Stanford Health Care Advantage 2018 Abridged Formulary ......MG, 6.3-1 MG. 3. QL (60 per 30 days) buprenorphine hcl sublingual tablet 2 mg, 8 mg: 2. PA; QL (90 per 30 days) buprenorphine-naloxone

Stanford Health Care Advantage2018 Abridged FormularyPartial List of Covered Drugs

PLEASE READ THIS DOCUMENT CONTAINS INFORMATION ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN00018031 1This abridged formulary was updated on 09012017 This is not a complete list of drugs covered by our plan For a complete listing or other questions please contact Stanford Health Care Advantage Member Care Services at 1-855-996-8422 or for TTY users 711 8 am to 8 pm seven days a week (except Thanksgiving and Christmas) from October 1 through February 14 and Monday through Friday (except holidays) from February 15 through September 30 or visit StanfordHealthCareAdvantageorg

Table of Contents

Analgesics3Anesthetics 5Anti-AddictionSubstance Abuse Treatment Agents 6Antianxiety Agents6Antibacterials 7Anticancer Agents 10Anticholinergic Agents 13Anticonvulsants13Antidementia Agents 15Antidepressants 15Antidiabetic Agents 16Antifungals18Antigout Agents 18Antihistamines19Anti-Infectives (Skin And Mucous Membrane)19Antimigraine Agents19Antimycobacterials19Antinausea Agents20Antiparasite Agents 20Antiparkinsonian Agents20Antipsychotic Agents21Antivirals (Systemic)22Blood ProductsModifiersVolume Expanders 24Caloric Agents25Cardiovascular Agents 26Central Nervous System Agents 30Contraceptives31Dental And Oral Agents34Dermatological Agents34Devices 36Enzyme ReplacementModifiers37Eye Ear Nose Throat Agents38Gastrointestinal Agents 39Genitourinary Agents41Heavy Metal Antagonists 41Hormonal Agents StimulantReplacementModifying 41

Immunological Agents45Inflammatory Bowel Disease Agents 48Irrigating Solutions49Metabolic Bone Disease Agents 49Miscellaneous Therapeutic Agents 49Ophthalmic Agents50Replacement Preparations50Respiratory Tract Agents 51Skeletal Muscle Relaxants 53Sleep Disorder Agents 53Vasodilating Agents53Vitamins And Minerals 53

Drug Name Drug Tier RequirementsLimits

AnalgesicsAnalgesics Miscellaneousacetaminophen-codeine oral solution 120-12 mg5 ml

2 QL (2700 per 30 days)

acetaminophen-codeine oral tablet 300-15 mg

2 QL (360 per 30 days)

(Tylenol-Codeine 3) 2 QL (360 per 30 days)

butalbital-acetaminophen-caff oral capsule 50-325-40 mg

(Capacet) 2 QL (180 per 30 days)

butalbital-acetaminophen-caff oral tablet50-325-40 mg

(Esgic) 2 QL (180 per 30 days)

endocet oral tablet 10-325 mg 2 QL (240 per 30 days)

hydrocodone-acetaminophen oral solution75-325 mg15 ml

(Hycet) 2 QL (2700 per 30 days)

hydrocodone-acetaminophen oral tablet10-300 mg

(Vicodin HP) 2 QL (390 per 30 days)

(Lorcet HD) 2 QL (360 per 30 days)

(Verdrocet) 2 QL (360 per 30 days)

(Vicodin) 2 QL (390 per 30 days)

(Norco) 2 QL (360 per 30 days)

(Vicodin ES) 2 QL (390 per 30 days)

(Lorcet Plus) 2 QL (360 per 30 days)

lorcet (hydrocodone) oral tablet 5-325 mg

lorcet hd oral tablet 10-325 mg 2 QL (360 per 30 days)

lorcet plus oral tablet 75-325 mg 2 QL (360 per 30 days)

morphine 2 mgml carpuject outer lf pf sdv 2 mgml

morphine 4 mgml carpuject outerlfpf sdv 4 mgml

You can find information on what the symbols and abbreviations in this table mean by going to the introduction pages of this document

morphine 8 mgml syringe 8 mgml 2

morphine concentrate oral solution 100 mg5 ml (20 mgml)

morphine intravenous syringe 10 mgml 2 mgml 4 mgml 8 mgml

morphine oral solution 10 mg5 ml 2 QL (700 per 30 days)

morphine oral solution 20 mg5 ml (4 mgml)

MORPHINE ORAL TABLET 15 MG 4 QL (180 per 30 days)

morphine oral tablet extended release 100 mg 200 mg 60 mg

(MS Contin) 2 QL (60 per 30 days)

morphine oral tablet extended release 15 mg 30 mg

morphine sulfate 10 mgml vial 10 mgml 2

oxycodone oral capsule 5 mg 2 QL (180 per 30 days)

oxycodone oral concentrate 20 mgml 2 QL (120 per 30 days)

oxycodone oral solution 5 mg5 ml 2 QL (1300 per 30 days)

oxycodone oral tablet 10 mg 2 QL (180 per 30 days)

oxycodone oral tablet 15 mg 30 mg (Roxicodone) 2 QL (120 per 30 days)

oxycodone oral tablet 5 mg (Roxicodone) 2 QL (180 per 30 days)

oxycodone oral tabletoral onlyextrel12 hr 10 mg 15 mg 20 mg 30 mg 40 mg 60 mg

(OxyContin) 2 QL (60 per 30 days)

oxycodone oral tabletoral onlyextrel12 hr 80 mg

(OxyContin) 5 NM NDS QL (120 per 30 days)

oxycodone-acetaminophen oral solution5-325 mg5 ml

2 QL (1800 per 30 days)

oxycodone-acetaminophen oral tablet 10-325 mg

(Endocet) 2 QL (240 per 30 days)

oxycodone-acetaminophen oral tablet25-325 mg 5-325 mg

oxycodone-acetaminophen oral tablet75-325 mg

OXYCONTIN ORAL TABLETORAL ONLYEXTREL12 HR 10 MG 15 MG 20 MG 30 MG 40 MG 60 MG

OXYCONTIN ORAL TABLETORAL ONLYEXTREL12 HR 80 MG

tramadol oral tablet 50 mg (Ultram) 1 GC QL (240 per 30 days)

vicodin es oral tablet 75-300 mg 2 QL (390 per 30 days)

vicodin hp oral tablet 10-300 mg 2 QL (390 per 30 days)

vicodin oral tablet 5-300 mg 2 QL (390 per 30 days)

zebutal oral capsule 50-325-40 mg 2 QL (180 per 30 days)Nonsteroidal Anti-Inflammatory Agentsdiclofenac sodium oral tablet extended release 24 hr 100 mg

(Voltaren-XR) 2

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

ibuprofen oral suspension 100 mg5 ml (Childrens Ibuprofen) 2

ibuprofen oral tablet 400 mg 600 mg 800 mg

indomethacin oral capsule 25 mg 1 GC QL (240 per 30 days)

indomethacin oral capsule extended release 75 mg

meloxicam oral tablet 15 mg 75 mg (Mobic) 1 GC

nabumetone oral tablet 500 mg 750 mg 2

naproxen oral suspension 125 mg5 ml (Naprosyn) 2

naproxen oral tablet 250 mg 375 mg 1 GC

naproxen oral tablet 500 mg (Naprosyn) 1 GC

naproxen oral tabletdelayed release (drec) 375 mg 500 mg

(EC-Naprosyn) 2

AnestheticsLocal Anestheticslidocaine hcl injection solution 20 mgml (2 )

(Xylocaine) 2

lidocaine hcl mucous membrane jelly 2 2

lidocaine hcl mucous membrane solution4 (40 mgml)

lidocaine topical adhesive patchmedicated 5

(Lidoderm) 2 PA QL (90 per 30 days)

lidocaine topical ointment 5 2 PA QL (90 per 30 days)

lidocaine viscous mucous membrane solution 2

Anti-AddictionSubstance Abuse Treatment AgentsAnti-AddictionSubstance Abuse Treatment AgentsBUNAVAIL BUCCAL FILM 21-03 MG

BUNAVAIL BUCCAL FILM 42-07 MG 63-1 MG

buprenorphine hcl sublingual tablet 2 mg 8 mg

2 PA QL (90 per 30 days)

buprenorphine-naloxone sublingual tablet2-05 mg 8-2 mg

CHANTIX CONTINUING MONTH BOX ORAL TABLET 1 MG

CHANTIX ORAL TABLET 05 MG 1 MG

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

SUBOXONE SUBLINGUAL FILM 12-3 MG 8-2 MG

ZUBSOLV SUBLINGUAL TABLET 14-036 MG 114-29 MG 29-071 MG 57-14 MG

ZUBSOLV SUBLINGUAL TABLET 86-21 MG

Antianxiety AgentsBenzodiazepinesalprazolam oral tablet 025 mg 05 mg 1 mg

(Xanax) 1 GC QL (120 per 30 days)

alprazolam oral tablet 2 mg (Xanax) 1 GC QL (150 per 30 days)

alprazolam oral tablet extended release 24 hr 05 mg 1 mg 2 mg

(Xanax XR) 2 QL (120 per 30 days)

alprazolam oral tablet extended release 24 hr 3 mg

clonazepam oral tablet 05 mg 1 mg (Klonopin) 1 GC QL (90 per 30 days)

clonazepam oral tablet 2 mg (Klonopin) 1 GC QL (300 per 30 days)

clonazepam oral tabletdisintegrating0125 mg 025 mg 05 mg 1 mg

clonazepam oral tabletdisintegrating 2 mg

DIASTAT ACUDIAL RECTAL KIT 125-15-175-20 MG 5-75-10 MG

DIASTAT RECTAL KIT 25 MG 4

diazepam intensol oral concentrate 5 mgml

2 QL (1200 per 30 days)

diazepam oral solution 5 mg5 ml (1 mgml)

2 QL (1200 per 30 days)

diazepam oral tablet 10 mg 2 mg 5 mg (Valium) 1 GC QL (120 per 30 days)

lorazepam 2 mgml oral concent 2 mgml (Lorazepam Intensol) 2 QL (150 per 30 days)

lorazepam intensol oral concentrate 2 mgml

lorazepam oral tablet 05 mg 1 mg (Ativan) 1 GC QL (90 per 30 days)

lorazepam oral tablet 2 mg (Ativan) 1 GC QL (150 per 30 days)

AntibacterialsAminoglycosidesBETHKIS INHALATION SOLUTION FOR NEBULIZATION 300 MG4 ML

5 PA BvD NM NDS

neomycin oral tablet 500 mg 1 GC

TOBI PODHALER INHALATION CAPSULE WINHALATION DEVICE 28 MG

5 NM NDS QL (224 per 28 days)

Antibacterials Miscellaneousclindamycin hcl oral capsule 150 mg 300 mg 75 mg

(Cleocin HCl) 2

metronidazole oral tablet 250 mg 500 mg (Flagyl) 2

nitrofurantoin macrocrystal oral capsule100 mg 25 mg 50 mg

(Macrodantin) 2 QL (120 per 30 days)

nitrofurantoin monohydm-cryst oral capsule 100 mg

(Macrobid) 2 QL (60 per 30 days)

XIFAXAN ORAL TABLET 200 MG 5 PA NM NDS QL (9 per 30 days)

XIFAXAN ORAL TABLET 550 MG 5 PA NM NDSCephalosporinscefadroxil oral capsule 500 mg 2

cefadroxil oral suspension for reconstitution 250 mg5 ml 500 mg5 ml

cefadroxil oral tablet 1 gram 2

cefdinir oral capsule 300 mg 2

cefdinir oral suspension for reconstitution125 mg5 ml 250 mg5 ml

cefprozil oral suspension for reconstitution 125 mg5 ml 250 mg5 ml

cefprozil oral tablet 250 mg 500 mg 2

cefuroxime axetil oral tablet 250 mg 500 mg

cephalexin oral capsule 250 mg 500 mg (Keflex) 1 GC

cephalexin oral capsule 750 mg (Keflex) 2

cephalexin oral suspension for reconstitution 125 mg5 ml 250 mg5 ml

cephalexin oral tablet 250 mg 500 mg 2Macrolidesazithromycin intravenous recon soln 500 mg

(Zithromax) 2

azithromycin oral packet 1 gram (Zithromax) 2

azithromycin oral suspension for reconstitution 100 mg5 ml 200 mg5 ml

(Zithromax) 2

azithromycin oral tablet 250 mg (Zithromax Z-Pak) 2

azithromycin oral tablet 250 mg (6 pack) 500 mg (3 pack)

azithromycin oral tablet 500 mg (Zithromax TRI-PAK) 2

azithromycin oral tablet 600 mg (Zithromax) 2

clarithromycin oral suspension for reconstitution 125 mg5 ml 250 mg5 ml

clarithromycin oral tablet 250 mg 500 mg

clarithromycin oral tablet extended release 24 hr 500 mg

Miscellaneous B-Lactam AntibioticsCAYSTON INHALATION SOLUTION FOR NEBULIZATION 75 MGML

