Comprehensive Formulary Template 2017...4 You should contact us to ask us for an initial coverage decision for a formulary, copay lowering, or utilization restriction exception. When

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me d i c a r e R x(PDP)

This plan, Navitus MedicareRx (PDP), is offered by Navitus Health Solutions and underwritten by Dean Health Insurance, Inc., a Federally-Qualifi ed Medicare Contracting Prescription Drug Plan.

S9701_801_2017_SOM_FORM_V01Last Updated 10/17/2016

HPMS Formulary Submission ID 00017376 Version 5

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

This formulary was updated on 10/17/2016. For more recent information or other questions, please contact Navitus MedicareRx Customer Care at 1-866-270-3877 or, for TTY users, 711, available 24 hours a day, 7 days a week (except Thanksgiving and Christmas), or visit the member portal at https://medicarerx.navitus.com.

When this drug list (formulary) refers to “we,” “us”, or “our,” “plan,” or “our plan,” it means Navitus MedicareRx (PDP).

This document includes a list of the drugs (formulary) for our plan which is current as of 10/17/2016. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages.

You must generally use network pharmacies to use your prescription drug benefi t. Benefi ts, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 2018, and from time to time during the year.

NAVITUS MEDICARERX (PDP)LIST OF COVERED DRUGS

COMPREHENSIVE FORMULARY 2017State of Montana

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What is the Navitus MedicareRx (PDP) Formulary?

A formulary is a list of covered drugs selected by Navitus MedicareRx in consultation with a team of health

care providers, which represents the prescription therapies believed to be a necessary part of a quality

treatment program. Navitus MedicareRx will generally cover the drugs listed in our formulary as long as the

drug is medically necessary, the prescription is filled at a Navitus MedicareRx network pharmacy, and other

plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence

of Coverage.

Can the Formulary (drug list) change?

Generally, we will not discontinue or reduce coverage of a drug during the 2017 coverage year except when

a new, less expensive generic drug becomes available or when new adverse information about the safety or

effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our

formulary, will not affect members who are currently taking the drug. It will remain available at the same

cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that

you have continued access for the remainder of the coverage year to the formulary drugs that were available

when you chose our plan, except for cases in which you can save additional money or we can ensure your

safety.

If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy

restrictions on a drug, or move a drug to a higher cost-sharing tier, we must notify affected members of the

change at least 60 days before the change becomes effective, or at the time the member requests a refill of

the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug

Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug

from the market, we will immediately remove the drug from our formulary and provide notice to members

who take the drug. The enclosed formulary is current as of 10/17/2016. To get updated information about

the drugs covered by Navitus MedicareRx, please contact us. Our contact information appears on the front

and back cover pages.

In the event of CMS-approved non-maintenance changes to the formulary throughout the plan year,

Navitus MedicareRx (PDP) may make changes via errata sheets and through the Explanation of Benefits

(EOB) mailed to you monthly. Additionally, you may visit our website at https://medicarerx.navitus.com for

a link to the errata sheet.

How do I use the Formulary?

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

Medical Condition

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

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

condition are listed under the category, “Cardiovascular Agents”. If you know what your drug is used

for, look for the category name in the list that begins page 7. Then look under the category name for

your drug.

Alphabetical Listing

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

page 94. The Index provides an alphabetical list of all of the drugs included in this document. Both

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

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

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

What are generic drugs?

Navitus MedicareRx covers both brand name drugs and generic drugs. A generic drug is approved by the

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

than brand name drugs.

Are there any restrictions on my coverage?

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

may include:

Prior Authorization: Navitus MedicareRx requires you or your physician to get prior authorization

for certain drugs. This means that you will need to get approval from Navitus MedicareRx before

you fill your prescriptions. If you don’t get approval, Navitus MedicareRx may not cover the drug.

Quantity Limits: For certain drugs, Navitus MedicareRx limits the amount of the drug that Navitus

MedicareRx will cover. For example, Navitus MedicareRx provides 18 tablets per prescription for

Imitrex Tabs. This may be in addition to a standard one-month or three-month supply.

Step Therapy: In some cases, Navitus MedicareRx requires you to first try certain drugs to treat your

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

Drug B both treat your medical condition, Navitus MedicareRx may not cover Drug B unless you try

Drug A first. If Drug A does not work for you, Navitus MedicareRx will then cover Drug B.

Prior Authorization Restriction for New Starts Only (PA NSO): If you are a new member, you

(or your physician) are required to get prior authorization from Navitus Medicare Rx (PDP) before

you fill your prescription for this drug. Without prior approval, Navitus Medicare Rx (PDP) may not

cover this drug.

Prior Authorization Restriction for Part B vs Part D Determination (PA BvD): This drug may be

eligible for payment under Medicare Part B or Part D. You (or your physician) are required to get

prior authorization from Navitus Medicare Rx (PDP) to determine that this drug is covered under

Medicare Part D before you fill your prescription for this drug. Without prior approval, Navitus

Medicare Rx (PDP) may not cover this drug.

Non-Mail-Order Drug (NM): Drugs that are not available for an extended supply (greater than 34

day supply) through retail or Mail Order are noted with “NM” in the notes column of your

Formulary.

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

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

by visiting our Web site. We have posted on-line documents that explain our prior authorization and step

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

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

You can ask Navitus MedicareRx to make an exception to these restrictions or limits or for a list of other,

similar drugs that may treat your health condition. See the section, “How do I request an exception to the

Navitus MedicareRx formulary?” below for information about how to request an exception.

What are over-the counter (OTC) drugs?

OTC drugs are non-prescription drugs that are not normally covered by a Medicare Prescription Drug Plan.

Navitus MedicareRx pays for certain OTC drugs. The cost to Navitus MedicareRx of these OTC drugs will

not count toward your total Part D drug costs (that is, the amount you pay does not count for the coverage

gap.

What if my drug is not on the Formulary?

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

and ask if your drug is covered.

If you learn that Navitus MedicareRx does not cover your drug, you have two options:

You can ask Customer Care for a list of similar drugs that are covered by Navitus MedicareRx.

When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is

covered by Navitus MedicareRx.

You can ask Navitus MedicareRx to make an exception and cover your drug. See below for

information about how to request an exception.

How do I request an exception to the Navitus MedicareRx Formulary?

You can ask Navitus MedicareRx to make an exception to our coverage rules. There are several types of

exceptions that you can ask us to make.

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

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

at a lower cost-sharing tier.

You can ask us to cover a formulary drug at a lower cost-sharing tier. If approved, this would lower

the amount you must pay for your drug.

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

Navitus MedicareRx limits the amount of the drug that we will cover. If your drug has a quantity

limit, you can ask us to waive the limit and cover a greater amount.

Generally, Navitus MedicareRx will only approve your request for an exception if the alternative drugs

included on the plan’s formulary, or additional utilization restrictions would not be as effective in treating

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

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You should contact us to ask us for an initial coverage decision for a formulary, copay lowering, or

utilization restriction exception. When you request a formulary exception, copay lowering, or utilization

restriction exception you should submit a statement from your prescriber or physician supporting

your request. Generally, we must make our decision within 72 hours of getting your prescriber’s supporting

statement. You can request an expedited (fast) exception if you or your doctor believe that your health could

be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must

give you a decision no later than 24 hours after we get a supporting statement from your doctor or other

prescriber.

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

exception?

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

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

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

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

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

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

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

cover a temporary 34-day supply (unless you have a prescription written for fewer days) when you go to a

network pharmacy. After your first 34-day supply, we will not pay for these drugs, even if you have been a

member of the plan less than 90 days.

If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have

provided you with up to a 98-day transition supply, consistent with dispensing increment, (unless you have a

prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days

you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your

drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day

emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary

exception.

Level of Care Changes

Navitus’ level of care transition process accounts for unplanned changes for members. In some instances,

these changes may result in the prescribed drug regimen(s) not being available on our formulary. These

instances usually occur when a member moves from one treatment setting to another. This could include

members who:

• Enter long-term care (LTC) facilities with a discharge list of medications from the hospital with very

short-term planning taken into account (e.g., less than 8 hours)

• Are discharged from a hospital to a home with very short-term planning taken into account

• End their skilled nursing facility Medicare Part A stay (where payments include all pharmacy charges)

and who need to go back to their Part D plan formulary

• Give up hospice status to revert to standard Medicare Part A and Part B benefits

• End an LTC facility stay and return to their home

• Are discharged from psychiatric hospitals with drug regimens that are highly tailored to them.

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These changes often result in members and/or prescribers using Navitus’ exceptions and/or appeals

processes. For these types of changes, we will make coverage determinations and re-determinations as

quickly as the member’s health requires.

Navitus ensures proper medication continuance for members upon discharge from an LTC facility or other

facilities to ensure an effective transition of care. This may include:

• A refill upon entrance to, or discharge from, an LTC facility. The current standard of care promotes

caregivers receiving outpatient Part D prescriptions before discharge from a Part A stay. Members,

through no fault of their own, may not have access to the balance of their prescription.

• Navitus allows the member to access a refill upon entrance to, or discharge from, an LTC facility.

To process these transition refills, the pharmacy may need to call Navitus MedicareRx Customer Care

(phone numbers are on the back cover of this booklet). Navitus MedicareRx Customer Care can help the

pharmacy process an override.

For more information

For more detailed information about your Navitus MedicareRx prescription drug coverage, please review

your Evidence of Coverage and other plan materials.

If you have questions about Navitus MedicareRx, please contact us. Our contact information, along with the

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

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

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

visit http://www.medicare.gov.

Navitus MedicareRx Formulary

The formulary that begins on page 7 provides coverage information about the drugs covered by Navitus

MedicareRx. If you have trouble finding your drug in the list, turn to the Index that begins on page 94.

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

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

The second column of the chart lists the Drug Tier. You can reference the Summary of Benefits booklet or

Chapter 4 (Section 5.2) in the Evidence of Coverage booklet to learn what your copay or coinsurance will be.

Tier 1 includes preferred generics and some lower cost brand products

Tier 2 includes preferred brand products and some high cost non-preferred generics

Tier 3 includes non-preferred products (may include some high cost non-preferred generics)

Tier 4 includes specialty drugs

Tier $0 includes certain preventative medications

If you are taking a Tier 3 covered brand name drug that has a covered generic equivalent available, in

addition to your brand coinsurance, you will be responsible for the difference between the brand drug

cost and the generic equivalent drug cost. See examples on the next page.

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Example 1: If a Tier 3 brand name drug is $550, and the available generic equivalent cost is $520,

you would pay your coinsurance (Tier 3 brand 50% coinsurance) plus the difference between the cost

of the brand drug and generic drug.

$550 x 50% = $275 (Tier 3 Coinsurance)

$550 - $520 = $30 (Difference between Brand cost and Generic cost)

Final Cost = $305 ($275 + $30)

Example 2: If your Tier 3 brand coinsurance plus the difference in cost between a Tier 3 brand name

drug and the available generic equivalent is higher than the cost of the brand drug, you will only be

responsible for the cost of the brand drug. For example, if a Tier 3 brand name drug is $250, and the

available generic equivalent is $50, you would not be responsible for more than the cost of the brand

name drug.

$250 x 50% = $125 (Tier 3 Coinsurance)

$250 - $50 = $200 (Difference between Brand cost and Generic cost)

$125 + $200 = $325 (Coinsurance plus Difference)

Final cost = $250 (You will not pay more than the cost of the brand name drug)

Please contact Customer Care if you have questions or unsure if your covered brand name drug has a

covered generic equivalent available.

The information in the Requirements/Limits column tells you if Navitus MedicareRx has any special

requirements for coverage of your drug.

The symbol PA in the Notes column indicates that prior authorization may apply.

The symbol PA BvD in the Notes column indicates that prior authorization may apply for

medications that could be eligible for payment under either Medicare Part B or Part D.

The symbol PA NSO in the Notes column indicates that prior authorization may apply on certain

medications for new members of the plan.

The symbol QL in the Notes column indicates that quantities dispensed may be limited.

The symbol ST in the Notes column indicates that step therapy may apply.

The symbol NM in the Notes column indicates that the drug is not available via your mail-order

benefit.

The symbols LSP & SP in the Notes column indicate that the drug is a specialty product and

qualifies for a lower rate when filled through the Preferred Specialty Pharmacy (more detail can be

found in Chapter 4, Section 5.2 of your Evidence of Coverage booklet).

The * symbol after the tier indicates that the drug is covered by the plan’s supplemental wrap coverage only.

Payments for these drugs do not count toward your Medicare Part D “out-of-pocket costs” or your “total

drug costs” because they are for drugs that are not generally covered by Medicare. In addition, if you are

receiving extra help to pay for your prescriptions through a program like Low Income Subsidy (LIS), you

will not get any extra help to pay for this drug.

DRUG NAME DRUG TIER REQUIREMENTS/LIMITS

ADHD/ ANTI-NARCOLEPSY/ ANTI-OBESITY/ ANOREXIANTSAMPHETAMINES

3*ADDERALL TAB 10MG, 12.5MG, 15MG, 30MG

3ADDERALL TAB 5MG, 7.5MG, 20MG

2ADDERALL XR CAP

2amphetamine/ dextroamphetamine ER cap

1amphetamine/ dextroamphetamine tab

3DESOXYN TAB PA

3DEXEDRINE CAP

2dextroamphetamine ER cap

2dextroamphetamine soln

1dextroamphetamine tab

1METAPROTERENOL SYRUP

1methamphetamine tab PA

3PROCENTRA SOLN

2VYVANSE CAPATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD) AGENTS

1guanfacine ER tab

3INTUNIV TAB

3STRATTERA CAP QL=60 Quantity/30 DaysSTIMULANTS - MISC.

2armodafinil tab PA QL=30 Quantity/30 Days

3CONCERTA TAB

3DAYTRANA PATCH

2dexmethylphenidate ER cap

2dexmethylphenidate tab

3FOCALIN TAB

3FOCALIN XR CAP

3METADATE CD CAP

3*METHYLIN CHEW TAB

2METHYLIN SOLN

2methylphenidate CD cap

2methylphenidate chew tab

2methylphenidate ER cap

1methylphenidate ER tab 10mg, 20mg

2METHYLPHENIDATE ER TAB 18MG, 27MG, 36MG, 54MG

2methylphenidate soln

1methylphenidate tab

2modafinil tab PA QL=60 Quantity/30 Days

3*NUVIGIL TAB 50MG, 150MG, 250MG PA QL=30 Quantity/30 Days

3NUVIGIL/ ARMODAFINIL TAB 200MG PA QL=30 Quantity/30 Days

3PROVIGIL TAB PA QL=60 Quantity/30 Days

3RITALIN LA CAP

3RITALIN TAB

AMEBICIDES

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

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AMEBICIDES

3*YODOXIN TAB

AMINOGLYCOSIDESAMINOGLYCOSIDES

2amikacin sulfate inj

2gentamicin inj

2gentamicin/ nacl inj

2GENTAMICIN/ NACL INJ 0.9MG/ ML, 1.4MG/ ML

1neomycin tab

2paromomycin cap

3STREPTOMYCIN INJ

4TOBI NEB SOLN LSP NM PA

4TOBI PODHALER NM PA SP

2TOBRAMYCIN INJ

2tobramycin inj

4tobramycin neb soln LSP NM PA

ANALGESICS - ANTI-INFLAMMATORYANTIRHEUMATIC - ENZYME INHIBITORS

4XELJANZ ER TAB 11MG LSP NM PA QL=30 Quantity/30 Days

4XELJANZ TAB LSP NM PA QL=60 Quantity/30 DaysANTIRHEUMATIC ANTIMETABOLITES

3RHEUMATREX TABANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES

4HUMIRA INJ LSP NM PA

4HUMIRA PEN INJ LSP NM PA

4SIMPONI ARIA INJ NM PA SP

4SIMPONI INJ LSP NM PAGOLD COMPOUNDS

2RIDAURA CAPINTERLEUKIN-1 BLOCKERS

4ARCALYST INJ NM PAINTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA)

4KINERET INJ NM PAINTERLEUKIN-1BETA BLOCKERS

4ILARIS INJ NM PANONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)

3ANAPROX DS TAB 550MG

3*ANAPROX TAB

3ARTHROTEC TAB

3CELEBREX CAP QL=60 Quantity/30 Days

2celecoxib cap QL=60 Quantity/30 Days

3DAYPRO TAB

1diclofenac DR tab

1diclofenac potassium tab

1diclofenac SR tab

2diclofenac/ misoprostol tab


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3EC-NAPROSYN TAB

1etodolac cap

2etodolac ER tab

1etodolac tab

3FELDENE CAP

3FENOPROFEN CAP

2fenoprofen tab

1flurbiprofen tab

1ibuprofen susp (rx only)

1ibuprofen tab (rx only)

2INDOCIN SUPP

2INDOCIN SUSP

1indomethacin cap

1indomethacin ER cap

1ketoprofen cap

3KETOPROFEN ER CAP

2ketorolac inj

1ketorolac tab QL=20 Quantity/5 Days

1MECLOFENAMATE CAP

2mefenamic acid cap

1meloxicam tab

3MOBIC SUSP

3MOBIC TAB

3*MOTRIN SUSP (OTC)

3MOTRIN SUSP (RX)

1nabumetone tab

3*NAPROSYN SUSP

3*NAPROSYN TAB 250MG, 375MG

3NAPROSYN TAB 500MG

1naproxen EC tab

1naproxen sodium tab

3NAPROXEN SR TAB 750MG

1*naproxen susp

2NAPROXEN SUSP 125MG/ 5ML

1naproxen tab

2oxaprozin tab

2piroxicam cap

3PONSTEL CAP

1sulindac tab

2tolmetin sodium cap

2TOLMETIN SODIUM TAB

3*VOLTAREN XR TABPYRIMIDINE SYNTHESIS INHIBITORS

3ARAVA TAB

1leflunomide tabSELECTIVE COSTIMULATION MODULATORS


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4ORENCIA INJ NM PA

4ORENCIA SC INJ LSP NM PASOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS

4ENBREL INJ LSP NM PA

4ENBREL SURECLICK INJ LSP NM PA

ANALGESICS - NONNARCOTICSALICYLATES

$0*aspirin chew tab 81mg

$0*aspirin EC tab 81mg, 325mg

$0*ASPIRIN TAB 81MG

$0*aspirin tab 81mg, 325mg

1*CHOLINE MAGNESIUM TRISALICYLATE TAB 1000MG

1*choline magnesium trisalicylate tab 500mg, 750mg

1diflunisal tab 500mg

1*salsalate tab

ANALGESICS - OPIOIDOPIOID AGONISTS

3ABSTRAL TAB PA QL=120 Quantity/30 Days

3ACTIQ LOZENGE PA QL=120 Quantity/30 Days

1codeine sulfate tab QL=240 Quantity/30 Days

3DEMEROL INJ PA

3DEMEROL TAB 100MG QL=360 Quantity/30 Days

3DEMEROL TAB 50MG QL=720 Quantity/30 Days

3DILAUDID PF INJ

3DILAUDID TAB 2MG QL=450 Quantity/30 Days



3DILAUDID-5 LIQUID QL=2400 Quantity/30 Days

3DOLOPHINE TAB QL=360 Quantity/30 Days

3DURAGESIC PATCH QL=10 Quantity/30 Days

3EMBEDA CAP QL=60 Quantity/30 Days

3EXALGO TAB QL=60 Quantity/30 Days

2fentanyl lozenge PA QL=120 Quantity/30 Days

2fentanyl patch QL=10 Quantity/30 Days

3FENTORA TAB PA QL=120 Quantity/30 Days

2hydromorphone ER tab QL=60 Quantity/30 Days

2hydromorphone inj 2mg/ ml

2hydromorphone liquid QL=2400 Quantity/30 Days

2hydromorphone PF inj

1*HYDROMORPHONE SUPP

1hydromorphone tab 2mg QL=450 Quantity/30 Days



2HYSINGLA ER TAB QL=30 Quantity/30 Days

3KADIAN CAP QL=60 Quantity/30 Days


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3LAZANDA NASAL SPRAY PA QL=30 Quantity/30 Days

2LEVORPHANOL TAB QL=240 Quantity/30 Days

2meperidine inj PA

3MEPERIDINE ORAL SOLN

1meperidine tab 100mg QL=360 Quantity/30 Days

1meperidine tab 50mg QL=720 Quantity/30 Days

1methadone conc

3METHADONE INJ

3*METHADONE INTENSOL CONC

1methadone oral soln 10mg/ 5ml QL=1800 Quantity/30 Days

1METHADONE ORAL SOLN 10MG/ 5ML QL=1800 Quantity/30 Days

1METHADONE ORAL SOLN 5MG/ 5ML QL=3600 Quantity/30 Days

1methadone oral soln 5mg/ 5ml QL=3600 Quantity/30 Days

1methadone tab QL=360 Quantity/30 Days

1*methadose tab

3MORPHINE SULFATE ER BEAD CAP QL=60 Quantity/30 Days

2morphine sulfate ER cap QL=60 Quantity/30 Days

1morphine sulfate ER tab QL=120 Quantity/30 Days

2morphine sulfate inj PA_BvD

3MORPHINE SULFATE INJ PA_BvD

2MORPHINE SULFATE INJ 10MG/ ML, 15MG/ ML PA_BvD

3morphine sulfate inj PF 4mg/ ml, 8mg/ ml, 10mg/ ml PA_BvD

1morphine sulfate soln 10mg/ 5ml QL=1800 Quantity/30 Days

1morphine sulfate soln 20mg/ 5ml QL=900 Quantity/30 Days

1morphine sulfate soln 20mg/ ml QL=180 Quantity/30 Days

1morphine sulfate tab QL=180 Quantity/30 Days

3MS CONTIN TAB QL=120 Quantity/30 Days

2NUCYNTA ER TAB QL=60 Quantity/30 Days

3NUCYNTA TAB 50MG QL=360 Quantity/30 Days

3NUCYNTA TAB 75MG, 100MG QL=180 Quantity/30 Days

3OPANA ER TAB (CRUSH RESISTANT) QL=60 Quantity/30 Days

3OPANA TAB QL=360 Quantity/30 Days

1oxycodone cap QL=360 Quantity/30 Days

2oxycodone oral soln 20mg/ ml QL=270 Quantity/30 Days

2oxycodone oral soln 5mg/ 5ml QL=5400 Quantity/30 Days

1oxycodone tab 10mg, 15mg, 20mg, 30mg QL=180 Quantity/30 Days

1oxycodone tab 5mg QL=360 Quantity/30 Days

1oxycodone/ acetaminophen tab QL=360 Quantity/30 Days

2OXYCONTIN CR TAB QL=60 Quantity/30 Days

2OXYCONTIN CR TAB 80MG QL=120 Quantity/30 Days

2oxymorphone ER tab QL=60 Quantity/30 Days

2oxymorphone tab QL=360 Quantity/30 Days

3ROBINUL INJ PA_BvD

3ROXICODONE TAB 15MG, 30MG QL=180 Quantity/30 Days

3ROXICODONE TAB 5MG QL=360 Quantity/30 Days

2tramadol ER tab QL=60 Quantity/30 Days


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1tramadol tab QL=240 Quantity/30 Days

3ULTRAM ER TAB QL=60 Quantity/30 Days

3ULTRAM TAB QL=240 Quantity/30 DaysOPIOID COMBINATIONS

1acetaminophen/ codeine soln QL=4980 Quantity/30 Days

1acetaminophen/ codeine tab QL=390 Quantity/30 Days

3CAPITAL/ CODEINE SUSP QL=4980 Quantity/30 Days

3DIHYDROCODEINE/ ASPIRIN/ CAFFEINE CAP QL=330 Quantity/30 Days

3HYCET SOLN QL=5400 Quantity/30 Days

1hydrocodone/ acetaminophen soln QL=5400 Quantity/30 Days

2hydrocodone/ acetaminophen tab 2.5-325mg QL=360 Quantity/30 Days

2hydrocodone/ acetaminophen tab 5-300mg, 7.5-300mg, 10-300mg

QL=390 Quantity/30 Days

1hydrocodone/ acetaminophen tab 5-325mg, 7.5-325mg, 10-325mg

QL=360 Quantity/30 Days

2hydrocodone/ ibuprofen tab QL=480 Quantity/30 Days

3IBUDONE TAB QL=480 Quantity/30 Days

3*LORTAB ELIXIR

3NORCO TAB QL=360 Quantity/30 Days

2OXYCODONE/ ACETAMINOPHEN SOLN QL=1800 Quantity/30 Days

1oxycodone/ acetaminophen tab QL=360 Quantity/30 Days

1oxycodone/ aspirin tab QL=360 Quantity/30 Days

2oxycodone/ ibuprofen tab QL=240 Quantity/30 Days

2OXYCODONE/ IBUPROFEN TAB 5-400MG QL=240 Quantity/30 Days

3PERCOCET TAB QL=360 Quantity/30 Days

3*PERCODAN TAB

3PRIMLEV TAB QL=390 Quantity/30 Days

3REPREXAIN TAB QL=480 Quantity/30 Days

3ROXICET SOLN QL=1800 Quantity/30 Days

2tramadol/ acetaminophen tab QL=360 Quantity/30 Days

3*TREZIX CAP

3TYLENOL/ CODEINE TAB QL=390 Quantity/30 Days

3ULTRACET TAB QL=360 Quantity/30 Days

3*VICOPROFEN TAB

3XODOL TAB QL=390 Quantity/30 Days

3ZAMICET SOLN QL=5400 Quantity/30 DaysOPIOID PARTIAL AGONISTS

3BUPRENEX INJ

2buprenorphine inj

2buprenorphine SL tab

2buprenorphine/ naloxone SL tab QL=90 Quantity/30 Days

2butorphanol inj

2butorphanol nasal spray QL=4 Quantity/30 Days

3BUTRANS PATCH QL=4 Quantity/28 Days

2pentazocine/ naloxone tab QL=360 Quantity/30 Days

2SUBOXONE FILM 12-3MG QL=60 Quantity/30 Days


12


2SUBOXONE FILM 2-0.5MG, 4-1MG, 8-2MG QL=90 Quantity/30 Days

ANDROGENS-ANABOLICANABOLIC STEROIDS

3ANADROL TAB

3*OXANDRIN TAB

1oxandrolone tabANDROGENS

2ANDRODERM PATCH 2MG PA QL=60 Quantity/30 Days

2ANDRODERM PATCH 4MG PA QL=30 Quantity/30 Days

2ANDROGEL 1% (25MG) PA QL=30 Quantity/30 Days

2ANDROGEL 1% (50MG) PA QL=60 Quantity/30 Days

2ANDROGEL 1.62% (1.25GM) PA QL=30 Quantity/30 Days

2ANDROGEL 1.62% (2.5GM) PA QL=60 Quantity/30 Days

2ANDROGEL 50MG PA QL=60 Quantity/30 Days

3ANDROGEL PUMP 1% PA QL=4 Quantity/30 Days

2ANDROGEL PUMP 1.62% PA QL=2 Quantity/30 Days

3*ANDROID/ TESTRED CAP PA

3AXIRON SOLN PA QL=2 Quantity/30 Days

2danazol cap

3DEPO-TESTOSTERONE INJ

3FORTESTA GEL/ TESTOSTERONE GEL PUMP PA QL=2 Quantity/30 Days

3METHITEST TAB PA

2methyltestosterone cap 10mg PA

1testosterone cypionate inj

2testosterone enanthate inj

3TESTOSTERONE GEL 1% PA QL=120 Quantity/30 Days

2testosterone gel 1% (25mg) PA QL=30 Quantity/30 Days

2testosterone gel 50mg PA QL=60 Quantity/30 Days

3TESTOSTERONE GEL PUMP 1% PA QL=4 Quantity/30 Days

3TESTOSTERONE GEL/ TESTIM GEL 1% PA QL=60 Quantity/30 Days

2testosterone pump 1% PA QL=4 Quantity/30 Days

3VOGELXO GEL PUMP 1% PA QL=4 Quantity/30 Days

ANORECTAL AGENTSINTRARECTAL STEROIDS

3*CORTENEMA ENEMA

3*CORTIFOAM

2hydrocortisone enema

3UCERIS RECTAL FOAM PARECTAL COMBINATIONS

3*ANALPRAM-E KIT

3*ANALPRAM-HC CREAM

1*hydrocortisone pramoxine cream

2*lidocaine/ hydrocortisone creamRECTAL STEROIDS

3ANUSOL-HC CREAM

3*ANUSOL-HC SUPP


13


1*hydrocortisone supp

1procto-pak cream

3*PROCTOCORT CREAM

1proctocream-HC 2.5%

ANTHELMINTICSANTHELMINTICS

4ALBENZA TAB NM

2BILTRICIDE TAB

4EMVERM CHEW TAB NM

2ivermectin tab

3STROMECTOL TAB

ANTIANGINAL AGENTSANTIANGINALS-OTHER

2RANEXA TABNITRATES

3DILATRATE SR CAP

3*IMDUR ER TAB

1isoditrate ER tab

3ISORDIL TAB

1ISOSORBIDE DINITRATE ER TAB

1isosorbide dinitrate tab

1isosorbide mononitrate ER tab

1isosorbide mononitrate tab

3NITRO-BID OINT

3NITRO-DUR PATCH 0.1MG, 0.2MG, 0.4MG, 0.6MG

2NITRO-DUR PATCH 0.3MG, 0.8MG

1*nitroglycerin cap

2nitroglycerin lingual spray

1nitroglycerin patch

2nitroglycerin sl tab

3NITROLINGUAL PUMP SPRAY

3NITROMIST AEROSOL

2NITROSTAT SL TAB

ANTIANXIETY AGENTSANTIANXIETY AGENTS - MISC.

3*BUSPAR TAB

1buspirone tab 5mg, 10mg, 15mg

1*buspirone tab 7.5mg

2HYDROXYZINE IM SOLN

2hydroxyzine inj

1HYDROXYZINE PAMOATE CAP 100MG

1hydroxyzine pamoate cap 25mg, 50mg

1hydroxyzine syrup

1hydroxyzine tab

1meprobamate tab

3VISTARIL CAP


14


BENZODIAZEPINES

2alprazolam ER tab

3ALPRAZOLAM INTENSOL CONC

2alprazolam ODT

1alprazolam tab

3ATIVAN TAB

1chlordiazepoxide cap

1clorazepate dipotassium tab

1diazepam intensol conc

1DIAZEPAM SOLN

1diazepam tab

1lorazepam intensol conc

1lorazepam tab

3*NIRAVAM TAB

1oxazepam cap

3*TRANXENE T TAB 15MG

3TRANXENE T TAB 3.75MG, 7.5MG

3VALIUM TAB

3XANAX TAB

3XANAX XR TAB

ANTIARRHYTHMICSANTIARRHYTHMICS TYPE I-A

1disopyramide cap

3NORPACE CAP

2NORPACE CR CAP

2PROCAINAMIDE INJ

2quinidine gluconate CR tab

2QUINIDINE GLUCONATE INJ

3QUINIDINE SULFATE ER TAB

1QUINIDINE SULFATE TABANTIARRHYTHMICS TYPE I-B

2mexiletine capANTIARRHYTHMICS TYPE I-C

2flecainide tab

2propafenone ER cap

1propafenone tab

3RYTHMOL SR CAP

3RYTHMOL TABANTIARRHYTHMICS TYPE III

2AMIODARONE HCL IN DEXTROSE 5% IV SOLN

2amiodarone inj 50mg/ ml

1amiodarone tab

3*CORDARONE TAB

2dofetilide cap

2MULTAQ TAB

2NEXTERONE INJ


15


2TIKOSYN CAP

ANTIASTHMATIC AND BRONCHODILATOR AGENTSANTIASTHMATIC - MONOCLONAL ANTIBODIES

4NUCALA INJ NM PA

4XOLAIR INJ LSP NM PAANTI-INFLAMMATORY AGENTS

2CROMOLYN NEB SOLN PA_BvDBRONCHODILATORS - ANTICHOLINERGICS

2ATROVENT HFA INHALER

2INCRUSE ELLIPTA INHALER

1ipratropium neb PA_BvD

2SPIRIVA HANDIHALER

2SPIRIVA RESPIMAT INHALERLEUKOTRIENE MODULATORS

3ACCOLATE TAB

1montelukast chew tab

2montelukast granules

1montelukast tab

3SINGULAIR CHEW TAB

3SINGULAIR GRANULES

3SINGULAIR TAB

2zafirlukast tab

3ZYFLO CR TAB

3ZYFLO TABSELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS

3DALIRESP TABSTEROID INHALANTS

1ARNUITY ELLIPTA INHALER QL=1 Quantity/30 Days

1ASMANEX HFA INHALER QL=1 Quantity/30 Days

1ASMANEX INHALER QL=1 Quantity/30 Days

1budesonide neb PA_BvD QL=60 Quantity/30 Days

1FLOVENT DISKUS QL=1 Quantity/30 Days

1FLOVENT HFA INHALER QL=2 Quantity/30 Days

3PULMICORT NEB SUSP PA_BvD QL=60 Quantity/30 DaysSYMPATHOMIMETICS

2ADVAIR DISKUS QL=1 Quantity/30 Days

2ADVAIR HFA INHALER QL=1 Quantity/30 Days

1albuterol ER tab

1albuterol neb 0.083%, 0.5% PA_BvD

2albuterol neb 0.63mg/ 3ml, 1.25mg/ 3ml PA_BvD

1albuterol syrup

1albuterol tab

2BREO ELLIPTA INHALER QL=1 Quantity/30 Days

3BROVANA NEB SOLN PA_BvD

2COMBIVENT RESPIMAT

2DULERA INHALER QL=1 Quantity/30 Days


16


2FORADIL AEROLIZE CAP

1ipratropium/ albuterol neb PA_BvD

2levalbuterol neb PA_BvD

3LEVALBUTEROL/ XOPENEX HFA INHALER ST QL=4 Quantity/30 Days

3METAPROTERENOL TAB

3PERFOROMIST NEB PA_BvD

2SEREVENT DISK

2STIOLTO INHALER

2terbutaline sulfate inj

1terbutaline tab

2VENTOLIN HFA INHALER 18GM QL=4 Quantity/30 Days

2VENTOLIN HFA INHALER 8GM QL=9 Quantity/30 Days

3VOSPIRE ER TAB

3XOPENEX NEB 0.31MG/ 3ML, 0.63MG/ 3ML, 1.25MG/ 3ML

PA_BvD

3*XOPENEX NEB CONCXANTHINES

2aminophylline inj

2ELIXOPHYLLINE ELIXIR

3*LUFYLLIN TAB

3THEO-24 CR CAP

1theophylline ER tab

1theophylline soln

1theophylline SR tab

ANTICOAGULANTSCOUMARIN ANTICOAGULANTS

3COUMADIN TAB

1warfarin tabDIRECT FACTOR XA INHIBITORS

2ELIQUIS TAB

2XARELTO TAB

2XARELTO TAB STARTER PACKHEPARINS AND HEPARINOID-LIKE AGENTS

3ARIXTRA SOLN 2.5MG/ 0.5ML PA

4ARIXTRA SOLN 5MG/ 0.4ML, 7.5MG/ 0.6ML, 10MG/ 0.8ML

NM PA

2enoxaparin inj QL=34 Quantity/17 Days

2fondaparinux soln 2.5mg/ 0.5ml PA

4fondaparinux soln 5mg/ 0.4ml, 7.5mg/ 0.6ml, 10mg/ 0.8ml

NM PA

3FRAGMIN INJ

4FRAGMIN INJ 95000UNIT NM

2heparin sodium inj PA_BvD

2HEPARIN SODIUM INJ 2000UNIT/ ML, 2500UNIT/ ML

PA_BvD

2heparin sodium/ d5w inj PA_BvD


17


2HEPARIN SODIUM/ NACL INJ PA_BvD

2heparin sodium/ nacl inj PA_BvD

2HEPARIN/ D5W INJ PA_BvD

3LOVENOX INJ QL=34 Quantity/17 DaysTHROMBIN INHIBITORS

2ARGATROBAN IN SODIUM CHLORIDE IV SOLN

2argatroban inj

2PRADAXA CAP

ANTICONVULSANTSAMPA GLUTAMATE RECEPTOR ANTAGONISTS

3FYCOMPA SUSP PA_NSO

3FYCOMPA TAB PA_NSOANTICONVULSANTS - BENZODIAZEPINES

2clonazepam ODT

1clonazepam tab

3DIAZEPAM RECTAL GEL

3KLONOPIN TAB

2ONFI SUSP PA_NSO

2ONFI TAB PA_NSOANTICONVULSANTS - MISC.

