Health Insurance Marketplace Generics Plus Drug List · BCBSTX Health Insurance Marketplace 5 Tier Generics Plus Preferred Drug List December 2017 (2016 Plan Year) II . How to use

41722-K TX HIM © Prime Therapeutics LLC 12/17

December 2017 (2016 Plan Year)

Health Insurance Marketplace Generics Plus Drug List

Please consider talking to your doctor about prescribing preferred medications, which may

help reduce your out-of-pocket costs. This list may help guide you and your doctor in

selecting an appropriate medication for you.

The drug list is regularly updated. Please visit bcbstx.com for the most up-to-date

information.

To find a contracting pharmacy, please access the link below:

https://www.myprime.com/en/find-pharmacy.html

Contents

Introduction ...................................................................... I

How drugs are selected ................................................... I

How member payment is determined .............................. I

How to use this list .......................................................... II

Drugs used to treat multiple conditions .......................... II

Generic drugs ................................................................. II

Consider talking to your doctor about generic

drugs ........................................................................... II

Coverage considerations ............................................... III

Specialty drugs ............................................................... V

Prime Specialty by AllianceRx Walgreens

Prime ........................................................................... V

Abbreviation key ............................................................ VI

Therapeutic Class Drug List

Anti-Infective Agents ....................................................... 1

Biologicals ..................................................................... 13

Antineoplastic Agents ................................................... 15

Endocrine and Metabolic Drugs ................................... 21

Cardiovascular Agents .................................................. 41

Respiratory Agents ....................................................... 60

Gastrointestinal Agents ................................................. 67

Genitourinary Agents .................................................... 74

Central Nervous System Drugs .................................... 77

Analgesics and Anesthetics .......................................... 96

Neuromuscular Drugs ................................................. 109

Nutritional Products .................................................... 119

Hematological Agents ................................................. 150

Topical Products ......................................................... 162

Miscellaneous Products .............................................. 182

Index ........................................................................... 187

To search for a drug name within this PDF document, use the Control and F keys on your keyboard, or

go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking

for and click on Search.

Texas Residents -- Find and estimate prices for medicines on this formulary at: https://www.myprime.com/v/BCBSTX/COMMERCIAL/TXMKTGNPLS/en/find-medicine.html

https://www.myprime.com/en/find-pharmacy.html

https://www.myprime.com/v/BCBSTX/COMMERCIAL/TXMKTGNPLS/en/find-medicine.html

BCBSTX Health Insurance Marketplace 5 Tier Generics Plus Preferred Drug List December 2017 (2016 Plan Year)

I

Introduction

Members are encouraged to show this list to their physicians and pharmacists. Physicians are

encouraged to prescribe drugs on this list, when right for the member. However decisions regarding

therapy and treatment are always between members and their physician.

Drug lists updates – This list is regularly updated as generic drugs become available and changes take place in

the pharmaceuticals market. For the most up-to-date information, visit bcbstx.com and log in to

Blue Access for MembersSM or call the number on the back of your ID card. Physicians can access the list from

the provider portal at bcbstx.com.

How drugs are selected

Drugs on this list are selected based on the recommendations of a committee made up of physicians and

pharmacists from throughout the country. The committee, which includes at least one representative from

BCBSTX, reviews drugs regulated by the U.S. Food and Drug Administration (FDA).

Both drugs that are newly approved by the FDA as well as those that have been on the market for some time are

considered. Drugs are selected based on safety, efficacy, cost and how they compare to other drugs currently on

the list.

How member payment is determined

This list shows prescription drug products in tiers. Generally, each drug is placed into one of five member

payment tiers: Preferred Generic (Tier 1), Non-preferred Generic (Tier 2), Preferred Brand (Tier 3),

Non-preferred Brand (Tier 4) and Specialty (Tier 5). Please refer to the ACA Preventive (ACA) section for drugs

marked with an "A" in the drug tier column. To verify your payment amount for a drug, visit bcbstx.com and log in

to Blue Access for Members or call the number on the back of your ID card.

Your pharmacy benefit includes coverage for many prescription drugs, although some exclusions may apply.

Generally, if a drug is not listed on the drug list it is not covered. For example, drugs indicated for cosmetic

purposes, e.g., Propecia, for hair growth, may not be covered. Drugs that are not FDA-approved for self-

administration may be available through your medical benefit.




II

How to use this list

Generic drugs are shown in lower-case boldface type. Most generic drugs are followed by a reference brand

drug in (parentheses). Some generic products have no reference brand.

Example: atorvastatin (Lipitor – brand is NF)

Brand prescription drugs are shown in capital letters followed by the generic name.

Drugs used to treat multiple conditions

Some drugs in the same dosage form may be used to treat more than one medical condition. In these instances,

each medication is classified according to its first FDA-approved use. Please check the index if you do not find

your particular medication in the class/condition section that corresponds to your use.

Generic drugs

Using generic drugs, when right for you, can help you save on your out-of-pocket medication costs. Generic drugs

must be approved by the FDA just as brand drugs are, and must meet the same standards.

There are two types of generic drugs:

• A generic equivalent is made with the same active ingredient(s) at the same dosage as the reference drug.

• A generic alternative is a drug typically used to treat the same condition, but the active ingredient(s)

differs from the brand drug.

According to the FDA, compared to its brand counterpart, an FDA-approved generic drug:

• Is chemically the same

• Works just as well in the body

• Is as safe and effective

• Meets the same standards set by the FDA

The main difference between the reference brand drug and the generic equivalent is that the generic often costs

much less.

Preferred brand drugs typically move to a non-preferred brand tier after a generic equivalent becomes available.

You may be responsible for the brand member payment amount plus the difference in cost between the brand

and generic equivalent if you or your doctor requests the reference brand rather than the generic. Generic drugs

have the lowest member payment amount.

Consider talking to your doctor about generic drugs

If your doctor writes a prescription for a brand drug that does not have a generic equivalent, consider asking if an

appropriate generic alternative is available.

You can also let your pharmacist know that you would like a generic equivalent for a brand drug, whenever one is

available. Your pharmacist can usually substitute a generic equivalent for its brand counterpart without a new

prescription from your doctor.

Only your doctor can determine whether a generic alternative is right for you and must prescribe the medication.




III

Coverage considerations

Most prescription drug benefit plans provide coverage for up to a 30-day supply of medication, with some

exceptions. Your plan may also provide coverage for up to a 90-day supply of maintenance medications.

Maintenance medications are those drugs you may take on an ongoing basis for conditions such as high blood

pressure, diabetes or high cholesterol.

Over-the-counter exclusions: Your benefit plan does not provide coverage for prescription medications that

have an over-the-counter version. You should refer to your benefit plan materials for details about your particular

benefits.

Compounded medications: Your benefit plan does not provide coverage for compounded medications. Please

see your plan materials or call the number on the back of your ID card to determine whether compounded

medications are covered and/or verify your payment amount.

Repackaged medications: Repackaged versions of medications already available on the market are not covered.

Prior Authorization (PA): Your benefit plan may require prior authorization for certain drugs. This means that

your doctor will need to submit a prior authorization request for coverage of these medications, and the request

will need to be approved, before the medication will be covered under your plan. For the preferred medications

listed in this document, if a prior authorization is commonly required, it will be noted next to the medication with a

dot under the prior authorization column. Some plans may have prior authorization on additional medications

beyond those noted in this document.

Step Therapy (ST): Your benefit plan may include a step therapy program. This means you may need to try

another proven, cost-effective medication before coverage may be available for the drug included in the program.

Many brand drugs have less-expensive generic or brand alternatives that might be an option for you. For the

preferred medications listed in this document, if a step therapy is commonly required it will generally be noted

next to the medication with a dot under the step therapy column. Some plans may have step therapy programs on

additional medications beyond those noted in this document.

Dispensing Limits (DL): Drug Dispensing limits are designed to help encourage medication use as intended by

the FDA. Coverage limits are placed on medications in certain drug categories. For the preferred medications

listed in this document, if a dispensing limit applies, it will generally be noted next to the medication with a dot

under the dispensing limits column. Limits may include: quantity of covered medication per prescription, quantity

of covered medication in a given time period, coverage only for members within a certain age range, and

coverage only for members of a specific gender. If your doctor prescribes a greater quantity of medication than

what the dispensing limit allows, you can still get the medication. However, you will be responsible for the full cost

of the prescription beyond what your coverage allows.* For a list of medications and their dispensing limits, visit

bcbstx.com.

*Please note: For certain controlled substance medications, some state laws may not allow coverage by a health

benefit plan of such medication if dispensed in a quantity beyond what the dispensing limit allows. You will be

responsible for the full cost of the prescription with no benefits applied if the dispensed quantity exceeds the

dispensing limit.

Limited Distribution (LD): Medicines marked as "Limited Distribution" have restrictions on where you may obtain

a medication. This may include requiring the use of a designated pharmacy to fill a prescription.




IV

ACA Preventive (ACA): Medicines marked in the ACA column are under the Affordable Care Act coverage of

preventive services. These products have limited or $0 member cost-sharing (copay or co-insurance), when

meeting the conditions as outlined under the regulation. These are also indicated with an "A" in the drug tier

column. Examples of these drug categories include aspirin, breast cancer preventive, fluoride supplements, folic

acid supplements, gonorrhea prophylaxis (newborn), iron supplements, tobacco cessation, vaccines, vitamin D

supplements, and some FDA approved contraceptive methods. To see what contraceptive products may be

covered, visit www.bcbstx.com/pdf/rx/contraceptive-list-tx.pdf

Remember, medication decisions are between you and your doctor. Only you and your doctor can determine

which medication is right for you. Discuss any questions or concerns you have about medications you are taking

or are prescribed with your doctor. BCBSTX does not provide health care services and, therefore, cannot

guarantee any results or outcomes.


http://www.bcbstx.com/pdf/rx/contraceptive-list-tx.pdf



V

Specialty drugs

Specialty drugs are used in the treatment of medical conditions such as hepatitis, hemophilia, multiple sclerosis

and rheumatoid arthritis. Specialty drugs may be oral, topical, or injectable medications that can either be self-

administered or administered by a health care professional. For a current list of specialty medications,

visit myprime.com or bcbstx.com and log in to Blue Access for Members.

Note that some drug classes may be excluded by some plans and therefore may not be covered under your

pharmacy benefit. Your plan may have a different coverage level for self-administered specialty drugs. If you

have questions about your coverage for specialty medications or your prescription drug benefit, call the

number on the back of your ID card.

Prime Specialty by AllianceRx Walgreens Prime

Through Prime Specialty by AllianceRx Walgreens Prime, members can have covered specialty medications

delivered directly to them or their doctor’s office. When you receive specialty medications through Prime Specialty

by AllianceRx Walgreens Prime, you also receive at no additional charge the following services:

• Coordination of coverage between you, your doctor and your health plan

• Educational materials about your particular condition and information about managing potential

medication side effects

• Syringes, sharps containers and other supplies with every shipment for self-injectables

• 24/7/365 phone access to a pharmacist for urgent medication issues

To order through Prime Specialty by AllianceRx Walgreens Prime:

• Have your doctor call or fax your prescription to Prime Specialty by AllianceRx Walgreens Prime. Your

doctor can call 877-627-6337 or fax to 877-828-3939.

• If you have an existing prescription for a covered specialty medication, you can call 877-627-6337 to

transfer your prescription.

• A coordinator will contact you to arrange delivery of your medication.

• The prescription can be shipped directly to you or your prescribing doctor’s office. Each package is

individually marked for each member. Refrigerated drugs are shipped in temperature-controlled

packaging.

If you have questions, please contact Prime Specialty by AllianceRx Walgreens Prime at 877-627-6337,

visit www.alliancerxwp.com, or call the number on the back of your ID card.

• Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (“HCSC”).

HCSC is an independent licensee of the Blue Cross Blue Shield Association. HCSC contracts with Prime Therapeutics to provide

pharmacy benefit management and mail order pharmacy services and to administer this specialty pharmacy program. HCSC, as

well as several other independent Blue Cross and Blue Shield licensees, has an ownership interest in Prime Therapeutics LLC.




VI

Abbreviation key

cap ...................................................................... capsules

chew .................................................................. chewable

conc ............................................................. concentrate

cr .......................................................... controlled release

dr ............................................................. delayed release

ec ................................................................ enteric coated

effe................................................................. effervescent

equiv ................................................................ equivalent

er ........................................................... extended release

inhal................................................................... inhalation

inj ......................................................................... injection

liq .............................................................................. liquid

lotn ........................................................................... lotion

nebu ................................................................... nebulizer

odt ............................................. orally disintegrating tabs

oint ..................................................................... ointment

ophth ................................................................. opthalmic

osm .......................................................... osmotic release

powd ..................................................................... powder

sa ............................................................ sustained action

sl ...................................................................... sublingual

soln ....................................................................... solution

sr .......................................................... sustained release

suppos ........................................................ suppositories

susp ................................................................ suspension

tab ...........................................................................tablets

td ................................................................... transdermal

You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List

(also known as a formulary). To request this exception, you, or your prescriber, can call the number on the back

of your ID card to ask for a review. If you have a health condition that may jeopardize your life, health or keep you

from regaining function, or your current drug therapy uses a non-covered drug, you, or your prescriber, may be

able to ask for an expedited review process. BCBSTX will let you, and your prescriber, know the coverage

decision within 24 hours after they receive your request for an expedited review. If the coverage request is

denied, BCBSTX will let you and your prescriber know why it was denied and offer you a covered alternative

drug (if applicable). Call the number on the back of your ID card if you have any questions.



bcbstx.com

bcbstx.com

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To receive language or communication assistance free of charge, please call us at 855-710-6984.

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https://ocrportal.hhs.gov/

http://www.hhs.gov/ocr/office/file/index.html

2016

Texas Residents -- Find and estimate prices for medicines on this formulary at:https://www.myprime.com/v/BCBSTX/COMMERCIAL/TXMKTGNPLS/en/find-medicine.html

BCBSTX Health Insurance Marketplace 5 Tier Generics Plus Preferred Drug List December (2016 Plan Year) 1

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ANTI-INFECTIVE AGENTSPENICILLINSAMOXICILLIN - amoxicillin

(trihydrate) chew tab 125 mg4

AMOXICILLIN - amoxicillin(trihydrate) chew tab 250 mg

4

amoxicillin (trihydrate) cap250 mg

1

amoxicillin (trihydrate) cap500 mg

1

amoxicillin (trihydrate) forsusp 125 mg/5ml

1


1


1


1

amoxicillin (trihydrate) tab500 mg

1

amoxicillin (trihydrate) tab875 mg

1

amoxicillin & k clavulanatefor susp 200-28.5 mg/5ml

2

amoxicillin & k clavulanatefor susp 250-62.5 mg/5ml(Augmentin)

2

amoxicillin & k clavulanatefor susp 400-57 mg/5ml

2

amoxicillin & k clavulanatefor susp 600-42.9 mg/5ml(Augmentin es-600)

2

amoxicillin & k clavulanatetab er 12hr 1000-62.5 mg(Augmentin xr)

2

amoxicillin & k clavulanatetab 250-125 mg

2

Drug Name Dru

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amoxicillin & k clavulanatetab 500-125 mg(Augmentin)

2

amoxicillin & k clavulanatetab 875-125 mg(Augmentin)

2

AMOXICILLIN/CLAVULANATEP - amoxicillin & kclavulanate chew tab200-28.5 mg

2

AMOXICILLIN/CLAVULANATEP - amoxicillin & kclavulanate chew tab 400-57mg

2

AMPICILLIN - ampicillin cap500 mg

1

AUGMENTIN - amoxicillin& k clavulanate for susp125-31.25 mg/5ml

4

dicloxacillin sodium cap250 mg

2

dicloxacillin sodium cap500 mg

2

MOXATAG - amoxicillin(trihydrate) tab er 24hr 775mg

4

PENICILLIN V POTASSIUM -penicillin v potassium forsoln 125 mg/5ml

1

PENICILLIN V POTASSIUM -penicillin v potassium forsoln 250 mg/5ml

1

penicillin v potassium tab250 mg

1

penicillin v potassium tab500 mg

1

CEPHALOSPORINSCEDAX - ceftibuten cap 400

mg4

2016



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CEDAX - ceftibuten for susp180 mg/5ml

4

CEFACLOR - cefaclor for susp125 mg/5ml

4


4


4

cefaclor cap 250 mg 2

cefaclor cap 500 mg 2

CEFACLOR ER - cefaclormonohydrate tab er 12hr500 mg

4

cefadroxil cap 500 mg 1

cefadroxil for susp250 mg/5ml

2

cefadroxil for susp500 mg/5ml

2

cefadroxil tab 1 gm 2

cefdinir cap 300 mg 2

cefdinir for susp 125 mg/5ml 2

cefdinir for susp 250 mg/5ml 2

CEFDITOREN PIVOXIL -cefditoren pivoxil tab 200 mg(base equivalent)

4

CEFDITOREN PIVOXIL -cefditoren pivoxil tab 400 mg(base equivalent)

4

cefixime for susp100 mg/5ml (Suprax)

2

cefixime for susp200 mg/5ml (Suprax)

2

cefpodoxime proxetil forsusp 50 mg/5ml

2

cefpodoxime proxetil forsusp 100 mg/5ml

2

Drug Name Dru

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cefpodoxime proxetil tab100 mg

2

cefpodoxime proxetil tab200 mg

2

cefprozil for susp125 mg/5ml

2

cefprozil for susp250 mg/5ml

2

cefprozil tab 250 mg 2

cefprozil tab 500 mg 2

CEFTIBUTEN - ceftibuten cap400 mg

4

CEFTIBUTEN - ceftibuten forsusp 180 mg/5ml

4

CEFTIN - cefuroxime axetil forsusp 125 mg/5ml

3

CEFTIN - cefuroxime axetil forsusp 250 mg/5ml

4

cefuroxime axetil tab 250 mg(Ceftin)

2

cefuroxime axetil tab 500 mg(Ceftin)

2

CEPHALEXIN - cephalexin tab250 mg

4

CEPHALEXIN - cephalexin tab500 mg

4

cephalexin cap 250 mg(Keflex)

1


1


2

cephalexin for susp125 mg/5ml

2

cephalexin for susp250 mg/5ml

2

2016



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SPECTRACEF - cefditorenpivoxil tab 400 mg (baseequivalent)

4

SUPRAX - cefixime cap 400mg

4

SUPRAX - cefixime chew tab100 mg

4

SUPRAX - cefixime chew tab200 mg

4

SUPRAX - cefixime for susp100 mg/5ml

4


4


4

MACROLIDESAZITHROMYCIN -

azithromycin powd pack forsusp 1 gm

4

azithromycin for susp100 mg/5ml (Zithromax)

2

azithromycin for susp200 mg/5ml (Zithromax)

2

azithromycin tab 250 mg(Zithromax)

1 •


1 •


2 •

CLARITHROMYCIN -clarithromycin for susp 125mg/5ml

2

CLARITHROMYCIN -clarithromycin for susp 250mg/5ml

2

clarithromycin tab er 24hr500 mg

2 •

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clarithromycin tab 250 mg(Biaxin)

2

clarithromycin tab 500 mg(Biaxin)

2

DIFICID - fidaxomicin tab 200mg

4

E.E.S. GRANULES -erythromycin ethylsuccinatefor susp 200 mg/5ml

4

E.E.S. 400 - erythromycinethylsuccinate tab 400 mg

4

ERY-TAB - erythromycin tabdelayed release 250 mg

4


4


4

ERYPED 200 - erythromycinethylsuccinate for susp 200mg/5ml

4

ERYPED 400 - erythromycinethylsuccinate for susp 400mg/5ml

4

ERYTHROCIN STEARATE -erythromycin stearate tab250 mg

4

ERYTHROMYCIN BASE -erythromycin tab 250 mg

4

ERYTHROMYCIN BASE -erythromycin tab 500 mg

4

ERYTHROMYCINETHYLSUCCINA -erythromycin ethylsuccinatetab 400 mg

4

erythromycin ethylsuccinatefor susp 200 mg/5ml (E.e.s.granules)

2

2016



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erythromycin w/ delayedrelease particles cap250 mg

2

PCE - erythromycin w/ entericcoated particles tab 333 mg

4

PCE - erythromycin w/ entericcoated particles tab 500 mg

4

ZITHROMAX - azithromycinpowd pack for susp 1 gm

4

ZMAX - azithromycin extendedrelease for oral susp 2 gm

4

TETRACYCLINESdemeclocycline hcl tab

150 mg2

demeclocycline hcl tab300 mg

2

doxycycline hyclate cap50 mg

2

doxycycline hyclate cap100 mg (Vibramycin)

2

doxycycline hyclate tabdelayed release 50 mg(Doryx)

2 •

doxycycline hyclate tabdelayed release 75 mg

2 •


2 •


2 •

doxycycline hyclate tabdelayed release 200 mg(Doryx)

2 •

doxycycline hyclate tab20 mg

2

doxycycline hyclate tab75 mg (Acticlate)

2

doxycycline hyclate tab100 mg

2

Drug Name Dru

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doxycycline hyclate tab150 mg (Acticlate)

2

doxycycline monohydratecap 50 mg

2

doxycycline monohydratecap 75 mg (Monodox)

2 •

doxycycline monohydratecap 100 mg (Monodox)

2

doxycycline monohydratecap 150 mg (Adoxa)

2 •

doxycycline monohydratefor susp 25 mg/5ml(Vibramycin)

2

doxycycline monohydratetab 50 mg (Adoxa)

2

doxycycline monohydratetab 75 mg (Adoxa)

2

doxycycline monohydratetab 100 mg (Adoxa pak1/100)

2

doxycycline monohydratetab 150 mg (Adoxa pak1/150)

2 •

minocycline hcl cap 50 mg(Minocin)

1


1


1

MINOCYCLINE HCL ER -minocycline hcl tab er 24hr45 mg

2 •

minocycline hcl tab er 24hr90 mg

2 •

minocycline hcl tab er 24hr135 mg

2 •

minocycline hcl tab 50 mg 2


2016



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TETRACYCLINE HCL -tetracycline hcl cap 250 mg

4

TETRACYCLINE HCL -tetracycline hcl cap 500 mg

4

tetracycline hcl cap 250 mg(Tetracycline hcl)

2

tetracycline hcl cap 500 mg(Tetracycline hcl)

2

FLUOROQUINOLONESciprofloxacin for oral

susp 250 mg/5ml (5%)(5 gm/100ml) (Cipro)

2

ciprofloxacin for oralsusp 500 mg/5ml (10%)(10 gm/100ml) (Cipro)

2

CIPROFLOXACIN HCL -ciprofloxacin hcl tab 100 mg(base equiv)

4

ciprofloxacin hcl tab 250 mg(base equiv) (Cipro)

1

ciprofloxacin hcl tab 500 mg(base equiv) (Cipro)

1

ciprofloxacin hcl tab 750 mg(base equiv)

1

ciprofloxacin-ciprofloxacinhcl tab er 24hr 500 mg(base eq) (Cipro xr)

2

ciprofloxacin-ciprofloxacinhcl tab er 24hr1000 mg(base eq) (Cipro xr)

2

FACTIVE - gemifloxacinmesylate tab 320 mg (baseequiv)

4

LEVOFLOXACIN - levofloxacinoral soln 25 mg/ml

2

levofloxacin tab 250 mg(Levaquin)

1

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1


1

moxifloxacin hcl tab 400 mg(base equiv) (Avelox)

2

OFLOXACIN - ofloxacin tab300 mg

4

ofloxacin tab 400 mg 2

AMINOGLYCOSIDESBETHKIS - tobramycin nebu

soln 300 mg/4ml5 • • •

KITABIS PAK - tobramycinnebu soln 300 mg/5ml

5 • • •

neomycin sulfate tab 500 mg 1

paromomycin sulfate cap250 mg

2

TOBI PODHALER - tobramycininhal cap 28 mg

5 • • •

TOBRAMYCIN - tobramycinnebu soln 300 mg/5ml

5 • • •

tobramycin nebu soln300 mg/5ml (Tobi)

5 • • •

SULFONAMIDESSULFADIAZINE - sulfadiazine

tab 500 mg3

ANTIMYCOBACTERIAL AGENTSCYCLOSERINE - cycloserine

cap 250 mg4

ethambutol hcl tab 100 mg(Myambutol)

2

ethambutol hcl tab 400 mg(Myambutol)

2

ISONIAZID - isoniazid syrup 50mg/5ml

4

isoniazid tab 100 mg 1

isoniazid tab 300 mg 1

2016



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its

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A

Lim

ited

Dis

tribu

tion

PASER - aminosalicylic acid ergranules packet 4 gm

4

PRIFTIN - rifapentine tab 150mg

3

pyrazinamide tab 500 mg 2

rifabutin cap 150 mg(Mycobutin)

2

RIFAMATE - isoniazid &rifampin cap 150-300 mg

4

rifampin cap 150 mg (Rifadin) 2

rifampin cap 300 mg (Rifadin) 2

RIFATER - isoniazid-rifampinw/ pyrazinamide tab50-120-300 mg

4

SIRTURO - bedaquilinefumarate tab 100 mg (baseequiv)

4 •

TRECATOR - ethionamide tab250 mg

4

ANTIFUNGALSBIO-STATIN - nystatin cap

500000 unit4

BIO-STATIN - nystatin cap1000000 unit

4

CRESEMBA -isavuconazonium sulfate cap186 mg

4 •

fluconazole for susp 10 mg/ml (Diflucan)

1

fluconazole for susp 40 mg/ml (Diflucan)

2

fluconazole tab 50 mg(Diflucan)

1


1


1

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ited

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tion


2

flucytosine cap 250 mg(Ancobon)

2

flucytosine cap 500 mg(Ancobon)

2

griseofulvin microsize susp125 mg/5ml

2

griseofulvin microsize tab500 mg (Grifulvin v)

2

griseofulvin ultramicrosizetab 125 mg (Gris-peg)

2

griseofulvin ultramicrosizetab 250 mg (Gris-peg)

2

itraconazole cap 100 mg(Sporanox)

2

ketoconazole tab 200 mg 1

NOXAFIL - posaconazole susp40 mg/ml

3 •

NOXAFIL - posaconazole tabdelayed release 100 mg

3 •

nystatin oral powder 2

nystatin tab 500000 unit 2

ONMEL - itraconazole tab 200mg

4

SPORANOX - itraconazole oralsoln 10 mg/ml

4

terbinafine hcl tab 250 mg(Lamisil)

1

voriconazole for susp40 mg/ml (Vfend)

2 •

voriconazole tab 50 mg(Vfend)

2 •

voriconazole tab 200 mg(Vfend)

2 •

ANTIVIRALS

2016



Drug Name Dru

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A

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ited

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tion

abacavir sulfate soln 20 mg/ml (base equiv) (Ziagen)

2 •

abacavir sulfate tab 300 mg(base equiv) (Ziagen)

2 •

abacavir sulfate-lamivudinetab 600-300 mg (Epzicom)

2 •

abacavir sulfate-lamivudine-zidovudine tab300-150-300 mg (Trizivir)

2 •

acyclovir cap 200 mg(Zovirax)

1

acyclovir susp 200 mg/5ml(Zovirax)

2

acyclovir tab 400 mg(Zovirax)

1

acyclovir tab 800 mg(Zovirax)

1

adefovir dipivoxil tab 10 mg(Hepsera)

2

APTIVUS - tipranavir cap 250mg

4 •

APTIVUS - tipranavir oral soln100 mg/ml

4 •

ATRIPLA - efavirenz-emtricitabine-tenofovir df tab600-200-300 mg

3 •

BARACLUDE - entecavir oralsoln 0.05 mg/ml

3

COMPLERA - emtricitabine-rilpivirine-tenofovir df tab200-25-300 mg

4 •

CRIXIVAN - indinavir sulfatecap 200 mg

4 •

CRIXIVAN - indinavir sulfatecap 400 mg

4 •

DAKLINZA - daclatasvirdihydrochloride tab 30 mg(base equivalent)

5 • •

Drug Name Dru

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ited

Dis

tribu

tion


5 • •


5 • •

DESCOVY - emtricitabine-tenofovir alafenamidefumarate tab 200-25 mg

3 •

didanosine delayed releasecapsule 125 mg (Videx ec)

2 •


2 •


2 •


2 •

EDURANT - rilpivirine hcl tab25 mg (base equivalent)

4 •

EMTRIVA - emtricitabine caps200 mg

4 •

EMTRIVA - emtricitabine soln10 mg/ml

4 •

entecavir tab 0.5 mg(Baraclude)

2

entecavir tab 1 mg(Baraclude)

2

EPCLUSA - sofosbuvir-velpatasvir tab 400-100 mg

5 • •

EPIVIR - lamivudine oral soln10 mg/ml

4 •

EPIVIR HBV - lamivudine oralsoln 5 mg/ml (hbv)

4

EPZICOM - abacavir sulfate-lamivudine tab 600-300 mg

3 •

EVOTAZ - atazanavir sulfate-cobicistat tab 300-150 mg(base equiv)

4 •

2016



Drug Name Dru

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ing

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its

AC

A

Lim

ited

Dis

tribu

tion

famciclovir tab 125 mg(Famvir)

2


2


2

fosamprenavir calciumtab 700 mg (base equiv)(Lexiva)

2 •

FUZEON - enfuvirtide for inj 90mg

5 • •

GENVOYA - elvitegrav-cobic-emtricitab-tenofov af tab150-150-200-10 mg

3 •

HARVONI - ledipasvir-sofosbuvir tab 90-400 mg

5 • •

INTELENCE - etravirine tab 25mg

3 •

INTELENCE - etravirine tab100 mg

3 •

INTELENCE - etravirine tab200 mg

3 •

INVIRASE - saquinavirmesylate cap 200 mg

4 •

INVIRASE - saquinavirmesylate tab 500 mg

4 •

ISENTRESS - raltegravirpotassium chew tab 25 mg(base equiv)

3 •

ISENTRESS - raltegravirpotassium chew tab 100 mg(base equiv)

3 •

ISENTRESS - raltegravirpotassium packet for susp100 mg (base equiv)

3 •

ISENTRESS - raltegravirpotassium tab 400 mg (baseequiv)

3 •

Drug Name Dru

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A

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ited

Dis

tribu

tion

ISENTRESS HD - raltegravirpotassium tab 600 mg (baseequiv)

3 •

KALETRA - lopinavir-ritonavirsoln 400-100 mg/5ml (80-20mg/ml)

3 •

KALETRA - lopinavir-ritonavirtab 100-25 mg

3 •

KALETRA - lopinavir-ritonavirtab 200-50 mg

3 •

lamivudine oral soln 10 mg/ml (Epivir)

2 •

lamivudine tab 100 mg (hbv)(Epivir hbv)

2

lamivudine tab 150 mg(Epivir)

2 •

lamivudine tab 300 mg(Epivir)

2 •

lamivudine-zidovudine tab150-300 mg (Combivir)

2 •

LEXIVA - fosamprenavircalcium susp 50 mg/ml(base equiv)

4 •

LEXIVA - fosamprenavircalcium tab 700 mg (baseequiv)

4 •

lopinavir-ritonavir soln400-100 mg/5ml (80-20 mg/ml) (Kaletra)

2 •

MODERIBA - ribavirin tab 200mg & ribavirin 400 mg tabtherapy pack

5 • •

MODERIBA - ribavirin tab 400mg & ribavirin 600 mg tabtherapy pack

5 • •

MODERIBA 1200 DOSEPACK - ribavirin tab 600 mg

5 • •

MODERIBA 800 DOSE PACK -ribavirin tab 400 mg

5 • •

2016



Drug Name Dru

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A

Lim

ited

Dis

tribu

tion

nevirapine tab er 24hr100 mg (Viramune xr)

2 •

nevirapine tab er 24hr400 mg (Viramune xr)

2 •

nevirapine tab 200 mg(Viramune)

1 •

NORVIR - ritonavir cap 100 mg 4 •NORVIR - ritonavir oral soln 80

mg/ml3 •

NORVIR - ritonavir tab 100 mg 3 •ODEFSEY - emtricitabine-

rilpivirine-tenofovir af tab200-25-25 mg

3 •

OLYSIO - simeprevir sodiumcap 150 mg (baseequivalent)

5 • •

oseltamivir phosphatecap 30 mg (base equiv)(Tamiflu)

2 •


2 •


2 •

PEGASYS - peginterferonalfa-2a inj 180 mcg/ml

5 • •

PEGASYS - peginterferonalfa-2a inj 180 mcg/0.5ml

5 • •

PEGASYS PROCLICK -peginterferon alfa-2a inj 135mcg/0.5ml

5 • •

PEGASYS PROCLICK -peginterferon alfa-2a inj 180mcg/0.5ml

5 • •

PEGINTRON - peginterferonalfa-2b for inj kit 50mcg/0.5ml

5 • •

Drug Name Dru

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A

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ited

Dis

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tion


5 • •


5 • •


5 • •

PREZCOBIX - darunavir-cobicistat tab 800-150 mg

4 •

PREZISTA - darunavirethanolate susp 100 mg/ml(base equiv)

3 •

PREZISTA - darunavirethanolate tab 75 mg (baseequiv)

3 •


3 •


3 •


3 •

REBETOL - ribavirin soln 40mg/ml

5 • •

RELENZA DISKHALER -zanamivir aero powderbreath activated 5 mg/blister

4 •

RESCRIPTOR - delavirdinemesylate tab 100 mg

4 •

RESCRIPTOR - delavirdinemesylate tab 200 mg

4 •

REYATAZ - atazanavir sulfatecap 150 mg (base equiv)

3 •


3 •

2016



Drug Name Dru

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ited

Dis

tribu

tion


3 •

REYATAZ - atazanavir sulfateoral powder packet 50 mg(base equiv)

4 •

RIBASPHERE - ribavirin tab400 mg

5 • •

RIBASPHERE - ribavirin tab600 mg

5 • •

RIBASPHERE RIBAPAK -ribavirin tab 200 mg &ribavirin 400 mg tab therapypack

5 • •

RIBASPHERE RIBAPAK -ribavirin tab 400 mg &ribavirin 600 mg tab therapypack

5 • •

RIBASPHERE RIBAPAK -ribavirin tab 400 mg

5 • •

RIBASPHERE RIBAPAK -ribavirin tab 600 mg

5 • •

ribavirin cap 200 mg(Rebetol)

5 • •

ribavirin for inhal soln 6 gm(Virazole)

2

ribavirin tab 200 mg(Copegus)

5 • •

rimantadine hydrochloridetab 100 mg (Flumadine)

2

SELZENTRY - maraviroc oralsoln 20 mg/ml

4 •

SELZENTRY - maraviroc tab25 mg

4 •


4 •


4 •

Drug Name Dru

g Ti

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Prio

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horiz

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n

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y

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A

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ited

Dis

tribu

tion


4 •

SITAVIG - acyclovir buccal tab50 mg

4

SOVALDI - sofosbuvir tab 400mg

5 • •

stavudine cap 15 mg (Zerit) 2 •stavudine cap 20 mg (Zerit) 2 •stavudine cap 30 mg (Zerit) 2 •stavudine cap 40 mg (Zerit) 2 •STRIBILD - elvitegrav-cobic-

emtricitab-tenofovdf tab150-150-200-300 mg

3 •

SUSTIVA - efavirenz cap 50mg

3 •

SUSTIVA - efavirenz cap 200mg

3 •

SUSTIVA - efavirenz tab 600mg

3 •

TAMIFLU - oseltamivirphosphate cap 30 mg (baseequiv)

4 •


4 •


4 •

TAMIFLU - oseltamivirphosphate for susp 6 mg/ml(base equiv)

4 •

TECHNIVIE - ombitasvir-paritaprevir-ritonavir tab12.5-75-50 mg

5 • •

TIVICAY - dolutegravir sodiumtab 10 mg (base equiv)

3 •


3 •

2016



Drug Name Dru

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its

AC

A

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ited

Dis

tribu

tion


3 •

TRIUMEQ - abacavir-dolutegravir-lamivudine tab600-50-300 mg

4 •

TRUVADA - emtricitabine-tenofovir disoproxil fumaratetab 100-150 mg

3 •


3 •


3 •


3 •

TYBOST - cobicistat tab 150mg

4 •

valacyclovir hcl tab 500 mg(Valtrex)

2

valacyclovir hcl tab 1 gm(Valtrex)

2

VALCYTE - valganciclovir hclfor soln 50 mg/ml (baseequiv)

3

valganciclovir hcl for soln50 mg/ml (base equiv)(Valcyte)

2

valganciclovir hcl tab450 mg (base equivalent)(Valcyte)

2

VIDEX - didanosine for soln 2gm

3 •

VIDEX - didanosine for soln 4gm

3 •

VIEKIRA PAK - ombitas-paritapre-riton & dasab tabpak 12.5-75-50 & 250 mg

5 • •

Drug Name Dru

g Ti

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Lim

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A

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ited

Dis

tribu

tion

VIEKIRA XR - dasab-ombit-paritap-riton tab er 24hr200-8.33-50-33.33 mg

5 • •

VIRACEPT - nelfinavirmesylate tab 250 mg

4 •

VIRACEPT - nelfinavirmesylate tab 625 mg

4 •

VIRAMUNE - nevirapine susp50 mg/5ml

3 •

VIRAMUNE XR - nevirapinetab er 24hr 100 mg

4 •

VIRAZOLE - ribavirin for inhalsoln 6 gm

4

VIREAD - tenofovir disoproxilfumarate oral powder 40 mg/gm

3 •

VIREAD - tenofovir disoproxilfumarate tab 150 mg

3 •


3 •


3 •


3 •

ZEPATIER - elbasvir-grazoprevir tab 50-100 mg

5 • •

ZERIT - stavudine for oral soln1 mg/ml

4 •

ZIAGEN - abacavir sulfate soln20 mg/ml (base equiv)

3 •

zidovudine cap 100 mg(Retrovir)

2 •

zidovudine syrup 10 mg/ml(Retrovir)

2 •

zidovudine tab 300 mg 2 •ANTIMALARIALSatovaquone-proguanil hcl

tab 62.5-25 mg (Malarone)2

2016



Drug Name Dru

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A

Lim

ited

Dis

tribu

tion

atovaquone-proguanil hcltab 250-100 mg (Malarone)

2

CHLOROQUINEPHOSPHATE - chloroquinephosphate tab 250 mg

1

chloroquine phosphate tab500 mg (Aralen)

1

COARTEM - artemether-lumefantrine tab 20-120 mg

4

DARAPRIM - pyrimethaminetab 25 mg

3 •

hydroxychloroquine sulfatetab 200 mg (Plaquenil)

1

mefloquine hcl tab 250 mg 2

PRIMAQUINE PHOSPHATE -primaquine phosphate tab26.3 mg (15 mg base)

3

quinine sulfate cap 324 mg(Qualaquin)

2

ANTHELMINTICSALBENZA - albendazole tab

200 mg3

BILTRICIDE - praziquantel tab600 mg

3

EMVERM - mebendazole chewtab 100 mg

4

ivermectin tab 3 mg(Stromectol)

2

ANTI-INFECTIVE AGENTS - MISC.ALINIA - nitazoxanide for susp

100 mg/5ml4 •

ALINIA - nitazoxanide tab 500mg

4 •

atovaquone susp750 mg/5ml (Mepron)

2

CAYSTON - aztreonam lysinefor inhal soln 75 mg (baseequivalent)

5 • • •

Drug Name Dru

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A

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ited

Dis

tribu

tion

clindamycin hcl cap 75 mg(Cleocin)

1


1


1

clindamycin palmitate hclfor soln 75 mg/5ml (baseequiv) (Cleocin pediatric gr)

2

dapsone tab 25 mg 2

dapsone tab 100 mg 2

IMPAVIDO - miltefosine cap 50mg

3

linezolid for susp100 mg/5ml (Zyvox)

2 •

linezolid tab 600 mg (Zyvox) 2 •metronidazole cap 375 mg

(Flagyl)2

metronidazole tab 250 mg(Flagyl)

1

metronidazole tab 500 mg(Flagyl)

1

NEBUPENT - pentamidineisethionate for nebulizationsoln 300 mg

4

PRIMSOL - trimethoprim hcloral soln 50 mg/5ml (baseequiv)

4

SIVEXTRO - tedizolidphosphate tab 200 mg

4

sulfamethoxazole-trimethoprim susp200-40 mg/5ml

1

sulfamethoxazole-trimethoprim tab400-80 mg (Bactrim)

1

2016



Drug Name Dru

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its

AC

A

Lim

ited

Dis

tribu

tion

sulfamethoxazole-trimethoprim tab800-160 mg (Bactrim ds)

1

tinidazole tab 250 mg(Tindamax)

2

tinidazole tab 500 mg(Tindamax)

2

trimethoprim tab 100 mg 1

vancomycin hcl cap 125 mg(Vancocin hcl)

2

vancomycin hcl cap 250 mg(Vancocin hcl)

2

XIFAXAN - rifaximin tab 200mg

4 •

XIFAXAN - rifaximin tab 550mg

3 •

ZYVOX - linezolid for susp 100mg/5ml

4 •

ZYVOX - linezolid tab 600 mg 4 •BIOLOGICALSVACCINESAFLURIA PF 2017-2018 -

influenza virus vaccine splitpf susp pref syringe 0.5 ml

A •

AFLURIA QUADRIVALENT2017 - influenza virus vacsplit quadrivalent susp prefsyr 0.5ml

A •

AFLURIA QUADRIVALENT2017 - influenza virusvaccine split quadrivalent iminj

A •

AFLURIA 2017-2018 -influenza virus vaccine splitim susp

A •

ENGERIX-B - hepatitis bvaccine (recombinant) susp10 mcg/0.5ml

A •

Drug Name Dru

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A

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ited

Dis

tribu

tion

ENGERIX-B - hepatitis bvaccine (recombinant) susp20 mcg/ml

A •

ENGERIX-B - hepatitis bvaccine (recombinant) 10mcg/0.5ml

A •

ENGERIX-B - hepatitis bvaccine (recombinant) 20mcg/ml

A •

FLUAD 2017-2018 - influenzavac type a&b surface ant adjsusp pref syr 0.5 ml

A •

FLUARIX QUADRIVALENT2017 - influenza virus vacsplit quadrivalent susp prefsyr 0.5ml

A •

FLUBLOK QUADRIVALENT2017 - influenza vac recombha quad pf soln pref syr 0.5ml

A •

FLUBLOK 2015-2016 -influenza virus vacrecombinant hemagglutinin(ha) pf inj

A •

FLUBLOK 2017-2018 -influenza virus vacrecombinant hemagglutinin(ha) pf inj

A •

FLUCELVAX QUADRIVALENT20 - influenza vac tiss-cultsubunt quad susp pref syr0.5 ml

A •

FLUCELVAX QUADRIVALENT20 - influenza vac tissue-cultured subunit quadrivalentim susp

A •

FLULAVAL QUADRIVALENT201 - influenza virus vac splitquadrivalent susp pref syr0.5ml

A •

2016



Drug Name Dru

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Lim

its

AC

A

Lim

ited

Dis

tribu

tion

FLULAVAL QUADRIVALENT201 - influenza virus vaccinesplit quadrivalent im inj

A •

FLUMIST QUADRIVALENT -influenza virus vaccine livequadrivalent intranasal susp

A •

FLUVIRIN 2015-2016 -influenza vac type a&bsurface antigen susp pref syr0.5 ml

A •

FLUVIRIN 2015-2016 -influenza virus vaccine typesa & b surface antigen imsusp

A •

FLUVIRIN 2017-2018 -influenza vac type a&bsurface antigen susp pref syr0.5 ml

A •

FLUVIRIN 2017-2018 -influenza virus vaccine typesa & b surface antigen imsusp

A •

FLUZONE HIGH-DOSE PF2017 - influenza virus vacsplit high-dose pf susp prefsyr 0.5ml

A •

FLUZONE INTRADERMALQUADR - influenza virus vacsplit quad intradermal pen 9mcg/strain

A •

FLUZONE QUADRIVALENT2017 - influenza virus vacsplit quadrivalent susp prefsyr 0.25 ml

A •

FLUZONE QUADRIVALENT2017 - influenza virus vacsplit quadrivalent susp prefsyr 0.5ml

A •

Drug Name Dru

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Lim

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A

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ited

Dis

tribu

tion

FLUZONE QUADRIVALENT2017 - influenza virusvaccine split quadrivalent iminj

A •

IMOVAX RABIES (H.D.C.V.) -rabies virus vaccine, hdc inj

A •

PNEUMOVAX 23 -pneumococcal vaccinepolyvalent inj 25 mcg/0.5ml

A •

PNEUMOVAX 23/1 DOSE -pneumococcal vaccinepolyvalent inj 25 mcg/0.5ml

A •

PREVNAR 13 - Pneumococcal13-valent conjugate vaccineinj

A •

RABAVERT - rabies vaccine,pcec for inj

A •

RECOMBIVAX HB - hepatitis bvaccine (recombinant) susp5 mcg/0.5ml

A •

RECOMBIVAX HB - hepatitis bvaccine (recombinant) susp10 mcg/ml

A •

RECOMBIVAX HB - hepatitis bvaccine (recombinant) susp40 mcg/ml

A •

VIVOTIF - typhoid vaccine capdelayed release

4

ZOSTAVAX - zoster vaccinelive for subcutaneous susp19400 unit/0.65ml

A •

TOXOIDSADACEL - tet tox-diph-acell

pertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml

A •

BOOSTRIX - tet tox-diph-acellpertuss ad inj 5-2.5-18.5 lf-lf-mcg/0.5ml

A •

2016



Drug Name Dru

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A

Lim

ited

Dis

tribu

tion

DAPTACEL - diph, acellularpert & tet tox inj 15 lf-23mcg-5 lf/0.5ml

4

DIPHTHERIA/TETANUSTOXOID - diphtheria-tetanustox adsorbed (dt) im inj 25-5unit/0.5ml

4

INFANRIX - diph, acellular pert& tet tox inj 25 lf-58 mcg-10lf/0.5ml

4

KINRIX - diph-tetanus tox ad-acell pert & polio virus, ipvvac inj

4

PEDIARIX - diph-tetanus tox-acell pert-hepatitis b-polioipv vac inj

4

PENTACEL - diph-ac per-tettox ad-poliov-haemoph bpoly vac for im susp

4

QUADRACEL - diph-tetanustox ad-acell pert & poliovirus, ipv vac inj

4

TENIVAC - tetanus-diphtheriatoxoids (td) inj 5-2 lfu

4

TETANUS/DIPHTHERIATOXOID - tetanus-diphtheriatoxoids (td) inj 2-2 lf/0.5ml

4

PASSIVE IMMUNIZING AGENTSHEPAGAM B - hepatitis b

immune globulin (human) injsoln

4

HYPERHEP B S/D - hepatitis bimmune globulin (human) iminj soln

4

HYPERRAB S/D - rabiesimmune globulin (human) inj150 unit/ml

4

Drug Name Dru

g Ti

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n

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Dis

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Lim

its

AC

A

Lim

ited

Dis

tribu

tion

HYPERTET S/D - tetanusimmune globulin (human) inj250 unit/ml

4

HYQVIA - immun glob inj 2.5gm/25ml-hyaluron inj 200unt/1.25 ml kit

4 • •

HYQVIA - immun glob inj 5gm/50ml-hyaluron inj 400unt/2.5 ml kit

4 • •

HYQVIA - immun glob inj 10gm/100ml-hyaluron inj 800unt/5 ml kit

4 • •


4 • •


4 • •

IMOGAM RABIES-HT - rabiesimmune globulin (human) inj150 unit/ml

4

NABI-HB - hepatitis b immuneglobulin (human) im inj soln

4

VARIZIG - varicella-zosterimmune glob (human) im inj125 unit/1.2ml

4

BIOLOGICALS MISCGRASTEK - timothy grass

pollen allergen ext tab sl2800 bau

4 • •

ORALAIR - grass mixed pollenext tab sl 300 ir (index ofreactivity)

4 • • •

RAGWITEK - short ragweedpollen allergen extract tab sl12 amb a 1-u

4 • •

ANTINEOPLASTIC AGENTSANTINEOPLASTICS

2016



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ACTIMMUNE - interferongamma-1b inj 100mcg/0.5ml (2000000unit/0.5ml)

5 • •

AFINITOR - everolimus tab 2.5mg

5 • • •

AFINITOR - everolimus tab 5mg

5 • • •

AFINITOR - everolimus tab 7.5mg

5 • • •

AFINITOR - everolimus tab 10mg

5 • • •

AFINITOR DISPERZ -everolimus tab for oral susp2 mg

5 • • •


5 • • •


5 • • •

ALECENSA - alectinib hcl cap150 mg (base equivalent)

5 • • •

ALKERAN - melphalan tab 2mg

3

ALUNBRIG - brigatinib tab 30mg

5 • • •

anastrozole tab 1 mg(Arimidex)

1

bexarotene cap 75 mg(Targretin)

5 • •

bicalutamide tab 50 mg(Casodex)

1

BOSULIF - bosutinib tab 100mg

5 • • •

BOSULIF - bosutinib tab 500mg

5 • • •

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ited

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tion

CABOMETYX - cabozantinibs-malate tab 20 mg (baseequivalent)

5 • • •


5 • • •


5 • • •

capecitabine tab 150 mg(Xeloda)

5 • •

capecitabine tab 500 mg(Xeloda)

5 • •

CAPRELSA - vandetanib tab100 mg

5 • • •

CAPRELSA - vandetanib tab300 mg

5 • • •

COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 1 x 20mg (100 dose) kit

5 • • •

COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 3 x 20mg (140 dose) kit

5 • • •

COMETRIQ - cabozantinib s-malate cap 3 x 20 mg (60mg dose) kit

5 • • •

COTELLIC - cobimetinibfumarate tab 20 mg (baseequivalent)

5 • • •

CYCLOPHOSPHAMIDE -cyclophosphamide cap 25mg

4

CYCLOPHOSPHAMIDE -cyclophosphamide cap 50mg

4

ELIGARD - leuprolide acetate(3 month) for subcutaneousinj kit 22.5mg

5 • •

2016



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tion

ELIGARD - leuprolide acetate(4 month) for subcutaneousinj kit 30 mg

5 • •

ELIGARD - leuprolide acetate(6 month) for subcutaneousinj kit 45 mg

5 • •

ELIGARD - leuprolide acetatefor subcutaneous inj kit 7.5mg

5 • •

EMCYT - estramustinephosphate sodium cap 140mg

4

ERIVEDGE - vismodegib cap150 mg

5 • • •

ETOPOSIDE - etoposide cap50 mg

4

exemestane tab 25 mg(Aromasin)

2

FARESTON - toremifene citratetab 60 mg (base equivalent)

4

FARYDAK - panobinostatlactate cap 10 mg (baseequivalent)

5 • • •


5 • • •


5 • • •

flutamide cap 125 mg 2

GILOTRIF - afatinib dimaleatetab 20 mg (base equivalent)

5 • • •


5 • • •


5 • • •

GLEEVEC - imatinibmesylate tab 100 mg (baseequivalent)

5 • • •

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GLEEVEC - imatinibmesylate tab 400 mg (baseequivalent)

5 • • •

GLEOSTINE - lomustine cap 5mg

4

GLEOSTINE - lomustine cap10 mg

4


4


4

HEXALEN - altretamine cap 50mg

5 • •

HYCAMTIN - topotecan hcl cap0.25 mg (base equiv)

5 • •

HYCAMTIN - topotecan hcl cap1 mg (base equiv)

5 • •

hydroxyurea cap 500 mg(Hydrea)

2

IBRANCE - palbociclib cap 75mg

5 • • •


5 • • •


5 • • •

ICLUSIG - ponatinib hcl tab 15mg (base equiv)

5 • • •

ICLUSIG - ponatinib hcl tab 45mg (base equiv)

5 • • •

imatinib mesylate tab100 mg (base equivalent)(Gleevec)

5 • • •

imatinib mesylate tab400 mg (base equivalent)(Gleevec)

5 • • •

IMBRUVICA - ibrutinib cap 140mg

5 • • •

INLYTA - axitinib tab 1 mg 5 • • •

2016



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tion

INLYTA - axitinib tab 5 mg 5 • • •INTRON A - interferon alfa-2b

inj 6000000 unit/ml5 • •

INTRON A - interferon alfa-2binj 10000000 unit/ml

5 • •

INTRON A - interferon alfa-2bfor inj 10000000 unit

5 • •


5 • •


5 • •

INTRON A W/DILUENT -interferon alfa-2b for inj10000000 unit

5 • •


5 • •


5 • •

IRESSA - gefitinib tab 250 mg 5 • • •JAKAFI - ruxolitinib phosphate

tab 5 mg (base equivalent)5 • • •

JAKAFI - ruxolitinib phosphatetab 10 mg (base equivalent)

5 • • •


5 • • •


5 • • •


5 • • •

KISQALI - ribociclib succinatetab 200 mg (base equiv)

5 • • •

KISQALI FEMARA 200 DOSE -ribociclib tab 200 mg &letrozole tab 2.5 mg therapypack

5 • • •

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5 • • •


5 • • •

LENVIMA 10 MG DAILYDOSE - lenvatinib captherapy pack 10 mg (10 mgdaily dose)

5 • • •

LENVIMA 14 MG DAILYDOSE - lenvatinib captherapy pack 10 & 4 mg (14mg daily dose)

5 • • •

LENVIMA 18 MG DAILYDOSE - lenvatinib captherapy pack 10 & 4 (2) mg(18 mg daily dose)

5 • • •

LENVIMA 20 MG DAILYDOSE - lenvatinib captherapy pack 10 (2) mg (20mg daily dose)

5 • • •

LENVIMA 24 MG DAILYDOSE - lenvatinib captherapy pack 10 (2) & 4 mg(24 mg daily dose)

5 • • •

LENVIMA 8 MG DAILY DOSE -lenvatinib cap therapy pack4 (2) mg (8 mg daily dose)

5 • • •

letrozole tab 2.5 mg (Femara) 1

LEUCOVORIN CALCIUM -leucovorin calcium tab 10mg

3

LEUCOVORIN CALCIUM -leucovorin calcium tab 15mg

3

leucovorin calcium tab 5 mg 2

2016



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ited

Dis

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tion

leucovorin calcium tab25 mg

2

LEUKERAN - chlorambucil tab2 mg

3

leuprolide acetate inj kit5 mg/ml

5 • •

LONSURF - trifluridine-tipiraciltab 15-6.14 mg

5 • • •

LONSURF - trifluridine-tipiraciltab 20-8.19 mg

5 • • •

LYNPARZA - olaparib cap 50mg

5 • • •

LYSODREN - mitotane tab 500mg

5 • •

MATULANE - procarbazine hclcap 50 mg

5 • •

megestrol acetate susp40 mg/ml (Megace oral)

2

megestrol acetate tab 20 mg 1

megestrol acetate tab 40 mg 1

MEKINIST - trametinib dimethylsulfoxide tab 0.5 mg (baseequivalent)

5 • • •

MEKINIST - trametinib dimethylsulfoxide tab 2 mg (baseequivalent)

5 • • •

melphalan tab 2 mg (Alkeran) 2

mercaptopurine tab 50 mg 2

MESNEX - mesna tab 400 mg 4

METHOTREXATE SODIUM -methotrexate sodium inj 250mg/10ml (25 mg/ml)

1

methotrexate sodium for inj1 gm

2

methotrexate sodium inj pf50 mg/2ml (25 mg/ml)

1

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1


1


1


1

methotrexate sodium inj50 mg/2ml (25 mg/ml)

1

methotrexate sodium tab2.5 mg (base equiv)

2

MYLERAN - busulfan tab 2 mg 3

NEXAVAR - sorafenibtosylate tab 200 mg (baseequivalent)

5 • • •

NILANDRON - nilutamide tab150 mg

4

nilutamide tab 150 mg(Nilandron)

2

NINLARO - ixazomibcitrate cap 2.3 mg (baseequivalent)

5 • • •

NINLARO - ixazomib citratecap 3 mg (base equivalent)

5 • • •

NINLARO - ixazomib citratecap 4 mg (base equivalent)

5 • • •

ODOMZO - sonidegibphosphate cap 200 mg(base equivalent)

5 • • •

POMALYST - pomalidomidecap 1 mg

5 • • •


5 • • •


5 • • •


5 • • •

2016



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ited

Dis

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tion

PURIXAN - mercaptopurinesusp 2000 mg/100ml (20mg/ml)

5 •

RUBRACA - rucaparibcamsylate tab 200 mg (baseequivalent)

5 • • •


5 • • •


5 • • •

RYDAPT - midostaurin cap 25mg

5 • • •

SOLTAMOX - tamoxifen citrateoral soln 10 mg/5ml (baseequivalent)

4

SPRYCEL - dasatinib tab 20mg

5 • • •


5 • • •


5 • • •


5 • • •


5 • • •


5 • • •

STIVARGA - regorafenib tab 40mg

5 • • •

SUTENT - sunitinib malate cap12.5 mg (base equivalent)

5 • • •

SUTENT - sunitinib malate cap25 mg (base equivalent)

5 • • •

SUTENT - sunitinib malate cap37.5 mg (base equivalent)

5 • • •

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SUTENT - sunitinib malate cap50 mg (base equivalent)

5 • • •

SYLATRON - peginterferonalfa-2b for inj kit 200 mcg

5 • •


5 • •


5 • •

TABLOID - thioguanine tab 40mg

4 •

TAFINLAR - dabrafenibmesylate cap 50 mg (baseequivalent)

5 • • •

TAFINLAR - dabrafenibmesylate cap 75 mg (baseequivalent)

5 • • •

TAGRISSO - osimertinibmesylate tab 40 mg (baseequivalent)

5 • • •

TAGRISSO - osimertinibmesylate tab 80 mg (baseequivalent)

5 • • •

tamoxifen citrate tab 10 mg(base equivalent)

1 •

tamoxifen citrate tab 20 mg(base equivalent)

1 •

TARCEVA - erlotinib hcl tab 25mg (base equivalent)

5 • • •

TARCEVA - erlotinib hcl tab100 mg (base equivalent)

5 • • •

TARCEVA - erlotinib hcl tab150 mg (base equivalent)

5 • • •

TARGRETIN - bexarotene cap75 mg

5 • •

TASIGNA - nilotinib hcl cap 150mg (base equivalent)

5 • • •

TASIGNA - nilotinib hcl cap 200mg (base equivalent)

5 • • •

2016



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ited

Dis

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temozolomide cap 5 mg(Temodar)

5 • •


5 • •


5 • •


5 • •


5 • •


5 • •

tretinoin cap 10 mg 5 • •TREXALL - methotrexate

sodium tab 5 mg (baseequiv)

4

TREXALL - methotrexatesodium tab 7.5 mg (baseequiv)

4

TREXALL - methotrexatesodium tab 10 mg (baseequiv)

4

TREXALL - methotrexatesodium tab 15 mg (baseequiv)

4

TYKERB - lapatinib ditosylatetab 250 mg (base equiv)

5 • • •

VENCLEXTA - venetoclax tab10 mg

5 • • •


5 • • •


5 • • •

VENCLEXTA STARTINGPACK - venetoclax tabtherapy starter pack 10 & 50& 100 mg

5 • • •

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VOTRIENT - pazopanib hcl tab200 mg (base equiv)

5 • • •

XALKORI - crizotinib cap 200mg

5 • • •

XALKORI - crizotinib cap 250mg

5 • • •

XTANDI - enzalutamide cap 40mg

5 • • •

ZEJULA - niraparib tosylatecap 100 mg (baseequivalent)

5 • • •

ZELBORAF - vemurafenib tab240 mg

5 • • •

ZOLINZA - vorinostat cap 100mg

5 • • •

ZYDELIG - idelalisib tab 100mg

5 • • •

ZYDELIG - idelalisib tab 150mg

5 • • •

ZYKADIA - ceritinib cap 150mg

5 • • •

ZYTIGA - abiraterone acetatetab 250 mg

5 • • •

ZYTIGA - abiraterone acetatetab 500 mg

5 • • •

ENDOCRINE AND METABOLIC DRUGSCORTICOSTEROIDSACTIVE INJECTION KIT KL-3 -

triamcinolone inj 40 mg/ml &lidocaine 1% & ammonia inhkit

4

budesonide delayedrelease particles cap 3 mg(Entocort ec)

2

CORTISONE ACETATE -cortisone acetate tab 25 mg

3

2016



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DEXAMETHASONE -dexamethasone soln 0.5mg/5ml

4

DEXAMETHASONE -dexamethasone tab 1 mg

4

DEXAMETHASONE -dexamethasone tab 2 mg

4

dexamethasone elixir0.5 mg/5ml

2

DEXAMETHASONEINTENSOL - dexamethasoneconc 1 mg/ml

4

dexamethasone tab 0.5 mg 1



dexamethasone tab 4 mg 1

dexamethasone tab 6 mg 1

DEXPAK 10 DAY -dexamethasone tab therapypack 1.5 mg (35)

4


4


4 • •

fludrocortisone acetate tab0.1 mg

2

hydrocortisone tab 5 mg(Cortef)

2


2


2

JTT PHYSICIANS KIT -triamcinolone inj 40 mg/ml &lidocaine 1% & ammonia inhkit

4

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ited

Dis

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tion

MEDROL - methylprednisolonetab 2 mg

4

methylprednisolone tabtherapy pack 4 mg (21)(Medrol dosepak)

2

methylprednisolone tab4 mg (Medrol)

2


2


2


2

MILLIPRED - prednisolonesod phosphate oral soln 10mg/5ml (base equiv)

4

MILLIPRED - prednisolone tab5 mg

4

MILLIPRED DP - prednisolonetab therapy pack 5 mg (21)

4

MILLIPRED DP - prednisolonetab therapy pack 5 mg (48)

4

PHYSICIANS EZ USE JOINTT - triamcinolone inj 40 mg/ml& lidocaine 1% & ammoniainh kit

4

prednisolone sod phosorally disintegr tab 10 mg(base eq) (Orapred odt)

2


2


2

prednisolone sod phosphoral soln 6.7 mg/5ml(5 mg/5ml base)(Pediapred)

2

2016



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ited

Dis

tribu

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prednisolone sod phosphateoral soln 15 mg/5ml (baseequiv)

1

prednisolone sod phosphateoral soln 10 mg/5ml (baseequiv) (Millipred)

2

prednisolone sod phosphateoral soln 20 mg/5ml (baseequiv) (Veripred 20)

2

PREDNISOLONE SODIUMPHOSP - prednisolonesodium phosphate oral soln25 mg/5ml (base eq)

4

prednisolone syrup15 mg/5ml (usp solutionequivalent)

1

PREDNISONE - prednisoneoral soln 5 mg/5ml

4

PREDNISONE - prednisonetab therapy pack 5 mg (21)

4


4


4


4

PREDNISONE - prednisonetab 50 mg

4

PREDNISONE INTENSOL -prednisone conc 5 mg/ml

4

prednisone tab 1 mg 1

prednisone tab 2.5 mg 1




RAYOS - prednisone tabdelayed release 1 mg

4

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Dis

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4


4

UCERIS - budesonide tab er24hr 9 mg

4

VERIPRED 20 - prednisolonesod phosphate oral soln 20mg/5ml (base equiv)

4

ANDROGEN-ANABOLICANADROL-50 - oxymetholone

tab 50 mg4 •

ANDROGEL - testosterone tdgel 25 mg/2.5gm (1%)

4 • •

ANDROGEL - testosterone tdgel 50 mg/5gm (1%)

4 • •

ANDROGEL - testosteronetd gel 20.25 mg/1.25gm(1.62%)

4 • •

ANDROGEL - testosterone tdgel 40.5 mg/2.5gm (1.62%)

4 • •

ANDROGEL PUMP -testosterone td gel 20.25mg/act (1.62%)

4 • •

danazol cap 50 mg 2 •danazol cap 100 mg 2 •danazol cap 200 mg 2 •DEPO-TESTOSTERONE -

testosterone cypionate im injin oil 100 mg/ml

4 • •

DEPO-TESTOSTERONE -testosterone cypionate im injin oil 200 mg/ml

4 • •

FORTESTA - testosterone tdgel 10mg/act (2%)

4 • •

METHITEST -methyltestosterone oral tab10 mg

4 •

2016



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ited

Dis

tribu

tion

methyltestosterone cap10 mg (Testred)

2 •

oxandrolone tab 2.5 mg(Oxandrin)

2 •

oxandrolone tab 10 mg(Oxandrin)

2 •

testosterone cypionate iminj in oil 100 mg/ml (Depo-testosterone)

2 • •

testosterone cypionate iminj in oil 200 mg/ml (Depo-testosterone)

2 • •

testosterone enanthate iminj in oil 200 mg/ml

2 • •

testosterone td gel25 mg/2.5gm (1%)(Androgel)

2 • •

testosterone td gel50 mg/5gm (1%) (Androgel)

2 • •

testosterone td gel 12.5 mg/act (1%) (Androgel pump)

2 • •

testosterone td soln 30 mg/act (Axiron)

2 • •

ESTROGENSALORA - estradiol td patch

twice weekly 0.025 mg/24hr4 •

ALORA - estradiol td patchtwice weekly 0.05 mg/24hr

4 •


4 •


4 •

ANGELIQ - drospirenone-estradiol tab 0.25-0.5 mg

4

ANGELIQ - drospirenone-estradiol tab 0.5-1 mg

4

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A

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Dis

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CLIMARA PRO - estradiol-levonorgestrel td patchweekly 0.045-0.015 mg/day

4

COMBIPATCH - estradiol-norethindrone ace td pttw0.05-0.14 mg/day

3

COMBIPATCH - estradiol-norethindrone ace td pttw0.05-0.25 mg/day

3

DELESTROGEN - estradiolvalerate im in oil 10 mg/ml

4


4


4

DIVIGEL - estradiol td gel 0.25mg/0.25gm (0.1%)

3

DIVIGEL - estradiol td gel 0.5mg/0.5gm (0.1%)

3

DIVIGEL - estradiol td gel 1mg/gm (0.1%)

3

DUAVEE - conjugatedestrogens-bazedoxifene tab0.45-20 mg

4

ELESTRIN - estradiol gel0.06% (0.52 mg/0.87 gmmetered-dose pump)

4

esterified estrogens &methyltestosterone tab0.625-1.25 mg

2

esterified estrogens &methyltestosterone tab1.25-2.5 mg

2

estradiol & norethindroneacetate tab 0.5-0.1 mg(Activella)

2

estradiol & norethindroneacetate tab 1-0.5 mg(Activella)

2

2016



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A

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ited

Dis

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tion

estradiol tab 0.5 mg (Estrace) 1

estradiol tab 1 mg (Estrace) 1

estradiol tab 2 mg (Estrace) 1

estradiol td patch twiceweekly 0.025 mg/24hr(Vivelle-dot)

2 •


2 •


2 •


2 •


2 •

estradiol td patch weekly0.025 mg/24hr (Climara)

2 •

estradiol td patchweekly 0.0375 mg/24hr(37.5 mcg/24hr) (Climara)

2 •


2 •


2 •


2 •


2 •

estradiol valerate im in oil20 mg/ml (Delestrogen)

2

estradiol valerate im in oil40 mg/ml (Delestrogen)

2

ESTROGEL - estradiol gel0.06% (0.75 mg/1.25 gmmetered-dose pump)

4

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ited

Dis

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tion

ESTROPIPATE - estropipatetab 0.75 mg

1

ESTROPIPATE - estropipatetab 1.5 mg

1

ESTROPIPATE - estropipatetab 3 mg

4

EVAMIST - estradioltransdermal spray 1.53 mg/spray

4

FEMHRT LOW DOSE -norethindrone acetate-ethinyl estradiol tab 0.5mg-2.5 mcg

4

MENEST - esterified estrogenstab 0.3 mg

4


4


4

MENOSTAR - estradiol tdpatch weekly 14 mcg/24hr

4 •

MINIVELLE - estradiol td patchtwice weekly 0.025 mg/24hr

4 •

MINIVELLE - estradiol tdpatch twice weekly 0.0375mg/24hr

4 •


4 •


4 •


4 •

norethindrone acetate-ethinyl estradiol tab0.5 mg-2.5 mcg (Femhrt lowdose)

2

norethindrone acetate-ethinyl estradiol tab1 mg-5 mcg

2

2016



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ited

Dis

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tion

PREFEST - estradiol tab 1mg(15)/estrad-norgestimatetab 1-0.09mg(15)

4

PREMARIN - estrogens,conjugated tab 0.3 mg

4


4


4


4


4

PREMPHASE - conj est0.625(14)/conj est-medroxypro ac tab0.625-5mg(14)

4

PREMPRO - conjugatedestrogen-medroxyprogestacetate tab 0.3-1.5 mg

4


4


4

PREMPRO - conjugatedestrogen-medroxyprogestacetate tab 0.625-5 mg

4

CONTRACEPTIVESBEYAZ - drospirenone-ethinyl

estrad-levomefolate tab3-0.02-0.451 mg

4 •

DEPO-PROVERACONTRACEPTIV -medroxyprogesteroneacetate im susp prefilled syr150 mg/ml

A •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

DEPO-PROVERACONTRACEPTIV -medroxyprogesteroneacetate im susp 150 mg/ml

A •

DEPO-SUBQ PROVERA104 - medroxyprogesteroneacetate susp pref syr 104mg/0.65ml

A •

desogest-eth estrad& eth estrad tab0.15-0.02/0.01 mg(21/5)(Mircette)

A •

desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa)

2

desogestrel & ethinylestradiol tab0.15 mg-30 mcg (Desogen)

1

drospirenone-ethinylestrad-levomefolate tab3-0.02-0.451 mg (Beyaz)

2

drospirenone-ethinylestradiol tab 3-0.02 mg(Yaz)

2

drospirenone-ethinylestradiol tab 3-0.03 mg(Yasmin 28)

2

ELLA - ulipristal acetate tab 30mg

A • •

ethynodiol diacetate &ethinyl estradiol tab1 mg-35 mcg

2

ethynodiol diacetate &ethinyl estradiol tab1 mg-50 mcg (Zovia 1/50e)

2

FALESSA - levonorgest-ethestrad tab 0.1 mg-20 mcg &fa tab 1 mg kit

4 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

GENERESS FE -norethindrone & ethinylestradiol-fe chew tab 0.8mg-25 mcg

4 •

levonor-eth est tab0.15-0.02/0.025/0.03 mg&eth est 0.01 mg(Quartette)

2

levonorg-eth est tab0.1-0.02mg(84) & ethest tab 0.01mg(7)(Loseasonique)

A •

levonorg-eth est tab0.15-0.03mg(84) & eth esttab 0.01mg(7) (Seasonique)

2

levonorgestrel & ethinylestradiol (91-day) tab0.15-0.03 mg

A •

levonorgestrel &ethinyl estradiol tab0.1 mg-20 mcg

1

levonorgestrel &ethinyl estradiol tab0.15 mg-30 mcg

2

LEVONORGESTREL ANDETHINY - levonorgestrel-ethinyl estradiol (continuous)tab 90-20 mcg

2 •

levonorgestrel tab 1.5 mg 2 •levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg

2

LO LOESTRIN FE - norethin-eth estradiol-fe tab 1 mg-10mcg (24)/10 mcg (2)

4 •

medroxyprogesteroneacetate im susp prefilledsyr 150 mg/ml (Depo-provera contrac)

A •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

medroxyprogesteroneacetate im susp 150 mg/ml(Depo-provera contrac)

A •

MINASTRIN 24 FE -norethindrone ace-ethestradiol-fe chew tab 1mg-20 mcg (24)

4 •

NATAZIA - estradiol valerate-dienogest tab 3 mg /2-2mg/2-3 mg/1 mg

4 •

NECON 1/50-28 -norethindrone & mestranoltab 1 mg-50 mcg

4 •

norethindrone &ethinyl estradiol tab0.4 mg-35 mcg (Ovcon-35)

2

norethindrone &ethinyl estradioltab 0.5 mg-35 mcg(Brevicon-28)

2

norethindrone & ethinylestradiol tab 1 mg-35 mcg(Norinyl 1+35)

1

norethindrone & ethinylestradiol-fe chew tab0.4 mg-35 mcg (Femcon fe)

A •

norethindrone & ethinylestradiol-fe chew tab0.8 mg-25 mcg (Generessfe)

2

norethindrone ac-ethinyl estrad-fe tab1-20/1-30/1-35 mg-mcg(Estrostep fe)

2

norethindrone ace & ethinylestradiol tab 1 mg-20 mcg(Loestrin 1/20-21)

2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

norethindrone ace &ethinyl estradiol tab1.5 mg-30 mcg (Loestrin1.5/30-21)

2

norethindrone ace &ethinyl estradiol-fe tab1 mg-20 mcg (Loestrin fe1/20)

A •

norethindrone ace &ethinyl estradiol-fe tab1.5 mg-30 mcg (Loestrin fe1.5/30)

2

norethindrone ace-ethestradiol-fe chew tab1 mg-20 mcg (24) (Minastrin24 fe)

2

norethindrone ace-ethinyl estradiol-fe tab1 mg-20 mcg (24)

2

norethindrone tab 0.35 mg(Nor-qd)

A •

norethindrone-eth estradioltab 0.5-35/0.75-35/1-35 mg-mcg (Ortho-novum 7/7/7)

2

norethindrone-eth estradioltab 0.5-35/1-35/0.5-35 mg-mcg (Tri-norinyl 28)

2

norgestimate &ethinyl estradiol tab0.25 mg-35 mcg (Ortho-cyclen)

1

norgestimate-eth estrad tab0.18-25/0.215-25/0.25-25 mg-mcg (Ortho tri-cyclen lo)

2

norgestimate-eth estrad tab0.18-35/0.215-35/0.25-35 mg-mcg (Ortho tri-cyclen)

A •

norgestrel & ethinylestradiol tab0.3 mg-30 mcg

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

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n

Ste

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NUVARING - etonogestrel-ethinyl estradiol va ring0.120-0.015 mg/24hr

A • •

OGESTREL - norgestrel &ethinyl estradiol tab 0.5mg-50 mcg

4 •

ORTHO TRI-CYCLEN LO -norgestimate-eth estrad tab0.18-25/0.215-25/0.25-25mg-mcg

4 •

PARAGARD INTRAUTERINECOP - copper iud

A • •

QUARTETTE - levonor-eth esttab 0.15-0.02/0.025/0.03 mg&eth est 0.01 mg

4 •

SAFYRAL - drospirenone-ethinyl estrad-levomefolatetab 3-0.03-0.451 mg

4 •

XULANE - norelgestromin-ethinyl estradiol td ptwk150-35 mcg/24hr

A • •

PROGESTINSmedroxyprogesterone

acetate tab 2.5 mg(Provera)

1

medroxyprogesteroneacetate tab 5 mg (Provera)

1

medroxyprogesteroneacetate tab 10 mg (Provera)

1

MEGACE ES - megestrolacetate susp 625 mg/5ml

4

megestrol acetate susp625 mg/5ml (Megace es)

2

norethindrone acetate tab5 mg (Aygestin)

2

progesterone im in oil50 mg/ml

2

progesterone micronizedcap 100 mg (Prometrium)

2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

progesterone micronizedcap 200 mg (Prometrium)

2

ANTIDIABETICSacarbose tab 25 mg

(Precose)2

acarbose tab 50 mg(Precose)

2

acarbose tab 100 mg(Precose)

2

ACTOPLUS MET XR -pioglitazone hcl-metforminhcl tab er 24hr 15-1000 mg

4

ACTOPLUS MET XR -pioglitazone hcl-metforminhcl tab er 24hr 30-1000 mg

4

ALOGLIPTIN - alogliptinbenzoate tab 6.25 mg (baseequiv)

4 •

ALOGLIPTIN - alogliptinbenzoate tab 12.5 mg (baseequiv)

4 •

ALOGLIPTIN - alogliptinbenzoate tab 25 mg (baseequiv)

4 •

ALOGLIPTIN/METFORMINHCL - alogliptin-metforminhcl tab 12.5-500 mg

4 •

ALOGLIPTIN/METFORMINHCL - alogliptin-metforminhcl tab 12.5-1000 mg

4 •

ALOGLIPTIN/PIOGLITAZONE - alogliptin-pioglitazone tab 12.5-15 mg

4 •


4 •


4 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ALOGLIPTIN/PIOGLITAZONE - alogliptin-pioglitazone tab 25-15 mg

4 •


4 •


4 •

AVANDIA - rosiglitazonemaleate tab 2 mg (baseequiv)

4

AVANDIA - rosiglitazonemaleate tab 4 mg (baseequiv)

4

BD GLUCOSE - glucose chewtab 5 gm

4

BYDUREON - exenatide for injextended release susp 2 mg

4 • •

BYDUREON PEN - exenatideextended release for susppen-injector 2 mg

4 • •

BYETTA - exenatide soln pen-injector 5 mcg/0.02ml

4 • •

BYETTA - exenatide soln pen-injector 10 mcg/0.04ml

4 • •

CHLORPROPAMIDE -chlorpropamide tab 100 mg

4

CHLORPROPAMIDE -chlorpropamide tab 250 mg

4

CVS GLUCOSE - glucosechew tab 4 gm

4

CYCLOSET - bromocriptinemesylate tab 0.8 mg (baseequivalent)

4

DEX4 - glucose-vitamin c chewtab 4-0.006 gm

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

DEX4 FAST ACTINGGLUCOSE - glucose gel 15gm/33gm

4

DEX4 FAST ACTINGGLUCOSE - glucose-vitaminc chew tab 4-0.006 gm

4

DEX4 NATURALS - glucose-vitamin c chew tab 4-0.006gm

4

DEX4 POUCH PACK -glucose-vitamin c chew tab4-0.006 gm

4

DEX4 QUICK DISSOLVEGLUCO - glucose chew tab 4gm

4

FARXIGA - dapagliflozinpropanediol tab 5 mg (baseequivalent)

4 •

FARXIGA - dapagliflozinpropanediol tab 10 mg (baseequivalent)

4 •

glimepiride tab 1 mg(Amaryl)

1


1


1

glipizide tab er 24hr 2.5 mg(Glucotrol xl)

1

glipizide tab er 24hr 5 mg(Glucotrol xl)

1

glipizide tab er 24hr 10 mg(Glucotrol xl)

2

glipizide tab 5 mg (Glucotrol) 1

glipizide tab 10 mg(Glucotrol)

1

glipizide-metformin hcl tab2.5-250 mg

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

glipizide-metformin hcl tab2.5-500 mg

2

glipizide-metformin hcl tab5-500 mg

2

GLUCAGEN HYPOKIT -glucagon hcl (rdna) for inj 1mg (base equiv)

4

GLUCAGON EMERGENCYKIT - glucagon (rdna) for injkit 1 mg

3

GLUCOSE - glucose chew tab4 gm

4

GLUCOSE - glucose-vitamin cchew tab 4-0.006 gm

4

glucose gel 40% 1

glucose oral liquid15 gm/59ml

2

GLUMETZA - metformin hcl taber 24hr modified release 500mg

4

GLUMETZA - metformin hcltab er 24hr modified release1000 mg

4

glyburide micronized tab1.5 mg (Glynase)

1

glyburide micronized tab3 mg (Glynase)

1

glyburide micronized tab6 mg (Glynase)

1

glyburide tab 1.25 mg 1

glyburide tab 2.5 mg 1

glyburide tab 5 mg 1

glyburide-metformin tab1.25-250 mg (Glucovance)

1

glyburide-metformin tab2.5-500 mg (Glucovance)

1

glyburide-metformin tab5-500 mg (Glucovance)

1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

GLYSET - miglitol tab 25 mg 4



GLYXAMBI - empagliflozin-linagliptin tab 10-5 mg

4 •

GLYXAMBI - empagliflozin-linagliptin tab 25-5 mg

4 •

INSTA-GLUCOSE - glucosegel 77.4%

4

INVOKAMET - canagliflozin-metformin hcl tab 50-500 mg

3 •

INVOKAMET - canagliflozin-metformin hcl tab 50-1000mg

3 •


3 •


3 •

INVOKAMET XR -canagliflozin-metformin hcltab er 24hr 50-500 mg

3 •


3 •


3 •


3 •

INVOKANA - canagliflozin tab100 mg

3 •

INVOKANA - canagliflozin tab300 mg

3 •

JANUMET - sitagliptin-metformin hcl tab 50-500 mg

3 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

JANUMET - sitagliptin-metformin hcl tab 50-1000mg

3 •

JANUMET XR - sitagliptin-metformin hcl tab er 24hr50-500 mg

3 •


3 •


3 •

JANUVIA - sitagliptinphosphate tab 25 mg (baseequiv)

3 •


3 •


3 •

JARDIANCE - empagliflozintab 10 mg

3 •

JARDIANCE - empagliflozintab 25 mg

3 •

JENTADUETO - linagliptin-metformin hcl tab 2.5-500mg

4 •


4 •


4 •

JENTADUETO XR - linagliptin-metformin hcl tab er 24hr2.5-1000 mg

4 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

JENTADUETO XR - linagliptin-metformin hcl tab er 24hr5-1000 mg

4 •

KAZANO - alogliptin-metforminhcl tab 12.5-500 mg

4 •

KAZANO - alogliptin-metforminhcl tab 12.5-1000 mg

4 •

KOMBIGLYZE XR -saxagliptin-metformin hcl taber 24hr 2.5-1000 mg

3 •

KOMBIGLYZE XR -saxagliptin-metformin hcl taber 24hr 5-500 mg

3 •

KOMBIGLYZE XR -saxagliptin-metformin hcl taber 24hr 5-1000 mg

3 •

KORLYM - mifepristone tab300 mg

5 • • •

KROGER GLUCOSE -glucose-vitamin c chew tab4-0.006 gm

4

metformin hcl tab er 24hr500 mg (Glucophage xr)

1

metformin hcl tab er 24hr750 mg (Glucophage xr)

1

metformin hcl tab er 24hrosmotic 500 mg (Fortamet)

2

metformin hcl tab er24hr osmotic 1000 mg(Fortamet)

2

metformin hcl tab er 24hrmodified release 500 mg(Glumetza)

2

metformin hcl tab er 24hrmodified release 1000 mg(Glumetza)

2

metformin hcl tab 500 mg(Glucophage)

1

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1


1

miglitol tab 25 mg (Glyset) 2



nateglinide tab 60 mg(Starlix)

2

nateglinide tab 120 mg(Starlix)

2

NESINA - alogliptin benzoatetab 6.25 mg (base equiv)

4 •

NESINA - alogliptin benzoatetab 12.5 mg (base equiv)

4 •

NESINA - alogliptin benzoatetab 25 mg (base equiv)

4 •

ONGLYZA - saxagliptin hcl tab2.5 mg (base equiv)

3 •

ONGLYZA - saxagliptin hcl tab5 mg (base equiv)

3 •

OSENI - alogliptin-pioglitazonetab 12.5-15 mg

4 •


4 •


4 •

OSENI - alogliptin-pioglitazonetab 25-15 mg

4 •


4 •


4 •

pioglitazone hcl tab 15 mg(base equiv) (Actos)

1


1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1

pioglitazone hcl-glimepiridetab 30-2 mg (Duetact)

2

pioglitazone hcl-glimepiridetab 30-4 mg (Duetact)

2

pioglitazone hcl-metforminhcl tab 15-500 mg (Actoplusmet)

2

pioglitazone hcl-metforminhcl tab 15-850 mg (Actoplusmet)

2

PROGLYCEM - diazoxide susp50 mg/ml

4

RA TRUEPLUS GLUCOSE -glucose gel 15 gm/32ml

4

repaglinide tab 0.5 mg(Prandin)

2

repaglinide tab 1 mg(Prandin)

2

repaglinide tab 2 mg(Prandin)

2

REPAGLINIDE/METFORMINHYD - repaglinide-metforminhcl tab 1-500 mg

2

REPAGLINIDE/METFORMINHYD - repaglinide-metforminhcl tab 2-500 mg

2

RIOMET - metformin hcl oralsoln 500 mg/5ml

4

SYMLINPEN 120 - pramlintideacetate pen-inj 2700mcg/2.7ml (1000 mcg/ml)

4 •

SYMLINPEN 60 - pramlintideacetate pen-inj 1500mcg/1.5ml (1000 mcg/ml)

4 •

SYNJARDY - empagliflozin-metformin hcl tab 5-500 mg

4 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

SYNJARDY - empagliflozin-metformin hcl tab 5-1000 mg

4 •

SYNJARDY - empagliflozin-metformin hcl tab 12.5-500mg

4 •

SYNJARDY - empagliflozin-metformin hcl tab 12.5-1000mg

4 •

SYNJARDY XR -empagliflozin-metformin hcltab er 24hr 5-1000 mg

4 •


4 •

SYNJARDY XR -empagliflozin-metformin hcltab er 24hr 12.5-1000 mg

4 •


4 •

TANZEUM - albiglutide for solnpen-injector 30 mg

4 • •

TANZEUM - albiglutide for solnpen-injector 50 mg

4 • •

TOLAZAMIDE - tolazamide tab250 mg

2

TOLAZAMIDE - tolazamide tab500 mg

4

TOLBUTAMIDE - tolbutamidetab 500 mg

4

TRADJENTA - linagliptin tab 5mg

4 •

TRULICITY - dulaglutide solnpen-injector 0.75 mg/0.5ml

4 • •

TRULICITY - dulaglutide solnpen-injector 1.5 mg/0.5ml

4 • •

VICTOZA - liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)

3 • •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

WALGREENS GLUCOSE -glucose chew tab 4 gm

4

WALGREENS GLUCOSE -glucose-vitamin c chew tab4-0.006 gm

4

XIGDUO XR - dapagliflozin-metformin hcl tab er 24hr5-500 mg

4 •


4 •


4 •


4 •

Rapid-Acting InsulinsAPIDRA - insulin glulisine inj

100 unit/ml4 • •

APIDRA SOLOSTAR - insulinglulisine soln pen-injector inj100 unit/ml

4 • •

HUMALOG - insulin lispro inj100 unit/ml

4 • •

HUMALOG - insulin lispro solncartridge 100 unit/ml

4 • •

HUMALOG JUNIORKWIKPEN - insulin lispro solnpen-injector 100 unit/ml

4 • •

HUMALOG KWIKPEN - insulinlispro soln pen-injector 100unit/ml

4 • •

HUMALOG KWIKPEN - insulinlispro soln pen-injector 200unit/ml

4 • •

NOVOLOG - insulin aspart inj100 unit/ml

2 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NOVOLOG FLEXPEN - insulinaspart soln pen-injector 100unit/ml

2 •

NOVOLOG PENFILL - insulinaspart soln cartridge 100unit/ml

2 •

Short-Acting InsulinsAFREZZA - insulin regular

(human) inh powd 8 (60) &12 (30) unit/cart

4 • •

AFREZZA - insulin regular(human) inh powd 4 & 8 &12 unit/cart (60)

4 • •

AFREZZA - insulin regular(human) inhal powd 4 (30) &8 (60) unit/cart

4 • •


4 • •


4 • •

AFREZZA - insulin regular(human) inhalation powder 4unit/cartridge

4 • •

AFREZZA - insulin regular(human) inhalation powder 8unit/cartridge

4 • •

AFREZZA - insulin regular(human) inhalation powder12 unit/cartridge

4 • •

HUMULIN R - insulin regular(human) inj 100 unit/ml

4 • •

HUMULIN R U-500(CONCENTR - insulin regular(human) inj 500 unit/ml

3 •

2016



Drug Name Dru

g Ti

er

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n

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

HUMULIN R U-500KWIKPEN - insulin regular(human) soln pen-injector500 unit/ml

3 •

NOVOLIN R - insulin regular(human) inj 100 unit/ml

2 •

NOVOLIN R RELION - insulinregular (human) inj 100 unit/ml

2 •

RELION R - insulin regular(human) inj 100 unit/ml

3 •

Intermediate-Acting InsulinsHUMALOG MIX 50/50 - insulin

lispro protamine & lispro inj100 unit/ml (50-50)

4 • •

HUMALOG MIX 50/50KWIKPEN - insulin lispro prot& lispro sus pen-inj 100 unit/ml (50-50)

4 • •

HUMALOG MIX 75/25 - insulinlispro prot & lispro inj 100unit/ml (75-25)

4 • •

HUMALOG MIX 75/25KWIKPEN - insulin lispro prot& lispro sus pen-inj 100 unit/ml (75-25)

4 • •

HUMULIN N - insulin nph(human) (isophane) inj 100unit/ml

4 • •

HUMULIN N KWIKPEN -insulin nph (human)(isophane) susp pen-injector100 unit/ml

4 • •

HUMULIN 70/30 - insulin nphisophane & regular humaninj 100 unit/ml (70-30)

4 • •

HUMULIN 70/30 KWIKPEN -insulin nph & regular susppen-inj 100 unit/ml (70-30)

4 • •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NOVOLIN N - insulin nph(human) (isophane) inj 100unit/ml

2 •

NOVOLIN N RELION - insulinnph (human) (isophane) inj100 unit/ml

2 •

NOVOLIN 70/30 - insulin nphisophane & regular humaninj 100 unit/ml (70-30)

2 •

NOVOLIN 70/30 RELION -insulin nph isophane &regular human inj 100 unit/ml (70-30)

2 •

NOVOLOG MIX 70/30 - insulinaspart prot & aspart (human)inj 100 unit/ml (70-30)

2 •

NOVOLOG MIX 70/30PREFILL - insulin aspart prot& aspart sus pen-inj 100unit/ml (70-30)

2 •

Basal InsulinsLANTUS - insulin glargine inj

100 unit/ml3 •

LANTUS SOLOSTAR - insulinglargine soln pen-injector100 unit/ml

3 •

LEVEMIR - insulin detemir inj100 unit/ml

3 •

LEVEMIR FLEXTOUCH -insulin detemir soln pen-injector 100 unit/ml

3 •

TOUJEO SOLOSTAR - insulinglargine soln pen-injector300 unit/ml

3 •

TRESIBA FLEXTOUCH -insulin degludec soln pen-injector 100 unit/ml

3 •

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion

TRESIBA FLEXTOUCH -insulin degludec soln pen-injector 200 unit/ml

3 •

THYROID AGENTSARMOUR THYROID - thyroid

tab 15 mg (1/4 grain)4

ARMOUR THYROID - thyroidtab 120 mg (2 grain)

4


4


4


4

levothyroxine sodium tab25 mcg (Synthroid)

1


1


1


1


1


1


1


1


1


1


1


1

Drug Name Dru

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

liothyronine sodium tab5 mcg (Cytomel)

2


2


2

methimazole tab 5 mg(Tapazole)

1

methimazole tab 10 mg(Tapazole)

1

NATURE-THROID - thyroid tab16.25 mg

4


4

NATURE-THROID - thyroid tab48.75 mg (3/4 grain)

4

NATURE-THROID - thyroid tab65 mg

4


4


4


4


4


4


4

NATURE-THROID - thyroid tab325 mg (5 grain)

4


4

NATURE-THROID NT-2.5 -thyroid tab 162.5 mg (2 1/2grain)

4

propylthiouracil tab 50 mg 2

2016



Drug Name Dru

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ited

Dis

tribu

tion

SYNTHROID - levothyroxinesodium tab 25 mcg

4


4


4


4


4


4


4


4


4


4


4


4

thyroid tab 30 mg (1/2 grain)(Armour thyroid)

1

thyroid tab 60 mg (1 grain)(Armour thyroid)

1

thyroid tab 90 mg (11/2 grain) (Armour thyroid)

1

thyroid tab 120 mg (2 grain)(Armour thyroid)

1

THYROLAR-1 - liotrix (t3-t4)tab 60 mg (12.5-50 mcg)

4

THYROLAR-1/2 - liotrix (t3-t4)tab 30 mg (6.25-25 mcg)

4

THYROLAR-1/4 - liotrix (t3-t4)tab 15 mg (3.1-12.5 mcg)

4

Drug Name Dru

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A

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ited

Dis

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tion

THYROLAR-2 - liotrix (t3-t4)tab 120 mg (25-100 mcg)

4

THYROLAR-3 - liotrix (t3-t4)tab 180 mg (37.5-150 mcg)

4

TIROSINT - levothyroxinesodium cap 13 mcg

4


4


4


4


4


4


4


4


4


4

WESTHROID - thyroid tab 32.5mg

4

WESTHROID - thyroid tab 65mg

4

WESTHROID - thyroid tab 97.5mg

4


4


4

WP THYROID - thyroid tab16.25 mg

4


4

2016



Drug Name Dru

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A

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ited

Dis

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tion

WP THYROID - thyroid tab48.75 mg (3/4 grain)

4

WP THYROID - thyroid tab 65mg

4


4


4


4

WP THYROID - thyroid tab 130mg

4

OXYTOCICSCERVIDIL - dinoprostone

vaginal inserts 10 mg4

METHERGINE -methylergonovine maleatetab 0.2 mg

2

PREPIDIL - dinoprostonecervical gel 0.5 mg/3gm

4

PROSTIN E2 - dinoprostonevaginal suppos 20 mg

4

ENDOCRINE and METABOLIC AGENTS - MISC.ACTONEL - risedronate

sodium tab 5 mg4 •

ACTONEL - risedronatesodium tab 30 mg

4 •

ACTONEL - risedronatesodium tab 35 mg

4 •

ALENDRONATE SODIUM -alendronate sodium oral soln70 mg/75ml

4 •

ALENDRONATE SODIUM -alendronate sodium tab 40mg

4 •

alendronate sodium tab5 mg

1 •

Drug Name Dru

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A

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ited

Dis

tribu

tion


1 •


1 •

alendronate sodium tab70 mg (Fosamax)

1 •

ATELVIA - risedronate sodiumtab delayed release 35 mg

4 •

BINOSTO - alendronatesodium effervescent tab 70mg

4 •

BUPHENYL - sodiumphenylbutyrate tab 500 mg

5 • •

cabergoline tab 0.5 mg 2

calcitonin (salmon)nasal soln 200 unit/act(Miacalcin)

2

calcitriol cap 0.25 mcg(Rocaltrol)

2

calcitriol cap 0.5 mcg(Rocaltrol)

2

calcitriol oral soln 1 mcg/ml(Rocaltrol)

2

CARBAGLU - carglumic acidtab 200 mg

5 • •

CYSTADANE - betaine powderfor oral solution

4 •

desmopressin acetate inj4 mcg/ml (Ddavp)

2

desmopressin acetate nasalsoln 0.01% (refrigerated)(Ddavp)

2

desmopressin acetate nasalspray soln 0.01% (Ddavp)

2

desmopressin acetatenasal spray soln 0.01%(refrigerated)

2

2016



Drug Name Dru

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its

AC

A

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ited

Dis

tribu

tion

desmopressin acetate tab0.1 mg (Ddavp)

2

desmopressin acetate tab0.2 mg (Ddavp)

2

doxercalciferol cap 0.5 mcg(Hectorol)

2

doxercalciferol cap 1 mcg(Hectorol)

2

doxercalciferol cap 2.5 mcg(Hectorol)

2

EGRIFTA - tesamorelin acetatefor inj 1 mg (base equiv)

5 • •

ETIDRONATE DISODIUM -etidronate disodium tab 200mg

4

ETIDRONATE DISODIUM -etidronate disodium tab 400mg

4

FORTEO - teriparatide(recombinant) inj 600mcg/2.4ml

5 • • •

FOSAMAX PLUS D -alendronate sodium-cholecalciferol tab 70-2800mg-unit

4 •

FOSAMAX PLUS D -alendronate sodium-cholecalciferol tab 70-5600mg-unit

4 •

H.P. ACTHAR - corticotropin injgel 80 unit/ml

5 • •

ibandronate sodium tab150 mg (base equivalent)(Boniva)

2 •

INCRELEX - mecasermin inj 40mg/4ml (10 mg/ml)

5 • •

KUVAN - sapropterindihydrochloride powderpacket 100 mg

5 • •

Drug Name Dru

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n

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

KUVAN - sapropterindihydrochloride powderpacket 500 mg

5 • •

KUVAN - sapropterindihydrochloride soluble tab100 mg

5 • •

levocarnitine oral soln1 gm/10ml (10%) (Carnitor)

2

levocarnitine tab 330 mg(Carnitor)

2

MIACALCIN - calcitonin(salmon) inj 200 unit/ml

4

MYALEPT - metreleptin forsubcutaneous inj 11.3 mg

5 • •

NATPARA - parathyroidhormone (recombinant) forinj cartridge 25 mcg

5 •


5 •


5 •


5 •

octreotide acetate inj50 mcg/ml (0.05 mg/ml)(Sandostatin)

5 • •


5 • •


5 • •


5 • •

2016



Drug Name Dru

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its

AC

A

Lim

ited

Dis

tribu

tion

octreotide acetate inj1000 mcg/ml (1 mg/ml)(Sandostatin)

5 • •

OMNITROPE - somatropin forinj 5.8 mg

5 • •

OMNITROPE - somatropin inj 5mg/1.5ml

5 • •

OMNITROPE - somatropin inj10 mg/1.5ml

5 • •

ORFADIN - nitisinone cap 2 mg 5 • •ORFADIN - nitisinone cap 5 mg 5 • •ORFADIN - nitisinone cap 10

mg5 • •

ORFADIN - nitisinone cap 20mg

5 •

ORFADIN - nitisinone susp 4mg/ml

5 •

OSPHENA - ospemifene tab 60mg

4

paricalcitol cap 1 mcg(Zemplar)

2

paricalcitol cap 2 mcg(Zemplar)

2

paricalcitol cap 4 mcg 2

raloxifene hcl tab 60 mg(Evista)

2 •

RAVICTI - glycerolphenylbutyrate liquid 1.1 gm/ml

5 • •

risedronate sodium tabdelayed release 35 mg(Atelvia)

2 •

risedronate sodium tab 5 mg(Actonel)

2 •

risedronate sodium tab30 mg (Actonel)

2 •


2 •

Drug Name Dru

g Ti

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its

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A

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ited

Dis

tribu

tion


2 •

SAMSCA - tolvaptan tab 15 mg 5 • • •SAMSCA - tolvaptan tab 30 mg 5 • • •SENSIPAR - cinacalcet hcl tab

30 mg (base equiv)3

SENSIPAR - cinacalcet hcl tab60 mg (base equiv)

3

SENSIPAR - cinacalcet hcl tab90 mg (base equiv)

3

SIGNIFOR - pasireotidediaspartate inj 0.3 mg/ml(base equiv)

5 • •


5 • •


5 • •

sodium phenylbutyrate oralpowder 3 gm/teaspoonful(Buphenyl)

5 • •

sodium phenylbutyrate tab500 mg (Buphenyl)

5 • •

SOMAVERT - pegvisomant forinj 10 mg (as protein)

5 • •


5 • •


5 • •


5 • •


5 • •

STIMATE - desmopressinacetate nasal soln 1.5 mg/ml

3

2016



Drug Name Dru

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A

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ited

Dis

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tion

STRENSIQ - asfotase alfasubcutaneous inj 18mg/0.45ml

5 •


5 •

STRENSIQ - asfotase alfasubcutaneous inj 40 mg/ml

5 •


5 •

SYNAREL - nafarelin acetatenasal soln 2 mg/ml (200mcg/act) (base eq)

4

TYMLOS - abaloparatidesubcutaneous soln pen-injector 3120 mcg/1.56ml

5 • • •

XURIDEN - uridine triacetateoral granules packet 2 gm

5 •

CARDIOVASCULAR AGENTSCARDIOTONICSDIGOXIN - digoxin oral soln

0.05 mg/ml4

digoxin tab 125 mcg(0.125 mg) (Lanoxin)

2

digoxin tab 250 mcg(0.25 mg) (Lanoxin)

2

LANOXIN - digoxin tab 62.5mcg (0.0625 mg)

4

LANOXIN - digoxin tab 125mcg (0.125 mg)

4

LANOXIN - digoxin tab 187.5mcg (0.1875 mg)

4


2


4

ANTIANGINAL AGENTS

Drug Name Dru

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ited

Dis

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tion

DILATRATE SR - isosorbidedinitrate cap er 40 mg

4

ISORDIL TITRADOSE -isosorbide dinitrate tab 40mg

4

ISOSORBIDE DINITRATE ER -isosorbide dinitrate tab er 40mg

2

isosorbide dinitrate tab 5 mg(Isordil titradose)

2

isosorbide dinitrate tab10 mg

2


2


2

isosorbide mononitrate taber 24hr 30 mg

1


1


2

isosorbide mononitrate tab10 mg

1

isosorbide mononitrate tab20 mg

1

NITRO-BID - nitroglycerin oint2%

4

NITRO-DUR - nitroglycerin tdpatch 24hr 0.3 mg/hr

4

NITRO-DUR - nitroglycerin tdpatch 24hr 0.8 mg/hr

4

nitroglycerin cap er 2.5 mg 1

nitroglycerin cap er 6.5 mg 2

nitroglycerin cap er 9 mg 2

NITROGLYCERIN LINGUAL -nitroglycerin lingual aerosol400 mcg/spray

4

2016



Drug Name Dru

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Lim

its

AC

A

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ited

Dis

tribu

tion

nitroglycerin sl tab 0.3 mg(Nitrostat)

2


2


2

nitroglycerin td patch 24hr0.1 mg/hr (Nitro-dur)

2


2


2


2

nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray)(Nitrolingual pumpspr)

2

NITROMIST - nitroglycerinlingual aerosol 400 mcg/spray

4

NITROSTAT - nitroglycerin sltab 0.3 mg

3


3


3

RANEXA - ranolazine tab er12hr 500 mg

4

RANEXA - ranolazine tab er12hr 1000 mg

4

BETA BLOCKERSacebutolol hcl cap 200 mg

(Sectral)1

acebutolol hcl cap 400 mg(Sectral)

1

atenolol tab 25 mg(Tenormin)

1

Drug Name Dru

g Ti

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its

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A

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ited

Dis

tribu

tion


1


1

betaxolol hcl tab 10 mg(Kerlone)

2

betaxolol hcl tab 20 mg(Kerlone)

2

bisoprolol fumarate tab 5 mg(Zebeta)

1

bisoprolol fumarate tab10 mg (Zebeta)

2

BYSTOLIC - nebivolol hcl tab2.5 mg (base equivalent)

4

BYSTOLIC - nebivolol hcl tab 5mg (base equivalent)

4

BYSTOLIC - nebivolol hcl tab10 mg (base equivalent)

4

BYSTOLIC - nebivolol hcl tab20 mg (base equivalent)

4

carvedilol tab 3.125 mg(Coreg)

1


1


1

carvedilol tab 25 mg (Coreg) 1

COREG CR - carvedilolphosphate cap er 24hr 10mg

4


4


4

2016



Drug Name Dru

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its

AC

A

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ited

Dis

tribu

tion


4

HEMANGEOL - propranolol hcloral soln 4.28 mg/ml (3.75mg/ml base equiv)

4 •

INDERAL XL - propranolol hclsustained-release beads caper 24hr 80 mg

4

INDERAL XL - propranolol hclsustained-release beads caper 24hr 120 mg

4

INNOPRAN XL - propranololhcl sustained-release beadscap er 24hr 80 mg

4

INNOPRAN XL - propranololhcl sustained-release beadscap er 24hr 120 mg

4

labetalol hcl tab 100 mg(Trandate)

2


2


2

metoprolol succinate tab er24hr 25 mg (tartrate equiv)(Toprol xl)

1

metoprolol succinate tab er24hr 50 mg (tartrate equiv)(Toprol xl)

1

metoprolol succinate taber 24hr 100 mg (tartrateequiv) (Toprol xl)

2

metoprolol succinate taber 24hr 200 mg (tartrateequiv) (Toprol xl)

2

METOPROLOL TARTRATE -metoprolol tartrate tab 37.5mg

4

Drug Name Dru

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

METOPROLOL TARTRATE -metoprolol tartrate tab 75 mg

4

metoprolol tartrate tab25 mg

1

metoprolol tartrate tab50 mg (Lopressor)

1

metoprolol tartrate tab100 mg (Lopressor)

