molina texas marketplace · molina texas marketplace ... bayer adv tab 325mg tier 0 bayer asa tab...

PA - Prior Authorization QL - Special Quantity Limit may apply ST - Step Therapy Age - Special Age Limit may apply Tier 0 = Preventative Services at $0 copay; Tier 1 = Formulary Generic Drugs Tier 2 = Formulary Preferred Brand Drugs; Tier 3 = Formulary Non-Preferred Brand Drugs Tier 4 = Specialty Drugs; DME = Coinsurance may apply

1

Molina Texas Marketplace (09/01/2014)

Drug Name Drug Tier Requirements/Limits

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS Amphetamines amphetamine cap 5mg er Tier 1 AGE

amphetamine cap 10mg er Tier 1 AGE





amphetamine tab 5mg Tier 1 AGE

amphetamine tab 7.5mg Tier 1 AGE


amphetamine tab 12.5mg Tier 1 AGE




dextroamphet cap 5mg er Tier 1 AGE



dextroamphet tab 5mg Tier 1 AGE

dextroamphet tab 10mg Tier 1 AGE

methamphetam tab 5mg Tier 1 AGE

VYVANSE CAP 20MG Tier 3 PA; AGE






zenzedi tab 5mg Tier 1 AGE

zenzedi tab 10mg Tier 1 AGE

Attention-Deficit/Hyperactivity Disorder (ADHD) Agents INTUNIV TAB 1MG Tier 3 PA

INTUNIV TAB 2MG Tier 3 PA



STRATTERA CAP 10MG Tier 2 AGE







2



Stimulants - Misc. DAYTRANA DIS 15MG/9HR Tier 3 PA; AGE

dexmethylph cap 15mg er Tier 1 PA; AGE



dexmethylph tab 2.5mg Tier 1 AGE

dexmethylph tab 5mg Tier 1 AGE

dexmethylph tab 10mg Tier 1 AGE

FOCALIN XR CAP 5MG Tier 3 PA; AGE








metadate tab 20mg er Tier 1 AGE

methylin tab 5mg Tier 1 AGE


methylin tab 10mg er Tier 1 AGE


methylin tab 20mg er Tier 1 AGE

methylphenid cap 10mg Tier 1 AGE


methylphenid cap 20mg er Tier 1 AGE







methylphenid tab 5mg Tier 1 AGE


methylphenid tab 10mg er Tier 1 AGE




methylphenid tab 20mg sr Tier 1 AGE




modafinil tab 100mg Tier 1 PA


3


modafinil tab 200mg Tier 1 PA

NUVIGIL TAB 50MG Tier 3 PA



RITALIN LA CAP 10MG Tier 3 PA; AGE

AMINOGLYCOSIDES Aminoglycosides neomycin tab 500mg Tier 1

paromomycin cap 250mg Tier 1 PA

TOBI NEB 300/5ML Tier 4 PA

tobramycin neb 300/5ml Tier 4 PA

ANALGESICS - ANTI-INFLAMMATORY Anti-TNF-alpha - Monoclonoal Antibodies HUMIRA KIT 20MG/0.4 Tier 4 PA

HUMIRA KIT 40MG/0.8 Tier 4 PA

HUMIRA PEN KIT 40MG/0.8 Tier 4 PA

HUMIRA PEN KIT CROHNS Tier 4 PA

HUMIRA PEN KIT PSORIASI Tier 4 PA

Antirheumatic Antimetabolites RHEUMATREX TAB 2.5MG Tier 2

Gold Compounds RIDAURA CAP 3MG Tier 3

Interleukin-1 Blockers ARCALYST INJ 220MG Tier 4 PA

Interleukin-1 Receptor Antagonist (IL-1Ra) KINERET INJ Tier 4 PA

Nonsteroidal Anti-inflammatory Agents (NSAIDs) CELEBREX CAP 100MG Tier 2 PA

CELEBREX CAP 200MG Tier 2 PA

CELEBREX CAP 400MG Tier 2 PA

diclofenac tab 25mg dr Tier 1



etodolac cap 200mg Tier 1

etodolac cap 300mg Tier 1

etodolac er tab 400mg Tier 1



etodolac tab 400mg Tier 1

etodolac tab 500mg Tier 1

fenoprofen tab 600mg Tier 1

flurbiprofen tab 50mg Tier 1


4


flurbiprofen tab 100mg Tier 1

ibuprofen tab 400mg Tier 1



indomethacin cap 25mg Tier 1

indomethacin cap 50mg Tier 1

indomethacin cap 75mg er Tier 1

ketoprofen cap 200mg er Tier 1

ketorolac tab 10mg Tier 1

meclofen sod cap 50mg Tier 1

meclofen sod cap 100mg Tier 1

mefenam acid cap 250mg Tier 1

meloxicam tab 7.5mg Tier 1

meloxicam tab 15mg Tier 1

nabumetone tab 500mg Tier 1

nabumetone tab 750mg Tier 1

naproxen sod tab 550mg Tier 1

naproxen tab 375mg Tier 1

naproxen tab 500mg Tier 1

oxaprozin tab 600mg Tier 1

piroxicam cap 10mg Tier 1

piroxicam cap 20mg Tier 1

sulindac tab 150mg Tier 1

sulindac tab 200mg Tier 1

tolmetin sod cap 400mg Tier 1

tolmetin sod tab 200mg Tier 1

tolmetin sod tab 600mg Tier 1

Pyrimidine Synthesis Inhibitors leflunomide tab 10mg Tier 1

leflunomide tab 20mg Tier 1

Selective Costimulation Modulators ORENCIA INJ 250MG Tier 4 PA

Soluble Tumor Necrosis Factor Receptor Agents ENBREL INJ 25/0.5ML Tier 4 PA

ENBREL INJ 25MG Tier 4 PA

ENBREL INJ 50MG/ML Tier 4 PA

ENBREL SRCLK INJ 50MG/ML Tier 4 PA

ANALGESICS - NonNarcotic Analgesic Combinations alagesic cap Tier 1

anolor 300 cap Tier 1

bupap tab 50-650mg Tier 1

but/apap/caf cap Tier 1


5


but/apap/caf tab Tier 1

but/asa/caff cap Tier 1

but/asa/caff tab Tier 1

butal/apap tab 50-325mg Tier 1

butalbital tab cpd Tier 1

capacet cap Tier 1

cephadyn tab 50-650mg Tier 1

margesic cap Tier 1

marten-tab tab 50-325mg Tier 1

PHRENILIN CAP FORTE Tier 2

promacet tab 50-650mg Tier 1

repan tab Tier 1

Salicylates anacin tab 81mg ec Tier 0

aspir-81 tab 81mg ec Tier 0

aspir-low tab 81mg ec Tier 0

aspirin adlt tab 81mg Tier 0

aspirin chil chw 81mg Tier 0

aspirin chld chw 81mg Tier 0

aspirin chw 81mg Tier 0

aspirin low chw 81mg Tier 0

aspirin low tab 81mg ec Tier 0

aspirin tab 5gr ec Tier 0

aspirin tab 81mg Tier 0

aspirin tab 81mg ec Tier 0

aspirin tab 325mg Tier 0

aspirin tab 325mg ec Tier 0

aspirtab tab 324mg ec Tier 0

bayer adv tab 325mg Tier 0

bayer asa tab 325mg Tier 0

bayer low chw 81mg Tier 0

bayer low tab 81mg ec Tier 0

child asa chw 81mg Tier 0

child asa ls chw 81mg Tier 0

cho mag tris liq 500/5ml Tier 1

cho mag tris tab 500mg Tier 1



cvs aspirin tab 81mg ec Tier 0

cvs aspirin tab 325mg Tier 0

cvs aspirin tab 325mg ec Tier 0

cvs chld asa chw 81mg Tier 0

diflunisal tab 500mg Tier 1


6


ecotrin low tab 81mg ec Tier 0

ecpirin tab 325mg ec Tier 0

eq aspirin tab 325mg Tier 0

eq aspirin tab 325mg ec Tier 0

eq child asa chw 81mg Tier 0

eql aspirin tab 81mg ec Tier 0

eql aspirin tab 325mg Tier 0

eql aspirin tab 325mg ec Tier 0

eql chld asa chw 81mg Tier 0

gnp aspirin chw 81mg Tier 0

gnp aspirin tab 81mg ec Tier 0

gnp aspirin tab 325mg Tier 0

gnp aspirin tab 325mg ec Tier 0

halfprin tab 81mg ec Tier 0

hm aspirin chw 81mg Tier 0

hm aspirin tab 325mg Tier 0

kls aspirin tab 81mg ec Tier 0

kls aspirin tab 325mg ec Tier 0

kp aspirin tab 81mg ec Tier 0

miniprin low tab 81mg ec Tier 0

mm aspirin tab 325mg Tier 0

norwich asa tab 325mg Tier 0

px aspirin chw 81mg Tier 0

px aspirin tab 81mg ec Tier 0

px aspirin tab 325mg Tier 0

px aspirin tab 325mg ec Tier 0

qc aspirin tab 325mg Tier 0

qc aspirin tab 325mg ec Tier 0

qc child asa chw 81mg Tier 0

ra aspirin chw 81mg Tier 0

ra aspirin tab 81mg ec Tier 0

ra aspirin tab 325mg Tier 0

ra aspirin tab 325mg ec Tier 0

ra child asa chw 81mg Tier 0

salsalate tab 500mg Tier 1

salsalate tab 750mg Tier 1

sb aspirin tab 325mg Tier 0

sb aspirin tab 325mg ec Tier 0

sb child asa chw 81mg Tier 0

sm aspirin chw 81mg Tier 0

sm aspirin tab 81mg ec Tier 0

sm aspirin tab 325mg Tier 0

sm aspirin tab 325mg ec Tier 0


7


sm child asa chw 81mg Tier 0

st joseph as chw 81mg Tier 0

tgt aspirin chw 81mg Tier 0

tgt aspirin chw child Tier 0

tgt aspirin tab 81mg ec Tier 0

tgt aspirin tab 325mg Tier 0

th aspirin tab 81mg ec Tier 0

th aspirin tab 325mg Tier 0

th aspirin tab 325mg ec Tier 0

ANALGESICS - OPIOID Opioid Agonists codeine sulf tab 30mg Tier 1

codeine sulf tab 60mg Tier 1

fentanyl dis 12mcg/hr Tier 1 ST




fentanyl dis 100mcg/h Tier 1 ST

hydromorphon liq 1mg/ml Tier 1

hydromorphon tab 2mg Tier 1



levorphanol tab 2mg Tier 1

meperidine sol 50mg/5ml Tier 1 PA

meperidine tab 50mg Tier 1

meperidine tab 100mg Tier 1

meperitab tab 50mg Tier 1

meperitab tab 100mg Tier 1

methadone tab 5mg Tier 1



methadose tab 5mg Tier 1



morphine sul cap 20mg er Tier 1






morphine sul tab 15mg Tier 1

morphine sul tab 15mg er Tier 1

morphine sul tab 30mg Tier 1


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NUCYNTA ER TAB 50MG Tier 3 PA





NUCYNTA TAB 50MG Tier 3 PA



oxycodone cap 5mg Tier 1

oxycodone tab 5mg Tier 1





OXYCONTIN TAB 10MG CR Tier 3 PA







oxymorphone tab 5mg er Tier 1 PA

oxymorphone tab 7.5mg er Tier 1 PA






oxymorphone tab hcl 5mg Tier 1

oxymorphone tab hcl 10mg Tier 1

tramadol hcl tab 50mg Tier 1

tramadol hcl tab 100mg er Tier 1 PA



Opioid Combinations apap/codeine sol 120-12/5 Tier 1

apap/codeine tab 300-15mg Tier 1



ascomp/cod cap 30mg Tier 1


9


but/apap/caf cap codeine Tier 1

but/asa/caf/ cap cod 30mg Tier 1

co-gesic tab 5-500mg Tier 1

endocet tab 5-325mg Tier 1

endocet tab 7.5-325 Tier 1

endocet tab 7.5-500m Tier 1



endodan tab Tier 1

hydroco/apap sol 7.5-325 Tier 1

hydroco/apap sol 7.5-500 Tier 1

hydroco/apap tab 2.5-500 Tier 1

hydroco/apap tab 5-325mg Tier 1









hydrocod/ibu tab 2.5-200 Tier 1

hydrocod/ibu tab 5-200mg Tier 1

hydrocod/ibu tab 7.5-200 Tier 1

hydrocod/ibu tab 10-200mg Tier 1

ibudone tab 5-200mg Tier 1

ibudone tab 10-200mg Tier 1

oxycod/apap cap 5-500mg Tier 1

oxycod/apap tab 5-325mg Tier 1

oxycod/apap tab 7.5-325 Tier 1

oxycod/apap tab 7.5-500 Tier 1



oxycod/asa tab Tier 1

oxycod/ibu tab 5-400mg Tier 1

reprexain tab 10-200mg Tier 1

ROXICET SOL 5-325/5 Tier 2

roxicet tab 5-325mg Tier 1

ROXICET TAB 5-500MG Tier 2

Opioid Partial Agonists bupren/nalox sub 2-0.5mg Tier 1 PA

bupren/nalox sub 8-2mg Tier 1 PA

buprenorphin sub 2mg Tier 1 PA


10


buprenorphin sub 8mg Tier 1 PA

butorphanol sol 10mg/ml Tier 1 PA

BUTRANS DIS 5MCG/HR Tier 3 PA



ANDROGENS-ANABOLIC Anabolic Steroids ANADROL-50 TAB 50MG Tier 3 PA

oxandrolone tab 2.5mg Tier 1 PA

oxandrolone tab 10mg Tier 1 PA

Androgens ANDRODERM DIS 2.5MG/24 Tier 2 PA

ANDRODERM DIS 2MG/24HR Tier 2 PA



android cap 10mg Tier 1

ANDROXY TAB 10MG Tier 2

danazol cap 50mg Tier 1



METHITEST TAB 10MG Tier 2

testost cyp inj 100mg/ml Tier 1

testost cyp inj 200mg/ml Tier 1

testost enan inj 200mg/ml Tier 1

ANORECTAL AGENTS Intrarectal Steroids colocort ene 100mg Tier 1

hydrocort ene 100mg Tier 1

Rectal Combinations hc pramoxine cre 1-1% Tier 1

hc pramoxine cre 2.5-1% Tier 1

lidazone cre Tier 1

lidocaine/hc cre 3%-0.5% Tier 1

PROCORT CRE Tier 2

PROCTOFOAM AER HC 1% Tier 2

Rectal Steroids anucort-hc sup 25mg Tier 1

hemril-30 sup 30mg Tier 1

hydrocort ac sup 25mg Tier 1

hydrocort ac sup 30mg Tier 1

procto-pak cre 1% Tier 1

proctocream cre hc 2.5% Tier 1


11


proctosol hc cre 2.5% Tier 1

proctozone cre -hc 2.5% Tier 1

rectacort-hc sup 25mg Tier 1

Vasodilating Agents RECTIV OIN 0.4% Tier 2

ANTHELMINTICS Anthelmintics ALBENZA TAB 200MG Tier 3

mebendazole chw 100mg Tier 1

STROMECTOL TAB 3MG Tier 3

ANTI-INFECTIVE AGENTS - MISC. Anti-infective Agents - Misc. metronidazol cap 375mg Tier 1

metronidazol tab 250mg Tier 1

metronidazol tab 500mg Tier 1

NEBUPENT INH 300MG Tier 3 PA

PRIMSOL SOL 50MG/5ML Tier 3 PA

trimethoprim tab 100mg Tier 1

vancomycin cap 125mg Tier 1 PA

vancomycin cap 250mg Tier 1 PA

XIFAXAN TAB 200MG Tier 3 PA

XIFAXAN TAB 550MG Tier 3 PA

Anti-infective Misc. - Combinations e.s.p. sus 200-600 Tier 1

ees/sulfisox sus 200-600 Tier 1

smz-tmp sus Tier 1

smz-tmp sus 200-40/5 Tier 1

smz-tmp tab 400-80mg Tier 1

smz/tmp ds tab 800-160 Tier 1

Antiprotozoal Agents ALINIA SUS 100MG/5M Tier 3

ALINIA TAB 500MG Tier 3

atovaquone sus 750/5ml Tier 1

MEPRON SUS Tier 3

Ketolides KETEK TAB 300MG Tier 3 PA

KETEK TAB 400MG Tier 3 PA

Leprostatics dapsone tab 25mg Tier 1

dapsone tab 100mg Tier 1

Lincosamides clindamycin cap 75mg Tier 1 PA


12


clindamycin cap 150mg Tier 1

clindamycin cap 300mg Tier 1 PA

clindamycin sol 75mg/5ml Tier 1

Oxazolidinones ZYVOX SUS 100MG/5M Tier 4 PA

ZYVOX TAB 600MG Tier 4 PA

ANTIANGINAL AGENTS Antianginals-Other RANEXA TAB 500MG Tier 3 PA

RANEXA TAB 1000MG Tier 3 PA

Nitrates DILATRATE SR CAP 40MG Tier 2

isochron tab 40mg cr Tier 1

isoditrate tab 40mg er Tier 1

ISORDIL TAB 40MG Tier 2

isosorb din sub 2.5mg Tier 1

isosorb din sub 5mg Tier 1

isosorb din tab 5mg Tier 1




isosorb din tab 40mg er Tier 1

isosorb mono tab 10mg Tier 1

isosorb mono tab 20mg Tier 1

isosorb mono tab 30mg er Tier 1



minitran dis 0.1mg/hr Tier 1




NITRO-DUR DIS 0.3MG/HR Tier 2

NITRO-DUR DIS 0.8MG/HR Tier 2

nitro-time cap 2.5mg cr Tier 1

nitro-time cap 6.5mg cr Tier 1

nitro-time cap 9mg cr Tier 1

nitroglycer aer 400mcg Tier 1

nitroglycer cap 2.5mg er Tier 1

nitroglycer cap 2.5mg sr Tier 1

nitroglycer cap 6.5mg cr Tier 1

nitroglycer cap 6.5mg er Tier 1

nitroglycer cap 9mg cr Tier 1

nitroglycer cap 9mg er Tier 1


13


nitroglycer dis 0.1mg/hr Tier 1




nitroglyceri dis 0.6mg/hr Tier 1

nitroglycrn spr lingual Tier 1

NITROSTAT SUB 0.3MG Tier 2



ANTIANXIETY AGENTS Antianxiety Agents - Misc. buspirone tab 5mg Tier 1

buspirone tab 7.5mg Tier 1

buspirone tab 10mg Tier 1



hydroxyz hcl sol 10mg/5ml Tier 1

hydroxyz hcl syp 10mg/5ml Tier 1

hydroxyz hcl tab 10mg Tier 1



hydroxyz pam cap 25mg Tier 1



meprobamate tab 200mg Tier 1

meprobamate tab 400mg Tier 1

Benzodiazepines alprazolam tab 0.5mg Tier 1

alprazolam tab 0.25mg Tier 1

alprazolam tab 1mg Tier 1

alprazolam tab 2mg Tier 1

chlordiazep cap 5mg Tier 1



cloraz dipot tab 3.75mg Tier 1

cloraz dipot tab 7.5mg Tier 1

cloraz dipot tab 15mg Tier 1

diazepam sol 1mg/ml Tier 1

diazepam tab 2mg Tier 1



lorazepam tab 0.5mg Tier 1

lorazepam tab 1mg Tier 1


14


lorazepam tab 2mg Tier 1

oxazepam cap 10mg Tier 1



ANTIARRHYTHMICS Antiarrhythmics Type I-A disopyramide cap 100mg Tier 1

disopyramide cap 150mg Tier 1

quinidine gl tab 324mg cr Tier 1

quinidine gl tab 324mg er Tier 1

quinidine su tab 200mg Tier 1

quinidine su tab 300mg Tier 1

quinidine su tab 300mg er Tier 1

Antiarrhythmics Type I-B mexiletine cap 150mg Tier 1

mexiletine cap 200mg Tier 1

mexiletine cap 250mg Tier 1

Antiarrhythmics Type I-C flecainide tab 50mg Tier 1

flecainide tab 100mg Tier 1

flecainide tab 150mg Tier 1

propafenone cap 225mg er Tier 1

propafenone cap 325mg er Tier 1

propafenone cap 425mg sr Tier 1

propafenone tab 150mg Tier 1



Antiarrhythmics Type III amiodarone tab 200mg Tier 1

amiodarone tab 400mg Tier 1

MULTAQ TAB 400MG Tier 3 PA

PACERONE TAB 100MG Tier 2

pacerone tab 200mg Tier 1

TIKOSYN CAP 125MCG Tier 3 PA



ANTIASTHMATIC AND BRONCHODILATOR AGENTS Anti-Inflammatory Agents cromolyn sod neb 20mg/2ml Tier 1

Antiasthmatic - Monoclonal Antibodies XOLAIR SOL 150MG Tier 4 PA

Bronchodilators - Anticholinergics


15


ATROVENT HFA AER 17MCG Tier 2

ipratropium sol 0.02%inh Tier 1

SPIRIVA CAP HANDIHLR Tier 2

TUDORZA PRES AER 400/ACT Tier 2

Leukotriene Modulators montelukast chw 4mg Tier 1

montelukast chw 5mg Tier 1

montelukast gra 4mg Tier 1

montelukast tab 10mg Tier 1

zafirlukast tab 10mg Tier 1

zafirlukast tab 20mg Tier 1

ZYFLO CR TAB 600MG Tier 3 PA

Selective Phosphodiesterase 4 (PDE4) Inhibitors DALIRESP TAB 500MCG Tier 3 PA

Steroid Inhalants ALVESCO AER 80MCG Tier 3 PA

ALVESCO AER 160MCG Tier 3 PA

ASMANEX 7 AER 110MCG Tier 2






budesonide sus 0.5mg/2 Tier 1

budesonide sus 0.25mg/2 Tier 1

FLOVENT DISK AER 50MCG Tier 2



FLOVENT HFA AER 44MCG Tier 2



PULMICORT INH 90MCG Tier 3 PA

PULMICORT INH 180MCG Tier 3 PA

PULMICORT SUS 1MG/2ML Tier 2

QVAR AER 40MCG Tier 2

QVAR AER 80MCG Tier 2

Sympathomimetics ADVAIR DISKU AER 100/50 Tier 2 ST

ADVAIR DISKU AER 250/50 Tier 2 ST

ADVAIR DISKU AER 500/50 Tier 2 ST

ADVAIR HFA AER 45/21 Tier 2 ST




16


albuterol neb 0.5% Tier 1

albuterol neb 0.63mg/3 Tier 1

albuterol neb 0.083% Tier 1

albuterol neb 1.25mg/3 Tier 1

albuterol syp 2mg/5ml Tier 1

albuterol tab 2mg Tier 1

albuterol tab 4mg Tier 1

albuterol tab 4mg er Tier 1

albuterol tab 8mg er Tier 1

ARCAPTA CAP 75MCG Tier 3 PA

BROVANA NEB 15MCG Tier 3 PA

COMBIVENT AER Tier 2

COMBIVENT AER RESPIMAT Tier 2

DULERA AER 100-5MCG Tier 2 ST

DULERA AER 200-5MCG Tier 2 ST

FORADIL CAP AEROLIZE Tier 2 ST

MAXAIR AUTOH AER 200MCG Tier 2

metaproteren syp 10mg/5ml Tier 1

metaproteren tab 10mg Tier 1

metaproteren tab 20mg Tier 1

PROAIR HFA AER Tier 2

SEREVENT DIS AER 50MCG Tier 2 ST

SYMBICORT AER 80-4.5 Tier 2 ST

SYMBICORT AER 160-4.5 Tier 2 ST

terbutaline tab 2.5mg Tier 1

terbutaline tab 5mg Tier 1

VENTOLIN HFA AER Tier 2

XOPENEX HFA AER Tier 2 PA

Xanthines aminophyllin tab 100mg Tier 1

aminophyllin tab 200mg Tier 1

ELIXOPHYLLIN ELX 80/15ML Tier 2

THEO-24 CAP 100MG CR Tier 2



THEO-24 CAP 400MG ER Tier 2

theochron tab 100mg cr Tier 1



theophylline sol 80/15ml Tier 1

theophylline tab 100mg cr Tier 1

theophylline tab 100mg er Tier 1

theophylline tab 200mg cr Tier 1


17







ANTICOAGULANTS Coumarin Anticoagulants jantoven tab 1mg Tier 1

jantoven tab 2.5mg Tier 1

jantoven tab 2mg Tier 1





jantoven tab 7.5mg Tier 1


warfarin tab 1mg Tier 1

warfarin tab 2.5mg Tier 1






warfarin tab 7.5mg Tier 1


Direct Factor Xa Inhibitors XARELTO TAB 10MG Tier 3 PA

XARELTO TAB 15MG Tier 3 PA

XARELTO TAB 20MG Tier 3 PA

Heparins And Heparinoid-Like Agents enoxaparin inj 30/0.3ml Tier 4 QL

enoxaparin inj 40/0.4ml Tier 4 QL



enoxaparin inj 100mg/ml Tier 4 QL

enoxaparin inj 120/0.8 Tier 4 QL

enoxaparin inj 150mg/ml Tier 4 QL

enoxaparin inj 300/3ml Tier 4 QL

fondaparinux sol 2.5/0.5 Tier 4 PA



fondaparinux sol 10/0.8 Tier 4 PA

FRAGMIN INJ 2500/0.2 Tier 4 PA


18




FRAGMIN INJ 10000/ML Tier 4 PA

FRAGMIN INJ 12500UNT Tier 4 PA



FRAGMIN INJ 25000/ML Tier 4 PA

Thrombin Inhibitors PRADAXA CAP 75MG Tier 3 PA

PRADAXA CAP 150MG Tier 3 PA

ANTICONVULSANTS Anticonvulsants - Benzodiazepines clonazepam tab 0.5mg Tier 1

clonazepam tab 1mg Tier 1

clonazepam tab 2mg Tier 1

diazepam gel 2.5mg Tier 1

diazepam gel 10mg Tier 1

diazepam gel 20mg Tier 1

Anticonvulsants - Misc. BANZEL SUS 40MG/ML Tier 3 PA

BANZEL TAB 200MG Tier 3 PA

BANZEL TAB 400MG Tier 3 PA

carbamazepin cap 100mg er Tier 1



carbamazepin chw 100mg Tier 1

carbamazepin sus 100/5ml Tier 1

carbamazepin tab 200mg Tier 1

carbamazepin tab 200mg er Tier 1

carbamazepin tab 400mg er Tier 1

epitol tab 200mg Tier 1

gabapentin cap 100mg Tier 1



gabapentin tab 600mg Tier 1

gabapentin tab 800mg Tier 1

LAMICTAL CHW 2MG Tier 2

LAMICTAL ODT TAB 25MG Tier 3 PA




LAMICTAL XR KIT Tier 3 PA

lamotrigine chw 5mg Tier 1


19


lamotrigine chw 25mg Tier 1

lamotrigine tab 25mg Tier 1

lamotrigine tab 25mg er Tier 1 PA









levetiraceta sol 100mg/ml Tier 1

levetiraceta sol 500/5ml Tier 1

levetiraceta tab 250mg Tier 1




LYRICA CAP 25MG Tier 3 PA








oxcarbazepin sus 300mg/5m Tier 1

oxcarbazepin tab 150mg Tier 1



POTIGA TAB 50MG Tier 3 PA




primidone tab 50mg Tier 1

primidone tab 250mg Tier 1

TEGRETOL-XR TAB 100MG Tier 2

topiragen tab 25mg Tier 1




topiramate cap 15mg Tier 1

topiramate cap 25mg Tier 1

topiramate tab 25mg Tier 1


20





VIMPAT SOL 10MG/ML Tier 3 PA

VIMPAT TAB 50MG Tier 3 PA




zonisamide cap 25mg Tier 1



Carbamates felbamate sus 600/5ml Tier 1

felbamate tab 400mg Tier 1

felbamate tab 600mg Tier 1

GABA Modulators GABITRIL TAB 12MG Tier 2

GABITRIL TAB 16MG Tier 2

SABRIL POW 500MG Tier 4 PA

SABRIL TAB 500MG Tier 4 PA

tiagabine tab 2mg Tier 1

tiagabine tab 4mg Tier 1

Hydantoins DILANTIN CAP 30MG Tier 2

PEGANONE TAB 250MG Tier 2

phenytoin chw 50mg Tier 1

phenytoin ex cap 100mg Tier 1



phenytoin sus 125/5ml Tier 1

Succinimides CELONTIN CAP 300MG Tier 2

ethosuximide cap 250mg Tier 1

ethosuximide sol 250/5ml Tier 1

Valproic Acid divalproex cap 125mg Tier 1

divalproex tab 125mg dr Tier 1


divalproex tab 250mg er Tier 1


divalproex tab 500mg er Tier 1

STAVZOR CAP 125MG Tier 3



21



valproic acd cap 250mg Tier 1

valproic acd sol 250/5ml Tier 1

valproic acd syp 250/5ml Tier 1

ANTIDEPRESSANTS Alpha-2 Receptor Antagonists (Tetracyclics) mirtazapine tab 7.5mg Tier 1

mirtazapine tab 15mg Tier 1

mirtazapine tab 15mg odt Tier 1





Antidepressants - Misc. budeprion tab 100mg sr Tier 1

budeprion tab 150mg sr Tier 1

budeprion xl tab 150mg Tier 1 PA

budeprion xl tab 300mg Tier 1 PA

bupropion tab 75mg Tier 1

bupropion tab 100mg Tier 1

bupropion tab 100mg er Tier 1

bupropion tab 100mg sr Tier 1





bupropn hcl tab 150mg xl Tier 1 PA

bupropn hcl tab 300mg xl Tier 1 PA

maprotiline tab 25mg Tier 1



Modified Cyclics nefazodone tab 50mg Tier 1

nefazodone tab 100mg Tier 1




OLEPTRO TAB 24HR150 Tier 3

OLEPTRO TAB 24HR300 Tier 3

trazodone tab 50mg Tier 1





22


VIIBRYD KIT Tier 3 PA

VIIBRYD TAB 10MG Tier 3 PA



Monoamine Oxidase Inhibitors (MAOIs) EMSAM DIS 6MG/24HR Tier 3 PA

EMSAM DIS 9MG/24HR Tier 3 PA

EMSAM DIS 12MG/24H Tier 3 PA

MARPLAN TAB 10MG Tier 2

phenelzine tab 15mg Tier 1

tranylcyprom tab 10mg Tier 1

Selective Serotonin Reuptake Inhibitors (SSRIs) citalopram tab 10mg Tier 1

citalopram tab 20mg Tier 1

citalopram tab 40mg Tier 1

escitalopram tab 10mg Tier 1

escitalopram tab 20mg Tier 1

fluoxetine cap 10mg 10mg Tier 1


fluoxetine cap 40mg Tier 1 PA

fluoxetine sol 20mg/5ml Tier 1 PA

fluoxetine tab 10mg Tier 1

fluoxetine tab 20mg Tier 1

FLUOXETINE TAB 60MG Tier 3

fluvoxamine cap 100mg er Tier 1

fluvoxamine cap 150mg er Tier 1

fluvoxamine tab 25mg Tier 1



paroxetine sus 10mg/5ml Tier 1

paroxetine tab 10mg Tier 1




sertraline tab 25mg Tier 1



Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) CYMBALTA CAP 20MG Tier 2 PA

CYMBALTA CAP 30MG Tier 2 PA

CYMBALTA CAP 60MG Tier 2 PA

duloxetine cap 20mg Tier 1 PA



23



PRISTIQ TAB 50MG Tier 3 PA

PRISTIQ TAB 100MG Tier 3 PA

venlafaxine cap 37.5mg Tier 1

venlafaxine cap 75mg er Tier 1

venlafaxine cap 150mg er Tier 1

venlafaxine tab 25mg Tier 1

venlafaxine tab 37.5mg Tier 1




Tricyclic Agents amitriptylin tab 10mg Tier 1

amitriptylin tab 25mg Tier 1





amoxapine tab 25mg Tier 1




clomipramine cap 25mg Tier 1



desipramine tab 10mg Tier 1






doxepin hcl cap 10mg Tier 1






doxepin hcl con 10mg/ml Tier 1

imipram hcl tab 10mg Tier 1



nortriptylin cap 10mg Tier 1



24




nortriptylin sol 10mg/5ml Tier 1

protriptylin tab 5mg Tier 1

protriptylin tab 10mg Tier 1

trimipramine cap 25mg Tier 1



ANTIDIABETICS Alpha-Glucosidase Inhibitors acarbose tab 25mg Tier 1

acarbose tab 50mg Tier 1

acarbose tab 100mg Tier 1

GLYSET TAB 25MG Tier 2



Antidiabetic - Amylin Analogs SYMLINPEN 60 INJ 1000MCG Tier 3 PA

SYMLNPEN 120 INJ 1000MCG Tier 3 PA

Antidiabetic Combinations AVANDAMET TAB 2-500MG Tier 2 PA

AVANDAMET TAB 2-1000MG Tier 2 PA



AVANDARYL TAB 4-1MG Tier 2 PA





glip/metform tab 2.5-250m Tier 1

glip/metform tab 5-500mg Tier 1

glyb/metform tab 1.25-250 Tier 1

glyb/metform tab 2.5-500 Tier 1

glyb/metform tab 5-500mg Tier 1

JENTADUETO TAB 2.5-500 Tier 2 ST



pioglita/met tab 15-500mg Tier 1

pioglita/met tab 15-850mg Tier 1

Biguanides GLUMETZA TAB 500MG Tier 2

GLUMETZA TAB 1000MG Tier 2

metformin er tab 1000mg Tier 1


25


metformin tab 500mg Tier 1

metformin tab 500mg er Tier 1

metformin tab 750mg er Tier 1



Diabetic Other GLUCAGON KIT 1MG Tier 2

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors JANUVIA TAB 25MG Tier 2 ST

JANUVIA TAB 50MG Tier 2 ST

JANUVIA TAB 100MG Tier 2 ST

ONGLYZA TAB 2.5MG Tier 3 PA

ONGLYZA TAB 5MG Tier 3 PA

TRADJENTA TAB 5MG Tier 2 ST

Dopamine Receptor Agonists - Antidiabetic CYCLOSET TAB 0.8MG Tier 2

Incretin Mimetic Agents (GLP-1 Receptor Agonists) BYETTA INJ 5MCG Tier 3 PA

BYETTA INJ 10MCG Tier 3 PA

VICTOZA INJ 18MG/3ML Tier 3 PA

Insulin APIDRA INJ SOLOSTAR Tier 2

APIDRA INJ U-100 Tier 2

HUMALOG INJ 100/ML SOLN Tier 2

HUMALOG KWIK INJ 100/ML Tier 2

HUMALOG MIX INJ 50/50 Tier 2

HUMALOG MIX INJ 50/50KWP Tier 2

HUMALOG MIX INJ 75/25KWP Tier 2

HUMALOG MIX SUS 75/25 Tier 2

HUMULIN INJ 70/30 Tier 2

HUMULIN N INJ U-100 Tier 2

HUMULIN N PN INJ U-100 Tier 2

HUMULIN PEN INJ 70/30 Tier 2

HUMULIN R INJ U-100 Tier 2

LANTUS INJ 100/ML Tier 2

LANTUS INJ SOLOSTAR Tier 2

LEVEMIR INJ Tier 2

LEVEMIR INJ FLEXPEN Tier 2

NOVOLIN INJ 70/30 Tier 2

NOVOLIN N INJ U-100 Tier 2

NOVOLIN R INJ U-100 Tier 2

NOVOLOG INJ 100/ML Tier 2

NOVOLOG INJ FLEXPEN Tier 2


26


NOVOLOG INJ PENFILL Tier 2

NOVOLOG MIX INJ 70/30 Tier 2

NOVOLOG MIX INJ FLEXPEN Tier 2

Insulin Sensitizing Agents AVANDIA TAB 2MG Tier 2 PA

AVANDIA TAB 4MG Tier 2 PA

AVANDIA TAB 8MG Tier 2 PA

pioglitazone tab 15mg Tier 1



Meglitinide Analogues nateglinide tab 60mg Tier 1

nateglinide tab 120mg Tier 1

PRANDIN TAB 0.5MG Tier 2

repaglinide Tier 1

repaglinide tab 0.5mg Tier 1

Sulfonylureas chlorpropam tab 100mg Tier 1

chlorpropam tab 250mg Tier 1

glimepiride tab 1mg Tier 1



glipizide er tab 2.5mg Tier 1

glipizide er tab 5mg Tier 1

glipizide er tab 10mg Tier 1

glipizide tab 5mg Tier 1

glipizide tab 10mg Tier 1

glipizide xl tab 2.5mg Tier 1

glipizide xl tab 5mg Tier 1

glipizide xl tab 10mg Tier 1

glyburid mcr tab 1.5mg Tier 1

glyburid mcr tab 3mg Tier 1

glyburid mcr tab 6mg Tier 1

glyburide tab 1.25mg Tier 1

glyburide tab 2.5mg Tier 1

glyburide tab 5mg Tier 1

tolazamide tab 250mg Tier 1

tolazamide tab 500mg Tier 1

tolbutamide tab 500mg Tier 1

ANTIDIARRHEALS Antiperistaltic Agents anti-diarrhe cap 2mg Tier 1

anti-diarrhe tab 2mg Tier 1


27


diamode tab 2mg Tier 1

diphen/atrop liq 2.5/5 Tier 1

diphen/atrop tab 2.5mg Tier 1

imperim tab 2mg Tier 1

kls anti-dia tab 2mg Tier 1

lofene tab 2.5mg Tier 1

lonox tab 2.5mg Tier 1

loperamide cap 2mg Tier 1

loperamide tab 2mg Tier 1

MOTOFEN TAB Tier 3

sm anti-diar tab 2mg Tier 1

ANTIDOTES Antidotes - Chelating Agents CHEMET CAP 100MG Tier 3

EXJADE TAB 125MG Tier 4 PA



FERRIPROX TAB 500MG Tier 4 PA

Opioid Antagonists VIVITROL INJ 380MG Tier 4 PA

ANTIEMETICS 5-HT3 Receptor Antagonists ANZEMET TAB 50MG Tier 3 PA

ANZEMET TAB 100MG Tier 3 PA

granisetron tab 1mg Tier 1 PA

GRANISOL SOL 2MG/10ML Tier 2 PA

ondansetron tab 4mg Tier 1

ondansetron tab 4mg odt Tier 1


ondansetron tab 8mg odt Tier 1


ZUPLENZ MIS 4MG Tier 2 PA

ZUPLENZ MIS 8MG Tier 2 PA

Antiemetics - Anticholinergic ANTIVERT TAB 50MG Tier 2

dramamine tab 25mg Tier 1

meclizine tab 12.5mg Tier 1

meclizine tab 25mg Tier 1

medi-meclizi tab 25mg Tier 1

motion relf tab 25mg Tier 1

motion sick tab 25mg Tier 1

TRANSDERM-SC DIS 1.5MG Tier 3

trimethobenz cap 300mg Tier 1


28


wal-dram ii tab 25mg Tier 1

Antiemetics - Miscellaneous CESAMET CAP 1MG Tier 3 PA

dronabinol cap 2.5mg Tier 1

dronabinol cap 5mg Tier 1

dronabinol cap 10mg Tier 1

Substance P/Neurokinin 1 (NK1) Receptor Antagonists EMEND CAP 40MG Tier 3 PA

EMEND CAP 80MG Tier 3 PA

EMEND CAP 125MG Tier 3 PA

EMEND PAK 80 & 125 Tier 3 PA

ANTIFUNGALS Antifungals bio-statin pow Tier 1

griseofulvin sus 125/5ml Tier 1

griseofulvin tab micr 500 Tier 1

griseofulvin tab ultr 125 Tier 1

griseofulvin tab ultr 250 Tier 1

nystatin pow Tier 1

nystatin tab 500000 Tier 1

terbinafine tab 250mg Tier 1

Imidazole-Related Antifungals fluconazole sus 10mg/ml Tier 1

fluconazole sus 40mg/ml Tier 1

fluconazole tab 50mg Tier 1




itraconazole cap 100mg Tier 1 PA

ketoconazole tab 200mg Tier 1

NOXAFIL SUS 40MG/ML Tier 2 PA

voriconazole tab 50mg Tier 1 PA

voriconazole tab 200mg Tier 1 PA

ANTIHISTAMINES Antihistamines - Alkylamines dexchlorphen syp 2mg/5ml Tier 1

Antihistamines - Ethanolamines af-diphedryl elx 12.5/5ml Tier 1

aler-cap cap 25mg Tier 1

allergy cap 25mg Tier 1

allergy med cap 25mg Tier 1

allergy rel elx 12.5/5ml Tier 1


29


allergy relf cap 25mg Tier 1

altaryl elx 12.5/5ml Tier 1

altaryl syp 12.5/5ml Tier 1

anti-hist cap 25mg Tier 1

antihistamin cap 25mg Tier 1

arbinoxa liq 4mg/5ml Tier 1

arbinoxa tab 4mg Tier 1

banophen cap 25mg Tier 1

banophen cap 50mg Tier 1

carbinoxamin liq 4mg/5ml Tier 1

carbinoxamin tab 4mg Tier 1

clemastine syp 0.5/5ml Tier 1

clemastine tab 2.68mg Tier 1

comp allergy cap 25mg Tier 1

cvs allergy cap 25mg Tier 1

diphenhist cap 25mg Tier 1

diphenhydram cap 25mg Tier 1

diphenhydram cap 50mg Tier 1

diphenhydram elx 12.5/5ml Tier 1

dormin cap 25mg Tier 1

dytuss syp 12.5/5ml Tier 1

eq allergy cap 25mg Tier 1

eql allergy cap 25mg Tier 1

genahist cap 25mg Tier 1

geri-dryl cap 25mg Tier 1

gnp allergy cap 25mg Tier 1

medi-phedryl cap 25mg Tier 1

medi-phedryl elx 12.5/5ml Tier 1

mp aller med cap 25mg Tier 1

pharbedryl cap 25mg Tier 1

pharbedryl cap 50mg Tier 1

px allergy cap 25mg Tier 1

q-dryl cap 25mg Tier 1

quenalin syp 12.5/5ml Tier 1

silphen coug syp 12.5/5ml Tier 1

wal-dryl cap 25mg Tier 1

Antihistamines - Non-Sedating all day allg sol 1mg/ml Tier 1

all day allg sol 5mg/5ml Tier 1

all day allg syp 1mg/ml Tier 1

all day allg syp 5mg/5ml Tier 1

aller-ease tab 180mg Tier 1

aller-fex tab 180mg Tier 1


30


aller-tec sol 1mg/ml Tier 1

allergy chld sol 1mg/ml Tier 1

allergy comp sol 1mg/ml Tier 1

allergy rel sol 1mg/ml Tier 1

allergy relf sol 5mg/5ml Tier 1

allergy relf tab 180mg Tier 1

cetirizine sol 1mg/ml Tier 1

cetirizine sol 5mg/5ml Tier 1

cetirizine syp 1mg/ml Tier 1

cetirizine syp 5mg/5ml Tier 1

cvs allergy tab 180mg Tier 1

desloratadin tab 2.5 odt Tier 1 PA

desloratadin tab 5mg Tier 1 PA

desloratadin tab 5mg odt Tier 1 PA

fexofenadine tab 180mg Tier 1

gnp allergy tab 180mg Tier 1

wal-fex allr tab 180mg Tier 1

wal-zyr sol 1mg/ml Tier 1

wal-zyr sol 5mg/5ml Tier 1

Antihistamines - Phenothiazines phenadoz sup 12.5mg Tier 1

phenadoz sup 25mg Tier 1

promethazine sol 6.25/5ml Tier 1

promethazine sup 12.5mg Tier 1

promethazine sup 25mg Tier 1

promethazine syp 6.25/5ml Tier 1

promethazine tab 12.5mg Tier 1

promethazine tab 25mg Tier 1

promethazine tab 50mg Tier 1

promethegan sup 12.5mg Tier 1

promethegan sup 25mg Tier 1

promethegan sup 50mg Tier 1

Antihistamines - Piperidines cyproheptad syp 2mg/5ml Tier 1

cyproheptad tab 4mg Tier 1

ANTIHYPERLIPIDEMICS Antihyperlipidemics - Combinations VYTORIN TAB 10-10MG Tier 3 PA

