CCA - 81151 · PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 800-700-3874 (TTY: 1-800-735-2929). 주의:

Pharmacy Formulary

Applicable to Medi-Cal

Alliance Care IHSS Health Plans

May 1 2021

This formulary and other plan-specific coverage documents are accessible online at

httpwwwccah-allianceorgpharmacyhtml

Link to the Medi-Cal and Alliance Care IHSS membersrsquo homepage

httpccah-allianceorgmembershtml

Notice This formulary is subject to change and all previous versions of the formulary are no longer in effect

Notice of non-discrimination Discrimination is against the law Central California Alliance for Health (the Alliance)

complies with applicable federal and State civil rights laws and does not discriminate

(exclude or treat people differently) on the basis of race color national origin creed

ancestry religion language age marital status sex sexual orientation gender identity

health status physical or mental disability or identification with any other persons or

groups defined in Penal Code 42256 and the Alliance will provide all Covered Services

in a culturally and linguistically appropriate manner The Alliance

Provides free aids and services to people with disabilities to communicate effectively

with us such as

Qualified sign language interpreters

Written information in other formats (braille large print audio accessible

electronic formats and other formats)

Provides free language services to people whose primary language is not English

such as

Qualified interpreters

Information written in other languages

If you need these services contact Member Services

If you believe that the Alliance has failed to provide these services or discriminated in

another way on the basis of race color national origin creed ancestry religion

language age marital status sex sexual orientation gender identity health status

physical or mental disability or identification with any other persons or groups defined in

Penal Code 42256 you can file a grievance with

Central California Alliance for Health Attn Grievance Department 1600 Green Hills Road Scotts Valley CA 95066 800-700-3874 x5816 (TTY 1-800-735-2929) Fax 831-430-5579 Email GrievanceCoordinatorccah-allianceorg

You can file a grievance in person or by mail fax or email If you need help filing a

grievance Member Services or a Grievance Coordinator is available to help you

You can also file a civil rights complaint with the US Department of Health and Human

Services Office for Civil Rights electronically through the Office for Civil Rights

Complaint Portal available at httpsocrportalhhsgov or by mail or phone at

US 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 httpswwwhhsgovocrfiling-with-ocr

ATENCIOacuteN Si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica

Llame al 800-700-3874 (TTY Llame al 1-800-855-3000)

CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số

800-700-3874 (TTY 1-800-735-2929)

PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong

sa wika nang walang bayad Tumawag sa 800-700-3874 (TTY 1-800-735-2929)

주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다

800-700-3874 (TTY 1-800-735-2929) 번으로 전화해 주십시오

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 800-700-3874

(TTY 1-800-735-2929）

ՈՒՇԱԴՐՈՒԹՅՈՒՆ Եթե խո ս ո ւ մ եք հայ ե ր ե ն ապա ձեզ ան վ ճ ար կար ո ղ

են տր ամ ադ ր վ ե լ լե զ վ ակ ան աջ ակ ց ո ւ թ յ ան ծառ այ ո ւ թյ ո ւ ն ն ե ր Զան

գ ահ ար ե ք 800-700-3874 (TTY (հ ե ռ ատի պ) 1-800-735-2929)

ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги

перевода Звоните 800-700-3874 (телетайп 1-800-735-2929)

زبانی بصورت رایگان برای شما اگر به زبان فارسی گفتگو می کنید تسهیلات توجه تماس بگیرید (TTY 1-800-735-2929) 3874-700-800با فراهم می باشد

注意事項日本語を話される場合無料の言語支援をご利用いただけます800-700-

3874 (TTY 1-800-735-2929）までお電話にてご連絡ください

LUS CEEV Yog tias koj hais lus Hmoob cov kev pab txog lus muaj kev pab dawb rau koj

Hu rau [1-800-700-3874] (TTY [1-800-735-2929])

ਧਿਆਨ ਧਿਓ ਜ ਤਸੀ ਪਜਾਬੀ ਬਲਿ ਹ ਤਾ ਭਾਸ਼ਾ ਧ ਿ ਚ ਸਹਾਇਤਾ ਸ ਾ ਤਹਾਡ ਲਈ ਮਫਤ ਉਪਲਬਿ ਹ 800-700-3874 (TTY 1-800-735-2929) ਤ ਕਾਲ ਕਰ

بالمجان اتصل مقرب 800-700-3874 كل المساعدة اللغویة تتوافرفإن خدمات

ملحوظة إذا كنت تتحدث اذكر اللغة (1-800-735-2929 )رقم هاتف الصم والبكم

धयान द यदद आप द िदी बोलत तो आपक ललए मफत म भाषा स ायता सवाएि उपलबध 800-700-

3874 (TTY 1-800-735-2929) पर कॉल कर

เรยน ถาคณพดภาษาไทยคณสามารถใชบรการชวยเหลอทางภาษาไดฟร โทร 800-700-3874 (TTY 1-800-735-2929)

បរយតន បរ ើសនជាអនកនយាយ ភាសាខមែ ប សវាជនយខមែនកភាសា រោយមនគតឈន ល គអាចមានសរារររ ើអនក ច ទ សពទ 800-700-3874 (TTY 1-800-735-2929)

ໂປດຊາບຖາວາ ທານເວ າພາສາ ລາວການບ ລ ການຊວຍເຫ ອດານພາສາ ໂດຍບ ເສຽຄາ ແມນມພອມໃຫທານ ໂທຣ 800-700-3874 (TTY 1-800-735-2929

TOC-1

Table of Contents

Informational Section 2

Analgesic Anti-Inflammatory Or Antipyretic - Drugs For Pain And Fever 24

Anesthetics - Drugs For Pain And Fever 33

Anorectal Preparations - Rectal Preparations 33

Antidotes And Other Reversal Agents - Drugs For Overdose Or Poisoning 33

Anti-Infective Agents - Drugs For Infections 34

Antineoplastics - Drugs For Cancer 42

Antiseptics And Disinfectants - Antiseptics And Disinfectants 52

Biologicals - Biological Agents 52

Cardiovascular Therapy Agents - Drugs For The Heart 62

Central Nervous System Agents - Drugs For The Nervous System 70

Chemical Dependency Agents To Treat - Drugs For Addiction 82

Chemicals-Pharmaceutical Adjuvants 83

Cognitive Disorder Therapy - Drugs For The Nervous System 85

Contraceptives - Drugs For Women 85

Dermatological - Drugs For The Skin 99

Eating Disorder Therapy - Drugs For Eating Disorders 112

Electrolyte Balance-Nutritional Products - Drugs For Nutrition 112

Endocrine - Hormones 135

Gastrointestinal Therapy Agents - Drugs For The Stomach 143

Genitourinary Therapy - Drugs For The Urinary System 160

Gout And Hyperuricemia Therapy - Drugs For Pain And Fever 163

Hematological Agents - Drugs For The Blood 163

Immunosuppressive Agents - Drugs For Organ Transplants 167

Locomotor System - Drugs For Muscles Ligaments Tendons And Bones 167

Medical Supplies And Durable Medical Equipment (Dme) - Medical Supplies And Durable Medical Equipment 168

Medical Supply Fdb Superset 181

Metabolic Modifiers - Drugs That Alter Metabolism 192

Mouth-Throat-Dental - Preparations - Drugs For The Mouth And Throat 192

Ophthalmic Agents - Drugs For The Eye 194

Otic (Ear) - Drugs For The Ear 202

Respiratory Therapy Agents - Drugs For The Lungs 203

Vaginal Products - Drugs For Women 224

2

Informational Section

Introduction

Alliance Member Services Contact Information If you have any questions about this handbook your benefits or how to get care please call us at 1-800-700-3874 (TTY for the hearing-impaired at 1-800-735-2929) It is our job to help you understand your health plan and how to use it Our Representatives speak English and Spanish We use a telephone language line for members who speak other languages You can reach one of our Member Services Representatives Monday-Friday between 800 am and 600 pm You can also visit our Web site wwwccah-allianceorg

Message from Alliance pharmacy department Central California Alliance for Health (The Alliance) with direction from the Pharmacy amp Therapeutics (PampT) Committee has developed this formulary to be used by Alliance providers and Medi-Cal and Alliance Care IHSS members

The PampT committee will continue to update and revise this formulary based on quality of care considerations and sound financial principles The Alliancersquos contract with the State of California requires mandatory generic substitution whenever an equivalent product is available By Alliance policy the only prescription drugs not requiring mandatory generic substitution are Coumadin Dilantin and Lanoxin However clinicians may prescribe a Brand Name drug with a ldquodo not substituterdquo order when there is clinical justification for doing so In the latter case a Prior Authorization must be submitted to the Alliance for consideration prior to dispensing the drug to an Alliance member Over-the-counter (OTC) drugs are not a covered benefit for Alliance Care IHSS health plan except for loratadine cetirizine fexofenadine ketotifen prenatal vitamins nicotine patches and gum OTC contraceptives and diabetic supplies These OTC drugs are denoted in the Formulary with the ldquoOTCrdquo symbol OTC drugs that are Medi-Cal benefits only are denoted with the symbol ldquoOTC MediCalrdquo There is more information about symbols used in the formulary in the Informational section The formulary can be changed every month and changes are effective on the 1st of the month after quarterly PampT committee meetings Formulary changes are published in the Alliance Member bulletins provider bulletins and in this formulary guide Changes to the formulary may include adding or removing coverage requirements or limits addition of or removal of prior authorization requirements See the Informational section for more details on the formulary symbols and what they mean

4

The Alliance will not make changes to the drug tiers as a result of PampT committee that would result in a higher copayment amount please see drug tier section for more information

Definitions

Brand Name Drug A drug that is marketed under a proprietary trademark protected name The brand name drug shall be listed in all CAPITAL letters Coinsurance A percentage of the cost of a covered health care benefit that an enrollee pays after the enrollee has paid the deductible if a deductible applies to the health care benefit such as the prescription drug benefit Copayment A fixed dollar amount that an enrollee pays for a covered health care benefit after the enrollee has paid the deductible if a deductible applies to the health care benefit such as a prescription drug benefit

Coordination of Benefits Means that if you have more than one insurance carrier there is a specific order as to which insurance will pay first and which will pay last The one that is billed first is your primary insurance The insurance that is billed next is your secondary insurance Even if you have more than one insurance carrier the provider cannot collect more than the rate set by the insurance carriers If you have questions about which insurance is your primary please call Member Services Deductible Is the amount an enrollee pays for covered health care benefits before the enrollees health plan begins payment for all or part of the cost of the health care benefit under the terms of the policy Drug Tier Is a group of prescription drugs that corresponds to a specified cost sharing tier in the health plans prescription drug coverage The tier in which a prescription drug is placed determines the enrollees portion of the cost for the drug Enrollee

Is a person enrolled in a health plan who is entitled to receive services from the plan All

references to enrollees in this formulary template shall also include subscribers as

defined in this section below

Exception request Is a request for coverage of a prescription drug If an enrollee his or her designee or prescribing health care provider submits an exception request for coverage of a prescription drug the health plan must cover the prescription drug when the drug is determined to be medically necessary to treat the enrollees condition

6

Exigent circumstances When an enrollee is suffering from a health condition that may seriously jeopardize the enrollees life health or ability to regain maximum function or when an enrollee is undergoing a current course of treatment using a nonformulary drug Formulary The complete list of drugs preferred for use and eligible for coverage under a health plan product and includes all drugs covered under the outpatient prescription drug benefit of the health plan product Formulary is also known as a prescription drug list Generic drug Is the same drug as its brand name equivalent in dosage safety strength how it is taken quality performance and intended use A generic drug is listed in bold and italicized lowercase letters Medical Supplies The pharmacy department will review authorization requests for blood glucose meters test strips lancets syringes needles and sharps containers All other requests for medical supplies will need to be sent to the Utilization Management department The fax number for the Utilization Management department is (831) 430-5850 Medically Necessary Those health care mental health care and substance use disorder services or products that are (a) furnished in accordance with professionally recognized standards of practice (b) determined by the treating provider to be consistent with the medical condition mental illness or substance use disorder and (c) furnished at the most appropriate type supply and level of service that consider the potential risks benefits and alternatives Member A person who becomes enrolled (enrollee) in Central California Alliance for Health to receive health care In this formulary a Member is also referred to as ldquoyourdquo Nonformulary drug A prescription drug that is not listed on the health plans formulary Out-of-pocket cost Are copayments coinsurance and the applicable deductible plus all costs for health care services that are not covered by the health plan Over the counter A medicine or product available for retail sale but which can be considered for payment by the plan with a valid prescription

Prescribing provider A health care provider authorized to write a prescription to treat a medical condition for a health plan enrollee Prescription Is an oral written or electronic order by a prescribing provider for a specific enrollee that contains the name of the prescription drug the quantity of the prescribed drug the date of issue the name and contact information of the prescribing provider the signature of the prescribing provider if the prescription is in writing and if requested by the enrollee the medical condition or purpose for which the drug is being prescribed Prescription drug A drug that is prescribed by the enrollees prescribing provider and requires a prescription under applicable law Prior Authorization A health plans requirement that the enrollee or the enrollees prescribing provider obtain the health plans authorization for a prescription drug before the health plan will cover the drug The health plan shall grant a prior authorization when it is medically necessary for the enrollee to obtain the drug Step Therapy A process specifying the sequence in which different prescription drugs for a given medical condition and medically appropriate for a particular patient are prescribed The health plan may require the enrollee to try one or more drugs to treat the enrollees medical condition before the health plan will cover a particular drug for the condition pursuant to a step therapy request If the enrollees prescribing provider submits a request for step therapy exception the health plans shall make exceptions to step therapy when the criteria is met Subscriber Means the person who is responsible for payment to a plan or whose employment or other status except for family dependency is the basis for eligibility for membership in the plan

8

Using Your Health Plan Formulary

There are a few ways to look up a drug in the formulary

1 You can find a drug by looking for the therapeutic category of the drug in the categorical list of prescription drugs This is list is in the Table of contents If you choose a therapeutic class in the Table of contents you can double click on the name and it will take you to the drugs in the class listing

a If you are using an electronic version of the drug list you can also use the PDF Search Function by pressing Ctrl + F on your computer keyboard Type the name of the therapeutic class you are looking for in the search box

b If you are using a print version of the drug list you can search for the name of the therapeutic class in the Table of contents or the Index at the end of this guide

2 If you have the generic or brand name of the drugs you can also use the Index of prescription drugs You can find the Index in the Table of contents

a If you are using an electronic version of the drug list you can use the PDF Search Function by pressing Ctrl + F on your computer keyboard Type the generic or brand name of the drug you are looking for in the search box

b If you are using a print version of the drug list you can search for the generic or brand name of the drug in the Index at the end of this guide

c If a generic equivalent of a brand name drug is not available or is not

covered the drug will not be listed separately by its generic name in the formulary

3 You can call member services and ask them to help you find out if your drug is covered on the formulary You can request a paper copy of the formulary by contacting member services

4 You can ask your doctor to call our pharmacy department ask if a drug is covered or ask your doctor to look up the formulary document online The Alliance formulary is located on the member services webpage but it is also available for providers on the provider webpage

How drugs are listed in the categorical list of prescriptions drugs

1 Drugs are listed alphabetically by its brand and generic names in the therapeutic category and class to which it belongs

2 The generic name of a brand name drug is included after the brand name in parenthesis and all bold and italicized lowercase letters

3 If a generic equivalent for a brand name drug is available and both the brand name and generic equivalents are covered the generic drug will be listed separately from the brand name drug in all bold and italicized lowercase letters

4 In the event a generic drug is marketed under a proprietary trademark protected brand name the brand name will be listed in all CAPITAL letters after the generic name in parentheses and regular typeface with first letter of each word capitalized

a example Wixela Inhub Inhaler

10

Drug Tiers (Alliance Care IHSS Health Plan only)

Tier copayment amounts apply

per prescription for a 30-day supply of generic drugs per prescription for a 30-day supply of brand name drugs

per prescription for a 90-day supply of maintenance drugs of generic drugs per prescription for a 90-day supply of brand name drugs

If the cost of drug is lower than the copayment member will pay for the lower cost

No copayment for prescription drugs provided in an inpatient setting

No copayment for drugs administered in the doctorrsquos office or in an outpatient facility

Copayment may be less for a ldquopartial fillrdquo please see ldquoWhat your doctor can prescriberdquo section of more information on what ldquopartial fillrdquo means

Tier Copayment Description

Tier 1 $500 Generic and Specialty generic drugs

Tier 2 $1500 Brand and Specialty brand drugs

coinsurance amounts in accordance with Health and safety code 1367656

Formulary Symbols Key

Symbol Description andor Coverage Requirements and Limits

Age Age limits apply We only pay for this drug or dosage form for certain age groups based on information about the drugrsquos safety efficacy and cost

CT Contraceptives zero copay for Alliance Care IHSS health plan

DD Diabetes DrugsDevices

IHSS Drugs that are covered benefits under the Alliance Care IHSS health plan Drugs that are carved-out benefits for the Medi-Cal health plan and State Fee for service Medi-Cal is responsible for payment

OCH Orally administered cancer drugs

OTC Over-the-Counter drugs that are covered by Alliance Care IHSS health plan and Medi-Cal health plan

OTC MediCal Over-the-Counter drugs that are covered on the drug list with a valid prescription from a provider for Medi-Cal health plan only Requires a prior authorization for coverage under Alliance Care IHSS health plan

PA Prior Authorization is required We require advanced approval of coverage on some drugs before they will be paid for If Prior Authorization is required for a drug or dosage form providers must show you have a medically accepted use for the drug and other treatments have not worked or are not appropriate Other requirements may apply depending on the drug

PA NSO Prior Authorization is required for a member who has been newly started on the drug

QL Quantity Limits apply We will pay for a maximum daily amount based on information about the drugrsquos medically accepted use and cost

ST Step Therapy is required If we have paid for you to have the required step therapy drug(s) in the past this drug will be paid for at the pharmacy without need for a Prior Authorization or step therapy exception request The drug list will show you which drugs are required first

SP Drug is a specialty drug and can only be dispensed by US Bioservices pharmacy (exceptions for medical necessity are considered on a case by case basis)

12

Getting Pharmacy Benefits

Drugs given in a doctorrsquos office or drugs covered under the medical benefit

Your doctor will know what drugs these are If your doctor prescribes these your doctor can contact us for more information about obtaining these drugs for you These drugs can be given to you in different ways sometimes through an injection in your vein skin or other body part There are no coinsurance amounts for these drugs on the Alliance care IHSS health plan or the Medi-Cal health plan

Your doctor can ask about coverage restrictions or submit a prior authorization by calling Alliance provider services at 831-430-5504 or by calling Pharmacy prior authorizations at 831-430-5507 Your doctor can also fax a prior authorization to us or use our online prior authorization portal

If you have questions about coverage for drugs given to you in a doctorrsquos office you can call member services at (800) 700-3874 These drugs are not listed on the Formulary

What Your Doctor Can Prescribe

Your PCP has a list of drugs that are approved by the Plan This list is called a formulary A group of doctors and pharmacists reviews and updates the formulary list every year to make sure that the drugs on it are safe and useful If your doctor thinks that you need to take a drug that isnrsquot on this list or if your doctor feels you need a drug that isnrsquot usually prescribed for the specific medical condition you have your doctor can send us a request for prior authorization The presence of a prescription drug on the formulary does not guarantee that it will be prescribed by your doctor for a particular medical condition

You or your doctor can request that the pharmacy fill only part of the prescription at one time You would get the rest of the prescribed amount later This is called a ldquopartial fillrdquo and applies only to what are called Schedule 2 drugs These are drugs like opioids and stimulants Your copayment on a partial fill will be prorated and will be less than the copayment stated in the drug tier section

Your pharmacy can call MedImpact to ask for a 5 day emergency supply override for you at any time

How to get prior authorization for a drug

Drugs that require a prior authorization are noted with the symbol ldquoPArdquo on the formulary guide

The request for prior authorization lets us know why you need that drug Prior authorization means that both your doctor and the Plan or the Planrsquos Contractor agree

that the services you will receive are medically necessary We will need to approve the request before covering that drug for you When there is more than one drug that is appropriate for the treatment of a medical condition we may require your doctor to try the preferred drug first before requesting authorization to prescribe any of the others This is known as ldquostep therapyrdquo Your provider may request an exception to the step therapy process for a prescription drug

When we get a request for prior authorization for a drug we will reply to your doctor within 24-hours from the time the request was received If we do not respond within 24-hours the request is considered to be approved Authorization requests for exigent circumstances will be given priority and a 72-hour supply of the covered outpatient drug will be dispensed until a determination has been made or the 24-hour period has expired Please see the ldquoDefinitionsrdquo section of this document for an explanation of the term ldquoexigent circumstancesrdquo

If we approve the request then you can get the drug If we deny the request you have the right to file a complaint As part of the grievance process you your personal representative or your provider may ask for an external exception review This means we would send the authorization request and the information we received from your provider to an outside physician who would review our decision For more information on how to file a complaint or asking for an external exception review please call member services at 1-800-700-3874 The Alliance Care IHSS health plan and Medi-Cal member handbooks contain all of your appeal rights and procedures too

The Plan will not limit or exclude coverage for a drug you are taking if the drug had been previously approved for coverage by the Plan and your doctor continues to prescribe the drug as long as the drug is appropriately prescribed and is considered safe and effective for treating your medical condition This does not mean that your doctor cannot choose to prescribe a different drug or that a generic equivalent of the drug cannot be substituted

How to find a pharmacy

If you are filling or refilling a prescription you must get your prescribed drugs from a pharmacy that works with the Alliance We contract with a company called MedImpact for pharmacy services and we use their network of pharmacies You must go to one of these pharmacies for your prescription drugs Some of the pharmacies have locations throughout California

You can find a list of pharmacies that work with the Alliance in the Alliance Provider Directory at

httpwwwccah-allianceorgaspnetformsMedimpactLocatoraspx

You can also find a pharmacy near you by calling Member Services at 800-700-3874 (TTY 800-735-2929 or 711)

Once you choose a pharmacy take your prescription to the pharmacy Give the pharmacy your prescription with your Alliance ID card Make sure the pharmacy knows

14

about all drugs you are taking and any allergies you have If you have any questions about your prescription make sure you ask the pharmacist

If you need to get a prescription filled at an out-of-area pharmacy because of an emergency or for treatment of an urgent medical condition please ask the pharmacy to call us at 1-800-700-3874 We will explain to the pharmacy how they can bill us for the drug

Your pharmacy can also call MedImpact to get a 5 day emergency supply of drugs for you If there is a State of emergency issued in your local area your pharmacy can also call MedImpact to get an emergency override for your drugs

Some drugs are known as specialty drugs These drugs may have special handling or storage requirements or you will need extra guidance from a care team at the pharmacy for that drug

The Alliance has a preferred Specialty pharmacy called US Bioservices pharmacy which is also shown in our Alliance Provider directory The specialty drugs which are required to be filled at US Bioservices are shown on the formulary with an ldquoSPrdquo symbol

You may request an exception to using US Bioservices pharmacy by calling member services The Alliance may allow you to use a different specialty pharmacy besides US Bioservices pharmacy but not the retail pharmacy of your choice This is because only specialty pharmacies carry these drugs and sometimes only one or two pharmacies have access to dispense that drug

The Alliance also offers a mail order pharmacy program Did you know you can get a 90-day supply of most prescription drugs mailed to you through MedImpact Direct Talk to your doctor about getting a 90-day supply with free standard delivery To set-up mail order for your drugs visit httpswwwmedimpactcom or call 855-873-8739

Address

Santa Cruz County Main Office

1600 Green Hills Road

Suite 101

Scotts Valley CA 95066-

4981

(831) 430-5500

Hours M-F 8am-5pm

Monterey County Office 950 East Blanco Road

Suite 101

Salinas CA 93901-3400

(831) 755-6000

Hours M-F 8am-5pm

Merced County Office 530 West 16th Street

Suite B

Merced CA 95340-4710

(209) 381-5300

Hours M-F 8am-5pm

Phone Directory

Automated System (831) 430-5501

Authorizations ndash Pharmacy (831) 430-5507

Authorizations ndash Non-Pharmacy (831) 430-5506

Status Requests for Non-Pharmacy (831) 430-5511

Care Management (831) 430-5512

Claims Inquiries (831) 430-5503

EDI Support Line (831) 430-5510

Health Education (831) 430-5580

Member Services (831) 430-5505

Provider Services (831) 430-5504

Department Fax Numbers

Administration (831) 430-5852

Claims (831) 430-5858

Finance (831) 430-5853

Health Services PA and RAFs (831) 430-5850


Pharmacy Authorizations (831) 430-5851


16

Carve-out Drugs (applies to Medi-Cal health plan only)

The following drugs are carved out from the Alliance formulary for AIDS and Hep B indications They are to be billed to State Medi-Cal via EDS not the Alliance Some of the drugs may require a TREATMENT AUTHORIZATION REQUEST (TAR) submitted to State Medi-Cal and approved prior to dispensing These are denoted with the Formulary symbol ldquoIHSSrdquo as they are benefits for Alliance Care health plan

AIDS Drugs ( and Hep B )Drugs TAR Required (YN)

AbacavirLamivudine N

Abacavir Sulfate N

Abacavir SulfateDolutegravirLamivudine (Triumeq) N

Atazanavir Sulfate N

AtazanavirCobicistat (Evotaz) N

BictegravirEmtricitabineTenofovir Alafenamide (Biktarvy) N

CabotegravirRilpivirine (Cabenuva) Y

Cobicistat (Tybost) N

Darunavir Ethanolate N

DarunavirCobicistat (Prezcobix) N

DarunavirCobicistatEmtricitabineTenofovir Alafenamide (Symtuza)

N

Delavirdine Mesylate N

Dolutegravir (Tivicay) N

Dolutegravir (Tivicay PD) Y

Dolutegravir Lamivudine (Dovato) N

Dolutegravir Rilpivirine (Juluca) N

Doravine (Pifeltro) N

Doravirine Lamivudine Tenofovir disoproxil fumarate (Delstrigo)

N

Efavirenz N

EfavirenzEmtricitabineTenofovir Disoproxil Fumarate ( Atripla)

N

EfavirenzLamivudineTenofovir Disoproxil Fumarate ( Symfi LO)

N

EfavirenzLamivudineTenofovir Disoproxil Fumarate ( Symfi ) N

Elvitegravir (Vitekta) N

ElvitegravirCobicistatEmtricitabineTenofovir Disoproxil Fumarate (Stribild)

N

AIDS Drugs ( and Hep B )Drugs Continued TAR Required (YN)

ElvitegravirCobicistatEmtricitabineTenofovir alafenamide (Genvoya)

N

EmtricitabineRilpivirineTenofovir Alafenamide (Odefsey) N

EmtricitabineRilpivirine Tenofovir Disoproxil Fumarate (Complera)

N

EmtricitabineTenofovir Alafenamide ( Descovy) N

Emtricitabine N

Enfuvirtide Y

Etravirine N

Fosamprenavir Calcium N

Fostemsavir (Rukobia) Y

Ibalizumab-uiyk ( Trogarzo ) N

Indinavir Sulfate N

Lamivudine N

Lamivudine Tenofovir disoproxil fumarate ( Cimduo) N

LopinavirRitonavir N

Maraviroc N

Nelfinavir Mesylate N

Nevirapine N

Raltegravir Potassium N

Rilpivirine Hydrochloride N

Ritonavir N

Saquinavir N

Saquinavir Mesylate N

Stavudine N

Tenofovir Alafenamide (Vemlidy) N

Tenofovir Disoproxil-Emtricitabine N

Tenofovir Disoproxil Fumarate N

Tipranavir N

ZidovudineLamivudine N

ZidovudineLamivudine Abacavir Sulfate N

18


The following drugs are carved out from the Alliance formulary for Mental Health indications They are to be billed to State Medi-Cal via EDS not the Alliance Some of the drugs may require a TREATMENT AUTHORIZATION REQUEST (TAR) submitted to State Medi-Cal and approved prior to dispensing These are denoted with the Formulary symbol ldquoIHSSrdquo as they are benefits for Alliance Care health plan

Psychiatric Drugs TAR Requirement (YN)

Amantadine HCl N

Amantadine HCl ER Y

Aripiprazole Y(Age 0-17)

Aripiprazole lauroxil (Aristada Initio) Y

Asenapine (Saphris) Y(Age 0-17)

Benztropine Mesylate N

Brexpiprazole Y

Cariprazine Y

Chlorpromazine HCl Y(Age 0-17)

Clozapine Y(Age 0-17)

Fluphenazine Decanoate Y

Fluphenazine HCl Y(Age 0-17)

Haloperidol Y(Age 0-17)

Haloperidol Decanoate Y(Age 0-17)

Haloperidol Lactate Y(Age 0-17)

Iloperidone (Fanapt) Y(Age 0-17)

Isocarboxazid Y

Lithium Carbonate N

Lithium Citrate N

Loxapine Aerosol Powder Breath Activated (Adasuve) Y

Loxapine Succinate Y(Age 0-17)

Lumateperone (Caplyta) Y

Lurasidone Hydrochloride Y(Age 0-17)

Molindone HCl Y(Age 0-17)

Olanzapine Y(Age 0-17)

Olanzapine Fluoxetine HCl Y

Olanzapine Pamoate Monohydrate (Zyprexa Relprevv) Y

Psychiatric Drugs Continued TAR Requirement (YN)

Paliperidone (Invega) Y

Paliperidone Palmitate (Invega Sustenna) Y

Paliperidone Palmitate (Invega Trinza) Y

Perphenazine Y(Age 0-17)

Phenelzine Sulfate Y

Pimavanserin (Nuplazid) Y

Pimozide Y

Quetiapine Y(Age 0-17)

Risperidone Y(Age 0-17)

Risperidone ER injectable suspension (Perseris) Y

Risperidone Microspheres Y

Selegiline (transdermal only) Y

Thioridazine HCl Y(Age 0-17)

Thiothixene Y(Age 0-17)

Thiothixene HCl Y(Age 0-17)

Tranylcypromine Sulfate Y

Trifluoperazine HCl Y(Age 0-17)

Trihexyphenidyl N

Ziprasidone HCl Y(Age 0-17)

Ziprasidone Mesylate Y

20


The following drugs are carved out from the Alliance formulary for Opioid Detoxification indication They are to be billed to State Medi-Cal via EDS not the Alliance Some of the drugs may require a TREATMENT AUTHORIZATION REQUEST (TAR) submitted to State Medi-Cal and approved prior to dispensing These are denoted with the Formulary symbol ldquoIHSSrdquo as they are benefits for Alliance Care health plan

Alcohol Heroin Detoxification and Dependency Treatment Drugs

TAR Requirement (YN)

Acamprosate Calcium N

Buprenorphine HCl ( Does not require a TAR except for the drugs below)

N

Buprenorphine Extended-Release Inj (Sublocade) N

Buprenorphine HCl (Belbuca) Y

Buprenorphine Implant (Probuphine) Y

BuprenorphineNaloxone HCl N

Naloxone HCl N

Naltrexone (oral) N

Naltrexone Microsphere Injectable Suspension (Vivitrol) N

Lofexidine Hydrochloride (Lucemyra) Y

Disulfiram (Antabuse) N


The following drugs are carved out from the Alliance formulary for Blood and Coagulation Factors They are to be billed to State Medi-Cal via EDS not the Alliance Some of the drugs may require a TREATMENT AUTHORIZATION REQUEST (TAR) submitted to State Medi-Cal prior to dispensing These are denoted with the Formulary symbol ldquoIHSSrdquo as they are benefits for Alliance Care health plan

Blood and Coagulation Factors

Antihemophilic factor VIIIvon Willebrand factor complex (human)

Anti-inhibitor

Coagulation factor X (human)

Emicizumab (Hemlibra)

Factor VIIa (antihemophilic factor recombinant)

Factor VIIa (antihemophilic factor recombinant)-jncw (Sevenfact) per mcg

Factor VIII (antihemophilic factor human)

Factor VIII (antihemophilic factor recombinant)

Factor VIII (antihemophilic factor recombinant) (Afstyla) per IU

Factor VIII (antihemophilic factor recombinant) (Novoeight)

Factor VIII (antihemophilic factor recombinant) (Nuwiq) per IU

Factor VIII (antihemophilic factor recombinant) PEGylated per IU

Factor VIII (Recombinant) GlycoPEGylated-exei

Factor VIII antihemophilic factor (recombinant) glycopegylated-exei (Esperoct) per IU

Factor IX (antihemophilic factor purified nonrecombinant)

Factor IX (antihemophilic factor recombinant)

Factor IX (antihemophilic factor recombinant) (Rixubis)

Factor IX albumin fusion protein (recombinant) (Idelvion) per IU

Factor IX complex

Factor X (human) per IU

Factor XIII (antihemophilic factor human)

Factor XIII A-Subunit (recombinant)

Hemophilia clotting factor not otherwise classified

Injection factor VIII (antihemophilic factor recombinant) (Obizur)

Injection factor VIII fc fusion protein (recombinant)

Injection Factor IX (antihemophilic factor recombinant) glycopegylated (Rebinyn) 1 IU

Injection factor IX fusion protein (recombinant)

22

Von Willebrand factor (recombinant) (Vonvendi) per IU

Von Willebrand factor complex (human) Wilate

Von Willebrand factor complex (Humate-P)

Nutritional Supplements (applies Medi-Cal health plan only)

The Alliance covers oral nutritional supplements and enteral formulas for Medi-Cal health plan members when medically necessary A prior authorization will need to be submitted via the Alliance Portal or by fax to the Alliance Pharmacy Department at (831)430-5851 Please include the following when submitting a Prior Authorization

bull Copy of prescribing providerrsquos prescription

bull Completed Prior Authorization request form

bull Recent chart notes that address medical justification as to why the member is unable to meet hisher nutritional needs with standard or fortified foods

bull Growth charts for pediatric members or relevant weight history for adult members Conditions that may necessitate oral nutritional supplements or enteral formulas include but are not limited to

bull Increased metabolic needs

bull Cowrsquos milk allergyintolerance to standard formulas in infancy

bull Preterm birth

bull Cancer with significant weight loss

bull Decubitus ulcers

bull ESRD on HD or PD

bull Severe swallowing or chewing difficulty

bull Conditions impairing digestion and absorption

bull Failure to Thrive

bull Underweight status or unintended weight loss defined by the Medi-Cal guidelines The Alliance will not authorize oral nutrition supplements when used for convenience or preference of the member or provider All requests will be reviewed for medical necessity by the Alliancersquos Registered Dietitian (RD) For a list of covered products please see the Medi-Cal Enteral Formulary available here The Alliancersquos Enteral Nutrition policy can be accessed here

Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL =

Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The

Counter MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT =

Contraceptives | OCH = Orally Administered Anti-Cancer Drug

24

Prescription Drug Name Drug Tier

Coverage Requirements and Limits

Analgesic Anti-Inflammatory Or Antipyretic - Drugs For Pain And Fever

Analgesic Opioid Agonists - Arthritis And Pain Drugs

hydromorphone oral tablet 2 mg 1 QL (6 per 1 day)


methadone oral tablet 10 mg 5 mg 1 PA

morphine oral solution 10 mg5 ml 1 QL (25 per 1 day)

MORPHINE ORAL TABLET 15 MG 1 QL (3 per 1 day)

morphine oral tablet extended release 100 mg 200 mg 30 mg 60 mg

1 PA NSO QL (60 per 30 days)

morphine oral tablet extended release 15 mg 1 QL (60 per 30 days)

oxycodone oral solution 5 mg5 ml 1 QL (30 per 1 day)

oxycodone oral tablet 10 mg 1 QL (3 per 1 day)


tramadol oral tablet 100 mg 1 QL (6 per 1 day)


Analgesic Opioid Codeine Combinations - Arthritis And Pain Drugs

acetaminophen-codeine oral solution 120-12 mg5 ml 2 QL (500 per 1 day)

acetaminophen-codeine oral tablet 300-15 mg 300-30 mg 300-60 mg

1 QL (5 per 1 day)

Analgesic Opioid Hydrocodone And Non-Salicylate Combinations - Arthritis And Pain Drugs

hydrocodone-acetaminophen oral solution 10-325 mg15 ml(15 ml)

1 QL (65 per 1 day)

hydrocodone-acetaminophen oral solution 75-325 mg15 ml

1 QL (65 per 1 day)

hydrocodone-acetaminophen oral tablet 10-325 mg 75-325 mg

1 QL (5 per 1 day)

hydrocodone-acetaminophen oral tablet 25-325 mg 1 QL (10 per 1 day)


hydrocodone bitartrateacetaminophen (Lorcet (Hydrocodone) Oral Tablet 5-325 Mg)

1 QL (9 per 1 day)

hydrocodone bitartrateacetaminophen (Lorcet Hd Oral Tablet 10-325 Mg)

1 QL (5 per 1 day)





25



hydrocodone bitartrateacetaminophen (Lorcet Plus Oral Tablet 75-325 Mg)

1 QL (5 per 1 day)

Analgesic Opioid Hydrocodone And Nsaid Combinations - Arthritis And Pain Drugs

hydrocodone-ibuprofen oral tablet 75-200 mg 1 QL (6 per 1 day)

Analgesic Opioid Hydrocodone Combinations - Arthritis And Pain Drugs


1 QL (65 per 1 day)


1 QL (65 per 1 day)


1 QL (5 per 1 day)





1 QL (9 per 1 day)


1 QL (5 per 1 day)


1 QL (5 per 1 day)

Analgesic Opioid Oxycodone And Non-Salicylate Combinations - Arthritis And Pain Drugs

oxycodone hclacetaminophen (Endocet Oral Tablet 10-325 Mg 75-325 Mg)

1 QL (90 per 30 days)


1 QL (6 per 1 day)

oxycodone-acetaminophen oral tablet 10-325 mg 75-325 mg



1 QL (6 per 1 day)

Analgesic Opioid Oxycodone Combinations - Arthritis And Pain Drugs







26




1 QL (6 per 1 day)




1 QL (6 per 1 day)

Analgesic Opioid Tramadol And Non-Salicylate Combinations - Arthritis And Pain Drugs

tramadol-acetaminophen oral tablet 375-325 mg 1 QL (6 per 1 day)

Analgesic Opioid Tramadol Combinations - Arthritis And Pain Drugs


Analgesic Or Antipyretic Non-Opioid - Arthritis And Pain Drugs

8 hour pain reliever oral tablet extended release 650 mg 1 OTC Medical

acephen rectal suppository 120 mg 325 mg 650 mg 1 OTC Medical

acetaminophen oral capsule 325 mg 500 mg 1

acetaminophen oral liquid 500 mg15 ml 1 OTC Medical QL (500 per 1 day)

acetaminophen oral tablet 325 mg 500 mg 1 OTC Medical

acetaminophen oral tablet extended release 650 mg 1 OTC Medical

acetaminophen oral tabletdisintegrating 160 mg 80 mg 1 OTC Medical

acetaminophen rectal suppository 120 mg 650 mg 1 OTC Medical

athenol oral tablet 325 mg 1 OTC Medical

betatemp oral suspension 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

childrens mapap oral tabletchewable 160 mg 80 mg 1 OTC Medical

childrens mapap oral tabletdisintegrating 80 mg 1 OTC Medical

childrens non-aspirin oral tabletchewable 80 mg 1 OTC Medical

childrens pain relief oral suspension 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

childrens pain reliever oral tabletchewable 80 mg 1 OTC Medical

childrens pain-fever relief oral suspension 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

childrens pain-fever relief oral tabletdisintegrating 160 mg

1 OTC Medical





27



childrens q-pap oral suspension 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

childrens tactinal oral tabletchewable 80 mg 1 OTC Medical

childrens tylenol oral tabletchewable 160 mg 1 OTC Medical

feverall rectal suppository 120 mg 325 mg 650 mg 1 OTC Medical

FEVERALL RECTAL SUPPOSITORY 80 MG (acetaminophen)

2 OTC Medical

infants pain reliever oral dropssuspension 80 mg08 ml

1 OTC Medical QL (500 per 1 day)

jr acetaminophen oral tabletdisintegrating 160 mg 1 OTC Medical

junior mapap oral tabletdisintegrating 160 mg 1 OTC Medical

little remedies fever and pain oral liquid 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

mapap (acetaminophen) oral capsule 500 mg 1 OTC Medical

mapap (acetaminophen) oral liquid 500 mg15 ml 1 OTC Medical QL (500 per 1 day)

mapap (acetaminophen) oral suspension 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

mapap (acetaminophen) oral syringe 32 mgml 1 OTC Medical QL (500 per 1 day)

mapap (acetaminophen) oral tablet 325 mg 1 OTC Medical

mapap arthritis pain oral tablet extended release 650 mg

1 OTC Medical

mapap extra strength oral tablet 500 mg 1 OTC Medical

masophen oral tablet 325 mg 500 mg 1 OTC Medical

non-aspirin child rectal suppository 120 mg 1 OTC Medical

non-aspirin childrens oral drops 100 mgml 1 OTC Medical QL (500 per 1 day)

non-aspirin extra strength oral tablet 500 mg 1 OTC Medical

non-aspirin jr strength oral tabletchewable 160 mg 1 OTC Medical

non-aspirin oral tabletchewable 80 mg 1 OTC Medical

non-aspirin pain relief oral tablet 500 mg 1 OTC Medical

nortemp oral drops 80 mg08 ml 1 OTC Medical QL (500 per 1 day)





28



pain relief 8hr oral tablet extended release 650 mg 1 OTC Medical

pain reliever (acetaminophen) oral capsule 500 mg 1

pain reliever jr strength oral tabletchewable 160 mg 1 OTC Medical

pediacare fever reducer oral suspension 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

pharbetol oral tablet 325 mg 500 mg 1 OTC Medical

q-pap extra strength oral tablet 500 mg 1 OTC Medical

q-pap oral liquid 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

q-pap oral tablet 325 mg 1 OTC Medical

silapap oral liquid 160 mg5 ml 1 OTC Medical QL (500 per 1 day)

tactinal extra strength oral tablet 500 mg 1 OTC Medical

tactinal oral tablet 325 mg 1 OTC Medical

tylophen oral capsule 500 mg 1 OTC Medical

Analgesic Or Antipyretic Non-OpioidSedative Combinations - Arthritis And Pain Drugs

butalbital-acetaminophen oral tablet 50-325 mg 1 QL (6 per 1 day)

butalbital-acetaminophen-caff oral tablet 50-325-40 mg 1 QL (6 per 1 day)

butalbitalacetaminophen (Marten-Tab Oral Tablet 50-325 Mg)

1 QL (6 per 1 day)

butalbitalacetaminophen (Tencon Oral Tablet 50-325 Mg) 1 QL (6 per 1 day)

Anti-Inflammatory Tumor Necrosis Factor Inhibiting AgntsTnf-Alpha Sel - Arthritis And Pain Drugs

RENFLEXIS INTRAVENOUS RECON SOLN 100 MG (infliximab-abda)

2 PA SP

Dmard - Anti-Inflammatory Tumor Necrosis Factor Inhibiting Agents - Arthritis And Pain Drugs


2 PA SP

Dmard - Antimalarials - Arthritis And Pain Drugs

hydroxychloroquine oral tablet 200 mg 1 QL (3 per 1 day)

Dmard - Antimetabolites - Arthritis And Pain Drugs





29



methotrexate sodium injection solution 25 mgml 1

methotrexate sodium oral tablet 25 mg 1 OCH

XATMEP ORAL SOLUTION 25 MGML (methotrexate) 2 OCH AGE (Max 11 Years)

Dmard - Gold Compounds - Arthritis And Pain Drugs

RIDAURA ORAL CAPSULE 3 MG (auranofin) 2 PA

Dmard - Immunosuppressives - Arthritis And Pain Drugs

azathioprine oral tablet 50 mg 1

cyclophosphamide intravenous recon soln 1 gram 2 gram 500 mg

1 PA

cyclophosphamide intravenous solution 200 mgml 1 PA

CYCLOPHOSPHAMIDE ORAL CAPSULE 25 MG 50 MG (cyclophosphamide)

2 PA SP

cyclophosphamide oral tablet 25 mg 50 mg 1 PA OCH

cyclosporine modified oral capsule 100 mg 25 mg 50 mg

1 SP

cyclosporine modified oral solution 100 mgml 1 SP AGE (Max 11 Years)

mycophenolate mofetil oral capsule 250 mg 1

mycophenolate mofetil oral suspension for reconstitution 200 mgml

1 AGE (Max 11 Years)

mycophenolate mofetil oral tablet 500 mg 1

Dmard - Janus Kinase (Jak) Inhibitors - Arthritis And Pain Drugs

OLUMIANT ORAL TABLET 1 MG 2 MG (baricitinib) 2 PA NSO SP

Dmard - Other - Arthritis And Pain Drugs

AZULFIDINE ORAL TABLET 500 MG (sulfasalazine) 2

CUPRIMINE ORAL CAPSULE 250 MG (penicillamine) 2

DEPEN TITRATABS ORAL TABLET 250 MG (penicillamine)

2

d-penamine oral tablet 125 mg 1

minocycline oral capsule 100 mg 50 mg 75 mg 1

penicillamine oral capsule 250 mg 1

penicillamine oral tablet 250 mg 1

sulfasalazine oral tablet 500 mg 1





30



Dmard - Pyrimidine Synthesis Inhibitors - Arthritis And Pain Drugs

leflunomide oral tablet 10 mg 20 mg 1 QL (31 per 1 day)

Nsaid Analgesic Cyclooxygenase-2 (Cox-2) Selective Inhibitors - Arthritis And Pain Drugs

celecoxib oral capsule 100 mg 200 mg 400 mg 50 mg 1 QL (2 per 1 day)

Nsaid Analgesics (Cox Non-Specific) - Other - Arthritis And Pain Drugs

nabumetone oral tablet 500 mg 750 mg 1

sulindac oral tablet 150 mg 200 mg 1

Nsaid Analgesics (Cox Non-Specific) - Oxicam Derivatives - Arthritis And Pain Drugs

meloxicam oral tablet 15 mg 75 mg 1

piroxicam oral capsule 10 mg 20 mg 1

Nsaid Analgesics (Cox Non-Specific) - Phenylacetic Acid Derivatives - Arthritis And Pain Drugs

diclofenac potassium oral tablet 50 mg 1

diclofenac sodium oral tablet extended release 24 hr 100 mg

1

diclofenac sodium oral tabletdelayed release (drec) 25 mg 50 mg 75 mg

1

Nsaid Analgesics (Cox Non-Specific) - Propionic Acid Derivatives - Arthritis And Pain Drugs

addaprin oral tablet 200 mg 1 OTC

ADVIL JUNIOR STRENGTH ORAL TABLETCHEWABLE 100 MG (ibuprofen)

1 OTC Medical

ADVIL ORAL TABLET 100 MG 200 MG (ibuprofen) 1 OTC Medical

child ibuprofen oral suspension 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

CHILDRENS ADVIL ORAL SUSPENSION 100 MG5 ML (ibuprofen)


childrens ibu-drops oral dropssuspension 50 mg125 ml


childrens ibuprofen oral suspension 100 mg5 ml 1 OTC Medical QL (500 per 1 day)





31



childrens profen ib oral suspension 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

ibuprofen (Ibu Oral Tablet 400 Mg 600 Mg 800 Mg) 1

ibu-drops oral dropssuspension 50 mg125 ml 1 OTC Medical QL (500 per 1 day)

ibuprofen jr strength oral tabletchewable 100 mg 1 OTC Medical

ibuprofen oral capsule 200 mg 1 OTC Medical

ibuprofen oral suspension 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

ibuprofen oral tablet 100 mg 200 mg 1 OTC Medical

ibuprofen oral tablet 400 mg 600 mg 800 mg 1

infants advil oral dropssuspension 50 mg125 ml 1 OTC Medical

infants ibuprofen oral dropssuspension 50 mg125 ml 1 OTC Medical QL (500 per 1 day)

INFANTS MOTRIN ORAL DROPSSUSPENSION 50 MG125 ML (ibuprofen)


ketoprofen oral capsule 25 mg 50 mg 75 mg 1

naproxen oral suspension 125 mg5 ml 1 QL (500 per 1 day)

naproxen oral tablet 250 mg 375 mg 500 mg 1

naproxen oral tabletdelayed release (drec) 375 mg 500 mg

1

naproxen sodium oral tablet 275 mg 550 mg 1

wal-profen oral capsule 200 mg 1 OTC Medical

wal-profen oral tablet 200 mg 1 OTC Medical

Nsaid Analgesics (Cox Non-Specific) - Indole Acetic Acid Derivatives - Arthritis And Pain Drugs

etodolac oral capsule 200 mg 300 mg 1

etodolac oral tablet 400 mg 500 mg 1

indomethacin oral capsule 25 mg 50 mg 1

indomethacin oral capsule extended release 75 mg 1

Salicylate Analgesic Combinations - Arthritis And Pain Drugs

added strength pain reliever oral tablet 250-250-65 mg 1 OTC Medical





32



EXCEDRIN MIGRAINE ORAL TABLET 250-250-65 MG (aspirinacetaminophencaffeine)

1 OTC Medical

goodys migraine relief oral tablet 250-250-65 mg 1 OTC Medical

migraine formula oral tablet 250-250-65 mg 1 OTC Medical

pain reliever plus oral tablet 250-250-65 mg 1 OTC Medical

pamprin max oral tablet 250-250-65 mg 1 OTC Medical

vanquish oral tablet 227-194-33 mg 1

Salicylate Analgesic Combinations Buffered - Arthritis And Pain Drugs


Salicylate Analgesics - Arthritis And Pain Drugs

adult aspirin regimen oral tabletdelayed release (drec) 81 mg

1 OTC Medical

aspirin low dose oral tabletdelayed release (drec) 81 mg

1 OTC Medical

aspirin oral tablet 325 mg 1 OTC Medical

aspirin oral tabletchewable 81 mg 1 OTC Medical

aspirin oral tabletdelayed release (drec) 325 mg 500 mg 650 mg 81 mg

1 OTC Medical

aspirin rectal suppository 300 mg 600 mg 1 OTC Medical

aspir-low oral tabletdelayed release (drec) 81 mg 1 OTC Medical

aspir-trin oral tabletdelayed release (drec) 325 mg 1 OTC Medical

bayer advanced oral tablet 500 mg 1 OTC Medical

BAYER CHEWABLE ASPIRIN ORAL TABLETCHEWABLE 81 MG (aspirin)

1 OTC Medical

child aspirin oral tabletchewable 81 mg 1 OTC Medical

ec prin oral tabletdelayed release (drec) 325 mg 1 OTC Medical

ecotrin oral tabletdelayed release (drec) 325 mg 1 OTC Medical

effervescent pain relief oral tablet effervescent 324 mg 1 OTC Medical

lo-dose aspirin oral tabletdelayed release (drec) 81 mg 1 OTC Medical

st joseph aspirin oral tabletchewable 81 mg 1 OTC Medical

st joseph aspirin oral tabletdelayed release (drec) 81 mg

1 OTC Medical

Salicylate Analgesics Buffered - Arthritis And Pain Drugs





33



aspirinbuffd-calcium carb-mag oral tablet 325 mg 1 OTC Medical

bayer plus extra strength oral tablet 500 mg 1 OTC Medical

bufferin oral tablet 325 mg 1 OTC Medical

tri-buffered aspirin oral tablet 325 mg 1 OTC Medical

Anesthetics - Drugs For Pain And Fever

General Anesthetic - Parenteral Benzodiazepines - Drugs For Sedation

midazolam (pf) injection cartridge 5 mgml 1

midazolam (pf) injection solution 5 mgml 1

midazolam (pf) injection syringe 5 mgml 1

midazolam injection solution 5 mgml 1

Local Anesthetic - Amides - Drugs For Sedation

lidocaine topical ointment 5 1 QL (3544 per 30 days)

Anorectal Preparations - Rectal Preparations

Anorectal - Glucocorticoids - Rectal Preparations

anucort-hc rectal suppository 25 mg 1 QL (12 per 30 days)

hydrocortisone acetate rectal suppository 25 mg 30 mg 1 QL (12 per 30 days)

hydrocortisone (Procto-Med Hc Topical Cream With Perineal Applicator 25 )

1

hydrocortisone (Proctosol Hc Topical Cream With Perineal Applicator 25 )

1

hydrocortisone (Proctozone-Hc Topical Cream With Perineal Applicator 25 )

1

Anorectal - Hemorrhoidal Combinations Other - Rectal Preparations

hemorrhoidal rectal suppository 025-3 1 OTC Medical QL (12 per 30 days)

Anorectal - Hemorrhoidal Rectal Glucocorticoid-Local Anesthetic Comb - Rectal Preparations

hydrocortisone-pramoxine rectal cream 1-1 25-1 1 QL (30 per 30 days)

Anorectal - Hemorrhoidal Single Agents Other - Rectal Preparations

hemorrhoidal suppository rectal suppository 025 1 OTC Medical QL (12 per 30 days)

Antidotes And Other Reversal Agents - Drugs For Overdose Or Poisoning





34



Antidote - Acetaminophen Poisoning - Drugs For Overdose Or Poisoning

acetylcysteine intravenous solution 200 mgml (20 ) 1

acetylcysteine solution 100 mgml (10 ) 200 mgml (20 )

1

Chelating Agents - Copper - Drugs For Overdose Or Poisoning



2




Chelating Agents - Lead Poisoning - Drugs For Overdose Or Poisoning

CHEMET ORAL CAPSULE 100 MG (succimer) 2

Anti-Infective Agents - Drugs For Infections

Amebicides - Drugs For Parasites

paromomycin oral capsule 250 mg 1

Aminoglycoside Antibiotic - Antibiotics

neomycin oral tablet 500 mg 1

Aminopenicillin Antibiotic - Antibiotics

amoxicillin oral capsule 250 mg 500 mg 1

amoxicillin oral suspension for reconstitution 125 mg5 ml 200 mg5 ml 250 mg5 ml 400 mg5 ml

1 QL (500 per 1 day)

amoxicillin oral tablet 500 mg 875 mg 1

amoxicillin oral tabletchewable 125 mg 250 mg 1

ampicillin oral capsule 250 mg 500 mg 1

Aminopenicillin Antibiotic - Beta-Lactamase Inhibitor Combinations - Antibiotics

amoxicillin-pot clavulanate oral suspension for reconstitution 200-285 mg5 ml 250-625 mg5 ml 400-57 mg5 ml 600-429 mg5 ml


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

1

amoxicillin-pot clavulanate oral tabletchewable 200-285 mg 400-57 mg

1





35



AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-3125 MG5 ML (amoxicillinpotassium clavulanate)


Anthelmintic Agents - Benzimidazole Derivatives - Drugs For Parasites

albendazole oral tablet 200 mg 1 PA

Anthelmintic Agents - Macrocyclic Lactones - Drugs For Parasites

ivermectin oral tablet 3 mg 1

Anthelmintic Agents Other - Drugs For Parasites


pinworm treatment oral suspension 50 mgml 1 OTC Medical QL (100 per 1 day)

pin-x oral suspension 50 mgml 1 QL (100 per 1 day)

PIN-X ORAL TABLETCHEWABLE 250 MG (pyrantel pamoate)

2

reeses pinworm medicine oral suspension 50 mgml 1 OTC Medical QL (100 per 1 day)

Antibacterial Folate Antagonist - Other Combinations - Antibiotics

sulfamethoxazole-trimethoprim oral suspension 200-40 mg5 ml


sulfamethoxazole-trimethoprim oral tablet 400-80 mg 800-160 mg

1

sulfatrim oral suspension 200-40 mg5 ml 1 QL (500 per 1 day)

Antibacterial Folate Antagonist Others - Antibiotics

trimethoprim oral tablet 100 mg 1

Antibacterial Nitrofuran Derivatives - Antibiotics

nitrofurantoin macrocrystal oral capsule 100 mg 25 mg 50 mg

1

nitrofurantoin monohydm-cryst oral capsule 100 mg 1

nitrofurantoin oral suspension 25 mg5 ml 1 QL (500 per 1 day)

Antifungal - Allylamines - Drugs For Fungus

terbinafine hcl oral tablet 250 mg 1 QL (31 per 1 day)

Antifungal - Amphoteric Polyene Macrolides - Drugs For Fungus

amphotericin b injection recon soln 50 mg 1 PA





36



NYSTATIN (BULK) POWDER 50 MILLION UNIT 2

NYSTATIN (BULK) POWDER 500 MILLION UNIT 1 QL (500 per 1 day)

nystatin oral tablet 500000 unit 1

Antifungal - Fluorinated Pyrimidine-Type Agents - Drugs For Fungus

flucytosine oral capsule 250 mg 500 mg 1

Antifungal - Imidazoles - Drugs For Fungus

ketoconazole oral tablet 200 mg 1

Antifungal - Triazoles - Drugs For Fungus

fluconazole oral suspension for reconstitution 10 mgml 40 mgml


fluconazole oral tablet 100 mg 150 mg 200 mg 50 mg 1

itraconazole oral capsule 100 mg 1

Antifungal Other - Drugs For Fungus


griseofulvin microsize oral suspension 125 mg5 ml 1 QL (500 per 1 day)

griseofulvin microsize oral tablet 500 mg 1

griseofulvin ultramicrosize oral tablet 125 mg 250 mg 1

Antileprotic - Sulfone Agents - Antibiotics

dapsone oral tablet 100 mg 25 mg 1

Antimalarials - Drugs For Parasites

chloroquine phosphate oral tablet 250 mg 1 PA NSO QL (40 per 10 days)



PRIMAQUINE ORAL TABLET 263 MG 2

pyrimethamine oral tablet 25 mg 1

quinine sulfate oral capsule 324 mg 1 PA NSO

Antiprotozoal Agents - Other - Drugs For Parasites

atovaquone oral suspension 750 mg5 ml 1

Antiprotozoal-Antibacterial 1St Generation 2-Methyl-5-Nitroimidazole - Drugs For Infections





37



metronidazole oral tablet 250 mg 500 mg 1

Antiretroviral - Hiv-1 Integrase Strand Transfer Inhibitors - Drugs For Viral Infections

ISENTRESS ORAL TABLET 400 MG (raltegravir potassium)

2 IHSS QL (2 per 1 day)

TIVICAY ORAL TABLET 50 MG (dolutegravir sodium) 2 IHSS QL (1 per 1 day)

Antiretroviral - Nucleoside And Nucleotide Analog Rtis Combinations - Drugs For Viral Infections

DESCOVY ORAL TABLET 200-25 MG (emtricitabinetenofovir alafenamide fumarate)


TRUVADA ORAL TABLET 200-300 MG (emtricitabinetenofovir disoproxil fumarate)


Antiretroviral - Nucleoside Reverse Transcriptase Inhibitors (Nrti) - Drugs For Viral Infections

didanosine oral capsuledelayed release(drec) 125 mg 200 mg 250 mg 400 mg

1 QL (1 per 1 day)

zidovudine oral tablet 300 mg 1 QL (2 per 1 day)

Antitubercular - D-Alanine Analogs - Antibiotics

cycloserine oral capsule 250 mg 1

Antitubercular - Isonicotinic Acid Derivatives - Antibiotics

isoniazid oral solution 50 mg5 ml 1 QL (500 per 1 day)

isoniazid oral tablet 100 mg 300 mg 1

Antitubercular - Niacinamide Derivatives - Antibiotics

pyrazinamide oral tablet 500 mg 1

Antitubercular - Rifamycin And Derivatives - Antibiotics

PRIFTIN ORAL TABLET 150 MG (rifapentine) 2

rifampin oral capsule 150 mg 300 mg 1

Antitubercular Agents Other - Antibiotics

ethambutol oral tablet 100 mg 400 mg 1

TRECATOR ORAL TABLET 250 MG (ethionamide) 2

Carbapenem Antibiotics (Thienamycins) - Antibiotics

ertapenem injection recon soln 1 gram 1 QL (1 per 1 day)





38



Cephalosporin Antibiotics - 1St Generation - Antibiotics

cefadroxil oral capsule 500 mg 1

cefadroxil oral suspension for reconstitution 250 mg5 ml 500 mg5 ml


cefadroxil oral tablet 1 gram 1

cephalexin oral capsule 250 mg 500 mg 1

cephalexin oral suspension for reconstitution 125 mg5 ml 250 mg5 ml


cephalexin oral tablet 250 mg 500 mg 1

Cephalosporin Antibiotics - 2Nd Generation - Antibiotics

cefaclor oral capsule 250 mg 500 mg 1

cefaclor oral suspension for reconstitution 125 mg5 ml 250 mg5 ml 375 mg5 ml


cefprozil oral suspension for reconstitution 125 mg5 ml 250 mg5 ml

1

cefuroxime axetil oral tablet 250 mg 500 mg 1

Cephalosporin Antibiotics - 3Rd Generation - Antibiotics

cefdinir oral capsule 300 mg 1

cefdinir oral suspension for reconstitution 125 mg5 ml 250 mg5 ml


cefixime oral suspension for reconstitution 100 mg5 ml 200 mg5 ml


cefpodoxime oral suspension for reconstitution 100 mg5 ml 50 mg5 ml

1

cefpodoxime oral tablet 100 mg 200 mg 1

Chloramphenicol Antibiotics And Derivatives - Single Agents - Antibiotics

chloramphenicol sod succinate intravenous recon soln 1 gram

1 PA

Fluoroquinolone Antibiotics - Antibiotics

CIPRO ORAL SUSPENSIONMICROCAPSULE RECON 250 MG5 ML 500 MG5 ML (ciprofloxacin)


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

1





39



ciprofloxacin oral suspensionmicrocapsule recon 250 mg5 ml 500 mg5 ml


levofloxacin oral tablet 250 mg 500 mg 750 mg 1

ofloxacin oral tablet 300 mg 400 mg 1

Glycopeptide Antibiotics - Antibiotics

FIRVANQ ORAL RECON SOLN 25 MGML 50 MGML (vancomycin hcl)

2

vancomycin in 09 sodium chl intravenous solution 15 gram500 ml

1 PA

vancomycin intravenous recon soln 1000 mg 10 gram 500 mg

1

vancomycin intravenous recon soln 125 gram 5 gram 750 mg

1

VANCOMYCIN INTRAVENOUS RECON SOLN 15 GRAM (vancomycin hcl)

1 PA

vancomycin intravenous recon soln 250 mg 1 QL (2 per 1 day)

vancomycin oral capsule 125 mg 250 mg 1 QL (240 per 60 days)

Hepatitis B Treatment- Nucleoside Analogs (Antiviral) - Drugs For Viral Infections

entecavir oral tablet 05 mg 1 mg 1 QL (30 per 30 days)

Hepatitis C - Interferons - Drugs For Viral Infections

PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 135 MCG05 ML 180 MCG05 ML (peginterferon alfa-2a)

2 PA SP

PEGASYS SUBCUTANEOUS SOLUTION 180 MCGML (peginterferon alfa-2a)

2 PA SP

PEGASYS SUBCUTANEOUS SYRINGE 180 MCG05 ML (peginterferon alfa-2a)

2 PA SP

PEGINTRON SUBCUTANEOUS KIT 50 MCG05 ML (peginterferon alfa-2b)

2 PA SP

Hepatitis C - Ns5a Inhibitor And Ns34A Protease Inhibitor Combination - Drugs For Viral Infections

MAVYRET ORAL TABLET 100-40 MG (glecaprevirpibrentasvir)

2 PA SP





40



Hepatitis C - Ns5b Polymerase And Ns5a Inhibitor Combinations - Drugs For Viral Infections

ledipasvir-sofosbuvir oral tablet 90-400 mg 1 PA SP

sofosbuvir-velpatasvir oral tablet 400-100 mg 1 PA SP

Hepatitis C - Nucleoside Analogs - Drugs For Viral Infections

ribavirin (Ribasphere Oral Capsule 200 Mg) 1 PA SP

ribavirin (Ribasphere Oral Tablet 200 Mg) 1 PA SP

ribavirin oral capsule 200 mg 1 PA SP

ribavirin oral tablet 200 mg 1 PA SP

Herpes Antiviral Agent - Purine Analogs - Drugs For Viral Infections

acyclovir oral capsule 200 mg 1

acyclovir oral suspension 200 mg5 ml 1 QL (500 per 1 day)

acyclovir oral tablet 400 mg 800 mg 1

valacyclovir oral tablet 1 gram 500 mg 1

Influenza Antiviral Agents - Neuraminidase Inhibitors - Drugs For Viral Infections

oseltamivir oral capsule 30 mg 45 mg 75 mg 1

oseltamivir oral suspension for reconstitution 6 mgml 1 QL (360 per 183 days)

RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5 MGACTUATION (zanamivir)


Influenza Antiviral Agents - Pa Endonuclease Inhibitor - Drugs For Viral Infections

XOFLUZA ORAL TABLET 20 MG 40 MG (baloxavir marboxil)


Lincosamide Antibiotics - Antibiotics

clindamycin hcl oral capsule 150 mg 300 mg 75 mg 1

clindamycin palmitate hcl (Clindamycin Pediatric Oral Recon Soln 75 Mg5 Ml)


Macrolide Antibiotics - Antibiotics

azithromycin oral packet 1 gram 1

azithromycin oral suspension for reconstitution 100 mg5 ml 200 mg5 ml


azithromycin oral tablet 250 mg 500 mg 600 mg 1





41



clarithromycin oral suspension for reconstitution 125 mg5 ml 250 mg5 ml


clarithromycin oral tablet 250 mg 500 mg 1

clarithromycin oral tablet extended release 24 hr 500 mg

1

erythromycin ethylsuccinate (EES 400 Oral Tablet 400 Mg)

1

erythromycin base (Ery-Tab Oral TabletDelayed Release (DrEc) 250 Mg 500 Mg)

1

erythromycin stearate (Erythrocin (As Stearate) Oral Tablet 250 Mg)

1

erythromycin ethylsuccinate oral suspension for reconstitution 200 mg5 ml 400 mg5 ml


erythromycin ethylsuccinate oral tablet 400 mg 1

erythromycin oral capsuledelayed release(drec) 250 mg

1

erythromycin oral tablet 250 mg 500 mg 1

erythromycin oral tabletdelayed release (drec) 250 mg 333 mg 500 mg

1

Misc Anti-Infective - Drugs For Infections

methenamine hippurate oral tablet 1 gram 1

methenamine mandelate oral tablet 05 g 1 gram 1

NEBUPENT INHALATION RECON SOLN 300 MG (pentamidine isethionate)

2 PA SP

UROQID-ACID NO2 ORAL TABLET 500-500 MG (methenamine mandelatesodium phosphatemonobasic)

2

Penicillin Antibiotic - Natural - Antibiotics

BICILLIN L-A INTRAMUSCULAR SYRINGE 1200000 UNIT2 ML 2400000 UNIT4 ML 600000 UNITML (penicillin g benzathine)

2

penicillin v potassium oral recon soln 125 mg5 ml 250 mg5 ml


penicillin v potassium oral tablet 250 mg 500 mg 1

Penicillin Antibiotic - Penicillinase-Resistant - Antibiotics





42



dicloxacillin oral capsule 250 mg 500 mg 1

Penicillin Natural Antibiotic Combinations - Extended Release - Antibiotics

BICILLIN C-R INTRAMUSCULAR SYRINGE 1200000 UNIT 2 ML(600K600K) 1200000 UNIT 2 ML(900K300K) (penicillin g benzathinepenicillin g procaine)

2

Protease Inhibitors (Non-Peptidic) Antiretroviral - Drugs For Viral Infections

PREZISTA ORAL TABLET 800 MG (darunavir ethanolate) 2 IHSS QL (1 per 1 day)

Protease Inhibitors (Peptidic) Antiretroviral - Drugs For Viral Infections

ritonavir oral tablet 100 mg 1 IHSS QL (1 per 1 day)

Rifamycins And Related Derivative Antibiotics - Antibiotics



Tetracycline Antibiotics - Antibiotics

doxycycline hyclate oral capsule 100 mg 50 mg 1

doxycycline hyclate oral tablet 100 mg 150 mg 50 mg 75 mg

1

doxycycline monohydrate oral capsule 100 mg 50 mg 1

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

1


doxycycline monohydrate (Okebo Oral Capsule 100 Mg) 1

tetracycline oral capsule 250 mg 500 mg 1

Antineoplastics - Drugs For Cancer

Anp - Human Vascular Endothelial Growth Factor Inhib Rec-Mc Antibody - Drugs For Cancer

AVASTIN INTRAVENOUS SOLUTION 25 MGML (bevacizumab)

2 PA SP

Antineoplasic-EpidermGrowth Factor-Egfr (Erbb1)Her-2 (Erbb2)RInhib - Drugs For Cancer

lapatinib oral tablet 250 mg 1 PA OCH

TYKERB ORAL TABLET 250 MG (lapatinib ditosylate) 2 PA OCH





43



Antineoplastic - Cyp17 (17 Alpha-HydroxylaseC1720-Lyase) Inhibitor - Drugs For Cancer

abiraterone oral tablet 250 mg 1 PA SP

abiraterone oral tablet 500 mg 1 PA OCH

ZYTIGA ORAL TABLET 250 MG 500 MG (abiraterone acetate)

2 PA SP

Antineoplastic - 1St Generation Egfr Tyrosine Kinase Inhibitor - Drugs For Cancer

erlotinib oral tablet 100 mg 150 mg 25 mg 1 PA SP QL (1 per 1 day)

IRESSA ORAL TABLET 250 MG (gefitinib) 2 PA SP

TARCEVA ORAL TABLET 100 MG 150 MG 25 MG (erlotinib hcl)

2 PA SP QL (1 per 1 day)

Antineoplastic - 2Nd Generation Egfr Tyrosine Kinase Inhibitor - Drugs For Cancer

GILOTRIF ORAL TABLET 20 MG 30 MG 40 MG (afatinib dimaleate)

2 PA OCH

Antineoplastic - 3Rd Generation Egfr Tyrosine Kinase Inhibitor - Drugs For Cancer

TAGRISSO ORAL TABLET 40 MG 80 MG (osimertinib mesylate)

2 PA SP

Antineoplastic - Alkylating Agent - Alkyl Sulfonates - Drugs For Cancer

busulfan intravenous solution 60 mg10 ml 2 SP QL (500 per 1 day)

BUSULFEX INTRAVENOUS SOLUTION 60 MG10 ML (busulfan)

2 SP QL (500 per 1 day)

MYLERAN ORAL TABLET 2 MG (busulfan) 2 SP

Antineoplastic - Alkylating Agent - Ethylenimines And Methylmelamines - Drugs For Cancer

HEXALEN ORAL CAPSULE 50 MG (altretamine) 2 SP

thiotepa injection recon soln 100 mg 15 mg 1

Antineoplastic - Alkylating Agent - Methylhydrazines - Drugs For Cancer

MATULANE ORAL CAPSULE 50 MG (procarbazine hcl) 2 OCH

Antineoplastic - Alkylating Agent - Nitrogen Mustard With Rescue Agent - Drugs For Cancer





44



ifosfamide-mesna intravenous kit 1-1 gram 3000-1000 mg

1

Antineoplastic - Alkylating Agent - Nitrogen Mustards - Drugs For Cancer

ALKERAN ORAL TABLET 2 MG (melphalan) 2 OCH


1 PA



2 PA SP


ifosfamide intravenous recon soln 1 gram 3 gram 1

ifosfamide intravenous solution 1 gram20 ml 3 gram60 ml

1

LEUKERAN ORAL TABLET 2 MG (chlorambucil) 2 OCH

melphalan oral tablet 2 mg 1 OCH

Antineoplastic - Alkylating Agent - Nitrosoureas - Drugs For Cancer

BICNU INTRAVENOUS RECON SOLN 100 MG (carmustine)

2

Antineoplastic - Alkylating Agent - Triazenes - Drugs For Cancer

dacarbazine intravenous recon soln 100 mg 200 mg 1 PA

TEMODAR INTRAVENOUS RECON SOLN 100 MG (temozolomide)

1 SP

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

1 PA SP

Antineoplastic - Anaplastic Lymphoma Kinase (Alk) Inhibitors - Drugs For Cancer

ALECENSA ORAL CAPSULE 150 MG (alectinib hcl) 2 PA SP

ALUNBRIG ORAL TABLET 180 MG 30 MG 90 MG (brigatinib)

2 PA OCH

ALUNBRIG ORAL TABLETSDOSE PACK 90 MG (7)- 180 MG (23) (brigatinib)

2 PA OCH

XALKORI ORAL CAPSULE 200 MG 250 MG (crizotinib) 2 PA SP

ZYKADIA ORAL CAPSULE 150 MG (ceritinib) 2 PA SP

Antineoplastic - Antiadrenals - Drugs For Cancer





45



LYSODREN ORAL TABLET 500 MG (mitotane) 2 PA OCH

Antineoplastic - Antiandrogens - Drugs For Cancer



bicalutamide oral tablet 50 mg 1 OCH

flutamide oral capsule 125 mg 1 SP

XTANDI ORAL CAPSULE 40 MG (enzalutamide) 2 PA SP

XTANDI ORAL TABLET 40 MG 80 MG (enzalutamide) 2 PA OCH


2 PA SP

Antineoplastic - Antimetabolite - Folic Acid Analogs - Drugs For Cancer

methotrexate sodium (pf) injection solution 25 mgml 1




Antineoplastic - Antimetabolite - Purine Analogs - Drugs For Cancer

ARRANON INTRAVENOUS SOLUTION 250 MG50 ML (nelarabine)

2

cladribine intravenous solution 10 mg10 ml 1

mercaptopurine oral tablet 50 mg 1 OCH

NIPENT INTRAVENOUS RECON SOLN 10 MG (pentostatin)

2

PURIXAN ORAL SUSPENSION 20 MGML (mercaptopurine)

2 OCH AGE (Max 11 Years)

TABLOID ORAL TABLET 40 MG (thioguanine) 2 PA SP

Antineoplastic - Antimetabolite - Pyrimidine Analogs - Drugs For Cancer

fluorouracil (Adrucil Intravenous Solution 25 Gram50 Ml 500 Mg10 Ml)

1 PA

capecitabine oral tablet 150 mg 500 mg 1 PA SP

floxuridine injection recon soln 05 gram 1

fluorouracil intravenous solution 1 gram20 ml 1


fluorouracil intravenous solution 500 mg10 ml 1 PA NSO





46



gemcitabine intravenous recon soln 1 gram 200 mg 1

gemcitabine intravenous recon soln 2 gram 1

gemcitabine intravenous solution 1 gram263 ml (38 mgml) 100 mgml 2 gram526 ml (38 mgml) 200 mg526 ml (38 mgml)

1

GEMZAR INTRAVENOUS RECON SOLN 1 GRAM 200 MG (gemcitabine hcl)

2

Antineoplastic - Antimetabolite - Urea Derivatives - Drugs For Cancer

hydroxyurea oral capsule 500 mg 1 OCH

Antineoplastic - Aromatase Inhibitors - Drugs For Cancer

anastrozole oral tablet 1 mg 1 OCH

exemestane oral tablet 25 mg 1 OCH

letrozole oral tablet 25 mg 1 OCH

Antineoplastic - Braf Kinase Inhibitors - Drugs For Cancer

TAFINLAR ORAL CAPSULE 50 MG 75 MG (dabrafenib mesylate)

2 PA SP

Antineoplastic - Brutons Tyrosine Kinase (Btk) Inhibitor - Drugs For Cancer

CALQUENCE ORAL CAPSULE 100 MG (acalabrutinib) 2 PA OCH

IMBRUVICA ORAL CAPSULE 140 MG 70 MG (ibrutinib) 2 PA OCH

IMBRUVICA ORAL TABLET 140 MG 280 MG 420 MG 560 MG (ibrutinib)

2 PA OCH

Antineoplastic - Cd20 Specific Recombinant Monoclonal Antibody Agents - Drugs For Cancer

ARZERRA INTRAVENOUS SOLUTION 1000 MG50 ML 100 MG5 ML (ofatumumab)

2 PA SP

GAZYVA INTRAVENOUS SOLUTION 1000 MG40 ML (obinutuzumab)

2 PA SP

RITUXAN HYCELA SUBCUTANEOUS SOLUTION 1400 MG117 ML (120 MGML) 1600 MG134 ML (120 MGML) (rituximabhyaluronidase human recombinant)

2 PA SP

RITUXAN INTRAVENOUS CONCENTRATE 10 MGML (rituximab)

2 PA SP

Antineoplastic - Cyclin-Dependent Kinase (Cdk) 46 Inhibitors - Drugs For Cancer





47



IBRANCE ORAL CAPSULE 100 MG 125 MG 75 MG (palbociclib)

2 PA OCH

IBRANCE ORAL TABLET 100 MG 125 MG 75 MG (palbociclib)

2 PA OCH

KISQALI ORAL TABLET 200 MGDAY (200 MG X 1) 400 MGDAY (200 MG X 2) 600 MGDAY (200 MG X 3) (ribociclib succinate)

2 PA SP

VERZENIO ORAL TABLET 100 MG 150 MG 200 MG 50 MG (abemaciclib)

2 PA SP

Antineoplastic - Epipodophyllotoxins - Drugs For Cancer

etoposide intravenous solution 20 mgml 1

etoposide oral capsule 50 mg 1 OCH

teniposide intravenous solution 50 mg5 ml 1 SP QL (500 per 1 day)

etoposide (Toposar Intravenous Solution 20 MgMl) 1

Antineoplastic - Estrogens - Drugs For Cancer

EMCYT ORAL CAPSULE 140 MG (estramustine phosphate sodium)

2 PA SP

Antineoplastic - Interferons - Drugs For Cancer

SYLATRON SUBCUTANEOUS KIT 200 MCG 300 MCG 600 MCG (peginterferon alfa-2b)

2 PA SP

Antineoplastic - Lhrh (Gnrh) Agonist Analog Pituitary Suppressants - Drugs For Cancer

LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 225 MG (leuprolide acetate)

2 PA SP


2 PA SP


2 PA SP

LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 75 MG (leuprolide acetate)

2 PA SP

Antineoplastic - Mast Cell Stabilizers - Drugs For Cancer

cromolyn oral concentrate 100 mg5 ml 1 QL (500 per 1 day)

Antineoplastic - Mek1 And Mek2 Kinase Inhibitors - Drugs For Cancer





48



MEKINIST ORAL TABLET 05 MG 2 MG (trametinib dimethyl sulfoxide)

2 PA SP

Antineoplastic - Multikinase Inhibitors - Drugs For Cancer

CABOMETYX ORAL TABLET 20 MG 40 MG 60 MG (cabozantinib s-malate)

2 PA SP

COMETRIQ ORAL CAPSULE 100 MGDAY(80 MG X1-20 MG X1) 140 MGDAY(80 MG X1-20 MG X3) 60 MGDAY (20 MG X 3DAY) (cabozantinib s-malate)

2 PA OCH

ICLUSIG ORAL TABLET 10 MG 15 MG 30 MG 45 MG (ponatinib hcl)

2 PA OCH

NEXAVAR ORAL TABLET 200 MG (sorafenib tosylate) 2 PA SP

STIVARGA ORAL TABLET 40 MG (regorafenib) 2 PA SP

Antineoplastic - Other - Drugs For Cancer

TICE BCG INTRAVESICAL SUSPENSION FOR RECONSTITUTION 50 MG (bcg live)

2 AGE (Min 19 Years)

Antineoplastic - Pan-Class I Pi3k Inhibitors - Drugs For Cancer

ALIQOPA INTRAVENOUS RECON SOLN 60 MG (copanlisib di-hcl)

2 PA

Antineoplastic - Phosphatidylinositol 3-Kinase (Pi3k) Inhibitors - Drugs For Cancer


2 PA

ZYDELIG ORAL TABLET 100 MG 150 MG (idelalisib) 2 PA OCH

Antineoplastic - Pi3k-Delta Inhibitors - Drugs For Cancer


Antineoplastic - Platinum Complexes - Drugs For Cancer

carboplatin intravenous solution 10 mgml 1

cisplatin intravenous solution 1 mgml 1

oxaliplatin intravenous recon soln 100 mg 50 mg 1 PA

oxaliplatin intravenous solution 100 mg20 ml 200 mg40 ml 50 mg10 ml (5 mgml)

1 PA

Antineoplastic - Poly (Adp-Ribose) Polymerase (Parp) Inhibitors - Drugs For Cancer





49



LYNPARZA ORAL CAPSULE 50 MG (olaparib) 2 PA OCH

LYNPARZA ORAL TABLET 100 MG 150 MG (olaparib) 2 PA OCH

ZEJULA ORAL CAPSULE 100 MG (niraparib tosylate) 2 PA SP

Antineoplastic - Progestins - Drugs For Cancer

megestrol oral tablet 20 mg 40 mg 1 OCH QL (8 per 1 day)

Antineoplastic - Proteasome Enzyme Inhibitors - Drugs For Cancer

NINLARO ORAL CAPSULE 23 MG 3 MG 4 MG (ixazomib citrate)

2 PA SP

VELCADE INJECTION RECON SOLN 35 MG (bortezomib)

2 PA SP

Antineoplastic - Protein-Tyrosine Kinase Inhibitors - Drugs For Cancer

BOSULIF ORAL TABLET 100 MG 400 MG 500 MG (bosutinib)

2 PA SP


CAPRELSA ORAL TABLET 100 MG 300 MG (vandetanib) 2 PA OCH

GLEEVEC ORAL TABLET 100 MG 400 MG (imatinib mesylate)

2 PA SP

imatinib oral tablet 100 mg 400 mg 1 PA SP



2 PA OCH

INLYTA ORAL TABLET 1 MG 5 MG (axitinib) 2 PA SP

LENVIMA ORAL CAPSULE 10 MGDAY (10 MG X 1) 12 MGDAY (4 MG X 3) 14 MGDAY(10 MG X 1-4 MG X 1) 18 MGDAY (10 MG X 1-4 MG X2) 20 MGDAY (10 MG X 2) 24 MGDAY(10 MG X 2-4 MG X 1) 4 MG 8 MGDAY (4 MG X 2) (lenvatinib mesylate)

2 PA OCH

QINLOCK ORAL TABLET 50 MG (ripretinib) 2 PA OCH

RYDAPT ORAL CAPSULE 25 MG (midostaurin) 2 PA SP

SPRYCEL ORAL TABLET 100 MG 140 MG 20 MG 50 MG 70 MG 80 MG (dasatinib)

2 PA SP

SUTENT ORAL CAPSULE 125 MG 25 MG 375 MG 50 MG (sunitinib malate)

2 PA SP





50



TASIGNA ORAL CAPSULE 150 MG 200 MG 50 MG (nilotinib hcl)