3APTIOM TAB PA_NSO

2BANZEL SUSP

2BANZEL TAB

3BRIVIACT INJ PA_NSO

3BRIVIACT SOLN PA_NSO

3BRIVIACT TAB PA_NSO QL=60 Quantity/30 Days

1carbamazepine chew tab

2carbamazepine ER tab

2carbamazepine SR cap

1carbamazepine susp

1carbamazepine tab

3CARBATROL SR CAP

1gabapentin cap

2gabapentin soln

1gabapentin tab

3KEPPRA ORAL SOLN

3KEPPRA TAB

3KEPPRA XR TAB

3LAMICTAL CHEW TAB

3LAMICTAL ODT

3*LAMICTAL ODT KIT

3LAMICTAL STARTER KIT

3LAMICTAL TAB

3LAMICTAL XR KIT

3LAMICTAL XR TAB

1lamotrigine chew tab


18


2lamotrigine ER tab

2lamotrigine ODT

3*lamotrigine ODT kit

1lamotrigine tab

2levetiracetam ER tab

3LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN

2levetiracetam inj

1levetiracetam soln

1levetiracetam tab

2LYRICA CAP

2LYRICA SOLN

3MYSOLINE TAB

3NEURONTIN CAP

3NEURONTIN SOLN

3NEURONTIN TAB

1oxcarbazepine susp

1oxcarbazepine tab

3OXTELLAR XR TAB

2POTIGA TAB PA_NSO QL=90 Quantity/30 Days

1primidone tab

3SPRITAM ODT PA_NSO

3TEGRETOL SUSP

3TEGRETOL TAB

3TEGRETOL XR TAB

3TOPAMAX SPRINKLE CAP

3TOPAMAX TAB

3TOPIRAMATE ER CAP PA_NSO

1topiramate sprinkle cap

1topiramate tab

2TRILEPTAL SUSP

3TRILEPTAL TAB

3TROKENDI XR CAP PA_NSO

2VIMPAT INJ

2VIMPAT SOLN

2VIMPAT TAB QL=60 Quantity/30 Days

3ZONEGRAN CAP

1zonisamide capCARBAMATES

2felbamate susp

2felbamate tab

3FELBATOL SUSP

3FELBATOL TABGABA MODULATORS

2GABITRIL TAB 12MG, 16MG

3GABITRIL TAB 2MG, 4MG

4SABRIL POWDER NM PA_NSO


19


4SABRIL TAB NM PA_NSO

2tiagabine tabHYDANTOINS

3CEREBYX INJ

3DILANTIN CAP 100MG

2DILANTIN CAP 30MG

3DILANTIN INFATABS

3DILANTIN SUSP

2fosphenytoin inj

2PEGANONE TAB

3PHENYTEK CAP

2phenytoin chew tab

1phenytoin EX cap

2phenytoin inj

1phenytoin suspSUCCINIMIDES

2CELONTIN CAP

2ethosuximide cap

1ethosuximide soln

3ZARONTIN CAP

3ZARONTIN SOLNVALPROIC ACID

3DEPACON INJ

3DEPAKENE CAP

3DEPAKENE SYRUP

3DEPAKOTE DR TAB

3DEPAKOTE ER TAB

3DEPAKOTE SPRINKLE CAP

1divalproex DR tab

1divalproex ER tab

1divalproex sprinkle cap

2valproate inj

1valproic acid cap

1valproic acid syrup

ANTIDEPRESSANTSALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)

1mirtazapine ODT

1mirtazapine tab

3REMERON SOLUTAB

3REMERON TABANTIDEPRESSANTS - MISC.

3APLENZIN TAB ST

2bupropion SR tab

1bupropion tab

1bupropion XL tab

1MAPROTILINE TAB


20


3*WELLBUTRIN TAB

3WELLBUTRIN XL TABMODIFIED CYCLICS

1NEFAZODONE TAB 100MG, 150MG, 200MG

1nefazodone tab 250mg

2trazodone tab 300mg

1trazodone tab 50mg, 100mg, 150mg

3TRINTELLIX TAB ST QL=30 Quantity/30 Days

3VIIBRYD 10/ 20/ 40MG STARTER KIT ST QL=30 Quantity/30 Days

3VIIBRYD TAB ST QL=30 Quantity/30 DaysMONOAMINE OXIDASE INHIBITORS (MAOIS)

3EMSAM PATCH

2MARPLAN TAB

2NARDIL TAB

3PARNATE TAB

1phenelzine tab

2tranylcypromine tabSELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)

3CELEXA TAB

1citalopram oral soln

1citalopram tab

2escitalopram soln

1escitalopram tab

1fluoxetine cap

1fluoxetine soln

1fluoxetine tab

2fluvoxamine ER cap ST

1fluvoxamine tab

3LEXAPRO SOLN

3LEXAPRO TAB

2paroxetine ER tab

3PAROXETINE ORAL SUSP

1paroxetine tab

3PAXIL CR TAB

3PAXIL TAB

3PEXEVA TAB ST

3PROZAC CAP

1sertraline soln

1sertraline tab

3ZOLOFT CONC

3ZOLOFT TABSEROTONIN MODULATORS

1nefazodone tab 50mg

3*OLEPTRO TAB

3VIIBRYD 10/ 20MG STARTER KIT ST QL=30 Quantity/30 DaysSEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)


21


3CYMBALTA CAP QL=60 Quantity/30 Days

3DESVENLAFAXINE ER TAB ST

2duloxetine cap QL=60 Quantity/30 Days

3DULOXETINE DR CAP ST QL=30 Quantity/30 Days

3EFFEXOR XR CAP

3FETZIMA CAP ST QL=30 Quantity/30 Days

3FETZIMA CAP TITRATION PACK ST QL=30 Quantity/30 Days

3IRENKA CAP ST QL=90 Quantity/30 Days

3KHEDEZLA ER TAB ST

3PRISTIQ TAB ST

1venlafaxine ER cap

3VENLAFAXINE ER TAB

1venlafaxine ER tab

1VENLAFAXINE ER TAB 225MG

2venlafaxine tabTRICYCLIC AGENTS

1amitriptyline tab

1AMOXAPINE TAB

3ANAFRANIL CAP

2clomipramine cap

2desipramine tab

1doxepin cap

1DOXEPIN CAP 75MG

1doxepin soln

3ELAVIL TAB

2imipramine pamoate cap

1imipramine tab

3NORPRAMIN TAB

1nortriptyline cap

1NORTRIPTYLINE SOLN

3PAMELOR CAP

2protriptyline tab

3SURMONTIL CAP

3TOFRANIL TAB

3*TOFRANIL-PM CAP

2trimipramine cap

ANTIDIABETICSALPHA-GLUCOSIDASE INHIBITORS

1acarbose tab

3GLYSET TAB

2miglitol tab

3PRECOSE TABANTIDIABETIC - AMYLIN ANALOGS

3SYMLINPEN INJANTIDIABETIC COMBINATIONS

3ACTOPLUS MET TAB


22


3ACTOPLUS MET XR TAB

2*AVANDAMET TAB

2*AVANDARYL TAB

3DUETACT TAB

1glipizide/ metformin tab

3*GLUCOVANCE TAB 1.25-250MG

3GLUCOVANCE TAB 2.5-500MG, 5-500MG

1glyburide/ metformin tab

2JANUMET TAB QL=60 Quantity/30 Days

2JANUMET XR TAB QL=60 Quantity/30 Days

2KOMBIGLYZE XR TAB QL=30 Quantity/30 Days

2pioglitazone/ glimepiride tab

2pioglitazone/ metformin tab

3REPAGLINIDE/ METFORMIN TAB

2SYNJARDY TAB QL=60 Quantity/30 Days

2XIGDUO XR TAB 5-1000MG QL=60 Quantity/30 Days

2XIGDUO XR TAB 5-500MG, 10-500MG, 10-1000MG QL=30 Quantity/30 DaysBIGUANIDES

3GLUCOPHAGE TAB

3GLUCOPHAGE XR TAB

$0metformin ER tab 500mg, 750mg

$0metformin tab

3RIOMET SOLNDIABETIC OTHER

2GLUCAGEN HYPOKIT INJ

2GLUCAGON KIT

4KORLYM TAB NM PA

3PROGLYCEM SUSPDIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS

2JANUVIA TAB QL=30 Quantity/30 Days

2ONGLYZA TAB QL=30 Quantity/30 DaysDOPAMINE RECEPTOR AGONISTS - ANTIDIABETIC

3CYCLOSET TABINCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)

2BYDUREON INJ

2BYDUREON PEN INJ

3BYETTA INJ

3TRULICITY INJ

2VICTOZA INJINSULIN

2HUMULIN R U-500 INJ

2HUMULIN R U-500 KWIKPEN

2LANTUS INJ

2LANTUS SOLOSTAR INJ

2LEVEMIR FLEXTOUCH

2LEVEMIR INJ


23


2NOVOLIN MIX 70/ 30 VIAL

2NOVOLIN N VIAL

2NOVOLIN R VIAL

2NOVOLOG FLEXPEN INJ

2NOVOLOG MIX FLEXPEN INJ

2NOVOLOG MIX INJ

2NOVOLOG PENFILL

2NOVOLOG VIAL

2TOUJEO SOLOSTAR INJ

2TRESIBA INJINSULIN SENSITIZING AGENTS

3ACTOS TAB

2AVANDIA TAB

1pioglitazone tabMEGLITINIDE ANALOGUES

2nateglinide tab

3PRANDIN TAB

1repaglinide tab

3STARLIX TABSODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS

2FARXIGA TAB QL=30 Quantity/30 Days

2JARDIANCE TAB QL=30 Quantity/30 DaysSULFONYLUREAS

3AMARYL TAB

1CHLORPROPAMIDE TAB

3*DIABETA TAB

1glimepiride tab

1glipizide ER tab

1glipizide tab

3GLUCOTROL TAB

3GLUCOTROL XL TAB

1glyburide micronized tab

1glyburide tab

3GLYNASE TAB

1tolazamide tab

2TOLBUTAMIDE TAB

ANTIDIARRHEALSANTIPERISTALTIC AGENTS

1diphenoxylate/ atropine liquid

1diphenoxylate/ atropine tab

3LOMOTIL TAB

1loperamide cap

3*opium tincture

ANTIDOTESANTIDOTES

2fomepizole inj


24


ANTIDOTES - CHELATING AGENTS

2CHEMET CAP

4EXJADE TAB (FOR SUSPENSION) LSP NM

4FERRIPROX SOLN NM PA

4FERRIPROX TAB NM PA

4JADENU TAB LSP NMOPIOID ANTAGONISTS

2depade tab

2naloxone inj 0.4mg/ ml

3*REVIA TAB

ANTIDOTES AND SPECIFIC ANTAGONISTSOPIOID ANTAGONISTS

2NALOXONE INJ 2MG/ 2ML

2naloxone inj 4mg/ 10ml

2NALOXONE SOLN CARTRIDGE

ANTIEMETICS5-HT3 RECEPTOR ANTAGONISTS

3ANZEMET INJ

3ANZEMET TAB PA_BvD QL=9 Quantity/2 Days

2granisetron inj

1granisetron tab PA_BvD QL=9 Quantity/2 Days

2ondansetron inj

1ondansetron ODT PA_BvD

1ondansetron soln PA_BvD

1ondansetron tab PA_BvD

3SANCUSO PATCH QL=1 Quantity/7 Days

3ZOFRAN INJ

3ZOFRAN ODT PA_BvD

3ZOFRAN SOLN PA_BvD

3ZOFRAN TAB PA_BvDANTIEMETICS - ANTICHOLINERGIC

3*BONINE CHEW TAB

1*meclizine chew tab

1meclizine tab

3TIGAN CAP PA

3TIGAN INJ

3TRANSDERM-SCOP PATCH

1trimethobenzamide cap PAANTIEMETICS - MISCELLANEOUS

2AKYNZEO CAP NM PA_BvD QL=1 Quantity/7 Days

3CESAMET CAP PA

2dronabinol cap PA

3MARINOL CAP PASUBSTANCE P/ NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS

2EMEND CAP PA_BvD QL=3 Quantity/2 Days

2EMEND CAP THERAPY PACK PA_BvD QL=3 Quantity/2 Days


25


2VARUBI TAB PA_BvD QL=2 Quantity/14 Days

ANTIFUNGALSANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS)

4CANCIDAS INJ NM

2ERAXIS INJ

3MYCAMINE INJANTIFUNGALS

3ABELCET INJ PA_BvD

3AMBISOME INJ PA_BvD

2AMPHOTERICIN INJ PA_BvD

3ANCOBON CAP

2flucytosine cap

3*GRIFULVIN V TAB

3GRIS-PEG TAB

2griseofulvin micro tab

2griseofulvin susp

2griseofulvin tab

3LAMISIL GRANULES

3LAMISIL TAB

1*nystatin oral powder

1nystatin tab

1terbinafine tabIMIDAZOLE-RELATED ANTIFUNGALS

3DIFLUCAN SUSP

3DIFLUCAN TAB

2fluconazole inj

1fluconazole susp

1fluconazole tab

2itraconazole cap PA

1ketoconazole tab

4NOXAFIL DR TAB NM PA

2NOXAFIL SUSP PA

3SPORANOX CAP PA

3SPORANOX SOLN PA

3VFEND INJ PA

4VFEND SUSP NM PA

4VFEND TAB NM PA

2voriconazole inj PA

2voriconazole susp PA

4voriconazole tab NM PA

ANTIHISTAMINESANTIHISTAMINES - ETHANOLAMINES

2carbinoxamine soln

2carbinoxamine tab

2clemastine tab

2diphenhydramine elixir (rx only)


26


2diphenhydramine injANTIHISTAMINES - NON-SEDATING

3*ALLEGRA SYRUP

3*ALLEGRA TAB

1*cetirizine cap

1*cetirizine chew tab

2cetirizine soln 5mg/ 5ml

1*cetirizine tab

3*CLARINEX REDITAB

3CLARINEX SYRUP

3CLARINEX TAB

2*CLARITIN CAP

2*CLARITIN CHEW TAB

3*CLARITIN REDITAB

3*CLARITIN SYRUP

3*CLARITIN TAB

3*DESLORATADINE ODT

2desloratadine tab

1*fexofenadine syrup

1*fexofenadine tab

2levocetirizine soln

1levocetirizine tab

1*loratadine ODT

1*loratadine syrup

1*loratadine tab

3XYZAL SOLN

3XYZAL TAB

3*ZYRTEC CAP

3*ZYRTEC CHEW

3*ZYRTEC SYRUP

3*ZYRTEC TABANTIHISTAMINES - PHENOTHIAZINES

3PHENERGAN INJ

2promethazine inj

2promethazine supp

1promethazine syrup

1promethazine tabANTIHISTAMINES - PIPERIDINES

1cyproheptadine syrup

1cyproheptadine tab

ANTIHYPERLIPIDEMICSANTIHYPERLIPIDEMICS - COMBINATIONS

3VYTORIN TAB QL=30 Quantity/30 DaysANTIHYPERLIPIDEMICS - MISC.

4KYNAMRO INJ NM PA

3LOVAZA CAP


27


2omega-3-acid ethyl esters cap

3VASCEPA CAP PABILE ACID SEQUESTRANTS

1cholestyramine bulk powder

1cholestyramine light bulk powder

1cholestyramine light powder packets

1cholestyramine powder packets

3COLESTID GRANULE

3*COLESTID POWDER PACK

3COLESTID TAB

2colestipol granule

2colestipol granule packets

1colestipol tab

3QUESTRAN LIGHT POWDER 4GM/ DOSE

3*QUESTRAN LIGHT POWDER PACK

3QUESTRAN POWDER

2WELCHOL PACKET

2WELCHOL TABFIBRIC ACID DERIVATIVES

3ANTARA CAP

2fenofibrate cap

2fenofibrate micronized cap

2fenofibrate tab

2fenofibric acid DR cap

3FENOGLIDE TAB

3FIBRICOR TAB

1gemfibrozil tab

3LIPOFEN CAP

3LOFIBRA CAP

3LOFIBRA TAB

3LOPID TAB

3TRICOR TAB

2TRIGLIDE TAB

3TRILIPIX CAPHMG COA REDUCTASE INHIBITORS

3ALTOPREV ER TAB

1atorvastatin tab

2fluvastatin cap

2fluvastatin ER tab

3*LESCOL CAP

3LESCOL XL TAB

3LIPITOR TAB

3LIVALO TAB

$0lovastatin tab

3*MEVACOR TAB

3PRAVACHOL TAB


28


$0pravastatin tab

1rosuvastatin tab

$0simvastatin tab

3ZOCOR TABINTESTINAL CHOLESTEROL ABSORPTION INHIBITORS

2ZETIA TAB QL=30 Quantity/30 DaysMICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN (MTP) INHIBITORS

4JUXTAPID CAP NM PANICOTINIC ACID DERIVATIVES

2niacin ER tab

1NIACOR TAB

3NIASPAN ER TAB

ANTIHYPERTENSIVESACE INHIBITORS

3ACCUPRIL TAB

3*ACEON TAB

3ALTACE CAP

1benazepril tab

1captopril tab

1enalapril tab

1fosinopril tab

1lisinopril tab

3LOTENSIN TAB 20MG, 40MG

3*LOTENSIN TAB 5MG, 10MG

3MAVIK TAB

1moexipril tab

1perindopril tab

3PRINIVIL TAB

1quinapril tab

1ramipril cap

1trandolapril tab

3VASOTEC TABAGENTS FOR PHEOCHROMOCYTOMA

4DEMSER CAP NM

3DIBENZYLINE CAP

2phenoxybenzamine capANGIOTENSIN II RECEPTOR ANTAGONISTS

3ATACAND TAB

3AVAPRO TAB

3BENICAR TAB

2candesartan tab

3COZAAR TAB

3DIOVAN TAB

3EDARBI TAB

2EPROSARTAN MESYLATE TAB

1irbesartan tab


29


1losartan tab

3MICARDIS TAB

2telmisartan tab

3*TEVETEN TAB

1valsartan tabANTIADRENERGIC ANTIHYPERTENSIVES

3CARDURA TAB

3CATAPRES TAB

3CATAPRES-TTS PATCH

2clonidine patch

1clonidine tab

1doxazosin tab

1guanfacine IR tab

1methyldopa tab

3MINIPRESS CAP

1prazosin cap

3RESERPINE TAB

3TENEX TAB

1terazosin capANTIHYPERTENSIVE COMBINATIONS

3ACCURETIC TAB

2amlodipine/ benazepril cap

2amlodipine/ valsartan tab

2amlodipine/ valsartan/ hydrochlorothiazide tab

3ATACAND HCT TAB

1atenolol/ chlorthalidone tab

3AVALIDE TAB

3AZOR TAB

1benazepril/ hydrochlorothiazide tab

3BENICAR HCT TAB

1bisoprolol/ hydrochlorothiazide tab

2candesartan/ hydrochlorothiazide tab

1captopril/ hydrochlorothiazide tab 25-15mg, 50-15mg

1CAPTOPRIL/ HYDROCHLOROTHIAZIDE TAB 25-25MG, 50-25MG

3CLORPRES TAB

3CORZIDE TAB

3DIOVAN HCT TAB

2DUTOPROL TAB

3EDARBYCLOR TAB

1enalapril/ hydrochlorothiazide tab

3EXFORGE HCT TAB

3EXFORGE TAB

1fosinopril/ hydrochlorothiazide tab

3HYZAAR TAB

1irbesartan/ hydrochlorothiazide tab


30


1lisinopril/ hydrochlorothiazide tab

3*LOPRESSOR HCT TAB 100-25MG

3LOPRESSOR HCT TAB 50-25MG

1losartan/ hydrochlorothiazide tab

3*LOTREL CAP 2.5-10MG

3LOTREL CAP 5-10MG, 5-20MG, 10-20MG, 10-40MG

1methyldopa/ hydrochlorothiazide tab

2metoprolol/ hydrochlorothiazide tab

3MICARDIS HCT TAB

1moexipril/ hydrochlorothiazide tab

2nadolol/ bendroflumethiazide tab

3PRINIVIL TAB

3PRINZIDE TAB

1propranolol/ hydrochlorothiazide tab

1quinapril/ hydrochlorothiazide tab

3TARKA TAB

3TEKTURNA HCT TAB

2telmisartan/ amlodipine tab

2telmisartan/ hydrochlorothiazide tab

3TENORETIC TAB

3TEVETEN HCT TAB

2trandolapril/ verapamil ER tab

3TRIBENZOR TAB

3TWYNSTA TAB

1valsartan/ hydrochlorothiazide tab

3VASERETIC TAB

3ZIAC TABDIRECT RENIN INHIBITORS

3TEKTURNA TABSELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)

2eplerenone tab

3INSPRA TABVASODILATORS

2hydralazine inj

1hydralazine tab

1minoxidil tab

ANTI-INFECTIVE AGENTS - MISC.ANTI-INFECTIVE AGENTS - MISC.

3AZACTAM/ DEXTROSE INJ

2aztreonam inj

2bacitracin inj

4CAYSTON INHALATION SOLN NM PA

2colistimeth inj

4DALVANCE INJ NM

3FLAGYL CAP

3*FLAGYL ER TAB


31


3FLAGYL TAB

1metronidazole cap

1metronidazole tab

2metronidazole/ nacl inj

2NEBUPENT NEB PA_BvD

2PENTAM INJ PA_BvD

3*PRIMSOL SOLN

3*TINDAMAX TAB 250MG

3TINDAMAX TAB 500MG

2tinidazole tab

1trimethoprim tab

3VANCOCIN CAP 125MG ST QL=56 Quantity/10 Days

4VANCOCIN CAP 250MG NM ST QL=56 Quantity/10 Days

2vancomycin cap ST QL=56 Quantity/10 Days

2vancomycin inj

2vancomycin inj.

1*VANCOMYCIN ORAL SOLN KIT

2VANCOMYCIN/ DEXTROSE INJ

3XIFAXAN TAB 200MG QL=9 Quantity/3 Days

3XIFAXAN TAB 550MG PA QL=60 Quantity/30 DaysANTI-INFECTIVE MISC. - COMBINATIONS

3BACTRIM DS TAB

3BACTRIM TAB

1sulfamethoxazole/ trimethoprim DS tab

2SULFAMETHOXAZOLE/ TRIMETHOPRIM INJ

1sulfamethoxazole/ trimethoprim susp

1sulfamethoxazole/ trimethoprim tabANTIPROTOZOAL AGENTS

2ALINIA SUSP

2ALINIA TAB

2atovaquone susp

3MEPRON SUSPCARBAPENEMS

2cilastatin/ imipenem inj

3DORIBAX INJ

3INVANZ INJ

2meropenem inj

3MERREM INJ

3PRIMAXIN INJCHLORAMPHENICOLS

3CHLORAMPHENICOL INJCYCLIC LIPOPEPTIDES

4CUBICIN INJ NM

4daptomycin inj NMGLYCYLCYCLINES

4TYGACIL INJ NM


32


KETOLIDES

3KETEK TABLEPROSTATICS

1dapsone tabLINCOSAMIDES

3CLEOCIN CAP

3CLEOCIN INJ

3CLEOCIN PED ORAL SOLN

3CLEOCIN PHOSPHATE INJ

3CLEOCIN/ DEXTROSE INJ

1clindamycin cap

2clindamycin inj

2clindamycin soln

3LINCOCIN INJ 300MG/ ML

2lincomycin inj 300mg/ mlOXAZOLIDINONES

4linezolid IV soln NM PA

4linezolid susp 100mg/ 5ml NM PA

4linezolid tab NM PA

4SIVEXTRO INJ NM PA QL=6 Quantity/15 Days

4SIVEXTRO TAB NM PA QL=6 Quantity/15 Days

4ZYVOX IV SOLN NM PA

4ZYVOX SUSP 100MG/ 5ML NM PA

4ZYVOX TAB NM PAPOLYMYXINS

2polymyxin B injSTREPTOGRAMINS

4SYNERCID INJ NM

ANTIMALARIALSANTIMALARIAL COMBINATIONS

2atovaquone/ proguanil tab

2COARTEM TAB

2MALARONE TABANTIMALARIALS

3*ARALEN TAB

2chloroquine tab

4DARAPRIM TAB NM

1hydroxychloroquine tab

2mefloquine tab

3PLAQUENIL TAB

2PRIMAQUINE TAB

3QUALAQUIN CAP

2quinine sulfate cap

ANTIMYASTHENIC AGENTSANTIMYASTHENIC AGENTS

2GUANIDINE TAB


33


3MESTINON SYRUP

3MESTINON TAB

1pyridostigm tab

ANTIMYASTHENIC/ CHOLINERGIC AGENTSANTIMYASTHENIC/ CHOLINERGIC AGENTS

3MESTINON TIMESPAN TAB

2pyridostigmine CR tab

ANTIMYCOBACTERIAL AGENTSANTI TB COMBINATIONS

2RIFAMATE CAP

3RIFATER TABANTIMYCOBACTERIAL AGENTS

3CAPASTAT INJ

2ethambutol tab

2ISONIAZID INJ

1ISONIAZID SYRUP

1isoniazid tab

3MYAMBUTOL TAB

3MYCOBUTIN CAP

2PASER GRANULE

2PRIFTIN TAB

1pyrazinamide tab

2rifabutin cap

3RIFADIN CAP

3RIFADIN INJ

2rifampin cap

2rifampin inj

4SIRTURO TAB NM SP

3TRECATOR TAB

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIESALKYLATING AGENTS

4ALKERAN INJ NM

4BICNU INJ NM

2BUSULFEX INJ

2carboplatin inj

2CISPLATIN INJ 200MG/ 200ML

2cisplatin inj 50mg/ 50ml, 100mg/ 100ml

2CYCLOPHOSPHAMIDE CAP PA_BvD

2GLEOSTINE CAP

4HEXALEN CAP NM

3IFEX INJ 1GM

2IFEX INJ 3GM

2ifosfamide inj

2LEUKERAN TAB

2LOMUSTINE CAP

4melphalan inj NM


34


2MUSTARGEN INJ

2oxaliplatin inj

3*TEMODAR CAP

2*temozolomide cap

2THIOTEPA INJ

4TREANDA INJ NM PA_NSO

3ZANOSAR INJANTIMETABOLITES

2adrucil inj PA_BvD

4ALIMTA INJ NM

3ARRANON INJ

2azacitidine inj

2*capecitabine tab

2cladribine inj PA_BvD

3CLOLAR INJ

2CYTARABINE INJ PA_BvD

2cytarabine PF inj PA_BvD

4DACOGEN INJ NM

4decitabine inj NM

2fludarabine inj

2fluorouracil inj PA_BvD

4FOLOTYN INJ NM PA_NSO

2gemcitabine inj 200mg, 1gm

3gemcitabine inj 38mg/ ml

3GEMZAR INJ

2mercaptopurine tab

1methotrexate inj 1gm

1METHOTREXATE INJ 250MG/ 10ML

1methotrexate inj 50mg/ 2ml

1methotrexate PF inj 25mg/ ml

1methotrexate tab

3PURIXAN SUSP

2TABLOID TAB

2TREXALL TAB

4VIDAZA INJ NM

3*XELODA TABANTINEOPLASTIC - ANGIOGENESIS INHIBITORS

4AVASTIN INJ NM

4CYRAMZA INJ NM PA_NSO

4ZALTRAP INJ NM PA_NSOANTINEOPLASTIC - ANTIBODIES

4DARZALEX INJ NM PA_NSO

4EMPLICITI INJ NM PA_NSO

4ERBITUX INJ NM

4HERCEPTIN INJ NM

4KADCYLA INJ NM PA_NSO


35


4KEYTRUDA INJ NM PA_NSO

4KEYTRUDA IV SOLN NM PA_NSO

4OPDIVO INJ NM PA_NSO

4PERJETA INJ NM PA_NSO

4RITUXAN INJ NM

4TECENTRIQ INJ NM PA_NSO

4VECTIBIX INJ NM

4YERVOY INJ NM PA_NSOANTINEOPLASTIC - BCL-2 INHIBITORS

4VENCLEXTA TAB 100MG NM PA_NSO

3VENCLEXTA TAB 10MG, 50MG PA_NSO

4VENCLEXTA TAB STARTING PACK NM PA_NSOANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS

4ERIVEDGE CAP NM PA_NSO SP

4ODOMZO CAP LSP NM PA_NSOANTINEOPLASTIC - HORMONAL AGENTS

1anastrozole tab

3ARIMIDEX TAB

3AROMASIN TAB

1bicalutamide tab

3CASODEX TAB

3ELIGARD INJ

2EMCYT CAP

2exemestane tab

2FARESTON TAB

4FASLODEX INJ NM

3FEMARA TAB

2flutamide cap

1letrozole tab

2leuprolide inj

4LUPRON DEPOT INJ NM

2LYSODREN TAB

3MEGACE ORAL SUSP PA

1megestrol acetate susp PA

1megestrol acetate tab PA_NSO

$0tamoxifen tab

4TRELSTAR DEPOT INJ NM

4TRELSTAR LA INJ NM

4TRELSTAR MIX INJ NM

4ZYTIGA TAB NM PA_NSO SPANTINEOPLASTIC - HORMONAL AND RELATED AGENTS

2FIRMAGON INJ PA_NSO

4HYDROXYPROGESTERONE CAPROATE INJ NM PA_NSO

2NILANDRON TAB

2nilutamide tab

3SOLTAMOX ORAL SOLN PA_NSO


36


4XTANDI CAP NM PA_NSO SP QL=120 Quantity/30 Days

ANTINEOPLASTIC - IMMUNOMODULATORS

4POMALYST CAP NM PA_NSOANTINEOPLASTIC ANTIBIOTICS

2adriamycin inj PA_BvD

2BLEO INJ PA_BvD

2bleomycin inj PA_BvD

4COSMEGEN INJ NM

2daunorubicin inj

3DAUNOXOME INJ

4DOXIL INJ NM

3ELLENCE INJ

2epirubicin inj

3IDAMYCIN PFS INJ

2idarubicin inj

4lipodox inj NM

2mitomycin inj 20mg, 40mg

2MITOMYCIN INJ 5MG

2mitoxantrone injANTINEOPLASTIC COMBINATIONS

4LONSURF TAB NM PA_NSO SPANTINEOPLASTIC ENZYME INHIBITORS

4AFINITOR DISPERZ TAB LSP NM PA_NSO

4AFINITOR TAB LSP NM PA_NSO QL=30Quantity/30Day4ALECENSA CAP NM PA_NSO SP

4BELEODAQ INJ NM PA_NSO

4BOSULIF TAB NM PA_NSO SP

4CABOMETYX TAB NM PA_NSO SP

4CAPRELSA TAB NM PA_NSO

4COMETRIQ CAP DOSE PACK NM PA_NSO

4COTELLIC TAB NM PA_NSO SP

4FARYDAK CAP NM PA_NSO SP

4GILOTRIF TAB NM PA_NSO QL=30 Quantity/30 Days

4GLEEVEC TAB LSP NM PA_NSO

4IBRANCE CAP NM PA_NSO SP

4ICLUSIG TAB NM PA_NSO

4imatinib tab LSP NM PA_NSO

4IMBRUVICA CAP NM PA_NSO QL=120 Quantity/30 Days

4INLYTA TAB NM PA_NSO SP QL=240 Quantity/30 Days

4IRESSA TAB NM PA_NSO

4ISTODAX INJ NM PA_NSO

4JAKAFI TAB NM PA_NSO SP QL=60 Quantity/30 Days


37


4LENVIMA CAP THERAPY PACK NM PA_NSO

4LYNPARZA CAP NM PA_NSO

4MEKINIST TAB LSP NM PA_NSO

4NEXAVAR TAB NM PA_NSO SP

4NINLARO CAP NM PA_NSO SP

2SPRYCEL TAB PA_NSO

4STIVARGA TAB NM PA_NSO SP QL=120 Quantity/30 Days

4SUTENT CAP NM PA_NSO SP

4TAFINLAR CAP LSP NM PA_NSO QL=120 Quantity/30 Days

4TAGRISSO TAB NM PA_NSO

4TARCEVA TAB LSP NM PA_NSO

4TASIGNA CAP LSP NM PA_NSO

4TORISEL INJ NM

4TYKERB TAB LSP NM PA_NSO

4VECTIBIX INJ NM

4VOTRIENT TAB LSP NM PA_NSO

4XALKORI CAP NM PA_NSO SP

4ZELBORAF TAB NM PA_NSO SP

4ZOLINZA CAP LSP NM PA_NSO

4ZYDELIG TAB NM PA_NSO

4ZYKADIA CAP NM PA_NSOANTINEOPLASTIC ENZYMES

4ERWINAZE INJ NM PA_NSO

4ONCASPAR INJ NMANTINEOPLASTICS MISC.