VYTORIN TAB 10-20MG Tier 3 PA



Antihyperlipidemics - Misc. LOVAZA CAP 1GM Tier 3 PA


31


omega-3-acid cap 1gm Tier 1 PA

Bile Acid Sequestrants cholestyram pow 4gm POWD Tier 1

cholestyram pow 4gm lite POWD Tier 1

colestipol gra 5gm Tier 1

colestipol tab 1gm Tier 1

prevalite pow 4gm Tier 1

WELCHOL TAB 625MG Tier 2 PA

Fibric Acid Derivatives fenofibrate tab 48mg Tier 1

fenofibrate tab 54mg Tier 1

fenofibrate tab 160mg Tier 1

FENOGLIDE TAB 40MG Tier 3

FENOGLIDE TAB 120MG Tier 3

gemfibrozil tab 600mg Tier 1

TRIGLIDE TAB 50MG Tier 3

HMG CoA Reductase Inhibitors ADVICOR TAB 500-20MG Tier 3 PA

ADVICOR TAB 750-20MG Tier 3 PA

ADVICOR TAB 1000-20 Tier 3 PA

ADVICOR TAB 1000-40 Tier 3 PA

ALTOPREV TAB 20MG ER Tier 3 PA



atorvastatin tab 10mg Tier 1 ST




CRESTOR TAB 5MG Tier 3 PA




fluvastatin cap 20mg Tier 1

fluvastatin cap 40mg Tier 1

LIVALO TAB 1MG Tier 3 PA



lovastatin tab 10mg Tier 1



pravastatin tab 10mg Tier 1




32



SIMCOR TAB 500-20MG Tier 3 PA



SIMCOR TAB 1000-20 Tier 3 PA

SIMCOR TAB 1000-40 Tier 3 PA

simvastatin tab 5mg Tier 1





Intestinal Cholesterol Absorption Inhibitors ZETIA TAB 10MG Tier 2 PA

Nicotinic Acid Derivatives niacin er tab 500mg Tier 1

niacin er tab 750mg Tier 1

niacin er tab 1000mg Tier 1

niacor tab 500mg Tier 1

NIASPAN TAB 500MG ER Tier 2

NIASPAN TAB 750MG ER Tier 2

NIASPAN TAB 1000 ER Tier 2

ANTIHYPERTENSIVES ACE Inhibitors benazepril tab 5mg Tier 1

benazepril tab 10mg Tier 1



captopril tab 12.5mg Tier 1

captopril tab 25mg Tier 1



enalapril tab 2.5mg Tier 1

enalapril tab 5mg Tier 1



fosinopril tab 10mg Tier 1



lisinopril tab 2.5mg Tier 1

lisinopril tab 5mg Tier 1





33



moexipril tab 7.5mg Tier 1

moexipril tab 15mg Tier 1

perindopril tab 2mg Tier 1



quinapril tab 5mg Tier 1




ramipril cap 1.25mg Tier 1

ramipril cap 2.5mg Tier 1

ramipril cap 5mg Tier 1

ramipril cap 10mg Tier 1

trandolapril tab 1mg Tier 1



Agents for Pheochromocytoma DIBENZYLINE CAP 10MG Tier 3

Angiotensin II Receptor Antagonists BENICAR TAB 5MG Tier 2 ST

BENICAR TAB 20MG Tier 2 ST

BENICAR TAB 40MG Tier 2 ST

candesartan tab 4mg Tier 1 ST




DIOVAN TAB 40MG Tier 2 ST




EDARBI TAB 40MG Tier 3 PA

EDARBI TAB 80MG Tier 3 PA

eprosart mes tab 600mg Tier 1 PA

irbesartan tab 75mg Tier 1 PA

irbesartan tab 300mg Tier 1

losartan pot tab 25mg Tier 1



MICARDIS TAB 20MG Tier 3 PA



telmisartan tab 20mg Tier 1 PA


34




valsartan tab 40mg Tier 1 ST




Antiadrenergic Antihypertensives clonidine dis 0.1/24hr Tier 1

clonidine dis 0.2/24hr Tier 1

clonidine dis 0.3/24hr Tier 1

clonidine tab 0.1mg Tier 1



doxazosin tab 1mg Tier 1




guanfacine tab 1mg Tier 1

guanfacine tab 2mg Tier 1

methyldopa tab 250mg Tier 1

methyldopa tab 500mg Tier 1

prazosin hcl cap 1mg Tier 1



terazosin cap 1mg Tier 1




Antihypertensive Combinations amlod/benazp cap 2.5-10mg Tier 1 PA

amlod/benazp cap 5-10mg Tier 1 PA





atenol/chlor tab 50-25mg Tier 1

atenol/chlor tab 100-25mg Tier 1

AZOR TAB 5-20MG Tier 3 PA




bisoprl/hctz tab 2.5/6.25 Tier 1

bisoprl/hctz tab 5-6.25mg Tier 1


35


bisoprl/hctz tab 10/6.25 Tier 1

captopr/hctz tab 25-15mg Tier 1




lisinop/hctz tab 10-12.5 Tier 1

lisinop/hctz tab 20-12.5 Tier 1

lisinop/hctz tab 20-25mg Tier 1

losartan/hct tab 50-12.5 Tier 1

losartan/hct tab 100-12.5 Tier 1

losartan/hct tab 100-25 Tier 1

MICARDIS HCT Tier 3 PA

telmis/amlod tab 40-5mg Tier 1 PA




telmisa/hctz tab 40-12.5 Tier 1 PA

telmisa/hctz tab 80-12.5 Tier 1 PA

telmisa/hctz tab 80-25mg Tier 1 PA

TWYNSTA TAB 40-5MG Tier 3 PA




Direct Renin Inhibitors TEKTURNA TAB 150MG Tier 3 PA

TEKTURNA TAB 300MG Tier 3 PA

Selective Aldosterone Receptor Antagonists (SARAs) eplerenone tab 25mg Tier 1 PA

eplerenone tab 50mg Tier 1 PA

Vasodilators hydralazine tab 10mg Tier 1

hydralazine tab 25mg Tier 1



minoxidil tab 2.5mg Tier 1

minoxidil tab 10mg Tier 1

ANTIMALARIALS Antimalarial Combinations atovaq/progu tab 62.5-25 Tier 1

atovaq/progu tab 250-100 Tier 1

COARTEM TAB 20-120MG Tier 3

Antimalarials


36


chloroquine tab 250mg Tier 1

chloroquine tab 500mg Tier 1

DARAPRIM TAB 25MG Tier 2

hydroxychlor tab 200mg Tier 1

mefloquine tab 250mg Tier 1

PRIMAQUINE TAB 26.3MG Tier 2

quinine sulf cap 324mg Tier 1

ANTIMYASTHENIC AGENTS Antimyasthenic Agents MESTINON SYP 60MG/5ML Tier 2

MESTINON TAB TIMESPAN Tier 2

MYTELASE TAB 10MG Tier 2

pyridostigm tab 60mg Tier 1

ANTIMYCOBACTERIAL AGENTS Anti TB Combinations isonarif cap Tier 1

RIFATER TAB Tier 2

Antimycobacterial Agents cycloserine cap 250mg Tier 1 PA

ethambutol tab 100mg Tier 1

ethambutol tab 400mg Tier 1

isoniazid syp 50mg/5ml Tier 1

isoniazid tab 100mg Tier 1

isoniazid tab 300mg Tier 1

MYCOBUTIN CAP 150MG Tier 2

PASER GRA 4GM Tier 2 PA

PRIFTIN TAB 150MG Tier 3

pyrazinamide tab 500mg Tier 1

rifabutin cap 150mg Tier 1

rifampin cap 150mg Tier 1

rifampin cap 300mg Tier 1

TRECATOR TAB 250MG Tier 2

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES Alkylating Agents ALKERAN TAB 2MG Tier 3

cyclophosph tab 25mg Tier 1

cyclophosph tab 50mg Tier 1

HEXALEN CAP 50MG Tier 3 PA

LEUKERAN TAB 2MG Tier 3

lomustine cap 10mg Tier 3




37


MYLERAN TAB 2MG Tier 3

TEMODAR CAP 5MG Tier 4 PA






temozolomide cap 5mg Tier 4 PA






Antimetabolites capecitabine tab 150mg Tier 4 PA

capecitabine tab 500mg Tier 4 PA

mercaptopur tab 50mg Tier 1

methotrexate tab 2.5mg Tier 1

OFORTA TAB 10MG Tier 4 PA

TABLOID TAB 40MG Tier 3 PA

XELODA TAB 150MG Tier 4 PA

XELODA TAB 500MG Tier 4 PA

Antineoplastic - Hedgehog Pathway Inhibitors ERIVEDGE CAP 150MG Tier 4 PA

Antineoplastic - Hormonal and Related Agents anastrozole tab 1mg Tier 1

bicalutamide tab 50mg Tier 1

ELIGARD INJ 7.5MG Tier 4 PA

ELIGARD INJ 22.5MG Tier 4 PA

ELIGARD INJ 30MG Tier 4 PA

ELIGARD INJ 45MG Tier 4 PA

EMCYT CAP 140MG Tier 3

exemestane tab 25mg Tier 1

FARESTON TAB 60MG Tier 3

flutamide cap 125mg Tier 1

letrozole tab 2.5mg Tier 1

leuprolide inj 1mg/0.2 Tier 4 PA

LUPRON DEPOT INJ 3.75MG Tier 4 PA




LUPRON DEPOT INJ 30MG Tier 4 PA

LYSODREN TAB 500MG Tier 3


38


megestrol ac sus 40mg/ml Tier 1

megestrol ac sus 400mg/10 Tier 1

megestrol ac tab 20mg Tier 1

megestrol ac tab 40mg Tier 1

NILANDRON TAB 150MG Tier 3 PA

tamoxifen tab 10mg Tier 1

tamoxifen tab 20mg Tier 1

TRELSTAR DEP INJ 3.75MG Tier 4 PA

TRELSTAR LA INJ 11.25MG Tier 4 PA

VANTAS KIT 50MG Tier 4 PA

ZYTIGA TAB 250MG Tier 4 PA

Antineoplastic Enzyme Inhibitors AFINITOR TAB 2.5MG Tier 4 PA

AFINITOR TAB 5MG Tier 4 PA

AFINITOR TAB 7.5MG Tier 4 PA

AFINITOR TAB 10MG Tier 4 PA

CAPRELSA TAB 100MG Tier 4 PA

CAPRELSA TAB 300MG Tier 4 PA

GLEEVEC TAB 100MG Tier 4 PA

GLEEVEC TAB 400MG Tier 4 PA

JAKAFI TAB 5MG Tier 4 PA





NEXAVAR TAB 200MG Tier 4 PA

SPRYCEL TAB 20MG Tier 4 PA






SUTENT CAP 12.5MG Tier 4 PA

SUTENT CAP 25MG Tier 4 PA

SUTENT CAP 50MG Tier 4 PA

TARCEVA TAB 25MG Tier 4 PA



TASIGNA CAP 150MG Tier 4 PA

TASIGNA CAP 200MG Tier 4 PA

TYKERB TAB 250MG Tier 4 PA

VANDETANIB TAB 100MG Tier 4 PA

VANDETANIB TAB 300MG Tier 4 PA


39


VOTRIENT TAB 200MG Tier 4 PA

XALKORI CAP 200MG Tier 4 PA

XALKORI CAP 250MG Tier 4 PA

ZELBORAF TAB 240MG Tier 4 PA

ZOLINZA CAP 100MG Tier 4 PA

Antineoplastics Misc. ACTIMMUNE INJ 2MU/0.5 Tier 4 PA

ALFERON N INJ 5MU/ML Tier 4 PA

hydroxyurea cap 500mg Tier 1

INTRON-A INJ 3MU PEN Tier 4 PA


INTRON-A INJ 10MU Tier 4 PA





MATULANE CAP 50MG Tier 3 PA

PROLEUKIN INJ 22MU Tier 4 PA

TARGRETIN CAP 75MG Tier 4 PA

tretinoin cap 10mg Tier 1 PA

Chemotherapy Rescue/Antidote Agents leucovor ca tab 5mg Tier 1

leucovor ca tab 10mg Tier 1



Mitotic Inhibitors etoposide cap 50mg Tier 1 PA

ANTIPARKINSON AGENTS Antiparkinson Adjuvants carbidopa tab 25mg Tier 1

LODOSYN TAB 25MG Tier 2

Antiparkinson Anticholinergics benztropine inj 1mg/ml Tier 1

benztropine tab 0.5mg Tier 1

benztropine tab 1mg Tier 1

benztropine tab 2mg Tier 1

trihexyphen elx 0.4mg/ml Tier 1

trihexyphen tab 2mg Tier 1

trihexyphen tab 5mg Tier 1

Antiparkinson COMT Inhibitors entacapone tab 200mg Tier 1

TASMAR TAB 100MG Tier 3


40


Antiparkinson Dopaminergics amantadine cap 100mg Tier 1

amantadine syp 50mg/5ml Tier 1

amantadine tab 100mg Tier 1

APOKYN INJ Tier 4 PA

APOKYN INJ 10MG/ML Tier 4 PA

bromocriptin cap 5mg Tier 1

bromocriptin tab 2.5mg Tier 1

carb/levo er tab 25-100mg Tier 1

carb/levo er tab 50-200mg Tier 1

carb/levo sr tab 25-100mg Tier 1

carb/levo sr tab 50-200mg Tier 1

carb/levo tab 10-100mg Tier 1



pramipexole tab 0.5mg Tier 1





pramipexole tab 1mg Tier 1

ropinirole tab 0.5mg Tier 1

ropinirole tab 0.25mg Tier 1

ropinirole tab 1mg Tier 1


ropinirole tab 2mg er Tier 1 PA








Antiparkinson Monoamine Oxidase Inhibitors AZILECT TAB 0.5MG Tier 3 PA

AZILECT TAB 1MG Tier 3 PA

selegiline cap 5mg Tier 1

selegiline tab 5mg Tier 1

ZELAPAR TAB 1.25MG Tier 3 PA

ANTIPSYCHOTICS/ANTIMANIC AGENTS Antimanic Agents lithium carb cap 150mg Tier 1

lithium carb cap 300mg Tier 1


41


lithium carb cap 600mg Tier 1

lithium carb tab 300mg Tier 1

lithium carb tab 300mg er Tier 1

lithium carb tab 450mg er Tier 1

LITHIUM CITR SOL 8MEQ/5ML Tier 2

Antipsychotics - Misc. LATUDA TAB 20MG Tier 2 ST

LATUDA TAB 40MG Tier 2 ST



ziprasidone cap 20mg Tier 1 ST




Benzisoxazoles FANAPT PAK Tier 3 PA

FANAPT TAB 1MG Tier 3 PA







INVEGA TAB 1.5MG Tier 3 PA

INVEGA TAB 3MG Tier 3 PA



risperidone sol 1mg/ml Tier 1

risperidone tab 0.5mg Tier 1

risperidone tab 0.5mg od Tier 1

risperidone tab 0.25 odt Tier 1

risperidone tab 0.25mg Tier 1

risperidone tab 1mg Tier 1

risperidone tab 1mg odt Tier 1







Butyrophenones haloperidol con 2mg/ml Tier 1

haloperidol tab 0.5mg Tier 1


42


haloperidol tab 1mg Tier 1





Dibenzapines clozapine tab 12.5/odt Tier 1

clozapine tab 25mg Tier 1

clozapine tab 25mg odt Tier 1


clozapine tab 100/odt Tier 1



loxapine cap 5mg Tier 1




olanzapine tab 2.5mg Tier 1 ST

olanzapine tab 5mg Tier 1 ST

olanzapine tab 7.5mg Tier 1 ST




quetiapine tab 25mg Tier 1 ST






SAPHRIS SUB 5MG Tier 3 PA

SAPHRIS SUB 10MG Tier 3 PA

SEROQUEL XR TAB 50MG Tier 3 PA





Phenothiazines chlorpromaz tab 10mg Tier 1

chlorpromaz tab 25mg Tier 1




compro sup 25mg Tier 1


43


fluphenazine con 5mg/ml Tier 1

fluphenazine elx 2.5/5ml Tier 1

fluphenazine tab 1mg Tier 1

fluphenazine tab 2.5mg Tier 1



perphenazine tab 2mg Tier 1




prochlorper sup 25mg Tier 1

prochlorper tab 5mg Tier 1

prochlorper tab 10mg Tier 1

thioridazine tab 10mg Tier 1




trifluoperaz tab 1mg Tier 1




Quinolinone Derivatives ABILIFY DISC TAB 10MG Tier 3 ST

ABILIFY DISC TAB 15MG Tier 3 ST

ABILIFY SOL 1MG/ML Tier 3 ST

ABILIFY TAB 2MG Tier 3 ST






Thioxanthenes thiothixene cap 1mg Tier 1

thiothixene cap 2mg Tier 1



ANTISEPTICS DISINFECTANTS Chlorine Antiseptics PHISOHEX LIQ 3% Tier 2

ANTIVIRALS Antiretrovirals abacav/lamiv tab /zidovud Tier 1

abacavir tab 300mg Tier 1


44


APTIVUS CAP 250MG Tier 2

APTIVUS SOL Tier 2

ATRIPLA TAB Tier 2

COMPLERA TAB Tier 2

CRIXIVAN CAP 100MG Tier 2



didanosine cap 125mg Tier 1




EDURANT TAB 25MG Tier 2

EMTRIVA CAP 200MG Tier 2

EMTRIVA SOL 10MG/ML Tier 2

EPIVIR HBV SOL 5MG/ML Tier 2

EPIVIR HBV TAB 100MG Tier 2

EPZICOM TAB 600-300 Tier 2

FUZEON INJ 90MG Tier 4 PA

FUZEON KIT Tier 4 PA

INTELENCE TAB 25MG Tier 4 PA



INVIRASE CAP 200MG Tier 2

INVIRASE TAB 500MG Tier 2

ISENTRESS CHW 25MG Tier 2

ISENTRESS CHW 100MG Tier 2

ISENTRESS TAB 400MG Tier 2

KALETRA SOL Tier 2

KALETRA TAB 100-25MG Tier 2

KALETRA TAB 200-50MG Tier 2

lamivud/zido tab 150-300 Tier 1

lamivudine tab 100mg Tier 1



LEXIVA SUS 50MG/ML Tier 2

LEXIVA TAB 700MG Tier 2

nevirapine sus 50mg/5ml Tier 1

nevirapine tab 200mg Tier 1

nevirapine tab 400mg er Tier 1

NORVIR CAP 100MG Tier 2

NORVIR SOL 80MG/ML Tier 2

NORVIR TAB 100MG Tier 2

PREZISTA TAB 75MG Tier 2


45






RESCRIPTOR TAB 100 MG Tier 2

RESCRIPTOR TAB 200MG Tier 2

REYATAZ CAP 100MG Tier 2




SELZENTRY TAB 150MG Tier 2

SELZENTRY TAB 300MG Tier 2

stavudine cap 15mg Tier 1




stavudine sol 1mg/ml Tier 1

STRIBILD TAB Tier 2 PA

SUSTIVA CAP 50MG Tier 2

SUSTIVA CAP 200MG Tier 2

SUSTIVA TAB 600MG Tier 2

TRIZIVIR TAB Tier 2

TRUVADA TAB 200-300 Tier 2

VIRACEPT POW 50MG/GM Tier 2

VIRACEPT TAB 250MG Tier 2

VIRACEPT TAB 625MG Tier 2

VIRAMUNE XR TAB 400MG Tier 2

VIREAD TAB 150MG Tier 2




ZIAGEN SOL 20MG/ML Tier 2

zidovudine cap 100mg Tier 1

zidovudine syp 50mg/5ml Tier 1

zidovudine tab 300mg Tier 1

CMV Agents VALCYTE SOL 50MG/ML Tier 3 PA

VALCYTE TAB 450MG Tier 3 PA

Hepatitis Agents adefov dipiv tab 10mg Tier 1

BARACLUDE SOL .05MG/ML Tier 2

BARACLUDE TAB 0.5MG Tier 2

BARACLUDE TAB 1MG Tier 2


46


HEPSERA TAB 10MG Tier 2

INCIVEK TAB 375MG Tier 4 PA

INFERGEN INJ 9MCG Tier 4 PA

INFERGEN INJ 15MCG Tier 4 PA

PEG-INTRON KIT 50MCG Tier 4 PA

PEG-INTRON KIT 50MCG RP Tier 4 PA


PEG-INTRON KIT 80MCG RP Tier 4 PA

PEG-INTRON KIT 120 RP Tier 4 PA


PEG-INTRON KIT 150 RP Tier 4 PA


PEGASYS INJ Tier 4 PA

PEGASYS INJ 180MCG/M Tier 4 PA

PEGASYS INJ PROCLICK Tier 4 PA

PEGASYS KIT Tier 4 PA

REBETOL SOL 40MG/ML Tier 4 PA

RIBAPAK PAK 800/DAY Tier 4 PA



ribasphere cap 200mg Tier 4 PA

ribasphere tab 200mg Tier 4 PA



RIBATAB PAK 1000/DAY Tier 4 PA

RIBATAB TAB 800/DAY Tier 4 PA

RIBATAB TAB 1200/DAY Tier 4 PA

ribavirin cap 200mg Tier 4 PA

ribavirin tab 200mg Tier 4 PA

TYZEKA TAB 600MG Tier 2

VICTRELIS CAP 200MG Tier 4 PA

Herpes Agents acyclovir cap 200mg Tier 1

acyclovir sus 200/5ml Tier 1 PA

acyclovir tab 400mg Tier 1

acyclovir tab 800mg Tier 1

famciclovir tab 125mg Tier 1



valacyclovir tab 1gm Tier 1 PA

valacyclovir tab 500mg Tier 1 PA

Influenza Agents RELENZA MIS DISKHALE Tier 2


47


rimantadine tab 100mg Tier 1

TAMIFLU CAP 30MG Tier 2



TAMIFLU SUS 6MG/ML Tier 2

TAMIFLU SUS 12MG/ML Tier 2

ASSORTED CLASSES Chelating Agents CUPRIMINE CAP 250MG Tier 2

SYPRINE CAP 250MG Tier 3

Immunomodulators REVLIMID CAP 5MG Tier 4 PA

REVLIMID CAP 10MG Tier 4 PA



THALOMID CAP 50MG Tier 4 PA




Immunosuppressive Agents AZASAN TAB 75 MG Tier 2

AZASAN TAB 100MG Tier 2

azathioprine tab 50mg Tier 1

CELLCEPT SUS 200MG/ML Tier 3

cyclosporine cap 25mg Tier 1

cyclosporine cap 25mg mod Tier 1

cyclosporine cap 50mg mod Tier 1

cyclosporine cap 100mg Tier 1

cyclosporine cap 100mg md Tier 1

cyclosporine sol modified Tier 1

gengraf cap 25mg Tier 1

gengraf cap 100mg Tier 1

gengraf sol 100mg/ml Tier 1

hecoria cap 0.5mg Tier 1

hecoria cap 1mg Tier 1

hecoria cap 5mg Tier 1

mycophenolat cap 250mg Tier 1

mycophenolat tab 500mg Tier 1

mycophenolic tab 180mg dr Tier 1

mycophenolic tab 360mg dr Tier 1

MYFORTIC TAB 180MG Tier 3

MYFORTIC TAB 360MG Tier 3

RAPAMUNE SOL 1MG/ML Tier 3


48


RAPAMUNE TAB 0.5MG Tier 3

RAPAMUNE TAB 1MG Tier 3

RAPAMUNE TAB 2MG Tier 3

SANDIMMUNE SOL 100MG/ML Tier 1

sirolimus tab 0.5mg Tier 1

tacrolimus cap 0.5mg Tier 1

tacrolimus cap 1mg Tier 1

tacrolimus cap 5mg Tier 1

ZORTRESS TAB 0.5MG Tier 3



Potassium Removing Resins kalexate pow Tier 1

kionex pow usp Tier 1

sod poly sul pow Tier 1

BETA BLOCKERS Alpha-Beta Blockers carvedilol tab 3.125mg Tier 1

carvedilol tab 6.25mg Tier 1

carvedilol tab 12.5mg Tier 1

carvedilol tab 25mg Tier 1

COREG CR CAP 10MG Tier 3 PA




labetalol tab 100mg Tier 1



Beta Blockers Cardio-Selective acebutolol cap 200mg Tier 1

acebutolol cap 400mg Tier 1

atenolol tab 25mg Tier 1



betaxolol tab 10mg Tier 1

betaxolol tab 20mg Tier 1

bisoprol fum tab 5mg Tier 1

bisoprol fum tab 10mg Tier 1

BYSTOLIC TAB 2.5MG Tier 3

BYSTOLIC TAB 5MG Tier 3



metoprol tar tab 25mg Tier 1


49




metoprolol tab 25mg er Tier 1




Beta Blockers Non-Selective LEVATOL TAB 20MG Tier 2

nadolol tab 20mg Tier 1



pindolol tab 5mg Tier 1

pindolol tab 10mg Tier 1

propranolol cap 60mg er Tier 1




propranolol tab 10mg Tier 1





sorine tab 80mg Tier 1




sotalol af tab 80mg Tier 1



sotalol hcl tab 80mg Tier 1




timolol mal tab 5mg Tier 1



CALCIUM CHANNEL BLOCKERS Calcium Channel Blockers afeditab tab 30mg cr Tier 1

afeditab tab 60mg cr Tier 1

amlodipine tab 2.5mg Tier 1

amlodipine tab 5mg Tier 1

amlodipine tab 10mg Tier 1


50


cartia xt cap 120/24hr Tier 1




COVERA-HS TAB 180MG Tier 2 PA

COVERA-HS TAB 240MG Tier 2 PA

dilt-cd cap 120mg Tier 1




dilt-xr cap 120mg Tier 1



diltiazem cap 60mg er Tier 1


diltiazem cap 120mg cd Tier 1


diltiazem cap 120mg/24 Tier 1














diltiazem tab 30mg Tier 1




diltzac cap 120mg/24 Tier 1





DYNACIRC CR TAB 5MG Tier 2

DYNACIRC CR TAB 10MG Tier 2

felodipine tab 2.5mg er Tier 1


51


felodipine tab 5mg er Tier 1

felodipine tab 10mg er Tier 1

isradipine cap 2.5mg Tier 1

isradipine cap 5mg Tier 1

nicardipine cap 20mg Tier 1 PA

nicardipine cap 30mg Tier 1 PA

nifediac cc tab 30mg er Tier 1



nifedical xl tab 30mg Tier 1

nifedical xl tab 60mg Tier 1

nifedipine cap 10mg Tier 1

nifedipine cap 20mg Tier 1

nifedipine tab 30mg er Tier 1



nimodipine cap 30mg Tier 1 PA

nisoldipine tab 8.5mg er Tier 1 PA

nisoldipine tab 17mg er Tier 1 PA

nisoldipine tab 20mg Tier 1 PA

nisoldipine tab 25.5mg Tier 1 PA


nisoldipine tab 34mg er Tier 1 PA


taztia xt cap 120mg/24 Tier 1





verapamil cap 120mg er Tier 1

verapamil cap 120mg sr Tier 1






verapamil tab 40mg Tier 1



verapamil tab 120mg er Tier 1

verapamil tab 120mg sr Tier 1




52




CARDIOTONICS Cardiac Glycosides digoxin tab 0.25mg Tier 1

digoxin tab 0.125mg Tier 1

CARDIOVASCULAR AGENTS - MISC. Impotence Agents CIALIS TAB 2.5MG Tier 3 PA; QL

CIALIS TAB 5MG Tier 3 PA; QL



LEVITRA TAB 2.5MG Tier 3 PA; QL

LEVITRA TAB 5MG Tier 3 PA; QL



STAXYN TAB 10MG Tier 3 PA; QL

VIAGRA TAB 25MG Tier 3 PA; QL



yohimbine tab 5.4mg Tier 1 PA

Prostaglandin Vasodilators REMODULIN INJ 1MG/ML Tier 4 PA

REMODULIN INJ 2.5MG/ML Tier 4 PA

REMODULIN INJ 5MG/ML Tier 4 PA

REMODULIN INJ 10MG/ML Tier 4 PA

VENTAVIS SOL 10MCG/ML Tier 4 PA

Pulmonary Hypertension - Endothelin Receptor Antagonists LETAIRIS TAB 5MG Tier 4 PA

LETAIRIS TAB 10MG Tier 4 PA

TRACLEER TAB 62.5MG Tier 4 PA

TRACLEER TAB 125MG Tier 4 PA

Pulmonary Hypertension - Phosphodiesterase Inhibitors sildenafil tab 20mg Tier 4 PA

CEPHALOSPORINS Cephalosporins - 1st Generation cefadroxil cap 500mg Tier 1

cefadroxil sus 250/5ml Tier 1

cefadroxil sus 500/5ml Tier 1

cefadroxil tab 1gm Tier 1

cephalexin cap 250mg Tier 1

cephalexin cap 500mg Tier 1


53


cephalexin cap 750mg Tier 2 PA

cephalexin sus 125/5ml Tier 1

cephalexin sus 250/5ml Tier 1

cephalexin tab 250mg Tier 1

cephalexin tab 500mg Tier 1

KEFLEX CAP 750MG Tier 2 PA

Cephalosporins - 2nd Generation cefaclor cap 250mg Tier 1

cefaclor cap 500mg Tier 1

cefaclor sus 125/5ml Tier 1



cefprozil sus 125/5ml Tier 1

cefprozil sus 250/5ml Tier 1

cefprozil tab 250mg Tier 1

cefprozil tab 500mg Tier 1

CEFTIN SUS 250/5ML Tier 2

cefuroxime sus 125/5ml Tier 1

cefuroxime tab 250mg Tier 1

cefuroxime tab 500mg Tier 1

Cephalosporins - 3rd Generation CEDAX CAP 400MG Tier 3 PA

cefdinir cap 300mg Tier 1

cefdinir sus 125/5ml Tier 1

cefdinir sus 250/5ml Tier 1

cefditoren tab 200mg Tier 1

cefditoren tab 400mg Tier 1

cefpodo prox sus 50mg/5ml Tier 1

cefpodo prox sus 100/5ml Tier 1

cefpodoxime tab 100mg Tier 1

cefpodoxime tab 200mg Tier 1

ceftibuten cap 400mg Tier 1 PA

SUPRAX SUS 100/5ML Tier 2

SUPRAX SUS 200/5ML Tier 2

SUPRAX TAB 400MG Tier 2

CONTRACEPTIVES Combination Contraceptives - Oral altavera tab Tier 0

alyacen tab 1/35 Tier 0

alyacen tab 7/7/7 Tier 0

amethyst tab 90-20mcg Tier 0

apri tab Tier 0

aranelle tab Tier 0


54


aviane tab Tier 0

azurette tab 28 day Tier 0

balziva tab Tier 0

briellyn tab Tier 0

caziant pak Tier 0

cesia pak Tier 0

chateal tab 0.15/30 Tier 0

cryselle-28 tab 28 tabs Tier 0

cyclafem tab 1/35 Tier 0

cyclafem tab 7/7/7 Tier 0

dasetta tab 1/35 Tier 0

dasetta tab 7/7/7 Tier 0

drospir/ethi tab 3-0.03mg Tier 0

elinest tab Tier 0

emoquette tab Tier 0

enpresse-28 tab Tier 0

enskyce tab Tier 0

estarylla tab 0.25-35 Tier 0

falmina tab Tier 0

gianvi tab 3-0.02mg Tier 0

gildagia tab 0.4-35 Tier 0

gildess fe tab 1.5/30 Tier 0

gildess fe tab 1/20 Tier 0

gildess tab 1.5/30 Tier 0

gildess tab 1/20 Tier 0

junel 1.5/30 tab Tier 0

junel 1/20 tab Tier 0

junel fe tab 1.5/30 Tier 0

junel fe tab 1/20 Tier 0

kariva tab 28 day Tier 0

kelnor tab 1/35 Tier 0

kurvelo tab 0.15/30 Tier 0

leena tab Tier 0

lessina tab Tier 0

levonest tab Tier 0

levonor/ethi tab 0.1-0.02 Tier 0

levonor/ethi tab estradio Tier 0

levora-28 tab 0.15/30 Tier 0

loryna tab 3-0.02mg Tier 0

low-ogestrel tab Tier 0

lutera tab Tier 0

marlissa tab 0.15/30 Tier 0

microgestin tab 1.5/30 Tier 0


55


microgestin tab 1/20 Tier 0

microgestin tab fe1.5/30 Tier 0

microgestin tab fe 1/20 Tier 0

mono-linyah tab 0.25-35 Tier 0

mononessa tab Tier 0

myzilra tab Tier 0

necon tab 0.5/35 Tier 0

necon tab 1/35 Tier 0

necon tab 1/50-28 Tier 0

necon tab 7/7/7 Tier 0

norgest/eth tab estrad Tier 0

norgest/ethi tab 0.25/35 Tier 0

norgest/ethi tab estradio Tier 0

nortrel tab 0.5/35 Tier 0

nortrel tab 1/35 Tier 0

nortrel tab 7/7/7 Tier 0

ocella tab 3-0.03mg Tier 0

ogestrel tab Tier 0

orsythia tab Tier 0

philith tab 0.4-35 Tier 0

pirmella tab 1/35 Tier 0

pirmella tab 7/7/7 Tier 0

portia-28 tab Tier 0

previfem tab Tier 0

reclipsen tab Tier 0

solia tab Tier 0

sprintec 28 tab 28 day Tier 0

sronyx tab Tier 0

syeda tab 3-0.03mg Tier 0

tilia fe tab Tier 0

tri-estaryll tab Tier 0

tri-legest tab fe Tier 0

tri-linyah tab Tier 0

tri-previfem tab Tier 0

tri-sprintec tab Tier 0

trinessa tab Tier 0

trivora-28 tab Tier 0

velivet pak Tier 0

vestura tab 3-0.02mg Tier 0

viorele tab Tier 0

wera tab 0.5/35 Tier 0

wymzya fe chw 0.4mg-35 Tier 0

zarah tab 3-0.03mg Tier 0


56


zenchent fe chw Tier 0

zenchent fe chw 0.4mg-35 Tier 0

zenchent tab Tier 0

zeosa chw Tier 0

zovia 1/35e tab Tier 0

zovia 1/50e tab Tier 0

Combination Contraceptives - Transdermal xulane dis 150-35 Tier 0

Combination Contraceptives - Vaginal NUVARING MIS Tier 0

Emergency Contraceptives ELLA TAB 30MG Tier 0

levonorgestr tab 0.75mg Tier 0

levonorgestr tab 1.5mg Tier 0

my way tab 1.5mg Tier 0

next choice tab 0.75mg Tier 0

next choice tab 1.5mg Tier 0

Progestin Contraceptives - IUD MIRENA IUD SYSTEM Tier 0 PA

Progestin Contraceptives - Injectable DEPO-SQ PROV INJ 104 Tier 2

medroxypr ac inj 150mg/ml Tier 0

Progestin Contraceptives - Oral camila tab 0.35mg Tier 0

errin tab 0.35mg Tier 0

heather tab 0.35mg Tier 0

jencycla tab 0.35mg Tier 0

jolivette tab 0.35mg Tier 0

nora-be tab 0.35mg Tier 0

norethindron tab 0.35mg Tier 0

CORTICOSTEROIDS Glucocorticosteroids asmalpred sol 15mg/5ml Tier 1

asmalpred sol plus Tier 1

baycadron elx 0.5/5ml Tier 1

budesonide cap 3mg/24hr Tier 1 PA

cortisone ac tab 25mg Tier 1

dexamethason elx 0.5/5ml Tier 1

dexamethason sol 0.5/5ml Tier 1

dexamethason tab 0.5mg Tier 1




57


dexamethason tab 1mg Tier 1




hydrocort tab 20mg Tier 1

methylpred pak 4mg Tier 1

methylpred tab 4mg Tier 1




MILLIPRED SOL 10MG/5ML Tier 2

MILLIPRED TAB 5MG Tier 2

ORAPRED ODT TAB 10MG Tier 2 PA



pred sod pho sol 5mg/5ml Tier 1

pred sod pho sol 6.7/5ml Tier 1

prednisolone sol 15mg/5ml Tier 1

prednisolone sol 25mg/5ml Tier 1

prednisolone syp 15mg/5ml Tier 1

prednisone pak 5mg Tier 1

prednisone pak 10mg Tier 1

prednisone sol 5mg/5ml Tier 1

prednisone tab 1mg Tier 1

prednisone tab 2.5mg Tier 1





VERIPRED 20 SOL 20MG/5ML Tier 2

Mineralocorticoids fludrocort tab 0.1mg Tier 1

COUGH/COLD/ALLERGY Antitussives benzonatate cap 100mg Tier 1

benzonatate cap 200mg Tier 1

hydrocod/hom syp 5-1.5/5 Tier 1

hydromet syp 5-1.5/5 Tier 1

Cough/Cold/Allergy Combinations allergy-d tab 12 hour Tier 1

allergy-d tab 60-120mg Tier 1

alrgy relf d tab 180-240 Tier 1

biocotron liq 100-10/5 Tier 1


58


brom/pse/dm syp Tier 1

bromfed dm syp Tier 1

broncotron liq 10-100/5 Tier 1

c-phen dm syp Tier 1

ceron-dm syp Tier 1

cheratussin sol dac Tier 1

cheratussin syp ac Tier 1

diabetic tus liq children Tier 1

diabetic tus liq dm Tier 1

dimetane dx syp Tier 1

dm/gg sol Tier 1

dm/gg sol 10-100/5 Tier 1

fexofen/pse tab 180-240 Tier 1

g-tron liq 10-100/5 Tier 1

gani-tuss dm liq 100-10/5 Tier 1

gani-tuss nr liq 100-10/5 Tier 1

gg/codeine sol 100-10/5 Tier 1

gnp tussin liq dm Tier 1

gnp tussin liq dm cough Tier 1

guaiasorb dm liq 100-10/5 Tier 1

guaiatussin syp ac Tier 1

guaifenesin sol dac Tier 1

guaifenesin syp ac Tier 1

hm tussin liq adlt dm Tier 1

hyd polst-ch liq lor pols Tier 1

iophen c-nr liq 100-10/5 Tier 1

iophen dm-nr liq 100-10/5 Tier 1

medi-tuss dm liq diabetic Tier 1

myci-gc sol 100-10/5 Tier 1

mytussin ac syp 100-10/5 Tier 1

mytussin dac sol Tier 1

novagest/cod sol expect Tier 1

ped formula liq 100-10/5 Tier 1

prometh vc syp 6.25-5/5 Tier 1

prometh vc syp plain Tier 1

prometh vc/ syp codeine Tier 1

prometh/cod syp 6.25-10 Tier 1

promethazine syp dm Tier 1

px tussin dm liq 100-10/5 Tier 1

ra tussin dm liq 100-10/5 Tier 1

robafen ac syp 100-10/5 Tier 1

robitussin liq cgh/cong Tier 1

robitussin liq to go dm Tier 1


59


romilar ac sol 100-10/5 Tier 1

safe tussin liq 10-100/5 Tier 1

sb cgh contr liq dm Tier 1

sildec pe-dm syp Tier 1

siltussin dm liq das Tier 1

siltussin-dm liq diabetic Tier 1

tgt cough liq form dm Tier 1

tolu-sed dm liq 100-10/5 Tier 1

tusnel diabt liq 10-100/5 Tier 1

tussin adult liq cgh/cong Tier 1

tussin cough liq 10-100/5 Tier 1

tussin cough liq congesti Tier 1

tussin dm liq Tier 1

tussin dm liq 100-10/5 Tier 1

tussin dm liq clear Tier 1

wal-fex d tab 12 hour Tier 1

wal-fex d tab 24 hour Tier 1

wal-tussin liq dm Tier 1

Misc. Respiratory Inhalants sod chloride neb 0.9% Tier 1

sodium chlor neb 3% Tier 1

Mucolytics acetylcyst sol 10% Tier 1

acetylcyst sol 20% Tier 1

DERMATOLOGICALS Acne Products adapalene cre 0.1% Tier 1

adapalene gel 0.1% Tier 1

amnesteem cap 10mg Tier 1 PA



ATRALIN GEL 0.05% Tier 2 AGE

avita cre 0.025% Tier 1 AGE

avita gel 0.025% Tier 1 AGE

AZELEX CRE 20% Tier 2

claravis cap 10mg Tier 1 PA




clindacin-p pad 1% Tier 1

clindamax gel 1% Tier 1

clindamax lot 10mg/ml Tier 1

clindamy/ben gel 1-5% Tier 1


60


clindamy/ben gel 1.2-5% Tier 1

clindamycin aer 1% Tier 1

clindamycin gel 1% Tier 1

clindamycin lot 1% Tier 1

clindamycin lot 10mg/ml Tier 1

clindamycin pad 1% Tier 1

clindamycin sol 1% Tier 1

erythromycin gel 2% Tier 1

erythromycin gel /benzoyl Tier 1

erythromycin sol 2% Tier 1

myorisan cap 10mg Tier 1 PA



sotret cap 10mg Tier 1 PA



TRETIN-X CRE 0.0375% Tier 2 AGE

tretinoin cre 0.1% Tier 1 AGE



tretinoin gel 0.01% Tier 1 AGE

tretinoin gel 0.025% Tier 1 AGE

zenatane cap 10mg Tier 1 PA



Anti-inflammatory Agents - Topical FLECTOR DIS 1.3% Tier 2

Antibiotics - Topical ALTABAX OIN 1% Tier 3

CENTANY AT KIT 2% Tier 2

centany oin 2% Tier 1

CORTISPORIN OIN 1% Tier 2

gentamicin cre 0.1% Tier 1

gentamicin oin 0.1% Tier 1

mupirocin ca cre 2% Tier 1

mupirocin cre 2% Tier 1

mupirocin oin 2% Tier 1

Antifungals - Topical antifungal cre 1% Tier 1

antifungal cre 2% Tier 1

athlete foot cre 1% Tier 1

baza antifun cre 2% Tier 1

ciclodan cre 0.77% Tier 1


61


ciclopirox cre 0.77% Tier 1

ciclopirox sus 0.77% Tier 1

clotrim/beta cre 1-0.05% Tier 1

clotrim/beta cre diprop Tier 1

clotrim/beta lot diprop Tier 1

clotrimazole cre 1% Tier 1

clotrimazole sol 1% Tier 1

desenex cre 1% Tier 1

econazole cre 1% Tier 1

ERTACZO CRE 2% Tier 3

EXELDERM CRE 1% Tier 2

EXELDERM SOL 1% Tier 2

fungicure spr intens Tier 1

jock itch cre 1% Tier 1

ketoconazole cre 2% Tier 1

ketoconazole sha 2% Tier 1

LOTRIMIN ULT CRE 1% Tier 2

MENTAX CRE 1% Tier 2

micaderm cre 2% Tier 1

miconazole cre 2% Tier 1

MICONAZOLE POW NITRATE Tier 1

micro guard cre 2% Tier 1

mp clotrimaz cre 1% Tier 1

NAFTIN CRE 1% Tier 2

NAFTIN CRE 2% Tier 2

NAFTIN GEL 1% Tier 2

neosporin af cre 2% jock Tier 1

NIZORAL A-D SHA 1% Tier 2

nuzole cre 2% Tier 1

nyamyc pow 100000 Tier 1

nystat/triam cre Tier 1

nystat/triam oin Tier 1

nystatin cre 100000 Tier 1

nystatin oin 100000 Tier 1

NYSTATIN POW Tier 1

nystatin pow 100000 Tier 1

nystop pow 100000 Tier 1

OXISTAT CRE 1% Tier 3

OXISTAT LOT 1% Tier 3

pedi-dri pow 100000 Tier 1

podactin cre 2% Tier 1

remedy cre antifung Tier 1

ringworm cre 1% Tier 1


62


sm antifungl cre 2% Tier 1

soothe&cool cre inzo 2% Tier 1

Antineoplastic or Premalignant Lesion Agents - Topical fluorouracil cre 5% Tier 1