5 NM LA NDS

INVANZ INJECTION RECON SOLN 1 GRAM

Penicillinsamoxicillin oral capsule 250 mg 500 mg 1 GC

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

amoxicillin oral tablet 500 mg 875 mg 1 GC

amoxicillin oral tabletchewable 125 mg 250 mg

amoxicillin-pot clavulanate oral suspension for reconstitution 200-285 mg5 ml 400-57 mg5 ml

amoxicillin-pot clavulanate oral suspension for reconstitution 250-625 mg5 ml

(Augmentin) 2

(Augmentin ES-600) 2

amoxicillin-pot clavulanate oral tablet250-125 mg

amoxicillin-pot clavulanate oral tablet500-125 mg 875-125 mg

(Augmentin) 2

amoxicillin-pot clavulanate oral tablet extended release 12 hr 1000-625 mg

(Augmentin XR) 2

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

dicloxacillin oral capsule 250 mg 500 mg 2

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

penicillin v potassium oral tablet 250 mg 500 mg

Quinolonesciprofloxacin hcl oral tablet 100 mg 750 mg

ciprofloxacin hcl oral tablet 250 mg 500 mg

(Cipro) 1 GC

levofloxacin intravenous solution 25 mgml

levofloxacin oral solution 250 mg10 ml 2

levofloxacin oral tablet 250 mg 500 mg 750 mg

(Levaquin) 2

ofloxacin oral tablet 300 mg 400 mg 2Sulfonamidessulfadiazine oral tablet 500 mg 2

sulfamethoxazole-trimethoprim intravenous solution 400-80 mg5 ml

sulfamethoxazole-trimethoprim oral suspension 200-40 mg5 ml

(Sulfatrim) 2

sulfamethoxazole-trimethoprim oral tablet 400-80 mg

(Bactrim) 1 GC

(Bactrim DS) 1 GC

Tetracyclinesdoxy-100 intravenous recon soln 100 mg 2

doxycycline hyclate oral capsule 100 mg 50 mg

(Morgidox) 2

doxycycline hyclate oral tablet 100 mg 20 mg

doxycycline hyclate oral tabletdelayed release (drec) 100 mg 150 mg 75 mg

doxycycline hyclate oral tabletdelayed release (drec) 200 mg 50 mg

(Doryx) 2

minocycline oral capsule 100 mg 50 mg 75 mg

(Minocin) 2

minocycline oral tablet 100 mg 50 mg 75 mg

minocycline oral tablet extended release 24 hr 135 mg 45 mg 90 mg

Anticancer AgentsAnticancer AgentsAFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 2 MG 3 MG 5 MG

5 PA NSO NM NDS QL (112 per 28 days)

AFINITOR ORAL TABLET 10 MG 5 PA NSO NM NDS QL (56 per 28 days)

AFINITOR ORAL TABLET 25 MG 5 MG 75 MG

anastrozole oral tablet 1 mg (Arimidex) 1 GC

bicalutamide oral tablet 50 mg (Casodex) 2

DROXIA ORAL CAPSULE 200 MG 300 MG 400 MG

ELIGARD (3 MONTH) SUBCUTANEOUS SYRINGE 225 MG

ELIGARD SUBCUTANEOUS SYRINGE 75 MG (1 MONTH)

ERIVEDGE ORAL CAPSULE 150 MG

exemestane oral tablet 25 mg (Aromasin) 2

hydroxyurea oral capsule 500 mg (Hydrea) 2

INLYTA ORAL TABLET 1 MG 5 PA NSO NM NDS QL (180 per 30 days)

JAKAFI ORAL TABLET 10 MG 15 MG 20 MG 25 MG 5 MG

letrozole oral tablet 25 mg (Femara) 2

LEUKERAN ORAL TABLET 2 MG 4

leuprolide subcutaneous kit 1 mg02 ml 2

LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 1125 MG 225 MG

5 NM NDS

LUPRON DEPOT (4 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG

5 NM NDS

LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 375 MG 75 MG

5 NM NDS

LYSODREN ORAL TABLET 500 MG 5 NM NDS

megestrol oral tablet 20 mg 40 mg 2

mercaptopurine oral tablet 50 mg 2

methotrexate sodium injection solution 25 mgml

2 PA BvD

methotrexate sodium oral tablet 25 mg 2 PA BvD ST

NEXAVAR ORAL TABLET 200 MG 5 PA NSO NM NDS QL (120 per 30 days)

paclitaxel intravenous concentrate 6 mgml

POMALYST ORAL CAPSULE 1 MG 2 MG 3 MG 4 MG

PURIXAN ORAL SUSPENSION 20 MGML

5 NM NDS

REVLIMID ORAL CAPSULE 10 MG 15 MG 25 MG 20 MG 25 MG 5 MG

5 PA NSO NM LA NDS

SOLTAMOX ORAL SOLUTION 10 MG5 ML

SPRYCEL ORAL TABLET 100 MG 140 MG 50 MG 70 MG 80 MG

SPRYCEL ORAL TABLET 20 MG 5 PA NSO NM NDS QL (60 per 30 days)

STIVARGA ORAL TABLET 40 MG 5 PA NSO NM NDS QL (84 per 28 days)

SUTENT ORAL CAPSULE 125 MG 25 MG 375 MG 50 MG

tamoxifen oral tablet 10 mg 20 mg 2

TARCEVA ORAL TABLET 100 MG 25 MG

TARCEVA ORAL TABLET 150 MG 5 PA NSO NM NDS QL (90 per 30 days)

TASIGNA ORAL CAPSULE 150 MG 200 MG

tretinoin (chemotherapy) oral capsule 10 mg

5 NM NDS

TREXALL ORAL TABLET 10 MG 15 MG 5 MG 75 MG

4 PA BvD ST

TYKERB ORAL TABLET 250 MG 5 NM NDS

VOTRIENT ORAL TABLET 200 MG 5 PA NSO NM NDS QL (120 per 30 days)

XALKORI ORAL CAPSULE 200 MG 250 MG

XTANDI ORAL CAPSULE 40 MG 5 PA NSO NM NDS QL (120 per 30 days)

ZELBORAF ORAL TABLET 240 MG 5 PA NSO NM NDS QL (240 per 30 days)

ZYTIGA ORAL TABLET 250 MG 5 PA NSO NM NDS QL (120 per 30 days)

Anticholinergic AgentsAntimuscarinicsAntispasmodicsatropine injection syringe 005 mgml 2

propantheline oral tablet 15 mg 2

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

(Carbatrol) 2

carbamazepine oral suspension 100 mg5 ml

(Tegretol) 2

carbamazepine oral tablet 200 mg (Epitol) 2

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

(Tegretol XR) 2

carbamazepine oral tabletchewable 100 mg

DILANTIN ORAL CAPSULE 30 MG 2

divalproex oral capsule delayed rel sprinkle 125 mg

(Depakote Sprinkles) 2

divalproex oral tablet extended release 24 hr 250 mg 500 mg

(Depakote ER) 2

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

(Depakote) 2

epitol oral tablet 200 mg 2

gabapentin oral capsule 100 mg 300 mg 400 mg

(Neurontin) 2

gabapentin oral solution 250 mg5 ml (Neurontin) 2

gabapentin oral tablet 600 mg 800 mg (Neurontin) 2

GRALISE 30-DAY STARTER PACK ORAL TABLET EXTENDED RELEASE 24 HR 300 MG (9)- 600 MG (69)

4 ST QL (78 per 30 days)

GRALISE ORAL TABLET EXTENDED RELEASE 24 HR 300 MG 600 MG

lamotrigine oral tablet 100 mg 150 mg 200 mg 25 mg

(Lamictal) 2

lamotrigine oral tablet extended release 24hr 100 mg 200 mg 25 mg 250 mg 300 mg 50 mg

(Lamictal XR) 2

lamotrigine oral tablet chewable dispersible 25 mg 5 mg

(Lamictal) 2

lamotrigine oral tabletdisintegrating 100 mg 200 mg 25 mg 50 mg

(Lamictal ODT) 2

levetiracetam intravenous solution 500 mg5 ml

(Keppra) 2

levetiracetam oral solution 100 mgml (Keppra) 2

levetiracetam oral tablet 1000 mg 250 mg 500 mg

(Keppra) 2

levetiracetam oral tablet 750 mg (Roweepra) 2

levetiracetam oral tablet extended release 24 hr 500 mg 750 mg

(Keppra XR) 2

LYRICA ORAL CAPSULE 100 MG 150 MG 200 MG 225 MG 25 MG 300 MG 50 MG 75 MG

LYRICA ORAL SOLUTION 20 MGML

phenytoin sodium extended oral capsule100 mg

(Dilantin Extended) 2

phenytoin sodium extended oral capsule200 mg 300 mg

(Phenytek) 2

ROWEEPRA ORAL TABLET 1000 MG 500 MG 750 MG

SPRITAM ORAL TABLET FOR SUSPENSION 1000 MG

SPRITAM ORAL TABLET FOR SUSPENSION 250 MG 500 MG 750 MG

topiramate oral capsule sprinkle 15 mg 25 mg

(Topamax) 2

topiramate oral capsulesprinkleer 24hr100 mg 150 mg 200 mg 25 mg 50 mg

(Qudexy XR) 2

topiramate oral tablet 100 mg 200 mg 50 mg

(Topamax) 2

topiramate oral tablet 25 mg (Topamax) 1 GC

TROKENDI XR ORAL CAPSULEEXTENDED RELEASE 24HR 100 MG 25 MG 50 MG

TROKENDI XR ORAL CAPSULEEXTENDED RELEASE 24HR 200 MG

Antidementia AgentsAntidementia Agentsdonepezil oral tablet 10 mg 23 mg 5 mg (Aricept) 2 QL (30 per 30 days)

donepezil oral tabletdisintegrating 10 mg 5 mg

memantine oral solution 2 mgml 2 QL (360 per 30 days)

memantine oral tablet 10 mg 5 mg (Namenda) 2 QL (60 per 30 days)

memantine oral tabletsdose pack 5-10 mg

(Namenda Titration Pak)

NAMENDA XR ORAL CAPSPRINKLEER 24HR DOSE PACK 7-14-21-28 MG

NAMENDA XR ORAL CAPSULESPRINKLEER 24HR 14 MG 21 MG 28 MG 7 MG

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

bupropion hcl oral tablet 100 mg 75 mg 2

bupropion hcl oral tablet extended release 12 hr 100 mg 150 mg 200 mg

(Wellbutrin SR) 2

bupropion hcl oral tablet extended release 24 hr 150 mg 300 mg

(Wellbutrin XL) 2

citalopram oral solution 10 mg5 ml 2 QL (600 per 30 days)

citalopram oral tablet 10 mg 20 mg 40 mg

(Celexa) 1 GC QL (30 per 30 days)

escitalopram oxalate oral solution 5 mg5 ml

escitalopram oxalate oral tablet 10 mg 20 mg 5 mg

(Lexapro) 1 GC

fluoxetine oral capsule 10 mg 20 mg (Prozac) 1 GC

fluoxetine oral capsule 40 mg (Prozac) 2

fluoxetine oral capsuledelayed release(drec) 90 mg

(Prozac Weekly) 2 QL (4 per 28 days)

fluoxetine oral solution 20 mg5 ml (4 mgml)

fluoxetine oral tablet 10 mg 20 mg (Sarafem) 2

FLUOXETINE ORAL TABLET 60 MG

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

(Paxil) 1 GC

paroxetine hcl oral tablet extended release 24 hr 125 mg 25 mg 375 mg

(Paxil CR) 2

PAXIL ORAL SUSPENSION 10 MG5 ML

sertraline oral concentrate 20 mgml (Zoloft) 2

sertraline oral tablet 100 mg 25 mg 50 mg

(Zoloft) 1 GC

trazodone oral tablet 100 mg 50 mg 1 GC

trazodone oral tablet 150 mg 300 mg 2

venlafaxine oral capsuleextended release 24hr 150 mg

(Effexor XR) 2 QL (30 per 30 days)

venlafaxine oral capsuleextended release 24hr 375 mg 75 mg

venlafaxine oral tablet 100 mg 25 mg 375 mg 50 mg 75 mg

venlafaxine oral tablet extended release 24hr 150 mg 375 mg 75 mg

venlafaxine oral tablet extended release 24hr 225 mg

Antidiabetic AgentsAntidiabetic Agents MiscellaneousINVOKANA ORAL TABLET 100 MG

INVOKANA ORAL TABLET 300 MG

JANUMET ORAL TABLET 50-1000 MG 50-500 MG

JANUMET XR ORAL TABLET ER MULTIPHASE 24 HR 100-1000 MG

JANUMET XR ORAL TABLET ER MULTIPHASE 24 HR 50-1000 MG 50-500 MG

JANUVIA ORAL TABLET 100 MG 25 MG 50 MG

metformin oral tablet 1000 mg (Glucophage) 6 GC QL (75 per 30 days)

metformin oral tablet extended release 24 hr 500 mg

(Glucophage XR) 6 GC QL (120 per 30 days)

pioglitazone oral tablet 15 mg 30 mg 45 mg

(Actos) 2 QL (30 per 30 days)

TRADJENTA ORAL TABLET 5 MG 3 QL (30 per 30 days)

VICTOZA 3-PAK SUBCUTANEOUS PEN INJECTOR 06 MG01 ML (18 MG3 ML)

InsulinsHUMALOG KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNITML 200 UNITML (3 ML)

HUMALOG SUBCUTANEOUS CARTRIDGE 100 UNITML

HUMALOG SUBCUTANEOUS SOLUTION 100 UNITML

LANTUS SOLOSTAR SUBCUTANEOUS INSULIN PEN 100 UNITML (3 ML)

LANTUS SUBCUTANEOUS SOLUTION 100 UNITML

TOUJEO SOLOSTAR SUBCUTANEOUS INSULIN PEN 300 UNITML (15 ML)