2 PA SP

VOTRIENT ORAL TABLET 200 MG (pazopanib hcl) 2 PA SP

Antineoplastic - Retinoids - Drugs For Cancer

tretinoin (antineoplastic) oral capsule 10 mg 1 PA SP

Antineoplastic - Selective Estrogen Receptor Modulators (Serms) - Drugs For Cancer

tamoxifen oral tablet 10 mg 20 mg 1 OCH

Antineoplastic - Taxanes - Drugs For Cancer

onxol intravenous concentrate 6 mgml 1

paclitaxel intravenous concentrate 6 mgml 1

Antineoplastic - Topoisomerase I Inhibitors - Drugs For Cancer

HYCAMTIN ORAL CAPSULE 025 MG 1 MG (topotecan hcl)

2 PA SP

irinotecan intravenous solution 100 mg5 ml 300 mg15 ml 40 mg2 ml

1

irinotecan intravenous solution 500 mg25 ml 1

topotecan intravenous recon soln 4 mg 1

topotecan intravenous solution 4 mg4 ml (1 mgml) 1

Antineoplastic - Vinca Alkaloids And Analogs - Drugs For Cancer

NAVELBINE INTRAVENOUS SOLUTION 10 MGML 50 MG5 ML (vinorelbine tartrate)

2

vinblastine intravenous solution 1 mgml 1 PA

vincristine sulfate (Vincasar Pfs Intravenous Solution 1 MgMl 2 Mg2 Ml)

1

vinorelbine intravenous solution 10 mgml 50 mg5 ml 2

Antineoplastic Antibiotic - Anthracyclines - Drugs For Cancer

adriamycin intravenous recon soln 10 mg 1

doxorubicin hcl (Adriamycin Intravenous Recon Soln 50 Mg)

1

doxorubicin hcl (Adriamycin Intravenous Solution 10 Mg5 Ml 2 MgMl 20 Mg10 Ml 50 Mg25 Ml)

1

daunorubicin intravenous recon soln 20 mg 1





51



daunorubicin intravenous solution 5 mgml 1

doxorubicin intravenous recon soln 10 mg 50 mg 1 PA

doxorubicin intravenous solution 10 mg5 ml 2 mgml 20 mg10 ml 50 mg25 ml

1 PA

epirubicin intravenous recon soln 200 mg 50 mg 1

epirubicin intravenous solution 200 mg100 ml 50 mg25 ml

1

Antineoplastic Antibiotic - Others - Drugs For Cancer

bleomycin injection recon soln 15 unit 30 unit 1 PA

mitomycin intravenous recon soln 20 mg 40 mg 5 mg 1

mitomycin (Mutamycin Intravenous Recon Soln 20 Mg 40 Mg 5 Mg)

1

ZANOSAR INTRAVENOUS RECON SOLN 1 GRAM (streptozocin)

2

Antineoplastic-Anti-Programmed Cell Death Receptor-1 (Pd-1) Mc Antib - Drugs For Cancer

KEYTRUDA INTRAVENOUS SOLUTION 25 MGML (pembrolizumab)

2 PA SP

OPDIVO INTRAVENOUS SOLUTION 100 MG10 ML 240 MG24 ML 40 MG4 ML (nivolumab)

2 PA SP

Epidermal Growth Factor Recept (Her-2) Subdomain Ii Blocker Rec-Mc Ab - Drugs For Cancer

PERJETA INTRAVENOUS SOLUTION 420 MG14 ML (30 MGML) (pertuzumab)

2 PA SP

Epidermal Growth Factor Recept Blocker (Her-1 Type) Rec-Mc Antibody - Drugs For Cancer

ERBITUX INTRAVENOUS SOLUTION 100 MG50 ML 200 MG100 ML (cetuximab)

2 PA SP

PORTRAZZA INTRAVENOUS SOLUTION 800 MG50 ML (16 MGML) (necitumumab)

2 PA SP






52



HERCEPTIN HYLECTA SUBCUTANEOUS SOLUTION 600 MG-10000 UNIT5 ML (trastuzumab-hyaluronidase-oysk)

2 SP

HERCEPTIN INTRAVENOUS RECON SOLN 150 MG 440 MG (trastuzumab)

2 PA SP

Methotrexate Rescue Agents - Drugs For Cancer

leucovorin calcium oral tablet 10 mg 15 mg 1


Methotrexate Rescue Agents - Folic Acid Antagonist Type - Drugs For Cancer



Antiseptics And Disinfectants - Antiseptics And Disinfectants

Antiseptic - Alcohols - Antiseptics And Disinfectants

ALCOHOL PREP PADS TOPICAL PADS MEDICATED (alcohol antiseptic pads)

2 DD

Antiseptic - Biguanides - Antiseptics And Disinfectants

betasept surgical scrub topical liquid 4 1 OTC Medical

chlorhexidine gluconate topical liquid 4 1

dyna-hex topical liquid 4 1 OTC Medical

HIBICLENS TOPICAL LIQUID 4 (chlorhexidine gluconate)

2

Antiseptic - IodineIodophores - Antiseptics And Disinfectants

lugols topical solution 5-10 1 QL (500 per 1 day)

Antiseptic - Oxidizing Agents - Antiseptics And Disinfectants

CARBAMIDE PEROXIDE (BULK) POWDER 100 (carbamide peroxide)

2 OTC Medical

Biologicals - Biological Agents

Hepatitis A And Hepatitis B Vaccine Combinations - Vaccines

TWINRIX (PF) INTRAMUSCULAR SUSPENSION 720 ELISA UNIT- 20 MCGML (hepatitis a virus and hepatitis b virus vaccinepf)






53



TWINRIX (PF) INTRAMUSCULAR SYRINGE 720 ELISA UNIT- 20 MCGML (hepatitis a virus and hepatitis b virus vaccinepf)


Hepatitis A Vaccine - Single Agents - Vaccines

HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1440 ELISA UNITML 720 ELISA UNIT05 ML (hepatitis a virus vaccinepf)


HAVRIX (PF) INTRAMUSCULAR SYRINGE 1440 ELISA UNITML 720 ELISA UNIT05 ML (hepatitis a virus vaccinepf)


VAQTA (PF) INTRAMUSCULAR SUSPENSION 25 UNIT05 ML 50 UNITML (hepatitis a virus vaccinepf)


VAQTA (PF) INTRAMUSCULAR SYRINGE 25 UNIT05 ML 50 UNITML (hepatitis a virus vaccinepf)


Hepatitis B Vaccine Combinations - Vaccines

PEDIARIX (PF) INTRAMUSCULAR SYRINGE 10 MCG-25LF-25 MCG-10LF05 ML (hep b virusrcmbdipthpertus(acell)tetpolio vaccinepf)


Hepatitis B Vaccines - Single Agents - Vaccines

ENGERIX-B (PF) INTRAMUSCULAR SUSPENSION 20 MCGML (hepatitis b virus vaccine recombinantpf)


ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 20 MCGML (hepatitis b virus vaccine recombinantpf)


ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SUSPENSION 10 MCG05 ML (hepatitis b virus vaccine recombinantpf)


ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 10 MCG05 ML (hepatitis b virus vaccine recombinantpf)


HEPLISAV-B (PF) INTRAMUSCULAR SOLUTION 20 MCG05 ML (hepatitis b vaccine recombinantvaccine adjuvant cpg 1018pf)


HEPLISAV-B (PF) INTRAMUSCULAR SYRINGE 20 MCG05 ML (hepatitis b vaccine recombinantvaccine adjuvant cpg 1018pf)






54



RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10 MCGML 40 MCGML 5 MCG05 ML (hepatitis b virus vaccine recombinantpf)


RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCGML 5 MCG05 ML (hepatitis b virus vaccine recombinantpf)


Immune Globulin - Gamma Globulin (Igg) Human - Biological Agents

HYQVIA IG COMPONENT SUBCUTANEOUS SOLUTION 10 GRAM100 ML (10 ) 25 GRAM25 ML (10 ) 20 GRAM200 ML (10 ) 30 GRAM300 ML (10 ) 5 GRAM50 ML (10 ) (immune globulingamm(igg)glycineiga greater than 50 mcgml)

2 SP

Immune Globulin - Hepatitis B - Biological Agents

HEPAGAM B INJECTION SOLUTION gt312 UNITML GREATR THAN 312 UNITML (5 ML) (hepatitis b immune globulinmaltose)


HYPERHEP B INTRAMUSCULAR SOLUTION 220 UNITML 220 UNITML (5 ML) (hepatitis b immune globulin)


HYPERHEP B INTRAMUSCULAR SYRINGE 220 UNITML (hepatitis b immune globulin)


HYPERHEP B NEONATAL INTRAMUSCULAR SYRINGE 110 UNIT05 ML (hepatitis b immune globulin)


NABI-HB INTRAMUSCULAR SOLUTION GREATER THAN 1560 UNIT5 ML GREATR THAN 312 UNITML (hepatitis b immune globulin)


Immune Globulin - Rabies - Biological Agents

HYPERRAB (PF) INTRAMUSCULAR SOLUTION 300 UNITML (rabies immune globulinpf)


HYPERRAB SD (PF) INTRAMUSCULAR SOLUTION 150 UNITML (rabies immune globulinpf)


IMOGAM RABIES-HT (PF) INTRAMUSCULAR SOLUTION 150 UNITML (rabies immune globulinpf)


KEDRAB (PF) INTRAMUSCULAR SOLUTION 150 UNITML (rabies immune globulinpf)


Immune Globulin - Tetanus - Biological Agents





55



HYPERTET SD (PF) INTRAMUSCULAR SYRINGE 250 UNIT (tetanus immune globulinpf)


Live Vaccine And Live Virus Formulations - Vaccines

BCG VACCINE LIVE (PF) PERCUTANEOUS SUSPENSION FOR RECONSTITUTION 50 MG (bcg vaccine livepf)


FLUMIST QUAD 2020-2021 NASAL NASAL SPRAY SYRINGE 10EXP65-75 FF UNIT02 ML (influenza vaccine quadrivalent live 2020-2021 (2 yrs-49 yrs))


M-M-R II (PF) SUBCUTANEOUS RECON SOLN 1000-12500 TCID5005 ML (measles mumps and rubella vaccine livepf)


PROQUAD (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10EXP3-43-3- 399 TCID5005 (measles mumps rubella and varicella vaccine livepf)


ROTARIX ORAL SUSPENSION FOR RECONSTITUTION 10EXP6 CCID50ML (rotavirus vaccine live oral attenuated89-12 strain g1p(8))


ROTATEQ VACCINE ORAL SOLUTION 2 ML (rotavirus vaccine live oral pentavalent)

2 QL (500 per 1 day) AGE (Min 19 Years)



VARIVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 1350 UNIT05 ML (varicella virus vaccine livepf)


YF-VAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10 EXP474 UNIT05 ML (yellow fever vaccine livepf)


ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 19400 UNIT065 ML (zoster vaccine livepf)


Toxoid Vaccine Combinations - Vaccines

ADACEL(TDAP ADOLESNADULT)(PF) INTRAMUSCULAR SUSPENSION 2 LF-(25-5-3-5 MCG)-5LF05 ML (diphtheriapertussis(acellular)tetanus vaccinepf)






56



ADACEL(TDAP ADOLESNADULT)(PF) INTRAMUSCULAR SYRINGE 2 LF-(25-5-3-5 MCG)-5LF05 ML (diphtheriapertussis(acellular)tetanus vaccinepf)


BOOSTRIX TDAP INTRAMUSCULAR SUSPENSION 25-8-5 LF-MCG-LF05ML (diphtheriapertussis(acellular)tetanus vaccine)


BOOSTRIX TDAP INTRAMUSCULAR SYRINGE 25-8-5 LF-MCG-LF05ML (diphtheriapertussis(acellular)tetanus vaccine)


DAPTACEL (DTAP PEDIATRIC) (PF) INTRAMUSCULAR SUSPENSION 15-10-5 LF-MCG-LF05ML (diphtheria pertussis (acell) tetanus pediatric vaccinepf)


INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION 25-58-10 LF-MCG-LF05ML (diphtheria pertussis (acell) tetanus pediatric vaccinepf)


INFANRIX (DTAP) (PF) INTRAMUSCULAR SYRINGE 25-58-10 LF-MCG-LF05ML (diphtheria pertussis (acell) tetanus pediatric vaccinepf)


KINRIX (PF) INTRAMUSCULAR SUSPENSION 25 LF-58 MCG-10 LF05 ML (diphtheria pertussis(acell)tetanuspolio vaccinepf)


KINRIX (PF) INTRAMUSCULAR SYRINGE 25 LF-58 MCG-10 LF05 ML (diphtheria pertussis(acell)tetanuspolio vaccinepf)




PENTACEL (PF) INTRAMUSCULAR KIT 15 LF UNIT-20 MCG-5 LF05 ML (diphtheriapertussis(acell)tetanuspoliohaemophilus bpf)


PENTACEL DTAP-IPV COMPNT (PF) INTRAMUSCULAR SUSPENSION 15 LF-48 MCG- 5 LF UNIT05ML 15 LF-48 MCG- 62 DU05 ML (diphtherpertus(acel)tetanuspolio vacccomponent 1 of 2pf)






57



QUADRACEL (PF) INTRAMUSCULAR SUSPENSION 15 LF-48 MCG- 5 LF UNIT05ML (diphtheria pertussis(acell)tetanuspolio vaccinepf)


TDVAX INTRAMUSCULAR SUSPENSION 2-2 LF UNIT05 ML (tetanus and diphtheria toxoids adult)


TENIVAC (PF) INTRAMUSCULAR SUSPENSION 5 LF UNIT- 2 LF UNIT05ML (tetanus and diphtheria toxoids adsorbed adultpf)


TENIVAC (PF) INTRAMUSCULAR SYRINGE 5-2 LF UNIT05 ML (tetanus and diphtheria toxoids adsorbed adultpf)


TETANUSDIPHTHERIA TOX PED(PF) INTRAMUSCULAR SUSPENSION 5-25 LF UNIT05 ML (tetanusdiphtheria toxoid pedpf)


Vaccine Bacterial - Gram Negative Bacilli (Non-Enteric) - Vaccines

ACTHIB (PF) INTRAMUSCULAR RECON SOLN 10 MCG05 ML (haemophilus b conjugate vaccine(tetanus toxoid conjugate)pf)


HIBERIX (PF) INTRAMUSCULAR RECON SOLN 10 MCG05 ML (haemophilus b conjugate vaccine(tetanus toxoid conjugate)pf)


PEDVAX HIB (PF) INTRAMUSCULAR SOLUTION 75 MCG05 ML (haemophilus b conjugate vaccine (meningococcal protconj)pf)


Vaccine Bacterial - Gram Negative Cocci - Vaccines

MENACTRA (PF) INTRAMUSCULAR SOLUTION 4 MCG05 ML (meningococcalvaccine acyw-135diphtheria toxoid conjpf)


MENOMUNE - ACYW-135 (PF) SUBCUTANEOUS RECON SOLN 50 MCG (meningococcal vaccine acyw-135pf)


MENOMUNE - ACYW-135 SUBCUTANEOUS RECON SOLN 50 MCG (meningococcal vac acyw-135)


MENQUADFI (PF) INTRAMUSCULAR SOLUTION 10 MCG05 ML (meningococcal vaccine acy and w-135conj tetanus toxoidpf)






58



MENVEO A-C-Y-W-135-DIP (PF) INTRAMUSCULAR KIT 10-5 MCG05 ML (meningococcalvaccine acyw-135diphtheria toxoid conjpf)


MENVEO MENA COMPONENT (PF) INTRAMUSCULAR RECON SOLN 10 MCG 05 ML (FINAL) (meningococcal a diphtheria-conj vaccine component 1 of 2pf)


MENVEO MENCYW-135 COMPNT (PF) INTRAMUSCULAR RECON SOLN 5 MCG X 3 05 ML (FINAL) (meningococcal cyw-135dip-conj vaccine component 2 of 2pf)


Vaccine Bacterial - Gram Positive Cocci - Vaccines

PNEUMOVAX-23 INJECTION SOLUTION 25 MCG05 ML (pneumococcal 23-valent polysaccharide vaccine)


PNEUMOVAX-23 INJECTION SYRINGE 25 MCG05 ML (pneumococcal 23-valent polysaccharide vaccine)


PREVNAR 13 (PF) INTRAMUSCULAR SYRINGE 05 ML (pneumococcal 13-valent conjugate vaccine (diphtheria crm)pf)


Vaccine Bacterial - Meningococcal Group B Vaccines - Vaccines

BEXSERO INTRAMUSCULAR SYRINGE 50-50-50-25 MCG05 ML (meningococcal group b vaccine 4-component)


TRUMENBA INTRAMUSCULAR SYRINGE 120 MCG05 ML (neisseria meningitidis group b lipidated fhbp recombinant)


Vaccine Bacterial - Other - Vaccines



Vaccine Bacterial - Toxin-Producing Bacilli - Vaccines

BIOTHRAX INTRAMUSCULAR SUSPENSION 05 MLDOSE (anthrax vaccine)


Vaccine Mixed Combinations (Bacterial And Viral) - Vaccines





59





Vaccine Viral - Human Papillomavirus (Hpv) Vaccines - Vaccines

GARDASIL (PF) INTRAMUSCULAR SUSPENSION 20-40-40-20 MCG05 ML (human papillomavirus vaccine quadrivalentpf)


GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION 05 ML (human papillomavirus vaccine 9-valentpf)


GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE 05 ML (human papillomavirus vaccine 9-valentpf)


Vaccine Viral - Influenza A And B - Vaccines

AFLURIA QD 2020-21(3YR UP)(PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)05 ML (influenza virus vaccine quadrivalent 2020-21 (36 mos up)pf)


AFLURIA QD 2020-21(6-35MO)(PF) INTRAMUSCULAR SYRINGE 30 MCG (75 MCG X 4)025 ML (influenza virus vaccine quadrival 2020-21 (6 mos-35 mos)pf)


AFLURIA QUAD 2020-2021(6MO UP) INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)05 ML (influenza virus vaccine quadrivalent 2020-21 (6 mos and up))


FLUAD 2020-2021 (65 YR UP)(PF) INTRAMUSCULAR SYRINGE 45 MCG (15 MCG X 3)05 ML (influenza vaccine tvs 2020-21 (65 yr up)adjuvant mf59c1pf)


FLUAD QUAD 2020-21(65Y UP)(PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)05 ML (influenza vaccine quadrivalent 2020-21 (65 yr up)mf59c1pf)


FLUARIX QUAD 2020-2021 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)05 ML (influenza virus vaccine quadrival 2020-2021(6 mos and up)pf)


FLUBLOK QUAD 2020-2021 (PF) INTRAMUSCULAR SYRINGE 180 MCG (45 MCG X 4)05 ML (influenza virus vaccine qv 2020-21(18 yrs and older)rcmbpf)


FLUCELVAX QUAD 2020-2021 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)05 ML (flu vaccine quad 2020-2021(4 years and older)cell derivedpf)






60



FLUCELVAX QUAD 2020-2021 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)05 ML (flu vaccine quadriv 2020-2021(4 years and older)cell derived)


FLULAVAL QUAD 2020-2021 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)05 ML (influenza virus vaccine quadrival 2020-2021(6 mos and up)pf)




FLUZONE HIGHDOSE QUAD 20-21 PF INTRAMUSCULAR SYRINGE 240 MCG07 ML (influenza virus vaccine quadrival split 2020-21(65 yr up)pf)


FLUZONE QUAD 2020-2021 (PF) INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)05 ML (influenza virus vaccine quadrival 2020-2021(6 mos and up)pf)


FLUZONE QUAD 2020-2021 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)05 ML (influenza virus vaccine quadrival 2020-2021(6 mos and up)pf)


FLUZONE QUAD 2020-2021 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)05 ML (influenza virus vaccine quadrivalent 2020-21 (6 mos and up))


Vaccine Viral - Japanese Encephalitis - Vaccines

IXIARO (PF) INTRAMUSCULAR SYRINGE 6 MCG05 ML (japanese encephalitis vaccinepf)


Vaccine Viral - Measles - Vaccines





Vaccine Viral - Mumps And Related - Vaccines







61





Vaccine Viral - Poliomyelitis - Vaccines

IPOL INJECTION SUSPENSION 40-8-32 UNIT05 ML (poliomyelitis vaccine killed)


Vaccine Viral - Rabies - Vaccines

IMOVAX RABIES VACCINE (PF) INTRAMUSCULAR RECON SOLN 25 UNIT (rabies vaccine human diploid cellpf)


RABAVERT (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 25 UNIT (rabies vaccine purified chicken embryo cell (pcec)pf)


Vaccine Viral - Rotavirus - Vaccines





Vaccine Viral - Rubella - Vaccines





Vaccine Viral - Varicella - Vaccines



SHINGRIX (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 50 MCG05 ML (varicella-zoster virus glycoprotein erecas01b adjuvantpf)








62





Vaccine Viral Combinations - Vaccines





Cardiovascular Therapy Agents - Drugs For The Heart

Ace Inhibitor And Calcium Channel Blocker Combinations - Drugs For High Blood Pressure

amlodipine-benazepril oral capsule 10-20 mg 10-40 mg 25-10 mg 5-10 mg 5-20 mg 5-40 mg

1

Ace Inhibitor And Diuretic Combinations - Drugs For High Blood Pressure

benazepril-hydrochlorothiazide oral tablet 10-125 mg 20-125 mg 20-25 mg 5-625 mg

1 QL (1 per 1 day)

enalapril-hydrochlorothiazide oral tablet 10-25 mg 5-125 mg

1

fosinopril-hydrochlorothiazide oral tablet 10-125 mg 20-125 mg

1

lisinopril-hydrochlorothiazide oral tablet 10-125 mg 20-125 mg 20-25 mg

1

Ace Inhibitors - Drugs For High Blood Pressure

benazepril oral tablet 10 mg 20 mg 40 mg 5 mg 1

captopril oral tablet 100 mg 125 mg 25 mg 50 mg 1 QL (3 per 1 day)

enalapril maleate oral tablet 10 mg 25 mg 20 mg 5 mg 1

EPANED ORAL SOLUTION 1 MGML (enalapril maleate) 2 AGE (Max 11 Years)

fosinopril oral tablet 10 mg 20 mg 40 mg 1

lisinopril oral tablet 10 mg 25 mg 20 mg 30 mg 40 mg 5 mg

1

perindopril erbumine oral tablet 2 mg 4 mg 8 mg 1

QBRELIS ORAL SOLUTION 1 MGML (lisinopril) 2 QL (450 per 1 day) AGE (Max 11 Years)





63



quinapril oral tablet 10 mg 20 mg 40 mg 5 mg 1

ramipril oral capsule 125 mg 10 mg 25 mg 5 mg 1

trandolapril oral tablet 1 mg 2 mg 4 mg 1

Aldosterone Receptor Antagonists - Drugs For High Blood Pressure

CAROSPIR ORAL SUSPENSION 25 MG5 ML (spironolactone)


spironolactone oral tablet 100 mg 25 mg 50 mg 1

Alpha-Beta Blockers - Drugs For High Blood Pressure

carvedilol oral tablet 125 mg 25 mg 3125 mg 625 mg 1

labetalol oral tablet 100 mg 200 mg 300 mg 1

Angiotensin Ii Receptor Blocker (Arb)-Calcium Channel Blocker Comb - Drugs For High Blood Pressure

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

1

Angiotensin Ii Receptor Blocker (Arb)-Diuretic Combinations - Drugs For High Blood Pressure

irbesartan-hydrochlorothiazide oral tablet 150-125 mg 300-125 mg

1

losartan-hydrochlorothiazide oral tablet 100-125 mg 100-25 mg 50-125 mg

1

valsartan-hydrochlorothiazide oral tablet 160-125 mg 160-25 mg 320-125 mg 320-25 mg 80-125 mg

1 QL (1 per 1 day)

Angiotensin Ii Receptor Blockers (Arbs) - Drugs For High Blood Pressure

irbesartan oral tablet 150 mg 300 mg 75 mg 1

losartan oral tablet 100 mg 25 mg 50 mg 1

telmisartan oral tablet 20 mg 40 mg 80 mg 1

valsartan oral tablet 160 mg 320 mg 40 mg 80 mg 1 QL (1 per 1 day)

Antianginal - Coronary Vasodilators (Nitrates) - Drugs For Angina

DILATRATE-SR ORAL CAPSULE EXTENDED RELEASE 40 MG (isosorbide dinitrate)

2

ISORDIL ORAL TABLET 40 MG (isosorbide dinitrate) 2

isosorbide dinitrate oral tablet 10 mg 20 mg 30 mg 40 mg 5 mg

1





64



isosorbide dinitrate oral tablet extended release 40 mg 1

isosorbide mononitrate oral tablet 10 mg 20 mg 1

isosorbide mononitrate oral tablet extended release 24 hr 120 mg 30 mg 60 mg

1

nitroglycerin (Minitran Transdermal Patch 24 Hour 01 MgHr 02 MgHr 04 MgHr 06 MgHr)

1

nitroglycerin (Nitro-Bid Transdermal Ointment 2 ) 2

nitroglycerin sublingual tablet 03 mg 04 mg 06 mg 1

nitroglycerin transdermal patch 24 hour 01 mghr 02 mghr 04 mghr 06 mghr

1

Antiarrhythmic - Class Ia - Drugs For Abnormal Heart Rhythms

disopyramide phosphate oral capsule 100 mg 150 mg 1

quinidine sulfate oral tablet 200 mg 300 mg 1

Antiarrhythmic - Class Ib - Drugs For Abnormal Heart Rhythms

mexiletine oral capsule 150 mg 200 mg 250 mg 1

Antiarrhythmic - Class Ic - Drugs For Abnormal Heart Rhythms

flecainide oral tablet 100 mg 150 mg 50 mg 1

propafenone oral tablet 150 mg 225 mg 300 mg 1

Antiarrhythmic - Class Ii - Drugs For Abnormal Heart Rhythms

sotalol hcl (Sorine Oral Tablet 120 Mg 160 Mg 240 Mg 80 Mg)

1

sotalol hcl (Sotalol Af Oral Tablet 120 Mg 160 Mg 80 Mg) 1

sotalol oral tablet 120 mg 160 mg 240 mg 80 mg 1

Antiarrhythmic - Class Iii - Drugs For Abnormal Heart Rhythms

amiodarone oral tablet 100 mg 200 mg 400 mg 1

amiodarone hcl (Pacerone Oral Tablet 200 Mg) 1

Antiarrhythmic - Class Iv - Drugs For Abnormal Heart Rhythms

diltiazem hcl intravenous recon soln 100 mg 1

diltiazem hcl intravenous solution 5 mgml 1

verapamil oral tablet 120 mg 40 mg 80 mg 1

Antihyperlipidemic - Bile Acid Sequestrants - Drugs For Cholesterol





65



cholestyramine (with sugar) oral powder in packet 4 gram

1

cholestyramineaspartame (Cholestyramine Light Oral Powder In Packet 4 Gram)

1

colestipol oral packet 5 gram 1

colestipol oral tablet 1 gram 1

cholestyramineaspartame (Prevalite Oral Powder In Packet 4 Gram)

1

Antihyperlipidemic - Fibric Acid Derivatives - Drugs For Cholesterol

fenofibrate micronized oral capsule 134 mg 200 mg 67 mg

1

fenofibrate nanocrystallized oral tablet 145 mg 48 mg 1

fenofibrate oral tablet 160 mg 54 mg 1

gemfibrozil oral tablet 600 mg 1

Antihyperlipidemic - Hmg Coa Reductase Inhibitors (Statins) - Drugs For Cholesterol

atorvastatin oral tablet 10 mg 20 mg 40 mg 80 mg 1 QL (1 per 1 day)

lovastatin oral tablet 10 mg 20 mg 40 mg 1

pravastatin oral tablet 10 mg 20 mg 40 mg 80 mg 1

rosuvastatin oral tablet 10 mg 20 mg 40 mg 5 mg 1 QL (1 per 1 day)

simvastatin oral tablet 10 mg 20 mg 40 mg 5 mg 1

Antihyperlipidemic - Nicotinic Acid Derivatives - Drugs For Cholesterol

niacin oral tablet 500 mg 1 OTC Medical

niacin oral tablet extended release 24 hr 1000 mg 500 mg 750 mg

1

niacin (Niacor Oral Tablet 500 Mg) 1

Antihyperlipidemic - Omega-3 Fatty Acid Type - Drugs For Cholesterol

omega-3 acid ethyl esters oral capsule 1 gram 1

Antihyperlipidemic - Selective Cholesterol Absorption Inhibitor - Drugs For Cholesterol

ezetimibe oral tablet 10 mg 1

Antihyperlipidemic Agents - Dietary Source - Drugs For Cholesterol






66



Beta Blockers Cardiac Selective - Drugs For High Blood Pressure

atenolol oral tablet 100 mg 25 mg 50 mg 1

bisoprolol fumarate oral tablet 10 mg 5 mg 1

metoprolol succinate oral tablet extended release 24 hr 100 mg 200 mg 25 mg 50 mg

1

metoprolol tartrate oral tablet 100 mg 50 mg 1

metoprolol tartrate oral tablet 25 mg 375 mg 75 mg 1

Beta Blockers Cardiac Selective Intrinsic Sympathomimetic Activity - Drugs For High Blood Pressure

acebutolol oral capsule 200 mg 400 mg 1

Beta Blockers Non-Cardiac Selective - Drugs For High Blood Pressure

nadolol oral tablet 20 mg 40 mg 80 mg 1

propranolol oral capsuleextended release 24 hr 120 mg 160 mg 60 mg 80 mg

1

propranolol oral solution 20 mg5 ml (4 mgml) 40 mg5 ml (8 mgml)


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

1


1



timolol maleate oral tablet 5 mg 1

Calcium Channel Blockers - Benzothiazepines - Drugs For High Blood Pressure

diltiazem hcl (Cartia Xt Oral CapsuleExtended Release 24Hr 120 Mg 180 Mg 240 Mg 300 Mg)

1


diltiazem hcl oral capsuleextended release 24 hr 360 mg 420 mg

1

diltiazem hcl oral capsuleextended release 24hr 120 mg 180 mg 240 mg 300 mg

1

diltiazem hcl oral tablet 120 mg 30 mg 60 mg 90 mg 1

diltiazem hcl oral tablet extended release 24 hr 180 mg 240 mg 300 mg 360 mg 420 mg

1





67



diltiazem in dextrose 5 intravenous solution 100 mg100 ml (1 mgml) 125 mg125 ml (1 mgml) 250 mg250 ml (1 mgml)

1

dilt-xr oral capsuleextrel 24h degradable 120 mg 180 mg 240 mg

1

diltiazem hcl (Taztia Xt Oral CapsuleExtended Release 24 Hr 120 Mg 180 Mg 240 Mg 300 Mg 360 Mg)

1

diltiazem hcl (Tiadylt Er Oral CapsuleExtended Release 24 Hr 120 Mg 180 Mg 240 Mg 300 Mg 360 Mg 420 Mg)

1

Calcium Channel Blockers - Dihydropyridines - Drugs For High Blood Pressure

nifedipine (Afeditab Cr Oral Tablet Extended Release 30 Mg)

1

amlodipine oral tablet 10 mg 25 mg 5 mg 1

felodipine oral tablet extended release 24 hr 10 mg 25 mg 5 mg

1

isradipine oral capsule 25 mg 5 mg 1 QL (4 per 1 day) AGE (Max 11 Years)

KATERZIA ORAL SUSPENSION 1 MGML (amlodipine benzoate)

2 QL (150 per 1 day) AGE (Max 11 Years)

nifedipine oral capsule 10 mg 20 mg 1

nifedipine oral tablet extended release 24hr 30 mg 60 mg 90 mg

1

nifedipine oral tablet extended release 30 mg 60 mg 90 mg

1

Calcium Channel Blockers - Phenylakylamines - Drugs For High Blood Pressure

verapamil oral capsuleext rel pellets 24 hr 120 mg 180 mg 240 mg 360 mg

1


verapamil oral tablet extended release 120 mg 180 mg 240 mg

1

Cardiac Selective Beta Blocker-Thiazide Diuretic And Related Comb - Drugs For High Blood Pressure

atenolol-chlorthalidone oral tablet 100-25 mg 50-25 mg 1

bisoprolol-hydrochlorothiazide oral tablet 10-625 mg 25-625 mg 5-625 mg

1





68



metoprolol ta-hydrochlorothiaz oral tablet 100-25 mg 100-50 mg 50-25 mg

1

Cardiovascular Sympathomimetic - Anaphylaxis Therapy Single Agents - Drugs For Serious Allergic Reaction

epinephrine hcl (pf) injection solution 1 mgml (1 ml) 1 QL (500 per 1 day)

epinephrine injection auto-injector 015 mg015 ml 015 mg03 ml 03 mg03 ml


epinephrine injection solution 1 mgml 1 QL (500 per 1 day)

EPIPEN 2-PAK INJECTION AUTO-INJECTOR 03 MG03 ML (epinephrine)


EPIPEN JR 2-PAK INJECTION AUTO-INJECTOR 015 MG03 ML (epinephrine)


SYMJEPI INJECTION SYRINGE 015 MG03 ML 03 MG03 ML (epinephrine)


Cardiovascular Sympathomimetics - Drugs For Serious Allergic Reaction



midodrine oral tablet 10 mg 25 mg 5 mg 1

Central Alpha-2 Receptor Agonists - Drugs For High Blood Pressure

clonidine hcl oral tablet 01 mg 02 mg 03 mg 1

clonidine transdermal patch weekly 01 mg24 hr 02 mg24 hr 03 mg24 hr

1

guanfacine oral tablet 1 mg 2 mg 1

methyldopa oral tablet 250 mg 500 mg 1

Digitalis Glycosides - Drugs For The Heart

digoxin (Digitek Oral Tablet 125 Mcg (0125 Mg) 250 Mcg (025 Mg))

1

digoxin (Digox Oral Tablet 125 Mcg (0125 Mg) 250 Mcg (025 Mg))

1

DIGOXIN ORAL SOLUTION 50 MCGML (005 MGML) 2 AGE (Max 11 Years)

digoxin oral tablet 125 mcg (0125 mg) 250 mcg (025 mg)

1

LANOXIN ORAL TABLET 125 MCG (0125 MG) 250 MCG (025 MG) (digoxin)

2





69



Direct Acting Vasodilators - Drugs For High Blood Pressure

hydralazine oral tablet 10 mg 100 mg 25 mg 50 mg 1

minoxidil oral tablet 10 mg 25 mg 1

Diuretic - Aldosterone Receptor Antagonist Non-Selective - Drugs For High Blood Pressure




Diuretic - Carbonic Anhydrase Inhibitors - Drugs For High Blood Pressure

acetazolamide oral capsule extended release 500 mg 1

acetazolamide oral tablet 125 mg 250 mg 1

Diuretic - Loop - Drugs For High Blood Pressure

bumetanide oral tablet 05 mg 1 mg 2 mg 1

EDECRIN ORAL TABLET 25 MG (ethacrynic acid) 2 PA

furosemide oral solution 10 mgml 1 QL (500 per 1 day)

furosemide oral solution 40 mg5 ml (8 mgml) 1 QL (500 per 1 day)

furosemide oral tablet 20 mg 40 mg 80 mg 1

torsemide oral tablet 10 mg 100 mg 20 mg 5 mg 1

Diuretic - Potassium Sparing - Drugs For High Blood Pressure

amiloride oral tablet 5 mg 1

Diuretic - Potassium Sparing-Thiazide And Related Combinations - Drugs For High Blood Pressure

spironolacton-hydrochlorothiaz oral tablet 25-25 mg 1

triamterene-hydrochlorothiazid oral capsule 375-25 mg 50-25 mg

1

triamterene-hydrochlorothiazid oral tablet 375-25 mg 75-50 mg

1

Diuretic - Thiazides And Related - Drugs For High Blood Pressure

chlorthalidone oral tablet 25 mg 50 mg 1

DIURIL ORAL SUSPENSION 250 MG5 ML (chlorothiazide)






70



HYDROCHLOROTHIAZIDE (BULK) POWDER 100 (hydrochlorothiazide)

2

hydrochlorothiazide oral capsule 125 mg 1

hydrochlorothiazide oral tablet 125 mg 1

hydrochlorothiazide oral tablet 25 mg 50 mg 1

indapamide oral tablet 125 mg 25 mg 1

metolazone oral tablet 10 mg 25 mg 5 mg 1

Peripheral Alpha-1 Receptor Blockers - Drugs For High Blood Pressure

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

prazosin oral capsule 1 mg 2 mg 5 mg 1

terazosin oral capsule 1 mg 10 mg 2 mg 5 mg 1

Vasodilator Combinations - Drugs For High Blood Pressure

BIDIL ORAL TABLET 20-375 MG (isosorbide dinitratehydralazine hcl)

2 PA

Central Nervous System Agents - Drugs For The Nervous System

Antianxiety Agent - Antihistamine Type - Drugs For Anxiety

hydroxyzine hcl oral solution 10 mg5 ml 1 QL (500 per 1 day)

hydroxyzine hcl oral tablet 10 mg 25 mg 50 mg 1

hydroxyzine pamoate oral capsule 100 mg 25 mg 50 mg

1

Antianxiety Agent - Benzodiazepines - Drugs For Anxiety

chlordiazepoxide hcl oral capsule 10 mg 25 mg 5 mg 1

clonazepam oral tablet 05 mg 1 mg 2 mg 1

clonazepam oral tabletdisintegrating 0125 mg 025 mg 05 mg 1 mg 2 mg


diazepam injection solution 5 mgml 1

diazepam injection syringe 5 mgml 1

diazepam (Diazepam Intensol Oral Concentrate 5 MgMl) 1 QL (500 per 1 day)

diazepam oral solution 5 mg5 ml (1 mgml) 1 QL (500 per 1 day)

diazepam oral tablet 10 mg 2 mg 5 mg 1

lorazepam oral concentrate 2 mgml 1 QL (3 per 1 day) AGE (Max 11 Years)





71



lorazepam oral tablet 05 mg 1 mg 2 mg 1

Antianxiety Agent - Non-Benzodiazepine - Drugs For Anxiety

buspirone oral tablet 10 mg 15 mg 30 mg 5 mg 75 mg 1

Anticonvulsant - Barbiturates And Derivatives - Drugs For Seizures Personality DisorderNerve Pain

phenobarbital oral elixir 20 mg5 ml (4 mgml) 1 QL (500 per 1 day)

phenobarbital oral tablet 100 mg 162 mg 324 mg 648 mg 972 mg

1

phenobarbital oral tablet 15 mg 30 mg 60 mg 1

primidone oral tablet 250 mg 50 mg 1

Anticonvulsant - Benzodiazepines - Drugs For Seizures Personality DisorderNerve Pain




diazepam rectal kit 125-15-175-20 mg 25 mg 5-75-10 mg


NAYZILAM NASAL SPRAYNON-AEROSOL 5 MGSPRAY (01 ML) (midazolam)

2

VALTOCO NASAL SPRAYNON-AEROSOL 10 MGSPRAY (01 ML) 15 MG2 SPRAY (7501ML X 2) 20 MG2 SPRAY (10MG01ML X2) 5 MGSPRAY (01 ML) (diazepam)

2

Anticonvulsant - Carboxylic Acid Derivatives - Drugs For Seizures Personality DisorderNerve Pain

divalproex oral capsule delayed rel sprinkle 125 mg 1

divalproex oral tablet extended release 24 hr 250 mg 500 mg

1

divalproex oral tabletdelayed release (drec) 125 mg 250 mg 500 mg

1

valproic acid (as sodium salt) oral solution 250 mg5 ml 1 QL (1500 per 1 day)

valproic acid oral capsule 250 mg 1

Anticonvulsant - Gaba Analogs - Drugs For Seizures Personality DisorderNerve Pain





72



gabapentin oral capsule 100 mg 300 mg 400 mg 1

gabapentin oral solution 250 mg5 ml 1 QL (500 per 1 day)

gabapentin oral tablet 600 mg 800 mg 1

pregabalin oral capsule 100 mg 150 mg 200 mg 25 mg 50 mg 75 mg

1 QL (3 per 1 day)

pregabalin oral capsule 225 mg 300 mg 1 QL (2 per 1 day)

pregabalin oral solution 20 mgml 1 QL (900 per 1 day)

Anticonvulsant - Gaba Re-Uptake Inhibitor Nipecotic Acid Derivatives - Drugs For Seizures Personality DisorderNerve Pain

tiagabine oral tablet 12 mg 16 mg 2 mg 4 mg 1 PA

Anticonvulsant - Hydantoins - Drugs For Seizures Personality DisorderNerve Pain

phenytoin sodium extended (Dilantin Extended Oral Capsule 100 Mg)

2

phenytoin (Dilantin Infatabs Oral TabletChewable 50 Mg) 2

DILANTIN-125 ORAL SUSPENSION 125 MG5 ML (phenytoin)


PEGANONE ORAL TABLET 250 MG (ethotoin) 2

phenytoin sodium extended (Phenytek Oral Capsule 200 Mg 300 Mg)

2

phenytoin oral suspension 125 mg5 ml 1 QL (500 per 1 day)

phenytoin oral tabletchewable 50 mg 1

phenytoin sodium extended oral capsule 100 mg 200 mg 300 mg

1

Anticonvulsant - Iminostilbene Derivatives - Drugs For Seizures Personality DisorderNerve Pain

carbamazepine oral capsule er multiphase 12 hr 100 mg 200 mg 300 mg

1

carbamazepine oral suspension 100 mg5 ml 1 QL (1500 per 1 day)

carbamazepine oral tablet 200 mg 1

carbamazepine oral tablet extended release 12 hr 100 mg 200 mg 400 mg

1

carbamazepine oral tabletchewable 100 mg 1

carbamazepine (Epitol Oral Tablet 200 Mg) 1





73



oxcarbazepine oral suspension 300 mg5 ml (60 mgml) 1 QL (500 per 1 day)

oxcarbazepine oral tablet 150 mg 300 mg 600 mg 1

Anticonvulsant - Monosaccharide Derivatives - Drugs For Seizures Personality DisorderNerve Pain

topiramate oral capsule sprinkle 15 mg 25 mg 1

topiramate oral tablet 100 mg 200 mg 25 mg 50 mg 1

Anticonvulsant - Phenyltriazine Derivatives - Drugs For Seizures Personality DisorderNerve Pain

lamotrigine oral tablet 100 mg 150 mg 200 mg 25 mg 1

lamotrigine oral tablet chewable dispersible 25 mg 5 mg

1

Anticonvulsant - Pyrrolidine Derivatives - Drugs For Seizures Personality DisorderNerve Pain

levetiracetam oral solution 100 mgml 1 QL (1500 per 1 day)

levetiracetam oral tablet 1000 mg 250 mg 500 mg 750 mg

1

SPRITAM ORAL TABLET FOR SUSPENSION 1000 MG 250 MG 500 MG 750 MG (levetiracetam)

1

Anticonvulsant - Succinimides - Drugs For Seizures Personality DisorderNerve Pain

CELONTIN ORAL CAPSULE 300 MG (methsuximide) 2

ethosuximide oral capsule 250 mg 1

ethosuximide oral solution 250 mg5 ml 1 QL (500 per 1 day)

Anticonvulsant - Sulfonamide Derivatives - Drugs For Seizures Personality DisorderNerve Pain

zonisamide oral capsule 100 mg 25 mg 50 mg 1

Antidepressant - Alpha-2 Receptor Antagonists (Nassa) - Drugs For Depression

mirtazapine oral tablet 15 mg 30 mg 45 mg 1

mirtazapine oral tablet 75 mg 1

mirtazapine oral tabletdisintegrating 15 mg 30 mg 45 mg

1 QL (1 per 1 day)

Antidepressant - Selective Serotonin Reuptake Inhibitors (Ssris) - Drugs For Depression





74



citalopram oral solution 10 mg5 ml 1 QL (20 per 1 day)

citalopram oral tablet 10 mg 1 QL (4 per 1 day)

citalopram oral tablet 20 mg 40 mg 1

escitalopram oxalate oral solution 5 mg5 ml 1 QL (500 per 1 day)

escitalopram oxalate oral tablet 10 mg 20 mg 1 QL (2 per 1 day)

escitalopram oxalate oral tablet 5 mg 1 QL (3 per 1 day)

fluoxetine oral capsule 10 mg 20 mg 40 mg 1

fluoxetine oral solution 20 mg5 ml (4 mgml) 1 QL (500 per 1 day)

fluoxetine oral tablet 10 mg 1 AGE (Min 2 Years and Max 12 Years)

fluvoxamine oral tablet 100 mg 25 mg 50 mg 1

paroxetine hcl oral tablet 10 mg 20 mg 30 mg 40 mg 1

sertraline oral concentrate 20 mgml 1 QL (500 per 1 day)

sertraline oral tablet 100 mg 25 mg 50 mg 1

Antidepressant - Serotonin-2 Antagonist-Reuptake Inhibitors (Saris) - Drugs For Depression

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

1

trazodone oral tablet 100 mg 150 mg 300 mg 50 mg 1

Antidepressant - Serotonin-Norepinephrine Reuptake Inhibitors (Snris) - Drugs For Depression

desvenlafaxine succinate oral tablet extended release 24 hr 100 mg 50 mg

1 QL (1 per 1 day)

desvenlafaxine succinate oral tablet extended release 24 hr 25 mg

1 QL (3 per 1 day)

duloxetine oral capsuledelayed release(drec) 20 mg 60 mg

1 QL (2 per 1 day)

duloxetine oral capsuledelayed release(drec) 30 mg 1 QL (3 per 1 day)

venlafaxine oral capsuleextended release 24hr 150 mg 375 mg

1 QL (2 per 1 day)

venlafaxine oral capsuleextended release 24hr 75 mg 1 QL (3 per 1 day)

venlafaxine oral tablet 100 mg 25 mg 375 mg 50 mg 1 QL (2 per 1 day)

venlafaxine oral tablet 75 mg 1 QL (3 per 1 day)





75



Antidepressant - Ssri And Serotonin (5-Ht) Receptor Modulator - Drugs For Depression

TRINTELLIX ORAL TABLET 10 MG 20 MG 5 MG (vortioxetine hydrobromide)

2 PA

Antidepressant - Tricyclic-Benzodiazepine Combinations - Drugs For Depression

amitriptyline-chlordiazepoxide oral tablet 125-5 mg 25-10 mg

1

Antidepressant-Norepinephrine And Dopamine Reuptake Inhibitors (Ndris) - Drugs For Depression

bupropion hcl oral tablet 100 mg 75 mg 1

bupropion hcl oral tablet extended release 24 hr 150 mg 1 QL (3 per 1 day)

bupropion hcl oral tablet extended release 24 hr 300 mg 1

bupropion hcl oral tablet sustained-release 12 hr 100 mg 150 mg 200 mg

1

Antidepressant-Tricyclics And Related (Non-Select Reuptake Inhibitors) - Drugs For Depression

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

1

amoxapine oral tablet 100 mg 150 mg 25 mg 50 mg 1

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

1

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

1

doxepin oral concentrate 10 mgml 1 QL (500 per 1 day)

imipramine hcl oral tablet 10 mg 25 mg 50 mg 1

maprotiline oral tablet 25 mg 50 mg 75 mg 1

nortriptyline oral capsule 10 mg 25 mg 50 mg 75 mg 1

nortriptyline oral solution 10 mg5 ml 1 QL (500 per 1 day)

protriptyline oral tablet 10 mg 5 mg 1

trimipramine oral capsule 100 mg 25 mg 50 mg 1

Antiparkinson - Dopaminergic-Periph Comt-Dopa-Decarboxylase Inhib Comb - Drugs For Parkinson





76



carbidopa-levodopa-entacapone oral tablet 125-50-200 mg 1875-75-200 mg 25-100-200 mg 3125-125-200 mg 375-150-200 mg 50-200-200 mg

1

Antiparkinson - Dopaminerg-Peripheral Dopa-Decarboxylase Inhibit Comb - Drugs For Parkinson

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

1

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

1

carbidopa-levodopa oral tabletdisintegrating 10-100 mg 25-100 mg 25-250 mg

1

Antiparkinson Adjuvant - Peripheral Comt Inhibitors - Drugs For Parkinson

entacapone oral tablet 200 mg 1

Antiparkinson Therapy - Monoamine Oxidase Inhibitor(Mao-B) - Drugs For Parkinson

selegiline hcl oral capsule 5 mg 1

selegiline hcl oral tablet 5 mg 1

Antiparkinson Therapy - Non-Ergot Dopamine Agonist Agents - Drugs For Parkinson

pramipexole oral tablet 0125 mg 025 mg 05 mg 075 mg 1 mg 15 mg

1

ropinirole oral tablet 025 mg 05 mg 1 mg 2 mg 3 mg 4 mg 5 mg

1

Antipsychotic - Phenothiazines Piperazine - Drugs For Severe Mental Disorders

prochlorperazine maleate oral tablet 10 mg 5 mg 1

Attention Deficit-Hyperact Disorder (Adhd)- Alpha-2 Receptor Agonist - Drugs For Attention Deficit Disorder

guanfacine oral tablet extended release 24 hr 1 mg 2 mg 3 mg 4 mg

1 QL (1 per 1 day)

Attention Deficit-Hyperactivity (Adhd) Therapy Stimulant-Type - Drugs For Attention Deficit Disorder

dexmethylphenidate oral capsuleer biphasic 50-50 10 mg 15 mg 20 mg 25 mg 30 mg 35 mg 40 mg 5 mg

1

dexmethylphenidate oral tablet 10 mg 25 mg 5 mg 1





77



dextroamphetamine oral capsule extended release 10 mg 15 mg 5 mg

1

dextroamphetamine oral tablet 10 mg 5 mg 1 QL (30 per 30 days)

dextroamphetamine-amphetamine oral capsuleextended release 24hr 10 mg 15 mg 20 mg 25 mg 30 mg 5 mg

1 QL (2 per 1 day)

dextroamphetamine-amphetamine oral tablet 10 mg 125 mg 15 mg 20 mg 30 mg 5 mg 75 mg

1 QL (3 per 1 day)

methylphenidate hcl oral capsule er biphasic 30-70 10 mg 20 mg 30 mg 40 mg 50 mg 60 mg

1 QL (1 per 1 day)

methylphenidate hcl oral capsuleer biphasic 50-50 10 mg 20 mg 30 mg 40 mg

1 QL (1 per 1 day)

methylphenidate hcl oral capsuleer biphasic 50-50 60 mg

1

methylphenidate hcl oral solution 10 mg5 ml 1

methylphenidate hcl oral solution 5 mg5 ml 1 QL (10 per 1 day)

methylphenidate hcl oral tablet 10 mg 20 mg 5 mg 1 QL (3 per 1 day)

methylphenidate hcl oral tablet extended release 10 mg 20 mg

1 QL (2 per 1 day)

methylphenidate hcl oral tablet extended release 24hr 18 mg 27 mg 54 mg 72 mg

1 QL (1 per 1 day)

methylphenidate hcl oral tablet extended release 24hr 36 mg

1 QL (2 per 1 day)

methylphenidate hcl oral tabletchewable 10 mg 25 mg 5 mg

1

dextroamphetamine sulfate (Zenzedi Oral Tablet 10 Mg 5 Mg)


Attention Deficit-Hyperactivity Disorder (Adhd) Therapy Nri-Type - Drugs For Attention Deficit Disorder

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

1 QL (1 per 1 day)

Benzodiazepines - Drugs For Seizures Personality DisorderNerve Pain


1






78












estazolam oral tablet 1 mg 2 mg 1

flurazepam oral capsule 15 mg 30 mg 1






2

temazepam oral capsule 15 mg 30 mg 75 mg 1


2

Bipolar Therapy Agents - Anticonvulsant Type - Drugs For Seizures Personality DisorderNerve Pain


1




1







79




1


1




Cannabis And Cannabinoid Receptor Agonists - Drugs For Seizures Personality DisorderNerve Pain

dronabinol oral capsule 10 mg 25 mg 5 mg 1 PA

Cns Stimulant - Amphetamine Combinations - Drugs For Attention Deficit Disorder


1 QL (2 per 1 day)


1 QL (3 per 1 day)

Cns Stimulant - Amphetamines - Drugs For Attention Deficit Disorder


1




Fibromyalgia Agents - Gaba Analogs - Drugs For Seizures Personality DisorderNerve Pain


1 QL (3 per 1 day)



Fibromyalgia Agents - Serotonin-Norepinephrine Reuptake-Inhib (Snris) - Drugs For Seizures Personality DisorderNerve Pain


1 QL (2 per 1 day)






80



Migraine Therapy - Carboxylic Acid Derivatives - Drugs For Migraine Headaches


1

Migraine Therapy - Selective Serotonin Agonists 5-Ht(1) - Drugs For Migraine Headaches

rizatriptan oral tablet 10 mg 5 mg 1 QL (9 per 30 days)

rizatriptan oral tabletdisintegrating 10 mg 5 mg 1 QL (9 per 30 days)

sumatriptan nasal spraynon-aerosol 20 mgactuation 5 mgactuation


sumatriptan succinate oral tablet 100 mg 25 mg 50 mg 1 QL (9 per 30 days)

sumatriptan succinate subcutaneous cartridge 4 mg05 ml 6 mg05 ml


sumatriptan succinate subcutaneous pen injector 4 mg05 ml 6 mg05 ml


sumatriptan succinate subcutaneous solution 6 mg05 ml


sumatriptan succinate subcutaneous syringe 6 mg05 ml


Narcolepsy Therapy Agents - Non-Sympathomimetic - Drugs For Sleep Disorder

armodafinil oral tablet 150 mg 200 mg 250 mg 50 mg 1 PA

modafinil oral tablet 100 mg 200 mg 1

Narcolepsy Therapy Agents - Stimulant-Type Piperadine Derivative - Drugs For Sleep Disorder





1

Narcolepsy Therapy Agents- Stimulant-TypeSympathomimeticAmphetamines - Drugs For Sleep Disorder


1






81




1 QL (3 per 1 day)



Sedative-Hypnotic - Antihistamines - Drugs For Insomnia

alka-seltzer plus allergy oral tablet 25 mg 1 OTC Medical

compoz oral tablet 25 mg 1 OTC Medical

diphenhydramine hcl oral capsule 25 mg 50 mg 1 OTC Medical

nightime sleep oral capsule 50 mg 1 OTC Medical

nighttime sleep aid (diphen) oral liquid 50 mg30 ml 1 OTC Medical

nighttime sleep-aid (doxylamn) oral tablet 25 mg 1 OTC Medical

nytol oral tablet 25 mg 1 OTC Medical

restfully sleep oral tablet 25 mg 1 OTC Medical

simply sleep oral tablet 25 mg 1 OTC Medical

sleep aid (diphenhydramine) oral capsule 25 mg 1 OTC Medical

sleep tablet (diphenhydramine) oral tablet 25 mg 1 OTC Medical

sominex oral tablet 25 mg 1 OTC Medical

ultra sleep (doxylamine succ) oral tablet 25 mg 1 OTC Medical

unisom (diphenhydramine) oral liquid 50 mg30 ml 1 OTC Medical

UNISOM (DOXYLAMINE) ORAL TABLET 25 MG (doxylamine succinate)

1 OTC Medical

unisom sleepgels oral capsule 50 mg 1 OTC Medical

wal-sleep z oral capsule 25 mg 1 OTC Medical

wal-sleep z oral liquid 50 mg30 ml 1 OTC Medical QL (500 per 1 day)

wal-som (diphenhydramine) oral capsule 50 mg 1 OTC Medical

wal-som (doxylamine) oral tablet 25 mg 1 OTC Medical

z-sleep oral capsule 25 mg 1 OTC Medical

z-sleep oral liquid 50 mg30 ml 1 OTC Medical

Sedative-Hypnotic - Barbiturates - Drugs For Insomnia

pentobarbital sodium injection solution 50 mgml 1 PA NSO






82




1


Sedative-Hypnotic - Benzodiazepines - Drugs For Insomnia



lorazepam injection solution 2 mgml 4 mgml 1


Sedative-Hypnotic - Gaba-Receptor Modulators - Drugs For Insomnia

eszopiclone oral tablet 1 mg 2 mg 3 mg 1

zaleplon oral capsule 10 mg 5 mg 1 QL (1 per 1 day)

zolpidem oral tablet 10 mg 5 mg 1 QL (1 per 1 day)

zolpidem oral tabletext release multiphase 125 mg 625 mg

1 QL (1 per 1 day)

Chemical Dependency Agents To Treat - Drugs For Addiction

Smoking Deterrents - Ne And Dopamine Reuptake Inhibitor (Ndri)-Type - Drugs For Smoking Addiction

bupropion hcl (smoking deter) oral tablet extended release 12 hr 150 mg

1

bupropion hcl oral tablet sustained-release 12 hr 150 mg

1

Smoking Deterrents - Nicotine-Type - Drugs For Smoking Addiction

NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 MG24 HR 21 MG24 HR 7 MG24 HR (nicotine)

2 OTC

nicorelief buccal gum 2 mg 4 mg 1 OTC

NICORETTE BUCCAL GUM 2 MG 4 MG (nicotine polacrilex)

2 OTC

NICORETTE BUCCAL MINI LOZENGE 2 MG 4 MG (nicotine polacrilex)

2 OTC

nicotine (polacrilex) buccal gum 2 mg 4 mg 1 OTC

nicotine (polacrilex) buccal lozenge 2 mg 4 mg 1 OTC

nicotine transdermal patch 24 hour 14 mg24 hr 21 mg24 hr 22 mg24 hr 7 mg24 hr

1 OTC





83



NICOTINE TRANSDERMAL PATCH TD DAILY SEQUENTIAL 21-14-7 MG24 HR

2 OTC

stop smoking aid buccal lozenge 2 mg 4 mg 1 OTC

Smoking Deterrents - Nicotinic Receptor Partial Agonist Alpha4beta2 - Drugs For Smoking Addiction

CHANTIX CONTINUING MONTH BOX ORAL TABLET 1 MG (varenicline tartrate)

2 QL (336 per 365 days)

CHANTIX ORAL TABLET 05 MG 1 MG (varenicline tartrate)

2 QL (336 per 365 days)

CHANTIX STARTING MONTH BOX ORAL TABLETSDOSE PACK 05 MG (11)- 1 MG (42) (varenicline tartrate)


Chemicals-Pharmaceutical Adjuvants

Bulk Chemicals

ALUMINUM HYDROXIDE GEL (BULK) GRANULES 100 (aluminum hydroxide)

2 OTC Medical

ALUMINUM HYDROXIDE GEL (BULK) POWDER 2 OTC Medical

BISMUTH SUBCARBONATE (BULK) POWDER 2 OTC Medical

BISMUTH SUBNITRATE (BULK) POWDER 100 (bismuth subnitrate)

2 OTC Medical

BISMUTH SUBSALICYLATE (BULK) POWDER 2 OTC Medical

CALAMINE (BULK) POWDER (calamine) 2 OTC Medical

CAPSAICIN (BULK) POWDER 2 OTC Medical


2 OTC Medical

CHOLECALCIFEROL (VIT D3)(BULK) LIQUID 2400 UNITML (cholecalciferol (vitamin d3))

1 OTC

DOCUSATE SODIUM (BULK) POWDER (docusate sodium)

2 OTC Medical

FERROUS SULFATE DRIED (BULK) POWDER 100 (ferrous sulfate dried)

2 OTC Medical


2

HYPROMELLOSE (BULK) POWDER 23 AND 10 2 OTC Medical





84



MAGNESIUM HYDROXIDE (BULK) POWDER 100 (magnesium hydroxide)

2 OTC Medical

METHOCEL K 100 M POWDER 23 AND 10 (hypromellose)

2 OTC Medical



POLYETHYLENE GLYCOL 3350(BULK) POWDER 1

POLYVINYL ALCOHOL (BULK) POWDER 100 (polyvinyl alcohol)

2 OTC Medical

PSYLLIUM HUSK (BULK) POWDER 100 (psyllium husk)

2 OTC Medical

SIMETHICONE (BULK) LIQUID (simethicone) 2 OTC Medical QL (500 per 1 day)

WATER (BULK) LIQUID (water) 2 OTC Medical QL (500 per 1 day)

Chemicals - Fixed Oils

CASTOR OIL OIL (castor oil) 1 OTC Medical QL (500 per 1 day)

Chemicals - Solvents

GLYCERIN (BULK) LIQUID 1 QL (500 per 1 day)

GLYCERIN (BULK) LIQUID 100 (glycerin) 2 QL (500 per 1 day)

Pharmaceutical Adjuvant - Inhalation Vehicles

HYPER-SAL INHALATION SOLUTION FOR NEBULIZATION 35 7 (sodium chloride for inhalation)

2

nebusal inhalation solution for nebulization 3 1

NEBUSAL INHALATION SOLUTION FOR NEBULIZATION 6 (sodium chloride for inhalation)

2

PULMOSAL INHALATION SOLUTION FOR NEBULIZATION 7 (sodium chloride for inhalation)

2

sodium chloride inhalation solution for nebulization 09 10 3 7

1

Pharmaceutical Adjuvant - Oral Vehicles

ENFAMIL WATER ORAL LIQUID (water) 2 OTC Medical QL (500 per 1 day)





85



GERBER GOOD START WATER ORAL LIQUID (water) 1 OTC Medical QL (500 per 1 day)

SIMILAC STERILIZED WATER ORAL LIQUID (water) 2 OTC Medical QL (500 per 1 day)

Pharmaceutical Adjuvant - Surfactants

TRITON X-100 LIQUID (octoxynol 9) 2 OTC Medical QL (500 per 1 day)

Pharmaceutical Adjuvant - Suspending Agents


HYPROMELLOSE POWDER 2 OTC Medical

METHOCEL E 4 M POWDER (hypromellose) 2 OTC Medical


2 OTC Medical


2 OTC Medical

Cognitive Disorder Therapy - Drugs For The Nervous System

Alzheimers Disease Therapy - Cholinesterase Inhibitors - Drugs For Alzheimers Disease

donepezil oral tablet 10 mg 5 mg 1

donepezil oral tabletdisintegrating 10 mg 5 mg 1

rivastigmine tartrate oral capsule 15 mg 3 mg 45 mg 6 mg

1 PA

Alzheimers Disease Therapy - Nmda Receptor Antagonists - Drugs For Alzheimers Disease

memantine oral capsulesprinkleer 24hr 14 mg 21 mg 28 mg 7 mg

1 PA NSO

memantine oral tablet 10 mg 5 mg 1

Cognitive Disorder Therapy - Cerebral Vasodilators - Drugs For Alzheimers Disease

ergoloid oral tablet 1 mg 1 PA

Contraceptives - Drugs For Women

Contraceptive Implant - Progestin - Birth Control Pills





86



NEXPLANON SUBDERMAL IMPLANT 68 MG (etonogestrel)

2 CT

Contraceptive Injectable - Progestin - Birth Control Pills

DEPO-SUBQ PROVERA 104 SUBCUTANEOUS SYRINGE 104 MG065 ML (medroxyprogesterone acetate)


medroxyprogesterone intramuscular suspension 150 mgml


medroxyprogesterone intramuscular syringe 150 mgml 1 QL (1 per 84 days)

Contraceptive Intrauterine - Copper Iud - Birth Control Pills

PARAGARD T 380A INTRAUTERINE INTRAUTERINE DEVICE 380 SQUARE MM (copper)

2 CT QL (1 per 999 days)

Contraceptive Intrauterine - Progesterone Iud - Birth Control Pills

MIRENA INTRAUTERINE INTRAUTERINE DEVICE 20 MCG24 HOURS (6 YRS) 52 MG (levonorgestrel)


Contraceptive Oral - Biphasic - Birth Control Pills

levonorgestrelethinyl estradiol and ethinyl estradiol (Amethia Lo Oral TabletsDose Pack3 Month 010 Mg-20 Mcg (84)10 Mcg (7))

1 CT

levonorgestrelethinyl estradiol and ethinyl estradiol (Amethia Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (84)10 Mcg (7))

1 CT

levonorgestrelethinyl estradiol and ethinyl estradiol (Ashlyna Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (84)10 Mcg (7))

1 CT

desogestrel-ethinyl estradiolethinyl estradiol (Azurette (28) Oral Tablet 015-002 Mgx21 001 Mg X 5)

1 CT

desogestrel-ethinyl estradiolethinyl estradiol (Bekyree (28) Oral Tablet 015-002 Mgx21 001 Mg X 5)

1 CT

camrese lo oral tabletsdose pack3 month 010 mg-20 mcg (84)10 mcg (7)

1 CT

camrese oral tabletsdose pack3 month 015 mg-30 mcg (84)10 mcg (7)

1 CT

levonorgestrelethinyl estradiol and ethinyl estradiol (Daysee Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (84)10 Mcg (7))

1 CT





87



desog-eestradioleestradiol oral tablet 015-002 mgx21 001 mg x 5

1 CT

levonorgestrelethinyl estradiol and ethinyl estradiol (Jaimiess Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (84)10 Mcg (7))

1 CT

desogestrel-ethinyl estradiolethinyl estradiol (Kariva (28) Oral Tablet 015-002 Mgx21 001 Mg X 5)

1 CT

desogestrel-ethinyl estradiolethinyl estradiol (Kimidess (28) Oral Tablet 015-002 Mgx21 001 Mg X 5)

1 CT

l norgesteestradiol-eestrad oral tabletsdose pack3 month 010 mg-20 mcg (84)10 mcg (7) 015 mg-30 mcg (84)10 mcg (7)

1 CT

LO LOESTRIN FE ORAL TABLET 1 MG-10 MCG (24)10 MCG (2) (norethindrone acetate-ethinyl estradiolferrous fumarate)

2 CT

levonorgestrelethinyl estradiol and ethinyl estradiol (Lojaimiess Oral TabletsDose Pack3 Month 010 Mg-20 Mcg (84)10 Mcg (7))

1 CT

necon 1011 (28) oral tablet 05-351-35 mg-mcgmg-mcg 1 CT

desogestrel-ethinyl estradiolethinyl estradiol (Pimtrea (28) Oral Tablet 015-002 Mgx21 001 Mg X 5)

1 CT

desogestrel-ethinyl estradiolethinyl estradiol (Simliya (28) Oral Tablet 015-002 Mgx21 001 Mg X 5)

1 CT

levonorgestrelethinyl estradiol and ethinyl estradiol (Simpesse Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (84)10 Mcg (7))

1 CT

desogestrel-ethinyl estradiolethinyl estradiol (Viorele (28) Oral Tablet 015-002 Mgx21 001 Mg X 5)

1 CT

desogestrel-ethinyl estradiolethinyl estradiol (Volnea (28) Oral Tablet 015-002 Mgx21 001 Mg X 5)

1 CT

Contraceptive Oral - Monophasic - Birth Control Pills

levonorgestrelethinyl estradiol (Afirmelle Oral Tablet 01-20 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Altavera (28) Oral Tablet 015-003 Mg)

1 CT

norethindrone-ethinyl estradiol (Alyacen 135 (28) Oral Tablet 1-35 Mg-Mcg)

1 CT





88



levonorgestrelethinyl estradiol (Amethyst (28) Oral Tablet 90-20 Mcg (28))

1 CT

desogestrel-ethinyl estradiol (Apri Oral Tablet 015-003 Mg)

1 CT

levonorgestrelethinyl estradiol (Aubra Oral Tablet 01-20 Mg-Mcg)

1 CT

norethindrone acetate-ethinyl estradiol (Aurovela 1530 (21) Oral Tablet 15-30 Mg-Mcg)

1 CT


1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Aurovela 24 Fe Oral Tablet 1 Mg-20 Mcg (24)75 Mg (4))

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Aurovela Fe 1530 (28) Oral Tablet 15 Mg-30 Mcg (21)75 Mg (7))

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Aurovela Fe 1-20 (28) Oral Tablet 1 Mg-20 Mcg (21)75 Mg (7))

1 CT

levonorgestrelethinyl estradiol (Aviane Oral Tablet 01-20 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Ayuna Oral Tablet 015-003 Mg)

1 CT

norethindrone-ethinyl estradiol (Balziva (28) Oral Tablet 04-35 Mg-Mcg)

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Blisovi 24 Fe Oral Tablet 1 Mg-20 Mcg (24)75 Mg (4))

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Blisovi Fe 1530 (28) Oral Tablet 15 Mg-30 Mcg (21)75 Mg (7))

1 CT


1 CT

norethindrone-ethinyl estradiol (Briellyn Oral Tablet 04-35 Mg-Mcg)

1 CT





89



norethindrone acetate-ethinyl estradiolferrous fumarate (Charlotte 24 Fe Oral TabletChewable 1 Mg-20 Mcg(24) 75 Mg (4))

1

levonorgestrelethinyl estradiol (Chateal (28) Oral Tablet 015-003 Mg)

1 CT

norgestrel-ethinyl estradiol (Cryselle (28) Oral Tablet 03-30 Mg-Mcg)

1 CT

norethindrone-ethinyl estradiol (Cyclafem 135 (28) Oral Tablet 1-35 Mg-Mcg)

1 CT

desogestrel-ethinyl estradiol (Cyred Oral Tablet 015-003 Mg)

1 CT

norethindrone-ethinyl estradiol (Dasetta 135 (28) Oral Tablet 1-35 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Delyla (28) Oral Tablet 01-20 Mg-Mcg)

1 CT

desogestrel-ethinyl estradiol oral tablet 015-003 mg 1 CT

drospirenone-ethinyl estradiol oral tablet 3-002 mg 3-003 mg

1 CT

norgestrel-ethinyl estradiol (Elinest Oral Tablet 03-30 Mg-Mcg)

1 CT

desogestrel-ethinyl estradiol (Emoquette Oral Tablet 015-003 Mg)

1 CT

desogestrel-ethinyl estradiol (Enskyce Oral Tablet 015-003 Mg)

1 CT

norgestimate-ethinyl estradiol (Estarylla Oral Tablet 025-35 Mg-Mcg)

1 CT

ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg 1-50 mg-mcg

1 CT

levonorgestrelethinyl estradiol (Falmina (28) Oral Tablet 01-20 Mg-Mcg)

1 CT

norgestimate-ethinyl estradiol (Femynor Oral Tablet 025-35 Mg-Mcg)

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Gemmily Oral Capsule 1 Mg-20 Mcg (24)75 Mg (4))

1

gianvi (28) oral tablet 3-002 mg 1 CT





90



norethindrone-ethinyl estradiol (Gildagia Oral Tablet 04-35 Mg-Mcg)

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Hailey 24 Fe Oral Tablet 1 Mg-20 Mcg (24)75 Mg (4))

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Hailey Fe 1530 (28) Oral Tablet 15 Mg-30 Mcg (21)75 Mg (7))

1


1

norethindrone acetate-ethinyl estradiol (Hailey Oral Tablet 15-30 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Iclevia Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (91))

1

levonorgestrelethinyl estradiol (Introvale Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (91))

1 CT

desogestrel-ethinyl estradiol (Isibloom Oral Tablet 015-003 Mg)

1 CT

ethinyl estradioldrospirenone (Jasmiel (28) Oral Tablet 3-002 Mg)

1 CT

jolessa oral tabletsdose pack3 month 015 mg-30 mcg (91)

1 CT

desogestrel-ethinyl estradiol (Juleber Oral Tablet 015-003 Mg)

1 CT

norethindrone acetate-ethinyl estradiol (Junel 1530 (21) Oral Tablet 15-30 Mg-Mcg)

1 CT


1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Junel Fe 1530 (28) Oral Tablet 15 Mg-30 Mcg (21)75 Mg (7))

1 CT


1 CT





91



norethindrone acetate-ethinyl estradiolferrous fumarate (Junel Fe 24 Oral Tablet 1 Mg-20 Mcg (24)75 Mg (4))

1 CT

desogestrel-ethinyl estradiol (Kalliga Oral Tablet 015-003 Mg)

1 CT

ethynodiol diacetate-ethinyl estradiol (Kelnor 135 (28) Oral Tablet 1-35 Mg-Mcg)

1 CT

ethynodiol diacetate-ethinyl estradiol (Kelnor 1-50 (28) Oral Tablet 1-50 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Kurvelo (28) Oral Tablet 015-003 Mg)

1 CT

norethindrone acetate-ethinyl estradiol (Larin 1530 (21) Oral Tablet 15-30 Mg-Mcg)

1 CT


1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Larin 24 Fe Oral Tablet 1 Mg-20 Mcg (24)75 Mg (4))

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Larin Fe 1530 (28) Oral Tablet 15 Mg-30 Mcg (21)75 Mg (7))

1 CT


1 CT

levonorgestrelethinyl estradiol (Larissia Oral Tablet 01-20 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Lessina Oral Tablet 01-20 Mg-Mcg)

1 CT

levonorgestrel-ethinyl estrad oral tablet 01-20 mg-mcg 015-003 mg 90-20 mcg (28)

1 CT

levonorgestrel-ethinyl estrad oral tabletsdose pack3 month 015 mg-30 mcg (91)

1 CT

levonorgestrelethinyl estradiol (Levora-28 Oral Tablet 015-003 Mg)

1 CT

levonorgestrelethinyl estradiol (Lillow (28) Oral Tablet 015-003 Mg)

1 CT





92



norethindrone acetate-ethinyl estradiolferrous fumarate (Lomedia 24 Fe Oral Tablet 1 Mg-20 Mcg (24)75 Mg (4))

1 CT

ethinyl estradioldrospirenone (Loryna (28) Oral Tablet 3-002 Mg)

1 CT

norgestrel-ethinyl estradiol (Low-Ogestrel (28) Oral Tablet 03-30 Mg-Mcg)

1 CT

ethinyl estradioldrospirenone (Lo-Zumandimine (28) Oral Tablet 3-002 Mg)

1 CT

levonorgestrelethinyl estradiol (Lutera (28) Oral Tablet 01-20 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Marlissa (28) Oral Tablet 015-003 Mg)

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Melodetta 24 Fe Oral TabletChewable 1 Mg-20 Mcg(24) 75 Mg (4))

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Mibelas 24 Fe Oral TabletChewable 1 Mg-20 Mcg(24) 75 Mg (4))

1 CT

norethindrone acetate-ethinyl estradiol (Microgestin 1530 (21) Oral Tablet 15-30 Mg-Mcg)

1 CT


1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Microgestin Fe 1530 (28) Oral Tablet 15 Mg-30 Mcg (21)75 Mg (7))

1 CT


1 CT

norgestimate-ethinyl estradiol (Mili Oral Tablet 025-35 Mg-Mcg)

1 CT

norgestimate-ethinyl estradiol (Mono-Linyah Oral Tablet 025-35 Mg-Mcg)

1 CT

mononessa (28) oral tablet 025-35 mg-mcg 1 CT

norethindrone-ethinyl estradiol (Necon 0535 (28) Oral Tablet 05-35 Mg-Mcg)

1 CT

necon 150 (28) oral tablet 1-50 mg-mcg 1 CT





93



ethinyl estradioldrospirenone (Nikki (28) Oral Tablet 3-002 Mg)

1 CT

norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg 15-30 mg-mcg

1 CT

norethindrone-eestradiol-iron oral capsule 1 mg-20 mcg (24)75 mg (4)

1 CT

norethindrone-eestradiol-iron oral tablet 1 mg-20 mcg (21)75 mg (7) 1 mg-20 mcg (24)75 mg (4) 15 mg-30 mcg (21)75 mg (7)

1 CT

norethindrone-eestradiol-iron oral tabletchewable 1 mg-20 mcg(24) 75 mg (4)

1 CT

norgestimate-ethinyl estradiol oral tablet 025-35 mg-mcg

1 CT

norethindrone-ethinyl estradiol (Nortrel 0535 (28) Oral Tablet 05-35 Mg-Mcg)

1 CT

nortrel 135 (21) oral tablet 1-35 mg-mcg (21) 1 CT


1 CT

norgestimate-ethinyl estradiol (Nymyo Oral Tablet 025-35 Mg-Mcg)

1

ocella oral tablet 3-003 mg 1 CT

ogestrel (28) oral tablet 05-50 mg-mcg 1 CT

levonorgestrelethinyl estradiol (Orsythia Oral Tablet 01-20 Mg-Mcg)

1 CT

norethindrone-ethinyl estradiol (Philith Oral Tablet 04-35 Mg-Mcg)

1 CT

norethindrone-ethinyl estradiol (Pirmella Oral Tablet 1-35 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Portia 28 Oral Tablet 015-003 Mg)

1 CT

norgestimate-ethinyl estradiol (Previfem Oral Tablet 025-35 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Quasense Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (91))

1 CT

desogestrel-ethinyl estradiol (Reclipsen (28) Oral Tablet 015-003 Mg)

1 CT





94



levonorgestrelethinyl estradiol (Setlakin Oral TabletsDose Pack3 Month 015 Mg-30 Mcg (91))

1 CT

norgestimate-ethinyl estradiol (Sprintec (28) Oral Tablet 025-35 Mg-Mcg)

1 CT

levonorgestrelethinyl estradiol (Sronyx Oral Tablet 01-20 Mg-Mcg)

1 CT

ethinyl estradioldrospirenone (Syeda Oral Tablet 3-003 Mg)

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Tarina 24 Fe Oral Tablet 1 Mg-20 Mcg (24)75 Mg (4))

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Tarina Fe 120 (28) Oral Tablet 1 Mg-20 Mcg (21)75 Mg (7))

1 CT

tyblume oral tabletchewable 01 mg- 20 mcg 1 CT

ethinyl estradioldrospirenone (Vestura (28) Oral Tablet 3-002 Mg)

1 CT

levonorgestrelethinyl estradiol (Vienva Oral Tablet 01-20 Mg-Mcg)

1 CT

norethindrone-ethinyl estradiol (Vyfemla (28) Oral Tablet 04-35 Mg-Mcg)

1 CT

norgestimate-ethinyl estradiol (Vylibra Oral Tablet 025-35 Mg-Mcg)

1 CT

norethindrone-ethinyl estradiol (Wera (28) Oral Tablet 05-35 Mg-Mcg)

1 CT

norethindrone-ethinyl estradiolferrous fumarate (Wymzya Fe Oral TabletChewable 04Mg-35Mcg(21) And 75 Mg (7))

1 CT

ethinyl estradioldrospirenone (Zarah Oral Tablet 3-003 Mg)

1 CT

norethindrone-ethinyl estradiol (Zenchent (28) Oral Tablet 04-35 Mg-Mcg)

1 CT

norethindrone-ethinyl estradiolferrous fumarate (Zenchent Fe Oral TabletChewable 04Mg-35Mcg(21) And 75 Mg (7))

1 CT

ethynodiol diacetate-ethinyl estradiol (Zovia 135E (28) Oral Tablet 1-35 Mg-Mcg)

1 CT





95




1 CT

ethinyl estradioldrospirenone (Zumandimine (28) Oral Tablet 3-003 Mg)

1 CT

Contraceptive Oral - Progestin - Birth Control Pills

norethindrone (Camila Oral Tablet 035 Mg) 1 CT

norethindrone (Deblitane Oral Tablet 035 Mg) 1 CT

norethindrone (Errin Oral Tablet 035 Mg) 1 CT

norethindrone (Heather Oral Tablet 035 Mg) 1 CT

norethindrone (Incassia Oral Tablet 035 Mg) 1 CT

norethindrone (Jencycla Oral Tablet 035 Mg) 1 CT

jolivette oral tablet 035 mg 1 CT

norethindrone (Lyleq Oral Tablet 035 Mg) 1

norethindrone (Lyza Oral Tablet 035 Mg) 1 CT

nora-be oral tablet 035 mg 1 CT

norethindrone (contraceptive) oral tablet 035 mg 1 CT

norethindrone (Norlyda Oral Tablet 035 Mg) 1 CT

norethindrone (Norlyroc Oral Tablet 035 Mg) 1 CT

norethindrone (Sharobel Oral Tablet 035 Mg) 1 CT

norethindrone (Tulana Oral Tablet 035 Mg) 1 CT

Contraceptive Oral - Quadraphasic - Birth Control Pills

levonorgestrelethinyl estradiol and ethinyl estradiol (Fayosim Oral TabletsDose Pack3 Month 015 Mg-20 Mcg 015 Mg-25 Mcg)

1 CT

rivelsa oral tabletsdose pack3 month 015 mg-20 mcg 015 mg-25 mcg

1 CT

Contraceptive Oral - Triphasic - Birth Control Pills

norethindrone-ethinyl estradiol (Alyacen 777 (28) Oral Tablet 050751 Mg- 35 Mcg)

1 CT

norethindrone-ethinyl estradiol (Aranelle (28) Oral Tablet 05105-35 Mg-Mcg)

1 CT

desogestrel-ethinyl estradiol (Caziant (28) Oral Tablet 0112515-25 Mg-Mcg)

1 CT





96



norethindrone-ethinyl estradiol (Cyclafem 777 (28) Oral Tablet 050751 Mg- 35 Mcg)

1 CT

norethindrone-ethinyl estradiol (Dasetta 777 (28) Oral Tablet 050751 Mg- 35 Mcg)

1 CT

levonorgestrelethinyl estradiol (Enpresse Oral Tablet 50-30 (6)75-40 (5)125-30(10))

1 CT

leena 28 oral tablet 05105-35 mg-mcg 1 CT

levonorgestrelethinyl estradiol (Levonest (28) Oral Tablet 50-30 (6)75-40 (5)125-30(10))

1 CT

levonorg-eth estrad triphasic oral tablet 50-30 (6)75-40 (5)125-30(10)

1 CT

levonorgestrelethinyl estradiol (Myzilra Oral Tablet 50-30 (6)75-40 (5)125-30(10))

1 CT

necon 777 (28) oral tablet 050751 mg- 35 mcg 1 CT

norgestimate-ethinyl estradiol oral tablet 0180215025 mg-25 mcg 0180215025 mg-35 mcg (28)

1 CT

norethindrone-ethinyl estradiol (Nortrel 777 (28) Oral Tablet 050751 Mg- 35 Mcg)

1 CT

norethindrone-ethinyl estradiol (Nylia 777 (28) Oral Tablet 050751 Mg- 35 Mcg)

1

norethindrone-ethinyl estradiol (Pirmella Oral Tablet 050751 Mg- 35 Mcg)

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Tilia Fe Oral Tablet 1-20(5)1-30(7) 1Mg-35Mcg (9))

1 CT

norgestimate-ethinyl estradiol (Tri Femynor Oral Tablet 0180215025 Mg-35 Mcg (28))

1 CT

norgestimate-ethinyl estradiol (Tri-Estarylla Oral Tablet 0180215025 Mg-35 Mcg (28))

1 CT

norethindrone acetate-ethinyl estradiolferrous fumarate (Tri-Legest Fe Oral Tablet 1-20(5)1-30(7) 1Mg-35Mcg (9))