4ACTIMMUNE INJ NM SP

2*ALFERON-N INJ

4bexarotene cap LSP NM PA_NSO

2dacarbazine inj

3HYDREA CAP

1hydroxyurea cap

4INTRON-A INJ 18000000UNIT, 50000000UNIT NM SP

2INTRON-A INJ 6000000UNIT, 10000000UNIT

2MATULANE CAP

4PENTOSTATIN INJ NM

4PROLEUKIN INJ NM

4SYLATRON KIT NM PA_NSO SP

4SYNRIBO INJ NM

4TARGRETIN CAP LSP NM PA_NSO

2tretinoin cap

2TRISENOX SOLN

3UVADEX INJCHEMOTHERAPY ADJUNCTS

4ELITEK INJ NM


38


4KEPIVANCE INJ NMCHEMOTHERAPY RESCUE/ ANTIDOTE AGENTS

2amifostine inj

2dexrazoxane inj

3FUSILEV INJ

2leucovorin calcium inj

1LEUCOVORIN TAB 10MG, 15MG

1leucovorin tab 5mg, 25mg

4levoleucovorin inj 175mg/ 17.5ml NM

3levoleucovorin inj 50mg

2mesna inj

3MESNEX INJ

2MESNEX TAB

3ZINECARD INJMITOTIC INHIBITORS

4ABRAXANE INJ NM

4DOCEFREZ INJ NM

4docetaxel conc inj NM

4DOCETAXEL FOR INJ CONC NM

2DOCETAXEL IV SOLN

2DOCETAXEL NON-ALCOHOL FORMULA IV SOLN

3ETOPOPHOSPHATE INJ

2*etoposide cap

2etoposide inj

4HALAVEN INJ NM

4JEVTANA INJ NM

4MARQIBO INJ NM

2paclitaxel inj

3TAXOL INJ

4TAXOTERE INJ NM

3VINBLASTINE INJ PA_BvD

2vincristine inj PA_BvD

2vinorelbine injTOPOISOMERASE I INHIBITORS

3CAMPTOSTAR INJ

2*HYCAMTIN CAP PA

4HYCAMTIN INJ NM

2irinotecan inj 40mg/ 2ml, 100mg/ 5ml

2IRINOTECAN INJ 500MG/ 25ML

2topotecan inj

ANTIPARKINSON AGENTSANTIPARKINSON ADJUVANTS

2carbidopa tab

3LODOSYN TABANTIPARKINSON ANTICHOLINERGICS

2benztropine inj


39


1benztropine tab

3COGENTIN INJ

1trihexyphenidyl elixir

1trihexyphenidyl tabANTIPARKINSON COMT INHIBITORS

3COMTAN TAB

2entacapone tab

3TASMAR TAB

2tolcapone tabANTIPARKINSON DOPAMINERGICS

1amantadine cap

1amantadine soln

3AMANTADINE TAB

4APOKYN INJ NM

2bromocriptine cap

2bromocriptine tab

1carbidopa/ levodopa ER tab

1carbidopa/ levodopa ODT

1carbidopa/ levodopa tab

2CARBIDOPA/ LEVODOPA/ ENTACAPONE TAB

3MIRAPEX ER TAB

3MIRAPEX TAB

3NEUPRO PATCH

3*PARLODEL CAP

2pramipexole ER tab

1pramipexole tab

3REQUIP TAB

3REQUIP XL TAB

2ropinirole ER tab

1ropinirole tab

3RYTARY ER CAP ST

3SINEMET CR TAB

3SINEMET TABANTIPARKINSON MONOAMINE OXIDASE INHIBITORS

2AZILECT TAB

3ELDEPRYL CAP

1selegiline cap

1selegiline tab

3ZELAPAR ODT

ANTIPSYCHOTICS/ ANTIMANIC AGENTSANTIMANIC AGENTS

1lithium carbonate cap

1lithium carbonate ER tab

1lithium carbonate tab

1lithium citrate soln

3LITHOBID CR TAB


40


ANTIPSYCHOTICS - MISC.

2EQUETRO CAP

3GEODON CAP

3GEODON INJ

3LATUDA TAB PA_NSO QL=30 Quantity/30 Days

4NUPLAZID TAB NM PA_NSO

4VRAYLAR CAP NM PA_NSO QL=30 Quantity/30 Days

3VRAYLAR CAP THERAPY PACK PA_NSO QL=30 Quantity/30 Days

2ziprasidone capBENZISOXAZOLES

3FANAPT TAB PA_NSO QL=60 Quantity/30 Days

3FANAPT TAB TITRATION PACK PA_NSO QL=60 Quantity/30 Days

3INVEGA INJ PA_NSO

3INVEGA SUSTENNA INJ PA_NSO

3INVEGA TAB PA_NSO

3INVEGA TRINZA INJ PA_NSO

2paliperidone SR tab PA_NSO

3RISPERDAL INJ PA_NSO

3RISPERDAL M TAB

3RISPERDAL SOLN

3RISPERDAL TAB

2risperidone ODT

1risperidone soln

1risperidone tabBUTYROPHENONES

3HALDOL DECANOATE INJ

3HALDOL LACTATE INJ

2haloperidol decanoate inj

2haloperidol lactate inj

1haloperidol lactate soln

1haloperidol tabDIBENZAPINES

2clozapine ODT

2clozapine tab

3CLOZARIL TAB

3FAZACLO ODT 25MG, 100MG

2FAZACLO/ CLOZAPINE ODT 12.5MG, 150MG, 200MG

1loxapine cap

2olanzapine inj

2olanzapine ODT

1olanzapine tab

1quetiapine tab

3SAPHRIS SL TAB PA_NSO QL=60 Quantity/30 Days

3SEROQUEL TAB

2SEROQUEL XR TAB


41


3VERSACLOZ SUSP

3ZYPREXA INJ

3ZYPREXA TAB

4ZYPREXA ZYDIS TAB 15MG, 20MG NM

3ZYPREXA ZYDIS TAB 5MG, 10MGDIHYDROINDOLONES

3MOLINDONE TABPHENOTHIAZINES

2CHLORPROMAZINE INJ

1chlorpromazine tab

2fluphenazine decanoate inj

2FLUPHENAZINE ELIXIR

2FLUPHENAZINE INJ

2FLUPHENAZINE ORAL CONC

1fluphenazine tab

1perphenazine tab

2prochlorperazine inj

1prochlorperazine supp

1prochlorperazine tab

1thioridazine tab

1trifluoperazine tabQUINOLINONE DERIVATIVES

3ABILIFY DISC TAB PA_NSO QL=60 Quantity/30 Days

3ABILIFY INJ PA_NSO

3ABILIFY MAINTENA INJ PA_NSO

3ABILIFY TAB

3aripiprazole ODT PA_NSO QL=60 Quantity/30 Days

2aripiprazole tab

4ARISTADA INJ NM PA_NSO

3REXULTI TAB PA_NSO QL=30 Quantity/30 DaysTHIOXANTHENES

1thiothixene cap

ANTISEPTICS & DISINFECTANTSCHLORINE ANTISEPTICS

3*PHISOHEX LIQUID

ANTIVIRALSANTIRETROVIRALS

2abacavir tab

4abacavir/ lamivudine tab NM

2abacavir/ lamivudine/ zidovudine tab

4APTIVUS CAP NM

4APTIVUS SOLN NM

4ATRIPLA TAB NM

4COMBIVIR TAB NM

4COMPLERA TAB NM

2CRIXIVAN CAP


42


4DESCOVY TAB NM

2didanosine DR cap

4EDURANT TAB NM

2EMTRIVA CAP

2EMTRIVA SOLN

3EPIVIR SOLN

3EPIVIR TAB

4EPZICOM TAB NM

4EVOTAZ TAB NM

4FUZEON INJ LSP NM 4GENVOYA TAB NM

4INTELENCE TAB 100MG, 200MG NM

2INTELENCE TAB 25MG

2INVIRASE CAP

4INVIRASE TAB NM

4ISENTRESS CHEW TAB 100MG NM

2ISENTRESS CHEW TAB 25MG

2ISENTRESS POWDER PACK

4ISENTRESS TAB 400MG NM

4KALETRA SOLN NM

2KALETRA TAB 100-25MG

4KALETRA TAB 200-50MG NM

2lamivudine soln

2lamivudine tab

2lamivudine/ zidovudine tab NM

2LEXIVA SUSP

4LEXIVA TAB NM

2nevirapine ER tab

2NEVIRAPINE SUSP

1nevirapine tab

2NORVIR CAP

2NORVIR SOLN

2NORVIR TAB

4ODEFSEY TAB NM

4PREZCOBIX TAB NM

2PREZISTA SUSP

4PREZISTA TAB 600MG, 800MG NM

2PREZISTA TAB 75MG, 150MG

2RESCRIPTOR TAB

3RETROVIR CAP

2RETROVIR INJ

3RETROVIR SYRUP

4REYATAZ CAP NM

4REYATAZ POWDER PACKET NM

4SELZENTRY TAB NM

2stavudine cap


43


2stavudine soln

4STRIBILD TAB NM

2SUSTIVA CAP

2SUSTIVA TAB

2TIVICAY TAB 10MG, 25MG NM

4TIVICAY TAB 50MG NM

4TRIUMEQ TAB NM

3TRIZIVIR TAB

4TRUVADA TAB NM

2TYBOST TAB

3VIDEX EC CAP

2VIDEX SOLN 2GM

3*VIDEX SOLN 4GM

4VIRACEPT TAB NM

3VIRAMUNE SUSP

3VIRAMUNE TAB

3VIRAMUNE XR TAB

2VIREAD POWDER

4VIREAD TAB NM

4VITEKTA TAB NM

3ZERIT CAP

3ZERIT SOLN

2ZIAGEN SOLN

3ZIAGEN TAB

2zidovudine cap

2zidovudine syrup

2zidovudine tabCMV AGENTS

2cidofovir inj

3CYTOVENE INJ PA_BvD

2ganciclovir inj PA_BvD

4VALCYTE SOLN NM

4VALCYTE TAB NM

4valganciclovir soln NM

4valganciclovir tab NMHEPATITIS AGENTS

2adefovir dipivoxil tab

3BARACLUDE ORAL SOLN

3BARACLUDE TAB

3COPEGUS TAB NM

2entecavir tab

2EPIVIR HBV SOLN

3EPIVIR HBV TAB

4HARVONI TAB LSP NM PA QL=30 Quantity/30 Days

3HEPSERA TAB

2lamivudine tab


44


4PEG-INTRON KIT LSP NM 4PEGASYS PROCLICK INJ LSP NM 3REBETOL CAP NM

4REBETOL SOLN LSP NM4RIBAPAK TAB 400MG, 600MG LSP NM 4RIBAPAK TAB DOSE PACK LSP NM 2ribasphere tab 200mg

2ribavirin cap 200mg

3ribavirin tab 400mg

4RIBAVIRIN TAB 400MG, 600MG LSP NM 4ribavirin tab 600mg LSP NM 4SOVALDI TAB LSP NM PA QL=30 Quantity/30 Days

3TYZEKA TAB

4ZEPATIER TAB LSP NM PA QL=30 Quantity/30 DaysHERPES AGENTS

1acyclovir cap

2acyclovir inj PA_BvD

2ACYCLOVIR INJ PA_BvD

1acyclovir susp

1acyclovir tab

2famciclovir tab

3FAMVIR TAB

2valacyclovir tab

3VALTREX TAB

3ZOVIRAX CAP

3ZOVIRAX SUSP

3*ZOVIRAX TABINFLUENZA AGENTS

3FLUMADINE TAB

2RELENZA DISKHALER QL=56 Quantity/180 Days

1rimantadine tab

2TAMIFLU CAP 30MG QL=84 Quantity/180 Days

2TAMIFLU CAP 45MG, 75MG QL=28 Quantity/180 Days

2TAMIFLU SUSP 6MG/ ML QL=9 Quantity/180 DaysRESPIRATORY SYNCYTIAL VIRUS (RSV) AGENTS

4VIRAZOLE INHALATION SOLN NM

ASSORTED CLASSESCHELATING AGENTS

2DEPEN TITRA TAB

3SYPRINE CAP PAIMMUNOMODULATORS

4REVLIMID CAP NM PA_NSO SP QL=30 Quantity/30 Days

4THALOMID CAP NM PA_NSO SPIMMUNOSUPPRESSIVE AGENTS

3ASTAGRAF XL CAP PA_BvD


45


4ATGAM INJ NM PA_BvD

3AZASAN TAB PA_BvD

3AZATHIOPRINE INJ PA_BvD

1azathioprine tab PA_BvD

3CELLCEPT CAP PA_BvD

2CELLCEPT INJ PA_BvD

3CELLCEPT SUSP PA_BvD

3CELLCEPT TAB PA_BvD

2cyclosporine cap PA_BvD

2cyclosporine inj PA_BvD

2cyclosporine modified cap 25mg, 100mg PA_BvD

2CYCLOSPORINE MODIFIED CAP 50MG PA_BvD

2cyclosporine modified soln PA_BvD

3ENVARSUS XR TAB PA_BvD

2gengraf cap PA_BvD

3IMURAN TAB PA_BvD

1mycophenolate cap PA_BvD

2mycophenolate DR tab PA_BvD

2mycophenolate mofetil susp PA_BvD

1mycophenolate tab PA_BvD

3MYFORTIC TAB PA_BvD

3NEORAL CAP PA_BvD

3NEORAL SOLN PA_BvD

4NULOJIX INJ NM PA_BvD

3PROGRAF CAP PA_BvD

3PROGRAF INJ PA_BvD

2RAPAMUNE SOLN PA_BvD

3RAPAMUNE TAB PA_BvD

3SANDIMMUNE CAP PA_BvD

3SANDIMMUNE INJ PA_BvD

2SANDIMMUNE ORAL SOLN PA_BvD

4SIMULECT INJ NM

2sirolimus tab PA_BvD

2tacrolimus cap PA_BvD

4THYMOGLOBULIN INJ NM PA_BvD

2ZORTRESS TAB PA_NSOIRRIGATION SOLUTIONS

2lactated ringers irrigation

2physiosol irrigation soln

2ringers irrigation soln

2sterile water irrigationLYMPHATIC AGENTS

4SYLVANT INJ NMPOTASSIUM REMOVING RESINS

3KAYEXALATE POWDER

1sodium polystyrene oral susp


46


2sodium polystyrene powder

1*sodium polystyrene rectal susp

3VELTASSA POWDER FOR ORAL SUSP PASYSTEMIC LUPUS ERYTHEMATOSUS AGENTS

4BENLYSTA INJ NM

BETA BLOCKERSALPHA-BETA BLOCKERS

1carvedilol tab

3COREG CR CAP

3COREG TAB

2labetalol inj

1labetalol tab

3*TRANDATE TABBETA BLOCKERS CARDIO-SELECTIVE

1acebutolol cap

1atenolol tab

1betaxolol tab

1bisoprolol fumarate tab

2BYSTOLIC TAB

3*KERLONE TAB

3LOPRESSOR TAB 100MG

3*LOPRESSOR TAB 50MG

1metoprolol ER tab

2metoprolol inj

1metoprolol tab

3SECTRAL CAP

3TENORMIN TAB

3TOPROL XL TAB

3ZEBETA TABBETA BLOCKERS NON-SELECTIVE

3BETAPACE AF TAB

3BETAPACE TAB

3CORGARD TAB

3INDERAL LA CAP

3INNOPRAN XL CAP

3*LEVATOL TAB

1nadolol tab

1pindolol tab

1propranolol ER cap

2propranolol inj

1PROPRANOLOL SOLN

1propranolol tab

1sotalol AF tab

1sotalol tab

1timolol maleate tab

BIOLOGICALS MISC


47


BIOLOGICALS MISC

4ADAGEN INJ NM PA

CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS

3ADALAT CC ER TAB

1amlodipine tab

3CALAN SR TAB

3CALAN TAB

3CARDENE INJ

3CARDIZEM CD CAP

3CARDIZEM LA TAB

3CARDIZEM TAB

1diltiazem CD cap

1diltiazem ER cap

2DILTIAZEM INJ 100MG

2diltiazem inj 5mg/ ml

2diltiazem LA tab

1diltiazem SR cap

1diltiazem tab

1diltiazem XR cap

2felodipine ER tab

1isradipine cap

1nicardipine cap

2nicardipine inj

1nifedipine cap

1nifedipine ER tab

2nimodipine cap

3*NIMOTOP CAP

2nisoldipine ER tab

2NISOLDIPINE SR TAB

3NORVASC TAB

3PROCARDIA CAP

3PROCARDIA XL TAB

3SULAR TAB

3TIAZAC CAP

1verapamil CR tab

2verapamil ER cap 100mg, 200mg, 300mg

1verapamil ER cap 120mg, 180mg, 240mg, 360mg

2verapamil inj

1verapamil tab

3VERELAN CAP

CARDIOTONICSCARDIAC GLYCOSIDES

2digoxin inj

1digoxin soln

1digoxin tab 125mcg QL=30 Quantity/30 Days


48


1digoxin tab 250mcg

3LANOXIN INJ

3LANOXIN TAB 125MCG QL=30 Quantity/30 Days

3LANOXIN TAB 250MCG

CARDIOVASCULAR AGENTS - MISC.CARDIOVASCULAR AGENTS MISC. - COMBINATIONS

2amlodipine/ atorvastatin tab

2BIDIL TAB

3CADUET TABPROSTAGLANDIN VASODILATORS

4REMODULIN INJ NM PA_BvD

4TYVASO INHALATION SOLN NM PA

4VENTAVIS INHALATION SOLN NM PAPULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS

4LETAIRIS TAB NM PA QL=30 Quantity/30 Days

4OPSUMIT TAB NM PA QL=30 Quantity/30 Days

4TRACLEER TAB NM PA QL=60 Quantity/30 DaysPULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS

4ADCIRCA TAB LSP NM PA

4REVATIO INJ NM PA

4REVATIO TAB NM PA

4sildenafil inj NM PA

1sildenafil tab PAPULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST

4UPTRAVI TAB NM PA QL=60 Quantity/30 Days

4UPTRAVI TITRATION PACK NM PA QL=200 Quantity/30 DaysPULMONARY HYPERTENSION - SOL GUANYLATE CYCLASE STIMULATOR

4ADEMPAS TAB NM PASINUS NODE INHIBITORS

3CORLANOR TAB PA

CEPHALOSPORINSCEPHALOSPORIN COMBINATIONS

3AVYCAZ INJ

3ZERBAXA INJCEPHALOSPORINS - 1ST GENERATION

1cefadroxil cap

1cefadroxil susp

1cefadroxil tab

2CEFAZOLIN INJ 20GM

2cefazolin inj 500mg, 1gm, 10gm, 20gm

1cephalexin cap

1cephalexin susp

1CEPHALEXIN TAB

3*KEFLEX CAPCEPHALOSPORINS - 2ND GENERATION

2cefaclor cap


49


3CEFACLOR ER TAB

2CEFACLOR SUSP

3CEFOTETAN INJ 10GM

2cefotetan inj 1gm, 2gm

2cefoxitin inj

2cefprozil susp

2cefprozil tab

3CEFTIN SUSP

3CEFTIN TAB

1*cefuroxime axetil susp

2cefuroxime inj

1cefuroxime tab

3ZINACEF INJCEPHALOSPORINS - 3RD GENERATION

3CEDAX CAP

3CEDAX SUSP

2cefdinir cap

2cefdinir susp

2cefixime susp

2cefotaxime inj

2cefpodoxime proxetil susp

2cefpodoxime proxetil tab

2ceftazidime inj

2ceftriaxone sodium inj

3CLAFORAN INJ

3FORTAZ INJ

3*SPECTRACEF TAB

3SUPRAX CAP

3SUPRAX CHEW TAB

3SUPRAX SUSPCEPHALOSPORINS - 4TH GENERATION

2cefepime inj

3MAXIPIME INJCEPHALOSPORINS - 5TH GENERATION

4TEFLARO INJ NM

CONTRACEPTIVESCOMBINATION CONTRACEPTIVES - ORAL

$0amethia tab

$0amethyst tab

$0apri tab

$0aranelle tab

$0aviane tab

$0balziva tab

3BREVICON TAB

$0cesia tab

$0cryselle tab


50


$0cyclafem tab

3CYCLESSA TAB

3DESOGEN TAB

$0enpresse tab

3*ESTROSTEP FE TAB

3FEMCON FE CHEW TAB

3GENERESS FE CHEW TAB

$0gianvi/ ocella/ loryna tab

$0*jolessa tab/ amethia LO tab

$0junel FE tab

$0junel tab

$0kariva tab

$0kelnor tab

$0levora-28 tab

3LO LOESTRIN FE TAB

3LOESTRIN FE TAB

3LOESTRIN TAB

3LOSEASONIQUE TAB

3MINASTRIN CHEW TAB

3*MIRCETTE TAB

2NATAZIA TAB

$0necon tab

$0nikki 28 day tab

$0norethindrone/ ethinyl estradiol FE chew tab

$0norethindrone/ ethinyl estradiol FE tab

3NORINYL TAB

3OGESTREL TAB

3ORTHO TRI-CYCLEN LO TAB

3ORTHO TRI-CYCLEN TAB

3ORTHO-CYCLEN TAB

3ORTHO-NOVUM TAB

3OVCON 35 TAB

$0previfem tab

2QUARTETTE TAB

$0quasense tab

$0SAFYRAL TAB

3SEASONIQUE TAB

$0tri-legest FE tab

$0tri-nessa lo tab

3TRI-NORINYL TAB

$0trinessa tab

$0YASMIN TAB

$0YAZ TAB

$0zeosa tab

$0zovia tabCOMBINATION CONTRACEPTIVES - TRANSDERMAL


51


3*ORTHO-EVRA PATCH

$0XULANE PATCHCOMBINATION CONTRACEPTIVES - VAGINAL

$0NUVARINGCOPPER CONTRACEPTIVES - IUD

$0*PARAGARD IUDEMERGENCY CONTRACEPTIVES

$0*levonorgestrel tabPROGESTIN CONTRACEPTIVES - IMPLANTS

$0*IMPLANON/ NEXPLANON IMPLANTPROGESTIN CONTRACEPTIVES - INJECTABLE

3DEPO PROVERA INJ 150MG/ ML

$0medroxyprogesterone injPROGESTIN CONTRACEPTIVES - IUD

$0*MIRENA IUDPROGESTIN CONTRACEPTIVES - ORAL

3NOR-QD TAB

$0norethindrone tab

CORTICOSTEROIDSGLUCOCORTICOSTEROIDS

3A-HYDROCORT INJ

4budesonide EC cap NM

1CORTEF TAB

2CORTISONE AC TAB

3DEPO-MEDROL INJ

1DEXAMETHASONE CONC

1dexamethasone elixir

2dexamethasone phosphate inj

2DEXAMETHASONE SODIUM PHOSPHATE INJ

1*dexamethasone soln

1dexamethasone tab

1DEXAMETHASONE TAB 1MG, 2MG

3DEXPAK TAB 1.5MG

4ENTOCORT EC CAP NM

3FLO-PRED ORAL SUSP

1hydrocortisone tab

2KENALOG INJ

1MEDROL TAB 2MG

3MEDROL TAB 4MG, 8MG, 16MG, 32MG

3MEDROL TAB DOSE PACK

2methylprednisolone acetate inj

2methylprednisolone inj PA_BvD

1methylprednisolone pak

3METHYLPREDNISOLONE PF INJ

2methylprednisolone succinate inj PA_BvD

1methylprednisolone tab


52


3MILLIPRED DP PAK

3MILLIPRED SOLN

3MILLIPRED TAB

3ORAPRED ODT

3*ORAPRED SOLN

2prednisolone ODT

3PREDNISOLONE ORAL SOLN

1prednisolone sodium phosphate oral soln

1*prednisolone syrup

2PREDNISONE CONC

1PREDNISONE SOLN

1prednisone tab

1PREDNISONE TAB 50MG

2PREDNISONE TAB DOSE PACK

3SOLU-CORTEF INJ 100MG, 500MG, 1000MG

2SOLU-CORTEF INJ 250MG

3SOLU-MEDROL INJ PA_BvD

3UCERIS TAB PA QL=30 Quantity/30 Days

3VERIPRED SOLNMINERALOCORTICOIDS

1fludrocortisone tab

COUGH/ COLD/ ALLERGYANTITUSSIVES

1*benzonatate cap 100mg, 200mg

3*BENZONATATE CAP 150MG

1*hydrocodone/ homatropine syrup

3*TESSALON/ ZONATUSS CAP

1*tussigon tabCOUGH/ COLD/ ALLERGY COMBINATIONS

3*ALBATUSSIN LIQUID

3*aldex tab

3*ALLEGRA-D 12-HOUR TAB

3*ALLEGRA-D 24-HOUR TAB

3*BROMFED DM SYRUP

3*BRONTEX LIQUID

1*cetirizine/ pseudoephedrine tab

3CLARINEX-D ER TAB

3*CLARINEX-D TAB

3*CLARITIN-D TAB

3*DECON-A ELIXIR

3*DECONEX DM TAB

3*dextromethorphan/ guaifenesin liquid

3*donatussin liquid

3*ED A-HIST LIQUID

3*ENTRE-COUGH LIQUID

3*EXACTUSS LIQUID


53


1*fexofenadine/ pseudoephedrine 12-hour tab

1*fexofenadine/ pseudoephedrine 24 hour tab

3*GILTUSS LIQUID

1*guaifenesin/ codeine liquid

1*guaifenesin/ codeine syrup QL=240 Quantity/ Per Dispensing

3*HDC DM SYRUP

3*hydrocodone/ chlorpheniramine susp QL=120 Quantity/ Per Dispensing

3*hydrocodone/ chlorpheniramine/ pseudoephedrine liquid

1*loratadine/ pseudoephedrine tab

3*NEOTUSS LIQUID

3*PANATUSS PEDIATRIC LIQUID

3*PEDIATEX TDM SUSP

3*PHENYLEPHRINE-GUAIFENESIN LIQD

3*phenylephrine/ guaifenesin tab

3*PHENYLHIST LIQUID

3*promethazine DM syrup

1promethazine VC syrup

1*promethazine w/ codeine syrup

3*pseudoephedrine/ codeine/ guaifenesin syrup

3*PYRIL D TAB

3*RESCON TAB

3*REZIRA SOLN

3*SEMPREX-D CAP

3*SINUVENT TAB

3*SUTTAR-SF SYRUP

3*TUSNEL C SYRUP

3*TUSNEL CAP

3*TUSSI-ORGANI SYRUP QL=240 Quantity/ Per Dispensing

3*TUSSI-ORGANIDIN DM-S SOLN

3*TUSSICAPS QL=20 Quantity/ Per Dispensing

3*tussin DM liquid

3*TUSSIONEX SUSP QL=120 Quantity/ Per Dispensing

3*ZUTRIPRO LIQUID QL=120 Quantity/ Per Dispensing

3*ZYRTEC-D TABMISC. RESPIRATORY INHALANTS

3*HYPER SAL NEB

1*sodium chloride nebMUCOLYTICS

1acetylcysteine soln PA_BvD

DERMATOLOGICALSACNE PRODUCTS

3ABSORICA CAP

3ACANYA GEL

2adapalene cream PA

2adapalene gel PA


54


2ADAPALENE LOTION/ DIFFERIN LOTION PA

3ATRALIN GEL PA

3AZELEX CREAM PA

3BENZACLIN GEL

3BENZAMYCIN GEL

3BENZAMYCIN GEL PACK

3*CLARIFOAM EF FOAM

3CLEOCIN-T GEL

3CLEOCIN-T LOTION

3CLEOCIN-T PAD

3CLEOCIN-T SOLN

3CLINDACIN KIT

3CLINDAGEL

2clindamycin foam

1clindamycin gel

1clindamycin lotion

1clindamycin pad

1clindamycin soln

2clindamycin/ benzoyl peroxide gel

3clindamycin/ tretinoin gel

3DIFFERIN CREAM PA

3DIFFERIN GEL 0.1% PA

2DIFFERIN GEL 0.3% PA

3DUAC GEL

2EPIDUO (FORTE) GEL PA

2EPIDUO GEL PA

3ERYGEL 2%

1erythromycin gel

1erythromycin pad

1erythromycin soln

2erythromycin/ benzoyl peroxide gel

3EVOCLIN FOAM

2isotretinoin cap

3KLARON LOTION

3ONEXTON GEL

3*PLEXION SCT CREAM

3RETIN-A CREAM PA

3RETIN-A GEL PA

2RETIN-A MICRO GEL PA

3*ROSULA FOAM

2sulfacetamide lotion

3*sulfacetamide sodium/ sulfur aerosol

2*sulfacetamide sodium/ sulfur emulsion

1*sulfacetamide sodium/ sulfur lotion

2*SULFACETAMIDE/ SULFUR EMULSION

3*sulfacleanse susp


55


3*SUMADAN WASH

3*SUMAXIN PAD

3*SUMAXIN SUSP

3TRETIN-X CREAM PA

2tretinoin cream PA

2tretinoin gel PA

2tretinoin micro gel PA

3VELTIN GEL

3ZIANA GELANTIBIOTICS - TOPICAL

3ALTABAX OINT

3BACTROBAN CREAM

3*BACTROBAN OINT

3*CENTANY OINT

3CORTISPORIN CREAM

3CORTISPORIN OINT

1gentamicin cream

1gentamicin oint

2mupirocin cream

2mupirocin ointANTIFUNGALS - TOPICAL

1ciclopirox cream

1ciclopirox gel

2ciclopirox shampoo

1ciclopirox soln

1ciclopirox susp

2clotrimazole cream

2clotrimazole soln

1clotrimazole/ betamethasone cream

2clotrimazole/ betamethasone lotion

2econazole cream

3ERTACZO CREAM

3EXELDERM CREAM

3EXELDERM SOLN

3EXTINA FOAM

3*iodoquinol/ hydrocortisone cream

1ketoconazole cream

2ketoconazole foam

1ketoconazole shampoo

3LOPROX SHAMPOO

3LOTRISONE CREAM

3MENTAX CREAM

2NAFTIFINE CREAM 1%

2naftifine cream 2%

3*NAFTIN CREAM 1%

3NAFTIN CREAM 2%


56


3NAFTIN GEL

3NIZORAL SHAMPOO

1nystatin cream

1nystatin oint

1nystatin powder

2oxiconazole nitrate cream

3OXISTAT CREAM

3OXISTAT LOTIONANTI-INFLAMMATORY AGENTS - TOPICAL

2diclofenac gel QL=5 Quantity/14 Days

2diclofenac soln

3FLECTOR PATCH PA QL=60 Quantity/30 Days

3VOLTAREN GEL QL=10 Quantity/30 DaysANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL

