state pharmacy product list - uhccommunityplan.com · entex hc liq phenylephrine w/ hydrocodone-gg...

29
State Pharmacy Product List Hawaii Effective Date: 1/1/2013 M854429-C 2/13 ©2013 United Healthcare Services, Inc.

Upload: lamdan

Post on 15-May-2019

221 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

State Pharmacy Product List Hawaii Effective Date: 1/1/2013

M854429-C 2/13 ©2013 United Healthcare Services, Inc.

Page 2: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

2

UnitedHealthcare Community Plan covers selected Over The Counter (OTC) and Center for Medicare and Medicaid Services (CMS) excluded drugs. If a drug is covered, the generic version of the drug is provided when it is available. OTC products covered are restricted to generics when available. Brand names are provided as reference only. To be processed, the physician must provide a written prescription for the drug. If your drug is not included in the covered drug list, you should talk to your physician about prescribing a covered drug that is an effective and acceptable alternative. All claims submitted for products whose manufacturer does not participate in the Federal Rebate Program will not process. Most, if not all products, are available from multiple manufacturers/labelers. Pharmacies should endeavor to dispense a product of a different labeler that participates with the Federal Rebate Program.

Table of Contents

Acne Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Analgesics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Anorectal Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Birth Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Cough/Cold/Allergy Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Dermatological - Antibiotics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Dermatological - Antifungals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Dermatological - Corticosteroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Dermatologcals - Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Emollients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Eye Drops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Gastrointestinal (GI) Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Mouth/Throat/Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Otic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Smoking Cessation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Testing Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Urinary Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Vaginal Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Vitamins/Minerals/Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Page 3: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

3

Acne Products

DRY & CLEAR CRE 10% benzoyl peroxide cream 10%

BENZAGEL-10 GEL 10% benzoyl peroxide gel 10%

BENZAGEL-5 GEL 5% benzoyl peroxide gel 5%

TRIAZ CLEANS LOT 10% benzoyl peroxide lotion 10%

CLEAN&CLEAR LOT EXFOLIAT benzoyl peroxide lotion 5%

Analgesics

TYLENOL CAP 500 MG acetaminophen cap 500 mg

TYLENOL JR CHW 160 MG acetaminophen chew tab 160 mg

TYLENOL GO CHW EXTRA ST acetaminophen chew tab 500 mg

CHLD TYLENOL CHW 80 MG acetaminophen chew tab 80 mg

TYLENOL CHLD ELX 160/5 ML acetaminophen elixir 160 mg/ 5ml

TYLENOL LIQ 167 MG/5 ML acetaminophen liquid 167 mg/ 5ml

T-PANOL DRO 100 MG/ML acetaminophen soln 100 mg/ml

TYLENOL SOL 500/15 ML acetaminophen soln 160 mg/5 ml

FEVERALL SUP 80 MG acetaminophen suppos 80 mg

TYLENOL CHLD SUS 160/5 ML acetaminophen susp 160 mg/5 ml

TYLENOL INF DRO 80/0.8 ML acetaminophen susp 80 mg/0.8 ml

TYLENOL JR TAB 160 MG acetaminophen tab 160 mg

TYLENOL TAB 325 MG acetaminophen tab 325 mg

TYLENOL TAB 500 MG acetaminophen tab 500 mg

TYLENOL ARTH TAB 650 MG acetaminophen tab cr 650 mg

BUFFERIN TAB 324 MG aspirin buffered tab 325 mg

ST JOSEPH CHW 75 MG ADU aspirin chew tab 75 mg

BAYER CHILD CHW ASA 81 MG aspirin chew tab 81 mg

ASPIRIN SUP 600 MG aspirin suppos 600 mg

LOW DOSE ASA TAB 81 MG aspirin tab 81 mg

ASA TAB 325 MG EC aspirin tab delayed release 325 mg

ECOTRIN M/S TAB 500 MG EC aspirin tab delayed release 500 mg

ASA TAB 650 MG EC aspirin tab delayed release 650 mg

BUFFERIN TAB LOW DOSE aspirin tab delayed release 81 mg

EASPRIN TAB 975 MG EC aspirin tab delayed release 975 mg

EXCEDRIN TAB EX ST aspirin-acetaminophen-caffeine tab 250-250-65 mg

ASCRIPTIN TAB aspirin-al hydro-mg hydro-ca carb tab 325-50-50-87 mg

ASCRIPTIN TAB A/D aspirin-al hydro-mg hydro-ca carb tab 325-75-75-71 mg

PHRENILIN TAB 50-325 butalbital-acetaminophen tab 50-325 mg PA

SEDAPAP TAB 50-650 MG butalbital-acetaminophen tab 50-650 mg PA

ESGIC CAP butalbital-acetaminophen-caffeine cap 50-325-40 mg PA

Page 4: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

4

ESGIC-PLUS CAP butalbital-acetaminophen-caffeine cap 50-500-40 mg PA

FIORICET TAB butalbital-acetaminophen-caffeine tab 50-325-40 mg PA

ESGIC-PLUS TAB butalbital-acetaminophen-caffeine tab 50-500-40 mg PA

FIORINAL CAP butalbital-aspirin-caffeine cap 50-325-40 mg PA

FIORINAL TAB butalbital-aspirin-caffeine tab 50-325-40 mg PA

MOTRIN CHW 100 MG ibuprofen chew tab 100 mg

MOTRIN DRO 40 MG/ML ibuprofen susp 40 mg/ml

MOTRIN TAB 100 MG ibuprofen tab 100 mg

ADVIL TAB 200 MG ibuprofen tab 200 mg

ALEVE TAB 220 MG naproxen sodium tab 220 mg

Anorectal Agents

phenylephrine-shark liver oil-glyc-pet cream 0.25-3-12-18%

PREPARATION SUP H phenyleph-shark liver oil-cocoa butter suppos 0.25-3-85.5%

TUCKS SUP 51% starch suppositories 51%

Birth Control

TROJAN condoms

ORTHO COIL ortho diaphragm

ORTHO FLAT ortho diaphragm

ORTHO FLEX ortho diaphragm

Cough/Cold/Allergy Products

TESSALON PER CAP 100 MG benzonatate cap 100 mg

TESSALON CAP 200 MG benzonatate cap 200 mg

DIMETAPP CLD ELX /ALLERGY brompheniramine & phenylephrine elixir 1-2.5 mg/5 ml

BROMFED CAP 12-120 CR brompheniramine & pseudoephedrine cap cr 12-120 mg

BROMFED PD CAP 6-60 MG CR brompheniramine & pseudoephedrine cap cr 6-60 mg

DIMETAPP ELX CLD/ALLE brompheniramine & pseudoephedrine elixir 1-15 mg/5 ml

ACCUHIST DRO brompheniramine & pseudoephedrine liquid 1-12.5 mg/ml

SILDEC SYP 4-45/5 ML brompheniramine & pseudoephedrine syrup 4-45 mg/5 ml

TUSSI-12 S SUS 4-30 MG/5 ML chlorphen tannate-carbetapentane tannate susp 4-30 mg/5 ml

RONDEC DRO chlorpheniramine & phenylephrine liquid 1-3.5 mg/ml

ED A-HIST LIQ 4-10/5 ML chlorpheniramine & phenylephrine liquid 4-10 mg/5 ml

RONDEC SYP chlorpheniramine & phenylephrine syrup 4-12.5 mg/5 ml

ED A-HIST TAB 8-20 CR chlorpheniramine & phenylephrine tab cr 8-20 mg

DECONAMINE CAP 8-120 SR chlorpheniramine & pseudoephedrine cap cr 8-120 mg

ACCUHIST DRO 0.8-9 MG chlorpheniramine & pseudoephedrine drops 0.8-9 mg/ml

CO-PYRONIL 2 LIQ chlorpheniramine & pseudoephedrine liquid 2-30 mg/5 ml

Page 5: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

5

TRIA COLD/AL SYP 1-15 MG/5 ML chlorpheniramine & pseudoephedrine syrup 1-15 mg/5 ml

CHLOR-TRIMET SYP 2 MG/5 ML chlorpheniramine maleate syrup 2 mg/5 ml

CHLOR-TRIMET TAB 4 MG chlorpheniramine maleate tab 4 mg

CHLOR-TRIMET TAB 12 MG CR chlorpheniramine maleate tab cr 12 mg

RYNATAN PED SUS chlorpheniramine tan-phenylephrine tan susp 4.5-5 mg/5 ml

ROBITUSS PED LIQ CGH/COLD chlorpheniramine-dm liquid 1-7.5 mg/5 ml

ROBITUSSIN LIQ CGH/COLD chlorpheniramine-dm liquid 2-15 mg/5 ml

DIMETAPP SYP CGH/COLD chlorpheniramine-dm syrup 1-7.5 mg/5 ml

CORICIDIN TAB CGH&COLD chlorpheniramine-dm tab 4-30 mg

EXTENDRYL SYP chlorpheniramine-pe-methscopolamine syrup 2-10-1.25 mg/5 ml

DALLERGY SYP chlorphen-pe-methscopolamine syrup 2-10-0.625 mg/5 ml

TYL ALLERGY/ TAB SINUS chlorphen-pseudoephedrine w/ apap tab 2-30-500 mg

TAVIST-1 TAB 1.34 MG clemastine fumarate tab 1.34 mg (1 mg base equiv)

BENYLIN ADLT SYP 15 MG/5 ML dextromethorphan hbr syrup 15 mg/5 ml

CREOMULSION SYP CHILDREN dextromethorphan hbr syrup 5 mg/5 ml

BENYLIN PED SYP 7.5/5 ML dextromethorphan hbr syrup 7.5 mg/5 ml

DELSYM LIQ 30 MG/5 ML dextromethorphan polistirex liquid cr 30 mg/5 ml

CHERACOL-D LIQ 100-10/5 dextromethorphan-guaifenesin liquid 10-100 mg/5 ml

ROBITUSSIN LIQ CGH/CONG dextromethorphan-guaifenesin liquid 10-200 mg/5 ml

DURATUSS DM ELX dextromethorphan-guaifenesin solution 25-225 mg/5 ml

ROBITUSSIN SYP DM dextromethorphan-guaifenesin syrup 10-100 mg/5 ml

AQUATAB DM SYP 10-200 MG dextromethorphan-guaifenesin syrup 10-200 mg/5 ml

ROBITUSSIN SYP DM dextromethorphan-guaifenesin syrup 15-100 mg/5 ml

MUCINEX DM TAB 30-600 ER dextromethorphan-guaifenesin tab sr 12hr 30-600 mg

BENADRYL CAP 25 MG diphenhydramine hcl cap 25 mg

BENADRYL ALG CHW CHILD diphenhydramine hcl chew tab 12.5 mg

BENADRYL ALL LIQ 12.5/5 ML diphenhydramine hcl liquid 12.5 mg/5 ml

BENYLIN SYP 12.5/5 ML diphenhydramine hcl syrup 12.5 mg/5 ml

BENADRYL ALG TAB 25 MG diphenhydramine hcl tab 25 mg

ORGANIDIN NR LIQ 100/5 ML guaifenesin liquid 100 mg/5 ml

ROBITUSSIN SYP 100/5 ML guaifenesin syrup 100 mg/5 ml

DURATUSS G TAB 1200 CR guaifenesin tab sr 12hr 1200 mg

MUCINEX TAB 600 MG ER guaifenesin tab sr 12hr 600 mg

TUSSI-ORGANI LIQ S NR guaifenesin-codeine soln 100-10 mg/5 ml

CGU WC LIQ guaifenesin-codeine soln 100-6.3 mg/5 ml

HYCODAN SYP 5-1.5/5 hydrocodone w/ homatropine syrup 5-1.5 mg/5 ml

HYCODAN TAB 5 MG hydrocodone w/ homatropine tab 5-1.5 mg

PNEUMOTUSSIN SYP 2.5/200 hydrocodone-guaifenesin syrup 2.5-200 mg/5 ml

CODICLEAR DH SYP 3.5-100 hydrocodone-guaifenesin syrup 3.5-100 mg/5 ml

CODICLEAR DH SYP hydrocodone-guaifenesin syrup 3.5-300 mg/5 ml

PANCOF XP SYP hydrocodone-guaifenesin syrup 3-90 mg/5 ml

VICODIN TUSS SYP 5-100/5 hydrocodone-guaifenesin syrup 5-100 mg/5 ml

Page 6: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

6

CLARITIN-D TAB 5-120 MG loratadine & pseudoephedrine tab sr 12hr 5-120 mg

CLARITIN-D TAB 10-240 MG loratadine & pseudoephedrine tab sr 24hr 10-240 mg

NTZ SOL 0.05% oxymetazoline hcl nasal soln 0.05%

TUSSI-12D S SUS phenyleph tan-pyrilamine tan-carbeta tan susp 5-30-30 mg/5 ml

ACCUHIST PDX SYP phenyleph-bromphen-dm-guaifenesin syrup 5-2-5-50 mg/5 ml

ATUSS HC SYP phenyleph-chlorphen w/ hydrocodone syrup 10-2-2.5 mg/5 ml

ATUSS MS SYP phenyleph-chlorphen w/ hydrocodone syrup 10-2-5 mg/5 ml

ENDAL-HD SYP 5-2-1.67 phenyleph-chlorphen w/ hydrocodone syrup 5-2-1.67 mg/5 ml

HISTUSSIN HC SYP phenyleph-chlorphen w/ hydrocodone syrup 5-2-2.5 mg/5 ml

ENDAL-HD SYP phenyleph-chlorphen w/ hydrocodone syrup 7.5-2-2 mg/5 ml

ENDAL-HD SYP PLUS phenyleph-chlorphen w/ hydrocodone syrup 7.5-2-3.5 mg/5 ml

RYNATUSS PED SUS phenyleph-ephed-cpm w/ carbetapentane susp 5-5-4-30 mg/5 ml

RYNATUSS TAB phenyleph-ephed-cpm w/ carbetapentane tab 10-10-5-60 mg

CODIMAL DH SYP phenyleph-pyrilamine w/ hydrocodone syrup 5-8.33-1.66 mg/5 ml

DIMETAPP DRO DECONGES phenylephrine hcl drops 1.25 mg/0.8 ml

NEO-SYNEPHRI SOL 0.25% phenylephrine hcl nasal soln 0.25%

NEO-SYNEPHRI SOL 0.5% phenylephrine hcl nasal soln 0.5%

NEO-SYNEPHRI SPR 1% phenylephrine hcl nasal soln 1%

SUDAFED PE TAB 10MG phenylephrine hcl tab 10 mg

ROBITUSSIN LIQ CGH/CLD phenylephrine w/ dm-gg liqd 5-10-100 mg/5 ml

TUSSAFED HC SYP phenylephrine w/ hydrocodone-gg syrup 7.5-2.5-50 mg/5 ml

ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml

DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm elixir 2.5-1-5 mg/5 ml

PANCOF PD SYP phenylephrine-chlorphen-dihydrocodeine syrup 7.5-2-3 mg/5 ml

NOREL DM SOL phenylephrine-chlorphen-dm liquid 10-4-15 mg/5 ml

RONDEC-DM DRO 3.5-1-3 phenylephrine-chlorphen-dm liquid 3.5-1-3 mg/ml

ROBITUSSIN LIQ CGH/ALRG phenylephrine-chlorphen-dm liquid 5-2-10 mg/5 ml

ATUSS DM SYP 10-2-15 M phenylephrine-chlorphen-dm syrup 10-2-15 mg/5 ml

RONDEC-DM SYP phenylephrine-chlorphen-dm syrup 12.5-4-15 mg/5 ml

TUSSAR DM SYP phenylephrine-chlorphen-dm syrup 5-2-15 mg/5 ml

ATUSS DR SYP phenylephrine-chlorphen-dm syrup 6-2-15 mg/5 ml

DIMETAPP DRO DCON/CGH phenylephrine-dm drops 1.25-2.5 mg/0.8 ml

RESCON-GG LIQ phenylephrine-guaifenesin liqd 5-100 mg/5 ml

DECON-E LIQ phenylephrine-guaifenesin liqd 7.5-100 mg/5 ml (1.5-20 mg/ml)