1 CT

norgestimate-ethinyl estradiol (Tri-Linyah Oral Tablet 0180215025 Mg-35 Mcg (28))

1 CT

norgestimate-ethinyl estradiol (Tri-Lo-Estarylla Oral Tablet 0180215025 Mg-25 Mcg)

1 CT





97



norgestimate-ethinyl estradiol (Tri-Lo-Marzia Oral Tablet 0180215025 Mg-25 Mcg)

1 CT

norgestimate-ethinyl estradiol (Tri-Lo-Mili Oral Tablet 0180215025 Mg-25 Mcg)

1 CT

norgestimate-ethinyl estradiol (Tri-Lo-Sprintec Oral Tablet 0180215025 Mg-25 Mcg)

1 CT

norgestimate-ethinyl estradiol (Tri-Mili Oral Tablet 0180215025 Mg-35 Mcg (28))

1 CT

trinessa (28) oral tablet 0180215025 mg-35 mcg (28) 1 CT

trinessa lo oral tablet 0180215025 mg-25 mcg 1 CT

norgestimate-ethinyl estradiol (Tri-Nymyo Oral Tablet 0180215025 Mg-35 Mcg (28))

1

norgestimate-ethinyl estradiol (Tri-Previfem (28) Oral Tablet 0180215025 Mg-35 Mcg (28))

1 CT

norgestimate-ethinyl estradiol (Tri-Sprintec (28) Oral Tablet 0180215025 Mg-35 Mcg (28))

1 CT

levonorgestrelethinyl estradiol (Trivora (28) Oral Tablet 50-30 (6)75-40 (5)125-30(10))

1 CT

norgestimate-ethinyl estradiol (Tri-Vylibra Lo Oral Tablet 0180215025 Mg-25 Mcg)

1 CT

norgestimate-ethinyl estradiol (Tri-Vylibra Oral Tablet 0180215025 Mg-35 Mcg (28))

1 CT

desogestrel-ethinyl estradiol (Velivet Triphasic Regimen (28) Oral Tablet 0112515-25 Mg-Mcg)

1 CT

Contraceptive Transdermal Combinations - Birth Control Pills

xulane transdermal patch weekly 150-35 mcg24 hr 1 CT

Contraceptive Transdermal Combinations - Estrogen And Progestin Comb - Birth Control Pills


norelgestrominethinyl estradiol (Zafemy Transdermal Patch Weekly 150-35 Mcg24 Hr)

1

Contraceptives - Intravaginal Systemic - Birth Control Pills

etonogestrel-ethinyl estradiol vaginal ring 012-0015 mg24 hr

1 CT





98



Contraceptives - Intravaginal Systemic - Estrogen And Progestin Comb - Birth Control Pills

etonogestrelethinyl estradiol (Eluryng Vaginal Ring 012-0015 Mg24 Hr)

1 CT


1 CT

Emergency Contraceptives - Birth Control Pills

aftera oral tablet 15 mg 1 CT

econtra ez oral tablet 15 mg 1 CT

ELLA ORAL TABLET 30 MG (ulipristal acetate) 2 CT

fallback solo oral tablet 15 mg 1 CT

levonorgestrel oral tablet 15 mg 1 CT

my choice oral tablet 15 mg 1 CT

my way oral tablet 15 mg 1 CT

new day oral tablet 15 mg 1 CT

next choice one dose oral tablet 15 mg 1 CT

opcicon one-step oral tablet 15 mg 1 CT

option-2 oral tablet 15 mg 1 CT

take action oral tablet 15 mg 2 CT

Emergency Contraceptives - Progesterone AgonistAntagonist Type - Birth Control Pills


Emergency Contraceptives - Progestin Type - Birth Control Pills














99





Spermicides - Birth Control Pills

CONCEPTROL VAGINAL GEL 4 (nonoxynol 9) 2 CT

GYNOL II VAGINAL GEL 3 (nonoxynol 9) 2 CT

TODAY CONTRACEPTIVE SPONGE VAGINAL CONTRACEPTIVE SPONGE 1000 MG (nonoxynol 9)

2 CT

VAGINAL CONTRACEPTIVE FILM VAGINAL FILM 28 (nonoxynol 9)

2 CT

vaginal contraceptive foam vaginal foam 125 1 CT

vcf contraceptive gel vaginal gel 4 1 CT

Dermatological - Drugs For The Skin

Acne Therapy Topical - Anti-Infective - Drugs For The Skin

clindamycin phosphate topical gel 1 1

clindamycin phosphate topical lotion 1 1

clindamycin phosphate topical solution 1 1 QL (500 per 1 day)

clindamycin phosphate topical swab 1 1

erythromycin with ethanol topical gel 2 1

erythromycin with ethanol topical solution 2 1 QL (500 per 1 day)

metronidazole topical cream 075 1

sulfacetamide sodium (acne) topical suspension 10 1 QL (500 per 1 day)

Acne Therapy Topical - Keratolytic - Drugs For The Skin

acne control cleanser topical cleanser 10 1 OTC Medical

acne foaming wash topical cleanser 10 1 OTC Medical

acne medication topical gel 10 1 OTC Medical


acne medication topical lotion 10 1 OTC Medical

ACNE MEDICATION TOPICAL LOTION 5 (benzoyl peroxide)

1 OTC Medical

acne treatment (benzoyl perox) topical cream 10 1 OTC Medical

acne vanishing topical cream 10 1 OTC Medical

acne-clear topical gel 10 1 OTC Medical





100



advanced exfoliating cleanser topical cleanser 5 1 OTC Medical

benzoyl peroxide topical cleanser 3 6 7 1

benzoyl peroxide topical cleanser 5 9 1 OTC Medical

benzoyl peroxide topical gel 10 25 1 OTC Medical

benzoyl peroxide topical lotion 10 1 OTC Medical

bp wash acne treatment topical kit 8-5 1 OTC Medical

BP WASH TOPICAL CLEANSER 10 (benzoyl peroxide) 1 OTC Medical

BP WASH TOPICAL CLEANSER 25 (benzoyl peroxide)

1

bp wash topical cleanser 7 2 OTC Medical

bpo topical gel 8 1

clean-clear continuous control topical cleanser 10 1 OTC Medical

clearasil daily clear(benzoyl) topical cream 10 1 OTC Medical

clearasil ultra topical cream 10 1 OTC Medical

creamy acne face topical cleanser 4 1 OTC Medical

daylogic acne treatment topical gel 10 1 OTC Medical

foaming acne face wash topical cleanser 10 1 OTC Medical

NEUTROGENA ON THE SPOT TOPICAL CREAM 25 (benzoyl peroxide)

1

panoxyl topical cleanser 10 4 1 OTC Medical

panoxyl-4 topical cleanser 4 1 OTC Medical

persa-gel topical gel 10 1 OTC Medical

potassium hydroxide topical solution 5 1 QL (500 per 1 day)

targeted acne spot treatment topical cream 25 1 OTC Medical

Acne Therapy Topical - Retinoids And Derivatives - Drugs For The Skin

adapalene topical gel 01 1

avita topical cream 0025 1

tretinoin topical cream 0025 005 01 1

tretinoin topical gel 001 0025 005 1

Antipsoriatic Agents-Interleukin-17 (Il-17) Antagonist Mc Antibody - Drugs For The Skin





101



TALTZ AUTOINJECTOR SUBCUTANEOUS AUTO-INJECTOR 80 MGML (ixekizumab)

2 PA SP

TALTZ SYRINGE SUBCUTANEOUS SYRINGE 80 MGML (ixekizumab)

2 PA SP

Dermatological - Antibacterial Aminoglycosides - Drugs For The Skin

gentamicin topical cream 01 1

gentamicin topical ointment 01 1

Dermatological - Antibacterial Mixtures - Drugs For The Skin

double antibiotic (btracn zn) topical ointment 500-10000 unitgram

1 OTC Medical

double antibiotic topical ointment 500-10000 unitgram 1 OTC Medical

first aid antibiotic topical ointment 35-500-10000 mg-unit-unit

1 OTC Medical

neosporin (neo-bac-polym) topical ointment 35mg-400 unit- 5000 unitgram

1 OTC Medical

polysporin (bacitracin zinc) topical ointment 500-10000 unitgram

1 OTC Medical

POLYSPORIN TOPICAL PACKET 500-10000 UNITGRAM (bacitracinpolymyxin b sulfate)

2 OTC Medical

triple antibiotic topical ointment 35mg-400 unit- 5000 unitgram

1 OTC Medical

wal-sporin topical ointment 500-10000 unitgram 1 OTC Medical

Dermatological - Antibacterial Other - Drugs For The Skin

mupirocin topical ointment 2 1

Dermatological - Antibacterial Polymyxins And Derivatives - Drugs For The Skin

bacitracin topical ointment 500 unitgram 1 OTC Medical

bacitracin zinc topical ointment 500 unitgram 1 OTC Medical

bacitraycin plus topical ointment 500 unitgram 1 OTC Medical

Dermatological - Antibacterial-Local Anesthetic Combinations - Drugs For The Skin

antibiotic plus (pramoxine) topical cream 35-10000-10 mg-unit-mggram

1 OTC Medical

multi antibiotic plus topical cream 35-10000-10 mg-unit-mggram

1 OTC Medical





102



neosporin plus pain relief topical cream 35-10000-10 mg-unit-mggram

1 OTC Medical

tri-biozene topical ointment 35-500-10000 mg-unit-unitg

1 OTC Medical

Dermatological - Antifungal Allylamines - Drugs For The Skin

antifungal (terbinafine) topical cream 1 1 OTC Medical

LAMISIL AT TOPICAL CREAM 1 (terbinafine hcl) 2 OTC Medical

terbinafine hcl topical cream 1 1 OTC Medical

Dermatological - Antifungal Amphoteric Polyene Macrolides - Drugs For The Skin

nystatin (Nyamyc Topical Powder 100000 UnitGram) 1

nystatin topical cream 100000 unitgram 1

nystatin topical ointment 100000 unitgram 1

nystatin topical powder 100000 unitgram 1

nystatin (Nystop Topical Powder 100000 UnitGram) 1

Dermatological - Antifungal Hydroxypyridinone - Drugs For The Skin

ciclopirox topical cream 077 1

ciclopirox topical gel 077 1

ciclopirox topical shampoo 1 1 QL (500 per 1 day)

ciclopirox topical solution 8 1 QL (500 per 1 day)

ciclopirox topical suspension 077 1 QL (500 per 1 day)

Dermatological - Antifungal Imidazole And Related Agents - Drugs For The Skin

aloe vesta antifungal (micon) topical ointment 2 1 OTC Medical

antifungal (clotrimazole) topical cream 1 1 OTC Medical

antifungal cream (miconazole) topical cream 2 1 OTC Medical

antifungal ringworm topical cream 1 1 OTC Medical

anti-fungal topical powder 2 1 OTC Medical

athletes foot (clotrimazole) topical cream 1 1 OTC Medical

athletes foot topical aerosol powder 2 1 OTC Medical

athletic foot cream topical cream 1 1 OTC Medical

azolen tincture topical tincture 2 1 OTC Medical

baza antifungal topical cream 2 1 OTC Medical





103



clotrimazole af topical cream 1 1 OTC Medical

clotrimazole topical cream 1 1 OTC Medical

clotrimazole topical solution 1 1 QL (500 per 1 day)

critic-aid clear af(miconazol) topical ointment 2 1 OTC Medical

dermafungal topical cream 2 1 OTC Medical

desenex topical powder 2 1 OTC Medical

econazole topical cream 1 1

fungi cure topical spraynon-aerosol 1 1 OTC Medical

FUNGOID TINCTURE TOPICAL TINCTURE 2 (miconazole nitrate)

2 OTC Medical

inzo antifungal topical cream 2 1 OTC Medical

jock itch (clotrimazole) topical cream 1 1 OTC Medical

ketoconazole topical cream 2 1

ketoconazole topical shampoo 2 1 QL (500 per 1 day)

lotrimin af topical aerosolspray 2 1 OTC Medical

micatin topical cream 2 1 OTC Medical

miconazole nitrate topical aerosol powder 2 1 OTC Medical

micro-guard topical powder 2 1 OTC Medical

NIZORAL A-D TOPICAL SHAMPOO 1 (ketoconazole) 2 OTC Medical QL (500 per 1 day)

remedy phytoplex antifungal topical ointment 2 1 OTC Medical

triple paste af topical ointment 2 1 OTC Medical

zeasorb af topical powder 2 1 OTC Medical

Dermatological - Antifungal Thiocarbamate - Drugs For The Skin

blis-to-sol (tolnaftate) topical solution 1 1 OTC Medical

formula 3 topical solution 1 1 OTC Medical QL (500 per 1 day)

fungoid-d topical cream 1 1 OTC Medical

medi-first anti-fungal topical packet 1 1 OTC Medical

TINACTIN TOPICAL CREAM 1 (tolnaftate) 2 OTC Medical

tolcylen topical solution 1 1 OTC Medical

tolnaftate topical cream 1 1 OTC Medical





104



Dermatological - Antifungal-Glucocorticoid Combinations - Drugs For The Skin

clotrimazole-betamethasone topical cream 1-005 1

nystatin-triamcinolone topical cream 100000-01 unitg-

1

nystatin-triamcinolone topical ointment 100000-01 unitgram-

1

Dermatological - Antineoplastic Antimetabolites - Drugs For The Skin

fluorouracil topical cream 5 1

Dermatological - Antiperspirants - Drugs For The Skin

bromi-lotion topical lotion 20 1

certain dri topical liquid 1

DRYSOL DAB-O-MATIC TOPICAL SOLUTION 20 (aluminum chloride)

2

hypercare topical liquid 15 (wv) 1

roll-on deodorant topical liquid 1

XERAC AC TOPICAL SOLUTION 625 (aluminum chloride)


Dermatological - Antipsoriatic Agents Topical - Drugs For The Skin

calcipotriene scalp solution 0005 1 PA

calcipotriene topical cream 0005 1 QL (60 per 30 days)

calcipotriene topical ointment 0005 1 PA

Dermatological - Antiseborrheic - Drugs For The Skin

anti-dandruff topical shampoo 1 1 OTC Medical QL (500 per 1 day)

dandruff shampoo (pyrithione) scalp shampoo 1 1 OTC Medical QL (500 per 1 day)

selenium sulfide topical lotion 25 1 QL (500 per 1 day)

selenium sulfide topical shampoo 225 1 QL (500 per 1 day)

selsun blue topical shampoo 1 1 OTC Medical QL (500 per 1 day)

sulfacetamide sodium topical cleanser 10 1

Dermatological - Antiseborrheic Combinations - Drugs For The Skin





105



anti-dandruff with menthol topical shampoo 1 1 OTC Medical QL (500 per 1 day)

Dermatological - Antiviral Herpes - Drugs For The Skin

ABREVA TOPICAL CREAM 10 (docosanol) 2 OTC Medical

docosanol topical cream 10 1 OTC Medical

Dermatological - Astringent Combinations - Drugs For The Skin

boro-packs topical powder in packet 51-49 1 OTC Medical

DOMEBORO TOPICAL POWDER IN PACKET 952-1347 MG (calcium acetatealuminum sulfate)

2 OTC Medical

pedi-boro soak topical powder in packet 839-1191 mg 1 OTC Medical

Dermatological - Burn Products Anti-Infective - Drugs For The Skin

silver sulfadiazine topical cream 1 1

ssd topical cream 1 1

Dermatological - Emollient Mixtures - Drugs For The Skin

a and d (lan pet) topical ointment 1 OTC Medical

vitamin a and d topical ointment 1 OTC Medical

vits a and d-white pet-lanolin topical ointment 1 OTC Medical

vits a and d-white pet-lanolin topical ointment in packet 1 OTC Medical

Dermatological - Emollients - Drugs For The Skin

glycerin and rose water topical liquid 10 1 QL (500 per 1 day)

glycerin topical liquid 10 1 QL (500 per 1 day)

glycerin topical solution 995 2 QL (500 per 1 day)

Dermatological - Enzymes - Drugs For The Skin

SANTYL TOPICAL OINTMENT 250 UNITGRAM (collagenase clostridium histolyticum)

2 PA

Dermatological - Glucocorticoid - Drugs For The Skin

hydrocortisone (Ala-Cort Topical Cream 1 25 ) 1

alclometasone topical ointment 005 1

anti-itch (hc) topical cream 1 1 OTC Medical

anti-itch (hc) topical ointment 1 1 OTC Medical

aquanil hc topical lotion 1 1 OTC Medical

aquaphor itch relief topical ointment 1 1





106



beta-hc topical lotion 1 1 OTC Medical

betamethasone dipropionate topical cream 005 1

betamethasone dipropionate topical lotion 005 1

betamethasone dipropionate topical ointment 005 1

betamethasone valerate topical cream 01 1

betamethasone valerate topical lotion 01 1

betamethasone valerate topical ointment 01 1

betamethasone augmented topical cream 005 1

betamethasone augmented topical lotion 005 1

betamethasone augmented topical ointment 005 1

clobetasol scalp solution 005 1 QL (500 per 1 day)

clobetasol topical cream 005 1

clobetasol topical ointment 005 1

clobetasol topical shampoo 005 1 QL (500 per 1 day)

clobetasol-emollient topical cream 005 1

clobetasol propionate (Cormax Scalp Solution 005 ) 1 QL (500 per 1 day)

cortaid topical cream 1 1 OTC Medical

cortisone (hydrocortisone) topical cream 1 1 OTC Medical

cortizone-10 topical cream 1 1 OTC Medical

cortizone-10 topical ointment 1 1 OTC Medical

DERMA-SMOOTHEFS BODY OIL TOPICAL OIL 001 (fluocinolone acetonide)

2

desonide topical cream 005 1 QL (60 per 1 day)

desonide topical lotion 005 1 QL (60 per 1 day)

desonide topical ointment 005 1 QL (60 per 1 day)

desoximetasone topical cream 005 1 QL (60 per 1 day)

desoximetasone topical cream 025 1

desoximetasone topical ointment 005 1 QL (60 per 1 day)

desoximetasone topical ointment 025 1

fluocinolone topical cream 001 1

fluocinolone topical oil 001 1

fluocinolone topical ointment 0025 1





107



fluocinolone topical solution 001 1

fluocinonide topical cream 005 1

fluocinonide topical cream 01 1 QL (60 per 1 day)

fluocinonide topical ointment 005 1

fluocinonide topical solution 005 1 QL (500 per 1 day)

fluocinonideemollient base (Fluocinonide-E Topical Cream 005 )

1

fluticasone propionate topical cream 005 1

fluticasone propionate topical ointment 0005 1

halobetasol propionate topical cream 005 1

halobetasol propionate topical ointment 005 1 QL (60 per 1 day)

hydrocortisone acetate topical cream 05 1 1 OTC Medical

hydrocortisone acetate topical ointment 1 1 OTC Medical

hydrocortisone plus topical cream 1 1 OTC Medical

hydrocortisone topical cream 05 1 OTC Medical

hydrocortisone topical cream 1 25 1

hydrocortisone topical lotion 1 1 OTC Medical

hydrocortisone topical lotion 25 1

hydrocortisone topical ointment 05 1 OTC Medical

hydrocortisone topical ointment 1 25 1

hydrocortisone-pramoxine topical cream 25-1 1 QL (30 per 30 days)

hydrocream topical cream 1 1 OTC Medical

hydroskin topical lotion 1 1 OTC Medical

mometasone topical cream 01 1

mometasone topical ointment 01 1

mometasone topical solution 01 1

obagi nu-derm tolereen topical lotion 05 1 OTC Medical

prednicarbate topical ointment 01 1

preparation h hydrocortisone topical cream 1 1 OTC Medical


1


1





108



recort plus topical cream 1 1 OTC Medical

scalp relief topical solution 1 1 OTC Medical QL (500 per 1 day)

scalpicin anti-itch topical solution 1 1 OTC Medical QL (500 per 1 day)

soothing care (hydrocortisone) topical cream 1 1 OTC Medical

triamcinolone acetonide topical cream 0025 01 05

1

triamcinolone acetonide topical lotion 0025 01 1

triamcinolone acetonide topical ointment 0025 005 01 05

1

triamcinolone acetonide (Triderm Topical Cream 01 05 )

1

vanicream hc topical cream 1 1 OTC Medical

Dermatological - Glucocorticoid-Emollient Combinations - Drugs For The Skin

anti-itch (hc) with aloe-vit e topical cream 1 1 OTC Medical

anti-itch plus topical cream 1 1 OTC Medical

cortisone with aloe topical cream 1 1 OTC Medical


hydrocortisone-aloe vera topical cream 1 1 OTC Medical

hydroskin with aloe topical cream 1 1 OTC Medical

Dermatological - Glucocorticoid-Local Anesthetic Combinations - Drugs For The Skin


Dermatological - Immunomodulator - Imidazoquinolinamines - Drugs For The Skin

imiquimod topical cream in packet 5 1

Dermatological - Keratolytic-Antimitotic Single Agents - Drugs For The Skin

podofilox topical solution 05 1 QL (500 per 1 day)

psoriasis medicated topical shampoo 3 1 OTC Medical QL (500 per 1 day)

sal-plant topical gel 17 1 OTC Medical





109



scalp relief topical liquid 3 1 OTC Medical QL (500 per 1 day)

wart remover topical liquid 17 1 OTC Medical

Dermatological - Local Anesthetic Combinations - Drugs For The Skin

hot and cold pain relief topical adhesive patchmedicated 4-1

1 OTC Medical

lidocaine-prilocaine topical cream 25-25 1 QL (30 per 30 days)

Dermatological - Lubricants - Drugs For The Skin

lubricating jelly (chlorhexid) topical gel 1 OTC Medical

maxilube topical gel 1 OTC Medical

personal lubricating jelly topical gel 1 OTC Medical

surgilube topical gel 1 OTC Medical

Dermatological - Nsaid Single Agents - Drugs For The Skin

diclofenac sodium topical gel 1 1 QL (500 per 30 days)

Dermatological - Protectant Combinations - Drugs For The Skin

calamine-zinc oxide topical lotion 8-8 1 OTC Medical QL (500 per 1 day)

vitamin a and d diaper rash topical ointment 1 OTC Medical

Dermatological - Protectants - Drugs For The Skin

boudreauxs butt paste topical ointment 16 1 OTC Medical

BOUDREAUXS BUTT PASTE TOPICAL OINTMENT 40 (zinc oxide)

2 OTC Medical

DESITIN RAPID RELIEF TOPICAL CREAM 13 (zinc oxide)

2 OTC Medical

diaper rash topical ointment 40 1 OTC Medical

dr smiths diaper topical ointment 10 1 OTC Medical

periguard topical ointment 1 OTC Medical

PERISHIELD TOPICAL OINTMENT 38 (zinc oxide) 2 OTC Medical

pharmabase barrier topical ointment 938 2 OTC Medical

TRIPLE PASTE TOPICAL OINTMENT 128 (zinc oxide) 2 OTC Medical

zinc oxide topical ointment 25 1 OTC Medical






110



Dermatological - Retinoids (Vitamin A Derivatives) - Topical Cosmetic - Drugs For The Skin

tretinoin (emollient) topical cream 005 1

Dermatological - Rosacea Therapy Topical - Drugs For The Skin


metronidazole topical gel 075 1 1

Dermatological - Topical Local Anesthetic Amides - Drugs For The Skin

lido king topical adhesive patchmedicated 4 1 OTC

lidocaine hcl mucous membrane jelly 2 1

lidocaine pain relief topical adhesive patchmedicated 4

1 OTC

lidocaine topical adhesive patchmedicated 5 1 QL (90 per 30 days)


Dermatological - Topical Local Anesthetic Esters - Drugs For The Skin

advocate pain relief topical liquid 10 1 OTC Medical

Dermatological Irritants-Counter-Irritant Combinations - Drugs For The Skin

cool heat (m-salicylate-menth) topical cream 30-10 2 OTC Medical

cool n heat extra strength topical stick 30-10 2 OTC Medical

icy hot topical cream 30-10 2 OTC Medical

pain relief cream topical cream 4-30-10 2 OTC Medical

pain relieving rub (camphor) topical cream 4-30-10 2 OTC Medical

TIGER BALM (WITH CAPSICUM) TOPICAL ADHESIVE PATCHMEDICATED 16-24-80 MG (capsicum oleoresinmentholcamphor)

2 OTC Medical

TIGER BALM TOPICAL ADHESIVE PATCHMEDICATED 230-70 MG (mentholcamphor)

2 OTC Medical

TIGER BALM TOPICAL CREAM 11-10 (mentholcamphor)

2 OTC Medical

TIGER BALM TOPICAL CREAM 11-11 (mentholcamphorantiarthritic combination no1)

2 OTC Medical

TIGER BALM TOPICAL CREAM 3-15-5 (methyl salicylatementholcamphor)

2 OTC Medical

tiger balm topical ointment 11-11 2 OTC Medical





111



Dermatological Irritants-Counter-Irritant Single Agents - Drugs For The Skin

arthritis pain relief(capsaic) topical cream 0075 01

1 OTC Medical

BENGAY COLD THERAPY TOPICAL GEL 5 (menthol) 2 OTC Medical

BENGAY VANISHING SCENT TOPICAL GEL 25 (menthol)

2 OTC Medical

capsaicin topical adhesive patchmedicated 0025 1 OTC Medical

capsaicin topical cream 0025 1 OTC Medical

capsaicin topical liquid 015 1 OTC Medical

capsicum topical adhesive patchmedicated 0025 1 OTC Medical

cool and heat topical adhesive patchmedicated 5 2 OTC Medical

high potency capsaicin topical cream 01 1 OTC Medical

ICY HOT (MENTHOL) TOPICAL AEROSOLSPRAY 16 (menthol)

2 OTC Medical

ICY HOT ADVANCED RELIEF PATCH TOPICAL ADHESIVE PATCHMEDICATED 75 (menthol)

2 OTC Medical

ICY HOT NO MESS TOPICAL LIQUID 16 (menthol) 2 OTC Medical

ICY HOT PAIN RELIEVING TOPICAL GEL 25 (menthol)

2 OTC Medical

medicated heat patch topical adhesive patchmedicated 0025

1 OTC Medical

ultracin m topical gel 5 2 OTC Medical

zostrix topical cream 0033 1 OTC Medical

zostrix-hp topical cream 01 1 OTC Medical

Scabicide And Pediculicide Combinations - Drugs For The Skin

complete lice treatment topical kit 4-033-05 1 OTC Medical

lice complete kit 1-2-3 topical kit 4-033-05 1 OTC Medical

lice killing topical shampoo 033-4 1 OTC Medical

lice pyrinyl shampoo topical shampoo 033-4 1 OTC Medical

lice solution topical kit 4-033-05 1 OTC Medical

lice treatment topical liquid 1 OTC Medical QL (500 per 1 day)

rid complete lice elim kit topical kit 4-033-05 1 OTC Medical





112



rid lice killing topical shampoo 033-4 1 OTC Medical

Scabicide And Pediculicide Single Agents - Drugs For The Skin

crotamiton (Crotan Topical Lotion 10 ) 2

EURAX TOPICAL CREAM 10 (crotamiton) 2

EURAX TOPICAL LOTION 10 (crotamiton) 2

home lice-bedbug-dust mite spr aerosolspray 05 1 OTC Medical

lice bedding spray aerosolspray 05 1 OTC Medical

lice cream rinse topical liquid 1 1 OTC Medical QL (500 per 1 day)

lice treatment (permethrin) topical liquid 1 1 OTC Medical QL (500 per 1 day)

NIX CREME RINSE TOPICAL LIQUID 1 (permethrin) 1 OTC Medical QL (500 per 1 day)

permethrin topical cream 5 1

rid complete lice elim kit aerosolspray 05 1 OTC Medical

stop lice aerosolspray 05 1 OTC Medical

Wound Care - Dressings - Drugs For The Skin

SILVASORB TOPICAL GELEXTENDED RELEASE (silver)

2 OTC Medical

Eating Disorder Therapy - Drugs For Eating Disorders

Appetite Stimulants - Cannabinoids - Drugs For Eating Disorders


Appetite Stimulants - Progestin Hormone Type - Drugs For Eating Disorders

megestrol oral suspension 400 mg10 ml (40 mgml) 1 PA QL (500 per 1 day)

Electrolyte Balance-Nutritional Products - Drugs For Nutrition

B-Complex Vitamin Combinations - Drugs For Nutrition

b complex-vitamin c-folic acid oral tablet 400 mcg 1 OTC Medical

b-complex with vitamin c oral tablet 1 OTC Medical

b-complex with vitamin c oral tablet extended release 1 OTC Medical

DIALYVITE 800 WITH ZINC 15 ORAL TABLET 08-15 MG (vitamin b complex with vitamin cfolic acidzinc citrate)

2 OTC Medical





113




2 OTC Medical

dialyvite oral tablet 100-1 mg 1

full spectrum b-vitamin c oral tablet 08 mg 1 OTC Medical

mynephrocaps oral capsule 1 mg 1

nephro-vite oral tablet 08 mg 1 OTC Medical

renal caps oral capsule 1 mg 1

renal vitamin oral tablet 08 mg 1 OTC Medical

renal-vite oral tablet 08 mg 1 OTC Medical

rena-vite oral tablet 08 mg 1 OTC Medical

reno caps oral capsule 1 mg 1

super b complex-vitamin c oral tablet 1 OTC Medical

superplex-t oral tablet 1 OTC Medical

triphrocaps oral capsule 1 mg 1

virt-caps oral capsule 1 mg 1

west-vite with folic acid oral tablet 08 mg 1 OTC Medical

B-Complex Vitamins - Drugs For Nutrition

vitamin b complex oral capsule 1 OTC Medical

vitamins b complex oral capsule 1 OTC Medical

B-Complex Vitamins And Combinations - Drugs For Nutrition

dialyvite oral tablet 1-100-300-50 mg-mg-mcg-mg 1

nephplex rx oral tablet 1-60-300-125 mg-mg-mcg-mg 1

nephro-vite rx oral tablet 1-60-300 mg-mg-mcg 1

rena-vite rx oral tablet 1-60-300 mg-mg-mcg 1

vol-care rx oral tablet 1-60-300 mg-mg-mcg 1

vp-vite rx oral tablet 1-60-300 mg-mg-mcg 1

Bioflavonoid Combinations - Drugs For Nutrition

ear health formula oral tablet 200-100 mg 1 OTC Medical

Dextrose And Lactated Ringers Solutions - Drugs For Nutrition

dextrose 5 -lactated ringers intravenous parenteral solution

1 PA

Dextrose And Sodium Chloride Solutions - Drugs For Nutrition





114



d10 -045 sodium chloride intravenous parenteral solution

1 PA


1 PA

d5 and 09 sodium chloride intravenous parenteral solution

1 PA


1 PA

dextrose 10 and 02 nacl intravenous parenteral solution

1 PA

dextrose 5-02 sod chloride intravenous parenteral solution

1 PA

dextrose 5-03 sodchloride intravenous parenteral solution

1 PA

Dextrose Solutions - Drugs For Nutrition

dextrose 10 in water (d10w) intravenous parenteral solution 10

1 PA


1 PA

dextrose 25 in water (d25w) intravenous syringe 1 PA

dextrose 30 in water (d30w) intravenous parenteral solution

1 PA


1 PA


1 PA

dextrose 5 in water (d5w) intravenous piggyback 5 1 PA


1 PA



1 PA

Dextrose Solutions Concentrated - Drugs For Nutrition


1 PA





115





1 PA


1 PA


Diluents - Sodium Chloride - Drugs For Nutrition

sodium chloride 09 injection solution 1

sodium chloride injection syringe 09 1

Electrolyte Depleters - Ion Exchange Resin - Drugs For Nutrition

kionex (with sorbitol) oral suspension 15-193 gram60 ml


sodium polystyrene sulfonate (Kionex Oral Powder) 1 QL (500 per 1 day)

sodium polystyrene (sorb free) oral suspension 15 gram60 ml


sodium polystyrene sulfonate oral powder 1 QL (500 per 1 day)

sodium polystyrene sulfonatesorbitol solution (Sps (With Sorbitol) Oral Suspension 15-20 Gram60 Ml)


Irrigation Solutions - Drugs For Nutrition

LACTATED RINGERS IRRIGATION SOLUTION (ringers solutionlactated)

2 PA

ringers irrigation solution 1 PA

sodium chloride irrigation solution 09 1

Minerals And Electrolytes - Calcium Replacement - Drugs For Nutrition

calci-chew oral tabletchewable 500 mg calcium (1250 mg)

1 OTC Medical

calci-mix oral capsule 500 mg calcium (1250 mg) 1 OTC Medical

calcium 600 oral tablet 600 mg calcium (1500 mg) 1 OTC Medical

CALCIUM ACETATE ORAL TABLET 667 MG 2

calcium acetate(phosphat bind) oral tablet 667 mg 1

calcium carbonate oral suspension 500 mg5 ml (1250 mg5 ml)


calcium carbonate oral tablet 500 mg calcium (1250 mg) 600 mg calcium (1500 mg)

1 OTC Medical





116



calcium carbonate oral tabletchewable 500 mg calcium (1250 mg)

1 OTC Medical

calcium citrate oral tablet 200 mg (950 mg) 1 OTC Medical

CALCIUM CITRATE ORAL TABLET 250 MG CALCIUM (calcium citrate)

1 OTC Medical

calcium gluconate oral tablet 60 mg calcium (650 mg) 1 OTC Medical

calcium lactate oral tablet 84 mg (648 mg) 1 OTC Medical

coral calcium oral tablet 390 mg calcium (1000 mg) 1 OTC Medical

natural calcium oral tablet 500 mg calcium (1250 mg) 1 OTC Medical

oysco-500 oral tablet 500 mg calcium (1250 mg) 1 OTC Medical

super calcium oral tablet 600 mg calcium (1500 mg) 1 OTC Medical

Minerals And Electrolytes - Calcium Replacement Combinations - Drugs For Nutrition

calcium carbonate-vit d3-min oral tablet 600 mg calcium- 400 unit

1 OTC Medical

calcium carbonate-vit d3-min oral tabletchewable 600 mg (1500 mg)-200 unit

1 OTC Medical

Minerals And Electrolytes - Calcium ReplacementVitamin D Combinations - Drugs For Nutrition

calcium 500 + d (d3) oral tablet 500 mg(1250mg) -125 unit

1 OTC Medical

calcium 500 + d oral tablet 500 mg(1250mg) -200 unit 1 OTC Medical

calcium 500 + d oral tabletchewable 500 mg(1250mg) -400 unit

1 OTC Medical

calcium 600 + d(3) oral capsule 600 mg calcium- 200 unit

1 OTC Medical

calcium 600 + d(3) oral tablet 600 mg(1500mg) -200 unit 600 mg(1500mg) -400 unit 600-125 mg-unit

1 OTC Medical

calcium 600 with vitamin d3 oral capsule 600 mg(1500mg) -400 unit 600 mg(1500mg) -500 unit

1 OTC Medical

CALCIUM 600 WITH VITAMIN D3 ORAL TABLETCHEWABLE 600 MG(1500MG) -400 UNIT (calcium carbonatecholecalciferol (vitamin d3))

2 OTC Medical

calcium carbonate-vitamin d3 oral capsule 600 mg(1500mg) -400 unit 600 mg(1500mg) -500 unit

1 OTC Medical





117



calcium carbonate-vitamin d3 oral tablet 1000 mg(2500 mg)-800 unit

1 OTC Medical

calcium carbonate-vitamin d3 oral tablet 250-125 mg-unit 500 mg(1250mg) -125 unit 500 mg(1250mg) -200 unit 500mg (1250mg) -600 unit 600 mg(1500mg) -400 unit 600 mg(1500mg) -800 unit

1 OTC Medical

CALCIUM CARBONATE-VITAMIN D3 ORAL TABLETCHEWABLE 500-100 MG-UNIT (calcium carbonatecholecalciferol (vitamin d3))

2 OTC Medical

calcium citrate-vitamin d2 oral tablet 315 mg-5 mcg (200 unit)

1 OTC Medical

calcium citrate-vitamin d3 oral liquid 1000 mg-10 mcg 30 ml

1 OTC Medical


1 OTC Medical

calcium citrate-vitamin d3 oral tablet 200 mg-625 mcg (250 unit) 250 mg-5 mcg (200 unit) 315 mg-5 mcg (200 unit) 315 mg-625 mcg (250 unit)

1 OTC Medical

calcium+d oral tablet 400-1333 mg-unit 1 OTC Medical

CALTRATE 600 PLUS D ORAL TABLETCHEWABLE 600 MG (1500 MG)-800 UNIT (calcium carbonatecholecalciferol (vitamin d3))

1 OTC Medical

CALTRATE WITH VITAMIN D3 ORAL TABLET 600 MG(1500MG) -800 UNIT (calcium carbonatecholecalciferol (vitamin d3))

1 OTC Medical

CITRACAL-D3 SLOW RELEASE ORAL TABLET EXTENDED RELEASE 600 MG-125 MCG (500 UNIT) (calcium carbonate and citratecholecalciferol (vit d3))

2 OTC Medical

citrus calcium-vitamin d3 oral tablet 200 mg-625 mcg (250 unit)

1 OTC Medical

hi-cal plus vit d oral tablet 500 mg(1250mg) -200 unit 1 OTC Medical

liquid calcium with vitamin d oral capsule 600 mg calcium- 200 unit

1 OTC Medical

oysco 500d oral tablet 500 mg(1250mg) -200 unit 1 OTC Medical

oyster shell calcium-vit d2 oral tablet 250 (625)-125 mg-unit

1 OTC Medical





118



oyster shell calcium-vit d3 oral powder in packet 500 mg(1250mg) -200 unit

1 OTC Medical

oyster shell calcium-vit d3 oral tablet 500 mg(1250mg) -200 unit 500 mg(1250mg) -400 unit

1 OTC Medical

oystercal-d oral tablet 500 mg(1250mg) -400 unit 1 OTC Medical

PARVA-CAL 500 ORAL TABLET 500 MG-5 MCG (200 UNIT) (calcium carbonatecalcium gluconateergocalciferol (vit d2))

1 OTC Medical

Minerals And Electrolytes - Electrolytes And Dextrose - Drugs For Nutrition

electrolyte-48 in d5w intravenous parenteral solution 1 PA

IONOSOL-B IN D5W INTRAVENOUS PARENTERAL SOLUTION 5 (electrolyte-b solutiondextrose 5 in water)

2 PA

IONOSOL-MB IN D5W INTRAVENOUS PARENTERAL SOLUTION 5 (electrolyte-mb solutiondextrose 5 in water)

2 PA

ISOLYTE-P IN 5 DEXTROSE INTRAVENOUS PARENTERAL SOLUTION 5 (electrolyte-p solutiondextrose 5 in water)

2 PA

NORMOSOL-M IN 5 DEXTROSE INTRAVENOUS PARENTERAL SOLUTION (electrolyte-m solutiondextrose 5 in water)

2 PA

NORMOSOL-R IN 5 DEXTROSE INTRAVENOUS PARENTERAL SOLUTION 5 (electrolyte-r solutiondextrose 5 in water)

2 PA

Minerals And Electrolytes - Iodine - Drugs For Nutrition

sski oral solution 1 gramml 1 QL (500 per 1 day)

strong iodine oral solution 5 1 QL (500 per 1 day)

Minerals And Electrolytes - Iron - Drugs For Nutrition

feosol oral tablet 325 mg (65 mg iron) 1 OTC Medical

FEOSOL ORAL TABLET 45 MG (ironcarbonyl) 2 OTC Medical

ferate oral tablet 240 mg (27 mg iron) 1 OTC Medical

fer-iron oral drops 15 mg iron (75 mg)ml 1 OTC Medical QL (500 per 1 day)

ferosul oral tablet 325 mg (65 mg iron) 1 OTC Medical





119



ferrocite oral tablet 324 mg (106 mg iron) 1

ferrous fumarate oral tablet 324 mg (106 mg iron) 1 OTC Medical

ferrous gluconate oral tablet 236 mg (27 mg iron) 324 mg (375 mg iron) 324 mg (38 mg iron)

1 OTC Medical

ferrous gluconate oral tablet 240 mg (27 mg iron) 256 mg (28 mg iron)

1 OTC Medical

ferrous sulfate oral drops 15 mg iron (75 mg)ml 1 OTC Medical QL (500 per 1 day)

ferrous sulfate oral elixir 220 mg (44 mg iron)5 ml 1 OTC Medical QL (500 per 1 day)

ferrous sulfate oral liquid 300 mg (60 mg iron)5 ml 1 OTC Medical QL (500 per 1 day)

ferrous sulfate oral tablet 325 mg (65 mg iron) 1 OTC Medical

ferrous sulfate oral tabletdelayed release (drec) 324 mg (65 mg iron)

1 OTC Medical


1 OTC Medical


2 OTC Medical

high potency iron oral tablet 134 mg (27 mg iron) 27 mg iron

1 OTC Medical

INFED INJECTION SOLUTION 50 MGML (iron dextran complex)

2 PA

iron (dried) oral tablet extended release 160 mg (50 mg iron)

1 OTC Medical

iron oral capsule extended release 325 mg (65 mg iron) 1 OTC Medical

pediatric fe-vite oral drops 15 mg iron (75 mg)ml 1 QL (500 per 1 day)

slow release iron oral tablet extended release 142 mg (45 mg iron) 143 mg (45 mg iron) 250 mg (50 mg iron)

1 OTC Medical

slow release iron oral tablet extended release 144 mg (45 mg iron) 160 mg (50 mg iron)

1 OTC Medical

SLOW RELEASE IRON ORAL TABLET EXTENDED RELEASE 159 MG (45 MG IRON) (ferrous sulfate dried)

1 OTC Medical

Minerals And Electrolytes - Iron Combinations - Drugs For Nutrition

ferocon oral capsule 110-05 mg 1





120



tl icon oral capsule 110-05 mg 1

tricon oral capsule 110-05 mg 1

Minerals And Electrolytes - Magnesium - Drugs For Nutrition

laxative dietary supplement oral tablet 500 mg 1 OTC Medical

mag-g oral tablet 27 mg magnesium (500 mg) 1 OTC Medical

magnesium oral tablet 200 mg 1 OTC Medical

MAGNESIUM OXIDE ORAL CAPSULE 400 MG MAGNESIUM (magnesium oxide)

2 OTC Medical

magnesium oxide oral capsule 500 mg 1 OTC Medical

magnesium oxide oral tablet 200 mg magnesium 400 mg magnesium

1 OTC Medical

magnesium oxide oral tablet 250 mg magnesium 2 OTC Medical

magnesium oxide oral tablet 400 mg (2413 mg magnesium) 500 mg

1 OTC Medical

magnesium oxide oral tablet 420 mg 2 OTC Medical

magnesium oxide oral tabletchewable 200 mg magnesium

1 OTC Medical

magnesium sulfate in 09 nacl intravenous solution 20 gram290 ml (69 mgml)

1 PA

magnesium sulfate in d5w intravenous piggyback 3 gram50 ml

1 PA

magnesium sulfate in d5w intravenous solution 10 gram100 ml 20 gram290 ml (69 mgml)

1 PA

magnesium sulfate in lr intravenous solution 20 gram500 ml 25 gram250 ml 50 gram500 ml

1 PA

MAGOX ORAL TABLET 400 MG (2413 MG MAGNESIUM) (magnesium oxide)

1 OTC Medical

mgo oral tablet 400 mg (2413 mg magnesium) 1 OTC Medical

phillips oral tablet 500 mg 1 OTC Medical

URO-MAG ORAL CAPSULE 845 MG MAG (140 MG) (magnesium oxide)

2 OTC Medical

Minerals And Electrolytes - Oral Electrolytes - Drugs For Nutrition

CERALYTE 90 ORAL PACKET 90-80-20-30 MEQ (sodiumchloride saltpotassiumcitrate)

2 OTC Medical





121



CERALYTE-70 ORAL PACKET 70-60-20-30 MEQ (sodiumchloride saltpotassiumcitrate)

2 OTC Medical

CERALYTE-70 ORAL POWDER IN PACKET 23-15-29-160 G-G-G-KCAL50 G (sodium chloridepotassium chloridesodium citraterice syrup)

2 OTC Medical

ceralyte-70 oral powder in packet 440-300-32 mg-mg-kcal10 g

1 OTC Medical

oralyte oral solution 1 OTC Medical

pediatric electrolyte oral solution 1 OTC Medical

pediatric freezer pops oral solution 1 OTC Medical

Minerals And Electrolytes - Parenteral Electrolyte Combinations - Drugs For Nutrition

HYPERLYTE CR INTRAVENOUS SOLUTION 25-20-5-5-30-30 MEQ20 ML (sodiumpotassiummagnesiumcalciumchlorideacetate)

2 PA

ISOLYTE-S INTRAVENOUS PARENTERAL SOLUTION (electrolyte-s solution)

2 PA

NORMOSOL-R PH 74 INTRAVENOUS PARENTERAL SOLUTION (electrolyte-r (ph 74))

2 PA

PLASMA-LYTE 148 INTRAVENOUS PARENTERAL SOLUTION (electrolyte-148 solution)

2 PA

PLASMA-LYTE A INTRAVENOUS PARENTERAL SOLUTION (electrolyte-a solution)

2 PA

TPN ELECTROLYTES II INTRAVENOUS SOLUTION 18-18-5-45-35 MEQ20 ML (sodiumpotassiummagnesiumcalciumchlorideacetate)

2 PA

Minerals And Electrolytes - Phosphate - Drugs For Nutrition

phospha 250 neutral oral tablet 250 mg 1

phospho-trin 250 neutral oral tablet 250 mg 1

virt-phos 250 neutral oral tablet 250 mg 1

Minerals And Electrolytes - Potassium Combinations - Drugs For Nutrition

potassium bicarb and chloride oral tablet effervescent 25 meq

1





122



Minerals And Electrolytes - Potassium For Injection - Drugs For Nutrition

potassium chlorid-d5-045nacl intravenous parenteral solution 10 meql 20 meql 30 meql 40 meql

1 PA

potassium chloride in 09nacl intravenous parenteral solution 20 meql 40 meql

1 PA

potassium chloride in 5 dex intravenous parenteral solution 20 meql 30 meql 40 meql

1 PA

potassium chloride in lr-d5 intravenous parenteral solution 20 meql 40 meql

1 PA

potassium chloride in water intravenous piggyback 10 meq100 ml

1 PA

potassium chloride in water intravenous piggyback 10 meq50 ml 20 meq100 ml 20 meq50 ml 30 meq100 ml 40 meq100 ml

1 PA

potassium chloride intravenous solution 2 meqml 1 PA

potassium chloride-045 nacl intravenous parenteral solution 20 meql

1 PA

potassium chloride-d5-02nacl intravenous parenteral solution 10 meql 20 meql 30 meql 40 meql

1 PA

potassium chloride-d5-03nacl intravenous parenteral solution 20 meql

1 PA

potassium chloride-d5-09nacl intravenous parenteral solution 20 meql 40 meql

1 PA

Minerals And Electrolytes - Potassium Oral - Drugs For Nutrition

effer-k oral tablet effervescent 25 meq 1

k-effervescent oral tablet effervescent 25 meq 1

potassium chloride (Klor-Con M10 Oral TabletEr ParticlesCrystals 10 Meq)

1


1


1

potassium chloride (Klor-Con Sprinkle Oral Capsule Extended Release 10 Meq 8 Meq)

1

potassium bicarb-citric acid oral tablet effervescent 25 meq

1





123



potassium chloride oral capsule extended release 10 meq 8 meq

1

potassium chloride oral liquid 20 meq15 ml 40 meq15 ml


potassium chloride oral tablet extended release 10 meq 20 meq 8 meq

1

potassium chloride oral tableter particlescrystals 10 meq 20 meq

1

Minerals And Electrolytes - Trace Minerals - Drugs For Nutrition

selenium oral capsule 200 mcg 1 OTC Medical

selenium oral tablet 100 mcg 1 OTC Medical

selenium oral tablet 200 mcg 50 mcg 1 OTC Medical

selenium oral tabletdelayed release (drec) 200 mcg 1 OTC Medical

selenomax oral tablet 200 mcg 1 OTC Medical

SELENOMETHIONINE ORAL TABLET 200 MCG (selenomethionine)

2 OTC Medical

Parenteral Nutrition - Amino Acid And Dextrose Combinations - Drugs For Nutrition

CLINIMIX 5D15W SULFITE FREE INTRAVENOUS PARENTERAL SOLUTION 5 (amino acids 5 dextrose 15 in water)

2 PA

CLINIMIX 5D25W SULFITE-FREE INTRAVENOUS PARENTERAL SOLUTION 5 (amino acids 5 dextrose 25 in water)

2 PA

CLINIMIX 275D5W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 275 (amino acids 275 dextrose 5 in water)

2 PA

CLINIMIX 425D10W SULF FREE INTRAVENOUS PARENTERAL SOLUTION 425 (amino acids 425 dextrose 10 in water)

2 PA

CLINIMIX 425D5W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 425 (amino acids 425 in dextrose 5 in water)

2 PA

CLINIMIX 425-D20W SULF-FREE INTRAVENOUS PARENTERAL SOLUTION 425 (amino acids 425 dextrose 20 in water)

2 PA





124




2 PA

CLINIMIX 5-D20W(SULFITE-FREE) INTRAVENOUS PARENTERAL SOLUTION 5 (amino acids 5 dextrose 20 in water)

2 PA

CLINIMIX 6-D5W (SULFITE-FREE) INTRAVENOUS PARENTERAL SOLUTION 6-5 (amino acid 6 in dextrose 5 water)

2 PA

CLINIMIX 8-D10W(SULFITE-FREE) INTRAVENOUS PARENTERAL SOLUTION 8-10 (amino acids 8 in dextrose 10 water)

2 PA


2 PA

Parenteral Nutrition - Amino Acid And Electrolytes Combination - Drugs For Nutrition

AMINOSYN 7 WITH ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 7 (amino acids 7 electrolyte-tpn soln)

2 PA

AMINOSYN 85 -ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 85 (amino acids 85 electrolyte-tpn soln)

2 PA

AMINOSYN II 85 -ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 85 (amino acids 85 electrolyte-tpn soln)

2 PA

AMINOSYN M 35 INTRAVENOUS PARENTERAL SOLUTION 35 (amino acids 35 electrolyte-m solution)

2 PA

Parenteral Nutrition - Amino Acid Solutions - Drugs For Nutrition

AMINOSYN 10 INTRAVENOUS PARENTERAL SOLUTION 10 (parenteral amino acid 10 combination no2)

2 PA


2 PA





125



AMINOSYN II 10 INTRAVENOUS PARENTERAL SOLUTION 10 (parenteral amino acid 10 combination no1)

2 PA


2 PA


2 PA


2 PA

AMINOSYN-HBC 7 INTRAVENOUS PARENTERAL SOLUTION 7 (amino acids 7 )

2 PA

AMINOSYN-PF 10 INTRAVENOUS PARENTERAL SOLUTION 10 (parenteral amino acid 10 combination no5 (pediatric))

2 PA

AMINOSYN-PF 7 (SULFITE-FREE) INTRAVENOUS PARENTERAL SOLUTION 7 (parenteral amino acid 7 combination no1 (pediatric))

2 PA

AMINOSYN-RF 52 INTRAVENOUS PARENTERAL SOLUTION 52 (parenteral amino acid 52 combination no1 (renal))

2 PA

CLINIMIX E 275D10W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 275 (amino acid 275 no2dextrose 10 electrolytes no29)

2 PA

CLINIMIX E 275D5W SULF FREE INTRAVENOUS PARENTERAL SOLUTION 275 (amino acids 275 calciumelectrolyte-tpn solnd5w)

2 PA

CLINIMIX E 425D10W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 425 (amino acids 425 calciumelectrolyte-tpn solndextrose 10)

2 PA

CLINIMIX E 425D25W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 425 (amino acids 425 calciumelectrolyte-tpn solnd25w)

2 PA


2 PA





126



CLINIMIX E 5D15W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5 (amino acids 5 dextrose 15 electrolytes)

2 PA

CLINIMIX E 5D20W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5 (amino acids 5 calciumelectrolyte-tpn solndextrose 20 )

2 PA


2 PA

CLINISOL SF 15 INTRAVENOUS PARENTERAL SOLUTION 15 (parenteral amino acid 15 combination no5)

2 PA

FREAMINE HBC 69 INTRAVENOUS PARENTERAL SOLUTION 69 (amino acids 69 )

2 PA

FREAMINE III 10 INTRAVENOUS PARENTERAL SOLUTION 10 (parenteral amino acid 10 combination no4)

2 PA

HEPATAMINE 8 INTRAVENOUS PARENTERAL SOLUTION 8 (amino acids 8 )

2 PA

NEPHRAMINE 54 INTRAVENOUS PARENTERAL SOLUTION 54 (amino acids 54 )

2 PA

PLENAMINE INTRAVENOUS PARENTERAL SOLUTION 15 (parenteral amino acid 15 combination no1)

2 PA

PREMASOL 10 INTRAVENOUS PARENTERAL SOLUTION 10 (parenteral amino acid 10 combination no7)

2 PA


2 PA

PROSOL 20 INTRAVENOUS PARENTERAL SOLUTION (parenteral amino acid 20 combination no1)

2 PA

TRAVASOL 10 INTRAVENOUS PARENTERAL SOLUTION 10 (parenteral amino acid 10 combination no6)

2 PA

TROPHAMINE 10 INTRAVENOUS PARENTERAL SOLUTION 10 (amino acids 10 )

2 PA





127




2 PA

Parenteral Nutrition - Amino Acid Dextrose E-Lytes And Fat Emul Comb - Drugs For Nutrition

KABIVEN INTRAVENOUS EMULSION 331-98-39 (amino acid 331 no1d98wfat emulsionselectrolyte no10)

1 PA

PERIKABIVEN INTRAVENOUS EMULSION 236-68-35 (amino acid 236 no1d68wfat emulsionselectrolytes no9)

1 PA

Parenteral Nutrition - Intravenous Fat Emulsions - Drugs For Nutrition

INTRALIPID INTRAVENOUS EMULSION 20 30 (fat emulsions)

2 PA

NUTRILIPID INTRAVENOUS EMULSION 20 (fat emulsions)

2 PA

smoflipid intravenous emulsion 20 1 PA

Parenteral Nutrition-Amino Acid Dextrose And Electrolytes Combination - Drugs For Nutrition


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





128




2 PA


2 PA

CLINIMIX E 8-D10W SULFITEFREE INTRAVENOUS PARENTERAL SOLUTION 8-10 (amino acid 8 comb no3d10wparenteral electrolytes no37)

2 PA


2 PA

Pediatric Vitamins - Drugs For Nutrition

pedia tri-vite oral drops 750 unit-35 mg -400 unitml 1 OTC Medical QL (500 per 1 day) AGE (Max 5 Years)

pediatric multivitamin no171 oral drops 750 unit-35 mg- 400 unitml


pediatric poly-vite oral drops 250 mcg-50 mg- 10-mcg-5 mgml


pediatric tri-vite oral drops 750 unit-35 mg -400 unitml 1 QL (500 per 1 day)

POLY-VI-SOL ORAL DROPS 250 MCG-50 MG- 10 MCGML (pediatric multivitamin no192)

2 OTC Medical QL (500 per 1 day) AGE (Max 5 Years)

poly-vita oral drops 1500-35-400 unit-mg-unitml 1 OTC Medical QL (500 per 1 day) AGE (Max 5 Years)

poly-vitamin oral drops 1500-35-400 unit-mg-unitml 1 OTC Medical QL (500 per 1 day) AGE (Max 5 Years)

TRI-VI-SOL ORAL DROPS 250 MCG-50 MG- 10 MCGML (vitamin a palmitateascorbic acidcholecalciferol (vit d3))


tri-vita oral drops 1500-35-400 unit-mg-unitml 1 OTC Medical QL (500 per 1 day) AGE (Max 5 Years)

tri-vitamin oral drops 1500-35-400 unit-mg-unitml 1 OTC Medical QL (500 per 1 day) AGE (Max 5 Years)

vit a palmitate-vit c-vit d3 oral drops 750 unit-35 mg -400 unitml


Pediatric Vitamins And Mineral Combinations - Drugs For Nutrition





129



AQUADEKS PEDIATRIC ORAL DROPS 400 MCGML (pediatric multivitamin no40phytonadione (vit k1))

2 AGE (Max 4 Years)

baby iron-multivitamin oral drops 10 mgml 1 OTC Medical AGE (Max 5 Years)

pedi multivit no194-iron sulf oral drops 10 mg ironml 1 QL (500 per 1 day) AGE (Max 5 Years)

pediatric poly-vite with iron oral drops 11 mg ironml 1 QL (500 per 1 day) AGE (Max 5 Years)

POLY-VI-SOL WITH IRON ORAL DROPS 11 MG IRONML (pediatric multivitamin no189ferrous sulfate)


poly-vita (iron) oral drops 1500 unit-400 unit-10 mgml 1 OTC Medical QL (500 per 1 day) AGE (Max 5 Years)

poly-vitamin with iron oral drops 1500 unit-400 unit-10 mgml


Pediatric Vitamins With Fluoride And Minerals Combinations - Drugs For Nutrition

multi-vit with fluoride-iron oral drops 025mg fluoride -10 mg ironml

1 OTC Medical

Pediatric Vitamins With Fluoride Combinations - Drugs For Nutrition


1 OTC Medical

multivit-fluor (vit e acetate) oral drops 025 mgml 1 QL (500 per 1 day) AGE (Max 5 Years)

tri-vite with fluoride oral drops 025 mg fluor (055 mg)ml 05 mg fluoride (11 mg)ml


Prenatal Vitamins And Minerals - Drugs For Nutrition

prenatal oral tablet 28 mg iron- 800 mcg 1

GF QL (1 per 1 day) AGE (Min 10 Years and Max 50 Years)

prenatal vitamin oral tablet 27 mg iron- 08 mg 1

OTC Medical GF QL (1 per 1 day) AGE (Min 10 Years and Max 50 Years)

prenatal vits96-iron fum-folic oral tablet 27 mg iron- 800 mcg

1


Ringers And Lactated Ringers Solutions - Drugs For Nutrition





130



LACTATED RINGERS INTRAVENOUS PARENTERAL SOLUTION (ringers solutionlactated)

2 PA

ringers intravenous parenteral solution 1 PA

Sodium Chloride Flushes - Drugs For Nutrition

bd posiflush normal saline 09 injection syringe 1

MONOJECT 09 SODIUM CHLORIDE INJECTION SYRINGE (sodium chloride 09 (flush))

1

MONOJECT PREFILL ADVANCED NS INJECTION SYRINGE (sodium chloride 09 (flush))

1

MONOJECT PREFILL SALINE FLUSH INJECTION SYRINGE (sodium chloride 09 (flush))

2

Sodium Chloride Solutions Concentrated - Drugs For Nutrition

sodium chloride 3 intravenous parenteral solution 3

1 PA


1 PA

Sodium Chloride Parenteral - Drugs For Nutrition


bd pre-filled normal saline injection syringe 2


1


1


2

normal saline flush injection syringe 1


1 PA

sodium chloride 09 (flush) injection syringe 1



1 PA


1 PA





131



Vitamins - B-1 Thiamine And Derivatives - Drugs For Nutrition

thiamine hcl (vitamin b1) injection solution 100 mgml 1 PA

vitamin b-1 (mononitrate) oral tablet 100 mg 1 OTC Medical

vitamin b-1 oral tablet 100 mg 1 OTC Medical

Vitamins - B-12 Cyanocobalamin And Derivatives - Drugs For Nutrition

b-12 dots oral tablet 500 mcg 1 OTC Medical

cyanocobalamin (vitamin b-12) injection solution 1000 mcgml

1 QL (10 per 1 day)

CYANOCOBALAMIN (VITAMIN B-12) ORAL CAPSULE 1000 MCG 3000 MCG (cyanocobalamin (vitamin b-12))

1 OTC Medical

cyanocobalamin (vitamin b-12) oral capsule 5000 mcg 1 OTC Medical

CYANOCOBALAMIN (VITAMIN B-12) ORAL LOZENGE 50 MCG (cyanocobalamin (vitamin b-12))

1 OTC Medical

CYANOCOBALAMIN (VITAMIN B-12) ORAL TABLET 1000 MCG

1 OTC Medical

cyanocobalamin (vitamin b-12) oral tablet 100 mcg 250 mcg 50 mcg

1 OTC Medical

cyanocobalamin (vitamin b-12) oral tablet 500 mcg 1

cyanocobalamin (vitamin b-12) oral tablet extended release 1000 mcg

1 OTC Medical

cyanocobalamin (vitamin b-12) oral tabletchewable 500 mcg

1 OTC Medical

cyanocobalamin (vitamin b-12) sublingual tablet 1000 mcg 2500 mcg

1 OTC Medical


1 OTC Medical

PHYSICIANS EZ USE B-12 INJECTION KIT 1000 MCGML (cyanocobalamin (vitamin b-12))

1 PA QL (10 per 1 day)

Vitamins - B-3 Niacin And Derivatives - Drugs For Nutrition

endur-acin oral tablet extended release 250 mg 500 mg 750 mg

1 OTC Medical

NIACIN (INOSITOL NIACINATE) ORAL CAPSULE 455 MG NIACIN (500 MG) 500 MG (niacin (inositol niacinate))

2 OTC Medical

niacin (inositol niacinate) oral tablet 500 mg 1 OTC Medical





132



niacin (niacinamide) oral tablet 500 mg 1 OTC Medical

niacin oral capsule extended release 250 mg 500 mg 1 OTC Medical

niacin oral tablet 100 mg 50 mg 1 OTC Medical


niacin oral tablet extended release 1000 mg 1 OTC Medical

niacin oral tablet extended release 250 mg 500 mg 750 mg

1 OTC Medical

NIAVASC 750 ORAL TABLET EXTENDED RELEASE 750 MG (niacin)

2

NIAVASC ORAL TABLET EXTENDED RELEASE 500 MG (niacin)

2

SLO-NIACIN ORAL TABLET EXTENDED RELEASE 250 MG 500 MG 750 MG (niacin)

2 OTC Medical

Vitamins - B-6 Pyridoxine And Derivatives - Drugs For Nutrition

pyridoxine (vitamin b6) oral tablet 250 mg 50 mg 500 mg

1 OTC Medical

pyridoxine (vitamin b6) oral tablet extended release 200 mg

1 OTC Medical

vitamin b-6 oral capsule 50 mg 1 OTC Medical

vitamin b-6 oral tablet 100 mg 25 mg 250 mg 1 OTC Medical

Vitamins - D Derivatives - Drugs For Nutrition

baby ddrops oral drops 10 mcgdrop (400 unitdrop) 1 OTC Medical

baby vitamin d3 oral drops 10 mcgdrop (400 unitdrop) 1 OTC Medical

babys super daily d3 oral drops 10 mcgdrop (400 unitdrop)


bio-d-mulsion forte oral drops 50 mcgdrop (2 000 unitdrop)

2 OTC Medical

bio-d-mulsion oral drops 10 mcgdrop (400 unitdrop) 2 OTC Medical

calcidol oral drops 200 mcgml (8000 unitml) 1 OTC Medical QL (500 per 1 day)

calcitriol oral capsule 025 mcg 05 mcg 1

calcitriol oral solution 1 mcgml 1 AGE (Max 11 Years)

CHOLECALCIFEROL (VIT D3)(BULK) LIQUID 1 MILLION UNITGRAM (cholecalciferol (vitamin d3))






133




1 OTC

cholecalciferol (vitamin d3) oral capsule 1250 mcg (50000 unit) 125 mcg (5000 unit) 250 mcg (10000 unit)

1 OTC Medical

cholecalciferol (vitamin d3) oral drops 10 mcgdrop (400 unitdrop)

1 OTC Medical

cholecalciferol (vitamin d3) oral drops 10 mcgml (400 unitml)


cholecalciferol (vitamin d3) oral drops 125 mcg05 ml (5k unit05ml)


CHOLECALCIFEROL (VITAMIN D3) ORAL DROPS 125 MCGML (5000 UNITML) (cholecalciferol (vitamin d3))


cholecalciferol (vitamin d3) oral liquid 10 mcg5 ml (400 unit5 ml)


CHOLECALCIFEROL (VITAMIN D3) ORAL LIQUID 125 MCG5 ML (500 UNIT5 ML) (cholecalciferol (vitamin d3))

2 OTC Medical

cholecalciferol (vitamin d3) oral tablet 125 mcg (5000 unit) 25 mcg (1000 unit)

1 OTC Medical

cholecalciferol (vitamin d3) oral tablet 50 mcg (2000 unit)

2 OTC Medical

CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 75 MCG (3000 UNIT) (cholecalciferol (vitamin d3))

2 OTC Medical

cholecalciferol (vitamin d3) oral tabletchewable 25 mcg (1000 unit)

2 OTC Medical

d3 dots oral tablet 50 mcg (2000 unit) 1 OTC Medical

ddrops oral drops 25 mcgdrop ( 1000 unitdrop) 50 mcgdrop (2 000 unitdrop)

1 OTC Medical

decara oral capsule 1250 mcg (50000 unit) 1 OTC Medical


DECARA ORAL CAPSULE 625 MCG (25000 UNIT) (cholecalciferol (vitamin d3))

2 OTC Medical

delta d3 oral tablet 10 mcg (400 unit) 1 OTC Medical

dialyvite vitamin d oral capsule 125 mcg (5000 unit) 1 OTC Medical

DIALYVITE VITAMIN D3 MAX ORAL TABLET 1250 MCG (50000 UNIT) (cholecalciferol (vitamin d3))

2 OTC Medical





134



d-vi-sol oral drops 10 mcgml (400 unitml) 1 OTC Medical QL (500 per 1 day)

d-vita oral drops 10 mcgml (400 unitml) 1 OTC Medical QL (500 per 1 day)

ergocalciferol (vitamin d2) (Ergocalciferol (Vitamin D2) Oral Capsule 1250 Mcg (50000 Unit))

1

ergocalciferol (vitamin d2) oral drops 200 mcgml (8000 unitml)


ergocalciferol (vitamin d2) oral tablet 10 mcg (400 unit) 1 OTC Medical

kids first vitamin d3 oral tabletchewable 25 mcg (1000 unit)

1 OTC Medical

KIDS VITAMIN D3 ORAL TABLETCHEWABLE 10 MCG (400 UNIT) (cholecalciferol (vitamin d3))

2 OTC Medical

pediatric d-vite oral drops 10 mcgml (400 unitml) 1 QL (500 per 1 day)

REPLESTA ORAL WAFER 1250 MCG (50000 UNIT) (cholecalciferol (vitamin d3))

2 OTC Medical

SUPER DAILY D3 ORAL DROPS 25 MCGDROP ( 1000 UNITDROP) (cholecalciferol (vitamin d3))

2 OTC Medical

super daily d3 oral drops 50 mcgdrop (2 000 unitdrop) 1 OTC Medical

THERA-D 4000 ORAL TABLET 100 MCG (4000 UNIT) (cholecalciferol (vitamin d3))

1 OTC Medical

thera-d oral tablet 50 mcg (2000 unit) 1 OTC Medical

VITAMIN D3 ORAL CAPSULE 10 MCG (400 UNIT) (cholecalciferol (vitamin d3))

1 OTC Medical

vitamin d3 oral capsule 100 mcg (4000 unit) 25 mcg (1000 unit) 50 mcg (2000 unit)

1 OTC Medical

vitamin d3 oral tablet 10 mcg (400 unit) 25 mcg (1000 unit)

1 OTC Medical

vitamin d3 oral tabletchewable 25 mcg (1000 unit) 2 OTC Medical

weekly-d oral capsule 1250 mcg (50000 unit) 1 OTC Medical

Vitamins - E - Drugs For Nutrition

vitamin e (dl acetate) oral capsule 400 unit 450 mg (1000 unit)

1 OTC Medical

vitamin e mixed oral capsule 1000 unit 1 OTC Medical

vitamin e oral capsule 1000 unit 400 unit 1 OTC Medical





135



Vitamins - Folic Acid And Derivatives - Drugs For Nutrition

fa-8 oral capsule 08 mg 1 OTC Medical

FOLIC ACID (BULK) POWDER 100 (folic acid) 2 OTC Medical

FOLIC ACID ORAL CAPSULE 08 MG 1 OTC Medical

folic acid oral tablet 1 mg 1

folic acid oral tablet 400 mcg 800 mcg 1 OTC Medical

Vitamins - K Phytonadione And Derivatives - Drugs For Nutrition

K1-1000 ORAL CAPSULE 1000 MCG (phytonadione (vit k1))

2

MEPHYTON ORAL TABLET 5 MG (phytonadione (vit k1)) 2

phytonadione (vitamin k1) oral tablet 5 mg 1

PHYTONADIONE (VITAMIN K1) SUBLINGUAL TABLET 500 MCG (phytonadione (vit k1))

2

Endocrine - Hormones

Agents To Treat Hypoglycemia (Hyperglycemics) - Drugs For Diabetes

BAQSIMI NASAL SPRAYNON-AEROSOL 3 MGACTUATION (glucagon)

2 DD

GLUCAGEN HYPOKIT INJECTION RECON SOLN 1 MG (glucagonhuman recombinant)

2 DD

glucagonhuman recombinant (Glucagon Emergency Kit (Human) Injection Recon Soln 1 Mg)

2 DD

glucose oral tabletchewable 4 gram 2 DD

GVOKE HYPOPEN 1-PACK SUBCUTANEOUS AUTO-INJECTOR 05 MG01 ML 1 MG02 ML (glucagon)

2 DD

GVOKE PFS 1-PACK SYRINGE SUBCUTANEOUS SYRINGE 05 MG01 ML 1 MG02 ML (glucagon)

2 DD

trueplus glucose oral tabletchewable 4 gram 1 OTC Medical

Androgen - Single Agents - Drugs For Men

androxy oral tablet 10 mg 1

Antidiuretic And Vasopressor Hormones - Hormones

desmopressin nasal spray with pump 10 mcgspray (01 ml)

1

desmopressin oral tablet 01 mg 02 mg 1





136



Antihyperglycemic - Alpha-Glucosidase Inhibitors - Drugs For Diabetes

acarbose oral tablet 100 mg 25 mg 50 mg 1 DD

Antihyperglycemic - Dipeptidyl Peptidase-4 (Dpp-4) Inhibitors - Drugs For Diabetes

alogliptin oral tablet 125 mg 25 mg 625 mg 1 DD QL (1 per 1 day)

Antihyperglycemic - Meglitinide Analogs - Drugs For Diabetes

repaglinide oral tablet 05 mg 1 mg 2 mg 1 DD

Antihyperglycemic - Sglt-2 Inhibitor And Biguanide Combinations - Drugs For Diabetes

SEGLUROMET ORAL TABLET 25-1000 MG 25-500 MG 75-1000 MG 75-500 MG (ertugliflozin pidolatemetformin hcl)

2 PA NSO DD

Antihyperglycemic - Sglt-2 Inhibitor And Dpp-4 Inhibitor Combinations - Drugs For Diabetes

STEGLUJAN ORAL TABLET 15-100 MG 5-100 MG (ertugliflozin pidolatesitagliptin phosphate)

2 PA NSO DD

Antihyperglycemic - Sodium Glucose Cotransporter-2 (Sglt2) Inhibitors - Drugs For Diabetes

STEGLATRO ORAL TABLET 15 MG (ertugliflozin pidolate)

2 DD QL (1 per 1 day)

STEGLATRO ORAL TABLET 5 MG (ertugliflozin pidolate) 2 DD QL (2 per 1 day)

Antihyperglycemic - Sulfonylurea And Biguanide Combinations - Drugs For Diabetes

glyburide-metformin oral tablet 125-250 mg 25-500 mg 5-500 mg

1 DD

Antihyperglycemic - Sulfonylurea Derivatives - Drugs For Diabetes

glimepiride oral tablet 1 mg 2 mg 4 mg 1 DD

glipizide oral tablet 10 mg 5 mg 1 DD

glipizide oral tablet extended release 24hr 10 mg 25 mg 5 mg

1 DD

glyburide micronized oral tablet 15 mg 3 mg 6 mg 1 DD

glyburide oral tablet 125 mg 25 mg 5 mg 1 DD

Antihyperglycemic Amylin Analog-Type - Drugs For Diabetes





137



SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR 2700 MCG27 ML (pramlintide acetate)

2 PA DD


2 PA DD

Antihyperglycemic Incretin MimeticGlp-1 Receptor Agonist Analog-Type - Drugs For Diabetes

RYBELSUS ORAL TABLET 14 MG 3 MG 7 MG (semaglutide)

2 PA DD

TANZEUM SUBCUTANEOUS PEN INJECTOR 30 MG05 ML 50 MG05 ML (albiglutide)

2 PA DD

TRULICITY SUBCUTANEOUS PEN INJECTOR 075 MG05 ML 15 MG05 ML 3 MG05 ML 45 MG05 ML (dulaglutide)

2 ST DD QL (6 per 84 days)

Antihyperglycemic-Dipeptidyl Peptidase-4 Inhibit And Thiazolidinedione - Drugs For Diabetes

alogliptin-pioglitazone oral tablet 125-15 mg 125-30 mg 125-45 mg 25-15 mg 25-30 mg 25-45 mg


Antihyperglycemic-Dipeptidyl Peptidase-4(Dpp-4)Inhibitor And Biguanide - Drugs For Diabetes

alogliptin-metformin oral tablet 125-1000 mg 125-500 mg


Antithyroid Agents Thionamides - Imidazole Derivatives - Drugs For Thyroid

methimazole oral tablet 10 mg 5 mg 1

Antithyroid Agents Thionamides - Thiouracil Derivatives - Drugs For Thyroid

propylthiouracil oral tablet 50 mg 1

Bone Resorption Inhibitors - Bisphosphonates - Drugs For Menopause And Bone Loss

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

1

ibandronate oral tablet 150 mg 1

Calcimimetic Parathyroid Calcium Receptor Sensitivity Enhancer - Drugs For Menopause And Bone Loss

cinacalcet oral tablet 30 mg 60 mg 90 mg 1 PA

Calcitonins - Drugs For Menopause And Bone Loss





138



calcitonin (salmon) nasal spraynon-aerosol 200 unitactuation

1

Estrogen-Progestin - Drugs For Women

norethindrone acetate-ethinyl estradiol (Fyavolv Oral Tablet 05-25 Mg-Mcg 1-5 Mg-Mcg)

1

norethindrone acetate-ethinyl estradiol (Jinteli Oral Tablet 1-5 Mg-Mcg)

1

lopreeza oral tablet 05-01 mg 1-05 mg 1


1

Estrogens - Drugs For Women

estradiol oral tablet 05 mg 1 mg 2 mg 1

estradiol transdermal patch semiweekly 0025 mg24 hr 00375 mg24 hr 005 mg24 hr 0075 mg24 hr 01 mg24 hr


estradiol transdermal patch weekly 0025 mg24 hr 00375 mg24 hr 005 mg24 hr 006 mg24 hr 0075 mg24 hr 01 mg24 hr

1

Fertility Enhancer - Preterm Birth Prevention Progesterone-Type - Drugs For Women

hydroxyprogest(pf)(preg presv) intramuscular oil 250 mgml (1 ml)

1 PA

hydroxyprogesterone cap(ppres) intramuscular oil 250 mgml

1 PA

MAKENA (PF) SUBCUTANEOUS AUTO-INJECTOR 275 MG11 ML (hydroxyprogesterone caproatepf)

2 PA

MAKENA INTRAMUSCULAR OIL 250 MGML (hydroxyprogesterone caproate)

2 PA

MAKENA INTRAMUSCULAR OIL 250 MGML (1 ML) (hydroxyprogesterone caproatepf)

2 PA

Glucocorticoids - Drugs For Inflammation

cortisone oral tablet 25 mg 1

prednisone (Deltasone Oral Tablet 20 Mg) 1

DEXAMETHASONE INTENSOL ORAL DROPS 1 MGML (dexamethasone)






139



dexamethasone oral elixir 05 mg5 ml 1 QL (500 per 1 day)

dexamethasone oral tablet 05 mg 075 mg 15 mg 4 mg 6 mg

1

dexamethasone oral tablet 1 mg 2 mg 1

dexamethasone sodium phos (pf) injection solution 10 mgml

1

dexamethasone sodium phos (pf) injection syringe 10 mgml

1

dexamethasone sodium phosphate injection solution 10 mgml 4 mgml

1

dexamethasone sodium phosphate injection syringe 4 mgml

1

hydrocortisone oral tablet 10 mg 20 mg 5 mg 1

methylprednisolone acetate injection suspension 40 mgml 80 mgml

1

methylprednisolone oral tablet 16 mg 32 mg 4 mg 8 mg

1

methylprednisolone oral tabletsdose pack 4 mg 1

MILLIPRED ORAL TABLET 5 MG (prednisolone) 2

prednisolone sodium phosphate oral solution 10 mg5 ml 15 mg5 ml (3 mgml) 20 mg5 ml (4 mgml) 5 mg base5 ml (67 mg5 ml)


prednisolone sodium phosphate oral solution 25 mg5 ml (5 mgml)


PREDNISONE INTENSOL ORAL CONCENTRATE 5 MGML (prednisone)


prednisone oral solution 5 mg5 ml 1 QL (500 per 1 day)

prednisone oral tablet 1 mg 10 mg 25 mg 20 mg 5 mg 50 mg

1

SOLU-CORTEF ACT-O-VIAL (PF) INJECTION RECON SOLN 1000 MG8 ML 100 MG2 ML 250 MG2 ML 500 MG4 ML (hydrocortisone sodium succinatepf)

2

Human Insulins - Fixed Combinations - Drugs For Diabetes

HUMULIN 7030 U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNITML (70-30) (insulin nph human isophaneinsulin regular human)

2 DD





140



NOVOLIN 7030 U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNITML (70-30) (insulin nph human isophaneinsulin regular human)

2 DD

Human Insulins - Intermediate Acting - Drugs For Diabetes

HUMULIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNITML (insulin nph human isophane)

2 DD

NOVOLIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNITML (insulin nph human isophane)

2 DD

Human Insulins - Short Acting - Drugs For Diabetes

HUMULIN R REGULAR U-100 INSULN INJECTION SOLUTION 100 UNITML (insulin regular human)

2 DD

HUMULIN R U-500 (CONC) INSULIN SUBCUTANEOUS SOLUTION 500 UNITML (insulin regular human)

2 DD

HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNITML (3 ML) (insulin regular human)

2 DD

NOVOLIN R REGULAR U-100 INSULN INJECTION SOLUTION 100 UNITML (insulin regular human)

2 DD

Insulin Analogs - Fixed Combinations - Drugs For Diabetes

HUMALOG MIX 50-50 INSULN U-100 SUBCUTANEOUS SUSPENSION 100 UNITML (50-50) (insulin lispro protamine and insulin lispro)

2 DD

HUMALOG MIX 75-25(U-100)INSULN SUBCUTANEOUS SUSPENSION 100 UNITML (75-25) (insulin lispro protamine and insulin lispro)

2 DD

insulin asp prt-insulin aspart subcutaneous solution 100 unitml (70-30)

1 DD

NOVOLOG MIX 70-30 U-100 INSULN SUBCUTANEOUS SOLUTION 100 UNITML (70-30) (insulin aspart protamine humaninsulin aspart)

2 DD

Insulin Analogs - Long Acting - Drugs For Diabetes

BASAGLAR KWIKPEN U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNITML (3 ML) (insulin glarginehuman recombinant analog)

2 DD





141



LANTUS SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNITML (3 ML) (insulin glarginehuman recombinant analog)

2 PA DD

LANTUS U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNITML (insulin glarginehuman recombinant analog)

2 PA NSO DD

SEMGLEE PEN U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNITML (3 ML) (insulin glarginehuman recombinant analog)

2 DD

SEMGLEE U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNITML (insulin glarginehuman recombinant analog)

2 DD

Insulin Analogs - Rapid Acting - Drugs For Diabetes

ADMELOG SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNITML (insulin lispro)

2 DD

ADMELOG U-100 INSULIN LISPRO SUBCUTANEOUS SOLUTION 100 UNITML (insulin lispro)

1 DD

HUMALOG U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNITML (insulin lispro)

2 PA NSO DD

insulin lispro subcutaneous insulin pen half-unit 100 unitml

1 PA DD

Insulin Response Enhancers - Biguanides - Drugs For Diabetes

metformin oral tablet 1000 mg 500 mg 850 mg 1 DD

metformin oral tablet extended release 24 hr 500 mg 750 mg

1 DD

Insulin Response Enhancers - Thiazolidinediones (Ppar-Gamma Agonists) - Drugs For Diabetes

pioglitazone oral tablet 15 mg 30 mg 45 mg 1 DD

Lhrh (Gnrh) Agonist Analog Pituitary Suppressants - Drugs For Women


2 PA SP


2 PA SP

Menopausal Symptoms Supressant - Hormonal Agents - Drugs For Women





142



INTRAROSA VAGINAL INSERT 65 MG (prasterone (dhea))

2

Mineralocorticoids - Drugs For Inflammation

fludrocortisone oral tablet 01 mg 1

Oxytocic - Ergot Alkaloids - Drugs For Women

methylergonovine oral tablet 02 mg 1

Progestins - Drugs For Women


1 PA


1 PA


2 PA


2 PA


2 PA

medroxyprogesterone oral tablet 10 mg 25 mg 5 mg 1

norethindrone acetate oral tablet 5 mg 1

progesterone micronized oral capsule 100 mg 200 mg 1 QL (2 per 1 day)

Prolactin Inhibitor - Ergot Derivative Dopamine Receptor Agonists - Drugs For Women

cabergoline oral tablet 05 mg 1 QL (8 per 30 days)

Selective Estrogen Receptor Modulators (Serms) - Drugs For Menopause And Bone Loss

raloxifene oral tablet 60 mg 1

Thyroid Hormones - Animal Source (Porcine) - Drugs For Thyroid

nature-throid oral tablet 11375 mg 130 mg 14625 mg 1625 mg 1625 mg 195 mg 260 mg 325 mg 325 mg 4875 mg 65 mg 8125 mg 975 mg

1

np thyroid oral tablet 120 mg 15 mg 30 mg 60 mg 90 mg

1

westhroid oral tablet 130 mg 195 mg 325 mg 65 mg 975 mg

1





143



wp thyroid oral tablet 11375 mg 130 mg 1625 mg 325 mg 4875 mg 65 mg 8125 mg 975 mg