2CARAC CREAM

2diclofenac gel PA_NSO

3EFUDEX CREAM

2*FLUOROPLEX CREAM

2fluorouracil cream

2fluorouracil soln

4PANRETIN GEL NM

4PICATO GEL 0.015% NM QL=3 Quantity/10 Days

4PICATO GEL 0.05% NM QL=2 Quantity/10 Days

3SOLARAZE GEL PA_NSO

4TARGRETIN GEL LSP NM

2TOLAK CREAM

4VALCHLOR GEL NM PA_NSO QL=4 Quantity/30 DaysANTIPRURITICS - TOPICAL

3DOXEPIN/ PRUDOXIN/ ZONALON CREAMANTIPSORIATICS

28-MOP CAP

2acitretin cap

2calcipotriene cream

2calcipotriene oint

2calcipotriene soln

4COSENTYX INJ LSP NM PA

3DOVONEX CREAM

2methoxsalen cap

3OXSORALEN ULTRA CAP

3SORIATANE CAP

3SORILUX FOAM

3TAZORAC CREAM

3TAZORAC GEL

2VECTICAL/ CALCITRIOL OINTANTISEBORRHEIC PRODUCTS

3*OVACE CREAM


57


3*OVACE PLUS SHAMPOO

3*OVACE PLUS WASH

3*OVACE WASH

3*seb-prev cream

1selenium sulfide lotion

2*selenium sulfide shampoo

3*sodium sulfacetamide gel

3*sodium sulfacetamide shampoo

3*sodium sulfacetamide/ urea padANTIVIRALS - TOPICAL

2acyclovir oint

2DENAVIR CREAM

3XERESE CREAM

3ZOVIRAX CREAM

2ZOVIRAX OINTBURN PRODUCTS

3SILVADENE CREAM

1silver sulfadiazine cream

2SULFAMYLON CREAM

3SULFAMYLON SOLNCORTICOSTEROIDS - TOPICAL

3*ACLOVATE CREAM

3ALA SCALP LOTION

2alclometasone cream

2alclometasone oint

2AMCINONIDE CREAM PA

3AMCINONIDE LOTION

2AMCINONIDE OINT PA

3APEXICON E CREAM PA

1augmented betamethasone cream

1augmented betamethasone gel

1augmented betamethasone lotion

1augmented betamethasone oint

1betamethasone dipropionate cream

1betamethasone dipropionate lotion

1betamethasone dipropionate oint

1betamethasone valerate cream

2betamethasone valerate foam PA

1betamethasone valerate lotion

1betamethasone valerate oint

2calcipotriene/ betamethasone oint

3CAPEX SHAMPOO

2clobetasol foam PA

2clobetasol lotion PA

2clobetasol propionate cream

2clobetasol propionate emollient cream PA


58


2clobetasol propionate gel PA

2clobetasol propionate oint PA

2clobetasol propionate soln PA

2clobetasol shampoo PA

2clobetasol spray PA

3CLOBEX LOTION PA

3CLOBEX SHAMPOO PA

3CLOBEX SPRAY PA

3CLODERM CREAM/ CLOCORTOLONE CREAM PA

3*CORDRAN CREAM

3*CORDRAN LOTION

3CORDRAN TAPE

3*CUTIVATE CREAM

3CUTIVATE LOTION PA

3*DERMA-SMOOTH/ FS OIL

3DERMATOP CREAM

3*DERMATOP OINT

2DESONATE GEL PA

2desonide cream PA

2desonide lotion PA

2desonide oint

3DESOWEN CREAM PA

3DESOWEN LOTION PA

1desoximetasone cream

2desoximetasone gel

3DESOXIMETASONE OINT 0.05%

2desoximetasone oint 0.25%

2DIFLORASONE CREAM PA

2DIFLORASONE DIACETATE OINT PA

1diflorasone oint

3DIPROLENE AF CREAM

3DIPROLENE LOTION

3DIPROLENE OINT

3ELOCON CREAM

3ELOCON LOTION

3ELOCON OINT

1fluocinolone acetonide cream

2fluocinolone acetonide oil

1fluocinolone acetonide oint

1fluocinolone acetonide topical soln

1fluocinonide cream

1fluocinonide gel

1fluocinonide oint

1fluocinonide soln

2flurandrenolide cream

3*flurandrenolide lotion


59


1fluticasone cream

1fluticasone oint

2fluticasone propionate lotion PA

2halobetasol cream

2halobetasol oint

3HALOG CREAM PA

3HALOG OINT PA

2hydrocortisone butyrate cream

2hydrocortisone butyrate hydrophilic lipo base cream PA

2hydrocortisone butyrate oint

2hydrocortisone butyrate soln

1hydrocortisone cream

1*hydrocortisone lotion 0.25%, 0.5%

1hydrocortisone lotion 1%, 2.5%

1hydrocortisone oint

2hydrocortisone valerate cream

2hydrocortisone valerate oint

3KENALOG SPRAY

3LOCOID CREAM PA

3LOCOID LOTION PA

3LOCOID OINT PA

3LOCOID SOLN PA

1mometasone cream

1mometasone furoate oint

1mometasone lotion

3*NUCORT LOTION

3OLUX FOAM PA

3PANDEL CREAM PA

3*PRAMOSONE LOTION

1prednicarbate cream

1prednicarbate oint

3TACLONEX OINT

3TACLONEX SCALP

3TEMOVATE CREAM

3*TEMOVATE E CREAM

3*TEMOVATE GEL PA

3TEMOVATE OINT PA

3*TEMOVATE SOLN PA

3*TEXACORT SOLN

2TOPICORT CREAM 0.05%

3TOPICORT CREAM 0.25%

3TOPICORT GEL PA

3TOPICORT LP OINT PA

3TOPICORT OINT PA

1triamcinolone cream

1triamcinolone lotion


60


1triamcinolone oint 0.025%, 0.1%, 0.5%

1TRIAMCINOLONE OINT 0.05%

2triamcinolone spray

3ULTRAVATE CREAM PA

3ULTRAVATE LOTION

3ULTRAVATE OINT PA

3VANOS CREAM

3*VERDESO FOAMEMOLLIENT/ KERATOLYTIC AGENTS

3*KERAFOAMEMOLLIENTS

1ammonium lactate cream

1ammonium lactate lotion

3*LAC-HYDRIN CREAM

3*LAC-HYDRIN LOTIONENZYMES - TOPICAL

2SANTYL OINTIMMUNOMODULATING AGENTS - TOPICAL

3ALDARA CREAM

2imiquimod cream

3ZYCLARA CREAMIMMUNOSUPPRESSIVE AGENTS - TOPICAL

2ELIDEL CREAM

3PROTOPIC OINT

2tacrolimus ointKERATOLYTIC/ ANTIMITOTIC AGENTS

3CONDYLOX GEL

3*CONDYLOX SOLN

2podofilox soln

3*SALEX SHAMPOOLOCAL ANESTHETICS - TOPICAL

3EMLA CREAM

1*lidocaine cream

1lidocaine gel

2lidocaine oint ST

2lidocaine patch PA QL=90 Quantity/30 Days

1lidocaine soln

1lidocaine/ prilocaine cream

3LIDODERM PATCH PA QL=90 Quantity/30 Days

3*XYLOCAINE SOLNMISC. TOPICAL

1*aluminum chloride soln

1*DRYSOL SOLNROSACEA AGENTS

2FINACEA FOAM

2FINACEA GEL


61


3METROCREAM

3METROGEL ST

3METROLOTION

2metronidazole cream

2metronidazole gel

1metronidazole lotion

3NORITATE CREAM STSCABICIDES & PEDICULICIDES

3ELIMITE CREAM

2EURAX CREAM

3EURAX LOTION

2lindane lotion 1%

2LINDANE LOTION 1%

2lindane shampoo

2malathion lotion

3*NATROBA SUSP QL=1 Quantity/ Per Dispensing

3OVIDE LOTION

1permethrin cream

3SKLICE LOTION QL=1 Quantity/15 Days

2*SPINOSAD SUSP QL=120 Quantity/ Per Dispensing

3*ULESFIA LOTION QL=4 Quantity/ Per DispensingWOUND CARE PRODUCTS

4REGRANEX GEL NM QL=2 Quantity/15 Days

DIAGNOSTIC PRODUCTSDIAGNOSTIC DRUGS

2*GLUCAGEN INJDIAGNOSTIC TESTS

2*ACCU-CHEK AVIVA PLUS TEST STRIP

2*ACCU-CHEK SMARTVIEW TEST STRIP

2*ACCU-CHEK TEST STRIP

1*CLINISTIX

2*FREESTYLE INSULINX TEST STRIP

2*FREESTYLE LITE TEST STRIP

2*FREESTYLE TEST STRIP

1*KETO-DIASTIX

1*KETOSTIX

2*PRECISION XTRA TEST STRIP

2*URINE TEST STRIP

DIGESTIVE AIDSDIGESTIVE ENZYMES

2CREON CAP

3PANCREAZE CAP ST

3PERTZYE CAP ST

4SUCRAID ORAL SOLN NM PA

3ULTRESA CAP ST

3ZENPEP CAP ST


62


DIURETICSCARBONIC ANHYDRASE INHIBITORS

2acetazolamide ER cap

2acetazolamide inj

1ACETAZOLAMIDE TAB 125MG

1acetazolamide tab 250mg

3DIAMOX SEQUEL CAP

1methazolamide tabDIURETIC COMBINATIONS

3ALDACTAZIDE TAB

1amiloride/ hydrochlorothiazide tab

3DYAZIDE CAP

3MAXZIDE TAB

1spironolactone/ hydrochlorothiazide tab

1triamterene/ hydrochlorothiazide cap 37.5-25mg

2TRIAMTERENE/ HYDROCHLOROTHIAZIDE CAP 50-25MG

1triamterene/ hydrochlorothiazide tabLOOP DIURETICS

2bumetanide inj

1bumetanide tab

3*DEMADEX TAB 100MG

3DEMADEX TAB 5MG, 10MG, 20MG

2EDECRIN TAB

2ethacrynic acid tab

2furosemide inj

1furosemide soln 10mg/ ml

1FUROSEMIDE SOLN 8MG/ ML

1furosemide tab

3LASIX TAB

1torsemide tabPOTASSIUM SPARING DIURETICS

3ALDACTONE TAB

1amiloride tab

2DYRENIUM CAP

1spironolactone tabTHIAZIDES AND THIAZIDE-LIKE DIURETICS

2chlorothiazide inj

1CHLOROTHIAZIDE TAB 250MG

1chlorothiazide tab 500mg

1*CHLORTHALIDONE TAB 100MG

1chlorthalidone tab 25mg

1CHLORTHALIDONE TAB 25MG, 50MG

3DIURIL INJ

2DIURIL SUSP

1hydrochlorothiazide cap


63


1hydrochlorothiazide tab

1indapamide tab

1METHYCLOTHIAZIDE TAB

1metolazone tab

3MICROZIDE CAP

ENDOCRINE AND METABOLIC AGENTS - MISC.BONE DENSITY REGULATORS

3ACTONEL TAB

2ALENDRONATE TAB 40MG

1alendronate tab 5mg, 10mg, 35mg, 70mg

3*ATELVIA TAB ST

3BONIVA INJ PA_BvD

3BONIVA TAB QL=1 Quantity/30 Days

2calcitonin nasal spray

2etidronate disodium tab 200mg

2ETIDRONATE DISODIUM TAB 400MG

4FORTEO INJ LSP NM PA

2FORTICAL SPRAY

3FOSAMAX + D TAB

3FOSAMAX SOLN

3FOSAMAX TAB

2ibandronate inj PA_BvD

2ibandronate tab QL=1 Quantity/30 Days

3MIACALCIN INJ PA_BvD

3MIACALCIN NASAL SPRAY

4NATPARA INJ NM PA

2pamidronate disodium 3mg/ ml, 9mg/ ml PA_BvD

2pamidronate disodium inj 30mg, 90mg

3PAMIDRONATE INJ 6MG/ ML PA_BvD

3PROLIA INJ

3RECLAST INJ

3*risedronate DR tab ST

1risedronate tab

4XGEVA INJ NM PA

2zoledronic acid inj

4ZOLEDRONIC ACID INJ 4MG NM

2zoledronic acid IV soln

4ZOMETA INJ NMGROWTH HORMONE RECEPTOR ANTAGONISTS

4SOMAVERT INJ NM PAGROWTH HORMONES

4NORDITROPIN INJ 10MG/ 1.5ML LSP NM PA

4NORDITROPIN INJ 15MG/ 1.5ML LSP NM PA

4NORDITROPIN INJ 30MG/ 3ML LSP NM PA

4NORDITROPIN INJ 5MG/ 1.5ML LSP NM PAHORMONE RECEPTOR MODULATORS


64


3EVISTA TAB

$0raloxifene tabINSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS)

4INCRELEX INJ NM PA SPLHRH/ GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS

4LUPRON DEPO-PED INJ NM

4LUPRON DEPOT INJ NM

4SYNAREL NASAL SOLN NMMETABOLIC MODIFIERS

4ALDURAZYME INJ NM

4BUPHENYL ORAL POWDER NM

2*BUPHENYL TAB

1calcitriol cap PA_BvD

2calcitriol inj PA_BvD

1calcitriol oral soln PA_BvD

3CARBAGLU TAB PA

3CARNITOR INJ PA_BvD

3CARNITOR ORAL SOLN PA_BvD

3CARNITOR TAB PA_BvD

2doxercalciferol cap PA_BvD

2doxercalciferol inj PA_BvD

4ELAPRASE INJ NM

4FABRAZYME INJ NM

3HECTOROL CAP PA_BvD

3HECTOROL INJ PA_BvD

4KUVAN POWDER PACKET NM PA SP

4KUVAN TAB NM PA SP

2levocarnitine inj PA_BvD

1levocarnitine oral soln PA_BvD

1levocarnitine tab PA_BvD

4MYOZYME/ LUMIZYME INJ NM

4NAGLAZYME INJ NM

4ORFADIN CAP NM PA

2paricalcitol cap PA_BvD

2paricalcitol inj PA_BvD

4RAVICTI LIQUID NM PA

3ROCALTROL CAP PA_BvD

3ROCALTROL SOLN PA_BvD

2SENSIPAR TAB

2sodium phenylbutyrate oral powder

4STRENSIQ INJ NM PA

3ZEMPLAR CAP PA_BvD

3ZEMPLAR INJ PA_BvDPOSTERIOR PITUITARY HORMONES

3DDAVP INJ

3DDAVP NASAL SOLN


65


3DDAVP NASAL SPRAY

3DDAVP TAB

2desmopressin inj

2desmopressin nasal soln

2desmopressin nasal spray

2desmopressin tab

2STIMATE NASAL SPRAYPROLACTIN INHIBITORS

1cabergoline tabSOMATOSTATIC AGENTS

2octreotide inj

4SANDOSTATIN INJ LSP NM

3SANDOSTATIN INJ 50MCG/ ML

4SANDOSTATIN KIT LAR INJ LSP NM

4SIGNIFOR INJ NM PA QL=60 Quantity/30 Days

4SOMATULINE INJ NM

ESTROGENSESTROGEN COMBINATIONS

3ACTIVELLA TAB

3ANGELIQ TAB

3CLIMARA PRO PATCH

3COMBIPATCH

1*esterified estrogens/ methyltestosterone tab

3FEMHRT LOW DOSE TAB

$0jinteli tab

$0mimvey LO tab

2mimvey tab

$0norethindrone acetate/ ethinyl estradiol tab

3PREFEST TAB

2PREMPHASE TAB

2PREMPRO TABESTROGENS

3ALORA/ MINIVELLE PATCH

3CLIMARA PATCH

3DELESTROGEN INJ

3DEPO ESTRADIOL INJ

3ESTRACE TAB

1estradiol patch

1estradiol tab

2estradiol twice weekly patch

2estradiol valerate inj

1estropipate tab 0.75mg, 1.5mg

1ESTROPIPATE TAB 0.75MG, 1.5MG, 3MG

3EVAMIST SPRAY

3MENEST TAB

3MENOSTAR PATCH


66


3PREMARIN INJ

2PREMARIN TAB

3VIVELLE-DOT PATCH

FLUOROQUINOLONESFLUOROQUINOLONES

3AVELOX INJ

3AVELOX TAB

3CIPRO D5W IV INJ

3CIPRO SUSP

3CIPRO TAB

3*CIPRO XR TAB

2ciprofloxacin ER tab

2ciprofloxacin inj

2ciprofloxacin susp

1ciprofloxacin tab

2CIPROFLOXACN INJ

3*LEVAQUIN ORAL SOLN

3LEVAQUIN TAB

2levofloxacin inj

1levofloxacin oral soln

1levofloxacin tab

2levofloxacin/ d5w inj

3MOXIFLOXACIN INJ

2moxifloxacin tab

3*NOROXIN TAB

2OFLOXACIN TAB

GASTROINTESTINAL AGENTS - MISC.BILE ACID SYNTHESIS DISORDER AGENTS

4CHOLBAM CAP NM PAGALLSTONE SOLUBILIZING AGENTS

3ACTIGALL CAP

4CHENODAL TAB NM

3URSO FORTE TAB

3URSO TAB

1ursodiol cap

2ursodiol tabGASTROINTESTINAL ANTIALLERGY AGENTS

2cromolyn soln

3GASTROCROM SOLNGASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS

3AMITIZA CAP PAGASTROINTESTINAL STIMULANTS

2metoclopramide inj

1metoclopramide soln

1metoclopramide tab

3REGLAN TAB


67


INFLAMMATORY BOWEL AGENTS

2APRISO CAP

2ASACOL HD/ MESALAMINE TAB

3AZULFIDINE DR TAB

3AZULFIDINE TAB

1balsalazide cap

2CANASA SUPP

4CIMZIA KIT LSP NM PA

3COLAZAL CAP

2DELZICOL CAP

3DIPENTUM CAP

2LIALDA TAB

2mesalamine enema

2mesalamine enema kit

3PENTASA CR CAP ST

4REMICADE INJ NM PA

3SFROWASA ENEMA

1sulfasalazine EC tab

1sulfasalazine tabINTESTINAL ACIDIFIERS

1lactulose solnIRRITABLE BOWEL SYNDROME (IBS) AGENTS

2alosetron tab

3LINZESS CAP PA QL=30 Quantity/30 Days

3LOTRONEX TABPERIPHERAL OPIOID RECEPTOR ANTAGONISTS

3MOVANTIK TAB PA

3RELISTOR INJ PA

3RELISTOR INJ KIT PAPHOSPHATE BINDER AGENTS

3AURYXIA TAB

1calcium acetate cap

1calcium acetate tab

3ELIPHOS TAB

2FOSRENOL CHEW TAB

2FOSRENOL POWDER PACK

3PHOSLO CAP

2PHOSLYRA SOLN

3RENAGEL TAB

2RENVELA PACKET

2RENVELA/ SEVELAMER CARBONATE TAB

3VELPHORO CHEW TABSHORT BOWEL SYNDROME (SBS) AGENTS

4GATTEX INJ NM PA

GENITOURINARY AGENTS - MISCELLANEOUSALKALINIZERS


68


1*CYTRA-3 SYRUP

1*ORACIT SOLN

2potassium citrate CR tab 15meq

2potassium citrate CR tab 5meq, 10meq

1*potassium citrate/ citric acid granule

1*potassium citrate/ citric acid soln

1*sodium citrate/ citric acid soln

1*tricitrates soln

3UROCIT-K TABCYSTINOSIS AGENTS

2CYSTAGON CAP PAGENITOURINARY IRRIGANTS

2neomycin/ polymyxin gu irrigation soln

2sodium chloride irrigation solnINTERSTITIAL CYSTITIS AGENTS

2ELMIRON CAPPROSTATIC HYPERTROPHY AGENTS

1alfuzosin tab

3AVODART CAP

3CARDURA XL TAB

2dutasteride cap

2dutasteride/ tamsulosin cap

1finasteride tab

3FLOMAX CAP

3JALYN CAP

3PROSCAR TAB

3RAPAFLO CAP

1tamsulosin cap

2UROXATRAL TABURINARY ANALGESICS

1*phenazopyridine tab

3*PYRIDIUM TABURINARY STONE AGENTS

3LITHOSTAT TAB

3THIOLA TAB

GOUT AGENTSGOUT AGENT COMBINATIONS

1probenecid/ colchicine tabGOUT AGENTS

1allopurinol tab

3COLCHICINE/ COLCRYS TAB PA

2MITIGARE CAP

2ULORIC TAB ST

3ZYLOPRIM TABURICOSURICS

1probenecid tab


69


HEMATOLOGICAL AGENTS - MISC.BRADYKININ B2 RECEPTOR ANTAGONISTS

4FIRAZYR INJ NM PACOMPLEMENT INHIBITORS

4BERINERT INJ KIT NM PA

4CINRYZE INJ NM PA

4RUCONEST INJ NM PAHEMATORHEOLOGIC AGENTS

1pentoxifylline ER tabPLATELET AGGREGATION INHIBITORS

2AGGRENOX CAP

3AGRYLIN CAP

1anagrelide cap

3BRILINTA TAB

1cilostazol tab

1clopidogrel tab

1dipyridamole tab

2EFFIENT TAB

3PERSANTINE TAB

3PLAVIX TAB

3*PLETAL TAB

1*ticlopidine tab 250mg

1*TICLOPIDINE TAB 250MG

3ZONTIVITY TAB PA

HEMATOPOIETIC AGENTSAGENTS FOR GAUCHER DISEASE

4CEREZYME INJ NM

4VPRIV INJ NM

4ZAVESCA CAP NM PAAGENTS FOR SICKLE CELL ANEMIA

2DROXIA CAPCOBALAMINS

1*cyanocobalamin inj

3*NASCOBAL SPRAYFOLIC ACID/ FOLATES

$0*folic acid tab

$0*folic acid tab 1mgHEMATOPOIETIC GROWTH FACTORS

3ARANESP INJ 100MCG/ 0.5ML PA_BvD ST

3ARANESP INJ 100MCG/ ML PA_BvD ST








70










2EPOGEN INJ PA_BvD

4GRANIX INJ LSP NM

2*LEUKINE INJ

4NEULASTA INJ LSP NM

2*NEUMEGA INJ

3PROCRIT INJ PA_BvD

4PROMACTA TAB LSP NM PA

4ZARXIO INJ NM SPHEMATOPOIETIC MIXTURES

1*ferrex forte cap

1*folbee tab

1*IRON POLYSACCH/ THREONIC ACID/ B12/ FA CAP

1*multigen folic tab

1*multigen plus tab

1*multigen tab

3*MULTIVITAMIN TAB

3*multivitamin tab

3*REPLIVA TAB

1*tricon capIRON

$0*ferrous sulfate elixir

$0*FERROUS SULFATE LIQUID

$0*ferrous sulfate soln

$0*FERROUS SULFATE SYRUP

$0*IRON SUSPSTEM CELL MOBILIZERS

4MOZOBIL INJ NM

HEMOSTATICSHEMOSTATICS - SYSTEMIC

3*AMICAR SYRUP

3*AMICAR TAB

1*aminocaproic acid syrup

3*AMINOCAPROIC ACID TAB 1000MG

1*aminocaproic acid tab 500mg

3CYKLOKAPRON INJ

3LYSTEDA TAB

2tranex acid tab

2tranexamic acid IV soln


71


HYPNOTICSBARBITURATE HYPNOTICS

3BUTISOL SODIUM

1phenobarbital elixir

1PHENOBARBITAL TAB 15MG, 30MG, 60MG, 100MG

1phenobarbital tab 16.2mg, 32.4mg, 64.8mg, 97.2mgNON-BARBITURATE HYPNOTICS

3AMBIEN TAB 10MG QL=30 Quantity/30 Days

3AMBIEN TAB 5MG QL=60 Quantity/30 Days

1estazolam tab

1eszopiclone tab QL=30 Quantity/30 Days

1FLURAZEPAM CAP

3HALCION TAB

3LUNESTA TAB QL=30 Quantity/30 Days

3RESTORIL CAP

3SONATA CAP QL=30 Quantity/30 Days

1temazepam cap 15mg, 30mg

2temazepam cap 7.5mg, 22.5mg

1triazolam tab

1zaleplon cap QL=30 Quantity/30 Days

1zolpidem tab 10mg QL=30 Quantity/30 Days

1zolpidem tab 5mg QL=60 Quantity/30 DaysSELECTIVE MELATONIN RECEPTOR AGONISTS

4HETLIOZ CAP NM PA QL=30 Quantity/30 Days

3ROZEREM TAB PA QL=30 Quantity/30 Days

HYPNOTICS/ SEDATIVES/ SLEEP DISORDER AGENTSBARBITURATE HYPNOTICS

2*SECONAL CAPNON-BARBITURATE HYPNOTICS

1TRIAZOLAM TAB

LAXATIVESLAXATIVE COMBINATIONS

3COLYTE FLAVOR PACK

$0gavilyte-G soln

3GOLYTELY SOLN

2MOVIPREP

$0peg 3350/ electrolytes soln

$0trilyte solnLAXATIVES - MISCELLANEOUS

3KRISTALOSE PACKET

1lactulose soln

2polyethylene glycol bulk powder 3350SALINE LAXATIVES

3OSMOPREP TAB

LOCAL ANESTHETICS-PARENTERAL


72


LOCAL ANESTHETICS - AMIDES

2lidocaine inj

3XYLOCAINE INJ

MACROLIDESAZITHROMYCIN

2azithromycin inj

1azithromycin susp

1azithromycin tab

3ZITHROMAX INJ

3ZITHROMAX POWDER PACK

3ZITHROMAX SUSP

3ZITHROMAX TAB

3ZITHROMAX TAB Z-PACK

3ZMAX SUSPCLARITHROMYCIN

3BIAXIN SUSP

3BIAXIN TAB

3*BIAXIN XL TAB

2clarithromycin ER tab

1clarithromycin susp

1clarithromycin tabERYTHROMYCINS

1ERY-TAB TAB

2ERYPED SUSP

3ERYTHROCIN INJ

1*ERYTHROMYCIN CAP

1*erythromycin DR cap

1*erythromycin stearate tab

2erythromycin susp

2ERYTHROMYCIN TAB

3PCE EC TABFIDAXOMICIN

4DIFICID TAB NM ST QL=20 Quantity/5 Days

MEDICAL DEVICESBANDAGES-DRESSINGS-TAPE

2GAUZE PADCONTRACEPTIVES

$0*CERVICAL CAP

$0*DIAPHRAGM

$0*FEMALE CONDOMSDIABETIC SUPPLIES

$0*ACCU-CHEK NANO METER

1*CALIBRATION LIQUID

$0*FREESTYLE FREEDOM LITE METER

$0*FREESTYLE KIT INSULINX

$0*FREESTYLE LITE METER


73


1*LANCET DEVICE

1*LANCET KIT

1*LANCETS

$0*PRECISION XTRA METERMISC. DEVICES

2ALCOHOL SWABSPARENTERAL THERAPY SUPPLIES

2INSULIN SYRINGE

2PEN NEEDLERESPIRATORY THERAPY SUPPLIES

2*AEROCHAMBER

1*PEAK FLOW METER

MEDICAL DEVICES AND SUPPLIESDIABETIC SUPPLIES

$0*ACCU-CHEK AVIVA PLUS METER

$0*ACCU-CHEK NANO SMARTVIEW METER

MIGRAINE PRODUCTSMIGRAINE COMBINATIONS

1*acetaminophen/ isometheptene/ dichloral capMIGRAINE PRODUCTS

3*D.H.E. INJ

2dihydroergotamine inj

2ERGOMAR SL TAB

3MIGRANAL/ DIHYDROERGOTAMINE SPRAY QL=16 Quantity/30 DaysSEROTONIN AGONISTS

2almotriptan tab QL=18 Quantity/30 Days

3*ALSUMA INJ QL=4 Quantity/ Per Dispensing

3AMERGE TAB QL=18 Quantity/30 Days

3AXERT TAB QL=18 Quantity/30 Days

3FROVA TAB QL=18 Quantity/30 Days

2frovatriptan tab QL=18 Quantity/30 Days

3IMITREX INJ QL=10 Quantity/30 Days

3IMITREX TAB QL=18 Quantity/30 Days

3MAXALT MLT TAB QL=36 Quantity/60 Days

3MAXALT TAB QL=36 Quantity/60 Days

2naratriptan tab QL=18 Quantity/30 Days

3RELPAX TAB QL=18 Quantity/30 Days

1rizatriptan ODT QL=36 Quantity/60 Days

1rizatriptan tab QL=36 Quantity/60 Days

1sumatriptan auto-injector 4mg/ 0.5ml QL=10 Quantity/30 Days

1sumatriptan auto-injector 6mg/ 0.5ml QL=10 Quantity/30 Days

1sumatriptan inj 4mg/ 0.5ml, 6mg/ 0.5ml QL=10 Quantity/30 Days

1SUMATRIPTAN INJ 6MG/ 0.5ML QL=10 Quantity/30 Days

2sumatriptan nasal spray QL=12 Quantity/30 Days

1sumatriptan refill inj 4mg/ 0.5ml, 6mg/ 0.5ml QL=10 Quantity/30 Days

1sumatriptan tab QL=18 Quantity/30 Days


74


2SUMATRIPTAN/ IMITREX NASAL SPRAY QL=12 Quantity/30 Days

3SUMAVEL DOSEPRO INJ QL=10 Quantity/30 Days

2zolmitriptan ODT QL=18 Quantity/30 Days

2zolmitriptan tab QL=18 Quantity/30 Days

3ZOMIG NASAL SPRAY 2.5MG QL=16 Quantity/30 Days

3ZOMIG NASAL SPRAY 5MG QL=12 Quantity/30 Days

3ZOMIG TAB QL=18 Quantity/30 Days

3ZOMIG ZMT TAB QL=18 Quantity/30 Days

MINERALS & ELECTROLYTESBICARBONATES

2sodium lactate injCHLORIDE

2ammonium chloride injELECTROLYTE MIXTURES

2d10w/ nacl inj

2D10W/ NACL INJ

2d2.5w/ nacl inj

2D5W/ NACL INJ

2d5w/ nacl inj

2dextrose 5% in lactated ringers

2ELECTROLYTE/ D5W INJ

2IONOSOL-B/ D5W INJ

2IONOSOL-MB/ D5W INJ

2ISOLYTE-P/ D5W INJ

2ISOLYTE-S INJ

2kcl/ d5w inj

2kcl/ d5w/ lr inj

2KCL/ D5W/ LR INJ

2kcl/ d5w/ nacl inj

2KCL/ D5W/ NACL INJ

2kcl/ nacl inj

2lactated ringers inj

2NORMOSOL INJ

2NORMOSOL-M/ D5W INJ

2NORMOSOL-R INJ

2normosol-R inj

2PLASMA-LYTE INJ

2PLASMA-LYTE-A INJ

2PLASMA-LYTE/ D5W INJ

2ringers inj

2tpn electrolyte injFLUORIDE

$0*FLUOR-A-DAY TAB

$0*LURIDE SOLN

$0*LURIDE TAB

$0*sodium fluoride chew tab


75


$0*sodium fluoride soln

$0*SODIUM FLUORIDE TABMAGNESIUM

2magnesium sulfate inj

3MAGNESIUM SULFATE/ D5W INJ

2magnesium sulfate/ d5w injPHOSPHATE

3*K-PHOS NEUTRAL TAB

2*K-PHOS TAB

1*phospha 250 neutral tabPOTASSIUM

3K-TABS CR TAB

2KLOR-CON M15 TAB

1klor-con m20 ER tab

3*KLOR-CON POWDER PACKET

3*MICRO-K CAP

1*potassium bicarbonate effer tab

1*potassium chloride effer tab

1potassium chloride ER cap

1potassium chloride ER tab

1POTASSIUM CHLORIDE ER TAB 8MEQ, 20MEQ

2potassium chloride inj

1potassium chloride liquid

1*potassium chloride powder packetSODIUM

2sodium chloride injZINC

1*zinc sulfate cap

MOUTH/ THROAT/ DENTAL AGENTSANESTHETICS TOPICAL ORAL

3*FIRST MOUTHWASH BLM SUSP

1LIDOCAINE ORAL SOLN 4%

1lidocaine viscous soln

3*LTA 360 KITANTI-INFECTIVES - THROAT

1clotrimazole troche

3*FIRST DUKES MOUTHWASH

3*FIRST MARYS MOUTHWASH

1nystatin susp

3ORAVIG TABANTISEPTICS - MOUTH/ THROAT

3*PERIDEX SOLN

1periogard solnDENTAL PRODUCTS

2*PREVIDENT 5000 BOOSTER PASTE

2*PREVIDENT 5000 DRY MOUTH GEL


76


2*PREVIDENT RINSE

$0*sodium fluoride cream

1*sodium fluoride gel

1*sodium fluoride paste

1*sodium fluoride rinse

1*sodium fluoride/ potassium nitrate pasteSTEROIDS - MOUTH/ THROAT

1triamcinolone/ oragel pasteTHROAT PRODUCTS - MISC.

2cevimeline cap

3EVOXAC CAP

1pilocarpine tab

3SALAGEN TAB

MULTIVITAMINSB-COMPLEX W/ FOLIC ACID

3*B-complex multivitamin tab

3*CEFOL TAB

1*DIALYVITE TAB

1*DIALYVITE/ IRON TAB

1*DIALYVITE/ ZINC TAB

3*DIATZ ZN TAB

1*FOLBEE PLUS CZ TAB

3*NEPHRO CAP

1*renaphro cap

1*SM B-COMPLEX/ VITAMIN C TABMULTIPLE VITAMINS W/ MINERALS

1*multivitamins w/ minerals tab

3*STROVITE TABPED MULTI VITAMINS W/ FL & FE

3*ESCAVITE CHEW TAB

1*pediatric multiple vitamins/ fluoride/ iron solnPED MV W/ FLUORIDE

3*pediatric multiple vitamins/ fluoride chew tab

1*pediatric multiple vitamins/ fluoride soln

3*QUFLORA PEDIATRIC CHEW TAB

3*QUFLORA PEDIATRIC DROPPRENATAL VITAMINS

3*PRENATAL VITAMIN (RX ONLY)

1*PRENATAL VITAMINS (PRENATAL PLUS/ PREPLUS/ PRENAPLUS)

MUSCULOSKELETAL THERAPY AGENTSCENTRAL MUSCLE RELAXANTS

1baclofen tab

1carisoprodol tab

1chlorzoxazone tab

1cyclobenzaprine tab 5mg, 10mg


77


2cyclobenzaprine tab 7.5mg

3FEXMID TAB

3METAXALONE TAB 400MG

2metaxalone tab 800mg

1methocarbamol tab

2orphenadrine citrate inj

1orphenadrine ER tab

3*PARAFON FORTE TAB

3*ROBAXIN TAB

3SKELAXIN TAB

3SOMA TAB

2tizanidine cap

1tizanidine tab

3ZANAFLEX CAPDIRECT MUSCLE RELAXANTS

2DANTRIUM CAP 100MG

3DANTRIUM CAP 25MG, 50MG

2dantrolene capMUSCLE RELAXANT COMBINATIONS

1carisoprodol/ aspirin tab

2carisoprodol/ aspirin/ codeine tab

NASAL AGENTS - SYSTEMIC AND TOPICALNASAL AGENT COMBINATIONS

3DYMISTA NASAL INHALER PANASAL ANTIALLERGY

3ASTEPRO NASAL SPRAY

2azelastine nasal spray

2olopatadine nasal spray

3PATANASE NASAL SPRAYNASAL ANTICHOLINERGICS

3ATROVENT NASAL SOLN

1ipratropium nasal sprayNASAL ANTI-INFECTIVES

3BACTROBAN NASAL OINTNASAL STEROIDS

3BECONASE AQ NASAL SUSP ST QL=2 Quantity/15 Days

2budesonide nasal spray ST QL=2 Quantity/15 Days

1flunisolide nasal spray QL=2 Quantity/15 Days

1fluticasone nasal spray QL=2 Quantity/15 Days

2mometasone nasal spray ST QL=2 Quantity/15 Days

3*NASACORT AQ NASAL SPRAY (RX ONLY) QL=2 Quantity/15 Days

2NASONEX NASAL SPRAY ST QL=2 Quantity/15 Days

3OMNARIS NASAL SPRAY ST QL=2 Quantity/15 Days

3QNASL CHILDRENS INHALER ST QL=2 Quantity/15 Days

3QNASL INHALER ST QL=2 Quantity/15 Days

2triamcinolone nasal spray (rx only) QL=2 Quantity/15 Days


78


3VERAMYST NASAL SPRAY ST QL=2 Quantity/15 Days

3ZETONNA NASAL SOLN ST QL=2 Quantity/15 Days

NEUROMUSCULAR AGENTSALS AGENTS

4RILUTEK TAB NM

2riluzole tab

NUTRIENTSCARBOHYDRATES

2dextrose inj PA_BvDLIPIDS

2intralipid inj 20% PA_BvD

3INTRALIPID INJ 30% PA_BvD

3LIPOSYN III IV SOLN PA_BvDPROTEINS

2AMINOSYN II 8.5%/ ELECTROLYTE INJ PA_BvD

3AMINOSYN II INJ PA_BvD

2AMINOSYN II INJ 4.25 PA_BvD

3AMINOSYN INJ 7% PA_BvD

3AMINOSYN M INJ PA_BvD

2aminosyn-hf inj PA_BvD

3AMINOSYN-RF INJ 5.2% PA_BvD

2CLINIMIX E INJ PA_BvD

2CLINIMIX INJ PA_BvD

3CLINIMIX INJ 2.75/ D5W PA_BvD

3FREAMINE HBC INJ PA_BvD

2HEPATAMINE SOLN PA_BvD

3NEPHRAMINE INJ PA_BvD

2novamine inj PA_BvD

2premasol inj PA_BvD

3PROCALAMINE INJ PA_BvD

3PROSOL INJ PA_BvD

3TROPHAMINE INJ PA_BvD

OPHTHALMIC AGENTSARTIFICIAL TEARS AND LUBRICANTS

2LACRISERT OPHTH INSERTBETA-BLOCKERS - OPHTHALMIC

3BETAGAN OPHTH SOLN

1betaxolol ophth soln

2BETIMOL OPHTH SOLN

2BETOPTIC-S OPHTH SOLN

1carteolol ophth soln

2COMBIGAN OPHTH SOLN

3COSOPT OPHTH SOLN

2COSOPT PF OPHTH SOLN

1dorzolamide/ timolol ophth soln

2ISTALOL OPHTH SOLN


79


1*levobunolol ophth soln 0.25%

1levobunolol ophth soln 0.5%

2METIPRANOLOL OPHTH SOLN

1timolol maleate ophth soln

1timolol ophth gel

3TIMOPTIC OCUDOSE OPHTH SOLN

3*TIMOPTIC OPHTH SOLN

3TIMOPTIC-XE OPHTH SOLNCYCLOPLEGIC MYDRIATICS

1atropine sulfate ophth soln 1%

1ATROPINE SULFATE OPHTH SOLN 1%

3*CYCLOGYL OPHTH SOLN

1*cyclopentolate ophth soln

1*homatropine ophth soln

3*ISOPTO ATROPINE OPHTH SOLN

3*MYDRIACYL OPHTH SOLN

1*tropicamide ophth solnMIOTICS

3ISOPTO CARPINE OPHTH SOLN

2PHOSPHOLINE OPHTH SOLN

1pilocarpine ophth solnOPHTHALMIC ADRENERGIC AGENTS

2ALPHAGAN P OPHTH SOLN

2apraclonidine ophth soln

1brimonidine ophth soln

3IOPIDINE OPHTH SOLN 0.5%

2IOPIDINE OPHTH SOLN 1%

2SIMBRINZA OPHTH SUSPOPHTHALMIC ANTI-INFECTIVES

2AZASITE OPHTH SOLN

2BACITRACIN OPHTH OINT

1bacitracin/ neomycin/ polymyxin b ophth oint

1bacitracin/ polymyxin b ophth oint

3BESIVANCE OPHTH SUSP ST

3BLEPH-10 OPHTH SOLN

3CILOXAN OPHTH OINT

3CILOXAN OPHTH SOLN

1ciprofloxacin ophth soln

1erythromycin ophth oint

2gatifloxacin ophth soln ST

1gentamicin ophth oint

1gentamicin ophth soln

2levofloxacin opth soln

2MOXEZA OPHTH SOLN

2NATACYN OPHTH SUSP

1neomycin/ gramicidin/ polymyxin b ophth soln


80


3NEOSPORIN OPHTH SOLN

3OCUFLOX OPHTH DROP

1ofloxacin ophth soln

1polymyxin b/ trimethoprim ophth soln

3POLYTRIM OPHTH SOLN

1sodium sulfacetamide ophth soln

2SULFACETAMIDE SODIUM OPHTH OINT

1tobramycin ophth soln

3TOBREX OPHTH OINT

3TOBREX OPHTH SOLN

2trifluridine ophth soln

2VIGAMOX OPHTH SOLN

3VIROPTIC OPHTH SOLN

2ZIRGAN OPHTH GEL

3ZYMAXID OPHTH SOLN STOPHTHALMIC DECONGESTANTS

3*MYDFRIN OPHTH SOLN

3NAPHAZOLINE OPHTH SOLN

1*phenylephrine ophth solnOPHTHALMIC IMMUNOMODULATORS

2RESTASIS OPHTH EMULSIONOPHTHALMIC LOCAL ANESTHETICS

3ALCAINE OPHTH SOLN

1proparacaine ophth solnOPHTHALMIC STEROIDS

2ALREX OPHTH SUSP

1bacitracin/ polymyxin/ neomcyin/ hydrocortisone ophth oint

2BLEPHAMIDE OPHTH SUSP

3BLEPHAMIDE S.O.P OPHTH OINT

1dexamethasone ophth soln

1DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN

2DUREZOL OPHTH EMULSION

3FLAREX OPHTH SUSP

1fluorometholone ophth susp

3FML FORTE OPHTH SUSP

3FML LIQUIFLM OPHTH SUSP

3FML OPHTH OINT

2LOTEMAX OPHTH GEL

2LOTEMAX OPHTH OINT

2LOTEMAX OPHTH SUSP

2MAXIDEX OPHTH SUSP

3MAXITROL OPHTH OINT

3MAXITROL OPHTH SUSP

1neomycin/ polymyxin/ dexamethasone ophth oint


81


1neomycin/ polymyxin/ dexamethasone ophth susp

1neomycin/ polymyxin/ hydrocortisone ophth susp

3PRED FORTE OPHTH SUSP

2PRED MILD OPHTH SUSP

2PRED-G OPHTH SUSP

3PRED-G S.O.P OPHTH OINT

1prednisolone ophth susp

2PREDNISOLONE SODIUM PHOSPHATE OPHTH SOLN

1sulfacetamide/ prednisolone ophth soln

2TOBRADEX OPHTH OINT

3TOBRADEX OPHTH SUSP

3TOBRADEX ST OPHTH SOLN

1tobramycin/ dexamethasone ophth susp

2VEXOL OPHTH SUSP

2ZYLET OPHTH SUSPOPHTHALMICS - MISC.