PHENERGAN VC SYP /CODEINE phenylephrine-promethazine w/ codeine syrup 5-6.25-10 mg/5 ml

CODIMAL DM SYP phenylephrine-pyrilamine-dm syrup 5-8.33-10 mg/5 ml

PHENERGAN/ SYP CODEINE promethazine w/ codeine syrup 6.25-10 mg/5 ml

PHENERGAN DM SYP promethazine-dm syrup 6.25-15 mg/5 ml

TANAFED DMX SUS pseudoephed tan-dexchlorphen tan-dm tan sus 75-2.5-25 mg/5 ml

DIMETAPP DM ELX CLD/COUG pseudoephed-bromphen-dm elixir 15-1-5 mg/5 ml

ACCUHIST PDX DRO pseudoephed-bromphen-dm liquid 12.5-1-3 mg/ml

Page 7: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

7

PROHIST DM DRO pseudoephed-bromphen-dm liquid 12-1-5 mg/ml

DIMETANE-DX SYP pseudoephed-bromphen-dm syrup 30-2-10 mg/5 ml

DALLERGY DM SYP pseudoephed-bromphen-dm syrup 30-3-15 mg/5 ml

RONDEC DM SYP pseudoephed-bromphen-dm syrup 45-4-15 mg/5 ml

NEO DM SYP pseudoephed-bromphen-dm syrup 50-3-30 mg/5 ml

ANAPLEX DM SYP pseudoephed-bromphen-dm syrup 60-4-30 mg/5 ml

ACCUHIST DM SYP pseudoephed-bromphen-dm-gg syrup 30-2-5-50 mg/5 ml

PEDIACARE LIQ MULTI-SY pseudoephed-chlorphen-dm liq 15-1-5 mg/5 ml

PEDIACARE LIQ NITEREST pseudoephed-chlorphen-dm liq 15-1-7.5 mg/5 ml

DIBROMM EXT CAP 120 MG CR pseudoephedrine hcl cap sr 12hr 120 mg

SUDAFED CHLD CHW NON-DRSY pseudoephedrine hcl chew tab 15 mg

SUDAFED CHLD LIQ 15 MG/5 ML pseudoephedrine hcl liq 15 mg/5 ml

PEDIACARE DRO 7.5/0.8 pseudoephedrine hcl soln 7.5 mg/0.8 ml

SUDAFED TAB 30 MG pseudoephedrine hcl tab 30 mg

SUDAFED TAB 60 MG pseudoephedrine hcl tab 60 mg

INFAN TYLEN DRO DCON/FVR pseudoephedrine w/ acetaminophen soln 7.5-80 mg/0.8 ml

SINE-AID TAB MAX STR pseudoephedrine w/ acetaminophen tab 30-500 mg

INF TYLENOL DRO COLD/CGH pseudoephedrine w/ apap-dm liq 15-160-5 mg/1.6 ml

TYLENOL COLD TAB NO-DROWS pseudoephedrine w/ apap-dm tab 30-325-15 mg

NUCOFED EXP SYP PED pseudoephedrine w/ cod-gg soln 30-10-100 mg/5 ml

ROBITUSSIN CAP COLD/CGH pseudoephedrine w/ dm-gg cap 30-10-200 mg

ROBITUSSIN DRO PEDIATRC pseudoephedrine w/ dm-gg liquid 15-5-100 mg/2.5 ml

NOVAHISTINE LIQ DH pseudoephedrine-chlorphen w/ codeine liq 30-2-10 mg/5 ml

ROBITUSS PED LIQ CGH/COLD pseudoephedrine-dm liqd 15-7.5 mg/5 ml

PEDIACARE SOL DCON/CGH pseudoephedrine-dm soln 7.5-2.5 mg/0.8 ml

DIMETAPP SYP CGH/COLD pseudoephedrine-dm syrup 15-7.5 mg/5 ml

TYLENOL COLD TAB pseudoephedrine-dm-gg w/ apap tab 30-15-200-325 mg

GUAIFED CAP CR pseudoephedrine-guaifenesin cap cr 120-250 mg

RESPAIRE-60 CAP CR pseudoephedrine-guaifenesin cap cr 60-200 mg

TRIAMINIC SYP CHST CON pseudoephedrine-guaifenesin syrup 15-50 mg/5 ml

ROBITUSSIN SYP PE pseudoephedrine-guaifenesin syrup 30-100 mg/5 ml

PANMIST S SYP 40-200/5 pseudoephedrine-guaifenesin syrup 40-200 mg/5 ml

DURATUSS GP TAB 120/1200 pseudoephedrine-guaifenesin tab sr 12hr 120-1200 mg

ZEPHREX LA TAB 120-600 pseudoephedrine-guaifenesin tab sr 12hr 120-600 mg

PANMIST JR TAB 45-600 CR pseudoephedrine-guaifenesin tab sr 12hr 45-600 mg

PROFEN II TAB 45-800 MG pseudoephedrine-guaifenesin tab sr 12hr 45-800 mg

PANMIST JR TAB 595-48 MG pseudoephedrine-guaifenesin tab sr 12hr 48-595 mg

SUDAL SR TAB 50-1200 pseudoephedrine-guaifenesin tab sr 12hr 50-1200 mg

TOURO LA-LD TAB pseudoephedrine-guaifenesin tab sr 12hr 50-525 mg

AMBIFED-G TAB 60-1000 MG pseudoephedrine-guaifenesin tab sr 12hr 60-1000 mg

AQUATAB D TAB 60-1200 MG pseudoephedrine-guaifenesin tab sr 12hr 60-1200 mg

Page 8: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

8

HISTEX DA TAB 60-500 MG pseudoephedrine-guaifenesin tab sr 12hr 60-500 mg

MAXIFED-G TAB 60-580 CR pseudoephedrine-guaifenesin tab sr 12hr 60-580 mg

DECONSAL II TAB 60-600 CR pseudoephedrine-guaifenesin tab sr 12hr 60-600 mg

MEDENT LD TAB pseudoephedrine-guaifenesin tab sr 12hr 60-800 mg

MAXIFED TAB 80-700 CR pseudoephedrine-guaifenesin tab sr 12hr 80-700 mg

MAXIFED TAB 80-780 MG pseudoephedrine-guaifenesin tab sr 12hr 80-780 mg

PANMIST-LA TAB 80-800 MG pseudoephedrine-guaifenesin tab sr 12hr 80-800 mg

PANMIST LA TAB 795-85 MG pseudoephedrine-guaifenesin tab sr 12hr 85-795 mg

CHILD MOTRIN SUS COLD pseudoephedrine-ibuprofen susp 15-100 mg/5 ml

DIMETAPP TAB SINUS pseudoephedrine-ibuprofen tab 30-200 mg

RYNA-12 S SUS pyrilamine tan-phenyleph tan susp 30-5 mg/5 ml

AYR NASAL DRO 0.65% saline nasal soln 0.65%

ARY ALLERGY SPR & SINUS saline nasal soln 2.65%

OCEAN NASAL SPR 0.65% saline nasal spray 0.65%

ACTIFED SYP 1.25-30 triprolidine & pseudoephedrine syrup 1.25-30 mg/5 ml

ACTIFED TAB 2.5-60 MG triprolidine & pseudoephedrine tab 2.5-60 mg

Dermatological - Antibiotics

BACIGUENT OIN 500U/GM bacitracin oint 500 unit/gm

POLYSPORIN OIN bacitracin-polymyxin b oint

MYCITRACIN OIN neomycin-bacitracin-polymyxin oint

Dermatological - Antifungals

MICATIN AER 2% miconazole nitrate aerosol 2%

MICATIN CRE 2% miconazole nitrate cream 2%

ALOE VESTA OIN 2% miconazole nitrate ointment 2%

MIRANEL AF SOL 2% miconazole nitrate soln 2%

DESENEX MAX CRE 1% terbinafine hcl cream 1%

TINACTIN AER 1% tolnaftate aerosol 1%

TINACTIN AER POWD 1% tolnaftate aerosol pow 1%

TINACTIN CRE 1% tolnaftate cream 1%

TINACTIN SOL 1% tolnaftate soln 1%

Dermatological - Corticosteroids

CORT-DOME CRE 0.5% hydrocortisone cream 0.5%

CORT-DOME CRE 1% hydrocortisone cream 1%

HYDROCORT CRE 0.5% hydrocortisone-aloe vera cream 0.5%

Page 9: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

9

Dermatologcals - Miscellaneous

ACID MANTLE CRE aluminum acetate cream

ALUMINUM SOL ACETATE aluminum acetate soln

DOMEBORO POW PACKETS aluminum sulfate & calcium acetate powd pack

CALAMINE LOT calamine lotion

CAPZASIN-P CRE 0.025% capsaicin cream 0.025%

CAPZASIN-P CRE 0.035% capsaicin cream 0.035%

DOUBLECAP CRE 0.05% capsaicin cream 0.05%

ZOSTRIX-HP CRE 0.075% capsaicin cream 0.075%

CAPZASIN-HP CRE 0.1% capsaicin cream 0.1%

DOLORAC CRE TOPICAL capsaicin cream 0.25%

ICY HOT GEL ARTHRIT capsaicin gel 0.025%

CAPSAGEL XS GEL 0.05% capsaicin gel 0.05%

CAPSAGEL MS GEL 0.075% capsaicin gel 0.075%

CAPSAICIN LOT 0.025% capsaicin lotion 0.025%

CASTIVA LOT capsaicin lotion 0.035%

CAPSIN LOT 0.075% capsaicin lotion 0.075%

HIBICLENS LIQ 4% chlorhexidine gluconate liquid 4%

AVEENO BATH PAK TREATMNT colloidal oatmeal packet

LACTICARE LOT 5% lactic acid (ammonium lactate) lotion 5%

SOLARCAINE GEL ALOE EXT lidocaine hcl gel 0.5%

NIX LIQ 1% permethrin creme rinse 1%

NIX LICE SPR CONTROL permethrin liq spray 0.25%

POVIDONE-IOD SOL 0.75% povidone-iodine soln 0.75%

BETADINE SOL 10% povidone-iodine soln 10%

PYRE/PIPERON LIQ pyrethrins-piperonyl butoxide liq 0.2-2%

RID LIQ pyrethrins-piperonyl butoxide liq 0.3-3%

END LICE M/S LIQ pyrethrins-piperonyl butoxide liq 0.33-4%

TEGRIN-LT SHAMPOO pyrethrins-piperonyl butoxide shampoo 0.3-3%

PRONTO SHA W/RINSE pyrethrins-piperonyl butoxide shampoo 0.33-4%

COMPOUND W LIQ 17% salicylic acid liquid 17%

SEBACLEAR LIQ 2% salicylic acid liquid 2%

SCALP AID LIQ salicylic acid liquid 3%

MOSCO CALLUS SOL CRN RMVR salicylic acid soln 12.24%

SCHOLL CORN/ SOL CALLUS salicylic acid soln 12.6%

WART OFF SOL 17% salicylic acid soln 17%

CARMOL 40 LOT urea lotion 40%

Page 10: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

10

Emollients

BETA CARE CRE emollient

BETA CARE LOT emollient

CETAPHIL CREAM emollient

CETAPHIL DAY LOT ADVA emollient

CETAPHIL LOTION emollient

DERMAPHOR OIN emollient

E-OINTMENT OIN emollient

PETROLATUM GEL WHITE white petrolatum gel

Eye Drops

TEARS AGAIN GEL NGHT/DAY artificial tear ophth gel

LACRI-LUB NP OIN OP artificial tear ophth ointment

HYPOTEARS SOL OP artificial tear ophth solution

REFRESH PLUS DRO 0.5% OP carboxymethylcellulose sodium ophth soln 0.5%

GENTEAL PF SOL 0.3% hypromellose ophth soln 0.3%

TEARGEN II SOL OP hypromellose ophth soln 0.4%

ZADITOR DRO 0.025%OP ketotifen fumarate ophth soln 0.025% (base equiv)