1

nadolol tab 20 mg (Corgard) 2



pindolol tab 5 mg 2

pindolol tab 10 mg 2

PROPRANOLOL HCL -propranolol hcl oral soln 20mg/5ml

4

PROPRANOLOL HCL -propranolol hcl oral soln 40mg/5ml

4

propranolol hcl cap er 24hr60 mg (Inderal la)

2


2


2


2

propranolol hcl tab 10 mg 1





sotalol hcl (afib/afl) tab80 mg (Betapace af)

2


2

2016



Drug Name Dru

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its

AC

A

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ited

Dis

tribu

tion


2

sotalol hcl tab 80 mg(Betapace)

1


1


1

sotalol hcl tab 240 mg 2

SOTYLIZE - sotalol hcl oralsolution 5 mg/ml

4

TIMOLOL MALEATE - timololmaleate tab 5 mg

4


4


4

CALCIUM CHANNEL BLOCKERSamlodipine besylate tab

2.5 mg (Norvasc)1

amlodipine besylate tab5 mg (Norvasc)

1

amlodipine besylate tab10 mg (Norvasc)

1

CARDIZEM LA - diltiazem hclcoated beads tab er 24hr120 mg

4

diltiazem hcl cap er 12hr60 mg

2


2


2


1


2

Drug Name Dru

g Ti

er

Prio

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horiz

atio

n

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p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2

diltiazem hcl coated beadscap er 24hr 120 mg(Cardizem cd)

1


1


2

diltiazem hcl coated beadscap er 24hr 300 mg

2


2

diltiazem hcl coated beadstab er 24hr 180 mg(Cardizem la)

2


2


2


2


2

diltiazem hcl extendedrelease beads cap er 24hr120 mg (Tiazac)

2


2

2016



Drug Name Dru

g Ti

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2


2


2


2

diltiazem hcl tab 30 mg(Cardizem)

1


1

diltiazem hcl tab 90 mg 1


1

felodipine tab er 24hr 2.5 mg 2

felodipine tab er 24hr 5 mg 2

felodipine tab er 24hr 10 mg 2

isradipine cap 2.5 mg 2

isradipine cap 5 mg 2

nicardipine hcl cap 20 mg 2

nicardipine hcl cap 30 mg 2

nifedipine cap 10 mg(Procardia)

2

nifedipine cap 20 mg 2

nifedipine tab er 24hr 30 mg(Adalat cc)

1


2


2

Drug Name Dru

g Ti

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Prio

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n

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Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

nifedipine tab er 24hrosmotic release 30 mg(Procardia xl)

1


2


2

nimodipine cap 30 mg 2

NISOLDIPINE ER - nisoldipinetab er 24hr 20 mg

4

NISOLDIPINE ER - nisoldipinetab er 24hr 25.5 mg

4


4


4

nisoldipine tab er 24hr8.5 mg (Sular)

2

nisoldipine tab er 24hr17 mg (Sular)

2

nisoldipine tab er 24hr34 mg (Sular)

2

NYMALIZE - nimodipine oralsoln 60 mg/20ml

4

verapamil hcl cap er 24hr100 mg (Verelan pm)

2

verapamil hcl cap er 24hr120 mg (Verelan)

2


2


2


2


2

2016



Drug Name Dru

g Ti

er

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horiz

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n

Ste

p Th

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2

verapamil hcl tab er 120 mg(Calan sr)

1


1


1

verapamil hcl tab 40 mg 2

verapamil hcl tab 80 mg(Calan)

1

verapamil hcl tab 120 mg(Calan)

1

ANTIARRHYTHMICSamiodarone hcl tab 100 mg 2

amiodarone hcl tab 200 mg(Cordarone)

1

amiodarone hcl tab 400 mg 2

disopyramide phosphatecap 100 mg (Norpace)

2

disopyramide phosphatecap 150 mg (Norpace)

2

dofetilide cap 125 mcg(0.125 mg) (Tikosyn)

2


2


2

flecainide acetate tab 50 mg 2

flecainide acetate tab100 mg

2

flecainide acetate tab150 mg

2

mexiletine hcl cap 150 mg 2



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

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p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

MULTAQ - dronedarone hcl tab400 mg (base equivalent)

4

NORPACE - disopyramidephosphate cap 100 mg

4

NORPACE - disopyramidephosphate cap 150 mg

4

NORPACE CR - disopyramidephosphate cap er 12hr 100mg

4

NORPACE CR - disopyramidephosphate cap er 12hr 150mg

4

propafenone hcl cap er 12hr225 mg (Rythmol sr)

2


2


2

propafenone hcl tab 150 mg(Rythmol)

2

propafenone hcl tab 225 mg(Rythmol)

2

propafenone hcl tab 300 mg 2

quinidine gluconate tab er324 mg

2

QUINIDINE SULFATE -quinidine sulfate tab 200 mg

4

QUINIDINE SULFATE -quinidine sulfate tab 300 mg

2

TIKOSYN - dofetilide cap 125mcg (0.125 mg)

4


4


4

ANTIHYPERTENSIVES

2016



Drug Name Dru

g Ti

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n

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p Th

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y

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

amlodipine besylate-benazepril hcl cap2.5-10 mg (Lotrel)

2

amlodipine besylate-benazepril hcl cap 5-10 mg(Lotrel)

2


2


2

amlodipine besylate-benazepril hcl cap10-20 mg (Lotrel)

2

amlodipine besylate-benazepril hcl cap10-40 mg (Lotrel)

2

amlodipine besylate-olmesartan medoxomil tab5-20 mg (Azor)

2


2


2


2

amlodipine besylate-valsartan tab 5-160 mg(Exforge)

2


2


2

Drug Name Dru

g Ti

er

Prio

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horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2

amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)

2

amlodipine-valsartan-hydrochlorothiazide tab5-160-25 mg (Exforge hct)

2

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforgehct)

2


2


2

atenolol & chlorthalidonetab 50-25 mg (Tenoretic 50)

1

atenolol & chlorthalidonetab 100-25 mg (Tenoretic100)

1

AZOR - amlodipine besylate-olmesartan medoxomil tab5-20 mg

4


4


4


4

benazepril &hydrochlorothiazide tab5-6.25 mg

2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

benazepril &hydrochlorothiazide tab10-12.5 mg (Lotensin hct)

2

benazepril &hydrochlorothiazide tab20-12.5 mg (Lotensin hct)

2

benazepril &hydrochlorothiazide tab20-25 mg (Lotensin hct)

2

benazepril hcl tab 5 mg 1

benazepril hcl tab 10 mg(Lotensin)

1


1


1

BENICAR - olmesartanmedoxomil tab 5 mg

4


4


4

BENICAR HCT -olmesartan medoxomil-hydrochlorothiazide tab20-12.5 mg

4

BENICAR HCT -olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg

4

BENICAR HCT -olmesartan medoxomil-hydrochlorothiazide tab40-25 mg

4

bisoprolol &hydrochlorothiazide tab2.5-6.25 mg (Ziac)

1

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

bisoprolol &hydrochlorothiazide tab5-6.25 mg (Ziac)

1

bisoprolol &hydrochlorothiazide tab10-6.25 mg (Ziac)

1

BYVALSON - nebivolol-valsartan tab 5-80 mg

4

candesartan cilexetil tab4 mg (Atacand)

2


2


2


2

candesartan cilexetil-hydrochlorothiazide tab16-12.5 mg (Atacand hct)

2

candesartan cilexetil-hydrochlorothiazide tab32-12.5 mg (Atacand hct)

2

candesartan cilexetil-hydrochlorothiazide tab32-25 mg (Atacand hct)

2

captopril tab 12.5 mg 2

captopril tab 25 mg 2



CAPTOPRIL/HYDROCHLOROTHIA -captopril &hydrochlorothiazide tab25-15 mg

4


4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4


4

clonidine hcl tab 0.1 mg(Catapres)

1


1


1

clonidine hcl td patchweekly 0.1 mg/24hr(Catapres-tts-1)

2


2


2

CLORPRES - clonidine &chlorthalidone tab 0.1-15 mg

4


4


4

DEMSER - metyrosine cap 250mg

4

DIBENZYLINE -phenoxybenzamine hcl cap10 mg

4

doxazosin mesylate tab1 mg (Cardura)

1

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1


1


1

DUTOPROL - metoprolol &hydrochlorothiazide tab er24hr 25-12.5 mg

4


4


4

EDARBI - azilsartan medoxomiltab 40 mg

4

EDARBI - azilsartan medoxomiltab 80 mg

4

EDARBYCLOR - azilsartanmedoxomil-chlorthalidonetab 40-12.5 mg

4

EDARBYCLOR - azilsartanmedoxomil-chlorthalidonetab 40-25 mg

4

enalapril maleate &hydrochlorothiazide tab5-12.5 mg

1

enalapril maleate &hydrochlorothiazide tab10-25 mg (Vaseretic)

1

enalapril maleate tab 2.5 mg(Vasotec)

1

enalapril maleate tab 5 mg(Vasotec)

1


1


1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

EPANED - enalapril maleateoral soln 1 mg/ml

4

eplerenone tab 25 mg(Inspra)

2

eplerenone tab 50 mg(Inspra)

2

EPROSARTAN MESYLATE -eprosartan mesylate tab 600mg

2

fosinopril sodium &hydrochlorothiazide tab10-12.5 mg

2

fosinopril sodium &hydrochlorothiazide tab20-12.5 mg

2

fosinopril sodium tab 10 mg 1



guanfacine hcl tab 1 mg(Tenex)

1

guanfacine hcl tab 2 mg(Tenex)

1

hydralazine hcl tab 10 mg 1




irbesartan tab 75 mg(Avapro)

1


1


1

irbesartan-hydrochlorothiazide tab150-12.5 mg (Avalide)

1

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

irbesartan-hydrochlorothiazide tab300-12.5 mg (Avalide)

1

lisinopril &hydrochlorothiazide tab10-12.5 mg (Zestoretic)

1

lisinopril &hydrochlorothiazide tab20-12.5 mg (Zestoretic)

1

lisinopril &hydrochlorothiazide tab20-25 mg (Zestoretic)

1

lisinopril tab 2.5 mg (Zestril) 1

lisinopril tab 5 mg (Prinivil) 1



lisinopril tab 30 mg (Zestril) 1

lisinopril tab 40 mg (Zestril) 1

losartan potassium &hydrochlorothiazide tab50-12.5 mg (Hyzaar)

1

losartan potassium &hydrochlorothiazide tab100-12.5 mg (Hyzaar)

1

losartan potassium &hydrochlorothiazide tab100-25 mg (Hyzaar)

1

losartan potassium tab25 mg (Cozaar)

1


1


1

methyldopa tab 250 mg 1

methyldopa tab 500 mg 1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

METHYLDOPA/HYDROCHLOROTHI -methyldopa &hydrochlorothiazide tab250-15 mg

4

METHYLDOPA/HYDROCHLOROTHI -methyldopa &hydrochlorothiazide tab250-25 mg

4

metoprolol &hydrochlorothiazide tab50-25 mg (Lopressor hct)

2

metoprolol &hydrochlorothiazide tab100-25 mg (Lopressor hct)

2

METOPROLOL/HYDROCHLOROTHI -metoprolol &hydrochlorothiazide tab100-50 mg

2

minoxidil tab 2.5 mg 1

minoxidil tab 10 mg 1

moexipril hcl tab 7.5 mg 2

moexipril hcl tab 15 mg 2

moexipril-hydrochlorothiazide tab7.5-12.5 mg

2

moexipril-hydrochlorothiazide tab15-12.5 mg

2

moexipril-hydrochlorothiazide tab15-25 mg

2

nadolol &bendroflumethiazide tab40-5 mg (Corzide)

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

nadolol &bendroflumethiazide tab80-5 mg (Corzide)

2

olmesartan medoxomil tab5 mg (Benicar)

2


2


2

olmesartan medoxomil-hydrochlorothiazide tab20-12.5 mg (Benicar hct)

2

olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg (Benicar hct)

2

olmesartan medoxomil-hydrochlorothiazide tab40-25 mg (Benicar hct)

2

olmesartan-amlodipine-hydrochlorothiazide tab20-5-12.5 mg (Tribenzor)

2


2

olmesartan-amlodipine-hydrochlorothiazide tab40-5-25 mg (Tribenzor)

2


2

olmesartan-amlodipine-hydrochlorothiazide tab40-10-25 mg (Tribenzor)

2

perindopril erbumine tab2 mg

1

perindopril erbumine tab4 mg (Aceon)

2

perindopril erbumine tab8 mg (Aceon)

2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

phenoxybenzamine hcl cap10 mg (Dibenzyline)

2

prazosin hcl cap 1 mg(Minipress)

1


1


2

PRESTALIA - perindoprilarginine-amlodipine besylatetab 3.5-2.5 mg

4

PRESTALIA - perindoprilarginine-amlodipine besylatetab 7-5 mg

4

PRESTALIA - perindoprilarginine-amlodipine besylatetab 14-10 mg

4

PROPRANOLOL/HYDROCHLOROTH -propranolol &hydrochlorothiazide tab40-25 mg

4

PROPRANOLOL/HYDROCHLOROTH -propranolol &hydrochlorothiazide tab80-25 mg

4

QBRELIS - lisinopril oral soln 1mg/ml

4

quinapril hcl tab 5 mg(Accupril)

1


1


1


1

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

quinapril-hydrochlorothiazide tab10-12.5 mg (Accuretic)

2

quinapril-hydrochlorothiazide tab20-12.5 mg (Accuretic)

2

quinapril-hydrochlorothiazide tab20-25 mg (Accuretic)

2

ramipril cap 1.25 mg (Altace) 1

ramipril cap 2.5 mg (Altace) 1

ramipril cap 5 mg (Altace) 1

ramipril cap 10 mg (Altace) 1

TARKA - trandolapril-verapamilhcl tab er 1-240 mg

4


4


4


4

TEKTURNA - aliskirenfumarate tab 150 mg (baseequivalent)

4

TEKTURNA - aliskirenfumarate tab 300 mg (baseequivalent)

4

TEKTURNA HCT - aliskiren-hydrochlorothiazide tab150-12.5 mg

4

TEKTURNA HCT - aliskiren-hydrochlorothiazide tab150-25 mg

4

TEKTURNA HCT - aliskiren-hydrochlorothiazide tab300-12.5 mg

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

TEKTURNA HCT - aliskiren-hydrochlorothiazide tab300-25 mg

4

telmisartan tab 20 mg(Micardis)

2


2


2

telmisartan-amlodipine tab40-5 mg (Twynsta)

2


2


2


2

telmisartan-hydrochlorothiazide tab40-12.5 mg (Micardis hct)

2

telmisartan-hydrochlorothiazide tab80-12.5 mg (Micardis hct)

2

telmisartan-hydrochlorothiazide tab80-25 mg (Micardis hct)

2

terazosin hcl cap 1 mg 1




trandolapril tab 1 mg (Mavik) 1



trandolapril-verapamil hcltab er 1-240 mg (Tarka)

2


2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2


2

TRIBENZOR -olmesartan-amlodipine-hydrochlorothiazide tab20-5-12.5 mg

4


4

TRIBENZOR -olmesartan-amlodipine-hydrochlorothiazide tab40-5-25 mg

4


4

TRIBENZOR -olmesartan-amlodipine-hydrochlorothiazide tab40-10-25 mg

4

valsartan tab 40 mg (Diovan) 2

valsartan tab 80 mg (Diovan) 2

valsartan tab 160 mg(Diovan)

2

valsartan tab 320 mg(Diovan)

2

valsartan-hydrochlorothiazide tab80-12.5 mg (Diovan hct)

1


2

valsartan-hydrochlorothiazide tab160-25 mg (Diovan hct)

2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1

valsartan-hydrochlorothiazide tab320-25 mg (Diovan hct)

1

VECAMYL - mecamylamine hcltab 2.5 mg

4 •

DIURETICSacetazolamide cap er 12hr

500 mg (Diamox)2

acetazolamide tab 125 mg 2

acetazolamide tab 250 mg 2

ALDACTAZIDE -spironolactone &hydrochlorothiazide tab50-50 mg

4

amiloride &hydrochlorothiazide tab5-50 mg

1

amiloride hcl tab 5 mg 2

bumetanide tab 0.5 mg 1

bumetanide tab 1 mg 1

bumetanide tab 2 mg 2

CHLOROTHIAZIDE -chlorothiazide tab 250 mg

4

chlorothiazide tab 500 mg 1

chlorthalidone tab 25 mg 2

chlorthalidone tab 50 mg 2

DIURIL - chlorothiazide susp250 mg/5ml

4

DYRENIUM - triamterene cap50 mg

4

DYRENIUM - triamterene cap100 mg

4

EDECRIN - ethacrynic acid tab25 mg

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ethacrynic acid tab 25 mg(EDECRIN)

2

FUROSEMIDE - furosemideoral soln 8 mg/ml

4

furosemide oral soln 10 mg/ml

1

furosemide tab 20 mg (Lasix) 1



hydrochlorothiazide cap12.5 mg (Microzide)

1

hydrochlorothiazide tab12.5 mg

1

hydrochlorothiazide tab25 mg

1

hydrochlorothiazide tab50 mg

1

indapamide tab 1.25 mg 1

indapamide tab 2.5 mg 1

KEVEYIS - dichlorphenamidetab 50 mg

4 •

methazolamide tab 25 mg(Neptazane)

2

methazolamide tab 50 mg(Neptazane)

2

METHYCLOTHIAZIDE -methyclothiazide tab 5 mg

4

metolazone tab 2.5 mg 2

metolazone tab 5 mg 2

metolazone tab 10 mg 2

spironolactone &hydrochlorothiazide tab25-25 mg (Aldactazide)

2

spironolactone tab 25 mg(Aldactone)

1


1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2

torsemide tab 5 mg(Demadex)

1


1


1


2

triamterene &hydrochlorothiazide cap37.5-25 mg (Dyazide)

1

triamterene &hydrochlorothiazide tab37.5-25 mg (Maxzide-25)

1

triamterene &hydrochlorothiazide tab75-50 mg (Maxzide)

1

TRIAMTERENE/HYDROCHLOROTH -triamterene &hydrochlorothiazide cap50-25 mg

4

VASOPRESSORSEPINEPHRINE - epinephrine

solution auto-injector 0.15mg/0.15ml (1:1000)

4

EPINEPHRINE - epinephrinesolution auto-injector 0.3mg/0.3ml (1:1000)

4

EPINEPHRINE -AUTHORIZED GENERICTO EPIPEN - epinephrinesolution auto-injector 0.15mg/0.3ml (1:2000)

3

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

EPINEPHRINE -AUTHORIZED GENERICTO EPIPEN - epinephrinesolution auto-injector 0.3mg/0.3ml (1:1000)

3

EPIPEN 2-PAK - epinephrinesolution auto-injector 0.3mg/0.3ml (1:1000)

3

EPIPEN-JR 2-PAK -epinephrine solution auto-injector 0.15 mg/0.3ml(1:2000)

3

midodrine hcl tab 2.5 mg 2

midodrine hcl tab 5 mg 2

midodrine hcl tab 10 mg 2

NORTHERA - droxidopa cap100 mg

4 •


4 •


4 •

ANTIHYPERLIPIDEMICSALTOPREV - lovastatin tab er

24hr 20 mg4 •

ALTOPREV - lovastatin tab er24hr 40 mg

4 •

ALTOPREV - lovastatin tab er24hr 60 mg

4 •

ANTARA - fenofibratemicronized cap 30 mg

4 • •

ANTARA - fenofibratemicronized cap 90 mg

4 • •

atorvastatin calcium tab10 mg (base equivalent)(Lipitor)

1


1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1


1

cholestyramine light powderpackets 4 gm

2

cholestyramine light powder4 gm/dose (Questran light)

2

cholestyramine powderpackets 4 gm (Questran)

2

cholestyramine powder4 gm/dose (Questran)

2

choline fenofibrate cap dr45 mg (fenofibric acidequiv) (Trilipix)

2 •

choline fenofibrate cap dr135 mg (fenofibric acidequiv) (Trilipix)

2 •

colestipol hcl granulepackets 5 gm (Colestidflavored)

2

colestipol hcl granules 5 gm(Colestid flavored)

2

colestipol hcl tab 1 gm(Colestid)

2

CRESTOR - rosuvastatincalcium tab 5 mg

4


4


4


4

ezetimibe tab 10 mg (Zetia) 2 •ezetimibe-simvastatin tab

10-10 mg (Vytorin)2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ezetimibe-simvastatin tab10-20 mg (Vytorin)

2


2


2

FENOFIBRATE - fenofibratecap 50 mg

4 • •

FENOFIBRATE - fenofibratecap 150 mg

4 • •

fenofibrate micronized cap43 mg

2 •

fenofibrate micronized cap67 mg (Lofibra)

2 •

fenofibrate micronized cap130 mg

2 •


2 •


2 •

fenofibrate tab 40 mg(Fenoglide)

2 •

fenofibrate tab 48 mg (Tricor) 2 •fenofibrate tab 54 mg

(Lofibra)1 •

fenofibrate tab 120 mg(Fenoglide)

2 •

fenofibrate tab 145 mg(Tricor)

2 •

fenofibrate tab 160 mg(Lofibra)

2 •

FENOFIBRIC ACID - fenofibricacid tab 35 mg

4 • •

FENOFIBRIC ACID - fenofibricacid tab 105 mg

4 • •

FENOGLIDE - fenofibrate tab40 mg

4 • •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

FENOGLIDE - fenofibrate tab120 mg

4 • •

FIBRICOR - fenofibric acid tab35 mg

4 • •

FIBRICOR - fenofibric acid tab105 mg

4 • •

fluvastatin sodium cap20 mg (Lescol)

2

fluvastatin sodium cap40 mg (Lescol)

2

fluvastatin sodium tab er 24hr 80 mg (Lescol xl)

2

gemfibrozil tab 600 mg(Lopid)

1 •

JUXTAPID - lomitapidemesylate cap 5 mg (baseequiv)

5 • • •


5 • • •


5 • • •


5 • • •


5 • • •


5 • • •

KYNAMRO - mipomersensodium soln prefilled syringe200 mg/ml

5 • • •

LESCOL XL - fluvastatinsodium tab er 24 hr 80 mg

4 •

LIPOFEN - fenofibrate cap 50mg

4 • •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

LIPOFEN - fenofibrate cap 150mg

4 • •

LIVALO - pitavastatin calciumtab 1 mg (base equiv)

4 •


4 •


4 •

lovastatin tab 10 mg 1

lovastatin tab 20 mg 1

lovastatin tab 40 mg(Mevacor)

1

niacin tab er 500 mg(antihyperlipidemic)(Niaspan)

2


2


2

omega-3-acid ethyl esterscap 1 gm (Lovaza)

2

PRALUENT - alirocumabsubcutaneous soln pen-injector 75 mg/ml

5 • • •

PRALUENT - alirocumabsubcutaneous soln pen-injector 150 mg/ml

5 • • •

pravastatin sodium tab10 mg

1

pravastatin sodium tab20 mg (Pravachol)

1


1


2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

REPATHA - evolocumabsubcutaneous soln prefilledsyringe 140 mg/ml

5 • • •

REPATHA PUSHTRONEXSYSTEM - evolocumabsubcutaneous soln cartridge/infusor 420 mg/3.5ml

5 • • •

REPATHA SURECLICK -evolocumab subcutaneoussoln auto-injector 140 mg/ml

5 • • •

rosuvastatin calcium tab5 mg (Crestor)

2


2


2


2

simvastatin tab 5 mg (Zocor) 1

simvastatin tab 10 mg(Zocor)

1


1


1


1

TRIGLIDE - fenofibrate tab 160mg

4 • •

VASCEPA - icosapent ethyl cap0.5 gm

4

VASCEPA - icosapent ethyl cap1 gm

4

VYTORIN - ezetimibe-simvastatin tab 10-10 mg

4 •


4 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4 •


4 •

WELCHOL - colesevelam hclpacket for susp 3.75 gm

3

WELCHOL - colesevelam hcltab 625 mg

3

ZETIA - ezetimibe tab 10 mg 4 •CARDIOVASCULAR AGENTS - MISC.ADCIRCA - tadalafil tab 20 mg

(pah)5 • • •

ADEMPAS - riociguat tab 0.5mg

5 • • •

ADEMPAS - riociguat tab 1 mg 5 • • •ADEMPAS - riociguat tab 1.5

mg5 • • •

ADEMPAS - riociguat tab 2 mg 5 • • •ADEMPAS - riociguat tab 2.5

mg5 • • •

amlodipine besylate-atorvastatin calcium tab2.5-10 mg (Caduet)

2


2


2

amlodipine besylate-atorvastatin calcium tab5-10 mg (Caduet)

2


2


2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2


2


2


2


2

BIDIL - isosorbide dinitrate-hydralazine hcl tab 20-37.5mg

4

CIALIS - tadalafil tab 2.5 mg 3 • •CIALIS - tadalafil tab 5 mg 3 • •CORLANOR - ivabradine hcl

tab 5 mg (base equiv)4

CORLANOR - ivabradine hcltab 7.5 mg (base equiv)

4

ENTRESTO - sacubitril-valsartan tab 24-26 mg

3 • •


3 • •


3 • •

ISOXSUPRINE HCL -isoxsuprine hcl tab 20 mg

4

isoxsuprine hcl tab 10 mg 2

LETAIRIS - ambrisentan tab 5mg

5 • • •

LETAIRIS - ambrisentan tab 10mg

5 • • •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

OPSUMIT - macitentan tab 10mg

5 • • •

ORENITRAM - treprostinildiolamine tab er 0.125 mg(base equiv)

5 • • •


5 • • •

ORENITRAM - treprostinildiolamine tab er 1 mg (baseequiv)

5 • • •


5 • • •

ORENITRAM - treprostinildiolamine tab er 5 mg (baseequiv)

5 • • •

REVATIO - sildenafil citrate forsuspension 10 mg/ml

5 • • •

sildenafil citrate tab 20 mg(Revatio)

5 • •

TRACLEER - bosentan tab62.5 mg

5 • • •

TRACLEER - bosentan tab 125mg

5 • • •

TYVASO - treprostinilinhalation solution 0.6 mg/ml

5 • • •

TYVASO REFILL - treprostinilinhalation solution 0.6 mg/ml

5 • • •

TYVASO STARTER -treprostinil inhalationsolution 0.6 mg/ml

5 • • •

UPTRAVI - selexipag tabtherapy pack 200 mcg (140)& 800 mcg (60)

5 • • •

UPTRAVI - selexipag tab 200mcg

5 • • •


5 • • •

2016



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5 • • •


5 • • •


5 • • •


5 • • •


5 • • •


5 • • •

VENTAVIS - iloprost inhalationsolution 10 mcg/ml

5 • • •

VENTAVIS - iloprost inhalationsolution 20 mcg/ml

5 • • •

ERECTILE DYSFUNCTIONCIALIS - tadalafil tab 2.5 mg 3 • •CIALIS - tadalafil tab 5 mg 3 • •RESPIRATORY AGENTSANTIHISTAMINESbrompheniramine maleate

tab sr 12hr 6 mg2

carbinoxamine maleate soln4 mg/5ml

2

carbinoxamine maleate tab4 mg

2

CLEMASTINE FUMARATE -clemastine fumarate tab2.68 mg

1

cyproheptadine hcl syrup2 mg/5ml

2

cyproheptadine hcl tab 4 mg 2

DESLORATADINE ODT -desloratadine tab orallydisintegrating 2.5 mg

2

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DESLORATADINE ODT -desloratadine tab orallydisintegrating 5 mg

2

desloratadine tab 5 mg(Clarinex)

2

KARBINAL ER - carbinoxaminemaleate extended releasesusp 4 mg/5ml

4

levocetirizinedihydrochloride soln2.5 mg/5ml (0.5 mg/ml)(Xyzal)

2

levocetirizinedihydrochloride tab 5 mg(Xyzal)

2

promethazine hcl suppos12.5 mg

2

promethazine hcl suppos25 mg

2

promethazine hcl suppos50 mg

2

promethazine hcl syrup6.25 mg/5ml

1

promethazine hcl tab12.5 mg

1

promethazine hcl tab 25 mg 1

promethazine hcl tab 50 mg 1

NASAL AGENTS - SYSTEMIC and TOPICALADRENALIN - epinephrine hcl

nasal soln 0.1%4

azelastine hcl nasal spray0.1% (137 mcg/spray)

2 •

azelastine hcl nasal spray0.15% (205.5 mcg/spray)(Astepro)

2 •

BACTROBAN NASAL -mupirocin calcium nasal oint2%

4 •

2016



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DYMISTA - azelastine hcl-fluticasone prop nasal spray137-50 mcg/act

4 •

FLUNISOLIDE - flunisolidenasal soln 25 mcg/act(0.025%)

2 •

fluticasone propionate nasalsusp 50 mcg/act

1 •

ipratropium bromide nasalsoln 0.03% (21 mcg/spray)(Atrovent)

2 •

ipratropium bromide nasalsoln 0.06% (42 mcg/spray)(Atrovent)

2 •

mometasone furoate nasalsusp 50 mcg/act (Nasonex)

2 •

olopatadine hcl nasal soln0.6% (Patanase)

2 •

OMNARIS - ciclesonide nasalsusp 50 mcg/act

4 •

QNASL - beclomethasonedipropionate nasal aerosol80 mcg/act

4 •

QNASL CHILDRENS -beclomethasonedipropionate nasal aerosol40 mcg/act

4 •

ZETONNA - ciclesonide nasalaerosol soln 37 mcg/act (50mcg/valve)

4 •

COUGH/COLD/ALLERGYacetylcysteine inhal soln

10%2

acetylcysteine inhal soln20%

2

benzonatate cap 100 mg(Tessalon perles)

1

benzonatate cap 150 mg 2

Drug Name Dru

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benzonatate cap 200 mg 1

brompheniramine &pseudoephedrine tab sr12hr 6-45 mg

1

CAPCOF - phenylephrine-chlorphen w/ codeine syrup5-2-10 mg/5ml

4

CODAR AR - chlorpheniraminew/ codeine liquid 2-8 mg/5ml

4

FLOWTUSS - hydrocodone-guaifenesin soln 2.5-200mg/5ml

4

GILPHEX TR - phenylephrine-guaifenesin tab 10-388 mg

4

GILTUSS TR - phenylephrinew/ dm-gg tab 10-28-388 mg

4

guaifenesin-codeine liquid225-7.5 mg/5ml

2

guaifenesin-codeine soln100-6.3 mg/5ml

1

guaifenesin-codeine soln100-10 mg/5ml

1

HISTEX-AC - phenylephrine-triprolidine-codeine syrup10-2.5-10 mg/5ml

4

HYCOFENIX -pseudoephedrine w/hydrocodone-gg soln30-2.5-200 mg/5ml

4

hydrocod polst-chlorphenpolst er susp 10-8 mg/5ml(Tussionex pennkineti)

2

hydrocodone w/homatropine syrup5-1.5 mg/5ml

2

hydrocodone w/homatropine tab 5-1.5 mg

2

HYPERSAL - sodium chloridesoln nebu 3.5%

4

2016



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M-END PE - phenylephrine-bromphen w/ codeine liqd3.33-1.33-6.33 mg/5ml

4

MAR-COF BP -pseudoephedrine-bromphen-codeine liqd30-2-7.5 mg/5ml

4

NEBUSAL - sodium chloridesoln nebu 6%

4

NEOTUSS PLUS -phenylephrine-chlorphen-dmliquid 7.5-4-30 mg/5ml

4

NINJACOF-XG - guaifenesin-codeine liquid 200-8 mg/5ml

2

OBREDON - hydrocodone-guaifenesin soln 2.5-200mg/5ml

4

phenylephrine w/ dm-gg liqd2.5-7.5-88 mg/ml

2

phenylephrine-brompheniramine-dmliquid 7.5-4-15 mg/5ml

2

PHENYLEPHRINE/GUAIFENESIN -phenylephrine-guaifenesinliqd 7.5-100 mg/5ml (1.5-20mg/ml)

2

POLY-TUSSIN AC -phenylephrine-bromphenw/ codeine liquid 10-4-10mg/5ml

4

PRO-CLEAR AC - codeine-pyrilamine syrup 9-8.33mg/5ml

4

PRO-RED AC - phenylephrine-dexchlorphenir-codeinesyrup 5-1-9 mg/5ml

4

promethazine &phenylephrine syrup6.25-5 mg/5ml

1

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promethazine w/ codeinesyrup 6.25-10 mg/5ml

1

promethazine-dm syrup6.25-15 mg/5ml

1

promethazine-phenylephrine-codeinesyrup 6.25-5-10 mg/5ml

1

pseudoeph-chlorphenw/ hydrocodone soln60-4-5 mg/5ml (Zutripro)

2

pseudoephed-bromphen-dmsyrup 30-2-10 mg/5ml

2

pseudoephedrine w/ cod-ggsoln 30-10-100 mg/5ml

2

REZIRA - pseudoephedrinew/ hydrocodone soln 60-5mg/5ml

4

SEMPREX-D - acrivastine &pseudoephedrine cap 8-60mg

4

sodium chloride soln nebu0.9%

1

sodium chloride soln nebu3%

2

sodium chloride soln nebu7% (Hyper-sal)

2

sodium chloride soln nebu10%

2

TUSNEL - pseudoephedrine w/dm-gg tab 60-30-400 mg

4

TUSNEL C - pseudoephedrinew/ cod-gg syrup 30-10-100mg/5ml

2

TUSSICAPS - hydrocod polst-chlorphen polst cap er 12hr5-4 mg

4

TUSSICAPS - hydrocod polst-chlorphen polst cap er 12hr10-8 mg

4

2016



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TUZISTRA XR - codeine polist-chlorphen polist er susp14.7-2.8 mg/5ml

4

VITUZ - hydrocodone-chlorpheniramine soln 5-4mg/5ml

4

Z-TUSS AC - chlorpheniraminew/ codeine liquid 2-9 mg/5ml

4

ANTIASTHMATIC and BRONCHODILATOR AGENTSADVAIR DISKUS - fluticasone-

salmeterol aer powder ba100-50 mcg/dose

4 •

ADVAIR DISKUS - fluticasone-salmeterol aer powder ba250-50 mcg/dose

4 •

ADVAIR DISKUS - fluticasone-salmeterol aer powder ba500-50 mcg/dose

4 •

ADVAIR HFA - fluticasone-salmeterol inhal aerosol45-21 mcg/act

4 •


4 •


4 •

AEROSPAN - flunisolide hfainhal aerosol 80 mcg/act

4 •

albuterol sulfate soln nebu0.083% (2.5 mg/3ml)

2 •

albuterol sulfate soln nebu0.5% (5 mg/ml)

2 •

albuterol sulfate soln nebu0.63 mg/3ml (base equiv)

2 •

albuterol sulfate soln nebu1.25 mg/3ml (base equiv)

2 •

albuterol sulfate syrup2 mg/5ml

1

Drug Name Dru

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albuterol sulfate tab er 12hr4 mg (Vospire er)

2

albuterol sulfate tab er 12hr8 mg (Vospire er)

2

albuterol sulfate tab 2 mg 2

albuterol sulfate tab 4 mg 2

ALVESCO - ciclesonide inhalaerosol 80 mcg/act

4 •

ALVESCO - ciclesonide inhalaerosol 160 mcg/act

4 •

ANORO ELLIPTA -umeclidinium-vilanterol aeropowd ba 62.5-25 mcg/inh

4 •

ARCAPTA NEOHALER -indacaterol maleate inhalpowder cap 75 mcg (baseequiv)

4 •

ASMANEX TWISTHALER 120ME - mometasone furoateinhal powd 220 mcg/inh(breath activated)

4 •

ASMANEX TWISTHALER 30MET - mometasone furoateinhal powd 110 mcg/inh(breath activated)

4 •


4 •


4 •

ATROVENT HFA - ipratropiumbromide hfa inhal aerosol 17mcg/act

4 •

2016



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BEVESPI AEROSPHERE -glycopyrrolate-formoterolfumarate aerosol 9-4.8 mcg/act

4 •

BREO ELLIPTA - fluticasonefuroate-vilanterol aero powdba 100-25 mcg/inh

4 •

BREO ELLIPTA - fluticasonefuroate-vilanterol aero powdba 200-25 mcg/inh

4 •

BROVANA - arformoteroltartrate soln nebu 15mcg/2ml (base equiv)

4

budesonide inhalation susp0.25 mg/2ml (Pulmicort)

2 •

budesonide inhalation susp0.5 mg/2ml (Pulmicort)

2 •

budesonide inhalation susp1 mg/2ml (Pulmicort)

2 •

COMBIVENT RESPIMAT -ipratropium-albuterol inhalaerosol soln 20-100 mcg/act

4 •

CROMOLYN SODIUM -cromolyn sodium soln nebu20 mg/2ml

4 •

DALIRESP - roflumilast tab 500mcg

4

DULERA - mometasonefuroate-formoterol fumarateaerosol 100-5 mcg/act

4 •

DULERA - mometasonefuroate-formoterol fumarateaerosol 200-5 mcg/act

4 •

dyphylline-guaifenesin liqd100-100 mg/5ml

2

ELIXOPHYLLIN - theophyllineelixir 80 mg/15ml

4

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FLOVENT DISKUS -fluticasone propionate aerpow ba 50 mcg/blister

3 •


3 •


3 •

FLOVENT HFA - fluticasonepropionate hfa inhal aero 44mcg/act (50/valve)

3 •

FLOVENT HFA - fluticasonepropionate hfa inhal aer 110mcg/act (125/valve)

3 •

FLOVENT HFA - fluticasonepropionate hfa inhal aer 220mcg/act (250/valve)

3 •

FLUTICASONEPROPIONATE/SA -fluticasone-salmeterol aerpowder ba 55-14 mcg/act

3 •


3 •


3 •

ipratropium bromide inhalsoln 0.02%

1 •

ipratropium-albuterol nebusoln 0.5-2.5(3) mg/3ml

2 •

levalbuterol hcl soln nebuconc 1.25 mg/0.5ml(base equiv) (Xopenexconcentrate)

2 •

2016



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levalbuterol hcl soln nebu0.31 mg/3ml (base equiv)(Xopenex)

2 •


2 •


2 •

METAPROTERENOLSULFATE - metaproterenolsulfate syrup 10 mg/5ml

4

METAPROTERENOLSULFATE - metaproterenolsulfate tab 20 mg

4

montelukast sodium chewtab 4 mg (base equiv)(Singulair)

1

montelukast sodium chewtab 5 mg (base equiv)(Singulair)

1

montelukast sodiumoral granules packet 4 mg(base equiv) (Singulair)

2

montelukast sodium tab10 mg (base equiv)(Singulair)

1

NUCALA - mepolizumab for inj100 mg

5 •

PERFOROMIST - formoterolfumarate soln nebu 20mcg/2ml

4

PROAIR HFA - albuterol sulfateinhal aero 108 mcg/act(90mcg base equiv)

3 •

PROAIR RESPICLICK -albuterol sulfate aer pow ba108 mcg/act (90 mcg baseequiv)

3 •

Drug Name Dru

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PROVENTIL HFA - albuterolsulfate inhal aero 108 mcg/act (90mcg base equiv)

4 •

PULMICORT - budesonideinhalation susp 1 mg/2ml

4 •

PULMICORT FLEXHALER -budesonide inhal aeropowd 90 mcg/act (breathactivated)

4 •

PULMICORT FLEXHALER -budesonide inhal aeropowd 180 mcg/act (breathactivated)

4 •

QVAR - beclomethasonediprop inhal aero soln 40mcg/act (50/valve)

3 •

QVAR - beclomethasonediprop inhal aero soln 80mcg/act (100/valve)

3 •

SEEBRI NEOHALER -glycopyrrolate inhal cap 15.6mcg

4 •

SEREVENT DISKUS -salmeterol xinafoate aerpow ba 50 mcg/dose (baseequiv)

3 •

SPIRIVA HANDIHALER -tiotropium bromidemonohydrate inhal cap 18mcg (base equiv)

3 •

SPIRIVA RESPIMAT -tiotropium bromidemonohydrate inhal aerosol1.25 mcg/act

3 •

SPIRIVA RESPIMAT -tiotropium bromidemonohydrate inhal aerosol2.5 mcg/act

3 •

2016



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STIOLTO RESPIMAT -tiotropium br-olodaterol inhalaero soln 2.5-2.5 mcg/act

3 •

STRIVERDI RESPIMAT -olodaterol hcl inhal aerosolsoln 2.5 mcg/act (baseequiv)

4 •

SYMBICORT - budesonide-formoterol fumarate dihydaerosol 80-4.5 mcg/act

3 •

SYMBICORT - budesonide-formoterol fumarate dihydaerosol 160-4.5 mcg/act

3 •

terbutaline sulfate tab2.5 mg

2

terbutaline sulfate tab 5 mg 2

THEO-24 - theophylline cap er24hr 100 mg

4


4


4


4

theophylline soln80 mg/15ml

2

theophylline tab er 12hr100 mg

1


2


2


2


2


2

Drug Name Dru

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TUDORZA PRESSAIR -aclidinium bromide aerosolpowd breath activated 400mcg/act

4 •

UTIBRON NEOHALER -indacaterol-glycopyrrolateinhal cap 27.5-15.6 mcg

4 •

VENTOLIN HFA - albuterolsulfate inhal aero 108 mcg/act (90mcg base equiv)

3 •

XOPENEX HFA - levalbuteroltartrate inhal aerosol 45mcg/act (base equiv)

4 •

zafirlukast tab 10 mg(Accolate)

2

zafirlukast tab 20 mg(Accolate)

2

zileuton tab er 12hr 600 mg(Zyflo cr)

2

ZYFLO - zileuton tab 600 mg 4

ZYFLO CR - zileuton tab er12hr 600 mg

4

RESPIRATORY AGENTS - MISC.CUROSURF - poractant alfa

intratracheal susp 120mg/1.5ml

4

CUROSURF - poractant alfaintratracheal susp 240mg/3ml

4

ESBRIET - pirfenidone cap 267mg

5 • • •

ESBRIET - pirfenidone tab 267mg

5 • • •

ESBRIET - pirfenidone tab 801mg

5 • • •

INFASURF - calfactant in nacl0.9% intratracheal susp 35mg/ml

4

2016



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KALYDECO - ivacaftor packet50 mg

5 • • •

KALYDECO - ivacaftor packet75 mg

5 • • •

KALYDECO - ivacaftor tab 150mg

5 • • •

OFEV - nintedanib esylate cap100 mg (base equivalent)

5 • • •

OFEV - nintedanib esylate cap150 mg (base equivalent)

5 • • •

ORKAMBI - lumacaftor-ivacaftor tab 100-125 mg

5 • • •

ORKAMBI - lumacaftor-ivacaftor tab 200-125 mg

5 • • •

PULMOZYME - dornase alfainhal soln 1 mg/ml

5 • •

SURVANTAINTRATRACHEAL -beractant in nacl 0.9%intratracheal susp 25 mg/ml

4

GASTROINTESTINAL AGENTSLAXATIVESbisacodyl tab & peg 3350-

kcl-sod bicarb-nacl forsoln kit

2

GIALAX - polyethylene glycol3350 - kit

4

GOLYTELY - peg 3350-kcl-nabicarb-nacl-na sulfate packet227.1 gm

4

KRISTALOSE - lactulose oralcrystal packet 10 gm

4

KRISTALOSE - lactulose oralcrystal packet 20 gm

4

lactulose solution10 gm/15ml

1

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MOVIPREP - peg 3350-kcl-nacl-na sulfate-naascorbate-c for soln 100 gm

4

OSMOPREP - sod phosmono-sod phos di tabs1.102-0.398 gm(1.5gm naphos)

4

PCP 100 - mag cit-bisacodyl-petrolat-peg-metoclopramide-electrol kit

4

peg 3350-kcl-sod bicarb-naclfor soln 420 gm (Nulytely/flavor pack)

1 •

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm(Golytely)

1 •

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm(Colyte-flavor packs)

1 •

polyethylene glycol 3350oral packet

2

polyethylene glycol 3350oral powder

1

PREPOPIK - sod picosulfate-mg oxide-citric acid pack 10mg-3.5 gm-12 gm

4

SUPREP BOWEL PREPKIT - sod sulfate-pot sulf-mgsulf oral sol 17.5-3.13-1.6gm/180ml

4

ANTIDIARRHEALSdiphenoxylate w/ atropine

tab 2.5-0.025 mg (Lomotil)2

DIPHENOXYLATE/ATROPINE - diphenoxylatew/ atropine liq 2.5-0.025mg/5ml

4

MOTOFEN - difenoxin w/atropine tab 1-0.025 mg

4

2016



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MYTESI - crofelemer tabdelayed release 125 mg

4

opium tincture 1% (10 mg/ml) (morphine equiv)

2

PAREGORIC - paregorictincture 2 mg/5ml (morphineequivalent)

4

RESTORA RX - lactobacilluscasei-folic acid cap 60-1.25mg

4

RESTORA SPRINKLES -lactobacillus casei-folic acidpacket 15-0.25 mg

4

ULCER DRUGSACIPHEX - rabeprazole

sodium ec tab 20 mg4 •

amoxicillin cap-clarithro tab-lansopraz cap dr therapypack (Prevpac)

2

BELLADONNA & OPIUM -belladonna alkaloids &opium suppos 16.2-30 mg

4

BELLADONNA ALKALOIDS &OP - belladonna alkaloids &opium suppos 16.2-60 mg

4

CARAFATE - sucralfate susp 1gm/10ml

4

chlordiazepoxide hcl-clidinium bromide cap5-2.5 mg (Librax)

2

cimetidine hcl soln300 mg/5ml

2

cimetidine tab 300 mg 1



CUVPOSA - glycopyrrolate oralsoln 1 mg/5ml

4

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DEXILANT - dexlansoprazolecap delayed release 30 mg

4 •

DEXILANT - dexlansoprazolecap delayed release 60 mg

4 •

dicyclomine hcl cap 10 mg(Bentyl)

1

dicyclomine hcl oral soln10 mg/5ml

2

dicyclomine hcl tab 20 mg(Bentyl)

1

DONNATAL - pb-hyoscy-atrop-scopol elix16.2-0.1037-0.0194-0.0065mg/5ml

4

DONNATAL - pb-hyoscy-atrop-scopol tab16.2-0.1037-0.0194-0.0065mg

4

esomeprazole magnesiumcap delayed release 20 mg(base eq) (Nexium)

2 •

esomeprazole magnesiumcap delayed release 40 mg(base eq) (Nexium)

2 •

famotidine for susp40 mg/5ml (Pepcid)

2

famotidine tab 40 mg(Pepcid)

1

FIRST-LANSOPRAZOLE -lansoprazole susp 3 mg/ml(compound kit)

4

FIRST-OMEPRAZOLE -omeprazole susp 2 mg/ml(compound kit)

4

glycopyrrolate tab 1 mg(Robinul)

2

glycopyrrolate tab 2 mg(Robinul forte)

2

2016



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hyoscyamine sulfate elixir0.125 mg/5ml

1

hyoscyamine sulfate soln0.125 mg/ml

2

hyoscyamine sulfate tabdisint 0.125 mg (Anaspaz)

2

hyoscyamine sulfate tab er12hr 0.375 mg (Levbid)

2

hyoscyamine sulfate tab sl0.125 mg (Levsin/sl)

2

hyoscyamine sulfate tab0.125 mg (Levsin)

2

lansoprazole cap delayedrelease 15 mg (Prevacid)

2 •

lansoprazole cap delayedrelease 30 mg (Prevacid)

2 •

methscopolamine bromidetab 2.5 mg (Pamine)

2

methscopolamine bromidetab 5 mg (Pamine forte)

2

misoprostol tab 100 mcg(Cytotec)

1

misoprostol tab 200 mcg(Cytotec)

1

NEXIUM - esomeprazolemagnesium for delayedrelease susp packet 5 mg

4 •


4 •


4 •


4 •

Drug Name Dru

g Ti

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horiz

atio

n

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NEXIUM - esomeprazolemagnesium for delayedrelease susp pack 2.5 mg

4 •

NIZATIDINE - nizatidine oralsoln 15 mg/ml

2

nizatidine cap 150 mg 1

nizatidine cap 300 mg (Axid) 2

OMECLAMOX-PAK -amoxicillin cap-clarithro tabw/ omepraz cap dr therapypack

4

OMEPRAZOLE + SYRSPENDSF - omeprazole susp 2 mg/ml (compound kit)

4

omeprazole cap delayedrelease 10 mg (Prilosec)

1 •


1 •


1 •

omeprazole-sodiumbicarbonate cap20-1100 mg (Zegerid)

2 •

omeprazole-sodiumbicarbonate cap40-1100 mg (Zegerid)

2 •

omeprazole-sodiumbicarbonate powd pack forsusp 20-1680 mg (Zegerid)

2 • •

omeprazole-sodiumbicarbonate powd pack forsusp 40-1680 mg (Zegerid)

2 • •

pantoprazole sodium ectab 20 mg (base equiv)(Protonix)

1 •

pantoprazole sodium ectab 40 mg (base equiv)(Protonix)

1 •

2016



Drug Name Dru

g Ti

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ing

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its

AC

A

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ited

Dis

tribu

tion

pb-hyoscy-atrop-scopol tab16.2-0.1037-0.0194-0.0065 mg(Donnatal)

2

PROPANTHELINE BROMIDE -propantheline bromide tab15 mg

4

PYLERA - bismuth subcit-metronidazole-tetracyclinecap 140-125-125 mg

4

rabeprazole sodium ec tab20 mg (Aciphex)

2 •

ranitidine hcl cap 150 mg 2

ranitidine hcl cap 300 mg 2

ranitidine hcl syrup 15 mg/ml (75 mg/5ml)

1

ranitidine hcl tab 300 mg(Zantac)

1

sucralfate tab 1 gm(Carafate)

2

SYMAX DUOTAB -hyoscyamine sulfate tab er0.375 mg (0.125 mg ir/0.25mg er)

4

ANTIEMETICSAKYNZEO - netupitant-

palonosetron cap 300-0.5mg

4 •

ANZEMET - dolasetronmesylate tab 50 mg

4 •

ANZEMET - dolasetronmesylate tab 100 mg

4 •

aprepitant capsule therapypack 80 & 125 mg (Emend)

2 •

aprepitant capsule 80 mg(Emend)

2 •

CESAMET - nabilone cap 1 mg 4

Drug Name Dru

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horiz

atio

n

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

DICLEGIS - doxylamine-pyridoxine tab delayedrelease 10-10 mg

4

dronabinol cap 2.5 mg(Marinol)

2 •

dronabinol cap 5 mg(Marinol)

2 •

dronabinol cap 10 mg(Marinol)

2 •

EMEND - aprepitant capsule40 mg

3 •


3 •


3 •

EMEND - aprepitant for oralsusp 125 mg (125 mg/5ml)

3 •

EMEND TRIPACK - aprepitantcapsule therapy pack 80 &125 mg

3 •

granisetron hcl tab 1 mg 2 •ondansetron hcl oral soln

4 mg/5ml (Zofran)2 •

ondansetron hcl tab 4 mg(Zofran)

1 •

ondansetron hcl tab 8 mg(Zofran)

2 •

ondansetron hcl tab 24 mg 2 •ondansetron orally

disintegrating tab 4 mg(Zofran odt)

1 •

ondansetron orallydisintegrating tab 8 mg(Zofran odt)

2 •

SANCUSO - granisetron tdpatch 3.1 mg/24hr (contains34.3 mg)

4 •

2016



Drug Name Dru

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n

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

scopolamine td patch 72hr1 mg/3days (Transderm-scop)

2

TRANSDERM-SCOP -scopolamine td patch 72hr 1mg/3days

4

trimethobenzamide hcl cap300 mg (Tigan)

2

VARUBI - rolapitant hcl tab 90mg (base equiv)

4 • •

ZUPLENZ - ondansetron oralsoluble film 4 mg

4 •

ZUPLENZ - ondansetron oralsoluble film 8 mg

4 •

DIGESTIVE AIDSCREON - pancrelipase

(lip-prot-amyl) dr cap3000-9500-15000 unit

3

CREON - pancrelipase(lip-prot-amyl) dr cap6000-19000-30000 unit

3


3


3


3

PANCREAZE - pancrelipase(lip-prot-amyl) dr cap2600-6200-10850 unit

4


4


4

Drug Name Dru

g Ti

er

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n

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pens

ing

Lim

its

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A

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ited

Dis

tribu

tion


4


4

PERTZYE - pancrelipase(lip-prot-amyl) dr cap4000-14375-15125 unit

4


4


4


4

SUCRAID - sacrosidase soln8500 unit/ml

5 • •

VIOKACE - pancrelipase(lip-prot-amyl) tab10440-39150-39150 unit

4

VIOKACE - pancrelipase(lip-prot-amyl) tab20880-78300-78300 unit

4

ZENPEP - pancrelipase(lip-prot-amyl) dr cap3000-10000-16000 unit

3


3


3


3

2016



Drug Name Dru

g Ti

er

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n

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


3


3


3

GASTROINTESTINAL AGENTS- MISC.alosetron hcl tab 0.5 mg

(base equiv) (Lotronex)2

alosetron hcl tab 1 mg (baseequiv) (Lotronex)

2

AMITIZA - lubiprostone cap 8mcg

4

AMITIZA - lubiprostone cap 24mcg

4

APRISO - mesalamine cap er24hr 0.375 gm

4

ASACOL HD - mesalamine tabdelayed release 800 mg

4

AURYXIA - ferric citrate tab 1gm (210 mg ferric iron)

4

balsalazide disodium cap750 mg (Colazal)

2

calcium acetate (phosphatebinder) cap 667 mg(169 mg ca) (Phoslo)

2

calcium acetate (phosphatebinder) tab 667 mg(Eliphos)

2

CANASA - mesalamine suppos1000 mg

3

CHENODAL - chenodiol tab250 mg

5 • •

CHOLBAM - cholic acid cap 50mg

5 •

Drug Name Dru

g Ti

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Prio

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ing

Lim

its

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A

Lim

ited

Dis

tribu

tion

CHOLBAM - cholic acid cap250 mg

5 •

CIMZIA - certolizumab pegol injkit 2 x 200 mg/ml

5 • • •

CIMZIA STARTER KIT -certolizumab pegol inj kit 6 x200 mg/ml

5 • • •

cromolyn sodium oral conc100 mg/5ml (Gastrocrom)

2

DELZICOL - mesalamine capdr 400 mg

4

DIPENTUM - olsalazinesodium cap 250 mg

4

ENTEREG - alvimopan cap 12mg

4

FOSRENOL - lanthanumcarbonate chew tab 500 mg(elemental)

4

FOSRENOL - lanthanumcarbonate chew tab 750 mg(elemental)

4

FOSRENOL - lanthanumcarbonate chew tab 1000mg (elemental)

4

FOSRENOL - lanthanumcarbonate oral powder pack750 mg (elemental)

4

FOSRENOL - lanthanumcarbonate oral powder pack1000 mg (elemental)

4

GATTEX - teduglutide (rdna)for inj kit 5 mg

5 • •

GIAZO - balsalazide disodiumtab 1.1 gm

4

lactulose (encephalopathy)solution 10 gm/15ml

1

lanthanum carbonate chewtab 500 mg (elemental)(Fosrenol)

2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2


2

LIALDA - mesalamine tabdelayed release 1.2 gm

4

LINZESS - linaclotide cap 72mcg

4


4


4

LOTRONEX - alosetron hcl tab0.5 mg (base equiv)

4

LOTRONEX - alosetron hcl tab1 mg (base equiv)

4

MESALAMINE DR -mesalamine tab delayedrelease 800 mg

4

mesalamine enema 4 gm 2

mesalamine tab delayedrelease 1.2 gm (Lialda)

2

metoclopramide hcl soln5 mg/5ml (10 mg/10ml)

1

metoclopramide hcl tab5 mg (Reglan)

1

metoclopramide hcl tab10 mg (Reglan)

1

METOCLOPRAMIDE ODT -metoclopramide hcl orallydisintegrating tab 5 mg(base eq)

2

METOCLOPRAMIDE ODT -metoclopramide hcl orallydisintegrating tab 10 mg(base eq)

4

Drug Name Dru

g Ti

er

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n

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

MOVANTIK - naloxegoloxalate tab 12.5 mg (baseequivalent)

4

MOVANTIK - naloxegol oxalatetab 25 mg (base equivalent)

4

OCALIVA - obeticholic acid tab5 mg

5 • • •

OCALIVA - obeticholic acid tab10 mg

5 • • •

PENTASA - mesalamine cap er250 mg

4

PENTASA - mesalamine cap er500 mg

4

PHOSLYRA - calcium acetate(phosphate binder) oral soln667 mg/5ml

4

RELISTOR - methylnaltrexonebromide inj 8 mg/0.4ml (20mg/ml)

4

RELISTOR - methylnaltrexonebromide inj 12 mg/0.6ml (20mg/ml)

4

RENAGEL - sevelamer hcl tab400 mg

4

RENAGEL - sevelamer hcl tab800 mg

4

RENVELA - sevelamercarbonate packet 0.8 gm

3

RENVELA - sevelamercarbonate packet 2.4 gm

3

RENVELA - sevelamercarbonate tab 800 mg

3

sevelamer carbonate packet0.8 gm (Renvela)

2

sevelamer carbonate packet2.4 gm (Renvela)

2

sevelamer carbonate tab800 mg (Renvela)

2

2016



Drug Name Dru

g Ti

er

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n

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

SFROWASA - mesalaminesulfite-free (sf) enema 4gm/60ml

4

sulfasalazine tab delayedrelease 500 mg (Azulfidineen-tabs)

2

sulfasalazine tab 500 mg(Azulfidine)

2

TRULANCE - plecanatide tab 3mg

4

ursodiol cap 300 mg(Actigall)

2

ursodiol tab 250 mg (Urso250)

2

ursodiol tab 500 mg (Ursoforte)

2

VELPHORO - sucroferricoxyhydroxide chew tab 500mg

3

VIBERZI - eluxadoline tab 75mg

3

VIBERZI - eluxadoline tab 100mg

3

XERMELO - telotristat etipratetab 250 mg (telotristat ethylequiv)

5 •

GENITOURINARY AGENTSURINARY ANTI-INFECTIVESMACRODANTIN -

nitrofurantoinmacrocrystalline cap 25 mg

4

methenamine hippurate tab1 gm (Hiprex)

2

METHENAMINEMANDELATE - methenaminemandelate tab 0.5 gm

4

methenamine mandelate tab1 gm

2

Drug Name Dru

g Ti

er

Prio

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horiz

atio

n

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y

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

methenamine-hyos-methblue-sod phos-phen saltab 81.6 mg

2

methenamine-hyosc-methblue-benz acid-phenyl saltab 81.6mg (Prosed/ds)

2

methenamine-hyosc-methblue-sod phos-phen salcap 118 mg

2

methenamine-hyosc-methblue-sod phos-phen salcap 120 mg

2

methenamine-hyosc-methblue-sod phos-phen saltab 81 mg

2

methenamine-hyoscamine-meth blue-sod phos cap120 mg

2

methenamine-hyoscamine-meth blue-sod phos tab81.6 mg (Urogesic-blue)

2

MONUROL - fosfomycintromethamine powd pack 3gm (base equivalent)

4

nitrofurantoinmacrocrystalline cap25 mg (Macrodantin)

2


2


2

nitrofurantoin monohydratemacrocrystalline cap100 mg (Macrobid)

2

nitrofurantoin susp25 mg/5ml (Furadantin)

2

2016



Drug Name Dru

g Ti

er

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atio

n

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

URIMAR-T - methenamine-hyosc-meth blue-sod phos-phen sal tab 120 mg

4

URINARY ANTISPASMODICSbethanechol chloride tab

5 mg (Urecholine)1

bethanechol chloride tab10 mg (Urecholine)

2


2


2

darifenacin hydrobromidetab er 24hr 7.5 mg (baseequiv) (Enablex)

2

darifenacin hydrobromidetab er 24hr 15 mg (baseequiv) (Enablex)

2

ENABLEX - darifenacinhydrobromide tab er 24hr7.5 mg (base equiv)

4

ENABLEX - darifenacinhydrobromide tab er 24hr 15mg (base equiv)

4

flavoxate hcl tab 100 mg 2

GELNIQUE - oxybutyninchloride td gel 10%

4

GELNIQUE PUMP - oxybutyninchloride td gel 10%

4

MYRBETRIQ - mirabegron taber 24 hr 25 mg

3

MYRBETRIQ - mirabegron taber 24 hr 50 mg

3

oxybutynin chloride syrup5 mg/5ml

1

oxybutynin chloride tab er24hr 5 mg (Ditropan xl)

2

Drug Name Dru

g Ti

er

Prio

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horiz

atio

n

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Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2


2

oxybutynin chloride tab5 mg

2

OXYTROL - oxybutynin tdpatch twice weekly 3.9mg/24hr

4

tolterodine tartrate cap er24hr 2 mg (Detrol la)

2

tolterodine tartrate cap er24hr 4 mg (Detrol la)

2

tolterodine tartrate tab 1 mg(Detrol)

2

tolterodine tartrate tab 2 mg(Detrol)

2

TOVIAZ - fesoterodinefumarate tab er 24hr 4 mg

4

TOVIAZ - fesoterodinefumarate tab er 24hr 8 mg

4

trospium chloride cap er24hr 60 mg

2

trospium chloride tab 20 mg 2

VESICARE - solifenacinsuccinate tab 5 mg

3

VESICARE - solifenacinsuccinate tab 10 mg

3

VAGINAL PRODUCTSAVC - sulfanilamide vaginal

cream 15%4

CLEOCIN - clindamycinphosphate vaginal suppos100 mg

4

clindamycin phosphatevaginal cream 2% (Cleocin)

2

2016



Drug Name Dru

g Ti

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n

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

CLINDESSE - clindamycinphosphate (one dose)vaginal cream 2%

4

ESTRACE - estradiol vaginalcream 0.1 mg/gm

3

estradiol vaginal tab 10 mcg(Vagifem)

2

ESTRING - estradiol vaginalring 2 mg (7.5 mcg/24hrs)

4

FEM PH - acetic acid-oxyquinoline vaginal gel0.9-0.025%

4

FEMRING - estradiol acetatevaginal ring 0.05 mg/24hr

4

FEMRING - estradiol acetatevaginal ring 0.1 mg/24hr

4

GYNAZOLE-1 - butoconazolenitrate (one dose) vaginalcream 2%

4

metronidazole vaginal gel0.75% (Metrogel-vaginal)

2

MICONAZOLE 3 - miconazolenitrate vaginal suppos 200mg

4

NUVESSA - metronidazolevaginal gel 1.3%

4

PREMARIN - estrogens,conjugated vaginal cream0.625 mg/gm

4

RELAGARD - acetic acid-oxyquinoline vaginal gel0.9-0.025%

4

terconazole vaginal cream0.4% (Terazol 7)

2

terconazole vaginal cream0.8% (Terazol 3)

2

terconazole vaginal suppos80 mg

2

Drug Name Dru

g Ti

er

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n

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

VAGIFEM - estradiol vaginaltab 10 mcg

3

GENITOURINARY AGENTS - MISC.alfuzosin hcl tab er 24hr

10 mg (Uroxatral)1

AVODART - dutasteride cap0.5 mg

4

CARDURA XL - doxazosinmesylate tab er 24 hr 4 mg(base equiv)

4

CARDURA XL - doxazosinmesylate tab er 24 hr 8 mg(base equiv)

4

CYSTAGON - cysteaminebitartrate cap 50 mg

5 • •

CYSTAGON - cysteaminebitartrate cap 150 mg

5 • •

dutasteride cap 0.5 mg(Avodart)

2

dutasteride-tamsulosin hclcap 0.5-0.4 mg (Jalyn)

2

ELMIRON - pentosanpolysulfate sodium caps 100mg

4

finasteride tab 5 mg(Proscar)

1

JALYN - dutasteride-tamsulosinhcl cap 0.5-0.4 mg

4

K-PHOS NO 2 - potassium &sodium acid phosphates tab305-700 mg

4

LITHOSTAT - acetohydroxamicacid tab 250 mg

4

ORACIT - sodium citrate &citric acid soln 490-640mg/5ml

4

phenazopyridine hcl tab100 mg (Pyridium)

1

2016



Drug Name Dru

g Ti

er

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horiz

atio

n

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y

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

phenazopyridine hcl tab200 mg (Pyridium)

1

pot & sod citrates w/ cit acsoln 550-500-334 mg/5ml

2

potassium citrate &citric acid powder pack3300-1002 mg

2

potassium citrate & citricacid soln 1100-334 mg/5ml

2

potassium citrate tab er 5meq (540 mg) (Urocit-k 5)

2


2


2

PROCYSBI - cysteaminebitartrate cap delayedrelease 25 mg (base equiv)

5 • •

PROCYSBI - cysteaminebitartrate cap delayedrelease 75 mg (base equiv)

5 • •

RAPAFLO - silodosin cap 4 mg 4

RAPAFLO - silodosin cap 8 mg 4

sodium citrate & citric acidsoln 500-334 mg/5ml(Shohls solution modi)

2

tamsulosin hcl cap 0.4 mg(Flomax)

1

THIOLA - tiopronin tab 100 mg 4 •CENTRAL NERVOUS SYSTEM DRUGSANTIANXIETY AGENTSALPRAZOLAM INTENSOL -

alprazolam conc 1 mg/ml4

alprazolam orallydisintegrating tab 0.25 mg(Niravam)

2

alprazolam orallydisintegrating tab 0.5 mg

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

alprazolam orallydisintegrating tab 1 mg

2

alprazolam orallydisintegrating tab 2 mg

2

alprazolam tab er 24hr0.5 mg (Xanax xr)

2

alprazolam tab er 24hr 1 mg(Xanax xr)

2


2


2

alprazolam tab 0.25 mg(Xanax)

1

alprazolam tab 0.5 mg(Xanax)

1

alprazolam tab 1 mg (Xanax) 1

alprazolam tab 2 mg (Xanax) 1

buspirone hcl tab 5 mg 1

buspirone hcl tab 7.5 mg 2




chlordiazepoxide hcl cap5 mg

1


1


1

clorazepate dipotassium tab3.75 mg (Tranxene t)

1

clorazepate dipotassium tab7.5 mg (Tranxene t)

1

clorazepate dipotassium tab15 mg (Tranxene t)

2

DIAZEPAM - diazepam oralsoln 1 mg/ml

4

2016



Drug Name Dru

g Ti

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

diazepam conc 5 mg/ml 2

diazepam tab 2 mg (Valium) 1



hydroxyzine hcl syrup10 mg/5ml

1

hydroxyzine hcl tab 10 mg 1



HYDROXYZINE PAMOATE -hydroxyzine pamoate cap100 mg

4

hydroxyzine pamoate cap25 mg (Vistaril)

1

hydroxyzine pamoate cap50 mg (Vistaril)

1

lorazepam conc 2 mg/ml(Lorazepam intensol)

2

lorazepam tab 0.5 mg(Ativan)

1

lorazepam tab 1 mg (Ativan) 1

lorazepam tab 2 mg (Ativan) 1

meprobamate tab 200 mg 2

meprobamate tab 400 mg 2

oxazepam cap 10 mg 2



ANTIDEPRESSANTSamitriptyline hcl tab 10 mg 1

amitriptyline hcl tab 25 mg 1





Drug Name Dru

g Ti

er

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atio

n

Ste

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Dis

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

AMOXAPINE - amoxapine tab25 mg

4


4


4


4

APLENZIN - bupropion hbr taber 24hr 174 mg

4 •


4 •


4 •

bupropion hcl tab er 12hr100 mg (Wellbutrin sr)

1


1


2

bupropion hcl tab er 24hr150 mg (Wellbutrin xl)

2

bupropion hcl tab er 24hr300 mg (Wellbutrin xl)

2

bupropion hcl tab 75 mg(Wellbutrin)

2

bupropion hcl tab 100 mg(Wellbutrin)

2

citalopram hydrobromideoral soln 10 mg/5ml

2

citalopram hydrobromidetab 10 mg (base equiv)(Celexa)

1


1

2016



Drug Name Dru

g Ti

er

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n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1

clomipramine hcl cap 25 mg(Anafranil)

2


2


2

desipramine hcl tab 10 mg(Norpramin)

2


2


2


2


2


2

DESVENLAFAXINE ER -desvenlafaxine tab er 24hr50 mg

4 •

DESVENLAFAXINE ER -desvenlafaxine tab er 24hr100 mg

4 •

desvenlafaxine succinatetab er 24hr 25 mg (baseequiv) (Pristiq)

2 •


2 •


2 •

doxepin hcl cap 10 mg 1


Drug Name Dru

g Ti

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n

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion





doxepin hcl conc 10 mg/ml 1

DULOXETINE HCL -duloxetine hcl enteric coatedpellets cap 40 mg (base eq)

4 • •

duloxetine hcl entericcoated pellets cap 20 mg(base eq) (Cymbalta)

2 •


2 •


2 •

EMSAM - selegiline td patch24hr 6 mg/24hr

4


4


4

escitalopram oxalate soln5 mg/5ml (base equiv)(Lexapro)

2

escitalopram oxalatetab 5 mg (base equiv)(Lexapro)

1


1


1

FETZIMA - levomilnacipranhcl cap er 24hr 20 mg (baseequivalent)

4 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4 •


4 •

FETZIMA - levomilnacipran hclcap er 24hr 120 mg (baseequivalent)

4 •

FETZIMA TITRATION PACK -levomilnacipran hcl cap er24hr 20 & 40 mg therapypack

4 •

FLUOXETINE DR - fluoxetinehcl cap delayed release 90mg

2 • •

FLUOXETINE HCL - fluoxetinehcl tab 60 mg

4 •

fluoxetine hcl cap 10 mg(Prozac)

1


1


1

fluoxetine hcl solution20 mg/5ml

1

fluoxetine hcl tab 10 mg 1

fluoxetine hcl tab 20 mg 2

fluvoxamine maleate cap er24hr 100 mg

2

fluvoxamine maleate cap er24hr 150 mg

2

fluvoxamine maleate tab25 mg

2


2


2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

FORFIVO XL - bupropion hcltab er 24hr 450 mg

4 •

imipramine hcl tab 10 mg(Tofranil)

1


1


1

imipramine pamoate cap75 mg (Tofranil-pm)

2


2


2


2

KHEDEZLA - desvenlafaxinetab er 24hr 50 mg

4 •

KHEDEZLA - desvenlafaxinetab er 24hr 100 mg

4 •

MAPROTILINE HCL -maprotiline hcl tab 25 mg

4 •


4 •


4 •

MARPLAN - isocarboxazid tab10 mg

4

mirtazapine orallydisintegrating tab 15 mg(Remeron soltab)

2


2


2

mirtazapine tab 7.5 mg 2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

mirtazapine tab 15 mg(Remeron)

1


1


1

NEFAZODONE HCL -nefazodone hcl tab 100 mg

4


4


4

nefazodone hcl tab 50 mg 2

nefazodone hcl tab 250 mg 2

NORTRIPTYLINE HCL -nortriptyline hcl soln 10mg/5ml

4

nortriptyline hcl cap 10 mg(Pamelor)

1


1


1


1

paroxetine hcl tab er 24hr12.5 mg (Paxil cr)

2

paroxetine hcl tab er 24hr25 mg (Paxil cr)

2

paroxetine hcl tab er 24hr37.5 mg (Paxil cr)

2

paroxetine hcl tab 10 mg(Paxil)

1


1


1

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1

PAXIL - paroxetine hcl oralsusp 10 mg/5ml (base equiv)

4 •

PEXEVA - paroxetine mesylatetab 10 mg (base equiv)

4 •


4 •


4 •


4 •

phenelzine sulfate tab 15 mg(Nardil)

2

PRISTIQ - desvenlafaxinesuccinate tab er 24hr 25 mg(base equiv)

4 • •

PRISTIQ - desvenlafaxinesuccinate tab er 24hr 50 mg(base equiv)

4 • •

PRISTIQ - desvenlafaxinesuccinate tab er 24hr 100mg (base equiv)

4 • •

protriptyline hcl tab 5 mg 2

protriptyline hcl tab 10 mg 2

sertraline hcl oral conc20 mg/ml (Zoloft)

2

sertraline hcl tab 25 mg(Zoloft)

1


1


1

SURMONTIL - trimipraminemaleate cap 25 mg

4


4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4

tranylcypromine sulfate tab10 mg (Parnate)

2

trazodone hcl tab 50 mg 1




trimipramine maleate cap25 mg (Surmontil)

2


2


2

TRINTELLIX - vortioxetine hbrtab 5 mg (base equiv)

4 •


4 •


4 •

venlafaxine hcl cap er 24hr37.5 mg (base equivalent)(Effexor xr)

1

venlafaxine hcl cap er 24hr75 mg (base equivalent)(Effexor xr)

1

venlafaxine hcl cap er 24hr150 mg (base equivalent)(Effexor xr)

1

venlafaxine hcl tab er 24hr37.5 mg (base equivalent)(Venlafaxine hcl er)

2

venlafaxine hcl tab er 24hr75 mg (base equivalent)(Venlafaxine hcl er)

2

venlafaxine hcl tab er 24hr150 mg (base equivalent)(Venlafaxine hcl er)

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

venlafaxine hcl tab er 24hr225 mg (base equivalent)

2

venlafaxine hcl tab 25 mg 2

venlafaxine hcl tab 37.5 mg 2




VIIBRYD - vilazodone hcl tab10 mg

4 •


4 •


4 •

VIIBRYD STARTER PACK -vilazodone hcl tab starter kit10 (7) & 20 (23) mg

4 •

ANTIPSYCHOTICSABILIFY - aripiprazole tab 2 mg 4 •ABILIFY - aripiprazole tab 5 mg 4 •ABILIFY - aripiprazole tab 10

mg4 •

ABILIFY - aripiprazole tab 15mg

4 •


4 •


4 •

ADASUVE - loxapine aerosolpowder breath activated 10mg

4

aripiprazole oral solution1 mg/ml

2 •

aripiprazole orallydisintegrating tab 10 mg

2 •

aripiprazole orallydisintegrating tab 15 mg

2 •

aripiprazole tab 2 mg (Abilify) 2 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

aripiprazole tab 5 mg (Abilify) 2 •aripiprazole tab 10 mg

(Abilify)2 •

aripiprazole tab 15 mg(Abilify)

2 •


2 •


2 •

chlorpromazine hcl tab10 mg

2


2


2


2


2

CLOZAPINE ODT - clozapineorally disintegrating tab 12.5mg

4 •

CLOZAPINE ODT - clozapineorally disintegrating tab 150mg

4 •

CLOZAPINE ODT - clozapineorally disintegrating tab 200mg

4 •

clozapine orallydisintegrating tab 25 mg(Fazaclo)

2 •

clozapine orallydisintegrating tab 100 mg(Fazaclo)

2 •

clozapine tab 25 mg(Clozaril)

2 •

clozapine tab 50 mg 2 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

clozapine tab 100 mg(Clozaril)

2 •

clozapine tab 200 mg 2 •EQUETRO - carbamazepine

(antipsychotic) cap er 12hr100 mg

4

EQUETRO - carbamazepine(antipsychotic) cap er 12hr200 mg

4

EQUETRO - carbamazepine(antipsychotic) cap er 12hr300 mg

4

FANAPT - iloperidone tab 1 mg 4 •FANAPT - iloperidone tab 2 mg 4 •FANAPT - iloperidone tab 4 mg 4 •FANAPT - iloperidone tab 6 mg 4 •FANAPT - iloperidone tab 8 mg 4 •FANAPT - iloperidone tab 10

mg4 •

FANAPT - iloperidone tab 12mg

4 •

FANAPT TITRATION PACK -iloperidone tab 1 mg & 2 mg& 4 mg & 6 mg titration pak

4 •

FAZACLO - clozapine orallydisintegrating tab 12.5 mg

4 •

FAZACLO - clozapine orallydisintegrating tab 25 mg

4 •


4 •


4 •


4 •

FLUPHENAZINE HCL -fluphenazine hcl elixir 2.5mg/5ml

3

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

FLUPHENAZINE HCL -fluphenazine hcl oral conc 5mg/ml

3

fluphenazine hcl tab 1 mg 1

fluphenazine hcl tab 2.5 mg 1



haloperidol lactate oral conc2 mg/ml

1

haloperidol tab 0.5 mg 1

haloperidol tab 1 mg 1





INVEGA - paliperidone tab er24hr 1.5 mg

4 •

INVEGA - paliperidone tab er24hr 3 mg

4 •


4 •


4 •

LATUDA - lurasidone hcl tab 20mg

4 •


4 •


4 •


4 •

LATUDA - lurasidone hcl tab120 mg

4 •

LITHIUM - lithium oral solution8 meq/5ml

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

LITHIUM CARBONATE -lithium carbonate cap 150mg

4

LITHIUM CARBONATE -lithium carbonate cap 600mg

4

lithium carbonate cap150 mg (Lithium carbonate)

1

lithium carbonate cap300 mg

1

lithium carbonate cap600 mg (Lithium carbonate)

1

lithium carbonate tab er300 mg (Lithobid)

2

lithium carbonate tab er450 mg

2

lithium carbonate tab300 mg

1

LITHOBID - lithium carbonatetab er 300 mg

4

loxapine succinate cap 5 mg 2

loxapine succinate cap10 mg

2


2


2

NUPLAZID - pimavanserintartrate tab 17 mg (baseequivalent)

4 •

olanzapine orallydisintegrating tab 5 mg(Zyprexa zydis)

2 •


2 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2 •


2 •

olanzapine tab 2.5 mg(Zyprexa)

1 •

olanzapine tab 5 mg(Zyprexa)

1 •

olanzapine tab 7.5 mg(Zyprexa)

1 •


1 •


2 •


2 •

paliperidone tab er 24hr1.5 mg (Invega)

2 •

paliperidone tab er 24hr3 mg (Invega)

2 •


2 •


2 •

perphenazine tab 2 mg 2




prochlorperazine maleatetab 5 mg (base equivalent)(Compazine)

1

prochlorperazine maleatetab 10 mg (baseequivalent) (Compazine)

1

prochlorperazine suppos25 mg

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

quetiapine fumarate tab er24hr 50 mg (Seroquel xr)

2 •


2 •


2 •


2 •


2 •

quetiapine fumarate tab25 mg (Seroquel)

1 •


1 •


1 •


2 •


2 •


2 •

REXULTI - brexpiprazole tab0.25 mg

4 •

REXULTI - brexpiprazole tab0.5 mg

4 •

REXULTI - brexpiprazole tab 1mg

4 •


4 •


4 •


4 •

risperidone orallydisintegrating tab 0.25 mg

2 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

risperidone orallydisintegrating tab 0.5 mg(Risperdal m-tab)

2 •

risperidone orallydisintegrating tab 1 mg(Risperdal m-tab)

2 •


2 •


2 •


2 •

risperidone soln 1 mg/ml(Risperdal)

2 •

risperidone tab 0.25 mg(Risperdal)

1 •

risperidone tab 0.5 mg(Risperdal)

1 •

risperidone tab 1 mg(Risperdal)

1 •


1 •


1 •


1 •

SAPHRIS - asenapine maleatesl tab 2.5 mg (base equiv)

4 •

SAPHRIS - asenapine maleatesl tab 5 mg (base equiv)

4 •

SAPHRIS - asenapine maleatesl tab 10 mg (base equiv)

4 •

SEROQUEL XR - quetiapinefumarate tab er 24hr 50 mg

3 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


3 •


3 •


3 •


3 •

thioridazine hcl tab 10 mg 2




thiothixene cap 1 mg 2




trifluoperazine hcl tab 1 mg(base equivalent)

2


2


2


2

VERSACLOZ - clozapine susp50 mg/ml

4 •

VRAYLAR - cariprazine hcl captherapy pack 1.5 mg (1) & 3mg (6)

4 •

VRAYLAR - cariprazine hcl cap1.5 mg (base equivalent)

4 •

VRAYLAR - cariprazine hcl cap3 mg (base equivalent)

4 •

VRAYLAR - cariprazine hcl cap4.5 mg (base equivalent)

4 •

VRAYLAR - cariprazine hcl cap6 mg (base equivalent)

4 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ziprasidone hcl cap 20 mg(Geodon)

2 •


2 •


2 •


2 •

HYPNOTICSBUTISOL SODIUM -

butabarbital sodium tab 30mg

4

DORAL - quazepam tab 15 mg 4

estazolam tab 1 mg 1

estazolam tab 2 mg 1

eszopiclone tab 1 mg(Lunesta)

2 •


2 •


2 •

FLURAZEPAM HCL -flurazepam hcl cap 15 mg

4

FLURAZEPAM HCL -flurazepam hcl cap 30 mg

4

HETLIOZ - tasimelteon capsule20 mg

4 • • •

midazolam hcl syrup 2 mg/ml (base equivalent)

2

PHENOBARBITAL -phenobarbital tab 15 mg

4


4


4


4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

phenobarbital elixir20 mg/5ml

2

phenobarbital tab 16.2 mg 1




QUAZEPAM - quazepam tab15 mg

4

ROZEREM - ramelteon tab 8mg

4 •

SECONAL SODIUM -secobarbital sodium cap 100mg

4

SILENOR - doxepin hcl (sleep)tab 3 mg (base equiv)

4 •

SILENOR - doxepin hcl (sleep)tab 6 mg (base equiv)

4 •

temazepam cap 7.5 mg(Restoril)

2

temazepam cap 15 mg(Restoril)

1

temazepam cap 22.5 mg(Restoril)

2

temazepam cap 30 mg(Restoril)

1

TRIAZOLAM - triazolam tab0.125 mg

1

triazolam tab 0.25 mg(Halcion)

2

zaleplon cap 5 mg (Sonata) 1 •zaleplon cap 10 mg (Sonata) 1 •zolpidem tartrate sl tab

1.75 mg (Intermezzo)2 •

zolpidem tartrate sl tab3.5 mg (Intermezzo)

2 •

zolpidem tartrate tab er6.25 mg (Ambien cr)

2 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

zolpidem tartrate tab er12.5 mg (Ambien cr)

2 •

zolpidem tartrate tab 5 mg(Ambien)

1 •

zolpidem tartrate tab 10 mg(Ambien)

1 •

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTSamphetamine-

dextroamphetamine cap er24hr 5 mg (Adderall xr)

2 •

amphetamine-dextroamphetamine cap er24hr 10 mg (Adderall xr)

2 •


2 •


2 •


2 •


2 •

amphetamine-dextroamphetamine tab5 mg (Adderall)

2 •

amphetamine-dextroamphetamine tab7.5 mg (Adderall)

2 •


2 •

amphetamine-dextroamphetamine tab12.5 mg (Adderall)

2 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2 •


2 •


2 •

armodafinil tab 50 mg(Nuvigil)

2 • •


2 • •


2 • •


2 • •

atomoxetine hcl cap 10 mg(base equiv) (Strattera)

2 •


2 •


2 •


2 •


2 •


2 •


2 •

caffeine citrate oral soln60 mg/3ml (10 mg/ml baseequiv)

2

clonidine hcl tab er 12hr0.1 mg (Kapvay)

2 •

dexmethylphenidate hcl caper 24 hr 5 mg (Focalin xr)

2 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2 •


2 •


2 •


2 •


2 •


2 •


2 •

dexmethylphenidate hcl tab2.5 mg (Focalin)

2 •

dexmethylphenidate hcl tab5 mg (Focalin)

2 •

dexmethylphenidate hcl tab10 mg (Focalin)

2 •

dextroamphetaminesulfate cap er 24hr 5 mg(Dexedrine)

2 •


2 •


2 •

dextroamphetamine sulfateoral solution 5 mg/5ml(Procentra)

2 •

dextroamphetamine sulfatetab 5 mg

2 •

dextroamphetamine sulfatetab 10 mg

2 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

FOCALIN XR -dexmethylphenidate hcl caper 24 hr 10 mg

4 •


4 •


4 •


4 •

guanfacine hcl tab er 24hr1 mg (base equiv) (Intuniv)

2 •


2 •


2 •


2 •

methamphetamine hcl tab5 mg (Desoxyn)

2 •

METHYLPHENIDATE HCL -methylphenidate hcl chewtab 2.5 mg

2 •

METHYLPHENIDATE HCL -methylphenidate hcl chewtab 5 mg

2 •

METHYLPHENIDATE HCL -methylphenidate hcl chewtab 10 mg

2 •

methylphenidate hcl cap er10 mg (cd)

2 •


2 •


2 •


2 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2 •


2 •

methylphenidate hcl cap er24hr 20 mg (la) (Ritalin la)

2 •


2 •


2 •

METHYLPHENIDATE HCLER - methylphenidate hcl taber 24hr 18 mg

2 •


2 •


2 •


2 •

methylphenidate hcl soln5 mg/5ml (Methylin)

2 •

methylphenidate hcl soln10 mg/5ml (Methylin)

2 •

methylphenidate hcl taber osmotic release (osm)18 mg (Concerta)

2 •


2 •


2 •


2 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

methylphenidate hcl tab er10 mg

2 •

methylphenidate hcl tab er20 mg

2 •

methylphenidate hcl tab5 mg (Ritalin)

2 •


2 •


2 •

modafinil tab 100 mg(Provigil)

2 • •

modafinil tab 200 mg(Provigil)

2 • •

NUVIGIL - armodafinil tab 50mg

4 • •


4 • •


4 • •


4 • •

STRATTERA - atomoxetine hclcap 10 mg (base equiv)

4 •


4 •


4 •


4 •


4 •


4 •


4 •

VYVANSE - lisdexamfetaminedimesylate cap 10 mg

4 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4 •


4 •


4 •


4 •


4 •


4 •

VYVANSE - lisdexamfetaminedimesylate chew tab 10 mg

4 •


4 •


4 •


4 •


4 •


4 •

PSYCHOTHERAPEUTIC and NEUROLOGICALAGENTS - MISC.acamprosate calcium tab

delayed release 333 mg2

AMPYRA - dalfampridine tab er12hr 10 mg

5 • • •

AUBAGIO - teriflunomide tab 7mg

5 • •

AUBAGIO - teriflunomide tab14 mg

5 • •

AUSTEDO - deutetrabenazinetab 6 mg

5 • • •


5 • • •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


5 • • •

AVONEX - interferon beta-1afor im inj kit 30mcg(33mcg(6.6 mu)/vial)

5 • •

AVONEX - interferon beta-1aim prefilled syringe kit 30mcg/0.5ml

5 • •

AVONEX PEN - interferonbeta-1a im auto-injector kit30 mcg/0.5ml

5 • •

BETASERON - interferonbeta-1b for inj kit 0.3 mg

5 • •

BRISDELLE - paroxetinemesylate cap 7.5 mg (baseequiv)

4

bupropion hcl (smokingdeterrent) tab er 12hr150 mg (Zyban)

A •

CHANTIX - varenicline tartratetab 0.5 mg (base equiv)

A •

CHANTIX - varenicline tartratetab 1 mg (base equiv)

A •

CHANTIX CONTINUINGMONTH - varenicline tartratetab 1 mg (base equiv)

A •

CHANTIX STARTING MONTHPA - varenicline tartrate tab0.5 mg x 11 & tab 1 mg x 42pack

A •

CHLORDIAZEPOXIDE/AMITRIPT -chlordiazepoxide-amitriptyline tab 5-12.5 mg

4

CHLORDIAZEPOXIDE/AMITRIPT -chlordiazepoxide-amitriptyline tab 10-25 mg

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

COMMIT - nicotine polacrilexlozenge 2 mg

A •

COMMIT - nicotine polacrilexlozenge 4 mg

A •

COPAXONE - glatirameracetate soln prefilled syringe20 mg/ml

5 • •

COPAXONE - glatirameracetate soln prefilled syringe40 mg/ml

5 • •

disulfiram tab 250 mg(Antabuse)

2

disulfiram tab 500 mg(Antabuse)

2

donepezil hydrochlorideorally disintegrating tab5 mg

2

donepezil hydrochlorideorally disintegrating tab10 mg

2

donepezil hydrochloride tab5 mg (Aricept)

1


1


2

ERGOLOID MESYLATES -ergoloid mesylates tab 1 mg

2

EXELON - rivastigmine tdpatch 24hr 4.6 mg/24hr

4


4


4

EXTAVIA - interferon beta-1bfor inj kit 0.3 mg

5 • • •

FLUOXETINE - fluoxetine hcl(pmdd) cap 10 mg

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

FLUOXETINE - fluoxetine hcl(pmdd) cap 20 mg

2

fluoxetine hcl (pmdd) tab10 mg (Sarafem)

2

fluoxetine hcl (pmdd) tab20 mg (Sarafem)

2

GALANTAMINEHYDROBROMIDE -galantamine hydrobromideoral soln 4 mg/ml

4

galantamine hydrobromidecap er 24hr 8 mg(Razadyne er)

2


2


2

galantamine hydrobromidetab 4 mg (Razadyne)

2


2


2

GILENYA - fingolimod hcl cap0.5 mg (base equiv)

5 • •

glatiramer acetate solnprefilled syringe 20 mg/ml(Copaxone)

5 • •

glatiramer acetate solnprefilled syringe 40 mg/ml(Copaxone)

5 • •

GRALISE - gabapentin (once-daily) tab 300 mg

4 •

GRALISE - gabapentin (once-daily) tab 600 mg

4 •

2016



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ited

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tion

GRALISE STARTER -gabapentin (once-daily) tabpack 300 mg (9) & 600 mg(69)

4 •

HORIZANT - gabapentinenacarbil tab er 300 mg

4 •

HORIZANT - gabapentinenacarbil tab er 600 mg

4 •

INGREZZA - valbenazinetosylate cap 40 mg (baseequiv)

5 • • •

INGREZZA - valbenazinetosylate cap 80 mg (baseequiv)

5 • • •

memantine hcl oral solution2 mg/ml (Namenda)

2

memantine hcl tab 5 mg(Namenda)

2

memantine hcl tab 10 mg(Namenda)

2

memantine hcl tab 5 mg (28)& 10 mg (21) titration pak(Namenda titration pa)

2

NAMENDA - memantine hcltab 5 mg

4

NAMENDA - memantine hcltab 10 mg

4

NAMENDA TITRATION PAK -memantine hcl tab 5 mg (28)& 10 mg (21) titration pak

4

NAMENDA XR - memantinehcl cap er 24hr 7 mg

4


4


4


4

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ited

Dis

tribu

tion

NAMENDA XR TITRATIONPACK - memantine hcl cap er24hr 7 mg & 14 mg & 21 mg& 28 mg pack

4

NAMZARIC - memantine hcl-donepezil hcl cap er 24hr7-10 mg

4


4


4


4

NAMZARIC - memantine-donepezil cap er 24hr 7 & 14& 21 & 28-10 mg pack

4

NICODERM CQ - nicotine tdpatch 24hr 7 mg/24hr

A •


A •


A •

NICORETTE - nicotinepolacrilex gum 2 mg

A •

NICORETTE - nicotinepolacrilex gum 4 mg

A •

NICORETTE - nicotinepolacrilex lozenge 2 mg

A •

NICORETTE - nicotinepolacrilex lozenge 4 mg

A •

NICORETTE MINI - nicotinepolacrilex lozenge 2 mg

A •

NICORETTE MINI - nicotinepolacrilex lozenge 4 mg

A •

NICORETTE STARTER KIT -nicotine polacrilex gum 2 mg

A •

2016



Drug Name Dru

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ited

Dis

tribu

tion

NICORETTE STARTER KIT -nicotine polacrilex gum 4 mg

A •

nicotine polacrilex gum2 mg

A •

nicotine polacrilex gum4 mg

A •

nicotine polacrilex lozenge2 mg

A •

nicotine polacrilex lozenge4 mg

A •

nicotine td patch 24hr7 mg/24hr

A •

nicotine td patch 24hr14 mg/24hr

A •

Nicotine td patch 24hr21 mg/24hr

A •

NICOTINE TRANSDERMALSYST - nicotine td patch 24hr kit 21-14-7 mg/24hr

A •

NICOTROL INHALER -nicotine inhaler system 10mg (4 mg delivered)

A •

NICOTROL NS - nicotine nasalspray 10 mg/ml (0.5 mg/spray)

A •

NUEDEXTA -dextromethorphan hbr-quinidine sulfate cap 20-10mg

3

olanzapine-fluoxetine hclcap 3-25 mg (Symbyax)

2


2


2


2

Drug Name Dru

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ited

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tribu

tion


2

ORAP - pimozide tab 1 mg 4

ORAP - pimozide tab 2 mg 4

paroxetine mesylate cap7.5 mg (base equiv)(Brisdelle)

2

PERPHENAZINE/AMITRIPTYLIN -perphenazine-amitriptylinetab 2-10 mg

4


4


4


4


4

pimozide tab 1 mg (Orap) 2

pimozide tab 2 mg (Orap) 2

PLEGRIDY - peginterferonbeta-1a soln pen-injector125 mcg/0.5ml

5 • •

PLEGRIDY - peginterferonbeta-1a soln prefilled syringe125 mcg/0.5ml

5 • •

PLEGRIDY STARTER PACK -peginterferon beta-1a solnpen-inj 63 & 94 mcg/0.5mlpack

5 • •

2016



Drug Name Dru

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ited

Dis

tribu

tion

PLEGRIDY STARTER PACK -peginterferon beta-1a solnpref syr 63 & 94 mcg/0.5mlpack

5 • •

REBIF - interferon beta-1asoln pref syr 22 mcg/0.5ml(12mu/ml)

5 • •

REBIF - interferon beta-1asoln pref syr 44 mcg/0.5ml(24mu/ml)

5 • •

REBIF REBIDOSE - interferonbeta-1a soln auto-inj 22mcg/0.5ml (12mu/ml)

5 • •

REBIF REBIDOSE - interferonbeta-1a soln auto-inj 44mcg/0.5ml (24mu/ml)

5 • •

REBIF REBIDOSETITRATION - interferonbeta-1a auto-inj 6x8.8mcg/0.2ml & 6x22mcg/0.5ml

5 • •

REBIF TITRATION PACK -interferon beta-1a pref syr6x8.8 mcg/0.2ml & 6x22mcg/0.5ml

5 • •

rivastigmine tartrate cap1.5 mg (Exelon)

2

rivastigmine tartrate cap3 mg (Exelon)

2

rivastigmine tartrate cap4.5 mg (Exelon)

2

rivastigmine tartrate cap6 mg (Exelon)

2

rivastigmine td patch 24hr4.6 mg/24hr (Exelon)

2


2


2

Drug Name Dru

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A

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ited

Dis

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tion

SARAFEM - fluoxetine hcl(pmdd) tab 10 mg

4

SARAFEM - fluoxetine hcl(pmdd) tab 20 mg

4

SAVELLA - milnacipran hcl tab12.5 mg

4 •

SAVELLA - milnacipran hcl tab25 mg

4 •


4 •


4 •

SAVELLA TITRATION PACK -milnacipran hcl tab 12.5 mg(5) & 25 mg (8) & 50 mg (42)pak

4 •

TECFIDERA - dimethylfumarate capsule delayedrelease 120 mg

5 • •

TECFIDERA - dimethylfumarate capsule delayedrelease 240 mg

5 • •

TECFIDERA STARTERPACK - dimethyl fumaratecapsule dr starter pack 120mg & 240 mg

5 • •

tetrabenazine tab 12.5 mg(Xenazine)

5 • • •

tetrabenazine tab 25 mg(Xenazine)

5 • • •

XENAZINE - tetrabenazine tab12.5 mg

5 • • •

XENAZINE - tetrabenazine tab25 mg

5 • • •

XYREM - sodium oxybate oralsolution 500 mg/ml

5 • • •

ZINBRYTA - daclizumab solnprefilled syringe 150 mg/ml

5 • • •

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion

ZYBAN - bupropion hcl(smoking deterrent) tab er12hr 150 mg

A •

ANALGESICS AND ANESTHETICSANALGESICS - NON-NARCOTICALLZITAL - butalbital-

acetaminophen tab 25-325mg

4

aspirin chew tab 81 mg A •aspirin tab delayed release

81 mgA •

butalbital-acetaminophentab 50-300 mg

2

butalbital-acetaminophentab 50-325 mg

2

butalbital-acetaminophen-caffeine cap 50-300-40 mg(Fioricet)

2

butalbital-acetaminophen-caffeine cap 50-325-40 mg

2

butalbital-acetaminophen-caffeine tab 50-325-40 mg(Esgic)

2

butalbital-aspirin-caffeinecap 50-325-40 mg (Fiorinal)

2

BUTALBITAL/ASPIRIN/CAFFEI - butalbital-aspirin-caffeine tab 50-325-40 mg

4

choline & magnesiumsalicylates liq 500 mg/5ml

2

diflunisal tab 500 mg 2

DURAXIN - acetaminophen-salicylamide-phenyltoloxamine cap300-200-20mg

2

LEVACET - aspirin-apap-salicylamide-caffeine tab500-250-150-32.5 mg

4

Drug Name Dru

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A

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ited

Dis

tribu

tion

salsalate tab 500 mg(Disalcid)

2

salsalate tab 750 mg(Disalcid)

2

TENCON - butalbital-acetaminophen tab 50-325mg

2

VANATOL LQ - butalbital-acetaminophen-caffeine soln50-325-40 mg/15ml

2

VANATOL S - butalbital-acetaminophen-caffeine soln50-325-40 mg/15ml

2

ANALGESICS - NARCOTICABSTRAL - fentanyl citrate sl

tab 100 mcg (base equiv)4 • •

ABSTRAL - fentanyl citrate sltab 200 mcg (base equiv)

4 • •


4 • •


4 • •


4 • •


4 • •

acetaminophen w/ codeinesoln 120-12 mg/5ml

1

acetaminophen w/ codeinetab 300-15 mg (Tylenol/codeine)

1

acetaminophen w/ codeinetab 300-30 mg (Tylenol/codeine #3)

1

acetaminophen w/ codeinetab 300-60 mg (Tylenol/codeine #4)

1

2016



Drug Name Dru

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its

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A

Lim

ited

Dis

tribu

tion

ACETAMINOPHEN/CAFFEINE/DI -acetaminophen-caffeine-dihydrocodeine cap320.5-30-16 mg

2

ASPIRIN-CAFFEINE-DIHYDROC - aspirin-caffeine-dihydrocodeine cap356.4-30-16 mg

4

BELBUCA - buprenorphine hclbuccal film 75 mcg (baseequivalent)

4 •


4 •


4 •


4 •


4 •


4 •


4 •

BUNAVAIL - buprenorphine-naloxone buccal film 2.1-0.3mg (base equiv)

4 •

BUNAVAIL - buprenorphine-naloxone buccal film 4.2-0.7mg (base equiv)

4 •

BUNAVAIL - buprenorphine-naloxone buccal film 6.3-1mg (base equiv)

4 •

Drug Name Dru

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ited

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tribu

tion

BUPRENORPHINE -buprenorphine td patchweekly 5 mcg/hr

4 •

BUPRENORPHINE -buprenorphine td patchweekly 7.5 mcg/hr

4 •


4 •


4 •


4 •

buprenorphine hcl sl tab2 mg (base equiv)

2 •

buprenorphine hcl sl tab8 mg (base equiv)

2 •

buprenorphine hcl-naloxonehcl sl tab 2-0.5 mg (baseequiv)

2 •

buprenorphine hcl-naloxonehcl sl tab 8-2 mg (baseequiv)

2 •

butalbital-acetaminophen-caff w/ cod cap50-300-40-30 mg (Fioricet/codeine)

2

butalbital-acetaminophen-caff w/ cod cap50-325-40-30 mg

2

butalbital-aspirin-caff w/ codeine cap50-325-40-30 mg (Fiorinal/codeine #3)

2

butorphanol tartrate nasalsoln 10 mg/ml

2 •

2016



Drug Name Dru

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ited

Dis

tribu

tion

BUTRANS - buprenorphine tdpatch weekly 5 mcg/hr

4 •

BUTRANS - buprenorphine tdpatch weekly 7.5 mcg/hr

4 •


4 •


4 •


4 •

CODEINE SULFATE - codeinesulfate tab 15 mg

4


4


4

codeine sulfate tab 15 mg(Codeine sulfate)

2


2


2

CONZIP - tramadol hcl cap er24hr biphasic release 100mg

4 •


4 •


4 •

EMBEDA - morphine-naltrexone cap er 20-0.8 mg

4 •


4 •

EMBEDA - morphine-naltrexone cap er 50-2 mg

4 •

Drug Name Dru

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ited

Dis

tribu

tion


4 •


4 •

EMBEDA - morphine-naltrexone cap er 100-4 mg

4 •

EXALGO - hydromorphone hcltab er 24hr deter 32 mg

4 •

FENTANYL - fentanyl td patch72hr 37.5 mcg/hr

4 •


4 •


4 •

fentanyl citrate lozenge on ahandle 200 mcg (Actiq)

2 • •


2 • •


2 • •


2 • •


2 • •


2 • •

fentanyl td patch 72hr12 mcg/hr (Duragesic)

2 •


2 •


2 •


2 •


2 •

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion

FENTORA - fentanyl citratebuccal tab 100 mcg (baseequiv)

4 • •


4 • •


4 • •


4 • •


4 • •

hydrocodone-acetaminophen soln7.5-325 mg/15ml (Hycet)

2

hydrocodone-acetaminophen tab2.5-325 mg

2

hydrocodone-acetaminophen tab10-325 mg (Norco)

1

hydrocodone-acetaminophen tab5-300 mg (Xodol)

2

hydrocodone-acetaminophen tab7.5-300 mg (Xodol)

2

hydrocodone-acetaminophen tab5-325 mg (Norco)

1

hydrocodone-acetaminophen tab7.5-325 mg (Norco)

1

hydrocodone-acetaminophen tab10-300 mg (Xodol)

2

Drug Name Dru

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A

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ited

Dis

tribu

tion

hydrocodone-ibuprofen tab5-200 mg (Reprexain)

2

hydrocodone-ibuprofen tab7.5-200 mg (Vicoprofen)

1

hydrocodone-ibuprofen tab10-200 mg (Ibudone)

2

HYDROMORPHONE HCL -hydromorphone hcl suppos3 mg

4

hydromorphone hcl liqd1 mg/ml (Dilaudid)

2

hydromorphone hcl tab er24hr deter 8 mg (Exalgo)

2 •


2 •


2 •


2 •

hydromorphone hcl tab2 mg (Dilaudid)

1


1


2

HYSINGLA ER - hydrocodonebitartrate tab er 24hr deter20 mg

4 •


4 •


4 •


4 •

2016



Drug Name Dru

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ing

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its

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A

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ited

Dis

tribu

tion


4 •


4 •


4 •

IONSYS - fentanyl hcliontophoretic td system 40mcg/act (base equiv)

4

KADIAN - morphine sulfate caper 24hr 40 mg

4 •

KADIAN - morphine sulfate caper 24hr 200 mg

4 •

LAZANDA - fentanyl citratenasal spray 100 mcg/act(base equiv)

4 • •


4 • •


4 • •

LEVORPHANOL TARTRATE -levorphanol tartrate tab 2 mg

4

LORTAB - hydrocodone-acetaminophen soln 10-300mg/15ml

4

MEPERIDINE HCL -meperidine hcl oral soln 50mg/5ml

4

meperidine hcl tab 50 mg(Demerol)

2

meperidine hcl tab 100 mg(Demerol)

2

Drug Name Dru

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A

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ited

Dis

tribu

tion

MEPERIDINE HCL/PROMETHAZI - meperidinew/ promethazine cap 50-25mg

4

methadone hcl conc 10 mg/ml (Methadose)

2

methadone hcl soln5 mg/5ml (Methadone hcl)

2

methadone hcl soln10 mg/5ml (Methadone hcl)

2

methadone hcl tab for oralsusp 40 mg

1

methadone hcl tab 5 mg(Dolophine hcl)

1

methadone hcl tab 10 mg(Dolophine)

