOUJEO SOLO INJ 300IU/ML 6 CG; MO

TRESIBA INJ 100UNIT 6 CG; MO

TRESIBA FLEXINJ 100UNIT 6 CG; MO

TRESIBA FLEXINJ 200UNIT 6 CG; MO

BLOOD PRODUCTS/MODIFIERS/VOLUME EXPANDERS


57


Anticoagulants

ELIQUIS TAB 2.5MG 6 CG; MO; QL 60 PER 30 DAYS

ELIQUIS TAB 5MG 6 CG; MO; QL 90 PER 30 DAYS

ELIQUIS ST P TAB 5MG 6 CG; MO; QL 90 PER 30 DAYS

enoxaparin sodium inj 100 mg/ml 3 MO; QL 35 PER 90 DAYS

enoxaparin sodium inj 120 mg/0.8ml 3 MO; QL 28 PER 90 DAYS

enoxaparin sodium inj 150 mg/ml 3 MO; QL 35 PER 90 DAYS

enoxaparin sodium inj 30 mg/0.3ml 3 MO; QL 10.5 PER 90 DAYS




fondaparinux sodium subcutaneous inj 10 mg/0.8ml 5 MO; QL 28 PER 90 DAYS

fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml 4 MO; QL 17.5 PER 90 DAYS

fondaparinux sodium subcutaneous inj 5 mg/0.4ml 5 MO; QL 14 PER 90 DAYS

fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml 5 MO; QL 21 PER 90 DAYS

FRAGMIN INJ 10000/ML 5 MO

FRAGMIN INJ 12500UNT 5 MO



FRAGMIN INJ 2500/0.2 4 MO




heparin sodium (porcine) inj 1000 unit/ml 2 CG; MO




jantoven tab 1 mg 1 CG; MO



jantoven tab 2.5 mg 1 CG; MO





jantoven tab 7.5 mg 1 CG; MO

PRADAXA CAP 110MG 6 CG; MO; QL 60 PER 30 DAYS



SAVAYSA TAB 15MG 6 CG; MO; QL 30 PER 30 DAYS


58




warfarin sodium tab 1 mg 1 CG; MO



warfarin sodium tab 2.5 mg 1 CG; MO





warfarin sodium tab 7.5 mg 1 CG; MO

XARELTO TAB 10MG 6 CG; MO; QL 30 PER 30 DAYS


XARELTO TAB 2.5MG 6 CG; MO; QL 60 PER 30 DAYS


XARELTO STAR TAB 15/20MG 6 CG; MO; QL 102 PER 365 DAYS

Blood Formation Modifiers

anagrelide hcl cap 0.5 mg 2 CG; MO

anagrelide hcl cap 1 mg 2 CG; MO

ARANESP INJ 100MCG 5 MO; PA









ARANESP INJ 60MCG PREFILLED SYRINGE 4 MO; PA

FULPHILA INJ 6/0.6ML 5 MO, QL 1.2 PER 30 DAYS; PA

GRANIX INJ 300/0.5 5 MO; ST; PA

GRANIX INJ 300/1ML 5 MO; ST; PA



LEUKINE INJ 250MCG 5 MO; PA

MULPLETA TAB 3MG 3 MO; QL 7 PER 7 DAYS; PA

NEULASTA INJ 6MG/0.6M 5 MO; PA

NEUPOGEN INJ 300/0.5 5 MO; PA

NEUPOGEN INJ 300MCG 5 MO; PA


59


NEUPOGEN INJ 480/0.8 5 MO; PA

NEUPOGEN INJ 480MCG 5 MO; PA

NIVESTYM INJ 300/0.5 5 MO; B/D PA

NIVESTYM INJ 480/0.8 5 MO; B/D PA

OXBRYTA TAB 500MG 5 MO; PA; QL 90 PER 30 DAYS

PROCRIT INJ 10000/ML 4 MO; PA






PROMACTA PAK 25MG 5 MO; QL 90 PER 30 DAYS; PA

PROMACTA POW 12.5MG 5 MO; QL 180 PER 30 DAYS; PA

PROMACTA TAB 12.5MG 5 MO; PA

PROMACTA TAB 25MG 5 MO; PA



RETACRIT INJ 10000UNT 4 MO; PA

RETACRIT INJ 2000UNIT 4 MO; PA


RETACRIT INJ 40000UNT 4 MO; PA


UDENYCA INJ 6MG/.6ML 5 MO; QL 1.2 PER 30 DAYS; PA

ZARXIO INJ 300/0.5 5 MO; PA

ZARXIO INJ 480/0.8 5 MO; PA

ZIEXTENZO INJ 6/0.6ML 5 MO

Hemostasis Agent

tranexamic acid tab 650 mg 2 CG; MO

Platelet Modifying Agents

aspirin-dipyridamole cap er 12hr 25-200 mg 3 MO

BRILINTA TAB 60MG 3 MO

BRILINTA TAB 90MG 3 MO

CABLIVI KIT 11MG 5 MO; PA

cilostazol tab 100 mg 1 CG; MO

cilostazol tab 50 mg 1 CG; MO

clopidogrel bisulfate tab 75 mg 1 CG; MO

dipyridamole tab 25 mg 1 CG; MO



prasugrel hcl tab 10 mg 3 MO


60


prasugrel hcl tab 5 mg 3 MO

CARDIOVASCULAR AGENTS

Alpha-adrenergic Agonists

clonidine hcl tab 0.1 mg 1 CG; MO



clonidine td patch weekly 0.1 mg/24hr 2 CG; MO



guanfacine hcl tab 1 mg 4 MO

guanfacine hcl tab 2 mg 4 MO

methyldopa tab 250 mg 1 CG; MO

methyldopa tab 500 mg 1 CG; MO

midodrine hcl tab 10 mg 2 CG; MO

midodrine hcl tab 2.5 mg 2 CG; MO

midodrine hcl tab 5 mg 2 CG; MO

NORTHERA CAP 100MG 5 MO; PA



Alpha-adrenergic Blocking Agents

phenoxybenzamine hcl cap 10 mg 5 MO

prazosin hcl cap 1 mg 2 CG; MO



Angiotensin II Receptor Antagonists

candesartan cilexetil tab 16 mg 1 CG; MO




irbesartan tab 150 mg 1 CG; MO



losartan potassium tab 100 mg 1 CG; MO



olmesartan medoxomil tab 20 mg 2 CG; MO



telmisartan tab 20 mg 1 CG; MO



61



valsartan tab 160 mg 1 CG; MO




Angiotensin-converting Enzyme (ACE) Inhibitors

benazepril hcl tab 10 mg 1 CG; MO




captopril tab 100 mg 1 CG; MO

captopril tab 12.5 mg 1 CG; MO



enalapril maleate tab 10 mg 1 CG; MO

enalapril maleate tab 2.5 mg 1 CG; MO



fosinopril sodium tab 10 mg 1 CG; MO



lisinopril tab 10 mg 1 CG; MO

lisinopril tab 2.5 mg 1 CG; MO





moexipril hcl tab 15 mg 1 CG; MO

moexipril hcl tab 7.5 mg 1 CG; MO

perindopril er bumine tab 2 mg 1 CG; MO



quinapril hcl tab 10 mg 1 CG; MO




ramipril cap 1.25 mg 1 CG; MO

ramipril cap 10 mg 1 CG; MO

ramipril cap 2.5 mg 1 CG; MO

ramipril cap 5 mg 1 CG; MO


62


trandolapril tab 1 mg 1 CG; MO



Antiarrhythmics

amiodarone hcl tab 100 mg 2 CG; MO



disopyramide phosphate cap 100 mg 2 CG; MO

disopyramide phosphate cap 150 mg 2 CG; MO

dofetilide cap 125 mcg 3 MO



flecainide acetate tab 100 mg 2 CG; MO



MEXILETINE CAP 150MG 3 MO



MULTAQ TAB 400MG 3 MO

NORPACE CAP 100MG CR 4 MO

NORPACE CAP 150MG CR 4 MO

pacerone tab 100 mg 1 CG; MO

pacerone tab 200 mg 1 CG; MO

propafenone hcl cap er 225 mg 4 MO



propafenone hcl tab 150 mg 2 CG; MO



quinidine gluconate tab er 324 mg 4 MO

quinidine sulfate tab 200 mg 2 CG; MO

quinidine sulfate tab 300 mg 2 CG; MO

sorine tab 120 mg 1 CG; MO




sotalol af tab 120 mg 1 CG; MO

sotalol hcl tab 120 mg 1 CG; MO




63



Beta-adrenergic Blocking Agents

acebutolol hcl cap 200 mg 1 CG; MO

acebutolol hcl cap 400 mg 1 CG; MO

atenolol tab 100 mg 1 CG; MO



betaxolol hcl tab 10 mg 2 CG; MO

betaxolol hcl tab 20 mg 2 CG; MO

bisoprolol fumarate tab 10 mg 1 CG; MO

bisoprolol fumarate tab 5 mg 1 CG; MO

BYSTOLIC TAB 10MG 3 MO

BYSTOLIC TAB 2.5MG 3 MO



carvedilol tab 12.5 mg 1 CG; MO

carvedilol tab 25 mg 1 CG; MO



INNOPRAN XL CAP 120MG 4 MO

INNOPRAN XL CAP 80MG 4 MO

labetalol hcl tab 100 mg 2 CG; MO



metoprolol succinate tab er 100 mg 1 CG; MO


metoprolol succinate tab er 25 mg) 1 CG; MO


metoprolol tartrate tab 100 mg 1 CG; MO



nadolol tab 20 mg 2 CG; MO



pindolol tab 10 mg 2 CG; MO

pindolol tab 5 mg 2 CG; MO

propranolol hcl cap er 120 mg 2 CG; MO





64


propranolol hcl oral soln 20 mg/5ml 2 CG; MO

propranolol hcl oral soln 40 mg/5ml 2 CG; MO

propranolol hcl tab 10 mg 1 CG; MO





Calcium Channel Blocking Agents

amlodipine besylate tab 10 mg 1 CG; MO

amlodipine besylate tab 2.5 mg 1 CG; MO

amlodipine besylate tab 5 mg 1 CG; MO

CARDIZEM LA TAB 120MG 4 MO

cartia xt cap 120mg/24hr 1 CG; MO




diltiazem hcl beads cap er 24hr 420 mg 1 CG; MO

diltiazem hcl beads cap er 360 mg 1 CG; MO

diltiazem hcl cap er 120 mg 1 CG; MO



diltiazem hcl coated beads cap er 120 mg 1 CG; MO




diltiazem hcl tab 120 mg 1 CG; MO




dilt-xr cap 120 mg 1 CG; MO



felodipine tab er 10 mg 1 CG; MO

felodipine tab er 2.5 mg 1 CG; MO

felodipine tab er 5 mg 1 CG; MO

isradipine cap 2.5 mg 4 MO

isradipine cap 5 mg 4 MO

matzim la 180 mg/24hr 2 CG; MO




65




nicardipine hcl cap 20 mg 4 MO

nicardipine hcl cap 30 mg 4 MO

nifedipine cap 10 mg 1 CG; MO

nifedipine cap 20 mg 1 CG; MO

nifedipine tab er 30 mg 1 CG; MO



nifedipine tab er osmotic release 30 mg 1 CG; MO



nimodipine cap 30 mg 5 MO

nisoldipine tab er 17 mg 4 MO


nisoldipine tab er 25.5 mg 4 MO



NISOLDIPINE TAB 34MG ER 4 MO

NISOLDIPINE TAB 8.5MG ER 4 MO

taztia xt cap 120 mg/24hr 1 CG; MO





VERAPAMIL CAP 360MG SR 2 CG; MO

verapamil hcl cap er 100 mg 2 CG; MO






verapamil hcl tab 120 mg 1 CG; MO



verapamil hcl tab er 120 mg 1 CG; MO



Cardiovascular Agents, Other

aliskiren fumarate tab 150 mg 4 MO; QL 30 PER 30 DAYS


66


aliskiren fumarate tab 300 mg 4 MO; QL 30 PER 30 DAYS

amlodipine besylate-atorvastatin calcium tab 10-10 mg 2 CG; MO




amlodipine besylate-atorvastatin calcium tab 2.5-10 mg 2 CG; MO







amlodipine besylate-benazepril hcl cap 10-20 mg 1 CG; MO


amlodipine besylate-benazepril hcl cap 2.5-10 mg 1 CG; MO




amlodipine besylate-olmesartan medoxomil tab 10-20 mg 2 CG; MO




amlodipine besylate-valsartan tab 10-160 mg 1 CG; MO




amlodipine-valsartan-hydrochlorothiazide tab 10-160-12.5 mg 2 CG; MO

amlodipine-valsartan-hydrochlorothiazide tab 10-160-25 mg 2 CG; MO


amlodipine-valsartan-hydrochlorothiazide tab 5-160-12.5 mg 2 CG; MO


atenolol & chlorthalidone tab 100-25 mg 1 CG; MO

atenolol & chlorthalidone tab 50-25 mg 1 CG; MO

benazepril & hydrochlorothiazide tab 10-12.5 mg 1 CG; MO


benazepril & hydrochlorothiazide tab 20-25 mg 1 CG; MO


BIDIL TAB 3 MO

bisoprolol & hydrochlorothiazide tab 10-6.25 mg 1 CG; MO

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg 1 CG; MO


67


bisoprolol & hydrochlorothiazide tab 5-6.25 mg 1 CG; MO

candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg 1 CG; MO

candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg 1 CG; MO

candesartan cilexetil-hydrochlorothiazide tab 32-25 mg 1 CG; MO

captopril & hydrochlorothiazide tab 25-15 mg 1 CG; MO




CORLANOR SOL 5MG/5ML 4 MO; QL 450 PER 30 DAYS

CORLANOR TAB 5MG 4 MO; QL 60 PER 30 DAYS; PA

CORLANOR TAB 7.5MG 4 MO; QL 60 PER 30 DAYS; PA

DEMSER CAP 250MG 5 MO

digitek tab 0.125 mg 1 CG; MO; QL 30 PER 30 DAYS

digitek tab 0.25 mg 1 CG; MO

digox tab 0.125 mg 1 CG; MO; QL 30 PER 30 DAYS

digox tab 0.25 mg 1 CG; MO

DIGOXIN SOL 50MCG/ML 3 MO

digoxin tab 0.125 mg 1 CG; MO; QL 30 PER 30 DAYS

digoxin tab 0.25 mg 1 CG; MO

enalapril maleate & hydrochlorothiazide tab 10-25 mg 1 CG; MO

enalapril maleate & hydrochlorothiazide tab 5-12.5 mg 1 CG; MO

ENTRESTO TAB 24-26MG 4 MO; QL 60 PER 30 DAYS; PA



fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg 1 CG; MO

fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg 1 CG; MO

irbesartan-hydrochlorothiazide tab 150-12.5 mg 1 CG; MO

irbesartan-hydrochlorothiazide tab 300-12.5 mg 1 CG; MO

LANOXIN TAB 0.0625MG 4 MO; QL 60 PER 30 DAYS

lisinopril & hydrochlorothiazide tab 10-12.5 mg 1 CG; MO

lisinopril & hydrochlorothiazide tab 20-12.5 mg 1 CG; MO

lisinopril & hydrochlorothiazide tab 20-25 mg 1 CG; MO

losartan potassium & hydrochlorothiazide tab 100-12.5 mg 1 CG; MO

losartan potassium & hydrochlorothiazide tab 100-25 mg 1 CG; MO

losartan potassium & hydrochlorothiazide tab 50-12.5 mg 1 CG; MO

methyldopa & hydrochlorothiazide tab 250-15 mg 1 CG; MO

methyldopa & hydrochlorothiazide tab 250-25 mg 1 CG; MO

metoprolol & hydrochlorothiazide tab 100-25 mg 2 CG; MO




68


olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg 2 CG; MO

olmesartan medoxomil-hydrochlorothiazide tab 40-12.5 mg 2 CG; MO

olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg 2 CG; MO

olmesartan-amlodipine-hydrochlorothiazide tab 20-5-12.5 mg 2 CG; MO


olmesartan-amlodipine-hydrochlorothiazide tab 40-10-25 mg 2 CG; MO


olmesartan-amlodipine-hydrochlorothiazide tab 40-5-25 mg 2 CG; MO

pentoxifylline tab er 400 mg 1 CG; MO

propranolol & hydrochlorothiazide tab 40-25 mg 2 CG; MO

propranolol & hydrochlorothiazide tab 80-25 mg 2 CG; MO

quinapril-hydrochlorothiazide tab 10-12.5 mg 1 CG; MO

quinapril-hydrochlorothiazide tab 20-12.5 mg 1 CG; MO

quinapril-hydrochlorothiazide tab 20-25 mg 1 CG; MO

ranolazine tab er 1000 mg 3 MO

ranolazine tab er 500 mg 3 MO

telmisartan-amlodipine tab 40-10 mg 2 CG; MO




telmisartan-hydrochlorothiazide tab 40-12.5 mg 2 CG; MO

telmisartan-hydrochlorothiazide tab 80-12.5 mg 2 CG; MO

telmisartan-hydrochlorothiazide tab 80-25 mg 2 CG; MO

trandolapril-verapamil hcl tab er 1-240 mg 1 CG; MO




valsartan-hydrochlorothiazide tab 160-12.5 mg 1 CG; MO

valsartan-hydrochlorothiazide tab 160-25 mg 1 CG; MO


valsartan-hydrochlorothiazide tab 320-25 mg 1 CG; MO


VYNDAMAX CAP 61MG 5 MO; QL 30 PER 30 DAYS; PA

VYNDAQEL CAP 20MG 5 MO; QL 120 PER 30 DAYS; PA

Diuretics, Carbonic Anhydrase Inhibitors

acetazolamide cap er 500 mg 2 CG; MO

acetazolamide tab 125 mg 2 CG; MO

acetazolamide tab 250 mg 2 CG; MO

KEVEYIS TAB 50MG 5 MO; QL 120 PER 30 DAYS; PA

methazolamide tab 25 mg 2 CG; MO


69


methazolamide tab 50 mg 2 CG; MO

Diuretics, Loop

bumetanide inj 0.25 mg/ml 2 CG; MO

bumetanide tab 0.5 mg 1 CG; MO

bumetanide tab 1 mg 1 CG; MO

bumetanide tab 2 mg 1 CG; MO

ethacrynic acid tab 25 mg 5 MO

furosemide inj 10 mg/ml 2 CG; MO

furosemide oral soln 10 mg/ml 2 CG; MO

furosemide oral soln 8 mg/ml 2 CG; MO

furosemide tab 20 mg 1 CG; MO



torsemide tab 10 mg 1 CG; MO




Diuretics, Potassium-sparing

amiloride hcl tab 5 mg 2 CG; MO

eplerenone tab 25 mg 2 CG; MO

eplerenone tab 50 mg 2 CG; MO

spironolactone tab 100 mg 1 CG; MO



triamterene cap 100 mg 2 CG; MO

triamterene cap 50 mg 2 CG; MO

Diuretics, Thiazide

ALDACTAZIDE TAB 25/25 4 MO

ALDACTAZIDE TAB 50/50 4 MO

amiloride & hydrochlorothiazide tab 5-50 mg 1 CG; MO

chlorthalidone tab 25 mg 1 CG; MO

chlorthalidone tab 50 mg 1 CG; MO

DIURIL SUS 250/5ML 4 MO

hydrochlorothiazide cap 12.5 mg 1 CG; MO

hydrochlorothiazide tab 12.5 mg 1 CG; MO

hydrochlorothiazide tab 25 mg 1 CG; MO

hydrochlorothiazide tab 50 mg 1 CG; MO

indapamide tab 1.25 mg 1 CG; MO

indapamide tab 2.5 mg 1 CG; MO

metolazone tab 10 mg 2 CG; MO


70


metolazone tab 2.5 mg 2 CG; MO

metolazone tab 5 mg 2 CG; MO

spironolactone & hydrochlorothiazide tab 25-25 mg 2 CG; MO

triamterene & hydrochlorothiazide cap 37.5-25 mg 1 CG; MO

triamterene & hydrochlorothiazide tab 37.5-25 mg 1 CG; MO

triamterene & hydrochlorothiazide tab 75-50 mg 1 CG; MO

Dyslipidemics, Fibric Acid Derivatives

FENOFIBRATE CAP 150MG 3 MO

FENOFIBRATE CAP 50MG 2 CG; MO

fenofibrate micronized cap 130 mg 2 CG; MO





fenofibrate tab 120 mg 2 CG; MO






fenofibric cap dr 135 mg 2 CG; MO

fenofibric cap dr 45 mg 2 CG; MO

gemfibrozil tab 600 mg 1 CG; MO

Dyslipidemics, HMG CoA Reductase Inhibitors

atorvastatin calcium tab 10 mg 1 CG; MO




fluvastatin sodium cap 20 mg 1 CG; MO

fluvastatin sodium cap 40 mg 1 CG; MO

fluvastatin sodium tab er 80 mg 2 CG; MO

LIVALO TAB 1MG 4 MO; ST



lovastatin tab 10 mg 1 CG; MO



pravastatin sodium tab 10 mg 1 CG; MO




71



rosuvastatin calcium tab 10 mg 1 CG; MO




simvastatin tab 10 mg 1 CG; MO





Dyslipidemics, Other

cholestyramine light powder 4 gm/dose 2 CG; MO

cholestyramine powder packets 4 gm 2 CG; MO

colesevelam hcl packet for susp 3.75 gm 3 MO

colesevelam hcl tab 625 mg 3 MO

colestipol hcl granule packets 5 gm 2 CG; MO

colestipol hcl tab 1 gm 2 CG; MO

ezetimibe tab 10 mg 1 CG; MO

ezetimibe-simvastatin tab 10-10 mg 2 CG; MO




JUXTAPID CAP 10MG 5 MO; QL 30 PER 30 DAYS; PA






niacin tab er 1000 mg 2 CG; MO



niacor tab 500 mg 2 CG; MO

omega-3-acid ethyl esters cap 1 gm 3 MO

PRALUENT INJ 150MG/ML 4 MO; QL 2 PER 28 DAYS; PA

PRALUENT INJ 75MG/ML 4 MO; QL 2 PER 28 DAYS; PA

prevalite powder packets 4 gm 2 CG; MO

REPATHA INJ 140MG/ML 4 MO; QL 3 PER 28 DAYS; PA

REPATHA PUSH INJ 420/3.5 4 MO; QL 3.5 PER 28 DAYS; PA

REPATHA SURE INJ 140MG/ML 4 MO; QL 3 PER 28 DAYS; PA

VASCEPA CAP 0.5GM 4 MO


72


VASCEPA CAP 1GM 4 MO

Vasodilators, Direct-acting Arterial

hydralazine hcl tab 10 mg 1 CG; MO




minoxidil tab 10 mg 4 MO

minoxidil tab 2.5 mg 4 MO

Vasodilators, Direct-acting Arterial/Venous

isosorbide dinitrate tab 10 mg 2 CG; MO



isosorbide dinitrate tab 40 mg 5 MO


isosorbide mononitrate tab 10 mg 1 CG; MO

isosorbide mononitrate tab 20 mg 1 CG; MO

isosorbide mononitrate tab er 120 mg 1 CG; MO



minitran dis 0.1 mg/hr 2 CG; MO




nitro-bid oint 2% 2 CG; MO

NITRO-DUR DIS 0.3MG/HR 4 MO

NITRO-DUR DIS 0.8MG/HR 4 MO

nitroglycerin sl tab 0.3 mg 1 CG; MO



nitroglycerin td patch 24hr 0.1 mg/hr 2 CG; MO




nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) 4 MO

RECTIV OIN 0.4% 4 MO

CENTRAL NERVOUS SYSTEM AGENTS

Attention Deficit Hyperactivity Disorder Agents, Amphetamines

amphetamine-dextroamphetamine cap er 10 mg 2 CG; MO; QL 30 PER 30

DAYS; PA amphetamine-dextroamphetamine cap er 15 mg 2 CG; MO; QL 30 PER 30

DAYS; PA


73



DAYS; PA amphetamine-dextroamphetamine cap er 25 mg 2 CG; MO; QL 30 PER 30 DAYS;

PA


DAYS; PA amphetamine-dextroamphetamine cap er 5 mg 2 CG; MO; QL 30 PER 30

DAYS; PA

amphetamine-dextroamphetamine tab 10 mg 2 CG; MO; QL 90 PER 30 DAYS

amphetamine-dextroamphetamine tab 12.5 mg 2 CG; MO; QL 90 PER 30 DAYS





amphetamine-dextroamphetamine tab 7.5 mg 2 CG; MO; QL 90 PER 30 DAYS

dextroamphetamine sulfate cap er 10 mg 2 CG; MO; QL 180 PER 30

DAYS; PA dextroamphetamine sulfate cap er 15 mg 2 CG; MO; QL 120 PER 30

DAYS; PA dextroamphetamine sulfate cap er 5 mg 2 CG; MO; QL 60 PER 30

DAYS; PA dextroamphetamine sulfate tab 10 mg 2 CG; MO; QL 180 PER 30 DAYS;

PA

dextroamphetamine sulfate tab 5 mg 2 CG; MO; QL 90 PER 30

DAYS; PA zenzedi tab 10 mg 2 CG; MO; QL 180 PER 30

DAYS; PA

zenzedi tab 15 mg 4 MO; QL 90 PER 30 DAYS; PA

zenzedi tab 2.5 mg 4 MO; QL 90 PER 30 DAYS; PA



zenzedi tab 5 mg 2 CG; MO; QL 90 PER 30

DAYS; PA

zenzedi tab 7.5 mg 4 MO; QL 90 PER 30 DAYS; PA

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines

atomoxetine hcl cap 10 mg 3 MO; QL 60 PER 30 DAYS







clonidine hcl tab er 0.1 mg 4 MO


74


dexmethylphenidate hcl cap er 10 mg 4 MO; QL 30 PER 30 DAYS; PA



dexmethylphenidate hcl cap er 25 mg 2 CG; MO; QL 30 PER 30

DAYS; PA


dexmethylphenidate hcl cap er 35 mg 2 CG; MO; QL 30 PER 30

DAYS; PA



dexmethylphenidate hcl tab 10 mg 2 CG; MO; QL 60 PER 30

DAYS; PA dexmethylphenidate hcl tab 2.5 mg 2 CG; MO; QL 60 PER 30

DAYS; PA dexmethylphenidate hcl tab 5 mg 2 CG; MO; QL 60 PER 30

DAYS; PA

guanfacine hcl tab er 1 mg 4 MO




methylphenidate hcl cap er 10 mg (cd) 4 MO; QL 30 PER 30 DAYS; PA


methylphenidate hcl cap er 24hr 10 mg (la) 4 MO; QL 180 PER 30 DAYS; PA





methylphenidate hcl cap er 60 mg (la) 4 MO; QL 30 PER 30 DAYS; PA

methylphenidate hcl chew tab 10 mg 2 CG; MO; QL 180 PER 30

DAYS; PA methylphenidate hcl chew tab 2.5 mg 2 CG; MO; QL 90 PER 30

DAYS; PA methylphenidate hcl chew tab 5 mg 2 CG; MO; QL 90 PER 30

DAYS; PA

methylphenidate hcl soln 10 mg/5ml 4 MO; PA

methylphenidate hcl soln 5 mg/5ml 4 MO; PA

methylphenidate hcl tab 10 mg 2 CG; MO; QL 90 PER 30

DAYS; PA methylphenidate hcl tab 20 mg 2 CG; MO; QL 90 PER 30

DAYS; PA methylphenidate hcl tab 5 mg 2 CG; MO; QL 90 PER 30

DAYS; PA

methylphenidate hcl tab er (osm) 18 mg 4 MO; QL 30 PER 30 DAYS; PA


75





methylphenidate hcl tab er 10 mg 4 MO; QL 180 PER 30 DAYS; PA


methylphenidate hcl tab er 24hr 18 mg 4 MO; QL 30 PER 30 DAYS; PA




SUNOSI TAB 150MG 4 MO; QL 30 PER 30 DAYS; PA

SUNOSI TAB 75MG 4 MO; QL 30 PER 30 DAYS; PA

Central Nervous System, Other

AUSTEDO TAB 12MG 5 MO; QL 120 PER 30 DAYS; PA



NUEDEXTA CAP 20-10MG 4 MO; PA

riluzole tab 50 mg 2 CG; MO; PA

TEGSEDI INJ 284/1.5 5 MO; PA

tetrabenazine tab 12.5 mg 5 MO; PA

tetrabenazine tab 25 mg 5 MO; PA

Fibromyalgia Agents

duloxetine hcl cap 20 mg 2 CG; MO; QL 60 PER 30 DAYS


duloxetine hcl cap 40 mg 3 MO; QL 90 PER 30 DAYS


pregabalin cap 100 mg 2 MO; QL 90 PER 30 DAYS








pregabalin sol 20mg/ml 2 MO; QL 900 PER 30 DAYS

SAVELLA MIS TITR PAK 3 MO; QL 110 PER 365 DAYS

SAVELLA TAB 100MG 3 MO; QL 60 PER 30 DAYS

SAVELLA TAB 12.5MG 3 MO; QL 60 PER 30 DAYS



Multiple Sclerosis Agents


76


AUBAGIO TAB 14MG 5 MO; QL 30 PER 30 DAYS; PA

AUBAGIO TAB 7MG 5 MO; QL 30 PER 30 DAYS; PA

AVONEX PEN KIT 30MCG 5 MO; QL 4 PER 28 DAYS; PA

AVONEX PREFLKIT 30MCG 5 MO; QL 4 PER 28 DAYS; PA

BETASERON INJ 0.3MG 5 MO; QL 15 PER 30 DAYS; PA

dalfampridine tab er 10 mg 5 MO; QL 60 PER 30 DAYS; PA

EXTAVIA INJ 0.3MG 5 MO; QL 15 PER 30 DAYS; PA

GILENYA CAP 0.5MG 5 MO; QL 30 PER 30 DAYS; PA

glatiramer inj 20 mg/ml 5 MO; QL 30 PER 30 DAYS; PA

glatiramer inj 40 mg/ml 5 MO; QL 12 PER 28 DAYS; PA

glatopa inj 20 mg/ml 5 MO; QL 30 PER 30 DAYS; PA

glatopa inj 40 mg/ml 5 MO; QL 12 PER 28 DAYS; PA

MAVENCLAD PAK 10MG(10) 5 MO; PA





MAVENCLAD PAK 10MG(8) 5 MO; QL 16 PER 365 DAYS; PA

MAVENCLAD PAK 10MG(9) 5 MO; QL 18 PER 365 DAYS; PA

MAYZENT TAB 0.25MG 5 MO; QL 120 PER 30 DAYS; PA

MAYZENT TAB 2MG 5 MO; QL 30 PER 30 DAYS; PA

PLEGRIDY INJ 5 MO; QL 1 PER 28 DAYS; PA

PLEGRIDY INJ PEN 5 MO; QL 1 PER 28 DAYS; PA

PLEGRIDY PEN INJ STARTER 5 MO; QL 2 PER 365 DAYS; PA

REBIF INJ 22/0.5 5 MO; QL 6 PER 28 DAYS; PA

REBIF INJ 44/0.5 5 MO; QL 6 PER 28 DAYS; PA

REBIF REBIDO INJ 22/0.5 5 MO; QL 6 PER 28 DAYS; PA

REBIF REBIDO INJ 44/0.5 5 MO; QL 6 PER 28 DAYS; PA

REBIF REBIDO INJ TITRATN 5 MO; QL 8.4 PER 365 DAYS; PA

REBIF TITRTN INJ PACK 5 MO; QL 8.4 PER 365 DAYS; PA

TECFIDERA CAP 120MG 5 MO; QL 60 PER 30 DAYS; PA

TECFIDERA CAP 240MG 5 MO; QL 60 PER 30 DAYS; PA

TECFIDERA MIS STARTER 5 MO; QL 120 PER 365

DAYS; PA

VUMERITY CAP 231MG 5 MO; QL 120 PER 30 DAYS;

PA

DENTAL AND ORAL AGENTS

Dental and Oral Agents

cevimeline hcl cap 30 mg 4 MO

chlorhexidine gluconate soln 0.12% 1 CG; MO

doxycycline hyclate tab 20 mg 2 CG; MO


77


pilocarpine hcl tab 5 mg 2 CG; MO

pilocarpine hcl tab 7.5 mg 2 CG; MO

triamcinolone acetonide dental paste 0.1% 2 CG; MO

DERMATOLOGICAL AGENTS

Dermatological Agents

acitretin cap 10 mg 4 MO

acitretin cap 17.5 mg 5 MO

acitretin cap 25 mg 4 MO

adapalene cream 0.1% 2 CG; MO; PA

adapalene gel 0.1% 2 CG; MO; PA

adapalene gel 0.3% 2 CG; MO; PA

adapalene soln 0.1% 2 CG; MO; PA

adapalene-benzoyl peroxide gel 0.1-2.5% 3 MO; PA

amnesteem cap 10 mg 4 MO; PA



azelaic acid gel 15% 3 MO

calcipotriene cream 0.005% 4 MO

calcipotriene oint 0.005% 4 MO

calcipotriene soln 0.005% 2 CG; MO

calcipotriene-betamethasone dipropionate oint 0.005-0.064% 4 MO; QL 400 PER 28 DAYS

CALCITRIOL OIN 3MCG/GM 4 MO

CARAC CRE 0.5% 4 MO

claravis cap 10 mg 4 MO; PA




clindamycin phosphate-benzoyl peroxide gel 1-5% 4 MO

clotrimazole w/ betamethasone cream 1-0.05% 2 CG; MO

clotrimazole w/ betamethasone lotion 1-0.05% 2 CG; MO

CONDYLOX GEL 0.5% 4 MO

CORTISPORIN CRE 0.5% 4 MO

CORTISPORIN OIN 1% 4 MO

COSENTYX INJ 300 DOSE 5 MO; PA

COSENTYX PEN INJ 300 DOSE 5 MO; PA

diclofenac sodium (actinic keratoses) gel 3% 4 MO

diclofenac sodium gel 1% 2 CG; MO; QL 1000 PER

30 DAYS

diclofenac sodium soln 1.5% 4 MO; PA

DOXEPIN HCL CRE 5% 5 MO; QL 45 PER 30 DAYS


78


doxycycline hyclate tab dr 200 mg 4 MO

doxycycline monohydrate cap 150 mg 4 MO

ENSTILAR AER 5 MO; QL 120 PER 30 DAYS

EPIDUO FORTE GEL 0.3-2.5% 4 MO; PA

erythromycin/benzoyl peroxide gel 5-3% 2 CG; MO

FINACEA AER 15% 3 MO

FLUOROPLEX CRE 1% 4 MO

fluorouracil cream 5% 2 CG; MO

fluorouracil soln 2% 2 CG; MO

fluorouracil soln 5% 2 CG; MO

FLUOROURACIL CRE 0.5% 5 MO

ILUMYA SOL 100MG/ML 5 MO; QL 2 PER 28 DAYS;