1

Thyroid Hormones - Synthetic T3 (Triiodothyronine) - Drugs For Thyroid

liothyronine intravenous solution 10 mcgml 1

liothyronine oral tablet 25 mcg 5 mcg 50 mcg 1

Thyroid Hormones - Synthetic T4 (Thyroxine) - Drugs For Thyroid

euthyrox oral tablet 100 mcg 112 mcg 125 mcg 137 mcg 150 mcg 175 mcg 200 mcg 25 mcg 50 mcg 75 mcg 88 mcg

1

levothyroxine oral tablet 100 mcg 112 mcg 125 mcg 137 mcg 150 mcg 175 mcg 200 mcg 25 mcg 300 mcg 50 mcg 75 mcg 88 mcg

1

UNITHROID ORAL TABLET 100 MCG 112 MCG 125 MCG 137 MCG 150 MCG 175 MCG 200 MCG 25 MCG 300 MCG 50 MCG 75 MCG 88 MCG (levothyroxine sodium)

2

Gastrointestinal Therapy Agents - Drugs For The Stomach

Antacid - Alginate Combinations - Drugs For Ulcers And Stomach Acid

GAVISCON ORAL TABLETCHEWABLE 80-142 MG (magnesium trisilicatealuminum hydroxsod bicarbalginic ac)

2 OTC Medical

Antacid - Aluminum - Drugs For Ulcers And Stomach Acid


2 OTC Medical

aluminum hydroxide gel oral suspension 320 mg5 ml 600 mg5 ml


Antacid - Antacid Combinations - Drugs For Ulcers And Stomach Acid

acid gone antacid estrength oral tabletchewable 160-105 mg

1 OTC Medical

acid gone antacid oral suspension 95-358 mg15 ml 1 OTC Medical QL (500 per 1 day)

antacid (calcium carb-mag hyd) oral tabletchewable 550-110 mg

1 OTC Medical

antacid exst (ca carb-mag hyd) oral tabletchewable 675-135 mg

1 OTC Medical





144



antacid supreme oral suspension 400-135 mg5 ml 1 OTC Medical QL (500 per 1 day)

foaming antacid oral suspension 95-358 mg15 ml 1 OTC Medical QL (500 per 1 day)

GAVISCON EXTRA STRENGTH ORAL TABLETCHEWABLE 160-105 MG (magnesium carbonatealuminum hydroxide)

2 OTC Medical

heartburn antacid oral tabletchewable 160-105 mg 1 OTC Medical

heartburn relief oral tabletchewable 160-105 mg 1 OTC Medical

MAG-AL ORAL SUSPENSION 200-200 MG5 ML (magnesium hydroxidealuminum hydroxide)


mi-acid(calcium carb-mag hydr) oral tabletchewable 700-300 mg

1 OTC Medical

Antacid - Bicarbonate - Drugs For Ulcers And Stomach Acid

sodium bicarbonate oral tablet 325 mg 650 mg 1 OTC Medical

Antacid - Calcium - Drugs For Ulcers And Stomach Acid

alcalak oral tabletchewable 168 mg calcium (420 mg) 1 OTC Medical

antacid extra-strength oral tabletchewable 300 mg (750 mg)

1 OTC Medical

antacid ultra strength oral tabletchewable 400 mg calcium (1000 mg) 470 mg calcium (1177 mg)

1 OTC Medical

calcium antacid oral tabletchewable 200 mg calcium (500 mg)

1 OTC Medical



calcium carbonate oral tablet 260 mg calcium (648 mg) 1 OTC Medical


1 OTC Medical

cal-gest antacid oral tabletchewable 200 mg calcium (500 mg)

1 OTC Medical

childrens antacid oral suspension 400 mg5 ml 1 OTC Medical

childrens pepto oral tabletchewable 400 mg 1 OTC Medical

childrens soothe oral tabletchewable 400 mg 1 OTC Medical

flavor chews antacid oral tabletchewable 300 mg (750 mg)

1 OTC Medical





145



TUMS EXTRA STRENGTH SMOOTHIES ORAL TABLETCHEWABLE 300 MG (750 MG) (calcium carbonate)

2 OTC Medical

TUMS ORAL TABLETCHEWABLE 200 MG CALCIUM (500 MG) (calcium carbonate)

2 OTC Medical

tums ultra oral tabletchewable 470 mg calcium (1177 mg)

1 OTC Medical

ultra strength antacid oral tabletchewable 400 mg calcium (1000 mg)

1 OTC Medical

Antacid - Magnesium - Drugs For Ulcers And Stomach Acid

magnesium oxide oral tablet 400 mg (2413 mg magnesium)

1 OTC Medical

PHILLIPS MILK OF MAGNESIA ORAL TABLETCHEWABLE 311 MG (magnesium hydroxide)

2 OTC Medical

ri-mag oral suspension 540 mg5 ml 1 OTC Medical QL (500 per 1 day)

Antacid - Simethicone Combinations - Drugs For Ulcers And Stomach Acid

almacone oral suspension 200-200-20 mg5 ml 1 OTC Medical QL (500 per 1 day)

almacone-2 oral suspension 400-400-40 mg5 ml 1 OTC Medical QL (500 per 1 day)

antacid anti-gas oral suspension 400-400-40 mg5 ml 1 OTC Medical QL (500 per 1 day)

antacid ii plus simethicone oral suspension 400-400-30 mg5 ml


antacid with simethicone oral suspension 200-200-20 mg5 ml

1 OTC Medical

antacid-antigas ii oral suspension 400-400-30 mg5 ml 1 OTC Medical QL (500 per 1 day)

antacid-antigas oral suspension 400-400-40 mg5 ml 1 OTC Medical QL (500 per 1 day)

comfort gel extra strength oral suspension 400-400-40 mg5 ml


comfort gel oral suspension 200-200-20 mg5 ml 1 OTC Medical

flanax antacid oral suspension 200-200-20 mg5 ml 1 OTC Medical





146



gelusil antacid and anti-gas oral tabletchewable 200-200-25 mg

1 OTC Medical

geri-lanta oral suspension 200-200-20 mg5 ml 1 OTC Medical

liquid antacid oral suspension 400-400-40 mg5 ml 1 OTC Medical QL (500 per 1 day)

maalox advanced oral suspension 200-200-20 mg5 ml 1 OTC Medical QL (500 per 1 day)

MAALOX ADVANCED ORAL TABLETCHEWABLE 1000-60 MG (calcium carbonatesimethicone)

2 OTC Medical

MAALOX MAXIMUM STRENGTH ORAL SUSPENSION 400-400-40 MG5 ML (magnesium hydroxidealuminum hydroxidesimethicone)


mi-acid oral suspension 200-200-20 mg5 ml 400-400-40 mg5 ml


mintox maximum strength oral suspension 400-400-40 mg5 ml


mintox oral suspension 200-200-20 mg5 ml 1 OTC Medical QL (500 per 1 day)

mintox plus oral tabletchewable 200-200-25 mg 1 OTC Medical

ri-gel oral suspension 200-200-20 mg5 ml 1 OTC Medical

ri-mag plus oral suspension 540-40 mg5 ml 1 OTC Medical QL (500 per 1 day)

ri-mox oral suspension 200-200-20 mg5 ml 1 OTC Medical QL (500 per 1 day)

ri-mox plus oral suspension 225-200-25 mg5 ml 1 OTC Medical QL (500 per 1 day)

Antidiarrheal - Antiperistaltic Agents - Drugs For Diarrhea

anti-diarrheal (loperamide) oral capsule 2 mg 1 OTC Medical

anti-diarrheal (loperamide) oral liquid 1 mg5 ml 1 OTC Medical QL (500 per 1 day)

anti-diarrheal (loperamide) oral tablet 2 mg 1 OTC Medical

diamode oral tablet 2 mg 1 OTC Medical

loperamide oral capsule 2 mg 1 OTC Medical

loperamide oral liquid 1 mg5 ml 1 mg75 ml 1 OTC Medical QL (500 per 1 day)





147



Antidiarrheal - Bismuth Agents - Drugs For Diarrhea

anti-diarrheal oral suspension 262 mg15 ml 1 OTC Medical QL (500 per 1 day)

bismatrol oral suspension 262 mg15 ml 525 mg15 ml 1 OTC Medical QL (500 per 1 day)

bismatrol oral tabletchewable 262 mg 1 OTC Medical

bismuth maximum strength oral suspension 525 mg15 ml



diotame instydose oral suspension in packet 524 mg30 ml


kaopectate (bismuth subsalicy) oral suspension 262 mg15 ml


kaopectate ex str (bismuth ss) oral suspension 525 mg15 ml


peptic relief oral suspension 262 mg15 ml 1 OTC Medical QL (500 per 1 day)

pink bismuth oral suspension 262 mg15 ml 1 OTC Medical QL (500 per 1 day)

pink bismuth oral tablet 262 mg 1 OTC Medical

stomach relief oral tablet 262 mg 1 OTC Medical

Antidiarrheal Antiperistaltic-Anticholinergic Combinations - Drugs For Diarrhea

diphenoxylate-atropine oral liquid 25-0025 mg5 ml 1 QL (500 per 1 day)

diphenoxylate-atropine oral tablet 25-0025 mg 1

Antiemetic - Anticholinergics - Drugs For Vomiting And Nausea

scopolamine base transdermal patch 3 day 1 mg over 3 days


TRANSDERM-SCOP TRANSDERMAL PATCH 3 DAY 1 MG OVER 3 DAYS (scopolamine)


Antiemetic - Antihistamines - Drugs For Vomiting And Nausea

dramamine less drowsy oral tablet 25 mg 1 OTC Medical

meclizine oral tablet 125 mg 25 mg 1 OTC Medical

meclizine oral tabletchewable 25 mg 1 OTC Medical

medi-meclizine oral tablet 25 mg 1 OTC Medical





148



motion relief (meclizine) oral tablet 25 mg 1 OTC Medical

motion sickness (meclizine) oral tablet 25 mg 1 OTC Medical

motion sickness ii oral tablet 25 mg 1 OTC Medical

motion sickness relief(mecliz) oral tablet 25 mg 1 OTC Medical

motion sickness relief(mecliz) oral tabletchewable 25 mg

1 OTC Medical

travel-ease (meclizine) oral tablet 25 mg 1 OTC Medical

verticalm oral tablet 25 mg 1 OTC Medical

wal-dram 2 oral tablet 25 mg 1 OTC Medical

Antiemetic - Cannabinoid Type - Drugs For Vomiting And Nausea


Antiemetic - Phenothiazines - Drugs For Vomiting And Nausea

prochlorperazine (Compro Rectal Suppository 25 Mg) 1

promethazine hcl (Phenadoz Rectal Suppository 125 Mg 25 Mg)

1


prochlorperazine rectal suppository 25 mg 1

promethazine oral syrup 625 mg5 ml 1 QL (500 per 1 day)

promethazine oral tablet 125 mg 25 mg 50 mg 1

promethazine rectal suppository 125 mg 25 mg 50 mg 1

promethazine hcl (Promethegan Rectal Suppository 125 Mg 25 Mg 50 Mg)

1

Antiemetic - Selective Serotonin 5-Ht3 Antagonists - Drugs For Vomiting And Nausea

ANZEMET ORAL TABLET 100 MG (dolasetron mesylate) 2

ANZEMET ORAL TABLET 50 MG (dolasetron mesylate) 2 QL (3 per 1 day)

granisetron hcl oral tablet 1 mg 1

ondansetron hcl intravenous solution 2 mgml 1

ondansetron hcl oral solution 4 mg5 ml 1 QL (500 per 1 day)

ondansetron hcl oral tablet 24 mg 4 mg 8 mg 1

ondansetron oral tabletdisintegrating 4 mg 8 mg 1





149



Antiemetic - Substance P-Neurokinin 1 (Nk1) Receptor Antagonists - Drugs For Vomiting And Nausea

aprepitant oral capsule 125 mg 1 QL (1 per 14 days)



aprepitant oral capsuledose pack 125 mg (1)- 80 mg (2) 1 QL (3 per 14 days)

Colonic Acidifier (Ammonia Inhibitor) - Drugs For The Stomach

lactulose (Enulose Oral Solution 10 Gram15 Ml) 1

lactulose (Generlac Oral Solution 10 Gram15 Ml) 1

lactulose oral solution 10 gram15 ml 1

Digestive Enzyme Mixtures - Drugs For The Stomach

CREON ORAL CAPSULEDELAYED RELEASE(DREC) 12000-38000 -60000 UNIT 24000-76000 -120000 UNIT 3000-9500- 15000 UNIT 36000-114000- 180000 UNIT 6000-19000 -30000 UNIT (lipaseproteaseamylase)

2

PANCREAZE ORAL CAPSULEDELAYED RELEASE(DREC) 10500-35500- 61500 UNIT 16800-56800- 98400 UNIT 2600-6200- 10850 UNIT 21000-54700- 83900 UNIT 4200-14200- 24600 UNIT (lipaseproteaseamylase)

2

ZENPEP ORAL CAPSULEDELAYED RELEASE(DREC) 10000-32000 -42000 UNIT 10000-34000 -55000 UNIT 15000-47000 -63000 UNIT 15000-51000 -82000 UNIT 20000-63000- 84000 UNIT 20000-68000 -109000 UNIT 25000-79000- 105000 UNIT 25000-85000- 136000 UNIT 3000-10000 -14000-UNIT 3000-10000- 16000 UNIT 40000-126000- 168000 UNIT 40000-136000- 218000 UNIT 5000-17000 -27000 UNIT 5000-17000- 24000 UNIT (lipaseproteaseamylase)

2

Gallstone Solubilizing (Litholysis) Agents - Drugs For The Stomach

ursodiol oral capsule 300 mg 1

ursodiol oral tablet 250 mg 500 mg 1

Gastric Acid Secretion Reducers - Histamine H2-Receptor Antagonists - Drugs For Ulcers And Stomach Acid





150



acid control (ranitidine) oral tablet 150 mg 75 mg 1 OTC Medical

acid controller oral tablet 10 mg 20 mg 1 OTC Medical

acid reducer (famotidine) oral tablet 10 mg 20 mg 1 OTC Medical

acid reducer (ranitidine) oral tablet 150 mg 75 mg 1 OTC Medical

acid-pep oral tablet 20 mg 1

cimetidine hcl oral solution 300 mg5 ml 1 QL (500 per 1 day)

cimetidine oral tablet 200 mg 300 mg 400 mg 800 mg 1

famotidine (pf) intravenous solution 20 mg2 ml 1

famotidine intravenous solution 10 mgml 1

famotidine oral suspension 40 mg5 ml (8 mgml) 1 QL (150 per 1 day) AGE (Max 11 Years)

famotidine oral tablet 20 mg 40 mg 1

heartburn prevention oral tablet 20 mg 1 OTC Medical

heartburn relief (famotidine) oral tablet 20 mg 1 OTC Medical

heartburn relief (ranitidine) oral tablet 150 mg 75 mg 1 OTC Medical

ranitidine hcl oral syrup 15 mgml 1 QL (1500 per 1 day)

ranitidine hcl oral tablet 150 mg 300 mg 75 mg 1 OTC Medical

wal-zan 150 oral tablet 150 mg 1 OTC Medical


ZANTAC MAXIMUM STRENGTH ORAL TABLET 150 MG (ranitidine hcl)

2 OTC Medical

ZANTAC ORAL TABLET 150 MG (ranitidine hcl) 1

Gastric Acid Secretion Reducing Agents - Proton Pump Inhibitors (Ppis) - Drugs For Ulcers And Stomach Acid

heartburn treatment 24 hour oral capsuledelayed release(drec) 15 mg

1 OTC Medical

lansoprazole oral capsuledelayed release(drec) 15 mg 1 QL (31 per 1 day)

lansoprazole oral capsuledelayed release(drec) 30 mg 1

omeprazole oral capsuledelayed release(drec) 10 mg 20 mg 40 mg

1

omeprazole oral tabletdelayed release (drec) 20 mg 1 OTC Medical

omeprazole oral tabletdisintegrat delay rel 20 mg 1





151



pantoprazole oral tabletdelayed release (drec) 20 mg 40 mg

1

Gastric Mucosa - Cytoprotective Prostaglandin Analogs - Drugs For Ulcers And Stomach Acid

misoprostol oral tablet 100 mcg 200 mcg 1

Gastrointestinal Antiflatulents - Drugs For The Stomach

anti-gas maximum strength oral capsule 166 mg 1 OTC Medical

anti-gas ultra strength oral capsule 180 mg 1 OTC Medical

bicarsim forte oral tablet 125 mg 1 OTC Medical

BICARSIM ORAL TABLET 80 MG (simethicone) 2 OTC Medical

gas relief (simethicone) oral capsule 125 mg 250 mg 1 OTC Medical

gas relief (simethicone) oral tabletchewable 80 mg 1 OTC Medical

gas relief 80 (simethicone) oral tabletchewable 80 mg 1 OTC Medical

gas relief extra strength oral capsule 125 mg 1 OTC Medical

gas relief extra strength oral tabletchewable 125 mg 1 OTC Medical

gas-x extra strength oral capsule 125 mg 2 OTC Medical

GAS-X EXTRA STRENGTH ORAL TABLETCHEWABLE 125 MG (simethicone)

2 OTC Medical

gas-x ultra-strength oral capsule 180 mg 1 OTC Medical

infants gas relief oral dropssuspension 40 mg06 ml 1 OTC Medical QL (500 per 1 day)

little tummys gas relief oral dropssuspension 40 mg06 ml

1 OTC Medical

mi-acid gas relief(simethicon) oral tabletchewable 80 mg

1 OTC Medical

mytab gas (simethicone) oral tabletchewable 80 mg 1 OTC Medical

mytab gas maximum strength oral tabletchewable 125 mg

1 OTC Medical

PHAZYME ORAL CAPSULE 180 MG (simethicone) 2 OTC Medical


Gastrointestinal Prokinetic Agents - D2 Antagonist5-Ht4 Agonists - Drugs For The Stomach





152



metoclopramide hcl oral solution 5 mg5 ml 1 QL (500 per 1 day)

metoclopramide hcl oral tablet 10 mg 5 mg 1

Gi Antispasmodic - Belladonna Alkaloids - Drugs For Stomach Cramps

ed-spaz oral tabletdisintegrating 0125 mg 1

hyoscyamine sulfate oral elixir 0125 mg5 ml 1 QL (500 per 1 day)

hyoscyamine sulfate oral tablet 0125 mg 1

hyoscyamine sulfate oral tabletdisintegrating 0125 mg 1

hyoscyamine sulfate sublingual tablet 0125 mg 1

hyosyne oral drops 0125 mgml 1 QL (14 per 1 day)

oscimin oral tablet 0125 mg 1

oscimin oral tabletdisintegrating 0125 mg 1

oscimin sl sublingual tablet 0125 mg 1

Gi Antispasmodic - Quaternary Ammonium Compounds - Drugs For Stomach Cramps

glycopyrrolate oral tablet 1 mg 15 mg 2 mg 1

propantheline oral tablet 15 mg 1

Gi Antispasmodic - Synthetic Tertiary Amines - Drugs For Stomach Cramps

dicyclomine oral capsule 10 mg 1

dicyclomine oral solution 10 mg5 ml 1 QL (500 per 1 day)

dicyclomine oral tablet 20 mg 1

Inflammatory Bowel Agent - Aminosalicylates And Related Agents - Drugs For Inflammatory Bowel Disease

APRISO ORAL CAPSULEEXTENDED RELEASE 24HR 0375 GRAM (mesalamine)

2


balsalazide oral capsule 750 mg 1

mesalamine oral capsule (with del rel tablets) 400 mg 1

mesalamine oral capsuleextended release 24hr 0375 gram

1

mesalamine oral tabletdelayed release (drec) 12 gram 800 mg

1

mesalamine rectal enema 4 gram60 ml 1





153




Inflammatory Bowel Agent - Glucocorticoids - Drugs For Inflammatory Bowel Disease

hydrocortisone (Colocort Rectal Enema 100 Mg60 Ml) 1

hydrocortisone rectal enema 100 mg60 ml 1

Inflammatory Bowel Agent - Tumor Necrosis Factor Alpha Blockers - Drugs For Inflammatory Bowel Disease


2 PA SP

Laxative - Bulk Forming - Drugs To Prevent Constipation

colox oral capsule 750 mg 1 OTC Medical

daily fiber (psyllium-aspart) oral powder in packet 3 gram

1

daily fiber (psyllium-sucrose) oral powder 3 gram7 gram 34 gram7 gram

1 OTC Medical

daily fiber oral capsule 04 gram 1 OTC Medical

EVAC ORAL POWDER 3 GRAM3 GRAM (psyllium husk) 1 OTC Medical

fiber (psyllium husk) oral capsule 04 gram 1 OTC Medical

fiber (psyllium husk-sugar) oral powder 34 gram11 gram 34 gram12 gram 34 gram7 gram

1 OTC Medical

fiber laxative (psyllium husk) oral capsule 052 gram 1 OTC Medical

fiber smooth oral powder 1 OTC Medical

fiber therapy (m-cellsugar) oral powder 2 gram19 gram 1 OTC Medical

fiber therapy (psyllium-sucro) oral powder 3 gram12 gram

1 OTC Medical


1

fiber therapy(psyl seed-sugar) oral powder 1 OTC Medical

HYDROCIL INSTANT ORAL PACKET (psyllium seed) 1 OTC Medical

konsyl (sugar) oral powder 34 gram11 gram 2 OTC Medical

konsyl (sugar) oral powder in packet 34 gram 2 OTC Medical

KONSYL DAILY FIBER (STEVIA) ORAL POWDER 35 GRAM58 GRAM (psyllium husksweetleaf)

1 OTC Medical





154



KONSYL EASY MIX ORAL POWDER 43 GRAM6 GRAM (psyllium husk)

2 OTC Medical

KONSYL SUGAR-FREE (ASPARTAME) ORAL POWDER 35 GRAM58 GRAM (psyllium huskaspartame)

1 OTC Medical

KONSYL SUGAR-FREE (ASPARTAME) ORAL POWDER IN PACKET 35 GRAM (psyllium huskaspartame)

1 OTC Medical

KONSYL SUGAR-FREE ORAL CAPSULE 052 GRAM (psyllium husk)

1 OTC Medical

KONSYL SUGAR-FREE ORAL POWDER IN PACKET 6 GRAM (psyllium husk)

1 OTC Medical

META APPETITE CTRL (ASPARTAME) ORAL POWDER 3 GRAM58 GRAM 3 GRAM595 GRAM (psyllium huskaspartame)

2 OTC Medical

METAMUCIL (WITH SUGAR) ORAL POWDER 34 GRAM12 GRAM 34 GRAM7 GRAM (psyllium husk (with sugar))

2 OTC Medical

METAMUCIL FIBER SINGLES ORAL POWDER IN PACKET 34 GRAM (psyllium huskaspartame)

2 OTC Medical

METAMUCIL FIBER THIN ORAL WAFER 2 GRAM 25 GRAM (psyllium husk (with sugar))

2 OTC Medical

METAMUCIL FREE ORAL POWDER 3 GRAM7 GRAM (psyllium husk (with sugar))

2 OTC Medical

METAMUCIL ORAL CAPSULE 04 GRAM 052 GRAM (psyllium husk)

2 OTC Medical

METAMUCIL ORAL POWDER 34 GRAM54 GRAM (psyllium husk)

2 OTC Medical

metamucil plus calcium oral capsule 1-60 gram-mg 1 OTC Medical

mucilin sf oral powder in packet 35 gram 1 OTC Medical

natural daily fiber oral powder 34 gram58 gram 1 OTC Medical

natural fiber laxative oral capsule 052 gram 1 OTC Medical

natural fiber supplement oral powder 6 gram6 gram 1 OTC Medical

NATURAL FIBER SUPPLEMNT(ASPRT) ORAL POWDER IN PACKET 34 GRAM (psyllium huskaspartame)

1 OTC Medical

natural vegetable oral powder 1 OTC Medical


2 OTC Medical





155



psyllium husk oral capsule 04 gram 1

PSYLLIUM HUSK ORAL POWDER 26 GRAM41 GRAM (psyllium husk)

2 OTC Medical

reguloid (aspartame) oral powder 3 gram58 gram 1 OTC Medical

reguloid (psyllium husk) oral capsule 04 gram 052 gram

1 OTC Medical

WAL-MUCIL FIBER (ASPARTAME) ORAL POWDER 34 GRAM58 GRAM (psyllium huskaspartame)

2 OTC Medical

wal-mucil fiber oral capsule 052 gram 1 OTC Medical

wal-mucil with calcium oral capsule 1-60 gram-mg 1 OTC Medical

Laxative - Lubricant - Drugs To Prevent Constipation

FLEET MINERAL OIL RECTAL ENEMA (mineral oil) 1 OTC Medical

Laxative - Saline And Osmotic - Drugs To Prevent Constipation

citrate of magnesia oral solution 1 OTC Medical QL (500 per 1 day)

citroma oral solution 1 OTC Medical QL (500 per 1 day)

clearlax oral powder 17 gramdose 1 OTC Medical

lactulose (Constulose Oral Solution 10 Gram15 Ml) 1

dulcolax (magnesium hydroxide) oral suspension 400 mg5 ml

1

fleet glycerin (child) rectal suppository 1 OTC Medical

GAVILAX ORAL POWDER 17 GRAMDOSE (polyethylene glycol 3350)

2 OTC Medical

gentlelax oral powder 17 gramdose 1 OTC Medical

glycerin (adult) rectal suppository 1 OTC Medical

glycerin (child) rectal suppository 1 OTC Medical

glycolax oral powder 17 gramdose 1 OTC Medical

healthylax oral powder in packet 17 gram 1 OTC Medical


laxaclear oral powder 17 gramdose 1 OTC Medical

laxative peg 3350 oral powder 17 gramdose 1 OTC Medical

MAGNESIUM CITRATE (BULK) POWDER (magnesium citrate)

2 OTC Medical





156



magnesium citrate oral solution 1 OTC Medical QL (500 per 1 day)

milk of magnesia concentrated oral suspension 2400 mg10 ml


milk of magnesia oral suspension 400 mg5 ml 1 OTC Medical QL (500 per 1 day)

MIRALAX ORAL POWDER 17 GRAMDOSE (polyethylene glycol 3350)

2 OTC Medical

MIRALAX ORAL POWDER IN PACKET 17 GRAM (polyethylene glycol 3350)

2 OTC Medical

PEDIA-LAX ORAL TABLETCHEWABLE 400 MG (170 MG MAGNESIUM) (magnesium hydroxide)

2 OTC Medical

PEDIA-LAX RECTAL SOLUTION 28 GRAM27 ML (glycerin)

2 OTC Medical

PHILLIPS MILK OF MAGNESIA ORAL SUSPENSION 400 MG5 ML (magnesium hydroxide)


polyethylene glycol 3350 oral powder 17 gramdose 1 OTC Medical

polyethylene glycol 3350 oral powder in packet 17 gram 1 OTC Medical

powderlax oral powder 17 gramdose 1 OTC Medical

powderlax oral powder in packet 17 gram 1 OTC Medical

purelax oral powder 17 gramdose 1 OTC Medical

purelax oral powder in packet 17 gram 1 OTC Medical

smoothlax oral powder 17 gramdose 1 OTC Medical

smoothlax oral powder in packet 17 gram 1 OTC Medical

Laxative - SalineOsmotic Mixtures - Drugs To Prevent Constipation

disposable enema rectal enema 19-7 gram118 ml 1 OTC Medical

enema disposable rectal enema 19-7 gram118 ml 1 OTC Medical

enema rectal enema 19-7 gram118 ml 1 OTC Medical

FLEET ENEMA EXTRA RECTAL ENEMA 19-7 GRAM197 ML (sodium phosphatemonobasicsodium phosphatedibasic)

2 OTC Medical

gavilyte-c oral recon soln 240-2272-672 -584 gram 1

peg 3350sod sulfsod bicarbsod chloridepotassium chloride (Gavilyte-G Oral Recon Soln 236-2274-674 -586 Gram)

1





157



sodium chloridesodium bicarbonatepotassium chloridepeg (Gavilyte-N Oral Recon Soln 420 Gram)

1

GOLYTELY ORAL POWDER IN PACKET 2271-215-636 GRAM (peg 3350sod sulfsod bicarbsod chloridepotassium chloride)

2

peg 3350-electrolytes oral recon soln 236-2274-674 -586 gram 240-2272-672 -584 gram

1

peg-electrolyte soln oral recon soln 420 gram 1

sodium chloridesodium bicarbonatepotassium chloridepeg (Trilyte With Flavor Packets Oral Recon Soln 420 Gram)

1

Laxative - Stimulant - Drugs To Prevent Constipation

alophen (bisacodyl) oral tabletdelayed release (drec) 5 mg

1 OTC Medical

bisac-evac rectal suppository 10 mg 1 OTC Medical

bisacodyl oral tabletdelayed release (drec) 5 mg 1 OTC Medical

bisacodyl rectal suppository 10 mg 1 OTC Medical

biscolax rectal suppository 10 mg 1 OTC Medical

castor oil oral oil 100 1 OTC Medical QL (500 per 1 day)

chocolate laxative oral tabletchewable 15 mg 1 OTC Medical

evac-u-gen (sennosides) oral tablet 86 mg 1 OTC Medical

ex-lax (sennosides) oral tablet 15 mg 1 OTC Medical

EX-LAX (SENNOSIDES) ORAL TABLETCHEWABLE 15 MG (sennosides)

1 OTC Medical

EX-LAX MAXIMUM STRENGTH ORAL TABLET 25 MG (sennosides)

2 OTC Medical

FLEET BISACODYL RECTAL ENEMA 10 MG30 ML (bisacodyl)

2 OTC Medical

laxative (bisacodyl) rectal suppository 10 mg 1 OTC Medical

laxative (sennosides) oral tablet 25 mg 1 OTC Medical

laxative maximum strength oral tablet 25 mg 1 OTC Medical

laxative pills regular oral tablet 15 mg 1 OTC Medical

natural senna laxative oral tablet 86 mg 1 OTC Medical





158



perdiem overnight relief oral tablet 15 mg 1 OTC Medical

senexon oral syrup 88 mg5 ml 1 OTC Medical QL (500 per 1 day)

senexon oral tablet 86 mg 1 OTC Medical

senna oral capsule 86 mg 1 OTC Medical

SENNA ORAL SYRUP 176 MG5 ML (senna leaf extract) 2 OTC Medical QL (500 per 1 day)

senna oral syrup 88 mg5 ml 1 OTC Medical QL (500 per 1 day)

senna oral tablet 86 mg 1 OTC Medical

senna-extra oral tablet 172 mg 1 OTC Medical

SENOKOT EXTRA STRENGTH ORAL TABLET 172 MG (sennosides)

2 OTC Medical

SENOKOT ORAL TABLET 86 MG (sennosides) 2 OTC Medical

the magic bullet rectal suppository 10 mg 1 OTC Medical

Laxative - Stimulant And SalineOsmotic Combinations - Drugs To Prevent Constipation

bisacodylsodium chlorsodium bicarbpotassium chlpeg 3350 (Gavilyte-H And Bisacodyl Oral Kit 5-210 Mg-Gram)

1

Laxative - Stimulant And Surfactant Combinations - Drugs To Prevent Constipation

COLACE 2-IN-1 ORAL TABLET 86-50 MG (sennosidesdocusate sodium)

2 OTC Medical

doc-q-lax oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

laxacin oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

medi-laxx oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

p-col rite oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

peri-colace oral tablet 86-50 mg 1 OTC Medical

senexon-s oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)





159



sennalax-s oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

sennosides-docusate sodium oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

senokot-s oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

stool softener-laxative oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

stool softener-stimulant laxat oral capsule 86-50 mg 1 OTC

stool softener-stimulant laxat oral tablet 86-50 mg 1 OTC Medical QL (500 per 1 day)

Laxative - Surfactant - Drugs To Prevent Constipation

COLACE CLEAR ORAL CAPSULE 50 MG (docusate sodium)

1 OTC Medical

COLACE ORAL CAPSULE 100 MG (docusate sodium) 1 OTC Medical

col-rite oral capsule 250 mg 1 OTC Medical

doc-q-lace oral capsule 100 mg 1 OTC Medical

docu oral liquid 50 mg5 ml 1 OTC Medical QL (500 per 1 day)


2 OTC Medical

docusate sodium oral capsule 250 mg 1 OTC Medical

docusate sodium oral tablet 100 mg 1 OTC Medical

docusate sodium rectal enema 283 mg5 ml 1 OTC Medical

docusol rectal enema 283 mg 1 OTC Medical

dok oral capsule 100 mg 1 OTC Medical

dok oral tablet 100 mg 1 OTC Medical

dulcoease oral capsule 100 mg 1 OTC Medical

dulcolax stool softener (dss) oral capsule 100 mg 1 OTC Medical

enemeez rectal enema 283 mg5 ml 1 OTC Medical

kids mini enema rectal enema 100 mg5 ml 1 OTC Medical

pedia-lax stool softener oral syrup 50 mg15 ml 1 OTC Medical QL (500 per 1 day)

phillips liqui-gels oral capsule 100 mg 1 OTC Medical





160



promolaxin oral tablet 100 mg 1 OTC Medical

silace oral liquid 50 mg5 ml 1 OTC Medical QL (500 per 1 day)

silace oral syrup 60 mg15 ml 1 OTC Medical QL (500 per 1 day)

stool softener oral capsule 100 mg 50 mg 1 OTC Medical

Peptic Ulcer - Gastric Lumen Adherent Cytoprotectives - Drugs For Ulcers And Stomach Acid

sucralfate oral suspension 100 mgml 1 QL (1500 per 1 day)

sucralfate oral tablet 1 gram 1

Genitourinary Therapy - Drugs For The Urinary System

GU Irrigants - Drugs For The Urinary System

acetic acid irrigation solution 025 1 QL (5000 per 1 day)

Interstitial Cystitis Agents - Drugs For The Urinary System

ELMIRON ORAL CAPSULE 100 MG (pentosan polysulfate sodium)

2 PA

Phosphate Binders - Calcium-Based - Drugs For The Urinary System

calcium acetate(phosphat bind) oral capsule 667 mg 1


calcium acetate (Eliphos Oral Tablet 667 Mg) 1

PHOSLYRA ORAL SOLUTION 667 MG (169 MG CALCIUM)5 ML (calcium acetate)


Phosphate Binders - Drugs For The Urinary System






sevelamer carbonate oral powder in packet 08 gram 24 gram

1 PA

sevelamer carbonate oral tablet 800 mg 1 PA QL (12 per 1 day)

Prostatic Hypertrophy Agent - Alpha-1-Adrenoceptor Antagonists - Drugs For The Prostate





161



alfuzosin oral tablet extended release 24 hr 10 mg 1 QL (1 per 1 day)

tamsulosin oral capsule 04 mg 1

Prostatic Hypertrophy Agent - Type Ii 5-Alpha Reductase Inhibitors - Drugs For The Prostate

finasteride oral tablet 5 mg 1

Prostatic Hypertrophy Agent-Type I And Ii 5-Alpha Reductase Inhibitors - Drugs For The Prostate

dutasteride oral capsule 05 mg 1

Urinary Acidifier - Phosphates - Drugs For Infections

K-PHOS NO 2 ORAL TABLET 305-700 MG (sodium phosphatemonobasicpotassium phosphatemonobasic)

2

K-PHOS ORIGINAL ORAL TABLETSOLUBLE 500 MG (potassium phosphatemonobasic)

2




Urinary Alkalinizer - Citrates - Drugs For Infections

cytra k crystals oral packet 3300-1002 mg 1

cytra-k oral solution 1100-334 mg5 ml 1

potassium citrate oral tablet extended release 10 meq (1080 mg) 5 meq (540 mg)

1

potassium citrate-citric acid oral packet 3300-1002 mg 1

potassium citrate-citric acid oral solution 1100-334 mg5 ml

1

sodium citrate-citric acid oral solution 500-334 mg5 ml 1

Urinary Analgesics - Drugs For Infections

phenazopyridine oral tablet 100 mg 200 mg 1

Urinary Antibacterial - Methenamine And Salts - Drugs For Infections







162




2

Urinary Antibacterial - Nitrofuran Derivatives - Drugs For Infections


1



Urinary Antispasmodic - Antichol M(3) Muscarinic Selective (Bladder) - Drugs For The Bladder

solifenacin oral tablet 10 mg 5 mg 1

Urinary Antispasmodic - Anticholinergics Non-Selective - Drugs For The Bladder










Urinary Antispasmodic - Smooth Muscle Relaxants - Drugs For The Bladder

oxybutynin chloride oral syrup 5 mg5 ml 1 QL (500 per 1 day)

oxybutynin chloride oral tablet 5 mg 1

oxybutynin chloride oral tablet extended release 24hr 10 mg 15 mg 5 mg

1

OXYTROL FOR WOMEN TRANSDERMAL PATCH 4 DAY 39 MG24 HOUR (oxybutynin)

2

OXYTROL TRANSDERMAL PATCH SEMIWEEKLY 39 MG24 HR (oxybutynin)

2 PA

tolterodine oral capsuleextended release 24hr 2 mg 4 mg

1





163



tolterodine oral tablet 1 mg 2 mg 1

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HR 4 MG 8 MG (fesoterodine fumarate)

2 PA

trospium oral tablet 20 mg 1 QL (2 per 1 day)

Urinary Retention Therapy - Parasympathomimetic Agents - Drugs For The Bladder

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

1

Gout And Hyperuricemia Therapy - Drugs For Pain And Fever

Gout Acute Therapy - Antimitotics - Gout Drugs

colchicine oral capsule 06 mg 1

colchicine oral tablet 06 mg 1

Gout And Hyperuricemia - Antimitotic-Uricosuric Combinations - Gout Drugs

probenecid-colchicine oral tablet 500-05 mg 1

Hyperuricemia Therapy - Uricosurics - Gout Drugs

probenecid oral tablet 500 mg 1

Hyperuricemia Therapy - Xanthine Oxidase Inhibitors - Gout Drugs

allopurinol oral tablet 100 mg 300 mg 1

Hematological Agents - Drugs For The Blood

Anticoagulants - Citrate-Based - Drugs To Prevent Blood Clots

anticoag citrate phos dextrose solution 263-222 gram-mg100ml


Anticoagulants - Coumarin - Drugs To Prevent Blood Clots

COUMADIN ORAL TABLET 1 MG 10 MG 2 MG 25 MG 3 MG 4 MG 5 MG 6 MG 75 MG (warfarin sodium)

2

warfarin sodium (Jantoven Oral Tablet 1 Mg 10 Mg 2 Mg 25 Mg 3 Mg 4 Mg 5 Mg 6 Mg 75 Mg)

1

warfarin oral tablet 1 mg 10 mg 2 mg 25 mg 3 mg 4 mg 5 mg 6 mg 75 mg

1

Direct Factor Xa Inhibitors - Drugs To Prevent Blood Clots

ELIQUIS DVT-PE TREAT 30D START ORAL TABLETSDOSE PACK 5 MG (74 TABS) (apixaban)

2





164



ELIQUIS ORAL TABLET 25 MG (apixaban) 2 QL (60 per 30 days)


XARELTO DVT-PE TREAT 30D START ORAL TABLETSDOSE PACK 15 MG (42)- 20 MG (9) (rivaroxaban)


XARELTO ORAL TABLET 10 MG 20 MG (rivaroxaban) 2 QL (30 per 30 days)

XARELTO ORAL TABLET 15 MG (rivaroxaban) 2 QL (42 per 30 days)

XARELTO ORAL TABLET 25 MG (rivaroxaban) 2 QL (2 per 1 day)

Erythropoietins - Drugs For The Blood

RETACRIT INJECTION SOLUTION 10000 UNITML 2000 UNITML 20000 UNIT2 ML 20000 UNITML 3000 UNITML 4000 UNITML 40000 UNITML (epoetin alfa-epbx)

2 PA SP

Granulocyte Colony-Stimulating Factor (G-Csf) - Drugs For The Blood

NIVESTYM INJECTION SOLUTION 300 MCGML 480 MCG16 ML (filgrastim-aafi)

2 PA SP

NIVESTYM SUBCUTANEOUS SYRINGE 300 MCG05 ML 480 MCG08 ML (filgrastim-aafi)

2 PA SP

ZARXIO INJECTION SYRINGE 300 MCG05 ML 480 MCG08 ML (filgrastim-sndz)

2 PA SP

Hematorheologic Agents - Drugs For The Blood

pentoxifylline oral tablet extended release 400 mg 1

Heparin Flush Formulations - Drugs To Prevent Blood Clots

hep flush-10 (pf) intravenous solution 10 unitml 1

heparin (porcine) in 09 nacl intravenous parenteral solution 10000 unit1000 ml 2500 unit500 ml (5 unitml) 5000 unit1000 ml 5000 unit500 ml (10 unitml)

1 PA

heparin (porcine) in 09 nacl intravenous parenteral solution 100 unit100 ml (1 unitml)

1

heparin lock flush (porcine) intravenous solution 10 unitml



1

heparin lock intravenous solution 100 unitml 1





165



heparin porcine (pf) intravenous solution 100 unitml (1 ml)

1

Heparins - Drugs To Prevent Blood Clots



1 PA


1

heparin (porcine) injection cartridge 5000 unitml (1 ml) 1

heparin (porcine) injection solution 1000 unitml 10000 unitml 20000 unitml 5000 unitml

1

heparin (porcine) injection syringe 5000 unitml 1




1

heparin lock flush (porcine) intravenous syringe 100 unitml

1

heparin lock flush intravenous syringe 10 unitml 1 QL (500 per 1 day)


heparin lockflush(porcine)(pf) intravenous syringe 10 unitml 100 unitml

1

heparin porcine (pf) injection solution 1000 unitml 5000 unit05 ml

1

heparin porcine (pf) injection syringe 5000 unit05 ml 1


1

heparin porcine (pf) intravenous syringe 10 unitml 100 unitml

1

heparin porcine (pf) subcutaneous syringe 5000 unit05 ml

1

Low Molecular Weight Heparins - Drugs To Prevent Blood Clots

enoxaparin subcutaneous solution 300 mg3 ml 1





166



enoxaparin subcutaneous syringe 100 mgml 120 mg08 ml 150 mgml 30 mg03 ml 40 mg04 ml 60 mg06 ml 80 mg08 ml

1

Platelet Aggregation Inhib - Cyclopentyl-Triazolo-Pyrimidines (Cptps) - Drugs For The Blood

BRILINTA ORAL TABLET 60 MG 90 MG (ticagrelor) 2 ST

Platelet Aggregation Inhibitors - Phosphodiesterase Iii Inhibitors - Drugs For The Blood

cilostazol oral tablet 100 mg 50 mg 1

Platelet Aggregation Inhibitors - Quinazoline Agents - Drugs For The Blood

anagrelide oral capsule 05 mg 1 mg 1

Platelet Aggregation Inhibitors - Salicylates - Drugs For The Blood


1 OTC Medical


aspirin oral tabletdelayed release (drec) 500 mg 650 mg 81 mg

1 OTC Medical





1 OTC Medical







1 OTC Medical

Platelet Aggregation Inhibitors - Thienopyridine Agents - Drugs For The Blood

clopidogrel oral tablet 300 mg 75 mg 1

prasugrel oral tablet 10 mg 5 mg 1





167



Platelet Aggregation Inhib-Pdesterase And Adenosine Deaminase Inhibitr - Drugs For The Blood

dipyridamole oral tablet 25 mg 50 mg 75 mg 1

Thrombolytic - Tissue Plasminogen Activators - Drugs For The Blood

CATHFLO ACTIVASE INTRA-CATHETER RECON SOLN 2 MG (alteplase)

2 QL (2 per 1 day)

Immunosuppressive Agents - Drugs For Organ Transplants

Immunosuppressive - Interferon Gamma Inhibitor Monoclonal Antibody - Drugs For Organ Transplants

GAMIFANT INTRAVENOUS SOLUTION 5 MGML (emapalumab-lzsg)

2

Immunosuppressive - Calcineurin Inhibitors - Drugs For Organ Transplants


1 SP


tacrolimus oral capsule 05 mg 1 mg 5 mg 1

Immunosuppressive - Inosine Monophosphate Dehydrogenase Inhibitors - Drugs For Organ Transplants





Immunosuppressive - Purine Analogs - Drugs For Organ Transplants


Locomotor System - Drugs For Muscles Ligaments Tendons And Bones

Als Agents - Benzathiazoles - Drugs For Nerves And Muscles

riluzole oral tablet 50 mg 1 SP

Antimyasthenic Agent - Reversible Cholinesterase Inhibitors - Drugs For Nerves And Muscles

pyridostigmine bromide oral syrup 60 mg5 ml 1 QL (1500 per 1 day)

pyridostigmine bromide oral tablet 30 mg 1






168



Skeletal Muscle Relaxant - Central Muscle Relaxants - Drugs For Muscles Ligaments Tendons And Bones

baclofen oral tablet 10 mg 20 mg 1

baclofen oral tablet 5 mg 1

cyclobenzaprine oral tablet 10 mg 5 mg 1

methocarbamol oral tablet 500 mg 750 mg 1

tizanidine oral tablet 2 mg 4 mg 1

Skeletal Muscle Relaxant - Direct Muscle Relaxants - Drugs For Muscles Ligaments Tendons And Bones

dantrolene oral capsule 100 mg 25 mg 50 mg 1 PA

Medical Supplies And Durable Medical Equipment (Dme) - Medical Supplies And Durable Medical Equipment

Medical Supplies And Dme - Blood Glucose Tests - Medical Supplies And Durable Medical Equipment

ONETOUCH VERIO TEST STRIPS STRIP (blood sugar diagnostic)

2 DD QL (200 per 30 days)

Medical Supplies And Dme - Female Condoms - Medical Supplies And Durable Medical Equipment

FC2 FEMALE CONDOM (condoms female) 1 CT

Medical Supplies And Dme - Glucose Monitoring Test Supplies - Medical Supplies And Durable Medical Equipment

1ST TIER UNILET COMFORTOUCH 28 GAUGE 30 GAUGE (lancets)

2 DD

2-IN-1 LANCET DEVICE 30 GAUGE (lancets) 2 DD

ACCU-CHEK FASTCLIX LANCET DRUM (lancets) 2 DD

ACCU-CHEK FASTCLIX LANCING DEV KIT (lancing devicelancets)

2 DD

ACCU-CHEK MULTICLIX LANCET (lancets) 2 DD

ACCU-CHEK MULTICLIX LANCET KIT (lancing devicelancets)

2 DD

ACCU-CHEK SAFE-T-PRO 23 GAUGE (lancets) 2 DD

ACCU-CHEK SAFE-T-PRO PLUS 23 GAUGE (lancets) 2 DD





169



ACCU-CHEK SOFT DEV LANCETS KIT (lancing devicelancets)

2 DD

ACCU-CHEK SOFTCLIX LANCETS (lancets) 2 DD

ACTI-LANCE LANCETS 17 GAUGE 23 GAUGE 28 GAUGE (lancets)

2 DD

ADJUSTABLE LANCING DEVICE (lancing device) 2 DD

ADVANCED LANCING DEVICE KIT (lancing devicelancets)

2 DD

ADVANCED TRAVEL LANCETS 28 GAUGE 30 GAUGE (lancets)

2 DD

ADVOCATE LANCET 26 GAUGE 30 GAUGE (lancets) 2 DD

ADVOCATE LANCING DEVICE (lancing device) 2 DD

ALTERNATE SITE LANCET 26 GAUGE (lancets) 2 DD

ALTERNATE SITE LANCING DEVICE (lancing device) 2 DD

AQUA LANCE LANCING DEVICE (lancing device) 2 DD

ASSURE HAEMOLANCE PLUS 12 MM (blade lancet safety)

2 DD

ASSURE HAEMOLANCE PLUS 18 GAUGE 21 GAUGE 25 GAUGE 28 GAUGE (lancets)

2 DD

ASSURE LANCE 25 GAUGE 28 GAUGE (lancets) 2 DD

ASSURE LANCE PLUS 21 GAUGE 25 GAUGE 30 GAUGE (lancets)

2 DD

AUTO-LANCET MINI (lancing device) 2 DD

AUTOLET IMPRESSION LANC DEV KIT (lancing devicelancets)

2 DD

AUTOLET LANCING DEVICE (lancing device) 2 DD

AUTOLET PLUS LANCING DEVICE (lancing device) 2 DD

BD MICROTAINER LANCET 15 X 2 MM (blade lancet safety)

2 DD

BD MICROTAINER LANCET 21 GAUGE 30 GAUGE (lancets)

2 DD

BD ULTRA FINE LANCETS 33 GAUGE (lancets) 2 DD

BD ULTRA-FINE II LANCETS 30 GAUGE (lancets) 2 DD

BULLSEYE MINI SAFETY LANCETS 21 GAUGE 25 GAUGE 28 GAUGE (lancets)

2 DD





170



BUTTERFLY TOUCH LANCET 30 GAUGE (lancets) 2

CARELANCE ULT LANCING DEVICE (lancing device) 2 DD

CAREONE LANCING DEVICE (lancing device) 2 DD

CAREONE ULTRA THIN LANCET (lancets) 2 DD

CARESENS LANCETS 30 GAUGE (lancets) 2 DD

CARESENS PREM LANCING DEVICE (lancing device) 2 DD

CARETOUCH LANCING DEVICE (lancing device) 2 DD

CARETOUCH SAFETY LANCETS 26 GAUGE (lancets) 2 DD

CARETOUCH TWIST LANCET 28 GAUGE 30 GAUGE (lancets)

2 DD

CLEVER CHEK LANCETS 30 GAUGE (lancets) 2 DD

COAGUCHEK LANCETS (lancets) 2 DD

COLOR LANCETS 21 GAUGE (lancets) 2 DD

COMFORT EZ LANCETS 21 GAUGE 23 GAUGE 28 GAUGE (lancets)

2 DD

COMFORT LANCETS (lancets) 2 DD

COMFORT TOUCH PLUS SAFETY LANC 30 GAUGE (lancets)

2

COMFORT TOUCH ULT THIN LANCETS 31 GAUGE (lancets)

2

DROPLET GENTEEL LANCING DEVICE (lancing device) 2

DROPLET LANCETS 30 GAUGE (lancets) 2 DD

DROPLET LANCING DEVICE (lancing device) 2 DD

EASY CLICK LANCING DEVICE (lancing device) 2 DD

EASY COMFORT LANCETS 30 GAUGE (lancets) 2 DD

EASY MINI EJECT LANCING DEVICE (lancing device) 2 DD

EASY TOUCH LANCING DEVICE (lancing device) 2 DD

EASY TOUCH SAFETY LANCETS 21 GAUGE 23 GAUGE 26 GAUGE (lancets)

2 DD

EASY TOUCH TWIST LANCETS 28 GAUGE 30 GAUGE 32 GAUGE 33 GAUGE (lancets)

2 DD

EASY TWIST AND CAP LANCETS 28 GAUGE (lancets) 2 DD

EMBRACE LANCING DEVICE (lancing device) 2





171



E-Z JECT LANCETS 26 GAUGE 30 GAUGE 32 GAUGE 33 GAUGE (lancets)

2 DD

E-Z JECT THIN LANCETS 28 GAUGE (lancets) 2 DD

EZ SMART LANCETS 28 GAUGE (lancets) 2 DD

EZ-LETS 26 GAUGE (lancets) 2 DD

FIFTY50 SAFETY SEAL LANCETS 30 GAUGE 32 GAUGE (lancets)

2 DD

FINE 30 UNIVERSAL LANCETS 30 GAUGE (lancets) 2 DD

FINGERSTIX LANCETS (lancets) 2 DD

FORA LANCING DEVICE (lancing device) 2 DD

FORACARE LANCETS 30 GAUGE (lancets) 2 DD

FREESTYLE LANCETS 28 GAUGE (lancets) 2 DD

FREESTYLE UNISTIK 2 (lancets) 2 DD

GLUCOCOM LANCETS 28 GAUGE 30 GAUGE 33 GAUGE (lancets)

2 DD

GMATE LANCETS 30 GAUGE (lancets) 2 DD

GMATE LANCING DEVICE (lancing device) 2 DD

GOJJI LANCETS 30 GAUGE (lancets) 2 DD

GOJJI LANCING DEVICE (lancing device) 1 DD

HEALTHY ACCENTS AUTOLET (lancing device) 2 DD

HEALTHY ACCENTS UNILET LANCET 30 GAUGE (lancets)

2 DD

HYPOLANCE AST LANCING KIT (lancing devicelancets) 2 DD

INCONTROL LANCING DEVICE (lancing device) 2 DD

INCONTROL SUPER THIN LANCETS 30 GAUGE (lancets)

2 DD

INCONTROL ULTRA THIN LANCETS 28 GAUGE (lancets) 2 DD

INJECT EASE LANCETS 28 GAUGE 30 GAUGE (lancets) 2 DD

INVACARE LANCETS 30 GAUGE (lancets) 2 DD

LANCETS 21 GAUGE 26 GAUGE 28 GAUGE 30 GAUGE 33 GAUGE

2 DD

LANCETS SUPER THIN (lancets) 2 DD

LANCETSTHIN 23 GAUGE 28 GAUGE (lancets) 2 DD





172



LANCETSULTRA THIN 26 GAUGE (lancets) 2 DD

LANCING DEVICE 2 DD

LANCING DEVICE WITH LANCETS KIT 2 DD

LANCING SYSTEM (lancing device) 2 DD

LANZO LANCING DEVICE KIT (lancing devicelancets) 2 DD

LITE TOUCH LANCETS 28 GAUGE 30 GAUGE 33 GAUGE (lancets)

2 DD

LITE TOUCH LANCING DEVICE (lancing device) 2 DD

MEDISENSE THIN LANCETS 28 GAUGE (lancets) 2 DD

MEDLANCE PLUS LANCETS 21 GAUGE 25 GAUGE 30 GAUGE (lancets)

2 DD

MICRO THIN LANCETS 33 GAUGE (lancets) 2 DD

MICROLET 2 LANCING DEVICE KIT (lancing devicelancets)

2 DD

MICROLET LANCET (lancets) 2 DD

MINI LANCING DEVICE (lancing device) 2 DD

MONOLET LANCETS 21 GAUGE (lancets) 2 DD

MONOLET THIN LANCETS 28 GAUGE (lancets) 2 DD

MULTI-LANCET DEVICE 2 KIT (lancing devicelancets) 2 DD

MYGLUCOHEALTH LANCETS 30 GAUGE (lancets) 2 DD

NOVA SAFETY LANCETS 23 GAUGE 28 GAUGE (lancets)

2 DD

NOVA SUREFLEX LANCETS (lancets) 2 DD

ON CALL LANCET 30 GAUGE (lancets) 2 DD

ON CALL LANCING DEVICE (lancing device) 2 DD

ON CALL PLUS LANCET 30 GAUGE (lancets) 2 DD

ON CALL PLUS LANCING DEVICE (lancing device) 2 DD

ONETOUCH DELICA LANC DEVICE KIT (lancing devicelancets)

2 DD

ONETOUCH DELICA LANCETS 30 GAUGE 33 GAUGE (lancets)

2 DD

ONETOUCH DELICA PLUS LANC DEV KIT (lancing devicelancets)

2 OTC

ONETOUCH DELICA PLUS LANCET 33 GAUGE (lancets) 2 OTC





173



ONETOUCH SURESOFT LANCING DEV 28 GAUGE (lancets)

2 DD

ONETOUCH ULTRASOFT LANCETS (lancets) 2 DD

ONETOUCH VERIO FLEX START KIT (blood-glucose meter)


ONETOUCH VERIO HIGH CONTROL SOLUTION (blood glucose calibration control solution high)

2 DD

ONETOUCH VERIO MID CONTROL SOLUTION (blood glucose calibration control solution normal)

2 DD

ON-THE-GO LANCETS 30 GAUGE (lancets) 2 DD

PIP LANCET 28 GAUGE 30 GAUGE (lancets) 2 DD

PRESSURE ACTIVATED LANCETS 21 GAUGE 28 GAUGE (lancets)

2 DD

PRO COMFORT LANCET 30 GAUGE 31 GAUGE (lancets)

2 DD

PRODIGY LANCETS 26 GAUGE 28 GAUGE (lancets) 2 DD

PRODIGY LANCING DEVICE (lancing device) 2 DD

PRODIGY TWIST TOP LANCET 28 GAUGE (lancets) 2 DD

PURE COMFORT LANCETS 30 GAUGE (lancets) 1 DD

PURE COMFORT SAFETY LANCETS 30 GAUGE (lancets)

1 DD

PUSH BUTTON SAFETY LANCETS 21 GAUGE 28 GAUGE (lancets)

2 DD

READYLANCE SAFETY LANCETS 21 GAUGE 23 GAUGE 26 GAUGE 28 GAUGE 30 GAUGE (lancets)

2 DD

RELIAMED LANCET 23 GAUGE 28 GAUGE 30 GAUGE (lancets)

2 DD

RELIAMED MINI LANCING DEVICE (lancing device) 2 DD

RELIAMED SAFETY SEAL LANCETS 28 GAUGE 30 GAUGE (lancets)

2 DD

RELION THIN LANCETS 26 GAUGE (lancets) 2 DD

RELION ULTRA THIN PLUS LANCETS (lancets) 2 DD

RIGHTEST GD500 LANCING DEVICE (lancing device) 2 DD

RIGHTEST GL300 LANCETS 30 GAUGE (lancets) 2 DD





174



SAFETY LANCETS 21 GAUGE 26 GAUGE 28 GAUGE (lancets)

2 DD

SAFETY SEAL LANCETS 28 GAUGE 30 GAUGE (lancets)

2 DD

SAFETY-LET LANCETS 30 GAUGE (lancets) 2 DD

SINGLE-LET (lancets) 2 DD

SMART SENSE LANCETS 21 GAUGE 26 GAUGE 33 GAUGE (lancets)

2 DD

SMARTDIABETES VANTAGE (lancing device) 2 DD

SMARTEST LANCET (lancets) 2 DD

SOF-SERTER INSERTION DEVICE (diabetic suppliesmiscell)

2 DD

SOFT TOUCH LANCETS (lancets) 2 DD

SOLUS V2 LANCETS 28 GAUGE 30 GAUGE (lancets) 2 DD

SOLUS V2 LANCING DEVICE KIT (lancing devicelancets)

2 DD

STERILANCE TL 30 GAUGE 32 GAUGE (lancets) 2 DD

SUPER THIN LANCETS 28 GAUGE 30 GAUGE (lancets) 2 DD

SURE COMFORT LANCETS 18 GAUGE 21 GAUGE 23 GAUGE 28 GAUGE 30 GAUGE (lancets)

2 DD

SURE COMFORT LANCING PEN (lancing device) 2 DD

SUREFLEX DEVICE WITH LANCETS KIT (lancing devicelancets)

2 DD

SUREFLEX LANCING DEVICE (lancing device) 2 DD

SURE-LANCE 26 GAUGE 28 GAUGE (lancets) 2 DD

SURE-LANCE ULTRA THIN 30 GAUGE (lancets) 2 DD

SURE-PEN LANCING DEVICE (lancing device) 2 DD

SURE-TOUCH LANCET (lancets) 2 DD

TECHLITE LANCETS 25 GAUGE 28 GAUGE 30 GAUGE (lancets)

2 DD

TELCARE LANCETS 30 GAUGE (lancets) 2 DD

THIN LANCETS 26 GAUGE (lancets) 2 DD

TOPCARE UNIVERSAL1 LANCET 33 GAUGE (lancets) 2 DD

TRUE COMFORT LANCET 30 GAUGE (lancets) 2 DD





175



TRUEDRAW LANCING DEVICE (lancing device) 2 DD

TRUEPLUS LANCETS 26 GAUGE 28 GAUGE 30 GAUGE 33 GAUGE (lancets)

2 DD

TWIST LANCETS 30 GAUGE 32 GAUGE (lancets) 2 DD

ULTI-LANCE (lancing device) 2 DD

ULTI-LANCE KIT (lancing devicelancets) 2 DD

ULTILET BASIC LANCETS 30 GAUGE (lancets) 2 DD

ULTILET CLASSIC LANCETS 28 GAUGE 30 GAUGE 33 GAUGE (lancets)

2 DD

ULTILET LANCETS 28 GAUGE 30 GAUGE 33 GAUGE (lancets)

2 DD

ULTILET SAFETY LANCETS 23 GAUGE (lancets) 2 DD

ULTRA FINE LANCETS 30 GAUGE (lancets) 1 OTC

ULTRA THIN II LANCETS 30 GAUGE (lancets) 2 DD

ULTRA THIN LANCETS 28 GAUGE 30 GAUGE 33 GAUGE (lancets)

2 DD

ULTRA THIN LANCETS 31 GAUGE (lancets) 1 OTC Medical

ULTRA THIN PLUS LANCETS 33 GAUGE (lancets) 2 DD

ULTRA TLC LANCETS (lancets) 2 DD

ULTRA-CARE LANCETS 30 GAUGE (lancets) 2 DD

ULTRALANCE LANCETS 26 GAUGE 28 GAUGE (lancets)

2 DD

ULTRA-THIN II LANCETS 26 GAUGE 28 GAUGE (lancets)

2 DD

UNILET COMFORTOUCH LANCET 26 GAUGE (lancets) 2 DD

UNILET EXCELITE II LANCET (lancets) 2 DD

UNILET EXCELITE LANCET (lancets) 2 DD

UNILET GP LANCET (lancets) 2 DD

UNILET LANCET 28 GAUGE 33 GAUGE (lancets) 2 DD

UNILET SUPER THIN LANCETS 30 GAUGE (lancets) 2 DD

UNISTIK 2 DEVICE KIT (lancing devicelancets) 2 DD

UNISTIK 2 EXTRA KIT (lancing devicelancets) 2 DD

UNISTIK 2 NORMAL LANCETDEVICE KIT (lancing devicelancets)

2 DD





176



UNISTIK 3 COMFORT DEVICE KIT (lancing devicelancets)

2 DD

UNISTIK 3 COMFORT LANCET (lancets) 2 DD

UNISTIK 3 EXTRA LANCET 21 GAUGE (lancets) 2 DD

UNISTIK 3 GENTLE 30 GAUGE (lancets) 2 DD

UNISTIK 3 KIT (lancing devicelancets) 2 DD

UNISTIK 3 LANCETS 21 GAUGE (lancets) 2 DD

UNISTIK 3 NEONATAL DEVICE KIT (lancing devicelancets)

2 DD

UNISTIK 3 NORMAL LANCET 23 GAUGE (lancets) 2 DD

UNISTIK CZT LANCET 23 GAUGE 28 GAUGE (lancets) 2 DD

UNISTIK PRO LANCET 21 GAUGE 25 GAUGE 28 GAUGE (lancets)

2 DD

UNISTIK SAFETY 28 GAUGE 30 GAUGE (lancets) 2 DD

UNISTIK TOUCH LANCETS 21 GAUGE 23 GAUGE 28 GAUGE 30 GAUGE (lancets)

2 DD

UNIVERSAL 1 LANCETS 21 GAUGE 26 GAUGE 30 GAUGE 33 GAUGE (lancets)

2 DD

VIVAGUARD LANCET 30 GAUGE (lancets) 1 OTC

VIVAGUARD LANCING DEVICE (lancing device) 2 DD

Medical Supplies And Dme - Incontinence Supplies - Medical Supplies And Durable Medical Equipment

PREVAIL BLADDER CONTROL PAD PAD (incontinence padlinerdisp)

1 OTC Medical

Medical Supplies And Dme - Insulin Needles-Syringes And Admin Supplies - Medical Supplies And Durable Medical Equipment

BD ULTRA-FINE NANO PEN NEEDLE NEEDLE 32 GAUGE X 532 (pen needle diabetic)

2 DD

BD VEO INSULIN SYR (HALF UNIT) SYRINGE 03 ML 31 GAUGE X 1564 (syringe with needleinsulin 03 ml (half unit mark))

2 DD

BD VEO INSULIN SYRINGE UF SYRINGE 1 ML 31 GAUGE X 1564 (syringe with needledisposableinsulin 1 ml)

2 DD





177



BD VEO INSULIN SYRINGE UF SYRINGE 12 ML 31 GAUGE X 1564 (syringe with needleinsulin05 ml)

2 DD

SURE COMFORT INS SYR U-100 SYRINGE 05 ML 29 GAUGE X 12 (syringe with needleinsulin05 ml)

2 DD

Medical Supplies And Dme - Male Condoms - Medical Supplies And Durable Medical Equipment

CONDOMS-PREM LUBRICATED DEVICE (condoms latex lubricated)

2 CT

DUREX AVANTI BARE REAL FEEL (condoms non-latex lubricated)

1 CT

Medical Supplies And Dme - Miscellaneous Other - Medical Supplies And Durable Medical Equipment

SHARPS CONTAINER (containerempty) 2 OTC Medical

Medical Supplies And Dme - Needles And Syringes - Medical Supplies And Durable Medical Equipment

BD LUER-LOK SYRINGE SYRINGE 1 ML (syringe disposable 1 ml)

1

BD LUER-LOK SYRINGE SYRINGE 1 ML 20 GAUGE X 1 (syringe with needledisposable 1 ml)

2

BD PRECISIONGLIDE NON-STERILE NEEDLE 25 GAUGE X 58 (needles disposable)

1

BD REGULAR BEVEL NEEDLES NEEDLE 18 GAUGE X 1 22 GAUGE X 1 (needles disposable)

1

BD SAFETYGLIDE NEEDLE NEEDLE 25 X 58 (needles safety)

1

MONOJECT HYPODERMIC NEEDLES NEEDLE 18 GAUGE X 1 25 GAUGE X 1 14 25 GAUGE X 58 25 X 2 (needles disposable)

1

MONOJECT HYPODERMIC POLYPROPYL NEEDLE 18 GAUGE X 1 12 (needles disposable)

1

SURGUARD2 SAFETY NEEDLE 18 GAUGE X 1 12 18 GAUGE X 1 25 GAUGE X 1 12 25 GAUGE X 1 25 X 58 (needles safety)

1

Medical Supplies And Dme - Peak Flow Meters - Medical Supplies And Durable Medical Equipment





178



AIRZONE PEAK FLOW METER DEVICE (peak flow meter)

2 OTC Medical

ASTHMA CHECK METER DEVICE (peak flow meter) 2 OTC Medical

CLEVER CHOICE PEAK FLOW METER DEVICE (peak flow meter)

2

IN-CHECK NASAL WITH MASK DEVICE (peak flow meter)

2 OTC Medical

IN-CHECK ORAL FLOW METER DEVICE (peak flow meter)

2 OTC Medical

MICROLIFE PEAK FLOW METER DEVICE (peak flow meter)

2 OTC Medical

MINI WRIGHT PEAK FLOW METER DEVICE (peak flow meter)

2

PEAK AIR PEAK FLOW METER DEVICE (peak flow meter)

2 OTC Medical

PERSONAL BEST FULL RANGE DEVICE (peak flow meter)

2 OTC Medical

PIKO 1 DEVICE (peak flow meter) 2 OTC Medical

POCKET PEAK FLOW METER DEVICE (peak flow meter) 2 OTC Medical

PURECOMFORT PEAK FLOW METER DEVICE (peak flow meter)

2

TRUZONE PEAK FLOW METER DEVICE (peak flow meter)

2

Medical Supplies And Dme - Respiratory Therapy Supplies - Medical Supplies And Durable Medical Equipment

AEROCHAMBER MINI SPACER (inhaler assist devices) 2

AEROCHAMBER MV SPACER (inhaler assist devices) 2

AEROCHAMBER PLUS FLOW-VU SPACER (inhaler assist devices)

2

AEROCHAMBER PLUS FLOW-VUS MSK SPACER (inhalerassist device with small mask)

2

AEROCHAMBER PLUS Z STAT LG MSK SPACER (inhalerassist device with large mask)

2

AEROCHAMBER PLUS Z STAT MD MSK SPACER (inhalerassist device with medium mask)

2





179



AEROCHAMBER PLUS Z STAT SM MSK SPACER (inhalerassist device with small mask)

2

AEROCHAMBER PLUS Z STAT SPACER (inhaler assist devices)

2

AEROCHAMBER WITH FLOWSIGNAL SPACER (inhaler assist devices)

2

AEROCHAMBER Z-STAT PLUS-FLW SG SPACER (inhaler assist devices)

2

AEROTRACH PLUS SPACER (inhaler assist devices) 2

BREATHERITE VALVED MDI CHAMBER SPACER (inhaler assist devices)

2

EASIVENT HOLDING CHAMBER SPACER (inhaler assist devices)

2

EASIVENT MASK LARGE DEVICE (inhaler assist devices accessories)

2

EASIVENT MASK MEDIUM DEVICE (inhaler assist devices accessories)

2

EASIVENT MASK SMALL DEVICE (inhaler assist devices accessories)

2

LITE TOUCH-MEDIUM MASK DEVICE (inhaler assist devices accessories)

2

LITEAIRE MDI CHAMBER SPACER (inhaler assist devices)

2

MICROCHAMBER SPACER (inhaler assist devices) 2

MICROSPACER SPACER (inhaler assist devices) 2

MOUTHPIECE DEVICE (inhaler assist devices accessories)

2 OTC Medical

ONE WAY VALVED MOUTHPIECE DEVICE (inhaler assist devices accessories)

2 OTC Medical

OPTICHAMBER ADULT MASK-LARGE DEVICE (inhaler assist devices accessories)

2

OPTICHAMBER DIAMOND LG MASK SPACER (inhalerassist device with large mask)

2

OPTICHAMBER DIAMOND VHC SPACER (inhaler assist devices)

2





180



OPTICHAMBER DIAMOND-MED MSK SPACER (inhalerassist device with medium mask)

2

OPTICHAMBER DIAMOND-SML MASK SPACER (inhalerassist device with small mask)

2

PANDA MASK DEVICE (inhaler assist devices accessories)

2 OTC Medical

PEDIATRIC PANDA MASK DEVICE (inhaler assist devices accessories)

2 OTC Medical

PEDIATRIC SMALL MASK DEVICE (inhaler assist devices accessories)

2 OTC Medical

POCKET CHAMBER SPACER (inhaler assist devices) 2

PRIMEAIRE SPACER (inhaler assist devices) 2

PROCHAMBER SPACER (inhaler assist devices) 2

SIDESTREAM PEDIATRIC FACE MASK DEVICE (inhaler assist devices accessories)

2 OTC Medical

SILICONE MASK - PEDIATRIC DEVICE (inhaler assist devices accessories)

2 OTC Medical

VORTEX ADULT MASK DEVICE (inhaler assist devices accessories)

2 OTC Medical

VORTEX FROG MASK-CHILD DEVICE (inhaler assist devices accessories)

2

VORTEX HOLDING CHAMBER SPACER (inhaler assist devices)

2

VORTEX LADYBUG MASK-TODDLER DEVICE (inhaler assist devices accessories)

2

VORTEX VHC LADYBUG MASK-TODDLR SPACER (inhalerassist device with small mask)

2

Medical Supplies And Dme - Urine Ketone Tests - Medical Supplies And Durable Medical Equipment

KETONE CARE STRIP (urine acetone teststrips) 1 DD

KETONE URINE TEST STRIP (urine acetone teststrips) 1 DD

KETOSTIX STRIP (urine acetone teststrips) 1 DD

Medical Supplies And Dme- Blood Collection Sets With Local Anesthetics - Medical Supplies And Durable Medical Equipment





181



LIDO BDK KIT 21 GAUGE X 1- 25 -25 (blood collection setlidocaineprilocaine)

1

Medical Supply Fdb Superset



2 DD




2 DD



2 DD




2 DD


ACTI-LANCE LANCETS 23 GAUGE 28 GAUGE (lancets) 2 DD



2 DD


2 DD

ADVOCATE LANCET 30 GAUGE (lancets) 2 DD





2


2


2





182




2



2 OTC Medical





2 DD


2 DD



2 DD




2 DD




1


2


2 DD


2 DD


1


1


1





183






2 DD


2 DD


2 DD


2 DD


2


2 DD










2 DD



2




2 DD






184




2


2


2 CT





1 CT


2


2


2


2






2 DD


2 DD




2 DD









185




2 DD








2 DD







2 DD



2 OTC Medical


2 OTC Medical



2 DD







LANCETS 21 GAUGE 26 GAUGE 28 GAUGE 33 GAUGE

2 DD






186





LANCING DEVICE 2 DD





2 DD



2


2



2 DD



2 DD


2 OTC Medical




2

MONOJECT HYPODERMIC NEEDLES NEEDLE 18 GAUGE X 1 25 GAUGE X 1 14 25 X 2 (needles disposable)

1


1




2 OTC Medical






187





2 DD







2 OTC Medical


2 DD


2 DD


2 OTC



2 DD





2 DD


2 DD





2


2


2





188




2


2


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical






2 DD


1 OTC Medical



2 DD







1 DD


2





189




2 DD


2 DD


2 DD



2 DD






2 DD


2 DD



2 OTC Medical


2 OTC Medical



2 DD




2 DD




2 DD







190




2 DD


2 DD



2 DD







1


2 DD






TRUEPLUS KETONE STRIP (urine acetone teststrips) 1 DD

TRUEPLUS LANCETS 26 GAUGE 30 GAUGE 33 GAUGE (lancets)

2 DD


2






2 DD





191




2 DD




ULTRA THIN LANCETS 28 GAUGE 33 GAUGE (lancets) 2 DD





2 DD


2 DD





UNILET LANCET 28 GAUGE (lancets) 2 DD





2 DD







2 DD







192




2 DD



2 DD


2 DD




2 OTC Medical


2


2


2


2

Metabolic Modifiers - Drugs That Alter Metabolism

Hyperparathyroid Treatment Agents - Vitamin D Analog-Type - Drugs That Alter Metabolism



doxercalciferol oral capsule 05 mcg 1 mcg 25 mcg 1 PA

Metabolic Modifier - Carnitine Replenisher Agents - Drugs That Alter Metabolism

levocarnitine (with sugar) oral solution 100 mgml 1 QL (1000 per 1 day)

levocarnitine oral tablet 330 mg 1 QL (290 per 1 day)

Mouth-Throat-Dental - Preparations - Drugs For The Mouth And Throat

Dental Product - Fluoride Preparations - Drugs For The Mouth And Throat

fluoride (sodium) oral drops 05 mg (11 mg sodfluorid)ml

1

Mouth And Throat - Antifungals - Drugs For The Mouth And Throat





193



clotrimazole mucous membrane troche 10 mg 1

nystatin oral suspension 100000 unitml 1 QL (500 per 1 day)

Mouth And Throat - Anti-Infective-Local Anesthetic Combinations - Drugs For The Mouth And Throat

ORASEP MUCOUS MEMBRANE SPRAYNON-AEROSOL 2-05-01 (benzocainementholcetylpyridinium chloride)


Mouth And Throat - Antiseptics - Drugs For The Mouth And Throat

antiseptic mouth cleanser mucous membrane solution 10


cank-oxide mucous membrane solution 10 1 OTC Medical QL (500 per 1 day)

chlorhexidine gluconate mucous membrane mouthwash 012

1

chlorhexidine gluconate (Paroex Oral Rinse Mucous Membrane Mouthwash 012 )

1

chlorhexidine gluconate (Periogard Mucous Membrane Mouthwash 012 )

1

Mouth And Throat - Glucocorticoids - Drugs For The Mouth And Throat

triamcinolone acetonide (Oralone Dental Paste 01 ) 1 QL (5 per 30 days)

triamcinolone acetonide dental paste 01 1 QL (5 per 30 days)

Mouth And Throat - Local Anesthetic Amides - Drugs For The Mouth And Throat


lidocaine hcl mucous membrane solution 4 (40 mgml)


lidocaine hcl (Lidocaine Viscous Mucous Membrane Solution 2 )


Mouth And Throat - Local Anesthetic Esters - Drugs For The Mouth And Throat

anbesol (benzocaine) mucous membrane gel 10 1 OTC Medical

anbesol (benzocaine) mucous membrane liquid 10 1 OTC Medical

Mouth And Throat - Local Anesthetic Others - Drugs For The Mouth And Throat

sore throat (phenol) mucous membrane aerosolspray 14

1 OTC Medical

sore throat mucous membrane aerosolspray 1 OTC Medical





194



Mouth And Throat - Protectants - Drugs For The Mouth And Throat

lemon glycerin mucous membrane swab 75 1

Mouth And Throat - Saliva Stimulants - Drugs For The Mouth And Throat

cevimeline oral capsule 30 mg 1 PA NSO

pilocarpine hcl oral tablet 5 mg 75 mg 1

Periodontal Product - Tetracycline-Type Collagenase Inhibitors - Drugs For The Mouth And Throat

doxycycline hyclate oral tablet 20 mg 1

Ophthalmic Agents - Drugs For The Eye

Artificial Tears And Lubricant Combinations - Drugs For The Eye

ADVANCED EYE RELIEF OPHTHALMIC (EYE) DROPS 1-03 (glycerinpropylene glycol)


artificial tears (petromin) ophthalmic (eye) ointment 83-15

1 OTC Medical

artificial tears (pf) ophthalmic (eye) dropperette 1 OTC Medical QL (35 per 1 day)

artificial tears (pf) ophthalmic (eye) dropperette 01-03


artificial tears(dext70-hypro) ophthalmic (eye) drops 01-03


artificial tears(glycerin-peg) ophthalmic (eye) drops 1-03


artificial tears(pg-hypm-glyc) ophthalmic (eye) drops 1-02-02


artificial tears(pvalch-povid) ophthalmic (eye) drops 05-06


genteal tears mild ophthalmic (eye) drops 01-03 1 OTC Medical QL (35 per 1 day)

GENTEAL TEARS MODERATE OPHTHALMIC (EYE) DROPS 01-03-02 (dextranhypromelloseglycerin)

1 OTC Medical

lubricant eye (cmc-glycerin) ophthalmic (eye) drops 05-09


lubricant eye (pg-peg 400) ophthalmic (eye) drops 04-03






195



lubricant eye ophthalmic (eye) ointment 568-415 573-425

1 OTC Medical

MOISTURE DROPS OPHTHALMIC (EYE) DROPS 1-03 (glycerinpropylene glycol)


natural tears (pf) ophthalmic (eye) dropperette 01-03 1 OTC Medical QL (35 per 1 day)

REFRESH OPTIVE OPHTHALMIC (EYE) DROPS 05-09 (carboxymethylcellulose sodiumglycerin)

2

SYSTANE ULTRA OPHTHALMIC (EYE) DROPS 04-03 (propylene glycolpolyethylene glycol 400)


tears naturale free (pf) ophthalmic (eye) dropperette 01-03


Artificial Tears And Lubricant Single Agents - Drugs For The Eye

ARTIFICIAL TEARS (CMC) OPHTHALMIC (EYE) DROPS 1 (carboxymethylcellulose sodium)


artificial tears (polyvin alc) ophthalmic (eye) drops 14


eq gentle ophthalmic (eye) drops 03 1 OTC Medical

GENTEAL TEARS SEVERE GEL OPHTHALMIC (EYE) GEL 03 (hypromellose)

2 OTC Medical

gonak ophthalmic (eye) drops 25 1 OTC Medical QL (35 per 1 day)

goniosoft ophthalmic (eye) drops 25 1 OTC Medical QL (35 per 1 day)

goniotaire ophthalmic (eye) drops 25 1 OTC Medical QL (35 per 1 day)

goniovisc ophthalmic (eye) drops 25 1 OTC Medical

isopto tears ophthalmic (eye) drops 05 1 OTC Medical QL (35 per 1 day)

lubricant dry eye relief ophthalmic (eye) drops liquid gel 1


lubricant eye drops ophthalmic (eye) drops 025 1 OTC Medical

lubricant eye drops ophthalmic (eye) drops 05 1 OTC Medical QL (35 per 1 day)

lubricating plus ophthalmic (eye) dropperette 05 1 OTC Medical QL (35 per 1 day)





196



pure and gentle eye ophthalmic (eye) drops 03 1 OTC Medical QL (35 per 1 day)

REFRESH CELLUVISC OPHTHALMIC (EYE) DROPPERETTEGEL 1 (carboxymethylcellulose sodium)


REFRESH CONTACTS OPHTHALMIC (EYE) DROPS (carboxymethylcellulose sodium)


restore tears ophthalmic (eye) drops 05 1 OTC Medical QL (35 per 1 day)

revive plus ophthalmic (eye) dropperette 05 1 OTC Medical QL (35 per 1 day)

STERILE LUBRICANT OPHTHALMIC (EYE) DROPS LIQUID GEL 07 (carboxymethylcellulose sodium)


SYSTANE GEL OPHTHALMIC (EYE) GEL 03 (hypromellose)

2 OTC Medical

tears again (pva) ophthalmic (eye) drops 14 1 OTC Medical QL (35 per 1 day)

THERATEARS OPHTHALMIC (EYE) DROPPERETTEGEL 1 (carboxymethylcellulose sodium)


THERATEARS OPHTHALMIC (EYE) DROPS 025 (carboxymethylcellulose sodium)


Miotics - Cholinesterase Inhibitors - Drugs For Glaucoma

PHOSPHOLINE IODIDE OPHTHALMIC (EYE) DROPS 0125 (echothiophate iodide)

2 QL (35 per 1 day)

Miotics - Direct Acting - Drugs For Glaucoma

pilocarpine hcl ophthalmic (eye) drops 1 2 4 1 QL (35 per 1 day)

Ophthalmic - Antibacterial-Glucocorticoid Combinations - Anti-InfectiveAnti-Inflammatories

sulfacetamide sodiumprednisolone acetate (Blephamide SOP Ophthalmic (Eye) Ointment 10-02 )

2

neomycin-bacitracin-poly-hc ophthalmic (eye) ointment 35-400-10000 mg-unitg-1

1

neomycin-polymyxin b-dexameth ophthalmic (eye) dropssuspension 35mgml-10000 unitml-01

1 QL (35 per 1 day)





197



neomycin-polymyxin b-dexameth ophthalmic (eye) ointment 35 mgg-10000 unitg-01

1

neomycin-polymyxin-hc ophthalmic (eye) dropssuspension 35-10000-10 mg-unit-mgml

1 QL (35 per 1 day)

neomycin sulfatebacitracin zincpolymyxin bhydrocortisone (Neo-Polycin Hc Ophthalmic (Eye) Ointment 35-400-10000 Mg-UnitG-1)

1

sulfacetamide-prednisolone ophthalmic (eye) drops 10 -023 (025 )

1 QL (35 per 1 day)

TOBRADEX OPHTHALMIC (EYE) OINTMENT 03-01 (tobramycindexamethasone)