1

MORPHINE SULFATE -morphine sulfate suppos 5mg

3


3


3


3

MORPHINE SULFATE -morphine sulfate tab 15 mg

3

MORPHINE SULFATE -morphine sulfate tab 30 mg

3

morphine sulfate cap er 24hr10 mg (Kadian)

2 •


2 •


2 •

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion


2 •


2 •


2 •


2 •

MORPHINE SULFATE ER -morphine sulfate beads caper 24hr 30 mg

2 •


2 •


2 •


2 •


2 •


2 •

morphine sulfate oral soln10 mg/5ml

2

morphine sulfate oral soln20 mg/5ml

2

morphine sulfate oral soln100 mg/5ml (20 mg/ml)

2

morphine sulfate tab er15 mg (Ms contin)

2 •


2 •


2 •

Drug Name Dru

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A

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ited

Dis

tribu

tion


2 •


2 •

NUCYNTA - tapentadol hcl tab50 mg

4 •


4 •


4 •

NUCYNTA ER - tapentadol hcltab er 12hr 50 mg

4 •


4 •


4 •


4 •


4 •

OPANA ER (CRUSHRESISTANT - oxymorphonehcl tab er 12hr deter 5 mg

4 •

OPANA ER (CRUSHRESISTANT - oxymorphonehcl tab er 12hr deter 7.5 mg

4 •


4 •


4 •


4 •


4 •

2016



Drug Name Dru

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A

Lim

ited

Dis

tribu

tion


4 •

OXAYDO - oxycodone hcl tababuse deter 5 mg

4

OXAYDO - oxycodone hcl tababuse deter 7.5 mg

4

oxycodone hcl cap 5 mg 2

oxycodone hcl conc100 mg/5ml (20 mg/ml)(Oxycodone hcl)

2

OXYCODONE HCL ER -oxycodone hcl tab er 12hrdeter 10 mg

4 •


4 •


4 •


4 •


4 •


4 •


4 •

oxycodone hcl soln5 mg/5ml (Oxycodone hcl)

2

oxycodone hcl tab 5 mg(Roxicodone)

1

oxycodone hcl tab 10 mg 2


2

Drug Name Dru

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ing

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its

AC

A

Lim

ited

Dis

tribu

tion

oxycodone hcl tab 20 mg 2


2

oxycodone w/acetaminophen tab2.5-325 mg (Percocet)

2

oxycodone w/acetaminophen tab5-325 mg (Percocet)

1

oxycodone w/acetaminophen tab7.5-325 mg (Percocet)

2

oxycodone w/acetaminophen tab10-325 mg (Percocet)

2

oxycodone-aspirin tab4.8355-325 mg (Percodan)

2

OXYCODONE/ACETAMINOPHEN -oxycodone w/acetaminophen soln 5-325mg/5ml

2

OXYCODONE/IBUPROFEN -oxycodone-ibuprofen tab5-400 mg

2

OXYCONTIN - oxycodone hcltab er 12hr deter 10 mg

3 •


3 •


3 •


3 •


3 •


3 •


3 •

2016



Drug Name Dru

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

oxymorphone hcl tab 5 mg(Opana)

2

oxymorphone hcl tab 10 mg(Opana)

2

OXYMORPHONEHYDROCHLORIDE -oxymorphone hcl tab er 12hr5 mg

2 •

OXYMORPHONEHYDROCHLORIDE -oxymorphone hcl tab er 12hr7.5 mg

2 •


2 •


2 •


2 •


2 •


2 •

pentazocine w/ naloxone tab50-0.5 mg

2

PRIMLEV - oxycodone w/acetaminophen tab 5-300mg

4

PRIMLEV - oxycodone w/acetaminophen tab 7.5-300mg

4

Drug Name Dru

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its

AC

A

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ited

Dis

tribu

tion

PRIMLEV - oxycodone w/acetaminophen tab 10-300mg

4

PROBUPHINE IMPLANTKIT - buprenorphine hclsubdermal implant 74.2 mg(base equiv)

4 •

SUBOXONE - buprenorphinehcl-naloxone hcl sl film 2-0.5mg (base equiv)

4 •

SUBOXONE - buprenorphinehcl-naloxone hcl sl film 4-1mg (base equiv)

4 •


4 •


4 •

SUBSYS - fentanyl sublingualspray 100 mcg

4 • •


4 • •


4 • •


4 • •


4 • •

SUBSYS - fentanyl sublingualspray 1200 mcg (600 mcg x2)

4 • •

SUBSYS - fentanyl sublingualspray 1600 mcg (800 mcg x2)

4 • •

SYNALGOS-DC - aspirin-caffeine-dihydrocodeine cap356.4-30-16 mg

4

2016



Drug Name Dru

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Lim

its

AC

A

Lim

ited

Dis

tribu

tion

TRAMADOL HCL ER -tramadol hcl cap er 24hrbiphasic release 100 mg

4 •


4 •


4 •


4 •

tramadol hcl tab er 24hr100 mg

2 •


2 •


2 •

tramadol hcl tab er 24hrbiphasic release 100 mg

2 •


2 •


2 •

tramadol hcl tab 50 mg(Ultram)

1 •

tramadol-acetaminophen tab37.5-325 mg (Ultracet)

1

TREZIX - acetaminophen-caffeine-dihydrocodeine cap320.5-30-16 mg

4

XTAMPZA ER - oxycodone caper 12hr abuse-deterrent 9mg

4 •

XTAMPZA ER - oxycodone caper 12hr abuse-deterrent 13.5mg

4 •

Drug Name Dru

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Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4 •


4 •


4 •

ZAMICET - hydrocodone-acetaminophen soln 10-325mg/15ml

4

ZOHYDRO ER - hydrocodonebitartrate cap er 12hr abuse-deterrent 10 mg

4 •


4 •


4 •


4 •


4 •


4 •

ZUBSOLV - buprenorphine hcl-naloxone hcl sl tab 0.7-0.18mg (base eq)

4 •


4 •


4 •

2016



Drug Name Dru

g Ti

er

Prio

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atio

n

Ste

p Th

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y

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4 •


4 •


4 •

ANALGESICS - ANTI-INFLAMMATORYACTEMRA - tocilizumab

subcutaneous soln prefilledsyringe 162 mg/0.9ml

5 • • •

ARCALYST - rilonacept for inj220 mg

5 • • •

celecoxib cap 50 mg(Celebrex)

2 •


2 •


2 •


2 •

diclofenac potassium tab50 mg

2

diclofenac sodium tabdelayed release 25 mg

2


1


1

diclofenac sodium tab er24hr 100 mg

2

diclofenac w/ misoprostoltab delayed release50-0.2 mg (Arthrotec 50)

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

diclofenac w/ misoprostoltab delayed release75-0.2 mg (Arthrotec 75)

2

ENBREL - etanercept forsubcutaneous inj 25 mg

5 • • •

ENBREL - etanerceptsubcutaneous soln prefilledsyringe 25 mg/0.5ml

5 • • •

ENBREL - etanerceptsubcutaneous soln prefilledsyringe 50 mg/ml

5 • • •

ENBREL SURECLICK -etanercept subcutaneoussolution auto-injector 50 mg/ml

5 • • •

etodolac cap 200 mg 2

etodolac cap 300 mg 2

etodolac tab er 24hr 400 mg 2



etodolac tab 400 mg 2

etodolac tab 500 mg 2

FENOPROFEN CALCIUM -fenoprofen calcium cap 200mg

4

FENOPROFEN CALCIUM -fenoprofen calcium cap 400mg

4

fenoprofen calcium tab600 mg

2

FENORTHO - fenoprofencalcium cap 200 mg

4

FENORTHO - fenoprofencalcium cap 400 mg

4

flurbiprofen tab 50 mg 1

flurbiprofen tab 100 mg 1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

HUMIRA - adalimumabprefilled syringe kit 10mg/0.2ml

5 • • •


5 • • •


5 • • •

HUMIRA PEDIATRICCROHNS D - adalimumabprefilled syringe kit 40mg/0.8ml

5 • • •

HUMIRA PEN - adalimumabpen-injector kit 40 mg/0.8ml

5 • • •

HUMIRA PEN-CROHNSDISEASE - adalimumab pen-injector kit 40 mg/0.8ml

5 • • •

HUMIRA PEN-PSORIASISSTAR - adalimumab pen-injector kit 40 mg/0.8ml

5 • • •

ibuprofen tab 400 mg 1



indomethacin cap er 75 mg 2

indomethacin cap 25 mg 1

indomethacin cap 50 mg 1

ketoprofen cap 50 mg 1

ketoprofen cap 75 mg 1

ketorolac tromethamine tab10 mg

1 •

KINERET - anakinrasubcutaneous soln prefilledsyringe 100 mg/0.67ml

5 • • •

leflunomide tab 10 mg(Arava)

2

leflunomide tab 20 mg(Arava)

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

MECLOFENAMATE SODIUM -meclofenamate sodium cap50 mg

4

MECLOFENAMATE SODIUM -meclofenamate sodium cap100 mg

4

mefenamic acid cap 250 mg(Ponstel)

2

meloxicam tab 7.5 mg(Mobic)

1

meloxicam tab 15 mg (Mobic) 1

nabumetone tab 500 mg 1

nabumetone tab 750 mg 1

NALFON - fenoprofen calciumcap 400 mg

4

naproxen sodium tab er24hr 375 mg (base equiv)(Naprelan)

2

naproxen sodium tab er24hr 500 mg (base equiv)(Naprelan)

2

naproxen sodium tab275 mg (Anaprox)

1

naproxen sodium tab550 mg (Anaprox ds)

1

naproxen susp 125 mg/5ml 2

naproxen tab ec 375 mg (Ec-naprosyn)

1

naproxen tab ec 500 mg (Ec-naprosyn)

1

naproxen tab 250 mg(Naprosyn)

1


1


1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ORENCIA - abataceptsubcutaneous soln prefilledsyringe 50 mg/0.4ml

5 • • •

ORENCIA - abataceptsubcutaneous soln prefilledsyringe 87.5 mg/0.7ml

5 • • •

ORENCIA - abataceptsubcutaneous soln prefilledsyringe 125 mg/ml

5 • • •

ORENCIA CLICKJECT -abatacept subcutaneoussoln auto-injector 125 mg/ml

5 • • •

OTEZLA - apremilast tabstarter therapy pack 10 mg &20 mg & 30 mg

5 • • •

OTEZLA - apremilast tab 30mg

5 • • •

OTREXUP - methotrexate solnpf auto-injector 10 mg/0.4ml

4

OTREXUP - methotrexatesoln pf auto-injector 12.5mg/0.4ml

4


4


4


4


4


4

oxaprozin tab 600 mg(Daypro)

2

piroxicam cap 10 mg(Feldene)

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

piroxicam cap 20 mg(Feldene)

2

RASUVO - methotrexatesoln pf auto-injector 7.5mg/0.15ml

4

RASUVO - methotrexate solnpf auto-injector 10 mg/0.2ml

4


4


4


4


4


4


4


4

RIDAURA - auranofin cap 3 mg 4

SIMPONI - golimumabsubcutaneous soln auto-injector 50 mg/0.5ml

5 • • •

SIMPONI - golimumabsubcutaneous soln auto-injector 100 mg/ml

5 • • •

SIMPONI - golimumabsubcutaneous soln prefilledsyringe 50 mg/0.5ml

5 • • •

SIMPONI - golimumabsubcutaneous soln prefilledsyringe 100 mg/ml

5 • • •

sulindac tab 150 mg 1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

sulindac tab 200 mg 1

TOLMETIN SODIUM - tolmetinsodium cap 400 mg

2

XELJANZ - tofacitinib citratetab 5 mg (base equivalent)

5 • • •

XELJANZ XR - tofacitinibcitrate tab er 24hr 11 mg(base equivalent)

5 • • •

MIGRAINE PRODUCTSalmotriptan malate tab

6.25 mg (Axert)2 •

almotriptan malate tab12.5 mg (Axert)

2 •

AXERT - almotriptan malatetab 6.25 mg

4 •

AXERT - almotriptan malatetab 12.5 mg

4 •

CAMBIA - diclofenacpotassium packet 50 mg

4

D.H.E. 45 - dihydroergotaminemesylate inj 1 mg/ml

4 •

dihydroergotamine mesylateinj 1 mg/ml (D.h.e. 45)

2 •

eletriptan hydrobromide tab20 mg (base equivalent)(Relpax)

2 •

eletriptan hydrobromide tab40 mg (base equivalent)(Relpax)

2 •

ERGOMAR - ergotaminetartrate sl tab 2 mg

4

ergotamine w/ caffeine tab1-100 mg (Cafergot)

2

FROVA - frovatriptan succinatetab 2.5 mg (base equivalent)

4 •

frovatriptan succinate tab2.5 mg (base equivalent)(Frova)

2 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

IMITREX - sumatriptan nasalspray 5 mg/act

3 •

IMITREX - sumatriptan nasalspray 20 mg/act

3 •

isometheptene-caffeine-acetaminophen tab65-20-325 mg (Prodrin)

2

isometheptene-dichloral-acetaminophen cap65-100-325 mg

2

MIGRANAL -dihydroergotamine mesylatenasal spray 4 mg/ml

4 •

naratriptan hcl tab 1 mg(base equiv) (Amerge)

2 •

naratriptan hcl tab 2.5 mg(base equiv) (Amerge)

2 •

RELPAX - eletriptanhydrobromide tab 20 mg(base equivalent)

4 •

RELPAX - eletriptanhydrobromide tab 40 mg(base equivalent)

4 •

rizatriptan benzoate oraldisintegrating tab 5 mg(base eq) (Maxalt-mlt)

2 •

rizatriptan benzoate oraldisintegrating tab 10 mg(base eq) (Maxalt-mlt)

2 •

rizatriptan benzoate tab5 mg (base equivalent)(Maxalt)

2 •

rizatriptan benzoate tab10 mg (base equivalent)(Maxalt)

2 •

sumatriptan nasal spray5 mg/act (Imitrex)

2 •

sumatriptan nasal spray20 mg/act (Imitrex)

2 •

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

SUMATRIPTAN SUCCINATE -sumatriptan succinatesolution prefilled syringe 6mg/0.5ml

4 •

sumatriptan succinate inj6 mg/0.5ml (Imitrex)

2 •

sumatriptan succinatesolution auto-injector4 mg/0.5ml (Imitrex statdosesys)

2 •

sumatriptan succinatesolution auto-injector6 mg/0.5ml (Imitrex statdosesys)

2 •

sumatriptan succinatesolution cartridge4 mg/0.5ml (Imitrex statdoseref)

2 •

sumatriptan succinatesolution cartridge6 mg/0.5ml (Imitrex statdoseref)

2 •

sumatriptan succinate tab25 mg (Imitrex)

1 •


1 •


1 •

zolmitriptan orallydisintegrating tab 2.5 mg(Zomig zmt)

2 •

zolmitriptan orallydisintegrating tab 5 mg(Zomig zmt)

2 •

zolmitriptan tab 2.5 mg(Zomig)

2 •

zolmitriptan tab 5 mg(Zomig)

2 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

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n

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p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ZOMIG - zolmitriptan nasalspray 2.5 mg/spray unit

4 •

ZOMIG - zolmitriptan nasalspray 5 mg/spray unit

4 •

GOUT AGENTSallopurinol tab 100 mg

(Zyloprim)1

allopurinol tab 300 mg(Zyloprim)

1

COLCHICINE - colchicine cap0.6 mg

4

COLCHICINE - colchicine tab0.6 mg

4

colchicine w/ probenecid tab0.5-500 mg

2

COLCRYS - colchicine tab 0.6mg

4

MITIGARE - colchicine cap 0.6mg

4

probenecid tab 500 mg 2

ULORIC - febuxostat tab 40 mg 4

ULORIC - febuxostat tab 80 mg 4

NEUROMUSCULAR DRUGSANTICONVULSANTSAPTIOM - eslicarbazepine

acetate tab 200 mg4

APTIOM - eslicarbazepineacetate tab 400 mg

4


4


4

BANZEL - rufinamide susp 40mg/ml

4

BANZEL - rufinamide tab 200mg

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

BANZEL - rufinamide tab 400mg

4

BRIVIACT - brivaracetam oralsoln 10 mg/ml

4

BRIVIACT - brivaracetam tab10 mg

4


4


4


4


4

carbamazepine cap er 12hr100 mg (Carbatrol)

2


2


2

carbamazepine chew tab100 mg

2

carbamazepine susp100 mg/5ml (Tegretol)

2

carbamazepine tab er 12hr100 mg (Tegretol-xr)

2


2


2

carbamazepine tab 200 mg(Tegretol)

2

CARBATROL - carbamazepinecap er 12hr 100 mg

4


4


4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

CELONTIN - methsuximide cap300 mg

4

clonazepam orallydisintegrating tab0.125 mg

2

clonazepam orallydisintegrating tab 0.25 mg

2

clonazepam orallydisintegrating tab 0.5 mg

2

clonazepam orallydisintegrating tab 1 mg

2

clonazepam orallydisintegrating tab 2 mg

2

clonazepam tab 0.5 mg(Klonopin)

1

clonazepam tab 1 mg(Klonopin)

1

clonazepam tab 2 mg(Klonopin)

1

DEPAKENE - valproate sodiumoral soln 250 mg/5ml (baseequiv)

4

DEPAKENE - valproic acid cap250 mg

4

DIASTAT ACUDIAL - diazepamrectal gel delivery system 10mg

3

DIASTAT ACUDIAL - diazepamrectal gel delivery system 20mg

3

DIASTAT PEDIATRIC -diazepam rectal gel deliverysystem 2.5 mg

3

DIAZEPAM RECTAL GEL -diazepam rectal gel deliverysystem 2.5 mg

4

DIAZEPAM RECTAL GEL -diazepam rectal gel deliverysystem 10 mg

4

2016



Drug Name Dru

g Ti

er

Prio

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horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

DIAZEPAM RECTAL GEL -diazepam rectal gel deliverysystem 20 mg

4

DILANTIN - phenytoin sodiumextended cap 30 mg

4

DILANTIN - phenytoin sodiumextended cap 100 mg

4

DILANTIN INFATABS -phenytoin chew tab 50 mg

4

DILANTIN-125 - phenytoinsusp 125 mg/5ml

4

divalproex sodium capdelayed release sprinkle125 mg (Depakotesprinkles)

2

divalproex sodium tabdelayed release 125 mg(Depakote)

1


1


2

divalproex sodium tab er 24hr 250 mg (Depakote er)

2

divalproex sodium tab er 24hr 500 mg (Depakote er)

2

ethosuximide cap 250 mg(Zarontin)

2

ethosuximide soln250 mg/5ml (Zarontin)

2

felbamate susp 600 mg/5ml(Felbatol)

2

felbamate tab 400 mg(Felbatol)

2

felbamate tab 600 mg(Felbatol)

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

FYCOMPA - perampanel susp0.5 mg/ml

4

FYCOMPA - perampanel tab 2mg

4


4


4


4

FYCOMPA - perampanel tab10 mg

4

FYCOMPA - perampanel tab12 mg

4

gabapentin cap 100 mg(Neurontin)

1


1


1

gabapentin oral soln250 mg/5ml (Neurontin)

2

gabapentin tab 600 mg(Neurontin)

2

gabapentin tab 800 mg(Neurontin)

2

GABITRIL - tiagabine hcl tab12 mg

4

GABITRIL - tiagabine hcl tab16 mg

4

LAMICTAL ODT - lamotrigineorally disintegrating tab 25mg

4


4

2016



Drug Name Dru

g Ti

er

Prio

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horiz

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n

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p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4


4

LAMICTAL ODT - lamotriginetab disint 25 mg (21) & 50mg (7) titration kit

4

LAMICTAL ODT - lamotriginetab disint 50 mg (42)- 100mg(14) titration kit

4

LAMICTAL ODT - lamotriginetab disint 25 (14) & 50 mg(14) & 100 mg (7) kit

4

LAMICTAL STARTER/NOTTAKI - lamotrigine tab 25 mg(42) & 100 mg (7) starter kit

4

LAMICTAL STARTER/TAKINGC - lamotrigine tab 25 mg(84) & 100 mg (14) starter kit

4

LAMICTAL STARTER/TAKINGV - lamotrigine tab 25 mg(35) starter kit

4

LAMICTAL XR - lamotrigine taber 24hr 25 mg (21) & 50 mg(7) titration kit

4

LAMICTAL XR - lamotrigine taber 24hr 25 (14) & 50 mg (14)& 100 mg(7) kit

4

LAMICTAL XR - lamotriginetab er 24hr 50 (14) & 100mg(14) & 200 mg(7) kit

4

lamotrigine orallydisintegrating tab 25 mg(Lamictal odt)

2


2

Drug Name Dru

g Ti

er

Prio

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horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2


2

lamotrigine tab chewabledispersible 5 mg (Lamictalchewable di)

2

lamotrigine tab chewabledispersible 25 mg (Lamictalchewable di)

2

lamotrigine tab disint 25 mg(21) & 50 mg (7) titrationkit (Lamictal odt)

2

lamotrigine tab disint 50 mg(42)- 100 mg(14) titrationkit (Lamictal odt)

2

lamotrigine tab disint 25 (14)& 50 mg (14) & 100 mg (7)kit (Lamictal odt)

2

lamotrigine tab er 24hr25 mg (Lamictal xr)

2


2


2


2


2


2

lamotrigine tab 25 mg(Lamictal)

1


1


1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1

lamotrigine tab 25 mg (35)starter kit (Lamictal starter/tak)

2

lamotrigine tab 25 mg (42)& 100 mg (7) starter kit(Lamictal starter/not)

2

lamotrigine tab 25 mg (84)& 100 mg (14) starter kit(Lamictal starter/tak)

2

levetiracetam oral soln100 mg/ml (Keppra)

2

levetiracetam tab er 24hr500 mg (Keppra xr)

2

levetiracetam tab er 24hr750 mg (Keppra xr)

2

levetiracetam tab 250 mg(Keppra)

1


2


2


2

LYRICA - pregabalin cap 25mg

4 •


4 •


4 •


4 •


4 •


4 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4 •


4 •

LYRICA - pregabalin soln 20mg/ml

4 •

ONFI - clobazam suspension2.5 mg/ml

4

ONFI - clobazam tab 10 mg 4

ONFI - clobazam tab 20 mg 4

oxcarbazepine susp300 mg/5ml (60 mg/ml)(Trileptal)

2

oxcarbazepine tab 150 mg(Trileptal)

1


2


2

OXTELLAR XR -oxcarbazepine tab er 24hr150 mg

4


4


4

PEGANONE - ethotoin tab 250mg

4

PHENYTEK - phenytoinsodium extended cap 200mg

4

PHENYTEK - phenytoinsodium extended cap 300mg

4

phenytoin chew tab 50 mg(Dilantin infatabs)

2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

phenytoin sodium extendedcap 100 mg (Dilantin)

2

phenytoin sodium extendedcap 200 mg (Phenytek)

2

phenytoin sodium extendedcap 300 mg (Phenytek)

2

phenytoin susp 125 mg/5ml(Dilantin-125)

2

primidone tab 50 mg(Mysoline)

1

primidone tab 250 mg(Mysoline)

2

QUDEXY XR - topiramate caper 24hr sprinkle 25 mg

4


4


4


4


4

SABRIL - vigabatrin powd pack500 mg

3 •

SABRIL - vigabatrin tab 500mg

3 •

SPRITAM - levetiracetam tabdisintegrating soluble 250mg

4 •


4 •


4 •


4 •

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

TEGRETOL - carbamazepinesusp 100 mg/5ml

4

TEGRETOL - carbamazepinetab 200 mg

4

TEGRETOL-XR -carbamazepine tab er 12hr100 mg

4


4


4

tiagabine hcl tab 2 mg(Gabitril)

2

tiagabine hcl tab 4 mg(Gabitril)

2

TOPIRAMATE ER - topiramatecap er 24hr sprinkle 25 mg

4


4


4


4


4

topiramate sprinkle cap15 mg (Topamax sprinkle)

2

topiramate sprinkle cap25 mg (Topamax sprinkle)

2

topiramate tab 25 mg(Topamax)

1


1


1

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


1

TROKENDI XR - topiramatecap er 24hr 25 mg

4


4


4


4

valproate sodium oral soln250 mg/5ml (base equiv)(Depakene)

2

valproic acid cap 250 mg(Depakene)

2

vigabatrin powd pack500 mg (Sabril)

2 •

VIMPAT - lacosamide oralsolution 10 mg/ml

4

VIMPAT - lacosamide tab 50mg

4


4


4


4

ZARONTIN - ethosuximide cap250 mg

4

ZARONTIN - ethosuximide soln250 mg/5ml

4

zonisamide cap 25 mg(Zonegran)

1

zonisamide cap 50 mg 2

zonisamide cap 100 mg(Zonegran)

2

ANTIPARKINSON AGENTS

Drug Name Dru

g Ti

er

Prio

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horiz

atio

n

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

amantadine hcl cap 100 mg 2

amantadine hcl syrup50 mg/5ml

1

amantadine hcl tab 100 mg 2

APOKYN - apomorphine hclsoln cartridge 30 mg/3ml

5 • •

AZILECT - rasagiline mesylatetab 0.5 mg (base equiv)

4

AZILECT - rasagiline mesylatetab 1 mg (base equiv)

4

benztropine mesylate tab0.5 mg

1

benztropine mesylate tab1 mg

1

benztropine mesylate tab2 mg

1

bromocriptine mesylate cap5 mg (base equivalent)(Parlodel)

2

bromocriptine mesylate tab2.5 mg (base equivalent)(Parlodel)

2

carbidopa & levodopaorally disintegrating tab10-100 mg

2


2


2

carbidopa & levodopa tab er25-100 mg (Sinemet cr)

2

carbidopa & levodopa tab er50-200 mg (Sinemet cr)

2

carbidopa & levodopa tab10-100 mg (Sinemet)

1

2016



Drug Name Dru

g Ti

er

Prio

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horiz

atio

n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


2


2

carbidopa tab 25 mg(Lodosyn)

2

CARBIDOPA/LEVODOPA/ENTACA - carbidopa-levodopa-entacapone tabs12.5-50-200 mg

4


4

CARBIDOPA/LEVODOPA/ENTACA - carbidopa-levodopa-entacapone tabs25-100-200 mg

4


4


4

CARBIDOPA/LEVODOPA/ENTACA - carbidopa-levodopa-entacapone tabs50-200-200 mg

4

DUOPA - carbidopa-levodopaenteral susp 4.63-20 mg/ml

4 •

entacapone tab 200 mg(Comtan)

2

MIRAPEX ER - pramipexoledihydrochloride tab er 24hr0.375 mg

4


4

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4


4

MIRAPEX ER - pramipexoledihydrochloride tab er 24hr 3mg

4


4


4

NEUPRO - rotigotine td patch24hr 1 mg/24hr

4


4


4


4


4


4

pramipexole dihydrochloridetab er 24hr 0.375 mg(Mirapex er)

2


2

pramipexole dihydrochloridetab er 24hr 1.5 mg (Mirapexer)

2


2

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion

pramipexole dihydrochloridetab er 24hr 3 mg (Mirapexer)

2


2

pramipexole dihydrochloridetab er 24hr 4.5 mg (Mirapexer)

2

pramipexole dihydrochloridetab 0.125 mg (Mirapex)

1


1


1


1

pramipexole dihydrochloridetab 1 mg (Mirapex)

1


1

rasagiline mesylate tab0.5 mg (base equiv)(Azilect)

2

rasagiline mesylate tab 1 mg(base equiv) (Azilect)

2

ropinirole hydrochloridetab er 24hr 2 mg (baseequivalent) (Requip xl)

2


2


2


2

Drug Name Dru

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tion


2

ropinirole hydrochloride tab0.25 mg (Requip)

1

ropinirole hydrochloride tab0.5 mg (Requip)

1

ropinirole hydrochloride tab1 mg (Requip)

1


1


1


1


1

RYTARY - carbidopa &levodopa cap er 23.75-95mg

4


4


4


4

selegiline hcl cap 5 mg(Eldepryl)

2

selegiline hcl tab 5 mg 2

STALEVO 100 - carbidopa-levodopa-entacapone tabs25-100-200 mg

4

STALEVO 125 - carbidopa-levodopa-entacapone tabs31.25-125-200 mg

4

2016



Drug Name Dru

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A

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ited

Dis

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tion


4

STALEVO 200 - carbidopa-levodopa-entacapone tabs50-200-200 mg

4


4


4

TASMAR - tolcapone tab 100mg

4

tolcapone tab 100 mg(Tasmar)

2

trihexyphenidyl hcl elixir0.4 mg/ml

2

trihexyphenidyl hcl tab 2 mg 1

trihexyphenidyl hcl tab 5 mg 1

ZELAPAR - selegiline hcl orallydisintegrating tab 1.25 mg

4

NEUROMUSCULAR AGENTSriluzole tab 50 mg (Rilutek) 2

MUSCULOSKELETAL THERAPY AGENTSAMRIX - cyclobenzaprine hcl

cap er 24hr 15 mg4

AMRIX - cyclobenzaprine hclcap er 24hr 30 mg

4

baclofen tab 10 mg 1

baclofen tab 20 mg 2

carisoprodol tab 250 mg(Soma)

2

carisoprodol tab 350 mg(Soma)

1

carisoprodol w/ aspirin &codeine tab 200-325-16 mg

2

Drug Name Dru

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Lim

its

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A

Lim

ited

Dis

tribu

tion

carisoprodol w/ aspirin tab200-325 mg

2

CHLORZOXAZONE -chlorzoxazone tab 250 mg

2

chlorzoxazone tab 500 mg(Parafon forte dsc)

1

cyclobenzaprine hcl tab5 mg

1

cyclobenzaprine hcl tab7.5 mg (Fexmid)

2

cyclobenzaprine hcl tab10 mg

1

dantrolene sodium cap25 mg (Dantrium)

2

dantrolene sodium cap50 mg (Dantrium)

2

dantrolene sodium cap100 mg

2

LORZONE - chlorzoxazone tab375 mg

4

LORZONE - chlorzoxazone tab750 mg

4

METAXALONE - metaxalonetab 400 mg

4

metaxalone tab 800 mg(Skelaxin)

2

methocarbamol tab 500 mg(Robaxin)

1

methocarbamol tab 750 mg(Robaxin-750)

1

orphenadrine citrate tab er12hr 100 mg

2

SOMA - carisoprodol tab 250mg

4

tizanidine hcl cap 2 mg(base equivalent)(Zanaflex)

2 •

2016



Drug Name Dru

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tion


2 •


2 •

tizanidine hcl tab 2 mg (baseequivalent)

1 •

tizanidine hcl tab 4 mg (baseequivalent) (Zanaflex)

1 •

ANTIMYASTHENIC AGENTSGUANIDINE HCL - guanidine

hcl tab 125 mg4

MESTINON - pyridostigminebromide syrup 60 mg/5ml

4

MESTINON TIMESPAN -pyridostigmine bromide taber 180 mg

4

pyridostigmine bromidetab er 180 mg (Mestinontimespan)

2

pyridostigmine bromide tab60 mg (Mestinon)

2

NUTRITIONAL PRODUCTSVITAMINSBABY DDROPS -

cholecalciferol drops 400unit/0.03ml (per drop)

A •

cholecalciferol cap 400 unit A •cholecalciferol cap 1000 unit A •cholecalciferol cap 50000

unit1

cholecalciferol chew tab 400unit

A •

cholecalciferol chew tab1000 unit

A •

cholecalciferol drops 5000unit/ml (1000 unit/0.2ml)

A •

Drug Name Dru

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A

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ited

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cholecalciferol drops 400unit/0.03ml (per drop)

A •

cholecalciferol oral liquid400 unit/ml

A •

cholecalciferol tab 400 unit A •cholecalciferol tab 1000 unit A •cholecalciferol tab 50000

unit1

D-VI-SOL - cholecalciferol oralliquid 400 unit/ml

A •

DDROPS - cholecalciferoldrops 1000 unit/0.03ml (perdrop)

A •

DECARA - cholecalciferol cap25000 unit

4

ergocalciferol cap 50000 unit(Drisdol)

1

MEPHYTON - phytonadionetab 5 mg

3

phytonadione inj 1 mg/0.5ml(2 mg/ml)

2

POTABA - potassiumaminobenzoate cap 500 mg

4

SUPER DAILY D3 -cholecalciferol drops 1000unit/0.03ml (per drop)

A •

VITAMELTS VITAMIN D -cholecalciferol orallydisintegrating tab 1000 unit

A •

VITAMIN D2 - ergocalciferoltab 400 unit

A •

VITAMIN D3 - cholecalciferoloral liquid 1200 unit/15ml

A •

VITAMIN D3 - cholecalciferolspray 1000 unit/spray

A •

WELLESSE VITAMIN D3 -cholecalciferol oral liquid1000 unit/10ml

A •

2016



Drug Name Dru

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MULTIVITAMINSACTIVE OB - prenatal w/o a w/

fe cbn-fa-dha cap 20-1-320mg

4

ADVANCED AM/PM - multiplevitamins w/ calcium therapypack

4

ATABEX EC - prenatal vit w/dss-iron carbonyl-fa tab dr29-1 mg

4

b-complex w/ c & folic acidcap 1 mg (Nephrocaps)

1

b-complex w/ c & folic acidtab 1 mg (Nephro-vite rx)

1

b-complex w/ c & folic acidtab 5 mg

1

BAL-CARE DHA - prenat w/fepoly-na fered-fa tab 27-1 &omega cap dr 430mg

4

BP FOLINATAL PLUSB - prenatal w/ calciumcarbonate-b6-b12-fa tab 1mg

4

BP MULTINATAL PLUS -prenatal w/o a vit w/ fe fum-fa tab chew 40-1 mg

4

BP MULTINATAL PLUS -prenatal w/o a vit w/ fefumarate-fa tab 30-1 mg

4

C-BUFF - multiple vitamins w/minerals powder

4

C-NATE DHA - prenatal vitw/ fe fum-fa-omega 3 cap28-1-200 mg

4

CALCIUM PNV - prenatal w/ovit a w/ fe fum-fa-omega 3cap 28-1-250 mg

4

Drug Name Dru

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CITRANATAL ASSURE -prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 300 mgpack

4

CITRANATAL B-CALM - prenatw/o a w/fecbn-feglu-fa tab20-1 mg & vit b6 tab pak

4

CITRANATAL BLOOM -prenatal vit w/ dss-fe cbn-fegluc-fa tab 90-1 mg

4

CITRANATAL DHA - prenat w/o a w/fecbn-fegl-dss-fa tab &dha cap 250 mg pack

4

CITRANATAL HARMONY -prenat w/o a w/fe fum-fecbn-dss-fa-dha cap 27-1-260mg

4

CITRANATAL RX - prenatal w/o a w/ fe carbonyl-fe gluc-dss-fa tab 27-1mg

4

CITRANATAL 90 DHA - prenatw/o a w/fecbn-fegl-dss-fa tab90 &dha cap 300mg pak

4

CO-NATAL FA - prenatal vit w/fe fumarate-fa tab 29-1 mg

4

COMPLETE NATAL DHA -prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 250pk

4

COMPLETENATE - prenatal vitw/ fe fumarate-fa chew tab29-1 mg

4

CONCEPT DHA - prenatal w/fefum-fe poly -fa-omega 3 cap53.5-38-1 mg

4

CONCEPT OB - prenatal w/o a w/fe fum-fe poly-fa cap130-92.4-1 mg

4

2016



Drug Name Dru

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ing

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its

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A

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ited

Dis

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tion

DIALYVITE SUPREME D -multiple vitamins w/ minerals& fa tab 3 mg

4

DIALYVITE 3000 - b-complexw/ c-biotin-e-minerals & folicacid tab 3 mg

4

DIALYVITE 5000 - b-complexw/ c-biotin-e-minerals & folicacid tab 5 mg

4

DIALYVITE/ZINC - b-complexw/ c-zn & folic acid tab 1 mg

4

DOTHELLE DHA - prenatal w/fe fum-fe poly -fa-omega 3cap 53.5-38-1 mg

4

DUET DHA BALANCED -prenat w/fe poly-na fered-fatab 25-1 & omega cap 267mg

4

DUET DHA 400 - prenat w/fepoly-na fered-fa tab 25-1 &omega cap 400 mg

4

ELITE-OB - prenatal vit w/ ironcarbonyl-fa tab 50-1.25 mg

4

ENBRACE HR - prenatal vit w/fe gly cys-fa-omega 3 fattyacids cap

4

END FATIGUE DAILYENERGY - multiple vitaminsw/ minerals powder

4

ESCAVITE - pediatric multiplevitamins w/ fl-fe chew tab0.25-7.5 mg

4

ESCAVITE D - pediatricmultiple vitamins w/ fl-fechew tab 0.25-6 mg

4

ESCAVITE LQ - pediatricmultiple vitamins w/ fl-fedrops 0.25-6 mg/ml

4

Drug Name Dru

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A

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ited

Dis

tribu

tion

FLORIVA - ped multiplevitamins & minerals w/ flchew tab 0.25 mg

4

FLORIVA - ped multiplevitamins & minerals w/ flchew tab 0.5 mg

4

FLORIVA - ped multiplevitamins & minerals w/ flchew tab 1 mg

4

FLORIVA PLUS - pediatricmultiple vitamins w/ fluoridesoln 0.25 mg/ml

1

FOCALGIN CA - prenat w/oa w/fecbn-fegl-dss-fa tab &dha cap 300 mg pack

4

FOCALGIN 90 DHA - prenat w/o a w/fecbn-fegl-dss-fa tab90 &dha cap 300mg pak

4

FOLCAL DHA - prenatal w/o vita w/ fe fum-dss-fa-dha cap27-1.25-300 mg

4

FOLCAPS OMEGA 3 - prenatalvit w/ fe cbn-fe asp glyc-fa-omega 3 cap 27-1mg

4

FOLET DHA - prenat w/fecbn-bisg-methylf-dss tab dr &dha cap pak

4

FOLET ONE - prenat w/o a w/fecbn-bisg-methylf-dss-dhacap 38-1-225 mg

4

FOLGARD OS - multiple vit w/min & calcium-folic acid tab500-1.1 mg

4

FOLIVANE-OB - prenatal w/o a w/fe fum-fe poly-fa cap130-92.4-1 mg

4

HEMENATAL OB - prenat vit-fepoly cmplx-fe heme poly-fatab 28-6-1 mg

4

2016



Drug Name Dru

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ited

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tion

HEMENATAL OB + DHA -prenat-fe poly cmplx-feheme poly-fa tab & omega 3cap pck

4

INATAL ADVANCE - prenatalvit w/ dss-iron carbonyl-fatab 90-1 mg

4

INATAL GT - prenatal vit w/dss-iron carbonyl-fa tab 90-1mg

4

INATAL ULTRA - prenatal vit w/dss-iron carbonyl-fa tab 90-1mg

4

INFANATE BALANCE -prenatal w/o a w/fe cbn-dss-fa-dha cap 29-1-265 mg

4

M-VIT - prenatal vit w/ fefumarate-fa tab 27-1 mg

4

MARNATAL-F - prenatal w/o vita w/ fe polysac cmplx-fa cap60-1 mg

4

MEGA MULTIVITAMIN -multiple vitamins w/ mineralspowder

4

multiple vitamins w/minerals & fa tab 1.25 mg(Corvite)

1

MYNATAL - prenatalmultivitamins & minerals w/iron & fa cap 1 mg

4

MYNATAL ADVANCE -prenatal vit w/ dss-ironcarbonyl-fa tab 90-1 mg

4

MYNATAL PLUS - prenatal vitw/ fe fumarate-fa tab 65-1mg

4

MYNATAL ULTRACAPLET -prenatal vit w/ dss-ironcarbonyl-fa tab 90-1 mg

4

Drug Name Dru

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tion

MYNATAL-Z - prenatal vit w/ fefumarate-fa tab 65-1 mg

4

MYNATE 90 PLUS - prenatalvit w/ dss-fe fumarate-fa taber 90-1 mg

4

NATACHEW - prenatal vit w/ fefum-fe bisglycin-fa chew tab28-1 mg

4

NATALVIT - prenatal vit w/ fefumarate-fa tab 75-1 mg

4

NATELLE ONE - prenatal w/ovit a w/ fe fum-fa-omega 3cap 28-1-250 mg

4

NEEVO DHA - prenat w/o a w/fefum-methylfol-omegas cap27-1.13 mg

4

NEPHPLEX RX - b-complex w/c-zn & folic acid tab 1 mg

4

NESTABS - prenatal vit w/o vita w/ fe bisglycinate-fa tab32-1 mg

4

NESTABS ABC - prenatal w/ovit a w/fe polysac-fa-ca tab &omega 3 cap

4

NESTABS DHA - prenat w/o aw/ fe bisglyc-fa tab 32-1 mg& omega cap pack

4

NESTABS ONE - prenat w/oa w/fecbn-bisg-methylf-dhacap 38-1-225 mg

4

NEWGEN - prenatal vit w/o vita w/ fe bisglycinate-fa tab32-1 mg

4

NEXA PLUS - prenatal w/o vita w/ fe fum-doc-fa-dha cap29-1.25-350 mg

4

NICOMIDE - niacinamidew/ zn-cu-methylfolate tab750-25-1.5-0.5 mg

4

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion

NIVA-PLUS - prenatal vit w/ fefumarate-fa tab 27-1 mg

4

O-CAL FA - prenatal vit w/ fefumarate-fa tab 27-1 mg

4

O-CAL PRENATAL - prenatalvit w/ fe fumarate-fa tab 15-1mg

4

OB COMPLETE - prenatalvit w/ iron carbonyl-fa tab50-1.25 mg

4

OB COMPLETE GOLD -prenat w/o a w/fecbn-methfol-fa-dha cap27.5-1-200 mg

4

OB COMPLETE ONE -prenatal w/o a w/fecbn-fe asp glyc-fa-fish cap50-1-476 mg

4

OB COMPLETE PETITE -prenat w/o a w/fecbn-feaspglyc-fa-omega cap35-5-1-200 mg

4

OB COMPLETE PREMIER -prenatal vit w/ fe cbn-fe aspglyc-fa tab 30-20-1 mg

4

OB COMPLETE/DHA - prenatw/ iron cbn-fe asp glyc-fa-omega cap 30-10-1-200 mg

4

OBSTETRIX DHA - prenat w/fecbn-fa-dss tab 29-1 mg &omega 3 cap 387 mg pak

4

OBSTETRIX EC - prenatal vitw/ dss-iron carbonyl-fa tab29-1 mg

4

OBSTETRIX ONE - prenat w/oa w/fecbn-bisg-methylf-dss-dha cap 38-1-225 mg

4

pediatric multiple vitaminsw/ fl-fe drops 0.25-10 mg/ml

1

Drug Name Dru

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ited

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pediatric multiple vitaminsw/ fluoride chew tab0.25 mg

1

pediatric multiple vitaminsw/ fluoride chew tab0.5 mg

1

pediatric multiple vitaminsw/ fluoride chew tab 1 mg

1

pediatric multiple vitaminsw/ fluoride soln 0.25 mg/ml

1

pediatric multiple vitaminsw/ fluoride soln 0.5 mg/ml

1

pediatric vitamins acd w/fluoride soln 0.25 mg/ml

1

pediatric vitamins acd w/fluoride soln 0.5 mg/ml

1

PHLEXY-VITS - multiplevitamins w/ minerals powder

4

PNV OB+DHA - prenat w/o aw/fecbn-fegl-dss-fa tab &dha cap 250 mg pack

4

PNV PRENATAL PLUSMULTIVI - prenatal vit w/ fefumarate-fa tab 27-1 mg

4

PNV TABS 29-1 - prenatal vitw/ iron carbonyl-fa tab 29-1mg

4

PNV-DHA - prenat w/o a w/fefum-methfol-fa-dha cap27-0.6-0.4-300 mg

4

PNV-DHA+DOCUSATE -prenatal w/o vit a w/ fe fum-dss-fa-dha cap 27-1.25-300mg

4

PNV-OMEGA - prenat w/o a w/fe fumerate-methylfolate-fa-omega 3 cap

4

2016



Drug Name Dru

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PNV-SELECT - prenatal vit w/fe fum-methylfolate-fa tab27-0.6-0.4 mg

4

PNV-TOTAL - prenat w/ fecbn-fe bisglyc-fa-fish oil cap35-5-1.2 mg

4

PNV-VP-U - prenatal w/o avit w/ fe fumarate-fa cap106.5-1 mg

4

POLY-VI-FLOR - ped multiplevit w/ fluoride biphasic chewtab 0.25 mg

4

POLY-VI-FLOR - ped multiplevit w/ fluoride biphasic chewtab 0.5 mg

4

POLY-VI-FLOR - ped multiplevit w/ fluoride biphasic chewtab 1 mg

4

POLY-VI-FLOR - ped multiplevit w/ fluoride biphasic susp0.25 mg/ml

4

POLY-VI-FLOR FS - pediatricmultiple vit w/ fluoride oralstrip 0.25 mg

4

POLY-VI-FLOR FS - pediatricmultiple vit w/ fluoride oralstrip 0.5 mg

4

POLY-VI-FLOR FS - pediatricmultiple vitamins w/ fluorideoral strip 1 mg

4

POLY-VI-FLOR/IRON - pedmultiple vit w/ fl-fe biphasicchew tab 0.5-10 mg

4

POLY-VI-FLOR/IRON - pedmultiple vitamin w/ fl-febiphasic susp 0.25-7 mg/ml

4

PR NATAL 400 - prenat-febis-fe prot succ-fa-ca tab &omega 3 cap 400 pk

4

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PR NATAL 400 EC - prenat-febis-fe prot succ-fa-ca tab &omega cap dr 400 pk

4

PR NATAL 430 - prenat-febis-fe prot succ-fa-ca tab &omega 3 cap 430 pk

4

PR NATAL 430 EC - prenat-febis-fe prot succ-fa-ca tab &omega cap dr 430 pk

4

PREFERA OB - prenat vit-fepoly cmplx-fe heme poly-fatab 34-1 mg

4

PREFERAOB +DHA - prenat-fe poly cmplx 28mg-fe hemepoly-fa tab&dha cap pack

4

PREFERAOB ONE - prenat-fepoly cmplx-fe heme poly-fa-dha cap 22-6-1-200 mg

4

PRENAISSANCE - prenatal w/o vit a w/ fe fum-dss-fa-dhacap 29-1.25-325 mg

4

PRENAISSANCE BALANCE -prenatal w/o vit a w/ fe cbn-dss-fa-dha cap 30-1-260 mg

4

PRENAISSANCE HARMONYDHA - prenat w/fe poly-nafered-fa tab 27-1 & omegacap dr 380mg

4

PRENAISSANCE NEXT -prenatal w/ calcium-vit b6-fa-ginger tab 1.2 mg

4

PRENAISSANCE NEXT-B -prenatal w/ calcium-vit b6-fa-ginger tab 1.22 mg

4

PRENAISSANCE PLUS -prenatal w/o a w/fe cbn-dss-fa-dha cap 28-1-250 mg

4

PRENATABS RX - prenatal vitw/ iron carbonyl-fa tab 29-1mg

4

2016



Drug Name Dru

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ited

Dis

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PRENATAL - prenatal vit w/ fefumarate-fa tab 27-1 mg

4

PRENATAL PLUS - prenatal vitw/ fe fumarate-fa tab 27-1mg

3

PRENATAL PLUS IRON -prenatal vit w/ iron carbonyl-fa tab 29-1 mg

4

PRENATAL VITAMINS PLUSLO - prenatal vit w/ fefumarate-fa tab 27-1 mg

3

PRENATAL 19 - prenatal vit w/dss-fe fumarate-fa tab 29-1mg

4

PRENATAL 19 - prenatal vit w/fe fumarate-fa chew tab 29-1mg

4

PRENATAL-U - prenatal w/oa vit w/ fe fumarate-fa cap106.5-1 mg

4

PRENATE - prenat mv & minw/ l-methylfolate-fa chew tab0.6-0.4 mg

4

PRENATE AM - prenatal w/calcium-vit b6-vit b12-fa-ginger tab 1 mg

4

PRENATE DHA - prenat w/o aw/feaspg-methfol-fa-dha cap18-0.6-0.4-300 mg

4

PRENATE DHA - prenat w/o aw/fefum-methfol-fa-dha cap28-0.6-0.4-300 mg

4

PRENATE ELITE - prenatal vitw/ fe fum-methylfolate-fa tab26-0.6-0.4 mg

4

PRENATE ELITE - prenatal w/fe asp gly-l methylfol-fa tab20-0.6-0.4 mg

4

Drug Name Dru

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PRENATE ENHANCE - prenatw/o a w/fefum-methfol-fa-dha cap 28-0.6-0.4-400 mg

4

PRENATE ESSENTIAL -prenat w/o a w/feasp-methylf-fa-omeg cap29-0.6-0.4-340 mg

4

PRENATE ESSENTIAL -prenat w/o a w/feaspg-methfol-fa-dha cap18-0.6-0.4-300 mg

4

PRENATE MINI - prenat w/o aw/fecbn-methylf-fa-dha cap29-0.6-0.4-350 mg

4

PRENATE MINI - prenat w/oaw/fecb-feasp-meth-fa-dhacap 18-0.6-0.4-350 mg

4

PRENATE PIXIE - prenat w/o aw/feaspg-methfol-fa-dha cap10-0.6-0.4-200 mg

4

PRENATE RESTORE - prenatw/o a w/fefum-methfol-fa-dha cap 27-0.6-0.4-400 mg

4

PRENA1 CHEW - prenat w/b2-b6-b12-d3-folic acid chewtab 1.4 mg

4

PRENA1 PEARL - prenat w/oaw/fefum-na fered-fa-dha caper 30-1.4-200 mg

4

PREPLUS - prenatal vit w/ fefumarate-fa tab 27-1 mg

4

PRETAB - prenatal vit w/ fefumarate-fa tab 29-1 mg

4

PROVIDA DHA - prenat w/o aw/fe fum-fe poly-fa-dha cap16-16-1.25-110 mg

4

PROVIDA OB - prenatal w/oa w/fe fum-fe poly-fa cap20-20-1.25 mg

4

2016



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PUREFE OB PLUS - prenatalw/o a w/fe fum-fe poly-fa cap162.115.2-1 mg

4

QUFLORA FE - multi vit w/ min& fluoride-iron-fa chew tab0.25 mg

4

QUFLORA PEDIATRIC -pediatric multiple vitamins w/fluoride chew tab 0.25 mg

4

QUFLORA PEDIATRIC -pediatric multiple vitamins w/fluoride chew tab 0.5 mg

4

QUFLORA PEDIATRIC -pediatric multiple vitamins w/fluoride chew tab 1 mg

4

QUFLORA PEDIATRIC -pediatric multiple vitamins w/fluoride soln 0.25 mg/ml

1

QUFLORA PEDIATRIC -pediatric multiple vitamins w/fluoride soln 0.5 mg/ml

1

R-NATAL OB - prenatal w/o a w/fe cbn-fa-dha cap20-1-320 mg

4

RELNATE DHA - prenatal vitw/ fe fum-fa-omega 3 cap28-1-200 mg

4

SE-NATAL 19 - prenatal vit w/dss-fe fumarate-fa tab 29-1mg

4

SE-NATAL 19 - prenatal vit w/fe fumarate-fa chew tab 29-1mg

4

SELECT-OB - prenat w/fepolycmplx-methylfol-fachew tab 29-0.6-0.4 mg

4

SELECT-OB - prenatal vit w/ fepolysac cmplx-fa chew tab29-1 mg

4

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SELECT-OB+DHA - prenatalmv w/fe poly-fa chw 29-1 mg& dha cap 250 mg pak

4

SUPER NU-THERA - multiplevitamins w/ minerals powder

4

TARON-BC - prenat w/o a w/ fecbnyl-fa tab 20-1 mg & vit b6tab pak

4

TARON-C DHA - prenatal w/fefum-fe poly -fa-omega 3 cap53.5-38-1 mg

4

TARON-PREX - prenatal w/ovit a w/ fe fum-dss-fa-dhacap 30-1.2-265 mg

4

TEXAVITE LQ - pediatricmultivitamins w/fl-fe-zndrops 0.25-7-3 mg/ml

4

THRIVITE RX - prenatal vit w/iron carbonyl-fa tab 29-1 mg

4

THRIVITE 19 - prenatal vit w/dss-fe fumarate-fa tab 29-1mg

4

TL FOLATE - prenatal vit w/fe fum-methylfolate-fa tab27-0.5-0.5 mg

4

TL G-FOL OS - multiple vit w/min & calcium-folic acid tab500-1.1 mg

4

TL-CARE DHA - prenatal w/fefumarate-fa-dss-fish oil cap27-1-500 mg

4

TL-FLUORIVITE - pediatricmultiple vitamins w/ fl-fechew tab 0.25-7.5 mg

4

TL-SELECT - prenatal w/o vita w/ fe fum-dss-fa-dha cap29-1.25-325 mg

4

2016



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TRI-TABS DHA - prenat w/o aw/ fe bisglyc-fa tab 32-1 mg& omega cap pack

4

TRI-VI-FLOR - ped vit acd & l-methylfol w/ fl biphasic susp0.25 mg/ml

4

TRI-VI-FLOR - ped vit acd & l-methylfol w/ fl biphasic susp0.5 mg/ml

4

TRI-VI-FLORO - ped vit acd& l-methylfol w/ fl biphasicsusp 0.25 mg/ml

4

TRI-VI-FLORO - ped vit acd& l-methylfol w/ fl biphasicsusp 0.5 mg/ml

4

TRI-VIT/FLUORIDE/IRON -pediatric vitamins acdfluoride & fe drops 0.25-10mg/ml

4

TRICARE - prenatal vit w/ fefumarate-fa tab 27-1 mg

4

TRICARE PRENATAL - prenatw/o vit a w/ fe pyrophos-methylf chew tab 4.5-1 mg

4

TRICARE PRENATALCOMPLEAT - prenat w/o afefum-fa tab 27-1 mg & fishoil chew cap pak

4

TRICARE PRENATALDHA ONE - prenatal w/fefumarate-fa-dss-fish oil cap27-1-500 mg

4

TRICARE PRENATAL DHAONE/ - prenatal multivitamins& minerals w/iron & fa cap0.8 mg

4

TRINATAL RX 1 - prenatal vitw/ fe fumarate-fa tab 60-1mg

4

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TRINATE - prenatal vit w/ fefumarate-fa tab 28-1 mg

4

TRISTART DHA - prenat w/o aw/fecbn-methylf-fa-dha cap31-0.6-0.4-200 mg

4

TRISTART ONE - prenat w/o aw/fecbn-methylf-fa-dha cap35-1-215 mg

4

TRIVEEN-DUO DHA - prenat-fe bis-fe prot succ-fa-ca tab& omega 3 cap 400 pk

4

UDAMIN SP - multiple vitaminsw/ minerals & fa tab 1 mg

4

ULTIMATECARE ONE -prenatal vit w/ fe cbn-fe aspglyc-fa-omega 3 cap 27-1mg

4

VEMAVITE-PRX 2 - prenatal w/o vit a w/ fe fum-dss-fa-dhacap 27-1.25-300 mg

4

VENA-BAL DHA - prenat w/fepoly-na fered-fa tab 27-1 &omega cap dr 430mg

4

VINATE DHA RF - prenat w/oa w/fefum-methylfol-omegascap 27-1.13 mg

4

VINATE II - prenatal vit w/ febisglycinate chelate-fa tab29-1 mg

4

VINATE M - prenatal vit w/ sel-fe fumarate-fa tab 27-1 mg

4

VINATE ONE - prenatal vit w/fe fumarate-fa tab 60-1 mg

4

VIRT NATE - prenatal vit w/ fefumarate-fa tab 28-1 mg

4

VIRT-ADVANCE - prenatal vitw/ dss-iron carbonyl-fa tab90-1 mg

4

2016



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VIRT-C DHA - prenatal w/fefum-fe poly -fa-omega 3 cap53.5-38-1 mg

4

VIRT-NATE DHA - prenatal vitw/ fe fum-fa-omega 3 cap28-1-200 mg

4

VIRT-PN - prenatal vit w/ fefum-methylfolate-fa tab27-0.6-0.4 mg

4

VIRT-PN DHA - prenat w/o aw/fefum-methfol-fa-dha cap27-0.6-0.4-300 mg

4

VIRT-PN PLUS - prenat w/o aw/ fe fumerate-methylfolate-fa-omega 3 cap

4

VIRT-SELECT - prenatal w/ovit a w/ fe fum-dss-fa-dhacap 29-1.25-325 mg

4

VIRT-VITE GT - prenatal vit w/dss-iron carbonyl-fa tab 90-1mg

4

VIRTPREX - prenatal w/o vita w/ fe fum-dss-fa-dha cap26-1.2-300 mg

4

VITA-PREN - prenatal vit w/docusate-iron-fa tab 65-1 mg

4

VITAFOL FE+ - prenat-fepoly-methol-fa-dha cap 90-1-200mg & dss 50mg cap

4

VITAFOL GUMMIES - prenatvit w/ fe phos-fa-omegachew tab 3.33-0.333-34.8mg

4

VITAFOL ULTRA - prenat w/fe poly-methylfol-fa-dha cap29-0.6-0.4-200 mg

4

VITAFOL-NANO - prenatal w/oa w/ fefum-l methylfol-fa tab18-0.6-0.4 mg

4

Drug Name Dru

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VITAFOL-OB - prenatal vit w/ fefumarate-fa tab 65-1 mg

4

VITAFOL-OB+DHA - prenatalmv w/fe fum-fa tab 65-1 mg& dha cap 250 mg pack

4

VITAFOL-ONE - prenatal mv w/fe polysac cmplx-fa-dha cap29-1-200 mg

4

VITAL-D RX - b-complex w/ c-biotin-d-zinc & folic acid tab1 mg

4

VITAMEDMD ONE RX/QUATREFO - prenat w/o aw/fefum-methfol-fa-dha cap30-0.6-0.4-200 mg

4

VITAMEDMD REDICHEW RX -prenat w/ b2-b6-b12-d3-folicacid chew tab 1.4 mg

4

VITAPEARL - prenat w/oa w/fefum-na fered-fa-dha cap er30-1.4-200 mg

4

VITATRUE - prenat w/o a w/fechel-fa tab 30-1.4 mg & dhacap 300mg pk

4

VIVA DHA - prenatal vit w/fe fum-fa-omega 3 cap28-1-200 mg

4

VOL-NATE - prenatal vit w/ fefumarate-fa tab 28-1 mg

4

VOL-PLUS - prenatal vit w/ fefumarate-fa tab 27-1 mg

4

VOL-TAB RX - prenatal vit w/iron carbonyl-fa tab 29-1 mg

4

VP-CH-PNV - prenatal w/o vita w/ fe cbn-dss-fa-dha cap30-1-260 mg

4

VP-GGR-B6 PRENATAL -prenatal w/ calcium-vit b6-fa-ginger tab 1.2 mg

4

2016



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VP-HEME OB - prenat vit-fepoly cmplx-fe heme poly-fatab 28-6-1 mg

4

VP-HEME OB + DHA - prenat-fe poly cmplx-fe heme poly-fa tab & omega 3 cap pck

4

VP-HEME ONE - prenat-fe polycmplx-fe heme poly-fa-dhacap 22-6-1-200 mg

4

VP-PNV-DHA - prenatal vitw/ fe fum-fa-omega 3 cap28-1-215.8 mg

4

ZATEAN-PN DHA - prenat w/o a w/fefum-methfol-fa-dhacap 27-0.6-0.4-300 mg

4

ZATEAN-PN PLUS - prenatw/o a w/ fe fumerate-methylfolate-fa-omega 3 cap

4

MINERALS and ELECTROLYTESCALCIFOL - ca carb-folic acid-

vit d-b6-b12-boron-magwafer 1342-1.6 mg

4

CALCIUM-FOLIC ACID PLUSD - ca carb-folic acid-vit d-b6-b12-boron-mag wafer1342-1 mg

4

EFFER-K - potassiumbicarbonate-citric acid effertab 10 meq

4

EFFER-K - potassiumbicarbonate-citric acid effertab 20 meq

4

FLORICAL - sodium fluoride w/calcium carb cap 8.3-364 mg

A •

FLORICAL - sodium fluoride w/calcium carb tab 8.3-364 mg

A •

FLORIVA - sodium fluoride-vitamin d liqd drops 0.25 mg/ml-400 unit/ml

4 •

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FLUOR-A-DAY - sodiumfluoride-xylitol chew tab 0.55(0.25 mg f)-236.79 mg

4 •

FLUOR-A-DAY - sodiumfluoride-xylitol chew tab 2.2(1 mg f)-236.79 mg

4 •

FLUORABON - sodium fluoridesoln 0.25 mg/0.6ml (from0.55 mg/0.6ml naf)

4 •

FLURA-DROPS - sodiumfluoride soln 0.25 mg/drop f(from 0.55 mg/drop naf)

4 •

GALZIN - zinc acetate cap 25mg (elemental zinc)

4

GALZIN - zinc acetate cap 50mg (elemental zinc)

4

GNP VITAMIN D-400 - calciumcarbonate-cholecalciferol tab90 mg-400 unit

4

IODINE STRONG - iodinesolution strong 5% (lugol's)

4

K-PHOS - potassiumphosphate monobasic tab500 mg

4

K-TAB - potassium chloride taber 8 meq (600 mg)

4

K-TAB - potassium chloride taber 20 meq (1500 mg)

4

KLOR-CON M15 - potassiumchloride microencapsulatedcrys er tab 15 meq

4

MAGNEBIND 400 -magnesium-calcium-folicacid tab 400-200-1 mg

4

MONOCAL - sodiummonofluorophosphate-calcium carb tab 22.75-625mg

A •

2016



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pot bicarbonate & chlorideeffer tab 25 meq

2

pot phos monobasic w/sodphos di & monobas tab155-852-130mg (K-phosneutral)

2

potassium bicarbonate effertab 25 meq

2

POTASSIUM CHLORIDE -potassium chloride oral soln20% (40 meq/15ml)

2

potassium chloride cap er 8meq (Micro-k)

2

potassium chloride cap er10 meq (Micro-k)

2

POTASSIUM CHLORIDE ER -potassium chloride tab er 8meq (600 mg)

1

POTASSIUM CHLORIDE ER -potassium chloride tab er 20meq (1500 mg)

4

potassium chloridemicroencapsulated crys ertab 10 meq

1

potassium chloridemicroencapsulated crys ertab 20 meq

1

potassium chloride oral soln10% (20 meq/15ml)

2

potassium chloride powderpacket 20 meq

2

potassium chloride tab er 8meq (600 mg)

1

potassium chloride tab er 10meq (K-tab)

1

SODIUM FLUORIDE - sodiumfluoride tab 0.5 mg f (from1.1 mg naf)

4 •

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SODIUM FLUORIDE - sodiumfluoride tab 1 mg f (from 2.2mg naf)

4 •

sodium fluoride chew tab0.25 mg f (from 0.55 mgnaf) (Luride)

1 •

sodium fluoride chew tab0.5 mg f (from 1.1 mg naf)(Luride)

1 •

sodium fluoride chew tab1 mg f (from 2.2 mg naf)(Luride)

1 •

sodium fluoride soln0.125 mg/drop f (0.275 mg/drop naf)

2 •

sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)(Luride)

1 •

SSKI - potassium iodide soln 1gm/ml

4

NUTRIENTSacetylcysteine cap 600 mg 2

ADD-INS COMPLETE - aminoacids pack

4

amino acids cap 2

amino acids tab 2

ARGIMENT - amino acids pack 4

ARGIMENT AT - amino acidspack

4

CARDIOVID PLUS - dha-epa-vit b6-b12-folic acid cap240-360-20-0.5-0.8 mg

4

COMPLETE AMINO ACIDMIX - amino acids oralpowder

4

COMPLEX ESSENTIAL MSD -amino acids oral powder

4

2016



Drug Name Dru

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COMPLEX JUNIOR MSD -amino acids oral powder

4

COMPLEX MSUD - aminoacids oral powder

4

COMPLEX MSUD AMINOACID B - amino acids bar

4

DEQUASINE - amino acids tab 4

ESSENTIAL AMINO ACIDMIX - amino acids oralpowder

4

G-PREPROTEIN - amino acidsoral liquid

4

GLUTARADE AMINO ACIDBLEN - amino acids oralpowder

4

GLUTARADE ESSENTIALGA-1 - amino acids oralpowder

4

GLUTARADE JUNIOR GA-1 -amino acids oral powder

4

HEPAMENT - amino acidspack

4

LECITHIN - lecithin granules 4

LIQUACEL - amino acids oralliquid

4

LIQUACEL PUMP + GO -amino acids oral liquid

4

NUTRASENTIALS - aminoacids oral powder

4

NUTRESTORE - glutaminepowd pack 5 gm

4

PERIFLEX LQ PKU - aminoacids oral liquid

4

PHENYLADE - amino acidsoral powder

4

PHENYLADE AMINO ACID -amino acids bar

4

Drug Name Dru

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PHENYLADE AMINO ACIDBLEN - amino acids pack

4

PHENYLADE MTE - aminoacids oral powder

4

PHENYLADE MTE AMINOACID - amino acids pack

4

PHENYLADE PHEBLOC -amino acids oral powder

4

PHENYLADE PHEBLOC -amino acids tab

4

PHENYLADE40 DRINK MIX -amino acids pack

4

PHLEXY-10 - amino acids cap 4

PREPROTEIN - amino acidsoral liquid

4

PREPROTEIN 20 - aminoacids oral liquid

4

SOLVIL - amino acids pack 4

TRIAMINO - amino acids tab 4

XPHE MAXAMUM - aminoacids oral powder

4

XPHE MAXAMUM - aminoacids pack

4

DIETARY PRODUCTSA-SOY - nutritional supplement

liquid4

ACERFLEX - nutritionalsupplement powder

4

ADVERA - nutritionalsupplement liquid

4

ALITRAQ - nutritionalsupplement pack

4

ARGINAID - nutritionalsupplement pack

4

ARGINAID EXTRA - nutritionalsupplement liquid

4

2016



Drug Name Dru

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BALANCE TOTALNUTRITIONAL - nutritionalsupplement liquid

4

BALANCED NUTRITIONALDRIN - nutritional supplementliquid

4

BALANCED NUTRITIONALSHAK - nutritionalsupplement liquid

4

BCAD 1 - nutritionalsupplement powder

4

BCAD 2 - nutritionalsupplement powder

4

BEEF/POTATOES/PEAS -nutritional supplement liquid

4

BENECALORIE - nutritionalsupplement liquid

4

BOOST - nutritionalsupplement liquid

4

BOOST BREEZE - nutritionalsupplement liquid

4

BOOST CALORIE SMART -nutritional supplement liquid

4

BOOST COMPACT - nutritionalsupplement liquid

4

BOOST GLUCOSECONTROL - nutritionalsupplement liquid

4

BOOST HIGH PROTEIN -nutritional supplement liquid

4

BOOST HIGH PROTEIN -nutritional supplementpowder

4

BOOST KID ESSENTIALS1.0 - nutritional supplementliquid

4

BOOST KID ESSENTIALS1.5 - nutritional supplementliquid

4

Drug Name Dru

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BOOST KIDS ESSENTIALS -nutritional supplement liquid

4

BOOST PLUS - nutritionalsupplement liquid

4

BOOST PUDDING - nutritionalsupplement pudding

4

BOOST SMOOTHIE -nutritional supplement liquid

4

BOOST VHC - nutritionalsupplement liquid

4

BOOST 100 CALORIESMART - nutritionalsupplement liquid

4

BOOST/BENEFIBER -nutritional supplement liquid

4

CALCILO XD - infant foodspowder

4

CAMINO PRO BETTERMILK/GLY - nutritional supplementpack

4

CAMINO PRO COMPLETE/GLYTA - nutritionalsupplement bar

4

CAMINO PRO PKU - nutritionalsupplement liquid

4

CAMINO PRO RESTORE/GLYTAC - nutritionalsupplement liquid

4

CAMINO PRO SWIRL -nutritional supplement pack

4

CAMINO PRO 15PE -nutritional supplement liquid

4

CARDIOTEK-RX - folic acid-b12-b6-arginine-blackpepper tab

4

CARNATION BREAKFASTESSEN - nutritionalsupplement liquid

4

2016



Drug Name Dru

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tion

CARNATION BREAKFASTESSEN - nutritionalsupplement pack

4

CARNATION INSTANTBREAKFA - nutritionalsupplement liquid

4

CEREFOLIN - l-methylfolatew/ vit b12-vit b6-vit b2 tab6-1-50-5 mg

4

CHOICE DM - nutritionalsupplement liquid

4

CHOICE DM TF - nutritionalsupplement liquid

4

CHOLEXTRA - nutritionalsupplement powder

4

CLICK ESPRESSO PROTEINDR - nutritional supplementpowder

4

COMPLEAT - nutritionalsupplement liquid

4

COMPLEAT CLOSEDSYSTEM - nutritionalsupplement liquid

4

COMPLEAT PEDIATRIC -nutritional supplement liquid

4

COMPLEAT PEDIATRICREDUCE - nutritionalsupplement liquid

4

COMPLETE NUTRITION -nutritional supplement liquid

4

COMPLETE NUTRITIONPLUS - nutritionalsupplement liquid

4

COMPLETE PROTEIN& VITAMI - nutritionalsupplement powder

4

CRITICARE HN - nutritionalsupplement liquid

4

Drug Name Dru

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CRUCIAL - nutritionalsupplement liquid

4

CVS NUTRITION LIQUID -nutritional supplement liquid

4

CVS NUTRITION PLUS -nutritional supplement liquid

4

CVS NUTRITIONAL SHAKE -nutritional supplement liquid

4

CYCLINEX-1 - nutritionalsupplement powder

4

CYCLINEX-2 - nutritionalsupplement powder

4

DIABETIC TF - nutritionalsupplement liquid

4

DIABETISHIELD - nutritionalsupplement liquid

4

DIABETISOURCE - nutritionalsupplement liquid

4

DIABETISOURCE AC -nutritional supplement liquid

4

DIARESQ - nutritionalsupplement pack

4

DIARESQ CHILDRENS -nutritional supplement pack

4

DUOCAL - nutritionalsupplement powder

4

EAA SUPPLEMENT -nutritional supplement pack

4

EGG/PRO - nutritionalsupplement powder

4

EGGS/APPLES/OATS -nutritional supplement liquid

4

ELECARE - nutritionalsupplement powder

4

ELECARE JR - nutritionalsupplement powder

4

2016



Drug Name Dru

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ELECARE/DHA/ARA -nutritional supplementpowder

4

ENLIVE - nutritionalsupplement liquid

4

ENSURE - nutritionalsupplement bar

4

ENSURE - nutritionalsupplement liquid

4

ENSURE - nutritionalsupplement powder

4

ENSURE ACTIVE - nutritionalsupplement liquid

4

ENSURE ACTIVE HEARTHEALT - nutritionalsupplement liquid

4

ENSURE ACTIVE HIGHPROTEI - nutritionalsupplement liquid

4

ENSURE ACTIVE LIGHT -nutritional supplement liquid

4

ENSURE BONE HEALTHREVIGO - nutritionalsupplement liquid

4

ENSURE CLEAR - nutritionalsupplement liquid

4

ENSURE CLINICALSTRENGTH - nutritionalsupplement liquid

4

ENSURE COMPACT -nutritional supplement liquid

4

ENSURE COMPLETE -nutritional supplement liquid

4

ENSURE COMPLETENUTRITION - nutritionalsupplement liquid

4

ENSURE ENLIVE - nutritionalsupplement liquid

4

Drug Name Dru

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ENSURE HEALTHY MOM -nutritional supplement bar

4

ENSURE HEALTHY MOM -nutritional supplement liquid

4

ENSURE HIGH CALCIUM -nutritional supplement liquid

4

ENSURE HIGH PROTEIN -nutritional supplement liquid

4

ENSURE HIGH PROTEIN -nutritional supplementpowder

4

ENSURE IMMUNE HEALTH -nutritional supplement liquid

4

ENSURE MUSCLE HEALTHREVI - nutritional supplementliquid

4

ENSURE NUTRA SHAKE HI-CAL - nutritional supplementliquid

4

ENSURE NUTRITIONSHAKE - nutritionalsupplement liquid

4

ENSURE PLUS - nutritionalsupplement liquid

4

ENSURE PLUS HN - nutritionalsupplement liquid

4

ENSURE PRE-SURGERY -nutritional supplement liquid

4

ENSURE PUDDING -nutritional supplementpudding

4

ENSURE SURGERYIMMUNONUTR - nutritionalsupplement liquid

4

ENSURE/FIBER - nutritionalsupplement liquid

4

ENU NUTRITIONAL SHAKE -nutritional supplement liquid

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

EO28 SPLASH - nutritionalsupplement liquid

4

EQ NUTRITIONAL SHAKE -nutritional supplement liquid

4

EQ NUTRITIONAL SHAKEPLUS - nutritionalsupplement liquid

4

EQ WEIGHT LOSSSHAKE ULTR - nutritionalsupplement liquid

4

EQUATE - nutritionalsupplement liquid

4

EQUATE PLUS - nutritionalsupplement liquid

4

F.A.A. - nutritional supplementliquid

4

FALESSA - levomefolateglucosamine tab 1 mg (folateequivalent)

4

FIBER FLOW - nutritionalsupplement liquid

4

FIBER-STAT - nutritionalsupplement liquid

4

FIBERSOURCE CLOSEDSYSTEM - nutritionalsupplement liquid

4

FIBERSOURCE HN -nutritional supplement liquid

4

FIBERSOURCE HN CLOSEDSYS - nutritional supplementliquid

4

FLAVOR PACKETS - nutritionalsupplement flavor pack

4

FLAVOUR PAC - nutritionalsupplement flavor pack

4

folic acid-pyridoxine-cyanocobalamin tab2.5-25-2 mg

2

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

FORTA DRINK - nutritionalsupplement powder

4

FORTA SHAKE - nutritionalsupplement powder

4

FRUITIVITS - nutritionalsupplement pack

4

GA - nutritional supplementpowder

4

GA EXPRESS15 - nutritionalsupplement pack

4

GA GEL - nutritionalsupplement pack

4

GA-1 ANAMIX EARLYYEARS - nutritionalsupplement powder

4

GLUCERNA - nutritionalsupplement bar

4

GLUCERNA - nutritionalsupplement liquid

4

GLUCERNA ADVANCESHAKE - nutritionalsupplement liquid

4

GLUCERNA CARBSTEADY -nutritional supplement liquid

4

GLUCERNA CEREALCRUNCHY F - nutritionalsupplement misc

4

GLUCERNA CRISPYDELIGHTS - nutritionalsupplement bar

4

GLUCERNA HUNGERSMART SHA - nutritionalsupplement liquid

4

GLUCERNA MEAL - nutritionalsupplement bar

4

GLUCERNA MEALREPLACEMENT - nutritionalsupplement bar

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

GLUCERNA MINI SNACK -nutritional supplement bar

4

GLUCERNA MINI SNACKS -nutritional supplement bar

4

GLUCERNA OS - nutritionalsupplement liquid

4

GLUCERNA SELECT -nutritional supplement liquid

4

GLUCERNA SHAKE -nutritional supplement liquid

4

GLUCERNA SNACK -nutritional supplement bar

4

GLUCERNA SNACK SHAKE -nutritional supplement liquid

4

GLUCERNA WEIGHTLOSS SHAK - nutritionalsupplement liquid

4

GLUCERNA 1.0 CAL -nutritional supplement liquid

4

GLUCERNA 1.0 CAL/FIBER -nutritional supplement liquid

4

GLUCERNA 1.0 WITHCARBSTE - nutritionalsupplement liquid

4


4


4

GLUCO BURST - nutritionalsupplement liquid

4

GLUTAREX-1 - nutritionalsupplement powder

4

GLUTAREX-2 - nutritionalsupplement powder

4

GLYCOSADE - nutritionalsupplement pack

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

GLYTACTIN BETTERMILKDE-L - nutritional supplementpack

4

GLYTACTIN BETTERMILK 15 -nutritional supplement pack

4

GLYTACTIN BUILD 10PE -nutritional supplement pack

4

GLYTACTIN COMPLETE10PE - nutritional supplementbar

4

GLYTACTIN RESTORE LITE10 - nutritional supplementliquid

4

GLYTACTIN RESTORE LITE10 - nutritional supplementpack

4

GLYTACTIN RESTORE 10 -nutritional supplement liquid

4

GLYTACTIN RESTORE 5 -nutritional supplement pack

4

GLYTACTIN RTD 10 -nutritional supplement liquid

4

GLYTACTIN RTD 15 -nutritional supplement liquid

4

GLYTROL - nutritionalsupplement liquid

4

GLYTROL PREBIO1 -nutritional supplement liquid

4

GNP NUTRITIONAL DRINK -nutritional supplement liquid

4

GNP NUTRITIONAL DRINKPLU - nutritional supplementliquid

4

GOAT MILK - nutritionalsupplement powder

4

HAELAN HTPI FERMENTEDORG - nutritional supplementliquid

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

HAELAN 951 FERMENTEDORGA - nutritionalsupplement liquid

4

HCU ANAMIX EARLY YEARS -nutritional supplementpowder

4

HCU ANAMIX NEXT -nutritional supplementpowder

4

HCU COOLER - nutritionalsupplement liquid

4

HCU EXPRESS - nutritionalsupplement pack

4

HCU EXPRESS20 - nutritionalsupplement pack

4

HCU GEL - nutritionalsupplement pack

4

HCU LOPHLEX LQ - nutritionalsupplement liquid

4

HCY 1 - nutritional supplementpowder

4

HCY 2 - nutritional supplementpowder

4

HEALTH SOURCE SOYPROTEIN - nutritionalsupplement powder

4

HEALTHY ACCENTS NUTRAFIT - nutritional supplementliquid

4

HEARTBAR - nutritionalsupplement bar

4

HI-CAL - nutritional supplementliquid

4

HIGH-PROTEINNUTRITIONAL - nutritionalsupplement liquid

4

HM NUTRISURE - nutritionalsupplement liquid

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

HM NUTRISURE PLUS -nutritional supplement liquid

4

HOM 2 - nutritional supplementpowder

4

HOMACTIN AA PLUS -nutritional supplement liquid

4

HOMINEX-1 - nutritionalsupplement powder

4

HOMINEX-2 - nutritionalsupplement powder

4

I-VALEX-1 - nutritionalsupplement powder

4

I-VALEX-2 - nutritionalsupplement powder

4

IMMUNOPRO RX - nutritionalsupplement powder

4

IMPACT - nutritionalsupplement liquid

4

IMPACT ADVANCEDRECOVERY - nutritionalsupplement liquid

4

IMPACT GLUTAMINE -nutritional supplement liquid

4

IMPACT PEPTIDE 1.5 -nutritional supplement liquid

4

IMPACT 1.5 - nutritionalsupplement liquid

4

IMPACT/FIBER - nutritionalsupplement liquid

4

IMUPLUS - nutritionalsupplement pack

4

INNOVACIN - nutritionalsupplement liquid

4

INTROLITE - nutritionalsupplement liquid

4

ISOCAL - nutritionalsupplement liquid

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ISOCAL HN - nutritionalsupplement liquid

4

ISOCAL HN PLUS - nutritionalsupplement liquid

4

ISOSOURCE - nutritionalsupplement liquid

4

ISOSOURCE CLOSEDSYSTEM - nutritionalsupplement liquid

4

ISOSOURCE HN - nutritionalsupplement liquid

4

ISOSOURCE VHN - nutritionalsupplement liquid

4

ISOSOURCE 1.5 CAL -nutritional supplement liquid

4

ISOVACTIN AA PLUS -nutritional supplement liquid

4

IVA ANAMIX EARLY YEARS -nutritional supplementpowder

4

IVA ANAMIX NEXT - nutritionalsupplement powder

4

JEVITY 1 CAL - nutritionalsupplement liquid

4

JEVITY 1 CAL/FIBER -nutritional supplement liquid

4

JEVITY 1.2 CAL - nutritionalsupplement liquid

4

JEVITY 1.2 CAL/FIBER -nutritional supplement liquid

4

JEVITY 1.5 CAL - nutritionalsupplement liquid

4

JEVITY 1.5 CAL/FIBER -nutritional supplement liquid

4

JUICE PLUS FIBRE -nutritional supplement liquid

4

JUVEN - nutritional supplementpack

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

JUVEN - nutritional supplementpowder

4

JUVEN NUTRIVIGOR -nutritional supplement pack

4

JUVEN REVIGOR - nutritionalsupplement pack

4

K-PAX IMMUNE BOOSTERPROT - nutritionalsupplement powder

4

KATE FARMS COREESSENTIAL - nutritionalsupplement liquid

4

KETOCAL 3:1 - nutritionalsupplement powder

4

KETOCAL 4:1 - nutritionalsupplement liquid

4

KETOCAL 4:1 - nutritionalsupplement powder

4

KETOCAL 4:1 LQ MULTIFIBE - nutritional supplementliquid

4

KETOGEN - nutritionalsupplement powder

4

KETONEX-1 - nutritionalsupplement powder

4

KETONEX-2 - nutritionalsupplement powder

4

KETOVIE - nutritionalsupplement liquid

4

KETOVIE PEPTIDE -nutritional supplement liquid

4

KETOVOLVE 4:1 - nutritionalsupplement powder

4

KIDS PROTEIN ORGANICNUTR - nutritionalsupplement liquid

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

L-METHYL-MC NAC -l-methylfolate-methylcobalamin-acetylcysttab 6-2-600 mg

4

LANAFLEX - nutritionalsupplement pack

4

LEU-FREE COOLER -nutritional supplement liquid

4

LIPISTART - nutritionalsupplement powder

4

LIQUID HOPE - nutritionalsupplement liquid

4

LMD - nutritional supplementpowder

4

LOPHLEX - nutritionalsupplement pack

4

LOPHLEX LQ 20 - nutritionalsupplement liquid

4

LPS CRITICAL CARE SUGARF - nutritional supplementliquid

4

LPS SUGAR FREE - nutritionalsupplement liquid

4

MCT PRO-CAL - nutritionalsupplement pack

4

MCT PROCAL - nutritionalsupplement powder

4

MERITENE - nutritionalsupplement powder

4

METAFORM - nutritionalsupplement pack

4

METHIONAID - nutritionalsupplement powder

4

MMA/PA ANAMIX EARLYYEARS - nutritionalsupplement powder

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

MMA/PA ANAMIX NEXT -nutritional supplementpowder

4

MMA/PA COOLER - nutritionalsupplement liquid

4

MMA/PA COOLER15 -nutritional supplement liquid

4

MMA/PA GEL - nutritionalsupplement pack

4

MODULEN IBD - nutritionalsupplement powder

4

MONOGEN - nutritionalsupplement powder

4

MSUD AID - nutritionalsupplement powder

4

MSUD ANAMIX EARLYYEARS - nutritionalsupplement powder

4

MSUD COOLER - nutritionalsupplement liquid

4

MSUD EXPRESS - nutritionalsupplement pack

4

MSUD EXPRESS20 -nutritional supplement pack

4

MSUD GEL - nutritionalsupplement pack

4

MSUD LOPHLEX LQ -nutritional supplement liquid

4

MSUD MAXAMAID - nutritionalsupplement powder

4

MSUD MAXAMUM - nutritionalsupplement powder

4

MSUD 2 - nutritionalsupplement powder

4

NEOCATE INFANT DHA/ARA - nutritional supplementpowder

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NEOCATE JUNIOR - nutritionalsupplement powder

4

NEOCATE JUNIOR/PREBIOTICS - nutritionalsupplement powder

4

NEOCATE NUTRA - nutritionalsupplement powder

4

NEOCATE SPLASH -nutritional supplement liquid

4

NEPRO - nutritionalsupplement liquid

4

NEPRO WITH CARBSTEADY - nutritionalsupplement liquid

4

NEPRO WITHCARBSTEADY - nutritionalsupplement liquid

4

NESTLE FLAVOR - nutritionalsupplement flavor pack

4

NESTLE FLAVOR EXTRASTREN - nutritionalsupplement flavor pack

4

NESTLE FLAVOR FOR KIDS -nutritional supplement flavorpack

4

NOURISH - nutritionalsupplement liquid

4

NOVASOURCEPULMONARY - nutritionalsupplement liquid

4

NOVASOURCE RENAL -nutritional supplement liquid

4

NUTRA BALANCE DIABETICNU - nutritional supplementbar

4

NUTRA BALANCE FIBERCOOKI - nutritionalsupplement misc

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NUTRA BALANCE PROTEINFOR - nutritional supplementmisc

4

NUTRA SHAKE - nutritionalsupplement liquid (frozen)

4

NUTRA SHAKE/SUPREME -nutritional supplement liquid(frozen)

4

NUTRA/BALANCE RE/GEN -nutritional supplement liquid(frozen)

4

NUTRA/BALANCE RE/GEN FREE - nutritionalsupplement liquid (frozen)

4

NUTRA/SHAKE - nutritionalsupplement liquid (frozen)

4

NUTRA/SHAKE FRUIT PLUS -nutritional supplement liquid(frozen)

4

NUTRA/SHAKE SUPREME -nutritional supplement liquid(frozen)

4

NUTRA/SHAKE SUPREME -nutritional supplement liquid

4

NUTRAMENT - nutritionalsupplement liquid

4

NUTRAMINE - nutritionalsupplement pack

4

NUTRAMINE APPLE AMINOBIT - nutritional supplementpack

4

NUTRAMINE BANANAAMINO B - nutritionalsupplement pack

4

NUTRAMINE CHOCOLATEAMINO - nutritionalsupplement pack

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NUTRAMINE MANGO AMINOBI - nutritional supplementpack

4

NUTRAMINE MIXEDFLAVORS A - nutritionalsupplement pack

4

NUTRAMINE PEACHES& CREAM - nutritionalsupplement pack

4

NUTRAMINE PINEAPPLEAMINO - nutritionalsupplement pack

4

NUTREN JR - nutritionalsupplement liquid

4

NUTREN JR FIBER -nutritional supplement liquid

4

NUTREN JUNIOR - nutritionalsupplement liquid

4

NUTREN JUNIOR 1.0 -nutritional supplement liquid

4

NUTREN JUNIOR/FIBER -nutritional supplement liquid

4

NUTREN PULMONARY -nutritional supplement liquid

4

NUTREN RENAL - nutritionalsupplement liquid

4

NUTREN 1.0 - nutritionalsupplement liquid

4

NUTREN 1.0 CAL - nutritionalsupplement liquid

4

NUTREN 1.0/FIBER -nutritional supplement liquid

4

NUTREN 1.0/FIBER/ULTRAPAK - nutritionalsupplement liquid

4


4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4

NUTREN 1.5 FIBER -nutritional supplement liquid

4


4


4

NUTRICIA PREOP - nutritionalsupplement pack

4

NUTRIFOCUS - nutritionalsupplement liquid

4

NUTRIHEAL - nutritionalsupplement liquid

4

NUTRIHEP 1.5 CAL -nutritional supplement liquid

4

NUTRIRENAL - nutritionalsupplement liquid

4

NUTRITIONAL DRINK -nutritional supplement liquid

4

NUTRITIONAL DRINK MIX -nutritional supplementpowder

4

NUTRITIONAL DRINK PLUS -nutritional supplement liquid

4

NUTRITIONAL DRINK SHAKEM - nutritional supplementpowder

4

NUTRITIONAL SHAKE -nutritional supplement liquid

4

NUTRITIONAL SHAKECOMPLET - nutritionalsupplement liquid

4

NUTRITIONAL SHAKE HIGHPR - nutritional supplementliquid

4

NUTRITIONAL SHAKE PLUS -nutritional supplement liquid

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NUTRITIONAL SHAKE PLUSPR - nutritional supplementliquid

4

NUTRITIONALSUPPLEMENT - nutritionalsupplement liquid

4

nutritional supplement liquid 2

NUTRITIONAL SUPPLEMENTPL - nutritional supplementliquid

4

NUTRIVENT - nutritionalsupplement liquid

4

NUTRIVENT 1.5 - nutritionalsupplement liquid

4

OA 1 - nutritional supplementpowder

4

OA 2 - nutritional supplementpowder

4

OPTICLEANSE GHI -nutritional supplementpowder

4

OPTIMENTAL - nutritionalsupplement liquid

4

OPTISOURCE VERYHIGH PROT - nutritionalsupplement liquid

4

ORANGE CHICKEN/CARROTS/BR - nutritionalsupplement liquid

4

ORGANIC NUTRITIONCOMPLET - nutritionalsupplement liquid

4

ORGANIC NUTRITIONPLANT B - nutritionalsupplement liquid

4

ORGANIC NUTRITIONVEGAN-A - nutritionalsupplement liquid

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ORGANIC PEDIA SMART -nutritional supplementpowder

4

OS 2 - nutritional supplementpowder

4

OSMOLITE - nutritionalsupplement liquid

4

OSMOLITE HN - nutritionalsupplement liquid

4

OSMOLITE 1 CAL - nutritionalsupplement liquid

4

OSMOLITE 1.0 CAL -nutritional supplement liquid

4


4


4

OXEPA - nutritionalsupplement liquid

4

OXEPA 1.5 - nutritionalsupplement liquid

4

PEDIASURE - nutritionalsupplement liquid

4

PEDIASURE ENTERALFORMULA - nutritionalsupplement liquid

4

PEDIASURE GROW & GAIN -nutritional supplement liquid

4

PEDIASURE NUTRIPALS -nutritional supplement bar

4

PEDIASURE NUTRIPALS -nutritional supplement liquid

4

PEDIASURE PEDIATRIC -nutritional supplement liquid

4

PEDIASURE PEPTIDE 1.0CAL - nutritional supplementliquid

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

PEDIASURE PEPTIDE 1.5CAL - nutritional supplementliquid

4

PEDIASURE SHAKE MIX -nutritional supplementpowder

4

PEDIASURE SHAKE WITHFIBE - nutritional supplementliquid

4

PEDIASURE SIDEKICKS -nutritional supplement liquid

4

PEDIASURE SIDEKICKS -nutritional supplementpowder

4

PEDIASURE SIDEKICKSCLEAR - nutritionalsupplement liquid

4

PEDIASURE SIDEKICKSSHAKE - nutritionalsupplement liquid

4

PEDIASURE WITH FIBER -nutritional supplement liquid

4

PEDIASURE 1.0 CAL/FIBER -nutritional supplement liquid

4

PEDIASURE 1.5 CAL -nutritional supplement liquid

4

PEDIASURE 1.5 CAL WITHFI - nutritional supplementliquid

4

PEDIASURE 1.5 CAL/FIBER -nutritional supplement liquid

4

PEDIATRIC DRINK - nutritionalsupplement liquid

4

PEDIATRIC PEPTINEX DT -nutritional supplement liquid

4

PEDIATRIC PEPTINEX DT/FIB - nutritional supplementliquid

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

PEPDITE JUNIOR - nutritionalsupplement pack

4

PEPTAMEN - nutritionalsupplement liquid

4

PEPTAMEN AF - nutritionalsupplement liquid

4

PEPTAMEN BARIATRIC -nutritional supplement liquid

4

PEPTAMEN INTENSE VHP -nutritional supplement liquid

4

PEPTAMEN JUNIOR -nutritional supplement liquid

4

PEPTAMEN JUNIOR -nutritional supplementpowder

4

PEPTAMEN JUNIOR FIBER -nutritional supplement liquid

4

PEPTAMEN JUNIOR HP -nutritional supplement liquid

4

PEPTAMEN JUNIOR 1 CAL -nutritional supplement liquid

4

PEPTAMEN JUNIOR 1 CAL/PRE - nutritional supplementliquid

4

PEPTAMEN JUNIOR 1.5 CAL -nutritional supplement liquid

4

PEPTAMEN JUNIOR/PREBIO1 - nutritionalsupplement liquid

4

PEPTAMEN OS - nutritionalsupplement liquid

4

PEPTAMEN OS 1.5 - nutritionalsupplement liquid

4

PEPTAMEN VHP - nutritionalsupplement liquid

4

PEPTAMEN 1 CAL - nutritionalsupplement liquid

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

PEPTAMEN 1 CAL/PREBIO1 -nutritional supplement liquid

4

PEPTAMEN 1.5 - nutritionalsupplement liquid

4

PEPTAMEN 1.5 CAL -nutritional supplement liquid

4

PEPTAMEN 1.5 CAL/PREBIO1 - nutritionalsupplement liquid

4

PEPTAMEN/PREBIO1 -nutritional supplement liquid

4

PEPTINEX DT - nutritionalsupplement liquid

4

PEPTINEX DT WITHPREBIOTI - nutritionalsupplement liquid

4

PEPTINEX 1.0 - nutritionalsupplement liquid

4

PEPTINEX 1.5 - nutritionalsupplement liquid

4

PERATIVE - nutritionalsupplement liquid

4

PERATIVE 1.3 CAL - nutritionalsupplement liquid

4

PERIFLEX ADVANCE -nutritional supplementpowder

4

PERIFLEX JUNIOR -nutritional supplementpowder

4

PFD 1 - nutritional supplementpowder

4

PFD 2 - nutritional supplementpowder

4

PHENACTIN AA PLUS -nutritional supplement liquid

4

PHENEX-1 - nutritionalsupplement powder

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

PHENEX-2 - nutritionalsupplement powder

4

PHENYL-FREE 2 - nutritionalsupplement powder

4

PHENYL-FREE 2HP -nutritional supplementpowder

4

PHENYLADE DRINK MIX -nutritional supplementpowder

4

PHENYLADE ESSENTIALDRINK - nutritionalsupplement pack

4

PHENYLADE ESSENTIALDRINK - nutritionalsupplement powder

4

PHENYLADE GMP - nutritionalsupplement pack

4

PHENYLADE GMP - nutritionalsupplement powder

4

PHENYLADE GMP MIX-IN -nutritional supplement pack

4

PHENYLADE RTD PKU 10 -nutritional supplement liquid

4

PHENYLADE60 DRINK MIX -nutritional supplement pack

4

PHENYLADE60 DRINK MIX -nutritional supplementpowder

4

PHLEXY-10 - nutritionalsupplement pack

4

PHYTOFUSION - nutritionalsupplement pack

4

PIVOT 1.5 CAL - nutritionalsupplement liquid

4

PKU COOLER 10 - nutritionalsupplement liquid

4

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


4


4

PKU EASY MICROTABS -nutritional supplement tabsdelayed release

4

PKU EXPRESS - nutritionalsupplement pack

4

PKU EXPRESS20 - nutritionalsupplement pack

4

PKU GEL - nutritionalsupplement pack

4

PKU LOPHLEX LQ 20 -nutritional supplement liquid

4

PKU PERIFLEX EARLYYEARS - nutritionalsupplement powder

4

PKU PERIFLEX JUNIORPLUS - nutritionalsupplement powder

4

PKU SPHERE 15 - nutritionalsupplement pack

4

PKU SPHERE 20 - nutritionalsupplement pack

4

PKU TRIO - nutritionalsupplement powder

4

PKU 2 - nutritional supplementpowder

4

PKU 3 - nutritional supplementpowder

4

POLYCAL - nutritionalsupplement powder

4

PORTAGEN - nutritionalsupplement powder

4

PPA/MMA EXPRESS -nutritional supplement pack

4

Drug Name Dru

g Ti

er

Prio

r Aut

horiz

atio

n

Ste

p Th

erap

y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

PRO-CAL - nutritionalsupplement pack

4

PRO-CAL - nutritionalsupplement powder

4

PRO-PHREE - nutritionalsupplement powder

4

PROBALANCE - nutritionalsupplement liquid

4

PROMACTIN AA PLUS -nutritional supplement liquid

4

PROMOD - nutritionalsupplement liquid

4

PROMOD - nutritionalsupplement powder

4

PROMOTE - nutritionalsupplement liquid

4

PROMOTE WITH FIBER -nutritional supplement liquid

4

PROMOTE 1.0 - nutritionalsupplement liquid

4

PROMOTE 1.0 WITH FIBER -nutritional supplement liquid

4

PROMOTE/FIBER - nutritionalsupplement liquid

4

PRONOURISH - nutritionalsupplement liquid

4

PROPIMEX-1 - nutritionalsupplement powder

4

PROPIMEX-2 - nutritionalsupplement powder

4

PROSOURCE - nutritionalsupplement liquid

4

PROSOURCE - nutritionalsupplement powder

4

PROSOURCE NO CARB -nutritional supplement liquid

4

PROSOURCE PLUS -nutritional supplement liquid

4

2016



Drug Name Dru

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ing

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AC

A

Lim

ited

Dis

tribu

tion

PROSOURCE TF - nutritionalsupplement liquid

4

PROSOURCE ZAC - nutritionalsupplement liquid

4

PROSURE - nutritionalsupplement liquid

4

PROTAIN XL - nutritionalsupplement liquid

4

PROTEIN FORTIFIEDCOOKIE - nutritionalsupplement misc

4

PROVIMIN - nutritionalsupplement powder

4

PULMOCARE - nutritionalsupplement liquid

4

PULMOCARE 1.5 - nutritionalsupplement liquid

4

PX VANILLA PLUS - nutritionalsupplement liquid

4

QUINOA KALE & HEMP -nutritional supplement liquid

4

RA BALANCEDNUTRITIONAL - nutritionalsupplement liquid

4

RA BALANCEDNUTRITIONAL P - nutritionalsupplement liquid

4

RA NUTRITIONALSUPPLEMENT - nutritionalsupplement liquid

4

RA NUTRITIONAL SUPPORT -nutritional supplementpowder

4

RA PEDIATRICNUTRITIONAL - nutritionalsupplement liquid

4

RE/GEN PROTEINFORTIFIED - nutritionalsupplement misc

4

Drug Name Dru

g Ti

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ing

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A

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ited

Dis

tribu

tion

RE/NEPH - nutritionalsupplement liquid

4

RE/NEPH HP/HC - nutritionalsupplement liquid (frozen)

4

RE/NEPH LP/HC - nutritionalsupplement liquid

4

RE/NEPH REDUCEDSUGAR - nutritionalsupplement liquid

4

RENALCAL - nutritionalsupplement liquid

4

RENASTART - nutritionalsupplement powder

4

REPLETE - nutritionalsupplement liquid

4

REPLETE FIBER - nutritionalsupplement liquid

4

REPLETE FIBER 1 CAL -nutritional supplement liquid

4

REPLETE/FIBER/ULTRAPAK -nutritional supplement liquid

4

RESOURCE ARGINAID -nutritional supplement pack

4

RESOURCE DAIRYTHICK HONE - nutritionalsupplement liquid

4

RESOURCE DIABETIC TF -nutritional supplement liquid

4

RESOURCE JUICE DRINK -nutritional supplement liquid(frozen)

4

RESOURCE JUST FORKIDS - nutritional supplementliquid

4

RESOURCE JUST FOR KIDSWI - nutritional supplementliquid

4

2016



Drug Name Dru

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ing

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A

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ited

Dis

tribu

tion

RESOURCE JUST FOR KIDS1. - nutritional supplementliquid

4

RESOURCE SUPPORT -nutritional supplement liquid

4

RESOURCE THICKENUPTHICKE - nutritionalsupplement liquid

4

RESOURCE 2.0 - nutritionalsupplement liquid

4

RESPALOR - nutritionalsupplement liquid

4

RESURGEX - nutritionalsupplement pack

4

RESURGEX PLUS - nutritionalsupplement pack

4

RESURGEX SELECT -nutritional supplement pack

4

S.O.S. 15 - nutritionalsupplement pack

4


4


4

SALMON/OATS/SQUASH -nutritional supplement liquid

4

SB COMPLETE NUTRITION -nutritional supplement liquid

4

SB COMPLETE NUTRITIONPLU - nutritional supplementliquid

4

SCANDICAL - nutritionalsupplement powder

4

SCANDISHAKE - nutritionalsupplement misc

4

SCANDISHAKE - nutritionalsupplement pack

4

Drug Name Dru

g Ti

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ing

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A

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ited

Dis

tribu

tion

SCANDISHAKE - nutritionalsupplement powder

4

SM NUTRI-DRINK - nutritionalsupplement liquid

4

SM NUTRI-DRINK + -nutritional supplement liquid

4

SOL CARB - nutritionalsupplement powder

4

SOURCE COOKIE BAR -nutritional supplement bar

4

SOY PROTEIN SHAKE -nutritional supplementpowder

4

SUBDUE - nutritionalsupplement liquid

4

SUBDUE PLUS - nutritionalsupplement liquid

4

SUPLENA - nutritionalsupplement liquid

4

SUPLENA RTU - nutritionalsupplement liquid

4

SUPLENA WITH CARBSTEADY - nutritionalsupplement liquid

4

SUPLENA 1.8 WITHCARBSTEA - nutritionalsupplement liquid

4

THICK-IT BEEF LASAGNAPUR - nutritional supplementmisc

4

THICK-IT CHICKEN A LA KIN -nutritional supplement misc

4

THICK-IT MAPLE CINNAMONF - nutritional supplementmisc

4

THICK-IT MIXED FRUIT AND -nutritional supplement misc

4

2016



Drug Name Dru

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ing

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its

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A

Lim

ited

Dis

tribu

tion

THICK-IT SEASONEDCHICKEN - nutritionalsupplement misc

4

THICK-IT SWEET CORNPUREE - nutritionalsupplement misc

4

THICK-IT THICKENEDCRANBE - nutritionalsupplement liquid

4

THRIVACIN DETOX -nutritional supplement liquid

4

THRIVACIN 30 - nutritionalsupplement liquid

4

TOLEREX - nutritionalsupplement pack

4

TWOCAL HN - nutritionalsupplement liquid

4

TWOCAL HN 2.0 - nutritionalsupplement liquid

4

TYLACTIN RESTORE 10 -nutritional supplement liquid

4

TYLACTIN RESTORE 5PE -nutritional supplement pack

4

TYLACTIN RTD 15 - nutritionalsupplement liquid

4

TYR ANAMIX EARLY YEARS -nutritional supplementpowder

4

TYR ANAMIX NEXT -nutritional supplementpowder

4

TYR COOLER - nutritionalsupplement liquid

4

TYR COOLER20 - nutritionalsupplement liquid

4

TYR EXPRESS - nutritionalsupplement pack

4

Drug Name Dru

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ing

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its

AC

A

Lim

ited

Dis

tribu

tion

TYR EXPRESS20 - nutritionalsupplement pack

4

TYR GEL - nutritionalsupplement pack

4

TYR LOPHLEX LQ - nutritionalsupplement liquid

4

TYREX-1 - nutritionalsupplement powder

4

TYREX-2 - nutritionalsupplement powder

4

TYROS 1 - nutritionalsupplement powder

4

TYROS 2 - nutritionalsupplement powder

4

UCD ANAMIX JUNIOR -nutritional supplementpowder

4

UCD TRIO - nutritionalsupplement powder

4

UCD 2 - nutritional supplementpowder

4

ULTRACAL - nutritionalsupplement liquid

4

ULTRACAL HN PLUS -nutritional supplement liquid

4

ULTRAMINO SOY PROTEIN -nutritional supplementpowder

4

UTYMAX - nutritionalsupplement pack

4

VHC 2.25 - nutritionalsupplement liquid

4

VILACTIN AA PLUS -nutritional supplement liquid

4

VITAJOULE - nutritionalsupplement powder

4

VITAL AF 1.2 CAL - nutritionalsupplement liquid

4

2016



Drug Name Dru

g Ti

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A

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ited

Dis

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tion

VITAL AF 1.2 CALADVANCED - nutritionalsupplement liquid

4

VITAL HIGH PROTEIN -nutritional supplement liquid

4

VITAL HN - nutritionalsupplement pack

4

VITAL HP 1.0 CAL - nutritionalsupplement liquid

4

VITAL JR - nutritionalsupplement liquid

4

VITAL PEPTIDE 1.5 CAL -nutritional supplement liquid

4

VITAL 1.0 CAL - nutritionalsupplement liquid

4

VITAL 1.5 CAL - nutritionalsupplement liquid

4

VITAPRO - nutritionalsupplement powder

4

VITAQUICK - nutritionalsupplement powder

4

VIVONEX PEDIATRIC -nutritional supplement pack

4

VIVONEX PLUS - nutritionalsupplement powder

4

VIVONEX RTF - nutritionalsupplement liquid

4

VIVONEX T.E.N. - nutritionalsupplement pack

4

WELLNESS ESSENTIALS -nutritional supplement kit

4

WELLNESS ESSENTIALS AI -nutritional supplement kit

4

WELLNESS ESSENTIALSBLOOD - nutritionalsupplement kit

4

Drug Name Dru

g Ti

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A

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ited

Dis

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tion

WELLNESS ESSENTIALSFOR J - nutritionalsupplement kit

4

WELLNESS ESSENTIALSFOR M - nutritionalsupplement kit

4

WELLNESS ESSENTIALSFOR P - nutritionalsupplement kit

4

WELLNESS ESSENTIALSFOR W - nutritionalsupplement kit

4

WND 1 - nutritional supplementpowder

4

WND 2 - nutritional supplementpowder

4

XAQUIL XR - levomefolateglucosamine tab er 30 mg

4

XLEU MAXAMAID - nutritionalsupplement powder

4

XLEU MAXAMUM - nutritionalsupplement powder

4

XLYS-XTRP MAXAMAID -nutritional supplementpowder

4

XLYS-XTRP MAXAMUM -nutritional supplementpowder

4

XMET MAXAMAID - nutritionalsupplement powder

4

XMET MAXAMUM - nutritionalsupplement powder

4

XMTVI MAXAMAID - nutritionalsupplement powder

4

XMTVI MAXAMUM - nutritionalsupplement powder

4

XPHE MAXAMAID - nutritionalsupplement powder

4

2016



Drug Name Dru

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A

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ited

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tribu

tion

XPHE-XTYR MAXAMAID -nutritional supplementpowder

4

XTRACAL PLUS - nutritionalsupplement liquid

4

XYZBAC - dietary managementproduct - tabs

2

ZYTAZE - zinc citrate-phytasecap 25-500 mg

4

HEMATOLOGICAL AGENTSHEMATOPOIETIC AGENTSABANEU-SL -

cyanocobalamin-methylcobalamin tab sl600-600 mcg

4

ACTIVE FE - fe carbonyl-fa-b complex-a-c-d-e-min tab75-1.25 mg

4

ANIMI-3 - folic acid-b6-b12-d-omega 3-phytosterols cap 1mg

4

ANIMI-3/VITAMIN D - folicacid-b6-b12-d-omega 3-phytosterols cap 1 mg

4

ARANESP ALBUMIN FREE -darbepoetin alfa soln inj 25mcg/ml

5 • •


5 • •


5 • •


5 • •


5 • •

Drug Name Dru

g Ti

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A

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ited

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tribu

tion


5 • •

ARANESP ALBUMINFREE - darbepoetin alfasoln prefilled syringe 10mcg/0.4ml

5 • •


5 • •


5 • •


5 • •

ARANESP ALBUMIN FREE -darbepoetin alfa solnprefilled syringe 100mcg/0.5ml

5 • •


5 • •


5 • •


5 • •

ARANESP ALBUMIN FREE -darbepoetin alfa solnprefilled syringe 500 mcg/ml

5 • •

B-6 FOLIC ACID - cobalaminecombination cap

4

2016



Drug Name Dru

g Ti

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ing

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its

AC

A

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ited

Dis

tribu

tion

BIFERARX - polysacch fecmplx-fe heme poly-fa-b12tab 22-6-1-0.025 mg

4

BP VIT 3 - folic acid-vit b6-vitb12-omega 3-phytosterolscap 1 mg

4

carbonyl iron susp15 mg/1.25ml (elementaliron)