NAPHCON-A SOL OP naphazoline w/ pheniramine ophth soln 0.025-0.3%

AK-NEFRIN SOL 0.12% phenylephrine hcl ophth soln 0.12%

MYDFRIN SOL 2.5% OP phenylephrine hcl ophth soln 2.5%

LIQUIFILM SOL TEARS polyvinyl alcohol ophth soln 1.4%

MURO 128 OIN 5% OP sodium chloride hypertonic ophth oint 5%

VISINE SOL 0.05% OP tetrahydrozoline hcl ophth soln 0.05%

Gastrointestinal (GI) Products

ACIDOPHILUS acidophilus caps and tabs

ACIDOPHILUS XTRA acidophilus

ACIDOPHILUS/BIFIDUS WAFER acidophilus/bifidus

ACIDOPHILUS/CITRUS PECTIN acidophilus/citrus pectin tabs

ACIDOPHILUS/PECTIN acidophilus/pectin caps

MAALOX PLUS CHW alum & mag hydroxide-simethicone chew tab 200-200-25 mg

MYLANTA SUS alum & mag hydroxide-simethicone susp 200-200-20 mg/5 ml

MAALOX PLUS SUS alum & mag hydroxide-simethicone susp 225-200-25 mg/5 ml

MYLANTA II SUS alum & mag hydroxide-simethicone susp 400-400-40 mg/5 ml

KUDROX DS SUS alum & mag hydroxide-simethicone susp 500-450-40 mg/5 ml

GENATON CHW alum hydrox-mag trisil-alginic acid-sod bicarb chew tab

MAALOX SUS aluminum & magnesium hydroxides susp 225-200 mg/5 ml

GAVISCON CHW EX-STR aluminum hydroxide-magnesium carbonate chew tab 160-105 mg

Page 11: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

11

GAVISCON SUS aluminum hydroxide-magnesium carbonate susp 31.7-137 mg/5 ml

GAVISCON SUS aluminum hydroxide-magnesium carbonate susp 508-475 mg/10 ml

GAVISCON SUS aluminum hydroxide-magnesium carbonate susp 95-358 mg/15 ml

GAVISCON CHW aluminum hydroxide-magnesium trisilicate chew tab 80-20 mg

ATROPINE SUL TAB 0.4 MG atropine sulfate tab 0.4 mg

KAOPECTATE SUS 600/15 ML attapulgite susp 600 mg/15 ml

FLEET BISACO ENE 10/30 ML bisacodyl enema 10 mg/30 ml

DULCOLAX SUP 10 MG bisacodyl suppos 10 mg

DULCOLAX TAB 5 MG EC bisacodyl tab delayed release 5 mg

FLEET PREP KIT #1 bisacodyl-sod biphos/sod phos prep kit

PEPTO-BISMOL CHW 262 MG bismuth subsalicylate chew tab 262 mg

PEPTO-BISMOL SUS 527/30 ML bismuth subsalicylate susp 262 mg/15 ml

PEPTO-BISMOL SUS 525/15 ML bismuth subsalicylate susp 525 mg/15 ml

PEPTO BISMOL TAB 262 MG bismuth subsalicylate tab 262 mg

MYLANTA TAB calcium & magnesium carbonates tab 311-232 mg

MAALOX QUICK CHW DISSOLVE calcium carbonate (antacid) chew tab 1000 mg

MYLANTA CHW 400 MG calcium carbonate (antacid) chew tab 400 mg

TUMS CHW 500 MG calcium carbonate (antacid) chew tab 500 mg

MAALOX QUICK CHW DISSOLVE calcium carbonate (antacid) chew tab 600 mg

TUMS E-X CHW 750 MG calcium carbonate (antacid) chew tab 750 mg

CALCIUM CARB TAB 650 MG calcium carbonate (antacid) tab 650 mg

MYLANTA SUS SUPREME calcium carbonate-mag hydroxide susp 400-135 mg/5 ml

FIBERCON TAB 625 MG calcium polycarbophil tab 625 mg

DIONEX SYP 100-30 casanthranol-dss syrup 30-100 mg/5 ml

SURFAK CAP 240 MG docusate calcium cap 240 mg

DIALOSE CAP 100 MG docusate potassium cap 100 mg

KASOF CAP 240 MG docusate potassium cap 240 mg

COLACE CAP 100 MG docusate sodium cap 100 mg

COLACE CAP 50 MG docusate sodium cap 50 mg

ENEMEEZ MINI ENE docusate sodium enema 283 mg

COLACE LIQ 150/15 ML docusate sodium liquid 150 mg/15 ml

PEDIA-LAX LIQ 50 MG docusate sodium liquid 50 mg/15 ml

COLACE SYP 60/15 ML docusate sodium syrup 60 mg/15 ml

EMETROL SOL LEMONMIN fructose-dextrose-phosphoric acid oral soln

FLEET ENE BABYLAX glycerin enema pediatric 2.3 gm/average delivered dose

PEDIA-LAX SUP 1GM glycerin suppos 1 gm

BENEFIBER POW guar gum oral powder

LEVSINEX CAP 0.375 CR hyoscyamine sulfate cap sr 12hr 0.375 mg

LEVSIN ELX 0.125/5 hyoscyamine sulfate elixir 0.125 mg/5 ml

LEVSIN DRO 0.125/ML hyoscyamine sulfate soln 0.125 mg/ml

LEVSIN TAB 0.125 MG hyoscyamine sulfate tab 0.125 mg

Page 12: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

12

NULEV TAB 0.125 MG hyoscyamine sulfate tab disp 0.125 mg

LEVSIN/SL SUB 0.125 MG hyoscyamine sulfate tab sl 0.125 mg

LEVBID TAB 0.375 ER hyoscyamine sulfate tab sr 12hr 0.375 mg

FLORANEX lactobacillus

IMODIUM A-D LIQ 1 MG/5 ML loperamide hcl liq 1 mg/5 ml (0.2 mg/ml)

IMODIUM A-D LIQ MINT loperamide hcl liq 1 mg/7.5 ml

IMODIUM ADV CHW 2-125 MG loperamide-simethicone chew tab 2-125 mg

IMODIUM MS TAB RELIEF loperamide-simethicone tab 2-125 mg

PHILLIPS MOM CHW 311 MG magnesium hydroxide chew tab 311 mg

MAG-OX 400 TAB 400 MG magnesium oxide tab 400 mg

MAOX TAB 420 MG magnesium oxide tab 420 mg

CITRUCEL POW ORANGE methylcellulose powder laxative

CITRUCEL TAB 500 MG methylcellulose tab 500 mg

MINERAL OIL mineral oil

FLEET OIL ENE mineral oil enema

PEG 3350 POW polyethylene glycol 3350 oral packet

PROBIOTIC FORMULA probiotic product caps

METAMUCIL CAP 0.52 GM psyllium cap 0.52 gm

KONSYL POW 100% psyllium powder 100%

KONSYL KIDS POW 28% psyllium powder 28%

METAMUCIL POW ORANGE psyllium powder 33%

METAMUCIL POW 48.57% psyllium powder 48.57%

KONSYL-D POW psyllium powder 50%

KONSYL-D POW 52.3% psyllium powder 52.3%

HYDROCIL POW 95% psyllium powder 95%

METAMUCIL POW 28% CIT psyllium powder packet 28%

SENNA SYP senna syrup 176 mg/5 ml

SENOKOT TAB 187 MG senna tab 187 mg

SENOKOT SYP 8.8 MG/5 ML sennosides syrup 8.8 mg/5 ml

EX-LAX TAB 15 MG sennosides tab 15 mg

EX-LAX TAB MAX ST sennosides tab 25 mg

SENOKOT TAB 8.6 MG sennosides tab 8.6 mg

SENOKOT S TAB 8.6-50 MG sennosides-docusate sodium tab 8.6-50 mg

PHAZYME-125 CAP simethicone cap 125 mg

PHAZYME MS CAP 166 MG simethicone cap 166 mg

PHAZYME CAP 180 MG simethicone cap 180 mg

GAS-X EX-STR CHW 125 MG simethicone chew tab 125 mg

MYLICON-80 CHW 80 MG simethicone chew tab 80 mg

MYLICON DRO 40/0.6 ML simethicone susp 40 mg/0.6 ml

SODIUM POW BICARBON sodium bicarbonate powder

Page 13: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

13

BELL-ANS TAB 650 MG sodium bicarbonate tab 650 mg

FLEET ENE sodium phosphates - enema

FL PHOSPHO SOL UNFLAVOR sodium phosphates - soln

SORBITOL SOL 70% sorbitol oral solution 70%

Mouth/Throat/Dental

SALIVA SUBST SOL artificial saliva - solution

IOSAT TAB 130 MG potassium iodide tab 130 mg

THYROSAFE TAB 65 MG potassium iodide tab 65 mg

PREVIDENT CRE 5000 PLS sodium fluoride cream 1.1%

THERA-FLUR GEL 1.1% sodium fluoride gel 1.1% (0.5% f)

sodium fluoride rinse 0.02%

LISTRN TOOTH SOL DEFENSE sodium fluoride rinse 0.0221% (0.01% f)

PREVIDENT SOL RINSE sodium fluoride rinse 0.2%

GEL-KAM CON 0.63% stannous fluoride conc 0.63%

GEL-KAM GEL 0.4% stannous fluoride gel 0.4%

Otic Agents

AURALGAN SOL OTIC benzocaine-antipyrine otic soln 1.4-5.4%

DEBROX SOL 6.5% OT carbamide peroxide 6.5% otic soln

Smoking Cessation

NICORETTE GUM 2 MG nicotine polacrilex gum 2 mg

NICORETTE DS GUM 4 MG nicotine polacrilex gum 4 mg

COMMIT LOZ 2 MG nicotine polacrilex lozenge 2 mg

COMMIT LOZ 4 MG nicotine polacrilex lozenge 4 mg

PROSTEP DIS 11 MG/24 nicotine td patch 24hr 11 mg/24hr

HABITROL DIS 14 MG/24 nicotine td patch 24hr 14 mg/24hr

HABITROL DIS 21 MG/24 nicotine td patch 24hr 21 mg/24hr

PROSTEP DIS 22 MG/24 nicotine td patch 24hr 22 mg/24hr

HABITROL DIS 7 MG/24 nicotine td patch 24hr 7 mg/24hr

Testing Supplies

BILI-LABSTIX TES STRIPS

CHEMSTRIP TEST STRIPS

COMBISTIX TES STRIPS

HEMA-COMBIST TES STRIPS

Page 14: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

14

KETO-DIASTIX TES

LABSTIX TES

MULTISTIX TES SG STRIP

URISTIX 4 TES STRIPS

URISTIX TES STRIPS

Urinary Agents

UTIRA-C TAB methenamine-hyos-meth blue-sod phos-phen sal tab 81.6 mg

PYRIDIUM TAB 100 MG phenazopyridine hcl tab 100 mg

PYRIDIUM TAB 200 MG phenazopyridine hcl tab 200 mg

URO-TRIN TAB 95 MG phenazopyridine hcl tab 95 mg

BARIDIUM TAB 97.2 MG phenazopyridine hcl tab 97 mg

BICITRA SOL sodium citrate & citric acid soln 500-334 mg/5 ml

Vaginal Products

MYCELEX-G CRE 1% VAG clotrimazole vaginal cream 1%

GYNE-LOTRIMI CRE 3 clotrimazole vaginal cream 2%

MYCELEX-G TAB 100MG VA clotrimazole vaginal tab 100 mg

GYNE-LOTRIM TAB 3 clotrimazole vaginal tab 200 mg

GYNE-LOTRIM KIT 3 clotrimazole vaginal tab 200 mg & 1% cream kit

MONISTAT 7 CRE 2% miconazole nitrate vaginal cream 2%

MONISTAT 3 CRE 4% miconazole nitrate vaginal cream 4% (200 mg/5 gm)

MONISTAT 3 KIT COMBINAT miconazole nitrate vaginal kit

MONISTAT 3 KIT COMBO PK miconazole nitrate vaginal supp 200 mg & 2% cream 9 gm kit

MONISTAT 7 SUP 100 MG miconazole nitrate vaginal suppos 100 mg

DELFEN AER nonoxynol-9 foam 12.5%

GYNOL II GEL 2% nonoxynol-9 gel 2%

ORTHO-GYNOL GEL 1% octoxynol gel 1%

Vitamins/Minerals/Electrolytes

VITAMIN C CHW 1000 MG ascorbic acid chew tab 1000 mg

C/ROSE HIPS LIQ 300/5 ML ascorbic acid liquid 300 mg/5 ml

LIQUID C 500 LIQ 500/15 ML ascorbic acid liquid 500 mg/15 ml

LIQUI C LIQ 500/5 ML ascorbic acid liquid 500 mg/5 ml

ascorbic acid syrup 300 mg/5 ml

PROTEXIN SYP ascorbic acid syrup 500 mg/15 ml

VITAMIN C TAB 2000 MG ascorbic acid tab 2000 mg

Page 15: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

15

ACEROLA C TAB 300 MG ascorbic acid tab 300 mg

C/ROSE HIPS TAB 750 MG TR ascorbic acid tab cr 750 mg

NEPHROCAPS CAP b-complex w/ c & folic acid cap 1 mg

NEPHRO-VITE TAB b-complex w/ c & folic acid tab 0.8 mg

DICAL-D TAB 500MG calcium 500 mg w/ vitamin d tab

CAL SUP-600 TAB calcium 600 mg w/ vitamin d tab

OS-CAL 500 TAB calcium carbonate tab 1250 mg (500 mg elemental ca)

OS-CAL TAB 500 + D calcium carbonate-vitamin d tab 500 mg-125 unit

POSTURE-D TAB 600 MG calcium carbonate-vitamin d tab 600 mg-125 unit

CALTRATE 600 CHW +D PLUS calcium carb-vit d w/ minerals chew tab 600 mg-400 unit

CALTRATE 600 TAB +D PLUS calcium carb-vit d w/ minerals tabs 600 mg-400 unit

CITRACAL + D TAB calcium citrate-vitamin d tab 315 mg-200 unit (elemental ca)

CITRACAL TAB MAXIMUM calcium citrate-vitamin d tab 315 mg-250 unit (elemental ca)

CALCIUM LACT TAB 650 MG calcium lactate tab 650 mg

VITAMIN D CAP 400 UNIT cholecalciferol cap 400 unit

VITAMIN D CAP 2000 UNIT cholecalciferol cap 2000 unit

D3-50 CAP cholecalciferol cap 50000 unit

BIO-D DRO -MULSION cholecalciferol drops 400 unit/0.03 ml

BIO-D-MULSIO DRO FORTE cholecalciferol drops 2000 unit/0.03 ml

VITAMIN D TAB 400 UNIT cholecalciferol tab 400 unit

VITAMIN D TAB 1000 UNIT cholecalciferol tab 1000 unit

VITAMIN D TAB 2000 UNIT cholecalciferol tab 2000 unit

RUBRAMIN-PC INJ 1000 MCG cyanocobalamin inj 1000 mcg/ml

CALOMIST SPR 25 MCG cyanocobalamin nasal spray 25 mcg/spray (25 mcg/0.1 ml)

DELTALIN CAP 50000 IU ergocalciferol cap 50000 unit

DRISDOL DRO 8000/ML ergocalciferol soln 8000 unit/ml

FERREX 150 CAP PLUS fe bisglycinate-fe polysaccharide-vit c cap 80-70-50 mg

NIFEREX CAP ferrous bisglycinate-iron polysaccharide cap 40-20 mg

HEMOCYTE TAB 325 MG ferrous fumarate tab 325 mg (106 mg elemental fe)

FERGON TAB 240 MG ferrous gluconate tab 240 mg (27 mg elemental fe)

