140
Drug ID Drug Description Type of Charge 12NS1000 1/2 NORMAL SALINE 1,000 ML BAG Medication 12NS20K 1/2 NS W 20 MEQ KCL 1,000 ML BAG Medication 246ENEMA 246 ENEMA 120 ML BOT Medication ABACAV3 ABACAVIR SULFATE 300 MG TAB Medication ABAT250V ABATACEPT 250 MG/10 ML VIAL Medication ABAT250V ABATACEPT 250 MG/10 ML VIAL Medication as an Additive ACAMP333 ACAMPROSATE CALCIUM DELAYED RELEASE 333MG TAB Medication ACAR50 ACARBOSE 50 MG TAB Medication ACD5 ANTICOAGULANT CITRATE DEXTROSE 2 ML SYRINGE Medication ACD5 ANTICOAGULANT CITRATE DEXTROSE 2 ML SYRINGE Medication as an Additive ACDA ANTICOAGULANT CITRATE DEXTROSE 1,000 ML BAG Medication ACDA ANTICOAGULANT CITRATE DEXTROSE 1,000 ML BAG Medication as an Additive ACEBU200 ACEBUTOLOL 200 MG CAP Medication ACEBU400 ACEBUTOLOL 400 MG CAP Medication ACET600C ACETYLCYSTEINE 600 MG CAPSULE Medication ACETA100V ACETAMINOPHEN 10 MG/ML 100 ML PREMIX Medication ACETA120R ACETAMINOPHEN 120 MG SUPP Medication ACETA160L ACETAMINOPHEN 160 MG/5 ML CUP (BUBBLE GUM) Medication ACETA325L ACETAMINOPHEN 325 MG/10.15 ML CUP Medication ACETA325R ACETAMINOPHEN 325 MG SUPP Medication ACETA325T ACETAMINOPHEN 325 MG TAB Medication ACETA500T ACETAMINOPHEN 500 MG TAB Medication ACETA650L ACETAMINOPHEN 650 MG/20.3 ML CUP Medication ACETA650R ACETAMINOPHEN 650 MG SUPP Medication ACETA650X ACETAMINOPHEN-XR 650 MG Medication ACETA80T ACETAMINOPHEN 80 MG CHEW Medication ACETAZ250T acetaZOLAMIDE 250 MG TAB Medication ACETAZ500V acetaZOLAMIDE 500 MG VIAL Medication ACETAZ500V acetaZOLAMIDE 500 MG VIAL Medication as an Additive ACETIC250 ACETIC ACID 0.25 % IRRIGATION 250 ML BOTTLE Medication ACETICQIRR ACETIC ACID 0.25 % IRRIGATION 1000 ML BOTTLE Medication ACETONE ACETONE 480 ML BOT Medication ACETYLC10 ACETYLCYSTEINE 20% 10 ML ORAL/INHALATION Medication ACETYLC30 ACETYLCYSTEINE 20% 30 ML INJECTION Medication ACETYLC30 ACETYLCYSTEINE 20% 30 ML INJECTION Medication as an Additive ACETYLC4 ACETYLCYSTEINE 20% 4 ML ORAL/INHALATION Medication ACTIVELLA ACTIVELLA 0.1/0.5 MG 28 TAB PACK Medication ACYC5OIN15 ACYCLOVIR 5% OINT 15 GM TUBE Medication ACYCLO1V ACYCLOVIR 1,000 MG/20 ML VIAL Medication ACYCLO1V ACYCLOVIR 1,000 MG/20 ML VIAL Medication as an Additive ACYCLO200C ACYCLOVIR 200 MG CAP Medication Page 1 of 140

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Drug ID Drug Description Type of Charge

12NS1000 1/2 NORMAL SALINE 1,000 ML BAG Medication

12NS20K 1/2 NS W 20 MEQ KCL 1,000 ML BAG Medication

246ENEMA 246 ENEMA 120 ML BOT Medication

ABACAV3 ABACAVIR SULFATE 300 MG TAB Medication

ABAT250V ABATACEPT 250 MG/10 ML VIAL Medication

ABAT250V ABATACEPT 250 MG/10 ML VIAL Medication as an Additive

ACAMP333 ACAMPROSATE CALCIUM DELAYED RELEASE 333MG TAB Medication

ACAR50 ACARBOSE 50 MG TAB Medication

ACD5 ANTICOAGULANT CITRATE DEXTROSE 2 ML SYRINGE Medication

ACD5 ANTICOAGULANT CITRATE DEXTROSE 2 ML SYRINGE Medication as an Additive

ACDA ANTICOAGULANT CITRATE DEXTROSE 1,000 ML BAG Medication

ACDA ANTICOAGULANT CITRATE DEXTROSE 1,000 ML BAG Medication as an Additive

ACEBU200 ACEBUTOLOL 200 MG CAP Medication

ACEBU400 ACEBUTOLOL 400 MG CAP Medication

ACET600C ACETYLCYSTEINE 600 MG CAPSULE Medication

ACETA100V ACETAMINOPHEN 10 MG/ML 100 ML PREMIX Medication

ACETA120R ACETAMINOPHEN 120 MG SUPP Medication

ACETA160L ACETAMINOPHEN 160 MG/5 ML CUP (BUBBLE GUM) Medication

ACETA325L ACETAMINOPHEN 325 MG/10.15 ML CUP Medication

ACETA325R ACETAMINOPHEN 325 MG SUPP Medication

ACETA325T ACETAMINOPHEN 325 MG TAB Medication

ACETA500T ACETAMINOPHEN 500 MG TAB Medication

ACETA650L ACETAMINOPHEN 650 MG/20.3 ML CUP Medication

ACETA650R ACETAMINOPHEN 650 MG SUPP Medication

ACETA650X ACETAMINOPHEN-XR 650 MG Medication

ACETA80T ACETAMINOPHEN 80 MG CHEW Medication

ACETAZ250T acetaZOLAMIDE 250 MG TAB Medication

ACETAZ500V acetaZOLAMIDE 500 MG VIAL Medication

ACETAZ500V acetaZOLAMIDE 500 MG VIAL Medication as an Additive

ACETIC250 ACETIC ACID 0.25 % IRRIGATION 250 ML BOTTLE Medication

ACETICQIRR ACETIC ACID 0.25 % IRRIGATION 1000 ML BOTTLE Medication

ACETONE ACETONE 480 ML BOT Medication

ACETYLC10 ACETYLCYSTEINE 20% 10 ML ORAL/INHALATION Medication

ACETYLC30 ACETYLCYSTEINE 20% 30 ML INJECTION Medication

ACETYLC30 ACETYLCYSTEINE 20% 30 ML INJECTION Medication as an Additive

ACETYLC4 ACETYLCYSTEINE 20% 4 ML ORAL/INHALATION Medication

ACTIVELLA ACTIVELLA 0.1/0.5 MG 28 TAB PACK Medication

ACYC5OIN15 ACYCLOVIR 5% OINT 15 GM TUBE Medication

ACYCLO1V ACYCLOVIR 1,000 MG/20 ML VIAL Medication

ACYCLO1V ACYCLOVIR 1,000 MG/20 ML VIAL Medication as an Additive

ACYCLO200C ACYCLOVIR 200 MG CAP Medication

Page 1 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

ACYCLO200S ACYCLOVIR 200 MG/5 ML CUP Medication

ACYCLO500V ACYCLOVIR 500 MG/10 ML VIAL Medication

ACYCLO500V ACYCLOVIR 500 MG/10 ML VIAL Medication as an Additive

ACYCLO800C ACYCLOVIR 800 MG TAB Medication

ADALI40 ADALIMUMAB 40 MG SYRINGE Medication

ADAP45CR ADAPALENE 0.1% CREAM 45 GM TUBE Medication

ADDER10XR DEXTROAMPHETAMINE/AMPHETAMINE 10 MG XR CAP Medication

ADDER15XR DEXTROAMPHETAMINE/AMPHETAMINE 15 MG XR CAP Medication

ADDERAL10 DEXTROAMPHETAMINE/AMPHETAMINE 10 MG TAB Medication

ADEN3VIA ADENOSINE 60 MG/20 ML VIAL Medication

ADEN3VIA ADENOSINE 60 MG/20 ML VIAL Medication as an Additive

ADENO12SYR ADENOSINE 12 MG/4 ML VIAL Medication

ADENO630V ADENOSINE 90 MG/30 ML INJ Medication

ADENO6SYR ADENOSINE 6 MG/2 ML SYRINGE Medication

ADOINT A D OINTMENT 60 GM TUBE Medication

ADUD A D OINTMENT 5 GM PACKET Medication

AEROZOINSP AEROZOIN SPRAY 120 ML BOT Medication

AGGRENOX DIPYRIDAMOLE/ASPIRIN 1 CAPSULE Medication

AICC1000U ANTI-INHIBITOR COAGULANT COMPLEX (ANTI-FVIII INHIB) 1,000U/20 ML (FEIBA)/U Medication

AICC1000U ANTI-INHIBITOR COAGULANT COMPLEX (ANTI-FVIII INHIB) 1,000U/20 ML (FEIBA)/U Medication as an Additive

ALBU0.633 ALBUTEROL SULFATE 0.63 MG/3 ML NEB SOL Medication

ALBUM25100 ALBUMIN 25% 25GM/100ML BOT Medication

ALBUM2550 ALBUMIN 25% 12.5GM/50ML BOT Medication

ALBUM25500 ALBUMIN 5% 25 GM/500 ML BOTTLE Medication

ALBUM5250 ALBUMIN 5% 12.5 GM/250 ML BOT Medication

ALBUM550 ALBUMIN 5% 2.5 GM/50 ML BOTTLE Medication

ALBUT125 ALBUTEROL 1.25 MG/3 ML NEB SOLUTION Medication

ALBUT2.5 ALBUTEROL 2.5 MG/0.5 ML NEB SOL Medication

ALBUT4SR ALBUTEROL SR TAB 4 MG SRTABLET Medication

ALBUTE2L ALBUTEROL 2 MG/5 ML CUP Medication

ALBUTFIN18 ALBUTEROL ORAL INHALER 200 PUFF Medication

ALBUTHFA60 ALBUTEROL ORAL INHALER 60 PUFF Medication

ALCOHOL5ML ALCOHOL DEHYRATED FOR INJECTION 5 ML VIAL Medication

ALDES22 ALDESLEUKIN 1800000 IU VIAL Medication

ALDES22 ALDESLEUKIN 1800000 IU VIAL Medication as an Additive

ALEN35T ALENDRONATE 35 MG TAB Medication

ALEN70T ALENDRONATE 70 MG TAB Medication

ALFENT5ML ALFENTANIL 2500 MCG/5 ML AMP Medication

ALFENT5ML ALFENTANIL 2500 MCG/5 ML AMP Medication as an Additive

ALISK150T ALISKIREN 150 MG TAB Medication

ALKASEL ALKA SELTZER 1 PKT (2 TABS) Medication

ALLOP100T ALLOPURINOL 100 MG TAB Medication

Page 2 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

ALLOP300T ALLOPURINOL 300 MG TAB Medication

ALOSET1 ALOSETRON 1 MG TAB Medication

ALPHA1P ALPHA-1-PROTEINASE INHIBITOR (ZEMAIRA) ~1,000 MG VIAL (CHARGE PER MG) Medication

ALPHA1P ALPHA-1-PROTEINASE INHIBITOR (ZEMAIRA) ~1,000 MG VIAL (CHARGE PER MG) Medication as an Additive

ALPHAP1000 ALPHA-1-PROTEINASE INHIBITOR (PROLASTIN C) ~1,000 MG VIAL (CHARGE PER MG) Medication

ALPHAP1000 ALPHA-1-PROTEINASE INHIBITOR (PROLASTIN C) ~1,000 MG VIAL (CHARGE PER MG) Medication as an Additive

ALPRAZ1 ALPRAZolam 1 MG TAB Medication

ALPRAZ25 ALPRAZolam 0.25 MG TAB Medication

ALPRAZ5 ALPRAZolam 0.5 MG TAB Medication

ALPROS ALPROSTADIL 500 MCG/ML VIAL Medication

ALTCATHFLO ALTEPLASE CATHFLO 2 MG VIAL Medication

ALTCATHFLO ALTEPLASE CATHFLO 2 MG VIAL Medication as an Additive

ALUMIRRIG ALUM 1% IRRIGATION 3000 ML BAG Medication

ALUMIRRIG ALUM 1% IRRIGATION 3000 ML BAG Medication as a Carrier

ALVI12CA ALVIMOPAN 12 MG CAPSULE Medication

AMANTA100C AMANTADINE 100 MG CAP Medication

AMANTA100L AMANTADINE 100 MG/10 ML BOTTLE Medication

AMBR10TAB AMBRISENTAN 10 MG TABLET Medication

AMBR5TAB AMBRISENTAN 5 MG TAB Medication

AMCIN1OINT AMCINONIDE 0.1 % OINTMENT 60 GM TUBE Medication

AMERISPRY BENZOCAINE 20% SPRAY 57 GM CAN Medication

AMIKACIN AMIKACIN 500 MG/2 ML VIAL Medication

AMILOR5T aMILoride 5 MG TAB Medication

AMINACID15 AMINO ACIDS 15% 1,000 ML BOTTLE Medication

AMINACID15 AMINO ACIDS 15% 1,000 ML BOTTLE Medication as a Carrier

AMINACID15 AMINO ACIDS 15% 1,000 ML BOTTLE Medication as an Additive

AMINO10500 AMINO ACIDS 10% 500 ML BOT Medication

AMINO10500 AMINO ACIDS 10% 500 ML BOT Medication as a Carrier

AMINO10500 AMINO ACIDS 10% 500 ML BOT Medication as an Additive

AMINO8500 HEPATAMINE 8% 500 ML BOT Medication

AMINOC500T AMINOCAPROIC ACID 500 MG TAB Medication

AMINOC5I AMINOCAPROIC ACID 5 GM/20 ML VIAL Medication

AMINOC5I AMINOCAPROIC ACID 5 GM/20 ML VIAL Medication as an Additive

AMINOCL AMINOCAPROIC ACID 1250 MG/5 ML ORAL SOL Medication

AMINOP250I AMINOPHYLLINE 250 MG/10 ML VIAL Medication

AMINOP250I AMINOPHYLLINE 250 MG/10 ML VIAL Medication as an Additive

AMIO100S AMIODARONE 150 MG/100 ML PREMIX INJ Medication

AMIO200S AMIODARONE 360 MG/200ML PREMIX BAG Medication

AMIO50VI4 AMIODARONE 900 MG/18 ML VIAL Medication

AMIO50VI4 AMIODARONE 900 MG/18 ML VIAL Medication as an Additive

AMIOD200T AMIODARONE 200 MG TAB Medication

Page 3 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

AMIOIV AMIODARONE 150 MG/3 ML VIAL Medication

AMIOIV AMIODARONE 150 MG/3 ML VIAL Medication as an Additive

AMITRIP100 AMITRIPTYLINE 100 MG TAB Medication

AMITRIP10T AMITRIPTYLINE 10 MG TAB Medication

AMITRIP150 AMITRIPTYLINE 150 MG TAB Medication

AMITRIP25T AMITRIPTYLINE 25 MG TAB Medication

AMITRIP50T AMITRIPTYLINE 50 MG TAB Medication

AMITRIP75T AMITRIPTYLINE 75 MG TAB Medication

AMLODI10 amLODIPine 10 MG TAB Medication

AMLODI2.5 amLODIPine 2.5 MG TAB Medication

AMLODI5 amLODIPine 5 MG TAB Medication

AMMONIAVAP AMMONIA AROMATIC VAPOROLES Medication

AMOBAR500 AMOBARBITAL SODIUM 500 MG POWDER VIAL FOR INJ Medication

AMOBAR500 AMOBARBITAL SODIUM 500 MG POWDER VIAL FOR INJ Medication as an Additive