A •

CENTRATEX - ferrousfumarate-fa-b complex-c-zn-mg-mn-cu cap 106-1 mg

4

CERDELGA - eliglustat tartratecap 84 mg (base equivalent)

5 • • •

CIFEREX - folic acid-cholecalciferol cap 1mg-3775 unit

4

CORVITE FE - ironcombination tab

4

CORVITE 150 - ironcombination tab

4

cyanocobalamin inj1000 mcg/ml

1

DERMACINRX PUREFOLIX -folic acid-cholecalciferol tab1 mg-5000 unit

4

DIVISTA - folic acid-vit b6-vitb12-omega 3-biotin-cr cap 1mg

4

DROXIA - hydroxyurea cap200 mg

4


4


4

DURACHOL - folic acid-cholecalciferol cap 1mg-3775 unit

4

Drug Name Dru

g Ti

er

Prio

r Aut

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n

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ing

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its

AC

A

Lim

ited

Dis

tribu

tion

EPOGEN - epoetin alfa inj2000 unit/ml

5 • •


5 • •


5 • •


5 • •


5 • •

fe fum-iron polysacchcomplex-fa-b cmplx-c-zn-mn-cu cap (Tandem plus)

1

fe fumarate w/ b12-vit c-fa-ifc cap110-0.015-75-0.5-240 mg

1

fe fumarate-vit c-vitb12-fa cap 460 (151fe)-60-0.01-1 mg

2

FER-IN-SOL - ferrous sulfatesoln 75 mg/ml (15 mg/mlelemental fe)

A •

FERIVA - fe bisglycin-fecarbonyl-c-fa-b12-biotin-dsscap 75-1 mg

4

FERIVA 21/7 - fe asparto gly-b12-fa-c-dss-succinic acid-zn tab 75-1 mg

4

FERIVAFA - iron-c-fa-b12-biotin-copper-docusate cap110-1 mg

4

FERRALET 90 - fe carbonyl-fegluconate-fa-vit b12-vit c-dsstab 90-1 mg

4

FERRAPLUS 90 - iron-folicacid-vit b12-vit c-docusatesod tab 90-1 mg

4

2016



Drug Name Dru

g Ti

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ing

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its

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A

Lim

ited

Dis

tribu

tion

FERRETTS CHEWABLEIRON - carbonyl iron chewtab 18 mg (elemental iron)

A •

FERRO-PLEX HEMATINIC - fefum-dss-vit c-vit e-vit b12-if-fa tab 115-1 mg

4

FERROTRIN - iron w/b12-vit c-fa-ifc cap36-0.015-75-0.5-240 mg

4

ferrous fumarate-fa-bcomplex-c-zn-mg-mn-cutab 106-1 mg

1

ferrous fumarate-folic acidtab 324-1 mg

1

FERROUS SULFATE - ferroussulfate liquid 220 mg/5ml (44mg/5ml elemental fe)

A •

FERROUS SULFATE - ferroussulfate syrup 300 mg/5ml(60 mg/5ml elemental fe)

A •

ferrous sulfate elixir220 mg/5ml (44 mg/5mlelemental fe)

A •

ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe)

A •

FOCALGIN DSS - fe carbonyl-fe gluconate-fa-vit b12-vit c-dss tab 90-1 mg

4

folic acid cap 0.8 mg A •folic acid tab 400 mcg A •folic acid tab 800 mcg A •folic acid tab 1 mg 1

folic acid-vitamin b6-vitaminb12 tab 2.2-25-0.5 mg

1

folic acid-vitamin b6-vitaminb12 tab 2.2-25-1 mg(Folgard rx)

1

Drug Name Dru

g Ti

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A

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ited

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tribu

tion

folic acid-vitamin b6-vitaminb12 tab 2.5-25-1 mg

1

FOLIVANE-F - fe fum-fe poly-fa-c-b3 cap62.5-62.5-1-40-3mg(125 mgfe)

4

FOLIVANE-PLUS - fe fum-iron polysacch complex-fa-bcomplex-c-biotin cap

4

FOLIXAPURE - folic acid-cholecalciferol tab 1mg-5000 unit

4

FUSION PLUS - fe fum-ironpoly cmplx-fa-b cmplx-c-biotin-probiotic cap

4

FUSION SPRINKLES - fe fum-fe polys cmplx-fa-c-probioticpack 7-0.25-50-5 mg

4

GRANIX - tbo-filgrastimsoln prefilled syringe 300mcg/0.5ml

5 •

GRANIX - tbo-filgrastimsoln prefilled syringe 480mcg/0.8ml

5 •

HEMATOGEN FA - fefumarate-vit c-vit b12-fa cap200-250-0.01-1 mg

4

HEMETAB - polysacch fecmplx-fe heme poly-fa-b12tab 22-6-1-0.025 mg

4

HEMOCYTE PLUS - ferrousfumarate-fa-b complex-c-zn-mg-mn-cu cap 106-1 mg

4

ICAR PEDIATRIC - carbonyliron susp 15 mg/1.25ml(elemental iron)

A •

INTEGRA F - fe fum-fe poly-fa-c-b3 cap62.5-62.5-1-40-3mg(125 mgfe)

4

2016



Drug Name Dru

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A

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ited

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tribu

tion

INTEGRA PLUS - fe fum-ironpolysacch complex-fa-bcomplex-c-biotin cap

4

IRON CHEWS PEDIATRIC -carbonyl iron chew tab 15mg (elemental iron)

A •

iron combination cap 1

iron polysacch complex-vitb12-fa cap 150-0.025-1 mg

1

iron-docusate-b12-folic acid-c-e-cu-biotin tab 150-1 mg(Hematron-af)

1

iron-folic acid-vit c-vit b6-vitb12-zinc tab 150-1.25 mg(Corvite 150)

2

IROSPAN 24/6 - fe bisglyc-fepolys-succ acd-b cmplx-c-ca-fa tab ther pk

4

IS 24/6 - fe bisglyc-fe polys-succ acd-b cmplx-c-ca-fa tabther pk

4

LEUKINE - sargramostimlyophilized for inj 250 mcg

5 • •

MAXFE - iron-fa-vit b12-biotin-vit c-docusate-mg-zn tab160-1 mg

4

MIRCERA - methoxy peg-epoetin beta soln prefilledsyr 30 mcg/0.3ml

4 •


4 •


4 •


4 •

Drug Name Dru

g Ti

er

Prio

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n

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A

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ited

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tribu

tion


4 •


4 •

MULTIGEN - fe asparto gly-succ acd-c-threonic acd-b12-des stom tab

4

MULTIGEN FOLIC - fe aspartogly-succinic acd-vit c-threonic acd-b12-fa tab

4

MULTIGEN PLUS - fe aspartgly-fe fum-succ acd-c-threonic acd-b12-fa tab

4

NASCOBAL - cyanocobalaminnasal spray 500 mcg/0.1ml

4

NEPHRON FA - ferrousfumarate w/ fa-dss-bcomplex-vit c tab

4

NEULASTA - pegfilgrastim solnprefilled syringe 6 mg/0.6ml

5 • •

NEULASTA ONPRO KIT -pegfilgrastim soln prefilledsyringe kit 6 mg/0.6ml

5 • •

NEUPOGEN - filgrastim inj 300mcg/ml

5 • •

NEUPOGEN - filgrastim inj 480mcg/1.6ml (300 mcg/ml)

5 • •

NEUPOGEN - filgrastimsoln prefilled syringe 300mcg/0.5ml

5 • •

NEUPOGEN - filgrastimsoln prefilled syringe 480mcg/0.8ml (600 mcg/ml)

5 • •

NEURIN-SL - cyanocobalamin-methylcobalamin tab sl600-600 mcg

4

2016



Drug Name Dru

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its

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A

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ited

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tribu

tion

NOXIFOL-D - folic acid-cholecalciferol tab 1mg-2500 unit

4

NUFERA - iron combination tab 4

ORTHO D - folic acid-cholecalciferol cap 1mg-3775 unit

4

PRE-FOLIC - folic acid-vitaminc tab 1-100 mg

4

PROCRIT - epoetin alfa inj2000 unit/ml

5 • •


5 • •


5 • •


5 • •


5 • •


5 • •

PROFERRIN-FORTE - ironheme polypeptide-folic acidtab 12-1 mg (fe equiv)

4

PROMACTA - eltrombopagolamine tab 12.5 mg (baseequiv)

5 • • •

PROMACTA - eltrombopagolamine tab 25 mg (baseequiv)

5 • • •


5 • • •


5 • • •

PROTECTIRON - ironpolysacch-fa-b complex-vitc-e & minerals tab 60-1 mg

4

Drug Name Dru

g Ti

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Prio

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n

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ing

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its

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A

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ited

Dis

tribu

tion

PUREFE PLUS - ferrousfumarate-fa-b complex-c-zn-mg-mn-cu cap 106-1 mg

4

REVESTA - folic acid-cholecalciferol cap 1mg-5750 unit

4

SPATONE PUR-ABSORBIRON - ferrous sulfate liquid5 mg/20ml (elemental iron)

4

TANDEM F - ferrous fum-iron polysacch-fa cap162-115.2-1 mg (106 mg fe)

4

TARON FORTE - febisglycinate-fe polysacch-vitc-vit b12-fa cap

4

ZARXIO - filgrastim-sndzsoln prefilled syringe 300mcg/0.5ml

5 •

ZARXIO - filgrastim-sndzsoln prefilled syringe 480mcg/0.8ml

5 •

ZAVARA - folic acid-cholecalciferol cap 1mg-5750 unit

4

ZAVESCA - miglustat cap 100mg

5 • •

ZOLATE - folic acid-cholecalciferol cap 1mg-3775 unit

4

ANTICOAGULANTSCOUMADIN - warfarin sodium

tab 1 mg4

COUMADIN - warfarin sodiumtab 2 mg

4

COUMADIN - warfarin sodiumtab 2.5 mg

4


4

2016



Drug Name Dru

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ited

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tribu

tion


4


4


4

COUMADIN - warfarin sodiumtab 7.5 mg

4


4

ELIQUIS - apixaban tab 2.5 mg 3 •ELIQUIS - apixaban tab 5 mg 3 •enoxaparin sodium inj

30 mg/0.3ml (Lovenox)2 •

enoxaparin sodium inj40 mg/0.4ml (Lovenox)

2 •


2 •


2 •

enoxaparin sodium inj100 mg/ml (Lovenox)

2 •


2 •

enoxaparin sodium inj150 mg/ml (Lovenox)

2 •

enoxaparin sodium inj300 mg/3ml (Lovenox)

2 •

fondaparinux sodiumsubcutaneous inj2.5 mg/0.5ml (Arixtra)

2 •

fondaparinux sodiumsubcutaneous inj5 mg/0.4ml (Arixtra)

2 •

fondaparinux sodiumsubcutaneous inj7.5 mg/0.6ml (Arixtra)

2 •

Drug Name Dru

g Ti

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its

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A

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ited

Dis

tribu

tion

fondaparinux sodiumsubcutaneous inj10 mg/0.8ml (Arixtra)

2 •

FRAGMIN - dalteparin sodiuminj 10000 unit/ml

4 •

FRAGMIN - dalteparin sodiuminj 2500 unit/0.2ml

4 •


4 •


4 •


4 •


4 •


4 •


4 •

heparin sodium (porcine) inj1000 unit/ml

2


2


2


2

heparin sodium (porcine) pfinj 5000 unit/0.5ml

2

PRADAXA - dabigatranetexilate mesylate cap 75mg (etexilate base eq)

4 •


4 •


4 •

2016



Drug Name Dru

g Ti

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its

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A

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ited

Dis

tribu

tion

SAVAYSA - edoxaban tosylatetab 15 mg (base equivalent)

4 •


4 •


4 •

warfarin sodium tab 1 mg(Coumadin)

1


1

warfarin sodium tab 2.5 mg(Coumadin)

1


1


1


1


1

warfarin sodium tab 7.5 mg(Coumadin)

1


1

XARELTO - rivaroxaban tab 10mg

3 •


3 •


3 •

XARELTO STARTER PACK -rivaroxaban tab startertherapy pack 15 mg & 20 mg

3 •

HEMOSTATICSAMICAR - aminocaproic acid

oral soln 0.25 gm/ml4

AMICAR - aminocaproic acidtab 500 mg

4

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AMICAR - aminocaproic acidtab 1000 mg

4

tranexamic acid tab 650 mg(Lysteda)

2

HEMATOLOGICAL AGENTS - MISC.ADVATE - antihemophilic factor

rahf-pfm for inj 250 unit5 • •

ADVATE - antihemophilic factorrahf-pfm for inj 500 unit

5 • •


5 • •


5 • •


5 • •


5 • •


5 • •

ADYNOVATE - antihemophilicfactor recomb pegylated forinj 250 unit

5 •


5 •


5 • •


5 •


5 • •


5 •

2016



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ited

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tion


5 • •

AGGRENOX - aspirin-dipyridamole cap er 12hr25-200 mg

4

ALPHANATE/VONWILLEBRAND -antihemophilic factor/vwf(human) for inj 250 unit

5 • •


5 • •


5 • •


5 • •


5 • •

ALPHANINE SD - coagulationfactor ix for inj 500 unit

5 • •


5 • •


5 • •

ALPROLIX - coagulation factorix (recomb) (rfixfc) for inj 250unit

5 • •

ALPROLIX - coagulation factorix (recomb) (rfixfc) for inj 500unit

5 • •

Drug Name Dru

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ALPROLIX - coagulation factorix (recomb) (rfixfc) for inj1000 unit

5 • •


5 • •


5 • •


5 • •

anagrelide hcl cap 0.5 mg(Agrylin)

2

anagrelide hcl cap 1 mg 2

aspirin-dipyridamole cap er12hr 25-200 mg (Aggrenox)

2

BEBULIN - factor ix complexfor inj 200-1200 unit

5 • •

BENEFIX - coagulation factorix (recombinant) for inj kit250 unit

5 • •


5 • •


5 • •


5 • •


5 • •

BERINERT - c1 esteraseinhibitor (human) for iv inj kit500 unit

5 • •

BRILINTA - ticagrelor tab 60mg

3

2016



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BRILINTA - ticagrelor tab 90mg

3

cilostazol tab 50 mg (Pletal) 1

cilostazol tab 100 mg (Pletal) 1

clopidogrel bisulfate tab75 mg (base equiv) (Plavix)

1

clopidogrel bisulfate tab300 mg (base equiv)(Plavix)

2

COAGADEX - coagulationfactor x (human) for inj 250unit

5 • •

COAGADEX - coagulationfactor x (human) for inj 500unit

5 • •

CORIFACT - factor xiiiconcentrate (human) for injkit 1000-1600 unit

5 • •

dipyridamole tab 25 mg(Persantine)

1


2


2

EFFIENT - prasugrel hcl tab 5mg (base equiv)

4

EFFIENT - prasugrel hcl tab 10mg (base equiv)

4

ELOCTATE - antihemophilicfactor (recomb) rfviiifc for inj250 unit

5 • •


5 • •


5 • •

Drug Name Dru

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ing

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A

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ited

Dis

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tion


5 • •


5 • •


5 • •


5 • •


5 • •


5 • •


5 • •

FEIBA - antiinhibitor coagulantcomplex for inj

5 • •

FIRAZYR - icatibant acetate inj30 mg/3ml (base equivalent)

5 • • •

HELIXATE FS - antihemophilicfactor (recombinant) for injkit 250 unit

5 • •


5 • •


5 • •


5 • •

2016



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tion


5 • •

HEMOFIL M - antihemophilicfactor (human) for inj 250unit

5 • •


5 • •


5 • •


5 • •

HUMATE-P - antihemophilicfactor/vwf (human) for inj250-600 unit

5 • •


5 • •


5 • •

IDELVION - coagulation factorix (recomb) (rix-fp) for inj 250unit

5 • •

IDELVION - coagulation factorix (recomb) (rix-fp) for inj 500unit

5 • •

IDELVION - coagulation factorix (recomb) (rix-fp) for inj1000 unit

5 • •

IDELVION - coagulation factorix (recomb) (rix-fp) for inj2000 unit

5 • •

IXINITY - coagulation factor ix(recombinant) for inj 250 unit

5 • •

Drug Name Dru

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ited

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tion

IXINITY - coagulation factor ix(recombinant) for inj 500 unit

5 • •

IXINITY - coagulation factor ix(recombinant) for inj 1000unit

5 • •


5 • •


5 • •


5 • •

KCENTRA - prothrombincomplex conc human for injkit 500 unit

4

KCENTRA - prothrombincomplex conc human for injkit 1000 unit

4

KOATE - antihemophilic factor(human) for inj 250 unit

5 • •


5 • •


5 • •

KOATE-DVI - antihemophilicfactor (human) for inj 250unit

5 • •


5 • •


5 • •

KOGENATE FS -antihemophilic factor(recombinant) for inj kit 250unit

5 • •

2016



Drug Name Dru

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tion


5 • •


5 • •


5 • •


5 • •

KOGENATE FS BIO-SET -antihemophilic factor(recombinant) for inj kit 250unit

5 • •


5 • •


5 • •


5 • •


5 • •

KOVALTRY - antihemophilicfactor (recombinant) for inj250 unit

5 • •

Drug Name Dru

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A

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ited

Dis

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tion


5 • •


5 • •


5 • •


5 • •

MONOCLATE-P -antihemophilic factor(human) for inj kit 1000 unit

5 • •

MONOCLATE-P -antihemophilic factor(human) for inj kit 1500 unit

5 • •

MONONINE - coagulationfactor ix for inj 1000 unit

5 • •

NOVOEIGHT - antihemophilicfactor (recombinant) for inj250 unit

5 • •


5 • •


5 • •


5 • •


5 • •


5 • •

2016



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ited

Dis

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tion

NOVOSEVEN RT - coagulationfactor viia (recomb) for inj 1mg (1000 mcg)

5 • •


5 • •


5 • •


5 • •

NUWIQ - antihemophilic factor(bdd-rfviii) for inj kit 250 unit

5 • •


5 • •


5 • •


5 • •


5 • •


5 • •


5 • •

NUWIQ - antihemophilic factor(bdd-rfviii) for inj 250 unit

5 • •


5 • •


5 • •


5 • •


5 • •


5 • •

Drug Name Dru

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ited

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tion


5 • •

OBIZUR - antihemophilic factor(recomb porc) rpfviii for inj500 unit

5 • •

pentoxifylline tab er 400 mg 1

prasugrel hcl tab 5 mg (baseequiv) (Effient)

2

prasugrel hcl tab 10 mg(base equiv) (Effient)

2

PROFILNINE - factor ixcomplex for inj 500 unit

5 • •


5 • •


5 • •

PROFILNINE SD - factor ixcomplex for inj 500 unit

5 • •


5 • •


5 • •

RECOMBINATE -antihemophilic factor(recombinant) for inj 220-400unit

5 • •

RECOMBINATE -antihemophilic factor(recombinant) for inj 401-800unit

5 • •

RECOMBINATE -antihemophilic factor(recombinant) for inj801-1240 unit

5 • •


5 • •

2016



Drug Name Dru

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tion


5 • •

RIASTAP - fibrinogen conc(human) inj approximately 1gm (900-1300 mg)

4 •

RIXUBIS - coagulation factor ix(recombinant) for inj 250 unit

5 • •

RIXUBIS - coagulation factor ix(recombinant) for inj 500 unit

5 • •

RIXUBIS - coagulation factorix (recombinant) for inj 1000unit

5 • •


5 • •


5 • •

RUCONEST - c1 esteraseinhibitor (recombinant) for ivinj 2100 unit

5 •

TRETTEN - coagulationfactor xiii a-subunit for inj2000-3125 unit

5 • •

WILATE - antihemophilic factor/vwf (human) for inj 500-500unit kit

5 • •

WILATE - antihemophilicfactor/vwf (human) for inj1000-1000 unit kit

5 • •

XYNTHA - antihemophilicfactor recombinant paf for injkit 250 unit

5 • •


5 • •

Drug Name Dru

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tion


5 • •


5 • •

XYNTHA SOLOFUSE -antihemophilic factorrecombinant paf for inj kit250 unit

5 • •


5 • •


5 • •


5 • •


5 • •

ZONTIVITY - vorapaxarsulfate tab 2.08 mg (baseequivalent)

4

TOPICAL PRODUCTSOPHTHALMIC AGENTSACUVAIL - ketorolac

tromethamine (pf) ophth soln0.45%

4

AKTEN - lidocaine hcl ophthgel 3.5%

4

ALOCRIL - nedocromil sodiumophth soln 2%

4

2016



Drug Name Dru

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ited

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tion

ALOMIDE - lodoxamidetromethamine ophth soln0.1%

4

ALPHAGAN P - brimonidinetartrate ophth soln 0.1%

4

ALREX - loteprednol etabonateophth susp 0.2%

4

apraclonidine hcl ophth soln0.5% (base equivalent)(Iopidine)

2

ATROPINE SULFATE -atropine sulfate ophth oint1%

4

ATROPINE SULFATE -atropine sulfate ophth soln1%

1

AZASITE - azithromycin ophthsoln 1%

4

azelastine hcl ophth soln0.05%

2

AZOPT - brinzolamide ophthsusp 1%

4

BACITRACIN - bacitracin ophthoint 500 unit/gm

3

bacitracin-polymyxin bophth oint

1

bacitracin-polymyxin-neomycin-hc ophth oint1%

2

BEPREVE - bepotastinebesilate ophth soln 1.5%

4

BESIVANCE - besifloxacinhcl ophth susp 0.6% (baseequiv)

4

BETADINE OPHTHALMICPREP - povidone-iodineophth soln 5%

4

betaxolol hcl ophth soln0.5%

2

Drug Name Dru

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tion

BETIMOL - timolol ophth soln0.25%

4

BETIMOL - timolol ophth soln0.5%

4

BETOPTIC-S - betaxolol hclophth susp 0.25%

4

BIMATOPROST - bimatoprostophth soln 0.03%

4 • •

BLEPHAMIDE - sulfacetamidesodium-prednisolone ophthsusp 10-0.2%

4

BLEPHAMIDE S.O.P. -sulfacetamide sodium-prednisolone ophth oint10-0.2%

4

brimonidine tartrate ophthsoln 0.15% (Alphagan p)

2

brimonidine tartrate ophthsoln 0.2%

1

BROMFENAC - bromfenacsodium ophth soln 0.09%(base equiv) (once-daily)

2

carteolol hcl ophth soln 1% 1

CILOXAN - ciprofloxacin hclophth oint 0.3%

4

ciprofloxacin hcl ophth soln0.3% (Ciloxan)

1

COMBIGAN - brimonidinetartrate-timolol maleateophth soln 0.2-0.5%

4

COSOPT PF - dorzolamide hcl-timolol maleate ophth sol22.3-6.8 mg/ml pf

4

cromolyn sodium ophth soln4%

1

CYCLOGYL - cyclopentolatehcl ophth soln 0.5%

4

2016



Drug Name Dru

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A

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ited

Dis

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tion

CYCLOMYDRIL -cyclopentolate w/phenylephrine ophth soln0.2-1%

4

cyclopentolate hcl ophthsoln 0.5% (Cyclogyl)

2

cyclopentolate hcl ophthsoln 1% (Cyclogyl)

1

cyclopentolate hcl ophthsoln 2% (Cyclogyl)

2

CYSTARAN - cysteamine hclophth soln 0.44% (baseequivalent)

5 • •

DEXAMETHASONE SODIUMPHOS - dexamethasonesodium phosphate ophthsoln 0.1%

1

diclofenac sodium ophthsoln 0.1%

1

dorzolamide hcl ophth soln2% (Trusopt)

2

dorzolamide hcl-timololmaleate ophth soln22.3-6.8 mg/ml (Cosopt)

1

DUREZOL - difluprednateophth emulsion 0.05%

4

EMADINE - emedastinedifumarate ophth soln 0.05%(base equiv)

4

epinastine hcl ophth soln0.05% (Elestat)

2

erythromycin ophth oint5 mg/gm

1

FLAREX - fluorometholoneacetate ophth susp 0.1%

4

fluorometholone ophth susp0.1% (Fml liquifilm)

2

Drug Name Dru

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ited

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tion

FLURBIPROFEN SODIUM -flurbiprofen sodium ophthsoln 0.03%

1

FML - fluorometholone ophthoint 0.1%

4

FML FORTE - fluorometholoneophth susp 0.25%

4

gatifloxacin ophth soln 0.5%(Zymaxid)

2

GELFILM OP - gelatinadsorbable ophth film

4

GENTAK - gentamicin sulfateophth oint 0.3%

1

gentamicin sulfate ophthsoln 0.3% (Garamycin)

1

homatropine hbr ophth soln5% (Isopto homatropine)

1

ILEVRO - nepafenac ophthsusp 0.3%

4

IOPIDINE - apraclonidinehcl ophth soln 1% (baseequivalent)

4

ISTALOL - timolol maleateophth soln 0.5% (once-daily)

4

ketorolac tromethamineophth soln 0.4% (Acular ls)

2

ketorolac tromethamineophth soln 0.5% (Acular)

1

LACRISERT - artificial tearophth insert

4

LASTACAFT - alcaftadineophth soln 0.25%

4

latanoprost ophth soln0.005% (Xalatan)

1 •

levobunolol hcl ophth soln0.5% (Betagan)

1

levofloxacin ophth soln 0.5% 2

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion

LOTEMAX - loteprednoletabonate ophth gel 0.5%

4

LOTEMAX - loteprednoletabonate ophth oint 0.5%

4

LOTEMAX - loteprednoletabonate ophth susp 0.5%

4

LUMIGAN - bimatoprost ophthsoln 0.01%

4 • •

MAXIDEX - dexamethasoneophth susp 0.1%

4

METIPRANOLOL -metipranolol ophth soln0.3%

4

MITOSOL - mitomycin forophth soln kit 0.2 mg

4

MOXEZA - moxifloxacin hclophth soln 0.5% (base eq) (2times daily)

4

moxifloxacin hcl ophthsoln 0.5% (base equiv)(Vigamox)

2

NATACYN - natamycin ophthsusp 5%

3

neomycin-bacitraczn-polymyx5(3.5)mg-400unt-10000untop oin

2

neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml (Neosporin)

2

neomycin-polymyxin-dexamethasone ophth oint0.1% (Maxitrol)

1

neomycin-polymyxin-dexamethasone ophthsusp 0.1% (Maxitrol)

1

Drug Name Dru

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A

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ited

Dis

tribu

tion

NEOMYCIN/POLYMYXIN/HYDROC - neomycin-polymyxin-hc ophth susp

4

NEVANAC - nepafenac ophthsusp 0.1%

4

ofloxacin ophth soln 0.3%(Ocuflox)

1

olopatadine hcl ophth soln0.1% (base equivalent)(Patanol)

2

olopatadine hcl ophth soln0.2% (base equivalent)(Pataday)

2

PATADAY - olopatadine hclophth soln 0.2% (baseequivalent)

4

PATANOL - olopatadine hclophth soln 0.1% (baseequivalent)

4

PAZEO - olopatadine hcl ophthsoln 0.7% (base equivalent)

4

phenylephrine hcl ophthsoln 2.5%

2

phenylephrine hcl ophthsoln 10%

2

PHOSPHOLINE IODIDE -echothiophate iodide ophthfor soln 0.125%

4

pilocarpine hcl ophth soln1% (Isopto carpine)

2


2


2

polymyxin b-trimethoprimophth soln 10000 unit/ml-0.1% (Polytrim)

1

PRED MILD - prednisoloneacetate ophth susp 0.12%

4

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion

PRED-G - gentamicin-prednisolone ace ophth susp0.3-1%

4

PRED-G S.O.P. - gentamicin-prednisolone ace ophth oint0.3-0.6%

4

prednisolone acetate ophthsusp 1% (Pred forte)

2

PREDNISOLONE SODIUMPHOSP - prednisolonesodium phosphate ophthsoln 1%

4

PREDNISOLONE/MOXIFLOXACIN -prednisolone-moxifloxacinopth soln 1-0.5%

4

PREDNISOLONE/MOXIFLOXACIN -prednisolone-moxifloxacin-bromfenac opth sol1-0.5-0.09%

4

PREDNISOLONE/MOXIFLOXACIN -prednisolone-moxifloxacin-ketorolac opth sol1-0.5-0.5%

4

PROLENSA - bromfenacsodium ophth soln 0.07%(base equivalent)

4

proparacaine hcl ophth soln0.5% (Alcaine)

1

RESCULA - unoprostoneisopropyl ophth soln 0.15%

4 • •

RESTASIS - cyclosporine(ophth) emulsion 0.05%

4 •

RESTASIS MULTIDOSE -cyclosporine (ophth)emulsion 0.05%

4 •

Drug Name Dru

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A

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ited

Dis

tribu

tion

SIMBRINZA - brinzolamide-brimonidine tartrate ophthsusp 1-0.2%

4

SULFACETAMIDE SODIUM -sulfacetamide sodium ophthoint 10%

4

sulfacetamide sodium ophthsoln 10% (Bleph-10)

2

sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%

1

tetracaine hcl ophth soln0.5%

1

timolol maleate ophth gelforming soln 0.25%(Timoptic-xe)

2

timolol maleate ophth gelforming soln 0.5%(Timoptic-xe)

2

timolol maleate ophth soln0.25% (Timoptic)

1

timolol maleate ophth soln0.5% (Timoptic)

1

TIMOPTIC OCUDOSE - timololmaleate preservative freeophth soln 0.25%

4

TIMOPTIC OCUDOSE - timololmaleate preservative freeophth soln 0.5%

4

TOBRADEX - tobramycin-dexamethasone ophth oint0.3-0.1%

4

TOBRADEX ST - tobramycin-dexamethasone ophth susp0.3-0.05%

4

tobramycin ophth soln 0.3%(Tobrex)

1

2016



Drug Name Dru

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A

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ited

Dis

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tion

tobramycin-dexamethasoneophth susp 0.3-0.1%(Tobradex)

2

TOBREX - tobramycin ophthoint 0.3%

4

TRAVATAN Z - travoprostophth soln 0.004%(benzalkonium free) (bakfree)

4 • •

trifluridine ophth soln 1%(Viroptic)

2

tropicamide ophth soln 0.5% 1

tropicamide ophth soln 1%(Mydriacyl)

1

VIGAMOX - moxifloxacin hclophth soln 0.5% (baseequiv)

4

XIIDRA - lifitegrast ophth soln5%

4 • •

ZIOPTAN - tafluprost ophthsoln 0.0015%

4 • •

ZIRGAN - ganciclovir ophth gel0.15%

4

ZYLET - loteprednol etabonate-tobramycin ophth susp0.5-0.3%

4

OTIC AGENTSacetic acid otic soln 2% 2

CETRAXAL - ciprofloxacinhcl otic soln 0.2% (baseequivalent)

4

CIPRO HC - ciprofloxacin-hydrocortisone otic susp0.2-1%

4

CIPRODEX - ciprofloxacin-dexamethasone otic susp0.3-0.1%

4

Drug Name Dru

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Lim

its

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A

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ited

Dis

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tion

CIPROFLOXACIN -ciprofloxacin hcl otic soln0.2% (base equivalent)

4

COLY-MYCIN S - neomycin-colistin-hc-thonzonium oticsusp 3.3-3-10-0.5 mg/ml

4

fluocinolone acetonide (otic)oil 0.01% (Dermotic)

2

hydrocortisone w/ aceticacid otic soln 1-2%

2

neomycin-polymyxin-hc oticsoln 1% (Cortisporin)

2

neomycin-polymyxin-hc oticsusp 3.5 mg/ml-10000 unit/ml-1%

2

ofloxacin otic soln 0.3% 2

OTOVEL - ciprofloxacin-fluocinolone aceton (pf) oticsoln 0.3-0.025%

4

MOUTH/THROAT/DENTAL AGENTSACT TOTAL CARE DRY

MOUTH - sodium fluoriderinse 0.02%

A •

benzocaine mouth/throataerosol 20%

1

BOCASAL - artificial saliva -packet

4

CAPHOSOL - artificial saliva -solution

4

cevimeline hcl cap 30 mg(Evoxac)

2

chlorhexidine gluconatesoln 0.12% (Peridex)

1

clotrimazole troche 10 mg 2

COLGATE DRY MOUTHRELIEF - sodium fluoridemouthwash 2.1 mg/10ml

A •

2016



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CREST COMPLETE - sodiumfluoride paste 0.243%

A •

DEBACTEROL - sulfuric acid-sulfonated phenolics soln30-50%

4

EQL DENTAL TRAVEL PACK -sodium fluoride paste0.243% & mouthwash kit

A •

EQL TRAVEL TOOTHBRUSH/TOO - sodiummonofluorophosphate paste0.15%

A •

GEL-KAM - stannous fluoridegel 0.4%

A •

GEL-KAM ORAL CARERINSE - stannous fluorideconc 0.63%

4 •

GELCLAIR - povidone-sodiumhyaluronate-glycyrrhetinicacid gel

4

LIDOCAINE HCL - lidocainehcl laryngotracheal soln 4%

2

lidocaine hcl viscous soln2%

1

LISTERINE ESSENTIALCARE - sodmonofluorophosph-eucal-men-methyl sal-thymol gel0.76%

A •

LISTERINE NATURALS WITHF - sodium fluoride rinse0.02%

4 •

LISTERINE RESTORING -sodium fluoride rinse0.0221% (0.01% f)

A •

LISTERINE SMART RINSE -sodium fluoride rinse0.0221% (0.01% f)

A •

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LISTERINE TOTAL CARE -sodium fluoride rinse0.0221% (0.01% f)

A •

LISTERINE TOTAL CAREPLUS - sodium fluoride rinse0.0221% (0.01% f)

A •

LISTERINE TOTAL CAREZERO - sodium fluoride rinse0.02%

A •

LISTERINE WHITENING/RESTO - sodium fluoriderinse 0.0221% (0.01% f)

A •

MUCOTROL - oral wound careproducts - wafer

4

NAFRINSE DAILY/ACIDULATED - sodiumfluoride-phosphoric acid forsoln 1 mg/5ml (f equiv)

4 •

NAFRINSE DAILY/NEUTRAL -7odium fluoride for soln rinse0.05%

4 •

NAFRINSE WEEKLY - sodiumfluoride for soln rinse 0.2%

4 •

NEUTRASAL - artificial saliva -packet

4

NUMOISYN - artificial saliva -solution

4

nystatin susp 100000 unit/ml 2

OMNI GEL - stannous fluoridegel 0.4%

A •

ORAFATE - sucralfate-malatepaste 10%

4 •

ORAMAGICRX - oral woundcare products - for susprinse

4

ORAVIG - miconazole buccaltab 50 mg (mouth-throat)

4

PARODONTAX - stannousfluoride paste 0.454%

A •

2016



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PHOS FLUR - sodium fluoriderinse 0.044%

A •

PHOS-FLUR ORTHODEFENSE - sodium fluoriderinse 0.044%

A •

pilocarpine hcl tab 5 mg(Salagen)

2

pilocarpine hcl tab 7.5 mg(Salagen)

2

PREVIDENT FLUORIDE -sodium fluoride gel 1.1%(0.5% f)

4 •

PREVIDENT 5000 BOOSTER -sodium fluoride paste 1.1%

4 •

PREVIDENT 5000 BOOSTERPL - sodium fluoride paste1.1%

4 •

PREVIDENT 5000 DRYMOUTH - sodium fluoride gel1.1% (0.5% f)

4 •

PREVIDENT 5000 ENAMELPRO - sodium fluoride-potassium nitrate paste1.1-5%

4 •

PREVIDENT 5000 PLUS -sodium fluoride cream 1.1%

4 •

PREVIDENT 5000SENSITIVE - sodiumfluoride-potassium nitratepaste 1.1-5%

4 •

PROTHELIAL - sucralfate-malate paste 10%

4 •

SALICEPT - oral wound careproducts - for susp rinse

4

SALIVAMAX - artificial saliva -packet

4

SALIVATE RX - artificial saliva -packet

4

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SENSODYNE REPAIR &PROTEC - stannous fluoridepaste 0.454%

A •

sodium fluoride cream 1.1%(Prevident 5000 plus)

1 •

sodium fluoride gel 1.1%(0.5% f) (Prevident fluoride)

1 •

sodium fluoride paste 1.1%(Prevident 5000 boost)

1 •

sodium fluoride rinse0.0221% (0.01% f)

A •

sodium fluoride rinse 0.05% A •sodium fluoride rinse 0.2%

(Prevident)1 •

sodium fluoride-potassiumnitrate paste 1.1-5%(Prevident 5000 sensi)

1 •

stannous fluoride conc0.63% (Gel-kam oral care ri)

A •

stannous fluoride gel 0.4% A •STANNOUS FLUORIDE

RINSE - stannous fluoride liq0.1%

A •

THERA-FLUR-N - sodiumfluoride gel 1.1% (0.5% f)

4 •

triamcinolone acetonidedental paste 0.1%

2

ANORECTAL AGENTSANALPRAM-HC -

hydrocortisone acetate w/pramoxine rectal lotn 2.5-1%

4

CORTIFOAM - hydrocortisoneacetate rectal foam 10% (90mg/dose)

3

hydrocortisone acetatesuppos 25 mg (Anusol-hc)

2

hydrocortisone acetatesuppos 30 mg (Proctocort)

2

2016



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hydrocortisone acetate w/pramoxine rectal cream1-1% (Analpram-hc)

2

hydrocortisone acetate w/pramoxine rectal cream2.5-1% (Analpram-hc)

2

hydrocortisone enema100 mg/60ml (Cortenema)

2

hydrocortisone rectal cream1% (Proctocort)

2

hydrocortisone rectal cream2.5% (Anusol-hc)

1

LIDOCAINE HCL-HYDROCORTIS - lidocaine-hydrocortisone acetate rectalgel 2.8-0.55%

4

lidocaine-hydrocortisoneacetate rectal cream3-0.5%

2

PROCORT - hydrocortisoneacetate w/ pramoxine rectalcream 1.85-1.15%

4

PROCTOFOAM HC -hydrocortisone acetate w/pramoxine rectal foam 1-1%

4

RECTIV - nitroglycerin oint0.4%

4

UCERIS - budesonide rectalfoam 2 mg/act

4

DERMATOLOGICALSABSORICA - isotretinoin cap

10 mg4

ABSORICA - isotretinoin cap20 mg

4


4


4

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4


4

acitretin cap 10 mg(Soriatane)

2

acitretin cap 17.5 mg(Soriatane)

2

acitretin cap 25 mg(Soriatane)

2

ACUICYN DAILY EYELID &EY - eyelid cleansers - liquid

4

acyclovir oint 5% (Zovirax) 2

adapalene cream 0.1%(Differin)

2

adapalene gel 0.1% (Differin) 2

adapalene gel 0.3% (Differin) 2

adapalene-benzoylperoxide gel 0.1-2.5%(Epiduo)

2

ALA-QUIN - clioquinol-hccream 3-0.5%

4

alclometasone dipropionatecream 0.05% (Aclovate)

2

alclometasone dipropionateoint 0.05%

2

ALCORTIN A - iodoquinol-hydrocortisone-aloepolysaccharide gel 1-2-1%

4

ALEVICYN ANTIPRURITICSG - dermatological productsmisc - liquid

4

ALOQUIN - iodoquinol-aloepolysaccharides gel 1.25-1%

4

ALTABAX - retapamulin oint1%

4

AMCINONIDE - amcinonidecream 0.1%

4

2016



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APEXICON E - diflorasonediacetate emollient basecream 0.05%

4

ASTERO - lidocaine hcl gel 4% 4

ATOPICLAIR - dermatologicalproducts misc - cream

4

ATRAPRO CP - wounddressings - kit

4

ATRAPRO DERMAL SPRAY -wound cleansers - liquid

4

AVAR - sulfacetamide sodiumw/ sulfur cleansing pad9.5-5%

4

AVENOVA - eyelid cleansers -liquid

4

AVENOVA/NEUTROX - eyelidcleansers - liquid

4

BEAU RX - scar treatmentproducts - gel

2

BENSAL HP - salicylic acid &benzoic acid oint 3-6%

4

BENZIQ - benzoyl peroxide gel5.25 %

4

BENZIQ LS - benzoyl peroxidegel 2.75%

4

BENZIQ WASH - benzoylperoxide liq 5.25%

2

benzoyl peroxide cloth 6% 2

benzoyl peroxide foam 5.3%(Benzefoam)

2

benzoyl peroxide foam 9.8%(Benzefoamultra)

2

benzoyl peroxide liq 2.5% 2

benzoyl peroxide liq 7% 2

benzoyl peroxide lotion 6% 2

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benzoyl peroxide-erythromycin gel 5-3%(Benzamycin)

2

betamethasone dipropionateaugmented cream 0.05%(Diprolene af)

2

betamethasone dipropionateaugmented gel 0.05%

2

betamethasone dipropionateaugmented lotion 0.05%(Diprolene)

2

betamethasone dipropionateaugmented oint 0.05%(Diprolene)

2

betamethasone dipropionatecream 0.05%

2

betamethasone dipropionatelotion 0.05%

2

betamethasone dipropionateoint 0.05%

2

betamethasone valerateaerosol foam 0.12% (Luxiq)

2

betamethasone valeratecream 0.1% (baseequivalent)

2

betamethasone valeratelotion 0.1% (baseequivalent)

2

betamethasone valerate oint0.1% (base equivalent)

2

BP CLEANSING WASH -sulfacetamide sodium-sulfurin urea emulsion 10-4%

2

calcipotriene cream 0.005%(Dovonex)

2

calcipotriene oint 0.005% 2

calcipotriene soln 0.005%(50 mcg/ml)

2

2016



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calcipotriene-betamethasonedipropionate oint0.005-0.064% (Taclonex)

2

CALCITRIOL - calcitriol oint 3mcg/gm

4

CAPEX - fluocinoloneacetonide shampoo 0.01%

4

CARAC - fluorouracil cream0.5%

4

CEM-UREA - urea soln 45% 4

CENTANY - mupirocin oint 2% 4

CERACADE - dermatologicalproducts misc - emulsion

4

ciclopirox gel 0.77% 2

ciclopirox olamine cream0.77% (base equiv)

2

ciclopirox olamine susp0.77% (base equiv)

2

ciclopirox shampoo 1%(Loprox shampoo)

2

ciclopirox solution 8%(Penlac Nail Lacquer)

2

clindamycin phosph-benzoylperoxide (refrig) gel 1.2(1)-5% (Duac)

2

clindamycin phosphatefoam 1% (Evoclin)

2

clindamycin phosphate gel1% (Cleocin-t)

2

clindamycin phosphatelotion 1% (Cleocin-t)

2

clindamycin phosphate soln1% (Cleocin-t)

2

clindamycin phosphateswab 1% (Cleocin-t)

2

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clindamycin phosphate-benzoyl peroxide gel 1-5%(Benzaclin)

2

clindamycin phosphate-tretinoin gel 1.2-0.025%(Ziana)

2

clobetasol propionate cream0.05% (Temovate)

2

clobetasol propionateemollient base cream0.05% (Temovate e)

2

clobetasol propionateemulsion foam 0.05%(Olux-e)

2

clobetasol propionate foam0.05% (Olux)

2

clobetasol propionate gel0.05% (Temovate)

2

clobetasol propionate lotion0.05% (Clobex)

2

clobetasol propionate oint0.05% (Temovate)

2

clobetasol propionateshampoo 0.05% (Clobex)

2

clobetasol propionate soln0.05% (Temovate)

2

clobetasol propionate spray0.05% (Clobex)

2

CLOCORTOLONE PIVALATE -clocortolone pivalate cream0.1%

4

CLOCORTOLONE PIVALATEPUM - clocortolone pivalatecream 0.1%

4

CLODERM - clocortolonepivalate cream 0.1%

4

CLODERM PUMP -clocortolone pivalate cream0.1%

4

2016



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clotrimazole w/betamethasone cream1-0.05% (Lotrisone)

2

clotrimazole w/betamethasone lotion1-0.05%

2

COAL TAR - coal tar soln 20% 4

CONDYLOX - podofilox gel0.5%

4

COPASIL - emollient - gel 4

CORDRAN - flurandrenolidecream 0.05%

4

CORDRAN - flurandrenolidelotion 0.05%

4

CORDRAN - flurandrenolideoint 0.05%

4

CORDRAN - flurandrenolidetape 4 mcg/sqcm

4

CORTANE-B - hydrocortisone-pramoxine-chloroxylenol lot10-10-1mg/ml

4

CORTISPORIN - bacitracin-polymyxin-neomycin hc oint1%

4

CORTISPORIN - neomycin-polymyxin-hc crm 3.5 mg/gm-10000 unt/gm-0.5%

4

COSENTYX - secukinumabsubcutaneous soln prefilledsyringe 150 mg/ml

5 • • •

COSENTYX SENSOREADYPEN - secukinumabsubcutaneous soln auto-injector 150 mg/ml

5 • • •

DENAVIR - penciclovir cream1%

4

DESONATE - desonide gel0.05%

4

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desonide cream 0.05%(Desowen)

2

desonide lotion 0.05%(Desowen)

2

desonide oint 0.05%(Desowen)

2

desoximetasone cream0.05% (Topicort)

2

desoximetasone cream0.25% (Topicort)

2

desoximetasone gel 0.05%(Topicort)

2

desoximetasone oint 0.05%(Topicort)

2

desoximetasone oint 0.25%(Topicort)

2

diclofenac sodium (actinickeratoses) gel 3%(Solaraze)

2

diclofenac sodium gel 1%(Voltaren)

2

diclofenac sodium soln 1.5%(Pennsaid)

2

DIFFERIN - adapalene lotion0.1%

4

DIFLORASONE DIACETATE -diflorasone diacetate cream0.05%

4

DIFLORASONE DIACETATE -diflorasone diacetate oint0.05%

2

DOXEPINHYDROCHLORIDE -doxepin hcl cream 5%

4

DRITHO-CREME HP -anthralin cream 1%

4

econazole nitrate cream 1% 2

2016



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ECOZA - econazole nitratefoam 1%

4

ELETONE - dermatologicalproducts misc - cream

4

ELETONE TWINPACK -dermatological productsmisc - cream

4

ELIDEL - pimecrolimus cream1%

4 •

EMULSION SB -dermatological productsmisc - emulsion

4

ENSTILAR - calcipotriene-betamethasone dipropionatefoam 0.005-0.064%

3

ENTTY SPRAY EMULSION -dermatological productsmisc - emulsion

4

EPICERAM - dermatologicalproducts misc - emulsion

4

EPIFOAM - pramoxine-hcaerosol foam 1-1%

4

ERTACZO - sertaconazolenitrate cream 2%

4

erythromycin gel 2% (Erygel) 2

erythromycin pads 2% 2

erythromycin soln 2% 2

ESSENTRA WIPES 9X9"CLEAN - isopropyl alcoholwipes 70%

4

EURAX - crotamiton cream10%

4

EURAX - crotamiton lotion 10% 4

EXELDERM - sulconazolenitrate cream 1%

4

EXELDERM - sulconazolenitrate solution 1%

4

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EXODERM - sodiumthiosulfate-salicylic acidlotion 25-1%

2

FABIOR - tazarotene (acne)foam 0.1%

4

FINACEA - azelaic acid foam15%

3

FINACEA - azelaic acid gel15%

3

FLECTOR - diclofenacepolamine patch 1.3%

4

fluocinolone acetonidecream 0.01%

2

fluocinolone acetonidecream 0.025% (Synalar)

2

fluocinolone acetonide oil0.01% (body oil) (Derma-smoothe/fs bod)

2

fluocinolone acetonide oil0.01% (scalp oil) (Derma-smoothe/fs sca)

2

fluocinolone acetonide oint0.025% (Synalar)

2

fluocinolone acetonide soln0.01% (Synalar)

2

fluocinonide cream 0.05% 2

fluocinonide cream 0.1%(Vanos)

2 •

fluocinonide emulsified basecream 0.05%

2

fluocinonide gel 0.05% 2

fluocinonide oint 0.05% 2

fluocinonide soln 0.05% 2

FLUOROPLEX - fluorouracilcream 1%

4

FLUOROURACIL - fluorouracilcream 0.5%

4

2016



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FLUOROURACIL - fluorouracilsoln 2%

2

FLUOROURACIL - fluorouracilsoln 5%

2

fluorouracil cream 5%(Efudex)

2

flurandrenolide cream 0.05%(CORDRAN)

2

flurandrenolide lotion 0.05%(Cordran)

2

flurandrenolide oint 0.05%(Cordran)

2

fluticasone propionatecream 0.05% (Cutivate)

2

fluticasone propionate lotion0.05% (Cutivate)

2

fluticasone propionate oint0.005%

2

GENADUR - dermatologicalproducts misc - liquid

4

GENTAMICIN SULFATE -gentamicin sulfate oint 0.1%

4

gentamicin sulfate cream0.1%

2

halobetasol propionatecream 0.05% (Ultravate)

2

halobetasol propionate oint0.05% (Ultravate)

2

HALOG - halcinonide cream0.1%

4

HALOG - halcinonide oint 0.1% 4

HALOTIN - haloprogin cream1%

4

HPR - dermatological products,misc. - aerosol foam

4

HPR PLUS - dermatologicalproducts misc - cream

4

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HPR PLUS - dermatologicalproducts, misc. - aerosolfoam

4

hyaluronate sodium(emollient) gel 0.2% (Hylira)

2

hydrocortisone butyratecream 0.1% (Locoid)

2

hydrocortisone butyratehydrophilic lipo basecream 0.1% (Locoidlipocream)

2

hydrocortisone butyrate oint0.1% (Locoid)

2

hydrocortisone butyratesoln 0.1% (Locoid)

2

hydrocortisone cream 2.5% 1

hydrocortisone lotion 2%(Ala scalp)

2

hydrocortisone lotion 2.5% 2

hydrocortisone oint 2.5% 1

hydrocortisone valeratecream 0.2%

2

hydrocortisone valerate oint0.2% (Westcort)

2

HYLATOPIC PLUS -dermatological productsmisc - cream

4

HYLATOPIC PLUS -dermatological products,misc. - aerosol foam

4

HYLIRA - hyaluronate sodium(emollient) lotion 0.1%

4

imiquimod cream 5%(Aldara)

2 •

iodoquinol-hc cream 1% 2

iodoquinol-hydrocortisonein aloe vehicle cream1-1.9% (Vytone)

2

2016



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A

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Dis

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isotretinoin cap 10 mg 2




JUBLIA - efinaconazole soln10%

4

KENALOG - triamcinoloneacetonide aerosol soln 0.147mg/gm

4

KERYDIN - tavaborole soln 5% 4

ketoconazole cream 2% 2

ketoconazole foam 2%(Extina)

2

ketoconazole shampoo 2%(Nizoral)

2

lactic acid (ammoniumlactate) cream 12% (Lac-hydrin)

1

lactic acid (ammoniumlactate) lotion 10%

2

lactic acid (ammoniumlactate) lotion 12% (Lac-hydrin)

2

lactic acid w/ vitamin ecream 10%-3500 unit/30gm

1

LAVARE WOUND WASH -wound cleansers - gel

4

LEVULAN KERASTICK -aminolevulinic acid hcl forsoln 20% (stick applicator)

4

lidocaine hcl gel 2% 1

lidocaine hcl soln 4%(Xylocaine)

1

lidocaine oint 5% 2

lidocaine patch 5%(Lidoderm)

2

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lidocaine-prilocaine creamkit 2.5-2.5%

2

lidocaine-prilocaine cream2.5-2.5% (Emla)

2

LINDANE - lindane shampoo1%

2

LOCOID - hydrocortisonebutyrate lotion 0.1%

4

LOTRIMIN ULTRA - butenafinehcl cream 1%

4

LOUTREX - antiseborrheicproducts misc - cream

4

LUXAMEND - wound dressings- cream

2

LUZU - luliconazole cream 1% 4

mafenide acetate packet fortopical soln 5% (50 gm)(Sulfamylon)

2

malathion lotion 0.5%(Ovide)

2

MENTAX - butenafine hclcream 1%

4

methoxsalen rapid cap10 mg (Oxsoralen ultra)

2

metronidazole cream 0.75%(Metrocream)

2

metronidazole gel 0.75% 2

metronidazole gel 1%(Metrogel)

2

metronidazole lotion 0.75%(Metrolotion)

2

MICROCYN - wound cleansers- gel

4

MICROCYN - wound cleansers- liquid

4

MICROCYN SKIN ANDWOUND H - woundcleansers - gel

4

2016



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A

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ited

Dis

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MIRVASO - brimonidine tartrategel 0.33% (base equivalent)

4

mometasone furoate cream0.1% (Elocon)

2

mometasone furoate oint0.1% (Elocon)

2

mometasone furoatesolution 0.1% (lotion)(Elocon)

2

mupirocin calcium cream2% (Bactroban)

2

mupirocin oint 2%(Bactroban)

1

naftifine hcl cream 1% 2

naftifine hcl cream 2%(Naftin)

2

NAFTIN - naftifine hcl cream2%

4

NAFTIN - naftifine hcl gel 1% 4

NAFTIN - naftifine hcl gel 2% 4

NATROBA - spinosad susp0.9%

4

NEO-SYNALAR - neomycinsulfate-fluocinoloneacetonide cream 0.5-0.025%

4

NEOSALUS - dermatologicalproducts misc - cream

4

NEOSALUS - dermatologicalproducts, misc. - aerosolfoam

4

NEOSALUS - emollient - lotion 4

NEOSALUS CP -dermatological productsmisc - cream

4

NOBLE MYSTIQUE EMU-LAC - lactic acid (ammoniumlactate) cream 10%

4

Drug Name Dru

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Dis

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Lim

its

AC

A

Lim

ited

Dis

tribu

tion

NOVACORT - pramoxine-hcgel 1-2%

4

NUCORT - hydrocortisoneacetate lotion 2%

4

NUVAIL - dermatologicalproducts misc - solution

4

nystatin cream 100000 unit/gm

2

nystatin oint 100000 unit/gm 2

nystatin topical powder100000 unit/gm

2

nystatin-triamcinolonecream 100000-0.1 unit/gm-%

2

nystatin-triamcinolone oint100000-0.1 unit/gm-%

2

ONEXTON - clindamycinphosphate-benzoyl peroxidegel 1.2-3.75%

4

OVACE PLUS - sulfacetamidesodium cream 10%

4

OVACE PLUS - sulfacetamidesodium foam 9.8%

4

OVACE PLUS - sulfacetamidesodium lotion 9.8%

4

oxiconazole nitrate cream1% (Oxistat)

2

OXISTAT - oxiconazole nitratecream 1%

4

OXISTAT - oxiconazole nitratelotion 1%

4

PANDEL - hydrocortisoneprobutate cream 0.1%

4

PANRETIN - alitretinoin gel0.1%

4

PENNSAID - diclofenac sodiumsoln 2%

4

2016



Drug Name Dru

g Ti

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Prio

r Aut

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n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

permethrin cream 5%(Elimite)

2

PICATO - ingenol mebutate gel0.015%

4 •

PICATO - ingenol mebutate gel0.05%

4 •

PLEXION CLEANSINGCLOTHS - sulfacetamidesodium w/ sulfur cleansingcloth 9.8-4.8%

4

PODOCON 25 IN BENZOINTIN - podophyllum resin soln25%

4

podofilox soln 0.5%(Condylox)

2

PRAMOSONE - pramoxine-hccream 1-1%

4

PRAMOSONE - pramoxine-hclotion 1-1%

4

PRAMOSONE - pramoxine-hclotion 1-2.5%

4

PRAMOSONE - pramoxine-hcoint 1-1%

4

PRAMOSONE - pramoxine-hcoint 1-2.5%

4

PRAMOSONE E - pramoxine-hc emollient base cream1-2.5%

4

pramoxine-hc cream 1-2.5%(Pramosone)

2

prednicarbate cream 0.1%(Dermatop)

2

prednicarbate oint 0.1%(Dermatop)

2

PROMISEB - antiseborrheicproducts misc - cream

4

PRUCLAIR - dermatologicalproducts misc - cream

4

Drug Name Dru

g Ti

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Prio

r Aut

horiz

atio

n

Ste

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Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

PRUDOXIN - doxepin hclcream 5%

4

PRUMYX - dermatologicalproducts misc - cream

4

PSORCON - diflorasonediacetate cream 0.05%

4

RECEDO - scar treatmentproducts - gel

2

RECURA - antifungalcombination products misc -cream

4

REGENECARE - lidocaine hcl-collagen-aloe vera gel 2%

4

REGRANEX - becaplermin gel0.01%

4 •

RIAX - benzoyl peroxide foam5.5%

4

RIAX - benzoyl peroxide foam9.5%

4

RYNODERM - urea cream37.5%

4

salicylic acid cream 6% 2

salicylic acid er film-formingsoln 28.5% (Ultrasal-er)

2

salicylic acid film formingliquid 27.5% (Virasal)

2

salicylic acid foam 6%(Salvax)

2

salicylic acid gel 6% (Keralyt) 2

salicylic acid lotion 6% 2

salicylic acid shampoo 6%(Salex)

2

salicylic acid soln 26% 2

SANTYL - collagenase oint 250unit/gm

4

scar treatment products- gel

2

2016



Drug Name Dru

g Ti

er

Prio

r Aut

horiz

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n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

selenium sulfide lotion 2.5% 1

selenium sulfide-pyrithionezinc in urea shampoo2.25%

2

SELRX - selenium sulfide-pyrithione zinc in ureashampoo 2.3%

4

SERNIVO - betamethasonedipropionate spray emulsion0.05% (base equiv)

4

SILVER NITRATE - silvernitrate oint 10%

4

SILVER NITRATE - silvernitrate soln 0.5%

4

SILVER NITRATE - silvernitrate soln 10%

4


4


4

silver sulfadiazine cream 1%(Silvadene)

1

SILVRSTAT WOUNDDRESSING - silver - gel

4

skin protectants misc -cream

2

SKLICE - ivermectin lotion0.5%

4

SODIUM SULFACETAMIDEWASH - sulfacetamidesodium in bakuchiol vehiclewash 10%

4

SODIUM SULFACETAMIDE/SULF - sulfacetamide sodiumw/ sulfur lotion 10-5%

2

SODIUM SULFACETAMIDE/SULF - sulfacetamide sodiumw/ sulfur susp 10-5%

4

Drug Name Dru

g Ti

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Prio

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

SODIUM SULFACETAMIDE/SULF - sulfacetamidesodium-sulfur in ureaemulsion 10-5%

4

SOOLANTRA - ivermectincream 1%

3

SORILUX - calcipotriene foam0.005%

4

SP SCAR MANAGEMENT -scar treatment products - gel

4

SPINOSAD - spinosad susp0.9%

4

SSS 10-5 - sulfacetamidesodium w/ sulfur foam10-5%

2

STELARA - ustekinumab inj 45mg/0.5ml

5 • • •

STELARA - ustekinumab solnprefilled syringe 45 mg/0.5ml

5 • • •

STELARA - ustekinumab solnprefilled syringe 90 mg/ml

5 • • •

sulfacetamide sodiumcleansing gel 10% (Ovaceplus wash)

2

sulfacetamide sodium liquid10% (Ovace wash)

2

sulfacetamide sodium lotion10% (acne) (Klaron)

2

sulfacetamide sodiumshampoo 10% (Ovace plus)

2

sulfacetamide sodium w/sulfur cleanser 9.8-4.8%(Plexion cleanser)

2

sulfacetamide sodium w/sulfur cleanser 10-2%(Avar ls cleanser)

2

sulfacetamide sodium w/sulfur cleansing pad10-4% (Sumaxin)

2

2016



Drug Name Dru

g Ti

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Prio

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horiz

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n

Ste

p Th

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y

Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

sulfacetamide sodium w/sulfur cream 9.8-4.8%(Plexion)

2

sulfacetamide sodium w/sulfur cream 10-2% (Avar-e ls)

2

sulfacetamide sodium w/sulfur cream 10-5%

2

sulfacetamide sodium w/sulfur emulsion 10-1%

2

sulfacetamide sodium w/sulfur emulsion 10-5%

2

sulfacetamide sodium w/sulfur lotion 9.8-4.8%(Plexion)

2

sulfacetamide sodium w/sulfur susp 8-4% (Sumaxints)

2

sulfacetamide sodium w/sulfur wash 9-4% (Sumaxinwash)

2

sulfacetamide sodiumw/ sulfur wash 9-4.5%(Sumadan wash)

2

SULFAMYLON - mafenideacetate cream 85 mg/gm

4

SYNERA - lidocaine-tetracainetopical patch 70-70 mg

4

TACLONEX - calcipotriene-betamethasone dipropionatesusp 0.005-0.064%

4

tacrolimus oint 0.03%(Protopic)

2 •

tacrolimus oint 0.1%(Protopic)

2

TALTZ - ixekizumabsubcutaneous soln auto-injector 80 mg/ml

5 • • •

Drug Name Dru

g Ti

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Dis

pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

TALTZ - ixekizumabsubcutaneous soln prefilledsyringe 80 mg/ml

5 • • •

TARGRETIN - bexarotene gel1%

5 • •

tazarotene cream 0.1%(Tazorac)

2

TAZORAC - tazarotene cream0.05%

3

TAZORAC - tazarotene cream0.1%

3

TAZORAC - tazarotene gel0.05%

3

TAZORAC - tazarotene gel0.1%

3

TETRIX - dermatologicalproducts misc - cream

2

TEXACORT - hydrocortisonesoln 2.5%

4

TOLAK - fluorouracil cream 4% 4

TOPICORT - desoximetasonecream 0.05%

4

TOPICORT - desoximetasoneoint 0.05%

4

TOPICORT - desoximetasonespray 0.25%

4

tretinoin cream 0.025%(Retin-a)

2

tretinoin cream 0.05% (Retin-a)

2

tretinoin cream 0.1% (Retin-a)

2

tretinoin gel 0.01% (Retin-a) 2

tretinoin gel 0.025% (Retin-a) 2

tretinoin gel 0.05% (Atralin) 2

tretinoin microsphere gel0.04% (Retin-a micro)

2

2016



Drug Name Dru

g Ti

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n

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

tretinoin microsphere gel0.1% (Retin-a micro pump)

2

TRI-CHLOR - trichloroaceticacid liqd 80%

4

triamcinolone acetonideaerosol soln 0.147 mg/gm(Kenalog)

2

triamcinolone acetonidecream 0.025%

1


1


1

triamcinolone acetonidelotion 0.025%

2

triamcinolone acetonidelotion 0.1%

2

triamcinolone acetonide oint0.025%

1


1


2

TRIANEX - triamcinoloneacetonide oint 0.05%

4

TRIDESILON - desonide cream0.05%

2

ULESFIA - benzyl alcohollotion 5%

4

ULTRASAL-ER - salicylic acider film-forming soln 28.5%

4

ULTRAVATE - halobetasolpropionate lotion 0.05%

4

URAMAXIN - urea inammonium lactate vehiclefoam 20%

4

urea cream 39% (Aluvea) 2

urea cream 40% 2

Drug Name Dru

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n

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

urea cream 45% (Uramaxin) 2

urea cream 47% (Keralac) 2

urea cream 50% 2

urea foam 40% (Hydro 40foam)

2

urea gel 45% (Uramaxin) 2

urea in lactic acid vehiclefoam 35% (Hydro 35)

2

UREA IN ZINCUNDECYLENATE - urea inzinc undecylenate-lactic acidvehicle emulsion 50%

2

urea lotion 40% 2

UREA NAIL - urea in zincundecylenate-lactic acidvehicle stick 50%

4

urea suspension 50% 2

UREA TOPICAL - ureasuspension 40%

2

UREVAZ - urea cream 44% 4

UTOPIC - urea cream 41% 4

VALCHLOR - mechlorethaminehcl gel 0.016% (baseequivalent)

5 • •

VECTICAL - calcitriol oint 3mcg/gm

4

VENELEX - balsam peru-castor oil oint

4

VERDESO - desonide foam0.05%

4

VEREGEN - sinecatechins oint15%

4

VOLTAREN - diclofenacsodium gel 1%

4

VUSION - miconazole-zincoxide-white petrolatum oint0.25-15-81.35%

4

2016



Drug Name Dru

g Ti

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n

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its

AC

A

Lim

ited

Dis

tribu

tion

VYTONE - iodoquinol-hydrocortisone in aloevehicle cream 1-1.9%

4

XERESE - acyclovir-hydrocortisone cream 5-1%

4

XEROFORM NON-OCCLUSIVE OI - bismuthtribromophenate-petrolatumdressing pads

4

XEROFORM OCCLUSIVEPETROL - bismuthtribromophenate-petrolatumdressing - misc

4

XEROFORM OCCLUSIVEPETROL - bismuthtribromophenate-petrolatumdressing pads

4

XOLEGEL - ketoconazole gel2%

4

ZACLIR CLEANSING - benzoylperoxide lotion 8%

4

ZITHRANOL - anthralinshampoo 1%

4

ZONALON - doxepin hcl cream5%

4

ZOVIRAX - acyclovir cream 5% 4

ZYCLARA - imiquimod cream3.75%

4 •

ZYCLARA PUMP - imiquimodcream 2.5%

4 •

ZYCLARA PUMP - imiquimodcream 3.75%

4 •

MISCELLANEOUS PRODUCTSANTISEPTICS & DISINFECTANTSANASEPT - sodium

hypochlorite liquid 0.057%4

FORMA-RAY - formaldehydesolution 20%

4

Drug Name Dru

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A

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ited

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tribu

tion

formaldehyde solution 10% 1

LUGOLS STRONG IODINE -iodine solution

4

ANTIDOTESCETYLEV - acetylcysteine

effervescent tab 500 mg4

CETYLEV - acetylcysteineeffervescent tab 2.5 gm

4

CHEMET - succimer cap 100mg

3

EVZIO - naloxone hcl solutionauto-injector 0.4 mg/0.4ml

4

EVZIO - naloxone hcl solutionauto-injector 2 mg/0.4ml

4

EXJADE - deferasirox tab fororal susp 125 mg

5 • •


5 • •


5 • •

FERRIPROX - deferiprone oralsoln 100 mg/ml

5 • •

FERRIPROX - deferiprone tab500 mg

5 • •

JADENU - deferasirox tab 90mg

5 •


5 •


5 •

NALOXONE HCL - naloxonehcl soln prefilled syringe 2mg/2ml

4

naloxone hcl inj 0.4 mg/ml 2

naltrexone hcl tab 50 mg(Revia)

2

2016



Drug Name Dru

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its

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A

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ited

Dis

tribu

tion

NARCAN - naloxone hcl nasalspray 4 mg/0.1ml

3

PENTETATE CALCIUMTRISODI - pentetate calciumtrisodium iv or inhalationsoln 200 mg/ml

4

PENTETATE ZINCTRISODIUM - pentetate zinctrisodium iv or inhalationsoln 200 mg/ml

4

RADIOGARDASE - prussianblue insoluble cap 0.5 gm

4

VISTOGARD - uridinetriacetate oral granulespacket 10 gm

5 •

DIAGNOSTIC PRODUCTSBAYER BREEZE 2 TEST

DISC - glucose blood testdisk

2 •

BAYER CONTOUR BLOODGLUCO - glucose blood teststrip

2 •

BAYER CONTOUR NEXTBLOOD - glucose blood teststrip

2 •

GLUCAGEN DIAGNOSTIC -glucagon hcl (rdna)diagnostic for inj 1 mg (baseequiv)

4

KETONE BLOOD TESTSTRIPS-VARIOUS

4

URINE TEST STRIPS-VARIOUS

4

ALTERNATIVE MEDICINESCITRUS BERGAMOT - citrus

bergamot oral powder 250mg/0.25 gm

4

Drug Name Dru

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Lim

its

AC

A

Lim

ited

Dis

tribu

tion

CO-BALAMIN - ubiquinol-vit b12-resveratrol-fa cap200-5-400-0.8 mg

4

CO-VERATROL - ubiquinol-vit b12-resveratrol-fa cap200-5-400-0.8 mg

4

MEDICAL DEVICESBLOOD GLUCOSE

CALIBRATION LIQUID-VARIOUS

4

BREATHERITE - spacer/aerosol-holding chambers -device

3

BREATHERITECOLLAPSIBLE - spacer/aerosol-holding chambers -device

3

BREATHERITE RIGIDSPACER - spacer/aerosol-holding chambers - device

3

BREATHERITE VALVED MDICH - respiratory therapysupplies - devices

3

BREATHERITE W/LARGEMASK - spacer/aerosol-holding chambers - device

3

BREATHERITE W/MEDIUMMASK - spacer/aerosol-holding chambers - device

3

BREATHERITE W/SMALLMASK - spacer/aerosol-holding chambers - device

3

CAYA - diaphragm arc-spring A •HURRISEAL - dental

desensitizing product -solution

4

INSULIN PEN NEEDLES-VARIOUS

3 •

2016



Drug Name Dru

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A

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ited

Dis

tribu

tion

INSULIN SYRINGES-VARIOUS

3 •

LANCETS-VARIOUS 3

LANCING DEVICE-VARIOUS 4

OMNIFLEX DIAPHRAGM -diaphragms

A •

RESPIRATORY THERAPYSUPPLIES-VARIOUS

4

SPACERS-VARIOUS 4

WIDE-SEAL SILICONEDIAPHR - diaphragm wideseal 60 mm

A •


A •


A •


A •


A •


A •


A •


A •

PHARMACEUTICAL ADJUVANTSSANARE SCAR THERAPY -

cream base4

ASSORTED CLASSES

Drug Name Dru

g Ti

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its

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A

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ited

Dis

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tion

ASTAGRAF XL - tacrolimuscap er 24hr 0.5 mg

4 •

ASTAGRAF XL - tacrolimuscap er 24hr 1 mg

4 •

ASTAGRAF XL - tacrolimuscap er 24hr 5 mg

4 •

ATGAM - lymphocyte immuneglobulin anti-thymocyte g inj50 mg/ml(eq)

4

AZASAN - azathioprine tab 75mg

4

AZASAN - azathioprine tab 100mg

4

azathioprine tab 50 mg(Imuran)

2

CUPRIMINE - penicillaminecap 250 mg

5 • •

cyclosporine cap 25 mg(Sandimmune)

2

cyclosporine cap 100 mg(Sandimmune)

2

CYCLOSPORINE MODIFIED -cyclosporine modified cap50 mg

3

cyclosporine modified cap25 mg (Neoral)

2

cyclosporine modifiedcap 50 mg (Cyclosporinemodifie)

2

cyclosporine modified cap100 mg (Neoral)

2

cyclosporine modified oralsoln 100 mg/ml (Neoral)

2

DEPEN TITRATABS -penicillamine tab 250 mg

5 • •

ENVARSUS XR - tacrolimustab er 24hr 0.75 mg

4

2016



Drug Name Dru

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ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion

ENVARSUS XR - tacrolimustab er 24hr 1 mg

4

ENVARSUS XR - tacrolimustab er 24hr 4 mg

4

mycophenolate mofetil cap250 mg (Cellcept)

2

mycophenolate mofetilfor oral susp 200 mg/ml(Cellcept)

2

mycophenolate mofetil tab500 mg (Cellcept)

2

mycophenolate sodium tabdr 180 mg (mycophenolicacid equiv) (Myfortic)

2

mycophenolate sodium tabdr 360 mg (mycophenolicacid equiv) (Myfortic)

2

NEORAL - cyclosporinemodified cap 25 mg

4

NEORAL - cyclosporinemodified cap 100 mg

4

NEORAL - cyclosporinemodified oral soln 100 mg/ml

4

PROGRAF - tacrolimus cap 0.5mg

4

PROGRAF - tacrolimus cap 1mg

4

PROGRAF - tacrolimus cap 5mg

4

RAPAMUNE - sirolimus oralsoln 1 mg/ml

3

REVLIMID - lenalidomide caps2.5 mg

5 • • •

REVLIMID - lenalidomide cap 5mg

5 • • •

REVLIMID - lenalidomide cap10 mg

5 • • •

Drug Name Dru

g Ti

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n

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pens

ing

Lim

its

AC

A

Lim

ited

Dis

tribu

tion


5 • • •


5 • • •


5 • • •

SANDIMMUNE - cyclosporinecap 25 mg

4

SANDIMMUNE - cyclosporinecap 100 mg

4

SANDIMMUNE - cyclosporineoral soln 100 mg/ml

4

sirolimus tab 0.5 mg(Rapamune)

2

sirolimus tab 1 mg(Rapamune)

2

sirolimus tab 2 mg(Rapamune)

2

sodium polystyrenesulfonate oral susp15 gm/60ml (Sps)

2

sodium polystyrenesulfonate powder(Kayexalate)

2

sodium polystyrenesulfonate rectal susp30 gm/120ml

2

SYPRINE - trientine hcl cap250 mg

5 • •

tacrolimus cap 0.5 mg(Prograf)

2

tacrolimus cap 1 mg(Prograf)

2

tacrolimus cap 5 mg(Prograf)

2

THALOMID - thalidomide cap50 mg

5 • • •

2016



Drug Name Dru

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Lim

its

AC

A

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ited

Dis

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tion


5 • • •


5 • • •


5 • • •

VELTASSA - patiromer sorbitexcalcium for susp packet 8.4gm (base eq)

4 •


4 •


4 •

ZORTRESS - everolimus tab0.25 mg

4


4


4

2016



INDEX

Aabacavir sulfate-lamivudine tab 600-300 mg

(Epzicom)......................................................................... 7abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg (Trizivir)................................................7abacavir sulfate soln 20 mg/ml (base equiv)

(Ziagen).............................................................................7abacavir sulfate tab 300 mg (base equiv) (Ziagen)........7ABANEU-SL -cyanocobalamin-methylcobalamin tab sl

600-600 mcg................................................................. 150ABILIFY -aripiprazole tab 2 mg.........................................82ABILIFY -aripiprazole tab 5 mg.........................................82ABILIFY -aripiprazole tab 10 mg.......................................82ABILIFY -aripiprazole tab 15 mg.......................................82ABILIFY -aripiprazole tab 20 mg.......................................82ABILIFY -aripiprazole tab 30 mg.......................................82ABSORICA -isotretinoin cap 10 mg................................ 170ABSORICA -isotretinoin cap 20 mg................................ 170ABSORICA -isotretinoin cap 25 mg................................ 170ABSORICA -isotretinoin cap 30 mg................................ 170ABSORICA -isotretinoin cap 35 mg................................ 170ABSORICA -isotretinoin cap 40 mg................................ 170ABSTRAL -fentanyl citrate sl tab 100 mcg (base

equiv)...............................................................................96ABSTRAL -fentanyl citrate sl tab 200 mcg (base





equiv)...............................................................................96acamprosate calcium tab delayed release 333 mg......91acarbose tab 25 mg (Precose)....................................... 29acarbose tab 50 mg (Precose)....................................... 29acarbose tab 100 mg (Precose)..................................... 29acebutolol hcl cap 200 mg (Sectral)..............................42acebutolol hcl cap 400 mg (Sectral)..............................42ACERFLEX -nutritional supplement powder...................131ACETAMINOPHEN/CAFFEINE/DI -acetaminophen-

caffeine-dihydrocodeine cap 320.5-30-16 mg................97acetaminophen w/ codeine soln 120-12 mg/5ml..........96acetaminophen w/ codeine tab 300-15 mg (Tylenol/

codeine)..........................................................................96acetaminophen w/ codeine tab 300-30 mg (Tylenol/

codeine #3).................................................................... 96

acetaminophen w/ codeine tab 300-60 mg (Tylenol/codeine #4).................................................................... 96

acetazolamide cap er 12hr 500 mg (Diamox)............... 54acetazolamide tab 125 mg..............................................54acetazolamide tab 250 mg..............................................54acetic acid otic soln 2%................................................167acetylcysteine cap 600 mg........................................... 130acetylcysteine inhal soln 10%........................................61acetylcysteine inhal soln 20%........................................61ACIPHEX -rabeprazole sodium ec tab 20 mg.................. 68acitretin cap 10 mg (Soriatane)....................................170acitretin cap 17.5 mg (Soriatane).................................170acitretin cap 25 mg (Soriatane)....................................170ACTEMRA -tocilizumab subcutaneous soln prefilled

syringe 162 mg/0.9ml................................................... 105ACTIMMUNE -interferon gamma-1b inj 100 mcg/0.5ml

(2000000 unit/0.5ml).......................................................16ACTIVE FE -fe carbonyl-fa-b complex-a-c-d-e-min tab

75-1.25 mg....................................................................150ACTIVE INJECTION KIT KL-3 -triamcinolone inj 40 mg/ml

& lidocaine 1% & ammonia inh kit................................. 21ACTIVE OB -prenatal w/o a w/fe cbn-fa-dha cap 20-1-320

mg..................................................................................120ACTONEL -risedronate sodium tab 5 mg......................... 38ACTONEL -risedronate sodium tab 30 mg....................... 38ACTONEL -risedronate sodium tab 35 mg....................... 38ACTOPLUS MET XR -pioglitazone hcl-metformin hcl tab

er 24hr 15-1000 mg........................................................29ACTOPLUS MET XR -pioglitazone hcl-metformin hcl tab

er 24hr 30-1000 mg........................................................29ACT TOTAL CARE DRY MOUTH -sodium fluoride rinse

0.02%.............................................................................167ACUICYN DAILY EYELID & EY -eyelid cleansers -

liquid.............................................................................. 170ACUVAIL -ketorolac tromethamine (pf) ophth soln

0.45%.............................................................................162acyclovir cap 200 mg (Zovirax)........................................7acyclovir oint 5% (Zovirax)...........................................170acyclovir susp 200 mg/5ml (Zovirax).............................. 7acyclovir tab 400 mg (Zovirax)........................................ 7acyclovir tab 800 mg (Zovirax)........................................ 7ADACEL -tet tox-diph-acell pertuss ad inj 5-2-15.5 lf-lf-

mcg/0.5ml........................................................................14adapalene-benzoyl peroxide gel 0.1-2.5%

(Epiduo)........................................................................170adapalene cream 0.1% (Differin)..................................170adapalene gel 0.1% (Differin)....................................... 170adapalene gel 0.3% (Differin)....................................... 170ADASUVE -loxapine aerosol powder breath activated 10

mg....................................................................................82ADCIRCA -tadalafil tab 20 mg (pah).................................58ADD-INS COMPLETE -amino acids pack...................... 130

2016



adefovir dipivoxil tab 10 mg (Hepsera)...........................7ADEMPAS -riociguat tab 0.5 mg.......................................58ADEMPAS -riociguat tab 1 mg..........................................58ADEMPAS -riociguat tab 1.5 mg.......................................58ADEMPAS -riociguat tab 2 mg..........................................58ADEMPAS -riociguat tab 2.5 mg.......................................58ADRENALIN -epinephrine hcl nasal soln 0.1%................ 60ADVAIR DISKUS -fluticasone-salmeterol aer powder ba

100-50 mcg/dose............................................................ 63ADVAIR DISKUS -fluticasone-salmeterol aer powder ba

250-50 mcg/dose............................................................ 63ADVAIR DISKUS -fluticasone-salmeterol aer powder ba

500-50 mcg/dose............................................................ 63ADVAIR HFA -fluticasone-salmeterol inhal aerosol 45-21

mcg/act............................................................................ 63ADVAIR HFA -fluticasone-salmeterol inhal aerosol 115-21

mcg/act............................................................................ 63ADVAIR HFA -fluticasone-salmeterol inhal aerosol 230-21

mcg/act............................................................................ 63ADVANCED AM/PM -multiple vitamins w/ calcium therapy

pack............................................................................... 120ADVATE -antihemophilic factor rahf-pfm for inj 250

unit................................................................................. 156ADVATE -antihemophilic factor rahf-pfm for inj 500






unit................................................................................. 156ADVERA -nutritional supplement liquid...........................131ADYNOVATE -antihemophilic factor recomb pegylated for

inj 250 unit.................................................................... 156ADYNOVATE -antihemophilic factor recomb pegylated for



inj 1000 unit.................................................................. 156ADYNOVATE -antihemophilic factor recomb pegylated for



inj 3000 unit.................................................................. 157AEROSPAN -flunisolide hfa inhal aerosol 80 mcg/act......63

AFINITOR DISPERZ -everolimus tab for oral susp 2mg....................................................................................16



AFINITOR -everolimus tab 2.5 mg....................................16AFINITOR -everolimus tab 5 mg.......................................16AFINITOR -everolimus tab 7.5 mg....................................16AFINITOR -everolimus tab 10 mg.....................................16AFLURIA 2017-2018 -influenza virus vaccine split im

susp................................................................................. 13AFLURIA PF 2017-2018 -influenza virus vaccine split pf

susp pref syringe 0.5 ml.................................................13AFLURIA QUADRIVALENT 2017 -influenza virus vaccine

split quadrivalent im inj...................................................13AFLURIA QUADRIVALENT 2017 -influenza virus vac split

quadrivalent susp pref syr 0.5ml....................................13AFREZZA -insulin regular (human) inhalation powder 4

unit/cartridge....................................................................34AFREZZA -insulin regular (human) inhalation powder 8

unit/cartridge....................................................................34AFREZZA -insulin regular (human) inhalation powder 12

unit/cartridge....................................................................34AFREZZA -insulin regular (human) inhal powd 4 (30) & 8

(60) unit/cart....................................................................34AFREZZA -insulin regular (human) inhal powd 4 (60) & 8

(30) unit/cart....................................................................34AFREZZA -insulin regular (human) inhal powd 4 (90) & 8

(90) unit/cart....................................................................34AFREZZA -insulin regular (human) inh powd 4 & 8 & 12

unit/cart (60)....................................................................34AFREZZA -insulin regular (human) inh powd 8 (60) & 12

(30) unit/cart....................................................................34AGGRENOX -aspirin-dipyridamole cap er 12hr 25-200

mg..................................................................................157AKTEN -lidocaine hcl ophth gel 3.5%.............................162AKYNZEO -netupitant-palonosetron cap 300-0.5 mg.......70ALA-QUIN -clioquinol-hc cream 3-0.5%..........................170ALBENZA -albendazole tab 200 mg................................. 12albuterol sulfate soln nebu 0.083% (2.5 mg/3ml).........63albuterol sulfate soln nebu 0.5% (5 mg/ml)..................63albuterol sulfate soln nebu 0.63 mg/3ml (base

equiv).............................................................................. 63albuterol sulfate soln nebu 1.25 mg/3ml (base

equiv).............................................................................. 63albuterol sulfate syrup 2 mg/5ml...................................63albuterol sulfate tab er 12hr 4 mg (Vospire er)............ 63albuterol sulfate tab er 12hr 8 mg (Vospire er)............ 63albuterol sulfate tab 2 mg...............................................63albuterol sulfate tab 4 mg...............................................63

2016



alclometasone dipropionate cream 0.05%(Aclovate)..................................................................... 170

alclometasone dipropionate oint 0.05%......................170ALCORTIN A -iodoquinol-hydrocortisone-aloe

polysaccharide gel 1-2-1%...........................................170ALDACTAZIDE -spironolactone & hydrochlorothiazide tab

50-50 mg......................................................................... 54ALECENSA -alectinib hcl cap 150 mg (base

equivalent).......................................................................16ALENDRONATE SODIUM -alendronate sodium oral soln

70 mg/75ml..................................................................... 38ALENDRONATE SODIUM -alendronate sodium tab 40

mg....................................................................................38alendronate sodium tab 5 mg........................................ 38alendronate sodium tab 10 mg...................................... 38alendronate sodium tab 35 mg...................................... 38alendronate sodium tab 70 mg (Fosamax)...................38ALEVICYN ANTIPRURITIC SG -dermatological products

misc - liquid...................................................................170alfuzosin hcl tab er 24hr 10 mg (Uroxatral)..................76ALINIA -nitazoxanide for susp 100 mg/5ml.......................12ALINIA -nitazoxanide tab 500 mg..................................... 12ALITRAQ -nutritional supplement pack...........................131ALKERAN -melphalan tab 2 mg....................................... 16allopurinol tab 100 mg (Zyloprim)............................... 109allopurinol tab 300 mg (Zyloprim)............................... 109ALLZITAL -butalbital-acetaminophen tab 25-325 mg....... 96almotriptan malate tab 6.25 mg (Axert).......................108almotriptan malate tab 12.5 mg (Axert).......................108ALOCRIL -nedocromil sodium ophth soln 2%................ 162ALOGLIPTIN/METFORMIN HCL -alogliptin-metformin hcl

tab 12.5-500 mg............................................................. 29ALOGLIPTIN/METFORMIN HCL -alogliptin-metformin hcl

tab 12.5-1000 mg........................................................... 29ALOGLIPTIN/PIOGLITAZONE -alogliptin-pioglitazone tab

12.5-15 mg......................................................................29ALOGLIPTIN/PIOGLITAZONE -alogliptin-pioglitazone tab



25-15 mg......................................................................... 29ALOGLIPTIN/PIOGLITAZONE -alogliptin-pioglitazone tab

25-30 mg......................................................................... 29ALOGLIPTIN/PIOGLITAZONE -alogliptin-pioglitazone tab

25-45 mg......................................................................... 29ALOGLIPTIN -alogliptin benzoate tab 6.25 mg (base

equiv)...............................................................................29ALOGLIPTIN -alogliptin benzoate tab 12.5 mg (base

equiv)...............................................................................29ALOGLIPTIN -alogliptin benzoate tab 25 mg (base

equiv)...............................................................................29

ALOMIDE -lodoxamide tromethamine ophth soln0.1%...............................................................................163

ALOQUIN -iodoquinol-aloe polysaccharides gel1.25-1%......................................................................... 170

ALORA -estradiol td patch twice weekly 0.025mg/24hr........................................................................... 24

ALORA -estradiol td patch twice weekly 0.05 mg/24hr.....24ALORA -estradiol td patch twice weekly 0.075

mg/24hr........................................................................... 24ALORA -estradiol td patch twice weekly 0.1 mg/24hr.......24alosetron hcl tab 0.5 mg (base equiv) (Lotronex)........72alosetron hcl tab 1 mg (base equiv) (Lotronex)...........72ALPHAGAN P -brimonidine tartrate ophth soln 0.1%.....163ALPHANATE/VON WILLEBRAND -antihemophilic factor/

vwf (human) for inj 250 unit......................................... 157ALPHANATE/VON WILLEBRAND -antihemophilic factor/

vwf (human) for inj 500 unit......................................... 157ALPHANATE/VON WILLEBRAND -antihemophilic factor/

vwf (human) for inj 1000 unit....................................... 157ALPHANATE/VON WILLEBRAND -antihemophilic factor/

vwf (human) for inj 1500 unit....................................... 157ALPHANATE/VON WILLEBRAND -antihemophilic factor/

vwf (human) for inj 2000 unit....................................... 157ALPHANINE SD -coagulation factor ix for inj 500

unit................................................................................. 157ALPHANINE SD -coagulation factor ix for inj 1000

unit................................................................................. 157ALPHANINE SD -coagulation factor ix for inj 1500

unit................................................................................. 157ALPRAZOLAM INTENSOL -alprazolam conc 1 mg/

ml..................................................................................... 77alprazolam orally disintegrating tab 0.5 mg.................77alprazolam orally disintegrating tab 1 mg....................77alprazolam orally disintegrating tab 2 mg....................77alprazolam orally disintegrating tab 0.25 mg

(Niravam)........................................................................77alprazolam tab er 24hr 0.5 mg (Xanax xr).....................77alprazolam tab er 24hr 1 mg (Xanax xr)........................77alprazolam tab er 24hr 2 mg (Xanax xr)........................77alprazolam tab er 24hr 3 mg (Xanax xr)........................77alprazolam tab 0.25 mg (Xanax).................................... 77alprazolam tab 0.5 mg (Xanax)...................................... 77alprazolam tab 1 mg (Xanax)..........................................77alprazolam tab 2 mg (Xanax)..........................................77ALPROLIX -coagulation factor ix (recomb) (rfixfc) for inj

250 unit......................................................................... 157ALPROLIX -coagulation factor ix (recomb) (rfixfc) for inj

500 unit......................................................................... 157ALPROLIX -coagulation factor ix (recomb) (rfixfc) for inj

1000 unit....................................................................... 157ALPROLIX -coagulation factor ix (recomb) (rfixfc) for inj

2000 unit....................................................................... 157

2016



ALPROLIX -coagulation factor ix (recomb) (rfixfc) for inj3000 unit....................................................................... 157

ALPROLIX -coagulation factor ix (recomb) (rfixfc) for inj4000 unit....................................................................... 157

ALREX -loteprednol etabonate ophth susp 0.2%........... 163ALTABAX -retapamulin oint 1%.......................................170ALTOPREV -lovastatin tab er 24hr 20 mg........................ 55ALTOPREV -lovastatin tab er 24hr 40 mg........................ 55ALTOPREV -lovastatin tab er 24hr 60 mg........................ 55ALUNBRIG -brigatinib tab 30 mg......................................16ALVESCO -ciclesonide inhal aerosol 80 mcg/act............. 63ALVESCO -ciclesonide inhal aerosol 160 mcg/act........... 63amantadine hcl cap 100 mg......................................... 115amantadine hcl syrup 50 mg/5ml................................ 115amantadine hcl tab 100 mg.......................................... 115AMCINONIDE -amcinonide cream 0.1%........................ 170AMICAR -aminocaproic acid oral soln 0.25 gm/ml......... 156AMICAR -aminocaproic acid tab 500 mg........................156AMICAR -aminocaproic acid tab 1000 mg......................156amiloride & hydrochlorothiazide tab 5-50 mg..............54amiloride hcl tab 5 mg.................................................... 54amino acids cap.............................................................130amino acids tab..............................................................130amiodarone hcl tab 100 mg............................................46amiodarone hcl tab 400 mg............................................46amiodarone hcl tab 200 mg (Cordarone)......................46AMITIZA -lubiprostone cap 8 mcg.................................... 72AMITIZA -lubiprostone cap 24 mcg.................................. 72amitriptyline hcl tab 10 mg.............................................78amitriptyline hcl tab 25 mg.............................................78amitriptyline hcl tab 50 mg.............................................78amitriptyline hcl tab 75 mg.............................................78amitriptyline hcl tab 100 mg...........................................78amitriptyline hcl tab 150 mg...........................................78amlodipine besylate-atorvastatin calcium tab 2.5-10

mg (Caduet)................................................................... 58amlodipine besylate-atorvastatin calcium tab 2.5-20

mg (Caduet)................................................................... 58amlodipine besylate-atorvastatin calcium tab 2.5-40

mg (Caduet)................................................................... 58amlodipine besylate-atorvastatin calcium tab 5-10 mg

(Caduet).......................................................................... 58amlodipine besylate-atorvastatin calcium tab 5-20 mg



(Caduet).......................................................................... 59amlodipine besylate-atorvastatin calcium tab 10-10

mg (Caduet)................................................................... 59amlodipine besylate-atorvastatin calcium tab 10-20

mg (Caduet)................................................................... 59

amlodipine besylate-atorvastatin calcium tab 10-40mg (Caduet)................................................................... 59

amlodipine besylate-atorvastatin calcium tab 10-80mg (Caduet)................................................................... 59

amlodipine besylate-benazepril hcl cap 2.5-10 mg(Lotrel)............................................................................ 47

amlodipine besylate-benazepril hcl cap 5-10 mg(Lotrel)............................................................................ 47





amlodipine besylate-olmesartan medoxomil tab 5-20mg (Azor)....................................................................... 47




amlodipine besylate tab 2.5 mg (Norvasc)................... 44amlodipine besylate tab 5 mg (Norvasc)...................... 44amlodipine besylate tab 10 mg (Norvasc).................... 44amlodipine besylate-valsartan tab 5-160 mg

(Exforge).........................................................................47amlodipine besylate-valsartan tab 5-320 mg



(Exforge).........................................................................47amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg (Exforge hct)........................................ 47amlodipine-valsartan-hydrochlorothiazide tab

5-160-25 mg (Exforge hct)........................................... 47amlodipine-valsartan-hydrochlorothiazide tab

10-160-12.5 mg (Exforge hct)...................................... 47amlodipine-valsartan-hydrochlorothiazide tab

10-160-25 mg (Exforge hct)......................................... 47amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg (Exforge hct)......................................... 47AMOXAPINE -amoxapine tab 25 mg................................78AMOXAPINE -amoxapine tab 50 mg................................78AMOXAPINE -amoxapine tab 100 mg..............................78AMOXAPINE -amoxapine tab 150 mg..............................78AMOXICILLIN/CLAVULANATE P -amoxicillin & k

clavulanate chew tab 200-28.5 mg.................................. 1

2016



AMOXICILLIN/CLAVULANATE P -amoxicillin & kclavulanate chew tab 400-57 mg..................................... 1

amoxicillin & k clavulanate for susp 200-28.5mg/5ml.............................................................................. 1

amoxicillin & k clavulanate for susp 400-57 mg/5ml..... 1amoxicillin & k clavulanate for susp 250-62.5 mg/5ml

(Augmentin)..................................................................... 1amoxicillin & k clavulanate for susp 600-42.9 mg/5ml

(Augmentin es-600)........................................................ 1amoxicillin & k clavulanate tab er 12hr 1000-62.5 mg

(Augmentin xr)................................................................ 1amoxicillin & k clavulanate tab 250-125 mg................... 1amoxicillin & k clavulanate tab 500-125 mg

(Augmentin)..................................................................... 1amoxicillin & k clavulanate tab 875-125 mg

(Augmentin)..................................................................... 1AMOXICILLIN -amoxicillin (trihydrate) chew tab 125

mg......................................................................................1AMOXICILLIN -amoxicillin (trihydrate) chew tab 250

mg......................................................................................1amoxicillin cap-clarithro tab-lansopraz cap dr therapy

pack (Prevpac).............................................................. 68amoxicillin (trihydrate) cap 250 mg.................................1amoxicillin (trihydrate) cap 500 mg.................................1amoxicillin (trihydrate) for susp 125 mg/5ml..................1amoxicillin (trihydrate) for susp 200 mg/5ml..................1amoxicillin (trihydrate) for susp 250 mg/5ml..................1amoxicillin (trihydrate) for susp 400 mg/5ml..................1amoxicillin (trihydrate) tab 500 mg..................................1amoxicillin (trihydrate) tab 875 mg..................................1amphetamine-dextroamphetamine cap er 24hr 5 mg

(Adderall xr)...................................................................88amphetamine-dextroamphetamine cap er 24hr 10 mg





(Adderall xr)...................................................................88amphetamine-dextroamphetamine tab 5 mg

(Adderall)........................................................................88amphetamine-dextroamphetamine tab 7.5 mg

(Adderall)........................................................................88amphetamine-dextroamphetamine tab 10 mg

(Adderall)........................................................................88amphetamine-dextroamphetamine tab 12.5 mg

(Adderall)........................................................................88amphetamine-dextroamphetamine tab 15 mg

(Adderall)........................................................................88

amphetamine-dextroamphetamine tab 20 mg(Adderall)........................................................................88

amphetamine-dextroamphetamine tab 30 mg(Adderall)........................................................................88

AMPICILLIN -ampicillin cap 500 mg................................... 1AMPYRA -dalfampridine tab er 12hr 10 mg..................... 91AMRIX -cyclobenzaprine hcl cap er 24hr 15 mg............ 118AMRIX -cyclobenzaprine hcl cap er 24hr 30 mg............ 118ANADROL-50 -oxymetholone tab 50 mg..........................23anagrelide hcl cap 1 mg............................................... 157anagrelide hcl cap 0.5 mg (Agrylin)............................ 157ANALPRAM-HC -hydrocortisone acetate w/ pramoxine

rectal lotn 2.5-1%..........................................................169ANASEPT -sodium hypochlorite liquid 0.057%.............. 182anastrozole tab 1 mg (Arimidex)................................... 16ANDROGEL PUMP -testosterone td gel 20.25 mg/act

(1.62%)............................................................................ 23ANDROGEL -testosterone td gel 25 mg/2.5gm (1%)....... 23ANDROGEL -testosterone td gel 50 mg/5gm (1%).......... 23ANDROGEL -testosterone td gel 20.25 mg/1.25gm

(1.62%)............................................................................ 23ANDROGEL -testosterone td gel 40.5 mg/2.5gm

(1.62%)............................................................................ 23ANGELIQ -drospirenone-estradiol tab 0.25-0.5 mg..........24ANGELIQ -drospirenone-estradiol tab 0.5-1 mg...............24ANIMI-3/VITAMIN D -folic acid-b6-b12-d-omega 3-

phytosterols cap 1 mg.................................................. 150ANIMI-3 -folic acid-b6-b12-d-omega 3-phytosterols cap 1

mg..................................................................................150ANORO ELLIPTA -umeclidinium-vilanterol aero powd ba

62.5-25 mcg/inh.............................................................. 63ANTARA -fenofibrate micronized cap 30 mg.................... 55ANTARA -fenofibrate micronized cap 90 mg.................... 55ANZEMET -dolasetron mesylate tab 50 mg..................... 70ANZEMET -dolasetron mesylate tab 100 mg................... 70APEXICON E -diflorasone diacetate emollient base

cream 0.05%.................................................................171APIDRA -insulin glulisine inj 100 unit/ml...........................34APIDRA SOLOSTAR -insulin glulisine soln pen-injector inj

100 unit/ml.......................................................................34APLENZIN -bupropion hbr tab er 24hr 174 mg................ 78APLENZIN -bupropion hbr tab er 24hr 348 mg................ 78APLENZIN -bupropion hbr tab er 24hr 522 mg................ 78APOKYN -apomorphine hcl soln cartridge 30

mg/3ml...........................................................................115apraclonidine hcl ophth soln 0.5% (base equivalent)

(Iopidine)...................................................................... 163aprepitant capsule 80 mg (Emend)............................... 70aprepitant capsule therapy pack 80 & 125 mg

(Emend).......................................................................... 70APRISO -mesalamine cap er 24hr 0.375 gm................... 72APTIOM -eslicarbazepine acetate tab 200 mg............... 109

2016



APTIOM -eslicarbazepine acetate tab 400 mg............... 109APTIOM -eslicarbazepine acetate tab 600 mg............... 109APTIOM -eslicarbazepine acetate tab 800 mg............... 109APTIVUS -tipranavir cap 250 mg........................................7APTIVUS -tipranavir oral soln 100 mg/ml........................... 7ARANESP ALBUMIN FREE -darbepoetin alfa soln inj 25

mcg/ml........................................................................... 150ARANESP ALBUMIN FREE -darbepoetin alfa soln inj 40





mcg/ml........................................................................... 150ARANESP ALBUMIN FREE -darbepoetin alfa soln

prefilled syringe 10 mcg/0.4ml..................................... 150ARANESP ALBUMIN FREE -darbepoetin alfa soln

prefilled syringe 25 mcg/0.42ml................................... 150ARANESP ALBUMIN FREE -darbepoetin alfa soln







prefilled syringe 500 mcg/ml........................................ 150ARCALYST -rilonacept for inj 220 mg.............................105ARCAPTA NEOHALER -indacaterol maleate inhal powder

cap 75 mcg (base equiv)................................................63ARGIMENT -amino acids pack....................................... 130ARGIMENT AT -amino acids pack..................................130ARGINAID EXTRA -nutritional supplement liquid...........131ARGINAID -nutritional supplement pack.........................131aripiprazole orally disintegrating tab 10 mg.................82aripiprazole orally disintegrating tab 15 mg.................82aripiprazole oral solution 1 mg/ml.................................82aripiprazole tab 2 mg (Abilify)........................................82aripiprazole tab 5 mg (Abilify)........................................83aripiprazole tab 10 mg (Abilify)......................................83aripiprazole tab 15 mg (Abilify)......................................83aripiprazole tab 20 mg (Abilify)......................................83aripiprazole tab 30 mg (Abilify)......................................83armodafinil tab 50 mg (Nuvigil)......................................88

armodafinil tab 150 mg (Nuvigil)................................... 88armodafinil tab 200 mg (Nuvigil)................................... 88armodafinil tab 250 mg (Nuvigil)................................... 88ARMOUR THYROID -thyroid tab 15 mg (1/4 grain)......... 36ARMOUR THYROID -thyroid tab 120 mg (2 grain).......... 36ARMOUR THYROID -thyroid tab 180 mg (3 grain).......... 36ARMOUR THYROID -thyroid tab 240 mg (4 grain).......... 36ARMOUR THYROID -thyroid tab 300 mg (5 grain).......... 36ASACOL HD -mesalamine tab delayed release 800

mg....................................................................................72ASMANEX TWISTHALER 120 ME -mometasone furoate

inhal powd 220 mcg/inh (breath activated)....................63ASMANEX TWISTHALER 30 MET -mometasone furoate

inhal powd 110 mcg/inh (breath activated).................... 63ASMANEX TWISTHALER 30 MET -mometasone furoate

inhal powd 220 mcg/inh (breath activated)....................63ASMANEX TWISTHALER 60 MET -mometasone furoate

inhal powd 220 mcg/inh (breath activated)....................63A-SOY -nutritional supplement liquid.............................. 131ASPIRIN-CAFFEINE-DIHYDROC -aspirin-caffeine-

dihydrocodeine cap 356.4-30-16 mg............................. 97aspirin chew tab 81 mg...................................................96aspirin-dipyridamole cap er 12hr 25-200 mg