FEOSOL ELX 220/5 ML ferrous sulfate elixir 220 mg/5 ml (44 mg/5 ml elemental fe)

FER-IN-SOL DRO 15 MG/ML ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe)

FOLVITE TAB 1 MG folic acid tab 1 mg

FOLIC ACID TAB 200 MCG folic acid tab 200 mcg

NIFEREX-150 CAP FORTE iron polysacch complex-vit b12-fa cap 150-0.025-1 mg

ELITE IRON TAB 15 MG iron tab 15 mg

Page 16: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

16

IRON TAB 25 MG iron tab 25 mg

CHELATED FE TAB 30 MG iron tab 30 mg

FEOSOL TAB 45 MG iron tab 45 mg

IRCON TAB 66 MG iron tab 66 mg

CITRACAL PLS TAB multiple minerals w/ vitamins tab

MULTICEBRIN TAB multiple vitamin tab

VIGRAN PLUS TAB multiple vitamins w/ iron tab

CENTRUM CHW SILVER multiple vitamins w/ minerals chew tab

THERAGRAN-M TAB multiple vitamins w/ minerals tab

PEDIALYTE SOL GRAPE oral electrolyte solution

POLY-VI-SOL CHW pediatric multiple vitamin chew tab

THERA MULTI LIQ pediatric multiple vitamin liq

THERAGRAN JR CHW pediatric multiple vitamin w/ c & fa chew tab

HOMICEBRIN LIQ pediatric multiple vitamin w/ c liqd 60 mg/5 ml

VI-DAYLIN LIQ pediatric multiple vitamin w/ c liqd 60 mg/5 ml

ABDEC DRO pediatric multiple vitamin w/ c soln 35 mg/ml

VI-DAYLIN DRO pediatric multiple vitamin w/ c soln 35 mg/ml

FLINTSTONES CHW GUMMIES pediatric multiple vitamin w/ minerals & c chew tab

SESAME ST CHW VITAMINS pediatric multiple vitamin w/ minerals & c chew tab 60 mg

VITAMAX CHW pediatric multiple vitamin w/ minerals & c chew tab 60 mg

POLY-VI-FLOR CHW FE 0.5 MG pediatric multiple vitamins w/ fl-fe chew tab 0.5-12 mg

VI-DAYLIN/F CHW /FE pediatric multiple vitamins w/ fl-fe chew tab 1-12 mg

VI-DAYLIN/F DRO FE pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml

POLY-VI-FLOR DRO FE 0.5 MG pediatric multiple vitamins w/ fl-fe drops 0.5-10 mg/ml

POLY-VI-FLOR CHW 0.25 MG pediatric multiple vitamins w/ fluoride chew tab 0.25 mg

ADEFLOR CHW 0.5 MG pediatric multiple vitamins w/ fluoride chew tab 0.5 mg

ADEFLOR CHW 1 MG pediatric multiple vitamins w/ fluoride chew tab 1 mg

ADEFLOR DRO pediatric multiple vitamins w/ fluoride soln 0.25 mg/ml

POLY-VI-FLOR DRO 0.5 MG/ML pediatric multiple vitamins w/ fluoride soln 0.5 mg/ml

HONEY BEARS CHW IRON-ZIN pediatric multiple vitamins w/ iron chew tab

SPIDER-MAN CHW /IRON pediatric multiple vitamins w/ iron chew tab 15 mg

VI-DAYLIN DRO /IRON pediatric multiple vitamins w/ iron drops 10 mg/ml

HONEY BEARS CHW pediatric vitamin chew tab

VI-DAYLIN/F DRO ADC/FE pediatric vitamins acd fluoride & fe drops 0.25-10 mg/ml

VI-DAYLIN/F DRO /ADC pediatric vitamins acd w/ fluoride soln 0.25 mg/ml

VI-DAYLIN DRO FE/ADC pediatric vitamins acd w/ iron drops 10 mg/ml

VI-DAYLIN DRO ADC pediatric vitamins adc drops 1500 unit-400 unit-35 mg/ml

MEPHYTON TAB 5MG phytonadione tab 5 mg

PIC 200 CAP polysaccharide iron complex cap 434.8 mg (200 mg elem fe)

NIFEREX ELX 100/5 ML polysaccharide iron complex elixir 100 mg/5 ml

Page 17: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

17

K-PHOS TAB NEUTRAL pot phos monobasic w/sod phos di & monobas tab 155-852-130 mg

K-LYTE-LIME TAB 25 MEQ EF potassium bicarbonate effer tab 25 meq

POT IODIDE SOL 1 GM/ML potassium iodide soln 1 gm/ml

K-PHOS TAB potassium phosphate monobasic tab 500 mg

SM PRENATAL TAB VITAMINS prenatal vit w/ fe fumarate-fa tab 28-0.8 mg

HEXA-BETALIN TAB 25 MG pyridoxine hcl tab 25 mg

HEXA-BETALIN TAB 50 MG pyridoxine hcl tab 50 mg

VITAMIN B-6 TAB 100 MG TR pyridoxine hcl tab cr 100 mg

VITAMIN B-6 TAB 50 MG TR pyridoxine hcl tab cr 50 mg

VITAMIN B-6 TAB 500 MG CR pyridoxine hcl tab cr 500 mg

LURIDE SF CHW 0.25 MG sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)

LURIDE CHW 0.5 MG F sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)

LURIDE CHW 1 MG sodium fluoride chew tab 1 mg f (from 2.2 mg naf)

LURIDE DRO 0.125 MG sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop naf)

FLUORABON DRO sodium fluoride soln 0.25 mg/0.6 ml (from 0.55 mg/0.6 ml naf)

FLURA DRO 0.25 MG sodium fluoride soln 0.25 mg/drop f (from 0.55 mg/drop naf)

PEDIAFLOR DRO 0.5 MG/ML sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)

BETALIN S ELX 2.25/5 ML thiamine hcl elixir 2.25 mg/5 ml

BETALIN S TAB 100 MG thiamine hcl tab 100 mg

BETALIN S TAB 50 MG thiamine hcl tab 50 mg

VITAMIN B-1 TAB 500 MG thiamine hcl tab 500 mg

VITAMIN B-1 TAB 100 MG thiamine mononitrate tab 100 mg

THIAMINE MON TAB 50 MG thiamine mononitrate tab 50 mg

THIAMILATE TAB 20 MG thiamine pyrophosphate tab 20 mg

AQUASOL-A CAP 25000 IU vitamin a cap 25000 unit

ALPHALIN CAP 50000 IU vitamin a cap 50000 iu

AQUASOL A DRO 5000/0.1 vitamin a soln 5000 iu/0.1 ml

VITAMIN A TAB 15000 UNT vitamin a tab 15000 unit

VITAMIN A TAB 25000 UNT vitamin a tab 25000 unit

PALMITATE-A TAB 5000 vitamin a tab 5000 unit

ZINC CHW 25 MG zinc chew tab 25 mg

ZINC TAB 100 MG zinc tab 100 mg

ZINC CHELATE TAB 30 MG zinc tab 30 mg

CHELATED ZN TAB 35 MG zinc tab 35 mg

ZN ASPARTATE TAB 40 MG zinc tab 40 mg

Page 18: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

18

Index

A

ABDEC DRO . . . . . . . . . . . . . . . . . . . . . 16

ACCUHIST DM SYP . . . . . . . . . . . . . . . . . . 7

ACCUHIST DRO . . . . . . . . . . . . . . . . . . . . 4

ACCUHIST PDX . . . . . . . . . . . . . . . . . . . . 6

ACEROLA C TAB. . . . . . . . . . . . . . . . . . . 15

acetaminophen cap . . . . . . . . . . . . . . . . . . . 3

acetaminophen chew . . . . . . . . . . . . . . . . . . 3

acetaminophen elixir . . . . . . . . . . . . . . . . . . 3

acetaminophen liquid . . . . . . . . . . . . . . . . . . 3

acetaminophen soln . . . . . . . . . . . . . . . . . . . 3

acetaminophen suppos . . . . . . . . . . . . . . . . . 3

acetaminophen susp . . . . . . . . . . . . . . . . . . 3

acetaminophen tab . . . . . . . . . . . . . . . . . . . 3

acetaminophen tab cr . . . . . . . . . . . . . . . . . . 3

ACID MANTLE CRE . . . . . . . . . . . . . . . . . . 9

acidophilus. . . . . . . . . . . . . . . . . . . . . . . 10

ACIDOPHILUS . . . . . . . . . . . . . . . . . . . . 10

acidophilus/bifidus . . . . . . . . . . . . . . . . . . 10

ACIDOPHILUS/BIFIDUS WAFER . . . . . . . . . 10

acidophilus caps and tabs . . . . . . . . . . . . . . 10

ACIDOPHILUS/CITRUS PECTIN . . . . . . . . . 10

acidophilus/citrus pectin tabs. . . . . . . . . . . . . 10

ACIDOPHILUS/PECTIN. . . . . . . . . . . . . . . 10

acidophilus/pectin caps . . . . . . . . . . . . . . . . 10

ACIDOPHILUS XTRA . . . . . . . . . . . . . . . . 10

ACTIFED SYP. . . . . . . . . . . . . . . . . . . . . . 8

ACTIFED TAB . . . . . . . . . . . . . . . . . . . . . . 8

ADEFLOR CHW . . . . . . . . . . . . . . . . . . . 16

ADEFLOR DRO. . . . . . . . . . . . . . . . . . . . 16

ADVIL TAB. . . . . . . . . . . . . . . . . . . . . . . . 4

AK-NEFRIN SO. . . . . . . . . . . . . . . . . . . . 10

ALEVE TAB . . . . . . . . . . . . . . . . . . . . . . . 4

ALOE VESTA OIN . . . . . . . . . . . . . . . . . . . 8

ALPHALIN CAP. . . . . . . . . . . . . . . . . . . . 17

alum hydrox-mag trisil-alginic acid-sod bicarb chew tab. . . . . . . . . . . . . . . . . . 10