B/D PA

imiquimod cream 5% 2 CG; MO

isotretinoin cap 10 mg 4 MO; PA




lactic acid (ammonium lactate) cream 12% 2 CG; MO

lactic acid (ammonium lactate) lotion 12% 2 CG; MO

methoxsalen rapid cap 10 mg 5 MO

MIRVASO GEL 0.33% 4 MO; PA

myorisan cap 10 mg 4 MO; PA




PICATO GEL 0.015% 5 MO

PICATO GEL 0.05% 5 MO

pimecrolimus cream 1% 4 MO

podofilox soln 0.5% 2 CG; MO

REGRANEX GEL 0.01% 5 MO; PA

SANTYL OIN 250/GM 3 MO

selenium sulfide lotion 2.5% 1 CG; MO

SILIQ INJ 210/1.5 5 MO; PA

SKYRIZI INJ 150 DOSE 5 MO; QL 2 PER 28 DAYS; PA

STELARA INJ 5MG/0.5 5 MO; PA

STELARA INJ 90MG/ML 5 MO; PA

TACLONEX SUS 5 MO; QL 400 PER 30 DAYS

tacrolimus oint 0.03% 4 MO

tacrolimus oint 0.1% 4 MO


79


TALTZ INJ 80MG/ML 5 MO; PA

tazarotene cream 0.1% 3 MO; QL 100 PER 30 DAYS

TAZORAC CRE 0.05% 4 MO; PA

TAZORAC GEL 0.05% 4 MO; QL 100 PER 30 DAYS; PA

TAZORAC GEL 0.1% 4 MO; QL 100 PER 30 DAYS; PA

TREMFYA INJ 100MG/ML 5 MO; PA

tretinoin cream 0.025% 2 CG; MO; PA



tretinoin gel 0.01% 2 CG; MO; PA



tretinoin microsphere gel 0.04% 2 CG; MO; PA

tretinoin microsphere gel 0.1% 2 CG; MO; PA

VEREGEN OIN 15% 5 MO

zenatane cap 10 mg 4 MO; PA




ZYCLARA PUMP CRE 2.5% 5 MO

ZYCLARA PUMP CRE 3.75% 5 MO

DIABETES SUPPLIES

Diabetes Supplies

GAUZE PADS & DRESSINGS - PADS 2 X 2 1 CG; MO

INSULIN PEN NEEDLE 1 CG; MO; QL 200 PER 30 DAYS

INSULIN SYRINGE (DISP) U-100 0.3 ML 1 CG; MO; QL 200 PER 30 DAYS

INSULIN SYRINGE (DISP) U-100 1 ML 1 CG; MO; QL 200 PER 30 DAYS

INSULIN SYRINGE (DISP) U-100 1/2 ML 1 CG; MO; QL 200 PER 30 DAYS

ISOPROPYL ALCOHOL 0.7 ML/ML MEDICATED PAD 1 CG; MO

NEEDLES, INSULIN DISP., SAFETY 1 CG; MO; QL 200 PER 30 DAYS

ELECTROLYTES/MINERALS/METALS/VITAMINS

Electrolyte/Mineral /Metal Modifiers

deferasirox tab 125mg 5 MO; PA





FERRIPROX SOL 100MG/ML 5 MO; PA


80


FERRIPROX TAB 500MG 5 MO; PA

FERRIPROX TAB 1000MG 5 MO; PA

JADENU TAB 180MG 5 MO; PA

JADENU SPRKL GRA 180MG 5 MO; PA



kionex susp 15 gm/60ml 2 CG; MO

levocarnitine oral soln 1 gm/10ml 2 CG; MO

levocarnitine tab 330 mg 2 CG; MO

LOKELMA PAK 10GM 4 MO; QL 34 PER 30 DAYS

LOKELMA PAK 5GM 4 MO; QL 30 PER 30 DAYS

penicillamine tab 250 mg 5 MO

SAMSCA TAB 15MG 5 MO; QL 30 PER 60 DAYS

SAMSCA TAB 30MG 5 MO; QL 60 PER 30 DAYS

sodium polystyrene sulfonate oral susp 15 gm/60ml 2 CG; MO

sodium polystyrene sulfonate powder 2 CG; MO

trientine hcl cap 250 mg 5 MO

VELTASSA POW 16.8GM 5 MO; QL 30 PER 30 DAYS



Electrolyte/Mineral Replacement

AMINOSYN II INJ 10% 4 MO; B/D PA

AMINOSYN II INJ 15% 4 MO; B/D PA

AMINOSYN-PF INJ 10% 4 MO; B/D PA

AMINOSYN-PF INJ 7% 4 MO; B/D PA

CARBAGLU TAB 200MG 5 MO

CLINIMIX INJ 4.25/D5W 4 MO; B/D PA

CLINIMIX INJ 5%/D15W 4 MO; B/D PA

CLINIMIX INJ 5%/D20W 4 MO; B/D PA

CLINIMIX E INJ 2.75/D5W 4 MO; B/D PA

CLINIMIX E INJ 4.25/D10 4 MO; B/D PA

CLINIMIX E INJ 4.25/D5W 4 MO; B/D PA

CLINIMIX E INJ 5%/D15W 4 MO; B/D PA

CLINIMIX E INJ 5%/D20W 4 MO; B/D PA

clinimix inj4.25/d10 4 MO; B/D PA

D10W/NACL INJ 0.2% 3 MO


D2.5W/NACL INJ 0.45% 3 MO


dextrose 5% w/ sodium chloride 0.2% 2 CG; MO


81




dextrose inj 10% 1 CG; MO

dextrose inj 5% 1 CG; MO

FREAMINE HBC INJ 6.9% 4 MO; B/D PA

HEPATAMINE SOL 8% 4 MO; B/D PA

intralipid inj 20% 4 MO; B/D PA

ISOLYTE-P INJ/D5W 4 MO

ISOLYTE-S INJ 4 MO

kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj 2 CG; MO

kcl 20 meq/l (0.15%) in d5w lactated ringers 2 CG; MO







klor-con 10 tab 10 meq er 1 CG; MO

klor-con 8 tab 8 meq er 1 CG; MO

klor-con m 10 tab 10 meq er 1 CG; MO



magnesium sulfate inj 50% 2 CG; MO

NEPHRAMINE INJ 5.4% 4 MO; B/D PA

NORMOSOL -M INJ/D5W 4 MO

NORMOSOL -R INJ/D5W 3 MO

NORMOSOL-R INJPH 7.4 4 MO

nutrilipid emu20% 4 MO; B/D PA

PLASMA-LYTE INJ-148 4 MO

PLASMA-LYTE INJ-A 4 MO

plenamine inj15% 4 MO; B/D PA

POT CHL/D5W INJ 40MEQ/L 3 MO

POT CHLORID TAB 20MEQ ER 2 CG; MO

potassium chloride 20 meq/l (0.15%) in dextrose 5% inj 2 CG; MO

potassium chloride 20 meq/l (0.15%) in nacl 0.45% inj 2 CG; MO



potassium chloride cap er 10 meq 1 CG; MO

potassium chloride cap er 8 meq 2 CG; MO

potassium chloride inj 10 meq/100ml 1 CG; MO


82


potassium chloride inj 2 meq/ml 1 CG; MO



potassium chloride micro er tab 10 meq 1 CG; MO

potassium chloride micro er tab 20 meq 2 CG; MO

potassium chloride oral soln 10% 2 CG; MO

potassium chloride oral soln 20% 2 CG; MO

potassium chloride tab er 10 meq 1 CG; MO

potassium chloride tab er 8 meq 1 CG; MO

potassium citrate tab er 10 meq 2 CG; MO



premasol sol 10% 4 MO; B/D PA

PRENATAL VITAMIN WITH MINERALS AND

FOLIC ACID GREATER THAN 0.8 MG ORAL

TABLET

2 CG; MO

PROCALAMINE INJ 3% 4 MO; B/D PA

prosol inj 20% 4 MO; B/D PA

sodium chloride irrigation soln 0.9% 1 CG; MO

sodium chloride iv soln 0.45% 1 CG; MO

sodium chloride iv soln 0.9% 1 CG; MO

sodium chloride iv soln 3% 1 CG; MO

sodium chloride iv soln 5% 1 CG; MO

SODIUM FLUORIDE 2.2 MG (FLUORIDE ION 1

MG) ORAL TABLET

2 CG; MO

TPN ELECTROL INJ 3 MO

TRAVASOL INJ 10% 4 MO; B/D PA

TROPHAMINE INJ 10% 4 MO; B/D PA

Phosphate Binders

calcium acetate cap 667 mg 2 CG; MO

calcium acetate tab 667 mg 2 CG; MO

FOSRENOL POW 1000MG 5 MO

FOSRENOL POW 750MG 5 MO

lanthanum carbonate chew tab 1000 mg 5 MO



sevelamer carbonate packet 0.8 gm 3 MO; QL 180 PER 30 DAYS

sevelamer carbonate packet 2.4 gm 3 MO; QL 90 PER 30 DAYS

sevelamer carbonate tab 800 mg 3 MO

sevelamer hcl tab 800 mg 5 MO

VELPHORO CHW 500MG 5 MO


83


GASTROINTESTINAL AGENTS

Antispasmodics, Gastrointestinal

CUVPOSA SOL 1MG/5ML 4 MO

dicyclomine hcl cap 10 mg 1 CG; MO

dicyclomine hcl oral soln 10 mg/5ml 2 CG; MO

dicyclomine hcl tab 20 mg 1 CG; MO

glycopyrrolate tab 1 mg 2 CG; MO

glycopyrrolate tab 2 mg 2 CG; MO

methscopolamine bromide tab 2.5 mg 4 MO

methscopolamine bromide tab 5 mg 4 MO

propantheline bromide tab 15 mg 4 MO

TRANSDERM-SCDIS 1.5MG 4 MO; QL 10 PER 30 DAYS

Gastrointestinal Agents, Other

amoxicillin cap-clarithro tab-lansopraz cap dr therapy pack 2 CG; MO

CHENODAL TAB 250MG 5 MO

cromolyn sodium oral conc 100 mg/5ml 4 MO

diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml 1 CG; MO

diphenoxylate w/ atropine tab 2.5-0.025 mg 1 CG; MO

GATTEX KIT 5MG 5 MO; PA

gavilyte-c sol 1 CG; MO

gavilyte-n solflav pk 1 CG; MO

GOLYTELY SOL 3 MO

loperamide hcl cap 2 mg 2 CG; MO

metoclopramide hcl odt tab 5 mg 4 MO

metoclopramide hcl soln 5 mg/5ml 1 CG; MO

metoclopramide hcl tab 10 mg 1 CG; MO

metoclopramide hcl tab 5 mg 1 CG; MO

MOVIPREP SOL 3 MO

MYALEPT INJ 11.3MG 5 MO; PA

NUTROPIN AQ INJ 10MG/2ML 5 MO; PA

NUTROPIN AQ INJ 20MG/2ML 5 MO; PA

NUTROPIN AQ INJ NUSPIN 5 5 MO; PA

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm 1 CG; MO

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm 1 CG; MO

peg 3350-kcl-sod bicarb-nacl for soln 420 gm 2 CG; MO

PYLERA CAP 5 MO

RELISTOR INJ 12/0.6ML 3 MO; QL 18 PER 30 DAYS; PA

RELISTOR INJ 8/0.4ML 3 MO; QL 12 PER 30 DAYS; PA

RELISTOR TAB 150MG 3 MO; QL 90 PER 30 DAYS; PA


84


SAIZEN INJ 5MG 5 MO; PA

SAIZEN INJ 8.8MG 5 MO; PA

SAIZENPREP INJ 8.8MG 5 MO; PA

SEROSTIM INJ 4MG 5 MO; PA



SUPREP BOWEL SOL PREP KIT 3 MO

TALICIA CAP 4 MO

trilyte sol 2 CG; MO

ursodiol tab 250 mg 3 MO

ursodiol tab 500 mg 3 MO

XIFAXAN TAB 200MG 5 MO; PA

XIFAXAN TAB 550MG 5 MO; PA

ZORBTIVE INJ 8.8MG 5 MO; PA

Histamine2 (H2) Receptor Antagonists

cimetidine hcl soln 300 mg/5ml 2 CG; MO

cimetidine tab 200 mg 1 CG; MO




famotidine for susp 40 mg/5ml 2 CG; MO

famotidine tab 20 mg 1 CG; MO

famotidine tab 40 mg 1 CG; MO

nizatidine cap 150 mg 1 CG; MO

nizatidine cap 300 mg 1 CG; MO

nizatidine oral soln 15 mg/ml 4 MO

Irritable Bowel Syndrome Agents

alosetron hcl tab 0.5 mg 5 MO; PA

alosetron hcl tab 1 mg 5 MO; PA

AMITIZA CAP 24MCG 3 MO; QL 60 PER 30 DAYS

AMITIZA CAP 8MCG 3 MO; QL 60 PER 30 DAYS

LINZESS CAP 145MCG 3 MO; QL 30 PER 30 DAYS



Laxatives

constulose solution 10 gm/15ml 2 CG; MO

enulose solution 10 gm/15ml 1 CG; MO

generlac solution 10 gm/15ml 1 CG; MO

kristalose packet 10 gm 4 MO

kristalose packet 20 gm 4 MO


85


lactulose oral crystal packet 10 gm 4 MO

lactulose solution 10 gm/15ml 2 CG; MO

Protectants

misoprostol tab 100 mcg 2 CG; MO

misoprostol tab 200 mcg 2 CG; MO

sucralfate sus 1gm/10ml 2 CG; MO

sucralfate tab 1 gm 2 CG; MO

Proton Pump Inhibitors

DEXILANT CAP 30MG DR 4 MO; QL 30 PER 30 DAYS

DEXILANT CAP 60MG DR 4 MO; QL 30 PER 30 DAYS

esomeprazole magnesium cap dr 20 mg 2 CG; MO; QL 30 PER 30 DAYS

esomeprazole magnesium cap dr 40 mg 2 CG; MO; QL 30 PER 30 DAYS

lansoprazole cap dr 15 mg 1 CG; MO; QL 30 PER 30 DAYS

lansoprazole cap dr 30 mg 1 CG; MO; QL 30 PER 30 DAYS

NEXIUM GRA 10MG DR 3 MO; QL 30 PER 30 DAYS

NEXIUM GRA 2.5MG DR 3 MO; QL 30 PER 30 DAYS




omeprazole cap dr 10 mg 1 CG; MO; QL 30 PER 30 DAYS



pantoprazole sodium ec tab 20 mg 1 CG; MO; QL 30 PER 30 DAYS

pantoprazole sodium ec tab 40 mg 1 CG; MO; QL 30 PER 30 DAYS

PRILOSEC POW 10MG 4 MO

PRILOSEC POW 2.5MG 4 MO

rabeprazole sodium ec tab 20 mg 2 CG; MO; QL 30 PER 30 DAYS

GENETIC OR ENZYME DISORDER: REPLACEMENT, MODIFIERS, TREATMENT

Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

ARALAST NP INJ 1000MG 5 MO; PA

CERDELGA CAP 84MG 5 MO; PA

CHOLBAM CAP 250MG 5 MO; PA

CHOLBAM CAP 50MG 5 MO; PA

CREON CAP 12000UNT 3 MO


CREON CAP 3000UNIT 3 MO


CREON CAP 6000UNIT 3 MO

CYSTADANE POW 5 MO

CYSTAGON CAP 150MG 4 MO


86


CYSTAGON CAP 50MG 4 MO

CYSTARAN SOL 0.44% 5 MO; QL 60 PER 28 DAYS; PA

GALAFOLD CAP 123MG 5 MO; QL 14 PER 28 DAYS; PA

GLASSIA INJ 5 MO; PA

KUVAN POW 100MG 5 MO; PA

KUVAN POW 500MG 5 MO; PA

KUVAN TAB 100MG 5 MO; PA

miglustat cap 100 mg 5 MO; PA

OCALIVA TAB 10MG 5 MO; QL 30 PER 30 DAYS; PA

OCALIVA TAB 5MG 5 MO; QL 30 PER 30 DAYS; PA

ORFADIN CAP 10MG 5 MO



ORFADIN SUS 4MG/ML 5 MO

PALYNZIQ INJ 10/0.5ML 5 MO; QL 14 PER 28 DAYS; PA

PALYNZIQ INJ 2.5/0.5 5 MO; QL 4 PER 28 DAYS; PA

PALYNZIQ INJ 20MG/ML 5 MO; QL 56 PER 28 DAYS; PA

phenylbutyrate oral powder 3 gm 5 MO

PROLASTIN-C INJ 1000MG 5 MO; PA

RAVICTI LIQ 1.1GM/ML 5 MO; PA

sodium phenylbutyrate tab 500 mg 5 MO

SUCRAID SOL 8500/ML 5 MO

ZEMAIRA INJ 1000MG 5 MO; PA

ZENPEP CAP 40000 3 MO

GENITOURINARY AGENTS

Antispasmodics, Urinary

darifenacin hydrobromide tab er 15 mg 4 MO

darifenacin hydrobromide tab er 7.5 mg 4 MO

flavoxate hcl tab 100 mg 2 CG; MO

GELNIQUE GEL 10% PUMP 4 MO

MYRBETRIQ TAB 25MG 3 MO

MYRBETRIQ TAB 50MG 3 MO

oxybutynin chloride syrup 5 mg/5ml 1 CG; MO

oxybutynin chloride tab 5 mg 1 CG; MO

oxybutynin chloride tab er 10 mg 1 CG; MO



solifenacin tab 10 mg 3 MO

solifenacin tab 5 mg 3 MO

tolterodine tartrate cap er 2 mg 2 CG; MO


87


tolterodine tartrate cap er 4 mg 2 CG; MO

tolterodine tartrate tab 1 mg 2 CG; MO

tolterodine tartrate tab 2 mg 2 CG; MO

TOVIAZ TAB 4MG 3 MO

TOVIAZ TAB 8MG 3 MO

trospium chloride cap er 60 mg 2 CG; MO

trospium chloride tab 20 mg 2 CG; MO

VESICARE TAB 10MG 3 MO

VESICARE TAB 5MG 3 MO

Benign Prostatic Hypertrophy Agents

alfuzosin hcl tab er 10 mg 1 CG; MO

CARDURA XL TAB 4MG 4 MO

CARDURA XL TAB 8MG 4 MO

doxazosin mesylate tab 1 mg 1 CG; MO




dutasteride cap 0.5 mg 1 CG; MO

finasteride tab 5 mg 1 CG; MO

silodosin cap 4 mg 3 MO

silodosin cap 8 mg 3 MO

tadalafil tab 2.5 mg 4 MO; QL 30 PER 30 DAYS; PA

tadalafil tab 5 mg 4 MO; QL 30 PER 30 DAYS; PA

tamsulosin hcl cap 0.4 mg 1 CG; MO

terazosin hcl cap 1 mg 1 CG; MO




Genitourinary Agents, Other

bethanechol chloride tab 10 mg 2 CG; MO




CUPRIMINE CAP 250MG 5 MO

dutasteride-tamsulosin hcl cap 0.5-0.4 mg 4 MO

ELMIRON CAP 100MG 4 MO

penicillamine cap 250 mg 5 MO

sildenafil tab 100 mg 4 QL 6 PER 30 DAYS; MO; E


88




HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (ADRENAL)

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal)

alclometasone dipropionate cream 0.05% 2 CG; MO

alclometasone dipropionate oint 0.05% 2 CG; MO

amcinonide cream 0.1% 4 MO

amcinonide lotion 0.1% 4 MO

amcinonide oint 0.1% 4 MO

apexicon e cream 0.05% 4 MO

betamethasone dipropionate augmented cream 0.05% 2 CG; MO

betamethasone dipropionate augmented gel 0.05% 2 CG; MO

betamethasone dipropionate augmented lotion 0.05% 2 CG; MO

betamethasone dipropionate augmented oint 0.05% 2 CG; MO

betamethasone dipropionate cream 0.05% 2 CG; MO

betamethasone dipropionate lotion 0.05% 2 CG; MO

betamethasone dipropionate oint 0.05% 2 CG; MO

betamethasone valerate aerosol foam 0.12% 4 MO

betamethasone valerate cream 0.1% 2 CG; MO

betamethasone valerate lotion 0.1% 2 CG; MO

betamethasone valerate oint 0.1% 2 CG; MO

CAPEX SHA 0.01% 4 MO

clobetasol propionate cream 0.05% 2 CG; MO

clobetasol propionate emollient base cream 0.05% 2 CG; MO

clobetasol propionate gel 0.05% 2 CG; MO

clobetasol propionate oint 0.05% 2 CG; MO

clobetasol propionate soln 0.05% 2 CG; MO

cloddan shampoo 0.05% 4 MO

DESONATE GEL 0.05% 3 MO

desonide cream 0.05% 2 CG; MO

desonide lotion 0.05% 2 CG; MO

desonide oint 0.05% 2 CG; MO

desoximetasone cream 0.05% 4 MO

desoximetasone cream 0.25% 4 MO

desoximetasone gel 0.05% 4 MO

desoximetasone oint 0.05% 4 MO

desoximetasone oint 0.25% 4 MO

diflorasone diacetate cream 0.05% 4 MO

diflorasone diacetate oint 0.05% 4 MO


89


fludrocortisone acetate tab 0.1 mg 1 CG; MO

fluocinolone acetonide cream 0.01% 2 CG; MO

fluocinolone acetonide cream 0.025% 2 CG; MO

fluocinolone acetonide oil 0.01% (scalp oil) 2 CG; MO

fluocinolone acetonide oint 0.025% 2 CG; MO

fluocinolone acetonide soln 0.01% 2 CG; MO

fluocinonide cream 0.1% 2 CG; MO

fluocinonide emulsified base cream 0.05% 2 CG; MO

fluocinonide gel 0.05% 2 CG; MO

fluocinonide oint 0.05% 2 CG; MO

fluocinonide soln 0.05% 2 CG; MO

flurandrenolide cream 0.05% 4 MO

fluticasone propionate cream 0.05% 2 CG; MO

fluticasone propionate lotion 0.05% 2 CG; MO

fluticasone propionate oint 0.005% 2 CG; MO

H.P. ACTHAR INJ 80UNIT 5 MO; PA

halobetasol propionate cream 0.05% 2 CG; MO

halobetasol propionate oint 0.05% 2 CG; MO

hydrocortisone butyrate cream 0.1% 2 CG; MO

hydrocortisone butyrate oint 0.1% 2 CG; MO

hydrocortisone butyrate soln 0.1% 2 CG; MO

hydrocortisone cream 2.5% 1 CG; MO

hydrocortisone lotion 2.5% 1 CG; MO

hydrocortisone oint 2.5% 1 CG; MO

hydrocortisone valerate cream 0.2% 2 CG; MO

hydrocortisone valerate oint 0.2% 2 CG; MO

mometasone furoate cream 0.1% 1 CG; MO

mometasone furoate oint 0.1% 1 CG; MO

mometasone furoate solution 0.1% (lotion) 1 CG; MO

nolix cream 0.05% 2 CG; MO

PANDEL CRE 0.1% 4 MO

PREDNICARBAT CRE 0.1% 3 MO

prednicarbate oint 0.1% 2 CG; MO

prednisone conc 5 mg/ml 1 CG; MO

prednisone oral soln 5 mg/5ml 1 CG; MO

prednisone tab 1 mg 1 CG; MO


prednisone tab 2.5 mg 1 CG; MO




90



prednisone tab therapy pack 10 mg (21) 1 CG; MO




procto-med cream 2.5% 2 CG; MO

proctosol hc rectal cream 2.5% 2 CG; MO

proctozone hc rectal cream 2.5% 2 CG; MO

PSORCON CRE 0.05% 4 MO

RAYOS TAB 1MG 5 MO

RAYOS TAB 2MG 5 MO

RAYOS TAB 5MG 5 MO

triamcinolone acetonide aerosol soln 0.147 mg/gm 4 MO

triamcinolone acetonide cream 0.025% 1 CG; MO



triamcinolone acetonide lotion 0.025% 1 CG; MO

triamcinolone acetonide lotion 0.1% 1 CG; MO

triamcinolone acetonide oint 0.025% 1 CG; MO



HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY)

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary)

desmopressin acetate nasal spray soln 0.01% (refrigerated) 2 CG; MO

desmopressin acetate tab 0.1 mg 2 CG; MO

desmopressin acetate tab 0.2 mg 2 CG; MO

EGRIFTA SOL 1MG 5 MO; QL 60 PER 30 DAYS; PA

GENOTROPIN INJ0.2MG 4 MO; PA






GENOTROPIN INJ 1.6MG 5 MO; PA

GENOTROPIN INJ 1.8MG 5 MO; PA

GENOTROPIN INJ 12MG 5 MO; PA




HUMATROPE INJ 12MG 5 MO; PA


91





INCRELEX INJ 40MG/4ML 5 MO

NORDITROPIN INJ 10/1.5ML 5 MO; PA


NORDITROPIN INJ 30/3ML 5 MO; PA


OMNITROPE INJ 10/1.5ML 5 MO; PA

OMNITROPE INJ 5/1.5ML 5 MO; PA

ORILISSA TAB 150MG 5 MO; QL 28 PER 28 DAYS; PA

ORILISSA TAB 200MG 5 MO; QL 56 PER 28 DAYS; PA

STIMATE SOL 1.5MG/ML 4 MO

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS)

Anabolic Steroids

ANADROL-50 TAB 50MG 3 MO; PA

oxandrolone tab 10 mg 4 MO; QL 60 PER 30 DAYS; PA

oxandrolone tab 2.5 mg 4 MO; QL 240 PER 30 DAYS; PA

Androgens

ANDRODERM DIS 2MG/24HR 3 MO; PA

ANDRODERM DIS 4MG/24HR 3 MO; PA

danazol cap 100 mg 2 CG; MO



methitest tab 10 mg 4 MO; PA

methyltestosterone cap 10 mg 5 MO; PA

testosterone cypionate im inj in oil 100 mg/ml 2 CG; MO; PA

testosterone cypionate im inj in oil 200 mg/ml 2 CG; MO; PA

testosterone enanthate im inj in oil 200 mg/ml 2 CG; MO; PA

testosterone td gel 20.25 mg/1.25gm (1.62%) 3 MO; PA

testosterone td gel 20.25 mg/act (1.62%) 3 MO; PA

testosterone td gel 40.5 mg/2.5gm (1.62%) 3 MO; PA

Estrogens

altavera tab 0.15 mg-30 mcg 2 CG; MO

alyacen tab 1 mg-35 mcg 2 CG; MO

amabelz tab 0.5-0.1 mg 1 CG; MO

amabelz tab 1-0.5 mg 1 CG; MO

amethia lo tab 2 CG; MO; QL 91 PER 91 DAYS

amethia tab 2 CG; MO; QL 91 PER 91 DAYS


92


apri tab 0.15 mg-30 mcg 2 CG; MO

aranelle tab 0.5-35/1-35/0.5-35 mg-mcg 2 CG; MO

ashlyna tab 2 CG; MO; QL 91 PER 91 DAYS

aubra tab 0.1 mg-20 mcg 2 CG; MO

aviane tab 0.1 mg-20 mcg 2 CG; MO

balziva tab 0.4 mg-35 mcg 2 CG; MO

blisovi fe tab 1 mg-20 mcg (24) 2 CG; MO

blisovi fe tab 1.5 mg-30 mcg 2 CG; MO

briellyn tab 0.4 mg-35 mcg 2 CG; MO

camrese lo tab 2 CG; MO; QL 91 PER 91 DAYS

caziant pak 2 CG; MO

CLIMARA PRO DISWEEKLY 4 MO

COMBIPATCH DIS 0.05/.14 4 MO

COMBIPATCH DIS 0.05/.25 4 MO

cryselle-28 tab 0.3 mg-30 mcg 2 CG; MO

cyclafem tab 1 mg-35 mcg 2 CG; MO

cyclafem tab7/7/7 2 CG; MO

cyred tab 2 CG; MO

DEPO-ESTRADIOL INJ 5MG/ML 4 MO

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) 2 CG; MO

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg 2 CG; MO

drospirenone-ethinyl estradiol tab 3-0.02 mg 2 CG; MO

drospirenone-ethinyl estradiol tab 3-0.03 mg 2 CG; MO

drospirenone-ethinyl estrad-levomefolate tab 3-0.02-0.451 mg 2 CG; MO

ELESTRIN GEL 0.06% 3 MO

eluryng mis 2 CG; MO

emoquette tab 0.15 mg-30 mcg 2 CG; MO

enpresse-28 tab 2 CG; MO

enskyce tab 2 CG; MO

estarylla tab 0.25 mg-35 mcg 2 CG; MO

ESTRACE VAGINAL CREAM 0.1 MG/GM 4 MO

estradiol & norethindrone acetate tab 0.5-0.1 mg 1 CG; MO

estradiol & norethindrone acetate tab 1-0.5 mg 1 CG; MO

estradiol tab 0.5 mg 1 CG; MO

estradiol tab 1 mg 1 CG; MO

estradiol tab 2 mg 1 CG; MO

estradiol td patch twice weekly 0.025 mg/24hr 2 CG; MO





93



estradiol td patch weekly 0.025 mg/24hr 2 CG; MO






estradiol vaginal cream 0.1 mg/gm 3 MO

estradiol vaginal tab 10 mcg 4 MO

estradiol valerate im in oil 20 mg/ml 2 CG; MO

estradiol valerate im in oil 40 mg/ml 2 CG; MO

ESTRING MIS 2MG 4 MO; QL 1 PER 90 DAYS

ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg 2 CG; MO

ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg 2 CG; MO

etonogesteremisethy est 2 CG; MO

falmina tab 2 CG; MO

FEMRING MIS 0.05/24H 4 MO; QL 1 PER 90 DAYS

FEMRING MIS 0.1MG/24 4 MO; QL 1 PER 90 DAYS

femynor tab 0.25 mg-35 mcg 2 CG; MO

fyavolv tab 0.5 mg-2.5 mcg 4 MO

fyavolv tab 1 mg-5 mcg 1 CG; MO

gianvi tab 3-0.02 mg 2 CG; MO

hailey 24 tab fe 2 CG; MO

introvale tab 2 CG; MO; QL 91 PER 91 DAYS

isibloom tab 2 CG; MO

jasmiel tab 3-0.02mg 2 CG; MO

jinteli tab 1 mg-5 mcg 1 CG; MO

juleber tab 0.15 mg-30 mcg 2 CG; MO

junel fe tab 1 mg-20 mcg 2 CG; MO

junel fe tab 1 mg-20 mcg (24) 2 CG; MO

junel fe tab 1.5 mg-30 mcg 2 CG; MO

junel tab 1 mg-20 mcg 2 CG; MO

junel tab 1.5 mg-30 mcg 2 CG; MO

kaitlib fe chew tab 0.8 mg-25 mcg 2 CG; MO

kariva tab28 day 2 CG; MO

kelnor tab 1 mg-35 mcg 2 CG; MO

kelnor tab 1 mg-50 mcg 2 CG; MO

kurvelo tab 0.15 mg-30 mcg 2 CG; MO

larin fe tab 1 mg-20 mcg 2 CG; MO

larin fe tab 1.5 mg-30 mcg 2 CG; MO


94


larin tab 1 mg-20 mcg 2 CG; MO

larin tab 1.5 mg-30 mcg 2 CG; MO

larissia tab 0.1 mg-20 mcg 2 CG; MO

layolis fe chew tab 0.8 mg-25 mcg 2 CG; MO

leena tab 2 CG; MO

lessina tab 0.1 mg-20 mcg 2 CG; MO

levonest tab 2 CG; MO

levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg 2 CG; MO; QL 91 PER 91 DAYS

levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg 2 CG; MO

levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg 2 CG; MO

levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg 2 CG; MO

levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg 2 CG; MO

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab 0.01mg(7) 2 CG; MO; QL 91 PER 91 DAYS

levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7) 2 CG; MO; QL 91 PER 91 DAYS

levora-28 tab 0.15 mg-30 mcg 2 CG; MO

LO LOESTRIN TAB1-10-10 4 MO

loryna tab 3-0.02 mg 2 CG; MO

low-ogestrel tab 0.3 mg-30 mcg 2 CG; MO

lutera tab 0.1 mg-20 mcg 2 CG; MO

marlissa tab 0.15 mg-30 mcg 2 CG; MO

melodetta fe chew tab 1 mg-20 mcg (24) 3 MO

menest tab 0.3 mg 4 MO; NEW PA



mibelas 24 chwfe 3 MO

microgestin fe tab 1 mg-20 mcg 2 CG; MO

microgestin fe tab 1.5 mg-30 mcg 2 CG; MO

microgestin tab 1 mg-20 mcg 2 CG; MO

microgestin tab 1.5 mg-30 mcg 2 CG; MO

mili tab 0.25 mg-35 mcg 2 CG; MO

mimvey tab 1-0.5 mg 1 CG; MO

necon tab 0.5 mg-35 mcg 2 CG; MO

nikki tab 3-0.02 mg 2 CG; MO

norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg 2 CG; MO

norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg 2 CG; MO

norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg 2 CG; MO

norethindrone ace-eth estradiol-fe chew tab 1 mg-20 mcg (24) 3 MO

norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24) 2 CG; MO

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5 mcg 4 MO

norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg 1 CG; MO


95


norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg 1 CG; MO

norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-mcg 1 CG; MO

norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg 1 CG; MO

nortrel tab 0.5 mg-35 mcg 2 CG; MO

nortrel tab 0.5-35/0.75-35/1-35 mg-mcg 2 CG; MO

nortrel tab 1 mg-35 mcg 2 CG; MO

ocella tab 3-0.03 mg 2 CG; MO

ogestrel tab 0.5 mg-50 mcg 2 CG; MO

orsythia tab 0.1 mg-20 mcg 2 CG; MO

pimtrea tab 2 CG; MO

pirmella tab 1 mg-35 mcg 2 CG; MO

portia-28 tab 0.15 mg-30 mcg 2 CG; MO

PREMARIN TAB 0.3MG 3 MO





PREMARIN VAG CRE 0.625MG 3 MO

PREMPHASE TAB 4 MO

PREMPRO TAB 0.625-2.5 3 MO



PREMPRO TAB 0.625-5 3 MO

previfem tab 0.25 mg-35 mcg 2 CG; MO

reclipsen tab 0.15 mg-30 mcg 2 CG; MO

setlakin tab 2 CG; MO; QL 91 PER 91 DAYS

sprintec 28 tab28 day 2 CG; MO

sronyx tab 2 CG; MO

syeda tab 3-0.03 mg 2 CG; MO

tarina 24 fe tab 2 CG; MO

tarina fe tab 1 mg-20 mcg 2 CG; MO

tri-estaryll tab 2 CG; MO

tri-legest tab fe 2 CG; MO

tri-lo tab estaryll 2 CG; MO

tri-lo- tab sprintec 2 CG; MO

tri-mili tab 2 CG; MO

tri-previfem tab 2 CG; MO

tri-sprintec tab 2 CG; MO

trivora-28 tab 2 CG; MO

tri-vylibra tab 2 CG; MO


96


tri-vylibra tab lo 2 CG; MO

velivet pak 2 CG; MO

vienva tab 0.1-20 2 CG; MO

vyfemla tab 0.4 mg-35 mcg 2 CG; MO

vylibra tab 0.25 mg-35 mcg 2 CG; MO

wymzya fe chew tab 0.4 mg-35 mcg 2 CG; MO

xulane dis150-35 4 MO

yuvafem tab 10 mcg 4 MO

zarah tab 3-0.03 mg 2 CG; MO

zovia tab 1 mg-35 mcg 2 CG; MO

Progestins

camila tab 0.35 mg 1 CG; MO

CRINONE GEL 4% VAG 4 MO; PA

CRINONE GEL 8% VAG 4 MO; PA

deblitane tab 0.35 mg 1 CG; MO

DEPO-PROVERA INJ 400/ML 4 MO; QL 10 PER 28 DAYS

DEPO-SQ PROV INJ 104 4 MO; QL 0.65 PER 90 DAYS

errin tab 0.35 mg 2 CG; MO

incassia tab 0.35 mg 1 CG; MO

LUPANETA KIT 11.25-5 5 MO; QL 1 PER 84 DAYS; PA

LUPANETA KIT 3.75-5 5 MO; QL 1 PER 28 DAYS; PA

lyza tab 0.35 mg 1 CG; MO

medroxyprogesterone acetate im susp 150 mg/ml 2 CG; MO; QL 1 PER 90 DAYS

medroxyprogesterone acetate tab 10 mg 1 CG; MO

medroxyprogesterone acetate tab 2.5 mg 1 CG; MO

medroxyprogesterone acetate tab 5 mg 1 CG; MO

megestrol acetate susp 40 mg/ml 1 CG; MO

megestrol acetate susp 625 mg/5ml 4 MO

megestrol acetate tab 20 mg 1 CG; MO

megestrol acetate tab 40 mg 1 CG; MO

norethindrone acetate tab 5 mg 2 CG; MO

norethindrone tab 0.35 mg 1 CG; MO

progesterone micronized cap 100 mg 2 CG; MO

progesterone micronized cap 200 mg 2 CG; MO

sharobel tab 0.35 mg 1 CG; MO

Selective Estrogen Receptor Modifying Agents

DUAVEE TAB 0.45-20 4 MO; QL 30 PER 30 DAYS

raloxifene hcl tab 60 mg 2 CG; MO

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (THYROID)

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid)


97


levo-t tab 100 mcg 1 CG; MO












levothyroxine sodium tab 100 mcg 1 CG; MO












liothyronine sodium tab 25 mcg 2 CG; MO



SYNTHROID TAB 100MCG 3 MO












TIROSINT CAP 100MCG 4 MO


98











unithroid tab 100 mcg 1 CG; MO











HORMONAL AGENTS, SUPPRESSANT (ADRENAL)

Hormonal Agents, Suppressant (Adrenal)

LYSODREN TAB 500MG 3 MO

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)

Hormonal Agents, Suppressant (Pituitary)

bromocriptine mesylate cap 5 mg 4 MO

bromocriptine mesylate tab 2.5 mg 3 MO

cabergoline tab 0.5 mg 3 MO

ELIGARD INJ 22.5MG 3 MO; QL 1 PER 84 DAYS

ELIGARD INJ 30MG 3 MO; QL 1 PER 112 DAYS

ELIGARD INJ 45MG 3 MO; QL 1 PER 168 DAYS

ELIGARD INJ 7.5MG 3 MO; QL 1 PER 28 DAYS

FIRMAGON INJ 120MG 5 MO; QL 4 PER 365 DAYS

FIRMAGON INJ 80MG 4 MO; QL 1 PER 28 DAYS

INBRIJA CAP 42 MG 5 MO; QL 300 PER 30 DAYS; PA

leuprolide acetate inj kit 5 mg/ml 4 MO

LUPRON DEPOT INJ 11.25MG 5 MO; QL 1 PER 84 DAYS



LUPRON DEPOT INJ 30MG 5 MO; QL 1 PER 112 DAYS


99


LUPRON DEPOT INJ 45MG 5 MO; QL 1 PER 168 DAYS


octreotide acetate inj 100 mcg/ml 4 MO; PA





SIGNIFOR INJ 0.3MG/ML 5 MO; QL 60 PER 30 DAYS; PA



SOMATULINE INJ 120/.5ML 5 MO; NEW PA

SOMATULINE INJ 60/0.2ML 5 MO; PA

SOMATULINE INJ 90/0.3ML 5 MO; PA

SOMAVERT INJ 10MG 5 MO; PA





SYNAREL SOL 2MG/ML 5 MO

TRELSTAR MIX INJ 11.25MG 5 MO; QL 1 PER 84 DAYS



HORMONAL AGENTS, SUPPRESSANT (THYROID)