2

tobramycin-dexamethasone ophthalmic (eye) dropssuspension 03-01

1 QL (35 per 1 day)

Ophthalmic - Anticholinergics - Drugs For The Eye

atropine ophthalmic (eye) drops 1 1 QL (35 per 1 day)

atropine ophthalmic (eye) ointment 1 1

cyclopentolate ophthalmic (eye) drops 05 1 2 1 QL (35 per 1 day)

homatropaire ophthalmic (eye) drops 5 1 QL (35 per 1 day)

homatropine hbr ophthalmic (eye) drops 5 1 QL (35 per 1 day)

tropicamide ophthalmic (eye) drops 05 1 1

Ophthalmic - Antihistamine-Decongestant Combinations - Drugs For Itchy Eye

allergy eye (naphazoline-phen) ophthalmic (eye) drops 0025-03


eye allergy relief ophthalmic (eye) drops 002675-0315


NAPHCON-A OPHTHALMIC (EYE) DROPS 0025-03 (naphazoline hclpheniramine maleate)


OPCON-A OPHTHALMIC (EYE) DROPS 002675-0315 (naphazoline hclpheniramine maleate)


Ophthalmic - Antihistamines - Drugs For Itchy Eye

alaway ophthalmic (eye) drops 0025 (0035 ) 1 OTC QL (35 per 1 day)

azelastine ophthalmic (eye) drops 005 1 OTC Medical

ketotifen fumarate ophthalmic (eye) drops 0025 (0035 )

1 OTC QL (35 per 1 day)





198



olopatadine ophthalmic (eye) drops 01 02 1

wal-zyr (ketotifen) ophthalmic (eye) drops 0025 (0035 )


ZADITOR OPHTHALMIC (EYE) DROPS 0025 (0035 ) (ketotifen fumarate)


Ophthalmic - Anti-Inflammatory Glucocorticoids - Anti-InfectiveAnti-Inflammatories

dexamethasone sodium phosphate ophthalmic (eye) drops 01

1 QL (35 per 1 day)

FLAREX OPHTHALMIC (EYE) DROPSSUSPENSION 01 (fluorometholone acetate)

2 QL (35 per 1 day)

fluorometholone ophthalmic (eye) dropssuspension 01

1 QL (35 per 1 day)

FML SOP OPHTHALMIC (EYE) OINTMENT 01 (fluorometholone)

2

MAXIDEX OPHTHALMIC (EYE) DROPSSUSPENSION 01 (dexamethasone)

2 QL (1 per 1 day)

PRED MILD OPHTHALMIC (EYE) DROPSSUSPENSION 012 (prednisolone acetate)

2 QL (35 per 1 day)

prednisolone acetate (pf) ophthalmic (eye) dropssuspension 1

1 QL (35 per 1 day)

prednisolone acetate ophthalmic (eye) dropssuspension 1

1 QL (35 per 1 day)

prednisolone sodium phosphate ophthalmic (eye) drops 1

1 QL (35 per 1 day)

Ophthalmic - Anti-Inflammatory Nsaids - Anti-InfectiveAnti-Inflammatories

bromfenac ophthalmic (eye) drops 009 1 PA NSO

diclofenac sodium ophthalmic (eye) drops 01 1 QL (35 per 1 day)

flurbiprofen sodium ophthalmic (eye) drops 003 1 QL (5 per 1 day)

ketorolac ophthalmic (eye) drops 04 05 1 QL (35 per 1 day)

Ophthalmic - Beta Blockers-Carbonic Anhydrase Inhibitor Combinations - Drugs For Glaucoma

dorzolamide-timolol ophthalmic (eye) drops 223-68 mgml

1 QL (35 per 1 day)

Ophthalmic - Carbonic Anhydrase Inhibitors - Drugs For Glaucoma





199



dorzolamide ophthalmic (eye) drops 2 1 QL (35 per 1 day)

Ophthalmic - Decongestants - Drugs For Itchy Eye

phenylephrine hcl ophthalmic (eye) drops 10 25 1 QL (35 per 1 day)

Ophthalmic - Diagnostic Agents - Drugs For The Eye

flucaine ophthalmic (eye) drops 025-05 1 QL (35 per 1 day)

fluorescein-proparacaine ophthalmic (eye) drops 025-05

1 QL (35 per 1 day)

Ophthalmic - Gonioscopic Solutions - Drugs For The Eye





Ophthalmic - Hyperosmolar Agents - Drugs For The Eye

artificial tears(dext70-hypro) ophthalmic (eye) drops 1 OTC Medical QL (35 per 1 day)

muro 128 ophthalmic (eye) drops 2 5 1

muro 128 ophthalmic (eye) ointment 5 1 OTC Medical

retaine nacl ophthalmic (eye) drops 5 1 OTC Medical

retaine nacl ophthalmic (eye) ointment 5 1 OTC Medical

sochlor ophthalmic (eye) drops 5 1 OTC Medical

sochlor ophthalmic (eye) ointment 5 1 OTC Medical

sodium chloride ophthalmic (eye) drops 5 1 OTC Medical

sodium chloride ophthalmic (eye) ointment 5 1 OTC Medical

Ophthalmic - Intraocular Pressure Reducing Agents Beta-Blockers - Drugs For Glaucoma

levobunolol ophthalmic (eye) drops 05 1 QL (35 per 1 day)

metipranolol ophthalmic (eye) drops 03 1 QL (35 per 1 day)

timolol maleate ophthalmic (eye) drops 025 05 1 QL (35 per 1 day)

Ophthalmic - Irrigation Solutions - Drugs For The Eye





200



collyrium ophthalmic (eye) irrigation solution 1 OTC Medical QL (500 per 1 day)

EYE IRRIGATING SOLUTION OPHTHALMIC (EYE) IRRIGATION SOLUTION (sodium borateboric acidwatersodium chloride)


eye wash (boric acid) ophthalmic (eye) irrigation solution


eye wash sterile ophthalmic (eye) solution 1 OTC Medical QL (500 per 1 day)

OCUSOFT IRRIGATING OPHTH SOLN OPHTHALMIC (EYE) DROPS (sodium phosphatemonobasicsodium chloride)


sterile eye wash ophthalmic (eye) irrigation solution 1 OTC Medical QL (500 per 1 day)

Ophthalmic - Local Anesthetic Esters - Drugs For The Eye

proparacaine hcl (Alcaine Ophthalmic (Eye) Drops 05 ) 1

proparacaine ophthalmic (eye) drops 05 1

Ophthalmic - Local Anesthetic Amides - Drugs For The Eye

AKTEN (PF) OPHTHALMIC (EYE) GEL 35 (lidocaine hclpf)

1

Ophthalmic - Mast Cell Stabilizers - Drugs For Itchy Eye

cromolyn ophthalmic (eye) drops 4 1 QL (35 per 1 day)

Ophthalmic Antibacterial Mixtures - Anti-InfectiveAnti-Inflammatories

bacitracin-polymyxin b ophthalmic (eye) ointment 500-10000 unitgram

1

neomycin-bacitracin-polymyxin ophthalmic (eye) ointment 35-400-10000 mg-unit-unitg

1

neomycin-polymyxin-gramicidin ophthalmic (eye) drops 175 mg-10000 unit-0025mgml

1 QL (35 per 1 day)

neomycin sulfatebacitracinpolymyxin b (Neo-Polycin Ophthalmic (Eye) Ointment 35-400-10000 Mg-Unit-UnitG)

1 OTC Medical

bacitracinpolymyxin b sulfate (Polycin Ophthalmic (Eye) Ointment 500-10000 UnitGram)

1

polymyxin b sulf-trimethoprim ophthalmic (eye) drops 10000 unit- 1 mgml

1 QL (35 per 1 day)





201



Ophthalmic Antibiotic - Aminoglycosides - Anti-InfectiveAnti-Inflammatories

gentamicin sulfate (Gentak Ophthalmic (Eye) Ointment 03 (3 MgGram))

1

gentamicin ophthalmic (eye) drops 03 1 QL (35 per 1 day)

gentamicin ophthalmic (eye) ointment 03 (3 mggram)

1

tobramycin ophthalmic (eye) drops 03 1 QL (35 per 1 day)

TOBREX OPHTHALMIC (EYE) OINTMENT 03 (tobramycin)

2

Ophthalmic Antibiotic - Dehydropeptidase Inhibitors - Anti-InfectiveAnti-Inflammatories

bacitracin ophthalmic (eye) ointment 500 unitgram 1

Ophthalmic Antibiotic - Fluoroquinolones - Anti-InfectiveAnti-Inflammatories

CILOXAN OPHTHALMIC (EYE) OINTMENT 03 (ciprofloxacin hcl)

2

ciprofloxacin hcl ophthalmic (eye) drops 03 1 QL (35 per 1 day)

levofloxacin ophthalmic (eye) drops 05 1 QL (1 per 1 day)

moxifloxacin ophthalmic (eye) drops 05 1 QL (35 per 1 day)

ofloxacin ophthalmic (eye) drops 03 1 QL (35 per 1 day)

Ophthalmic Antibiotic - Macrolides - Anti-InfectiveAnti-Inflammatories

erythromycin ophthalmic (eye) ointment 5 mggram (05 )

1

Ophthalmic Antibiotic - Sulfonamides - Anti-InfectiveAnti-Inflammatories

sulfacetamide sodium (Bleph-10 Ophthalmic (Eye) Drops 10 )

1 QL (35 per 1 day)

sulfacetamide sodium ophthalmic (eye) drops 10 1 QL (35 per 1 day)

sulfacetamide sodium ophthalmic (eye) ointment 10 1

Ophthalmic Antifungals - Anti-InfectiveAnti-Inflammatories

NATACYN OPHTHALMIC (EYE) DROPSSUSPENSION 5 (natamycin)

2 QL (35 per 1 day)

Ophthalmic Antifungals - Tetraene Polyene-Type - Drugs For The Eye


2 QL (35 per 1 day)





202



Ophthalmic Antivirals - Anti-InfectiveAnti-Inflammatories

trifluridine ophthalmic (eye) drops 1 1 QL (35 per 1 day)

Ophthalmic-Intraocular Press Reducing Sel Alpha Adrenergic Agonists - Drugs For Glaucoma

brimonidine ophthalmic (eye) drops 02 1 QL (35 per 1 day)

Ophthalmic-Intraocular Pressure Reducing Agents Prostaglandin Analogs - Drugs For Glaucoma

latanoprost ophthalmic (eye) drops 0005 1 QL (25 per 1 day)

Ophthalmic-Intraocular Pressure Reducing Agents Rho Kinase Inhibitors - Drugs For Glaucoma

RHOPRESSA OPHTHALMIC (EYE) DROPS 002 (netarsudil mesylate)

2 PA

Otic (Ear) - Drugs For The Ear

Otic (Ear) - Anti-Infective Mixtures - Anti-InfectiveAnti-Inflammatories

acetic acid-aluminum acetate otic (ear) drops 2 1 QL (35 per 1 day)

Otic (Ear) - Anti-Infective-Glucocorticoid Combinations - Anti-InfectiveAnti-Inflammatories

CIPRO HC OTIC (EAR) DROPSSUSPENSION 02-1 (ciprofloxacin hclhydrocortisone)

2 QL (35 per 1 day)

ciprofloxacin-dexamethasone otic (ear) dropssuspension 03-01

1 QL (35 per 1 day)

CORTISPORIN-TC OTIC (EAR) DROPSSUSPENSION 33-3-10-05 MGML (neomycin sulfcolistin sulhydrocortisone acthonzonium brom)

2 QL (35 per 1 day)

neomycin-polymyxin-hc otic (ear) dropssuspension 35-10000-1 mgml-unitml-

1 QL (35 per 1 day)

neomycin-polymyxin-hc otic (ear) solution 35-10000-1 mgml-unitml-

1 QL (35 per 1 day)

Otic (Ear) - Anti-Infectives Other - Antibiotics

acetic acid otic (ear) solution 2 1 QL (35 per 1 day)

Otic (Ear) - Fluoroquinolones - Antibiotics

ciprofloxacin hcl otic (ear) dropperette 02 1 QL (2 per 1 day)

ofloxacin otic (ear) drops 03 1 QL (35 per 1 day)





203



Otic (Ear) - Glucocorticoids - Anti-InfectiveAnti-Inflammatories

hydrocortisoneacetic acid (Acetasol Hc Otic (Ear) Drops 1-2 )

1 QL (35 per 1 day)

hydrocortisone-acetic acid otic (ear) drops 1-2 1 QL (35 per 1 day)

Otic (Ear) - Wax Removers-Softeners - Wax Removal

auro eardrops otic (ear) drops 65 1 OTC Medical QL (35 per 1 day)

debrox otic (ear) drops 65 1 OTC Medical QL (35 per 1 day)

ear drops (carbamide peroxide) otic (ear) drops 65 1 OTC Medical QL (35 per 1 day)

ear drops otc otic (ear) drops 65 1 OTC Medical QL (35 per 1 day)

ear wax removal system otic (ear) combo pack 65 1 OTC Medical QL (35 per 1 day)

murine ear wax removal system otic (ear) drops 65 1 OTC Medical QL (35 per 1 day)

Respiratory Therapy Agents - Drugs For The Lungs

1St Generation Antihistamine-Decongestant Combinations - Drugs For Cough And Cold

aprodine oral tablet 25-60 mg 1 OTC Medical

child dometuss-da oral liquid 1-25 mg5 ml 1 OTC Medical QL (500 per 1 day)

childrens dibromm cold-allerg oral solution 1-25 mg5 ml


cold and allergy (bromphen-pe) oral solution 1-25 mg5 ml


cold and allergy(triprolidine) oral tablet 25-60 mg 1 OTC Medical

cold-allergy-sinus oral tablet 25-60 mg 1 OTC Medical

dallergy (chlorpheniramine-pe) oral drops 1-25 mgml 1 OTC Medical

ed a-hist oral liquid 4-10 mg5 ml 1 OTC Medical QL (500 per 1 day)

ed a-hist oral tablet 4-10 mg 1 OTC Medical





204



ED CHLORPED D ORAL DROPS 2-5 MGML (chlorpheniramine maleatephenylephrine hcl)


EXAPHEN ORAL TABLET 35-10 MG (chlorpheniramine maleatephenylephrine hcl)

2 OTC Medical

glenmax peb oral liquid 4-10 mg5 ml 1 OTC Medical QL (500 per 1 day)

LODRANE D ORAL CAPSULE 4-60 MG (brompheniramine maleatepseudoephedrine hcl)

2 OTC Medical

lohist - d oral liquid 2-30 mg5 ml 1 OTC Medical QL (500 per 1 day)

MAXIFED TR ORAL TABLET 125-30 MG (triprolidine hclpseudoephedrine hcl)

2 OTC Medical

maxi-tuss pe oral liquid 2-5 mg5 ml 1 OTC Medical QL (500 per 1 day)

maxi-tuss tr oral syrup 125-30 mg5 ml 1 OTC Medical QL (500 per 1 day)

nasal decongest-antihistamine oral tablet 25-60 mg 1 OTC Medical

PHENAGIL ORAL TABLET 35-10 MG (chlorpheniramine maleatephenylephrine hcl)

2 OTC Medical

promethazine-phenylephrine oral syrup 625-5 mg5 ml 1 QL (500 per 1 day)

rynex pse oral liquid 1-15 mg5 ml 1 OTC Medical QL (500 per 1 day)

suphedrine pe cold and allergy oral tablet 4-10 mg 1 OTC Medical

wal-act d cold and allergy oral tablet 25-60 mg 1 OTC Medical

wal-tap oral solution 1-25 mg5 ml 1 OTC Medical QL (500 per 1 day)

2Nd Generation Antihistamine-Decongestant Combinations - Drugs For Cough And Cold

alavert d-12 allergy-sinus oral tablet extended release 12 hr 5-120 mg


allerclear d-12hr oral tablet extended release 12 hr 5-120 mg


allergy relief d12 oral tablet extended release 12 hr 5-120 mg


allergy relief-d (cetirizine) oral tablet extended release 12 hr 5-120 mg






205



allergy relief-d(fexofenadine) oral tablet extended release 12 hr 60-120 mg


aller-tec d oral tablet extended release 12 hr 5-120 mg 1 OTC QL (2 per 1 day)

cetiri-d oral tablet extended release 12 hr 5-120 mg 1 OTC QL (2 per 1 day)

fexofenadine-pseudoephedrine oral tablet extended release 12 hr 60-120 mg



1 QL (1 per 1 day)

wal-itin d 12 hour oral tablet extended release 12 hr 5-120 mg


Antihistamine - 1St Generation - Alkylamines - Drugs For Allergies

aller-chlor oral tablet 4 mg 1 OTC Medical

allergy (chlorpheniramine) oral tablet 4 mg 1 OTC Medical

chlorhist oral tablet 4 mg 1 OTC Medical

wal-finate oral tablet 4 mg 1 OTC Medical

Antihistamine - 1St Generation - Ethanolamines - Drugs For Allergies

aler-cap oral capsule 25 mg 1 OTC Medical


allergy (diphenhydramine) oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

allergy medication oral capsule 25 mg 1 OTC Medical

allergy medicine oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

allergy medicine oral tablet 25 mg 1 OTC Medical

allergy relief(diphenhydramin) oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

antihistamine oral capsule 25 mg 1 OTC Medical

banophen allergy oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

banophen oral capsule 25 mg 50 mg 1 OTC Medical

banophen oral tablet 25 mg 1 OTC Medical

BENADRYL ALLERGY ORAL LIQUID 125 MG5 ML (diphenhydramine hcl)

1 OTC Medical





206



BENADRYL ALLERGY ORAL TABLET 25 MG (diphenhydramine hcl)

1 OTC Medical

childrens allergy (diphenhyd) oral elixir 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

childrens allergy (diphenhyd) oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

childrens allergy (diphenhyd) oral tabletchewable 125 mg

1 OTC Medical

childrens aurodryl allergy oral liquid 125 mg5 ml 1 OTC

clemastine oral tablet 268 mg 1


dailyhist-1 oral tablet 134 mg 1 OTC Medical

dayhist allergy oral tablet 134 mg 1 OTC Medical

diphedryl oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

diphenhist oral capsule 25 mg 1 OTC Medical

diphenhist oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

diphenhist oral tablet 25 mg 1 OTC Medical

diphenhydramine hcl injection solution 50 mgml 1

diphenhydramine hcl injection syringe 50 mgml 1


diphenhydramine hcl oral elixir 125 mg5 ml 1

diphenhydramine hcl oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

diphenhydramine hcl oral syrup 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

geri-dryl oral liquid 125 mg5 ml 1

m-dryl oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

naramin oral liquid in packet 125 mg5 ml 1 OTC Medical QL (500 per 1 day)


q-dryl oral capsule 25 mg 1 OTC Medical





207



q-dryl oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)


siladryl sa oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

silphen cough oral syrup 125 mg5 ml 1 OTC Medical QL (500 per 1 day)




total allergy medicine oral tablet 25 mg 1 OTC Medical

valu-dryl allergy oral tablet 25 mg 1 OTC Medical

valu-dryl oral tabletchewable 125 mg 1 OTC Medical

wal-dryl allergy oral capsule 25 mg 1 OTC Medical

wal-dryl allergy oral liquid 125 mg5 ml 1 OTC Medical QL (500 per 1 day)

wal-dryl allergy oral tablet 25 mg 1 OTC Medical

Antihistamine - 1St Generation - Phenothiazines - Drugs For Allergies


1





1

Antihistamine - 1St Generation - Piperidines - Drugs For Allergies

cyproheptadine oral syrup 2 mg5 ml 1 QL (500 per 1 day)

cyproheptadine oral tablet 4 mg 1

Antihistamines - 1St Generation - Drugs For Allergies









208












1 OTC Medical


1 OTC Medical



1 OTC Medical


















209












1





1

















210












Antihistamines - 2Nd Generation - Drugs For Allergies

alavert oral tabletdisintegrating 10 mg 1 OTC

all day allergy (cetirizine) oral solution 1 mgml 1 OTC QL (500 per 1 day)

all day allergy (cetirizine) oral tabletchewable 10 mg 1 PA NSO OTC

ALLEGRA ALLERGY ORAL TABLET 60 MG (fexofenadine hcl)

1 PA NSO OTC

aller-ease oral suspension 30 mg5 ml 1 OTC Medical QL (240 per 1 day)

allergy relief (cetirizine) oral solution 1 mgml 1 OTC QL (500 per 1 day)

allergy relief (loratadine) oral tabletdisintegrating 10 mg

1 OTC

aller-tec oral tablet 10 mg 1 OTC

cetirizine oral solution 1 mgml 5 mg5 ml 1 OTC QL (500 per 1 day)

cetirizine oral tablet 10 mg 5 mg 1 OTC

cetirizine oral tabletchewable 10 mg 5 mg 1 PA NSO OTC

child allergy relf(cetirizine) oral solution 1 mgml 1 OTC QL (500 per 1 day)

child allergy relf(cetirizine) oral tabletchewable 10 mg 1 PA NSO OTC

childrens allegra allergy oral suspension 30 mg5 ml 1 OTC Medical QL (240 per 1 day)

childrens allergy complete oral solution 1 mgml 1 OTC QL (500 per 1 day)

childrens allergy relief(fex) oral suspension 30 mg5 ml 1 OTC Medical QL (240 per 1 day)

childrens allergy relief(lor) oral tabletchewable 5 mg 1 OTC





211



childrens allergy(cetirizine) oral solution 1 mgml 1 OTC QL (500 per 1 day)

childrens aller-tec oral solution 1 mgml 1 OTC QL (500 per 1 day)

childrens cetirizine oral solution 1 mgml 1 OTC QL (500 per 1 day)

childrens cetirizine oral tabletchewable 10 mg 1 PA NSO OTC

childrens wal-fex oral suspension 30 mg5 ml 1 OTC Medical QL (240 per 1 day)

childrens wal-zyr oral solution 1 mgml 1 OTC QL (500 per 1 day)

childrens wal-zyr oral tabletchewable 10 mg 1 PA NSO OTC

CHILDRENS ZYRTEC ALLERGY ORAL SOLUTION 1 MGML (cetirizine hcl)


childs all day allergy(cetir) oral solution 1 mgml 1 OTC QL (500 per 1 day)

CLARITIN REDITABS ORAL TABLETDISINTEGRATING 5 MG (loratadine)

2 OTC Medical

fexofenadine oral suspension 30 mg5 ml 1 OTC Medical QL (240 per 1 day)

fexofenadine oral tablet 180 mg 1 OTC QL (1 per 1 day)


loradamed oral tablet 10 mg 1 OTC

loratadine oral solution 5 mg5 ml 1 OTC QL (500 per 1 day)

loratadine oral tablet 10 mg 1 OTC

loratadine oral tabletdisintegrating 10 mg 1 OTC

wal-fex allergy oral tablet 180 mg 1 OTC QL (1 per 1 day)


wal-itin oral solution 5 mg5 ml 1 OTC QL (500 per 1 day)

wal-itin oral tablet 10 mg 1 OTC

wal-itin oral tabletdisintegrating 10 mg 1 OTC

wal-zyr (cetirizine) oral tablet 10 mg 1 OTC

Antihistamines - 2Nd Generation - Piperazines - Drugs For Allergies




cetirizine oral solution 5 mg5 ml 1 OTC QL (500 per 1 day)






212

















Antihistamines - 2Nd Generation - Piperidines - Drugs For Allergies



1 PA NSO OTC



1 OTC






2 OTC Medical







213













Antitussives - Non-Opioid - Drugs For Allergies

benzonatate oral capsule 100 mg 200 mg 1

day-time cough oral syrup 5 mg5 ml 1 OTC Medical QL (500 per 1 day)

dextromethorphan polistirex oral suspensionextended rel 12 hr 30 mg5 ml

1 OTC Medical

robitussin pediatric oral syrup 75 mg5 ml 1 OTC Medical QL (500 per 1 day)

tussin cough (dm only) oral liquid 15 mg5 ml 1 OTC Medical QL (500 per 1 day)

vicks dayquil cough oral syrup 5 mg5 ml 1 OTC Medical QL (500 per 1 day)

Asthma Therapy - AlphaBeta Adrenergic Agents - Drugs For AsthmaCopd


epinephrine injection syringe 01 mgml 1 QL (4 per 365 days)

Asthma Therapy - Inhaled Corticosteroids (Glucocorticoids) - Drugs For AsthmaCopd

AEROSPAN INHALATION HFA AEROSOL INHALER 80 MCGACTUATION (flunisolide)

2

ARMONAIR RESPICLICK INHALATION AEROSOL POWDR BREATH ACTIVATED 113 MCGACTUATION 232 MCGACTUATION 55 MCGACTUATION (fluticasone propionate)

2





214



ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE 100 MCGACTUATION 200 MCGACTUATION 50 MCGACTUATION (fluticasone furoate)

2

ASMANEX HFA INHALATION HFA AEROSOL INHALER 100 MCGACTUATION 200 MCGACTUATION 50 MCGACTUATION (mometasone furoate)

2

ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG ACTUATION (30) 110 MCG ACTUATION (7) 220 MCG ACTUATION (120) 220 MCG ACTUATION (14) 220 MCG ACTUATION (30) 220 MCG ACTUATION (60) (mometasone furoate)

2

budesonide inhalation suspension for nebulization 025 mg2 ml 05 mg2 ml 1 mg2 ml

1

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCGACTUATION 250 MCGACTUATION 50 MCGACTUATION (fluticasone propionate)

2

FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCGACTUATION 220 MCGACTUATION 44 MCGACTUATION (fluticasone propionate)

2

PULMICORT FLEXHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 180 MCGACTUATION 90 MCGACTUATION (budesonide)

2

QVAR INHALATION AEROSOL 40 MCGACTUATION 80 MCGACTUATION (beclomethasone dipropionate)

2

QVAR REDIHALER INHALATION HFA AEROSOL BREATH ACTIVATED 40 MCGACTUATION 80 MCGACTUATION (beclomethasone dipropionate)

2

Asthma Therapy - Leukotriene Receptor Antagonists - Drugs For AsthmaCopd

montelukast oral granules in packet 4 mg 1 AGE (Max 1 Years)

montelukast oral tablet 10 mg 1

montelukast oral tabletchewable 4 mg 5 mg 1

Asthma Therapy - Mast Cell Stabilizers - Drugs For AsthmaCopd

cromolyn inhalation solution for nebulization 20 mg2 ml






215



Asthma Therapy - Monoclonal Antibodies To Immunoglobulin E (Ige) - Drugs For AsthmaCopd

XOLAIR SUBCUTANEOUS SYRINGE 150 MGML 75 MG05 ML (omalizumab)

2 PA

Asthma Therapy - Xanthines - Drugs For AsthmaCopd

theophylline anhydrous (Elixophyllin Oral Elixir 80 Mg15 Ml)

1

theophylline anhydrous (Theochron Oral Tablet Extended Release 12 Hr 100 Mg 200 Mg 300 Mg)

1

theophylline oral solution 80 mg15 ml 1

theophylline oral tablet extended release 12 hr 100 mg 200 mg 300 mg 450 mg

1

theophylline oral tablet extended release 24 hr 400 mg 600 mg

1

AsthmaCopd - Phosphodiesterase-4 (Pde4) Inhibitors - Drugs For AsthmaCopd

DALIRESP ORAL TABLET 250 MCG 500 MCG (roflumilast)

2 PA NSO

AsthmaCopd - Anticholinergic Agents Inhaled Long Acting - Drugs For AsthmaCopd

INCRUSE ELLIPTA INHALATION BLISTER WITH DEVICE 625 MCGACTUATION (umeclidinium bromide)

2

TUDORZA PRESSAIR INHALATION AEROSOL POWDR BREATH ACTIVATED 400 MCGACTUATION (aclidinium bromide)

2

AsthmaCopd - Anticholinergic Agents Inhaled Short Acting - Drugs For AsthmaCopd

ATROVENT HFA INHALATION HFA AEROSOL INHALER 17 MCGACTUATION (ipratropium bromide)

2

ipratropium bromide inhalation solution 002 1 QL (500 per 1 day)

AsthmaCopd - Beta 2-Adrenergic Agents Inhaled Ultra-Long Acting - Drugs For AsthmaCopd

ARCAPTA NEOHALER INHALATION CAPSULE WINHALATION DEVICE 75 MCG (indacaterol maleate)

2 PA NSO





216



STRIVERDI RESPIMAT INHALATION MIST 25 MCGACTUATION (olodaterol hcl)

2

AsthmaCopd Therapy - Beta 2-Adrenergic Agents Inhaled Long Acting - Drugs For AsthmaCopd

SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50 MCGDOSE (salmeterol xinafoate)

2 PA NSO AGE (Max 17 Years)

AsthmaCopd Therapy - Beta 2-Adrenergic Agents Inhaled Short Acting - Drugs For AsthmaCopd

albuterol sulfate inhalation hfa aerosol inhaler 90 mcgactuation

1

albuterol sulfate inhalation solution for nebulization 063 mg3 ml 125 mg3 ml 25 mg 3 ml (0083 ) 5 mgml

1

levalbuterol tartrate inhalation hfa aerosol inhaler 45 mcgactuation

1

PROAIR RESPICLICK INHALATION AEROSOL POWDR BREATH ACTIVATED 90 MCGACTUATION (albuterol sulfate)

2

AsthmaCopd Therapy - Beta Adrenergic Agents - Drugs For AsthmaCopd

albuterol sulfate oral syrup 2 mg5 ml 1 QL (500 per 1 day)

albuterol sulfate oral tablet 2 mg 4 mg 1 PA NSO

albuterol sulfate oral tablet extended release 12 hr 4 mg 8 mg

1 PA NSO

metaproterenol oral tablet 10 mg 20 mg 1 PA NSO

AsthmaCopd Therapy - Beta Adrenergic-Anticholinergic Combinations - Drugs For AsthmaCopd

ANORO ELLIPTA INHALATION BLISTER WITH DEVICE 625-25 MCGACTUATION (umeclidinium bromidevilanterol trifenatate)

2

BEVESPI AEROSPHERE INHALATION HFA AEROSOL INHALER 9-48 MCG (glycopyrrolateformoterol fumarate)

2

COMBIVENT RESPIMAT INHALATION MIST 20-100 MCGACTUATION (ipratropium bromidealbuterol sulfate)

2





217



ipratropium-albuterol inhalation solution for nebulization 05 mg-3 mg(25 mg base)3 ml

1 QL (1500 per 30 days)

STIOLTO RESPIMAT INHALATION MIST 25-25 MCGACTUATION (tiotropium bromideolodaterol hcl)

2

UTIBRON NEOHALER INHALATION CAPSULE WINHALATION DEVICE 275-156 MCG (indacaterol maleateglycopyrrolate)

2

AsthmaCopd Therapy - Beta Adrenergic-Glucocorticoid Combinations - Drugs For AsthmaCopd

ADVAIR HFA INHALATION HFA AEROSOL INHALER 115-21 MCGACTUATION 230-21 MCGACTUATION 45-21 MCGACTUATION (fluticasone propionatesalmeterol xinafoate)

2 PA

BREO ELLIPTA INHALATION BLISTER WITH DEVICE 100-25 MCGDOSE 200-25 MCGDOSE (fluticasone furoatevilanterol trifenatate)

2 PA

budesonide-formoterol inhalation hfa aerosol inhaler 160-45 mcgactuation 80-45 mcgactuation


fluticasone propion-salmeterol inhalation aerosol powdr breath activated 113-14 mcgactuation 232-14 mcgactuation 55-14 mcgactuation

1

fluticasone propion-salmeterol inhalation blister with device 100-50 mcgdose 250-50 mcgdose 500-50 mcgdose


fluticasone propionatesalmeterol xinafoate (Wixela Inhub Inhalation Blister With Device 100-50 McgDose 250-50 McgDose 500-50 McgDose)


AsthmaCopd Tx - Beta-Adrenergic-Anticholinergic-Glucocorticoid Comb - Drugs For Cystic Fibrosis

TRELEGY ELLIPTA INHALATION BLISTER WITH DEVICE 100-625-25 MCG 200-625-25 MCG (fluticasone furoateumeclidinium bromidevilanterol trifenat)

2 PA

Decongestant-Expectorant Combinations - Drugs For Cough And Cold

congest-eze oral tablet 60-400 mg 1 OTC Medical

mucus relief d (pseudoephed) oral tablet 40-400 mg 1 OTC Medical

pseudoephedrine-guaifenesin oral tablet 60-375 mg 1 OTC Medical





218



RESPAIRE-30 ORAL CAPSULE 30-150 MG (guaifenesinpseudoephedrine hcl)

2 OTC Medical

triacting expectorant oral syrup 15-50 mg5 ml 1 OTC Medical QL (500 per 1 day)

tussin pe oral syrup 30-100 mg5 ml 1 OTC Medical QL (500 per 1 day)

Expectorants - Single Agents General - Drugs For Cough And Cold

chest congestion relief oral tablet 400 mg 1

child mucinex chest congestion oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

childrens chest congestion oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

diabetic tussin ex oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

expectorant oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

expectorant oral tablet 200 mg 1

guaifenesin oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

guaifenesin oral tablet 200 mg 1

mucinex fast-max chest-congest oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

mucus relief er oral tablet extended release 12hr 600 mg

1

pediatric cough and cold oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

refenesen oral tablet 400 mg 1

robafen oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

scot-tussin expectorant oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

siltussin sa oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

tab tussin oral tablet 400 mg 1





219



tussin chest congestion oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

wal-tussin oral liquid 100 mg5 ml 1 OTC Medical QL (500 per 1 day)

Mucolytics - Drugs For The Lungs


1

Nasal Anticholinergics - Allergy

ipratropium bromide nasal spraynon-aerosol 21 mcg (003 ) 42 mcg (006 )

1

Nasal Antihistamines - Allergy

azelastine nasal aerosolspray 137 mcg (01 ) 1

azelastine nasal spraynon-aerosol 2055 mcg (015 ) 1

Nasal Corticosteroids - Allergy

24 hour allergy relief nasal spraysuspension 50 mcgactuation

1 OTC Medical

aller-cort nasal aerosolspray 55 mcg 1

aller-flo nasal spraysuspension 50 mcgactuation 2 OTC

allergy relief (fluticasone) nasal spraysuspension 50 mcgactuation

2 OTC

budesonide nasal spraynon-aerosol 32 mcgactuation 1 OTC Medical

childrens 24 hr allergy relief nasal spraysuspension 50 mcgactuation

2 OTC

clarispray nasal spraysuspension 50 mcgactuation 2 OTC

FLONASE ALLERGY RELIEF NASAL SPRAYSUSPENSION 50 MCGACTUATION (fluticasone propionate)

2 OTC Medical

FLONASE SENSIMIST NASAL SPRAYSUSPENSION 275 MCGACTUATION (fluticasone furoate)


flunisolide nasal spraynon-aerosol 25 mcg (0025 ) 1

fluticasone propionate nasal spraysuspension 50 mcgactuation

2 OTC

NASACORT NASAL AEROSOLSPRAY 55 MCG (triamcinolone acetonide)

2 OTC Medical





220



nasal allergy nasal aerosolspray 55 mcg 1 OTC Medical

triamcinolone acetonide nasal aerosolspray 55 mcg 1 OTC Medical

Nasal Mast Cell Stabilizers - Allergy

cromolyn nasal spraynon-aerosol 52 mgspray (4 ) 1 OTC Medical

NASALCROM NASAL SPRAYNON-AEROSOL 52 MGSPRAY (4 ) (cromolyn sodium)

2 OTC Medical

Nasal Moisturizers - Allergy

altamist nasal aerosolspray 065 1 OTC Medical

ayr saline nasal aerosolspray 065 1 OTC Medical

ayr saline nasal drops 065 1 OTC Medical QL (500 per 1 day)

deep sea nasal nasal aerosolspray 065 1 OTC Medical

little remedies nasal aerosolspray 065 1 OTC Medical

little remedies saline mist nasal aerosolspray 09 1 OTC Medical

nasal mist nasal aerosolspray 09 1 OTC Medical

ocean nasal nasal aerosolspray 065 1 OTC Medical

saline mist nasal aerosolspray 065 1 OTC Medical

saline nasal nasal aerosolspray 065 1 OTC Medical

saline nose nasal aerosolspray 065 1 OTC Medical

sterile saline nasal aerosolspray 09 1 OTC Medical

Nasal Sympathomimetic Decongestants (Intranasal) - Allergy

ADRENALIN NASAL SOLUTION 1 MGML (epinephrine hcl)


little noses nasal drops 0125 1 OTC Medical

Non-Opioid Antitus-1St Gen Antihist-Decongest-AnalgesicNon-Salicylat - Drugs For Cough And Cold

cold multi-symptom nighttime oral liquid 625-5-10-325 mg15 ml

2 OTC Medical

Non-Opioid Antitussive-1St Gen Antihistamine-Analgesic Non-Salicylate - Drugs For Cough And Cold

cold-flu relief oral liquid 125-30-1000 mg30 ml 1 OTC Medical QL (500 per 1 day)





221



cough-sore throat night oral liquid 125-30-1000 mg30 ml


Non-Opioid Antitussive-1St GenAntihistamine-Decongestant Combinations - Drugs For Cough And Cold

bio-dtuss dmx oral liquid 1-30-20 mg5 ml 1 OTC Medical QL (500 per 1 day)

brompheniramine-pseudoeph-dm oral syrup 2-30-10 mg5 ml


brotapp dm oral elixir 1-15-5 mg5 ml 1 OTC Medical QL (500 per 1 day)

DELTUSS DMX (DEXCHLORPHEN) ORAL LIQUID 1-30-15 MG5 ML (dexchlorpheniramine maleatepseudoepheddextromethorphan hbr)


dimaphen dm oral solution 1-25-5 mg5 ml 1 OTC Medical QL (500 per 1 day)

Non-Opioid Antitussive-Antihistamine Combinations - Drugs For Cough And Cold

promethazine-dm oral syrup 625-15 mg5 ml 1 QL (500 per 1 day)

Non-Opioid Antitussive-Decongestant-Expectorant Combinations - Drugs For Cough And Cold

despec-dm (phenyleph-dm-guaif) oral liquid 5-10-100 mg5 ml


wal-tussin cough and cold cf oral liquid 5-10-100 mg5 ml


Non-Opioid Antitussive-Expectorant Combinations - Drugs For Cough And Cold

antitussive dm oral syrup 10-100 mg5 ml 1 OTC Medical QL (500 per 1 day)

chest congestion relief dm oral tablet 20-400 mg 1 OTC Medical

cough control dm oral syrup 10-100 mg5 ml 1 OTC Medical QL (500 per 1 day)

COUGH FORMULA DM ORAL SYRUP 10-100 MG5 ML (guaifenesindextromethorphan hbr)


cough syrup dm oral syrup 10-100 mg5 ml 1 OTC Medical QL (500 per 1 day)





222



dextromethorphan-guaifenesin oral syrup 10-100 mg5 ml


expectorant dm oral liquid 20-300 mg5 ml 1 OTC Medical QL (500 per 1 day)

g-tron oral liquid 10-100 mg5 ml 1 OTC Medical QL (500 per 1 day)

mucus relief cough oral liquid 5-100 mg5 ml 1 OTC Medical QL (500 per 1 day)

mucus relief dm oral tablet 20-400 mg 1 OTC Medical

neo-tuss oral liquid 30-200 mg5 ml 1 OTC Medical QL (500 per 1 day)

SCOT-TUSSIN SENIOR ORAL LIQUID 15-200 MG5 ML (guaifenesindextromethorphan hbr)


TRISPEC DMX ORAL LIQUID 10-187 MG5 ML (guaifenesindextromethorphan hbr)


tussin cough-chest congestion oral liquid 10-100 mg5 ml


tussin dm max oral liquid 10-200 mg5 ml 1 OTC Medical QL (500 per 1 day)

tussin dm oral syrup 10-100 mg5 ml 15-100 mg5 ml 1 OTC Medical QL (500 per 1 day)

VICKS DAYQUIL MUCUS CONTROL DM ORAL LIQUID 10-200 MG15 ML (guaifenesindextromethorphan hbr)


wal-tussin dm clear oral syrup 10-100 mg5 ml 1 OTC Medical QL (500 per 1 day)

zyncof oral liquid 20-400 mg5 ml 1 OTC Medical QL (500 per 1 day)

Opioid Antitussive-Expectorant Combinations - Drugs For Cough And Cold

cheratussin ac oral liquid 10-100 mg5 ml 1 QL (240 per 30 days) AGE (Min 18 Years)

codeine-guaifenesin oral liquid 10-100 mg5 ml 1 QL (240 per 30 days) AGE (Min 18 Years)

coditussin ac oral liquid 10-200 mg5 ml 1 AGE (Min 18 Years)

ninjacof-xg oral liquid 8-200 mg5 ml 1 QL (240 per 30 days) AGE (Min 18 Years)





223



relcof c oral liquid 63-100 mg5 ml 1 QL (240 per 30 days) AGE (Min 18 Years)

robafen ac oral liquid 10-100 mg5 ml 1 QL (240 per 30 days) AGE (Min 18 Years)

Systemic Sympathomimetic Decongestants - Drugs For Cough And Cold

12 hour decongestant oral tablet extended release 120 mg

1 OTC Medical

12 hour nasal decongest (pse) oral tablet extended release 120 mg

1 OTC Medical

adult nasal decongestant oral liquid 15 mg5 ml 1 OTC Medical QL (500 per 1 day)

CHILDRENS SUDAFED ORAL LIQUID 15 MG5 ML (pseudoephedrine hcl)


nasal and sinus decongestant oral tablet 30 mg 1 OTC Medical

nasal decongestant (pe) oral tablet 10 mg 1 OTC Medical

nasal decongestant (pseudoeph) oral capsule (abuse-resistant) 30 mg

1 OTC Medical

pseudoephedrine hcl oral liquid 30 mg5 ml 1 OTC Medical QL (500 per 1 day)

pseudoephedrine hcl oral tablet 30 mg 60 mg 1 OTC Medical

sinus pressure-cong relief pe oral tablet 10 mg 1 OTC Medical

sudafed 12 hour oral tablet extended release 120 mg 2 OTC Medical

SUDAFED 24 HOUR ORAL TABLET EXTENDED RELEASE 24 HR 240 MG (pseudoephedrine hcl)

1 OTC Medical

SUDAFED ORAL TABLET 30 MG (pseudoephedrine hcl) 1 OTC Medical

sudogest 12-hour oral tablet extended release 120 mg 1 OTC Medical

sudogest oral tablet 30 mg 60 mg 1 OTC Medical

suphedrin oral liquid 15 mg5 ml 1 OTC Medical QL (500 per 1 day)

suphedrine 12 hour oral tablet extended release 120 mg 1 OTC Medical

valu-tapp decongestant oral drops 75 mg08 ml 1 OTC Medical QL (500 per 1 day)

wal-phed d oral tablet extended release 120 mg 1 OTC Medical

wal-phed oral tablet 30 mg 1 OTC Medical





224



zephrex-d oral tablet (abuse-resistant) 30 mg 1 OTC Medical

Vaginal Products - Drugs For Women

Vaginal Antibacterial - Lincosamides - Drugs For Infections

CLEOCIN VAGINAL SUPPOSITORY 100 MG (clindamycin phosphate)

2

clindamycin phosphate vaginal cream 2 1

Vaginal Antibacterial - Sulfonamides - Drugs For Infections

AVC VAGINAL VAGINAL CREAM 15 (sulfanilamide) 2

Vaginal Antifungal - Imidazoles - Drugs For Infections

1-day vaginal ointment 65 1 OTC Medical

3 day vaginal vaginal cream 200 mg5 gram (4 ) 1 OTC Medical

3-day vaginal vaginal cream 2 1 OTC Medical

clotrimazole vaginal cream 1 1 OTC Medical

clotrimazole vaginal tablet 100 mg 1 OTC Medical

clotrimazole-7 vaginal cream 1 1 OTC Medical

miconazole 7 vaginal suppository 100 mg 1 OTC Medical

miconazole nitrate vaginal cream 2 1 OTC Medical

miconazole nitrate vaginal kit 1200-2 mg- 1 OTC Medical

miconazole-3 prefilcreamwipe vaginal kit 4 (200 mg)- 2 (9 gram)

1 OTC Medical

miconazole-3 vaginal kit 200 mg- 2 (9 gram) 1 OTC Medical

miconazole-3 vaginal suppository 200 mg 1

miconazole-skin clnsr17 vaginal kit 4 (200 mg)- 2 (9 gram)

1 OTC Medical

MONISTAT 1 COMBO PACK VAGINAL KIT 1200-2 MG- (miconazole nitrate)

2 OTC Medical

MONISTAT 3 VAGINAL COMB PACKPREFILL APPL CREAM 4 (200 MG)- 2 (9 GRAM) (miconazole nitrate)

2 OTC Medical

MONISTAT 3 VAGINAL CREAM 200 MG5 GRAM (4 ) (miconazole nitrate)

2 OTC Medical

MONISTAT 3 VAGINAL KIT 200 MG- 2 (9 GRAM) (miconazole nitrate)

2 OTC Medical





225




2 OTC Medical

monistat 7 vaginal cream 2 1 OTC Medical

tioconazole-1 vaginal ointment 65 1 OTC Medical

vagistat-3 vaginal kit 200 mg- 2 (9 gram) 1 OTC Medical

Vaginal Antifungal - Triazoles - Drugs For Infections

terconazole vaginal cream 04 08 1

terconazole vaginal suppository 80 mg 1

Vaginal Antiprotozoal-Antibacterial - Nitroimidazole Derivatives - Drugs For Infections

metronidazole vaginal gel 075 1

Vaginal Estrogens - Drugs For Women

estradiol vaginal cream 001 (01 mggram) 1

estradiol vaginal tablet 10 mcg 1

PREMARIN VAGINAL CREAM 0625 MGGRAM (estrogens conjugated)

2 GF AGE (Max 2 Years)

estradiol (Yuvafem Vaginal Tablet 10 Mcg) 1

226

Index of Drugs

1

12 hour decongestant 223

12 hour nasal decongest

(pse) 223

1-day 224

1ST TIER UNILET

COMFORTOUCH 168 181

2

24 hour allergy relief 219

2-IN-1 LANCET DEVICE 168

181

3

3 day vaginal 224

3-day vaginal 224

8

8 hour pain reliever 26

A

a and d (lan pet) 105

abiraterone 43 45

ABREVA 105

acarbose 136

ACCU-CHEK FASTCLIX

LANCET DRUM 168 181

ACCU-CHEK FASTCLIX

LANCING DEV 168 181

ACCU-CHEK MULTICLIX

LANCET 168 181

ACCU-CHEK SAFE-T-PRO

168 181


PLUS 168 181

ACCU-CHEK SOFT DEV

LANCETS 169 181

ACCU-CHEK SOFTCLIX

LANCETS 169 181

acebutolol 66

acephen 26

acetaminophen 26

acetaminophen-codeine 24

Acetasol Hc 203

acetazolamide 69

acetic acid 160 202

acetic acid-aluminum acetate

202

acetylcysteine 34 219

acid control (ranitidine) 150

acid controller 150

acid gone antacid 143

acid gone antacid estrength

143

acid reducer (famotidine) 150

acid reducer (ranitidine) 150

acid-pep 150

acne control cleanser 99

acne foaming wash 99

acne medication 99

ACNE MEDICATION 99

acne treatment (benzoyl

perox) 99

acne vanishing 99

acne-clear 99

ACTHIB (PF) 57

ACTI-LANCE LANCETS 169

181

acyclovir 40

ADACEL(TDAP

ADOLESNADULT)(PF) 55

56

adapalene 100

addaprin 30

added strength pain reliever

31

ADJUSTABLE LANCING

DEVICE 169 181

ADMELOG SOLOSTAR U-

100 INSULIN 141

ADMELOG U-100 INSULIN

LISPRO 141

ADRENALIN 220

adriamycin 50

Adriamycin 50

Adrucil 45

adult aspirin regimen 32 166

adult nasal decongestant 223

227

ADVAIR HFA 217

advanced exfoliating cleanser

100

ADVANCED EYE RELIEF

194

ADVANCED LANCING

DEVICE 169 181

ADVANCED TRAVEL

LANCETS 169 181

ADVIL 30

ADVIL JUNIOR STRENGTH

30

ADVOCATE LANCET 169

181

ADVOCATE LANCING

DEVICE 169 181

advocate pain relief 110

AEROCHAMBER MINI 178

181

AEROCHAMBER MV 178

181

AEROCHAMBER PLUS

FLOW-VU 178 181

AEROCHAMBER PLUS

FLOW-VUS MSK 178

AEROCHAMBER PLUS Z

STAT 179 181

AEROCHAMBER PLUS Z

STAT LG MSK 178

AEROCHAMBER PLUS Z

STAT MD MSK 178

AEROCHAMBER PLUS Z

STAT SM MSK 179

AEROCHAMBER WITH

FLOWSIGNAL 179 181

AEROCHAMBER Z-STAT

PLUS-FLW SG 179 182

AEROSPAN 213

AEROTRACH PLUS 179 182

Afeditab Cr 67

Afirmelle 87

AFLURIA QD 2020-21(3YR

UP)(PF) 59

AFLURIA QD 2020-21(6-

35MO)(PF) 59

AFLURIA QUAD 2020-

2021(6MO UP) 59

aftera 98

AIRZONE PEAK FLOW

METER 178 182

AKTEN (PF) 200

Ala-Cort 105

alavert 210 212

alavert d-12 allergy-sinus 204

alaway 197

albendazole 35

albuterol sulfate 216

Alcaine 200

alcalak 144

alclometasone 105

ALCOHOL PREP PADS 52

ALECENSA 44

alendronate 137

aler-cap 205 207

alfuzosin 161

ALIQOPA 48

alka-seltzer plus allergy 81

205 207

ALKERAN 44

all day allergy (cetirizine) 210

211

ALLEGRA ALLERGY 210

212

aller-chlor 205 207

allerclear d-12hr 204

aller-cort 219

aller-ease 210 212

aller-flo 219

allergy (chlorpheniramine)

205 207

allergy (diphenhydramine)

205 208

allergy eye (naphazoline-

phen) 197

allergy medication 205 208

allergy medicine 205 208

allergy relief (cetirizine) 210

211

allergy relief (fluticasone) 219

allergy relief (loratadine) 210

212

allergy relief d12 204

228

allergy relief(diphenhydramin)

205 208

allergy relief-d (cetirizine) 204

allergy relief-d(fexofenadine)

205

aller-tec 210 211

aller-tec d 205

allopurinol 163

almacone 145

almacone-2 145

aloe vesta antifungal (micon)

102

alogliptin 136

alogliptin-metformin 137

alogliptin-pioglitazone 137

alophen (bisacodyl) 157

altamist 220

Altavera (28) 87

ALTERNATE SITE LANCET

169 182

ALTERNATE SITE LANCING

DEVICE 169 182

aluminum hydroxide gel 143

ALUMINUM HYDROXIDE

GEL (BULK) 83 143

ALUNBRIG 44

Alyacen 135 (28) 87

Alyacen 777 (28) 95

Amethia 86

Amethia Lo 86

Amethyst (28) 88

amiloride 69

AMINOSYN 10 124

AMINOSYN 7 WITH

ELECTROLYTES 124

AMINOSYN 85 124

AMINOSYN 85 -

ELECTROLYTES 124

AMINOSYN II 10 125

AMINOSYN II 15 125

AMINOSYN II 85 125

AMINOSYN II 85 -

ELECTROLYTES 124

AMINOSYN M 35 124 125

AMINOSYN-HBC 7 125

AMINOSYN-PF 10 125

AMINOSYN-PF 7

(SULFITE-FREE) 125

AMINOSYN-RF 52 125

amiodarone 64

amitriptyline 75

amitriptyline-chlordiazepoxide

75 77

amlodipine 67

amlodipine-benazepril 62

amlodipine-valsartan 63

amoxapine 75

amoxicillin 34

amoxicillin-pot clavulanate 34

amphotericin b 35

ampicillin 34

anagrelide 166

anastrozole 46

anbesol (benzocaine) 193

androxy 135

ANORO ELLIPTA 216

antacid (calcium carb-mag

hyd) 143

antacid anti-gas 145

antacid exst (ca carb-mag

hyd) 143

antacid extra-strength 144

antacid ii plus simethicone

145

antacid supreme 144

antacid ultra strength 144

antacid with simethicone 145

antacid-antigas 145

antacid-antigas ii 145

antibiotic plus (pramoxine)

101

anticoag citrate phos

dextrose 163

anti-dandruff 104

anti-dandruff with menthol 105

anti-diarrheal 147

229

anti-diarrheal (loperamide)

146

anti-fungal 102

antifungal (clotrimazole) 102

antifungal (terbinafine) 102

antifungal cream

(miconazole) 102

antifungal ringworm 102

anti-gas maximum strength

151

anti-gas ultra strength 151

antihistamine 205 208

anti-itch (hc) 105

anti-itch (hc) with aloe-vit e

108

anti-itch plus 108

antiseptic mouth cleanser 193

antitussive dm 221

anucort-hc 33

ANZEMET 148

aprepitant 149

Apri 88

APRISO 152

aprodine 203

AQUA LANCE LANCING

DEVICE 169 182

AQUADEKS PEDIATRIC 129

aquanil hc 105

aquaphor itch relief 105

Aranelle (28) 95

ARCAPTA NEOHALER 215

armodafinil 80

ARMONAIR RESPICLICK

213

ARNUITY ELLIPTA 214

ARRANON 45

arthritis pain relief(capsaic)

111

ARTIFICIAL TEARS (CMC)

195

artificial tears (petromin) 194

artificial tears (pf) 194

artificial tears (polyvin alc) 195

artificial tears(dext70-hypro)

194 199

artificial tears(glycerin-peg)

194

artificial tears(pg-hypm-glyc)

194

artificial tears(pvalch-povid)

194

ARZERRA 46

Ashlyna 86

ASMANEX HFA 214

ASMANEX TWISTHALER

214

aspirin 32 166

aspirin low dose 32

aspirinbuffd-calcium carb-

mag 33

aspir-low 32 166

aspir-trin 32 166

ASSURE HAEMOLANCE

PLUS 169 182

ASSURE LANCE 169 182

ASSURE LANCE PLUS 169

182

ASTHMA CHECK METER

178 182

atenolol 66

atenolol-chlorthalidone 67

athenol 26

athletes foot 102

athletes foot (clotrimazole)

102

athletic foot cream 102

atomoxetine 77

atorvastatin 65

atovaquone 36

atropine 197

ATROVENT HFA 215

Aubra 88

AUGMENTIN 35

auro eardrops 203

Aurovela 1530 (21) 88

Aurovela 120 (21) 88

Aurovela 24 Fe 88

230

Aurovela Fe 1530 (28) 88

Aurovela Fe 1-20 (28) 88

AUTO-LANCET MINI 169

182

AUTOLET IMPRESSION

LANC DEV 169 182

AUTOLET LANCING

DEVICE 169 182

AUTOLET PLUS LANCING

DEVICE 169 182

AVASTIN 42

AVC VAGINAL 224

Aviane 88

avita 100

ayr saline 220

Ayuna 88

azathioprine 29 167

azelastine 197 219

azithromycin 40

azolen tincture 102

AZULFIDINE 29 152

Azurette (28) 86

B

b complex-vitamin c-folic acid

112

b-12 dots 131

baby ddrops 132

baby iron-multivitamin 129

baby vitamin d3 132

babys super daily d3 132

bacitracin 101 201

bacitracin zinc 101

bacitracin-polymyxin b 200

bacitraycin plus 101

baclofen 168

balsalazide 152

Balziva (28) 88

banophen 205 208

banophen allergy 205 208

BAQSIMI 135

BASAGLAR KWIKPEN U-

100 INSULIN 140

bayer advanced 32 166

BAYER CHEWABLE

ASPIRIN 32 166

bayer plus extra strength 33

baza antifungal 102

BCG VACCINE LIVE (PF)

55 58

b-complex with vitamin c 112

BD LUER-LOK SYRINGE

177 182

BD MICROTAINER LANCET

169 182

bd posiflush normal saline

09 130

BD PRECISIONGLIDE NON-

STERILE 177 182

bd pre-filled normal saline 130

BD REGULAR BEVEL

NEEDLES 177 182

BD SAFETYGLIDE NEEDLE

177 182

BD ULTRA FINE LANCETS

169 183

BD ULTRA-FINE II

LANCETS 169 183

BD ULTRA-FINE NANO PEN

NEEDLE 176 183

BD VEO INSULIN SYR

(HALF UNIT) 176 183

BD VEO INSULIN SYRINGE

UF 176 177 183

Bekyree (28) 86

BENADRYL ALLERGY 205

206 208

benazepril 62

benazepril-

hydrochlorothiazide 62

BENGAY COLD THERAPY

111

BENGAY VANISHING

SCENT 111

benzonatate 213

benzoyl peroxide 100

beta-hc 106

betamethasone dipropionate

106

betamethasone valerate 106

231

betamethasone augmented

106

betasept surgical scrub 52

betatemp 26

bethanechol chloride 163

BEVESPI AEROSPHERE216

BEXSERO 58

bicalutamide 45

BICARSIM 151

bicarsim forte 151

BICILLIN C-R 42

BICILLIN L-A 41

BICNU 44

BIDIL 70

bio-d-mulsion 132

bio-d-mulsion forte 132

bio-dtuss dmx 221

BIOTHRAX 58

bisac-evac 157

bisacodyl 157

biscolax 157

bismatrol 147

bismuth maximum strength

147

BISMUTH SUBCARBONATE

(BULK) 83

BISMUTH SUBNITRATE

(BULK) 83

BISMUTH SUBSALICYLATE

(BULK) 83 147

bisoprolol fumarate 66

bisoprolol-


bleomycin 51

Bleph-10 201

Blephamide SOP 196

Blisovi 24 Fe 88

Blisovi Fe 1530 (28) 88

Blisovi Fe 120 (28) 88

blis-to-sol (tolnaftate) 103

BOOSTRIX TDAP 56

boro-packs 105

BOSULIF 49

boudreauxs butt paste 109

BOUDREAUXS BUTT

PASTE 109

bp wash 100

BP WASH 100

bp wash acne treatment 100

bpo 100

BREATHERITE VALVED

MDI CHAMBER 179 183

BREO ELLIPTA 217

Briellyn 88

BRILINTA 166

brimonidine 202

bromfenac 198

bromi-lotion 104

brompheniramine-

pseudoeph-dm 221

brotapp dm 221

budesonide 214 219

budesonide-formoterol 217

bufferin 33

BULLSEYE MINI SAFETY

LANCETS 169 183

bumetanide 69

bupropion hcl 75 82

bupropion hcl (smoking

deter) 82

buspirone 71

busulfan 43

BUSULFEX 43

butalbital-acetaminophen 28

butalbital-acetaminophen-caff

28

BUTTERFLY TOUCH

LANCET 170 183

C

cabergoline 142

CABOMETYX 48

CALAMINE (BULK) 83

calamine-zinc oxide 109

calci-chew 115

calcidol 132

232

calci-mix 115

calcipotriene 104

calcitonin (salmon) 138

calcitriol 132 192

calcium 500 + d 116

calcium 500 + d (d3) 116

calcium 600 115

calcium 600 + d(3) 116

calcium 600 with vitamin d3

116

CALCIUM 600 WITH

VITAMIN D3 116

CALCIUM ACETATE 115

calcium acetate(phosphat

bind) 115 160

calcium antacid 144

calcium carbonate 115 116

144

calcium carbonate-vit d3-min

116

calcium carbonate-vitamin d3

116 117

CALCIUM CARBONATE-

VITAMIN D3 117

calcium citrate 116

CALCIUM CITRATE 116

calcium citrate-vitamin d2 117


calcium gluconate 116

calcium lactate 116

calcium+d 117

cal-gest antacid 144

CALQUENCE 46 49

CALTRATE 600 PLUS D 117

CALTRATE WITH VITAMIN

D3 117

Camila 95

camrese 86

camrese lo 86

cank-oxide 193

capecitabine 45

CAPRELSA 49

capsaicin 111

CAPSAICIN (BULK) 83

capsicum 111

captopril 62

carbamazepine 72 78

CARBAMIDE PEROXIDE

(BULK) 52 83

carbidopa-levodopa 76

carbidopa-levodopa-

entacapone 76

carboplatin 48

CARELANCE ULT LANCING

DEVICE 170 183

CAREONE LANCING

DEVICE 170 183

CAREONE ULTRA THIN

LANCET 170 183

CARESENS LANCETS 170

183

CARESENS PREM

LANCING DEVICE 170

183

CARETOUCH LANCING

DEVICE 170 183

CARETOUCH SAFETY

LANCETS 170 183

CARETOUCH TWIST

LANCET 170 183

CAROSPIR 63 69

Cartia Xt 66

carvedilol 63

castor oil 157

CASTOR OIL 84

CATHFLO ACTIVASE 167

Caziant (28) 95

cefaclor 38

cefadroxil 38

cefdinir 38

cefixime 38

cefpodoxime 38

cefprozil 38

cefuroxime axetil 38

celecoxib 30

CELONTIN 73

233

cephalexin 38

CERALYTE 90 120

ceralyte-70 121

CERALYTE-70 121

certain dri 104

cetiri-d 205

cetirizine 210 211 212

cevimeline 194

CHANTIX 83

CHANTIX CONTINUING

MONTH BOX 83

CHANTIX STARTING

MONTH BOX 83

Charlotte 24 Fe 89

Chateal (28) 89

CHEMET 34

cheratussin ac 222

chest congestion relief 218

chest congestion relief dm

221

child allergy relf(cetirizine)

210 212

child aspirin 32 166

child dometuss-da 203

child ibuprofen 30

child mucinex chest

congestion 218

childrens 24 hr allergy relief

219

CHILDRENS ADVIL 30

childrens allegra allergy 210

212

childrens allergy (diphenhyd)

206 208

childrens allergy complete

210 212

childrens allergy relief(fex)

210 212

childrens allergy relief(lor)

210 212

childrens allergy(cetirizine)

211 212

childrens aller-tec 211 212

childrens antacid 144

childrens aurodryl allergy

206 208

childrens cetirizine 211 212

childrens chest congestion

218

childrens dibromm cold-

allerg 203

childrens ibu-drops 30

childrens ibuprofen 30

childrens mapap 26

childrens non-aspirin 26

childrens pain relief 26

childrens pain reliever 26

childrens pain-fever relief 26

childrens pepto 144

childrens profen ib 31

childrens q-pap 27

childrens soothe 144

CHILDRENS SUDAFED 223

childrens tactinal 27

childrens tylenol 27

childrens wal-fex 211 212

childrens wal-zyr 211 212

CHILDRENS ZYRTEC

ALLERGY 211 212

childs all day allergy(cetir)

211 212

chloramphenicol sod

succinate 38

chlordiazepoxide hcl 70 77

chlorhexidine gluconate 52

193

chlorhist 205 208

chloroquine phosphate 36

chlorthalidone 69

chocolate laxative 157

CHOLECALCIFEROL (VIT

D3)(BULK) 83 132 133

cholecalciferol (vitamin d3)

133

CHOLECALCIFEROL

(VITAMIN D3) 133

cholestyramine (with sugar)

65

Cholestyramine Light 65

234

ciclopirox 102

cilostazol 166

CILOXAN 201

cimetidine 150

cimetidine hcl 150

cinacalcet 137

CIPRO 38

CIPRO HC 202

ciprofloxacin 39

ciprofloxacin hcl 38 201 202

ciprofloxacin-dexamethasone

202

cisplatin 48

citalopram 74

CITRACAL-D3 SLOW

RELEASE 117

citrate of magnesia 155

citroma 155

citrus calcium-vitamin d3 117

cladribine 45

clarispray 219

clarithromycin 41

CLARITIN REDITABS 211

212

clean-clear continuous

control 100

clearasil daily clear(benzoyl)

100

clearasil ultra 100

clearlax 155

clemastine 206 208

CLEOCIN 224

CLEVER CHEK LANCETS

170 183

CLEVER CHOICE PEAK

FLOW METER 178 183

clindamycin hcl 40

Clindamycin Pediatric 40

clindamycin phosphate 99

224

CLINIMIX 5D15W

SULFITE FREE 123

CLINIMIX 5D25W

SULFITE-FREE 123

CLINIMIX 275D5W

SULFIT FREE 123

CLINIMIX 425D10W

SULF FREE 123

CLINIMIX 425D5W

SULFIT FREE 123

CLINIMIX 425-D20W

SULF-FREE 123

CLINIMIX 425-D25W

SULF-FREE 124

CLINIMIX 5-

D20W(SULFITE-FREE)

124

CLINIMIX 6-D5W

(SULFITE-FREE) 124

CLINIMIX 8-

D10W(SULFITE-FREE)

124

CLINIMIX 8-

D14W(SULFITE-FREE)

124

CLINIMIX E 275D10W

SUL FREE 125 127

CLINIMIX E 275D5W

SULF FREE 125 127

CLINIMIX E 425D10W

SUL FREE 125 127

CLINIMIX E 425D25W

SUL FREE 125 127

CLINIMIX E 425D5W

SULF FREE 125 127

CLINIMIX E 5D15W

SULFIT FREE 126 127

CLINIMIX E 5D20W

SULFIT FREE 126 128

CLINIMIX E 5D25W

SULFIT FREE 126 128

CLINIMIX E 8-D10W

SULFITEFREE 128

CLINIMIX E 8-D14W

SULFITEFREE 128

CLINISOL SF 15 126

clobetasol 106

clobetasol-emollient 106

clonazepam 70 71 78

clonidine 68

clonidine hcl 68

clopidogrel 166

clotrimazole 103 193 224

235

clotrimazole af 103

clotrimazole-7 224

clotrimazole-betamethasone

104

COAGUCHEK LANCETS

170 183

codeine-guaifenesin 222

coditussin ac 222

COLACE 159

COLACE 2-IN-1 158

COLACE CLEAR 159

colchicine 163

cold and allergy (bromphen-

pe) 203

cold and allergy(triprolidine)

203

cold multi-symptom nighttime

220

cold-allergy-sinus 203

cold-flu relief 220

colestipol 65

collyrium 200

Colocort 153

COLOR LANCETS 170 183

colox 153

col-rite 159

COMBIVENT RESPIMAT 216

COMETRIQ 48

COMFORT EZ LANCETS

170 183

comfort gel 145

comfort gel extra strength 145

COMFORT LANCETS 170

183

COMFORT TOUCH PLUS

SAFETY LANC 170 184

COMFORT TOUCH ULT

THIN LANCETS 170 184

complete lice treatment 111

compoz 81 206 208

Compro 148

CONCEPTROL 99

CONDOMS-PREM

LUBRICATED 177 184

congest-eze 217

Constulose 155

cool and heat 111

cool heat (m-salicylate-

menth) 110

cool n heat extra strength 110

coral calcium 116

Cormax 106

cortaid 106

cortisone 138

cortisone (hydrocortisone)

106

cortisone with aloe 108

CORTISPORIN-TC 202

cortizone-10 106

cough control dm 221

COUGH FORMULA DM 221

cough syrup dm 221

cough-sore throat night 221

COUMADIN 163

creamy acne face 100

CREON 149

critic-aid clear af(miconazol)

103

cromolyn 47 200 214 220

Crotan 112

Cryselle (28) 89

CUPRIMINE 29 34

cyanocobalamin (vitamin b-

12) 131

CYANOCOBALAMIN

(VITAMIN B-12) 131

Cyclafem 135 (28) 89


cyclobenzaprine 168

cyclopentolate 197

cyclophosphamide 29 44

CYCLOPHOSPHAMIDE 29

44

cycloserine 37

cyclosporine modified 29 167

236

cyproheptadine 207 208

Cyred 89

cytra k crystals 161

cytra-k 161

D

d10 -045 sodium

chloride 114

d25 -045 sodium

chloride 114

d3 dots 133

d5 and 09 sodium

chloride 114

d5 -045 sodium chloride

114

dacarbazine 44

daily fiber 153

daily fiber (psyllium-aspart)

153

daily fiber (psyllium-sucrose)

153

dailyhist-1 206 208

DALIRESP 215

dallergy (chlorpheniramine-

pe) 203

dandruff shampoo

(pyrithione) 104

dantrolene 168

dapsone 36

DAPTACEL (DTAP

PEDIATRIC) (PF) 56

Dasetta 135 (28) 89

Dasetta 777 (28) 96

daunorubicin 50 51

dayhist allergy 206 208

daylogic acne treatment 100

Daysee 86

day-time cough 213

ddrops 133

Deblitane 95

debrox 203

decara 133

DECARA 133

deep sea nasal 220

delta d3 133

Deltasone 138

DELTUSS DMX

(DEXCHLORPHEN) 221

Delyla (28) 89

DEPEN TITRATABS 29 34

DEPO-SUBQ PROVERA 104

86

dermafungal 103

DERMA-SMOOTHEFS

BODY OIL 106

DESCOVY 37

desenex 103

desipramine 75

DESITIN RAPID RELIEF 109

desmopressin 135

desog-eestradioleestradiol

87

desogestrel-ethinyl estradiol

89

desonide 106

desoximetasone 106

despec-dm (phenyleph-dm-

guaif) 221

desvenlafaxine succinate 74

dexamethasone 139

DEXAMETHASONE

INTENSOL 138

dexamethasone sodium phos

(pf) 139

dexamethasone sodium

phosphate 139 198

dexmethylphenidate 76

dextroamphetamine 77 79

80

dextroamphetamine-

amphetamine 77 79 81

dextromethorphan polistirex

213

dextromethorphan-

guaifenesin 222

dextrose 10 and 02

nacl 114

dextrose 10 in water

(d10w) 114


(d20w) 114

237


(d25w) 114 115


(d30w) 114 115


(d40w) 114 115

dextrose 5 in water (d5w)

114

dextrose 5 -lactated ringers

113

dextrose 5-02 sod

chloride 114

dextrose 5-03

sodchloride 114


(d50w) 114 115


(d70w) 114

diabetic tussin ex 218

dialyvite 113

DIALYVITE 800 WITH ZINC

15 112


50 113

dialyvite vitamin d 133

DIALYVITE VITAMIN D3

MAX 133

diamode 146

diaper rash 109

diazepam 70 71 78

Diazepam Intensol 70 78

diclofenac potassium 30

diclofenac sodium 30 109

198

dicloxacillin 42

dicyclomine 152

didanosine 37

Digitek 68

Digox 68

digoxin 68

DIGOXIN 68

Dilantin Extended 72

Dilantin Infatabs 72

DILANTIN-125 72

DILATRATE-SR 63

diltiazem hcl 64 66

diltiazem in dextrose 5 67

dilt-xr 67

dimaphen dm 221

diotame instydose 147

diphedryl 206

diphenhist 206 208

diphenhydramine hcl 81 206

208 209

diphenoxylate-atropine 147

dipyridamole 167

disopyramide phosphate 64

disposable enema 156

DIURIL 69

divalproex 71 78 79 80

docosanol 105

doc-q-lace 159

doc-q-lax 158

docu 159

docusate sodium 159

DOCUSATE SODIUM

(BULK) 83 159

docusol 159

dok 159

DOMEBORO 105

donepezil 85

dorzolamide 199

dorzolamide-timolol 198

double antibiotic 101

double antibiotic (btracn zn)

101

doxazosin 70

doxepin 75

doxercalciferol 192

doxorubicin 51

doxycycline hyclate 42 194

doxycycline monohydrate 42

d-penamine 29 34

dr smiths diaper 109

dramamine less drowsy 147

dronabinol 79 112 148

238

DROPLET GENTEEL

LANCING DEVICE 170

184

DROPLET LANCETS 170

184

DROPLET LANCING

DEVICE 170 184

drospirenone-ethinyl estradiol

89

DRYSOL DAB-O-MATIC 104

dulcoease 159

dulcolax (magnesium

hydroxide) 155

dulcolax stool softener (dss)

159

duloxetine 74 79

DUREX AVANTI BARE

REAL FEEL 177 184

dutasteride 161

d-vi-sol 134

d-vita 134

dyna-hex 52

E

ec prin 32 166

EES 400 41

ear drops (carbamide

peroxide) 203

ear drops otc 203

ear health formula 113

ear wax removal system 203

EASIVENT HOLDING

CHAMBER 179 184

EASIVENT MASK LARGE

179 184

EASIVENT MASK MEDIUM

179 184

EASIVENT MASK SMALL

179 184

EASY CLICK LANCING

DEVICE 170 184

EASY COMFORT LANCETS

170 184

EASY MINI EJECT

LANCING DEVICE 170

184

EASY TOUCH LANCING

DEVICE 170 184

EASY TOUCH SAFETY

LANCETS 170 184

EASY TOUCH TWIST

LANCETS 170 184

EASY TWIST AND CAP

LANCETS 170 184

econazole 103

econtra ez 98

ecotrin 32 166

ed a-hist 203

ED CHLORPED D 204

EDECRIN 69

ed-spaz 152 162

effer-k 122

effervescent pain relief 32

electrolyte-48 in d5w 118

Elinest 89

Eliphos 160

ELIQUIS 164

ELIQUIS DVT-PE TREAT

30D START 163

Elixophyllin 215

ELLA 98

ELMIRON 160

Eluryng 98

EMBRACE LANCING

DEVICE 170 184

EMCYT 47

Emoquette 89

enalapril maleate 62

enalapril-hydrochlorothiazide

62

Endocet 25 26

endur-acin 131

enema 156

enema disposable 156

enemeez 159

ENFAMIL WATER 84

ENGERIX-B (PF) 53

ENGERIX-B PEDIATRIC

(PF) 53

enoxaparin 165 166

239

Enpresse 96

Enskyce 89

entacapone 76

entecavir 39

Enulose 149

EPANED 62

epinephrine 68 213

epinephrine hcl (pf) 68

EPIPEN 2-PAK 68

EPIPEN JR 2-PAK 68

epirubicin 51

Epitol 72 79

eq gentle 195

ERBITUX 51

ergocalciferol (vitamin d2) 134

Ergocalciferol (Vitamin D2)

134

ergoloid 85

erlotinib 43

Errin 95

ertapenem 37

Ery-Tab 41

Erythrocin (As Stearate) 41

erythromycin 41 201

erythromycin ethylsuccinate

41

erythromycin with ethanol 99

escitalopram oxalate 74

Estarylla 89

estazolam 78 82

estradiol 138 225

eszopiclone 82

ethambutol 37

ethosuximide 73

ethynodiol diac-eth estradiol

89

etodolac 31

etonogestrel-ethinyl estradiol

97 98

etoposide 47

EURAX 112

euthyrox 143

EVAC 153

evac-u-gen (sennosides) 157

EXAPHEN 204

EXCEDRIN MIGRAINE 32

exemestane 46

ex-lax (sennosides) 157

EX-LAX (SENNOSIDES) 157

EX-LAX MAXIMUM

STRENGTH 157

expectorant 218

expectorant dm 222

eye allergy relief 197

EYE IRRIGATING

SOLUTION 200

eye wash (boric acid) 200

eye wash sterile 200

E-Z JECT LANCETS 171 184

E-Z JECT THIN LANCETS

171 184

EZ SMART LANCETS 171

184

ezetimibe 65

EZ-LETS 171 184

F

fa-8 135

fallback solo 98

Falmina (28) 89

famotidine 150

famotidine (pf) 150

Fayosim 95

FC2 FEMALE CONDOM 168

184

felodipine 67

Femynor 89

fenofibrate 65

fenofibrate micronized 65

fenofibrate nanocrystallized

65

feosol 118

FEOSOL 118

ferate 118

fer-iron 118

240

ferocon 119

ferosul 118

ferrocite 119

ferrous fumarate 119

ferrous gluconate 119

ferrous sulfate 119

FERROUS SULFATE

DRIED (BULK) 83 119

feverall 27

FEVERALL 27

fexofenadine 211 212 213

fexofenadine-

pseudoephedrine 205

fiber (psyllium husk) 153

fiber (psyllium husk-sugar)

153

fiber laxative (psyllium husk)

153

fiber smooth 153

fiber therapy (m-cellsugar)

153

fiber therapy (psyllium-sucro)

153

fiber therapy(psyl seed-

sugar) 153

FIFTY50 SAFETY SEAL

LANCETS 171 185

finasteride 161

FINE 30 UNIVERSAL

LANCETS 171 185

FINGERSTIX LANCETS 171

185

first aid antibiotic 101

FIRVANQ 39

flanax antacid 145

FLAREX 198

flavor chews antacid 144

flecainide 64

FLEET BISACODYL 157

FLEET ENEMA EXTRA 156

fleet glycerin (child) 155

FLEET MINERAL OIL 155

FLONASE ALLERGY

RELIEF 219

FLONASE SENSIMIST 219

FLOVENT DISKUS 214

FLOVENT HFA 214

floxuridine 45

FLUAD 2020-2021 (65 YR

UP)(PF) 59

FLUAD QUAD 2020-21(65Y

UP)(PF) 59

FLUARIX QUAD 2020-2021

(PF) 59

FLUBLOK QUAD 2020-2021

(PF) 59

flucaine 199

FLUCELVAX QUAD 2020-

2021 60


2021 (PF) 59

fluconazole 36

flucytosine 36

fludrocortisone 142

FLULAVAL QUAD 2020-

2021 (PF) 60

FLUMIST QUAD 2020-2021

55 60

flunisolide 219

fluocinolone 106 107

fluocinonide 107

Fluocinonide-E 107

fluorescein-proparacaine 199

fluoride (sodium) 192

fluorometholone 198

fluorouracil 45 104

fluoxetine 74

flurazepam 78 82

flurbiprofen sodium 198

flutamide 45

fluticasone propionate 107

219

fluticasone propion-

salmeterol 217

fluvoxamine 74

FLUZONE HIGHDOSE

QUAD 20-21 PF 60

241

FLUZONE QUAD 2020-2021

60


(PF) 60

FML SOP 198

foaming acne face wash 100

foaming antacid 144

folic acid 135

FOLIC ACID 135

FOLIC ACID (BULK) 135

FORA LANCING DEVICE

171 185

FORACARE LANCETS 171

185

formula 3 103

fosinopril 62

fosinopril-hydrochlorothiazide

62

FREAMINE HBC 69 126

FREAMINE III 10 126

FREESTYLE LANCETS 171

185

FREESTYLE UNISTIK 2 171

185

full spectrum b-vitamin c 113

fungi cure 103

FUNGOID TINCTURE 103

fungoid-d 103

furosemide 69

Fyavolv 138

G

gabapentin 72

GAMIFANT 167

GARDASIL (PF) 59

GARDASIL 9 (PF) 59

gas relief (simethicone) 151

gas relief 80 (simethicone)

151

gas relief extra strength 151

gas-x extra strength 151

GAS-X EXTRA STRENGTH

151

gas-x ultra-strength 151

GAVILAX 155

gavilyte-c 156

Gavilyte-G 156

Gavilyte-H And Bisacodyl 158

Gavilyte-N 157

GAVISCON 143

GAVISCON EXTRA

STRENGTH 144

GAZYVA 46

gelusil antacid and anti-gas

146

gemcitabine 46

gemfibrozil 65

Gemmily 89

GEMZAR 46

Generlac 149

Gentak 201

gentamicin 101 201

genteal tears mild 194

GENTEAL TEARS

MODERATE 194

GENTEAL TEARS SEVERE

GEL 195

gentlelax 155

GERBER GOOD START

WATER 85

geri-dryl 206 209

geri-lanta 146

gianvi (28) 89

Gildagia 90

GILOTRIF 43

GLEEVEC 49

glenmax peb 204

glimepiride 136

glipizide 136

GLUCAGEN HYPOKIT 135

Glucagon Emergency Kit

(Human) 135

GLUCOCOM LANCETS 171

185

glucose 135

glyburide 136

glyburide micronized 136

242

glyburide-metformin 136

glycerin 105

glycerin (adult) 155

GLYCERIN (BULK) 84

glycerin (child) 155

glycerin and rose water 105

glycolax 155

glycopyrrolate 152

GMATE LANCETS 171 185

GMATE LANCING DEVICE

171 185

GOJJI LANCETS 171 185

GOJJI LANCING DEVICE

171 185

GOLYTELY 157

gonak 195 199

goniosoft 195 199

goniotaire 195 199

goniovisc 195 199

goodys migraine relief 32

granisetron hcl 148

griseofulvin microsize 36

griseofulvin ultramicrosize 36

g-tron 222

guaifenesin 218

guanfacine 68 76

GVOKE HYPOPEN 1-PACK

135

GVOKE PFS 1-PACK

SYRINGE 135

GYNOL II 99

H

Hailey 90

Hailey 24 Fe 90

Hailey Fe 1530 (28) 90

Hailey Fe 120 (28) 90

halobetasol propionate 107

HAVRIX (PF) 53

HEALTHY ACCENTS

AUTOLET 171 185

HEALTHY ACCENTS

UNILET LANCET 171 185

healthylax 155

heartburn antacid 144

heartburn prevention 150

heartburn relief 144

heartburn relief (famotidine)

150

heartburn relief (ranitidine)

150

heartburn treatment 24 hour

150

Heather 95

hemorrhoidal 33

hemorrhoidal suppository 33

hep flush-10 (pf) 164 165

HEPAGAM B 54

heparin (porcine) 165

heparin (porcine) in 09

nacl 164 165

heparin lock 164 165

heparin lock flush 165

heparin lock flush (porcine)

164 165

heparin lockflush(porcine)(pf)

165

heparin porcine (pf) 165

HEPATAMINE 8 126

HEPLISAV-B (PF) 53

HERCEPTIN 52

HERCEPTIN HYLECTA 52

HEXALEN 43

HIBERIX (PF) 57

HIBICLENS 52

hi-cal plus vit d 117

high potency capsaicin 111

high potency iron 119

homatropaire 197

homatropine hbr 197

home lice-bedbug-dust mite

spr 112

hot and cold pain relief 109

HUMALOG MIX 50-50

INSULN U-100 140

HUMALOG MIX 75-25(U-

100)INSULN 140

243

HUMALOG U-100 INSULIN

141

HUMULIN 7030 U-100

INSULIN 139

HUMULIN N NPH U-100

INSULIN 140

HUMULIN R REGULAR U-

100 INSULN 140

HUMULIN R U-500 (CONC)