AMOXAP25T AMOXAPINE 25 MG TAB Medication

AMOXCHEW25 AMOXICILLIN 250 MG CHEW Medication

AMOXEP100T AMOXAPINE 100 MG TAB Medication

AMOXEP150T AMOXAPINE 150 MG TAB Medication

AMOXEP50T AMOXAPINE 50 MG TAB Medication

AMOXI125BU AMOXICILLIN 125 MG/5 ML 150ML BULK BOTTLE Medication

AMOXI250BU AMOXICILLIN 250 MG/5 ML 150 ML BULK BOTTLE Medication

AMOXIC250C AMOXICILLIN 250 MG CAP Medication

AMOXIC500C AMOXICILLIN 500 MG CAP/TAB Medication

AMPHO50V AMPHOTERICIN B 50 MG VIAL Medication

AMPHOLIPOS AMPHOTERICIN B LIPOSOME 50 MG VIAL Medication

AMPHOLIPOS AMPHOTERICIN B LIPOSOME 50 MG VIAL Medication as an Additive

AMPICI1V AMPICILLIN 1,000 MG VIAL Medication

AMPICI1V AMPICILLIN 1,000 MG VIAL Medication as an Additive

AMPICI250V AMPICILLIN 250 MG VIAL Medication

AMPICI250V AMPICILLIN 250 MG VIAL Medication as an Additive

AMPICI2PB AMPICILLIN 2,000 MG VIAL Medication

AMPICI2PB AMPICILLIN 2,000 MG VIAL Medication as an Additive

AMPICI500V AMPICILLIN 500 MG VIAL Medication

AMPICI500V AMPICILLIN 500 MG VIAL Medication as an Additive

ANAG05 ANAGRELIDE 0.5 MG CAP Medication

ANAKINRA ANAKINRA 100MG/0.67ML INJ Medication

ANAST1 ANASTROZOLE 1 MG TAB Medication

ANBESOLGEL BENZOCAINE 10% GEL 9.9 GM GEL Medication

ANGIOT2.5V ANGIOTENSIN II 2.5 MG/ML VIAL Medication

ANGIOT2.5V ANGIOTENSIN II 2.5 MG/ML VIAL Medication as an Additive

ANTITHROM ANTITHROMBIN III HUMAN ~500 UNIT VIAL (CHARGE PER UNIT) Medication

ANUSOLHCCR ANUSOL HC (HYDROCORTISONE 2.5%) 30 GM CREAM Medication

Page 4 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

ANUSOLRHC ANUSOL HC 25 MG SUPPOSITORY Medication

APIX2.5T1 APIXABAN 2.5 MG TAB Medication

APIX5T APIXABAN 5 MG TAB Medication

APRACL1OPS APRACLONIDINE 1% OPTH SOL (2 X 0.1 ML POUCH) Medication

APRE125C APREPITANT 125 MG CAP Medication

APRE40C APREPITANT 40 MG CAP Medication

APRE80C APREPITANT 80 MG CAP Medication

AQUA2OZ AQUAPHOR HEALING OINTMENT 50 GM TUBE Medication

AQUA2OZ AQUAPHOR HEALING OINTMENT 50 GM TUBE Medication as a Compound

ARGA1SOL ARGATROBAN 125 MG/125 ML PREMIX Medication

ARGAT100 ARGATROBAN 100 MG/ML 2.5 ML INJ Medication

ARGAT100 ARGATROBAN 100 MG/ML 2.5 ML INJ Medication as an Additive

ARGAT50 ARGATROBAN 50 MG/50 ML PREMIX Medication

ARGIN300IV ARGININE 300 ML BOT Medication

ARIP15 ARIPiprazole 15 MG TAB Medication

ARIPIP ARIPiprazole 10 MG TAB Medication

ARIPIP1064 ARIPIPRAZOLE LAUROXIL 1,064 MG/3.9 ML SUSP ER SYRINGE Medication

ARIPIP2 ARIPiprazole 2 MG TAB Medication

ARIPIP400 ARIPiprazole 400 MG SYRINGE KIT (ABILIFY MAINTENA) Medication

ARIPIP5 ARIPiprazole 5 MG TAB Medication

ARIPIP675 ARIPIPRAZOLE LAUROXIL SUBMICRONIZED 675 MG/2.4 ML SUSP ER SYRINGE Medication

ARIPIP882 ARIPIPRAZOLE LAUROXIL 882 MG/3.2 ML SUSP ER SYRINGE Medication

ARMO150T ARMODAFINIL 150 MG TABLET Medication

ARMO250T ARMODAFINIL 250 MG TABLET Medication

ARMO50T ARMODAFINIL 50 MG TAB Medication

ARTIFTEARS ARTIFICIAL TEARS SOLUTION (LIQUIFILM) 15 ML Medication

ARTTEAR35O ARTIFICIAL TEARS OINTMENT (AKWA TEARS) 3.5 GM Medication

ASA325EC ASPIRIN - ENTERIC COATED 325 MG TAB Medication

ASA325S ASPIRIN 300 MG SUPP Medication

ASA325T ASPIRIN 325 MG TAB Medication

ASA650S ASPIRIN 600 MG SUPP Medication

ASA81E ASPIRIN - ENTERIC COATED 81 MG TAB Medication

ASA81T ASPIRIN 81 MG CHEWABLE Medication

ASEN5SLT ASENAPINE 5 MG SL TAB Medication

ASPERCREME ASPERCREME (TROLAMINE SAL 10%) 2 OZ Medication

ATENOL100T ATENOLOL 100 MG TAB Medication

ATENOL25T ATENOLOL 25 MG TAB Medication

ATENOL50T ATENOLOL 50 MG TAB Medication

ATOMOX10 ATOMOXETINE 10 MG CAP Medication

ATOMOX18 ATOMOXETINE 18 MG CAP Medication

ATOMOX25 ATOMOXETINE 25 MG CAP Medication

ATOMOX40 ATOMOXETINE 40 MG CAP Medication

Page 5 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

ATOMOX60 ATOMOXETINE 60 MG CAP Medication

ATOR10T ATORVASTATIN 10 MG TAB Medication

ATOR20T ATORVASTATIN 20 MG TAB Medication

ATOR40T ATORVASTATIN 40 MG TAB Medication

ATOR80T ATORVASTATIN 80 MG TAB Medication

ATOV750L ATOVAQUONE 750 MG/5 ML CUP Medication

ATRO1OPH2M ATROPINE 1% OPHTH SOLN 2 ML BOT Medication

ATRO1OPH5M ATROPINE 1% OPHTH SOLN 5 ML BOT Medication

ATROP1MG10 ATROPINE 1 MG/10 ML SYRINGE Medication

ATROP1MGML ATROPINE 1 MG/ML 1 ML VIAL Medication

ATROP4MG20 ATROPINE 0.4 MG/ML 20 ML VIAL Medication

ATROP4MG20 ATROPINE 0.4 MG/ML 20 ML VIAL Medication as an Additive

ATROP4V ATROPINE 0.4 MG/ML 1 ML VIAL Medication

ATROPOPHOT ATROPINE 1% OPHTH OINT 3.5 GM TUBE Medication

ATROPPEDIN ATROPINE 0.25 MG/5 ML SYRINGE Medication

AUG250S75M AMOXICILLIN/CLAVULANATE 250 MG/5 ML SUSP 75ML BOTTLE Medication

AUGMEN250T AMOXICILLIN/CLAVULANATE 250 MG TAB Medication

AUGMEN400 AMOXICILLIN/CLAVULANATE 400 MG/5 ML SUSP 100ML *BULK* Medication

AUGMEN500T AMOXICILLIN/CLAVULANATE 500 MG TAB Medication

AUGMEN875T AMOXICILLIN/CLAVULANATE 875 MG TAB Medication

AUGXR1000 AMOXICILLIN/CLAVULANATE XR 1,000 MG TAB Medication

AURANOF3C AURANOFIN 3 MG CAP Medication

AVCC SULFANILAMIDE CREAM VAGINAL CREAM 4 OZ TUBE Medication

AVITENE MICROFIBRILLAR COLLAGEN HEMOST 1 PKT POWDER Medication

AYR AYR SALINE NASAL GEL 14GM Medication

AZAC100V AZACITIDINE 100 MG VIAL Medication

AZAC100V AZACITIDINE 100 MG VIAL Medication as an Additive

AZAC100VSQ AZACITIDINE 100 MG/4 ML VIAL *SUBCUTANEOUS* Medication

AZAC100VSQ AZACITIDINE 100 MG/4 ML VIAL *SUBCUTANEOUS* Medication as an Additive

AZATHIO50T azaTHIOprine 50 MG TAB Medication

AZELASNAS AZELASTINE 137 MCG/DOSE NASAL SPRAY 30 ML (0.1%) Medication

AZIT2.5D AZITHROMYCIN 1% OPH SOLN 2.5 ML BOTTLE Medication

AZITH100S AZITHROMYCIN 100 MG/5 ML SUSP 15 ML BOTTLE Medication

AZITH1GMS AZITHROMYCIN SUSP 1 GM PKT Medication

AZITH200S AZITHROMYCIN 200 MG/5 ML SUSP 15 ML BOTTLE Medication

AZITH6T AZITHROMYCIN 600 MG TAB Medication

AZITHR250 AZITHROMYCIN 250 MG TAB Medication

AZITHR500V AZITHROMYCIN 500 MG VIAL Medication

AZITHR500V AZITHROMYCIN 500 MG VIAL Medication as an Additive

AZTREO1V AZTREONAM 1,000 MG VIAL Medication

AZTREO1V AZTREONAM 1,000 MG VIAL Medication as an Additive

AZTREO2V AZTREONAM 2,000 MG VIAL Medication

Page 6 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

AZTREO2V AZTREONAM 2,000 MG VIAL Medication as an Additive

BABYOIL JOHNSONS BABY OIL 89 ML BOT Medication

BACI120O BACITRACIN 0.9 GM OINT PACKET Medication

BACITRACV BACITRACIN 50000 UNIT VIAL Medication

BACITRACV BACITRACIN 50000 UNIT VIAL Medication as an Additive

BACITROINT BACITRACIN 30 GM OINT TUBE Medication

BACITROPOI BACITRACIN 3.5 GM OPHTH OINT TUBE Medication

BACLOF10T BACLOFEN 10 MG TAB Medication

BACLOF20T BACLOFEN 20 MG TAB Medication

BACLOINTRA BACLOFEN 0.5 MG/ML 20 ML INTRATHECAL KIT Medication

BACLOINTRB BACLOFEN 0.05 MG/ML INTRATHECAL KIT 1 ML TEST Medication

BACLOINTRC BACLOFEN 2 MG/ML 20 ML INTRATHECAL KIT Medication

BAGBALM EMOLLIENT 226.8 GM CAN Medication

BBAG BRIDGE BAG OF TPN/PPN Medication

BCGV50V BCG VACCINE USP 1 ML (RECONSTITUTED) VIAL Medication

BCGV50V BCG VACCINE USP 1 ML (RECONSTITUTED) VIAL Medication as an Additive

BDRGEL BDR GEL 10 ML TOPICAL SYRINGE Medication

BELA250P BELATACEPT 250 MG INJECTION Medication

BELA250P BELATACEPT 250 MG INJECTION Medication as an Additive

BENAZEP20 BENAZEPRIL 20 MG TAB Medication

BENAZEP5 BENAZEPRIL 5 MG TAB Medication

BENDAM25V BENDAMUSTINE 100 MG/4 ML VIAL Medication

BENDAM25V BENDAMUSTINE 100 MG/4 ML VIAL Medication as an Additive

BENGAY BENGAY OINT 1 OZ TUBE Medication

BENGAY85 BENGAY CREAM 85 GM TUBE Medication

BENPER150 BENZOYL PEROXIDE 10% WASH 150 ML BOT Medication

BENZ0.252 BENZYLPENICILLOYL POLYLYSINE 0.25 ML AMP (PRE-PEN) Medication

BENZ0.5S2 BENZOCAINE 20% UNIT DOSE SPRAY 0.5 ML Medication

BENZ1GEL2 BENZOYL PEROXIDE/CLINDAMYCIN GEL 50 GM JAR Medication

BENZ60TI13 BENZOIN COMPOUND TINCTURE 60 ML BOTTLE Medication

BENZ9GEL BENZOCAINE 20% GEL 9 GM TUBE (ANBESOL MAX STRGTH) Medication

BENZOCOM48 BENZOIN COMPOUND TINCTURE 480 ML BOTTLE Medication

BENZON100C BENZONATATE 100 MG PERLES Medication

BENZOYL10G BENZOYL PEROXIDE 10% GEL 42.5 GM TUBE Medication

BENZOYL10L BENZOYL PEROXIDE 10% LOTION 30 ML BOT Medication

BENZOYLP5G BENZOYL PEROXIDE 5% GEL 42.5 GM TUBE Medication

BENZOYLP5L BENZOYL PEROXIDE 5% LOTION 30 ML BOT Medication

BENZTR1T BENZTROPINE MESYLATE 1 MG TAB Medication

BENZTR2AMP BENZTROPINE MESYLATE 2 MG/2 ML AMP Medication

BENZTR2T BENZTROPINE MESYLATE 2 MG TAB Medication

BENZTR5T BENZTROPINE MESYLATE 0.5 MG TAB Medication

BERACT BERACTANT SUSPENSION 25 MG/ML 8ML BOT Medication

Page 7 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

BERACT4 BERACTANT SUSPENSION 25 MG/ML 4ML BOT Medication

BETAMETH12 BETAMETHASONE 12 MG/2 ML SYRINGE Medication

BETAMETH6V BETAMETHASONE 6 MG/ML 5ML VIAL Medication

BETAXOL25 BETAXOLOL-S 0.25% OPHTH SUSP 10 ML Medication

BETHAN10T BETHANECHOL CHLORIDE 10 MG TAB Medication

BETHAN25T BETHANECHOL CHLORIDE 25 MG TAB Medication

BEVACIZ100 BEVACIZUMAB 100 MG/4 ML SDV Medication

BEVACIZ100 BEVACIZUMAB 100 MG/4 ML SDV Medication as an Additive

BEVACIZ400 BEVACIZUMAB 400 MG/16 ML SDV Medication

BEVACIZ400 BEVACIZUMAB 400 MG/16 ML SDV Medication as an Additive

BEZLO1000V BEZLOTOXUMAB 1,000 MG/40 ML VIAL Medication

BEZLO1000V BEZLOTOXUMAB 1,000 MG/40 ML VIAL Medication as an Additive

BIAFINE BIAFINE WOUND CARE EMULSION 45 GM TUBE Medication

BICAL50T BICALUTAMIDE 50 MG TAB Medication

BICIL90030 BICILLIN CR 900/300 SYRINGE Medication

BICILCR1.2 BICILLIN CR 1,200,000 UNIT SYR Medication

BICILLA12 PENICILLIN G BENZATHINE 1,200,000 UNIT TUBEX Medication

BICILLA24 PENICILLIN G BENZATHINE 2,400,000 UNIT TUBEX Medication

BICILLA600 PENICILLIN G BENZATHINE 600000 UNIT TUBEX Medication

BICITRA30 BICITRA 30 ML CUP Medication

BIFID4 ALIGN (BIFIDOBACTERIUM INFANTIS) 4 MG CAP Medication

BIMA2.5S BIMATOPROST 0.01% OPTH SOL 2.5 ML BOTTLE Medication

BISACO10R BISACODYL 10 MG SUPP Medication

BISACO5T BISACODYL 5 MG EC Medication

BISM1CAP BISMUTH/METRONID/TETRACYCLINE (PYLERA) CAPSULE Medication

BISM500P11 BISMUTH SUBGALLATE 30 GM POWDER Medication

BISMU262T BISMUTH SUBSALICYLATE 262 MG TAB Medication

BISMUTH30 BISMUTH SUBSALICYLATE 524 MG/30 ML CUP Medication

BISOP5 BISOPROLOL 5 MG TAB Medication

BIVALIR BIVALIRUDIN 250 MG INJ Medication

BIVALIR BIVALIRUDIN 250 MG INJ Medication as an Additive

BLACKWID WIDOW SPIDER ANTIVENIN 2.5 ML SDV Medication

BLEOM15V BLEOMYCIN 15 UNIT VIAL Medication

BLEOM15V BLEOMYCIN 15 UNIT VIAL Medication as an Additive

BLEPH3O BLEPHAMIDE OPHTH OINT 3.5 GM TUBE Medication

BLEPH5S BLEPHAMIDE OPTH SUSP 5 ML BOT Medication

BORTEZ3.5 BORTEZOMIB 3.5 MG VIAL Medication

BORTEZ3.5 BORTEZOMIB 3.5 MG VIAL Medication as an Additive

BOSUPP B AND O SUPP Medication

BOTOX BOTULINUM TOXIN TYPE A 100 UNIT VIAL Medication

BREX1TAB BREXPIPRAZOLE 1 MG TAB Medication

BREX4TAB BREXPIPRAZOLE 4 MG TAB Medication

Page 8 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

BRIM2OPH BRIMONIDINE TARTRATE 0.2% OPHTH SOL 5 ML Medication

BRIM5DRO2 BRIMONIDINE 0.2%/TIMOLOL 0.5% OPHTH SOL 5 ML (COMBIGAN) Medication

BRIMO1OPTH BRIMONIDINE TARTRATE 0.1% OPHTH SOL 5 ML Medication

BRIMOPTH BRIMONIDINE TARTRATE 0.15 % OPTH SOL 5 ML Medication

BRINZOPTH BRINZOLAMIDE 1% OPHTH SUSP 10 ML Medication

BROMOCR2T BROMOCRIPTINE MESYLATE 2.5 MG TAB Medication

BSS15ML BALANCED SALT SOLUTION 15 ML BOT Medication

BSS500 BALANCED SALT SOLUTION 500 ML BOT Medication

BSSPLUS500 BALANCED SALT SOLUTION PLUS 500 ML BOT Medication

BUDE0.25 BUDESONIDE 0.25 MG/2ML NEB SOLUTION Medication

BUDES0.5 BUDESONIDE 0.5 MG/2 ML NEB SOL Medication

BUDES3EC BUDESONIDE 3 MG EC CAP Medication

BUDES9ER BUDESONIDE 9 MG EXTENDED REL TAB Medication

BUDESAQUA BUDESONIDE AQUA 32 MCG NASAL SPRAY 8.43 ML Medication

BUFFERIN BUFFERED ASPIRIN 325 MG TAB Medication

BUMETA1T BUMETANIDE 1 MG TAB Medication

BUMETA5T BUMETANIDE 0.5 MG TAB Medication

BUMETAN1V BUMETANIDE 1 MG/4 ML VIAL Medication

BUMETAN1V BUMETANIDE 1 MG/4 ML VIAL Medication as an Additive

BUMETAN25V BUMETANIDE 2.5 MG/10 ML VIAL Medication

BUMETAN25V BUMETANIDE 2.5 MG/10 ML VIAL Medication as an Additive

BUP150XL buPROPion XL 150 MG 24-HR TAB Medication

BUP300XL buPROPion XL 300 MG 24-HR TAB Medication

BUPI10SU BUPIVACAINE LIPOSOME 1.3% 10 ML VIAL Medication

BUPI10SU BUPIVACAINE LIPOSOME 1.3% 10 ML VIAL Medication as an Additive

BUPI10VI5 BUPIVACAINE HCL 0.5%/1:200000 10 ML VIAL Medication

BUPI2.5V6 BUPIVACAINE 0.25% 10 ML SDV Medication

BUPI2.5V6 BUPIVACAINE 0.25% 10 ML SDV Medication as a Carrier

BUPI2.5V6 BUPIVACAINE 0.25% 10 ML SDV Medication as an Additive

BUPI25E BUPIVACAINE 0.25% EPI 1:200000 10 ML SDV Medication

BUPI25EMDV BUPIVACAINE 0.25% EPI 1:200000 50 ML MDV Medication

BUPI25ESDV BUPIVACAINE 0.25% EPI 1:200000 30 ML SDV Medication

BUPI75ESDV BUPIVACAINE 0.75% EPI 1:200000 30 ML SDV Medication

BUPIV10SDV BUPIVACAINE 0.5% 10 ML SDV Medication

BUPIV10SDV BUPIVACAINE 0.5% 10 ML SDV Medication as a Carrier

BUPIV10SDV BUPIVACAINE 0.5% 10 ML SDV Medication as an Additive

BUPIV25SDV BUPIVACAINE 0.25% 30 ML SDV Medication

BUPIV25SDV BUPIVACAINE 0.25% 30 ML SDV Medication as a Carrier

BUPIV25SDV BUPIVACAINE 0.25% 30 ML SDV Medication as an Additive

BUPIV5EMDV BUPIVACAINE HCL/EPI 1:200000 50 ML SOL Medication

BUPIV5ESDV BUPIVACAINE 0.5% W/EPI 1:200000 30 ML SDV Medication

BUPIV5MDV BUPIVACAINE HCL 0.5% 50 ML MDV Medication

Page 9 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

BUPIV5SDV BUPIVACAINE 0.5% 30 ML SDV Medication

BUPIV5SDV BUPIVACAINE 0.5% 30 ML SDV Medication as a Carrier

BUPIV5SDV BUPIVACAINE 0.5% 30 ML SDV Medication as an Additive

BUPIV75SDV BUPIVACAINE HCL 0.75% 30 ML SDV Medication

BUPIV75SDV BUPIVACAINE HCL 0.75% 30 ML SDV Medication as an Additive

BUPIVSPINA BUPIVACAINE 0.75% 2 ML AMP Medication

BUPR10TDM BUPRENORPHINE 10 MCG/HR-7 DAY 1 PATCH (BUTRANS) Medication

BUPR20TDM BUPRENORPHINE 20 MCG/HR-7 DAY PATCH (BUTRANS) Medication

BUPR5TDM BUPRENORPHINE 5 MCG/HR 7 DAY PATCH (BUTRANS) Medication

BUPREN2 BUPRENORPHINE 2 MG TAB Medication

BUPREN8 BUPRENORPHINE 8 MG TAB Medication

BUPRO100CR buPROPion SR 100 MG 12-HR TAB Medication

BUPRO150CR buPROPion SR 150 MG 12-HR TAB Medication

BUPROP100T buPROPion 100 MG TAB Medication

BUPROP75T buPROPion 75 MG TAB Medication

BUSPIR10T busPIRone 10 MG TAB Medication

BUSPIR5T busPIRone 5 MG TAB Medication

BUSPIR7.5T busPIRone 7.5 MG TAB Medication

BUSULFA2T BUSULFAN 2 MG TAB Medication

BUTORPH4V BUTORPHANOL TART 2 MG/ML 1 ML VIAL Medication

BUTORPHNS BUTORPHANOL NASAL SPRAY 10 MG/ML 2.5 ML Medication

C1EI500V C1 ESTERASE INHIBITOR HUMAN, 500 UNIT Medication

C1EI500V C1 ESTERASE INHIBITOR HUMAN, 500 UNIT Medication as an Additive

CABER0.5TB CABERGOLINE 0.5 MG TAB Medication

CAFERGOT ERGOTAMINE/CAFFEINE TAB Medication

CAFF200 CAFFEINE TAB 200 MG TAB Medication

CAFFCIT60 CAFFEINE (CITRATED) 20 MG/ML 3ML ORALSOL Medication

CAFFCITINJ CAFFEINE (CITRATED) 20 MG/ML 3ML INJECTION Medication

CAFFCITINJ CAFFEINE (CITRATED) 20 MG/ML 3ML INJECTION Medication as an Additive

CAFFEINEBV CAFFEINE NA BENZOATE 500MG/2ML AMP Medication

CAFFEINEBV CAFFEINE NA BENZOATE 500MG/2ML AMP Medication as an Additive

CALACE1TAB CALCIUM ACETATE 667 MG CAP Medication

CALACES CALCIUM ACETATE 1334 MG/10 ML SOLUTION Medication

CALADRYLOT CALADRYL LOTION (CALAMINE 8%/PRAMOXINE HCL 1%) 177 ML BOTT Medication

CALAMINE CALAMINE LOTION 177 ML BOTTLE Medication

CALCARB500 CALCIUM CARBONATE 500 MG CHEW TAB Medication

CALCARBCUP CALCIUM CARBONATE 1250 MG/5 ML CUP (500MG CA++) Medication

CALCHLJET CALCIUM CHLORIDE 1 GM/10 ML SYRINGE Medication

CALCHLJET CALCIUM CHLORIDE 1 GM/10 ML SYRINGE Medication as an Additive

CALCHLVIAL CALCIUM CHLORIDE 1 GM/10 ML VIAL Medication

CALCHLVIAL CALCIUM CHLORIDE 1 GM/10 ML VIAL Medication as an Additive

CALCIT950 CALCIUM CITRATE 950 MG (ELEMENTAL CA 200MG) Medication

Page 10 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

CALCITNS CALCITONIN RECOMBINANT NASAL SPRAY (200 UNIT/SPRAY) 3.7 ML Medication

CALCITO400 CALCITONIN-SALMON 400 UNIT/2 ML VIAL (CHARGE PER UNIT) Medication

CALCITRI1A CALCITRIOL 1 MCG/ML 1ML AMP Medication

CALCITROL CALCITRIOL 0.25 MCG CAP Medication

CALGLUC1V CALCIUM GLUCONATE 1 GM/10 ML VIAL Medication

CALGLUC1V CALCIUM GLUCONATE 1 GM/10 ML VIAL Medication as an Additive

CALITROLIQ CALCITRIOL 1 MCG/ML 15ML DROPPER BOTTLE Medication

CAMPHO CAMPHO-PHENIQUE 2 OZ BOT Medication

CAN100 CANAGLIFLOZIN 100 MG TAB Medication

CAN300 CANAGLIFLOZIN 300 MG TAB Medication

CANGREL50V CANGRELOR 50 MG VIAL Medication

CANGREL50V CANGRELOR 50 MG VIAL Medication as an Additive

CAPECIT500 CAPECITABINE 500 MG TAB Medication

CAPOZ2515 CAPTOPRIL/HCTZ 25/15 MG TAB Medication

CAPOZ5015 CAPTOPRIL/HCTZ 50/15 MG TAB Medication

CAPS8KIT CAPSAICIN 8% PATCH KIT Medication

CAPSA25CR CAPSAICIN 0.025% CREAM 60 GM Medication

CAPTOPR12T CAPTOPRIL 12.5 MG TAB Medication

CAPTOPR50T CAPTOPRIL 50 MG TAB Medication

CARBAM1ER carBAMazepine ER 100 MG 12-HR CAP Medication

CARBAM2ER carBAMazepine ER 200 MG 12-HR CAP Medication

CARBAM3ER carBAMazepine ER 300 MG 12-HR CAP Medication

CARBAMAZ1S carBAMazepine XR 100 MG 12-HR TAB Medication

CARBAMAZ1T carBAMazepine 100 MG CHEWABLE TABLET Medication

CARBAMAZ2S carBAMazepine XR 200 MG 12-HR TAB Medication

CARBAMAZ2T carBAMazepine 200 MG TAB Medication

CARBAMAZLQ carBAMazepine 200 MG/10 ML CUP Medication

CARBAMIDE CARBAMIDE PEROXIDE (GLY-OXIDE) SOL 15 ML Medication

CARBAMIDOT CARBAMIDE PEROXIDE (DEBROX) OTIC SOL 15 ML Medication

CARBFE50 CARBONYL IRON 45 MG TAB Medication

CARBID25T CARBIDOPA 25 MG TAB Medication

CARBLEV36 CARBIDOPA/LEVODOPA 36.25/145 MG (RYTARY) ER CAP Medication

CARBOPL450 CARBOplatin 450 MG/45 ML VIAL Medication

CARBOPL450 CARBOplatin 450 MG/45 ML VIAL Medication as an Additive

CARBOPROST CARBOPROST 250 MCG/1 ML AMP Medication

CARFIL30V CARFILZOMIB 30 MG VIAL Medication

CARFIL30V CARFILZOMIB 30 MG VIAL Medication as an Additive

CARI250T2 CARISOPRODOL 250 MG TABLET Medication

CARISOPROD CARISOPRODOL 350 MG TAB Medication

CARMEX CARMEX 7.5 GM JAR Medication

CARMUS100V CARMUSTINE 3.3 MG/ML 30ML VIAL Medication

CARMUS100V CARMUSTINE 3.3 MG/ML 30ML VIAL Medication as an Additive

Page 11 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

CARMUSWFR CARMUSTINE 8 WAFER/BOX Medication

CARV10CR CARVEDILOL CR 10 MG CAP Medication

CARV25 CARVEDILOL 25 MG TAB Medication

CARV3125 CARVEDILOL 3.125 MG TAB Medication

CARV625 CARVEDILOL 6.25 MG TAB Medication

CEFAC250C CEFACLOR 250 MG CAP Medication

CEFADR500C CEFADROXIL 500 MG CAP Medication

CEFADRBU25 CEFADROXIL 250 MG/5 ML 100 ML BOT Medication

CEFAZ1PIG ceFAZolin 1,000 MG VIAL Medication

CEFAZ1PIG ceFAZolin 1,000 MG VIAL Medication as an Additive

CEFAZ2PNS ceFAZolin 2 GM/100 ML PREMIX BAG IN *NS* Medication

CEFDINIR60 CEFDINIR 125 MG/5 ML SUSP 60ML *BULK* Medication

CEFE2VIA9 CEFEPIME 2,000 MG VIAL Medication

CEFE2VIA9 CEFEPIME 2,000 MG VIAL Medication as an Additive

CEFEP1000 CEFEPIME 1,000 MG VIAL Medication

CEFEP1000 CEFEPIME 1,000 MG VIAL Medication as an Additive

CEFIX100BK CEFIXIME 100 MG/5 ML SUSP 50 ML *BULK* Medication

CEFIXI400T CEFIXIME 400 MG TAB Medication

CEFOTA1000 CEFOTAXIME 1,000 MG VIAL Medication

CEFOTA1000 CEFOTAXIME 1,000 MG VIAL Medication as an Additive

CEFOTE1V cefoTEtan 1,000 MG VIAL Medication

CEFOTE1V cefoTEtan 1,000 MG VIAL Medication as an Additive

CEFOTE2V cefoTEtan 2,000 MG VIAL Medication

CEFOTE2V cefoTEtan 2,000 MG VIAL Medication as an Additive

CEFOXI1PIG cefOXitin 1,000 MG VIAL Medication

CEFOXI1PIG cefOXitin 1,000 MG VIAL Medication as an Additive

CEFOXI1PRE cefOXitin/DEXTROSE 1 GM/50 ML DUPLEX BAG Medication

CEFOXI2PIG cefOXitin 2,000 MG VIAL Medication

CEFOXI2PIG cefOXitin 2,000 MG VIAL Medication as an Additive

CEFOXI2PRE cefOXitin/DEXTROSE 2 GM/50 ML DUPLEX BAG Medication

CEFPOD200 CEFPODOXIME 200 MG TAB Medication

CEFPODSUSP CEFPODOXIME 100 MG/5 ML SUSP 100 ML BOTTLE Medication

CEFTAR400V CEFTAROLINE 400 MG VIAL Medication

CEFTAR400V CEFTAROLINE 400 MG VIAL Medication as an Additive

CEFTAR600V CEFTAROLINE 600 MG VIAL Medication

CEFTAR600V CEFTAROLINE 600 MG VIAL Medication as an Additive

CEFTAZ1PIG cefTAZidime 1,000 MG VIAL Medication

CEFTAZ1PIG cefTAZidime 1,000 MG VIAL Medication as an Additive

CEFTAZ2PIG cefTAZidime 2,000 MG VIAL Medication

CEFTAZ2PIG cefTAZidime 2,000 MG VIAL Medication as an Additive

CEFTAZAVI cefTAZidime/AVIBACTAM 2.5 GM VIAL Medication

CEFTAZAVI cefTAZidime/AVIBACTAM 2.5 GM VIAL Medication as an Additive

Page 12 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

CEFTAZLOCK cefTAZidime LOCK W/HEPARIN Medication

CEFTAZLOCK cefTAZidime LOCK W/HEPARIN Medication as an Additive

CEFTOL15V CEFTOLOZANE/TAZOBACTAM 1.5 GM VIAL Medication

CEFTOL15V CEFTOLOZANE/TAZOBACTAM 1.5 GM VIAL Medication as an Additive

CEFTRI1PIG cefTRIAXone 1,000 MG VIAL Medication

CEFTRI1PIG cefTRIAXone 1,000 MG VIAL Medication as an Additive

CEFTRI250V cefTRIAXone 250 MG VIAL Medication

CEFTRI250V cefTRIAXone 250 MG VIAL Medication as an Additive

CEFTRI2PIG cefTRIAXone 2,000 MG VIAL Medication

CEFTRI2PIG cefTRIAXone 2,000 MG VIAL Medication as an Additive

CEFURO15PI CEFUROXIME 1500 MG VIAL Medication

CEFURO15PI CEFUROXIME 1500 MG VIAL Medication as an Additive

CEFURO250T CEFUROXIME 250 MG TAB Medication

CEFURO750P CEFUROXIME 750 MG VIAL Medication

CEFURO750P CEFUROXIME 750 MG VIAL Medication as an Additive

CELEC100 CELECOXIB 100 MG CAP Medication

CELEC200 CELECOXIB 200 MG CAP Medication

CENTRUM CENTRUM TAB Medication

CEPACOLLOZ BENZOCAINE/MENTHOL 16 LOZ PER BOX Medication

CEPHAL125S CEPHALEXIN 125 MG/5 ML SUSP 100 ML BOTTLE Medication

CEPHAL250C CEPHALEXIN 250 MG CAP Medication

CEPHAL250S CEPHALEXIN 250 MG/5 ML SUSP 100 ML BOTTLE Medication

CEPHAL500C CEPHALEXIN 500 MG CAP Medication

CERT400S CERTOLIZUMAB PEGOL 200 MG/1ML KIT Medication

CETAPHIL CETAPHIL CREAM 16 OZ JAR Medication

CETAPHILCL CETAPHIL CLEANSER 236 ML (8 OZ) BOT Medication

CETAPHILM CETAPHIL MOISTURIZING LOTION 473 ML (16 OZ) BOT Medication

CETIR10 CETIRIZINE 10 MG TAB Medication

CETIR5LB CETIRIZINE 5 MG/5 ML CUP Medication

CEVIMEL30 CEVIMELINE 30 MG CAP Medication

CHARCOALSS ACTIVATED CHARCOAL W/SORBITOL 25 GM/120 ML BOT Medication

CHARCOSUSP ACTIVATED CHARCOAL 25 GM/120 ML BOT Medication

CHLORAM2T CHLORAMBUCIL 2 MG TAB Medication

CHLORASLZ CHLORASEPTIC LOZENGES BOX OF 18 Medication

CHLORASPY CHLORASEPTIC SPRAY (ORAL ANESTHETIC/ANALGESIC) 177 ML BOT Medication

CHLORDI10C chlordiazePOXIDE 10 MG CAP Medication

CHLORDI25C chlordiazePOXIDE 25 MG CAP Medication

CHLORDI5C chlordiazePOXIDE 5 MG CAP Medication

CHLORHE15 CHLORHEXIDINE (0.12%) ORAL RINSE 15 ML CUP Medication

CHLORHE4S HIBICLENS (CHLORHEXIDINE GLUCONATE 4%) 4 OZ BOTTLE Medication

CHLORHEPKT CHLORHEXIDINE SCRUB PACKET Medication

CHLOROP230 CHLOROPROCAINE-MPF 2% 20 ML VIAL Medication

Page 13 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

CHLOROP330 CHLOROPROCAINE-MPF 3% 20 ML SDV Medication

CHLOROTH25 CHLOROTHIAZIDE 250 MG TAB Medication

CHLOROTH50 CHLOROTHIAZIDE 500 MG TAB Medication

CHLORP100T chlorproMAZINE 100 MG TAB Medication

CHLORP10T chlorproMAZINE 10 MG TAB Medication

CHLORP25T chlorproMAZINE 25 MG TAB Medication

CHLORP50A chlorproMAZINE 50 MG/2 ML AMP Medication

CHLORP50A chlorproMAZINE 50 MG/2 ML AMP Medication as an Additive

CHLORPHE4T CHLORPHENIRAMINE MAL 4 MG TAB Medication

CHLORPHLIQ CHLORPHENIRAMINE MAL 2 MG/5 ML BOT Medication

CHLORTH25T CHLORTHALIDONE 25 MG TAB Medication

CHLORTH50T CHLORTHALIDONE 50 MG TAB Medication

CHOLESTY4 CHOLESTYRAMINE 4 GM (ACTIVE DRUG) PACKET Medication

CHOLESTY4 CHOLESTYRAMINE 4 GM (ACTIVE DRUG) PACKET Medication as a Compound

CICL6.6S CICLOPIROX NAIL LACQR SOLUTION 6.6 ML BOTTLE Medication

CIDOF375V CIDOFOVIR 375 MG/5 ML VIAL Medication

CIDOF375V CIDOFOVIR 375 MG/5 ML VIAL Medication as an Additive

CILOST50 CILOSTAZOL 50 MG TABLET Medication

CINACALCET CINACALCET 30 MG TABLET Medication

CIPR200P10 CIPROFLOXACIN 200MG/100ML D5W PREMIX BAG Medication

CIPR500S CIPROFLOXACIN 500 MG/5 ML SUSP 100 ML BOTTLE Medication

CIPRODOTIC CIPROFLOXACIN 0.3%/DEXAMETHASONE 0.1% OTIC 7.5ML BOTTLE Medication

CIPROFL250 CIPROFLOXACIN 250 MG TAB Medication

CIPROFL500 CIPROFLOXACIN 500 MG TAB Medication

CIPROIVBAG CIPROFLOXACIN 400MG/200ML D5W PREMIX BAG Medication

CIPROOPH25 CIPROFLOXACIN 0.3% OPTH SOL 2.5 ML Medication

CIPROOPHSO CIPROFLOXACIN 0.3% OPTH SOL 5 ML Medication

CISATR10MD CISATRACURIUM 2 MG/ML 10 ML VIAL Medication

CISATR10MD CISATRACURIUM 2 MG/ML 10 ML VIAL Medication as an Additive

CISATR20MH CISATRACURIUM 10 MG/ML CONCENTRATED 20 ML VIAL Medication

CISATR20MH CISATRACURIUM 10 MG/ML CONCENTRATED 20 ML VIAL Medication as an Additive