fluorouracil dro 2% Tier 1

fluorouracil dro 5% Tier 1

fluorouracil sol 2% Tier 1

fluorouracil sol 5% Tier 1

PANRETIN GEL 0.1% Tier 3 PA

PICATO GEL 0.05% Tier 3 PA

PICATO GEL 0.015% Tier 3 PA

Antipruritics - Topical prudoxin cre 5% Tier 1

Antipsoriatics acitretin cap 10mg Tier 1 PA

acitretin cap 17.5mg Tier 1 PA

acitretin cap 25mg Tier 1 PA

AMEVIVE INJ 15MG Tier 4 PA

calcipotrien cre 0.005% Tier 1

calcipotrien oin 0.005% Tier 1

calcipotrien sol 0.005% Tier 1

calcitrene oin 0.005% Tier 1

calcitriol oin 3mcg/gm Tier 1

DRITHO-CREME CRE HP 1% Tier 2

DRITHO-SCALP CRE 0.5% Tier 2

methoxsalen cap 10mg Tier 1 PA

8-MOP CAP 10MG Tier 3 PA

OXSORALEN-UL CAP 10MG Tier 3 PA

SORIATANE CAP 10MG Tier 3 PA

SORIATANE CAP 17.5MG Tier 3 PA

SORIATANE CAP 25MG Tier 3 PA

STELARA INJ 45MG/0.5 Tier 4 PA

STELARA INJ 90MG/ML Tier 4 PA

TAZORAC GEL 0.1% Tier 2

TAZORAC GEL 0.05% Tier 2

Antiseborrheic Products selenium sul lot 2.5% Tier 1

selenium sul sha 2.5% Tier 1

selenium sul sha 2.25% Tier 1

Antivirals - Topical DENAVIR CRE 1% Tier 2

Burn Products


63


silver sulfa cre 1% Tier 1

ssd af cre 1% Tier 1

ssd cre 1% Tier 1

SULFAMYLON CRE 85MG/GM Tier 3

thermazene cre 1% Tier 1

Corticosteroids - Topical ala cort cre 1% Tier 1

ala-cort lot 1% Tier 1

alclometason cre 0.05% Tier 1

alclometason oin 0.05% Tier 1

alphatrex gel 0.05% Tier 1

amcinonide cre 0.1% Tier 1

amcinonide lot 0.1% Tier 1

anti-itch cre 1% Tier 1

anti-itch cre 1%pls 10 Tier 1

anti-itch cre /aloe/e Tier 1

anti-itch cre /oatmeal Tier 1

anti-itch lot 1% Tier 1

apexicon oin 0.05% Tier 1

aquanil hc lot 1% Tier 1

aug betamet cre 0.05% Tier 1

aug betamet gel 0.05% Tier 1

aug betamet lot 0.05% Tier 1

aug betamet oin 0.05% Tier 1

aveeno cre 1% Tier 1

beta hc lot 1% Tier 1

betameth dip cre 0.05% Tier 1

betameth dip lot 0.05% Tier 1

betameth dip oin 0.05% Tier 1

betameth val cre 0.1% Tier 1

betameth val lot 0.1% Tier 1

betameth val oin 0.1% Tier 1

calcipotrien oin betameth Tier 1 PA

caldecort cre 1% Tier 1

clobetasol cre 0.05% Tier 1

clobetasol oin 0.05% Tier 1

clobetasol sol 0.05% Tier 1

clocortolone cre piv 0.1% Tier 1

CLODERM CRE 0.1% Tier 3

CLODERM CRE 0.1% PMP Tier 3

CORDRAN 24X3 TAP 4MCG/CM Tier 3

CORDRAN 80X3 TAP 4MCG/CM Tier 3

CORDRAN LOT 0.05% Tier 3


64


CORDRAN SP CRE 0.05% Tier 3

cormax oin 0.05% Tier 1

cormax scalp sol 0.05% Tier 1

cormax sol 0.05% Tier 1

cort intense cre heal 1% Tier 1

cortaid adv cre 1% 12 hr Tier 1

cortaid cre 1% Tier 1

cortisone + cre 1% Tier 1

cortisone cre 1% Tier 1

cortisone lot 1% Tier 1

cortizone-10 lot eczema Tier 1

cortizone-10 lot hydraten Tier 1

cvs cort int cre heal 1% Tier 1

desonide cre 0.05% Tier 1

desonide lot 0.05% Tier 1

desonide oin 0.05% Tier 1

desoximetas cre 0.05% Tier 1

desoximetas cre 0.25% Tier 1

desoximetas gel 0.05% Tier 1

desoximetas oin 0.05% Tier 1

desoximetas oin 0.25% Tier 1

diflorasone cre 0.05% Tier 1

diflorasone oin 0.05% Tier 1

eq hydrocort cre 1% Tier 1

fluocin acet cre 0.01% Tier 1

fluocin acet cre 0.025% Tier 1

fluocin acet oil body Tier 1

fluocin acet oil scalp Tier 1

fluocin acet oin 0.025% Tier 1

fluocin acet sol 0.01% Tier 1

fluocinonide cre 0.1% Tier 1

fluocinonide cre 0.05% Tier 1

fluocinonide gel 0.05% Tier 1

fluocinonide oin 0.05% Tier 1

fluocinonide sol 0.05% Tier 1

fluticasone cre 0.05% Tier 1

fluticasone lot 0.05% Tier 1

fluticasone oin 0.005% Tier 1

gnp hydrocor cre 1% plus Tier 1

halobetasol cre 0.05% Tier 1

halobetasol oin 0.05% Tier 1

HALOG CRE 0.1% Tier 2

HALOG OIN 0.1% Tier 2


65


hc pramoxine cre 1-2.5% Tier 1

hc valerate cre 0.2% Tier 1

hc valerate oin 0.2% Tier 1

hydro-lotion lot 1% Tier 1

hydrocort cre 1% Tier 1

hydrocort cre 1% plus Tier 1

hydrocort cre 1%pls 10 Tier 1

hydrocort cre 1%pls 12 Tier 1

hydrocort cre 2.5% Tier 1

hydrocort lot 1% Tier 1

hydrocort lot 2.5% Tier 1

hydrocort oin 2.5% Tier 1

hydrocream cre 1% Tier 1

hydroskin cre 1% Tier 1

itch-x lot 1% Tier 1

KENALOG AER SPRAY Tier 2

kericort 10 cre 1% Tier 1

lokara lot 0.05% Tier 1

med-derm hc cre 1% Tier 1

mometasone cre 0.1% Tier 1

mometasone oin 0.1% Tier 1

mometasone sol 0.1% Tier 1

mp hydrocort cre 1% Tier 1

neosporin cre eczema Tier 1

noble formul cre hc 1% Tier 1

pramcort cre 1-1% Tier 1

prednicarbat cre 0.1% Tier 1

prednicarbat oin 0.1% Tier 1

prep h hc cre 1% Tier 1

qc hydrocort cre 1% Tier 1

ra anti-itch cre 1% Tier 1

ra hydrocort cre 1% Tier 1

ra hydrocort cre 1%pls 12 Tier 1

recort plus cre 1% Tier 1

rederm lot 1% Tier 1

sarnol-hc lot 1% Tier 1

sb hydrocort cre 1% Tier 1

scalacort lot 2% Tier 1

sm hydrocort cre 1% Tier 1

TACLONEX OIN Tier 3 PA

TACLONEX SUS Tier 3 PA

th hydrocort cre 1% Tier 1

theracort lot 1% Tier 1


66


triamcinolon cre 0.1% Tier 1



triamcinolon lot 0.1% Tier 1

triamcinolon lot 0.025% Tier 1

triamcinolon oin 0.1% Tier 1




triderm cre 0.1% Tier 1

VANOS CRE 0.1% Tier 2

Emollients al12 lot 12% Tier 1

amlactin cre 12% Tier 1

amlactin lot 12% Tier 1

ammonium lac cre 12% Tier 1

ammonium lac lot 12% Tier 1

geri-hydrola cre 12% Tier 1

geri-hydrola lot 12% Tier 1

laclotion lot 12% Tier 1

moist skin cre 12% Tier 1

moist skin lot 12% Tier 1

skin trtment lot 12% Tier 1

Enzymes - Topical SANTYL OIN 250/GM Tier 3

Immunomodulating Agents - Topical imiquimod cre 5% Tier 1

Immunosuppressive Agents - Topical ELIDEL CRE 1% Tier 2 PA

PROTOPIC OIN 0.1% Tier 2 PA

PROTOPIC OIN 0.03% Tier 2 PA

Keratolytic/Antimitotic Agents podofilox sol 0.5% Tier 1

Local Anesthetics - Topical lido/prilocn cre 2.5-2.5% Tier 1

lidocaine gel 2% Tier 1

lidocaine gel 2% jelly Tier 1

lidocaine oin 5% Tier 1

lidocaine pad 5% Tier 1 PA

lidocaine sol 4% 4% Tier 1

LIDODERM DIS 5% Tier 2 PA

regenecare gel ha 2% Tier 1


67


SYNERA DIS 70-70MG Tier 3 PA

Misc. Topical hypercare sol 20% Tier 1

Rosacea Agents FINACEA GEL 15% Tier 2

metronidazol cre 0.75% Tier 1

metronidazol gel 0.75% Tier 1

metronidazol gel 1% Tier 2

metronidazol lot 0.75% Tier 1

rosadan cre 0.75% Tier 1

rosadan gel 0.75% Tier 1

vitazol cre 0.75% Tier 1

Scabicides Pediculicides acticin cre 5% Tier 1

EURAX CRE 10% Tier 2

EURAX LOT 10% Tier 2

lindane sha 1% Tier 1

malathion lot 0.5% Tier 1 ST

NIX LICE SPR CONTROL Tier 2

permethrin cre 5% Tier 1

PRONTO AER 0.4% Tier 2

PYRE/PIPERON LIQ Tier 2

SKLICE LOT 0.5% Tier 3 PA

spinosad sus 0.9% Tier 1

ULESFIA LOT 5% Tier 3 ST

Wound Care Products REGRANEX GEL 0.01% Tier 3 PA

DIAGNOSTIC PRODUCTS Diagnostic Drugs THYROGEN INJ 1.1MG Tier 4 PA

Diagnostic Tests CHEMSTRIP 2 TES GP Tier 2

CHEMSTRIP 5 TES OB Tier 2

CHEMSTRIP 7 TES Tier 2

CHEMSTRIP 9 TES STRIPS Tier 2

CHEMSTRIP 10 TES MD Tier 2

CHEMSTRIP TES -10 SG Tier 2

CHEMSTRIP TES UGK Tier 2

COMBISTIX TES Tier 2

CVS KETONE TES CARE Tier 2

HEMA-COMBIST TES Tier 2

KETO-DIASTIX TES Tier 2


68


LABSTIX TES Tier 2

MULTISTIX 5 TES Tier 2


MULTISTIX 8 TES SG Tier 2




MULTISTIX TES Tier 2

TRUETEST TES Tier 2

URINARY TRAC TES INFECTIO Tier 2

URISTIX 4 TES Tier 2

URISTIX TES Tier 2

DIGESTIVE AIDS Digestive Enzymes CREON CAP 3000UNIT Tier 3

CREON CAP 6000UNIT Tier 3

CREON CAP 12000UNT Tier 3

CREON CAP 24000UNT Tier 3

PANCREAZE CAP 4200UNIT Tier 3

PANCREAZE CAP 10500UNT Tier 3



pancrelipase cap 5000unit Tier 1

PERTZYE CAP Tier 3

ULTRESA CAP 13800UNT Tier 3



ZENPEP CAP 3000UNIT Tier 3

ZENPEP CAP 10000UNT Tier 3




DIURETICS Carbonic Anhydrase Inhibitors acetazolamid cap 500mg er Tier 1

acetazolamid tab 125mg Tier 1

acetazolamid tab 250mg Tier 1

methazolamid tab 25mg Tier 1

methazolamid tab 50mg Tier 1

Diuretic Combinations spirono/hctz tab 25/25 Tier 1

triamt/hctz cap 37.5-25 Tier 1

triamt/hctz tab 37.5-25 Tier 1


69


triamt/hctz tab 75-50mg Tier 1

Loop Diuretics bumetanide tab 0.5mg Tier 1

bumetanide tab 1mg Tier 1

bumetanide tab 2mg Tier 1

EDECRIN TAB 25MG Tier 2

furosemide sol 10mg/ml Tier 1

furosemide tab 20mg Tier 1



torsemide tab 5mg Tier 1




Potassium Sparing Diuretics amiloride tab 5mg Tier 1

DYRENIUM CAP 50MG Tier 2

DYRENIUM CAP 100MG Tier 2

spironolact tab 25mg Tier 1



Thiazides and Thiazide-Like Diuretics chlorothiaz tab 250mg Tier 1

chlorothiaz tab 500mg Tier 1

chlorthalid tab 25mg Tier 1

chlorthalid tab 50mg Tier 1

hydrochlorot cap 12.5mg Tier 1

hydrochlorot tab 12.5mg Tier 1

hydrochlorot tab 25mg Tier 1

hydrochlorot tab 50mg Tier 1

indapamide tab 1.25mg Tier 1

indapamide tab 2.5mg Tier 1

methyclothia tab 5mg Tier 1

metolazone tab 2.5mg Tier 1

metolazone tab 5mg Tier 1

metolazone tab 10mg Tier 1

ENDOCRINE AND METABOLIC AGENTS - MISC. Bone Density Regulators ACTONEL TAB 5MG Tier 2 PA

ACTONEL TAB 30MG Tier 2 PA



alendronate sol 70/75ml Tier 2 PA


70


alendronate tab 5mg Tier 1





calcitonin spr 200/act Tier 1

etidron disd tab 200mg Tier 3

etidron disd tab 400mg Tier 3

FORTEO SOL 600/2.4 Tier 4 PA

ibandronate tab 150mg Tier 1 PA

PROLIA SOL 60MG/ML Tier 4 PA

SKELID TAB 200MG Tier 3

XGEVA INJ Tier 4 PA

Growth Hormone Receptor Antagonists SOMAVERT INJ 10MG Tier 4 PA

SOMAVERT INJ 15MG Tier 4 PA

SOMAVERT INJ 20MG Tier 4 PA

Growth Hormones TEV-TROPIN INJ 5MG Tier 4 PA

Hormone Receptor Modulators EVISTA TAB 60MG Tier 2

raloxifene tab 60mg Tier 1

Insulin-Like Growth Factors (Somatomedins) INCRELEX INJ 40MG/4ML Tier 4 PA

LHRH/GnRH Agonist Analog Pituitary Suppressants SUPPRELIN LA KIT 50MG Tier 4 PA

SYNAREL SOL 2MG/ML Tier 4 PA

Metabolic Modifiers ALDURAZYME INJ 2.9MG/5M Tier 4 PA

calcitriol cap 0.5mcg Tier 1

calcitriol cap 0.25mcg Tier 1

calcitriol inj 1mcg/ml Tier 1

doxercalcif cap 0.5mcg Tier 1

doxercalcif cap 1mcg Tier 1

doxercalcif cap 2.5mcg Tier 1

doxercalcif inj Tier 1

doxercalcif inj 4mcg/2ml Tier 1

ELAPRASE INJ 6MG/3ML Tier 4 PA

FABRAZYME INJ 5MG Tier 4 PA

FABRAZYME INJ 35MG Tier 4 PA

HECTOROL CAP 0.5MCG Tier 3

HECTOROL CAP 1MCG Tier 3


71


HECTOROL CAP 2.5MCG Tier 3

HECTOROL INJ 2MCG/ML Tier 3

HECTOROL INJ 4MCG/2ML Tier 3

KUVAN TAB 100MG Tier 4 PA

levocarnitin sol 1gm/10ml Tier 1

levocarnitin tab 330mg Tier 1

LUMIZYME INJ 50MG Tier 4 PA

MYOZYME INJ 50MG Tier 4 PA

NAGLAZYME INJ 1MG/ML Tier 4 PA

paricalcitol cap 1 mcg Tier 1 PA



SENSIPAR TAB 30MG Tier 4 PA



ZEMPLAR CAP 1MCG Tier 3 PA



Posterior Pituitary Hormones desmopressin inj 4mcg/ml Tier 4 PA

desmopressin sol 0.01% Tier 4 PA

desmopressin spr 0.01% Tier 1 PA

desmopressin tab 0.1mg Tier 1

desmopressin tab 0.2mg Tier 1

minirin spr nasal Tier 1 PA

STIMATE SOL 1.5MG/ML Tier 4 PA

Somatostatic Agents octreotide inj 50mcg/ml Tier 4 PA

octreotide inj 100mcg Tier 4 PA




SANDOSTATIN KIT LAR 10MG Tier 4 PA



SOMATULINE INJ 60/0.2ML Tier 4 PA

SOMATULINE INJ 90/0.3ML Tier 4 PA

SOMATULINE INJ 120/.5ML Tier 4 PA

Vasopressin Receptor Antagonists SAMSCA TAB 15MG Tier 4 PA

SAMSCA TAB 30MG Tier 4 PA

ESTROGENS Estrogen Combinations


72


COMBIPATCH DIS .05/.14 Tier 2

COMBIPATCH DIS .05/.25 Tier 2

covaryx hs tab Tier 1

covaryx tab Tier 1

eemt hs tab Tier 1

eemt tab Tier 1

essian h.s. tab Tier 1

essian tab Tier 1

est estrogen tab mtest Tier 1

est estrogen tab mtest ds Tier 1

est estrogen tab mtest hs Tier 1

FEMHRT TAB 0.5-2.5 Tier 2

jevantique tab 1mg-5mcg Tier 1

jinteli tab 1mg-5mcg Tier 1

mtest hs/est tab estrogen Tier 1

mtest/est tab estrogen Tier 1

PREMPHASE TAB Tier 2

PREMPRO TAB 0.3-1.5 Tier 2

PREMPRO TAB 0.45-1.5 Tier 2

PREMPRO TAB 0.625-5 Tier 2

PREMPRO TAB .625-2.5 Tier 2

Estrogens ALORA DIS 0.1MG Tier 2

ALORA DIS 0.05MG Tier 2



CENESTIN TAB 0.3MG Tier 3





ENJUVIA TAB 0.3MG Tier 2





ESTRADERM DIS 0.1MG Tier 2

ESTRADERM DIS 0.05MG Tier 2

estradiol dis 0.1mg Tier 1






73



estradiol tab 0.5mg Tier 1

estradiol tab 1mg Tier 1

estradiol tab 2mg Tier 1

MENEST TAB 0.3MG Tier 2




MINIVELLE DIS 0.1MG Tier 2




PREMARIN TAB 0.3MG Tier 2





VIVELLE-DOT DIS 0.1MG Tier 2





FLUOROQUINOLONES Fluoroquinolones CIPRO (5%) SUS 250MG/5 Tier 2 PA

CIPRO (10%) SUS 500MG/5 Tier 2 PA

ciprofloxacn tab 100mg Tier 1 PA

ciprofloxacn tab 250mg Tier 1



FACTIVE TAB 320MG Tier 3 PA

levofloxacin tab 250mg Tier 1 PA



NOROXIN TAB 400MG Tier 2 PA

ofloxacin tab 200mg Tier 1



GASTROINTESTINAL AGENTS - MISC. Gallstone Solubilizing Agents ursodiol cap 300mg Tier 1

ursodiol tab 250mg Tier 1

ursodiol tab 500mg Tier 1


74


Gastrointestinal Chloride Channel Activators AMITIZA CAP 8MCG Tier 3 PA

AMITIZA CAP 24MCG Tier 3 PA

Gastrointestinal Stimulants metoclopram sol 5mg/5ml Tier 1

metoclopram sol 10/10ml Tier 1

metoclopram tab 5mg Tier 1

metoclopram tab 10mg Tier 1

Inflammatory Bowel Agents ASACOL TAB 400MG DR Tier 2

balsalazide cap 750mg Tier 1

CIMZIA KIT Tier 4 PA

DIPENTUM CAP 250MG Tier 2

LIALDA TAB 1.2GM Tier 2

PENTASA CAP 250MG CR Tier 2

PENTASA CAP 500MG CR Tier 2

REMICADE INJ 100MG Tier 4 PA

sulfasalazin tab 500mg Tier 1

sulfasalazin tab 500mg dr Tier 1

sulfazine ec tab 500mg Tier 1

sulfazine tab 500mg Tier 1

Intestinal Acidifiers enulose sol 10gm/15 Tier 1

generlac sol 10gm/15 Tier 1

lactulose sol 10gm/15 10gm/15ml Tier 1

Irritable Bowel Syndrome (IBS) Agents LINZESS CAP 145MCG Tier 3 PA

LINZESS CAP 290MCG Tier 3 PA

Peripheral Opioid Receptor Antagonists RELISTOR KIT 12/0.6ML Tier 4 PA

Phosphate Binder Agents calc acetate cap 667mg Tier 1

calc acetate tab 667mg Tier 1

FOSRENOL CHW 500MG Tier 3 PA



RENAGEL TAB 400MG Tier 2 ST

RENAGEL TAB 800MG Tier 2 ST

RENVELA TAB 800MG Tier 2 ST

GENITOURINARY Urinary Antispasmodics DETROL LA CAP 2MG Tier 2 ST


75


DETROL LA CAP 4MG Tier 2 ST

tolterodine cap 2mg er Tier 1 ST

tolterodine cap 4mg er Tier 1 ST

GENITOURINARY AGENTS - MISCELLANEOUS Alkalinizers pot citrate tab 540mg Tier 1

pot citrate tab 1080mg Tier 1

Genitourinary Irrigants argyl saline sol 0.9% Tier 1

curity salin sol 0.9% irr Tier 1

sod chloride sol 0.45%irr Tier 1

sodium chlor sol 0.9% irr Tier 1

Interstitial Cystitis Agents ELMIRON CAP 100MG Tier 2

Prostatic Hypertrophy Agents alfuzosin tab 10mg Tier 1

AVODART CAP 0.5MG Tier 3 PA

finasteride tab 5mg Tier 1

RAPAFLO CAP 4MG Tier 3

RAPAFLO CAP 8MG Tier 3

tamsulosin cap 0.4mg Tier 1

Urinary Analgesics phenazo tab 200mg Tier 1

phenazopyrid tab 100mg Tier 1

phenazopyrid tab 200mg Tier 1

GOUT AGENTS Gout Agent Combinations proben/colch tab 500-0.5 Tier 1

Gout Agents allopurinol tab 100mg Tier 1

allopurinol tab 300mg Tier 1

COLCRYS TAB 0.6MG Tier 3

ULORIC TAB 40MG Tier 3 PA

ULORIC TAB 80MG Tier 3 PA

Uricosurics probenecid tab 500mg Tier 1

HEMATOLOGICAL AGENTS - MISC. Antihemophilic Products ADVATE INJ 250UNIT Tier 4 PA

ADVATE INJ 500UNIT Tier 4 PA




76




ALPHANATE INJ VWF/HUM Tier 4 PA

ALPHANINE SD INJ 500UNIT Tier 4 PA

ALPHANINE SD INJ 1000UNIT Tier 4 PA

BEBULIN INJ 200-1200 Tier 4 PA

BEBULIN VH INJ 200-1200 Tier 4 PA

BENEFIX INJ 250UNIT Tier 4 PA




FEIBA NF INJ Tier 4 PA

FEIBA VH INJ IMMUNO Tier 4 PA

HELIXATE FS INJ 250UNIT Tier 4 PA




HELIXATE FS SOL 250UNIT Tier 4 PA



HEMOFIL M INJ 220-400 Tier 4 PA

HEMOFIL M INJ 401-800 Tier 4 PA

HUMATE-P INJ 500UNIT Tier 4 PA




HUMATE-P SOL 600UNIT Tier 4 PA



KOATE-DVI INJ 250UNIT Tier 4 PA



KOGENATE FS INJ 250/BS Tier 4 PA

KOGENATE FS INJ 250UNIT Tier 4 PA







MONOCLATE-P INJ 250UNIT Tier 4 PA




77



MONONINE INJ 250UNIT Tier 4 PA



NOVOSEVEN INJ 1200MCG Tier 4 PA



PROFILNINE INJ 500UNIT Tier 4 PA

RECOMBINATE INJ 220-400 Tier 4 PA



REFACTO INJ 500UNIT Tier 4 PA

Complement Inhibitors CINRYZE SOL 500 UNIT Tier 4 PA

Hematorheologic Agents pentoxifylli tab 400mg er Tier 1

Platelet Aggregation Inhibitors AGGRENOX CAP 25-200MG Tier 3

anagrelide cap 0.5mg Tier 1

anagrelide cap 1mg Tier 1

BRILINTA TAB 90MG Tier 3 PA

cilostazol tab 50mg Tier 1

cilostazol tab 100mg Tier 1

clopidogrel tab 75mg Tier 1

clopidogrel tab 300mg Tier 1 PA

dipyridamole tab 25mg Tier 1



EFFIENT TAB 5MG Tier 3

EFFIENT TAB 10MG Tier 3

ticlopidine tab 250mg Tier 1

HEMATOPOIETIC AGENTS Agents for Gaucher Disease CEREZYME INJ 200UNIT Tier 4 PA

CEREZYME INJ 400UNIT Tier 4 PA

Folic Acid/Folates fa-8 tab 0.8mg Tier 0

folic acid tab 1mg Tier 1

folic acid tab 400mcg Tier 0



sm folic acd tab 400mcg Tier 0


78


yl folic aci tab 400mcg Tier 0

Hematopoietic Growth Factors ARANESP INJ 25MCG Tier 4 PA

ARANESP INJ 40MCG Tier 4 PA







EPOGEN INJ 2000/ML Tier 4 PA





LEUKINE INJ 250MCG Tier 4 PA

LEUKINE INJ 500 MCG Tier 4 PA

NEULASTA INJ 6MG/0.6M Tier 4 PA

NEUMEGA INJ 5MG Tier 4 PA

NEUPOGEN INJ 300/0.5 Tier 4 PA

NEUPOGEN INJ 300MCG Tier 4 PA

NEUPOGEN INJ 480/0.8 Tier 4 PA

NEUPOGEN INJ 480MCG Tier 4 PA

NPLATE INJ 250MCG Tier 4 PA

NPLATE INJ 500MCG Tier 4 PA

PROCRIT INJ 2000/ML Tier 4 PA






PROMACTA TAB 12.5MG Tier 4 PA

PROMACTA TAB 25MG Tier 4 PA



Hematopoietic Mixtures ferocon cap Tier 1

ferotrin cap Tier 1

ferotrinsic cap Tier 1

ferrex 150 cap forte Tier 1

foltrin cap Tier 1

iferex 150 cap forte Tier 1

martinic cap Tier 1


79


myferon 150 cap forte Tier 1

poly-iron cap 150 fort Tier 1

polysacchari cap iron Tier 1

tl icon cap Tier 1

tricon cap Tier 1

Iron fer-iron dro 15mg/ml Tier 0

ferosul elx 220/5ml Tier 0

ferrous dro 15mg/ml Tier 0

ferrous sulf dro 15mg/ml Tier 0

ferrous sulf elx 220/5ml Tier 0

iron supplmt dro 15mg/ml Tier 0

wee care sus 15/1.25 Tier 0

Stem Cell Mobilizers MOZOBIL INJ Tier 4 PA

HYPNOTICS Barbiturate Hypnotics phenobarb elx 20mg/5ml Tier 1

phenobarb sol 20mg/5ml Tier 1

phenobarb tab 15mg Tier 1

phenobarb tab 16.2mg Tier 1







Non-Barbiturate Hypnotics chloral hydr syp 500/5ml Tier 1

estazolam tab 1mg Tier 1

estazolam tab 2mg Tier 1

eszopiclone tab 1mg Tier 1 PA



flurazepam cap 15mg Tier 1

flurazepam cap 30mg Tier 1

LUNESTA TAB 1MG Tier 3 PA



SOMNOTE CAP 500MG Tier 2

temazepam cap 7.5mg Tier 1

temazepam cap 15mg Tier 1

temazepam cap 30mg Tier 1


80


triazolam tab 0.25mg Tier 1

triazolam tab 0.125mg Tier 1

zaleplon cap 5mg Tier 1

zaleplon cap 10mg Tier 1

zolpidem tab 5mg Tier 1

zolpidem tab 10mg Tier 1

Selective Melatonin Receptor Agonists ROZEREM TAB 8MG Tier 3 PA

LAXATIVES Laxative Combinations COLYTE/FLAVR SOL PACKS Tier 2

gavilyte-c sol Tier 1

gavilyte-g sol Tier 1

MOVIPREP SOL Tier 2

peg 3350 sol electrol Tier 1

peg-3350 sol electrol Tier 1

PREPOPIK PAK Tier 2

SUPREP BOWEL SOL PREP Tier 2

Laxatives - Miscellaneous clearlax pow POWD Tier 1

constulose sol 10gm/15 Tier 1

cvs purelax pow Tier 1

dulcolax pow balance Tier 1

eql clearlax pow Tier 1

gavilax pow Tier 1

gentlelax pow POWD Tier 1

glycolax pow 3350 nf Tier 1

gnp clearlax pow Tier 1

hm clearlax pow Tier 1

lactulose sol 10gm/15 10gm/15ml Tier 1

lactulose sol 20gm/30 Tier 1

laxaclear pow Tier 1

natura-lax pow 3350 nf Tier 1

peg 3350 pow POWD Tier 1

polyeth glyc pow 3350 nf POWD Tier 1

polyeth glyc pow 3350-grx Tier 1

ra laxative pow POWD Tier 1

sm clearlax pow Tier 1

smooth lax pow Tier 1

sw clearlax pow Tier 1

Saline Laxatives OSMOPREP TAB 1.5GM Tier 2

VISICOL TAB 1.5GM Tier 2


81


MACROLIDES Azithromycin azithromycin pow 1gm pak Tier 1

azithromycin sus 100/5ml Tier 1

azithromycin sus 200/5ml Tier 1

azithromycin tab 250mg Tier 1



ZMAX SUS 2GM Tier 2 PA

Clarithromycin clarithromyc sus 125/5ml Tier 1

clarithromyc sus 250/5ml Tier 1

clarithromyc tab 250mg Tier 1

clarithromyc tab 500mg Tier 1

Erythromycins e.e.s. 400 tab 400mg Tier 1

E.E.S. GRAN SUS 200/5ML Tier 1

ERY-TAB TAB 333MG EC Tier 1

ERY-TAB TAB 500MG EC Tier 1

ERYPED SUS 200/5ML Tier 1

ERYPED SUS 400/5ML Tier 2

erythrocin tab 250mg Tier 1

erythrom eth tab 400mg Tier 1

erythromycin cap 250mg ec Tier 1

erythromycin tab 250mg bs Tier 1

erythromycin tab 500mg bs Tier 1

Fidaxomicin DIFICID TAB 200MG Tier 4 PA

MEDICAL DEVICES Contraceptives FC2 FEMALE MIS CONDOM Tier 0

FC FEMALE MIS CONDOM Tier 0

FEMCAP MIS 22MM Tier 0



OMNIFLEX DPR Tier 0

ORTHO COIL DPR KIT 50 Tier 0



ORTHO FLAT DPR KIT 55 Tier 0




82








ORTHO FLEX DPR 65MM Tier 0




PARAGARD IUD T380A Tier 0

PRENTIF MIS 22MM Tier 0




PRENTIF MIS FITTING Tier 0

TODAY SPONGE MIS Tier 0

WIDE-SEAL DPR KIT 60 Tier 0








Diabetic Supplies LANCETS DME

MEIJER LANCETS DME

MEIJER LANCETS THIN DME

TRUERESULT KIT DME QL

Parenteral Therapy Supplies INSULIN PEN NEEDLES DME

INSULIN SYRINGES DME

Respiratory Therapy Supplies INSPIREASE MIS MOUTHPCE Tier 2 QL

INSPIREASE MIS REP MOUT Tier 2 QL

SPACERS Tier 2 QL

MIGRAINE PRODUCTS Migraine Combinations CAFERGOT TAB 1-100MG Tier 2

epidrin cap Tier 1

isometh/apap cap dichlor Tier 1

MIGERGOT SUP 2/100 Tier 2


83


migragesic cap ida Tier 1

nodolor cap Tier 1

Migraine Products dihydroergot inj 1mg/ml Tier 1

dihydroergot spr 4mg/ml Tier 1

ERGOMAR SUB 2MG Tier 2

Serotonin Agonists AXERT TAB 6.25MG Tier 3 PA; QL

AXERT TAB 12.5MG Tier 3 PA

FROVA TAB 2.5MG Tier 3 PA; QL

naratriptan tab 1mg Tier 1 ST; QL

naratriptan tab 2.5mg Tier 1 ST; QL

RELPAX TAB 20MG Tier 2 ST; QL

RELPAX TAB 40MG Tier 2 ST; QL

rizatriptan tab 5mg Tier 1 ST; QL

rizatriptan tab 10mg Tier 1 ST; QL

sumatriptan inj 4mg/0.5 Tier 1 PA; QL

sumatriptan inj 6mg/0.5 SOAJ; SOCT;

SOLN

Tier 1 PA; QL

sumatriptan spr 5mg/act Tier 1 QL

sumatriptan spr 20mg/act Tier 1 QL

sumatriptan tab 25mg Tier 1 QL



zolmitriptan tab 2.5 mg Tier 2 ST; QL

zolmitriptan tab 2.5mg Tier 2 ST; QL

zolmitriptan tab 5mg Tier 2 ST; QL

MINERALS ELECTROLYTES Fluoride epiflur chw 0.5mg f Tier 0

epiflur chw 0.25mg f Tier 0

epiflur chw 1mg f Tier 1

fluor-a-day dro 0.125mg Tier 0

FLUORABON DRO Tier 2

fluoride chw 0.5mg f Tier 0

fluoride chw 0.25mg f Tier 0

fluoride chw 1mg f Tier 1

fluoritab chw 0.5mg f Tier 0

fluoritab chw 0.25mg f Tier 0

fluoritab chw 1mg f Tier 1

fluoritab chw 2.2mg Tier 1

fluoritab dro 0.125mg Tier 0

flura-drops dro 0.25mg f Tier 0


84


flura-drops dro 0.125mg Tier 0

karidium dro 0.125mg Tier 0

ludent chw 0.5mg f Tier 0

ludent chw 0.25mg f Tier 0

ludent chw 1mg f Tier 1

nafrinse chw 1mg f Tier 1

nafrinse dro 0.125mg Tier 0

sod fluoride chw 0.5mg f Tier 0

sod fluoride chw 0.25mg f Tier 0

sod fluoride chw 1.1mg Tier 0

sod fluoride chw 1mg f Tier 1

sod fluoride chw 2.2mg Tier 1

sod fluoride dro 0.5mg/ml Tier 0

sod fluoride tab 0.5mg f Tier 0

Potassium klor-con 8 tab 8meq er Tier 1

klor-con 10 tab 10meq er Tier 1

klor-con m10 tab 10meq er Tier 1

KLOR-CON M15 TAB Tier 2

klor-con m20 tab 20meq er Tier 1

pot chloride cap 8meq er Tier 1

pot chloride cap 10meq er Tier 1

pot chloride liq 10% Tier 1

pot chloride liq 20% Tier 1

pot chloride liq 20% sf Tier 1

pot chloride sol 10% sf Tier 1

pot chloride tab 8meq er Tier 1

pot chloride tab 8meq sr Tier 1

pot chloride tab 10meq cr Tier 1

pot chloride tab 10meq er Tier 1

pot cl micro tab 10meq cr Tier 1

pot cl micro tab 10meq er Tier 1

pot cl micro tab 20meq er Tier 1

MOUTH/THROAT/DENTAL AGENTS Anesthetics Topical Oral lidocaine sol 2% visc Tier 1

lidocaine sol 4% 4% Tier 1

Anti-infectives - Throat clotrimazole loz 10mg Tier 1

clotrimazole tro 10mg Tier 1

nystatin sus 100000 Tier 1

ORAVIG TAB 50MG Tier 3

Antiseptics - Mouth/Throat


85


chlorhex glu sol 0.12% Tier 1

periogard sol 0.12% Tier 1

Steroids - Mouth/Throat oralone pst 0.1% Tier 1

triamcin/ora pst 0.1% Tier 1

triamcinolon pst 0.1% Tier 1

Throat Products - Misc. cevimeline cap 30mg Tier 1

pilocarpine tab 5mg Tier 1

pilocarpine tab 7.5mg Tier 1

MULTIVITAMINS B-Complex w/ Folic Acid mynephrocaps cap Tier 1

renal cap softgel Tier 1

renalpren cap Tier 1

renaphro cap Tier 1

reno cap Tier 1

triphrocaps cap Tier 1

Ped MV w/ Fluoride acd/fluoride dro 0.25mg Tier 1

mult-vit/fl chw 0.5mg Tier 1

multi-vit/fl chw 0.5mg Tier 1

multi-vit/fl chw 0.25mg Tier 1

multi-vit/fl chw 1mg Tier 1

multi-vit/fl dro 0.5mg/ml Tier 1

multi-vit/fl dro 0.25mg Tier 1

multivit/fl chw 0.5mg Tier 1

multivit/fl chw 0.25mg Tier 1

multivit/fl chw 1mg Tier 1

mvc-fluoride chw 0.5mg Tier 1

mvc-fluoride chw 0.25mg Tier 1

mvc-fluoride chw 1mg Tier 1

poly-vi-flor chw 0.5mg Tier 1

poly-vi-flor chw 0.25mg Tier 1

poly-vi-flor chw 1mg Tier 1

poly-vit/fl dro 0.25mg Tier 1

polyvit/fl dro 0.5mg/ml Tier 1

tri-vit/fl dro 0.5mg Tier 1

tri-vit/fl dro 0.25mg Tier 1

tri-vit/fluo dro 0.5mg Tier 1

tri-vit/fluo dro 0.25mg Tier 1

tri-vita/fl dro 0.25mg Tier 1

Ped Multi Vitamins w/Fl FE


86


multi-vit/fe dro /fl 0.25 Tier 1

multi-vit/fl dro /fe 0.25 Tier 1

POLY-VI-FLOR CHW W/IRON Tier 2

poly-vit/fe dro /fl 0.5 Tier 1

poly-vit/fe dro /fl 0.25 Tier 1

tri-vit/fe dro /fl 0.25 Tier 1

Prenatal Vitamins CL PRENATAL TAB 28-0.8MG Tier 2

CONCEPT DHA CAP Tier 2

CONCEPT OB CAP Tier 2

CVS PRENATAL TAB Tier 2

CVS PRENATAL TAB 28-0.8MG Tier 2

EQL PRENATAL TAB FORMULA Tier 2

EZFE FORTE CAP Tier 2

FOLIVANE-OB CAP Tier 2

GNP DAILY MIS PRENATAL Tier 2

GNP PRENATAL TAB 28-0.8MG Tier 2

HM PRENATAL TAB Tier 2

KP PRENATAL TAB MULTIVIT Tier 2

ONE-A-DAY PAK PRENATAL Tier 2

prenaplus tab Tier 1

prenatabs rx tab Tier 1

prenatal 19 chw tab Tier 1

prenatal 19 tab Tier 1

PRENATAL TAB Tier 2

PRENATAL TAB 28-0.8MG Tier 2

PRENATAL TAB COMPLETE Tier 2

PRENATAL TAB FORMULA Tier 2

prenatal tab plus Tier 1

prenatal tab plus fe Tier 1

PRENATAL+DHA MIS Tier 2

PRENATAL+DHA MIS WOMENS Tier 2

PRENATAL-U CAP Tier 2

PROFE FORTE CAP 155-1MG Tier 2

PX PRENATAL TAB MULTIVIT Tier 2

QC PRENATAL TAB 28-0.8MG Tier 2

RA ONE DAILY MIS Tier 2

RA PRENATAL TAB 28-0.8MG Tier 2

RA PRENATAL TAB FORMULA Tier 2

SM PRENATAL TAB VITAMINS Tier 2

STUART PREN TAB Tier 2

TARON-C DHA CAP Tier 2

TH PRENATAL TAB VITAMINS Tier 2


87


TRIVEEN-U CAP Tier 2

VINATE AZ EX TAB Tier 2

VINATE II TAB Tier 2

MUSCULOSKELETAL THERAPY AGENTS Central Muscle Relaxants baclofen tab 10mg Tier 1

baclofen tab 20mg Tier 1

carisoprodol tab 250mg Tier 1

carisoprodol tab 350mg Tier 1

chlorzoxazon tab 500mg Tier 1

cyclobenzapr tab 10mg Tier 1

ed baclofen tab 10mg Tier 1

LORZONE TAB 375MG Tier 3

LORZONE TAB 750MG Tier 3

metaxalone tab 800mg Tier 1

methocarbam tab 500mg Tier 1

methocarbam tab 750mg Tier 1

orphenadrine tab 100mg er Tier 1

tizanidine cap 2mg Tier 1



tizanidine tab 2mg Tier 1

tizanidine tab 4mg Tier 1

Direct Muscle Relaxants dantrolene cap 25mg Tier 1

dantrolene cap 50mg Tier 1

dantrolene cap 100mg Tier 1

Muscle Relaxant Combinations carisopr/asa tab 200-325 Tier 1

orph/asa/caf tab Tier 1

orphen cpd tab ds Tier 1

Viscosupplements EUFLEXXA INJ 10MG/ML Tier 4 PA

HYALGAN INJ 20MG/2ML Tier 4 PA

ORTHOVISC INJ 15MG/ML Tier 4 PA

SUPARTZ INJ 25/2.5ML Tier 4 PA

SYNVISC INJ 8MG/ML Tier 4 PA

SYNVISC ONE INJ 8MG/ML Tier 4 PA

NASAL AGENTS - SYSTEMIC AND TOPICAL Nasal Anti-infectives BACTROBAN OIN NASAL 2% Tier 2