Antithyroid Agents

methimazole tab 10 mg 1 CG; MO

methimazole tab 5 mg 1 CG; MO

propylthiouracil tab 50 mg 2 CG; MO

IMMUNOLOGICAL AGENTS

Angioedema Agents

BERINERT INJ 500UNIT 5 MO; PA

CINRYZE SOL 500 UNIT 5 MO; PA

icatibant inj 30mg/3ml 5 MO; PA

RUCONEST INJ 2100UNIT 5 MO; PA

TAKHZYRO INJ 300/2ML 5 MO; PA

Immune Suppressants

ASTAGRAF XL CAP 0.5MG 4 MO; B/D PA

ASTAGRAF XL CAP 1MG 4 MO; B/D PA

ASTAGRAF XL CAP 5MG 5 MO; B/D PA

azathioprine tab 100 mg 4 MO; B/D PA

azathioprine tab 50 mg 2 CG; MO; B/D PA


100


azathioprine tab 75 mg 4 MO; B/D PA

CIMZIA KIT 5 MO; PA

CIMZIA PREFL KIT 200MG/ML 5 MO; PA

cyclosporine cap 100 mg 2 CG; MO; B/D PA

cyclosporine cap 25 mg 2 CG; MO; B/D PA

cyclosporine modified cap 100 mg 2 CG; MO; B/D PA



cyclosporine modified oral soln 100 mg/ml 2 CG; MO; B/D PA

ENBREL INJ 25/0.5ML 5 MO; PA

ENBREL INJ 25MG 5 MO; PA

ENBREL INJ 50MG/ML 5 MO; PA

ENBREL MINI INJ 50MG/ML 5 MO; PA

ENBREL SRCLK INJ 50MG/ML 5 MO; PA

ENVARSUS XR TAB 0.75MG 4 MO; B/D PA

ENVARSUS XR TAB 1MG 4 MO; B/D PA

ENVARSUS XR TAB 4MG 4 MO; B/D PA

everolimus tab 0.25mg 4 MO; B/D PA



gengraf cap 100 mg 2 CG; MO; B/D PA

gengraf cap 25 mg 2 CG; MO; B/D PA

gengraf sol 100 mg/ml 2 CG; MO; B/D PA

HUMIRA INJ 10/0.1ML 5 MO; PA

HUMIRA INJ 10MG/0.2 5 MO; PA



HUMIRA KIT 20MG/0.4 5 MO; PA

HUMIRA KIT 40MG/0.8 5 MO; PA

HUMIRA PEN INJ 40/0.4ML 5 MO; PA

HUMIRA PEN INJ 40MG/0.8 5 MO; PA

HUMIRA PEN INJ CD/UC/HS 5 MO; PA

HUMIRA PEN INJ PS/UV 5 MO; PA

HUMIRA PEN KIT CD/UC/HS 5 MO; PA

HUMIRA PEN KIT PS/UV 5 MO; PA

KINERET INJ 5 MO; PA

mercaptopurine tab 50 mg 2 CG; MO

methotrexate sodium inj 25 mg/ml 1 CG; MO

methotrexate sodium inj pf 50 mg/2ml 1 CG; MO

methotrexate sodium tab 2.5 mg 1 CG; MO


101


mycophenolate mofetil cap 250 mg 2 CG; MO; B/D PA

mycophenolate mofetil for oral susp 200 mg/ml 5 MO; B/D PA

mycophenolate mofetil tab 500 mg 2 CG; MO; B/D PA

mycophenolate sodium tab dr 180 mg 4 MO; B/D PA

mycophenolate sodium tab dr 360 mg 4 MO; B/D PA

ORENCIA INJ 125MG/ML 5 MO; PA

ORENCIA INJ 50/0.4 5 MO; PA

ORENCIA INJ 87.5/0.7 5 MO; PA

ORENCIA CLCK INJ 125MG/ML 5 MO; QL 4 PER 28 DAYS; PA

PROGRAF GRA 0.2MG 5 MO; B/D PA

PROGRAF GRA 1MG 5 MO; B/D PA

RAPAMUNE SOL 1MG/ML 5 MO; B/D PA

RINVOQ TAB 15 MG ER 5 MO; QL 30 PER 30 DAYS; PA

SANDIMMUNE SOL 100MG/ML 4 MO; B/D PA

SIMPONI INJ 100MG/ML 5 MO; PA

SIMPONI INJ 50/0.5ML 5 MO; PA

sirolimus oral soln 1 mg/ml 5 MO; B/D PA

sirolimus tab 0.5 mg 4 MO; B/D PA

sirolimus tab 1 mg 4 MO; B/D PA

sirolimus tab 2 mg 5 MO; B/D PA

tacrolimus cap 0.5 mg 2 CG; MO; B/D PA

tacrolimus cap 1 mg 2 CG; MO; B/D PA

tacrolimus cap 5 mg 2 CG; MO; B/D PA

trexall tab 10 mg 4 MO



trexall tab 7.5 mg 4 MO

XATMEP SOL 2.5MG/ML 4 MO

XELJANZ TAB 10MG 5 MO; PA

XELJANZ TAB 5MG 5 MO; PA

XELJANZ XR TAB 11MG 5 MO; PA

XELJANZ XR TAB 22MG 5 MO; PA

ZORTRESS TAB 1MG 5 MO; B/D PA

Immunizing Agents, Passive

FLEBOGAMMA INJ 5GM/50ML 5 MO; PA

GAMMAGARD INJ 2.5GM/25 5 MO; PA

GAMMAGARD SD INJ 10GM HU 5 MO; PA

GAMMAGARD SD INJ 5GM HU 5 MO; PA

GAMMAKED INJ 1GM/10ML 5 MO; PA

GAMMAPLEX INJ 5% 5 MO; PA


102


GAMUNEX-C INJ 1GM/10ML 5 MO; PA

OCTAGAM INJ 1GM 5 MO; PA

OCTAGAM INJ 2GM/20ML 5 MO; PA

PRIVIGEN INJ 20GRAMS 5 MO; PA

Immunomodulators

ACTEMRA INJ 162/0.9 5 MO; QL 3.6 PER 28 DAYS; PA

ACTEMRA INJ ACTPEN 5 MO; QL 3.6 PER 28 DAYS; PA

ACTIMMUNE INJ 2MU/0.5 5 MO

ARCALYST INJ 220MG 5 MO; PA

BENLYSTA INJ 200MG/ML 5 MO; PA

leflunomide tab 10 mg 2 CG; MO

leflunomide tab 20 mg 2 CG; MO

OTEZLA TAB 10/20/30MG 5 MO; PA

OTEZLA TAB 30MG 5 MO; PA

RIDAURA CAP 3MG 5 MO

Vaccines

ACTHIB INJ 3 MO

ADACEL INJ 3 MO

BCG VACCINE INJ 4 MO

BEXSERO INJ 3 MO

BOOSTRIX INJ 3 MO

DAPTACEL INJ 3 MO

DIP/TET PED INJ 25-5LFU 3 MO

ENGERIX-B INJ 10/0.5ML 3 MO; B/D PA

ENGERIX-B INJ 20MCG/ML 3 MO; B/D PA

GARDASIL 9 INJ 3 MO

HAVRIX INJ 1440UNIT 3 MO

HAVRIX INJ 720UNIT 3 MO

HIBERIX SOL 10MCG 3 MO

IMOVAX RABIE INJ 2.5/ML 4 MO; B/D PA

INFANRIX INJ 3 MO

IPOL INJ INACTIVE 3 MO

IXIARO INJ 3 MO

KINRIX INJ 3 MO

MENACTRA INJ 3 MO

MENVEO INJ 3 MO

M-M-R II INJ 3 MO

PEDIARIX INJ 0.5ML 4 MO

PEDVAX HIB INJ 3 MO

PROQUAD INJ 3 MO


103


QUADRACEL INJ 3 MO

RABAVERT INJ 4 MO; B/D PA

RECOMBIVA HB INJ 10MCG/ML 3 MO; B/D PA

RECOMBIVA HB INJ 5MCG/0.5 3 MO; B/D PA

RECOMBIVA-HB INJ 40MCG/ML 3 MO; B/D PA

ROTARIX SUS 3 MO

ROTATEQ SOL 3 MO

SHINGRIX INJ 50MCG 3 MO

TENIVAC INJ 5-2LF 3 MO

TRUMENBA INJ 3 MO

TWINRIX INJ 3 MO

TYPHIM VI INJ 3 MO

VAQTA INJ 25/0.5ML 3 MO

VAQTA INJ 50UNT/ML 3 MO

VARIVAX INJ 3 MO

YF-VAX INJ 3 MO

ZOSTAVAX INJ 3 MO

INFLAMMATORY BOWEL DISEASE AGENTS

Aminosalicylates

APRISO CAP 0.375 GM 3 MO

balsalazide disodium cap 750 mg 2 CG; MO

DIPENTUM CAP 250MG 5 MO

mesalamine cap 0.375 gm 3 MO

mesalamine cap dr 400 mg 3 MO

mesalamine enema 4 gm 4 MO

mesalamine suppos 1000 mg 4 MO

mesalamine tab delayed release 1.2 gm 3 MO

PENTASA CAP 250MG CR 4 MO

PENTASA CAP 500MG CR 5 MO

Glucocorticoids

budesonide dr particles cap 3 mg 4 MO

budesonide tab er 9 mg 5 MO

cortisone acetate tab 25 mg 2 CG; MO

dexamethasone conc 1 mg/ml 2 CG; MO

dexamethasone elixir 0.5 mg/5ml 2 CG; MO

dexamethasone tab 0.5 mg 1 CG; MO


dexamethasone tab 1 mg 1 CG; MO




104




hydrocortisone enema 100 mg/60ml 2 CG; MO

hydrocortisone tab 10 mg 2 CG; MO



MEDROL TAB 2MG 4 MO

methylprednisolone tab 16 mg 2 CG; MO




methylprednisolone tab therapy pack 4 mg (21) 1 CG; MO

millipred tab 5 mg 4 MO

prednisolone sod phosph oral soln 5 mg/5ml 2 CG; MO

prednisolone sod phosphate oral soln 10 mg/5ml 4 MO

prednisolone sod phosphate oral soln 20 mg/5ml 4 MO

prednisolone sodium phosphate oral soln 25 mg/5ml 2 CG; MO

prednisolone syrup 15 mg/5ml 2 CG; MO

procto-pak rectal cream 1% 2 CG; MO

UCERIS AER 2MG/ACT 4 MO

Sulfonamides

sulfasalazine tab 500 mg 1 CG; MO

sulfasalazine tab dr 500 mg 2 CG; MO

METABOLIC BONE DISEASE AGENTS

Metabolic Bone Disease Agents

alendronate sodium oral soln 70 mg/75ml 2 CG; MO

alendronate sodium tab 10 mg 1 CG; MO

alendronate sodium tab 35 mg 1 CG; MO

alendronate sodium tab 70 mg 1 CG; MO; QL 4 PER 28 DAYS

BINOSTO TAB 70MG 4 MO; QL 4 PER 28 DAYS

calcitonin nasal soln 200 unit/act 2 CG; MO; QL 3.7 PER 30 DAYS

calcitriol cap 0.25 mcg 1 CG; MO

calcitriol cap 0.5 mcg 1 CG; MO

calcitriol oral soln 1 mcg/ml 2 CG; MO

cinacalcet hcl tab 30 mg 5 MO; B/D PA



doxercalciferol cap 0.5 mcg 4 MO

doxercalciferol cap 1 mcg 4 MO


105


doxercalciferol cap 2.5 mcg 4 MO

EVENITY INJ 105 MG 5 MO; QL 2.34 PER 30 DAYS; PA

FORTEO SOL 600/2.4 5 MO; PA

ibandronate sodium tab 150 mg 2 CG; MO; QL 1 PER 28 DAYS

NATPARA INJ 100MCG 5 MO; QL 2 PER 28 DAYS; PA




paricalcitol cap 1 mcg 2 CG; MO



PROLIA SOL 60MG/ML 3 MO; QL 2 PER 365 DAYS; PA

risedronate sodium tab 150 mg 2 CG; MO; QL 1 PER 28 DAYS

risedronate sodium tab 30 mg 2 CG; MO

risedronate sodium tab 35 mg 2 CG; MO; QL 4 PER 28 DAYS

risedronate sodium tab 5 mg 2 CG; MO

risedronate sodium tab dr 35 mg 2 CG; MO; QL 4 PER 28 DAYS

SENSIPAR TAB 30MG 3 MO; B/D PA



XGEVA INJ 5 MO; PA

OPHTHALMIC AGENTS

Ophthalmic Agents, Other

ATROPINE SUL SOL 1% OP 3 MO

bacitracin-polymyxin b ophth oint 2 CG; MO

BLEPHAMIDE SUS OP 4 MO

blephamide ophth oint 10-0.2% 4 MO

LACRISERT MIS 5MG OP 4 MO

neo/poly/bacoin/hc 1%op 2 CG; MO

NEO/POLY/GRA SOL OP 3 MO

neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt

op oin

2

CG; MO

neomycin-polymyxin-dexamethasone ophth oint 0.1% 2 CG; MO

neomycin-polymyxin-dexamethasone ophth susp 0.1% 2 CG; MO

neomycin-polymyxin-hc ophth susp 2 CG; MO

polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% 1 CG; MO

PRED-G SUS OP 4 MO

PRED-G S.O.P OIN OP 4 MO

proparacaine hcl ophth soln 0.5% 1 CG; MO

RESTASIS EMU 0.05% 3 MO


106


SULF/PRED NA SOL OP 3 MO

TOBRADEX SUS 0.3-0.1% 3 MO

TOBRADEX ST SUS 0.3-0.05 4 MO

tobramycin-dexamethasone ophth susp 0.3-0.1% 2 CG; MO

XIIDRA DRO 5% 4 MO; PA

ZYLET SUS 0.5-0.3% 4 MO

Ophthalmic Anti-allergy Agents

ALOCRIL SOL 2% 4 MO

ALOMIDE SOL 0.1% OP 4 MO

azelastine hcl ophth soln 0.05% 2 CG; MO

BEPREVE DRO 1.5% 4 MO

cromolyn sodium ophth soln 4% 1 CG; MO

epinastine hcl ophth soln 0.05% 2 CG; MO

LASTACAFT SOL 0.25% 4 MO

olopatadine hcl ophth soln 0.1% 2 CG; MO

olopatadine hcl ophth soln 0.2% 2 CG; MO

PAZEO DRO 0.7% 3 MO

Ophthalmic Antiglaucoma Agents

ALPHAGAN P SOL 0.1% 3 MO

ALPHAGAN P SOL 0.15% 3 MO

apraclonidine hcl ophth soln 0.5% 2 CG; MO

AZOPT SUS 1% OP 3 MO

betaxolol hcl ophth soln 0.5% 2 CG; MO

BETIMOL SOL 0.25% 3 MO

BETIMOL SOL 0.5% 3 MO

BETOPTIC-S SUS 0.25% OP 4 MO

brimonidine tartrate ophth soln 0.15% 1 CG; MO

brimonidine tartrate ophth soln 0.2% 1 CG; MO

carteolol hcl ophth soln 1% 1 CG; MO

COMBIGAN SOL 0.2/0.5% 3 MO

dorzolamide hcl ophth soln 2% 2 CG; MO

dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml 2 CG; MO

IOPIDINE SOL 1% OP 4 MO

levobunolol hcl ophth soln 0.5% 2 CG; MO

PHOSPHOLINE SOL 0.125%OP 4 MO

pilocarpine hcl ophth soln 1% 2 CG; MO



ROCKLATAN DROP 4 MO; QL 5 PER 30 DAYS

SIMBRINZA SUS 1-0.2% 4 MO


107


TIMOLOL GEL SOL 0.25% OP 3 MO

TIMOLOL GEL SOL 0.5% OP 3 MO

timolol maleate ophth soln 0.25% 1 CG; MO

timolol maleate ophth soln 0.5% 1 CG; MO

Ophthalmic Anti-inflammatories

ALREX SUS 0.2% 3 MO

dexamethasone sodium phosphate ophth soln 0.1% 2 CG; MO

diclofenac sodium ophth soln 0.1% 1 CG; MO

DUREZOL EMU 0.05% 3 MO

FLAREX SUS 0.1% OP 3 MO

fluorometholone ophth susp 0.1% 2 CG; MO

flurbiprofen sodium ophth soln 0.03% 1 CG; MO

FML OIN 0.1% OP 3 MO

FML FORTE SUS 0.25% OP 3 MO

ILEVRO DRO 0.3% OP 3 MO; QL 6 PER 30 DAYS

ketorolac tromethamine ophth soln 0.4% 2 CG; MO

ketorolac tromethamine ophth soln 0.5% 2 CG; MO

LOTEMAX GEL 0.5% 4 MO; QL 20 PER 365 DAYS

LOTEMAX OIN 0.5% 4 MO; QL 14 PER 365 DAYS

LOTEMAX SUS 0.5% 4 MO

loteprednol etabonate ophth susp 0.5% 3 MO

MAXIDEX SUS 0.1% OP 3 MO

NEVANAC SUS 0.1% 3 MO; QL 6 PER 30 DAYS

PRED MILD SUS 0.12% OP 3 MO

prednisolone sodium phosphate ophth soln 1% 2 CG; MO

PREDNISOLONE SUS 1% OP 3 MO

PROLENSA SOL 0.07% 3 MO; QL 12 PER 365 DAYS

Ophthalmic Prostaglandin and Prostamide Analogs

bimatoprost ophth soln 0.03% 2 CG; MO

latanoprost ophth soln 0.005% 1 CG; MO

LUMIGAN SOL 0.01% 3 MO

travoprost drop 0.004% 2 CG; MO

OTIC AGENTS

Otic Agents

CIPRO HC SUS OTIC 4 MO

CIPRODEX SUS 0.3-0.1% 3 MO

fluocinolone acetonide (otic) oil 0.01% 2 CG; MO

hydrocortisone w/ acetic acid otic soln 1-2% 2 CG; MO

neomycin-polymyxin-hc otic soln 1% 2 CG; MO

neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1% 2 CG; MO


108


RESPIRATORY TRACT/PULMONARY AGENTS

Antihistamines

azelastine hcl nasal spray 0.1% (137 mcg/spray) 2 CG; MO; QL 60 PER 30 DAYS

azelastine hcl nasal spray 0.15% (205.5 mcg/spray) 2 CG; MO; QL 60 PER 30 DAYS

cetirizine hcl oral soln 1 mg/ml 1 CG; MO

cyproheptadine hcl syrup 2 mg/5ml 1 CG; MO

cyproheptadine hcl tab 4 mg 1 CG; MO

desloratadine tab 5 mg 2 CG; MO

hydroxyzine hcl syrup 10 mg/5ml 2 CG; MO

levocetirizine dihydrochloride soln 2.5 mg/5ml 2 CG; MO

levocetirizine dihydrochloride tab 5 mg 1 CG; MO

olopatadine hcl nasal soln 0.6% 4 MO; QL 30.5 PER 30 DAYS

promethazine hcl suppos 12.5 mg 2 CG; MO

promethazine hcl suppos 25 mg 2 CG; MO

promethegan hcl suppos 50 mg 2 CG; MO

promethazine hcl syrup 6.25 mg/5ml 1 CG; MO

promethazine hcl tab 12.5 mg 1 CG; MO

promethazine hcl tab 25 mg 1 CG; MO

promethazine hcl tab 50 mg 1 CG; MO

Anti-inflammatories, Inhaled Corticosteroids

ARNUITY ELPT INH 100MCG 3 MO; QL 30 PER 30 DAYS



ASMANEX 120 AER 220MCG 4 MO; QL 1 PER 30 DAYS




ASMANEX HFA AER 100 MCG 4 MO; QL 26 PER 30 DAYS



BECONASE AQ SUS 0.042% 4 MO; QL 50 PER 25 DAYS

budesonide inhalation susp 0.25 mg/2ml 4 MO; QL 120 PER 30 DAYS;

B/D PA budesonide inhalation susp 0.5 mg/2ml 4 MO; QL 120 PER 30 DAYS;

B/D PA budesonide inhalation susp 1 mg/2ml 4 MO; QL 120 PER 30 DAYS;

B/D PA

FLOVENT DISK AER 100MCG 3 MO; QL 60 PER 30 DAYS



FLOVENT HFA AER 110MCG 3 MO; QL 24 PER 30 DAYS


109


FLOVENT HFA AER 220MCG 3 MO; QL 24 PER 30 DAYS

FLOVENT HFA AER 44MCG 3 MO; QL 21.2 PER 30 DAYS

flunisolide nasal soln 0.025% 2 CG; MO; QL 50 PER 30 DAYS

fluticasone propionate nasal susp 50 mcg/act 1 CG; MO

mometasone furoate nasal susp 50 mcg/act 2 CG; MO; QL 34 PER 30 DAYS

QVAR REDI HALAER 80MCG 3 MO; QL 21.2 PER 30 DAYS

QVAR REDI HALAER 40MCG 3 MO; QL 10.6 PER 30 DAYS

Antileukotrienes

montelukast sodium chew tab 4 mg 1 CG; MO

montelukast sodium chew tab 5 mg 1 CG; MO

montelukast sodium oral granules packet 4 mg 4 MO

montelukast sodium tab 10 mg 1 CG; MO

zafirlukast tab 10 mg 2 CG; MO

zafirlukast tab 20 mg 2 CG; MO

zileuton tab er 600 mg 5 MO

ZYFLO TAB 600MG 5 MO; ST

Bronchodilators, Anticholinergic

ATROVENT HFAAER17MCG 4 MO; QL 25.8 PER 30 DAYS

INCRUSE ELPTA INH 62.5MCG 3 MO; QL 30 PER 30 DAYS

ipratropium bromide inhal soln 0.02% 1 CG; MO; QL 312.5 PER

30 DAYS; B/D PA

ipratropium bromide nasal soln 0.03% 2 CG; MO

ipratropium bromide nasal soln 0.06% 2 CG; MO

SPIRIVA AER 1.25MCG 3 MO; QL 4 PER 30 DAYS

SPIRIVA CAP HANDI HLR 3 MO; QL 30 PER 30 DAYS

SPIRIVA SPR 2.5MCG 3 MO; QL 4 PER 30 DAYS

YUPELRI SOL 5 MO; QL 30 PER 30 DAYS; B/D PA

Bronchodilators, Sympathomimetic

albuterol aer hfa (PROAIR HFA) 2 CG; MO; QL 34 PER 30 DAYS

albuterol aer hfa (PROVENTIL HFA) 2 CG; MO; QL 26.8 PER 30

DAYS albuterol sulfate soln nebu 0.083% 1 CG; MO; QL 525 PER 30

DAYS; B/D PA albuterol sulfate soln nebu 0.5% 2 CG; MO; QL 100 PER 30

DAYS; B/D PA albuterol sulfate soln nebu 0.63 mg/3ml 2 CG; MO; QL 375 PER 30

DAYS; B/D PA

albuterol sulfate soln nebu 1.25 mg/3ml 1 CG; MO; QL 375 PER 30

DAYS; B/D PA

albuterol sulfate syrup 2 mg/5ml 2 CG; MO


110


albuterol sulfate tab 2 mg 3 MO

albuterol sulfate tab 4 mg 3 MO

albuterol sulfate tab er 4 mg 3 MO

albuterol sulfate tab er 8 mg 3 MO

ARCAPTA CAP 75MCG 4 MO; QL 30 PER 30 DAYS

BROVANA NEB 15MCG 4 MO; QL 120 PER 30 DAYS;

B/D PA

EPINEPHRINE INJ0.15MG 3 MO

EPINEPHRINE INJ0.3MG 2 CG; MO

epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000) 2 CG; MO

EPIPEN 2-PAK INJ 0.3MG 3 MO

EPIPEN-JR INJ 0.15MG 3 MO

levalbuterol hcl soln nebu 0.31 mg/3ml 2 CG; MO; QL 540 PER 30

DAYS; B/D PA levalbuterol hcl soln nebu 0.63 mg/3ml 2 CG; MO; QL 540 PER 30

DAYS; B/D PA levalbuterol hcl soln nebu 1.25 mg/3ml 2 CG; MO; QL 90 PER 30

DAYS; B/D PA levalbuterol hcl soln nebu conc 1.25 mg/0.5ml 2 CG; MO; QL 90 PER 30 DAYS;

B/D PA

LEVALBUTEROL AER 45/ACT 2 CG; MO; QL 30 PER 30 DAYS

metaproterenol sulfate syrup 10 mg/5ml 4 MO

PERFOROMIST NEB 20MCG 4 MO; QL 120 PER 30 DAYS;

B/D PA

PROAIR HFA AER 3 MO; QL 17 PER 30 DAYS

PROAIR RESPI AER 3 MO; QL 2 PER 30 DAYS

SEREVENT DIS AER 50MCG 3 MO; QL 60 PER 30 DAYS

STRIVERDI AER 2.5MCG 4 MO; QL 4 PER 30 DAYS

terbutaline sulfate tab 2.5 mg 4 MO

terbutaline sulfate tab 5 mg 4 MO

XOPENEX HFA AER 4 MO; QL 30 PER 30 DAYS

Cystic Fibrosis Agents

BETHKIS NEB 300/4ML 5 MO; B/D PA

KALYDECO PAK 25MG 5 MO; PA



KALYDECO TAB 150MG 5 MO; PA

ORKAMBI TAB 100-125 5 MO; QL 112 PER 28 DAYS; PA

ORKAMBI TAB 200-125 5 MO; QL 112 PER 28 DAYS; PA

PULMOZYME SOL 1MG/ML 5 MO; PA

TOBI PODHALR CAP 28MG 5 MO; QL 224 PER 56 DAYS

tobramycin nebu soln 300 mg/5ml 5 MO; B/D PA


111


TRIKAFTA TAB 5 MO; QL 84 PER 30 DAYS; PA

Mast Cell Stabilizers

cromolyn sodium soln nebu 20 mg/2ml 2 CG; MO; B/D PA

Phosphodiesterase Inhibitors, Airways Disease

DALIRESP TAB 250MCG 4 MO; PA

DALIRESP TAB 500MCG 4 MO; PA

theophylline soln 80 mg/15ml 2 CG; MO

theophylline tab er 300 mg 3 MO

theophylline tab er 400 mg 2 CG; MO

theophylline tab er 600 mg 2 CG; MO

Pulmonary Antihypertensives

ADEMPAS TAB 0.5MG 5 MO; QL 90 PER 30 DAYS; PA


ADEMPAS TAB 1MG 5 MO; QL 90 PER 30 DAYS; PA


ADEMPAS TAB 2MG 5 MO; QL 90 PER 30 DAYS; PA

alyq tab 20mg 5 MO; QL 60 PER 30 DAYS; PA

ambrisentan tab 10mg 5 MO; QL 30 PER 30 DAYS; PA

ambrisentan tab 5mg 5 MO; QL 30 PER 30 DAYS; PA

OPSUMIT TAB 10MG 5 MO; QL 30 PER 30 DAYS; PA

ORENITRAM TAB 0.125MG 4 MO; PA


ORENITRAM TAB 1MG 5 MO; PA


ORENITRAM TAB 5MG 5 MO; PA

sildenafil citrate tab 20 mg 2 CG; MO; QL 90 PER 30

DAYS; PA sildenafil sus 10 mg/ml 5 MO; PA

tadalafil tab 20mg 5 MO; QL 60 PER 30 DAYS; PA

UPTRAVI TAB 1000MCG 5 MO; QL 60 PER 30 DAYS; PA




UPTRAVI TAB 200/800MCG 5 MO; QL 400 PER 365

DAYS; PA





VENTAVIS SOL 10MCG/ML 5 MO; QL 270 PER 30 DAYS; PA


112


VENTAVIS SOL 20MCG/ML 5 MO; QL 270 PER 30 DAYS; PA

Pulmonary Fibrosis Agents

ESBRIET CAP 267MG 5 MO; PA

OFEV CAP 100MG 5 MO; PA

OFEV CAP 150MG 5 MO; PA

Respiratory Tract Agents, Other

acetylcysteine inhal soln 10% 2 CG; MO; B/D PA

acetylcysteine inhal soln 20% 2 CG; MO; B/D PA

ADVAIR HFA AER 115/21 3 MO; QL 24 PER 30 DAYS



ANORO ELLIPTA AER 62.5-25 3 MO; QL 60 PER 30 DAYS

BREO ELLIPTA INH 100-25 3 MO; QL 60 PER 30 DAYS

BREO ELLIPTA INH 200-25 3 MO; QL 60 PER 30 DAYS

COMBIVENT AER 20-100 3 MO; QL 8 PER 30 DAYS

fluticasone/salmeterol inhal 100/50 3 MO; QL 60 PER 30 DAYS



ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml 2 CG; MO; QL 540 PER 30

DAYS; B/D PA

promethazine & phenylephrine syrup 6.25-5 mg/5ml 2 CG; MO

SEMPREX-D CAP 8-60MG 4 MO

STIOLTO AER 2.5-2.5 3 MO; QL 4 PER 30 DAYS

SYMBICORT AER 160-4.5 3 MO; QL 12 PER 30 DAYS

SYMBICORT AER 80-4.5 3 MO; QL 13.8 PER 30 DAYS

TRELEGY AER ELLIPTA 3 MO; QL 60 PER 30 DAYS

wixela inhubaer 100/50 3 MO; QL 60 PER 30 DAYS



XOLAIR INJ 150MG/ML 5 MO; B/D PA

XOLAIR INJ 75/0.5 5 MO; B/D PA

XOLAIR SOL 150MG 5 MO; B/D PA

SKELETAL MUSCLE RELAXANTS

Skeletal Muscle Relaxants

carisoprodol tab 350 mg 1 CG; MO; PA

chlorzoxazone tab 500 mg 1 CG; MO

cyclobenzaprine hcl tab 10 mg 1 CG; MO

cyclobenzaprine hcl tab 5 mg 1 CG; MO

methocarbamol tab 500 mg 1 CG; MO

methocarbamol tab 750 mg 1 CG; MO


113


orphenadrine citrate tab er 100 mg 1 CG; MO

SLEEP DISORDER AGENTS

GABA Receptor Modulators

eszopiclone tab 1 mg 1 CG; MO; QL 30 PER 30 DAYS



temazepam cap 15 mg 1 CG; MO; QL 30 PER 30 DAYS

temazepam cap 22.5 mg 1 CG; MO; QL 30 PER 30 DAYS

temazepam cap 30 mg 1 CG; MO; QL 30 PER 30 DAYS

temazepam cap 7.5 mg 1 CG; MO; QL 30 PER 30 DAYS

zaleplon cap 10 mg 1 CG; MO; QL 60 PER 30 DAYS

zaleplon cap 5 mg 1 CG; MO; QL 30 PER 30 DAYS

zolpidem tartrate sl tab 1.75 mg 4 MO; QL 30 PER 30 DAYS

zolpidem tartrate sl tab 3.5 mg 4 MO; QL 30 PER 30 DAYS

zolpidem tartrate tab 10 mg 1 CG; MO; QL 30 PER 30 DAYS

zolpidem tartrate tab 5 mg 1 CG; MO; QL 30 PER 30 DAYS

zolpidem tartrate tab er 12.5 mg 2 CG; MO; QL 30 PER 30 DAYS

zolpidem tartrate tab er 6.25 mg 2 CG; MO; QL 60 PER 30 DAYS

Sleep Disorders, Other

armodafinil tab 150 mg 2 CG; MO; QL 30 PER 30

DAYS; PA armodafinil tab 200 mg 2 CG; MO; QL 30 PER 30

DAYS; PA

armodafinil tab 250 mg 2 CG; MO; QL 30 PER 30 DAYS; PA

armodafinil tab 50 mg 2 CG; MO; QL 60 PER 30

DAYS; PA

doxepin tab 3 mg 3 MO; QL 30 PER 30 DAYS

doxepin tab 6 mg 3 MO; QL 30 PER 30 DAYS

HETLIOZ CAP 20MG 5 MO; QL 30 PER 30 DAYS; PA

modafinil tab 100 mg 2 CG; MO; QL 30 PER 30

DAYS; PA modafinil tab 200 mg 2 CG; MO; QL 30 PER 30

DAYS; PA

ramelteon tab 8 mg 2 CG; MO; QL 30 PER 30 DAYS

WAKIX TAB 17.8MG 5 MO; QL 60 PER 30 DAYS; PA

WAKIX TAB 4.45MG 5 MO; QL 60 PER 30 DAYS; PA

XYREM SOL 500MG/ML 5 MO; QL 540 PER 30 DAYS; PA

114

Index of Drugs

1st Generation/Typical ................................................ 41

2nd Generation/Atypical ............................................. 42

abacavir sulfate soln 20 mg/ml....................................... 47

abacavir sulfate tab 300 mg ........................................... 47

abacavir sulfate-lamivudine tab 600-300 mg .................. 47

abacavir sulfate-lamivudine-zidovudine tab 300-150-300

mg ............................................................................. 47

ABELCET INJ 5MG/ML .............................................. 27

ABILIFY MAININJ300MG .......................................... 51

ABILIFY MAININJ400MG .......................................... 51

abiraterone acetate tab 250 mg ...................................... 32

acamprosate calcium tab dr 333 mg ............................... 10

acarbose tab 100 mg ...................................................... 53

acarbose tab 25 mg ........................................................ 53

acarbose tab 50 mg ........................................................ 53

acebutolol hcl cap 200 mg ............................................. 63

acebutolol hcl cap 400 mg ............................................. 63

acetaminophen w/ codeine soln 120-12 mg/5ml ................ 8

acetaminophen w/ codeine tab 300-15 mg ........................ 8



acetazolamide cap er 500 mg ......................................... 68

acetazolamide tab 125 mg .............................................. 68

acetazolamide tab 250 mg .............................................. 68

acetic acid otic soln 2% ................................................. 11

acetylcysteine inhal soln 10% ...................................... 112

acetylcysteine inhal soln 20% ...................................... 112

acitretin cap 10 mg ........................................................ 77

acitretin cap 17.5 mg ..................................................... 77

acitretin cap 25 mg ........................................................ 77

ACTEMRA INJ 162/0.9 .............................................. 102

ACTEMRA INJ ACTPEN ........................................... 102

ACTHIB INJ ............................................................... 102

ACTIMMUNE INJ 2MU/0.5 ...................................... 102

acyclovir cap 200 mg ..................................................... 46

acyclovir cream 5% ....................................................... 46

acyclovir oint 5% ........................................................... 46

acyclovir sodium iv soln 50 mg/ml ................................. 46

acyclovir susp 200 mg/5ml ............................................. 46

acyclovir tab 400 mg...................................................... 46

acyclovir tab 800 mg...................................................... 46

ADACEL INJ .............................................................. 102

adapalene cream 0.1%................................................... 77

adapalene gel 0.1% ....................................................... 77

adapalene gel 0.3% ....................................................... 77

adapalene soln 0.1% ...................................................... 77

adapalene-benzoyl peroxide gel 0.1-2.5% ...................... 77

adefovir dipivoxil tab 10 mg ........................................... 45

ADEMPAS TAB 0.5MG ............................................. 111

ADEMPAS TAB 1.5MG ............................................. 111

ADEMPAS TAB 1MG ................................................ 111

ADEMPAS TAB 2.5MG ............................................. 111

ADEMPAS TAB 2MG ................................................ 111

ADVAIR HFA AER 115/21 ....................................... 112

ADVAIR HFA AER 230/21 ....................................... 112

ADVAIR HFA AER 45/21 ......................................... 112

AFINITOR DIS TAB 2MG ........................................... 34



AFINITOR TAB 10MG................................................. 34

AFINITOR TAB 2.5MG................................................ 34

AFINITOR TAB 5MG .................................................. 34

AFINITOR TAB 7.5MG................................................ 34

AJOVY INJ 225/1.5 ...................................................... 30

albendazole tab 200 mg ................................................. 38

albuterol aer hfa (PROAIR HFA) .................................. 109

albuterol aer hfa (PROVENTIL HFA) ........................... 109

albuterol sulfate soln nebu 0.083% .............................. 109

albuterol sulfate soln nebu 0.5% .................................. 109

albuterol sulfate soln nebu 0.63 mg/3ml ....................... 109

albuterol sulfate soln nebu 1.25 mg/3ml ....................... 109

albuterol sulfate syrup 2 mg/5ml .................................. 109

albuterol sulfate tab 2 mg ............................................ 110

albuterol sulfate tab 4 mg ............................................ 110

albuterol sulfate tab er 4 mg ........................................ 110

albuterol sulfate tab er 8 mg ........................................ 110

alclometasone dipropionate cream 0.05% ...................... 88

alclometasone dipropionate oint 0.05% ......................... 88

Alcohol Deterrents/Anti-craving ................................. 10

ALDACTAZIDE TAB 25/25 ......................................... 69

ALDACTAZIDE TAB 50/50 ......................................... 69

ALECENSA CAP 150MG ............................................. 34

alendronate sodium oral soln 70 mg/75ml .................... 104

alendronate sodium tab 10 mg ..................................... 104



alfuzosin hcl tab er 10 mg .............................................. 87

ALINIA SUS 100/5ML ................................................. 38

ALINIA TAB 500MG ................................................... 38

aliskiren fumarate tab 150 mg ........................................ 65

115

aliskiren fumarate tab 300 mg ........................................ 66

Alkylating Agents ........................................................ 32

allopurinol tab 100 mg................................................... 38

allopurinol tab 300 mg................................................... 29

almotriptan malate tab 12.5 mg ..................................... 31

almotriptan malate tab 6.25 mg ..................................... 31

ALOCRIL SOL 2% ..................................................... 106

ALOMIDE SOL 0.1% OP ........................................... 106

alosetron hcl tab 0.5 mg ................................................. 84

alosetron hcl tab 1 mg.................................................... 84

Alpha-adrenergic Agonists .......................................... 60

Alpha-adrenergic Blocking Agents ............................. 60

ALPHAGAN P SOL 0.1% .......................................... 106

ALPHAGAN P SOL 0.15% ........................................ 106

alprazolam conc 1 mg/ml ............................................... 49

alprazolam odt tab 0.25 mg............................................ 49

alprazolam odt tab 0.5 mg ............................................. 49

alprazolam odt tab 1 mg ................................................ 49

alprazolam odt tab 2 mg ................................................ 49

alprazolam tab 0.25 mg ................................................. 49

alprazolam tab 0.5 mg ................................................... 49

alprazolam tab 1 mg ...................................................... 49

alprazolam tab 2 mg ...................................................... 49

alprazolam tab er 1 mg .................................................. 49


alprazolam tab er 24hr 0.5 mg ....................................... 49


ALREX SUS 0.2% ...................................................... 107

altavera tab 0.15 mg-30 mcg .......................................... 91

ALUNBRIG PAK.......................................................... 34

ALUNBRIG TAB 180MG ............................................. 34

ALUNBRIG TAB 30MG ............................................... 34

ALUNBRIG TAB 90MG ............................................... 34

alyacen tab 1 mg-35 mcg ............................................... 91

alyq tab 20mg .............................................................. 111

amabelz tab 0.5-0.1 mg .................................................. 91

amabelz tab 1-0.5 mg ..................................................... 91

amantadine hcl cap 100 mg ........................................... 48

amantadine hcl syrup 50 mg/5ml .................................... 39

amantadine hcl tab 100 mg ............................................ 48

AMBISOME INJ 50MG ................................................ 27

ambrisentan tab 10mg.................................................. 111

ambrisentan tab 5mg ................................................... 111

amcinonide cream 0.1% ................................................. 88

amcinonide lotion 0.1% ................................................. 88

amcinonide oint 0.1% .................................................... 88

amethia lo tab ................................................................ 91

amethia tab .................................................................... 91

amikacin sulfate inj 500 mg/2ml ..................................... 11

amiloride & hydrochlorothiazide tab 5-50 mg ................ 69

amiloride hcl tab 5 mg ................................................... 69

Aminoglycosides........................................................... 11

Aminosalicylates ........................................................ 103

AMINOSYN II INJ 10% ............................................... 80

AMINOSYN II INJ 15% ............................................... 80

AMINOSYN-PF INJ 10% ............................................. 80

AMINOSYN-PF INJ 7% ............................................... 80

amiodarone hcl tab 100 mg ............................................ 62



AMITIZA CAP 24MCG ................................................ 84

AMITIZA CAP 8MCG .................................................. 84

amitriptyline hcl tab 10 mg ............................................ 25

amitriptyline hcl tab 100 mg .......................................... 25

amitriptyline hcl tab 150 mg .......................................... 25




amlodipine besylate tab 10 mg ....................................... 64

amlodipine besylate tab 2.5 mg ...................................... 64

amlodipine besylate tab 5 mg ......................................... 64

amlodipine besylate-atorvastatin calcium tab 10-10 mg . 66




amlodipine besylate-atorvastatin calcium tab 2.5-10 mg 66



amlodipine besylate-atorvastatin calcium tab 5-10 mg ... 66




amlodipine besylate-benazepril hcl cap 10-20 mg .......... 66

amlodipine besylate-benazepril hcl cap 10-40 mg .......... 66

amlodipine besylate-benazepril hcl cap 2.5-10 mg ......... 66

amlodipine besylate-benazepril hcl cap 5-10 mg ............ 66



amlodipine besylate-olmesartan medoxomil tab 10-20 mg

.................................................................................. 66

amlodipine besylate-olmesartan medoxomil tab 10-40 mg

.................................................................................. 66

amlodipine besylate-olmesartan medoxomil tab 5-20 mg 66

amlodipine besylate-olmesartan medoxomil tab 5-40 mg 66

amlodipine besylate-valsartan tab 10-160 mg ................ 66

amlodipine besylate-valsartan tab 10-320 mg ................ 66

amlodipine besylate-valsartan tab 5-160 mg .................. 66

amlodipine besylate-valsartan tab 5-320 mg .................. 66

amlodipine-valsartan-hydrochlorothiazide tab 10-160-12.5

mg ............................................................................. 66

116

amlodipine-valsartan-hydrochlorothiazide tab 10-160-25

mg ............................................................................. 66


mg ............................................................................. 66

amlodipine-valsartan-hydrochlorothiazide tab 5-160-12.5

mg ............................................................................. 66


mg ............................................................................. 66

amnesteem cap 10 mg .................................................... 77

amnesteem cap 20 mg .................................................... 77

amnesteem cap 40 mg .................................................... 77

amoxapine tab 100 mg ................................................... 25

amoxapine tab 150 mg ................................................... 25

amoxapine tab 25 mg ..................................................... 25

amoxapine tab 50 mg ..................................................... 25

amoxicillin & k clavulanate chew tab 200-28.5 mg ........ 15

amoxicillin & k clavulanate chew tab 400-57 mg ........... 15

amoxicillin & k clavulanate for susp 200-28.5 mg/5ml ... 15


amoxicillin & k clavulanate for susp 400-57 mg/5ml ...... 15


amoxicillin & k clavulanate tab 250-125 mg .................. 15



amoxicillin (trihydrate) cap 250 mg ............................... 15

amoxicillin (trihydrate) cap 500 mg ............................... 15

amoxicillin (trihydrate) chew tab 125 mg ....................... 15

amoxicillin (trihydrate) chew tab 250 mg ....................... 15

amoxicillin (trihydrate) for susp 125 mg/5ml .................. 15




amoxicillin (trihydrate) tab 500 mg ................................ 15

amoxicillin (trihydrate) tab 875 mg ................................ 15

amoxicillin cap-clarithro tab-lansopraz cap dr therapy

pack ........................................................................... 83

AMOX-POT CLA TAB ER ........................................... 15

amphetamine-dextroamphetamine cap er 10 mg ............. 72





amphetamine-dextroamphetamine cap er 5 mg ............... 73

amphetamine-dextroamphetamine tab 10 mg ................. 73

amphetamine-dextroamphetamine tab 12.5 mg ............... 73




amphetamine-dextroamphetamine tab 5 mg ................... 73

amphetamine-dextroamphetamine tab 7.5 mg................. 73

amphotericin b for iv soln 50 mg .................................... 27

ampicillin & sulbactam sodium for inj 1-0.5 gm ............. 15

ampicillin & sulbactam sodium for inj 15 gm ................. 15

ampicillin & sulbactam sodium for inj 2-1 gm ................ 15

ampicillin cap 500 mg .................................................... 15

ampicillin sodium for inj 1 gm........................................ 15

ampicillin sodium for inj 125 mg .................................... 16

ampicillin sodium for iv soln 10 gm................................ 16

Anabolic Steroids ......................................................... 91

ANADROL-50 TAB 50MG .......................................... 91

anagrelide hcl cap 0.5 mg .............................................. 58

anagrelide hcl cap 1 mg ................................................. 58

Analgesics ....................................................................... 7