CISATR5MD CISATRACURIUM BESYLATE 2 MG/ML 5 ML VIAL Medication

CISATR5MD CISATRACURIUM BESYLATE 2 MG/ML 5 ML VIAL Medication as an Additive

CISPLAT100 CISplatin 100 MG/100 ML MDV Medication

CITAL10 CITALOPRAM 10 MG TAB Medication

CITAL20 CITALOPRAM 20 MG TAB Medication

CITAL20L CITALOPRAM ORAL SOLUTION 20 MG/10 ML CUP Medication

CITRACALD CITRACAL D (CITRACAL MAXIMUM) TABLET 315MG CA ELEMTAL+ 250IU VITAMIN D Medication

CLADRI10V CLADRIBINE 1 MG/ML 10ML VIAL Medication

CLADRI10V CLADRIBINE 1 MG/ML 10ML VIAL Medication as an Additive

CLARI500XL CLARITHROMYCIN XL 500 MG TAB Medication

Page 14 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

CLARIT250S CLARITHROMYCIN 250 MG/5 ML SUSP 50 ML *BULK* Medication

CLARIT250T CLARITHROMYCIN 250 MG TAB Medication

CLARITIND LORATADINE 5 MG/PSEUDOEPHEDRINE 120MG 12HR SR TAB Medication

CLEV100V CLEVIDIPINE 0.5 MG/ML 100 ML PREMIX Medication

CLEVID50 CLEVIDIPINE 0.5 MG/ML 50 ML PREMIX Medication

CLIN40CR2 CLINDAMYCIN 2% VAG CREAM 40 GM (7 DAY) Medication

CLINDA150C CLINDAMYCIN 150 MG CAP Medication

CLINDA300P CLINDAMYCIN 300 MG/50 ML D5W PREMIX BAG Medication

CLINDA300V CLINDAMYCIN 300 MG/2 ML VIAL Medication

CLINDA300V CLINDAMYCIN 300 MG/2 ML VIAL Medication as an Additive

CLINDA600P CLINDAMYCIN 600 MG/50 ML D5W PREMIX BAG Medication

CLINDA900P CLINDAMYCIN 900 MG/50 ML D5W PREMIX BAG Medication

CLINDABULK CLINDAMYCIN ORAL SOLN 75 MG/5 ML 100 ML *BULK* Medication

CLINDATGEL CLINDAMYCIN 1% TOPICAL GEL 30 GM Medication

CLINDATSOL CLINDAMYCIN 1% TOPICAL SOL 60 ML Medication

CLO10T cloBAZam 10 MG TAB Medication

CLO20 CLOFARABINE 20 MG/20 ML VIAL Medication

CLO20 CLOFARABINE 20 MG/20 ML VIAL Medication as an Additive

CLOBET5CR3 CLOBETASOL PROPIONATE 0.05% CREAM 30 GM TUBE Medication

CLOBET5OI3 CLOBETASOL PROPIONATE 0.05% OINT 30 GM TUBE Medication

CLOMIP25C clomiPRAMINE 25 MG CAP Medication

CLONAZ25W clonazePAM 0.25 MG WAFER TABLET Medication

CLONAZEP1T clonazePAM 1 MG TAB Medication

CLONAZEP5T clonazePAM 0.5 MG TAB Medication

CLONID100V cloNIDine HCL 100 MCG/ML 10ML VIAL Medication

CLONID100V cloNIDine HCL 100 MCG/ML 10ML VIAL Medication as a Carrier

CLONID100V cloNIDine HCL 100 MCG/ML 10ML VIAL Medication as an Additive

CLONIDI1P cloNIDine 0.1 MG/DAY WEEKLY PATCH Medication

CLONIDI1T cloNIDine HCL 0.1 MG TAB Medication

CLONIDI2P cloNIDine 0.2 MG/DAY WEEKLY PATCH Medication

CLONIDI2T cloNIDine HCL 0.2 MG TAB Medication

CLONIDI3P cloNIDine 0.3 MG/DAY WEEKLY PATCH Medication

CLONIDI3T cloNIDine HCL 0.3 MG TAB Medication

CLOP300 CLOPIDOGREL 300 MG TAB Medication

CLOP75 CLOPIDOGREL 75 MG TAB Medication

CLORAZ375T CLORAZEPATE DIPOTASSIUM 3.75 MG Medication

CLOTRI10T CLOTRIMAZOLE 10 MG TROCHE Medication

CLOTRI1C CLOTRIMAZOLE 1% CREAM 15 GM TUBE Medication

CLOTRI1C3 CLOTRIMAZOLE 1% CREAM 30 GM TUBE Medication

CLOTRIL30 CLOTRIMAZOLE 1% TOPICAL SOLUTION 30 ML BOT Medication

CLOTRIVC CLOTRIMAZOLE 45 GM VAGINAL CREAM TUBE Medication

CLOZA150OD CLOZAPINE 150 MG ORALLY DISINTEGRATING (FAZACLO) Medication

Page 15 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

CLOZAP1OD CLOZAPINE 100 MG ORALLY DISINTEGRATING (FAZACLO) Medication

CLOZAP25OD CLOZAPINE 25 MG ORALLY DISINTEGRATING TAB (FAZACLO) Medication

COCAINE44 COCAINE 4% 4ML BOT Medication

CODEINE30T CODEINE 30 MG TAB Medication

COENZQ1010 CO-ENZYME Q10 100 MG CAP Medication

COLACE100 DOCUSATE SODIUM 100 MG LCAP Medication

COLACE100L DOCUSATE SODIUM 100 MG/10 ML CUP Medication

COLACE50C DOCUSATE SODIUM 50 MG LCAP Medication

COLCHICI6T COLCHICINE 0.6 MG TAB Medication

COLE3.752 COLESEVELAM HCL 3.75 GM PKT Medication

COLESEV625 COLESEVELAM HCL 625 MG TAB Medication

COLEST1 COLESTIPOL 1 GM TAB Medication

COLLAGOINT COLLAGENASE (SANTYL) OINTMENT 30 GM TUBE Medication

CONIVPRE CONIVAPTAN 20MG/100ML D5W PREMIX Medication

CONJEST125 CONJUGATED ESTROGENS 1.25 MG TAB Medication

CONJEST25V CONJUGATED ESTROGENS 25 MG INJ Medication

CONJEST25V CONJUGATED ESTROGENS 25 MG INJ Medication as an Additive

CONJEST3T CONJUGATED ESTROGENS 0.3 MG TAB Medication

CONJEST45 CONJUGATED ESTROGENS 0.45 MG TAB Medication

CONJEST625 CONJUGATED ESTROGENS 0.625 MG TAB Medication

CONJEST9T CONJUGATED ESTROGENS 0.9 MG TAB Medication

CONJESTVAG ESTROGENS CONJUGATED VAG CR 30 GM TUBE Medication

CORTISPCRM CORTISPORIN CREAM 7.5 GM TUBE Medication

CORTISPOPO CORTISPORIN OPHTHALMIC OINT 3.5 GM Medication

CORTISPOPS CORTISPORIN OPHTHALMIC SUSPENSION 7.5 ML Medication

CORTISPOTL CORTISPORIN OTIC SOLUTION 10 ML Medication

CORTISPOTS CORTISPORIN OTIC SUSPENSION 10 ML Medication

CORZIDE805 NADOLOL/BENDROFLUMETHIAZIDE 80/5 MG TAB Medication

COSOPT DORZOLAMIDE/TIMOLOL (COSOPT) OPHTH SOL 10 ML Medication

COSOPTUD DORZOLAMIDE/TIMOLOL (COSOPT) OPHTH SOL 0.2 ML AMPULE Medication

COSYNTR25V COSYNTROPIN 250 MCG/1 ML VIAL Medication

COSYNTR25V COSYNTROPIN 250 MCG/1 ML VIAL Medication as an Additive

CREON12 PANCRELIPASE (CREON-12) DR CAP Medication

CREON24 PANCRELIPASE (CREON-24) DR CAP Medication

CREON3 PANCRELIPASE (CREON-3) DR CAP Medication

CREON6 PANCRELIPASE (CREON-6) DR CAP Medication

CROMOLOPHS CROMOLYN SODIUM 4% OPHTH SOL 10 ML Medication

CUSIV CUSTOM IV SOLUTION Medication

CYANIDANTI CYANIDE ANTIDOTE KIT (NITHIODOTE) (SOD NITRITE/SOD THIOSULFATE) Medication

CYANO1000T CYANOCOBALAMIN (VIT B-12) 1000 MCG TAB Medication

CYANOCOB1T CYANOCOBALAMIN (VIT B-12) 100 MCG TAB Medication

CYANOCOB1V CYANOCOBALAMIN (VIT B-12) 1000 MCG VIAL Medication

Page 16 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

CYANOCOB5T CYANOCOBALAMIN (VIT B-12) 500 MCG TAB Medication

CYCL100S4 cycloSPORINE MODIFIED 100 MG/ML 50 ML ORAL SOL Medication

CYCLO1GM CYCLOPHOSPHAMIDE 1000 MG/50 ML PWVL Medication

CYCLO1GM CYCLOPHOSPHAMIDE 1000 MG/50 ML PWVL Medication as an Additive

CYCLO2GM CYCLOPHOSPHAMIDE 2000 MG/100 ML PWVL Medication

CYCLO2GM CYCLOPHOSPHAMIDE 2000 MG/100 ML PWVL Medication as an Additive

CYCLOBEN10 CYCLOBENZAPRINE 10 MG TAB Medication

CYCLOPEN05 CYCLOPENTOLATE HCL 0.5% OPHTH SOL 15 ML Medication

CYCLOPEN1S CYCLOPENTOLATE HCL 1% OPHTH SOL 2 ML Medication

CYCLOPH25T CYCLOPHOSPHAMIDE 25 MG CAP Medication

CYCLOPH500 CYCLOPHOSPHAMIDE 500 MG/25 ML VIAL Medication

CYCLOPH500 CYCLOPHOSPHAMIDE 500 MG/25 ML VIAL Medication as an Additive

CYCLOS100M cycloSPORINE MODIFIED 100 MG CAP Medication

CYCLOS25MC cycloSPORINE MODIFIED 25 MG CAP Medication

CYCLOSP100 cycloSPORINE 100 MG CAP Medication

CYCLOSP25C cycloSPORINE 25 MG CAP Medication

CYCLOSPGTT cycloSPORINE 0.05% OPHTH EMULSION 0.4 ML UD Medication

CYCLOSPINJ cycloSPORINE 50 MG/ML 5ML VIAL Medication

CYCLOSPINJ cycloSPORINE 50 MG/ML 5ML VIAL Medication as an Additive

CYCLOSPLIQ cycloSPORINE 100 MG/ML 50ML BOT Medication

CYPROHEP4T CYPROHEPTADINE 4 MG TAB Medication

CYTA100V CYTARABINE 100 MG/5 ML VIAL Medication

CYTA100V CYTARABINE 100 MG/5 ML VIAL Medication as an Additive

CYTARAB2G CYTARABINE 2,000 MG/20 ML VIAL Medication

CYTARAB2G CYTARABINE 2,000 MG/20 ML VIAL Medication as an Additive

D101000 DEXTROSE 10% 1000 ML BAG Medication

D101000 DEXTROSE 10% 1000 ML BAG Medication as a Carrier

D101000 DEXTROSE 10% 1000 ML BAG Medication as an Additive

D10250 DEXTROSE 10% 250 ML BAG Medication

D10250 DEXTROSE 10% 250 ML BAG Medication as a Carrier

D10250 DEXTROSE 10% 250 ML BAG Medication as an Additive

D10500 DEXTROSE 10% 500 ML BAG Medication

D10500 DEXTROSE 10% 500 ML BAG Medication as a Carrier

D10500 DEXTROSE 10% 500 ML BAG Medication as an Additive

D2510 DEXTROSE 25% 2.5 GM/10 ML SYRINGE Medication

D2510 DEXTROSE 25% 2.5 GM/10 ML SYRINGE Medication as an Additive

D5050 DEXTROSE 50% 50 ML SYRINGE Medication

D5050 DEXTROSE 50% 50 ML SYRINGE Medication as an Additive

D5050V DEXTROSE 50% 50 ML VIAL Medication

D5050V DEXTROSE 50% 50 ML VIAL Medication as an Additive

D5100 D5W 100 ML BAG Medication

D51000 D5W 1000 ML BAG Medication

Page 17 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

D520K D5 W/KCL 20MEQ/L 1000 ML BAG Medication

D5250 D5W 250 ML BAG Medication

D550 D5W 50 ML BAG Medication

D5500 D5W 500 ML BAG Medication

D5500 D5W 500 ML BAG Medication as a Carrier

D5500 D5W 500 ML BAG Medication as an Additive

D5H1000 D5 1/2 NORMAL SALINE 1000 ML BAG Medication

D5H20K D51/2NS W/KCL 20MEQ/L 1000 ML BAG Medication

D5H40K D51/2NS W/KCL 40MEQ/L 1000 ML BAG Medication

D5H500 D5 1/2 NORMAL SALINE 500 ML BAG Medication

D5LR1000 D5LR 1000 ML BAG Medication

D5LR20K D5LR W/KCL 20MEQ/L 1000 ML BAG Medication

D5LR500 D5LR 500 ML BAG Medication

D5NS1000 DEXTROSE 5% SOD CHL 0.9% 1000 ML BAG Medication

D5NS20K D5NS W/KCL 20MEQ/L 1000 ML BAG Medication

D5NS40K D5NS W/KCL 40MEQ/L 1000 ML BAG Medication

D5Q1000 D5 1/4 NORMAL SALINE 1000 ML BAG Medication

D5Q20K D51/4NS W/KCL 20MEQ/L 1000 ML BAG Medication

D5Q500 D5 1/4 NORMAL SALINE 500 ML BAG Medication

DABI110C DABIGATRAN 110 MG CAP Medication

DABI150C DABIGATRAN 150 MG CAP Medication

DABI75C DABIGATRAN 75 MG CAP Medication

DACARBA200 DACARBAZINE 200 MG/20 ML VIAL Medication

DACARBA200 DACARBAZINE 200 MG/20 ML VIAL Medication as an Additive

DACTINOM5V DACTINOMYCIN 500 MCG VIAL Medication

DACTINOM5V DACTINOMYCIN 500 MCG VIAL Medication as an Additive

DAKINS DAKINS 0.5% FULL STRENGTH SOLN 473 ML BOT Medication

DAKINS1/4 DAKINS 0.125% 1/4 STRENGTH 473 ML BOT Medication

DAKINSHALF DAKINS 0.25% 1/2 STRENGTH 473 ML BOT Medication

DANTROL100 DANTROLENE SODIUM 100 MG CAP Medication

DANTROL20V DANTROLENE SODIUM 20 MG VIAL Medication

DANTROL25C DANTROLENE SODIUM 25 MG CAP Medication

DANTROL50C DANTROLENE SODIUM 50 MG CAP Medication

DAPSON100 DAPSONE 100 MG TAB Medication

DAPTOM500 DAPTOmycin 500 MG VIAL Medication

DAPTOM500 DAPTOmycin 500 MG VIAL Medication as an Additive

DARATU400V DARATUMUMAB 400 MG/20 ML VIAL Medication

DARATU400V DARATUMUMAB 400 MG/20 ML VIAL Medication as an Additive

DARBEP25 DARBEPOETIN ALFA 25 MCG VIAL Medication

DARBEP40 DARBEPOETIN ALFA 40 MCG VIAL Medication

DARBEP60 DARBEPOETIN ALFA 60 MCG VIAL Medication

DARBEPOET DARBEPOETIN ALFA 100 MCG VIAL Medication

Page 18 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

DAUNORU20V DAUNOrubicin 20 MG/4 ML VIAL Medication

DAUNORU20V DAUNOrubicin 20 MG/4 ML VIAL Medication as an Additive

DEFEROX2 DEFEROXAMINE 2 GM VIAL Medication

DEFEROX2 DEFEROXAMINE 2 GM VIAL Medication as an Additive

DEGA120P3 DEGARELIX 120 MG VIAL Medication

DEGA80 DEGARELIX 80 MG VIAL Medication

DEMECLOC15 DEMECLOCYCLINE 150 MG TAB Medication

DEMECLOC30 DEMECLOCYCLINE 300 MG TAB Medication

DEN060S DENOSUMAB 60 MG/ML 1 ML INJ Medication

DENO120S DENOSUMAB 120 MG/1.7 ML INJ Medication

DEOXYRIBON DORNASE ALFA 2.5 MG/2.5 ML AMP Medication

DERMABOND DERMABOND 1 APP BOT Medication

DERMOPLAST DERMOPLAST SPRAY 1 CAN Medication

DESENEX85G MICONAZOLE NITRATE 2% POW 85 GM BOT Medication

DESENEXPWD MICONAZOLE NITRATE 2% POW 45 GRAM Medication

DESIPR10T DESIPRAMINE 10 MG TAB Medication

DESIPR25T DESIPRAMINE 25 MG TAB Medication

DESITINPAS DESITIN PASTE 57 GM TUBE Medication

DESMOPR1 DESMOPRESSIN ACETATE 0.1 MG TAB Medication

DESMOPR2 DESMOPRESSIN ACETATE 0.2 MG TAB Medication

DESMOPRINJ DESMOPRESSIN ACETATE 4 MCG/ML 1ML AMP Medication

DESMOPRINJ DESMOPRESSIN ACETATE 4 MCG/ML 1ML AMP Medication as an Additive

DESMOPRNAS DESMOPRESSIN ACETATE 10 MCG/0.1ML 5 ML NASAL SPRAY Medication

DESONI120L DESONIDE 0.05% LOTION 120 ML BOT Medication

DESONI5C DESONIDE 0.05% CREAM 15GM TUBE Medication

DESONI5O DESONIDE 0.05% OINTMENT 15GM TUBE Medication

DESOX2560C DESOXIMETASONE 0.25% CREAM 60 GM Medication

DESOXI25CR DESOXIMETASONE 0.25% CREAM 15 GM TUBE Medication

DESOXI25OI DESOXIMETASONE 0.25% OINTMENT 15 GM TUBE Medication

DESV50TA DESVENLAFAXINE 50 MG ER TAB Medication

DEX70 DEXTROSE 70% 2000 ML Medication

DEX70 DEXTROSE 70% 2000 ML Medication as a Carrier

DEX70 DEXTROSE 70% 2000 ML Medication as an Additive

DEXAMET10V DEXAMETHASONE 10 MG/ML 1ML VIAL Medication

DEXAMET10V DEXAMETHASONE 10 MG/ML 1ML VIAL Medication as an Additive

DEXAMET1T dexAMETHasone 1 MG TAB Medication

DEXAMET2T dexAMETHasone 2 MG TAB Medication

DEXAMET4T dexAMETHasone 4 MG TAB Medication

DEXAMET4V DEXAMETHASONE 4 MG/ML 1 ML VIAL Medication

DEXAMET5T dexAMETHasone 0.5 MG TAB Medication

DEXAMET75T dexAMETHasone 0.75 MG TAB Medication

DEXAMETMDV dexAMETHasone 4 MG/ML 5ML MDV Medication

Page 19 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

DEXAMETOPS dexAMETHasone SOD PHOS OPHTH SOL 0.1% 5 ML Medication

DEXAMORAL dexAMETHasone 2 MG/2 ML ORAL SYRINGE Medication

DEXAMORAL5 dexAMETHasone 5 MG/5 ML ORAL SYRINGE Medication

DEXM100S DEXMEDETOMIDINE 400 MCG/100 ML PREMIX Medication

DEXMEDET DEXMEDETOMIDINE 0.2MG/2ML VIAL Medication

DEXMEDET DEXMEDETOMIDINE 0.2MG/2ML VIAL Medication as an Additive

DEXMETH5XR DEXMETHYLPHENIDATE XR 5MG CAP Medication

DEXR500V2 DEXRAZOXANE 500 MG VIAL Medication

DEXR500V2 DEXRAZOXANE 500 MG VIAL Medication as an Additive

DEXT1CAP5 DEXTROMETHORPHAN/QUINIDINE 20 MG/10 MG CAP Medication

DEXTRAND5 DEXTRAN 40 10% D5W 500 ML BAG Medication

DEXTRANNS DEXTRAN 40/SODIUM CHLORIDE 500 ML SOL Medication

DEXTROAM10 DEXTROAMPHETAMINE SR 10 MG SRCAPSULE Medication

DEXTROAM15 DEXTROAMPHETAMINE SR 15 MG SRCAPSULE Medication

DEXTROAMP5 DEXTROAMPHETAMINE SULFATE 5 MG TAB Medication

DEXTROPED DEXTROMETHORPHAN 7.5 MG/5 ML CUP (ROBITUSSIN PEDIATRIC) Medication

DHE45 DIHYDROERGOTAMINE MESYLATE 1 MG AMP Medication

DHE45 DIHYDROERGOTAMINE MESYLATE 1 MG AMP Medication as an Additive

DIA10RECTA DIAZEPAM 10 MG ACUDIAL RECTAL GEL Medication

DIA2.5RECT diazePAM 2.5 MG RECTAL GEL Medication

DIAZEP10T DIAZEPAM 10 MG TAB Medication

DIAZEP10VL DIAZEPAM 10 MG/2 ML VIAL Medication

DIAZEP10VL DIAZEPAM 10 MG/2 ML VIAL Medication as an Additive

DIAZEP2T DIAZEPAM 2 MG TAB Medication

DIAZEP5T DIAZEPAM 5 MG TAB Medication

DIBUCAOINT DIBUCAINE 1% OINTMENT 30 GM TUBE Medication

DICL30AD DICLOFENAC 1.3% EPOLAMINE PATCH 5 PATCH/BOX Medication

DICLO100G DICLOFENAC SOD 1% GEL 100 GM Medication

DICLOF1OPH DICLOFENAC 0.1% OPTH SOL 2.5 ML Medication

DICLOF25T DICLOFENAC SODIUM 25 MG DELAYED RELEASE TAB Medication

DICLOF50T DICLOFENAC SODIUM 50 MG DELAYED RELEASE TAB Medication

DICLOF75T DICLOFENAC SODIUM 75 MG DELAYED RELEASE TAB Medication

DICLOFX100 DICLOFENAC SOD 100 MG XR TAB Medication

DICLOPOT50 DICLOFENAC POTASSIUM 50 MG TAB Medication

DICLOX250C DICLOXACILLIN SODIUM 250 MG CAP Medication

DICYCLO10C DICYCLOMINE 10 MG CAP Medication

DICYCLO10L DICYCLOMINE 10 MG/5 ML CUP Medication

DICYCLO20T DICYCLOMINE 20 MG TAB Medication

DICYCLO20V DICYCLOMINE 10 MG/ML 2ML VIAL Medication

DIFLUNI500 DIFLUNISAL 500 MG TAB Medication

DIGIFAB DIGOXIN IMUNE FAB 40 MG VIAL Medication

DIGIFAB DIGOXIN IMUNE FAB 40 MG VIAL Medication as an Additive

Page 20 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

DIGOX.5INJ DIGOXIN 250 MCG/ML 2 ML AMP Medication

DIGOX125L DIGOXIN LIQUID 125 MCG/2.5 ML ORAL SYRINGE Medication

DIGOX125T DIGOXIN 125 MCG TAB Medication

DIGOX25T DIGOXIN 250 MCG TAB Medication

DILTIA100M dilTIAZem 100 MG/100 ML D5 KIT Medication

DILTIA100M dilTIAZem 100 MG/100 ML D5 KIT Medication as a Carrier

DILTIA10IN dilTIAZem 50 MG/10 ML VIAL Medication

DILTIA10IN dilTIAZem 50 MG/10 ML VIAL Medication as an Additive

DILTIA125P dilTIAZem 125 MG/125 ML PREMIX BAG Medication

DILTIA30T dilTIAZem 30 MG TAB Medication

DILTIA5INJ dilTIAZem 25 MG/5 ML VIAL Medication

DILTIA5INJ dilTIAZem 25 MG/5 ML VIAL Medication as an Additive

DILTIA60T dilTIAZem 60 MG TAB Medication

DILTIA90T dilTIAZem 90 MG TAB Medication

DILTIZ120E dilTIAZem 120 MG ER CAP *24HR* Medication

DILTIZ180E dilTIAZem 180 MG ER CAP *24HR* Medication

DILTIZ240E dilTIAZem 240 MG ER *24HR* Medication

DILTIZ300E dilTIAZem 300 MG ER CAP *24HR* Medication

DIME5050 DIMETHYL SULFOXIDE 50 ML IRRIGATION BOT Medication

DIMEN50T dimenhyDRINATE 50 MG TAB Medication

DIMERC100I DIMERCAPROL 100 MG/ML 3 ML AMP Medication

DINOP10SUP DINOPROSTONE 10 MG VAGINAL INSERT Medication

DIPHEN125L diphenhydrAMINE 12.5 MG/5 ML CUP Medication

DIPHEN25C diphenhydrAMINE 25 MG TAB Medication

DIPHEN50C diphenhydrAMINE 50 MG CAP Medication

DIPHEN50V diphenhydrAMINE 50MG/ML INJ Medication

DIPHENCRM diphenhydrAMINE 1% CREAM 30GM TUBE Medication

DIPHTETADU TETANUS & DIPHTHERIA TOXOIDS 0.5 ML TUBEX Medication

DIPHTETPED TETANUS & DIPHTHERIA TOXOIDS PEDIATRIC 0.5 ML Medication

DIPROLE05C BETAMETHASONE DIPROP *AUGMENTED* 0.05% CREAM 15 GM TUBE Medication

DIPROLE05O BETAMETHASONE DIPROP *AUGMENTED* 0.05% OINT 15 GM TUBE Medication

DIPROSO15 BETAMETHASONE DIPROPIONATE 0.05% CREAM 15 GM TUBE Medication

DIPROSO15O BETAMETHASONE DIPROPIONATE 0.05% OINT 15 GM TUBE Medication

DIPROSO45 BETAMETHASONE DIPROPIONATE 0.05% CREAM 45 GM TUBE Medication

DIPROSO45O BETAMETHASONE DIPROPIONATE 0.05% OINT 45 GM TUBE Medication

DIPYRID25T DIPYRIDAMOLE 25 MG TAB Medication

DISULF250T DISULFIRAM 250 MG TAB Medication

DIVALP125T DIVALPROEX SODIUM 125 MG DELAYED RELEASE TAB Medication

DIVALP12SP DIVALPROEX SODIUM 125 MG SPRINKLE CAP Medication

DIVALP250T DIVALPROEX SODIUM 250 MG DELAYED RELEASE TAB Medication

DIVALP2ER DIVALPROEX SODIUM 250 MG *24 HR* EXTENDED RELEASE TAB Medication

DIVALP500T DIVALPROEX SODIUM 500 MG DELAYED RELEASE TAB Medication

Page 21 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

DIVALP5ER DIVALPROEX SODIUM 500 MG *24 HR* EXTENDED RELEASE TAB Medication

DOBU250I3 DOBUTamine PREMIX 250 MG/250 ML BAG Medication

DOBUTAM250 DOBUTamine 250 MG/20 ML VIAL Medication

DOBUTAM250 DOBUTamine 250 MG/20 ML VIAL Medication as an Additive

DOBUTDRIP DOBUTamine PREMIX 500 MG/250 ML BAG Medication

DOBUTDRIP1 DOBUTamine PREMIX 1,000 MG/250 ML BAG Medication

DOBUTSYR DOBUTamine 100MG/50ML SYRINGE Medication

DOCE10SO1 DOCEtaxel 10 MG/ML 8 ML VIAL Medication

DOCE10SO1 DOCEtaxel 10 MG/ML 8 ML VIAL Medication as an Additive

DOCOS2GM DOCOSANOL 10% 2 GM TUBE Medication

DOCUCAL240 DOCUSATE CALCIUM 240 MG LCAP Medication

DODDNOSE PHENYLEPHRINE 0.5%/LIDOCAINE 2% 10 ML BOT Medication

DOFE125 DOFETILIDE 125 MCG CAP Medication

DOFE250 DOFETILIDE 250 MCG CAP Medication

DOFE500 DOFETILIDE 500 MCG CAP Medication

DOLU50 DOLUTEGRAVIR SODIUM 50 MG TAB Medication

DOMEBORPWD DOMEBORO 2.2 GM PACKET Medication

DONE10ODT DONEPEZIL 10 MG OD TAB Medication

DONE23T DONEPEZIL 23 MG TAB Medication

DONE5ODT DONEPEZIL 5 MG OD TAB Medication

DONNATTAB DONNATAL (HYOSCYAMINE/ATROPINE/SCOPALAMINE/PHENOBARBITAL) TAB Medication

DOPAMI400V DOPamine 400 MG/10 ML VIAL Medication

DOPAMI400V DOPamine 400 MG/10 ML VIAL Medication as an Additive

DOPAMIDRIP DOPamine 400MG/250ML PREMIX Medication

DORZ10 DORZOLAMIDE 2% OPHTH SOL 10 ML Medication

DOXAPRAMVL DOXAPRAM 20 MG/ML 20ML VIAL Medication

DOXAPRAMVL DOXAPRAM 20 MG/ML 20ML VIAL Medication as an Additive

DOXAZO2 DOXAZOSIN 2 MG TAB Medication

DOXEPICONC DOXEPIN 10 MG/ML LIQ 120ML BOT Medication

DOXEPIN100 DOXEPIN 100 MG CAP Medication

DOXEPIN10C DOXEPIN 10 MG CAP Medication

DOXEPIN150 DOXEPIN 150 MG CAP Medication

DOXEPIN25C DOXEPIN 25 MG CAP Medication

DOXEPIN50C DOXEPIN 50 MG CAP Medication

DOXEPIN75C DOXEPIN 75 MG CAP Medication

DOXER0.5 DOXERCALCIFEROL 0.5 MCG CAP Medication

DOXORUB10V DOXOrubicin 10 MG/5 ML VIAL Medication

DOXORUB50 DOXOrubicin LIPOSOMAL 50 MG/25 ML VIAL Medication

DOXORUB50 DOXOrubicin LIPOSOMAL 50 MG/25 ML VIAL Medication as an Additive

DOXORUB50V DOXOrubicin 50 MG/25 ML VIAL Medication

DOXORUB50V DOXOrubicin 50 MG/25 ML VIAL Medication as an Additive

DOXY100T DOXYCYCLINE 100 MG TAB Medication

Page 22 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

DOXY100V DOXYCYCLINE 100 MG/5 ML VIAL Medication

DOXY100V DOXYCYCLINE 100 MG/5 ML VIAL Medication as an Additive

DOXY50C DOXYCYCLINE 50 MG CAP Medication

DOXY50SYR DOXYCYCLINE CALCIUM 100 MG/10 ML SYRUP Medication

DRONAB2.5 DRONABINOL 2.5 MG LCAP Medication

DRONE400T DRONEDARONE 400 MG TAB Medication

DULOXET20 DULoxetine 20 MG DR CAP Medication

DULOXET30 DULoxetine 30 MG DR CAP Medication

ECHOTH12OP ECHOTHIOPHATE 0.125% OPTH SOL 5 ML Medication

ECONAZ1C15 ECONAZOLE NITRATE 1% CREAM 15 GM TUBE Medication

EES200L ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML SUSP 100ML *BULK* Medication

EES400L ERYTHROMYCIN ETHYLSUCCINATE 400 MG/5 ML SUSP 100ML *BULK* Medication

EFAV1TAB EFAVIRENZ/EMTRICITAB/TENOFOVIR TABLET (600-200-300) Medication

EFAV200 EFAVIRENZ 200 MG CAP Medication

ELETRIP20 ELETRIPTAN 20 MG TAB Medication

EMETROL15 EMETROL ORAL SOLN 120 ML BOT Medication

ENA125I ENALAPRILAT 1.25 MG/ML 1ML VIAL Medication

ENALAP10T ENALAPRIL 10 MG TAB Medication

ENALAP25T ENALAPRIL 2.5 MG TAB Medication

ENALAP25V ENALAPRILAT 1.25 MG/ML 2ML VIAL Medication

ENALAP5T ENALAPRIL 5 MG TAB Medication

ENEMEEZ ENEMEEZ MINI ENEMA Medication

ENO80S ENOXAPARIN 80 MG/0.8 ML SYRINGE Medication

ENOX120 ENOXAPARIN 120 MG/0.8 ML SYRINGE Medication

ENOX150 ENOXAPARIN 150 MG/1 ML SYRINGE Medication

ENOX60 ENOXAPARIN 60 MG/0.6 ML SYRINGE Medication

ENOXAP100 ENOXAPARIN 100 MG/1 ML SYRINGE Medication

ENOXAP30 ENOXAPARIN 30 MG/0.3 ML SYRINGE Medication

ENOXAP40 ENOXAPARIN 40 MG/0.4 ML SYRINGE Medication

ENTAC200T ENTACAPONE 200 MG TAB Medication

ENTE0.5T ENTECAVIR 0.5 MG TABLET Medication

EPHEDR10SY ePHEDrine 5 MG/ML 10ML SYRINGE Medication

EPHEDRI50A ePHEDrine SULFATE 50 MG/ML AMP Medication

EPHEDRI50A ePHEDrine SULFATE 50 MG/ML AMP Medication as an Additive

EPI30IVMDV EPINEPHrine 1 MG/ML 30 ML MDV Medication

EPI30IVMDV EPINEPHrine 1 MG/ML 30 ML MDV Medication as an Additive

EPIAMP EPINEPHrine 0.1% 1 MG/1 ML AMP Medication

EPIAMP EPINEPHrine 0.1% 1 MG/1 ML AMP Medication as an Additive

EPIFENT fentaNYL STANDARD EPIDURAL (fentaNYL 3MCG/ML+BUPIVACAINE 0.05%) 250ML Medication

EPIFENT fentaNYL STANDARD EPIDURAL (fentaNYL 3MCG/ML+BUPIVACAINE 0.05%) 250ML Medication as an Additive

EPILD L&D STANDARD EPIDURAL(FENTANYL 2 MCG/ML+0.1% BUPIVACAINE IN NS)-100 ML Medication

Page 23 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

EPILD L&D STANDARD EPIDURAL(FENTANYL 2 MCG/ML+0.1% BUPIVACAINE IN NS)-100 ML Medication as an Additive

EPINON fentaNYL *NON-STANDARD* EPIDURAL (fentaNYL+BUPIVACAINE) 250ML Medication

EPINON fentaNYL *NON-STANDARD* EPIDURAL (fentaNYL+BUPIVACAINE) 250ML Medication as an Additive

EPIPEN EPINEPHrine 0.3 MG/0.3 ML AUTO INJECTOR Medication

EPIROPI2 ROPIVACAINE 0.2% EPIDURAL 250 ML CARTRIDGE ***FROM PREMIX BAGS*** Medication

EPIROPI2 ROPIVACAINE 0.2% EPIDURAL 250 ML CARTRIDGE ***FROM PREMIX BAGS*** Medication as an Additive

EPISYR EPINEPHRINE HCL IN 0.9 % NACL 100 MCG/10 ML SYRINGE Medication

EPISYRINGE EPINEPHrine 0.01% 1 MG/10 ML SYRINGE Medication

EPITOP30ML EPINEPHrine 1 MG/ML TOPICAL SOLN 30ML BOTTLE Medication

EPLER25T EPLERENONE 25 MG TAB Medication

EPOP0.5P EPOPROSTENOL 0.5 MG VIAL Medication

EPOP0.5P EPOPROSTENOL 0.5 MG VIAL Medication as an Additive

EPOP1.5V EPOPROSTENOL 1.5 MG VIAL Medication

EPS4LB MAGNESIUM SULFATE 4 LB BOX Medication

EPT20V EPTIFIBATIDE 20,000 MCG/10 ML VIAL Medication

EPT75V EPTIFIBATIDE 75 MG/100 ML VIAL Medication

EPT75V EPTIFIBATIDE 75 MG/100 ML VIAL Medication as a Carrier

ERLO25T ERLOTINIB 25 MG TAB Medication

ERTAP1GM ERTAPENEM 1,000 MG VIAL Medication

ERTAP1GM ERTAPENEM 1,000 MG VIAL Medication as an Additive

ERYOPTH1GM ERYTHROMYCIN 0.5% OPHTH OINT 1 GM TUBE Medication

ERYOPTH35G ERYTHROMYCIN 0.5% OPHTH OINT 3.5 GM TUBE Medication

ERYT500V ERYTHROMYCIN LACT 500 MG VIAL Medication

ERYT500V ERYTHROMYCIN LACT 500 MG VIAL Medication as an Additive

ERYTH2TOP ERYTHROMYCIN BASE 2% GEL 60 GM TUBE Medication

ERYTHB250T ERYTHROMYCIN BASE 250 MG EC TAB Medication

ERYTHB333T ERYTHROMYCIN BASE 333 MG EC TAB Medication

ESCITAL10 ESCITALOPRAM 10 MG TAB Medication

ESCITLIQ10 ESCITALOPRAM 10 MG/10 ML CUP Medication

ESGICTAB FIORICET (BUTALBITAL 50MG/APAP 325MG/CAFFEINE 40MG) CAP/TAB Medication

ESLICA200T ESLICARBAZEPINE ACETATE 200 MG TAB Medication

ESLICA400T ESLICARBAZEPINE ACETATE 400 MG TAB Medication

ESMOLOL10V ESMOLOL 100 MG/10 ML VIAL Medication

ESMOLOL10V ESMOLOL 100 MG/10 ML VIAL Medication as an Additive

ESMOLOLPRE ESMOLOL 2,500 MG/250 ML PREMIX BAG Medication

ESOMEP40IV ESOMEPRAZOLE 40 MG VIAL Medication

ESOMEP40IV ESOMEPRAZOLE 40 MG VIAL Medication as an Additive

ESTRAD25 ESTRADIOL 0.025 MG/DAY 7 DAY PATCH (CLIMARA) Medication

ESTRADCR ESTRADIOL 0.01% VAG CREAM 42.5 GM TUBE Medication

ESTRADIO1T ESTRADIOL 1 MG TAB Medication

ESTRADIO2T ESTRADIOL 2 MG TAB Medication

ESTROPAT ESTRADIOL 0.1 MG/DAY 7 DAY PATCH (CLIMARA) Medication

Page 24 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

ESTROPAT5 ESTRADIOL 0.05 MG/DAY 7 DAY PATCH (CLIMARA) Medication

ESZOPIC1 ESZOPICLONE 1 MG TAB Medication

ETANER25V ETANERCEPT 25 MG VIAL Medication

ETANER50 ETANERCEPT 50 MG SYRINGE Medication

ETHA2AMP ETHANOLAMINE OLEATE 5% 2 ML AMP Medication

ETHACRY25T ETHACRYNIC ACID 25 MG TAB Medication

ETHAMB400T ETHAMBUTOL HCL 400 MG TAB Medication

ETHOSU250C ETHOSUXIMIDE 250 MG CAP Medication

ETHOSU250L ETHOSUXIMIDE 250 MG/5 ML BOT Medication

ETHYLCHSPY ETHYL CHLORIDE SPRAY 3.5 OZ BOT Medication

ETODOL200C ETODOLAC 200 MG CAP Medication

ETODOL300C ETODOLAC 300 MG CAP Medication

ETODOL400X ETODOLAC 400 MG ER TAB Medication

ETOM2SOL12 ETOMIDATE 40 MG/20 ML VIAL Medication

ETOM2SOL12 ETOMIDATE 40 MG/20 ML VIAL Medication as an Additive

ETOMID20A ETOMIDATE 20 MG/10 ML VIAL Medication

ETOMID20A ETOMIDATE 20 MG/10 ML VIAL Medication as an Additive

ETONOG68I ETONOGESTREL 68 MG IMPLANT Medication

ETOPOSID10 ETOPOSIDE 100 MG/5 ML VIAL Medication

ETOPOSID10 ETOPOSIDE 100 MG/5 ML VIAL Medication as an Additive

EUCERIN4OZ EUCERIN 120 GM JAR Medication

EXCEDRIN ACETAMINOPHEN/ASPIRIN/CAFFEINE 250/250/65 MG TAB Medication

EXEMEST EXEMESTANE 25 MG TAB Medication

EXEN10 EXENATIDE 250 MCG/ML 2.4 ML (10 MCG/DOSE) (BYETTA) Medication

EXEN2GER EXENATIDE 2 MG SYRINGE (BYDUREON) Medication

EXEN5 EXENATIDE 250 MCG/ML 1.2 ML (5 MCG/DOSE) (BYETTA) Medication

EYESTRE EYE STREAM 30 ML EYE WASH SOLUTION Medication

EZETIM10 EZETIMIBE 10 MG TAB Medication

FACT1000 Factor VIIa, Recombinant 1000 MCG VIAL (NOVOSEVEN) Medication

FACT1000 Factor VIIa, Recombinant 1000 MCG VIAL (NOVOSEVEN) Medication as an Additive

FACT2000 Factor VIIa, Recombinant 2000 MCG VIAL (NOVOSEVEN) Medication

FACT2000 Factor VIIa, Recombinant 2000 MCG VIAL (NOVOSEVEN) Medication as an Additive

FACT5000 FACTOR VIIa, Recombinant 5000 mcg VIAL (NOVOSEVEN) Medication

FACT5000 FACTOR VIIa, Recombinant 5000 mcg VIAL (NOVOSEVEN) Medication as an Additive

FAM10 FAMOTIDINE 10 MG TAB Medication

FAMCI500 FAMCICLOVIR 500 MG TAB Medication

FAMO20PI FAMOTIDINE 20 MG/50 ML PREMIX IV Medication

FAMO20PI FAMOTIDINE 20 MG/50 ML PREMIX IV Medication as a Carrier

FAMOTI20L FAMOTIDINE 20 MG/2.5 ML ORAL SYRINGE Medication

FAMOTI20T FAMOTIDINE 20 MG TAB Medication

FAMOTI20V FAMOTIDINE 20 MG/2 ML VIAL Medication

FAMOTI20V FAMOTIDINE 20 MG/2 ML VIAL Medication as an Additive

Page 25 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

FEBU40TA FEBUXOSTAT 40 MG TAB Medication

FELBAM400 FELBAMATE 400 MG TAB Medication

FELBAM600 FELBAMATE 600 MG TAB Medication

FELODI25 FELODIPINE 2.5 MG ER TAB Medication

FELODI5 FELODIPINE 5 MG ER TAB Medication

FENO45CA FENOFIBRIC ACID 45 MG DR CAP Medication

FENOF200 FENOFIBRATE 200 MG CAP Medication

FENOF67 FENOFIBRATE 67 MG CAP Medication

FENT2AMP fentaNYL CITRATE 50 MCG/ML 2ML AMP Medication

FENT2AMP fentaNYL CITRATE 50 MCG/ML 2ML AMP Medication as an Additive

FENT5AMP FENTANYL CITRATE 50 MCG/ML 5ML AMP Medication

FENT5AMP FENTANYL CITRATE 50 MCG/ML 5ML AMP Medication as an Additive

FENTA100PT fentaNYL TRANSDERMAL PATCH 100 MCG/HR X 72 HR PATCH Medication

FENTA12PT fentaNYL TRANSDERMAL PATCH 12 MCG/HR X 72 HR PATCH Medication

FENTA25PT fentaNYL TRANSDERMAL PATCH 25 MCG/HR X 72 HR PATCH Medication

FENTA50PT fentaNYL TRANSDERMAL PATCH 50 MCG/HR X 72 HR PATCH Medication

FENTA75PT fentaNYL TRANSDERMAL PATCH 75 MCG/HR X 72 HR PATCH Medication

FENTGTT10 fentaNYL DRIP 10 MCG/ML 100 ML CASSETTE Medication

FENTPCA10 fentaNYL PCA 10 MCG/ML 100 ML CASSETTE Medication

FERAHEME FERUMOXYTOL 510 MG/17 ML VIAL Medication

FERAHEME FERUMOXYTOL 510 MG/17 ML VIAL Medication as an Additive

FERGLU300T FERROUS GLUCONATE 324 MG (36 MG IRON)TAB Medication

FEROFOLIC FERO-FOLIC-500 TAB (FERROUS SULFATE 105MG/ FOLIC ACID 0.8MG/VIT C 500MG) Medication

FERR8SOLU FERRIC SUBSULFATE 1 APP/8 ML BOT Medication

FERROSEQUL FERROUS FUMARATE/ASCORBIC ACID 65 MG FE/25 MG TAB Medication

FERSUL160T FERROUS SULFATE 140 MG ER TAB (45 MG ELEMENTAL IRON) Medication

FERSUL300L FERROUS SULFATE LIQUID 300 MG/5 ML (60 MG ELEMENTAL IRON/5 ML) CUP Medication

FERSUL325T FERROUS SULFATE 325 MG (ELEMENTAL IRON 65 MG) TAB Medication

FERSULDROP FERROUS SULFATE (15 MG FE/1 ML) 50 ML BOT Medication

FEXOF180 FEXOFENADINE 180 MG TAB Medication

FEXOF60 FEXOFENADINE 60 MG TAB Medication

FIBERCONT POLYCARBOPHIL TAB 625MG Medication

FIDA200T FIDAXOMICIN 200 MG TAB Medication

FILGRS300 FILGRASTIM-SNDZ 300 MCG/0.5 ML SYRINGE Medication

FILGRS480 FILGRASTIM-SNDZ 480 MCG/0.8 ML SYRINGE Medication

FINAST5 FINASTERIDE 5 MG TAB Medication

FIORINAL3 FIORINAL WITH CODEINE (BUTALBITAL 50/ASA 325/CAFFEINE 40/CODEINE 30MG) Medication

FIORINALT FIORINAL (BUTALBITAL 50MG/ ASPIRIN 325MG/ CAFFEINE40 MG)CAPSULE Medication

FLAVOXATE FLAVOXATE 100 MG TAB Medication

FLEC50 FLECAINIDE 50 MG TAB Medication

FLECAINIDE FLECAINIDE 100 MG TAB Medication

FLEETENEMA FLEETS ENEMA 1 BOTTLE Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

FLEETOIL MINERAL OIL 1 ENEMA BOT Medication

FLEETPED FLEETS PEDIATRIC ENEMA Medication

FLU10T FLUoxetine 10 MG CAP Medication

FLUC500C1 FLUCYTOSINE 500 MG CAP Medication

FLUCON100T FLUCONAZOLE 100 MG TAB Medication

FLUCON150T FLUCONAZOLE 150 MG TAB Medication

FLUCON200P FLUCONAZOLE 200MG/100ML NORMAL SALINE *PREMIX* Medication

FLUCON400P FLUCONAZOLE 400MG/200ML NORMAL SALINE *PREMIX* Medication

FLUCON40S FLUCONAZOLE 40 MG/ML SUSP 35ML BOT Medication

FLUDARA50V FLUDARABINE 50 MG VIAL Medication

FLUDROCO1T FLUDROCORTISONE ACETATE 0.1 MG TAB Medication

FLUMAZ10VL FLUMAZENIL 0.1 MG/ML VIAL Medication

FLUMAZ5VL FLUMAZENIL 0.1 MG/ML 5ML VIAL Medication

FLUOCIN30C FLUOCINONIDE 0.05% CREAM 30 GM TUBE Medication

FLUOCIN30O FLUOCINONIDE 0.05% OINT 30 GM TUBE Medication

FLUOCIN60S FLUOCINONIDE 0.05% SOLUTION 60 ML BOT Medication

FLUOCINO1C FLUOCINOLONE 0.01% CREAM 15 GM TUBE Medication

FLUOCINO1L FLUOCINOLONE 0.01% SOLUTION 60 ML Medication

FLUOCINO2C FLUOCINOLONE 0.025% CREAM 15 GM TUBE Medication

FLUOCINO2O FLUOCINOLONE 0.025% OINT 15 GM TUBE Medication

FLUORESBOT FLUORESCEIN 0.25%/PROPARACAINE 0.5% OPHTH SOLN 5 ML BOT Medication

FLUORESC10 FLUORESCEIN 10% INJECTION 5 ML Medication

FLUOROME1 FLUOROMETHOLONE 0.1% OPHTH SUSP 5 ML Medication

FLUOROME2 FLUOROMETHOLONE 0.25% OPHTH SUSP 5 ML Medication

FLUOROURAC FLUOROURACIL 500 MG/10 ML VIAL Medication

FLUOROURAC FLUOROURACIL 500 MG/10 ML VIAL Medication as an Additive

FLUORSTRIP FLUORESCEIN OPHTHALMIC 1 MG STRIP Medication

FLUOX1WK FLUoxetine ONCE WEEKLY 90 MG CAP Medication

FLUOXET20 FLUoxetine 20 MG CAP Medication

FLUOXET20L FLUoxetine 20 MG/5 ML CUP Medication

FLUPHEN1T fluPHENAZine 1 MG TAB Medication

FLUPHEN25D fluPHENAZine decanoate 25 MG/ML 5ML VIAL Medication

FLUPHEN2T fluPHENAZine 2.5 MG TAB Medication

FLUPHEN2V fluPHENAZine 25 MG/10 ML VIAL Medication

FLUPHEN5OC fluPHENAZine 5 MG/ML ORAL CONC Medication

FLUPHEN5T fluPHENAZine 5 MG TAB Medication

FLURAZE15 FLURAZEPAM 15 MG CAP Medication

FLURBIPROF FLURBIPROFEN 0.03% OPTH SOL 2.5 ML Medication

FLUTAM FLUTAMIDE 125 MG CAP Medication

FLUTNAS FLUTICASONE NASAL SPRAY**50/SPRAY** 120 SPRAY Medication

FLUV20T FLUVASTATIN 20 MG CAP Medication

FLUVOX50T FLUVOXAMINE 50 MG TAB Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

FOLIC4T FOLIC ACID 0.4 MG TAB Medication

FOLICT FOLIC ACID 1 MG TAB Medication

FOLICV FOLIC ACID 5 MG/ML 10ML VIAL Medication

FOLICV FOLIC ACID 5 MG/ML 10ML VIAL Medication as an Additive

FOMEPIZSDV FOMEPIZOLE 1000 MG/ML 1.5 ML VIAL Medication

FOMEPIZSDV FOMEPIZOLE 1000 MG/ML 1.5 ML VIAL Medication as a Carrier

FOMEPIZSDV FOMEPIZOLE 1000 MG/ML 1.5 ML VIAL Medication as an Additive

FONDA10 FONDAPARINUX SODIUM 10 MG/0.8 ML SYRINGE Medication

FONDA25 FONDAPARINUX SODIUM 2.5 MG/0.5 ML SYRINGE Medication

FONDA5 FONDAPARINUX SODIUM 5 MG/0.4 ML SYRINGE Medication

FONDA75 FONDAPARINUX SODIUM 7.5 MG/0.6 ML SYRINGE Medication

FORMO20/2 FORMOTEROL FUMARATE 20 MCG/2 ML NEB SOL Medication

FOSAPR150V FOSAPREPITANT DIMEGLUMINE 150 MG/5 ML VIAL Medication

FOSAPR150V FOSAPREPITANT DIMEGLUMINE 150 MG/5 ML VIAL Medication as an Additive

FOSF3PAC FOSFOMYCIN TROMETHAMINE 3 GM PACKET Medication

FOSINO10T FOSINOPRIL 10 MG TAB Medication

FOSPHE100V FOSPHENYTOIN SODIUM 100 PE/2 ML VIAL Medication

FOSPHE100V FOSPHENYTOIN SODIUM 100 PE/2 ML VIAL Medication as an Additive

FOSPHE500V FOSPHENYTOIN SODIUM 500 PE/10 ML VIAL Medication

FOSPHE500V FOSPHENYTOIN SODIUM 500 PE/10 ML VIAL Medication as an Additive

FSSHAM120 FLUOCINOLONE ACETONIDE 0.1%- 120 ML BOT Medication

FUROSEM100 FUROSEMIDE 100 MG/10 ML VIAL Medication

FUROSEM20T FUROSEMIDE 20 MG TAB Medication

FUROSEM20V FUROSEMIDE 20 MG/2 ML VIAL Medication

FUROSEM40L FUROSEMIDE SOLUTION 40 MG/5 ML CUP Medication

FUROSEM40T FUROSEMIDE 40 MG TAB Medication

FUROSEM40V FUROSEMIDE 40 MG/4 ML VIAL Medication

FUROSEM40V FUROSEMIDE 40 MG/4 ML VIAL Medication as an Additive

FUROSEM80T FUROSEMIDE 80 MG TAB Medication

FVIII1000 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~1,000 UNIT/15 ML KIT (HUMATE-P) Medication

FVIII1000 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~1,000 UNIT/15 ML KIT (HUMATE-P) Medication as an Additive

FVIII250 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~250 UNIT/5 ML KIT (HUMATE-P) Medication

FVIII250 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~250 UNIT/5 ML KIT (HUMATE-P) Medication as an Additive

FVIII500 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~500 UNIT/10 ML KIT (HUMATE-P) Medication

FVIII500 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~500 UNIT/10 ML KIT (HUMATE-P) Medication as an Additive

GABAPEN100 GABAPENTIN 100 MG CAP Medication

GABAPEN300 GABAPENTIN 300 MG CAP Medication

GABAPEN400 GABAPENTIN 400 MG CAP Medication

GABAPSUSP GABAPENTIN 250 MG/5 ML CUP Medication

GALANT GALANTAMINE 4 MG TAB Medication

GALANTER8 GALANTAMINE 8 MG ER CAP Medication

GALSULF GALSULFASE 5 MG/5 ML VIAL Medication

Page 28 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

GALSULF GALSULFASE 5 MG/5 ML VIAL Medication as an Additive

GANCIC500V GANCICLOVIR 500 MG VIAL Medication

GANCIC500V GANCICLOVIR 500 MG VIAL Medication as an Additive

GANCICOP GANCICLOVIR 0.15% OPHTH GEL 5 GM Medication

GATI2.5S GATIFLOXACIN 0.5% OPHTH SOL 2.5 ML Medication

GAVISCONT GAVISCON EX STRGTH 1 TAB CTB Medication

GELFILM GELFILM OPHTH FILM #1 (1X2 INCH) Medication

GELFLOW GEL-FLOW KIT Medication

GELFOAM+C GELFOAM PLUS COMPRESSED HEMOSTASIS KIT Medication

GELFOAM100 GELFOAM SIZE 100 SPONGE Medication

GELFOAM127 SURGIFOAM 12-7 1 SPONGE Medication

GELFOAMPLU GELFOAM PLUS HEMOSTASIS KIT Medication

GEMCIT1000 GEMCITABINE 1,000 MG/26.3 ML VIAL Medication

GEMCIT200I GEMCITABINE 200 MG/5.26 ML VIAL Medication

GEMFIB600 GEMFIBROZIL 600 MG TAB Medication

GENTA20A GENTAMICIN ** PEDIATRIC **20 MG/2 ML AMP Medication

GENTA20A GENTAMICIN ** PEDIATRIC **20 MG/2 ML AMP Medication as an Additive

GENTA3L GENTAMICIN 0.3% OPHTH SOL 5 ML Medication

GENTA3O GENTAMICIN 0.3% OPHTHALMIC OINT 3.5 GM Medication

GENTA80A GENTAMICIN SULFATE 80 MG/2 ML AMP Medication

GENTA80A GENTAMICIN SULFATE 80 MG/2 ML AMP Medication as an Additive

GENTIAVIO1 GENTIAN VIOLET 1% 59 ML BOT Medication

GENTLOCK GENT LOCK THERAPY W/HEPARIN Medication

GENTLOCK GENT LOCK THERAPY W/HEPARIN Medication as an Additive

GICOCKTAIL GI COCKTAIL 30 ML CUP Medication

GLATIR20 GLATIRAMER ACETATE 20 MG/1 ML SYRINGE Medication

GLATIR40 GLATIRAMER ACETATE 40MG/ML SYRINGE Medication

GLIM1T GLIMEPIRIDE 1 MG TAB Medication

GLIM2T GLIMEPIRIDE 2 MG TAB Medication

GLIPIZ10 glipiZIDE 10 MG TAB Medication

GLIPIZ25SR glipiZIDE XL 2.5 MG 24-HR TAB Medication

GLIPIZ5 glipiZIDE 5 MG TAB Medication

GLIPIZ5SR glipiZIDE XL 5 MG 24-HR TAB Medication

GLUCAGON1V GLUCAGON 1 MG VIAL Medication

GLUCOS2ML GLUCOSE (DEXTROSE) GEL 0.8 G/2 ML ORAL SYRINGE Medication

GLYBURI25T glyBURIDE 2.5 MG TAB Medication

GLYBURI5 glyBURIDE 5 MG TAB Medication

GLYC0.2V4 GLYCOPYRROLATE 0.4MG/2ML VIAL Medication

GLYC50SO FLOLAN STERILE DILUENT 50 ML Medication

GLYCERIAD GLYCERIN SUPPOSITORY ADULT Medication

GLYCERICH GLYCERINE SUPPOSITORY **CHILD** Medication

GLYCINE30 GLYCINE IRR 3,000 ML BAG Medication

Page 29 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

GLYCOPYR1T GLYCOPYRROLATE 1 MG TAB Medication

GLYCOPYR1V GLYCOPYRROLATE 0.2 MG/1 ML VIAL Medication

GOLYTELY4 GOLYTELY 4,000 ML BOT Medication

GRAN01 GRANISETRON 0.1 MG/ML VIAL Medication

GRAN1V GRANISETRON 1 MG/ML VIAL Medication

GUAI120L ROBITUSSIN CF (DM 20MG, guaiFENesin 200MG, PE 10MG)10 ML CUP Medication

GUAIFEN guaiFENesin 200 MG/10 ML CUP Medication

GUAIFEN5 guaiFENesin 100 MG/5 ML CUP Medication

GUAIFEN600 guaiFENesin 600 MG ERTABLET (MUCINEX) Medication

GUANF1ER guanFACINE 1 MG ER TAB (INTUNIV) Medication

GUANFA1T guanFACINE 1 MG TAB Medication

GUAR1PAC2 BENEFIBER 4 GM POWDER PACKET (WHEAT DEXTRIN-GLUTEN FREE) Medication

H201IRBOTA STERILE WATER FOR IRR *BOTTLE* 1,000 ML BOT Medication

H2O1000IV STERILE WATER FOR INJECTION 1000 ML BAG Medication

H2O10VL STERILE WATER FOR INJECTION 10 ML VIAL Medication

H2O10VL STERILE WATER FOR INJECTION 10 ML VIAL Medication as a Carrier

H2O10VL STERILE WATER FOR INJECTION 10 ML VIAL Medication as an Additive

H2O1500IRR STERILE WATER FOR IRR *BOTTLE* 1,500 ML BOT Medication

H2O20VL STERILE WATER FOR INJECTION 20 ML VIAL Medication

H2O20VL STERILE WATER FOR INJECTION 20 ML VIAL Medication as a Carrier

H2O20VL STERILE WATER FOR INJECTION 20 ML VIAL Medication as an Additive

H2O30VL STERILE WATER FOR INJECTION 30 ML VIAL Medication

H2O30VL STERILE WATER FOR INJECTION 30 ML VIAL Medication as an Additive

H2O500IRR STERILE WATER FOR IRRIGATION 500 ML *BOTTLE* Medication

HAEMBVAC HAEMOPHILUS B CONJUGATE VACCINE 10 MCG/0.5 ML VIAL Medication

HALOP100DE HALOPERIDOL DECANOATE 100 MG/ML 1ML AMP Medication

HALOP50DEC HALOPERIDOL DECANOATE 50 MG/ML 1ML AMP Medication

HALOPECONC HALOPERIDOL 2 MG/ML 5 ML ORAL CONC Medication

HALOPER.5 HALOPERIDOL 0.5 MG TAB Medication

HALOPER1 HALOPERIDOL 1 MG TAB Medication

HALOPER10T HALOPERIDOL 10 MG TAB Medication

HALOPER2 HALOPERIDOL 2 MG TAB Medication

HALOPER5 HALOPERIDOL 5 MG TAB Medication

HALOPER5A HALOPERIDOL 5 MG/ML AMP Medication

HBIG1ML HEPATITIS B IMMUNE GLOBULIN 1 ML VIAL Medication

HBIG5ML HEPATITIS B IMMUNE GLOBULIN 5 ML VIAL Medication

HCTZ12.5 hydroCHLOROthiazide 12.5 MG CAP Medication

HCTZ25 hydroCHLOROthiazide 25 MG TAB Medication

HCTZ50 hydroCHLOROthiazide 50 MG TAB Medication

HEMI313V HEMIN 313 MG/44.7 ML INJ Medication

HEMI313V HEMIN 313 MG/44.7 ML INJ Medication as an Additive

HEP100PF HEPARIN LOCK CENTRAL FLUSH 500 UNITS/5 ML(100 UNITS/ML) SYRINGE ***PF*** Medication

Page 30 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

HEP100PF HEPARIN LOCK CENTRAL FLUSH 500 UNITS/5 ML(100 UNITS/ML) SYRINGE ***PF*** Medication as an Additive