Nasal Antiallergy


88


azelastine spr 0.1% Tier 1

PATANASE SPR 0.6% Tier 3 PA

Nasal Anticholinergics ipratropium spr 0.03% Tier 1

ipratropium spr 0.06% Tier 1

Nasal Steroids BECONASE AQ SUS 0.042% Tier 2 ST

budesonide sus 32mcg Tier 1 ST

flunisolide spr 0.025% Tier 1

flunisolide spr 29mcg Tier 1

fluticasone spr 50mcg Tier 1

NASONEX SPR 50MCG/AC Tier 2 ST

OMNARIS SPR Tier 2 ST

QNASL AER 80MCG Tier 3 ST

RHINOCORT SUS AQUA Tier 2 ST

triamcinolon spr 55mcg/ac Tier 1

VERAMYST SPR 27.5MCG Tier 2 ST

Sympathomimetic Decongestants congest aid tab 30mg Tier 1

congestion tab 30mg Tier 1

decongestant tab 30mg Tier 1

decongestant tab 60mg Tier 1

eq suphedrin tab 30mg Tier 1

genaphed tab 30mg Tier 1

medi-phedrin tab 30mg Tier 1

nasal decon syp 30mg/5ml Tier 1

nasal decong tab 30mg Tier 1

pseudoephedr syp 30mg/5ml Tier 1

pseudoephedr tab 30mg Tier 1

pseudoephedr tab 60mg Tier 1

psudatabs tab 30mg Tier 1

ra suphedrin tab 30mg Tier 1

sb pseudophe tab 30mg Tier 1

simply stuff tab 30mg Tier 1

sm nasal dec tab 30mg Tier 1

sudanyl tab 30mg Tier 1

sudogest tab 30mg Tier 1

sudogest tab 60mg Tier 1

sudophed tab 30mg Tier 1

suphedrine tab 30mg Tier 1

sw nasal dec tab 30mg Tier 1

TYZINE PED DRO 0.05% Tier 2

TYZINE SOL 0.1% Tier 2


89


wal-phed tab 30mg Tier 1

NEUROMUSCULAR AGENTS ALS Agents riluzole tab 50mg Tier 3 PA

Neuromuscular Blocking Agent - Neurotoxins BOTOX INJ 100UNIT Tier 4 PA

MYOBLOC INJ 2500/0.5 Tier 4 PA

MYOBLOC INJ 5000/ML Tier 4 PA

MYOBLOC INJ 10000/2 Tier 4 PA

OPHTHALMIC AGENTS Artificial Tears and Lubricants LACRISERT MIS 5MG OP Tier 3 PA

Beta-blockers - Ophthalmic betaxolol sol 0.5% op Tier 1

BETOPTIC-S SUS 0.25% OP Tier 2

carteolol sol 1% op Tier 1

COMBIGAN SOL 0.2/0.5% Tier 2

dorzol/timol sol 2-0.5%op Tier 1

levobunolol sol 0.5% op Tier 1

levobunolol sol 0.25% op Tier 1

metipranolol sol 0.3% Tier 1

metipranolol sol 0.3% oph Tier 1

timolol gel sol 0.5% op Tier 1

timolol gel sol 0.25% op Tier 1

timolol mal sol 0.5% op Tier 1

timolol mal sol 0.25% op Tier 1

TIMOPTIC OCU SOL 0.5% OP Tier 2

TIMOPTIC OCU SOL 0.25% OP Tier 2

Cycloplegic Mydriatics ak-pentolate sol 1% op Tier 1

atropin-care sol 1% op Tier 1

ATROPINE SUL OIN 1% OP Tier 2

atropine sul sol 1% op Tier 1

CYCLOGYL SOL 0.5% OP Tier 2

cyclopentol sol 1% op Tier 1

cyclopentol sol 2% op Tier 1

cylate sol 1% op Tier 1

homatropaire sol 5% op Tier 1

homatropine sol 5% op Tier 1

ISO HOMATROP SOL 2% OP Tier 2

mydral sol 0.5% op Tier 1

mydral sol 1% op Tier 1


90


tropicamide sol 0.5% op Tier 1

tropicamide sol 1% op Tier 1

Miotics PHOSPHOLINE SOL 0.125%OP Tier 2

pilocarpine sol 1% op Tier 1



Ophthalmic Adrenergic Agents ALPHAGAN P SOL 0.1% Tier 2

apraclonidin sol 0.5% op Tier 1

brimonidine sol 0.2% op Tier 1

brimonidine sol 0.15% Tier 1

IOPIDINE SOL 1% OP Tier 3

Ophthalmic Anti-infectives bacitracin oin op Tier 1

BESIVANCE SUS 0.6% Tier 3 PA

CILOXAN OIN 0.3% OP Tier 2

ciprofloxacn sol 0.3% op Tier 1

erythromycin oin 5mg/gm Tier 1

erythromycin oin op Tier 1

garamycin oin 0.3% op Tier 1

gatifloxacin sol 0.5% Tier 1 PA

gentak oin 0.3% op Tier 1

gentak sol 0.3% op Tier 1

gentamicin oin 0.3% op Tier 1

gentamicin sol 0.3% op Tier 1

gentasol sol 0.3% op Tier 1

ilotycin oin op Tier 1

MOXEZA SOL 0.5% Tier 2 PA

NATACYN SUS 5% OP Tier 2

neo-polycin oin op Tier 1

neo/bac/poly oin op Tier 1

neo/poly/gra sol op Tier 1

ofloxacin dro 0.3% op Tier 1

polymyxin b/ sol trimethp Tier 1

romycin oin op Tier 1

sod sulfacet sol 10% op Tier 1

sulfacet sod oin 10% op Tier 1

sulfacet sod sol 10% op Tier 1

tobramycin sol 0.3% op Tier 1

tobrasol sol 0.3% op Tier 1

TOBREX OIN 0.3% OP Tier 2

trifluridine sol 1% op Tier 1


91


trimethoprim sol polymyxn Tier 1

VIGAMOX DRO 0.5% Tier 2 PA

ZIRGAN GEL 0.15% Tier 2 PA

ZYMAXID SOL 0.5% Tier 2 PA

Ophthalmic Decongestants naphazoline sol 0.1% op Tier 1

Ophthalmic Immunomodulators RESTASIS EMU 0.05% Tier 3 PA

Ophthalmic Local Anesthetics parcaine sol 0.5% op Tier 1

proparacaine sol 0.5% op Tier 1

Ophthalmic Steroids ALREX SUS 0.2% Tier 2

BLEPHAMIDE OIN S.O.P. Tier 2

BLEPHAMIDE SUS OP Tier 2

dexameth pho sol 0.1% op Tier 1

DUREZOL EMU 0.05% Tier 3

FLAREX SUS 0.1% OP Tier 2

fluor-op sus 0.1% op Tier 1

fluoromethol sus 0.1% op Tier 1

FML FORTE SUS 0.25% OP Tier 2

FML OIN 0.1% OP Tier 2

LOTEMAX GEL 0.5% Tier 2

LOTEMAX OIN 0.5% Tier 2

LOTEMAX SUS 0.5% Tier 2

neo-polycin oin hc 1%op Tier 1

neo/poly/bac oin /hc 1%op Tier 1

neo/poly/dex oin 0.1% op Tier 1

neo/poly/dex sus 0.1% op Tier 1

neo/poly/hc sus op Tier 1

poly-dex oin 0.1% op Tier 1

PRED MILD SUS 0.12% OP Tier 2

PRED SOD PHO SOL 1% OP Tier 1

PRED-G S.O.P OIN OP Tier 2

PRED-G SUS OP Tier 2

prednisolone sus 1% op Tier 1

sulf/pred na sol op Tier 1

tobra/dexame sus 0.3-0.1% Tier 1

TOBRADEX OIN 0.3-0.1% Tier 2

VEXOL SUS 1% OP Tier 2

Ophthalmics - Misc. ACUVAIL SOL 0.45% Tier 2

ALAMAST DRO 0.1% Tier 3


92


alaway child dro 0.025%op Tier 1

alaway dro 0.025%op Tier 1

allergy eye dro 0.025%op Tier 1

ALOCRIL SOL 2% Tier 3 PA

ALOMIDE SOL 0.1% OP Tier 2

antihistamin dro 0.025%op Tier 1

AZOPT SUS 1% OP Tier 2

BEPREVE DRO 1.5% Tier 2 PA

bromfenac sol 0.09% Tier 1

claritin eye dro 0.025%op Tier 1

cromolyn sod sol 4% op Tier 1

cvs allergy dro 0.025%op Tier 1

diclofenac sol 0.1% op Tier 1

dorzolamide sol 2% op Tier 1

EMADINE SOL 0.05% OP Tier 3

epinastine dro 0.05% Tier 1

eq itchy eye dro 0.025%op Tier 1

eye itch rel dro 0.025%op Tier 1

flurbiprofen sol 0.03% op Tier 1

itchy eye dro 0.025%op Tier 1

ketorolac sol 0.4% Tier 1

ketorolac sol 0.5% Tier 1

ketotif fum dro 0.025%op Tier 1

LASTACAFT SOL 0.25% Tier 3

NEVANAC SUS 0.1% Tier 3

PATANOL SOL 0.1% OP Tier 2 ST

wal-zyr dro 0.025%op Tier 1

zyrtec itchy dro 0.025%op Tier 1

Prostaglandins - Ophthalmic latanoprost sol 0.005% Tier 1

LUMIGAN SOL 0.01% Tier 2

LUMIGAN SOL 0.03% Tier 2

TRAVATAN Z DRO 0.004% Tier 2

travoprost dro 0.004% Tier 2

ZIOPTAN DRO 0.0015% Tier 2

OTIC AGENTS Otic Agents - Miscellaneous ace acd/alum sol 2% otic Tier 1

acetic acid sol 2% otic Tier 1

Otic Anti-infectives ofloxacin dro 0.3%otic Tier 1

Otic Combinations antipy/benzo sol otic Tier 1


93


aurax sol 5.5-1.4% Tier 1

aurodex sol otic Tier 1

CIPRO HC SUS OTIC Tier 2

CIPRODEX SUS 0.3-0.1% Tier 2

COLY-MYCIN S SUS OTIC Tier 2

CORTISPORIN SUS -TC OTIC Tier 2

neo/poly/hc sol 1% otic Tier 1

neo/poly/hc sus 1% otic Tier 1

Otic Steroids acetasol hc sol otic Tier 1

fluocin acet oil 0.01% Tier 1

hc/acet acid sol otic Tier 1

OXYTOCICS Oxytocics methylergon tab 0.2mg Tier 1

PASSIVE IMMUNIZING AGENTS Immune Serums BIVIGAM INJ 10% 10gm/100ml Tier 4 PA

CARIMUNE NF INJ 3GM Tier 4 PA



FLEBOGAMMA INJ 5% Tier 4 PA

FLEBOGAMMA INJ 10% Tier 4 PA

FLEBOGAMMA INJ DIF 5% .5gm/10ml, 5% Tier 4 PA

GAMASTAN S/D INJ Tier 4 PA

GAMMAGARD SD INJ 2.5GM HU Tier 4 PA

GAMMAGARD SD INJ 5GM HU Tier 4 PA

GAMMAGARD SD INJ 10GM HU Tier 4 PA

GAMMAPLEX INJ 5GM Tier 4 PA

GAMUNEX INJ 10% Tier 4 PA

HIZENTRA INJ 2GM/10ML Tier 4 PA

HYPERRHO S/D INJ 300MCG Tier 4 PA

OCTAGAM INJ 1GM Tier 4 PA



PRIVIGEN INJ 10GRAMS Tier 4 PA

PRIVIGEN INJ 20GRAMS Tier 4 PA

RHOGAM PLUS INJ 300MCG Tier 4 PA

VIVAGLOBIN SOL 160MG/ML Tier 4 PA

WINRHO SDF INJ 1500UNIT Tier 4 PA



WINRHO SDF INJ 15000UNT Tier 4 PA


94


Monoclonal Antibodies SYNAGIS INJ 50MG Tier 4 PA

SYNAGIS INJ 100MG/ML Tier 4 PA

PENICILLINS Aminopenicillins amoxicillin cap 250mg Tier 1

amoxicillin cap 500mg Tier 1

amoxicillin chw 125mg Tier 1

amoxicillin chw 250mg Tier 1

amoxicillin sus 125/5ml Tier 1




amoxicillin tab 500mg Tier 1

amoxicillin tab 875mg Tier 1

ampicillin cap 250mg Tier 1

ampicillin cap 500mg Tier 1

ampicillin sus 125/5ml Tier 1

ampicillin sus 250/5ml Tier 1

MOXATAG TAB 775MG Tier 3 PA

Natural Penicillins penicilln vk sol 125/5ml Tier 1

penicilln vk sol 250/5ml Tier 1

penicilln vk tab 250mg Tier 1

penicilln vk tab 500mg Tier 1

Penicillin Combinations amox-pot cla tab er Tier 1

amox/k clav chw 200mg Tier 1

amox/k clav chw 400mg Tier 1

amox/k clav sus 200/5ml Tier 1




amox/k clav tab 250mg Tier 1



AUGMENTIN SUS 125/5ML Tier 2

Penicillinase-Resistant Penicillins dicloxacill cap 250mg Tier 1

dicloxacill cap 500mg Tier 1

PROGESTINS Progestins


95


medroxypr ac tab 2.5mg Tier 1

medroxypr ac tab 5mg Tier 1

medroxypr ac tab 10mg Tier 1

norethin ace tab 5mg Tier 1

progesterone cap 100mg Tier 1

progesterone cap 200mg Tier 1

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. Agents for Chemical Dependency acampro cal tab 333mg Tier 1 PA

CAMPRAL TAB 333MG Tier 3 PA

disulfiram tab 250mg Tier 1

disulfiram tab 500mg Tier 1

Anti-Cataplectic Agents XYREM SOL 500MG/ML Tier 4 PA

Antidementia Agents donepezil tab 5mg Tier 1

donepezil tab 5mg odt Tier 1

donepezil tab 10mg Tier 1

donepezil tab 10mg odt Tier 1

galantamine cap 8mg er Tier 1



galantamine tab 4mg Tier 1



NAMENDA SOL 10MG/5ML Tier 2 PA

NAMENDA TAB 5MG Tier 2 PA

NAMENDA TAB 10MG Tier 2 PA

rivastigmine cap 3mg Tier 1

Combination Psychotherapeutics perphen/amit tab 2-10mg Tier 1

perphen/amit tab 2-25mg Tier 1




Fibromyalgia Agents SAVELLA MIS TITR PAK Tier 3 PA

SAVELLA TAB 12.5MG Tier 3 PA

SAVELLA TAB 25MG Tier 3 PA



Movement Disorder Drug Therapy


96


XENAZINE TAB 12.5MG Tier 4 PA

XENAZINE TAB 25MG Tier 4 PA

Multiple Sclerosis Agents AVONEX KIT 30MCG Tier 4 PA

AVONEX PEN KIT 30MCG Tier 4 PA

AVONEX PREFL KIT 30MCG Tier 4 PA

COPAXONE KIT 20MG/ML Tier 4 PA

EXTAVIA INJ 0.3MG Tier 4 PA

GILENYA CAP 0.5MG Tier 4 PA

REBIF INJ 22/0.5 Tier 4 PA

REBIF INJ 44/0.5 Tier 4 PA

REBIF REBIDO INJ 22/0.5 Tier 4 PA

REBIF REBIDO INJ 44/0.5 Tier 4 PA

REBIF REBIDO SOL TITRATN Tier 4 PA

REBIF TITRTN SOL PACK Tier 4 PA

TYSABRI INJ Tier 4 PA

Premenstrual Dysphoric Disorder (PMDD) Agents fluoxetine cap 10mg 10mg Tier 1


Pseudobulbar Affect (PBA) Agents NUEDEXTA CAP 20-10MG Tier 3 PA

Psychotherapeutic and Neurological Agents - Misc. ergoloid mes tab 1mg oral Tier 1

ORAP TAB 1MG Tier 2 PA

ORAP TAB 2MG Tier 2 PA

Restless Leg Syndrome (RLS) Agents HORIZANT TAB 600MG Tier 3 PA

Smoking Deterrents buproban tab 150mg Tier 0 QL

bupropion tab 150mg Tier 0 QL

CHANTIX PAK 0.5& 1MG Tier 0 QL

CHANTIX PAK 1MG Tier 0 QL

CHANTIX TAB 0.5MG Tier 0 QL

CHANTIX TAB 1MG Tier 0 QL

cvs nicotine dis 7mg/24hr Tier 0 QL

cvs nicotine dis 14mg/24h Tier 0 QL

cvs nicotine dis 21mg/24h Tier 0 QL

cvs nicotine gum 2mg cinn Tier 0 QL

cvs nicotine gum 2mg mint Tier 0 QL

cvs nicotine gum 2mg orig Tier 0 QL

cvs nicotine gum 2mgfruit Tier 0 QL

cvs nicotine gum 4mg cinn Tier 0 QL


97


cvs nicotine gum 4mg mint Tier 0 QL

cvs nicotine gum 4mg orig Tier 0 QL

cvs nicotine gum 4mgfruit Tier 0 QL

cvs nicotine loz 2mg mint Tier 0 QL

cvs nicotine loz 4mg mint Tier 0 QL

cvs nts dis step 1 Tier 0 QL

eq nicotine dis 7mg/24hr Tier 0 QL

eq nicotine dis 14mg/24h Tier 0 QL

eq nicotine dis 21mg/24h Tier 0 QL

eq nicotine gum 2mg cinn Tier 0 QL

eq nicotine gum 2mg mint Tier 0 QL

eq nicotine gum 2mg orig Tier 0 QL

eq nicotine gum 2mgfruit Tier 0 QL

eq nicotine gum 4mg cinn Tier 0 QL

eq nicotine gum 4mg mint Tier 0 QL

eq nicotine gum 4mg orig Tier 0 QL

eq nicotine gum 4mg ref Tier 0 QL

eq nicotine gum 4mg strt Tier 0 QL

eq nicotine gum 4mgfruit Tier 0 QL

eq nicotine loz 2mg cher Tier 0 QL

eq nicotine loz 2mg mint Tier 0 QL

eq nicotine loz 4mg chry Tier 0 QL

eq nicotine loz 4mg mint Tier 0 QL

eql nicotine dis 7mg/24hr Tier 0 QL

eql nicotine dis 14mg/24h Tier 0 QL

eql nicotine dis 21mg/24h Tier 0 QL

eql nicotine gum 2mg Tier 0 QL

eql nicotine gum 2mg ref Tier 0 QL

eql nicotine gum 2mg strt Tier 0 QL

eql nicotine gum 4mg Tier 0 QL

eql nicotine gum 4mg ref Tier 0 QL

eql nicotine gum 4mg strt Tier 0 QL

eql nicotine loz 2mg mint Tier 0 QL

eql nicotine loz 4mg mint Tier 0 QL

gnp nicotine gum 2mg mint Tier 0 QL

gnp nicotine gum 2mg orig Tier 0 QL

gnp nicotine gum 4mg mint Tier 0 QL

gnp nicotine gum 4mg orig Tier 0 QL

gnp nicotine loz 2mg mint Tier 0 QL

gnp nicotine loz 4mg mint Tier 0 QL

hm nicotine dis 14mg/24h Tier 0 QL

hm nicotine dis 21mg/24h Tier 0 QL

hm nicotine gum 2mg mint Tier 0 QL


98


hm nicotine gum 4mg mint Tier 0 QL

hm nicotine loz 2mg mint Tier 0 QL

hm nicotine loz 4mg mint Tier 0 QL

kls quit2 gum 2mg Tier 0 QL

kls quit4 gum 4mg Tier 0 QL

nicorelief gum 2mg mint Tier 0 QL

nicorelief gum 2mg orig Tier 0 QL

nicorelief gum 4mg mint Tier 0 QL

nicorelief gum 4mg orig Tier 0 QL

nicorelief loz 2mg mint Tier 0 QL

nicorelief loz 4mg mint Tier 0 QL

nicotine dis 7mg/24hr Tier 0 QL

nicotine dis 14mg/24h Tier 0 QL

nicotine dis 21mg/24h Tier 0 QL

nicotine dis step 1 Tier 0 QL



nicotine gum 2mg Tier 0 QL

nicotine gum 2mgfruit Tier 0 QL

nicotine gum 4mg Tier 0 QL

nicotine loz 2mg chry Tier 0 QL

nicotine loz 2mg mint Tier 0 QL

nicotine loz 4mg chry Tier 0 QL

nicotine loz 4mg cinn Tier 0 QL

nicotine loz 4mg mint Tier 0 QL

nicotine pol gum 2mg Tier 0 QL

nicotine pol gum 2mg cinn Tier 0 QL

nicotine pol gum 2mg mint Tier 0 QL

nicotine pol gum 2mg orig Tier 0 QL

nicotine pol gum 2mg ref Tier 0 QL

nicotine pol gum 2mg strt Tier 0 QL

nicotine pol gum 2mgfruit Tier 0 QL

nicotine pol gum 4mg Tier 0 QL

nicotine pol gum 4mg mint Tier 0 QL

nicotine pol gum 4mg orig Tier 0 QL

nicotine pol gum 4mg ref Tier 0 QL

nicotine pol gum 4mg strt Tier 0 QL

nicotine pol gum 4mgfruit Tier 0 QL

nicotine pol loz 2mg cinn Tier 0 QL

nicotine pol loz 2mg mint Tier 0 QL

nicotine pol loz 4mg chry Tier 0 QL

nicotine pol loz 4mg mint Tier 0 QL

nicotine td dis 7mg/24hr Tier 0 QL


99


nicotine td dis 14mg/24h Tier 0 QL

nicotine td dis 21mg/24h Tier 0 QL

NICOTROL INH Tier 0 PA; QL

NICOTROL NS SPR 10MG/ML Tier 0 PA; QL

ra nicotine dis 7mg/24hr Tier 0 QL

ra nicotine dis 14mg/24h Tier 0 QL

ra nicotine dis 21mg/24h Tier 0 QL

ra nicotine gum 2mg Tier 0 QL

ra nicotine gum 2mg cinn Tier 0 QL

ra nicotine gum 2mg mint Tier 0 QL

ra nicotine gum 2mgfruit Tier 0 QL

ra nicotine gum 4mg Tier 0 QL

ra nicotine gum 4mg frut Tier 0 QL

ra nicotine gum 4mg mint Tier 0 QL

ra nicotine loz 2mg mint Tier 0 QL

ra nicotine loz 4mg mint Tier 0 QL

sm nicotine dis 7mg/24hr Tier 0 QL

sm nicotine dis 14mg/24h Tier 0 QL

sm nicotine dis 21mg Tier 0 QL

sm nicotine gum 2mg Tier 0 QL

sm nicotine gum 2mg mint Tier 0 QL

sm nicotine gum 4mg Tier 0 QL

sm nicotine gum 4mg mint Tier 0 QL

sm nicotine loz 2mg mint Tier 0 QL

sm nicotine loz 4mg mint Tier 0 QL

stop smoking gum 2mg mint Tier 0 QL

stop smoking gum 2mg orig Tier 0 QL

stop smoking gum 4mg Tier 0 QL

stop smoking loz 2mg mint Tier 0 QL

stop smoking loz 4mg mint Tier 0 QL

sw nicotine gum 2mg mint Tier 0 QL

sw nicotine gum 4mg Tier 0 QL

sw nicotine loz 2mg mint Tier 0 QL

sw nicotine loz 4mg mint Tier 0 QL

tgt nicotine dis 7mg/24hr Tier 0 QL

tgt nicotine dis 14mg/24h Tier 0 QL

tgt nicotine dis 21mg/24h Tier 0 QL

tgt nicotine gum 2mg mint Tier 0 QL

tgt nicotine gum 2mg orig Tier 0 QL

tgt nicotine gum 2mgfruit Tier 0 QL

tgt nicotine gum 4mg Tier 0 QL

tgt nicotine gum 4mg mint Tier 0 QL

tgt nicotine gum 4mg orig Tier 0 QL


100


tgt nicotine loz 2mg chry Tier 0 QL

tgt nicotine loz 2mg mint Tier 0 QL

tgt nicotine loz 4mg chry Tier 0 QL

tgt nicotine loz 4mg mint Tier 0 QL

thrive gum 2mg mint Tier 0 QL

thrive gum 4mg mint Tier 0 QL

RESPIRATORY AGENTS - MISC. Alpha-Proteinase Inhibitor (Human) ARALAST NP INJ 400MG Tier 4 PA

ARALAST NP INJ 1000MG Tier 4 PA

GLASSIA INJ Tier 4 PA

PROLASTIN INJ 1000MG Tier 4 PA

PROLASTIN-C INJ 1000MG Tier 4 PA

ZEMAIRA INJ 1000MG Tier 4 PA

Cystic Fibrosis Agents KALYDECO TAB 150MG Tier 4 PA

PULMOZYME SOL 1MG/ML Tier 4 PA

SULFONAMIDES Sulfonamides SULFADIAZINE TAB 500MG Tier 2

TETRACYCLINES Tetracyclines demeclocycl tab 150mg Tier 1

demeclocycl tab 300mg Tier 1

doxycycl hyc cap 50mg Tier 1

doxycycl hyc cap 100mg Tier 1

doxycycl hyc tab 75mg dr Tier 1

doxycycl hyc tab 100mg Tier 1



doxycycline sus 25mg/5ml Tier 1

doxycycline tab 20mg Tier 1 PA

minocycline cap 50mg Tier 1

minocycline cap 100mg Tier 1

morgidox cap 1x100mg Tier 1

morgidox cap 2x100mg Tier 1

tetracycline cap 250mg Tier 1

tetracycline cap 500mg Tier 1

VIBRAMYCIN SYP 50MG/5ML Tier 2 PA

THYROID AGENTS Antithyroid Agents methimazole tab 5mg Tier 1


101


methimazole tab 10mg Tier 1

propylthiour tab 50mg Tier 1

Thyroid Hormones ARMOUR THYRO TAB 15MG Tier 1

ARMOUR THYRO TAB 120MG Tier 1




levothroid tab 25mcg Tier 1












levothyroxin tab 25mcg Tier 1












levoxyl tab 25mcg Tier 1












102


liothyronine tab 5mcg Tier 1



np thyroid tab 30mg Tier 1



THYROLAR-1 TAB 60MG Tier 2

THYROLAR-1/2 TAB 30MG Tier 2

THYROLAR-1/4 TAB 15MG Tier 2



unith direct tab 25mcg Tier 1











unithroid tab 25mcg Tier 1












ULCER DRUGS Antispasmodics bella alk/pb tab 16.2mg Tier 1

CANTIL TAB 25MG Tier 2

chlord/clidi cap 5-2.5mg Tier 1

colidrops dro 0.125/ml Tier 1

dicyclomine cap 10mg Tier 1

dicyclomine sol 10mg/5ml Tier 1

dicyclomine tab 20mg Tier 1


103


glycopyrrol inj 0.2mg/ml .2mg/ml Tier 1

glycopyrrol tab 1mg Tier 1

glycopyrrol tab 2mg Tier 1

hyomax tab 0.125mg Tier 1

hyomax-sl sub 0.125mg Tier 1

hyoscyamine dro 0.125/ml Tier 1

hyoscyamine elx 0.125/5 Tier 1

hyoscyamine sub 0.125mg Tier 1

hyoscyamine tab 0.125mg TABS Tier 1

hyosyne dro 0.125/ml Tier 1

hyosyne elx 0.125/5 Tier 1

methscopolam tab 2.5mg Tier 1

oscimin sub 0.125mg Tier 1

oscimin tab 0.125mg TABS Tier 1

propanthelin tab 15mg Tier 1

quadrapax elx Tier 1

se-donna elx pb hyos Tier 1

symax-sl sub 0.125mg Tier 1

H-2 Antagonists acid control tab 20mg Tier 1

acid control tab 150mg Tier 1

acid reducer tab 20mg Tier 1



acid relief tab 200mg Tier 1

cimetidine sol 300/5ml Tier 1

cimetidine tab 200mg Tier 1




eq heartburn tab relief Tier 1

famotidine sus 40mg/5ml Tier 1 PA

famotidine tab 20mg Tier 1

heartbrn rel tab 200mg Tier 1

heartburn tab 20mg Tier 1



heartburn tab relief 200mg Tier 1

nizatidine cap 150mg Tier 1

nizatidine cap 300mg Tier 1

qc heartburn tab 200mg Tier 1

ranitidine syp 15mg/ml Tier 1

ranitidine syp 75mg/5ml Tier 1


104


ranitidine syp 150/10ml Tier 1

ranitidine tab 150mg Tier 1

ranitidine tab 300mg Tier 1

sm acid redu tab 200mg Tier 1

wal-zan tab 150mg Tier 1

Misc. Anti-Ulcer sucralfate tab 1gm Tier 1

Proton Pump Inhibitors ACIPHEX TAB 20MG Tier 3 PA

DEXILANT CAP 30MG DR Tier 3 PA

DEXILANT CAP 60MG DR Tier 3 PA

hrtbrn rel cap 15mg dr Tier 1

lansoprazole cap 15mg dr Tier 1

lansoprazole cap 30mg dr Tier 1

NEXIUM CAP 20MG Tier 3 PA

NEXIUM CAP 40MG Tier 3 PA

omeprazole cap 10mg Tier 1

omeprazole cap 20mg Tier 1

omeprazole cap 40mg Tier 1 PA

pantoprazole tab 20mg Tier 1

pantoprazole tab 40mg Tier 1

rabeprazole tab 20mg Tier 1 PA

Ulcer Drugs - Prostaglandins misoprostol tab 100mcg Tier 1

misoprostol tab 200mcg Tier 1

URINARY ANTI-INFECTIVES Urinary Anti-infectives MACRODANTIN CAP 25MG Tier 2

methenam hip tab 1gm Tier 1

MONUROL PAK GRANULES Tier 3 PA

nitrofur mac cap 50mg Tier 1

nitrofur mac cap 100mg Tier 1

nitrofurantn cap 100mg Tier 1

nitrofurantn sus 25mg/5ml Tier 1

URINARY ANTISPASMODICS Urinary Antispasmodics bethanechol tab 5mg Tier 1

bethanechol tab 10mg Tier 1



ENABLEX TAB 7.5MG Tier 2 ST

ENABLEX TAB 15MG Tier 2 ST


105


flavoxate tab 100mg Tier 1

GELNIQUE GEL 10% Tier 2 PA

oxybutynin syp 5mg/5ml Tier 1

oxybutynin tab 5mg Tier 1

tolterodine tab 1mg Tier 1 ST

tolterodine tab 2mg Tier 1 ST

TOVIAZ TAB 4MG Tier 2 ST

TOVIAZ TAB 8MG Tier 2 ST

trospium chl cap 60mg er Tier 1 ST

VESICARE TAB 5MG Tier 3 PA

VESICARE TAB 10MG Tier 3 PA

VACCINES Viral Vaccines AFLURIA INJ 2011-12 Tier 0

AFLURIA INJ 2012-13 Tier 0

AFLURIA INJ PF 10-11 Tier 0



AGRIFLU INJ PF 10-11 Tier 0

EZ USE FLU KIT 2012-13 Tier 0

FLUARIX INJ PF 10-11 Tier 0



FLUARIX PF INJ 2013-14 Tier 0

FLUARIX QUAD INJ 2013-14 Tier 0

FLULAVAL INJ 2010-11 Tier 0




FLUVIRIN INJ 2011-12 Tier 0

FLUVIRIN INJ 2012-13 Tier 0

FLUVIRIN INJ PF 11-12 Tier 0

FLUVIRIN INJ PF 12-13 Tier 0

FLUZONE INJ INTRADRM Tier 0

FLUZONE INJ PF 11-12 Tier 0



FLUZONE PED/ INJ PF 11-12 Tier 0



FLUZONE QUAD INJ 13-14 Tier 0

FLUZONE SPLT INJ 2011-12 Tier 0



106



INFLUENZA A INJ PF09H1N1 Tier 0

VAGINAL PRODUCTS Miscellaneous Vaginal Products ACID JELLY GEL VAG/APPL Tier 2

Spermicides encare gel 4% Tier 0

Vaginal Anti-infectives clindamycin cre 2% vag Tier 1

GYNAZOLE-1 CRE 2% Tier 2

metronidazol gel 0.75%vag Tier 1

NYSTATIN VAG TAB 100000 Tier 1

terconazole cre 0.4% Tier 1

terconazole cre 0.8% Tier 1

terconazole sup 80mg Tier 1

vandazole gel 0.75% Tier 1

zazole cre 0.4% Tier 1

zazole cre 0.8% Tier 1

zazole sup 80mg Tier 1

Vaginal Estrogens PREMARIN VAG CRE 0.625MG Tier 2

VAGIFEM TAB 10MCG Tier 2

VASOPRESSORS Anaphylaxis Therapy Agents ADRENACLICK INJ 0.3MG Tier 2

AUVI-Q INJ 0.3MG Tier 2

epinephrine inj 0.3mg Tier 1

EPIPEN 2-PAK INJ 0.3MG Tier 2

EPIPEN INJ 0.3MG Tier 2

EPIPEN-JR INJ 0.15MG Tier 2

EPIPEN-JR INJ 2-PAK Tier 2

TWINJECT INJ 0.3MG Tier 2

VITAMINS Oil Soluble Vitamins A-25 CAP 25000UNT Tier 1

bio-d-mulsio liq 400unit Tier 0

child vit d chw 400unit Tier 0

d3 kids chw 400unit Tier 0

d-3 gummy chw 400unit Tier 0

d-400 tab 400unit Tier 0

d-vita liq 400unit Tier 0

delta d3 tab 400unit Tier 0


107


ergocalcifer cap 50000unt Tier 1

gnp vit d tab 400unit Tier 0

just d liq 400unit Tier 0

MEPHYTON TAB 5MG Tier 2

sm vitamin d tab 400unit Tier 0

vit d gummie chw 400unit Tier 0

VITAMIN A CAP 25000UNT Tier 1

vitamin d3 chw 400unit Tier 0

vitamin d3 dro 400unit Tier 0

vitamin d3 tab 400unit Tier 0

vitamin d cap 50000unt Tier 1

vitamin d chw 400unit Tier 0

vitamin d dro 400unit Tier 0

vitamin d tab 400unit Tier 0

108

Index 8 8-MOP CAP 10MG ............................. 62

A A-25 CAP 25000UNT ....................... 106

abacav/lamiv tab /zidovud ................. 43 abacavir tab 300mg .......................... 43

ABILIFY DISC TAB 10MG .................... 43

ABILIFY DISC TAB 15MG .................... 43 ABILIFY SOL 1MG/ML ........................ 43

ABILIFY TAB 10MG ............................ 43 ABILIFY TAB 15MG ............................ 43

ABILIFY TAB 20MG ............................ 43 ABILIFY TAB 2MG ............................. 43

ABILIFY TAB 30MG ............................ 43 ABILIFY TAB 5MG ............................. 43

acampro cal tab 333mg ..................... 95 acarbose tab 100mg.......................... 24

acarbose tab 25mg ........................... 24 acarbose tab 50mg ........................... 24

acd/fluoride dro 0.25mg .................... 85 ace acd/alum sol 2% otic ................... 92

acebutolol cap 200mg ....................... 48

acebutolol cap 400mg ....................... 48 acetasol hc sol otic ............................ 93

acetazolamid cap 500mg er ................ 68 acetazolamid tab 125mg .................... 68

acetazolamid tab 250mg .................... 68 acetic acid sol 2% otic ....................... 92

acetylcyst sol 10% ............................ 59 acetylcyst sol 20% ............................ 59

acid control tab 150mg .................... 103 acid control tab 20mg ...................... 103

ACID JELLY GEL VAG/APPL ............... 106 acid reducer tab 150mg ................... 103

acid reducer tab 200mg ................... 103 acid reducer tab 20mg ..................... 103

acid relief tab 200mg ...................... 103

ACIPHEX TAB 20MG ........................ 104 acitretin cap 10mg ............................ 62

acitretin cap 17.5mg ......................... 62 acitretin cap 25mg ............................ 62

acticin cre 5% .................................. 67 ACTIMMUNE INJ 2MU/0.5................... 39

ACTONEL TAB 150MG ........................ 69 ACTONEL TAB 30MG .......................... 69

ACTONEL TAB 35MG .......................... 69 ACTONEL TAB 5MG ........................... 69

ACUVAIL SOL 0.45% ........................ 91 acyclovir cap 200mg ......................... 46

acyclovir sus 200/5ml ....................... 46 acyclovir tab 400mg ......................... 46

acyclovir tab 800mg ......................... 46 adapalene cre 0.1% ......................... 59

adapalene gel 0.1% .......................... 59

adefov dipiv tab 10mg ...................... 45 ADRENACLICK INJ 0.3MG ................ 106

ADVAIR DISKU AER 100/50 ............... 15 ADVAIR DISKU AER 250/50 ............... 15

ADVAIR DISKU AER 500/50 ............... 15 ADVAIR HFA AER 115/21 .................. 15

ADVAIR HFA AER 230/21 .................. 15 ADVAIR HFA AER 45/21 .................... 15

ADVATE INJ 1000UNIT ...................... 75 ADVATE INJ 1500UNIT ...................... 75

ADVATE INJ 2000UNIT ...................... 75 ADVATE INJ 250UNIT ....................... 75

ADVATE INJ 3000UNIT ...................... 76 ADVATE INJ 500UNIT ....................... 75

ADVICOR TAB 1000-20 ..................... 31

ADVICOR TAB 1000-40 ..................... 31 ADVICOR TAB 500-20MG .................. 31

ADVICOR TAB 750-20MG .................. 31 af-diphedryl elx 12.5/5ml .................. 28

afeditab tab 30mg cr ........................ 49 afeditab tab 60mg cr ........................ 49

AFINITOR TAB 10MG ........................ 38 AFINITOR TAB 2.5MG ....................... 38

AFINITOR TAB 5MG .......................... 38 AFINITOR TAB 7.5MG ....................... 38

AFLURIA INJ 2011-12 ..................... 105 AFLURIA INJ 2012-13 ..................... 105

AFLURIA INJ PF 10-11 .................... 105 AFLURIA INJ PF 11-12 .................... 105

AFLURIA INJ PF 12-13 .................... 105

AGGRENOX CAP 25-200MG ............... 77 AGRIFLU INJ PF 10-11 .................... 105

ak-pentolate sol 1% op ..................... 89 al12 lot 12% .................................... 66

ala cort cre 1% ................................ 63 ala-cort lot 1% ................................ 63

alagesic cap ....................................... 4 ALAMAST DRO 0.1% ......................... 91

alaway child dro 0.025%op ............... 91 alaway dro 0.025%op ....................... 91

109

ALBENZA TAB 200MG ........................ 11

albuterol neb 0.083% ........................ 16 albuterol neb 0.5% ........................... 15

albuterol neb 0.63mg/3 ..................... 16 albuterol neb 1.25mg/3 ..................... 16

albuterol syp 2mg/5ml ...................... 16 albuterol tab 2mg ............................. 16

albuterol tab 4mg ............................. 16 albuterol tab 4mg er ......................... 16

albuterol tab 8mg er ......................... 16 alclometason cre 0.05% .................... 63

alclometason oin 0.05% .................... 63 ALDURAZYME INJ 2.9MG/5M .............. 70

alendronate sol 70/75ml .................... 69 alendronate tab 10mg ....................... 70

alendronate tab 35mg ....................... 70

alendronate tab 40mg ....................... 70 alendronate tab 5mg ......................... 69

alendronate tab 70mg ....................... 70 aler-cap cap 25mg ............................ 28

ALFERON N INJ 5MU/ML .................... 39 alfuzosin tab 10mg ........................... 75

ALINIA SUS 100MG/5M ..................... 11 ALINIA TAB 500MG ........................... 11

ALKERAN TAB 2MG ........................... 36 all day allg sol 1mg/ml ...................... 29

all day allg sol 5mg/5ml ..................... 29 all day allg syp 1mg/ml ..................... 29

all day allg syp 5mg/5ml .................... 29 aller-ease tab 180mg ........................ 29

aller-fex tab 180mg .......................... 29

allergy cap 25mg .............................. 28 allergy chld sol 1mg/ml ..................... 30

allergy comp sol 1mg/ml ................... 30 allergy eye dro 0.025%op .................. 92

allergy med cap 25mg ....................... 28 allergy rel elx 12.5/5ml ..................... 28

allergy rel sol 1mg/ml ....................... 30 allergy relf cap 25mg ........................ 28

allergy relf sol 5mg/5ml ..................... 30 allergy relf tab 180mg ....................... 30

allergy-d tab 12 hour ........................ 57 allergy-d tab 60-120mg ..................... 57

aller-tec sol 1mg/ml .......................... 29 allopurinol tab 100mg ....................... 75

allopurinol tab 300mg ....................... 75

ALOCRIL SOL 2% .............................. 92 ALOMIDE SOL 0.1% OP ..................... 92

ALORA DIS 0.025MG ........................ 72

ALORA DIS 0.05MG .......................... 72 ALORA DIS 0.075MG ........................ 72

ALORA DIS 0.1MG ............................ 72 ALPHAGAN P SOL 0.1%..................... 90

ALPHANATE INJ VWF/HUM................. 76 ALPHANINE SD INJ 1000UNIT ............ 76

ALPHANINE SD INJ 500UNIT .............. 76 alphatrex gel 0.05% ......................... 63

alprazolam tab 0.25mg ..................... 13 alprazolam tab 0.5mg ....................... 13

alprazolam tab 1mg .......................... 13 alprazolam tab 2mg .......................... 13

ALREX SUS 0.2% ............................. 91 alrgy relf d tab 180-240 .................... 57

ALTABAX OIN 1% ............................. 60

altaryl elx 12.5/5ml .......................... 29 altaryl syp 12.5/5ml ......................... 29

altavera tab ..................................... 53 ALTOPREV TAB 20MG ER ................... 31

ALTOPREV TAB 40MG ER ................... 31 ALTOPREV TAB 60MG ER ................... 31

ALVESCO AER 160MCG ..................... 15 ALVESCO AER 80MCG ....................... 15

alyacen tab 1/35 .............................. 53 alyacen tab 7/7/7 ............................. 53

amantadine cap 100mg..................... 40 amantadine syp 50mg/5ml ................ 40

amantadine tab 100mg ..................... 40 amcinonide cre 0.1% ........................ 63

amcinonide lot 0.1% ......................... 63

amethyst tab 90-20mcg .................... 53 AMEVIVE INJ 15MG .......................... 62

amiloride tab 5mg ............................ 69 aminophyllin tab 100mg .................... 16

aminophyllin tab 200mg .................... 16 amiodarone tab 200mg ..................... 14

amiodarone tab 400mg ..................... 14 AMITIZA CAP 24MCG ........................ 74

AMITIZA CAP 8MCG .......................... 74 amitriptylin tab 100mg ..................... 23

amitriptylin tab 10mg ....................... 23 amitriptylin tab 150mg ..................... 23

amitriptylin tab 25mg ....................... 23 amitriptylin tab 50mg ....................... 23

amitriptylin tab 75mg ....................... 23

amlactin cre 12% ............................. 66 amlactin lot 12% .............................. 66

110

amlod/benazp cap 10-20mg ............... 34

amlod/benazp cap 10-40mg ............... 34 amlod/benazp cap 2.5-10mg .............. 34

amlod/benazp cap 5-10mg ................. 34 amlod/benazp cap 5-20mg ................. 34

amlod/benazp cap 5-40mg ................. 34 amlodipine tab 10mg ......................... 49

amlodipine tab 2.5mg ........................ 49 amlodipine tab 5mg .......................... 49

ammonium lac cre 12% ..................... 66 ammonium lac lot 12% ...................... 66

amnesteem cap 10mg ....................... 59 amnesteem cap 20mg ....................... 59

amnesteem cap 40mg ....................... 59 amox/k clav chw 200mg .................... 94

amox/k clav chw 400mg .................... 94

amox/k clav sus 200/5ml ................... 94 amox/k clav sus 250/5ml ................... 94

amox/k clav sus 400/5ml ................... 94 amox/k clav sus 600/5ml ................... 94

amox/k clav tab 250mg ..................... 94 amox/k clav tab 500mg ..................... 94

amox/k clav tab 875mg ..................... 94 amoxapine tab 100mg ....................... 23

amoxapine tab 150mg ....................... 23 amoxapine tab 25mg ........................ 23

amoxapine tab 50mg ........................ 23 amoxicillin cap 250mg ....................... 94

amoxicillin cap 500mg ....................... 94 amoxicillin chw 125mg ...................... 94

amoxicillin chw 250mg ...................... 94

amoxicillin sus 125/5ml ..................... 94 amoxicillin sus 200/5ml ..................... 94

amoxicillin sus 250/5ml ..................... 94 amoxicillin sus 400/5ml ..................... 94

amoxicillin tab 500mg ....................... 94 amoxicillin tab 875mg ....................... 94

amox-pot cla tab er ........................... 94 amphetamine cap 10mg er ................. 1

amphetamine cap 15mg er ................. 1 amphetamine cap 20mg er ................. 1

amphetamine cap 25mg er ................. 1 amphetamine cap 30mg er ................. 1

amphetamine cap 5mg er ................... 1 amphetamine tab 10mg ...................... 1

amphetamine tab 12.5mg ................... 1

amphetamine tab 15mg ...................... 1 amphetamine tab 20mg ...................... 1

amphetamine tab 30mg ...................... 1

amphetamine tab 5mg ........................ 1 amphetamine tab 7.5mg ..................... 1

ampicillin cap 250mg ........................ 94 ampicillin cap 500mg ........................ 94

ampicillin sus 125/5ml ...................... 94 ampicillin sus 250/5ml ...................... 94

anacin tab 81mg ec ............................ 5 ANADROL-50 TAB 50MG .................... 10

anagrelide cap 0.5mg ....................... 77 anagrelide cap 1mg .......................... 77

anastrozole tab 1mg ......................... 37 ANDRODERM DIS 2.5MG/24 .............. 10

ANDRODERM DIS 2MG/24HR ............. 10 ANDRODERM DIS 4MG/24HR ............. 10

ANDRODERM DIS 5MG/24HR ............. 10

android cap 10mg ............................ 10 ANDROXY TAB 10MG ........................ 10

anolor 300 cap ................................... 4 anti-diarrhe cap 2mg ........................ 26

anti-diarrhe tab 2mg ........................ 26 antifungal cre 1% ............................. 60

antifungal cre 2% ............................. 60 anti-hist cap 25mg ........................... 29

antihistamin cap 25mg...................... 29 antihistamin dro 0.025%op ............... 92

anti-itch cre /aloe/e .......................... 63 anti-itch cre /oatmeal ....................... 63

anti-itch cre 1% ............................... 63 anti-itch cre 1%pls 10 ...................... 63

anti-itch lot 1% ................................ 63

antipy/benzo sol otic ........................ 92 ANTIVERT TAB 50MG ........................ 27

anucort-hc sup 25mg ........................ 10 ANZEMET TAB 100MG ....................... 27

ANZEMET TAB 50MG ......................... 27 apap/codeine sol 120-12/5 .................. 8

apap/codeine tab 300-15mg ................ 8 apap/codeine tab 300-30mg ................ 8

apap/codeine tab 300-60mg ................ 8 apexicon oin 0.05% .......................... 63

APIDRA INJ SOLOSTAR ..................... 25 APIDRA INJ U-100 ............................ 25

APOKYN INJ ..................................... 40 APOKYN INJ 10MG/ML ...................... 40

apraclonidin sol 0.5% op ................... 90

apri tab ........................................... 53 APTIVUS CAP 250MG ........................ 43

111

APTIVUS SOL ................................... 44

aquanil hc lot 1% .............................. 63 ARALAST NP INJ 1000MG ................. 100

ARALAST NP INJ 400MG .................. 100 aranelle tab ...................................... 53

ARANESP INJ 100MCG ....................... 78 ARANESP INJ 150MCG ....................... 78

ARANESP INJ 200MCG ....................... 78 ARANESP INJ 25MCG ......................... 78



arbinoxa liq 4mg/5ml ........................ 29 arbinoxa tab 4mg ............................. 29

ARCALYST INJ 220MG ........................ 3

ARCAPTA CAP 75MCG ........................ 16 argyl saline sol 0.9% ......................... 75