aluminum acetate . . . . . . . . . . . . . . . . . . . . 9

aluminum hydroxide-magnesium carbonate chew tab 10

aluminum hydroxide-magnesium carbonate susp . . 11

aluminum hydroxide-magnesium trisilicate chew tab 11

aluminum & magnesium hydroxides susp . . . . . . 10

ALUMINUM SOL ACETATE . . . . . . . . . . . . . . 9

aluminum sulfate & calcium acetate powd pack . . . . 9

alum & mag hydroxide-simethicone chew tab . . . . 10

alum & mag hydroxide-simethicone susp . . . . . . 10

AMBIFED-G TAB . . . . . . . . . . . . . . . . . . . . 7

ANAPLEX DM SYP . . . . . . . . . . . . . . . . . . . 7

AQUASOL-A CAP . . . . . . . . . . . . . . . . . . 17

AQUASOL A DRO . . . . . . . . . . . . . . . . . . 17

AQUATAB DM SYP . . . . . . . . . . . . . . . . . . . 5

AQUATAB D TAB . . . . . . . . . . . . . . . . . . . . 7

artificial saliva - solution. . . . . . . . . . . . . . . . 13

artificial tear ophth gel. . . . . . . . . . . . . . . . . 10

artificial tear ophth ointment . . . . . . . . . . . . . 10

artificial tear ophth solution . . . . . . . . . . . . . . 10

ARY ALLERGY SPR & SINUS. . . . . . . . . . . . . 8

ASA TAB. . . . . . . . . . . . . . . . . . . . . . . . . 3

ascorbic acid chew tab . . . . . . . . . . . . . . . . 14

ascorbic acid liquid . . . . . . . . . . . . . . . . . . 14

ascorbic acid syrup . . . . . . . . . . . . . . . . . . 14

ascorbic acid tab . . . . . . . . . . . . . . . . . 14, 15

ascorbic acid tab cr . . . . . . . . . . . . . . . . . . 15

ASCRIPTIN TAB . . . . . . . . . . . . . . . . . . . . 3

ASCRIPTIN TAB A/D. . . . . . . . . . . . . . . . . . 3

aspirin-acetaminophen-caffeine tab . . . . . . . . . . 3

aspirin-al hydro-mg hydro-ca carb tab . . . . . . . . . 3

aspirin buffered tab . . . . . . . . . . . . . . . . . . . 3

aspirin chew tab . . . . . . . . . . . . . . . . . . . . . 3

ASPIRIN SUP. . . . . . . . . . . . . . . . . . . . . . 3

aspirin suppos . . . . . . . . . . . . . . . . . . . . . . 3

aspirin tab . . . . . . . . . . . . . . . . . . . . . . . . 3

aspirin tab delayed release . . . . . . . . . . . . . . . 3

atropine sulfate tab . . . . . . . . . . . . . . . . . . 11

Page 19: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

19

ATROPINE SUL TAB . . . . . . . . . . . . . . . . . 11

attapulgite susp . . . . . . . . . . . . . . . . . . . . 11

ATUSS DM SYP . . . . . . . . . . . . . . . . . . . . 6

ATUSS DR SYP. . . . . . . . . . . . . . . . . . . . . 6

ATUSS HC SYP . . . . . . . . . . . . . . . . . . . . 6

ATUSS MS SYP . . . . . . . . . . . . . . . . . . . . 6

AURALGAN SOL OTIC . . . . . . . . . . . . . . . 13

AVEENO BATH PAK TREATMNT . . . . . . . . . . . 9

AYR NASAL DRO. . . . . . . . . . . . . . . . . . . . 8

B

BACIGUENT OIN . . . . . . . . . . . . . . . . . . . 8

bacitracin oint . . . . . . . . . . . . . . . . . . . . . . 8

bacitracin-polymyxin b oint . . . . . . . . . . . . . . . 8

BARIDIUM TAB . . . . . . . . . . . . . . . . . . . . 14

BAYER CHILD CHW ASA. . . . . . . . . . . . . . . 3

b-complex w/ c & folic acid . . . . . . . . . . . . . . 15

BELL-ANS TAB . . . . . . . . . . . . . . . . . . . . 13

BENADRYL ALG CHW CHILD . . . . . . . . . . . . 5

BENADRYL ALG TAB . . . . . . . . . . . . . . . . . 5

BENADRYL ALL LIQ . . . . . . . . . . . . . . . . . . 5

BENADRYL CAP . . . . . . . . . . . . . . . . . . . . 5

BENEFIBER POW . . . . . . . . . . . . . . . . . . 11

BENYLIN ADLT SYP . . . . . . . . . . . . . . . . . . 5

BENYLIN PED SYP . . . . . . . . . . . . . . . . . . 5

BENYLIN SYP . . . . . . . . . . . . . . . . . . . . . 5

BENZAGEL-5 GEL. . . . . . . . . . . . . . . . . . . 3

BENZAGEL-10 GEL . . . . . . . . . . . . . . . . . . 3

benzocaine-antipyrine otic soln. . . . . . . . . . . . 13

benzonatate cap . . . . . . . . . . . . . . . . . . . . . 4

benzoyl peroxide cream . . . . . . . . . . . . . . . . . 3

benzoyl peroxide gel . . . . . . . . . . . . . . . . . . 3

benzoyl peroxide lotion . . . . . . . . . . . . . . . . . 3

BETA CARE CRE. . . . . . . . . . . . . . . . . . . 10

BETA CARE LOT . . . . . . . . . . . . . . . . . . . 10

BETADINE SOL 1 . . . . . . . . . . . . . . . . . . . 9

BETALIN S ELX . . . . . . . . . . . . . . . . . . . . 17

BETALIN S TAB . . . . . . . . . . . . . . . . . . . . 17

BICITRA SOL . . . . . . . . . . . . . . . . . . . . . 14

BILI-LABSTIX TES STRIPS . . . . . . . . . . . . . 13

BIO-D DRO -MULSION . . . . . . . . . . . . . . . 15

BIO-D-MULSIO DRO FORTE. . . . . . . . . . . . 15

bisacodyl enema. . . . . . . . . . . . . . . . . . . . 11

bisacodyl-sod biphos/sod phos prep kit . . . . . . . 11

bisacodyl suppos . . . . . . . . . . . . . . . . . . . 11

bisacodyl tab delayed release . . . . . . . . . . . . 11

bismuth subsalicylate chew tab. . . . . . . . . . . . 11

bismuth subsalicylate susp . . . . . . . . . . . . . . 11

bismuth subsalicylate tab . . . . . . . . . . . . . . . 11

BROMFED CAP 12-120 CR . . . . . . . . . . . . . 4

BROMFED PD CAP CR . . . . . . . . . . . . . . . . 4

brompheniramine & phenylephrine elixir . . . . . . . . 4

brompheniramine & pseudoephedrine cap cr . . . . . 4

brompheniramine & pseudoephedrine elixir . . . . . . 4

brompheniramine & pseudoephedrine liquid. . . . . . 4

brompheniramine & pseudoephedrine syrup. . . . . . 4

BUFFERIN TAB. . . . . . . . . . . . . . . . . . . . . 3

BUFFERIN TAB LOW DOSE . . . . . . . . . . . . . 3

butalbital-acetaminophen-caffeine . . . . . . . . . 3, 4

butalbital-acetaminophen . . . . . . . . . . . . . . . 3

butalbital-aspirin-caffeine . . . . . . . . . . . . . . . . 4

C

CALAMINE LOT . . . . . . . . . . . . . . . . . . . . 9

calamine lotion. . . . . . . . . . . . . . . . . . . . . . 9

calcium 500 mg w/ vitamin d tab . . . . . . . . . . . 15

calcium 600 mg w/ vitamin d tab . . . . . . . . . . . 15

calcium carbonate (antacid) chew tab . . . . . . . . 11

calcium carbonate (antacid) tab . . . . . . . . . . . 11

calcium carbonate-mag hydroxide susp . . . . . . . 11

calcium carbonate tab. . . . . . . . . . . . . . . . . 15

calcium carbonate-vitamin d tab . . . . . . . . . . . 15

CALCIUM CARB TAB . . . . . . . . . . . . . . . . 11

calcium carb-vit d w/ minerals chew tab . . . . . . . 15

calcium carb-vit d w/ minerals tabs . . . . . . . . . 15

calcium citrate-vitamin d tab . . . . . . . . . . . . . 15

calcium lactate tab. . . . . . . . . . . . . . . . . . . 15

CALCIUM LACT TAB . . . . . . . . . . . . . . . . . 15

Page 20: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

20

calcium & magnesium carbonates tab . . . . . . . . 11

calcium polycarbophil tab . . . . . . . . . . . . . . . 11

CALOMIST SPR . . . . . . . . . . . . . . . . . . . 15

CAL SUP-600 TAB . . . . . . . . . . . . . . . . . . 15

CALTRATE 600 CHW +D PLUS . . . . . . . . . . 15

CALTRATE 600 TAB +D PLUS . . . . . . . . . . . 15

CAPSAGEL MS GEL . . . . . . . . . . . . . . . . . 9

CAPSAGEL XS GEL . . . . . . . . . . . . . . . . . . 9

capsaicin cream . . . . . . . . . . . . . . . . . . . . . 9

capsaicin gel. . . . . . . . . . . . . . . . . . . . . . . 9

CAPSAICIN LOT . . . . . . . . . . . . . . . . . . . . 9

capsaicin lotion . . . . . . . . . . . . . . . . . . . . . 9

CAPSIN LOT . . . . . . . . . . . . . . . . . . . . . . 9

CAPZASIN-HP CRE . . . . . . . . . . . . . . . . . . 9

CAPZASIN-P CRE . . . . . . . . . . . . . . . . . . . 9

carbamide peroxide 6.5% otic soln. . . . . . . . . . 13

carboxymethylcellulose sodium ophth soln . . . . . 10

CARMOL 40 LOT. . . . . . . . . . . . . . . . . . . . 9

casanthranol-dss syrup . . . . . . . . . . . . . . . . 11

CASTIVA LOT . . . . . . . . . . . . . . . . . . . . . . 9

CENTRUM CHW SILVER . . . . . . . . . . . . . . 16

CETAPHIL CREAM. . . . . . . . . . . . . . . . . . 10

CETAPHIL DAY LOT ADVA . . . . . . . . . . . . . 10

CETAPHIL LOTION. . . . . . . . . . . . . . . . . . 10

CGU WC LIQ . . . . . . . . . . . . . . . . . . . . . . 5

CHELATED FE TAB . . . . . . . . . . . . . . . . . 16

CHELATED ZN TAB . . . . . . . . . . . . . . . . . 17

CHEMSTRIP TEST STRIPS . . . . . . . . . . . . . 13

CHERACOL-D LIQ. . . . . . . . . . . . . . . . . . . 5

CHILD MOTRIN SUS COLD . . . . . . . . . . . . . 8

CHLD TYLENOL CHW . . . . . . . . . . . . . . . . 3

chlorhexidine gluconate liquid . . . . . . . . . . . . . 9

chlorpheniramine-dm liquid . . . . . . . . . . . . . . . 5

chlorpheniramine-dm syrup . . . . . . . . . . . . . . . 5

chlorpheniramine-dm tab . . . . . . . . . . . . . . . . 5

chlorpheniramine maleate syrup . . . . . . . . . . . . 5

chlorpheniramine maleate tab. . . . . . . . . . . . . . 5

chlorpheniramine maleate tab cr . . . . . . . . . . . . 5

chlorpheniramine-pe-methscopolamine syrup . . . . . 5

chlorpheniramine & phenylephrine liquid. . . . . . . . 4

chlorpheniramine & phenylephrine syrup. . . . . . . . 4

chlorpheniramine & phenylephrine tab cr . . . . . . . 4

chlorpheniramine & pseudoephedrine cap cr . . . . . 4

chlorpheniramine & pseudoephedrine drops. . . . . . 4

chlorpheniramine & pseudoephedrine liquid . . . . 4, 5

chlorpheniramine tan-phenylephrine tan susp . . . . . 5

chlorphen-pe-methscopolamine syrup . . . . . . . . . 5

chlorphen-pseudoephedrine w/ apap tab . . . . . . . 5

chlorphen tannate-carbetapentane tannate susp . . . 4

CHLOR-TRIMET SYP . . . . . . . . . . . . . . . . . 5

CHLOR-TRIMET TAB . . . . . . . . . . . . . . . . . 5

CHLOR-TRIMET TAB CR . . . . . . . . . . . . . . . 5

cholecalciferol cap . . . . . . . . . . . . . . . . . . 15

cholecalciferol drops . . . . . . . . . . . . . . . . . 15

cholecalciferol tab . . . . . . . . . . . . . . . . . . . 15

CITRACAL + D TAB . . . . . . . . . . . . . . . . . 15

CITRACAL PLS TAB . . . . . . . . . . . . . . . . . 16

CITRACAL TAB MAXIMUM . . . . . . . . . . . . . 15

CITRUCEL POW ORANGE. . . . . . . . . . . . . 12

CITRUCEL TAB. . . . . . . . . . . . . . . . . . . . 12

CLARITIN-D TAB . . . . . . . . . . . . . . . . . . . . 6

CLEAN&CLEAR LOT EXFOLIAT . . . . . . . . . . . 3

clemastine fumarate tab . . . . . . . . . . . . . . . . . 5

clotrimazole vaginal cream . . . . . . . . . . . . . . 14

clotrimazole vaginal tab . . . . . . . . . . . . . . . . 14

clotrimazole vaginal tab 200 mg & 1% cream kit . . 14

CODICLEAR DH SYP . . . . . . . . . . . . . . . . . 5

CODIMAL DH SYP. . . . . . . . . . . . . . . . . . . 6

CODIMAL DM SYP. . . . . . . . . . . . . . . . . . . 6

COLACE CAP . . . . . . . . . . . . . . . . . . . . 11

COLACE LIQ . . . . . . . . . . . . . . . . . . . . . 11

COLACE SYP. . . . . . . . . . . . . . . . . . . . . 11

colloidal oatmeal packet. . . . . . . . . . . . . . . . . 9

COMBISTIX TES STRIPS . . . . . . . . . . . . . . 13

COMMIT LOZ. . . . . . . . . . . . . . . . . . . . . 13

COMPOUND W LIQ . . . . . . . . . . . . . . . . . 9

condoms . . . . . . . . . . . . . . . . . . . . . . . . . 4

CO-PYRONIL 2 LIQ . . . . . . . . . . . . . . . . . . 4

Page 21: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

21

CORICIDIN TAB CGH&COLD . . . . . . . . . . . . 5

CORT-DOME CRE . . . . . . . . . . . . . . . . . . . 8

CREOMULSION SYP CHILDREN . . . . . . . . . . 5

C/ROSE HIPS LIQ . . . . . . . . . . . . . . . . . . 14

C/ROSE HIPS TAB 750 MG TR . . . . . . . . . . 15

cyanocobalamin inj . . . . . . . . . . . . . . . . . . 15

cyanocobalamin nasal spray . . . . . . . . . . . . . 15

D

D3-50 CAP . . . . . . . . . . . . . . . . . . . . . . 15

DALLERGY DM SYP . . . . . . . . . . . . . . . . . . 7

DALLERGY SYP . . . . . . . . . . . . . . . . . . . . 5

DEBROX SOL 6.5% OT . . . . . . . . . . . . . . . 13

DECONAMINE CAP 8-120 SR . . . . . . . . . . . . 4

DECON-E LIQ . . . . . . . . . . . . . . . . . . . . . 6

DECONSAL II TAB 60-600 CR . . . . . . . . . . . . 8

DELFEN AER . . . . . . . . . . . . . . . . . . . . . 14

DELSYM LIQ . . . . . . . . . . . . . . . . . . . . . . 5

DELTALIN CAP . . . . . . . . . . . . . . . . . . . . 15

DERMAPHOR OIN. . . . . . . . . . . . . . . . . . 10

DESENEX MAX CRE . . . . . . . . . . . . . . . . . 8

dextromethorphan-guaifenesin liquid . . . . . . . . . 5