ANALGESICS ............................................................... 7

anastrozole tab 1 mg ...................................................... 34

ANDRODERM DIS 2MG/24HR .................................. 91

ANDRODERM DIS 4MG/24HR .................................. 91

Androgens .................................................................... 91

ANESTHETICS ........................................................... 10

Angioedema Agents .................................................... 99

Angiotensin II Receptor Antagonists .......................... 60

Angiotensin-converting Enzyme (ACE) Inhibitors ..... 61

ANORO ELLIPTA AER 62.5-25................................. 112

ANTI-ADDICTION/SUBSTANCE ABUSE

TREATMENT AGENTS ......................................... 10

Antiandrogens .............................................................. 32

Antiangiogenic Agents ................................................. 33

Antiarrhythmics........................................................... 62

ANTIBACTERIALS ................................................... 11

Antibacterials, Other ................................................... 11

Anticholinergics ........................................................... 39

Anticoagulants ............................................................. 57

ANTICONVULSANTS ............................................... 19

Anticonvulsants, Other ................................................ 19

Anti-cytomegalovirus (CMV) Agents .......................... 45

ANTIDEMENTIA AGENTS ....................................... 22

Antidementia Agents, Other ........................................ 22

ANTIDEPRESSANTS ................................................. 23

Antidepressants, Other ................................................ 23

Antidiabetic Agents...................................................... 53

ANTIEMETICS ........................................................... 26

Antiemetics, Other ....................................................... 26

Antiestrogens/Modifiers .............................................. 33

Antifungals ................................................................... 27

ANTIFUNGALS .......................................................... 27

Antigout Agents ........................................................... 28

ANTIGOUT AGENTS ................................................ 28

Antihelminthics ............................................................ 38

Anti-hepatitis B (HBV) Agents .................................... 45

Anti-hepatitis C (HCV) Agents ................................... 45

117

Anti-hepatitis C (HCV) Agents, Other ........................ 45

Anti-hepatitis C (HCV) Direct Acting Agents ............. 45

Antiherpetic Agents ..................................................... 46

Antihistamines ........................................................... 108

Anti-HIV Agents, Integrase Inhibitors (INSTI) .......... 46

Anti-HIV Agents, Nucleoside and Nucleotide Reverse

Transcriptase Inhibitors (NRTI) ............................. 47

Anti-HIV Agents, Other .............................................. 47

Anti-HIV Agents, Protease Inhibitors ......................... 48

Anti-inflammatories, Inhaled Corticosteroids .......... 108

ANTI-INFLAMMATORY AGENTS.......................... 29

Anti-influenza Agents .................................................. 48

Antileukotrienes ......................................................... 109

Antimetabolites ............................................................ 33

Antimigraine Agents .................................................... 30

ANTIMIGRAINE AGENTS ....................................... 30

ANTIMYASTHENIC AGENTS ................................. 31

ANTIMYCOBACTERIALS ....................................... 31

Antimycobacterials, Other .......................................... 32

ANTINEOPLASTICS ................................................. 32

Antineoplastics, Other ................................................. 33

ANTIPARASITICS ..................................................... 38

ANTIPARKINSON AGENTS ..................................... 39

Antiparkinson Agents, Other ...................................... 39

Antiprotozoals .............................................................. 38

ANTIPSYCHOTICS ................................................... 41

Antispasmodics, Gastrointestinal ................................ 83

Antispasmodics, Urinary ............................................. 86

Antispasticity Agents ................................................... 44

ANTISPASTICITY AGENTS ..................................... 44

Antithyroid Agents ...................................................... 99

Antituberculars ............................................................ 32

ANTIVIRALS .............................................................. 45

ANXIOLYTICS ........................................................... 49

Anxiolytics, Other ........................................................ 49

apexicon e cream 0.05% ................................................ 88

APLENZIN TAB 174MG .............................................. 23

APLENZIN TAB 348MG .............................................. 23

APLENZIN TAB 522MG .............................................. 23

APOKYN INJ 10MG/ML .............................................. 39

apraclonidine hcl ophth soln 0.5% ............................... 106

aprepitant capsule 125 mg ............................................. 26

aprepitant capsule 40 mg ............................................... 26

aprepitant capsule 80 mg ............................................... 26

aprepitant capsule therapy pack 80 & 125 mg................ 26

apri tab 0.15 mg-30 mcg ................................................ 92

APRISO CAP 0.375 GM ............................................. 103

APTIOM TAB 200MG .................................................. 21

APTIOM TAB 400MG .................................................. 21

APTIOM TAB 600MG .................................................. 21

APTIOM TAB 800MG .................................................. 21

APTIVUS CAP 250MG................................................. 48

APTIVUS SOL.............................................................. 48

ARALAST NP INJ 1000MG ........................................ 85

aranelle tab 0.5-35/1-35/0.5-35 mg-mcg ........................ 92

ARANESP INJ 100MCG ............................................... 58

ARANESP INJ 10MCG................................................. 58

ARANESP INJ 150MCG ............................................... 58

ARANESP INJ 200MCG ............................................... 58

ARANESP INJ 25MCG................................................. 58

ARANESP INJ 300MCG ............................................... 58

ARANESP INJ 40MCG................................................. 58

ARANESP INJ 500MCG ............................................... 58

ARANESP INJ 60MCG................................................. 58

ARANESP INJ 60MCG PREFILLED SYRINGE .......... 58

ARCALYST INJ 220MG ............................................ 102

ARCAPTA CAP 75MCG ............................................ 110

aripiprazole odt tab 10 mg ............................................. 51

aripiprazole odt tab 15 mg ............................................. 51

aripiprazole oral solution 1 mg/ml ................................. 51

aripiprazole tab 10 mg ................................................... 51


aripiprazole tab 2 mg ..................................................... 51



aripiprazole tab 5 mg ..................................................... 51

ARISTADA INJ 1064MG ............................................. 42

ARISTADA INJ 441MG/1. ........................................... 42

ARISTADA INJ 662MG/2 ............................................ 42

ARISTADA INJ 882MG/3 ............................................ 42

ARISTADA INJ INITIO ............................................... 42

armodafinil tab 150 mg ................................................ 113



armodafinil tab 50 mg .................................................. 113

ARNUITY ELPT INH 100MCG ................................. 108

ARNUITY ELPT INH 200MCG ................................. 108

ARNUITY ELPT INH 50MCG ................................... 108

Aromatase Inhibitors, 3rd Generation ........................ 34

ascomp/codeine cap 50-325-40-30 mg ............................. 8

ashlyna tab .................................................................... 92

ASMANEX 120 AER 220MCG .................................. 108

ASMANEX 30 AER 110MCG ................................... 108

ASMANEX 30 AER 220MCG ................................... 108

ASMANEX 60 AER 220MCG ................................... 108

ASMANEX HFA AER 100 MCG ............................... 108

ASMANEX HFA AER 200 MCG ............................... 108

ASMANEX HFA AER 50 MCG ................................. 108

aspirin-dipyridamole cap er 12hr 25-200 mg ................. 59

ASTAGRAF XL CAP 0.5MG ....................................... 99

118

ASTAGRAF XL CAP 1MG .......................................... 99

ASTAGRAF XL CAP 5MG .......................................... 99

atazanavir sulfate cap 150 mg ........................................ 48



atenolol & chlorthalidone tab 100-25 mg ....................... 66

atenolol & chlorthalidone tab 50-25 mg ......................... 66

atenolol tab 100 mg ....................................................... 63

atenolol tab 25 mg ......................................................... 63

atenolol tab 50 mg ......................................................... 63

atomoxetine hcl cap 10 mg ............................................. 73

atomoxetine hcl cap 100 mg ........................................... 73






atorvastatin calcium tab 10 mg ...................................... 70




atovaquone susp 750 mg/5ml ......................................... 38

atovaquone-proguanil hcl tab 250-100 mg ..................... 38

atovaquone-proguanil hcl tab 62.5-25 mg ...................... 38

ATRIPLA TAB ............................................................. 46

ATROPINE SUL SOL 1% OP ..................................... 105

ATROVENT HFAAER17MCG................................... 109

Attention Deficit Hyperactivity Disorder Agents,

Amphetamines ......................................................... 72

Attention Deficit Hyperactivity Disorder Agents, Non-

amphetamines .......................................................... 73

AUBAGIO TAB 14MG ................................................. 76

AUBAGIO TAB 7MG ................................................... 76

aubra tab 0.1 mg-20 mcg ............................................... 92

AUSTEDO TAB 12MG................................................. 75

AUSTEDO TAB 6MG .................................................. 75

AUSTEDO TAB 9MG .................................................. 75

aviane tab 0.1 mg-20 mcg .............................................. 92

AVONEX PEN KIT 30MCG ........................................ 76

AVONEX PREFLKIT 30MCG...................................... 76

AVYCAZ INJ 2-0.5GM ................................................ 13

AYVAKIT TAB 100MG ............................................... 34

AYVAKIT TAB 200MG ............................................... 34

AYVAKIT TAB 300MG ............................................... 34

AZASITE SOL 1% ........................................................ 16

azathioprine tab 100 mg ................................................ 99

azathioprine tab 50 mg .................................................. 99

azathioprine tab 75 mg ................................................ 100

azelaic acid gel 15% ...................................................... 77

azelastine hcl nasal spray 0.1% (137 mcg/spray) ......... 108

azelastine hcl nasal spray 0.15% (205.5 mcg/spray)..... 108

azelastine hcl ophth soln 0.05% ................................... 106

azithromycin iv for soln 500 mg ..................................... 16

azithromycin powd pack for susp 1 gm ........................... 16

azithromycin susp 100 mg/5ml ....................................... 16

azithromycin susp 200 mg/5ml ....................................... 16

azithromycin tab 250 mg ................................................ 16



AZOPT SUS 1% OP .................................................... 106

aztreonam for inj 1 gm ................................................... 15

bacitracin ophth oint 500 unit/gm .................................. 11

bacitracin-polymyxin b ophth oint ................................ 105

baclofen tab 10 mg ........................................................ 44

baclofen tab 20 mg ........................................................ 44

baclofen tab 5 mg .......................................................... 44

BACTOCILL INJ DEX 1GM ........................................ 16

BACTOCILL INJ DEX 2GM ........................................ 16

balsalazide disodium cap 750 mg ................................. 103

BALVERSA TAB 3MG ................................................ 34

BALVERSA TAB 4MG ................................................ 34

BALVERSA TAB 5MG ................................................ 34

balziva tab 0.4 mg-35 mcg ............................................. 92

BANZEL SUS 40MG/ML ............................................. 21

BANZEL TAB 200MG ................................................. 21

BANZEL TAB 400MG ................................................. 21

BAQSIMI ...................................................................... 55

BARACLUDE SOL.05 MG/ML ................................... 45

BASAGLAR INJ 100UNIT ........................................... 55

BCG VACCINE INJ .................................................... 102

BECONASE AQ SUS 0.042%..................................... 108

benazepril & hydrochlorothiazide tab 10-12.5 mg .......... 66

benazepril & hydrochlorothiazide tab 20-12.5 mg .......... 66

benazepril & hydrochlorothiazide tab 20-25 mg............. 66

benazepril & hydrochlorothiazide tab 5-6.25 mg ............ 66

benazepril hcl tab 10 mg ................................................ 61



benazepril hcl tab 5 mg .................................................. 61

Benign Prostatic Hypertrophy Agents ........................ 87

BENLYSTA INJ 200MG/ML ...................................... 102

benznidazole tab 100mg .................................................. 38 benznidazole tab 12.5mg ................................................. 38

Benzodiazepines ........................................................... 49

benztropine mesylate tab 0.5 mg .................................... 39

benztropine mesylate tab 1 mg ....................................... 39

benztropine mesylate tab 2 mg ....................................... 39

BEPREVE DRO 1.5% ................................................. 106

BERINERT INJ 500UNIT ............................................. 99

BESIVANCE SUS 0.6%............................................... 17

119

Beta-adrenergic Blocking Agents ................................ 63

Beta-lactam, Cephalosporins ....................................... 13

Beta-lactam, Other ...................................................... 15

Beta-lactam, Penicillins ............................................... 15

betamethasone dipropionate augmented cream 0.05% ... 88

betamethasone dipropionate augmented gel 0.05% ........ 88

betamethasone dipropionate augmented lotion 0.05% .... 88

betamethasone dipropionate augmented oint 0.05% ....... 88

betamethasone dipropionate cream 0.05% ..................... 88

betamethasone dipropionate lotion 0.05% ...................... 88

betamethasone dipropionate oint 0.05%......................... 88

betamethasone valerate aerosol foam 0.12% .................. 88

betamethasone valerate cream 0.1% .............................. 88

betamethasone valerate lotion 0.1% ............................... 88

betamethasone valerate oint 0.1% .................................. 88

BETASERON INJ 0.3MG ............................................. 76

betaxolol hcl ophth soln 0.5% ...................................... 106

betaxolol hcl tab 10 mg .................................................. 63

betaxolol hcl tab 20 mg .................................................. 63

bethanechol chloride tab 10 mg ..................................... 87


bethanechol chloride tab 5 mg ....................................... 87


BETHKIS NEB 300/4ML ............................................ 110

BETIMOL SOL 0.25% ................................................ 106

BETIMOL SOL 0.5% .................................................. 106

BETOPTIC-S SUS 0.25% OP ...................................... 106

bexarotene cap 75 mg .................................................... 38

BEXSERO INJ ............................................................ 102

bicalutamide tab 50 mg .................................................. 32

BICILLIN C-R INJ 1200000 ......................................... 16

BICILLIN C-R INJ 900/300 .......................................... 16

BICILLIN L-A INJ 1200000 ......................................... 16

BICILLIN L-A INJ 2400000 ......................................... 16

BICILLIN L-A INJ 600000 ........................................... 16

BIDIL TAB ................................................................... 66

BIKTARVY TAB.......................................................... 46

bimatoprost ophth soln 0.03% ...................................... 107

BINOSTO TAB 70MG ................................................ 104

BIPOLAR AGENTS .................................................... 51

Bipolar Agents, Other .................................................. 51

bisoprolol & hydrochlorothiazide tab 10-6.25 mg .......... 66

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg ......... 66

bisoprolol & hydrochlorothiazide tab 5-6.25 mg ............ 67

bisoprolol fumarate tab 10 mg ....................................... 63

bisoprolol fumarate tab 5 mg ......................................... 63

blephamide ophth oint 10-0.2%.................................... 105

BLEPHAMIDE SUS OP ............................................ 105

blisovi fe tab 1 mg-20 mcg (24) ...................................... 92

blisovi fe tab 1.5 mg-30 mcg .......................................... 92

Blood Formation Modifiers ......................................... 58

BLOOD GLUCOSE REGULATORS ......................... 53

BLOOD PRODUCTS/MODIFIERS/VOLUME

EXPANDERS ........................................................... 56

BOOSTRIX INJ .......................................................... 102

BOSULIF TAB 100MG................................................. 35

BOSULIF TAB 400MG................................................. 35

BOSULIF TAB 500MG................................................. 35

BRAFTOVI CAP 75MG ............................................... 35

BREO ELLIPTA INH 100-25 ...................................... 112

BREO ELLIPTA INH 200-25 ...................................... 112

briellyn tab 0.4 mg-35 mcg ............................................ 92

BRILINTA TAB 60MG................................................. 59

BRILINTA TAB 90MG................................................. 59

brimonidine tartrate ophth soln 0.15% ......................... 106

brimonidine tartrate ophth soln 0.2% ........................... 106

BRIVIACT SOL 10MG/ML .......................................... 19

BRIVIACT TAB 100MG .............................................. 19

BRIVIACT TAB 10MG ................................................ 19

BRIVIACT TAB 25MG ................................................ 19

BRIVIACT TAB 50MG ................................................ 19

BRIVIACT TAB 75MG ................................................ 19

bromocriptine mesylate cap 5 mg ................................... 98

bromocriptine mesylate tab 2.5 mg................................. 98

Bronchodilators, Anticholinergic .............................. 109

Bronchodilators, Sympathomimetic .......................... 109

BROVANA NEB 15MCG ........................................... 110

BRUKINSA CAP 80MG ................................................ 35

budesonide dr particles cap 3 mg ................................. 103

budesonide inhalation susp 0.25 mg/2ml ...................... 108

budesonide inhalation susp 0.5 mg/2ml ........................ 108

budesonide inhalation susp 1 mg/2ml ........................... 108

budesonide tab er 9 mg ................................................ 103

bumetanide inj 0.25 mg/ml ............................................. 69

bumetanide tab 0.5 mg ................................................... 69

bumetanide tab 1 mg ...................................................... 69

bumetanide tab 2 mg ...................................................... 69

buprenorphine hcl sl tab 2 mg ........................................ 10

buprenorphine hcl sl tab 8 mg ........................................ 10

buprenorphine hcl-naloxone hcl sl film 12-3 mg ............. 10

buprenorphine hcl-naloxone hcl sl film 2-0.5 mg ............ 10

buprenorphine hcl-naloxone hcl sl film 4-1 mg ............... 10

buprenorphine hcl-naloxone hcl sl film 8-2 mg ............... 10

buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg ............. 10

buprenorphine hcl-naloxone hcl sl tab 8-2 mg ................ 10

bupropion hcl (smoking deterrent) tab er 150 mg ........... 11

bupropion hcl tab 100 mg .............................................. 23

bupropion hcl tab 75 mg ................................................ 23

bupropion hcl tab er 100 mg .......................................... 23

bupropion hcl tab er 12hr 200 mg .................................. 23

120


bupropion hcl tab er 150 mg xl ...................................... 23


BUPROPION TAB 450MG XL ..................................... 23

buspirone hcl tab 10 mg ................................................. 49



buspirone hcl tab 5 mg ................................................... 49

buspirone hcl tab 7.5 mg ................................................ 49

butalbital-acetaminophen tab 50-325 mg ......................... 7

butalbital-acetaminophen-caff w/ cod cap 50-300-40-30

mg ............................................................................... 8

butalbital-acetaminophen-caff w/ cod cap 50-325-40-30

mg ............................................................................... 8

butalbital-acetaminophen-caffeine cap 50-300-40 mg ...... 7

butalbital-acetaminophen-caffeine cap 50-325-40 mg ...... 7

butalbital-acetaminophen-caffeine tab 50-325-40 mg ....... 7

butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg .. 8

butalbital-aspirin-caffeine cap 50-325-40 mg ................... 7

butorphanol tartrate nasal soln 10 mg/ml......................... 8

BYSTOLIC TAB 10MG ................................................ 63

BYSTOLIC TAB 2.5MG ............................................... 63

BYSTOLIC TAB 20MG ................................................ 63

BYSTOLIC TAB 5MG .................................................. 63

cabergoline tab 0.5 mg .................................................. 98

CABLIVI ...................................................................... 59

CABOMETYX TAB 20MG ......................................... 35

CABOMETYX TAB 40MG ......................................... 35

CABOMETYX TAB 60MG ......................................... 35

cafergot tab 1-100 mg .................................................... 30

calcipotriene cream 0.005%........................................... 77

calcipotriene oint 0.005% .............................................. 77

calcipotriene soln 0.005% .............................................. 77

calcipotriene-betamethasone dipropionate oint 0.005-

0.064% ...................................................................... 77

calcitonin nasal soln 200 unit/act ................................. 104

calcitriol cap 0.25 mcg ................................................ 104

calcitriol cap 0.5 mcg .................................................. 104

CALCITRIOL OIN 3MCG/GM .................................... 77

calcitriol oral soln 1 mcg/ml ........................................ 104

calcium acetate cap 667 mg ........................................... 82

calcium acetate tab 667 mg ............................................ 82

Calcium Channel Blocking Agents .............................. 64

Calcium Channel Modifying Agents ........................... 19

CALQUENCE CAP 100MG.......................................... 35

camila tab 0.35 mg ........................................................ 96

camrese lo tab ............................................................... 92

candesartan cilexetil tab 16 mg ...................................... 60

candesartan cilexetil tab 32 mg ...................................... 60

candesartan cilexetil tab 4 mg ........................................ 60

candesartan cilexetil tab 8 mg ........................................ 60

candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg

.................................................................................. 67

candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg

.................................................................................. 67

candesartan cilexetil-hydrochlorothiazide tab 32-25 mg 67

CAPEX SHA 0.01% ...................................................... 88

CAPLYTA CAP 42MG .................................................. 42

CAPRELSA TAB 100MG ............................................. 35

CAPRELSA TAB 300MG ............................................. 35

captopril & hydrochlorothiazide tab 25-15 mg ............... 67




captopril tab 100 mg ...................................................... 61

captopril tab 12.5 mg ..................................................... 61

captopril tab 25 mg ........................................................ 61

captopril tab 50 mg ........................................................ 61

CARAC CRE 0.5% ....................................................... 77

CARB/LEVO 50TAB/ENTACAP ................................. 39

CARB/LEVO 75TAB/ENTACAP ................................. 39

CARB/LEVO100TAB/ENTACAP ................................ 39




CARBAGLU TAB 200MG ........................................... 80

carbamazepine cap er 100 mg ........................................ 21



carbamazepine chew tab 100 mg .................................... 21

carbamazepine susp 100 mg/5ml .................................... 21

carbamazepine tab 200 mg ............................................ 21

carbamazepine tab er 100 mg ........................................ 21



carbidopa & levodopa odt tab 10-100 mg ...................... 40



carbidopa & levodopa tab 10-100 mg ............................ 40



carbidopa & levodopa tab er 25-100 mg ........................ 40

carbidopa & levodopa tab er 50-200 mg ........................ 40

carbidopa tab 25 mg ...................................................... 40

CARDIOVASCULAR AGENTS................................. 60

Cardiovascular Agents, Other ..................................... 65

CARDIZEM LA TAB 120MG ...................................... 64

CARDURA XL TAB 4MG........................................... 87

CARDURA XL TAB 8MG........................................... 87

carisoprodol tab 350 mg .............................................. 112

121

carteolol hcl ophth soln 1% ......................................... 106

cartia xt cap 120mg/24hr ............................................... 64




carvedilol tab 12.5 mg ................................................... 63

carvedilol tab 25 mg ...................................................... 63

carvedilol tab 3.125 mg ................................................. 63

carvedilol tab 6.25 mg ................................................... 63

caspofungin acetate for iv soln 50 mg ............................ 27

caspofungin acetate for iv soln 70 mg ............................ 27

CAYSTON INH 75MG ................................................. 15

caziant pak .................................................................... 92

cefaclor cap 250 mg ....................................................... 13

cefaclor cap 500 mg ....................................................... 13

cefaclor monohydrate tab er 500 mg .............................. 13

CEFACLOR SUS 125/5ML ........................................... 13

CEFACLOR SUS 250/5ML ........................................... 13

CEFACLOR SUS 375/5ML ........................................... 13

cefadroxil cap 500 mg .................................................... 13

cefadroxil for susp 250 mg/5ml ...................................... 13

cefadroxil for susp 500 mg/5ml ...................................... 13

cefadroxil tab 1 gm ........................................................ 13

cefazolin sodium for inj 1 gm ......................................... 13

cefazolin sodium for inj 10 gm ....................................... 13

cefazolin sodium for inj 500 mg ..................................... 13

cefdinir cap 300 mg ....................................................... 13

cefdinir for susp 125 mg/5ml .......................................... 13

cefdinir for susp 250 mg/5ml .......................................... 13

cefepime hcl for inj 1 gm ................................................ 14

cefepime hcl for inj 2 gm ................................................ 14

cefixime cap 400mg ....................................................... 14

cefixime chew tab 100 mg .............................................. 14

cefixime chew tab 200 mg .............................................. 14

cefixime for susp 100 mg/5ml ......................................... 14

cefixime for susp 200 mg/5ml ......................................... 14

cefotetan disodium for inj 1 gm ...................................... 14

cefotetan disodium for inj 2 gm ...................................... 14

cefoxitin sodium for inj 10 gm ........................................ 14

cefoxitin sodium for iv soln 1 gm .................................... 14

cefoxitin sodium for iv soln 2 gm .................................... 14

cefpodoxime proxetil for susp 100 mg/5ml ..................... 14

cefpodoxime proxetil for susp 50 mg/5ml ....................... 14

cefpodoxime proxetil tab 100 mg .................................... 14

cefpodoxime proxetil tab 200 mg .................................... 14

cefprozil for susp 125 mg/5ml ........................................ 14

cefprozil for susp 250 mg/5ml ........................................ 14

cefprozil tab 250 mg ...................................................... 14

cefprozil tab 500 mg ...................................................... 14

ceftazidime for inj 1 gm .................................................. 14



ceftriaxone sodium for inj 1 gm ...................................... 14

ceftriaxone sodium for inj 10 gm .................................... 14

ceftriaxone sodium for inj 2 gm ...................................... 14

ceftriaxone sodium for inj 250 mg .................................. 14

ceftriaxone sodium for inj 500 mg .................................. 14

cefuroxime axetil tab 250 mg ......................................... 14

cefuroxime axetil tab 500 mg ......................................... 14

cefuroxime sodium for inj 7.5 gm ................................... 14

cefuroxime sodium for inj 750 mg .................................. 14

cefuroxime sodium for iv soln 1.5 gm ............................. 14

celecoxib cap 100 mg ..................................................... 29

celecoxib cap 200 mg ..................................................... 29

celecoxib cap 400 mg ..................................................... 29

celecoxib cap 50 mg ....................................................... 29

CELONTIN CAP 300MG.............................................. 19

CENTRAL NERVOUS SYSTEM AGENTS .............. 72

Central Nervous System, Other................................... 75

cephalexin cap 250 mg................................................... 14



cephalexin for susp 125 mg/5ml ..................................... 14

cephalexin for susp 250 mg/5ml ..................................... 14

cephalexin tab 250 mg ................................................... 14

cephalexin tab 500 mg ................................................... 14

CERDELGA CAP 84MG .............................................. 85

cetirizine hcl oral soln 1 mg/ml .................................... 108

cevimeline hcl cap 30 mg ............................................... 76

CHANTIX PAK 0.5& 1MG .......................................... 11

CHANTIX PAK 1MG ................................................... 11

CHANTIX TAB 0.5MG ................................................ 11

CHANTIX TAB 1MG ................................................... 11

CHENODAL TAB 250MG ........................................... 83

chlordiazepoxide hcl cap 10 mg ..................................... 49

chlordiazepoxide hcl cap 25 mg ..................................... 50

chlordiazepoxide hcl cap 5 mg ....................................... 50

chlordiazepoxide-amitriptyline tab 10-25 mg ................. 23

chlordiazepoxide-amitriptyline tab 5-12.5 mg ................ 23

chlorhexidine gluconate soln 0.12% ............................... 76

chloroquine phosphate tab 250 mg ................................. 38

chloroquine phosphate tab 500 mg ................................. 38

chlorpromazine hcl tab 10 mg ........................................ 41

chlorpromazine hcl tab 100 mg ...................................... 41

chlorpromazine hcl tab 200 mg ...................................... 41



chlorthalidone tab 25 mg ............................................... 69

chlorthalidone tab 50 mg ............................................... 69

chlorzoxazone tab 500 mg ............................................ 112

122

CHOLBAM CAP 250MG.............................................. 85

CHOLBAM CAP 50MG ............................................... 85

cholestyramine light powder 4 gm/dose .......................... 71

cholestyramine powder packets 4 gm ............................. 71

Cholinesterase Inhibitors ............................................. 22

ciclopirox gel 0.77% ...................................................... 27

ciclopirox olamine cream 0.77% .................................... 27

ciclopirox olamine susp 0.77%....................................... 27

ciclopirox shampoo 1% .................................................. 27

ciclopirox solution 8% ................................................... 27

cilostazol tab 100 mg ..................................................... 59

cilostazol tab 50 mg ....................................................... 59

CILOXAN OIN 0.3% OP .............................................. 17

CIMDUO TAB 300-300 ................................................ 47

cimetidine hcl soln 300 mg/5ml ...................................... 84

cimetidine tab 200 mg .................................................... 84




CIMZIA KIT ............................................................... 100

CIMZIA PREFL KIT 200MG/ML ............................... 100

cinacalcet hcl tab 30 mg .............................................. 104



CINRYZE SOL 500 UNIT ............................................ 99

CIPRO HC SUS OTIC................................................. 107

CIPRODEX SUS 0.3-0.1% .......................................... 107

ciprofloxacin 200 mg/100ml in d5w ............................... 17

ciprofloxacin hcl ophth soln 0.3% .................................. 17

ciprofloxacin hcl tab 100 mg .......................................... 17




citalopram hydrobromide oral soln 10 mg/5ml ............... 24

citalopram hydrobromide tab 10 mg .............................. 24



claravis cap 10 mg ......................................................... 77

claravis cap 20 mg ......................................................... 77

claravis cap 30 mg ......................................................... 77

claravis cap 40 mg ......................................................... 77

clarithromycin for susp 125 mg/5ml ............................... 16

clarithromycin for susp 250 mg/5ml ............................... 17

clarithromycin tab 250 mg ............................................. 17

clarithromycin tab 500 mg ............................................. 17

clarithromycin tab er 500 mg ......................................... 17

CLEOCIN SUP 100MG................................................. 11

CLIMARA PRO DISWEEKLY ..................................... 92

clindacin-p pad 1% ........................................................ 12

clindamycin hcl cap 150 mg ........................................... 12

clindamycin hcl cap 300 mg ........................................... 12

clindamycin hcl cap 75 mg ............................................. 12

clindamycin palmitate hcl for soln 75 mg/5ml ................ 12

clindamycin phosphate foam 1% .................................... 12

clindamycin phosphate gel 1% ....................................... 12

clindamycin phosphate in d5w iv soln 300 mg/50ml ....... 12



clindamycin phosphate inj 300 mg/2ml .......................... 12



clindamycin phosphate lotion 1% ................................... 12

clindamycin phosphate soln 1% ..................................... 12

clindamycin phosphate swab 1% .................................... 12

clindamycin phosphate vaginal cream 2% ...................... 12

clindamycin phosphate-benzoyl peroxide gel 1-5% ........ 77

clindamycin phosphate-tretinoin gel 1.2-0.025% ............ 12

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 (1)-

5% ............................................................................. 12

CLINDESSE CRE2% ................................................... 12

CLINIMIX E INJ 2.75/D5W......................................... 80

CLINIMIX E INJ 4.25/D10 .......................................... 80

CLINIMIX E INJ 4.25/D5W......................................... 80

CLINIMIX E INJ 5%/D15W ........................................ 80

CLINIMIX E INJ 5%/D20W ........................................ 80

CLINIMIX INJ 4.25/D5W ............................................. 80

CLINIMIX INJ 5%/D15W............................................. 80

CLINIMIX INJ 5%/D20W............................................. 80

clinimix inj4.25/d10 ....................................................... 80

clobazam suspension 2.5 mg/ml ..................................... 19

clobazam tab 10 mg ....................................................... 19

clobazam tab 20 mg ....................................................... 19

clobetasol propionate cream 0.05% ............................... 88

clobetasol propionate emollient base cream 0.05% ........ 88

clobetasol propionate gel 0.05% .................................... 88

clobetasol propionate oint 0.05% ................................... 88

clobetasol propionate soln 0.05% .................................. 88

cloddan shampoo 0.05% ................................................ 88

clomipramine hcl cap 25 mg .......................................... 25



clonazepam odt tab 0.125 mg ......................................... 50

clonazepam odt tab 0.25 mg ........................................... 50

clonazepam odt tab 0.5 mg ............................................. 50

clonazepam odt tab 1 mg ............................................... 50

clonazepam odt tab 2 mg ............................................... 50

clonazepam tab 0.5 mg .................................................. 50

clonazepam tab 1 mg ..................................................... 50

clonazepam tab 2 mg ..................................................... 50

clonidine hcl tab 0.1 mg ................................................. 60

123



clonidine hcl tab er 0.1 mg ............................................. 73

clonidine td patch weekly 0.1 mg/24hr ........................... 60



clopidogrel bisulfate tab 75 mg ...................................... 59

clorazepate dipotassium tab 15 mg ................................ 50

clorazepate dipotassium tab 3.75 mg.............................. 50

clorazepate dipotassium tab 7.5 mg ............................... 50

clotrimazole cream 1% .................................................. 27

clotrimazole soln 1% ..................................................... 27

clotrimazole troche 10 mg .............................................. 27

clotrimazole w/ betamethasone cream 1-0.05% .............. 77

clotrimazole w/ betamethasone lotion 1-0.05% .............. 77

clozapine odt tab 100 mg ............................................... 44

clozapine odt tab 12.5 mg .............................................. 44

clozapine odt tab 25 mg ................................................. 44

clozapine tab 100 mg ..................................................... 44

CLOZAPINE TAB 150/ODT ........................................ 44

clozapine tab 200 mg ..................................................... 44

CLOZAPINE TAB 200/ODT ........................................ 44

clozapine tab 25 mg ....................................................... 44

clozapine tab 50 mg ....................................................... 44

COARTEM TAB 20-120MG ......................................... 38

CODEINE SULF TAB 30MG ......................................... 8

CODEINE SULF TAB 60MG ......................................... 8

COLCHICINE TAB0.6MG .......................................... 29

COLCRYS TAB 0.6MG ................................................ 29

colesevelam hcl packet for susp 3.75 gm ........................ 71

colesevelam hcl tab 625 mg ........................................... 71

colestipol hcl granule packets 5 gm ................................ 71

colestipol hcl tab 1 gm ................................................... 71

colistimethate sod for inj 150 mg ................................... 12

COMBIGAN SOL 0.2/0.5% ........................................ 106

COMBIPATCH DIS 0.05/.14 ....................................... 92

COMBIPATCH DIS 0.05/.25 ....................................... 92

COMBIVENT AER 20-100 ........................................ 112

COMETRIQ KIT 100MG .............................................. 35

COMETRIQ KIT 140MG .............................................. 35

COMETRIQ KIT 60MG ................................................ 35

COMPLERA TAB ........................................................ 46

compro suppos 25 mg .................................................... 26

CONDYLOX GEL 0.5% ............................................... 77

constulose solution 10 gm/15ml ..................................... 84

COPIKTRA CAP 15MG ............................................... 35

COPIKTRA CAP 25MG ............................................... 35

CORLANOR SOL 5MG/5ML ....................................... 67

CORLANOR TAB 5MG ............................................... 67

CORLANOR TAB 7.5MG ............................................ 67

cortisone acetate tab 25 mg ......................................... 103

CORTISPORIN CRE 0.5%............................................ 77

CORTISPORIN OIN 1% ............................................... 77

COSENTYX INJ 300 DOSE ......................................... 77

COSENTYX PEN INJ 300 DOSE ................................. 77

COTELLIC TAB 20MG ................................................ 35

CREON CAP 12000UNT .............................................. 85

CREON CAP 24000UNT .............................................. 85

CREON CAP 3000UNIT ............................................... 85

CREON CAP 36000UNT .............................................. 85

CREON CAP 6000UNIT ............................................... 85

CRESEMBA CAP 186 MG ........................................... 27

CRINONE GEL 4% VAG ............................................. 96

CRINONE GEL 8% VAG ............................................. 96

CRIXIVAN CAP 200MG .............................................. 48

CRIXIVAN CAP 400MG .............................................. 48

cromolyn sodium ophth soln 4% .................................. 106

cromolyn sodium oral conc 100 mg/5ml ......................... 83

cryselle-28 tab 0.3 mg-30 mcg ....................................... 92

CUPRIMINE CAP 250MG ........................................... 87

CUVPOSA SOL 1MG/5ML .......................................... 83

cyclafem tab 1 mg-35 mcg.............................................. 92

cyclafem tab7/7/7 ........................................................... 92

cyclobenzaprine hcl tab 10 mg ..................................... 112

cyclobenzaprine hcl tab 5 mg ....................................... 112

CYCLOPHOSPH CAP 25MG ....................................... 32

CYCLOPHOSPH CAP 50MG ....................................... 32

CYCLOSET TAB 0.8MG .............................................. 53

cyclosporine cap 100 mg .............................................. 100

cyclosporine cap 25 mg ............................................... 100

cyclosporine modified cap 100 mg ............................... 100

cyclosporine modified cap 25 mg ................................. 100

cyclosporine modified cap 50 mg ................................. 100

cyclosporine modified oral soln 100 mg/ml .................. 100

cyproheptadine hcl syrup 2 mg/5ml .............................. 108

cyproheptadine hcl tab 4 mg ........................................ 108

cyred tab........................................................................ 92

CYSTADANE POW .................................................... 85

CYSTAGON CAP 150MG ............................................ 85

CYSTAGON CAP 50MG .............................................. 86

CYSTARAN SOL 0.44% .............................................. 86

Cystic Fibrosis Agents ............................................... 110

D10W/NACL INJ 0.2% ................................................ 80

D10W/NACL INJ 0.45% .............................................. 80

D2.5W/NACL INJ 0.45% ............................................. 80

D5W/NACL INJ 0.225% ............................................... 80

dalfampridine tab er 10 mg ............................................ 76

DALIRESP TAB 250MCG .......................................... 111

DALIRESP TAB 500MCG .......................................... 111

DALVANCE SOL 500MG ............................................ 12

124

danazol cap 100 mg ....................................................... 91

danazol cap 200 mg ....................................................... 91

danazol cap 50 mg ......................................................... 91

dantrolene sodium cap 100 mg....................................... 44

dantrolene sodium cap 25 mg ........................................ 44

dantrolene sodium cap 50 mg ........................................ 45

dapsone tab 100 mg ....................................................... 32

dapsone tab 25 mg ......................................................... 32

DAPTACEL INJ ......................................................... 102

daptomycin for iv soln 500 mg ....................................... 12

DARAPRIM TAB 25MG .............................................. 39

darifenacin hydrobromide tab er 15 mg ......................... 86

darifenacin hydrobromide tab er 7.5 mg ........................ 86

DAURISMO TAB 100MG ............................................ 35

DAURISMO TAB 25MG .............................................. 35

deblitane tab 0.35 mg..................................................... 96

deferasirox tab 125mg ................................................... 79




deferasirox tab 90mg ..................................................... 79

DELSTRIGO TAB ....................................................... 46

demeclocycline hcl tab 150 mg....................................... 18

demeclocycline hcl tab 300 mg....................................... 18

DEMSER CAP 250MG ................................................. 67

DENAVIR CRE 1% ...................................................... 46

Dental and Oral Agents ............................................... 76

DENTAL AND ORAL AGENTS ................................ 76

DEPO-ESTRADIOL INJ 5MG/ML ............................... 92

DEPO-PROVERA INJ 400/ML ..................................... 96

DEPO-SQ PROV INJ 104 ............................................. 96

Dermatological Agents ................................................. 77

DERMATOLOGICAL AGENTS ............................... 77

DESCOVY TAB 200/25 ................................................ 47

desipramine hcl tab 10 mg ............................................. 25

desipramine hcl tab 100 mg ........................................... 25

desipramine hcl tab 150 mg ........................................... 25




desloratadine tab 5 mg................................................. 108

desmopressin acetate nasal spray soln 0.01%

(refrigerated) ............................................................. 90

desmopressin acetate tab 0.1 mg .................................... 90

desmopressin acetate tab 0.2 mg .................................... 90

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5) .................................................................... 92