ARMOUR THYRO TAB 120MG ............ 101 ARMOUR THYRO TAB 15MG .............. 101

ARMOUR THYRO TAB 180MG ............ 101 ARMOUR THYRO TAB 240MG ............ 101

ARMOUR THYRO TAB 300MG ............ 101 ASACOL TAB 400MG DR..................... 74

ascomp/cod cap 30mg ........................ 8 asmalpred sol 15mg/5ml ................... 56

asmalpred sol plus ............................ 56 ASMANEX 120 AER 220MCG ............... 15

ASMANEX 14 AER 220MCG ................. 15 ASMANEX 30 AER 110MCG ................. 15

ASMANEX 30 AER 220MCG ................. 15

ASMANEX 60 AER 220MCG ................. 15 ASMANEX 7 AER 110MCG .................. 15

aspir-81 tab 81mg ec ......................... 5 aspirin adlt tab 81mg ......................... 5

aspirin chil chw 81mg ......................... 5 aspirin chld chw 81mg ........................ 5

aspirin chw 81mg .............................. 5 aspirin low chw 81mg ......................... 5

aspirin low tab 81mg ec ...................... 5 aspirin tab 325mg .............................. 5

aspirin tab 325mg ec .......................... 5 aspirin tab 5gr ec ............................... 5

aspirin tab 81mg ............................... 5 aspirin tab 81mg ec ........................... 5

aspir-low tab 81mg ec ........................ 5

aspirtab tab 324mg ec ........................ 5 atenol/chlor tab 100-25mg ................ 34

atenol/chlor tab 50-25mg .................. 34

atenolol tab 100mg .......................... 48 atenolol tab 25mg ............................ 48

atenolol tab 50mg ............................ 48 athlete foot cre 1% .......................... 60

atorvastatin tab 10mg ...................... 31 atorvastatin tab 20mg ...................... 31

atorvastatin tab 40mg ...................... 31 atorvastatin tab 80mg ...................... 31

atovaq/progu tab 250-100 ................ 35 atovaq/progu tab 62.5-25 ................. 35

atovaquone sus 750/5ml ................... 11 ATRALIN GEL 0.05% ......................... 59

ATRIPLA TAB ................................... 44 atropin-care sol 1% op ..................... 89

ATROPINE SUL OIN 1% OP ................ 89

atropine sul sol 1% op ...................... 89 ATROVENT HFA AER 17MCG .............. 14

aug betamet cre 0.05% .................... 63 aug betamet gel 0.05% .................... 63

aug betamet lot 0.05% ..................... 63 aug betamet oin 0.05% .................... 63

AUGMENTIN SUS 125/5ML ................ 94 aurax sol 5.5-1.4% .......................... 92

aurodex sol otic ............................... 92 AUVI-Q INJ 0.3MG .......................... 106

AVANDAMET TAB 2-1000MG .............. 24 AVANDAMET TAB 2-500MG ................ 24

AVANDAMET TAB 4-1000MG .............. 24 AVANDAMET TAB 4-500MG ................ 24

AVANDARYL TAB 4-1MG .................... 24

AVANDARYL TAB 4-2MG .................... 24 AVANDARYL TAB 4-4MG .................... 24

AVANDARYL TAB 8-2MG .................... 24 AVANDARYL TAB 8-4MG .................... 24

AVANDIA TAB 2MG ........................... 26 AVANDIA TAB 4MG ........................... 26

AVANDIA TAB 8MG ........................... 26 aveeno cre 1% ................................ 63

aviane tab ....................................... 53 avita cre 0.025% ............................. 59

avita gel 0.025%.............................. 59 AVODART CAP 0.5MG ....................... 75

AVONEX KIT 30MCG ......................... 96 AVONEX PEN KIT 30MCG ................... 96

AVONEX PREFL KIT 30MCG ................ 96

AXERT TAB 12.5MG .......................... 83 AXERT TAB 6.25MG .......................... 83

112

AZASAN TAB 100MG ......................... 47

AZASAN TAB 75 MG .......................... 47 azathioprine tab 50mg ....................... 47

azelastine spr 0.1% .......................... 87 AZELEX CRE 20% ............................. 59

AZILECT TAB 0.5MG .......................... 40 AZILECT TAB 1MG............................. 40

azithromycin pow 1gm pak ................ 81 azithromycin sus 100/5ml .................. 81

azithromycin sus 200/5ml .................. 81 azithromycin tab 250mg .................... 81

azithromycin tab 500mg .................... 81 azithromycin tab 600mg .................... 81

AZOPT SUS 1% OP ........................... 92 AZOR TAB 10-20MG .......................... 34

AZOR TAB 10-40MG .......................... 34

AZOR TAB 5-20MG ............................ 34 AZOR TAB 5-40MG ............................ 34

azurette tab 28 day ........................... 54 B bacitracin oin op ............................... 90 baclofen tab 10mg ............................ 87

baclofen tab 20mg ............................ 87 BACTROBAN OIN NASAL 2% .............. 87

balsalazide cap 750mg ...................... 74 balziva tab ....................................... 54

banophen cap 25mg .......................... 29 banophen cap 50mg .......................... 29

BANZEL SUS 40MG/ML ...................... 18 BANZEL TAB 200MG .......................... 18

BANZEL TAB 400MG .......................... 18

BARACLUDE SOL .05MG/ML ............... 45 BARACLUDE TAB 0.5MG ..................... 45

BARACLUDE TAB 1MG ....................... 45 baycadron elx 0.5/5ml ....................... 56

bayer adv tab 325mg ......................... 5 bayer asa tab 325mg ......................... 5

bayer low chw 81mg .......................... 5 bayer low tab 81mg ec ....................... 5

baza antifun cre 2% .......................... 60 BEBULIN INJ 200-1200 ...................... 76

BEBULIN VH INJ 200-1200 ................. 76 BECONASE AQ SUS 0.042% ............... 88

bella alk/pb tab 16.2mg ................... 102 benazepril tab 10mg ......................... 32

benazepril tab 20mg ......................... 32

benazepril tab 40mg ......................... 32 benazepril tab 5mg ........................... 32

BENEFIX INJ 1000UNIT ..................... 76

BENEFIX INJ 2000UNIT ..................... 76 BENEFIX INJ 250UNIT ....................... 76

BENEFIX INJ 500UNIT ....................... 76 BENICAR TAB 20MG ......................... 33

BENICAR TAB 40MG ......................... 33 BENICAR TAB 5MG ........................... 33

benzonatate cap 100mg .................... 57 benzonatate cap 200mg .................... 57

benztropine inj 1mg/ml ..................... 39 benztropine tab 0.5mg ...................... 39

benztropine tab 1mg ........................ 39 benztropine tab 2mg ........................ 39

BEPREVE DRO 1.5% ......................... 92 BESIVANCE SUS 0.6% ...................... 90

beta hc lot 1% ................................. 63

betameth dip cre 0.05% ................... 63 betameth dip lot 0.05% .................... 63

betameth dip oin 0.05% ................... 63 betameth val cre 0.1% ..................... 63

betameth val lot 0.1% ...................... 63 betameth val oin 0.1% ..................... 63

betaxolol sol 0.5% op ....................... 89 betaxolol tab 10mg .......................... 48

betaxolol tab 20mg .......................... 48 bethanechol tab 10mg .................... 104

bethanechol tab 25mg .................... 104 bethanechol tab 50mg .................... 104

bethanechol tab 5mg ...................... 104 BETOPTIC-S SUS 0.25% OP .............. 89

bicalutamide tab 50mg ..................... 37

biocotron liq 100-10/5 ...................... 57 bio-d-mulsio liq 400unit .................. 106

bio-statin pow .................................. 28 bisoprl/hctz tab 10/6.25 .................... 34

bisoprl/hctz tab 2.5/6.25 ................... 34 bisoprl/hctz tab 5-6.25mg ................. 34

bisoprol fum tab 10mg ...................... 48 bisoprol fum tab 5mg ....................... 48

BIVIGAM INJ 10% ............................ 93 BLEPHAMIDE OIN S.O.P. ................... 91

BLEPHAMIDE SUS OP ........................ 91 BOTOX INJ 100UNIT ......................... 89

briellyn tab ...................................... 54 BRILINTA TAB 90MG ......................... 77

brimonidine sol 0.15% ...................... 90

brimonidine sol 0.2% op ................... 90 brom/pse/dm syp ............................. 57

113

bromfed dm syp ............................... 58

bromfenac sol 0.09% ........................ 92 bromocriptin cap 5mg ....................... 40

bromocriptin tab 2.5mg ..................... 40 broncotron liq 10-100/5 ..................... 58

BROVANA NEB 15MCG ....................... 16 budeprion tab 100mg sr .................... 21

budeprion tab 150mg sr .................... 21 budeprion xl tab 150mg ..................... 21

budeprion xl tab 300mg ..................... 21 budesonide cap 3mg/24hr.................. 56

budesonide sus 0.25mg/2 .................. 15 budesonide sus 0.5mg/2 .................... 15

budesonide sus 32mcg ...................... 88 bumetanide tab 0.5mg ...................... 69

bumetanide tab 1mg ......................... 69

bumetanide tab 2mg ......................... 69 bupap tab 50-650mg .......................... 4

bupren/nalox sub 2-0.5mg .................. 9 bupren/nalox sub 8-2mg .................... 9

buprenorphin sub 2mg ....................... 9 buprenorphin sub 8mg ....................... 9

buproban tab 150mg ......................... 96 bupropion tab 100mg ........................ 21

bupropion tab 100mg er .................... 21 bupropion tab 100mg sr .................... 21

bupropion tab 150mg ........................ 96 bupropion tab 150mg er .................... 21

bupropion tab 150mg sr .................... 21 bupropion tab 200mg er .................... 21

bupropion tab 200mg sr .................... 21

bupropion tab 75mg .......................... 21 bupropn hcl tab 150mg xl .................. 21

bupropn hcl tab 300mg xl .................. 21 buspirone tab 10mg .......................... 13

buspirone tab 15mg .......................... 13 buspirone tab 30mg .......................... 13

buspirone tab 5mg ............................ 13 buspirone tab 7.5mg ......................... 13

but/apap/caf cap ............................... 4 but/apap/caf cap codeine .................... 8

but/apap/caf tab ................................ 4 but/asa/caf/ cap cod 30mg ................. 9

but/asa/caff cap ................................ 5 but/asa/caff tab ................................. 5

butal/apap tab 50-325mg ................... 5

butalbital tab cpd ............................... 5 butorphanol sol 10mg/ml ................... 10

BUTRANS DIS 10MCG/HR .................. 10

BUTRANS DIS 20MCG/HR .................. 10 BUTRANS DIS 5MCG/HR ................... 10

BYETTA INJ 10MCG .......................... 25 BYETTA INJ 5MCG ............................ 25

BYSTOLIC TAB 10MG ........................ 48 BYSTOLIC TAB 2.5MG ....................... 48

BYSTOLIC TAB 20MG ........................ 48 BYSTOLIC TAB 5MG .......................... 48

C CAFERGOT TAB 1-100MG .................. 82

calc acetate cap 667mg .................... 74 calc acetate tab 667mg ..................... 74

calcipotrien cre 0.005% .................... 62 calcipotrien oin 0.005% .................... 62

calcipotrien oin betameth .................. 63

calcipotrien sol 0.005% ..................... 62 calcitonin spr 200/act ....................... 70

calcitrene oin 0.005% ....................... 62 calcitriol cap 0.25mcg ....................... 70

calcitriol cap 0.5mcg ......................... 70 calcitriol inj 1mcg/ml ........................ 70

calcitriol oin 3mcg/gm ...................... 62 caldecort cre 1% .............................. 63

camila tab 0.35mg ........................... 56 CAMPRAL TAB 333MG ....................... 95

candesartan tab 16mg ...................... 33 candesartan tab 32mg ...................... 33

candesartan tab 4mg ........................ 33 candesartan tab 8mg ........................ 33

CANTIL TAB 25MG .......................... 102

capacet cap ....................................... 5 capecitabine tab 150mg .................... 37

capecitabine tab 500mg .................... 37 CAPRELSA TAB 100MG ...................... 38

CAPRELSA TAB 300MG ...................... 38 captopr/hctz tab 25-15mg ................. 35

captopr/hctz tab 25-25mg ................. 35 captopr/hctz tab 50-15mg ................. 35

captopr/hctz tab 50-25mg ................. 35 captopril tab 100mg ......................... 32

captopril tab 12.5mg ........................ 32 captopril tab 25mg ........................... 32

captopril tab 50mg ........................... 32 carb/levo er tab 25-100mg ................ 40

carb/levo er tab 50-200mg ................ 40

carb/levo sr tab 25-100mg ................ 40 carb/levo sr tab 50-200mg ................ 40

114

carb/levo tab 10-100mg .................... 40

carb/levo tab 25-100mg .................... 40 carb/levo tab 25-250mg .................... 40

carbamazepin cap 100mg er .............. 18 carbamazepin cap 200mg er .............. 18

carbamazepin cap 300mg er .............. 18 carbamazepin chw 100mg .................. 18

carbamazepin sus 100/5ml ................ 18 carbamazepin tab 200mg ................... 18

carbamazepin tab 200mg er ............... 18 carbamazepin tab 400mg er ............... 18

carbidopa tab 25mg .......................... 39 carbinoxamin liq 4mg/5ml.................. 29

carbinoxamin tab 4mg ....................... 29 CARIMUNE NF INJ 12GM .................... 93

CARIMUNE NF INJ 3GM ...................... 93

CARIMUNE NF INJ 6GM ...................... 93 carisopr/asa tab 200-325 ................... 87

carisoprodol tab 250mg ..................... 87 carisoprodol tab 350mg ..................... 87

carteolol sol 1% op ........................... 89 cartia xt cap 120/24hr ....................... 49

cartia xt cap 180/24hr ....................... 50 cartia xt cap 240/24hr ....................... 50

cartia xt cap 300/24hr ....................... 50 carvedilol tab 12.5mg ........................ 48

carvedilol tab 25mg .......................... 48 carvedilol tab 3.125mg ...................... 48

carvedilol tab 6.25mg ........................ 48 caziant pak ...................................... 54

CEDAX CAP 400MG ........................... 53

cefaclor cap 250mg ........................... 53 cefaclor cap 500mg ........................... 53

cefaclor sus 125/5ml ......................... 53 cefaclor sus 250/5ml ......................... 53

cefaclor sus 375/5ml ......................... 53 cefadroxil cap 500mg ........................ 52

cefadroxil sus 250/5ml ...................... 52 cefadroxil sus 500/5ml ...................... 52

cefadroxil tab 1gm ............................ 52 cefdinir cap 300mg ........................... 53

cefdinir sus 125/5ml.......................... 53 cefdinir sus 250/5ml.......................... 53

cefditoren tab 200mg ........................ 53 cefditoren tab 400mg ........................ 53

cefpodo prox sus 100/5ml .................. 53

cefpodo prox sus 50mg/5ml ............... 53 cefpodoxime tab 100mg .................... 53

cefpodoxime tab 200mg .................... 53

cefprozil sus 125/5ml ....................... 53 cefprozil sus 250/5ml ....................... 53

cefprozil tab 250mg .......................... 53 cefprozil tab 500mg .......................... 53

ceftibuten cap 400mg ....................... 53 CEFTIN SUS 250/5ML ....................... 53

cefuroxime sus 125/5ml .................... 53 cefuroxime tab 250mg ...................... 53

cefuroxime tab 500mg ...................... 53 CELEBREX CAP 100MG ........................ 3

CELEBREX CAP 200MG ........................ 3 CELEBREX CAP 400MG ........................ 3

CELLCEPT SUS 200MG/ML ................. 47 CELONTIN CAP 300MG ...................... 20

CENESTIN TAB 0.3MG ....................... 72

CENESTIN TAB 0.45MG ..................... 72 CENESTIN TAB 0.625MG ................... 72

CENESTIN TAB 0.9MG ....................... 72 CENESTIN TAB 1.25MG ..................... 72

CENTANY AT KIT 2% ........................ 60 centany oin 2% ................................ 60

cephadyn tab 50-650mg ..................... 5 cephalexin cap 250mg ...................... 52

cephalexin cap 500mg ...................... 52 cephalexin cap 750mg ...................... 52

cephalexin sus 125/5ml .................... 53 cephalexin sus 250/5ml .................... 53

cephalexin tab 250mg....................... 53 cephalexin tab 500mg....................... 53

CEREZYME INJ 200UNIT .................... 77

CEREZYME INJ 400UNIT .................... 77 ceron-dm syp .................................. 58

CESAMET CAP 1MG .......................... 28 cesia pak......................................... 54

cetirizine sol 1mg/ml ........................ 30 cetirizine sol 5mg/5ml ...................... 30

cetirizine syp 1mg/ml ....................... 30 cetirizine syp 5mg/5ml...................... 30

cevimeline cap 30mg ........................ 85 CHANTIX PAK 0.5& 1MG ................... 96

CHANTIX PAK 1MG ........................... 96 CHANTIX TAB 0.5MG ........................ 96

CHANTIX TAB 1MG ........................... 96 chateal tab 0.15/30 .......................... 54

CHEMET CAP 100MG ......................... 27

CHEMSTRIP 10 TES MD ..................... 67 CHEMSTRIP 2 TES GP ....................... 67

115

CHEMSTRIP 5 TES OB........................ 67

CHEMSTRIP 7 TES ............................. 67 CHEMSTRIP 9 TES STRIPS ................. 67

CHEMSTRIP TES -10 SG..................... 67 CHEMSTRIP TES UGK ........................ 67

cheratussin sol dac............................ 58 cheratussin syp ac ............................ 58

child asa chw 81mg ............................ 5 child asa ls chw 81mg ........................ 5

child vit d chw 400unit .................... 106 chloral hydr syp 500/5ml ................... 79

chlord/clidi cap 5-2.5mg .................. 102 chlordiazep cap 10mg ........................ 13

chlordiazep cap 25mg ........................ 13 chlordiazep cap 5mg ......................... 13

chlorhex glu sol 0.12% ...................... 84

chloroquine tab 250mg ...................... 35 chloroquine tab 500mg ...................... 36

chlorothiaz tab 250mg ....................... 69 chlorothiaz tab 500mg ....................... 69

chlorpromaz tab 100mg ..................... 42 chlorpromaz tab 10mg....................... 42

chlorpromaz tab 200mg ..................... 42 chlorpromaz tab 25mg....................... 42

chlorpromaz tab 50mg....................... 42 chlorpropam tab 100mg .................... 26

chlorpropam tab 250mg .................... 26 chlorthalid tab 25mg ......................... 69

chlorthalid tab 50mg ......................... 69 chlorzoxazon tab 500mg .................... 87

cho mag tris liq 500/5ml ..................... 5

cho mag tris tab 1000mg .................... 5 cho mag tris tab 500mg ...................... 5

cho mag tris tab 750mg ...................... 5 cholestyram pow 4gm ....................... 31

cholestyram pow 4gm lite .................. 31 CIALIS TAB 10MG ............................. 52

CIALIS TAB 2.5MG ............................ 52 CIALIS TAB 20MG ............................. 52

CIALIS TAB 5MG ............................... 52 ciclodan cre 0.77% ........................... 60

ciclopirox cre 0.77%.......................... 60 ciclopirox sus 0.77% ......................... 61

cilostazol tab 100mg ......................... 77 cilostazol tab 50mg ........................... 77

CILOXAN OIN 0.3% OP ...................... 90

cimetidine sol 300/5ml .................... 103 cimetidine tab 200mg ...................... 103

cimetidine tab 300mg ..................... 103

cimetidine tab 400mg ..................... 103 cimetidine tab 800mg ..................... 103

CIMZIA KIT ..................................... 74 CINRYZE SOL 500 UNIT .................... 77

CIPRO (10%) SUS 500MG/5 .............. 73 CIPRO (5%) SUS 250MG/5 ................ 73

CIPRO HC SUS OTIC ......................... 93 CIPRODEX SUS 0.3-0.1% .................. 93

ciprofloxacn sol 0.3% op ................... 90 ciprofloxacn tab 100mg ..................... 73

ciprofloxacn tab 250mg ..................... 73 ciprofloxacn tab 500mg ..................... 73

ciprofloxacn tab 750mg ..................... 73 citalopram tab 10mg ........................ 22

citalopram tab 20mg ........................ 22

citalopram tab 40mg ........................ 22 CL PRENATAL TAB 28-0.8MG ............. 86

claravis cap 10mg ............................ 59 claravis cap 20mg ............................ 59

claravis cap 30mg ............................ 59 claravis cap 40mg ............................ 59

clarithromyc sus 125/5ml .................. 81 clarithromyc sus 250/5ml .................. 81

clarithromyc tab 250mg .................... 81 clarithromyc tab 500mg .................... 81

claritin eye dro 0.025%op ................. 92 clearlax pow .................................... 80

clemastine syp 0.5/5ml ..................... 29 clemastine tab 2.68mg ..................... 29

clindacin-p pad 1% ........................... 59

clindamax gel 1%............................. 59 clindamax lot 10mg/ml ..................... 59

clindamy/ben gel 1.2-5% .................. 59 clindamy/ben gel 1-5% ..................... 59

clindamycin aer 1% .......................... 60 clindamycin cap 150mg ..................... 11

clindamycin cap 300mg ..................... 12 clindamycin cap 75mg ...................... 11

clindamycin cre 2% vag .................. 106 clindamycin gel 1% .......................... 60

clindamycin lot 1% ........................... 60 clindamycin lot 10mg/ml ................... 60

clindamycin pad 1% ......................... 60 clindamycin sol 1% .......................... 60

clindamycin sol 75mg/5ml ................. 12

clobetasol cre 0.05% ........................ 63 clobetasol oin 0.05% ........................ 63

116

clobetasol sol 0.05% ......................... 63

clocortolone cre piv 0.1% .................. 63 CLODERM CRE 0.1% ......................... 63

CLODERM CRE 0.1% PMP ................... 63 clomipramine cap 25mg ..................... 23

clomipramine cap 50mg ..................... 23 clomipramine cap 75mg ..................... 23

clonazepam tab 0.5mg ...................... 18 clonazepam tab 1mg ......................... 18

clonazepam tab 2mg ......................... 18 clonidine dis 0.1/24hr ........................ 34

clonidine dis 0.2/24hr ........................ 34 clonidine dis 0.3/24hr ........................ 34

clonidine tab 0.1mg .......................... 34 clonidine tab 0.2mg .......................... 34

clonidine tab 0.3mg .......................... 34

clopidogrel tab 300mg ....................... 77 clopidogrel tab 75mg ......................... 77

cloraz dipot tab 15mg ........................ 13 cloraz dipot tab 3.75mg ..................... 13

cloraz dipot tab 7.5mg ....................... 13 clotrim/beta cre 1-0.05% ................... 61

clotrim/beta cre diprop ...................... 61 clotrim/beta lot diprop ....................... 61

clotrimazole cre 1% .......................... 61 clotrimazole loz 10mg ....................... 84

clotrimazole sol 1% ........................... 61 clotrimazole tro 10mg ....................... 84

clozapine tab 100/odt ........................ 42 clozapine tab 100mg ......................... 42

clozapine tab 12.5/odt ....................... 42

clozapine tab 200mg ......................... 42 clozapine tab 25mg ........................... 42

clozapine tab 25mg odt ..................... 42 clozapine tab 50mg ........................... 42

COARTEM TAB 20-120MG .................. 35 codeine sulf tab 30mg ........................ 7

codeine sulf tab 60mg ........................ 7 co-gesic tab 5-500mg ......................... 9

COLCRYS TAB 0.6MG......................... 75 colestipol gra 5gm ............................ 31

colestipol tab 1gm............................. 31 colidrops dro 0.125/ml .................... 102

colocort ene 100mg .......................... 10 COLY-MYCIN S SUS OTIC ................... 93

COLYTE/FLAVR SOL PACKS ................ 80

COMBIGAN SOL 0.2/0.5% .................. 89 COMBIPATCH DIS .05/.14 .................. 71

COMBIPATCH DIS .05/.25 ................. 72

COMBISTIX TES ............................... 67 COMBIVENT AER .............................. 16

COMBIVENT AER RESPIMAT ............... 16 comp allergy cap 25mg ..................... 29

COMPLERA TAB ................................ 44 compro sup 25mg ............................ 42

CONCEPT DHA CAP ........................... 86 CONCEPT OB CAP ............................. 86

congest aid tab 30mg ....................... 88 congestion tab 30mg ........................ 88

constulose sol 10gm/15 .................... 80 COPAXONE KIT 20MG/ML .................. 96

CORDRAN 24X3 TAP 4MCG/CM .......... 63 CORDRAN 80X3 TAP 4MCG/CM .......... 63

CORDRAN LOT 0.05% ....................... 63

CORDRAN SP CRE 0.05% .................. 63 COREG CR CAP 10MG ....................... 48

COREG CR CAP 20MG ....................... 48 COREG CR CAP 40MG ....................... 48

COREG CR CAP 80MG ....................... 48 cormax oin 0.05% ............................ 64

cormax scalp sol 0.05% .................... 64 cormax sol 0.05% ............................ 64

cort intense cre heal 1% ................... 64 cortaid adv cre 1% 12 hr................... 64

cortaid cre 1% ................................. 64 cortisone + cre 1% ........................... 64

cortisone ac tab 25mg ...................... 56 cortisone cre 1% .............................. 64

cortisone lot 1% ............................... 64

CORTISPORIN OIN 1% ..................... 60 CORTISPORIN SUS -TC OTIC ............. 93

cortizone-10 lot eczema .................... 64 cortizone-10 lot hydraten .................. 64

covaryx hs tab ................................. 72 covaryx tab ..................................... 72

COVERA-HS TAB 180MG ................... 50 COVERA-HS TAB 240MG ................... 50

c-phen dm syp ................................. 58 CREON CAP 12000UNT...................... 68

CREON CAP 24000UNT...................... 68 CREON CAP 3000UNIT ...................... 68

CREON CAP 6000UNIT ...................... 68 CRESTOR TAB 10MG ......................... 31

CRESTOR TAB 20MG ......................... 31

CRESTOR TAB 40MG ......................... 31 CRESTOR TAB 5MG .......................... 31

117

CRIXIVAN CAP 100MG ....................... 44

CRIXIVAN CAP 200MG ....................... 44 CRIXIVAN CAP 400MG ....................... 44

cromolyn sod neb 20mg/2ml .............. 14 cromolyn sod sol 4% op .................... 92

cryselle-28 tab 28 tabs ...................... 54 CUPRIMINE CAP 250MG ..................... 47

curity salin sol 0.9% irr ..................... 75 cvs allergy cap 25mg......................... 29

cvs allergy dro 0.025%op .................. 92 cvs allergy tab 180mg ....................... 30

cvs aspirin tab 325mg ........................ 5 cvs aspirin tab 325mg ec .................... 5

cvs aspirin tab 81mg ec ...................... 5 cvs chld asa chw 81mg ....................... 5

cvs cort int cre heal 1% ..................... 64

CVS KETONE TES CARE ..................... 67 cvs nicotine dis 14mg/24h ................. 96

cvs nicotine dis 21mg/24h ................. 96 cvs nicotine dis 7mg/24hr .................. 96

cvs nicotine gum 2mg cinn ................. 96 cvs nicotine gum 2mg mint ................ 96

cvs nicotine gum 2mg orig ................. 96 cvs nicotine gum 2mgfruit .................. 96

cvs nicotine gum 4mg cinn ................. 96 cvs nicotine gum 4mg mint ................ 96

cvs nicotine gum 4mg orig ................. 97 cvs nicotine gum 4mgfruit .................. 97

cvs nicotine loz 2mg mint .................. 97 cvs nicotine loz 4mg mint .................. 97

cvs nts dis step 1 .............................. 97

CVS PRENATAL TAB .......................... 86 CVS PRENATAL TAB 28-0.8MG ............ 86

cvs purelax pow ................................ 80 cyclafem tab 1/35 ............................. 54

cyclafem tab 7/7/7 ............................ 54 cyclobenzapr tab 10mg ...................... 87

CYCLOGYL SOL 0.5% OP ................... 89 cyclopentol sol 1% op........................ 89

cyclopentol sol 2% op........................ 89 cyclophosph tab 25mg ....................... 36

cyclophosph tab 50mg ....................... 36 cycloserine cap 250mg ...................... 36

CYCLOSET TAB 0.8MG ....................... 25 cyclosporine cap 100mg .................... 47

cyclosporine cap 100mg md ............... 47

cyclosporine cap 25mg ...................... 47 cyclosporine cap 25mg mod ............... 47

cyclosporine cap 50mg mod .............. 47

cyclosporine sol modified .................. 47 cylate sol 1% op .............................. 89

CYMBALTA CAP 20MG ....................... 22 CYMBALTA CAP 30MG ....................... 22

CYMBALTA CAP 60MG ....................... 22 cyproheptad syp 2mg/5ml ................. 30

cyproheptad tab 4mg ........................ 30 D d-3 gummy chw 400unit ................. 106 d3 kids chw 400unit ....................... 106

d-400 tab 400unit .......................... 106 DALIRESP TAB 500MCG .................... 15

danazol cap 100mg .......................... 10 danazol cap 200mg .......................... 10

danazol cap 50mg ............................ 10

dantrolene cap 100mg ...................... 87 dantrolene cap 25mg ........................ 87

dantrolene cap 50mg ........................ 87 dapsone tab 100mg .......................... 11

dapsone tab 25mg ........................... 11 DARAPRIM TAB 25MG ....................... 36

dasetta tab 1/35 .............................. 54 dasetta tab 7/7/7 ............................. 54

DAYTRANA DIS 15MG/9HR .................. 2 decongestant tab 30mg .................... 88

decongestant tab 60mg .................... 88 delta d3 tab 400unit ....................... 106

demeclocycl tab 150mg .................. 100 demeclocycl tab 300mg .................. 100

DENAVIR CRE 1% ............................ 62

DEPO-SQ PROV INJ 104 .................... 56 desenex cre 1% ............................... 61

desipramine tab 100mg .................... 23 desipramine tab 10mg ...................... 23

desipramine tab 150mg .................... 23 desipramine tab 25mg ...................... 23

desipramine tab 50mg ...................... 23 desipramine tab 75mg ...................... 23

desloratadin tab 2.5 odt .................... 30 desloratadin tab 5mg ........................ 30

desloratadin tab 5mg odt .................. 30 desmopressin inj 4mcg/ml ................ 71

desmopressin sol 0.01% ................... 71 desmopressin spr 0.01% ................... 71

desmopressin tab 0.1mg ................... 71

desmopressin tab 0.2mg ................... 71 desonide cre 0.05% .......................... 64

118

desonide lot 0.05% ........................... 64

desonide oin 0.05% .......................... 64 desoximetas cre 0.05% ..................... 64

desoximetas cre 0.25% ..................... 64 desoximetas gel 0.05% ..................... 64

desoximetas oin 0.05% ..................... 64 desoximetas oin 0.25% ..................... 64

DETROL LA CAP 2MG ......................... 74 DETROL LA CAP 4MG ......................... 74

dexameth pho sol 0.1% op ................ 91 dexamethason elx 0.5/5ml ................. 56

dexamethason sol 0.5/5ml ................. 56 dexamethason tab 0.5mg .................. 56

dexamethason tab 0.75mg................. 56 dexamethason tab 1.5mg .................. 56

dexamethason tab 1mg ..................... 56

dexamethason tab 2mg ..................... 57 dexamethason tab 4mg ..................... 57

dexamethason tab 6mg ..................... 57 dexchlorphen syp 2mg/5ml ................ 28

DEXILANT CAP 30MG DR ................. 104 DEXILANT CAP 60MG DR ................. 104

dexmethylph cap 15mg er .................. 2 dexmethylph cap 30mg er .................. 2

dexmethylph cap 40mg er .................. 2 dexmethylph tab 10mg ....................... 2

dexmethylph tab 2.5mg ...................... 2 dexmethylph tab 5mg ........................ 2

dextroamphet cap 10mg er ................. 1 dextroamphet cap 15mg er ................. 1

dextroamphet cap 5mg er ................... 1

dextroamphet tab 10mg ..................... 1 dextroamphet tab 5mg ....................... 1

diabetic tus liq children ...................... 58 diabetic tus liq dm ............................ 58

diamode tab 2mg .............................. 26 diazepam gel 10mg ........................... 18

diazepam gel 2.5mg .......................... 18 diazepam gel 20mg ........................... 18

diazepam sol 1mg/ml ........................ 13 diazepam tab 10mg .......................... 13

diazepam tab 2mg ............................ 13 diazepam tab 5mg ............................ 13

DIBENZYLINE CAP 10MG ................... 33 diclofenac sol 0.1% op....................... 92

diclofenac tab 25mg dr ....................... 3

diclofenac tab 50mg dr ....................... 3 diclofenac tab 75mg dr ....................... 3

dicloxacill cap 250mg ........................ 94

dicloxacill cap 500mg ........................ 94 dicyclomine cap 10mg .................... 102

dicyclomine sol 10mg/5ml ............... 102 dicyclomine tab 20mg ..................... 102

didanosine cap 125mg ...................... 44 didanosine cap 200mg ...................... 44

didanosine cap 250mg ...................... 44 didanosine cap 400mg ...................... 44

DIFICID TAB 200MG ......................... 81 diflorasone cre 0.05% ....................... 64

diflorasone oin 0.05% ....................... 64 diflunisal tab 500mg ........................... 5

digoxin tab 0.125mg ........................ 52 digoxin tab 0.25mg .......................... 52

dihydroergot inj 1mg/ml ................... 83

dihydroergot spr 4mg/ml .................. 83 DILANTIN CAP 30MG ........................ 20

DILATRATE SR CAP 40MG ................. 12 dilt-cd cap 120mg ............................ 50

dilt-cd cap 180mg ............................ 50 dilt-cd cap 240mg ............................ 50

dilt-cd cap 300mg ............................ 50 diltiazem cap 120mg cd .................... 50

diltiazem cap 120mg er ..................... 50 diltiazem cap 120mg/24 .................... 50

diltiazem cap 180mg cd .................... 50 diltiazem cap 180mg er ..................... 50

diltiazem cap 180mg/24 .................... 50 diltiazem cap 240mg cd .................... 50

diltiazem cap 240mg er ..................... 50

diltiazem cap 240mg/24 .................... 50 diltiazem cap 300mg cd .................... 50

diltiazem cap 300mg er ..................... 50 diltiazem cap 300mg/24 .................... 50

diltiazem cap 360mg cd .................... 50 diltiazem cap 360mg er ..................... 50

diltiazem cap 360mg/24 .................... 50 diltiazem cap 420mg/24 .................... 50

diltiazem cap 60mg er ...................... 50 diltiazem cap 90mg er ...................... 50

diltiazem tab 120mg ......................... 50 diltiazem tab 30mg........................... 50

diltiazem tab 60mg........................... 50 diltiazem tab 90mg........................... 50

dilt-xr cap 120mg ............................. 50

dilt-xr cap 180mg ............................. 50 dilt-xr cap 240mg ............................. 50

119

diltzac cap 120mg/24 ........................ 50

diltzac cap 180mg/24 ........................ 50 diltzac cap 240mg/24 ........................ 50

diltzac cap 300mg/24 ........................ 50 diltzac cap 360mg/24 ........................ 50

dimetane dx syp ............................... 58 DIOVAN TAB 160MG .......................... 33

DIOVAN TAB 320MG .......................... 33 DIOVAN TAB 40MG ........................... 33

DIOVAN TAB 80MG ........................... 33 DIPENTUM CAP 250MG ...................... 74

diphen/atrop liq 2.5/5 ....................... 27 diphen/atrop tab 2.5mg ..................... 27

diphenhist cap 25mg ......................... 29 diphenhydram cap 25mg ................... 29

diphenhydram cap 50mg ................... 29

diphenhydram elx 12.5/5ml ............... 29 dipyridamole tab 25mg ...................... 77

dipyridamole tab 50mg ...................... 77 dipyridamole tab 75mg ...................... 77

disopyramide cap 100mg ................... 14 disopyramide cap 150mg ................... 14

disulfiram tab 250mg ........................ 95 disulfiram tab 500mg ........................ 95

divalproex cap 125mg ....................... 20 divalproex tab 125mg dr .................... 20

divalproex tab 250mg dr .................... 20 divalproex tab 250mg er .................... 20

divalproex tab 500mg dr .................... 20 divalproex tab 500mg er .................... 20

dm/gg sol ........................................ 58

dm/gg sol 10-100/5 .......................... 58 donepezil tab 10mg ........................... 95

donepezil tab 10mg odt ..................... 95 donepezil tab 5mg ............................ 95

donepezil tab 5mg odt ....................... 95 dormin cap 25mg .............................. 29

dorzol/timol sol 2-0.5%op .................. 89 dorzolamide sol 2% op ...................... 92

doxazosin tab 1mg ............................ 34 doxazosin tab 2mg ............................ 34

doxazosin tab 4mg ............................ 34 doxazosin tab 8mg ............................ 34

doxepin hcl cap 100mg ...................... 23 doxepin hcl cap 10mg........................ 23

doxepin hcl cap 150mg ...................... 23

doxepin hcl cap 25mg........................ 23 doxepin hcl cap 50mg........................ 23

doxepin hcl cap 75mg ....................... 23

doxepin hcl con 10mg/ml .................. 23 doxercalcif cap 0.5mcg ..................... 70

doxercalcif cap 1mcg ........................ 70 doxercalcif cap 2.5mcg ..................... 70

doxercalcif inj .................................. 70 doxercalcif inj 4mcg/2ml ................... 70

doxycycl hyc cap 100mg ................. 100 doxycycl hyc cap 50mg ................... 100

doxycycl hyc tab 100mg.................. 100 doxycycl hyc tab 100mg dr .............. 100

doxycycl hyc tab 150mg dr .............. 100 doxycycl hyc tab 75mg dr ............... 100

doxycycline sus 25mg/5ml .............. 100 doxycycline tab 20mg ..................... 100

dramamine tab 25mg ....................... 27

DRITHO-CREME CRE HP 1% .............. 62 DRITHO-SCALP CRE 0.5% ................. 62

dronabinol cap 10mg ........................ 28 dronabinol cap 2.5mg ....................... 28

dronabinol cap 5mg .......................... 28 drospir/ethi tab 3-0.03mg ................. 54

dulcolax pow balance ........................ 80 DULERA AER 100-5MCG .................... 16

DULERA AER 200-5MCG .................... 16 duloxetine cap 20mg ........................ 22

duloxetine cap 30mg ........................ 22 duloxetine cap 60mg ........................ 22

DUREZOL EMU 0.05% ....................... 91 d-vita liq 400unit ........................... 106

DYNACIRC CR TAB 10MG .................. 50

DYNACIRC CR TAB 5MG .................... 50 DYRENIUM CAP 100MG ..................... 69

DYRENIUM CAP 50MG ....................... 69 dytuss syp 12.5/5ml ......................... 29

E e.e.s. 400 tab 400mg ....................... 81

E.E.S. GRAN SUS 200/5ML ................ 81 e.s.p. sus 200-600 ........................... 11

econazole cre 1% ............................. 61 ecotrin low tab 81mg ec ...................... 5

ecpirin tab 325mg ec .......................... 6 ed baclofen tab 10mg ....................... 87

EDARBI TAB 40MG ........................... 33 EDARBI TAB 80MG ........................... 33

EDECRIN TAB 25MG ......................... 69

EDURANT TAB 25MG ........................ 44 eemt hs tab ..................................... 72

120

eemt tab .......................................... 72

ees/sulfisox sus 200-600 ................... 11 EFFIENT TAB 10MG ........................... 77

EFFIENT TAB 5MG ............................. 77 ELAPRASE INJ 6MG/3ML .................... 70

ELIDEL CRE 1% ................................ 66 ELIGARD INJ 22.5MG ........................ 37

ELIGARD INJ 30MG ........................... 37 ELIGARD INJ 45MG ........................... 37

ELIGARD INJ 7.5MG .......................... 37 elinest tab ........................................ 54

ELIXOPHYLLIN ELX 80/15ML .............. 16 ELLA TAB 30MG ................................ 56

ELMIRON CAP 100MG ........................ 75 EMADINE SOL 0.05% OP ................... 92

EMCYT CAP 140MG ........................... 37

EMEND CAP 125MG ........................... 28 EMEND CAP 40MG ............................. 28

EMEND CAP 80MG ............................. 28 EMEND PAK 80 & 125 ........................ 28

emoquette tab .................................. 54 EMSAM DIS 12MG/24H ...................... 22

EMSAM DIS 6MG/24HR ...................... 22 EMSAM DIS 9MG/24HR ...................... 22

EMTRIVA CAP 200MG ........................ 44 EMTRIVA SOL 10MG/ML ..................... 44

ENABLEX TAB 15MG ........................ 104 ENABLEX TAB 7.5MG ....................... 104

enalapril tab 10mg ............................ 32 enalapril tab 2.5mg ........................... 32

enalapril tab 20mg ............................ 32

enalapril tab 5mg .............................. 32 ENBREL INJ 25/0.5ML......................... 4

ENBREL INJ 25MG .............................. 4 ENBREL INJ 50MG/ML ......................... 4

ENBREL SRCLK INJ 50MG/ML .............. 4 encare gel 4% ................................ 106

endocet tab 10-325mg ....................... 9 endocet tab 10-650mg ....................... 9

endocet tab 5-325mg ......................... 9 endocet tab 7.5-325 ........................... 9

endocet tab 7.5-500m ........................ 9 endodan tab ...................................... 9

ENJUVIA TAB 0.3MG .......................... 72 ENJUVIA TAB 0.45MG ........................ 72

ENJUVIA TAB 0.625MG ...................... 72

ENJUVIA TAB 0.9MG .......................... 72 ENJUVIA TAB 1.25MG ........................ 72

enoxaparin inj 100mg/ml .................. 17

enoxaparin inj 120/0.8 ..................... 17 enoxaparin inj 150mg/ml .................. 17

enoxaparin inj 30/0.3ml .................... 17 enoxaparin inj 300/3ml ..................... 17

enoxaparin inj 40/0.4ml .................... 17 enoxaparin inj 60/0.6ml .................... 17

enoxaparin inj 80/0.8ml .................... 17 enpresse-28 tab ............................... 54

enskyce tab ..................................... 54 entacapone tab 200mg ..................... 39

enulose sol 10gm/15 ........................ 74 epidrin cap ...................................... 82

epiflur chw 0.25mg f ......................... 83 epiflur chw 0.5mg f .......................... 83

epiflur chw 1mg f ............................. 83

epinastine dro 0.05% ....................... 92 epinephrine inj 0.3mg ..................... 106

EPIPEN 2-PAK INJ 0.3MG ................ 106 EPIPEN INJ 0.3MG .......................... 106

EPIPEN-JR INJ 0.15MG .................... 106 EPIPEN-JR INJ 2-PAK ...................... 106

epitol tab 200mg .............................. 18 EPIVIR HBV SOL 5MG/ML .................. 44

EPIVIR HBV TAB 100MG .................... 44 eplerenone tab 25mg ........................ 35

eplerenone tab 50mg ........................ 35 EPOGEN INJ 10000/ML ..................... 78

EPOGEN INJ 2000/ML ....................... 78 EPOGEN INJ 20000/ML ..................... 78

EPOGEN INJ 3000/ML ....................... 78

EPOGEN INJ 4000/ML ....................... 78 eprosart mes tab 600mg ................... 33

EPZICOM TAB 600-300 ..................... 44 eq allergy cap 25mg ......................... 29

eq aspirin tab 325mg .......................... 6 eq aspirin tab 325mg ec ...................... 6

eq child asa chw 81mg ........................ 6 eq heartburn tab relief .................... 103

eq hydrocort cre 1% ......................... 64 eq itchy eye dro 0.025%op ............... 92

eq nicotine dis 14mg/24h .................. 97 eq nicotine dis 21mg/24h .................. 97

eq nicotine dis 7mg/24hr .................. 97 eq nicotine gum 2mg cinn ................. 97

eq nicotine gum 2mg mint ................. 97

eq nicotine gum 2mg orig .................. 97 eq nicotine gum 2mgfruit .................. 97