INSULIN 140


KWIKPEN 140

HYCAMTIN 50

hydralazine 69


HYDROCHLOROTHIAZIDE

(BULK) 70 83

HYDROCIL INSTANT 153

hydrocodone-acetaminophen

24 25

hydrocodone-ibuprofen 25

hydrocortisone 107 139 153

hydrocortisone acetate 33

107

hydrocortisone plus 107 108

hydrocortisone-acetic acid

203

hydrocortisone-aloe vera 108

hydrocortisone-pramoxine 33

107 108

hydrocream 107

hydromorphone 24

hydroskin 107

hydroskin with aloe 108

hydroxychloroquine 28 36

hydroxyprogest(pf)(preg

presv) 138 142

hydroxyprogesterone

cap(ppres) 138 142

hydroxyurea 46

hydroxyzine hcl 70

hydroxyzine pamoate 70

hyoscyamine sulfate 152 162

hyosyne 152 162

hypercare 104

HYPERHEP B 54

HYPERHEP B NEONATAL

54

HYPERLYTE CR 121

HYPERRAB (PF) 54

HYPERRAB SD (PF) 54

HYPER-SAL 84

HYPERTET SD (PF) 55

HYPOLANCE AST LANCING

171 185

HYPROMELLOSE 85

HYPROMELLOSE (BULK)

83 85

HYQVIA IG COMPONENT 54

I

ibandronate 137

IBRANCE 47

Ibu 31

ibu-drops 31

ibuprofen 31

ibuprofen jr strength 31

Iclevia 90

ICLUSIG 48

icy hot 110

ICY HOT (MENTHOL) 111

ICY HOT ADVANCED

RELIEF PATCH 111

ICY HOT NO MESS 111

ICY HOT PAIN RELIEVING

111

ifosfamide 44

ifosfamide-mesna 44

imatinib 49

IMBRUVICA 46 49

imipramine hcl 75

imiquimod 108

IMOGAM RABIES-HT (PF) 54

IMOVAX RABIES VACCINE

(PF) 61

Incassia 95

IN-CHECK NASAL WITH

MASK 178 185

244

IN-CHECK ORAL FLOW

METER 178 185

INCONTROL LANCING

DEVICE 171 185

INCONTROL SUPER THIN

LANCETS 171 185

INCONTROL ULTRA THIN

LANCETS 171 185

INCRUSE ELLIPTA 215

indapamide 70

indomethacin 31

INFANRIX (DTAP) (PF) 56

infants advil 31

infants gas relief 151

infants ibuprofen 31

INFANTS MOTRIN 31

infants pain reliever 27

INFED 119

INJECT EASE LANCETS

171 185

INLYTA 49

insulin asp prt-insulin aspart

140

insulin lispro 141

INTRALIPID 127

INTRAROSA 142

Introvale 90

INVACARE LANCETS 171

185

inzo antifungal 103

IONOSOL-B IN D5W 118

IONOSOL-MB IN D5W 118

IPOL 61

ipratropium bromide 215 219

ipratropium-albuterol 217

irbesartan 63

irbesartan-


IRESSA 43

irinotecan 50

iron 119

iron (dried) 119

ISENTRESS 37

Isibloom 90

ISOLYTE-P IN 5

DEXTROSE 118

ISOLYTE-S 121

isoniazid 37

isopto tears 195

ISORDIL 63

isosorbide dinitrate 63 64

isosorbide mononitrate 64

isradipine 67

itraconazole 36

ivermectin 35

IXIARO (PF) 60

J

Jaimiess 87

Jantoven 163

Jasmiel (28) 90

Jencycla 95

Jinteli 138

jock itch (clotrimazole) 103

jolessa 90

jolivette 95

jr acetaminophen 27

Juleber 90

Junel 1530 (21) 90

Junel 120 (21) 90

Junel Fe 1530 (28) 90

Junel Fe 120 (28) 90

Junel Fe 24 91

junior mapap 27

K

K1-1000 135

KABIVEN 127

Kalliga 91

kaopectate (bismuth

subsalicy) 147

kaopectate ex str (bismuth

ss) 147

Kariva (28) 87

KATERZIA 67

KEDRAB (PF) 54

245

k-effervescent 122

Kelnor 135 (28) 91

Kelnor 1-50 (28) 91

ketoconazole 36 103

KETONE CARE 180 185

KETONE URINE TEST 180

185

ketoprofen 31

ketorolac 198

KETOSTIX 180 185

ketotifen fumarate 197

KEYTRUDA 51

kids first vitamin d3 134

kids mini enema 159

KIDS VITAMIN D3 134

Kimidess (28) 87

KINRIX (PF) 56

Kionex 115

kionex (with sorbitol) 115

KISQALI 47

Klor-Con M10 122

Klor-Con M15 122

Klor-Con M20 122

Klor-Con Sprinkle 122

konsyl (sugar) 153

KONSYL DAILY FIBER

(STEVIA) 153

KONSYL EASY MIX 154

KONSYL SUGAR-FREE 154

KONSYL SUGAR-FREE

(ASPARTAME) 154

K-PHOS NO 2 161

K-PHOS ORIGINAL 161

Kurvelo (28) 91

L

l norgesteestradiol-eestrad

87

labetalol 63

LACTATED RINGERS 115

130

lactulose 149 155

LAMISIL AT 102

lamotrigine 73

LANCETS 171 185

LANCETS SUPER THIN 171

185

LANCETSTHIN 171 186

LANCETSULTRA THIN 172

186

LANCING DEVICE 172 186

LANCING DEVICE WITH

LANCETS 172 186

LANCING SYSTEM 172 186

LANOXIN 68

lansoprazole 150

LANTUS SOLOSTAR U-100

INSULIN 141

LANTUS U-100 INSULIN 141

LANZO LANCING DEVICE

172 186

lapatinib 42

Larin 1530 (21) 91

Larin 120 (21) 91

Larin 24 Fe 91

Larin Fe 1530 (28) 91

Larin Fe 120 (28) 91

Larissia 91

latanoprost 202

laxacin 158

laxaclear 155

laxative (bisacodyl) 157

laxative (sennosides) 157

laxative dietary supplement

120

laxative maximum strength

157

laxative peg 3350 155

laxative pills regular 157

ledipasvir-sofosbuvir 40

leena 28 96

leflunomide 30

lemon glycerin 194

LENVIMA 49

Lessina 91

letrozole 46

246

leucovorin calcium 52

LEUKERAN 44

levalbuterol tartrate 216

levetiracetam 73

levobunolol 199

levocarnitine 192

levocarnitine (with sugar) 192

levofloxacin 39 201

Levonest (28) 96

levonorgestrel 98

levonorgestrel-ethinyl estrad

91

levonorg-eth estrad triphasic

96

Levora-28 91

levothyroxine 143

lice bedding spray 112

lice complete kit 1-2-3 111

lice cream rinse 112

lice killing 111

lice pyrinyl shampoo 111

lice solution 111

lice treatment 111

lice treatment (permethrin)

112

LIDO BDK 181

lido king 110

lidocaine 33 110

lidocaine hcl 110 193

lidocaine pain relief 110

Lidocaine Viscous 193

lidocaine-prilocaine 109

Lillow (28) 91

liothyronine 143

liquid antacid 146

liquid calcium with vitamin d

117

lisinopril 62

lisinopril-hydrochlorothiazide

62

LITE TOUCH LANCETS 172

186

LITE TOUCH LANCING

DEVICE 172 186

LITE TOUCH-MEDIUM

MASK 179 186

LITEAIRE MDI CHAMBER

179 186

little noses 220

little remedies 220

little remedies fever and pain

27

little remedies saline mist 220

little tummys gas relief 151

LO LOESTRIN FE 87

lo-dose aspirin 32 166

LODRANE D 204

lohist - d 204

Lojaimiess 87

Lomedia 24 Fe 92

loperamide 146

lopreeza 138

loradamed 211 213

loratadine 211 213

lorazepam 70 71 78 82

Lorcet (Hydrocodone) 24 25

Lorcet Hd 24 25

Lorcet Plus 25

Loryna (28) 92

losartan 63

losartan-hydrochlorothiazide

63

lotrimin af 103

lovastatin 65

Low-Ogestrel (28) 92

Lo-Zumandimine (28) 92

lubricant dry eye relief 195

lubricant eye 195

lubricant eye (cmc-glycerin)

194

lubricant eye (pg-peg 400)

194

lubricant eye drops 195

lubricating jelly (chlorhexid)

109

247

lubricating plus 195

lugols 52

LUPRON DEPOT 47 141

LUPRON DEPOT (3

MONTH) 47 141

LUPRON DEPOT (4

MONTH) 47

LUPRON DEPOT (6

MONTH) 47

Lutera (28) 92

Lyleq 95

LYNPARZA 49

LYSODREN 45

Lyza 95

M

maalox advanced 146

MAALOX ADVANCED 146

MAALOX MAXIMUM

STRENGTH 146

MAG-AL 144

mag-g 120

magnesium 120

magnesium citrate 156

MAGNESIUM CITRATE

(BULK) 155

MAGNESIUM HYDROXIDE

(BULK) 84

magnesium oxide 120 145

MAGNESIUM OXIDE 120

magnesium sulfate in 09

nacl 120

magnesium sulfate in d5w

120

magnesium sulfate in lr 120

MAGOX 120

MAKENA 138 142

MAKENA (PF) 138 142

mapap (acetaminophen) 27

mapap arthritis pain 27

mapap extra strength 27

maprotiline 75

Marlissa (28) 92

Marten-Tab 28

masophen 27

MATULANE 43

MAVYRET 39

MAXIDEX 198

MAXIFED TR 204

maxilube 109

maxi-tuss pe 204

maxi-tuss tr 204

m-dryl 206 209

meclizine 147

medicated heat patch 111

medi-first anti-fungal 103

medi-laxx 158

medi-meclizine 147

MEDISENSE THIN

LANCETS 172 186

MEDLANCE PLUS

LANCETS 172 186

medroxyprogesterone 86 142

megestrol 49 112

MEKINIST 48

Melodetta 24 Fe 92

meloxicam 30

melphalan 44

memantine 85

MENACTRA (PF) 57

MENOMUNE - ACYW-135

57

MENOMUNE - ACYW-135

(PF) 57

MENQUADFI (PF) 57

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

(PF) 58

MENVEO MENA

COMPONENT (PF) 58

MENVEO MENCYW-135

COMPNT (PF) 58

MEPHYTON 135

mercaptopurine 45

mesalamine 152

META APPETITE CTRL

(ASPARTAME) 154

METAMUCIL 154

248

METAMUCIL (WITH

SUGAR) 154

METAMUCIL FIBER

SINGLES 154

METAMUCIL FIBER THIN

154

METAMUCIL FREE 154

metamucil plus calcium 154

metaproterenol 216

metformin 141

methadone 24

methenamine hippurate 41

161

methenamine mandelate 41

161

methimazole 137

methocarbamol 168

METHOCEL E 4 M 85

METHOCEL K 100 M 84 85

methotrexate sodium 29 45

methotrexate sodium (pf) 45

methyldopa 68

methylergonovine 142

methylphenidate hcl 77 80

methylprednisolone 139

methylprednisolone acetate

139

metipranolol 199

metoclopramide hcl 152

metolazone 70

metoprolol succinate 66

metoprolol ta-

hydrochlorothiaz 68

metoprolol tartrate 66

metronidazole 37 99 110

225

mexiletine 64

mgo 120

mi-acid 146

mi-acid gas relief(simethicon)

151

mi-acid(calcium carb-mag

hydr) 144

Mibelas 24 Fe 92

micatin 103

miconazole 7 224

miconazole nitrate 103 224

miconazole-3 224

miconazole-3

prefilcreamwipe 224

miconazole-skin clnsr17 224

MICRO THIN LANCETS 172

MICROCHAMBER 179 186

Microgestin 1530 (21) 92


Microgestin Fe 1530 (28) 92


micro-guard 103

MICROLET 2 LANCING

DEVICE 172 186

MICROLET LANCET 172

MICROLIFE PEAK FLOW

METER 178 186

MICROSPACER 179 186

midazolam 33 78

midazolam (pf) 33 78

midodrine 68

migraine formula 32

Mili 92

milk of magnesia 156

milk of magnesia

concentrated 156

MILLIPRED 139

MINI LANCING DEVICE 172

186

MINI WRIGHT PEAK FLOW

METER 178 186

Minitran 64

minocycline 29 42

minoxidil 69

mintox 146

mintox maximum strength 146

mintox plus 146

MIRALAX 156

MIRENA 86

mirtazapine 73

misoprostol 151

249

mitomycin 51

M-M-R II (PF) 55 60 61 62

modafinil 80

MOISTURE DROPS 195

mometasone 107

MONISTAT 1 COMBO PACK

224

MONISTAT 3 224

monistat 7 225

MONISTAT 7 225

MONOJECT 09 SODIUM

CHLORIDE 130

MONOJECT HYPODERMIC

NEEDLES 177 186

MONOJECT HYPODERMIC

POLYPROPYL 177 186

MONOJECT PREFILL

ADVANCED NS 130

MONOJECT PREFILL

SALINE FLUSH 130

MONOLET LANCETS 172

186

MONOLET THIN LANCETS

172 186

Mono-Linyah 92

mononessa (28) 92

montelukast 214

morphine 24

MORPHINE 24

motion relief (meclizine) 148

motion sickness (meclizine)

148

motion sickness ii 148

motion sickness relief(mecliz)

148

MOUTHPIECE 179 186

moxifloxacin 201

mucilin sf 154

mucinex fast-max chest-

congest 218

mucus relief cough 222

mucus relief d

(pseudoephed) 217

mucus relief dm 222

mucus relief er 218

multi antibiotic plus 101

MULTI-LANCET DEVICE 2

172 186

multi-vit with fluoride-iron 129

multivit-fluor (vit e acetate)

129

mupirocin 101

murine ear wax removal

system 203

muro 128 199

Mutamycin 51

my choice 98

my way 98

mycophenolate mofetil 29

167

MYGLUCOHEALTH

LANCETS 172 187

MYLERAN 43

mynephrocaps 113

mytab gas (simethicone) 151

mytab gas maximum strength

151

Myzilra 96

N

NABI-HB 54

nabumetone 30

nadolol 66

NAPHCON-A 197

naproxen 31

naproxen sodium 31

naramin 206 209

NASACORT 219

nasal allergy 220

nasal and sinus

decongestant 223

nasal decongestant (pe) 223

nasal decongestant

(pseudoeph) 223

nasal decongest-

antihistamine 204

nasal mist 220

NASALCROM 220

NATACYN 201

natural calcium 116

250

natural daily fiber 154

natural fiber laxative 154

natural fiber supplement 154

NATURAL FIBER

SUPPLEMNT(ASPRT) 154

natural senna laxative 157

natural tears (pf) 195

natural vegetable 154

nature-throid 142

NAVELBINE 50

NAYZILAM 71 78

NEBUPENT 41

nebusal 84

NEBUSAL 84

Necon 0535 (28) 92

necon 150 (28) 92

necon 1011 (28) 87

necon 777 (28) 96

nefazodone 74

neomycin 34

neomycin-bacitracin-poly-hc

196

neomycin-bacitracin-

polymyxin 200

neomycin-polymyxin b-

dexameth 196 197

neomycin-polymyxin-

gramicidin 200

neomycin-polymyxin-hc 197

202

Neo-Polycin 200

Neo-Polycin Hc 197

neosporin (neo-bac-polym)

101

neosporin plus pain relief 102

neo-tuss 222

nephplex rx 113

NEPHRAMINE 54 126

nephro-vite 113

nephro-vite rx 113

NEUTROGENA ON THE

SPOT 100

new day 98

NEXAVAR 48

NEXPLANON 86

next choice one dose 98

niacin 65 132

niacin (inositol niacinate) 131

NIACIN (INOSITOL

NIACINATE) 131

niacin (niacinamide) 132

Niacor 65

NIAVASC 132

NIAVASC 750 132

NICODERM CQ 82

nicorelief 82

NICORETTE 82

nicotine 82

NICOTINE 83

nicotine (polacrilex) 82

nifedipine 67

nightime sleep 81 209

nighttime sleep aid (diphen)

81 209

nighttime sleep-aid

(doxylamn) 81

Nikki (28) 93

ninjacof-xg 222

NINLARO 49

NIPENT 45

Nitro-Bid 64

nitrofurantoin 35 162

nitrofurantoin macrocrystal35

162

nitrofurantoin monohydm-

cryst 35 162

nitroglycerin 64

NIVESTYM 164

NIX CREME RINSE 112

NIZORAL A-D 103

non-aspirin 27

non-aspirin child 27

non-aspirin childrens 27

non-aspirin extra strength 27

251

non-aspirin jr strength 27

non-aspirin pain relief 27

nora-be 95

norethindrone (contraceptive)

95

norethindrone acetate 142

norethindrone ac-eth

estradiol 93 138

norethindrone-eestradiol-iron

93

norgestimate-ethinyl estradiol

93 96

Norlyda 95

Norlyroc 95

normal saline flush 130

NORMOSOL-M IN 5

DEXTROSE 118

NORMOSOL-R IN 5

DEXTROSE 118

NORMOSOL-R PH 74 121

nortemp 27

Nortrel 0535 (28) 93

nortrel 135 (21) 93

Nortrel 135 (28) 93

Nortrel 777 (28) 96

nortriptyline 75

NOVA SAFETY LANCETS

172 187

NOVA SUREFLEX

LANCETS 172 187

NOVOLIN 7030 U-100

INSULIN 140

NOVOLIN N NPH U-100

INSULIN 140

NOVOLIN R REGULAR U-

100 INSULN 140

NOVOLOG MIX 70-30 U-100

INSULN 140

np thyroid 142

NUTRILIPID 127

Nyamyc 102

Nylia 777 (28) 96

Nymyo 93

nystatin 36 102 193

NYSTATIN (BULK) 36 84

nystatin-triamcinolone 104

Nystop 102

nytol 81 206 209

O

obagi nu-derm tolereen 107

ocean nasal 220

ocella 93

OCUSOFT IRRIGATING

OPHTH SOLN 200

ofloxacin 39 201 202

ogestrel (28) 93

Okebo 42

olopatadine 198

OLUMIANT 29

omega-3 acid ethyl esters 65

omeprazole 150

ON CALL LANCET 172 187

ON CALL LANCING DEVICE

172 187

ON CALL PLUS LANCET

172 187

ON CALL PLUS LANCING

DEVICE 172 187

ondansetron 148

ondansetron hcl 148

ONE WAY VALVED

MOUTHPIECE 179 187

ONETOUCH DELICA LANC

DEVICE 172 187

ONETOUCH DELICA

LANCETS 172 187

ONETOUCH DELICA PLUS

LANC DEV 172 187


LANCET 172 187

ONETOUCH SURESOFT

LANCING DEV 173 187

ONETOUCH ULTRASOFT

LANCETS 173 187

ONETOUCH VERIO FLEX

START 173 187

ONETOUCH VERIO HIGH

CONTROL 173 187

ONETOUCH VERIO MID

CONTROL 173 187

252

ONETOUCH VERIO TEST

STRIPS 168 187

ON-THE-GO LANCETS 173

187

onxol 50

opcicon one-step 98

OPCON-A 197

OPDIVO 51

OPTICHAMBER ADULT

MASK-LARGE 179 187

OPTICHAMBER DIAMOND

LG MASK 179 187

OPTICHAMBER DIAMOND

VHC 179 187

OPTICHAMBER DIAMOND-

MED MSK 180 188


SML MASK 180 188

option-2 98 99

Oralone 193

oralyte 121

ORASEP 193

Orsythia 93

oscimin 152 162

oscimin sl 152 162

oseltamivir 40

oxaliplatin 48

oxcarbazepine 73

oxybutynin chloride 162

oxycodone 24

oxycodone-acetaminophen

25 26

OXYTROL 162

OXYTROL FOR WOMEN 162

oysco 500d 117

oysco-500 116

oyster shell calcium-vit d2 117


oystercal-d 118

P

Pacerone 64

paclitaxel 50

pain relief 8hr 28

pain relief cream 110

pain reliever

(acetaminophen) 28

pain reliever jr strength 28

pain reliever plus 32

pain relieving rub (camphor)

110

pamprin max 32

PANCREAZE 149

PANDA MASK 180 188

panoxyl 100

panoxyl-4 100

pantoprazole 151

PARAGARD T 380A 86

Paroex Oral Rinse 193

paromomycin 34

paroxetine hcl 74

PARVA-CAL 500 118

p-col rite 158

PEAK AIR PEAK FLOW

METER 178 188

pedi multivit no194-iron sulf

129

pedia tri-vite 128

pediacare fever reducer 28

PEDIA-LAX 156

pedia-lax stool softener 159

PEDIARIX (PF) 53 56

pediatric cough and cold 218

pediatric d-vite 134

pediatric electrolyte 121

pediatric fe-vite 119

pediatric freezer pops 121

pediatric multivitamin no171

128

PEDIATRIC PANDA MASK

180 188

pediatric poly-vite 128

pediatric poly-vite with iron

129

PEDIATRIC SMALL MASK

180 188

pediatric tri-vite 128

253

pedi-boro soak 105

PEDVAX HIB (PF) 57

peg 3350-electrolytes 157

PEGANONE 72

PEGASYS 39

PEGASYS PROCLICK 39

peg-electrolyte soln 157

PEGINTRON 39

penicillamine 29 34

penicillin v potassium 41

PENTACEL (PF) 56 59

PENTACEL DTAP-IPV

COMPNT (PF) 56

pentobarbital sodium 81

pentoxifylline 164

peptic relief 147

perdiem overnight relief 158

peri-colace 158

periguard 109

PERIKABIVEN 127

perindopril erbumine 62

Periogard 193

PERISHIELD 109

PERJETA 51

permethrin 112

persa-gel 100

PERSONAL BEST FULL

RANGE 178 188

personal lubricating jelly 109

pharbetol 28

pharmabase barrier 109

PHAZYME 151

Phenadoz 148 207 209

PHENAGIL 204

phenazopyridine 161

phenobarbital 71 81 82

phenylephrine hcl 199

Phenytek 72

phenytoin 72

phenytoin sodium extended

72

Philith 93

phillips 120

phillips liqui-gels 159

PHILLIPS MILK OF

MAGNESIA 145 156

PHOSLYRA 160

phospha 250 neutral 121 161

PHOSPHOLINE IODIDE 196

phospho-trin 250 neutral 121

161

PHYSICIANS EZ USE B-12

131

phytonadione (vitamin k1) 135

PHYTONADIONE (VITAMIN

K1) 135

PIKO 1 178 188

pilocarpine hcl 194 196

Pimtrea (28) 87

pink bismuth 147

pinworm treatment 35

pin-x 35

PIN-X 35

pioglitazone 141

PIP LANCET 173 188

Pirmella 93 96

piroxicam 30

PLASMA-LYTE 148 121

PLASMA-LYTE A 121

PLENAMINE 126

PNEUMOVAX-23 58

POCKET CHAMBER 180

188

POCKET PEAK FLOW

METER 178 188

podofilox 108

Polycin 200

polyethylene glycol 3350 156

POLYETHYLENE GLYCOL

3350(BULK) 84

polymyxin b sulf-trimethoprim

200

POLYSPORIN 101

polysporin (bacitracin zinc)

101

254

POLYVINYL ALCOHOL

(BULK) 84 85

POLY-VI-SOL 128

POLY-VI-SOL WITH IRON

129

poly-vita 128

poly-vita (iron) 129

poly-vitamin 128

poly-vitamin with iron 129

Portia 28 93

PORTRAZZA 51

potassium bicarb and

chloride 121

potassium bicarb-citric acid

122

potassium chlorid-d5-

045nacl 122

potassium chloride 122 123

potassium chloride in

09nacl 122

potassium chloride in 5

dex 122

potassium chloride in lr-d5

122

potassium chloride in water

122

potassium chloride-045

nacl 122

potassium chloride-d5-

02nacl 122


03nacl 122


09nacl 122

potassium citrate 161

potassium citrate-citric acid

161

potassium hydroxide 100

powderlax 156

pramipexole 76

prasugrel 166

pravastatin 65

prazosin 70

PRED MILD 198

prednicarbate 107

prednisolone acetate 198

prednisolone acetate (pf) 198

prednisolone sodium

phosphate 139 198

prednisone 139

PREDNISONE INTENSOL

139

pregabalin 72 79

PREMARIN 225

PREMASOL 10 126

PREMASOL 6 126

prenatal 129

prenatal vitamin 129

prenatal vits96-iron fum-folic

129

preparation h hydrocortisone

107

PRESSURE ACTIVATED

LANCETS 173 188

PREVAIL BLADDER

CONTROL PAD 176 188

Prevalite 65

Previfem 93

PREVNAR 13 (PF) 58

PREZISTA 42

PRIFTIN 37 42

PRIMAQUINE 36

PRIMEAIRE 180 188

primidone 71

PRO COMFORT LANCET

173 188

PROAIR RESPICLICK 216

probenecid 163

probenecid-colchicine 163

PROCHAMBER 180 188

prochlorperazine 148

prochlorperazine maleate 76

148

Procto-Med Hc 33 107

Proctosol Hc 33 107

Proctozone-Hc 33

255

PRODIGY LANCETS 173

188

PRODIGY LANCING

DEVICE 173 188

PRODIGY TWIST TOP

LANCET 173 188

progesterone micronized 142

promethazine 148 207 209

promethazine-dm 221

promethazine-phenylephrine

204

Promethegan 148 207 209

promolaxin 160

propafenone 64

propantheline 152

proparacaine 200

propranolol 66

propylthiouracil 137

PROQUAD (PF) 55 60 61

62

PROSOL 20 126

protriptyline 75

pseudoephedrine hcl 223

pseudoephedrine-guaifenesin

217

psoriasis medicated 108

psyllium husk 155

PSYLLIUM HUSK 155

PSYLLIUM HUSK (BULK) 84

154

PULMICORT FLEXHALER

214

PULMOSAL 84

pure and gentle eye 196

PURE COMFORT LANCETS

173 188

PURE COMFORT SAFETY

LANCETS 173 188

PURECOMFORT PEAK

FLOW METER 178 188

purelax 156

PURIXAN 45

PUSH BUTTON SAFETY

LANCETS 173 189

pyrazinamide 37

pyridostigmine bromide 167

pyridoxine (vitamin b6) 132

pyrimethamine 36

Q

QBRELIS 62

q-dryl 206 207 209

QINLOCK 49

q-pap 28

q-pap extra strength 28

QUADRACEL (PF) 57

Quasense 93

quinapril 63

quinidine sulfate 64

quinine sulfate 36

QVAR 214

QVAR REDIHALER 214

R

RABAVERT (PF) 61

raloxifene 142

ramipril 63

ranitidine hcl 150

READYLANCE SAFETY

LANCETS 173 189

Reclipsen (28) 93

RECOMBIVAX HB (PF) 54

recort plus 108

reeses pinworm medicine 35

refenesen 218

REFRESH CELLUVISC 196

REFRESH CONTACTS 196

REFRESH OPTIVE 195

reguloid (aspartame) 155

reguloid (psyllium husk) 155

relcof c 223

RELENZA DISKHALER 40

RELIAMED LANCET 173

189

RELIAMED MINI LANCING

DEVICE 173 189

256

RELIAMED SAFETY SEAL

LANCETS 173 189

RELION THIN LANCETS173

189

RELION ULTRA THIN PLUS

LANCETS 173 189

remedy phytoplex antifungal

103

renal caps 113

renal vitamin 113

renal-vite 113

rena-vite 113

rena-vite rx 113

RENFLEXIS 28 153

reno caps 113

repaglinide 136

REPLESTA 134

RESPAIRE-30 218

restfully sleep 81 207 209

restore tears 196

RETACRIT 164

retaine nacl 199

revive plus 196

RHOPRESSA 202

Ribasphere 40

ribavirin 40

rid complete lice elim kit 111

112

rid lice killing 112

RIDAURA 29

rifampin 37 42

ri-gel 146

RIGHTEST GD500

LANCING DEVICE 173

189

RIGHTEST GL300

LANCETS 173 189

riluzole 167

ri-mag 145

ri-mag plus 146

ri-mox 146

ri-mox plus 146

ringers 115 130

ritonavir 42

RITUXAN 46

RITUXAN HYCELA 46

rivastigmine tartrate 85

rivelsa 95

rizatriptan 80

robafen 218

robafen ac 223

robitussin pediatric 213

roll-on deodorant 104

ropinirole 76

rosuvastatin 65

ROTARIX 55 61

ROTATEQ VACCINE 55 61

RYBELSUS 137

RYDAPT 49

rynex pse 204

S

SAFETY LANCETS 174 189

SAFETY SEAL LANCETS

174 189

SAFETY-LET LANCETS 174

189

saline mist 220

saline nasal 220

saline nose 220

sal-plant 108

SANTYL 105

scalp relief 108 109

scalpicin anti-itch 108

scopolamine base 147

scot-tussin expectorant 218

SCOT-TUSSIN SENIOR 222

SEGLUROMET 136

selegiline hcl 76

selenium 123

selenium sulfide 104

selenomax 123

SELENOMETHIONINE 123

selsun blue 104

SEMGLEE PEN U-100

INSULIN 141

257

SEMGLEE U-100 INSULIN

141

senexon 158

senexon-s 158

senna 158

SENNA 158

senna-extra 158

sennalax-s 159

sennosides-docusate sodium

159

SENOKOT 158

SENOKOT EXTRA

STRENGTH 158

senokot-s 159

SEREVENT DISKUS 216

sertraline 74

Setlakin 94

sevelamer carbonate 160

Sharobel 95

SHARPS CONTAINER 177

SHINGRIX (PF) 61

SIDESTREAM PEDIATRIC

FACE MASK 180 189

silace 160

siladryl sa 207 209

silapap 28

SILICONE MASK -

PEDIATRIC 180 189

silphen cough 207 209

siltussin sa 218

SILVASORB 112

silver sulfadiazine 105

SIMETHICONE (BULK) 84

151

SIMILAC STERILIZED

WATER 85

Simliya (28) 87

Simpesse 87

simply sleep 81 207 209

simvastatin 65

SINGLE-LET 174 189

sinus pressure-cong relief pe

223

sleep aid (diphenhydramine)

81 209

sleep tablet

(diphenhydramine) 81 207

209

SLO-NIACIN 132

slow release iron 119

SLOW RELEASE IRON 119

SMART SENSE LANCETS

174 189

SMARTDIABETES

VANTAGE 174 189

SMARTEST LANCET 174

189

smoflipid 127

smoothlax 156

sochlor 199

sodium bicarbonate 144

sodium chloride 84 115 199

sodium chloride 045 130


130

sodium chloride 09 (flush)

130



sodium citrate-citric acid 161

sodium polystyrene (sorb

free) 115

sodium polystyrene sulfonate

115

sofosbuvir-velpatasvir 40

SOF-SERTER INSERTION

DEVICE 174 189

SOFT TOUCH LANCETS

174 189

solifenacin 162

SOLU-CORTEF ACT-O-VIAL

(PF) 139

SOLUS V2 LANCETS 174

189

SOLUS V2 LANCING

DEVICE 174 189

sominex 81 207 209

soothing care

(hydrocortisone) 108

sore throat 193

258

sore throat (phenol) 193

Sorine 64 66

sotalol 64 66

Sotalol Af 64 66

spironolactone 63 69

spironolacton-

hydrochlorothiaz 69

Sprintec (28) 94

SPRITAM 73

SPRYCEL 49

Sps (With Sorbitol) 115

Sronyx 94

ssd 105

sski 118

st joseph aspirin 32 166


STEGLATRO 136

STEGLUJAN 136

STERILANCE TL 174 189

sterile eye wash 200

STERILE LUBRICANT 196

sterile saline 220

STIOLTO RESPIMAT 217

STIVARGA 48

stomach relief 147

stool softener 160

stool softener-laxative 159

stool softener-stimulant laxat

159

stop lice 112

stop smoking aid 83

STRIVERDI RESPIMAT 216

strong iodine 118

sucralfate 160

SUDAFED 223

sudafed 12 hour 223

SUDAFED 24 HOUR 223

sudogest 223

sudogest 12-hour 223

sulfacetamide sodium 104

201

sulfacetamide sodium (acne)

99

sulfacetamide-prednisolone

197

sulfamethoxazole-

trimethoprim 35

sulfasalazine 29 153

sulfatrim 35

sulindac 30

sumatriptan 80

sumatriptan succinate 80

super b complex-vitamin c

113

super calcium 116

super daily d3 134

SUPER DAILY D3 134

SUPER THIN LANCETS 174

189

superplex-t 113

suphedrin 223

suphedrine 12 hour 223

suphedrine pe cold and

allergy 204

SURE COMFORT INS SYR

U-100 177 190

SURE COMFORT LANCETS

174 190

SURE COMFORT LANCING

PEN 174 190

SUREFLEX DEVICE WITH

LANCETS 174 190

SUREFLEX LANCING

DEVICE 174 190

SURE-LANCE 174 190

SURE-LANCE ULTRA THIN

174 190

SURE-PEN LANCING

DEVICE 174 190

SURE-TOUCH LANCET 174

190

surgilube 109

SURGUARD2 SAFETY 177

190

SUTENT 49

Syeda 94

SYLATRON 47

259

SYMJEPI 68

SYMLINPEN 120 137

SYMLINPEN 60 137

SYSTANE GEL 196

SYSTANE ULTRA 195

T

tab tussin 218

TABLOID 45

tacrolimus 167

tactinal 28

tactinal extra strength 28

TAFINLAR 46

TAGRISSO 43

take action 98 99

TALTZ AUTOINJECTOR 101

TALTZ SYRINGE 101

tamoxifen 50

tamsulosin 161

TANZEUM 137

TARCEVA 43

targeted acne spot treatment

100

Tarina 24 Fe 94

Tarina Fe 120 (28) 94

TASIGNA 50

Taztia Xt 67

TDVAX 57

tears again (pva) 196

tears naturale free (pf) 195

TECHLITE LANCETS 174

190

TELCARE LANCETS 174

190

telmisartan 63

temazepam 78 82

TEMODAR 44

temozolomide 44

Tencon 28

teniposide 47

TENIVAC (PF) 57

terazosin 70

terbinafine hcl 35 102

terconazole 225

TETANUSDIPHTHERIA

TOX PED(PF) 57

tetracycline 42

the magic bullet 158

Theochron 215

theophylline 215

thera-d 134

THERA-D 4000 134

THERATEARS 196

thiamine hcl (vitamin b1) 131


thiotepa 43

Tiadylt Er 67

tiagabine 72

TICE BCG 48 55

tiger balm 110

TIGER BALM 110

TIGER BALM (WITH

CAPSICUM) 110

Tilia Fe 96

timolol maleate 66 199

TINACTIN 103

tioconazole-1 225

TIVICAY 37

tizanidine 168

tl icon 120

TOBRADEX 197

tobramycin 201

tobramycin-dexamethasone

197

TOBREX 201

TODAY CONTRACEPTIVE

SPONGE 99

tolcylen 103

tolnaftate 103

tolterodine 162 163

TOPCARE UNIVERSAL1

LANCET 174 190

topiramate 73

Toposar 47

260

topotecan 50

torsemide 69

total allergy medicine 207

209

TOVIAZ 163

TPN ELECTROLYTES II 121

tramadol 24

tramadol-acetaminophen 26

trandolapril 63

TRANSDERM-SCOP 147

TRAVASOL 10 126

travel-ease (meclizine) 148

trazodone 74

TRECATOR 37

TRELEGY ELLIPTA 217

tretinoin 100

tretinoin (antineoplastic) 50

tretinoin (emollient) 110

Tri Femynor 96

triacting expectorant 218

triamcinolone acetonide 108

193 220

triamterene-

hydrochlorothiazid 69

tri-biozene 102

tri-buffered aspirin 33

tricon 120

Triderm 108

Tri-Estarylla 96

trifluridine 202

Tri-Legest Fe 96

Tri-Linyah 96

Tri-Lo-Estarylla 96

Tri-Lo-Marzia 97

Tri-Lo-Mili 97

Tri-Lo-Sprintec 97

Trilyte With Flavor Packets

157

trimethoprim 35

Tri-Mili 97

trimipramine 75

trinessa (28) 97

trinessa lo 97

TRINTELLIX 75

Tri-Nymyo 97

triphrocaps 113

triple antibiotic 101

TRIPLE PASTE 109

triple paste af 103

Tri-Previfem (28) 97

TRISPEC DMX 222

Tri-Sprintec (28) 97

TRITON X-100 85

TRI-VI-SOL 128

tri-vita 128

tri-vitamin 128

tri-vite with fluoride 129

Trivora (28) 97

Tri-Vylibra 97

Tri-Vylibra Lo 97

TROPHAMINE 10 126

TROPHAMINE 6 127

tropicamide 197

trospium 163

TRUE COMFORT LANCET

174 190

TRUEDRAW LANCING

DEVICE 175 190

trueplus glucose 135

TRUEPLUS KETONE 190

TRUEPLUS LANCETS 175

190

TRULICITY 137

TRUMENBA 58

TRUVADA 37

TRUZONE PEAK FLOW

METER 178 190

TUDORZA PRESSAIR 215

Tulana 95

TUMS 145

TUMS EXTRA STRENGTH

SMOOTHIES 145

tums ultra 145

tussin chest congestion 219

261

tussin cough (dm only) 213

tussin cough-chest

congestion 222

tussin dm 222

tussin dm max 222

tussin pe 218

TWINRIX (PF) 52 53

TWIST LANCETS 175 190

tyblume 94

TYKERB 42

tylophen 28

U

ULTI-LANCE 175 190

ULTILET BASIC LANCETS

175 190

ULTILET CLASSIC

LANCETS 175 190

ULTILET LANCETS 175 191

ULTILET SAFETY LANCETS

175 191

ULTRA FINE LANCETS 175

191

ultra sleep (doxylamine succ)

81

ultra strength antacid 145

ULTRA THIN II LANCETS

175 191

ULTRA THIN LANCETS 175

191

ULTRA THIN PLUS

LANCETS 175 191

ULTRA TLC LANCETS 175

191

ULTRA-CARE LANCETS

175 191

ultracin m 111

ULTRALANCE LANCETS

175 191

ULTRA-THIN II LANCETS

175 191

UNILET COMFORTOUCH

LANCET 175 191

UNILET EXCELITE II

LANCET 175 191

UNILET EXCELITE LANCET

175 191

UNILET GP LANCET 175

191


UNILET SUPER THIN

LANCETS 175 191

unisom (diphenhydramine)

81 209

UNISOM (DOXYLAMINE) 81

unisom sleepgels 81 209

UNISTIK 2 DEVICE 175 191

UNISTIK 2 EXTRA 175 191

UNISTIK 2 NORMAL

LANCETDEVICE 175

UNISTIK 3 176 191

UNISTIK 3 COMFORT

DEVICE 176 191

UNISTIK 3 COMFORT

LANCET 176 191

UNISTIK 3 EXTRA LANCET

176 191

UNISTIK 3 GENTLE 176 191

UNISTIK 3 LANCETS 176

191

UNISTIK 3 NEONATAL

DEVICE 176 191

UNISTIK 3 NORMAL

LANCET 176 191

UNISTIK CZT LANCET 176

191

UNISTIK PRO LANCET 176

192

UNISTIK SAFETY 176 192

UNISTIK TOUCH LANCETS

176 192

UNITHROID 143

UNIVERSAL 1 LANCETS

176 192

URO-MAG 120

UROQID-ACID NO2 41 162

ursodiol 149

UTIBRON NEOHALER 217

V

VAGINAL CONTRACEPTIVE

FILM 99

vaginal contraceptive foam 99

262

vagistat-3 225

valacyclovir 40

valproic acid 71 79

valproic acid (as sodium salt)

71 79

valsartan 63

valsartan-hydrochlorothiazide

63

VALTOCO 71 78

valu-dryl 207 210

valu-dryl allergy 207 210

valu-tapp decongestant 223

vancomycin 39

VANCOMYCIN 39

vancomycin in 09 sodium

chl 39

vanicream hc 108

vanquish 32

VAQTA (PF) 53

VARIVAX (PF) 55 61

vcf contraceptive gel 99

VELCADE 49

Velivet Triphasic Regimen

(28) 97

venlafaxine 74

verapamil 64 67

verticalm 148

VERZENIO 47

Vestura (28) 94

vicks dayquil cough 213

VICKS DAYQUIL MUCUS

CONTROL DM 222

Vienva 94

vinblastine 50

Vincasar Pfs 50

vinorelbine 50

Viorele (28) 87

virt-caps 113

virt-phos 250 neutral 121 161

vit a palmitate-vit c-vit d3 128

vitamin a and d 105

vitamin a and d diaper rash

109

vitamin b complex 113

vitamin b-1 131

vitamin b-1 (mononitrate) 131

vitamin b-6 132

vitamin d3 134

VITAMIN D3 134

vitamin e 134

vitamin e (dl acetate) 134

vitamin e mixed 134

vitamins b complex 113

vits a and d-white pet-lanolin

105

VIVAGUARD LANCET 176

192

VIVAGUARD LANCING

DEVICE 176 192

vol-care rx 113

Volnea (28) 87

VORTEX ADULT MASK 180

192

VORTEX FROG MASK-

CHILD 180 192

VORTEX HOLDING

CHAMBER 180 192

VORTEX LADYBUG MASK-

TODDLER 180 192

VORTEX VHC LADYBUG

MASK-TODDLR 180 192

VOTRIENT 50

vp-vite rx 113

Vyfemla (28) 94

Vylibra 94

W

wal-act d cold and allergy 204

wal-dram 2 148

wal-dryl allergy 207 210

wal-fex allergy 211 213

wal-finate 205 210

wal-itin 211 213

wal-itin d 12 hour 205

wal-mucil fiber 155

263

WAL-MUCIL FIBER

(ASPARTAME) 155

wal-mucil with calcium 155

wal-phed 223

wal-phed d 223

wal-profen 31

wal-sleep z 81 210

wal-som (diphenhydramine)

81

wal-som (doxylamine) 81

wal-sporin 101

wal-tap 204

wal-tussin 219

wal-tussin cough and cold cf

221

wal-tussin dm clear 222

wal-zan 150 150

wal-zan 75 150

wal-zyr (cetirizine) 211 212

wal-zyr (ketotifen) 198

warfarin 163

wart remover 109

WATER (BULK) 84

weekly-d 134

Wera (28) 94

westhroid 142

west-vite with folic acid 113

Wixela Inhub 217

wp thyroid 143

Wymzya Fe 94

X

XALKORI 44

XARELTO 164

XARELTO DVT-PE TREAT

30D START 164

XATMEP 29 45

XERAC AC 104

XOFLUZA 40

XOLAIR 215

XTANDI 45

xulane 97

Y

YF-VAX (PF) 55

Yuvafem 225

Z

ZADITOR 198

Zafemy 97

zaleplon 82

ZANOSAR 51

ZANTAC 150

ZANTAC MAXIMUM

STRENGTH 150

Zarah 94

ZARXIO 164

zeasorb af 103

ZEJULA 49

Zenchent (28) 94

Zenchent Fe 94

ZENPEP 149

Zenzedi 77 79 81

zephrex-d 224

zidovudine 37

zinc oxide 109

zolpidem 82

zonisamide 73

ZOSTAVAX (PF) 55 62

zostrix 111

zostrix-hp 111

Zovia 135E (28) 94

Zovia 150E (28) 95

z-sleep 81 210

Zumandimine (28) 95

ZYDELIG 48

ZYKADIA 44

zyncof 222

ZYTIGA 43 45

Notice of non-discrimination Discrimination is against the law Central California Alliance for Health (the Alliance)

complies with applicable federal and State civil rights laws and does not discriminate

(exclude or treat people differently) on the basis of race color national origin creed

ancestry religion language age marital status sex sexual orientation gender identity

health status physical or mental disability or identification with any other persons or

groups defined in Penal Code 42256 and the Alliance will provide all Covered Services

in a culturally and linguistically appropriate manner The Alliance

Provides free aids and services to people with disabilities to communicate effectively

with us such as

Qualified sign language interpreters

Written information in other formats (braille large print audio accessible

electronic formats and other formats)

Provides free language services to people whose primary language is not English

such as

Qualified interpreters

Information written in other languages

If you need these services contact Member Services

If you believe that the Alliance has failed to provide these services or discriminated in

another way on the basis of race color national origin creed ancestry religion

language age marital status sex sexual orientation gender identity health status

physical or mental disability or identification with any other persons or groups defined in

Penal Code 42256 you can file a grievance with

Central California Alliance for Health Attn Grievance Department 1600 Green Hills Road Scotts Valley CA 95066 800-700-3874 x5816 (TTY 1-800-735-2929) Fax 831-430-5579 Email GrievanceCoordinatorccah-allianceorg

You can file a grievance in person or by mail fax or email If you need help filing a

grievance Member Services or a Grievance Coordinator is available to help you







Washington DC 20201

1-800-368-1019 800-537-7697 (TDD)





800-700-3874 (TTY 1-800-735-2929)




800-700-3874 (TTY 1-800-735-2929) 번으로 전화해 주십시오


(TTY 1-800-735-2929）










Hu rau [1-800-700-3874] (TTY [1-800-735-2929])





3874 (TTY 1-800-735-2929) पर कॉल कर




TOC-1

Table of Contents


































2


Introduction




4


Definitions







6



8



















10



























12























14








Address



Suite 101


4981

(831) 430-5500

Hours M-F 8am-5pm


Suite 101


(831) 755-6000

Hours M-F 8am-5pm


Suite B


(209) 381-5300

Hours M-F 8am-5pm

Phone Directory













Claims (831) 430-5858

Finance (831) 430-5853





16





Abacavir Sulfate N










N








N

Efavirenz N


N


N




N



N



N


Emtricitabine N

Enfuvirtide Y

Etravirine N




Indinavir Sulfate N

Lamivudine N



Maraviroc N


Nevirapine N



Ritonavir N

Saquinavir N


Stavudine N




Tipranavir N



18




Amantadine HCl N

Amantadine HCl ER Y





Brexpiprazole Y

Cariprazine Y









Isocarboxazid Y

Lithium Carbonate N

Lithium Citrate N
















Pimozide Y











Trihexyphenidyl N



20







N





Naloxone HCl N

Naltrexone (oral) N








Anti-inhibitor

















Factor IX complex









22












bull Preterm birth












24





















1 QL (5 per 1 day)



1 QL (65 per 1 day)


1 QL (65 per 1 day)


1 QL (5 per 1 day)




1 QL (9 per 1 day)


1 QL (5 per 1 day)





25




1 QL (5 per 1 day)





1 QL (65 per 1 day)


1 QL (65 per 1 day)


1 QL (5 per 1 day)





1 QL (9 per 1 day)


1 QL (5 per 1 day)


1 QL (5 per 1 day)





1 QL (6 per 1 day)




1 QL (6 per 1 day)








26




1 QL (6 per 1 day)




1 QL (6 per 1 day)























1 OTC Medical





27








2 OTC Medical












1 OTC Medical














28



















1 QL (6 per 1 day)




2 PA SP



2 PA SP








29











1 PA



2 PA SP



1 SP












2










30
















1


1




1 OTC Medical












31



















1















32




1 OTC Medical










1 OTC Medical


1 OTC Medical




1 OTC Medical






1 OTC Medical








1 OTC Medical






33




















1


1


1












34






1




2






















1


1





35














2






1






1











36




































37















1 QL (1 per 1 day)





















38

















1









1




1 PA





1





39









2


1 PA


1


1


1 PA







2 PA SP


2 PA SP


2 PA SP


2 PA SP



2 PA SP





40





































41







1


1


1


1





1



1





2 PA SP


2



2









42






2











1



1







2 PA SP








43







2 PA SP








2 PA OCH



2 PA SP
















44




1




1 PA



2 PA SP




1





2




1 SP


1 PA SP




2 PA OCH


2 PA OCH








45












2 PA SP








2




2






1 PA










46






1


2









2 PA SP





2 PA OCH



2 PA SP


2 PA SP


2 PA SP


2 PA SP






47




2 PA OCH


2 PA OCH


2 PA SP


2 PA SP








2 PA SP



2 PA SP



2 PA SP


2 PA SP


2 PA SP


2 PA SP








48




2 PA SP



2 PA SP


2 PA OCH


2 PA OCH








2 PA



2 PA









1 PA






49










2 PA SP


2 PA SP



2 PA SP




2 PA SP




2 PA OCH



2 PA OCH




2 PA SP


2 PA SP





50




2 PA SP











2 PA SP


1






2



1





1


1






51






1 PA



1





1


2



2 PA SP


2 PA SP



2 PA SP



2 PA SP


2 PA SP






52




2 SP


2 PA SP










2 DD






2





2 OTC Medical









53


































54









2 SP


























55

































56





























57

































58
































59

































60
































61


































62













1



1 QL (1 per 1 day)


1


1


1








1







63















1



1


1


1 QL (1 per 1 day)








2



1





64






1


1




1











1















65




1


1




1



1













1












66







1








1




1


1






1



1


1



1





67




1


1


1


1



1



1






1


1



1



1




1





68




1



















1





1


1



1


2





69

























1


1









70




2












2 PA






1
















71









1










2


2




1


1








72







1 QL (3 per 1 day)







2






2




1



1




1







73











1




1


1











1 QL (1 per 1 day)






74


















1




1 QL (1 per 1 day)


1 QL (3 per 1 day)


1 QL (2 per 1 day)



1 QL (2 per 1 day)








75





2 PA



1






1



1



1


1













76




1



1


1


1








1


1





1 QL (1 per 1 day)



1






77




1



1 QL (2 per 1 day)


1 QL (3 per 1 day)


1 QL (1 per 1 day)


1 QL (1 per 1 day)


1





1 QL (2 per 1 day)


1 QL (1 per 1 day)


1 QL (2 per 1 day)


1





1 QL (1 per 1 day)



1






78



















2



2



1




1







79




1


1








1 QL (2 per 1 day)


1 QL (3 per 1 day)



1






1 QL (3 per 1 day)





1 QL (2 per 1 day)






80





1























1



1






81




1 QL (3 per 1 day)



















1 OTC Medical















82




1












1 QL (1 per 1 day)




1


1



2 OTC



2 OTC


2 OTC




1 OTC





83




2 OTC




2 QL (336 per 365 days)


2 QL (336 per 365 days)




Bulk Chemicals


2 OTC Medical




2 OTC Medical





2 OTC Medical


1 OTC


2 OTC Medical


2 OTC Medical


2






84




2 OTC Medical


2 OTC Medical





2 OTC Medical


2 OTC Medical










2



2


2


1







85












2 OTC Medical


2 OTC Medical






1 PA



1 PA NSO










86




2 CT















1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





87




1 CT


1 CT


1 CT


1 CT


1 CT


2 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT





88




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





89




1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1






90




1 CT


1 CT


1


1


1 CT


1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





91




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





92




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT






93




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





94




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





95




1 CT


1 CT



















1 CT


1 CT



1 CT


1 CT


1 CT





96




1 CT


1 CT


1 CT



1 CT


1 CT


1 CT



1 CT


1 CT


1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





97




1 CT


1 CT


1 CT


1 CT




1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT






1



1 CT





98





1 CT


1 CT






























99









2 CT


2 CT




















1 OTC Medical








100











1


bpo topical gel 8 1








1
















101




2 PA SP


2 PA SP






1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical










1 OTC Medical


1 OTC Medical





102




1 OTC Medical


1 OTC Medical
































103












2 OTC Medical

























104






1


1







2





















105










2 OTC Medical
















2 PA












106
























2















107









1
























1


1





108








1



1


1





















109







1 OTC Medical















2 OTC Medical


2 OTC Medical













110












1 OTC












2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical






111





1 OTC Medical



2 OTC Medical








2 OTC Medical


2 OTC Medical



2 OTC Medical


1 OTC Medical
















112


















2 OTC Medical












2 OTC Medical





113




2 OTC Medical





























1 PA






114




1 PA


1 PA


1 PA


1 PA


1 PA


1 PA


1 PA



1 PA


1 PA



1 PA


1 PA


1 PA



1 PA



1 PA



1 PA





115





1 PA


1 PA
















2 PA





1 OTC Medical








1 OTC Medical





116




1 OTC Medical



1 OTC Medical









1 OTC Medical


1 OTC Medical



1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical





117




1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical



1 OTC Medical



1 OTC Medical





118




1 OTC Medical


1 OTC Medical



1 OTC Medical




2 PA


2 PA


2 PA


2 PA


2 PA














119






1 OTC Medical


1 OTC Medical






1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical


2 PA


1 OTC Medical




1 OTC Medical


1 OTC Medical


1 OTC Medical







120










2 OTC Medical



1 OTC Medical



1 OTC Medical



1 OTC Medical


1 PA


1 PA


1 PA


1 PA


1 OTC Medical




2 OTC Medical



2 OTC Medical





121




2 OTC Medical


2 OTC Medical


1 OTC Medical






2 PA


2 PA


2 PA


2 PA


2 PA


2 PA







1





122





1 PA


1 PA


1 PA


1 PA


1 PA


1 PA



1 PA


1 PA


1 PA


1 PA





1


1


1


1


1





123




1




1


1








2 OTC Medical



2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





124




2 PA


2 PA


2 PA


2 PA


2 PA



2 PA


2 PA


2 PA


2 PA



2 PA


2 PA





125




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





126




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





127




2 PA



1 PA


1 PA



2 PA


2 PA




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





128




2 PA


2 PA


2 PA


2 PA























129




2 AGE (Max 4 Years)











1 OTC Medical



1 OTC Medical










1







130




2 PA





1


1


2



1 PA


1 PA





1


1


2



1 PA




1 PA


1 PA





131










1 QL (10 per 1 day)


1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical


2 OTC Medical






132









1 OTC Medical


2


2


2 OTC Medical



1 OTC Medical


1 OTC Medical









2 OTC Medical











133




1 OTC


1 OTC Medical


1 OTC Medical










2 OTC Medical


1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical



1 OTC Medical




2 OTC Medical




2 OTC Medical





134






1





1 OTC Medical


2 OTC Medical



2 OTC Medical


2 OTC Medical



1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical







135











2




2




2 DD


2 DD


2 DD



2 DD


2 DD






1






136











2 PA NSO DD



2 PA NSO DD







1 DD





1 DD








137




2 PA DD


2 PA DD



2 PA DD


2 PA DD















1









138




1



1


1



1






1



1 PA


1 PA


2 PA


2 PA


2 PA










139





1



1


1


1


1



1


1











1


2



2 DD





140




2 DD



2 DD


2 DD



2 DD


2 DD


2 DD


2 DD



2 DD


2 DD


1 DD


2 DD



2 DD





141




2 PA DD


2 PA NSO DD


2 DD


2 DD



2 DD


1 DD


2 PA NSO DD


1 PA DD




1 DD





2 PA SP


2 PA SP






142




2







1 PA


1 PA


2 PA


2 PA


2 PA










1


1


1





143




1






1


1


2




2 OTC Medical



2 OTC Medical





1 OTC Medical



1 OTC Medical


1 OTC Medical





144






2 OTC Medical






1 OTC Medical






1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical


1 OTC Medical





1 OTC Medical





145




2 OTC Medical


2 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


2 OTC Medical









1 OTC Medical











146




1 OTC Medical





2 OTC Medical
























147





































148








1 OTC Medical









1







1













149














2


2


2









150






















2 OTC Medical




1 OTC Medical




1







151




1















2 OTC Medical




1 OTC Medical


1 OTC Medical



1 OTC Medical








152
























2





1


1






153









2 PA SP




1


1 OTC Medical





1 OTC Medical





1 OTC Medical


1






1 OTC Medical





154




2 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical







1 OTC Medical



2 OTC Medical





155





2 OTC Medical



1 OTC Medical


2 OTC Medical











1



2 OTC Medical










2 OTC Medical





156








2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical
















2 OTC Medical



1





157




1


2


1



1



1 OTC Medical










1 OTC Medical


2 OTC Medical


2 OTC Medical










158












2 OTC Medical





1



2 OTC Medical











159











1 OTC Medical






2 OTC Medical

















160















2 PA














1 PA







161











2


2








1



1











162




2



1



















1


2


2 PA


1





163





2 PA




1

















2


1


1



2





164












2 PA SP



2 PA SP


2 PA SP


2 PA SP






1 PA


1




1






165




1




1 PA


1



1





1


1




1


1



1


1


1







166




1









1 OTC Medical



1 OTC Medical





1 OTC Medical







1 OTC Medical








167







2 QL (2 per 1 day)




2



1 SP





















168



















2 DD




2 DD



2 DD







169




2 DD



2 DD



2 DD


2 DD







2 DD


2 DD



2 DD



2 DD




2 DD


2 DD




2 DD





170












2 DD





2 DD



2


2









2 DD


2 DD







171




2 DD





2 DD








2 DD







2 DD




2 DD





2 DD







172




LANCING DEVICE 2 DD





2 DD




2 DD



2 DD








2 DD







2 DD


2 DD


2 OTC






173




2 DD





2 DD


2 DD




2 DD


2 DD






1 DD


2 DD


2 DD


2 DD



2 DD









174




2 DD


2 DD




2 DD




2 DD




2 DD




2 DD



2 DD







2 DD









175





2 DD






2 DD


2 DD





2 DD






2 DD


2 DD










2 DD





176




2 DD







2 DD




2 DD



2 DD


2 DD





1 OTC Medical



2 DD


2 DD


2 DD





177




2 DD


2 DD



2 CT


1 CT





1


2


1


1


1


1


1


1






178




2 OTC Medical



2


2 OTC Medical


2 OTC Medical


2 OTC Medical


2


2 OTC Medical


2 OTC Medical




2


2





2


2


2


2





179




2


2


2


2



2


2


2


2


2


2


2




2 OTC Medical


2 OTC Medical


2


2


2





180




2


2


2 OTC Medical


2 OTC Medical


2 OTC Medical





2 OTC Medical


2 OTC Medical


2 OTC Medical


2


2


2


2










181




1




2 DD




2 DD



2 DD




2 DD





2 DD


2 DD






2


2


2





182




2



2 OTC Medical





2 DD


2 DD



2 DD




2 DD




1


2


2 DD


2 DD


1


1


1





183






2 DD


2 DD


2 DD


2 DD


2


2 DD










2 DD



2




2 DD






184




2


2


2 CT





1 CT


2


2


2


2






2 DD


2 DD




2 DD









185




2 DD








2 DD







2 DD



2 OTC Medical


2 OTC Medical



2 DD








2 DD






186





LANCING DEVICE 2 DD





2 DD



2


2



2 DD



2 DD


2 OTC Medical




2


1


1




2 OTC Medical






187





2 DD







2 OTC Medical


2 DD


2 DD


2 OTC



2 DD





2 DD


2 DD





2


2


2





188




2


2


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical






2 DD


1 OTC Medical



2 DD







1 DD


2





189




2 DD


2 DD


2 DD



2 DD






2 DD


2 DD



2 OTC Medical


2 OTC Medical



2 DD




2 DD




2 DD







190




2 DD


2 DD



2 DD







1


2 DD








2 DD


2






2 DD





191




2 DD









2 DD


2 DD










2 DD







2 DD







192




2 DD



2 DD


2 DD




2 OTC Medical


2


2


2


2












1






193













1


1


1















1 OTC Medical






194















1 OTC Medical














1 OTC Medical









195




1 OTC Medical





2












2 OTC Medical















196













2 OTC Medical








2 QL (35 per 1 day)





2


1


1 QL (35 per 1 day)





197




1


1 QL (35 per 1 day)


1


1 QL (35 per 1 day)


2


1 QL (35 per 1 day)


























198










1 QL (35 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


2


2 QL (1 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)








1 QL (35 per 1 day)






199









1 QL (35 per 1 day)

























200

















1





1


1


1 QL (35 per 1 day)


1 OTC Medical


1


1 QL (35 per 1 day)





201





1



1



2





2







1



1 QL (35 per 1 day)





2 QL (35 per 1 day)



2 QL (35 per 1 day)





202











2 PA






2 QL (35 per 1 day)


1 QL (35 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)










203





1 QL (35 per 1 day)


























204






2 OTC Medical



2 OTC Medical



2 OTC Medical





2 OTC Medical



















205










1 QL (1 per 1 day)





















1 OTC Medical





206




1 OTC Medical




1 OTC Medical

























207


















1





1













208












1 OTC Medical


1 OTC Medical



1 OTC Medical


















209












1





1

















210

















1 PA NSO OTC




1 OTC















211














2 OTC Medical
























212




















1 PA NSO OTC



1 OTC






2 OTC Medical







213

















1 OTC Medical









2


2





214




2


2


2


1


2


2


2


2


2












215





2 PA



1


1



1


1



2 PA NSO



2


2



2




2 PA NSO





216




2






1


1


1


2





1 PA NSO




2


2


2





217




1 QL (1500 per 30 days)


2


2



2 PA


2 PA




1







2 PA









218




2 OTC Medical














1











219







1



1






1 OTC Medical




2 OTC



2 OTC



2 OTC Medical





2 OTC


2 OTC Medical





220








2 OTC Medical




















2 OTC Medical







221































222































223







1 OTC Medical


1 OTC Medical







1 OTC Medical






1 OTC Medical













224







2















1 OTC Medical




1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical





225




2 OTC Medical















226

Index of Drugs

1



(pse) 223

1-day 224

1ST TIER UNILET

COMFORTOUCH 168 181

2



181

3

3 day vaginal 224

3-day vaginal 224

8


A


abiraterone 43 45

ABREVA 105

acarbose 136

ACCU-CHEK FASTCLIX

LANCET DRUM 168 181

ACCU-CHEK FASTCLIX

LANCING DEV 168 181

ACCU-CHEK MULTICLIX

LANCET 168 181


168 181


PLUS 168 181

ACCU-CHEK SOFT DEV

LANCETS 169 181

ACCU-CHEK SOFTCLIX

LANCETS 169 181

acebutolol 66

acephen 26

acetaminophen 26


Acetasol Hc 203

acetazolamide 69

acetic acid 160 202


202



acid controller 150



143



acid-pep 150



acne medication 99

ACNE MEDICATION 99


perox) 99

acne vanishing 99

acne-clear 99

ACTHIB (PF) 57


181

acyclovir 40

ADACEL(TDAP


56

adapalene 100

addaprin 30


31

ADJUSTABLE LANCING

DEVICE 169 181

ADMELOG SOLOSTAR U-

100 INSULIN 141


LISPRO 141

ADRENALIN 220

adriamycin 50

Adriamycin 50

Adrucil 45



227

ADVAIR HFA 217


100

ADVANCED EYE RELIEF

194

ADVANCED LANCING

DEVICE 169 181

ADVANCED TRAVEL

LANCETS 169 181

ADVIL 30


30

ADVOCATE LANCET 169

181

ADVOCATE LANCING

DEVICE 169 181



181

AEROCHAMBER MV 178

181

AEROCHAMBER PLUS

FLOW-VU 178 181

AEROCHAMBER PLUS

FLOW-VUS MSK 178

AEROCHAMBER PLUS Z

STAT 179 181

AEROCHAMBER PLUS Z

STAT LG MSK 178

AEROCHAMBER PLUS Z

STAT MD MSK 178

AEROCHAMBER PLUS Z

STAT SM MSK 179

AEROCHAMBER WITH

FLOWSIGNAL 179 181

AEROCHAMBER Z-STAT

PLUS-FLW SG 179 182

AEROSPAN 213


Afeditab Cr 67

Afirmelle 87


UP)(PF) 59


35MO)(PF) 59

AFLURIA QUAD 2020-

2021(6MO UP) 59

aftera 98

AIRZONE PEAK FLOW

METER 178 182

AKTEN (PF) 200

Ala-Cort 105

alavert 210 212


alaway 197

albendazole 35


Alcaine 200

alcalak 144

alclometasone 105


ALECENSA 44

alendronate 137

aler-cap 205 207

alfuzosin 161

ALIQOPA 48


205 207

ALKERAN 44


211

ALLEGRA ALLERGY 210

212

aller-chlor 205 207


aller-cort 219

aller-ease 210 212

aller-flo 219


205 207


205 208


phen) 197




211



212


228


205 208



205

aller-tec 210 211

aller-tec d 205

allopurinol 163

almacone 145

almacone-2 145


102

alogliptin 136




altamist 220

Altavera (28) 87


169 182


DEVICE 169 182


ALUMINUM HYDROXIDE

GEL (BULK) 83 143

ALUNBRIG 44

Alyacen 135 (28) 87

Alyacen 777 (28) 95

Amethia 86

Amethia Lo 86

Amethyst (28) 88

amiloride 69

AMINOSYN 10 124

AMINOSYN 7 WITH

ELECTROLYTES 124

AMINOSYN 85 124

AMINOSYN 85 -

ELECTROLYTES 124

AMINOSYN II 10 125

AMINOSYN II 15 125

AMINOSYN II 85 125

AMINOSYN II 85 -

ELECTROLYTES 124


AMINOSYN-HBC 7 125

AMINOSYN-PF 10 125

AMINOSYN-PF 7

(SULFITE-FREE) 125

AMINOSYN-RF 52 125

amiodarone 64

amitriptyline 75


75 77

amlodipine 67



amoxapine 75

amoxicillin 34


amphotericin b 35

ampicillin 34

anagrelide 166

anastrozole 46


androxy 135

ANORO ELLIPTA 216


hyd) 143



hyd) 143



145

antacid supreme 144



antacid-antigas 145



101


dextrose 163

anti-dandruff 104


anti-diarrheal 147

229


146

anti-fungal 102



antifungal cream

(miconazole) 102



151



anti-itch (hc) 105


108

anti-itch plus 108


antitussive dm 221

anucort-hc 33

ANZEMET 148

aprepitant 149

Apri 88

APRISO 152

aprodine 203

AQUA LANCE LANCING

DEVICE 169 182


aquanil hc 105


Aranelle (28) 95


armodafinil 80

ARMONAIR RESPICLICK

213

ARNUITY ELLIPTA 214

ARRANON 45


111


195





194 199


194


194


194

ARZERRA 46

Ashlyna 86

ASMANEX HFA 214

ASMANEX TWISTHALER

214

aspirin 32 166

aspirin low dose 32


mag 33

aspir-low 32 166

aspir-trin 32 166

ASSURE HAEMOLANCE

PLUS 169 182



182

ASTHMA CHECK METER

178 182

atenolol 66


athenol 26

athletes foot 102


102


atomoxetine 77

atorvastatin 65

atovaquone 36

atropine 197

ATROVENT HFA 215

Aubra 88

AUGMENTIN 35

auro eardrops 203

Aurovela 1530 (21) 88


Aurovela 24 Fe 88

230




182

AUTOLET IMPRESSION

LANC DEV 169 182

AUTOLET LANCING

DEVICE 169 182


DEVICE 169 182

AVASTIN 42

AVC VAGINAL 224

Aviane 88

avita 100

ayr saline 220

Ayuna 88

azathioprine 29 167

azelastine 197 219

azithromycin 40

azolen tincture 102

AZULFIDINE 29 152

Azurette (28) 86

B


112

b-12 dots 131

baby ddrops 132


baby vitamin d3 132


bacitracin 101 201

bacitracin zinc 101



baclofen 168

balsalazide 152

Balziva (28) 88

banophen 205 208


BAQSIMI 135

BASAGLAR KWIKPEN U-

100 INSULIN 140


BAYER CHEWABLE

ASPIRIN 32 166


baza antifungal 102


55 58


BD LUER-LOK SYRINGE

177 182


169 182


09 130


STERILE 177 182


BD REGULAR BEVEL

NEEDLES 177 182


177 182


169 183

BD ULTRA-FINE II

LANCETS 169 183


NEEDLE 176 183

BD VEO INSULIN SYR

(HALF UNIT) 176 183


UF 176 177 183

Bekyree (28) 86


206 208

benazepril 62

benazepril-


BENGAY COLD THERAPY

111

BENGAY VANISHING

SCENT 111

benzonatate 213


beta-hc 106


106


231


106


betatemp 26



BEXSERO 58

bicalutamide 45

BICARSIM 151

bicarsim forte 151

BICILLIN C-R 42

BICILLIN L-A 41

BICNU 44

BIDIL 70

bio-d-mulsion 132


bio-dtuss dmx 221

BIOTHRAX 58

bisac-evac 157

bisacodyl 157

biscolax 157

bismatrol 147


147


(BULK) 83

BISMUTH SUBNITRATE

(BULK) 83


(BULK) 83 147


bisoprolol-


bleomycin 51

Bleph-10 201

Blephamide SOP 196

Blisovi 24 Fe 88

Blisovi Fe 1530 (28) 88



BOOSTRIX TDAP 56

boro-packs 105

BOSULIF 49


BOUDREAUXS BUTT

PASTE 109

bp wash 100

BP WASH 100


bpo 100

BREATHERITE VALVED

MDI CHAMBER 179 183

BREO ELLIPTA 217

Briellyn 88

BRILINTA 166

brimonidine 202

bromfenac 198

bromi-lotion 104

brompheniramine-

pseudoeph-dm 221

brotapp dm 221

budesonide 214 219


bufferin 33


LANCETS 169 183

bumetanide 69

bupropion hcl 75 82


deter) 82

buspirone 71

busulfan 43

BUSULFEX 43



28

BUTTERFLY TOUCH

LANCET 170 183

C

cabergoline 142

CABOMETYX 48

CALAMINE (BULK) 83


calci-chew 115

calcidol 132

232

calci-mix 115

calcipotriene 104


calcitriol 132 192

calcium 500 + d 116

calcium 500 + d (d3) 116

calcium 600 115

calcium 600 + d(3) 116


116

CALCIUM 600 WITH

VITAMIN D3 116

CALCIUM ACETATE 115


bind) 115 160

calcium antacid 144


144


116


116 117

CALCIUM CARBONATE-

VITAMIN D3 117

calcium citrate 116

CALCIUM CITRATE 116




calcium lactate 116

calcium+d 117


CALQUENCE 46 49



D3 117

Camila 95

camrese 86

camrese lo 86

cank-oxide 193

capecitabine 45

CAPRELSA 49

capsaicin 111

CAPSAICIN (BULK) 83

capsicum 111

captopril 62

carbamazepine 72 78

CARBAMIDE PEROXIDE

(BULK) 52 83


carbidopa-levodopa-

entacapone 76

carboplatin 48


DEVICE 170 183

CAREONE LANCING

DEVICE 170 183

CAREONE ULTRA THIN

LANCET 170 183


183

CARESENS PREM

LANCING DEVICE 170

183

CARETOUCH LANCING

DEVICE 170 183

CARETOUCH SAFETY

LANCETS 170 183

CARETOUCH TWIST

LANCET 170 183

CAROSPIR 63 69

Cartia Xt 66

carvedilol 63

castor oil 157

CASTOR OIL 84


Caziant (28) 95

cefaclor 38

cefadroxil 38

cefdinir 38

cefixime 38

cefpodoxime 38

cefprozil 38


celecoxib 30

CELONTIN 73

233

cephalexin 38

CERALYTE 90 120

ceralyte-70 121

CERALYTE-70 121

certain dri 104

cetiri-d 205


cevimeline 194

CHANTIX 83

CHANTIX CONTINUING

MONTH BOX 83

CHANTIX STARTING

MONTH BOX 83

Charlotte 24 Fe 89

Chateal (28) 89

CHEMET 34

cheratussin ac 222



221


210 212



child ibuprofen 30

child mucinex chest

congestion 218


219

CHILDRENS ADVIL 30


212


206 208


210 212


210 212


210 212


211 212




206 208



218


allerg 203



childrens mapap 26





childrens pepto 144


childrens q-pap 27







CHILDRENS ZYRTEC

ALLERGY 211 212


211 212

chloramphenicol sod

succinate 38



193

chlorhist 205 208


chlorthalidone 69



D3)(BULK) 83 132 133


133

CHOLECALCIFEROL

(VITAMIN D3) 133


65


234

ciclopirox 102

cilostazol 166

CILOXAN 201

cimetidine 150

cimetidine hcl 150

cinacalcet 137

CIPRO 38

CIPRO HC 202

ciprofloxacin 39



202

cisplatin 48

citalopram 74

CITRACAL-D3 SLOW

RELEASE 117


citroma 155


cladribine 45

clarispray 219

clarithromycin 41


212


control 100


100

clearasil ultra 100

clearlax 155

clemastine 206 208

CLEOCIN 224

CLEVER CHEK LANCETS

170 183

CLEVER CHOICE PEAK

FLOW METER 178 183

clindamycin hcl 40



224

CLINIMIX 5D15W

SULFITE FREE 123

CLINIMIX 5D25W

SULFITE-FREE 123

CLINIMIX 275D5W

SULFIT FREE 123

CLINIMIX 425D10W

SULF FREE 123

CLINIMIX 425D5W

SULFIT FREE 123

CLINIMIX 425-D20W

SULF-FREE 123

CLINIMIX 425-D25W

SULF-FREE 124

CLINIMIX 5-

D20W(SULFITE-FREE)

124

CLINIMIX 6-D5W

(SULFITE-FREE) 124

CLINIMIX 8-

D10W(SULFITE-FREE)

124

CLINIMIX 8-

D14W(SULFITE-FREE)

124

CLINIMIX E 275D10W

SUL FREE 125 127

CLINIMIX E 275D5W

SULF FREE 125 127

CLINIMIX E 425D10W

SUL FREE 125 127

CLINIMIX E 425D25W

SUL FREE 125 127

CLINIMIX E 425D5W

SULF FREE 125 127

CLINIMIX E 5D15W

SULFIT FREE 126 127

CLINIMIX E 5D20W

SULFIT FREE 126 128

CLINIMIX E 5D25W

SULFIT FREE 126 128

CLINIMIX E 8-D10W

SULFITEFREE 128

CLINIMIX E 8-D14W

SULFITEFREE 128

CLINISOL SF 15 126

clobetasol 106


clonazepam 70 71 78

clonidine 68

clonidine hcl 68

clopidogrel 166


235

clotrimazole af 103

clotrimazole-7 224


104

COAGUCHEK LANCETS

170 183


coditussin ac 222

COLACE 159

COLACE 2-IN-1 158

COLACE CLEAR 159

colchicine 163


pe) 203


203


220


cold-flu relief 220

colestipol 65

collyrium 200

Colocort 153


colox 153

col-rite 159


COMETRIQ 48

COMFORT EZ LANCETS

170 183

comfort gel 145


COMFORT LANCETS 170

183

COMFORT TOUCH PLUS

SAFETY LANC 170 184

COMFORT TOUCH ULT



compoz 81 206 208

Compro 148

CONCEPTROL 99

CONDOMS-PREM

LUBRICATED 177 184

congest-eze 217

Constulose 155

cool and heat 111


menth) 110


coral calcium 116

Cormax 106

cortaid 106

cortisone 138


106


CORTISPORIN-TC 202

cortizone-10 106



cough syrup dm 221


COUMADIN 163


CREON 149


103

cromolyn 47 200 214 220

Crotan 112

Cryselle (28) 89

CUPRIMINE 29 34


12) 131

CYANOCOBALAMIN

(VITAMIN B-12) 131



cyclobenzaprine 168

cyclopentolate 197


CYCLOPHOSPHAMIDE 29

44

cycloserine 37


236


Cyred 89


cytra-k 161

D

d10 -045 sodium

chloride 114

d25 -045 sodium

chloride 114

d3 dots 133

d5 and 09 sodium

chloride 114


114

dacarbazine 44

daily fiber 153


153


153

dailyhist-1 206 208

DALIRESP 215


pe) 203

dandruff shampoo

(pyrithione) 104

dantrolene 168

dapsone 36

DAPTACEL (DTAP

PEDIATRIC) (PF) 56

Dasetta 135 (28) 89

Dasetta 777 (28) 96

daunorubicin 50 51



Daysee 86

day-time cough 213

ddrops 133

Deblitane 95

debrox 203

decara 133

DECARA 133

deep sea nasal 220

delta d3 133

Deltasone 138

DELTUSS DMX

(DEXCHLORPHEN) 221

Delyla (28) 89



86

dermafungal 103

DERMA-SMOOTHEFS

BODY OIL 106

DESCOVY 37

desenex 103

desipramine 75


desmopressin 135


87


89

desonide 106

desoximetasone 106


guaif) 221


dexamethasone 139

DEXAMETHASONE

INTENSOL 138


(pf) 139


phosphate 139 198



80

dextroamphetamine-



213

dextromethorphan-

guaifenesin 222

dextrose 10 and 02

nacl 114


(d10w) 114


(d20w) 114

237


(d25w) 114 115


(d30w) 114 115


(d40w) 114 115


114


113

dextrose 5-02 sod

chloride 114

dextrose 5-03

sodchloride 114


(d50w) 114 115


(d70w) 114


dialyvite 113


15 112


50 113



MAX 133

diamode 146

diaper rash 109

diazepam 70 71 78




198

dicloxacillin 42

dicyclomine 152

didanosine 37

Digitek 68

Digox 68

digoxin 68

DIGOXIN 68



DILANTIN-125 72

DILATRATE-SR 63

diltiazem hcl 64 66


dilt-xr 67

dimaphen dm 221


diphedryl 206

diphenhist 206 208


208 209


dipyridamole 167



DIURIL 69


docosanol 105

doc-q-lace 159

doc-q-lax 158

docu 159

docusate sodium 159

DOCUSATE SODIUM

(BULK) 83 159

docusol 159

dok 159

DOMEBORO 105

donepezil 85

dorzolamide 199




101

doxazosin 70

doxepin 75

doxercalciferol 192

doxorubicin 51



d-penamine 29 34




238

DROPLET GENTEEL

LANCING DEVICE 170

184

DROPLET LANCETS 170

184

DROPLET LANCING

DEVICE 170 184


89


dulcoease 159

dulcolax (magnesium

hydroxide) 155


159

duloxetine 74 79

DUREX AVANTI BARE

REAL FEEL 177 184

dutasteride 161

d-vi-sol 134

d-vita 134

dyna-hex 52

E

ec prin 32 166

EES 400 41


peroxide) 203

ear drops otc 203



EASIVENT HOLDING

CHAMBER 179 184

EASIVENT MASK LARGE

179 184


179 184

EASIVENT MASK SMALL

179 184

EASY CLICK LANCING

DEVICE 170 184


170 184

EASY MINI EJECT

LANCING DEVICE 170

184

EASY TOUCH LANCING

DEVICE 170 184

EASY TOUCH SAFETY

LANCETS 170 184

EASY TOUCH TWIST

LANCETS 170 184

EASY TWIST AND CAP

LANCETS 170 184

econazole 103

econtra ez 98

ecotrin 32 166

ed a-hist 203

ED CHLORPED D 204

EDECRIN 69

ed-spaz 152 162

effer-k 122



Elinest 89

Eliphos 160

ELIQUIS 164


30D START 163

Elixophyllin 215

ELLA 98

ELMIRON 160

Eluryng 98

EMBRACE LANCING

DEVICE 170 184

EMCYT 47

Emoquette 89



62

Endocet 25 26

endur-acin 131

enema 156


enemeez 159

ENFAMIL WATER 84

ENGERIX-B (PF) 53

ENGERIX-B PEDIATRIC

(PF) 53

enoxaparin 165 166

239

Enpresse 96

Enskyce 89

entacapone 76

entecavir 39

Enulose 149

EPANED 62

epinephrine 68 213


EPIPEN 2-PAK 68

EPIPEN JR 2-PAK 68

epirubicin 51

Epitol 72 79

eq gentle 195

ERBITUX 51



134

ergoloid 85

erlotinib 43

Errin 95

ertapenem 37

Ery-Tab 41


erythromycin 41 201


41



Estarylla 89

estazolam 78 82

estradiol 138 225

eszopiclone 82

ethambutol 37

ethosuximide 73


89

etodolac 31


97 98

etoposide 47

EURAX 112

euthyrox 143

EVAC 153


EXAPHEN 204


exemestane 46



EX-LAX MAXIMUM

STRENGTH 157

expectorant 218

expectorant dm 222


EYE IRRIGATING

SOLUTION 200





171 184


184

ezetimibe 65

EZ-LETS 171 184

F

fa-8 135

fallback solo 98

Falmina (28) 89

famotidine 150

famotidine (pf) 150

Fayosim 95


184

felodipine 67

Femynor 89

fenofibrate 65



65

feosol 118

FEOSOL 118

ferate 118

fer-iron 118

240

ferocon 119

ferosul 118

ferrocite 119



ferrous sulfate 119

FERROUS SULFATE

DRIED (BULK) 83 119

feverall 27

FEVERALL 27


fexofenadine-

pseudoephedrine 205



153


153

fiber smooth 153


153


153


sugar) 153

FIFTY50 SAFETY SEAL

LANCETS 171 185

finasteride 161

FINE 30 UNIVERSAL

LANCETS 171 185


185


FIRVANQ 39

flanax antacid 145

FLAREX 198


flecainide 64

FLEET BISACODYL 157




FLONASE ALLERGY

RELIEF 219


FLOVENT DISKUS 214

FLOVENT HFA 214

floxuridine 45

FLUAD 2020-2021 (65 YR

UP)(PF) 59


UP)(PF) 59


(PF) 59


(PF) 59

flucaine 199


2021 60


2021 (PF) 59

fluconazole 36

flucytosine 36

fludrocortisone 142

FLULAVAL QUAD 2020-

2021 (PF) 60


55 60

flunisolide 219


fluocinonide 107

Fluocinonide-E 107



fluorometholone 198

fluorouracil 45 104

fluoxetine 74

flurazepam 78 82


flutamide 45


219


salmeterol 217

fluvoxamine 74

FLUZONE HIGHDOSE

QUAD 20-21 PF 60

241


60


(PF) 60

FML SOP 198


foaming antacid 144

folic acid 135

FOLIC ACID 135


FORA LANCING DEVICE

171 185


185

formula 3 103

fosinopril 62


62

FREAMINE HBC 69 126

FREAMINE III 10 126


185


185


fungi cure 103


fungoid-d 103

furosemide 69

Fyavolv 138

G

gabapentin 72

GAMIFANT 167

GARDASIL (PF) 59

GARDASIL 9 (PF) 59



151




151


GAVILAX 155

gavilyte-c 156

Gavilyte-G 156


Gavilyte-N 157

GAVISCON 143

GAVISCON EXTRA

STRENGTH 144

GAZYVA 46


146

gemcitabine 46

gemfibrozil 65

Gemmily 89

GEMZAR 46

Generlac 149

Gentak 201

gentamicin 101 201


GENTEAL TEARS

MODERATE 194


GEL 195

gentlelax 155

GERBER GOOD START

WATER 85

geri-dryl 206 209

geri-lanta 146

gianvi (28) 89

Gildagia 90

GILOTRIF 43

GLEEVEC 49

glenmax peb 204

glimepiride 136

glipizide 136



(Human) 135


185

glucose 135

glyburide 136


242


glycerin 105


GLYCERIN (BULK) 84



glycolax 155

glycopyrrolate 152



171 185



171 185

GOLYTELY 157

gonak 195 199

goniosoft 195 199

goniotaire 195 199

goniovisc 195 199


granisetron hcl 148



g-tron 222

guaifenesin 218

guanfacine 68 76


135

GVOKE PFS 1-PACK

SYRINGE 135

GYNOL II 99

H

Hailey 90

Hailey 24 Fe 90

Hailey Fe 1530 (28) 90

Hailey Fe 120 (28) 90


HAVRIX (PF) 53

HEALTHY ACCENTS

AUTOLET 171 185

HEALTHY ACCENTS


healthylax 155





150


150


150

Heather 95

hemorrhoidal 33



HEPAGAM B 54



nacl 164 165




164 165


165


HEPATAMINE 8 126

HEPLISAV-B (PF) 53

HERCEPTIN 52


HEXALEN 43

HIBERIX (PF) 57

HIBICLENS 52




homatropaire 197

homatropine hbr 197


spr 112


HUMALOG MIX 50-50

INSULN U-100 140


100)INSULN 140

243


141

HUMULIN 7030 U-100

INSULIN 139

HUMULIN N NPH U-100

INSULIN 140


100 INSULN 140


INSULIN 140


KWIKPEN 140

HYCAMTIN 50

hydralazine 69


HYDROCHLOROTHIAZIDE

(BULK) 70 83



24 25




107



203



107 108

hydrocream 107

hydromorphone 24

hydroskin 107




presv) 138 142

hydroxyprogesterone

cap(ppres) 138 142

hydroxyurea 46

hydroxyzine hcl 70



hyosyne 152 162

hypercare 104

HYPERHEP B 54

HYPERHEP B NEONATAL

54

HYPERLYTE CR 121

HYPERRAB (PF) 54

HYPERRAB SD (PF) 54

HYPER-SAL 84

HYPERTET SD (PF) 55


171 185

HYPROMELLOSE 85

HYPROMELLOSE (BULK)