Sulfonylureasglimepiride oral tablet 1 mg 2 mg (Amaryl) 6 GC QL (30 per 30

glimepiride oral tablet 4 mg (Amaryl) 6 GC QL (60 per 30 days)

glipizide oral tablet 10 mg (Glucotrol) 6 GC QL (120 per 30 days)

glipizide oral tablet extended release 24hr10 mg

(Glucotrol XL) 6 GC QL (60 per 30 days)

glipizide oral tablet extended release 24hr25 mg 5 mg

AntifungalsAntifungalsclotrimazole mucous membrane troche 10 mg

clotrimazole topical cream 1 (Antifungal (clotrimazole))

clotrimazole topical solution 1 2

clotrimazole-betamethasone topical cream 1-005

(Lotrisone) 2

clotrimazole-betamethasone topical lotion 1-005

fluconazole oral suspension for reconstitution 10 mgml 40 mgml

(Diflucan) 2

fluconazole oral tablet 100 mg 150 mg 200 mg 50 mg

(Diflucan) 2

ketoconazole oral tablet 200 mg 2

ketoconazole topical cream 2 2

ketoconazole topical shampoo 2 (Nizoral) 2

nyamyc topical powder 100000 unitgram

nyata topical powder 100000 unitgram 2

nystatin oral suspension 100000 unitml 2

nystatin oral tablet 500000 unit 2

nystatin topical cream 100000 unitgram 2

nystatin topical ointment 100000 unitgram

nystatin topical powder 100000 unitgram

(Nystop) 2

nystop topical powder 100000 unitgram 2

terbinafine hcl oral tablet 250 mg (Lamisil) 1 GC

Antigout AgentsAntigout Agents Otherallopurinol oral tablet 100 mg 300 mg (Zyloprim) 1 GC

COLCRYS ORAL TABLET 06 MG 2

AntihistaminesAntihistamineshydroxyzine hcl intramuscular solution25 mgml 50 mgml

hydroxyzine hcl oral solution 10 mg5 ml 2

hydroxyzine hcl oral tablet 10 mg 25 mg 50 mg

levocetirizine oral solution 25 mg5 ml (Xyzal) 2

levocetirizine oral tablet 5 mg (Xyzal) 1 GC

Anti-Infectives (Skin And Mucous Membrane)Anti-Infectives (Skin And Mucous Membrane)metronidazole vaginal gel 075 (Metrogel Vaginal) 2

terconazole vaginal cream 04 (Terazol 7) 2

terconazole vaginal cream 08 2

terconazole vaginal suppository 80 mg 2

Antimigraine AgentsAntimigraine Agentsrizatriptan oral tablet 10 mg 5 mg (Maxalt) 2 QL (18 per 28 days)

rizatriptan oral tabletdisintegrating 10 mg 5 mg

(Maxalt-MLT) 2 QL (18 per 28 days)

sumatriptan succinate oral tablet 100 mg 25 mg 50 mg

(Imitrex) 2 QL (18 per 28 days)

sumatriptan succinate subcutaneous cartridge 4 mg05 ml 6 mg05 ml

(Imitrex STATdose Kit Refill)

sumatriptan succinate subcutaneous pen injector 4 mg05 ml 6 mg05 ml

(Imitrex STATdose Pen)

sumatriptan succinate subcutaneous solution 6 mg05 ml

sumatriptan succinate subcutaneous syringe 6 mg05 ml

AntimycobacterialsAntimycobacterialsdapsone oral tablet 100 mg 25 mg 2

isoniazid oral solution 50 mg5 ml 2

isoniazid oral tablet 100 mg 300 mg 1 GC

rifampin intravenous recon soln 600 mg (Rifadin) 2

rifampin oral capsule 150 mg 300 mg (Rifadin) 2

Antinausea AgentsAntinausea Agentsmeclizine oral tablet 125 mg 2

meclizine oral tablet 25 mg (Dramamine Less Drowsy)

ondansetron oral tabletdisintegrating 4 mg 8 mg

(Zofran ODT) 2 PA BvD

phenadoz rectal suppository 125 mg 2

prochlorperazine maleate oral tablet 10 mg 5 mg

(Compazine) 1 GC

promethazine injection solution 25 mgml 50 mgml

(Phenergan) 2

promethazine oral tablet 125 mg 25 mg 50 mg

promethazine rectal suppository 125 mg 25 mg 50 mg

(Promethegan) 2

promethegan rectal suppository 25 mg 50 mg

Antiparasite AgentsAntiparasite AgentsALBENZA ORAL TABLET 200 MG 5 NM NDS

atovaquone-proguanil oral tablet 250-100 mg

(Malarone) 2

(Malarone Pediatric) 2

hydroxychloroquine oral tablet 200 mg (Plaquenil) 2

mefloquine oral tablet 250 mg 2

Antiparkinsonian AgentsAntiparkinsonian Agentsbenztropine injection solution 2 mg2 ml (Cogentin) 2

benztropine oral tablet 05 mg 1 mg 2 mg

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

(Sinemet) 2

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

(Sinemet CR) 2

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

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

(Mirapex) 2

pramipexole oral tablet 05 mg (Mirapex) 1 GC

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

(Requip) 2

ropinirole oral tablet extended release 24 hr 12 mg 2 mg 4 mg 6 mg 8 mg

(Requip XL) 2

Antipsychotic AgentsAntipsychotic Agentschlorpromazine injection solution 25 mgml

chlorpromazine oral tablet 10 mg 100 mg 200 mg 25 mg 50 mg

clozapine oral tablet 100 mg (Clozaril) 2 QL (270 per 30 days)

clozapine oral tablet 200 mg 2 QL (135 per 30 days)

clozapine oral tabletdisintegrating 100 mg 125 mg 25 mg

(FazaClo) 2 ST QL (90 per 30 days)

clozapine oral tabletdisintegrating 150 mg

haloperidol oral tablet 05 mg 1 mg 10 mg 2 mg 20 mg 5 mg

LATUDA ORAL TABLET 120 MG 20 MG 40 MG 60 MG 80 MG

olanzapine intramuscular recon soln 10 mg

(Zyprexa) 2 QL (30 per 30 days)

olanzapine oral tablet 10 mg 15 mg 25 mg 20 mg 5 mg 75 mg

olanzapine oral tabletdisintegrating 10 mg 15 mg 20 mg 5 mg

(Zyprexa Zydis) 2 QL (30 per 30 days)

quetiapine oral tablet 100 mg 200 mg 25 mg 300 mg 400 mg 50 mg

(Seroquel) 2 QL (90 per 30 days)

quetiapine oral tablet extended release 24 hr 150 mg 200 mg 50 mg

(Seroquel XR) 2 QL (30 per 30 days)

quetiapine oral tablet extended release 24 hr 300 mg

(Seroquel XR) 5 NM NDS QL (60 per 30 days)

risperidone oral solution 1 mgml (Risperdal) 2 QL (480 per 30 days)

risperidone oral tablet 025 mg 05 mg 1 mg 2 mg 3 mg 4 mg

(Risperdal) 2 QL (60 per 30 days)

risperidone oral tabletdisintegrating 025 mg

risperidone oral tabletdisintegrating 05 mg 1 mg 2 mg

(Risperdal M-TAB) 2 QL (60 per 30 days)

risperidone oral tabletdisintegrating 3 mg 4 mg

VERSACLOZ ORAL SUSPENSION 50 MGML

5 ST NM NDS QL (540 per 30 days)

ziprasidone hcl oral capsule 20 mg 40 mg 60 mg 80 mg

(Geodon) 2 QL (60 per 30 days)

Antivirals (Systemic)AntiretroviralsATRIPLA ORAL TABLET 600-200-300 MG

5 NM NDS

COMPLERA ORAL TABLET 200-25-300 MG

5 NM NDS

ISENTRESS ORAL POWDER IN PACKET 100 MG

ISENTRESS ORAL TABLET 400 MG 5 NM NDS

ISENTRESS ORAL TABLETCHEWABLE 100 MG 25 MG

KALETRA ORAL TABLET 100-25 MG

5 NM NDS

lopinavir-ritonavir oral solution 400-100 mg5 ml

(Kaletra) 2

NORVIR ORAL CAPSULE 100 MG 3

NORVIR ORAL SOLUTION 80 MGML

NORVIR ORAL TABLET 100 MG 3

PREZISTA ORAL SUSPENSION 100 MGML

PREZISTA ORAL TABLET 150 MG 75 MG

5 NM NDS

REYATAZ ORAL CAPSULE 150 MG 200 MG 300 MG

5 NM NDS

REYATAZ ORAL POWDER IN PACKET 50 MG

5 NM NDS

STRIBILD ORAL TABLET 150-150-200-300 MG

5 NM NDS

TRUVADA ORAL TABLET 100-150 MG 133-200 MG 167-250 MG 200-300 MG

5 NM NDS

VIREAD ORAL POWDER 40 MGSCOOP (40 MGGRAM)

5 NM NDS

VIREAD ORAL TABLET 150 MG 200 MG 250 MG 300 MG

5 NM NDS

Antivirals Miscellaneousoseltamivir oral capsule 30 mg (Tamiflu) 2 QL (84 per 180 days)

oseltamivir oral capsule 45 mg (Tamiflu) 2 QL (48 per 180 days)

SYNAGIS INTRAMUSCULAR SOLUTION 50 MG05 ML

5 PA NM NDS

TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION 6 MGML

3 QL (540 per 180 days)

Hcv AntiviralsOLYSIO ORAL CAPSULE 150 MG 5 PA NM NDS QL (28

per 28 days)

SOVALDI ORAL TABLET 400 MG 5 PA NM NDS QL (28 per 28 days)

InterferonsINTRON A INJECTION RECON SOLN 10 MILLION UNIT (1 ML) 18 MILLION UNIT (1 ML) 50 MILLION UNIT (1 ML)

5 PA NSO NM NDS

INTRON A INJECTION SOLUTION 6 MILLION UNITML

5 PA NSO NM NDS

PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 135 MCG05 ML 180 MCG05 ML

5 NM NDS

PEGASYS SUBCUTANEOUS SOLUTION 180 MCGML

5 NM NDS

PEGASYS SUBCUTANEOUS SYRINGE 180 MCG05 ML

5 NM NDS

Nucleosides And Nucleotidesacyclovir oral capsule 200 mg (Zovirax) 2

acyclovir oral suspension 200 mg5 ml (Zovirax) 2

acyclovir oral tablet 400 mg 800 mg (Zovirax) 2

famciclovir oral tablet 125 mg 250 mg 500 mg

valacyclovir oral tablet 1 gram 500 mg (Valtrex) 2

Blood ProductsModifiersVolume ExpandersAnticoagulantsenoxaparin subcutaneous solution 300 mg3 ml

(Lovenox) 2

enoxaparin subcutaneous syringe 100 mgml 120 mg08 ml 150 mgml 30 mg03 ml 40 mg04 ml 60 mg06 ml 80 mg08 ml

(Lovenox) 2

jantoven oral tablet 1 mg 10 mg 2 mg 25 mg 3 mg 4 mg 5 mg 6 mg 75 mg

warfarin oral tablet 1 mg 2 mg 4 mg 5 mg 75 mg

(Jantoven) 1 GC

warfarin oral tablet 10 mg 25 mg 3 mg 6 mg

(Coumadin) 1 GC

XARELTO ORAL TABLET 10 MG 15 MG 20 MG

XARELTO ORAL TABLETSDOSE PACK 15 MG (42)- 20 MG (9)

Blood Formation ModifiersEPOGEN 10000 UNITSML VIAL SDV PF OUTER 10000 UNITML

EPOGEN INJECTION SOLUTION 2000 UNITML 20000 UNIT2 ML 20000 UNITML 3000 UNITML 4000 UNITML

NEULASTA SUBCUTANEOUS SYRINGE 6 MG06ML

5 NM NDS

NEUPOGEN INJECTION SOLUTION 300 MCGML 480 MCG16 ML

5 NM NDS

NEUPOGEN INJECTION SYRINGE 300 MCG05 ML 480 MCG08 ML

5 NM NDS

PROCRIT INJECTION SOLUTION 10000 UNITML 2000 UNITML 3000 UNITML 4000 UNITML

PROCRIT INJECTION SOLUTION 20000 UNITML

5 PA NM NDS QL (12 per 28 days)

Hematologic Agents Miscellaneousanagrelide oral capsule 05 mg (Agrylin) 2

anagrelide oral capsule 1 mg 2

tranexamic acid intravenous solution1000 mg10 ml (100 mgml)

(Cyklokapron) 2

tranexamic acid oral tablet 650 mg (Lysteda) 2 QL (30 per 30 days)Platelet-Aggregation Inhibitorsclopidogrel oral tablet 300 mg (Plavix) 2

clopidogrel oral tablet 75 mg (Plavix) 1 GC

EFFIENT ORAL TABLET 10 MG 5 MG

Caloric AgentsCaloric AgentsAMINO ACIDS 15 INTRAVENOUS PARENTERAL SOLUTION 15

4 PA BvD

CLINIMIX 5-D20W(SULFITE-FREE) INTRAVENOUS PARENTERAL SOLUTION 5

4 PA BvD

CLINIMIX E 425D25W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 425

4 PA BvD

CLINIMIX E 5D15W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5

4 PA BvD

CLINISOL SF 15 INTRAVENOUS PARENTERAL SOLUTION 15

4 PA BvD

dextrose 5 in water (d5w) intravenous parenteral solution

INTRALIPID INTRAVENOUS EMULSION 20 30

4 PA BvD

NUTRILIPID INTRAVENOUS EMULSION 20

4 PA BvD

PROSOL 20 INTRAVENOUS PARENTERAL SOLUTION

4 PA BvD

TRAVASOL 10 INTRAVENOUS PARENTERAL SOLUTION 10

4 PA BvD

TROPHAMINE 10 INTRAVENOUS PARENTERAL SOLUTION 10

4 PA BvD

Cardiovascular AgentsAlpha-Adrenergic Agentsclonidine hcl oral tablet 01 mg 02 mg 03 mg