3ACULAR LS OPHTH SOLN

3ACULAR OPHTH SOLN

3ACUVAIL OPHTH SOLN

2ALOCRIL OPHTH SOLN

2ALOMIDE OPHTH SOLN

1azelastine ophth soln

2AZOPT OPHTH SUSP

3BEPREVE OPHTH SOLN

2bromfenac ophth soln

2BROMFENAC OPHTH SOLN (TWICE DAILY)

1cromolyn sodium ophth soln

4CYSTARAN OPHTH SOLN NM PA SP QL=4 Quantity/30 Days

1diclofenac ophth soln

1dorzolamide ophth soln

3ELESTAT OPHTH SOLN

3EMADINE OPHTH SOLN

2epinastine ophth soln

1flurbiprofen ophth soln

2ILEVRO OPHTH SUSP

1ketorolac ophth soln

1*ketotifen ophth soln

3LASTACAFT OPHTH SOLN

2NEVANAC OPHTH SUSP

3OCUFEN OPHTH SOLN

2olopatadine ophth soln

2PATADAY OPHTH SOLN ST

3PATANOL OPHTH SOLN

2PROLENSA OPHTH SOLN

3TRUSOPT OPHTH SOLN


82


PROSTAGLANDINS - OPHTHALMIC

2BIMATOPROST OPHTH SOLN QL=2 Quantity/30 Days

1latanoprost ophth soln QL=2 Quantity/30 Days

2LUMIGAN OPHTH SOLN QL=2 Quantity/30 Days

2TRAVATAN Z OPHTH SOLN QL=2 Quantity/30 Days

2TRAVOPROST OPHTH SOLN QL=1 Quantity/30 Days

3XALATAN OPHTH SOLN QL=2 Quantity/30 Days

3ZIOPTAN OPHTH SOLN ST QL=1 Quantity/30 Days

OTIC AGENTSOTIC AGENTS - MISCELLANEOUS

1acetic acid otic soln

1ACETIC ACID/ ALUMINUM ACETATE OTIC SOLN

3*CRESYLATE OTIC SOLNOTIC ANTI-INFECTIVES

2*CIPROFLOXACIN OTIC SOLN

2ofloxacin otic solnOTIC COMBINATIONS

1*aero otic hydrocortisone soln

3CIPRO HC OTIC SUSP

2CIPRODEX OTIC SUSP

2COLY-MYCIN S OTIC SUSP

3*CORTANE-B AQUEOUS OTIC SOLN

3*CORTANE-B OTIC SOLN

3*CORTISPORIN OTIC SOLN

1neomycin/ polymyxin/ hydrocortisone otic soln

1neomycin/ polymyxin/ hydrocortisone otic susp

1*zotane hydrocortisone otic solnOTIC STEROIDS

3ACETASOL HC OTIC SOLN

1acetic acid/ hydrocortisone otic soln

3*DERMOTIC OIL

2fluocinolone otic oil

OXYTOCICSOXYTOCICS

2methylergonovine tab

PASSIVE IMMUNIZING AGENTSIMMUNE SERUMS

4BIVIGAM INJ NM PA

4CARIMUNE INJ NM PA

4FLEBOGAMMA INJ NM PA

2GAMASTAN S/ D INJ PA

4GAMMAGARD INJ NM PA

4HIZENTRA INJ NM PA_BvD SP

3HYPERRAB INJ PA_BvD

4OCTAGAM INJ NM PA


83


4PRIVIGEN INJ NM PAMONOCLONAL ANTIBODIES

4SYNAGIS INJ NM PA

PASSIVE IMMUNIZING AND TREATMENT AGENTSIMMUNE SERUMS

4CUVITRU INJ 8GM/ 40ML NM PA_BvD SP

PENICILLINSAMINOPENICILLINS

1amoxicillin cap

1amoxicillin chew tab 125mg

1AMOXICILLIN CHEW TAB 250MG

1amoxicillin susp

1amoxicillin tab

1ampicillin cap

2ampicillin inj

2AMPICILLIN SODIUM INJ

2ampicillin suspNATURAL PENICILLINS

2BICILLIN LA INJ

2PENICILLIN G PROCAINE INJ

2PENICILLIN G SODIUM INJ

2penicillin gk inj

2PENICILLIN GK/ DEXTROSE INJ

1penicillin vk soln

1penicillin vk tabPENICILLIN COMBINATIONS

1amoxicillin/ k clavulanate chew tab

2amoxicillin/ k clavulanate ER tab

1amoxicillin/ k clavulanate susp

1amoxicillin/ k clavulanate tab

2AMPICILLIN/ SULBACTAM INJ 1.5GM

2ampicillin/ sulbactam inj 2-1gm, 10-5gm

3AMPICILLIN/ SULBACTAM INJ 3GM

1AUGMENTIN CHEW TAB

3*AUGMENTIN SUSP

3AUGMENTIN SUSP 125MG/ 5ML

3*AUGMENTIN TAB

3*AUGMENTIN XR TAB

2BICILLIN CR INJ

2piperacillin/ tazobactam inj

3UNASYN BULK PACK

3UNASYN INJ

3ZOSYN INJ

3ZOSYN/ DEXTROSE INJPENICILLINASE-RESISTANT PENICILLINS

2ampicillin inj


84


2BACTOCILL/ DEXTROSE INJ

1dicloxacillin cap

2oxacillin inj

PROGESTINSPROGESTINS

3AYGESTIN TAB

1medroxyprogesterone acetate tab

3MEGACE ES SUSP PA

2megestrol ES susp PA

1norethindrone acetate tab

2progesterone cap

3PROMETRIUM CAP

3PROVERA TAB

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.AGENTS FOR CHEMICAL DEPENDENCY

2acamprosate calcium tab

2ANTABUSE TAB

2disulfiram tabANTI-CATAPLECTIC AGENTS

4XYREM SOLN NM PA QL=540 Quantity/30 DaysANTIDEMENTIA AGENTS

3ARICEPT TAB 23MG ST QL=30 Quantity/30 Days

3ARICEPT TAB 5MG, 10MG QL=60 Quantity/30 Days

1donepezil ODT QL=30 Quantity/30 Days

2donepezil tab 23mg ST QL=30 Quantity/30 Days

1donepezil tab 5mg, 10mg QL=60 Quantity/30 Days

3EXELON CAP

3EXELON PATCH

2galantamine ER cap

2GALANTAMINE SOLN

1galantamine tab

2memantine soln

1memantine tab

1memantine tab titration pack

3NAMENDA SOLN

3NAMENDA TAB

3NAMENDA TAB TITRATION PACK

2NAMENDA XR CAP

2NAMZARIC ER CAP ST

3RAZADYNE ER CAP

3RAZADYNE TAB

1rivastigmine cap

2rivastigmine patchCOMBINATION PSYCHOTHERAPEUTICS

1chlordiazepoxide/ amitriptyline tab

2olanzapine/ fluoxetine cap


85


1PERPHENAZINE/ AMITRIPTYLINE TAB

3SYMBYAX CAPFIBROMYALGIA AGENTS

2SAVELLA TAB QL=60 Quantity/30 Days

2SAVELLA TAB TITRATION PACKMOVEMENT DISORDER DRUG THERAPY

4tetrabenazine tab LSP NM PA

4XENAZINE TAB LSP NM PAMULTIPLE SCLEROSIS AGENTS

4AMPYRA TAB NM PA SP QL=60 Quantity/30 Days

4AUBAGIO TAB NM PA SP QL=30 Quantity/30 Days

4AVONEX AUTO INJECTOR KIT LSP NM

4AVONEX KIT LSP NM

4AVONEX PREFILLED INJ KIT LSP NM

4COPAXONE INJ LSP NM

4EXTAVIA INJ LSP NM ST

4GILENYA CAP LSP NM PA QL=30 Quantity/30 Days

4PLEGRIDY PEN INJECTOR LSP NM

4PLEGRIDY PEN STARTER PACK LSP NM

4PLEGRIDY PREFILLED SYRINGE LSP NM

4TECFIDERA CAP LSP NM

4TECFIDERA CAP STARTER PACK LSP NM

4TYSABRI INJ NM PAPSEUDOBULBAR AFFECT (PBA) AGENTS

2NUEDEXTA CAP QL=60 Quantity/30 DaysPSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.

2ergoloid mesylates tab

2ERGOLOID MESYLATES TAB 1MG

3ORAP TAB 1MG

3*ORAP TAB 2MG

2pimozide tab 1mg, 2mgSMOKING DETERRENTS

$0buproban tab

$0CHANTIX PAK

$0CHANTIX TAB

$0*COMMIT LOZENGE

$0*NICORETTE CQ PATCH

$0*NICORETTE GUM

$0*nicotine gum

$0*nicotine lozenge

$0*nicotine patch

$0*NICOTINE PATCH KIT

$0NICOTROL INHALER

$0NICOTROL NASAL SPRAY

$0ZYBAN SR TAB

RESPIRATORY AGENTS - MISC.


86


ALPHA-PROTEINASE INHIBITOR (HUMAN)

4ARALAST NP INJ NM

4GLASSIA INJ NM

4PROLASTIN INJ NM

4PROLASTIN-C INJ NMCYSTIC FIBROSIS AGENTS

4KALYDECO PACKET NM PA SP QL=60 Quantity/30 Days

4KALYDECO TAB NM PA SP QL=60 Quantity/30 Days

4ORKAMBI TAB NM PA SP QL=120 Quantity/30 Days

4PULMOZYME INHALATION SOLN LSP NM PA_BvDPULMONARY FIBROSIS AGENTS

4ESBRIET CAP NM PA SP

4OFEV CAP NM PA SP

SULFONAMIDESSULFONAMIDES

1SULFADIAZINE TAB

TETRACYCLINESTETRACYCLINES

1demeclocycline tab

2doxycycline hyclate cap

3*doxycycline hyclate DR tab

2doxycycline hyclate inj

2doxycycline hyclate tab

2doxycycline monohydrate cap

2doxycycline monohydrate tab

1doxycycline susp

3MINOCIN CAP 50MG, 100MG

3*MINOCIN CAP 75MG

1minocycline cap

2minocycline tab

3TETRACYCLINE CAP

3tetracycline cap

3VIBRAMYCIN SUSP

3VIBRAMYCIN SYRUP

3VIBRAMYCIN TAB

THYROID AGENTSANTITHYROID AGENTS

1methimazole tab

1propylthiouracil tab

3TAPAZOLE TABTHYROID HORMONES

1*ARMOUR THYROID TAB

3CYTOMEL TAB

1levothyroxine tab

2liothyronine inj


87


1liothyronine tab

3SYNTHROID TAB

1*thyroid tab

2THYROLAR TAB

3TIROSINT CAP

3TRIOSTAT INJ

TOXOIDSTOXOID COMBINATIONS

$0ADACEL INJ

$0BOOSTRIX INJ

$0BOOSTRIX SYRINGE PA_BvD

$0DAPTACEL INJ

$0DIPHTHERIA/ TETANUS VACCINE INJ PA_BvD

$0INFANRIX INJ

$0PEDIARIX INJ PA_BvD

$0QUADRACEL INJ

$0TENIVAC INJ PA_BvD

$0TETANUS/ DIPTHERIA TOXOID INJ PA_BvDTOXOIDS

$0TETANUS TOXOID INJ

ULCER DRUGSANTISPASMODICS

3*ANASPAZ TAB

2ATROPINE SULFATE INJ 0.05MG/ ML

2atropine sulfate inj 0.1mg/ ml

3BENTYL CAP

3BENTYL INJ

3BENTYL TAB

3*CANTIL TAB

1*chlordiazepoxide/ clidinium cap

3CUVPOSA SOLN

1dicyclomine cap

2dicyclomine inj

2dicyclomine soln

1dicyclomine tab

3*DONNATAL ELIXIR

3*DONNATAL TAB

2glycopyrrolate inj 0.4mg/ 2ml, 1mg/ 5ml

2glycopyrrolate inj 4mg/ 20ml PA_BvD

2glycopyrrolate tab

1*hyoscyamine sulfate CR tab

1*hyoscyamine sulfate elixir

1*hyoscyamine sulfate ODT

1*hyoscyamine sulfate SL tab

1*hyoscyamine sulfate soln

1*hyoscyamine sulfate tab


88


3*LEVBID TAB

3*LEVSIN INJ

3*LEVSIN SL TAB

3*LEVSIN TAB

3*LIBRAX CAP

2methscopolamine tab

3*PAMINE/ PAMINE FORTE TAB

2PROPANTHELINE TAB

3ROBINUL FORTE TAB

3ROBINUL INJ PA_BvD

3ROBINUL TAB

3*SYMAX DUOTABH-2 ANTAGONISTS

3*AXID CAP

3*AXID SOLN

1cimetidine oral soln

1cimetidine tab

2FAMOTIDINE IN NACL 0.9% IV SOLN

2famotidine inj

2FAMOTIDINE INJ 500MG/ 50ML

2famotidine susp

1famotidine tab

1nizatidine cap

2nizatidine soln

2NIZATIDINE SOLN 15MG/ ML

2PEPCID SUSP

3*PEPCID TAB

1ranitidine cap

2ranitidine inj

1ranitidine syrup

1ranitidine tab

3*TAGAMET TAB

3ZANTAC INJ

3ZANTAC TABMISC. ANTI-ULCER

1CARAFATE SUSP

3CARAFATE TAB

1sucralfate tabPROTON PUMP INHIBITORS

3DEXILANT CAP ST QL=30 Quantity/30 Days

2ESOMEPRAZOLE INJ 20MG

2esomeprazole inj 40mg

3*FIRST OMEPRAZOLE SUSP

1lansoprazole cap

3*LANSOPRAZOLE SUSP

3NEXIUM IV INJ


89


$0omeprazole cap 10mg, 20mg

1omeprazole cap 40mg

$0*OMEPRAZOLE DR TAB 20MG

$0*omeprazole magnesium DR cap

2pantoprazole inj

1pantoprazole tab

1*PREVACID 24HOUR CAP (OTC)

2PREVACID SOLUTAB

1rabeprazole tabULCER DRUGS - PROSTAGLANDINS

3CYTOTEC TAB

1misoprostol tabULCER THERAPY COMBINATIONS

2lansoprazole/ amoxicillin/ clarithromycin pack

3*omeprazole/ bicarbonate powder pack

3PREVPAC THERAPY PACK

3PYLERA CAP

1*ZEGERID OTC CAP

3*ZEGERID POWDER PACK

URINARY ANTI-INFECTIVESURINARY ANTI-INFECTIVE COMBINATIONS

3*UROQID #2 TABURINARY ANTI-INFECTIVES

2FURADANTIN SUSP

3HIPREX TAB

3MACROBID CAP

3MACRODANTIN CAP

3*MANDELAMINE TAB

2methenamine hippurate tab

3MONUROL PACKET

1nitrofurantoin cap

1nitrofurantoin macro cap

2nitrofurantoin susp

URINARY ANTISPASMODICSBETA-3 ADRENERGIC AGONISTS

2MYRBETRIQ TABURINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLIN) (NEW)

3DETROL TAB

3DITROPAN XL TAB

3GELNIQUE PATCH

3GELNIQUE PUMP ST

2oxybutynin ER tab

1oxybutynin syrup

1oxybutynin tab

3OXYTROL PATCH ST

2tolterodine tab


90


3TOVIAZ TAB ST

2trospium chloride SR cap

2trospium tab

2VESICARE TABURINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC)

2darifenacin SR tab ST

3DETROL LA CAP

3ENABLEX TAB ST

2tolterodine SR capURINARY ANTISPASMODICS - CHOLINERGIC AGONISTS (NEW)

1bethanechol tab

3URECHOLINE TAB STURINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS

2flavoxate tab

VACCINESBACTERIAL VACCINES

$0ACTHIB INJ

$0BCG VACCINE INJ PA_BvD

$0BEXSERO INJ

$0HIBERIX INJ

$0MENACTRA INJ

$0MENHIBRIX INJ

$0MENOMUNE A/ C/ Y/ W INJ

$0MENVEO INJ

$0PEDVAX HIB INJ

$0TRUMENBA INJ

$0TYPHIM VI INJ

$0*VIVOTIF BERNA CAP QL=4 Quantity/ Per DispensingMIXED VACCINE COMBINATIONS

$0COMVAX INJVIRAL VACCINES

$0CERVARIX INJ PA

$0ENGERIX-B INJ PA_BvD

$0GARDASIL 9 INJ PA

$0GARDASIL INJ PA

$0HAVRIX INJ

$0IMOVAX RABIES INJ PA_BvD

$0IPOL INJ

$0IXIARO INJ

$0M-M-R II INJ

$0PROQUAD INJ

$0RABAVERT INJ PA_BvD

$0RECOMBIVAX-HB INJ PA_BvD

$0ROTARIX SUSP

$0ROTATEQ SOLN

$0TWINRIX INJ PA_BvD


91


$0VAQTA INJ

$0VARIVAX INJ

$0YF-VAX INJ

$0ZOSTAVAX INJ PA

VAGINAL PRODUCTSMISCELLANEOUS VAGINAL PRODUCTS

3*FEM PH GELSPERMICIDES

$0*CONTRACEPTIVE FILM

$0*CONTRACEPTIVE FOAM

$0*CONTRACEPTIVE GEL

$0*contraceptive gel

$0*CONTRACEPTIVE SPONGE

$0*CONTRACEPTIVE SUPPVAGINAL ANTI-INFECTIVES

2AVC VAGINAL CREAM

3CLEOCIN SUPP

3CLEOCIN VAGINAL CREAM

1clindamycin vaginal cream

3*CLINDESSE VAGINAL CREAM

3METROGEL VAGINAL GEL

1metronidazole vaginal gel

3MICONAZOLE 3 SUPP

3TERAZOL 3 CREAM

3TERAZOL 7 CREAM

1terconazole cream

1terconazole suppVAGINAL ESTROGENS

3ESTRACE VAGINAL CREAM

2ESTRING

3FEMRING

2PREMARIN VAGINAL CREAM

3VAGIFEM TABVAGINAL PROGESTINS

2CRINONE GEL PA

2*ENDOMETRIN SUPP PA

3*PROGESTERONE SUPP PA

VASOPRESSORSANAPHYLAXIS THERAPY AGENTS

3ADRENACLICK INJ ST QL=2 Quantity/15 Days

3AUVI-Q INJ ST QL=2 Quantity/15 Days

2EPIPEN INJ QL=2 Quantity/15 Days

2EPIPEN-JR INJ QL=2 Quantity/15 Days

3TWINJECT INJ ST QL=2 Quantity/15 DaysNEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS

4NORTHERA CAP NM PA


92


VASOPRESSORS

1midodrine tab

VITAMINSOIL SOLUBLE VITAMINS

3*DRISDOL CAP

2*MEPHYTON TAB

$0*vitamin D cap 50000unit

$0*VITAMIN D TAB 400UNIT

$0*vitamin D3 cap 400unit, 1000unitWATER SOLUBLE VITAMINS

1*niacin cap

1*niacin CR tab

1*niacin tab (OTC)

1*NIACIN TR TAB (OTC)

1*niacinamide tab

3*POTABA CAP

3*SLO-NIACIN TAB


93

ALPHABETICAL LISTING OF DRUGS

Other

8-MOP CAP 57

A

abacavir tab 42 abacavir/ lamivudine tab 42 abacavir/ lamivudine/ zidovudine tab

42

ABELCET INJ 26 ABILIFY DISC TAB 42 ABILIFY INJ 42 ABILIFY MAINTENA INJ 42 ABILIFY TAB 42 ABRAXANE INJ 39 ABSORICA CAP 54 ABSTRAL TAB 10 acamprosate calcium tab 85 ACANYA GEL 54 acarbose tab 22 ACCOLATE TAB 16 ACCU-CHEK AVIVA PLUS METER

74

ACCU-CHEK AVIVA PLUS TEST STRIP

62

ACCU-CHEK NANO METER

73

ACCU-CHEK NANO SMARTVIEW METER

74

ACCU-CHEK SMARTVIEW TEST STRIP

62

ACCU-CHEK TEST STRIP 62 ACCUPRIL TAB 29 ACCURETIC TAB 30 acebutolol cap 47 ACEON TAB 29 acetaminophen/ codeine soln

12

acetaminophen/ codeine tab

12

acetaminophen/ isometheptene/ dichloral cap

74

ACETASOL HC OTIC SOLN

83

acetazolamide ER cap 63 acetazolamide inj 63 ACETAZOLAMIDE TAB 125MG

63

acetazolamide tab 250mg 63 acetic acid otic soln 83 ACETIC ACID/ ALUMINUM ACETATE OTIC SOLN

83

acetic acid/ hydrocortisone otic soln

83

acetylcysteine soln 54 acitretin cap 57 ACLOVATE CREAM 58 ACTHIB INJ 91 ACTIGALL CAP 67 ACTIMMUNE INJ 38 ACTIQ LOZENGE 10 ACTIVELLA TAB 66 ACTONEL TAB 64 ACTOPLUS MET TAB 22 ACTOPLUS MET XR TAB 23 ACTOS TAB 24 ACULAR LS OPHTH SOLN

82

ACULAR OPHTH SOLN 82 ACUVAIL OPHTH SOLN 82 acyclovir cap 45 acyclovir inj 45 ACYCLOVIR INJ 45 acyclovir oint 58 acyclovir susp 45 acyclovir tab 45 ADACEL INJ 88 ADAGEN INJ 48 ADALAT CC ER TAB 48 adapalene cream 54 adapalene gel 54 ADAPALENE LOTION/ DIFFERIN LOTION

55

ADCIRCA TAB 49 ADDERALL TAB 10MG, 12.5MG, 15MG, 30MG

7

ADDERALL TAB 5MG, 7.5MG, 20MG

7

ADDERALL XR CAP 7 adefovir dipivoxil tab 44 ADEMPAS TAB 49 ADRENACLICK INJ 92 adriamycin inj 37 adrucil inj 35 ADVAIR DISKUS 16 ADVAIR HFA INHALER 16 aero otic hydrocortisone soln

83

AEROCHAMBER 74 AFINITOR DISPERZ TAB 37 AFINITOR TAB 37 AGGRENOX CAP 70 AGRYLIN CAP 70 A-HYDROCORT INJ 52 AKYNZEO CAP 25 ALA SCALP LOTION 58 ALBATUSSIN LIQUID 53 ALBENZA TAB 14 albuterol ER tab 16 albuterol neb 0.083%, 0.5%

16

albuterol neb 0.63mg/ 3ml, 1.25mg/ 3ml

16

albuterol syrup 16 albuterol tab 16 ALCAINE OPHTH SOLN 81 alclometasone cream 58 alclometasone oint 58 ALCOHOL SWABS 74 ALDACTAZIDE TAB 63 ALDACTONE TAB 63 ALDARA CREAM 61 aldex tab 53 ALDURAZYME INJ 65 ALECENSA CAP 37 ALENDRONATE TAB 40MG

64

alendronate tab 5mg, 10mg, 35mg, 70mg

64

ALFERON-N INJ 38


94


alfuzosin tab 69 ALIMTA INJ 35 ALINIA SUSP 32 ALINIA TAB 32 ALKERAN INJ 34 ALLEGRA SYRUP 27 ALLEGRA TAB 27 ALLEGRA-D 12-HOUR TAB

53

ALLEGRA-D 24-HOUR TAB

53

allopurinol tab 69 almotriptan tab 74 ALOCRIL OPHTH SOLN 82 ALOMIDE OPHTH SOLN 82 ALORA/ MINIVELLE PATCH

66

alosetron tab 68 ALPHAGAN P OPHTH SOLN

80

alprazolam ER tab 15 ALPRAZOLAM INTENSOL CONC

15

alprazolam ODT 15 alprazolam tab 15 ALREX OPHTH SUSP 81 ALSUMA INJ 74 ALTABAX OINT 56 ALTACE CAP 29 ALTOPREV ER TAB 28 aluminum chloride soln 61 amantadine cap 40 amantadine soln 40 AMANTADINE TAB 40 AMARYL TAB 24 AMBIEN TAB 10MG 72 AMBIEN TAB 5MG 72 AMBISOME INJ 26 AMCINONIDE CREAM 58 AMCINONIDE LOTION 58 AMCINONIDE OINT 58 AMERGE TAB 74 amethia tab 50 amethyst tab 50 AMICAR SYRUP 71

AMICAR TAB 71 amifostine inj 39 amikacin sulfate inj 8 amiloride tab 63 amiloride/ hydrochlorothiazide tab

63

aminocaproic acid syrup 71 AMINOCAPROIC ACID TAB 1000MG

71

aminocaproic acid tab 500mg

71

aminophylline inj 17 AMINOSYN II 8.5%/ ELECTROLYTE INJ

79

AMINOSYN II INJ 79 AMINOSYN II INJ 4.25 79 AMINOSYN INJ 7% 79 AMINOSYN M INJ 79 aminosyn-hf inj 79 AMINOSYN-RF INJ 5.2% 79 AMIODARONE HCL IN DEXTROSE 5% IV SOLN

15

amiodarone inj 50mg/ ml 15 amiodarone tab 15 AMITIZA CAP 67 amitriptyline tab 22 amlodipine tab 48 amlodipine/ atorvastatin tab

49

amlodipine/ benazepril cap

30

amlodipine/ valsartan tab 30 amlodipine/ valsartan/ hydrochlorothiazide tab

30

ammonium chloride inj 75 ammonium lactate cream 61 ammonium lactate lotion 61 AMOXAPINE TAB 22 amoxicillin cap 84 amoxicillin chew tab 125mg

84

AMOXICILLIN CHEW TAB 250MG

84

amoxicillin susp 84 amoxicillin tab 84

amoxicillin/ k clavulanate chew tab

84

amoxicillin/ k clavulanate ER tab

84

amoxicillin/ k clavulanate susp

84

amoxicillin/ k clavulanate tab

84

amphetamine/ dextroamphetamine ER cap

7

amphetamine/ dextroamphetamine tab

7

AMPHOTERICIN INJ 26 ampicillin cap 84 ampicillin inj 84 ampicillin inj 84 AMPICILLIN SODIUM INJ

84

ampicillin susp 84 AMPICILLIN/ SULBACTAM INJ 1.5GM

84

ampicillin/ sulbactam inj 2-1gm, 10-5gm

84

AMPICILLIN/ SULBACTAM INJ 3GM

84

AMPYRA TAB 86 ANADROL TAB 13 ANAFRANIL CAP 22 anagrelide cap 70 ANALPRAM-E KIT 13 ANALPRAM-HC CREAM 13 ANAPROX DS TAB 550MG

8

ANAPROX TAB 8 ANASPAZ TAB 88 anastrozole tab 36 ANCOBON CAP 26 ANDRODERM PATCH 2MG

13

ANDRODERM PATCH 4MG

13

ANDROGEL 1% (25MG) 13 ANDROGEL 1% (50MG) 13


95


ANDROGEL 1.62% (1.25GM)

13

ANDROGEL 1.62% (2.5GM)

13

ANDROGEL 50MG 13 ANDROGEL PUMP 1% 13 ANDROGEL PUMP 1.62%

13

ANDROID/ TESTRED CAP

13

ANGELIQ TAB 66 ANTABUSE TAB 85 ANTARA CAP 28 ANUSOL-HC CREAM 13 ANUSOL-HC SUPP 13 ANZEMET INJ 25 ANZEMET TAB 25 APEXICON E CREAM 58 APLENZIN TAB 20 APOKYN INJ 40 apraclonidine ophth soln 80 apri tab 50 APRISO CAP 68 APTIOM TAB 18 APTIVUS CAP 42 APTIVUS SOLN 42 ARALAST NP INJ 87 ARALEN TAB 33 aranelle tab 50 ARANESP INJ 100MCG/ 0.5ML

70

ARANESP INJ 100MCG/ ML

70

ARANESP INJ 10MCG/ 0.4ML

70


70


70


70


70


70


71


71


71


71


71


71


71


71

ARAVA TAB 9 ARCALYST INJ 8 ARGATROBAN IN SODIUM CHLORIDE IV SOLN

18

argatroban inj 18 ARICEPT TAB 23MG 85 ARICEPT TAB 5MG, 10MG

85

ARIMIDEX TAB 36 aripiprazole ODT 42 aripiprazole tab 42 ARISTADA INJ 42 ARIXTRA SOLN 2.5MG/ 0.5ML

17

ARIXTRA SOLN 5MG/ 0.4ML, 7.5MG/ 0.6ML, 10MG/ 0.8ML

17

armodafinil tab 7 ARMOUR THYROID TAB 87 ARNUITY ELLIPTA INHALER

16

AROMASIN TAB 36 ARRANON INJ 35 ARTHROTEC TAB 8 ASACOL HD/ MESALAMINE TAB

68

ASMANEX HFA INHALER

16

ASMANEX INHALER 16 aspirin chew tab 81mg 10 aspirin EC tab 81mg, 325mg

10

ASPIRIN TAB 81MG 10 aspirin tab 81mg, 325mg 10 ASTAGRAF XL CAP 45 ASTEPRO NASAL SPRAY 78 ATACAND HCT TAB 30 ATACAND TAB 29 ATELVIA TAB 64 atenolol tab 47 atenolol/ chlorthalidone tab

30

ATGAM INJ 46 ATIVAN TAB 15 atorvastatin tab 28 atovaquone susp 32 atovaquone/ proguanil tab

33

ATRALIN GEL 55 ATRIPLA TAB 42 ATROPINE SULFATE INJ 0.05MG/ ML

88

atropine sulfate inj 0.1mg/ ml

88

atropine sulfate ophth soln 1%

80

ATROPINE SULFATE OPHTH SOLN 1%

80

ATROVENT HFA INHALER

16

ATROVENT NASAL SOLN

78

AUBAGIO TAB 86 augmented betamethasone cream

58

augmented betamethasone gel

58

augmented betamethasone lotion

58

augmented betamethasone oint

58

AUGMENTIN CHEW TAB

84


96


AUGMENTIN SUSP 84 AUGMENTIN SUSP 125MG/ 5ML

84

AUGMENTIN TAB 84 AUGMENTIN XR TAB 84 AURYXIA TAB 68 AUVI-Q INJ 92 AVALIDE TAB 30 AVANDAMET TAB 23 AVANDARYL TAB 23 AVANDIA TAB 24 AVAPRO TAB 29 AVASTIN INJ 35 AVC VAGINAL CREAM 92 AVELOX INJ 67 AVELOX TAB 67 aviane tab 50 AVODART CAP 69 AVONEX AUTO INJECTOR KIT

86

AVONEX KIT 86 AVONEX PREFILLED INJ KIT

86

AVYCAZ INJ 49 AXERT TAB 74 AXID CAP 89 AXID SOLN 89 AXIRON SOLN 13 AYGESTIN TAB 85 azacitidine inj 35 AZACTAM/ DEXTROSE INJ

31

AZASAN TAB 46 AZASITE OPHTH SOLN 80 AZATHIOPRINE INJ 46 azathioprine tab 46 azelastine nasal spray 78 azelastine ophth soln 82 AZELEX CREAM 55 AZILECT TAB 40 azithromycin inj 73 azithromycin susp 73 azithromycin tab 73 AZOPT OPHTH SUSP 82 AZOR TAB 30

aztreonam inj 31 AZULFIDINE DR TAB 68 AZULFIDINE TAB 68

B

bacitracin inj 31 BACITRACIN OPHTH OINT

80

bacitracin/ neomycin/ polymyxin b ophth oint

80

bacitracin/ polymyxin b ophth oint

80

bacitracin/ polymyxin/ neomcyin/ hydrocortisone ophth oint

81

baclofen tab 77 BACTOCILL/ DEXTROSE INJ

85

BACTRIM DS TAB 32 BACTRIM TAB 32 BACTROBAN CREAM 56 BACTROBAN NASAL OINT

78

BACTROBAN OINT 56 balsalazide cap 68 balziva tab 50 BANZEL SUSP 18 BANZEL TAB 18 BARACLUDE ORAL SOLN

44

BARACLUDE TAB 44 BCG VACCINE INJ 91 B-complex multivitamin tab

77

BECONASE AQ NASAL SUSP

78

BELEODAQ INJ 37 benazepril tab 29 benazepril/ hydrochlorothiazide tab

30

BENICAR HCT TAB 30 BENICAR TAB 29 BENLYSTA INJ 47 BENTYL CAP 88 BENTYL INJ 88

BENTYL TAB 88 BENZACLIN GEL 55 BENZAMYCIN GEL 55 BENZAMYCIN GEL PACK

55

benzonatate cap 100mg, 200mg

53

BENZONATATE CAP 150MG

53

benztropine inj 39 benztropine tab 40 BEPREVE OPHTH SOLN 82 BERINERT INJ KIT 70 BESIVANCE OPHTH SUSP

80

BETAGAN OPHTH SOLN 79 betamethasone dipropionate cream

58

betamethasone dipropionate lotion

58

betamethasone dipropionate oint

58

betamethasone valerate cream

58

betamethasone valerate foam

58

betamethasone valerate lotion

58

betamethasone valerate oint

58

BETAPACE AF TAB 47 BETAPACE TAB 47 betaxolol ophth soln 79 betaxolol tab 47 bethanechol tab 91 BETIMOL OPHTH SOLN 79 BETOPTIC-S OPHTH SOLN

79

bexarotene cap 38 BEXSERO INJ 91 BIAXIN SUSP 73 BIAXIN TAB 73 BIAXIN XL TAB 73 bicalutamide tab 36 BICILLIN CR INJ 84


97


BICILLIN LA INJ 84 BICNU INJ 34 BIDIL TAB 49 BILTRICIDE TAB 14 BIMATOPROST OPHTH SOLN

83

bisoprolol fumarate tab 47 bisoprolol/ hydrochlorothiazide tab

30

BIVIGAM INJ 83 BLEO INJ 37 bleomycin inj 37 BLEPH-10 OPHTH SOLN 80 BLEPHAMIDE OPHTH SUSP

81

BLEPHAMIDE S.O.P OPHTH OINT

81

BONINE CHEW TAB 25 BONIVA INJ 64 BONIVA TAB 64 BOOSTRIX INJ 88 BOOSTRIX SYRINGE 88 BOSULIF TAB 37 BREO ELLIPTA INHALER

16

BREVICON TAB 50 BRILINTA TAB 70 brimonidine ophth soln 80 BRIVIACT INJ 18 BRIVIACT SOLN 18 BRIVIACT TAB 18 BROMFED DM SYRUP 53 bromfenac ophth soln 82 BROMFENAC OPHTH SOLN (TWICE DAILY)