HEP2/2PF HEPARIN FLUSH 2 UNITS/2 ML(1 UNIT/ML) SYRINGE *PF* NEONATAL Medication

HEP5/5PF HEPARIN FLUSH 5 UNITS/5 ML(1 UNIT/ML) SYRINGE *PF* NEONATAL Medication

HEP5M10 HEPARIN DIALYSIS CATHETER 50,000UNITS/10ML (5,000UNIT/ML) VIAL Medication

HEPARIN10K HEPARIN SODIUM 10,000 UNIT/1 ML VIAL Medication

HEPARIN10K HEPARIN SODIUM 10,000 UNIT/1 ML VIAL Medication as an Additive

HEPARIN1K HEPARIN 10,000 UNITS/10 ML (1,000 UNITS/ML) VIAL Medication

HEPARINART HEPARIN 1000 UNITS/500 ML NS PREMIX (2 UNITS/ML) *CATH LAB ONLY* Medication

HEPARINDR HEPARIN 25,000 UNITS/250 ML (100 UNITS/ML) PREMIX BAG Medication

HEPB20SD HEPATITIS B VACCINE ADULT 20 MCG/1 ML VIAL Medication

HEPPROGMSD HEP B VACCINE PED (MERCK)PROGRAM 5 MCG/0.5 ML VIAL Medication

HEPPROGRAM HEPATITIS B VACCINE PED GSK PROGRAM 10 MCG/0.5 ML VIAL Medication

HEPPROGSYR HEP B VACCINE PED (MERCK) PROGRAM 5 MCG/0.5 ML SYRINGE Medication

HEPV5SD HEP B VACCINE PEDIATRIC (MERCK) 5 MCG/0.5 ML VIAL Medication

HEPVA HEPATITIS A VACCINE 1440 UNIT/ML 1 ML VIAL Medication

HEPVPED10 HEPATITIS B VACCINE PED GSK 10 MCG/0.5 ML VIAL Medication

HUM7030 INSULIN - HumuLIN 70/30 100 UNIT/ML 10ML VIAL Medication

HUM7030PEN INSULIN - HumuLIN 70/30 100 UNIT/ML KWIKPEN Medication

HUM7525 INSULIN - HumaLOG MIX 75/25 100 UNIT/ML 10ML VIAL Medication

HUM7525S INSULIN - HumaLOG MIX 75/25 100 UNIT/ML 3 ML KWIKPEN Medication

HUMNPH INSULIN - HUMAN NPH 100 UNIT/ML 10ML VIAL Medication

HUMNPH3 INSULIN - HUMAN NPH 100 UNIT/ML 3ML VIAL Medication

HUMR INSULIN - HUMAN REGULAR 100 UNIT/ML 10 ML VIAL Medication

HUMR INSULIN - HUMAN REGULAR 100 UNIT/ML 10 ML VIAL Medication as an Additive

HYAL150S3 HYALURONIDASE 150 UNIT/ML 1 ML VIAL Medication

HYAL2 HYLAN G-F 20 2 ML SYRINGE (8 MG/ML) Medication

HYAL200V HYALURONIDASE,OVINE 200 UNIT/1 ML 1.2 ML VIAL Medication

HYAL6 HYLAN G-F 20 6 ML SYRINGE (8 MG/ML) Medication

HYDRACET15 HYDROcodone/ACETAMINOPHEN 7.5-325 MG/15 ML CUP Medication

HYDRALA10 hydrALAZINE 10 MG TAB Medication

HYDRALA20V hydrALAZINE 20 MG/ML 1ML VIAL Medication

HYDRALA25 hydrALAZINE 25 MG TAB Medication

HYDRALA50 hydrALAZINE 50 MG TAB Medication

HYDRCOOINT HYDROCORTISONE VALERATE 0.2% OINTMENT 45 GM TUBE Medication

HYDROCO10F HYDROCORTISONE ACETATE 10% RECTAL FOAM 15 GM Medication

HYDROCO1C3 HYDROCORTISONE 1% CREAM 30 GM TUBE Medication

HYDROCO1C3 HYDROCORTISONE 1% CREAM 30 GM TUBE Medication as a Compound

HYDROCO1L4 HYDROCORTISONE 1% LOTION 120 ML BOT Medication

HYDROCO1O3 HYDROCORTISONE 1% OINT 30 GM TUBE Medication

HYDROCO2C1 HYDROCORTISONE 2.5% CREAM 20 GM TUBE Medication

HYDROCO2O2 HYDROCORTISONE 2.5% OINT 20 GM TUBE Medication

HYDROCO5C3 HYDROCORTISONE 0.5% CREAM 30 GM TUBE Medication

Page 31 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

HYDROCO5O3 HYDROCORTISONE 0.5% OINT 30 GM TUBE Medication

HYDROCOENE HYDROCORTISONE 100 MG/60 ML ENEMA Medication

HYDROCORT1 HYDROCORTISONE 10 MG TAB Medication

HYDROCOVAL HYDROCORTISONE VALERATE 0.2% CREAM 45 GM TUBE Medication

HYDROGEP16 HYDROGEN PEROXIDE 473 ML (16 OZ) BOT Medication

HYDROGNSIR HYDROGEN PEROXIDE/NS 1:1 IRR 1,000 ML BOT Medication

HYDROGWATE HYDROGEN PEROXIDE/H2O 1:1 IRR 1,000 ML BOT Medication

HYDROMGTT HYDROmorphone DRIP 200MCG/ML Medication

HYDROMOR1 HYDROmorphone HCL 1 MG INJECTION Medication

HYDROMOR1 HYDROmorphone HCL 1 MG INJECTION Medication as an Additive

HYDROMOR2A HYDROmorphone 2 MG/1 ML INJ Medication

HYDROMOR2A HYDROmorphone 2 MG/1 ML INJ Medication as an Additive

HYDROMOR2T HYDROmorphone 2 MG TAB Medication

HYDROMOR4A HYDROmorphone HCL 4 MG INJECTION Medication

HYDROMOR4A HYDROmorphone HCL 4 MG INJECTION Medication as an Additive

HYDROMOR4T HYDROmorphone 4 MG TAB Medication

HYDROMPCA HYDROmorphone PCA 200 MCG/ML-100 ML CARTRIDGE Medication

HYDROSUC1 HYDROCORTISONE SUCC 100 MG/2 ML VIAL Medication

HYDROSUC1 HYDROCORTISONE SUCC 100 MG/2 ML VIAL Medication as an Additive

HYDROSUC2 HYDROCORTISONE SUCC 250 MG/2 ML VIAL Medication

HYDROSUC2 HYDROCORTISONE SUCC 250 MG/2 ML VIAL Medication as an Additive

HYDROSUC5 HYDROCORTISONE SUCC 500 MG/4 ML VIAL Medication

HYDROSUC5 HYDROCORTISONE SUCC 500 MG/4 ML VIAL Medication as an Additive

HYDROXY10T hydrOXYzine HCL 10 MG TAB Medication

HYDROXY10V hydrOXYzine HCL 50 MG/ML VIAL Medication

HYDROXY25T hydrOXYzine HCL 25 MG TAB Medication

HYDROXY25V hydrOXYzine HCL 25 MG/ML VIAL Medication

HYDROXY50T hydrOXYzine HCL 50 MG TAB Medication

HYDROXYCHL HYDROXYCHLOROQUINE SULFATE 200 MG TAB Medication

HYDROXYURE HYDROXYUREA 500 MG CAP Medication

HYOSCAM1S HYOSCYAMINE 0.125 MG TAB (SL, CHEWABLE OR ORAL) Medication

HYPERTET TETANUS IMMUNE GLOBULIN 250 UNIT SYRINGE Medication

IBUP20VI IBUPROFEN LYSINE/PF 20 MG/2 ML NEONATAL Medication

IBUP20VI IBUPROFEN LYSINE/PF 20 MG/2 ML NEONATAL Medication as an Additive

IBUPRO100C IBUPROFEN 100 MG CHEW Medication

IBUPRO200 IBUPROFEN 200 MG TAB Medication

IBUPRO400 IBUPROFEN 400 MG TAB Medication

IBUPRO600 IBUPROFEN 600 MG TAB Medication

IBUPRO800 IBUPROFEN 800 MG TAB Medication

IBUPROSUS IBUPROFEN 100 MG/5 ML CUP Medication

IBUPROSUSP IBUPROFEN 200 MG/10 ML CUP Medication

IDARUB10V IDArubicin 10 MG/10 ML VIAL Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

IDARUB5V IDArubidin 5 MG/5 ML VIAL Medication

IFOSFA1 IFOSFAMIDE 1 GM/20 ML VIAL Medication

IFOSFA3 IFOSFAMIDE 3 GM/60 ML VIAL Medication

IFOSFA3 IFOSFAMIDE 3 GM/60 ML VIAL Medication as an Additive

ILEX ILEX (ZINC/WHITE PETROLATUM) PASTE 57 GM TUBE Medication

ILOP4TAB ILOPERIDONE 4 MG TAB Medication

ILOP6TAB ILOPERIDONE 6 MG TAB Medication

IMIPRAM10T IMIPRAMINE 10 MG TAB Medication

IMIPRAM25T IMIPRAMINE 25 MG TAB Medication

IMIPRAM50 IMIPRAMINE 50 MG TAB Medication

IMMU10/100 IMMUNE GLOBULIN 10% 10 GM/100 ML VIAL (GAMUNEX-C) Medication

IMMU10/100 IMMUNE GLOBULIN 10% 10 GM/100 ML VIAL (GAMUNEX-C) Medication as an Additive

IMMU10OCT IMMUNE GLOBULIN 10% 10 GM/100 ML VIAL (OCTAGAM) Medication

IMMU10OCT IMMUNE GLOBULIN 10% 10 GM/100 ML VIAL (OCTAGAM) Medication as an Additive

IMMU20/200 IMMUNE GLOBULIN 10% 20 GM/200 ML VIAL (GAMUNEX-C) Medication

IMMU20/200 IMMUNE GLOBULIN 10% 20 GM/200 ML VIAL (GAMUNEX-C) Medication as an Additive

IMMU20OCT IMMUNE GLOBULIN 10% 20 GM/200 ML VIAL (OCTAGAM) Medication

IMMU20OCT IMMUNE GLOBULIN 10% 20 GM/200 ML VIAL (OCTAGAM) Medication as an Additive

IMMU50VI3 IMMUNE GLOBULIN,GAMMA (IGG) 5 GM/50 ML (PRIVIGEN) Medication

IMMU50VI3 IMMUNE GLOBULIN,GAMMA (IGG) 5 GM/50 ML (PRIVIGEN) Medication as a Carrier

IMMU50VI3 IMMUNE GLOBULIN,GAMMA (IGG) 5 GM/50 ML (PRIVIGEN) Medication as an Additive

IMMU5OCT IMMUNE GLOBULIN 10% 5 GM/50 ML VIAL (OCTAGAM) Medication

IMMU5OCT IMMUNE GLOBULIN 10% 5 GM/50 ML VIAL (OCTAGAM) Medication as an Additive

INDAPAM INDAPAMIDE 2.5 MG TAB Medication

INDIGOC INDIGOTINDISULFONATE SOD 5 ML AMP Medication

INDO1VIA INDOMETHACIN SODIUM TRIHYDRATE 1 MG VIAL Medication

INDOCGREEN INDOCYANINE GREEN 25MG PWVL/DILUENT Medication

INDOMETH25 INDOMETHACIN 25 MG CAP Medication

INDOMETH50 INDOMETHACIN 50 MG CAP Medication

INDOMETH75 INDOMETHACIN SR 75 MG SRCAPSULE Medication

INDOMETHSU INDOMETHACIN 50 MG SUPP Medication

INFLIXABDA inFLIXimab-ABDA 100 MG/10 ML VIAL Medication

INFLIXABDA inFLIXimab-ABDA 100 MG/10 ML VIAL Medication as an Additive

INFLUCEL INFLUENZA VACCINE 0.5 ML (FLUCELVAX) 4yr-ADULT 2019-2020 *EGG FREE* Medication

INFLULAVQ INFLUENZA VACCINE 0.5 ML (FLULAVAL QUAD) 6mo-ADULT 2019-2020 Medication

INSGLU INSULIN APIDRA 100 UNIT/ML 10ML VIAL Medication

INSU500PEN INSULIN - HUMAN REGULAR *500 UNIT/ML* PEN ***HIGH ALERT*** Medication

INTER1A INTERFERON BETA 1A 30 MCG/0.5 ML PREFILLED SYR Medication

INTER1A22 INTERFERON BETA 1A 22 MCG/0.5 ML INJ Medication

INTER1A44 INTERFERON BETA 1A 44 MCG/0.5 ML INJ Medication

INTERFER1B INTERFERON BETA 1B 0.3 MG INJ Medication

INTRONA3 INTERFERON ALFA-2B 18 MILLION UNIT VIAL Medication

Page 33 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

IODINESTR STRONG IODINE (LUGOL'S SOL) (5%) 14 ML BOTTLE Medication

IODINETINC IODINE TINCTURE 2% 30 ML BOTTLE Medication

IOH30010 IOHEXOL 300 MG/ML 10ML VIAL Medication

IPRA03NA IPRATROPIUM NASAL SPRAY 0.03% 30 ML Medication

IPRA06NA IPRATROPIUM NASAL SPRAY 0.06% 15 ML Medication

IPRA2.5S9 IPRATROPIUM BROMIDE 0.5 MG/2.5 ML NEBSOL Medication

IPRA3AMP16 ALBUTEROL/IPRATROPIUM 3 ML NEB SOL Medication

IRB150 IRBESARTAN 150 MG TAB Medication

IRB300 IRBESARTAN 300 MG TAB Medication

IRB75 IRBESARTAN 75 MG TAB Medication

IRINOT100V IRINOTECAN 20 MG/ML 5 ML VIAL Medication

IRINOT100V IRINOTECAN 20 MG/ML 5 ML VIAL Medication as an Additive

IRONSUC IRON SUCROSE INJ 20 MG/ML 5ML VIAL Medication

IRONSUC IRON SUCROSE INJ 20 MG/ML 5ML VIAL Medication as an Additive

ISAVUC372V ISAVUCONAZONIUM 372 MG VIAL Medication

ISAVUC372V ISAVUCONAZONIUM 372 MG VIAL Medication as an Additive

ISOFLUR100 ISOFLURANE 100 ML BOT Medication

ISONIAZ300 ISONIAZID 300 MG TAB Medication

ISONIAZ50S ISONIAZID 50 MG/5 ML SYRUP Medication

ISOPRO1ML ISOPROTERENOL 0.2 MG/1 ML AMP Medication

ISOPRO1ML ISOPROTERENOL 0.2 MG/1 ML AMP Medication as an Additive

ISOPROP480 ISOPROPYL ALCOHOL 480 ML BOT Medication

ISOSOR10T ISOSORBIDE DINITRATE 10 MG TAB Medication

ISOSOR20T ISOSORBIDE DINITRATE 20 MG TAB Medication

ISOSOR30T ISOSORBIDE DINITRATE 30 MG TAB Medication

ISOSOR5T ISOSORBIDE DINITRATE 5 MG TAB Medication

ISOSORM20T ISOSORBIDE MONONITRATE 20 MG TAB Medication

ISOSORM30S ISOSORBIDE MONONITRATE 30 MG ER TAB Medication

ISOSORM60S ISOSORBIDE MONONITRATE 60 MG ER TAB Medication

ISOSULF1IN ISOSULFAN BLUE 10 MG/ML 5 ML SDPF VIAL Medication

ISOTRET40 ISOTRETINOIN 40 MG CAP Medication

ISOXSU10T ISOXSUPRINE 10 MG TAB Medication

ITRACON100 ITRACONAZOLE 100 MG CAP Medication

IVAB5TAB IVABRADINE 5 MG TAB Medication

KCL10RD KCL 10 MEQ IN SWI 100 ML PREMIX Medication

KCL10T POTASSIUM CHLORIDE 10 MEQ ER CAPSULE/TAB Medication

KCL20EFF POTASSIUM BICARB/CITRIC ACID 20 MEQ EFFERVESCENT TAB Medication

KCL20IV POTASSIUM CHLORIDE IV 20 MEQ/10 ML VIAL Medication

KCL20IV POTASSIUM CHLORIDE IV 20 MEQ/10 ML VIAL Medication as an Additive

KCL20L POTASSIUM CHLORIDE LIQUID 20 MEQ/15 ML CUP Medication

KCL20RD KCL 20 MEQ IN SWI 100ML PREMIX Medication

KCL20T POTASSIUM CHLORIDE 20 MEQ ER TAB Medication

Page 34 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

KCL40IV POTASSIUM CHLORIDE IV 40 MEQ/20 ML VIAL Medication

KCL40IV POTASSIUM CHLORIDE IV 40 MEQ/20 ML VIAL Medication as an Additive

KCL40L POTASSIUM CHLORIDE LIQUID 40 MEQ/30 ML CUP Medication

KCL8C POTASSIUM CHLORIDE ER 8MEQ SRTABLET Medication

KETAMI2 KETAMINE 100 MG/2 ML SYRINGE Medication

KETAMI200 KETAMINE 200 MG/20 ML MDV Medication

KETAMI200 KETAMINE 200 MG/20 ML MDV Medication as an Additive

KETAMI5ML KETAMINE 100MG/ML 5 ML VIAL Medication

KETAMI5ML KETAMINE 100MG/ML 5 ML VIAL Medication as an Additive

KETAMIINJ KETAMINE 500 MG/10 ML VIAL Medication

KETAMIINJ KETAMINE 500 MG/10 ML VIAL Medication as an Additive

KETO200C KETOPROFEN 200MG CAP 200 MG CAP Medication

KETOCONSHA KETOCONAZOLE 2% SHAMPOO 120 ML Medication

KETOCONTOP KETOCONAZOLE 2% CREAM 15 GM TUBE Medication

KETOPRO75C KETOPROFEN 75 MG CAP Medication

KETOR10T KETOROLAC TROMETHAMINE 10 MG TAB Medication

KETOR15INJ KETOROLAC 15 MG VIAL Medication

KETOR30INJ KETOROLAC 30 MG VIAL Medication

KETOR60INJ KETOROLAC 60 MG VIAL Medication

KETOROPSOL KETOROLAC 0.5% OPHTH SOL 5 ML Medication

KOND30UD MINERAL OIL SUSPENSION 30 ML CUP Medication

LABETA100T LABETALOL 100 MG TAB Medication

LABETA100V LABETALOL HCL 100 MG/20 ML VIAL Medication

LABETA100V LABETALOL HCL 100 MG/20 ML VIAL Medication as an Additive

LABETA200T LABETALOL 200 MG TAB Medication

LABETA200V LABETALOL 200 MG/40 ML VIAL Medication

LABETA200V LABETALOL 200 MG/40 ML VIAL Medication as an Additive

LABETA20V LABETALOL HCL 20 MG/4 ML INJ Medication

LABETA20V LABETALOL HCL 20 MG/4 ML INJ Medication as an Additive

LABETA300T LABETALOL 300 MG TAB Medication

LACHYDRIN5 AMMONIUM LACTATE 12% LOTION 400 GM BOTTLE Medication

LACO100T2 LACOSAMIDE 100 MG TAB Medication

LACO200L LACOSAMIDE 200 MG/20 ML CUP Medication

LACO200T2 LACOSAMIDE 200 MG TAB Medication

LACO200V LACOSAMIDE 200 MG/20 ML INJ Medication

LACO200V LACOSAMIDE 200 MG/20 ML INJ Medication as an Additive

LACTAID LACTAID TAB Medication

LACTOBACAP LACTOBACILLUS RHAMNOSUS GG CAPSULE Medication

LACTULO30L LACTULOSE 30 ML CUP Medication

LAMI10SO LAMIVUDINE 10 MG/ML ORAL SUSPENSION 240 ML BOTTLE Medication

LAMIV150T lamiVUDine 150 MG TAB Medication

LAMO100T2 lamoTRIgine 100 MG XR TAB Medication

Page 35 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

LAMO100T3 lamoTRIgine 100 MG ORALLY DISINT TAB Medication

LAMO25TA6 lamoTRIgine 25 MG XR TAB Medication

LAMO25TA7 lamoTRIgine 25 MG ORALLY DISINT TAB Medication

LAN15SOLU LANSOPRAZOLE 15 MG SOLUTAB Medication

LAN30SOLU LANSOPRAZOLE 30 MG SOLUTAB Medication

LANOLINCRM LANOLIN OINTMENT 0.25 OZ TUBE Medication

LANSOP15C LANSOPRAZOLE 15 MG DR CAP Medication

LANSOP30T LANSOPRAZOLE 30 MG DR CAP Medication

LANTHAN LANTHANUM CARBONATE 500 MG TAB Medication

LATANOPH25 LATANOPROST 0.005% OPHTH SOL 2.5 ML Medication

LECITHICAP LECITHIN CAP Medication

LEFLUN10 LEFLUNOMIDE 10 MG TAB Medication

LET LET GEL 3 ML Medication

LETROZ25 LETROZOLE 2.5 MG TAB Medication

LEUCOVO100 LEUCOVORIN CALCIUM 100 MG VIAL Medication

LEUCOVO50V LEUCOVORIN CALCIUM 50 MG VIAL Medication

LEUCOVO5T LEUCOVORIN CALCIUM 5 MG TAB Medication

LEV500L levoFLOXacin 500 MG/20 ML ORAL SOLUTION Medication

LEVA1.255 LEVALBUTEROL 1.25 MG/0.5ML NEB Medication

LEVA31 LEVALBUTEROL 0.31 MG/3 ML NEB SOLUTION ***PEDIATRIC*** Medication

LEVAL1.253 LEVALBUTEROL 1.25 MG/3 ML NEB Medication

LEVAL63 LEVALBUTEROL 0.63 MG/3 ML NEB SOLUTION Medication

LEVE750T56 levETIRAcetam 750 MG XR TAB Medication

LEVET1000P levETIRAcetam 1,000 MG/100 ML PREMIX BAG Medication

LEVET250T levETIRAcetam 250 MG TAB Medication

LEVET500 levETIRAcetam 500 MG TAB Medication

LEVET500IV levETIRAcetam 500 MG/5 ML VIAL Medication

LEVET500IV levETIRAcetam 500 MG/5 ML VIAL Medication as an Additive

LEVET500P levETIRAcetam 500 MG/100 ML PREMIX BAG Medication

LEVET500XR levETIRAcetam 500 MG XR TAB Medication

LEVETSOLN levETIRAcetam 500 MG/5 ML ORAL SOLN CUP Medication

LEVOBUN55 LEVOBUNOLOL 0.5 % OPHTH SOL 5 ML Medication

LEVOC1GM LEVOCARNITINE 1000 MG/5 ML VIAL Medication

LEVOC1GM LEVOCARNITINE 1000 MG/5 ML VIAL Medication as an Additive

LEVOC330 LEVOCARNITINE 330 MG CAP Medication

LEVOF250T levoFLOXacin 250 MG TAB Medication

LEVOF500P levoFLOXacin 500 MG/100 ML PREMIX BAG Medication

LEVOF500T levoFLOXacin 500 MG TAB Medication

LEVOF500V levoFLOXacin 500 MG/20 ML VIAL Medication

LEVOF500V levoFLOXacin 500 MG/20 ML VIAL Medication as an Additive

LEVOF750P levoFLOXacin 750 MG/150 ML PREMIX BAG Medication

LEVOF750T levoFLOXacin 750 MG TAB Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

LEVOM20ERC LEVOMILNACIPRAN 20 MG ER CAP Medication

LEVONOR15T LEVONORGESTREL 1.5 MG TAB Medication

LEVOPRE250 levoFLOXacin 250 MG/50 ML PREMIX BAG Medication

LEVOTH100V LEVOTHYROXINE SOD 100 MCG INJECTION Medication

LEVOTH112T LEVOTHYROXINE SOD 112 MCG TAB Medication

LEVOTH125T LEVOTHYROXINE SOD 125 MCG TAB Medication

LEVOTH137T LEVOTHYROXINE SOD 137 MCG TAB Medication

LEVOTH15T LEVOTHYROXINE SOD 150 MCG TAB Medication

LEVOTH175T LEVOTHYROXINE SOD 175 MCG TAB Medication

LEVOTH1T LEVOTHYROXINE SOD 100 MCG TAB Medication

LEVOTH25T LEVOTHYROXINE SOD 25 MCG TAB Medication

LEVOTH2T LEVOTHYROXINE SOD 200 MCG TAB Medication

LEVOTH5T LEVOTHYROXINE SOD 50 MCG TAB Medication

LEVOTH75T LEVOTHYROXINE SOD 75 MCG TAB Medication

LEVOTH88T LEVOTHYROXINE SOD 88 MCG TAB Medication

LIBRAXCAP LIBRAX 1 CAPSULE Medication

LID1MDV50 LIDOCAINE 1% (10 MG/ML) 50ML MDV Medication

LIDO100JET LIDOCAINE 2% 100 MG/5 ML SYRINGE Medication

LIDO10VI21 LIDOCAINE 1% (10 MG/ML) 10ML MDV Medication

LIDO10VI4 LIDOCAINE 1% W/EPI 1:200,000 10ML SDV Medication

LIDO10VI9 LIDOCAINE 1% (10 MG/ML) 2ML PF VIAL Medication

LIDO15AMP LIDOCAINE 1.5% 20 ML AMP PF Medication

LIDO15E30V LIDOCAINE 1.5% W/EPI 1:200,000 30ML SDV Medication

LIDO15EAMP LIDOCAINE 1.5% W/EPI 1:200,000 5ML PF AMP Medication

LIDO15PF LIDOCAINE 1% (10 MG/ML) PF 5 ML SDV (50 MG/5 ML) Medication

LIDO15PF LIDOCAINE 1% (10 MG/ML) PF 5 ML SDV (50 MG/5 ML) Medication as an Additive

LIDO1AMP LIDOCAINE HCL 1% MPF 10 ML POLY AMP Medication

LIDO1E110 LIDOCAINE 1% W/EPI 1:100,000 10ML MDV Medication

LIDO1E110 LIDOCAINE 1% W/EPI 1:100,000 10ML MDV Medication as an Additive

LIDO1E1MDV LIDOCAINE 1% W/EPI 1:100,000 30ML MDV Medication

LIDO1E1MDV LIDOCAINE 1% W/EPI 1:100,000 30ML MDV Medication as an Additive

LIDO1E2SDV LIDOCAINE 1% W/EPI 1:200,000 30ML SDV Medication

LIDO1MDV LIDOCAINE 1% (10 MG/ML) 20ML MDV Medication

LIDO1TTOP LIDOCAINE HCL 1% 30ML TEAR TOP/VIAL Medication

LIDO1TTOP LIDOCAINE HCL 1% 30ML TEAR TOP/VIAL Medication as an Additive

LIDO20VI12 LIDOCAINE 1% W/EPI 1:100,000 20ML MDV Medication

LIDO20VI12 LIDOCAINE 1% W/EPI 1:100,000 20ML MDV Medication as an Additive

LIDO20VI7 LIDOCAINE 2% PF 5 ML VIAL (20 MG/ML) Medication

LIDO2AMP LIDOCAINE 2% PF 10 ML AMP (20 MG/ML) Medication

LIDO2AMP LIDOCAINE 2% PF 10 ML AMP (20 MG/ML) Medication as an Additive

LIDO2E150 LIDOCAINE 2% W/EPI 1:100,000 50ML MDV Medication

LIDO2E1MDV LIDOCAINE 2% W/EPI 1:100,000 20ML MDV Medication

Page 37 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

LIDO2E2SDV LIDOCAINE 2% W/EPI 1:200,000 20ML SDV Medication

LIDO2GMBAG LIDOCAINE 2GM/D5W 500ML PREMIX Medication

LIDO2JEL30 LIDOCAINE 2% JELLY 30 APP/30 ML TUBE Medication

LIDO2JEL5 LIDOCAINE 2% JELLY 5 APP/5 ML TUBE Medication

LIDO2JEL5 LIDOCAINE 2% JELLY 5 APP/5 ML TUBE Medication as a Compound

LIDO2JEL6 LIDOCAINE 2% JELLY PF 6 ML APPLICATOR Medication

LIDO2MDV LIDOCAINE HCL 2% 20ML MDV Medication

LIDO2MDV LIDOCAINE HCL 2% 20ML MDV Medication as an Additive

LIDO2MDV10 LIDOCAINE HCL 2% 10 ML MDV Medication

LIDO2MDV50 LIDOCAINE HCL 20 MG/ML VIAL 50 ML MDV Medication

LIDO2MDV50 LIDOCAINE HCL 20 MG/ML VIAL 50 ML MDV Medication as an Additive

LIDO2PO100 LIDOCAINE 2% VISCOUS SOLUTION 100 ML BOTTLE Medication

LIDO2PO20 LIDOCAINE VISCOUS 2% SOLN 15 ML CUP Medication

LIDO2SDV2 LIDOCAINE HCL 2% MPF 2 ML VIAL Medication

LIDO2URO LIDOCAINE 2% UROJET 5 ML SYRINGE Medication

LIDO4/5 LIDOCAINE PF 4% 5 ML SOLUTION Medication

LIDO4TOPS LIDOCAINE HCL 4% TOPICAL SOLUTION 50 ML BOTTLE Medication

LIDO50VI6 LIDOCAINE 1% W/EPI 1:100,000 50ML MDV Medication

LIDO50VI6 LIDOCAINE 1% W/EPI 1:100,000 50ML MDV Medication as an Additive

LIDO5D75 LIDOCAINE HCL 5% W/DEXTROSE 7.5% 2 ML AMP Medication

LIDO5E2MDV LIDOCAINE 0.5% W/EPI 1:200,000 50ML MDV Medication

LIDO5MDV LIDOCAINE 0.5% 50ML MDV Medication

LIDO5MLOR LIDOCAINE 2% 20 MG/ML 5ML SYRINGE Medication

LIDO5OINT LIDOCAINE HCL 5% OINTMENT 35 GM TUBE Medication

LIDO5SDV LIDOCAINE MPF 0.5% 50 ML SDV Medication

LIDODRESS LIDOCAINE 4% CREAM 5 GM TUBE (L-M-X-4) Medication

LIDOPEDCOR LIDOCAINE 2 GM/D5W 250 ML PREMIX (8000 MCG/ML) Medication

LIDOPTCH1 LIDOCAINE 5% "SINGLE" PATCH Medication

LINA145C LINACLOTIDE 145 MCG CAP Medication

LINA5TAB2 LINAGLIPTIN 5 MG TAB Medication

LINA72C LINACLOTIDE 72 MCG CAP Medication

LINEZ600 LINEZOLID 600 MG/300 ML PREMIX BAG Medication

LINEZSUSP LINEZOLID 100 MG/5 ML SUSP 150ML BOTTLE Medication

LINZLID LINEZOLID 600 MG TAB Medication

LIOTHYR25T LIOTHYRONINE SOD 25 MCG TAB Medication

LIOTHYR5T LIOTHYRONINE SOD 5 MCG TAB Medication

LIPID20 FAT EMULSION 20% 500ML BAG Medication

LIPID20 FAT EMULSION 20% 500ML BAG Medication as a Carrier

LIPID20 FAT EMULSION 20% 500ML BAG Medication as an Additive

LIPID20250 FAT EMULSION 20% 250 ML BAG Medication

LIPID20250 FAT EMULSION 20% 250 ML BAG Medication as a Carrier

LIPID20250 FAT EMULSION 20% 250 ML BAG Medication as an Additive

Page 38 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

LIPID20L FAT EMULSION 20% 1000 ML BOT Medication

LIPID20L FAT EMULSION 20% 1000 ML BOT Medication as a Carrier

LIPID20L FAT EMULSION 20% 1000 ML BOT Medication as an Additive

LIRA6SYR LIRAGLUTIDE 6 MG/ML SYRINGE 3 ML Medication

LISDEX20C LISDEXAMFETAMINE 20 MG CAP Medication

LISDEX30C LISDEXAMFETAMINE 30 MG CAP OR CHEW TAB Medication

LISDEX50C LISDEXAMFETAMINE 50 MG CAP Medication

LISDEX70C LISDEXAMFETAMINE 70 MG CAP Medication

LISINO10T LISINOPRIL 10 MG TAB Medication

LISINO20T LISINOPRIL 20 MG TAB Medication

LISINO25T LISINOPRIL 2.5 MG TAB Medication

LISINO40T LISINOPRIL 40 MG TAB Medication

LISINO5T LISINOPRIL 5 MG TAB Medication

LITH300SR LITHIUM CARBONATE SR 300 MG SRTABLET Medication

LITH300T LITHIUM CARBONATE 300 MG TAB Medication

LITH450SR LITHIUM CARBONATE SR 450 MG SRTABLET Medication

LITHCIT8L LITHIUM CITRATE 8 MEQ/5 ML CUP Medication

LMX30 LIDOCAINE 4% CREAM 30 GM (LMX4) Medication

LOMOTIL25T DIPHENOXYLATE-ATROPINE TAB Medication

LOMOTIL5ML DIPHENOXYLATE-ATROPINE 2.5 MG/5 ML CUP Medication

LOMUST10C LOMUSTINE 10 MG CAP Medication

LOMUST40C LOMUSTINE 40 MG CAP Medication

LOPERAM1L LOPERAMIDE 2 MG/10 ML CUP Medication

LOPERAM2C LOPERAMIDE 2 MG CAP Medication

LORA2ORA LORAZEPAM 2 MG/1 ML ORAL CONC 30 ML BOTTLE Medication

LORAT10OD LORATADINE 10 MG ORALLY DISINTEGRATING TAB Medication

LORAT1L LORATADINE 5 MG/5 ML ORAL SOLUTION Medication

LORATA10 LORATADINE 10 MG TAB Medication

LORAZEP1T LORazepam 1 MG TAB Medication

LORAZEP2I LORazepam 2 MG/1 ML VIAL Medication

LORAZEP2MD LORazepam 2 MG/ML 10ML VIAL Medication

LORAZEP2MD LORazepam 2 MG/ML 10ML VIAL Medication as a Carrier

LORAZEP2MD LORazepam 2 MG/ML 10ML VIAL Medication as an Additive

LORAZEP5T LORazepam 0.5 MG TAB Medication

LOSAR100T LOSARTAN 100 MG TAB Medication

LOSAR25T LOSARTAN 25 MG TAB Medication

LOT0.55 LOTEPREDNOL ETABONATE 0.5% OPHTH SUSP 5 ML Medication

LOTRISCR45 LOTRISONE CREAM 45 GM TUBE Medication

LOTRISONCR LOTRISONE CREAM 15 GM TUBE Medication

LOTRISONLO LOTRISONE LOTION 30 ML BOTTLE Medication

LOVASTA20T LOVASTATIN 20 MG TAB Medication

LOXAPIN10C LOXAPINE SUCCINATE 10 MG CAP Medication

Page 39 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

LOXAPIN25C LOXAPINE SUCCINATE 25 MG CAP Medication

LOXAPIN5C LOXAPINE SUCCINATE 5 MG CAP Medication

LR1000 LACTATED RINGERS 1000 ML BAG Medication

LR500 LACTATED RINGERS 500 ML BAG Medication

LTAKIT LTA KIT (LIDOCAINE 4%) Medication

LUBEYEGEL CARBOXYMETHYLCELLULOSE (REFRESH CELLUVISC) 0.4 ML GEL DROPPERETTE Medication

LUBI24CAP LUBIPROSTONE 24 MCG GELCAP Medication

LUBI8CAP LUBIPROSTONE 8 MCG GELCAP Medication

LUBRID16OZ LUBRIDERM LOTION 480 ML BOT (16 OZ) Medication

LUBRIJEL27 LUBRICATING JELLY 3 GM PACKET Medication

LUM20G LUMBAR 20G BULK Medication

LURA20T LURASIDONE 20 MG TAB Medication

LURA40TA1 LURASIDONE 40 MG TAB Medication

MAG20WPRE MAGNESIUM SO4 20 GM/500 ML H2O PREMIX BAG Medication

MAG237MO MAGIC MOUTHWASH 20 ML UD CUP Medication

MAG2GMCOM MAGNESIUM SULFATE 2 GM/50 ML D5W BAG Medication

MAG4GMCOM MAGNESIUM SULFA 4 GM/50 ML D5W Medication

MAGBOLUS2W MAGNESIUM SO4 2 GM/50ML H2O PREMIX BAG Medication

MAGBOLUS4W MAGNESIUM SO4 4 GM/50ML H2O PREMIX BAG Medication

MAGCIT MAGNESIUM CITRATE 300 ML BOT Medication

MAGGLU500T MAGNESIUM GLUCONATE 500 MG TAB Medication

MAGOX250T MAGNESIUM OXIDE 400MG TAB (MAGNESIUM 240 MG) Medication

MAGPREMIXW MAGNESIUM S04 40GM/H2O 1000 ML PREMIX BAG Medication

MAGSUL16OZ MAGNESIUM SULFATE 16 OZ BOX Medication

MAGSUL1GMV MAGNESIUM SULFATE 1 GM/2 ML VIAL Medication

MAGSUL1GMV MAGNESIUM SULFATE 1 GM/2 ML VIAL Medication as an Additive

MAGSUL25GV MAGNESIUM SULFATE 25 GM/50 ML VIAL Medication

MAGSUL25GV MAGNESIUM SULFATE 25 GM/50 ML VIAL Medication as an Additive

MAGSUL5GMV MAGNESIUM SULF 5 GM/10 ML VIAL Medication

MAGSUL5GMV MAGNESIUM SULF 5 GM/10 ML VIAL Medication as an Additive

MAGSUL8IV MAGNESIUM SULFATE 8 MEQ/2 ML VIAL Medication

MAGSUL8IV MAGNESIUM SULFATE 8 MEQ/2 ML VIAL Medication as an Additive

MANFILTER 0.22 MICRON FILTER 1 UNIT Medication

MANNIT50ML MANNITOL 25% 12.5 GM/50ML VIAL Medication

MANNIT50ML MANNITOL 25% 12.5 GM/50ML VIAL Medication as an Additive

MANNITOL20 MANNITOL 20% 100 GM/500 ML BAG Medication

MANNITOL20 MANNITOL 20% 100 GM/500 ML BAG Medication as a Carrier

MANNITOL20 MANNITOL 20% 100 GM/500 ML BAG Medication as an Additive

MAPROTIL25 MAPROTILINE 25 MG TAB Medication

MASTISOL MASTISOL LIQUID ADHESIVE 2/3 ML VIAL Medication

MAXITOPHML MAXITROL OPTH SUSP 5 ML Medication

MAXITOPHOT MAXITROL OPHTH OINT 3.5 GM Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