(Catapres) 1 GC

doxazosin oral tablet 1 mg 2 mg 4 mg 8 mg

(Cardura) 2

Angiotensin Ii Receptor Antagonistsirbesartan oral tablet 150 mg 300 mg 75 mg

(Avapro) 6 GC

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

(Avalide) 2

losartan oral tablet 100 mg 25 mg 50 mg

(Cozaar) 6 GC

losartan-hydrochlorothiazide oral tablet100-125 mg 100-25 mg 50-125 mg

(Hyzaar) 6 GC

valsartan-hydrochlorothiazide oral tablet160-125 mg 160-25 mg 320-125 mg 320-25 mg 80-125 mg

(Diovan HCT) 2

Angiotensin-Converting Enzyme Inhibitorsbenazepril oral tablet 10 mg 5 mg 6 GC

benazepril oral tablet 20 mg 40 mg (Lotensin) 6 GC

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

(Vasotec) 2

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

(Zestril) 6 GC

lisinopril oral tablet 20 mg (Prinivil) 6 GC

lisinopril-hydrochlorothiazide oral tablet10-125 mg 20-125 mg 20-25 mg

(Zestoretic) 6 GC

QBRELIS ORAL SOLUTION 1 MGML

ramipril oral capsule 125 mg 10 mg 25 mg 5 mg

(Altace) 6 GC

Antiarrhythmic Agentsamiodarone intravenous solution 50 mgml

amiodarone oral tablet 100 mg 400 mg (Pacerone) 2

amiodarone oral tablet 200 mg (Pacerone) 1 GC

flecainide oral tablet 100 mg 150 mg 50 mg

pacerone oral tablet 100 mg 400 mg 2

pacerone oral tablet 200 mg 1 GC

propafenone oral capsuleextended release 12 hr 225 mg 325 mg 425 mg

(Rythmol SR) 2

propafenone oral tablet 150 mg 225 mg 300 mg

Beta-Adrenergic Blocking Agentsatenolol oral tablet 100 mg 25 mg 50 mg (Tenormin) 1 GC

carvedilol oral tablet 125 mg 25 mg 3125 mg 625 mg

(Coreg) 1 GC

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

(Toprol XL) 2

metoprolol tartrate intravenous solution 5 mg5 ml

(Lopressor) 2

metoprolol tartrate intravenous syringe 5 mg5 ml

metoprolol tartrate oral tablet 100 mg 50 mg

(Lopressor) 1 GC

metoprolol tartrate oral tablet 25 mg 1 GC

propranolol intravenous solution 1 mgml 2

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

(Inderal LA) 2

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

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

Calcium-Channel Blocking Agentscartia xt oral capsuleextended release 24hr 120 mg 180 mg 240 mg 300 mg

diltiazem 24hr er 180 mg cap 180 mg (Cartia XT) 2

diltiazem hcl intravenous solution 5 mgml

diltiazem hcl oral capsule extended release 180 mg 360 mg 420 mg

(Tiazac) 2

diltiazem hcl oral capsuleextended release 12 hr 120 mg 60 mg 90 mg

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

(Cardizem CD) 2

diltiazem hcl oral tablet 120 mg 60 mg (Cardizem) 2

diltiazem hcl oral tablet 30 mg (Cardizem) 1 GC

diltiazem hcl oral tablet 90 mg 2

dilt-xr oral capsuleext release degradable 120 mg 180 mg 240 mg

matzim la oral tablet extended release 24 hr 180 mg 240 mg 300 mg 360 mg 420 mg

taztia xt oral capsule extended release120 mg 180 mg 240 mg 300 mg 360 mg

verapamil oral capsule 24 hr er pellet ct100 mg 200 mg 300 mg

(Verelan PM) 2

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

(Verelan) 2

verapamil oral tablet 120 mg 80 mg (Calan) 1 GC

verapamil oral tablet 40 mg 2

verapamil oral tablet extended release120 mg 180 mg 240 mg

(Calan SR) 1 GC

Cardiovascular Agents Miscellaneoushydralazine injection solution 20 mgml 2

hydralazine oral tablet 10 mg 100 mg 25 mg 50 mg

RANEXA ORAL TABLET EXTENDED RELEASE 12 HR 1000 MG 500 MG

Dihydropyridinesafeditab cr oral tablet extended release30 mg 60 mg

amlodipine oral tablet 10 mg 25 mg 5 mg

(Norvasc) 1 GC

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

(Lotrel) 2

amlodipine-benazepril oral capsule 25-10 mg

nifedipine oral capsule 10 mg (Procardia) 2

nifedipine oral capsule 20 mg 2

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

(Procardia XL) 2

nifedipine oral tablet extended release 30 mg 60 mg 90 mg

(Adalat CC) 2

Diureticsfurosemide injection solution 10 mgml 2

furosemide injection syringe 10 mgml 2

furosemide oral solution 10 mgml 40 mg5 ml (8 mgml)

furosemide oral tablet 20 mg 40 mg 80 mg

(Lasix) 1 GC

hydrochlorothiazide oral capsule 125 mg (Microzide) 1 GC

hydrochlorothiazide oral tablet 125 mg 25 mg 50 mg

spironolactone oral tablet 100 mg (Aldactone) 2

spironolactone oral tablet 25 mg 50 mg (Aldactone) 1 GC

triamterene-hydrochlorothiazid oral capsule 375-25 mg

(Dyazide) 1 GC

triamterene-hydrochlorothiazid oral tablet 375-25 mg

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

Dyslipidemicsatorvastatin oral tablet 10 mg 20 mg 40 mg 80 mg

(Lipitor) 6 GC

fenofibrate micronized oral capsule 130 mg 134 mg 200 mg 43 mg 67 mg

fenofibrate oral tablet 160 mg 54 mg 2

gemfibrozil oral tablet 600 mg (Lopid) 1 GC

lovastatin oral tablet 10 mg 20 mg 40 mg

pravastatin oral tablet 10 mg 2

pravastatin oral tablet 20 mg 40 mg 80 mg

(Pravachol) 2

simvastatin oral tablet 10 mg 20 mg 40 mg 5 mg

(Zocor) 6 GC

simvastatin oral tablet 80 mg (Zocor) 6 GC QL (30 per 30 days)

Renin-Angiotensin-Aldosterone System Inhibitorseplerenone oral tablet 25 mg 50 mg (Inspra) 2

TEKTURNA ORAL TABLET 150 MG 300 MG

Vasodilatorsisosorbide dinitrate oral tablet 10 mg 20 mg 30 mg

isosorbide dinitrate oral tablet 5 mg (Isordil Titradose) 2

isosorbide dinitrate oral tablet extended release 40 mg

(ISOCHRON) 2

isosorbide mononitrate oral tablet 10 mg 2

isosorbide mononitrate oral tablet 20 mg 1 GC

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

isosorbide mononitrate oral tablet extended release 24 hr 30 mg

Central Nervous System AgentsCentral Nervous System AgentsAVONEX INTRAMUSCULAR PEN INJECTOR KIT 30 MCG05 ML

5 PA NM NDS

AVONEX INTRAMUSCULAR SYRINGE KIT 30 MCG05 ML

5 PA NM NDS

dexmethylphenidate oral tablet 10 mg 25 mg 5 mg

(Focalin) 2 QL (60 per 30 days)

dextroamphetamine oral capsule extended release 10 mg 15 mg 5 mg

(Dexedrine Spansule) 2 QL (120 per 30 days)

dextroamphetamine oral tablet 10 mg (Zenzedi) 2 QL (180 per 30 days)

dextroamphetamine oral tablet 5 mg (Dexedrine) 2 QL (180 per 30 days)

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

(Adderall XR) 2 QL (30 per 30 days)

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

(Adderall) 2 QL (60 per 30 days)

lithium carbonate oral capsule 150 mg 300 mg

lithium carbonate oral capsule 600 mg 2

lithium carbonate oral tablet 300 mg 2

lithium carbonate oral tablet extended release 300 mg

(Lithobid) 2

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

methylphenidate hcl oral capsule er biphasic 30-70 30 mg

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

(Ritalin LA) 2 QL (30 per 30 days)

methylphenidate hcl oral capsuleer biphasic 50-50 60 mg

methylphenidate hcl oral solution 10 mg5 ml 5 mg5 ml

(Methylin) 2 QL (900 per 30 days)

methylphenidate hcl oral tablet 10 mg 20 mg 5 mg

(Ritalin) 2 QL (90 per 30 days)

methylphenidate hcl oral tablet extended release 10 mg

(Metadate ER) 2 QL (90 per 30 days)

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

(Concerta) 2 QL (30 per 30 days)

methylphenidate hcl oral tablet extended release 24hr 36 mg

SAVELLA ORAL TABLET 100 MG 125 MG 25 MG 50 MG

SAVELLA ORAL TABLETSDOSE PACK 125 MG (5)-25 MG(8)-50 MG(42)

ContraceptivesContraceptivesaubra oral tablet 01-20 mg-mcg 2

aviane oral tablet 01-20 mg-mcg 2

blisovi 24 fe oral tablet 1 mg-20 mcg (24)75 mg (4)

blisovi fe 1530 (28) oral tablet 15 mg-30 mcg (21)75 mg (7)

delyla (28) oral tablet 01-20 mg-mcg 2

drospirenone-ethinyl estradiol oral tablet3-002 mg

(Gianvi (28)) 2

(Zarah) 2

enpresse oral tablet 50-30 (6)75-40 (5)125-30(10)

falmina (28) oral tablet 01-20 mg-mcg 2

femynor oral tablet 025-35 mg-mcg 2

gianvi (28) oral tablet 3-002 mg 2

introvale oral tabletsdose pack3 month015 mg-30 mcg

junel fe 1530 (28) oral tablet 15 mg-30 mcg (21)75 mg (7)

junel fe 24 oral tablet 1 mg-20 mcg (24)75 mg (4)

larin fe 1530 (28) oral tablet 15 mg-30 mcg (21)75 mg (7)

larissia oral tablet 01-20 mg-mcg 2

lessina oral tablet 01-20 mg-mcg 2

levonest (28) oral tablet 50-30 (6)75-40 (5)125-30(10)

levonor-eth estrad 015-003 outer 015-003 mg

(Portia) 2 QL (91 per 84 days)

levonorgestrel-ethinyl estrad oral tablet01-20 mg-mcg

(Aviane) 2

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

(Quasense) 2 QL (91 per 84 days)

levonorg-eth estrad triphasic oral tablet50-30 (6)75-40 (5)125-30(10)

(Myzilra) 2 QL (91 per 84 days)

levora-28 oral tablet 015-003 mg 2

lomedia 24 fe oral tablet 1 mg-20 mcg (24)75 mg (4)

loryna (28) oral tablet 3-002 mg 2

lutera (28) oral tablet 01-20 mg-mcg 2

marlissa oral tablet 015-003 mg 2

microgestin fe 1530 (28) oral tablet 15 mg-30 mcg (21)75 mg (7)

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

nikki (28) oral tablet 3-002 mg 2

noreth-estrad-fe 1-002(21)-75 1 mg-20 mcg (21)75 mg (7)

(Larin Fe 120 (28)) 2

norethindrone-eestradiol-iron oral tablet1 mg-20 mcg (24)75 mg (4)

(Microgestin 24 FE) 2

norgestimate-ethinyl estradiol oral tablet0180215025 mg-25 mcg

(Tri-Lo-Marzia) 2

norgestimate-ethinyl estradiol oral tablet0180215025 mg-35 mcg (28)

(Tri-Previfem (28)) 2

norgestimate-ethinyl estradiol oral tablet025-35 mg-mcg

(Sprintec (28)) 2

ocella oral tablet 3-003 mg 2

orsythia oral tablet 01-20 mg-mcg 2

portia oral tablet 015-003 mg 2

previfem oral tablet 025-35 mg-mcg 2

quasense oral tabletsdose pack3 month015 mg-30 mcg

setlakin oral tabletsdose pack3 month015 mg-30 mcg

sprintec (28) oral tablet 025-35 mg-mcg 2

sronyx oral tablet 01-20 mg-mcg 2

tarina fe 120 (28) oral tablet 1 mg-20 mcg (21)75 mg (7)

tri-legest fe oral tablet 1-20(5)1-30(7) 1mg-35mcg (9)

tri-lo-estarylla oral tablet 0180215025 mg-25 mcg

tri-lo-sprintec oral tablet 0180215025 mg-25 mcg

trinessa (28) oral tablet 0180215025 mg-35 mcg (28)

tri-previfem (28) oral tablet0180215025 mg-35 mcg (28)

tri-sprintec (28) oral tablet0180215025 mg-35 mcg (28)

trivora (28) oral tablet 50-30 (6)75-40 (5)125-30(10)

vestura (28) oral tablet 3-002 mg 2

vienva oral tablet 01-20 mg-mcg 2

zarah oral tablet 3-003 mg 2

Dental And Oral AgentsDental And Oral Agentschlorhexidine gluconate mucous membrane mouthwash 012

(Peridex) 2

periogard mucous membrane mouthwash012

triamcinolone acetonide dental paste 01

(Oralone) 2

Dermatological AgentsDermatological Agents Otheracyclovir topical ointment 5 (Zovirax) 2 QL (30 per 30 days)

ammonium lactate topical cream 12 (Geri-Hydrolac) 2

ammonium lactate topical lotion 12 (Geri-Hydrolac) 2

calcipotriene scalp solution 0005 2

calcipotriene topical cream 0005 (Dovonex) 2

calcipotriene topical ointment 0005 (Calcitrene) 2

diclofenac sodium topical drops 15 2 QL (300 per 30 days)

diclofenac sodium topical gel 3 (Solaraze) 5 PA NM NDS QL (100 per 28 days)

fluorouracil topical cream 05 (Carac) 5 NM NDS

fluorouracil topical cream 5 (Efudex) 2

fluorouracil topical solution 2 5 2

imiquimod topical cream in packet 5 (Aldara) 2 PA NSO QL (24 per 30 days)