(Aggrenox)................................................................... 157aspirin tab delayed release 81 mg.................................96ASTAGRAF XL -tacrolimus cap er 24hr 0.5 mg..............184ASTAGRAF XL -tacrolimus cap er 24hr 1 mg................ 184ASTAGRAF XL -tacrolimus cap er 24hr 5 mg................ 184ASTERO -lidocaine hcl gel 4%....................................... 171ATABEX EC -prenatal vit w/ dss-iron carbonyl-fa tab dr

29-1 mg......................................................................... 120ATELVIA -risedronate sodium tab delayed release 35

mg....................................................................................38atenolol & chlorthalidone tab 50-25 mg (Tenoretic

50)....................................................................................47atenolol & chlorthalidone tab 100-25 mg (Tenoretic

100)..................................................................................47atenolol tab 25 mg (Tenormin).......................................42atenolol tab 50 mg (Tenormin).......................................42atenolol tab 100 mg (Tenormin).....................................42ATGAM -lymphocyte immune globulin anti-thymocyte g inj

50 mg/ml(eq).................................................................184atomoxetine hcl cap 10 mg (base equiv)

(Strattera)....................................................................... 88atomoxetine hcl cap 18 mg (base equiv)




(Strattera)....................................................................... 88

2016



atomoxetine hcl cap 80 mg (base equiv)(Strattera)....................................................................... 88

atomoxetine hcl cap 100 mg (base equiv)(Strattera)....................................................................... 88

ATOPICLAIR -dermatological products misc - cream.....171atorvastatin calcium tab 10 mg (base equivalent)

(Lipitor)........................................................................... 55atorvastatin calcium tab 20 mg (base equivalent)



(Lipitor)........................................................................... 56atovaquone-proguanil hcl tab 62.5-25 mg

(Malarone)...................................................................... 11atovaquone-proguanil hcl tab 250-100 mg

(Malarone)...................................................................... 12atovaquone susp 750 mg/5ml (Mepron)....................... 12ATRAPRO CP -wound dressings - kit.............................171ATRAPRO DERMAL SPRAY -wound cleansers -

liquid.............................................................................. 171ATRIPLA -efavirenz-emtricitabine-tenofovir df tab

600-200-300 mg................................................................7ATROPINE SULFATE -atropine sulfate ophth oint

1%..................................................................................163ATROPINE SULFATE -atropine sulfate ophth soln

1%..................................................................................163ATROVENT HFA -ipratropium bromide hfa inhal aerosol

17 mcg/act.......................................................................63AUBAGIO -teriflunomide tab 7 mg....................................91AUBAGIO -teriflunomide tab 14 mg..................................91AUGMENTIN -amoxicillin & k clavulanate for susp

125-31.25 mg/5ml.............................................................1AURYXIA -ferric citrate tab 1 gm (210 mg ferric iron).......72AUSTEDO -deutetrabenazine tab 6 mg............................91AUSTEDO -deutetrabenazine tab 9 mg............................91AUSTEDO -deutetrabenazine tab 12 mg..........................91AVANDIA -rosiglitazone maleate tab 2 mg (base

equiv)...............................................................................29AVANDIA -rosiglitazone maleate tab 4 mg (base

equiv)...............................................................................29AVAR -sulfacetamide sodium w/ sulfur cleansing pad

9.5-5%........................................................................... 171AVC -sulfanilamide vaginal cream 15%............................ 75AVENOVA/NEUTROX -eyelid cleansers - liquid.............171AVENOVA -eyelid cleansers - liquid................................171AVODART -dutasteride cap 0.5 mg.................................. 76AVONEX -interferon beta-1a for im inj kit 30mcg

(33mcg(6.6 mu)/vial).......................................................91AVONEX -interferon beta-1a im prefilled syringe kit 30

mcg/0.5ml........................................................................91

AVONEX PEN -interferon beta-1a im auto-injector kit 30mcg/0.5ml........................................................................91

AXERT -almotriptan malate tab 6.25 mg........................ 108AXERT -almotriptan malate tab 12.5 mg........................ 108AZASAN -azathioprine tab 75 mg...................................184AZASAN -azathioprine tab 100 mg.................................184AZASITE -azithromycin ophth soln 1%...........................163azathioprine tab 50 mg (Imuran)..................................184azelastine hcl nasal spray 0.1% (137 mcg/spray)........ 60azelastine hcl nasal spray 0.15% (205.5 mcg/spray)

(Astepro).........................................................................60azelastine hcl ophth soln 0.05%.................................. 163AZILECT -rasagiline mesylate tab 0.5 mg (base

equiv).............................................................................115AZILECT -rasagiline mesylate tab 1 mg (base

equiv).............................................................................115AZITHROMYCIN -azithromycin powd pack for susp 1

gm......................................................................................3azithromycin for susp 100 mg/5ml (Zithromax)............. 3azithromycin for susp 200 mg/5ml (Zithromax)............. 3azithromycin tab 250 mg (Zithromax)............................. 3azithromycin tab 500 mg (Zithromax)............................. 3azithromycin tab 600 mg (Zithromax)............................. 3AZOPT -brinzolamide ophth susp 1%.............................163AZOR -amlodipine besylate-olmesartan medoxomil tab

5-20 mg........................................................................... 47AZOR -amlodipine besylate-olmesartan medoxomil tab

5-40 mg........................................................................... 47AZOR -amlodipine besylate-olmesartan medoxomil tab

10-20 mg......................................................................... 47AZOR -amlodipine besylate-olmesartan medoxomil tab

10-40 mg......................................................................... 47

BBABY DDROPS -cholecalciferol drops 400 unit/0.03ml

(per drop)...................................................................... 119BACITRACIN -bacitracin ophth oint 500 unit/gm............163bacitracin-polymyxin b ophth oint.............................. 163bacitracin-polymyxin-neomycin-hc ophth oint

1%..................................................................................163baclofen tab 10 mg........................................................118baclofen tab 20 mg........................................................118BACTROBAN NASAL -mupirocin calcium nasal oint

2%....................................................................................60BALANCED NUTRITIONAL DRIN -nutritional supplement

liquid.............................................................................. 132BALANCED NUTRITIONAL SHAK -nutritional

supplement liquid..........................................................132BALANCE TOTAL NUTRITIONAL -nutritional supplement

liquid.............................................................................. 132BAL-CARE DHA -prenat w/fe poly-na fered-fa tab 27-1 &

omega cap dr 430mg................................................... 120

2016



balsalazide disodium cap 750 mg (Colazal)................. 72BANZEL -rufinamide susp 40 mg/ml...............................109BANZEL -rufinamide tab 200 mg.................................... 109BANZEL -rufinamide tab 400 mg.................................... 110BARACLUDE -entecavir oral soln 0.05 mg/ml....................7BAYER BREEZE 2 TEST DISC -glucose blood test

disk................................................................................ 183BAYER CONTOUR BLOOD GLUCO -glucose blood test

strip................................................................................183BAYER CONTOUR NEXT BLOOD -glucose blood test

strip................................................................................183BCAD 1 -nutritional supplement powder.........................132BCAD 2 -nutritional supplement powder.........................132b-complex w/ c & folic acid cap 1 mg

(Nephrocaps)............................................................... 120b-complex w/ c & folic acid tab 5 mg..........................120b-complex w/ c & folic acid tab 1 mg (Nephro-vite

rx).................................................................................. 120BD GLUCOSE -glucose chew tab 5 gm........................... 29BEAU RX -scar treatment products - gel........................171BEBULIN -factor ix complex for inj 200-1200 unit.......... 157BEEF/POTATOES/PEAS -nutritional supplement

liquid.............................................................................. 132BELBUCA -buprenorphine hcl buccal film 75 mcg (base

equivalent).......................................................................97BELBUCA -buprenorphine hcl buccal film 150 mcg (base






equivalent).......................................................................97BELLADONNA & OPIUM -belladonna alkaloids & opium

suppos 16.2-30 mg.........................................................68BELLADONNA ALKALOIDS & OP -belladonna alkaloids

& opium suppos 16.2-60 mg..........................................68benazepril & hydrochlorothiazide tab 5-6.25 mg......... 47benazepril & hydrochlorothiazide tab 10-12.5 mg

(Lotensin hct)................................................................ 48benazepril & hydrochlorothiazide tab 20-12.5 mg

(Lotensin hct)................................................................ 48benazepril & hydrochlorothiazide tab 20-25 mg

(Lotensin hct)................................................................ 48benazepril hcl tab 5 mg.................................................. 48benazepril hcl tab 10 mg (Lotensin)..............................48benazepril hcl tab 20 mg (Lotensin)..............................48benazepril hcl tab 40 mg (Lotensin)..............................48

BENECALORIE -nutritional supplement liquid................132BENEFIX -coagulation factor ix (recombinant) for inj kit

250 unit......................................................................... 157BENEFIX -coagulation factor ix (recombinant) for inj kit

500 unit......................................................................... 157BENEFIX -coagulation factor ix (recombinant) for inj kit

1000 unit....................................................................... 157BENEFIX -coagulation factor ix (recombinant) for inj kit

2000 unit....................................................................... 157BENEFIX -coagulation factor ix (recombinant) for inj kit

3000 unit....................................................................... 157BENICAR HCT -olmesartan medoxomil-

hydrochlorothiazide tab 20-12.5 mg...............................48BENICAR HCT -olmesartan medoxomil-

hydrochlorothiazide tab 40-12.5 mg...............................48BENICAR HCT -olmesartan medoxomil-

hydrochlorothiazide tab 40-25 mg..................................48BENICAR -olmesartan medoxomil tab 5 mg.....................48BENICAR -olmesartan medoxomil tab 20 mg...................48BENICAR -olmesartan medoxomil tab 40 mg...................48BENSAL HP -salicylic acid & benzoic acid oint 3-6%.....171BENZIQ -benzoyl peroxide gel 5.25 %........................... 171BENZIQ LS -benzoyl peroxide gel 2.75%.......................171BENZIQ WASH -benzoyl peroxide liq 5.25%..................171benzocaine mouth/throat aerosol 20%....................... 167benzonatate cap 150 mg.................................................61benzonatate cap 200 mg.................................................61benzonatate cap 100 mg (Tessalon perles)..................61benzoyl peroxide cloth 6%........................................... 171benzoyl peroxide-erythromycin gel 5-3%

(Benzamycin)...............................................................171benzoyl peroxide foam 5.3% (Benzefoam)................. 171benzoyl peroxide foam 9.8% (Benzefoamultra)......... 171benzoyl peroxide liq 2.5%.............................................171benzoyl peroxide liq 7%................................................171benzoyl peroxide lotion 6%..........................................171benztropine mesylate tab 0.5 mg................................ 115benztropine mesylate tab 1 mg................................... 115benztropine mesylate tab 2 mg................................... 115BEPREVE -bepotastine besilate ophth soln 1.5%..........163BERINERT -c1 esterase inhibitor (human) for iv inj kit 500

unit................................................................................. 157BESIVANCE -besifloxacin hcl ophth susp 0.6% (base

equiv).............................................................................163BETADINE OPHTHALMIC PREP -povidone-iodine ophth

soln 5%......................................................................... 163betamethasone dipropionate augmented cream 0.05%

(Diprolene af)...............................................................171betamethasone dipropionate augmented gel

0.05%.............................................................................171betamethasone dipropionate augmented lotion 0.05%

(Diprolene)................................................................... 171

2016



betamethasone dipropionate augmented oint 0.05%(Diprolene)................................................................... 171

betamethasone dipropionate cream 0.05%................ 171betamethasone dipropionate lotion 0.05%.................171betamethasone dipropionate oint 0.05%.................... 171betamethasone valerate aerosol foam 0.12%

(Luxiq)...........................................................................171betamethasone valerate cream 0.1% (base

equivalent)................................................................... 171betamethasone valerate lotion 0.1% (base

equivalent)................................................................... 171betamethasone valerate oint 0.1% (base

equivalent)................................................................... 171BETASERON -interferon beta-1b for inj kit 0.3 mg...........91betaxolol hcl ophth soln 0.5%......................................163betaxolol hcl tab 10 mg (Kerlone)................................. 42betaxolol hcl tab 20 mg (Kerlone)................................. 42bethanechol chloride tab 5 mg (Urecholine)................75bethanechol chloride tab 10 mg (Urecholine)..............75bethanechol chloride tab 25 mg (Urecholine)..............75bethanechol chloride tab 50 mg (Urecholine)..............75BETHKIS -tobramycin nebu soln 300 mg/4ml.................... 5BETIMOL -timolol ophth soln 0.25%...............................163BETIMOL -timolol ophth soln 0.5%.................................163BETOPTIC-S -betaxolol hcl ophth susp 0.25%.............. 163BEVESPI AEROSPHERE -glycopyrrolate-formoterol

fumarate aerosol 9-4.8 mcg/act..................................... 64bexarotene cap 75 mg (Targretin)..................................16BEYAZ -drospirenone-ethinyl estrad-levomefolate tab

3-0.02-0.451 mg..............................................................26B-6 FOLIC ACID -cobalamine combination cap............. 150bicalutamide tab 50 mg (Casodex)................................16BIDIL -isosorbide dinitrate-hydralazine hcl tab 20-37.5

mg....................................................................................59BIFERARX -polysacch fe cmplx-fe heme poly-fa-b12 tab

22-6-1-0.025 mg........................................................... 151BILTRICIDE -praziquantel tab 600 mg..............................12BIMATOPROST -bimatoprost ophth soln 0.03%............ 163BINOSTO -alendronate sodium effervescent tab 70

mg....................................................................................38BIO-STATIN -nystatin cap 500000 unit............................... 6BIO-STATIN -nystatin cap 1000000 unit............................. 6bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for soln

kit.....................................................................................67bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg

(Ziac)............................................................................... 48bisoprolol & hydrochlorothiazide tab 5-6.25 mg

(Ziac)............................................................................... 48bisoprolol & hydrochlorothiazide tab 10-6.25 mg

(Ziac)............................................................................... 48bisoprolol fumarate tab 5 mg (Zebeta)..........................42bisoprolol fumarate tab 10 mg (Zebeta)........................42

BLEPHAMIDE S.O.P. -sulfacetamide sodium-prednisolone ophth oint 10-0.2%................................. 163

BLEPHAMIDE -sulfacetamide sodium-prednisolone ophthsusp 10-0.2%................................................................ 163

BLOOD GLUCOSE CALIBRATION LIQUID-VARIOUS.......................................................................183

BOCASAL -artificial saliva - packet.................................167BOOST/BENEFIBER -nutritional supplement liquid....... 132BOOST BREEZE -nutritional supplement liquid............. 132BOOST CALORIE SMART -nutritional supplement

liquid.............................................................................. 132BOOST 100 CALORIE SMART -nutritional supplement

liquid.............................................................................. 132BOOST COMPACT -nutritional supplement liquid..........132BOOST GLUCOSE CONTROL -nutritional supplement

liquid.............................................................................. 132BOOST HIGH PROTEIN -nutritional supplement

liquid.............................................................................. 132BOOST HIGH PROTEIN -nutritional supplement

powder...........................................................................132BOOST KID ESSENTIALS 1.0 -nutritional supplement

liquid.............................................................................. 132BOOST KID ESSENTIALS 1.5 -nutritional supplement

liquid.............................................................................. 132BOOST KIDS ESSENTIALS -nutritional supplement

liquid.............................................................................. 132BOOST -nutritional supplement liquid.............................132BOOST PLUS -nutritional supplement liquid.................. 132BOOST PUDDING -nutritional supplement pudding.......132BOOSTRIX -tet tox-diph-acell pertuss ad inj 5-2.5-18.5 lf-

lf-mcg/0.5ml.....................................................................14BOOST SMOOTHIE -nutritional supplement liquid........ 132BOOST VHC -nutritional supplement liquid.................... 132BOSULIF -bosutinib tab 100 mg....................................... 16BOSULIF -bosutinib tab 500 mg....................................... 16BP CLEANSING WASH -sulfacetamide sodium-sulfur in

urea emulsion 10-4%................................................... 171BP FOLINATAL PLUS B -prenatal w/ calcium carbonate-

b6-b12-fa tab 1 mg.......................................................120BP MULTINATAL PLUS -prenatal w/o a vit w/ fe fumarate-

fa tab 30-1 mg.............................................................. 120BP MULTINATAL PLUS -prenatal w/o a vit w/ fe fum-fa

tab chew 40-1 mg.........................................................120BP VIT 3 -folic acid-vit b6-vit b12-omega 3-phytosterols

cap 1 mg.......................................................................151BREATHERITE COLLAPSIBLE -spacer/aerosol-holding

chambers - device........................................................ 183BREATHERITE RIGID SPACER -spacer/aerosol-holding

chambers - device........................................................ 183BREATHERITE -spacer/aerosol-holding chambers -

device............................................................................ 183

2016



BREATHERITE VALVED MDI CH -respiratory therapysupplies - devices.........................................................183

BREATHERITE W/LARGE MASK -spacer/aerosol-holdingchambers - device........................................................ 183

BREATHERITE W/MEDIUM MASK -spacer/aerosol-holding chambers - device........................................... 183

BREATHERITE W/SMALL MASK -spacer/aerosol-holdingchambers - device........................................................ 183

BREO ELLIPTA -fluticasone furoate-vilanterol aero powdba 100-25 mcg/inh..........................................................64

BREO ELLIPTA -fluticasone furoate-vilanterol aero powdba 200-25 mcg/inh..........................................................64

BRILINTA -ticagrelor tab 60 mg...................................... 157BRILINTA -ticagrelor tab 90 mg...................................... 158brimonidine tartrate ophth soln 0.2%......................... 163brimonidine tartrate ophth soln 0.15% (Alphagan

p)................................................................................... 163BRISDELLE -paroxetine mesylate cap 7.5 mg (base

equiv)...............................................................................91BRIVIACT -brivaracetam oral soln 10 mg/ml..................110BRIVIACT -brivaracetam tab 10 mg............................... 110BRIVIACT -brivaracetam tab 25 mg............................... 110BRIVIACT -brivaracetam tab 50 mg............................... 110BRIVIACT -brivaracetam tab 75 mg............................... 110BRIVIACT -brivaracetam tab 100 mg............................. 110BROMFENAC -bromfenac sodium ophth soln 0.09%

(base equiv) (once-daily)..............................................163bromocriptine mesylate cap 5 mg (base equivalent)

(Parlodel)......................................................................115bromocriptine mesylate tab 2.5 mg (base equivalent)

(Parlodel)......................................................................115brompheniramine & pseudoephedrine tab sr 12hr

6-45 mg...........................................................................61brompheniramine maleate tab sr 12hr 6 mg................ 60BROVANA -arformoterol tartrate soln nebu 15 mcg/2ml

(base equiv).................................................................... 64budesonide delayed release particles cap 3 mg

(Entocort ec)..................................................................21budesonide inhalation susp 0.25 mg/2ml

(Pulmicort)......................................................................64budesonide inhalation susp 0.5 mg/2ml

(Pulmicort)......................................................................64budesonide inhalation susp 1 mg/2ml (Pulmicort)......64bumetanide tab 0.5 mg................................................... 54bumetanide tab 1 mg...................................................... 54bumetanide tab 2 mg...................................................... 54BUNAVAIL -buprenorphine-naloxone buccal film 2.1-0.3

mg (base equiv)..............................................................97BUNAVAIL -buprenorphine-naloxone buccal film 4.2-0.7

mg (base equiv)..............................................................97BUNAVAIL -buprenorphine-naloxone buccal film 6.3-1 mg

(base equiv).................................................................... 97

BUPHENYL -sodium phenylbutyrate tab 500 mg............. 38BUPRENORPHINE -buprenorphine td patch weekly 5

mcg/hr..............................................................................97BUPRENORPHINE -buprenorphine td patch weekly 7.5

mcg/hr..............................................................................97BUPRENORPHINE -buprenorphine td patch weekly 10



mcg/hr..............................................................................97buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base

equiv).............................................................................. 97buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base

equiv).............................................................................. 97buprenorphine hcl sl tab 2 mg (base equiv)................ 97buprenorphine hcl sl tab 8 mg (base equiv)................ 97bupropion hcl (smoking deterrent) tab er 12hr 150 mg

(Zyban)............................................................................91bupropion hcl tab er 12hr 100 mg (Wellbutrin sr)........78bupropion hcl tab er 12hr 150 mg (Wellbutrin sr)........78bupropion hcl tab er 12hr 200 mg (Wellbutrin sr)........78bupropion hcl tab er 24hr 150 mg (Wellbutrin xl)........ 78bupropion hcl tab er 24hr 300 mg (Wellbutrin xl)........ 78bupropion hcl tab 75 mg (Wellbutrin)........................... 78bupropion hcl tab 100 mg (Wellbutrin)......................... 78buspirone hcl tab 5 mg...................................................77buspirone hcl tab 7.5 mg................................................77buspirone hcl tab 10 mg.................................................77buspirone hcl tab 15 mg.................................................77buspirone hcl tab 30 mg.................................................77BUTALBITAL/ASPIRIN/CAFFEI -butalbital-aspirin-caffeine

tab 50-325-40 mg........................................................... 96butalbital-acetaminophen-caffeine cap 50-325-40

mg................................................................................... 96butalbital-acetaminophen-caffeine cap 50-300-40 mg

(Fioricet)......................................................................... 96butalbital-acetaminophen-caffeine tab 50-325-40 mg

(Esgic).............................................................................96butalbital-acetaminophen-caff w/ cod cap

50-325-40-30 mg............................................................97butalbital-acetaminophen-caff w/ cod cap

50-300-40-30 mg (Fioricet/codeine)............................ 97butalbital-acetaminophen tab 50-300 mg......................96butalbital-acetaminophen tab 50-325 mg......................96butalbital-aspirin-caffeine cap 50-325-40 mg

(Fiorinal)......................................................................... 96butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg

(Fiorinal/codeine #3).....................................................97BUTISOL SODIUM -butabarbital sodium tab 30 mg.........87butorphanol tartrate nasal soln 10 mg/ml.................... 97BUTRANS -buprenorphine td patch weekly 5 mcg/hr.......98

2016



BUTRANS -buprenorphine td patch weekly 7.5 mcg/hr......................................................................................98

BUTRANS -buprenorphine td patch weekly 10 mcg/hr......................................................................................98



BYDUREON -exenatide for inj extended release susp 2mg....................................................................................29

BYDUREON PEN -exenatide extended release for susppen-injector 2 mg............................................................29

BYETTA -exenatide soln pen-injector 5 mcg/0.02ml........ 29BYETTA -exenatide soln pen-injector 10 mcg/0.04ml...... 29BYSTOLIC -nebivolol hcl tab 2.5 mg (base

equivalent).......................................................................42BYSTOLIC -nebivolol hcl tab 5 mg (base equivalent).......42BYSTOLIC -nebivolol hcl tab 10 mg (base

equivalent).......................................................................42BYSTOLIC -nebivolol hcl tab 20 mg (base

equivalent).......................................................................42BYVALSON -nebivolol-valsartan tab 5-80 mg.................. 48

Ccabergoline tab 0.5 mg................................................... 38CABOMETYX -cabozantinib s-malate tab 20 mg (base

equivalent).......................................................................16CABOMETYX -cabozantinib s-malate tab 40 mg (base

equivalent).......................................................................16CABOMETYX -cabozantinib s-malate tab 60 mg (base

equivalent).......................................................................16caffeine citrate oral soln 60 mg/3ml (10 mg/ml base

equiv).............................................................................. 88CALCIFOL -ca carb-folic acid-vit d-b6-b12-boron-mag

wafer 1342-1.6 mg........................................................129CALCILO XD -infant foods powder................................. 132calcipotriene-betamethasone dipropionate oint

0.005-0.064% (Taclonex)............................................ 172calcipotriene cream 0.005% (Dovonex).......................171calcipotriene oint 0.005%..............................................171calcipotriene soln 0.005% (50 mcg/ml)....................... 171calcitonin (salmon) nasal soln 200 unit/act

(Miacalcin)......................................................................38CALCITRIOL -calcitriol oint 3 mcg/gm............................ 172calcitriol cap 0.25 mcg (Rocaltrol).................................38calcitriol cap 0.5 mcg (Rocaltrol)...................................38calcitriol oral soln 1 mcg/ml (Rocaltrol)........................38calcium acetate (phosphate binder) cap 667 mg (169

mg ca) (Phoslo).............................................................72calcium acetate (phosphate binder) tab 667 mg

(Eliphos)......................................................................... 72

CALCIUM-FOLIC ACID PLUS D -ca carb-folic acid-vit d-b6-b12-boron-mag wafer 1342-1 mg........................... 129

CALCIUM PNV -prenatal w/o vit a w/ fe fum-fa-omega 3cap 28-1-250 mg.......................................................... 120

CAMBIA -diclofenac potassium packet 50 mg................108CAMINO PRO BETTERMILK/GLY -nutritional supplement

pack............................................................................... 132CAMINO PRO COMPLETE/GLYTA -nutritional

supplement bar............................................................. 132CAMINO PRO 15PE -nutritional supplement liquid........ 132CAMINO PRO PKU -nutritional supplement liquid..........132CAMINO PRO RESTORE/GLYTAC -nutritional

supplement liquid..........................................................132CAMINO PRO SWIRL -nutritional supplement pack...... 132CANASA -mesalamine suppos 1000 mg.......................... 72candesartan cilexetil-hydrochlorothiazide tab 16-12.5

mg (Atacand hct).......................................................... 48candesartan cilexetil-hydrochlorothiazide tab 32-12.5

mg (Atacand hct).......................................................... 48candesartan cilexetil-hydrochlorothiazide tab 32-25

mg (Atacand hct).......................................................... 48candesartan cilexetil tab 4 mg (Atacand)..................... 48candesartan cilexetil tab 8 mg (Atacand)..................... 48candesartan cilexetil tab 16 mg (Atacand)................... 48candesartan cilexetil tab 32 mg (Atacand)................... 48CAPCOF -phenylephrine-chlorphen w/ codeine syrup

5-2-10 mg/5ml.................................................................61capecitabine tab 150 mg (Xeloda)................................. 16capecitabine tab 500 mg (Xeloda)................................. 16CAPEX -fluocinolone acetonide shampoo 0.01%...........172CAPHOSOL -artificial saliva - solution............................167CAPRELSA -vandetanib tab 100 mg................................ 16CAPRELSA -vandetanib tab 300 mg................................ 16CAPTOPRIL/HYDROCHLOROTHIA -captopril &

hydrochlorothiazide tab 25-15 mg..................................48CAPTOPRIL/HYDROCHLOROTHIA -captopril &



hydrochlorothiazide tab 50-25 mg..................................49captopril tab 12.5 mg...................................................... 48captopril tab 25 mg......................................................... 48captopril tab 50 mg......................................................... 48captopril tab 100 mg....................................................... 48CARAC -fluorouracil cream 0.5%....................................172CARAFATE -sucralfate susp 1 gm/10ml........................... 68CARBAGLU -carglumic acid tab 200 mg..........................38carbamazepine cap er 12hr 100 mg (Carbatrol).........110carbamazepine cap er 12hr 200 mg (Carbatrol).........110carbamazepine cap er 12hr 300 mg (Carbatrol).........110carbamazepine chew tab 100 mg................................ 110

2016



carbamazepine susp 100 mg/5ml (Tegretol)...............110carbamazepine tab er 12hr 100 mg (Tegretol-xr)....... 110carbamazepine tab er 12hr 200 mg (Tegretol-xr)....... 110carbamazepine tab er 12hr 400 mg (Tegretol-xr)....... 110carbamazepine tab 200 mg (Tegretol).........................110CARBATROL -carbamazepine cap er 12hr 100 mg....... 110CARBATROL -carbamazepine cap er 12hr 200 mg....... 110CARBATROL -carbamazepine cap er 12hr 300 mg....... 110CARBIDOPA/LEVODOPA/ENTACA -carbidopa-levodopa-

entacapone tabs 12.5-50-200 mg................................ 116CARBIDOPA/LEVODOPA/ENTACA -carbidopa-levodopa-

entacapone tabs 18.75-75-200 mg..............................116CARBIDOPA/LEVODOPA/ENTACA -carbidopa-levodopa-

entacapone tabs 25-100-200 mg................................. 116CARBIDOPA/LEVODOPA/ENTACA -carbidopa-levodopa-

entacapone tabs 31.25-125-200 mg............................116CARBIDOPA/LEVODOPA/ENTACA -carbidopa-levodopa-

entacapone tabs 37.5-150-200 mg..............................116CARBIDOPA/LEVODOPA/ENTACA -carbidopa-levodopa-

entacapone tabs 50-200-200 mg................................. 116carbidopa & levodopa orally disintegrating tab 10-100

mg................................................................................. 115carbidopa & levodopa orally disintegrating tab 25-100

mg................................................................................. 115carbidopa & levodopa orally disintegrating tab 25-250

mg................................................................................. 115carbidopa & levodopa tab er 25-100 mg (Sinemet

cr).................................................................................. 115carbidopa & levodopa tab er 50-200 mg (Sinemet

cr).................................................................................. 115carbidopa & levodopa tab 10-100 mg (Sinemet)........115carbidopa & levodopa tab 25-100 mg (Sinemet)........116carbidopa & levodopa tab 25-250 mg (Sinemet)........116carbidopa tab 25 mg (Lodosyn)...................................116carbinoxamine maleate soln 4 mg/5ml......................... 60carbinoxamine maleate tab 4 mg.................................. 60carbonyl iron susp 15 mg/1.25ml (elemental

iron)...............................................................................151CARDIOTEK-RX -folic acid-b12-b6-arginine-black pepper

tab..................................................................................132CARDIOVID PLUS -dha-epa-vit b6-b12-folic acid cap

240-360-20-0.5-0.8 mg.................................................130CARDIZEM LA -diltiazem hcl coated beads tab er 24hr

120 mg............................................................................ 44CARDURA XL -doxazosin mesylate tab er 24 hr 4 mg

(base equiv).................................................................... 76CARDURA XL -doxazosin mesylate tab er 24 hr 8 mg

(base equiv).................................................................... 76carisoprodol tab 250 mg (Soma)................................. 118carisoprodol tab 350 mg (Soma)................................. 118carisoprodol w/ aspirin & codeine tab 200-325-16

mg................................................................................. 118

carisoprodol w/ aspirin tab 200-325 mg......................118CARNATION BREAKFAST ESSEN -nutritional

supplement liquid..........................................................132CARNATION BREAKFAST ESSEN -nutritional

supplement pack...........................................................133CARNATION INSTANT BREAKFA -nutritional supplement

liquid.............................................................................. 133carteolol hcl ophth soln 1%......................................... 163carvedilol tab 3.125 mg (Coreg).....................................42carvedilol tab 6.25 mg (Coreg).......................................42carvedilol tab 12.5 mg (Coreg).......................................42carvedilol tab 25 mg (Coreg)..........................................42CAYA -diaphragm arc-spring........................................... 183CAYSTON -aztreonam lysine for inhal soln 75 mg (base

equivalent).......................................................................12C-BUFF -multiple vitamins w/ minerals powder..............120CEDAX -ceftibuten cap 400 mg.......................................... 1CEDAX -ceftibuten for susp 180 mg/5ml............................ 2cefaclor cap 250 mg.......................................................... 2cefaclor cap 500 mg.......................................................... 2CEFACLOR -cefaclor for susp 125 mg/5ml........................ 2CEFACLOR -cefaclor for susp 250 mg/5ml........................ 2CEFACLOR -cefaclor for susp 375 mg/5ml........................ 2CEFACLOR ER -cefaclor monohydrate tab er 12hr 500

mg......................................................................................2cefadroxil cap 500 mg.......................................................2cefadroxil for susp 250 mg/5ml....................................... 2cefadroxil for susp 500 mg/5ml....................................... 2cefadroxil tab 1 gm............................................................2cefdinir cap 300 mg...........................................................2cefdinir for susp 125 mg/5ml........................................... 2cefdinir for susp 250 mg/5ml........................................... 2CEFDITOREN PIVOXIL -cefditoren pivoxil tab 200 mg

(base equivalent).............................................................. 2CEFDITOREN PIVOXIL -cefditoren pivoxil tab 400 mg

(base equivalent).............................................................. 2cefixime for susp 100 mg/5ml (Suprax).......................... 2cefixime for susp 200 mg/5ml (Suprax).......................... 2cefpodoxime proxetil for susp 50 mg/5ml......................2cefpodoxime proxetil for susp 100 mg/5ml....................2cefpodoxime proxetil tab 100 mg.................................... 2cefpodoxime proxetil tab 200 mg.................................... 2cefprozil for susp 125 mg/5ml..........................................2cefprozil for susp 250 mg/5ml..........................................2cefprozil tab 250 mg..........................................................2cefprozil tab 500 mg..........................................................2CEFTIBUTEN -ceftibuten cap 400 mg................................2CEFTIBUTEN -ceftibuten for susp 180 mg/5ml..................2CEFTIN -cefuroxime axetil for susp 125 mg/5ml................ 2CEFTIN -cefuroxime axetil for susp 250 mg/5ml................ 2cefuroxime axetil tab 250 mg (Ceftin)............................. 2cefuroxime axetil tab 500 mg (Ceftin)............................. 2

2016



celecoxib cap 50 mg (Celebrex).................................. 105celecoxib cap 100 mg (Celebrex)................................ 105celecoxib cap 200 mg (Celebrex)................................ 105celecoxib cap 400 mg (Celebrex)................................ 105CELONTIN -methsuximide cap 300 mg..........................110CEM-UREA -urea soln 45%............................................172CENTANY -mupirocin oint 2%.........................................172CENTRATEX -ferrous fumarate-fa-b complex-c-zn-mg-

mn-cu cap 106-1 mg.................................................... 151cephalexin cap 250 mg (Keflex).......................................2cephalexin cap 500 mg (Keflex).......................................2cephalexin cap 750 mg (Keflex).......................................2CEPHALEXIN -cephalexin tab 250 mg...............................2CEPHALEXIN -cephalexin tab 500 mg...............................2cephalexin for susp 125 mg/5ml......................................2cephalexin for susp 250 mg/5ml......................................2CERACADE -dermatological products misc -

emulsion........................................................................ 172CERDELGA -eliglustat tartrate cap 84 mg (base

equivalent).....................................................................151CEREFOLIN -l-methylfolate w/ vit b12-vit b6-vit b2 tab

6-1-50-5 mg.................................................................. 133CERVIDIL -dinoprostone vaginal inserts 10 mg............... 38CESAMET -nabilone cap 1 mg......................................... 70CETRAXAL -ciprofloxacin hcl otic soln 0.2% (base

equivalent).....................................................................167CETYLEV -acetylcysteine effervescent tab 2.5 gm........ 182CETYLEV -acetylcysteine effervescent tab 500 mg....... 182cevimeline hcl cap 30 mg (Evoxac).............................167CHANTIX CONTINUING MONTH -varenicline tartrate tab

1 mg (base equiv).......................................................... 91CHANTIX STARTING MONTH PA -varenicline tartrate tab

0.5 mg x 11 & tab 1 mg x 42 pack.................................91CHANTIX -varenicline tartrate tab 0.5 mg (base

equiv)...............................................................................91CHANTIX -varenicline tartrate tab 1 mg (base equiv).......91CHEMET -succimer cap 100 mg.................................... 182CHENODAL -chenodiol tab 250 mg................................. 72CHLORDIAZEPOXIDE/AMITRIPT -chlordiazepoxide-

amitriptyline tab 5-12.5 mg.............................................91CHLORDIAZEPOXIDE/AMITRIPT -chlordiazepoxide-

amitriptyline tab 10-25 mg..............................................91chlordiazepoxide hcl cap 5 mg......................................77chlordiazepoxide hcl cap 10 mg....................................77chlordiazepoxide hcl cap 25 mg....................................77chlordiazepoxide hcl-clidinium bromide cap 5-2.5 mg

(Librax)........................................................................... 68chlorhexidine gluconate soln 0.12% (Peridex)...........167CHLOROQUINE PHOSPHATE -chloroquine phosphate

tab 250 mg......................................................................12chloroquine phosphate tab 500 mg (Aralen)................12CHLOROTHIAZIDE -chlorothiazide tab 250 mg...............54

chlorothiazide tab 500 mg.............................................. 54chlorpromazine hcl tab 10 mg....................................... 83chlorpromazine hcl tab 25 mg....................................... 83chlorpromazine hcl tab 50 mg....................................... 83chlorpromazine hcl tab 100 mg..................................... 83chlorpromazine hcl tab 200 mg..................................... 83CHLORPROPAMIDE -chlorpropamide tab 100 mg.......... 29CHLORPROPAMIDE -chlorpropamide tab 250 mg.......... 29chlorthalidone tab 25 mg................................................54chlorthalidone tab 50 mg................................................54CHLORZOXAZONE -chlorzoxazone tab 250 mg........... 118chlorzoxazone tab 500 mg (Parafon forte dsc).......... 118CHOICE DM -nutritional supplement liquid.....................133CHOICE DM TF -nutritional supplement liquid............... 133CHOLBAM -cholic acid cap 50 mg................................... 72CHOLBAM -cholic acid cap 250 mg................................. 72cholecalciferol cap 400 unit......................................... 119cholecalciferol cap 1000 unit....................................... 119cholecalciferol cap 50000 unit..................................... 119cholecalciferol chew tab 400 unit................................119cholecalciferol chew tab 1000 unit..............................119cholecalciferol drops 400 unit/0.03ml (per drop).......119cholecalciferol drops 5000 unit/ml (1000

unit/0.2ml).....................................................................119cholecalciferol oral liquid 400 unit/ml.........................119cholecalciferol tab 400 unit.......................................... 119cholecalciferol tab 1000 unit........................................ 119cholecalciferol tab 50000 unit...................................... 119cholestyramine light powder 4 gm/dose (Questran

light)................................................................................ 56cholestyramine light powder packets 4 gm................. 56cholestyramine powder 4 gm/dose (Questran)............56cholestyramine powder packets 4 gm (Questran).......56CHOLEXTRA -nutritional supplement powder................133choline & magnesium salicylates liq 500 mg/5ml........96choline fenofibrate cap dr 45 mg (fenofibric acid

equiv) (Trilipix).............................................................. 56choline fenofibrate cap dr 135 mg (fenofibric acid

equiv) (Trilipix).............................................................. 56CIALIS -tadalafil tab 2.5 mg......................................... 59,60CIALIS -tadalafil tab 5 mg............................................ 59,60ciclopirox gel 0.77%...................................................... 172ciclopirox olamine cream 0.77% (base equiv)............172ciclopirox olamine susp 0.77% (base equiv)..............172ciclopirox shampoo 1% (Loprox shampoo)............... 172ciclopirox solution 8% (Penlac Nail Lacquer)............ 172CIFEREX -folic acid-cholecalciferol cap 1 mg-3775

unit................................................................................. 151cilostazol tab 50 mg (Pletal).........................................158cilostazol tab 100 mg (Pletal).......................................158CILOXAN -ciprofloxacin hcl ophth oint 0.3%.................. 163cimetidine hcl soln 300 mg/5ml..................................... 68

2016



cimetidine tab 300 mg.....................................................68cimetidine tab 400 mg.....................................................68cimetidine tab 800 mg.....................................................68CIMZIA -certolizumab pegol inj kit 2 x 200 mg/ml............ 72CIMZIA STARTER KIT -certolizumab pegol inj kit 6 x 200

mg/ml...............................................................................72CIPRODEX -ciprofloxacin-dexamethasone otic susp

0.3-0.1%........................................................................ 167CIPROFLOXACIN -ciprofloxacin hcl otic soln 0.2% (base

equivalent).....................................................................167ciprofloxacin-ciprofloxacin hcl tab er 24hr 1000

mg(base eq) (Cipro xr)...................................................5ciprofloxacin-ciprofloxacin hcl tab er 24hr 500 mg

(base eq) (Cipro xr)........................................................ 5ciprofloxacin for oral susp 250 mg/5ml (5%) (5

gm/100ml) (Cipro)........................................................... 5ciprofloxacin for oral susp 500 mg/5ml (10%) (10

gm/100ml) (Cipro)........................................................... 5CIPROFLOXACIN HCL -ciprofloxacin hcl tab 100 mg

(base equiv)...................................................................... 5ciprofloxacin hcl ophth soln 0.3% (Ciloxan).............. 163ciprofloxacin hcl tab 750 mg (base equiv)..................... 5ciprofloxacin hcl tab 250 mg (base equiv) (Cipro).........5ciprofloxacin hcl tab 500 mg (base equiv) (Cipro).........5CIPRO HC -ciprofloxacin-hydrocortisone otic susp

0.2-1%........................................................................... 167citalopram hydrobromide oral soln 10 mg/5ml............78citalopram hydrobromide tab 10 mg (base equiv)

(Celexa)...........................................................................78citalopram hydrobromide tab 20 mg (base equiv)

(Celexa)...........................................................................78citalopram hydrobromide tab 40 mg (base equiv)

(Celexa)...........................................................................79CITRANATAL ASSURE -prenat w/o a w/fecbn-fegl-dss-fa

tab & dha cap 300 mg pack.........................................120CITRANATAL B-CALM -prenat w/o a w/fecbn-feglu-fa tab

20-1 mg & vit b6 tab pak............................................. 120CITRANATAL BLOOM -prenatal vit w/ dss-fe cbn-fe gluc-

fa tab 90-1 mg.............................................................. 120CITRANATAL DHA -prenat w/o a w/fecbn-fegl-dss-fa tab

& dha cap 250 mg pack...............................................120CITRANATAL 90 DHA -prenat w/o a w/fecbn-fegl-dss-fa

tab 90 &dha cap 300mg pak........................................120CITRANATAL HARMONY -prenat w/o a w/fe fum-fe cbn-

dss-fa-dha cap 27-1-260 mg........................................120CITRANATAL RX -prenatal w/o a w/ fe carbonyl-fe gluc-

dss-fa tab 27-1mg.........................................................120CITRUS BERGAMOT -citrus bergamot oral powder 250

mg/0.25 gm................................................................... 183CLARITHROMYCIN -clarithromycin for susp 125

mg/5ml...............................................................................3

CLARITHROMYCIN -clarithromycin for susp 250mg/5ml...............................................................................3

clarithromycin tab er 24hr 500 mg.................................. 3clarithromycin tab 250 mg (Biaxin)................................. 3clarithromycin tab 500 mg (Biaxin)................................. 3CLEMASTINE FUMARATE -clemastine fumarate tab 2.68

mg....................................................................................60CLEOCIN -clindamycin phosphate vaginal suppos 100

mg....................................................................................75CLICK ESPRESSO PROTEIN DR -nutritional supplement

powder...........................................................................133CLIMARA PRO -estradiol-levonorgestrel td patch weekly

0.045-0.015 mg/day........................................................24clindamycin hcl cap 75 mg (Cleocin)............................12clindamycin hcl cap 150 mg (Cleocin)..........................12clindamycin hcl cap 300 mg (Cleocin)..........................12clindamycin palmitate hcl for soln 75 mg/5ml (base

equiv) (Cleocin pediatric gr)........................................12clindamycin phosphate-benzoyl peroxide gel 1-5%

(Benzaclin)................................................................... 172clindamycin phosphate foam 1% (Evoclin)................ 172clindamycin phosphate gel 1% (Cleocin-t).................172clindamycin phosphate lotion 1% (Cleocin-t)............ 172clindamycin phosphate soln 1% (Cleocin-t)...............172clindamycin phosphate swab 1% (Cleocin-t)............. 172clindamycin phosphate-tretinoin gel 1.2-0.025%

(Ziana)...........................................................................172clindamycin phosphate vaginal cream 2%

(Cleocin)......................................................................... 75clindamycin phosph-benzoyl peroxide (refrig) gel 1.2

(1)-5% (Duac)............................................................... 172CLINDESSE -clindamycin phosphate (one dose) vaginal

cream 2%........................................................................76clobetasol propionate cream 0.05% (Temovate)........172clobetasol propionate emollient base cream 0.05%

(Temovate e)................................................................ 172clobetasol propionate emulsion foam 0.05% (Olux-

e)....................................................................................172clobetasol propionate foam 0.05% (Olux).................. 172clobetasol propionate gel 0.05% (Temovate)............. 172clobetasol propionate lotion 0.05% (Clobex)............. 172clobetasol propionate oint 0.05% (Temovate)............172clobetasol propionate shampoo 0.05% (Clobex).......172clobetasol propionate soln 0.05% (Temovate)........... 172clobetasol propionate spray 0.05% (Clobex)............. 172CLOCORTOLONE PIVALATE -clocortolone pivalate

cream 0.1%...................................................................172CLOCORTOLONE PIVALATE PUM -clocortolone pivalate

cream 0.1%...................................................................172CLODERM -clocortolone pivalate cream 0.1%...............172CLODERM PUMP -clocortolone pivalate cream

0.1%...............................................................................172

2016



clomipramine hcl cap 25 mg (Anafranil).......................79clomipramine hcl cap 50 mg (Anafranil).......................79clomipramine hcl cap 75 mg (Anafranil).......................79clonazepam orally disintegrating tab 0.125 mg......... 110clonazepam orally disintegrating tab 0.25 mg........... 110clonazepam orally disintegrating tab 0.5 mg............. 110clonazepam orally disintegrating tab 1 mg................ 110clonazepam orally disintegrating tab 2 mg................ 110clonazepam tab 0.5 mg (Klonopin)..............................110clonazepam tab 1 mg (Klonopin).................................110clonazepam tab 2 mg (Klonopin).................................110clonidine hcl tab er 12hr 0.1 mg (Kapvay)....................88clonidine hcl tab 0.1 mg (Catapres).............................. 49clonidine hcl tab 0.2 mg (Catapres).............................. 49clonidine hcl tab 0.3 mg (Catapres).............................. 49clonidine hcl td patch weekly 0.1 mg/24hr (Catapres-

tts-1)................................................................................49clonidine hcl td patch weekly 0.2 mg/24hr (Catapres-

tts-2)................................................................................49clonidine hcl td patch weekly 0.3 mg/24hr (Catapres-

tts-3)................................................................................49clopidogrel bisulfate tab 75 mg (base equiv)

(Plavix)..........................................................................158clopidogrel bisulfate tab 300 mg (base equiv)

(Plavix)..........................................................................158clorazepate dipotassium tab 3.75 mg (Tranxene t)......77clorazepate dipotassium tab 7.5 mg (Tranxene t)........77clorazepate dipotassium tab 15 mg (Tranxene t).........77CLORPRES -clonidine & chlorthalidone tab 0.1-15

mg....................................................................................49CLORPRES -clonidine & chlorthalidone tab 0.2-15

mg....................................................................................49CLORPRES -clonidine & chlorthalidone tab 0.3-15

mg....................................................................................49clotrimazole troche 10 mg............................................167clotrimazole w/ betamethasone cream 1-0.05%

(Lotrisone)....................................................................173clotrimazole w/ betamethasone lotion 1-0.05%..........173CLOZAPINE ODT -clozapine orally disintegrating tab 12.5

mg....................................................................................83CLOZAPINE ODT -clozapine orally disintegrating tab 150

mg....................................................................................83CLOZAPINE ODT -clozapine orally disintegrating tab 200

mg....................................................................................83clozapine orally disintegrating tab 25 mg

(Fazaclo)......................................................................... 83clozapine orally disintegrating tab 100 mg

(Fazaclo)......................................................................... 83clozapine tab 50 mg........................................................ 83clozapine tab 200 mg...................................................... 83clozapine tab 25 mg (Clozaril)........................................83clozapine tab 100 mg (Clozaril)..................................... 83

C-NATE DHA -prenatal vit w/ fe fum-fa-omega 3 cap28-1-200 mg..................................................................120

COAGADEX -coagulation factor x (human) for inj 250unit................................................................................. 158

COAGADEX -coagulation factor x (human) for inj 500unit................................................................................. 158

COAL TAR -coal tar soln 20%........................................ 173COARTEM -artemether-lumefantrine tab 20-120 mg....... 12CO-BALAMIN -ubiquinol-vit b12-resveratrol-fa cap

200-5-400-0.8 mg......................................................... 183CODAR AR -chlorpheniramine w/ codeine liquid 2-8

mg/5ml.............................................................................61CODEINE SULFATE -codeine sulfate tab 15 mg............. 98CODEINE SULFATE -codeine sulfate tab 30 mg............. 98CODEINE SULFATE -codeine sulfate tab 60 mg............. 98codeine sulfate tab 15 mg (Codeine sulfate)................98codeine sulfate tab 30 mg (Codeine sulfate)................98codeine sulfate tab 60 mg (Codeine sulfate)................98COLCHICINE -colchicine cap 0.6 mg............................. 109COLCHICINE -colchicine tab 0.6 mg..............................109colchicine w/ probenecid tab 0.5-500 mg................... 109COLCRYS -colchicine tab 0.6 mg...................................109colestipol hcl granule packets 5 gm (Colestid

flavored)......................................................................... 56colestipol hcl granules 5 gm (Colestid flavored).........56colestipol hcl tab 1 gm (Colestid)..................................56COLGATE DRY MOUTH RELIEF -sodium fluoride

mouthwash 2.1 mg/10ml.............................................. 167COLY-MYCIN S -neomycin-colistin-hc-thonzonium otic

susp 3.3-3-10-0.5 mg/ml.............................................. 167COMBIGAN -brimonidine tartrate-timolol maleate ophth

soln 0.2-0.5%................................................................ 163COMBIPATCH -estradiol-norethindrone ace td pttw

0.05-0.14 mg/day............................................................24COMBIPATCH -estradiol-norethindrone ace td pttw

0.05-0.25 mg/day............................................................24COMBIVENT RESPIMAT -ipratropium-albuterol inhal

aerosol soln 20-100 mcg/act..........................................64COMETRIQ -cabozantinib s-malate cap 3 x 20 mg (60 mg

dose) kit...........................................................................16COMETRIQ -cabozantinib s-mal cap 1 x 80 mg & 1 x 20

mg (100 dose) kit............................................................16COMETRIQ -cabozantinib s-mal cap 1 x 80 mg & 3 x 20

mg (140 dose) kit............................................................16COMMIT -nicotine polacrilex lozenge 2 mg......................92COMMIT -nicotine polacrilex lozenge 4 mg......................92COMPLEAT CLOSED SYSTEM -nutritional supplement

liquid.............................................................................. 133COMPLEAT -nutritional supplement liquid......................133COMPLEAT PEDIATRIC -nutritional supplement

liquid.............................................................................. 133

2016



COMPLEAT PEDIATRIC REDUCE -nutritionalsupplement liquid..........................................................133

COMPLERA -emtricitabine-rilpivirine-tenofovir df tab200-25-300 mg..................................................................7

COMPLETE AMINO ACID MIX -amino acids oralpowder...........................................................................130

COMPLETE NATAL DHA -prenat-fe bis-fe prot succ-fa-catab & omega 3 cap 250 pk.......................................... 120

COMPLETENATE -prenatal vit w/ fe fumarate-fa chew tab29-1 mg......................................................................... 120

COMPLETE NUTRITION -nutritional supplementliquid.............................................................................. 133

COMPLETE NUTRITION PLUS -nutritional supplementliquid.............................................................................. 133

COMPLETE PROTEIN & VITAMI -nutritional supplementpowder...........................................................................133

COMPLEX ESSENTIAL MSD -amino acids oralpowder...........................................................................130

COMPLEX JUNIOR MSD -amino acids oral powder......131COMPLEX MSUD AMINO ACID B -amino acids bar..... 131COMPLEX MSUD -amino acids oral powder..................131CO-NATAL FA -prenatal vit w/ fe fumarate-fa tab 29-1

mg..................................................................................120CONCEPT DHA -prenatal w/fe fum-fe poly -fa-omega 3

cap 53.5-38-1 mg......................................................... 120CONCEPT OB -prenatal w/o a w/fe fum-fe poly-fa cap

130-92.4-1 mg...............................................................120CONDYLOX -podofilox gel 0.5%.................................... 173CONZIP -tramadol hcl cap er 24hr biphasic release 100

mg....................................................................................98CONZIP -tramadol hcl cap er 24hr biphasic release 200

mg....................................................................................98CONZIP -tramadol hcl cap er 24hr biphasic release 300

mg....................................................................................98COPASIL -emollient - gel................................................ 173COPAXONE -glatiramer acetate soln prefilled syringe 20

mg/ml...............................................................................92COPAXONE -glatiramer acetate soln prefilled syringe 40

mg/ml...............................................................................92CORDRAN -flurandrenolide cream 0.05%......................173CORDRAN -flurandrenolide lotion 0.05%....................... 173CORDRAN -flurandrenolide oint 0.05%..........................173CORDRAN -flurandrenolide tape 4 mcg/sqcm............... 173COREG CR -carvedilol phosphate cap er 24hr 10 mg..... 42COREG CR -carvedilol phosphate cap er 24hr 20 mg..... 42COREG CR -carvedilol phosphate cap er 24hr 40 mg..... 42COREG CR -carvedilol phosphate cap er 24hr 80 mg..... 43CORIFACT -factor xiii concentrate (human) for inj kit

1000-1600 unit..............................................................158CORLANOR -ivabradine hcl tab 5 mg (base equiv)......... 59CORLANOR -ivabradine hcl tab 7.5 mg (base equiv)...... 59

CORTANE-B -hydrocortisone-pramoxine-chloroxylenol lot10-10-1mg/ml................................................................ 173

CORTIFOAM -hydrocortisone acetate rectal foam 10%(90 mg/dose).................................................................169

CORTISONE ACETATE -cortisone acetate tab 25 mg.....21CORTISPORIN -bacitracin-polymyxin-neomycin hc oint

1%..................................................................................173CORTISPORIN -neomycin-polymyxin-hc crm 3.5 mg/

gm-10000 unt/gm-0.5%................................................ 173CORVITE FE -iron combination tab................................151CORVITE 150 -iron combination tab...............................151COSENTYX -secukinumab subcutaneous soln prefilled

syringe 150 mg/ml........................................................ 173COSENTYX SENSOREADY PEN -secukinumab

subcutaneous soln auto-injector 150 mg/ml................ 173COSOPT PF -dorzolamide hcl-timolol maleate ophth sol

22.3-6.8 mg/ml pf..........................................................163COTELLIC -cobimetinib fumarate tab 20 mg (base

equivalent).......................................................................16COUMADIN -warfarin sodium tab 1 mg..........................154COUMADIN -warfarin sodium tab 2 mg..........................154COUMADIN -warfarin sodium tab 2.5 mg.......................154COUMADIN -warfarin sodium tab 3 mg..........................154COUMADIN -warfarin sodium tab 4 mg..........................155COUMADIN -warfarin sodium tab 5 mg..........................155COUMADIN -warfarin sodium tab 6 mg..........................155COUMADIN -warfarin sodium tab 7.5 mg.......................155COUMADIN -warfarin sodium tab 10 mg........................155CO-VERATROL -ubiquinol-vit b12-resveratrol-fa cap

200-5-400-0.8 mg......................................................... 183CREON -pancrelipase (lip-prot-amyl) dr cap

3000-9500-15000 unit.....................................................71CREON -pancrelipase (lip-prot-amyl) dr cap

6000-19000-30000 unit...................................................71CREON -pancrelipase (lip-prot-amyl) dr cap

12000-38000-60000 unit................................................ 71CREON -pancrelipase (lip-prot-amyl) dr cap

24000-76000-120000 unit.............................................. 71CREON -pancrelipase (lip-prot-amyl) dr cap

36000-114000-180000 unit.............................................71CRESEMBA -isavuconazonium sulfate cap 186 mg.......... 6CREST COMPLETE -sodium fluoride paste 0.243%..... 168CRESTOR -rosuvastatin calcium tab 5 mg.......................56CRESTOR -rosuvastatin calcium tab 10 mg.....................56CRESTOR -rosuvastatin calcium tab 20 mg.....................56CRESTOR -rosuvastatin calcium tab 40 mg.....................56CRITICARE HN -nutritional supplement liquid................133CRIXIVAN -indinavir sulfate cap 200 mg............................ 7CRIXIVAN -indinavir sulfate cap 400 mg............................ 7CROMOLYN SODIUM -cromolyn sodium soln nebu 20

mg/2ml.............................................................................64cromolyn sodium ophth soln 4%................................ 163

2016



cromolyn sodium oral conc 100 mg/5ml(Gastrocrom)..................................................................72

CRUCIAL -nutritional supplement liquid..........................133CUPRIMINE -penicillamine cap 250 mg......................... 184CUROSURF -poractant alfa intratracheal susp 120

mg/1.5ml..........................................................................66CUROSURF -poractant alfa intratracheal susp 240

mg/3ml.............................................................................66CUVPOSA -glycopyrrolate oral soln 1 mg/5ml................. 68CVS GLUCOSE -glucose chew tab 4 gm.........................29CVS NUTRITIONAL SHAKE -nutritional supplement

liquid.............................................................................. 133CVS NUTRITION LIQUID -nutritional supplement

liquid.............................................................................. 133CVS NUTRITION PLUS -nutritional supplement

liquid.............................................................................. 133cyanocobalamin inj 1000 mcg/ml................................ 151CYCLINEX-1 -nutritional supplement powder.................133CYCLINEX-2 -nutritional supplement powder.................133cyclobenzaprine hcl tab 5 mg......................................118cyclobenzaprine hcl tab 10 mg....................................118cyclobenzaprine hcl tab 7.5 mg (Fexmid)...................118CYCLOGYL -cyclopentolate hcl ophth soln 0.5%...........163CYCLOMYDRIL -cyclopentolate w/ phenylephrine ophth

soln 0.2-1%................................................................... 164cyclopentolate hcl ophth soln 0.5% (Cyclogyl)..........164cyclopentolate hcl ophth soln 1% (Cyclogyl).............164cyclopentolate hcl ophth soln 2% (Cyclogyl).............164CYCLOPHOSPHAMIDE -cyclophosphamide cap 25

mg....................................................................................16CYCLOPHOSPHAMIDE -cyclophosphamide cap 50

mg....................................................................................16CYCLOSERINE -cycloserine cap 250 mg.......................... 5CYCLOSET -bromocriptine mesylate tab 0.8 mg (base

equivalent).......................................................................29cyclosporine cap 25 mg (Sandimmune)..................... 184cyclosporine cap 100 mg (Sandimmune)................... 184cyclosporine modified cap 50 mg (Cyclosporine

modifie).........................................................................184cyclosporine modified cap 25 mg (Neoral).................184cyclosporine modified cap 100 mg (Neoral)...............184CYCLOSPORINE MODIFIED -cyclosporine modified cap

50 mg............................................................................ 184cyclosporine modified oral soln 100 mg/ml

(Neoral)......................................................................... 184cyproheptadine hcl syrup 2 mg/5ml..............................60cyproheptadine hcl tab 4 mg......................................... 60CYSTADANE -betaine powder for oral solution................38CYSTAGON -cysteamine bitartrate cap 50 mg.................76CYSTAGON -cysteamine bitartrate cap 150 mg...............76CYSTARAN -cysteamine hcl ophth soln 0.44% (base

equivalent).....................................................................164

DDAKLINZA -daclatasvir dihydrochloride tab 30 mg (base

equivalent)......................................................................... 7DAKLINZA -daclatasvir dihydrochloride tab 60 mg (base

equivalent)......................................................................... 7DAKLINZA -daclatasvir dihydrochloride tab 90 mg (base

equivalent)......................................................................... 7DALIRESP -roflumilast tab 500 mcg.................................64danazol cap 50 mg.......................................................... 23danazol cap 100 mg........................................................ 23danazol cap 200 mg........................................................ 23dantrolene sodium cap 100 mg................................... 118dantrolene sodium cap 25 mg (Dantrium)..................118dantrolene sodium cap 50 mg (Dantrium)..................118dapsone tab 25 mg..........................................................12dapsone tab 100 mg........................................................12DAPTACEL -diph, acellular pert & tet tox inj 15 lf-23

mcg-5 lf/0.5ml................................................................. 15DARAPRIM -pyrimethamine tab 25 mg............................ 12darifenacin hydrobromide tab er 24hr 7.5 mg (base

equiv) (Enablex)............................................................ 75darifenacin hydrobromide tab er 24hr 15 mg (base

equiv) (Enablex)............................................................ 75DDROPS -cholecalciferol drops 1000 unit/0.03ml (per

drop).............................................................................. 119DEBACTEROL -sulfuric acid-sulfonated phenolics soln

30-50%.......................................................................... 168DECARA -cholecalciferol cap 25000 unit....................... 119DELESTROGEN -estradiol valerate im in oil 10 mg/

ml..................................................................................... 24DELESTROGEN -estradiol valerate im in oil 20 mg/

ml..................................................................................... 24DELESTROGEN -estradiol valerate im in oil 40 mg/

ml..................................................................................... 24DELZICOL -mesalamine cap dr 400 mg...........................72demeclocycline hcl tab 150 mg....................................... 4demeclocycline hcl tab 300 mg....................................... 4DEMSER -metyrosine cap 250 mg................................... 49DENAVIR -penciclovir cream 1%.................................... 173DEPAKENE -valproate sodium oral soln 250 mg/5ml

(base equiv).................................................................. 110DEPAKENE -valproic acid cap 250 mg...........................110DEPEN TITRATABS -penicillamine tab 250 mg............. 184DEPO-PROVERA CONTRACEPTIV -

medroxyprogesterone acetate im susp 150 mg/ml........26DEPO-PROVERA CONTRACEPTIV -

medroxyprogesterone acetate im susp prefilled syr 150mg/ml...............................................................................26

DEPO-SUBQ PROVERA 104 -medroxyprogesteroneacetate susp pref syr 104 mg/0.65ml.............................26

2016



DEPO-TESTOSTERONE -testosterone cypionate im inj inoil 100 mg/ml.................................................................. 23

DEPO-TESTOSTERONE -testosterone cypionate im inj inoil 200 mg/ml.................................................................. 23

DEQUASINE -amino acids tab........................................131DERMACINRX PUREFOLIX -folic acid-cholecalciferol tab

1 mg-5000 unit..............................................................151DESCOVY -emtricitabine-tenofovir alafenamide fumarate

tab 200-25 mg...................................................................7desipramine hcl tab 10 mg (Norpramin)....................... 79desipramine hcl tab 25 mg (Norpramin)....................... 79desipramine hcl tab 50 mg (Norpramin)....................... 79desipramine hcl tab 75 mg (Norpramin)....................... 79desipramine hcl tab 100 mg (Norpramin)..................... 79desipramine hcl tab 150 mg (Norpramin)..................... 79DESLORATADINE ODT -desloratadine tab orally

disintegrating 2.5 mg...................................................... 60DESLORATADINE ODT -desloratadine tab orally

disintegrating 5 mg......................................................... 60desloratadine tab 5 mg (Clarinex)................................. 60desmopressin acetate inj 4 mcg/ml (Ddavp)................38desmopressin acetate nasal soln 0.01% (refrigerated)

(Ddavp)........................................................................... 38desmopressin acetate nasal spray soln 0.01%

(Ddavp)........................................................................... 38desmopressin acetate nasal spray soln 0.01%

(refrigerated).................................................................. 38desmopressin acetate tab 0.1 mg (Ddavp)...................39desmopressin acetate tab 0.2 mg (Ddavp)...................39desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5) (Mircette)........................................................26desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg(Cyclessa).......................................................................26

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg(Desogen).......................................................................26

DESONATE -desonide gel 0.05%...................................173desonide cream 0.05% (Desowen).............................. 173desonide lotion 0.05% (Desowen)............................... 173desonide oint 0.05% (Desowen).................................. 173desoximetasone cream 0.05% (Topicort)....................173desoximetasone cream 0.25% (Topicort)....................173desoximetasone gel 0.05% (Topicort)......................... 173desoximetasone oint 0.05% (Topicort)........................173desoximetasone oint 0.25% (Topicort)........................173DESVENLAFAXINE ER -desvenlafaxine tab er 24hr 50

mg....................................................................................79DESVENLAFAXINE ER -desvenlafaxine tab er 24hr 100

mg....................................................................................79desvenlafaxine succinate tab er 24hr 25 mg (base

equiv) (Pristiq)...............................................................79

desvenlafaxine succinate tab er 24hr 50 mg (baseequiv) (Pristiq)...............................................................79

desvenlafaxine succinate tab er 24hr 100 mg (baseequiv) (Pristiq)...............................................................79

DEXAMETHASONE -dexamethasone soln 0.5mg/5ml.............................................................................22

DEXAMETHASONE -dexamethasone tab 1 mg...............22DEXAMETHASONE -dexamethasone tab 2 mg...............22dexamethasone elixir 0.5 mg/5ml.................................. 22DEXAMETHASONE INTENSOL -dexamethasone conc 1

mg/ml...............................................................................22DEXAMETHASONE SODIUM PHOS -dexamethasone

sodium phosphate ophth soln 0.1%.............................164dexamethasone tab 0.5 mg............................................ 22dexamethasone tab 0.75 mg.......................................... 22dexamethasone tab 1.5 mg............................................ 22dexamethasone tab 4 mg............................................... 22dexamethasone tab 6 mg............................................... 22DEX4 FAST ACTING GLUCOSE -glucose gel 15

gm/33gm..........................................................................30DEX4 FAST ACTING GLUCOSE -glucose-vitamin c chew

tab 4-0.006 gm............................................................... 30DEX4 -glucose-vitamin c chew tab 4-0.006 gm................29DEXILANT -dexlansoprazole cap delayed release 30

mg....................................................................................68DEXILANT -dexlansoprazole cap delayed release 60

mg....................................................................................68dexmethylphenidate hcl cap er 24 hr 5 mg (Focalin

xr).................................................................................... 88dexmethylphenidate hcl cap er 24 hr 10 mg (Focalin







xr).................................................................................... 89dexmethylphenidate hcl tab 2.5 mg (Focalin).............. 89dexmethylphenidate hcl tab 5 mg (Focalin)................. 89dexmethylphenidate hcl tab 10 mg (Focalin)............... 89DEX4 NATURALS -glucose-vitamin c chew tab 4-0.006

gm....................................................................................30DEXPAK 10 DAY -dexamethasone tab therapy pack 1.5

mg (35)............................................................................22DEXPAK 13 DAY -dexamethasone tab therapy pack 1.5

mg (51)............................................................................22

2016



DEXPAK 6 DAY -dexamethasone tab therapy pack 1.5mg (21)............................................................................22

DEX4 POUCH PACK -glucose-vitamin c chew tab 4-0.006gm....................................................................................30

DEX4 QUICK DISSOLVE GLUCO -glucose chew tab 4gm....................................................................................30

dextroamphetamine sulfate cap er 24hr 5 mg(Dexedrine).....................................................................89



dextroamphetamine sulfate oral solution 5 mg/5ml(Procentra)..................................................................... 89

dextroamphetamine sulfate tab 5 mg........................... 89dextroamphetamine sulfate tab 10 mg......................... 89D.H.E. 45 -dihydroergotamine mesylate inj 1 mg/ml.......108DIABETIC TF -nutritional supplement liquid................... 133DIABETISHIELD -nutritional supplement liquid.............. 133DIABETISOURCE AC -nutritional supplement liquid......133DIABETISOURCE -nutritional supplement liquid............133DIALYVITE/ZINC -b-complex w/ c-zn & folic acid tab 1

mg..................................................................................121DIALYVITE 3000 -b-complex w/ c-biotin-e-minerals & folic

acid tab 3 mg................................................................121DIALYVITE 5000 -b-complex w/ c-biotin-e-minerals & folic

acid tab 5 mg................................................................121DIALYVITE SUPREME D -multiple vitamins w/ minerals &

fa tab 3 mg................................................................... 121DIARESQ CHILDRENS -nutritional supplement

pack............................................................................... 133DIARESQ -nutritional supplement pack..........................133DIASTAT ACUDIAL -diazepam rectal gel delivery system

10 mg............................................................................ 110DIASTAT ACUDIAL -diazepam rectal gel delivery system

20 mg............................................................................ 110DIASTAT PEDIATRIC -diazepam rectal gel delivery

system 2.5 mg.............................................................. 110diazepam conc 5 mg/ml..................................................78DIAZEPAM -diazepam oral soln 1 mg/ml..........................77DIAZEPAM RECTAL GEL -diazepam rectal gel delivery

system 2.5 mg.............................................................. 110DIAZEPAM RECTAL GEL -diazepam rectal gel delivery

system 10 mg............................................................... 110DIAZEPAM RECTAL GEL -diazepam rectal gel delivery

system 20 mg............................................................... 111diazepam tab 2 mg (Valium)...........................................78diazepam tab 5 mg (Valium)...........................................78diazepam tab 10 mg (Valium).........................................78DIBENZYLINE -phenoxybenzamine hcl cap 10 mg..........49DICLEGIS -doxylamine-pyridoxine tab delayed release

10-10 mg......................................................................... 70

diclofenac potassium tab 50 mg................................. 105diclofenac sodium (actinic keratoses) gel 3%

(Solaraze)..................................................................... 173diclofenac sodium gel 1% (Voltaren)...........................173diclofenac sodium ophth soln 0.1%............................164diclofenac sodium soln 1.5% (Pennsaid)................... 173diclofenac sodium tab delayed release 25 mg...........105diclofenac sodium tab delayed release 50 mg...........105diclofenac sodium tab delayed release 75 mg...........105diclofenac sodium tab er 24hr 100 mg....................... 105diclofenac w/ misoprostol tab delayed release 50-0.2

mg (Arthrotec 50)........................................................105diclofenac w/ misoprostol tab delayed release 75-0.2

mg (Arthrotec 75)........................................................105dicloxacillin sodium cap 250 mg..................................... 1dicloxacillin sodium cap 500 mg..................................... 1dicyclomine hcl cap 10 mg (Bentyl)..............................68dicyclomine hcl oral soln 10 mg/5ml............................ 68dicyclomine hcl tab 20 mg (Bentyl)...............................68didanosine delayed release capsule 125 mg (Videx

ec)......................................................................................7didanosine delayed release capsule 200 mg (Videx



ec)......................................................................................7DIFFERIN -adapalene lotion 0.1%..................................173DIFICID -fidaxomicin tab 200 mg........................................3DIFLORASONE DIACETATE -diflorasone diacetate

cream 0.05%.................................................................173DIFLORASONE DIACETATE -diflorasone diacetate oint

0.05%.............................................................................173diflunisal tab 500 mg.......................................................96DIGOXIN -digoxin oral soln 0.05 mg/ml............................41digoxin tab 125 mcg (0.125 mg) (Lanoxin)................... 41digoxin tab 250 mcg (0.25 mg) (Lanoxin)..................... 41dihydroergotamine mesylate inj 1 mg/ml (D.h.e.

45)..................................................................................108DILANTIN INFATABS -phenytoin chew tab 50 mg......... 111DILANTIN -phenytoin sodium extended cap 30 mg........111DILANTIN -phenytoin sodium extended cap 100 mg......111DILANTIN-125 -phenytoin susp 125 mg/5ml.................. 111DILATRATE SR -isosorbide dinitrate cap er 40 mg.......... 41diltiazem hcl cap er 12hr 60 mg.....................................44diltiazem hcl cap er 12hr 90 mg.....................................44diltiazem hcl cap er 12hr 120 mg...................................44diltiazem hcl cap er 24hr 120 mg...................................44diltiazem hcl cap er 24hr 180 mg...................................44diltiazem hcl cap er 24hr 240 mg...................................44diltiazem hcl coated beads cap er 24hr 300 mg...........44

2016



diltiazem hcl coated beads cap er 24hr 120 mg(Cardizem cd)................................................................ 44




diltiazem hcl coated beads tab er 24hr 180 mg(Cardizem la)................................................................. 44





diltiazem hcl extended release beads cap er 24hr 120mg (Tiazac).................................................................... 44






diltiazem hcl tab 90 mg...................................................45diltiazem hcl tab 30 mg (Cardizem)...............................45diltiazem hcl tab 60 mg (Cardizem)...............................45diltiazem hcl tab 120 mg (Cardizem).............................45DIPENTUM -olsalazine sodium cap 250 mg.....................72DIPHENOXYLATE/ATROPINE -diphenoxylate w/ atropine

liq 2.5-0.025 mg/5ml.......................................................67diphenoxylate w/ atropine tab 2.5-0.025 mg

(Lomotil)......................................................................... 67DIPHTHERIA/TETANUS TOXOID -diphtheria-tetanus tox

adsorbed (dt) im inj 25-5 unit/0.5ml............................... 15dipyridamole tab 25 mg (Persantine).......................... 158dipyridamole tab 50 mg (Persantine).......................... 158dipyridamole tab 75 mg (Persantine).......................... 158disopyramide phosphate cap 100 mg (Norpace).........46disopyramide phosphate cap 150 mg (Norpace).........46disulfiram tab 250 mg (Antabuse)................................. 92disulfiram tab 500 mg (Antabuse)................................. 92DIURIL -chlorothiazide susp 250 mg/5ml......................... 54divalproex sodium cap delayed release sprinkle 125

mg (Depakote sprinkles)............................................111

divalproex sodium tab delayed release 125 mg(Depakote)....................................................................111



divalproex sodium tab er 24 hr 250 mg (Depakoteer).................................................................................. 111

divalproex sodium tab er 24 hr 500 mg (Depakoteer).................................................................................. 111

DIVIGEL -estradiol td gel 0.25 mg/0.25gm (0.1%)........... 24DIVIGEL -estradiol td gel 0.5 mg/0.5gm (0.1%)............... 24DIVIGEL -estradiol td gel 1 mg/gm (0.1%)....................... 24DIVISTA -folic acid-vit b6-vit b12-omega 3-biotin-cr cap 1

mg..................................................................................151dofetilide cap 125 mcg (0.125 mg) (Tikosyn)................46dofetilide cap 250 mcg (0.25 mg) (Tikosyn)..................46dofetilide cap 500 mcg (0.5 mg) (Tikosyn)....................46donepezil hydrochloride orally disintegrating tab 5

mg................................................................................... 92donepezil hydrochloride orally disintegrating tab 10

mg................................................................................... 92donepezil hydrochloride tab 5 mg (Aricept).................92donepezil hydrochloride tab 10 mg (Aricept)...............92donepezil hydrochloride tab 23 mg (Aricept)...............92DONNATAL -pb-hyoscy-atrop-scopol elix

16.2-0.1037-0.0194-0.0065 mg/5ml...............................68DONNATAL -pb-hyoscy-atrop-scopol tab

16.2-0.1037-0.0194-0.0065 mg......................................68DORAL -quazepam tab 15 mg..........................................87dorzolamide hcl ophth soln 2% (Trusopt).................. 164dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml (Cosopt)............................................................164DOTHELLE DHA -prenatal w/fe fum-fe poly -fa-omega 3

cap 53.5-38-1 mg......................................................... 121doxazosin mesylate tab 1 mg (Cardura).......................49doxazosin mesylate tab 2 mg (Cardura).......................49doxazosin mesylate tab 4 mg (Cardura).......................49doxazosin mesylate tab 8 mg (Cardura).......................49doxepin hcl cap 10 mg....................................................79doxepin hcl cap 25 mg....................................................79doxepin hcl cap 50 mg....................................................79doxepin hcl cap 75 mg....................................................79doxepin hcl cap 100 mg..................................................79doxepin hcl cap 150 mg..................................................79doxepin hcl conc 10 mg/ml............................................ 79DOXEPIN HYDROCHLORIDE -doxepin hcl cream

5%..................................................................................173doxercalciferol cap 0.5 mcg (Hectorol).........................39doxercalciferol cap 1 mcg (Hectorol)............................39doxercalciferol cap 2.5 mcg (Hectorol).........................39doxycycline hyclate cap 50 mg....................................... 4

2016



doxycycline hyclate cap 100 mg (Vibramycin)...............4doxycycline hyclate tab delayed release 75 mg............ 4doxycycline hyclate tab delayed release 100 mg.......... 4doxycycline hyclate tab delayed release 150 mg.......... 4doxycycline hyclate tab delayed release 50 mg

(Doryx).............................................................................. 4doxycycline hyclate tab delayed release 200 mg

(Doryx).............................................................................. 4doxycycline hyclate tab 20 mg........................................ 4doxycycline hyclate tab 100 mg...................................... 4doxycycline hyclate tab 75 mg (Acticlate)......................4doxycycline hyclate tab 150 mg (Acticlate)....................4doxycycline monohydrate cap 50 mg............................. 4doxycycline monohydrate cap 150 mg (Adoxa).............4doxycycline monohydrate cap 75 mg (Monodox)..........4doxycycline monohydrate cap 100 mg (Monodox)........4doxycycline monohydrate for susp 25 mg/5ml

(Vibramycin).....................................................................4doxycycline monohydrate tab 50 mg (Adoxa)............... 4doxycycline monohydrate tab 75 mg (Adoxa)............... 4doxycycline monohydrate tab 100 mg (Adoxa pak

1/100).................................................................................4doxycycline monohydrate tab 150 mg (Adoxa pak

1/150).................................................................................4DRITHO-CREME HP -anthralin cream 1%.....................173dronabinol cap 2.5 mg (Marinol)....................................70dronabinol cap 5 mg (Marinol).......................................70dronabinol cap 10 mg (Marinol).....................................70drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin

28)....................................................................................26drospirenone-ethinyl estradiol tab 3-0.02 mg (Yaz).....26drospirenone-ethinyl estrad-levomefolate tab

3-0.02-0.451 mg (Beyaz)...............................................26DROXIA -hydroxyurea cap 200 mg................................ 151DROXIA -hydroxyurea cap 300 mg................................ 151DROXIA -hydroxyurea cap 400 mg................................ 151DUAVEE -conjugated estrogens-bazedoxifene tab

0.45-20 mg......................................................................24DUET DHA BALANCED -prenat w/fe poly-na fered-fa tab

25-1 & omega cap 267 mg.......................................... 121DUET DHA 400 -prenat w/fe poly-na fered-fa tab 25-1 &

omega cap 400 mg...................................................... 121DULERA -mometasone furoate-formoterol fumarate

aerosol 100-5 mcg/act....................................................64DULERA -mometasone furoate-formoterol fumarate

aerosol 200-5 mcg/act....................................................64DULOXETINE HCL -duloxetine hcl enteric coated pellets

cap 40 mg (base eq)......................................................79duloxetine hcl enteric coated pellets cap 20 mg (base

eq) (Cymbalta)............................................................... 79duloxetine hcl enteric coated pellets cap 30 mg (base

eq) (Cymbalta)............................................................... 79

duloxetine hcl enteric coated pellets cap 60 mg (baseeq) (Cymbalta)............................................................... 79

DUOCAL -nutritional supplement powder.......................133DUOPA -carbidopa-levodopa enteral susp 4.63-20 mg/

ml................................................................................... 116DURACHOL -folic acid-cholecalciferol cap 1 mg-3775

unit................................................................................. 151DURAXIN -acetaminophen-salicylamide-

phenyltoloxamine cap 300-200-20mg............................96DUREZOL -difluprednate ophth emulsion 0.05%........... 164dutasteride cap 0.5 mg (Avodart).................................. 76dutasteride-tamsulosin hcl cap 0.5-0.4 mg (Jalyn)......76DUTOPROL -metoprolol & hydrochlorothiazide tab er

24hr 25-12.5 mg............................................................. 49DUTOPROL -metoprolol & hydrochlorothiazide tab er

24hr 50-12.5 mg............................................................. 49DUTOPROL -metoprolol & hydrochlorothiazide tab er

24hr 100-12.5 mg........................................................... 49D-VI-SOL -cholecalciferol oral liquid 400 unit/ml............ 119DYMISTA -azelastine hcl-fluticasone prop nasal spray

137-50 mcg/act............................................................... 61dyphylline-guaifenesin liqd 100-100 mg/5ml................64DYRENIUM -triamterene cap 50 mg.................................54DYRENIUM -triamterene cap 100 mg...............................54

EEAA SUPPLEMENT -nutritional supplement pack......... 133econazole nitrate cream 1%......................................... 173ECOZA -econazole nitrate foam 1%...............................174EDARBI -azilsartan medoxomil tab 40 mg........................49EDARBI -azilsartan medoxomil tab 80 mg........................49EDARBYCLOR -azilsartan medoxomil-chlorthalidone tab

40-12.5 mg......................................................................49EDARBYCLOR -azilsartan medoxomil-chlorthalidone tab

40-25 mg......................................................................... 49EDECRIN -ethacrynic acid tab 25 mg.............................. 54EDURANT -rilpivirine hcl tab 25 mg (base equivalent).......7E.E.S. 400 -erythromycin ethylsuccinate tab 400 mg......... 3E.E.S. GRANULES -erythromycin ethylsuccinate for susp

200 mg/5ml....................................................................... 3EFFER-K -potassium bicarbonate-citric acid effer tab 10

meq................................................................................129EFFER-K -potassium bicarbonate-citric acid effer tab 20

meq................................................................................129EFFIENT -prasugrel hcl tab 5 mg (base equiv).............. 158EFFIENT -prasugrel hcl tab 10 mg (base equiv)............ 158EGG/PRO -nutritional supplement powder..................... 133EGGS/APPLES/OATS -nutritional supplement liquid..... 133EGRIFTA -tesamorelin acetate for inj 1 mg (base

equiv)...............................................................................39ELECARE/DHA/ARA -nutritional supplement

powder...........................................................................134

2016



ELECARE JR -nutritional supplement powder................133ELECARE -nutritional supplement powder..................... 133ELESTRIN -estradiol gel 0.06% (0.52 mg/0.87 gm

metered-dose pump)...................................................... 24ELETONE -dermatological products misc - cream......... 174ELETONE TWINPACK -dermatological products misc -

cream.............................................................................174eletriptan hydrobromide tab 20 mg (base equivalent)

(Relpax)........................................................................ 108eletriptan hydrobromide tab 40 mg (base equivalent)

(Relpax)........................................................................ 108ELIDEL -pimecrolimus cream 1%................................... 174ELIGARD -leuprolide acetate for subcutaneous inj kit 7.5

mg....................................................................................17ELIGARD -leuprolide acetate (3 month) for subcutaneous

inj kit 22.5mg...................................................................16ELIGARD -leuprolide acetate (4 month) for subcutaneous

inj kit 30 mg.................................................................... 17ELIGARD -leuprolide acetate (6 month) for subcutaneous

inj kit 45 mg.................................................................... 17ELIQUIS -apixaban tab 2.5 mg....................................... 155ELIQUIS -apixaban tab 5 mg.......................................... 155ELITE-OB -prenatal vit w/ iron carbonyl-fa tab 50-1.25

mg..................................................................................121ELIXOPHYLLIN -theophylline elixir 80 mg/15ml...............64ELLA -ulipristal acetate tab 30 mg....................................26ELMIRON -pentosan polysulfate sodium caps 100

mg....................................................................................76ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj

250 unit......................................................................... 158ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj



1000 unit....................................................................... 158ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj






6000 unit....................................................................... 158EMADINE -emedastine difumarate ophth soln 0.05%

(base equiv).................................................................. 164EMBEDA -morphine-naltrexone cap er 20-0.8 mg........... 98EMBEDA -morphine-naltrexone cap er 30-1.2 mg........... 98

EMBEDA -morphine-naltrexone cap er 50-2 mg.............. 98EMBEDA -morphine-naltrexone cap er 60-2.4 mg........... 98EMBEDA -morphine-naltrexone cap er 80-3.2 mg........... 98EMBEDA -morphine-naltrexone cap er 100-4 mg............ 98EMCYT -estramustine phosphate sodium cap 140

mg....................................................................................17EMEND -aprepitant capsule 40 mg.................................. 70EMEND -aprepitant capsule 80 mg.................................. 70EMEND -aprepitant capsule 125 mg................................ 70EMEND -aprepitant for oral susp 125 mg (125

mg/5ml)............................................................................70EMEND TRIPACK -aprepitant capsule therapy pack 80 &

125 mg............................................................................ 70EMSAM -selegiline td patch 24hr 6 mg/24hr.................... 79EMSAM -selegiline td patch 24hr 9 mg/24hr.................... 79EMSAM -selegiline td patch 24hr 12 mg/24hr.................. 79EMTRIVA -emtricitabine caps 200 mg................................ 7EMTRIVA -emtricitabine soln 10 mg/ml.............................. 7EMULSION SB -dermatological products misc -

emulsion........................................................................ 174EMVERM -mebendazole chew tab 100 mg......................12ENABLEX -darifenacin hydrobromide tab er 24hr 7.5 mg

(base equiv).................................................................... 75ENABLEX -darifenacin hydrobromide tab er 24hr 15 mg

(base equiv).................................................................... 75enalapril maleate & hydrochlorothiazide tab 5-12.5

mg................................................................................... 49enalapril maleate & hydrochlorothiazide tab 10-25 mg

(Vaseretic)...................................................................... 49enalapril maleate tab 2.5 mg (Vasotec).........................49enalapril maleate tab 5 mg (Vasotec)............................49enalapril maleate tab 10 mg (Vasotec)..........................49enalapril maleate tab 20 mg (Vasotec)..........................49ENBRACE HR -prenatal vit w/ fe gly cys-fa-omega 3 fatty

acids cap.......................................................................121ENBREL -etanercept for subcutaneous inj 25 mg.......... 105ENBREL -etanercept subcutaneous soln prefilled syringe

25 mg/0.5ml.................................................................. 105ENBREL -etanercept subcutaneous soln prefilled syringe

50 mg/ml....................................................................... 105ENBREL SURECLICK -etanercept subcutaneous solution

auto-injector 50 mg/ml..................................................105END FATIGUE DAILY ENERGY -multiple vitamins w/

minerals powder............................................................121ENGERIX-B -hepatitis b vaccine (recombinant) 10

mcg/0.5ml........................................................................13ENGERIX-B -hepatitis b vaccine (recombinant) 20 mcg/

ml..................................................................................... 13ENGERIX-B -hepatitis b vaccine (recombinant) susp 10

mcg/0.5ml........................................................................13ENGERIX-B -hepatitis b vaccine (recombinant) susp 20

mcg/ml............................................................................. 13

2016



ENLIVE -nutritional supplement liquid.............................134enoxaparin sodium inj 30 mg/0.3ml (Lovenox)..........155enoxaparin sodium inj 40 mg/0.4ml (Lovenox)..........155enoxaparin sodium inj 60 mg/0.6ml (Lovenox)..........155enoxaparin sodium inj 80 mg/0.8ml (Lovenox)..........155enoxaparin sodium inj 100 mg/ml (Lovenox).............155enoxaparin sodium inj 120 mg/0.8ml (Lovenox)........155enoxaparin sodium inj 150 mg/ml (Lovenox).............155enoxaparin sodium inj 300 mg/3ml (Lovenox)...........155ENSTILAR -calcipotriene-betamethasone dipropionate

foam 0.005-0.064%...................................................... 174ENSURE/FIBER -nutritional supplement liquid...............134ENSURE ACTIVE HEART HEALT -nutritional supplement

liquid.............................................................................. 134ENSURE ACTIVE HIGH PROTEI -nutritional supplement

liquid.............................................................................. 134ENSURE ACTIVE LIGHT -nutritional supplement

liquid.............................................................................. 134ENSURE ACTIVE -nutritional supplement liquid............ 134ENSURE BONE HEALTH REVIGO -nutritional

supplement liquid..........................................................134ENSURE CLEAR -nutritional supplement liquid............. 134ENSURE CLINICAL STRENGTH -nutritional supplement

liquid.............................................................................. 134ENSURE COMPACT -nutritional supplement liquid....... 134ENSURE COMPLETE -nutritional supplement liquid..... 134ENSURE COMPLETE NUTRITION -nutritional

supplement liquid..........................................................134ENSURE ENLIVE -nutritional supplement liquid............ 134ENSURE HEALTHY MOM -nutritional supplement

bar..................................................................................134ENSURE HEALTHY MOM -nutritional supplement

liquid.............................................................................. 134ENSURE HIGH CALCIUM -nutritional supplement

liquid.............................................................................. 134ENSURE HIGH PROTEIN -nutritional supplement

liquid.............................................................................. 134ENSURE HIGH PROTEIN -nutritional supplement

powder...........................................................................134ENSURE IMMUNE HEALTH -nutritional supplement

liquid.............................................................................. 134ENSURE MUSCLE HEALTH REVI -nutritional

supplement liquid..........................................................134ENSURE NUTRA SHAKE HI-CAL -nutritional supplement

liquid.............................................................................. 134ENSURE -nutritional supplement bar..............................134ENSURE -nutritional supplement liquid.......................... 134ENSURE -nutritional supplement powder.......................134ENSURE NUTRITION SHAKE -nutritional supplement

liquid.............................................................................. 134ENSURE PLUS HN -nutritional supplement liquid..........134ENSURE PLUS -nutritional supplement liquid................134

ENSURE PRE-SURGERY -nutritional supplementliquid.............................................................................. 134

ENSURE PUDDING -nutritional supplementpudding..........................................................................134

ENSURE SURGERY IMMUNONUTR -nutritionalsupplement liquid..........................................................134

entacapone tab 200 mg (Comtan)............................... 116entecavir tab 0.5 mg (Baraclude).....................................7entecavir tab 1 mg (Baraclude)........................................7ENTEREG -alvimopan cap 12 mg.................................... 72ENTRESTO -sacubitril-valsartan tab 24-26 mg................ 59ENTRESTO -sacubitril-valsartan tab 49-51 mg................ 59ENTRESTO -sacubitril-valsartan tab 97-103 mg.............. 59ENTTY SPRAY EMULSION -dermatological products

misc - emulsion.............................................................174ENU NUTRITIONAL SHAKE -nutritional supplement

liquid.............................................................................. 134ENVARSUS XR -tacrolimus tab er 24hr 0.75 mg........... 184ENVARSUS XR -tacrolimus tab er 24hr 1 mg................ 185ENVARSUS XR -tacrolimus tab er 24hr 4 mg................ 185EO28 SPLASH -nutritional supplement liquid.................135EPANED -enalapril maleate oral soln 1 mg/ml................. 50EPCLUSA -sofosbuvir-velpatasvir tab 400-100 mg............7EPICERAM -dermatological products misc -

emulsion........................................................................ 174EPIFOAM -pramoxine-hc aerosol foam 1-1%.................174epinastine hcl ophth soln 0.05% (Elestat).................. 164EPINEPHRINE - AUTHORIZED GENERIC TO EPIPEN

-epinephrine solution auto-injector 0.15 mg/0.3ml(1:2000)........................................................................... 55

EPINEPHRINE - AUTHORIZED GENERIC TO EPIPEN-epinephrine solution auto-injector 0.3 mg/0.3ml(1:1000)........................................................................... 55

EPINEPHRINE -epinephrine solution auto-injector 0.15mg/0.15ml (1:1000).........................................................55

EPINEPHRINE -epinephrine solution auto-injector 0.3mg/0.3ml (1:1000)...........................................................55

EPIPEN-JR 2-PAK -epinephrine solution auto-injector0.15 mg/0.3ml (1:2000).................................................. 55

EPIPEN 2-PAK -epinephrine solution auto-injector 0.3mg/0.3ml (1:1000)...........................................................55

EPIVIR HBV -lamivudine oral soln 5 mg/ml (hbv)...............7EPIVIR -lamivudine oral soln 10 mg/ml.............................. 7eplerenone tab 25 mg (Inspra).......................................50eplerenone tab 50 mg (Inspra).......................................50EPOGEN -epoetin alfa inj 2000 unit/ml...........................151EPOGEN -epoetin alfa inj 3000 unit/ml...........................151EPOGEN -epoetin alfa inj 4000 unit/ml...........................151EPOGEN -epoetin alfa inj 10000 unit/ml.........................151EPOGEN -epoetin alfa inj 20000 unit/ml.........................151EPROSARTAN MESYLATE -eprosartan mesylate tab 600

mg....................................................................................50

2016



EPZICOM -abacavir sulfate-lamivudine tab 600-300mg......................................................................................7

EQL DENTAL TRAVEL PACK -sodium fluoride paste0.243% & mouthwash kit..............................................168

EQL TRAVEL TOOTHBRUSH/TOO -sodiummonofluorophosphate paste 0.15%............................. 168

EQ NUTRITIONAL SHAKE -nutritional supplementliquid.............................................................................. 135

EQ NUTRITIONAL SHAKE PLUS -nutritional supplementliquid.............................................................................. 135

EQUATE -nutritional supplement liquid...........................135EQUATE PLUS -nutritional supplement liquid................ 135EQUETRO -carbamazepine (antipsychotic) cap er 12hr

100 mg............................................................................ 83EQUETRO -carbamazepine (antipsychotic) cap er 12hr

200 mg............................................................................ 83EQUETRO -carbamazepine (antipsychotic) cap er 12hr

300 mg............................................................................ 83EQ WEIGHT LOSS SHAKE ULTR -nutritional supplement

liquid.............................................................................. 135ergocalciferol cap 50000 unit (Drisdol).......................119ERGOLOID MESYLATES -ergoloid mesylates tab 1

mg....................................................................................92ERGOMAR -ergotamine tartrate sl tab 2 mg.................. 108ergotamine w/ caffeine tab 1-100 mg (Cafergot)........108ERIVEDGE -vismodegib cap 150 mg............................... 17ERTACZO -sertaconazole nitrate cream 2%.................. 174ERYPED 200 -erythromycin ethylsuccinate for susp 200

mg/5ml...............................................................................3ERYPED 400 -erythromycin ethylsuccinate for susp 400

mg/5ml...............................................................................3ERY-TAB -erythromycin tab delayed release 250 mg........ 3ERY-TAB -erythromycin tab delayed release 333 mg........ 3ERY-TAB -erythromycin tab delayed release 500 mg........ 3ERYTHROCIN STEARATE -erythromycin stearate tab

250 mg.............................................................................. 3ERYTHROMYCIN BASE -erythromycin tab 250 mg.......... 3ERYTHROMYCIN BASE -erythromycin tab 500 mg.......... 3ERYTHROMYCIN ETHYLSUCCINA -erythromycin

ethylsuccinate tab 400 mg............................................... 3erythromycin ethylsuccinate for susp 200 mg/5ml

(E.e.s. granules).............................................................. 3erythromycin gel 2% (Erygel).......................................174erythromycin ophth oint 5 mg/gm...............................164erythromycin pads 2%.................................................. 174erythromycin soln 2%................................................... 174erythromycin w/ delayed release particles cap 250

mg......................................................................................4ESBRIET -pirfenidone cap 267 mg...................................66ESBRIET -pirfenidone tab 267 mg....................................66ESBRIET -pirfenidone tab 801 mg....................................66

ESCAVITE D -pediatric multiple vitamins w/ fl-fe chew tab0.25-6 mg......................................................................121

ESCAVITE LQ -pediatric multiple vitamins w/ fl-fe drops0.25-6 mg/ml................................................................. 121

ESCAVITE -pediatric multiple vitamins w/ fl-fe chew tab0.25-7.5 mg...................................................................121

escitalopram oxalate soln 5 mg/5ml (base equiv)(Lexapro)........................................................................ 79

escitalopram oxalate tab 5 mg (base equiv)(Lexapro)........................................................................ 79



esomeprazole magnesium cap delayed release 20 mg(base eq) (Nexium)....................................................... 68

esomeprazole magnesium cap delayed release 40 mg(base eq) (Nexium)....................................................... 68

ESSENTIAL AMINO ACID MIX -amino acids oralpowder...........................................................................131

ESSENTRA WIPES 9X9" CLEAN -isopropyl alcoholwipes 70%.....................................................................174

estazolam tab 1 mg......................................................... 87estazolam tab 2 mg......................................................... 87esterified estrogens & methyltestosterone tab

0.625-1.25 mg................................................................ 24esterified estrogens & methyltestosterone tab

1.25-2.5 mg.....................................................................24ESTRACE -estradiol vaginal cream 0.1 mg/gm................76estradiol & norethindrone acetate tab 0.5-0.1 mg

(Activella)....................................................................... 24estradiol & norethindrone acetate tab 1-0.5 mg

(Activella)....................................................................... 24estradiol tab 0.5 mg (Estrace)........................................25estradiol tab 1 mg (Estrace)...........................................25estradiol tab 2 mg (Estrace)...........................................25estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-

dot).................................................................................. 25estradiol td patch twice weekly 0.0375 mg/24hr

(Vivelle-dot)....................................................................25estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-

dot).................................................................................. 25estradiol td patch twice weekly 0.075 mg/24hr (Vivelle-

dot).................................................................................. 25estradiol td patch twice weekly 0.1 mg/24hr (Vivelle-

dot).................................................................................. 25estradiol td patch weekly 0.025 mg/24hr (Climara)......25estradiol td patch weekly 0.05 mg/24hr (Climara)........25estradiol td patch weekly 0.06 mg/24hr (Climara)........25estradiol td patch weekly 0.075 mg/24hr (Climara)......25estradiol td patch weekly 0.1 mg/24hr (Climara)..........25

2016



estradiol td patch weekly 0.0375 mg/24hr (37.5mcg/24hr) (Climara)...................................................... 25

estradiol vaginal tab 10 mcg (Vagifem).........................76estradiol valerate im in oil 20 mg/ml (Delestrogen).....25estradiol valerate im in oil 40 mg/ml (Delestrogen).....25ESTRING -estradiol vaginal ring 2 mg (7.5

mcg/24hrs).......................................................................76ESTROGEL -estradiol gel 0.06% (0.75 mg/1.25 gm

metered-dose pump)...................................................... 25ESTROPIPATE -estropipate tab 0.75 mg......................... 25ESTROPIPATE -estropipate tab 1.5 mg........................... 25ESTROPIPATE -estropipate tab 3 mg.............................. 25eszopiclone tab 1 mg (Lunesta).................................... 87eszopiclone tab 2 mg (Lunesta).................................... 87eszopiclone tab 3 mg (Lunesta).................................... 87ethacrynic acid tab 25 mg (EDECRIN).......................... 54ethambutol hcl tab 100 mg (Myambutol)........................ 5ethambutol hcl tab 400 mg (Myambutol)........................ 5ethosuximide cap 250 mg (Zarontin).......................... 111ethosuximide soln 250 mg/5ml (Zarontin).................. 111ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg................................................................................. 26ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg (Zovia 1/50e)......................................................... 26ETIDRONATE DISODIUM -etidronate disodium tab 200

mg....................................................................................39ETIDRONATE DISODIUM -etidronate disodium tab 400

mg....................................................................................39etodolac cap 200 mg..................................................... 105etodolac cap 300 mg..................................................... 105etodolac tab er 24hr 400 mg........................................ 105etodolac tab er 24hr 500 mg........................................ 105etodolac tab er 24hr 600 mg........................................ 105etodolac tab 400 mg......................................................105etodolac tab 500 mg......................................................105ETOPOSIDE -etoposide cap 50 mg..................................17EURAX -crotamiton cream 10%......................................174EURAX -crotamiton lotion 10%....................................... 174EVAMIST -estradiol transdermal spray 1.53 mg/spray..... 25EVOTAZ -atazanavir sulfate-cobicistat tab 300-150 mg

(base equiv)...................................................................... 7EVZIO -naloxone hcl solution auto-injector 0.4

mg/0.4ml........................................................................182EVZIO -naloxone hcl solution auto-injector 2

mg/0.4ml........................................................................182EXALGO -hydromorphone hcl tab er 24hr deter 32

mg....................................................................................98EXELDERM -sulconazole nitrate cream 1%...................174EXELDERM -sulconazole nitrate solution 1%................ 174EXELON -rivastigmine td patch 24hr 4.6 mg/24hr............92EXELON -rivastigmine td patch 24hr 9.5 mg/24hr............92EXELON -rivastigmine td patch 24hr 13.3 mg/24hr..........92

exemestane tab 25 mg (Aromasin)................................17EXJADE -deferasirox tab for oral susp 125 mg.............. 182EXJADE -deferasirox tab for oral susp 250 mg.............. 182EXJADE -deferasirox tab for oral susp 500 mg.............. 182EXODERM -sodium thiosulfate-salicylic acid lotion

25-1%............................................................................ 174EXTAVIA -interferon beta-1b for inj kit 0.3 mg.................. 92ezetimibe-simvastatin tab 10-10 mg (Vytorin)..............56ezetimibe-simvastatin tab 10-20 mg (Vytorin)..............56ezetimibe-simvastatin tab 10-40 mg (Vytorin)..............56ezetimibe-simvastatin tab 10-80 mg (Vytorin)..............56ezetimibe tab 10 mg (Zetia)............................................ 56FF.A.A. -nutritional supplement liquid................................135FABIOR -tazarotene (acne) foam 0.1%.......................... 174FACTIVE -gemifloxacin mesylate tab 320 mg (base

equiv)................................................................................. 5FALESSA -levomefolate glucosamine tab 1 mg (folate

equivalent).....................................................................135FALESSA -levonorgest-eth estrad tab 0.1 mg-20 mcg & fa

tab 1 mg kit.....................................................................26famciclovir tab 125 mg (Famvir)...................................... 8famciclovir tab 250 mg (Famvir)...................................... 8famciclovir tab 500 mg (Famvir)...................................... 8famotidine for susp 40 mg/5ml (Pepcid).......................68famotidine tab 40 mg (Pepcid).......................................68FANAPT -iloperidone tab 1 mg......................................... 83FANAPT -iloperidone tab 2 mg......................................... 83FANAPT -iloperidone tab 4 mg......................................... 83FANAPT -iloperidone tab 6 mg......................................... 83FANAPT -iloperidone tab 8 mg......................................... 83FANAPT -iloperidone tab 10 mg....................................... 83FANAPT -iloperidone tab 12 mg....................................... 83FANAPT TITRATION PACK -iloperidone tab 1 mg & 2 mg

& 4 mg & 6 mg titration pak...........................................83FARESTON -toremifene citrate tab 60 mg (base

equivalent).......................................................................17FARXIGA -dapagliflozin propanediol tab 5 mg (base

equivalent).......................................................................30FARXIGA -dapagliflozin propanediol tab 10 mg (base

equivalent).......................................................................30FARYDAK -panobinostat lactate cap 10 mg (base



equivalent).......................................................................17FAZACLO -clozapine orally disintegrating tab 12.5

mg....................................................................................83FAZACLO -clozapine orally disintegrating tab 25 mg....... 83FAZACLO -clozapine orally disintegrating tab 100 mg..... 83

2016



FAZACLO -clozapine orally disintegrating tab 150 mg..... 83FAZACLO -clozapine orally disintegrating tab 200 mg..... 83fe fumarate-vit c-vit b12-fa cap 460 (151 fe)-60-0.01-1

mg................................................................................. 151fe fumarate w/ b12-vit c-fa-ifc cap 110-0.015-75-0.5-240

mg................................................................................. 151fe fum-iron polysacch complex-fa-b cmplx-c-zn-mn-

cu cap (Tandem plus)................................................ 151FEIBA -antiinhibitor coagulant complex for inj................ 158felbamate susp 600 mg/5ml (Felbatol)........................ 111felbamate tab 400 mg (Felbatol).................................. 111felbamate tab 600 mg (Felbatol).................................. 111felodipine tab er 24hr 2.5 mg......................................... 45felodipine tab er 24hr 5 mg............................................ 45felodipine tab er 24hr 10 mg.......................................... 45FEMHRT LOW DOSE -norethindrone acetate-ethinyl

estradiol tab 0.5 mg-2.5 mcg......................................... 25FEM PH -acetic acid-oxyquinoline vaginal gel