MAXZIDE25T TRIAMTERENE/HCTZ 37.5-25 MG TAB Medication

MAXZIDETAB TRIAMTERENE/HCTZ 75-50 MG TAB Medication

MCT30LIQ MEDIUM CHAIN TRIGLYCERIDES 946 ML BOT (1 QUART) Medication

MECLIZ125T MECLIZINE 12.5 MG TAB Medication

MECLIZ25TB MECLIZINE 25 MG TAB Medication

MECLOFE100 MECLOFENAMATE 100 MG CAP Medication

MEDROX100V medroxyPROGESTERone ACETA 150 MG/ML 1 ML VIAL Medication

MEDROXY10T medroxyPROGESTERone ACETA 10 MG TAB Medication

MEDROXY25T medroxyPROGESTERone ACETATE 2.5 MG TAB Medication

MEGES10ML MEGESTROL ACETATE 400 MG/10 ML CUP Medication

MEGESTR20T MEGESTROL ACETATE 20 MG TAB Medication

MEGESTR40T MEGESTROL ACETATE 40 MG TAB Medication

MELA3 MELATONIN 3 MG TAB Medication

MELOX7.5 MELOXICAM 7.5 MG TAB Medication

MEMANTINE5 MEMANTINE 5 MG TAB Medication

MEMANTXR14 MEMANTINE 14 MG ER CAP Medication

MEMANTXR21 MEMANTINE 21 MG ER CAP Medication

MEMANTXR28 MEMANTINE 28 MG ER CAP Medication

MEMANTXR7 MEMANTINE 7 MG ER CAP Medication

MENINGDIPMENINGOCOCCAL CONJ VACC (9MO TO 55 YRS OR BOOSTERS) A,C,Y,W-135 &

DIPHTHERMedication

MENTHOLAOT MENTHOLATUM OINT 30 GM (1 OZ) Medication

MEPERI100A MEPERIDINE 100 MG/ML AMP Medication

MEPERI100A MEPERIDINE 100 MG/ML AMP Medication as an Additive

MEPERID25A MEPERIDINE 25 MG/ML AMP Medication

MEPERID25A MEPERIDINE 25 MG/ML AMP Medication as an Additive

MEPERID50A MEPERIDINE 50 MG/ML AMP Medication

MEPERID50A MEPERIDINE 50 MG/ML AMP Medication as an Additive

MEPERID50T MEPERIDINE 50 MG TAB Medication

MEPERPCA MEPERIDINE PCA 10 MG/ML 100 ML NO BASAL Medication

MEPIVA15SD MEPIVACAINE 1.5% (15 MG/ML) 30 ML SDV Medication

MEPIVA2MDV MEPIVACAINE 2% (20 MG/ML) 50 ML MDV Medication

MEPOLI100V MEPOLIZUMAB 100 MG/1 ML VIAL Medication

MER1I MEROPENEM 1,000 MG VIAL Medication

MER1I MEROPENEM 1,000 MG VIAL Medication as an Additive

MERCAPTO50 MERCAPTOPURINE 50 MG TAB Medication

MERO500P2 MEROPENEM 500 MG VIAL Medication

MERO500P2 MEROPENEM 500 MG VIAL Medication as an Additive

MESA1.2T MESALAMINE 1.2 GM DR TAB Medication

MESAL375 MESALAMINE 0.375 GM ER CAPSULE Medication

MESALA250C MESALAMINE 250 MG CONTROLLED RELEASE CAP Medication

MESALA400C MESALAMINE 400 MG DELAYED RELEASE CAP Medication

MESALA4EN MESALAMINE 4 GM ENEMA Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

MESALSUPP1 MESALAMINE 1,000 MG SUPP Medication

MESNA1GM MESNA 1 GM/10 ML VIAL Medication

MESNA1GM MESNA 1 GM/10 ML VIAL Medication as an Additive

METAXAL800 METAXALONE 800 MG TAB Medication

METF500T metFORMIN 500 MG TAB Medication

METF500XR metFORMIN 500 MG ER TAB Medication

METF750XR metFORMIN 750 MG ER TAB Medication

METF850T metFORMIN 850 MG TAB Medication

METH25VI10 metHOTREXate 50 MG/2 ML VIAL Medication

METH25VI10 metHOTREXate 50 MG/2 ML VIAL Medication as an Additive

METH25VI11 metHOTREXate PF 1 GM/40ML VIAL Medication

METH25VI11 metHOTREXate PF 1 GM/40ML VIAL Medication as an Additive

METH25VI18 metHOTREXate 250 MG/10 ML VIAL Medication

METH25VI18 metHOTREXate 250 MG/10 ML VIAL Medication as an Additive

METH5SOL methaDONE 1 MG/1 ML ORAL SYRINGE Medication

METHACHLNG METHACHOLINE CHALLENGE TEST (5 COLOR CODED SYRINGES) Medication

METHAD10C methaDONE 10 MG/ML ORAL LIQ (PER ML FROM 30 ML BOT) Medication

METHADO10T methaDONE 10 MG TAB Medication

METHADO5L methaDONE 5 MG/5 ML CUP Medication

METHADO5T methaDONE 5 MG TAB Medication

METHENHIP1 METHENAMINE HIPPURATE 1 GM TAB Medication

METHIMA5 methIMAzole 5 MG TAB Medication

METHO2.5 METHOTREXATE 2.5 MG TAB Medication

METHO50 metHOTREXate PF 50 MG/2 ML VIAL Medication

METHO50 metHOTREXate PF 50 MG/2 ML VIAL Medication as an Additive

METHOC1GMV METHOCARBAMOL 1000 MG/10 ML VIAL Medication

METHOC1GMV METHOCARBAMOL 1000 MG/10 ML VIAL Medication as an Additive

METHOC500T METHOCARBAMOL 500 MG TAB Medication

METHOC750T METHOCARBAMOL 750 MG TAB Medication

METHYCLO5T METHYCLOTHIAZIDE 5 MG TAB Medication

METHYLD250 METHYLDOPA 250 MG TAB Medication

METHYLEN5M METHYLENE BLUE 0.5 % (50 MG/10 ML) 10ML Medication

METHYLER27 METHYLPHENIDATE 27 MG ER TAB Medication

METHYLERIM METHYLERGONOVINE MALEATE 200 MCG AMP Medication

METHYLERPO METHYLERGONOVINE MALEATE 0.2 MG TAB Medication

METHYLNA12 METHYLNALTREXONE 12 MG/0.6 ML INJ Medication

METHYLNA8 METHYLNALTREXONE 8 MG/0.4 ML SYRINGE Medication

METHYLP125 methylPREDNISolone SS 125 MG VIAL Medication

METHYLP125 methylPREDNISolone SS 125 MG VIAL Medication as an Additive

METHYLP16T methylPREDNISolone 16 MG TAB Medication

METHYLP1K methylPREDNISolone SS 1,000 MG/16 ML VIAL Medication

METHYLP1K methylPREDNISolone SS 1,000 MG/16 ML VIAL Medication as an Additive

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

METHYLP2K methylPREDNISolone SS 2,000 MG VIAL Medication

METHYLP2K methylPREDNISolone SS 2,000 MG VIAL Medication as an Additive

METHYLP40S methylPREDNISolone SS 40 MG VIAL Medication

METHYLP4PK methylPREDNISolone 1 UNIT BULK Medication

METHYLP4T methylPREDNISolone 4 MG TAB Medication

METHYLP500 methylPREDNISolone SS 500 MG/8 ML VIAL Medication

METHYLP500 methylPREDNISolone SS 500 MG/8 ML VIAL Medication as an Additive

METHYLPA40 methylPREDNISolone ACETATE 40 MG/ML 1ML VIAL Medication

METHYLPA80 methylPREDNISolone ACETATE 80 MG/ML 1ML VIAL Medication

METHYLPHE1 METHYLPHENIDATE 10 MG TAB Medication

METHYLPHE2 METHYLPHENIDATE 20 MG ER TAB Medication

METHYLPHE5 METHYLPHENIDATE 5 MG TAB Medication

METHYLPHER METHYLPHENIDATE 18 MG ER TAB Medication

METOCLO10L METOCLOPRAMIDE 10 MG/10 ML ORAL SOLN Medication

METOCLO10T METOCLOPRAMIDE 10 MG TAB Medication

METOCLO10V METOCLOPRAMIDE 10 MG/2 ML VIAL Medication

METOCLO10V METOCLOPRAMIDE 10 MG/2 ML VIAL Medication as an Additive

METOCLO5T METOCLOPRAMIDE 5 MG TAB Medication

METOLAZ25T METOLAZONE 2.5 MG TAB Medication

METOLAZ5T METOLAZONE 5 MG TAB Medication

METOPR100 METOPROLOL TARTRATE 100 MG TAB Medication

METOPR12 METOPROLOL TARTRATE 12.5 MG TAB Medication

METOPR12SR METOPROLOL SUCCINATE 12.5 MG ER TAB Medication

METOPR25 METOPROLOL TARTRATE 25 MG TAB Medication

METOPR25SR METOPROLOL SUCCINATE 25 MG ER TAB Medication

METOPR50 METOPROLOL TARTRATE 50 MG TAB Medication

METOPR50SR METOPROLOL SUCCINATE 50 MG ER TAB Medication

METOPRO5A METOPROLOL TARTRATE 5 MG/5 ML AMP Medication

METRON500P metroNIDAZOLE 500 MG/100 ML *PREMIX BAG* Medication

METRON5INJ metroNIDAZOLE 5 MG/ML IV (USING PREMIX) Medication

METRON5INJ metroNIDAZOLE 5 MG/ML IV (USING PREMIX) Medication as an Additive

METRONI250 metroNIDAZOLE 250 MG TAB Medication

METRONI250 metroNIDAZOLE 250 MG TAB Medication as a Compound

METRONIGEL metroNIDAZOLE 1% TOPICAL GEL 60 GM Medication

METRVAGGEL metroNIDAZOLE 0.75% VAGINAL GEL 70 GM TUBE Medication

MEXILET150 MEXILETINE 150 MG CAP Medication

MEXILET200 MEXILETINE 200 MG CAP Medication

MEXILET250 MEXILETINE 250 MG CAP Medication

MEXSANAPWD MEXSANA 311 APP/311 GM CAN Medication

MICA100V MICAFUNGIN SODIUM SDV 100 MG VIAL Medication

MICA100V MICAFUNGIN SODIUM SDV 100 MG VIAL Medication as an Additive

MICON2C MICONAZOLE 2% CREAM 30 GM TUBE Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

MICONALOEO MICONAZOLE 2% OINTMENT 150 APP/150 GM TUBE (5 OZ) Medication

MICONAZ100 MICONAZOLE 100 MG VAGSUPP Medication

MICONAZ200 MICONAZOLE 200 MG VAGSUPP Medication

MICONAZ45V MICONAZOLE-7 VAGINAL CREAM 2% 45 GM Medication

MICONCRIT MICONAZOLE 2% OINTMENT 57 APP/57 GM TUBE (2 OZ) Medication

MIDAZ10MG MIDAZOLAM 10 MG/2 ML VIAL Medication

MIDAZ10MG MIDAZOLAM 10 MG/2 ML VIAL Medication as an Additive

MIDAZ2MG MIDAZOLAM 2 MG/2 ML VIAL Medication

MIDAZ2MG MIDAZOLAM 2 MG/2 ML VIAL Medication as an Additive

MIDAZ2SOL2 MIDAZOLAM 10 MG/5 ML ORAL SYRUP Medication

MIDAZ50MG MIDAZOLAM 50 MG/10 ML SDV Medication

MIDAZ50MG MIDAZOLAM 50 MG/10 ML SDV Medication as an Additive

MIDAZ55V MIDAZOLAM 5 MG/5 ML VIAL Medication

MIDAZ55V MIDAZOLAM 5 MG/5 ML VIAL Medication as an Additive

MIDAZOLAM MIDAZOLAM 5 MG/1 ML VIAL Medication

MIDAZOLAM MIDAZOLAM 5 MG/1 ML VIAL Medication as an Additive

MIDO5T MIDODRINE 5 MG TAB Medication

MIDODR2.5T MIDODRINE 2.5 MG TAB Medication

MILLIGS.2 MILLIPORE GS 0.2 MICRON FILTER SET BLUE Medication

MILN12.5 MILNACIPRAN 12.5 MG TAB Medication

MILN50TA MILNACIPRAN 50 MG TAB Medication

MILRIN10V MILRINONE 1 MG/ML 10 ML VIAL Medication

MILRIN10V MILRINONE 1 MG/ML 10 ML VIAL Medication as an Additive

MILRINPRE MILRINONE 20 MG/100 ML D5W PREMIX Medication

MINERAL30L MINERAL OIL 30 ML CUP Medication

MINERALSTE MINERAL OIL STERILE 10 ML VIAL Medication

MINOCYC100 MINOCYCLINE 100 MG CAP Medication

MINOCYC50C MINOCYCLINE 50 MG CAP Medication

MINOXIDIL2 MINOXIDIL 2.5 MG TAB Medication

MINOXIDILT MINOXIDIL 10 MG TAB Medication

MIRALAX17 POLYETHYLENE GLYCOL/LYTES 17 GM PKT Medication

MIRTSOL15 MIRTAZAPINE SOLTAB 15 MG TAB Medication

MIRTSOL30 MIRTAZAPINE SOLTAB 30 MG TAB Medication

MISOPR100T MISOPROSTOL 100 MCG TAB Medication

MISOPR200T miSOPROStol 200 MCG TAB Medication

MISOPR25T MISOPROSTOL 25 MCG TAB Medication

MITO2VIA22 mitoXANTRONE 25 MG/12.5 ML VIAL Medication

MITO2VIA22 mitoXANTRONE 25 MG/12.5 ML VIAL Medication as an Additive

MITO40PD mitoMYcin 40 MG VIAL Medication

MITO40PD mitoMYcin 40 MG VIAL Medication as an Additive

MITO500T MITOTANE 500 MG TAB Medication

MITOM4TOP mitoMYcin 0.4 MG/ML TOPICAL SYRINGE Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

MITOMYCIN5 mitoMYcin 5 MG/10 ML VIAL Medication

MITOMYCIN5 mitoMYcin 5 MG/10 ML VIAL Medication as an Additive

MMRIIV MEASLES MUMPS RUBELLA VACCINE Medication

MODAF100 MODAFINIL 100 MG TAB Medication

MOEX75T MOEXIPRIL 7.5 MG TAB Medication

MOM30L MILK OF MAGNESIA 30 ML CUP Medication

MON10 MONTELUKAST 10 MG TAB Medication

MON4 MONTELUKAST 4 MG CHEW Medication

MON5 MONTELUKAST 5 MG CHEWTAB Medication

MORPHIN20L morphine SULFATE 20 MG/1 ML UD ORAL CONCENTRATE Medication

MOX400 MOXIFLOXACIN 400 MG TAB Medication

MOXIPREMIX MOXIFLOXACIN 400MG/250ML PREMIX BAG Medication

MOXOPTH.5 MOXIFLOXACIN 0.5% OPH DROP 3 ML BOT Medication

MS100SR morphine 100MG SR*12 HR* 100 MG TAB Medication

MS10A morphine SULFATE 10 MG/ML 1 ML AMP Medication

MS10A morphine SULFATE 10 MG/ML 1 ML AMP Medication as an Additive

MS10L morphine SULFATE 10 MG/5 ML CUP Medication

MS10PCA morphine PCA 1000 MCG/ML-100 ML CARTRIDGE Medication

MS10SR24 morphine 10 MG SR *24 HR* (KADIAN) SRCAPSULE Medication

MS15 morphine SULFATE 15 MG IR TAB Medication

MS15SR morphine 15 MG SR *12 HR* TAB (MS CONTIN) Medication

MS200 morphine PF 10 MG/ML 20ML AMP Medication

MS20L0.5 morphine SULFATE 10 MG/0.5ML CONCENTRATE ORAL SYRINGE Medication

MS20L30 morphine SULFATE 20 MG/ML 30ML BULK Medication

MS20SR24 morphine 20 MG SR *24 HR* (KADIAN) SRCAPSULE Medication

MS250 morphine PF 25 MG/ML 10ML AMP Medication

MS250 morphine PF 25 MG/ML 10ML AMP Medication as a Carrier

MS250 morphine PF 25 MG/ML 10ML AMP Medication as an Additive

MS2A morphine SULFATE 2 MG/ML 1ML AMP Medication

MS2A morphine SULFATE 2 MG/ML 1ML AMP Medication as an Additive

MS30 morphine SULFATE 30 MG IR TAB Medication

MS30SR morphine 30 MG SR*12 HR*TAB (MS CONTIN) Medication

MS30SR24 morphine 30 MG SR *24 HR* (KADIAN) SRCAPSULE Medication

MS4A morphine SULFATE 4 MG/ML 1 ML AMP Medication

MS4A morphine SULFATE 4 MG/ML 1 ML AMP Medication as an Additive

MS500 morphine PF 25 MG/ML 20ML AMP Medication

MS50SR24 morphine 50 MG SR *24 HR* (KADIAN) SRCAPSULE Medication

MS50V20ML morphine SULFATE 50 MG/ML 20ML VIAL Medication

MS50V20ML morphine SULFATE 50 MG/ML 20ML VIAL Medication as an Additive

MS5PF morphine PF 5 MG/10 ML AMP Medication

MS5PF morphine PF 5 MG/10 ML AMP Medication as an Additive

MUCINEXDM guaiFENesin 600 MG/DEXTROMETHORPHAN 30 MG ER TAB (MUCINEX DM) Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

MULTVITLIQ MULTIVITAMIN/MINERALS LIQUID 15 ML CUP Medication

MUPIRO15 MUPIROCIN 2% CREAM 15 GM TUBE Medication

MUPIRO22 MUPIROCIN 2% OINTMENT 22 GM TUBE Medication

MURO1282SO SODIUM CHLORIDE 2% OPH SOL 20 DROP/ML BOT Medication

MURO1285SO SODIUM CHLORIDE 5% OPTH SOL 15 ML Medication

MURO128OIN SODIUM CHLORIDE 5% OPTH OINT 3.5 GM Medication

MVI12 MVI 12 10 ML VIAL Medication

MVI12 MVI 12 10 ML VIAL Medication as an Additive

MVIPED MVI PEDIATRIC 5 ML VIAL Medication

MVIPED MVI PEDIATRIC 5 ML VIAL Medication as an Additive

MYCO180T MYCOPHENOLIC ACID 180 MG DELAYED REL TAB Medication

MYCO500V MYCOPHENOLATE MOFETIL 500 MG INJ Medication

MYCO500V MYCOPHENOLATE MOFETIL 500 MG INJ Medication as an Additive

MYCOLOGCRM MYCOLOG (NYSTATIN/TRIAMCINOLONE) CREAM 15 GM Medication

MYCOLOGOIN MYCOLOG OINTMENT 15 GM TUBE Medication

MYCOP250C MYCOPHENOLATE MOFETIL 250 MG CAP Medication

MYCOSUSP MYCOPHENOLATE MOFETIL 200MG/ML 160 ML BOTTLE Medication

MYLANTA30 MYLANTA MAXIMUM STRENGTH 30 ML CUP Medication

NABUME500T NABUMETONE 500 MG TABLET Medication

NABUME750T NABUMETONE 750 MG TAB Medication

NACETIV ACETAMINOPHEN NEO-PED IV 10 MG/ML SYRINGE Medication

NACYCLO5/1 ACYCLOVIR IV 5 MG/ML NEONATAL SYRINGE Medication

NACYCLO5/1 ACYCLOVIR IV 5 MG/ML NEONATAL SYRINGE Medication as an Additive

NADO20TA2 NADOLOL 20 MG TAB Medication

NADOLOL40T NADOLOL 40 MG TAB Medication

NALBUPH10M NALBUPHINE 10 MG/ML 10ML VIAL Medication

NALBUPH10M NALBUPHINE 10 MG/ML 10ML VIAL Medication as an Additive

NALBUPH10V NALBUPHINE HCL 10 MG/1 ML AMP Medication

NALBUPH10V NALBUPHINE HCL 10 MG/1 ML AMP Medication as an Additive

NALOX.410 NALOXONE 0.4MG/ML 10ML INJ Medication

NALOX.410 NALOXONE 0.4MG/ML 10ML INJ Medication as an Additive

NALOX.41V NALOXONE 0.4 MG/ML VIAL Medication

NALOX.41V NALOXONE 0.4 MG/ML VIAL Medication as an Additive

NALOX11IV NALOXONE 1 MG/ML 2 ML SYRINGE Medication

NALOX11IV NALOXONE 1 MG/ML 2 ML SYRINGE Medication as an Additive

NALOXE125T NALOXEGOL 12.5 MG TAB Medication

NALTREX380 NALTREXONE 380 MG EXTENDED RELEASE INJ Medication

NALTREX50 NALTREXONE 50 MG TAB Medication

NAMP50/1 AMPICILLIN IV 50 MG/ML NEONATAL Medication

NAMP50/1 AMPICILLIN IV 50 MG/ML NEONATAL Medication as an Additive

NAPHCOA5ML NAPHCON A OPHTHALMIC SOL 5ML BOTTLE Medication

NAPHCOAOPH NAPHCON A OPHTHALMIC SOL 15ML BOTTLE Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

NAPRO500 NAPROXEN 500 MG CR TAB Medication

NAPROS220 NAPROXEN 220 MG TAB Medication

NAPROX250T NAPROXEN 250 MG TAB Medication

NAPROX375T NAPROXEN 375 MG TAB Medication

NAPROX500T NAPROXEN 500 MG TAB Medication

NAPROX550T NAPROXEN 550 MG TAB Medication

NATALI300 NATALIZUMAB 300 MG/15 ML VIAL Medication

NATEG120 NATEGLINIDE 120 MG TAB Medication

NAZITH AZITHROMYCIN NEO IV 500 MG VIAL NEONATAL Medication

NAZITH AZITHROMYCIN NEO IV 500 MG VIAL NEONATAL Medication as an Additive

NCEFOT CEFOTAXIME 100 MG/ML NEONATAL SYRINGE Medication

NCEFOT CEFOTAXIME 100 MG/ML NEONATAL SYRINGE Medication as an Additive

NCEFTRI cefTRIAXone 25 MG/ML INFANT SYRINGE Medication

NCEFTRI cefTRIAXone 25 MG/ML INFANT SYRINGE Medication as an Additive

NCLIND6/ML CLINDAMYCIN NEO-PED IV 6 MG/ML SYRINGE Medication

NCLO cloNIDine 1 MCG/ML NEONATAL ORAL SYRINGE Medication

NEBI10TAB NEBIVOLOL HCL 10 MG TAB Medication

NEBI5TAB NEBIVOLOL HCL 5 MG TAB Medication

NEBMS04 MORPHINE PF NEBULIZED SOLUTION Medication

NEDOCRO2 NEDOCROMIL 2% OPTH SOL 5 ML Medication

NEF50 NEFAZODONE 50 MG TAB Medication

NEFAZ150Y NEFAZODONE 150 MG TAB Medication

NEILMED NeilMed SINUS RINSE (NAHCO3/NACL)POWDER PKT Medication

NEOFAM FAMOTIDINE 20MG/2ML VIAL-NEONATAL Medication

NEOFAM FAMOTIDINE 20MG/2ML VIAL-NEONATAL Medication as an Additive

NEOFOSP FOSPHENYTOIN NEO-PED IV 8 PE/ML SYRINGE Medication

NEOFOSP FOSPHENYTOIN NEO-PED IV 8 PE/ML SYRINGE Medication as an Additive

NEOIV NEONATAL IV SOLUTION (CUSTOM) Medication

NEOMETRO metroNIDAZOLE NEO-PED IV 5 MG/ML SYRINGE Medication

NEOMYC500T NEOMYCIN 500 MG TAB Medication

NEOPHENO PHENobarbital 10 MG/ML IV NEONATAL SYRINGE Medication

NEOPHENO PHENobarbital 10 MG/ML IV NEONATAL SYRINGE Medication as an Additive

NEOPOLYIRR NEOMYCIN & POLYMYXIN B SOL FOR IRR,U.S.P. 1 ML AMP Medication

NEOPOLYIRR NEOMYCIN & POLYMYXIN B SOL FOR IRR,U.S.P. 1 ML AMP Medication as an Additive

NEOSPOPS NEOSPORIN OPHTHALMIC SOLUTION 30 DROP/10 ML BOT Medication

NEOSPOROIN NEOSPORIN TOPICAL OINT 15 GM TUBE Medication

NEOSPOROPO NEOSPORIN OPTHALMIC OINTMENT 3.5 GM Medication

NEOSPORPKT NEOSPORIN PKT 1/32 OZ Medication

NEOSPPLUS NEOSPORIN PLUS OINTMENT 30 GM TUBE Medication

NEOST5SY NEOSTIGMINE METHYSULFATE 1 MG/ML 5ML SYRINGE Medication

NEOSTI1000 NEOSTIGMINE METHYSULFATE 1 MG/ML 10 ML VIAL Medication

NEOSTI1000 NEOSTIGMINE METHYSULFATE 1 MG/ML 10 ML VIAL Medication as an Additive

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

NEPAFE1 NEPAFENAC 0.1% OPTH SUSP 3 ML Medication

NEPHROVITE NEPHROVITE TAB Medication

NEUT5ML SODIUM BICARBONATE 4% 5 ML VIAL (NEUT) Medication

NEUT5ML SODIUM BICARBONATE 4% 5 ML VIAL (NEUT) Medication as an Additive

NEUTRA125C PHOS-NAK PKT (PHOS 16 MEQ, K 7 MEQ, NA 7 MEQ) Medication

NFEN fentaNYL CITRATE 10 MCG/ML NEONATAL INJ Medication

NFEN fentaNYL CITRATE 10 MCG/ML NEONATAL INJ Medication as an Additive

NFLU FLUCONAZOLE 10 MG/ML ORAL SYRINGE Medication

NFUR FUROSEMIDE 10 MG/ML SOLUTION ORAL SYRINGE Medication

NGENT2/1 GENTAMICIN *NEONATAL* 2 MG/ML IV SYRINGE Medication

NGENT2/1 GENTAMICIN *NEONATAL* 2 MG/ML IV SYRINGE Medication as an Additive

NIACIN250C NIACIN SUSTAINED RELEASE 250 MG SRCAPSULE Medication

NIACIN500C NIACIN 500 MG SR CAP Medication

NIACIN500T NIACIN 500 MG TAB Medication

NICAR20PRE niCARdipine 20 MG/200 ML NS PREMIX BAG Medication

NICARD25IV niCARdipine HCL 2.5 MG/ML 10 ML INJ Medication

NICARD25IV niCARdipine HCL 2.5 MG/ML 10 ML INJ Medication as an Additive

NICO2LOZ13 NICOTINE POLACRILEX 2 MG LOZENGE Medication

NICO4LOZ15 NICOTINE POLACRILEX 4 MG LOZENGE Medication

NICOR2C NICOTINE POLACRILEX GUM 2 MG CHEWING PIECE Medication

NICOR4C NICOTINE POLACRILEX GUM 4 MG CHEWING PIECE Medication

NICOTIN14P NICOTINE TRANSDERMAL PATCH 14 MG PATCH Medication

NICOTIN21P NICOTINE TRANSDERMAL PATCH 21 MG PATCH Medication

NICOTIN7P NICOTINE TRANSDERMAL PATCH 7 MG PATCH Medication

NIF30CC NIFEdipine CC 30 MG 24-HR TAB Medication

NIF60CC NIFEdipine CC 60 MG 24-HR TAB Medication

NIF90CC NIFEdipine CC 90 MG 24-HR TAB Medication

NIFEDIP10C NIFEdipine 10 MG CAP Medication

NIFEREX150 NIFEREX-150 CAPSULE Medication

NIMODI30C niMODipine 30 MG CAP Medication

NITR4.9S NITROGLYCERIN SPRAY 400 MCG/SPRAY (60 SPRAY BOTTLE) Medication

NITROFU25C NITROFURANTOIN 25 MG CAP Medication

NITROFU25L NITROFURANTOIN 25 MG/5 ML CUP Medication

NITROFU50C NITROFURANTOIN 50 MG CAP Medication

NITROFUMAC NITROFURANTOIN 100 MG CAP (MACROBID) Medication

NITROPPRE NITROPRUSSIDE IN 0.9% NACL 50 MG/100 ML PREMIX Medication

NITROPR50V NITROPRUSSIDE SODIUM 50 MG/2 ML VIAL Medication

NITROPR50V NITROPRUSSIDE SODIUM 50 MG/2 ML VIAL Medication as an Additive

NITROSYR NITROGLYCERIN 6 MG/30 ML SYRINGE *CATHLAB 200 MCG/ML* Medication

NLORO LORAZEPAM 2 MG/1 ML CONCENTRATED ORAL SYRINGE Medication

NMCT MEDIUM CHAIN TRIGLYCERIDES 3 ML ORALSYR Medication

NMOR morphine 0.4 MG/ML NEONATAL ORAL SYRINGE Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

NORCO HYDROcodone 10 MG/APAP 325 MG TAB Medication

NORCO5 HYDROcodone 5 MG/APAP 325 MG TAB Medication

NORCO7.5 HYDROcodone 7.5 MG/APAP 325 MG TAB Medication

NOREPI4AMP NORepinephrine BITARTRATE 4 MG/4 ML AMP Medication

NOREPI4AMP NORepinephrine BITARTRATE 4 MG/4 ML AMP Medication as an Additive

NOREPIPRE NORepinephrine 8 MG/250 ML PREMIX Medication

NORETHIN5T NORETHINDRONE ACETATE 5 MG TAB Medication

NORTRIP10C NORTRIPTYLINE 10 MG CAP Medication

NORTRIP10L NORTRIPTYLINE 10 MG/5 ML CUP Medication

NORTRIP25C NORTRIPTYLINE 25 MG CAP Medication

NORTRIP50C NORTRIPTYLINE 50 MG CAP Medication

NORTRIP75C NORTRIPTYLINE 75 MG CAP Medication

NPENGK100M NEO-PED PENICILLIN G POTASSIUM IV 100,000 UNIT/ML SYRINGE Medication

NPENGK100M NEO-PED PENICILLIN G POTASSIUM IV 100,000 UNIT/ML SYRINGE Medication as an Additive

NS100 NORMAL SALINE 0.9% 100 ML BAG Medication

NS100 NORMAL SALINE 0.9% 100 ML BAG Medication as a Carrier

NS100 NORMAL SALINE 0.9% 100 ML BAG Medication as an Additive

NS1000 NORMAL SALINE 0.9% 1000 ML BAG Medication

NS1000IRRI NACL 0.9% IRRIGATION *BOTTLE* 1,000 ML BOT Medication

NS100ADDVA NORMAL SALINE 0.9% ADD-VANTAGE 100 ML BAG Medication

NS100AG NORMAL SALINE 0.9% 108 ML BAG Medication

NS100MINI NORMAL SALINE MINI BAG 100 ML BAG Medication

NS100MINI NORMAL SALINE MINI BAG 100 ML BAG Medication as a Carrier

NS100MINI NORMAL SALINE MINI BAG 100 ML BAG Medication as an Additive

NS1500IRRI NACL 0.9% IRRIGATION *BOTTLE* 1,500 ML BOT Medication

NS20K 0.9% NACL 1000ML W/ 20MEQ KCL 1,000 ML BAG Medication

NS20VL NORMAL SALINE 0.9% 20 ML VIAL Medication

NS20VL NORMAL SALINE 0.9% 20 ML VIAL Medication as a Carrier

NS25 NORMAL SALINE 0.9% 25 ML BAG Medication

NS250 NORMAL SALINE 0.9% 250 ML BAG Medication

NS250IRRI NACL 0.9% IRRIGATION *BOTTLE* 250 ML BOT Medication

NS3000IRRI NACL 0.9% IRRIGATION *BAG* 3000 ML BAG Medication

NS30BACTVL NORMAL SALINE 0.9% 30 ML VIAL Medication

NS40K 0.9% NACL 1000ML W/ 40MEQ KCL 1,000 ML BAG Medication

NS50 NORMAL SALINE 0.9% 50 ML BAG Medication

NS500 NORMAL SALINE 0.9% 500 ML BAG Medication

NS500IRRI NACL 0.9% IRRIGATION *BOTTLE* 500 ML BOT Medication

NS50ADDVAN NORMAL SALINE 0.9% ADD-VANTAGE 50 ML BAG Medication

NS50MINI NORMAL SALINE MINI BAG 50 ML BAG Medication

NTG1GMPKG NITROGLYCERIN OINTMENT 2% (1 GM FOIL PACK) Medication

NTG25C NITROGLYCERIN 2.5 MG SR CAP Medication

NTG2P NITROGLYCERIN 0.2 MG/HR PATCH Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