PENNSAID TOPICAL SOLUTION IN METERED-DOSE PUMP 20 MGGRAM ACTUATION(2 )

TOLAK TOPICAL CREAM 4 4

VOLTAREN TOPICAL GEL 1 2

ZOVIRAX TOPICAL CREAM 5 5 NM NDS QL (5 per 4 days)

Dermatological Antibacterialsclindamycin phosphate topical foam 1 (Evoclin) 2

clindamycin phosphate topical gel 1 (Clindagel) 2

clindamycin phosphate topical lotion 1 (Cleocin T) 2

clindamycin phosphate topical solution 1

(Cleocin T) 2

clindamycin phosphate topical swab 1 (Clindacin ETZ) 2

clindamycin-benzoyl peroxide topical gel12 (1 base) -5

(Duac) 2

clindamycin-benzoyl peroxide topical gel1-5

(Benzaclin) 2

metronidazole topical cream 075 (MetroCream) 2

metronidazole topical gel 075 (Rosadan) 2

metronidazole topical gel 1 (Metrogel) 2

metronidazole topical lotion 075 (MetroLotion) 2

neuac topical gel 12 (1 base) -5 2Dermatological Anti-Inflammatory Agentsala-cort topical cream 1 2

ala-cort topical cream 25 1 GC

ala-scalp topical lotion 2 2

clobetasol 005 cream 005 (Temovate) 2

clobetasol scalp solution 005 (Cormax) 2

clobetasol topical foam 005 (Olux) 2

clobetasol topical gel 005 2

clobetasol topical lotion 005 (Clobex) 2

clobetasol topical ointment 005 (Temovate) 2

clobetasol topical shampoo 005 (Clodan) 2

clobetasol-emollient topical cream 005 2

cormax scalp solution 005 2

desonide topical cream 005 (Tridesilon) 2

desonide topical lotion 005 (DesOwen) 2

desonide topical ointment 005 2

fluocinonide topical gel 005 2

fluocinonide topical ointment 005 2

fluocinonide topical solution 005 2

hydrocortisone topical cream 1 (Cortizone-10) 1 GC

hydrocortisone topical cream 25 (Ala-Cort) 1 GC

hydrocortisone topical lotion 25 2

hydrocortisone topical ointment 1 (Anti-Itch (HC)) 1 GC

hydrocortisone topical ointment 25 1 GC

mometasone topical cream 01 (Elocon) 2

mometasone topical ointment 01 (Elocon) 2

mometasone topical solution 01 2

procto-med hc topical cream with perineal applicator 25

procto-pak topical cream with perineal applicator 1

proctosol hc topical cream with perineal applicator 25

proctozone-hc topical cream with perineal applicator 25

triamcinolone acetonide topical cream0025

triamcinolone acetonide topical cream 01

(Triderm) 2

triamcinolone acetonide topical lotion0025 01

triamcinolone acetonide topical ointment0025

triamcinolone acetonide topical ointment01 05

tridesilon topical cream 005 2Dermatological Retinoidsadapalene topical cream 01 (Differin) 2

adapalene topical gel 01 (Differin) 2

tretinoin topical cream 0025 005 01

(Retin-A) 2 PA

tretinoin topical gel 001 0025 (Retin-A) 2 PAScabicides And Pediculicidesmalathion topical lotion 05 (Ovide) 2

permethrin topical cream 5 (Elimite) 2

DevicesDevicesBD INSULIN SYR 05 ML 6MMX31G 12 ML 31 GAUGE X 1564

BD ULTRA-FINE PEN NDL 4MMX32G NANO 32 GAUGE X 532

INSULIN SYRINGE-NEEDLE U-100 SYRINGE 12 ML 28 GAUGE

(Monoject Ultra Comfort Insulin)

PEN NEEDLE DIABETIC NEEDLE 29 GAUGE X 12

(Advocate Pen Needle) 2

Enzyme ReplacementModifiersEnzyme ReplacementModifiersCREON ORAL CAPSULEDELAYED RELEASE(DREC) 12000-38000 -60000 UNIT 24000-76000 -120000 UNIT 3000-9500- 15000 UNIT 36000-114000- 180000 UNIT 6000-19000 -30000 UNIT

FABRAZYME INTRAVENOUS RECON SOLN 35 MG

5 NM NDS

KUVAN ORAL TABLETSOLUBLE 100 MG

5 NM NDS

ORFADIN ORAL CAPSULE 10 MG 2 MG 5 MG

5 PA NM NDS

ORFADIN ORAL SUSPENSION 4 MGML

5 PA NM NDS

PERTZYE ORAL CAPSULEDELAYED RELEASE(DREC) 16000-57500- 60500 UNIT

5 NM NDS

PERTZYE ORAL CAPSULEDELAYED RELEASE(DREC) 4000-14375- 15125 UNIT 8000-28750- 30250 UNIT

PULMOZYME INHALATION SOLUTION 1 MGML

5 PA BvD NM NDS

ZENPEP ORAL CAPSULEDELAYED RELEASE(DREC) 10000-34000 -55000 UNIT 15000-51000 -82000 UNIT 20000-68000 -109000 UNIT 25000-85000- 136000 UNIT 3000-10000- 16000 UNIT 40000-136000- 218000 UNIT 5000-17000 -27000 UNIT

Eye Ear Nose Throat AgentsEye Ear Nose Throat Agents Miscellaneousazelastine nasal aerosolspray 137 mcg (01 )

azelastine nasal spraynon-aerosol 015 (2055 mcg)

(Astepro) 2 QL (30 per 25 days)

azelastine ophthalmic drops 005 2

cromolyn ophthalmic drops 4 2

ipratropium bromide nasal spraynon-aerosol 003

olopatadine nasal spraynon-aerosol 06

(Patanase) 2 QL (305 per 30 days)

olopatadine ophthalmic drops 01 (Patanol) 2Eye Ear Nose Throat Anti-Infectives Agentserythromycin ophthalmic ointment 5 mggram (05 )

gentak ophthalmic ointment 03 (3 mggram)

gentamicin ophthalmic drops 03 2

MOXEZA OPHTHALMIC DROPS VISCOUS 05

neomycin-polymyxin b-dexameth ophthalmic dropssuspension 35mgml-10000 unitml-01

(Maxitrol) 2

neomycin-polymyxin b-dexameth ophthalmic ointment 35 mgg-10000 unitg-01

(Maxitrol) 2

neomycin-polymyxin-hc ophthalmic dropssuspension 35-10000-10 mg-unit-mgml

neomycin-polymyxin-hc otic dropssuspension 35-10000-1 mgml-unitml-

neomycin-polymyxin-hc otic solution 35-10000-1 mgml-unitml-

ofloxacin ophthalmic drops 03 (Ocuflox) 2

ofloxacin otic drops 03 (Floxin) 2

TOBRADEX OPHTHALMIC OINTMENT 03-01

TOBRADEX ST OPHTHALMIC DROPSSUSPENSION 03-005

tobramycin-dexamethasone ophthalmic dropssuspension 03-01

(TobraDex) 2

VIGAMOX OPHTHALMIC DROPS 05

Eye Ear Nose Throat Anti-Inflammatory Agentsfluticasone nasal spraysuspension 50 mcgactuation

(ClariSpray) 1 GC

ketorolac ophthalmic drops 04 (Acular LS) 2

ketorolac ophthalmic drops 05 (Acular) 2

prednisolone acetate ophthalmic dropssuspension 1

(Pred Forte) 2

RESTASIS OPHTHALMIC DROPPERETTE 005

Gastrointestinal AgentsAntiulcer Agents And Acid Suppressantsfamotidine oral suspension 40 mg5 ml (8 mgml)

(Pepcid) 2

famotidine oral tablet 20 mg 40 mg (Pepcid) 1 GC

omeprazole oral capsuledelayed release(drec) 10 mg

omeprazole oral capsuledelayed release(drec) 20 mg 40 mg

pantoprazole intravenous recon soln 40 mg

(Protonix) 2

pantoprazole oral tabletdelayed release (drec) 20 mg 40 mg

(Protonix) 1 GC

ranitidine hcl injection solution 50 mg2 ml (25 mgml)

(Zantac) 2

ranitidine hcl oral syrup 15 mgml 2

ranitidine hcl oral tablet 150 mg (Wal-Zan 150) 1 GC

ranitidine hcl oral tablet 300 mg (Zantac) 1 GCGastrointestinal Agents Otherconstulose oral solution 10 gram15 ml 2

dicyclomine oral capsule 10 mg (Bentyl) 2

dicyclomine oral solution 10 mg5 ml 2

dicyclomine oral tablet 20 mg 2

diphenoxylate-atropine oral liquid 25-0025 mg5 ml

diphenoxylate-atropine oral tablet 25-0025 mg

(Lomotil) 2

enulose oral solution 10 gram15 ml 2

generlac oral solution 10 gram15 ml 2

lactulose oral solution 10 gram15 ml (Generlac) 2

loperamide oral capsule 2 mg (Imodium A-D) 2

metoclopramide hcl injection solution 5 mgml

metoclopramide hcl oral solution 5 mg5 ml

metoclopramide hcl oral tablet 10 mg 5 mg

(Reglan) 1 GC

ursodiol oral capsule 300 mg (Actigall) 2

ursodiol oral tablet 250 mg (URSO 250) 2

ursodiol oral tablet 500 mg (URSO Forte) 2Laxativesgavilyte-c oral recon soln 240-2272-672 -584 gram

gavilyte-g oral recon soln 236-2274-674 -586 gram

peg 3350-electrolytes oral recon soln 236-2274-674 -586 gram

(Golytely) 2

polyethylene glycol 3350 oral powder 17 gramdose

(Laxative PEG 3350) 2

Phosphate Binderscalcium acetate oral capsule 667 mg 2

calcium acetate oral tablet 667 mg (Eliphos) 2

eliphos oral tablet 667 mg 2

PHOSLYRA ORAL SOLUTION 667 MG (169 MG CALCIUM)5 ML

RENVELA ORAL TABLET 800 MG 3

sevelamer carbonate oral powder in packet 08 gram 24 gram

(Renvela) 2

Genitourinary AgentsAntispasmodics Urinaryoxybutynin chloride oral syrup 5 mg5 ml 1 GC

oxybutynin chloride oral tablet 5 mg 2

oxybutynin chloride oral tablet extended release 24hr 10 mg 15 mg 5 mg

(Ditropan XL) 2

VESICARE ORAL TABLET 10 MG 5 MG

Genitourinary Agents Miscellaneousfinasteride oral tablet 5 mg (Proscar) 1 GC

tamsulosin oral capsuleextended release 24hr 04 mg

(Flomax) 2

Heavy Metal AntagonistsHeavy Metal AntagonistsCUPRIMINE ORAL CAPSULE 250 MG

5 PA NM NDS

DEPEN TITRATABS ORAL TABLET 250 MG

5 PA NM NDS

EXJADE ORAL TABLET DISPERSIBLE 125 MG 250 MG 500 MG

5 PA NM NDS

JADENU ORAL TABLET 180 MG 360 MG 90 MG

5 PA NM NDS

JADENU SPRINKLE ORAL GRANULES IN PACKET 180 MG 360 MG 90 MG

5 PA NM NDS

Hormonal Agents StimulantReplacementModifyingAndrogensANDRODERM TRANSDERMAL PATCH 24 HOUR 2 MG24 HOUR 4 MG24 HR

ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP 2025 MG125 GRAM (162 )

ANDROGEL TRANSDERMAL GEL IN PACKET 162 (2025 MG125 GRAM) 162 (405 MG25 GRAM)

testosterone cypionate intramuscular oil100 mgml 200 mgml

(Depo-Testosterone) 2 PA

testosterone transdermal gel in packet 1 (25 mg25gram)

(AndroGel) 2 PA QL (300 per 30 days)

testosterone transdermal gel in packet 1 (50 mg5 gram)

(Vogelxo) 2 PA QL (300 per 30 days)

Estrogens And AntiestrogensESTRACE VAGINAL CREAM 001 (01 MGGRAM)

estradiol oral tablet 05 mg 1 mg 2 mg (Estrace) 2

estradiol transdermal patch semiweekly0025 mg24 hr

(Vivelle-Dot) 2 QL (8 per 28 days)

estradiol transdermal patch semiweekly00375 mg24 hr 005 mg24 hr 0075 mg24 hr 01 mg24 hr

(Minivelle) 2 QL (8 per 28 days)

estradiol transdermal patch weekly 0025 mg24 hr 00375 mg24 hr 005 mg24 hr 006 mg24 hr 0075 mg24 hr 01 mg24 hr

(Climara) 2 QL (4 per 28 days)

ESTRING VAGINAL RING 2 MG (75 MCG 24 HOUR)

PREMARIN INJECTION RECON SOLN 25 MG

PREMARIN ORAL TABLET 03 MG 045 MG 0625 MG 09 MG 125 MG

PREMARIN VAGINAL CREAM 0625 MGGRAM

PREMPHASE ORAL TABLET 0625 MG (14) 0625MG-5MG(14)

PREMPRO ORAL TABLET 03-15 MG 045-15 MG 0625-25 MG 0625-5 MG

yuvafem vaginal tablet 10 mcg 2 QL (18 per 28 days)GlucocorticoidsMineralocorticoidsmethylprednisolone oral tablet 16 mg 32 mg 4 mg 8 mg

(Medrol) 2 PA BvD

methylprednisolone oral tabletsdose pack4 mg

(Medrol (Pak)) 2 PA BvD

prednisolone sodium phosphate oral solution 15 mg5 ml (3 mgml) 25 mg5 ml (5 mgml)

2 PA BvD

prednisolone sodium phosphate oral solution 5 mg base5 ml (67 mg5 ml)