83 85


I

ibandronate 137

IBRANCE 47

Ibu 31

ibu-drops 31

ibuprofen 31


Iclevia 90

ICLUSIG 48

icy hot 110


ICY HOT ADVANCED

RELIEF PATCH 111

ICY HOT NO MESS 111


111

ifosfamide 44

ifosfamide-mesna 44

imatinib 49

IMBRUVICA 46 49

imipramine hcl 75

imiquimod 108



(PF) 61

Incassia 95

IN-CHECK NASAL WITH

MASK 178 185

244

IN-CHECK ORAL FLOW

METER 178 185

INCONTROL LANCING

DEVICE 171 185


LANCETS 171 185


LANCETS 171 185

INCRUSE ELLIPTA 215

indapamide 70

indomethacin 31


infants advil 31



INFANTS MOTRIN 31


INFED 119

INJECT EASE LANCETS

171 185

INLYTA 49


140

insulin lispro 141

INTRALIPID 127

INTRAROSA 142

Introvale 90


185

inzo antifungal 103



IPOL 61



irbesartan 63

irbesartan-


IRESSA 43

irinotecan 50

iron 119

iron (dried) 119

ISENTRESS 37

Isibloom 90

ISOLYTE-P IN 5

DEXTROSE 118

ISOLYTE-S 121

isoniazid 37

isopto tears 195

ISORDIL 63



isradipine 67

itraconazole 36

ivermectin 35

IXIARO (PF) 60

J

Jaimiess 87

Jantoven 163

Jasmiel (28) 90

Jencycla 95

Jinteli 138


jolessa 90

jolivette 95

jr acetaminophen 27

Juleber 90

Junel 1530 (21) 90

Junel 120 (21) 90

Junel Fe 1530 (28) 90

Junel Fe 120 (28) 90

Junel Fe 24 91

junior mapap 27

K

K1-1000 135

KABIVEN 127

Kalliga 91

kaopectate (bismuth

subsalicy) 147


ss) 147

Kariva (28) 87

KATERZIA 67

KEDRAB (PF) 54

245

k-effervescent 122

Kelnor 135 (28) 91

Kelnor 1-50 (28) 91

ketoconazole 36 103

KETONE CARE 180 185


185

ketoprofen 31

ketorolac 198

KETOSTIX 180 185


KEYTRUDA 51


kids mini enema 159

KIDS VITAMIN D3 134

Kimidess (28) 87

KINRIX (PF) 56

Kionex 115


KISQALI 47

Klor-Con M10 122

Klor-Con M15 122

Klor-Con M20 122


konsyl (sugar) 153

KONSYL DAILY FIBER

(STEVIA) 153

KONSYL EASY MIX 154


KONSYL SUGAR-FREE

(ASPARTAME) 154

K-PHOS NO 2 161

K-PHOS ORIGINAL 161

Kurvelo (28) 91

L


87

labetalol 63


130

lactulose 149 155

LAMISIL AT 102

lamotrigine 73

LANCETS 171 185


185

LANCETSTHIN 171 186


186


LANCING DEVICE WITH

LANCETS 172 186


LANOXIN 68

lansoprazole 150


INSULIN 141



172 186

lapatinib 42

Larin 1530 (21) 91

Larin 120 (21) 91

Larin 24 Fe 91

Larin Fe 1530 (28) 91

Larin Fe 120 (28) 91

Larissia 91

latanoprost 202

laxacin 158

laxaclear 155




120


157




leena 28 96

leflunomide 30

lemon glycerin 194

LENVIMA 49

Lessina 91

letrozole 46

246


LEUKERAN 44


levetiracetam 73

levobunolol 199

levocarnitine 192


levofloxacin 39 201

Levonest (28) 96

levonorgestrel 98


91


96

Levora-28 91

levothyroxine 143




lice killing 111


lice solution 111

lice treatment 111


112

LIDO BDK 181

lido king 110

lidocaine 33 110





Lillow (28) 91

liothyronine 143

liquid antacid 146


117

lisinopril 62


62


186

LITE TOUCH LANCING

DEVICE 172 186

LITE TOUCH-MEDIUM

MASK 179 186


179 186

little noses 220

little remedies 220


27



LO LOESTRIN FE 87


LODRANE D 204

lohist - d 204

Lojaimiess 87

Lomedia 24 Fe 92

loperamide 146

lopreeza 138

loradamed 211 213

loratadine 211 213



Lorcet Hd 24 25

Lorcet Plus 25

Loryna (28) 92

losartan 63


63

lotrimin af 103

lovastatin 65




lubricant eye 195


194


194



109

247


lugols 52

LUPRON DEPOT 47 141

LUPRON DEPOT (3

MONTH) 47 141

LUPRON DEPOT (4

MONTH) 47

LUPRON DEPOT (6

MONTH) 47

Lutera (28) 92

Lyleq 95

LYNPARZA 49

LYSODREN 45

Lyza 95

M

maalox advanced 146

MAALOX ADVANCED 146

MAALOX MAXIMUM

STRENGTH 146

MAG-AL 144

mag-g 120

magnesium 120


MAGNESIUM CITRATE

(BULK) 155

MAGNESIUM HYDROXIDE

(BULK) 84


MAGNESIUM OXIDE 120


nacl 120


120


MAGOX 120

MAKENA 138 142

MAKENA (PF) 138 142




maprotiline 75

Marlissa (28) 92

Marten-Tab 28

masophen 27

MATULANE 43

MAVYRET 39

MAXIDEX 198

MAXIFED TR 204

maxilube 109

maxi-tuss pe 204

maxi-tuss tr 204

m-dryl 206 209

meclizine 147



medi-laxx 158

medi-meclizine 147

MEDISENSE THIN

LANCETS 172 186

MEDLANCE PLUS

LANCETS 172 186


megestrol 49 112

MEKINIST 48

Melodetta 24 Fe 92

meloxicam 30

melphalan 44

memantine 85

MENACTRA (PF) 57

MENOMUNE - ACYW-135

57

MENOMUNE - ACYW-135

(PF) 57

MENQUADFI (PF) 57


(PF) 58

MENVEO MENA

COMPONENT (PF) 58

MENVEO MENCYW-135

COMPNT (PF) 58

MEPHYTON 135

mercaptopurine 45

mesalamine 152

META APPETITE CTRL

(ASPARTAME) 154

METAMUCIL 154

248

METAMUCIL (WITH

SUGAR) 154

METAMUCIL FIBER

SINGLES 154


154

METAMUCIL FREE 154


metaproterenol 216

metformin 141

methadone 24


161


161

methimazole 137

methocarbamol 168

METHOCEL E 4 M 85




methyldopa 68





139

metipranolol 199


metolazone 70


metoprolol ta-

hydrochlorothiaz 68



225

mexiletine 64

mgo 120

mi-acid 146


151


hydr) 144

Mibelas 24 Fe 92

micatin 103

miconazole 7 224


miconazole-3 224

miconazole-3

prefilcreamwipe 224








micro-guard 103

MICROLET 2 LANCING

DEVICE 172 186

MICROLET LANCET 172

MICROLIFE PEAK FLOW

METER 178 186

MICROSPACER 179 186

midazolam 33 78


midodrine 68

migraine formula 32

Mili 92


milk of magnesia

concentrated 156

MILLIPRED 139


186


METER 178 186

Minitran 64

minocycline 29 42

minoxidil 69

mintox 146


mintox plus 146

MIRALAX 156

MIRENA 86

mirtazapine 73

misoprostol 151

249

mitomycin 51

M-M-R II (PF) 55 60 61 62

modafinil 80

MOISTURE DROPS 195

mometasone 107


224

MONISTAT 3 224

monistat 7 225

MONISTAT 7 225

MONOJECT 09 SODIUM

CHLORIDE 130

MONOJECT HYPODERMIC

NEEDLES 177 186

MONOJECT HYPODERMIC

POLYPROPYL 177 186

MONOJECT PREFILL

ADVANCED NS 130

MONOJECT PREFILL

SALINE FLUSH 130

MONOLET LANCETS 172

186


172 186

Mono-Linyah 92

mononessa (28) 92

montelukast 214

morphine 24

MORPHINE 24



148



148

MOUTHPIECE 179 186

moxifloxacin 201

mucilin sf 154


congest 218


mucus relief d

(pseudoephed) 217

mucus relief dm 222

mucus relief er 218



172 186



129

mupirocin 101


system 203

muro 128 199

Mutamycin 51

my choice 98

my way 98


167

MYGLUCOHEALTH

LANCETS 172 187

MYLERAN 43

mynephrocaps 113



151

Myzilra 96

N

NABI-HB 54

nabumetone 30

nadolol 66

NAPHCON-A 197

naproxen 31

naproxen sodium 31

naramin 206 209

NASACORT 219

nasal allergy 220

nasal and sinus

decongestant 223


nasal decongestant

(pseudoeph) 223

nasal decongest-

antihistamine 204

nasal mist 220

NASALCROM 220

NATACYN 201

natural calcium 116

250




NATURAL FIBER





nature-throid 142

NAVELBINE 50

NAYZILAM 71 78

NEBUPENT 41

nebusal 84

NEBUSAL 84

Necon 0535 (28) 92

necon 150 (28) 92

necon 1011 (28) 87

necon 777 (28) 96

nefazodone 74

neomycin 34


196


polymyxin 200


dexameth 196 197

neomycin-polymyxin-

gramicidin 200


202

Neo-Polycin 200

Neo-Polycin Hc 197


101


neo-tuss 222

nephplex rx 113

NEPHRAMINE 54 126

nephro-vite 113

nephro-vite rx 113

NEUTROGENA ON THE

SPOT 100

new day 98

NEXAVAR 48

NEXPLANON 86


niacin 65 132


NIACIN (INOSITOL

NIACINATE) 131


Niacor 65

NIAVASC 132

NIAVASC 750 132

NICODERM CQ 82

nicorelief 82

NICORETTE 82

nicotine 82

NICOTINE 83


nifedipine 67



81 209

nighttime sleep-aid

(doxylamn) 81

Nikki (28) 93

ninjacof-xg 222

NINLARO 49

NIPENT 45

Nitro-Bid 64



162


cryst 35 162

nitroglycerin 64

NIVESTYM 164

NIX CREME RINSE 112

NIZORAL A-D 103

non-aspirin 27




251



nora-be 95


95



estradiol 93 138


93


93 96

Norlyda 95

Norlyroc 95


NORMOSOL-M IN 5

DEXTROSE 118

NORMOSOL-R IN 5

DEXTROSE 118


nortemp 27

Nortrel 0535 (28) 93

nortrel 135 (21) 93

Nortrel 135 (28) 93

Nortrel 777 (28) 96

nortriptyline 75

NOVA SAFETY LANCETS

172 187

NOVA SUREFLEX

LANCETS 172 187

NOVOLIN 7030 U-100

INSULIN 140

NOVOLIN N NPH U-100

INSULIN 140


100 INSULN 140


INSULN 140

np thyroid 142

NUTRILIPID 127

Nyamyc 102

Nylia 777 (28) 96

Nymyo 93

nystatin 36 102 193



Nystop 102

nytol 81 206 209

O


ocean nasal 220

ocella 93

OCUSOFT IRRIGATING

OPHTH SOLN 200


ogestrel (28) 93

Okebo 42

olopatadine 198

OLUMIANT 29


omeprazole 150



172 187

ON CALL PLUS LANCET

172 187


DEVICE 172 187

ondansetron 148

ondansetron hcl 148

ONE WAY VALVED

MOUTHPIECE 179 187


DEVICE 172 187

ONETOUCH DELICA

LANCETS 172 187


LANC DEV 172 187


LANCET 172 187

ONETOUCH SURESOFT

LANCING DEV 173 187

ONETOUCH ULTRASOFT

LANCETS 173 187

ONETOUCH VERIO FLEX

START 173 187

ONETOUCH VERIO HIGH

CONTROL 173 187

ONETOUCH VERIO MID

CONTROL 173 187

252

ONETOUCH VERIO TEST

STRIPS 168 187


187

onxol 50

opcicon one-step 98

OPCON-A 197

OPDIVO 51

OPTICHAMBER ADULT

MASK-LARGE 179 187

OPTICHAMBER DIAMOND

LG MASK 179 187

OPTICHAMBER DIAMOND

VHC 179 187


MED MSK 180 188


SML MASK 180 188

option-2 98 99

Oralone 193

oralyte 121

ORASEP 193

Orsythia 93

oscimin 152 162

oscimin sl 152 162

oseltamivir 40

oxaliplatin 48

oxcarbazepine 73


oxycodone 24


25 26

OXYTROL 162


oysco 500d 117

oysco-500 116



oystercal-d 118

P

Pacerone 64

paclitaxel 50

pain relief 8hr 28


pain reliever

(acetaminophen) 28




110

pamprin max 32

PANCREAZE 149

PANDA MASK 180 188

panoxyl 100

panoxyl-4 100

pantoprazole 151

PARAGARD T 380A 86


paromomycin 34

paroxetine hcl 74

PARVA-CAL 500 118

p-col rite 158

PEAK AIR PEAK FLOW

METER 178 188


129

pedia tri-vite 128


PEDIA-LAX 156


PEDIARIX (PF) 53 56







128


180 188



129


180 188


253

pedi-boro soak 105

PEDVAX HIB (PF) 57


PEGANONE 72

PEGASYS 39

PEGASYS PROCLICK 39


PEGINTRON 39

penicillamine 29 34


PENTACEL (PF) 56 59

PENTACEL DTAP-IPV

COMPNT (PF) 56


pentoxifylline 164

peptic relief 147


peri-colace 158

periguard 109

PERIKABIVEN 127


Periogard 193

PERISHIELD 109

PERJETA 51

permethrin 112

persa-gel 100

PERSONAL BEST FULL

RANGE 178 188


pharbetol 28


PHAZYME 151


PHENAGIL 204

phenazopyridine 161



Phenytek 72

phenytoin 72


72

Philith 93

phillips 120


PHILLIPS MILK OF

MAGNESIA 145 156

PHOSLYRA 160




161


131



K1) 135

PIKO 1 178 188


Pimtrea (28) 87

pink bismuth 147


pin-x 35

PIN-X 35

pioglitazone 141

PIP LANCET 173 188

Pirmella 93 96

piroxicam 30

PLASMA-LYTE 148 121

PLASMA-LYTE A 121

PLENAMINE 126

PNEUMOVAX-23 58

POCKET CHAMBER 180

188

POCKET PEAK FLOW

METER 178 188

podofilox 108

Polycin 200


POLYETHYLENE GLYCOL

3350(BULK) 84


200

POLYSPORIN 101


101

254

POLYVINYL ALCOHOL

(BULK) 84 85

POLY-VI-SOL 128


129

poly-vita 128


poly-vitamin 128


Portia 28 93

PORTRAZZA 51


chloride 121


122


045nacl 122



09nacl 122


dex 122


122


122


nacl 122


02nacl 122


03nacl 122


09nacl 122



161


powderlax 156

pramipexole 76

prasugrel 166

pravastatin 65

prazosin 70

PRED MILD 198

prednicarbate 107



prednisolone sodium

phosphate 139 198

prednisone 139

PREDNISONE INTENSOL

139

pregabalin 72 79

PREMARIN 225

PREMASOL 10 126

PREMASOL 6 126

prenatal 129



129


107

PRESSURE ACTIVATED

LANCETS 173 188

PREVAIL BLADDER

CONTROL PAD 176 188

Prevalite 65

Previfem 93

PREVNAR 13 (PF) 58

PREZISTA 42

PRIFTIN 37 42

PRIMAQUINE 36

PRIMEAIRE 180 188

primidone 71

PRO COMFORT LANCET

173 188


probenecid 163


PROCHAMBER 180 188



148


Proctosol Hc 33 107

Proctozone-Hc 33

255

PRODIGY LANCETS 173

188

PRODIGY LANCING

DEVICE 173 188

PRODIGY TWIST TOP

LANCET 173 188



promethazine-dm 221


204


promolaxin 160

propafenone 64

propantheline 152

proparacaine 200

propranolol 66



62

PROSOL 20 126

protriptyline 75



217


psyllium husk 155

PSYLLIUM HUSK 155


154

PULMICORT FLEXHALER

214

PULMOSAL 84



173 188

PURE COMFORT SAFETY

LANCETS 173 188

PURECOMFORT PEAK

FLOW METER 178 188

purelax 156

PURIXAN 45

PUSH BUTTON SAFETY

LANCETS 173 189

pyrazinamide 37



pyrimethamine 36

Q

QBRELIS 62

q-dryl 206 207 209

QINLOCK 49

q-pap 28


QUADRACEL (PF) 57

Quasense 93

quinapril 63


quinine sulfate 36

QVAR 214

QVAR REDIHALER 214

R

RABAVERT (PF) 61

raloxifene 142

ramipril 63

ranitidine hcl 150

READYLANCE SAFETY

LANCETS 173 189

Reclipsen (28) 93


recort plus 108


refenesen 218



REFRESH OPTIVE 195



relcof c 223


RELIAMED LANCET 173

189


DEVICE 173 189

256


LANCETS 173 189


189


LANCETS 173 189


103

renal caps 113

renal vitamin 113

renal-vite 113

rena-vite 113

rena-vite rx 113

RENFLEXIS 28 153

reno caps 113

repaglinide 136

REPLESTA 134

RESPAIRE-30 218


restore tears 196

RETACRIT 164

retaine nacl 199

revive plus 196

RHOPRESSA 202

Ribasphere 40

ribavirin 40


112


RIDAURA 29

rifampin 37 42

ri-gel 146

RIGHTEST GD500

LANCING DEVICE 173

189

RIGHTEST GL300

LANCETS 173 189

riluzole 167

ri-mag 145

ri-mag plus 146

ri-mox 146

ri-mox plus 146

ringers 115 130

ritonavir 42

RITUXAN 46

RITUXAN HYCELA 46


rivelsa 95

rizatriptan 80

robafen 218

robafen ac 223



ropinirole 76

rosuvastatin 65

ROTARIX 55 61


RYBELSUS 137

RYDAPT 49

rynex pse 204

S


SAFETY SEAL LANCETS

174 189


189

saline mist 220

saline nasal 220

saline nose 220

sal-plant 108

SANTYL 105






SEGLUROMET 136

selegiline hcl 76

selenium 123


selenomax 123


selsun blue 104

SEMGLEE PEN U-100

INSULIN 141

257


141

senexon 158

senexon-s 158

senna 158

SENNA 158

senna-extra 158

sennalax-s 159


159

SENOKOT 158

SENOKOT EXTRA

STRENGTH 158

senokot-s 159

SEREVENT DISKUS 216

sertraline 74

Setlakin 94


Sharobel 95


SHINGRIX (PF) 61


FACE MASK 180 189

silace 160

siladryl sa 207 209

silapap 28

SILICONE MASK -

PEDIATRIC 180 189


siltussin sa 218

SILVASORB 112



151

SIMILAC STERILIZED

WATER 85

Simliya (28) 87

Simpesse 87


simvastatin 65

SINGLE-LET 174 189


223


81 209

sleep tablet


209

SLO-NIACIN 132



SMART SENSE LANCETS

174 189

SMARTDIABETES

VANTAGE 174 189

SMARTEST LANCET 174

189

smoflipid 127

smoothlax 156

sochlor 199





130


130





free) 115


115



DEVICE 174 189

SOFT TOUCH LANCETS

174 189

solifenacin 162


(PF) 139


189

SOLUS V2 LANCING

DEVICE 174 189

sominex 81 207 209

soothing care


sore throat 193

258


Sorine 64 66

sotalol 64 66

Sotalol Af 64 66


spironolacton-

hydrochlorothiaz 69

Sprintec (28) 94

SPRITAM 73

SPRYCEL 49


Sronyx 94

ssd 105

sski 118



STEGLATRO 136

STEGLUJAN 136




sterile saline 220


STIVARGA 48

stomach relief 147

stool softener 160



159

stop lice 112

stop smoking aid 83


strong iodine 118

sucralfate 160

SUDAFED 223

sudafed 12 hour 223

SUDAFED 24 HOUR 223

sudogest 223



201


99


197

sulfamethoxazole-

trimethoprim 35


sulfatrim 35

sulindac 30

sumatriptan 80



113

super calcium 116

super daily d3 134

SUPER DAILY D3 134


189

superplex-t 113

suphedrin 223



allergy 204


U-100 177 190


174 190


PEN 174 190


LANCETS 174 190

SUREFLEX LANCING

DEVICE 174 190

SURE-LANCE 174 190


174 190

SURE-PEN LANCING

DEVICE 174 190


190

surgilube 109


190

SUTENT 49

Syeda 94

SYLATRON 47

259

SYMJEPI 68

SYMLINPEN 120 137

SYMLINPEN 60 137

SYSTANE GEL 196

SYSTANE ULTRA 195

T

tab tussin 218

TABLOID 45

tacrolimus 167

tactinal 28


TAFINLAR 46

TAGRISSO 43

take action 98 99


TALTZ SYRINGE 101

tamoxifen 50

tamsulosin 161

TANZEUM 137

TARCEVA 43


100

Tarina 24 Fe 94

Tarina Fe 120 (28) 94

TASIGNA 50

Taztia Xt 67

TDVAX 57




190

TELCARE LANCETS 174

190

telmisartan 63

temazepam 78 82

TEMODAR 44

temozolomide 44

Tencon 28

teniposide 47

TENIVAC (PF) 57

terazosin 70


terconazole 225

TETANUSDIPHTHERIA

TOX PED(PF) 57

tetracycline 42


Theochron 215

theophylline 215

thera-d 134

THERA-D 4000 134

THERATEARS 196



thiotepa 43

Tiadylt Er 67

tiagabine 72

TICE BCG 48 55

tiger balm 110

TIGER BALM 110

TIGER BALM (WITH

CAPSICUM) 110

Tilia Fe 96


TINACTIN 103

tioconazole-1 225

TIVICAY 37

tizanidine 168

tl icon 120

TOBRADEX 197

tobramycin 201


197

TOBREX 201

TODAY CONTRACEPTIVE

SPONGE 99

tolcylen 103

tolnaftate 103

tolterodine 162 163

TOPCARE UNIVERSAL1

LANCET 174 190

topiramate 73

Toposar 47

260

topotecan 50

torsemide 69


209

TOVIAZ 163


tramadol 24


trandolapril 63

TRANSDERM-SCOP 147

TRAVASOL 10 126


trazodone 74

TRECATOR 37

TRELEGY ELLIPTA 217

tretinoin 100



Tri Femynor 96



193 220

triamterene-


tri-biozene 102


tricon 120

Triderm 108

Tri-Estarylla 96

trifluridine 202

Tri-Legest Fe 96

Tri-Linyah 96

Tri-Lo-Estarylla 96

Tri-Lo-Marzia 97

Tri-Lo-Mili 97

Tri-Lo-Sprintec 97


157

trimethoprim 35

Tri-Mili 97

trimipramine 75

trinessa (28) 97

trinessa lo 97

TRINTELLIX 75

Tri-Nymyo 97

triphrocaps 113


TRIPLE PASTE 109

triple paste af 103


TRISPEC DMX 222


TRITON X-100 85

TRI-VI-SOL 128

tri-vita 128

tri-vitamin 128


Trivora (28) 97

Tri-Vylibra 97

Tri-Vylibra Lo 97

TROPHAMINE 10 126

TROPHAMINE 6 127

tropicamide 197

trospium 163

TRUE COMFORT LANCET

174 190

TRUEDRAW LANCING

DEVICE 175 190


TRUEPLUS KETONE 190


190

TRULICITY 137

TRUMENBA 58

TRUVADA 37

TRUZONE PEAK FLOW

METER 178 190


Tulana 95

TUMS 145

TUMS EXTRA STRENGTH

SMOOTHIES 145

tums ultra 145


261


tussin cough-chest

congestion 222

tussin dm 222

tussin dm max 222

tussin pe 218

TWINRIX (PF) 52 53


tyblume 94

TYKERB 42

tylophen 28

U

ULTI-LANCE 175 190


175 190

ULTILET CLASSIC

LANCETS 175 190



175 191


191


81



175 191


191

ULTRA THIN PLUS

LANCETS 175 191


191

ULTRA-CARE LANCETS

175 191

ultracin m 111

ULTRALANCE LANCETS

175 191


175 191

UNILET COMFORTOUCH

LANCET 175 191

UNILET EXCELITE II

LANCET 175 191


175 191


191


UNILET SUPER THIN

LANCETS 175 191


81 209





UNISTIK 2 NORMAL

LANCETDEVICE 175

UNISTIK 3 176 191

UNISTIK 3 COMFORT

DEVICE 176 191

UNISTIK 3 COMFORT

LANCET 176 191


176 191



191

UNISTIK 3 NEONATAL

DEVICE 176 191

UNISTIK 3 NORMAL

LANCET 176 191


191


192



176 192

UNITHROID 143

UNIVERSAL 1 LANCETS

176 192

URO-MAG 120


ursodiol 149


V


FILM 99


262

vagistat-3 225

valacyclovir 40

valproic acid 71 79


71 79

valsartan 63


63

VALTOCO 71 78

valu-dryl 207 210



vancomycin 39

VANCOMYCIN 39


chl 39

vanicream hc 108

vanquish 32

VAQTA (PF) 53

VARIVAX (PF) 55 61


VELCADE 49


(28) 97

venlafaxine 74

verapamil 64 67

verticalm 148

VERZENIO 47

Vestura (28) 94


VICKS DAYQUIL MUCUS

CONTROL DM 222

Vienva 94

vinblastine 50

Vincasar Pfs 50

vinorelbine 50

Viorele (28) 87

virt-caps 113



vitamin a and d 105


109


vitamin b-1 131


vitamin b-6 132

vitamin d3 134

VITAMIN D3 134

vitamin e 134


vitamin e mixed 134



105


192

VIVAGUARD LANCING

DEVICE 176 192

vol-care rx 113

Volnea (28) 87


192

VORTEX FROG MASK-

CHILD 180 192

VORTEX HOLDING

CHAMBER 180 192


TODDLER 180 192

VORTEX VHC LADYBUG

MASK-TODDLR 180 192

VOTRIENT 50

vp-vite rx 113

Vyfemla (28) 94

Vylibra 94

W


wal-dram 2 148



wal-finate 205 210

wal-itin 211 213


wal-mucil fiber 155

263

WAL-MUCIL FIBER

(ASPARTAME) 155


wal-phed 223

wal-phed d 223

wal-profen 31

wal-sleep z 81 210


81


wal-sporin 101

wal-tap 204

wal-tussin 219


221


wal-zan 150 150

wal-zan 75 150



warfarin 163

wart remover 109

WATER (BULK) 84

weekly-d 134

Wera (28) 94

westhroid 142


Wixela Inhub 217

wp thyroid 143

Wymzya Fe 94

X

XALKORI 44

XARELTO 164


30D START 164

XATMEP 29 45

XERAC AC 104

XOFLUZA 40

XOLAIR 215

XTANDI 45

xulane 97

Y

YF-VAX (PF) 55

Yuvafem 225

Z

ZADITOR 198

Zafemy 97

zaleplon 82

ZANOSAR 51

ZANTAC 150

ZANTAC MAXIMUM

STRENGTH 150

Zarah 94

ZARXIO 164

zeasorb af 103

ZEJULA 49

Zenchent (28) 94

Zenchent Fe 94

ZENPEP 149

Zenzedi 77 79 81

zephrex-d 224

zidovudine 37

zinc oxide 109

zolpidem 82

zonisamide 73

ZOSTAVAX (PF) 55 62

zostrix 111

zostrix-hp 111

Zovia 135E (28) 94

Zovia 150E (28) 95

z-sleep 81 210

Zumandimine (28) 95

ZYDELIG 48

ZYKADIA 44

zyncof 222

ZYTIGA 43 45







Washington DC 20201

1-800-368-1019 800-537-7697 (TDD)





800-700-3874 (TTY 1-800-735-2929)




800-700-3874 (TTY 1-800-735-2929) 번으로 전화해 주십시오


(TTY 1-800-735-2929）










Hu rau [1-800-700-3874] (TTY [1-800-735-2929])





3874 (TTY 1-800-735-2929) पर कॉल कर




TOC-1

Table of Contents


































2


Introduction




4


Definitions







6



8



















10



























12























14








Address



Suite 101


4981

(831) 430-5500

Hours M-F 8am-5pm


Suite 101


(831) 755-6000

Hours M-F 8am-5pm


Suite B


(209) 381-5300

Hours M-F 8am-5pm

Phone Directory













Claims (831) 430-5858

Finance (831) 430-5853





16





Abacavir Sulfate N










N








N

Efavirenz N


N


N




N



N



N


Emtricitabine N

Enfuvirtide Y

Etravirine N




Indinavir Sulfate N

Lamivudine N



Maraviroc N


Nevirapine N



Ritonavir N

Saquinavir N


Stavudine N




Tipranavir N



18




Amantadine HCl N

Amantadine HCl ER Y





Brexpiprazole Y

Cariprazine Y









Isocarboxazid Y

Lithium Carbonate N

Lithium Citrate N
















Pimozide Y











Trihexyphenidyl N



20







N





Naloxone HCl N

Naltrexone (oral) N








Anti-inhibitor

















Factor IX complex









22












bull Preterm birth












24





















1 QL (5 per 1 day)



1 QL (65 per 1 day)


1 QL (65 per 1 day)


1 QL (5 per 1 day)




1 QL (9 per 1 day)


1 QL (5 per 1 day)





25




1 QL (5 per 1 day)





1 QL (65 per 1 day)


1 QL (65 per 1 day)


1 QL (5 per 1 day)





1 QL (9 per 1 day)


1 QL (5 per 1 day)


1 QL (5 per 1 day)





1 QL (6 per 1 day)




1 QL (6 per 1 day)








26




1 QL (6 per 1 day)




1 QL (6 per 1 day)























1 OTC Medical





27








2 OTC Medical












1 OTC Medical














28



















1 QL (6 per 1 day)




2 PA SP



2 PA SP








29











1 PA



2 PA SP



1 SP












2










30
















1


1




1 OTC Medical












31



















1















32




1 OTC Medical










1 OTC Medical


1 OTC Medical




1 OTC Medical






1 OTC Medical








1 OTC Medical






33




















1


1


1












34






1




2






















1


1





35














2






1






1











36




































37















1 QL (1 per 1 day)





















38

















1









1




1 PA





1





39









2


1 PA


1


1


1 PA







2 PA SP


2 PA SP


2 PA SP


2 PA SP



2 PA SP





40





































41







1


1


1


1





1



1





2 PA SP


2



2









42






2











1



1







2 PA SP








43







2 PA SP








2 PA OCH



2 PA SP
















44




1




1 PA



2 PA SP




1





2




1 SP


1 PA SP




2 PA OCH


2 PA OCH








45












2 PA SP








2




2






1 PA










46






1


2









2 PA SP





2 PA OCH



2 PA SP


2 PA SP


2 PA SP


2 PA SP






47




2 PA OCH


2 PA OCH


2 PA SP


2 PA SP








2 PA SP



2 PA SP



2 PA SP


2 PA SP


2 PA SP


2 PA SP








48




2 PA SP



2 PA SP


2 PA OCH


2 PA OCH








2 PA



2 PA









1 PA






49










2 PA SP


2 PA SP



2 PA SP




2 PA SP




2 PA OCH



2 PA OCH




2 PA SP


2 PA SP





50




2 PA SP











2 PA SP


1






2



1





1


1






51






1 PA



1





1


2



2 PA SP


2 PA SP



2 PA SP



2 PA SP


2 PA SP






52




2 SP


2 PA SP










2 DD






2





2 OTC Medical









53


































54









2 SP


























55

































56





























57

































58
































59

































60
































61


































62













1



1 QL (1 per 1 day)


1


1


1








1







63















1



1


1


1 QL (1 per 1 day)








2



1





64






1


1




1











1















65




1


1




1



1













1












66







1








1




1


1






1



1


1



1





67




1


1


1


1



1



1






1


1



1



1




1





68




1



















1





1


1



1


2





69

























1


1









70




2












2 PA






1
















71









1










2


2




1


1








72







1 QL (3 per 1 day)







2






2




1



1




1







73











1




1


1











1 QL (1 per 1 day)






74


















1




1 QL (1 per 1 day)


1 QL (3 per 1 day)


1 QL (2 per 1 day)



1 QL (2 per 1 day)








75





2 PA



1






1



1



1


1













76




1



1


1


1








1


1





1 QL (1 per 1 day)



1






77




1



1 QL (2 per 1 day)


1 QL (3 per 1 day)


1 QL (1 per 1 day)


1 QL (1 per 1 day)


1





1 QL (2 per 1 day)


1 QL (1 per 1 day)


1 QL (2 per 1 day)


1





1 QL (1 per 1 day)



1






78



















2



2



1




1







79




1


1








1 QL (2 per 1 day)


1 QL (3 per 1 day)



1






1 QL (3 per 1 day)





1 QL (2 per 1 day)






80





1























1



1






81




1 QL (3 per 1 day)



















1 OTC Medical















82




1












1 QL (1 per 1 day)




1


1



2 OTC



2 OTC


2 OTC




1 OTC





83




2 OTC




2 QL (336 per 365 days)


2 QL (336 per 365 days)




Bulk Chemicals


2 OTC Medical




2 OTC Medical





2 OTC Medical


1 OTC


2 OTC Medical


2 OTC Medical


2






84




2 OTC Medical


2 OTC Medical





2 OTC Medical


2 OTC Medical










2



2


2


1







85












2 OTC Medical


2 OTC Medical






1 PA



1 PA NSO










86




2 CT















1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





87




1 CT


1 CT


1 CT


1 CT


1 CT


2 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT





88




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





89




1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1






90




1 CT


1 CT


1


1


1 CT


1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





91




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





92




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT






93




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





94




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





95




1 CT


1 CT



















1 CT


1 CT



1 CT


1 CT


1 CT





96




1 CT


1 CT


1 CT



1 CT


1 CT


1 CT



1 CT


1 CT


1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





97




1 CT


1 CT


1 CT


1 CT




1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT






1



1 CT





98





1 CT


1 CT






























99









2 CT


2 CT




















1 OTC Medical








100











1


bpo topical gel 8 1








1
















101




2 PA SP


2 PA SP






1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical










1 OTC Medical


1 OTC Medical





102




1 OTC Medical


1 OTC Medical
































103












2 OTC Medical

























104






1


1







2





















105










2 OTC Medical
















2 PA












106
























2















107









1
























1


1





108








1



1


1





















109







1 OTC Medical















2 OTC Medical


2 OTC Medical













110












1 OTC












2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical






111





1 OTC Medical



2 OTC Medical








2 OTC Medical


2 OTC Medical



2 OTC Medical


1 OTC Medical
















112


















2 OTC Medical












2 OTC Medical





113




2 OTC Medical





























1 PA






114




1 PA


1 PA


1 PA


1 PA


1 PA


1 PA


1 PA



1 PA


1 PA



1 PA


1 PA


1 PA



1 PA



1 PA



1 PA





115





1 PA


1 PA
















2 PA





1 OTC Medical








1 OTC Medical





116




1 OTC Medical



1 OTC Medical









1 OTC Medical


1 OTC Medical



1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical





117




1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical



1 OTC Medical



1 OTC Medical





118




1 OTC Medical


1 OTC Medical



1 OTC Medical




2 PA


2 PA


2 PA


2 PA


2 PA














119






1 OTC Medical


1 OTC Medical






1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical


2 PA


1 OTC Medical




1 OTC Medical


1 OTC Medical


1 OTC Medical







120










2 OTC Medical



1 OTC Medical



1 OTC Medical



1 OTC Medical


1 PA


1 PA


1 PA


1 PA


1 OTC Medical




2 OTC Medical



2 OTC Medical





121




2 OTC Medical


2 OTC Medical


1 OTC Medical






2 PA


2 PA


2 PA


2 PA


2 PA


2 PA







1





122





1 PA


1 PA


1 PA


1 PA


1 PA


1 PA



1 PA


1 PA


1 PA


1 PA





1


1


1


1


1





123




1




1


1








2 OTC Medical



2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





124




2 PA


2 PA


2 PA


2 PA


2 PA



2 PA


2 PA


2 PA


2 PA



2 PA


2 PA





125




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





126




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





127




2 PA



1 PA


1 PA



2 PA


2 PA




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





128




2 PA


2 PA


2 PA


2 PA























129




2 AGE (Max 4 Years)











1 OTC Medical



1 OTC Medical










1







130




2 PA





1


1


2



1 PA


1 PA





1


1


2



1 PA




1 PA


1 PA





131










1 QL (10 per 1 day)


1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical


2 OTC Medical






132









1 OTC Medical


2


2


2 OTC Medical



1 OTC Medical


1 OTC Medical









2 OTC Medical











133




1 OTC


1 OTC Medical


1 OTC Medical










2 OTC Medical


1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical



1 OTC Medical




2 OTC Medical




2 OTC Medical





134






1





1 OTC Medical


2 OTC Medical



2 OTC Medical


2 OTC Medical



1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical







135











2




2




2 DD


2 DD


2 DD



2 DD


2 DD






1






136











2 PA NSO DD



2 PA NSO DD







1 DD





1 DD








137




2 PA DD


2 PA DD



2 PA DD


2 PA DD















1









138




1



1


1



1






1



1 PA


1 PA


2 PA


2 PA


2 PA










139





1



1


1


1


1



1


1











1


2



2 DD





140




2 DD



2 DD


2 DD



2 DD


2 DD


2 DD


2 DD



2 DD


2 DD


1 DD


2 DD



2 DD





141




2 PA DD


2 PA NSO DD


2 DD


2 DD



2 DD


1 DD


2 PA NSO DD


1 PA DD




1 DD





2 PA SP


2 PA SP






142




2







1 PA


1 PA


2 PA


2 PA


2 PA










1


1


1





143




1






1


1


2




2 OTC Medical



2 OTC Medical





1 OTC Medical



1 OTC Medical


1 OTC Medical





144






2 OTC Medical






1 OTC Medical






1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical


1 OTC Medical





1 OTC Medical





145




2 OTC Medical


2 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


2 OTC Medical









1 OTC Medical











146




1 OTC Medical





2 OTC Medical
























147





































148








1 OTC Medical









1







1













149














2


2


2









150






















2 OTC Medical




1 OTC Medical




1







151




1















2 OTC Medical




1 OTC Medical


1 OTC Medical



1 OTC Medical








152
























2





1


1






153









2 PA SP




1


1 OTC Medical





1 OTC Medical





1 OTC Medical


1






1 OTC Medical





154




2 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical







1 OTC Medical



2 OTC Medical





155





2 OTC Medical



1 OTC Medical


2 OTC Medical











1



2 OTC Medical










2 OTC Medical





156








2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical
















2 OTC Medical



1





157




1


2


1



1



1 OTC Medical










1 OTC Medical


2 OTC Medical


2 OTC Medical










158












2 OTC Medical





1



2 OTC Medical











159











1 OTC Medical






2 OTC Medical

















160















2 PA














1 PA







161











2


2








1



1











162




2



1



















1


2


2 PA


1





163





2 PA




1

















2


1


1



2





164












2 PA SP



2 PA SP


2 PA SP


2 PA SP






1 PA


1




1






165




1




1 PA


1



1





1


1




1


1



1


1


1







166




1









1 OTC Medical



1 OTC Medical





1 OTC Medical







1 OTC Medical








167







2 QL (2 per 1 day)




2



1 SP





















168



















2 DD




2 DD



2 DD







169




2 DD



2 DD



2 DD


2 DD







2 DD


2 DD



2 DD



2 DD




2 DD


2 DD




2 DD





170












2 DD





2 DD



2


2









2 DD


2 DD







171




2 DD





2 DD








2 DD







2 DD




2 DD





2 DD







172




LANCING DEVICE 2 DD





2 DD




2 DD



2 DD








2 DD







2 DD


2 DD


2 OTC






173




2 DD





2 DD


2 DD




2 DD


2 DD






1 DD


2 DD


2 DD


2 DD



2 DD









174




2 DD


2 DD




2 DD




2 DD




2 DD




2 DD



2 DD







2 DD









175





2 DD






2 DD


2 DD





2 DD






2 DD


2 DD










2 DD





176




2 DD







2 DD




2 DD



2 DD


2 DD





1 OTC Medical



2 DD


2 DD


2 DD





177




2 DD


2 DD



2 CT


1 CT





1


2


1


1


1


1


1


1






178




2 OTC Medical



2


2 OTC Medical


2 OTC Medical


2 OTC Medical


2


2 OTC Medical


2 OTC Medical




2


2





2


2


2


2





179




2


2


2


2



2


2


2


2


2


2


2




2 OTC Medical


2 OTC Medical


2


2


2





180




2


2


2 OTC Medical


2 OTC Medical


2 OTC Medical





2 OTC Medical


2 OTC Medical


2 OTC Medical


2


2


2


2










181




1




2 DD




2 DD



2 DD




2 DD





2 DD


2 DD






2


2


2





182




2



2 OTC Medical





2 DD


2 DD



2 DD




2 DD




1


2


2 DD


2 DD


1


1


1





183






2 DD


2 DD


2 DD


2 DD


2


2 DD










2 DD



2




2 DD






184




2


2


2 CT





1 CT


2


2


2


2






2 DD


2 DD




2 DD









185




2 DD








2 DD







2 DD



2 OTC Medical


2 OTC Medical



2 DD








2 DD






186





LANCING DEVICE 2 DD





2 DD



2


2



2 DD



2 DD


2 OTC Medical




2


1


1




2 OTC Medical






187





2 DD







2 OTC Medical


2 DD


2 DD


2 OTC



2 DD





2 DD


2 DD





2


2


2





188




2


2


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical






2 DD


1 OTC Medical



2 DD







1 DD


2





189




2 DD


2 DD


2 DD



2 DD






2 DD


2 DD



2 OTC Medical


2 OTC Medical



2 DD




2 DD




2 DD







190




2 DD


2 DD



2 DD







1


2 DD








2 DD


2






2 DD





191




2 DD









2 DD


2 DD










2 DD







2 DD







192




2 DD



2 DD


2 DD




2 OTC Medical


2


2


2


2












1






193













1


1


1















1 OTC Medical






194















1 OTC Medical














1 OTC Medical









195




1 OTC Medical





2












2 OTC Medical















196













2 OTC Medical








2 QL (35 per 1 day)





2


1


1 QL (35 per 1 day)





197




1


1 QL (35 per 1 day)


1


1 QL (35 per 1 day)


2


1 QL (35 per 1 day)


























198










1 QL (35 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


2


2 QL (1 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)








1 QL (35 per 1 day)






199









1 QL (35 per 1 day)

























200

















1





1


1


1 QL (35 per 1 day)


1 OTC Medical


1


1 QL (35 per 1 day)





201





1



1



2





2







1



1 QL (35 per 1 day)





2 QL (35 per 1 day)



2 QL (35 per 1 day)





202











2 PA






2 QL (35 per 1 day)


1 QL (35 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)










203





1 QL (35 per 1 day)


























204






2 OTC Medical



2 OTC Medical



2 OTC Medical





2 OTC Medical



















205










1 QL (1 per 1 day)





















1 OTC Medical





206




1 OTC Medical




1 OTC Medical

























207


















1





1













208












1 OTC Medical


1 OTC Medical



1 OTC Medical


















209












1





1

















210

















1 PA NSO OTC




1 OTC















211














2 OTC Medical
























212




















1 PA NSO OTC



1 OTC






2 OTC Medical







213

















1 OTC Medical









2


2





214




2


2


2


1


2


2


2


2


2












215





2 PA



1


1



1


1



2 PA NSO



2


2



2




2 PA NSO





216




2






1


1


1


2





1 PA NSO




2


2


2





217




1 QL (1500 per 30 days)


2


2



2 PA


2 PA




1







2 PA









218




2 OTC Medical














1











219







1



1






1 OTC Medical




2 OTC



2 OTC



2 OTC Medical





2 OTC


2 OTC Medical





220








2 OTC Medical




















2 OTC Medical







221































222































223







1 OTC Medical


1 OTC Medical







1 OTC Medical






1 OTC Medical













224







2















1 OTC Medical




1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical





225




2 OTC Medical















226

Index of Drugs

1



(pse) 223

1-day 224

1ST TIER UNILET

COMFORTOUCH 168 181

2



181

3

3 day vaginal 224

3-day vaginal 224

8


A


abiraterone 43 45

ABREVA 105

acarbose 136

ACCU-CHEK FASTCLIX

LANCET DRUM 168 181

ACCU-CHEK FASTCLIX

LANCING DEV 168 181

ACCU-CHEK MULTICLIX

LANCET 168 181


168 181


PLUS 168 181

ACCU-CHEK SOFT DEV

LANCETS 169 181

ACCU-CHEK SOFTCLIX

LANCETS 169 181

acebutolol 66

acephen 26

acetaminophen 26


Acetasol Hc 203

acetazolamide 69

acetic acid 160 202


202



acid controller 150



143



acid-pep 150



acne medication 99

ACNE MEDICATION 99


perox) 99

acne vanishing 99

acne-clear 99

ACTHIB (PF) 57


181

acyclovir 40

ADACEL(TDAP


56

adapalene 100

addaprin 30


31

ADJUSTABLE LANCING

DEVICE 169 181

ADMELOG SOLOSTAR U-

100 INSULIN 141


LISPRO 141

ADRENALIN 220

adriamycin 50

Adriamycin 50

Adrucil 45



227

ADVAIR HFA 217


100

ADVANCED EYE RELIEF

194

ADVANCED LANCING

DEVICE 169 181

ADVANCED TRAVEL

LANCETS 169 181

ADVIL 30


30

ADVOCATE LANCET 169

181

ADVOCATE LANCING

DEVICE 169 181



181

AEROCHAMBER MV 178

181

AEROCHAMBER PLUS

FLOW-VU 178 181

AEROCHAMBER PLUS

FLOW-VUS MSK 178

AEROCHAMBER PLUS Z

STAT 179 181

AEROCHAMBER PLUS Z

STAT LG MSK 178

AEROCHAMBER PLUS Z

STAT MD MSK 178

AEROCHAMBER PLUS Z

STAT SM MSK 179

AEROCHAMBER WITH

FLOWSIGNAL 179 181

AEROCHAMBER Z-STAT

PLUS-FLW SG 179 182

AEROSPAN 213


Afeditab Cr 67

Afirmelle 87


UP)(PF) 59


35MO)(PF) 59

AFLURIA QUAD 2020-

2021(6MO UP) 59

aftera 98

AIRZONE PEAK FLOW

METER 178 182

AKTEN (PF) 200

Ala-Cort 105

alavert 210 212


alaway 197

albendazole 35


Alcaine 200

alcalak 144

alclometasone 105


ALECENSA 44

alendronate 137

aler-cap 205 207

alfuzosin 161

ALIQOPA 48


205 207

ALKERAN 44


211

ALLEGRA ALLERGY 210

212

aller-chlor 205 207


aller-cort 219

aller-ease 210 212

aller-flo 219


205 207


205 208


phen) 197




211



212


228


205 208



205

aller-tec 210 211

aller-tec d 205

allopurinol 163

almacone 145

almacone-2 145


102

alogliptin 136




altamist 220

Altavera (28) 87


169 182


DEVICE 169 182


ALUMINUM HYDROXIDE

GEL (BULK) 83 143

ALUNBRIG 44

Alyacen 135 (28) 87

Alyacen 777 (28) 95

Amethia 86

Amethia Lo 86

Amethyst (28) 88

amiloride 69

AMINOSYN 10 124

AMINOSYN 7 WITH

ELECTROLYTES 124

AMINOSYN 85 124

AMINOSYN 85 -

ELECTROLYTES 124

AMINOSYN II 10 125

AMINOSYN II 15 125

AMINOSYN II 85 125

AMINOSYN II 85 -

ELECTROLYTES 124


AMINOSYN-HBC 7 125

AMINOSYN-PF 10 125

AMINOSYN-PF 7

(SULFITE-FREE) 125

AMINOSYN-RF 52 125

amiodarone 64

amitriptyline 75


75 77

amlodipine 67



amoxapine 75

amoxicillin 34


amphotericin b 35

ampicillin 34

anagrelide 166

anastrozole 46


androxy 135

ANORO ELLIPTA 216


hyd) 143



hyd) 143



145

antacid supreme 144



antacid-antigas 145



101


dextrose 163

anti-dandruff 104


anti-diarrheal 147

229


146

anti-fungal 102



antifungal cream

(miconazole) 102



151



anti-itch (hc) 105


108

anti-itch plus 108


antitussive dm 221

anucort-hc 33

ANZEMET 148

aprepitant 149

Apri 88

APRISO 152

aprodine 203

AQUA LANCE LANCING

DEVICE 169 182


aquanil hc 105


Aranelle (28) 95


armodafinil 80

ARMONAIR RESPICLICK

213

ARNUITY ELLIPTA 214

ARRANON 45


111


195





194 199


194


194


194

ARZERRA 46

Ashlyna 86

ASMANEX HFA 214

ASMANEX TWISTHALER

214

aspirin 32 166

aspirin low dose 32


mag 33

aspir-low 32 166

aspir-trin 32 166

ASSURE HAEMOLANCE

PLUS 169 182



182

ASTHMA CHECK METER

178 182

atenolol 66


athenol 26

athletes foot 102


102


atomoxetine 77

atorvastatin 65

atovaquone 36

atropine 197

ATROVENT HFA 215

Aubra 88

AUGMENTIN 35

auro eardrops 203

Aurovela 1530 (21) 88


Aurovela 24 Fe 88

230




182

AUTOLET IMPRESSION

LANC DEV 169 182

AUTOLET LANCING

DEVICE 169 182


DEVICE 169 182

AVASTIN 42

AVC VAGINAL 224

Aviane 88

avita 100

ayr saline 220

Ayuna 88

azathioprine 29 167

azelastine 197 219

azithromycin 40

azolen tincture 102

AZULFIDINE 29 152

Azurette (28) 86

B


112

b-12 dots 131

baby ddrops 132


baby vitamin d3 132


bacitracin 101 201

bacitracin zinc 101



baclofen 168

balsalazide 152

Balziva (28) 88

banophen 205 208


BAQSIMI 135

BASAGLAR KWIKPEN U-

100 INSULIN 140


BAYER CHEWABLE

ASPIRIN 32 166


baza antifungal 102


55 58


BD LUER-LOK SYRINGE

177 182


169 182


09 130


STERILE 177 182


BD REGULAR BEVEL

NEEDLES 177 182


177 182


169 183

BD ULTRA-FINE II

LANCETS 169 183


NEEDLE 176 183

BD VEO INSULIN SYR

(HALF UNIT) 176 183


UF 176 177 183

Bekyree (28) 86


206 208

benazepril 62

benazepril-


BENGAY COLD THERAPY

111

BENGAY VANISHING

SCENT 111

benzonatate 213


beta-hc 106


106


231


106


betatemp 26



BEXSERO 58

bicalutamide 45

BICARSIM 151

bicarsim forte 151

BICILLIN C-R 42

BICILLIN L-A 41

BICNU 44

BIDIL 70

bio-d-mulsion 132


bio-dtuss dmx 221

BIOTHRAX 58

bisac-evac 157

bisacodyl 157

biscolax 157

bismatrol 147


147


(BULK) 83

BISMUTH SUBNITRATE

(BULK) 83


(BULK) 83 147


bisoprolol-


bleomycin 51

Bleph-10 201

Blephamide SOP 196

Blisovi 24 Fe 88

Blisovi Fe 1530 (28) 88



BOOSTRIX TDAP 56

boro-packs 105

BOSULIF 49


BOUDREAUXS BUTT

PASTE 109

bp wash 100

BP WASH 100


bpo 100

BREATHERITE VALVED

MDI CHAMBER 179 183

BREO ELLIPTA 217

Briellyn 88

BRILINTA 166

brimonidine 202

bromfenac 198

bromi-lotion 104

brompheniramine-

pseudoeph-dm 221

brotapp dm 221

budesonide 214 219


bufferin 33


LANCETS 169 183

bumetanide 69

bupropion hcl 75 82


deter) 82

buspirone 71

busulfan 43

BUSULFEX 43



28

BUTTERFLY TOUCH

LANCET 170 183

C

cabergoline 142

CABOMETYX 48

CALAMINE (BULK) 83


calci-chew 115

calcidol 132

232

calci-mix 115

calcipotriene 104


calcitriol 132 192

calcium 500 + d 116

calcium 500 + d (d3) 116

calcium 600 115

calcium 600 + d(3) 116


116

CALCIUM 600 WITH

VITAMIN D3 116

CALCIUM ACETATE 115


bind) 115 160

calcium antacid 144


144


116


116 117

CALCIUM CARBONATE-

VITAMIN D3 117

calcium citrate 116

CALCIUM CITRATE 116




calcium lactate 116

calcium+d 117


CALQUENCE 46 49



D3 117

Camila 95

camrese 86

camrese lo 86

cank-oxide 193

capecitabine 45

CAPRELSA 49

capsaicin 111

CAPSAICIN (BULK) 83

capsicum 111

captopril 62

carbamazepine 72 78

CARBAMIDE PEROXIDE

(BULK) 52 83


carbidopa-levodopa-

entacapone 76

carboplatin 48


DEVICE 170 183

CAREONE LANCING

DEVICE 170 183

CAREONE ULTRA THIN

LANCET 170 183


183

CARESENS PREM

LANCING DEVICE 170

183

CARETOUCH LANCING

DEVICE 170 183

CARETOUCH SAFETY

LANCETS 170 183

CARETOUCH TWIST

LANCET 170 183

CAROSPIR 63 69

Cartia Xt 66

carvedilol 63

castor oil 157

CASTOR OIL 84


Caziant (28) 95

cefaclor 38

cefadroxil 38

cefdinir 38

cefixime 38

cefpodoxime 38

cefprozil 38


celecoxib 30

CELONTIN 73

233

cephalexin 38

CERALYTE 90 120

ceralyte-70 121

CERALYTE-70 121

certain dri 104

cetiri-d 205


cevimeline 194

CHANTIX 83

CHANTIX CONTINUING

MONTH BOX 83

CHANTIX STARTING

MONTH BOX 83

Charlotte 24 Fe 89

Chateal (28) 89

CHEMET 34

cheratussin ac 222



221


210 212



child ibuprofen 30

child mucinex chest

congestion 218


219

CHILDRENS ADVIL 30


212


206 208


210 212


210 212


210 212


211 212




206 208



218


allerg 203



childrens mapap 26





childrens pepto 144


childrens q-pap 27







CHILDRENS ZYRTEC

ALLERGY 211 212


211 212

chloramphenicol sod

succinate 38



193

chlorhist 205 208


chlorthalidone 69



D3)(BULK) 83 132 133


133

CHOLECALCIFEROL

(VITAMIN D3) 133


65


234

ciclopirox 102

cilostazol 166

CILOXAN 201

cimetidine 150

cimetidine hcl 150

cinacalcet 137

CIPRO 38

CIPRO HC 202

ciprofloxacin 39



202

cisplatin 48

citalopram 74

CITRACAL-D3 SLOW

RELEASE 117


citroma 155


cladribine 45

clarispray 219

clarithromycin 41


212


control 100


100

clearasil ultra 100

clearlax 155

clemastine 206 208

CLEOCIN 224

CLEVER CHEK LANCETS

170 183

CLEVER CHOICE PEAK

FLOW METER 178 183

clindamycin hcl 40



224

CLINIMIX 5D15W

SULFITE FREE 123

CLINIMIX 5D25W

SULFITE-FREE 123

CLINIMIX 275D5W

SULFIT FREE 123

CLINIMIX 425D10W

SULF FREE 123

CLINIMIX 425D5W

SULFIT FREE 123

CLINIMIX 425-D20W

SULF-FREE 123

CLINIMIX 425-D25W

SULF-FREE 124

CLINIMIX 5-

D20W(SULFITE-FREE)

124

CLINIMIX 6-D5W

(SULFITE-FREE) 124

CLINIMIX 8-

D10W(SULFITE-FREE)

124

CLINIMIX 8-

D14W(SULFITE-FREE)

124

CLINIMIX E 275D10W

SUL FREE 125 127

CLINIMIX E 275D5W

SULF FREE 125 127

CLINIMIX E 425D10W

SUL FREE 125 127

CLINIMIX E 425D25W

SUL FREE 125 127

CLINIMIX E 425D5W

SULF FREE 125 127

CLINIMIX E 5D15W

SULFIT FREE 126 127

CLINIMIX E 5D20W

SULFIT FREE 126 128

CLINIMIX E 5D25W

SULFIT FREE 126 128

CLINIMIX E 8-D10W

SULFITEFREE 128

CLINIMIX E 8-D14W

SULFITEFREE 128

CLINISOL SF 15 126

clobetasol 106


clonazepam 70 71 78

clonidine 68

clonidine hcl 68

clopidogrel 166


235

clotrimazole af 103

clotrimazole-7 224


104

COAGUCHEK LANCETS

170 183


coditussin ac 222

COLACE 159

COLACE 2-IN-1 158

COLACE CLEAR 159

colchicine 163


pe) 203


203


220


cold-flu relief 220

colestipol 65

collyrium 200

Colocort 153


colox 153

col-rite 159


COMETRIQ 48

COMFORT EZ LANCETS

170 183

comfort gel 145


COMFORT LANCETS 170

183

COMFORT TOUCH PLUS

SAFETY LANC 170 184

COMFORT TOUCH ULT



compoz 81 206 208

Compro 148

CONCEPTROL 99

CONDOMS-PREM

LUBRICATED 177 184

congest-eze 217

Constulose 155

cool and heat 111


menth) 110


coral calcium 116

Cormax 106

cortaid 106

cortisone 138


106


CORTISPORIN-TC 202

cortizone-10 106



cough syrup dm 221


COUMADIN 163


CREON 149


103

cromolyn 47 200 214 220

Crotan 112

Cryselle (28) 89

CUPRIMINE 29 34


12) 131

CYANOCOBALAMIN

(VITAMIN B-12) 131



cyclobenzaprine 168

cyclopentolate 197


CYCLOPHOSPHAMIDE 29

44

cycloserine 37


236


Cyred 89


cytra-k 161

D

d10 -045 sodium

chloride 114

d25 -045 sodium

chloride 114

d3 dots 133

d5 and 09 sodium

chloride 114


114

dacarbazine 44

daily fiber 153


153


153

dailyhist-1 206 208

DALIRESP 215


pe) 203

dandruff shampoo

(pyrithione) 104

dantrolene 168

dapsone 36

DAPTACEL (DTAP

PEDIATRIC) (PF) 56

Dasetta 135 (28) 89

Dasetta 777 (28) 96

daunorubicin 50 51



Daysee 86

day-time cough 213

ddrops 133

Deblitane 95

debrox 203

decara 133

DECARA 133

deep sea nasal 220

delta d3 133

Deltasone 138

DELTUSS DMX

(DEXCHLORPHEN) 221

Delyla (28) 89



86

dermafungal 103

DERMA-SMOOTHEFS

BODY OIL 106

DESCOVY 37

desenex 103

desipramine 75


desmopressin 135


87


89

desonide 106

desoximetasone 106


guaif) 221


dexamethasone 139

DEXAMETHASONE

INTENSOL 138


(pf) 139


phosphate 139 198



80

dextroamphetamine-



213

dextromethorphan-

guaifenesin 222

dextrose 10 and 02

nacl 114


(d10w) 114


(d20w) 114

237


(d25w) 114 115


(d30w) 114 115


(d40w) 114 115


114


113

dextrose 5-02 sod

chloride 114

dextrose 5-03

sodchloride 114


(d50w) 114 115


(d70w) 114


dialyvite 113


15 112


50 113



MAX 133

diamode 146

diaper rash 109

diazepam 70 71 78




198

dicloxacillin 42

dicyclomine 152

didanosine 37

Digitek 68

Digox 68

digoxin 68

DIGOXIN 68



DILANTIN-125 72

DILATRATE-SR 63

diltiazem hcl 64 66


dilt-xr 67

dimaphen dm 221


diphedryl 206

diphenhist 206 208


208 209


dipyridamole 167



DIURIL 69


docosanol 105

doc-q-lace 159

doc-q-lax 158

docu 159

docusate sodium 159

DOCUSATE SODIUM

(BULK) 83 159

docusol 159

dok 159

DOMEBORO 105

donepezil 85

dorzolamide 199




101

doxazosin 70

doxepin 75

doxercalciferol 192

doxorubicin 51



d-penamine 29 34




238

DROPLET GENTEEL

LANCING DEVICE 170

184

DROPLET LANCETS 170

184

DROPLET LANCING

DEVICE 170 184


89


dulcoease 159

dulcolax (magnesium

hydroxide) 155


159

duloxetine 74 79

DUREX AVANTI BARE

REAL FEEL 177 184

dutasteride 161

d-vi-sol 134

d-vita 134

dyna-hex 52

E

ec prin 32 166

EES 400 41


peroxide) 203

ear drops otc 203



EASIVENT HOLDING

CHAMBER 179 184

EASIVENT MASK LARGE

179 184


179 184

EASIVENT MASK SMALL

179 184

EASY CLICK LANCING

DEVICE 170 184


170 184

EASY MINI EJECT

LANCING DEVICE 170

184

EASY TOUCH LANCING

DEVICE 170 184

EASY TOUCH SAFETY

LANCETS 170 184

EASY TOUCH TWIST

LANCETS 170 184

EASY TWIST AND CAP

LANCETS 170 184

econazole 103

econtra ez 98

ecotrin 32 166

ed a-hist 203

ED CHLORPED D 204

EDECRIN 69

ed-spaz 152 162

effer-k 122



Elinest 89

Eliphos 160

ELIQUIS 164


30D START 163

Elixophyllin 215

ELLA 98

ELMIRON 160

Eluryng 98

EMBRACE LANCING

DEVICE 170 184

EMCYT 47

Emoquette 89



62

Endocet 25 26

endur-acin 131

enema 156


enemeez 159

ENFAMIL WATER 84

ENGERIX-B (PF) 53

ENGERIX-B PEDIATRIC

(PF) 53

enoxaparin 165 166

239

Enpresse 96

Enskyce 89

entacapone 76

entecavir 39

Enulose 149

EPANED 62

epinephrine 68 213


EPIPEN 2-PAK 68

EPIPEN JR 2-PAK 68

epirubicin 51

Epitol 72 79

eq gentle 195

ERBITUX 51



134

ergoloid 85

erlotinib 43

Errin 95

ertapenem 37

Ery-Tab 41


erythromycin 41 201


41



Estarylla 89

estazolam 78 82

estradiol 138 225

eszopiclone 82

ethambutol 37

ethosuximide 73


89

etodolac 31


97 98

etoposide 47

EURAX 112

euthyrox 143

EVAC 153


EXAPHEN 204


exemestane 46



EX-LAX MAXIMUM

STRENGTH 157

expectorant 218

expectorant dm 222


EYE IRRIGATING

SOLUTION 200





171 184


184

ezetimibe 65

EZ-LETS 171 184

F

fa-8 135

fallback solo 98

Falmina (28) 89

famotidine 150

famotidine (pf) 150

Fayosim 95


184

felodipine 67

Femynor 89

fenofibrate 65



65

feosol 118

FEOSOL 118

ferate 118

fer-iron 118

240

ferocon 119

ferosul 118

ferrocite 119



ferrous sulfate 119

FERROUS SULFATE

DRIED (BULK) 83 119

feverall 27

FEVERALL 27


fexofenadine-

pseudoephedrine 205



153


153

fiber smooth 153


153


153


sugar) 153

FIFTY50 SAFETY SEAL

LANCETS 171 185

finasteride 161

FINE 30 UNIVERSAL

LANCETS 171 185


185


FIRVANQ 39

flanax antacid 145

FLAREX 198


flecainide 64

FLEET BISACODYL 157




FLONASE ALLERGY

RELIEF 219


FLOVENT DISKUS 214

FLOVENT HFA 214

floxuridine 45

FLUAD 2020-2021 (65 YR

UP)(PF) 59


UP)(PF) 59


(PF) 59


(PF) 59

flucaine 199


2021 60


2021 (PF) 59

fluconazole 36

flucytosine 36

fludrocortisone 142

FLULAVAL QUAD 2020-

2021 (PF) 60


55 60

flunisolide 219


fluocinonide 107

Fluocinonide-E 107



fluorometholone 198

fluorouracil 45 104

fluoxetine 74

flurazepam 78 82


flutamide 45


219


salmeterol 217

fluvoxamine 74

FLUZONE HIGHDOSE

QUAD 20-21 PF 60

241


60


(PF) 60

FML SOP 198


foaming antacid 144

folic acid 135

FOLIC ACID 135


FORA LANCING DEVICE

171 185


185

formula 3 103

fosinopril 62


62

FREAMINE HBC 69 126

FREAMINE III 10 126


185


185


fungi cure 103


fungoid-d 103

furosemide 69

Fyavolv 138

G

gabapentin 72

GAMIFANT 167

GARDASIL (PF) 59

GARDASIL 9 (PF) 59



151




151


GAVILAX 155

gavilyte-c 156

Gavilyte-G 156


Gavilyte-N 157

GAVISCON 143

GAVISCON EXTRA

STRENGTH 144

GAZYVA 46


146

gemcitabine 46

gemfibrozil 65

Gemmily 89

GEMZAR 46

Generlac 149

Gentak 201

gentamicin 101 201


GENTEAL TEARS

MODERATE 194


GEL 195

gentlelax 155

GERBER GOOD START

WATER 85

geri-dryl 206 209

geri-lanta 146

gianvi (28) 89

Gildagia 90

GILOTRIF 43

GLEEVEC 49

glenmax peb 204

glimepiride 136

glipizide 136



(Human) 135


185

glucose 135

glyburide 136


242


glycerin 105


GLYCERIN (BULK) 84



glycolax 155

glycopyrrolate 152



171 185



171 185

GOLYTELY 157

gonak 195 199

goniosoft 195 199

goniotaire 195 199

goniovisc 195 199


granisetron hcl 148



g-tron 222

guaifenesin 218

guanfacine 68 76


135

GVOKE PFS 1-PACK

SYRINGE 135

GYNOL II 99

H

Hailey 90

Hailey 24 Fe 90

Hailey Fe 1530 (28) 90

Hailey Fe 120 (28) 90


HAVRIX (PF) 53

HEALTHY ACCENTS

AUTOLET 171 185

HEALTHY ACCENTS


healthylax 155





150


150


150

Heather 95

hemorrhoidal 33



HEPAGAM B 54



nacl 164 165




164 165


165


HEPATAMINE 8 126

HEPLISAV-B (PF) 53

HERCEPTIN 52


HEXALEN 43

HIBERIX (PF) 57

HIBICLENS 52




homatropaire 197

homatropine hbr 197


spr 112


HUMALOG MIX 50-50

INSULN U-100 140


100)INSULN 140

243


141

HUMULIN 7030 U-100

INSULIN 139

HUMULIN N NPH U-100

INSULIN 140


100 INSULN 140


INSULIN 140


KWIKPEN 140

HYCAMTIN 50

hydralazine 69


HYDROCHLOROTHIAZIDE

(BULK) 70 83



24 25




107



203



107 108

hydrocream 107

hydromorphone 24

hydroskin 107




presv) 138 142

hydroxyprogesterone

cap(ppres) 138 142

hydroxyurea 46

hydroxyzine hcl 70



hyosyne 152 162

hypercare 104

HYPERHEP B 54

HYPERHEP B NEONATAL

54

HYPERLYTE CR 121

HYPERRAB (PF) 54

HYPERRAB SD (PF) 54

HYPER-SAL 84

HYPERTET SD (PF) 55


171 185

HYPROMELLOSE 85

HYPROMELLOSE (BULK)