dextromethorphan-guaifenesin solution . . . . . . . . 5

dextromethorphan-guaifenesin syrup . . . . . . . . . 5

dextromethorphan-guaifenesin tab sr . . . . . . . . . 5

dextromethorphan hbr syrup . . . . . . . . . . . . . . 5

dextromethorphan polistirex liquid cr . . . . . . . . . . 5

DIALOSE CAP . . . . . . . . . . . . . . . . . . . . 11

DIBROMM EXT CAP CR . . . . . . . . . . . . . . . 7

DICAL-D TAB . . . . . . . . . . . . . . . . . . . . . 15

DIMETANE-DX SYP . . . . . . . . . . . . . . . . . . 7

DIMETAPP CLD ELX /ALLERGY . . . . . . . . . . . 4

DIMETAPP DM ELX CLD/COUG . . . . . . . . . . . 6

DIMETAPP DM ELX COLD/CGH . . . . . . . . . . . 6

DIMETAPP DRO DCON/CGH . . . . . . . . . . . . 6

DIMETAPP DRO DECONGES . . . . . . . . . . . . 6

DIMETAPP ELX CLD/ALLE . . . . . . . . . . . . . . 4

DIMETAPP SYP CGH/COLD . . . . . . . . . . . 5, 7

DIMETAPP TAB SINUS . . . . . . . . . . . . . . . . 8

DIONEX SYP . . . . . . . . . . . . . . . . . . . . . 11

diphenhydramine hcl cap . . . . . . . . . . . . . . . . 5

diphenhydramine hcl chew tab . . . . . . . . . . . . . 5

diphenhydramine hcl liquid . . . . . . . . . . . . . . . 5

diphenhydramine hcl syrup . . . . . . . . . . . . . . . 5

diphenhydramine hcl tab . . . . . . . . . . . . . . . . 5

docusate calcium cap . . . . . . . . . . . . . . . . . 11

docusate potassium cap . . . . . . . . . . . . . . . 11

docusate sodium cap . . . . . . . . . . . . . . . . . 11

docusate sodium enema . . . . . . . . . . . . . . . 11

docusate sodium liquid . . . . . . . . . . . . . . . . 11

docusate sodium syrup . . . . . . . . . . . . . . . . 11

DOLORAC CRE TOPICAL . . . . . . . . . . . . . . 9

DOMEBORO POW PACKETS . . . . . . . . . . . . 9

DOUBLECAP CRE. . . . . . . . . . . . . . . . . . . 9

DRISDOL DRO. . . . . . . . . . . . . . . . . . . . 15

DRY & CLEAR CRE . . . . . . . . . . . . . . . . . . 3

DULCOLAX SUP . . . . . . . . . . . . . . . . . . . 11

DULCOLAX TAB EC . . . . . . . . . . . . . . . . . 11

DURATUSS DM ELX . . . . . . . . . . . . . . . . . . 5

DURATUSS GP TAB . . . . . . . . . . . . . . . . . . 7

DURATUSS G TAB CR . . . . . . . . . . . . . . . . 5

E

EASPRIN TAB EC . . . . . . . . . . . . . . . . . . . 3

ECOTRIN M/S TAB EC . . . . . . . . . . . . . . . . 3

ED A-HIST LIQ . . . . . . . . . . . . . . . . . . . . . 4

ED A-HIST TAB CR . . . . . . . . . . . . . . . . . . 4

ELITE IRON TAB . . . . . . . . . . . . . . . . . . . 15

EMETROL SOL LEMONMIN . . . . . . . . . . . . 11

emollient . . . . . . . . . . . . . . . . . . . . . . . . 10

ENDAL-HD SYP . . . . . . . . . . . . . . . . . . . . 6

ENDAL-HD SYP . . . . . . . . . . . . . . . . . . . . 6

ENDAL-HD SYP PLUS. . . . . . . . . . . . . . . . . 6

END LICE M/S LIQ. . . . . . . . . . . . . . . . . . . 9

ENEMEEZ MINI ENE . . . . . . . . . . . . . . . . 11

ENTEX HC LIQ . . . . . . . . . . . . . . . . . . . . . 6

E-OINTMENT OIN . . . . . . . . . . . . . . . . . . 10

ergocalciferol cap . . . . . . . . . . . . . . . . . . . 15

Page 22: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

22

ergocalciferol soln . . . . . . . . . . . . . . . . . . . 15

ESGIC CAP. . . . . . . . . . . . . . . . . . . . . . . 3

ESGIC-PLUS CAP . . . . . . . . . . . . . . . . . . . 4

ESGIC-PLUS TAB . . . . . . . . . . . . . . . . . . . 4

EXCEDRIN TAB EX ST . . . . . . . . . . . . . . . . 3

EX-LAX TAB . . . . . . . . . . . . . . . . . . . . . . 12

EX-LAX TAB MAX ST . . . . . . . . . . . . . . . . . 12

EXTENDRYL SYP . . . . . . . . . . . . . . . . . . . 5

F

fe bisglycinate-fe polysaccharide-vit c cap. . . . . . 15

FEOSOL ELX . . . . . . . . . . . . . . . . . . . . . 15

FEOSOL TAB . . . . . . . . . . . . . . . . . . . . . 16

FERGON TAB . . . . . . . . . . . . . . . . . . . . 15

FER-IN-SOL DRO . . . . . . . . . . . . . . . . . . 15

FERREX 150 CAP PLUS . . . . . . . . . . . . . . 15

ferrous bisglycinate-iron polysaccharide cap . . . . 15

ferrous fumarate tab . . . . . . . . . . . . . . . . . . 15

ferrous gluconate tab . . . . . . . . . . . . . . . . . 15

ferrous sulfate elixir . . . . . . . . . . . . . . . . . . 15

ferrous sulfate soln . . . . . . . . . . . . . . . . . . 15

FEVERALL SUP . . . . . . . . . . . . . . . . . . . . 3

FIBERCON TAB . . . . . . . . . . . . . . . . . . . 11

FIORICET TAB . . . . . . . . . . . . . . . . . . . . . 4

FIORINAL CAP . . . . . . . . . . . . . . . . . . . . . 4

FIORINAL TAB . . . . . . . . . . . . . . . . . . . . . 4

FLEET BISACO ENE. . . . . . . . . . . . . . . . . 11

FLEET ENE . . . . . . . . . . . . . . . . . . . . . . 13

FLEET ENE BABYLAX . . . . . . . . . . . . . . . . 11

FLEET OIL ENE. . . . . . . . . . . . . . . . . . . . 12

FLEET PREP KIT . . . . . . . . . . . . . . . . . . . 11

FLINTSTONES CHW GUMMIES. . . . . . . . . . 16

FLORANEX . . . . . . . . . . . . . . . . . . . . . . 12

FL PHOSPHO SOL UNFLAVOR . . . . . . . . . . 13

FLUORABON DRO . . . . . . . . . . . . . . . . . 17

FLURA DRO . . . . . . . . . . . . . . . . . . . . . 17

folic acid tab . . . . . . . . . . . . . . . . . . . . . . 15

folic acid tab . . . . . . . . . . . . . . . . . . . . . . 15

FOLIC ACID TAB . . . . . . . . . . . . . . . . . . . 15

FOLVITE TAB . . . . . . . . . . . . . . . . . . . . . 15

fructose-dextrose-phosphoric acid oral soln . . . . . 11

G

GAS-X EX-STR CHW . . . . . . . . . . . . . . . . 12

GAVISCON CHW . . . . . . . . . . . . . . . . . . 11

GAVISCON CHW EX-STR . . . . . . . . . . . . . 10

GAVISCON SUS . . . . . . . . . . . . . . . . . . . 11

GEL-KAM CON. . . . . . . . . . . . . . . . . . . . 13

GEL-KAM GEL . . . . . . . . . . . . . . . . . . . . 13

GENATON CHW . . . . . . . . . . . . . . . . . . . 10

GENTEAL PF SOL . . . . . . . . . . . . . . . . . . 10

glycerin enema pediatric . . . . . . . . . . . . . . . 11

glycerin suppos . . . . . . . . . . . . . . . . . . . . 11

GUAIFED CAP CR . . . . . . . . . . . . . . . . . . . 7

guaifenesin-codeine soln . . . . . . . . . . . . . . . . 5

guaifenesin liquid . . . . . . . . . . . . . . . . . . . . 5

guaifenesin syrup . . . . . . . . . . . . . . . . . . . . 5

guaifenesin tab sr . . . . . . . . . . . . . . . . . . . . 5

guar gum oral powder . . . . . . . . . . . . . . . . . 11

GYNE-LOTRIMI CRE . . . . . . . . . . . . . . . . 14

GYNE-LOTRIM KIT . . . . . . . . . . . . . . . . . 14

GYNE-LOTRIM TAB . . . . . . . . . . . . . . . . . 14

GYNOL II GEL . . . . . . . . . . . . . . . . . . . . 14

H

HABITROL DIS . . . . . . . . . . . . . . . . . . . . 13

HEMA-COMBIST TES STRIPS . . . . . . . . . . . 13

HEMOCYTE TAB . . . . . . . . . . . . . . . . . . . 15

HEXA-BETALIN TAB . . . . . . . . . . . . . . . . . 17

HIBICLENS LIQ . . . . . . . . . . . . . . . . . . . . 9

HISTEX DA TAB . . . . . . . . . . . . . . . . . . . . 8

HISTUSSIN HC SYP . . . . . . . . . . . . . . . . . . 6

HOMICEBRIN LIQ . . . . . . . . . . . . . . . . . . 16

HONEY BEARS CHW. . . . . . . . . . . . . . . . 16

HONEY BEARS CHW IRON-ZIN . . . . . . . . . 16

HYCODAN SYP . . . . . . . . . . . . . . . . . . . . 5

HYCODAN TAB. . . . . . . . . . . . . . . . . . . . . 5

HYDROCIL POW . . . . . . . . . . . . . . . . . . 12

Page 23: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

23

hydrocodone-guaifenesin syrup . . . . . . . . . . . . 5

hydrocodone w/ homatropine syrup . . . . . . . . . . 5

hydrocodone w/ homatropine tab . . . . . . . . . . . 5

HYDROCORT CRE . . . . . . . . . . . . . . . . . . 8

hydrocortisone-aloe vera cream . . . . . . . . . . . . 8

hydrocortisone cream . . . . . . . . . . . . . . . . . 8

hyoscyamine sulfate cap sr . . . . . . . . . . . . . . 11

hyoscyamine sulfate elixir . . . . . . . . . . . . . . . 11

hyoscyamine sulfate soln . . . . . . . . . . . . . . . 11

hyoscyamine sulfate tab. . . . . . . . . . . . . . . . 11

hyoscyamine sulfate tab disp . . . . . . . . . . . . . 12

hyoscyamine sulfate tab sl . . . . . . . . . . . . . . 12

hyoscyamine sulfate tab sr . . . . . . . . . . . . . . 12

HYPOTEARS SOL OP . . . . . . . . . . . . . . . . 10

hypromellose ophth soln . . . . . . . . . . . . . . . 10

I

ibuprofen chew tab . . . . . . . . . . . . . . . . . . . 4

ibuprofen susp. . . . . . . . . . . . . . . . . . . . . . 4

ibuprofen tab. . . . . . . . . . . . . . . . . . . . . . . 4

ICY HOT GEL ARTHRIT . . . . . . . . . . . . . . . . 9

IMODIUM A-D LIQ . . . . . . . . . . . . . . . . . . 12

IMODIUM A-D LIQ MINT . . . . . . . . . . . . . . 12

IMODIUM ADV CHW . . . . . . . . . . . . . . . . 12

IMODIUM MS TAB RELIEF . . . . . . . . . . . . . 12

INFAN TYLEN DRO DCON/FVR . . . . . . . . . . . 7

INF TYLENOL DRO COLD/CGH. . . . . . . . . . . 7

IOSAT TAB . . . . . . . . . . . . . . . . . . . . . . 13

IRCON TAB . . . . . . . . . . . . . . . . . . . . . . 16

iron polysacch complex-vit b12-fa cap . . . . . . . . 15

iron tab . . . . . . . . . . . . . . . . . . . . . . . 15, 16

IRON TAB . . . . . . . . . . . . . . . . . . . . . . . 16

K

KAOPECTATE SUS . . . . . . . . . . . . . . . . . 11

KASOF CAP . . . . . . . . . . . . . . . . . . . . . 11

KETO-DIASTIX TES . . . . . . . . . . . . . . . . . 14

ketotifen fumarate ophth soln . . . . . . . . . . . . . 10

K-LYTE-LIME TAB EF . . . . . . . . . . . . . . . . . 17

KONSYL-D POW . . . . . . . . . . . . . . . . . . . 12

KONSYL KIDS POW. . . . . . . . . . . . . . . . . 12

KONSYL POW . . . . . . . . . . . . . . . . . . . . 12

K-PHOS TAB . . . . . . . . . . . . . . . . . . . . . 17

K-PHOS TAB NEUTRAL . . . . . . . . . . . . . . . 17

KUDROX DS SUS . . . . . . . . . . . . . . . . . . 10

L

LABSTIX TES . . . . . . . . . . . . . . . . . . . . . 14

LACRI-LUB NP OIN OP . . . . . . . . . . . . . . . 10

lactic acid lotion . . . . . . . . . . . . . . . . . . . . . 9

LACTICARE LOT . . . . . . . . . . . . . . . . . . . . 9

lactobacillus . . . . . . . . . . . . . . . . . . . . . . 12

LEVBID TAB ER. . . . . . . . . . . . . . . . . . . . 12

LEVSIN DRO . . . . . . . . . . . . . . . . . . . . . 11

LEVSIN ELX . . . . . . . . . . . . . . . . . . . . . . 11

LEVSINEX CAP CR . . . . . . . . . . . . . . . . . 11

LEVSIN/SL SUB . . . . . . . . . . . . . . . . . . . 12

LEVSIN TAB . . . . . . . . . . . . . . . . . . . . . . 11

lidocaine hcl gel . . . . . . . . . . . . . . . . . . . . . 9

LIQUI C LIQ. . . . . . . . . . . . . . . . . . . . . . 14

LIQUID C 500 LIQ . . . . . . . . . . . . . . . . . . 14

LIQUIFILM SOL TEARS . . . . . . . . . . . . . . . 10

LISTRN TOOTH SOL DEFENSE . . . . . . . . . . 13

loperamide hcl liq . . . . . . . . . . . . . . . . . . . 12

loperamide-simethicone chew tab . . . . . . . . . . 12

loperamide-simethicone tab . . . . . . . . . . . . . 12

loratadine & pseudoephedrine tab sr . . . . . . . . . . 6

LOW DOSE ASA TAB . . . . . . . . . . . . . . . . . 3

LURIDE CHW F . . . . . . . . . . . . . . . . . . . 17

LURIDE CHW . . . . . . . . . . . . . . . . . . . . 17

LURIDE DRO . . . . . . . . . . . . . . . . . . . . . 17

LURIDE SF CHW . . . . . . . . . . . . . . . . . . 17

Page 24: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

24

M

MAALOX PLUS CHW . . . . . . . . . . . . . . . . 10

MAALOX PLUS SUS . . . . . . . . . . . . . . . . . 10

MAALOX QUICK CHW DISSOLVE. . . . . . . . . 11

MAALOX SUS. . . . . . . . . . . . . . . . . . . . . 10

magnesium hydroxide chew tab . . . . . . . . . . . 12

magnesium oxide tab . . . . . . . . . . . . . . . . . 12

MAG-OX 400 TAB . . . . . . . . . . . . . . . . . . 12

MAOX TAB . . . . . . . . . . . . . . . . . . . . . . 12

MAXIFED-G TAB 60-580 CR . . . . . . . . . . . . . 8

MAXIFED TAB 80-700 CR . . . . . . . . . . . . . . . 8

MAXIFED TAB . . . . . . . . . . . . . . . . . . . . . 8

MEDENT LD TAB . . . . . . . . . . . . . . . . . . . . 8

MEPHYTON TAB 5MG. . . . . . . . . . . . . . . . 16

METAMUCIL CAP 0.52 GM . . . . . . . . . . . . . 12

METAMUCIL POW 28% CIT . . . . . . . . . . . . 12

METAMUCIL POW . . . . . . . . . . . . . . . . . . 12

METAMUCIL POW ORANGE. . . . . . . . . . . . 12

methenamine-hyos-meth blue-sod phos-phen sal tab. . . . . . . . . . . . . . . . . 14