(Pediapred) 2 PA BvD

prednisone oral solution 5 mg5 ml 2 PA BvD

prednisone oral tablet 1 mg 2 PA BvD

prednisone oral tablet 10 mg 25 mg 5 mg 50 mg

1 PA BvD GC

prednisone oral tablet 20 mg (Deltasone) 1 PA BvD GC

prednisone oral tabletsdose pack 10 mg 10 mg (48 pack) 5 mg 5 mg (48 pack)

2 PA BvD

Pituitarydesmopressin 10 mcg01 ml spr 10 mcgspray (01 ml)

(DDAVP) 2

desmopressin injection solution 4 mcgml (DDAVP) 2

desmopressin nasal solution 01 mgml (refrigerate)

(DDAVP) 2

desmopressin nasal spraynon-aerosol 10 mcgspray (01 ml)

desmopressin oral tablet 01 mg 02 mg (DDAVP) 2

GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 02 MG025 ML

GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 04 MG025 ML 06 MG025 ML 08 MG025 ML 1 MG025 ML 12 MG025 ML 14 MG025 ML 16 MG025 ML 18 MG025 ML 2 MG025 ML

5 PA NM NDS

GENOTROPIN SUBCUTANEOUS CARTRIDGE 12 MGML (36 UNITML) 5 MGML (15 UNITML)

5 PA NM NDS

HUMATROPE INJECTION CARTRIDGE 12 MG (36 UNIT) 24 MG (72 UNIT) 6 MG (18 UNIT)

5 PA NM NDS

HUMATROPE INJECTION RECON SOLN 5 (15 UNIT) MG

5 PA NM NDS

NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 10 MG15 ML (67 MGML) 15 MG15 ML (10 MGML) 30 MG3 ML (10 MGML)

5 PA NM NDS

NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 5 MG15 ML (33 MGML)

NUTROPIN AQ NUSPIN SUBCUTANEOUS PEN INJECTOR 10 MG2 ML (5 MGML) 20 MG2 ML (10 MGML) 5 MG2 ML (25 MGML)

5 PA NM NDS

OMNITROPE SUBCUTANEOUS CARTRIDGE 10 MG15 ML (67 MGML) 5 MG15 ML (33 MGML)

5 PA NM NDS

OMNITROPE SUBCUTANEOUS RECON SOLN 58 MG

5 PA NM NDS

SAIZEN CLICKEASY SUBCUTANEOUS CARTRIDGE 88 MG151 ML (FINAL CONC)

5 PA NM NDS

SAIZEN SUBCUTANEOUS RECON SOLN 5 MG 88 MG

5 PA NM NDS

SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG 5 MG 6 MG

5 PA NM NDS

STIMATE NASAL SPRAYNON-AEROSOL 150 MCGSPRAY (01 ML)

ZOMACTON SUBCUTANEOUS RECON SOLN 10 MG

5 PA NM NDS

ZORBTIVE SUBCUTANEOUS RECON SOLN 88 MG

5 PA NM NDS

ProgestinsDEPO-PROVERA INTRAMUSCULAR SOLUTION 400 MGML

medroxyprogesterone intramuscular suspension 150 mgml

(Depo-Provera) 2 QL (1 per 84 days)

medroxyprogesterone oral tablet 10 mg 25 mg 5 mg

(Provera) 1 GC

progesterone micronized oral capsule 100 mg 200 mg

(Prometrium) 2

Thyroid And Antithyroid Agentslevothyroxine intravenous recon soln 100 mcg

5 NM NDS

levothyroxine oral tablet 100 mcg 125 mcg 150 mcg 175 mcg 200 mcg 75 mcg

(Levoxyl) 2

levothyroxine oral tablet 112 mcg 300 mcg

(Unithroid) 2

(Levo-T) 2

levothyroxine oral tablet 25 mcg (Levo-T) 1 GC

levothyroxine oral tablet 50 mcg (Unithroid) 1 GC

liothyronine intravenous solution 10 mcgml

(Triostat) 2

liothyronine oral tablet 25 mcg 5 mcg 50 mcg

(Cytomel) 2

Immunological AgentsImmunological AgentsASTAGRAF XL ORAL CAPSULEEXTENDED RELEASE 24HR 05 MG 1 MG 5 MG

4 PA BvD

azathioprine oral tablet 50 mg (Imuran) 2 PA BvD

CIMZIA POWDER FOR RECONST SUBCUTANEOUS KIT 400 MG (200 MG X 2 VIALS)

5 PA NM NDS

CIMZIA SUBCUTANEOUS SYRINGE KIT 400 MG2 ML (200 MGML X 2)

5 PA NM NDS

cyclosporine modified oral capsule 100 mg

(Neoral) 2 PA BvD

cyclosporine modified oral capsule 25 mg 50 mg

(Gengraf) 2 PA BvD

cyclosporine modified oral solution 100 mgml

(Gengraf) 2 PA BvD

ENBREL SUBCUTANEOUS RECON SOLN 25 MG (1 ML)

5 PA NM NDS

ENBREL SUBCUTANEOUS SYRINGE 25 MG05ML (051) 50 MGML (098 ML)

5 PA NM NDS

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR 50 MGML (098 ML)

5 PA NM NDS

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HR 075 MG 1 MG 4 MG

4 PA BvD

gengraf oral capsule 100 mg 25 mg 50 mg

2 PA BvD

gengraf oral solution 100 mgml 2 PA BvD

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS SYRINGE KIT 40 MG08 ML 40 MG08 ML (6 PACK)

5 PA NM NDS

HUMIRA PEN CROHNS-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 40 MG08 ML

5 PA NM NDS

HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT 40 MG08 ML

5 PA NM NDS

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG08 ML

5 PA NM NDS

HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG02 ML 20 MG04 ML 40 MG08 ML

5 PA NM NDS

leflunomide oral tablet 10 mg 20 mg (Arava) 2

mycophenolate mofetil oral capsule 250 mg

(CellCept) 2 PA BvD

mycophenolate mofetil oral suspension for reconstitution 200 mgml

(CellCept) 5 PA BvD NM NDS

mycophenolate mofetil oral tablet 500 mg (CellCept) 2 PA BvD

ORENCIA CLICKJECT SUBCUTANEOUS AUTO-INJECTOR 125 MGML

5 PA NM NDS

ORENCIA SUBCUTANEOUS SYRINGE 125 MGML 50 MG04 ML 875 MG07 ML

5 PA NM NDS

PROGRAF INTRAVENOUS SOLUTION 5 MGML

4 PA BvD

SIMPONI ARIA INTRAVENOUS SOLUTION 125 MGML

5 PA NM NDS

SIMPONI SUBCUTANEOUS PEN INJECTOR 100 MGML 50 MG05 ML

5 PA NM NDS

SIMPONI SUBCUTANEOUS SYRINGE 100 MGML 50 MG05 ML

5 PA NM NDS

tacrolimus oral capsule 05 mg 1 mg 5 mg

(Prograf) 2 PA BvD

XELJANZ ORAL TABLET 5 MG 5 PA NM NDS QL (60 per 30 days)

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HR 11 MG

VaccinesADACEL(TDAP ADOLESNADULT)(PF) INTRAMUSCULAR SUSPENSION 2 LF-(25-5-3-5 MCG)-5LF05 ML

BOOSTRIX TDAP INTRAMUSCULAR SUSPENSION 25-8-5 LF-MCG-LF05ML

BOOSTRIX TDAP INTRAMUSCULAR SYRINGE 25-8-5 LF-MCG-LF05ML

ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 20 MCGML

3 PA BvD

ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SUSPENSION 10 MCG05 ML

3 PA BvD

ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 10 MCG05 ML

3 PA BvD

HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1440 ELISA UNITML

HAVRIX (PF) INTRAMUSCULAR SYRINGE 720 ELISA UNIT05 ML

MENACTRA (PF) INTRAMUSCULAR SOLUTION 4 MCG05 ML

MENVEO A-C-Y-W-135-DIP (PF) INTRAMUSCULAR KIT 10-5 MCG05 ML

RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10 MCGML 40 MCGML

3 PA BvD

RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCGML 5 MCG05 ML

3 PA BvD

RECOMBIVAX HB 5 MCG05 ML VL OUTER PF SDV 5 MCG05 ML

3 PA BvD

TWINRIX (PF) INTRAMUSCULAR SUSPENSION 720 ELISA UNIT -20 MCGML

TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG05 ML

TYPHIM VI INTRAMUSCULAR SYRINGE 25 MCG05 ML

VAQTA (PF) INTRAMUSCULAR SYRINGE 25 UNIT05 ML 50 UNITML

ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 19400 UNIT065 ML

Inflammatory Bowel Disease AgentsInflammatory Bowel Disease AgentsAPRISO ORAL CAPSULEEXTENDED RELEASE 24HR 0375 GRAM

CANASA RECTAL SUPPOSITORY 1000 MG

DELZICOL ORAL CAPSULE (WITH DEL REL TABLETS) 400 MG

LIALDA ORAL TABLETDELAYED RELEASE (DREC) 12 GRAM

mesalamine oral tabletdelayed release (drec) 800 mg

(Asacol HD) 2

sulfasalazine oral tablet 500 mg (Azulfidine) 2

sulfasalazine oral tabletdelayed release (drec) 500 mg

(Azulfidine EN-tabs) 2

Irrigating SolutionsIrrigating Solutionssodium chloride irrigation solution 09 (Sterile Saline) 2

water for irrigation sterile irrigation solution

(Curity Sterile Water) 2

Metabolic Bone Disease AgentsMetabolic Bone Disease Agentsalendronate oral solution 70 mg75 ml 2 QL (300 per 28 days)

alendronate oral tablet 10 mg 5 mg 1 GC

alendronate oral tablet 35 mg 1 GC QL (4 per 28 days)

alendronate oral tablet 40 mg 2

alendronate oral tablet 70 mg (Fosamax) 1 GC QL (4 per 28 days)

calcitriol intravenous solution 1 mcgml 2

calcitriol oral capsule 025 mcg 05 mcg (Rocaltrol) 2

calcitriol oral solution 1 mcgml (Rocaltrol) 2

ibandronate intravenous solution 3 mg3 ml

ibandronate oral tablet 150 mg (Boniva) 2 QL (1 per 28 days)

SENSIPAR ORAL TABLET 30 MG 3 QL (60 per 30 days)

SENSIPAR ORAL TABLET 60 MG 5 NM NDS QL (60 per 30 days)

Miscellaneous Therapeutic AgentsMiscellaneous Therapeutic AgentsELMIRON ORAL CAPSULE 100 MG 4

hydroxyzine pamoate oral capsule 100 mg

hydroxyzine pamoate oral capsule 25 mg 50 mg

(Vistaril) 2

leucovorin calcium 200 mg vial latex-free pf sdv 200 mg

leucovorin calcium injection recon soln100 mg 350 mg

leucovorin calcium oral tablet 10 mg 15 mg 25 mg 5 mg

levocarnitine (with sugar) oral solution100 mgml

(Carnitor) 2

levocarnitine oral tablet 330 mg (Carnitor) 2

MESTINON ORAL SYRUP 60 MG5 ML

5 NM NDS

pyridostigmine bromide oral tablet 60 mg (Mestinon) 2

pyridostigmine bromide oral tablet extended release 180 mg

(Mestinon Timespan) 2

Ophthalmic AgentsAntiglaucoma AgentsALPHAGAN P OPHTHALMIC DROPS 01

bimatoprost ophthalmic drops 003 2

brimonidine ophthalmic drops 015 (Alphagan P) 2

brimonidine ophthalmic drops 02 1 GC

dorzolamide-timolol ophthalmic drops223-68 mgml

(Cosopt) 2

latanoprost ophthalmic drops 0005 (Xalatan) 2

LUMIGAN OPHTHALMIC DROPS 001

timolol maleate ophthalmic drops 025 05

(Timoptic) 1 GC

timolol maleate ophthalmic gel forming solution 025 05

(Timoptic-XE) 2

Replacement PreparationsReplacement Preparationsd5 -045 sodium chloride intravenous parenteral solution

dextrose 5 -lactated ringers intravenous parenteral solution

klor-con m10 oral tableter particlescrystals 10 meq

klor-con sprinkle oral capsule extended release 10 meq 8 meq

potassium chlorid-d5-045nacl intravenous parenteral solution 10 meql 20 meql 30 meql 40 meql

potassium chloride intravenous piggyback10 meq100 ml 20 meq100 ml 40 meq100 ml

potassium chloride intravenous solution 2 2 meqml

potassium chloride oral capsule extended release 10 meq 8 meq

(Klor-Con Sprinkle) 2

potassium chloride oral liquid 20 meq15 ml 40 meq15 ml

potassium chloride oral tablet extended release 10 meq

(Klor-Con 10) 2

potassium chloride oral tablet extended release 20 meq 8 meq

(K-Tab) 2

potassium chloride oral tableter particlescrystals 10 meq

(Klor-Con M10) 2

(Klor-Con M20) 2

potassium citrate oral tablet extended release 10 meq (1080 mg)

(Urocit-K 10) 2

potassium citrate oral tablet extended release 15 meq

(Urocit-K 15) 2

(Urocit-K 5) 2

sodium chloride 045 intravenous parenteral solution 045

sodium chloride intravenous parenteral solution 25 meqml

Respiratory Tract AgentsAnti-Inflammatories Inhaled CorticosteroidsADVAIR DISKUS INHALATION BLISTER WITH DEVICE 100-50 MCGDOSE 250-50 MCGDOSE 500-50 MCGDOSE