121

eq nicotine gum 4mg cinn .................. 97

eq nicotine gum 4mg mint ................. 97 eq nicotine gum 4mg orig .................. 97

eq nicotine gum 4mg ref .................... 97 eq nicotine gum 4mg strt ................... 97

eq nicotine gum 4mgfruit ................... 97 eq nicotine loz 2mg cher .................... 97

eq nicotine loz 2mg mint .................... 97 eq nicotine loz 4mg chry .................... 97

eq nicotine loz 4mg mint .................... 97 eq suphedrin tab 30mg ...................... 88

eql allergy cap 25mg ......................... 29 eql aspirin tab 325mg ......................... 6

eql aspirin tab 325mg ec .................... 6 eql aspirin tab 81mg ec ...................... 6

eql chld asa chw 81mg ....................... 6

eql clearlax pow ................................ 80 eql nicotine dis 14mg/24h .................. 97

eql nicotine dis 21mg/24h .................. 97 eql nicotine dis 7mg/24hr .................. 97

eql nicotine gum 2mg ........................ 97 eql nicotine gum 2mg ref ................... 97

eql nicotine gum 2mg strt .................. 97 eql nicotine gum 4mg ........................ 97

eql nicotine gum 4mg ref ................... 97 eql nicotine gum 4mg strt .................. 97

eql nicotine loz 2mg mint ................... 97 eql nicotine loz 4mg mint ................... 97

EQL PRENATAL TAB FORMULA ............ 86 ergocalcifer cap 50000unt ................ 106

ergoloid mes tab 1mg oral ................. 96

ERGOMAR SUB 2MG .......................... 83 ERIVEDGE CAP 150MG ...................... 37

errin tab 0.35mg .............................. 56 ERTACZO CRE 2%............................. 61

ERYPED SUS 200/5ML ....................... 81 ERYPED SUS 400/5ML ....................... 81

ERY-TAB TAB 333MG EC .................... 81 ERY-TAB TAB 500MG EC .................... 81

erythrocin tab 250mg ........................ 81 erythrom eth tab 400mg .................... 81

erythromycin cap 250mg ec ............... 81 erythromycin gel /benzoyl .................. 60

erythromycin gel 2% ......................... 60 erythromycin oin 5mg/gm .................. 90

erythromycin oin op .......................... 90

erythromycin sol 2% ......................... 60 erythromycin tab 250mg bs ............... 81

erythromycin tab 500mg bs ............... 81

escitalopram tab 10mg ..................... 22 escitalopram tab 20mg ..................... 22

essian h.s. tab ................................. 72 essian tab ....................................... 72

est estrogen tab mtest ...................... 72 est estrogen tab mtest ds.................. 72

est estrogen tab mtest hs ................. 72 estarylla tab 0.25-35 ........................ 54

estazolam tab 1mg ........................... 79 estazolam tab 2mg ........................... 79

ESTRADERM DIS 0.05MG .................. 72 ESTRADERM DIS 0.1MG .................... 72

estradiol dis 0.025mg ....................... 72 estradiol dis 0.0375mg ..................... 72

estradiol dis 0.05mg ......................... 72

estradiol dis 0.06mg ......................... 72 estradiol dis 0.075mg ....................... 72

estradiol dis 0.1mg ........................... 72 estradiol tab 0.5mg .......................... 73

estradiol tab 1mg ............................. 73 estradiol tab 2mg ............................. 73

eszopiclone tab 1mg ......................... 79 eszopiclone tab 2mg ......................... 79

eszopiclone tab 3mg ......................... 79 ethambutol tab 100mg ..................... 36

ethambutol tab 400mg ..................... 36 ethosuximide cap 250mg .................. 20

ethosuximide sol 250/5ml ................. 20 etidron disd tab 200mg ..................... 70

etidron disd tab 400mg ..................... 70

etodolac cap 200mg ........................... 3 etodolac cap 300mg ........................... 3

etodolac er tab 400mg ........................ 3 etodolac er tab 500mg ........................ 3

etodolac er tab 600mg ........................ 3 etodolac tab 400mg ............................ 3

etodolac tab 500mg ............................ 3 etoposide cap 50mg ......................... 39

EUFLEXXA INJ 10MG/ML ................... 87 EURAX CRE 10% .............................. 67

EURAX LOT 10% .............................. 67 EVISTA TAB 60MG ............................ 70

EXELDERM CRE 1% .......................... 61 EXELDERM SOL 1% .......................... 61

exemestane tab 25mg ...................... 37

EXJADE TAB 125MG .......................... 27 EXJADE TAB 250MG .......................... 27

122

EXJADE TAB 500MG .......................... 27

EXTAVIA INJ 0.3MG .......................... 96 eye itch rel dro 0.025%op .................. 92

EZ USE FLU KIT 2012-13 ................. 105 EZFE FORTE CAP............................... 86

F fa-8 tab 0.8mg ................................. 77

FABRAZYME INJ 35MG ....................... 70 FABRAZYME INJ 5MG......................... 70

FACTIVE TAB 320MG ......................... 73 falmina tab ...................................... 54

famciclovir tab 125mg ....................... 46 famciclovir tab 250mg ....................... 46

famciclovir tab 500mg ....................... 46 famotidine sus 40mg/5ml ................ 103

famotidine tab 20mg ....................... 103

FANAPT PAK ..................................... 41 FANAPT TAB 10MG ............................ 41

FANAPT TAB 12MG ............................ 41 FANAPT TAB 1MG .............................. 41

FANAPT TAB 2MG .............................. 41 FANAPT TAB 4MG .............................. 41

FANAPT TAB 6MG .............................. 41 FANAPT TAB 8MG .............................. 41

FARESTON TAB 60MG ........................ 37 FC FEMALE MIS CONDOM ................... 81

FC2 FEMALE MIS CONDOM ................. 81 FEIBA NF INJ .................................... 76

FEIBA VH INJ IMMUNO ...................... 76 felbamate sus 600/5ml ...................... 20

felbamate tab 400mg ........................ 20

felbamate tab 600mg ........................ 20 felodipine tab 10mg er ...................... 51

felodipine tab 2.5mg er ..................... 50 felodipine tab 5mg er ........................ 50

FEMCAP MIS 22MM ........................... 81 FEMCAP MIS 26MM ........................... 81

FEMCAP MIS 30MM ........................... 81 FEMHRT TAB 0.5-2.5 ......................... 72

fenofibrate tab 160mg ....................... 31 fenofibrate tab 48mg ......................... 31

fenofibrate tab 54mg ......................... 31 FENOGLIDE TAB 120MG ..................... 31

FENOGLIDE TAB 40MG ...................... 31 fenoprofen tab 600mg ........................ 3

fentanyl dis 100mcg/h ........................ 7

fentanyl dis 12mcg/hr ........................ 7 fentanyl dis 25mcg/hr ........................ 7

fentanyl dis 50mcg/hr ......................... 7

fentanyl dis 75mcg/hr ......................... 7 fer-iron dro 15mg/ml ........................ 79

ferocon cap ..................................... 78 ferosul elx 220/5ml .......................... 79

ferotrin cap ..................................... 78 ferotrinsic cap .................................. 78

ferrex 150 cap forte .......................... 78 FERRIPROX TAB 500MG .................... 27

ferrous dro 15mg/ml ........................ 79 ferrous sulf dro 15mg/ml .................. 79

ferrous sulf elx 220/5ml .................... 79 fexofen/pse tab 180-240 ................... 58

fexofenadine tab 180mg ................... 30 FINACEA GEL 15% ........................... 67

finasteride tab 5mg .......................... 75

FLAREX SUS 0.1% OP ....................... 91 flavoxate tab 100mg ....................... 104

FLEBOGAMMA INJ 10% ..................... 93 FLEBOGAMMA INJ 5% ....................... 93

FLEBOGAMMA INJ DIF 5% ................. 93 flecainide tab 100mg ........................ 14

flecainide tab 150mg ........................ 14 flecainide tab 50mg .......................... 14

FLECTOR DIS 1.3% .......................... 60 FLOVENT DISK AER 100MCG ............. 15

FLOVENT DISK AER 250MCG ............. 15 FLOVENT DISK AER 50MCG ............... 15

FLOVENT HFA AER 110MCG ............... 15 FLOVENT HFA AER 220MCG ............... 15

FLOVENT HFA AER 44MCG ................. 15

FLUARIX INJ PF 10-11 .................... 105 FLUARIX INJ PF 11-12 .................... 105

FLUARIX INJ PF 12-13 .................... 105 FLUARIX PF INJ 2013-14 ................. 105

FLUARIX QUAD INJ 2013-14 ............ 105 fluconazole sus 10mg/ml ................... 28

fluconazole sus 40mg/ml ................... 28 fluconazole tab 100mg ...................... 28

fluconazole tab 150mg ...................... 28 fluconazole tab 200mg ...................... 28

fluconazole tab 50mg ....................... 28 fludrocort tab 0.1mg ......................... 57

FLULAVAL INJ 2010-11 ................... 105 FLULAVAL INJ 2011-12 ................... 105

FLULAVAL INJ 2012-13 ................... 105

FLULAVAL INJ 2013-14 ................... 105 flunisolide spr 0.025% ...................... 88

123

flunisolide spr 29mcg ........................ 88

fluocin acet cre 0.01% ....................... 64 fluocin acet cre 0.025% ..................... 64

fluocin acet oil 0.01% ........................ 93 fluocin acet oil body .......................... 64

fluocin acet oil scalp .......................... 64 fluocin acet oin 0.025% ..................... 64

fluocin acet sol 0.01% ....................... 64 fluocinonide cre 0.05% ...................... 64

fluocinonide cre 0.1% ........................ 64 fluocinonide gel 0.05% ...................... 64

fluocinonide oin 0.05% ...................... 64 fluocinonide sol 0.05% ...................... 64

FLUORABON DRO .............................. 83 fluor-a-day dro 0.125mg.................... 83

fluoride chw 0.25mg f ........................ 83

fluoride chw 0.5mg f ......................... 83 fluoride chw 1mg f ............................ 83

fluoritab chw 0.25mg f ...................... 83 fluoritab chw 0.5mg f ........................ 83

fluoritab chw 1mg f ........................... 83 fluoritab chw 2.2mg .......................... 83

fluoritab dro 0.125mg........................ 83 fluoromethol sus 0.1% op .................. 91

fluor-op sus 0.1% op ......................... 91 fluorouracil cre 5% ............................ 62

fluorouracil dro 2% ........................... 62 fluorouracil dro 5% ........................... 62

fluorouracil sol 2% ............................ 62 fluorouracil sol 5% ............................ 62

fluoxetine cap 10mg .................... 22, 96

fluoxetine cap 20mg .................... 22, 96 fluoxetine cap 40mg .......................... 22

fluoxetine sol 20mg/5ml .................... 22 fluoxetine tab 10mg .......................... 22

fluoxetine tab 20mg .......................... 22 FLUOXETINE TAB 60MG ..................... 22

fluphenazine con 5mg/ml ................... 42 fluphenazine elx 2.5/5ml ................... 43

fluphenazine tab 10mg ...................... 43 fluphenazine tab 1mg ........................ 43

fluphenazine tab 2.5mg ..................... 43 fluphenazine tab 5mg ........................ 43

flura-drops dro 0.125mg .................... 83 flura-drops dro 0.25mg f .................... 83

flurazepam cap 15mg ........................ 79

flurazepam cap 30mg ........................ 79 flurbiprofen sol 0.03% op .................. 92

flurbiprofen tab 100mg ....................... 3

flurbiprofen tab 50mg ......................... 3 flutamide cap 125mg ........................ 37

fluticasone cre 0.05% ....................... 64 fluticasone lot 0.05% ........................ 64

fluticasone oin 0.005% ..................... 64 fluticasone spr 50mcg ....................... 88

fluvastatin cap 20mg ........................ 31 fluvastatin cap 40mg ........................ 31

FLUVIRIN INJ 2011-12 .................... 105 FLUVIRIN INJ 2012-13 .................... 105

FLUVIRIN INJ PF 11-12 ................... 105 FLUVIRIN INJ PF 12-13 ................... 105

fluvoxamine cap 100mg er ................ 22 fluvoxamine cap 150mg er ................ 22

fluvoxamine tab 100mg .................... 22

fluvoxamine tab 25mg ...................... 22 fluvoxamine tab 50mg ...................... 22

FLUZONE INJ INTRADRM ................. 105 FLUZONE INJ PF 11-12 ................... 105

FLUZONE INJ PF 12-13 ................... 105 FLUZONE INJ PF 13-14 ................... 105

FLUZONE PED/ INJ PF 11-12 ............ 105 FLUZONE PED/ INJ PF 12-13 ............ 105

FLUZONE PED/ INJ PF 13-14 ............ 105 FLUZONE QUAD INJ 13-14 .............. 105

FLUZONE SPLT INJ 2011-12 ............ 105 FLUZONE SPLT INJ 2012-13 ............ 105

FLUZONE SPLT INJ 2013-14 ............ 105 FML FORTE SUS 0.25% OP ................ 91

FML OIN 0.1% OP ............................ 91

FOCALIN XR CAP 10MG ....................... 2 FOCALIN XR CAP 15MG ....................... 2



FOCALIN XR CAP 40MG ....................... 2 FOCALIN XR CAP 5MG ......................... 2

folic acid tab 1000mcg ...................... 77 folic acid tab 1mg ............................. 77

folic acid tab 400mcg ........................ 77 folic acid tab 800mcg ........................ 77

FOLIVANE-OB CAP ............................ 86 foltrin cap ....................................... 78

fondaparinux sol 10/0.8 .................... 17

fondaparinux sol 2.5/0.5 ................... 17 fondaparinux sol 5.0/0.4 ................... 17

124

fondaparinux sol 7.5/0.6 .................... 17

FORADIL CAP AEROLIZE .................... 16 FORTEO SOL 600/2.4 ........................ 70

fosinopril tab 10mg ........................... 32 fosinopril tab 20mg ........................... 32

fosinopril tab 40mg ........................... 32 FOSRENOL CHW 1000MG ................... 74

FOSRENOL CHW 500MG .................... 74 FOSRENOL CHW 750MG .................... 74

FRAGMIN INJ 10000/ML ..................... 18 FRAGMIN INJ 12500UNT .................... 18

FRAGMIN INJ 15000UNT .................... 18 FRAGMIN INJ 18000UNT .................... 18

FRAGMIN INJ 2500/0.2 ...................... 17 FRAGMIN INJ 25000/ML ..................... 18

FRAGMIN INJ 5000/0.2 ...................... 17

FRAGMIN INJ 7500/0.3 ...................... 18 FROVA TAB 2.5MG ............................ 83

fungicure spr intens .......................... 61 furosemide sol 10mg/ml .................... 69

furosemide tab 20mg ........................ 69 furosemide tab 40mg ........................ 69

furosemide tab 80mg ........................ 69 FUZEON INJ 90MG ............................ 44

FUZEON KIT ..................................... 44 G gabapentin cap 100mg ...................... 18 gabapentin cap 300mg ...................... 18

gabapentin cap 400mg ...................... 18 gabapentin tab 600mg ...................... 18

gabapentin tab 800mg ...................... 18

GABITRIL TAB 12MG ......................... 20 GABITRIL TAB 16MG ......................... 20

galantamine cap 16mg er .................. 95 galantamine cap 24mg er .................. 95

galantamine cap 8mg er .................... 95 galantamine tab 12mg ....................... 95

galantamine tab 4mg ........................ 95 galantamine tab 8mg ........................ 95

GAMASTAN S/D INJ ........................... 93 GAMMAGARD SD INJ 10GM HU ........... 93

GAMMAGARD SD INJ 2.5GM HU .......... 93 GAMMAGARD SD INJ 5GM HU ............. 93

GAMMAPLEX INJ 5GM ........................ 93 GAMUNEX INJ 10% ........................... 93

gani-tuss dm liq 100-10/5.................. 58

gani-tuss nr liq 100-10/5 ................... 58 garamycin oin 0.3% op ...................... 90

gatifloxacin sol 0.5% ........................ 90

gavilax pow ..................................... 80 gavilyte-c sol ................................... 80

gavilyte-g sol ................................... 80 GELNIQUE GEL 10% ....................... 105

gemfibrozil tab 600mg ...................... 31 genahist cap 25mg ........................... 29

genaphed tab 30mg ......................... 88 generlac sol 10gm/15 ....................... 74

gengraf cap 100mg .......................... 47 gengraf cap 25mg ............................ 47

gengraf sol 100mg/ml....................... 47 gentak oin 0.3% op .......................... 90

gentak sol 0.3% op .......................... 90 gentamicin cre 0.1% ........................ 60

gentamicin oin 0.1% ........................ 60

gentamicin oin 0.3% op .................... 90 gentamicin sol 0.3% op .................... 90

gentasol sol 0.3% op ........................ 90 gentlelax pow .................................. 80

geri-dryl cap 25mg ........................... 29 geri-hydrola cre 12% ........................ 66

geri-hydrola lot 12% ........................ 66 gg/codeine sol 100-10/5 ................... 58

gianvi tab 3-0.02mg ......................... 54 gildagia tab 0.4-35 ........................... 54

gildess fe tab 1.5/30 ......................... 54 gildess fe tab 1/20 ........................... 54

gildess tab 1.5/30 ............................ 54 gildess tab 1/20 ............................... 54

GILENYA CAP 0.5MG ......................... 96

GLASSIA INJ .................................. 100 GLEEVEC TAB 100MG ....................... 38

GLEEVEC TAB 400MG ....................... 38 glimepiride tab 1mg ......................... 26

glimepiride tab 2mg ......................... 26 glimepiride tab 4mg ......................... 26

glip/metform tab 2.5-250m ............... 24 glip/metform tab 5-500mg ................ 24

glipizide er tab 10mg ........................ 26 glipizide er tab 2.5mg ....................... 26

glipizide er tab 5mg .......................... 26 glipizide tab 10mg ............................ 26

glipizide tab 5mg.............................. 26 glipizide xl tab 10mg ........................ 26

glipizide xl tab 2.5mg ....................... 26

glipizide xl tab 5mg .......................... 26 GLUCAGON KIT 1MG ........................ 25

125

GLUMETZA TAB 1000MG .................... 24

GLUMETZA TAB 500MG ...................... 24 glyb/metform tab 1.25-250 ................ 24

glyb/metform tab 2.5-500 ................. 24 glyb/metform tab 5-500mg ................ 24

glyburid mcr tab 1.5mg ..................... 26 glyburid mcr tab 3mg ........................ 26

glyburid mcr tab 6mg ........................ 26 glyburide tab 1.25mg ........................ 26

glyburide tab 2.5mg .......................... 26 glyburide tab 5mg ............................. 26

glycolax pow 3350 nf ........................ 80 glycopyrrol inj 0.2mg/ml .................. 102

glycopyrrol tab 1mg ........................ 103 glycopyrrol tab 2mg ........................ 103

GLYSET TAB 100MG .......................... 24

GLYSET TAB 25MG ............................ 24 GLYSET TAB 50MG ............................ 24

gnp allergy cap 25mg ........................ 29 gnp allergy tab 180mg ...................... 30

gnp aspirin chw 81mg ........................ 6 gnp aspirin tab 325mg........................ 6

gnp aspirin tab 325mg ec ................... 6 gnp aspirin tab 81mg ec ..................... 6

gnp clearlax pow ............................... 80 GNP DAILY MIS PRENATAL ................. 86

gnp hydrocor cre 1% plus .................. 64 gnp nicotine gum 2mg mint ............... 97

gnp nicotine gum 2mg orig ................ 97 gnp nicotine gum 4mg mint ............... 97

gnp nicotine gum 4mg orig ................ 97

gnp nicotine loz 2mg mint .................. 97 gnp nicotine loz 4mg mint .................. 97

GNP PRENATAL TAB 28-0.8MG............ 86 gnp tussin liq dm .............................. 58

gnp tussin liq dm cough ..................... 58 gnp vit d tab 400unit ....................... 107

granisetron tab 1mg .......................... 27 GRANISOL SOL 2MG/10ML ................. 27

griseofulvin sus 125/5ml .................... 28 griseofulvin tab micr 500 ................... 28

griseofulvin tab ultr 125 ..................... 28 griseofulvin tab ultr 250 ..................... 28

g-tron liq 10-100/5 ........................... 58 guaiasorb dm liq 100-10/5 ................. 58

guaiatussin syp ac ............................ 58

guaifenesin sol dac ............................ 58 guaifenesin syp ac ............................ 58

guanfacine tab 1mg .......................... 34

guanfacine tab 2mg .......................... 34 GYNAZOLE-1 CRE 2% ..................... 106

H halfprin tab 81mg ec .......................... 6

halobetasol cre 0.05% ...................... 64 halobetasol oin 0.05% ...................... 64

HALOG CRE 0.1%............................. 64 HALOG OIN 0.1% ............................. 64

haloperidol con 2mg/ml .................... 41 haloperidol tab 0.5mg ....................... 41

haloperidol tab 10mg ........................ 42 haloperidol tab 1mg ......................... 41

haloperidol tab 20mg ........................ 42 haloperidol tab 2mg ......................... 42

haloperidol tab 5mg ......................... 42

hc pramoxine cre 1-1%..................... 10 hc pramoxine cre 1-2.5% .................. 64

hc pramoxine cre 2.5-1% .................. 10 hc valerate cre 0.2% ........................ 65

hc valerate oin 0.2% ........................ 65 hc/acet acid sol otic .......................... 93

heartbrn rel tab 200mg ................... 103 heartburn tab 150mg ...................... 103

heartburn tab 200mg ...................... 103 heartburn tab 20mg ....................... 103

heartburn tab relief ........................ 103 heather tab 0.35mg .......................... 56

hecoria cap 0.5mg ............................ 47 hecoria cap 1mg .............................. 47

hecoria cap 5mg .............................. 47

HECTOROL CAP 0.5MCG .................... 70 HECTOROL CAP 1MCG....................... 70

HECTOROL CAP 2.5MCG .................... 70 HECTOROL INJ 2MCG/ML .................. 71

HECTOROL INJ 4MCG/2ML ................. 71 HELIXATE FS INJ 1000UNIT ............... 76

HELIXATE FS INJ 2000UNIT ............... 76 HELIXATE FS INJ 250UNIT ................ 76

HELIXATE FS INJ 500UNIT ................ 76 HELIXATE FS SOL 1000UNIT .............. 76

HELIXATE FS SOL 250UNIT ............... 76 HELIXATE FS SOL 500UNIT ............... 76

HEMA-COMBIST TES ......................... 67 HEMOFIL M INJ 220-400 ................... 76

HEMOFIL M INJ 401-800 ................... 76

hemril-30 sup 30mg ......................... 10 HEPSERA TAB 10MG ......................... 45

126

HEXALEN CAP 50MG .......................... 36

HIZENTRA INJ 2GM/10ML .................. 93 hm aspirin chw 81mg ......................... 6

hm aspirin tab 325mg ........................ 6 hm clearlax pow ............................... 80

hm nicotine dis 14mg/24h ................. 97 hm nicotine dis 21mg/24h ................. 97

hm nicotine gum 2mg mint ................ 97 hm nicotine gum 4mg mint ................ 97

hm nicotine loz 2mg mint .................. 98 hm nicotine loz 4mg mint .................. 98

HM PRENATAL TAB ............................ 86 hm tussin liq adlt dm ......................... 58

homatropaire sol 5% op .................... 89 homatropine sol 5% op ..................... 89

HORIZANT TAB 600MG ...................... 96

hrtbrn rel cap 15mg dr .................... 104 HUMALOG INJ 100/ML ....................... 25

HUMALOG KWIK INJ 100/ML .............. 25 HUMALOG MIX INJ 50/50 ................... 25

HUMALOG MIX INJ 50/50KWP ............ 25 HUMALOG MIX INJ 75/25KWP ............ 25

HUMALOG MIX SUS 75/25 ................. 25 HUMATE-P INJ 1000UNIT ................... 76

HUMATE-P INJ 2000UNIT ................... 76 HUMATE-P INJ 500UNIT ..................... 76

HUMATE-P INJ 600UNIT ..................... 76 HUMATE-P SOL 1200UNIT .................. 76

HUMATE-P SOL 2400UNIT .................. 76 HUMATE-P SOL 600UNIT .................... 76

HUMIRA KIT 20MG/0.4 ....................... 3

HUMIRA KIT 40MG/0.8 ....................... 3 HUMIRA PEN KIT 40MG/0.8 ................. 3

HUMIRA PEN KIT CROHNS .................. 3 HUMIRA PEN KIT PSORIASI ................. 3

HUMULIN INJ 70/30 .......................... 25 HUMULIN N INJ U-100 ....................... 25

HUMULIN N PN INJ U-100 .................. 25 HUMULIN PEN INJ 70/30 .................... 25

HUMULIN R INJ U-100 ....................... 25 HYALGAN INJ 20MG/2ML ................... 87

hyd polst-ch liq lor pols ..................... 58 hydralazine tab 100mg ...................... 35

hydralazine tab 10mg ........................ 35 hydralazine tab 25mg ........................ 35

hydralazine tab 50mg ........................ 35

hydrochlorot cap 12.5mg ................... 69 hydrochlorot tab 12.5mg ................... 69

hydrochlorot tab 25mg ..................... 69

hydrochlorot tab 50mg ..................... 69 hydroco/apap sol 7.5-325 ................... 9

hydroco/apap sol 7.5-500 ................... 9 hydroco/apap tab 10-325mg ............... 9

hydroco/apap tab 10-500mg ............... 9 hydroco/apap tab 10-650mg ............... 9

hydroco/apap tab 2.5-500 ................... 9 hydroco/apap tab 5-325mg ................. 9

hydroco/apap tab 5-500mg ................. 9 hydroco/apap tab 7.5-325 ................... 9

hydroco/apap tab 7.5-500 ................... 9 hydroco/apap tab 7.5-650 ................... 9

hydroco/apap tab 7.5-750 ................... 9 hydrocod/hom syp 5-1.5/5 ................ 57

hydrocod/ibu tab 10-200mg ................ 9

hydrocod/ibu tab 2.5-200 .................... 9 hydrocod/ibu tab 5-200mg .................. 9

hydrocod/ibu tab 7.5-200 .................... 9 hydrocort ac sup 25mg ..................... 10

hydrocort ac sup 30mg ..................... 10 hydrocort cre 1% ............................. 65

hydrocort cre 1% plus ...................... 65 hydrocort cre 1%pls 10 ..................... 65

hydrocort cre 1%pls 12 ..................... 65 hydrocort cre 2.5% .......................... 65

hydrocort ene 100mg ....................... 10 hydrocort lot 1% .............................. 65

hydrocort lot 2.5% ........................... 65 hydrocort oin 2.5% .......................... 65

hydrocort tab 20mg .......................... 57

hydrocream cre 1% .......................... 65 hydro-lotion lot 1% .......................... 65

hydromet syp 5-1.5/5 ....................... 57 hydromorphon liq 1mg/ml ................... 7

hydromorphon tab 2mg ...................... 7 hydromorphon tab 4mg ...................... 7

hydromorphon tab 8mg ...................... 7 hydroskin cre 1% ............................. 65

hydroxychlor tab 200mg ................... 36 hydroxyurea cap 500mg ................... 39

hydroxyz hcl sol 10mg/5ml................ 13 hydroxyz hcl syp 10mg/5ml ............... 13

hydroxyz hcl tab 10mg ..................... 13 hydroxyz hcl tab 25mg ..................... 13

hydroxyz hcl tab 50mg ..................... 13

hydroxyz pam cap 100mg ................. 13 hydroxyz pam cap 25mg ................... 13

127

hydroxyz pam cap 50mg .................... 13

hyomax tab 0.125mg ...................... 103 hyomax-sl sub 0.125mg .................. 103

hyoscyamine dro 0.125/ml ............... 103 hyoscyamine elx 0.125/5 ................. 103

hyoscyamine sub 0.125mg ............... 103 hyoscyamine tab 0.125mg ............... 103

hyosyne dro 0.125/ml ..................... 103 hyosyne elx 0.125/5 ....................... 103

hypercare sol 20% ............................ 67 HYPERRHO S/D INJ 300MCG .............. 93

I ibandronate tab 150mg ..................... 70

ibudone tab 10-200mg ....................... 9 ibudone tab 5-200mg ......................... 9

ibuprofen tab 400mg .......................... 4

ibuprofen tab 600mg .......................... 4 ibuprofen tab 800mg .......................... 4

iferex 150 cap forte ........................... 78 ilotycin oin op ................................... 90

imipram hcl tab 10mg ....................... 23 imipram hcl tab 25mg ....................... 23

imipram hcl tab 50mg ....................... 23 imiquimod cre 5% ............................. 66

imperim tab 2mg .............................. 27 INCIVEK TAB 375MG ......................... 46

INCRELEX INJ 40MG/4ML ................... 70 indapamide tab 1.25mg ..................... 69

indapamide tab 2.5mg ....................... 69 indomethacin cap 25mg ...................... 4

indomethacin cap 50mg ...................... 4

indomethacin cap 75mg er .................. 4 INFERGEN INJ 15MCG ....................... 46

INFERGEN INJ 9MCG ......................... 46 INFLUENZA A INJ PF09H1N1 ............ 106

INSPIREASE MIS MOUTHPCE .............. 82 INSPIREASE MIS REP MOUT ............... 82

INSULIN PEN NEEDLES ...................... 82 INSULIN SYRINGES ........................... 82

INTELENCE TAB 100MG ..................... 44 INTELENCE TAB 200MG ..................... 44

INTELENCE TAB 25MG ....................... 44 INTRON-A INJ 10MU.......................... 39

INTRON-A INJ 10MU PEN ................... 39 INTRON-A INJ 18MU.......................... 39

INTRON-A INJ 25MU.......................... 39

INTRON-A INJ 3MU PEN ..................... 39 INTRON-A INJ 50MU.......................... 39

INTRON-A INJ 5MU PEN .................... 39

INTUNIV TAB 1MG .............................. 1 INTUNIV TAB 2MG .............................. 1

INTUNIV TAB 3MG .............................. 1 INTUNIV TAB 4MG .............................. 1

INVEGA TAB 1.5MG .......................... 41 INVEGA TAB 3MG ............................. 41

INVEGA TAB 6MG ............................. 41 INVEGA TAB 9MG ............................. 41

INVIRASE CAP 200MG ...................... 44 INVIRASE TAB 500MG ...................... 44

iophen c-nr liq 100-10/5 ................... 58 iophen dm-nr liq 100-10/5 ................ 58

IOPIDINE SOL 1% OP ....................... 90 ipratropium sol 0.02%inh .................. 15

ipratropium spr 0.03% ...................... 88

ipratropium spr 0.06% ...................... 88 irbesartan tab 300mg ....................... 33

irbesartan tab 75mg ......................... 33 iron supplmt dro 15mg/ml ................. 79

ISENTRESS CHW 100MG ................... 44 ISENTRESS CHW 25MG ..................... 44

ISENTRESS TAB 400MG .................... 44 ISO HOMATROP SOL 2% OP .............. 89

isochron tab 40mg cr ........................ 12 isoditrate tab 40mg er ...................... 12

isometh/apap cap dichlor .................. 82 isonarif cap ..................................... 36

isoniazid syp 50mg/5ml .................... 36 isoniazid tab 100mg ......................... 36

isoniazid tab 300mg ......................... 36

ISORDIL TAB 40MG .......................... 12 isosorb din sub 2.5mg ...................... 12

isosorb din sub 5mg ......................... 12 isosorb din tab 10mg ........................ 12

isosorb din tab 20mg ........................ 12 isosorb din tab 30mg ........................ 12

isosorb din tab 40mg er .................... 12 isosorb din tab 5mg .......................... 12

isosorb mono tab 10mg .................... 12 isosorb mono tab 120mg er ............... 12

isosorb mono tab 20mg .................... 12 isosorb mono tab 30mg er ................. 12

isosorb mono tab 60mg er ................. 12 isradipine cap 2.5mg ........................ 51

isradipine cap 5mg ........................... 51

itch-x lot 1% ................................... 65 itchy eye dro 0.025%op .................... 92

128

itraconazole cap 100mg ..................... 28

J JAKAFI TAB 10MG ............................. 38

JAKAFI TAB 15MG ............................. 38 JAKAFI TAB 20MG ............................. 38

JAKAFI TAB 25MG ............................. 38 JAKAFI TAB 5MG ............................... 38

jantoven tab 10mg ............................ 17 jantoven tab 1mg ............................. 17

jantoven tab 2.5mg ........................... 17 jantoven tab 2mg ............................. 17

jantoven tab 3mg ............................. 17 jantoven tab 4mg ............................. 17

jantoven tab 5mg ............................. 17 jantoven tab 6mg ............................. 17

jantoven tab 7.5mg ........................... 17

JANUVIA TAB 100MG ......................... 25 JANUVIA TAB 25MG .......................... 25

JANUVIA TAB 50MG .......................... 25 jencycla tab 0.35mg .......................... 56

JENTADUETO TAB 2.5-1000 ............... 24 JENTADUETO TAB 2.5-500 ................. 24

JENTADUETO TAB 2.5-850 ................. 24 jevantique tab 1mg-5mcg .................. 72

jinteli tab 1mg-5mcg ......................... 72 jock itch cre 1% ............................... 61

jolivette tab 0.35mg .......................... 56 junel 1.5/30 tab................................ 54

junel 1/20 tab .................................. 54 junel fe tab 1.5/30 ............................ 54

junel fe tab 1/20 ............................... 54

just d liq 400unit ............................ 107 K KALETRA SOL ................................... 44 KALETRA TAB 100-25MG ................... 44

KALETRA TAB 200-50MG ................... 44 kalexate pow .................................... 48

KALYDECO TAB 150MG .................... 100 karidium dro 0.125mg ....................... 83

kariva tab 28 day .............................. 54 KEFLEX CAP 750MG .......................... 53

kelnor tab 1/35 ................................ 54 KENALOG AER SPRAY ........................ 65

kericort 10 cre 1% ............................ 65 KETEK TAB 300MG ............................ 11

KETEK TAB 400MG ............................ 11

ketoconazole cre 2% ......................... 61 ketoconazole sha 2% ........................ 61

ketoconazole tab 200mg ................... 28

KETO-DIASTIX TES .......................... 67 ketoprofen cap 200mg er .................... 4

ketorolac sol 0.4% ........................... 92 ketorolac sol 0.5% ........................... 92

ketorolac tab 10mg ............................ 4 ketotif fum dro 0.025%op ................. 92

KINERET INJ ...................................... 3 kionex pow usp ................................ 48

klor-con 10 tab 10meq er .................. 84 klor-con 8 tab 8meq er ..................... 84

klor-con m10 tab 10meq er ............... 84 KLOR-CON M15 TAB ......................... 84

klor-con m20 tab 20meq er ............... 84 kls anti-dia tab 2mg ......................... 27

kls aspirin tab 325mg ec ..................... 6

kls aspirin tab 81mg ec ....................... 6 kls quit2 gum 2mg ........................... 98

kls quit4 gum 4mg ........................... 98 KOATE-DVI INJ 1000UNIT ................. 76

KOATE-DVI INJ 250UNIT ................... 76 KOATE-DVI INJ 500UNIT ................... 76

KOGENATE FS INJ 1000/BS ............... 76 KOGENATE FS INJ 1000UNIT ............. 76

KOGENATE FS INJ 2000/BS ............... 76 KOGENATE FS INJ 2000UNIT ............. 76

KOGENATE FS INJ 250/BS ................. 76 KOGENATE FS INJ 250UNIT ............... 76

KOGENATE FS INJ 500/BS ................. 76 KOGENATE FS INJ 500UNIT ............... 76

kp aspirin tab 81mg ec ....................... 6

KP PRENATAL TAB MULTIVIT ............. 86 kurvelo tab 0.15/30 .......................... 54

KUVAN TAB 100MG .......................... 71 L labetalol tab 100mg .......................... 48 labetalol tab 200mg .......................... 48

labetalol tab 300mg .......................... 48 LABSTIX TES ................................... 67

laclotion lot 12% .............................. 66 LACRISERT MIS 5MG OP ................... 89

lactulose sol 10gm/15 .................. 74, 80 lactulose sol 20gm/30 ....................... 80

LAMICTAL CHW 2MG ........................ 18 LAMICTAL ODT TAB 100MG ............... 18

LAMICTAL ODT TAB 200MG ............... 18

LAMICTAL ODT TAB 25MG ................. 18 LAMICTAL ODT TAB 50MG ................. 18

129

LAMICTAL XR KIT .............................. 18

lamivud/zido tab 150-300 .................. 44 lamivudine tab 100mg ....................... 44

lamivudine tab 150mg ....................... 44 lamivudine tab 300mg ....................... 44

lamotrigine chw 25mg ....................... 18 lamotrigine chw 5mg ......................... 18

lamotrigine tab 100mg ...................... 19 lamotrigine tab 100mg er .................. 19

lamotrigine tab 150mg ...................... 19 lamotrigine tab 200mg ...................... 19

lamotrigine tab 200mg er .................. 19 lamotrigine tab 250mg er .................. 19

lamotrigine tab 25mg ........................ 19 lamotrigine tab 25mg er .................... 19

lamotrigine tab 300mg er .................. 19

lamotrigine tab 50mg er .................... 19 LANCETS ......................................... 82

lansoprazole cap 15mg dr ................ 104 lansoprazole cap 30mg dr ................ 104

LANTUS INJ 100/ML .......................... 25 LANTUS INJ SOLOSTAR ..................... 25

LASTACAFT SOL 0.25% ..................... 92 latanoprost sol 0.005% ..................... 92

LATUDA TAB 120MG .......................... 41 LATUDA TAB 20MG ........................... 41

LATUDA TAB 40MG ........................... 41 LATUDA TAB 80MG ........................... 41

laxaclear pow ................................... 80 leena tab ......................................... 54

leflunomide tab 10mg ......................... 4

leflunomide tab 20mg ......................... 4 lessina tab ....................................... 54

LETAIRIS TAB 10MG .......................... 52 LETAIRIS TAB 5MG ........................... 52

letrozole tab 2.5mg ........................... 37 leucovor ca tab 10mg ........................ 39

leucovor ca tab 15mg ........................ 39 leucovor ca tab 25mg ........................ 39

leucovor ca tab 5mg .......................... 39 LEUKERAN TAB 2MG.......................... 36

LEUKINE INJ 250MCG ........................ 78 LEUKINE INJ 500 MCG ....................... 78

leuprolide inj 1mg/0.2 ....................... 37 LEVATOL TAB 20MG .......................... 49

LEVEMIR INJ .................................... 25

LEVEMIR INJ FLEXPEN ....................... 25 levetiraceta sol 100mg/ml .................. 19

levetiraceta sol 500/5ml .................... 19

levetiraceta tab 1000mg ................... 19 levetiraceta tab 250mg ..................... 19

levetiraceta tab 500mg ..................... 19 levetiraceta tab 750mg ..................... 19

LEVITRA TAB 10MG .......................... 52 LEVITRA TAB 2.5MG ......................... 52

LEVITRA TAB 20MG .......................... 52 LEVITRA TAB 5MG ............................ 52

levobunolol sol 0.25% op .................. 89 levobunolol sol 0.5% op .................... 89

levocarnitin sol 1gm/10ml ................. 71 levocarnitin tab 330mg ..................... 71

levofloxacin tab 250mg ..................... 73 levofloxacin tab 500mg ..................... 73

levofloxacin tab 750mg ..................... 73

levonest tab .................................... 54 levonor/ethi tab 0.1-0.02 .................. 54

levonor/ethi tab estradio ................... 54 levonorgestr tab 0.75mg ................... 56

levonorgestr tab 1.5mg ..................... 56 levora-28 tab 0.15/30 ....................... 54

levorphanol tab 2mg ........................... 7 levothroid tab 100mcg .................... 101

levothroid tab 112mcg .................... 101 levothroid tab 125mcg .................... 101



levothroid tab 25mcg ...................... 101

levothroid tab 300mcg .................... 101 levothroid tab 50mcg ...................... 101

levothroid tab 75mcg ...................... 101 levothroid tab 88mcg ...................... 101

levothyroxin tab 100mcg ................. 101 levothyroxin tab 112mcg ................. 101



levothyroxin tab 200mcg ................. 101 levothyroxin tab 25mcg .................. 101

levothyroxin tab 300mcg ................. 101 levothyroxin tab 50mcg .................. 101

levothyroxin tab 75mcg .................. 101

levothyroxin tab 88mcg .................. 101 levoxyl tab 100mcg ........................ 101

130

levoxyl tab 112mcg ......................... 101

levoxyl tab 125mcg ......................... 101 levoxyl tab 137mcg ......................... 101

levoxyl tab 150mcg ......................... 101 levoxyl tab 175mcg ......................... 101

levoxyl tab 200mcg ......................... 101 levoxyl tab 25mcg ........................... 101

levoxyl tab 50mcg ........................... 101 levoxyl tab 75mcg ........................... 101

levoxyl tab 88mcg ........................... 101 LEXIVA SUS 50MG/ML ....................... 44

LEXIVA TAB 700MG ........................... 44 LIALDA TAB 1.2GM ........................... 74

lidazone cre ..................................... 10 lido/prilocn cre 2.5-2.5% ................... 66

lidocaine gel 2% ............................... 66

lidocaine gel 2% jelly ........................ 66 lidocaine oin 5% ............................... 66

lidocaine pad 5% .............................. 66 lidocaine sol 2% visc ......................... 84

lidocaine sol 4% ......................... 66, 84 lidocaine/hc cre 3%-0.5% .................. 10

LIDODERM DIS 5% ........................... 66 lindane sha 1%................................. 67

LINZESS CAP 145MCG ....................... 74 LINZESS CAP 290MCG ....................... 74

liothyronine tab 25mcg .................... 102 liothyronine tab 50mcg .................... 102

liothyronine tab 5mcg ...................... 101 lisinop/hctz tab 10-12.5 ..................... 35

lisinop/hctz tab 20-12.5 ..................... 35

lisinop/hctz tab 20-25mg ................... 35 lisinopril tab 10mg ............................ 32

lisinopril tab 2.5mg ........................... 32 lisinopril tab 20mg ............................ 32

lisinopril tab 30mg ............................ 32 lisinopril tab 40mg ............................ 32

lisinopril tab 5mg .............................. 32 lithium carb cap 150mg ..................... 40

lithium carb cap 300mg ..................... 40 lithium carb cap 600mg ..................... 40

lithium carb tab 300mg ..................... 41 lithium carb tab 300mg er .................. 41

lithium carb tab 450mg er .................. 41 LITHIUM CITR SOL 8MEQ/5ML ............ 41

LIVALO TAB 1MG .............................. 31

LIVALO TAB 2MG .............................. 31 LIVALO TAB 4MG .............................. 31

LODOSYN TAB 25MG ........................ 39

lofene tab 2.5mg .............................. 27 lokara lot 0.05% .............................. 65

lomustine cap 100mg ....................... 36 lomustine cap 10mg ......................... 36

lomustine cap 40mg ......................... 36 lonox tab 2.5mg ............................... 27

loperamide cap 2mg ......................... 27 loperamide tab 2mg ......................... 27

lorazepam tab 0.5mg ........................ 13 lorazepam tab 1mg .......................... 13

lorazepam tab 2mg .......................... 13 loryna tab 3-0.02mg ......................... 54

LORZONE TAB 375MG ....................... 87 LORZONE TAB 750MG ....................... 87

losartan pot tab 100mg ..................... 33

losartan pot tab 25mg ...................... 33 losartan pot tab 50mg ...................... 33

losartan/hct tab 100-12.5 ................. 35 losartan/hct tab 100-25 .................... 35

losartan/hct tab 50-12.5 ................... 35 LOTEMAX GEL 0.5% ......................... 91

LOTEMAX OIN 0.5% ......................... 91 LOTEMAX SUS 0.5% ......................... 91

LOTRIMIN ULT CRE 1% ..................... 61 lovastatin tab 10mg.......................... 31

lovastatin tab 20mg.......................... 31 lovastatin tab 40mg.......................... 31

LOVAZA CAP 1GM ............................ 30 low-ogestrel tab ............................... 54

loxapine cap 10mg ........................... 42

loxapine cap 25mg ........................... 42 loxapine cap 50mg ........................... 42

loxapine cap 5mg ............................. 42 ludent chw 0.25mg f ......................... 84

ludent chw 0.5mg f .......................... 84 ludent chw 1mg f ............................. 84