82

bromocriptine cap 40 bromocriptine tab 40 BRONTEX LIQUID 53 BROVANA NEB SOLN 16 budesonide EC cap 52 budesonide nasal spray 78 budesonide neb 16 bumetanide inj 63 bumetanide tab 63

BUPHENYL ORAL POWDER

65

BUPHENYL TAB 65 BUPRENEX INJ 12 buprenorphine inj 12 buprenorphine SL tab 12 buprenorphine/ naloxone SL tab

12

buproban tab 86 bupropion SR tab 20 bupropion tab 20 bupropion XL tab 20 BUSPAR TAB 14 buspirone tab 5mg, 10mg, 15mg

14

buspirone tab 7.5mg 14 BUSULFEX INJ 34 BUTISOL SODIUM 72 butorphanol inj 12 butorphanol nasal spray 12 BUTRANS PATCH 12 BYDUREON INJ 23 BYDUREON PEN INJ 23 BYETTA INJ 23 BYSTOLIC TAB 47

C

cabergoline tab 66 CABOMETYX TAB 37 CADUET TAB 49 CALAN SR TAB 48 CALAN TAB 48 calcipotriene cream 57 calcipotriene oint 57 calcipotriene soln 57 calcipotriene/ betamethasone oint

58

calcitonin nasal spray 64 calcitriol cap 65 calcitriol inj 65 calcitriol oral soln 65 calcium acetate cap 68 calcium acetate tab 68 CALIBRATION LIQUID 73 CAMPTOSTAR INJ 39

CANASA SUPP 68 CANCIDAS INJ 26 candesartan tab 29 candesartan/ hydrochlorothiazide tab

30

CANTIL TAB 88 CAPASTAT INJ 34 capecitabine tab 35 CAPEX SHAMPOO 58 CAPITAL/ CODEINE SUSP

12

CAPRELSA TAB 37 captopril tab 29 captopril/ hydrochlorothiazide tab 25-15mg, 50-15mg

30

CAPTOPRIL/ HYDROCHLOROTHIAZIDE TAB 25-25MG, 50-25MG

30

CARAC CREAM 57 CARAFATE SUSP 89 CARAFATE TAB 89 CARBAGLU TAB 65 carbamazepine chew tab 18 carbamazepine ER tab 18 carbamazepine SR cap 18 carbamazepine susp 18 carbamazepine tab 18 CARBATROL SR CAP 18 carbidopa tab 39 carbidopa/ levodopa ER tab

40

carbidopa/ levodopa ODT 40 carbidopa/ levodopa tab 40 CARBIDOPA/ LEVODOPA/ ENTACAPONE TAB

40

carbinoxamine soln 26 carbinoxamine tab 26 carboplatin inj 34 CARDENE INJ 48 CARDIZEM CD CAP 48 CARDIZEM LA TAB 48 CARDIZEM TAB 48


98


CARDURA TAB 30 CARDURA XL TAB 69 CARIMUNE INJ 83 carisoprodol tab 77 carisoprodol/ aspirin tab 78 carisoprodol/ aspirin/ codeine tab

78

CARNITOR INJ 65 CARNITOR ORAL SOLN 65 CARNITOR TAB 65 carteolol ophth soln 79 carvedilol tab 47 CASODEX TAB 36 CATAPRES TAB 30 CATAPRES-TTS PATCH 30 CAYSTON INHALATION SOLN

31

CEDAX CAP 50 CEDAX SUSP 50 cefaclor cap 49 CEFACLOR ER TAB 50 CEFACLOR SUSP 50 cefadroxil cap 49 cefadroxil susp 49 cefadroxil tab 49 CEFAZOLIN INJ 20GM 49 cefazolin inj 500mg, 1gm, 10gm, 20gm

49

cefdinir cap 50 cefdinir susp 50 cefepime inj 50 cefixime susp 50 CEFOL TAB 77 cefotaxime inj 50 CEFOTETAN INJ 10GM 50 cefotetan inj 1gm, 2gm 50 cefoxitin inj 50 cefpodoxime proxetil susp 50 cefpodoxime proxetil tab 50 cefprozil susp 50 cefprozil tab 50 ceftazidime inj 50 CEFTIN SUSP 50 CEFTIN TAB 50 ceftriaxone sodium inj 50

cefuroxime axetil susp 50 cefuroxime inj 50 cefuroxime tab 50 CELEBREX CAP 8 celecoxib cap 8 CELEXA TAB 21 CELLCEPT CAP 46 CELLCEPT INJ 46 CELLCEPT SUSP 46 CELLCEPT TAB 46 CELONTIN CAP 20 CENTANY OINT 56 cephalexin cap 49 cephalexin susp 49 CEPHALEXIN TAB 49 CEREBYX INJ 20 CEREZYME INJ 70 CERVARIX INJ 91 CERVICAL CAP 73 CESAMET CAP 25 cesia tab 50 cetirizine cap 27 cetirizine chew tab 27 cetirizine soln 5mg/ 5ml 27 cetirizine tab 27 cetirizine/ pseudoephedrine tab

53

cevimeline cap 77 CHANTIX PAK 86 CHANTIX TAB 86 CHEMET CAP 25 CHENODAL TAB 67 CHLORAMPHENICOL INJ

32

chlordiazepoxide cap 15 chlordiazepoxide/ amitriptyline tab

85

chlordiazepoxide/ clidinium cap

88

chloroquine tab 33 chlorothiazide inj 63 CHLOROTHIAZIDE TAB 250MG

63

chlorothiazide tab 500mg 63 CHLORPROMAZINE INJ 42

chlorpromazine tab 42 CHLORPROPAMIDE TAB

24

CHLORTHALIDONE TAB 100MG

63

chlorthalidone tab 25mg 63 CHLORTHALIDONE TAB 25MG, 50MG

63

chlorzoxazone tab 77 CHOLBAM CAP 67 cholestyramine bulk powder

28

cholestyramine light bulk powder

28

cholestyramine light powder packets

28

cholestyramine powder packets

28

CHOLINE MAGNESIUM TRISALICYLATE TAB 1000MG

10

choline magnesium trisalicylate tab 500mg, 750mg

10

ciclopirox cream 56 ciclopirox gel 56 ciclopirox shampoo 56 ciclopirox soln 56 ciclopirox susp 56 cidofovir inj 44 cilastatin/ imipenem inj 32 cilostazol tab 70 CILOXAN OPHTH OINT 80 CILOXAN OPHTH SOLN 80 cimetidine oral soln 89 cimetidine tab 89 CIMZIA KIT 68 CINRYZE INJ 70 CIPRO D5W IV INJ 67 CIPRO HC OTIC SUSP 83 CIPRO SUSP 67 CIPRO TAB 67 CIPRO XR TAB 67 CIPRODEX OTIC SUSP 83 ciprofloxacin ER tab 67


99


ciprofloxacin inj 67 ciprofloxacin ophth soln 80 CIPROFLOXACIN OTIC SOLN

83

ciprofloxacin susp 67 ciprofloxacin tab 67 CIPROFLOXACN INJ 67 CISPLATIN INJ 200MG/ 200ML

34

cisplatin inj 50mg/ 50ml, 100mg/ 100ml

34

citalopram oral soln 21 citalopram tab 21 cladribine inj 35 CLAFORAN INJ 50 CLARIFOAM EF FOAM 55 CLARINEX REDITAB 27 CLARINEX SYRUP 27 CLARINEX TAB 27 CLARINEX-D ER TAB 53 CLARINEX-D TAB 53 clarithromycin ER tab 73 clarithromycin susp 73 clarithromycin tab 73 CLARITIN CAP 27 CLARITIN CHEW TAB 27 CLARITIN REDITAB 27 CLARITIN SYRUP 27 CLARITIN TAB 27 CLARITIN-D TAB 53 clemastine tab 26 CLEOCIN CAP 33 CLEOCIN INJ 33 CLEOCIN PED ORAL SOLN

33

CLEOCIN PHOSPHATE INJ

33

CLEOCIN SUPP 92 CLEOCIN VAGINAL CREAM

92

CLEOCIN/ DEXTROSE INJ

33

CLEOCIN-T GEL 55 CLEOCIN-T LOTION 55 CLEOCIN-T PAD 55

CLEOCIN-T SOLN 55 CLIMARA PATCH 66 CLIMARA PRO PATCH 66 CLINDACIN KIT 55 CLINDAGEL 55 clindamycin cap 33 clindamycin foam 55 clindamycin gel 55 clindamycin inj 33 clindamycin lotion 55 clindamycin pad 55 clindamycin soln 33 clindamycin soln 33 clindamycin vaginal cream

92

clindamycin/ benzoyl peroxide gel

55

clindamycin/ tretinoin gel 55 CLINDESSE VAGINAL CREAM

92

CLINIMIX E INJ 79 CLINIMIX INJ 79 CLINIMIX INJ 2.75/ D5W 79 CLINISTIX 62 clobetasol foam 58 clobetasol lotion 58 clobetasol propionate cream

58

clobetasol propionate emollient cream

58

clobetasol propionate gel 59 clobetasol propionate oint

59

clobetasol propionate soln

59

clobetasol shampoo 59 clobetasol spray 59 CLOBEX LOTION 59 CLOBEX SHAMPOO 59 CLOBEX SPRAY 59 CLODERM CREAM/ CLOCORTOLONE CREAM

59

CLOLAR INJ 35 clomipramine cap 22

clonazepam ODT 18 clonazepam tab 18 clonidine patch 30 clonidine tab 30 clopidogrel tab 70 clorazepate dipotassium tab

15

CLORPRES TAB 30 clotrimazole cream 56 clotrimazole soln 56 clotrimazole troche 76 clotrimazole/ betamethasone cream

56

clotrimazole/ betamethasone lotion

56

clozapine ODT 41 clozapine tab 41 CLOZARIL TAB 41 COARTEM TAB 33 codeine sulfate tab 10 COGENTIN INJ 40 COLAZAL CAP 68 COLCHICINE/ COLCRYS TAB

69

COLESTID GRANULE 28 COLESTID POWDER PACK

28

COLESTID TAB 28 colestipol granule 28 colestipol granule packets

28

colestipol tab 28 colistimeth inj 31 COLY-MYCIN S OTIC SUSP

83

COLYTE FLAVOR PACK 72 COMBIGAN OPHTH SOLN

79

COMBIPATCH 66 COMBIVENT RESPIMAT 16 COMBIVIR TAB 42 COMETRIQ CAP DOSE PACK

37

COMMIT LOZENGE 86 COMPLERA TAB 42


100


COMTAN TAB 40 COMVAX INJ 91 CONCERTA TAB 7 CONDYLOX GEL 61 CONDYLOX SOLN 61 CONTRACEPTIVE FILM 92 CONTRACEPTIVE FOAM 92 CONTRACEPTIVE GEL 92 contraceptive gel 92 CONTRACEPTIVE SPONGE

92

CONTRACEPTIVE SUPP 92 COPAXONE INJ 86 COPEGUS TAB 44 CORDARONE TAB 15 CORDRAN CREAM 59 CORDRAN LOTION 59 CORDRAN TAPE 59 COREG CR CAP 47 COREG TAB 47 CORGARD TAB 47 CORLANOR TAB 49 CORTANE-B AQUEOUS OTIC SOLN

83

CORTANE-B OTIC SOLN 83 CORTEF TAB 52 CORTENEMA ENEMA 13 CORTIFOAM 13 CORTISONE AC TAB 52 CORTISPORIN CREAM 56 CORTISPORIN OINT 56 CORTISPORIN OTIC SOLN

83

CORZIDE TAB 30 COSENTYX INJ 57 COSMEGEN INJ 37 COSOPT OPHTH SOLN 79 COSOPT PF OPHTH SOLN

79

COTELLIC TAB 37 COUMADIN TAB 17 COZAAR TAB 29 CREON CAP 62 CRESYLATE OTIC SOLN 83 CRINONE GEL 92

CRIXIVAN CAP 42 CROMOLYN NEB SOLN 16 cromolyn sodium ophth soln

82

cromolyn soln 67 cryselle tab 50 CUBICIN INJ 32 CUTIVATE CREAM 59 CUTIVATE LOTION 59 CUVITRU INJ 8GM/ 40ML

84

CUVPOSA SOLN 88 cyanocobalamin inj 70 cyclafem tab 51 CYCLESSA TAB 51 cyclobenzaprine tab 5mg, 10mg

77

cyclobenzaprine tab 7.5mg

78

CYCLOGYL OPHTH SOLN

80

cyclopentolate ophth soln 80 CYCLOPHOSPHAMIDE CAP

34

CYCLOSET TAB 23 cyclosporine cap 46 cyclosporine inj 46 cyclosporine modified cap 25mg, 100mg

46

CYCLOSPORINE MODIFIED CAP 50MG

46

cyclosporine modified soln

46

CYKLOKAPRON INJ 71 CYMBALTA CAP 22 cyproheptadine syrup 27 cyproheptadine tab 27 CYRAMZA INJ 35 CYSTAGON CAP 69 CYSTARAN OPHTH SOLN

82

CYTARABINE INJ 35 cytarabine PF inj 35 CYTOMEL TAB 87 CYTOTEC TAB 90

CYTOVENE INJ 44 CYTRA-3 SYRUP 69

D

D.H.E. INJ 74 d10w/ nacl inj 75 D10W/ NACL INJ 75 d2.5w/ nacl inj 75 D5W/ NACL INJ 75 d5w/ nacl inj 75 dacarbazine inj 38 DACOGEN INJ 35 DALIRESP TAB 16 DALVANCE INJ 31 danazol cap 13 DANTRIUM CAP 100MG 78 DANTRIUM CAP 25MG, 50MG

78

dantrolene cap 78 dapsone tab 33 DAPTACEL INJ 88 daptomycin inj 32 DARAPRIM TAB 33 darifenacin SR tab 91 DARZALEX INJ 35 daunorubicin inj 37 DAUNOXOME INJ 37 DAYPRO TAB 8 DAYTRANA PATCH 7 DDAVP INJ 65 DDAVP NASAL SOLN 65 DDAVP NASAL SPRAY 66 DDAVP TAB 66 decitabine inj 35 DECON-A ELIXIR 53 DECONEX DM TAB 53 DELESTROGEN INJ 66 DELZICOL CAP 68 DEMADEX TAB 100MG 63 DEMADEX TAB 5MG, 10MG, 20MG

63

demeclocycline tab 87 DEMEROL INJ 10 DEMEROL TAB 100MG 10 DEMEROL TAB 50MG 10


101


DEMSER CAP 29 DENAVIR CREAM 58 DEPACON INJ 20 depade tab 25 DEPAKENE CAP 20 DEPAKENE SYRUP 20 DEPAKOTE DR TAB 20 DEPAKOTE ER TAB 20 DEPAKOTE SPRINKLE CAP

20

DEPEN TITRA TAB 45 DEPO ESTRADIOL INJ 66 DEPO PROVERA INJ 150MG/ ML

52

DEPO-MEDROL INJ 52 DEPO-TESTOSTERONE INJ

13

DERMA-SMOOTH/ FS OIL

59

DERMATOP CREAM 59 DERMATOP OINT 59 DERMOTIC OIL 83 DESCOVY TAB 43 desipramine tab 22 DESLORATADINE ODT 27 desloratadine tab 27 desmopressin inj 66 desmopressin nasal soln 66 desmopressin nasal spray 66 desmopressin tab 66 DESOGEN TAB 51 DESONATE GEL 59 desonide cream 59 desonide lotion 59 desonide oint 59 DESOWEN CREAM 59 DESOWEN LOTION 59 desoximetasone cream 59 desoximetasone gel 59 DESOXIMETASONE OINT 0.05%

59

desoximetasone oint 0.25%

59

DESOXYN TAB 7

DESVENLAFAXINE ER TAB

22

DETROL LA CAP 91 DETROL TAB 90 DEXAMETHASONE CONC

52

dexamethasone elixir 52 dexamethasone ophth soln

81

dexamethasone phosphate inj

52

DEXAMETHASONE SODIUM PHOSPHATE INJ

52

DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN

81

dexamethasone soln 52 dexamethasone tab 52 DEXAMETHASONE TAB 1MG, 2MG

52

DEXEDRINE CAP 7 DEXILANT CAP 89 dexmethylphenidate ER cap

7

dexmethylphenidate tab 7 DEXPAK TAB 1.5MG 52 dexrazoxane inj 39 dextroamphetamine ER cap

7

dextroamphetamine soln 7 dextroamphetamine tab 7 dextromethorphan/ guaifenesin liquid

53

dextrose 5% in lactated ringers

75

dextrose inj 79 DIABETA TAB 24 DIALYVITE TAB 77 DIALYVITE/ IRON TAB 77 DIALYVITE/ ZINC TAB 77 DIAMOX SEQUEL CAP 63 DIAPHRAGM 73 DIATZ ZN TAB 77 diazepam intensol conc 15

DIAZEPAM RECTAL GEL

18

DIAZEPAM SOLN 15 diazepam tab 15 DIBENZYLINE CAP 29 diclofenac DR tab 8 diclofenac gel 57 diclofenac gel 57 diclofenac ophth soln 82 diclofenac potassium tab 8 diclofenac soln 57 diclofenac SR tab 8 diclofenac/ misoprostol tab

8

dicloxacillin cap 85 dicyclomine cap 88 dicyclomine inj 88 dicyclomine soln 88 dicyclomine tab 88 didanosine DR cap 43 DIFFERIN CREAM 55 DIFFERIN GEL 0.1% 55 DIFFERIN GEL 0.3% 55 DIFICID TAB 73 DIFLORASONE CREAM 59 DIFLORASONE DIACETATE OINT

59

diflorasone oint 59 DIFLUCAN SUSP 26 DIFLUCAN TAB 26 diflunisal tab 500mg 10 digoxin inj 48 digoxin soln 48 digoxin tab 125mcg 48 digoxin tab 250mcg 49 DIHYDROCODEINE/ ASPIRIN/ CAFFEINE CAP

12

dihydroergotamine inj 74 DILANTIN CAP 100MG 20 DILANTIN CAP 30MG 20 DILANTIN INFATABS 20 DILANTIN SUSP 20 DILATRATE SR CAP 14 DILAUDID PF INJ 10 DILAUDID TAB 2MG 10


102


DILAUDID TAB 4MG 10 DILAUDID TAB 8MG 10 DILAUDID-5 LIQUID 10 diltiazem CD cap 48 diltiazem ER cap 48 DILTIAZEM INJ 100MG 48 diltiazem inj 5mg/ ml 48 diltiazem LA tab 48 diltiazem SR cap 48 diltiazem tab 48 diltiazem XR cap 48 DIOVAN HCT TAB 30 DIOVAN TAB 29 DIPENTUM CAP 68 diphenhydramine elixir (rx only)

26

diphenhydramine inj 27 diphenoxylate/ atropine liquid

24

diphenoxylate/ atropine tab

24

DIPHTHERIA/ TETANUS VACCINE INJ

88

DIPROLENE AF CREAM 59 DIPROLENE LOTION 59 DIPROLENE OINT 59 dipyridamole tab 70 disopyramide cap 15 disulfiram tab 85 DITROPAN XL TAB 90 DIURIL INJ 63 DIURIL SUSP 63 divalproex DR tab 20 divalproex ER tab 20 divalproex sprinkle cap 20 DOCEFREZ INJ 39 docetaxel conc inj 39 DOCETAXEL FOR INJ CONC

39

DOCETAXEL IV SOLN 39 DOCETAXEL NON-ALCOHOL FORMULA IV SOLN

39

dofetilide cap 15 DOLOPHINE TAB 10

donatussin liquid 53 donepezil ODT 85 donepezil tab 23mg 85 donepezil tab 5mg, 10mg 85 DONNATAL ELIXIR 88 DONNATAL TAB 88 DORIBAX INJ 32 dorzolamide ophth soln 82 dorzolamide/ timolol ophth soln

79

DOVONEX CREAM 57 doxazosin tab 30 doxepin cap 22 DOXEPIN CAP 75MG 22 doxepin soln 22 DOXEPIN/ PRUDOXIN/ ZONALON CREAM

57

doxercalciferol cap 65 doxercalciferol inj 65 DOXIL INJ 37 doxycycline hyclate cap 87 doxycycline hyclate DR tab

87

doxycycline hyclate inj 87 doxycycline hyclate tab 87 doxycycline monohydrate cap

87

doxycycline monohydrate tab

87

doxycycline susp 87 DRISDOL CAP 93 dronabinol cap 25 DROXIA CAP 70 DRYSOL SOLN 61 DUAC GEL 55 DUETACT TAB 23 DULERA INHALER 16 duloxetine cap 22 DULOXETINE DR CAP 22 DURAGESIC PATCH 10 DUREZOL OPHTH EMULSION

81

dutasteride cap 69 dutasteride/ tamsulosin cap

69

DUTOPROL TAB 30 DYAZIDE CAP 63 DYMISTA NASAL INHALER

78

DYRENIUM CAP 63

E

EC-NAPROSYN TAB 9 econazole cream 56 ED A-HIST LIQUID 53 EDARBI TAB 29 EDARBYCLOR TAB 30 EDECRIN TAB 63 EDURANT TAB 43 EFFEXOR XR CAP 22 EFFIENT TAB 70 EFUDEX CREAM 57 ELAPRASE INJ 65 ELAVIL TAB 22 ELDEPRYL CAP 40 ELECTROLYTE/ D5W INJ

75

ELESTAT OPHTH SOLN 82 ELIDEL CREAM 61 ELIGARD INJ 36 ELIMITE CREAM 62 ELIPHOS TAB 68 ELIQUIS TAB 17 ELITEK INJ 38 ELIXOPHYLLINE ELIXIR

17

ELLENCE INJ 37 ELMIRON CAP 69 ELOCON CREAM 59 ELOCON LOTION 59 ELOCON OINT 59 EMADINE OPHTH SOLN 82 EMBEDA CAP 10 EMCYT CAP 36 EMEND CAP 25 EMEND CAP THERAPY PACK

25

EMLA CREAM 61 EMPLICITI INJ 35 EMSAM PATCH 21


103


EMTRIVA CAP 43 EMTRIVA SOLN 43 EMVERM CHEW TAB 14 ENABLEX TAB 91 enalapril tab 29 enalapril/ hydrochlorothiazide tab

30

ENBREL INJ 10 ENBREL SURECLICK INJ

10

ENDOMETRIN SUPP 92 ENGERIX-B INJ 91 enoxaparin inj 17 enpresse tab 51 entacapone tab 40 entecavir tab 44 ENTOCORT EC CAP 52 ENTRE-COUGH LIQUID 53 ENVARSUS XR TAB 46 EPIDUO (FORTE) GEL 55 EPIDUO GEL 55 epinastine ophth soln 82 EPIPEN INJ 92 EPIPEN-JR INJ 92 epirubicin inj 37 EPIVIR HBV SOLN 44 EPIVIR HBV TAB 44 EPIVIR SOLN 43 EPIVIR TAB 43 eplerenone tab 31 EPOGEN INJ 71 EPROSARTAN MESYLATE TAB

29

EPZICOM TAB 43 EQUETRO CAP 41 ERAXIS INJ 26 ERBITUX INJ 35 ergoloid mesylates tab 86 ERGOLOID MESYLATES TAB 1MG

86

ERGOMAR SL TAB 74 ERIVEDGE CAP 36 ERTACZO CREAM 56 ERWINAZE INJ 38 ERYGEL 2% 55

ERYPED SUSP 73 ERY-TAB TAB 73 ERYTHROCIN INJ 73 ERYTHROMYCIN CAP 73 erythromycin DR cap 73 erythromycin gel 55 erythromycin ophth oint 80 erythromycin pad 55 erythromycin soln 55 erythromycin stearate tab 73 erythromycin susp 73 ERYTHROMYCIN TAB 73 erythromycin/ benzoyl peroxide gel

55

ESBRIET CAP 87 ESCAVITE CHEW TAB 77 escitalopram soln 21 escitalopram tab 21 ESOMEPRAZOLE INJ 20MG

89

esomeprazole inj 40mg 89 estazolam tab 72 esterified estrogens/ methyltestosterone tab

66

ESTRACE TAB 66 ESTRACE VAGINAL CREAM

92

estradiol patch 66 estradiol tab 66 estradiol twice weekly patch

66

estradiol valerate inj 66 ESTRING 92 estropipate tab 0.75mg, 1.5mg

66

ESTROPIPATE TAB 0.75MG, 1.5MG, 3MG

66

ESTROSTEP FE TAB 51 eszopiclone tab 72 ethacrynic acid tab 63 ethambutol tab 34 ethosuximide cap 20 ethosuximide soln 20 etidronate disodium tab 200mg

64

ETIDRONATE DISODIUM TAB 400MG

64

etodolac cap 9 etodolac ER tab 9 etodolac tab 9 ETOPOPHOSPHATE INJ 39 etoposide cap 39 etoposide inj 39 EURAX CREAM 62 EURAX LOTION 62 EVAMIST SPRAY 66 EVISTA TAB 65 EVOCLIN FOAM 55 EVOTAZ TAB 43 EVOXAC CAP 77 EXACTUSS LIQUID 53 EXALGO TAB 10 EXELDERM CREAM 56 EXELDERM SOLN 56 EXELON CAP 85 EXELON PATCH 85 exemestane tab 36 EXFORGE HCT TAB 30 EXFORGE TAB 30 EXJADE TAB (FOR SUSPENSION)

25

EXTAVIA INJ 86 EXTINA FOAM 56

F

FABRAZYME INJ 65 famciclovir tab 45 FAMOTIDINE IN NACL 0.9% IV SOLN

89

famotidine inj 89 FAMOTIDINE INJ 500MG/ 50ML

89

famotidine susp 89 famotidine tab 89 FAMVIR TAB 45 FANAPT TAB 41 FANAPT TAB TITRATION PACK

41

FARESTON TAB 36 FARXIGA TAB 24


104


FARYDAK CAP 37 FASLODEX INJ 36 FAZACLO ODT 25MG, 100MG

41

FAZACLO/ CLOZAPINE ODT 12.5MG, 150MG, 200MG

41

felbamate susp 19 felbamate tab 19 FELBATOL SUSP 19 FELBATOL TAB 19 FELDENE CAP 9 felodipine ER tab 48 FEM PH GEL 92 FEMALE CONDOMS 73 FEMARA TAB 36 FEMCON FE CHEW TAB 51 FEMHRT LOW DOSE TAB

66

FEMRING 92 fenofibrate cap 28 fenofibrate micronized cap

28

fenofibrate tab 28 fenofibric acid DR cap 28 FENOGLIDE TAB 28 FENOPROFEN CAP 9 fenoprofen tab 9 fentanyl lozenge 10 fentanyl patch 10 FENTORA TAB 10 ferrex forte cap 71 FERRIPROX SOLN 25 FERRIPROX TAB 25 ferrous sulfate elixir 71 FERROUS SULFATE LIQUID

71

ferrous sulfate soln 71 FERROUS SULFATE SYRUP

71

FETZIMA CAP 22 FETZIMA CAP TITRATION PACK

22

FEXMID TAB 78 fexofenadine syrup 27

fexofenadine tab 27 fexofenadine/ pseudoephedrine 12-hour tab

54

fexofenadine/ pseudoephedrine 24 hour tab

54

FIBRICOR TAB 28 FINACEA FOAM 61 FINACEA GEL 61 finasteride tab 69 FIRAZYR INJ 70 FIRMAGON INJ 36 FIRST DUKES MOUTHWASH

76

FIRST MARYS MOUTHWASH

76

FIRST MOUTHWASH BLM SUSP

76

FIRST OMEPRAZOLE SUSP

89

FLAGYL CAP 31 FLAGYL ER TAB 31 FLAGYL TAB 32 FLAREX OPHTH SUSP 81 flavoxate tab 91 FLEBOGAMMA INJ 83 flecainide tab 15 FLECTOR PATCH 57 FLOMAX CAP 69 FLO-PRED ORAL SUSP 52 FLOVENT DISKUS 16 FLOVENT HFA INHALER 16 fluconazole inj 26 fluconazole susp 26 fluconazole tab 26 flucytosine cap 26 fludarabine inj 35 fludrocortisone tab 53 FLUMADINE TAB 45 flunisolide nasal spray 78 fluocinolone acetonide cream

59

fluocinolone acetonide oil 59

fluocinolone acetonide oint

59

fluocinolone acetonide topical soln

59

fluocinolone otic oil 83 fluocinonide cream 59 fluocinonide gel 59 fluocinonide oint 59 fluocinonide soln 59 FLUOR-A-DAY TAB 75 fluorometholone ophth susp

81

FLUOROPLEX CREAM 57 fluorouracil cream 57 fluorouracil inj 35 fluorouracil soln 57 fluoxetine cap 21 fluoxetine soln 21 fluoxetine tab 21 fluphenazine decanoate inj

42

FLUPHENAZINE ELIXIR 42 FLUPHENAZINE INJ 42 FLUPHENAZINE ORAL CONC

42

fluphenazine tab 42 flurandrenolide cream 59 flurandrenolide lotion 59 FLURAZEPAM CAP 72 flurbiprofen ophth soln 82 flurbiprofen tab 9 flutamide cap 36 fluticasone cream 60 fluticasone nasal spray 78 fluticasone oint 60 fluticasone propionate lotion

60

fluvastatin cap 28 fluvastatin ER tab 28 fluvoxamine ER cap 21 fluvoxamine tab 21 FML FORTE OPHTH SUSP

81

FML LIQUIFLM OPHTH SUSP

81


105


FML OPHTH OINT 81 FOCALIN TAB 7 FOCALIN XR CAP 7 FOLBEE PLUS CZ TAB 77 folbee tab 71 folic acid tab 70 folic acid tab 1mg 70 FOLOTYN INJ 35 fomepizole inj 24 fondaparinux soln 2.5mg/ 0.5ml

17

fondaparinux soln 5mg/ 0.4ml, 7.5mg/ 0.6ml, 10mg/ 0.8ml

17

FORADIL AEROLIZE CAP

17

FORTAZ INJ 50 FORTEO INJ 64 FORTESTA GEL/ TESTOSTERONE GEL PUMP

13

FORTICAL SPRAY 64 FOSAMAX + D TAB 64 FOSAMAX SOLN 64 FOSAMAX TAB 64 fosinopril tab 29 fosinopril/ hydrochlorothiazide tab

30

fosphenytoin inj 20 FOSRENOL CHEW TAB 68 FOSRENOL POWDER PACK

68

FRAGMIN INJ 17 FRAGMIN INJ 95000UNIT

17

FREAMINE HBC INJ 79 FREESTYLE FREEDOM LITE METER

73

FREESTYLE INSULINX TEST STRIP

62

FREESTYLE KIT INSULINX

73

FREESTYLE LITE METER

73

FREESTYLE LITE TEST STRIP

62

FREESTYLE TEST STRIP 62 FROVA TAB 74 frovatriptan tab 74 FURADANTIN SUSP 90 furosemide inj 63 furosemide soln 10mg/ ml 63 FUROSEMIDE SOLN 8MG/ ML

63

furosemide tab 63 FUSILEV INJ 39 FUZEON INJ 43 FYCOMPA SUSP 18 FYCOMPA TAB 18

G

gabapentin cap 18 gabapentin soln 18 gabapentin tab 18 GABITRIL TAB 12MG, 16MG

19

GABITRIL TAB 2MG, 4MG

19

galantamine ER cap 85 GALANTAMINE SOLN 85 galantamine tab 85 GAMASTAN S/ D INJ 83 GAMMAGARD INJ 83 ganciclovir inj 44 GARDASIL 9 INJ 91 GARDASIL INJ 91 GASTROCROM SOLN 67 gatifloxacin ophth soln 80 GATTEX INJ 68 GAUZE PAD 73 gavilyte-G soln 72 GELNIQUE PATCH 90 GELNIQUE PUMP 90 gemcitabine inj 200mg, 1gm

35

gemcitabine inj 38mg/ ml 35 gemfibrozil tab 28 GEMZAR INJ 35

GENERESS FE CHEW TAB

51

gengraf cap 46 gentamicin cream 56 gentamicin inj 8 gentamicin oint 56 gentamicin ophth oint 80 gentamicin ophth soln 80 gentamicin/ nacl inj 8 GENTAMICIN/ NACL INJ 0.9MG/ ML, 1.4MG/ ML

8

GENVOYA TAB 43 GEODON CAP 41 GEODON INJ 41 gianvi/ ocella/ loryna tab 51 GILENYA CAP 86 GILOTRIF TAB 37 GILTUSS LIQUID 54 GLASSIA INJ 87 GLEEVEC TAB 37 GLEOSTINE CAP 34 glimepiride tab 24 glipizide ER tab 24 glipizide tab 24 glipizide/ metformin tab 23 GLUCAGEN HYPOKIT INJ

23

GLUCAGEN INJ 62 GLUCAGON KIT 23 GLUCOPHAGE TAB 23 GLUCOPHAGE XR TAB 23 GLUCOTROL TAB 24 GLUCOTROL XL TAB 24 GLUCOVANCE TAB 1.25-250MG

23

GLUCOVANCE TAB 2.5-500MG, 5-500MG

23

glyburide micronized tab 24 glyburide tab 24 glyburide/ metformin tab 23 glycopyrrolate inj 0.4mg/ 2ml, 1mg/ 5ml

88

glycopyrrolate inj 4mg/ 20ml

88

glycopyrrolate tab 88


106


GLYNASE TAB 24 GLYSET TAB 22 GOLYTELY SOLN 72 granisetron inj 25 granisetron tab 25 GRANIX INJ 71 GRIFULVIN V TAB 26 griseofulvin micro tab 26 griseofulvin susp 26 griseofulvin tab 26 GRIS-PEG TAB 26 guaifenesin/ codeine liquid

54

guaifenesin/ codeine syrup

54

guanfacine ER tab 7 guanfacine IR tab 30 GUANIDINE TAB 33

H

HALAVEN INJ 39 HALCION TAB 72 HALDOL DECANOATE INJ

41

HALDOL LACTATE INJ 41 halobetasol cream 60 halobetasol oint 60 HALOG CREAM 60 HALOG OINT 60 haloperidol decanoate inj 41 haloperidol lactate inj 41 haloperidol lactate soln 41 haloperidol tab 41 HARVONI TAB 44 HAVRIX INJ 91 HDC DM SYRUP 54 HECTOROL CAP 65 HECTOROL INJ 65 heparin sodium inj 17 HEPARIN SODIUM INJ 2000UNIT/ ML, 2500UNIT/ ML

17

heparin sodium/ d5w inj 17 HEPARIN SODIUM/ NACL INJ

18

heparin sodium/ nacl inj 18 HEPARIN/ D5W INJ 18 HEPATAMINE SOLN 79 HEPSERA TAB 44 HERCEPTIN INJ 35 HETLIOZ CAP 72 HEXALEN CAP 34 HIBERIX INJ 91 HIPREX TAB 90 HIZENTRA INJ 83 homatropine ophth soln 80 HUMIRA INJ 8 HUMIRA PEN INJ 8 HUMULIN R U-500 INJ 23 HUMULIN R U-500 KWIKPEN