ADVAIR HFA INHALATION HFA AEROSOL INHALER 115-21 MCGACTUATION 230-21 MCGACTUATION 45-21 MCGACTUATION

QVAR INHALATION AEROSOL 40 MCGACTUATION 80 MCGACTUATION

Antileukotrienesmontelukast oral granules in packet 4 mg (Singulair) 2

montelukast oral tablet 10 mg (Singulair) 1 GC

montelukast oral tabletchewable 4 mg 5 mg

(Singulair) 2

zafirlukast oral tablet 10 mg 20 mg (Accolate) 2Bronchodilatorsalbuterol sulfate inhalation solution for nebulization 063 mg3 ml 125 mg3 ml 25 mg 3 ml (0083 ) 5 mgml

2 PA BvD

albuterol sulfate oral syrup 2 mg5 ml 2

albuterol sulfate oral tablet 2 mg 4 mg 2

albuterol sulfate oral tablet extended release 12 hr 4 mg 8 mg

ATROVENT HFA INHALATION HFA AEROSOL INHALER 17 MCGACTUATION

COMBIVENT RESPIMAT INHALATION MIST 20-100 MCGACTUATION

ipratropium bromide inhalation solution002

2 PA BvD

PROAIR HFA INHALATION HFA AEROSOL INHALER 90 MCGACTUATION

PROAIR RESPICLICK INHALATION AEROSOL POWDR BREATH ACTIVATED 90 MCGACTUATION

SPIRIVA RESPIMAT INHALATION MIST 125 MCGACTUATION 25 MCGACTUATION

SPIRIVA WITH HANDIHALER INHALATION CAPSULE WINHALATION DEVICE 18 MCG

VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90 MCGACTUATION

Respiratory Tract Agents Otheracetylcysteine solution 100 mgml (10 ) 200 mgml (20 )

2 PA BvD

DALIRESP ORAL TABLET 500 MCG

XOLAIR SUBCUTANEOUS RECON SOLN 150 MG

5 PA NM NDS

Skeletal Muscle RelaxantsSkeletal Muscle Relaxantscyclobenzaprine oral tablet 10 mg 5 mg 2

cyclobenzaprine oral tablet 75 mg (Fexmid) 2

methocarbamol oral tablet 500 mg (Robaxin) 2

methocarbamol oral tablet 750 mg (Robaxin-750) 2

Sleep Disorder AgentsSleep Disorder Agentszaleplon oral capsule 10 mg 5 mg (Sonata) 2 QL (60 per 30 days)

zolpidem oral tablet 10 mg 5 mg (Ambien) 2 QL (30 per 30 days)

zolpidem oral tabletext release multiphase 125 mg 625 mg

(Ambien CR) 2 QL (30 per 30 days)

Vasodilating AgentsVasodilating AgentsADCIRCA ORAL TABLET 20 MG 5 PA NM NDS QL (60

per 30 days)

CIALIS ORAL TABLET 25 MG 5 MG

sildenafil intravenous solution 10 mg125 ml

(Revatio) 5 PA NM NDS QL (375 per 1 day)

sildenafil oral tablet 20 mg (Revatio) 2 PA QL (90 per 30 days)

TRACLEER ORAL TABLET 125 MG 625 MG

5 PA NM LA NDS QL (60 per 30 days)

Vitamins And MineralsVitamins And Mineralsfluoride (sodium) oral tablet 1 mg (22 mg sod fluoride)

pnv prenatal plus multivit tab sf gluten-free 27 mg iron- 1 mg

3 ALL RX PRENATAL VITAMINS COVERABLE UNDER PART D

prenatal vitamin plus low iron oral tablet27 mg iron- 1 mg

sodium fluoride 05 mgml drop df sfgluten-free 05 mg (11 mg sodfluorid)ml

acetaminophen-codeine 3acetylcysteine 53acyclovir 24 34ADACEL(TDAP ADOLESNADULT)(PF)47adapalene 36ADCIRCA 53ADVAIR DISKUS51ADVAIR HFA51afeditab cr 28AFINITOR 10AFINITOR DISPERZ 10ala-cort 35ala-scalp 35ALBENZA 20albuterol sulfate 52alendronate 49allopurinol 18ALPHAGAN P 50alprazolam 6 7AMINO ACIDS 15 25amiodarone 27amitriptyline 15amlodipine 28amlodipine-benazepril 28ammonium lactate 34amoxicillin 9amoxicillin-pot clavulanate 9anagrelide 25anastrozole 11ANDRODERM 41ANDROGEL41 42APRISO48ASTAGRAF XL 45atenolol 27atorvastatin 29atovaquone-proguanil 20ATRIPLA22

atropine 13ATROVENT HFA52aubra 31aviane 31AVONEX 30azathioprine 45azelastine 38azithromycin 8BD INSULIN SYRINGE ULTRA-FINE36BD ULTRA-FINE NANO PEN NEEDLES 37benazepril 26benztropine 20BETHKIS7bicalutamide 11bimatoprost 50blisovi 24 fe 31blisovi fe 1530 (28) 32blisovi fe 120 (28) 32BOOSTRIX TDAP47brimonidine 50BUNAVAIL6buprenorphine hcl 6buprenorphine-naloxone 6bupropion hcl 15butalbital-acetaminophen-caff 3calcipotriene 34calcitriol 49calcium acetate 40CANASA48carbamazepine 13carbidopa-levodopa 20cartia xt 27carvedilol 27CAYSTON9cefadroxil 8cefdinir 8

cefprozil 8cefuroxime axetil 8cephalexin 8CHANTIX 6CHANTIX CONTINUING MONTH BOX6CHANTIX STARTING MONTH BOX6chlorhexidine gluconate 34chlorpromazine 21CIALIS 53CIMZIA 45CIMZIA POWDER FOR RECONST 45ciprofloxacin hcl 9citalopram 15clarithromycin 8clindamycin hcl 7clindamycin phosphate 35clindamycin-benzoyl peroxide 35CLINIMIX 5-D20W(SULFITE-FREE) 25CLINIMIX E 425D25W SUL FREE 25CLINIMIX E 5D15W SULFIT FREE25CLINIMIX E 5D20W SULFIT FREE25CLINISOL SF 15 25clobetasol 35clobetasol-emollient 35clonazepam 7clonidine hcl 26clopidogrel 25clotrimazole 18clotrimazole-betamethasone 18clozapine 21COLCRYS 18

COMBIVENT RESPIMAT 52COMPLERA22constulose 40cormax 35CREON 37cromolyn 38CUPRIMINE 41cyclobenzaprine 53cyclosporine modified 45d5 -045 sodium chloride 50DALIRESP 53dapsone 19delyla (28) 32DELZICOL 48DEPEN TITRATABS41DEPO-PROVERA 44desmopressin 43desonide 35dexmethylphenidate 30dextroamphetamine 30dextroamphetamine-amphetamine 30dextrose 5 in water (d5w) 25dextrose 5 -lactated ringers 50DIASTAT7DIASTAT ACUDIAL 7diazepam 7diazepam intensol 7diclofenac sodium 5 34dicloxacillin 9dicyclomine 40DILANTIN 13diltiazem hcl 27 28dilt-xr 28diphenoxylate-atropine 40divalproex 13donepezil 15dorzolamide-timolol 50doxazosin 26doxy-100 10

doxycycline hyclate 10drospirenone-ethinyl estradiol 32DROXIA 11EFFIENT 25ELIGARD11ELIGARD (3 MONTH) 11ELIGARD (4 MONTH) 11ELIGARD (6 MONTH) 11eliphos 40ELMIRON 49enalapril maleate 26ENBREL 45ENBREL SURECLICK46endocet 3ENGERIX-B (PF)47ENGERIX-B PEDIATRIC (PF)47enoxaparin 24enpresse 32enulose 40ENVARSUS XR 46epitol 13eplerenone 30EPOGEN24ERIVEDGE 11erythromycin 38escitalopram oxalate 15ESTRACE 42estradiol 42ESTRING 42exemestane 11EXJADE41FABRAZYME37falmina (28) 32famciclovir 24famotidine 39femynor 32fenofibrate 29fenofibrate micronized 29finasteride 41

flecainide 27fluconazole 18fluocinonide 35fluoride (sodium) 53 54fluorouracil 34fluoxetine 15 16FLUOXETINE 16fluticasone 39furosemide 29gabapentin 13gavilyte-c 40gavilyte-g 40gemfibrozil 29generlac 40gengraf 46GENOTROPIN43GENOTROPIN MINIQUICK 43gentak 38gentamicin 38gianvi (28) 32glimepiride 17glipizide 17 18GRALISE13GRALISE 30-DAY STARTER PACK 13haloperidol 21HAVRIX (PF) 47HUMALOG17HUMALOG KWIKPEN 17HUMATROPE 43HUMIRA 46HUMIRA PEDIATRIC CROHNS START 46HUMIRA PEN 46HUMIRA PEN CROHNS-UC-HS START 46HUMIRA PEN PSORIASIS-UVEITIS 46hydralazine 28

hydrochlorothiazide 29hydrocodone-acetaminophen 3hydrocortisone 35 36hydroxychloroquine 20hydroxyurea 11hydroxyzine hcl 19hydroxyzine pamoate 49ibandronate 49ibuprofen 5imiquimod 34indomethacin 5INLYTA11INSULIN SYRINGE-NEEDLE U-100 37INTRALIPID25INTRON A 23introvale 32INVANZ 9INVOKANA 16ipratropium bromide 38 52irbesartan 26irbesartan-hydrochlorothiazide 26ISENTRESS 22isoniazid 19isosorbide dinitrate 30isosorbide mononitrate 30JADENU41JADENU SPRINKLE 41JAKAFI11jantoven 24JANUMET16JANUMET XR 16JANUVIA 17junel fe 1530 (28) 32junel fe 120 (28) 32junel fe 24 32KALETRA22ketoconazole 18ketorolac 39klor-con m10 50

klor-con m15 50klor-con m20 50klor-con sprinkle 50KUVAN 37lactulose 40lamotrigine 14LANTUS17LANTUS SOLOSTAR17larin fe 1530 (28) 32larin fe 120 (28) 32larissia 32latanoprost 50LATUDA 21leflunomide 46lessina 32letrozole 11leucovorin calcium 49LEUKERAN11leuprolide 11levetiracetam 14levocarnitine 49levocarnitine (with sugar) 49levocetirizine 19levofloxacin 10levonest (28) 32levonorgestrel-ethinyl estrad 32levonorg-eth estrad triphasic 32levora-28 32levothyroxine 45LIALDA48lidocaine 5 6lidocaine hcl 5lidocaine viscous 6liothyronine 45lisinopril 26lisinopril-hydrochlorothiazide 26lithium carbonate 31lomedia 24 fe 33loperamide 40lopinavir-ritonavir 22

lorazepam 7lorazepam intensol 7lorcet (hydrocodone) 3lorcet hd 3lorcet plus 3loryna (28) 33losartan 26losartan-hydrochlorothiazide 26lovastatin 29LUMIGAN 50LUPRON DEPOT 11LUPRON DEPOT (3 MONTH)11LUPRON DEPOT (4 MONTH)11LUPRON DEPOT (6 MONTH)11lutera (28) 33LYRICA14LYSODREN 11malathion 36marlissa 33matzim la 28meclizine 20medroxyprogesterone 44mefloquine 20megestrol 11meloxicam 5memantine 15MENACTRA (PF)47MENVEO A-C-Y-W-135-DIP (PF)48mercaptopurine 11mesalamine 48MESTINON50metformin 17methocarbamol 53methotrexate sodium 12methylphenidate hcl 31methylprednisolone 42

metoclopramide hcl 40metoprolol succinate 27metoprolol tartrate 27metronidazole 7 19 35microgestin fe 1530 (28) 33microgestin fe 120 (28) 33minocycline 10mometasone 36mononessa (28) 33montelukast 52morphine 3 4MORPHINE 4morphine concentrate 4MOXEZA38mycophenolate mofetil 46nabumetone 5NAMENDA XR 15naproxen 5neomycin 7neomycin-polymyxin b-dexameth 38neomycin-polymyxin-hc 39neuac 35NEULASTA24NEUPOGEN24NEXAVAR 12nifedipine 29nikki (28) 33nitrofurantoin macrocrystal 7nitrofurantoin monohydm-cryst 8NORDITROPIN FLEXPRO44norethindrone-eestradiol-iron 33norgestimate-ethinyl estradiol 33NORVIR 22NUTRILIPID 26NUTROPIN AQ NUSPIN44nyamyc 18nyata 18nystatin 18

nystop 18ocella 33ofloxacin 10 39olanzapine 21olopatadine 38OLYSIO 23omeprazole 39OMNITROPE 44ondansetron 20ORENCIA46ORENCIA CLICKJECT 46ORFADIN 37orsythia 33oseltamivir 23oxybutynin chloride 41oxycodone 4oxycodone-acetaminophen 4OXYCONTIN4 5pacerone 27paclitaxel 12pantoprazole 39paroxetine hcl 16PAXIL 16peg 3350-electrolytes 40PEGASYS 23PEGASYS PROCLICK 23PEN NEEDLE DIABETIC37penicillin v potassium 9PENNSAID34periogard 34permethrin 36PERTZYE 37phenadoz 20phenytoin sodium extended 14PHOSLYRA41pioglitazone 17polyethylene glycol 3350 40POMALYST 12portia 33

potassium chlorid-d5-045nacl 50potassium chloride 51potassium citrate 51pramipexole 21pravastatin 29prednisolone acetate 39prednisolone sodium phosphate 43prednisone 43PREMARIN 42PREMPHASE 42PREMPRO42prenatal plus (calcium carb) 53prenatal vitamin plus low iron 54previfem 33PREZISTA 22PROAIR HFA 52PROAIR RESPICLICK52prochlorperazine maleate 20PROCRIT 25procto-med hc 36procto-pak 36proctosol hc 36proctozone-hc 36progesterone micronized 45PROGRAF46promethazine 20promethegan 20propafenone 27propantheline 13propranolol 27PROSOL 20 26PULMOZYME 37PURIXAN12pyridostigmine bromide 50QBRELIS 26quasense 33quetiapine 21QVAR52ramipril 26