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg ....... 92

DESONATE GEL 0.05%............................................... 88

desonide cream 0.05% ................................................... 88

desonide lotion 0.05% .................................................... 88

desonide oint 0.05% ....................................................... 88

desoximetasone cream 0.05% ........................................ 88

desoximetasone cream 0.25% ........................................ 88

desoximetasone gel 0.05% ............................................. 88

desoximetasone oint 0.05% ............................................ 88

desoximetasone oint 0.25% ............................................ 88

DESVENLAFAX TAB 100MG ER ............................... 24

DESVENLAFAX TAB 50MG ER ................................. 24

desvenlafaxine succinate tab er 100 mg.......................... 24

desvenlafaxine succinate tab er 25 mg ........................... 24

desvenlafaxine succinate tab er 50 mg ........................... 24

dexamethasone conc 1 mg/ml ....................................... 103

dexamethasone elixir 0.5 mg/5ml ................................. 103

dexamethasone sodium phosphate ophth soln 0.1% ...... 107

dexamethasone tab 0.5 mg ........................................... 103

dexamethasone tab 0.75 mg ......................................... 103

dexamethasone tab 1 mg .............................................. 103

dexamethasone tab 1.5 mg ........................................... 103




DEXILANT CAP 30MG DR ......................................... 85

DEXILANT CAP 60MG DR ......................................... 85

dexmethylphenidate hcl cap er 10 mg ............................. 74







dexmethylphenidate hcl cap er 5 mg ............................... 74

dexmethylphenidate hcl tab 10 mg ................................. 74

dexmethylphenidate hcl tab 2.5 mg................................. 74

dexmethylphenidate hcl tab 5 mg ................................... 74

dextroamphetamine sulfate cap er 10 mg ....................... 73

dextroamphetamine sulfate cap er 15 mg ....................... 73

dextroamphetamine sulfate cap er 5 mg ......................... 73

dextroamphetamine sulfate tab 10 mg ............................ 73

dextroamphetamine sulfate tab 5 mg .............................. 73

dextrose 5% w/ sodium chloride 0.2% ............................ 80

dextrose 5% w/ sodium chloride 0.45% .......................... 81

dextrose 5% w/ sodium chloride 0.9% ............................ 81

dextrose inj 10% ............................................................ 81

dextrose inj 5% .............................................................. 81

Diabetes Supplies ......................................................... 79

DIABETES SUPPLIES ............................................... 79

DIASTAT ACDL GEL 12.5-20 ..................................... 19

DIASTAT ACDL GEL 5-10MG .................................... 19

DIASTAT PED GEL 2.5M GEL ................................... 19

125

diazepam conc 5 mg/ml .................................................. 19

DIAZEPAM GEL 10MG ............................................... 19

DIAZEPAM GEL 2.5MG .............................................. 20

DIAZEPAM GEL 20MG ............................................... 20

diazepam oral soln 1 mg/ml ........................................... 20

diazepam tab 10 mg ....................................................... 20

diazepam tab 2 mg ......................................................... 20

diazepam tab 5 mg ......................................................... 20

diclofenac potassium tab 50 mg ..................................... 29

diclofenac sodium (actinic keratoses) gel 3% ................. 77

diclofenac sodium gel 1% .............................................. 77

diclofenac sodium ophth soln 0.1% .............................. 107

diclofenac sodium soln 1.5% .......................................... 77

diclofenac sodium tab dr 25 mg ..................................... 29



diclofenac sodium tab er 100 mg .................................... 29

diclofenac w/ misoprostol tab delayed release 50-0.2 mg 29

diclofenac w/ misoprostol tab delayed release 75-0.2 mg 29

dicloxacillin sodium cap 250 mg .................................... 16

dicloxacillin sodium cap 500 mg .................................... 16

dicyclomine hcl cap 10 mg ............................................. 83

dicyclomine hcl oral soln 10 mg/5ml .............................. 83

dicyclomine hcl tab 20 mg.............................................. 83

didanosine dr capsule 200 mg ........................................ 47



DIFICID TAB 200MG .................................................. 17

diflorasone diacetate cream 0.05% ................................ 88

diflorasone diacetate oint 0.05% .................................... 88

diflunisal tab 500 mg ..................................................... 29

digitek tab 0.125 mg ...................................................... 67

digitek tab 0.25 mg ........................................................ 67

digox tab 0.125 mg ........................................................ 67

digox tab 0.25 mg .......................................................... 67

DIGOXIN SOL 50MCG/ML ......................................... 67

digoxin tab 0.125 mg ..................................................... 67

digoxin tab 0.25 mg ....................................................... 67

DIHYDROERGOT SPR 4MG/ML ................................ 30

dilantin cap 30 mg ......................................................... 21

diltiazem hcl beads cap er 24hr 420 mg ......................... 64

diltiazem hcl beads cap er 360 mg ................................. 64

diltiazem hcl cap er 120 mg ........................................... 64

diltiazem hcl cap er 60 mg ............................................. 64

diltiazem hcl cap er 90 mg ............................................. 64

diltiazem hcl coated beads cap er 120 mg ...................... 64




diltiazem hcl tab 120 mg ................................................ 64

diltiazem hcl tab 30 mg .................................................. 64



dilt-xr cap 120 mg.......................................................... 64

dilt-xr cap 180 mg.......................................................... 64

dilt-xr cap 240 mg.......................................................... 64

DIP/TET PED INJ 25-5LFU ........................................ 102

DIPENTUM CAP 250MG ........................................... 103

diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml ............. 83

diphenoxylate w/ atropine tab 2.5-0.025 mg ................... 83

dipyridamole tab 25 mg ................................................. 59



disopyramide phosphate cap 100 mg .............................. 62

disopyramide phosphate cap 150 mg .............................. 62

disulfiram tab 250 mg .................................................... 10

disulfiram tab 500 mg .................................................... 10

Diuretics, Carbonic Anhydrase Inhibitors .................. 68

Diuretics, Loop ............................................................. 69

Diuretics, Potassium-sparing ....................................... 69

Diuretics, Thiazide ....................................................... 69

DIURIL SUS 250/5ML .................................................. 69

divalproex sodium cap dr sprinkle 125 mg ..................... 52

divalproex sodium tab dr 125 mg ................................... 52



divalproex sodium tab er 250 mg ................................... 52

divalproex sodium tab er 500 mg ................................... 52

dofetilide cap 125 mcg ................................................... 62



donepezil hydrochloride odt tab 10 mg ........................... 22

donepezil hydrochloride odt tab 5 mg ............................ 22

donepezil hydrochloride tab 10 mg ................................ 22

donepezil hydrochloride tab 23 mg ................................ 22

donepezil hydrochloride tab 5 mg .................................. 22

Dopamine Agonists ...................................................... 39

Dopamine Precursors/ L-Amino Acid Decarboxylase

Inhibitors .................................................................. 40

DORYX MPC TAB 120MG ......................................... 18

dorzolamide hcl ophth soln 2% .................................... 106

dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml

................................................................................ 106

DOVATO TAB 50-300MG ........................................... 48

doxazosin mesylate tab 1 mg .......................................... 87




doxepin hcl cap 10 mg ................................................... 49

doxepin hcl cap 100 mg ................................................. 49

126

doxepin hcl cap 150 mg ................................................. 49




doxepin hcl conc 10 mg/ml ............................................. 49

DOXEPIN HCL CRE 5% .............................................. 77

doxepin tab 3 mg ......................................................... 113

doxepin tab 6 mg ......................................................... 113

doxercalciferol cap 0.5 mcg ......................................... 104

doxercalciferol cap 1 mcg ............................................ 104

doxercalciferol cap 2.5 mcg ......................................... 105

doxycycline hyclate cap 100 mg ..................................... 18

doxycycline hyclate cap 50 mg ....................................... 18

doxycycline hyclate for inj 100 mg ................................. 18

doxycycline hyclate tab 100 mg ...................................... 18

doxycycline hyclate tab 20 mg ........................................ 76

doxycycline hyclate tab delayed release 150 mg ............. 18

doxycycline hyclate tab dr 100 mg ................................. 18



doxycycline hyclate tab dr 50 mg ................................... 18

doxycycline hyclate tab dr 75 mg ................................... 18

doxycycline monohydrate cap 100 mg ............................ 18

doxycycline monohydrate cap 150 mg ............................ 78

doxycycline monohydrate cap 50 mg .............................. 18

doxycycline monohydrate cap 75 mg .............................. 18

doxycycline monohydrate for susp 25 mg/5ml ................ 18

doxycycline monohydrate tab 100 mg ............................. 18

doxycycline monohydrate tab 150 mg ............................. 18

doxycycline monohydrate tab 50 mg............................... 18

doxycycline monohydrate tab 75 mg............................... 18

DRIZALMA CAP 20 MG DR ....................................... 24




dronabinol cap 10 mg .................................................... 26

dronabinol cap 2.5 mg ................................................... 26

dronabinol cap 5 mg ...................................................... 26

drospirenone-ethinyl estradiol tab 3-0.02 mg ................. 92

drospirenone-ethinyl estradiol tab 3-0.03 mg ................. 92

drospirenone-ethinyl estrad-levomefolate tab 3-0.02-0.451

mg ............................................................................. 92

DROXIA CAP 200MG .................................................. 33

DROXIA CAP 300MG .................................................. 33

DROXIA CAP 400MG .................................................. 33

DUAVEE TAB 0.45-20 ................................................. 96

duloxetine hcl cap 20 mg ............................................... 75




duramorph inj pf 0.5 mg/ml.............................................. 8

duramorph inj pf 1 mg/ml ................................................ 8

DUREZOL EMU 0.05% .............................................. 107

dutasteride cap 0.5 mg ................................................... 87

dutasteride-tamsulosin hcl cap 0.5-0.4 mg ..................... 87

Dyslipidemics, Fibric Acid Derivatives ....................... 70

Dyslipidemics, HMG CoA Reductase Inhibitors ........ 70

Dyslipidemics, Other.................................................... 71

econazole nitrate cream 1% ........................................... 27

EDURANT TAB 25MG ................................................ 46

efavirenz cap 200 mg ..................................................... 46

efavirenz cap 50 mg ....................................................... 46

efavirenz tab 600 mg ...................................................... 46

EGRIFTA SOL 1MG..................................................... 90

Electrolyte/Mineral /Metal Modifiers ......................... 79

Electrolyte/Mineral Replacement ................................ 80

ELECTROLYTES/MINERALS/METALS/VITAMINS

.................................................................................. 79

ELESTRIN GEL 0.06% ................................................. 92

ELIGARD INJ 22.5MG ................................................. 98

ELIGARD INJ 30MG .................................................... 98

ELIGARD INJ 45MG .................................................... 98

ELIGARD INJ 7.5MG ................................................... 98

ELIQUIS ST P TAB 5MG ............................................. 57

ELIQUIS TAB 2.5MG................................................... 57

ELIQUIS TAB 5MG ..................................................... 57

ELMIRON CAP 100MG ............................................... 87

eluryng mis .................................................................... 92

EMCYT CAP 140MG ................................................... 33

EMEND SUS 125MG.................................................... 26

Emetogenic Therapy Adjuncts .................................... 26

EMGALITY INJ 100MG/ML ........................................ 30

EMGALITY INJ 120MG/ML ........................................ 30

emoquette tab 0.15 mg-30 mcg ....................................... 92

EMSAM DIS 12MG/24H .............................................. 23

EMSAM DIS 6MG/24HR.............................................. 23

EMSAM DIS 9MG/24HR.............................................. 24

EMTRIVA CAP 200MG ............................................... 47

EMTRIVA SOL 10MG/ML ........................................... 47

enalapril maleate & hydrochlorothiazide tab 10-25 mg .. 67

enalapril maleate & hydrochlorothiazide tab 5-12.5 mg . 67

enalapril maleate tab 10 mg ........................................... 61

enalapril maleate tab 2.5 mg .......................................... 61

enalapril maleate tab 20 mg ........................................... 61

enalapril maleate tab 5 mg............................................. 61

ENBREL INJ 25/0.5ML .............................................. 100

ENBREL INJ 25MG .................................................... 100

ENBREL INJ 50MG/ML ............................................. 100

ENBREL MINI INJ 50MG/ML ................................... 100

ENBREL SRCLK INJ 50MG/ML................................ 100

127

endocet tab 10-325 mg ..................................................... 8

endocet tab 5-325 mg ....................................................... 8

endocet tab 7.5-325 mg .................................................... 8

ENGERIX-B INJ 10/0.5ML ....................................... 102

ENGERIX-B INJ 20MCG/ML.................................... 102

enoxaparin sodium inj 100 mg/ml .................................. 57

enoxaparin sodium inj 120 mg/0.8ml.............................. 57

enoxaparin sodium inj 150 mg/ml .................................. 57

enoxaparin sodium inj 30 mg/0.3ml ............................... 57




enpresse-28 tab .............................................................. 92

enskyce tab .................................................................... 92

ENSTILAR AER ........................................................... 78

entacapone tab 200 mg .................................................. 39

entecavir tab 0.5 mg ...................................................... 45

entecavir tab 1 mg ......................................................... 45

ENTRESTO TAB 24-26MG .......................................... 67

ENTRESTO TAB 49-51MG .......................................... 67

ENTRESTO TAB 97-103MG ........................................ 67

enulose solution 10 gm/15ml .......................................... 84

ENVARSUS XR TAB 0.75MG ................................... 100

ENVARSUS XR TAB 1MG ........................................ 100

ENVARSUS XR TAB 4MG ........................................ 100

EPCLUSA TAB 400-100 ............................................... 45

EPIDIOLEX SOL 100MG/ML ..................................... 19

EPIDUO FORTE GEL 0.3-2.5% ................................... 78

epinastine hcl ophth soln 0.05% ................................... 106

EPINEPHRINE INJ0.15MG ........................................ 110

EPINEPHRINE INJ0.3MG .......................................... 110

epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000)

................................................................................ 110

EPIPEN 2-PAK INJ 0.3MG ......................................... 110

EPIPEN-JR INJ 0.15MG ............................................. 110

epitol tab 200 mg ........................................................... 21

EPIVIR HBV SOL 5MG/ML ........................................ 45

eplerenone tab 25 mg ..................................................... 69

eplerenone tab 50 mg ..................................................... 69

EQUETRO CAP 100MG ............................................... 52

EQUETRO CAP 200MG ............................................... 52

EQUETRO CAP 300MG ............................................... 52

ERAXIS INJ 100MG ..................................................... 27

ERAXIS INJ 50MG ....................................................... 27

ergoloid mesylates tab 1 mg ........................................... 22

Ergot Alkaloids ............................................................ 30

ergotamine w/ caffeine tab 1-100 mg.............................. 30

ERIVEDGE CAP 150MG.............................................. 35

ERLEADA TAB 60MG................................................. 32

erlotinib hcl tab 100 mg ................................................. 35

erlotinib hcl tab 150 mg ................................................. 35

erlotinib hcl tab 25 mg ................................................... 35

errin tab 0.35 mg ........................................................... 96

ertapenem sodium for inj 1 gm ....................................... 15

ERYTHROCIN INJ 500MG ......................................... 17

erythromycin ethylsuccinate for susp 200 mg/5ml .......... 17

erythromycin ethylsuccinate for susp 400 mg/5ml .......... 17

erythromycin ethylsuccinate tab 400 mg......................... 17

erythromycin gel 2% ...................................................... 17

erythromycin ophth oint 5 mg/gm ................................... 17

erythromycin pads 2% ................................................... 17

erythromycin soln 2% .................................................... 17

erythromycin stearate tab 250 mg .................................. 17

erythromycin tab 250 mg bs ........................................... 17

erythromycin tab 500 mg bs ........................................... 17

erythromycin tab dr 250 mg ........................................... 17



erythromycin w/ delayed release particles cap 250 mg ... 17

erythromycin/benzoyl peroxide gel 5-3% ........................ 78

ESBRIET CAP 267MG ............................................... 112

escitalopram oxalate soln 5 mg/5ml ............................... 50

escitalopram oxalate tab 10 mg...................................... 50

escitalopram oxalate tab 20 mg...................................... 50

escitalopram oxalate tab 5 mg ....................................... 50

esgic tab 50-325-40 mg .................................................... 7

esomeprazole magnesium cap dr 20 mg ......................... 85

esomeprazole magnesium cap dr 40 mg ......................... 85

estarylla tab 0.25 mg-35 mcg ......................................... 92

estazolam tab 1 mg ........................................................ 50

estazolam tab 2 mg ........................................................ 50

ESTRACE VAGINAL CREAM 0.1 MG/GM ................ 92

estradiol & norethindrone acetate tab 0.5-0.1 mg .......... 92

estradiol & norethindrone acetate tab 1-0.5 mg ............. 92

estradiol tab 0.5 mg ....................................................... 92

estradiol tab 1 mg .......................................................... 92

estradiol tab 2 mg .......................................................... 92

estradiol td patch twice weekly 0.025 mg/24hr ............... 92

estradiol td patch twice weekly 0.0375 mg/24hr ............. 92

estradiol td patch twice weekly 0.05 mg/24hr ................. 92

estradiol td patch twice weekly 0.075 mg/24hr ............... 92

estradiol td patch twice weekly 0.1 mg/24hr ................... 93

estradiol td patch weekly 0.025 mg/24hr ........................ 93

estradiol td patch weekly 0.0375 mg/24hr ...................... 93

estradiol td patch weekly 0.05 mg/24hr .......................... 93

estradiol td patch weekly 0.06 mg/24hr .......................... 93

estradiol td patch weekly 0.075 mg/24hr ........................ 93

estradiol td patch weekly 0.1 mg/24hr ............................ 93

estradiol vaginal cream 0.1 mg/gm ................................ 93

estradiol vaginal tab 10 mcg .......................................... 93

128

estradiol valerate im in oil 20 mg/ml .............................. 93

estradiol valerate im in oil 40 mg/ml .............................. 93

ESTRING MIS 2MG ..................................................... 93

Estrogens ...................................................................... 91

eszopiclone tab 1 mg .................................................... 113



ethacrynic acid tab 25 mg .............................................. 69

ethambutol hcl tab 100 mg ............................................. 32

ethambutol hcl tab 400 mg ............................................. 32

ethosuximide cap 250 mg ............................................... 19

ethosuximide soln 250 mg/5ml ....................................... 19

ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg

.................................................................................. 93

ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg

.................................................................................. 93

etodolac cap 200 mg ...................................................... 29

etodolac cap 300 mg ...................................................... 29

etodolac tab 400 mg ....................................................... 29

etodolac tab 500 mg ....................................................... 29

etodolac tab er 400 mg .................................................. 29



etonogesteremisethy est................................................... 93

EVENITY INJ 105 MG ............................................... 105

everolimus tab 0.25mg .................................................. 100

everolimus tab 0.5mg .................................................... 100

everolimus tab 0.75mg .................................................. 100 everolimus tab 2.5mg ...................................................... 35

everolimus tab 5mg ......................................................... 35

everolimus tab 7.5mg ...................................................... 35

EVOTAZ TAB 300-150 ................................................ 48

exemestane tab 25 mg .................................................... 34

EXTAVIA INJ 0.3MG................................................... 76

ezetimibe tab 10 mg ....................................................... 71

ezetimibe-simvastatin tab 10-10 mg ............................... 71




falmina tab .................................................................... 93

famciclovir tab 125 mg .................................................. 46



famotidine for susp 40 mg/5ml ....................................... 84

famotidine tab 20 mg ..................................................... 84

famotidine tab 40 mg ..................................................... 84

FANAPT PAK .............................................................. 42

FANAPT TAB 10MG.................................................... 42

FANAPT TAB 12MG.................................................... 42

FANAPT TAB 1MG ..................................................... 42

FANAPT TAB 2MG ..................................................... 42

FANAPT TAB 4MG ..................................................... 42

FANAPT TAB 6MG ..................................................... 42

FANAPT TAB 8MG ..................................................... 42

FARYDAK CAP 10MG ................................................ 35

FARYDAK CAP 20MG ................................................ 35

febuxostat tab 40 mg ...................................................... 29

febuxostat tab 80 mg ...................................................... 29

felbamate susp 600 mg/5ml ............................................ 20

felbamate tab 400 mg ..................................................... 21

felbamate tab 600 mg ..................................................... 21

felodipine tab er 10 mg .................................................. 64

felodipine tab er 2.5 mg ................................................. 64

felodipine tab er 5 mg .................................................... 64

FEMRING MIS 0.05/24H .............................................. 93

FEMRING MIS 0.1MG/24 ............................................ 93

femynor tab 0.25 mg-35 mcg .......................................... 93

FENOFIBRATE CAP 150MG ....................................... 70

FENOFIBRATE CAP 50MG ......................................... 70

fenofibrate micronized cap 130 mg ................................ 70



fenofibrate micronized cap 43 mg .................................. 70

fenofibrate micronized cap 67 mg .................................. 70

fenofibrate tab 120 mg ................................................... 70



fenofibrate tab 40 mg ..................................................... 70



fenofibric cap dr 135 mg ................................................ 70

fenofibric cap dr 45 mg .................................................. 70

fenoprofen calcium tab 600 mg ...................................... 29

FENOPROFEN CAP 400MG ....................................... 29

fentanyl citrate lozenge 1200 mcg .................................... 8

fentanyl citrate lozenge 1600 mcg .................................... 8

fentanyl citrate lozenge 200 mcg ...................................... 8




fentanyl td patch 72hr 100 mcg/hr .................................... 7

fentanyl td patch 72hr 12 mcg/hr ..................................... 7


fentanyl td patch 72hr 37.5 mcg/hr ................................... 7





FERRIPROX SOL 100MG/ML .................................... 79

FERRIPROX TAB 1000MG......................................... 80

FERRIPROX TAB 500MG .......................................... 80

129

FETZIMA CAP 120MG ................................................ 24

FETZIMA CAP 20MG .................................................. 24

FETZIMA CAP 40MG .................................................. 24

FETZIMA CAP 80MG .................................................. 24

FETZIMA CAP TITRATION ........................................ 24

FINACEA AER 15% ..................................................... 78

finasteride tab 5 mg ....................................................... 87

FIRDAPSE TAB 10 MG ............................................... 31

FIRMAGON INJ 120MG .............................................. 98

FIRMAGON INJ 80MG ................................................ 98

FLAREX SUS 0.1% OP .............................................. 107

flavoxate hcl tab 100 mg ................................................ 86

FLEBOGAMMA INJ 5GM/50ML .............................. 101

flecainide acetate tab 100 mg ......................................... 62

flecainide acetate tab 150 mg ......................................... 62

flecainide acetate tab 50 mg ........................................... 62

FLOVENT DISK AER 100MCG ................................. 108

FLOVENT DISK AER 250MCG ................................. 108

FLOVENT DISK AER 50MCG................................... 108

FLOVENT HFA AER 110MCG .................................. 108

FLOVENT HFA AER 220MCG .................................. 109

FLOVENT HFA AER 44MCG .................................... 109

fluconazole for susp 10 mg/ml ........................................ 27

fluconazole for susp 40 mg/ml ........................................ 27

fluconazole in nacl 0.9% inj 200 mg/100ml .................... 27

fluconazole in nacl 0.9% inj 400 mg/200ml .................... 27

fluconazole tab 100 mg .................................................. 27



fluconazole tab 50 mg .................................................... 27

flucytosine cap 250 mg................................................... 27

flucytosine cap 500 mg................................................... 27

fludrocortisone acetate tab 0.1 mg ................................. 89

flunisolide nasal soln 0.025% ...................................... 109

fluocinolone acetonide (otic) oil 0.01% ........................ 107

fluocinolone acetonide cream 0.01% .............................. 89

fluocinolone acetonide cream 0.025% ............................ 89

fluocinolone acetonide oil 0.01% (scalp oil) ................... 89

fluocinolone acetonide oint 0.025% ............................... 89

fluocinolone acetonide soln 0.01% ................................. 89

fluocinonide cream 0.1% ............................................... 89

fluocinonide emulsified base cream 0.05% ..................... 89

fluocinonide gel 0.05% .................................................. 89

fluocinonide oint 0.05% ................................................. 89

fluocinonide soln 0.05% ................................................. 89

fluorometholone ophth susp 0.1% ................................ 107

FLUOROPLEX CRE 1% ............................................... 78

FLUOROURACIL CRE 0.5% ....................................... 78

fluorouracil cream 5% ................................................... 78

fluorouracil soln 2% ...................................................... 78

fluorouracil soln 5% ...................................................... 78

fluoxetine hcl cap 10 mg ................................................ 24



fluoxetine hcl cap dr 90 mg ............................................ 24

fluoxetine hcl solution 20 mg/5ml ................................... 24

fluoxetine hcl tab 10 mg ................................................. 24

fluoxetine hcl tab 20 mg ................................................. 24

fluphenazine decanoate inj 25 mg/ml ............................. 41

fluphenazine hcl elixir 2.5 mg/5ml .................................. 41

fluphenazine hcl inj 2.5 mg/ml........................................ 41

fluphenazine hcl oral conc 5 mg/ml ................................ 41

fluphenazine hcl tab 1 mg .............................................. 41

fluphenazine hcl tab 10 mg............................................. 41

fluphenazine hcl tab 2.5 mg............................................ 41

fluphenazine hcl tab 5 mg .............................................. 41

flurandrenolide cream 0.05% ......................................... 89

flurbiprofen sodium ophth soln 0.03% .......................... 107

flurbiprofen tab 100 mg ................................................. 29

flutamide cap 125 mg ..................................................... 32

fluticasone propionate cream 0.05% .............................. 89

fluticasone propionate lotion 0.05% ............................... 89

fluticasone propionate nasal susp 50 mcg/act ............... 109

fluticasone propionate oint 0.005% ................................ 89

fluticasone/salmeterol inhal 100/50.............................. 112



fluvastatin sodium cap 20 mg ......................................... 70

fluvastatin sodium cap 40 mg ......................................... 70

fluvastatin sodium tab er 80 mg ..................................... 70

fluvoxamine maleate cap er 100 mg ............................... 24

fluvoxamine maleate cap er 150 mg ............................... 24

fluvoxamine maleate tab 100 mg .................................... 24

fluvoxamine maleate tab 25 mg ...................................... 24

fluvoxamine maleate tab 50 mg ...................................... 24

FML FORTE SUS 0.25% OP ...................................... 107

FML OIN 0.1% OP...................................................... 107

fondaparinux sodium subcutaneous inj 10 mg/0.8ml....... 57

fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml...... 57

fondaparinux sodium subcutaneous inj 5 mg/0.4ml ........ 57

fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml...... 57

FORFIVO XL TAB 450MG ......................................... 23

FORTEO SOL 600/2.4 ................................................ 105

fosamprenavir calcium tab 700 mg ................................ 48

fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg 67

fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg 67

fosinopril sodium tab 10 mg ........................................... 61



FOSRENOL POW 1000MG .......................................... 82

130

FOSRENOL POW 750MG ............................................ 82

FRAGMIN INJ 10000/ML............................................. 57

FRAGMIN INJ 12500UNT ........................................... 57

FRAGMIN INJ 15000UNT ........................................... 57

FRAGMIN INJ 18000UNT ........................................... 57

FRAGMIN INJ 2500/0.2 ............................................... 57

FRAGMIN INJ 5000/0.2 ............................................... 57

FRAGMIN INJ 7500/0.3 ............................................... 57

FRAGMIN INJ 95000UNT ........................................... 57

FREAMINE HBC INJ 6.9% .......................................... 81

frovatriptan succinate tab 2.5 mg ................................... 31

FULPHILA INJ 6/0.6ML................................................ 58

furosemide inj 10 mg/ml ................................................. 69

furosemide oral soln 10 mg/ml ....................................... 69

furosemide oral soln 8 mg/ml ......................................... 69

furosemide tab 20 mg ..................................................... 69



FUZEON INJ 90MG ..................................................... 48

fyavolv tab 0.5 mg-2.5 mcg ............................................ 93

fyavolv tab 1 mg-5 mcg .................................................. 93

FYCOMPA SUS 0.5MG/ML ......................................... 21

FYCOMPA TAB 10MG ................................................ 21

FYCOMPA TAB 12MG ................................................ 21

FYCOMPA TAB 2MG .................................................. 21

FYCOMPA TAB 4MG .................................................. 21

FYCOMPA TAB 6MG .................................................. 21

FYCOMPA TAB 8MG .................................................. 21

GABA Receptor Modulators ..................................... 113

gabapentin cap 100 mg .................................................. 20



gabapentin oral soln 250 mg/5ml ................................... 20

gabapentin tab 600 mg................................................... 20

gabapentin tab 800 mg................................................... 20

GALAFOLD CAP 123MG ............................................ 86

galantamine hydrobromide cap er 16 mg ....................... 22

galantamine hydrobromide cap er 24 mg ....................... 22

galantamine hydrobromide cap er 8 mg ......................... 22

galantamine hydrobromide oral soln 4 mg/ml ................ 22

galantamine hydrobromide tab 12 mg ............................ 22

galantamine hydrobromide tab 4 mg .............................. 22

galantamine hydrobromide tab 8 mg .............................. 22

Gamma-aminobutyric Acid (GABA) Augmenting

Agents ....................................................................... 19

GAMMAGARD INJ 2.5GM/25 .................................. 101

GAMMAGARD SD INJ 10GM HU ............................ 101

GAMMAGARD SD INJ 5GM HU .............................. 101

GAMMAKED INJ 1GM/10ML ................................... 101

GAMMAPLEX INJ 5% .............................................. 101

GAMUNEX-C INJ 1GM/10ML ................................. 102

GARDASIL 9 INJ ...................................................... 102

GASTROINTESTINAL AGENTS.............................. 83

Gastrointestinal Agents, Other .................................... 83

gatifloxacin ophth soln 0.5% .......................................... 17

GATTEX KIT 5MG ...................................................... 83

GAUZE PADS & DRESSINGS - PADS 2 X 2 .............. 79

gavilyte-c sol ................................................................. 83

gavilyte-n solflav pk ....................................................... 83

GELNIQUE GEL 10% PUMP ....................................... 86

gemfibrozil tab 600 mg .................................................. 70

generlac solution 10 gm/15ml ........................................ 84

Genetic or Enzyme Disorder: Replacement, Modifiers,

Treatment ................................................................. 85

GENETIC OR ENZYME DISORDER:

REPLACEMENT, MODIFIERS, TREATMENT .. 85

gengraf cap 100 mg ..................................................... 100

gengraf cap 25 mg ....................................................... 100

gengraf sol 100 mg/ml ................................................. 100

GENITOURINARY AGENTS .................................... 86

Genitourinary Agents, Other ...................................... 87

GENOTROPIN INJ 12MG ........................................... 90

GENOTROPIN INJ 1MG ............................................. 90



GENOTROPIN INJ0.2MG ........................................... 90








gentak oint 0.3% ............................................................ 11

gentamicin in saline inj 0.8 mg/ml .................................. 11

gentamicin in saline inj 1 mg/ml..................................... 11



gentamicin sulfate cream 0.1% ...................................... 11

gentamicin sulfate inj 40 mg/ml...................................... 11

gentamicin sulfate oint 0.1% .......................................... 11

gentamicin sulfate ophth soln 0.3% ................................ 11

GENVOYA TAB .......................................................... 46

GEODON INJ 20MG .................................................... 51

gianvi tab 3-0.02 mg ...................................................... 93

GILENYA CAP 0.5MG ................................................. 76

GILOTRIF TAB 20MG ................................................. 35

GILOTRIF TAB 30MG ................................................. 35

GILOTRIF TAB 40MG ................................................. 35

GLASSIA INJ ............................................................... 86

131

glatiramer inj 20 mg/ml ................................................. 76

glatiramer inj 40 mg/ml ................................................. 76

glatopa inj 20 mg/ml ...................................................... 76

glatopa inj 40 mg/ml ...................................................... 76

GLEOSTINE CAP 100MG ........................................... 32

GLEOSTINE CAP 10MG............................................. 32

GLEOSTINE CAP 40MG............................................. 32

glimepiride tab 1 mg ...................................................... 53



glipizide tab 10 mg ........................................................ 53

glipizide tab 5 mg .......................................................... 53

glipizide tab er 10 mg .................................................... 53

glipizide tab er 2.5 mg ................................................... 53

glipizide tab er 5 mg ...................................................... 53

glipizide-metformin hcl tab 2.5-250 mg .......................... 53

glipizide-metformin hcl tab 2.5-500 mg .......................... 53

glipizide-metformin hcl tab 5-500 mg ............................. 53

GLUCAGEN INJ HYPOKIT ......................................... 55

GLUCAGON KIT 1MG ................................................ 55

Glucocorticoids .......................................................... 103

Glutamate Reducing Agents ........................................ 20

glyburide micronized tab 1.5 mg .................................... 53

glyburide micronized tab 3 mg ....................................... 53

glyburide micronized tab 6 mg ....................................... 53

glyburide tab 1.25 mg .................................................... 53

glyburide tab 2.5 mg ...................................................... 53

glyburide tab 5 mg ......................................................... 53

glyburide-metformin tab 1.25-250 mg ............................ 53

glyburide-metformin tab 2.5-500 mg .............................. 53

glyburide-metformin tab 5-500 mg ................................. 53

Glycemic Agents .......................................................... 55

glycopyrrolate tab 1 mg ................................................. 83

glycopyrrolate tab 2 mg ................................................. 83

GOLYTELY SOL ......................................................... 83

granisetron hcl tab 1 mg ................................................ 26

GRANIX INJ 300/0.5 .................................................... 58

GRANIX INJ 300/1ML ................................................. 58

GRANIX INJ 480/0.8 .................................................... 58

GRANIX INJ 480/1.6 .................................................... 58

griseofulvin microsize susp 125 mg/5ml ......................... 27

griseofulvin microsize tab 500 mg .................................. 27

griseofulvin ultramicrosize tab 125 mg .......................... 27

griseofulvin ultramicrosize tab 250 mg .......................... 28

guanfacine hcl tab 1 mg ................................................. 60

guanfacine hcl tab 2 mg ................................................. 60

guanfacine hcl tab er 1 mg ............................................. 74




GUANIDINE TAB 125MG .......................................... 31

H.P. ACTHAR INJ 80UNIT .......................................... 89

hailey 24 tab fe .............................................................. 93

halobetasol propionate cream 0.05% ............................. 89

halobetasol propionate oint 0.05% ................................. 89

haloperidol decanoate im soln 100 mg/ml ...................... 41

haloperidol decanoate im soln 50 mg/ml ........................ 41

haloperidol lactate inj 5 mg/ml ...................................... 41

haloperidol lactate oral conc 2 mg/ml ............................ 41

haloperidol tab 0.5 mg ................................................... 41

haloperidol tab 1 mg ...................................................... 41

haloperidol tab 10 mg .................................................... 41


haloperidol tab 20 mg .................................................... 41


HARVONI TAB 90-400MG .......................................... 45

HAVRIX INJ 1440UNIT ............................................. 102

HAVRIX INJ 720UNIT ............................................... 102

Hemostasis Agent ......................................................... 59

heparin sodium (porcine) inj 1000 unit/ml ..................... 57

heparin sodium (porcine) inj 10000 unit/ml.................... 57

heparin sodium (porcine) inj 20000 unit/ml.................... 57

heparin sodium (porcine) inj 5000 unit/ml ..................... 57

HEPATAMINE SOL 8% .............................................. 81

HETLIOZ CAP 20MG ................................................ 113

HIBERIX SOL 10MCG ............................................... 102

Histamine2 (H2) Receptor Antagonists ....................... 84

Hormonal Agents, Stimulant/Replacement/Modifying

(Adrenal) .................................................................. 88

HORMONAL AGENTS,

STIMULANT/REPLACEMENT/MODIFYING

(ADRENAL) ............................................................. 88


(Pituitary) ................................................................. 90

HORMONAL AGENTS,


(PITUITARY) .......................................................... 90

HORMONAL AGENTS,


(SEX ......................................................................... 91


(Thyroid) .................................................................. 96

HORMONAL AGENTS,


(THYROID) ............................................................. 96

Hormonal Agents, Suppressant (Adrenal) .................. 98

HORMONAL AGENTS, SUPPRESSANT (ADRENAL)

.................................................................................. 98

Hormonal Agents, Suppressant (Pituitary) ................. 98

HORMONAL AGENTS, SUPPRESSANT

(PITUITARY) .......................................................... 98

132

HORMONAL AGENTS, SUPPRESSANT (THYROID)

.................................................................................. 99

HUMALOG INJ 100/ML .............................................. 55

HUMALOG JR INJ 100/ML ........................................ 55

HUMALOG KWIK INJ 100/ML ................................... 55

HUMALOG KWIK INJ 200/ML ................................... 56

HUMALOG MIX INJ 50/50 .......................................... 56

HUMALOG MIX INJ 50/50 KWP ................................ 56

HUMALOG MIX INJ 75/25 KWP ................................ 56

HUMALOG MIX SUS 75/25 ........................................ 56

HUMATROPE INJ 12MG ............................................ 90

HUMATROPE INJ 24MG ............................................ 91

HUMATROPE INJ 5MG .............................................. 91

HUMATROPE INJ 6MG .............................................. 91

HUMIRA INJ 10/0.1ML.............................................. 100

HUMIRA INJ 10MG/0.2 ............................................. 100

HUMIRA INJ 20/0.2ML.............................................. 100

HUMIRA INJ 40/0.4ML.............................................. 100

HUMIRA KIT 20MG/0.4 ............................................ 100

HUMIRA KIT 40MG/0.8 ............................................ 100

HUMIRA PEN INJ 40/0.4ML .................................... 100

HUMIRA PEN INJ 40MG/0.8 .................................... 100

HUMIRA PEN INJ CD/UC/HS .................................. 100

HUMIRA PEN INJ PS/UV ......................................... 100

HUMIRA PEN KIT CD/UC/HS ................................. 100

HUMIRA PEN KIT PS/UV ........................................ 100

HUMULIN INJ 70/30 .................................................... 56

HUMULIN INJ 70/30 KWP .......................................... 56

HUMULIN N INJ U-100 .............................................. 56

HUMULIN N INJ U-100 KWP .................................... 56

HUMULIN R INJ U-100 .............................................. 56

HUMULIN R INJ U-500 .............................................. 56

hydralazine hcl tab 10 mg .............................................. 72

hydralazine hcl tab 100 mg ............................................ 72



hydrochlorothiazide cap 12.5 mg ................................... 69

hydrochlorothiazide tab 12.5 mg .................................... 69

hydrochlorothiazide tab 25 mg ....................................... 69

hydrochlorothiazide tab 50 mg ....................................... 69

hydrocodone-acetaminophen soln 7.5-325 mg/15ml ......... 9

hydrocodone-acetaminophen tab 10-300 mg .................... 9

hydrocodone-acetaminophen tab 10-325 mg .................... 9

hydrocodone-acetaminophen tab 5-300 mg ...................... 9

hydrocodone-acetaminophen tab 5-325 mg ...................... 9

hydrocodone-acetaminophen tab 7.5-300 mg ................... 9

hydrocodone-acetaminophen tab 7.5-325 mg ................... 9

hydrocodone-ibuprofen tab 10-200 mg ............................. 9

hydrocodone-ibuprofen tab 5-200 mg .............................. 9

hydrocodone-ibuprofen tab 7.5-200 mg ............................ 9

hydrocortisone butyrate cream 0.1% .............................. 89

hydrocortisone butyrate oint 0.1% ................................. 89

hydrocortisone butyrate soln 0.1% ................................. 89

hydrocortisone cream 2.5% ........................................... 89

hydrocortisone enema 100 mg/60ml ............................. 104

hydrocortisone lotion 2.5% ............................................ 89

hydrocortisone oint 2.5% ............................................... 89

hydrocortisone tab 10 mg............................................. 104

hydrocortisone tab 20 mg............................................. 104

hydrocortisone tab 5 mg .............................................. 104

hydrocortisone valerate cream 0.2% .............................. 89

hydrocortisone valerate oint 0.2% ................................. 89

hydrocortisone w/ acetic acid otic soln 1-2% ............... 107

hydromorphone hcl liqd 1 mg/ml ...................................... 9

hydromorphone hcl preservative free (pf) inj 10 mg/ml .... 9

hydromorphone hcl tab 2 mg............................................ 9



hydromorphone hcl tab er 12 mg ..................................... 7



hydromorphone hcl tab er 8 mg ....................................... 7

hydroxychloroquine sulfate tab 200 mg .......................... 39

hydroxyurea cap 500 mg ................................................ 33

hydroxyzine hcl syrup 10 mg/5ml ................................. 108

hydroxyzine hcl tab 10 mg.............................................. 49



hydroxyzine pamoate cap 100 mg................................... 49

hydroxyzine pamoate cap 25 mg .................................... 49

hydroxyzine pamoate cap 50 mg .................................... 49

ibandronate sodium tab 150 mg ................................... 105

IBRANCE CAP 100MG ................................................ 35

IBRANCE CAP 125MG ................................................ 35

IBRANCE CAP 75MG .................................................. 35

IBRANCE TAB 100MG ................................................ 35

IBRANCE TAB 125MG ................................................ 35

IBRANCE TAB 75MG .................................................. 35

ibuprofen susp 100 mg/5ml ............................................ 29

ibuprofen tab 400 mg ..................................................... 29

ibuprofen tab 600 mg ..................................................... 29

ibuprofen tab 800 mg ..................................................... 29

icatibant inj 30mg/3ml .................................................... 99

ICLUSIG TAB 15MG ................................................... 35

ICLUSIG TAB 45MG ................................................... 35

IDHIFA TAB 100MG.................................................... 35

IDHIFA TAB 50MG ..................................................... 36

ILEVRO DRO 0.3% OP .............................................. 107

ILUMYA SOL 100MG/ML ........................................... 78

imatinib mesylate tab 100 mg ......................................... 36

133

imatinib mesylate tab 400 mg ......................................... 36

IMBRUVICA CAP 140MG .......................................... 36

IMBRUVICA CAP 70MG ............................................ 36

IMBRUVICA TAB 140MG .......................................... 36

IMBRUVICA TAB 280MG ........................................... 36

IMBRUVICA TAB 420MG ........................................... 36

IMBRUVICA TAB 560MG ........................................... 36

imipenem-cilastatin intravenous for soln 250 mg............ 15

imipenem-cilastatin intravenous for soln 500 mg............ 15

imipramine hcl tab 10 mg .............................................. 25



imipramine pamoate cap 100 mg ................................... 25



imipramine pamoate cap 75 mg ..................................... 26

imiquimod cream 5% ..................................................... 78

Immune Suppressants ................................................. 99

Immunizing Agents, Passive ...................................... 101

IMMUNOLOGICAL AGENTS .................................. 99

Immunomodulators ................................................... 102

IMOVAX RABIE INJ 2.5/ML ..................................... 102

INBRIJA CAP 42 MG ................................................... 98

incassia tab 0.35 mg ...................................................... 96

INCRELEX INJ 40MG/4ML ......................................... 91

INCRUSE ELPTA INH 62.5MCG ............................... 109

indapamide tab 1.25 mg ................................................. 69

indapamide tab 2.5 mg ................................................... 69

indomethacin cap 25 mg ................................................ 29

indomethacin cap 50 mg ................................................ 29

indomethacin cap er 75 mg ............................................ 29

INFANRIX INJ ........................................................... 102

INFLAMMATORY BOWEL DISEASE AGENTS .. 103

INLYTA TAB 1MG ...................................................... 36

INLYTA TAB 5MG ...................................................... 36

INNOPRAN XL CAP 120MG ....................................... 63

INNOPRAN XL CAP 80MG ......................................... 63

INREBIC CAP 100MG ................................................. 36

INS ASP PROT INJ FLEXPEN ...................................... 56

INSULIN ASPA INJ 100/ML ......................................... 56

INSULIN ASPA INJ 70/30 ............................................. 56 INSULIN ASPA INJ FLEXPEN ..................................... 56