0.9-0.025%...................................................................... 76FEMRING -estradiol acetate vaginal ring 0.05

mg/24hr........................................................................... 76FEMRING -estradiol acetate vaginal ring 0.1 mg/24hr..... 76FENOFIBRATE -fenofibrate cap 50 mg............................ 56FENOFIBRATE -fenofibrate cap 150 mg.......................... 56fenofibrate micronized cap 43 mg.................................56fenofibrate micronized cap 130 mg...............................56fenofibrate micronized cap 67 mg (Lofibra)................. 56fenofibrate micronized cap 134 mg (Lofibra)............... 56fenofibrate micronized cap 200 mg (Lofibra)............... 56fenofibrate tab 40 mg (Fenoglide)................................. 56fenofibrate tab 120 mg (Fenoglide)............................... 56fenofibrate tab 54 mg (Lofibra)...................................... 56fenofibrate tab 160 mg (Lofibra).................................... 56fenofibrate tab 48 mg (Tricor)........................................ 56fenofibrate tab 145 mg (Tricor)...................................... 56FENOFIBRIC ACID -fenofibric acid tab 35 mg................. 56FENOFIBRIC ACID -fenofibric acid tab 105 mg............... 56FENOGLIDE -fenofibrate tab 40 mg................................. 56FENOGLIDE -fenofibrate tab 120 mg............................... 57FENOPROFEN CALCIUM -fenoprofen calcium cap 200

mg..................................................................................105FENOPROFEN CALCIUM -fenoprofen calcium cap 400

mg..................................................................................105fenoprofen calcium tab 600 mg................................... 105FENORTHO -fenoprofen calcium cap 200 mg............... 105FENORTHO -fenoprofen calcium cap 400 mg............... 105fentanyl citrate lozenge on a handle 200 mcg

(Actiq)............................................................................. 98fentanyl citrate lozenge on a handle 400 mcg

(Actiq)............................................................................. 98fentanyl citrate lozenge on a handle 600 mcg

(Actiq)............................................................................. 98

fentanyl citrate lozenge on a handle 800 mcg(Actiq)............................................................................. 98



FENTANYL -fentanyl td patch 72hr 37.5 mcg/hr...............98FENTANYL -fentanyl td patch 72hr 62.5 mcg/hr...............98FENTANYL -fentanyl td patch 72hr 87.5 mcg/hr...............98fentanyl td patch 72hr 12 mcg/hr (Duragesic)..............98fentanyl td patch 72hr 25 mcg/hr (Duragesic)..............98fentanyl td patch 72hr 50 mcg/hr (Duragesic)..............98fentanyl td patch 72hr 75 mcg/hr (Duragesic)..............98fentanyl td patch 72hr 100 mcg/hr (Duragesic)............98FENTORA -fentanyl citrate buccal tab 100 mcg (base

equiv)...............................................................................99FENTORA -fentanyl citrate buccal tab 200 mcg (base




equiv)...............................................................................99FER-IN-SOL -ferrous sulfate soln 75 mg/ml (15 mg/ml

elemental fe)................................................................. 151FERIVA 21/7 -fe asparto gly-b12-fa-c-dss-succinic acid-zn

tab 75-1 mg...................................................................151FERIVAFA -iron-c-fa-b12-biotin-copper-docusate cap

110-1 mg....................................................................... 151FERIVA -fe bisglycin-fe carbonyl-c-fa-b12-biotin-dss cap

75-1 mg......................................................................... 151FERRALET 90 -fe carbonyl-fe gluconate-fa-vit b12-vit c-

dss tab 90-1 mg........................................................... 151FERRAPLUS 90 -iron-folic acid-vit b12-vit c-docusate sod

tab 90-1 mg...................................................................151FERRETTS CHEWABLE IRON -carbonyl iron chew tab

18 mg (elemental iron)................................................. 152FERRIPROX -deferiprone oral soln 100 mg/ml.............. 182FERRIPROX -deferiprone tab 500 mg............................182FERRO-PLEX HEMATINIC -fe fum-dss-vit c-vit e-vit b12-

if-fa tab 115-1 mg......................................................... 152FERROTRIN -iron w/ b12-vit c-fa-ifc cap

36-0.015-75-0.5-240 mg...............................................152ferrous fumarate-fa-b complex-c-zn-mg-mn-cu tab

106-1 mg.......................................................................152ferrous fumarate-folic acid tab 324-1 mg....................152ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elemental

fe).................................................................................. 152FERROUS SULFATE -ferrous sulfate liquid 220 mg/5ml

(44 mg/5ml elemental fe)............................................. 152

2016



FERROUS SULFATE -ferrous sulfate syrup 300 mg/5ml(60 mg/5ml elemental fe)............................................. 152

ferrous sulfate soln 75 mg/ml (15 mg/ml elementalfe).................................................................................. 152

FETZIMA -levomilnacipran hcl cap er 24hr 20 mg (baseequivalent).......................................................................79




FETZIMA TITRATION PACK -levomilnacipran hcl cap er24hr 20 & 40 mg therapy pack...................................... 80

FIBER FLOW -nutritional supplement liquid................... 135FIBERSOURCE CLOSED SYSTEM -nutritional

supplement liquid..........................................................135FIBERSOURCE HN CLOSED SYS -nutritional

supplement liquid..........................................................135FIBERSOURCE HN -nutritional supplement liquid.........135FIBER-STAT -nutritional supplement liquid.....................135FIBRICOR -fenofibric acid tab 35 mg............................... 57FIBRICOR -fenofibric acid tab 105 mg............................. 57FINACEA -azelaic acid foam 15%.................................. 174FINACEA -azelaic acid gel 15%..................................... 174finasteride tab 5 mg (Proscar)....................................... 76FIRAZYR -icatibant acetate inj 30 mg/3ml (base

equivalent).....................................................................158FIRST-LANSOPRAZOLE -lansoprazole susp 3 mg/ml

(compound kit)................................................................ 68FIRST-OMEPRAZOLE -omeprazole susp 2 mg/ml

(compound kit)................................................................ 68FLAREX -fluorometholone acetate ophth susp 0.1%..... 164FLAVOR PACKETS -nutritional supplement flavor

pack............................................................................... 135FLAVOUR PAC -nutritional supplement flavor pack....... 135flavoxate hcl tab 100 mg.................................................75flecainide acetate tab 50 mg.......................................... 46flecainide acetate tab 100 mg........................................ 46flecainide acetate tab 150 mg........................................ 46FLECTOR -diclofenac epolamine patch 1.3%................ 174FLORICAL -sodium fluoride w/ calcium carb cap 8.3-364

mg..................................................................................129FLORICAL -sodium fluoride w/ calcium carb tab 8.3-364

mg..................................................................................129FLORIVA -ped multiple vitamins & minerals w/ fl chew tab

0.25 mg......................................................................... 121FLORIVA -ped multiple vitamins & minerals w/ fl chew tab

0.5 mg........................................................................... 121FLORIVA -ped multiple vitamins & minerals w/ fl chew tab

1 mg.............................................................................. 121

FLORIVA PLUS -pediatric multiple vitamins w/ fluoridesoln 0.25 mg/ml............................................................ 121

FLORIVA -sodium fluoride-vitamin d liqd drops 0.25 mg/ml-400 unit/ml............................................................... 129

FLOVENT DISKUS -fluticasone propionate aer pow ba 50mcg/blister....................................................................... 64

FLOVENT DISKUS -fluticasone propionate aer pow ba100 mcg/blister................................................................64

FLOVENT DISKUS -fluticasone propionate aer pow ba250 mcg/blister................................................................64

FLOVENT HFA -fluticasone propionate hfa inhal aer 110mcg/act (125/valve)........................................................ 64

FLOVENT HFA -fluticasone propionate hfa inhal aer 220mcg/act (250/valve)........................................................ 64

FLOVENT HFA -fluticasone propionate hfa inhal aero 44mcg/act (50/valve)...........................................................64

FLOWTUSS -hydrocodone-guaifenesin soln 2.5-200mg/5ml.............................................................................61

FLUAD 2017-2018 -influenza vac type a&b surface antadj susp pref syr 0.5 ml................................................. 13

FLUARIX QUADRIVALENT 2017 -influenza virus vac splitquadrivalent susp pref syr 0.5ml....................................13

FLUBLOK 2015-2016 -influenza virus vac recombinanthemagglutinin (ha) pf inj.................................................13

FLUBLOK 2017-2018 -influenza virus vac recombinanthemagglutinin (ha) pf inj.................................................13

FLUBLOK QUADRIVALENT 2017 -influenza vac recombha quad pf soln pref syr 0.5 ml......................................13

FLUCELVAX QUADRIVALENT 20 -influenza vac tiss-cultsubunt quad susp pref syr 0.5 ml.................................. 13

FLUCELVAX QUADRIVALENT 20 -influenza vac tissue-cultured subunit quadrivalent im susp........................... 13

fluconazole for susp 10 mg/ml (Diflucan).......................6fluconazole for susp 40 mg/ml (Diflucan).......................6fluconazole tab 50 mg (Diflucan).....................................6fluconazole tab 100 mg (Diflucan)...................................6fluconazole tab 150 mg (Diflucan)...................................6fluconazole tab 200 mg (Diflucan)...................................6flucytosine cap 250 mg (Ancobon)................................. 6flucytosine cap 500 mg (Ancobon)................................. 6fludrocortisone acetate tab 0.1 mg............................... 22FLULAVAL QUADRIVALENT 201 -influenza virus vaccine

split quadrivalent im inj...................................................14FLULAVAL QUADRIVALENT 201 -influenza virus vac split

quadrivalent susp pref syr 0.5ml....................................13FLUMIST QUADRIVALENT -influenza virus vaccine live

quadrivalent intranasal susp...........................................14FLUNISOLIDE -flunisolide nasal soln 25 mcg/act

(0.025%).......................................................................... 61fluocinolone acetonide cream 0.01%.......................... 174fluocinolone acetonide cream 0.025% (Synalar)........174

2016



fluocinolone acetonide oil 0.01% (body oil) (Derma-smoothe/fs bod)..........................................................174

fluocinolone acetonide oil 0.01% (scalp oil) (Derma-smoothe/fs sca)...........................................................174

fluocinolone acetonide oint 0.025% (Synalar)............174fluocinolone acetonide (otic) oil 0.01%

(Dermotic).................................................................... 167fluocinolone acetonide soln 0.01% (Synalar).............174fluocinonide cream 0.05%............................................ 174fluocinonide cream 0.1% (Vanos)................................ 174fluocinonide emulsified base cream 0.05%................174fluocinonide gel 0.05%..................................................174fluocinonide oint 0.05%................................................ 174fluocinonide soln 0.05%................................................174FLUORABON -sodium fluoride soln 0.25 mg/0.6ml (from

0.55 mg/0.6ml naf)........................................................129FLUOR-A-DAY -sodium fluoride-xylitol chew tab 0.55

(0.25 mg f)-236.79 mg..................................................129FLUOR-A-DAY -sodium fluoride-xylitol chew tab 2.2 (1 mg

f)-236.79 mg..................................................................129fluorometholone ophth susp 0.1% (Fml liquifilm)..... 164FLUOROPLEX -fluorouracil cream 1%...........................174fluorouracil cream 5% (Efudex)................................... 175FLUOROURACIL -fluorouracil cream 0.5%....................174FLUOROURACIL -fluorouracil soln 2%.......................... 175FLUOROURACIL -fluorouracil soln 5%.......................... 175FLUOXETINE DR -fluoxetine hcl cap delayed release 90

mg....................................................................................80FLUOXETINE -fluoxetine hcl (pmdd) cap 10 mg..............92FLUOXETINE -fluoxetine hcl (pmdd) cap 20 mg..............92fluoxetine hcl cap 10 mg (Prozac).................................80fluoxetine hcl cap 20 mg (Prozac).................................80fluoxetine hcl cap 40 mg (Prozac).................................80FLUOXETINE HCL -fluoxetine hcl tab 60 mg...................80fluoxetine hcl (pmdd) tab 10 mg (Sarafem).................. 92fluoxetine hcl (pmdd) tab 20 mg (Sarafem).................. 92fluoxetine hcl solution 20 mg/5ml................................. 80fluoxetine hcl tab 10 mg................................................. 80fluoxetine hcl tab 20 mg................................................. 80FLUPHENAZINE HCL -fluphenazine hcl elixir 2.5

mg/5ml.............................................................................83FLUPHENAZINE HCL -fluphenazine hcl oral conc 5 mg/

ml..................................................................................... 84fluphenazine hcl tab 1 mg.............................................. 84fluphenazine hcl tab 2.5 mg........................................... 84fluphenazine hcl tab 5 mg.............................................. 84fluphenazine hcl tab 10 mg............................................ 84FLURA-DROPS -sodium fluoride soln 0.25 mg/drop f

(from 0.55 mg/drop naf)............................................... 129flurandrenolide cream 0.05% (CORDRAN)................. 175flurandrenolide lotion 0.05% (Cordran).......................175flurandrenolide oint 0.05% (Cordran)..........................175

FLURAZEPAM HCL -flurazepam hcl cap 15 mg.............. 87FLURAZEPAM HCL -flurazepam hcl cap 30 mg.............. 87FLURBIPROFEN SODIUM -flurbiprofen sodium ophth

soln 0.03%.................................................................... 164flurbiprofen tab 50 mg.................................................. 105flurbiprofen tab 100 mg................................................ 105flutamide cap 125 mg......................................................17FLUTICASONE PROPIONATE/SA -fluticasone-salmeterol

aer powder ba 55-14 mcg/act........................................ 64FLUTICASONE PROPIONATE/SA -fluticasone-salmeterol

aer powder ba 113-14 mcg/act...................................... 64FLUTICASONE PROPIONATE/SA -fluticasone-salmeterol

aer powder ba 232-14 mcg/act...................................... 64fluticasone propionate cream 0.05% (Cutivate).........175fluticasone propionate lotion 0.05% (Cutivate)..........175fluticasone propionate nasal susp 50 mcg/act............ 61fluticasone propionate oint 0.005%.............................175fluvastatin sodium cap 20 mg (Lescol).........................57fluvastatin sodium cap 40 mg (Lescol).........................57fluvastatin sodium tab er 24 hr 80 mg (Lescol xl)........57FLUVIRIN 2015-2016 -influenza vac type a&b surface

antigen susp pref syr 0.5 ml...........................................14FLUVIRIN 2017-2018 -influenza vac type a&b surface

antigen susp pref syr 0.5 ml...........................................14FLUVIRIN 2015-2016 -influenza virus vaccine types a & b

surface antigen im susp................................................. 14FLUVIRIN 2017-2018 -influenza virus vaccine types a & b

surface antigen im susp................................................. 14fluvoxamine maleate cap er 24hr 100 mg.....................80fluvoxamine maleate cap er 24hr 150 mg.....................80fluvoxamine maleate tab 25 mg.....................................80fluvoxamine maleate tab 50 mg.....................................80fluvoxamine maleate tab 100 mg...................................80FLUZONE HIGH-DOSE PF 2017 -influenza virus vac split

high-dose pf susp pref syr 0.5ml....................................14FLUZONE INTRADERMAL QUADR -influenza virus vac

split quad intradermal pen 9 mcg/strain.........................14FLUZONE QUADRIVALENT 2017 -influenza virus

vaccine split quadrivalent im inj..................................... 14FLUZONE QUADRIVALENT 2017 -influenza virus vac

split quadrivalent susp pref syr 0.25 ml......................... 14FLUZONE QUADRIVALENT 2017 -influenza virus vac

split quadrivalent susp pref syr 0.5ml............................ 14FML -fluorometholone ophth oint 0.1%...........................164FML FORTE -fluorometholone ophth susp 0.25%..........164FOCALGIN CA -prenat w/o a w/fecbn-fegl-dss-fa tab &

dha cap 300 mg pack...................................................121FOCALGIN 90 DHA -prenat w/o a w/fecbn-fegl-dss-fa tab

90 &dha cap 300mg pak..............................................121FOCALGIN DSS -fe carbonyl-fe gluconate-fa-vit b12-vit c-

dss tab 90-1 mg........................................................... 152

2016



FOCALIN XR -dexmethylphenidate hcl cap er 24 hr 10mg....................................................................................89




FOLCAL DHA -prenatal w/o vit a w/ fe fum-dss-fa-dhacap 27-1.25-300 mg..................................................... 121

FOLCAPS OMEGA 3 -prenatal vit w/ fe cbn-fe asp glyc-fa-omega 3 cap 27-1mg...............................................121

FOLET DHA -prenat w/fecbn-bisg-methylf-dss tab dr &dha cap pak.................................................................. 121

FOLET ONE -prenat w/o a w/fecbn-bisg-methylf-dss-dhacap 38-1-225 mg.......................................................... 121

FOLGARD OS -multiple vit w/ min & calcium-folic acid tab500-1.1 mg....................................................................121

folic acid cap 0.8 mg.....................................................152folic acid-pyridoxine-cyanocobalamin tab 2.5-25-2

mg................................................................................. 135folic acid tab 400 mcg...................................................152folic acid tab 800 mcg...................................................152folic acid tab 1 mg.........................................................152folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5

mg................................................................................. 152folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg..... 152folic acid-vitamin b6-vitamin b12 tab 2.2-25-1 mg

(Folgard rx).................................................................. 152FOLIVANE-F -fe fum-fe poly-fa-c-b3 cap

62.5-62.5-1-40-3mg(125 mg fe)................................... 152FOLIVANE-OB -prenatal w/o a w/fe fum-fe poly-fa cap

130-92.4-1 mg...............................................................121FOLIVANE-PLUS -fe fum-iron polysacch complex-fa-b

complex-c-biotin cap.....................................................152FOLIXAPURE -folic acid-cholecalciferol tab 1 mg-5000

unit................................................................................. 152fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml

(Arixtra).........................................................................155fondaparinux sodium subcutaneous inj 5 mg/0.4ml

(Arixtra).........................................................................155fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml

(Arixtra).........................................................................155fondaparinux sodium subcutaneous inj 10 mg/0.8ml

(Arixtra).........................................................................155FORFIVO XL -bupropion hcl tab er 24hr 450 mg............. 80formaldehyde solution 10%..........................................182FORMA-RAY -formaldehyde solution 20%..................... 182FORTA DRINK -nutritional supplement powder..............135FORTA SHAKE -nutritional supplement powder.............135FORTEO -teriparatide (recombinant) inj 600

mcg/2.4ml........................................................................39

FORTESTA -testosterone td gel 10mg/act (2%)...............23FOSAMAX PLUS D -alendronate sodium-cholecalciferol

tab 70-2800 mg-unit....................................................... 39FOSAMAX PLUS D -alendronate sodium-cholecalciferol

tab 70-5600 mg-unit....................................................... 39fosamprenavir calcium tab 700 mg (base equiv)

(Lexiva)............................................................................. 8fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg................................................................................... 50fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg................................................................................... 50fosinopril sodium tab 10 mg.......................................... 50fosinopril sodium tab 20 mg.......................................... 50fosinopril sodium tab 40 mg.......................................... 50FOSRENOL -lanthanum carbonate chew tab 500 mg

(elemental).......................................................................72FOSRENOL -lanthanum carbonate chew tab 750 mg

(elemental).......................................................................72FOSRENOL -lanthanum carbonate chew tab 1000 mg

(elemental).......................................................................72FOSRENOL -lanthanum carbonate oral powder pack 750

mg (elemental)................................................................ 72FOSRENOL -lanthanum carbonate oral powder pack

1000 mg (elemental).......................................................72FRAGMIN -dalteparin sodium inj 10000 unit/ml..............155FRAGMIN -dalteparin sodium inj 2500 unit/0.2ml...........155FRAGMIN -dalteparin sodium inj 5000 unit/0.2ml...........155FRAGMIN -dalteparin sodium inj 7500 unit/0.3ml...........155FRAGMIN -dalteparin sodium inj 12500 unit/0.5ml.........155FRAGMIN -dalteparin sodium inj 15000 unit/0.6ml.........155FRAGMIN -dalteparin sodium inj 18000 unit/0.72ml.......155FRAGMIN -dalteparin sodium inj 95000 unit/3.8ml.........155FROVA -frovatriptan succinate tab 2.5 mg (base

equivalent).....................................................................108frovatriptan succinate tab 2.5 mg (base equivalent)

(Frova).......................................................................... 108FRUITIVITS -nutritional supplement pack.......................135FUROSEMIDE -furosemide oral soln 8 mg/ml..................54furosemide oral soln 10 mg/ml...................................... 54furosemide tab 20 mg (Lasix)........................................ 54furosemide tab 40 mg (Lasix)........................................ 54furosemide tab 80 mg (Lasix)........................................ 54FUSION PLUS -fe fum-iron poly cmplx-fa-b cmplx-c-

biotin-probiotic cap........................................................152FUSION SPRINKLES -fe fum-fe polys cmplx-fa-c-

probiotic pack 7-0.25-50-5 mg..................................... 152FUZEON -enfuvirtide for inj 90 mg..................................... 8FYCOMPA -perampanel susp 0.5 mg/ml........................111FYCOMPA -perampanel tab 2 mg.................................. 111FYCOMPA -perampanel tab 4 mg.................................. 111FYCOMPA -perampanel tab 6 mg.................................. 111FYCOMPA -perampanel tab 8 mg.................................. 111

2016



FYCOMPA -perampanel tab 10 mg................................ 111FYCOMPA -perampanel tab 12 mg................................ 111

GGA-1 ANAMIX EARLY YEARS -nutritional supplement

powder...........................................................................135gabapentin cap 100 mg (Neurontin)............................111gabapentin cap 300 mg (Neurontin)............................111gabapentin cap 400 mg (Neurontin)............................111gabapentin oral soln 250 mg/5ml (Neurontin)............111gabapentin tab 600 mg (Neurontin).............................111gabapentin tab 800 mg (Neurontin).............................111GABITRIL -tiagabine hcl tab 12 mg................................ 111GABITRIL -tiagabine hcl tab 16 mg................................ 111GA EXPRESS15 -nutritional supplement pack...............135GA GEL -nutritional supplement pack.............................135galantamine hydrobromide cap er 24hr 8 mg

(Razadyne er)................................................................ 92galantamine hydrobromide cap er 24hr 16 mg

(Razadyne er)................................................................ 92galantamine hydrobromide cap er 24hr 24 mg

(Razadyne er)................................................................ 92GALANTAMINE HYDROBROMIDE -galantamine

hydrobromide oral soln 4 mg/ml.................................... 92galantamine hydrobromide tab 4 mg (Razadyne)........92galantamine hydrobromide tab 8 mg (Razadyne)........92galantamine hydrobromide tab 12 mg (Razadyne)......92GALZIN -zinc acetate cap 25 mg (elemental zinc)......... 129GALZIN -zinc acetate cap 50 mg (elemental zinc)......... 129GA -nutritional supplement powder.................................135gatifloxacin ophth soln 0.5% (Zymaxid)..................... 164GATTEX -teduglutide (rdna) for inj kit 5 mg......................72GELCLAIR -povidone-sodium hyaluronate-glycyrrhetinic

acid gel..........................................................................168GELFILM OP -gelatin adsorbable ophth film.................. 164GEL-KAM ORAL CARE RINSE -stannous fluoride conc

0.63%.............................................................................168GEL-KAM -stannous fluoride gel 0.4%........................... 168GELNIQUE -oxybutynin chloride td gel 10%.................... 75GELNIQUE PUMP -oxybutynin chloride td gel 10%.........75gemfibrozil tab 600 mg (Lopid)......................................57GENADUR -dermatological products misc - liquid..........175GENERESS FE -norethindrone & ethinyl estradiol-fe

chew tab 0.8 mg-25 mcg................................................27GENTAK -gentamicin sulfate ophth oint 0.3%................ 164gentamicin sulfate cream 0.1%....................................175GENTAMICIN SULFATE -gentamicin sulfate oint

0.1%...............................................................................175gentamicin sulfate ophth soln 0.3% (Garamycin)......164GENVOYA -elvitegrav-cobic-emtricitab-tenofov af tab

150-150-200-10 mg.......................................................... 8GIALAX -polyethylene glycol 3350 - kit............................ 67

GIAZO -balsalazide disodium tab 1.1 gm......................... 72GILENYA -fingolimod hcl cap 0.5 mg (base equiv)...........92GILOTRIF -afatinib dimaleate tab 20 mg (base

equivalent).......................................................................17GILOTRIF -afatinib dimaleate tab 30 mg (base

equivalent).......................................................................17GILOTRIF -afatinib dimaleate tab 40 mg (base

equivalent).......................................................................17GILPHEX TR -phenylephrine-guaifenesin tab 10-388

mg....................................................................................61GILTUSS TR -phenylephrine w/ dm-gg tab 10-28-388

mg....................................................................................61glatiramer acetate soln prefilled syringe 20 mg/ml

(Copaxone).....................................................................92glatiramer acetate soln prefilled syringe 40 mg/ml

(Copaxone).....................................................................92GLEEVEC -imatinib mesylate tab 100 mg (base

equivalent).......................................................................17GLEEVEC -imatinib mesylate tab 400 mg (base

equivalent).......................................................................17GLEOSTINE -lomustine cap 5 mg.................................... 17GLEOSTINE -lomustine cap 10 mg.................................. 17GLEOSTINE -lomustine cap 40 mg.................................. 17GLEOSTINE -lomustine cap 100 mg................................ 17glimepiride tab 1 mg (Amaryl)........................................30glimepiride tab 2 mg (Amaryl)........................................30glimepiride tab 4 mg (Amaryl)........................................30glipizide-metformin hcl tab 2.5-250 mg.........................30glipizide-metformin hcl tab 2.5-500 mg.........................30glipizide-metformin hcl tab 5-500 mg............................30glipizide tab er 24hr 2.5 mg (Glucotrol xl).................... 30glipizide tab er 24hr 5 mg (Glucotrol xl)....................... 30glipizide tab er 24hr 10 mg (Glucotrol xl)..................... 30glipizide tab 5 mg (Glucotrol).........................................30glipizide tab 10 mg (Glucotrol).......................................30GLUCAGEN DIAGNOSTIC -glucagon hcl (rdna)

diagnostic for inj 1 mg (base equiv).............................183GLUCAGEN HYPOKIT -glucagon hcl (rdna) for inj 1 mg

(base equiv).................................................................... 30GLUCAGON EMERGENCY KIT -glucagon (rdna) for inj

kit 1 mg........................................................................... 30GLUCERNA ADVANCE SHAKE -nutritional supplement

liquid.............................................................................. 135GLUCERNA 1.0 CAL/FIBER -nutritional supplement

liquid.............................................................................. 136GLUCERNA 1.0 CAL -nutritional supplement liquid....... 136GLUCERNA 1.2 CAL -nutritional supplement liquid....... 136GLUCERNA 1.5 CAL -nutritional supplement liquid....... 136GLUCERNA CARBSTEADY -nutritional supplement

liquid.............................................................................. 135GLUCERNA CEREAL CRUNCHY F -nutritional

supplement misc...........................................................135

2016



GLUCERNA CRISPY DELIGHTS -nutritional supplementbar..................................................................................135

GLUCERNA HUNGER SMART SHA -nutritionalsupplement liquid..........................................................135

GLUCERNA MEAL -nutritional supplement bar..............135GLUCERNA MEAL REPLACEMENT -nutritional

supplement bar............................................................. 135GLUCERNA MINI SNACK -nutritional supplement

bar..................................................................................136GLUCERNA MINI SNACKS -nutritional supplement

bar..................................................................................136GLUCERNA -nutritional supplement bar.........................135GLUCERNA -nutritional supplement liquid..................... 135GLUCERNA OS -nutritional supplement liquid...............136GLUCERNA SELECT -nutritional supplement liquid...... 136GLUCERNA SHAKE -nutritional supplement liquid........136GLUCERNA SNACK -nutritional supplement bar...........136GLUCERNA SNACK SHAKE -nutritional supplement

liquid.............................................................................. 136GLUCERNA WEIGHT LOSS SHAK -nutritional

supplement liquid..........................................................136GLUCERNA 1.0 WITH CARBSTE -nutritional supplement

liquid.............................................................................. 136GLUCO BURST -nutritional supplement liquid............... 136glucose gel 40%...............................................................30GLUCOSE -glucose chew tab 4 gm................................. 30GLUCOSE -glucose-vitamin c chew tab 4-0.006 gm........30glucose oral liquid 15 gm/59ml......................................30GLUMETZA -metformin hcl tab er 24hr modified release

500 mg............................................................................ 30GLUMETZA -metformin hcl tab er 24hr modified release

1000 mg.......................................................................... 30GLUTARADE AMINO ACID BLEN -amino acids oral

powder...........................................................................131GLUTARADE ESSENTIAL GA-1 -amino acids oral

powder...........................................................................131GLUTARADE JUNIOR GA-1 -amino acids oral

powder...........................................................................131GLUTAREX-1 -nutritional supplement powder................136GLUTAREX-2 -nutritional supplement powder................136glyburide-metformin tab 1.25-250 mg

(Glucovance)..................................................................30glyburide-metformin tab 2.5-500 mg (Glucovance)..... 30glyburide-metformin tab 5-500 mg (Glucovance)........ 30glyburide micronized tab 1.5 mg (Glynase)..................30glyburide micronized tab 3 mg (Glynase).....................30glyburide micronized tab 6 mg (Glynase).....................30glyburide tab 1.25 mg..................................................... 30glyburide tab 2.5 mg....................................................... 30glyburide tab 5 mg.......................................................... 30glycopyrrolate tab 1 mg (Robinul).................................68glycopyrrolate tab 2 mg (Robinul forte)........................68

GLYCOSADE -nutritional supplement pack....................136GLYSET -miglitol tab 25 mg..............................................31GLYSET -miglitol tab 50 mg..............................................31GLYSET -miglitol tab 100 mg............................................31GLYTACTIN BETTERMILK DE-L -nutritional supplement

pack............................................................................... 136GLYTACTIN BETTERMILK 15 -nutritional supplement

pack............................................................................... 136GLYTACTIN BUILD 10PE -nutritional supplement

pack............................................................................... 136GLYTACTIN COMPLETE 10PE -nutritional supplement

bar..................................................................................136GLYTACTIN RESTORE LITE 10 -nutritional supplement

liquid.............................................................................. 136GLYTACTIN RESTORE LITE 10 -nutritional supplement

pack............................................................................... 136GLYTACTIN RESTORE 10 -nutritional supplement

liquid.............................................................................. 136GLYTACTIN RESTORE 5 -nutritional supplement

pack............................................................................... 136GLYTACTIN RTD 10 -nutritional supplement liquid........ 136GLYTACTIN RTD 15 -nutritional supplement liquid........ 136GLYTROL -nutritional supplement liquid.........................136GLYTROL PREBIO1 -nutritional supplement liquid........ 136GLYXAMBI -empagliflozin-linagliptin tab 10-5 mg............ 31GLYXAMBI -empagliflozin-linagliptin tab 25-5 mg............ 31GNP NUTRITIONAL DRINK -nutritional supplement

liquid.............................................................................. 136GNP NUTRITIONAL DRINK PLU -nutritional supplement

liquid.............................................................................. 136GNP VITAMIN D-400 -calcium carbonate-cholecalciferol

tab 90 mg-400 unit....................................................... 129GOAT MILK -nutritional supplement powder.................. 136GOLYTELY -peg 3350-kcl-na bicarb-nacl-na sulfate

packet 227.1 gm............................................................. 67G-PREPROTEIN -amino acids oral liquid.......................131GRALISE -gabapentin (once-daily) tab 300 mg................92GRALISE -gabapentin (once-daily) tab 600 mg................92GRALISE STARTER -gabapentin (once-daily) tab pack

300 mg (9) & 600 mg (69)............................................. 93granisetron hcl tab 1 mg................................................ 70GRANIX -tbo-filgrastim soln prefilled syringe 300

mcg/0.5ml......................................................................152GRANIX -tbo-filgrastim soln prefilled syringe 480

mcg/0.8ml......................................................................152GRASTEK -timothy grass pollen allergen ext tab sl 2800

bau...................................................................................15griseofulvin microsize susp 125 mg/5ml........................ 6griseofulvin microsize tab 500 mg (Grifulvin v).............6griseofulvin ultramicrosize tab 125 mg (Gris-peg)........ 6griseofulvin ultramicrosize tab 250 mg (Gris-peg)........ 6guaifenesin-codeine liquid 225-7.5 mg/5ml..................61

2016



guaifenesin-codeine soln 100-6.3 mg/5ml.................... 61guaifenesin-codeine soln 100-10 mg/5ml..................... 61guanfacine hcl tab er 24hr 1 mg (base equiv)

(Intuniv).......................................................................... 89guanfacine hcl tab er 24hr 2 mg (base equiv)



(Intuniv).......................................................................... 89guanfacine hcl tab 1 mg (Tenex)................................... 50guanfacine hcl tab 2 mg (Tenex)................................... 50GUANIDINE HCL -guanidine hcl tab 125 mg................. 119GYNAZOLE-1 -butoconazole nitrate (one dose) vaginal

cream 2%........................................................................76

HHAELAN 951 FERMENTED ORGA -nutritional

supplement liquid..........................................................137HAELAN HTPI FERMENTED ORG -nutritional

supplement liquid..........................................................136halobetasol propionate cream 0.05% (Ultravate).......175halobetasol propionate oint 0.05% (Ultravate)...........175HALOG -halcinonide cream 0.1%................................... 175HALOG -halcinonide oint 0.1%....................................... 175haloperidol lactate oral conc 2 mg/ml...........................84haloperidol tab 0.5 mg.................................................... 84haloperidol tab 1 mg....................................................... 84haloperidol tab 2 mg....................................................... 84haloperidol tab 5 mg....................................................... 84haloperidol tab 10 mg..................................................... 84haloperidol tab 20 mg..................................................... 84HALOTIN -haloprogin cream 1%.................................... 175HARVONI -ledipasvir-sofosbuvir tab 90-400 mg................ 8HCU ANAMIX EARLY YEARS -nutritional supplement

powder...........................................................................137HCU ANAMIX NEXT -nutritional supplement

powder...........................................................................137HCU COOLER -nutritional supplement liquid................. 137HCU EXPRESS -nutritional supplement pack................ 137HCU EXPRESS20 -nutritional supplement pack............ 137HCU GEL -nutritional supplement pack.......................... 137HCU LOPHLEX LQ -nutritional supplement liquid..........137HCY 1 -nutritional supplement powder........................... 137HCY 2 -nutritional supplement powder........................... 137HEALTH SOURCE SOY PROTEIN -nutritional

supplement powder...................................................... 137HEALTHY ACCENTS NUTRA FIT -nutritional supplement

liquid.............................................................................. 137HEARTBAR -nutritional supplement bar.........................137HELIXATE FS -antihemophilic factor (recombinant) for inj

kit 250 unit.................................................................... 158

HELIXATE FS -antihemophilic factor (recombinant) for injkit 500 unit.................................................................... 158

HELIXATE FS -antihemophilic factor (recombinant) for injkit 1000 unit.................................................................. 158



HEMANGEOL -propranolol hcl oral soln 4.28 mg/ml (3.75mg/ml base equiv).......................................................... 43

HEMATOGEN FA -fe fumarate-vit c-vit b12-fa cap200-250-0.01-1 mg....................................................... 152

HEMENATAL OB + DHA -prenat-fe poly cmplx-fe hemepoly-fa tab & omega 3 cap pck....................................122

HEMENATAL OB -prenat vit-fe poly cmplx-fe heme poly-fa tab 28-6-1 mg...........................................................121

HEMETAB -polysacch fe cmplx-fe heme poly-fa-b12 tab22-6-1-0.025 mg........................................................... 152

HEMOCYTE PLUS -ferrous fumarate-fa-b complex-c-zn-mg-mn-cu cap 106-1 mg..............................................152

HEMOFIL M -antihemophilic factor (human) for inj 250unit................................................................................. 159




HEPAGAM B -hepatitis b immune globulin (human) injsoln.................................................................................. 15

HEPAMENT -amino acids pack.......................................131heparin sodium (porcine) inj 1000 unit/ml..................155heparin sodium (porcine) inj 5000 unit/ml..................155heparin sodium (porcine) inj 10000 unit/ml................155heparin sodium (porcine) inj 20000 unit/ml................155heparin sodium (porcine) pf inj 5000 unit/0.5ml........ 155HETLIOZ -tasimelteon capsule 20 mg..............................87HEXALEN -altretamine cap 50 mg................................... 17HI-CAL -nutritional supplement liquid..............................137HIGH-PROTEIN NUTRITIONAL -nutritional supplement

liquid.............................................................................. 137HISTEX-AC -phenylephrine-triprolidine-codeine syrup

10-2.5-10 mg/5ml............................................................61HM NUTRISURE -nutritional supplement liquid..............137HM NUTRISURE PLUS -nutritional supplement

liquid.............................................................................. 137HOMACTIN AA PLUS -nutritional supplement liquid......137homatropine hbr ophth soln 5% (Isopto

homatropine)............................................................... 164HOMINEX-1 -nutritional supplement powder..................137HOMINEX-2 -nutritional supplement powder..................137HOM 2 -nutritional supplement powder.......................... 137

2016



HORIZANT -gabapentin enacarbil tab er 300 mg.............93HORIZANT -gabapentin enacarbil tab er 600 mg.............93H.P. ACTHAR -corticotropin inj gel 80 unit/ml...................39HPR -dermatological products, misc. - aerosol foam......175HPR PLUS -dermatological products, misc. - aerosol

foam...............................................................................175HPR PLUS -dermatological products misc - cream........175HUMALOG -insulin lispro inj 100 unit/ml...........................34HUMALOG -insulin lispro soln cartridge 100 unit/ml.........34HUMALOG JUNIOR KWIKPEN -insulin lispro soln pen-

injector 100 unit/ml......................................................... 34HUMALOG KWIKPEN -insulin lispro soln pen-injector 100

unit/ml.............................................................................. 34HUMALOG KWIKPEN -insulin lispro soln pen-injector 200

unit/ml.............................................................................. 34HUMALOG MIX 75/25 -insulin lispro prot & lispro inj 100

unit/ml (75-25).................................................................35HUMALOG MIX 50/50 -insulin lispro protamine & lispro inj

100 unit/ml (50-50)......................................................... 35HUMALOG MIX 50/50 KWIKPEN -insulin lispro prot &

lispro sus pen-inj 100 unit/ml (50-50).............................35HUMALOG MIX 75/25 KWIKPEN -insulin lispro prot &

lispro sus pen-inj 100 unit/ml (75-25).............................35HUMATE-P -antihemophilic factor/vwf (human) for inj

250-600 unit.................................................................. 159HUMATE-P -antihemophilic factor/vwf (human) for inj

500-1200 unit................................................................ 159HUMATE-P -antihemophilic factor/vwf (human) for inj

1000-2400 unit..............................................................159HUMIRA -adalimumab prefilled syringe kit 10

mg/0.2ml........................................................................106HUMIRA -adalimumab prefilled syringe kit 20

mg/0.4ml........................................................................106HUMIRA -adalimumab prefilled syringe kit 40

mg/0.8ml........................................................................106HUMIRA PEDIATRIC CROHNS D -adalimumab prefilled

syringe kit 40 mg/0.8ml................................................ 106HUMIRA PEN -adalimumab pen-injector kit 40

mg/0.8ml........................................................................106HUMIRA PEN-CROHNS DISEASE -adalimumab pen-

injector kit 40 mg/0.8ml................................................ 106HUMIRA PEN-PSORIASIS STAR -adalimumab pen-

injector kit 40 mg/0.8ml................................................ 106HUMULIN 70/30 -insulin nph isophane & regular human

inj 100 unit/ml (70-30).................................................... 35HUMULIN 70/30 KWIKPEN -insulin nph & regular susp

pen-inj 100 unit/ml (70-30)............................................. 35HUMULIN N -insulin nph (human) (isophane) inj 100 unit/

ml..................................................................................... 35HUMULIN N KWIKPEN -insulin nph (human) (isophane)

susp pen-injector 100 unit/ml......................................... 35HUMULIN R -insulin regular (human) inj 100 unit/ml........34

HUMULIN R U-500 (CONCENTR -insulin regular (human)inj 500 unit/ml..................................................................34

HUMULIN R U-500 KWIKPEN -insulin regular (human)soln pen-injector 500 unit/ml.......................................... 35

HURRISEAL -dental desensitizing product - solution.....183hyaluronate sodium (emollient) gel 0.2% (Hylira)......175HYCAMTIN -topotecan hcl cap 0.25 mg (base equiv)......17HYCAMTIN -topotecan hcl cap 1 mg (base equiv)...........17HYCOFENIX -pseudoephedrine w/ hydrocodone-gg soln

30-2.5-200 mg/5ml..........................................................61hydralazine hcl tab 10 mg.............................................. 50hydralazine hcl tab 25 mg.............................................. 50hydralazine hcl tab 50 mg.............................................. 50hydralazine hcl tab 100 mg............................................ 50hydrochlorothiazide cap 12.5 mg (Microzide).............. 54hydrochlorothiazide tab 12.5 mg................................... 54hydrochlorothiazide tab 25 mg...................................... 54hydrochlorothiazide tab 50 mg...................................... 54hydrocodone-acetaminophen soln 7.5-325 mg/15ml

(Hycet).............................................................................99hydrocodone-acetaminophen tab 2.5-325 mg..............99hydrocodone-acetaminophen tab 7.5-325 mg

(Norco)............................................................................99hydrocodone-acetaminophen tab 5-325 mg

(Norco)............................................................................99hydrocodone-acetaminophen tab 10-325 mg

(Norco)............................................................................99hydrocodone-acetaminophen tab 7.5-300 mg

(Xodol)............................................................................ 99hydrocodone-acetaminophen tab 5-300 mg

(Xodol)............................................................................ 99hydrocodone-acetaminophen tab 10-300 mg

(Xodol)............................................................................ 99hydrocodone-ibuprofen tab 10-200 mg (Ibudone)....... 99hydrocodone-ibuprofen tab 5-200 mg (Reprexain)......99hydrocodone-ibuprofen tab 7.5-200 mg

(Vicoprofen)................................................................... 99hydrocodone w/ homatropine syrup 5-1.5 mg/5ml......61hydrocodone w/ homatropine tab 5-1.5 mg..................61hydrocod polst-chlorphen polst er susp 10-8 mg/5ml

(Tussionex pennkineti).................................................61hydrocortisone acetate suppos 25 mg (Anusol-

hc)................................................................................. 169hydrocortisone acetate suppos 30 mg

(Proctocort)..................................................................169hydrocortisone acetate w/ pramoxine rectal cream

1-1% (Analpram-hc)....................................................170hydrocortisone acetate w/ pramoxine rectal cream

2.5-1% (Analpram-hc).................................................170hydrocortisone butyrate cream 0.1% (Locoid)...........175hydrocortisone butyrate hydrophilic lipo base cream

0.1% (Locoid lipocream)............................................175

2016



hydrocortisone butyrate oint 0.1% (Locoid)...............175hydrocortisone butyrate soln 0.1% (Locoid)..............175hydrocortisone cream 2.5%..........................................175hydrocortisone enema 100 mg/60ml

(Cortenema)................................................................. 170hydrocortisone lotion 2.5%.......................................... 175hydrocortisone lotion 2% (Ala scalp)..........................175hydrocortisone oint 2.5%..............................................175hydrocortisone rectal cream 2.5% (Anusol-hc)......... 170hydrocortisone rectal cream 1% (Proctocort)............170hydrocortisone tab 5 mg (Cortef).................................. 22hydrocortisone tab 10 mg (Cortef)................................ 22hydrocortisone tab 20 mg (Cortef)................................ 22hydrocortisone valerate cream 0.2%...........................175hydrocortisone valerate oint 0.2% (Westcort)............175hydrocortisone w/ acetic acid otic soln 1-2%............ 167HYDROMORPHONE HCL -hydromorphone hcl suppos 3

mg....................................................................................99hydromorphone hcl liqd 1 mg/ml (Dilaudid).................99hydromorphone hcl tab er 24hr deter 8 mg

(Exalgo).......................................................................... 99hydromorphone hcl tab er 24hr deter 12 mg



(Exalgo).......................................................................... 99hydromorphone hcl tab 2 mg (Dilaudid).......................99hydromorphone hcl tab 4 mg (Dilaudid).......................99hydromorphone hcl tab 8 mg (Dilaudid).......................99hydroxychloroquine sulfate tab 200 mg

(Plaquenil)...................................................................... 12hydroxyurea cap 500 mg (Hydrea)................................ 17hydroxyzine hcl syrup 10 mg/5ml................................. 78hydroxyzine hcl tab 10 mg............................................. 78hydroxyzine hcl tab 25 mg............................................. 78hydroxyzine hcl tab 50 mg............................................. 78hydroxyzine pamoate cap 25 mg (Vistaril)................... 78hydroxyzine pamoate cap 50 mg (Vistaril)................... 78HYDROXYZINE PAMOATE -hydroxyzine pamoate cap

100 mg............................................................................ 78HYLATOPIC PLUS -dermatological products, misc. -

aerosol foam................................................................. 175HYLATOPIC PLUS -dermatological products misc -

cream.............................................................................175HYLIRA -hyaluronate sodium (emollient) lotion 0.1%.....175hyoscyamine sulfate elixir 0.125 mg/5ml......................69hyoscyamine sulfate soln 0.125 mg/ml.........................69hyoscyamine sulfate tab disint 0.125 mg

(Anaspaz)....................................................................... 69hyoscyamine sulfate tab er 12hr 0.375 mg

(Levbid)...........................................................................69

hyoscyamine sulfate tab 0.125 mg (Levsin).................69hyoscyamine sulfate tab sl 0.125 mg (Levsin/sl).........69HYPERHEP B S/D -hepatitis b immune globulin (human)

im inj soln........................................................................15HYPERRAB S/D -rabies immune globulin (human) inj 150

unit/ml.............................................................................. 15HYPERSAL -sodium chloride soln nebu 3.5%..................61HYPERTET S/D -tetanus immune globulin (human) inj

250 unit/ml.......................................................................15HYQVIA -immun glob inj 2.5 gm/25ml-hyaluron inj 200

unt/1.25 ml kit................................................................. 15HYQVIA -immun glob inj 5 gm/50ml-hyaluron inj 400

unt/2.5 ml kit................................................................... 15HYQVIA -immun glob inj 10 gm/100ml-hyaluron inj 800

unt/5 ml kit...................................................................... 15HYQVIA -immun glob inj 20 gm/200ml-hyaluron inj 1600

unt/10 ml kit.................................................................... 15HYQVIA -immun glob inj 30 gm/300ml-hyaluron inj 2400

unt/15 ml kit.................................................................... 15HYSINGLA ER -hydrocodone bitartrate tab er 24hr deter

20 mg.............................................................................. 99HYSINGLA ER -hydrocodone bitartrate tab er 24hr deter




80 mg............................................................................ 100HYSINGLA ER -hydrocodone bitartrate tab er 24hr deter

100 mg.......................................................................... 100HYSINGLA ER -hydrocodone bitartrate tab er 24hr deter

120 mg.......................................................................... 100

Iibandronate sodium tab 150 mg (base equivalent)

(Boniva).......................................................................... 39IBRANCE -palbociclib cap 75 mg..................................... 17IBRANCE -palbociclib cap 100 mg................................... 17IBRANCE -palbociclib cap 125 mg................................... 17ibuprofen tab 400 mg.................................................... 106ibuprofen tab 600 mg.................................................... 106ibuprofen tab 800 mg.................................................... 106ICAR PEDIATRIC -carbonyl iron susp 15 mg/1.25ml

(elemental iron).............................................................152ICLUSIG -ponatinib hcl tab 15 mg (base equiv)............... 17ICLUSIG -ponatinib hcl tab 45 mg (base equiv)............... 17IDELVION -coagulation factor ix (recomb) (rix-fp) for inj

250 unit......................................................................... 159IDELVION -coagulation factor ix (recomb) (rix-fp) for inj

500 unit......................................................................... 159

2016



IDELVION -coagulation factor ix (recomb) (rix-fp) for inj1000 unit....................................................................... 159

IDELVION -coagulation factor ix (recomb) (rix-fp) for inj2000 unit....................................................................... 159

ILEVRO -nepafenac ophth susp 0.3%............................ 164imatinib mesylate tab 100 mg (base equivalent)

(Gleevec)........................................................................ 17imatinib mesylate tab 400 mg (base equivalent)

(Gleevec)........................................................................ 17IMBRUVICA -ibrutinib cap 140 mg................................... 17imipramine hcl tab 10 mg (Tofranil).............................. 80imipramine hcl tab 25 mg (Tofranil).............................. 80imipramine hcl tab 50 mg (Tofranil).............................. 80imipramine pamoate cap 75 mg (Tofranil-pm)............. 80imipramine pamoate cap 100 mg (Tofranil-pm)........... 80imipramine pamoate cap 125 mg (Tofranil-pm)........... 80imipramine pamoate cap 150 mg (Tofranil-pm)........... 80imiquimod cream 5% (Aldara)......................................175IMITREX -sumatriptan nasal spray 5 mg/act.................. 108IMITREX -sumatriptan nasal spray 20 mg/act................ 108IMMUNOPRO RX -nutritional supplement powder.........137IMOGAM RABIES-HT -rabies immune globulin (human)

inj 150 unit/ml..................................................................15IMOVAX RABIES (H.D.C.V.) -rabies virus vaccine, hdc

inj..................................................................................... 14IMPACT/FIBER -nutritional supplement liquid................ 137IMPACT ADVANCED RECOVERY -nutritional

supplement liquid..........................................................137IMPACT GLUTAMINE -nutritional supplement liquid...... 137IMPACT -nutritional supplement liquid............................ 137IMPACT 1.5 -nutritional supplement liquid......................137IMPACT PEPTIDE 1.5 -nutritional supplement liquid..... 137IMPAVIDO -miltefosine cap 50 mg....................................12IMUPLUS -nutritional supplement pack.......................... 137INATAL ADVANCE -prenatal vit w/ dss-iron carbonyl-fa

tab 90-1 mg...................................................................122INATAL GT -prenatal vit w/ dss-iron carbonyl-fa tab 90-1

mg..................................................................................122INATAL ULTRA -prenatal vit w/ dss-iron carbonyl-fa tab

90-1 mg......................................................................... 122INCRELEX -mecasermin inj 40 mg/4ml (10 mg/ml)..........39indapamide tab 1.25 mg..................................................54indapamide tab 2.5 mg....................................................54INDERAL XL -propranolol hcl sustained-release beads

cap er 24hr 80 mg..........................................................43INDERAL XL -propranolol hcl sustained-release beads

cap er 24hr 120 mg........................................................43indomethacin cap er 75 mg..........................................106indomethacin cap 25 mg.............................................. 106indomethacin cap 50 mg.............................................. 106INFANATE BALANCE -prenatal w/o a w/fe cbn-dss-fa-dha

cap 29-1-265 mg.......................................................... 122

INFANRIX -diph, acellular pert & tet tox inj 25 lf-58mcg-10 lf/0.5ml............................................................... 15

INFASURF -calfactant in nacl 0.9% intratracheal susp 35mg/ml...............................................................................66

INGREZZA -valbenazine tosylate cap 40 mg (baseequiv)...............................................................................93

INGREZZA -valbenazine tosylate cap 80 mg (baseequiv)...............................................................................93

INLYTA -axitinib tab 1 mg..................................................17INLYTA -axitinib tab 5 mg..................................................18INNOPRAN XL -propranolol hcl sustained-release beads

cap er 24hr 80 mg..........................................................43INNOPRAN XL -propranolol hcl sustained-release beads

cap er 24hr 120 mg........................................................43INNOVACIN -nutritional supplement liquid......................137INSTA-GLUCOSE -glucose gel 77.4%............................. 31INSULIN PEN NEEDLES-VARIOUS...............................183INSULIN SYRINGES-VARIOUS......................................184INTEGRA F -fe fum-fe poly-fa-c-b3 cap

62.5-62.5-1-40-3mg(125 mg fe)................................... 152INTEGRA PLUS -fe fum-iron polysacch complex-fa-b

complex-c-biotin cap.....................................................153INTELENCE -etravirine tab 25 mg......................................8INTELENCE -etravirine tab 100 mg....................................8INTELENCE -etravirine tab 200 mg....................................8INTROLITE -nutritional supplement liquid.......................137INTRON A -interferon alfa-2b for inj 10000000 unit..........18INTRON A -interferon alfa-2b for inj 18000000 unit..........18INTRON A -interferon alfa-2b for inj 50000000 unit..........18INTRON A -interferon alfa-2b inj 6000000 unit/ml............ 18INTRON A -interferon alfa-2b inj 10000000 unit/ml.......... 18INTRON A W/DILUENT -interferon alfa-2b for inj

10000000 unit................................................................. 18INTRON A W/DILUENT -interferon alfa-2b for inj

18000000 unit................................................................. 18INTRON A W/DILUENT -interferon alfa-2b for inj

50000000 unit................................................................. 18INVEGA -paliperidone tab er 24hr 1.5 mg........................84INVEGA -paliperidone tab er 24hr 3 mg...........................84INVEGA -paliperidone tab er 24hr 6 mg...........................84INVEGA -paliperidone tab er 24hr 9 mg...........................84INVIRASE -saquinavir mesylate cap 200 mg..................... 8INVIRASE -saquinavir mesylate tab 500 mg...................... 8INVOKAMET -canagliflozin-metformin hcl tab 50-500

mg....................................................................................31INVOKAMET -canagliflozin-metformin hcl tab 150-500



mg....................................................................................31

2016



INVOKAMET XR -canagliflozin-metformin hcl tab er 24hr50-500 mg.......................................................................31

INVOKAMET XR -canagliflozin-metformin hcl tab er 24hr50-1000 mg.....................................................................31

INVOKAMET XR -canagliflozin-metformin hcl tab er 24hr150-500 mg.....................................................................31

INVOKAMET XR -canagliflozin-metformin hcl tab er 24hr150-1000 mg...................................................................31

INVOKANA -canagliflozin tab 100 mg.............................. 31INVOKANA -canagliflozin tab 300 mg.............................. 31IODINE STRONG -iodine solution strong 5%

(lugol's).......................................................................... 129iodoquinol-hc cream 1%............................................... 175iodoquinol-hydrocortisone in aloe vehicle cream

1-1.9% (Vytone)........................................................... 175IONSYS -fentanyl hcl iontophoretic td system 40 mcg/act

(base equiv).................................................................. 100IOPIDINE -apraclonidine hcl ophth soln 1% (base

equivalent).....................................................................164ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml..... 64ipratropium bromide inhal soln 0.02%..........................64ipratropium bromide nasal soln 0.03% (21 mcg/spray)

(Atrovent)....................................................................... 61ipratropium bromide nasal soln 0.06% (42 mcg/spray)

(Atrovent)....................................................................... 61irbesartan-hydrochlorothiazide tab 150-12.5 mg

(Avalide)..........................................................................50irbesartan-hydrochlorothiazide tab 300-12.5 mg

(Avalide)..........................................................................50irbesartan tab 75 mg (Avapro)....................................... 50irbesartan tab 150 mg (Avapro)..................................... 50irbesartan tab 300 mg (Avapro)..................................... 50IRESSA -gefitinib tab 250 mg........................................... 18IRON CHEWS PEDIATRIC -carbonyl iron chew tab 15 mg

(elemental iron).............................................................153iron combination cap.................................................... 153iron-docusate-b12-folic acid-c-e-cu-biotin tab 150-1

mg (Hematron-af)........................................................153iron-folic acid-vit c-vit b6-vit b12-zinc tab 150-1.25 mg

(Corvite 150)................................................................ 153iron polysacch complex-vit b12-fa cap 150-0.025-1

mg................................................................................. 153IROSPAN 24/6 -fe bisglyc-fe polys-succ acd-b cmplx-c-

ca-fa tab ther pk........................................................... 153IS 24/6 -fe bisglyc-fe polys-succ acd-b cmplx-c-ca-fa tab

ther pk........................................................................... 153ISENTRESS HD -raltegravir potassium tab 600 mg (base

equiv)................................................................................. 8ISENTRESS -raltegravir potassium chew tab 25 mg (base

equiv)................................................................................. 8ISENTRESS -raltegravir potassium chew tab 100 mg

(base equiv)...................................................................... 8

ISENTRESS -raltegravir potassium packet for susp 100mg (base equiv)................................................................8

ISENTRESS -raltegravir potassium tab 400 mg (baseequiv)................................................................................. 8

ISOCAL HN -nutritional supplement liquid......................138ISOCAL HN PLUS -nutritional supplement liquid........... 138ISOCAL -nutritional supplement liquid............................ 137isometheptene-caffeine-acetaminophen tab 65-20-325

mg (Prodrin)................................................................ 108isometheptene-dichloral-acetaminophen cap

65-100-325 mg............................................................. 108ISONIAZID -isoniazid syrup 50 mg/5ml.............................. 5isoniazid tab 100 mg......................................................... 5isoniazid tab 300 mg......................................................... 5ISORDIL TITRADOSE -isosorbide dinitrate tab 40

mg....................................................................................41ISOSORBIDE DINITRATE ER -isosorbide dinitrate tab er

40 mg.............................................................................. 41isosorbide dinitrate tab 10 mg.......................................41isosorbide dinitrate tab 20 mg.......................................41isosorbide dinitrate tab 30 mg.......................................41isosorbide dinitrate tab 5 mg (Isordil titradose).......... 41isosorbide mononitrate tab er 24hr 30 mg................... 41isosorbide mononitrate tab er 24hr 60 mg................... 41isosorbide mononitrate tab er 24hr 120 mg................. 41isosorbide mononitrate tab 10 mg................................ 41isosorbide mononitrate tab 20 mg................................ 41ISOSOURCE 1.5 CAL -nutritional supplement liquid......138ISOSOURCE CLOSED SYSTEM -nutritional supplement

liquid.............................................................................. 138ISOSOURCE HN -nutritional supplement liquid............. 138ISOSOURCE -nutritional supplement liquid....................138ISOSOURCE VHN -nutritional supplement liquid...........138isotretinoin cap 10 mg.................................................. 176isotretinoin cap 20 mg.................................................. 176isotretinoin cap 30 mg.................................................. 176isotretinoin cap 40 mg.................................................. 176ISOVACTIN AA PLUS -nutritional supplement liquid......138ISOXSUPRINE HCL -isoxsuprine hcl tab 20 mg.............. 59isoxsuprine hcl tab 10 mg..............................................59isradipine cap 2.5 mg......................................................45isradipine cap 5 mg.........................................................45ISTALOL -timolol maleate ophth soln 0.5% (once-

daily).............................................................................. 164itraconazole cap 100 mg (Sporanox).............................. 6IVA ANAMIX EARLY YEARS -nutritional supplement

powder...........................................................................138IVA ANAMIX NEXT -nutritional supplement powder.......138I-VALEX-1 -nutritional supplement powder..................... 137I-VALEX-2 -nutritional supplement powder..................... 137ivermectin tab 3 mg (Stromectol).................................. 12

2016



IXINITY -coagulation factor ix (recombinant) for inj 250unit................................................................................. 159






JJADENU -deferasirox tab 90 mg.....................................182JADENU -deferasirox tab 180 mg...................................182JADENU -deferasirox tab 360 mg...................................182JAKAFI -ruxolitinib phosphate tab 5 mg (base

equivalent).......................................................................18JAKAFI -ruxolitinib phosphate tab 10 mg (base




equivalent).......................................................................18JALYN -dutasteride-tamsulosin hcl cap 0.5-0.4 mg..........76JANUMET -sitagliptin-metformin hcl tab 50-500 mg.........31JANUMET -sitagliptin-metformin hcl tab 50-1000 mg.......31JANUMET XR -sitagliptin-metformin hcl tab er 24hr

50-500 mg.......................................................................31JANUMET XR -sitagliptin-metformin hcl tab er 24hr

50-1000 mg.....................................................................31JANUMET XR -sitagliptin-metformin hcl tab er 24hr

100-1000 mg...................................................................31JANUVIA -sitagliptin phosphate tab 25 mg (base

equiv)...............................................................................31JANUVIA -sitagliptin phosphate tab 50 mg (base

equiv)...............................................................................31JANUVIA -sitagliptin phosphate tab 100 mg (base

equiv)...............................................................................31JARDIANCE -empagliflozin tab 10 mg............................. 31JARDIANCE -empagliflozin tab 25 mg............................. 31JENTADUETO -linagliptin-metformin hcl tab 2.5-1000

mg....................................................................................31JENTADUETO -linagliptin-metformin hcl tab 2.5-500

mg....................................................................................31JENTADUETO -linagliptin-metformin hcl tab 2.5-850

mg....................................................................................31JENTADUETO XR -linagliptin-metformin hcl tab er 24hr

2.5-1000 mg....................................................................31

JENTADUETO XR -linagliptin-metformin hcl tab er 24hr5-1000 mg.......................................................................32

JEVITY 1 CAL/FIBER -nutritional supplement liquid...... 138JEVITY 1.2 CAL/FIBER -nutritional supplement

liquid.............................................................................. 138JEVITY 1.5 CAL/FIBER -nutritional supplement

liquid.............................................................................. 138JEVITY 1 CAL -nutritional supplement liquid..................138JEVITY 1.2 CAL -nutritional supplement liquid...............138JEVITY 1.5 CAL -nutritional supplement liquid...............138JTT PHYSICIANS KIT -triamcinolone inj 40 mg/ml &

lidocaine 1% & ammonia inh kit.....................................22JUBLIA -efinaconazole soln 10%....................................176JUICE PLUS FIBRE -nutritional supplement liquid.........138JUVEN -nutritional supplement pack.............................. 138JUVEN -nutritional supplement powder.......................... 138JUVEN NUTRIVIGOR -nutritional supplement pack.......138JUVEN REVIGOR -nutritional supplement pack.............138JUXTAPID -lomitapide mesylate cap 5 mg (base

equiv)...............................................................................57JUXTAPID -lomitapide mesylate cap 10 mg (base





equiv)...............................................................................57

KKADIAN -morphine sulfate cap er 24hr 40 mg............... 100KADIAN -morphine sulfate cap er 24hr 200 mg............. 100KALETRA -lopinavir-ritonavir soln 400-100 mg/5ml (80-20

mg/ml)................................................................................8KALETRA -lopinavir-ritonavir tab 100-25 mg......................8KALETRA -lopinavir-ritonavir tab 200-50 mg......................8KALYDECO -ivacaftor packet 50 mg................................ 67KALYDECO -ivacaftor packet 75 mg................................ 67KALYDECO -ivacaftor tab 150 mg....................................67KARBINAL ER -carbinoxamine maleate extended release

susp 4 mg/5ml................................................................ 60KATE FARMS CORE ESSENTIAL -nutritional supplement

liquid.............................................................................. 138KAZANO -alogliptin-metformin hcl tab 12.5-1000 mg.......32KAZANO -alogliptin-metformin hcl tab 12.5-500 mg.........32KCENTRA -prothrombin complex conc human for inj kit

500 unit......................................................................... 159KCENTRA -prothrombin complex conc human for inj kit

1000 unit....................................................................... 159

2016



KENALOG -triamcinolone acetonide aerosol soln 0.147mg/gm............................................................................176

KERYDIN -tavaborole soln 5%........................................176KETOCAL 4:1 LQ MULTI FIBE -nutritional supplement

liquid.............................................................................. 138KETOCAL 4:1 -nutritional supplement liquid.................. 138KETOCAL 3:1 -nutritional supplement powder............... 138KETOCAL 4:1 -nutritional supplement powder............... 138ketoconazole cream 2%................................................176ketoconazole foam 2% (Extina)................................... 176ketoconazole shampoo 2% (Nizoral)...........................176ketoconazole tab 200 mg..................................................6KETOGEN -nutritional supplement powder.................... 138KETONE BLOOD TEST STRIPS-VARIOUS.................. 183KETONEX-1 -nutritional supplement powder..................138KETONEX-2 -nutritional supplement powder..................138ketoprofen cap 50 mg................................................... 106ketoprofen cap 75 mg................................................... 106ketorolac tromethamine ophth soln 0.5%

(Acular)......................................................................... 164ketorolac tromethamine ophth soln 0.4% (Acular

ls)...................................................................................164ketorolac tromethamine tab 10 mg............................. 106KETOVIE -nutritional supplement liquid..........................138KETOVIE PEPTIDE -nutritional supplement liquid......... 138KETOVOLVE 4:1 -nutritional supplement powder.......... 138KEVEYIS -dichlorphenamide tab 50 mg........................... 54KHEDEZLA -desvenlafaxine tab er 24hr 50 mg............... 80KHEDEZLA -desvenlafaxine tab er 24hr 100 mg............. 80KIDS PROTEIN ORGANIC NUTR -nutritional supplement

liquid.............................................................................. 138KINERET -anakinra subcutaneous soln prefilled syringe

100 mg/0.67ml.............................................................. 106KINRIX -diph-tetanus tox ad-acell pert & polio virus, ipv

vac inj.............................................................................. 15KISQALI FEMARA 200 DOSE -ribociclib tab 200 mg &

letrozole tab 2.5 mg therapy pack..................................18KISQALI FEMARA 400 DOSE -ribociclib tab 200 mg &

letrozole tab 2.5 mg therapy pack..................................18KISQALI FEMARA 600 DOSE -ribociclib tab 200 mg &

letrozole tab 2.5 mg therapy pack..................................18KISQALI -ribociclib succinate tab 200 mg (base

equiv)...............................................................................18KITABIS PAK -tobramycin nebu soln 300 mg/5ml.............. 5KLOR-CON M15 -potassium chloride microencapsulated

crys er tab 15 meq....................................................... 129KOATE -antihemophilic factor (human) for inj 250

unit................................................................................. 159KOATE -antihemophilic factor (human) for inj 500

unit................................................................................. 159KOATE -antihemophilic factor (human) for inj 1000

unit................................................................................. 159

KOATE-DVI -antihemophilic factor (human) for inj 250unit................................................................................. 159



KOGENATE FS -antihemophilic factor (recombinant) forinj kit 250 unit............................................................... 159

KOGENATE FS -antihemophilic factor (recombinant) forinj kit 500 unit............................................................... 160

KOGENATE FS -antihemophilic factor (recombinant) forinj kit 1000 unit............................................................. 160



KOGENATE FS BIO-SET -antihemophilic factor(recombinant) for inj kit 250 unit.................................. 160

KOGENATE FS BIO-SET -antihemophilic factor(recombinant) for inj kit 500 unit.................................. 160

KOGENATE FS BIO-SET -antihemophilic factor(recombinant) for inj kit 1000 unit................................ 160



KOMBIGLYZE XR -saxagliptin-metformin hcl tab er 24hr2.5-1000 mg....................................................................32

KOMBIGLYZE XR -saxagliptin-metformin hcl tab er 24hr5-500 mg......................................................................... 32

KOMBIGLYZE XR -saxagliptin-metformin hcl tab er 24hr5-1000 mg.......................................................................32

KORLYM -mifepristone tab 300 mg.................................. 32KOVALTRY -antihemophilic factor (recombinant) for inj

250 unit......................................................................... 160KOVALTRY -antihemophilic factor (recombinant) for inj

500 unit......................................................................... 160KOVALTRY -antihemophilic factor (recombinant) for inj

1000 unit....................................................................... 160KOVALTRY -antihemophilic factor (recombinant) for inj

2000 unit....................................................................... 160KOVALTRY -antihemophilic factor (recombinant) for inj

3000 unit....................................................................... 160K-PAX IMMUNE BOOSTER PROT -nutritional

supplement powder...................................................... 138K-PHOS NO 2 -potassium & sodium acid phosphates tab

305-700 mg.....................................................................76K-PHOS -potassium phosphate monobasic tab 500

mg..................................................................................129KRISTALOSE -lactulose oral crystal packet 10 gm.......... 67KRISTALOSE -lactulose oral crystal packet 20 gm.......... 67

2016



KROGER GLUCOSE -glucose-vitamin c chew tab4-0.006 gm......................................................................32

K-TAB -potassium chloride tab er 8 meq (600 mg).........129K-TAB -potassium chloride tab er 20 meq (1500 mg).....129KUVAN -sapropterin dihydrochloride powder packet 100

mg....................................................................................39KUVAN -sapropterin dihydrochloride powder packet 500

mg....................................................................................39KUVAN -sapropterin dihydrochloride soluble tab 100

mg....................................................................................39KYNAMRO -mipomersen sodium soln prefilled syringe

200 mg/ml....................................................................... 57

Llabetalol hcl tab 100 mg (Trandate)...............................43labetalol hcl tab 200 mg (Trandate)...............................43labetalol hcl tab 300 mg (Trandate)...............................43LACRISERT -artificial tear ophth insert...........................164lactic acid (ammonium lactate) cream 12% (Lac-

hydrin).......................................................................... 176lactic acid (ammonium lactate) lotion 10%.................176lactic acid (ammonium lactate) lotion 12% (Lac-

hydrin).......................................................................... 176lactic acid w/ vitamin e cream 10%-3500

unit/30gm......................................................................176lactulose (encephalopathy) solution 10 gm/15ml........72lactulose solution 10 gm/15ml....................................... 67LAMICTAL ODT -lamotrigine orally disintegrating tab 25

mg..................................................................................111LAMICTAL ODT -lamotrigine orally disintegrating tab 50



mg..................................................................................112LAMICTAL ODT -lamotrigine tab disint 25 (14) & 50 mg

(14) & 100 mg (7) kit....................................................112LAMICTAL ODT -lamotrigine tab disint 25 mg (21) & 50

mg (7) titration kit......................................................... 112LAMICTAL ODT -lamotrigine tab disint 50 mg (42)- 100

mg(14) titration kit.........................................................112LAMICTAL STARTER/NOT TAKI -lamotrigine tab 25 mg

(42) & 100 mg (7) starter kit.........................................112LAMICTAL STARTER/TAKING C -lamotrigine tab 25 mg

(84) & 100 mg (14) starter kit.......................................112LAMICTAL STARTER/TAKING V -lamotrigine tab 25 mg

(35) starter kit............................................................... 112LAMICTAL XR -lamotrigine tab er 24hr 25 (14) & 50 mg

(14) & 100 mg(7) kit..................................................... 112LAMICTAL XR -lamotrigine tab er 24hr 50 (14) & 100

mg(14) & 200 mg(7) kit................................................ 112

LAMICTAL XR -lamotrigine tab er 24hr 25 mg (21) & 50mg (7) titration kit......................................................... 112

lamivudine oral soln 10 mg/ml (Epivir)........................... 8lamivudine tab 150 mg (Epivir)........................................ 8lamivudine tab 300 mg (Epivir)........................................ 8lamivudine tab 100 mg (hbv) (Epivir hbv).......................8lamivudine-zidovudine tab 150-300 mg (Combivir)....... 8lamotrigine orally disintegrating tab 25 mg (Lamictal

odt)................................................................................ 112lamotrigine orally disintegrating tab 50 mg (Lamictal



odt)................................................................................ 112lamotrigine tab chewable dispersible 5 mg (Lamictal

chewable di)................................................................ 112lamotrigine tab chewable dispersible 25 mg (Lamictal

chewable di)................................................................ 112lamotrigine tab disint 25 (14) & 50 mg (14) & 100 mg

(7) kit (Lamictal odt)................................................... 112lamotrigine tab disint 25 mg (21) & 50 mg (7) titration

kit (Lamictal odt).........................................................112lamotrigine tab disint 50 mg (42)- 100 mg(14) titration

kit (Lamictal odt).........................................................112lamotrigine tab er 24hr 25 mg (Lamictal xr)............... 112lamotrigine tab er 24hr 50 mg (Lamictal xr)............... 112lamotrigine tab er 24hr 100 mg (Lamictal xr)............. 112lamotrigine tab er 24hr 200 mg (Lamictal xr)............. 112lamotrigine tab er 24hr 250 mg (Lamictal xr)............. 112lamotrigine tab er 24hr 300 mg (Lamictal xr)............. 112lamotrigine tab 25 mg (42) & 100 mg (7) starter kit

(Lamictal starter/not)..................................................113lamotrigine tab 25 mg (84) & 100 mg (14) starter kit

(Lamictal starter/tak).................................................. 113lamotrigine tab 25 mg (Lamictal).................................112lamotrigine tab 100 mg (Lamictal)...............................112lamotrigine tab 150 mg (Lamictal)...............................112lamotrigine tab 200 mg (Lamictal)...............................113lamotrigine tab 25 mg (35) starter kit (Lamictal starter/

tak)................................................................................ 113LANAFLEX -nutritional supplement pack........................139LANCETS-VARIOUS........................................................184LANCING DEVICE-VARIOUS......................................... 184LANOXIN -digoxin tab 62.5 mcg (0.0625 mg).................. 41LANOXIN -digoxin tab 125 mcg (0.125 mg)..................... 41LANOXIN -digoxin tab 187.5 mcg (0.1875 mg)................ 41LANOXIN -digoxin tab 250 mcg (0.25 mg)....................... 41lansoprazole cap delayed release 15 mg

(Prevacid)....................................................................... 69lansoprazole cap delayed release 30 mg

(Prevacid)....................................................................... 69

2016



lanthanum carbonate chew tab 500 mg (elemental)(Fosrenol).......................................................................72



LANTUS -insulin glargine inj 100 unit/ml.......................... 35LANTUS SOLOSTAR -insulin glargine soln pen-injector

100 unit/ml.......................................................................35LASTACAFT -alcaftadine ophth soln 0.25%................... 164latanoprost ophth soln 0.005% (Xalatan)....................164LATUDA -lurasidone hcl tab 20 mg...................................84LATUDA -lurasidone hcl tab 40 mg...................................84LATUDA -lurasidone hcl tab 60 mg...................................84LATUDA -lurasidone hcl tab 80 mg...................................84LATUDA -lurasidone hcl tab 120 mg.................................84LAVARE WOUND WASH -wound cleansers - gel.......... 176LAZANDA -fentanyl citrate nasal spray 100 mcg/act (base

equiv).............................................................................100LAZANDA -fentanyl citrate nasal spray 300 mcg/act (base

equiv).............................................................................100LAZANDA -fentanyl citrate nasal spray 400 mcg/act (base

equiv).............................................................................100LECITHIN -lecithin granules............................................131leflunomide tab 10 mg (Arava).....................................106leflunomide tab 20 mg (Arava).....................................106LENVIMA 14 MG DAILY DOSE -lenvatinib cap therapy

pack 10 & 4 mg (14 mg daily dose)...............................18LENVIMA 18 MG DAILY DOSE -lenvatinib cap therapy

pack 10 & 4 (2) mg (18 mg daily dose)......................... 18LENVIMA 24 MG DAILY DOSE -lenvatinib cap therapy

pack 10 (2) & 4 mg (24 mg daily dose)......................... 18LENVIMA 10 MG DAILY DOSE -lenvatinib cap therapy

pack 10 mg (10 mg daily dose)..................................... 18LENVIMA 20 MG DAILY DOSE -lenvatinib cap therapy

pack 10 (2) mg (20 mg daily dose)................................18LENVIMA 8 MG DAILY DOSE -lenvatinib cap therapy

pack 4 (2) mg (8 mg daily dose)....................................18LESCOL XL -fluvastatin sodium tab er 24 hr 80 mg.........57LETAIRIS -ambrisentan tab 5 mg..................................... 59LETAIRIS -ambrisentan tab 10 mg................................... 59letrozole tab 2.5 mg (Femara)........................................ 18LEUCOVORIN CALCIUM -leucovorin calcium tab 10

mg....................................................................................18LEUCOVORIN CALCIUM -leucovorin calcium tab 15

mg....................................................................................18leucovorin calcium tab 5 mg..........................................18leucovorin calcium tab 25 mg........................................19LEU-FREE COOLER -nutritional supplement liquid....... 139LEUKERAN -chlorambucil tab 2 mg................................. 19LEUKINE -sargramostim lyophilized for inj 250 mcg...... 153leuprolide acetate inj kit 5 mg/ml.................................. 19

LEVACET -aspirin-apap-salicylamide-caffeine tab500-250-150-32.5 mg..................................................... 96

levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (baseequiv) (Xopenex concentrate).....................................64

levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)(Xopenex)....................................................................... 65



LEVEMIR FLEXTOUCH -insulin detemir soln pen-injector100 unit/ml.......................................................................35

LEVEMIR -insulin detemir inj 100 unit/ml..........................35levetiracetam oral soln 100 mg/ml (Keppra)...............113levetiracetam tab er 24hr 500 mg (Keppra xr)............113levetiracetam tab er 24hr 750 mg (Keppra xr)............113levetiracetam tab 250 mg (Keppra)............................. 113levetiracetam tab 500 mg (Keppra)............................. 113levetiracetam tab 750 mg (Keppra)............................. 113levetiracetam tab 1000 mg (Keppra)........................... 113levobunolol hcl ophth soln 0.5% (Betagan)............... 164levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)..... 39levocarnitine tab 330 mg (Carnitor)...............................39levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5

mg/ml) (Xyzal)................................................................60levocetirizine dihydrochloride tab 5 mg (Xyzal)...........60LEVOFLOXACIN -levofloxacin oral soln 25 mg/ml.............5levofloxacin ophth soln 0.5%.......................................164levofloxacin tab 250 mg (Levaquin)................................ 5levofloxacin tab 500 mg (Levaquin)................................ 5levofloxacin tab 750 mg (Levaquin)................................ 5levonor-eth est tab 0.15-0.02/0.025/0.03 mg &eth est

0.01 mg (Quartette).......................................................27levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mg.................................................................. 27levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg................................................................................. 27levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg................................................................................. 27LEVONORGESTREL AND ETHINY -levonorgestrel-

ethinyl estradiol (continuous) tab 90-20 mcg.................27levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg...............................27levonorgestrel tab 1.5 mg...............................................27levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7) (Loseasonique)........................................... 27levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7) (Seasonique)............................................... 27LEVORPHANOL TARTRATE -levorphanol tartrate tab 2

mg..................................................................................100levothyroxine sodium tab 25 mcg (Synthroid).............36levothyroxine sodium tab 50 mcg (Synthroid).............36

2016



levothyroxine sodium tab 75 mcg (Synthroid).............36levothyroxine sodium tab 88 mcg (Synthroid).............36levothyroxine sodium tab 100 mcg (Synthroid)...........36levothyroxine sodium tab 112 mcg (Synthroid)...........36levothyroxine sodium tab 125 mcg (Synthroid)...........36levothyroxine sodium tab 137 mcg (Synthroid)...........36levothyroxine sodium tab 150 mcg (Synthroid)...........36levothyroxine sodium tab 175 mcg (Synthroid)...........36levothyroxine sodium tab 200 mcg (Synthroid)...........36levothyroxine sodium tab 300 mcg (Synthroid)...........36LEVULAN KERASTICK -aminolevulinic acid hcl for soln

20% (stick applicator)................................................... 176LEXIVA -fosamprenavir calcium susp 50 mg/ml (base

equiv)................................................................................. 8LEXIVA -fosamprenavir calcium tab 700 mg (base

equiv)................................................................................. 8LIALDA -mesalamine tab delayed release 1.2 gm........... 73lidocaine hcl gel 2%...................................................... 176LIDOCAINE HCL-HYDROCORTIS -lidocaine-

hydrocortisone acetate rectal gel 2.8-0.55%............... 170LIDOCAINE HCL -lidocaine hcl laryngotracheal soln

4%..................................................................................168lidocaine hcl soln 4% (Xylocaine)............................... 176lidocaine hcl viscous soln 2%..................................... 168lidocaine-hydrocortisone acetate rectal cream

3-0.5%........................................................................... 170lidocaine oint 5%........................................................... 176lidocaine patch 5% (Lidoderm).................................... 176lidocaine-prilocaine cream 2.5-2.5% (Emla)............... 176lidocaine-prilocaine cream kit 2.5-2.5%...................... 176LINDANE -lindane shampoo 1%.....................................176linezolid for susp 100 mg/5ml (Zyvox)..........................12linezolid tab 600 mg (Zyvox).......................................... 12LINZESS -linaclotide cap 72 mcg..................................... 73LINZESS -linaclotide cap 145 mcg................................... 73LINZESS -linaclotide cap 290 mcg................................... 73liothyronine sodium tab 5 mcg (Cytomel).................... 36liothyronine sodium tab 25 mcg (Cytomel).................. 36liothyronine sodium tab 50 mcg (Cytomel).................. 36LIPISTART -nutritional supplement powder.................... 139LIPOFEN -fenofibrate cap 50 mg......................................57LIPOFEN -fenofibrate cap 150 mg....................................57LIQUACEL -amino acids oral liquid................................ 131LIQUACEL PUMP + GO -amino acids oral liquid........... 131LIQUID HOPE -nutritional supplement liquid..................139lisinopril & hydrochlorothiazide tab 10-12.5 mg

(Zestoretic).....................................................................50lisinopril & hydrochlorothiazide tab 20-12.5 mg

(Zestoretic).....................................................................50lisinopril & hydrochlorothiazide tab 20-25 mg

(Zestoretic).....................................................................50lisinopril tab 5 mg (Prinivil)............................................50

lisinopril tab 10 mg (Prinivil)..........................................50lisinopril tab 20 mg (Prinivil)..........................................50lisinopril tab 2.5 mg (Zestril).......................................... 50lisinopril tab 30 mg (Zestril)........................................... 50lisinopril tab 40 mg (Zestril)........................................... 50LISTERINE ESSENTIAL CARE -sod monofluorophosph-

eucal-men-methyl sal-thymol gel 0.76%......................168LISTERINE NATURALS WITH F -sodium fluoride rinse

0.02%.............................................................................168LISTERINE RESTORING -sodium fluoride rinse 0.0221%

(0.01% f)........................................................................168LISTERINE SMART RINSE -sodium fluoride rinse

0.0221% (0.01% f)........................................................168LISTERINE TOTAL CARE PLUS -sodium fluoride rinse

0.0221% (0.01% f)........................................................168LISTERINE TOTAL CARE -sodium fluoride rinse 0.0221%

(0.01% f)........................................................................168LISTERINE TOTAL CARE ZERO -sodium fluoride rinse

0.02%.............................................................................168LISTERINE WHITENING/RESTO -sodium fluoride rinse

0.0221% (0.01% f)........................................................168lithium carbonate cap 300 mg....................................... 84lithium carbonate cap 150 mg (Lithium carbonate).....84lithium carbonate cap 600 mg (Lithium carbonate).....84LITHIUM CARBONATE -lithium carbonate cap 150

mg....................................................................................84LITHIUM CARBONATE -lithium carbonate cap 600

mg....................................................................................84lithium carbonate tab er 450 mg....................................84lithium carbonate tab er 300 mg (Lithobid).................. 84lithium carbonate tab 300 mg........................................ 84LITHIUM -lithium oral solution 8 meq/5ml.........................84LITHOBID -lithium carbonate tab er 300 mg.................... 84LITHOSTAT -acetohydroxamic acid tab 250 mg...............76LIVALO -pitavastatin calcium tab 1 mg (base equiv)........ 57LIVALO -pitavastatin calcium tab 2 mg (base equiv)........ 57LIVALO -pitavastatin calcium tab 4 mg (base equiv)........ 57LMD -nutritional supplement powder.............................. 139L-METHYL-MC NAC -l-methylfolate-methylcobalamin-

acetylcyst tab 6-2-600 mg............................................139LOCOID -hydrocortisone butyrate lotion 0.1%................176LO LOESTRIN FE -norethin-eth estradiol-fe tab 1 mg-10

mcg (24)/10 mcg (2).......................................................27LONSURF -trifluridine-tipiracil tab 15-6.14 mg................. 19LONSURF -trifluridine-tipiracil tab 20-8.19 mg................. 19LOPHLEX LQ 20 -nutritional supplement liquid..............139LOPHLEX -nutritional supplement pack..........................139lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)

(Kaletra)............................................................................ 8lorazepam conc 2 mg/ml (Lorazepam intensol)...........78lorazepam tab 0.5 mg (Ativan)....................................... 78lorazepam tab 1 mg (Ativan).......................................... 78

2016



lorazepam tab 2 mg (Ativan).......................................... 78LORTAB -hydrocodone-acetaminophen soln 10-300

mg/15ml.........................................................................100LORZONE -chlorzoxazone tab 375 mg.......................... 118LORZONE -chlorzoxazone tab 750 mg.......................... 118losartan potassium & hydrochlorothiazide tab 50-12.5

mg (Hyzaar)....................................................................50losartan potassium & hydrochlorothiazide tab

100-12.5 mg (Hyzaar)....................................................50losartan potassium & hydrochlorothiazide tab 100-25

mg (Hyzaar)....................................................................50losartan potassium tab 25 mg (Cozaar)........................50losartan potassium tab 50 mg (Cozaar)........................50losartan potassium tab 100 mg (Cozaar)......................50LOTEMAX -loteprednol etabonate ophth gel 0.5%.........165LOTEMAX -loteprednol etabonate ophth oint 0.5%........165LOTEMAX -loteprednol etabonate ophth susp 0.5%......165LOTRIMIN ULTRA -butenafine hcl cream 1%................ 176LOTRONEX -alosetron hcl tab 0.5 mg (base equiv).........73LOTRONEX -alosetron hcl tab 1 mg (base equiv)............73LOUTREX -antiseborrheic products misc - cream..........176lovastatin tab 10 mg........................................................57lovastatin tab 20 mg........................................................57lovastatin tab 40 mg (Mevacor)..................................... 57loxapine succinate cap 5 mg......................................... 84loxapine succinate cap 10 mg....................................... 84loxapine succinate cap 25 mg....................................... 84loxapine succinate cap 50 mg....................................... 84LPS CRITICAL CARE SUGAR F -nutritional supplement

liquid.............................................................................. 139LPS SUGAR FREE -nutritional supplement liquid..........139LUGOLS STRONG IODINE -iodine solution.................. 182LUMIGAN -bimatoprost ophth soln 0.01%......................165LUXAMEND -wound dressings - cream..........................176LUZU -luliconazole cream 1%.........................................176LYNPARZA -olaparib cap 50 mg.......................................19LYRICA -pregabalin cap 25 mg.......................................113LYRICA -pregabalin cap 50 mg.......................................113LYRICA -pregabalin cap 75 mg.......................................113LYRICA -pregabalin cap 100 mg.....................................113LYRICA -pregabalin cap 150 mg.....................................113LYRICA -pregabalin cap 200 mg.....................................113LYRICA -pregabalin cap 225 mg.....................................113LYRICA -pregabalin cap 300 mg.....................................113LYRICA -pregabalin soln 20 mg/ml.................................113LYSODREN -mitotane tab 500 mg....................................19

MMACRODANTIN -nitrofurantoin macrocrystalline cap 25

mg....................................................................................74mafenide acetate packet for topical soln 5% (50 gm)

(Sulfamylon).................................................................176

MAGNEBIND 400 -magnesium-calcium-folic acid tab400-200-1 mg................................................................129

malathion lotion 0.5% (Ovide)......................................176MAPROTILINE HCL -maprotiline hcl tab 25 mg...............80MAPROTILINE HCL -maprotiline hcl tab 50 mg...............80MAPROTILINE HCL -maprotiline hcl tab 75 mg...............80MAR-COF BP -pseudoephedrine-bromphen-codeine liqd

30-2-7.5 mg/5ml..............................................................62MARNATAL-F -prenatal w/o vit a w/ fe polysac cmplx-fa

cap 60-1 mg..................................................................122MARPLAN -isocarboxazid tab 10 mg............................... 80MATULANE -procarbazine hcl cap 50 mg........................ 19MAXFE -iron-fa-vit b12-biotin-vit c-docusate-mg-zn tab

160-1 mg.......................................................................153MAXIDEX -dexamethasone ophth susp 0.1%................ 165MCT PRO-CAL -nutritional supplement pack................. 139MCT PROCAL -nutritional supplement powder.............. 139MECLOFENAMATE SODIUM -meclofenamate sodium

cap 50 mg.....................................................................106MECLOFENAMATE SODIUM -meclofenamate sodium

cap 100 mg...................................................................106MEDROL -methylprednisolone tab 2 mg.......................... 22medroxyprogesterone acetate im susp 150 mg/ml

(Depo-provera contrac)................................................27medroxyprogesterone acetate im susp prefilled syr

150 mg/ml (Depo-provera contrac).............................27medroxyprogesterone acetate tab 2.5 mg

(Provera).........................................................................28medroxyprogesterone acetate tab 5 mg (Provera)......28medroxyprogesterone acetate tab 10 mg

(Provera).........................................................................28mefenamic acid cap 250 mg (Ponstel)........................106mefloquine hcl tab 250 mg.............................................12MEGACE ES -megestrol acetate susp 625 mg/5ml......... 28MEGA MULTIVITAMIN -multiple vitamins w/ minerals

powder...........................................................................122megestrol acetate susp 625 mg/5ml (Megace es)........28megestrol acetate susp 40 mg/ml (Megace oral)......... 19megestrol acetate tab 20 mg..........................................19megestrol acetate tab 40 mg..........................................19MEKINIST -trametinib dimethyl sulfoxide tab 0.5 mg

(base equivalent)............................................................ 19MEKINIST -trametinib dimethyl sulfoxide tab 2 mg (base

equivalent).......................................................................19meloxicam tab 7.5 mg (Mobic).....................................106meloxicam tab 15 mg (Mobic)......................................106melphalan tab 2 mg (Alkeran)........................................19memantine hcl oral solution 2 mg/ml (Namenda)........93memantine hcl tab 5 mg (28) & 10 mg (21) titration pak

(Namenda titration pa)................................................. 93memantine hcl tab 5 mg (Namenda)............................. 93memantine hcl tab 10 mg (Namenda)........................... 93

2016



M-END PE -phenylephrine-bromphen w/ codeine liqd3.33-1.33-6.33 mg/5ml....................................................62

MENEST -esterified estrogens tab 0.3 mg....................... 25MENEST -esterified estrogens tab 0.625 mg................... 25MENEST -esterified estrogens tab 1.25 mg..................... 25MENOSTAR -estradiol td patch weekly 14 mcg/24hr....... 25MENTAX -butenafine hcl cream 1%................................176MEPERIDINE HCL/PROMETHAZI -meperidine w/

promethazine cap 50-25 mg........................................ 100MEPERIDINE HCL -meperidine hcl oral soln 50

mg/5ml...........................................................................100meperidine hcl tab 50 mg (Demerol)...........................100meperidine hcl tab 100 mg (Demerol).........................100MEPHYTON -phytonadione tab 5 mg.............................119meprobamate tab 200 mg...............................................78meprobamate tab 400 mg...............................................78mercaptopurine tab 50 mg............................................. 19MERITENE -nutritional supplement powder................... 139MESALAMINE DR -mesalamine tab delayed release 800

mg....................................................................................73mesalamine enema 4 gm................................................73mesalamine tab delayed release 1.2 gm (Lialda).........73MESNEX -mesna tab 400 mg...........................................19MESTINON -pyridostigmine bromide syrup 60

mg/5ml...........................................................................119MESTINON TIMESPAN -pyridostigmine bromide tab er

180 mg.......................................................................... 119METAFORM -nutritional supplement pack......................139METAPROTERENOL SULFATE -metaproterenol sulfate

syrup 10 mg/5ml............................................................. 65METAPROTERENOL SULFATE -metaproterenol sulfate

tab 20 mg........................................................................65METAXALONE -metaxalone tab 400 mg........................118metaxalone tab 800 mg (Skelaxin).............................. 118metformin hcl tab er 24hr 500 mg (Glucophage xr).....32metformin hcl tab er 24hr 750 mg (Glucophage xr).....32metformin hcl tab er 24hr modified release 500 mg

(Glumetza)......................................................................32metformin hcl tab er 24hr modified release 1000 mg

(Glumetza)......................................................................32metformin hcl tab er 24hr osmotic 500 mg

(Fortamet).......................................................................32metformin hcl tab er 24hr osmotic 1000 mg

(Fortamet).......................................................................32metformin hcl tab 500 mg (Glucophage)...................... 32metformin hcl tab 850 mg (Glucophage)...................... 32metformin hcl tab 1000 mg (Glucophage).................... 32methadone hcl conc 10 mg/ml (Methadose).............. 100methadone hcl soln 5 mg/5ml (Methadone hcl).........100methadone hcl soln 10 mg/5ml (Methadone hcl).......100methadone hcl tab for oral susp 40 mg......................100methadone hcl tab 10 mg (Dolophine)........................100

methadone hcl tab 5 mg (Dolophine hcl)................... 100methamphetamine hcl tab 5 mg (Desoxyn)..................89methazolamide tab 25 mg (Neptazane).........................54methazolamide tab 50 mg (Neptazane).........................54methenamine hippurate tab 1 gm (Hiprex)...................74methenamine-hyoscamine-meth blue-sod phos cap

120 mg............................................................................74methenamine-hyoscamine-meth blue-sod phos tab

81.6 mg (Urogesic-blue)...............................................74methenamine-hyosc-meth blue-benz acid-phenyl sal

tab 81.6mg (Prosed/ds)................................................74methenamine-hyosc-meth blue-sod phos-phen sal

cap 118 mg.................................................................... 74methenamine-hyosc-meth blue-sod phos-phen sal

cap 120 mg.................................................................... 74methenamine-hyosc-meth blue-sod phos-phen sal tab

81 mg..............................................................................74methenamine-hyos-meth blue-sod phos-phen sal tab

81.6 mg...........................................................................74METHENAMINE MANDELATE -methenamine mandelate

tab 0.5 gm.......................................................................74methenamine mandelate tab 1 gm................................ 74METHERGINE -methylergonovine maleate tab 0.2

mg....................................................................................38methimazole tab 5 mg (Tapazole)..................................36methimazole tab 10 mg (Tapazole)................................36METHIONAID -nutritional supplement powder............... 139METHITEST -methyltestosterone oral tab 10 mg.............23methocarbamol tab 750 mg (Robaxin-750).................118methocarbamol tab 500 mg (Robaxin)........................118methotrexate sodium for inj 1 gm................................. 19methotrexate sodium inj 50 mg/2ml (25 mg/ml)...........19methotrexate sodium inj pf 50 mg/2ml (25 mg/ml)...... 19methotrexate sodium inj pf 100 mg/4ml (25 mg/

ml)................................................................................... 19methotrexate sodium inj pf 200 mg/8ml (25 mg/



ml)................................................................................... 19METHOTREXATE SODIUM -methotrexate sodium inj 250

mg/10ml (25 mg/ml)........................................................19methotrexate sodium tab 2.5 mg (base equiv).............19methoxsalen rapid cap 10 mg (Oxsoralen ultra)........176methscopolamine bromide tab 2.5 mg (Pamine)......... 69methscopolamine bromide tab 5 mg (Pamine

forte)................................................................................69METHYCLOTHIAZIDE -methyclothiazide tab 5 mg..........54METHYLDOPA/HYDROCHLOROTHI -methyldopa &

hydrochlorothiazide tab 250-15 mg................................51

2016



METHYLDOPA/HYDROCHLOROTHI -methyldopa &hydrochlorothiazide tab 250-25 mg................................51

methyldopa tab 250 mg.................................................. 50methyldopa tab 500 mg.................................................. 50methylphenidate hcl cap er 24hr 20 mg (la) (Ritalin

la).....................................................................................90methylphenidate hcl cap er 24hr 30 mg (la) (Ritalin

la).....................................................................................90methylphenidate hcl cap er 24hr 40 mg (la) (Ritalin

la).....................................................................................90methylphenidate hcl cap er 10 mg (cd)........................ 89methylphenidate hcl cap er 20 mg (cd)........................ 89methylphenidate hcl cap er 30 mg (cd)........................ 89methylphenidate hcl cap er 40 mg (cd)........................ 89methylphenidate hcl cap er 50 mg (cd)........................ 90methylphenidate hcl cap er 60 mg (cd)........................ 90METHYLPHENIDATE HCL ER -methylphenidate hcl tab

er 24hr 18 mg.................................................................90METHYLPHENIDATE HCL ER -methylphenidate hcl tab



er 24hr 54 mg.................................................................90METHYLPHENIDATE HCL -methylphenidate hcl chew

tab 2.5 mg.......................................................................89METHYLPHENIDATE HCL -methylphenidate hcl chew

tab 5 mg..........................................................................89METHYLPHENIDATE HCL -methylphenidate hcl chew

tab 10 mg........................................................................89methylphenidate hcl soln 5 mg/5ml (Methylin)............ 90methylphenidate hcl soln 10 mg/5ml (Methylin).......... 90methylphenidate hcl tab er 10 mg.................................90methylphenidate hcl tab er 20 mg.................................90methylphenidate hcl tab er osmotic release (osm) 18

mg (Concerta)................................................................90methylphenidate hcl tab er osmotic release (osm) 27



mg (Concerta)................................................................90methylphenidate hcl tab 5 mg (Ritalin).........................90methylphenidate hcl tab 10 mg (Ritalin).......................90methylphenidate hcl tab 20 mg (Ritalin).......................90methylprednisolone tab 4 mg (Medrol).........................22methylprednisolone tab 8 mg (Medrol).........................22methylprednisolone tab 16 mg (Medrol).......................22methylprednisolone tab 32 mg (Medrol).......................22methylprednisolone tab therapy pack 4 mg (21)

(Medrol dosepak).......................................................... 22methyltestosterone cap 10 mg (Testred)...................... 24

METIPRANOLOL -metipranolol ophth soln 0.3%........... 165metoclopramide hcl soln 5 mg/5ml (10 mg/10ml)........73metoclopramide hcl tab 5 mg (Reglan).........................73metoclopramide hcl tab 10 mg (Reglan).......................73METOCLOPRAMIDE ODT -metoclopramide hcl orally

disintegrating tab 5 mg (base eq).................................. 73METOCLOPRAMIDE ODT -metoclopramide hcl orally

disintegrating tab 10 mg (base eq)................................ 73metolazone tab 2.5 mg....................................................54metolazone tab 5 mg.......................................................54metolazone tab 10 mg.....................................................54METOPROLOL/HYDROCHLOROTHI -metoprolol &

hydrochlorothiazide tab 100-50 mg................................51metoprolol & hydrochlorothiazide tab 50-25 mg

(Lopressor hct)..............................................................51metoprolol & hydrochlorothiazide tab 100-25 mg

(Lopressor hct)..............................................................51metoprolol succinate tab er 24hr 25 mg (tartrate

equiv) (Toprol xl)...........................................................43metoprolol succinate tab er 24hr 50 mg (tartrate



equiv) (Toprol xl)...........................................................43METOPROLOL TARTRATE -metoprolol tartrate tab 37.5

mg....................................................................................43METOPROLOL TARTRATE -metoprolol tartrate tab 75

mg....................................................................................43metoprolol tartrate tab 25 mg........................................ 43metoprolol tartrate tab 50 mg (Lopressor)................... 43metoprolol tartrate tab 100 mg (Lopressor)................. 43metronidazole cap 375 mg (Flagyl)............................... 12metronidazole cream 0.75% (Metrocream)................. 176metronidazole gel 0.75%...............................................176metronidazole gel 1% (Metrogel)................................. 176metronidazole lotion 0.75% (Metrolotion)...................176metronidazole tab 250 mg (Flagyl)................................ 12metronidazole tab 500 mg (Flagyl)................................ 12metronidazole vaginal gel 0.75% (Metrogel-

vaginal)........................................................................... 76mexiletine hcl cap 150 mg..............................................46mexiletine hcl cap 200 mg..............................................46mexiletine hcl cap 250 mg..............................................46MIACALCIN -calcitonin (salmon) inj 200 unit/ml...............39MICONAZOLE 3 -miconazole nitrate vaginal suppos 200

mg....................................................................................76MICROCYN SKIN AND WOUND H -wound cleansers -

gel.................................................................................. 176MICROCYN -wound cleansers - gel............................... 176MICROCYN -wound cleansers - liquid............................176midazolam hcl syrup 2 mg/ml (base equivalent)......... 87

2016



midodrine hcl tab 2.5 mg................................................55midodrine hcl tab 5 mg...................................................55midodrine hcl tab 10 mg.................................................55miglitol tab 25 mg (Glyset)............................................. 32miglitol tab 50 mg (Glyset)............................................. 32miglitol tab 100 mg (Glyset)........................................... 32MIGRANAL -dihydroergotamine mesylate nasal spray 4

mg/ml.............................................................................108MILLIPRED DP -prednisolone tab therapy pack 5 mg

(21).................................................................................. 22MILLIPRED DP -prednisolone tab therapy pack 5 mg

(48).................................................................................. 22MILLIPRED -prednisolone sod phosphate oral soln 10

mg/5ml (base equiv).......................................................22MILLIPRED -prednisolone tab 5 mg................................. 22MINASTRIN 24 FE -norethindrone ace-eth estradiol-fe

chew tab 1 mg-20 mcg (24)...........................................27MINIVELLE -estradiol td patch twice weekly 0.025

mg/24hr........................................................................... 25MINIVELLE -estradiol td patch twice weekly 0.0375




mg/24hr........................................................................... 25minocycline hcl cap 50 mg (Minocin)............................. 4minocycline hcl cap 75 mg (Minocin)............................. 4minocycline hcl cap 100 mg (Minocin)........................... 4MINOCYCLINE HCL ER -minocycline hcl tab er 24hr 45

mg......................................................................................4minocycline hcl tab er 24hr 90 mg..................................4minocycline hcl tab er 24hr 135 mg................................4minocycline hcl tab 50 mg............................................... 4minocycline hcl tab 75 mg............................................... 4minocycline hcl tab 100 mg............................................. 5minoxidil tab 2.5 mg........................................................51minoxidil tab 10 mg.........................................................51MIRAPEX ER -pramipexole dihydrochloride tab er 24hr

0.375 mg....................................................................... 116MIRAPEX ER -pramipexole dihydrochloride tab er 24hr

0.75 mg......................................................................... 116MIRAPEX ER -pramipexole dihydrochloride tab er 24hr

1.5 mg........................................................................... 116MIRAPEX ER -pramipexole dihydrochloride tab er 24hr

2.25 mg......................................................................... 116MIRAPEX ER -pramipexole dihydrochloride tab er 24hr 3

mg..................................................................................116MIRAPEX ER -pramipexole dihydrochloride tab er 24hr

3.75 mg......................................................................... 116

MIRAPEX ER -pramipexole dihydrochloride tab er 24hr4.5 mg........................................................................... 116

MIRCERA -methoxy peg-epoetin beta soln prefilled syr 30mcg/0.3ml......................................................................153



MIRCERA -methoxy peg-epoetin beta soln prefilled syr100 mcg/0.3ml.............................................................. 153



mirtazapine orally disintegrating tab 15 mg (Remeronsoltab).............................................................................80



mirtazapine tab 7.5 mg....................................................80mirtazapine tab 15 mg (Remeron)................................. 81mirtazapine tab 30 mg (Remeron)................................. 81mirtazapine tab 45 mg (Remeron)................................. 81MIRVASO -brimonidine tartrate gel 0.33% (base

equivalent).....................................................................177misoprostol tab 100 mcg (Cytotec)............................... 69misoprostol tab 200 mcg (Cytotec)............................... 69MITIGARE -colchicine cap 0.6 mg..................................109MITOSOL -mitomycin for ophth soln kit 0.2 mg..............165MMA/PA ANAMIX EARLY YEARS -nutritional supplement

powder...........................................................................139MMA/PA ANAMIX NEXT -nutritional supplement

powder...........................................................................139MMA/PA COOLER -nutritional supplement liquid........... 139MMA/PA COOLER15 -nutritional supplement liquid....... 139MMA/PA GEL -nutritional supplement pack....................139modafinil tab 100 mg (Provigil)......................................90modafinil tab 200 mg (Provigil)......................................90MODERIBA 1200 DOSE PACK -ribavirin tab 600 mg........ 8MODERIBA 800 DOSE PACK -ribavirin tab 400 mg.......... 8MODERIBA -ribavirin tab 200 mg & ribavirin 400 mg tab

therapy pack......................................................................8MODERIBA -ribavirin tab 400 mg & ribavirin 600 mg tab

therapy pack......................................................................8MODULEN IBD -nutritional supplement powder.............139moexipril hcl tab 7.5 mg................................................. 51moexipril hcl tab 15 mg.................................................. 51moexipril-hydrochlorothiazide tab 7.5-12.5 mg........... 51moexipril-hydrochlorothiazide tab 15-12.5 mg............ 51moexipril-hydrochlorothiazide tab 15-25 mg............... 51mometasone furoate cream 0.1% (Elocon)................ 177