23

HYCAMTIN CAP 39 HYCAMTIN INJ 39 HYCET SOLN 12 hydralazine inj 31 hydralazine tab 31 HYDREA CAP 38 hydrochlorothiazide cap 63 hydrochlorothiazide tab 64 hydrocodone/ acetaminophen soln

12

hydrocodone/ acetaminophen tab 2.5-325mg

12

hydrocodone/ acetaminophen tab 5-300mg, 7.5-300mg, 10-300mg

12

hydrocodone/ acetaminophen tab 5-325mg, 7.5-325mg, 10-325mg

12

hydrocodone/ chlorpheniramine susp

54

hydrocodone/ chlorpheniramine/ pseudoephedrine liquid

54

hydrocodone/ homatropine syrup

53

hydrocodone/ ibuprofen tab

12

hydrocortisone butyrate cream

60

hydrocortisone butyrate hydrophilic lipo base cream

60

hydrocortisone butyrate oint

60

hydrocortisone butyrate soln

60

hydrocortisone cream 60 hydrocortisone enema 13 hydrocortisone lotion 0.25%, 0.5%

60

hydrocortisone lotion 1%, 2.5%

60

hydrocortisone oint 60 hydrocortisone pramoxine cream

13

hydrocortisone supp 14 hydrocortisone tab 52 hydrocortisone valerate cream

60

hydrocortisone valerate oint

60

hydromorphone ER tab 10 hydromorphone inj 2mg/ ml

10

hydromorphone liquid 10 hydromorphone PF inj 10 HYDROMORPHONE SUPP

10

hydromorphone tab 2mg 10 hydromorphone tab 4mg 10 hydromorphone tab 8mg 10 hydroxychloroquine tab 33 HYDROXYPROGESTERONE CAPROATE INJ

36

hydroxyurea cap 38 HYDROXYZINE IM SOLN

14

hydroxyzine inj 14 HYDROXYZINE PAMOATE CAP 100MG

14


107


hydroxyzine pamoate cap 25mg, 50mg

14

hydroxyzine syrup 14 hydroxyzine tab 14 hyoscyamine sulfate CR tab

88

hyoscyamine sulfate elixir 88 hyoscyamine sulfate ODT 88 hyoscyamine sulfate SL tab

88

hyoscyamine sulfate soln 88 hyoscyamine sulfate tab 88 HYPER SAL NEB 54 HYPERRAB INJ 83 HYSINGLA ER TAB 10 HYZAAR TAB 30

I

ibandronate inj 64 ibandronate tab 64 IBRANCE CAP 37 IBUDONE TAB 12 ibuprofen susp (rx only) 9 ibuprofen tab (rx only) 9 ICLUSIG TAB 37 IDAMYCIN PFS INJ 37 idarubicin inj 37 IFEX INJ 1GM 34 IFEX INJ 3GM 34 ifosfamide inj 34 ILARIS INJ 8 ILEVRO OPHTH SUSP 82 imatinib tab 37 IMBRUVICA CAP 37 IMDUR ER TAB 14 imipramine pamoate cap 22 imipramine tab 22 imiquimod cream 61 IMITREX INJ 74 IMITREX TAB 74 IMOVAX RABIES INJ 91 IMPLANON/ NEXPLANON IMPLANT

52

IMURAN TAB 46 INCRELEX INJ 65

INCRUSE ELLIPTA INHALER

16

indapamide tab 64 INDERAL LA CAP 47 INDOCIN SUPP 9 INDOCIN SUSP 9 indomethacin cap 9 indomethacin ER cap 9 INFANRIX INJ 88 INLYTA TAB 37 INNOPRAN XL CAP 47 INSPRA TAB 31 INSULIN SYRINGE 74 INTELENCE TAB 100MG, 200MG

43

INTELENCE TAB 25MG 43 intralipid inj 20% 79 INTRALIPID INJ 30% 79 INTRON-A INJ 18000000UNIT, 50000000UNIT

38

INTRON-A INJ 6000000UNIT, 10000000UNIT

38

INTUNIV TAB 7 INVANZ INJ 32 INVEGA INJ 41 INVEGA SUSTENNA INJ 41 INVEGA TAB 41 INVEGA TRINZA INJ 41 INVIRASE CAP 43 INVIRASE TAB 43 iodoquinol/ hydrocortisone cream

56

IONOSOL-B/ D5W INJ 75 IONOSOL-MB/ D5W INJ 75 IOPIDINE OPHTH SOLN 0.5%

80

IOPIDINE OPHTH SOLN 1%

80

IPOL INJ 91 ipratropium nasal spray 78 ipratropium neb 16 ipratropium/ albuterol neb

17

irbesartan tab 29 irbesartan/ hydrochlorothiazide tab

30

IRENKA CAP 22 IRESSA TAB 37 irinotecan inj 40mg/ 2ml, 100mg/ 5ml

39

IRINOTECAN INJ 500MG/ 25ML

39

IRON POLYSACCH/ THREONIC ACID/ B12/ FA CAP

71

IRON SUSP 71 ISENTRESS CHEW TAB 100MG

43

ISENTRESS CHEW TAB 25MG

43

ISENTRESS POWDER PACK

43

ISENTRESS TAB 400MG 43 isoditrate ER tab 14 ISOLYTE-P/ D5W INJ 75 ISOLYTE-S INJ 75 ISONIAZID INJ 34 ISONIAZID SYRUP 34 isoniazid tab 34 ISOPTO ATROPINE OPHTH SOLN

80

ISOPTO CARPINE OPHTH SOLN

80

ISORDIL TAB 14 ISOSORBIDE DINITRATE ER TAB

14

isosorbide dinitrate tab 14 isosorbide mononitrate ER tab

14

isosorbide mononitrate tab

14

isotretinoin cap 55 isradipine cap 48 ISTALOL OPHTH SOLN 79 ISTODAX INJ 37 itraconazole cap 26 ivermectin tab 14 IXIARO INJ 91


108


J

JADENU TAB 25 JAKAFI TAB 37 JALYN CAP 69 JANUMET TAB 23 JANUMET XR TAB 23 JANUVIA TAB 23 JARDIANCE TAB 24 JEVTANA INJ 39 jinteli tab 66 jolessa tab/ amethia LO tab

51

junel FE tab 51 junel tab 51 JUXTAPID CAP 29

K

KADCYLA INJ 35 KADIAN CAP 10 KALETRA SOLN 43 KALETRA TAB 100-25MG

43

KALETRA TAB 200-50MG

43

KALYDECO PACKET 87 KALYDECO TAB 87 kariva tab 51 KAYEXALATE POWDER 46 kcl/ d5w inj 75 kcl/ d5w/ lr inj 75 KCL/ D5W/ LR INJ 75 kcl/ d5w/ nacl inj 75 KCL/ D5W/ NACL INJ 75 kcl/ nacl inj 75 KEFLEX CAP 49 kelnor tab 51 KENALOG INJ 52 KENALOG SPRAY 60 KEPIVANCE INJ 39 KEPPRA ORAL SOLN 18 KEPPRA TAB 18 KEPPRA XR TAB 18 KERAFOAM 61 KERLONE TAB 47 KETEK TAB 33

ketoconazole cream 56 ketoconazole foam 56 ketoconazole shampoo 56 ketoconazole tab 26 KETO-DIASTIX 62 ketoprofen cap 9 KETOPROFEN ER CAP 9 ketorolac inj 9 ketorolac ophth soln 82 ketorolac tab 9 KETOSTIX 62 ketotifen ophth soln 82 KEYTRUDA INJ 36 KEYTRUDA IV SOLN 36 KHEDEZLA ER TAB 22 KINERET INJ 8 KLARON LOTION 55 KLONOPIN TAB 18 KLOR-CON M15 TAB 76 klor-con m20 ER tab 76 KLOR-CON POWDER PACKET

76

KOMBIGLYZE XR TAB 23 KORLYM TAB 23 K-PHOS NEUTRAL TAB 76 K-PHOS TAB 76 KRISTALOSE PACKET 72 K-TABS CR TAB 76 KUVAN POWDER PACKET

65

KUVAN TAB 65 KYNAMRO INJ 27

L

labetalol inj 47 labetalol tab 47 LAC-HYDRIN CREAM 61 LAC-HYDRIN LOTION 61 LACRISERT OPHTH INSERT

79

lactated ringers inj 75 lactated ringers irrigation

46

lactulose soln 68 lactulose soln 68

LAMICTAL CHEW TAB 18 LAMICTAL ODT 18 LAMICTAL ODT KIT 18 LAMICTAL STARTER KIT

18

LAMICTAL TAB 18 LAMICTAL XR KIT 18 LAMICTAL XR TAB 18 LAMISIL GRANULES 26 LAMISIL TAB 26 lamivudine soln 43 lamivudine tab 43 lamivudine tab 43 lamivudine/ zidovudine tab

43

lamotrigine chew tab 18 lamotrigine ER tab 19 lamotrigine ODT 19 lamotrigine ODT kit 19 lamotrigine tab 19 LANCET DEVICE 74 LANCET KIT 74 LANCETS 74 LANOXIN INJ 49 LANOXIN TAB 125MCG 49 LANOXIN TAB 250MCG 49 lansoprazole cap 89 LANSOPRAZOLE SUSP 89 lansoprazole/ amoxicillin/ clarithromycin pack

90

LANTUS INJ 23 LANTUS SOLOSTAR INJ 23 LASIX TAB 63 LASTACAFT OPHTH SOLN

82

latanoprost ophth soln 83 LATUDA TAB 41 LAZANDA NASAL SPRAY

11

leflunomide tab 9 LENVIMA CAP THERAPY PACK

38

LESCOL CAP 28 LESCOL XL TAB 28


109


LETAIRIS TAB 49 letrozole tab 36 leucovorin calcium inj 39 LEUCOVORIN TAB 10MG, 15MG

39

leucovorin tab 5mg, 25mg 39 LEUKERAN TAB 34 LEUKINE INJ 71 leuprolide inj 36 levalbuterol neb 17 LEVALBUTEROL/ XOPENEX HFA INHALER

17

LEVAQUIN ORAL SOLN 67 LEVAQUIN TAB 67 LEVATOL TAB 47 LEVBID TAB 89 LEVEMIR FLEXTOUCH 23 LEVEMIR INJ 23 levetiracetam ER tab 19 LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN

19

levetiracetam inj 19 levetiracetam soln 19 levetiracetam tab 19 levobunolol ophth soln 0.25%

80

levobunolol ophth soln 0.5%

80

levocarnitine inj 65 levocarnitine oral soln 65 levocarnitine tab 65 levocetirizine soln 27 levocetirizine tab 27 levofloxacin inj 67 levofloxacin opth soln 80 levofloxacin oral soln 67 levofloxacin tab 67 levofloxacin/ d5w inj 67 levoleucovorin inj 175mg/ 17.5ml

39

levoleucovorin inj 50mg 39 levonorgestrel tab 52 levora-28 tab 51

LEVORPHANOL TAB 11 levothyroxine tab 87 LEVSIN INJ 89 LEVSIN SL TAB 89 LEVSIN TAB 89 LEXAPRO SOLN 21 LEXAPRO TAB 21 LEXIVA SUSP 43 LEXIVA TAB 43 LIALDA TAB 68 LIBRAX CAP 89 lidocaine cream 61 lidocaine gel 61 lidocaine inj 73 lidocaine oint 61 LIDOCAINE ORAL SOLN 4%

76

lidocaine patch 61 lidocaine soln 61 lidocaine viscous soln 76 lidocaine/ hydrocortisone cream

13

lidocaine/ prilocaine cream

61

LIDODERM PATCH 61 LINCOCIN INJ 300MG/ ML

33

lincomycin inj 300mg/ ml 33 lindane lotion 1% 62 LINDANE LOTION 1% 62 lindane shampoo 62 linezolid IV soln 33 linezolid susp 100mg/ 5ml 33 linezolid tab 33 LINZESS CAP 68 liothyronine inj 87 liothyronine tab 88 LIPITOR TAB 28 lipodox inj 37 LIPOFEN CAP 28 LIPOSYN III IV SOLN 79 lisinopril tab 29 lisinopril/ hydrochlorothiazide tab

31

lithium carbonate cap 40

lithium carbonate ER tab 40 lithium carbonate tab 40 lithium citrate soln 40 LITHOBID CR TAB 40 LITHOSTAT TAB 69 LIVALO TAB 28 LO LOESTRIN FE TAB 51 LOCOID CREAM 60 LOCOID LOTION 60 LOCOID OINT 60 LOCOID SOLN 60 LODOSYN TAB 39 LOESTRIN FE TAB 51 LOESTRIN TAB 51 LOFIBRA CAP 28 LOFIBRA TAB 28 LOMOTIL TAB 24 LOMUSTINE CAP 34 LONSURF TAB 37 loperamide cap 24 LOPID TAB 28 LOPRESSOR HCT TAB 100-25MG

31

LOPRESSOR HCT TAB 50-25MG

31

LOPRESSOR TAB 100MG

47

LOPRESSOR TAB 50MG 47 LOPROX SHAMPOO 56 loratadine ODT 27 loratadine syrup 27 loratadine tab 27 loratadine/ pseudoephedrine tab

54

lorazepam intensol conc 15 lorazepam tab 15 LORTAB ELIXIR 12 losartan tab 30 losartan/ hydrochlorothiazide tab

31

LOSEASONIQUE TAB 51 LOTEMAX OPHTH GEL 81 LOTEMAX OPHTH OINT 81 LOTEMAX OPHTH SUSP 81


110


LOTENSIN TAB 20MG, 40MG

29

LOTENSIN TAB 5MG, 10MG

29

LOTREL CAP 2.5-10MG 31 LOTREL CAP 5-10MG, 5-20MG, 10-20MG, 10-40MG

31

LOTRISONE CREAM 56 LOTRONEX TAB 68 lovastatin tab 28 LOVAZA CAP 27 LOVENOX INJ 18 loxapine cap 41 LTA 360 KIT 76 LUFYLLIN TAB 17 LUMIGAN OPHTH SOLN 83 LUNESTA TAB 72 LUPRON DEPO-PED INJ 65 LUPRON DEPOT INJ 36 LUPRON DEPOT INJ 36 LURIDE SOLN 75 LURIDE TAB 75 LYNPARZA CAP 38 LYRICA CAP 19 LYRICA SOLN 19 LYSODREN TAB 36 LYSTEDA TAB 71

M

MACROBID CAP 90 MACRODANTIN CAP 90 magnesium sulfate inj 76 MAGNESIUM SULFATE/ D5W INJ

76

magnesium sulfate/ d5w inj

76

MALARONE TAB 33 malathion lotion 62 MANDELAMINE TAB 90 MAPROTILINE TAB 20 MARINOL CAP 25 MARPLAN TAB 21 MARQIBO INJ 39 MATULANE CAP 38

MAVIK TAB 29 MAXALT MLT TAB 74 MAXALT TAB 74 MAXIDEX OPHTH SUSP 81 MAXIPIME INJ 50 MAXITROL OPHTH OINT

81

MAXITROL OPHTH SUSP

81

MAXZIDE TAB 63 meclizine chew tab 25 meclizine tab 25 MECLOFENAMATE CAP 9 MEDROL TAB 2MG 52 MEDROL TAB 4MG, 8MG, 16MG, 32MG

52

MEDROL TAB DOSE PACK

52

medroxyprogesterone acetate tab

85

medroxyprogesterone inj 52 mefenamic acid cap 9 mefloquine tab 33 MEGACE ES SUSP 85 MEGACE ORAL SUSP 36 megestrol acetate susp 36 megestrol acetate tab 36 megestrol ES susp 85 MEKINIST TAB 38 meloxicam tab 9 melphalan inj 34 memantine soln 85 memantine tab 85 memantine tab titration pack

85

MENACTRA INJ 91 MENEST TAB 66 MENHIBRIX INJ 91 MENOMUNE A/ C/ Y/ W INJ

91

MENOSTAR PATCH 66 MENTAX CREAM 56 MENVEO INJ 91 meperidine inj 11

MEPERIDINE ORAL SOLN

11

meperidine tab 100mg 11 meperidine tab 50mg 11 MEPHYTON TAB 93 meprobamate tab 14 MEPRON SUSP 32 mercaptopurine tab 35 meropenem inj 32 MERREM INJ 32 mesalamine enema 68 mesalamine enema kit 68 mesna inj 39 MESNEX INJ 39 MESNEX TAB 39 MESTINON SYRUP 34 MESTINON TAB 34 MESTINON TIMESPAN TAB

34

METADATE CD CAP 7 METAPROTERENOL SYRUP

7

METAPROTERENOL TAB

17

METAXALONE TAB 400MG

78

metaxalone tab 800mg 78 metformin ER tab 500mg, 750mg

23

metformin tab 23 methadone conc 11 METHADONE INJ 11 METHADONE INTENSOL CONC

11

methadone oral soln 10mg/ 5ml

11

METHADONE ORAL SOLN 10MG/ 5ML

11

METHADONE ORAL SOLN 5MG/ 5ML

11

methadone oral soln 5mg/ 5ml

11

methadone tab 11 methadose tab 11 methamphetamine tab 7


111


methazolamide tab 63 methenamine hippurate tab

90

methimazole tab 87 METHITEST TAB 13 methocarbamol tab 78 methotrexate inj 1gm 35 METHOTREXATE INJ 250MG/ 10ML

35

methotrexate inj 50mg/ 2ml

35

methotrexate PF inj 25mg/ ml

35

methotrexate tab 35 methoxsalen cap 57 methscopolamine tab 89 METHYCLOTHIAZIDE TAB

64

methyldopa tab 30 methyldopa/ hydrochlorothiazide tab

31

methylergonovine tab 83 METHYLIN CHEW TAB 7 METHYLIN SOLN 7 methylphenidate CD cap 7 methylphenidate chew tab 7 methylphenidate ER cap 7 methylphenidate ER tab 10mg, 20mg

7

METHYLPHENIDATE ER TAB 18MG, 27MG, 36MG, 54MG

7

methylphenidate soln 7 methylphenidate tab 7 methylprednisolone acetate inj

52

methylprednisolone inj 52 methylprednisolone pak 52 METHYLPREDNISOLONE PF INJ

52

methylprednisolone succinate inj

52

methylprednisolone tab 52 methyltestosterone cap 10mg

13

METIPRANOLOL OPHTH SOLN

80

metoclopramide inj 67 metoclopramide soln 67 metoclopramide tab 67 metolazone tab 64 metoprolol ER tab 47 metoprolol inj 47 metoprolol tab 47 metoprolol/ hydrochlorothiazide tab

31

METROCREAM 62 METROGEL 62 METROGEL VAGINAL GEL

92

METROLOTION 62 metronidazole cap 32 metronidazole cream 62 metronidazole gel 62 metronidazole lotion 62 metronidazole tab 32 metronidazole vaginal gel

92

metronidazole/ nacl inj 32 MEVACOR TAB 28 mexiletine cap 15 MIACALCIN INJ 64 MIACALCIN NASAL SPRAY

64

MICARDIS HCT TAB 31 MICARDIS TAB 30 MICONAZOLE 3 SUPP 92 MICRO-K CAP 76 MICROZIDE CAP 64 midodrine tab 93 miglitol tab 22 MIGRANAL/ DIHYDROERGOTAMINE SPRAY

74

MILLIPRED DP PAK 53 MILLIPRED SOLN 53 MILLIPRED TAB 53 mimvey LO tab 66 mimvey tab 66 MINASTRIN CHEW TAB 51

MINIPRESS CAP 30 MINOCIN CAP 50MG, 100MG

87

MINOCIN CAP 75MG 87 minocycline cap 87 minocycline tab 87 minoxidil tab 31 MIRAPEX ER TAB 40 MIRAPEX TAB 40 MIRCETTE TAB 51 MIRENA IUD 52 mirtazapine ODT 20 mirtazapine tab 20 misoprostol tab 90 MITIGARE CAP 69 mitomycin inj 20mg, 40mg 37 MITOMYCIN INJ 5MG 37 mitoxantrone inj 37 M-M-R II INJ 91 MOBIC SUSP 9 MOBIC TAB 9 modafinil tab 7 moexipril tab 29 moexipril/ hydrochlorothiazide tab

31

MOLINDONE TAB 42 mometasone cream 60 mometasone furoate oint 60 mometasone lotion 60 mometasone nasal spray 78 montelukast chew tab 16 montelukast granules 16 montelukast tab 16 MONUROL PACKET 90 MORPHINE SULFATE ER BEAD CAP

11

morphine sulfate ER cap 11 morphine sulfate ER tab 11 morphine sulfate inj 11 MORPHINE SULFATE INJ

11

MORPHINE SULFATE INJ 10MG/ ML, 15MG/ ML

11


112


morphine sulfate inj PF 4mg/ ml, 8mg/ ml, 10mg/ ml

11

morphine sulfate soln 10mg/ 5ml

11

morphine sulfate soln 20mg/ 5ml

11

morphine sulfate soln 20mg/ ml

11

morphine sulfate tab 11 MOTRIN SUSP (OTC) 9 MOTRIN SUSP (RX) 9 MOVANTIK TAB 68 MOVIPREP 72 MOXEZA OPHTH SOLN 80 MOXIFLOXACIN INJ 67 moxifloxacin tab 67 MOZOBIL INJ 71 MS CONTIN TAB 11 MULTAQ TAB 15 multigen folic tab 71 multigen plus tab 71 multigen tab 71 MULTIVITAMIN TAB 71 multivitamin tab 71 multivitamins w/ minerals tab

77

mupirocin cream 56 mupirocin oint 56 MUSTARGEN INJ 35 MYAMBUTOL TAB 34 MYCAMINE INJ 26 MYCOBUTIN CAP 34 mycophenolate cap 46 mycophenolate DR tab 46 mycophenolate mofetil susp

46

mycophenolate tab 46 MYDFRIN OPHTH SOLN 81 MYDRIACYL OPHTH SOLN

80

MYFORTIC TAB 46 MYOZYME/ LUMIZYME INJ

65

MYRBETRIQ TAB 90

MYSOLINE TAB 19

N

nabumetone tab 9 nadolol tab 47 nadolol/ bendroflumethiazide tab

31

NAFTIFINE CREAM 1% 56 naftifine cream 2% 56 NAFTIN CREAM 1% 56 NAFTIN CREAM 2% 56 NAFTIN GEL 57 NAGLAZYME INJ 65 naloxone inj 0.4mg/ ml 25 NALOXONE INJ 2MG/ 2ML

25

naloxone inj 4mg/ 10ml 25 NALOXONE SOLN CARTRIDGE

25

NAMENDA SOLN 85 NAMENDA TAB 85 NAMENDA TAB TITRATION PACK

85

NAMENDA XR CAP 85 NAMZARIC ER CAP 85 NAPHAZOLINE OPHTH SOLN

81

NAPROSYN SUSP 9 NAPROSYN TAB 250MG, 375MG

9

NAPROSYN TAB 500MG 9 naproxen EC tab 9 naproxen sodium tab 9 NAPROXEN SR TAB 750MG

9

naproxen susp 9 NAPROXEN SUSP 125MG/ 5ML

9

naproxen tab 9 naratriptan tab 74 NARDIL TAB 21 NASACORT AQ NASAL SPRAY (RX ONLY)

78

NASCOBAL SPRAY 70

NASONEX NASAL SPRAY

78

NATACYN OPHTH SUSP 80 NATAZIA TAB 51 nateglinide tab 24 NATPARA INJ 64 NATROBA SUSP 62 NEBUPENT NEB 32 necon tab 51 NEFAZODONE TAB 100MG, 150MG, 200MG

21

nefazodone tab 250mg 21 nefazodone tab 50mg 21 neomycin tab 8 neomycin/ gramicidin/ polymyxin b ophth soln

80

neomycin/ polymyxin gu irrigation soln

69

neomycin/ polymyxin/ dexamethasone ophth oint

81

neomycin/ polymyxin/ dexamethasone ophth susp

82

neomycin/ polymyxin/ hydrocortisone ophth susp

82

neomycin/ polymyxin/ hydrocortisone otic soln

83

neomycin/ polymyxin/ hydrocortisone otic susp

83

NEORAL CAP 46 NEORAL SOLN 46 NEOSPORIN OPHTH SOLN

81

NEOTUSS LIQUID 54 NEPHRAMINE INJ 79 NEPHRO CAP 77 NEULASTA INJ 71 NEUMEGA INJ 71 NEUPRO PATCH 40 NEURONTIN CAP 19 NEURONTIN SOLN 19 NEURONTIN TAB 19 NEVANAC OPHTH SUSP 82


113


nevirapine ER tab 43 NEVIRAPINE SUSP 43 nevirapine tab 43 NEXAVAR TAB 38 NEXIUM IV INJ 89 NEXTERONE INJ 15 niacin cap 93 niacin CR tab 93 niacin ER tab 29 niacin tab (OTC) 93 NIACIN TR TAB (OTC) 93 niacinamide tab 93 NIACOR TAB 29 NIASPAN ER TAB 29 nicardipine cap 48 nicardipine inj 48 NICORETTE CQ PATCH 86 NICORETTE GUM 86 nicotine gum 86 nicotine lozenge 86 nicotine patch 86 NICOTINE PATCH KIT 86 NICOTROL INHALER 86 NICOTROL NASAL SPRAY

86

nifedipine cap 48 nifedipine ER tab 48 nikki 28 day tab 51 NILANDRON TAB 36 nilutamide tab 36 nimodipine cap 48 NIMOTOP CAP 48 NINLARO CAP 38 NIRAVAM TAB 15 nisoldipine ER tab 48 NISOLDIPINE SR TAB 48 NITRO-BID OINT 14 NITRO-DUR PATCH 0.1MG, 0.2MG, 0.4MG, 0.6MG

14

NITRO-DUR PATCH 0.3MG, 0.8MG

14

nitrofurantoin cap 90 nitrofurantoin macro cap 90 nitrofurantoin susp 90

nitroglycerin cap 14 nitroglycerin lingual spray

14

nitroglycerin patch 14 nitroglycerin sl tab 14 NITROLINGUAL PUMP SPRAY

14

NITROMIST AEROSOL 14 NITROSTAT SL TAB 14 nizatidine cap 89 nizatidine soln 89 NIZATIDINE SOLN 15MG/ ML

89

NIZORAL SHAMPOO 57 NORCO TAB 12 NORDITROPIN INJ 10MG/ 1.5ML

64

NORDITROPIN INJ 15MG/ 1.5ML

64

NORDITROPIN INJ 30MG/ 3ML

64

NORDITROPIN INJ 5MG/ 1.5ML

64

norethindrone acetate tab 85 norethindrone acetate/ ethinyl estradiol tab

66

norethindrone tab 52 norethindrone/ ethinyl estradiol FE chew tab

51

norethindrone/ ethinyl estradiol FE tab

51

NORINYL TAB 51 NORITATE CREAM 62 NORMOSOL INJ 75 NORMOSOL-M/ D5W INJ

75

NORMOSOL-R INJ 75 normosol-R inj 75 NOROXIN TAB 67 NORPACE CAP 15 NORPACE CR CAP 15 NORPRAMIN TAB 22 NOR-QD TAB 52 NORTHERA CAP 92 nortriptyline cap 22

NORTRIPTYLINE SOLN 22 NORVASC TAB 48 NORVIR CAP 43 NORVIR SOLN 43 NORVIR TAB 43 novamine inj 79 NOVOLIN MIX 70/ 30 VIAL

24

NOVOLIN N VIAL 24 NOVOLIN R VIAL 24 NOVOLOG FLEXPEN INJ

24

NOVOLOG MIX FLEXPEN INJ

24

NOVOLOG MIX INJ 24 NOVOLOG PENFILL 24 NOVOLOG VIAL 24 NOXAFIL DR TAB 26 NOXAFIL SUSP 26 NUCALA INJ 16 NUCORT LOTION 60 NUCYNTA ER TAB 11 NUCYNTA TAB 50MG 11 NUCYNTA TAB 75MG, 100MG

11

NUEDEXTA CAP 86 NULOJIX INJ 46 NUPLAZID TAB 41 NUVARING 52 NUVIGIL TAB 50MG, 150MG, 250MG

7

NUVIGIL/ ARMODAFINIL TAB 200MG

7

nystatin cream 57 nystatin oint 57 nystatin oral powder 26 nystatin powder 57 nystatin susp 76 nystatin tab 26

O

OCTAGAM INJ 83 octreotide inj 66 OCUFEN OPHTH SOLN 82


114


OCUFLOX OPHTH DROP

81

ODEFSEY TAB 43 ODOMZO CAP 36 OFEV CAP 87 ofloxacin ophth soln 81 ofloxacin otic soln 83 OFLOXACIN TAB 67 OGESTREL TAB 51 olanzapine inj 41 olanzapine ODT 41 olanzapine tab 41 olanzapine/ fluoxetine cap

85

OLEPTRO TAB 21 olopatadine nasal spray 78 olopatadine ophth soln 82 OLUX FOAM 60 omega-3-acid ethyl esters cap

28

omeprazole cap 10mg, 20mg

90

omeprazole cap 40mg 90 OMEPRAZOLE DR TAB 20MG

90

omeprazole magnesium DR cap

90

omeprazole/ bicarbonate powder pack

90

OMNARIS NASAL SPRAY

78

ONCASPAR INJ 38 ondansetron inj 25 ondansetron ODT 25 ondansetron soln 25 ondansetron tab 25 ONEXTON GEL 55 ONFI SUSP 18 ONFI TAB 18 ONGLYZA TAB 23 OPANA ER TAB (CRUSH RESISTANT)

11

OPANA TAB 11 OPDIVO INJ 36 opium tincture 24

OPSUMIT TAB 49 ORACIT SOLN 69 ORAP TAB 1MG 86 ORAP TAB 2MG 86 ORAPRED ODT 53 ORAPRED SOLN 53 ORAVIG TAB 76 ORENCIA INJ 10 ORENCIA SC INJ 10 ORFADIN CAP 65 ORKAMBI TAB 87 orphenadrine citrate inj 78 orphenadrine ER tab 78 ORTHO TRI-CYCLEN LO TAB

51

ORTHO TRI-CYCLEN TAB

51

ORTHO-CYCLEN TAB 51 ORTHO-EVRA PATCH 52 ORTHO-NOVUM TAB 51 OSMOPREP TAB 72 OVACE CREAM 57 OVACE PLUS SHAMPOO 58 OVACE PLUS WASH 58 OVACE WASH 58 OVCON 35 TAB 51 OVIDE LOTION 62 oxacillin inj 85 oxaliplatin inj 35 OXANDRIN TAB 13 oxandrolone tab 13 oxaprozin tab 9 oxazepam cap 15 oxcarbazepine susp 19 oxcarbazepine tab 19 oxiconazole nitrate cream 57 OXISTAT CREAM 57 OXISTAT LOTION 57 OXSORALEN ULTRA CAP

57

OXTELLAR XR TAB 19 oxybutynin ER tab 90 oxybutynin syrup 90 oxybutynin tab 90 oxycodone cap 11

oxycodone oral soln 20mg/ ml

11

oxycodone oral soln 5mg/ 5ml

11

oxycodone tab 10mg, 15mg, 20mg, 30mg

11

oxycodone tab 5mg 11 OXYCODONE/ ACETAMINOPHEN SOLN

12

oxycodone/ acetaminophen tab

11

oxycodone/ acetaminophen tab

11

oxycodone/ aspirin tab 12 oxycodone/ ibuprofen tab 12 OXYCODONE/ IBUPROFEN TAB 5-400MG

12

OXYCONTIN CR TAB 11 OXYCONTIN CR TAB 80MG

11

oxymorphone ER tab 11 oxymorphone tab 11 OXYTROL PATCH 90

P

paclitaxel inj 39 paliperidone SR tab 41 PAMELOR CAP 22 pamidronate disodium 3mg/ ml, 9mg/ ml

64

pamidronate disodium inj 30mg, 90mg

64

PAMIDRONATE INJ 6MG/ ML

64

PAMINE/ PAMINE FORTE TAB

89

PANATUSS PEDIATRIC LIQUID

54

PANCREAZE CAP 62 PANDEL CREAM 60 PANRETIN GEL 57 pantoprazole inj 90 pantoprazole tab 90


115


PARAFON FORTE TAB 78 PARAGARD IUD 52 paricalcitol cap 65 paricalcitol inj 65 PARLODEL CAP 40 PARNATE TAB 21 paromomycin cap 8 paroxetine ER tab 21 PAROXETINE ORAL SUSP

21

paroxetine tab 21 PASER GRANULE 34 PATADAY OPHTH SOLN 82 PATANASE NASAL SPRAY

78

PATANOL OPHTH SOLN 82 PAXIL CR TAB 21 PAXIL TAB 21 PCE EC TAB 73 PEAK FLOW METER 74 PEDIARIX INJ 88 PEDIATEX TDM SUSP 54 pediatric multiple vitamins/ fluoride chew tab

77

pediatric multiple vitamins/ fluoride soln

77

pediatric multiple vitamins/ fluoride/ iron soln

77

PEDVAX HIB INJ 91 peg 3350/ electrolytes soln

72

PEGANONE TAB 20 PEGASYS PROCLICK INJ

45

PEG-INTRON KIT 45 PEN NEEDLE 74 PENICILLIN G PROCAINE INJ

84

PENICILLIN G SODIUM INJ

84

penicillin gk inj 84 PENICILLIN GK/ DEXTROSE INJ

84

penicillin vk soln 84 penicillin vk tab 84 PENTAM INJ 32 PENTASA CR CAP 68 pentazocine/ naloxone tab

12

PENTOSTATIN INJ 38 pentoxifylline ER tab 70 PEPCID SUSP 89 PEPCID TAB 89 PERCOCET TAB 12 PERCODAN TAB 12 PERFOROMIST NEB 17 PERIDEX SOLN 76 perindopril tab 29 periogard soln 76 PERJETA INJ 36 permethrin cream 62 perphenazine tab 42 PERPHENAZINE/ AMITRIPTYLINE TAB

86

PERSANTINE TAB 70 PERTZYE CAP 62 PEXEVA TAB 21 phenazopyridine tab 69 phenelzine tab 21 PHENERGAN INJ 27 phenobarbital elixir 72 PHENOBARBITAL TAB 15MG, 30MG, 60MG, 100MG

72

phenobarbital tab 16.2mg, 32.4mg, 64.8mg, 97.2mg

72

phenoxybenzamine cap 29 phenylephrine ophth soln 81 phenylephrine/ guaifenesin tab

54

PHENYLEPHRINE-GUAIFENESIN LIQD

54

PHENYLHIST LIQUID 54 PHENYTEK CAP 20 phenytoin chew tab 20 phenytoin EX cap 20 phenytoin inj 20

phenytoin susp 20 PHISOHEX LIQUID 42 PHOSLO CAP 68 PHOSLYRA SOLN 68 phospha 250 neutral tab 76 PHOSPHOLINE OPHTH SOLN

80

physiosol irrigation soln 46 PICATO GEL 0.015% 57 PICATO GEL 0.05% 57 pilocarpine ophth soln 80 pilocarpine tab 77 pimozide tab 1mg, 2mg 86 pindolol tab 47 pioglitazone tab 24 pioglitazone/ glimepiride tab