NTG4P NITROGLYCERIN 0.4 MG/HR PATCH Medication

NTG4SL NITROGLYCERIN SUBLINGUAL 0.4 MG TAB (25 TAB BOTTLE) Medication

NTG50INJ NITROGLYCERIN 50 MG/10 ML VIAL Medication

NTG50INJ NITROGLYCERIN 50 MG/10 ML VIAL Medication as an Additive

NTG60OINT NITROGLYCERIN OINTMENT 2% (60 GM TUBE) Medication

NTG6P NITROGLYCERIN 0.6 MG/HR PATCH Medication

NTGDR NITROGLYCERIN 50 MG/250 ML PREMIX BOTTLE Medication

NTPN TPN NEONATAL FORMULA 24 HR BAG Medication

NTPNSTART TPN-NEO STARTER BAG (AA 4%/D10W) 250 ML PREMIX Medication

NVAN NEO-PED-VANCOMYCIN IV 5 MG/ML Medication

NVAN NEO-PED-VANCOMYCIN IV 5 MG/ML Medication as an Additive

NVIT BABY VITAMIN DROPS 1 ML ORAL SYRINGE Medication

NVITFE BABY VITAMIN DROPS W/IRON 1 ML ORAL SYRINGE Medication

NYST5SUSP NYSTATIN 500,000 UNIT/5 ML CUP Medication

NYST60SUSP NYSTATIN 100,000 UNIT/ML ORAL SUSP 60 ML *BULK* Medication

NYSTCRM30 NYSTATIN CREAM 30 GM TUBE Medication

NYSTCRM30 NYSTATIN CREAM 30 GM TUBE Medication as a Compound

NYSTTOPCRM NYSTATIN CREAM 15 GM TUBE Medication

NYSTTOPOIN NYSTATIN OINTMENT 15 GM TUBE Medication

NYSTTOPPWD NYSTATIN POWDER 15 GM BOT Medication

OBINUT1000 OBINUTUZUMAB 1,000 MG/40 ML VIAL Medication

OBINUT1000 OBINUTUZUMAB 1,000 MG/40 ML VIAL Medication as an Additive

OCEAN OCEAN SALINE NASAL SPRAY 44 ML BOTTLE Medication

OCRELI300V OCRELIZUMAB 300 MG/10 ML VIAL Medication

OCRELI300V OCRELIZUMAB 300 MG/10 ML VIAL Medication as an Additive

OCTREO05V OCTREOTIDE 50 MCG/1 ML AMP Medication

OCTREO05V OCTREOTIDE 50 MCG/1 ML AMP Medication as an Additive

OCTREO1V OCTREOTIDE 100 MCG/1 ML AMP Medication

OCTREO1V OCTREOTIDE 100 MCG/1 ML AMP Medication as an Additive

OCTREO5V OCTREOTIDE 500 MCG/1 ML AMP Medication

OCTREO5V OCTREOTIDE 500 MCG/1 ML AMP Medication as an Additive

OCUVITETAB OCUVITE TAB Medication

OFLOXOPH5 OFLOXACIN 0.3% OPHTH SLN 5 ML Medication

OLANPWVL OLANZapine 10 MG POWDER VIAL Medication

OLANZ10T OLANZapine 10 MG TAB Medication

OLANZ5T OLANZapine 5 MG TAB Medication

OLOP2.5D OLOPATADINE HCL 0.2% OPTHALMIC SOLUTION 2.5 ML Medication

OLOPAT1 OLOPATADINE 0.1% OPTHALMIC SOLN 5 ML BOT Medication

OMALIZ150 OMALIZUMAB 150 MG VIAL Medication

OMALIZ150 OMALIZUMAB 150 MG VIAL Medication as an Additive

OMEGA3 OMEGA-3-ACID ETHYL ESTERS 1 GM CAPSULE Medication

OMEP10C OMEPRAZOLE 10 MG SRCAPSULE Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

OMEP20C OMEPRAZOLE 20 MG SRCAPSULE Medication

OMEP40C OMEPRAZOLE 40 MG SRCAPSULE Medication

ONDA4SOL5 ONDANSETRON 4 MG/5 ML ORAL SYRINGE Medication

ONDANS1MG ONDANSETRON 2 MG/ML 20ML MDVIAL Medication

ONDANS1MG ONDANSETRON 2 MG/ML 20ML MDVIAL Medication as an Additive

ONDANS2ML ONDANSETRON 4 MG/2 ML VIAL Medication

ONDANS2ML ONDANSETRON 4 MG/2 ML VIAL Medication as an Additive

ONDANS4OD ONDANSETRON 4 MG ORALLY DISINTEGRATING TABLET Medication

ONDANS8OD ONDANSETRON 8 MG ORALLY DISINTEGRATING TABLET Medication

ONQPRE550 ROPIVACAINE 0.2% ON-Q 400 ML PUMP - 550 ML PREFILLED SINGLE LUMEN Medication

ONQPRE750 ROPIVACAINE 0.2% ON-Q 600 ML PUMP - 750 ML PREFILLED DOUBLE LUMEN Medication

ONQPRE750S ROPIVACAINE 0.2% ON-Q 600 ML PUMP - 750 ML PREFILLED SINGLE LUMEN Medication

OPIUMPERML OPIUM TINCTURE 10 MG/ML ORAL LIQUID (DISPENSE PER ML) Medication

OPIUMTINCT OPIUM TINCTURE 10 MG/ML 120 ML BOT Medication

ORABLEND ORA-BLEND SF 473 ML BOTTLE Medication

ORABLEND ORA-BLEND SF 473 ML BOTTLE Medication as a Compound

ORAPLUS ORA-PLUS 30 ML BOT Medication

ORASWEET ORA-SWEET 473 ML BOTTLE Medication

ORIT400 ORITAVANCIN 400 MG/40 ML VIAL Medication

ORIT400 ORITAVANCIN 400 MG/40 ML VIAL Medication as an Additive

ORPHENA100 ORPHENADRINE CITRATE 100 MG SRTABLET Medication

ORPHENA60A ORPHENADRINE CITRATE 60 MG/2 ML AMP Medication

OSCAL250 CALCIUM CARBONATE 625 MG (CA 250MG) + VIT D 125 UNIT TABLET Medication

OSCAL500 CALCIUM CARBONATE 1250 MG TAB (CA 500MG ELEMENTAL) Medication

OSCAL500+D CALCIUM CARBONATE 1250 MG (CA 500MG) + VIT D 200 UNIT TAB Medication

OSEL30CA OSELTAMIVIR PHOSPHATE 30 MG CAP Medication

OSEL45CA OSELTAMIVIR PHOSPHATE 45 MG CAPSULE Medication

OSEL6PDR OSELTAMIVIR PHOSPHATE 6 MG/ML 60 ML BOT Medication

OSELT75 OSELTAMIVIR PHOSPHATE 75 MG CAP Medication

OXACIL1INJ OXACILLIN SOD 1000 MG VIAL Medication

OXACIL1INJ OXACILLIN SOD 1000 MG VIAL Medication as an Additive

OXACIL2INJ OXACILLIN SOD 2000 MG VIAL Medication

OXACIL2INJ OXACILLIN SOD 2000 MG VIAL Medication as an Additive

OXAL100 OXALIPLATIN 100 MG/20 ML VIAL Medication

OXAND2.5 OXANDROLONE 2.5 MG TAB Medication

OXAPRO600 OXAPROZIN 600 MG TAB Medication

OXAZEP10C OXAZEPAM 10 MG CAP Medication

OXAZEP15C OXAZEPAM 15 MG CAP Medication

OXCARB150 OXcarbazepine 150 MG TAB Medication

OXCARB300 OXcarbazepine 300 MG TAB Medication

OXCARBSUSP OXcarbazepine SUSP 300 MG/5 ML ORAL SYRINGE Medication

OXY30LR OXYTOCIN 30,000 MILLIUNIT/500 ML LR COMPOUNDED Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

OXY5XL OXYBUTYNIN XL 5 MG ER TAB Medication

OXYBUTYL OXYBUTYNIN CHLORIDE 5 MG/5 ML BOT Medication

OXYBUTYNIN OXYBUTYNIN CHLORIDE 5 MG TAB Medication

OXYC15TE2 oxyCODONE CR 15 MG TAB Medication

OXYCOD30 oxyCODONE IR 30 MG TAB Medication

OXYCOD5 oxyCODONE IR 5 MG TAB Medication

OXYCODLIQ oxyCODONE IR 5 MG/5 ML CUP Medication

OXYCON10SR oxyCODONE CR 10 MG TAB Medication

OXYCON20SR oxyCODONE CR 20 MG TAB Medication

OXYCON40SR oxyCODONE CR 40 MG TAB Medication

OXYF oxyCODONE 20 MG/ML 30 ML BOTTLE Medication

OXYMETAZ30 OXYMETAZOLINE HCL 0.05% NASAL SPRAY 30 ML Medication

OXYMOR10ER oxyMORphone ER 10 MG TAB Medication

OXYMOR5IR oxyMORphone 5 MG TAB Medication

OXYTO10V OXYTOCIN 10 U/ML 10 ML VIAL Medication

OXYTO10V OXYTOCIN 10 U/ML 10 ML VIAL Medication as an Additive

OXYTO30PRE OXYTOCIN 30,000 MILLIUNIT/500 ML LR 500 ML PREMIX BAG Medication

OXYTOCIAMP OXYTOCIN 10 UNIT/ML VIAL Medication

OXYTOCIAMP OXYTOCIN 10 UNIT/ML VIAL Medication as an Additive

PACLIT100V PACLitaxel PROTEIN-BOUND 100 MG/50 ML VIAL Medication

PACLIT100V PACLitaxel PROTEIN-BOUND 100 MG/50 ML VIAL Medication as an Additive

PACLIT30 PACLitaxel 30 MG/5 ML VIAL Medication

PACLIT30 PACLitaxel 30 MG/5 ML VIAL Medication as an Additive

PALIP1.5T PALIPERIDONE 1.5 MG ER TAB Medication

PALIP117 PALIPERIDONE PALMITATE 117 MG/0.75 ML INJ Medication

PALIP156 PALIPERIDONE PALMITATE 156 MG/1 ML INJ Medication

PALIP234 PALIPERIDONE PALMITATE 234 MG/1.5 ML INJ Medication

PALIP3T PALIPERIDONE 3 MG ER TABLET Medication

PALIV50V PALIVIZUMAB 50 MG/0.5 ML VIAL Medication

PALIV50V PALIVIZUMAB 50 MG/0.5 ML VIAL Medication as an Additive

PALON0.075 PALONOSETRON HCL 0.075 MG/1.5 ML SYRINGE Medication

PALON0.25V PALONOSETRON HCL 0.25 MG/5 ML VIAL Medication

PALON0.25V PALONOSETRON HCL 0.25 MG/5 ML VIAL Medication as an Additive

PAMIDR30V PAMIDRONATE DISODIUM 30 MG/10 ML VIAL Medication

PANCURONIU PANCURONIUM BROMIDE 1 MG/1 ML 10ML VIAL Medication

PANI400V PANITUMUMAB 400 MG/20 ML INJ Medication

PANI400V PANITUMUMAB 400 MG/20 ML INJ Medication as an Additive

PANT20T PANTOPRAZOLE SODIUM 20 MG DR TABLET Medication

PANT40IV PANTOPRAZOLE SODIUM 40 MG/10 ML INJ Medication

PANT40IV PANTOPRAZOLE SODIUM 40 MG/10 ML INJ Medication as an Additive

PANT40T PANTOPRAZOLE SODIUM 40 MG DR TABLET Medication

PAPAVERAMP PAPAVERINE HCL 60 MG/2 ML VIAL Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

PAPAVERAMP PAPAVERINE HCL 60 MG/2 ML VIAL Medication as an Additive

PAR25/100 PARCOPA (CARBIDOPA/LEVODOPA) 25/100 MG ODT Medication

PARIC1C PARICALCITOL 1 MCG CAPSULE Medication

PAROXE10T PARoxetine 10 MG TAB Medication

PAROXE20T PARoxetine 20 MG TAB Medication

PAROXSUSP PARoxetine 10 MG/5 ML CUP Medication

PATIRO84 PATIROMER 8.4 GM ORAL SUSP PACKET Medication

PCC500U PCC (KCENTRA, FACTOR II,VII,IX,X,C,S) ~500 UNIT VIAL (CHARGE PER UNIT) Medication

PCC500U PCC (KCENTRA, FACTOR II,VII,IX,X,C,S) ~500 UNIT VIAL (CHARGE PER UNIT) Medication as an Additive

PCN500T PENICILLIN V POTASSIUM 500 MG TAB Medication

PCNBULK125 PENICILLIN VK 125 MG/5 ML SUSP 100 ML *BULK* Medication

PCNBULK250 PENICILLIN VK 250 MG/5 ML SUSP 100 ML *BULK* Medication

PEGASP5 PEGASPARGASE 3,750 UNIT/5 ML VIAL Medication

PEGASP5 PEGASPARGASE 3,750 UNIT/5 ML VIAL Medication as an Additive

PEMBRO25V PEMBROLIZUMAB 100 MG/4 ML VIAL Medication

PEMBRO25V PEMBROLIZUMAB 100 MG/4 ML VIAL Medication as an Additive

PEMET500V PEMETREXED 500 MG/20 ML VIAL Medication

PEMET500V PEMETREXED 500 MG/20 ML VIAL Medication as an Additive

PENICILGK5 PENICILLIN G POTASSIUM 5,000,000 UNIT VIAL Medication

PENICILGK5 PENICILLIN G POTASSIUM 5,000,000 UNIT VIAL Medication as an Additive

PENICILLAM PENICILLAMINE 250 MG CAP Medication

PENT20IV PENTobarbital SODIUM 50 MG/ML 20 ML AMP Medication

PENT20IV PENTobarbital SODIUM 50 MG/ML 20 ML AMP Medication as an Additive

PENTAMIINH PENTAMIDINE ISETHIONATE NEB 300 MG VIAL Medication

PENTAMIIV PENTAMIDINE ISETHIONATE IV 300 MG VIAL Medication

PENTAMIIV PENTAMIDINE ISETHIONATE IV 300 MG VIAL Medication as an Additive

PENTOS100 PENTOSAN POLYSULFATE SOD 100 MG CAP Medication

PENTOX400T PENTOXIFYLLINE ER 400 MG TAB Medication

PERAMP2T PERAMPANEL 2 MG TAB Medication

PERC0C10 oxyCODONE/APAP 10/325 MG TAB (PERCOCET) Medication

PERCOC7.5 oxyCODONE/APAP 7.5/325 MG TAB (PERCOCET) Medication

PERCOCET oxyCODONE/APAP 5/325 MG TAB (PERCOCET) Medication

PERM5CR PERMETHRIN 5% CREAM 60 GM Medication

PERMETCR PERMETHRIN CREAM RINSE 1% 59 ML BOTTLE Medication

PERPHEN4T PERPHENAZINE 4 MG TAB Medication

PETR30OINT PETROLATUM,WHITE USP 30 GM TUBE Medication

PETR30OINT PETROLATUM,WHITE USP 30 GM TUBE Medication as a Compound

PETR52.5 PETROLATUM 49 GM JAR Medication

PETR5OINT PETROLATUM, WHITE 5 GM PACKET Medication

PETR5OINT PETROLATUM, WHITE 5 GM PACKET Medication as a Compound

PETR71OINT PETROLATUM, WHITE USP 71 GM TUBE Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

PETR71OINT PETROLATUM, WHITE USP 71 GM TUBE Medication as a Compound

PHEN10TA30 PHENYLEPHRINE 10 MG TAB Medication

PHENAZOPY1 PHENAZOPYRIDINE HCL 100 MG TAB Medication

PHENAZOPY2 PHENAZOPYRIDINE HCL 200 MG TAB Medication

PHENOB100T PHENobarbital 100 MG TAB Medication

PHENOB130V PHENobarbital SODIUM 130 MG INJ Medication

PHENOB130V PHENobarbital SODIUM 130 MG INJ Medication as an Additive

PHENOB15T PHENobarbital 15 MG TAB Medication

PHENOB20L PHENobarbital 20 MG/5 ML ORAL CUP Medication

PHENOB30T PHENobarbital 32.4 MG TAB Medication

PHENOB65V PHENobarbital 65 MG/ML VIAL Medication

PHENOB65V PHENobarbital 65 MG/ML VIAL Medication as an Additive

PHENORSY PHENYLEPHRINE 10 MG/50 ML SYRINGE Medication

PHENTOL5V PHENTOLAMINE 5 MG VIAL 5 MG VIAL Medication

PHENTOL5V PHENTOLAMINE 5 MG VIAL 5 MG VIAL Medication as an Additive

PHENYL10IV PHENYLEPHRINE 10 MG/ML 1ML AMP Medication

PHENYL10IV PHENYLEPHRINE 10 MG/ML 1ML AMP Medication as an Additive

PHENYL10OP PHENYLEPHRINE 10% OPHTH SOL 5 ML Medication

PHENYL1NSO PHENYLEPHRINE 1% NASAL DROPS 30 ML Medication

PHENYL1NSP PHENYLEPHRINE 1% NASAL SPRAY 15 ML Medication

PHENYL2NSP PHENYLEPHRINE 1/2% NASAL SPRAY 15 ML Medication

PHENYL4NSP PHENYLEPHRINE 1/4% NASAL SPRAY 15 ML BOT Medication

PHENYL8NSO PHENYLEPHRINE 1/8% NASAL DROPS 15 ML Medication

PHENYORSYR PHENYLEPHRINE 100 MCG/ML 10 ML SYRINGE Medication

PHENYT100C PHENYTOIN ER 100 MG CAP Medication

PHENYT125L PHENYTOIN SODIUM 100 MG/4 ML CUP Medication

PHENYT50T PHENYTOIN SODIUM 50 MG CHEW Medication

PHOSPHOR K-PHOS NEUTRAL PHOSPHOROUS TAB 250 MG Medication

PHYSOST2IV PHYSOSTIGMINE SALICYLATE 2 MG/2 ML AMP Medication

PHYTON10IM PHYTONADIONE 10 MG/1 ML AMP Medication

PHYTON10IM PHYTONADIONE 10 MG/1 ML AMP Medication as an Additive

PHYTON1IM PHYTONADIONE NEONATAL 1 MG/0.5 ML AMP Medication

PILOCAR1OP PILOCARPINE 1% OPTHALMIC SOLUTION 15 ML Medication

PILOCAR2OP PILOCARPINE 2% OPHTHALMIC SOLUTION 15 ML Medication

PILOCAR4OP PILOCARPINE 4% OPTHALMIC SOLUTION 15 ML Medication

PILOCAR5 PILOCARPINE 5 MG TAB Medication

PINDOL10T PINDOLOL 10 MG TAB Medication

PINDOL5T PINDOLOL 5 MG TAB Medication

PIOGL15 PIOGLITAZONE 15 MG TAB Medication

PIOGL30 PIOGLITAZONE 30 MG TAB Medication

PIROXI10C PIROXICAM 10 MG CAP Medication

PLASLYTEA1 PLASMALYTE A 1000 ML BAG Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

PLASLYTEA5 PLASMALYTE A 500 ML BAG Medication

PNEUMOVAX PNEUMOCOCCAL 23 VACCINE 0.5 ML SYRINGE Medication

POLYSPOINT POLYSPORIN OINTMENT 30 GM TUBE Medication

POLYSPOPOI BACITRACIN ZINC/POLYMYXIN B OPTHALMIC OINTMENT 3.5 GM TUBE Medication

POTACE20ME POTASSIUM ACETATE 40 MEQ/20 ML VIAL Medication

POTACE20ME POTASSIUM ACETATE 40 MEQ/20 ML VIAL Medication as an Additive

POTCITRAT5 POTASSIUM CITRATE 5 MEQ ER TAB (540MG) Medication

POTGLU550T POTASSIUM GLUCONATE 550 MG TAB (K ELEMENTAL 90MG) Medication

POTIODLIQ POTASSIUM IODIDE 1 GM/ML 30 ML ORAL DROPS (SSKI) Medication

POTPHOS10 POTASSIUM PHOSPHATE 4.4 MEQ/ML 15 ML VIAL Medication

POTPHOS10 POTASSIUM PHOSPHATE 4.4 MEQ/ML 15 ML VIAL Medication as an Additive

POTPHOSMM POTASSIUM PHOSPHATE 3 MMOL/ML 15 ML VIAL Medication

POTPHOSMM POTASSIUM PHOSPHATE 3 MMOL/ML 15 ML VIAL Medication as an Additive

POVIDO30OI POVIDONE IODINE 10% OINTMENT 30 GM TUBE Medication

POVIDO4SOL POVIDONE IODINE 10% SOLUTION 120 ML Medication

POVIDO4SOL POVIDONE IODINE 10% SOLUTION 120 ML Medication as an Additive

POVIDOSTIK POVIDONE IODINE SWAB STICKS (3/PKG) Medication

PPN PPN PERIPHERAL LINE FORMULA WITH LIPIDS 24 HR BAG Medication

PRA1 PRAMIPEXOLE 1 MG TAB Medication

PRALIDOX1G PRALIDOXIME CHLORIDE 1 GM/20 ML VIAL Medication

PRALIDOX1G PRALIDOXIME CHLORIDE 1 GM/20 ML VIAL Medication as an Additive

PRAM1000 PRAMLINTIDE 60 PEN 1,000 MCG/ML 1.5 ML PEN Medication

PRAM125T PRAMIPEXOLE 0.125 MG TAB Medication

PRAM15T PRAMIPEXOLE 1.5 MG TAB Medication

PRAM25T PRAMIPEXOLE 0.25 MG TAB Medication

PRAM375ER PRAMIPEXOLE 0.375 MG ER TAB Medication

PRASU10T PRASUGREL 10 MG TAB Medication

PRAVAS10 PRAVASTATIN 10 MG TAB Medication

PRAVAS20 PRAVASTATIN 20 MG TAB Medication

PRAVAS40 PRAVASTATIN 40 MG TAB Medication

PRAVAS80 PRAVASTATIN 80 MG TAB Medication

PRAX2.5V PRAXBIND (idaruCIZUMAB) 2.5 GM/50 ML VIAL Medication

PRAX2.5V PRAXBIND (idaruCIZUMAB) 2.5 GM/50 ML VIAL Medication as an Additive

PRAZOS1C PRAZOSIN 1 MG CAP Medication

PRAZOS5C PRAZOSIN 5 MG CAP Medication

PRED10T predniSONE 10 MG TAB Medication

PRED1OPSOL prednisoLONE 1% OPHTH SOLN 10 ML BOT Medication

PRED1T predniSONE 1 MG TAB Medication

PRED20T predniSONE 20 MG TAB Medication

PRED50T predniSONE 50 MG TAB Medication

PRED5L predniSONE 5 MG/5 ML LIQUID CUP Medication

PRED5T predniSONE 5 MG TAB Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

PREDFORTE prednisoLONE ACETATE 1% 5 ML OPHTH SUSP Medication

PREDMILD prednisoLONE ACETATE 0.12% 5 ML OPHTH SOL Medication

PREDNISOL5 prednisoLONE 5 MG TAB Medication

PREDNN prednisoLONE 15 MG/5 ML CUP Medication

PREGAB100 PREGABALIN 100 MG CAP Medication

PREGAB25 PREGABALIN 25 MG CAP Medication

PREGAB50 PREGABALIN 50 MG CAP Medication

PREGAB75 PREGABALIN 75 MG CAP Medication

PREMPRO PREMPRO 0.625 MG-2.5 MG TAB Medication

PREMPRO1.5 PREMPRO 0.3 MG-1.5 MG TAB Medication

PREMPRO45 PREMPRO 0.45 MG-1.5 MG TAB Medication

PRENATVITT PRENATAL VITAMINS (60 MG FE) TAB Medication

PREPHOINT PREPARATION H 60 GM TUBE Medication

PREPHSUPP PREPARATION H SUPP Medication

PRIMAQU263 PRIMAQUINE PHOS 26.3 MG TAB Medication

PRIMID250T PRIMIDONE 250 MG TAB Medication

PRIMID50T PRIMIDONE 50 MG TAB Medication

PROBEN500T PROBENECID 500 MG TAB Medication

PROC500V PROCAINAMIDE 1,000 MG/2 ML VIAL Medication

PROC500V PROCAINAMIDE 1,000 MG/2 ML VIAL Medication as an Additive

PROCAIN1IV PROCAINAMIDE 1,000 MG/10 ML VIAL Medication

PROCHL10T PROCHLORPERAZINE 10 MG TAB Medication

PROCHL10V PROCHLORPERAZINE 10 MG/2 ML VIAL Medication

PROCHL10V PROCHLORPERAZINE 10 MG/2 ML VIAL Medication as an Additive

PROCHL25S PROCHLORPERAZINE 25 MG SUPP Medication

PROCHL5T PROCHLORPERAZINE 5 MG TAB Medication

PROCTOFOAM PRAMOXINE 1% FOAM 15 GM Medication

PROCTOFOHC PROCTOFOAM HC 10 GM CAN Medication

PROG100 PROGESTERONE 100 MG CAP Medication

PROGESOIL5 PROGESTERONE IN OIL 50 MG/ML 10 ML VIAL Medication

PROMETH12S PROMETHAZINE 12.5 MG SUPP Medication

PROMETH25P PROMETHAZINE IV 25 MG/50 ML KIT Medication

PROMETH25P PROMETHAZINE IV 25 MG/50 ML KIT Medication as an Additive

PROMETH25S PROMETHAZINE 25 MG SUPP Medication

PROMETH25T PROMETHAZINE 25 MG TAB Medication

PROMETH25V PROMETHAZINE 25 MG/1 ML AMP Medication

PROMETH25V PROMETHAZINE 25 MG/1 ML AMP Medication as an Additive

PROMETH50S PROMETHAZINE 50 MG SUPP Medication

PROMETHLIQ PROMETHAZINE 6.25 MG/5 ML CUP Medication

PROMETHVCC PROMETHAZINE VC/CODEINE 5 ML CUP Medication

PROP325C PROPAFENONE 325 MG SR CAP Medication

PROP425C PROPAFENONE 425 MG SR CAP Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

PROPA225SR PROPAFENONE 225 MG SR CAP Medication

PROPAFE225 PROPAFENONE 225 MG TAB Medication

PROPAFEN15 PROPAFENONE 150 MG TAB Medication

PROPARAOPH PROPARACAINE HCL 0.5% OPHTH SOL 15 ML Medication

PROPO100ML PROPOFOL 10,000 MCG/ML-100ML Medication

PROPO200MG PROPOFOL 10 MG/ML 20 ML VIAL (DIPRIVAN) Medication

PROPO50ML PROPOFOL 10 MG/ML 50 ML VIAL (DIPRIVAN) Medication

PROPRAN10T PROPRANOLOL 10 MG TAB Medication

PROPRAN120 PROPRANOLOL-LA 120 MG CAP Medication

PROPRAN160 PROPRANOLOL-LA 160 MG CAP Medication

PROPRAN1I PROPRANOLOL 1 MG/ML AMP Medication

PROPRAN1I PROPRANOLOL 1 MG/ML AMP Medication as an Additive

PROPRAN20L PROPRANOLOL 4 MG/ML NEONATAL ORAL SYRINGE Medication

PROPRAN20T PROPRANOLOL 20 MG TAB Medication

PROPRAN40T PROPRANOLOL 40 MG TAB Medication

PROPRAN60C PROPRANOLOL-LA 60 MG CAP Medication

PROPRAN80C PROPRANOLOL-LA 80 MG CAP Medication

PROPRAN80T PROPRANOLOL 80 MG TAB Medication

PROPRANL PROPRANOLOL 40 MG/5 ML CUP Medication

PROPYLTH50 PROPYLTHIOURICIL 50 MG TAB Medication

PROTAM250I PROTAMINE SULFATE 250 MG/25 ML SDV Medication

PROTAM50I PROTAMINE SULFATE 50 MG/5 ML SDV VIAL Medication

PROTRIP5T PROTRIPTYLINE 5 MG TAB Medication

PSEUDO120C PSEUDOEPHEDRINE 120 MG ER TAB Medication

PSEUDO30T PSEUDOEPHEDRINE 30 MG TAB Medication

PSEUDO60L PSEUDOEPHEDRINE LIQUID 60 MG/10 ML CUP Medication

PSEUDO60L PSEUDOEPHEDRINE LIQUID 60 MG/10 ML CUP Medication as a Compound

PSYLLIPKT PSYLLIUM PACKET Medication

PUMPREFILL PUMP REFILL *SPECIAL ORDER* Medication

PYRAZI500 PYRAZINAMIDE 500 MG TAB Medication

PYRIDOST10 PYRIDOSTIGMINE 10 MG/2 ML AMP Medication

PYRIDOST10 PYRIDOSTIGMINE 10 MG/2 ML AMP Medication as an Additive

PYRIDOST60 PYRIDOSTIGMINE 60 MG TAB Medication

PYRIDOX100 PYRIDOXINE 100 MG/ML VIAL Medication

PYRIDOX100 PYRIDOXINE 100 MG/ML VIAL Medication as an Additive

PYRIDOX1T PYRIDOXINE 100 MG TAB Medication

PYRIDOX50T PYRIDOXINE 50 MG TAB Medication

QUE100T QUEtiapine FUMARATE 100 MG TAB Medication

QUE200XRT QUEtiapine FUMARATE 200 MG XR TABLET Medication

QUE25T QUEtiapine FUMARATE 25 MG TAB Medication

QUE300T QUEtiapine FUMARATE 300 MG TAB Medication

QUE300XRT QUEtiapine FUMARATE 300 MG XR TABLET Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

QUE400T QUEtiapine FUMARATE 400MG TAB Medication

QUE50XRT QUEtiapine FUMARATE 50 MG XR TABLET Medication

QUINAP20 QUINAPRIL 20 MG TAB Medication

QUINAP40 QUINAPRIL 40 MG TAB Medication

QUINAP5 QUINAPRIL 5 MG TAB Medication

QUININE32C quiNINE SO4 324 MG CAP Medication

RABIESEMB RABIES VACCINE CHICK EMBRYO CELL 2.5 UNIT/1 ML VIAL Medication

RABIESIG10 RABIES IMMUNE GLOBULIN 1500 UNIT/10 ML VIAL Medication

RABIESIG2 RABIES IMMUNE GLOBULIN 300 UNIT/2 ML VIAL Medication

RABIESV RABIES VACCINE HUMAN DIPLOID 2.5 UNITS/1 ML VIAL Medication

RACEPI0.5 RACEMIC EPINEPHRINE 2.25% 0.5 ML NEBSOL Medication

RAL60 RALOXIFENE 60 MG TAB Medication

RALT400T RALTEGRAVIR POTASSIUM 400 MG TABLET Medication

RAMEL8 RAMELTEON 8 MG TAB Medication

RAMIPR125 RAMIPRIL 1.25 MG CAP Medication

RAMIPRI5 RAMIPRIL 5 MG CAP Medication

RANITI150L raNITIdine 150 MG/10 ML CUP Medication

RANOL500T RANOLAZINE 500 MG ER TAB Medication

RASA1TAB RASAGILINE MESYLATE 1 MG TAB Medication

RASB1.5V RASBURICASE 1.5 MG/ML VIAL Medication

RASB1.5V RASBURICASE 1.5 MG/ML VIAL Medication as an Additive

RASB7.5V RASBURICASE 7.5 MG/5 ML VIAL Medication

RASB7.5V RASBURICASE 7.5 MG/5 ML VIAL Medication as an Additive

REFRESHP REFRESH PLUS 0.5% (SENSITIVE/PF) 0.4 ML UD Medication

REGA0.4D REGADENOSON 0.4 MG/5 ML INJECTION Medication

REMIFENT REMIFENTANIL 1 MG VIAL Medication

REMIFENT REMIFENTANIL 1 MG VIAL Medication as an Additive

REMIFENT2 REMIFENTANIL 2 MG VIAL Medication

REMIFENT2 REMIFENTANIL 2 MG VIAL Medication as an Additive

REP5 REPAGLINIDE 0.5 MG TAB Medication

RHODIMM300 RHO(D) IMMUNE GLOBULIN 300 MCG (1500 UNIT) 2 ML SYRINGE Medication

RIFA550T rifAXIMin 550 MG TAB Medication

RIFAMP150C rifAMPin 150 MG CAP Medication

RIFAMP300C rifAMPin 300 MG CAP Medication

RIFAMP600V rifAMPin 600 MG VIAL Medication

RIFAMP600V rifAMPin 600 MG VIAL Medication as an Additive

RIFAX200T rifAXIMin 200 MG TAB Medication

RIS0.25 RisperiDONE 0.25 MG TAB Medication

RIS35T RISEDRONATE SODIUM 35 MG TAB Medication

RISE3OT RISEDRONATE SODIUM 30 MG TAB Medication

RISPER1ODT RisperiDONE M-TAB 1 MG ODT Medication

RISPER1S RisperiDONE ORAL SOLUTION 1 MG/ML 30ML BULK Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

RISPER37.5 RisperiDONE 37.5 MG LONG ACTING INJECTION Medication

RISPER5ODT RisperiDONE M-TAB 0.5 MG ODT Medication

RISPERKIT RisperiDONE 25 MG LONG ACTING INJECTION Medication

RITON100T RITONAVIR 100 MG TAB Medication

RITUX100 riTUXimab 100 MG/10 ML VIAL Medication

RITUX100 riTUXimab 100 MG/10 ML VIAL Medication as an Additive

RIVA10T RIVAROXABAN 10 MG TAB Medication

RIVA15TA1 RIVAROXABAN 15 MG TAB Medication

RIVA20T RIVAROXABAN 20 MG TAB Medication

RIVAR2.5T RIVAROXABAN 2.5 MG TABLET Medication

RIVAS46P RIVASTIGMINE 4.6 MG/24 HOUR PATCH Medication

RIVAS95P RIVASTIGMINE 9.5 MG/24 HOUR PATCH Medication

RIVASC RIVASTIGMINE 1.5 MG CAP Medication

RIZAT10 RIZATRIPTAN BENZOATE-MLT 10 MG ODT Medication

RIZAT5 RIZATRIPTAN BENZOATE-MLT 5 MG ODT Medication

ROBITDM5 guaiFENesin/DEXTROMETHORPHAN 100-10 MG/5 ML CUP Medication

ROBITDMSF guaiFENesin 200 MG/DEXTROMETHORPHAN 20 MG-10 ML CUP (ALCOHOL FREE) Medication

ROBITUAC10 guaiFENesin/CODEINE 200/20 MG 10 ML CUP (ROBITUSSIN AC SUGAR FREE) Medication

ROBITUAC5 guaiFENesin 100 MG/CODEINE 10 MG-5 ML CUP(ROBITUSSIN AC SUGAR FREE) Medication

ROCUR10ML ROCURONIUM 10 MG/ML 10ML VIAL Medication

ROCUR10ML ROCURONIUM 10 MG/ML 10ML VIAL Medication as an Additive

ROCUR5ML ROCURONIUM 10 MG/ML 5ML VIAL Medication

ROFL500T ROFLUMILAST 500 MCG TAB Medication

ROMIP250 ROMIPLOSTIM 250 MCG VIAL Medication

ROP1 rOPINIRole 1 MG TAB Medication

ROP2 rOPINIRole 2 MG TAB Medication

ROP25 rOPINIRole 0.25 MG TAB Medication

ROP5T rOPINIRole 5 MG TAB Medication

ROPI2TAB rOPINIRole 2 MG ER TAB Medication

ROPI4TAB rOPINIRole 4 MG ER TAB Medication

ROPIV2SDV ROPIVACAINE HCL 0.2% (2 MG/ML) SDV 200 ML Medication

ROPIV2SDV ROPIVACAINE HCL 0.2% (2 MG/ML) SDV 200 ML Medication as a Carrier

ROPIV2SDV ROPIVACAINE HCL 0.2% (2 MG/ML) SDV 200 ML Medication as an Additive

ROPIV2SDV1 ROPIVACAINE HCL 0.2% (2MG/ML) SDV 100 ML Medication

ROPIV2SDV1 ROPIVACAINE HCL 0.2% (2MG/ML) SDV 100 ML Medication as a Carrier

ROPIV2SDV1 ROPIVACAINE HCL 0.2% (2MG/ML) SDV 100 ML Medication as an Additive

ROPIV5S20 ROPIVACAINE 0.5% (5 MG/ML) 20 ML SDV Medication

ROPIV5S20 ROPIVACAINE 0.5% (5 MG/ML) 20 ML SDV Medication as a Carrier

ROPIV5S20 ROPIVACAINE 0.5% (5 MG/ML) 20 ML SDV Medication as an Additive

ROPIV5SDV ROPIVACAINE HCL 0.5% (5 MG/ML) SDV 30 ML Medication

ROPIV5SDV ROPIVACAINE HCL 0.5% (5 MG/ML) SDV 30 ML Medication as a Carrier

ROPIV5SDV ROPIVACAINE HCL 0.5% (5 MG/ML) SDV 30 ML Medication as an Additive

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

ROSUVAST10 ROSUVASTATIN 10 MG TAB Medication

ROSUVAST20 ROSUVASTATIN 20 MG TAB Medication

ROSUVAST40 ROSUVASTATIN 40 MG TAB Medication

ROSUVAST5 ROSUVASTATIN 5 MG TAB Medication

ROTI1P ROTIGOTINE 1 MG/24 HR PATCH Medication

ROTI2TDM ROTIGOTINE 2 MG/24 HR PATCH Medication

ROTI6TDM2 ROTIGOTINE 6 MG/24 HR PATCH Medication

RTNACL4 SODIUM CHLORIDE 3% INHALATION SOL 4 ML Medication

RTNACL7% SODIUM CHLORIDE 7% INHALATION SOL 4 ML Medication

RUFI200T RUFINAMIDE 200 MG TABLET Medication

SACUB2426T SACUBITRIL/VALSARTAN 24-26 MG TAB Medication

SACUB4951T SACUBITRIL/VALSARTAN 49-51 MG TAB Medication

SACUB97/10 SACUBITRIL/VALSARTAN 97-103 MG TAB Medication

SALIVAGEL BIOTENE DRY MOUTH ORALBALANCE GEL 42 GM TUBE Medication

SALSAL500T SALSALATE 500 MG TAB Medication

SALSAL750T SALSALATE 750 MG TAB Medication

SARNALOT SARNA LOTION (CAMPHOR 0.5%/MENTHOL 0.5%) 222 ML BOTTLE Medication

SCOPPATCH SCOPOLAMINE 1.5 MG PATCH (3 DAY) Medication

SECR16VI SECRETIN ACETATE HUMAN 16 MCG/8 ML VIAL Medication

SELEG5T SELEGILINE 5 MG CAP Medication

SELEG6P SELEGILINE HCL 6 MG/24 HR PATCH Medication

SELEN25SHA SELENIUM SULFIDE 2.5% LOTION/SHAMPOO 120 ML BOTTLE Medication

SENNA10ML SENNA LIQUID 17.6 MG/10 ML CUP Medication

SENNATAB SENNA TABLET (CONTAINS 8.6 MG SENNOSIDES) Medication

SENOKOTSTB SENNOSIDES 8.6/DOCUSATE 50MG TAB Medication

SEPTRA5INJ COTRIMOXAZOLE (SMX 800MG/TMP 160MG) 10 ML VIAL Medication

SEPTRA5INJ COTRIMOXAZOLE (SMX 800MG/TMP 160MG) 10 ML VIAL Medication as an Additive