2016



mometasone furoate nasal susp 50 mcg/act(Nasonex)....................................................................... 61

mometasone furoate oint 0.1% (Elocon).................... 177mometasone furoate solution 0.1% (lotion)

(Elocon)........................................................................ 177MONOCAL -sodium monofluorophosphate-calcium carb

tab 22.75-625 mg......................................................... 129MONOCLATE-P -antihemophilic factor (human) for inj kit

1000 unit....................................................................... 160MONOCLATE-P -antihemophilic factor (human) for inj kit

1500 unit....................................................................... 160MONOGEN -nutritional supplement powder...................139MONONINE -coagulation factor ix for inj 1000 unit........ 160montelukast sodium chew tab 4 mg (base equiv)

(Singulair).......................................................................65montelukast sodium chew tab 5 mg (base equiv)

(Singulair).......................................................................65montelukast sodium oral granules packet 4 mg (base

equiv) (Singulair)...........................................................65montelukast sodium tab 10 mg (base equiv)

(Singulair).......................................................................65MONUROL -fosfomycin tromethamine powd pack 3 gm

(base equivalent)............................................................ 74morphine sulfate cap er 24hr 10 mg (Kadian)............100morphine sulfate cap er 24hr 20 mg (Kadian)............100morphine sulfate cap er 24hr 30 mg (Kadian)............100morphine sulfate cap er 24hr 50 mg (Kadian)............101morphine sulfate cap er 24hr 60 mg (Kadian)............101morphine sulfate cap er 24hr 80 mg (Kadian)............101morphine sulfate cap er 24hr 100 mg (Kadian)..........101MORPHINE SULFATE ER -morphine sulfate beads cap

er 24hr 30 mg...............................................................101MORPHINE SULFATE ER -morphine sulfate beads cap





er 24hr 120 mg.............................................................101MORPHINE SULFATE -morphine sulfate suppos 5

mg..................................................................................100MORPHINE SULFATE -morphine sulfate suppos 10



mg..................................................................................100MORPHINE SULFATE -morphine sulfate tab 15 mg...... 100MORPHINE SULFATE -morphine sulfate tab 30 mg...... 100

morphine sulfate oral soln 10 mg/5ml........................ 101morphine sulfate oral soln 20 mg/5ml........................ 101morphine sulfate oral soln 100 mg/5ml (20 mg/

ml)................................................................................. 101morphine sulfate tab er 15 mg (Ms contin)................ 101morphine sulfate tab er 30 mg (Ms contin)................ 101morphine sulfate tab er 60 mg (Ms contin)................ 101morphine sulfate tab er 100 mg (Ms contin).............. 101morphine sulfate tab er 200 mg (Ms contin).............. 101MOTOFEN -difenoxin w/ atropine tab 1-0.025 mg............67MOVANTIK -naloxegol oxalate tab 12.5 mg (base

equivalent).......................................................................73MOVANTIK -naloxegol oxalate tab 25 mg (base

equivalent).......................................................................73MOVIPREP -peg 3350-kcl-nacl-na sulfate-na ascorbate-c

for soln 100 gm...............................................................67MOXATAG -amoxicillin (trihydrate) tab er 24hr 775 mg......1MOXEZA -moxifloxacin hcl ophth soln 0.5% (base eq) (2

times daily)....................................................................165moxifloxacin hcl ophth soln 0.5% (base equiv)

(Vigamox)..................................................................... 165moxifloxacin hcl tab 400 mg (base equiv) (Avelox).......5MSUD AID -nutritional supplement powder.................... 139MSUD ANAMIX EARLY YEARS -nutritional supplement

powder...........................................................................139MSUD COOLER -nutritional supplement liquid.............. 139MSUD EXPRESS -nutritional supplement pack............. 139MSUD EXPRESS20 -nutritional supplement pack......... 139MSUD GEL -nutritional supplement pack....................... 139MSUD LOPHLEX LQ -nutritional supplement liquid....... 139MSUD MAXAMAID -nutritional supplement powder.......139MSUD MAXAMUM -nutritional supplement powder....... 139MSUD 2 -nutritional supplement powder........................ 139MUCOTROL -oral wound care products - wafer.............168MULTAQ -dronedarone hcl tab 400 mg (base

equivalent).......................................................................46MULTIGEN -fe asparto gly-succ acd-c-threonic acd-b12-

des stom tab................................................................. 153MULTIGEN FOLIC -fe asparto gly-succinic acd-vit c-

threonic acd-b12-fa tab................................................ 153MULTIGEN PLUS -fe aspart gly-fe fum-succ acd-c-

threonic acd-b12-fa tab................................................ 153multiple vitamins w/ minerals & fa tab 1.25 mg

(Corvite)........................................................................122mupirocin calcium cream 2% (Bactroban)................. 177mupirocin oint 2% (Bactroban)....................................177M-VIT -prenatal vit w/ fe fumarate-fa tab 27-1 mg.......... 122MYALEPT -metreleptin for subcutaneous inj 11.3 mg...... 39mycophenolate mofetil cap 250 mg (Cellcept)...........185mycophenolate mofetil for oral susp 200 mg/ml

(Cellcept)...................................................................... 185mycophenolate mofetil tab 500 mg (Cellcept)............185

2016



mycophenolate sodium tab dr 180 mg (mycophenolicacid equiv) (Myfortic)................................................. 185

mycophenolate sodium tab dr 360 mg (mycophenolicacid equiv) (Myfortic)................................................. 185

MYLERAN -busulfan tab 2 mg..........................................19MYNATAL ADVANCE -prenatal vit w/ dss-iron carbonyl-fa

tab 90-1 mg...................................................................122MYNATAL PLUS -prenatal vit w/ fe fumarate-fa tab 65-1

mg..................................................................................122MYNATAL -prenatal multivitamins & minerals w/ iron & fa

cap 1 mg.......................................................................122MYNATAL ULTRACAPLET -prenatal vit w/ dss-iron

carbonyl-fa tab 90-1 mg............................................... 122MYNATAL-Z -prenatal vit w/ fe fumarate-fa tab 65-1

mg..................................................................................122MYNATE 90 PLUS -prenatal vit w/ dss-fe fumarate-fa tab

er 90-1 mg.................................................................... 122MYRBETRIQ -mirabegron tab er 24 hr 25 mg..................75MYRBETRIQ -mirabegron tab er 24 hr 50 mg..................75MYTESI -crofelemer tab delayed release 125 mg............68

NNABI-HB -hepatitis b immune globulin (human) im inj

soln.................................................................................. 15nabumetone tab 500 mg............................................... 106nabumetone tab 750 mg............................................... 106nadolol & bendroflumethiazide tab 40-5 mg

(Corzide)......................................................................... 51nadolol & bendroflumethiazide tab 80-5 mg

(Corzide)......................................................................... 51nadolol tab 20 mg (Corgard).......................................... 43nadolol tab 40 mg (Corgard).......................................... 43nadolol tab 80 mg (Corgard).......................................... 43NAFRINSE DAILY/ACIDULATED -sodium fluoride-

phosphoric acid for soln 1 mg/5ml (f equiv).................168NAFRINSE DAILY/NEUTRAL -7odium fluoride for soln

rinse 0.05%................................................................... 168NAFRINSE WEEKLY -sodium fluoride for soln rinse

0.2%...............................................................................168naftifine hcl cream 1%.................................................. 177naftifine hcl cream 2% (Naftin).................................... 177NAFTIN -naftifine hcl cream 2%..................................... 177NAFTIN -naftifine hcl gel 1%...........................................177NAFTIN -naftifine hcl gel 2%...........................................177NALFON -fenoprofen calcium cap 400 mg.....................106naloxone hcl inj 0.4 mg/ml........................................... 182NALOXONE HCL -naloxone hcl soln prefilled syringe 2

mg/2ml...........................................................................182naltrexone hcl tab 50 mg (Revia).................................182NAMENDA -memantine hcl tab 5 mg............................... 93NAMENDA -memantine hcl tab 10 mg............................. 93

NAMENDA TITRATION PAK -memantine hcl tab 5 mg(28) & 10 mg (21) titration pak.......................................93

NAMENDA XR -memantine hcl cap er 24hr 7 mg............93NAMENDA XR -memantine hcl cap er 24hr 14 mg.......... 93NAMENDA XR -memantine hcl cap er 24hr 21 mg.......... 93NAMENDA XR -memantine hcl cap er 24hr 28 mg.......... 93NAMENDA XR TITRATION PACK -memantine hcl cap er

24hr 7 mg & 14 mg & 21 mg & 28 mg pack.................. 93NAMZARIC -memantine-donepezil cap er 24hr 7 & 14 &

21 & 28-10 mg pack.......................................................93NAMZARIC -memantine hcl-donepezil hcl cap er 24hr

7-10 mg........................................................................... 93NAMZARIC -memantine hcl-donepezil hcl cap er 24hr

14-10 mg......................................................................... 93NAMZARIC -memantine hcl-donepezil hcl cap er 24hr

21-10 mg......................................................................... 93NAMZARIC -memantine hcl-donepezil hcl cap er 24hr

28-10 mg......................................................................... 93naproxen sodium tab er 24hr 375 mg (base equiv)

(Naprelan).....................................................................106naproxen sodium tab er 24hr 500 mg (base equiv)

(Naprelan).....................................................................106naproxen sodium tab 275 mg (Anaprox).................... 106naproxen sodium tab 550 mg (Anaprox ds)...............106naproxen susp 125 mg/5ml.......................................... 106naproxen tab ec 375 mg (Ec-naprosyn)......................106naproxen tab ec 500 mg (Ec-naprosyn)......................106naproxen tab 250 mg (Naprosyn)................................ 106naproxen tab 375 mg (Naprosyn)................................ 106naproxen tab 500 mg (Naprosyn)................................ 106naratriptan hcl tab 1 mg (base equiv) (Amerge)........ 108naratriptan hcl tab 2.5 mg (base equiv) (Amerge)..... 108NARCAN -naloxone hcl nasal spray 4 mg/0.1ml............ 183NASCOBAL -cyanocobalamin nasal spray 500

mcg/0.1ml......................................................................153NATACHEW -prenatal vit w/ fe fum-fe bisglycin-fa chew

tab 28-1 mg...................................................................122NATACYN -natamycin ophth susp 5%............................165NATALVIT -prenatal vit w/ fe fumarate-fa tab 75-1

mg..................................................................................122NATAZIA -estradiol valerate-dienogest tab 3 mg /2-2

mg/2-3 mg/1 mg............................................................. 27nateglinide tab 60 mg (Starlix).......................................32nateglinide tab 120 mg (Starlix).....................................32NATELLE ONE -prenatal w/o vit a w/ fe fum-fa-omega 3

cap 28-1-250 mg.......................................................... 122NATPARA -parathyroid hormone (recombinant) for inj

cartridge 25 mcg.............................................................39NATPARA -parathyroid hormone (recombinant) for inj

cartridge 50 mcg.............................................................39NATPARA -parathyroid hormone (recombinant) for inj

cartridge 75 mcg.............................................................39

2016



NATPARA -parathyroid hormone (recombinant) for injcartridge 100 mcg...........................................................39

NATROBA -spinosad susp 0.9%.....................................177NATURE-THROID NT-2.5 -thyroid tab 162.5 mg (2 1/2

grain)................................................................................36NATURE-THROID -thyroid tab 16.25 mg..........................36NATURE-THROID -thyroid tab 32.5 mg............................36NATURE-THROID -thyroid tab 65 mg...............................36NATURE-THROID -thyroid tab 81.25 mg..........................36NATURE-THROID -thyroid tab 97.5 mg............................36NATURE-THROID -thyroid tab 113.75 mg........................36NATURE-THROID -thyroid tab 130 mg.............................36NATURE-THROID -thyroid tab 146.25 mg....................... 36NATURE-THROID -thyroid tab 195 mg.............................36NATURE-THROID -thyroid tab 260 mg.............................36NATURE-THROID -thyroid tab 48.75 mg (3/4 grain)........36NATURE-THROID -thyroid tab 325 mg (5 grain)..............36NEBUPENT -pentamidine isethionate for nebulization

soln 300 mg.................................................................... 12NEBUSAL -sodium chloride soln nebu 6%.......................62NECON 1/50-28 -norethindrone & mestranol tab 1 mg-50

mcg.................................................................................. 27NEEVO DHA -prenat w/o a w/fefum-methylfol-omegas

cap 27-1.13 mg.............................................................122NEFAZODONE HCL -nefazodone hcl tab 100 mg........... 81NEFAZODONE HCL -nefazodone hcl tab 150 mg........... 81NEFAZODONE HCL -nefazodone hcl tab 200 mg........... 81nefazodone hcl tab 50 mg.............................................. 81nefazodone hcl tab 250 mg............................................ 81NEOCATE INFANT DHA/ARA -nutritional supplement

powder...........................................................................139NEOCATE JUNIOR/PREBIOTICS -nutritional supplement

powder...........................................................................140NEOCATE JUNIOR -nutritional supplement powder...... 140NEOCATE NUTRA -nutritional supplement powder....... 140NEOCATE SPLASH -nutritional supplement liquid.........140NEOMYCIN/POLYMYXIN/HYDROC -neomycin-

polymyxin-hc ophth susp..............................................165neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin.............................165neomycin-polymy-gramicid op sol

1.75-10000-0.025mg-unt-mg/ml (Neosporin)........... 165neomycin-polymyxin-dexamethasone ophth oint 0.1%

(Maxitrol)...................................................................... 165neomycin-polymyxin-dexamethasone ophth susp

0.1% (Maxitrol).............................................................165neomycin-polymyxin-hc otic soln 1%

(Cortisporin).................................................................167neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%.................................................................... 167neomycin sulfate tab 500 mg...........................................5NEORAL -cyclosporine modified cap 25 mg...................185

NEORAL -cyclosporine modified cap 100 mg.................185NEORAL -cyclosporine modified oral soln 100 mg/

ml................................................................................... 185NEOSALUS CP -dermatological products misc -

cream.............................................................................177NEOSALUS -dermatological products, misc. - aerosol

foam...............................................................................177NEOSALUS -dermatological products misc - cream...... 177NEOSALUS -emollient - lotion........................................ 177NEO-SYNALAR -neomycin sulfate-fluocinolone acetonide

cream 0.5-0.025%........................................................ 177NEOTUSS PLUS -phenylephrine-chlorphen-dm liquid

7.5-4-30 mg/5ml..............................................................62NEPHPLEX RX -b-complex w/ c-zn & folic acid tab 1

mg..................................................................................122NEPHRON FA -ferrous fumarate w/ fa-dss-b complex-vit

c tab...............................................................................153NEPRO -nutritional supplement liquid.............................140NEPRO WITH CARBSTEADY -nutritional supplement

liquid.............................................................................. 140NEPRO WITH CARB STEADY -nutritional supplement

liquid.............................................................................. 140NESINA -alogliptin benzoate tab 6.25 mg (base

equiv)...............................................................................32NESINA -alogliptin benzoate tab 12.5 mg (base

equiv)...............................................................................32NESINA -alogliptin benzoate tab 25 mg (base equiv).......32NESTABS ABC -prenatal w/o vit a w/fe polysac-fa-ca tab

& omega 3 cap............................................................. 122NESTABS DHA -prenat w/o a w/ fe bisglyc-fa tab 32-1 mg

& omega cap pack....................................................... 122NESTABS ONE -prenat w/o a w/fecbn-bisg-methylf-dha

cap 38-1-225 mg.......................................................... 122NESTABS -prenatal vit w/o vit a w/ fe bisglycinate-fa tab

32-1 mg......................................................................... 122NESTLE FLAVOR EXTRA STREN -nutritional

supplement flavor pack................................................ 140NESTLE FLAVOR FOR KIDS -nutritional supplement

flavor pack.....................................................................140NESTLE FLAVOR -nutritional supplement flavor

pack............................................................................... 140NEULASTA ONPRO KIT -pegfilgrastim soln prefilled

syringe kit 6 mg/0.6ml.................................................. 153NEULASTA -pegfilgrastim soln prefilled syringe 6

mg/0.6ml........................................................................153NEUPOGEN -filgrastim inj 300 mcg/ml...........................153NEUPOGEN -filgrastim inj 480 mcg/1.6ml (300 mcg/

ml)..................................................................................153NEUPOGEN -filgrastim soln prefilled syringe 300

mcg/0.5ml......................................................................153NEUPOGEN -filgrastim soln prefilled syringe 480

mcg/0.8ml (600 mcg/ml)...............................................153

2016



NEUPRO -rotigotine td patch 24hr 1 mg/24hr................ 116NEUPRO -rotigotine td patch 24hr 2 mg/24hr................ 116NEUPRO -rotigotine td patch 24hr 3 mg/24hr................ 116NEUPRO -rotigotine td patch 24hr 4 mg/24hr................ 116NEUPRO -rotigotine td patch 24hr 6 mg/24hr................ 116NEUPRO -rotigotine td patch 24hr 8 mg/24hr................ 116NEURIN-SL -cyanocobalamin-methylcobalamin tab sl

600-600 mcg................................................................. 153NEUTRASAL -artificial saliva - packet............................ 168NEVANAC -nepafenac ophth susp 0.1%........................ 165nevirapine tab er 24hr 100 mg (Viramune xr).................9nevirapine tab er 24hr 400 mg (Viramune xr).................9nevirapine tab 200 mg (Viramune)...................................9NEWGEN -prenatal vit w/o vit a w/ fe bisglycinate-fa tab

32-1 mg......................................................................... 122NEXA PLUS -prenatal w/o vit a w/ fe fum-doc-fa-dha cap

29-1.25-350 mg.............................................................122NEXAVAR -sorafenib tosylate tab 200 mg (base

equivalent).......................................................................19NEXIUM -esomeprazole magnesium for delayed release

susp packet 5 mg........................................................... 69NEXIUM -esomeprazole magnesium for delayed release

susp packet 10 mg......................................................... 69NEXIUM -esomeprazole magnesium for delayed release



susp pack 2.5 mg........................................................... 69niacin tab er 500 mg (antihyperlipidemic)

(Niaspan)........................................................................ 57niacin tab er 750 mg (antihyperlipidemic)

(Niaspan)........................................................................ 57niacin tab er 1000 mg (antihyperlipidemic)

(Niaspan)........................................................................ 57nicardipine hcl cap 20 mg.............................................. 45nicardipine hcl cap 30 mg.............................................. 45NICODERM CQ -nicotine td patch 24hr 7 mg/24hr.......... 93NICODERM CQ -nicotine td patch 24hr 14 mg/24hr........ 93NICODERM CQ -nicotine td patch 24hr 21 mg/24hr........ 93NICOMIDE -niacinamide w/ zn-cu-methylfolate tab

750-25-1.5-0.5 mg........................................................ 122NICORETTE MINI -nicotine polacrilex lozenge 2 mg....... 93NICORETTE MINI -nicotine polacrilex lozenge 4 mg....... 93NICORETTE -nicotine polacrilex gum 2 mg..................... 93NICORETTE -nicotine polacrilex gum 4 mg..................... 93NICORETTE -nicotine polacrilex lozenge 2 mg................93NICORETTE -nicotine polacrilex lozenge 4 mg................93NICORETTE STARTER KIT -nicotine polacrilex gum 2

mg....................................................................................93NICORETTE STARTER KIT -nicotine polacrilex gum 4

mg....................................................................................94

nicotine polacrilex gum 2 mg.........................................94nicotine polacrilex gum 4 mg.........................................94nicotine polacrilex lozenge 2 mg...................................94nicotine polacrilex lozenge 4 mg...................................94nicotine td patch 24hr 7 mg/24hr...................................94nicotine td patch 24hr 14 mg/24hr.................................94nicotine td patch 24hr 21 mg/24hr.................................94NICOTINE TRANSDERMAL SYST -nicotine td patch 24

hr kit 21-14-7 mg/24hr....................................................94NICOTROL INHALER -nicotine inhaler system 10 mg (4

mg delivered).................................................................. 94NICOTROL NS -nicotine nasal spray 10 mg/ml (0.5 mg/

spray)...............................................................................94nifedipine cap 20 mg.......................................................45nifedipine cap 10 mg (Procardia).................................. 45nifedipine tab er 24hr 30 mg (Adalat cc).......................45nifedipine tab er 24hr 60 mg (Adalat cc).......................45nifedipine tab er 24hr 90 mg (Adalat cc).......................45nifedipine tab er 24hr osmotic release 30 mg

(Procardia xl)................................................................. 45nifedipine tab er 24hr osmotic release 60 mg

(Procardia xl)................................................................. 45nifedipine tab er 24hr osmotic release 90 mg

(Procardia xl)................................................................. 45NILANDRON -nilutamide tab 150 mg............................... 19nilutamide tab 150 mg (Nilandron)................................ 19nimodipine cap 30 mg.....................................................45NINJACOF-XG -guaifenesin-codeine liquid 200-8

mg/5ml.............................................................................62NINLARO -ixazomib citrate cap 2.3 mg (base

equivalent).......................................................................19NINLARO -ixazomib citrate cap 3 mg (base

equivalent).......................................................................19NINLARO -ixazomib citrate cap 4 mg (base

equivalent).......................................................................19NISOLDIPINE ER -nisoldipine tab er 24hr 20 mg............ 45NISOLDIPINE ER -nisoldipine tab er 24hr 25.5 mg......... 45NISOLDIPINE ER -nisoldipine tab er 24hr 30 mg............ 45NISOLDIPINE ER -nisoldipine tab er 24hr 40 mg............ 45nisoldipine tab er 24hr 8.5 mg (Sular)...........................45nisoldipine tab er 24hr 17 mg (Sular)............................45nisoldipine tab er 24hr 34 mg (Sular)............................45NITRO-BID -nitroglycerin oint 2%..................................... 41NITRO-DUR -nitroglycerin td patch 24hr 0.3 mg/hr..........41NITRO-DUR -nitroglycerin td patch 24hr 0.8 mg/hr..........41nitrofurantoin macrocrystalline cap 25 mg

(Macrodantin).................................................................74nitrofurantoin macrocrystalline cap 50 mg

(Macrodantin).................................................................74nitrofurantoin macrocrystalline cap 100 mg

(Macrodantin).................................................................74

2016



nitrofurantoin monohydrate macrocrystalline cap 100mg (Macrobid)............................................................... 74

nitrofurantoin susp 25 mg/5ml (Furadantin)................ 74nitroglycerin cap er 2.5 mg............................................ 41nitroglycerin cap er 6.5 mg............................................ 41nitroglycerin cap er 9 mg............................................... 41NITROGLYCERIN LINGUAL -nitroglycerin lingual aerosol

400 mcg/spray................................................................ 41nitroglycerin sl tab 0.3 mg (Nitrostat)........................... 42nitroglycerin sl tab 0.4 mg (Nitrostat)........................... 42nitroglycerin sl tab 0.6 mg (Nitrostat)........................... 42nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur).........42nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur).........42nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur).........42nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur).........42nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray)

(Nitrolingual pumpspr).................................................42NITROMIST -nitroglycerin lingual aerosol 400 mcg/

spray................................................................................42NITROSTAT -nitroglycerin sl tab 0.3 mg...........................42NITROSTAT -nitroglycerin sl tab 0.4 mg...........................42NITROSTAT -nitroglycerin sl tab 0.6 mg...........................42NIVA-PLUS -prenatal vit w/ fe fumarate-fa tab 27-1

mg..................................................................................123nizatidine cap 150 mg..................................................... 69nizatidine cap 300 mg (Axid)..........................................69NIZATIDINE -nizatidine oral soln 15 mg/ml...................... 69NOBLE MYSTIQUE EMU-LAC -lactic acid (ammonium

lactate) cream 10%.......................................................177norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg (Femcon fe)...............................................27norethindrone & ethinyl estradiol-fe chew tab 0.8

mg-25 mcg (Generess fe)............................................ 27norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

(Brevicon-28)................................................................. 27norethindrone & ethinyl estradiol tab 1 mg-35 mcg

(Norinyl 1+35)................................................................ 27norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg

(Ovcon-35)......................................................................27norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg (Loestrin fe 1/20).................................................. 28norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30

mcg (Loestrin fe 1.5/30)...............................................28norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg (Loestrin 1/20-21)................................................. 27norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg (Loestrin 1.5/30-21).............................................. 28norethindrone ace-eth estradiol-fe chew tab 1 mg-20

mcg (24) (Minastrin 24 fe)............................................28norethindrone ace-ethinyl estradiol-fe tab 1 mg-20

mcg (24)......................................................................... 28

norethindrone acetate-ethinyl estradiol tab 1 mg-5mcg................................................................................. 25

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5mcg (Femhrt low dose)................................................25

norethindrone acetate tab 5 mg (Aygestin)..................28norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35

mg-mcg (Estrostep fe)................................................. 27norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35

mg-mcg (Ortho-novum 7/7/7)...................................... 28norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-

mcg (Tri-norinyl 28)...................................................... 28norethindrone tab 0.35 mg (Nor-qd)..............................28norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg

(Ortho-cyclen)................................................................28norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35

mg-mcg (Ortho tri-cyclen)........................................... 28norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25

mg-mcg (Ortho tri-cyclen lo).......................................28norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg........28NORPACE CR -disopyramide phosphate cap er 12hr 100

mg....................................................................................46NORPACE CR -disopyramide phosphate cap er 12hr 150

mg....................................................................................46NORPACE -disopyramide phosphate cap 100 mg........... 46NORPACE -disopyramide phosphate cap 150 mg........... 46NORTHERA -droxidopa cap 100 mg................................ 55NORTHERA -droxidopa cap 200 mg................................ 55NORTHERA -droxidopa cap 300 mg................................ 55nortriptyline hcl cap 10 mg (Pamelor)...........................81nortriptyline hcl cap 25 mg (Pamelor)...........................81nortriptyline hcl cap 50 mg (Pamelor)...........................81nortriptyline hcl cap 75 mg (Pamelor)...........................81NORTRIPTYLINE HCL -nortriptyline hcl soln 10

mg/5ml.............................................................................81NORVIR -ritonavir cap 100 mg........................................... 9NORVIR -ritonavir oral soln 80 mg/ml.................................9NORVIR -ritonavir tab 100 mg............................................ 9NOURISH -nutritional supplement liquid.........................140NOVACORT -pramoxine-hc gel 1-2%.............................177NOVASOURCE PULMONARY -nutritional supplement

liquid.............................................................................. 140NOVASOURCE RENAL -nutritional supplement

liquid.............................................................................. 140NOVOEIGHT -antihemophilic factor (recombinant) for inj

250 unit......................................................................... 160NOVOEIGHT -antihemophilic factor (recombinant) for inj

500 unit......................................................................... 160NOVOEIGHT -antihemophilic factor (recombinant) for inj

1000 unit....................................................................... 160NOVOEIGHT -antihemophilic factor (recombinant) for inj

1500 unit....................................................................... 160

2016



NOVOEIGHT -antihemophilic factor (recombinant) for inj2000 unit....................................................................... 160

NOVOEIGHT -antihemophilic factor (recombinant) for inj3000 unit....................................................................... 160

NOVOLIN 70/30 -insulin nph isophane & regular humaninj 100 unit/ml (70-30).................................................... 35

NOVOLIN 70/30 RELION -insulin nph isophane & regularhuman inj 100 unit/ml (70-30)........................................ 35

NOVOLIN N -insulin nph (human) (isophane) inj 100 unit/ml..................................................................................... 35

NOVOLIN N RELION -insulin nph (human) (isophane) inj100 unit/ml.......................................................................35

NOVOLIN R -insulin regular (human) inj 100 unit/ml........35NOVOLIN R RELION -insulin regular (human) inj 100

unit/ml.............................................................................. 35NOVOLOG FLEXPEN -insulin aspart soln pen-injector

100 unit/ml.......................................................................34NOVOLOG -insulin aspart inj 100 unit/ml......................... 34NOVOLOG MIX 70/30 -insulin aspart prot & aspart

(human) inj 100 unit/ml (70-30)......................................35NOVOLOG MIX 70/30 PREFILL -insulin aspart prot &

aspart sus pen-inj 100 unit/ml (70-30)........................... 35NOVOLOG PENFILL -insulin aspart soln cartridge 100

unit/ml.............................................................................. 34NOVOSEVEN RT -coagulation factor viia (recomb) for inj

1 mg (1000 mcg).......................................................... 161NOVOSEVEN RT -coagulation factor viia (recomb) for inj



8 mg (8000 mcg).......................................................... 161NOXAFIL -posaconazole susp 40 mg/ml............................6NOXAFIL -posaconazole tab delayed release 100 mg.......6NOXIFOL-D -folic acid-cholecalciferol tab 1 mg-2500

unit................................................................................. 154NUCALA -mepolizumab for inj 100 mg.............................65NUCORT -hydrocortisone acetate lotion 2%.................. 177NUCYNTA ER -tapentadol hcl tab er 12hr 50 mg...........101NUCYNTA ER -tapentadol hcl tab er 12hr 100 mg.........101NUCYNTA ER -tapentadol hcl tab er 12hr 150 mg.........101NUCYNTA ER -tapentadol hcl tab er 12hr 200 mg.........101NUCYNTA ER -tapentadol hcl tab er 12hr 250 mg.........101NUCYNTA -tapentadol hcl tab 50 mg............................. 101NUCYNTA -tapentadol hcl tab 75 mg............................. 101NUCYNTA -tapentadol hcl tab 100 mg........................... 101NUEDEXTA -dextromethorphan hbr-quinidine sulfate cap

20-10 mg......................................................................... 94NUFERA -iron combination tab.......................................154NUMOISYN -artificial saliva - solution............................ 168NUPLAZID -pimavanserin tartrate tab 17 mg (base

equivalent).......................................................................84

NUTRA/BALANCE RE/GEN FREE -nutritionalsupplement liquid (frozen)............................................140

NUTRA/BALANCE RE/GEN -nutritional supplement liquid(frozen).......................................................................... 140

NUTRA/SHAKE FRUIT PLUS -nutritional supplementliquid (frozen)................................................................ 140

NUTRA/SHAKE -nutritional supplement liquid(frozen).......................................................................... 140

NUTRA/SHAKE SUPREME -nutritional supplementliquid.............................................................................. 140

NUTRA/SHAKE SUPREME -nutritional supplement liquid(frozen).......................................................................... 140

NUTRA BALANCE DIABETIC NU -nutritional supplementbar..................................................................................140

NUTRA BALANCE FIBER COOKI -nutritional supplementmisc............................................................................... 140

NUTRA BALANCE PROTEIN FOR -nutritionalsupplement misc...........................................................140

NUTRAMENT -nutritional supplement liquid...................140NUTRAMINE APPLE AMINO BIT -nutritional supplement

pack............................................................................... 140NUTRAMINE BANANA AMINO B -nutritional supplement

pack............................................................................... 140NUTRAMINE CHOCOLATE AMINO -nutritional

supplement pack...........................................................140NUTRAMINE MANGO AMINO BI -nutritional supplement

pack............................................................................... 141NUTRAMINE MIXED FLAVORS A -nutritional supplement

pack............................................................................... 141NUTRAMINE -nutritional supplement pack.....................140NUTRAMINE PEACHES & CREAM -nutritional

supplement pack...........................................................141NUTRAMINE PINEAPPLE AMINO -nutritional

supplement pack...........................................................141NUTRASENTIALS -amino acids oral powder.................131NUTRA SHAKE/SUPREME -nutritional supplement liquid

(frozen).......................................................................... 140NUTRA SHAKE -nutritional supplement liquid

(frozen).......................................................................... 140NUTREN 1.0/FIBER/ULTRAPAK -nutritional supplement

liquid.............................................................................. 141NUTREN 1.0/FIBER -nutritional supplement liquid.........141NUTREN 1.0 CAL -nutritional supplement liquid............ 141NUTREN 1.5 CAL -nutritional supplement liquid............ 141NUTREN 2.0 CAL -nutritional supplement liquid............ 141NUTREN 1.5 FIBER -nutritional supplement liquid.........141NUTREN JR FIBER -nutritional supplement liquid......... 141NUTREN JR -nutritional supplement liquid.....................141NUTREN JUNIOR/FIBER -nutritional supplement

liquid.............................................................................. 141NUTREN JUNIOR -nutritional supplement liquid............141NUTREN JUNIOR 1.0 -nutritional supplement liquid......141

2016



NUTREN 1.0 -nutritional supplement liquid.................... 141NUTREN 1.5 -nutritional supplement liquid.................... 141NUTREN 2.0 -nutritional supplement liquid.................... 141NUTREN PULMONARY -nutritional supplement

liquid.............................................................................. 141NUTREN RENAL -nutritional supplement liquid............. 141NUTRESTORE -glutamine powd pack 5 gm.................. 131NUTRICIA PREOP -nutritional supplement pack........... 141NUTRIFOCUS -nutritional supplement liquid..................141NUTRIHEAL -nutritional supplement liquid.....................141NUTRIHEP 1.5 CAL -nutritional supplement liquid.........141NUTRIRENAL -nutritional supplement liquid.................. 141NUTRITIONAL DRINK MIX -nutritional supplement

powder...........................................................................141NUTRITIONAL DRINK -nutritional supplement liquid.....141NUTRITIONAL DRINK PLUS -nutritional supplement

liquid.............................................................................. 141NUTRITIONAL DRINK SHAKE M -nutritional supplement

powder...........................................................................141NUTRITIONAL SHAKE COMPLET -nutritional

supplement liquid..........................................................141NUTRITIONAL SHAKE HIGH PR -nutritional supplement

liquid.............................................................................. 141NUTRITIONAL SHAKE -nutritional supplement

liquid.............................................................................. 141NUTRITIONAL SHAKE PLUS -nutritional supplement

liquid.............................................................................. 141NUTRITIONAL SHAKE PLUS PR -nutritional supplement

liquid.............................................................................. 142nutritional supplement liquid....................................... 142NUTRITIONAL SUPPLEMENT -nutritional supplement

liquid.............................................................................. 142NUTRITIONAL SUPPLEMENT PL -nutritional supplement

liquid.............................................................................. 142NUTRIVENT -nutritional supplement liquid.....................142NUTRIVENT 1.5 -nutritional supplement liquid...............142NUVAIL -dermatological products misc - solution...........177NUVARING -etonogestrel-ethinyl estradiol va ring

0.120-0.015 mg/24hr...................................................... 28NUVESSA -metronidazole vaginal gel 1.3%.....................76NUVIGIL -armodafinil tab 50 mg.......................................90NUVIGIL -armodafinil tab 150 mg.....................................90NUVIGIL -armodafinil tab 200 mg.....................................90NUVIGIL -armodafinil tab 250 mg.....................................90NUWIQ -antihemophilic factor (bdd-rfviii) for inj kit 250

unit................................................................................. 161NUWIQ -antihemophilic factor (bdd-rfviii) for inj kit 500



unit................................................................................. 161

NUWIQ -antihemophilic factor (bdd-rfviii) for inj kit 2500unit................................................................................. 161



NUWIQ -antihemophilic factor (bdd-rfviii) for inj 250unit................................................................................. 161







NYMALIZE -nimodipine oral soln 60 mg/20ml..................45nystatin cream 100000 unit/gm....................................177nystatin oint 100000 unit/gm........................................177nystatin oral powder..........................................................6nystatin susp 100000 unit/ml....................................... 168nystatin tab 500000 unit....................................................6nystatin topical powder 100000 unit/gm.....................177nystatin-triamcinolone cream 100000-0.1 unit/gm-

%....................................................................................177nystatin-triamcinolone oint 100000-0.1 unit/gm-

%....................................................................................177OOA 1 -nutritional supplement powder..............................142OA 2 -nutritional supplement powder..............................142OB COMPLETE/DHA -prenat w/ iron cbn-fe asp glyc-fa-

omega cap 30-10-1-200 mg.........................................123OB COMPLETE GOLD -prenat w/o a w/fecbn-methfol-fa-

dha cap 27.5-1-200 mg................................................123OB COMPLETE ONE -prenatal w/o a w/fecbn-fe asp

glyc-fa-fish cap 50-1-476 mg........................................123OB COMPLETE PETITE -prenat w/o a w/fecbn-

feaspglyc-fa-omega cap 35-5-1-200 mg......................123OB COMPLETE PREMIER -prenatal vit w/ fe cbn-fe asp

glyc-fa tab 30-20-1 mg................................................. 123OB COMPLETE -prenatal vit w/ iron carbonyl-fa tab

50-1.25 mg....................................................................123OBIZUR -antihemophilic factor (recomb porc) rpfviii for inj

500 unit......................................................................... 161OBREDON -hydrocodone-guaifenesin soln 2.5-200

mg/5ml.............................................................................62

2016



OBSTETRIX DHA -prenat w/fecbn-fa-dss tab 29-1 mg &omega 3 cap 387 mg pak............................................ 123

OBSTETRIX EC -prenatal vit w/ dss-iron carbonyl-fa tab29-1 mg......................................................................... 123

OBSTETRIX ONE -prenat w/o a w/fecbn-bisg-methylf-dss-dha cap 38-1-225 mg............................................ 123

O-CAL FA -prenatal vit w/ fe fumarate-fa tab 27-1mg..................................................................................123

OCALIVA -obeticholic acid tab 5 mg.................................73OCALIVA -obeticholic acid tab 10 mg...............................73O-CAL PRENATAL -prenatal vit w/ fe fumarate-fa tab 15-1

mg..................................................................................123octreotide acetate inj 50 mcg/ml (0.05 mg/ml)

(Sandostatin)................................................................. 39octreotide acetate inj 100 mcg/ml (0.1 mg/ml)



(Sandostatin)................................................................. 39octreotide acetate inj 1000 mcg/ml (1 mg/ml)

(Sandostatin)................................................................. 40ODEFSEY -emtricitabine-rilpivirine-tenofovir af tab

200-25-25 mg....................................................................9ODOMZO -sonidegib phosphate cap 200 mg (base

equivalent).......................................................................19OFEV -nintedanib esylate cap 100 mg (base

equivalent).......................................................................67OFEV -nintedanib esylate cap 150 mg (base

equivalent).......................................................................67OFLOXACIN -ofloxacin tab 300 mg....................................5ofloxacin ophth soln 0.3% (Ocuflox)...........................165ofloxacin otic soln 0.3%................................................167ofloxacin tab 400 mg.........................................................5OGESTREL -norgestrel & ethinyl estradiol tab 0.5 mg-50

mcg.................................................................................. 28olanzapine-fluoxetine hcl cap 3-25 mg (Symbyax)......94olanzapine-fluoxetine hcl cap 6-25 mg (Symbyax)......94olanzapine-fluoxetine hcl cap 6-50 mg (Symbyax)......94olanzapine-fluoxetine hcl cap 12-25 mg

(Symbyax)...................................................................... 94olanzapine-fluoxetine hcl cap 12-50 mg

(Symbyax)...................................................................... 94olanzapine orally disintegrating tab 5 mg (Zyprexa

zydis)...............................................................................84olanzapine orally disintegrating tab 10 mg (Zyprexa



zydis)...............................................................................85olanzapine tab 2.5 mg (Zyprexa)................................... 85

olanzapine tab 5 mg (Zyprexa)...................................... 85olanzapine tab 7.5 mg (Zyprexa)................................... 85olanzapine tab 10 mg (Zyprexa).................................... 85olanzapine tab 15 mg (Zyprexa).................................... 85olanzapine tab 20 mg (Zyprexa).................................... 85olmesartan-amlodipine-hydrochlorothiazide tab

20-5-12.5 mg (Tribenzor).............................................. 51olmesartan-amlodipine-hydrochlorothiazide tab

40-5-12.5 mg (Tribenzor).............................................. 51olmesartan-amlodipine-hydrochlorothiazide tab

40-5-25 mg (Tribenzor)................................................. 51olmesartan-amlodipine-hydrochlorothiazide tab

40-10-12.5 mg (Tribenzor)............................................51olmesartan-amlodipine-hydrochlorothiazide tab

40-10-25 mg (Tribenzor)............................................... 51olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg (Benicar hct)..............................................51olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg (Benicar hct)..............................................51olmesartan medoxomil-hydrochlorothiazide tab 40-25

mg (Benicar hct)........................................................... 51olmesartan medoxomil tab 5 mg (Benicar).................. 51olmesartan medoxomil tab 20 mg (Benicar)................ 51olmesartan medoxomil tab 40 mg (Benicar)................ 51olopatadine hcl nasal soln 0.6% (Patanase).................61olopatadine hcl ophth soln 0.2% (base equivalent)

(Pataday)...................................................................... 165olopatadine hcl ophth soln 0.1% (base equivalent)

(Patanol)....................................................................... 165OLYSIO -simeprevir sodium cap 150 mg (base

equivalent)......................................................................... 9OMECLAMOX-PAK -amoxicillin cap-clarithro tab w/

omepraz cap dr therapy pack........................................ 69omega-3-acid ethyl esters cap 1 gm (Lovaza)............. 57OMEPRAZOLE + SYRSPEND SF -omeprazole susp 2

mg/ml (compound kit).....................................................69omeprazole cap delayed release 10 mg (Prilosec)...... 69omeprazole cap delayed release 20 mg (Prilosec)...... 69omeprazole cap delayed release 40 mg (Prilosec)...... 69omeprazole-sodium bicarbonate cap 20-1100 mg

(Zegerid)......................................................................... 69omeprazole-sodium bicarbonate cap 40-1100 mg

(Zegerid)......................................................................... 69omeprazole-sodium bicarbonate powd pack for susp

20-1680 mg (Zegerid)....................................................69omeprazole-sodium bicarbonate powd pack for susp

40-1680 mg (Zegerid)....................................................69OMNARIS -ciclesonide nasal susp 50 mcg/act................ 61OMNIFLEX DIAPHRAGM -diaphragms.......................... 184OMNI GEL -stannous fluoride gel 0.4%..........................168OMNITROPE -somatropin for inj 5.8 mg.......................... 40OMNITROPE -somatropin inj 5 mg/1.5ml.........................40

2016



OMNITROPE -somatropin inj 10 mg/1.5ml.......................40ondansetron hcl oral soln 4 mg/5ml (Zofran)...............70ondansetron hcl tab 24 mg............................................ 70ondansetron hcl tab 4 mg (Zofran)................................70ondansetron hcl tab 8 mg (Zofran)................................70ondansetron orally disintegrating tab 4 mg (Zofran

odt).................................................................................. 70ondansetron orally disintegrating tab 8 mg (Zofran

odt).................................................................................. 70ONEXTON -clindamycin phosphate-benzoyl peroxide gel

1.2-3.75%...................................................................... 177ONFI -clobazam suspension 2.5 mg/ml..........................113ONFI -clobazam tab 10 mg.............................................113ONFI -clobazam tab 20 mg.............................................113ONGLYZA -saxagliptin hcl tab 2.5 mg (base equiv)......... 32ONGLYZA -saxagliptin hcl tab 5 mg (base equiv)............ 32ONMEL -itraconazole tab 200 mg.......................................6OPANA ER (CRUSH RESISTANT -oxymorphone hcl tab

er 12hr deter 5 mg....................................................... 101OPANA ER (CRUSH RESISTANT -oxymorphone hcl tab

er 12hr deter 7.5 mg.................................................... 101OPANA ER (CRUSH RESISTANT -oxymorphone hcl tab

er 12hr deter 10 mg..................................................... 101OPANA ER (CRUSH RESISTANT -oxymorphone hcl tab




er 12hr deter 40 mg..................................................... 102opium tincture 1% (10 mg/ml) (morphine equiv)..........68OPSUMIT -macitentan tab 10 mg.....................................59OPTICLEANSE GHI -nutritional supplement powder..... 142OPTIMENTAL -nutritional supplement liquid...................142OPTISOURCE VERY HIGH PROT -nutritional

supplement liquid..........................................................142ORACIT -sodium citrate & citric acid soln 490-640

mg/5ml.............................................................................76ORAFATE -sucralfate-malate paste 10%........................168ORALAIR -grass mixed pollen ext tab sl 300 ir (index of

reactivity)......................................................................... 15ORAMAGICRX -oral wound care products - for susp

rinse...............................................................................168ORANGE CHICKEN/CARROTS/BR -nutritional

supplement liquid..........................................................142ORAP -pimozide tab 1 mg................................................ 94ORAP -pimozide tab 2 mg................................................ 94ORAVIG -miconazole buccal tab 50 mg (mouth-

throat)............................................................................ 168ORENCIA -abatacept subcutaneous soln prefilled syringe

50 mg/0.4ml.................................................................. 107

ORENCIA -abatacept subcutaneous soln prefilled syringe87.5 mg/0.7ml............................................................... 107

ORENCIA -abatacept subcutaneous soln prefilled syringe125 mg/ml..................................................................... 107

ORENCIA CLICKJECT -abatacept subcutaneous solnauto-injector 125 mg/ml................................................107

ORENITRAM -treprostinil diolamine tab er 0.125 mg(base equiv).................................................................... 59

ORENITRAM -treprostinil diolamine tab er 0.25 mg (baseequiv)...............................................................................59

ORENITRAM -treprostinil diolamine tab er 1 mg (baseequiv)...............................................................................59

ORENITRAM -treprostinil diolamine tab er 2.5 mg (baseequiv)...............................................................................59

ORENITRAM -treprostinil diolamine tab er 5 mg (baseequiv)...............................................................................59

ORFADIN -nitisinone cap 2 mg.........................................40ORFADIN -nitisinone cap 5 mg.........................................40ORFADIN -nitisinone cap 10 mg.......................................40ORFADIN -nitisinone cap 20 mg.......................................40ORFADIN -nitisinone susp 4 mg/ml.................................. 40ORGANIC NUTRITION COMPLET -nutritional

supplement liquid..........................................................142ORGANIC NUTRITION PLANT B -nutritional supplement

liquid.............................................................................. 142ORGANIC NUTRITION VEGAN-A -nutritional supplement

liquid.............................................................................. 142ORGANIC PEDIA SMART -nutritional supplement

powder...........................................................................142ORKAMBI -lumacaftor-ivacaftor tab 100-125 mg............. 67ORKAMBI -lumacaftor-ivacaftor tab 200-125 mg............. 67orphenadrine citrate tab er 12hr 100 mg.................... 118ORTHO D -folic acid-cholecalciferol cap 1 mg-3775

unit................................................................................. 154ORTHO TRI-CYCLEN LO -norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg.................................28oseltamivir phosphate cap 30 mg (base equiv)

(Tamiflu)............................................................................9oseltamivir phosphate cap 45 mg (base equiv)

(Tamiflu)............................................................................9oseltamivir phosphate cap 75 mg (base equiv)

(Tamiflu)............................................................................9OSENI -alogliptin-pioglitazone tab 12.5-15 mg.................32OSENI -alogliptin-pioglitazone tab 12.5-30 mg.................32OSENI -alogliptin-pioglitazone tab 12.5-45 mg.................32OSENI -alogliptin-pioglitazone tab 25-15 mg....................32OSENI -alogliptin-pioglitazone tab 25-30 mg....................32OSENI -alogliptin-pioglitazone tab 25-45 mg....................32OSMOLITE 1 CAL -nutritional supplement liquid............142OSMOLITE 1.0 CAL -nutritional supplement liquid.........142OSMOLITE 1.2 CAL -nutritional supplement liquid.........142OSMOLITE 1.5 CAL -nutritional supplement liquid.........142

2016



OSMOLITE HN -nutritional supplement liquid................ 142OSMOLITE -nutritional supplement liquid.......................142OSMOPREP -sod phos mono-sod phos di tabs

1.102-0.398 gm(1.5gm na phos)....................................67OS 2 -nutritional supplement powder..............................142OSPHENA -ospemifene tab 60 mg...................................40OTEZLA -apremilast tab 30 mg...................................... 107OTEZLA -apremilast tab starter therapy pack 10 mg & 20

mg & 30 mg..................................................................107OTOVEL -ciprofloxacin-fluocinolone aceton (pf) otic soln

0.3-0.025%.................................................................... 167OTREXUP -methotrexate soln pf auto-injector 10

mg/0.4ml........................................................................107OTREXUP -methotrexate soln pf auto-injector 12.5

mg/0.4ml........................................................................107OTREXUP -methotrexate soln pf auto-injector 15





mg/0.4ml........................................................................107OVACE PLUS -sulfacetamide sodium cream 10%.........177OVACE PLUS -sulfacetamide sodium foam 9.8%..........177OVACE PLUS -sulfacetamide sodium lotion 9.8%......... 177oxandrolone tab 2.5 mg (Oxandrin).............................. 24oxandrolone tab 10 mg (Oxandrin)............................... 24oxaprozin tab 600 mg (Daypro)................................... 107OXAYDO -oxycodone hcl tab abuse deter 5 mg............ 102OXAYDO -oxycodone hcl tab abuse deter 7.5 mg..........102oxazepam cap 10 mg...................................................... 78oxazepam cap 15 mg...................................................... 78oxazepam cap 30 mg...................................................... 78oxcarbazepine susp 300 mg/5ml (60 mg/ml)

(Trileptal)...................................................................... 113oxcarbazepine tab 150 mg (Trileptal).......................... 113oxcarbazepine tab 300 mg (Trileptal).......................... 113oxcarbazepine tab 600 mg (Trileptal).......................... 113OXEPA -nutritional supplement liquid............................. 142OXEPA 1.5 -nutritional supplement liquid....................... 142oxiconazole nitrate cream 1% (Oxistat)...................... 177OXISTAT -oxiconazole nitrate cream 1%........................177OXISTAT -oxiconazole nitrate lotion 1%......................... 177OXTELLAR XR -oxcarbazepine tab er 24hr 150 mg...... 113OXTELLAR XR -oxcarbazepine tab er 24hr 300 mg...... 113OXTELLAR XR -oxcarbazepine tab er 24hr 600 mg...... 113oxybutynin chloride syrup 5 mg/5ml............................ 75oxybutynin chloride tab er 24hr 5 mg (Ditropan xl).....75

oxybutynin chloride tab er 24hr 10 mg (Ditropanxl).....................................................................................75

oxybutynin chloride tab er 24hr 15 mg (Ditropanxl).....................................................................................75

oxybutynin chloride tab 5 mg........................................ 75OXYCODONE/ACETAMINOPHEN -oxycodone w/

acetaminophen soln 5-325 mg/5ml..............................102OXYCODONE/IBUPROFEN -oxycodone-ibuprofen tab

5-400 mg.......................................................................102oxycodone-aspirin tab 4.8355-325 mg

(Percodan)....................................................................102oxycodone hcl cap 5 mg.............................................. 102oxycodone hcl conc 100 mg/5ml (20 mg/ml)

(Oxycodone hcl)..........................................................102OXYCODONE HCL ER -oxycodone hcl tab er 12hr deter

10 mg............................................................................ 102OXYCODONE HCL ER -oxycodone hcl tab er 12hr deter






80 mg............................................................................ 102oxycodone hcl soln 5 mg/5ml (Oxycodone hcl).........102oxycodone hcl tab 10 mg............................................. 102oxycodone hcl tab 20 mg............................................. 102oxycodone hcl tab 5 mg (Roxicodone).......................102oxycodone hcl tab 15 mg (Roxicodone).....................102oxycodone hcl tab 30 mg (Roxicodone).....................102oxycodone w/ acetaminophen tab 2.5-325 mg

(Percocet).....................................................................102oxycodone w/ acetaminophen tab 5-325 mg

(Percocet).....................................................................102oxycodone w/ acetaminophen tab 7.5-325 mg

(Percocet).....................................................................102oxycodone w/ acetaminophen tab 10-325 mg

(Percocet).....................................................................102OXYCONTIN -oxycodone hcl tab er 12hr deter 10

mg..................................................................................102OXYCONTIN -oxycodone hcl tab er 12hr deter 15




mg..................................................................................102

2016



OXYCONTIN -oxycodone hcl tab er 12hr deter 60mg..................................................................................102

OXYCONTIN -oxycodone hcl tab er 12hr deter 80mg..................................................................................102

oxymorphone hcl tab 5 mg (Opana)............................103oxymorphone hcl tab 10 mg (Opana)..........................103OXYMORPHONE HYDROCHLORIDE -oxymorphone hcl

tab er 12hr 5 mg...........................................................103OXYMORPHONE HYDROCHLORIDE -oxymorphone hcl

tab er 12hr 7.5 mg........................................................103OXYMORPHONE HYDROCHLORIDE -oxymorphone hcl

tab er 12hr 10 mg.........................................................103OXYMORPHONE HYDROCHLORIDE -oxymorphone hcl




tab er 12hr 40 mg.........................................................103OXYTROL -oxybutynin td patch twice weekly 3.9

mg/24hr........................................................................... 75

Ppaliperidone tab er 24hr 1.5 mg (Invega)......................85paliperidone tab er 24hr 3 mg (Invega).........................85paliperidone tab er 24hr 6 mg (Invega).........................85paliperidone tab er 24hr 9 mg (Invega).........................85PANCREAZE -pancrelipase (lip-prot-amyl) dr cap

2600-6200-10850 unit.....................................................71PANCREAZE -pancrelipase (lip-prot-amyl) dr cap

4200-14200-24600 unit...................................................71PANCREAZE -pancrelipase (lip-prot-amyl) dr cap

10500-35500-61500 unit................................................ 71PANCREAZE -pancrelipase (lip-prot-amyl) dr cap

16800-56800-98400 unit................................................ 71PANCREAZE -pancrelipase (lip-prot-amyl) dr cap

21000-54700-83900 unit................................................ 71PANDEL -hydrocortisone probutate cream 0.1%............177PANRETIN -alitretinoin gel 0.1%.....................................177pantoprazole sodium ec tab 20 mg (base equiv)

(Protonix)........................................................................69pantoprazole sodium ec tab 40 mg (base equiv)

(Protonix)........................................................................69PARAGARD INTRAUTERINE COP -copper iud...............28PAREGORIC -paregoric tincture 2 mg/5ml (morphine

equivalent).......................................................................68paricalcitol cap 4 mcg.....................................................40paricalcitol cap 1 mcg (Zemplar)................................... 40paricalcitol cap 2 mcg (Zemplar)................................... 40PARODONTAX -stannous fluoride paste 0.454%...........168paromomycin sulfate cap 250 mg................................... 5

paroxetine hcl tab er 24hr 12.5 mg (Paxil cr)............... 81paroxetine hcl tab er 24hr 25 mg (Paxil cr).................. 81paroxetine hcl tab er 24hr 37.5 mg (Paxil cr)............... 81paroxetine hcl tab 10 mg (Paxil)....................................81paroxetine hcl tab 20 mg (Paxil)....................................81paroxetine hcl tab 30 mg (Paxil)....................................81paroxetine hcl tab 40 mg (Paxil)....................................81paroxetine mesylate cap 7.5 mg (base equiv)

(Brisdelle).......................................................................94PASER -aminosalicylic acid er granules packet 4 gm........ 6PATADAY -olopatadine hcl ophth soln 0.2% (base

equivalent).....................................................................165PATANOL -olopatadine hcl ophth soln 0.1% (base

equivalent).....................................................................165PAXIL -paroxetine hcl oral susp 10 mg/5ml (base

equiv)...............................................................................81PAZEO -olopatadine hcl ophth soln 0.7% (base

equivalent).....................................................................165pb-hyoscy-atrop-scopol tab 16.2-0.1037-0.0194-0.0065

mg (Donnatal)................................................................70PCE -erythromycin w/ enteric coated particles tab 333

mg......................................................................................4PCE -erythromycin w/ enteric coated particles tab 500

mg......................................................................................4PCP 100 -mag cit-bisacodyl-petrolat-peg-

metoclopramide-electrol kit.............................................67PEDIARIX -diph-tetanus tox-acell pert-hepatitis b-polio ipv

vac inj.............................................................................. 15PEDIASURE 1.0 CAL/FIBER -nutritional supplement

liquid.............................................................................. 143PEDIASURE 1.5 CAL/FIBER -nutritional supplement

liquid.............................................................................. 143PEDIASURE 1.5 CAL -nutritional supplement liquid...... 143PEDIASURE 1.5 CAL WITH FI -nutritional supplement

liquid.............................................................................. 143PEDIASURE ENTERAL FORMULA -nutritional

supplement liquid..........................................................142PEDIASURE GROW & GAIN -nutritional supplement

liquid.............................................................................. 142PEDIASURE NUTRIPALS -nutritional supplement

bar..................................................................................142PEDIASURE NUTRIPALS -nutritional supplement

liquid.............................................................................. 142PEDIASURE -nutritional supplement liquid.................... 142PEDIASURE PEDIATRIC -nutritional supplement

liquid.............................................................................. 142PEDIASURE PEPTIDE 1.0 CAL -nutritional supplement

liquid.............................................................................. 142PEDIASURE PEPTIDE 1.5 CAL -nutritional supplement

liquid.............................................................................. 143PEDIASURE SHAKE MIX -nutritional supplement

powder...........................................................................143

2016



PEDIASURE SHAKE WITH FIBE -nutritional supplementliquid.............................................................................. 143

PEDIASURE SIDEKICKS CLEAR -nutritional supplementliquid.............................................................................. 143

PEDIASURE SIDEKICKS -nutritional supplementliquid.............................................................................. 143

PEDIASURE SIDEKICKS -nutritional supplementpowder...........................................................................143

PEDIASURE SIDEKICKS SHAKE -nutritional supplementliquid.............................................................................. 143

PEDIASURE WITH FIBER -nutritional supplementliquid.............................................................................. 143

PEDIATRIC DRINK -nutritional supplement liquid.......... 143pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/

ml...................................................................................123pediatric multiple vitamins w/ fluoride chew tab 0.25

mg................................................................................. 123pediatric multiple vitamins w/ fluoride chew tab 0.5

mg................................................................................. 123pediatric multiple vitamins w/ fluoride chew tab 1

mg................................................................................. 123pediatric multiple vitamins w/ fluoride soln 0.25 mg/

ml...................................................................................123pediatric multiple vitamins w/ fluoride soln 0.5 mg/

ml...................................................................................123PEDIATRIC PEPTINEX DT/FIB -nutritional supplement

liquid.............................................................................. 143PEDIATRIC PEPTINEX DT -nutritional supplement

liquid.............................................................................. 143pediatric vitamins acd w/ fluoride soln 0.25 mg/

ml...................................................................................123pediatric vitamins acd w/ fluoride soln 0.5 mg/ml..... 123PEGANONE -ethotoin tab 250 mg..................................113PEGASYS -peginterferon alfa-2a inj 180 mcg/ml............... 9PEGASYS -peginterferon alfa-2a inj 180 mcg/0.5ml.......... 9PEGASYS PROCLICK -peginterferon alfa-2a inj 135

mcg/0.5ml.......................................................................... 9PEGASYS PROCLICK -peginterferon alfa-2a inj 180

mcg/0.5ml.......................................................................... 9PEGINTRON -peginterferon alfa-2b for inj kit 50




mcg/0.5ml.......................................................................... 9peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240

gm (Colyte-flavor packs)............................................. 67peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236

gm (Golytely)................................................................. 67

peg 3350-kcl-sod bicarb-nacl for soln 420 gm(Nulytely/flavor pack)................................................... 67

PENICILLIN V POTASSIUM -penicillin v potassium forsoln 125 mg/5ml............................................................... 1

PENICILLIN V POTASSIUM -penicillin v potassium forsoln 250 mg/5ml............................................................... 1

penicillin v potassium tab 250 mg...................................1penicillin v potassium tab 500 mg...................................1PENNSAID -diclofenac sodium soln 2%.........................177PENTACEL -diph-ac per-tet tox ad-poliov-haemoph b poly

vac for im susp............................................................... 15PENTASA -mesalamine cap er 250 mg............................73PENTASA -mesalamine cap er 500 mg............................73pentazocine w/ naloxone tab 50-0.5 mg......................103PENTETATE CALCIUM TRISODI -pentetate calcium

trisodium iv or inhalation soln 200 mg/ml.................... 183PENTETATE ZINC TRISODIUM -pentetate zinc trisodium

iv or inhalation soln 200 mg/ml.................................... 183pentoxifylline tab er 400 mg.........................................161PEPDITE JUNIOR -nutritional supplement pack............ 143PEPTAMEN/PREBIO1 -nutritional supplement liquid..... 144PEPTAMEN AF -nutritional supplement liquid................ 143PEPTAMEN BARIATRIC -nutritional supplement

liquid.............................................................................. 143PEPTAMEN 1 CAL/PREBIO1 -nutritional supplement

liquid.............................................................................. 144PEPTAMEN 1.5 CAL/PREBIO1 -nutritional supplement

liquid.............................................................................. 144PEPTAMEN 1 CAL -nutritional supplement liquid...........143PEPTAMEN 1.5 CAL -nutritional supplement liquid........144PEPTAMEN INTENSE VHP -nutritional supplement

liquid.............................................................................. 143PEPTAMEN JUNIOR/PREBIO1 -nutritional supplement

liquid.............................................................................. 143PEPTAMEN JUNIOR 1 CAL/PRE -nutritional supplement

liquid.............................................................................. 143PEPTAMEN JUNIOR 1 CAL -nutritional supplement

liquid.............................................................................. 143PEPTAMEN JUNIOR 1.5 CAL -nutritional supplement

liquid.............................................................................. 143PEPTAMEN JUNIOR FIBER -nutritional supplement

liquid.............................................................................. 143PEPTAMEN JUNIOR HP -nutritional supplement

liquid.............................................................................. 143PEPTAMEN JUNIOR -nutritional supplement liquid....... 143PEPTAMEN JUNIOR -nutritional supplement

powder...........................................................................143PEPTAMEN -nutritional supplement liquid......................143PEPTAMEN 1.5 -nutritional supplement liquid................144PEPTAMEN OS -nutritional supplement liquid............... 143PEPTAMEN OS 1.5 -nutritional supplement liquid......... 143PEPTAMEN VHP -nutritional supplement liquid............. 143

2016



PEPTINEX DT -nutritional supplement liquid..................144PEPTINEX DT WITH PREBIOTI -nutritional supplement

liquid.............................................................................. 144PEPTINEX 1.0 -nutritional supplement liquid................. 144PEPTINEX 1.5 -nutritional supplement liquid................. 144PERATIVE 1.3 CAL -nutritional supplement liquid..........144PERATIVE -nutritional supplement liquid........................144PERFOROMIST -formoterol fumarate soln nebu 20

mcg/2ml........................................................................... 65PERIFLEX ADVANCE -nutritional supplement

powder...........................................................................144PERIFLEX JUNIOR -nutritional supplement powder......144PERIFLEX LQ PKU -amino acids oral liquid.................. 131perindopril erbumine tab 2 mg...................................... 51perindopril erbumine tab 4 mg (Aceon)........................51perindopril erbumine tab 8 mg (Aceon)........................51permethrin cream 5% (Elimite).................................... 178PERPHENAZINE/AMITRIPTYLIN -perphenazine-

amitriptyline tab 2-10 mg................................................94PERPHENAZINE/AMITRIPTYLIN -perphenazine-




amitriptyline tab 4-50 mg................................................94perphenazine tab 2 mg................................................... 85perphenazine tab 4 mg................................................... 85perphenazine tab 8 mg................................................... 85perphenazine tab 16 mg................................................. 85PERTZYE -pancrelipase (lip-prot-amyl) dr cap

4000-14375-15125 unit...................................................71PERTZYE -pancrelipase (lip-prot-amyl) dr cap

8000-28750-30250 unit...................................................71PERTZYE -pancrelipase (lip-prot-amyl) dr cap

16000-57500-60500 unit................................................ 71PERTZYE -pancrelipase (lip-prot-amyl) dr cap

24000-86250-90750 unit................................................ 71PEXEVA -paroxetine mesylate tab 10 mg (base

equiv)...............................................................................81PEXEVA -paroxetine mesylate tab 20 mg (base



equiv)...............................................................................81PFD 1 -nutritional supplement powder............................144PFD 2 -nutritional supplement powder............................144PHENACTIN AA PLUS -nutritional supplement

liquid.............................................................................. 144phenazopyridine hcl tab 100 mg (Pyridium).................76

phenazopyridine hcl tab 200 mg (Pyridium).................77phenelzine sulfate tab 15 mg (Nardil)........................... 81PHENEX-1 -nutritional supplement powder....................144PHENEX-2 -nutritional supplement powder....................144phenobarbital elixir 20 mg/5ml...................................... 87PHENOBARBITAL -phenobarbital tab 15 mg................... 87PHENOBARBITAL -phenobarbital tab 30 mg................... 87PHENOBARBITAL -phenobarbital tab 60 mg................... 87PHENOBARBITAL -phenobarbital tab 100 mg................. 87phenobarbital tab 16.2 mg..............................................87phenobarbital tab 32.4 mg..............................................87phenobarbital tab 64.8 mg..............................................87phenobarbital tab 97.2 mg..............................................87phenoxybenzamine hcl cap 10 mg (Dibenzyline)........ 52PHENYLADE AMINO ACID -amino acids bar................ 131PHENYLADE AMINO ACID BLEN -amino acids

pack............................................................................... 131PHENYLADE -amino acids oral powder......................... 131PHENYLADE40 DRINK MIX -amino acids pack.............131PHENYLADE60 DRINK MIX -nutritional supplement

pack............................................................................... 144PHENYLADE DRINK MIX -nutritional supplement

powder...........................................................................144PHENYLADE60 DRINK MIX -nutritional supplement

powder...........................................................................144PHENYLADE ESSENTIAL DRINK -nutritional supplement

pack............................................................................... 144PHENYLADE ESSENTIAL DRINK -nutritional supplement

powder...........................................................................144PHENYLADE GMP MIX-IN -nutritional supplement

pack............................................................................... 144PHENYLADE GMP -nutritional supplement pack...........144PHENYLADE GMP -nutritional supplement powder.......144PHENYLADE MTE AMINO ACID -amino acids pack..... 131PHENYLADE MTE -amino acids oral powder................ 131PHENYLADE PHEBLOC -amino acids oral powder.......131PHENYLADE PHEBLOC -amino acids tab.....................131PHENYLADE RTD PKU 10 -nutritional supplement

liquid.............................................................................. 144PHENYLEPHRINE/GUAIFENESIN -phenylephrine-

guaifenesin liqd 7.5-100 mg/5ml (1.5-20 mg/ml)........... 62phenylephrine-brompheniramine-dm liquid 7.5-4-15

mg/5ml............................................................................ 62phenylephrine hcl ophth soln 2.5%.............................165phenylephrine hcl ophth soln 10%..............................165phenylephrine w/ dm-gg liqd 2.5-7.5-88 mg/ml............ 62PHENYL-FREE 2HP -nutritional supplement

powder...........................................................................144PHENYL-FREE 2 -nutritional supplement powder..........144PHENYTEK -phenytoin sodium extended cap 200

mg..................................................................................113

2016



PHENYTEK -phenytoin sodium extended cap 300mg..................................................................................113

phenytoin chew tab 50 mg (Dilantin infatabs)............113phenytoin sodium extended cap 100 mg

(Dilantin).......................................................................114phenytoin sodium extended cap 200 mg

(Phenytek).................................................................... 114phenytoin sodium extended cap 300 mg

(Phenytek).................................................................... 114phenytoin susp 125 mg/5ml (Dilantin-125)................. 114PHLEXY-10 -amino acids cap.........................................131PHLEXY-10 -nutritional supplement pack.......................144PHLEXY-VITS -multiple vitamins w/ minerals

powder...........................................................................123PHOS-FLUR ORTHO DEFENSE -sodium fluoride rinse

0.044%.......................................................................... 169PHOS FLUR -sodium fluoride rinse 0.044%...................169PHOSLYRA -calcium acetate (phosphate binder) oral soln

667 mg/5ml..................................................................... 73PHOSPHOLINE IODIDE -echothiophate iodide ophth for

soln 0.125%.................................................................. 165PHYSICIANS EZ USE JOINT T -triamcinolone inj 40 mg/

ml & lidocaine 1% & ammonia inh kit............................ 22PHYTOFUSION -nutritional supplement pack................ 144phytonadione inj 1 mg/0.5ml (2 mg/ml).......................119PICATO -ingenol mebutate gel 0.015%.......................... 178PICATO -ingenol mebutate gel 0.05%............................ 178pilocarpine hcl ophth soln 1% (Isopto carpine).........165pilocarpine hcl ophth soln 2% (Isopto carpine).........165pilocarpine hcl ophth soln 4% (Isopto carpine).........165pilocarpine hcl tab 5 mg (Salagen)..............................169pilocarpine hcl tab 7.5 mg (Salagen)...........................169pimozide tab 1 mg (Orap)...............................................94pimozide tab 2 mg (Orap)...............................................94pindolol tab 5 mg.............................................................43pindolol tab 10 mg...........................................................43pioglitazone hcl-glimepiride tab 30-2 mg (Duetact).....33pioglitazone hcl-glimepiride tab 30-4 mg (Duetact).....33pioglitazone hcl-metformin hcl tab 15-500 mg

(Actoplus met)...............................................................33pioglitazone hcl-metformin hcl tab 15-850 mg

(Actoplus met)...............................................................33pioglitazone hcl tab 15 mg (base equiv) (Actos)..........32pioglitazone hcl tab 30 mg (base equiv) (Actos)..........32pioglitazone hcl tab 45 mg (base equiv) (Actos)..........33piroxicam cap 10 mg (Feldene)................................... 107piroxicam cap 20 mg (Feldene)................................... 107PIVOT 1.5 CAL -nutritional supplement liquid................ 144PKU COOLER 10 -nutritional supplement liquid.............144PKU COOLER 15 -nutritional supplement liquid.............145PKU COOLER 20 -nutritional supplement liquid.............145

PKU EASY MICROTABS -nutritional supplement tabsdelayed release.............................................................145

PKU EXPRESS -nutritional supplement pack.................145PKU EXPRESS20 -nutritional supplement pack.............145PKU GEL -nutritional supplement pack.......................... 145PKU LOPHLEX LQ 20 -nutritional supplement liquid..... 145PKU 2 -nutritional supplement powder........................... 145PKU 3 -nutritional supplement powder........................... 145PKU PERIFLEX EARLY YEARS -nutritional supplement

powder...........................................................................145PKU PERIFLEX JUNIOR PLUS -nutritional supplement

powder...........................................................................145PKU SPHERE 15 -nutritional supplement pack..............145PKU SPHERE 20 -nutritional supplement pack..............145PKU TRIO -nutritional supplement powder.....................145PLEGRIDY -peginterferon beta-1a soln pen-injector 125

mcg/0.5ml........................................................................94PLEGRIDY -peginterferon beta-1a soln prefilled syringe

125 mcg/0.5ml................................................................ 94PLEGRIDY STARTER PACK -peginterferon beta-1a soln

pen-inj 63 & 94 mcg/0.5ml pack.................................... 94PLEGRIDY STARTER PACK -peginterferon beta-1a soln

pref syr 63 & 94 mcg/0.5ml pack...................................95PLEXION CLEANSING CLOTHS -sulfacetamide sodium

w/ sulfur cleansing cloth 9.8-4.8%............................... 178PNEUMOVAX 23/1 DOSE -pneumococcal vaccine

polyvalent inj 25 mcg/0.5ml............................................14PNEUMOVAX 23 -pneumococcal vaccine polyvalent inj

25 mcg/0.5ml.................................................................. 14PNV-DHA+DOCUSATE -prenatal w/o vit a w/ fe fum-dss-

fa-dha cap 27-1.25-300 mg..........................................123PNV-DHA -prenat w/o a w/fefum-methfol-fa-dha cap

27-0.6-0.4-300 mg........................................................ 123PNV OB+DHA -prenat w/o a w/fecbn-fegl-dss-fa tab &

dha cap 250 mg pack...................................................123PNV-OMEGA -prenat w/o a w/ fe fumerate-methylfolate-

fa-omega 3 cap.............................................................123PNV PRENATAL PLUS MULTIVI -prenatal vit w/ fe

fumarate-fa tab 27-1 mg...............................................123PNV-SELECT -prenatal vit w/ fe fum-methylfolate-fa tab

27-0.6-0.4 mg................................................................124PNV TABS 29-1 -prenatal vit w/ iron carbonyl-fa tab 29-1

mg..................................................................................123PNV-TOTAL -prenat w/ fe cbn-fe bisglyc-fa-fish oil cap

35-5-1.2 mg...................................................................124PNV-VP-U -prenatal w/o a vit w/ fe fumarate-fa cap

106.5-1 mg....................................................................124PODOCON 25 IN BENZOIN TIN -podophyllum resin soln

25%................................................................................178podofilox soln 0.5% (Condylox)...................................178POLYCAL -nutritional supplement powder......................145polyethylene glycol 3350 oral packet............................67

2016



polyethylene glycol 3350 oral powder.......................... 67polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1% (Polytrim)...................................................... 165POLY-TUSSIN AC -phenylephrine-bromphen w/ codeine

liquid 10-4-10 mg/5ml.....................................................62POLY-VI-FLOR/IRON -ped multiple vitamin w/ fl-fe

biphasic susp 0.25-7 mg/ml......................................... 124POLY-VI-FLOR/IRON -ped multiple vit w/ fl-fe biphasic

chew tab 0.5-10 mg......................................................124POLY-VI-FLOR FS -pediatric multiple vitamins w/ fluoride

oral strip 1 mg...............................................................124POLY-VI-FLOR FS -pediatric multiple vit w/ fluoride oral

strip 0.25 mg.................................................................124POLY-VI-FLOR FS -pediatric multiple vit w/ fluoride oral

strip 0.5 mg...................................................................124POLY-VI-FLOR -ped multiple vit w/ fluoride biphasic chew

tab 0.25 mg...................................................................124POLY-VI-FLOR -ped multiple vit w/ fluoride biphasic chew

tab 0.5 mg.....................................................................124POLY-VI-FLOR -ped multiple vit w/ fluoride biphasic chew

tab 1 mg........................................................................124POLY-VI-FLOR -ped multiple vit w/ fluoride biphasic susp

0.25 mg/ml.................................................................... 124POMALYST -pomalidomide cap 1 mg.............................. 19POMALYST -pomalidomide cap 2 mg.............................. 19POMALYST -pomalidomide cap 3 mg.............................. 19POMALYST -pomalidomide cap 4 mg.............................. 19PORTAGEN -nutritional supplement powder..................145pot & sod citrates w/ cit ac soln 550-500-334

mg/5ml............................................................................ 77POTABA -potassium aminobenzoate cap 500 mg..........119potassium bicarbonate effer tab 25 meq....................130potassium chloride cap er 8 meq (Micro-k)................130potassium chloride cap er 10 meq (Micro-k)..............130POTASSIUM CHLORIDE ER -potassium chloride tab er 8

meq (600 mg)............................................................... 130POTASSIUM CHLORIDE ER -potassium chloride tab er

20 meq (1500 mg)........................................................130potassium chloride microencapsulated crys er tab 10

meq............................................................................... 130potassium chloride microencapsulated crys er tab 20

meq............................................................................... 130potassium chloride oral soln 10% (20 meq/15ml)......130POTASSIUM CHLORIDE -potassium chloride oral soln

20% (40 meq/15ml)...................................................... 130potassium chloride powder packet 20 meq............... 130potassium chloride tab er 10 meq (K-tab).................. 130potassium chloride tab er 8 meq (600 mg).................130potassium citrate & citric acid powder pack 3300-1002

mg................................................................................... 77potassium citrate & citric acid soln 1100-334

mg/5ml............................................................................ 77

potassium citrate tab er 5 meq (540 mg) (Urocit-k5)......................................................................................77

potassium citrate tab er 10 meq (1080 mg) (Urocit-k10)....................................................................................77

potassium citrate tab er 15 meq (1620 mg) (Urocit-k15)....................................................................................77

pot bicarbonate & chloride effer tab 25 meq..............130pot phos monobasic w/sod phos di & monobas tab

155-852-130mg (K-phos neutral)...............................130PPA/MMA EXPRESS -nutritional supplement pack........145PRADAXA -dabigatran etexilate mesylate cap 75 mg

(etexilate base eq)........................................................155PRADAXA -dabigatran etexilate mesylate cap 110 mg

(etexilate base eq)........................................................155PRADAXA -dabigatran etexilate mesylate cap 150 mg

(etexilate base eq)........................................................155PRALUENT -alirocumab subcutaneous soln pen-injector

75 mg/ml......................................................................... 57PRALUENT -alirocumab subcutaneous soln pen-injector

150 mg/ml....................................................................... 57pramipexole dihydrochloride tab er 24hr 0.375 mg

(Mirapex er)..................................................................116pramipexole dihydrochloride tab er 24hr 0.75 mg



(Mirapex er)..................................................................116pramipexole dihydrochloride tab er 24hr 3 mg



(Mirapex er)..................................................................117pramipexole dihydrochloride tab 0.125 mg

(Mirapex).......................................................................117pramipexole dihydrochloride tab 0.25 mg



(Mirapex).......................................................................117pramipexole dihydrochloride tab 1 mg (Mirapex)......117pramipexole dihydrochloride tab 1.5 mg

(Mirapex).......................................................................117PRAMOSONE E -pramoxine-hc emollient base cream

1-2.5%........................................................................... 178PRAMOSONE -pramoxine-hc cream 1-1%.................... 178PRAMOSONE -pramoxine-hc lotion 1-1%......................178PRAMOSONE -pramoxine-hc lotion 1-2.5%...................178PRAMOSONE -pramoxine-hc oint 1-1%.........................178PRAMOSONE -pramoxine-hc oint 1-2.5%......................178

2016



pramoxine-hc cream 1-2.5% (Pramosone)................. 178prasugrel hcl tab 5 mg (base equiv) (Effient).............161prasugrel hcl tab 10 mg (base equiv) (Effient)...........161pravastatin sodium tab 10 mg....................................... 57pravastatin sodium tab 20 mg (Pravachol)...................57pravastatin sodium tab 40 mg (Pravachol)...................57pravastatin sodium tab 80 mg (Pravachol)...................57prazosin hcl cap 1 mg (Minipress)................................ 52prazosin hcl cap 2 mg (Minipress)................................ 52prazosin hcl cap 5 mg (Minipress)................................ 52PRED-G -gentamicin-prednisolone ace ophth susp

0.3-1%........................................................................... 166PRED-G S.O.P. -gentamicin-prednisolone ace ophth oint

0.3-0.6%........................................................................ 166PRED MILD -prednisolone acetate ophth susp

0.12%.............................................................................165prednicarbate cream 0.1% (Dermatop)....................... 178prednicarbate oint 0.1% (Dermatop)........................... 178PREDNISOLONE/MOXIFLOXACIN -prednisolone-

moxifloxacin-bromfenac opth sol 1-0.5-0.09%.............166PREDNISOLONE/MOXIFLOXACIN -prednisolone-

moxifloxacin-ketorolac opth sol 1-0.5-0.5%................. 166PREDNISOLONE/MOXIFLOXACIN -prednisolone-

moxifloxacin opth soln 1-0.5%..................................... 166prednisolone acetate ophth susp 1% (Pred forte).....166PREDNISOLONE SODIUM PHOSP -prednisolone

sodium phosphate ophth soln 1%................................166PREDNISOLONE SODIUM PHOSP -prednisolone

sodium phosphate oral soln 25 mg/5ml (base eq).........23prednisolone sod phos orally disintegr tab 10 mg

(base eq) (Orapred odt)............................................... 22prednisolone sod phos orally disintegr tab 15 mg

(base eq) (Orapred odt)............................................... 22prednisolone sod phos orally disintegr tab 30 mg

(base eq) (Orapred odt)............................................... 22prednisolone sod phosphate oral soln 15 mg/5ml

(base equiv)................................................................... 23prednisolone sod phosphate oral soln 10 mg/5ml

(base equiv) (Millipred)................................................ 23prednisolone sod phosphate oral soln 20 mg/5ml

(base equiv) (Veripred 20)........................................... 23prednisolone sod phosph oral soln 6.7 mg/5ml (5

mg/5ml base) (Pediapred)............................................22prednisolone syrup 15 mg/5ml (usp solution

equivalent)......................................................................23PREDNISONE INTENSOL -prednisone conc 5 mg/ml.....23PREDNISONE -prednisone oral soln 5 mg/5ml................23PREDNISONE -prednisone tab 50 mg............................. 23PREDNISONE -prednisone tab therapy pack 5 mg

(21).................................................................................. 23PREDNISONE -prednisone tab therapy pack 5 mg

(48).................................................................................. 23

PREDNISONE -prednisone tab therapy pack 10 mg(21).................................................................................. 23

PREDNISONE -prednisone tab therapy pack 10 mg(48).................................................................................. 23

prednisone tab 1 mg....................................................... 23prednisone tab 2.5 mg.................................................... 23prednisone tab 5 mg....................................................... 23prednisone tab 10 mg..................................................... 23prednisone tab 20 mg..................................................... 23PREFERAOB +DHA -prenat-fe poly cmplx 28mg-fe heme

poly-fa tab&dha cap pack.............................................124PREFERAOB ONE -prenat-fe poly cmplx-fe heme poly-

fa-dha cap 22-6-1-200 mg............................................124PREFERA OB -prenat vit-fe poly cmplx-fe heme poly-fa

tab 34-1 mg...................................................................124PREFEST -estradiol tab 1 mg(15)/estrad-norgestimate

tab 1-0.09mg(15)............................................................ 26PRE-FOLIC -folic acid-vitamin c tab 1-100 mg...............154PREMARIN -estrogens, conjugated tab 0.3 mg............... 26PREMARIN -estrogens, conjugated tab 0.45 mg............. 26PREMARIN -estrogens, conjugated tab 0.625 mg........... 26PREMARIN -estrogens, conjugated tab 0.9 mg............... 26PREMARIN -estrogens, conjugated tab 1.25 mg............. 26PREMARIN -estrogens, conjugated vaginal cream 0.625

mg/gm..............................................................................76PREMPHASE -conj est 0.625(14)/conj est-medroxypro ac

tab 0.625-5mg(14).......................................................... 26PREMPRO -conjugated estrogen-medroxyprogest

acetate tab 0.3-1.5 mg................................................... 26PREMPRO -conjugated estrogen-medroxyprogest

acetate tab 0.45-1.5 mg................................................. 26PREMPRO -conjugated estrogen-medroxyprogest

acetate tab 0.625-2.5 mg............................................... 26PREMPRO -conjugated estrogen-medroxyprogest

acetate tab 0.625-5 mg.................................................. 26PRENA1 CHEW -prenat w/ b2-b6-b12-d3-folic acid chew

tab 1.4 mg.....................................................................125PRENAISSANCE BALANCE -prenatal w/o vit a w/ fe cbn-

dss-fa-dha cap 30-1-260 mg........................................124PRENAISSANCE HARMONY DHA -prenat w/fe poly-na

fered-fa tab 27-1 & omega cap dr 380mg....................124PRENAISSANCE NEXT-B -prenatal w/ calcium-vit b6-fa-

ginger tab 1.22 mg....................................................... 124PRENAISSANCE NEXT -prenatal w/ calcium-vit b6-fa-

ginger tab 1.2 mg......................................................... 124PRENAISSANCE PLUS -prenatal w/o a w/fe cbn-dss-fa-

dha cap 28-1-250 mg...................................................124PRENAISSANCE -prenatal w/o vit a w/ fe fum-dss-fa-dha

cap 29-1.25-325 mg..................................................... 124PRENA1 PEARL -prenat w/oa w/fefum-na fered-fa-dha

cap er 30-1.4-200 mg...................................................125

2016



PRENATABS RX -prenatal vit w/ iron carbonyl-fa tab 29-1mg..................................................................................124

PRENATAL PLUS IRON -prenatal vit w/ iron carbonyl-fatab 29-1 mg...................................................................125

PRENATAL PLUS -prenatal vit w/ fe fumarate-fa tab 27-1mg..................................................................................125

PRENATAL 19 -prenatal vit w/ dss-fe fumarate-fa tab 29-1mg..................................................................................125

PRENATAL 19 -prenatal vit w/ fe fumarate-fa chew tab29-1 mg......................................................................... 125

PRENATAL -prenatal vit w/ fe fumarate-fa tab 27-1mg..................................................................................125

PRENATAL-U -prenatal w/o a vit w/ fe fumarate-fa cap106.5-1 mg....................................................................125

PRENATAL VITAMINS PLUS LO -prenatal vit w/ fefumarate-fa tab 27-1 mg...............................................125

PRENATE AM -prenatal w/ calcium-vit b6-vit b12-fa-ginger tab 1 mg............................................................ 125

PRENATE DHA -prenat w/o a w/feaspg-methfol-fa-dhacap 18-0.6-0.4-300 mg................................................. 125

PRENATE DHA -prenat w/o a w/fefum-methfol-fa-dha cap28-0.6-0.4-300 mg........................................................ 125

PRENATE ELITE -prenatal vit w/ fe fum-methylfolate-fatab 26-0.6-0.4 mg......................................................... 125

PRENATE ELITE -prenatal w/ fe asp gly-l methylfol-fa tab20-0.6-0.4 mg................................................................125

PRENATE ENHANCE -prenat w/o a w/fefum-methfol-fa-dha cap 28-0.6-0.4-400 mg..........................................125

PRENATE ESSENTIAL -prenat w/o a w/feaspg-methfol-fa-dha cap 18-0.6-0.4-300 mg..................................... 125

PRENATE ESSENTIAL -prenat w/o a w/feasp-methylf-fa-omeg cap 29-0.6-0.4-340 mg.......................................125

PRENATE MINI -prenat w/oa w/fecb-feasp-meth-fa-dhacap 18-0.6-0.4-350 mg................................................. 125

PRENATE MINI -prenat w/o a w/fecbn-methylf-fa-dha cap29-0.6-0.4-350 mg........................................................ 125

PRENATE PIXIE -prenat w/o a w/feaspg-methfol-fa-dhacap 10-0.6-0.4-200 mg................................................. 125

PRENATE -prenat mv & min w/ l-methylfolate-fa chew tab0.6-0.4 mg.....................................................................125

PRENATE RESTORE -prenat w/o a w/fefum-methfol-fa-dha cap 27-0.6-0.4-400 mg..........................................125

PREPIDIL -dinoprostone cervical gel 0.5 mg/3gm............38PREPLUS -prenatal vit w/ fe fumarate-fa tab 27-1

mg..................................................................................125PREPOPIK -sod picosulfate-mg oxide-citric acid pack 10

mg-3.5 gm-12 gm........................................................... 67PREPROTEIN -amino acids oral liquid...........................131PREPROTEIN 20 -amino acids oral liquid......................131PRESTALIA -perindopril arginine-amlodipine besylate tab

3.5-2.5 mg.......................................................................52

PRESTALIA -perindopril arginine-amlodipine besylate tab7-5 mg............................................................................. 52

PRESTALIA -perindopril arginine-amlodipine besylate tab14-10 mg......................................................................... 52

PRETAB -prenatal vit w/ fe fumarate-fa tab 29-1 mg......125PREVIDENT 5000 BOOSTER PL -sodium fluoride paste

1.1%...............................................................................169PREVIDENT 5000 BOOSTER -sodium fluoride paste

1.1%...............................................................................169PREVIDENT 5000 DRY MOUTH -sodium fluoride gel

1.1% (0.5% f)................................................................169PREVIDENT 5000 ENAMEL PRO -sodium fluoride-

potassium nitrate paste 1.1-5%................................... 169PREVIDENT FLUORIDE -sodium fluoride gel 1.1% (0.5%

f).....................................................................................169PREVIDENT 5000 PLUS -sodium fluoride cream

1.1%...............................................................................169PREVIDENT 5000 SENSITIVE -sodium fluoride-

potassium nitrate paste 1.1-5%................................... 169PREVNAR 13 -Pneumococcal 13-valent conjugate

vaccine inj....................................................................... 14PREZCOBIX -darunavir-cobicistat tab 800-150 mg............9PREZISTA -darunavir ethanolate susp 100 mg/ml (base

equiv)................................................................................. 9PREZISTA -darunavir ethanolate tab 75 mg (base




equiv)................................................................................. 9PRIFTIN -rifapentine tab 150 mg........................................ 6PRIMAQUINE PHOSPHATE -primaquine phosphate tab

26.3 mg (15 mg base)....................................................12primidone tab 50 mg (Mysoline).................................. 114primidone tab 250 mg (Mysoline)................................ 114PRIMLEV -oxycodone w/ acetaminophen tab 5-300

mg..................................................................................103PRIMLEV -oxycodone w/ acetaminophen tab 7.5-300

mg..................................................................................103PRIMLEV -oxycodone w/ acetaminophen tab 10-300

mg..................................................................................103PRIMSOL -trimethoprim hcl oral soln 50 mg/5ml (base

equiv)...............................................................................12PRISTIQ -desvenlafaxine succinate tab er 24hr 25 mg

(base equiv).................................................................... 81PRISTIQ -desvenlafaxine succinate tab er 24hr 50 mg

(base equiv).................................................................... 81PRISTIQ -desvenlafaxine succinate tab er 24hr 100 mg

(base equiv).................................................................... 81

2016



PR NATAL 400 EC -prenat-fe bis-fe prot succ-fa-ca tab &omega cap dr 400 pk................................................... 124

PR NATAL 430 EC -prenat-fe bis-fe prot succ-fa-ca tab &omega cap dr 430 pk................................................... 124

PR NATAL 400 -prenat-fe bis-fe prot succ-fa-ca tab &omega 3 cap 400 pk.................................................... 124

PR NATAL 430 -prenat-fe bis-fe prot succ-fa-ca tab &omega 3 cap 430 pk.................................................... 124

PROAIR HFA -albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv)........................................................65

PROAIR RESPICLICK -albuterol sulfate aer pow ba 108mcg/act (90 mcg base equiv).........................................65

PROBALANCE -nutritional supplement liquid.................145probenecid tab 500 mg................................................. 109PROBUPHINE IMPLANT KIT -buprenorphine hcl

subdermal implant 74.2 mg (base equiv).....................103PRO-CAL -nutritional supplement pack.......................... 145PRO-CAL -nutritional supplement powder......................145prochlorperazine maleate tab 5 mg (base equivalent)

(Compazine)...................................................................85prochlorperazine maleate tab 10 mg (base equivalent)

(Compazine)...................................................................85prochlorperazine suppos 25 mg....................................85PRO-CLEAR AC -codeine-pyrilamine syrup 9-8.33

mg/5ml.............................................................................62PROCORT -hydrocortisone acetate w/ pramoxine rectal

cream 1.85-1.15%........................................................ 170PROCRIT -epoetin alfa inj 2000 unit/ml..........................154PROCRIT -epoetin alfa inj 3000 unit/ml..........................154PROCRIT -epoetin alfa inj 4000 unit/ml..........................154PROCRIT -epoetin alfa inj 10000 unit/ml........................154PROCRIT -epoetin alfa inj 20000 unit/ml........................154PROCRIT -epoetin alfa inj 40000 unit/ml........................154PROCTOFOAM HC -hydrocortisone acetate w/

pramoxine rectal foam 1-1%........................................ 170PROCYSBI -cysteamine bitartrate cap delayed release 25

mg (base equiv)..............................................................77PROCYSBI -cysteamine bitartrate cap delayed release 75

mg (base equiv)..............................................................77PROFERRIN-FORTE -iron heme polypeptide-folic acid

tab 12-1 mg (fe equiv)..................................................154PROFILNINE -factor ix complex for inj 500 unit............. 161PROFILNINE -factor ix complex for inj 1000 unit........... 161PROFILNINE -factor ix complex for inj 1500 unit........... 161PROFILNINE SD -factor ix complex for inj 500 unit........161PROFILNINE SD -factor ix complex for inj 1000 unit......161PROFILNINE SD -factor ix complex for inj 1500 unit......161progesterone im in oil 50 mg/ml....................................28progesterone micronized cap 100 mg

(Prometrium)..................................................................28progesterone micronized cap 200 mg

(Prometrium)..................................................................29

PROGLYCEM -diazoxide susp 50 mg/ml......................... 33PROGRAF -tacrolimus cap 0.5 mg.................................185PROGRAF -tacrolimus cap 1 mg....................................185PROGRAF -tacrolimus cap 5 mg....................................185PROLENSA -bromfenac sodium ophth soln 0.07% (base

equivalent).....................................................................166PROMACTA -eltrombopag olamine tab 12.5 mg (base

equiv).............................................................................154PROMACTA -eltrombopag olamine tab 25 mg (base



equiv).............................................................................154PROMACTIN AA PLUS -nutritional supplement

liquid.............................................................................. 145promethazine & phenylephrine syrup 6.25-5

mg/5ml............................................................................ 62promethazine-dm syrup 6.25-15 mg/5ml.......................62promethazine hcl suppos 12.5 mg................................ 60promethazine hcl suppos 25 mg................................... 60promethazine hcl suppos 50 mg................................... 60promethazine hcl syrup 6.25 mg/5ml............................ 60promethazine hcl tab 12.5 mg........................................60promethazine hcl tab 25 mg...........................................60promethazine hcl tab 50 mg...........................................60promethazine-phenylephrine-codeine syrup 6.25-5-10

mg/5ml............................................................................ 62promethazine w/ codeine syrup 6.25-10 mg/5ml..........62PROMISEB -antiseborrheic products misc - cream........178PROMOD -nutritional supplement liquid......................... 145PROMOD -nutritional supplement powder......................145PROMOTE/FIBER -nutritional supplement liquid........... 145PROMOTE -nutritional supplement liquid....................... 145PROMOTE 1.0 -nutritional supplement liquid.................145PROMOTE WITH FIBER -nutritional supplement

liquid.............................................................................. 145PROMOTE 1.0 WITH FIBER -nutritional supplement

liquid.............................................................................. 145PRONOURISH -nutritional supplement liquid.................145propafenone hcl cap er 12hr 225 mg (Rythmol sr)...... 46propafenone hcl cap er 12hr 325 mg (Rythmol sr)...... 46propafenone hcl cap er 12hr 425 mg (Rythmol sr)...... 46propafenone hcl tab 300 mg.......................................... 46propafenone hcl tab 150 mg (Rythmol)........................ 46propafenone hcl tab 225 mg (Rythmol)........................ 46PROPANTHELINE BROMIDE -propantheline bromide tab

15 mg.............................................................................. 70proparacaine hcl ophth soln 0.5% (Alcaine).............. 166PRO-PHREE -nutritional supplement powder................ 145PROPIMEX-1 -nutritional supplement powder................145PROPIMEX-2 -nutritional supplement powder................145

2016



PROPRANOLOL/HYDROCHLOROTH -propranolol &hydrochlorothiazide tab 40-25 mg..................................52

PROPRANOLOL/HYDROCHLOROTH -propranolol &hydrochlorothiazide tab 80-25 mg..................................52

propranolol hcl cap er 24hr 60 mg (Inderal la).............43propranolol hcl cap er 24hr 80 mg (Inderal la).............43propranolol hcl cap er 24hr 120 mg (Inderal la)...........43propranolol hcl cap er 24hr 160 mg (Inderal la)...........43PROPRANOLOL HCL -propranolol hcl oral soln 20

mg/5ml.............................................................................43PROPRANOLOL HCL -propranolol hcl oral soln 40

mg/5ml.............................................................................43propranolol hcl tab 10 mg.............................................. 43propranolol hcl tab 20 mg.............................................. 43propranolol hcl tab 40 mg.............................................. 43propranolol hcl tab 60 mg.............................................. 43propranolol hcl tab 80 mg.............................................. 43propylthiouracil tab 50 mg............................................. 36PRO-RED AC -phenylephrine-dexchlorphenir-codeine

syrup 5-1-9 mg/5ml.........................................................62PROSOURCE NO CARB -nutritional supplement

liquid.............................................................................. 145PROSOURCE -nutritional supplement liquid.................. 145PROSOURCE -nutritional supplement powder...............145PROSOURCE PLUS -nutritional supplement liquid........145PROSOURCE TF -nutritional supplement liquid.............146PROSOURCE ZAC -nutritional supplement liquid..........146PROSTIN E2 -dinoprostone vaginal suppos 20 mg......... 38PROSURE -nutritional supplement liquid........................146PROTAIN XL -nutritional supplement liquid.................... 146PROTECTIRON -iron polysacch-fa-b complex-vit c-e &

minerals tab 60-1 mg................................................... 154PROTEIN FORTIFIED COOKIE -nutritional supplement

misc............................................................................... 146PROTHELIAL -sucralfate-malate paste 10%..................169protriptyline hcl tab 5 mg............................................... 81protriptyline hcl tab 10 mg............................................. 81PROVENTIL HFA -albuterol sulfate inhal aero 108 mcg/

act (90mcg base equiv)..................................................65PROVIDA DHA -prenat w/o a w/fe fum-fe poly-fa-dha cap

16-16-1.25-110 mg........................................................125PROVIDA OB -prenatal w/o a w/fe fum-fe poly-fa cap

20-20-1.25 mg...............................................................125PROVIMIN -nutritional supplement powder.................... 146PRUCLAIR -dermatological products misc - cream........178PRUDOXIN -doxepin hcl cream 5%............................... 178PRUMYX -dermatological products misc - cream...........178pseudoeph-chlorphen w/ hydrocodone soln 60-4-5

mg/5ml (Zutripro).......................................................... 62pseudoephed-bromphen-dm syrup 30-2-10

mg/5ml............................................................................ 62

pseudoephedrine w/ cod-gg soln 30-10-100mg/5ml............................................................................ 62

PSORCON -diflorasone diacetate cream 0.05%............ 178PULMICORT -budesonide inhalation susp 1 mg/2ml....... 65PULMICORT FLEXHALER -budesonide inhal aero powd

90 mcg/act (breath activated).........................................65PULMICORT FLEXHALER -budesonide inhal aero powd

180 mcg/act (breath activated)...................................... 65PULMOCARE -nutritional supplement liquid.................. 146PULMOCARE 1.5 -nutritional supplement liquid............ 146PULMOZYME -dornase alfa inhal soln 1 mg/ml............... 67PUREFE OB PLUS -prenatal w/o a w/fe fum-fe poly-fa

cap 162.115.2-1 mg......................................................126PUREFE PLUS -ferrous fumarate-fa-b complex-c-zn-mg-

mn-cu cap 106-1 mg.................................................... 154PURIXAN -mercaptopurine susp 2000 mg/100ml (20 mg/

ml)....................................................................................20PX VANILLA PLUS -nutritional supplement liquid.......... 146PYLERA -bismuth subcit-metronidazole-tetracycline cap

140-125-125 mg..............................................................70pyrazinamide tab 500 mg..................................................6pyridostigmine bromide tab er 180 mg (Mestinon

timespan)......................................................................119pyridostigmine bromide tab 60 mg (Mestinon)..........119QQBRELIS -lisinopril oral soln 1 mg/ml...............................52QNASL -beclomethasone dipropionate nasal aerosol 80

mcg/act............................................................................ 61QNASL CHILDRENS -beclomethasone dipropionate

nasal aerosol 40 mcg/act............................................... 61QUADRACEL -diph-tetanus tox ad-acell pert & polio

virus, ipv vac inj..............................................................15QUARTETTE -levonor-eth est tab 0.15-0.02/0.025/0.03

mg &eth est 0.01 mg......................................................28QUAZEPAM -quazepam tab 15 mg.................................. 87QUDEXY XR -topiramate cap er 24hr sprinkle 25

mg..................................................................................114QUDEXY XR -topiramate cap er 24hr sprinkle 50




mg..................................................................................114quetiapine fumarate tab er 24hr 50 mg (Seroquel

xr).................................................................................... 85quetiapine fumarate tab er 24hr 150 mg (Seroquel

xr).................................................................................... 85quetiapine fumarate tab er 24hr 200 mg (Seroquel

xr).................................................................................... 85

2016



quetiapine fumarate tab er 24hr 300 mg (Seroquelxr).................................................................................... 85

quetiapine fumarate tab er 24hr 400 mg (Seroquelxr).................................................................................... 85

quetiapine fumarate tab 25 mg (Seroquel)................... 85quetiapine fumarate tab 50 mg (Seroquel)................... 85quetiapine fumarate tab 100 mg (Seroquel)................. 85quetiapine fumarate tab 200 mg (Seroquel)................. 85quetiapine fumarate tab 300 mg (Seroquel)................. 85quetiapine fumarate tab 400 mg (Seroquel)................. 85QUFLORA FE -multi vit w/ min & fluoride-iron-fa chew tab

0.25 mg......................................................................... 126QUFLORA PEDIATRIC -pediatric multiple vitamins w/

fluoride chew tab 0.25 mg............................................126QUFLORA PEDIATRIC -pediatric multiple vitamins w/

fluoride chew tab 0.5 mg..............................................126QUFLORA PEDIATRIC -pediatric multiple vitamins w/

fluoride chew tab 1 mg.................................................126QUFLORA PEDIATRIC -pediatric multiple vitamins w/

fluoride soln 0.25 mg/ml...............................................126QUFLORA PEDIATRIC -pediatric multiple vitamins w/

fluoride soln 0.5 mg/ml.................................................126quinapril hcl tab 5 mg (Accupril)...................................52quinapril hcl tab 10 mg (Accupril).................................52quinapril hcl tab 20 mg (Accupril).................................52quinapril hcl tab 40 mg (Accupril).................................52quinapril-hydrochlorothiazide tab 10-12.5 mg

(Accuretic)......................................................................52quinapril-hydrochlorothiazide tab 20-12.5 mg

(Accuretic)......................................................................52quinapril-hydrochlorothiazide tab 20-25 mg

(Accuretic)......................................................................52quinidine gluconate tab er 324 mg................................46QUINIDINE SULFATE -quinidine sulfate tab 200 mg....... 46QUINIDINE SULFATE -quinidine sulfate tab 300 mg....... 46quinine sulfate cap 324 mg (Qualaquin).......................12QUINOA KALE & HEMP -nutritional supplement

liquid.............................................................................. 146QVAR -beclomethasone diprop inhal aero soln 40 mcg/act

(50/valve).........................................................................65QVAR -beclomethasone diprop inhal aero soln 80 mcg/act

(100/valve).......................................................................65

RRA BALANCED NUTRITIONAL -nutritional supplement

liquid.............................................................................. 146RA BALANCED NUTRITIONAL P -nutritional supplement

liquid.............................................................................. 146RABAVERT -rabies vaccine, pcec for inj.......................... 14rabeprazole sodium ec tab 20 mg (Aciphex)................70RADIOGARDASE -prussian blue insoluble cap 0.5

gm..................................................................................183

RAGWITEK -short ragweed pollen allergen extract tab sl12 amb a 1-u.................................................................. 15

raloxifene hcl tab 60 mg (Evista)...................................40ramipril cap 1.25 mg (Altace)......................................... 52ramipril cap 2.5 mg (Altace)........................................... 52ramipril cap 5 mg (Altace).............................................. 52ramipril cap 10 mg (Altace)............................................ 52RANEXA -ranolazine tab er 12hr 500 mg.........................42RANEXA -ranolazine tab er 12hr 1000 mg.......................42ranitidine hcl cap 150 mg............................................... 70ranitidine hcl cap 300 mg............................................... 70ranitidine hcl syrup 15 mg/ml (75 mg/5ml)................... 70ranitidine hcl tab 300 mg (Zantac).................................70RA NUTRITIONAL SUPPLEMENT -nutritional

supplement liquid..........................................................146RA NUTRITIONAL SUPPORT -nutritional supplement

powder...........................................................................146RAPAFLO -silodosin cap 4 mg..........................................77RAPAFLO -silodosin cap 8 mg..........................................77RAPAMUNE -sirolimus oral soln 1 mg/ml.......................185RA PEDIATRIC NUTRITIONAL -nutritional supplement

liquid.............................................................................. 146rasagiline mesylate tab 0.5 mg (base equiv)