methylcellulose powder laxative . . . . . . . . . . . 12

methylcellulose tab . . . . . . . . . . . . . . . . . . 12

MICATIN AER . . . . . . . . . . . . . . . . . . . . . . 8

MICATIN CRE. . . . . . . . . . . . . . . . . . . . . . 8

miconazole nitrate aerosol . . . . . . . . . . . . . . . 8

miconazole nitrate cream . . . . . . . . . . . . . . . . 8

miconazole nitrate ointment. . . . . . . . . . . . . . . 8

miconazole nitrate soln . . . . . . . . . . . . . . . . . 8

miconazole nitrate vaginal cream . . . . . . . . . . . 14

miconazole nitrate vaginal kit . . . . . . . . . . . . . 14

miconazole nitrate vaginal supp . . . . . . . . . . . 14

mineral oil . . . . . . . . . . . . . . . . . . . . . . . 12

MINERAL OIL. . . . . . . . . . . . . . . . . . . . . 12

mineral oil enema . . . . . . . . . . . . . . . . . . . 12

MIRANEL AF SOL . . . . . . . . . . . . . . . . . . . 8

MONISTAT 3 CRE . . . . . . . . . . . . . . . . . . 14

MONISTAT 3 KIT COMBINAT . . . . . . . . . . . . 14

MONISTAT 3 KIT COMBO PK. . . . . . . . . . . . . . . . 14

MONISTAT 7 CRE 2% . . . . . . . . . . . . . . . . . . . . . . . 14

MONISTAT 7 SUP . . . . . . . . . . . . . . . . . . . . . . . . . . 14

MOSCO CALLUS SOL CRN RMVR . . . . . . . . . . . 9

MOTRIN CHW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

MOTRIN DRO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

MOTRIN TAB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

MUCINEX DM TAB ER . . . . . . . . . . . . . . . . . . . . . . . 5

MUCINEX TAB ER. . . . . . . . . . . . . . . . . . . . . . . . . . . 5

MULTICEBRIN TAB . . . . . . . . . . . . . . . . . . . . . . . . . 16

multiple minerals w/ vitamins tab . . . . . . . . . . . . . . . 16

multiple vitamins w/ iron tab . . . . . . . . . . . . . . . . . . . 16

multiple vitamins w/ minerals chew tab . . . . . . . . . 16

multiple vitamins w/ minerals tab . . . . . . . . . . . . . . . 16

multiple vitamin tab . . . . . . . . . . . . . . . . . . . . . . . . . . 16

MULTISTIX TES SG STRIP . . . . . . . . . . . . . . . . . . 14

MURO 128 OIN 5% OP . . . . . . . . . . . . . . . . . . . . . 10

MYCELEX-G CRE 1% VAG . . . . . . . . . . . . . . . . . . 14

MYCELEX-G TAB VA. . . . . . . . . . . . . . . . . . . . . . . . 14

MYCITRACIN OIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

MYDFRIN SOL OP . . . . . . . . . . . . . . . . . . . . . . . . . 10

MYLANTA CHW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

MYLANTA II SUS . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

MYLANTA SUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

MYLANTA SUS SUPREME . . . . . . . . . . . . . . . . . . 11

MYLANTA TAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

MYLICON-80 CHW . . . . . . . . . . . . . . . . . . . . . . . .12

MYLICON DRO . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

N

naphazoline w/ pheniramine ophth soln . . . . . . . . . 10

NAPHCON-A SOL OP . . . . . . . . . . . . . . . . . . . . . . 10

naproxen sodium tab. . . . . . . . . . . . . . . . . . . . . . . . . . 4

NEO DM SYP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

neomycin-bacitracin-polymyxin oint . . . . . . . . . . . . 8

NEO-SYNEPHRI SOL . . . . . . . . . . . . . . . . . . . . . . 6

NEO-SYNEPHRI SPR . . . .. . . .. . . .. . . .. . . .. . . .. . 6

Page 25: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

25

NEPHROCAPS CAP. . . . . . . . . . . . . . . . . 15

NEPHRO-VITE TAB . . . . . . . . . . . . . . . . . 15

NICORETTE DS GUM . . . . . . . . . . . . . . . . 13

NICORETTE GUM . . . . . . . . . . . . . . . . . . 13

nicotine polacrilex gum . . . . . . . . . . . . . . . . 13

nicotine polacrilex lozenge . . . . . . . . . . . . . . 13

nicotine td patch. . . . . . . . . . . . . . . . . . . . 13

NIFEREX-150 CAP FORTE . . . . . . . . . . . . . 15

NIFEREX CAP . . . . . . . . . . . . . . . . . . . . 15

NIFEREX ELX. . . . . . . . . . . . . . . . . . . . . 16

NIX LICE SPR CONTROL. . . . . . . . . . . . . . . 9

NIX LIQ . . . . . . . . . . . . . . . . . . . . . . . . . 9

nonoxynol-9 foam . . . . . . . . . . . . . . . . . . . 14

nonoxynol-9 gel . . . . . . . . . . . . . . . . . . . . 14

NOREL DM SOL . . . . . . . . . . . . . . . . . . . . 6

NOVAHISTINE LIQ DH . . . . . . . . . . . . . . . . 7

NTZ SOL . . . . . . . . . . . . . . . . . . . . . . . . 6

NUCOFED EXP SYP PED. . . . . . . . . . . . . . . 7

NULEV TAB . . . . . . . . . . . . . . . . . . . . . . 12

O

OCEAN NASAL SPR. . . . . . . . . . . . . . . . . . 8

octoxynol gel. . . . . . . . . . . . . . . . . . . . . . 14

oral electrolyte solution . . . . . . . . . . . . . . . . 16

ORGANIDIN NR LIQ . . . . . . . . . . . . . . . . . 5

ORTHO COIL. . . . . . . . . . . . . . . . . . . . . . 4

ortho diaphragm . . . . . . . . . . . . . . . . . . . . . 4

ORTHO FLAT . . . . . . . . . . . . . . . . . . . . . . 4

ORTHO FLEX. . . . . . . . . . . . . . . . . . . . . . 4

ORTHO-GYNOL GEL . . . . . . . . . . . . . . . . 14

OS-CAL . . . . . . . . . . . . . . . . . . . . . . . . 15

OS-CAL TAB 500 + D . . . . . . . . . . . . . . . . 15

oxymetazoline hcl nasal soln . . . . . . . . . . . . . . 6

P

PALMITATE-A TAB . . . . . . . . . . . . . . . . . . 17

PANCOF PD SYP . . . . . . . . . . . . . . . . . . . 6

PANCOF XP SYP. . . . . . . . . . . . . . . . . . . . 5

PANMIST JR TAB CR . . . . . . . . . . . . . . . . . 7

PANMIST JR TAB . . . . . . . . . . . . . . . . . . . . 7

PANMIST-LA TAB. . . . . . . . . . . . . . . . . . . . 8

PANMIST S SYP . . . . . . . . . . . . . . . . . . . . 7

PEDIACARE DRO . . . . . . . . . . . . . . . . . . . 7

PEDIACARE LIQ MULTI-SY . . . . . . . . . . . . . . 7

PEDIACARE LIQ NITEREST . . . . . . . . . . . . . 7

PEDIACARE SOL DCON/CGH . . . . . . . . . . . 7

PEDIAFLOR DRO . . . . . . . . . . . . . . . . . . 17

PEDIA-LAX LIQ . . . . . . . . . . . . . . . . . . . . 11

PEDIA-LAX SUP . . . . . . . . . . . . . . . . . . . 11

PEDIALYTE SOL GRAPE . . . . . . . . . . . . . . 16

pediatric multiple vitamin chew tab . . . . . . . . . . 16

pediatric multiple vitamin liq . . . . . . . . . . . . . 16

pediatric multiple vitamins w/ fl-fe chew tab . . . . . 16

pediatric multiple vitamins w/ fl-fe drops . . . . . . 16

pediatric multiple vitamins w/ fluoride chew tab . . . 16

pediatric multiple vitamins w/ fluoride soln . . . . . 16

pediatric multiple vitamins w/ iron chew tab . . . . . 16

pediatric multiple vitamins w/ iron drops . . . . . . . 16

pediatric multiple vitamin w/ c & fa chew tab . . . . 16

pediatric multiple vitamin w/ c liqd . . . . . . . . . . 16

pediatric multiple vitamin w/ c soln . . . . . . . . . . 16

pediatric multiple vitamin w/ minerals & c chew tab 16

pediatric vitamin chew tab . . . . . . . . . . . . . . 16

pediatric vitamins acd fluoride & fe drops . . . . . . 16

pediatric vitamins acd w/ fluoride soln . . . . . . . . 16

pediatric vitamins acd w/ iron drops . . . . . . . . . 16

pediatric vitamins adc drops . . . . . . . . . . . . . 16

PEG 3350 POW . . . . . . . . . . . . . . . . . . . 12

PEPTO-BISMOL CHW . . . . . . . . . . . . . . . 11

PEPTO-BISMOL SUS . . . . . . . . . . . . . . . . 11

PEPTO BISMOL TAB . . . . . . . . . . . . . . . . 11

permethrin creme rinse . . . . . . . . . . . . . . . . . 9

permethrin liq spray . . . . . . . . . . . . . . . . . . . 9

PETROLATUM GEL WHITE . . . . . . . . . . . . . 10

PHAZYME-125 CAP . . . . . . . . . . . . . . . . . 12

Page 26: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

26

PHAZYME CAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

PHAZYME MS CAP. . . . . . . . . . . . . . . . . . . . . . . . . .12

phenazopyridine hcl tab . . . . . . . . . . . . . . . . . . . . . . .14

PHENERGAN DM SYP. . . . . . . . . . . . . . . . . . . . . . . . 6

PHENERGAN/ SYP CODEINE . . . . . . . . . . . . . . . . . 6

PHENERGAN VC SYP /CODEINE . . . . . . . . . . . . . 6

phenyleph-bromphen-dm-guaifenesin syrup . . . . . . . 6

phenyleph-chlorphen w/ hydrocodone syrup. . . . . . . 6

phenyleph-ephed-cpm w/ carbetapentane susp . . . . 6

phenyleph-ephed-cpm w/ carbetapentane tab . . . . . 6

phenyleph-pyrilamine w/ hydrocodone syrup. . . . . . . 6

phenylephrine-brompheniramine-dm elixir . . . . . . . . . 6

phenylephrine-chlorphen-dihydrocodeine syrup . . . . 6

phenylephrine-chlorphen-dm liquid. . . . . . . . . . . . . . . 6

phenylephrine-chlorphen-dm syrup. . . . . . . . . . . . . . . 6

phenylephrine-dm drops. . . . . . . . . . . . . . . . . . . . . . . . 6

phenylephrine-guaifenesin liqd . . . . . . . . . . . . . . . . . . 6

phenylephrine hcl drops . . . . . . . . . . . . . . . . . . . . . . . . 6

phenylephrine hcl nasal soln . . . . . . . . . . . . . . . . . . . . 6

phenylephrine hcl ophth soln . . . . . . . . . . . . . . . . . . 10

phenylephrine hcl tab . . . . . . . . . . . . . . . . . . . . . . . . . . 6

phenylephrine-promethazine w/ codeine syrup . . . . . 6

phenylephrine-pyrilamine-dm syrup . . . . . . . . . . . . . . 6

phenylephrine-shark liver oil-glyc-pet cream . . . . . . . 4

phenylephrine w/ dm-gg liqd . . . . . . . . . . . . . . . . . . . . 6

phenylephrine w/ hydrocodone-gg syrup . . . . . . . . . . 6

phenyleph-shark liver oil-cocoa butter suppos . . . . . 4

phenyleph tan-pyrilamine tan-carbeta tan susp . . . . . 6

PHILLIPS MOM CHW . . . . . . . . . . . . . . . . . . . . . . .12

PHRENILIN TAB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

phytonadione tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

PIC 200 CAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

PNEUMOTUSSIN SYP . . . . . . . . . . . . . . . . . . . . . . . . 5

polyethylene glycol 3350 oral packet . . . . . . . . . . . .12

polysaccharide iron complex cap . . . . . . . . . . . . . . . 16

polysaccharide iron complex elixir . . . . . . . . . . . . . . 16

POLYSPORIN OIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

POLY-VI-FLOR CHW. . . . . . . . . . . . . . . . . 16

POLY-VI-FLOR CHW FE . . . . . . . . . . . . . . . 16

POLY-VI-FLOR DRO . . . . . . . . . . . . . . . . . 16

POLY-VI-FLOR DRO FE . . . . . . . . . . . . . . . 16

polyvinyl alcohol ophth soln. . . . . . . . . . . . . . 10

POLY-VI-SOL CHW . . . . . . . . . . . . . . . . . 16

POSTURE-D TAB. . . . . . . . . . . . . . . . . . . 15

potassium bicarbonate effer tab . . . . . . . . . . . 17

potassium iodide soln . . . . . . . . . . . . . . . . . 17

potassium iodide tab . . . . . . . . . . . . . . . . . 13

potassium phosphate monobasic tab. . . . . . . . . 17

POT IODIDE SOL . . . . . . . . . . . . . . . . . . 17

pot phos monobasic w/sod phos di & monobas tab 17

povidone-iodine soln . . . . . . . . . . . . . . . . . . 9

POVIDONE-IOD SOL . . . . . . . . . . . . . . . . . 9

prenatal vit w/ fe fumarate-fa tab . . . . . . . . . . . 17

PREPARATION SUP H. . . . . . . . . . . . . . . . . 4

PREVIDENT CRE 5000 PLS . . . . . . . . . . . . 13

PREVIDENT SOL RINSE . . . . . . . . . . . . . . 13

PROBIOTIC FORMULA . . . . . . . . . . . . . . . 12

probiotic product caps . . . . . . . . . . . . . . . . 12

PROFEN II TAB . . . . . . . . . . . . . . . . . . . . . 7

PROHIST DM DRO . . . . . . . . . . . . . . . . . . 7

promethazine-dm syrup . . . . . . . . . . . . . . . . . 6

promethazine w/ codeine syrup . . . . . . . . . . . . 6

PRONTO SHA W/RINSE . . . . . . . . . . . . . . . 9

PROSTEP DIS . . . . . . . . . . . . . . . . . . . . 13

PROTEXIN SYP. . . . . . . . . . . . . . . . . . . . 14

pseudoephed-bromphen-dm elixir . . . . . . . . . . . 6

pseudoephed-bromphen-dm-gg syrup. . . . . . . . . 7

pseudoephed-bromphen-dm liquid . . . . . . . . 6, 7

pseudoephed-bromphen-dm syrup . . . . . . . . . . 7

pseudoephed-chlorphen-dm liq . . . . . . . . . . . . 7

pseudoephedrine-chlorphen w/ codeine liq . . . . . . 7