SEPTRADSTB COTRIMOXAZOLE DOUBLE STRENGTH (SMX 800MG/TMP 160MG) 1 DS TAB Medication

SEPTRASUSP COTRIMOXAZOLE SUSP (SMX 800MG/TMP 160MG) 20 ML CUP Medication

SEPTRATAB COTRIMOXAZOLE SINGLE STRENTH (SMX 400MG/TMP 80MG) 1 SS TAB Medication

SERTRA100T SERTRALINE 100 MG TAB Medication

SERTRA25T SERTRALINE 25 MG TAB Medication

SERTRA50T SERTRALINE 50 MG TAB Medication

SEVEL0.8P SEVELAMER CARBONATE 0.8 GM PACKET Medication

SEVEL2.4P SEVELAMER CARBONATE 2.4 GM PACKET Medication

SEVEL800 SEVELAMER CARBONATE 800 MG TAB Medication

SILD10S SILDENAFIL CITRATE 10 MG/12.5 ML INJ Medication

SILD20 SILDENAFIL CITRATE 20 MG TAB Medication

SILNITSTIK SILVER NITRATE 5 STICK BAG Medication

SILSULF400 SILVER sulfADIAZINE CREAM 400 GM JAR Medication

SILSULF50 SILVER sulfADIAZINE CREAM 50 GM JAR Medication

SILVNITSOL SILVER NITRATE 0.5% 960 ML SOL Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

SILVNITSOL SILVER NITRATE 0.5% 960 ML SOL Medication as an Additive

SIMETH80T SIMETHICONE 80 MG CHEWABLE TAB Medication

SIMETHDROP SIMETHICONE 20 MG/0.3 ML DROPS 30 ML Medication

SIMVAS10 SIMVASTATIN 10 MG TAB Medication

SIMVAS20 SIMVASTATIN 20 MG TAB Medication

SIMVAS40 SIMVASTATIN 40 MG TAB Medication

SIMVAS5 SIMVASTATIN 5 MG TAB Medication

SIN25100CR SINEMET-CR (CARBIDOPA/LEVODOPA) 25/100 MG CR TAB Medication

SINC5VIA SINCALIDE 5 MCG POWDER VIAL Medication

SINC5VIA SINCALIDE 5 MCG POWDER VIAL Medication as an Additive

SINEM10100 SINEMET (CARBIDOPA/LEVODOPA) 10/100 MG TAB Medication

SINEM25100 SINEMET (CARBIDOPA/LEVODOPA) 25/100 MG TAB Medication

SINEM25250 SINEMET (CARBIDOPA/LEVODOPA) 25/250 MG TAB Medication

SINEM50200 SINEMET-CR (CARBIDOPA/LEVODOPA) 50/200 MG CR TAB Medication

SIROL0.5T SIROLIMUS 0.5 MG TAB Medication

SLOWMAGTAB MAGNESIUM CHLORIDE 64 MG SRTABLET Medication

SNAKEANTEQ CROTALIDAE IMMUNE FAB (EQUINE) ANAVIP VIAL Medication

SNAKEANTEQ CROTALIDAE IMMUNE FAB (EQUINE) ANAVIP VIAL Medication as an Additive

SNAKEANTI CROTALIDAE IMMUNE FAB (OVINE) CROFAB 1 VIAL Medication

SNAKEANTI CROTALIDAE IMMUNE FAB (OVINE) CROFAB 1 VIAL Medication as an Additive

SODACE20VL SODIUM ACETATE 2 MEQ/ML 20 ML VIAL Medication

SODACE20VL SODIUM ACETATE 2 MEQ/ML 20 ML VIAL Medication as an Additive

SODBIC10SY SODIUM BICARBONATE 8.4% *PEDIATRIC* 10 MEQ/10 ML SYRINGE Medication

SODBIC325T SODIUM BICARBONATE 325 MG TAB Medication

SODBIC44SY SODIUM BICARBONATE 7.5% 44.6 MEQ/50 ML SYRINGE Medication

SODBIC44SY SODIUM BICARBONATE 7.5% 44.6 MEQ/50 ML SYRINGE Medication as an Additive

SODBIC50SY SODIUM BICARBONATE 8.4% 50 MEQ/50 ML SYRINGE Medication

SODBIC50SY SODIUM BICARBONATE 8.4% 50 MEQ/50 ML SYRINGE Medication as an Additive

SODBIC50VL SODIUM BICARBONATE 8.4% 50 MEQ/50 ML VIAL Medication

SODBIC50VL SODIUM BICARBONATE 8.4% 50 MEQ/50 ML VIAL Medication as a Carrier

SODBIC50VL SODIUM BICARBONATE 8.4% 50 MEQ/50 ML VIAL Medication as an Additive

SODBIC5SY SODIUM BICARBONATE 4.2% *INFANT* 5 MEQ/10 ML SYRINGE Medication

SODBIC625T SODIUM BICARBONATE 650 MG TAB Medication

SODCHL1T SODIUM CHLORIDE 1 GM TAB Medication

SODCHL234 SODIUM CHLORIDE 23.4% 120 MEQ/30 ML VIAL Medication

SODCHL234 SODIUM CHLORIDE 23.4% 120 MEQ/30 ML VIAL Medication as a Carrier

SODCHL234 SODIUM CHLORIDE 23.4% 120 MEQ/30 ML VIAL Medication as an Additive

SODCHL50IV SODIUM CHLORIDE 23.4% 400 MEQ/100 ML VIAL Medication

SODCHL50IV SODIUM CHLORIDE 23.4% 400 MEQ/100 ML VIAL Medication as a Carrier

SODCHL50IV SODIUM CHLORIDE 23.4% 400 MEQ/100 ML VIAL Medication as an Additive

SODI10VI2 SODIUM TETRADECYL 1% 2 ML VIAL Medication

SODI30VI3 SODIUM TETRADECYL 3% 2 ML VIAL Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

SODI30VI3 SODIUM TETRADECYL 3% 2 ML VIAL Medication as an Additive

SODPHOS3VL SODIUM PHOSPHATE 4 MEQ/ML 15 ML VIAL Medication

SODPHOS3VL SODIUM PHOSPHATE 4 MEQ/ML 15 ML VIAL Medication as an Additive

SODPHOSMM SODIUM PHOSPHATE 3 MMOL/ML 15 ML VIAL Medication

SODPHOSMM SODIUM PHOSPHATE 3 MMOL/ML 15 ML VIAL Medication as an Additive

SODZIRC10 SODIUM ZIRCONIUM CYCLOSILICATE 10 GM PACKET Medication

SOLIFEN5 SOLIFENACIN SUCCINATE 5 MG TAB Medication

SORBITOL30 SORBITOL SOLUTION 70% W/W 30ML BOT Medication

SOTAF80 SOTALOL AF 80 MG TAB Medication

SOTALO120 SOTALOL 120 MG TAB Medication

SOTALO80 SOTALOL 80 MG TAB Medication

SPIRON100T SPIRONOLACTONE 100 MG TAB Medication

SPIRON12T SPIRONOLACTONE 12.5 MG TAB Medication

SPIRON25T SPIRONOLACTONE 25 MG TAB Medication

SPS15 SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML CUP Medication

SPS30ENEMA SODIUM POLYSTYRENE SULFONATE 30 GM/120 ML ENEMA Medication

STALEV0150 STALEVO 150 (LEVODOPA 150MG, CARBIDOPA 37.5MG, ENTACAPONE 200MG) TAB Medication

STALEV100 STALEVO 100 (LEVODOPA 100MG, CARBIDOPA 25MG, ENTACAPONE 200MG) TAB Medication

STALEV50 STALEVO 50 (LEVODOPA 50MG, CARBIDOPA 12.5MG, ENTACAPONE 200MG) TAB Medication

STANFMW15M STANFORD MOUTH WASH 15 ML CUP Medication

STRESSTBZN STRESSTABS ADVANCED (MVI/ZINC) TAB Medication

SUBOX2/0.5 BUPRENORPHINE/NALOXONE 2/0.5 MG SL FILM Medication

SUBOX4/1FT BUPRENORPHINE/NALOXONE (SUBOXONE) 4/1 MG SL FILM Medication

SUBOX8/2SL BUPRENORPHINE/NALOXONE (SUBOXONE) 8/2 MG SL FILM Medication

SUCCI20MDV SUCCINYLCHOLINE 20 MG/ML 10 ML VIAL Medication

SUCCIM5 SUCCIMER POWDER 5 GM JAR Medication

SUCRAL1T SUCRALFATE 1 GM TAB Medication

SUFENTA1ML SUFENTANIL CITRATE 50 MCG/ML 1 ML AMP Medication

SUFENTA1ML SUFENTANIL CITRATE 50 MCG/ML 1 ML AMP Medication as an Additive

SUFENTA2ML SUFENTANIL 50 MCG/ML 2 ML AMP Medication

SUFENTA2ML SUFENTANIL 50 MCG/ML 2 ML AMP Medication as an Additive

SUFENTA5ML SUFentanil CITRATE 50 MCG/ML 5ML AMP Medication

SUFENTA5ML SUFentanil CITRATE 50 MCG/ML 5ML AMP Medication as an Additive

SUGAM200V SUGAMMADEX *MD/CRNA ORDER ENTRY* 200 MG/2 ML VIAL Medication

SUGAM500V SUGAMMADEX *MD/CRNA ORDER ENTRY* 500 MG/5 ML VIAL Medication

SULF10OPSO SULFACETAMIDE SODIUM 10% OPHTHALMIC SOL 15 ML BOTTLE Medication

SULFAD500T sulfADIAZINE 500 MG TAB Medication

SULFASAL5 SULFASALAZINE 500 MG TAB Medication

SULFASAL5E SULFASALAZINE 500 MG EC TAB Medication

SULFPRED10 SULFACETAMIDE/PREDNISOLONE 40 DROP/10 ML BOT Medication

SULINDA150 SULINDAC 150 MG TAB Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

SULINDA200 SULINDAC 200 MG TAB Medication

SUMAT25T SUMAtriptan 25 MG TAB Medication

SUMAT50T SUMAtriptan 50 MG TAB Medication

SUMATR6V SUMAtriptan 6 MG/0.5 ML VIAL Medication

SURGICEL24 OXIDIZED CELLULOSE FIBRILLAR HEMOSTAT 2"X4" PLEDG Medication

SURGICEL44 OXIDIZED CELLULOSE SNOW HEMOSTAT 4"X4" PLEDG Medication

SURGICEL48 OXIDIZED CELLULOSE HEMOSTAT 4"X8" PLEDG Medication

SURGIFOAM5 GELATIN SPONGE ABSORBABLE (SURGIFOAM 50 8CM X 6.25CM X 1CM) Medication

SYMBY6/25 OLANZapine/FLUoxetine 6/25 MG CAP Medication

T15ML APAP 360MG + CODEINE 36MG (TYLENOL+CODEINE ELIXIR)15 ML CUP Medication

T2 APAP 300MG/CODEINE 15MG (TYLENOL #2) TAB Medication

T3 APAP 300MG/CODEINE 30MG (TYLENOL#3) TAB Medication

T4 APAP 300MG/CODEINE 60MG(TYLENOL #4) TAB Medication

TACOINT TACROLIMUS 0.03% OINT 30 GM TUBE Medication

TACOINT TACROLIMUS 0.03% OINT 30 GM TUBE Medication as an Additive

TACR5V TACROLIMUS ANHYDROUS 5 MG/ML AMP Medication

TACR5V TACROLIMUS ANHYDROUS 5 MG/ML AMP Medication as an Additive

TACROL0.5 TACROLIMUS ANHYDROUS 0.5 MG CAP Medication

TACROL1C TACROLIMUS ANHYDROUS 1 MG CAP Medication

TADA20TA TADALAFIL 20 MG TAB Medication

TADALA5T TADALAFIL 5 MG TAB Medication

TAFL0.3S TAFLUPROST 0.0015 % OPH SOL UD (0.3 ML) Medication

TALC30AE TALC POWDER STERILE 4 GM INTRAPLEURAL AEROSOL Medication

TALC4 TALC POWDER STERILE 4 GM VIAL Medication

TALC4 TALC POWDER STERILE 4 GM VIAL Medication as an Additive

TALC5 TALC POWDER STERILE 5 GM VIAL Medication

TALC5 TALC POWDER STERILE 5 GM VIAL Medication as an Additive

TALWNX PENTAZOCINE/NALOXONE 50-0.5 MG TAB Medication

TAM4 TAMSULOSIN 0.4 MG CAP Medication

TAMOX10T TAMOXIFEN CITRATE 10 MG TAB Medication

TAPE50TA TAPENTADOL 50 MG TAB Medication

TAPE75TA TAPENTADOL 75 MG TAB Medication

TAZAROT TAZAROTENE 0.1% CREAM 30 GM TUBE Medication

TB TUBERCULIN PPD 5 TU/0.1 ML SKIN TEST Medication

TCN250C TETRACYCLINE 250 MG CAP Medication

TDAP ADACEL (TETANUS,DIPHTHERIA,PERTUSSIS VACCINE)11-64 YR Medication

TEDI200P TEDIZOLID PHOSPHATE 200 MG VIAL Medication

TEDI200P TEDIZOLID PHOSPHATE 200 MG VIAL Medication as an Additive

TEDI200T TEDIZOLID PHOSPHATE 200MG TAB Medication

TELA750P TELAVANCIN 750 MG VIAL Medication

TELA750P TELAVANCIN 750 MG VIAL Medication as an Additive

TEMAZE15C TEMAZEPAM 15 MG CAP Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

TEMAZE7.5C TEMAZEPAM 7.5 MG CAP Medication

TEMOZ250 TEMOZOLOMIDE 250 MG CAP Medication

TEMSI25 TEMSIROLIMUS 25 MG/ML 1 ML INJ Medication

TEMSI25 TEMSIROLIMUS 25 MG/ML 1 ML INJ Medication as an Additive

TENOFOV TENOFOVIR 300 MG TAB Medication

TERAZO1C TERAZOSIN 1 MG CAP Medication

TERAZO2C TERAZOSIN 2 MG CAP Medication

TERAZO5C TERAZOSIN 5 MG CAP Medication

TERB1CR15 TERBINAFINE 1% CREAM 12GM TUBE Medication

TERB250T TERBINAFINE 250 MG TAB Medication

TERBUT1A TERBUTALINE SULFATE 1 MG/ML 1ML AMP Medication

TERBUT1A TERBUTALINE SULFATE 1 MG/ML 1ML AMP Medication as an Additive

TERBUT25T TERBUTALINE SULFATE 2.5 MG TAB Medication

TESTCYP200 TESTOSTERONE CYPIONATE 200 MG/1 ML VIAL Medication

TESTOSGEL1 TESTOSTERONE 1% GEL 5 GM PACKET Medication

TETRAB12.5 TETRABENAZINE 12.5 MG TAB Medication

TETRAC20IN TETRACAINE 1%-10MG/ML 2ML AMP Medication

TETRACAOPS TETRACAINE 0.5% OPHTHALMIC SOLUTION 4 ML BOTTLE Medication

TETRAHOPTI TETRAHYDROZOLINE 0.05% OPTH SOL 15 ML BOT Medication

THALID50 THALIDOMIDE 50 MG CAP Medication

THEO24100C THEOPHYLLINE-SR 100 MG 24-HR CAP Medication

THEOER100 THEOPHYLLINE-ER 100 MG 12-HR TAB Medication

THEOER300 THEOPHYLLINE-ER 300 MG 12-HR TAB Medication

THEOP400P THEOPHYLLINE 400 MG/500 ML PREMIX Medication

THEOP80LIQ THEOPHYLLINE 80 MG/15 ML ELIXIR CUP Medication

THERALIQ THERAGRAN 5 ML CUP Medication

THERAMTAB THERAGRAN M TAB Medication

THERATAB THERAGRAN TAB Medication

THIAM100T THIAMINE HCL 100 MG TAB Medication

THIAM100V THIAMINE 100 MG/ML 2 ML VIAL Medication

THIAM100V THIAMINE 100 MG/ML 2 ML VIAL Medication as an Additive

THIORI25T THIORIDAZINE HCL 25 MG TAB Medication

THIOTH1C THIOTHIXENE 1 MG CAP Medication

THIOTH5C THIOTHIXENE 5 MG CAP Medication

THRO5000 THROMBIN (RECOMB) 5,000 UNIT VIAL Medication

THRO50002 THROMBIN (BOVINE) 5,000 UNIT VIAL Medication

THRO50004 THROMBIN (BOVINE) 5000 UNIT EPISTAXIS KIT Medication

THYROID15 THYROID 15 MG TAB Medication

THYROID60 THYROID 60 MG TAB Medication

TIAGAB4 tiaGABine 4 MG TAB Medication

TICA60T TICAGRELOR 60 MG TAB Medication

TICA90TA TICAGRELOR 90 MG TAB Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

TIGECY50VL TIGECYCLINE 50 MG/5 ML PWVL Medication

TIGECY50VL TIGECYCLINE 50 MG/5 ML PWVL Medication as an Additive

TIMOLO25OP TIMOLOL MALEATE 0.25% OPHTHALMIC SOLUTION 5 ML Medication

TIMOLO5OPS TIMOLOL MALEATE 0.5% OPHTH SOL 5 ML Medication

TIMOLXE5OP TIMOLOL MALEATE-XE 0.5% OPTH GEL 5 ML Medication

TISSEEL4 TISSEEL 4 ML KIT Medication

TISSEEL5 TISSEEL VH 10 ML KIT Medication

TIZ2 tizANidine 2 MG TAB Medication

TIZ4 tizANidine 4 MG TAB Medication

TNKK TENECTEPLASE 50 MG VIAL Medication

TOBRAM12V TOBRAMYCIN SULFATE 1.2 GM VIAL Medication

TOBRAM300S TOBRAMYCIN 300 MG/7.5 ML NEB SYRINGE Medication

TOBRAM80V TOBRAMYCIN SULFATE 80 MG/2 ML VIAL Medication

TOBRAM80V TOBRAMYCIN SULFATE 80 MG/2 ML VIAL Medication as an Additive

TOBRAMOPOT TOBRAMYCIN 0.3% OPTHALMIC OINTMENT 3.5 GM TUBE Medication

TOBRAMOPSO TOBRAMYCIN 0.3% OPHTHALMIC SOLUTION 5 ML Medication

TOBRDEXOPO TOBRADEX (TOBRAMYCIN 0.3%/DEXAMETHASONE 0.1%) OPHTH OINT 3.5 GM TUBE Medication

TOBRDEXOPS TOBRADEX(TOBRAMYCIN 0.3%/DEXAMETHASONE 0.1%) OPTHALMIC SUSP 5 ML Medication

TOCILI200V TOCILIZUMAB 200 MG/10 ML VIAL Medication

TOCILI200V TOCILIZUMAB 200 MG/10 ML VIAL Medication as an Additive

TOLNAF1CRM TOLNAFTATE 1% CREAM 15 GM TUBE Medication

TOLNAF1PWD TOLNAFTATE 45 GM POWDER Medication

TOLV15TA TOLVAPTAN 15 MG TABLET Medication

TOLV30TA TOLVAPTAN 30 MG TABLET Medication

TOP15 TOPIRAMATE 15 MG SPRINKLE CAP Medication

TOP25 TOPIRAMATE 25 MG TAB Medication

TOP25S TOPIRAMATE 25 MG SPRINKLE CAP Medication

TOPI100T TOPIRAMATE 100 MG TAB Medication

TOPOT4MG TOPOTECAN 4 MG/4 ML VIAL Medication

TORSEM10 TORSEMIDE 10 MG TAB Medication

TORSEM100 TORSEMIDE 100 MG TAB Medication

TPA100IV TPA 100 MG VIAL Medication

TPA100IV TPA 100 MG VIAL Medication as an Additive

TPA50V TPA 50 MG VIAL Medication

TPA50V TPA 50 MG VIAL Medication as an Additive

TPNCLI515 TPN-CLINIMIX 5/15 2000 ML BAG Medication

TPNCLI515E TPN-CLINIMIX E 5/15 1000ML BAG Medication

TPNCLI520 TPN-CLINIMIX 5/20 2000 ML BAG Medication

TPNCLI520E TPN-CLINIMIX E 5/20 1000ML BAG Medication

TPNCLIE515 TPN-CLINIMIX E 5/15 2000ML BAG Medication

TPNCLIE520 TPN-CLINIMIX E 5/20 2000ML BAG Medication

TPNCUSNOL TPN-CUSTOM-OUTSOURCED NOLIPIDS Medication

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Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

TPNCUSTOM TPN-CUSTOM-OUTSOURCED W/LIPIDS Medication

TRAMAD50T traMADol 50 MG TAB Medication

TRAMER100T traMADol ER 100 MG TAB Medication

TRAN1000P TRANEXAMIC ACID IN 0.7% NACL 1,000 MG/100 ML PIGGYBACK Medication

TRAN100A2 TRANEXAMIC ACID 1000 MG/10 ML AMP Medication

TRAN100A2 TRANEXAMIC ACID 1000 MG/10 ML AMP Medication as an Additive

TRANDOL1 TRANDOLAPRIL 1 MG TAB Medication

TRANEX650T TRANEXAMIC ACID 650 MG TAB Medication

TRAV2.5D TRAVOPROST Z 0.004% OPTH SOL 2.5 ML Medication

TRAZOD100T traZODone 100 MG TAB Medication

TRAZOD150T traZODone 150 MG TAB Medication

TRAZOD50T traZODone 50 MG TAB Medication

TREP10S TREPROSTINIL 10 MG/ML 20 ML VIAL Medication

TREP10S TREPROSTINIL 10 MG/ML 20 ML VIAL Medication as an Additive

TREP1S TREPROSTINIL 1 MG/ML 20 ML VIAL Medication

TREP1S TREPROSTINIL 1 MG/ML 20 ML VIAL Medication as an Additive

TREP2.5S TREPROSTINIL 2.5 MG/ML 20 ML VIAL Medication

TREP2.5S TREPROSTINIL 2.5 MG/ML 20 ML VIAL Medication as an Additive

TREP5S TREPROSTINIL 5 MG/ML 30 ML VIAL Medication

TREP5S TREPROSTINIL 5 MG/ML 30 ML VIAL Medication as an Additive

TRETIN25CR TRETINOIN 0.025% CREAM 20 GM TUBE Medication

TRETIN25GL TRETINOIN GEL 0.025% 15 GM TUBE Medication

TRIAM1C15 TRIAMCINOLONE ACETONIDE 0.1% CREAM 15 GM TUBE Medication

TRIAM1C1LB TRIAMCINOLONE 0.1% CREAM 454 GM JAR Medication

TRIAM1C80 TRIAMCINOLONE ACETONIDE 0.1% CREAM 80 GM TUBE Medication

TRIAM1L60 TRIAMCINOLONE ACETONIDE 0.1% LOTION 60 ML BOT Medication

TRIAM1O15 TRIAMCINOLONE ACETONIDE 0.1% OINTMENT 15 GM TUBE Medication

TRIAM1O1LB TRIAMCINOLONE ACETONIDE 0.1% OINTMENT 454 GM JAR Medication

TRIAM1O80 TRIAMCINOLONE ACETONIDE 0.1% OINTMENT 80 GM TUBE Medication

TRIAM25C1 TRIAMCINOLONE ACETONIDE 0.025% CREAM 454 GM JAR Medication

TRIAM25C15 TRIAMCINOLONE ACETONIDE 0.025% CREAM 15 GM TUBE Medication

TRIAM25C80 TRIAMCINOLONE ACETONIDE 0.025% CREAM 80 GM TUBE Medication

TRIAM25O15 TRIAMCINOLONE ACETONIDE 0.025% OINTMENT 15 GM TUBE Medication

TRIAM25O80 TRIAMCINOLONE ACETONIDE 0.025% OINTMENT 80 GM TUBE Medication

TRIAM5C15 TRIAMCINOLONE ACETONIDE 0.5% CREAM 15 GM TUBE Medication

TRIAMAC105 TRIAMCINOLONE ACETONIDE 10 MG/ML 5 ML VIAL Medication

TRIAMAC401 TRIAMCINOLONE ACETONIDE 40 MG/ML 1ML VIAL Medication

TRIAMC405 TRIAMCINOLONE ACETONIDE 40 MG/ML 5ML VIAL Medication

TRIAMORABA TRIAMCINOLONE ACETONIDE 0.1% DENTAL PASTE 5 GM TUBE Medication

TRIAMSPRAY TRIAMCINOLONE ACETONIDE SPRAY 63 GRAM Medication

TRIAMT50C TRIAMTERENE 50 MG CAP Medication

TRIAZO125 TRIAZOLAM 0.125 MG TAB Medication

Page 66 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

TRIAZO25 TRIAZOLAM 0.25 MG TAB Medication

TRIFLU2T TRIFLUOPERAZINE 2 MG TAB Medication

TRIFLU5T TRIFLUOPERAZINE 5 MG TAB Medication

TRIFLUR10P TRIFLURIDINE 1 % OPHTH SOLUTION 7.5 ML Medication

TRIHEXYPH2 TRIHEXYPHENIDYL 2 MG TAB Medication

TRIHEXYPH5 TRIHEXYPHENIDYL 5 MG TAB Medication

TRIMETHO2A TRIMETHOBENZAMIDE 200 MG/2 ML VIAL Medication

TRIMETHO3C TRIMETHOBENZAMIDE 300 MG CAP Medication

TRIMETHOPR TRIMETHOPRIM 100 MG TAB Medication

TROPICAM.5 TROPICAMIDE 0.5% OPTHALMIC SOLUTION 15 ML BOTTLE Medication

TROPICAM1 TROPICAMIDE 1% 15 ML OPTHALMIC SOLUTION Medication

TRUV2/3 TRUVADA (EMTRICITABINE/TENOFOVIR 200 MG/300 MG) TAB Medication

TUSSION5S HYDROCODONE 10MG/CHLORPHENIRAMINE 8MG-5 ML CUP (TUSSIONEX) Medication

ULTRACET traMADol/ACETAMINOPHEN 37.5/325 MG TAB Medication

UNASYN15 UNASYN (AMPICILLIN/SULBACTAM) 1.5 GM VIAL Medication

UNASYN15 UNASYN (AMPICILLIN/SULBACTAM) 1.5 GM VIAL Medication as an Additive

UNASYN3 UNASYN(AMPICILLIN/SULBACTAM) 3 GM VIAL Medication

UNASYN3 UNASYN(AMPICILLIN/SULBACTAM) 3 GM VIAL Medication as an Additive

UREA20CRM UREA 20% CREAM 85 GM Medication

URSO500T2 URSODIOL 500 MG TABLET Medication

URSODI300C URSODIOL 300 MG CAP Medication

USTEK130V USTEKINUMAB 130 MG/26 ML VIAL Medication

USTEK130V USTEKINUMAB 130 MG/26 ML VIAL Medication as an Additive

VALA500C VALACYCLOVIR 500 MG TAB Medication

VALGA VALGANCICLOVIR 450 MG TAB Medication

VALISO45C BETAMETHASONE VALERATE 0.1% CREAM 45 GM TUBE Medication

VALPRO250C VALPROIC ACID 250 MG CAP Medication

VALPRO500V VALPROATE SODIUM 500 MG/5 ML VIAL Medication

VALPRO500V VALPROATE SODIUM 500 MG/5 ML VIAL Medication as an Additive

VALPROL VALPROIC ACID 250 MG/5 ML UD LIQ Medication

VANC125S2 VANCOMYCIN 125 MG/2.5 ML ORAL SYRINGE Medication

VANC750BAG VANCOMYCIN 750 MG/250 ML PREMIX BAG Medication

VANC750FRB VANCOMYCIN 750 MG/150 ML PREMIX BAG IN NS (FROZEN) Medication

VANCO1.25P VANCOMYCIN 1.25 GM/250 ML PREMIX BAG IN NS Medication

VANCO1.5PR VANCOMYCIN 1.5 GM/500 ML PREMIX BAG IN NS Medication

VANCO1.75P VANCOMYCIN 1.75 GM/500 ML PREMIX BAG IN NS Medication

VANCO1FRB VANCOMYCIN 1 GM/200 ML PREMIX BAG IN NS (FROZEN) Medication

VANCO1GMC VANCOMYCIN HCL 1000 MG/10 ML VIAL & NS 250 ML BAG VIALMATE Medication

VANCO1GMI VANCOMYCIN 1000 MG/10 ML VIAL Medication

VANCO1GMI VANCOMYCIN 1000 MG/10 ML VIAL Medication as an Additive

VANCO2PRE VANCOMYCIN 2 GM/500 ML PREMIX BAG IN NS Medication

VANCOLOCK VANCO: LOCK THERAPY W/HEPARIN Medication

Page 67 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

VANCOLOCK VANCO: LOCK THERAPY W/HEPARIN Medication as an Additive

VAREN0.5 VARENICLINE 0.5 MG Medication

VARICELLA VARICELLA VIRUS VACCINE Medication

VASOP20INJ VASOPRESSIN 20 UNIT/1 ML AMP Medication

VASOP20INJ VASOPRESSIN 20 UNIT/1 ML AMP Medication as an Additive

VECU20VI4 VECURONIUM BROMIDE 20 MG VIAL Medication

VECUR10INJ VECURONIUM 10 MG VIAL Medication

VECUR10INJ VECURONIUM 10 MG VIAL Medication as an Additive

VEDO300 VEDOLIZUMAB 300 MG VIAL Medication

VEDO300 VEDOLIZUMAB 300 MG VIAL Medication as an Additive

VENLAF100 VENLAFAXINE 100 MG TAB Medication

VENLAF150X VENLAFAXINE XR 150 MG ER CAP Medication

VENLAF25 VENLAFAXINE 25 MG TAB Medication

VENLAF375X VENLAFAXINE XR 37.5 MG ER CAP Medication

VENLAF50 VENLAFAXINE 50 MG TAB Medication

VENLAF75X VENLAFAXINE XR 75 MG ER CAP Medication

VER120ERG VERAPAMIL ER 120 MG TAB Medication

VER180ERG VERAPAMIL ER 180 MG TAB Medication

VER240ERG VERAPAMIL ER 240 MG TAB Medication

VERA40TA5 VERAPAMIL 40 MG TAB Medication

VERA5INJ VERAPAMIL HCL 5 MG/2 ML VIAL Medication

VERAP120T VERAPAMIL 120 MG TAB Medication

VERAP80T VERAPAMIL 80 MG TAB Medication

VICOP HYDROcodone 7.5 MG/IBUPROFEN 200MG TAB (VICOPROFEN) Medication

VILA10TA VILAZODONE 10 MG TAB Medication

VILA20TA VILAZODONE 20 MG TAB Medication

VILA40TA VILAZODONE 40 MG TAB Medication

VINBLAST10 vinBLAStine SULFATE 10 MG/10 ML VIAL Medication

VINBLAST10 vinBLAStine SULFATE 10 MG/10 ML VIAL Medication as an Additive

VINCRI1INJ vinCRIStine SULFATE 1 MG/ML INJECTION Medication

VINCRI1INJ vinCRIStine SULFATE 1 MG/ML INJECTION Medication as an Additive

VINOR50 VINORELBINE 50 MG/5 ML VIAL Medication

VINOR50 VINORELBINE 50 MG/5 ML VIAL Medication as an Additive

VISCOAT5OP CHONDROITIN/HYALURONATE (VISCOAT) 0.5 ML OPHTH INJ Medication

VITA10MUC VITAMIN A 10000 UNIT LCAP Medication

VITAMINCR VITAMIN E CREAM 120 GM JAR Medication

VITB2100 RIBOFLAVIN (VIT B2) 100 MG TAB Medication

VITBCOMPLX VITAMIN B COMPLEX CAP Medication

VITC250T ASCORBIC ACID 250 MG TAB Medication

VITC500T ASCORBIC ACID (VIT C) 500 MG TAB Medication

VITC500V ASCORBIC ACID (VIT C) 500 MG/ML 50 ML VIAL Medication

VITC500V ASCORBIC ACID (VIT C) 500 MG/ML 50 ML VIAL Medication as an Additive

Page 68 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

VITCHEWFE CHEWABLE VITAMINS W/IRON Medication

VITCHEWTAB CHEWABLE VITAMINS (NO IRON) Medication

VITD1000U CHOLECALCIFEROL (VIT D3) 1000 UNIT TAB Medication

VITD2000U CHOLECALCIFEROL (VIT D3) 2000 UNIT TAB Medication

VITD400IU CHOLECALCIFEROL (VIT D3) 400 UNIT TAB Medication

VITD400L CHOLECALCIFEROL (VIT D3) 400 UNIT/ML ORAL LIQ 50ML BOT Medication

VITD5000U CHOLECALCIFEROL (VIT D3) 5000 UNIT CAP Medication

VITD50MUC ERGOCALCIFEROL (VIT D2) 50000 UNIT CAP Medication

VITE1000C VITAMIN E 1000 UNIT CAP Medication

VITE100C VITAMIN E 100 UNIT CAP Medication

VITE200C VITAMIN E 200 UNIT CAP Medication

VITE400C VITAMIN E 400 UNIT CAP Medication

VITEGTTS VITAMIN E 15 UNIT/0.3 ML-12 ML BOTTLE Medication

VOLUV500 HYDROXYETHYL STARCH 6%NS 500 ML BAG Medication

VOLUV500 HYDROXYETHYL STARCH 6%NS 500 ML BAG Medication as a Carrier

VORIC200 VORICONAZOLE 200 MG TAB Medication

VORIC200S VORICONAZOLE 200 MG/5 ML ORAL SUSP (75 ML BOTTLE) Medication

VORICON2 VORICONAZOLE 10 MG/ML 20 ML VIAL Medication

VORICON2 VORICONAZOLE 10 MG/ML 20 ML VIAL Medication as an Additive

VORT10TA1 VORTIOXETINE 10 MG TAB Medication

VWF1200 VON WILLEBRAND FACTOR ~1,200 UNIT/10 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication

VWF1200 VON WILLEBRAND FACTOR ~1,200 UNIT/10 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication as an Additive

VWF2400 VON WILLEBRAND FACTOR ~2,400 UNIT/15 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication

VWF2400 VON WILLEBRAND FACTOR ~2,400 UNIT/15 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication as an Additive

VWF600 VON WILLEBRAND FACTOR ~600 UNIT/5 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication

VWF600 VON WILLEBRAND FACTOR ~600 UNIT/5 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication as an Additive