RANEXA28ranitidine hcl 40RECOMBIVAX HB (PF)48RENVELA 41RESTASIS39REVLIMID12REYATAZ 23rifampin 19risperidone 22rizatriptan 19ropinirole 21ROWEEPRA14SAIZEN44SAIZEN CLICKEASY 44SAVELLA 31SENSIPAR49SEROSTIM 44sertraline 16setlakin 33sevelamer carbonate 41sildenafil 53SIMPONI 47SIMPONI ARIA 46simvastatin 29 30sodium chloride 49 51sodium chloride 045 51sodium chloride 09 51SOLTAMOX12SOVALDI 23SPIRIVA RESPIMAT 52SPIRIVA WITH HANDIHALER52spironolactone 29sprintec (28) 33SPRITAM 14SPRYCEL 12sronyx 33STIMATE 44STIVARGA12STRIBILD23

SUBOXONE 6sulfadiazine 10sulfamethoxazole-trimethoprim 10sulfasalazine 48sumatriptan succinate 19SUTENT 12SYNAGIS23tacrolimus 47TAMIFLU 23tamoxifen 12tamsulosin 41TARCEVA 12tarina fe 120 (28) 33TASIGNA 12taztia xt 28TEKTURNA30terbinafine hcl 18terconazole 19testosterone 42testosterone cypionate 42timolol maleate 50TOBI PODHALER7TOBRADEX 39TOBRADEX ST39tobramycin-dexamethasone 39TOLAK 34topiramate 14TOUJEO SOLOSTAR 17TRACLEER53TRADJENTA 17tramadol 5tranexamic acid 25TRAVASOL 10 26trazodone 16tretinoin 36tretinoin (chemotherapy) 12TREXALL 12triamcinolone acetonide 34 36triamterene-hydrochlorothiazid 29tridesilon 36

tri-legest fe 33tri-lo-estarylla 33tri-lo-sprintec 33trinessa (28) 34tri-previfem (28) 34tri-sprintec (28) 34trivora (28) 34TROKENDI XR 15TROPHAMINE 10 26TRUVADA 23TWINRIX (PF) 48TYKERB12TYPHIM VI 48ursodiol 40valacyclovir 24valsartan-hydrochlorothiazide 26VAQTA (PF) 48venlafaxine 16VENTOLIN HFA 52verapamil 28VERSACLOZ22VESICARE 41vestura (28) 34vicodin 5vicodin es 5vicodin hp 5VICTOZA 17vienva 34VIGAMOX 39VIREAD23VOLTAREN 34VOTRIENT12warfarin 24water for irrigation sterile 49XALKORI 12XARELTO 24XELJANZ 47XELJANZ XR 47XIFAXAN 8XOLAIR53

XTANDI 13yuvafem 42zafirlukast 52zaleplon 53zarah 34zebutal 5ZELBORAF 13ZENPEP38ziprasidone hcl 22zolpidem 53ZOMACTON 44ZORBTIVE 44ZOSTAVAX (PF)48ZOVIRAX35ZUBSOLV6ZYTIGA13

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با باشدی م فراهم شمای برا گانیرا بصورتی زبان التیتسه دیکنی م گفتگوفارسی زبان به اگر توجه

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(711الصم والبكم

ਧਿਆਨ ਧਿਓ ਜ ਤਸੀ ਪਜਾਬੀ ਬਲਿ ਹ ਤਾ ਭਾਸ਼ਾ ਧ ਿ ਚ ਸਹਾਇਤਾ ਸ ਾ ਤਹਾਡ ਲਈ ਮਫਤ ਉਪਲਬਿ ਹਤ ਕਾਲ ਕਰ

បរយតន បរើសនជាអនកនយាយភាសាខមែរ បសវាជនយខននកភាសា

បោយមនគតឈន ល គអាចមានសរាររបរ ើអនក ចរ ទរសពទ

धयान द यददआप द िदी बोलत तोआपक ललए मफत म भाषा स ायता सवाएि उपलबध पर कॉलकर

เรยน ถาคณพดภาษาไทยคณสามารถใชบรการชวยเหลอทางภาษาไดฟร โทร

PO Box 72530Oakland CA 94612StanfordHealthCareAdvantageorg

Stanford Health Care Advantage is an HMO with a Medicare Contract Enrollment in Stanford Health Care Advantage depends on contract renewal

The formulary may change at any time You will receive notice when necessary

ATTENTION If you speak Spanish language assistance services free of charge are available to you Call 1-855-996-8422 or for TTY users 711 800 am to 800 pm 7 days a week (except Thanksgiving and Christmas) from October 1 through February 14 and Monday to Friday (except holidays) from February 15 through September 30

ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-855-996-8422 o para los usuarios de 711 de 800 am a 800 pm los 7 diacuteas de la semana (excepto el Diacutea de Accioacuten de Gracias y Navidad) desde el 1 de Octubre hasta el 14 de Febrero y de lunes a viernes (excepto los diacuteas feriados) desde el 15 de Febrero hasta el 30 de Septiembre

00018031 1This abridged formulary was updated on 09012017 This is not a complete list of drugs covered by our plan For a complete listing or other questions please contact Stanford Health Care Advantage Member Care Services at 1-855-996-8422 or for TTY users 711 8 am to 8 pm seven days a week (except Thanksgiving and Christmas) from October 1 through February 14 and Monday through Friday (except holidays) from February 15 through September 30 or visit StanfordHealthCareAdvantageorg

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Anti-AddictionSubstance Abuse Treatment Agents

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticholinergic Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Anti-Infectives (Skin And Mucous Membrane)

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Antiparkinsonian Agents

Antipsychotic Agents

Antivirals (Systemic)

Blood ProductsModifiersVolume Expanders

Caloric Agents

Cardiovascular Agents

Central Nervous System Agents

Contraceptives

Dental And Oral Agents

Dermatological Agents

Devices

Enzyme ReplacementModifiers

Eye Ear Nose Throat Agents

Gastrointestinal Agents

Genitourinary Agents

Heavy Metal Antagonists

Hormonal Agents StimulantReplacementModifying

Immunological Agents

Inflammatory Bowel Disease Agents

Irrigating Solutions

Metabolic Bone Disease Agents

Miscellaneous Therapeutic Agents

Ophthalmic Agents

Replacement Preparations

Respiratory Tract Agents

Skeletal Muscle Relaxants

Sleep Disorder Agents

Vasodilating Agents

Vitamins And Minerals

2018 Abridged Formulary_Draft_20170911pdf

What is the Stanford Health Care Advantage (HMO) Abridged Formulary

Can the Formulary (drug list) change

How do I use the Formulary

Medical Condition

Alphabetical Listing

What are generic drugs

Are there any restrictions on my coverage

What if my drug is not on the Formulary

How do I request an exception to the Stanford Health Care Advantage HMO Formulary

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

For more information

Stanford Health Care Advantage (HMO) Formulary





Medical Condition









Table of Contents

2 QL (2700 per 30 days)

2 QL (1800 per 30 days)

(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









Table of Contents

2 QL (2700 per 30 days)

2 QL (1800 per 30 days)

(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









Table of Contents

2 QL (2700 per 30 days)

2 QL (1800 per 30 days)

(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









Table of Contents

2 QL (2700 per 30 days)

2 QL (1800 per 30 days)

(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









Table of Contents

2 QL (2700 per 30 days)

2 QL (1800 per 30 days)

(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









2 QL (2700 per 30 days)

2 QL (1800 per 30 days)

(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









2 QL (2700 per 30 days)

2 QL (1800 per 30 days)

(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









2 QL (1800 per 30 days)

(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Voltaren-XR) 2

(EC-Naprosyn) 2

(Xylocaine) 2

2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









2 QL (1200 per 30 days)

5 PA BvD NM NDS

(Cleocin HCl) 2

(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Zithromax) 2

5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 NM LA NDS

(Augmentin) 2

(Augmentin XR) 2

(Cipro) 1 GC

(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Levaquin) 2

(Sulfatrim) 2

(Bactrim) 1 GC

(Bactrim DS) 1 GC

(Morgidox) 2

(Doryx) 2

(Minocin) 2

5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 NM NDS

2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









2 PA BvD

5 NM NDS

5 PA NSO NM LA NDS

5 NM NDS

4 PA BvD ST

(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Carbatrol) 2

(Tegretol) 2

(Tegretol XR) 2

(Depakote ER) 2

(Depakote) 2

(Neurontin) 2

(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Lamictal) 2

(Lamictal XR) 2

(Lamictal) 2

(Lamictal ODT) 2

(Keppra) 2

(Keppra XR) 2

(Phenytek) 2

(Topamax) 2

(Qudexy XR) 2

(Topamax) 2

(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Wellbutrin SR) 2

(Wellbutrin XL) 2

(Lexapro) 1 GC

(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Paxil) 1 GC

(Paxil CR) 2

(Zoloft) 1 GC

(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Lotrisone) 2

(Diflucan) 2

(Nystop) 2

(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Compazine) 1 GC

(Phenergan) 2

(Promethegan) 2

(Malarone) 2

(Sinemet) 2

(Sinemet CR) 2

(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Mirapex) 2

(Requip) 2

(Requip XL) 2

5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 NM NDS

(Kaletra) 2

5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 NM NDS

5 PA NM NDS

3 QL (540 per 180 days)

per 28 days)

5 PA NSO NM NDS

5 NM NDS

(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Lovenox) 2

(Jantoven) 1 GC

(Coumadin) 1 GC

5 NM NDS

(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Cyklokapron) 2

4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









4 PA BvD

(Catapres) 1 GC

(Cardura) 2

(Avapro) 6 GC

(Avalide) 2

(Cozaar) 6 GC

(Hyzaar) 6 GC

(Diovan HCT) 2

(Vasotec) 2

(Zestril) 6 GC

(Zestoretic) 6 GC

(Altace) 6 GC

(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Rythmol SR) 2

(Coreg) 1 GC

(Toprol XL) 2

(Lopressor) 2

(Lopressor) 1 GC

(Inderal LA) 2

(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Tiazac) 2

(Cardizem CD) 2

(Verelan PM) 2

(Verelan) 2

(Calan SR) 1 GC

(Norvasc) 1 GC

(Lotrel) 2

(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Procardia XL) 2

(Adalat CC) 2

(Lasix) 1 GC

(Dyazide) 1 GC

(Maxzide-25mg) 1 GC

(Maxzide) 1 GC

(Lipitor) 6 GC

(Pravachol) 2

(Zocor) 6 GC

(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(ISOCHRON) 2

5 PA NM NDS

(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Lithobid) 2

(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Gianvi (28)) 2

(Zarah) 2

(Aviane) 2

(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Larin Fe 120 (28)) 2

(Tri-Lo-Marzia) 2

(Sprintec (28)) 2

(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Peridex) 2

(Oralone) 2

(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Cleocin T) 2

(Duac) 2

(Benzaclin) 2

(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Triderm) 2

(Retin-A) 2 PA

5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 NM NDS

5 PA NM NDS

5 NM NDS

5 PA BvD NM NDS

(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Maxitrol) 2

(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(TobraDex) 2

(ClariSpray) 1 GC

(Pred Forte) 2

(Pepcid) 2

(Protonix) 2

(Protonix) 1 GC

(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Zantac) 2

(Lomotil) 2

(Reglan) 1 GC

(Golytely) 2

(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Renvela) 2

(Ditropan XL) 2

(Flomax) 2

5 PA NM NDS

(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Medrol) 2 PA BvD

2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









2 PA BvD

1 PA BvD GC

2 PA BvD

(DDAVP) 2

5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 PA NM NDS

(Provera) 1 GC

(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Prometrium) 2

5 NM NDS

(Levoxyl) 2

(Unithroid) 2

(Levo-T) 2

(Triostat) 2

(Cytomel) 2

4 PA BvD

5 PA NM NDS

(Neoral) 2 PA BvD

(Gengraf) 2 PA BvD

5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 PA NM NDS

4 PA BvD

2 PA BvD

5 PA NM NDS

(CellCept) 2 PA BvD

5 PA NM NDS

4 PA BvD

5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 PA NM NDS

(Prograf) 2 PA BvD

3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









3 PA BvD

(Asacol HD) 2

(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Vistaril) 2

(Carnitor) 2

5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









5 NM NDS

(Cosopt) 2

(Timoptic) 1 GC

(Timoptic-XE) 2

(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Klor-Con 10) 2

(K-Tab) 2

(Klor-Con M10) 2

(Klor-Con M20) 2

(Urocit-K 10) 2

(Urocit-K 15) 2

(Urocit-K 5) 2

(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









(Singulair) 2

2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









2 PA BvD

5 PA NM NDS

per 30 days)

հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









հեռատիպ

H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









H2986_PD18_103 Accepted 2017

Analgesics

Anesthetics

Antianxiety Agents

Antibacterials

Anticancer Agents

Anticonvulsants

Antidementia Agents

Antidepressants

Antidiabetic Agents

Antifungals

Antigout Agents

Antihistamines

Antimigraine Agents

Antimycobacterials

Antinausea Agents

Antiparasite Agents

Caloric Agents

Contraceptives

Devices

Ophthalmic Agents

Vasodilating Agents




Medical Condition













Medical Condition









Documents

Stanford Health Care Advantage 2018 Abridged Formulary ......MG, 6.3-1 MG. 3. QL (60 per 30 days) buprenorphine hcl sublingual tablet 2 mg, 8 mg: 2. PA; QL (90 per 30 days) buprenorphine-naloxone