INSULIN ASPA INJ PENFILL ..................................... 56

INSULIN PEN NEEDLE ............................................... 79

INSULIN SYRINGE (DISP) U-100 0.3 ML .................. 79

INSULIN SYRINGE (DISP) U-100 1 ML ..................... 79

INSULIN SYRINGE (DISP) U-100 1/2 ML .................. 79

Insulins ......................................................................... 55

INTELENCE TAB 100MG .......................................... 46

INTELENCE TAB 200MG .......................................... 46

INTELENCE TAB 25MG ............................................ 47

intralipid inj 20%........................................................... 81

INTRON A INJ 10MU .................................................. 45

INTRON A INJ 18MU (POWDER) ............................... 45

INTRON A INJ 18MU (SOLUTION) ............................ 45

INTRON A INJ 25MU .................................................. 45

INTRON A INJ 50MU .................................................. 45

introvale tab .................................................................. 93

INVEGA SUST INJ 117/0.75 ........................................ 42

INVEGA SUST INJ 156MG/ML ................................... 42

INVEGA SUST INJ 234/1.5 .......................................... 42

INVEGA SUST INJ 39/0.25 .......................................... 43

INVEGA SUST INJ 78/0.5ML ...................................... 43

INVEGA TRINZINJ 273MG ......................................... 43




INVIRASE TAB 500MG ............................................... 48

INVOKAMET TAB150-1000 ...................................... 53

INVOKAMET TAB150-500 ........................................ 53

INVOKAMET TAB50-1000 ........................................ 53

INVOKAMET TAB50-500MG .................................... 53

INVOKAMET XRTAB150-1000 .................................. 53

INVOKAMET XRTAB150-500 .................................... 53

INVOKAMET XRTAB50-1000 .................................... 54

INVOKAMET XRTAB50-500MG ................................ 54

INVOKANA TAB 100MG ............................................ 54

INVOKANA TAB 300MG ............................................ 54

IOPIDINE SOL 1% OP ............................................... 106

IPOL INJ INACTIVE .................................................. 102

ipratropium bromide inhal soln 0.02% ......................... 109

ipratropium bromide nasal soln 0.03% ........................ 109

ipratropium bromide nasal soln 0.06% ........................ 109

ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml ...... 112

irbesartan tab 150 mg .................................................... 60

irbesartan tab 300 mg .................................................... 60

irbesartan tab 75 mg ...................................................... 60

irbesartan-hydrochlorothiazide tab 150-12.5 mg ............ 67

irbesartan-hydrochlorothiazide tab 300-12.5 mg ............ 67

IRESSA TAB 250MG ................................................... 36

Irritable Bowel Syndrome Agents ............................... 84

ISENTRESS CHW 100MG .......................................... 46

ISENTRESS CHW 25MG ............................................ 46

ISENTRESS HD TAB 600MG ...................................... 46

ISENTRESS POW 100MG ........................................... 46

ISENTRESS TAB 400MG ........................................... 46

isibloom tab ................................................................... 93

ISOLYTE-P INJ/D5W .................................................. 81

ISOLYTE-S INJ ............................................................ 81

isoniazid syrup 50 mg/5ml ............................................. 32

134

isoniazid tab 100 mg ...................................................... 32

isoniazid tab 300 mg ...................................................... 32

ISOPROPYL ALCOHOL 0.7 ML/ML MEDICATED PAD

.................................................................................. 79

isosorbide dinitrate tab 10 mg ........................................ 72




isosorbide dinitrate tab 5 mg.......................................... 72

isosorbide mononitrate tab 10 mg .................................. 72

isosorbide mononitrate tab 20 mg .................................. 72

isosorbide mononitrate tab er 120 mg ............................ 72

isosorbide mononitrate tab er 30 mg .............................. 72

isosorbide mononitrate tab er 60 mg .............................. 72

isotretinoin cap 10 mg ................................................... 78




isradipine cap 2.5 mg..................................................... 64

isradipine cap 5 mg ....................................................... 64

itraconazole cap 100 mg ................................................ 28

itraconazole oral soln 10 mg/ml ..................................... 28

ivermectin cream 1% ..................................................... 38

ivermectin tab 3 mg ....................................................... 38

IXIARO INJ ................................................................ 102

JADENU SPRKL GRA 180MG .................................... 80

JADENU SPRKL GRA 360MG .................................... 80

JADENU SPRKL GRA 90MG ...................................... 80

JADENU TAB 180MG .................................................. 80

JAKAFI TAB 10MG ..................................................... 36

JAKAFI TAB 15MG ..................................................... 36

JAKAFI TAB 20MG ..................................................... 36

JAKAFI TAB 25MG ..................................................... 36

JAKAFI TAB 5MG ....................................................... 36

jantoven tab 1 mg .......................................................... 57

jantoven tab 10 mg ........................................................ 57

jantoven tab 2 mg .......................................................... 57

jantoven tab 2.5 mg........................................................ 57

jantoven tab 3 mg .......................................................... 57

jantoven tab 4 mg .......................................................... 57

jantoven tab 5 mg .......................................................... 57

jantoven tab 6 mg .......................................................... 57

jantoven tab 7.5 mg........................................................ 57

JANUMET TAB 50-1000MG ........................................ 54

JANUMET TAB 50-500MG.......................................... 54

JANUMET XR TAB 100-1000MG .............................. 54

JANUMET XR TAB 50-1000MG ................................ 54

JANUMET XR TAB 50-500MG .................................. 54

JANUVIA TAB 100MG ................................................ 54

JANUVIA TAB 25MG .................................................. 54

JANUVIA TAB 50MG .................................................. 54

JARDIANCE TAB 10MG ............................................ 54

JARDIANCE TAB 25MG ............................................ 54

jasmiel tab 3-0.02mg....................................................... 93

JENTADUETO TAB 2.5-1000MG ............................... 54

JENTADUETO TAB 2.5-500MG ................................. 54

JENTADUETO TAB 2.5-850MG ................................. 54

JENTADUETO TAB XR 2.5-1000MG .......................... 54

JENTADUETO TAB XR 5-1000MG ............................ 54

jinteli tab 1 mg-5 mcg .................................................... 93

juleber tab 0.15 mg-30 mcg............................................ 93

JULUCA TAB 50-25MG ............................................... 47

junel fe tab 1 mg-20 mcg ................................................ 93

junel fe tab 1 mg-20 mcg (24) ........................................ 93

junel fe tab 1.5 mg-30 mcg ............................................. 93

junel tab 1 mg-20 mcg.................................................... 93

junel tab 1.5 mg-30 mcg ................................................. 93

JUXTAPID CAP 10MG ................................................ 71

JUXTAPID CAP 20MG ................................................ 71

JUXTAPID CAP 30MG ................................................ 71

JUXTAPID CAP 40MG ................................................ 71

JUXTAPID CAP 5MG .................................................. 71

JUXTAPID CAP 60MG ................................................ 71

kaitlib fe chew tab 0.8 mg-25 mcg .................................. 93

KALETRA TAB 100-25MG.......................................... 48

KALETRA TAB 200-50MG.......................................... 48

KALYDECO PAK 25MG ........................................... 110

KALYDECO PAK 50MG ........................................... 110

KALYDECO PAK 75MG ........................................... 110

KALYDECO TAB 150MG ......................................... 110

kariva tab28 day ............................................................ 93

kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj . 81

kcl 20 meq/l (0.15%) in d5w lactated ringers ................. 81

kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj ..... 81

kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj ... 81


kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj . 81


kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.9% inj....... 81

kelnor tab 1 mg-35 mcg ................................................. 93

kelnor tab 1 mg-50 mcg ................................................. 93

ketoconazole cream 2% ................................................. 28

ketoconazole foam 2% ................................................... 28

ketoconazole shampoo 2% ............................................. 28

ketoconazole tab 200 mg ................................................ 28

ketoprofen cap er 200 mg ............................................... 30

ketorolac tromethamine ophth soln 0.4% ..................... 107

ketorolac tromethamine ophth soln 0.5% ..................... 107

ketorolac tromethamine tab 10 mg ................................. 30

KEVEYIS TAB 50MG .................................................. 68

135

KINERET INJ ............................................................. 100

KINRIX INJ ................................................................ 102

kionex susp 15 gm/60ml ................................................. 80

KISQALI 200 PAK FEMARA ...................................... 33



KISQALI TAB 200DOSE ............................................. 36

KISQALI TAB 400DOSE ............................................. 36

KISQALI TAB 600DOSE ............................................. 36

klor-con 10 tab 10 meq er .............................................. 81

klor-con 8 tab 8 meq er .................................................. 81

klor-con m 10 tab 10 meq er .......................................... 81



KORLYM TAB 300MG ................................................ 55

KOSELUGO CAP 10MG ............................................... 36

KOSELUGO CAP 25MG ............................................... 36

kristalose packet 10 gm .................................................. 84

kristalose packet 20 gm .................................................. 84

kurvelo tab 0.15 mg-30 mcg ........................................... 93

KUVAN POW 100MG .................................................. 86

KUVAN POW 500MG .................................................. 86

KUVAN TAB 100MG ................................................... 86

labetalol hcl tab 100 mg................................................. 63



LACRISERT MIS 5MG OP ........................................ 105

lactic acid (ammonium lactate) cream 12% .................... 78

lactic acid (ammonium lactate) lotion 12% .................... 78

lactulose oral crystal packet 10 gm ................................ 85

lactulose solution 10 gm/15ml ........................................ 85

lamivudine oral soln 10 mg/ml ....................................... 47

lamivudine tab 100 mg (hbv) .......................................... 45

lamivudine tab 150 mg ................................................... 47

lamivudine tab 300 mg ................................................... 47

lamivudine-zidovudine tab 150-300 mg .......................... 47

lamotrigine odt tab 100 mg ............................................ 52

lamotrigine odt tab 200 mg ............................................ 52

lamotrigine odt tab 25 mg .............................................. 52

lamotrigine odt tab 50 mg .............................................. 52

lamotrigine tab 100 mg .................................................. 52



lamotrigine tab 25 mg .................................................... 52

lamotrigine tab 25 mg (35) starter kit ............................. 52

lamotrigine tab 25 mg (42) & 100 mg (7) starter kit ....... 52

lamotrigine tab 25 mg (84) & 100 mg (14) starter kit ..... 52

lamotrigine tab chewable dispersible 25 mg ................... 52

lamotrigine tab chewable dispersible 5 mg ..................... 52

lamotrigine tab er 100 mg .............................................. 52


lamotrigine tab er 25 mg ................................................ 52



lamotrigine tab er 50 mg ................................................ 52

LANOXIN TAB 0.0625MG .......................................... 67

lansoprazole cap dr 15 mg ............................................. 85

lansoprazole cap dr 30 mg ............................................. 85

lanthanum carbonate chew tab 1000 mg ........................ 82

lanthanum carbonate chew tab 500 mg .......................... 82

lanthanum carbonate chew tab 750 mg .......................... 82

LANTUS INJ 100/ML ................................................... 56

LANTUS SOLOSTAR INJ 100/ML .............................. 56

larin fe tab 1 mg-20 mcg ................................................ 93

larin fe tab 1.5 mg-30 mcg ............................................. 93

larin tab 1 mg-20 mcg .................................................... 94

larin tab 1.5 mg-30 mcg ................................................. 94

larissia tab 0.1 mg-20 mcg ............................................. 94

LASTACAFT SOL 0.25% .......................................... 106

latanoprost ophth soln 0.005%..................................... 107

LATUDA TAB 120MG ................................................. 43

LATUDA TAB 20MG ................................................... 43

LATUDA TAB 40MG ................................................... 43

LATUDA TAB 60MG ................................................... 43

LATUDA TAB 80MG ................................................... 43

Laxatives ...................................................................... 84

layolis fe chew tab 0.8 mg-25 mcg .................................. 94

LEDIPASVIR/SOFOSBUVIR TAB 90-400MG ............ 45

leena tab ........................................................................ 94

leflunomide tab 10 mg .................................................. 102

leflunomide tab 20 mg .................................................. 102

LENVIMA CAP 10 MG ................................................ 36

LENVIMA CAP 12MG ................................................. 36

LENVIMA CAP 14 MG ................................................ 36

LENVIMA CAP 18 MG ................................................ 36

LENVIMA CAP 20 MG ................................................ 36

LENVIMA CAP 24 MG ................................................ 36

LENVIMA CAP 4MG ................................................... 36

LENVIMA CAP 8MG ................................................... 36

lessina tab 0.1 mg-20 mcg .............................................. 94

letrozole tab 2.5 mg ....................................................... 34

leucovorin calcium tab 10 mg ........................................ 33



leucovorin calcium tab 5 mg .......................................... 33

LEUKERAN TAB 2MG ................................................ 32

LEUKINE INJ 250MCG ............................................... 58

leuprolide acetate inj kit 5 mg/ml ................................... 98

LEVALBUTEROL AER 45/ACT ................................ 110

levalbuterol hcl soln nebu 0.31 mg/3ml ........................ 110

136



levalbuterol hcl soln nebu conc 1.25 mg/0.5ml ............. 110

LEVEMIR INJ .............................................................. 56

LEVEMIR INJ FLEXTOUCH ....................................... 56

levetiracetam oral soln 100 mg/ml ................................. 19

levetiracetam tab 1000 mg ............................................. 19

levetiracetam tab 250 mg ............................................... 19



levetiracetam tab er 500 mg ........................................... 19

levetiracetam tab er 750 mg ........................................... 19

levobunolol hcl ophth soln 0.5% .................................. 106

levocarnitine oral soln 1 gm/10ml .................................. 80

levocarnitine tab 330 mg ................................................ 80

levocetirizine dihydrochloride soln 2.5 mg/5ml ............ 108

levocetirizine dihydrochloride tab 5 mg ....................... 108

levofloxacin in d5w iv soln 500 mg/100ml ...................... 17

levofloxacin in d5w iv soln 750 mg/150ml ...................... 17

levofloxacin iv soln 25 mg/ml ......................................... 17

levofloxacin ophth soln 0.5% ......................................... 17

levofloxacin oral soln 25 mg/ml ..................................... 17

levofloxacin tab 250 mg ................................................. 17



levonest tab.................................................................... 94

levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03

mg ............................................................................. 94

levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg .... 94

levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg... 94

levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-

mcg ............................................................................ 94

levonorgestrel-ethinyl estradiol (continuous) tab 90-20

mcg ............................................................................ 94

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7) .................................................................. 94

levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7) .................................................................. 94

levora-28 tab 0.15 mg-30 mcg........................................ 94

levorphanol tartrate tab 2 mg .......................................... 7

levo-t tab 100 mcg ......................................................... 97

levo-t tab 112 mcg ......................................................... 97

levo-t tab 125 mcg ......................................................... 97

levo-t tab 137 mcg ......................................................... 97

levo-t tab 150 mcg ......................................................... 97

levo-t tab 175 mcg ......................................................... 97

levo-t tab 200 mcg ......................................................... 97

levo-t tab 25 mcg ........................................................... 97

levo-t tab 300 mcg ......................................................... 97

levo-t tab 50 mcg ........................................................... 97

levo-t tab 75 mcg ........................................................... 97

levo-t tab 88 mcg ........................................................... 97

levothyroxine sodium tab 100 mcg ................................. 97







levothyroxine sodium tab 25 mcg ................................... 97





LEXIVA SUS 50MG/ML .............................................. 48

lidocaine hcl soln 4% ..................................................... 10

lidocaine hcl urethral/mucosal gel 2% ........................... 10

lidocaine hcl viscous soln 2% ........................................ 10

lidocaine oint 5% ........................................................... 10

lidocaine patch 5% ........................................................ 10

lidocaine-prilocaine cream 2.5-2.5% ............................. 10

lindane shampoo 1% ...................................................... 39

linezolid for susp 100 mg/5ml ........................................ 12

linezolid inj 2 mg/ml ...................................................... 12

linezolid tab 600 mg....................................................... 12

LINZESS CAP 145MCG ............................................... 84

LINZESS CAP 290MCG ............................................... 84

LINZESS CAP 72MCG ................................................. 84

liothyronine sodium tab 25 mcg ..................................... 97

liothyronine sodium tab 5 mcg ....................................... 97

liothyronine sodium tab 50 mcg ..................................... 97

lisinopril & hydrochlorothiazide tab 10-12.5 mg ............ 67

lisinopril & hydrochlorothiazide tab 20-12.5 mg ............ 67

lisinopril & hydrochlorothiazide tab 20-25 mg ............... 67

lisinopril tab 10 mg ........................................................ 61

lisinopril tab 2.5 mg ....................................................... 61




lisinopril tab 5 mg.......................................................... 61

lithium carbonate cap 150 mg ........................................ 52



lithium carbonate tab 300 mg ........................................ 53

lithium carbonate tab er 300 mg .................................... 53

lithium carbonate tab er 450 mg .................................... 53

LITHIUM SOL 8MEQ/5ML.......................................... 52

LIVALO TAB 1MG ...................................................... 70

LIVALO TAB 2MG ...................................................... 70

LIVALO TAB 4MG ...................................................... 70

137

LO LOESTRIN TAB1-10-10 ......................................... 94

Local Anesthetics ......................................................... 10

lodine tab 400 mg .......................................................... 30

LOKELMA PAK 10GM ................................................ 80

LOKELMA PAK 5GM .................................................. 80

LONSURF TAB 15-6.14 ............................................... 33

LONSURF TAB 20-8.19 ............................................... 33

loperamide hcl cap 2 mg ................................................ 83

lopinavir-ritonavir soln 80-20 mg/ml ............................. 48

lorazepam conc 2 mg/ml ................................................ 50

lorazepam tab 0.5 mg..................................................... 50

lorazepam tab 1 mg ....................................................... 50

lorazepam tab 2 mg ....................................................... 50

LORBRENA TAB 100MG ............................................ 36

LORBRENA TAB 25MG .............................................. 36

lorcet hd tab 10-325 mg ................................................... 9

lorcet plus tab 7.5-325 mg ............................................... 9

lorcet tab 5-325 mg .......................................................... 9

loryna tab 3-0.02 mg ...................................................... 94

losartan potassium & hydrochlorothiazide tab 100-12.5 mg

.................................................................................. 67

losartan potassium & hydrochlorothiazide tab 100-25 mg

.................................................................................. 67

losartan potassium & hydrochlorothiazide tab 50-12.5 mg

.................................................................................. 67

losartan potassium tab 100 mg....................................... 60

losartan potassium tab 25 mg ........................................ 60

losartan potassium tab 50 mg ........................................ 60

LOTEMAX GEL 0.5% ................................................ 107

LOTEMAX OIN 0.5%................................................. 107

LOTEMAX SUS 0.5% ................................................ 107

loteprednol etabonate ophth susp 0.5% ........................ 107

lovastatin tab 10 mg....................................................... 70



low-ogestrel tab 0.3 mg-30 mcg ..................................... 94

loxapine succinate cap 10 mg ........................................ 41


loxapine succinate cap 5 mg .......................................... 41


LUCEMYRA TAB 0.18MG .......................................... 10

LUMIGAN SOL 0.01% ............................................... 107

LUPANETA KIT 11.25-5 .............................................. 96

LUPANETA KIT 3.75-5 ................................................ 96

LUPRON DEPOT INJ 11.25MG ................................... 98

LUPRON DEPOT INJ 22.5MG ..................................... 98

LUPRON DEPOT INJ 3.75MG ..................................... 98

LUPRON DEPOT INJ 30MG ........................................ 98

LUPRON DEPOT INJ 45MG ........................................ 99

LUPRON DEPOT INJ 7.5MG ....................................... 99

lutera tab 0.1 mg-20 mcg ............................................... 94

LYNPARZA TAB 100MG ............................................ 36

LYNPARZA TAB 150MG ............................................ 36

LYSODREN TAB 500MG ............................................ 98

lyza tab 0.35 mg ............................................................. 96

Macrolides .................................................................... 16

magnesium sulfate inj 50% ............................................ 81

malathion lotion 0.5% .................................................... 39

maprotiline hcl tab 25 mg .............................................. 24



marlissa tab 0.15 mg-30 mcg ......................................... 94

MARPLAN TAB 10MG ................................................ 24

Mast Cell Stabilizers .................................................. 111

MATULANE CAP 50MG ............................................. 32

matzim la 180 mg/24hr .................................................. 64

matzim la 240 mg/24hr .................................................. 64

matzim la 300 mg/24hr .................................................. 64

matzim la 360 mg/24hr .................................................. 65

matzim la 420 mg/24hr .................................................. 65

MAVENCLAD PAK 10MG(10) ................................... 76

MAVENCLAD PAK 10MG(4) .................................... 76

MAVENCLAD PAK 10MG(5) .................................... 76

MAVENCLAD PAK 10MG(6) .................................... 76

MAVENCLAD PAK 10MG(7) .................................... 76

MAVENCLAD PAK 10MG(8) .................................... 76

MAVENCLAD PAK 10MG(9) .................................... 76

MAVYRET TAB100-40MG .......................................... 45

MAXIDEX SUS 0.1% OP ........................................... 107

MAYZENT TAB 0.25MG ............................................. 76

MAYZENT TAB 2MG .................................................. 76

meclizine hcl tab 12.5 mg ............................................... 26

meclizine hcl tab 25 mg .................................................. 26

meclofenamate sodium cap 100 mg ................................ 30

meclofenamate sodium cap 50 mg .................................. 30

MEDROL TAB 2MG .................................................. 104

medroxyprogesterone acetate im susp 150 mg/ml ........... 96

medroxyprogesterone acetate tab 10 mg ........................ 96

medroxyprogesterone acetate tab 2.5 mg ....................... 96

medroxyprogesterone acetate tab 5 mg .......................... 96

mefenamic acid cap 250 mg ........................................... 30

mefloquine hcl tab 250 mg ............................................. 39

megestrol acetate susp 40 mg/ml .................................... 96

megestrol acetate susp 625 mg/5ml ................................ 96

megestrol acetate tab 20 mg ........................................... 96

megestrol acetate tab 40 mg ........................................... 96

MEKINIST TAB 0.5MG ............................................... 36

MEKINIST TAB 2MG .................................................. 36

MEKTOVI TAB 15MG ................................................. 36

melodetta fe chew tab 1 mg-20 mcg (24) ........................ 94

138

meloxicam tab 15 mg ..................................................... 30

meloxicam tab 7.5 mg .................................................... 30

memantine hcl cap er 14 mg .......................................... 22



memantine hcl cap er 7 mg ............................................ 22

memantine hcl oral solution 2 mg/ml.............................. 22

memantine hcl tab 10 mg ............................................... 23

memantine hcl tab 5 mg ................................................. 23

MENACTRA INJ ........................................................ 102

menest tab 0.3 mg .......................................................... 94

menest tab 0.625 mg ...................................................... 94

menest tab 1.25 mg ........................................................ 94

MENTAX CRE 1% ....................................................... 28

MENVEO INJ ............................................................. 102

mercaptopurine tab 50 mg ........................................... 100

meropenem iv for soln 500 mg ....................................... 15

mesalamine cap 0.375 gm ............................................ 103

mesalamine cap dr 400 mg........................................... 103

mesalamine enema 4 gm .............................................. 103

mesalamine suppos 1000 mg ........................................ 103

mesalamine tab delayed release 1.2 gm ........................ 103

MESNEX TAB 400MG ................................................. 38

MESTINON SYP 60MG/5ML....................................... 31

Metabolic Bone Disease Agents ................................. 104

METABOLIC BONE DISEASE AGENTS .............. 104

metaproterenol sulfate syrup 10 mg/5ml....................... 110

metformin hcl tab 1000 mg............................................. 54

metformin hcl tab 500 mg .............................................. 54

metformin hcl tab 850 mg .............................................. 54

metformin hcl tab er 500 mg .......................................... 54

metformin hcl tab er 750 mg .......................................... 54

methadone hcl soln 10 mg/5ml ......................................... 7

methadone hcl soln 5 mg/5ml ........................................... 7

methadone hcl tab 10 mg ................................................. 7

methadone hcl tab 5 mg ................................................... 7

methazolamide tab 25 mg............................................... 68

methazolamide tab 50 mg............................................... 69

methenamine hippurate tab 1 gm ................................... 12

methimazole tab 10 mg .................................................. 99

methimazole tab 5 mg .................................................... 99

methitest tab 10 mg ........................................................ 91

methocarbamol tab 500 mg .......................................... 112

methocarbamol tab 750 mg .......................................... 112

methotrexate sodium inj 25 mg/ml ................................ 100

methotrexate sodium inj pf 50 mg/2ml .......................... 100

methotrexate sodium tab 2.5 mg ................................... 100

methoxsalen rapid cap 10 mg ......................................... 78

methscopolamine bromide tab 2.5 mg ............................ 83

methscopolamine bromide tab 5 mg ............................... 83

methyldopa & hydrochlorothiazide tab 250-15 mg ......... 67

methyldopa & hydrochlorothiazide tab 250-25 mg ......... 67

methyldopa tab 250 mg .................................................. 60

methyldopa tab 500 mg .................................................. 60

methylphenidate hcl cap er 10 mg (cd) ........................... 74


methylphenidate hcl cap er 24hr 10 mg (la) ................... 74





methylphenidate hcl cap er 60 mg (la)............................ 74

methylphenidate hcl chew tab 10 mg .............................. 74

methylphenidate hcl chew tab 2.5 mg ............................. 74

methylphenidate hcl chew tab 5 mg ................................ 74

methylphenidate hcl soln 10 mg/5ml............................... 74

methylphenidate hcl soln 5 mg/5ml ................................ 74

methylphenidate hcl tab 10 mg ....................................... 74

methylphenidate hcl tab 20 mg ....................................... 74

methylphenidate hcl tab 5 mg ......................................... 74

methylphenidate hcl tab er (osm) 18 mg ......................... 74




methylphenidate hcl tab er 10 mg ................................... 75


methylphenidate hcl tab er 24hr 18 mg .......................... 75




methylprednisolone tab 16 mg...................................... 104

methylprednisolone tab 32 mg...................................... 104

methylprednisolone tab 4 mg ....................................... 104

methylprednisolone tab 8 mg ....................................... 104

methylprednisolone tab therapy pack 4 mg (21) ........... 104

methyltestosterone cap 10 mg ........................................ 91

metoclopramide hcl odt tab 10 mg ................................. 26

metoclopramide hcl odt tab 5 mg ................................... 83

metoclopramide hcl soln 5 mg/5ml ................................. 83

metoclopramide hcl tab 10 mg ....................................... 83

metoclopramide hcl tab 5 mg ......................................... 83

metolazone tab 10 mg .................................................... 69

metolazone tab 2.5 mg ................................................... 70

metolazone tab 5 mg ...................................................... 70

metoprolol & hydrochlorothiazide tab 100-25 mg .......... 67

metoprolol & hydrochlorothiazide tab 100-50 mg .......... 67

metoprolol & hydrochlorothiazide tab 50-25 mg ............ 67

metoprolol succinate tab er 100 mg ............................... 63

metoprolol succinate tab er 200 mg ............................... 63

metoprolol succinate tab er 25 mg) ................................ 63

139

metoprolol succinate tab er 50 mg ................................. 63

metoprolol tartrate tab 100 mg ...................................... 63

metoprolol tartrate tab 25 mg ........................................ 63

metoprolol tartrate tab 50 mg ........................................ 63

metronidazole cap 375 mg ............................................. 12

metronidazole cream 0.75% ........................................... 12

metronidazole gel 0.75% ................................................ 12

metronidazole gel 1% .................................................... 12

metronidazole in nacl 0.79% iv soln 500 mg/100ml ........ 12

metronidazole lotion 0.75% ........................................... 12

metronidazole tab 250 mg .............................................. 12

metronidazole tab 500 mg .............................................. 12

metronidazole vaginal gel 0.75% ................................... 12

MEXILETINE CAP 150MG......................................... 62



mibelas 24 chwfe ........................................................... 94

miconazole nitrate vaginal suppos 200 mg ..................... 28

microgestin fe tab 1 mg-20 mcg ..................................... 94

microgestin fe tab 1.5 mg-30 mcg................................... 94

microgestin tab 1 mg-20 mcg ......................................... 94

microgestin tab 1.5 mg-30 mcg ...................................... 94

midodrine hcl tab 10 mg ................................................ 60

midodrine hcl tab 2.5 mg ............................................... 60

midodrine hcl tab 5 mg .................................................. 60

migergot suppos 2-100 mg ............................................. 30

miglitol tab 100 mg ........................................................ 54

miglitol tab 25 mg .......................................................... 54

miglitol tab 50 mg .......................................................... 54

miglustat cap 100 mg ..................................................... 86

mili tab 0.25 mg-35 mcg ................................................ 94

millipred tab 5 mg........................................................ 104

mimvey tab 1-0.5 mg ...................................................... 94

minitran dis 0.1 mg/hr.................................................... 72




minocycline hcl cap 100 mg ........................................... 18

minocycline hcl cap 50 mg ............................................. 18

minocycline hcl cap 75 mg ............................................. 18

minocycline hcl tab 100 mg ............................................ 18

minocycline hcl tab 50 mg.............................................. 18

minocycline hcl tab 75 mg.............................................. 19

minoxidil tab 10 mg ....................................................... 72

minoxidil tab 2.5 mg ...................................................... 72

mirtazapine odt tab 15 mg.............................................. 23



mirtazapine tab 15 mg ................................................... 23



mirtazapine tab 7.5 mg .................................................. 23

MIRVASO GEL 0.33% ................................................. 78

misoprostol tab 100 mcg ................................................ 85

misoprostol tab 200 mcg ................................................ 85

M-M-R II INJ .............................................................. 102

modafinil tab 100 mg ................................................... 113

modafinil tab 200 mg ................................................... 113

moexipril hcl tab 15 mg ................................................. 61

moexipril hcl tab 7.5 mg ................................................ 61

Molecular Target Inhibitors ........................................ 34

MOLINDONE TAB HCL 10MG ................................... 41

MOLINDONE TAB HCL 25MG ................................... 42

MOLINDONE TAB HCL 5MG..................................... 42

mometasone furoate cream 0.1% ................................... 89

mometasone furoate nasal susp 50 mcg/act .................. 109

mometasone furoate oint 0.1% ....................................... 89

mometasone furoate solution 0.1% (lotion) .................... 89

Monoamine Oxidase B (MAO-B) Inhibitors ............... 41

Monoamine Oxidase Inhibitors ................................... 23

montelukast sodium chew tab 4 mg .............................. 109

montelukast sodium chew tab 5 mg .............................. 109

montelukast sodium oral granules packet 4 mg ............ 109

montelukast sodium tab 10 mg ..................................... 109

MONUROL PAK GRANULES ..................................... 12

morphine sulfate beads cap er 120 mg ............................. 7

morphine sulfate beads cap er 30 mg ............................... 7




morphine sulfate cap er 10 mg ......................................... 7

morphine sulfate cap er 100 mg ....................................... 7


morphine sulfate cap er 30 mg ..................................... 7, 8




morphine sulfate oral soln 10 mg/5ml .............................. 9

morphine sulfate oral soln 100 mg/5ml ............................ 9

morphine sulfate oral soln 20 mg/5ml .............................. 8

morphine sulfate tab 15 mg .............................................. 9

morphine sulfate tab 30 mg .............................................. 9

morphine sulfate tab er 100 mg ........................................ 8

morphine sulfate tab er 15 mg .......................................... 8

morphine sulfate tab er 200 mg ........................................ 8



MOVIPREP SOL .......................................................... 83

MOXEZA SOL 0.5% .................................................... 17

moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8%

140

inj .............................................................................. 17

moxifloxacin hcl ophth soln 0.5% ................................... 18

moxifloxacin hcl tab 400 mg .......................................... 18

MULPLETA TAB 3MG ................................................ 58

MULTAQ TAB 400MG ................................................ 62

Multiple Sclerosis Agents............................................. 75

mupirocin cream 2% ...................................................... 12

mupirocin oint 2% ......................................................... 12

MYALEPT INJ 11.3MG................................................ 83

MYCAMINE INJ 100MG ............................................. 28

MYCAMINE INJ 50MG ............................................... 28

mycophenolate mofetil cap 250 mg .............................. 101

mycophenolate mofetil for oral susp 200 mg/ml............ 101

mycophenolate mofetil tab 500 mg ............................... 101

mycophenolate sodium tab dr 180 mg .......................... 101

mycophenolate sodium tab dr 360 mg .......................... 101

myorisan cap 10 mg ....................................................... 78

myorisan cap 20 mg ....................................................... 78

myorisan cap 30 mg ....................................................... 78

myorisan cap 40 mg ....................................................... 78

MYRBETRIQ TAB 25MG ........................................... 86

MYRBETRIQ TAB 50MG ........................................... 86

nabumetone tab 500 mg ................................................. 30

nabumetone tab 750 mg ................................................. 30

nadolol tab 20 mg .......................................................... 63

nadolol tab 40 mg .......................................................... 63

nadolol tab 80 mg .......................................................... 63

nafcillin sodium for inj 1 gm .......................................... 16

nafcillin sodium for inj 2 gm .......................................... 16

nafcillin sodium for iv soln 10 gm .................................. 16

naftifine hcl cream 1% ................................................... 28

naftifine hcl cream 2% ................................................... 28

NAFTIN GEL 1% ......................................................... 28

NAFTIN GEL 2% ......................................................... 28

naloxone hcl inj 0.4 mg/ml ............................................. 11

naloxone hcl soln cartridge 0.4 mg/ml............................ 11

naloxone hcl soln prefilled syringe 2 mg/2ml.................. 11

naltrexone hcl tab 50 mg ................................................ 10

NAMENDA XR CAP TITRATION ............................. 23

naproxen sodium tab 275 mg ......................................... 30

naproxen sodium tab 550 mg ......................................... 30

naproxen susp 125 mg/5ml ............................................. 30

naproxen tab 250 mg ..................................................... 30

naproxen tab 375 mg ..................................................... 30

naproxen tab 500 mg ..................................................... 30

naproxen tab ec 375 mg ................................................. 30

naproxen tab ec 500 mg ................................................. 30

naratriptan hcl tab 1 mg ................................................ 31

naratriptan hcl tab 2.5 mg ............................................. 31

NARCAN SPR .............................................................. 11

NATACYN SUS 5% OP ............................................... 28

nateglinide tab 120 mg................................................... 54

nateglinide tab 60 mg .................................................... 55

NATPARA INJ 100MCG ............................................ 105

NATPARA INJ 25MCG .............................................. 105

NATPARA INJ 50MCG .............................................. 105

NATPARA INJ 75MCG .............................................. 105

NAYZILAM SPRAY 5 MG .......................................... 20

necon tab 0.5 mg-35 mcg ............................................... 94

NEEDLES, INSULIN DISP., SAFETY ......................... 79

nefazodone hcl tab 100 mg ............................................. 24




nefazodone hcl tab 50 mg ............................................... 25

neo/poly/bacoin/hc 1%op ............................................. 105

NEO/POLY/GRA SOL OP .......................................... 105

neomycin sulfate tab 500 mg .......................................... 11

neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt

op oin ...................................................................... 105

neomycin-polymyxin-dexamethasone ophth oint 0.1% .. 105

neomycin-polymyxin-dexamethasone ophth susp 0.1% . 105

neomycin-polymyxin-hc ophth susp .............................. 105

neomycin-polymyxin-hc otic soln 1% ........................... 107

neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-

1% ........................................................................... 107