WARFAR05T WARFARIN SODIUM 0.5 MG TAB Medication

WARFAR10T WARFARIN SODIUM 10 MG TAB Medication

WARFAR1T WARFARIN SODIUM 1 MG TAB Medication

WARFAR25T WARFARIN SODIUM 2.5 MG TAB Medication

WARFAR2T WARFARIN SODIUM 2 MG TAB Medication

WARFAR3T WARFARIN SODIUM 3 MG TAB Medication

WARFAR4T WARFARIN SODIUM 4 MG TAB Medication

WARFAR5T WARFARIN SODIUM 5 MG TAB Medication

WARFAR75T WARFARIN SODIUM 7.5 MG TAB Medication

ZAFIR20T ZAFIRLUKAST 20 MG TAB Medication

ZIAC10 BISOPROLOL/HCTZ 10/6.25 MG TAB Medication

ZIAC2 BISOPROLOL/HCTZ 2.5/6.25 MG TAB Medication

ZIAC5T BISOPROLOL/HCTZ 5/6.25 MG TAB Medication

ZINCOXIDE ZINC OXIDE 20% OINT 30 GM TUBE Medication

Page 69 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

ZINCOXIDE ZINC OXIDE 20% OINT 30 GM TUBE Medication as a Compound

ZINCSULFAT ZINC SULFATE 220 MG CAP (50 MG ELEMENTAL ZINC) Medication

ZIPRA20 ZIPRASIDONE 20 MG CAP Medication

ZIPRA40 ZIPRASIDONE 40 MG CAP Medication

ZIPRAS20 ZIPRASIDONE HCL 20 MG/ML PWVL Medication

ZN50 ZINC GLUCONATE 50 MG TAB (7 MG ELEMENTAL ZINC) Medication

ZOLE4INF ZOLEDRONIC ACID (ZOMETA) 4 MG/100 ML INJ Medication

ZOLE5INF ZOLEDRONIC ACID (RECLAST) 5 MG/100 ML INJ Medication

ZOLM5OD ZOLMITRIPTAN 5 MG ORALLY DISINTEGRATING TAB Medication

ZOLMIT25OD ZOLMITRIPTAN 2.5 MG ORALLY DISINTEGRATING TAB Medication

ZOLPID10 ZOLPIDEM 10 MG TAB Medication

ZOLPID5 ZOLPIDEM 5 MG TAB Medication

ZONIS ZONISAMIDE 100 MG CAP Medication

ZONIS25 ZONISAMIDE 25 MG CAP Medication

ZOSTERVACC HERPES ZOSTER VACCINE LIVE INJECTION Medication

ZOSYN2.25 PIPERACILLIN/TAZOBACTAM 2.25 GM VIAL Medication

ZOSYN2.25 PIPERACILLIN/TAZOBACTAM 2.25 GM VIAL Medication as an Additive

ZOSYN3.375 PIPERACILLIN/TAZOBACTAM 3.375 GM VIAL Medication

ZOSYN3.375 PIPERACILLIN/TAZOBACTAM 3.375 GM VIAL Medication as an Additive

ZOSYN4.5 PIPERACILLIN/TAZOBACTAM 4.5 GM VIAL Medication

ZOSYN4.5 PIPERACILLIN/TAZOBACTAM 4.5 GM VIAL Medication as an Additive

Page 70 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

Charge

$22.00

$22.00

$10.87

$16.05

$3362.10

$3377.10

$9.69

$8.75

$35.58

$50.58

$53.18

$68.18

$8.89

$8.67

$0.09

$142.00

$0.00

$0.80

$0.93

$0.00

$0.00

$0.00

$1.54

$0.00

$0.10

$0.03

$7.84

$122.30

$174.50

$5.64

$24.40

$25.13

$40.91

$599.00

$614.00

$25.40

$85.37

$479.59

$110.00

$125.00

$9.42

Page 71 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$13.24

$75.00

$90.00

$12.62

$5352.58

$254.40

$15.99

$14.89

$9.63

$425.00

$440.00

$46.70

$329.08

$37.58

$1.06

$0.03

$25.84

$15.85

$41.75

$56.75

$26.00

$376.30

$188.15

$376.30

$188.15

$138.88

$26.00

$26.00

$8.20

$8.29

$50.67

$19.38

$257.70

$1635.00

$1650.00

$33.27

$31.85

$35.95

$71.20

$15.45

$0.23

$7.96

Page 72 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$8.33

$69.54

$35.80

$50.80

$36.30

$51.30

$8.46

$8.24

$8.37

$260.30

$390.04

$509.18

$60.00

$20.00

$178.84

$11.74

$9.41

$469.32

$469.32

$83.10

$4.60

$52.22

$7.92

$94.53

$47.62

$109.53

$39.30

$0.00

$0.00

$288.44

$36.67

$44.30

$77.00

$80.31

$69.10

$84.10

$120.96

$148.44

$60.75

$75.75

$17.05

Page 73 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$42.50

$57.50

$10.62

$7.98

$11.71

$8.36

$8.86

$9.87

$7.74

$8.61

$9.55

$0.36

$38.00

$74.48

$8.48

$7.78

$9.39

$11.35

$8.67

$27.59

$31.10

$7.89

$8.18

$161.88

$715.20

$730.20

$56.60

$71.60

$44.95

$59.95

$74.80

$89.80

$45.48

$60.48

$12.60

$110.16

$10.06

$5.36

$4535.00

$4550.00

$46.65

$52.39

Page 74 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$24.76

$18.17

$18.17

$36.98

$386.48

$138.43

$492.61

$4.69

$13.00

$1456.28

$1565.00

$1580.00

$591.58

$390.50

$45.57

$45.53

$0.00

$45.36

$0.00

$45.48

$0.00

$0.00

$20.64

$24.50

$15.07

$1.96

$3.16

$0.04

$1.28

$0.00

$1.32

$0.06

$0.03

$36.18

$2.08

$9.09

$8.55

$8.66

$11.17

$24.53

$14.63

$26.01

Page 75 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$11.17

$8.20

$8.23

$8.42

$9.91

$37.54

$59.29

$92.17

$34.80

$50.20

$106.94

$121.94

$40.20

$25.58

$38.92

$152.09

$14.64

$104.73

$12.10

$13.43

$15.91

$38.86

$345.55

$278.92

$3.44

$1517.30

$1532.30

$1579.05

$1594.05

$10.40

$75.96

$253.79

$64.21

$57.36

$64.21

$29.81

$16.39

$50.00

$65.00

$133.85

$148.85

$235.85

Page 76 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$250.85

$1.74

$0.18

$68.28

$83.28

$11.28

$156.93

$10.54

$8.62

$873.30

$94.70

$3471.90

$6.70

$200.00

$479.15

$494.15

$46.50

$2342.50

$2357.50

$8.85

$8.85

$7011.33

$7026.33

$1.17

$1.82

$40.17

$191.06

$22.82

$546.24

$3.66

$6.14

$35.37

$8.25

$1.90

$1.96

$1.72

$1.12

$8.09

$172.70

$8.22

$8.06

$1649.62

Page 77 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$941.90

$54.70

$146.30

$148.86

$9.98

$10.15

$2425.83

$2440.83

$9598.28

$9613.28

$11435.00

$11450.00

$54.48

$29.69

$323.76

$232.58

$400.38

$562.20

$240.76

$12.22

$0.76

$279.57

$0.06

$0.03

$12.07

$40.50

$7.70

$0.28

$9.21

$2878.18

$2893.18

$89.20

$138.50

$153.50

$220.75

$203.57

$4844.00

$4859.00

$47.41

$1412.30

$63.05

$60.41

Page 78 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$61.55

$126.03

$231.31

$213.11

$430.45

$12.53

$33.93

$49.77

$220.10

$26.00

$26.00

$32.27

$92.93

$54.88

$0.02

$10.13

$9.97

$29.30

$58.25

$39.72

$71.28

$13.28

$13.28

$430.70

$560.00

$28.38

$26.56

$3.86

$54.83

$31.36

$35.54

$29.52

$34.20

$27.12

$4.42

$55.53

$26.64

$3.94

$54.93

$49.56

$28.50

$34.82

Page 79 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$27.06

$4.36

$55.45

$30.50

$59.75

$28.26

$90.91

$113.12

$46.03

$12.53

$35.83

$9.61

$9.06

$8.86

$8.54

$9.21

$8.52

$9.48

$41.04

$30.03

$177.50

$8900.00

$8915.00

$51.23

$8.30

$0.05

$65.24

$125.22

$178.15

$89.70

$104.70

$8.89

$11.88

$1.23

$4.20

$0.06

$2.06

$38.98

$70.35

$24.40

$39.40

$0.03

Page 80 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$163.76

$55.28

$18.07

$9.04

$44.66

$77.45

$227.19

$3.56

$29.71

$31.13

$2282.00

$2297.00

$54.15

$10.99

$9.08

$987.57

$34.54

$9.62

$11.05

$9.05

$9.73

$9.83

$8.96

$8.36

$12.41

$8.02

$13.01

$3.56

$5.73

$0.15

$33.60

$12.18

$230.00

$245.00

$873.34

$3517.50

$3532.50

$12.15

$8.44

$0.81

$11827.35

$23684.70

Page 81 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$56383.73

$20.70

$10.10

$10.10

$10.10

$9.97

$11.88

$95.05

$39.10

$54.10

$53.70

$76.58

$65.43

$80.43

$52.10

$67.10

$347.17

$22.93

$41.73

$56.73

$92.70

$107.70

$150.40

$165.40

$64.85

$79.85

$68.14

$94.85

$109.85

$87.04

$17.67

$217.81

$350.88

$365.88

$611.38

$626.38

$50.60

$65.60

$68.00

$83.00

$1111.43

$1126.43

Page 82 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$50.95

$65.95

$322.45

$337.45

$39.50

$54.50

$37.25

$52.25

$43.55

$58.55

$52.53

$67.53

$12.84

$51.00

$66.00

$13.10

$16.57

$0.08

$3.16

$50.96

$8.64

$56.91

$9.05

$5215.62

$11.34

$2.34

$9.72

$0.13

$8.09

$9.44

$18.40

$13.59

$42.35

$7.15

$3.26

$8.34

$8.40

$8.56

$10.31

$0.00

$0.46

$73.84

Page 83 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$76.42

$8.42

$9.08

$25.32

$7.70

$16.69

$85.78

$128.85

$0.01

$0.93

$9.04

$9.37

$11.61

$12.00

$85.71

$2255.00

$2270.00

$9.90

$46.00

$45.46

$127.54

$359.85

$7.89

$7.86

$45.02

$52.49

$79.00

$85.96

$129.08

$846.50

$861.50

$58.76

$95.08

$76.89

$10.50

$10.80

$15.78

$7.72

$1340.00

$1355.00

$13.56

Page 84 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$70.95

$14.76

$0.93

$469.70

$204.90

$151.93

$8.47

$57.38

$42.35

$57.35

$67.38

$73.94

$37.40

$68.07

$36.39

$10.16

$8839.25

$8854.25

$327.89

$56.62

$20.98

$9.15

$8.68

$8.55

$124.70

$102.00

$152.00

$47.01

$7.87

$73.97

$7.98

$27.24

$8.35

$30.53

$12.79

$9.12

$9.52

$1.09

$32.92

$111.63

$14.85

$33.28

Page 85 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$17.32

$9.27

$273.11

$8.71

$0.14

$0.02

$0.45

$7.96

$20.87

$17.17

$12.31

$9.08

$116.34

$1434.64

$15.62

$735.02

$750.02

$15.62

$15.62

$15.62

$15.62

$556.14

$188.65

$83.39

$207.72

$142.51

$147.51

$9.55

$103.01

$11.34

$278.50

$369.75

$12.04

$16.41

$9.36

$9.69

$67.03

$300.00

$402.70

$7.85

$0.16

$39.28

Page 86 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$0.17

$127.72

$2095.15

$2110.15

$4155.33

$4170.33

$9.04

$71.92

$42.69

$18.74

$1065.08

$1080.08

$14.15

$9.24

$23.39

$11.77

$20.87

$116.56

$131.56

$650.40

$8.87

$53.75

$68.75

$97.70

$112.70

$22.00

$22.00

$77.50

$22.00

$22.00

$77.50

$22.00

$22.00

$77.50

$34.64

$57.76

$41.92

$74.03

$43.10

$58.10

$5.20

$22.00

Page 87 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$71.28

$8.14

$22.00

$22.00

$22.00

$77.50

$22.00

$49.86

$71.28

$22.00

$22.00

$71.28

$22.00

$22.00

$71.28

$71.28

$22.00

$71.28

$22.00

$16.43

$17.89

$17.13

$86.25

$101.25

$3721.10

$3736.10

$10.64

$10.64

$10.64

$8.67

$350.81

$9.91

$8.49

$9.17

$1370.00

$1385.00

$5586.20

$5601.20

$469.58

$737.78

$1095.26

$1810.22

Page 88 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$437.43

$452.43

$121.58

$173.60

$2321.28

$1500.35

$15.26

$27.91

$2863.22

$5344.02

$125.00

$173.00

$4.65

$6.39

$3.48

$7.98

$10.12

$2.63

$13.90

$10.97

$163.80

$226.38

$193.35

$82.75

$48.40

$50.32

$259.80

$44.12

$35.49

$21.25

$107.48

$107.48

$184.35

$36.42

$67.15

$8.04

$8.48

$9.02

$24.88

$7.85

$7.75

$27.38

Page 89 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$24.46

$9.11

$13.98

$247.70

$92.28

$107.28

$11.47

$1444.30

$1459.30

$30.31

$49.20

$58.02

$8.22

$8.40

$7.74

$7.86

$337.94

$444.05

$224.22

$190.21

$8.11

$25.86

$55.06

$7.89

$7.83

$2.95

$96.36

$54.78

$75.98

$9.29

$9.35

$9.71

$10.94

$9.19

$8.39

$8.14

$8.53

$8.03

$224.44

$8.84

$9193.10

$11513.00

Page 90 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$35.90

$15.93

$10.11

$10.08

$58.80

$19.04

$36.30

$67.00

$87.70

$7.81

$30.16

$59.33

$7.93

$8.62

$9.72

$9.09

$9.17

$10.34

$834.60

$0.13

$194.76

$1597.36

$2.03

$0.02

$9.12

$24.66

$2.56

$103.30

$153.12

$28.21

$121.70

$85.57

$27.02

$148.42

$169.03

$8.86

$12.41

$8.66

$9.29

$9.69

$9.92

$11.44

Page 91 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$11.44

$67.90

$51.65

$66.65

$121.44

$91.96

$83.10

$2033.00

$2048.00

$45.13

$0.06

$28.65

$17.99

$17.96

$17.95

$90.45

$0.54

$16.87

$21.12

$16.87

$7.72

$27.22

$55.65

$68.78

$97.41

$133.48

$148.48

$9.21

$44.42

$9.98

$8.36

$11.65

$8.60

$9.00

$9.75

$13.78

$51.55

$8119.25

$8134.25

$107.63

$122.63

$10.72

Page 92 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$110.50

$125.50

$8.47

$22.87

$21.37

$22.61

$15.93

$16.94

$114.45

$42.04

$126.50

$125.73

$74.34

$15.16

$80.65

$6.89

$26.74

$9.53

$9.34

$29.68

$14.89

$9.87

$60.86

$79.94

$94.24

$51.34

$70.42

$37.02

$41.76

$12.30

$41.92

$34.77

$136.20

$191.88

$523.84

$676.43

$57.70

$93.75

$104.22

$161.80

$71.25

Page 93 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$106.38

$104.22

$161.80

$753.04

$104.22

$161.80

$46.70

$57.70

$320.88

$11.61

$83.60

$98.60

$116.58

$1.50

$439.92

$1343.42

$1343.42

$50.37

$386.20

$401.20

$37.47

$44.07

$190.93

$205.93

$303.53

$18.11

$8.18

$12.81

$17.04

$9.92

$51.28

$51.28

$40.30

$72.00

$1160.12

$142.70

$200.00

$33.90

$75.29

$8.41

$8.72

$33.90

Page 94 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$13.26

$22.07

$1252.04

$2945.90

$1048.72

$42.50

$9.72

$10.91

$8.79

$60.78

$9.31

$9.14

$11.05

$38.82

$70.15

$37.62

$68.65

$1278.95

$63.43

$78.43

$5.72

$0.18

$31.67

$1773.82

$442.56

$1773.82

$1.87

$21.05

$4822.70

$6050.00

$9622.70

$12050.00

$24022.70

$30050.00

$0.07

$22.71

$45.74

$60.74

$18.13

$0.05

$24.60

$52.38

Page 95 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$23.31

$8.30

$8.42

$9.48

$9.40

$9.98

$11.35

$8.86

$24.59

$53.02

$25.54

$54.54

$71.10

$31.76

$32.91

$53.87

$78.18

$107.70

$107.70

$2075.00

$2090.00

$0.03

$0.48

$24.83

$0.25

$0.23

$1.90

$0.39

$2.57

$7.90

$8.46

$0.20

$283.62

$684.28

$1076.26

$11.35

$8.22

$10.86

$8.31

$10.00

$14.70

$0.90

Page 96 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$1.07

$1.67

$10.48

$196.58

$19.15

$23.77

$53.30

$55.90

$177.88

$402.57

$9.50

$106.70

$38.96

$131.11

$201.13

$160.61

$31.17

$53.29

$76.07

$35.04

$75.30

$113.96

$124.16

$240.84

$74.85

$89.85

$7.82

$32.88

$10.55

$10.27

$8.35

$382.70

$8.77

$195.76

$11.00

$8.55

$8.20

$35.59

$9.19

$54.64

$13.56

$10.66

Page 97 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$7.65

$8.03

$49.70

$83.75

$3315.00

$2624.00

$3330.00

$294.30

$138.10

$197.00

$293.30

$26.00

$916.25

$931.25

$120.96

$9.02

$98.52

$144.78

$261.54

$348.55

$568.27

$36.50

$8.21

$32.58

$8.23

$8.29

$29.64

$58.68

$8.14

$44.43

$59.43

$44.43

$59.43

$44.43

$59.43

$7.73

$7.84

$7.86

$9.48

$8.54

$15.17

$5780.00

Page 98 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$5795.00

$251.00

$266.00

$495.92

$163.31

$0.03

$342.26

$262.13

$182.41

$67.09

$19.87

$182.41

$190.14

$38.06

$10.36

$47.18

$62.18

$45.52

$45.52

$38.33

$53.33

$3.66

$51.88

$66.88

$9.98

$455.52

$1103.50

$8.37

$9.06

$8.40

$8.09

$8.04

$8.09

$431.90

$12.30

$8.15

$8.22

$56.30

$17.60

$1.09

$0.51

$18.36

Page 99 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$9.16

$39.50

$22.89

$30.38

$68.30

$0.17

$0.49

$0.42

$8.79

$20.08

$8.81

$0.37

$20.00

$22.00

$24.78

$39.78

$39.78

$20.00

$25.80

$40.80

$40.80

$26.00

$41.00

$20.00

$60.20

$146.26

$57.12

$11.15

$7.93

$8.18

$9.30

$8.40

$8.81

$37.08

$652.10

$2855.76

$8.10

$7.75

$7.79

$20693.00

$20708.00

$30.12

Page 100 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$59.28

$30.28

$30.28

$64.44

$41.02

$72.90

$40.88

$45.26

$57.50

$152.12

$0.00

$0.00

$0.00

$78.10

$175.34

$77.72

$15.16

$13.55

$57.05

$21.38

$45.47

$4.90

$31.55

$463.10

$156.62

$1017.90

$152.02

$3141.38

$13.38

$7.80

$54.10

$7.81

$8.03

$61.02

$145.03

$24.70

$10.00

$27.61

$26.91

$28.53

$28.60

$2.81

Page 101 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$3.36

$14.42

$8.28

$44.12

$0.00

$6.64

$6.64

$87.22

$26.54

$56.14

$25.04

$53.74

$8.44

$24.14

$52.30

$8.44

$87.22

$54.92

$90.28

$82.32

$124.53

$141.96

$199.08

$7.95

$76.10

$8.06

$71.10

$8.93

$12.47

$8.65

$8.29

$675.17

$1582.88

$1597.88

$7.85

$0.03

$7.68

$7.84

$8.08

$0.63

$1.10

$452.34

Page 102 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$350.81

$247.29

$357.63

$372.63

$18.12

$35.61

$42.07

$8.11

$8.08

$8.36

$3109.50

$3124.50

$4312.10

$4327.10

$7012.90

$7027.90

$8589.20

$8604.20

$1985.00

$1560.00

$2000.00

$2173.55

$2188.55

$8.59

$435.20

$1292.16

$220.62

$8.08

$8.36

$11.27

$250.36

$2295.18

$2310.18

$25.00

$25.00

$287.71

$290.90

$4178.14

$1617.26

$1617.26

$1325.02

$1731.70

Page 103 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$58.98

$1.52

$135.14

$83.71

$75.56

$26.00

$43.00

$9.03

$11.99

$9.35

$113.00

$128.00

$185.00

$200.00

$788.30

$803.30

$155.31

$7.78

$7.98

$1985.00

$2000.00

$0.00

$8.47

$8.06

$9.16

$8.78

$8.66

$8.93

$9.97

$2145.34

$19.32

$7.67

$26.31

$25.45

$45.82

$8.61

$8.17

$38.00

$53.00

$29.73

$46.10

$8.41

Page 104 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$41.00

$56.00

$8.28

$8.39

$27.20

$52.86

$110.33

$34.99

$74.58

$33.68

$67.56

$10.40

$55.72

$59.47

$8.84

$10.17

$31.70

$34.70

$37.70

$53.05

$0.39

$10.31

$26.56

$54.83

$11.75

$30.38

$59.60

$38.92

$70.28

$8.86

$11.12

$30.23

$55.32

$31.58

$141.75

$156.75

$0.25

$0.82

$11.17

$155.16

$16.83

$24.30

Page 105 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$19.67

$23.18

$18.17

$8.25

$26.37

$1.60

$8.24

$14.61

$1.94

$45.83

$0.03

$27.35

$34.70

$29.17

$70.70

$46.70

$11.67

$26.09

$36.00

$36.00

$36.00

$36.00

$15.55

$109.70

$10.68

$7.87

$57.05

$72.05

$82.10

$12.15

$15.79

$29.34

$102.18

$149.35

$8.91

$25.13

$52.38

$27.62

$145.00

$160.00

$52.68

$36.89

Page 106 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$24.68

$47.67

$55.90

$276.10

$8.37

$8.46

$8.40

$8.48

$8.56

$8.33

$8.17

$8.56

$8.20

$8.31

$8.33

$54.90

$29.40

$30.46

$27.78

$37.70

$27.60

$36.44

$55.34

$34.36

$28.60

$57.38

$35.10

$29.88

$58.98

$34.90

$65.25

$47.40

$26.10

$29.74

$58.80

$27.80

$56.38

$28.00

$36.96

$67.83

$36.88

$29.88

Page 107 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$60.42

$51.70

$46.07

$32.70

$18.00

$16.10

$27.72

$56.28

$29.90

$31.54

$61.05

$38.41

$8.78

$28.82

$30.91

$26.00

$99.62

$31.26

$60.70

$34.52

$31.00

$28.02

$28.41

$379.70

$36.04

$79.90

$52.28

$33.84

$27.77

$28.37

$27.77

$151.38

$592.76

$225.37

$8.91

$8.56

$144.13

$87.30

$159.13

$158.48

$98.78

$173.48

Page 108 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$227.43

$153.94

$242.43

$668.04

$22.06

$22.06

$12.91

$12.91

$8.78

$9.17

$8.37

$9.43

$8.74

$8.16

$7.91

$8.20

$9.31

$78.93

$8.43

$8.72

$12.12

$21.11

$1.54

$0.17

$64.76

$8.91

$8.09

$0.22

$7.73

$24.04

$58.70

$57.60

$122.00

$7.71

$11.27

$9.60

$75.77

$74.54

$50.69

$222.10

$11.06

$9.11

Page 109 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$9.88

$8.78

$22.00

$22.00

$43.30

$0.33

$16.43

$16.43

$6.52

$0.03

$70.00

$38.12

$38.12

$51.14

$12.93

$87.70

$87.70

$77.90

$57.16

$1.25

$0.15

$0.05

$54.22

$1.23

$39.75

$54.75

$43.13

$58.13

$40.20

$55.20

$39.75

$54.75

$15.51

$27.96

$42.96

$154.90

$169.90

$169.90

$8.12

$10.75

$31.84

$46.48

Page 110 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$8.06

$8.92

$48.39

$0.02

$0.19

$8.48

$130.70

$8.18

$7.97

$12.63

$8.39

$9.23

$7.65

$7.80

$8.18

$27.81

$27.81

$27.81

$25.78

$293.44

$2.35

$23.28

$50.92

$26.16

$55.54

$26.30

$55.76

$9.30

$77.34

$40.14

$44.14

$6907.50

$95.00

$110.00

$9.91

$65.00

$80.00

$19.63

$10.55

$9.94

$13.15

$36.51

Page 111 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$20.26

$125.00

$140.00

$14.73

$8.43

$8.48

$9.04

$9.03

$45.45

$60.45

$134.75

$149.75

$85.95

$100.95

$12.35

$350.00

$8.61

$8.22

$8.22

$8.15

$8.43

$8.12

$11.84

$46.40

$61.40

$89.90

$134.00

$8.10

$8.47

$8.06

$8.04

$470.16

$10.88

$84.46

$86.14

$300.00

$299.98

$45.96

$79.08

$8.96

$104.82

$152.65

Page 112 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$133.88

$188.98

$37.14

$32.80

$9.56

$49.58

$83.60

$48.06

$66.72

$10.36

$8.30

$9.67

$10.19

$10.25

$7.75

$25.36

$53.33

$8.02

$10.52

$10.91

$8.68

$7.75

$8.22

$7.92

$9.08

$8.28

$8.92

$25.22

$42.08

$40.48

$55.48

$8.25

$9.00

$352.64

$47.10

$8.25

$8.37

$8.49

$4.36

$596.00

$611.00

$2.18

Page 113 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$8.58

$25.91

$85.26

$34.30

$6.11

$27.39

$57.50

$23.68

$51.95

$16.32

$103.73

$212.05

$22.93

$50.45

$24.26

$52.50

$10.82

$9.61

$18.56

$15.91

$16.69

$155.00

$170.00

$74.18

$0.83

$27.47

$14.17

$9.62

$8.53

$8.00

$1.00

$10.41

$10.49

$9.52

$9.88

$9.52

$846.78

$861.78

$3574.10

$3589.10

$12.75

$162.70

Page 114 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$716.15

$731.15

$201.90

$36.78

$9.25

$1.37

$8.08

$13.59

$13.25

$9.90

$51.08

$147.86

$64.22

$18.55

$49.96

$93.62

$8.52

$75.42

$13.23

$9.83

$9.83

$553.80

$10.59

$29.76

$10.18

$425.00

$312.00

$440.00

$25.53

$54.52

$7.97

$11.62

$14.36

$25.80

$54.96

$352.70

$12.51

$69.75

$84.75

$62.23

$113.24

$8.28

Page 115 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$0.58

$314.44

$73.57

$17.48

$6.56

$6.55

$35.12

$65.53

$60.64

$97.43

$13.04

$332.00

$347.00

$155.91

$155.91

$12.31

$1747.61

$2.42

$8.72

$9.42

$122.66

$81.50

$96.50

$13.15

$14.09

$62.74

$100.05

$31.40

$60.88

$391.23

$406.23

$70.14

$109.30

$64.06

$101.70

$24.52

$3164.30

$11.69

$47.20

$62.20

$26.72

$34.60

Page 116 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$33.21

$0.04

$8.52

$8.78

$7.91

$8.74

$27248.24

$9.66

$62.50

$77.50

$61.63

$76.63

$37.25

$52.25

$58.22

$11.77

$14.42

$14.42

$30.00

$142.57

$13.18

$13.42

$0.11

$30.90

$60.25

$82.66

$124.95

$300.00

$42.08

$9.54

$24.74

$53.26

$67.78

$82.78

$58.44

$1.40

$85.22

$0.04

$3.62

$84.45

$66.76

$105.08

Page 117 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$388.63

$0.12

$41.02

$56.02

$0.42

$25.40

$54.32

$11.25

$8.02

$41.10

$56.10

$0.04

$0.04

$0.04

$281.66

$75.82

$116.40

$0.41

$0.58

$0.22

$0.24

$10.15

$10.15

$10.15

$9.25

$10.55

$11.21

$8.87

$22.55

$30.48

$289.82

$9.04

$26.50

$9.11

$11.81

$169.70

$742.70

$950.00

$50.66

$11.53

$11.25

$9.90

Page 118 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$9.04

$8.42

$8.66

$66.34

$104.55

$93.74

$10.75

$8.47

$10.50

$9.35

$10.90

$12.62

$38.03

$53.03

$22.00

$22.00

$77.50

$22.00

$5.38

$22.00

$22.00

$22.00

$22.00

$77.50

$9.42

$71.28

$26.00

$3.30

$22.00

$22.00

$4.64

$20.00

$8.25

$71.28

$22.00

$22.00

$5.38

$22.00

$22.00

$10.88

$8.67

$8.10

Page 119 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$8.28

$30.00

$55.20

$90.63

$114.93

$8.71

$84.08

$600.00

$400.00

$52.78

$67.78

$1.78

$0.19

$9.62

$42.86

$29.79

$15.00

$39.36

$43.53

$51.89

$17373.30

$17388.30

$0.64

$48785.00

$48800.00

$34.84

$65.18

$46.56

$61.56

$106.70

$121.70

$7.71

$47.62

$56.99

$31.30

$23.33

$236.19

$248.61

$2625.88

$3303.98

$10.06

$12.00

Page 120 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$0.19

$10.04

$25.83

$27.34

$55.80

$24.98

$52.85

$34.13

$51.78

$1685.00

$2635.00

$1685.00

$14.95

$889.60

$31.76

$32.00

$9.11

$9.11

$2935.00

$2950.00

$10.18

$67.70

$0.02

$0.04

$0.04

$24.47

$24.47

$217.68

$25.97

$71.25

$86.25

$102.50

$117.50

$852.00

$12.74

$8.96

$9.84

$10.19

$9.40

$10.92

$10.16

$53.70

Page 121 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$11.25

$8.52

$8.50

$16.28

$11.84

$8.17

$17.87

$13.50

$18.60

$26.41

$50.38

$1.61

$13.30

$10.59

$41.42

$73.40

$51.76

$26.28

$54.48

$4029.23

$4044.23

$73.40

$88.40

$51.19

$3024.66

$0.00

$0.00

$43.93

$3548.10

$4456.75

$385.10

$702.20

$899.38

$115.02

$25.32

$13113.00

$13128.00

$12.12

$54.50

$69.50

$8.14

$108.56

Page 122 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$157.33

$9.23

$20.80

$8.52

$11.10

$10.63

$63.52

$42.25

$57.25

$8.53

$33.56

$34.89

$43668.63

$43683.63

$13574.60

$13589.60

$9521.00

$9536.00

$53.12

$88.03

$8.60

$77.13

$158.85

$554.00

$346.25

$361.25

$20.75

$9.39

$25.45

$11.82

$10.82

$9.27

$66.21

$8.02

$10.44

$2.46

$11.00

$1.40

$0.13

$8.00

$2.75

Page 123 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$11.00

$0.04

$10.81

$11.07

$8.48

$107.65

$185.92

$7.77

$7.78

$8.15

$55.43

$102.36

$26.37

$1042.70

$1057.70

$31.50

$61.00

$82.20

$1.75

$26.91

$3.22

$2.77

$4.04

$27.76

$8.36

$17.88

$7.79

$8.21

$111.74

$138.48

$194.73

$32.90

$139.99

$142.66

$148.47

$11.17

$8.43

$9.17

$15.94

$20.34

$10.69

$68.18

Page 124 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$49.50

$263.14

$2.30

$56.79

$42.13

$57.13

$9.68

$0.02

$28.13

$78.70

$93.70

$97.30

$112.30

$1.34

$0.00

$55.58

$0.10

$400.00

$11.57

$230.78

$245.78

$1095.02

$11.46

$11.27

$11.07

$24.64

$27.25

$11.43

$10.58

$13.30

$13.30

$4222.70

$5300.00

$8.67

$8.79

$7.92

$38.28

$7.93

$7.93

$8.10

$14.15

$7.90

Page 125 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$37.69

$35.65

$27.54

$11.79

$19.86

$18.74

$19.86

$10.86

$16.98

$11.03

$16.98

$0.14

$2.48

$0.34

$8.18

$8.02

$8.20

$9.74

$250.05

$265.05

$226.70

$8.75

$67.10

$105.50

$22.57

$8.31

$7.80

$226.14

$10.10

$100.20

$28.67

$35.70

$50.70

$28.67

$8.73

$27.14

$55.55

$50.17

$8.42

$8.00

$17.23

$17.23

Page 126 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$15.78

$10.37

$9.55

$74.92

$89.00

$32.98

$71.90

$8.02

$11.15

$10.03

$41.90

$56.90

$35.60

$8.21

$8.46

$10.03

$10.47

$8.67

$9.27

$9.67

$111.16

$52.20

$12.46

$0.37

$0.02

$0.17

$8.00

$0.38

$530.00

$14.92

$99.50

$114.50

$9.12

$59.18

$74.18

$0.02

$0.02

$8.27

$8.86

$14.97

$8.24

$9.05

Page 127 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$31.33

$18.16

$9.12

$9.05

$9.05

$13.90

$831.50

$12836.94

$3231.92

$877.94

$26.00

$16.32

$30.22

$26.12

$9.42

$8.48

$17.27

$15.24

$37.33

$2341.25

$2356.25

$5610.75

$5625.75

$0.21

$485.94

$218.88

$233.88

$402.75

$417.75

$11.96

$206.70

$63.97

$11.46

$13.06

$494.00

$509.00

$37.17

$11.86

$34.05

$34.05

$14.15

$181.51

Page 128 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$1767.88

$13.45

$1186.10

$18.62

$2745.15

$2760.15

$28.92

$28.92

$28.92

$18.26

$17.87

$27.71

$12.65

$47.16

$24.64

$1.51

$0.24

$8.49

$8.16

$39.72

$71.28

$31.54

$24.80

$4353.38

$10.58

$10.59

$10.58

$10.69

$10.86

$14.11

$217.86

$195.16

$293.95

$120.28

$97.58

$171.98

$57.46

$34.76

$93.45

$90.42

$67.72

$134.65

Page 129 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$18.24

$18.24

$18.25

$18.24

$38.37

$28.57

$38.37

$26.00

$26.00

$23.21

$19.71

$19.71

$19.71

$4.81

$9.63

$8.05

$9.06

$38.02

$1035.30

$10.34

$26.26

$36.27

$1.93

$0.03

$0.03

$72.60

$87.60

$8.04

$18.29

$8.39

$8.08

$8.08

$8.08

$21.11

$16.82

$13.05

$267.20

$9.25

$11.56

$106.79

$40.41

$44.36

Page 130 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$95.50

$0.09

$1.67

$10.92

$13.45

$13.45

$9.87

$8.86

$265.50

$353.50

$8.97

$8.30

$8.62

$9.75

$17.68

$7.72

$3695.00

$3710.00

$8325.50

$8340.50

$30.26

$45.26

$56.42

$0.06

$57.82

$93.90

$48.04

$81.68

$45.96

$23.26

$79.08

$48.64

$0.07

$0.07

$33.48

$10.78

$63.48

$35.30

$12.60

$65.75

$82.70

$210.20

Page 131 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$284.38

$42.45

$57.45

$42.45

$57.45

$38.78

$25.95

$0.26

$10.47

$11.67

$10.65

$9.36

$7.86

$8.10

$20.99

$37.81

$10.37

$12.06

$10.37

$7.60

$0.15

$14.42

$15.62

$19.82

$70.66

$241.01

$7.99

$46.70

$88.40

$46.70

$88.40

$31.43

$63.96

$262.08

$440.30

$88.92

$13.61

$8.27

$8.05

$438.22

$8.77

Page 132 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$9.03

$39.79

$28.85

$192.70

$210.57

$257.52

$132.30

$34.39

$18.07

$8.60

$7.92

$8.03

$8.16

$481.10

$623.00

$475.96

$616.58

$10.30

$12.91

$102.99

$23.88

$15.56

$168.48

$207.70

$281.25

$207.70

$281.25

$8.46

$8.16

$8.28

$16.68

$10.67

$138.80

$171.82

$16.98

$131.00

$865.28

$880.28

$287.25

$1159.83

$1174.83

$7.86

Page 133 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$13.23

$759.22

$4916.88

$4931.88

$11.94

$9.52

$9.52

$9.52

$32.40

$16.29

$65.88

$103.98

$8.11

$49.70

$14.43

$101.29

$204.96

$22.20

$1.32

$131.74

$10.74

$8.12

$8.41

$46.04

$12.04

$0.29

$0.05

$0.03

$0.14

$47.58

$81.10

$8.50

$8.03

$10.43

$229.10

$194.94

$228.22

$7.72

$8.49

$14.07

$14.93

$16.50

Page 134 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$504.50

$519.50

$37.87

$42.93

$281.25

$591.74

$1850.02

$9.05

$9.69

$14091.18

$1071.92

$96.85

$40.95

$55.95

$313.70

$39.19

$44.72

$195.77

$3161.00

$3176.00

$1.33

$1.99

$485.12

$643.61

$10.48

$10.10

$11.07

$14.98

$1017.79

$8.43

$10.41

$26436.08

$26451.08

$13235.55

$13250.55

$400.00

$400.00

$400.00

$400.00

$400.00

$400.00

$400.00

Page 135 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$400.00

$7.71

$11.93

$88.10

$99.70

$114.70

$9.08

$13.81

$174.43

$8.53

$10.92

$7.78

$36324.63

$36339.63

$3719.38

$3734.38

$9245.95

$9260.95

$18456.88

$18471.88

$174.51

$41.34

$29.34

$48.88

$40.01

$33.09

$29.34

$47.69

$39.29

$31.42

$28.01

$40.97

$25.00

$34.73

$34.73

$51.72

$43.10

$126.74

$118.60

$241.18

$7.95

$14.79

Page 136 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$11.97

$7.72

$7.73

$234.85

$7.81

$7.67

$115.22

$10.08

$8.40

$28.69

$29.99

$91.28

$10.99

$8.81

$57.80

$72.80

$54.05

$69.05

$12.20

$15.20

$18.29

$4835.00

$4850.00

$16.19

$84.24

$90.64

$8.79

$64.18

$101.85

$10.17

$9.16

$60.50

$105.42

$68.10

$77.04

$77.78

$105.42

$87.26

$83.13

$98.13

$76.74

$35.00

Page 137 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$50.00

$18.35

$298.78

$424.08

$551.73

$54.36

$37.82

$68.90

$17624.15

$17639.15

$10.36

$8.43

$9.91

$12.55

$10.12

$8.35

$8.66

$9.31

$9.04

$7.93

$92.16

$8.20

$8.08

$8.83

$19.43

$19.43

$20.56

$164.20

$179.20

$52.25

$67.25

$1036.40

$1051.40

$974.29

$0.06

$5.24

$0.04

$0.02

$0.02

$0.02

$306.45

$321.45

Page 138 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$0.02

$0.02

$0.04

$0.21

$0.03

$2.55

$0.25

$9.94

$0.11

$0.02

$0.03

$0.07

$11.11

$162.50

$102.00

$68.04

$1278.51

$482.58

$497.58

$25.87

$38.93

$53.93

$38.93

$53.93

$38.93

$53.93

$8.12

$12.17

$10.54

$10.77

$10.67

$10.78

$10.79

$10.91

$12.00

$11.16

$8.71

$8.66

$8.66

$0.67

Page 139 of 140

Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***

$9.00

$0.07

$11.57

$17.68

$141.94

$0.02

$469.70

$757.70

$49.85

$67.25

$13.10

$13.10

$9.65

$8.25

$518.52

$65.78

$80.78

$68.00

$83.00

$93.48

$108.48

Page 140 of 140