LUMIGAN SOL 0.01% ....................... 92 LUMIGAN SOL 0.03% ....................... 92

LUMIZYME INJ 50MG ........................ 71 LUNESTA TAB 1MG ........................... 79

LUNESTA TAB 2MG ........................... 79 LUNESTA TAB 3MG ........................... 79

LUPRON DEPOT INJ 11.25MG ............. 37 LUPRON DEPOT INJ 22.5MG .............. 37

LUPRON DEPOT INJ 3.75MG .............. 37

LUPRON DEPOT INJ 30MG ................. 37 LUPRON DEPOT INJ 7.5MG ................ 37

131

lutera tab ......................................... 54

LYRICA CAP 100MG ........................... 19 LYRICA CAP 150MG ........................... 19

LYRICA CAP 200MG ........................... 19 LYRICA CAP 225MG ........................... 19

LYRICA CAP 25MG ............................ 19 LYRICA CAP 300MG ........................... 19

LYRICA CAP 50MG ............................ 19 LYRICA CAP 75MG ............................ 19

LYSODREN TAB 500MG ...................... 37 M MACRODANTIN CAP 25MG ............... 104 malathion lot 0.5% ........................... 67

maprotiline tab 25mg ........................ 21 maprotiline tab 50mg ........................ 21

maprotiline tab 75mg ........................ 21

margesic cap ..................................... 5 marlissa tab 0.15/30 ......................... 54

MARPLAN TAB 10MG ......................... 22 marten-tab tab 50-325mg .................. 5

martinic cap ..................................... 78 MATULANE CAP 50MG ....................... 39

MAXAIR AUTOH AER 200MCG ............. 16 mebendazole chw 100mg ................... 11

meclizine tab 12.5mg ........................ 27 meclizine tab 25mg ........................... 27

meclofen sod cap 100mg .................... 4 meclofen sod cap 50mg ...................... 4

med-derm hc cre 1% ........................ 65 medi-meclizi tab 25mg ...................... 27

medi-phedrin tab 30mg ..................... 88

medi-phedryl cap 25mg ..................... 29 medi-phedryl elx 12.5/5ml ................. 29

medi-tuss dm liq diabetic ................... 58 medroxypr ac inj 150mg/ml ............... 56

medroxypr ac tab 10mg..................... 95 medroxypr ac tab 2.5mg.................... 94

medroxypr ac tab 5mg ...................... 95 mefenam acid cap 250mg ................... 4

mefloquine tab 250mg ....................... 36 megestrol ac sus 400mg/10 ............... 38

megestrol ac sus 40mg/ml ................. 37 megestrol ac tab 20mg ...................... 38

megestrol ac tab 40mg ...................... 38 MEIJER LANCETS .............................. 82

MEIJER LANCETS THIN ...................... 82

meloxicam tab 15mg .......................... 4 meloxicam tab 7.5mg ......................... 4

MENEST TAB 0.3MG ......................... 73

MENEST TAB 0.625MG ...................... 73 MENEST TAB 1.25MG ........................ 73

MENEST TAB 2.5MG ......................... 73 MENTAX CRE 1% ............................. 61

meperidine sol 50mg/5ml .................... 7 meperidine tab 100mg ........................ 7

meperidine tab 50mg.......................... 7 meperitab tab 100mg ......................... 7

meperitab tab 50mg ........................... 7 MEPHYTON TAB 5MG ...................... 107

meprobamate tab 200mg .................. 13 meprobamate tab 400mg .................. 13

MEPRON SUS ................................... 11 mercaptopur tab 50mg ..................... 37

MESTINON SYP 60MG/5ML ................ 36

MESTINON TAB TIMESPAN ................ 36 metadate tab 20mg er ........................ 2

metaproteren syp 10mg/5ml ............. 16 metaproteren tab 10mg .................... 16

metaproteren tab 20mg .................... 16 metaxalone tab 800mg ..................... 87

metformin er tab 1000mg ................. 24 metformin tab 1000mg ..................... 25

metformin tab 500mg ....................... 24 metformin tab 500mg er ................... 25

metformin tab 750mg er ................... 25 metformin tab 850mg ....................... 25

methadone tab 10mg ......................... 7 methadone tab 40mg ......................... 7

methadone tab 5mg ........................... 7

methadose tab 10mg .......................... 7 methadose tab 40mg .......................... 7

methadose tab 5mg ........................... 7 methamphetam tab 5mg ..................... 1

methazolamid tab 25mg ................... 68 methazolamid tab 50mg ................... 68

methenam hip tab 1gm ................... 104 methimazole tab 10mg ................... 100

methimazole tab 5mg ..................... 100 METHITEST TAB 10MG ...................... 10

methocarbam tab 500mg .................. 87 methocarbam tab 750mg .................. 87

methotrexate tab 2.5mg ................... 37 methoxsalen cap 10mg ..................... 62

methscopolam tab 2.5mg ................ 103

methyclothia tab 5mg ....................... 69 methyldopa tab 250mg ..................... 34

132

methyldopa tab 500mg ...................... 34

methylergon tab 0.2mg ..................... 93 methylin tab 10mg ............................. 2

methylin tab 10mg er ......................... 2 methylin tab 20mg ............................. 2

methylin tab 20mg er ......................... 2 methylin tab 5mg .............................. 2

methylphenid cap 10mg ..................... 2 methylphenid cap 20mg ..................... 2

methylphenid cap 20mg er .................. 2 methylphenid cap 30mg ..................... 2



methylphenid cap 60mg ..................... 2

methylphenid tab 10mg ...................... 2 methylphenid tab 10mg er .................. 2

methylphenid tab 18mg er .................. 2 methylphenid tab 20mg ...................... 2

methylphenid tab 20mg er .................. 2 methylphenid tab 20mg sr .................. 2

methylphenid tab 27mg er .................. 2 methylphenid tab 36mg er .................. 2

methylphenid tab 54mg er .................. 2 methylphenid tab 5mg ........................ 2

methylpred pak 4mg ......................... 57 methylpred tab 16mg ........................ 57

methylpred tab 32mg ........................ 57 methylpred tab 4mg .......................... 57

methylpred tab 8mg .......................... 57

metipranolol sol 0.3% ....................... 89 metipranolol sol 0.3% oph ................. 89

metoclopram sol 10/10ml .................. 74 metoclopram sol 5mg/5ml ................. 74

metoclopram tab 10mg ..................... 74 metoclopram tab 5mg ....................... 74

metolazone tab 10mg ........................ 69 metolazone tab 2.5mg ....................... 69

metolazone tab 5mg ......................... 69 metoprol tar tab 100mg ..................... 49

metoprol tar tab 25mg ...................... 48 metoprol tar tab 50mg ...................... 48

metoprolol tab 100mg er ................... 49 metoprolol tab 200mg er ................... 49

metoprolol tab 25mg er ..................... 49

metoprolol tab 50mg er ..................... 49 metronidazol cap 375mg ................... 11

metronidazol cre 0.75% .................... 67

metronidazol gel 0.75% .................... 67 metronidazol gel 0.75%vag ............. 106

metronidazol gel 1% ........................ 67 metronidazol lot 0.75% ..................... 67

metronidazol tab 250mg ................... 11 metronidazol tab 500mg ................... 11

mexiletine cap 150mg ....................... 14 mexiletine cap 200mg ....................... 14

mexiletine cap 250mg ....................... 14 micaderm cre 2% ............................. 61

MICARDIS HCT ................................ 35 MICARDIS TAB 20MG........................ 33

MICARDIS TAB 40MG........................ 33 MICARDIS TAB 80MG........................ 33

miconazole cre 2% ........................... 61

MICONAZOLE POW NITRATE .............. 61 micro guard cre 2% .......................... 61

microgestin tab 1.5/30 ..................... 54 microgestin tab 1/20 ........................ 54

microgestin tab fe 1/20 ..................... 55 microgestin tab fe1.5/30 ................... 55

MIGERGOT SUP 2/100 ...................... 82 migragesic cap ida ........................... 82

MILLIPRED SOL 10MG/5ML ................ 57 MILLIPRED TAB 5MG ........................ 57

miniprin low tab 81mg ec .................... 6 minirin spr nasal .............................. 71

minitran dis 0.1mg/hr ....................... 12 minitran dis 0.2mg/hr ....................... 12

minitran dis 0.4mg/hr ....................... 12

minitran dis 0.6mg/hr ....................... 12 MINIVELLE DIS 0.0375MG ................. 73

MINIVELLE DIS 0.05MG .................... 73 MINIVELLE DIS 0.075MG................... 73

MINIVELLE DIS 0.1MG ...................... 73 minocycline cap 100mg ................... 100

minocycline cap 50mg .................... 100 minoxidil tab 10mg ........................... 35

minoxidil tab 2.5mg.......................... 35 MIRENA IUD SYSTEM ........................ 56

mirtazapine tab 15mg ....................... 21 mirtazapine tab 15mg odt ................. 21

mirtazapine tab 30mg ....................... 21 mirtazapine tab 30mg odt ................. 21

mirtazapine tab 45mg ....................... 21

mirtazapine tab 45mg odt ................. 21 mirtazapine tab 7.5mg ...................... 21

133

misoprostol tab 100mcg .................. 104

misoprostol tab 200mcg .................. 104 mm aspirin tab 325mg ....................... 6

modafinil tab 100mg .......................... 2 modafinil tab 200mg .......................... 2

moexipril tab 15mg ........................... 33 moexipril tab 7.5mg .......................... 33

moist skin cre 12% ........................... 66 moist skin lot 12% ............................ 66

mometasone cre 0.1% ...................... 65 mometasone oin 0.1% ...................... 65

mometasone sol 0.1% ....................... 65 MONOCLATE-P INJ 1000UNIT ............. 76

MONOCLATE-P INJ 1500UNIT ............. 76 MONOCLATE-P INJ 250UNIT ............... 76

MONOCLATE-P INJ 500UNIT ............... 76

mono-linyah tab 0.25-35 ................... 55 mononessa tab ................................. 55

MONONINE INJ 1000UNIT .................. 77 MONONINE INJ 250UNIT .................... 77

MONONINE INJ 500UNIT .................... 77 montelukast chw 4mg ....................... 15

montelukast chw 5mg ....................... 15 montelukast gra 4mg ........................ 15

montelukast tab 10mg....................... 15 MONUROL PAK GRANULES ............... 104

morgidox cap 1x100mg ................... 100 morgidox cap 2x100mg ................... 100

morphine sul cap 100mg er ................. 7 morphine sul cap 20mg er .................. 7

morphine sul cap 30mg er .................. 7

morphine sul cap 50mg er .................. 7 morphine sul cap 60mg er .................. 7

morphine sul cap 80mg er .................. 7 morphine sul tab 100mg er ................. 8

morphine sul tab 15mg ....................... 7 morphine sul tab 15mg er ................... 7

morphine sul tab 200mg er ................. 8 morphine sul tab 30mg ....................... 7

morphine sul tab 30mg er ................... 7 motion relf tab 25mg ......................... 27

motion sick tab 25mg ........................ 27 MOTOFEN TAB .................................. 27

MOVIPREP SOL ................................. 80 MOXATAG TAB 775MG ....................... 94

MOXEZA SOL 0.5% ........................... 90

MOZOBIL INJ ................................... 79 mp aller med cap 25mg ..................... 29

mp clotrimaz cre 1% ........................ 61

mp hydrocort cre 1% ........................ 65 mtest hs/est tab estrogen ................. 72

mtest/est tab estrogen ..................... 72 MULTAQ TAB 400MG......................... 14

MULTISTIX 10 TES SG ...................... 68 MULTISTIX 5 TES ............................. 68

MULTISTIX 7 TES ............................. 68 MULTISTIX 8 TES SG ........................ 68

MULTISTIX 9 TES ............................. 68 MULTISTIX 9 TES SG ........................ 68

MULTISTIX TES ................................ 68 multi-vit/fe dro /fl 0.25 ..................... 85

multivit/fl chw 0.25mg ...................... 85 multi-vit/fl chw 0.25mg..................... 85

multivit/fl chw 0.5mg ........................ 85

multi-vit/fl chw 0.5mg ...................... 85 multivit/fl chw 1mg .......................... 85

multi-vit/fl chw 1mg ......................... 85 multi-vit/fl dro /fe 0.25 ..................... 85

multi-vit/fl dro 0.25mg ..................... 85 multi-vit/fl dro 0.5mg/ml .................. 85

mult-vit/fl chw 0.5mg ....................... 85 mupirocin ca cre 2% ......................... 60

mupirocin cre 2% ............................. 60 mupirocin oin 2% ............................. 60

mvc-fluoride chw 0.25mg .................. 85 mvc-fluoride chw 0.5mg .................... 85

mvc-fluoride chw 1mg ...................... 85 my way tab 1.5mg ........................... 56

myci-gc sol 100-10/5 ........................ 58

MYCOBUTIN CAP 150MG ................... 36 mycophenolat cap 250mg ................. 47

mycophenolat tab 500mg .................. 47 mycophenolic tab 180mg dr .............. 47

mycophenolic tab 360mg dr .............. 47 mydral sol 0.5% op .......................... 89

mydral sol 1% op ............................. 89 myferon 150 cap forte ...................... 78

MYFORTIC TAB 180MG ...................... 47 MYFORTIC TAB 360MG ...................... 47

MYLERAN TAB 2MG........................... 36 mynephrocaps cap ........................... 85

MYOBLOC INJ 10000/2 ..................... 89 MYOBLOC INJ 2500/0.5 .................... 89

MYOBLOC INJ 5000/ML ..................... 89

myorisan cap 10mg .......................... 60 myorisan cap 20mg .......................... 60

134

myorisan cap 40mg ........................... 60

MYOZYME INJ 50MG .......................... 71 MYTELASE TAB 10MG ........................ 36

mytussin ac syp 100-10/5 .................. 58 mytussin dac sol ............................... 58

myzilra tab....................................... 55 N nabumetone tab 500mg ...................... 4 nabumetone tab 750mg ...................... 4

nadolol tab 20mg .............................. 49 nadolol tab 40mg .............................. 49

nadolol tab 80mg .............................. 49 nafrinse chw 1mg f ........................... 84

nafrinse dro 0.125mg ........................ 84 NAFTIN CRE 1% ............................... 61

NAFTIN CRE 2% ............................... 61

NAFTIN GEL 1% ............................... 61 NAGLAZYME INJ 1MG/ML ................... 71

NAMENDA SOL 10MG/5ML ................. 95 NAMENDA TAB 10MG ........................ 95

NAMENDA TAB 5MG .......................... 95 naphazoline sol 0.1% op .................... 91

naproxen sod tab 550mg .................... 4 naproxen tab 375mg .......................... 4

naproxen tab 500mg .......................... 4 naratriptan tab 1mg .......................... 83

naratriptan tab 2.5mg ....................... 83 nasal decon syp 30mg/5ml ................ 88

nasal decong tab 30mg ..................... 88 NASONEX SPR 50MCG/AC .................. 88

NATACYN SUS 5% OP ....................... 90

nateglinide tab 120mg ....................... 26 nateglinide tab 60mg ........................ 26

natura-lax pow 3350 nf ..................... 80 NEBUPENT INH 300MG ...................... 11

necon tab 0.5/35 .............................. 55 necon tab 1/35 ................................. 55

necon tab 1/50-28 ............................ 55 necon tab 7/7/7 ................................ 55

nefazodone tab 100mg ...................... 21 nefazodone tab 150mg ...................... 21

nefazodone tab 200mg ...................... 21 nefazodone tab 250mg ...................... 21

nefazodone tab 50mg ........................ 21 neo/bac/poly oin op .......................... 90

neo/poly/bac oin /hc 1%op ................ 91

neo/poly/dex oin 0.1% op .................. 91 neo/poly/dex sus 0.1% op ................. 91

neo/poly/gra sol op .......................... 90

neo/poly/hc sol 1% otic .................... 93 neo/poly/hc sus 1% otic .................... 93

neo/poly/hc sus op ........................... 91 neomycin tab 500mg .......................... 3

neo-polycin oin hc 1%op ................... 91 neo-polycin oin op ............................ 90

neosporin af cre 2% jock ................... 61 neosporin cre eczema ....................... 65

NEULASTA INJ 6MG/0.6M .................. 78 NEUMEGA INJ 5MG ........................... 78

NEUPOGEN INJ 300/0.5 .................... 78 NEUPOGEN INJ 300MCG .................... 78

NEUPOGEN INJ 480/0.8 .................... 78 NEUPOGEN INJ 480MCG .................... 78

NEVANAC SUS 0.1% ......................... 92

nevirapine sus 50mg/5ml .................. 44 nevirapine tab 200mg ....................... 44

nevirapine tab 400mg er ................... 44 NEXAVAR TAB 200MG ....................... 38

NEXIUM CAP 20MG ......................... 104 NEXIUM CAP 40MG ......................... 104

next choice tab 0.75mg .................... 56 next choice tab 1.5mg ...................... 56

niacin er tab 1000mg ........................ 32 niacin er tab 500mg ......................... 32

niacin er tab 750mg ......................... 32 niacor tab 500mg ............................. 32

NIASPAN TAB 1000 ER ...................... 32 NIASPAN TAB 500MG ER ................... 32

NIASPAN TAB 750MG ER ................... 32

nicardipine cap 20mg ........................ 51 nicardipine cap 30mg ........................ 51

nicorelief gum 2mg mint ................... 98 nicorelief gum 2mg orig .................... 98

nicorelief gum 4mg mint ................... 98 nicorelief gum 4mg orig .................... 98

nicorelief loz 2mg mint...................... 98 nicorelief loz 4mg mint...................... 98

nicotine dis 14mg/24h ...................... 98 nicotine dis 21mg/24h ...................... 98

nicotine dis 7mg/24hr ....................... 98 nicotine dis step 1 ............................ 98

nicotine dis step 2 ............................ 98 nicotine dis step 3 ............................ 98

nicotine gum 2mg ............................ 98

nicotine gum 2mgfruit ...................... 98 nicotine gum 4mg ............................ 98

135

nicotine loz 2mg chry ........................ 98

nicotine loz 2mg mint ........................ 98 nicotine loz 4mg chry ........................ 98

nicotine loz 4mg cinn......................... 98 nicotine loz 4mg mint ........................ 98

nicotine pol gum 2mg ........................ 98 nicotine pol gum 2mg cinn ................. 98

nicotine pol gum 2mg mint ................ 98 nicotine pol gum 2mg orig ................. 98

nicotine pol gum 2mg ref ................... 98 nicotine pol gum 2mg strt .................. 98

nicotine pol gum 2mgfruit .................. 98 nicotine pol gum 4mg ........................ 98

nicotine pol gum 4mg mint ................ 98 nicotine pol gum 4mg orig ................. 98

nicotine pol gum 4mg ref ................... 98

nicotine pol gum 4mg strt .................. 98 nicotine pol gum 4mgfruit .................. 98

nicotine pol loz 2mg cinn ................... 98 nicotine pol loz 2mg mint ................... 98

nicotine pol loz 4mg chry ................... 98 nicotine pol loz 4mg mint ................... 98

nicotine td dis 14mg/24h ................... 98 nicotine td dis 21mg/24h ................... 99

nicotine td dis 7mg/24hr .................... 98 NICOTROL INH ................................. 99

NICOTROL NS SPR 10MG/ML .............. 99 nifediac cc tab 30mg er ..................... 51

nifediac cc tab 60mg er ..................... 51 nifediac cc tab 90mg er ..................... 51

nifedical xl tab 30mg ......................... 51

nifedical xl tab 60mg ......................... 51 nifedipine cap 10mg .......................... 51

nifedipine cap 20mg .......................... 51 nifedipine tab 30mg er ...................... 51

nifedipine tab 60mg er ...................... 51 nifedipine tab 90mg er ...................... 51

NILANDRON TAB 150MG .................... 38 nimodipine cap 30mg ........................ 51

nisoldipine tab 17mg er ..................... 51 nisoldipine tab 20mg ......................... 51

nisoldipine tab 25.5mg ...................... 51 nisoldipine tab 30mg ......................... 51

nisoldipine tab 34mg er ..................... 51 nisoldipine tab 40mg ......................... 51

nisoldipine tab 8.5mg er .................... 51

NITRO-DUR DIS 0.3MG/HR ................ 12 NITRO-DUR DIS 0.8MG/HR ................ 12

nitrofur mac cap 100mg .................. 104

nitrofur mac cap 50mg .................... 104 nitrofurantn cap 100mg .................. 104

nitrofurantn sus 25mg/5ml .............. 104 nitroglycer aer 400mcg ..................... 12

nitroglycer cap 2.5mg er ................... 12 nitroglycer cap 2.5mg sr ................... 12

nitroglycer cap 6.5mg cr ................... 12 nitroglycer cap 6.5mg er ................... 12

nitroglycer cap 9mg cr ...................... 12 nitroglycer cap 9mg er ...................... 12

nitroglycer dis 0.1mg/hr.................... 12 nitroglycer dis 0.2mg/hr.................... 13

nitroglycer dis 0.4mg/hr.................... 13 nitroglycer dis 0.6mg/hr.................... 13

nitroglyceri dis 0.6mg/hr ................... 13

nitroglycrn spr lingual ....................... 13 NITROSTAT SUB 0.3MG .................... 13

NITROSTAT SUB 0.4MG .................... 13 NITROSTAT SUB 0.6MG .................... 13

nitro-time cap 2.5mg cr .................... 12 nitro-time cap 6.5mg cr .................... 12

nitro-time cap 9mg cr ....................... 12 NIX LICE SPR CONTROL .................... 67

nizatidine cap 150mg ...................... 103 nizatidine cap 300mg ...................... 103

NIZORAL A-D SHA 1% ...................... 61 noble formul cre hc 1% ..................... 65

nodolor cap ..................................... 82 nora-be tab 0.35mg ......................... 56

norethin ace tab 5mg ....................... 95

norethindron tab 0.35mg .................. 56 norgest/eth tab estrad ...................... 55

norgest/ethi tab 0.25/35 ................... 55 norgest/ethi tab estradio ................... 55

NOROXIN TAB 400MG ....................... 73 nortrel tab 0.5/35 ............................ 55

nortrel tab 1/35 ............................... 55 nortrel tab 7/7/7 .............................. 55

nortriptylin cap 10mg ....................... 23 nortriptylin cap 25mg ....................... 23

nortriptylin cap 50mg ....................... 23 nortriptylin cap 75mg ....................... 24

nortriptylin sol 10mg/5ml .................. 24 NORVIR CAP 100MG ......................... 44

NORVIR SOL 80MG/ML ...................... 44

NORVIR TAB 100MG ......................... 44 norwich asa tab 325mg ....................... 6

136

novagest/cod sol expect .................... 58

NOVOLIN INJ 70/30 .......................... 25 NOVOLIN N INJ U-100 ....................... 25

NOVOLIN R INJ U-100 ....................... 25 NOVOLOG INJ 100/ML ....................... 25

NOVOLOG INJ FLEXPEN ..................... 25 NOVOLOG INJ PENFILL ...................... 25

NOVOLOG MIX INJ 70/30 ................... 26 NOVOLOG MIX INJ FLEXPEN ............... 26

NOVOSEVEN INJ 1200MCG ................ 77 NOVOSEVEN INJ 2400MCG ................ 77

NOVOSEVEN INJ 4800MCG ................ 77 NOXAFIL SUS 40MG/ML ..................... 28

np thyroid tab 30mg ....................... 102 np thyroid tab 60mg ....................... 102

np thyroid tab 90mg ....................... 102

NPLATE INJ 250MCG ......................... 78 NPLATE INJ 500MCG ......................... 78

NUCYNTA ER TAB 100MG .................... 8 NUCYNTA ER TAB 150MG .................... 8

NUCYNTA ER TAB 200MG .................... 8 NUCYNTA ER TAB 250MG .................... 8

NUCYNTA ER TAB 50MG ...................... 8 NUCYNTA TAB 100MG ........................ 8

NUCYNTA TAB 50MG .......................... 8 NUCYNTA TAB 75MG .......................... 8

NUEDEXTA CAP 20-10MG ................... 96 NUVARING MIS ................................. 56

NUVIGIL TAB 150MG .......................... 3 NUVIGIL TAB 250MG .......................... 3

NUVIGIL TAB 50MG ............................ 3

nuzole cre 2% .................................. 61 nyamyc pow 100000 ......................... 61

nystat/triam cre ................................ 61 nystat/triam oin ................................ 61

nystatin cre 100000 .......................... 61 nystatin oin 100000 .......................... 61

nystatin pow .................................... 28 NYSTATIN POW ................................ 61

nystatin pow 100000 ......................... 61 nystatin sus 100000 .......................... 84

nystatin tab 500000 .......................... 28 NYSTATIN VAG TAB 100000 ............. 106

nystop pow 100000 ........................... 61 O ocella tab 3-0.03mg .......................... 55

OCTAGAM INJ 1GM ........................... 93 OCTAGAM INJ 25GM .......................... 93

OCTAGAM INJ 5GM ........................... 93

octreotide inj 1000mcg ..................... 71 octreotide inj 100mcg ....................... 71

octreotide inj 200mcg ....................... 71 octreotide inj 500mcg ....................... 71

octreotide inj 50mcg/ml .................... 71 ofloxacin dro 0.3% op ....................... 90

ofloxacin dro 0.3%otic ...................... 92 ofloxacin tab 200mg ......................... 73

ofloxacin tab 300mg ......................... 73 ofloxacin tab 400mg ......................... 73

OFORTA TAB 10MG........................... 37 ogestrel tab ..................................... 55

olanzapine tab 10mg ........................ 42 olanzapine tab 15mg ........................ 42

olanzapine tab 2.5mg ....................... 42

olanzapine tab 20mg ........................ 42 olanzapine tab 5mg .......................... 42

olanzapine tab 7.5mg ....................... 42 OLEPTRO TAB 24HR150 .................... 21

OLEPTRO TAB 24HR300 .................... 21 omega-3-acid cap 1gm ..................... 30

omeprazole cap 10mg ..................... 104 omeprazole cap 20mg ..................... 104

omeprazole cap 40mg ..................... 104 OMNARIS SPR.................................. 88

OMNIFLEX DPR ................................ 81 ondansetron tab 24mg ...................... 27

ondansetron tab 4mg ....................... 27 ondansetron tab 4mg odt .................. 27

ondansetron tab 8mg ....................... 27

ondansetron tab 8mg odt .................. 27 ONE-A-DAY PAK PRENATAL ............... 86

ONGLYZA TAB 2.5MG........................ 25 ONGLYZA TAB 5MG .......................... 25

oralone pst 0.1% ............................. 85 ORAP TAB 1MG ................................ 96

ORAP TAB 2MG ................................ 96 ORAPRED ODT TAB 10MG ................. 57

ORAPRED ODT TAB 15MG ................. 57 ORAPRED ODT TAB 30MG ................. 57

ORAVIG TAB 50MG ........................... 84 ORENCIA INJ 250MG .......................... 4

orph/asa/caf tab .............................. 87 orphen cpd tab ds ............................ 87

orphenadrine tab 100mg er ............... 87

orsythia tab ..................................... 55 ORTHO COIL DPR KIT 100 ................. 81

137

ORTHO COIL DPR KIT 105 ................. 81

ORTHO COIL DPR KIT 50 ................... 81 ORTHO FLAT DPR KIT 55 ................... 81

ORTHO FLAT DPR KIT 60 ................... 81 ORTHO FLAT DPR KIT 65 ................... 81




ORTHO FLEX DPR 65MM .................... 82 ORTHO FLEX DPR 70MM .................... 82

ORTHO FLEX DPR 75MM .................... 82 ORTHO FLEX DPR 80MM .................... 82

ORTHOVISC INJ 15MG/ML .................. 87

oscimin sub 0.125mg ...................... 103 oscimin tab 0.125mg ....................... 103

OSMOPREP TAB 1.5GM ...................... 80 oxandrolone tab 10mg ....................... 10

oxandrolone tab 2.5mg ...................... 10 oxaprozin tab 600mg ......................... 4

oxazepam cap 10mg ......................... 14 oxazepam cap 15mg ......................... 14

oxazepam cap 30mg ......................... 14 oxcarbazepin sus 300mg/5m .............. 19

oxcarbazepin tab 150mg .................... 19 oxcarbazepin tab 300mg .................... 19

oxcarbazepin tab 600mg .................... 19 OXISTAT CRE 1% ............................. 61

OXISTAT LOT 1% .............................. 61

OXSORALEN-UL CAP 10MG ................ 62 oxybutynin syp 5mg/5ml ................. 105

oxybutynin tab 5mg ........................ 105 oxycod/apap cap 5-500mg .................. 9

oxycod/apap tab 10-325mg ................ 9 oxycod/apap tab 10-650mg ................ 9

oxycod/apap tab 5-325mg .................. 9 oxycod/apap tab 7.5-325 .................... 9

oxycod/apap tab 7.5-500 .................... 9 oxycod/asa tab .................................. 9

oxycod/ibu tab 5-400mg ..................... 9 oxycodone cap 5mg ........................... 8

oxycodone tab 10mg .......................... 8 oxycodone tab 15mg .......................... 8

oxycodone tab 20mg .......................... 8

oxycodone tab 30mg .......................... 8 oxycodone tab 5mg ............................ 8

OXYCONTIN TAB 10MG CR .................. 8

OXYCONTIN TAB 15MG CR .................. 8 OXYCONTIN TAB 20MG CR .................. 8



oxymorphone tab 10mg er .................. 8 oxymorphone tab 15mg er .................. 8

oxymorphone tab 20mg er .................. 8 oxymorphone tab 30mg er .................. 8

oxymorphone tab 40mg er .................. 8 oxymorphone tab 5mg er .................... 8

oxymorphone tab 7.5mg er ................. 8 oxymorphone tab hcl 10mg ................. 8

oxymorphone tab hcl 5mg ................... 8

P PACERONE TAB 100MG ..................... 14

pacerone tab 200mg ......................... 14 PANCREAZE CAP 10500UNT ............... 68

PANCREAZE CAP 16800UNT ............... 68 PANCREAZE CAP 21000UNT ............... 68

PANCREAZE CAP 4200UNIT ............... 68 pancrelipase cap 5000unit ................. 68

PANRETIN GEL 0.1% ........................ 62 pantoprazole tab 20mg ................... 104

pantoprazole tab 40mg ................... 104 PARAGARD IUD T380A ...................... 82

parcaine sol 0.5% op ........................ 91 paricalcitol cap 1 mcg ....................... 71

paricalcitol cap 2 mcg ....................... 71

paricalcitol cap 4 mcg ....................... 71 paromomycin cap 250mg .................... 3

paroxetine sus 10mg/5ml .................. 22 paroxetine tab 10mg ........................ 22

paroxetine tab 20mg ........................ 22 paroxetine tab 30mg ........................ 22

paroxetine tab 40mg ........................ 22 PASER GRA 4GM .............................. 36

PATANASE SPR 0.6% ........................ 87 PATANOL SOL 0.1% OP ..................... 92

ped formula liq 100-10/5 .................. 58 pedi-dri pow 100000 ........................ 61

peg 3350 pow .................................. 80 peg 3350 sol electrol ........................ 80

peg-3350 sol electrol ........................ 80

PEGANONE TAB 250MG ..................... 20 PEGASYS INJ ................................... 46

138

PEGASYS INJ 180MCG/M ................... 46

PEGASYS INJ PROCLICK .................... 46 PEGASYS KIT ................................... 46

PEG-INTRON KIT 120 RP.................... 46 PEG-INTRON KIT 120MCG .................. 46

PEG-INTRON KIT 150 RP.................... 46 PEG-INTRON KIT 150MCG .................. 46

PEG-INTRON KIT 50MCG ................... 46 PEG-INTRON KIT 50MCG RP ............... 46

PEG-INTRON KIT 80MCG ................... 46 PEG-INTRON KIT 80MCG RP ............... 46

penicilln vk sol 125/5ml ..................... 94 penicilln vk sol 250/5ml ..................... 94

penicilln vk tab 250mg ...................... 94 penicilln vk tab 500mg ...................... 94

PENTASA CAP 250MG CR ................... 74

PENTASA CAP 500MG CR ................... 74 pentoxifylli tab 400mg er ................... 77

perindopril tab 2mg ........................... 33 perindopril tab 4mg ........................... 33

perindopril tab 8mg ........................... 33 periogard sol 0.12% .......................... 84

permethrin cre 5% ............................ 67 perphen/amit tab 2-10mg .................. 95

perphen/amit tab 2-25mg .................. 95 perphen/amit tab 4-10mg .................. 95

perphen/amit tab 4-25mg .................. 95 perphen/amit tab 4-50mg .................. 95

perphenazine tab 16mg ..................... 43 perphenazine tab 2mg ....................... 43

perphenazine tab 4mg ....................... 43

perphenazine tab 8mg ....................... 43 PERTZYE CAP ................................... 68

pharbedryl cap 25mg ........................ 29 pharbedryl cap 50mg ........................ 29

phenadoz sup 12.5mg ....................... 30 phenadoz sup 25mg .......................... 30

phenazo tab 200mg .......................... 75 phenazopyrid tab 100mg ................... 75

phenazopyrid tab 200mg ................... 75 phenelzine tab 15mg ......................... 22

phenobarb elx 20mg/5ml ................... 79 phenobarb sol 20mg/5ml ................... 79

phenobarb tab 100mg ....................... 79 phenobarb tab 15mg ......................... 79

phenobarb tab 16.2mg ...................... 79

phenobarb tab 30mg ......................... 79 phenobarb tab 32.4mg ...................... 79

phenobarb tab 60mg ........................ 79

phenobarb tab 64.8mg ..................... 79 phenobarb tab 97.2mg ..................... 79

phenytoin chw 50mg ........................ 20 phenytoin ex cap 100mg ................... 20

phenytoin ex cap 200mg ................... 20 phenytoin ex cap 300mg ................... 20

phenytoin sus 125/5ml ..................... 20 philith tab 0.4-35 ............................. 55

PHISOHEX LIQ 3% ........................... 43 PHOSPHOLINE SOL 0.125%OP ........... 90

PHRENILIN CAP FORTE ....................... 5 PICATO GEL 0.015% ........................ 62

PICATO GEL 0.05% .......................... 62 pilocarpine sol 1% op ....................... 90

pilocarpine sol 2% op ....................... 90

pilocarpine sol 4% op ....................... 90 pilocarpine tab 5mg .......................... 85

pilocarpine tab 7.5mg ....................... 85 pindolol tab 10mg ............................ 49

pindolol tab 5mg .............................. 49 pioglita/met tab 15-500mg ................ 24

pioglita/met tab 15-850mg ................ 24 pioglitazone tab 15mg ...................... 26

pioglitazone tab 30mg ...................... 26 pioglitazone tab 45mg ...................... 26

pirmella tab 1/35 ............................. 55 pirmella tab 7/7/7 ............................ 55

piroxicam cap 10mg ........................... 4 piroxicam cap 20mg ........................... 4

podactin cre 2% ............................... 61

podofilox sol 0.5% ........................... 66 poly-dex oin 0.1% op ....................... 91

polyeth glyc pow 3350 nf .................. 80 polyeth glyc pow 3350-grx ................ 80

poly-iron cap 150 fort ....................... 79 polymyxin b/ sol trimethp ................. 90

polysacchari cap iron ........................ 79 poly-vi-flor chw 0.25mg .................... 85

poly-vi-flor chw 0.5mg ...................... 85 poly-vi-flor chw 1mg ......................... 85

POLY-VI-FLOR CHW W/IRON ............. 86 poly-vit/fe dro /fl 0.25 ...................... 86

poly-vit/fe dro /fl 0.5 ........................ 86 poly-vit/fl dro 0.25mg ....................... 85

polyvit/fl dro 0.5mg/ml ..................... 85

portia-28 tab ................................... 55 pot chloride cap 10meq er ................. 84

139

pot chloride cap 8meq er ................... 84

pot chloride liq 10% .......................... 84 pot chloride liq 20% .......................... 84

pot chloride liq 20% sf ....................... 84 pot chloride sol 10% sf ...................... 84

pot chloride tab 10meq cr .................. 84 pot chloride tab 10meq er .................. 84

pot chloride tab 8meq er .................... 84 pot chloride tab 8meq sr .................... 84

pot citrate tab 1080mg ...................... 75 pot citrate tab 540mg ........................ 75

pot cl micro tab 10meq cr .................. 84 pot cl micro tab 10meq er .................. 84

pot cl micro tab 20meq er .................. 84 POTIGA TAB 200MG .......................... 19

POTIGA TAB 300MG .......................... 19

POTIGA TAB 400MG .......................... 19 POTIGA TAB 50MG ............................ 19

PRADAXA CAP 150MG ........................ 18 PRADAXA CAP 75MG ......................... 18

pramcort cre 1-1% ........................... 65 pramipexole tab 0.125mg .................. 40

pramipexole tab 0.25mg .................... 40 pramipexole tab 0.5mg ...................... 40

pramipexole tab 0.75mg .................... 40 pramipexole tab 1.5mg ...................... 40

pramipexole tab 1mg ........................ 40 PRANDIN TAB 0.5MG ......................... 26

pravastatin tab 10mg ........................ 31 pravastatin tab 20mg ........................ 31

pravastatin tab 40mg ........................ 31

pravastatin tab 80mg ........................ 31 prazosin hcl cap 1mg ......................... 34

prazosin hcl cap 2mg ......................... 34 prazosin hcl cap 5mg ......................... 34

PRED MILD SUS 0.12% OP ................. 91 PRED SOD PHO SOL 1% OP ............... 91

pred sod pho sol 5mg/5ml ................. 57 pred sod pho sol 6.7/5ml ................... 57

PRED-G S.O.P OIN OP ....................... 91 PRED-G SUS OP ................................ 91

prednicarbat cre 0.1% ....................... 65 prednicarbat oin 0.1% ....................... 65

prednisolone sol 15mg/5ml ................ 57 prednisolone sol 25mg/5ml ................ 57

prednisolone sus 1% op ..................... 91

prednisolone syp 15mg/5ml ............... 57 prednisone pak 10mg ........................ 57

prednisone pak 5mg ......................... 57

prednisone sol 5mg/5ml .................... 57 prednisone tab 10mg ........................ 57

prednisone tab 1mg.......................... 57 prednisone tab 2.5mg ....................... 57

prednisone tab 20mg ........................ 57 prednisone tab 50mg ........................ 57

prednisone tab 5mg.......................... 57 PREMARIN TAB 0.3MG ...................... 73

PREMARIN TAB 0.45MG .................... 73 PREMARIN TAB 0.625MG ................... 73

PREMARIN TAB 0.9MG ...................... 73 PREMARIN TAB 1.25MG .................... 73

PREMARIN VAG CRE 0.625MG .......... 106 PREMPHASE TAB .............................. 72

PREMPRO TAB .625-2.5 .................... 72

PREMPRO TAB 0.3-1.5 ...................... 72 PREMPRO TAB 0.45-1.5 .................... 72

PREMPRO TAB 0.625-5 ..................... 72 prenaplus tab .................................. 86

prenatabs rx tab .............................. 86 prenatal 19 chw tab .......................... 86

prenatal 19 tab ................................ 86 PRENATAL TAB................................. 86

PRENATAL TAB 28-0.8MG .................. 86 PRENATAL TAB COMPLETE ................. 86

PRENATAL TAB FORMULA .................. 86 prenatal tab plus .............................. 86

prenatal tab plus fe .......................... 86 PRENATAL+DHA MIS ........................ 86

PRENATAL+DHA MIS WOMENS .......... 86

PRENATAL-U CAP ............................. 86 PRENTIF MIS 22MM .......................... 82

PRENTIF MIS 25MM .......................... 82 PRENTIF MIS 28MM .......................... 82

PRENTIF MIS 31MM .......................... 82 PRENTIF MIS FITTING ....................... 82

prep h hc cre 1% ............................. 65 PREPOPIK PAK ................................. 80

prevalite pow 4gm............................ 31 previfem tab .................................... 55

PREZISTA TAB 150MG ...................... 44 PREZISTA TAB 400MG ...................... 45

PREZISTA TAB 600MG ...................... 45 PREZISTA TAB 75MG ........................ 44

PREZISTA TAB 800MG ...................... 45

PRIFTIN TAB 150MG ......................... 36 PRIMAQUINE TAB 26.3MG ................. 36

140

primidone tab 250mg ........................ 19

primidone tab 50mg .......................... 19 PRIMSOL SOL 50MG/5ML ................... 11

PRISTIQ TAB 100MG ......................... 23 PRISTIQ TAB 50MG ........................... 23

PRIVIGEN INJ 10GRAMS .................... 93 PRIVIGEN INJ 20GRAMS .................... 93

PROAIR HFA AER .............................. 16 proben/colch tab 500-0.5................... 75

probenecid tab 500mg ....................... 75 prochlorper sup 25mg ....................... 43

prochlorper tab 10mg ........................ 43 prochlorper tab 5mg .......................... 43

PROCORT CRE .................................. 10 PROCRIT INJ 10000/ML ..................... 78

PROCRIT INJ 2000/ML ....................... 78

PROCRIT INJ 20000/ML ..................... 78 PROCRIT INJ 3000/ML ....................... 78

PROCRIT INJ 4000/ML ....................... 78 PROCRIT INJ 40000/ML ..................... 78

proctocream cre hc 2.5% ................... 10 PROCTOFOAM AER HC 1% ................. 10

procto-pak cre 1% ............................ 10 proctosol hc cre 2.5% ....................... 10

proctozone cre -hc 2.5% .................... 11 PROFE FORTE CAP 155-1MG ............... 86

PROFILNINE INJ 500UNIT .................. 77 progesterone cap 100mg ................... 95

progesterone cap 200mg ................... 95 PROLASTIN INJ 1000MG .................. 100

PROLASTIN-C INJ 1000MG ............... 100

PROLEUKIN INJ 22MU........................ 39 PROLIA SOL 60MG/ML ....................... 70

promacet tab 50-650mg ..................... 5 PROMACTA TAB 12.5MG .................... 78

PROMACTA TAB 25MG ....................... 78 PROMACTA TAB 50MG ....................... 78

PROMACTA TAB 75MG ....................... 78 prometh vc syp 6.25-5/5 ................... 58

prometh vc syp plain ......................... 58 prometh vc/ syp codeine .................... 58

prometh/cod syp 6.25-10 .................. 58 promethazine sol 6.25/5ml ................ 30

promethazine sup 12.5mg ................. 30 promethazine sup 25mg .................... 30

promethazine syp 6.25/5ml ............... 30

promethazine syp dm ........................ 58 promethazine tab 12.5mg .................. 30

promethazine tab 25mg .................... 30

promethazine tab 50mg .................... 30 promethegan sup 12.5mg ................. 30

promethegan sup 25mg .................... 30 promethegan sup 50mg .................... 30

PRONTO AER 0.4% ........................... 67 propafenone cap 225mg er ................ 14

propafenone cap 325mg er ................ 14 propafenone cap 425mg sr ................ 14

propafenone tab 150mg .................... 14 propafenone tab 225mg .................... 14

propafenone tab 300mg .................... 14 propanthelin tab 15mg .................... 103

proparacaine sol 0.5% op .................. 91 propranolol cap 120mg er ................. 49

propranolol cap 160mg er ................. 49

propranolol cap 60mg er ................... 49 propranolol cap 80mg er ................... 49

propranolol tab 10mg ....................... 49 propranolol tab 20mg ....................... 49

propranolol tab 40mg ....................... 49 propranolol tab 60mg ....................... 49

propranolol tab 80mg ....................... 49 propylthiour tab 50mg .................... 101

PROTOPIC OIN 0.03% ...................... 66 PROTOPIC OIN 0.1% ........................ 66

protriptylin tab 10mg ........................ 24 protriptylin tab 5mg ......................... 24

prudoxin cre 5% .............................. 62 pseudoephedr syp 30mg/5ml ............. 88

pseudoephedr tab 30mg ................... 88

pseudoephedr tab 60mg ................... 88 psudatabs tab 30mg ......................... 88

PULMICORT INH 180MCG .................. 15 PULMICORT INH 90MCG .................... 15

PULMICORT SUS 1MG/2ML ................ 15 PULMOZYME SOL 1MG/ML ............... 100

px allergy cap 25mg ......................... 29 px aspirin chw 81mg .......................... 6

px aspirin tab 325mg .......................... 6 px aspirin tab 325mg ec ...................... 6

px aspirin tab 81mg ec ....................... 6 PX PRENATAL TAB MULTIVIT ............. 86

px tussin dm liq 100-10/5 ................. 58 pyrazinamide tab 500mg ................... 36