NEPHRAMINE INJ 5.4% ............................................ 81

NERLYNX TAB 40MG ................................................ 36

NEULASTA INJ 6MG/0.6M ......................................... 58

NEUPOGEN INJ 300/0.5 .............................................. 58

NEUPOGEN INJ 300MCG ........................................... 58

NEUPOGEN INJ 480/0.8 .............................................. 59

NEUPOGEN INJ 480MCG ........................................... 59

NEUPRO DIS 1MG/24HR ............................................ 39

NEUPRO DIS 2MG/24HR ............................................ 39

NEUPRO DIS 3MG/24HR ............................................ 39

NEUPRO DIS 4MG/24HR ............................................ 40

NEUPRO DIS 6MG/24HR ............................................ 40

NEUPRO DIS 8MG/24HR ............................................ 40

NEVANAC SUS 0.1% ................................................ 107

nevirapine susp 50 mg/5ml ............................................. 47

nevirapine tab 200 mg ................................................... 47

nevirapine tab er 100 mg ............................................... 47

nevirapine tab er 400 mg ............................................... 47

NEXAVAR TAB 200MG .............................................. 36

NEXIUM GRA 10MG DR ............................................ 85

NEXIUM GRA 2.5MG DR ........................................... 85

NEXIUM GRA 20MG DR ............................................ 85

NEXIUM GRA 40MG DR ............................................ 85

NEXIUM GRA 5MG DR .............................................. 85

141

niacin tab er 1000 mg .................................................... 71

niacin tab er 500 mg ...................................................... 71

niacin tab er 750 mg ...................................................... 71

niacor tab 500 mg .......................................................... 71

nicardipine hcl cap 20 mg .............................................. 65

nicardipine hcl cap 30 mg .............................................. 65

NICOTROL INH ........................................................... 11

NICOTROL NS SPR 10MG/ML ................................... 11

nifedipine cap 10 mg ...................................................... 65

nifedipine cap 20 mg ...................................................... 65

nifedipine tab er 30 mg .................................................. 65



nifedipine tab er osmotic release 30 mg ......................... 65



nikki tab 3-0.02 mg ........................................................ 94

nilutamide tab 150 mg ................................................... 32

nimodipine cap 30 mg .................................................... 65

NINLARO CAP 2.3MG ................................................ 34

NINLARO CAP 3MG ................................................... 34

NINLARO CAP 4MG ................................................... 34

NISOLDIPINE TAB 34MG ER ..................................... 65

NISOLDIPINE TAB 8.5MG ER .................................... 65

nisoldipine tab er 17 mg................................................. 65


nisoldipine tab er 25.5 mg .............................................. 65



nitro-bid oint 2% ........................................................... 72

NITRO-DUR DIS 0.3MG/HR....................................... 72

NITRO-DUR DIS 0.8MG/HR....................................... 72

nitrofurantoin macrocrystalline cap 100 mg ................... 13

nitrofurantoin macrocrystalline cap 25 mg..................... 13

nitrofurantoin macrocrystalline cap 50 mg..................... 13

nitrofurantoin monohydrate macrocrystalline cap 100 mg

.................................................................................. 13

nitrofurantoin susp 25 mg/5ml ....................................... 13

nitroglycerin sl tab 0.3 mg ............................................. 72



nitroglycerin td patch 24hr 0.1 mg/hr ............................. 72




nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray)......... 72

NIVESTYM INJ 300/0.5 ............................................... 59

NIVESTYM INJ 480/0.8 ............................................... 59

nizatidine cap 150 mg .................................................... 84

nizatidine cap 300 mg .................................................... 84

nizatidine oral soln 15 mg/ml ......................................... 84

N-methyl-D-aspartate (NMDA) Receptor Antagonist 22

nolix cream 0.05% ......................................................... 89

Nonsteroidal Anti-inflammatory Drugs ...................... 29

norco tab 10-325 mg ........................................................ 9

norco tab 5-325 mg .......................................................... 9

norco tab 7.5-325 mg ....................................................... 9

NORDITROPIN INJ 10/1.5ML ..................................... 91

NORDITROPIN INJ 15/1.5ML ..................................... 91

NORDITROPIN INJ 30/3ML ........................................ 91

NORDITROPIN INJ 5/1.5ML ....................................... 91

norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35

mcg ............................................................................ 94

norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25

mcg ............................................................................ 94

norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg . 94

norethindrone ace-eth estradiol-fe chew tab 1 mg-20 mcg

(24) ............................................................................ 94norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg

(24) ............................................................................ 94

norethindrone acetate tab 5 mg ...................................... 96

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5 mcg

.................................................................................. 94

norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg . 94

norethindrone tab 0.35 mg ............................................. 96

norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg ..... 95

norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-

mcg ............................................................................ 95

norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-

mcg ............................................................................ 95

NORITATE CRE 1% .................................................... 13

NORMOSOL -M INJ/D5W ........................................... 81

NORMOSOL -R INJ/D5W ............................................ 81

NORMOSOL-R INJPH 7.4............................................ 81

NORPACE CAP 100MG CR ......................................... 62

NORPACE CAP 150MG CR ......................................... 62

NORTHERA CAP 100MG ............................................ 60

NORTHERA CAP 200MG ............................................ 60

NORTHERA CAP 300MG ............................................ 60

nortrel tab 0.5 mg-35 mcg .............................................. 95

nortrel tab 0.5-35/0.75-35/1-35 mg-mcg ........................ 95

nortrel tab 1 mg-35 mcg................................................. 95

nortriptyline hcl cap 10 mg ............................................ 26




nortriptyline hcl soln 10 mg/5ml .................................... 26

NORVIR POW 100MG ................................................. 48

NORVIR SOL 80MG/ML ............................................. 48

NOURIANZ TAB 20 MG .............................................. 40

NOURIANZ TAB 40 MG .............................................. 40

142

NOVOLIN INJ 70/30 .................................................... 56

NOVOLIN INJ 70/30 RELION ..................................... 56

NOVOLIN INJ FLEXPEN ............................................ 56

NOVOLIN N INJ 100 UNIT......................................... 56

NOVOLIN N INJ U-100............................................... 56

NOVOLIN N INJ U-100 RELION ................................ 56

NOVOLIN R INJ 100 UNIT ......................................... 56

NOVOLIN R INJ U-100 ............................................... 56

NOVOLIN R INJ U-100 RELION ................................ 56

NOVOLOG INJ 100/ML ............................................... 56

NOVOLOG INJ FLEXPEN ........................................... 56

NOVOLOG INJ PENFILL ............................................ 56

NOVOLOG MIX INJ 70/30 .......................................... 56

NOVOLOG MIX INJ FLEXPEN .................................. 56

NOXAFIL SUS 40MG/ML ........................................... 28

NOXAFIL TAB 100MG ................................................ 28

NUBEQA TAB 300MG................................................. 32

NUEDEXTA CAP 20-10MG ......................................... 75

NUPLAZID CAP 34MG ............................................... 43

NUPLAZID TAB 10MG ............................................... 43

nutrilipid emu20% ......................................................... 81

NUTROPIN AQ INJ 10MG/2ML .................................. 83

NUTROPIN AQ INJ 20MG/2ML .................................. 83

NUTROPIN AQ INJ NUSPIN 5 .................................... 83

nyamyc powder 100000 unit/gm ..................................... 28

nystatin cream 100000 unit/gm ...................................... 28

nystatin oint 100000 unit/gm .......................................... 28

nystatin susp 100000 unit/ml .......................................... 28

nystatin tab 500000 unit ................................................. 28

nystatin topical powder 100000 unit/gm ......................... 28

nystatin-triamcinolone cream 100000-0.1 unit/gm-% ..... 28

nystatin-triamcinolone oint 100000-0.1 unit/gm-% ......... 28

nystop powder 100000 unit/gm ...................................... 28

OCALIVA TAB 10MG ................................................. 86

OCALIVA TAB 5MG ................................................... 86

ocella tab 3-0.03 mg ...................................................... 95

OCTAGAM INJ 1GM ................................................. 102

OCTAGAM INJ 2GM/20ML ...................................... 102

octreotide acetate inj 100 mcg/ml................................... 99

octreotide acetate inj 1000 mcg/ml ................................. 99


octreotide acetate inj 50 mcg/ml .................................... 99


ODEFSEY TAB ............................................................ 47

ODOMZO CAP 200MG ................................................ 37

OFEV CAP 100MG ..................................................... 112

OFEV CAP 150MG ..................................................... 112

ofloxacin ophth soln 0.3% .............................................. 18

ofloxacin otic soln 0.3% ................................................. 18

ofloxacin tab 300 mg...................................................... 18

ofloxacin tab 400 mg...................................................... 18

ogestrel tab 0.5 mg-50 mcg ............................................ 95

olanzapine for im inj 10 mg............................................ 43

olanzapine odt tab 10 mg ............................................... 43



olanzapine odt tab 5 mg ................................................. 43

olanzapine tab 10 mg ..................................................... 43


olanzapine tab 2.5 mg .................................................... 43


olanzapine tab 5 mg ....................................................... 43

olanzapine tab 7.5 mg .................................................... 43

olanzapine-fluoxetine hcl cap 12-25 mg ......................... 23

olanzapine-fluoxetine hcl cap 12-50 mg ......................... 23

olanzapine-fluoxetine hcl cap 3-25 mg ........................... 23



olmesartan medoxomil tab 20 mg ................................... 60

olmesartan medoxomil tab 40 mg ................................... 60

olmesartan medoxomil tab 5 mg ..................................... 60

olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg

.................................................................................. 68

olmesartan medoxomil-hydrochlorothiazide tab 40-12.5 mg

.................................................................................. 68

olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg

.................................................................................. 68

olmesartan-amlodipine-hydrochlorothiazide tab 20-5-12.5

mg ............................................................................. 68

olmesartan-amlodipine-hydrochlorothiazide tab 40-10-

12.5 mg ...................................................................... 68

olmesartan-amlodipine-hydrochlorothiazide tab 40-10-25

mg ............................................................................. 68

olmesartan-amlodipine-hydrochlorothiazide tab 40-5-12.5

mg ............................................................................. 68

olmesartan-amlodipine-hydrochlorothiazide tab 40-5-25

mg ............................................................................. 68

olopatadine hcl nasal soln 0.6%................................... 108

olopatadine hcl ophth soln 0.1% .................................. 106

olopatadine hcl ophth soln 0.2% .................................. 106

omega-3-acid ethyl esters cap 1 gm ............................... 71

omeprazole cap dr 10 mg ............................................... 85



OMNITROPE INJ 10/1.5ML ........................................ 91

OMNITROPE INJ 5/1.5ML .......................................... 91

ondansetron hcl oral soln 4 mg/5ml ............................... 27

ondansetron hcl tab 24 mg ............................................. 27

ondansetron hcl tab 4 mg ............................................... 27

ondansetron hcl tab 8 mg ............................................... 27

ondansetron odt tab 4 mg ............................................... 27

143

ondansetron odt tab 8 mg ............................................... 27

OPHTHALMIC AGENTS ........................................ 105

Ophthalmic Agents, Other ........................................ 105

Ophthalmic Anti-allergy Agents ............................... 106

Ophthalmic Antiglaucoma Agents ............................ 106

Ophthalmic Anti-inflammatories .............................. 107

Ophthalmic Prostaglandin and Prostamide Analogs 107

Opioid Analgesics, Long-acting ..................................... 7

Opioid Apnalgesics, Short-acting .................................. 8

Opioid Dependence Treatments .................................. 10

Opioid Reversal Agents ............................................... 11

OPSUMIT TAB 10MG ................................................ 111

ORENCIA CLCK INJ 125MG/ML .............................. 101

ORENCIA INJ 125MG/ML ......................................... 101

ORENCIA INJ 50/0.4 .................................................. 101

ORENCIA INJ 87.5/0.7 ............................................... 101

ORENITRAM TAB 0.125MG .................................... 111

ORENITRAM TAB 0.25MG ...................................... 111

ORENITRAM TAB 1MG........................................... 111

ORENITRAM TAB 2.5MG ........................................ 111

ORENITRAM TAB 5MG........................................... 111

ORFADIN CAP 10MG .................................................. 86

ORFADIN CAP 2MG ................................................... 86

ORFADIN CAP 5MG ................................................... 86

ORFADIN SUS 4MG/ML ............................................. 86

ORILISSA TAB 150MG ............................................... 91

ORILISSA TAB 200MG ............................................... 91

ORKAMBI TAB 100-125............................................ 110

ORKAMBI TAB 200-125............................................ 110

orphenadrine citrate tab er 100 mg .............................. 113

orsythia tab 0.1 mg-20 mcg ............................................ 95

oseltamivir phosphate cap 30 mg ................................... 48



oseltamivir phosphate for susp 6 mg/ml.......................... 49

OTEZLA TAB 10/20/30MG ........................................ 102

OTEZLA TAB 30MG.................................................. 102

Otic Agents ................................................................. 107

OTIC AGENTS ......................................................... 107

oxacillin sodium for inj 10 gm ........................................ 16

oxacillin sodium for inj 2 gm .......................................... 16

oxandrolone tab 10 mg .................................................. 91

oxandrolone tab 2.5 mg ................................................. 91

oxaprozin tab 600 mg .................................................... 30

oxazepam cap 10 mg ...................................................... 50

oxazepam cap 15 mg ...................................................... 50

oxazepam cap 30 mg ...................................................... 50

OXBRYTA TAB 500MG .............................................. 59

oxcarbazepine susp 300 mg/5ml ..................................... 21

oxcarbazepine tab 150 mg ............................................. 21



oxiconazole nitrate cream 1% ........................................ 28

OXISTAT LOT 1% ....................................................... 28

oxybutynin chloride syrup 5 mg/5ml ............................... 86

oxybutynin chloride tab 5 mg ......................................... 86

oxybutynin chloride tab er 10 mg ................................... 86

oxybutynin chloride tab er 15 mg ................................... 86

oxybutynin chloride tab er 5 mg ..................................... 86

oxycodone hcl cap 5 mg ................................................... 9

oxycodone hcl conc 100 mg/5ml ....................................... 9

oxycodone hcl soln 5 mg/5ml ........................................... 9

oxycodone hcl tab 10 mg .................................................. 9




oxycodone hcl tab 5 mg .................................................... 9

oxycodone w/ acetaminophen tab 10-325 mg ................... 9

oxycodone w/ acetaminophen tab 2.5-325 mg................... 9

oxycodone w/ acetaminophen tab 5-325 mg ..................... 9

oxycodone w/ acetaminophen tab 7.5-325 mg................... 9

oxycodone-aspirin tab 4.8355-325 mg............................ 10

oxycodone-ibuprofen tab 5-400 mg ................................ 10

oxymorphone hcl tab 10 mg ........................................... 10

oxymorphone hcl tab 5 mg ............................................. 10

oxymorphone hcl tab er 10 mg ......................................... 8





oxymorphone hcl tab er 5 mg ........................................... 8

oxymorphone hcl tab er 7.5 mg ........................................ 8

OZEMPIC INJ2/1.5ML ................................................. 55

pacerone tab 100 mg...................................................... 62

pacerone tab 200 mg...................................................... 62

paliperidone tab er 1.5 mg ............................................. 43

paliperidone tab er 3 mg ................................................ 43



PALYNZIQ INJ 10/0.5ML ............................................ 86

PALYNZIQ INJ 2.5/0.5 ................................................. 86

PALYNZIQ INJ 20MG/ML ........................................... 86

PANDEL CRE 0.1%...................................................... 89

PANRETIN GEL 0.1% .................................................. 38

pantoprazole sodium ec tab 20 mg ................................. 85

pantoprazole sodium ec tab 40 mg ................................. 85

Parasympathomimetics ............................................... 31

paricalcitol cap 1 mcg ................................................. 105



144

paromomycin sulfate cap 250 mg ................................... 11

paroxetine hcl tab 10 mg ................................................ 50




paroxetine hcl tab er 12.5 mg ......................................... 50

paroxetine hcl tab er 25 mg............................................ 50

paroxetine hcl tab er 37.5 mg ......................................... 50

paser granules packet 4 gm ............................................ 32

PAXIL SUS 10MG/5ML ............................................... 50

PAZEO DRO 0.7% ...................................................... 106

PEDIARIX INJ 0.5ML ................................................ 102

Pediculicides/Scabicides ............................................... 39

PEDVAX HIB INJ ..................................................... 102

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm . 83

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm . 83

peg 3350-kcl-sod bicarb-nacl for soln 420 gm ................ 83

PEGANONE TAB 250MG ............................................ 22

PEGASYS INJ .............................................................. 45

PEMAZYRE TAB 13.5MG ............................................ 37 PEMAZYRE TAB 4.5MG .............................................. 37

PEMAZYRE TAB 9MG ................................................. 37

PENICILL GK/INJ DEX 2MU ...................................... 16

PENICILL GK/INJ DEX 3MU ...................................... 16

penicillamine cap 250 mg .............................................. 87

penicillamine tab 250 mg ............................................... 80

penicillin g potassium for inj 20000000 unit ................... 16

penicillin g sodium for inj 5000000 unit ......................... 16

penicillin v potassium for soln 125 mg/5ml..................... 16

penicillin v potassium for soln 250 mg/5ml..................... 16

penicillin v potassium tab 250 mg .................................. 16

penicillin v potassium tab 500 mg .................................. 16

PENTAM 300 INJ 300MG ........................................... 39

pentamidine inh 300 mg .................................................. 39

PENTASA CAP 250MG CR ....................................... 103

PENTASA CAP 500MG CR ....................................... 103

pentazocine w/ naloxone tab 50-0.5 mg .......................... 10

pentoxifylline tab er 400 mg ........................................... 68

PERFOROMIST NEB 20MCG ................................... 110

perindopril er bumine tab 2 mg ...................................... 61



permethrin cream 5% .................................................... 39

perphenazine tab 16 mg ................................................. 42

perphenazine tab 2 mg ................................................... 42



perphenazine-amitriptyline tab 2-10 mg ......................... 23





PERSERIS INJ 120MG ................................................. 43

PERSERIS INJ 90MG ................................................... 43

PEXEVA TAB 10MG ................................................... 50

PEXEVA TAB 20MG ................................................... 50

PEXEVA TAB 30MG ................................................... 50

PEXEVA TAB 40MG ................................................... 50

phenelzine sulfate tab 15 mg .......................................... 24

phenobarbital elixir 20 mg/5ml ...................................... 20

phenobarbital tab 100 mg .............................................. 20

phenobarbital tab 15 mg ................................................ 20

phenobarbital tab 16.2 mg ............................................. 20






phenoxybenzamine hcl cap 10 mg .................................. 60

phenylbutyrate oral powder 3 gm ................................... 86

phenytoin chew tab 50 mg .............................................. 22

phenytoin sodium extended cap 100 mg.......................... 22



phenytoin susp 125 mg/5ml ............................................ 22

Phosphate Binders ....................................................... 82

Phosphodiesterase Inhibitors, Airways Disease ........ 111

PHOSPHOLINE SOL 0.125%OP ................................ 106

PICATO GEL 0.015% ................................................... 78

PICATO GEL 0.05% ..................................................... 78

PIFELTRO TAB 100MG ............................................... 47

pilocarpine hcl ophth soln 1% ...................................... 106



pilocarpine hcl tab 5 mg ................................................ 77

pilocarpine hcl tab 7.5 mg ............................................. 77

pimecrolimus cream 1%................................................. 78

pimozide tab 1 mg .......................................................... 42

pimozide tab 2 mg .......................................................... 42

pimtrea tab .................................................................... 95

pindolol tab 10 mg ......................................................... 63

pindolol tab 5 mg ........................................................... 63

pioglitazone hcl tab 15 mg ............................................. 55



pioglitazone hcl-glimepiride tab 30-2 mg ....................... 55

pioglitazone hcl-glimepiride tab 30-4 mg ....................... 55

pioglitazone hcl-metformin hcl tab 15-500 mg................ 55

piperacillin sod-tazobactam na for inj 3-0.375 gm ......... 16

piperacillin sod-tazobactam sod for inj 2-0.25 gm .......... 16

145

piperacillin sod-tazobactam sod for inj 36-4.5 gm .......... 16

piperacillin sod-tazobactam sod for inj 4-0.5 gm ............ 16

PIQRAY 200MG TAB DOSE ....................................... 37



pirmella tab 1 mg-35 mcg .............................................. 95

piroxicam cap 10 mg...................................................... 30

piroxicam cap 20 mg...................................................... 30

PLASMA-LYTE INJ-148 .............................................. 81

PLASMA-LYTE INJ-A ................................................. 81

Platelet Modifying Agents ........................................... 59

PLEGRIDY INJ............................................................. 76

PLEGRIDY INJ PEN .................................................... 76

PLEGRIDY PEN INJ STARTER .................................. 76

plenamine inj15% .......................................................... 81

podofilox soln 0.5% ....................................................... 78

polymyxin b sulfate for inj 500000 unit .......................... 13

polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1%

................................................................................ 105

POMALYST CAP 1MG ................................................ 33

POMALYST CAP 2MG ................................................ 33

POMALYST CAP 3MG ................................................ 33

POMALYST CAP 4MG ................................................ 33

portia-28 tab 0.15 mg-30 mcg ........................................ 95

posaconazole tab 100 mg dr ............................................ 28

POT CHL/D5W INJ 40MEQ/L ...................................... 81

POT CHLORID TAB 20MEQ ER ................................. 81

potassium chloride 20 meq/l (0.15%) in dextrose 5% inj 81

potassium chloride 20 meq/l (0.15%) in nacl 0.45% inj .. 81

potassium chloride 20 meq/l (0.15%) in nacl 0.9% inj .... 81

potassium chloride 40 meq/l (0.3%) in nacl 0.9% inj ...... 81

potassium chloride cap er 10 meq .................................. 81

potassium chloride cap er 8 meq .................................... 81

potassium chloride inj 10 meq/100ml ............................. 81

potassium chloride inj 2 meq/ml ..................................... 82



potassium chloride micro er tab 10 meq ......................... 82

potassium chloride micro er tab 20 meq ......................... 82

potassium chloride oral soln 10% .................................. 82

potassium chloride oral soln 20% .................................. 82

potassium chloride tab er 10 meq ................................... 82

potassium chloride tab er 8 meq..................................... 82

potassium citrate tab er 10 meq ..................................... 82

potassium citrate tab er 15 meq ..................................... 82

potassium citrate tab er 5 meq ....................................... 82

PRADAXA CAP 110MG .............................................. 57

PRADAXA CAP 150MG .............................................. 57

PRADAXA CAP 75MG ................................................ 57

PRALUENT INJ 150MG/ML ........................................ 71

PRALUENT INJ 75MG/ML .......................................... 71

pramipexole tab 0.125 mg .............................................. 40

pramipexole tab 0.25 mg ................................................ 40

pramipexole tab 0.5 mg .................................................. 40

pramipexole tab 0.75 mg ................................................ 40

pramipexole tab 1 mg .................................................... 40

pramipexole tab 1.5 mg .................................................. 40

pramipexole tab er 0.375 mg .......................................... 40

pramipexole tab er 0.75 mg............................................ 40

pramipexole tab er 1.5 mg ............................................. 40


pramipexole tab er 3 mg ................................................ 40


pramipexole tab er 4.5 mg ............................................. 40

prasugrel hcl tab 10 mg ................................................. 59

prasugrel hcl tab 5 mg ................................................... 60

pravastatin sodium tab 10 mg ........................................ 70




praziquantel tab 600 mg ................................................ 38

prazosin hcl cap 1 mg .................................................... 60



PRED MILD SUS 0.12% OP ....................................... 107

PRED-G S.O.P OIN OP ............................................... 105

PRED-G SUS OP ........................................................ 105

PREDNICARBAT CRE 0.1% ....................................... 89

prednicarbate oint 0.1% ................................................ 89

prednisolone sod phosph oral soln 5 mg/5ml ................ 104

prednisolone sod phosphate oral soln 10 mg/5ml ......... 104

prednisolone sod phosphate oral soln 20 mg/5ml ......... 104

prednisolone sodium phosphate ophth soln 1% ............ 107

prednisolone sodium phosphate oral soln 25 mg/5ml ... 104

PREDNISOLONE SUS 1% OP ................................... 107

prednisolone syrup 15 mg/5ml ..................................... 104

prednisone conc 5 mg/ml ............................................... 89

prednisone oral soln 5 mg/5ml ....................................... 89

prednisone tab 1 mg ....................................................... 89

prednisone tab 10 mg ..................................................... 89

prednisone tab 2.5 mg .................................................... 89


prednisone tab 5 mg ....................................................... 89


prednisone tab therapy pack 10 mg (21)......................... 90

prednisone tab therapy pack 10 mg (48)......................... 90

prednisone tab therapy pack 5 mg (21) .......................... 90

prednisone tab therapy pack 5 mg (48) .......................... 90

pregabalin cap 100 mg .................................................. 75


146



pregabalin cap 25 mg .................................................... 75




pregabalin sol 20mg/ml ................................................. 75

PREMARIN TAB 0.3MG .............................................. 95

PREMARIN TAB 0.45MG ............................................ 95

PREMARIN TAB 0.625MG .......................................... 95

PREMARIN TAB 0.9MG .............................................. 95

PREMARIN TAB 1.25MG ............................................ 95

PREMARIN VAG CRE 0.625MG ................................. 95

premasol sol 10% .......................................................... 82

PREMPHASE TAB ...................................................... 95

PREMPRO TAB 0.3-1.5 ................................................ 95

PREMPRO TAB 0.45-1.5 .............................................. 95

PREMPRO TAB 0.625-2.5 ............................................ 95

PREMPRO TAB 0.625-5 ............................................... 95

PRENATAL VITAMIN WITH MINERALS AND FOLIC

ACID GREATER THAN 0.8 MG ORAL TABLET ... 82

PRETOMANID TAB 200MG ........................................ 32

prevalite powder packets 4 gm ....................................... 71

previfem tab 0.25 mg-35 mcg ......................................... 95

PREZCOBIX TAB 800-150 ......................................... 48

PREZISTA SUS 100MG/ML ........................................ 48

PREZISTA TAB 150MG ............................................... 48

PREZISTA TAB 600MG ............................................... 48

PREZISTA TAB 75MG................................................. 48

PREZISTA TAB 800MG ............................................... 48

PRIFTIN TAB 150MG .................................................. 32

PRILOSEC POW 10MG ............................................... 85

PRILOSEC POW 2.5MG............................................... 85

PRIMAQUINE TAB 26.3MG....................................... 39

primidone tab 250 mg .................................................... 20

primidone tab 50 mg ...................................................... 20

primlev tab 10-300 mg ................................................... 10

primlev tab 5-300 mg ..................................................... 10

primlev tab 7.5-300 mg .................................................. 10

PRIVIGEN INJ 20GRAMS ......................................... 102

PROAIR HFA AER .................................................... 110

PROAIR RESPI AER .................................................. 110

probenecid tab 500 mg................................................... 29

probenecid/colchicine tab 0.5-500 mg ............................ 29

PROCALAMINE INJ 3% .............................................. 82

prochlorperazine maleate tab 10 mg .............................. 42

prochlorperazine maleate tab 5 mg ................................ 42

prochlorperazine suppos 25 mg ..................................... 26

PROCRIT INJ 10000/ML .............................................. 59

PROCRIT INJ 2000/ML ................................................ 59

PROCRIT INJ 20000/ML .............................................. 59

PROCRIT INJ 3000/ML ................................................ 59

PROCRIT INJ 4000/ML ................................................ 59

PROCRIT INJ 40000/ML .............................................. 59

procto-med cream 2.5% ................................................. 90

procto-pak rectal cream 1% ......................................... 104

proctosol hc rectal cream 2.5% ...................................... 90

proctozone hc rectal cream 2.5% ................................... 90

progesterone micronized cap 100 mg ............................. 96

progesterone micronized cap 200 mg ............................. 96

Progestins ..................................................................... 96

PROGLYCEM SUS 50MG/ML .................................... 55

PROGRAF GRA 0.2MG ............................................. 101

PROGRAF GRA 1MG ................................................ 101

PROLASTIN-C INJ 1000MG ........................................ 86

prolate tab 10-300 mg .................................................... 10

prolate tab 5-300 mg...................................................... 10

prolate tab 7.5-300 mg ................................................... 10

PROLENSA SOL 0.07% ............................................. 107

PROLIA SOL 60MG/ML ............................................ 105

PROMACTA PAK 25MG ............................................. 59

PROMACTA POW 12.5MG ......................................... 59

PROMACTA TAB 12.5MG .......................................... 59

PROMACTA TAB 25MG ............................................. 59

PROMACTA TAB 50MG ............................................. 59

PROMACTA TAB 75MG ............................................. 59

promethazine & phenylephrine syrup 6.25-5 mg/5ml .... 112

promethazine hcl suppos 12.5 mg ................................. 108

promethazine hcl suppos 25 mg.................................... 108

promethazine hcl syrup 6.25 mg/5ml ............................ 108

promethazine hcl tab 12.5 mg ...................................... 108

promethazine hcl tab 25 mg ......................................... 108

promethazine hcl tab 50 mg ......................................... 108

promethegan hcl suppos 50 mg .................................... 108

propafenone hcl cap er 225 mg ...................................... 62



propafenone hcl tab 150 mg ........................................... 62



propantheline bromide tab 15 mg................................... 83

proparacaine hcl ophth soln 0.5%................................ 105

Prophylactic ................................................................. 30

propranolol & hydrochlorothiazide tab 40-25 mg .......... 68

propranolol & hydrochlorothiazide tab 80-25 mg .......... 68

propranolol hcl cap er 120 mg ....................................... 63

propranolol hcl cap er 160 mg ....................................... 63

propranolol hcl cap er 60 mg ......................................... 63

propranolol hcl cap er 80 mg ......................................... 63

propranolol hcl oral soln 20 mg/5ml .............................. 64

147

propranolol hcl oral soln 40 mg/5ml .............................. 64

propranolol hcl tab 10 mg.............................................. 64





propylthiouracil tab 50 mg ............................................. 99

PROQUAD INJ ........................................................... 102

prosol inj 20% ............................................................... 82

Protectants ................................................................... 85

Proton Pump Inhibitors ............................................... 85

protriptyline hcl tab 10 mg ............................................. 26

protriptyline hcl tab 5 mg ............................................... 26

PSORCON CRE 0.05% ................................................. 90

Pulmonary Antihypertensives ................................... 111

Pulmonary Fibrosis Agents ....................................... 112

PULMOZYME SOL 1MG/ML ................................... 110

PURIXAN SUS 20MG/ML ........................................... 33

PYLERA CAP ............................................................... 83

pyrazinamide tab 500 mg ............................................... 32

pyridostigmine bromide tab 60 mg ................................. 31

pyridostigmine bromide tab er 180 mg ........................... 31

QUADRACEL INJ ..................................................... 103

quetiapine fumarate tab 100 mg ..................................... 43


quetiapine fumarate tab 25 mg ....................................... 43



quetiapine fumarate tab 50 mg ....................................... 43

quetiapine fumarate tab er 150 mg ................................. 43




quetiapine fumarate tab er 50 mg ................................... 44

quinapril hcl tab 10 mg .................................................. 61



quinapril hcl tab 5 mg .................................................... 61

quinapril-hydrochlorothiazide tab 10-12.5 mg ............... 68

quinapril-hydrochlorothiazide tab 20-12.5 mg ............... 68

quinapril-hydrochlorothiazide tab 20-25 mg .................. 68

quinidine gluconate tab er 324 mg ................................. 62

quinidine sulfate tab 200 mg .......................................... 62

quinidine sulfate tab 300 mg .......................................... 62

quinine sulfate cap 324 mg............................................. 39

Quinolones ................................................................... 17

QVAR REDI HALAER 40MCG ................................. 109

QVAR REDI HALAER 80MCG ................................. 109

RABAVERT INJ ......................................................... 103

raloxifene hcl tab 60 mg................................................. 96

ramelteon tab 8 mg ....................................................... 113

ramipril cap 1.25 mg ..................................................... 61

ramipril cap 10 mg ........................................................ 61

ramipril cap 2.5 mg ....................................................... 61

ramipril cap 5 mg .......................................................... 61

ranolazine tab er 1000 mg ............................................. 68

ranolazine tab er 500 mg ............................................... 68

RAPAMUNE SOL 1MG/ML ...................................... 101

rasagiline mesylate tab 0.5 mg ....................................... 41

rasagiline mesylate tab 1 mg .......................................... 41

RAVICTI LIQ 1.1GM/ML ............................................ 86

RAYOS TAB 1MG ....................................................... 90

RAYOS TAB 2MG ....................................................... 90

RAYOS TAB 5MG ....................................................... 90

REBIF INJ 22/0.5 .......................................................... 76

REBIF INJ 44/0.5 .......................................................... 76

REBIF REBIDO INJ 22/0.5 ........................................... 76

REBIF REBIDO INJ 44/0.5 ........................................... 76

REBIF REBIDO INJ TITRATN .................................... 76

REBIF TITRTN INJ PACK ........................................... 76

reclipsen tab 0.15 mg-30 mcg ........................................ 95

RECOMBIVA HB INJ 10MCG/ML ............................ 103

RECOMBIVA HB INJ 5MCG/0.5 ............................... 103

RECOMBIVA-HB INJ 40MCG/ML ............................ 103

RECTIV OIN 0.4% ....................................................... 72

REGRANEX GEL 0.01% .............................................. 78

RELENZA MISDISKHALE .......................................... 49

RELISTOR INJ 12/0.6ML ............................................. 83

RELISTOR INJ 8/0.4ML ............................................... 83

RELISTOR TAB 150MG .............................................. 83

repaglinide tab 0.5 mg ................................................... 55

repaglinide tab 1 mg ...................................................... 55

repaglinide tab 2 mg ...................................................... 55

REPATHA INJ 140MG/ML .......................................... 71

REPATHA PUSH INJ 420/3.5....................................... 71

REPATHA SURE INJ 140MG/ML ............................... 71

Respiratory Tract Agents, Other .............................. 112

RESPIRATORY TRACT/PULMONARY AGENTS108

RESTASIS EMU 0.05% .............................................. 105

RETACRIT INJ 10000UNT .......................................... 59

RETACRIT INJ 2000UNIT ........................................... 59


RETACRIT INJ 40000UNT .......................................... 59


Retinoids ...................................................................... 38

REVLIMID CAP 10MG ................................................ 33

REVLIMID CAP 15MG ................................................ 33

REVLIMID CAP 2.5MG ............................................... 33

REVLIMID CAP 20MG ................................................ 33

REVLIMID CAP 25MG ................................................ 33

148

REVLIMID CAP 5MG .................................................. 33

REXULTI TAB 0.25MG ............................................... 44

REXULTI TAB 0.5MG ................................................. 44

REXULTI TAB 1MG .................................................... 44

REXULTI TAB 2MG .................................................... 44

REXULTI TAB 3MG .................................................... 44

REXULTI TAB 4MG .................................................... 44

REYATAZ POW 50MG ................................................ 48

REYVOW TAB 100MG ................................................ 31

REYVOW TAB 50MG .................................................. 31

ribavirin cap 200 mg...................................................... 45

ribavirin tab 200 mg ...................................................... 45

rifabutin cap 150 mg ...................................................... 32

rifampin cap 150 mg ...................................................... 32

rifampin cap 300 mg ...................................................... 32

rifampin inj 600 mg ....................................................... 32

RIFATER TAB ............................................................. 32

riluzole tab 50 mg .......................................................... 75

rimantadine hydrochloride tab 100 mg .......................... 49

RINVOQ TAB 15 MG ER ........................................... 101

RIOMET SOL ............................................................... 55

risedronate sodium tab 150 mg .................................... 105

risedronate sodium tab 30 mg ...................................... 105

risedronate sodium tab 35 mg ...................................... 105

risedronate sodium tab 5 mg ........................................ 105

risedronate sodium tab dr 35 mg .................................. 105

RISPERDAL INJ 12.5MG ............................................ 51

RISPERDAL INJ 25MG ............................................... 51

RISPERDAL INJ 37.5MG ............................................ 51

RISPERDAL INJ 50MG ............................................... 51

risperidone odt tab 0.25 mg ........................................... 51

risperidone odt tab 0.5 mg ............................................. 51

risperidone odt tab 1 mg ................................................ 51




risperidone soln 1 mg/ml................................................ 51

risperidone tab 0.25 mg ................................................. 51

risperidone tab 0.5 mg ................................................... 51

risperidone tab 1 mg ...................................................... 51




ritonavir tab 100 mg ...................................................... 48

rivastigmine tartrate cap 1.5 mg .................................... 22

rivastigmine tartrate cap 3 mg ....................................... 22

rivastigmine tartrate cap 4.5 mg .................................... 22

rivastigmine tartrate cap 6 mg ....................................... 22

rivastigmine td patch 24hr 13.3 mg/24hr ........................ 22

rivastigmine td patch 24hr 4.6 mg/24hr .......................... 22

rivastigmine td patch 24hr 9.5 mg/24hr .......................... 22

rizatriptan benzoate odt tab 10 mg ................................. 31

rizatriptan benzoate odt tab 5 mg ................................... 31

rizatriptan benzoate tab 10 mg ....................................... 31

rizatriptan benzoate tab 5 mg ......................................... 31

ROCKLATAN DROP ................................................. 106

ropinirole hydrochloride tab 0.25 mg ............................. 40

ropinirole hydrochloride tab 0.5 mg ............................... 40

ropinirole hydrochloride tab 1 mg ................................. 40





ropinirole hydrochloride tab er 12 mg ........................... 40

ropinirole hydrochloride tab er 2 mg ............................. 40




rosuvastatin calcium tab 10 mg ...................................... 71



rosuvastatin calcium tab 5 mg ........................................ 71

ROTARIX SUS ........................................................... 103

ROTATEQ SOL .......................................................... 103

ROZLYTREK CAP 100 MG .......................................... 37

ROZLYTREK CAP 200 MG .......................................... 37

RUBRACA TAB 200MG .............................................. 34

RUBRACA TAB 250MG .............................................. 34

RUBRACA TAB 300MG .............................................. 34

RUCONEST INJ 2100UNIT.......................................... 99

RUZURGI TAB 10 MG ................................................. 31

RYDAPT CAP 25MG ................................................... 37

RYTARY CAP 145MG ................................................. 41

RYTARY CAP 195MG ................................................. 41

RYTARY CAP 245MG ................................................. 41

RYTARY CAP 95MG ................................................... 41

SAIZEN INJ 5MG ......................................................... 84

SAIZEN INJ 8.8MG ...................................................... 84

SAIZENPREP INJ 8.8MG ............................................ 84

SAMSCA TAB 15MG ................................................... 80

SAMSCA TAB 30MG ................................................... 80

SANCUSO DIS 3.1MG ................................................. 27

SANDIMMUNE SOL 100MG/ML ............................. 101

SANTYL OIN 250/GM ................................................. 78

SAPHRIS SUB 10MG ................................................... 44

SAPHRIS SUB 2.5MG .................................................. 44

SAPHRIS SUB 5MG ..................................................... 44

SAVAYSA TAB 15MG ................................................ 57

SAVAYSA TAB 30MG ................................................ 58

SAVAYSA TAB 60MG ................................................ 58

149

SAVELLA MIS TITR PAK ........................................... 75

SAVELLA TAB 100MG ............................................... 75

SAVELLA TAB 12.5MG .............................................. 75

SAVELLA TAB 25MG ................................................. 75

SAVELLA TAB 50MG ................................................. 75

scopolamine td patch 72hr 1 mg/3days........................... 26

SECUADO DIS 3.8MG ................................................. 44

SECUADO DIS 5.7MG ................................................. 44

SECUADO DIS 7.6MG ................................................. 44

Selective Estrogen Receptor Modifying Agents .......... 96

selegiline hcl cap 5 mg ................................................... 41

selegiline hcl tab 5 mg ................................................... 41

selenium sulfide lotion 2.5% .......................................... 78

SELZENTRY SOL 20MG/ML ..................................... 48

SELZENTRY TAB 150MG .......................................... 48

SELZENTRY TAB 25MG ........................................... 48

SELZENTRY TAB 300MG .......................................... 48

SELZENTRY TAB 75MG ........................................... 48

SEMPREX-D CAP 8-60MG ....................................... 112

SENSIPAR TAB 30MG .............................................. 105

SENSIPAR TAB 60MG .............................................. 105

SENSIPAR TAB 90MG .............................................. 105

SEREVENT DIS AER 50MCG ................................... 110

SEROSTIM INJ 4MG.................................................... 84

SEROSTIM INJ 5MG.................................................... 84

SEROSTIM INJ 6MG.................................................... 84

Serotonin (5-HT) 1b/1d Receptor Agonists ................. 31

sertraline hcl oral concentrate for solution 20 mg/ml ..... 50

sertraline hcl tab 100 mg ............................................... 51

sertraline hcl tab 25 mg ................................................. 51

sertraline hcl tab 50 mg ................................................. 51

setlakin tab .................................................................... 95

sevelamer carbonate packet 0.8 gm ................................ 82

sevelamer carbonate packet 2.4 gm ................................ 82

sevelamer carbonate tab 800 mg .................................... 82

sevelamer hcl tab 800 mg ............................................... 82

sharobel tab 0.35 mg ..................................................... 96

SHINGRIX INJ 50MCG .............................................. 103

SIGNIFOR INJ 0.3MG/ML ........................................... 99



SIKLOS TAB 1000MG ................................................. 33

SIKLOS TAB 100MG ................................................... 33

sildenafil citrate tab 20 mg........................................... 111

sildenafil sus 10 mg/ml.................................................. 111

sildenafil tab 100 mg...................................................... 87

sildenafil tab 25 mg ....................................................... 88

sildenafil tab 50 mg ....................................................... 88

SILIQ INJ 210/1.5 ......................................................... 78

silodosin cap 4 mg ......................................................... 87

silodosin cap 8 mg ......................................................... 87

silver sulfadiazine cream 1% ......................................... 18

SIMBRINZA SUS 1-0.2% .......................................... 106

SIMPONI INJ 100MG/ML .......................................... 101

SIMPONI INJ 50/0.5ML ............................................. 101

simvastatin tab 10 mg .................................................... 71



simvastatin tab 5 mg ...................................................... 71


sirolimus oral soln 1 mg/ml .......................................... 101

sirolimus tab 0.5 mg .................................................... 101

sirolimus tab 1 mg ....................................................... 101

sirolimus tab 2 mg ....................................................... 101

SIRTURO TAB 100MG ................................................ 32

SIVEXTRO INJ 200MG ................................................ 13

SIVEXTRO TAB 200MG.............................................. 13

Skeletal Muscle Relaxants ......................................... 112

SKELETAL MUSCLE RELAXANTS ..................... 112

SKLICE LOT 0.5% ....................................................... 38

SKYRIZI INJ 150 DOSE ................................................ 78

SLEEP DISORDER AGENTS .................................. 113

Sleep Disorders, Other ............................................... 113

Smoking Cessation Agents ........................................... 11

Sodium Channel Agents .............................................. 21

sodium chloride irrigation soln 0.9% ............................. 82

sodium chloride iv soln 0.45% ....................................... 82

sodium chloride iv soln 0.9% ......................................... 82

sodium chloride iv soln 3% ............................................ 82

sodium chloride iv soln 5% ............................................ 82

SODIUM FLUORIDE 2.2 MG (FLUORIDE ION 1 MG)