pseudoephedrine-dm-gg w/ apap tab . . . . . . . . . 7

pseudoephedrine-dm liqd. . . . . . . . . . . . . . . . 7

pseudoephedrine-dm soln . . . . . . . . . . . . . . . 7

Page 27: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

27

pseudoephedrine-dm syrup. . . . . . . . . . . . . . . 7

pseudoephedrine-guaifenesin cap cr. . . . . . . . . . 7

pseudoephedrine-guaifenesin syrup . . . . . . . . . . 7

pseudoephedrine-guaifenesin tab sr . . . . . . . 7, 8

pseudoephedrine hcl cap sr 12h . . . . . . . . . . . . 7

pseudoephedrine hcl chew tab . . . . . . . . . . . . . 7

pseudoephedrine hcl liq. . . . . . . . . . . . . . . . . 7

pseudoephedrine hcl soln . . . . . . . . . . . . . . . 7

pseudoephedrine hcl tab . . . . . . . . . . . . . . . . 7

pseudoephedrine-ibuprofen susp . . . . . . . . . . . 8

pseudoephedrine-ibuprofen tab . . . . . . . . . . . . 8

pseudoephedrine w/ acetaminophen soln . . . . . . . 7

pseudoephedrine w/ acetaminophen tab . . . . . . . 7

pseudoephedrine w/ apap-dm liq . . . . . . . . . . . 7

pseudoephedrine w/ apap-dm tab . . . . . . . . . . . 7

pseudoephedrine w/ cod-gg soln . . . . . . . . . . . 7

pseudoephedrine w/ dm-gg cap . . . . . . . . . . . . 7

pseudoephedrine w/ dm-gg liquid . . . . . . . . . . . 7

pseudoephed tan-dexchlorphen tan-dm tan sus. . . . 6

psyllium cap . . . . . . . . . . . . . . . . . . . . . . 12

psyllium powder . . . . . . . . . . . . . . . . . . . . 12

psyllium powder packet . . . . . . . . . . . . . . . . 12

PYRE/PIPERON LIQ. . . . . . . . . . . . . . . . . . 9

pyrethrins-piperonyl butoxide liq . . . . . . . . . . . . 9

pyrethrins-piperonyl butoxide shampoo . . . . . . . . 9

PYRIDIUM TAB . . . . . . . . . . . . . . . . . . . . 14

pyridoxine hcl tab . . . . . . . . . . . . . . . . . . . 17

pyridoxine hcl tab cr . . . . . . . . . . . . . . . . . . 17

pyrilamine tan-phenyleph tan susp . . . . . . . . . . . 8

R

REFRESH PLUS DRO 0.5% OP . . . . . . . . . . 10

RESCON-GG LIQ . . . . . . . . . . . . . . . . . . . 6

RESPAIRE-60 CAP CR . . . . . . . . . . . . . . . . 7

RID LIQ . . . . . . . . . . . . . . . . . . . . . . . . . 9

ROBITUSSIN CAP COLD/CGH . . . . . . . . . . . 7

ROBITUSSIN DRO PEDIATRC . . . . . . . . . . . . 7

ROBITUSSIN LIQ CGH/ALRG . . . . . . . . . . . . 6

ROBITUSSIN LIQ CGH/CLD . . . . . . . . . . . 5, 6

ROBITUSSIN LIQ CGH/CONG . . . . . . . . . . . 5

ROBITUSSIN SYP . . . . . . . . . . . . . . . . . . . 5

ROBITUSSIN SYP DM. . . . . . . . . . . . . . . . . 5

ROBITUSSIN SYP PE . . . . . . . . . . . . . . . . . 7

ROBITUSS PED LIQ CGH/COLD . . . . . . . . 5, 7

RONDEC-DM DRO . . . . . . . . . . . . . . . . . . 6

RONDEC DM SYP . . . . . . . . . . . . . . . . . 6, 7

RONDEC DRO . . . . . . . . . . . . . . . . . . . . . 4

RONDEC SYP . . . . . . . . . . . . . . . . . . . . . 4

RUBRAMIN-PC INJ . . . . . . . . . . . . . . . . . 15

RYNA-12 S SUS . . . . . . . . . . . . . . . . . . . . 8

RYNATAN PED SUS . . . . . . . . . . . . . . . . . . 5

RYNATUSS PED SUS . . . . . . . . . . . . . . . . . 6

RYNATUSS TAB . . . . . . . . . . . . . . . . . . . . 6

S

salicylic acid liquid . . . . . . . . . . . . . . . . . . . 9

salicylic acid soln . . . . . . . . . . . . . . . . . . . . 9

saline nasal soln . . . . . . . . . . . . . . . . . . . . . 8

saline nasal spray . . . . . . . . . . . . . . . . . . . . 8

SALIVA SUBST SOL . . . . . . . . . . . . . . . . . 13

SCALP AID LIQ. . . . . . . . . . . . . . . . . . . . . 9

SCHOLL CORN/ SOL CALLUS . . . . . . . . . . . 9

SEBACLEAR LIQ. . . . . . . . . . . . . . . . . . . . 9

SEDAPAP TAB . . . . . . . . . . . . . . . . . . . . . 3

SENNA SYP . . . . . . . . . . . . . . . . . . . . . 12

senna syrup . . . . . . . . . . . . . . . . . . . . . . 12

senna tab . . . . . . . . . . . . . . . . . . . . . . . 12

sennosides-docusate sodium tab . . . . . . . . . . 12

sennosides syrup . . . . . . . . . . . . . . . . . . . 12

sennosides tab . . . . . . . . . . . . . . . . . . . . 12

SENOKOT S TAB. . . . . . . . . . . . . . . . . . . 12

SENOKOT SYP. . . . . . . . . . . . . . . . . . . . 12

SENOKOT TAB . . . . . . . . . . . . . . . . . . . . 12

SESAME ST CHW VITAMINS. . . . . . . . . . . . 16

Page 28: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

28

SILDEC SYP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

simethicone cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

simethicone chew tab . . . . . . . . . . . . . . . . . . . . . . . . 12

simethicone susp . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

SINE-AID TAB MAX STR . . . . . . . . . . . . . . . . . . . . . 7

SM PRENATAL TAB VITAMINS . . . . . . . . . . . . . . . 17

sodium bicarbonate powder . . . . . . . . . . . . . . . . . . . 12

sodium bicarbonate tab . . . . . . . . . . . . . . . . . . . . . . 13

sodium chloride hypertonic ophth oint . . . . . . . . . . 10

sodium citrate & citric acid soln . . . . . . . . . . . . . . . . 14

sodium fluoride chew tab . . . . . . . . . . . . . . . . . . . . . 17

sodium fluoride cream . . . . . . . . . . . . . . . . . . . . . . . 13

sodium fluoride gel . . . . . . . . . . . . . . . . . . . . . . . . . . 13

sodium fluoride rinse . . . . . . . . . . . . . . . . . . . . . . . . . 13

sodium fluoride soln . . . . . . . . . . . . . . . . . . . . . . . . . 17

sodium phosphates - enema . . . . . . . . . . . . . . . . . . 13

sodium phosphates - soln . . . . . . . . . . . . . . . . . . . . 13

SODIUM POW BICARBON . . . . . . . . . . . . . . . . . 12

SOLARCAINE GEL ALOE EXT . . . . . . . . . . . . . . . . 9

sorbitol oral solution . . . . . . . . . . . . . . . . . . . . . . . . . 13

SORBITOL SOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

SPIDER-MAN CHW /IRON . . . . . . . . . . . . . . . . . . 16

stannous fluoride conc . . . . . . . . . . . . . . . . . . . . . . . 13

stannous fluoride gel . . . . . . . . . . . . . . . . . . . . . . . . . 13

starch suppositories . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ST JOSEPH CHW ADU . . . . . . . . . . . . . . . . . . . . . . 3

SUDAFED CHLD CHW NON-DRSY . . . . . . . . . . . 7

SUDAFED CHLD LIQ . . . . . . . . . . . . . . . . . . . . . . . . 7

SUDAFED PE TAB . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

SUDAFED TAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

SUDAL SR TAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

SURFAK CAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

T

TANAFED DMX SUS . . . . . . . . . . . . . . . . . . . . . . . . . 6

TAVIST-1 TAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

TEARGEN II SOL OP . . . . . . . . . . . . . . . . . . . . . . . 10

TEARS AGAIN GEL NGHT/DAY . . . . . . . . . . . . . . 10

TEGRIN-LT SHAMPOO . . . . . . . . . . . . . . . . . . . . . . 9

terbinafine hcl cream . . . . . . . . . . . . . . . . . . . . . . . . . . 8

TESSALON CAP . . . . . . . . . . . . . . . . . . . . 4

tetrahydrozoline hcl ophth soln . . . . . . . . . . . . 10

THERA-FLUR GEL . . . . . . . . . . . . . . . . . . 13

THERAGRAN JR CHW . . . . . . . . . . . . . . . 16

THERAGRAN-M TAB . . . . . . . . . . . . . . . . 16

THERA MULTI LIQ . . . . . . . . . . . . . . . . . . 16

THIAMILATE TAB . . . . . . . . . . . . . . . . . . . 17

thiamine hcl elixir . . . . . . . . . . . . . . . . . . . 17

thiamine hcl tab . . . . . . . . . . . . . . . . . . . . 17

thiamine mononitrate tab . . . . . . . . . . . . . . . 17

THIAMINE MON TAB . . . . . . . . . . . . . . . . 17

thiamine pyrophosphate tab. . . . . . . . . . . . . . 17

THYROSAFE TAB . . . . . . . . . . . . . . . . . . 13

TINACTIN AER . . . . . . . . . . . . . . . . . . . . . 8

TINACTIN AER POWD. . . . . . . . . . . . . . . . . 8

TINACTIN CRE . . . . . . . . . . . . . . . . . . . . . 8

TINACTIN SOL . . . . . . . . . . . . . . . . . . . . . 8

tolnaftate aerosol . . . . . . . . . . . . . . . . . . . . 8

tolnaftate cream . . . . . . . . . . . . . . . . . . . . . 8

tolnaftate soln . . . . . . . . . . . . . . . . . . . . . . 8

TOURO LA-LD TAB . . . . . . . . . . . . . . . . . . 7

T-PANOL DRO 100 MG/ML . . . . . . . . . . . . . . 3

TRIA COLD/AL SYP . . . . . . . . . . . . . . . . . . 5

TRIAMINIC SYP CHST CON . . . . . . . . . . . . . 7

TRIAZ CLEANS LOT . . . . . . . . . . . . . . . . . . 3

triprolidine & pseudoephedrine syrup . . . . . . . . 8

triprolidine & pseudoephedrine tab . . . . . . . . . . . 8

TROJAN . . . . . . . . . . . . . . . . . . . . . . . . . 4

TUCKS SUP . . . . . . . . . . . . . . . . . . . . . . 4

TUMS CHW. . . . . . . . . . . . . . . . . . . . . . 11

TUMS E-X CHW . . . . . . . . . . . . . . . . . . . 11

TUSSAFED HC SYP . . . . . . . . . . . . . . . . . . 6

TUSSAR DM SYP . . . . . . . . . . . . . . . . . . . 6

TUSSI-12D S SUS . . . . . . . . . . . . . . . . . . . 6

TUSSI-12 S SUS . . . . . . . . . . . . . . . . . . . . 4

TUSSI-ORGANI LIQ S NR . . . . . . . . . . . . . . 5

Page 29: State Pharmacy Product List - uhccommunityplan.com · ENTEX HC LIQ phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5 ml DIMETAPP DM ELX COLD/CGH phenylephrine-brompheniramine-dm

STATE PHARMACY PRODUCT LIST

29

TYL ALLERGY/ TAB SINUS . . . . . . . . . . . . . . 5

TYLENOL ARTH TAB. . . . . . . . . . . . . . . . . . 3

TYLENOL CAP . . . . . . . . . . . . . . . . . . . . . 3

TYLENOL CHLD ELX . . . . . . . . . . . . . . . . . 3

TYLENOL CHLD SUS . . . . . . . . . . . . . . . . . 3

TYLENOL COLD TAB . . . . . . . . . . . . . . . . . 7

TYLENOL COLD TAB NO-DROWS . . . . . . . . . 7

TYLENOL GO CHW EXTRA ST . . . . . . . . . . . 3

TYLENOL INF DRO . . . . . . . . . . . . . . . . . . 3

TYLENOL JR CHW. . . . . . . . . . . . . . . . . . . 3

TYLENOL JR TAB. . . . . . . . . . . . . . . . . . . . 3

TYLENOL LIQ. . . . . . . . . . . . . . . . . . . . . . 3

TYLENOL SOL . . . . . . . . . . . . . . . . . . . . . 3

TYLENOL TAB . . . . . . . . . . . . . . . . . . . . . 3

U

urea lotion 40% . . . . . . . . . . . . . . . . . . . . . 9

URISTIX 4 TES STRIPS . . . . . . . . . . . . . . . 14

URISTIX TES STRIPS . . . . . . . . . . . . . . . . 14

URO-TRIN TAB . . . . . . . . . . . . . . . . . . . . 14

UTIRA-C TAB . . . . . . . . . . . . . . . . . . . . . 14

V

VICODIN TUSS SYP . . . . . . . . . . . . . . . . . . 5

VI-DAYLIN DRO . . . . . . . . . . . . . . . . . . . 16

VI-DAYLIN DRO ADC . . . . . . . . . . . . . . . . 16

VI-DAYLIN DRO FE/ADC . . . . . . . . . . . . . . 16

VI-DAYLIN DRO /IRON . . . . . . . . . . . . . . . 16

VI-DAYLIN/F CHW /FE . . . . . . . . . . . . . . . 16

VI-DAYLIN/F DRO /ADC. . . . . . . . . . . . . . . 16

VI-DAYLIN/F DRO ADC/FE . . . . . . . . . . . . . 16

VI-DAYLIN/F DRO FE . . . . . . . . . . . . . . . . 16

VI-DAYLIN LIQ . . . . . . . . . . . . . . . . . . . . 16

VIGRAN PLUS TAB . . . . . . . . . . . . . . . . . 16

VISINE SOL OP . . . . . . . . . . . . . . . . . . . 10

VITAMAX CHW . . . . . . . . . . . . . . . . . . . . 16

vitamin a . . . . . . . . . . . . . . . . . . . . . . . . 17

VITAMIN A TAB . . . . . . . . . . . . . . . . . . . . 17

VITAMIN B-1 TAB . . . . . . . . . . . . . . . . . . . 17

VITAMIN C. . . . . . . . . . . . . . . . . . . . . . . 14

VITAMIN D . . . . . . . . . . . . . . . . . . . . . . 15

W

WART OFF SOL . . . . . . . . . . . . . . . . . . . . 9

white petrolatum gel. . . . . . . . . . . . . . . . . . 10

Z

ZADITOR DROOP . . . . . . . . . . . . . . . . . . 10

ZEPHREX LA TAB . . . . . . . . . . . . . . . . . . . 7

ZINC CHELATE TAB . . . . . . . . . . . . . . . . . 17

zinc chew tab . . . . . . . . . . . . . . . . . . . . . 17

ZINC CHW . . . . . . . . . . . . . . . . . . . . . . 17

zinc tab. . . . . . . . . . . . . . . . . . . . . . . . . 17

ZINC TAB . . . . . . . . . . . . . . . . . . . . . . . 17

ZN ASPARTATE TAB . . . . . . . . . . . . . . . . . 17

ZOSTRIX-HP CRE . . . . . . . . . . . . . . . . . . . 9