PYRE/PIPERON LIQ ........................... 67

pyridostigm tab 60mg ....................... 36

141

Q qc aspirin tab 325mg .......................... 6 qc aspirin tab 325mg ec ..................... 6

qc child asa chw 81mg ....................... 6 qc heartburn tab 200mg .................. 103

qc hydrocort cre 1% .......................... 65 QC PRENATAL TAB 28-0.8MG ............. 86

q-dryl cap 25mg ............................... 29 QNASL AER 80MCG ........................... 88

quadrapax elx ................................ 103 quenalin syp 12.5/5ml ....................... 29

quetiapine tab 100mg ....................... 42 quetiapine tab 200mg ....................... 42

quetiapine tab 25mg ......................... 42 quetiapine tab 300mg ....................... 42

quetiapine tab 400mg ....................... 42

quetiapine tab 50mg ......................... 42 quinapril tab 10mg ............................ 33

quinapril tab 20mg ............................ 33 quinapril tab 40mg ............................ 33

quinapril tab 5mg ............................. 33 quinidine gl tab 324mg cr .................. 14

quinidine gl tab 324mg er .................. 14 quinidine su tab 200mg ..................... 14

quinidine su tab 300mg ..................... 14 quinidine su tab 300mg er ................. 14

quinine sulf cap 324mg ...................... 36 QVAR AER 40MCG ............................. 15

QVAR AER 80MCG ............................. 15 R ra anti-itch cre 1% ............................ 65

ra aspirin chw 81mg ........................... 6 ra aspirin tab 325mg .......................... 6

ra aspirin tab 325mg ec ...................... 6 ra aspirin tab 81mg ec ........................ 6

ra child asa chw 81mg ........................ 6 ra hydrocort cre 1% .......................... 65

ra hydrocort cre 1%pls 12 ................. 65 ra laxative pow ................................. 80

ra nicotine dis 14mg/24h ................... 99 ra nicotine dis 21mg/24h ................... 99

ra nicotine dis 7mg/24hr .................... 99 ra nicotine gum 2mg ......................... 99

ra nicotine gum 2mg cinn .................. 99 ra nicotine gum 2mg mint .................. 99

ra nicotine gum 2mgfruit ................... 99

ra nicotine gum 4mg ......................... 99 ra nicotine gum 4mg frut ................... 99

ra nicotine gum 4mg mint ................. 99

ra nicotine loz 2mg mint ................... 99 ra nicotine loz 4mg mint ................... 99

RA ONE DAILY MIS ........................... 86 RA PRENATAL TAB 28-0.8MG ............. 86

RA PRENATAL TAB FORMULA ............. 86 ra suphedrin tab 30mg...................... 88

ra tussin dm liq 100-10/5 .................. 58 rabeprazole tab 20mg ..................... 104

raloxifene tab 60mg ......................... 70 ramipril cap 1.25mg ......................... 33

ramipril cap 10mg ............................ 33 ramipril cap 2.5mg ........................... 33

ramipril cap 5mg .............................. 33 RANEXA TAB 1000MG ....................... 12

RANEXA TAB 500MG ......................... 12

ranitidine syp 150/10ml .................. 103 ranitidine syp 15mg/ml ................... 103

ranitidine syp 75mg/5ml ................. 103 ranitidine tab 150mg ...................... 104

ranitidine tab 300mg ...................... 104 RAPAFLO CAP 4MG ........................... 75

RAPAFLO CAP 8MG ........................... 75 RAPAMUNE SOL 1MG/ML ................... 47

RAPAMUNE TAB 0.5MG ..................... 47 RAPAMUNE TAB 1MG ........................ 48

RAPAMUNE TAB 2MG ........................ 48 REBETOL SOL 40MG/ML .................... 46

REBIF INJ 22/0.5 ............................. 96 REBIF INJ 44/0.5 ............................. 96

REBIF REBIDO INJ 22/0.5 ................. 96

REBIF REBIDO INJ 44/0.5 ................. 96 REBIF REBIDO SOL TITRATN ............. 96

REBIF TITRTN SOL PACK ................... 96 reclipsen tab .................................... 55

RECOMBINATE INJ 220-400............... 77 RECOMBINATE INJ 401-800............... 77

RECOMBINATE INJ 801-1240 ............. 77 recort plus cre 1% ............................ 65

rectacort-hc sup 25mg ...................... 11 RECTIV OIN 0.4% ............................ 11

rederm lot 1% ................................. 65 REFACTO INJ 500UNIT ...................... 77

regenecare gel ha 2% ....................... 66 REGRANEX GEL 0.01% ..................... 67

RELENZA MIS DISKHALE ................... 46

RELISTOR KIT 12/0.6ML ................... 74 RELPAX TAB 20MG ........................... 83

142

RELPAX TAB 40MG ............................ 83

remedy cre antifung .......................... 61 REMICADE INJ 100MG ....................... 74

REMODULIN INJ 10MG/ML ................. 52 REMODULIN INJ 1MG/ML ................... 52

REMODULIN INJ 2.5MG/ML ................ 52 REMODULIN INJ 5MG/ML ................... 52

RENAGEL TAB 400MG ........................ 74 RENAGEL TAB 800MG ........................ 74

renal cap softgel ............................... 85 renalpren cap ................................... 85

renaphro cap .................................... 85 reno cap .......................................... 85

RENVELA TAB 800MG ........................ 74 repaglinide ....................................... 26

repaglinide tab 0.5mg ....................... 26

repan tab .......................................... 5 reprexain tab 10-200mg ..................... 9

RESCRIPTOR TAB 100 MG .................. 45 RESCRIPTOR TAB 200MG ................... 45

RESTASIS EMU 0.05% ....................... 91 REVLIMID CAP 10MG ......................... 47

REVLIMID CAP 15MG ......................... 47 REVLIMID CAP 25MG ......................... 47

REVLIMID CAP 5MG .......................... 47 REYATAZ CAP 100MG ........................ 45

REYATAZ CAP 150MG ........................ 45 REYATAZ CAP 200MG ........................ 45

REYATAZ CAP 300MG ........................ 45 RHEUMATREX TAB 2.5MG ................... 3

RHINOCORT SUS AQUA ..................... 88

RHOGAM PLUS INJ 300MCG ............... 93 RIBAPAK PAK 1000/DAY .................... 46

RIBAPAK PAK 1200/DAY .................... 46 RIBAPAK PAK 800/DAY ...................... 46

ribasphere cap 200mg ....................... 46 ribasphere tab 200mg ....................... 46

ribasphere tab 400mg ....................... 46 ribasphere tab 600mg ....................... 46

RIBATAB PAK 1000/DAY .................... 46 RIBATAB TAB 1200/DAY .................... 46

RIBATAB TAB 800/DAY ...................... 46 ribavirin cap 200mg .......................... 46

ribavirin tab 200mg ........................... 46 RIDAURA CAP 3MG ............................ 3

rifabutin cap 150mg .......................... 36

rifampin cap 150mg .......................... 36 rifampin cap 300mg .......................... 36

RIFATER TAB ................................... 36

riluzole tab 50mg ............................. 89 rimantadine tab 100mg ..................... 46

ringworm cre 1% ............................. 61 risperidone sol 1mg/ml ..................... 41

risperidone tab 0.25 odt .................... 41 risperidone tab 0.25mg ..................... 41

risperidone tab 0.5mg ....................... 41 risperidone tab 0.5mg od .................. 41

risperidone tab 1mg ......................... 41 risperidone tab 1mg odt .................... 41



risperidone tab 4mg ......................... 41

risperidone tab 4mg odt .................... 41 RITALIN LA CAP 10MG ........................ 3

rivastigmine cap 3mg ....................... 95 rizatriptan tab 10mg ......................... 83

rizatriptan tab 5mg........................... 83 robafen ac syp 100-10/5 ................... 58

robitussin liq cgh/cong ...................... 58 robitussin liq to go dm ...................... 58

romilar ac sol 100-10/5 .................... 58 romycin oin op ................................. 90

ropinirole tab 0.25mg ....................... 40 ropinirole tab 0.5mg ......................... 40

ropinirole tab 12mg er ...................... 40 ropinirole tab 1mg ............................ 40

ropinirole tab 2mg ............................ 40

ropinirole tab 2mg er ........................ 40 ropinirole tab 3mg ............................ 40

ropinirole tab 4mg ............................ 40 ropinirole tab 4mg er ........................ 40

ropinirole tab 5mg ............................ 40 ropinirole tab 6mg er ........................ 40

ropinirole tab 8mg er ........................ 40 rosadan cre 0.75% ........................... 67

rosadan gel 0.75% ........................... 67 ROXICET SOL 5-325/5 ........................ 9

roxicet tab 5-325mg ........................... 9 ROXICET TAB 5-500MG ....................... 9

ROZEREM TAB 8MG .......................... 80 S SABRIL POW 500MG ......................... 20

SABRIL TAB 500MG .......................... 20 safe tussin liq 10-100/5 .................... 59

143

salsalate tab 500mg ........................... 6

salsalate tab 750mg ........................... 6 SAMSCA TAB 15MG ........................... 71

SAMSCA TAB 30MG ........................... 71 SANDIMMUNE SOL 100MG/ML ............ 48

SANDOSTATIN KIT LAR 10MG ............ 71 SANDOSTATIN KIT LAR 20MG ............ 71

SANDOSTATIN KIT LAR 30MG ............ 71 SANTYL OIN 250/GM ......................... 66

SAPHRIS SUB 10MG .......................... 42 SAPHRIS SUB 5MG ............................ 42

sarnol-hc lot 1% ............................... 65 SAVELLA MIS TITR PAK ..................... 95

SAVELLA TAB 100MG ........................ 95 SAVELLA TAB 12.5MG ....................... 95

SAVELLA TAB 25MG .......................... 95

SAVELLA TAB 50MG .......................... 95 sb aspirin tab 325mg .......................... 6

sb aspirin tab 325mg ec ..................... 6 sb cgh contr liq dm ........................... 59

sb child asa chw 81mg ....................... 6 sb hydrocort cre 1% .......................... 65

sb pseudophe tab 30mg .................... 88 scalacort lot 2%................................ 65

se-donna elx pb hyos ...................... 103 selegiline cap 5mg ............................ 40

selegiline tab 5mg ............................. 40 selenium sul lot 2.5% ........................ 62

selenium sul sha 2.25% ..................... 62 selenium sul sha 2.5% ...................... 62

SELZENTRY TAB 150MG ..................... 45

SELZENTRY TAB 300MG ..................... 45 SENSIPAR TAB 30MG ........................ 71

SENSIPAR TAB 60MG ........................ 71 SENSIPAR TAB 90MG ........................ 71

SEREVENT DIS AER 50MCG ................ 16 SEROQUEL XR TAB 150MG ................. 42

SEROQUEL XR TAB 200MG ................. 42 SEROQUEL XR TAB 300MG ................. 42

SEROQUEL XR TAB 400MG ................. 42 SEROQUEL XR TAB 50MG ................... 42

sertraline tab 100mg ......................... 22 sertraline tab 25mg ........................... 22

sertraline tab 50mg ........................... 22 sildec pe-dm syp............................... 59

sildenafil tab 20mg ........................... 52

silphen coug syp 12.5/5ml ................. 29 siltussin dm liq das ........................... 59

siltussin-dm liq diabetic..................... 59

silver sulfa cre 1% ........................... 62 SIMCOR TAB 1000-20 ....................... 32

SIMCOR TAB 1000-40 ....................... 32 SIMCOR TAB 500-20MG .................... 32

SIMCOR TAB 500-40MG .................... 32 SIMCOR TAB 750-20MG .................... 32

simply stuff tab 30mg ....................... 88 simvastatin tab 10mg ....................... 32

simvastatin tab 20mg ....................... 32 simvastatin tab 40mg ....................... 32

simvastatin tab 5mg ......................... 32 simvastatin tab 80mg ....................... 32

sirolimus tab 0.5mg .......................... 48 SKELID TAB 200MG .......................... 70

skin trtment lot 12% ........................ 66

SKLICE LOT 0.5% ............................ 67 sm acid redu tab 200mg ................. 104

sm anti-diar tab 2mg ........................ 27 sm antifungl cre 2% ......................... 61

sm aspirin chw 81mg .......................... 6 sm aspirin tab 325mg ......................... 6

sm aspirin tab 325mg ec ..................... 6 sm aspirin tab 81mg ec ....................... 6

sm child asa chw 81mg ....................... 6 sm clearlax pow ............................... 80

sm folic acd tab 400mcg ................... 77 sm hydrocort cre 1% ........................ 65

sm nasal dec tab 30mg ..................... 88 sm nicotine dis 14mg/24h ................. 99

sm nicotine dis 21mg ........................ 99

sm nicotine dis 7mg/24hr .................. 99 sm nicotine gum 2mg ....................... 99

sm nicotine gum 2mg mint ................ 99 sm nicotine gum 4mg ....................... 99

sm nicotine gum 4mg mint ................ 99 sm nicotine loz 2mg mint .................. 99

sm nicotine loz 4mg mint .................. 99 SM PRENATAL TAB VITAMINS ............ 86

sm vitamin d tab 400unit ................ 107 smooth lax pow ............................... 80

smz/tmp ds tab 800-160 ................... 11 smz-tmp sus ................................... 11

smz-tmp sus 200-40/5 ..................... 11 smz-tmp tab 400-80mg .................... 11

sod chloride neb 0.9% ...................... 59

sod chloride sol 0.45%irr .................. 75 sod fluoride chw 0.25mg f ................. 84

144

sod fluoride chw 0.5mg f ................... 84

sod fluoride chw 1.1mg ..................... 84 sod fluoride chw 1mg f ...................... 84

sod fluoride chw 2.2mg ..................... 84 sod fluoride dro 0.5mg/ml .................. 84

sod fluoride tab 0.5mg f .................... 84 sod poly sul pow ............................... 48

sod sulfacet sol 10% op ..................... 90 sodium chlor neb 3% ........................ 59

sodium chlor sol 0.9% irr ................... 75 solia tab .......................................... 55

SOMATULINE INJ 120/.5ML ................ 71 SOMATULINE INJ 60/0.2ML ................ 71

SOMATULINE INJ 90/0.3ML ................ 71 SOMAVERT INJ 10MG ........................ 70

SOMAVERT INJ 15MG ........................ 70

SOMAVERT INJ 20MG ........................ 70 SOMNOTE CAP 500MG ....................... 79

soothe&cool cre inzo 2% .................... 62 SORIATANE CAP 10MG ...................... 62

SORIATANE CAP 17.5MG ................... 62 SORIATANE CAP 25MG ...................... 62

sorine tab 120mg.............................. 49 sorine tab 160mg.............................. 49

sorine tab 240mg.............................. 49 sorine tab 80mg ............................... 49

sotalol af tab 120mg ......................... 49 sotalol af tab 160mg ......................... 49

sotalol af tab 80mg ........................... 49 sotalol hcl tab 120mg ........................ 49

sotalol hcl tab 160mg ........................ 49

sotalol hcl tab 240mg ........................ 49 sotalol hcl tab 80mg .......................... 49

sotret cap 10mg ............................... 60 sotret cap 20mg ............................... 60

sotret cap 30mg ............................... 60 SPACERS ......................................... 82

spinosad sus 0.9% ............................ 67 SPIRIVA CAP HANDIHLR .................... 15

spirono/hctz tab 25/25 ...................... 68 spironolact tab 100mg ....................... 69

spironolact tab 25mg ......................... 69 spironolact tab 50mg ......................... 69

sprintec 28 tab 28 day ....................... 55 SPRYCEL TAB 100MG ........................ 38

SPRYCEL TAB 140MG ........................ 38

SPRYCEL TAB 20MG .......................... 38 SPRYCEL TAB 50MG .......................... 38

SPRYCEL TAB 70MG .......................... 38

SPRYCEL TAB 80MG .......................... 38 sronyx tab ....................................... 55

ssd af cre 1% .................................. 63 ssd cre 1% ...................................... 63

st joseph as chw 81mg ....................... 7 stavudine cap 15mg ......................... 45

stavudine cap 20mg ......................... 45 stavudine cap 30mg ......................... 45

stavudine cap 40mg ......................... 45 stavudine sol 1mg/ml ....................... 45

STAVZOR CAP 125MG ....................... 20 STAVZOR CAP 250MG ....................... 20

STAVZOR CAP 500MG ....................... 20 STAXYN TAB 10MG ........................... 52

STELARA INJ 45MG/0.5 ..................... 62

STELARA INJ 90MG/ML ..................... 62 STIMATE SOL 1.5MG/ML ................... 71

stop smoking gum 2mg mint ............. 99 stop smoking gum 2mg orig .............. 99

stop smoking gum 4mg ..................... 99 stop smoking loz 2mg mint................ 99

stop smoking loz 4mg mint................ 99 STRATTERA CAP 100MG ...................... 1

STRATTERA CAP 10MG ........................ 1 STRATTERA CAP 18MG ........................ 1



STRIBILD TAB .................................. 45

STROMECTOL TAB 3MG ..................... 11 STUART PREN TAB ........................... 86

sucralfate tab 1gm ......................... 104 sudanyl tab 30mg ............................ 88

sudogest tab 30mg ........................... 88 sudogest tab 60mg ........................... 88

sudophed tab 30mg .......................... 88 sulf/pred na sol op ........................... 91

sulfacet sod oin 10% op .................... 90 sulfacet sod sol 10% op .................... 90

SULFADIAZINE TAB 500MG ............. 100 SULFAMYLON CRE 85MG/GM ............. 63

sulfasalazin tab 500mg ..................... 74 sulfasalazin tab 500mg dr ................. 74

sulfazine ec tab 500mg ..................... 74

sulfazine tab 500mg ......................... 74 sulindac tab 150mg ............................ 4

145

sulindac tab 200mg ............................ 4

sumatriptan inj 4mg/0.5 .................... 83 sumatriptan inj 6mg/0.5 .................... 83

sumatriptan spr 20mg/act .................. 83 sumatriptan spr 5mg/act ................... 83

sumatriptan tab 100mg ..................... 83 sumatriptan tab 25mg ....................... 83

sumatriptan tab 50mg ....................... 83 SUPARTZ INJ 25/2.5ML ..................... 87

suphedrine tab 30mg ........................ 88 SUPPRELIN LA KIT 50MG ................... 70

SUPRAX SUS 100/5ML ....................... 53 SUPRAX SUS 200/5ML ....................... 53

SUPRAX TAB 400MG .......................... 53 SUPREP BOWEL SOL PREP ................. 80

SUSTIVA CAP 200MG ........................ 45

SUSTIVA CAP 50MG .......................... 45 SUSTIVA TAB 600MG ........................ 45

SUTENT CAP 12.5MG ......................... 38 SUTENT CAP 25MG ........................... 38

SUTENT CAP 50MG ........................... 38 sw clearlax pow ................................ 80

sw nasal dec tab 30mg ...................... 88 sw nicotine gum 2mg mint ................. 99

sw nicotine gum 4mg ........................ 99 sw nicotine loz 2mg mint ................... 99

sw nicotine loz 4mg mint ................... 99 syeda tab 3-0.03mg .......................... 55

symax-sl sub 0.125mg .................... 103 SYMBICORT AER 160-4.5 ................... 16

SYMBICORT AER 80-4.5..................... 16

SYMLINPEN 60 INJ 1000MCG ............. 24 SYMLNPEN 120 INJ 1000MCG ............. 24

SYNAGIS INJ 100MG/ML .................... 94 SYNAGIS INJ 50MG ........................... 94

SYNAREL SOL 2MG/ML ...................... 70 SYNERA DIS 70-70MG ....................... 66

SYNVISC INJ 8MG/ML ........................ 87 SYNVISC ONE INJ 8MG/ML ................. 87

SYPRINE CAP 250MG ......................... 47 T TABLOID TAB 40MG .......................... 37 TACLONEX OIN ................................. 65

TACLONEX SUS ................................ 65 tacrolimus cap 0.5mg ........................ 48

tacrolimus cap 1mg ........................... 48

tacrolimus cap 5mg ........................... 48 TAMIFLU CAP 30MG .......................... 47

TAMIFLU CAP 45MG .......................... 47

TAMIFLU CAP 75MG .......................... 47 TAMIFLU SUS 12MG/ML .................... 47

TAMIFLU SUS 6MG/ML ...................... 47 tamoxifen tab 10mg ......................... 38

tamoxifen tab 20mg ......................... 38 tamsulosin cap 0.4mg ....................... 75

TARCEVA TAB 100MG ....................... 38 TARCEVA TAB 150MG ....................... 38

TARCEVA TAB 25MG ......................... 38 TARGRETIN CAP 75MG ...................... 39

TARON-C DHA CAP ........................... 86 TASIGNA CAP 150MG ....................... 38

TASIGNA CAP 200MG ....................... 38 TASMAR TAB 100MG ......................... 39

TAZORAC GEL 0.05% ....................... 62

TAZORAC GEL 0.1% ......................... 62 taztia xt cap 120mg/24 ..................... 51

taztia xt cap 180mg/24 ..................... 51 taztia xt cap 240mg/24 ..................... 51

taztia xt cap 300mg/24 ..................... 51 taztia xt cap 360mg/24 ..................... 51

TEGRETOL-XR TAB 100MG ................ 19 TEKTURNA TAB 150MG ..................... 35

TEKTURNA TAB 300MG ..................... 35 telmis/amlod tab 40-10mg ................ 35

telmis/amlod tab 40-5mg .................. 35 telmis/amlod tab 80-10mg ................ 35

telmis/amlod tab 80-5mg .................. 35 telmisa/hctz tab 40-12.5 ................... 35

telmisa/hctz tab 80-12.5 ................... 35

telmisa/hctz tab 80-25mg ................. 35 telmisartan tab 20mg ....................... 33

telmisartan tab 40mg ....................... 33 telmisartan tab 80mg ....................... 34

temazepam cap 15mg ...................... 79 temazepam cap 30mg ...................... 79

temazepam cap 7.5mg ..................... 79 TEMODAR CAP 100MG ...................... 37

TEMODAR CAP 140MG ...................... 37 TEMODAR CAP 180MG ...................... 37

TEMODAR CAP 20MG ........................ 37 TEMODAR CAP 250MG ...................... 37

TEMODAR CAP 5MG .......................... 37 temozolomide cap 100mg ................. 37

temozolomide cap 140mg ................. 37

temozolomide cap 180mg ................. 37 temozolomide cap 20mg ................... 37

146

temozolomide cap 250mg .................. 37

temozolomide cap 5mg ...................... 37 terazosin cap 10mg ........................... 34

terazosin cap 1mg ............................ 34 terazosin cap 2mg ............................ 34

terazosin cap 5mg ............................ 34 terbinafine tab 250mg ....................... 28

terbutaline tab 2.5mg ........................ 16 terbutaline tab 5mg .......................... 16

terconazole cre 0.4% ...................... 106 terconazole cre 0.8% ...................... 106

terconazole sup 80mg ..................... 106 testost cyp inj 100mg/ml ................... 10

testost cyp inj 200mg/ml ................... 10 testost enan inj 200mg/ml ................. 10

tetracycline cap 250mg ................... 100

tetracycline cap 500mg ................... 100 TEV-TROPIN INJ 5MG ........................ 70

tgt aspirin chw 81mg .......................... 7 tgt aspirin chw child ........................... 7

tgt aspirin tab 325mg ......................... 7 tgt aspirin tab 81mg ec ...................... 7

tgt cough liq form dm ........................ 59 tgt nicotine dis 14mg/24h .................. 99

tgt nicotine dis 21mg/24h .................. 99 tgt nicotine dis 7mg/24hr................... 99

tgt nicotine gum 2mg mint ................. 99 tgt nicotine gum 2mg orig .................. 99

tgt nicotine gum 2mgfruit .................. 99 tgt nicotine gum 4mg ........................ 99

tgt nicotine gum 4mg mint ................. 99

tgt nicotine gum 4mg orig .................. 99 tgt nicotine loz 2mg chry ................... 99

tgt nicotine loz 2mg mint ................. 100 tgt nicotine loz 4mg chry ................. 100

tgt nicotine loz 4mg mint ................. 100 th aspirin tab 325mg .......................... 7

th aspirin tab 325mg ec ...................... 7 th aspirin tab 81mg ec ........................ 7

th hydrocort cre 1% .......................... 65 TH PRENATAL TAB VITAMINS ............. 86

THALOMID CAP 100MG ...................... 47 THALOMID CAP 150MG ...................... 47

THALOMID CAP 200MG ...................... 47 THALOMID CAP 50MG ........................ 47

THEO-24 CAP 100MG CR .................... 16

THEO-24 CAP 200MG CR .................... 16 THEO-24 CAP 300MG CR .................... 16

THEO-24 CAP 400MG ER ................... 16

theochron tab 100mg cr .................... 16 theochron tab 200mg cr .................... 16

theochron tab 300mg cr .................... 16 theophylline sol 80/15ml ................... 16

theophylline tab 100mg cr ................. 16 theophylline tab 100mg er................. 16

theophylline tab 200mg cr ................. 16 theophylline tab 200mg er................. 16

theophylline tab 300mg er................. 17 theophylline tab 400mg er................. 17

theophylline tab 450mg er................. 17 theophylline tab 600mg er................. 17

theracort lot 1% .............................. 65 thermazene cre 1% .......................... 63

thioridazine tab 100mg ..................... 43

thioridazine tab 10mg ....................... 43 thioridazine tab 25mg ....................... 43

thioridazine tab 50mg ....................... 43 thiothixene cap 10mg ....................... 43

thiothixene cap 1mg ......................... 43 thiothixene cap 2mg ......................... 43

thiothixene cap 5mg ......................... 43 thrive gum 2mg mint ...................... 100

thrive gum 4mg mint ...................... 100 THYROGEN INJ 1.1MG ...................... 67

THYROLAR-1 TAB 60MG .................. 102 THYROLAR-1/2 TAB 30MG ............... 102

THYROLAR-1/4 TAB 15MG ............... 102 THYROLAR-2 TAB 120MG ................ 102

THYROLAR-3 TAB 180MG ................ 102

tiagabine tab 2mg ............................ 20 tiagabine tab 4mg ............................ 20

ticlopidine tab 250mg ....................... 77 TIKOSYN CAP 125MCG ...................... 14

TIKOSYN CAP 250MCG ...................... 14 TIKOSYN CAP 500MCG ...................... 14

tilia fe tab ....................................... 55 timolol gel sol 0.25% op ................... 89

timolol gel sol 0.5% op ..................... 89 timolol mal sol 0.25% op .................. 89

timolol mal sol 0.5% op .................... 89 timolol mal tab 10mg ........................ 49

timolol mal tab 20mg ........................ 49 timolol mal tab 5mg ......................... 49

TIMOPTIC OCU SOL 0.25% OP ........... 89

TIMOPTIC OCU SOL 0.5% OP............. 89 tizanidine cap 2mg ........................... 87

147

tizanidine cap 4mg ............................ 87

tizanidine cap 6mg ............................ 87 tizanidine tab 2mg ............................ 87

tizanidine tab 4mg ............................ 87 tl icon cap ........................................ 79

TOBI NEB 300/5ML ............................ 3 tobra/dexame sus 0.3-0.1% ............... 91

TOBRADEX OIN 0.3-0.1% .................. 91 tobramycin neb 300/5ml ..................... 3

tobramycin sol 0.3% op ..................... 90 tobrasol sol 0.3% op ......................... 90

TOBREX OIN 0.3% OP ....................... 90 TODAY SPONGE MIS ......................... 82

tolazamide tab 250mg ....................... 26 tolazamide tab 500mg ....................... 26

tolbutamide tab 500mg ..................... 26

tolmetin sod cap 400mg ..................... 4 tolmetin sod tab 200mg ...................... 4

tolmetin sod tab 600mg ...................... 4 tolterodine cap 2mg er ...................... 75

tolterodine cap 4mg er ...................... 75 tolterodine tab 1mg ........................ 105

tolterodine tab 2mg ........................ 105 tolu-sed dm liq 100-10/5 ................... 59

topiragen tab 100mg ......................... 19 topiragen tab 200mg ......................... 19

topiragen tab 25mg........................... 19 topiragen tab 50mg........................... 19

topiramate cap 15mg ........................ 19 topiramate cap 25mg ........................ 19

topiramate tab 100mg ....................... 20

topiramate tab 200mg ....................... 20 topiramate tab 25mg......................... 19

topiramate tab 50mg......................... 19 torsemide tab 100mg ........................ 69

torsemide tab 10mg .......................... 69 torsemide tab 20mg .......................... 69

torsemide tab 5mg ............................ 69 TOVIAZ TAB 4MG ............................ 105

TOVIAZ TAB 8MG ............................ 105 TRACLEER TAB 125MG ...................... 52

TRACLEER TAB 62.5MG ..................... 52 TRADJENTA TAB 5MG ........................ 25

tramadol hcl tab 100mg er .................. 8 tramadol hcl tab 200mg er .................. 8

tramadol hcl tab 300mg er .................. 8

tramadol hcl tab 50mg ....................... 8 trandolapril tab 1mg .......................... 33

trandolapril tab 2mg ......................... 33

trandolapril tab 4mg ......................... 33 TRANSDERM-SC DIS 1.5MG............... 27

tranylcyprom tab 10mg ..................... 22 TRAVATAN Z DRO 0.004% ................ 92

travoprost dro 0.004% ..................... 92 trazodone tab 100mg ....................... 21

trazodone tab 150mg ....................... 21 trazodone tab 300mg ....................... 21

trazodone tab 50mg ......................... 21 TRECATOR TAB 250MG ..................... 36

TRELSTAR DEP INJ 3.75MG ............... 38 TRELSTAR LA INJ 11.25MG ................ 38

tretinoin cap 10mg ........................... 39 tretinoin cre 0.025% ........................ 60

tretinoin cre 0.05% .......................... 60

tretinoin cre 0.1% ............................ 60 tretinoin gel 0.01% .......................... 60

tretinoin gel 0.025% ......................... 60 TRETIN-X CRE 0.0375% .................... 60

triamcin/ora pst 0.1% ....................... 85 triamcinolon cre 0.025% ................... 66

triamcinolon cre 0.1% ...................... 65 triamcinolon cre 0.5% ...................... 66

triamcinolon lot 0.025% .................... 66 triamcinolon lot 0.1% ....................... 66

triamcinolon oin 0.025% ................... 66 triamcinolon oin 0.05% ..................... 66

triamcinolon oin 0.1% ....................... 66 triamcinolon oin 0.5% ....................... 66

triamcinolon pst 0.1% ...................... 85

triamcinolon spr 55mcg/ac ................ 88 triamt/hctz cap 37.5-25 .................... 68

triamt/hctz tab 37.5-25 .................... 68 triamt/hctz tab 75-50mg ................... 68

triazolam tab 0.125mg ...................... 80 triazolam tab 0.25mg ....................... 79

tricon cap ........................................ 79 triderm cre 0.1% ............................. 66

tri-estaryll tab.................................. 55 trifluoperaz tab 10mg ....................... 43

trifluoperaz tab 1mg ......................... 43 trifluoperaz tab 2mg ......................... 43

trifluoperaz tab 5mg ......................... 43 trifluridine sol 1% op ........................ 90

TRIGLIDE TAB 50MG ........................ 31

trihexyphen elx 0.4mg/ml ................. 39 trihexyphen tab 2mg ........................ 39

148

trihexyphen tab 5mg ......................... 39

tri-legest tab fe ................................ 55 tri-linyah tab .................................... 55

trimethobenz cap 300mg ................... 27 trimethoprim sol polymyxn ................ 90

trimethoprim tab 100mg .................... 11 trimipramine cap 100mg .................... 24

trimipramine cap 25mg ..................... 24 trimipramine cap 50mg ..................... 24

trinessa tab ...................................... 55 triphrocaps cap ................................. 85

tri-previfem tab ................................ 55 tri-sprintec tab ................................. 55

TRIVEEN-U CAP ................................ 86 tri-vit/fe dro /fl 0.25 .......................... 86

tri-vit/fl dro 0.25mg .......................... 85

tri-vit/fl dro 0.5mg ............................ 85 tri-vit/fluo dro 0.25mg ....................... 85

tri-vit/fluo dro 0.5mg ........................ 85 tri-vita/fl dro 0.25mg ........................ 85

trivora-28 tab ................................... 55 TRIZIVIR TAB ................................... 45

tropicamide sol 0.5% op .................... 89 tropicamide sol 1% op ....................... 89

trospium chl cap 60mg er ................ 105 TRUERESULT KIT .............................. 82

TRUETEST TES ................................. 68 TRUVADA TAB 200-300 ..................... 45

TUDORZA PRES AER 400/ACT ............ 15 tusnel diabt liq 10-100/5 ................... 59

tussin adult liq cgh/cong .................... 59

tussin cough liq 10-100/5 .................. 59 tussin cough liq congesti .................... 59

tussin dm liq .................................... 59 tussin dm liq 100-10/5 ...................... 59

tussin dm liq clear ............................. 59 TWINJECT INJ 0.3MG ...................... 106

TWYNSTA TAB 40-10MG .................... 35 TWYNSTA TAB 40-5MG ...................... 35

TWYNSTA TAB 80-10MG .................... 35 TWYNSTA TAB 80-5MG ...................... 35

TYKERB TAB 250MG .......................... 38 TYSABRI INJ .................................... 96

TYZEKA TAB 600MG .......................... 46 TYZINE PED DRO 0.05% .................... 88

TYZINE SOL 0.1% ............................. 88

U ULESFIA LOT 5% .............................. 67

ULORIC TAB 40MG ........................... 75

ULORIC TAB 80MG ........................... 75 ULTRESA CAP 13800UNT ................... 68

ULTRESA CAP 20700UNT ................... 68 ULTRESA CAP 23000UNT ................... 68

unith direct tab 100mcg .................. 102 unith direct tab 112mcg .................. 102



unith direct tab 25mcg .................... 102 unith direct tab 300mcg .................. 102

unith direct tab 50mcg .................... 102 unith direct tab 75mcg .................... 102

unith direct tab 88mcg .................... 102

unithroid tab 100mcg ..................... 102 unithroid tab 112mcg ..................... 102



unithroid tab 200mcg ..................... 102 unithroid tab 25mcg ....................... 102

unithroid tab 300mcg ..................... 102 unithroid tab 50mcg ....................... 102

unithroid tab 75mcg ....................... 102 unithroid tab 88mcg ....................... 102

URINARY TRAC TES INFECTIO ........... 68 URISTIX 4 TES ................................. 68

URISTIX TES ................................... 68

ursodiol cap 300mg .......................... 73 ursodiol tab 250mg .......................... 73

ursodiol tab 500mg .......................... 73 V VAGIFEM TAB 10MCG ..................... 106 valacyclovir tab 1gm ......................... 46

valacyclovir tab 500mg ..................... 46 VALCYTE SOL 50MG/ML .................... 45

VALCYTE TAB 450MG ........................ 45 valproic acd cap 250mg .................... 21

valproic acd sol 250/5ml ................... 21 valproic acd syp 250/5ml .................. 21

valsartan tab 160mg ........................ 34 valsartan tab 320mg ........................ 34

valsartan tab 40mg .......................... 34

valsartan tab 80mg .......................... 34 vancomycin cap 125mg .................... 11

149

vancomycin cap 250mg ..................... 11

vandazole gel 0.75% ....................... 106 VANDETANIB TAB 100MG .................. 38

VANDETANIB TAB 300MG .................. 38 VANOS CRE 0.1% ............................. 66

VANTAS KIT 50MG ............................ 38 velivet pak ....................................... 55

venlafaxine cap 150mg er .................. 23 venlafaxine cap 37.5mg ..................... 23

venlafaxine cap 75mg er .................... 23 venlafaxine tab 100mg ...................... 23

venlafaxine tab 25mg ........................ 23 venlafaxine tab 37.5mg ..................... 23

venlafaxine tab 50mg ........................ 23 venlafaxine tab 75mg ........................ 23

VENTAVIS SOL 10MCG/ML ................. 52

VENTOLIN HFA AER ........................... 16 VERAMYST SPR 27.5MCG ................... 88

verapamil cap 120mg er .................... 51 verapamil cap 120mg sr .................... 51



verapamil cap 360mg sr .................... 51 verapamil tab 120mg ........................ 51

verapamil tab 120mg er .................... 51 verapamil tab 120mg sr ..................... 51

verapamil tab 180mg er .................... 51 verapamil tab 180mg sr ..................... 51

verapamil tab 240mg er .................... 51

verapamil tab 240mg sr ..................... 52 verapamil tab 40mg .......................... 51

verapamil tab 80mg .......................... 51 VERIPRED 20 SOL 20MG/5ML ............. 57

VESICARE TAB 10MG ...................... 105 VESICARE TAB 5MG ........................ 105

vestura tab 3-0.02mg ........................ 55 VEXOL SUS 1% OP............................ 91

VIAGRA TAB 100MG .......................... 52 VIAGRA TAB 25MG ............................ 52

VIAGRA TAB 50MG ............................ 52 VIBRAMYCIN SYP 50MG/5ML ............ 100

VICTOZA INJ 18MG/3ML .................... 25 VICTRELIS CAP 200MG ...................... 46

VIGAMOX DRO 0.5% ......................... 90

VIIBRYD KIT .................................... 21 VIIBRYD TAB 10MG ........................... 22

VIIBRYD TAB 20MG .......................... 22

VIIBRYD TAB 40MG .......................... 22 VIMPAT SOL 10MG/ML ...................... 20

VIMPAT TAB 100MG .......................... 20 VIMPAT TAB 150MG .......................... 20

VIMPAT TAB 200MG .......................... 20 VIMPAT TAB 50MG ........................... 20

VINATE AZ EX TAB ........................... 86 VINATE II TAB ................................. 87

viorele tab ....................................... 55 VIRACEPT POW 50MG/GM ................. 45

VIRACEPT TAB 250MG ...................... 45 VIRACEPT TAB 625MG ...................... 45

VIRAMUNE XR TAB 400MG ................ 45 VIREAD TAB 150MG ......................... 45

VIREAD TAB 200MG ......................... 45

VIREAD TAB 250MG ......................... 45 VIREAD TAB 300MG ......................... 45

VISICOL TAB 1.5GM ......................... 80 vit d gummie chw 400unit ............... 107

VITAMIN A CAP 25000UNT .............. 107 vitamin d cap 50000unt .................. 107

vitamin d chw 400unit .................... 107 vitamin d dro 400unit ..................... 107

vitamin d tab 400unit ..................... 107 vitamin d3 chw 400unit ................... 107

vitamin d3 dro 400unit ................... 107 vitamin d3 tab 400unit .................... 107

vitazol cre 0.75% ............................. 67 VIVAGLOBIN SOL 160MG/ML ............. 93

VIVELLE-DOT DIS 0.025MG ............... 73

VIVELLE-DOT DIS 0.0375MG ............. 73 VIVELLE-DOT DIS 0.05MG ................. 73

VIVELLE-DOT DIS 0.075MG ............... 73 VIVELLE-DOT DIS 0.1MG .................. 73

VIVITROL INJ 380MG ........................ 27 voriconazole tab 200mg .................... 28

voriconazole tab 50mg ...................... 28 VOTRIENT TAB 200MG ...................... 38

VYTORIN TAB 10-10MG ..................... 30 VYTORIN TAB 10-20MG ..................... 30

VYTORIN TAB 10-40MG ..................... 30 VYTORIN TAB 10-80MG ..................... 30

VYVANSE CAP 20MG ........................... 1 VYVANSE CAP 30MG ........................... 1

VYVANSE CAP 40MG ........................... 1

VYVANSE CAP 50MG ........................... 1 VYVANSE CAP 60MG ........................... 1

150

VYVANSE CAP 70MG ........................... 1

W wal-dram ii tab 25mg ........................ 27

wal-dryl cap 25mg ............................ 29 wal-fex allr tab 180mg ...................... 30

wal-fex d tab 12 hour ........................ 59 wal-fex d tab 24 hour ........................ 59

wal-phed tab 30mg ........................... 88 wal-tussin liq dm .............................. 59

wal-zan tab 150mg ......................... 104 wal-zyr dro 0.025%op ....................... 92

wal-zyr sol 1mg/ml ........................... 30 wal-zyr sol 5mg/5ml ......................... 30

warfarin tab 10mg ............................ 17 warfarin tab 1mg .............................. 17

warfarin tab 2.5mg ........................... 17

warfarin tab 2mg .............................. 17 warfarin tab 3mg .............................. 17

warfarin tab 4mg .............................. 17 warfarin tab 5mg .............................. 17

warfarin tab 6mg .............................. 17 warfarin tab 7.5mg ........................... 17

wee care sus 15/1.25 ........................ 79 WELCHOL TAB 625MG ....................... 31

wera tab 0.5/35 ................................ 55 WIDE-SEAL DPR KIT 60 ..................... 82

WIDE-SEAL DPR KIT 65 ..................... 82 WIDE-SEAL DPR KIT 70 ..................... 82


WIDE-SEAL DPR KIT 85 ..................... 82


WINRHO SDF INJ 15000UNT .............. 93 WINRHO SDF INJ 1500UNIT ............... 93

WINRHO SDF INJ 2500UNIT ............... 93 WINRHO SDF INJ 5000UNIT ............... 93

wymzya fe chw 0.4mg-35 .................. 55 X XALKORI CAP 200MG ........................ 39 XALKORI CAP 250MG ........................ 39

XARELTO TAB 10MG .......................... 17 XARELTO TAB 15MG .......................... 17

XARELTO TAB 20MG .......................... 17 XELODA TAB 150MG ......................... 37

XELODA TAB 500MG ......................... 37

XENAZINE TAB 12.5MG ..................... 95 XENAZINE TAB 25MG ........................ 96

XGEVA INJ ...................................... 70

XIFAXAN TAB 200MG ........................ 11 XIFAXAN TAB 550MG ........................ 11

XOLAIR SOL 150MG ......................... 14 XOPENEX HFA AER ........................... 16

xulane dis 150-35 ............................ 56 XYREM SOL 500MG/ML ..................... 95

Y yl folic aci tab 400mcg ...................... 77

yohimbine tab 5.4mg ........................ 52 Z zafirlukast tab 10mg ......................... 15 zafirlukast tab 20mg ......................... 15

zaleplon cap 10mg ........................... 80 zaleplon cap 5mg ............................. 80

zarah tab 3-0.03mg .......................... 55

zazole cre 0.4% ............................. 106 zazole cre 0.8% ............................. 106

zazole sup 80mg ............................ 106 ZELAPAR TAB 1.25MG ....................... 40

ZELBORAF TAB 240MG...................... 39 ZEMAIRA INJ 1000MG ..................... 100

ZEMPLAR CAP 1MCG ......................... 71 ZEMPLAR CAP 2MCG ......................... 71

ZEMPLAR CAP 4MCG ......................... 71 zenatane cap 10mg .......................... 60

zenatane cap 20mg .......................... 60 zenatane cap 40mg .......................... 60

zenchent fe chw ............................... 55 zenchent fe chw 0.4mg-35 ................ 56

zenchent tab ................................... 56

ZENPEP CAP 10000UNT ..................... 68 ZENPEP CAP 15000UNT ..................... 68

ZENPEP CAP 20000UNT ..................... 68 ZENPEP CAP 25000UNT ..................... 68

ZENPEP CAP 3000UNIT ..................... 68 zenzedi tab 10mg ............................... 1

zenzedi tab 5mg ................................ 1 zeosa chw ....................................... 56

ZETIA TAB 10MG .............................. 32 ZIAGEN SOL 20MG/ML ...................... 45

zidovudine cap 100mg ...................... 45 zidovudine syp 50mg/5ml ................. 45

zidovudine tab 300mg ...................... 45 ZIOPTAN DRO 0.0015% .................... 92

ziprasidone cap 20mg ....................... 41

ziprasidone cap 40mg ....................... 41 ziprasidone cap 60mg ....................... 41

151

ziprasidone cap 80mg ........................ 41

ZIRGAN GEL 0.15% .......................... 91 ZMAX SUS 2GM ................................ 81

ZOLINZA CAP 100MG ........................ 39 zolmitriptan tab 2.5 mg ..................... 83

zolmitriptan tab 2.5mg ...................... 83 zolmitriptan tab 5mg ......................... 83

zolpidem tab 10mg ........................... 80 zolpidem tab 5mg ............................. 80

zonisamide cap 100mg ...................... 20 zonisamide cap 25mg ........................ 20

zonisamide cap 50mg ........................ 20 ZORTRESS TAB 0.25MG ..................... 48

ZORTRESS TAB 0.5MG ...................... 48

ZORTRESS TAB 0.75MG .................... 48 zovia 1/35e tab ................................ 56

zovia 1/50e tab ................................ 56 ZUPLENZ MIS 4MG ........................... 27

ZUPLENZ MIS 8MG ........................... 27 ZYFLO CR TAB 600MG ...................... 15

ZYMAXID SOL 0.5% ......................... 91 zyrtec itchy dro 0.025%op ................ 92

ZYTIGA TAB 250MG .......................... 38 ZYVOX SUS 100MG/5M ..................... 12

ZYVOX TAB 600MG ........................... 12

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