(Azilect).........................................................................117rasagiline mesylate tab 1 mg (base equiv)

(Azilect).........................................................................117RASUVO -methotrexate soln pf auto-injector 7.5

mg/0.15ml......................................................................107RASUVO -methotrexate soln pf auto-injector 10

mg/0.2ml........................................................................107RASUVO -methotrexate soln pf auto-injector 12.5






mg/0.5ml........................................................................107RASUVO -methotrexate soln pf auto-injector 30

mg/0.6ml........................................................................107RA TRUEPLUS GLUCOSE -glucose gel 15 gm/32ml......33RAVICTI -glycerol phenylbutyrate liquid 1.1 gm/ml...........40RAYOS -prednisone tab delayed release 1 mg................ 23RAYOS -prednisone tab delayed release 2 mg................ 23RAYOS -prednisone tab delayed release 5 mg................ 23RE/GEN PROTEIN FORTIFIED -nutritional supplement

misc............................................................................... 146

2016



RE/NEPH HP/HC -nutritional supplement liquid(frozen).......................................................................... 146

RE/NEPH LP/HC -nutritional supplement liquid..............146RE/NEPH -nutritional supplement liquid......................... 146RE/NEPH REDUCED SUGAR -nutritional supplement

liquid.............................................................................. 146REBETOL -ribavirin soln 40 mg/ml..................................... 9REBIF -interferon beta-1a soln pref syr 22 mcg/0.5ml

(12mu/ml)........................................................................ 95REBIF -interferon beta-1a soln pref syr 44 mcg/0.5ml

(24mu/ml)........................................................................ 95REBIF REBIDOSE -interferon beta-1a soln auto-inj 22

mcg/0.5ml (12mu/ml)...................................................... 95REBIF REBIDOSE -interferon beta-1a soln auto-inj 44

mcg/0.5ml (24mu/ml)...................................................... 95REBIF REBIDOSE TITRATION -interferon beta-1a auto-

inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml..........................95REBIF TITRATION PACK -interferon beta-1a pref syr

6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml...............................95RECEDO -scar treatment products - gel.........................178RECOMBINATE -antihemophilic factor (recombinant) for

inj 220-400 unit............................................................. 161RECOMBINATE -antihemophilic factor (recombinant) for

inj 401-800 unit............................................................. 161RECOMBINATE -antihemophilic factor (recombinant) for

inj 801-1240 unit...........................................................161RECOMBINATE -antihemophilic factor (recombinant) for

inj 1241-1800 unit.........................................................161RECOMBINATE -antihemophilic factor (recombinant) for

inj 1801-2400 unit.........................................................162RECOMBIVAX HB -hepatitis b vaccine (recombinant)

susp 5 mcg/0.5ml........................................................... 14RECOMBIVAX HB -hepatitis b vaccine (recombinant)

susp 10 mcg/ml.............................................................. 14RECOMBIVAX HB -hepatitis b vaccine (recombinant)

susp 40 mcg/ml.............................................................. 14RECTIV -nitroglycerin oint 0.4%..................................... 170RECURA -antifungal combination products misc -

cream.............................................................................178REGENECARE -lidocaine hcl-collagen-aloe vera gel

2%..................................................................................178REGRANEX -becaplermin gel 0.01%............................. 178RELAGARD -acetic acid-oxyquinoline vaginal gel

0.9-0.025%...................................................................... 76RELENZA DISKHALER -zanamivir aero powder breath

activated 5 mg/blister........................................................9RELION R -insulin regular (human) inj 100 unit/ml...........35RELISTOR -methylnaltrexone bromide inj 8 mg/0.4ml (20

mg/ml)..............................................................................73RELISTOR -methylnaltrexone bromide inj 12 mg/0.6ml

(20 mg/ml).......................................................................73

RELNATE DHA -prenatal vit w/ fe fum-fa-omega 3 cap28-1-200 mg..................................................................126

RELPAX -eletriptan hydrobromide tab 20 mg (baseequivalent).....................................................................108

RELPAX -eletriptan hydrobromide tab 40 mg (baseequivalent).....................................................................108

RENAGEL -sevelamer hcl tab 400 mg............................. 73RENAGEL -sevelamer hcl tab 800 mg............................. 73RENALCAL -nutritional supplement liquid...................... 146RENASTART -nutritional supplement powder................ 146RENVELA -sevelamer carbonate packet 0.8 gm..............73RENVELA -sevelamer carbonate packet 2.4 gm..............73RENVELA -sevelamer carbonate tab 800 mg.................. 73REPAGLINIDE/METFORMIN HYD -repaglinide-metformin

hcl tab 1-500 mg.............................................................33REPAGLINIDE/METFORMIN HYD -repaglinide-metformin

hcl tab 2-500 mg.............................................................33repaglinide tab 0.5 mg (Prandin)................................... 33repaglinide tab 1 mg (Prandin)...................................... 33repaglinide tab 2 mg (Prandin)...................................... 33REPATHA -evolocumab subcutaneous soln prefilled

syringe 140 mg/ml.......................................................... 58REPATHA PUSHTRONEX SYSTEM -evolocumab

subcutaneous soln cartridge/infusor 420 mg/3.5ml....... 58REPATHA SURECLICK -evolocumab subcutaneous soln

auto-injector 140 mg/ml..................................................58REPLETE/FIBER/ULTRAPAK -nutritional supplement

liquid.............................................................................. 146REPLETE FIBER 1 CAL -nutritional supplement

liquid.............................................................................. 146REPLETE FIBER -nutritional supplement liquid............. 146REPLETE -nutritional supplement liquid.........................146RESCRIPTOR -delavirdine mesylate tab 100 mg.............. 9RESCRIPTOR -delavirdine mesylate tab 200 mg.............. 9RESCULA -unoprostone isopropyl ophth soln

0.15%.............................................................................166RESOURCE ARGINAID -nutritional supplement

pack............................................................................... 146RESOURCE DAIRY THICK HONE -nutritional

supplement liquid..........................................................146RESOURCE DIABETIC TF -nutritional supplement

liquid.............................................................................. 146RESOURCE JUICE DRINK -nutritional supplement liquid

(frozen).......................................................................... 146RESOURCE JUST FOR KIDS -nutritional supplement

liquid.............................................................................. 146RESOURCE JUST FOR KIDS 1. -nutritional supplement

liquid.............................................................................. 147RESOURCE JUST FOR KIDS WI -nutritional supplement

liquid.............................................................................. 146RESOURCE 2.0 -nutritional supplement liquid...............147

2016



RESOURCE SUPPORT -nutritional supplementliquid.............................................................................. 147

RESOURCE THICKENUP THICKE -nutritionalsupplement liquid..........................................................147

RESPALOR -nutritional supplement liquid......................147RESPIRATORY THERAPY SUPPLIES-VARIOUS.........184RESTASIS -cyclosporine (ophth) emulsion 0.05%......... 166RESTASIS MULTIDOSE -cyclosporine (ophth) emulsion

0.05%.............................................................................166RESTORA RX -lactobacillus casei-folic acid cap 60-1.25

mg....................................................................................68RESTORA SPRINKLES -lactobacillus casei-folic acid

packet 15-0.25 mg..........................................................68RESURGEX -nutritional supplement pack......................147RESURGEX PLUS -nutritional supplement pack........... 147RESURGEX SELECT -nutritional supplement pack.......147REVATIO -sildenafil citrate for suspension 10 mg/ml....... 59REVESTA -folic acid-cholecalciferol cap 1 mg-5750

unit................................................................................. 154REVLIMID -lenalidomide cap 5 mg.................................185REVLIMID -lenalidomide cap 10 mg...............................185REVLIMID -lenalidomide cap 15 mg...............................185REVLIMID -lenalidomide cap 20 mg...............................185REVLIMID -lenalidomide cap 25 mg...............................185REVLIMID -lenalidomide caps 2.5 mg............................ 185REXULTI -brexpiprazole tab 0.25 mg............................... 85REXULTI -brexpiprazole tab 0.5 mg................................. 85REXULTI -brexpiprazole tab 1 mg.................................... 85REXULTI -brexpiprazole tab 2 mg.................................... 85REXULTI -brexpiprazole tab 3 mg.................................... 85REXULTI -brexpiprazole tab 4 mg.................................... 85REYATAZ -atazanavir sulfate cap 150 mg (base equiv)..... 9REYATAZ -atazanavir sulfate cap 200 mg (base equiv)..... 9REYATAZ -atazanavir sulfate cap 300 mg (base

equiv)...............................................................................10REYATAZ -atazanavir sulfate oral powder packet 50 mg

(base equiv).................................................................... 10REZIRA -pseudoephedrine w/ hydrocodone soln 60-5

mg/5ml.............................................................................62RIASTAP -fibrinogen conc (human) inj approximately 1

gm (900-1300 mg)........................................................162RIAX -benzoyl peroxide foam 5.5%................................ 178RIAX -benzoyl peroxide foam 9.5%................................ 178RIBASPHERE RIBAPAK -ribavirin tab 400 mg.................10RIBASPHERE RIBAPAK -ribavirin tab 600 mg.................10RIBASPHERE RIBAPAK -ribavirin tab 200 mg & ribavirin

400 mg tab therapy pack............................................... 10RIBASPHERE RIBAPAK -ribavirin tab 400 mg & ribavirin

600 mg tab therapy pack............................................... 10RIBASPHERE -ribavirin tab 400 mg................................. 10RIBASPHERE -ribavirin tab 600 mg................................. 10ribavirin cap 200 mg (Rebetol).......................................10

ribavirin for inhal soln 6 gm (Virazole)......................... 10ribavirin tab 200 mg (Copegus)..................................... 10RIDAURA -auranofin cap 3 mg.......................................107rifabutin cap 150 mg (Mycobutin)....................................6RIFAMATE -isoniazid & rifampin cap 150-300 mg..............6rifampin cap 150 mg (Rifadin)..........................................6rifampin cap 300 mg (Rifadin)..........................................6RIFATER -isoniazid-rifampin w/ pyrazinamide tab

50-120-300 mg..................................................................6riluzole tab 50 mg (Rilutek).......................................... 118rimantadine hydrochloride tab 100 mg

(Flumadine).................................................................... 10RIOMET -metformin hcl oral soln 500 mg/5ml..................33risedronate sodium tab delayed release 35 mg

(Atelvia).......................................................................... 40risedronate sodium tab 5 mg (Actonel)........................ 40risedronate sodium tab 30 mg (Actonel)...................... 40risedronate sodium tab 35 mg (Actonel)...................... 40risedronate sodium tab 150 mg (Actonel).................... 40risperidone orally disintegrating tab 0.25 mg.............. 85risperidone orally disintegrating tab 0.5 mg (Risperdal

m-tab)..............................................................................86risperidone orally disintegrating tab 1 mg (Risperdal




m-tab)..............................................................................86risperidone soln 1 mg/ml (Risperdal)............................86risperidone tab 0.25 mg (Risperdal)..............................86risperidone tab 0.5 mg (Risperdal)................................86risperidone tab 1 mg (Risperdal)...................................86risperidone tab 2 mg (Risperdal)...................................86risperidone tab 3 mg (Risperdal)...................................86risperidone tab 4 mg (Risperdal)...................................86rivastigmine tartrate cap 1.5 mg (Exelon).....................95rivastigmine tartrate cap 3 mg (Exelon)........................95rivastigmine tartrate cap 4.5 mg (Exelon).....................95rivastigmine tartrate cap 6 mg (Exelon)........................95rivastigmine td patch 24hr 4.6 mg/24hr (Exelon).........95rivastigmine td patch 24hr 9.5 mg/24hr (Exelon).........95rivastigmine td patch 24hr 13.3 mg/24hr (Exelon).......95RIXUBIS -coagulation factor ix (recombinant) for inj 250

unit................................................................................. 162RIXUBIS -coagulation factor ix (recombinant) for inj 500



unit................................................................................. 162

2016



RIXUBIS -coagulation factor ix (recombinant) for inj 3000unit................................................................................. 162

rizatriptan benzoate oral disintegrating tab 5 mg (baseeq) (Maxalt-mlt)........................................................... 108

rizatriptan benzoate oral disintegrating tab 10 mg(base eq) (Maxalt-mlt)................................................ 108

rizatriptan benzoate tab 5 mg (base equivalent)(Maxalt)......................................................................... 108

rizatriptan benzoate tab 10 mg (base equivalent)(Maxalt)......................................................................... 108

R-NATAL OB -prenatal w/o a w/fe cbn-fa-dha cap20-1-320 mg..................................................................126

ropinirole hydrochloride tab er 24hr 2 mg (baseequivalent) (Requip xl)...............................................117





ropinirole hydrochloride tab 0.25 mg (Requip)..........117ropinirole hydrochloride tab 0.5 mg (Requip)............117ropinirole hydrochloride tab 1 mg (Requip)...............117ropinirole hydrochloride tab 2 mg (Requip)...............117ropinirole hydrochloride tab 3 mg (Requip)...............117ropinirole hydrochloride tab 4 mg (Requip)...............117ropinirole hydrochloride tab 5 mg (Requip)...............117rosuvastatin calcium tab 5 mg (Crestor)...................... 58rosuvastatin calcium tab 10 mg (Crestor).................... 58rosuvastatin calcium tab 20 mg (Crestor).................... 58rosuvastatin calcium tab 40 mg (Crestor).................... 58ROZEREM -ramelteon tab 8 mg.......................................87RUBRACA -rucaparib camsylate tab 200 mg (base

equivalent).......................................................................20RUBRACA -rucaparib camsylate tab 250 mg (base

equivalent).......................................................................20RUBRACA -rucaparib camsylate tab 300 mg (base

equivalent).......................................................................20RUCONEST -c1 esterase inhibitor (recombinant) for iv inj

2100 unit....................................................................... 162RYDAPT -midostaurin cap 25 mg.....................................20RYNODERM -urea cream 37.5%....................................178RYTARY -carbidopa & levodopa cap er 23.75-95

mg..................................................................................117RYTARY -carbidopa & levodopa cap er 36.25-145



mg..................................................................................117

SSABRIL -vigabatrin powd pack 500 mg.......................... 114SABRIL -vigabatrin tab 500 mg...................................... 114SAFYRAL -drospirenone-ethinyl estrad-levomefolate tab

3-0.03-0.451 mg..............................................................28SALICEPT -oral wound care products - for susp

rinse...............................................................................169salicylic acid cream 6%................................................ 178salicylic acid er film-forming soln 28.5% (Ultrasal-

er).................................................................................. 178salicylic acid film forming liquid 27.5% (Virasal)....... 178salicylic acid foam 6% (Salvax)................................... 178salicylic acid gel 6% (Keralyt)......................................178salicylic acid lotion 6%................................................. 178salicylic acid shampoo 6% (Salex)..............................178salicylic acid soln 26%..................................................178SALIVAMAX -artificial saliva - packet..............................169SALIVATE RX -artificial saliva - packet...........................169SALMON/OATS/SQUASH -nutritional supplement

liquid.............................................................................. 147salsalate tab 500 mg (Disalcid)......................................96salsalate tab 750 mg (Disalcid)......................................96SAMSCA -tolvaptan tab 15 mg......................................... 40SAMSCA -tolvaptan tab 30 mg......................................... 40SANARE SCAR THERAPY -cream base....................... 184SANCUSO -granisetron td patch 3.1 mg/24hr (contains

34.3 mg).......................................................................... 70SANDIMMUNE -cyclosporine cap 25 mg....................... 185SANDIMMUNE -cyclosporine cap 100 mg..................... 185SANDIMMUNE -cyclosporine oral soln 100 mg/ml.........185SANTYL -collagenase oint 250 unit/gm.......................... 178SAPHRIS -asenapine maleate sl tab 2.5 mg (base

equiv)...............................................................................86SAPHRIS -asenapine maleate sl tab 5 mg (base

equiv)...............................................................................86SAPHRIS -asenapine maleate sl tab 10 mg (base

equiv)...............................................................................86SARAFEM -fluoxetine hcl (pmdd) tab 10 mg....................95SARAFEM -fluoxetine hcl (pmdd) tab 20 mg....................95SAVAYSA -edoxaban tosylate tab 15 mg (base

equivalent).....................................................................156SAVAYSA -edoxaban tosylate tab 30 mg (base

equivalent).....................................................................156SAVAYSA -edoxaban tosylate tab 60 mg (base

equivalent).....................................................................156SAVELLA -milnacipran hcl tab 12.5 mg............................95SAVELLA -milnacipran hcl tab 25 mg...............................95SAVELLA -milnacipran hcl tab 50 mg...............................95SAVELLA -milnacipran hcl tab 100 mg.............................95SAVELLA TITRATION PACK -milnacipran hcl tab 12.5 mg

(5) & 25 mg (8) & 50 mg (42) pak................................. 95

2016



SB COMPLETE NUTRITION -nutritional supplementliquid.............................................................................. 147

SB COMPLETE NUTRITION PLU -nutritional supplementliquid.............................................................................. 147

SCANDICAL -nutritional supplement powder................. 147SCANDISHAKE -nutritional supplement misc................ 147SCANDISHAKE -nutritional supplement pack................ 147SCANDISHAKE -nutritional supplement powder............ 147scar treatment products - gel...................................... 178scopolamine td patch 72hr 1 mg/3days (Transderm-

scop)............................................................................... 71SECONAL SODIUM -secobarbital sodium cap 100

mg....................................................................................87SEEBRI NEOHALER -glycopyrrolate inhal cap 15.6

mcg.................................................................................. 65SELECT-OB+DHA -prenatal mv w/fe poly-fa chw 29-1 mg

& dha cap 250 mg pak.................................................126SELECT-OB -prenatal vit w/ fe polysac cmplx-fa chew tab

29-1 mg......................................................................... 126SELECT-OB -prenat w/ fepolycmplx-methylfol-fa chew

tab 29-0.6-0.4 mg......................................................... 126selegiline hcl cap 5 mg (Eldepryl)............................... 117selegiline hcl tab 5 mg..................................................117selenium sulfide lotion 2.5%........................................ 179selenium sulfide-pyrithione zinc in urea shampoo

2.25%.............................................................................179SELRX -selenium sulfide-pyrithione zinc in urea shampoo

2.3%...............................................................................179SELZENTRY -maraviroc oral soln 20 mg/ml.................... 10SELZENTRY -maraviroc tab 25 mg..................................10SELZENTRY -maraviroc tab 75 mg..................................10SELZENTRY -maraviroc tab 150 mg................................10SELZENTRY -maraviroc tab 300 mg................................10SEMPREX-D -acrivastine & pseudoephedrine cap 8-60

mg....................................................................................62SE-NATAL 19 -prenatal vit w/ dss-fe fumarate-fa tab 29-1

mg..................................................................................126SE-NATAL 19 -prenatal vit w/ fe fumarate-fa chew tab

29-1 mg......................................................................... 126SENSIPAR -cinacalcet hcl tab 30 mg (base equiv).......... 40SENSIPAR -cinacalcet hcl tab 60 mg (base equiv).......... 40SENSIPAR -cinacalcet hcl tab 90 mg (base equiv).......... 40SENSODYNE REPAIR & PROTEC -stannous fluoride

paste 0.454%................................................................ 169SEREVENT DISKUS -salmeterol xinafoate aer pow ba 50

mcg/dose (base equiv)................................................... 65SERNIVO -betamethasone dipropionate spray emulsion

0.05% (base equiv).......................................................179SEROQUEL XR -quetiapine fumarate tab er 24hr 50

mg....................................................................................86SEROQUEL XR -quetiapine fumarate tab er 24hr 150

mg....................................................................................86

SEROQUEL XR -quetiapine fumarate tab er 24hr 200mg....................................................................................86



sertraline hcl oral conc 20 mg/ml (Zoloft).................... 81sertraline hcl tab 25 mg (Zoloft).................................... 81sertraline hcl tab 50 mg (Zoloft).................................... 81sertraline hcl tab 100 mg (Zoloft).................................. 81sevelamer carbonate packet 0.8 gm (Renvela)............ 73sevelamer carbonate packet 2.4 gm (Renvela)............ 73sevelamer carbonate tab 800 mg (Renvela)................. 73SFROWASA -mesalamine sulfite-free (sf) enema 4

gm/60ml...........................................................................74SIGNIFOR -pasireotide diaspartate inj 0.3 mg/ml (base

equiv)...............................................................................40SIGNIFOR -pasireotide diaspartate inj 0.6 mg/ml (base

equiv)...............................................................................40SIGNIFOR -pasireotide diaspartate inj 0.9 mg/ml (base

equiv)...............................................................................40sildenafil citrate tab 20 mg (Revatio)............................ 59SILENOR -doxepin hcl (sleep) tab 3 mg (base equiv)......87SILENOR -doxepin hcl (sleep) tab 6 mg (base equiv)......87SILVER NITRATE -silver nitrate oint 10%.......................179SILVER NITRATE -silver nitrate soln 0.5%.....................179SILVER NITRATE -silver nitrate soln 10%......................179SILVER NITRATE -silver nitrate soln 25%......................179SILVER NITRATE -silver nitrate soln 50%......................179silver sulfadiazine cream 1% (Silvadene)................... 179SILVRSTAT WOUND DRESSING -silver - gel................179SIMBRINZA -brinzolamide-brimonidine tartrate ophth

susp 1-0.2%.................................................................. 166SIMPONI -golimumab subcutaneous soln auto-injector 50

mg/0.5ml........................................................................107SIMPONI -golimumab subcutaneous soln auto-injector

100 mg/ml..................................................................... 107SIMPONI -golimumab subcutaneous soln prefilled syringe

50 mg/0.5ml.................................................................. 107SIMPONI -golimumab subcutaneous soln prefilled syringe

100 mg/ml..................................................................... 107simvastatin tab 5 mg (Zocor)......................................... 58simvastatin tab 10 mg (Zocor)....................................... 58simvastatin tab 20 mg (Zocor)....................................... 58simvastatin tab 40 mg (Zocor)....................................... 58simvastatin tab 80 mg (Zocor)....................................... 58sirolimus tab 0.5 mg (Rapamune)............................... 185sirolimus tab 1 mg (Rapamune).................................. 185sirolimus tab 2 mg (Rapamune).................................. 185SIRTURO -bedaquiline fumarate tab 100 mg (base

equiv)................................................................................. 6SITAVIG -acyclovir buccal tab 50 mg................................10

2016



SIVEXTRO -tedizolid phosphate tab 200 mg....................12skin protectants misc - cream..................................... 179SKLICE -ivermectin lotion 0.5%...................................... 179SM NUTRI-DRINK + -nutritional supplement liquid........ 147SM NUTRI-DRINK -nutritional supplement liquid........... 147sodium chloride soln nebu 0.9%................................... 62sodium chloride soln nebu 3%...................................... 62sodium chloride soln nebu 10%.................................... 62sodium chloride soln nebu 7% (Hyper-sal).................. 62sodium citrate & citric acid soln 500-334 mg/5ml

(Shohls solution modi)................................................ 77sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)

(Luride)......................................................................... 130sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)

(Luride)......................................................................... 130sodium fluoride chew tab 1 mg f (from 2.2 mg naf)

(Luride)......................................................................... 130sodium fluoride cream 1.1% (Prevident 5000

plus).............................................................................. 169sodium fluoride gel 1.1% (0.5% f) (Prevident

fluoride)........................................................................ 169sodium fluoride paste 1.1% (Prevident 5000

boost)............................................................................169sodium fluoride-potassium nitrate paste 1.1-5%

(Prevident 5000 sensi)............................................... 169sodium fluoride rinse 0.05%.........................................169sodium fluoride rinse 0.0221% (0.01% f).................... 169sodium fluoride rinse 0.2% (Prevident)...................... 169SODIUM FLUORIDE -sodium fluoride tab 0.5 mg f (from

1.1 mg naf)....................................................................130SODIUM FLUORIDE -sodium fluoride tab 1 mg f (from

2.2 mg naf)....................................................................130sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop

naf)................................................................................ 130sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)

(Luride)......................................................................... 130sodium phenylbutyrate oral powder 3 gm/teaspoonful

(Buphenyl)......................................................................40sodium phenylbutyrate tab 500 mg (Buphenyl)...........40sodium polystyrene sulfonate oral susp 15 gm/60ml

(Sps)..............................................................................185sodium polystyrene sulfonate powder

(Kayexalate)................................................................. 185sodium polystyrene sulfonate rectal susp 30

gm/120ml......................................................................185SODIUM SULFACETAMIDE/SULF -sulfacetamide

sodium-sulfur in urea emulsion 10-5%........................ 179SODIUM SULFACETAMIDE/SULF -sulfacetamide sodium

w/ sulfur lotion 10-5%...................................................179SODIUM SULFACETAMIDE/SULF -sulfacetamide sodium

w/ sulfur susp 10-5%....................................................179

SODIUM SULFACETAMIDE WASH -sulfacetamidesodium in bakuchiol vehicle wash 10%....................... 179

SOL CARB -nutritional supplement powder....................147SOLTAMOX -tamoxifen citrate oral soln 10 mg/5ml (base

equivalent).......................................................................20SOLVIL -amino acids pack..............................................131SOMA -carisoprodol tab 250 mg.....................................118SOMAVERT -pegvisomant for inj 10 mg (as protein)....... 40SOMAVERT -pegvisomant for inj 15 mg (as protein)....... 40SOMAVERT -pegvisomant for inj 20 mg (as protein)....... 40SOMAVERT -pegvisomant for inj 25 mg (as protein)....... 40SOMAVERT -pegvisomant for inj 30 mg (as protein)....... 40SOOLANTRA -ivermectin cream 1%.............................. 179SORILUX -calcipotriene foam 0.005%............................179S.O.S. 15 -nutritional supplement pack.......................... 147S.O.S. 20 -nutritional supplement pack.......................... 147S.O.S. 25 -nutritional supplement pack.......................... 147sotalol hcl (afib/afl) tab 80 mg (Betapace af)................43sotalol hcl (afib/afl) tab 120 mg (Betapace af)..............43sotalol hcl (afib/afl) tab 160 mg (Betapace af)..............44sotalol hcl tab 240 mg.....................................................44sotalol hcl tab 80 mg (Betapace)...................................44sotalol hcl tab 120 mg (Betapace).................................44sotalol hcl tab 160 mg (Betapace).................................44SOTYLIZE -sotalol hcl oral solution 5 mg/ml.................... 44SOURCE COOKIE BAR -nutritional supplement bar......147SOVALDI -sofosbuvir tab 400 mg..................................... 10SOY PROTEIN SHAKE -nutritional supplement

powder...........................................................................147SPACERS-VARIOUS....................................................... 184SPATONE PUR-ABSORB IRON -ferrous sulfate liquid 5

mg/20ml (elemental iron)..............................................154SPECTRACEF -cefditoren pivoxil tab 400 mg (base

equivalent)......................................................................... 3SPINOSAD -spinosad susp 0.9%................................... 179SPIRIVA HANDIHALER -tiotropium bromide monohydrate

inhal cap 18 mcg (base equiv).......................................65SPIRIVA RESPIMAT -tiotropium bromide monohydrate

inhal aerosol 1.25 mcg/act............................................. 65SPIRIVA RESPIMAT -tiotropium bromide monohydrate

inhal aerosol 2.5 mcg/act............................................... 65spironolactone & hydrochlorothiazide tab 25-25 mg

(Aldactazide).................................................................. 54spironolactone tab 25 mg (Aldactone)..........................54spironolactone tab 50 mg (Aldactone)..........................54spironolactone tab 100 mg (Aldactone)........................55SPORANOX -itraconazole oral soln 10 mg/ml....................6SPRITAM -levetiracetam tab disintegrating soluble 250

mg..................................................................................114SPRITAM -levetiracetam tab disintegrating soluble 500

mg..................................................................................114

2016



SPRITAM -levetiracetam tab disintegrating soluble 750mg..................................................................................114

SPRITAM -levetiracetam tab disintegrating soluble 1000mg..................................................................................114

SPRYCEL -dasatinib tab 20 mg........................................20SPRYCEL -dasatinib tab 50 mg........................................20SPRYCEL -dasatinib tab 70 mg........................................20SPRYCEL -dasatinib tab 80 mg........................................20SPRYCEL -dasatinib tab 100 mg......................................20SPRYCEL -dasatinib tab 140 mg......................................20SP SCAR MANAGEMENT -scar treatment products -

gel.................................................................................. 179SSKI -potassium iodide soln 1 gm/ml............................. 130SSS 10-5 -sulfacetamide sodium w/ sulfur foam

10-5%............................................................................ 179STALEVO 100 -carbidopa-levodopa-entacapone tabs

25-100-200 mg..............................................................117STALEVO 125 -carbidopa-levodopa-entacapone tabs

31.25-125-200 mg........................................................ 117STALEVO 150 -carbidopa-levodopa-entacapone tabs

37.5-150-200 mg.......................................................... 118STALEVO 200 -carbidopa-levodopa-entacapone tabs

50-200-200 mg..............................................................118STALEVO 50 -carbidopa-levodopa-entacapone tabs

12.5-50-200 mg.............................................................118STALEVO 75 -carbidopa-levodopa-entacapone tabs

18.75-75-200 mg.......................................................... 118stannous fluoride conc 0.63% (Gel-kam oral care

ri)................................................................................... 169stannous fluoride gel 0.4%...........................................169STANNOUS FLUORIDE RINSE -stannous fluoride liq

0.1%...............................................................................169stavudine cap 15 mg (Zerit)............................................10stavudine cap 20 mg (Zerit)............................................10stavudine cap 30 mg (Zerit)............................................10stavudine cap 40 mg (Zerit)............................................10STELARA -ustekinumab inj 45 mg/0.5ml........................179STELARA -ustekinumab soln prefilled syringe 45

mg/0.5ml........................................................................179STELARA -ustekinumab soln prefilled syringe 90 mg/

ml................................................................................... 179STIMATE -desmopressin acetate nasal soln 1.5 mg/

ml..................................................................................... 40STIOLTO RESPIMAT -tiotropium br-olodaterol inhal aero

soln 2.5-2.5 mcg/act....................................................... 66STIVARGA -regorafenib tab 40 mg...................................20STRATTERA -atomoxetine hcl cap 10 mg (base

equiv)...............................................................................90STRATTERA -atomoxetine hcl cap 18 mg (base

equiv)...............................................................................90STRATTERA -atomoxetine hcl cap 25 mg (base

equiv)...............................................................................90

STRATTERA -atomoxetine hcl cap 40 mg (baseequiv)...............................................................................90




STRENSIQ -asfotase alfa subcutaneous inj 18mg/0.45ml........................................................................41

STRENSIQ -asfotase alfa subcutaneous inj 28mg/0.7ml..........................................................................41

STRENSIQ -asfotase alfa subcutaneous inj 40 mg/ml..... 41STRENSIQ -asfotase alfa subcutaneous inj 80

mg/0.8ml..........................................................................41STRIBILD -elvitegrav-cobic-emtricitab-tenofovdf tab

150-150-200-300 mg...................................................... 10STRIVERDI RESPIMAT -olodaterol hcl inhal aerosol soln

2.5 mcg/act (base equiv)................................................66SUBDUE -nutritional supplement liquid.......................... 147SUBDUE PLUS -nutritional supplement liquid................147SUBOXONE -buprenorphine hcl-naloxone hcl sl film 2-0.5

mg (base equiv)............................................................103SUBOXONE -buprenorphine hcl-naloxone hcl sl film 4-1



mg (base equiv)............................................................103SUBSYS -fentanyl sublingual spray 100 mcg.................103SUBSYS -fentanyl sublingual spray 200 mcg.................103SUBSYS -fentanyl sublingual spray 400 mcg.................103SUBSYS -fentanyl sublingual spray 600 mcg.................103SUBSYS -fentanyl sublingual spray 800 mcg.................103SUBSYS -fentanyl sublingual spray 1200 mcg (600 mcg x

2)....................................................................................103SUBSYS -fentanyl sublingual spray 1600 mcg (800 mcg x

2)....................................................................................103SUCRAID -sacrosidase soln 8500 unit/ml........................ 71sucralfate tab 1 gm (Carafate)....................................... 70sulfacetamide sodium cleansing gel 10% (Ovace plus

wash).............................................................................179sulfacetamide sodium liquid 10% (Ovace wash)....... 179sulfacetamide sodium lotion 10% (acne) (Klaron).....179sulfacetamide sodium ophth soln 10%

(Bleph-10).....................................................................166sulfacetamide sodium-prednisolone ophth soln

10-0.23(0.25)%............................................................. 166sulfacetamide sodium shampoo 10% (Ovace

plus).............................................................................. 179SULFACETAMIDE SODIUM -sulfacetamide sodium ophth

oint 10%........................................................................ 166

2016



sulfacetamide sodium w/ sulfur cleanser 10-2% (Avarls cleanser).................................................................. 179

sulfacetamide sodium w/ sulfur cleanser 9.8-4.8%(Plexion cleanser)....................................................... 179

sulfacetamide sodium w/ sulfur cleansing pad 10-4%(Sumaxin)..................................................................... 179

sulfacetamide sodium w/ sulfur cream 10-5%........... 180sulfacetamide sodium w/ sulfur cream 10-2% (Avar-e

ls)...................................................................................180sulfacetamide sodium w/ sulfur cream 9.8-4.8%

(Plexion)....................................................................... 180sulfacetamide sodium w/ sulfur emulsion 10-1%...... 180sulfacetamide sodium w/ sulfur emulsion 10-5%...... 180sulfacetamide sodium w/ sulfur lotion 9.8-4.8%

(Plexion)....................................................................... 180sulfacetamide sodium w/ sulfur susp 8-4% (Sumaxin

ts).................................................................................. 180sulfacetamide sodium w/ sulfur wash 9-4.5%

(Sumadan wash)......................................................... 180sulfacetamide sodium w/ sulfur wash 9-4% (Sumaxin

wash).............................................................................180SULFADIAZINE -sulfadiazine tab 500 mg.......................... 5sulfamethoxazole-trimethoprim susp 200-40

mg/5ml............................................................................ 12sulfamethoxazole-trimethoprim tab 400-80 mg

(Bactrim).........................................................................12sulfamethoxazole-trimethoprim tab 800-160 mg

(Bactrim ds)................................................................... 13SULFAMYLON -mafenide acetate cream 85 mg/gm......180sulfasalazine tab delayed release 500 mg (Azulfidine

en-tabs)...........................................................................74sulfasalazine tab 500 mg (Azulfidine)........................... 74sulindac tab 150 mg...................................................... 107sulindac tab 200 mg...................................................... 108sumatriptan nasal spray 5 mg/act (Imitrex)................108sumatriptan nasal spray 20 mg/act (Imitrex)..............108sumatriptan succinate inj 6 mg/0.5ml (Imitrex)..........109sumatriptan succinate solution auto-injector 4

mg/0.5ml (Imitrex statdose sys)............................... 109sumatriptan succinate solution auto-injector 6

mg/0.5ml (Imitrex statdose sys)............................... 109sumatriptan succinate solution cartridge 4 mg/0.5ml

(Imitrex statdose ref)..................................................109sumatriptan succinate solution cartridge 6 mg/0.5ml

(Imitrex statdose ref)..................................................109SUMATRIPTAN SUCCINATE -sumatriptan succinate

solution prefilled syringe 6 mg/0.5ml........................... 109sumatriptan succinate tab 25 mg (Imitrex).................109sumatriptan succinate tab 50 mg (Imitrex).................109sumatriptan succinate tab 100 mg (Imitrex)...............109SUPER DAILY D3 -cholecalciferol drops 1000 unit/0.03ml

(per drop)...................................................................... 119

SUPER NU-THERA -multiple vitamins w/ mineralspowder...........................................................................126

SUPLENA -nutritional supplement liquid.........................147SUPLENA RTU -nutritional supplement liquid................ 147SUPLENA WITH CARB STEADY -nutritional supplement

liquid.............................................................................. 147SUPLENA 1.8 WITH CARBSTEA -nutritional supplement

liquid.............................................................................. 147SUPRAX -cefixime cap 400 mg.......................................... 3SUPRAX -cefixime chew tab 100 mg................................. 3SUPRAX -cefixime chew tab 200 mg................................. 3SUPRAX -cefixime for susp 100 mg/5ml............................ 3SUPRAX -cefixime for susp 200 mg/5ml............................ 3SUPRAX -cefixime for susp 500 mg/5ml............................ 3SUPREP BOWEL PREP KIT -sod sulfate-pot sulf-mg sulf

oral sol 17.5-3.13-1.6 gm/180ml.................................... 67SURMONTIL -trimipramine maleate cap 25 mg............... 81SURMONTIL -trimipramine maleate cap 50 mg............... 81SURMONTIL -trimipramine maleate cap 100 mg............. 82SURVANTA INTRATRACHEAL -beractant in nacl 0.9%

intratracheal susp 25 mg/ml...........................................67SUSTIVA -efavirenz cap 50 mg........................................ 10SUSTIVA -efavirenz cap 200 mg...................................... 10SUSTIVA -efavirenz tab 600 mg....................................... 10SUTENT -sunitinib malate cap 12.5 mg (base

equivalent).......................................................................20SUTENT -sunitinib malate cap 25 mg (base

equivalent).......................................................................20SUTENT -sunitinib malate cap 37.5 mg (base

equivalent).......................................................................20SUTENT -sunitinib malate cap 50 mg (base

equivalent).......................................................................20SYLATRON -peginterferon alfa-2b for inj kit 200 mcg...... 20SYLATRON -peginterferon alfa-2b for inj kit 300 mcg...... 20SYLATRON -peginterferon alfa-2b for inj kit 600 mcg...... 20SYMAX DUOTAB -hyoscyamine sulfate tab er 0.375 mg

(0.125 mg ir/0.25 mg er)................................................ 70SYMBICORT -budesonide-formoterol fumarate dihyd

aerosol 80-4.5 mcg/act...................................................66SYMBICORT -budesonide-formoterol fumarate dihyd

aerosol 160-4.5 mcg/act.................................................66SYMLINPEN 120 -pramlintide acetate pen-inj 2700

mcg/2.7ml (1000 mcg/ml)...............................................33SYMLINPEN 60 -pramlintide acetate pen-inj 1500

mcg/1.5ml (1000 mcg/ml)...............................................33SYNALGOS-DC -aspirin-caffeine-dihydrocodeine cap

356.4-30-16 mg.............................................................103SYNAREL -nafarelin acetate nasal soln 2 mg/ml (200

mcg/act) (base eq)..........................................................41SYNERA -lidocaine-tetracaine topical patch 70-70

mg..................................................................................180

2016



SYNJARDY -empagliflozin-metformin hcl tab 12.5-1000mg....................................................................................33

SYNJARDY -empagliflozin-metformin hcl tab 12.5-500mg....................................................................................33

SYNJARDY -empagliflozin-metformin hcl tab 5-500mg....................................................................................33

SYNJARDY -empagliflozin-metformin hcl tab 5-1000mg....................................................................................33

SYNJARDY XR -empagliflozin-metformin hcl tab er 24hr5-1000 mg.......................................................................33

SYNJARDY XR -empagliflozin-metformin hcl tab er 24hr10-1000 mg.....................................................................33

SYNJARDY XR -empagliflozin-metformin hcl tab er 24hr12.5-1000 mg..................................................................33

SYNJARDY XR -empagliflozin-metformin hcl tab er 24hr25-1000 mg.....................................................................33

SYNTHROID -levothyroxine sodium tab 25 mcg..............37SYNTHROID -levothyroxine sodium tab 50 mcg..............37SYNTHROID -levothyroxine sodium tab 75 mcg..............37SYNTHROID -levothyroxine sodium tab 88 mcg..............37SYNTHROID -levothyroxine sodium tab 100 mcg............37SYNTHROID -levothyroxine sodium tab 112 mcg............ 37SYNTHROID -levothyroxine sodium tab 125 mcg............37SYNTHROID -levothyroxine sodium tab 137 mcg............37SYNTHROID -levothyroxine sodium tab 150 mcg............37SYNTHROID -levothyroxine sodium tab 175 mcg............37SYNTHROID -levothyroxine sodium tab 200 mcg............37SYNTHROID -levothyroxine sodium tab 300 mcg............37SYPRINE -trientine hcl cap 250 mg................................185

TTABLOID -thioguanine tab 40 mg..................................... 20TACLONEX -calcipotriene-betamethasone dipropionate

susp 0.005-0.064%.......................................................180tacrolimus cap 0.5 mg (Prograf).................................. 185tacrolimus cap 1 mg (Prograf)..................................... 185tacrolimus cap 5 mg (Prograf)..................................... 185tacrolimus oint 0.03% (Protopic)................................. 180tacrolimus oint 0.1% (Protopic)................................... 180TAFINLAR -dabrafenib mesylate cap 50 mg (base

equivalent).......................................................................20TAFINLAR -dabrafenib mesylate cap 75 mg (base

equivalent).......................................................................20TAGRISSO -osimertinib mesylate tab 40 mg (base

equivalent).......................................................................20TAGRISSO -osimertinib mesylate tab 80 mg (base

equivalent).......................................................................20TALTZ -ixekizumab subcutaneous soln auto-injector 80

mg/ml.............................................................................180TALTZ -ixekizumab subcutaneous soln prefilled syringe

80 mg/ml....................................................................... 180

TAMIFLU -oseltamivir phosphate cap 30 mg (baseequiv)...............................................................................10



TAMIFLU -oseltamivir phosphate for susp 6 mg/ml (baseequiv)...............................................................................10

tamoxifen citrate tab 10 mg (base equivalent).............20tamoxifen citrate tab 20 mg (base equivalent).............20tamsulosin hcl cap 0.4 mg (Flomax)............................. 77TANDEM F -ferrous fum-iron polysacch-fa cap

162-115.2-1 mg (106 mg fe)........................................ 154TANZEUM -albiglutide for soln pen-injector 30 mg...........33TANZEUM -albiglutide for soln pen-injector 50 mg...........33TARCEVA -erlotinib hcl tab 25 mg (base equivalent)....... 20TARCEVA -erlotinib hcl tab 100 mg (base equivalent)..... 20TARCEVA -erlotinib hcl tab 150 mg (base equivalent)..... 20TARGRETIN -bexarotene cap 75 mg................................20TARGRETIN -bexarotene gel 1%....................................180TARKA -trandolapril-verapamil hcl tab er 1-240 mg......... 52TARKA -trandolapril-verapamil hcl tab er 2-180 mg......... 52TARKA -trandolapril-verapamil hcl tab er 2-240 mg......... 52TARKA -trandolapril-verapamil hcl tab er 4-240 mg......... 52TARON-BC -prenat w/o a w/ fe cbnyl-fa tab 20-1 mg & vit

b6 tab pak.....................................................................126TARON-C DHA -prenatal w/fe fum-fe poly -fa-omega 3

cap 53.5-38-1 mg......................................................... 126TARON FORTE -fe bisglycinate-fe polysacch-vit c-vit b12-

fa cap............................................................................ 154TARON-PREX -prenatal w/o vit a w/ fe fum-dss-fa-dha

cap 30-1.2-265 mg....................................................... 126TASIGNA -nilotinib hcl cap 150 mg (base equivalent)......20TASIGNA -nilotinib hcl cap 200 mg (base equivalent)......20TASMAR -tolcapone tab 100 mg.....................................118tazarotene cream 0.1% (Tazorac).................................180TAZORAC -tazarotene cream 0.05%..............................180TAZORAC -tazarotene cream 0.1%................................180TAZORAC -tazarotene gel 0.05%................................... 180TAZORAC -tazarotene gel 0.1%..................................... 180TECFIDERA -dimethyl fumarate capsule delayed release

120 mg............................................................................ 95TECFIDERA -dimethyl fumarate capsule delayed release

240 mg............................................................................ 95TECFIDERA STARTER PACK -dimethyl fumarate

capsule dr starter pack 120 mg & 240 mg.....................95TECHNIVIE -ombitasvir-paritaprevir-ritonavir tab

12.5-75-50 mg.................................................................10TEGRETOL -carbamazepine susp 100 mg/5ml............. 114TEGRETOL -carbamazepine tab 200 mg.......................114TEGRETOL-XR -carbamazepine tab er 12hr 100

mg..................................................................................114

2016



TEGRETOL-XR -carbamazepine tab er 12hr 200mg..................................................................................114

TEGRETOL-XR -carbamazepine tab er 12hr 400mg..................................................................................114

TEKTURNA -aliskiren fumarate tab 150 mg (baseequivalent).......................................................................52

TEKTURNA -aliskiren fumarate tab 300 mg (baseequivalent).......................................................................52

TEKTURNA HCT -aliskiren-hydrochlorothiazide tab150-12.5 mg....................................................................52

TEKTURNA HCT -aliskiren-hydrochlorothiazide tab150-25 mg.......................................................................52

TEKTURNA HCT -aliskiren-hydrochlorothiazide tab300-12.5 mg....................................................................52

TEKTURNA HCT -aliskiren-hydrochlorothiazide tab300-25 mg.......................................................................53

telmisartan-amlodipine tab 40-5 mg (Twynsta)............ 53telmisartan-amlodipine tab 80-5 mg (Twynsta)............ 53telmisartan-amlodipine tab 40-10 mg (Twynsta).......... 53telmisartan-amlodipine tab 80-10 mg (Twynsta).......... 53telmisartan-hydrochlorothiazide tab 40-12.5 mg

(Micardis hct).................................................................53telmisartan-hydrochlorothiazide tab 80-12.5 mg

(Micardis hct).................................................................53telmisartan-hydrochlorothiazide tab 80-25 mg

(Micardis hct).................................................................53telmisartan tab 20 mg (Micardis)................................... 53telmisartan tab 40 mg (Micardis)................................... 53telmisartan tab 80 mg (Micardis)................................... 53temazepam cap 7.5 mg (Restoril).................................. 87temazepam cap 15 mg (Restoril)................................... 87temazepam cap 22.5 mg (Restoril)................................ 87temazepam cap 30 mg (Restoril)................................... 87temozolomide cap 5 mg (Temodar)...............................21temozolomide cap 20 mg (Temodar).............................21temozolomide cap 100 mg (Temodar)...........................21temozolomide cap 140 mg (Temodar)...........................21temozolomide cap 180 mg (Temodar)...........................21temozolomide cap 250 mg (Temodar)...........................21TENCON -butalbital-acetaminophen tab 50-325 mg........ 96TENIVAC -tetanus-diphtheria toxoids (td) inj 5-2 lfu......... 15terazosin hcl cap 1 mg....................................................53terazosin hcl cap 2 mg....................................................53terazosin hcl cap 5 mg....................................................53terazosin hcl cap 10 mg..................................................53terbinafine hcl tab 250 mg (Lamisil)................................6terbutaline sulfate tab 2.5 mg........................................ 66terbutaline sulfate tab 5 mg........................................... 66terconazole vaginal cream 0.4% (Terazol 7).................76terconazole vaginal cream 0.8% (Terazol 3).................76terconazole vaginal suppos 80 mg............................... 76

testosterone cypionate im inj in oil 100 mg/ml (Depo-testosterone)..................................................................24

testosterone cypionate im inj in oil 200 mg/ml (Depo-testosterone)..................................................................24

testosterone enanthate im inj in oil 200 mg/ml............24testosterone td gel 12.5 mg/act (1%) (Androgel

pump)..............................................................................24testosterone td gel 25 mg/2.5gm (1%) (Androgel)....... 24testosterone td gel 50 mg/5gm (1%) (Androgel).......... 24testosterone td soln 30 mg/act (Axiron)....................... 24TETANUS/DIPHTHERIA TOXOID -tetanus-diphtheria

toxoids (td) inj 2-2 lf/0.5ml..............................................15tetrabenazine tab 12.5 mg (Xenazine)........................... 95tetrabenazine tab 25 mg (Xenazine).............................. 95tetracaine hcl ophth soln 0.5%.................................... 166tetracycline hcl cap 250 mg (Tetracycline hcl)...............5tetracycline hcl cap 500 mg (Tetracycline hcl)...............5TETRACYCLINE HCL -tetracycline hcl cap 250 mg...........5TETRACYCLINE HCL -tetracycline hcl cap 500 mg...........5TETRIX -dermatological products misc - cream............. 180TEXACORT -hydrocortisone soln 2.5%.......................... 180TEXAVITE LQ -pediatric multivitamins w/fl-fe-zn drops

0.25-7-3 mg/ml..............................................................126THALOMID -thalidomide cap 50 mg............................... 185THALOMID -thalidomide cap 100 mg............................. 186THALOMID -thalidomide cap 150 mg............................. 186THALOMID -thalidomide cap 200 mg............................. 186theophylline soln 80 mg/15ml........................................ 66theophylline tab er 12hr 100 mg....................................66theophylline tab er 12hr 200 mg....................................66theophylline tab er 12hr 300 mg....................................66theophylline tab er 12hr 450 mg....................................66theophylline tab er 24hr 400 mg....................................66theophylline tab er 24hr 600 mg....................................66THEO-24 -theophylline cap er 24hr 100 mg.....................66THEO-24 -theophylline cap er 24hr 200 mg.....................66THEO-24 -theophylline cap er 24hr 300 mg.....................66THEO-24 -theophylline cap er 24hr 400 mg.....................66THERA-FLUR-N -sodium fluoride gel 1.1% (0.5% f)...... 169THICK-IT BEEF LASAGNA PUR -nutritional supplement

misc............................................................................... 147THICK-IT CHICKEN A LA KIN -nutritional supplement

misc............................................................................... 147THICK-IT MAPLE CINNAMON F -nutritional supplement

misc............................................................................... 147THICK-IT MIXED FRUIT AND -nutritional supplement

misc............................................................................... 147THICK-IT SEASONED CHICKEN -nutritional supplement

misc............................................................................... 148THICK-IT SWEET CORN PUREE -nutritional supplement

misc............................................................................... 148

2016



THICK-IT THICKENED CRANBE -nutritional supplementliquid.............................................................................. 148

THIOLA -tiopronin tab 100 mg.......................................... 77thioridazine hcl tab 10 mg..............................................86thioridazine hcl tab 25 mg..............................................86thioridazine hcl tab 50 mg..............................................86thioridazine hcl tab 100 mg............................................86thiothixene cap 1 mg.......................................................86thiothixene cap 2 mg.......................................................86thiothixene cap 5 mg.......................................................86thiothixene cap 10 mg.....................................................86THRIVACIN DETOX -nutritional supplement liquid.........148THRIVACIN 30 -nutritional supplement liquid................. 148THRIVITE 19 -prenatal vit w/ dss-fe fumarate-fa tab 29-1

mg..................................................................................126THRIVITE RX -prenatal vit w/ iron carbonyl-fa tab 29-1

mg..................................................................................126thyroid tab 30 mg (1/2 grain) (Armour thyroid)............ 37thyroid tab 90 mg (1 1/2 grain) (Armour thyroid)......... 37thyroid tab 60 mg (1 grain) (Armour thyroid)............... 37thyroid tab 120 mg (2 grain) (Armour thyroid)............. 37THYROLAR-1/2 -liotrix (t3-t4) tab 30 mg (6.25-25

mcg).................................................................................37THYROLAR-1/4 -liotrix (t3-t4) tab 15 mg (3.1-12.5

mcg).................................................................................37THYROLAR-1 -liotrix (t3-t4) tab 60 mg (12.5-50 mcg)......37THYROLAR-2 -liotrix (t3-t4) tab 120 mg (25-100

mcg).................................................................................37THYROLAR-3 -liotrix (t3-t4) tab 180 mg (37.5-150

mcg).................................................................................37tiagabine hcl tab 2 mg (Gabitril).................................. 114tiagabine hcl tab 4 mg (Gabitril).................................. 114TIKOSYN -dofetilide cap 125 mcg (0.125 mg)................. 46TIKOSYN -dofetilide cap 250 mcg (0.25 mg)................... 46TIKOSYN -dofetilide cap 500 mcg (0.5 mg)..................... 46timolol maleate ophth gel forming soln 0.25%

(Timoptic-xe)................................................................166timolol maleate ophth gel forming soln 0.5%

(Timoptic-xe)................................................................166timolol maleate ophth soln 0.25% (Timoptic).............166timolol maleate ophth soln 0.5% (Timoptic)...............166TIMOLOL MALEATE -timolol maleate tab 5 mg............... 44TIMOLOL MALEATE -timolol maleate tab 10 mg............. 44TIMOLOL MALEATE -timolol maleate tab 20 mg............. 44TIMOPTIC OCUDOSE -timolol maleate preservative free

ophth soln 0.25%..........................................................166TIMOPTIC OCUDOSE -timolol maleate preservative free

ophth soln 0.5%............................................................166tinidazole tab 250 mg (Tindamax)..................................13tinidazole tab 500 mg (Tindamax)..................................13TIROSINT -levothyroxine sodium cap 13 mcg..................37TIROSINT -levothyroxine sodium cap 25 mcg..................37

TIROSINT -levothyroxine sodium cap 50 mcg..................37TIROSINT -levothyroxine sodium cap 75 mcg..................37TIROSINT -levothyroxine sodium cap 88 mcg..................37TIROSINT -levothyroxine sodium cap 100 mcg................37TIROSINT -levothyroxine sodium cap 112 mcg................37TIROSINT -levothyroxine sodium cap 125 mcg................37TIROSINT -levothyroxine sodium cap 137 mcg................37TIROSINT -levothyroxine sodium cap 150 mcg................37TIVICAY -dolutegravir sodium tab 10 mg (base equiv).....10TIVICAY -dolutegravir sodium tab 25 mg (base equiv).....10TIVICAY -dolutegravir sodium tab 50 mg (base equiv).....11tizanidine hcl cap 2 mg (base equivalent)

(Zanaflex)......................................................................118tizanidine hcl cap 4 mg (base equivalent)

(Zanaflex)......................................................................119tizanidine hcl cap 6 mg (base equivalent)

(Zanaflex)......................................................................119tizanidine hcl tab 2 mg (base equivalent)...................119tizanidine hcl tab 4 mg (base equivalent)

(Zanaflex)......................................................................119TL-CARE DHA -prenatal w/fe fumarate-fa-dss-fish oil cap

27-1-500 mg..................................................................126TL-FLUORIVITE -pediatric multiple vitamins w/ fl-fe chew

tab 0.25-7.5 mg............................................................ 126TL FOLATE -prenatal vit w/ fe fum-methylfolate-fa tab

27-0.5-0.5 mg................................................................126TL G-FOL OS -multiple vit w/ min & calcium-folic acid tab

500-1.1 mg....................................................................126TL-SELECT -prenatal w/o vit a w/ fe fum-dss-fa-dha cap

29-1.25-325 mg.............................................................126TOBI PODHALER -tobramycin inhal cap 28 mg.................5TOBRADEX ST -tobramycin-dexamethasone ophth susp

0.3-0.05%...................................................................... 166TOBRADEX -tobramycin-dexamethasone ophth oint

0.3-0.1%........................................................................ 166tobramycin-dexamethasone ophth susp 0.3-0.1%

(Tobradex).................................................................... 167tobramycin nebu soln 300 mg/5ml (Tobi)....................... 5tobramycin ophth soln 0.3% (Tobrex).........................166TOBRAMYCIN -tobramycin nebu soln 300 mg/5ml............5TOBREX -tobramycin ophth oint 0.3%........................... 167TOLAK -fluorouracil cream 4%........................................180TOLAZAMIDE -tolazamide tab 250 mg.............................33TOLAZAMIDE -tolazamide tab 500 mg.............................33TOLBUTAMIDE -tolbutamide tab 500 mg.........................33tolcapone tab 100 mg (Tasmar)................................... 118TOLEREX -nutritional supplement pack......................... 148TOLMETIN SODIUM -tolmetin sodium cap 400 mg....... 108tolterodine tartrate cap er 24hr 2 mg (Detrol la).......... 75tolterodine tartrate cap er 24hr 4 mg (Detrol la).......... 75tolterodine tartrate tab 1 mg (Detrol)............................ 75tolterodine tartrate tab 2 mg (Detrol)............................ 75

2016



TOPICORT -desoximetasone cream 0.05%................... 180TOPICORT -desoximetasone oint 0.05%....................... 180TOPICORT -desoximetasone spray 0.25%.................... 180TOPIRAMATE ER -topiramate cap er 24hr sprinkle 25

mg..................................................................................114TOPIRAMATE ER -topiramate cap er 24hr sprinkle 50




mg..................................................................................114topiramate sprinkle cap 15 mg (Topamax

sprinkle)........................................................................114topiramate sprinkle cap 25 mg (Topamax

sprinkle)........................................................................114topiramate tab 25 mg (Topamax).................................114topiramate tab 50 mg (Topamax).................................114topiramate tab 100 mg (Topamax)...............................114topiramate tab 200 mg (Topamax)...............................115torsemide tab 5 mg (Demadex)......................................55torsemide tab 10 mg (Demadex)....................................55torsemide tab 20 mg (Demadex)....................................55torsemide tab 100 mg (Demadex)..................................55TOUJEO SOLOSTAR -insulin glargine soln pen-injector

300 unit/ml.......................................................................35TOVIAZ -fesoterodine fumarate tab er 24hr 4 mg............ 75TOVIAZ -fesoterodine fumarate tab er 24hr 8 mg............ 75TRACLEER -bosentan tab 62.5 mg..................................59TRACLEER -bosentan tab 125 mg...................................59TRADJENTA -linagliptin tab 5 mg.....................................33tramadol-acetaminophen tab 37.5-325 mg

(Ultracet).......................................................................104TRAMADOL HCL ER -tramadol hcl cap er 24hr biphasic

release 100 mg.............................................................104TRAMADOL HCL ER -tramadol hcl cap er 24hr biphasic



release 300 mg.............................................................104tramadol hcl tab er 24hr biphasic release 100 mg.....104tramadol hcl tab er 24hr biphasic release 200 mg.....104tramadol hcl tab er 24hr biphasic release 300 mg.....104tramadol hcl tab er 24hr 100 mg..................................104tramadol hcl tab er 24hr 200 mg..................................104tramadol hcl tab er 24hr 300 mg..................................104tramadol hcl tab 50 mg (Ultram)..................................104trandolapril tab 1 mg (Mavik)......................................... 53trandolapril tab 2 mg (Mavik)......................................... 53trandolapril tab 4 mg (Mavik)......................................... 53

trandolapril-verapamil hcl tab er 1-240 mg (Tarka)......53trandolapril-verapamil hcl tab er 2-180 mg (Tarka)......53trandolapril-verapamil hcl tab er 2-240 mg (Tarka)......53trandolapril-verapamil hcl tab er 4-240 mg (Tarka)......53tranexamic acid tab 650 mg (Lysteda)........................ 156TRANSDERM-SCOP -scopolamine td patch 72hr 1

mg/3days......................................................................... 71tranylcypromine sulfate tab 10 mg (Parnate)...............82TRAVATAN Z -travoprost ophth soln 0.004%

(benzalkonium free) (bak free).....................................167trazodone hcl tab 50 mg.................................................82trazodone hcl tab 100 mg...............................................82trazodone hcl tab 150 mg...............................................82trazodone hcl tab 300 mg...............................................82TRECATOR -ethionamide tab 250 mg................................6TRESIBA FLEXTOUCH -insulin degludec soln pen-

injector 100 unit/ml......................................................... 35TRESIBA FLEXTOUCH -insulin degludec soln pen-

injector 200 unit/ml......................................................... 36tretinoin cap 10 mg......................................................... 21tretinoin cream 0.025% (Retin-a)................................. 180tretinoin cream 0.05% (Retin-a)................................... 180tretinoin cream 0.1% (Retin-a)..................................... 180tretinoin gel 0.05% (Atralin)..........................................180tretinoin gel 0.01% (Retin-a).........................................180tretinoin gel 0.025% (Retin-a).......................................180tretinoin microsphere gel 0.04% (Retin-a micro)....... 180tretinoin microsphere gel 0.1% (Retin-a micro

pump)............................................................................181TRETTEN -coagulation factor xiii a-subunit for inj

2000-3125 unit..............................................................162TREXALL -methotrexate sodium tab 5 mg (base

equiv)...............................................................................21TREXALL -methotrexate sodium tab 7.5 mg (base

equiv)...............................................................................21TREXALL -methotrexate sodium tab 10 mg (base

equiv)...............................................................................21TREXALL -methotrexate sodium tab 15 mg (base

equiv)...............................................................................21TREZIX -acetaminophen-caffeine-dihydrocodeine cap

320.5-30-16 mg.............................................................104triamcinolone acetonide aerosol soln 0.147 mg/gm

(Kenalog)......................................................................181triamcinolone acetonide cream 0.025%......................181triamcinolone acetonide cream 0.1%..........................181triamcinolone acetonide cream 0.5%..........................181triamcinolone acetonide dental paste 0.1%............... 169triamcinolone acetonide lotion 0.025%.......................181triamcinolone acetonide lotion 0.1%...........................181triamcinolone acetonide oint 0.025%..........................181triamcinolone acetonide oint 0.1%.............................. 181triamcinolone acetonide oint 0.5%.............................. 181

2016



TRIAMINO -amino acids tab........................................... 131TRIAMTERENE/HYDROCHLOROTH -triamterene &

hydrochlorothiazide cap 50-25 mg.................................55triamterene & hydrochlorothiazide cap 37.5-25 mg

(Dyazide).........................................................................55triamterene & hydrochlorothiazide tab 37.5-25 mg

(Maxzide-25)...................................................................55triamterene & hydrochlorothiazide tab 75-50 mg

(Maxzide)........................................................................ 55TRIANEX -triamcinolone acetonide oint 0.05%.............. 181triazolam tab 0.25 mg (Halcion)..................................... 87TRIAZOLAM -triazolam tab 0.125 mg...............................87TRIBENZOR -olmesartan-amlodipine-hydrochlorothiazide

tab 20-5-12.5 mg............................................................ 53TRIBENZOR -olmesartan-amlodipine-hydrochlorothiazide

tab 40-5-12.5 mg............................................................ 53TRIBENZOR -olmesartan-amlodipine-hydrochlorothiazide

tab 40-5-25 mg............................................................... 53TRIBENZOR -olmesartan-amlodipine-hydrochlorothiazide

tab 40-10-12.5 mg.......................................................... 53TRIBENZOR -olmesartan-amlodipine-hydrochlorothiazide

tab 40-10-25 mg............................................................. 53TRICARE PRENATAL COMPLEAT -prenat w/o a fefum-fa

tab 27-1 mg & fish oil chew cap pak............................127TRICARE PRENATAL DHA ONE/ -prenatal multivitamins

& minerals w/iron & fa cap 0.8 mg...............................127TRICARE PRENATAL DHA ONE -prenatal w/fe fumarate-

fa-dss-fish oil cap 27-1-500 mg................................... 127TRICARE PRENATAL -prenat w/o vit a w/ fe pyrophos-

methylf chew tab 4.5-1 mg...........................................127TRICARE -prenatal vit w/ fe fumarate-fa tab 27-1

mg..................................................................................127TRI-CHLOR -trichloroacetic acid liqd 80%......................181TRIDESILON -desonide cream 0.05%............................181trifluoperazine hcl tab 1 mg (base equivalent).............86trifluoperazine hcl tab 2 mg (base equivalent).............86trifluoperazine hcl tab 5 mg (base equivalent).............86trifluoperazine hcl tab 10 mg (base equivalent)...........86trifluridine ophth soln 1% (Viroptic)............................167TRIGLIDE -fenofibrate tab 160 mg................................... 58trihexyphenidyl hcl elixir 0.4 mg/ml............................ 118trihexyphenidyl hcl tab 2 mg........................................118trihexyphenidyl hcl tab 5 mg........................................118trimethobenzamide hcl cap 300 mg (Tigan)................. 71trimethoprim tab 100 mg................................................ 13trimipramine maleate cap 25 mg (Surmontil)...............82trimipramine maleate cap 50 mg (Surmontil)...............82trimipramine maleate cap 100 mg (Surmontil).............82TRINATAL RX 1 -prenatal vit w/ fe fumarate-fa tab 60-1

mg..................................................................................127TRINATE -prenatal vit w/ fe fumarate-fa tab 28-1 mg.....127TRINTELLIX -vortioxetine hbr tab 5 mg (base equiv).......82

TRINTELLIX -vortioxetine hbr tab 10 mg (base equiv).....82TRINTELLIX -vortioxetine hbr tab 20 mg (base equiv).....82TRISTART DHA -prenat w/o a w/fecbn-methylf-fa-dha cap

31-0.6-0.4-200 mg........................................................ 127TRISTART ONE -prenat w/o a w/fecbn-methylf-fa-dha cap

35-1-215 mg..................................................................127TRI-TABS DHA -prenat w/o a w/ fe bisglyc-fa tab 32-1 mg

& omega cap pack....................................................... 127TRIUMEQ -abacavir-dolutegravir-lamivudine tab

600-50-300 mg................................................................11TRIVEEN-DUO DHA -prenat-fe bis-fe prot succ-fa-ca tab

& omega 3 cap 400 pk.................................................127TRI-VI-FLORO -ped vit acd & l-methylfol w/ fl biphasic

susp 0.25 mg/ml........................................................... 127TRI-VI-FLORO -ped vit acd & l-methylfol w/ fl biphasic

susp 0.5 mg/ml............................................................. 127TRI-VI-FLOR -ped vit acd & l-methylfol w/ fl biphasic susp

0.25 mg/ml.................................................................... 127TRI-VI-FLOR -ped vit acd & l-methylfol w/ fl biphasic susp

0.5 mg/ml...................................................................... 127TRI-VIT/FLUORIDE/IRON -pediatric vitamins acd fluoride

& fe drops 0.25-10 mg/ml.............................................127TROKENDI XR -topiramate cap er 24hr 25 mg..............115TROKENDI XR -topiramate cap er 24hr 50 mg..............115TROKENDI XR -topiramate cap er 24hr 100 mg............115TROKENDI XR -topiramate cap er 24hr 200 mg............115tropicamide ophth soln 0.5%....................................... 167tropicamide ophth soln 1% (Mydriacyl)...................... 167trospium chloride cap er 24hr 60 mg............................75trospium chloride tab 20 mg..........................................75TRULANCE -plecanatide tab 3 mg................................... 74TRULICITY -dulaglutide soln pen-injector 0.75

mg/0.5ml..........................................................................33TRULICITY -dulaglutide soln pen-injector 1.5

mg/0.5ml..........................................................................33TRUVADA -emtricitabine-tenofovir disoproxil fumarate tab

100-150 mg.....................................................................11TRUVADA -emtricitabine-tenofovir disoproxil fumarate tab



200-300 mg.....................................................................11TUDORZA PRESSAIR -aclidinium bromide aerosol powd

breath activated 400 mcg/act.........................................66TUSNEL C -pseudoephedrine w/ cod-gg syrup 30-10-100

mg/5ml.............................................................................62TUSNEL -pseudoephedrine w/ dm-gg tab 60-30-400

mg....................................................................................62TUSSICAPS -hydrocod polst-chlorphen polst cap er 12hr

5-4 mg............................................................................. 62

2016



TUSSICAPS -hydrocod polst-chlorphen polst cap er 12hr10-8 mg........................................................................... 62

TUZISTRA XR -codeine polist-chlorphen polist er susp14.7-2.8 mg/5ml..............................................................63

TWOCAL HN -nutritional supplement liquid....................148TWOCAL HN 2.0 -nutritional supplement liquid..............148TYBOST -cobicistat tab 150 mg....................................... 11TYKERB -lapatinib ditosylate tab 250 mg (base

equiv)...............................................................................21TYLACTIN RESTORE 10 -nutritional supplement

liquid.............................................................................. 148TYLACTIN RESTORE 5PE -nutritional supplement

pack............................................................................... 148TYLACTIN RTD 15 -nutritional supplement liquid.......... 148TYMLOS -abaloparatide subcutaneous soln pen-injector

3120 mcg/1.56ml............................................................ 41TYR ANAMIX EARLY YEARS -nutritional supplement

powder...........................................................................148TYR ANAMIX NEXT -nutritional supplement powder..... 148TYR COOLER -nutritional supplement liquid..................148TYR COOLER20 -nutritional supplement liquid..............148TYREX-1 -nutritional supplement powder.......................148TYREX-2 -nutritional supplement powder.......................148TYR EXPRESS -nutritional supplement pack.................148TYR EXPRESS20 -nutritional supplement pack.............148TYR GEL -nutritional supplement pack...........................148TYR LOPHLEX LQ -nutritional supplement liquid...........148TYROS 1 -nutritional supplement powder...................... 148TYROS 2 -nutritional supplement powder...................... 148TYVASO REFILL -treprostinil inhalation solution 0.6 mg/

ml..................................................................................... 59TYVASO STARTER -treprostinil inhalation solution 0.6

mg/ml...............................................................................59TYVASO -treprostinil inhalation solution 0.6 mg/ml.......... 59

UUCD ANAMIX JUNIOR -nutritional supplement

powder...........................................................................148UCD 2 -nutritional supplement powder........................... 148UCD TRIO -nutritional supplement powder.................... 148UCERIS -budesonide rectal foam 2 mg/act....................170UCERIS -budesonide tab er 24hr 9 mg............................23UDAMIN SP -multiple vitamins w/ minerals & fa tab 1

mg..................................................................................127ULESFIA -benzyl alcohol lotion 5%................................ 181ULORIC -febuxostat tab 40 mg.......................................109ULORIC -febuxostat tab 80 mg.......................................109ULTIMATECARE ONE -prenatal vit w/ fe cbn-fe asp glyc-

fa-omega 3 cap 27-1mg...............................................127ULTRACAL HN PLUS -nutritional supplement liquid......148ULTRACAL -nutritional supplement liquid.......................148

ULTRAMINO SOY PROTEIN -nutritional supplementpowder...........................................................................148

ULTRASAL-ER -salicylic acid er film-forming soln28.5%.............................................................................181

ULTRAVATE -halobetasol propionate lotion 0.05%........ 181UPTRAVI -selexipag tab 200 mcg.....................................59UPTRAVI -selexipag tab 400 mcg.....................................59UPTRAVI -selexipag tab 600 mcg.....................................60UPTRAVI -selexipag tab 800 mcg.....................................60UPTRAVI -selexipag tab 1000 mcg...................................60UPTRAVI -selexipag tab 1200 mcg...................................60UPTRAVI -selexipag tab 1400 mcg...................................60UPTRAVI -selexipag tab 1600 mcg...................................60UPTRAVI -selexipag tab therapy pack 200 mcg (140) &

800 mcg (60)...................................................................59URAMAXIN -urea in ammonium lactate vehicle foam

20%................................................................................181urea cream 40%............................................................. 181urea cream 50%............................................................. 181urea cream 39% (Aluvea)..............................................181urea cream 47% (Keralac).............................................181urea cream 45% (Uramaxin)......................................... 181urea foam 40% (Hydro 40 foam).................................. 181urea gel 45% (Uramaxin)...............................................181urea in lactic acid vehicle foam 35% (Hydro 35)........181UREA IN ZINC UNDECYLENATE -urea in zinc

undecylenate-lactic acid vehicle emulsion 50%...........181urea lotion 40%.............................................................. 181UREA NAIL -urea in zinc undecylenate-lactic acid vehicle

stick 50%.......................................................................181urea suspension 50%....................................................181UREA TOPICAL -urea suspension 40%.........................181UREVAZ -urea cream 44%............................................. 181URIMAR-T -methenamine-hyosc-meth blue-sod phos-

phen sal tab 120 mg...................................................... 75URINE TEST STRIPS-VARIOUS....................................183ursodiol cap 300 mg (Actigall).......................................74ursodiol tab 250 mg (Urso 250)..................................... 74ursodiol tab 500 mg (Urso forte)................................... 74UTIBRON NEOHALER -indacaterol-glycopyrrolate inhal

cap 27.5-15.6 mcg..........................................................66UTOPIC -urea cream 41%.............................................. 181UTYMAX -nutritional supplement pack........................... 148

VVAGIFEM -estradiol vaginal tab 10 mcg...........................76valacyclovir hcl tab 1 gm (Valtrex)................................ 11valacyclovir hcl tab 500 mg (Valtrex)............................ 11VALCHLOR -mechlorethamine hcl gel 0.016% (base

equivalent).....................................................................181VALCYTE -valganciclovir hcl for soln 50 mg/ml (base

equiv)...............................................................................11

2016



valganciclovir hcl for soln 50 mg/ml (base equiv)(Valcyte)..........................................................................11

valganciclovir hcl tab 450 mg (base equivalent)(Valcyte)..........................................................................11

valproate sodium oral soln 250 mg/5ml (base equiv)(Depakene)................................................................... 115

valproic acid cap 250 mg (Depakene).........................115valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovan

hct).................................................................................. 53valsartan-hydrochlorothiazide tab 160-12.5 mg

(Diovan hct)................................................................... 53valsartan-hydrochlorothiazide tab 160-25 mg (Diovan

hct).................................................................................. 53valsartan-hydrochlorothiazide tab 320-12.5 mg

(Diovan hct)................................................................... 54valsartan-hydrochlorothiazide tab 320-25 mg (Diovan

hct).................................................................................. 54valsartan tab 40 mg (Diovan)......................................... 53valsartan tab 80 mg (Diovan)......................................... 53valsartan tab 160 mg (Diovan)....................................... 53valsartan tab 320 mg (Diovan)....................................... 53VANATOL LQ -butalbital-acetaminophen-caffeine soln

50-325-40 mg/15ml.........................................................96VANATOL S -butalbital-acetaminophen-caffeine soln

50-325-40 mg/15ml.........................................................96vancomycin hcl cap 125 mg (Vancocin hcl).................13vancomycin hcl cap 250 mg (Vancocin hcl).................13VARIZIG -varicella-zoster immune glob (human) im inj

125 unit/1.2ml................................................................. 15VARUBI -rolapitant hcl tab 90 mg (base equiv)................ 71VASCEPA -icosapent ethyl cap 0.5 gm............................ 58VASCEPA -icosapent ethyl cap 1 gm............................... 58VECAMYL -mecamylamine hcl tab 2.5 mg.......................54VECTICAL -calcitriol oint 3 mcg/gm................................181VELPHORO -sucroferric oxyhydroxide chew tab 500

mg....................................................................................74VELTASSA -patiromer sorbitex calcium for susp packet

8.4 gm (base eq).......................................................... 186VELTASSA -patiromer sorbitex calcium for susp packet

16.8 gm (base eq)........................................................ 186VELTASSA -patiromer sorbitex calcium for susp packet

25.2 gm (base eq)........................................................ 186VEMAVITE-PRX 2 -prenatal w/o vit a w/ fe fum-dss-fa-

dha cap 27-1.25-300 mg..............................................127VENA-BAL DHA -prenat w/fe poly-na fered-fa tab 27-1 &

omega cap dr 430mg................................................... 127VENCLEXTA STARTING PACK -venetoclax tab therapy

starter pack 10 & 50 & 100 mg......................................21VENCLEXTA -venetoclax tab 10 mg.................................21VENCLEXTA -venetoclax tab 50 mg.................................21VENCLEXTA -venetoclax tab 100 mg...............................21VENELEX -balsam peru-castor oil oint........................... 181

venlafaxine hcl cap er 24hr 37.5 mg (base equivalent)(Effexor xr).....................................................................82

venlafaxine hcl cap er 24hr 75 mg (base equivalent)(Effexor xr).....................................................................82

venlafaxine hcl cap er 24hr 150 mg (base equivalent)(Effexor xr).....................................................................82

venlafaxine hcl tab er 24hr 225 mg (baseequivalent)......................................................................82

venlafaxine hcl tab er 24hr 37.5 mg (base equivalent)(Venlafaxine hcl er).......................................................82

venlafaxine hcl tab er 24hr 75 mg (base equivalent)(Venlafaxine hcl er).......................................................82

venlafaxine hcl tab er 24hr 150 mg (base equivalent)(Venlafaxine hcl er).......................................................82

venlafaxine hcl tab 25 mg...............................................82venlafaxine hcl tab 37.5 mg............................................82venlafaxine hcl tab 50 mg...............................................82venlafaxine hcl tab 75 mg...............................................82venlafaxine hcl tab 100 mg.............................................82VENTAVIS -iloprost inhalation solution 10 mcg/ml........... 60VENTAVIS -iloprost inhalation solution 20 mcg/ml........... 60VENTOLIN HFA -albuterol sulfate inhal aero 108 mcg/act

(90mcg base equiv)........................................................66verapamil hcl cap er 24hr 120 mg (Verelan).................45verapamil hcl cap er 24hr 180 mg (Verelan).................45verapamil hcl cap er 24hr 240 mg (Verelan).................45verapamil hcl cap er 24hr 360 mg (Verelan).................46verapamil hcl cap er 24hr 100 mg (Verelan pm)...........45verapamil hcl cap er 24hr 200 mg (Verelan pm)...........45verapamil hcl cap er 24hr 300 mg (Verelan pm)...........45verapamil hcl tab er 120 mg (Calan sr).........................46verapamil hcl tab er 180 mg (Calan sr).........................46verapamil hcl tab er 240 mg (Calan sr).........................46verapamil hcl tab 40 mg................................................. 46verapamil hcl tab 80 mg (Calan)....................................46verapamil hcl tab 120 mg (Calan)..................................46VERDESO -desonide foam 0.05%..................................181VEREGEN -sinecatechins oint 15%................................181VERIPRED 20 -prednisolone sod phosphate oral soln 20

mg/5ml (base equiv).......................................................23VERSACLOZ -clozapine susp 50 mg/ml.......................... 86VESICARE -solifenacin succinate tab 5 mg..................... 75VESICARE -solifenacin succinate tab 10 mg................... 75VHC 2.25 -nutritional supplement liquid..........................148VIBERZI -eluxadoline tab 75 mg.......................................74VIBERZI -eluxadoline tab 100 mg.....................................74VICTOZA -liraglutide soln pen-injector 18 mg/3ml (6 mg/

ml)....................................................................................33VIDEX -didanosine for soln 2 gm......................................11VIDEX -didanosine for soln 4 gm......................................11VIEKIRA PAK -ombitas-paritapre-riton & dasab tab pak

12.5-75-50 & 250 mg..................................................... 11

2016



VIEKIRA XR -dasab-ombit-paritap-riton tab er 24hr200-8.33-50-33.33 mg.................................................... 11

vigabatrin powd pack 500 mg (Sabril)........................ 115VIGAMOX -moxifloxacin hcl ophth soln 0.5% (base

equiv).............................................................................167VIIBRYD STARTER PACK -vilazodone hcl tab starter kit

10 (7) & 20 (23) mg....................................................... 82VIIBRYD -vilazodone hcl tab 10 mg..................................82VIIBRYD -vilazodone hcl tab 20 mg..................................82VIIBRYD -vilazodone hcl tab 40 mg..................................82VILACTIN AA PLUS -nutritional supplement liquid.........148VIMPAT -lacosamide oral solution 10 mg/ml.................. 115VIMPAT -lacosamide tab 50 mg......................................115VIMPAT -lacosamide tab 100 mg....................................115VIMPAT -lacosamide tab 150 mg....................................115VIMPAT -lacosamide tab 200 mg....................................115VINATE DHA RF -prenat w/o a w/fefum-methylfol-omegas

cap 27-1.13 mg.............................................................127VINATE II -prenatal vit w/ fe bisglycinate chelate-fa tab

29-1 mg......................................................................... 127VINATE M -prenatal vit w/ sel-fe fumarate-fa tab 27-1

mg..................................................................................127VINATE ONE -prenatal vit w/ fe fumarate-fa tab 60-1

mg..................................................................................127VIOKACE -pancrelipase (lip-prot-amyl) tab

10440-39150-39150 unit................................................ 71VIOKACE -pancrelipase (lip-prot-amyl) tab

20880-78300-78300 unit................................................ 71VIRACEPT -nelfinavir mesylate tab 250 mg.....................11VIRACEPT -nelfinavir mesylate tab 625 mg.....................11VIRAMUNE -nevirapine susp 50 mg/5ml..........................11VIRAMUNE XR -nevirapine tab er 24hr 100 mg...............11VIRAZOLE -ribavirin for inhal soln 6 gm...........................11VIREAD -tenofovir disoproxil fumarate oral powder 40

mg/gm..............................................................................11VIREAD -tenofovir disoproxil fumarate tab 150 mg.......... 11VIREAD -tenofovir disoproxil fumarate tab 200 mg.......... 11VIREAD -tenofovir disoproxil fumarate tab 250 mg.......... 11VIREAD -tenofovir disoproxil fumarate tab 300 mg.......... 11VIRT-ADVANCE -prenatal vit w/ dss-iron carbonyl-fa tab

90-1 mg......................................................................... 127VIRT-C DHA -prenatal w/fe fum-fe poly -fa-omega 3 cap

53.5-38-1 mg.................................................................128VIRT-NATE DHA -prenatal vit w/ fe fum-fa-omega 3 cap

28-1-200 mg..................................................................128VIRT NATE -prenatal vit w/ fe fumarate-fa tab 28-1

mg..................................................................................127VIRT-PN DHA -prenat w/o a w/fefum-methfol-fa-dha cap

27-0.6-0.4-300 mg........................................................ 128VIRT-PN PLUS -prenat w/o a w/ fe fumerate-methylfolate-

fa-omega 3 cap.............................................................128

VIRT-PN -prenatal vit w/ fe fum-methylfolate-fa tab27-0.6-0.4 mg................................................................128

VIRTPREX -prenatal w/o vit a w/ fe fum-dss-fa-dha cap26-1.2-300 mg...............................................................128

VIRT-SELECT -prenatal w/o vit a w/ fe fum-dss-fa-dhacap 29-1.25-325 mg..................................................... 128

VIRT-VITE GT -prenatal vit w/ dss-iron carbonyl-fa tab90-1 mg......................................................................... 128

VISTOGARD -uridine triacetate oral granules packet 10gm..................................................................................183

VITAFOL FE+ -prenat-fepoly-methol-fa-dha cap 90-1-200mg & dss 50mg cap..................................................... 128

VITAFOL GUMMIES -prenat vit w/ fe phos-fa-omegachew tab 3.33-0.333-34.8 mg...................................... 128

VITAFOL-NANO -prenatal w/o a w/ fefum-l methylfol-fatab 18-0.6-0.4 mg......................................................... 128

VITAFOL-OB+DHA -prenatal mv w/fe fum-fa tab 65-1 mg& dha cap 250 mg pack...............................................128

VITAFOL-OB -prenatal vit w/ fe fumarate-fa tab 65-1mg..................................................................................128

VITAFOL-ONE -prenatal mv w/ fe polysac cmplx-fa-dhacap 29-1-200 mg.......................................................... 128

VITAFOL ULTRA -prenat w/fe poly-methylfol-fa-dha cap29-0.6-0.4-200 mg........................................................ 128

VITAJOULE -nutritional supplement powder...................148VITAL AF 1.2 CAL ADVANCED -nutritional supplement

liquid.............................................................................. 149VITAL AF 1.2 CAL -nutritional supplement liquid............148VITAL 1.0 CAL -nutritional supplement liquid................. 149VITAL 1.5 CAL -nutritional supplement liquid................. 149VITAL-D RX -b-complex w/ c-biotin-d-zinc & folic acid tab

1 mg.............................................................................. 128VITAL HIGH PROTEIN -nutritional supplement

liquid.............................................................................. 149VITAL HN -nutritional supplement pack.......................... 149VITAL HP 1.0 CAL -nutritional supplement liquid........... 149VITAL JR -nutritional supplement liquid.......................... 149VITAL PEPTIDE 1.5 CAL -nutritional supplement

liquid.............................................................................. 149VITAMEDMD ONE RX/QUATREFO -prenat w/o a w/

fefum-methfol-fa-dha cap 30-0.6-0.4-200 mg.............. 128VITAMEDMD REDICHEW RX -prenat w/ b2-b6-b12-d3-

folic acid chew tab 1.4 mg........................................... 128VITAMELTS VITAMIN D -cholecalciferol orally

disintegrating tab 1000 unit..........................................119VITAMIN D3 -cholecalciferol oral liquid 1200

unit/15ml........................................................................119VITAMIN D3 -cholecalciferol spray 1000 unit/spray........119VITAMIN D2 -ergocalciferol tab 400 unit.........................119VITAPEARL -prenat w/oa w/fefum-na fered-fa-dha cap er

30-1.4-200 mg...............................................................128

2016



VITA-PREN -prenatal vit w/ docusate-iron-fa tab 65-1mg..................................................................................128

VITAPRO -nutritional supplement powder...................... 149VITAQUICK -nutritional supplement powder...................149VITATRUE -prenat w/o a w/fe chel-fa tab 30-1.4 mg & dha

cap 300mg pk............................................................... 128VITUZ -hydrocodone-chlorpheniramine soln 5-4

mg/5ml.............................................................................63VIVA DHA -prenatal vit w/ fe fum-fa-omega 3 cap

28-1-200 mg..................................................................128VIVONEX PEDIATRIC -nutritional supplement pack...... 149VIVONEX PLUS -nutritional supplement powder........... 149VIVONEX RTF -nutritional supplement liquid................. 149VIVONEX T.E.N. -nutritional supplement pack............... 149VIVOTIF -typhoid vaccine cap delayed release................14VOL-NATE -prenatal vit w/ fe fumarate-fa tab 28-1

mg..................................................................................128VOL-PLUS -prenatal vit w/ fe fumarate-fa tab 27-1

mg..................................................................................128VOL-TAB RX -prenatal vit w/ iron carbonyl-fa tab 29-1

mg..................................................................................128VOLTAREN -diclofenac sodium gel 1%.......................... 181voriconazole for susp 40 mg/ml (Vfend).........................6voriconazole tab 50 mg (Vfend).......................................6voriconazole tab 200 mg (Vfend).....................................6VOTRIENT -pazopanib hcl tab 200 mg (base equiv)....... 21VP-CH-PNV -prenatal w/o vit a w/ fe cbn-dss-fa-dha cap

30-1-260 mg..................................................................128VP-GGR-B6 PRENATAL -prenatal w/ calcium-vit b6-fa-

ginger tab 1.2 mg......................................................... 128VP-HEME OB + DHA -prenat-fe poly cmplx-fe heme poly-

fa tab & omega 3 cap pck............................................129VP-HEME OB -prenat vit-fe poly cmplx-fe heme poly-fa

tab 28-6-1 mg............................................................... 129VP-HEME ONE -prenat-fe poly cmplx-fe heme poly-fa-

dha cap 22-6-1-200 mg................................................129VP-PNV-DHA -prenatal vit w/ fe fum-fa-omega 3 cap

28-1-215.8 mg...............................................................129VRAYLAR -cariprazine hcl cap 1.5 mg (base

equivalent).......................................................................86VRAYLAR -cariprazine hcl cap 3 mg (base

equivalent).......................................................................86VRAYLAR -cariprazine hcl cap 4.5 mg (base

equivalent).......................................................................86VRAYLAR -cariprazine hcl cap 6 mg (base

equivalent).......................................................................86VRAYLAR -cariprazine hcl cap therapy pack 1.5 mg (1) &

3 mg (6).......................................................................... 86VUSION -miconazole-zinc oxide-white petrolatum oint

0.25-15-81.35%.............................................................181VYTONE -iodoquinol-hydrocortisone in aloe vehicle

cream 1-1.9%................................................................182

VYTORIN -ezetimibe-simvastatin tab 10-10 mg............... 58VYTORIN -ezetimibe-simvastatin tab 10-20 mg............... 58VYTORIN -ezetimibe-simvastatin tab 10-40 mg............... 58VYTORIN -ezetimibe-simvastatin tab 10-80 mg............... 58VYVANSE -lisdexamfetamine dimesylate cap 10 mg.......90VYVANSE -lisdexamfetamine dimesylate cap 20 mg.......91VYVANSE -lisdexamfetamine dimesylate cap 30 mg.......91VYVANSE -lisdexamfetamine dimesylate cap 40 mg.......91VYVANSE -lisdexamfetamine dimesylate cap 50 mg.......91VYVANSE -lisdexamfetamine dimesylate cap 60 mg.......91VYVANSE -lisdexamfetamine dimesylate cap 70 mg.......91VYVANSE -lisdexamfetamine dimesylate chew tab 10

mg....................................................................................91VYVANSE -lisdexamfetamine dimesylate chew tab 20





mg....................................................................................91

WWALGREENS GLUCOSE -glucose chew tab 4 gm......... 34WALGREENS GLUCOSE -glucose-vitamin c chew tab

4-0.006 gm......................................................................34warfarin sodium tab 1 mg (Coumadin)....................... 156warfarin sodium tab 2 mg (Coumadin)....................... 156warfarin sodium tab 2.5 mg (Coumadin).................... 156warfarin sodium tab 3 mg (Coumadin)....................... 156warfarin sodium tab 4 mg (Coumadin)....................... 156warfarin sodium tab 5 mg (Coumadin)....................... 156warfarin sodium tab 6 mg (Coumadin)....................... 156warfarin sodium tab 7.5 mg (Coumadin).................... 156warfarin sodium tab 10 mg (Coumadin)..................... 156WELCHOL -colesevelam hcl packet for susp 3.75 gm.....58WELCHOL -colesevelam hcl tab 625 mg......................... 58WELLESSE VITAMIN D3 -cholecalciferol oral liquid 1000

unit/10ml........................................................................119WELLNESS ESSENTIALS AI -nutritional supplement

kit................................................................................... 149WELLNESS ESSENTIALS BLOOD -nutritional

supplement kit...............................................................149WELLNESS ESSENTIALS FOR J -nutritional supplement

kit................................................................................... 149WELLNESS ESSENTIALS FOR M -nutritional

supplement kit...............................................................149WELLNESS ESSENTIALS FOR P -nutritional supplement

kit................................................................................... 149

2016



WELLNESS ESSENTIALS FOR W -nutritionalsupplement kit...............................................................149

WELLNESS ESSENTIALS -nutritional supplementkit................................................................................... 149

WESTHROID -thyroid tab 32.5 mg................................... 37WESTHROID -thyroid tab 65 mg...................................... 37WESTHROID -thyroid tab 97.5 mg................................... 37WESTHROID -thyroid tab 130 mg.................................... 37WESTHROID -thyroid tab 195 mg.................................... 37WIDE-SEAL SILICONE DIAPHR -diaphragm wide seal 60

mm.................................................................................184WIDE-SEAL SILICONE DIAPHR -diaphragm wide seal 65







mm.................................................................................184WILATE -antihemophilic factor/vwf (human) for inj

500-500 unit kit............................................................. 162WILATE -antihemophilic factor/vwf (human) for inj

1000-1000 unit kit.........................................................162WND 1 -nutritional supplement powder.......................... 149WND 2 -nutritional supplement powder.......................... 149WP THYROID -thyroid tab 16.25 mg................................37WP THYROID -thyroid tab 32.5 mg..................................37WP THYROID -thyroid tab 65 mg.....................................38WP THYROID -thyroid tab 81.25 mg................................38WP THYROID -thyroid tab 97.5 mg..................................38WP THYROID -thyroid tab 113.75 mg.............................. 38WP THYROID -thyroid tab 130 mg...................................38WP THYROID -thyroid tab 48.75 mg (3/4 grain).............. 38

XXALKORI -crizotinib cap 200 mg...................................... 21XALKORI -crizotinib cap 250 mg...................................... 21XAQUIL XR -levomefolate glucosamine tab er 30

mg..................................................................................149XARELTO -rivaroxaban tab 10 mg..................................156XARELTO -rivaroxaban tab 15 mg..................................156XARELTO -rivaroxaban tab 20 mg..................................156XARELTO STARTER PACK -rivaroxaban tab starter

therapy pack 15 mg & 20 mg.......................................156XELJANZ -tofacitinib citrate tab 5 mg (base

equivalent).....................................................................108

XELJANZ XR -tofacitinib citrate tab er 24hr 11 mg (baseequivalent).....................................................................108

XENAZINE -tetrabenazine tab 12.5 mg............................ 95XENAZINE -tetrabenazine tab 25 mg............................... 95XERESE -acyclovir-hydrocortisone cream 5-1%............182XERMELO -telotristat etiprate tab 250 mg (telotristat ethyl

equiv)...............................................................................74XEROFORM NON-OCCLUSIVE OI -bismuth

tribromophenate-petrolatum dressing pads................. 182XEROFORM OCCLUSIVE PETROL -bismuth

tribromophenate-petrolatum dressing - misc............... 182XEROFORM OCCLUSIVE PETROL -bismuth

tribromophenate-petrolatum dressing pads................. 182XIFAXAN -rifaximin tab 200 mg........................................ 13XIFAXAN -rifaximin tab 550 mg........................................ 13XIGDUO XR -dapagliflozin-metformin hcl tab er 24hr

5-500 mg......................................................................... 34XIGDUO XR -dapagliflozin-metformin hcl tab er 24hr

5-1000 mg.......................................................................34XIGDUO XR -dapagliflozin-metformin hcl tab er 24hr

10-500 mg.......................................................................34XIGDUO XR -dapagliflozin-metformin hcl tab er 24hr

10-1000 mg.....................................................................34XIIDRA -lifitegrast ophth soln 5%....................................167XLEU MAXAMAID -nutritional supplement powder........ 149XLEU MAXAMUM -nutritional supplement powder.........149XLYS-XTRP MAXAMAID -nutritional supplement

powder...........................................................................149XLYS-XTRP MAXAMUM -nutritional supplement

powder...........................................................................149XMET MAXAMAID -nutritional supplement powder........149XMET MAXAMUM -nutritional supplement powder........149XMTVI MAXAMAID -nutritional supplement powder.......149XMTVI MAXAMUM -nutritional supplement powder.......149XOLEGEL -ketoconazole gel 2%.................................... 182XOPENEX HFA -levalbuterol tartrate inhal aerosol 45

mcg/act (base equiv)...................................................... 66XPHE MAXAMAID -nutritional supplement powder........149XPHE MAXAMUM -amino acids oral powder................. 131XPHE MAXAMUM -amino acids pack............................ 131XPHE-XTYR MAXAMAID -nutritional supplement

powder...........................................................................150XTAMPZA ER -oxycodone cap er 12hr abuse-deterrent 9

mg..................................................................................104XTAMPZA ER -oxycodone cap er 12hr abuse-deterrent

13.5 mg......................................................................... 104XTAMPZA ER -oxycodone cap er 12hr abuse-deterrent

18 mg............................................................................ 104XTAMPZA ER -oxycodone cap er 12hr abuse-deterrent

27 mg............................................................................ 104XTAMPZA ER -oxycodone cap er 12hr abuse-deterrent

36 mg............................................................................ 104

2016



XTANDI -enzalutamide cap 40 mg....................................21XTRACAL PLUS -nutritional supplement liquid.............. 150XULANE -norelgestromin-ethinyl estradiol td ptwk 150-35

mcg/24hr..........................................................................28XURIDEN -uridine triacetate oral granules packet 2

gm....................................................................................41XYNTHA -antihemophilic factor recombinant paf for inj kit

250 unit......................................................................... 162XYNTHA -antihemophilic factor recombinant paf for inj kit

500 unit......................................................................... 162XYNTHA -antihemophilic factor recombinant paf for inj kit

1000 unit....................................................................... 162XYNTHA -antihemophilic factor recombinant paf for inj kit

2000 unit....................................................................... 162XYNTHA SOLOFUSE -antihemophilic factor recombinant

paf for inj kit 250 unit................................................... 162XYNTHA SOLOFUSE -antihemophilic factor recombinant

paf for inj kit 500 unit................................................... 162XYNTHA SOLOFUSE -antihemophilic factor recombinant

paf for inj kit 1000 unit................................................. 162XYNTHA SOLOFUSE -antihemophilic factor recombinant

paf for inj kit 2000 unit................................................. 162XYNTHA SOLOFUSE -antihemophilic factor recombinant

paf for inj kit 3000 unit................................................. 162XYREM -sodium oxybate oral solution 500 mg/ml........... 95XYZBAC -dietary management product - tabs................150

Y

ZZACLIR CLEANSING -benzoyl peroxide lotion 8%........ 182zafirlukast tab 10 mg (Accolate).................................... 66zafirlukast tab 20 mg (Accolate).................................... 66zaleplon cap 5 mg (Sonata)............................................87zaleplon cap 10 mg (Sonata)..........................................87ZAMICET -hydrocodone-acetaminophen soln 10-325

mg/15ml.........................................................................104ZARONTIN -ethosuximide cap 250 mg.......................... 115ZARONTIN -ethosuximide soln 250 mg/5ml...................115ZARXIO -filgrastim-sndz soln prefilled syringe 300

mcg/0.5ml......................................................................154ZARXIO -filgrastim-sndz soln prefilled syringe 480

mcg/0.8ml......................................................................154ZATEAN-PN DHA -prenat w/o a w/fefum-methfol-fa-dha

cap 27-0.6-0.4-300 mg................................................. 129ZATEAN-PN PLUS -prenat w/o a w/ fe fumerate-

methylfolate-fa-omega 3 cap........................................129ZAVARA -folic acid-cholecalciferol cap 1 mg-5750

unit................................................................................. 154ZAVESCA -miglustat cap 100 mg................................... 154ZEJULA -niraparib tosylate cap 100 mg (base

equivalent).......................................................................21

ZELAPAR -selegiline hcl orally disintegrating tab 1.25mg..................................................................................118

ZELBORAF -vemurafenib tab 240 mg.............................. 21ZENPEP -pancrelipase (lip-prot-amyl) dr cap

3000-10000-16000 unit...................................................71ZENPEP -pancrelipase (lip-prot-amyl) dr cap

5000-17000-27000 unit...................................................71ZENPEP -pancrelipase (lip-prot-amyl) dr cap

10000-34000-55000 unit................................................ 71ZENPEP -pancrelipase (lip-prot-amyl) dr cap

15000-51000-82000 unit................................................ 71ZENPEP -pancrelipase (lip-prot-amyl) dr cap

20000-68000-109000 unit.............................................. 72ZENPEP -pancrelipase (lip-prot-amyl) dr cap

25000-85000-136000 unit.............................................. 72ZENPEP -pancrelipase (lip-prot-amyl) dr cap

40000-136000-218000 unit............................................ 72ZEPATIER -elbasvir-grazoprevir tab 50-100 mg...............11ZERIT -stavudine for oral soln 1 mg/ml............................ 11ZETIA -ezetimibe tab 10 mg............................................. 58ZETONNA -ciclesonide nasal aerosol soln 37 mcg/act (50

mcg/valve)....................................................................... 61ZIAGEN -abacavir sulfate soln 20 mg/ml (base equiv).....11zidovudine cap 100 mg (Retrovir)................................. 11zidovudine syrup 10 mg/ml (Retrovir)...........................11zidovudine tab 300 mg....................................................11zileuton tab er 12hr 600 mg (Zyflo cr)...........................66ZINBRYTA -daclizumab soln prefilled syringe 150 mg/

ml..................................................................................... 95ZIOPTAN -tafluprost ophth soln 0.0015%.......................167ziprasidone hcl cap 20 mg (Geodon)............................ 87ziprasidone hcl cap 40 mg (Geodon)............................ 87ziprasidone hcl cap 60 mg (Geodon)............................ 87ziprasidone hcl cap 80 mg (Geodon)............................ 87ZIRGAN -ganciclovir ophth gel 0.15%............................ 167ZITHRANOL -anthralin shampoo 1%..............................182ZITHROMAX -azithromycin powd pack for susp 1 gm....... 4ZMAX -azithromycin extended release for oral susp 2

gm......................................................................................4ZOHYDRO ER -hydrocodone bitartrate cap er 12hr

abuse-deterrent 10 mg................................................. 104ZOHYDRO ER -hydrocodone bitartrate cap er 12hr





abuse-deterrent 50 mg................................................. 104

2016



ZOLATE -folic acid-cholecalciferol cap 1 mg-3775unit................................................................................. 154

ZOLINZA -vorinostat cap 100 mg..................................... 21zolmitriptan orally disintegrating tab 2.5 mg (Zomig

zmt)............................................................................... 109zolmitriptan orally disintegrating tab 5 mg (Zomig

zmt)............................................................................... 109zolmitriptan tab 2.5 mg (Zomig)...................................109zolmitriptan tab 5 mg (Zomig)......................................109zolpidem tartrate sl tab 1.75 mg (Intermezzo)..............87zolpidem tartrate sl tab 3.5 mg (Intermezzo)................87zolpidem tartrate tab er 6.25 mg (Ambien cr)...............87zolpidem tartrate tab er 12.5 mg (Ambien cr)...............88zolpidem tartrate tab 5 mg (Ambien).............................88zolpidem tartrate tab 10 mg (Ambien)...........................88ZOMIG -zolmitriptan nasal spray 2.5 mg/spray unit........109ZOMIG -zolmitriptan nasal spray 5 mg/spray unit...........109ZONALON -doxepin hcl cream 5%................................. 182zonisamide cap 50 mg.................................................. 115zonisamide cap 25 mg (Zonegran).............................. 115zonisamide cap 100 mg (Zonegran)............................ 115ZONTIVITY -vorapaxar sulfate tab 2.08 mg (base

equivalent).....................................................................162ZORTRESS -everolimus tab 0.25 mg.............................186ZORTRESS -everolimus tab 0.5 mg...............................186ZORTRESS -everolimus tab 0.75 mg.............................186ZOSTAVAX -zoster vaccine live for subcutaneous susp

19400 unit/0.65ml........................................................... 14ZOVIRAX -acyclovir cream 5%....................................... 182Z-TUSS AC -chlorpheniramine w/ codeine liquid 2-9

mg/5ml.............................................................................63ZUBSOLV -buprenorphine hcl-naloxone hcl sl tab

0.7-0.18 mg (base eq)..................................................104ZUBSOLV -buprenorphine hcl-naloxone hcl sl tab

1.4-0.36 mg (base eq)..................................................104ZUBSOLV -buprenorphine hcl-naloxone hcl sl tab

2.9-0.71 mg (base eq)..................................................104ZUBSOLV -buprenorphine hcl-naloxone hcl sl tab 5.7-1.4

mg (base eq)................................................................ 105ZUBSOLV -buprenorphine hcl-naloxone hcl sl tab 8.6-2.1

mg (base eq)................................................................ 105ZUBSOLV -buprenorphine hcl-naloxone hcl sl tab 11.4-2.9

mg (base eq)................................................................ 105ZUPLENZ -ondansetron oral soluble film 4 mg................ 71ZUPLENZ -ondansetron oral soluble film 8 mg................ 71ZYBAN -bupropion hcl (smoking deterrent) tab er 12hr

150 mg............................................................................ 96ZYCLARA -imiquimod cream 3.75%...............................182ZYCLARA PUMP -imiquimod cream 2.5%..................... 182ZYCLARA PUMP -imiquimod cream 3.75%................... 182ZYDELIG -idelalisib tab 100 mg........................................21ZYDELIG -idelalisib tab 150 mg........................................21

ZYFLO CR -zileuton tab er 12hr 600 mg..........................66ZYFLO -zileuton tab 600 mg.............................................66ZYKADIA -ceritinib cap 150 mg........................................ 21ZYLET -loteprednol etabonate-tobramycin ophth susp

0.5-0.3%........................................................................ 167ZYTAZE -zinc citrate-phytase cap 25-500 mg................ 150ZYTIGA -abiraterone acetate tab 250 mg.........................21ZYTIGA -abiraterone acetate tab 500 mg.........................21ZYVOX -linezolid for susp 100 mg/5ml.............................13ZYVOX -linezolid tab 600 mg............................................13

Documents

Health Insurance Marketplace Generics Plus Drug List · BCBSTX Health Insurance Marketplace 5 Tier Generics Plus Preferred Drug List December 2017 (2016 Plan Year) II . How to use