83 85


I

ibandronate 137

IBRANCE 47

Ibu 31

ibu-drops 31

ibuprofen 31


Iclevia 90

ICLUSIG 48

icy hot 110


ICY HOT ADVANCED

RELIEF PATCH 111

ICY HOT NO MESS 111


111

ifosfamide 44

ifosfamide-mesna 44

imatinib 49

IMBRUVICA 46 49

imipramine hcl 75

imiquimod 108



(PF) 61

Incassia 95

IN-CHECK NASAL WITH

MASK 178 185

244

IN-CHECK ORAL FLOW

METER 178 185

INCONTROL LANCING

DEVICE 171 185


LANCETS 171 185


LANCETS 171 185

INCRUSE ELLIPTA 215

indapamide 70

indomethacin 31


infants advil 31



INFANTS MOTRIN 31


INFED 119

INJECT EASE LANCETS

171 185

INLYTA 49


140

insulin lispro 141

INTRALIPID 127

INTRAROSA 142

Introvale 90


185

inzo antifungal 103



IPOL 61



irbesartan 63

irbesartan-


IRESSA 43

irinotecan 50

iron 119

iron (dried) 119

ISENTRESS 37

Isibloom 90

ISOLYTE-P IN 5

DEXTROSE 118

ISOLYTE-S 121

isoniazid 37

isopto tears 195

ISORDIL 63



isradipine 67

itraconazole 36

ivermectin 35

IXIARO (PF) 60

J

Jaimiess 87

Jantoven 163

Jasmiel (28) 90

Jencycla 95

Jinteli 138


jolessa 90

jolivette 95

jr acetaminophen 27

Juleber 90

Junel 1530 (21) 90

Junel 120 (21) 90

Junel Fe 1530 (28) 90

Junel Fe 120 (28) 90

Junel Fe 24 91

junior mapap 27

K

K1-1000 135

KABIVEN 127

Kalliga 91

kaopectate (bismuth

subsalicy) 147


ss) 147

Kariva (28) 87

KATERZIA 67

KEDRAB (PF) 54

245

k-effervescent 122

Kelnor 135 (28) 91

Kelnor 1-50 (28) 91

ketoconazole 36 103

KETONE CARE 180 185


185

ketoprofen 31

ketorolac 198

KETOSTIX 180 185


KEYTRUDA 51


kids mini enema 159

KIDS VITAMIN D3 134

Kimidess (28) 87

KINRIX (PF) 56

Kionex 115


KISQALI 47

Klor-Con M10 122

Klor-Con M15 122

Klor-Con M20 122


konsyl (sugar) 153

KONSYL DAILY FIBER

(STEVIA) 153

KONSYL EASY MIX 154


KONSYL SUGAR-FREE

(ASPARTAME) 154

K-PHOS NO 2 161

K-PHOS ORIGINAL 161

Kurvelo (28) 91

L


87

labetalol 63


130

lactulose 149 155

LAMISIL AT 102

lamotrigine 73

LANCETS 171 185


185

LANCETSTHIN 171 186


186


LANCING DEVICE WITH

LANCETS 172 186


LANOXIN 68

lansoprazole 150


INSULIN 141



172 186

lapatinib 42

Larin 1530 (21) 91

Larin 120 (21) 91

Larin 24 Fe 91

Larin Fe 1530 (28) 91

Larin Fe 120 (28) 91

Larissia 91

latanoprost 202

laxacin 158

laxaclear 155




120


157




leena 28 96

leflunomide 30

lemon glycerin 194

LENVIMA 49

Lessina 91

letrozole 46

246


LEUKERAN 44


levetiracetam 73

levobunolol 199

levocarnitine 192


levofloxacin 39 201

Levonest (28) 96

levonorgestrel 98


91


96

Levora-28 91

levothyroxine 143




lice killing 111


lice solution 111

lice treatment 111


112

LIDO BDK 181

lido king 110

lidocaine 33 110





Lillow (28) 91

liothyronine 143

liquid antacid 146


117

lisinopril 62


62


186

LITE TOUCH LANCING

DEVICE 172 186

LITE TOUCH-MEDIUM

MASK 179 186


179 186

little noses 220

little remedies 220


27



LO LOESTRIN FE 87


LODRANE D 204

lohist - d 204

Lojaimiess 87

Lomedia 24 Fe 92

loperamide 146

lopreeza 138

loradamed 211 213

loratadine 211 213



Lorcet Hd 24 25

Lorcet Plus 25

Loryna (28) 92

losartan 63


63

lotrimin af 103

lovastatin 65




lubricant eye 195


194


194



109

247


lugols 52

LUPRON DEPOT 47 141

LUPRON DEPOT (3

MONTH) 47 141

LUPRON DEPOT (4

MONTH) 47

LUPRON DEPOT (6

MONTH) 47

Lutera (28) 92

Lyleq 95

LYNPARZA 49

LYSODREN 45

Lyza 95

M

maalox advanced 146

MAALOX ADVANCED 146

MAALOX MAXIMUM

STRENGTH 146

MAG-AL 144

mag-g 120

magnesium 120


MAGNESIUM CITRATE

(BULK) 155

MAGNESIUM HYDROXIDE

(BULK) 84


MAGNESIUM OXIDE 120


nacl 120


120


MAGOX 120

MAKENA 138 142

MAKENA (PF) 138 142




maprotiline 75

Marlissa (28) 92

Marten-Tab 28

masophen 27

MATULANE 43

MAVYRET 39

MAXIDEX 198

MAXIFED TR 204

maxilube 109

maxi-tuss pe 204

maxi-tuss tr 204

m-dryl 206 209

meclizine 147



medi-laxx 158

medi-meclizine 147

MEDISENSE THIN

LANCETS 172 186

MEDLANCE PLUS

LANCETS 172 186


megestrol 49 112

MEKINIST 48

Melodetta 24 Fe 92

meloxicam 30

melphalan 44

memantine 85

MENACTRA (PF) 57

MENOMUNE - ACYW-135

57

MENOMUNE - ACYW-135

(PF) 57

MENQUADFI (PF) 57


(PF) 58

MENVEO MENA

COMPONENT (PF) 58

MENVEO MENCYW-135

COMPNT (PF) 58

MEPHYTON 135

mercaptopurine 45

mesalamine 152

META APPETITE CTRL

(ASPARTAME) 154

METAMUCIL 154

248

METAMUCIL (WITH

SUGAR) 154

METAMUCIL FIBER

SINGLES 154


154

METAMUCIL FREE 154


metaproterenol 216

metformin 141

methadone 24


161


161

methimazole 137

methocarbamol 168

METHOCEL E 4 M 85




methyldopa 68





139

metipranolol 199


metolazone 70


metoprolol ta-

hydrochlorothiaz 68



225

mexiletine 64

mgo 120

mi-acid 146


151


hydr) 144

Mibelas 24 Fe 92

micatin 103

miconazole 7 224


miconazole-3 224

miconazole-3

prefilcreamwipe 224








micro-guard 103

MICROLET 2 LANCING

DEVICE 172 186

MICROLET LANCET 172

MICROLIFE PEAK FLOW

METER 178 186

MICROSPACER 179 186

midazolam 33 78


midodrine 68

migraine formula 32

Mili 92


milk of magnesia

concentrated 156

MILLIPRED 139


186


METER 178 186

Minitran 64

minocycline 29 42

minoxidil 69

mintox 146


mintox plus 146

MIRALAX 156

MIRENA 86

mirtazapine 73

misoprostol 151

249

mitomycin 51

M-M-R II (PF) 55 60 61 62

modafinil 80

MOISTURE DROPS 195

mometasone 107


224

MONISTAT 3 224

monistat 7 225

MONISTAT 7 225

MONOJECT 09 SODIUM

CHLORIDE 130

MONOJECT HYPODERMIC

NEEDLES 177 186

MONOJECT HYPODERMIC

POLYPROPYL 177 186

MONOJECT PREFILL

ADVANCED NS 130

MONOJECT PREFILL

SALINE FLUSH 130

MONOLET LANCETS 172

186


172 186

Mono-Linyah 92

mononessa (28) 92

montelukast 214

morphine 24

MORPHINE 24



148



148

MOUTHPIECE 179 186

moxifloxacin 201

mucilin sf 154


congest 218


mucus relief d

(pseudoephed) 217

mucus relief dm 222

mucus relief er 218



172 186



129

mupirocin 101


system 203

muro 128 199

Mutamycin 51

my choice 98

my way 98


167

MYGLUCOHEALTH

LANCETS 172 187

MYLERAN 43

mynephrocaps 113



151

Myzilra 96

N

NABI-HB 54

nabumetone 30

nadolol 66

NAPHCON-A 197

naproxen 31

naproxen sodium 31

naramin 206 209

NASACORT 219

nasal allergy 220

nasal and sinus

decongestant 223


nasal decongestant

(pseudoeph) 223

nasal decongest-

antihistamine 204

nasal mist 220

NASALCROM 220

NATACYN 201

natural calcium 116

250




NATURAL FIBER





nature-throid 142

NAVELBINE 50

NAYZILAM 71 78

NEBUPENT 41

nebusal 84

NEBUSAL 84

Necon 0535 (28) 92

necon 150 (28) 92

necon 1011 (28) 87

necon 777 (28) 96

nefazodone 74

neomycin 34


196


polymyxin 200


dexameth 196 197

neomycin-polymyxin-

gramicidin 200


202

Neo-Polycin 200

Neo-Polycin Hc 197


101


neo-tuss 222

nephplex rx 113

NEPHRAMINE 54 126

nephro-vite 113

nephro-vite rx 113

NEUTROGENA ON THE

SPOT 100

new day 98

NEXAVAR 48

NEXPLANON 86


niacin 65 132


NIACIN (INOSITOL

NIACINATE) 131


Niacor 65

NIAVASC 132

NIAVASC 750 132

NICODERM CQ 82

nicorelief 82

NICORETTE 82

nicotine 82

NICOTINE 83


nifedipine 67



81 209

nighttime sleep-aid

(doxylamn) 81

Nikki (28) 93

ninjacof-xg 222

NINLARO 49

NIPENT 45

Nitro-Bid 64



162


cryst 35 162

nitroglycerin 64

NIVESTYM 164

NIX CREME RINSE 112

NIZORAL A-D 103

non-aspirin 27




251



nora-be 95


95



estradiol 93 138


93


93 96

Norlyda 95

Norlyroc 95


NORMOSOL-M IN 5

DEXTROSE 118

NORMOSOL-R IN 5

DEXTROSE 118


nortemp 27

Nortrel 0535 (28) 93

nortrel 135 (21) 93

Nortrel 135 (28) 93

Nortrel 777 (28) 96

nortriptyline 75

NOVA SAFETY LANCETS

172 187

NOVA SUREFLEX

LANCETS 172 187

NOVOLIN 7030 U-100

INSULIN 140

NOVOLIN N NPH U-100

INSULIN 140


100 INSULN 140


INSULN 140

np thyroid 142

NUTRILIPID 127

Nyamyc 102

Nylia 777 (28) 96

Nymyo 93

nystatin 36 102 193



Nystop 102

nytol 81 206 209

O


ocean nasal 220

ocella 93

OCUSOFT IRRIGATING

OPHTH SOLN 200


ogestrel (28) 93

Okebo 42

olopatadine 198

OLUMIANT 29


omeprazole 150



172 187

ON CALL PLUS LANCET

172 187


DEVICE 172 187

ondansetron 148

ondansetron hcl 148

ONE WAY VALVED

MOUTHPIECE 179 187


DEVICE 172 187

ONETOUCH DELICA

LANCETS 172 187


LANC DEV 172 187


LANCET 172 187

ONETOUCH SURESOFT

LANCING DEV 173 187

ONETOUCH ULTRASOFT

LANCETS 173 187

ONETOUCH VERIO FLEX

START 173 187

ONETOUCH VERIO HIGH

CONTROL 173 187

ONETOUCH VERIO MID

CONTROL 173 187

252

ONETOUCH VERIO TEST

STRIPS 168 187


187

onxol 50

opcicon one-step 98

OPCON-A 197

OPDIVO 51

OPTICHAMBER ADULT

MASK-LARGE 179 187

OPTICHAMBER DIAMOND

LG MASK 179 187

OPTICHAMBER DIAMOND

VHC 179 187


MED MSK 180 188


SML MASK 180 188

option-2 98 99

Oralone 193

oralyte 121

ORASEP 193

Orsythia 93

oscimin 152 162

oscimin sl 152 162

oseltamivir 40

oxaliplatin 48

oxcarbazepine 73


oxycodone 24


25 26

OXYTROL 162


oysco 500d 117

oysco-500 116



oystercal-d 118

P

Pacerone 64

paclitaxel 50

pain relief 8hr 28


pain reliever

(acetaminophen) 28




110

pamprin max 32

PANCREAZE 149

PANDA MASK 180 188

panoxyl 100

panoxyl-4 100

pantoprazole 151

PARAGARD T 380A 86


paromomycin 34

paroxetine hcl 74

PARVA-CAL 500 118

p-col rite 158

PEAK AIR PEAK FLOW

METER 178 188


129

pedia tri-vite 128


PEDIA-LAX 156


PEDIARIX (PF) 53 56







128


180 188



129


180 188


253

pedi-boro soak 105

PEDVAX HIB (PF) 57


PEGANONE 72

PEGASYS 39

PEGASYS PROCLICK 39


PEGINTRON 39

penicillamine 29 34


PENTACEL (PF) 56 59

PENTACEL DTAP-IPV

COMPNT (PF) 56


pentoxifylline 164

peptic relief 147


peri-colace 158

periguard 109

PERIKABIVEN 127


Periogard 193

PERISHIELD 109

PERJETA 51

permethrin 112

persa-gel 100

PERSONAL BEST FULL

RANGE 178 188


pharbetol 28


PHAZYME 151


PHENAGIL 204

phenazopyridine 161



Phenytek 72

phenytoin 72


72

Philith 93

phillips 120


PHILLIPS MILK OF

MAGNESIA 145 156

PHOSLYRA 160




161


131



K1) 135

PIKO 1 178 188


Pimtrea (28) 87

pink bismuth 147


pin-x 35

PIN-X 35

pioglitazone 141

PIP LANCET 173 188

Pirmella 93 96

piroxicam 30

PLASMA-LYTE 148 121

PLASMA-LYTE A 121

PLENAMINE 126

PNEUMOVAX-23 58

POCKET CHAMBER 180

188

POCKET PEAK FLOW

METER 178 188

podofilox 108

Polycin 200


POLYETHYLENE GLYCOL

3350(BULK) 84


200

POLYSPORIN 101


101

254

POLYVINYL ALCOHOL

(BULK) 84 85

POLY-VI-SOL 128


129

poly-vita 128


poly-vitamin 128


Portia 28 93

PORTRAZZA 51


chloride 121


122


045nacl 122



09nacl 122


dex 122


122


122


nacl 122


02nacl 122


03nacl 122


09nacl 122



161


powderlax 156

pramipexole 76

prasugrel 166

pravastatin 65

prazosin 70

PRED MILD 198

prednicarbate 107



prednisolone sodium

phosphate 139 198

prednisone 139

PREDNISONE INTENSOL

139

pregabalin 72 79

PREMARIN 225

PREMASOL 10 126

PREMASOL 6 126

prenatal 129



129


107

PRESSURE ACTIVATED

LANCETS 173 188

PREVAIL BLADDER

CONTROL PAD 176 188

Prevalite 65

Previfem 93

PREVNAR 13 (PF) 58

PREZISTA 42

PRIFTIN 37 42

PRIMAQUINE 36

PRIMEAIRE 180 188

primidone 71

PRO COMFORT LANCET

173 188


probenecid 163


PROCHAMBER 180 188



148


Proctosol Hc 33 107

Proctozone-Hc 33

255

PRODIGY LANCETS 173

188

PRODIGY LANCING

DEVICE 173 188

PRODIGY TWIST TOP

LANCET 173 188



promethazine-dm 221


204


promolaxin 160

propafenone 64

propantheline 152

proparacaine 200

propranolol 66



62

PROSOL 20 126

protriptyline 75



217


psyllium husk 155

PSYLLIUM HUSK 155


154

PULMICORT FLEXHALER

214

PULMOSAL 84



173 188

PURE COMFORT SAFETY

LANCETS 173 188

PURECOMFORT PEAK

FLOW METER 178 188

purelax 156

PURIXAN 45

PUSH BUTTON SAFETY

LANCETS 173 189

pyrazinamide 37



pyrimethamine 36

Q

QBRELIS 62

q-dryl 206 207 209

QINLOCK 49

q-pap 28


QUADRACEL (PF) 57

Quasense 93

quinapril 63


quinine sulfate 36

QVAR 214

QVAR REDIHALER 214

R

RABAVERT (PF) 61

raloxifene 142

ramipril 63

ranitidine hcl 150

READYLANCE SAFETY

LANCETS 173 189

Reclipsen (28) 93


recort plus 108


refenesen 218



REFRESH OPTIVE 195



relcof c 223


RELIAMED LANCET 173

189


DEVICE 173 189

256


LANCETS 173 189


189


LANCETS 173 189


103

renal caps 113

renal vitamin 113

renal-vite 113

rena-vite 113

rena-vite rx 113

RENFLEXIS 28 153

reno caps 113

repaglinide 136

REPLESTA 134

RESPAIRE-30 218


restore tears 196

RETACRIT 164

retaine nacl 199

revive plus 196

RHOPRESSA 202

Ribasphere 40

ribavirin 40


112


RIDAURA 29

rifampin 37 42

ri-gel 146

RIGHTEST GD500

LANCING DEVICE 173

189

RIGHTEST GL300

LANCETS 173 189

riluzole 167

ri-mag 145

ri-mag plus 146

ri-mox 146

ri-mox plus 146

ringers 115 130

ritonavir 42

RITUXAN 46

RITUXAN HYCELA 46


rivelsa 95

rizatriptan 80

robafen 218

robafen ac 223



ropinirole 76

rosuvastatin 65

ROTARIX 55 61


RYBELSUS 137

RYDAPT 49

rynex pse 204

S


SAFETY SEAL LANCETS

174 189


189

saline mist 220

saline nasal 220

saline nose 220

sal-plant 108

SANTYL 105






SEGLUROMET 136

selegiline hcl 76

selenium 123


selenomax 123


selsun blue 104

SEMGLEE PEN U-100

INSULIN 141

257


141

senexon 158

senexon-s 158

senna 158

SENNA 158

senna-extra 158

sennalax-s 159


159

SENOKOT 158

SENOKOT EXTRA

STRENGTH 158

senokot-s 159

SEREVENT DISKUS 216

sertraline 74

Setlakin 94


Sharobel 95


SHINGRIX (PF) 61


FACE MASK 180 189

silace 160

siladryl sa 207 209

silapap 28

SILICONE MASK -

PEDIATRIC 180 189


siltussin sa 218

SILVASORB 112



151

SIMILAC STERILIZED

WATER 85

Simliya (28) 87

Simpesse 87


simvastatin 65

SINGLE-LET 174 189


223


81 209

sleep tablet


209

SLO-NIACIN 132



SMART SENSE LANCETS

174 189

SMARTDIABETES

VANTAGE 174 189

SMARTEST LANCET 174

189

smoflipid 127

smoothlax 156

sochlor 199





130


130





free) 115


115



DEVICE 174 189

SOFT TOUCH LANCETS

174 189

solifenacin 162


(PF) 139


189

SOLUS V2 LANCING

DEVICE 174 189

sominex 81 207 209

soothing care


sore throat 193

258


Sorine 64 66

sotalol 64 66

Sotalol Af 64 66


spironolacton-

hydrochlorothiaz 69

Sprintec (28) 94

SPRITAM 73

SPRYCEL 49


Sronyx 94

ssd 105

sski 118



STEGLATRO 136

STEGLUJAN 136




sterile saline 220


STIVARGA 48

stomach relief 147

stool softener 160



159

stop lice 112

stop smoking aid 83


strong iodine 118

sucralfate 160

SUDAFED 223

sudafed 12 hour 223

SUDAFED 24 HOUR 223

sudogest 223



201


99


197

sulfamethoxazole-

trimethoprim 35


sulfatrim 35

sulindac 30

sumatriptan 80



113

super calcium 116

super daily d3 134

SUPER DAILY D3 134


189

superplex-t 113

suphedrin 223



allergy 204


U-100 177 190


174 190


PEN 174 190


LANCETS 174 190

SUREFLEX LANCING

DEVICE 174 190

SURE-LANCE 174 190


174 190

SURE-PEN LANCING

DEVICE 174 190


190

surgilube 109


190

SUTENT 49

Syeda 94

SYLATRON 47

259

SYMJEPI 68

SYMLINPEN 120 137

SYMLINPEN 60 137

SYSTANE GEL 196

SYSTANE ULTRA 195

T

tab tussin 218

TABLOID 45

tacrolimus 167

tactinal 28


TAFINLAR 46

TAGRISSO 43

take action 98 99


TALTZ SYRINGE 101

tamoxifen 50

tamsulosin 161

TANZEUM 137

TARCEVA 43


100

Tarina 24 Fe 94

Tarina Fe 120 (28) 94

TASIGNA 50

Taztia Xt 67

TDVAX 57




190

TELCARE LANCETS 174

190

telmisartan 63

temazepam 78 82

TEMODAR 44

temozolomide 44

Tencon 28

teniposide 47

TENIVAC (PF) 57

terazosin 70


terconazole 225

TETANUSDIPHTHERIA

TOX PED(PF) 57

tetracycline 42


Theochron 215

theophylline 215

thera-d 134

THERA-D 4000 134

THERATEARS 196



thiotepa 43

Tiadylt Er 67

tiagabine 72

TICE BCG 48 55

tiger balm 110

TIGER BALM 110

TIGER BALM (WITH

CAPSICUM) 110

Tilia Fe 96


TINACTIN 103

tioconazole-1 225

TIVICAY 37

tizanidine 168

tl icon 120

TOBRADEX 197

tobramycin 201


197

TOBREX 201

TODAY CONTRACEPTIVE

SPONGE 99

tolcylen 103

tolnaftate 103

tolterodine 162 163

TOPCARE UNIVERSAL1

LANCET 174 190

topiramate 73

Toposar 47

260

topotecan 50

torsemide 69


209

TOVIAZ 163


tramadol 24


trandolapril 63

TRANSDERM-SCOP 147

TRAVASOL 10 126


trazodone 74

TRECATOR 37

TRELEGY ELLIPTA 217

tretinoin 100



Tri Femynor 96



193 220

triamterene-


tri-biozene 102


tricon 120

Triderm 108

Tri-Estarylla 96

trifluridine 202

Tri-Legest Fe 96

Tri-Linyah 96

Tri-Lo-Estarylla 96

Tri-Lo-Marzia 97

Tri-Lo-Mili 97

Tri-Lo-Sprintec 97


157

trimethoprim 35

Tri-Mili 97

trimipramine 75

trinessa (28) 97

trinessa lo 97

TRINTELLIX 75

Tri-Nymyo 97

triphrocaps 113


TRIPLE PASTE 109

triple paste af 103


TRISPEC DMX 222


TRITON X-100 85

TRI-VI-SOL 128

tri-vita 128

tri-vitamin 128


Trivora (28) 97

Tri-Vylibra 97

Tri-Vylibra Lo 97

TROPHAMINE 10 126

TROPHAMINE 6 127

tropicamide 197

trospium 163

TRUE COMFORT LANCET

174 190

TRUEDRAW LANCING

DEVICE 175 190


TRUEPLUS KETONE 190


190

TRULICITY 137

TRUMENBA 58

TRUVADA 37

TRUZONE PEAK FLOW

METER 178 190


Tulana 95

TUMS 145

TUMS EXTRA STRENGTH

SMOOTHIES 145

tums ultra 145


261


tussin cough-chest

congestion 222

tussin dm 222

tussin dm max 222

tussin pe 218

TWINRIX (PF) 52 53


tyblume 94

TYKERB 42

tylophen 28

U

ULTI-LANCE 175 190


175 190

ULTILET CLASSIC

LANCETS 175 190



175 191


191


81



175 191


191

ULTRA THIN PLUS

LANCETS 175 191


191

ULTRA-CARE LANCETS

175 191

ultracin m 111

ULTRALANCE LANCETS

175 191


175 191

UNILET COMFORTOUCH

LANCET 175 191

UNILET EXCELITE II

LANCET 175 191


175 191


191


UNILET SUPER THIN

LANCETS 175 191


81 209





UNISTIK 2 NORMAL

LANCETDEVICE 175

UNISTIK 3 176 191

UNISTIK 3 COMFORT

DEVICE 176 191

UNISTIK 3 COMFORT

LANCET 176 191


176 191



191

UNISTIK 3 NEONATAL

DEVICE 176 191

UNISTIK 3 NORMAL

LANCET 176 191


191


192



176 192

UNITHROID 143

UNIVERSAL 1 LANCETS

176 192

URO-MAG 120


ursodiol 149


V


FILM 99


262

vagistat-3 225

valacyclovir 40

valproic acid 71 79


71 79

valsartan 63


63

VALTOCO 71 78

valu-dryl 207 210



vancomycin 39

VANCOMYCIN 39


chl 39

vanicream hc 108

vanquish 32

VAQTA (PF) 53

VARIVAX (PF) 55 61


VELCADE 49


(28) 97

venlafaxine 74

verapamil 64 67

verticalm 148

VERZENIO 47

Vestura (28) 94


VICKS DAYQUIL MUCUS

CONTROL DM 222

Vienva 94

vinblastine 50

Vincasar Pfs 50

vinorelbine 50

Viorele (28) 87

virt-caps 113



vitamin a and d 105


109


vitamin b-1 131


vitamin b-6 132

vitamin d3 134

VITAMIN D3 134

vitamin e 134


vitamin e mixed 134



105


192

VIVAGUARD LANCING

DEVICE 176 192

vol-care rx 113

Volnea (28) 87


192

VORTEX FROG MASK-

CHILD 180 192

VORTEX HOLDING

CHAMBER 180 192


TODDLER 180 192

VORTEX VHC LADYBUG

MASK-TODDLR 180 192

VOTRIENT 50

vp-vite rx 113

Vyfemla (28) 94

Vylibra 94

W


wal-dram 2 148



wal-finate 205 210

wal-itin 211 213


wal-mucil fiber 155

263

WAL-MUCIL FIBER

(ASPARTAME) 155


wal-phed 223

wal-phed d 223

wal-profen 31

wal-sleep z 81 210


81


wal-sporin 101

wal-tap 204

wal-tussin 219


221


wal-zan 150 150

wal-zan 75 150



warfarin 163

wart remover 109

WATER (BULK) 84

weekly-d 134

Wera (28) 94

westhroid 142


Wixela Inhub 217

wp thyroid 143

Wymzya Fe 94

X

XALKORI 44

XARELTO 164


30D START 164

XATMEP 29 45

XERAC AC 104

XOFLUZA 40

XOLAIR 215

XTANDI 45

xulane 97

Y

YF-VAX (PF) 55

Yuvafem 225

Z

ZADITOR 198

Zafemy 97

zaleplon 82

ZANOSAR 51

ZANTAC 150

ZANTAC MAXIMUM

STRENGTH 150

Zarah 94

ZARXIO 164

zeasorb af 103

ZEJULA 49

Zenchent (28) 94

Zenchent Fe 94

ZENPEP 149

Zenzedi 77 79 81

zephrex-d 224

zidovudine 37

zinc oxide 109

zolpidem 82

zonisamide 73

ZOSTAVAX (PF) 55 62

zostrix 111

zostrix-hp 111

Zovia 135E (28) 94

Zovia 150E (28) 95

z-sleep 81 210

Zumandimine (28) 95

ZYDELIG 48

ZYKADIA 44

zyncof 222

ZYTIGA 43 45




800-700-3874 (TTY 1-800-735-2929)




800-700-3874 (TTY 1-800-735-2929) 번으로 전화해 주십시오


(TTY 1-800-735-2929）










Hu rau [1-800-700-3874] (TTY [1-800-735-2929])





3874 (TTY 1-800-735-2929) पर कॉल कर




TOC-1

Table of Contents


































2


Introduction




4


Definitions







6



8



















10



























12























14








Address



Suite 101


4981

(831) 430-5500

Hours M-F 8am-5pm


Suite 101


(831) 755-6000

Hours M-F 8am-5pm


Suite B


(209) 381-5300

Hours M-F 8am-5pm

Phone Directory













Claims (831) 430-5858

Finance (831) 430-5853





16





Abacavir Sulfate N










N








N

Efavirenz N


N


N




N



N



N


Emtricitabine N

Enfuvirtide Y

Etravirine N




Indinavir Sulfate N

Lamivudine N



Maraviroc N


Nevirapine N



Ritonavir N

Saquinavir N


Stavudine N




Tipranavir N



18




Amantadine HCl N

Amantadine HCl ER Y





Brexpiprazole Y

Cariprazine Y









Isocarboxazid Y

Lithium Carbonate N

Lithium Citrate N
















Pimozide Y











Trihexyphenidyl N



20







N





Naloxone HCl N

Naltrexone (oral) N








Anti-inhibitor

















Factor IX complex









22












bull Preterm birth












24





















1 QL (5 per 1 day)



1 QL (65 per 1 day)


1 QL (65 per 1 day)


1 QL (5 per 1 day)




1 QL (9 per 1 day)


1 QL (5 per 1 day)





25




1 QL (5 per 1 day)





1 QL (65 per 1 day)


1 QL (65 per 1 day)


1 QL (5 per 1 day)





1 QL (9 per 1 day)


1 QL (5 per 1 day)


1 QL (5 per 1 day)





1 QL (6 per 1 day)




1 QL (6 per 1 day)








26




1 QL (6 per 1 day)




1 QL (6 per 1 day)























1 OTC Medical





27








2 OTC Medical












1 OTC Medical














28



















1 QL (6 per 1 day)




2 PA SP



2 PA SP








29











1 PA



2 PA SP



1 SP












2










30
















1


1




1 OTC Medical












31



















1















32




1 OTC Medical










1 OTC Medical


1 OTC Medical




1 OTC Medical






1 OTC Medical








1 OTC Medical






33




















1


1


1












34






1




2






















1


1





35














2






1






1











36




































37















1 QL (1 per 1 day)





















38

















1









1




1 PA





1





39









2


1 PA


1


1


1 PA







2 PA SP


2 PA SP


2 PA SP


2 PA SP



2 PA SP





40





































41







1


1


1


1





1



1





2 PA SP


2



2









42






2











1



1







2 PA SP








43







2 PA SP








2 PA OCH



2 PA SP
















44




1




1 PA



2 PA SP




1





2




1 SP


1 PA SP




2 PA OCH


2 PA OCH








45












2 PA SP








2




2






1 PA










46






1


2









2 PA SP





2 PA OCH



2 PA SP


2 PA SP


2 PA SP


2 PA SP






47




2 PA OCH


2 PA OCH


2 PA SP


2 PA SP








2 PA SP



2 PA SP



2 PA SP


2 PA SP


2 PA SP


2 PA SP








48




2 PA SP



2 PA SP


2 PA OCH


2 PA OCH








2 PA



2 PA









1 PA






49










2 PA SP


2 PA SP



2 PA SP




2 PA SP




2 PA OCH



2 PA OCH




2 PA SP


2 PA SP





50




2 PA SP











2 PA SP


1






2



1





1


1






51






1 PA



1





1


2



2 PA SP


2 PA SP



2 PA SP



2 PA SP


2 PA SP






52




2 SP


2 PA SP










2 DD






2





2 OTC Medical









53


































54









2 SP


























55

































56





























57

































58
































59

































60
































61


































62













1



1 QL (1 per 1 day)


1


1


1








1







63















1



1


1


1 QL (1 per 1 day)








2



1





64






1


1




1











1















65




1


1




1



1













1












66







1








1




1


1






1



1


1



1





67




1


1


1


1



1



1






1


1



1



1




1





68




1



















1





1


1



1


2





69

























1


1









70




2












2 PA






1
















71









1










2


2




1


1








72







1 QL (3 per 1 day)







2






2




1



1




1







73











1




1


1











1 QL (1 per 1 day)






74


















1




1 QL (1 per 1 day)


1 QL (3 per 1 day)


1 QL (2 per 1 day)



1 QL (2 per 1 day)








75





2 PA



1






1



1



1


1













76




1



1


1


1








1


1





1 QL (1 per 1 day)



1






77




1



1 QL (2 per 1 day)


1 QL (3 per 1 day)


1 QL (1 per 1 day)


1 QL (1 per 1 day)


1





1 QL (2 per 1 day)


1 QL (1 per 1 day)


1 QL (2 per 1 day)


1





1 QL (1 per 1 day)



1






78



















2



2



1




1







79




1


1








1 QL (2 per 1 day)


1 QL (3 per 1 day)



1






1 QL (3 per 1 day)





1 QL (2 per 1 day)






80





1























1



1






81




1 QL (3 per 1 day)



















1 OTC Medical















82




1












1 QL (1 per 1 day)




1


1



2 OTC



2 OTC


2 OTC




1 OTC





83




2 OTC




2 QL (336 per 365 days)


2 QL (336 per 365 days)




Bulk Chemicals


2 OTC Medical




2 OTC Medical





2 OTC Medical


1 OTC


2 OTC Medical


2 OTC Medical


2






84




2 OTC Medical


2 OTC Medical





2 OTC Medical


2 OTC Medical










2



2


2


1







85












2 OTC Medical


2 OTC Medical






1 PA



1 PA NSO










86




2 CT















1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





87




1 CT


1 CT


1 CT


1 CT


1 CT


2 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT





88




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





89




1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1






90




1 CT


1 CT


1


1


1 CT


1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





91




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





92




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT






93




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





94




1 CT


1 CT


1 CT


1 CT


1 CT


1 CT



1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





95




1 CT


1 CT



















1 CT


1 CT



1 CT


1 CT


1 CT





96




1 CT


1 CT


1 CT



1 CT


1 CT


1 CT



1 CT


1 CT


1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT





97




1 CT


1 CT


1 CT


1 CT




1


1 CT


1 CT


1 CT


1 CT


1 CT


1 CT






1



1 CT





98





1 CT


1 CT






























99









2 CT


2 CT




















1 OTC Medical








100











1


bpo topical gel 8 1








1
















101




2 PA SP


2 PA SP






1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical










1 OTC Medical


1 OTC Medical





102




1 OTC Medical


1 OTC Medical
































103












2 OTC Medical

























104






1


1







2





















105










2 OTC Medical
















2 PA












106
























2















107









1
























1


1





108








1



1


1





















109







1 OTC Medical















2 OTC Medical


2 OTC Medical













110












1 OTC












2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical






111





1 OTC Medical



2 OTC Medical








2 OTC Medical


2 OTC Medical



2 OTC Medical


1 OTC Medical
















112


















2 OTC Medical












2 OTC Medical





113




2 OTC Medical





























1 PA






114




1 PA


1 PA


1 PA


1 PA


1 PA


1 PA


1 PA



1 PA


1 PA



1 PA


1 PA


1 PA



1 PA



1 PA



1 PA





115





1 PA


1 PA
















2 PA





1 OTC Medical








1 OTC Medical





116




1 OTC Medical



1 OTC Medical









1 OTC Medical


1 OTC Medical



1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical





117




1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical



1 OTC Medical



1 OTC Medical





118




1 OTC Medical


1 OTC Medical



1 OTC Medical




2 PA


2 PA


2 PA


2 PA


2 PA














119






1 OTC Medical


1 OTC Medical






1 OTC Medical


1 OTC Medical


2 OTC Medical


1 OTC Medical


2 PA


1 OTC Medical




1 OTC Medical


1 OTC Medical


1 OTC Medical







120










2 OTC Medical



1 OTC Medical



1 OTC Medical



1 OTC Medical


1 PA


1 PA


1 PA


1 PA


1 OTC Medical




2 OTC Medical



2 OTC Medical





121




2 OTC Medical


2 OTC Medical


1 OTC Medical






2 PA


2 PA


2 PA


2 PA


2 PA


2 PA







1





122





1 PA


1 PA


1 PA


1 PA


1 PA


1 PA



1 PA


1 PA


1 PA


1 PA





1


1


1


1


1





123




1




1


1








2 OTC Medical



2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





124




2 PA


2 PA


2 PA


2 PA


2 PA



2 PA


2 PA


2 PA


2 PA



2 PA


2 PA





125




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





126




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





127




2 PA



1 PA


1 PA



2 PA


2 PA




2 PA


2 PA


2 PA


2 PA


2 PA


2 PA





128




2 PA


2 PA


2 PA


2 PA























129




2 AGE (Max 4 Years)











1 OTC Medical



1 OTC Medical










1







130




2 PA





1


1


2



1 PA


1 PA





1


1


2



1 PA




1 PA


1 PA





131










1 QL (10 per 1 day)


1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical


2 OTC Medical






132









1 OTC Medical


2


2


2 OTC Medical



1 OTC Medical


1 OTC Medical









2 OTC Medical











133




1 OTC


1 OTC Medical


1 OTC Medical










2 OTC Medical


1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical



1 OTC Medical




2 OTC Medical




2 OTC Medical





134






1





1 OTC Medical


2 OTC Medical



2 OTC Medical


2 OTC Medical



1 OTC Medical



1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical







135











2




2




2 DD


2 DD


2 DD



2 DD


2 DD






1






136











2 PA NSO DD



2 PA NSO DD







1 DD





1 DD








137




2 PA DD


2 PA DD



2 PA DD


2 PA DD















1









138




1



1


1



1






1



1 PA


1 PA


2 PA


2 PA


2 PA










139





1



1


1


1


1



1


1











1


2



2 DD





140




2 DD



2 DD


2 DD



2 DD


2 DD


2 DD


2 DD



2 DD


2 DD


1 DD


2 DD



2 DD





141




2 PA DD


2 PA NSO DD


2 DD


2 DD



2 DD


1 DD


2 PA NSO DD


1 PA DD




1 DD





2 PA SP


2 PA SP






142




2







1 PA


1 PA


2 PA


2 PA


2 PA










1


1


1





143




1






1


1


2




2 OTC Medical



2 OTC Medical





1 OTC Medical



1 OTC Medical


1 OTC Medical





144






2 OTC Medical






1 OTC Medical






1 OTC Medical


1 OTC Medical


1 OTC Medical





1 OTC Medical


1 OTC Medical





1 OTC Medical





145




2 OTC Medical


2 OTC Medical


1 OTC Medical


1 OTC Medical



1 OTC Medical


2 OTC Medical









1 OTC Medical











146




1 OTC Medical





2 OTC Medical
























147





































148








1 OTC Medical









1







1













149














2


2


2









150






















2 OTC Medical




1 OTC Medical




1







151




1















2 OTC Medical




1 OTC Medical


1 OTC Medical



1 OTC Medical








152
























2





1


1






153









2 PA SP




1


1 OTC Medical





1 OTC Medical





1 OTC Medical


1






1 OTC Medical





154




2 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical







1 OTC Medical



2 OTC Medical





155





2 OTC Medical



1 OTC Medical


2 OTC Medical











1



2 OTC Medical










2 OTC Medical





156








2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical
















2 OTC Medical



1





157




1


2


1



1



1 OTC Medical










1 OTC Medical


2 OTC Medical


2 OTC Medical










158












2 OTC Medical





1



2 OTC Medical











159











1 OTC Medical






2 OTC Medical

















160















2 PA














1 PA







161











2


2








1



1











162




2



1



















1


2


2 PA


1





163





2 PA




1

















2


1


1



2





164












2 PA SP



2 PA SP


2 PA SP


2 PA SP






1 PA


1




1






165




1




1 PA


1



1





1


1




1


1



1


1


1







166




1









1 OTC Medical



1 OTC Medical





1 OTC Medical







1 OTC Medical








167







2 QL (2 per 1 day)




2



1 SP





















168



















2 DD




2 DD



2 DD







169




2 DD



2 DD



2 DD


2 DD







2 DD


2 DD



2 DD



2 DD




2 DD


2 DD




2 DD





170












2 DD





2 DD



2


2









2 DD


2 DD







171




2 DD





2 DD








2 DD







2 DD




2 DD





2 DD







172




LANCING DEVICE 2 DD





2 DD




2 DD



2 DD








2 DD







2 DD


2 DD


2 OTC






173




2 DD





2 DD


2 DD




2 DD


2 DD






1 DD


2 DD


2 DD


2 DD



2 DD









174




2 DD


2 DD




2 DD




2 DD




2 DD




2 DD



2 DD







2 DD









175





2 DD






2 DD


2 DD





2 DD






2 DD


2 DD










2 DD





176




2 DD







2 DD




2 DD



2 DD


2 DD





1 OTC Medical



2 DD


2 DD


2 DD





177




2 DD


2 DD



2 CT


1 CT





1


2


1


1


1


1


1


1






178




2 OTC Medical



2


2 OTC Medical


2 OTC Medical


2 OTC Medical


2


2 OTC Medical


2 OTC Medical




2


2





2


2


2


2





179




2


2


2


2



2


2


2


2


2


2


2




2 OTC Medical


2 OTC Medical


2


2


2





180




2


2


2 OTC Medical


2 OTC Medical


2 OTC Medical





2 OTC Medical


2 OTC Medical


2 OTC Medical


2


2


2


2










181




1




2 DD




2 DD



2 DD




2 DD





2 DD


2 DD






2


2


2





182




2



2 OTC Medical





2 DD


2 DD



2 DD




2 DD




1


2


2 DD


2 DD


1


1


1





183






2 DD


2 DD


2 DD


2 DD


2


2 DD










2 DD



2




2 DD






184




2


2


2 CT





1 CT


2


2


2


2






2 DD


2 DD




2 DD









185




2 DD








2 DD







2 DD



2 OTC Medical


2 OTC Medical



2 DD








2 DD






186





LANCING DEVICE 2 DD





2 DD



2


2



2 DD



2 DD


2 OTC Medical




2


1


1




2 OTC Medical






187





2 DD







2 OTC Medical


2 DD


2 DD


2 OTC



2 DD





2 DD


2 DD





2


2


2





188




2


2


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical






2 DD


1 OTC Medical



2 DD







1 DD


2





189




2 DD


2 DD


2 DD



2 DD






2 DD


2 DD



2 OTC Medical


2 OTC Medical



2 DD




2 DD




2 DD







190




2 DD


2 DD



2 DD







1


2 DD








2 DD


2






2 DD





191




2 DD









2 DD


2 DD










2 DD







2 DD







192




2 DD



2 DD


2 DD




2 OTC Medical


2


2


2


2












1






193













1


1


1















1 OTC Medical






194















1 OTC Medical














1 OTC Medical









195




1 OTC Medical





2












2 OTC Medical















196













2 OTC Medical








2 QL (35 per 1 day)





2


1


1 QL (35 per 1 day)





197




1


1 QL (35 per 1 day)


1


1 QL (35 per 1 day)


2


1 QL (35 per 1 day)


























198










1 QL (35 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


2


2 QL (1 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)








1 QL (35 per 1 day)






199









1 QL (35 per 1 day)

























200

















1





1


1


1 QL (35 per 1 day)


1 OTC Medical


1


1 QL (35 per 1 day)





201





1



1



2





2







1



1 QL (35 per 1 day)





2 QL (35 per 1 day)



2 QL (35 per 1 day)





202











2 PA






2 QL (35 per 1 day)


1 QL (35 per 1 day)


2 QL (35 per 1 day)


1 QL (35 per 1 day)


1 QL (35 per 1 day)










203





1 QL (35 per 1 day)


























204






2 OTC Medical



2 OTC Medical



2 OTC Medical





2 OTC Medical



















205










1 QL (1 per 1 day)





















1 OTC Medical





206




1 OTC Medical




1 OTC Medical

























207


















1





1













208












1 OTC Medical


1 OTC Medical



1 OTC Medical


















209












1





1

















210

















1 PA NSO OTC




1 OTC















211














2 OTC Medical
























212




















1 PA NSO OTC



1 OTC






2 OTC Medical







213

















1 OTC Medical









2


2





214




2


2


2


1


2


2


2


2


2












215





2 PA



1


1



1


1



2 PA NSO



2


2



2




2 PA NSO





216




2






1


1


1


2





1 PA NSO




2


2


2





217




1 QL (1500 per 30 days)


2


2



2 PA


2 PA




1







2 PA









218




2 OTC Medical














1











219







1



1






1 OTC Medical




2 OTC



2 OTC



2 OTC Medical





2 OTC


2 OTC Medical





220








2 OTC Medical




















2 OTC Medical







221































222































223







1 OTC Medical


1 OTC Medical







1 OTC Medical






1 OTC Medical













224







2















1 OTC Medical




1 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical


2 OTC Medical





225




2 OTC Medical















226

Index of Drugs

1



(pse) 223

1-day 224

1ST TIER UNILET

COMFORTOUCH 168 181

2



181

3

3 day vaginal 224

3-day vaginal 224

8


A


abiraterone 43 45

ABREVA 105

acarbose 136

ACCU-CHEK FASTCLIX

LANCET DRUM 168 181

ACCU-CHEK FASTCLIX

LANCING DEV 168 181

ACCU-CHEK MULTICLIX

LANCET 168 181


168 181


PLUS 168 181

ACCU-CHEK SOFT DEV

LANCETS 169 181

ACCU-CHEK SOFTCLIX

LANCETS 169 181

acebutolol 66

acephen 26

acetaminophen 26


Acetasol Hc 203

acetazolamide 69

acetic acid 160 202


202



acid controller 150



143



acid-pep 150



acne medication 99

ACNE MEDICATION 99


perox) 99

acne vanishing 99

acne-clear 99

ACTHIB (PF) 57


181

acyclovir 40

ADACEL(TDAP


56

adapalene 100

addaprin 30


31

ADJUSTABLE LANCING

DEVICE 169 181

ADMELOG SOLOSTAR U-

100 INSULIN 141


LISPRO 141

ADRENALIN 220

adriamycin 50

Adriamycin 50

Adrucil 45



227

ADVAIR HFA 217


100

ADVANCED EYE RELIEF

194

ADVANCED LANCING

DEVICE 169 181

ADVANCED TRAVEL

LANCETS 169 181

ADVIL 30


30

ADVOCATE LANCET 169

181

ADVOCATE LANCING

DEVICE 169 181



181

AEROCHAMBER MV 178

181

AEROCHAMBER PLUS

FLOW-VU 178 181

AEROCHAMBER PLUS

FLOW-VUS MSK 178

AEROCHAMBER PLUS Z

STAT 179 181

AEROCHAMBER PLUS Z

STAT LG MSK 178

AEROCHAMBER PLUS Z

STAT MD MSK 178

AEROCHAMBER PLUS Z

STAT SM MSK 179

AEROCHAMBER WITH

FLOWSIGNAL 179 181

AEROCHAMBER Z-STAT

PLUS-FLW SG 179 182

AEROSPAN 213


Afeditab Cr 67

Afirmelle 87


UP)(PF) 59


35MO)(PF) 59

AFLURIA QUAD 2020-

2021(6MO UP) 59

aftera 98

AIRZONE PEAK FLOW

METER 178 182

AKTEN (PF) 200

Ala-Cort 105

alavert 210 212


alaway 197

albendazole 35


Alcaine 200

alcalak 144

alclometasone 105


ALECENSA 44

alendronate 137

aler-cap 205 207

alfuzosin 161

ALIQOPA 48


205 207

ALKERAN 44


211

ALLEGRA ALLERGY 210

212

aller-chlor 205 207


aller-cort 219

aller-ease 210 212

aller-flo 219


205 207


205 208


phen) 197




211



212


228


205 208



205

aller-tec 210 211

aller-tec d 205

allopurinol 163

almacone 145

almacone-2 145


102

alogliptin 136




altamist 220

Altavera (28) 87


169 182


DEVICE 169 182


ALUMINUM HYDROXIDE

GEL (BULK) 83 143

ALUNBRIG 44

Alyacen 135 (28) 87

Alyacen 777 (28) 95

Amethia 86

Amethia Lo 86

Amethyst (28) 88

amiloride 69

AMINOSYN 10 124

AMINOSYN 7 WITH

ELECTROLYTES 124

AMINOSYN 85 124

AMINOSYN 85 -

ELECTROLYTES 124

AMINOSYN II 10 125

AMINOSYN II 15 125

AMINOSYN II 85 125

AMINOSYN II 85 -

ELECTROLYTES 124


AMINOSYN-HBC 7 125

AMINOSYN-PF 10 125

AMINOSYN-PF 7

(SULFITE-FREE) 125

AMINOSYN-RF 52 125

amiodarone 64

amitriptyline 75


75 77

amlodipine 67



amoxapine 75

amoxicillin 34


amphotericin b 35

ampicillin 34

anagrelide 166

anastrozole 46


androxy 135

ANORO ELLIPTA 216


hyd) 143



hyd) 143



145

antacid supreme 144



antacid-antigas 145



101


dextrose 163

anti-dandruff 104


anti-diarrheal 147

229


146

anti-fungal 102



antifungal cream

(miconazole) 102



151



anti-itch (hc) 105


108

anti-itch plus 108


antitussive dm 221

anucort-hc 33

ANZEMET 148

aprepitant 149

Apri 88

APRISO 152

aprodine 203

AQUA LANCE LANCING

DEVICE 169 182


aquanil hc 105


Aranelle (28) 95


armodafinil 80

ARMONAIR RESPICLICK

213

ARNUITY ELLIPTA 214

ARRANON 45


111


195





194 199


194


194


194

ARZERRA 46

Ashlyna 86

ASMANEX HFA 214

ASMANEX TWISTHALER

214

aspirin 32 166

aspirin low dose 32


mag 33

aspir-low 32 166

aspir-trin 32 166

ASSURE HAEMOLANCE

PLUS 169 182



182

ASTHMA CHECK METER

178 182

atenolol 66


athenol 26

athletes foot 102


102


atomoxetine 77

atorvastatin 65

atovaquone 36

atropine 197

ATROVENT HFA 215

Aubra 88

AUGMENTIN 35

auro eardrops 203

Aurovela 1530 (21) 88


Aurovela 24 Fe 88

230




182

AUTOLET IMPRESSION

LANC DEV 169 182

AUTOLET LANCING

DEVICE 169 182


DEVICE 169 182

AVASTIN 42

AVC VAGINAL 224

Aviane 88

avita 100

ayr saline 220

Ayuna 88

azathioprine 29 167

azelastine 197 219

azithromycin 40

azolen tincture 102

AZULFIDINE 29 152

Azurette (28) 86

B


112

b-12 dots 131

baby ddrops 132


baby vitamin d3 132


bacitracin 101 201

bacitracin zinc 101



baclofen 168

balsalazide 152

Balziva (28) 88

banophen 205 208


BAQSIMI 135

BASAGLAR KWIKPEN U-

100 INSULIN 140


BAYER CHEWABLE

ASPIRIN 32 166


baza antifungal 102


55 58


BD LUER-LOK SYRINGE

177 182


169 182


09 130


STERILE 177 182


BD REGULAR BEVEL

NEEDLES 177 182


177 182


169 183

BD ULTRA-FINE II

LANCETS 169 183


NEEDLE 176 183

BD VEO INSULIN SYR

(HALF UNIT) 176 183


UF 176 177 183

Bekyree (28) 86


206 208

benazepril 62

benazepril-


BENGAY COLD THERAPY

111

BENGAY VANISHING

SCENT 111

benzonatate 213


beta-hc 106


106


231


106


betatemp 26



BEXSERO 58

bicalutamide 45

BICARSIM 151

bicarsim forte 151

BICILLIN C-R 42

BICILLIN L-A 41

BICNU 44

BIDIL 70

bio-d-mulsion 132


bio-dtuss dmx 221

BIOTHRAX 58

bisac-evac 157

bisacodyl 157

biscolax 157

bismatrol 147


147


(BULK) 83

BISMUTH SUBNITRATE

(BULK) 83


(BULK) 83 147


bisoprolol-


bleomycin 51

Bleph-10 201

Blephamide SOP 196

Blisovi 24 Fe 88

Blisovi Fe 1530 (28) 88



BOOSTRIX TDAP 56

boro-packs 105

BOSULIF 49


BOUDREAUXS BUTT

PASTE 109

bp wash 100

BP WASH 100


bpo 100

BREATHERITE VALVED

MDI CHAMBER 179 183

BREO ELLIPTA 217

Briellyn 88

BRILINTA 166

brimonidine 202

bromfenac 198

bromi-lotion 104

brompheniramine-

pseudoeph-dm 221

brotapp dm 221

budesonide 214 219


bufferin 33


LANCETS 169 183

bumetanide 69

bupropion hcl 75 82


deter) 82

buspirone 71

busulfan 43

BUSULFEX 43



28

BUTTERFLY TOUCH

LANCET 170 183

C

cabergoline 142

CABOMETYX 48

CALAMINE (BULK) 83


calci-chew 115

calcidol 132

232

calci-mix 115

calcipotriene 104


calcitriol 132 192

calcium 500 + d 116

calcium 500 + d (d3) 116

calcium 600 115

calcium 600 + d(3) 116


116

CALCIUM 600 WITH

VITAMIN D3 116

CALCIUM ACETATE 115


bind) 115 160

calcium antacid 144


144


116


116 117

CALCIUM CARBONATE-

VITAMIN D3 117

calcium citrate 116

CALCIUM CITRATE 116




calcium lactate 116

calcium+d 117


CALQUENCE 46 49



D3 117

Camila 95

camrese 86

camrese lo 86

cank-oxide 193

capecitabine 45

CAPRELSA 49

capsaicin 111

CAPSAICIN (BULK) 83

capsicum 111

captopril 62

carbamazepine 72 78

CARBAMIDE PEROXIDE

(BULK) 52 83


carbidopa-levodopa-

entacapone 76

carboplatin 48


DEVICE 170 183

CAREONE LANCING

DEVICE 170 183

CAREONE ULTRA THIN

LANCET 170 183


183

CARESENS PREM

LANCING DEVICE 170

183

CARETOUCH LANCING

DEVICE 170 183

CARETOUCH SAFETY

LANCETS 170 183

CARETOUCH TWIST

LANCET 170 183

CAROSPIR 63 69

Cartia Xt 66

carvedilol 63

castor oil 157

CASTOR OIL 84


Caziant (28) 95

cefaclor 38

cefadroxil 38

cefdinir 38

cefixime 38

cefpodoxime 38

cefprozil 38


celecoxib 30

CELONTIN 73

233

cephalexin 38

CERALYTE 90 120

ceralyte-70 121

CERALYTE-70 121

certain dri 104

cetiri-d 205


cevimeline 194

CHANTIX 83

CHANTIX CONTINUING

MONTH BOX 83

CHANTIX STARTING

MONTH BOX 83

Charlotte 24 Fe 89

Chateal (28) 89

CHEMET 34

cheratussin ac 222



221


210 212



child ibuprofen 30

child mucinex chest

congestion 218


219

CHILDRENS ADVIL 30


212


206 208


210 212


210 212


210 212


211 212




206 208



218


allerg 203



childrens mapap 26





childrens pepto 144


childrens q-pap 27







CHILDRENS ZYRTEC

ALLERGY 211 212


211 212

chloramphenicol sod

succinate 38



193

chlorhist 205 208


chlorthalidone 69



D3)(BULK) 83 132 133


133

CHOLECALCIFEROL

(VITAMIN D3) 133


65


234

ciclopirox 102

cilostazol 166

CILOXAN 201

cimetidine 150

cimetidine hcl 150

cinacalcet 137

CIPRO 38

CIPRO HC 202

ciprofloxacin 39



202

cisplatin 48

citalopram 74

CITRACAL-D3 SLOW

RELEASE 117


citroma 155


cladribine 45

clarispray 219

clarithromycin 41


212


control 100


100

clearasil ultra 100

clearlax 155

clemastine 206 208

CLEOCIN 224

CLEVER CHEK LANCETS

170 183

CLEVER CHOICE PEAK

FLOW METER 178 183

clindamycin hcl 40



224

CLINIMIX 5D15W

SULFITE FREE 123

CLINIMIX 5D25W

SULFITE-FREE 123

CLINIMIX 275D5W

SULFIT FREE 123

CLINIMIX 425D10W

SULF FREE 123

CLINIMIX 425D5W

SULFIT FREE 123

CLINIMIX 425-D20W

SULF-FREE 123

CLINIMIX 425-D25W

SULF-FREE 124

CLINIMIX 5-

D20W(SULFITE-FREE)

124

CLINIMIX 6-D5W

(SULFITE-FREE) 124

CLINIMIX 8-

D10W(SULFITE-FREE)

124

CLINIMIX 8-

D14W(SULFITE-FREE)

124

CLINIMIX E 275D10W

SUL FREE 125 127

CLINIMIX E 275D5W

SULF FREE 125 127

CLINIMIX E 425D10W

SUL FREE 125 127

CLINIMIX E 425D25W

SUL FREE 125 127

CLINIMIX E 425D5W

SULF FREE 125 127

CLINIMIX E 5D15W

SULFIT FREE 126 127

CLINIMIX E 5D20W

SULFIT FREE 126 128

CLINIMIX E 5D25W

SULFIT FREE 126 128

CLINIMIX E 8-D10W

SULFITEFREE 128

CLINIMIX E 8-D14W

SULFITEFREE 128

CLINISOL SF 15 126

clobetasol 106


clonazepam 70 71 78

clonidine 68

clonidine hcl 68

clopidogrel 166


235

clotrimazole af 103

clotrimazole-7 224


104

COAGUCHEK LANCETS

170 183


coditussin ac 222

COLACE 159

COLACE 2-IN-1 158

COLACE CLEAR 159

colchicine 163


pe) 203


203


220


cold-flu relief 220

colestipol 65

collyrium 200

Colocort 153


colox 153

col-rite 159


COMETRIQ 48

COMFORT EZ LANCETS

170 183

comfort gel 145


COMFORT LANCETS 170

183

COMFORT TOUCH PLUS

SAFETY LANC 170 184

COMFORT TOUCH ULT



compoz 81 206 208

Compro 148

CONCEPTROL 99

CONDOMS-PREM

LUBRICATED 177 184

congest-eze 217

Constulose 155

cool and heat 111


menth) 110


coral calcium 116

Cormax 106

cortaid 106

cortisone 138


106


CORTISPORIN-TC 202

cortizone-10 106



cough syrup dm 221


COUMADIN 163


CREON 149


103

cromolyn 47 200 214 220

Crotan 112

Cryselle (28) 89

CUPRIMINE 29 34


12) 131

CYANOCOBALAMIN

(VITAMIN B-12) 131



cyclobenzaprine 168

cyclopentolate 197


CYCLOPHOSPHAMIDE 29

44

cycloserine 37


236


Cyred 89


cytra-k 161

D

d10 -045 sodium

chloride 114

d25 -045 sodium

chloride 114

d3 dots 133

d5 and 09 sodium

chloride 114


114

dacarbazine 44

daily fiber 153


153


153

dailyhist-1 206 208

DALIRESP 215


pe) 203

dandruff shampoo

(pyrithione) 104

dantrolene 168

dapsone 36

DAPTACEL (DTAP

PEDIATRIC) (PF) 56

Dasetta 135 (28) 89

Dasetta 777 (28) 96

daunorubicin 50 51



Daysee 86

day-time cough 213

ddrops 133

Deblitane 95

debrox 203

decara 133

DECARA 133

deep sea nasal 220

delta d3 133

Deltasone 138

DELTUSS DMX

(DEXCHLORPHEN) 221

Delyla (28) 89



86

dermafungal 103

DERMA-SMOOTHEFS

BODY OIL 106

DESCOVY 37

desenex 103

desipramine 75


desmopressin 135


87


89

desonide 106

desoximetasone 106


guaif) 221


dexamethasone 139

DEXAMETHASONE

INTENSOL 138


(pf) 139


phosphate 139 198



80

dextroamphetamine-



213

dextromethorphan-

guaifenesin 222

dextrose 10 and 02

nacl 114


(d10w) 114


(d20w) 114

237


(d25w) 114 115


(d30w) 114 115


(d40w) 114 115


114


113

dextrose 5-02 sod

chloride 114

dextrose 5-03

sodchloride 114


(d50w) 114 115


(d70w) 114


dialyvite 113


15 112


50 113



MAX 133

diamode 146

diaper rash 109

diazepam 70 71 78




198

dicloxacillin 42

dicyclomine 152

didanosine 37

Digitek 68

Digox 68

digoxin 68

DIGOXIN 68



DILANTIN-125 72

DILATRATE-SR 63

diltiazem hcl 64 66


dilt-xr 67

dimaphen dm 221


diphedryl 206

diphenhist 206 208


208 209


dipyridamole 167



DIURIL 69


docosanol 105

doc-q-lace 159

doc-q-lax 158

docu 159

docusate sodium 159

DOCUSATE SODIUM

(BULK) 83 159

docusol 159

dok 159

DOMEBORO 105

donepezil 85

dorzolamide 199




101

doxazosin 70

doxepin 75

doxercalciferol 192

doxorubicin 51



d-penamine 29 34




238

DROPLET GENTEEL

LANCING DEVICE 170

184

DROPLET LANCETS 170

184

DROPLET LANCING

DEVICE 170 184


89


dulcoease 159

dulcolax (magnesium

hydroxide) 155


159

duloxetine 74 79

DUREX AVANTI BARE

REAL FEEL 177 184

dutasteride 161

d-vi-sol 134

d-vita 134

dyna-hex 52

E

ec prin 32 166

EES 400 41


peroxide) 203

ear drops otc 203



EASIVENT HOLDING

CHAMBER 179 184

EASIVENT MASK LARGE

179 184


179 184

EASIVENT MASK SMALL

179 184

EASY CLICK LANCING

DEVICE 170 184


170 184

EASY MINI EJECT

LANCING DEVICE 170

184

EASY TOUCH LANCING

DEVICE 170 184

EASY TOUCH SAFETY

LANCETS 170 184

EASY TOUCH TWIST

LANCETS 170 184

EASY TWIST AND CAP

LANCETS 170 184

econazole 103

econtra ez 98

ecotrin 32 166

ed a-hist 203

ED CHLORPED D 204

EDECRIN 69

ed-spaz 152 162

effer-k 122



Elinest 89

Eliphos 160

ELIQUIS 164


30D START 163

Elixophyllin 215

ELLA 98

ELMIRON 160

Eluryng 98

EMBRACE LANCING

DEVICE 170 184

EMCYT 47

Emoquette 89



62

Endocet 25 26

endur-acin 131

enema 156


enemeez 159

ENFAMIL WATER 84

ENGERIX-B (PF) 53

ENGERIX-B PEDIATRIC

(PF) 53

enoxaparin 165 166

239

Enpresse 96

Enskyce 89

entacapone 76

entecavir 39

Enulose 149

EPANED 62

epinephrine 68 213


EPIPEN 2-PAK 68

EPIPEN JR 2-PAK 68

epirubicin 51

Epitol 72 79

eq gentle 195

ERBITUX 51



134

ergoloid 85

erlotinib 43

Errin 95

ertapenem 37

Ery-Tab 41


erythromycin 41 201


41



Estarylla 89

estazolam 78 82

estradiol 138 225

eszopiclone 82

ethambutol 37

ethosuximide 73


89

etodolac 31


97 98

etoposide 47

EURAX 112

euthyrox 143

EVAC 153


EXAPHEN 204


exemestane 46



EX-LAX MAXIMUM

STRENGTH 157

expectorant 218

expectorant dm 222


EYE IRRIGATING

SOLUTION 200





171 184


184

ezetimibe 65

EZ-LETS 171 184

F

fa-8 135

fallback solo 98

Falmina (28) 89

famotidine 150

famotidine (pf) 150

Fayosim 95


184

felodipine 67

Femynor 89

fenofibrate 65



65

feosol 118

FEOSOL 118

ferate 118

fer-iron 118

240

ferocon 119

ferosul 118

ferrocite 119



ferrous sulfate 119

FERROUS SULFATE

DRIED (BULK) 83 119

feverall 27

FEVERALL 27


fexofenadine-

pseudoephedrine 205



153


153

fiber smooth 153


153


153


sugar) 153

FIFTY50 SAFETY SEAL

LANCETS 171 185

finasteride 161

FINE 30 UNIVERSAL

LANCETS 171 185


185


FIRVANQ 39

flanax antacid 145

FLAREX 198


flecainide 64

FLEET BISACODYL 157




FLONASE ALLERGY

RELIEF 219


FLOVENT DISKUS 214

FLOVENT HFA 214

floxuridine 45

FLUAD 2020-2021 (65 YR

UP)(PF) 59


UP)(PF) 59


(PF) 59


(PF) 59

flucaine 199


2021 60


2021 (PF) 59

fluconazole 36

flucytosine 36

fludrocortisone 142

FLULAVAL QUAD 2020-

2021 (PF) 60


55 60

flunisolide 219


fluocinonide 107

Fluocinonide-E 107



fluorometholone 198

fluorouracil 45 104

fluoxetine 74

flurazepam 78 82


flutamide 45


219


salmeterol 217

fluvoxamine 74

FLUZONE HIGHDOSE

QUAD 20-21 PF 60

241


60


(PF) 60

FML SOP 198


foaming antacid 144

folic acid 135

FOLIC ACID 135


FORA LANCING DEVICE

171 185


185

formula 3 103

fosinopril 62


62

FREAMINE HBC 69 126

FREAMINE III 10 126


185


185


fungi cure 103


fungoid-d 103

furosemide 69

Fyavolv 138

G

gabapentin 72

GAMIFANT 167

GARDASIL (PF) 59

GARDASIL 9 (PF) 59



151




151


GAVILAX 155

gavilyte-c 156

Gavilyte-G 156


Gavilyte-N 157

GAVISCON 143

GAVISCON EXTRA

STRENGTH 144

GAZYVA 46


146

gemcitabine 46

gemfibrozil 65

Gemmily 89

GEMZAR 46

Generlac 149

Gentak 201

gentamicin 101 201


GENTEAL TEARS

MODERATE 194


GEL 195

gentlelax 155

GERBER GOOD START

WATER 85

geri-dryl 206 209

geri-lanta 146

gianvi (28) 89

Gildagia 90

GILOTRIF 43

GLEEVEC 49

glenmax peb 204

glimepiride 136

glipizide 136



(Human) 135


185

glucose 135

glyburide 136


242


glycerin 105


GLYCERIN (BULK) 84



glycolax 155

glycopyrrolate 152



171 185



171 185

GOLYTELY 157

gonak 195 199

goniosoft 195 199

goniotaire 195 199

goniovisc 195 199


granisetron hcl 148



g-tron 222

guaifenesin 218

guanfacine 68 76


135

GVOKE PFS 1-PACK

SYRINGE 135

GYNOL II 99

H

Hailey 90

Hailey 24 Fe 90

Hailey Fe 1530 (28) 90

Hailey Fe 120 (28) 90


HAVRIX (PF) 53

HEALTHY ACCENTS

AUTOLET 171 185

HEALTHY ACCENTS


healthylax 155





150


150


150

Heather 95

hemorrhoidal 33



HEPAGAM B 54



nacl 164 165




164 165


165


HEPATAMINE 8 126

HEPLISAV-B (PF) 53

HERCEPTIN 52


HEXALEN 43

HIBERIX (PF) 57

HIBICLENS 52




homatropaire 197

homatropine hbr 197


spr 112


HUMALOG MIX 50-50

INSULN U-100 140


100)INSULN 140

243


141

HUMULIN 7030 U-100

INSULIN 139

HUMULIN N NPH U-100

INSULIN 140


100 INSULN 140


INSULIN 140


KWIKPEN 140

HYCAMTIN 50

hydralazine 69


HYDROCHLOROTHIAZIDE

(BULK) 70 83



24 25




107



203



107 108

hydrocream 107

hydromorphone 24

hydroskin 107




presv) 138 142

hydroxyprogesterone

cap(ppres) 138 142

hydroxyurea 46

hydroxyzine hcl 70



hyosyne 152 162

hypercare 104

HYPERHEP B 54

HYPERHEP B NEONATAL

54

HYPERLYTE CR 121

HYPERRAB (PF) 54

HYPERRAB SD (PF) 54

HYPER-SAL 84

HYPERTET SD (PF) 55


171 185

HYPROMELLOSE 85

HYPROMELLOSE (BULK)

83 85


I

ibandronate 137

IBRANCE 47

Ibu 31

ibu-drops 31

ibuprofen 31


Iclevia 90

ICLUSIG 48

icy hot 110


ICY HOT ADVANCED

RELIEF PATCH 111

ICY HOT NO MESS 111


111

ifosfamide 44

ifosfamide-mesna 44

imatinib 49

IMBRUVICA 46 49

imipramine hcl 75

imiquimod 108



(PF) 61

Incassia 95

IN-CHECK NASAL WITH

MASK 178 185

244

IN-CHECK ORAL FLOW

METER 178 185

INCONTROL LANCING

DEVICE 171 185


LANCETS 171 185


LANCETS 171 185

INCRUSE ELLIPTA 215

indapamide 70

indomethacin 31


infants advil 31



INFANTS MOTRIN 31


INFED 119

INJECT EASE LANCETS

171 185

INLYTA 49


140

insulin lispro 141

INTRALIPID 127

INTRAROSA 142

Introvale 90


185

inzo antifungal 103



IPOL 61



irbesartan 63

irbesartan-


IRESSA 43

irinotecan 50

iron 119

iron (dried) 119

ISENTRESS 37

Isibloom 90

ISOLYTE-P IN 5

DEXTROSE 118

ISOLYTE-S 121

isoniazid 37

isopto tears 195

ISORDIL 63



isradipine 67

itraconazole 36

ivermectin 35

IXIARO (PF) 60

J

Jaimiess 87

Jantoven 163

Jasmiel (28) 90

Jencycla 95

Jinteli 138


jolessa 90

jolivette 95

jr acetaminophen 27

Juleber 90

Junel 1530 (21) 90

Junel 120 (21) 90

Junel Fe 1530 (28) 90

Junel Fe 120 (28) 90

Junel Fe 24 91

junior mapap 27

K

K1-1000 135

KABIVEN 127

Kalliga 91

kaopectate (bismuth

subsalicy) 147


ss) 147

Kariva (28) 87

KATERZIA 67

KEDRAB (PF) 54

245

k-effervescent 122

Kelnor 135 (28) 91

Kelnor 1-50 (28) 91

ketoconazole 36 103

KETONE CARE 180 185


185

ketoprofen 31

ketorolac 198

KETOSTIX 180 185


KEYTRUDA 51


kids mini enema 159

KIDS VITAMIN D3 134

Kimidess (28) 87

KINRIX (PF) 56

Kionex 115


KISQALI 47

Klor-Con M10 122

Klor-Con M15 122

Klor-Con M20 122


konsyl (sugar) 153

KONSYL DAILY FIBER

(STEVIA) 153

KONSYL EASY MIX 154


KONSYL SUGAR-FREE

(ASPARTAME) 154

K-PHOS NO 2 161

K-PHOS ORIGINAL 161

Kurvelo (28) 91

L


87

labetalol 63


130

lactulose 149 155

LAMISIL AT 102

lamotrigine 73

LANCETS 171 185


185

LANCETSTHIN 171 186


186


LANCING DEVICE WITH

LANCETS 172 186


LANOXIN 68

lansoprazole 150


INSULIN 141



172 186

lapatinib 42

Larin 1530 (21) 91

Larin 120 (21) 91

Larin 24 Fe 91

Larin Fe 1530 (28) 91

Larin Fe 120 (28) 91

Larissia 91

latanoprost 202

laxacin 158

laxaclear 155




120


157




leena 28 96

leflunomide 30

lemon glycerin 194

LENVIMA 49

Lessina 91

letrozole 46

246


LEUKERAN 44


levetiracetam 73

levobunolol 199

levocarnitine 192


levofloxacin 39 201

Levonest (28) 96

levonorgestrel 98


91


96

Levora-28 91

levothyroxine 143




lice killing 111


lice solution 111

lice treatment 111


112

LIDO BDK 181

lido king 110

lidocaine 33 110





Lillow (28) 91

liothyronine 143

liquid antacid 146


117

lisinopril 62


62


186

LITE TOUCH LANCING

DEVICE 172 186

LITE TOUCH-MEDIUM

MASK 179 186


179 186

little noses 220

little remedies 220


27



LO LOESTRIN FE 87


LODRANE D 204

lohist - d 204

Lojaimiess 87

Lomedia 24 Fe 92

loperamide 146

lopreeza 138

loradamed 211 213

loratadine 211 213



Lorcet Hd 24 25

Lorcet Plus 25

Loryna (28) 92

losartan 63


63

lotrimin af 103

lovastatin 65




lubricant eye 195


194


194



109

247


lugols 52

LUPRON DEPOT 47 141

LUPRON DEPOT (3

MONTH) 47 141

LUPRON DEPOT (4

MONTH) 47

LUPRON DEPOT (6

MONTH) 47

Lutera (28) 92

Lyleq 95

LYNPARZA 49

LYSODREN 45

Lyza 95

M

maalox advanced 146

MAALOX ADVANCED 146

MAALOX MAXIMUM

STRENGTH 146

MAG-AL 144

mag-g 120

magnesium 120


MAGNESIUM CITRATE

(BULK) 155

MAGNESIUM HYDROXIDE

(BULK) 84


MAGNESIUM OXIDE 120


nacl 120


120


MAGOX 120

MAKENA 138 142

MAKENA (PF) 138 142




maprotiline 75

Marlissa (28) 92

Marten-Tab 28

masophen 27

MATULANE 43

MAVYRET 39

MAXIDEX 198

MAXIFED TR 204

maxilube 109

maxi-tuss pe 204

maxi-tuss tr 204

m-dryl 206 209

meclizine 147



medi-laxx 158

medi-meclizine 147

MEDISENSE THIN

LANCETS 172 186

MEDLANCE PLUS

LANCETS 172 186


megestrol 49 112

MEKINIST 48

Melodetta 24 Fe 92

meloxicam 30

melphalan 44

memantine 85

MENACTRA (PF) 57

MENOMUNE - ACYW-135

57

MENOMUNE - ACYW-135

(PF) 57

MENQUADFI (PF) 57


(PF) 58

MENVEO MENA

COMPONENT (PF) 58

MENVEO MENCYW-135

COMPNT (PF) 58

MEPHYTON 135

mercaptopurine 45

mesalamine 152

META APPETITE CTRL

(ASPARTAME) 154

METAMUCIL 154

248

METAMUCIL (WITH

SUGAR) 154

METAMUCIL FIBER

SINGLES 154


154

METAMUCIL FREE 154


metaproterenol 216

metformin 141

methadone 24


161


161

methimazole 137

methocarbamol 168

METHOCEL E 4 M 85




methyldopa 68





139

metipranolol 199


metolazone 70


metoprolol ta-

hydrochlorothiaz 68



225

mexiletine 64

mgo 120

mi-acid 146


151


hydr) 144

Mibelas 24 Fe 92

micatin 103

miconazole 7 224


miconazole-3 224

miconazole-3

prefilcreamwipe 224








micro-guard 103

MICROLET 2 LANCING

DEVICE 172 186

MICROLET LANCET 172

MICROLIFE PEAK FLOW

METER 178 186

MICROSPACER 179 186

midazolam 33 78


midodrine 68

migraine formula 32

Mili 92


milk of magnesia

concentrated 156

MILLIPRED 139


186


METER 178 186

Minitran 64

minocycline 29 42

minoxidil 69

mintox 146


mintox plus 146

MIRALAX 156

MIRENA 86

mirtazapine 73

misoprostol 151

249

mitomycin 51

M-M-R II (PF) 55 60 61 62

modafinil 80

MOISTURE DROPS 195

mometasone 107


224

MONISTAT 3 224

monistat 7 225

MONISTAT 7 225

MONOJECT 09 SODIUM

CHLORIDE 130

MONOJECT HYPODERMIC

NEEDLES 177 186

MONOJECT HYPODERMIC

POLYPROPYL 177 186

MONOJECT PREFILL

ADVANCED NS 130

MONOJECT PREFILL

SALINE FLUSH 130

MONOLET LANCETS 172

186


172 186

Mono-Linyah 92

mononessa (28) 92

montelukast 214

morphine 24

MORPHINE 24



148



148

MOUTHPIECE 179 186

moxifloxacin 201

mucilin sf 154


congest 218


mucus relief d

(pseudoephed) 217

mucus relief dm 222

mucus relief er 218



172 186



129

mupirocin 101


system 203

muro 128 199

Mutamycin 51

my choice 98

my way 98


167

MYGLUCOHEALTH

LANCETS 172 187

MYLERAN 43

mynephrocaps 113



151

Myzilra 96

N

NABI-HB 54

nabumetone 30

nadolol 66

NAPHCON-A 197

naproxen 31

naproxen sodium 31

naramin 206 209

NASACORT 219

nasal allergy 220

nasal and sinus

decongestant 223


nasal decongestant

(pseudoeph) 223

nasal decongest-

antihistamine 204

nasal mist 220

NASALCROM 220

NATACYN 201

natural calcium 116

250




NATURAL FIBER





nature-throid 142

NAVELBINE 50

NAYZILAM 71 78

NEBUPENT 41

nebusal 84

NEBUSAL 84

Necon 0535 (28) 92

necon 150 (28) 92

necon 1011 (28) 87

necon 777 (28) 96

nefazodone 74

neomycin 34


196


polymyxin 200


dexameth 196 197

neomycin-polymyxin-

gramicidin 200


202

Neo-Polycin 200

Neo-Polycin Hc 197


101


neo-tuss 222

nephplex rx 113

NEPHRAMINE 54 126

nephro-vite 113

nephro-vite rx 113

NEUTROGENA ON THE

SPOT 100

new day 98

NEXAVAR 48

NEXPLANON 86


niacin 65 132


NIACIN (INOSITOL

NIACINATE) 131


Niacor 65

NIAVASC 132

NIAVASC 750 132

NICODERM CQ 82

nicorelief 82

NICORETTE 82

nicotine 82

NICOTINE 83


nifedipine 67



81 209

nighttime sleep-aid

(doxylamn) 81

Nikki (28) 93

ninjacof-xg 222

NINLARO 49

NIPENT 45

Nitro-Bid 64



162


cryst 35 162

nitroglycerin 64

NIVESTYM 164

NIX CREME RINSE 112

NIZORAL A-D 103

non-aspirin 27




251



nora-be 95


95



estradiol 93 138


93


93 96

Norlyda 95

Norlyroc 95


NORMOSOL-M IN 5

DEXTROSE 118

NORMOSOL-R IN 5

DEXTROSE 118


nortemp 27

Nortrel 0535 (28) 93

nortrel 135 (21) 93

Nortrel 135 (28) 93

Nortrel 777 (28) 96

nortriptyline 75

NOVA SAFETY LANCETS

172 187

NOVA SUREFLEX

LANCETS 172 187

NOVOLIN 7030 U-100

INSULIN 140

NOVOLIN N NPH U-100

INSULIN 140


100 INSULN 140


INSULN 140

np thyroid 142

NUTRILIPID 127

Nyamyc 102

Nylia 777 (28) 96

Nymyo 93

nystatin 36 102 193



Nystop 102

nytol 81 206 209

O


ocean nasal 220

ocella 93

OCUSOFT IRRIGATING

OPHTH SOLN 200


ogestrel (28) 93

Okebo 42

olopatadine 198

OLUMIANT 29


omeprazole 150



172 187

ON CALL PLUS LANCET

172 187


DEVICE 172 187

ondansetron 148

ondansetron hcl 148

ONE WAY VALVED

MOUTHPIECE 179 187


DEVICE 172 187

ONETOUCH DELICA

LANCETS 172 187


LANC DEV 172 187


LANCET 172 187

ONETOUCH SURESOFT

LANCING DEV 173 187

ONETOUCH ULTRASOFT

LANCETS 173 187

ONETOUCH VERIO FLEX

START 173 187

ONETOUCH VERIO HIGH

CONTROL 173 187

ONETOUCH VERIO MID

CONTROL 173 187

252

ONETOUCH VERIO TEST

STRIPS 168 187


187

onxol 50

opcicon one-step 98

OPCON-A 197

OPDIVO 51

OPTICHAMBER ADULT

MASK-LARGE 179 187

OPTICHAMBER DIAMOND

LG MASK 179 187

OPTICHAMBER DIAMOND

VHC 179 187


MED MSK 180 188


SML MASK 180 188

option-2 98 99

Oralone 193

oralyte 121

ORASEP 193

Orsythia 93

oscimin 152 162

oscimin sl 152 162

oseltamivir 40

oxaliplatin 48

oxcarbazepine 73


oxycodone 24


25 26

OXYTROL 162


oysco 500d 117

oysco-500 116



oystercal-d 118

P

Pacerone 64

paclitaxel 50

pain relief 8hr 28


pain reliever

(acetaminophen) 28




110

pamprin max 32

PANCREAZE 149

PANDA MASK 180 188

panoxyl 100

panoxyl-4 100

pantoprazole 151

PARAGARD T 380A 86


paromomycin 34

paroxetine hcl 74

PARVA-CAL 500 118

p-col rite 158

PEAK AIR PEAK FLOW

METER 178 188


129

pedia tri-vite 128


PEDIA-LAX 156


PEDIARIX (PF) 53 56







128


180 188



129


180 188


253

pedi-boro soak 105

PEDVAX HIB (PF) 57


PEGANONE 72

PEGASYS 39

PEGASYS PROCLICK 39


PEGINTRON 39

penicillamine 29 34


PENTACEL (PF) 56 59

PENTACEL DTAP-IPV

COMPNT (PF) 56


pentoxifylline 164

peptic relief 147


peri-colace 158

periguard 109

PERIKABIVEN 127


Periogard 193

PERISHIELD 109

PERJETA 51

permethrin 112

persa-gel 100

PERSONAL BEST FULL

RANGE 178 188


pharbetol 28


PHAZYME 151


PHENAGIL 204

phenazopyridine 161



Phenytek 72

phenytoin 72


72

Philith 93

phillips 120


PHILLIPS MILK OF

MAGNESIA 145 156

PHOSLYRA 160




161


131



K1) 135

PIKO 1 178 188


Pimtrea (28) 87

pink bismuth 147


pin-x 35

PIN-X 35

pioglitazone 141

PIP LANCET 173 188

Pirmella 93 96

piroxicam 30

PLASMA-LYTE 148 121

PLASMA-LYTE A 121

PLENAMINE 126

PNEUMOVAX-23 58

POCKET CHAMBER 180

188

POCKET PEAK FLOW

METER 178 188

podofilox 108

Polycin 200


POLYETHYLENE GLYCOL

3350(BULK) 84


200

POLYSPORIN 101


101

254

POLYVINYL ALCOHOL

(BULK) 84 85

POLY-VI-SOL 128


129

poly-vita 128


poly-vitamin 128


Portia 28 93

PORTRAZZA 51


chloride 121


122


045nacl 122



09nacl 122


dex 122


122


122


nacl 122


02nacl 122


03nacl 122


09nacl 122



161


powderlax 156

pramipexole 76

prasugrel 166

pravastatin 65

prazosin 70

PRED MILD 198

prednicarbate 107



prednisolone sodium

phosphate 139 198

prednisone 139

PREDNISONE INTENSOL

139

pregabalin 72 79

PREMARIN 225

PREMASOL 10 126

PREMASOL 6 126

prenatal 129



129


107

PRESSURE ACTIVATED

LANCETS 173 188

PREVAIL BLADDER

CONTROL PAD 176 188

Prevalite 65

Previfem 93

PREVNAR 13 (PF) 58

PREZISTA 42

PRIFTIN 37 42

PRIMAQUINE 36

PRIMEAIRE 180 188

primidone 71

PRO COMFORT LANCET

173 188


probenecid 163


PROCHAMBER 180 188



148


Proctosol Hc 33 107

Proctozone-Hc 33

255

PRODIGY LANCETS 173

188

PRODIGY LANCING

DEVICE 173 188

PRODIGY TWIST TOP

LANCET 173 188



promethazine-dm 221


204


promolaxin 160

propafenone 64

propantheline 152

proparacaine 200

propranolol 66



62

PROSOL 20 126

protriptyline 75



217


psyllium husk 155

PSYLLIUM HUSK 155


154

PULMICORT FLEXHALER

214

PULMOSAL 84



173 188

PURE COMFORT SAFETY

LANCETS 173 188

PURECOMFORT PEAK

FLOW METER 178 188

purelax 156

PURIXAN 45

PUSH BUTTON SAFETY

LANCETS 173 189

pyrazinamide 37



pyrimethamine 36

Q

QBRELIS 62

q-dryl 206 207 209

QINLOCK 49

q-pap 28


QUADRACEL (PF) 57

Quasense 93

quinapril 63


quinine sulfate 36

QVAR 214

QVAR REDIHALER 214

R

RABAVERT (PF) 61

raloxifene 142

ramipril 63

ranitidine hcl 150

READYLANCE SAFETY

LANCETS 173 189

Reclipsen (28) 93


recort plus 108


refenesen 218



REFRESH OPTIVE 195



relcof c 223


RELIAMED LANCET 173

189


DEVICE 173 189

256


LANCETS 173 189


189


LANCETS 173 189


103

renal caps 113

renal vitamin 113

renal-vite 113

rena-vite 113

rena-vite rx 113

RENFLEXIS 28 153

reno caps 113

repaglinide 136

REPLESTA 134

RESPAIRE-30 218


restore tears 196

RETACRIT 164

retaine nacl 199

revive plus 196

RHOPRESSA 202

Ribasphere 40

ribavirin 40


112


RIDAURA 29

rifampin 37 42

ri-gel 146

RIGHTEST GD500

LANCING DEVICE 173

189

RIGHTEST GL300

LANCETS 173 189

riluzole 167

ri-mag 145

ri-mag plus 146

ri-mox 146

ri-mox plus 146

ringers 115 130

ritonavir 42

RITUXAN 46

RITUXAN HYCELA 46


rivelsa 95

rizatriptan 80

robafen 218

robafen ac 223



ropinirole 76

rosuvastatin 65

ROTARIX 55 61


RYBELSUS 137

RYDAPT 49

rynex pse 204

S


SAFETY SEAL LANCETS

174 189


189

saline mist 220

saline nasal 220

saline nose 220

sal-plant 108

SANTYL 105






SEGLUROMET 136

selegiline hcl 76

selenium 123


selenomax 123


selsun blue 104

SEMGLEE PEN U-100

INSULIN 141

257


141

senexon 158

senexon-s 158

senna 158

SENNA 158

senna-extra 158

sennalax-s 159


159

SENOKOT 158

SENOKOT EXTRA

STRENGTH 158

senokot-s 159

SEREVENT DISKUS 216

sertraline 74

Setlakin 94


Sharobel 95


SHINGRIX (PF) 61


FACE MASK 180 189

silace 160

siladryl sa 207 209

silapap 28

SILICONE MASK -

PEDIATRIC 180 189


siltussin sa 218

SILVASORB 112



151

SIMILAC STERILIZED

WATER 85

Simliya (28) 87

Simpesse 87


simvastatin 65

SINGLE-LET 174 189


223


81 209

sleep tablet


209

SLO-NIACIN 132



SMART SENSE LANCETS

174 189

SMARTDIABETES

VANTAGE 174 189

SMARTEST LANCET 174

189

smoflipid 127

smoothlax 156

sochlor 199





130


130





free) 115


115



DEVICE 174 189

SOFT TOUCH LANCETS

174 189

solifenacin 162


(PF) 139


189

SOLUS V2 LANCING

DEVICE 174 189

sominex 81 207 209

soothing care


sore throat 193

258


Sorine 64 66

sotalol 64 66

Sotalol Af 64 66


spironolacton-

hydrochlorothiaz 69

Sprintec (28) 94

SPRITAM 73

SPRYCEL 49


Sronyx 94

ssd 105

sski 118



STEGLATRO 136

STEGLUJAN 136




sterile saline 220


STIVARGA 48

stomach relief 147

stool softener 160



159

stop lice 112

stop smoking aid 83


strong iodine 118

sucralfate 160

SUDAFED 223

sudafed 12 hour 223

SUDAFED 24 HOUR 223

sudogest 223



201


99


197

sulfamethoxazole-

trimethoprim 35


sulfatrim 35

sulindac 30

sumatriptan 80



113

super calcium 116

super daily d3 134

SUPER DAILY D3 134


189

superplex-t 113

suphedrin 223



allergy 204


U-100 177 190


174 190


PEN 174 190


LANCETS 174 190

SUREFLEX LANCING

DEVICE 174 190

SURE-LANCE 174 190


174 190

SURE-PEN LANCING

DEVICE 174 190


190

surgilube 109


190

SUTENT 49

Syeda 94

SYLATRON 47

259

SYMJEPI 68

SYMLINPEN 120 137

SYMLINPEN 60 137

SYSTANE GEL 196

SYSTANE ULTRA 195

T

tab tussin 218

TABLOID 45

tacrolimus 167

tactinal 28


TAFINLAR 46

TAGRISSO 43

take action 98 99


TALTZ SYRINGE 101

tamoxifen 50

tamsulosin 161

TANZEUM 137

TARCEVA 43


100

Tarina 24 Fe 94

Tarina Fe 120 (28) 94

TASIGNA 50

Taztia Xt 67

TDVAX 57




190

TELCARE LANCETS 174

190

telmisartan 63

temazepam 78 82

TEMODAR 44

temozolomide 44

Tencon 28

teniposide 47

TENIVAC (PF) 57

terazosin 70


terconazole 225

TETANUSDIPHTHERIA

TOX PED(PF) 57

tetracycline 42


Theochron 215

theophylline 215

thera-d 134

THERA-D 4000 134

THERATEARS 196



thiotepa 43

Tiadylt Er 67

tiagabine 72

TICE BCG 48 55

tiger balm 110

TIGER BALM 110

TIGER BALM (WITH

CAPSICUM) 110

Tilia Fe 96


TINACTIN 103

tioconazole-1 225

TIVICAY 37

tizanidine 168

tl icon 120

TOBRADEX 197

tobramycin 201


197

TOBREX 201

TODAY CONTRACEPTIVE

SPONGE 99

tolcylen 103

tolnaftate 103

tolterodine 162 163

TOPCARE UNIVERSAL1

LANCET 174 190

topiramate 73

Toposar 47

260

topotecan 50

torsemide 69


209

TOVIAZ 163


tramadol 24


trandolapril 63

TRANSDERM-SCOP 147

TRAVASOL 10 126


trazodone 74

TRECATOR 37

TRELEGY ELLIPTA 217

tretinoin 100



Tri Femynor 96



193 220

triamterene-


tri-biozene 102


tricon 120

Triderm 108

Tri-Estarylla 96

trifluridine 202

Tri-Legest Fe 96

Tri-Linyah 96

Tri-Lo-Estarylla 96

Tri-Lo-Marzia 97

Tri-Lo-Mili 97

Tri-Lo-Sprintec 97


157

trimethoprim 35

Tri-Mili 97

trimipramine 75

trinessa (28) 97

trinessa lo 97

TRINTELLIX 75

Tri-Nymyo 97

triphrocaps 113


TRIPLE PASTE 109

triple paste af 103


TRISPEC DMX 222


TRITON X-100 85

TRI-VI-SOL 128

tri-vita 128

tri-vitamin 128


Trivora (28) 97

Tri-Vylibra 97

Tri-Vylibra Lo 97

TROPHAMINE 10 126

TROPHAMINE 6 127

tropicamide 197

trospium 163

TRUE COMFORT LANCET

174 190

TRUEDRAW LANCING

DEVICE 175 190


TRUEPLUS KETONE 190


190

TRULICITY 137

TRUMENBA 58

TRUVADA 37

TRUZONE PEAK FLOW

METER 178 190


Tulana 95

TUMS 145

TUMS EXTRA STRENGTH

SMOOTHIES 145

tums ultra 145


261


tussin cough-chest

congestion 222

tussin dm 222

tussin dm max 222

tussin pe 218

TWINRIX (PF) 52 53


tyblume 94

TYKERB 42

tylophen 28

U

ULTI-LANCE 175 190


175 190

ULTILET CLASSIC

LANCETS 175 190



175 191


191


81



175 191


191

ULTRA THIN PLUS

LANCETS 175 191


191

ULTRA-CARE LANCETS

175 191

ultracin m 111

ULTRALANCE LANCETS

175 191


175 191

UNILET COMFORTOUCH

LANCET 175 191

UNILET EXCELITE II

LANCET 175 191


175 191


191


UNILET SUPER THIN

LANCETS 175 191


81 209





UNISTIK 2 NORMAL

LANCETDEVICE 175

UNISTIK 3 176 191

UNISTIK 3 COMFORT

DEVICE 176 191

UNISTIK 3 COMFORT

LANCET 176 191


176 191



191

UNISTIK 3 NEONATAL

DEVICE 176 191

UNISTIK 3 NORMAL

LANCET 176 191


191


192



176 192

UNITHROID 143

UNIVERSAL 1 LANCETS

176 192

URO-MAG 120


ursodiol 149


V


FILM 99


262

vagistat-3 225

valacyclovir 40

valproic acid 71 79


71 79

valsartan 63


63

VALTOCO 71 78

valu-dryl 207 210



vancomycin 39

VANCOMYCIN 39


chl 39

vanicream hc 108

vanquish 32

VAQTA (PF) 53

VARIVAX (PF) 55 61


VELCADE 49


(28) 97

venlafaxine 74

verapamil 64 67

verticalm 148

VERZENIO 47

Vestura (28) 94


VICKS DAYQUIL MUCUS

CONTROL DM 222

Vienva 94

vinblastine 50

Vincasar Pfs 50

vinorelbine 50

Viorele (28) 87

virt-caps 113



vitamin a and d 105


109


vitamin b-1 131


vitamin b-6 132

vitamin d3 134

VITAMIN D3 134

vitamin e 134


vitamin e mixed 134



105


192

VIVAGUARD LANCING

DEVICE 176 192

vol-care rx 113

Volnea (28) 87


192

VORTEX FROG MASK-

CHILD 180 192

VORTEX HOLDING

CHAMBER 180 192


TODDLER 180 192

VORTEX VHC LADYBUG

MASK-TODDLR 180 192

VOTRIENT 50

vp-vite rx 113

Vyfemla (28) 94

Vylibra 94

W


wal-dram 2 148



wal-finate 205 210

wal-itin 211 213


wal-mucil fiber 155

263

WAL-MUCIL FIBER

(ASPARTAME) 155


wal-phed 223

wal-phed d 223

wal-profen 31

wal-sleep z 81 210


81


wal-sporin 101

wal-tap 204

wal-tussin 219


221


wal-zan 150 150

wal-zan 75 150



warfarin 163

wart remover 109

WATER (BULK) 84

weekly-d 134

Wera (28) 94

westhroid 142


Wixela Inhub 217

wp thyroid 143

Wymzya Fe 94

X

XALKORI 44

XARELTO 164


30D START 164

XATMEP 29 45

XERAC AC 104

XOFLUZA 40

XOLAIR 215

XTANDI 45

xulane 97

Y

YF-VAX (PF) 55

Yuvafem 225

Z

ZADITOR 198

Zafemy 97

zaleplon 82

ZANOSAR 51

ZANTAC 150

ZANTAC MAXIMUM

STRENGTH 150

Zarah 94

ZARXIO 164

zeasorb af 103

ZEJULA 49

Zenchent (28) 94

Zenchent Fe 94

ZENPEP 149

Zenzedi 77 79 81

zephrex-d 224

zidovudine 37

zinc oxide 109

zolpidem 82

zonisamide 73

ZOSTAVAX (PF) 55 62

zostrix 111

zostrix-hp 111

Zovia 135E (28) 94

Zovia 150E (28) 95

z-sleep 81 210

Zumandimine (28) 95

ZYDELIG 48

ZYKADIA 44

zyncof 222

ZYTIGA 43 45

Documents

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