ORAL TABLET ........................................................ 82

sodium phenylbutyrate tab 500 mg ................................. 86

sodium polystyrene sulfonate oral susp 15 gm/60ml ....... 80

sodium polystyrene sulfonate powder ............................. 80

solifenacin tab 10 mg ..................................................... 86

solifenacin tab 5 mg ....................................................... 86

SOLTAMOX SOL 10MG/5ML ..................................... 33

SOMATULINE INJ 120/.5ML ..................................... 99

SOMATULINE INJ 60/0.2ML ..................................... 99

SOMATULINE INJ 90/0.3ML ..................................... 99

SOMAVERT INJ 10MG ............................................... 99

SOMAVERT INJ 15MG ............................................... 99

SOMAVERT INJ 20MG ............................................... 99

SOMAVERT INJ 25MG ............................................... 99

SOMAVERT INJ 30MG ............................................... 99

sorine tab 120 mg .......................................................... 62

sorine tab 160 mg .......................................................... 62

sorine tab 240 mg .......................................................... 62

sorine tab 80 mg ............................................................ 62

150

sotalol af tab 120 mg ..................................................... 62

sotalol hcl tab 120 mg .................................................... 62



sotalol hcl tab 80 mg ...................................................... 63

SOVALDI TAB400MG ................................................. 46

SPIRIVA AER 1.25MCG ............................................ 109

SPIRIVA CAP HANDI HLR ....................................... 109

SPIRIVA SPR 2.5MCG ............................................... 109

spironolactone & hydrochlorothiazide tab 25-25 mg ...... 70

spironolactone tab 100 mg ............................................. 69

spironolactone tab 25 mg ............................................... 69

spironolactone tab 50 mg ............................................... 69

sprintec 28 tab28 day ..................................................... 95

SPRITAM TAB 1000MG .............................................. 19

SPRITAM TAB 250MG ................................................ 19

SPRITAM TAB 500MG ................................................ 19

SPRITAM TAB 750MG ................................................ 19

SPRYCEL TAB 100MG ................................................ 37

SPRYCEL TAB 140MG ................................................ 37

SPRYCEL TAB 20MG .................................................. 37

SPRYCEL TAB 50MG .................................................. 37

SPRYCEL TAB 70MG .................................................. 37

SPRYCEL TAB 80MG .................................................. 37

sronyx tab ...................................................................... 95

SSRIs/SNRIs (Selective Serotonin Reuptake

Inhibitors/Serotonin Norepinephrine Reuptake

Inhibitors) .......................................................... 24, 50

STALEVO 100 TAB ..................................................... 39

STALEVO 125 TAB ..................................................... 39

STALEVO 150 TAB ..................................................... 39

STALEVO 200 TAB ..................................................... 39

STALEVO 50 TAB ...................................................... 39

STALEVO 75 TAB ...................................................... 39

stavudine cap 15 mg ...................................................... 47

stavudine cap 20 mg ...................................................... 47

stavudine cap 30 mg ...................................................... 47

stavudine cap 40 mg ...................................................... 47

STELARA INJ 5MG/0.5 ............................................... 78

STELARA INJ 90MG/ML............................................. 78

STIMATE SOL 1.5MG/ML .......................................... 91

STIOLTO AER 2.5-2.5 ................................................ 112

STIVARGA TAB 40MG ............................................... 37

streptomycin sulfate for inj 1 gm .................................... 11

STRIBILD TAB ............................................................ 46

STRIVERDI AER 2.5MCG ........................................ 110

SUCRAID SOL 8500/ML.............................................. 86

sucralfate sus 1gm/10ml.................................................. 85

sucralfate tab 1 gm ........................................................ 85

SULF/PRED NA SOL OP ........................................... 106

sulfacetamide sodium lotion 10% (acne) ........................ 18

sulfacetamide sodium ophth soln 10% ............................ 18

sulfadiazine tab 500 mg ................................................. 18

sulfamethoxazole-trimethoprim susp 200-40 mg/5ml ...... 18

sulfamethoxazole-trimethoprim tab 400-80 mg ............... 18

sulfamethoxazole-trimethoprim tab 800-160 mg ............. 18

SULFAMYLON CRE 85MG/GM ................................ 13

sulfasalazine tab 500 mg .............................................. 104

sulfasalazine tab dr 500 mg ......................................... 104

Sulfonamides ........................................................ 18, 104

sulindac tab 150 mg ....................................................... 30

sulindac tab 200 mg ....................................................... 30

sumatriptan nasal spray 20 mg/act ................................. 31

sumatriptan nasal spray 5 mg/act................................... 31

sumatriptan succinate inj 6 mg/0.5ml ............................. 31

sumatriptan succinate solution auto-injector 4 mg/0.5ml 31

sumatriptan succinate solution auto-injector 6 mg/0.5ml 31

sumatriptan succinate solution cartridge 4 mg/0.5ml ..... 31

sumatriptan succinate tab 100 mg .................................. 31

sumatriptan succinate tab 25 mg .................................... 31

sumatriptan succinate tab 50 mg .................................... 31

SUNOSI TAB 150MG ................................................... 75

SUNOSI TAB 75MG..................................................... 75

SUPRAX CAP 400MG .................................................. 15

SUPRAX SUS 500/5ML ............................................... 15

SUPREP BOWEL SOL PREP KIT ................................ 84

SUTENT CAP 12.5MG ................................................. 37

SUTENT CAP 25MG .................................................... 37

SUTENT CAP 37.5MG ................................................. 37

SUTENT CAP 50MG .................................................... 37

syeda tab 3-0.03 mg ....................................................... 95

SYLATRON KIT 200MCG ........................................... 45

SYLATRON KIT 300MCG ........................................... 45

SYMBICORT AER 160-4.5 ....................................... 112

SYMBICORT AER 80-4.5 ......................................... 112

SYMFI LO TAB............................................................ 47

SYMFI TAB .................................................................. 47

SYMLINPEN 60 INJ 1000MCG ................................... 55

SYMLNPEN 120 INJ 1000MCG ................................... 55

SYMPAZAN MIS 10MG .............................................. 20

SYMPAZAN MIS 20MG .............................................. 20

SYMPAZAN MIS 5MG ................................................ 20

SYMTUZA TAB ........................................................... 46

SYNAREL SOL 2MG/ML ............................................ 99

SYNJARDY TAB ......................................................... 55

SYNJARDY TAB 12.5-500MG..................................... 55

SYNJARDY TAB5-1000MG ........................................ 55

SYNJARDY TAB5-500MG .......................................... 55

SYNRIBO INJ 3.5MG ................................................... 34

SYNTHROID TAB 100MCG ....................................... 97

151







SYNTHROID TAB 25MCG ......................................... 97





TABLOID TAB 40MG .................................................. 33

TACLONEX SUS ......................................................... 78

tacrolimus cap 0.5 mg .................................................. 101

tacrolimus cap 1 mg ..................................................... 101

tacrolimus cap 5 mg ..................................................... 101

tacrolimus oint 0.03% .................................................... 78

tacrolimus oint 0.1% ...................................................... 78

tadalafil tab 2.5 mg ........................................................ 87

tadalafil tab 20mg ........................................................ 111

tadalafil tab 5 mg ........................................................... 87

TAFINLAR CAP 50MG ................................................ 37

TAFINLAR CAP 75MG ................................................ 37

TAGRISSO TAB 40MG ................................................ 37

TAGRISSO TAB 80MG ................................................ 37

TAKHZYRO INJ 300/2ML ........................................... 99

TALICIA CAP .............................................................. 84

TALTZ INJ 80MG/ML .................................................. 79

TALZENNA CAP 0.25MG ........................................... 34

TALZENNA CAP 1MG ................................................ 34

tamoxifen citrate tab 10 mg ............................................ 33

tamoxifen citrate tab 20 mg ............................................ 33

tamsulosin hcl cap 0.4 mg .............................................. 87

TARCEVA TAB 100MG .............................................. 37

TARCEVA TAB 150MG .............................................. 37

TARCEVA TAB 25MG ................................................ 37

TARGRETIN GEL 1% ................................................. 38

tarina 24 fe tab ............................................................... 95

tarina fe tab 1 mg-20 mcg .............................................. 95

TASIGNA CAP 150MG ................................................ 37

TASIGNA CAP 200MG ................................................ 37

TASIGNA CAP 50MG .................................................. 37

tazarotene cream 0.1% .................................................. 79

tazicef inj 1 gm .............................................................. 15

tazicef inj 2 gm .............................................................. 15

tazicef inj 6 gm .............................................................. 15

TAZORAC CRE 0.05% ................................................. 79

TAZORAC GEL 0.05% ................................................. 79

TAZORAC GEL 0.1%................................................... 79

taztia xt cap 120 mg/24hr ............................................... 65





TAZVERIK TAB 200MG .............................................. 37

TECFIDERA CAP 120MG ............................................ 76

TECFIDERA CAP 240MG ............................................ 76

TECFIDERA MIS STARTER ...................................... 76

TEFLARO INJ 400MG ................................................. 15

TEFLARO INJ 600MG ................................................. 15

TEGSEDI INJ 284/1.5 ................................................... 75

telmisartan tab 20 mg .................................................... 60



telmisartan-amlodipine tab 40-10 mg ............................. 68

telmisartan-amlodipine tab 40-5 mg ............................... 68

telmisartan-amlodipine tab 80-10 mg ............................. 68

telmisartan-amlodipine tab 80-5 mg ............................... 68

telmisartan-hydrochlorothiazide tab 40-12.5 mg ............ 68

telmisartan-hydrochlorothiazide tab 80-12.5 mg ............ 68

telmisartan-hydrochlorothiazide tab 80-25 mg ............... 68

temazepam cap 15 mg .................................................. 113

temazepam cap 22.5 mg ............................................... 113

temazepam cap 30 mg .................................................. 113

temazepam cap 7.5 mg ................................................. 113

tencon tab 50-325 mg ...................................................... 7

TENIVAC INJ 5-2LF .................................................. 103

tenofovir disoproxil fumarate tab 300 mg ....................... 47

terazosin hcl cap 1 mg ................................................... 87

terazosin hcl cap 10 mg ................................................. 87



terbinafine hcl tab 250 mg ............................................. 28

terbutaline sulfate tab 2.5 mg ....................................... 110

terbutaline sulfate tab 5 mg .......................................... 110

terconazole vaginal cream 0.4% .................................... 28

terconazole vaginal cream 0.8% .................................... 28

terconazole vaginal suppos 80 mg .................................. 28

testosterone cypionate im inj in oil 100 mg/ml ................ 91

testosterone cypionate im inj in oil 200 mg/ml ................ 91

testosterone enanthate im inj in oil 200 mg/ml................ 91

testosterone td gel 20.25 mg/1.25gm (1.62%) ................. 91

testosterone td gel 20.25 mg/act (1.62%) ........................ 91

testosterone td gel 40.5 mg/2.5gm (1.62%) ..................... 91

tetrabenazine tab 12.5 mg .............................................. 75

tetrabenazine tab 25 mg ................................................. 75

tetracycline hcl cap 250 mg ........................................... 19

tetracycline hcl cap 500 mg ........................................... 19

Tetracyclines ................................................................ 18

THALOMID CAP 100MG ............................................ 33

152

THALOMID CAP 150MG ............................................ 33

THALOMID CAP 200MG ............................................ 33

THALOMID CAP 50MG .............................................. 33

theophylline soln 80 mg/15ml ....................................... 111

theophylline tab er 300 mg ........................................... 111



thioridazine hcl tab 10 mg.............................................. 42

thioridazine hcl tab 100 mg ............................................ 42



thiothixene cap 1 mg ...................................................... 42

thiothixene cap 10 mg .................................................... 42



tiagabine hcl tab 12 mg .................................................. 20

tiagabine hcl tab 16 mg .................................................. 20

tiagabine hcl tab 2 mg.................................................... 20

tiagabine hcl tab 4 mg.................................................... 20

TIBSOVO TAB 250MG ................................................ 37

tigecycline for iv soln 50 mg .......................................... 13

TIMOLOL GEL SOL 0.25% OP ................................. 107

TIMOLOL GEL SOL 0.5% OP ................................... 107

timolol maleate ophth soln 0.25% ................................ 107

timolol maleate ophth soln 0.5% .................................. 107

timolol maleate tab 10 mg .............................................. 30

timolol maleate tab 20 mg .............................................. 31

timolol maleate tab 5 mg ................................................ 31

tinidazole tab 250 mg ..................................................... 13

tinidazole tab 500 mg ..................................................... 13

TIROSINT CAP 100MCG ............................................. 97

TIROSINT CAP 112MCG ............................................. 98

TIROSINT CAP 125MCG ............................................. 98

TIROSINT CAP 137MCG ............................................. 98

TIROSINT CAP 13MCG ............................................... 98

TIROSINT CAP 150MCG ............................................. 98

TIROSINT CAP 25MCG ............................................... 98

TIROSINT CAP 50MCG ............................................... 98

TIROSINT CAP 75MCG ............................................... 98

TIROSINT CAP 88MCG ............................................... 98

TIVICAY TAB 10MG ................................................... 46

TIVICAY TAB 25MG ................................................... 46

TIVICAY TAB 50MG ................................................... 46

tizanidine hcl tab 2 mg ................................................... 45

tizanidine hcl tab 4 mg ................................................... 45

TOBI PODHALR CAP 28MG ..................................... 110

TOBRADEX OIN 0.3-0.1% .......................................... 11

TOBRADEX ST SUS 0.3-0.05 .................................... 106

TOBRADEX SUS 0.3-0.1% ........................................ 106

tobramycin nebu soln 300 mg/5ml ................................ 110

tobramycin ophth soln 0.3% ........................................... 11

tobramycin sulfate inj 10 mg/ml ..................................... 11

tobramycin sulfate inj 40 mg/ml ..................................... 11

tobramycin-dexamethasone ophth susp 0.3-0.1% ......... 106

TOBREX OIN 0.3% OP ................................................ 11

tolcapone tab 100 mg ..................................................... 39

tolmetin sodium cap 400 mg ........................................... 30

tolmetin sodium tab 600 mg ........................................... 30

tolterodine tartrate cap er 2 mg ..................................... 86

tolterodine tartrate cap er 4 mg ..................................... 87

tolterodine tartrate tab 1 mg .......................................... 87

tolterodine tartrate tab 2 mg .......................................... 87

TOPIRAMATE CAP ER 100MG .................................. 21



TOPIRAMATE CAP ER 25MG .................................... 21

TOPIRAMATE CAP ER 50MG .................................... 21

topiramate sprinkle cap 15 mg ....................................... 21

topiramate sprinkle cap 25 mg ....................................... 21

topiramate tab 100 mg ................................................... 31

topiramate tab 200 mg ................................................... 31

topiramate tab 25 mg ..................................................... 31

topiramate tab 50 mg ..................................................... 31

toremifene citrate tab 60 mg .......................................... 33

torsemide tab 10 mg ....................................................... 69

torsemide tab 100 mg ..................................................... 69

torsemide tab 20 mg ....................................................... 69

torsemide tab 5 mg ........................................................ 69

TOUJEO MAX INJ 300IU/ML ..................................... 56

TOUJEO SOLO INJ 300IU/ML..................................... 56

TOVIAZ TAB 4MG ...................................................... 87

TOVIAZ TAB 8MG ...................................................... 87

TPN ELECTROL INJ .................................................... 82

TRADJENTA TAB 5MG ............................................. 55

tramadol hcl tab 50 mg .................................................. 10

tramadol hcl tab er 100 mg .............................................. 8

tramadol-acetaminophen tab 37.5-325 mg ..................... 10

trandolapril tab 1 mg ..................................................... 62



trandolapril-verapamil hcl tab er 1-240 mg ................... 68




tranexamic acid tab 650 mg ........................................... 59

TRANSDERM-SCDIS 1.5MG ...................................... 83

tranylcypromine sulfate tab 10 mg ................................. 24

TRAVASOL INJ 10% ................................................... 82

travoprost drop 0.004% ............................................... 107

trazodone hcl tab 100 mg ............................................... 25

153



trazodone hcl tab 50 mg ................................................. 25

Treatment Adjuncts ..................................................... 38

Treatment-Resistant .................................................... 44

TRECATOR TAB 250MG ............................................ 32

TRELEGY AER ELLIPTA ......................................... 112

TRELSTAR MIX INJ 11.25MG .................................... 99

TRELSTAR MIX INJ 22.5MG ...................................... 99

TRELSTAR MIX INJ 3.75MG ...................................... 99

TREMFYA INJ 100MG/ML.......................................... 79

TRESIBA FLEXINJ 100UNIT ...................................... 56

TRESIBA FLEXINJ 200UNIT ...................................... 56

TRESIBA INJ 100UNIT ................................................ 56

tretinoin cap 10 mg ........................................................ 38

tretinoin cream 0.025% ................................................. 79

tretinoin cream 0.05% ................................................... 79

tretinoin cream 0.1% ..................................................... 79

tretinoin gel 0.01% ........................................................ 79

tretinoin gel 0.025% ...................................................... 79

tretinoin gel 0.05% ........................................................ 79

tretinoin microsphere gel 0.04% .................................... 79

tretinoin microsphere gel 0.1% ...................................... 79

trexall tab 10 mg .......................................................... 101

trexall tab 15 mg .......................................................... 101

trexall tab 5 mg ............................................................ 101

trexall tab 7.5 mg ......................................................... 101

triamcinolone acetonide aerosol soln 0.147 mg/gm ........ 90

triamcinolone acetonide cream 0.025% ......................... 90

triamcinolone acetonide cream 0.1% ............................. 90

triamcinolone acetonide cream 0.5% ............................. 90

triamcinolone acetonide dental paste 0.1% .................... 77

triamcinolone acetonide lotion 0.025% .......................... 90

triamcinolone acetonide lotion 0.1% .............................. 90

triamcinolone acetonide oint 0.025% ............................. 90

triamcinolone acetonide oint 0.1% ................................. 90

triamcinolone acetonide oint 0.5% ................................. 90

triamterene & hydrochlorothiazide cap 37.5-25 mg ....... 70

triamterene & hydrochlorothiazide tab 37.5-25 mg ........ 70

triamterene & hydrochlorothiazide tab 75-50 mg ........... 70

triamterene cap 100 mg .................................................. 69

triamterene cap 50 mg .................................................... 69

Tricyclics ...................................................................... 25

trientine hcl cap 250 mg................................................. 80

tri-estaryll tab ................................................................ 95

trifluoperazine hcl tab 1 mg ........................................... 42

trifluoperazine hcl tab 10 mg ......................................... 42



trifluridine ophth soln 1% .............................................. 46

trihexyphenidyl hcl elixir 0.4 mg/ml ............................... 39

trihexyphenidyl hcl tab 2 mg .......................................... 39

trihexyphenidyl hcl tab 5 mg .......................................... 39

TRIKAFTA TAB ......................................................... 111

tri-legest tab fe............................................................... 95

tri-lo tab estaryll ............................................................ 95

tri-lo- tab sprintec .......................................................... 95

trilyte sol ....................................................................... 84

trimethobenzamide hcl cap 300 mg ................................ 26

trimethoprim tab 100 mg................................................ 13

tri-mili tab ..................................................................... 95

trimipramine maleate cap 100 mg .................................. 26

trimipramine maleate cap 25 mg .................................... 26

trimipramine maleate cap 50 mg .................................... 26

TRINTELLIX TAB 10MG ........................................... 25

TRINTELLIX TAB 20MG ........................................... 25

TRINTELLIX TAB 5MG ............................................. 25

tri-previfem tab .............................................................. 95

tri-sprintec tab ............................................................... 95

TRIUMEQ TAB ............................................................ 46

trivora-28 tab ................................................................ 95

tri-vylibra tab ................................................................ 95

tri-vylibra tab lo ............................................................ 96

TROPHAMINE INJ 10% ............................................. 82

trospium chloride cap er 60 mg ...................................... 87

trospium chloride tab 20 mg .......................................... 87

TRULICITY INJ 0.75/0.5 .............................................. 55

TRULICITY INJ 1.5/0.5 ................................................ 55

TRUMENBA INJ ........................................................ 103

TRUVADA TAB 100-150 ............................................. 47

TRUVADA TAB 133-200 ............................................. 47

TRUVADA TAB 167-250 ............................................. 47

TRUVADA TAB 200-300 ............................................. 47

TURALIO CAP 200MG ................................................ 37

TWINRIX INJ ............................................................. 103

TYBOST TAB 150MG .................................................. 48

TYKERB TAB 250MG ................................................. 37

TYPHIM VI INJ ......................................................... 103

UBRELVY TAB 100MG ............................................... 30

UBRELVY TAB 50MG ................................................. 30

UCERIS AER 2MG/ACT ............................................ 104

UDENYCA INJ 6MG/.6ML ........................................... 59

ULORIC TAB 40MG .................................................... 29

ULORIC TAB 80MG .................................................... 29

unithroid tab 100 mcg .................................................... 98






154

unithroid tab 25 mcg ...................................................... 98





UPTRAVI TAB 1000MCG ......................................... 111

UPTRAVI TAB 1200MCG ......................................... 111

UPTRAVI TAB 1400MCG ......................................... 111

UPTRAVI TAB 1600MCG ......................................... 111

UPTRAVI TAB 200/800MCG..................................... 111

UPTRAVI TAB 200MCG ........................................... 111

UPTRAVI TAB 400MCG ........................................... 111

UPTRAVI TAB 600MCG ........................................... 111

UPTRAVI TAB 800MCG ........................................... 111

ursodiol tab 250 mg ....................................................... 84

ursodiol tab 500 mg ....................................................... 84

Vaccines ..................................................................... 102

valacyclovir hcl tab 1 gm ............................................... 46

valacyclovir hcl tab 500 mg ........................................... 46

VALCHLOR GEL 0.016% ............................................ 32

valganciclovir hcl for soln 50 mg/ml .............................. 45

valganciclovir hcl tab 450 mg ........................................ 45

valproate sodium oral soln 250 mg/5ml.......................... 53

valproic acid cap 250 mg ............................................... 53

valsartan tab 160 mg ..................................................... 61

valsartan tab 320 mg ..................................................... 61

valsartan tab 40 mg ....................................................... 61

valsartan tab 80 mg ....................................................... 61

valsartan-hydrochlorothiazide tab 160-12.5 mg ............. 68

valsartan-hydrochlorothiazide tab 160-25 mg ................ 68

valsartan-hydrochlorothiazide tab 320-12.5 mg ............. 68

valsartan-hydrochlorothiazide tab 320-25 mg ................ 68

valsartan-hydrochlorothiazide tab 80-12.5 mg ............... 68

VALTOCO LIQ 15MG ................................................. 20

VALTOCO LIQ 20MG ................................................. 20

VALTOCO SPR 10MG .................................................. 20 VALTOCO SPR 5MG .................................................... 20

VANATOL LQ SOL ...................................................... 7

vancomycin hcl cap 125 mg ........................................... 13

vancomycin hcl cap 250 mg ........................................... 13

vancomycin hcl for iv soln 1 gm ..................................... 13

vancomycin hcl for iv soln 10 gm ................................... 13

vancomycin hcl for iv soln 500 mg ................................. 13

VAQTA INJ 25/0.5ML ................................................ 103

VAQTA INJ 50UNT/ML ............................................. 103

VARIVAX INJ ............................................................ 103

VASCEPA CAP 0.5GM ................................................ 71

VASCEPA CAP 1GM ................................................... 72

Vasodilators, Direct-acting Arterial ............................ 72

Vasodilators, Direct-acting Arterial/Venous ............... 72

velivet pak ..................................................................... 96

VELPHORO CHW 500MG ........................................... 82

VELTASSA POW 16.8GM ........................................... 80

VELTASSA POW 25.2GM ........................................... 80

VELTASSA POW 8.4GM ............................................. 80

VENCLEXTA TAB 100MG......................................... 37

VENCLEXTA TAB 10MG .......................................... 37

VENCLEXTA TAB 50MG .......................................... 37

VENCLEXTA TAB START PK ................................... 37

venlafaxine hcl cap er 150 mg ........................................ 51

venlafaxine hcl cap er 37.5 mg ....................................... 51

venlafaxine hcl cap er 75 mg .......................................... 51

venlafaxine hcl tab 100 mg............................................. 51

venlafaxine hcl tab 25 mg .............................................. 51

venlafaxine hcl tab 37.5 mg............................................ 51



venlafaxine hcl tab er 150 mg ........................................ 51

venlafaxine hcl tab er 225 mg ........................................ 51

venlafaxine hcl tab er 37.5 mg ....................................... 51

venlafaxine hcl tab er 75 mg .......................................... 51

VENTAVIS SOL 10MCG/ML .................................... 111

VENTAVIS SOL 20MCG/ML .................................... 112

VERAPAMIL CAP 360MG SR ..................................... 65

verapamil hcl cap er 100 mg .......................................... 65






verapamil hcl tab 120 mg ............................................... 65

verapamil hcl tab 40 mg................................................. 65

verapamil hcl tab 80 mg................................................. 65

verapamil hcl tab er 120 mg .......................................... 65



VEREGEN OIN 15% .................................................... 79

VERSACLOZ SUS 50MG/ML ..................................... 44

VERZENIO TAB 100MG ............................................. 34

VERZENIO TAB 150MG ............................................. 34

VERZENIO TAB 200MG ............................................. 34

VERZENIO TAB 50MG ............................................... 34

VESICARE TAB 10MG ................................................ 87

VESICARE TAB 5MG .................................................. 87

VIBRAMYCIN SYP 50MG/5ML ................................. 19

VICTOZA INJ 18MG/3ML ........................................... 55

vienva tab 0.1-20 ........................................................... 96

vigabatrin powd pack 500 mg ........................................ 20

vigabatrin tab 500 mg .................................................... 20

vigadrone powd pack 500 mg ......................................... 20

155

VIIBRYD KIT STARTER ............................................. 25

VIIBRYD TAB 10MG .................................................. 25

VIIBRYD TAB 20MG .................................................. 25

VIIBRYD TAB 40MG .................................................. 25

VIMPAT SOL 10MG/ML ............................................. 22

VIMPAT TAB 100MG .................................................. 22

VIMPAT TAB 150MG .................................................. 22

VIMPAT TAB 200MG .................................................. 22

VIMPAT TAB 50MG .................................................... 22

VIRACEPT TAB 250MG .............................................. 48

VIRACEPT TAB 625MG .............................................. 48

VIRAMUNE SUS 50MG/5ML ...................................... 47

VIREAD POW 40MG/GM ............................................ 45

VIREAD TAB 150MG .................................................. 45

VIREAD TAB 200MG .................................................. 45

VIREAD TAB 250MG .................................................. 45

VITRAKVI CAP 100MG .............................................. 37

VITRAKVI CAP 25MG ................................................ 38

VITRAKVI SOL 20MG/ML.......................................... 38

VIVITROL INJ 380MG................................................. 10

VIZIMPRO TAB 15MG ................................................ 38

VIZIMPRO TAB 30MG ................................................ 38

VIZIMPRO TAB 45MG ................................................ 38

voriconazole for inj 200 mg ........................................... 28

voriconazole for susp 40 mg/ml ...................................... 28

voriconazole tab 200 mg ................................................ 28

voriconazole tab 50 mg .................................................. 28

VOTRIENT TAB 200MG ............................................. 38

VRAYLAR CAP 1.5-3MG ............................................ 44

VRAYLAR CAP 1.5MG ............................................... 44

VRAYLAR CAP 3MG .................................................. 44

VRAYLAR CAP 4.5MG ............................................... 44

VRAYLAR CAP 6MG .................................................. 44

VUMERITY CAP 231MG.............................................. 76

vyfemla tab 0.4 mg-35 mcg ............................................ 96

vylibra tab 0.25 mg-35 mcg............................................ 96

VYNDAMAX CAP 61MG ............................................. 68

VYNDAQEL CAP 20MG .............................................. 68

WAKIX TAB 17.8MG ................................................. 113

WAKIX TAB 4.45MG ................................................. 113

warfarin sodium tab 1 mg .............................................. 58

warfarin sodium tab 10 mg ............................................ 58


warfarin sodium tab 2.5 mg ........................................... 58





warfarin sodium tab 7.5 mg ........................................... 58

wixela inhubaer 100/50 ................................................ 112

wixela inhubaer 250/50 ................................................ 112

wixela inhubaer 500/50 ................................................ 112

wymzya fe chew tab 0.4 mg-35 mcg ................................ 96

XALKORI CAP 200MG ............................................... 38

XALKORI CAP 250MG ............................................... 38

XARELTO STAR TAB 15/20MG ................................. 58

XARELTO TAB 10MG................................................. 58

XARELTO TAB 15MG................................................. 58

XARELTO TAB 2.5MG................................................ 58

XARELTO TAB 20MG................................................. 58

XATMEP SOL 2.5MG/ML ......................................... 101

XELJANZ TAB 10MG ................................................ 101

XELJANZ TAB 5MG.................................................. 101

XELJANZ XR TAB 11MG ........................................ 101

XELJANZ XR TAB 22MG ........................................ 101

XGEVA INJ ................................................................ 105

XIFAXAN TAB 200MG ............................................... 84

XIFAXAN TAB 550MG ............................................... 84

XIIDRA DRO 5% ....................................................... 106

XOLAIR INJ 150MG/ML ........................................... 112

XOLAIR INJ 75/0.5 .................................................... 112

XOLAIR SOL 150MG ................................................ 112

XOPENEX HFA AER ................................................. 110

XOSPATA TAB 40MG ................................................. 38

XPOVIO PAK 100MG ................................................... 34

XPOVIO PAK 60MG ..................................................... 34

XPOVIO PAK 80MG ..................................................... 34

XTANDI CAP 40MG .................................................... 32

xulane dis150-35 ........................................................... 96

XYREM SOL 500MG/ML .......................................... 113

YF-VAX INJ ............................................................... 103

YONSA TAB 125MG ................................................... 32

YUPELRI SOL............................................................. 109

yuvafem tab 10 mcg ....................................................... 96

zafirlukast tab 10 mg.................................................... 109

zafirlukast tab 20 mg.................................................... 109

zaleplon cap 10 mg ...................................................... 113

zaleplon cap 5 mg ........................................................ 113

zarah tab 3-0.03 mg ....................................................... 96

ZARXIO INJ 300/0.5 .................................................... 59

ZARXIO INJ 480/0.8 .................................................... 59

zebutal cap 50-325-40 mg ................................................ 7

ZEJULA CAP 100MG ................................................... 38

ZELAPAR TAB 1.25MG .............................................. 41

ZELBORAF TAB 240MG ............................................. 38

ZEMAIRA INJ 1000MG ............................................... 86

zenatane cap 10 mg ....................................................... 79

zenatane cap 20 mg ....................................................... 79

zenatane cap 30 mg ....................................................... 79

zenatane cap 40 mg ....................................................... 79

156

ZENPEP CAP 40000 ..................................................... 86

zenzedi tab 10 mg .......................................................... 73

zenzedi tab 15 mg .......................................................... 73

zenzedi tab 2.5 mg ......................................................... 73

zenzedi tab 20 mg .......................................................... 73

zenzedi tab 30 mg .......................................................... 73

zenzedi tab 5 mg ............................................................ 73

zenzedi tab 7.5 mg ......................................................... 73

zidovudine cap 100 mg................................................... 47

zidovudine syrup 10 mg/ml ............................................. 47

zidovudine tab 300 mg ................................................... 47

ZIEXTENZO INJ 6/0.6ML ............................................. 59

zileuton tab er 600 mg.................................................. 109

ziprasidone 80 mg .......................................................... 52

ziprasidone cap 20 mg ................................................... 52

ziprasidone cap 40 mg ................................................... 52

ziprasidone cap 60mg .................................................... 52

ZIPSOR CAP 25MG ..................................................... 30

ZIRGAN GEL 0.15% .................................................... 45

ZOLINZA CAP 100MG ................................................ 34

zolmitriptan odt tab 2.5 mg ............................................ 31

zolmitriptan odt tab 5 mg ............................................... 31

zolmitriptan tab 2.5 mg .................................................. 31

zolmitriptan tab 5 mg ..................................................... 31

zolpidem tartrate sl tab 1.75 mg ................................... 113

zolpidem tartrate sl tab 3.5 mg ..................................... 113

zolpidem tartrate tab 10 mg ......................................... 113

zolpidem tartrate tab 5 mg ........................................... 113

zolpidem tartrate tab er 12.5 mg .................................. 113

zolpidem tartrate tab er 6.25 mg .................................. 113

zonisamide cap 100 mg .................................................. 19

zonisamide cap 25 mg .................................................... 19

zonisamide cap 50 mg .................................................... 19

ZORBTIVE INJ 8.8MG ................................................. 84

ZORTRESS TAB 1MG ............................................... 101

ZOSTAVAX INJ ......................................................... 103

ZOSYN SOL 2-0.25GM ................................................ 16

ZOSYN SOL 3-0.375G ................................................. 16

zovia tab 1 mg-35 mcg ................................................... 96

ZUBSOLV SUB 1.4-0.36 .............................................. 10

ZUBSOLV SUB 11.4-2.9 .............................................. 10

ZUBSOLV SUB 2.9-0.71 .............................................. 11

ZUBSOLV SUB 5.7-1.4 ................................................ 11

ZUBSOLV SUB 8.6-2.1 ................................................ 11

ZYCLARA PUMP CRE 2.5% ....................................... 79

ZYCLARA PUMP CRE 3.75% ..................................... 79

ZYDELIG TAB 100MG ................................................ 38

ZYDELIG TAB 150MG ................................................ 38

ZYFLO TAB 600MG .................................................. 109

ZYKADIA TAB 150MG ............................................... 38

ZYLET SUS 0.5-0.3% ................................................. 106

ZYPREXA RELP INJ 210MG ....................................... 44

ZYTIGA TAB 500MG .................................................. 32

Notice Informing Individuals about Nondiscrimination and Accessibility Requirements:

Discrimination is Against the Law

Ultimate Health Plans complies with applicable Federal civil rights laws and does not discriminate on

the basis of race, color, national origin, age, disability, or sex. Ultimate Health Plans does not exclude

people or treat them differently because of race, color, national origin, age, disability, or sex. Ultimate

Health Plans:

• Provides free aids and services to people with disabilities to communicate effectively with us,

such as:

o Qualified sign language interpreterso Written information in other formats (large print, audio, accessible electronic formats,

other formats)

• Provides free language services to people whose primary language is not English, such as:

o Qualified interpreters

o Information written in other languages

If you need these services, contact Darilu Debi. If you believe that Ultimate Health Plans has failed to

provide these services or discriminated in another way on the basis of race, color, national origin, age,

disability, or sex, you can file a grievance with: Darilu Debi, Chief Operating Officer:

Address:

Phone:

Fax:

Email:

1244 Mariner Boulevard, Spring Hill, FL 34609

352-835-7151 (TTY users dial 711)

352-835-7169

[email protected]

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Darilu

Debi, Chief Operating Officer, is available to help you. You can also file a civil rights complaint with

the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the

Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or

by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW.,

Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

mailto:[email protected]

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

http://www.hhs.gov/ocr/office/file/index.html

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.

Llame al 1-888-657-4170 (TTY: 711).

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-888-657-4170 (TTY: 711).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1- 888-657-4170 (TTY: 711).

ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-

888-657-4170 (TTY: 711).

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電1-888-657-4170 (TTY: 711)。

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-888-657-4170 (ATS : 711).

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-657-4170 (TTY: 711).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-657-4170 (телетайп: 711).

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-888-657-4170 (رقم ھاتف الصم والبكم: 711).

ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-888-657-4170 (TTY: 711).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen

zur Verfügung. Rufnummer: 1-888-657-4170 (TTY: 711).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-4180 (TTY:

711)번으로 전화해 주십시오.

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-888-657-4170 (TTY: 711).

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες

παρέχονται δωρεάν. Καλέστε 1-888-657-4170 (TTY: 711).

ચના: જો તમે જરાતી બોલતા હો, તો િ ન: ક ભાષા સહાય સેવાઓ તમારા માટ"\ ઉપલ ધ છે. ફોન

કરો 1- 888-657-4170 (TTY: 711).

เรียน: ถาคุณพดภาษาไทยคุณสามารถใชบริการช่วยเหลือทางภาษาไดฟรี โทร 1-888-657-4170 (TTY: 711).

Good health is where you live.

COMMUNITY OUTREACH OFFICE 2713 Forest Road

Spring Hill, FL 34606

CORPORATE OFFICE 1244 Mariner Boulevard

Spring Hill, FL 34609

This formulary was updated on 07/01/2020. For more recent information or other questions, please contact Ultimate Health Plans Member Services at 1-888-657-4170 or, for TTY users, 711, Monday through Sunday from 8 a.m. to 8 p.m. (during certain times of the year we may use alternative technologies to answer your call on weekends and Federal holidays) or visit www.chooseultimate.com.

Documents

2020 UHP SNP Formulary - Ultimate Health Plans · H2962_2020 C-SNP Formulary_v120_C. 0020481, Version 20. 2020 formulary. list of covered drugs. PLEASE READ: THIS DOCUMENT CONTAINS