23

pioglitazone/ metformin tab

23

piperacillin/ tazobactam inj

84

piroxicam cap 9 PLAQUENIL TAB 33 PLASMA-LYTE INJ 75 PLASMA-LYTE/ D5W INJ

75

PLASMA-LYTE-A INJ 75 PLAVIX TAB 70 PLEGRIDY PEN INJECTOR

86

PLEGRIDY PEN STARTER PACK

86

PLEGRIDY PREFILLED SYRINGE

86

PLETAL TAB 70 PLEXION SCT CREAM 55 podofilox soln 61 polyethylene glycol bulk powder 3350

72

polymyxin B inj 33 polymyxin b/ trimethoprim ophth soln

81

POLYTRIM OPHTH SOLN

81

POMALYST CAP 37


116


PONSTEL CAP 9 POTABA CAP 93 potassium bicarbonate effer tab

76

potassium chloride effer tab

76

potassium chloride ER cap

76

potassium chloride ER tab

76

POTASSIUM CHLORIDE ER TAB 8MEQ, 20MEQ

76

potassium chloride inj 76 potassium chloride liquid 76 potassium chloride powder packet

76

potassium citrate CR tab 15meq

69

potassium citrate CR tab 5meq, 10meq

69

potassium citrate/ citric acid granule

69

potassium citrate/ citric acid soln

69

POTIGA TAB 19 PRADAXA CAP 18 pramipexole ER tab 40 pramipexole tab 40 PRAMOSONE LOTION 60 PRANDIN TAB 24 PRAVACHOL TAB 28 pravastatin tab 29 prazosin cap 30 PRECISION XTRA METER

74

PRECISION XTRA TEST STRIP

62

PRECOSE TAB 22 PRED FORTE OPHTH SUSP

82

PRED MILD OPHTH SUSP

82

PRED-G OPHTH SUSP 82 PRED-G S.O.P OPHTH OINT

82

prednicarbate cream 60 prednicarbate oint 60 prednisolone ODT 53 prednisolone ophth susp 82 PREDNISOLONE ORAL SOLN

53

PREDNISOLONE SODIUM PHOSPHATE OPHTH SOLN

82

prednisolone sodium phosphate oral soln

53

prednisolone syrup 53 PREDNISONE CONC 53 PREDNISONE SOLN 53 prednisone tab 53 PREDNISONE TAB 50MG

53

PREDNISONE TAB DOSE PACK

53

PREFEST TAB 66 PREMARIN INJ 67 PREMARIN TAB 67 PREMARIN VAGINAL CREAM

92

premasol inj 79 PREMPHASE TAB 66 PREMPRO TAB 66 PRENATAL VITAMIN (RX ONLY)

77

PRENATAL VITAMINS (PRENATAL PLUS/ PREPLUS/ PRENAPLUS)

77

PREVACID 24HOUR CAP (OTC)

90

PREVACID SOLUTAB 90 PREVIDENT 5000 BOOSTER PASTE

76

PREVIDENT 5000 DRY MOUTH GEL

76

PREVIDENT RINSE 77 previfem tab 51 PREVPAC THERAPY PACK

90

PREZCOBIX TAB 43 PREZISTA SUSP 43

PREZISTA TAB 600MG, 800MG

43

PREZISTA TAB 75MG, 150MG

43

PRIFTIN TAB 34 PRIMAQUINE TAB 33 PRIMAXIN INJ 32 primidone tab 19 PRIMLEV TAB 12 PRIMSOL SOLN 32 PRINIVIL TAB 29 PRINIVIL TAB 29 PRINZIDE TAB 31 PRISTIQ TAB 22 PRIVIGEN INJ 84 probenecid tab 69 probenecid/ colchicine tab

69

PROCAINAMIDE INJ 15 PROCALAMINE INJ 79 PROCARDIA CAP 48 PROCARDIA XL TAB 48 PROCENTRA SOLN 7 prochlorperazine inj 42 prochlorperazine supp 42 prochlorperazine tab 42 PROCRIT INJ 71 PROCTOCORT CREAM 14 proctocream-HC 2.5% 14 procto-pak cream 14 progesterone cap 85 PROGESTERONE SUPP 92 PROGLYCEM SUSP 23 PROGRAF CAP 46 PROGRAF INJ 46 PROLASTIN INJ 87 PROLASTIN-C INJ 87 PROLENSA OPHTH SOLN

82

PROLEUKIN INJ 38 PROLIA INJ 64 PROMACTA TAB 71 promethazine DM syrup 54 promethazine inj 27 promethazine supp 27


117


promethazine syrup 27 promethazine tab 27 promethazine VC syrup 54 promethazine w/ codeine syrup

54

PROMETRIUM CAP 85 propafenone ER cap 15 propafenone tab 15 PROPANTHELINE TAB 89 proparacaine ophth soln 81 propranolol ER cap 47 propranolol inj 47 PROPRANOLOL SOLN 47 propranolol tab 47 propranolol/ hydrochlorothiazide tab

31

propylthiouracil tab 87 PROQUAD INJ 91 PROSCAR TAB 69 PROSOL INJ 79 PROTOPIC OINT 61 protriptyline tab 22 PROVERA TAB 85 PROVIGIL TAB 7 PROZAC CAP 21 pseudoephedrine/ codeine/ guaifenesin syrup

54

PULMICORT NEB SUSP 16 PULMOZYME INHALATION SOLN

87

PURIXAN SUSP 35 PYLERA CAP 90 pyrazinamide tab 34 PYRIDIUM TAB 69 pyridostigm tab 34 pyridostigmine CR tab 34 PYRIL D TAB 54

Q

QNASL CHILDRENS INHALER

78

QNASL INHALER 78 QUADRACEL INJ 88 QUALAQUIN CAP 33

QUARTETTE TAB 51 quasense tab 51 QUESTRAN LIGHT POWDER 4GM/ DOSE

28

QUESTRAN LIGHT POWDER PACK

28

QUESTRAN POWDER 28 quetiapine tab 41 QUFLORA PEDIATRIC CHEW TAB

77

QUFLORA PEDIATRIC DROP

77

quinapril tab 29 quinapril/ hydrochlorothiazide tab

31

quinidine gluconate CR tab

15

QUINIDINE GLUCONATE INJ

15

QUINIDINE SULFATE ER TAB

15

QUINIDINE SULFATE TAB

15

quinine sulfate cap 33

R

RABAVERT INJ 91 rabeprazole tab 90 raloxifene tab 65 ramipril cap 29 RANEXA TAB 14 ranitidine cap 89 ranitidine inj 89 ranitidine syrup 89 ranitidine tab 89 RAPAFLO CAP 69 RAPAMUNE SOLN 46 RAPAMUNE TAB 46 RAVICTI LIQUID 65 RAZADYNE ER CAP 85 RAZADYNE TAB 85 REBETOL CAP 45 REBETOL SOLN 45 RECLAST INJ 64 RECOMBIVAX-HB INJ 91

REGLAN TAB 67 REGRANEX GEL 62 RELENZA DISKHALER 45 RELISTOR INJ 68 RELISTOR INJ KIT 68 RELPAX TAB 74 REMERON SOLUTAB 20 REMERON TAB 20 REMICADE INJ 68 REMODULIN INJ 49 RENAGEL TAB 68 renaphro cap 77 RENVELA PACKET 68 RENVELA/ SEVELAMER CARBONATE TAB

68

repaglinide tab 24 REPAGLINIDE/ METFORMIN TAB

23

REPLIVA TAB 71 REPREXAIN TAB 12 REQUIP TAB 40 REQUIP XL TAB 40 RESCON TAB 54 RESCRIPTOR TAB 43 RESERPINE TAB 30 RESTASIS OPHTH EMULSION

81

RESTORIL CAP 72 RETIN-A CREAM 55 RETIN-A GEL 55 RETIN-A MICRO GEL 55 RETROVIR CAP 43 RETROVIR INJ 43 RETROVIR SYRUP 43 REVATIO INJ 49 REVATIO TAB 49 REVIA TAB 25 REVLIMID CAP 45 REXULTI TAB 42 REYATAZ CAP 43 REYATAZ POWDER PACKET

43

REZIRA SOLN 54 RHEUMATREX TAB 8


118


RIBAPAK TAB 400MG, 600MG

45

RIBAPAK TAB DOSE PACK

45

ribasphere tab 200mg 45 ribavirin cap 200mg 45 ribavirin tab 400mg 45 RIBAVIRIN TAB 400MG, 600MG

45

ribavirin tab 600mg 45 RIDAURA CAP 8 rifabutin cap 34 RIFADIN CAP 34 RIFADIN INJ 34 RIFAMATE CAP 34 rifampin cap 34 rifampin inj 34 RIFATER TAB 34 RILUTEK TAB 79 riluzole tab 79 rimantadine tab 45 ringers inj 75 ringers irrigation soln 46 RIOMET SOLN 23 risedronate DR tab 64 risedronate tab 64 RISPERDAL INJ 41 RISPERDAL M TAB 41 RISPERDAL SOLN 41 RISPERDAL TAB 41 risperidone ODT 41 risperidone soln 41 risperidone tab 41 RITALIN LA CAP 7 RITALIN TAB 7 RITUXAN INJ 36 rivastigmine cap 85 rivastigmine patch 85 rizatriptan ODT 74 rizatriptan tab 74 ROBAXIN TAB 78 ROBINUL FORTE TAB 89 ROBINUL INJ 11 ROBINUL INJ 11 ROBINUL TAB 89

ROCALTROL CAP 65 ROCALTROL SOLN 65 ropinirole ER tab 40 ropinirole tab 40 ROSULA FOAM 55 rosuvastatin tab 29 ROTARIX SUSP 91 ROTATEQ SOLN 91 ROXICET SOLN 12 ROXICODONE TAB 15MG, 30MG

11

ROXICODONE TAB 5MG 11 ROZEREM TAB 72 RUCONEST INJ 70 RYTARY ER CAP 40 RYTHMOL SR CAP 15 RYTHMOL TAB 15

S

SABRIL POWDER 19 SABRIL TAB 20 SAFYRAL TAB 51 SALAGEN TAB 77 SALEX SHAMPOO 61 salsalate tab 10 SANCUSO PATCH 25 SANDIMMUNE CAP 46 SANDIMMUNE INJ 46 SANDIMMUNE ORAL SOLN

46

SANDOSTATIN INJ 66 SANDOSTATIN INJ 50MCG/ ML

66

SANDOSTATIN KIT LAR INJ

66

SANTYL OINT 61 SAPHRIS SL TAB 41 SAVELLA TAB 86 SAVELLA TAB TITRATION PACK

86

SEASONIQUE TAB 51 seb-prev cream 58 SECONAL CAP 72 SECTRAL CAP 47 selegiline cap 40

selegiline tab 40 selenium sulfide lotion 58 selenium sulfide shampoo 58 SELZENTRY TAB 43 SEMPREX-D CAP 54 SENSIPAR TAB 65 SEREVENT DISK 17 SEROQUEL TAB 41 SEROQUEL XR TAB 41 sertraline soln 21 sertraline tab 21 SFROWASA ENEMA 68 SIGNIFOR INJ 66 sildenafil inj 49 sildenafil tab 49 SILVADENE CREAM 58 silver sulfadiazine cream 58 SIMBRINZA OPHTH SUSP

80

SIMPONI ARIA INJ 8 SIMPONI INJ 8 SIMULECT INJ 46 simvastatin tab 29 SINEMET CR TAB 40 SINEMET TAB 40 SINGULAIR CHEW TAB 16 SINGULAIR GRANULES 16 SINGULAIR TAB 16 SINUVENT TAB 54 sirolimus tab 46 SIRTURO TAB 34 SIVEXTRO INJ 33 SIVEXTRO TAB 33 SKELAXIN TAB 78 SKLICE LOTION 62 SLO-NIACIN TAB 93 SM B-COMPLEX/ VITAMIN C TAB

77

sodium chloride inj 76 sodium chloride irrigation soln

69

sodium chloride neb 54 sodium citrate/ citric acid soln

69

sodium fluoride chew tab 75


119


sodium fluoride cream 77 sodium fluoride gel 77 sodium fluoride paste 77 sodium fluoride rinse 77 sodium fluoride soln 76 SODIUM FLUORIDE TAB 76 sodium fluoride/ potassium nitrate paste

77

sodium lactate inj 75 sodium phenylbutyrate oral powder

65

sodium polystyrene oral susp

46

sodium polystyrene powder

47

sodium polystyrene rectal susp

47

sodium sulfacetamide gel 58 sodium sulfacetamide ophth soln

81

sodium sulfacetamide shampoo

58

sodium sulfacetamide/ urea pad

58

SOLARAZE GEL 57 SOLTAMOX ORAL SOLN 36 SOLU-CORTEF INJ 100MG, 500MG, 1000MG

53

SOLU-CORTEF INJ 250MG

53

SOLU-MEDROL INJ 53 SOMA TAB 78 SOMATULINE INJ 66 SOMAVERT INJ 64 SONATA CAP 72 SORIATANE CAP 57 SORILUX FOAM 57 sotalol AF tab 47 sotalol tab 47 SOVALDI TAB 45 SPECTRACEF TAB 50 SPINOSAD SUSP 62 SPIRIVA HANDIHALER 16

SPIRIVA RESPIMAT INHALER

16

spironolactone tab 63 spironolactone/ hydrochlorothiazide tab

63

SPORANOX CAP 26 SPORANOX SOLN 26 SPRITAM ODT 19 SPRYCEL TAB 38 STARLIX TAB 24 stavudine cap 43 stavudine soln 44 sterile water irrigation 46 STIMATE NASAL SPRAY 66 STIOLTO INHALER 17 STIVARGA TAB 38 STRATTERA CAP 7 STRENSIQ INJ 65 STREPTOMYCIN INJ 8 STRIBILD TAB 44 STROMECTOL TAB 14 STROVITE TAB 77 SUBOXONE FILM 12-3MG

12

SUBOXONE FILM 2-0.5MG, 4-1MG, 8-2MG

13

SUCRAID ORAL SOLN 62 sucralfate tab 89 SULAR TAB 48 sulfacetamide lotion 55 SULFACETAMIDE SODIUM OPHTH OINT

81

sulfacetamide sodium/ sulfur aerosol

55

sulfacetamide sodium/ sulfur emulsion

55

sulfacetamide sodium/ sulfur lotion

55

sulfacetamide/ prednisolone ophth soln

82

SULFACETAMIDE/ SULFUR EMULSION

55

sulfacleanse susp 55 SULFADIAZINE TAB 87

sulfamethoxazole/ trimethoprim DS tab

32

SULFAMETHOXAZOLE/ TRIMETHOPRIM INJ

32

sulfamethoxazole/ trimethoprim susp

32

sulfamethoxazole/ trimethoprim tab

32

SULFAMYLON CREAM 58 SULFAMYLON SOLN 58 sulfasalazine EC tab 68 sulfasalazine tab 68 sulindac tab 9 SUMADAN WASH 56 sumatriptan auto-injector 4mg/ 0.5ml

74

sumatriptan auto-injector 6mg/ 0.5ml

74

sumatriptan inj 4mg/ 0.5ml, 6mg/ 0.5ml

74

SUMATRIPTAN INJ 6MG/ 0.5ML

74

sumatriptan nasal spray 74 sumatriptan refill inj 4mg/ 0.5ml, 6mg/ 0.5ml

74

sumatriptan tab 74 SUMATRIPTAN/ IMITREX NASAL SPRAY

75

SUMAVEL DOSEPRO INJ

75

SUMAXIN PAD 56 SUMAXIN SUSP 56 SUPRAX CAP 50 SUPRAX CHEW TAB 50 SUPRAX SUSP 50 SURMONTIL CAP 22 SUSTIVA CAP 44 SUSTIVA TAB 44 SUTENT CAP 38 SUTTAR-SF SYRUP 54 SYLATRON KIT 38 SYLVANT INJ 46 SYMAX DUOTAB 89 SYMBYAX CAP 86 SYMLINPEN INJ 22


120


SYNAGIS INJ 84 SYNAREL NASAL SOLN 65 SYNERCID INJ 33 SYNJARDY TAB 23 SYNRIBO INJ 38 SYNTHROID TAB 88 SYPRINE CAP 45

T

TABLOID TAB 35 TACLONEX OINT 60 TACLONEX SCALP 60 tacrolimus cap 46 tacrolimus oint 61 TAFINLAR CAP 38 TAGAMET TAB 89 TAGRISSO TAB 38 TAMIFLU CAP 30MG 45 TAMIFLU CAP 45MG, 75MG

45

TAMIFLU SUSP 6MG/ ML

45

tamoxifen tab 36 tamsulosin cap 69 TAPAZOLE TAB 87 TARCEVA TAB 38 TARGRETIN CAP 38 TARGRETIN GEL 57 TARKA TAB 31 TASIGNA CAP 38 TASMAR TAB 40 TAXOL INJ 39 TAXOTERE INJ 39 TAZORAC CREAM 57 TAZORAC GEL 57 TECENTRIQ INJ 36 TECFIDERA CAP 86 TECFIDERA CAP STARTER PACK

86

TEFLARO INJ 50 TEGRETOL SUSP 19 TEGRETOL TAB 19 TEGRETOL XR TAB 19 TEKTURNA HCT TAB 31 TEKTURNA TAB 31

telmisartan tab 30 telmisartan/ amlodipine tab

31

telmisartan/ hydrochlorothiazide tab

31

temazepam cap 15mg, 30mg

72

temazepam cap 7.5mg, 22.5mg

72

TEMODAR CAP 35 TEMOVATE CREAM 60 TEMOVATE E CREAM 60 TEMOVATE GEL 60 TEMOVATE OINT 60 TEMOVATE SOLN 60 temozolomide cap 35 TENEX TAB 30 TENIVAC INJ 88 TENORETIC TAB 31 TENORMIN TAB 47 TERAZOL 3 CREAM 92 TERAZOL 7 CREAM 92 terazosin cap 30 terbinafine tab 26 terbutaline sulfate inj 17 terbutaline tab 17 terconazole cream 92 terconazole supp 92 TESSALON/ ZONATUSS CAP

53

testosterone cypionate inj 13 testosterone enanthate inj 13 TESTOSTERONE GEL 1% 13 testosterone gel 1% (25mg)

13

testosterone gel 50mg 13 TESTOSTERONE GEL PUMP 1%

13

TESTOSTERONE GEL/ TESTIM GEL 1%

13

testosterone pump 1% 13 TETANUS TOXOID INJ 88 TETANUS/ DIPTHERIA TOXOID INJ

88

tetrabenazine tab 86

TETRACYCLINE CAP 87 tetracycline cap 87 TEVETEN HCT TAB 31 TEVETEN TAB 30 TEXACORT SOLN 60 THALOMID CAP 45 THEO-24 CR CAP 17 theophylline ER tab 17 theophylline soln 17 theophylline SR tab 17 THIOLA TAB 69 thioridazine tab 42 THIOTEPA INJ 35 thiothixene cap 42 THYMOGLOBULIN INJ 46 thyroid tab 88 THYROLAR TAB 88 tiagabine tab 20 TIAZAC CAP 48 ticlopidine tab 250mg 70 TICLOPIDINE TAB 250MG

70

TIGAN CAP 25 TIGAN INJ 25 TIKOSYN CAP 16 timolol maleate ophth soln

80

timolol maleate tab 47 timolol ophth gel 80 TIMOPTIC OCUDOSE OPHTH SOLN

80

TIMOPTIC OPHTH SOLN 80 TIMOPTIC-XE OPHTH SOLN

80

TINDAMAX TAB 250MG 32 TINDAMAX TAB 500MG 32 tinidazole tab 32 TIROSINT CAP 88 TIVICAY TAB 10MG, 25MG

44

TIVICAY TAB 50MG 44 tizanidine cap 78 tizanidine tab 78 TOBI NEB SOLN 8 TOBI PODHALER 8


121


TOBRADEX OPHTH OINT

82

TOBRADEX OPHTH SUSP

82

TOBRADEX ST OPHTH SOLN

82

TOBRAMYCIN INJ 8 tobramycin inj 8 tobramycin neb soln 8 tobramycin ophth soln 81 tobramycin/ dexamethasone ophth susp

82

TOBREX OPHTH OINT 81 TOBREX OPHTH SOLN 81 TOFRANIL TAB 22 TOFRANIL-PM CAP 22 TOLAK CREAM 57 tolazamide tab 24 TOLBUTAMIDE TAB 24 tolcapone tab 40 tolmetin sodium cap 9 TOLMETIN SODIUM TAB

9

tolterodine SR cap 91 tolterodine tab 90 TOPAMAX SPRINKLE CAP

19

TOPAMAX TAB 19 TOPICORT CREAM 0.05%

60

TOPICORT CREAM 0.25%

60

TOPICORT GEL 60 TOPICORT LP OINT 60 TOPICORT OINT 60 TOPIRAMATE ER CAP 19 topiramate sprinkle cap 19 topiramate tab 19 topotecan inj 39 TOPROL XL TAB 47 TORISEL INJ 38 torsemide tab 63 TOUJEO SOLOSTAR INJ 24 TOVIAZ TAB 91

tpn electrolyte inj 75 TRACLEER TAB 49 tramadol ER tab 11 tramadol tab 12 tramadol/ acetaminophen tab

12

TRANDATE TAB 47 trandolapril tab 29 trandolapril/ verapamil ER tab

31

tranex acid tab 71 tranexamic acid IV soln 71 TRANSDERM-SCOP PATCH

25

TRANXENE T TAB 15MG 15 TRANXENE T TAB 3.75MG, 7.5MG

15

tranylcypromine tab 21 TRAVATAN Z OPHTH SOLN

83

TRAVOPROST OPHTH SOLN

83

trazodone tab 300mg 21 trazodone tab 50mg, 100mg, 150mg

21

TREANDA INJ 35 TRECATOR TAB 34 TRELSTAR DEPOT INJ 36 TRELSTAR LA INJ 36 TRELSTAR MIX INJ 36 TRESIBA INJ 24 tretinoin cap 38 tretinoin cream 56 tretinoin gel 56 tretinoin micro gel 56 TRETIN-X CREAM 56 TREXALL TAB 35 TREZIX CAP 12 triamcinolone cream 60 triamcinolone lotion 60 triamcinolone nasal spray (rx only)

78

triamcinolone oint 0.025%, 0.1%, 0.5%

61

TRIAMCINOLONE OINT 0.05%

61

triamcinolone spray 61 triamcinolone/ oragel paste

77

triamterene/ hydrochlorothiazide cap 37.5-25mg

63

TRIAMTERENE/ HYDROCHLOROTHIAZIDE CAP 50-25MG

63

triamterene/ hydrochlorothiazide tab

63

triazolam tab 72 TRIAZOLAM TAB 72 TRIBENZOR TAB 31 tricitrates soln 69 tricon cap 71 TRICOR TAB 28 trifluoperazine tab 42 trifluridine ophth soln 81 TRIGLIDE TAB 28 trihexyphenidyl elixir 40 trihexyphenidyl tab 40 tri-legest FE tab 51 TRILEPTAL SUSP 19 TRILEPTAL TAB 19 TRILIPIX CAP 28 trilyte soln 72 trimethobenzamide cap 25 trimethoprim tab 32 trimipramine cap 22 tri-nessa lo tab 51 trinessa tab 51 TRI-NORINYL TAB 51 TRINTELLIX TAB 21 TRIOSTAT INJ 88 TRISENOX SOLN 38 TRIUMEQ TAB 44 TRIZIVIR TAB 44 TROKENDI XR CAP 19 TROPHAMINE INJ 79 tropicamide ophth soln 80 trospium chloride SR cap 91 trospium tab 91


122


TRULICITY INJ 23 TRUMENBA INJ 91 TRUSOPT OPHTH SOLN 82 TRUVADA TAB 44 TUSNEL C SYRUP 54 TUSNEL CAP 54 TUSSICAPS 54 tussigon tab 53 tussin DM liquid 54 TUSSIONEX SUSP 54 TUSSI-ORGANI SYRUP 54 TUSSI-ORGANIDIN DM-S SOLN

54

TWINJECT INJ 92 TWINRIX INJ 91 TWYNSTA TAB 31 TYBOST TAB 44 TYGACIL INJ 32 TYKERB TAB 38 TYLENOL/ CODEINE TAB

12

TYPHIM VI INJ 91 TYSABRI INJ 86 TYVASO INHALATION SOLN

49

TYZEKA TAB 45

U

UCERIS RECTAL FOAM 13 UCERIS TAB 53 ULESFIA LOTION 62 ULORIC TAB 69 ULTRACET TAB 12 ULTRAM ER TAB 12 ULTRAM TAB 12 ULTRAVATE CREAM 61 ULTRAVATE LOTION 61 ULTRAVATE OINT 61 ULTRESA CAP 62 UNASYN BULK PACK 84 UNASYN INJ 84 UPTRAVI TAB 49 UPTRAVI TITRATION PACK

49

URECHOLINE TAB 91

URINE TEST STRIP 62 UROCIT-K TAB 69 UROQID #2 TAB 90 UROXATRAL TAB 69 URSO FORTE TAB 67 URSO TAB 67 ursodiol cap 67 ursodiol tab 67 UVADEX INJ 38

V

VAGIFEM TAB 92 valacyclovir tab 45 VALCHLOR GEL 57 VALCYTE SOLN 44 VALCYTE TAB 44 valganciclovir soln 44 valganciclovir tab 44 VALIUM TAB 15 valproate inj 20 valproic acid cap 20 valproic acid syrup 20 valsartan tab 30 valsartan/ hydrochlorothiazide tab

31

VALTREX TAB 45 VANCOCIN CAP 125MG 32 VANCOCIN CAP 250MG 32 vancomycin cap 32 vancomycin inj 32 vancomycin inj. 32 VANCOMYCIN ORAL SOLN KIT

32

VANCOMYCIN/ DEXTROSE INJ

32

VANOS CREAM 61 VAQTA INJ 92 VARIVAX INJ 92 VARUBI TAB 26 VASCEPA CAP 28 VASERETIC TAB 31 VASOTEC TAB 29 VECTIBIX INJ 36 VECTIBIX INJ 36

VECTICAL/ CALCITRIOL OINT

57

VELPHORO CHEW TAB 68 VELTASSA POWDER FOR ORAL SUSP

47

VELTIN GEL 56 VENCLEXTA TAB 100MG

36

VENCLEXTA TAB 10MG, 50MG

36

VENCLEXTA TAB STARTING PACK

36

venlafaxine ER cap 22 VENLAFAXINE ER TAB 22 venlafaxine ER tab 22 VENLAFAXINE ER TAB 225MG

22

venlafaxine tab 22 VENTAVIS INHALATION SOLN

49

VENTOLIN HFA INHALER 18GM

17

VENTOLIN HFA INHALER 8GM

17

VERAMYST NASAL SPRAY

79

verapamil CR tab 48 verapamil ER cap 100mg, 200mg, 300mg

48

verapamil ER cap 120mg, 180mg, 240mg, 360mg

48

verapamil inj 48 verapamil tab 48 VERDESO FOAM 61 VERELAN CAP 48 VERIPRED SOLN 53 VERSACLOZ SUSP 42 VESICARE TAB 91 VEXOL OPHTH SUSP 82 VFEND INJ 26 VFEND SUSP 26 VFEND TAB 26 VIBRAMYCIN SUSP 87 VIBRAMYCIN SYRUP 87 VIBRAMYCIN TAB 87


123


VICOPROFEN TAB 12 VICTOZA INJ 23 VIDAZA INJ 35 VIDEX EC CAP 44 VIDEX SOLN 2GM 44 VIDEX SOLN 4GM 44 VIGAMOX OPHTH SOLN 81 VIIBRYD 10/ 20/ 40MG STARTER KIT

21

VIIBRYD 10/ 20MG STARTER KIT

21

VIIBRYD TAB 21 VIMPAT INJ 19 VIMPAT SOLN 19 VIMPAT TAB 19 VINBLASTINE INJ 39 vincristine inj 39 vinorelbine inj 39 VIRACEPT TAB 44 VIRAMUNE SUSP 44 VIRAMUNE TAB 44 VIRAMUNE XR TAB 44 VIRAZOLE INHALATION SOLN

45

VIREAD POWDER 44 VIREAD TAB 44 VIROPTIC OPHTH SOLN 81 VISTARIL CAP 14 vitamin D cap 50000unit 93 VITAMIN D TAB 400UNIT

93

vitamin D3 cap 400unit, 1000unit

93

VITEKTA TAB 44 VIVELLE-DOT PATCH 67 VIVOTIF BERNA CAP 91 VOGELXO GEL PUMP 1%

13

VOLTAREN GEL 57 VOLTAREN XR TAB 9 voriconazole inj 26 voriconazole susp 26 voriconazole tab 26 VOSPIRE ER TAB 17 VOTRIENT TAB 38

VPRIV INJ 70 VRAYLAR CAP 41 VRAYLAR CAP THERAPY PACK

41

VYTORIN TAB 27 VYVANSE CAP 7

W

warfarin tab 17 WELCHOL PACKET 28 WELCHOL TAB 28 WELLBUTRIN TAB 21 WELLBUTRIN XL TAB 21

X

XALATAN OPHTH SOLN 83 XALKORI CAP 38 XANAX TAB 15 XANAX XR TAB 15 XARELTO TAB 17 XARELTO TAB STARTER PACK

17

XELJANZ ER TAB 11MG 8 XELJANZ TAB 8 XELODA TAB 35 XENAZINE TAB 86 XERESE CREAM 58 XGEVA INJ 64 XIFAXAN TAB 200MG 32 XIFAXAN TAB 550MG 32 XIGDUO XR TAB 5-1000MG

23

XIGDUO XR TAB 5-500MG, 10-500MG, 10-1000MG

23

XODOL TAB 12 XOLAIR INJ 16 XOPENEX NEB 0.31MG/ 3ML, 0.63MG/ 3ML, 1.25MG/ 3ML

17

XOPENEX NEB CONC 17 XTANDI CAP 37 XULANE PATCH 52 XYLOCAINE INJ 73 XYLOCAINE SOLN 61 XYREM SOLN 85

XYZAL SOLN 27 XYZAL TAB 27

Y

YASMIN TAB 51 YAZ TAB 51 YERVOY INJ 36 YF-VAX INJ 92 YODOXIN TAB 8

Z

zafirlukast tab 16 zaleplon cap 72 ZALTRAP INJ 35 ZAMICET SOLN 12 ZANAFLEX CAP 78 ZANOSAR INJ 35 ZANTAC INJ 89 ZANTAC TAB 89 ZARONTIN CAP 20 ZARONTIN SOLN 20 ZARXIO INJ 71 ZAVESCA CAP 70 ZEBETA TAB 47 ZEGERID OTC CAP 90 ZEGERID POWDER PACK

90

ZELAPAR ODT 40 ZELBORAF TAB 38 ZEMPLAR CAP 65 ZEMPLAR INJ 65 ZENPEP CAP 62 zeosa tab 51 ZEPATIER TAB 45 ZERBAXA INJ 49 ZERIT CAP 44 ZERIT SOLN 44 ZETIA TAB 29 ZETONNA NASAL SOLN 79 ZIAC TAB 31 ZIAGEN SOLN 44 ZIAGEN TAB 44 ZIANA GEL 56 zidovudine cap 44 zidovudine syrup 44 zidovudine tab 44


124


ZINACEF INJ 50 zinc sulfate cap 76 ZINECARD INJ 39 ZIOPTAN OPHTH SOLN 83 ziprasidone cap 41 ZIRGAN OPHTH GEL 81 ZITHROMAX INJ 73 ZITHROMAX POWDER PACK

73

ZITHROMAX SUSP 73 ZITHROMAX TAB 73 ZITHROMAX TAB Z-PACK

73

ZMAX SUSP 73 ZOCOR TAB 29 ZOFRAN INJ 25 ZOFRAN ODT 25 ZOFRAN SOLN 25 ZOFRAN TAB 25 zoledronic acid inj 64 ZOLEDRONIC ACID INJ 4MG

64

zoledronic acid IV soln 64 ZOLINZA CAP 38 zolmitriptan ODT 75 zolmitriptan tab 75 ZOLOFT CONC 21 ZOLOFT TAB 21 zolpidem tab 10mg 72 zolpidem tab 5mg 72 ZOMETA INJ 64 ZOMIG NASAL SPRAY 2.5MG

75

ZOMIG NASAL SPRAY 5MG

75

ZOMIG TAB 75 ZOMIG ZMT TAB 75 ZONEGRAN CAP 19 zonisamide cap 19 ZONTIVITY TAB 70 ZORTRESS TAB 46 ZOSTAVAX INJ 92 ZOSYN INJ 84 ZOSYN/ DEXTROSE INJ 84

zotane hydrocortisone otic soln

83

zovia tab 51 ZOVIRAX CAP 45 ZOVIRAX CREAM 58 ZOVIRAX OINT 58 ZOVIRAX SUSP 45 ZOVIRAX TAB 45 ZUTRIPRO LIQUID 54 ZYBAN SR TAB 86 ZYCLARA CREAM 61 ZYDELIG TAB 38 ZYFLO CR TAB 16 ZYFLO TAB 16 ZYKADIA CAP 38 ZYLET OPHTH SUSP 82 ZYLOPRIM TAB 69 ZYMAXID OPHTH SOLN 81 ZYPREXA INJ 42 ZYPREXA TAB 42 ZYPREXA ZYDIS TAB 15MG, 20MG

42

ZYPREXA ZYDIS TAB 5MG, 10MG

42

ZYRTEC CAP 27 ZYRTEC CHEW 27 ZYRTEC SYRUP 27 ZYRTEC TAB 27 ZYRTEC-D TAB 54 ZYTIGA TAB 36 ZYVOX IV SOLN 33 ZYVOX SUSP 100MG/ 5ML

33

ZYVOX TAB 33


125

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Non-Discrimination Statement: State of Montana complies with applicable Federal civil rights laws, state

and local laws, rules, policies and executive orders and does not discriminate on the basis of race, color, sex,

pregnancy, childbirth or medical conditions related to pregnancy or childbirth, political or religious

affiliation or ideas, culture, creed, social origin or condition, genetic information, sexual orientation, gender

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status. State of Montana does not exclude people or treat them differently because of race, color, sex,

pregnancy, childbirth or medical conditions related to pregnancy or childbirth, political or religious

affiliation or ideas, culture, creed, social origin or condition, genetic information, sexual orientation, gender

identity or expression, national origin, ancestry, age, disability, military service or veteran status or marital

status. State of Montana provides free aids and services to people with disabilities to communicate

effectively with us, such as: qualified sign language interpreters and written information in other formats

(large print, audio, accessible electronic formats, other formats). State of Montana provides free language

services to people whose primary language is not English such as: qualified interpreters and information

written in other languages. If you need these services, contact the Customer Care Center at 866-270-3877. If

you believe that State of Montana has failed to provide these services or discriminated in another way on the

basis of race, color, sex, pregnancy, childbirth or medical conditions related to pregnancy or childbirth,

political or religious affiliation or ideas, culture, creed, social origin or condition, genetic information, sexual

orientation, gender identity or expression, national origin, ancestry, age, disability, military service or veteran

status or marital status you can file a grievance. If you need help filing a grievance, John Pavao, State

Diversity Coordinator, is available to help you. You can file a grievance in person or by mail, fax, or email:

John Pavao

State Diversity Program Coordinator

Department of Administration

State Human Resources Division

125 N. Roberts

P.O. Box 200127

Helena, MT 59620

Phone: (406) 444-3984

Email: [email protected]

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for

Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at

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200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

mailto:[email protected]

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

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